Southern Medical and Surgical Journal, 1836

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SOUTHERN MEDICAL

AXD

SURGICAL JOURNAL

Vol. I.] JUNE, 1836. [No. 1.

INTRODUCTION.

In commencing the discharge of our editorial duties, it is
proper that we make some brief observations, explanatory of
Hie nature and objects of the work we propose, and the motives
that have induced ss to engage in the undertaking.

Arguments need not be adduced to prove the great value and
utility of medical periodicals their importance, as means of
collecting and communicating useful information in a condensed
form, is duly appreciated by the profession in all the enlightened
nations oftks world,' and nowhere more highly than in the
United States, to the circumstances and necessities of whose
physicians they are peculiarly appropriate. Scattered over a
thinly populated but almost illimitably extended country, in
which the labours of physicians are most arduous and their
remuneration inadequate, few individuals can command money
to purchase or leisure to read a sufficient number of books to
enable them to keep pace with the improvements that are con-
stantly made in medicine ; besides, in many remote situations,
the difficulties in the way of obtaining books are almost insu-
perable, and new publications become old before they are
received.

Whilst European physicians, enjoying superior opportunities

and facilities for the acquisition of knowledge and the cultivation

of medicine, generally excel in medical erudition, and are justly

entitled to the credit of having composed the most learned and

I borate works, and having made manv of the most important
1

13S3

httrodact \jt\xaz

and valuable discoveries and improvements in medicine, t

are nevertheless so actuated by national jealousy and mutual
animosity, that they not unfrequently refuse to acknowledge
apply in one nation the most obvious improvements made in
another, and they arc moreover too much d. to bow d<

to authority, and yield implicit obedience to the dicta of distin-
guished men. American physicians, on the contrary, at a happy
distance from all such illiberal and improper influences, indepen-
dent of the doctrines or dogmas of any school. una wed by authori-
ty, lvgardkss of ages, names or nations, obedient only t-> the dic-
tates of true philosophy, inductive and eclectic, reason for them-
selves, and, selecting what is good and rejecting what is obj
tionable in every system and from every source, render them-
selves, as they may be truly styled, the most correct, energetic
and successful practitioners in the world! How essential!}
necessary, then, for the cause of humanity, that the details of
American practice be faithfully recorded, as criteria wher<
to test specious theories, not founded in practical observation !

There are now published in the United States several excel-
lent periodicals, whose value and claims on public respect and
patronage we most cheerfully acknowledge. So far from en-
tertaining any sentiment of hostility or unkindness to those who
have entered the field before us, we design and desire harmo-
niously to co-operate with them in labouring toad ' \e the same
great object, to advance tlie interests of that profession in which
the good of society is most deeply and vitally involved.

But although they have done and arc still accomplishing much
for the improvement of medicine, and are justly entitled to the
gratitude of physicians, and the appellation of benefactors of
mankind the profession at the South have long regarded and
anticipated, as a most desirable object, the establishment of a
Journal that should collect and preserve the valuable discoveries
and improvements of Southern practitioners relative to the na-
ture and treatment of dis-ases incident to Southern climates,
which, for the want of some such convenient and suitable n
sit. -lv. are generally entombed with him with whom they or
gate, and thus forever lost to the world.

It has long been lanv nted that in consequence of the obsta-
cles that have hitherto existed, with very rare exceptions, the
rich treasures of individual knowledge arising out of extensive

;>().] Introduction.

experience, close application, accurate observation, and the most
correct and rigid reasoning, have not been allowed to emanate
from or survive their possessor, unless through tlve uncertain
medium of oral communication.

Unwilling that such evils should longer exist, or that South-
ern physicians should longer want an appropriate vehicle of
communicating to each other and to the world the valuable
results of their observation, practice and reflection, we offer to
our cotemporaries the pages of a monthly periodical, cordially
inviting them to co-operate with us in the enterprise* and confi-

/dently trusting that they, with equal :zeal and interest, will come
to our assistance, and sustain a work so desirable, so important
to science and to humanity 1

As the principal design of this Journal is to collate and com-
. municate practical information ; practical essays of all kinds,
'1 histories of epidemics, reports of cases, the application of new
remedies, and all interesting medical facts and experiments,
will be thankfully received. Lung theoretical disquisitions, and
'prolix discussions on controverted points, will be excluded from
uur numbers ; place, however, will always be given to commu-
nications on the collateral sciences, and to all treatises that have
a useful bearing, or that may be calculated to promote the grand
object in view the improvement of medicine.

The various branches of natural history at the South present
fertile fields for cultivation. What wealthy treasures what
rich rewards are here promised to the zeal, industry and enter-
prize of the mineralogist, the geologist, the botanist, and the
zoologist! May we not hope from these fruitful sources to
derive mueh matter for our Journal, valuable and interesting,
not only to physicians but to the whole scientific wrorld ?

We feel deeply impressed with a sense of the weighty respon-
sibilities and arduous labours in which we are about to engage,
especially when we contemplate the vast extent of science which
must be kept under constant review, the unremitting demands on
our time, the enlightened tribunal before which we must appear,
and above all, our obligations to the sacred cause of humanity I
Nor should we have ventured to assume such high responsibili-
ties and to embark in such laborious duties, were it not for the
great advantages and facilities afforded us by our connexion
with the Medica] College of Georgia, the pledge of support made

Inlrodwch [June,

as by the rest of the Faculty, the assistance promised us by many
other eminent physicians, and a confident reliance on the cordial
co-operation of libera] and enlightened mi mbers of the profession
every where throughout our country, especially in the Southern

and Western States.

The College Library, to which we have constant access, will
receive a regular supply of the most valuable medical books as
fast as they issue from the press, to reviews of which a portion
of our Journal shall be devoted.

Our sole object, as reviewers, will be to present to our read
a faithful and plain analysis of new books, whereby to attr:
attention to their merits, and assist in promulgating useful know-
ledge. We will only exercise the invidious office of exposing
errors and defects, where they militate against sound doctrine
and safe practice, and are thereby calculated to mislead the
younger and less experienced members of the profession.
Attached to no party in medicine, advocates of no particular
doctrine, eclectics in science, zealous for improvement but Oppo-
sed to useless innovation, we trust we shall be able, unbiassed Im-
partiality or prejudice, to discern and commend what is excellent,
and condemn what is erroneous, without reference to the source
whence it comes.

Besides the valuable Journals of our own country, the mi
approved periodicals of Great Britain, France, Germany and
Italy, will furnish an inexhaustible fund of materials, that cannot
fail to add utility as well as interest to our numbers.

The monthly form has been selected, because best calculated
to an.v/, er tli" purposes designed, being preferable to either quar-
terly or hebdomadal publications. The former do no1 emanate
from the press sufficiently often to maintain a constant and regu-
lar supply of the newest intelligence in medicine, and the latter
are necessarily restricted to a compass too narrow to admit ol
any but v< ry short pieces, without dividing them into several
parts, to be continued through successive numbers, which at
once destroys much of the interest they might otherwise excite.

Contributors are requested t:> make their communications ovei
their own proper nam< s, as anonymous and fictitiously sign' i
ad with little interest, if read at all.

1836.] Remarks on Puerperal Peritonitis,

Paet l original matter.

ARTICLE I.

*uerperal Peritonitis. By J. P. Garvin, M. D.
of Waynesborough, Ga.

Among the diseases to which the human system is liable, but
re more dangerous in their character, or more- rapid in
their course, than Puerperal Peritonitis. \From the first notice
of ics appearance as an epidemic in 1664, to the present time,
frequent investigations have been made of its nature, and of the
treatment host adapted to its care ; but its true nature was long-
involved in obscurity, and consequently the treatment Avas ge-
nerally inefficient, and often pernicious. \ Modern research, how-
ever, lias in a great measure dispelled tills obscurity, and at the
present day, there exists but little difference of opinion as to its
pathology. But in rclatidn^towito-.rcmcdial course proper to be
pursued, practitioners do not evince the same unanimity. This
fact renders it important, that observations tending to establish,
or set aside the prevailing methods of treatment, should be laid
before the profession ; and it is with a view to this, and not. with
the expectation of offering any thing novel, either respecting its
pathology or treatment, that the writer presents the results of
his experience. m

\ Puerperal fever has always been considered ^ disease of high*
\y dangerous character, even in its sporadic form ; but it is when
it becomes an epidemic, that it assumes its most formidable as-
pect then dismay heralds its approach, and death too often
follows its footsteps. \ Some writers have asserted that in fatal-
ity it ranks next to the Plague. | This estimate of its danger
may have been correct in former times, under the treatment
suggested by an erroneous pathology, but at the present day, it
will scarcely be ranked so high in the scale of malignity. Still,
though modern investigation, by developing its true nature, lias
disarmed it of many of its terrors, yet there are few diseases
which excite greater alarm in the breast of the patient, or bring
n^ore anxiety, to the mind of the medical attendant.

vThe cases of Puerperal fever which have been observed by
the writer, with a few exceptions, were of an epidemic charac-
ler. XThe number of cases, the violence anil rapidity of their
oursc, and the absence of all the usual causes, justify us, we
think, in attributing to them an epidemic origin. No meteorolo-
gical register was kept during its prevalence, neither was any
marked peculiarity in the season observed. For some time pre-
vious, anginosc affections had been common, and scarlatina pre-

Remarks on Puerperal Peritonitis. [June.

vailed to a considerable extent That the peculiar atmosphe-
ric constitution by which some erruptive diseases are propaga-
ted, has an agency in exciting puerperal fever, we are not pre-
pared to assert, but the histories of this disorder generally, no-
lice the ^contemporaneous prevalence of some of the exanthe-
mata. Gordon states that 'leresypelas and puerperal fever be-
gan at Aberdeen at the same time, and afterwards kept pace
together they both arrived at: their acme together, and they
both ceased at the same time." i Clarke says, that during the
prevalence of an epidemic puerperal lever, which he describes,
" eruptive diseases, particularly those which are attended with
great depression of strength, had attacked great numbers of pa-
tients. Ulcerous sore throat with or without scarlatina had
been very general." Armstrong asserts that it frequently pre-
vails with eresypelas. The constitution of atmosphere which
generates disease, is a subject of deep interest, but the light of
science is yet too feeble to penetrate the darkness by which it is
shrouded. Wet, if we may be permitted to judge of the pro-
gress of future improvement by the past, we may indulge the
hope that at some day, not far distant, this mystery may be un-
veiled. \

Puerperal fever has been supposed by some eminent writers
to be of a contagious nature ^ and it must be conceded, that
there are many facts recorded in the histories of the disease,
which strongly tend to confirm this opinion, lllowever, in this
country at least, it is believed that there areHout few who con-
sider it to be contagious, except under peculiar circumstances^
In the cases which came under the writer's notice, there was
nothing which in the slightest degree indicated a contagious
origin. )

^nis disorder generally makes its attack during the week suc-
ling delivery ; but some cases have been related, which be-
gan at a much later period, and a few which were supposed
to have commenced before the confinement of the patient, llow-
ever, the most common time of its access, is on the second or
third day. I hi general, those attacks which are earliest made
after delivery, are most violent and dangerous. The most ma-
lignant case which we have ever witnessed, began a few hours
alter the birth of the child./

Puerperal fever is generally ushered in with chills or rigors.
In some cases the patient is not conscious of any cold stage;
yet it is probable that in no instance i^ it entirely absent, al-
though so slight and transient, as to escape notice. The cold
stage lasts but a short lime, and is followed by considerable heat,
and dryness of the surface. Pain is fell in the hypogastric re-
gion, in some cases very acute, in others dull and obscure, and
if pressure be made at, or near the seat of the pain, a sensation
of soreness is produced. This soreness soon spreads over the

lS3o.] Remarks on Puzrperql Perllonilii

whole or the greater portion of the abdomen, which soon bo-
comes slightly swollen. The pulse at this stage generally ranges
between 120 and 130 in a minute, and is usually full and strong,
and communicates a thrilling, or " vibratory'' sensation to the

finder ; vet in some of the worst cases, it is small and weak from
the beginning. The stomach is often affected with slight nau-
sea, and occasional vomiting the bowels are constipated the
tongue covered with a whitish coat, and the thirst considerable.
The breathing is hurried and a cough attends, which in some
instances, is very frequent and distressing. The patient is gene-
rally restless, but in her moments of quiet, lies upon her back,
with her feet drawn up. ( The secretion of milk, if it has com-
menced, is soon entirely Suspended, and the lochial discharge
is soon materially lessened in quantity, or is suppressed] After
this state of things has continued for some hours, varying in
different cases, there is generally a considerable remission of
all the symptoms, with the exception of the frequency of pulse,
which is rarely much abated. / This remission often raises in
the minds of the patient's friends sanguine hopes, which are soon
to be disappointed; for the disease soon renews its destructive
career, with a violence which seems to have gathered strength
during the previous calm. Some time after this return of the
violence of the disease, the pulse increases in frequency, and
loses some of its volume and strength the abdomen becomes
more tumid, and the tenderness is sometimes so exquisite, as to
render the slightest pressure insupportable. The countenance
expresses considerable anxiety, and there is occasional delirium.
\ The thirst is often insatiable the tongue assumes a dark or
brownish color, and, in some instances, a vomiting of a dark
fluid, and frequent and similar discharges from the bowels occur.
As the disease continues to progress, the pulse becomes more
feeble, and so frequent, as to render it difficult or impossible to
count it the delirium is constant the abdomen very much
swollen, and the discharges from the bowels involuntary. In
this condition, the patient lies for a few hours, and death then
eloves the melancholy scene.

The foregoing is a description of the disease as it appeared in
the most malignant cases witnessed by the writer. There was
not, however, an entire uniformity in the symptoms, in every in-
stance.' In some, but little nausea or vomiting occurred, and in
one patient, neither of these symptoms was exhibited in any stage
of the disease. The bowels were not uniformly constipated, and
diarrhoea sometimes shewed itself at an early period, and was
Usually a favourable symptom. With some patients the delirium
was slight and occasional ; with others it was perfect and con-
tinued. We witnessed one case in which the patient could lie
upon either side during the whole continuance of the disease. In
one or two instances there was -soms dysuria. The abdominal*

n I ' Peritonitis, [June,

pressure, and greal
>ms uniformly pn -
( The duration of^uerperad fever varies in different I and

in different seasons. In the sporadic cases, h
c >urse in from five to nine days. I In the epidemic form

and four or five days. Ir is stat

stween one andfouror five days. Ir is stat
h has taken place in less than twenty-four hours afti
attack. AWehave seen no case fatal before the third, nOr at a later
period than the fourth day. When the disease was subdued by
the treatment adopted, the symptoms gave way early hut the
patient rarely regained her usual health until after a consid rable
lapse of time.

No opportunity was afforded for post mortem examination,
but so fully and frequently have these been made, by eminent .\\\A
ipefent men, that there seems to be little left to be learned, in
relation to the morbid appearances developed by dissection. \
Evidenced of peritoneal inflammation present themselves in every
instance. Appearances of inflammation and its eon ces,

are also manifested by various abdominal and pelvic viscera : but
these seem to result from the spreading of the peritoneal inflam-
mation to those organs; and, indeed, to this exi- risidn th< re seems
generally to be an irresistible tendency. | This view of the nature
of this disease will account for the want of uniformity in the symp-
toms in different eases, and will explain the mode by which m
of them arc produced. Thus,\the constipation probably r< si Its
from the extension of the inflammation to the muscular c a* i f
the intestines the diarrhoea in the latter stages, from its fart!
extension to the mucous coat, and thedysuria, from thebladd< r
having become involved. iThese examples will suffice to show
in what manner many of tne symptoms are originated. Other
appearances, which do not admit cf such a solution, arc proba-
Lhe resr.lt of sympathy of other parts with the organs which
ii ive thus become successively involved. There so.mii< to us to
l)e no good reason for a b lief that this inflammation is of a pecu-
liar character. It. resembles inflammation of any other serous
membrane, and its peculiar fatality depends upon the extern
membrane attacked, and the Dumber and importance of the or-
which it involves in its course. With tins view of the
nature of puerperal fever, it cannot be a matter for surprise that
its unobstructed course is <<> rapid and its termination so fatal.

Armstrong divides the disease into two the 6rs1 o

inflammatory, and the second, or stage of effusion or collap
Dewees con id ra that there is another, intermediate to th se
stages, which he denominates the "gangrenous," and which he
defines as that -state of the parts which resembles death, bui i-
not death." For practical purposes, this last division is un.

ary, as there are no known signs by which ii presence
manifested l It is highly important thai we should be able. to

&

1830.] tictnarks on Puerperal Peritonitis. 9

distinguish the inflammatory stage from that which succeeds it ;
for it is only during the existence of the former that any mode of
treatment offers the least prospect of success. J Yet it has been
declared by high authority, that " the first stagps has no disco-
vered character by which it can be distinguished from the se-
cond." Armstrong has given a description of the first stage,
and though it has been objected to it, that it depicts no appearan-
ces which may not accompany the last, yet it is acknowledged
to be the best which has yet been furnished. He says, "in the
first stage, after tfie rigors have ceased, the pulse is hardly ever
loss than 120, and sometimes (though as far as I have observed,
very seldom.) as high as 140 in a minute; the blood does not
seem to flow in a soft, easy, and natural current, but comes
against the finger with a kind of vibratory motion, and more
than ordinary pressure is commonly required to stop its course
along the artery, which feels rather hard and tense. The skin
is dry, and hotter than natural, the patient complains of great
pain, and soreness of the abdomen, breathes forty times in a
minute, vomits mucus and bile, is generally bound in the belly,
has a white dry tongue, considerable thirst, and labors under the
restlessness and irritation of fever." To this description we
will venture to add, that during the continuance of the first
stage, the pulse maintains about the same degree of frequency
which characterized it when the disease was first fully developed.
A very marked and permanent increase in its frequency, is
usually the first appreciable sign that the boundaries of the first
stage have been passed.

There are but few diseases which require a more prompt and
energetic application of remedies to ensure a successful issue,
than puerperal peritonitis ; and yet it rarely happens, at least
to country practitioners, that the patient is seen until some hours
after the access of the fever. 1 The symptoms are too frequently
attributed to some transient cause; and when at last the patient
is undeceived, and the physician called, he too often finds that
the golden moment for successful action has passed awray, and
he is compelled to stand by with folded arms and witness the
swift ravages of the destroyer, j These remarks are particularly
applicable to sporadic attacks, and the earlier cases of an epi-
demic visitation. I It is a truth, to which in the present state of our
knowledge there is no exception, that it is only in the first stage
that the disease can be successfully combatted. . It is irue that
occasional recoveries have taken place after effusion had occur-
red, but such instances arc rare, and cannot fairly be held to be
exceptions to the rule, inasmuch as they never result from our
remedial applications, but arc consequent upon some occult con-
si ituiional operation. Since more correct pathological views of
the disease have prevailed, venesection has generally been con-
sidered as an indispensable operation in the treatment. Indeed

T0 Remarks on Puerperal Peritonitis. [June;

the testimony in its favor is ample and conclusive. The follow-
ing statement of deaths under different modes of treatment, we
have extracted from Mcintosh, and it plainly indicates the supe-
riority of bloodletting over all other curative methods, from which
it is excluded.

"The celebrated Dr. William Hunter saved one patient only
out of thirty-two ; his practice became fixed to give a good wine-
glass full of brandy at the commencement of the disease.

Dr. Hulme, who considered the disease partly of a putrid
naiure, and who employed bleeding in small quantities, and only
as a secondary remedy, lost almost every patient.

Dr. Leake, who recommended bleeding in small quantities,
and at long inte.vals, and who gave his patients bark, beef tea.
and cordials, to prevent putridity, lost thirteen patients, out of
nineteen, in one season.

Dr. Gordon, when he adopted a wTeak, vacillating practice,
lust twenty-three out of twenty-seven cases ; but afterwards he
used early and large bleedings, and out of fifty patients he lost,
only five.

Mr. Hey, of Leeds, saved only three out of thirteen cases be-
fore he began to bleed ; but by this sad experience he was after-
wards led to bleed boldly and early, and he lost only two out of
thirty-six."

To this testimony in favor of bloodletting, we might add that
of Denman, Armstrong, and many other distinguished practi-
tioners. That of the first mentioned writer is particularly strong
and convincing ; the more so, as he came to his conclusions in
its favor in defiance of all his prejudices and preconceived opi-
nions. These facts not only prove bleeding to be a powerful
and appropriate remedy, but they also shew, that to be ser-
viceable, it must be early and freely employed. \ Among the
advocates for venesection, some difference of opinion exists as
to the extent to which it should be carried, and the frequency
with which it should be repeated. Some writers have specified
the precise quantity of blood, more than which they deem it
unsafe to take ; but it is doubtless injudicious to fix upon any
given quantity as a limit. \The only safe rule is to abstract a
quantity sufficient to make a decided impression upon the sys^
tern, and to repeat it whenever the pulse recovers its volume and,
strength, and the abdominal pain and soreness arc still unabated. ^
Dewces and others recommend that the first bleeding be carried
to an extent sufficient to produce faintness ; and this is a good
rule for our government in all cases accompanied by high arterial
action, and to which we have been called early ; but in those
Cases where from the beginning the pulse has been very small.
frequent, and feeble, there is some doubt as to the propriety <f
so bold an application of the remedy. However, as this condi-
tion of the pulse usually indicates the most intense and danger-

183G.] Remarks on Puerperal Peritonitis. 11

ous form of the disorder, it may be that the failure of blood-
letting under such circumstances, is to be attributed rather to
the intensity of the disease, than to any inapplicability of the
remedy. But venesection, to be beneficial, must be confined to
the first stage ; in the second it will serve but to hasten the fatal
termination. Though an early resort to free bleeding, aided by
other appropriate remedies, will speedily arrest the progress of
the disease in a large majority of cases, yet so favorable an issue
is not always to be expected, even when it has been practiced
at the earliest hour and in the boldest manner. Peculiar malig-
nity may characterize the epidemic ; or the circumstances by
which the patient is surrounded may be such as to render any
treatment ineffectual. The local depletion effected by leeching,
often proves a valuable auxiliary to general bleeding ; but the
<lilTiculty of procuring leeches in the country, and smaller towns,
has hitherto confined the application to cases which occur in the
cities.

But though bloodletting be of primary importance, we should
not rely upon it, to the exclusion of other remedies, i There is
another remedial operation, which in efficacy is but little inferior
to bleeding we mean free purgation. We are aware that, in
relation to the use of purgatives, there is some difference of opi-
nion among practitioners ; but the objections urged against their
use seem to be theoretical, rather than the result of observation.
Indeed, nature seems to have indicated to us their applicability ;
for the spontaneous diarrhoea which sometimes occurs in the
early stage of the disease, is frequently followed by a marked
improvement in the condition of the patient, and mucji injury is
sustained when it is suddenly checked. \ If those who object to
purgatives have arrived at their conclusions from an observation
of their effects, when administered in such a manner as only to
produce a gentle and occasional action on the bowels, it is not a
matter for surprize that they found no benefit result from their
use ; but an argument drawn from their effects when carried
only to this extent, is entitled to no greater consideration th-m
would be an argument against bleeding, founded on its want of
success in the cases treated by Drs. Hulme and Leake. If we
cxp ect to derive material benefit from the action of purgatives,
we must administer them at such intervals, and in such doses, as
will procure regular and free evacuation of the bowels. When
this effect is produced, it will usually be followed by a subsidence
of the abdominal pain, tension, and tenderness ; and by a gene-
ral mitigation of the symptoms. \ \In illustration of the beneficial
action of free purgation, we here subjoin a brief history of a case
related by Denman. It occurred to him before he had begun to
use the lancet, and whilst he was in the practice of relying much
upon emetics. A soldier's wife was attacked with puerperal
fever thirty-six hours after delivery. An antimonial emetic was

12 Remarks on Puerperal Peritonitis, [Jni .

administered, which vomited but twice, but produced seventeen
stools in the course of six hours, fche hud some quiet sleep in
the night, and sweated profusely. Saline draughts wen1 then
prescribed, and afterward a decoction of bark, and the patient
perfectly recovered. I We will also relate briefly a case which
came under our own observation, and in which the beneficial
eflects of free purgation were also plainly exhibited. The case
was of sporadic origin. Mrs. was attacked with puer-
peral fever on the third day after delivery A We visited her six
hours after the attack, and found her labouring under considera-
ble pain in the hypogastric region, and great tenderness of the
abdomen. The pulse was about 130 in a minute, the skin hot
and dry, and there was much restlessness. Her condition, from
previous disease, was such as seemed to render venesection of
doubtful propriety ; it was therefore advised that she should
take a scruple of calomel, which was to be followed in two hours
by a mixture of senna infusion, and sulphate of magnesia, and
this was to be repeated hourly until a free evacuation of the
bowels wras effected A On the next visit the patient was found
to be much relieved, the pulse was reduced to 120 in a minute,
and the abdominal pain and soreness materially lessened. The
purgative had produced thirteen evacuations, some of them quite
large* It was not designed to cause such powerful catharsis, but
the patient had persisted in taking the mixture until it was ex-
haust d, in consequence of the decided relief which followed
each d scharge. The cathartic was ordered to be repeated, and
its operation followed by an anodyne. On the next day we
f nd the pulse reduced to 110 in a minute, and the pain and
soreness had nearly disappeared. A moderate action on the
\> wels, by the use of laxatives, was kept up for a few days, du-
ring which time the patient continued to improve, and soon re-
gained her usual health. But the use of purgatives should be
co .lined to the first stage; after this has passed by, only the
mildest laxatives should he administered, and when in the second
stage, diarrhoea occurs, even these should be discontinued.
There is some diversity of opinion as to what particular cathar-
tics are best adapted to such cases. Armstrong advises large
d B of calomel. In our hands, calomel has generally proved
very sluggish and uncerta n in its operation ; and for these rea-
sons, we have censed to rely upon it, except in combination
with some more active article. As we believe that, purgatives
are beneficial mainlv by the topical depletion which they effect,
fr in the vicinity of the inflamed parts, we have generally pre-
ferred those articles which produce the most prompt and copious
discharges.

Tl" ! are other auxiliary measures, whose application often
proves beneficial. At the head of these, Armstrong, Blundell
and others, place Opium. They advise that it should be given in

I&36.] Remarks oft PUerperal Peritonitis. 13

lar \ d >s is. as its effects are of a less stimulating nature, than
: used in smaller quantities. They suppose thai it possess-
es s >me efficacy in lowering the irritability of the vascular system
a j. I jhing inflammation. But there are many practitioners

w ..> object t-. the use of Opium, not only in consequence of its
stimulanl properties, but from a belief that it prevents, or retards,
th ! > i mi of purgatives. This last objection we believe to
be sr >undless; so far as our observation has extended, we have
ir seen any such effect following the use of Opium ; and
Armstrong asserts, that it does not interfere in the least writh the
action of purgatives in this disease. In relation to its stimulant
properties, the same writer declares, that they are manifested,
only when small doses are administered. But Opium should
never be given until after free depletion ; used then it will miti-
gate the pain, and procure sleep, without increasing the inflam-
matory symptoms in the slightest perceptible degree. Though
Opium should not possess the power of extinguishing inflamma-
tion, which has been ascribed to it, yet its action in mitigating the
sufferings of the patient, renders it an article too valuable to be
excluded from the treatment of puerperal fever.

After bloodletting has been carried to as great an extent as
may be deemed prudent, benefit will frequently be derived from
the application of blisters. It has been advised to confine their
use to the latter part of the first stage. They should be applied
to the inside of the thighs, and not to the abdomen, for an irrita-
tion of the abdominal surface would render those indications
obscure which are to be derived from an examination of that
part, by making it difficult to determine whether the sensation
of soreness which pressure produces, is the effect of the blister,
or of the continuance or increase of the internal inflammation.

It has been recommended to mercurialize the system as
speedily as possible ; and could this be effected at an early stage
of the disease, it probably would prove serviceable. But puer-
peral peritonitis is usually so rapid in its course, that we should
very rarely be able to bring the system under the action of the
mercury, except in a few of the milder cases, in which such a
treatment would be unnecessary. Moreover, to produce ptya-
lism by the internal use of mercurials, we should be compelled
to administer it in such a manner as to prevent its rapid passage
through the bowels, and thus, without any certainty of being able
to procure its constitutional action, we should deprive ourselves
of the opportunity of using purgatives, which certainly have
much higher claims upon our confidence. However, in some
instances, there is a degree of inflammation which remains even
when the depletory process has been carried to its greatest possi-
ble extent ; in these cases, calomel carried to the extent of slight:
ptyalism, will be found highly beneficial. The best mode of ad-
ministering it is in combination with opium, and aided by fric-
tions of the abdominal surface with mercurial ointment.

1A Remarks en Puerperal Peiutonitis. [June,

? ^ _

Fomentations, with flannels wrung out of warm water, may
he applied to the abdomen, as they often mitigate the pain; but
as they are inconveiiient, and their beneficial effects but transient,
it is probably besl to confine their use to cases attended by great
severity of pain.

Emetics, and oil of turpentine, have each their advocates ; but.
our observation of their effects lias been too limited to warrant
the expression of an opinion as to their merits. In relation to
the oil of turpentine, the reports are very contradictory ; some
lauding it highly, whilst others assert that they have never real-
ized benefit from its use.

The antiphlogistic regimen should be most rigidly enforced
throughout the whole course of the first stage; and as the signs
by which the commencement of the second is to be recognised
are uncertain, it will be prudent to refrain from the administra-
tion of anything of a stimulating nature, until the presence of this
stage is distinctly ascertained.

\ The treatment we have recommended is only applicable to
the first stage for the second there is no known remedy. In
the language of a late writer, "the wretched patient must in a
great measure be abandoned to her fate, as regards medical
treatment. Stimulants cordials opiates may be administered,
without reserve or apprehension, for the disease has spent upon
her the full force of its powrers, and in this instance, wre do not
know what can injure or what can benefit the case." But how-
ever hopeless the condition of the patient may seem, we should
never desert her until life is extinct. Remarkable changes do
sometimes occur, even under circumstances the most desperate,
and we should always be ready, in events of this kind, to lend
our aid. But even when no such alterations take place when
hope has expired in our own bosoms, our presence will often
prove a source of consolation to the despairing friends of the
sufferer, and will enable us to mitigate her pangs, and smooth
her passage to the grave.

v

1S36.J Remarks oil the Treatment of RheumatisjtL

ARTICLE IL.

Remarks on the Pathology and treatment of Rheumatism, read'
before the Medical Society of Augusta. By L. A. Dugas,
M. D. Proiessdr of Anatomy and Physiology in the Medical

College of Georgia, Member of the Geological Society of
France, &c.

Rheumatism is a disease of which we find no satisfactory
account prior to the Sixteenth century, towards the close of
which the attention of the Profession was called to it by the justly
celebrated Ballonins, under the singular appeLation it still retains.
Subsequently, the able pen of Sydenham delineated its charac-
teristics in bold relief, and made it a prominent feature in No-
sology.

The term Rheumatism, according to Villeueuve, (Diet, des
Sciences Med. torn. 48) is now applied to u a disease classed
amongst the Phlegmasia?, located in the muscular and fibrous
tissues of animal life, and attended with the following symptoms :
pain, more or less intense, either continued or intermitting, fixed
or wandering, and with or without heat, tumefaction, redness,
and pyrexia. It usually terminates by resolution, sometimes
suddenly, followed or not by metastasis, rarely by suppuration,
and still more seldom by gangrene. Lastly its course is extreme-
ly irregular, and its recurrence very frequent."

Scudamore defines Rheumatism to be: ''Pain of a peculiar
kind, usually attended with inflammatory action, affecting the
white fibrous textures belonging to joints, such as tendons, apon-
euroses, and ligaments , the synovial membranes of the bursa?
and tendons ; and nerves; occasioned by tiie influence of varia-
ble temperature, or by direct cold, or by moisture." It is called
either acute or chronic, according to the intensity and combina-
tion of the above symptoms. The causes of this disease are
extremely obscure, although they have, by universal consent,
been referred principally to atmospheric vicissitudes. Expo-
sure to a cold and humid air is peculiarly favourable to its de-
velopment Whether the low temperature and hygroscopick
condition of the atmosphere, alone concur in such cases to give
rise to Kheumatism, is extremely questionable. I believe it bv
no means improbable that the electric state of this medium is
highly influential in the production of Rheumatic pains, as well
as of many other phenomena connected with nervous affections.
It is not my design on the present occasion to inflict on the
reader even a recapitulation of the numerous predisposing and
proximate causes assigned to this disease. The profession i<
happily becoming satiated with speculations on aases which

i i Remarks on the Treatment of Rjieumatism. [June.

must over escape our present means of investigation; and a e
are now disposed to cultivate a more fruitful field that oi
fects. Lei us, therefore, hasten to the nature or Path* l< q < f
Rheumatism.

We have already said that it is now generally regarded .
inflammation of the muscular and fibrous tissues. This is, in-
deed, the doctrine which has prevailed, more or less, from the
earliest notice of this disease. It is true that many have consi-
dered this inflammation as of a peculiar kind. Sarcon ...id
other believers in the agency of. animalcules, &c. in the c lusation
of disease, exj lained this peculiarity by referring it to the ac q
of those diminutive beings on the white humors of joints,
Quarin viewed it as a constriction of the vessels, from cold.
Boerhaave called it an inflammation not sufficient U jp-

puration. Cullen admits the inflammation, but adds that the
muscular fibres are in a state of rigidity, which impedes and
renders painful any movement. "It is," according to this
tinguished pathologist, "an affection of these fibres Ives

an opportunity to the propagation of pains from one j< int to ano-
ther, along the course of the muscles; and which pains are
more severely felt in the extremities of the muscles t< rminating
in joints, because, beyond these, the oscillations are not propa-
gated." (Cullen's 1st lines.)

Bichat and Scudamore insist that it is a peculiar inflammation,
but do not attempt to define its nature. ViUeueuve states that
" several authors, without determining whether the proximate
cause of Rheumatism be spasm, irritation, or debility, affirmed
in general terms, some that Rheumatism was a peculiar affection
of the nerves, others that it was a lesion of sensibility, and a third
class that it was a special modification of the vital powers." (loc.
-it. P. 402). Villeueuve admits that the nerves of animal life
may he the seat and even the primary scat of Rheumatism, but
does not think those of organic life ever invaded by it. Scuda-
more, in his definition of Rheumatism, enumerates very specially
the nerves among the tissues affected by this peculiar inflamma-
tion. Sciatica is accordingly considered by him a Rheumatic
affection of the nervous trunk itself; whether of the nervous mat-
ter or of the neurilemma, he docs not determine.

It is evident that all the writers above cited looked upon
Rheumatism as located alone at the scat of pain. Of late yens,
however, attention has been called to a peculiar condition of the
spinal marrow ;is invariably connected with lesions of sensibility,
as well as with many of those affections classed among the

Neurosc -.
It appears that as far back as 1821, Mr. Player, in a letterto

the Editor of the Quarterly Journal of Science, stated that " the
occurrence of pain in distant parts (from tin* spine) forcibly at-
tracted my attention, and induced frequent examination of the

1-S38.J Remarks on the Treatment of Rheumatism. .. 17

spinal column ; and after some years' attention, I considered my-
self enabled to state, that in a great number of diseases, morbid
symptoms may be discovered about the origins of the nerves
which proceed to the affected parts, or to those spinal branches
which unite them ; and that if the spine be examined, more or
less pain will commonly be felt by the patient on the application
of pressure about or between those vertebrae from which such
nerves emerge."

In May, 1828, Dr. Thomas Brown published in the Glasgow
Medical Journal a very interesting article *' on Irritation of the
spinal nerves," the substance of which he asserts he read before
the Medical Society of that city in 1823. In this paper he refers
the morbid phenomena of the spinal nerves to a state of increased
irritability of their origin, which he terms "spinal irritation."
This affection of the spinal marrow is attended with more or less
pain on pressure of the vertebra? at the diseased point. Some
<>{' his cases were evidently Rheumatic, and indeed had been
treated as such by the previous attendant. His treatment con-
sisted principally of applications to the spine.

Dr. Darwall, early in 1829, inserted in the Midland Medical
and Surgical Reporter, his " Observations on some forms of Spi-
nal and Cerebral Irritation." He would establish the principle
- that disorders attacking the origins of nerves, or their attach-
ment to the central mass, whether this be the brain or spinal
chord, always disturb the functions of the organs to which such
nerves are destined."

" A treatise on Neuralgic diseases, dependent upon irritation
of the spinal marrow and Ganglia of the sympathetic nerve," by
Thomas Pridgin Teale, was issued from the London press in
1829. This invaluable publication l\as opened to our researches
one of the most fertile fields ever explored by the profession ; one
from which have already been elicited some of the most impor-
tant truths in the domain of Pathology. The observations of
Teale not only confirm the views of those who wrote before him
on Spinal Irritation, but are also extended to lesions of the
sympathetic ganglia. I would, however, at present, refer only
to that portion of his work which relates to our subject. It con-
tains a number of cases illustrative of his doctrines, some of
which, like those reported by Brown, had been considered as
rheumatic by other physicians, and indeed presented symptoms
*uch as are usually said to characterize some forms of this dis-
ease. It is not a little remarkable that with such facts before
them, neither Brown nor Teale should have thought of treating
the more acute forms of Rheumatism in the same manner. They
make no reference to it, and the merit of introducing a new and
rational mode of treatment of Rheumatism, was reserved for
our countryman, Dr. J. K. Mitchell, of Philadelphia, who, in
May 1831, published in the American Journal of Medical Sci-
3

lb Remarks on the Treatment of Rheumatism. [June,

ences, his first article on the subject: In addition to the eight
cases then reported, Dr. M. inserted five and thirty more in the
game Journal. August 1833; all of which concur in confirming
the spinal origin of Rheumatism, whether acute or chronic.

I must confess that neither of the transatlantic publications to
which I have referred, had led me to reflect on the nature of
Rheumatism ; nor was my attention drawn to it until the ap-
pearance of Dr. Mitchell's first paper. On reading this, how-
ever, and comparing his doctrine with the prevailing theories of
the Pathology of this malady. I became at once convinced that
it was impossible to reconcile ihe various symptoms of this dis-
ease, on any other principle than that of spinal irritation, and
that with this view of the subject, the treatment would be per-
fectly simple and efficacious.

From the definitions usually given of Rheumatism, the pain
is manifestly considered as dependent on the inflammation of
the parts in which it is seated. That simple inflammation of
the muscular or fibrous tissues should be the sole cause of the
pain. I cannot admit. It is true that the patient's sufferings are
generally proportioned to the degree of apparent inflammation,,
and consequently that acute is more distressing than chronic
Rheumatism. But, I would ask, why are not other inflamma-
torv affections of the same tissues equally painful ? It is impos-
sible not to perceive, on a close examination of the phenomena,
of Rheumatic inflammation, that they present several peculiari-
ties, which evidently distinguish it from ordinary inflammations ;
and indeed they are so strong as to have led some eminent pa-
thologists to deny that they constituted a whole, entitled to the
denomination of inflammation. Inflammat on is usually said to
be characterized by redness, heat, tumefaction, and pain, all of
which we find united in the most violent f<rms of Rheumatism.
But there are sequela; or terminations enumerated as belonging
to inflammation, which never follow Rheumatism. Inflammation
lerminates by resolution, suppuration, or mortification. Its rise,
progress, and termination, are more or less gradual; subject to
certain laws, and it is in most cases susceptible of removal by
the antiphlogistics. Rheumatism obeys no such laws of develop-
ment, progress, and declension; but, not unfrequently, manifests
itsclfand disappears with a degree of suddenness utterly at vari-
ance with the course of ordinary inflammations. Its mode of
termination is invariably the same, (by resolution) never pro-
ceeding to suppuration, or to mortification; and finally, it rarely,
if ever, yields to the antiphlogistic treatment directed to the scat
of pain.*

* I am ;iw;iro that there an- cases on record, of suppuration and even of
mortification having occurred in parts affected with Rheumatism, hut they
are so few that we may be permitted to doubt their authenticity, or rather to
ook upon them as mere coincidences, dependent on complications or pecu-

1836.] Remarks on the Treatment of Rheumatism. 19

The theory of spinal irritation is that alone by which all
these peculiarities can be explained. If the point from which a
given nerve arises be diseased, the functions of this nerve must
necessarily be vitiated ; and if its functions be vitiated, the con-
dition of those parts to which said nerve is distributed must also
be morbid. In the case of Rheumatism, the morbid condition
of the parts deriving nerves from a diseased portion of the spi-
nal chord, consists of inflammation of a peculiar character, in-
creased sensibility of the nervous extremities, amounting usually
to pain more or less acute, and, in many instances, diminished
motility. All admit lesions of motility to depend on an affection
of the motor system of nerves, and, inasmuch as the motor can-
not be separated or distinguished from the sensitive fibres after
their union in a common nerve, such lesions are referred to the
spinal chord. Why then should we not also regard all lesions
of sensibility not the result of local injury.f attributable to a
morbid state of that chord which presides over this function ?

Again, we see that not only the onset of Rheumatic inflam-
mation, but also its termination or cessation, is in many instances
extremely sudden, and indeed that sudden metastasis is by no
means unfrequent. These circumstances are most satisfactorily
accounted for by the fact that nerves arising very near each
other may be distributed to parts very remote. For instance,
the nerves of the right hand, though very distant at their termi-
nation from those of the left, are nevertheless very near them at
their origin in the medulla spinalis ; and hence a slight affection
of the medulla might for a time exist in one column, and subse-
quently extend or remove to that adjoining it ; thus producing
at first a derangement of function on one side of the body, and
then on the other. My opportunities have not as yet been suf-
ficient to enable me to assert, from observation, that metastases
of Rheumatism are limited to the periphery of nerves arising in
the proximity of each other. This, however, I am strongly in-
clined to think, will most frequently be found to be the case.
Whenever an upper and a lower extremity are simultaneously
affected, they most frequently belong to the same side of the
body. It will probably also be observed that the justly dreaded
translation of Rheumatism to the heart, is a much more com-
mon sequel of an affection of the upper than of the inferior ex-
tremities.

The difficulty attending post mortem examinations of the
medulla spinalis, has very much retarded our knowledge of the
pathological anatomy of this organ. Its condition in fatal cases

liarities of habit. The success of the antiphlogistic treatment directed to
the seat of pain, is equally doubtful, esppcially when we bear in mind the
strong tendency of Rheumatism to translation or sudden cessation without
appreciable cause.

Gout, Rheumatism, and Neuralsria.

30 Remarls mi the Treatment of Rheumatism. [Jul* ,

of Rheumatism hns never been systematically investigated.
We find, however, on record, a few cases which I think calcu-
lated to throw much light on our subject. One of these is re-
ported in Johnson's Medieo-Chirurgical Review, (Oct. 1827.
JP. 464) under the title of 4t Inflammation of the Spinal Marrow."
A youth, some time after bathing in the Seine, experienced wan-
dering pains, which subsequently extended to the whole surface
of the body, and became so intense that the least touch would
occasion loud cries. The pains continued unabated, delirium and
diarrhoea ensued, and he died on the ninth day. On opening the
spine, the medulla was, from the 7th cervical to the 8th dorsal
vertebrae, evidently softened and infiltrated with pus. In the
same Periodical (Jan. 1828, P. 184) is contained another case,
in which the patient had suffered severely from Rheumatic
pains in the upp* r part of the back, shoulders, and arms, and
finally became paralyzed in his arms. Dissection evinced that
from the 5th cervical to the 1 1th dorsal vertebra, the membranes
of the spinal canal were intensely inflamed, thickened, and cover-
ed with a bloody effusion. The marrow itself, for the same-
space, was similarly inflamed and softened.

Dr. Mitchell gives the history of two cases of spinal disease,
as corroborative of his views of Rheumatism. The first* was
one of caries of the lumbar vertebrar;, in which one ankle, and
the knee of the opposite side were tumefied, red, hot, and pain-
ful, afforded a fair specimen of acute Rheumatism. Relief
promptly followed leeching and a blister to the affected spine,
aJ though the ordinary treatment for Rheumatism had been pre-
viously resorted to without effect. The second case was that
of a physician who, after receiving an injury of the cervical ver-
t.jbra3, experienced an attack of acute Rheumatism of the hands
and wrists, which " wras always relieved by remedies applied to
the affected part of the spine, and aggravated by pressure or
rough friction there."

These four cases conclusively establish the fact, that irrita-
tion of the spinal contents is attended with the train of symp-
toms known to characterise Rheumatism. May we not then
by legitimate deduction infer that there is a spinal disease when-
ever wo encounter this train of symptoms ? If further evidence
be requisite, it is abundantly furnished by the numerous instanc-
es in which genuine, uncomplicated Rheumatism has been spee-
dily cured by medication applied exclusively to the spine. Dr.
Mitchell, reports forty-one cases successfully treated on the new
principles. In my own practice I have used no oilier plan for
the last five years, and its success has been uniformly prompt
and decisive. An unwillingness to swell this communication,

* American .Tourn;i I ofthi Medical Sciences, May, 1831, p. 55.
\ American Journal of the Medical Science. August, 1838, p. 860,

183G.] Remarks on the Treatment of '"Rheu *ji

deters me from transcribing from my n >to book, s
most interesting cases which came mirier my care-.

Pressure over the vertebrae corresponding to the origin i
nerves supplying the scat of suffering, though in many ins
attended with more or less pain, is not uniformly So. In soine,
not the slightest uneasiness is produced by it. I oannot howe-
ver, coincide with Dr. Mitchell, in considering die tenderness,
merely a proof of an irritated condition of the - spinal brac< s ;"
for, whenever this tenderness dues exist, it almost invariably
corresponds to the origin of the affected nerves. The degree of
sensitiveness may perhaps be indicative of the condition of the
membranes alone of the medulla.

In the case before us, we have a happy illustration of the im-
portance of localizing, and properly localizing diseases ; for so
long as Rheumatism was thought to be an affection of the wrlole
system, manifesting itself indifferently in one joint or another, all
remedial agents were directed to the general system. How
many poor wretches have we not seen subjected to the cruel
inflictions of a regular mercurial salivation, a systematic course
of sudorincs, antimonials, guaiacum, sarsaparilla, &c. the or-
deals of steaming, vapourizing, sweating, &c. and after all, the
patient doomed to limp the remainder of his days ! But I say
that it must be properly localized : for those who view the dis-
ease as confined to the seat of pain, will torture their patients
with frictions, fomentations, vesications, &e. with as little success
as those who endeavoured to drive out or neutralize the consti-
tutional impurity. We have now, I trust, traced Rheumatism
to its true source, and every remedy based on this belief, gives
additional evidence of its correctness. Regarding the disease
as seated in the spinal marrow, and believing its nature to be
irritation or sab-inflammation, the treatment to be instituted is
perfectly obvious. The local abstraction of blood, by leeching
or cupping the surface over the affected medulla, followed by
the more permanent revulsive action of vesicatories, constitutes
the most efficient treatment of Rheumatism. In many slight
cases, the mere application of a sinapism will readily allay the
pain ; in others a blister will be required and may be, or not,
preceded by cupping, according to the tenderness of the spine.
the constitution of the individual, dec. When the local affection
is so intense as to induce high febrile excitement, it may be pru-
dent to take blood from the arm, though this should not be car-
ried to excesss. The opiates will occasionally be found useful
adjuvants. In obstinate chronic cases, the counter-irritation will
be most advantageously kept up by the ointment of tartarized
antimony, and should be persevered in, as long as the disease
manifests a tendency to return. With this plan of treatment,
I repeat, the disease will be found almost uniformly to yield in a
few days, and without any internal remedies, or applications

>-)

Analysis of the Hydrant Water of Augusta. [June,

the sent of pain. Indeed, so confident do I feel of its efficacy,
that I now look upon Rheumatism, not long since the apprpbri-
um medicorum, as <5ne of the most manageable affections we are
I on to treat.

ARTICLE III.

Analysis of the Hydrant Water of Augusta, passing through
leaden pipes. By Lewis I). Ford, M. D., Professor of Che-
mistry in the Medical College of Georgia.

The extremely poisonous nature of the salts of lead has gen-
erally and very properly created a doubt in intelligent commu-
nities, as to the safety of using water that has been transmitted
through leaden tubes. This feeling in this community, together
with the occurrence of some cases of disease, which seemed to
warrant the suspicion of injury resulting from the use of water
conducted in leaden pipes, have led me to the particular exami-
nation of this subject. I place the result at your disposal, be-
cause I have not met with any detailed account of the method
of proceeding in such an examination, and therefore, it may
possess a general interest ; and because a knowledge of the fact
us to the nature and degree of the impregnation of the water,
with a saturnine preparation, may be of service to the commu-
nity, cither in quieting their apprehensions as to its use, or in
leading them to abandon it, according to their respective estima-
tions as to the quantity of this preparation which may be used
with safety.

This water is brought in a wooden conduit from the spring,
through the centre of the city. The service pipes inserted into
the main conduit, are, iu the majority of instances, of wood, while
others are of lead. There has never been discovered the slight-
est trace of lend impregnation in the water that passes through
the wooden pipes, although carefully examined in very many si-
tuations: while it is uniformly discoverable in every situation
when it passes through the leaden ones. This difference is not
surprising when we consider for ;i moment the construction oi
the aqueduct, and the constant flow of the water from the ser-
vice pipe .

1. The qualitative analysis. None of the usual agents of
lead produce any precipitate with this water, except the foe*

183*5.] Analysis of tlte Hydrant Water of Augusta. m:\

sulphuretted hydrogen gas, or its solution in water. Even the
hydro-sulphates produce no discoloration.

The sulphuretted hydrogen gas injures slightly the transpa-
rency of the water, producing a brow color throughout it.
The water thus discolored deposits no precipitate after many
days rest.

After passing the water through good filtering paper, it is not
discolored in the slightest degree by the sulphuretted hydrogen.
This fact assures us entirely, that the preparation of lead is insolu-
ble but in a state of so minute division as to be suspended in the
w iter without altering its transparency. It also explains the
r i son why neither the sulphuric acid, the sulphate, the hydrio-
date, nor chromate of potash will form a precipitate.

To determine more satisfactorily the presence of lead, a gal-
lon of the water was filtered the filter dried perfectly, burned
and the rcsidium placed on a glass capsule and a few drops of
nitric acid added, boiled upon a sand both, and the heat continued
until the mass was dry. A few drams of water were added and
boiled for a moment, and the solution filtered. I need scarcely
remark, that the object of treating the incinerated filter with ni-
tric acid, is to obtain the lead in the state of one of its soluble
salts, the nitrate. This solution with the sulphate of potash
gave a white precipitate, with sulphuric acid, and with the
carbonate of Potash, a white precipitate, with the chromate
of potash it gave a heavy dense yellow precipitate.

With a solution of hydriodate of potash, this solution produ-
ces a yellow^ precipitate, and if the solution of the hydriodate be
added with as little agitation of the test tube as possible, the
precipitate is recognized by a practiced e}reas the hyhriodate of
lead, by the peculiar appearance of the contents, when they
are thrown into motion, by turning the test tube in a circular
direction ; the surface of the fluid in contact with the glass, ex-
hibiting different shades of the yellow color, like the watered
ribbon ; an appearance produced doubtless by the partial crys-
tallization .of the precipitate. But this precipitate is recognized
as the hydriodate of lead by a still more striking characteristic.
By boiling the contents, a transparent solution is obtained, which,
on cooling slowly and at rest, deposites on the sides and bottom
of the tube beautiful, small, splendent yellow crystals.

A polished plate of zinc immersed in a portion of the above
solution, is speedily covered with a light spongy mass of pure
lead.

Thus each one of the foregoing: re-agents producing a change
in this solution, characteristic of the presence of lead, their con-
curring testimony establishes the fact beyond the possibility of
doubt, that the water thus passing through these leaden pines is
impregnated with one of the preparations of lead. What is this
preparation?

24 Puerperal Convulsions. [Juno

If a portion of the water he evaporated to dryness, and sul-
phuric acid be added to the residuum, an evident efiervesc
is produced. Whence we infer thai if is impregnated \\ Lb
carbonate of lead. Again, if a piece oi' lead be immersed in a
jar of this water, with its surface exposed to the atmosphere, the
bad is covered over with minute crystals oi carbonate of lead,
in the course of a few days.

2. The (j unit ('dative analysis. To determine the absolute
quantity of carbonate of lead in a given quantity of the water,
233 ounces were filtered, the filters burned, and treated w ith
nitric acid as above, and three ounces of solution of nitrate of
lead obtained. A solution of chromate of potash being added in
excess, the precipitated chromate of lead was suffered to
side and washed three times, dried in the tube from wh< nee it
was removed and weighed. Weight exactly one decigram
equal to 1.544 grains Troy. Thus from 256 ounces, or two
gallons, we obtain 1.696 grains of chromate of lead, which, ac*
cording to Wollaston's scale, is equivalent to 1JJ8 grains of car-
bonate of lead. Thus we arrive at the conclusion that th< re is
1.38 grains of carbonate of lead in every two gallons of this
water, which contains so much of the oxide of lead as, if unite d
with acetic acid, would form 1.044 grains of sugar of lead
nearly one grain to the gallon. It is proper I should state that
the water which has given this result was drawn from one of the
longest leaden service pipes. I may at some future period en-
deavour to estimate the reason wrhy this water acts upon the
lead, when it is known that in innumerable instances water is
transmitted through leaden tubes without being impregnated
with it.

ARTICLE IV.

Puerperal Convulsions.

hi the summer of 1633 1 delivered a lady of her second child.
The d< livery was accomplished within an hour and a half from
the first anouncemenl of labour. Beinghurried away to another
rase. I left her very comfortable, 30 or 40 minutes after deliver) .
About one hour and a half after, she was suddenly seized with a
\ery violent convulsion, of that species described by Velpeau as
Apoplectic Eclampsia. Before she could he administered to,
mother convulsion returned on the profound stupor and heavy

I J Puerperal ( 25

torous breathing which followed the first. A consultation of
physicians was present The pulse being slow, hut full and
il depletion was practise^ All the intermediate
a;> ; ptoms pontinued notwithstanding. Soon after

>nd paroxysm, I arrived. Whilst receiving the above
account, a third paroxysui supervened, which I witnessed, and
wfhich was very severe indeed commencing during the stupor
and stertorous bri athing, full pulse, foe, by a drawing of the eyes
then the head to .mil the body was universally con-

;ed, with frothing at the mouth, livid skin,/&cj This soon
;ided, and was followed by the same apoplectic symptoms.
On examination, notwithstanding the copious depletion from the
arm, it was discovered that the uterine hemorrhage was very
copious indeed ; the whole nankin, which had been but 10 or 15
minutes in application, being completely saturated, beside a large
quantity of coagulated blood surrounding her in bed. On the
external touch, the uterus presented no firmness ; but the whole
hypogastrium perfectly flaccid. The uterus was immediate ly
sped and agitated repeatedly through the abdominal parietes,
until its contractions could be distinctly perceived to return with
increasing strength, every four or five minutes. From the first
heat .on of the hand, no other paroxysm returned, and after
Kit fifteen minutes from the. commencement of this operation,
the apoplectic symptoms disappeared, and she opened her eyes
with intelligent expression, looked about as if surprised at see-
the family and physicians about her, and asked where was
her child. It was brought, and she received it into her arms.
She then asked for something to drink. A cup of weak tea was
soon brought, which she drank sitting, spoke several times,
was again placed in bed.
I remained with her about an hour after, continuing the manual
operation for exciting the uterus. Finding that she continued
free from all alarming symptoms, I instructed her nurse to main-
tain the perpetual contraction of the uterus by the same process
i had used, and left her, complaining of nothing but some painful
i ati ms in the uterus at every contraction, amounting to slight
after pains. The haemorrhage had been reduced to the ordinary
quantity for the period.

A few months after, I was j ires* at with another lady, who, af-
haying had several convulsions' of the same- character, the
first occurring in the latter part of the second stage of labour, was
then suffering the intermediate apoplectic symptoms. On direct-
ive; attention to tha abdom n, the uterus was found in the same
relaxed condition as in the form< r case. It was stimulated to
action by the same means, and within from 20 to 25 minutes, the
as well as the expression and color of the face, became
na1 a) al ; she opened her i yes with a natural expression, yawned,
I to uing her head to an * asy positio . It was found

1

2i> ml Convulsions. [Junc

that she also had flooded very copiously. She had no more con-
vulsions.

In view of the present state of the profession on this very in-
teresting and important disease, T cannot withhold the focts of

these cases from the public. They are given in the hope thai
in the present imperfect state of the pathology and treatment of*
these convulsions, the curative indications, in some cases ai
least, may be made so plain as- to lead to more favourable prac-
tical results. What is the pathology of these eases? Was-
there a passive haemorrhage From the uterus? And was there
at the same time a strong general action of the heart, and a>
great determination of blood to the brain ? And did the exci-
ting means used with the uterus equalize the action of the wholi
system, by arousing the energies of this passive organ ; and thus
by a prompt and decided derivation of excitement, at once re-
lieve the brain of its ruinous burthen? Or was the Eclampsia
a mere nervous phenomenon, arising out of the debility and con-
sequent increased irritability of the motor apparatus ; and the
symptoms strictly apoplectic, only a secondary effect, arising
from cerebral compression from blood forced into the brain 1>\
the violence of muscular contractions in this spasm ? And did
the excitement of the uterus so far employ the excitability of the
system as to relieve other parts of that excess which predispo-
sed to spasm ? Would not Ergot have produced the same be-
neficial effects as the manual operation employed, if it could
have been administered ? (yet it could not have been in either
case.) May or may not the previous bleeding have prepared
the system' more perfectly for this counter-excitation ? And
would further bleeding have ever produced this equalization of
action? Would not the patients have died without proper exci-
tation of the uterus having been directly effected? May not the
powerful antispasmodics which arc, when they can be, almost
always exhibited in these cases operate, when they do operate
beneficially, simply on this principle, (i. e.) exciting the uterus
particularly, rather than the system generally I Would not tar-
tar emetic have failed as well as continued depletion in these
cases ?

It is earnestly hoped, for ihc good of humanity, and the credit
of the profession, that these facts and interrogatories may ieadtd
more accuracy in pathology, and consequently, successful the-
rapeutics.

31. ANTONY.

S:jt>.j Sketch of a case of Bfoficnoceh.

ARTICLE V.

ch of a case of Bronchocele, successfully treated hy Iodine.
By Wm. W. Lee, M; D. of fcdiantown, S. C.

Brohchocele is a disease of such rare occurrence in the Uni-
ted States, that many physicians pass through life without even
an opportunity of beholding it. Its origin is exceedingly obscure;
the supposition that it arises from the use of snow-water, to
which it is ascribed in the Alpine regions, is disproved by the
fact, that it prevails to a great extent in Java and Sumatra,
where snow is unknown. It is also singular that writers rarely
mention the duration of cases when cured.

The case about to be related is interesting, both as it displays
the therapeutical efficacy of Iodine, and from the short time in
winch the cure was effected.

May 21st. 1833, I was requested to visit Mrs. R. D. set 32
years, labouring under goitre. The history of, the case wTas as
follows: Her mother had a small tumour resembling the

num adami in males, but which continued indolent through
life ; the daughter, about thirteen years previous to my visiting
her, perceived a small tumour forming in the situation of the
I gland, supposed to be a wen: she soon after married,
from which time the tumour, which had previously exhibited
little change, now began to enlarge rapidly, particularly after
Vie birth of each child; indeed this seems to be almost a diag-
nostic of bronchocele : an eminent surgeon was consulted, who
proposed extirpation, to which she would not consent. At the
time of my visit, it had so increased as to project anteriorly as
far as the point of the chin, extending laterally to the angles of
the jaws, and occupying the whole space between the chin and
clavicle; its surface was smooth, uniform, and hard; her head
was tixed ; elevation, depression, and rotation, wTere alike impos-
sible ; the dyspucea forced her to sleep resting on one side in a
li-recumbent posture, and when labouring under catarrh,
threatened suffocation. Recollecting the extreme danger, and,
in one instance, fatal result attending two cases related by
( r;>ch, I expressed the opinion that the extirpation of a tumour
of such magnitude, and so vascular, would cause death by ha>
morrhage ; at the same time, I stated that although the proba-
bility of a cure was greatly diminished by the long duration of
the disease, I thought there* was a possibility of it by a newly
discovered medicine (Iodine) ; and at the earnest solicitation of
herself and husband, consented to make the effort.

Considering Magendie's tincture needlessly strong, I preferred
Cartwright's formula. (Med. Rcc. No. 44, p. 260.)'

8 Sk '''.

B Iodine, xxvj.

Alcohol, 5j. IP. 55 drops thrice a day ; also to
apply by friction, morning and fcvening, the I imenl :

9 Tinct. Iodinte, (Gartwright) 3j.
Liniment. VolaT. 5vij. u>.

I considered the prospect of a cure sodoulJtftil, thai T neg
ed (what I have since greatly regretted.) to take the dimensions i
the tumour; still I recommended a svad\ perseverance in the
use of the remedy.

June 25th. 1 uas truly astonished at the wonderful change
effected ; the tumour had been reduced to the size of a g< >< se i
over the trachea, and had lost its redness; respiration was per-
fectly free, for she could sleep in any' position : the power of ele-
vation, depression and rotation was restored, and she seemed
full of hope.

July 9th. I was equally gratified at the rapid improvement ;
without a manual examination, even the existence of disei
would not have been suspected ; the power of motion was com-
pletely restored ; she could sleep even in the horizontal position,
and expressed herself both surprized and delighted at tne felici-
tous results; indeed it was to me a source of equal thankful-
ness and gratification that I had been instrumental in restoring
to health and usefulness a wife and mother of a large family,
dependent for subsistence on the personal industry of herself and
husband. I made -a minute examination of this case at a sub-
sequent period, (Nov. 1834) and found it precisely as last des-
cribed; there was one circumstance which had caused me much
solicitude, its possible increase after parturition; she had during
this interval given birth to another infant ; but my gratification
was extreme to perceive no disposition to a recurrence 'of disease;
I was therefore led to consider her radically cured.

1836.] Diagn st. Vfa

PaAt II. REVIEWS A#D

On the Diagnosis of Diseatei of tl
f anion of their phi/sic/' ark I general signs. B;
Gerhard, M. J)., Physician to the mdckley Hospital;
furer in the Philadelphia Medical Ass'ociatipn1 ; Fell
Philadelphia College of Physicians; McmtaJ of the Society
Modicale d'Observation, and of the Societe Anatomiqi
Paris, &c. 8vo. pp. 1S;J, Philadelphia, Key & BiddleylS36.

It is truly with pleasure, we call the attention of the Prbics
sion to the work before us. The diseases of which it treats.
certainly constitute one' of the most common and most lata I
classes of affections we have to encounter. ' That a correct di-
agnosis is the first and most important step in the treatment of
ase, will not be denied; yet, without the possession of the
physical means instituted by Avenbrugger and the immortal
Laennec, it is absolutely impossible to attain this desiral
knowledge. To those who are content with the stamp of me-
diocrity on their front, we have no reflections to offer ; but to
the honest, zealous, progressive physician, we would confident-
ly appeal. The elements of diagnosis derived from physical
means, have now been systematized at least ten years ; they
have been extensively adopted in Europe, as indispensable to
whoever desires to understand the affections of the pulmonary
and cardiac organs ; these affections are quite as frequuent and
destructive in our c >uritry as in any on the globe ; why is it
then, that we find those principles so reluctantly adopted among
us 1 Shall it be said, that whilst every medical tyro in Europe
can, with ease and certainty, distinguish the locality, extent and
nature of every variety of thoracic disease, that there are but
few practitioners in our country, who can distinguish pleurisy
from pneumonia? Tubercular phthisis from mere catarrh?
The fact is too true ; and yet we know of no school in the union
in which the principles of auscultation and percussion are prac-
tically taught ! There can be but little doubt, that much of the
apathy existing on this subject, is attributable to the prevalence
of the same state of feeling among those who are ostensibly on
the qui-vive for every information that can be of advantage to the
profession. How can it be expected, that young physicians
should strive to acquire that, which is of so little importance as
not to merit the attention of their teachers ? We could not re-
sist a sense of mortification, on hearing the acknowledgement
made by one of the most distinguished teachers of the north, a
few years since, when lecturing on pulmonary diseases, that Ik;
could say nothing concerning the stethoscope, for he had thus

$0 agnosia of Diseases of Vie Chest. [June,

far d >ne v< ry well without it, and its use was foo troublesome
cquire ! The influence of names unfortunately prevails to a
I in the medical profession. In tne case just
cited, how much error does it not cover! Auscultation will ne-
ver become general, until it In* advocated by those at the head
of the i i. T-he invaluable discdvery of lithotricy re-

mained in Europe in the hands of its author exclusively for
years. In cause Dupuytren preferred the knife. In this country
its introduction was retarded until very recently, by an abortive
attempt of one who, though deservedly pre-eminent, did not suf-
ficiently study the new instruments placed in his hands. We
sincerely hope, that the good sense of the profession will tri-
umph over the vain authority of title, and that the stethoscope
will, ere long, be deemed an essential part of every practition-
er's outfit.

That the little work of Dr. Gerhard, will do much to facilitate

branch of the art of diagnosis? we can entertain no doubt.

Its language is good, notwithstanding it is plain and intelligible

English. Dr, Gf. appears carefully to have avoided any ofthajt

irable pedantry, so commonly evinced by writers of.1
day, who, forgetful or ignorant of the richness and cogency of
our own language, continually resort to words of foreign origin.
Although the subject of which he treats is peculiarly French,
we find very f< w instances in which he has drawn on that lan-
guage f r words to convey his ideas.

The review of a manual is always an ungrateful perform-
ance, not only to the reviewer, but also to the author, for it Is
difficult to condense what has already been reduced to so small
a compass, ;md it is no less difficult to do justice to the work
by mere extracts; we shall therefore attempt simply to convey
some idea of the contents of the volume before us.

The history of the physical signs of disease, is premised by
general remarks on the conformation of the chest, on percussion
and oil auscultation. The rules laid down forexaming the tho-
rax aie highly important. Its anterior, posterior, and two la-
teral aspects, are successively studied in the normal state, and
with reference to the changes they undergo by disease of the
contained viscera.

The third chapter is devoted principally to the manual per-
formance of percussion, which " is mediate or immediate. Im-
" mediate percussion requires the ends of the fingers, or in some
" cases, their palmar surface to be struck quickly upon the walls
u of the thorax. Tins mode of percussion was once generally
"employed^ but h is now very properly and universally aban-
doned, on account of the production of less sound than may
"be obtained from mediate percussion, the greater pain caused
" to the patient, and the absolute impossibility of using this me-
u thod, when the cellular tissue is infiltrated with liquid or loader!

183G.J biagnosis of Diseases of tk (I. :u

- with fat. Mediate percussion was introduced by M. Piorry,

now Physician to the Hotel Dieu, of i'aris. A dense resisting
" body is placed in contact with the patient, and held with the
>; fingers of the left hand, while percussion i made upon it with
*; the right. The body interposed" between the fingers and the
" skin, is called a pleximeter ; it may be a thin plate of tvory,

- leather, or metal, or, what is generally most convenient, the;
"fore-finger of the left hand. An excellent pleximcter is -i
piece of caoutchouc, or common gum clastic about a quarter
"of an inch thick, and tolerably firm. This pleximeter is Very

- elastic* gives a good full sound, and prevents any pain 1.'

by the patient."

We give the decided preference to the ivory plate, such as is
attached to many of the stethoscopes now in use. The resist-
ance of the caoutchouc varies very much according to Chan
of temperature, and when yielding, it cannot be used in those
instances in which percussion is attended with pain.

,The chapter on auscultation is one of great interest, treating
as it does, of the manner of using the stethoscope, and of the
sounds detected in health and disease. " When the ear is ap-
" plied to the chest of a person in good health, a faint rushing
" sound is heard during the act of inspiration. When this sound
" is carefully analyzed, it will be found to consist of two ele-
" meats, more or less blended together. The first element, or
" the blowing sound, is that produced by the air passing through
'; the bronchial tubes. It resembles the sound made in the mouth
,J and fauces, when the air is quickly inhaled. It is heard most
" distinctly at the root of thedungs, over the trachea, and near the
' clavicles, especially the right. The second sound is the soft
" murmur caused by the expansion of the vesicles ; it is the best
" characteristic of a healthy pulmonary tissue. This sound is
" termed the vesicular murmur, or the vesicular respiration.
" from its anatomical seat. It is best heard where the tissue of
' of the lungs contains the greatest number of vesicles and the
" smallest bronchial tubes that is, at the base of the lungs, In
" the axilla, and at their anterior margin. The sound of expira-
tion is much more feeble than that of inspiration, and in a
ft healthy subject is almost confined to the parts where the first
" or blowing sound is heard. It is short, feeble, blowing, and
s not resemble the inspiratory murmur.''

These sounds present varieties dependent oil anatomical
structure, on difference of age, and on peculiarity of constitu-
te >n. Those resulting from disease are much more complicated,
and are arranged in classes and subdivisions, as follows : 1st.
Increase and diminution of the normal sounds of respiration ; 2d.
Increase of the blowing sound of respiration, withfeebli
absence of respiratory murmur; 3d. Imperfect bronchial, or
rude respiration. "In this variety, the blowin

i

3<2 ''' - i Utz Cites! . [June.

id is tn \\ than usual, and more pr-o

icular murmur is stii) heard, and is usually more feeble than
in a healthy lung ; in som it; is louder, but h is a i

soun ." Bronchia] respiration, in which "the v

murmur disappears when the pulmonary tissue is perfectly in-
durated, the blowing sounds are sttll heard; but much m

irigly than iu a natural state. * * * * The sensation
< nmuiflkatcd to the ear is thai of the air pj ssing through solid
;, and not through the spongy tissue of the lungs." 5th.
Strong bronchial or tubal respiration^ Here "the inspiration
and expiration are not only strongly blowing, without the k i I
trace of vesicular respiratiQn, but they are both very loud, and

emble the sound which would be produced by some one

ving strongly into the car." (>th. CaVernous espiration
" differing from the tubal respiration in Being limited to a
cumscribed portion of the lung, into which the air is heard to
pass, and from which it is forcibly expelled." 7th. Amphoric

riration. " As the air passes into cavities of very large si.. .

it produces a sound not unlike that caused by blowing smartly

a glass or metalic vessel."

The second class of alterations of respiration comprises the

accidental or adventitious sounds produced during the act of

piration. These species of rattle are termed KhoncHi, and
I >resent the following variety -s : 1 . The Cave? nous 1, Hon eh us, or
gurgling, "is the loudest and most easily heard of all the humid

nchi; the air passes through a liquid of moderate tenacity.
contained in a cavity of a size varying from that of a sj
almond to -i large orange, or in some oases ii nited only by die
])lcura and the; thoracic pariet.es." 2. The rMacou,s Rhonchus " is
analogous in character to the cavernous; it is more diffused,
but less intense. It is produced, like the gurgling, by the pas-

! of air through a liquid of little tenacity, but it must be con-
tained in the larger bronchi, instead of a. circumscribed cavil)."
3. The Crepitant lilionclms "is produced in the same bronchial
ramifications, or, ;is some suppose, in the pulmonary vesicles ;
and is caused by the passage of the air through a x^vy tenacious
liquid. The bubbles are, therefore, much smaller, and break
with a sharper noise than the mucous rhonchus." 4. Sub-crcpi-
tant Rhonchus. " This variety is distinguished from the prece-
ding, by the larger size of the bubbles, mad'* by the air passing

lUgh the smaller bronchial lubes, and the greater quanti:;
liquid. >). Sonorous Rhonchus, "This resembles the cooing of
;i pigeon, or still more nearly the sound of the bass-string of a
violin." 6, The Sibilant Rhonchus "resembles a tow whistle,
and, like the sonorous rhonchus, is heard both in the inspiration
and the expiration. '/. The Grating Sound "is caused by the
friction of the two surfaci s "!' the pleura, lined with false mem-
brane.-: up n ea< h other* and is heard in the. hitter stage i <>!' pleu-

1838.] Diagnosis of Diseases of the Chest. 33

risy, when the more liquid, part of the effusion 1ms been absorb-
ed. 8. Metallic Tinkling, "This is produced by the fall of a

drop of liquid from the upper p.u't of a cavity, upon the surface
of a liquid contained in it, which gives rise to a peculiar tink-
ling sound, a little similar to that produced by striking a pin
against a glass vessel."'

Having described the sounds produced by respiration, our
author passes to the consideration of the auscultation of the
voice. The modifications of the vocal resonance, consequent
on pulmonary disease, are enumerated under six heads, viz :
I. Increased resonance. 2. Bronchophony, or "a variety of
resonance of the voice, which is much louder and much more
distinct than is ever heard :n a healthy lung." *3. Pectoriloquy,
or " the resonance yielded by a cavity in the lung of moderate
size. * * * The voice seems to proceed from the
cavity and to enter the ear." 4. Amphoric resonance, when
4i the voice seems more hollow, more distant, and more diffused
than in Pectoriloquy." 5. Egophony. "When the voice is
transmitted through a layer of liquid contained in the cavity of
the pleura, it has a peculiar quivering intonation, resembling the
bleating of a goat, or the voice heard through a speaking trum-
pet." 6. Diminished resonance.

The indications derived from the cough and expectoration
arc sufficiently valuable to require some attention. The varie-
ties of cough noticed are the short and dry, suppressed, sonorous,
laryngeal, lo)sc mucous, hollow, and spasmodic. With regard
to the expectoration, attention is directed to its quantity, colour,
consistence, form, odour, and admixture with foreign matters.

All these physical signs being well understood, it is easy to
apply them to the diagnosis of the various forms of pulmonary
disease. This is done by our author .with brevity and perspi-
cuity. He successively passes in review Bronchitis, Emphy-
sema, Pneumonia, Gangrene, Phthisis, Pulmonary Apoplexy,
Pleur sy, Pneumo-thorax, and the tubercles of the bronchial
glands. The limits assigned to this article preclude any details
on these topics.

The situation and action of the heart, render it peculiarly
susceptible of study by auscultation and percussion. It is ob-
served that, " as a portion of the pericardium, and consequently
of the heart, is not covered by the lungs, percussion on the cor-
responding part of the chest must yield a dull sound, because
there is no lung and consequently no air benenth it ; that " in
the normal state, the impulsion of the heart is felt opposite the
cartilage of the the fifth rib, in a space about an inch square ;"
that " by placing the ear near the heart of a healthy individual,
we find that each pulsation is composed of two distinct sounds, ^^
which are followed by an interval of repose ;" that " the limit in a
which these sounds are heard varies according to the dimensions

')4 Tartar Kmciic in Obs&tfic Practice. [June*

of the chest and the thickness of its walls;" and lastly, thai
"besides the increase or diminution in the loudness of the two
sounds yielded by the heart, they may be changed in character
and tone. "

The most common cardiac affections are Pericarditis, lesions'
of the valves, Hypertrophy, and Dilatation ; all of which are
more or less readily detected with a knowledge of the physical
signs ; whereas, without them, a correct diagnosis cannot be
obtained.

Dr. G's work concludes with a chapter on the method of ac-
quiring a knowledge of the physical signs, to which I would espe-
cially call the attention of the reader. The method recommend-
ed will enable any practitioner of observation and industry to
render himself familiar with them in a comparatively short time.

We cannot conclude this paper without testifying to the merit
of the work of which we have given so imperfect a sketch. We
have made no criticisms, because we have had no occasion to do
so. The work, although a compilation from printed books, con-
tains many valuable additions, derived from the researches of
men still labouring in the cause of science, and who daily add to
our fund of knowledge. The opportunities enjoyed in Europe
and in this country by Dr. Gerhard, together with his known
talents, zeal and industry, entitle his productions to especial dis-
tinction. We wish his present work every success, and hope
that its favourable reception may prove an incentive to further
exertions. D.

Augusta, May 10///, 1836%

'

Observations on the use of Tartar Emetic m Obstetric Practice
By Eyoky Kennedy, M. D. Master of the Lying-in Hospi-
tal, Dublin.

The following very interesting memoir we have read with
great pleasure. The same pleasure we cannot withhold from
those of our friends who may not have seen it. We value it
no less for the candid, faithful spirit which it breathes through-
out, and the excellent field of observation of which it is the
gleaning, than the great importance of the cases to which it is

o well calculated to bring consoling and salutary assistance.

VVe designed%o make extracts of the most, valuable portions

j 83G.] Tartar Emetic in Obstetric Practice. &T>

for the benefit of our readers ; but on making the attempt, we
find it impossible, in justice to the author, and to the cause of
truth, to omit any part of it. We are highly gratified to find
that so valuable a practitioner as Dr. Kennedy lias been so fa-
vourably disposed towards American medical literature, as to
make this communication directly to the American Journal.
We understand, from a note of the Editor of the Journal, that
Dr. K. is the author of a valuable work on auscultation. We
hope it will not be long before we shall be enabled to enjoy the
pleasure we feel warranted to expect from its pages. As we
have not room in the present number for the whole essay, and
as it may be divided without other injury than withholding a
part for our next number, we shall give the first half only in the
present.

"If it be the duty of the hospital superintendent to avail himself of the op-
portunities afforded him of investigating new and interesting plans of treat-
ment, establishing what is correct and rejecting what is erroneous in prac-
tice, it is equally his duty to afford the results of his investigation and
experience to the public. The following observations assume to be, not
merely the result of one or two experiments or accidental cases, but the
report of practice adopted and tested by the experience of years in what will
be admitted .a sufficient field of observation. The plan here followed of
selecting a medicine and treating of its efficacy in several different diseases,
may appear to some to savour of empiricism. The only motive for this
variation from ordinary habit is brevity, a plea that has novelty as well as
simplicity to recommend it to my readers.

Tedious labour from Rigidity of the Os Uteri and Vagina. Some patients
continue for many hours in the first stage of labour, with partial dilatation
of the os uteri and external parts, in whom there may be no want of what,
are significantly termed grinding pains, a state more frequently met with in
first pregnancies and those who marry late in life. This state is to be care-
fully distinguished from false labour, which' it much resembles, by the partial
dilatation of the os uteri, protrusion of the membranes, and presence of
glairy discharge. It may continue for some hours, rendering the labour
more tedious than it would otherwise have been, the parts eventually be-
coming relaxed, and the labour terminating favourably ; it may continue for
many hours, exciting our dread as to the result of the case : or, in its more
obstinate forms, it may persist so long as to wear out the mother's strength
in unavailing efforts to overcome the difficulty it opposes to delivery, the
mother, child, or both, perhaps, falling a sacrifice. The difficulties to
encounter here, are premature, too forcible or irregular uterine action, pro-
pelling the child against the os uteri before it is sufficiently dilated or
/lilatablc, and absolute rigidity of the parts. It should be constantly borne
in mind that the first inconvenience is a very frequent cause of the second.
With this view of the subject, then, the two objects to be held in view, are,
mitigating too early, violent, or irregular uterine action when this is the
cause of delay, and producing relaxation when rigidity is present. Of the
efficacy of tartar emetic in producing the first effect, we shall presently
treat, when on the subject of violent labour ; for the present let us inquire
into its utility in the second. In tedious labour, from rigidity of the uterus,
the os is found slightly gaping, with a thickened, tense state of the lips, nnd
usually much heat of the parts. Bleeding from the arm, and, on the eonti-
nent, the use of the warm bath, have been had recourse to in these cases

i

>

36 Tartar Emetic in Obstetric Practice, [June,

Bleeding is attended with marked benefit when there is a full bounding
pulse, in a strong plethoric habit; but, as a general practice, it is not unin-
tended with inconveniences, often of a very serious nature. It. certainly

procures relaxation of the os uteri, but along with this it causes depres -
of too permanent a nature, and may thus seriously interfere with the future-
progress of the labour. Tartar emetic solution has been successfully em-
ployed in producing relaxation of the os uteri in these cases, and poj s<
the advantage of being much less permanently debilitating. It is an agent
by which the system can be with safety brought into a much greater degree
of temporary depression; between which state and relaxation of the con-
tractile tissues, a marked connection holds, if they do not absolutely stand in
the relation of cause and effect. The principal'recommendation, however,
to tartar emetic in these cases is, that in its use, the power of regelating the
necessary degree of lowering the system, exists completely in the hands of
the practitioner, as he has only to increase, or diminish, or suspend the doser
in order to produce the effect he wishes; and, when the we ssary effect Is
produced, the withdrawal of the medicine leaves the vital energies but little
impaired. The medicine has been used in the ordinary nauseating doses, as
in pneumonia, 5 or 0 grains of the tartrate of antimony, dissolved in e .
ounces of water, and generally 20 drops of laudanum, and a small quantity
of syrup added; one, two, or more table-spoonsful of this mixture are giv< n
at intervals of from fifteen minutes to two, three, or four houTs, according to
the effect it produces, and the necessity that exists for bringing the patienl
speedily or otherwise under its influence. Sometimes it is necessary to
cause irec vomiting in the first instance, or the ordinary doses produce no
nauseating effect ; in such cases the laudanum is better wit hheld, but may be
added afterwards if necessary. In other cases the medicine acts too vio-
lently as an emetic, or produces purging; here increasing the quantity of
the laudanum, and diminishing the dose, or allowing a longer interval to
intervene between the dosesr will be necessary. The accoucheur must,
therefore, watch carefully the effects of the medicine during its administra-
tion in every case in which it is employed ; these observations applying with
equal force to the forms of disease m which its utility has been proved.
Under some of the circumstances described, or where the antimonial in
every dose and form disagreed with the patient, small and frequently repeat-
ed doses of hippo [ipecac] have been substituted (three to five grams every
how or second hour,) and with good effect, not only in rigidity of the uterusT
mil in the other diseases in which tartar emetic w;is found efficacious. It
should be mentioned, that neither tartar emetic nor venesection have been
relied upon singly in some cases where it lias been necessary to produce
speedy dilatation of the os uteri, and where the plethoric state of the sys-
i< m described was present. In such, after depletion, the patient, was kept
for some hours under the influence of the nauseating mixture. One ci Be,
in particular, of a most threatening nature, maybe mentioned, in which a
strong, robusl woman was brought into the hospital with the arm forced
into the vagina, through a tense, rigid, and slightly dilated os uteri. She
was so treated, and with the besl results. T*here is a Bomewhat different
of the os nti ri, in which it occai kmally dilates very tardily also; here
the lip of the uterus is thin and stretched over the head of the child, not
a'i'. -ding the sensation of heal or rigidity of fibre observed in the case abov<
d< scribed. The extract of belladonna appeared of service in afewofthesi
c - j, al hough its general efficacy appeared very questionable. In two
( - of rigid os uteri, in which it was freely \\^c(], its application was fol-
1 wed I v head symptoms and depression of pulse; in one of which even
i isibility and stertor were present. It was, however, tried in many other
9, without being followed by these unuleasant effects. The last described

stt '" of the os uteri is also occasionally benefitted by the nauseating medi-
c Tt may depend, however,. upon other causes, not under our present

consideration, nor is ft looked upon with the same anxiety by the occouch-

1836.] Tartar Emetic in Obstetric Practice. 37

rur as a cause of tedious labour.* In concluding this branch of our sub]
not be inferred from what lias preceded, that tartar emetic will b
eceedin procuring dilatation of the os uteri; as it is in some ci
" unavailing, in others inadmissible. Its efficacy, however, in a
: which it has been used, fully warrants its attracting the
dtion of the obstetrician, and its success will depend much 0:1 a proper
selection being made of the cases in which it is available.

Irritable or Violent Labour. By no means an unfrequent eauee <! tedious
IT is extreme irritability or violence on the part of the mother, a state
frequently met with in first children, and in the lower ranks, but not
confined to these. The patient, from the very -commencement of her labour,
becomes violent and irritable, -keeps constantly changing her posture, and, if
d, tossing about ; is generally very violent and vociferous, and, when the
pain is present, bec9mes absolutely uncontrollable. By this means she loses
the effect of her uterine efforts she don't wait for these to bear down, but
keeps up a continued and unavailing straining at expulsion in their absence,
and, when they are present, she becomes violently restless, and forcibly and
suddenly inspires, in place of fixing her respiratory muscles to assist in expul-
sive efforts which would now prove availing. This state may continue for
many hours, or even for days, with more or less complete dilatation of the os
uteri, and with little or no advance of the child through the pelvis; the pa-
tient at length becomes fatigued. The irritation and restlessness continue,
bur the uterine efforts cease, and exhaustion setting in, we are obliged to
have recourse to instruments to effect the delivery. In some, the os uteri
is not even fully dilated at the period when force delivery becomes necessary,
and the crotchet is^then the only instrument available. In protracted violent
labour, however, the child is dead in the great proportion before delivery,
from the delay and violence of the parent. In these patients, where the
pulse is full and the habit plethoric, venesection is often of service. The
advantages that the use of tartar emetic off red in the cases already treat-
ed of, recommend it even more strongly to our notice in this. Long conti-
nued observation of its utility in cases of this kind, and the having found it

* In this species of rigidity, we have always succeeded in effecting the
desired dilatation by the fingers ; and more speedily than might general!}
be expected by the relaxing power of the antimonial, or of the Dilating
Pomade (Belladonna Ointment.) Only three days since, we were called to
a case of protracted labour, in which the woman had suffered the most se-
vere pains which ordinarily attend the first stage of labour, more than 30
hours. The labour was every way regular, for the first stage, except that
no dilatation whatever had been produced. From the exhausting power of
continued severe labour, her strength was much impaired, and the pains
had become comparatively weak. On examination, the parietes of the
uterus were so attenuated that the midwife doubtless had mistaken them
for the membranes covering the head. But on reaching back to the hollow
of the sacrum, the os uteri was found thin, but so closed that the point of one
finger could not be made to touch the membranes through it for many
minutes. So strong was the contraction, that after the finger was passed
into it, it caused not a little pain by its tension around the first joint of the fin-
ger. Soon, however, the end of another finger was passed then a third ;
and without other means the dilatation was effected, and the woman con-
ducted through the third stage of labour, and placed comfortably in bed,
within two hours from our arrival. [Ed.

38 Tartar Em tic in Obstetric Practice. [June.

procure the double effect 6f dilating the os uteri and softs parts, and sus-
the irritability and violence which so much interfered with the na-
tural progress of the Labour, have convinced me, that by its lull admimstra-
. in the cases described, we may often enable a woman to be speedily

;\m\ safely delivered by her own efforts, who, without it, would have suffered
from a tedious and dangerous labour, eventually, perhaps, requiring the use
of instruments. To produce any good effect, it must be freely administered,
the patient brought completely under its influence* and retained so whilst
any tendency to irritability or violence remains; nor does it appear to sus-
pend the labour altogether, as might be supposed; it merely mitigates or
regulates the violence of the pains, and under its use the labour progresses,
and the head advances into the pelvis. Tt should not, however, be persisted
in so long as to reduce the powers of the patient too much; it should be
discontinued when we have attained our object, quieting the patient.
These observations will also hold as to its utility and application in the cases
alluded to at the commencement of this paper, where the os uteri remains
undilatod from the occurrence of premature, forcible or irregular uterine and
abdominal efforts.

Puerperal Convulsions. The efficacy of tartar emetic in puerperal con-
vulsions, is quite as marked as in the preceding cases. It should, however,
be understood, that it has not been used to the total preclusion of bleeding,
which must always prove our sheet anchor in this violent disease. It r< n-
ders unnecessary the repeated bleedings we have hitherto been obliged to
have recourse to, as the only effectual means of checking or preventing the
repetition of the fits. After one copious bleeding, the tartar emetic is to be
freely administered, as already explained, and the patient kept well under
its influence. The return of the fits will by this means, in the great ma io-
rity of cases, be prevented; and even in the most obstinate cases, they will
be lessened in their severity and frequency. Its administration must not
he desisted from until the patient is delivered, unless it produces too great
prostration, even in diminished doses ; neither is its use to preclude a repe-
tition of the venesection, if symptoms should be sufficiently urgent to require
this; nor the use of such other local or ordinary means of treatment as are
generally had recourse to. There is a form ofvpuerperal convulsions, in
Avhich neither this nauseating plan of treatment nor free depletion afford the
benefit generally derived from them; on the contrary, the disease appears
to be aggravated by these. A remarkable case of this kind occurred some
months since in the Hospital, in which, after the patient, undergoing the or-
deal of depletion, the nauseating mixture, as well as purgatives, shaving and
cold applications to the head, sinapisms to the feet, blistering, and so forth,
the disease was becoming more and more violent under their use, when she
was put freely and rapidly under the influence of opium, and with almost
magical effect. It would, however, be wandering from the original plan of
tins paper, to go further into the subjects treated of, than in connexion with
1he use of tartar emetic in them ; we shall, therefore, only add, that this me-
dicine is admissible and eminently useful in all cases of puerperal convul?
. ions, in which depletion proves serviceable.

183<).] On Creosote. 80

[ Extract from the Mcdico-Chirurgical 1U \ Lew, tfo. 62, page 1 H. I
Oa " Crrosomy

As this powerful stranger, which has lately made its way into therapeul
is occasioning considerable curiosity, we shall here introduce an account of
its properties, mode of preparation, and medicinal agency, from a recent
edition of Dr. Gully's "-Formulary of New Medicines," published by
Churchill.

"The name of this remedy is derived from the Greek, ^p/a.c, flesh, and
tfww, to' preserve. It was discovered last year by M. Reichenbach de
RLansko, in pyroligenous acid, in the first instance, and subsequently in the
diil' rent kinds of tar. '

In the process which led to the discovery of creosote, M. Reichenbach
fou id that his fingers were deprived of their epidermis, and he conjectured,
from this vehement action on organic matter, that this substance might be
the mummifying principle of pyroligneous acid, and. might also serve an im-
portant therapeutical purpose in the living body. This explanation hafl
since been realized.

Physical Properties of Creosote.

Creosote is an oily, colourless, transparent liquid, of a penetrating odour,
resembling that of smoke, or smoked meat, and of a burning and exceedingly
caustic taste. It has a specific gravity of 1,037.

Chemical Properties.

It boils at 203 Centigrade, and is not congealed by a cold of 27 C.
It burns with a strong fuliginous flame. Witfy water at 20, it forms two
combinations, one a solution of one part in 80, and the other of 10 parts in
100. This aqueous solution does not change turnsol, nor is it neutralized by
acids or alkalis. Nitric acid causes red vapours. A small portion of con-
centrated sulphuric acid turns it red, but a larger quantity blackens it, the
acid itself being also decomposed. Acetic acid seems to be its specific sol-
vent, for it holds any quantity of it. All the acids, even the carbonic, separate
creosote from its combinations with potass and soda, without otherwise af-
fecting it. It dissolves a great number of salts, some with and some without
heat. Alcohol, ether, carburetted sulphur, and acetic ether, combine with
it in any proportion. It decomposes or dissolves resins, resinous colouring
matters, and other similar substances.

Shaken with white of eggy coagulation immediately takes place. Fresh
meat, soaked for an hour in a solution of creosote, and then dried, may be
exposed to the sun, without fear of putrefaction ; in a week it becomes
hard, has the smell of smoked meat, and becomes reddish brown. Fish may
be preserved in the same manner. Birds poisoned with creosote, remain
nearly two months without emitting any putrid odour.

These effects on animal matter closely resemble those of pyroligenous
acid and tar-water, and demonstrate almost to a certainty that creosote is
the preservative principle of those fluids. This, however, has been further
shown by the extraction of creosote from both of them. I shall confine
myself to the preparation of creosote from tar, as it is procured more abun-
dantly, and by an easier process, from that substance.

Preparation of Creosote.

In the dry distillation of tar from wood, the fluid collected in the receivers
contains an empyreumatic acid water, which is rejected, and oil of tar,

10 On Greosote. [June

which is placed in glass retorts and rectified. In these two distillations the
oil of tar is at firsl light, but as the heat is ufpreased, its gravity ai
\t one period of the process the oil sinks to the bo torn, and atliiid whicl
hi creosote, and consists mostly of eupione, and other substances th A
fere with the purity of the creosote, floats above it: this
and the pale yellow tar-oil is heated. Carbonate oi potass is ....
the carbonic acid is no longer 'disengaged on shaking; the mixtur . d

in order to separate the acetate of potass, and the oil is again distilk d
glass retort, and all the first products thai float on the water are rejei

oil is then dissolved ma solution of caustic potass of the epecifi*
1,12; heat is thereby developed, and a portion of the materials cod
eupione, &c. not being dissolved, floats on the surface, and is remov< .
alkaline solution is poured intjo an ojion capsule, and regularly heated to
boiling. It rapidly absorbs the oxygen of the atmosphere, whereb]
liar oxidizablc principle-in it is decomposed, and the mixture thou -

brown. After cooling in the open air, diluted sulphuric acid is added until
the oil is set at liberty. It is then distilled with water, holding a little c
tic potass, and the whole is kept boiling until the quantity of oil whic]
scs from the retort becomes diminished ; at this point the distillation si odd
cease. The oil and water in the receiver are again distilled with po1
and the same treatment with sulphuric acid repeated, as in the former
stance. A third distillation is then made, and a little phosphoric instead of
sulphuric acid is added, in order to take up some ammonia retained in the
oil.

The oil is then for the third time dissolved in caustic potass, and if the
preceding processes have been carefully managed, they combine, v it] i ut
leaving any residue of eupione, and the mixture, on exposure to the ; :r,
docs not turn brown, but takes on a slightly reddish tint. As long, liov e-
ver, as any eupione remains, and the mixture turns brown, the solution in
potass should be repeated. In this state, the creosote is not entirely pure,
but it may be used for medicinal purposes.

It may be obtained perfectly pure by distilling it with water alone,
rectifying the product of the distillation repeatedly, until no water p;
When the heat is raised to 203 C. The last product is creosote unalloyed
by cupiono, picamaro, water, or other matters.

M. lloichenbach endeavoured to simplify this tedious process; but he
found that the product was always unfit for internal use, while its action on
the surface was much impaired. So procured, its emetic effects were most
violent; a single drop applied to the tongue, caused, in the space of a minute,
excessive nausea, with tremors, succeeded by vomiting and great prostration
of the powers. These effects he attributes to the presence of eupiom , and
he therefore recommends the process above described to be followed on all
occasions.

Physiological Action of Creosote.

Applied on tin1 tongue in a concentrated form, creosote causes violent^
pain, though no redness or tumefaction is present : a strong taste of smoke
extends 1() t'1(' throat. Toured on the skin, it produces a burning sensation,
with rubefaetion and erosion.

Flies, spiders, and small fishes die in ihe course of two minutes, when
immersed in a solution of twelve drops of creosote, in two ounces of wati r.

Two drachms, given in half an ounce of water to a puppy dog, induced
the following symptoms: complete prostration of muscular power, drooping
of the head, fixation of the eyes, vertigo, apparent stupefaction of all the
senses; the respiration, from being laboured, was at the end of three
minutes almost entirely stopped by an abundant secretion of viscid, filamen-
tous mucus; to which was added vomiting of whitish milkv fluid, with so 18-
q die contraction ol the abdominal muscles. These symptoms got gradually

1836..] On Creosote. 41

-e for two hours, th ! respiration becoming more laborious, and at longer
,als, ili.' limbs being seized with tremor?, then with convulsive contrac-
tions, and the whole ending in dfeath.

( ) 1 opening the body of the animal, all the tissues of the body, except the
liver, exhaled a strong odour of creosote. The mucous digestive mem-
brane gave sighs of inflammation throughout its whole extent; the matters
contained in the stomach coagulated white of egg, and heated, gave out the
powerful tar-smell of creosote. In the heart and the immediate great ves-
sels, the blood appeared to be much more firmly coagulated than usual.
lungs were gorged o^er the greater part of the extent with reddish-
brown blood; the more ruddy parts of them floated in water readily: the
darker portions scarcely swam at all. No sign of congestion about the
brain appeared.

On injecting equal parts of creosote and water into the carotid artery of a
dog, the same symptoms wrere produced, but death ensued more speedily.

If concentrated or diluted creosote be added to blood, the latter thickens
and becomes reddish brown, with small spots of white, probable coagulated
albumen : on further exposure to the air, the blood passes to a yellowish-red
colour.

The signs of poisoning with creosote, therefore, are the redness of the
gastrointestinal mucous membrane, the peculiar thickness and colour of
the blood, the property possessed by the matters in the stomach of coagu-
lating albumen, and more especially' the peculiar odour exhaled by all the
tissues of the body.

Plants watered with a solution of creosote, fade and die in the course of a
few days.

Medicinal Employment.

M. Reichcnbach's first essays of his newly-discovered remedy were made
on slight burns, infantile excoriations, and wounds. Subsequently he was
induced to try it "in extensive burns by hot iron and boiling fluids : in itch
and various kinds of tetters : in gangrene consequent on extensive com-
pound fracture of the leg : in caries of the phalanges of the fingers and toes :
in tooth-ache, though it fails to put a stop to the caries of the tooth : in
open, fungous whitlow : in scrofulous ulcers of the throat, leg, and joints of
the fingers : in ulcerated white-swelling of the knee of two years' standing :
;i chancres and other syphilitic ulcers: in wounds from cutting and piercing
instruments, caustic alkalis, &c, in which cases the wounds did not cure by
suppuration, but by actual desiccation caused by the creosote. In all these
instances he has found the remedy most effectual and astonishingly rapid in
its operation. Thus in a case of old-standing and scrofulous ulceration of
the throat, with purulent discharge from the ears, the ointment of creosote
to the former, and the injection of creosote water into the latter, put an end
to both in the course of three weeks.

Internally, M. Reichenbach has given it in several cases of hemoptysis ;
in two of these, the sanguineous expectoration had continued for upwards of
a week, when the administration of four drops of creosote, on sugar, daily
for four days, arrested the flow of blood. .

Turning to the practice of the French physicians, we find that creosote
has been successfully employed in burns by Berthelot and Goupil, who ob-
serve, that in treating these with creosote, the tendency to cicatrize from
the circumference to the centre, and the consequent contractions and irre-
gularities, are avoided ; in various dry and moist tetters by Goupil, Coster,
Berthelot, Martin-Solon, Duchesnc-Duparc and Dauvergne; in chancres
and old venereal ulcers, by Kiinckel, Lessere, and others ; in sanious ulcer-
ation of the cervix uteri, by Colombat; m a cancerous ulcer of the nose,
by Breschet ; in chronic inflammation with suppuration of the edges of the
Jids, by Coster; in cancer of the womb, by Hvppolvte Cloquet andTea-
6

42 On Creosote. [June.

lier ; in varicose, ill-conditioned ulcers of the leg, by Goupil, &c. Chilblains
are also considerably benefited by frictions, with creosote ointment or water.
M. Regnart, of Paris, among many other patients, had the good fortune to
relieve the gifted Broussais from an excruciating tooth-ache, by the free
application of concentrated creosote to the carious tooth ; we cannot won-
der that the worthy professor should be an advocate of the doctrine of
* irritation.'

As this application of creosote may be of more extensive and familiar use
than many others, it may be well to inquire how it acts as a sedative in this
instance. When the teeth are painful it is almost always because the nervous
pulp near the root is exposed to the contact of the air. If in this circum-
stance a few drops of undiluted creosote are applied, a fierce increase of pain
is the first effect, then a total cessation of it : in this, either the nervous puip
is destroyed as by some caustic, or the creosote, by coagulating the albumen
of the fluids that are always flowing from the caries, forms an albuminous
layer that defends the pulp from the air ; or, lastly, it acts as a powerful
stimulant, causing the inflamed vessels of the pulp to contract and expel the
load of blood by which they are oppressed. In any case the pain is apt to
return, and this fact is only explicable by one of the two latter suppositions ;
for so long as the irritating cause, carious bone, remains, so long are the
vessels of the pulp liable to relapse into their former congestion.

Creosote has been employed by the French physicians in pulmonary phthi-
sis, but. from all that I have read on the subject, the alleged successful cases
are strained, and should not be recorded as such. It has not been more suc-
cessfully used in several Cases of chronic bronchitis by inhalation.

British practitioners have not as yet essayed the effects of creosote, and
indeed this is too often the case with regard to new remedies. My friend,
Dr. Copland, however, is an exception to this rule ; lie tells me he has em-
ployed it m cachectic affections as a tonic, and also in dropsical cases,
where it has proved diuretic. In two cases of diabetes, he considers that
he was not allowed to make a fair trial of it. The dose he gives is generally
from one to eight minims three or four times a day, combined with powdered
liquorice root, into pills. In porrigo favosa, he has used a lotion of saturated
solution of creosote with good effect.

My own experience of the effects of creosote is as yet confined to cases of
scrofulous ulcers of the leg, tooth-ache, lumbago, and aphthae. In the first
case, of ulcers, I premised a seton in the arm, and the rapid desiccation of
the ulcers caused by the creosote had no ill consequence on the brain or
any other viscus. In tooth-ache I have verified the reports above alluded
to. In the case of rheumatism I found the remedy at first produce distress-
ing nausea, but the warm and copious sweat that ensued soon compensated
for that symptom, and effectually removed the rheumatic pain ; copious diu-
resis was also one of its effects.

In a case of extensive apthous ulceration of the mouth occurring in an
adult, I employed the following wash with the greatest advantage; the
sloughs came away after the second time of washing, and the depressions
in the mucous membrane filled up with astonishing rapidity ; several of the
ulcerated surfaces were as large as half of a sixpence :

Creosote, 1-2 a drachm ; Gum Arabic Mucilage, 1 1-2 ounce ; Camphor
Mixture, 10 1-2 ounces. Mix. To wash the mouth every two hours.

Mode of administering Ci'eosote.

M. Reichenbach says, that his observations demonstrate that in the cure
of certain ulcers-, tetters and wounds, creosote water was sufficient. But it.
should be remembered that water does not dissolve more than about 1-S0th
of creosote a proportion that will be found inefficient in the generality oi
obstinate cases of ulceration. In such instances the employment of pure
creosote becomes necessary,

1 630.] On Creosote. 43

The application of concentrated creosote to ulcers, causes, in the first
instance, more or less of inflammation, which, however, quickly subsides ;
as soon as this inflammation appears, the remedy should be discontinued for
a few days, and the wounds allowed to remain quiet. The application is
then renewed with similar consequences; and this is repeated until the bad
condition of the ulcer is changed, that is, until the greenish pus becomes
white, the blue or white flesh becomes red, and firm granulations fill up the.
solution of continuity. Creosote should therefore be employed more freely
at tiie commencement than at the close of the treatment of these cases.
When the ulcer has taken on the appearance above described, it will suffice
to dress it with the creosote ointment, or water, or even desist altogether
from its use, and introduce other desiccating remedies.

The best mode of applying it, is by means of a camel-hair brush to paint
the surface of the sore ; or from five to a dozen drops may be placed on the
surface of a poultice, and this applied over the diseased point.

When used to stop external hgemorrhages, it may be poured by drops into
the wound ; but in these cases it seems to act with more certainty if imbibed
by cotton or lint, and thus applied.

To form a lotion for the employment of frictions, from two to eight drops
are added to each ounce of distilled water. Creosote ointment is made of
ten drops of that substance and one ounce of lard : it may be used either to
dress ulcers or to rub into the sound substance.

The internal administration is either in draught or pill ; the former being
composed of one or two drops of creosote dissolved in camphor mixture ; the
latter of the same quantity and some absorbent powder with mucilage. This
dose may be repeated three or four times a day, and may gradually be in-
creased to eight drops.

The inhalation of creosote is effected, first, by steeping paper in it and
placing this in approximation with the nostrils ; next, by heating the creosote
in the immediate neighbourhood of the patient, so that lie cannot fail to
inhale the fumes ; or, lastly, a portion of it may be poured into hot water in
a Mudge's inhaler, and the creosoted vapour inspired in the usual manner.

It should not be continued internally for too long a period, for it is apt to
produce irritation of the system and pains of the stomach and intestines.
Demulcents should accompany its employment, and should occasionally re-
place it.

From all that I have advanced concerning the therapeutical properties of
creosote, the following general conclusions may be made.

1. That creosote is beneficial in the different stages of burns.

2. It cures the majority of herpetic, furfuraceous, squamous, and crusta-
ceous skin diseases.

3. It cicatrizes obstinate syphilitic ulcers, prevents or diminishes suppu-
ration, and destroys the fungous growth without injuring the surrounding
tissues. It also corrects the condition of cancerous ulceration.

4. In phthisis and bronchitis, though it fails to cure either, it facilitates
greatly the expectoration.

5. Chronic lymphatic tumours are frequently dispersed by frictions or
fomentations of creosote.

6. It is almost always successful in allaying the pain of carious teeth, but
does not prevent its return or the progress of the caries.

7. It arrests capillary haemorrhage with remarkable certainty, but fails in
that from the large vessels.

8. It is an effectual remedy in atonic rheumatism, and may be tried with
-chance of success in cachectic disorders."

4-1 Causf qj [June,

[From the Medico-Chirurgical Review, Oct. IS35i I
The Cause of Sleep,

Many of our readers arc aware that a sharp controversj has existed, for

gome tunc pai t, between Messrs. Macnish ami CarmichaeJ, respecting the
cause ol' sleep. The following extract embodies the chief points of Mr. Car-
michael's doctrine.

"The absorbents and secerning vessels never remit, their offices those
carrying off the old particles from every part of the frame, and these d< ] o-
siting new ones in their place; the absorbents being most busy with ihe
muscular fibres, which are most exercised by labour, or the nervous fibres
most exercised by the operations of sensation, volition, and thought. Vet
these fibres, so exercised, are always the strongest and most powerful oj
their kind in the frame: the secerning vessels mi;; ! therefore be equal!;,
busy in restoring new particles in the place of the old, or during certain in-
fo n als, rather more busy, because more are restored than are taken a v
as is proved by the increase of size, proportioned to the occasional or 1
tual exercise of the parts. Yet it is evident that it is not during the mo-
ments of exercise that the great mass of new matter is deposited, other
tii" muscular and nervous fibres in question would go on thickening and
strengthening, the longer the exercise of labour and thought was continued ;
and this, we know, is contrary to fact; fatigue ensues, and rest is neces-
sary, and during that rest it is probable that the secerning vessels, though
always depositing new particles3, deposit much more, or the absorbents
remove much less, than at other times. By rv?\, J mean a mere cessation
from labour; and such rest is not sleep. The large mass of new particles
deposited on t lie muscles cannot affect their tough and insensible fibres by
any striking phenomenon : but when such a mass is deposited on the deli-
cate, tender, and sensible structure of the brain and nerve?, how differenl
must be the effect. If small in quantity, and while these organs are in a
state of active energy, it may be hurried unobserved into the existing acti-
vity of the living matter; but if large in quantity, and while the-
are resting from their labours, can it be that the extraneous and unassimila-
ted mass does not press its increasing weight on their fragile machinery, and
produce an effect somet! ing like the pressure of the over-swollen blood-
vessels, but natural, necessary, and healthful the paralysis, not of apo-
. Ir.it of sleep?

While the incumbent mass thus paralyses the vncephahn, the body is

rless ; there is no voluntary motion, no perception, no thought, no

m. But when the assimilation is complete in any one of the organs el

the mind, then thoughts arise; but there is no perception until the assinii-

omplete in one or more of the organs of the senses; until

then the simple current of our thoughts constitutes an ordinary dream.

If the nerves of motion continue invested in a newly deposited mass o!
nervous matter, while the mind anxiously desires and essays in vain to
move the/limbs this is nightmare. It these nerves are extricated fitom
th< ir trammels, - of the mind still continue

they command i\i\ the nerves obey this is somnambulism, lhit t)
dreams, whether ordinary and natural, or attended with the horrors t I
i ' mare or the perils of somnambulism, vanish as our Benses admit the
impressions of the external world. We are then awake; but-wKile thus
awake, if the nerves of motion are still aBleep if their trammels still conti-
upon them tins is the daynktre, so feelingly described by Air. Macnish.
If through any idioe ol assimilation were never suffi-

c otly considerable to paralyze, by the mass of new particles, the brain and
nerves of sense, the individual would exist as one that never flept, even

1830.] Cau&p'of

though his d srvous system Bhould ab1 in, in some <
which are the peculiar concouul

if. I , through an oj pos i jy, the depo-

i ii of d s should be so .- to continue

the p ' nd oaturaJ period of i lumb r, thii

would present- the rare and hith< is phenomena of prot

terminating even in death, as in the case of Elizabeth Per-
l by Mr? Macnieh. I > opposite idiosyncras

arise from opposite diseases of the secerning vessels of the head, one pro-
to excess, and tin1 other in an equal degree preventing, the effusion
of the due quantity of ri i * the b salthy and vigorous

if Mr nervous system.
If it should be asked, How can the same cause operate in different waj s .'
H \. ( ting process at one time cause sleep, and another not

cause^t I How can it, though unremitting in activity, at one time paralyze
the brain and nerves, and at another rather enliven and invigorate them.'
questions are difficult, and the more difficult because, m the material
world, we can find no object wherewith to compare and illustrate the phe-
nomena of mind. The clement of fire must suffice on the present occa-
sion, where no better ligament of analogy between tilings so different can
be had :

* Nutritnr ventis, ventis extinguitur ignis ;
Levis alit flammas, grandior, aura nee at.'

If a fire burns clearly, brightly, and fiercely, still it requires a constant sup-
ply of fuel to keep up its intensity, and replace the solid particles expended
m combustion, A small quantity frequently added, so far from paralyzing,
increases the activity of the fire : but when that activity is exhausted, when
the very energy of the rl lines, like the exertion of a powerful mind, has
w isted away the substance on which it fed and these flames sink enfeebled
and the fire is diminished and dull, if you heap over it a heavy mass of fuel,
the flames are smothered, the activity ceases, the element sleeps. Hours
are' required to extend the vivifying influence to the new matter ; at length
the increasing warmth pervades the . whole mass, the assimilation is com-
plete, and the smallest incitement stirs up again all the energies of the fur-
nace. If too little aliment be supplied to the glowing mas?, it will burn out
like an over worked brain in similar circumstances ; while too great a
weight of fuel cast on the exhausted hearth overwhelms the expiring em-
bers, and the result is the slumber of death, not of sleep."*

The hypothesis (for we believe it may be considered only as hypothesis)
of Mr. Carmichael is ingenious perhaps it may be true. The laws of al-
ternate sleep and activity, like all the laws imposed on us by the Creator,
are, no doubt, the wisest and the best that could be devised. We can
trace the operations of many of them but very few of them can we ex-
plain. It strikes us that there are some difficulties in the way of Mr. Car-
michael's explanation of the causes of sleep. If this image of death be
occasioned by the deposition of large masses of new matter on the delicate
organization of the brain and nerves, inducing the "paralysis of sleep, it is
curious how the bile of a Ilea or a bug will often disperse all these depositions,
and start us into wakefulness ! It is also curious that all animals become
more or less sleepy, during the very first process of digestion, in the stomach
and long before assimilation, much less deposition of assimilated matters,
can possibly commence. The dog, the hog, and the glutton fall fast asleep
as soon as the stomach is crammed to satiety. They are most awake and
active after digestion, and when assimUation, secretion, &c. arc in full play.

* The Phrenological Journal, June 1, 1835,

16 On ! of the Vena Porta. (June.
# L

le cold and hunger induce an almost irresistible pro-
is arise from depositions of matters on the brain
:i- wal of their parte and powers .'
[I . ry tiling is periodical or alternate in this world,

and nothing cons! . . m for a short time. The muscles cannot

- be in a state of contraction. The brain cannot always be flunking.
But the organ of the mind cannot cease to think, except through the mys-
p and, therefore, sleep was brd lined. How it is in-
duced we know not. Opium will often lull to repose by diminishing sensi-
; but still we arc totally ignorant how the sleep is produced in conse-
quence. We must, therefore

"Wait the great teacher Death, and God adore."

[Prom the American. Journal, Feb. 1830.}
PkyswlogicQl and Chemical Researches on the Blood of the Vena Porta.

The first No. of the forty-fourth volume of Rust's Magasin contains an
account of some highly interesting researches by Professor Schultz, respect-
ing the chemical and physiological differences between the blood of the ve-
na" porta, and that of the arteries and other veins. The following is a suc-
cinct summary of the results, as given in the Gazette Med. de Paris, (15th
August, 1885.)

1st. The blood of the vena porta is in general blacker than other venous
blood, although this difference is not always manifest to the sight : it is not
reddened by the neutral salts, or exposure to the atmosphere, or by the ac-
tion of oxygen.

2nd. The blood of the vena porta-dOes not generally coagulate, but when
it does, the coagula are less firm than those of the other arteries. In those
cases in which it has coagulated, it liquifies entirely or partly at the end of
from twelve to twenty-four hours, and produces, as well as that which docs
not coagulate, a black sediment, upon which is formed clear scrum.

3d. The blood of the vena porta contains on an average, when fresh, 5.23
per cent., and when dry, 0.74 per cent, less iibrine than the blood of the ar-
teries and the other veins.

4th. The liquid blood of the vena porta contains generally a little less
solid matter (O.ld to 0.3 per cent.) than the arterial blood and the other ve-
blpod.

6th. Its serum contains generally 1.58 less solid matter than the arterial
Brum, and 0.80 less than that of other venous blood, [n the dry slate, the
first is of an ash-gray, the second yellow, the third greenish-yellow.

0th. The blood of the vena porta contains proportionably more oruor* ami

less albumen ; the contrary is the case m the arterial blood : the dry cruor

of the vena porta is browinsh gray, that of the Other veins deep red, that

,.i the arteries bright red.

7th. The blood of the vena porta contains in its solid parts almost twice

as much fat as that of the arteries and the ether veins. The proportion is as

follows :

Blood of the vena porta, - - 1.06 per cent.
Arterial blood, - 0.92

Venous blood of the other veins, - 0.83 rt

1830. J Hydrocele of the Ace/.-. 47

8th. The dry serum of the vena porta contains but 0/i7 per cent.

tan the dry serum ofth fchfi other veins.

9th. rhe albuminous cruorof the vena porta - 1. 11 pei

,1 rre fat thanthatoftbe arterial Wood, and L.21 pi rem:, mora than I
the blood of the other \ . .

10th. It is in the fibrin that this difference is th 1 yfibrin

vend, porta contains 10.70 percent, of fat ; thai of the arteries 2.8-1 p< r

. so that "he diffi at.

llth. The fet efthe blood offche vena porta is blackisji brown and imctu-

,,:i.- ; thafcoi Lrl M-i-.l blood and other venous blood white, or yellowish-wiute

if the white chyle to two^thirds liquid and one-third

Hydrocele, of the Neclc.

Ever since its existence was first declared, this di.sea.sr
been generally unnoticed. by practitioners and by teachers. We
are pleased with an opportunity of re-publishing the notice of it
contained in the last No. of the American Journal, from James
O'Beirne, M. D. alike on account of the great importance. of its
diagnosis and treatment, and of the opportunity afforded of ex-
p ising the injurious influences extended to the cause of humanity
by the anathema of high authority. Those who arc full fledged
with the brilliant plumage of fame, or whose vanity causes them
to think themselves so, arc often wont to proscribe, in the most
pointed and dogmatical manner, the opinions and facts of those
who have not been so. puffed abroad as themselves. Thus it
has been with the valuable manuscript memoir' of Professor
Maunoir, of Geneva, on the disease to which he gave the name
of Hydrocele of the neck, and which, though essentially different.
in its nature, and requiring a very different mode of treatment.
has such a resemblance to Bronchocele, or goitre, that it has
been constantly confounded with the latter disease, and treated
accordingly. This valuable memoir was read to the Royal In-
stitute of France in 1815, and. as we are informed, subsequently
transferred to the Academy of Natural Sciences, by which body
the late celebrated Baron Percy was selected to report on its
merits. It was not, however, until April, 1817, that the Baron
presented his report, which proved highly unfavourable to Pro-
fessor Maunoir's opinions and practice. With the burthen of
this proscription, Professor M. did not rise to the publication of
his memoir for seven whole years ; at the end of which time he
did for the first time publish it, with the whole of the unfavour-
able report made thereon, nnd a most able and satisfactory de-

18 of the N* [7une'

juliar views on the subject. T3.it, (continues
O'Bi Lrne) it would appear that, as too often happens, the autho-
rity1 pf a greal same, aided by bold and specious objecti
proved more powerful than either the strongest i".

:is. as proven by the fact that nothing has been said about it
;'i Prance or England; and, even Delpech of the former, and
Lawrence of the hitter, have reported cases of this ven
which they have treated by incision, without making tin !^ast
allusion to the less dangerous and disfiguring treatment so
cessfully adopted by Professor M.

Since he was ac fidentally possessed of the essay " sur FTIy-
le du eou," O'Beirne lias been favoured with three stri
examples of the d all of which displayed the utter fall

of Baron Percy's objections, and which he proceeds to give.
follows :

Di<zg7Wss.^Accordii^toProfes8dr Maunoir, the disease has been often ob-
served withoul its true nature homo; known; as may be seen in treatises on
urs, and from one detailed by TIcisfer, and .three cases ''.noted bv Plou-
ciuet. He declares also, that all the cases of it which he b's seeD, had
been confounded with and treated as goitre, by numerous members of the
profession. The disease eonsists in the formation of serous cysts, commen-
cing very small at some point of the side of the neck, and gradually increasing
vcral years, to such a size as to occupy the whole, of the front and of one
side, of the neck, and seriously to impede respiration, deglutition and speech.

The tumour so formed conveys to the touch a distinct sense o fhu tu i-
tion, and contains a fluid of either a limpish, a reddish? or a dark coffee
colour, and coagulable by lieat. In the great majority' of instances, ;* exists
independently o'f'any enlargement of the thyroid gland: and in bis fourth

. it was situated behind the an^le of the lower jaw, and of course, >
removed from this gland. But he lias, in two instances, observed the con-
trary; and the second of bis cases, in which the gland enlarged and indurated
formed one-eighth of the whole tumour, is an example of this complication.

Treatment. With respect to the treatment of this/ disease, the learned
Professor's opinions and practice are these : "Although," he says, "there may
be great affinity between encysted tumours in the neck, and hydroc le i
tunica v iginalis, yet it appears to me that, in hydrocele of the neck, the cyst
is more dense, and morcdifficultto.be excited to aabesive inflammal
Accordingly its treatment should not be directed by analogy, and it is i ot
proper to have recourse to the euro by injection, although it seems, at a first
view, to be the best. I wished to try it, and have been obliged to renoi
it as a bad plan, and not one free from danger. An injection, which is not

. stimulating, will effect nothing, or almost nothing, on a very thick, and
m general, an old cyst. If a very active inj< ctfon be employed, it wilKcause
greal pain, andgive rise-to very alarming spasmodic symptoms. Moreover
I have to observe, thai Bometimes enlargement of the thyroid gland compli-
cates the treatment. In that case, the object is not merely to produ< e a l-
hesion of the walls of the sac ; if will be necessary to employ a mode of cure
by which we may succeed al the same time in resolving this glaj d, w ben it
projects 'into the tumour, as 1 have soon in two patients." A- to I ying
open the tumour bv incisions, as practised by Heister, or extirpation of the

'- orofoidv a part ol the cyst, he condi inns these op< rations as being
serioi I calculated to prolong producing a large

oiii! d, and one of a kind very slow in cicatrizing. In short, the treatment

1830.] Hydrocele of the Neck. 49

which. he lias been led to adopt and recommend consists in puncturing the
tumour, an<!, after e\ acuating fta contents, passing a seton through it in tho

direction of its longest diameter. By this plan a fresh accumulation of fluid
is prevented, the adhesion of the walls of the cyst, is insured, and the thy-
roid gland when it happens to be enlarged, is gradually reduced to its
natural size.

!l relates three cases, all of which are so generally interesting, that I
Bhall her6 give them in a comparatively abridged form.

i. A washer-woman named .Martin, aged 49, still menstruating,
with a spherical tumour on the front and left side of the neck, as large as
an infant's head, presented the first example of the disease that the Pro-
>i had seep, read, or heard of. Originally this tumour had been very
small, but increased in quite an insensible manner. It did not force the
head to incline to the left, but to the right side, and formed a sort of cush-
ion for her head to rest upon. She had taken burnt sponge, and many
other boasted remedies for .goitre, but without any benefit. Difficulty of
breathing and swallowing came on, and increased in proportion to the
growth of the tumour. One day, while washing at the river side, she
threw up a very great quantity of blood, fainted, and was supposed for some
moments to be dead. The haemoptysis and oppression continuing, and the
swelling being felt to contain a fluid, a trochar was passed into the most
prominent and fluctuating part of the tumour, and gave exit to a pint and a
half of a deep brown liquid, which coagulated by the application of heat.
Complete relief ensued. On the following day, the swelling had returned
to its former size, but fluctuation was less manifest, for infiltration had taken
place between the tumour and the skin.

At the end of fifteen days this infiltration had disappeared, and Vie cyst
was punctured by a trochar, and after being emptied, filled with warm red
wine and a small portion of alcohol. This injection, although retamed but
for a few moments, caused great pain and suffering. Swelling, redness,
trismus, and increasing pain, on the following day : leeches, poultices, ape-
rient medicines, and opium, ordered. -An abscess, external to the cyst,
opened and treated in the ordinary way, untd it healed. A third puncture
made in the upper part of the cyst by a sharp-pointed bistoury, and giving
exit to as considerable a quantity of fluid as at the second. A button-
pointed probe was then introduced into the -opening, and passed until it be-
came prominent at the most inferior part of the tumour ; the point of the
probe then cut upon, and the instrument withdrawn, leaving in its place a
single thread. This thread frequently renevyed : no accumulation of fluid.
A seton of ravelled linen passed, and caused abundant suppuration. This
seton continued for six weeks, and then removed by the patient, on account
of interfering with her ordinary occupations. Both openings iistulous for
some months ; the upper first closed ; and in the year 1813, when she was
G3 years of age, her neck was very slender, and her health robust.

Case II. Monsieur C, of Vevay, aged 40, had for many yeais a tumour
situated on the front and right side of the neck. This tumour extended
from the chin and lower jaw to the sternum and clavicle : and in the greater
part of its extent, there was a manifest sense of fluctuation, but points
corresponding to the thyroid gland appeared to be hard and prominent.
The swelling increased daily, became fatiguing from its weight, and ulti-
mately caused difficulty of respiration and speech, and occasionally attacks
m which he seemed to be on the point of expiring. A puncture made into
the upper and left portion of the tunlour, and a pint of limpid, amber-co-
loured, and perfectly inodorous fluid evacuated. This evacuation reduced
the tumour to one-eighth of its size, the remaining portion being formed by
the thyroid gland in an enlarged and indurated state. A blunt probe now
Introduced into the opening in the sac, and carried down to the inferior and
anterior portions of the tumour; the point of the probe cut upon, and a sin-
gle thread passed, in the usual way, as a seton. Great freedom of rc-sni,
7

tfO Hydrocele of the Netk. [June-

ration and in moving: the head, instantly followed the complete evacua
of the tumour. Next day, a fresh accumulation of fluid, but much let
quantity, and of a fetid, Banious kind; some fever; stomach deran.
Hyppo," followed by infusion of bark, and Spa and Seltzer Waters emplo
and restored the patient to Ins ordinary cairn state. Pieces of line;] gr
ally increased in size, and smeared with simple digestive ointment, introdu-
ced as setons ; injections of plain and hydrcsulpkurated water, and decoc-
tion of bark, with honey thrown into the sac.

Discharge less in quantity, and more purulent : the extent of the cavity
greatly contracted ; and the thyroid gland diminished in size. In a f. v.
months the patient's health was completely restored, ana his neck became-
of its natural size.

Case III. Mademoiselle T. D. aged 20, having for many years a large
tumour on the front, and a little to the right side of the neck, had been
subjected to all the known modes of treating goitre. This tumour was of
enormous size, and consisted in a great degree of fluid. The least move-
ment brought on cough, and attacks of suffocation. Her parents and friends
refused to permit a seton to be passed, but a puncture with a trochar was
made in the most depending part, and a cupful 6f fluid, resembling infusion
of coffee, was drawn off. The canula was then withdrawn, with a view of
retaining the rest of the fluid, and enabling a second puncture to be made
and a scton to be passed. The tumour was very little diminished ; the
wound was then covered with adhesive plaster, and a roller applied with
moderate firmness. After passing some hours in a very quiet state, she
indulged too freely at dinner, and in the evening felt oppressed in her breath-
ing, and the tumour became quite black. It was evident, in fact, that the
contents of the sac had passed into the subcutaneous cellular membrane.
She passed the night badly, and could scarcely swallow a few drops of an
anodyne draught. In the morning great difficulty of respiration, and total
incapability of swallowing; the part? surrounding "the tumour so swelled that
the neck was raised to the level of the chin and lower jaw, with which if
seemed to form one continued pillar. The. whole of the upper part of the
thorax was also infiltrated, and the alteration of the voice and dyspnoea
were such as to lead to the belief that the effervesced- fluid had penetrated
into the internal cellular tissue of the trachea.- In the course of the di \.
however, all these symptoms gradually diminished in severity, and the
swelling was considerably reduecd towards evening. She passed a good
night, and on the following morning deglutition and respiration were free.
On the fourth day from the operation, the original tumour was diminisl d
by one half, the infiltration and black colour of the skin had disappeared,
and the patient was in excellent health.

On the 90th of January, 1812, that is, after about six weeks had elapsed,
the tumour was as large and as distressing as ever. A hydrocele trochar.
with a flat elastic canula, was passed into its most depending part, and two
pints of a dark brown fluid, coagulable by heat, wit.1 oil charged. On
emptying the tumour, the thyroid gland was found moderately enlarged. A
blunt probe, armed With a single thread, introduced through the canula,
made prominent at the upper part of the cyst, and there cut upon uu'
could be withdrawn, and the thread left as a seton. For some days nervous
symptoms appeared. The two little incisions contracted so much, that the
thread could not be moved backwards and forwards but wilhgreat difficulty,
and such as to create a suspicion of its being lodged in the tissues of the
walls of the cvst, which it had cut in gliding, and of haying thus lefl the
cavity of the tumour. The silk thread withdrawn, at the instance of her
parents, and in order thai a fresh accumulation might perrail a puncti r a
be made by a bistoury, (instead of the trochar which had been found bo i!J-
siuted,) and enable a COtton wick to he passed as a seton. The tumour

soon regained In former size, and the oppression returned. The necessity
Qf this operation repeatedly urged, but as often delayed from some frivolous

IS3G. ] Hydrocele, of tht Neck. g

xt. The Professor sent for in great liaste, on the 16th of April, 1812.
and found her with complete loss of sense and motion, slow and stertorious
breathing, cold extremities, dilated pupils, and no pulse. iNo person being at
hand to aesisl in the proposed operation, the tumour was punctured by a
hydrocele trochar, and a pint of dark brown fluid discharged: Immediately
pulse, respiration, and in short, animation were restored ; but permission to
- a seton could net be obtained. On the 7th of May, the size of the' tu-
mour required that it should be again punctured. On the 24th of June, she
complained of violent pains in the head, great suffering and oppression.
Another puncture made in the swelling, and a quantity of fluid mixed, with
purulent matter, discharged. 25th, pains returned ; astringent applications;
increased enlargement of the neck ; distress and oppression alarming. Six
leeches applied, and the patient well purged. with castor oil, without any
relief. 27th, tumour punctured, and a less quantity of fluid, but more mix-
ed with pros, discharged. 21st of July, symptoms severe, and increasing so
much in violence, as to require another puncture, which was rendered diffi-
cult by the thickness which the infiltrated cellular membrane had acquired,
ami, consequently the increased depth at which the cyst was placed. A

-hread. and, subsequently, a large seton inserted; abundant fetid sup-
puration ; gradual contraction of the sac ; an abscess formed and opened at
the inferior and laternal part of the neck ; a fistulous opening for some
months at this point, and at length healed by an injection of a weak solution
of sulphate of copper. Seton removed ; tumour completely dispersed ; and
recovery perfcci in all respects. Dublin Journal of Medical and Chemical'

5^ On Caiicrr. [June

Past, hi. monthly periscope.

Cancer. Professor Benedict states that during a certain pe-
riod, the operation for cancer (not including cancer of the lip,)
was performed at the Clinique thirty-seven times ; and that,
with the exception of one or two cases treated by arsenic, a
radical cure was not obtained in a single case.

Extirpation of the breast was performed three times, and un-
der circumstances apparently very favourable; in all of which
the disease returned again. Of ninety-eight amputations of the
breast, which he has performed since he undertook the charge
of the Clinique, two ended fatally, from exhaustion during the
healing of the wound; and in all the rest, with the exception of
thirteen, the disease returned after the wound was healed, and
terminated in death. With regard to the remaining thirteen,
he observes he is morally convinced that, in several cases, an
error in diagnosis was committed, and breasts were removed
that were 'merely affected with scrofulous tumours, sarcoma, or
some other innocent change of structure.

On this statement, the editor of the Lancet observes : " The
above results are worthy of serious attention, and serve, unfor-
tunately, to confirm the opinion advanced by many surgeons.
that in most cases cancer is a constitutional, not a local dis-
ease." Amer. Jour. Feb. 183G, p. 513.

We give the above extract, not by way of recommending the
intelligence it contains, but of staying, if possible, its injurious
tendencies. We had thought that it was plain to all surgeons
by this time, that there were two grand errors in the practice
of surgery in this disease ; 1st. A want of early diagnosis.
2d. 1 rocrastination of the operation to too late a period the
latter arising sometimes from the former ; but most commonly
from tve patient's objections to the operation, or the surgeon
having been called in too advanced a stage or the disease.

Our experience in the treatment of this disease has certainly
not been great ; but still, small as it may have been, it leaves us
in far better hope of benefit from the knife than the above state-
ment would seem to justify, We have not kept a record of
ca^rs, but will give the last four. Of these, two cases, as well
characterized for the state of their advancement as those which
ordinarily bid defiance to the knife, wen; amputated. The
wounds healed kindly by adhesion, without any exhausting dis-
charge or irritation. The Women remained well. In the third,
the well marked scirrhus was so small and distinct that we could
not. resist the temptation to extirpate ii : a practice so long and
so justly condemned by the most judicious. This was done,
with the removal of a considerable portion of the adjoining sub-

IS.'**;.] On Cm

stance, making in all three to four oz. in weight"; an3 a
Btance whose whole diameter was not less than double that of
the scirrhus. The wound healed within few days. A few
months alter, however, the disease returned in the same place
With rapidly exasperating symptoms. A distinct scirrhus tume-
faction soon presented itself, larger than the whole substance
before extirpated : manifi sting the extension of its influence to-
wards that part of the breast nearest the axilla. Entire ampu-
tation of the whole glandular portion of the breast, with all the
adipose substance before the pectoral muscles, was now adopted
the incision extending to the glands and lymphatics between
the mammre and the axilla, whereby these were removed.
This wound was found well on removing the dressing on the
tilth day, and the patient has to this day, (now thirteen years,)
had no return &f symptoms. The fourth case was one in an old
lady, who had been watching its progress for ten or eleven
years. Its developement, although it had been slow, had now
arrived so near the state of ulceration that the nipple and a lit-
tle of the adjoining part dropped off during the operation. It
was, howrever, amputated very entirely, and the wound dressed
for adhesion. A consecutive haemorrhage coming on, caused
the wound to be re-opened for staunching the haemorrhage.
This delaved the cure to about the thirteenth day, by which time
it was so wrell that she was discharged to go home, about ninety
miles. About six or eight months after this operation, I recei-
ved a letter from the husband of the patient, stating that her
health was every way greatly improved that there had been
no threatenings of return of the disease, but that she had been
extremely well, had thriven finely, and that, in short, her health
was every' way better than it had been in twelve years. Be-
fore two years had elapsed, however, this patient's health be-
came impaired, manifesting, as her attendants said, a general
cancerous diathesis, of which she died after some months.

This experience, we say, leaves us in better hopes from sur-
gery in these cases. And we are compelled to believe that
there has been something, nay, much of the common errors to
wdiich we have before alluded, in the practice, the ill success of
which has been given us by Professor Benedict.

We are not of those who are willing to allow an English or
a Continental surgeon to doom a practice, because he may have
been unfortunate in not making early diagnosis, or in not per-
forming his operations with that science and thoroughness he
should have done. And more especially are we so, when we
know of very many practitioners throughout our Southern
country, and freely venture the opinion that there arc many
hundreds in these lTnitcd States, whose practice, if faithfully
detailed, will prove these points : that the amputation of the
cancerous breast, (not the extirpation of the scirrhus tumour,)

N Morbid Adhesion of the Placenta. [June.

will, if performed before a certain advanced and extended stage
of the disease, generally, if not always, prove finally curative;
and that when advanced to, or near the ulcerated state, espe-
cially if its progress has been slow, and after the close of men-
struation, the oi^ease will very generally return in the same, or
some other part; or a general impairment of health supervene,
l'or which the science affords no hope.

We are aware that there have been, and still are many
breast cullers, who occasionally find glorious opportunities of
mounting surgical stilts by cutting off and curing as cancerous,
a breast which has suffered a contusion by corsets, or a tedious
obstruction of the milk tubes.

Some such cases we have had the ill fortune to oppose in
consultation, but too often unsuccessfully. These misfortunes
are, however, the faults of ignorance or empiricism, and not of
science. We have long been of opinion that in several of the
important points of surgery, as well as practice, there is in the
United States at least a practical superiority over the transat-
lantic. We know this to be the fact in some places in the South
as well as North. And we should be pleased to sec the results
of Dr. Physic's practice on the point under consideration laid
beside the practice at the Clinique.

Morbid Adhesion of the Placenta.' In the American Jour*
nal for Feb. 1830, we find a case of morbid adhesion of the pla-
centa, as reported in the London Medical Quarter! v Review for
July, by Dr. Litchfield.

Mary Farrell, set. 32, was attended m her first confinement in
March, 1835. by Mr. Barry, of Brunswick Square. Labour
lingering pains light, and after long intervals. Sixteen hours
after the commencement of labour, the accoucheur administered
half a dracm of powdered Ergot, and repeated the dose every
two hours. At the expiration of twenty-four hours, a dead child
was expelled, and the uterus contracted forcibly around the
placenta, so as to baffle the frequent attempts of the accoucheur
to remove it. Eighteen hours after delivery, Dr. Litchfield
saw her in consultation. The uterus was found high up beneath
the abdominal parietes, and contracted at its fundus into a hard,
irregular tumour. The external parts were swollen and pain-
ful, arid the os uteri so rigid and unyielding as to resist the perse-
vering efforts of the hand to dilate it. Pulse full, hard, and 95.
Tongue furred and feverish : the face flushed, and severe pain in
the head.

Depletion, and small, repeated doses of tartarized antimony,
with fomentations of flannel to the pudendum, were prescribed.
Under this treatment the violence of the symptoms subsided, and

I830.J Morbid Adhesion of the Placenta. .".">

fresh, long continued, but unsuccessful attempts we
made to dilate the os uteri, and deliver the placenta: Bein
opinion that it would be impossible in the present state of the
parts to reach and overcome the adhesion, and having no fear of
immediate haemorrhage, it was resolved to wait, and watch
closely both the local and constitutional symptoms, abstain
for the present from farther manual interference.

Thus continued the case, the patient remaining in a wry satis-
factory state, until the fourth day, when the discharge, which had
set in as usual, became very copious, offensive, and of a greenish
colour. Chloride of soda was used for the correction of the
offensive odour, and the patient went on without unfavourable
symptoms till the eighth day, when a portion of the placenta,
equal to 1-3 of its usual weight, was thrown off in a putrid state.
From this time, small portions continued to oe detached at in-
tervals, until the twenty-first day, by which time all the placen-
tal structure was thrown off.

The progress of the case was unattended with pain or Iue-
morrhag;* ; the patient improved rapidly, during the time, in

its, strength, and appetite ; and at the end of one month
from delivery, menstruated in a regular way. Strong ligamen-
to is bands were found in the placental mass.

We consider this case as one of no trivial -importance. And
whilst we regard it as a faithful relation of lacts, we feel it a
duty to guard young practitioners, (and we may say some old
ones too,) against the danger of adopting a practice already too
common, and to the increase of which this case is calculated to
contribute we mean that of leaving placental delivery to na-
ture, from an undue confidence, not only in the efficiency, of un-
assisted nature, but in the safety to the mother with which the
placenta may be allowed to remain and putrify within the uterus.

It should be remembered, that a putrid foetus seldom fails to
manifest by various symptoms its deleterious effects on the vi-
tal energies of the mother ; and that the injurious influence of
the putrid placenta is still more manifest and certain.

It should be borne in mind also, that the decision of the con-
sultation in this case, of leaving to nature the final deliverance,
was not, by any means a matter of election ; but was really the
absolute and unavoidable necessity of the case. It was done,
and prudently too, because there could be no alternative but
what would be fraught with still greater danger. The case
truly resulted most happily. To adopt this plan however, in
our practice, whilst it might suit the partial theorisings of the
expectant practitioner, so well calculated to let patients die,
would, we apprehend comport but ill with the duties and ob-
ligations of the truly rational, which rank much higher than
mere passive expectation. These surely demand not only a
knowledge of the structure and functional arrangements ''the

Morbid A i of the Placenta. [June,

animal organization and the vital energies, both physiologica \
and pathologically considered; but also of the powers oj the
various resources, whether medical, instrumental, or manual,
which are at his command for assisting inefficient nature in Lh i
removal of noxious causes, and the correction of their effects.
To fold one's arms then, and rest in confidence, that unassis i d
nature will accomplish every good, would be, in main of these

es, but to leave the patient to die. Whilst, therefore
practitioner is bound not to administer mortal powers, he is no
less bound not to withliold anything which may contribute to the
well being of the patient : for there is little difference to the in-
terest and feelings of his employers, whether he kills, or allows
death to supervene for want of those administrations, which
were at his command. It is not enough for the practitioners to
have done what he chanced to think best by his partial reason-
ings, and speculative views- he is bound to do ad that die sci-
ence of medicine can afford for the welfare of his patient.

Whilst therefore, we acknowledge most candidly our great
obligation to Dr. Litchfield, for having reported the case, and
express our desire,, that all similar cases may be made public,
still we would only look on them as messengers of hope from
afar, which may serve to cheer us when we arc brought to bow
under our impotence, and humiliation, and witness the final
failure of our physical resources : and as calculated to shed a
ray of hope and comfort on her wdio is otherwise overwhelmed
with weakness, misery and despair.

It is stated that during the latter months of pregnancy, the
patient suffered fixed pains in the womb, arising, as she suppose d,
from a blow on the abdomen. It seemed probable to Dr. Litch-
field, that under these circumstances, the vessels of the uterus,
being stimulated to undue action, had thrown out coagulated
lymph, whereby fchc placental and uterine surfaces had become
morbidly united.

We believe Dr. Litchfield accounts correctly for the undue
attachment of the placenta: and are able to give a case of very
recent occurrence in corroboration, so far as relates to this
pathological point;

Lasl February we had the management of a case of very
protracted premature labour. The presentation when made,
was abdominal. Turning was of course effected as soon as
the band could be passed, and an eight month child delivered.
( )n finding the placenta not detached, the patient being much
fatigued and having no pains after delivery, was allowed to

about two hoars.

I't. rine contractions were then promoted by friction with the
hand, but no separation was effected. Alter occasional efforts,
for several hours, in the ordinary ways for deliverance, without
any encouragement, the hand was passed to the placenta, which

IQ'A Raid's Independent Spring Trt&s. f//

ild not then be detached in less than two hours, v.iih all the
effort pruden would affow. On inspection when delivered, a
rable portion of the uterine face of the placenta present-
ed an unusually d< rise, ev .1 and whitish appearance, which in-
duced me to believe that adhesive mnammation had existed.
This woman had, by a ride on the rail-rosR to Charleston, or
so, ne accid nt attending the trip, brought oua flooding, which,
though very considerable, and causing some days illness, was
not followed by abortion, hhe recovered, and returned home ;
after which she was occasionally troubled with irritations of the
uterus, from depression, which continued to increase until the
gravid uterus was placed high in the abdomen, and the patient
confined to bed for several days. In one instance, free vene-
section at the arm was necessary, on account of the inflamma-
tion of the uterus from this cause. Indeed the present prema-
ture delivery was brought 011 by a neglected return of the same
circumstances.

Do not these facts afford ground to suspect at least, that the
circumstance of adherent placenta is generally attributable to
inflammatory action some way produced ? And should it not
serve to direct the attention of the practitioner more particularly
to that state so often produced in the posterior region of the
uterus by even slight degrees of prolapsus in pregnancy ?

Reid's Independent Spring Truss. This is a truss invented
by our townsman, Rev. Henry Reid, and is truly what its name
imports an independent spring truss. It needs neither buckle,
button nor strap for its accurate and effectual retention in place.
It is retained solely by a spring power, and is alike applicable
to Hernia) on either or each side, by having a block at one end
and a cushion at the other ; or a block at both. A block simi-
lar to Stagner's is adopted, but altered to suit the peculiarities
of cases. The pressure is made by a well tempered spring,
which passes from one groin, behind the pelvis and to the oppo-
site side the metal being left untempered near the block, in
order to make, by binding it at pleasure, any little change in its
direction which the case may require. The whole metallic part
is covered with a strip of flannel, and is so shaped as to lie in
contact with the skin, making no sensible pressure but on the
hernial openings. We have witnessed its application in a va-
riety of cases, and are pleased with its neatness, simplicity, and
efficacy in the power of retention; and we have no reason to
doubt but that, whatever curative powers may attach to Stag-
ner's or Chase's blocks, will also be found with this. It has an
advantage over all other trusses in this, that as it needs no strap*

' I lull's has no strap, but has not the power of relcnUwH.

8

58 Dr. Praifs improved .Nipple Shield. [June.

to pass before the abdomen, it will be applicable to women in
parturition. This truss was subjected to the inspection of the
.Medical Society of this place, at a late session, and was referred
to a committee for testing its powers and reporting on it.
That committee reported iheir application of the ins'rument to
seven cases, in all of which its efficacy, neatness and conve-
nience were well demonstrated.

Dr. PratCs improved Nipple Shield. We have recently had
the pleasure of witnessing the effectual use of Dr. Pratt's latest
improvement of this valuable article; and have been delighted
with the ease and efficacy attending its application. Although
it would seem a trivial tiling, hcin^ nothing but a small metallic
cup, with the nipple of the heifer attached, still, when we reflect
on the great sufferings and injuries we have often witnessed in
consequence of the want of just such an article, we cannot bul
feci the greatest satisfaction in being able to recommend it most
freely to the notice of all those whose Office it is to prevent nnd
alleviate the sufferings of those for whose benefit it is intended.
However simple the instrument may appear on superficial ob-
servation, slill it is just what it should be. The metallic cup is
so constructed as to adhere wellr and at the same time, prevent
t' at drawing of the substance of the breast into it, as to obstruct
the milk ducts ; and the nipplo is so finely tanned and prepared
as not only to possess all the softness of velvet, or* of the best
buckskin, but is so well dissected and prepared as to be ca-
pable of being inverted for cleansing, and of collapsing so
effectually on suction, as to retain its place on the breast with-
out being held by the hand: We give below the report of the
Committee of the Medical Society of Augusta, to whom it was
referred.

"The committee to whom Dr. Pratt's improved nipple shk Id
wTas referred, take great pleasure in reporting, that they have
h( en able to demonstrate, in the most satisfactory manner, tin-
very complete adaptation of that instrument to its intended pur-

Your committee have been so fortunate as to sec its applica-
tion to a breasl in which, from great previous inflammation, the
milk vessels about the nipple were contracted, and consequently
always disposing to serious obstructions. All other means of
drawing the breast had been repeatedly used in the ease, with
n<> fetter effects than these <.f drawing so much of the breast
into the Opening of the instrument as entirely to obstruct, the
passage of milk ; and affording pain in various degrees. The
peculiar shape of tic m< Gallic portion of Dr. rratfs instrument
completely prevented both these difficulties; and at the same

L83&.J Mr. flfiddlemore's Repbrt. ;o

time, with all practical force in drawing, presented the lender
nipple from touching the metallic cap withitt. The valuable
quality of remaining adherent with) Lit being held on by the
hand, or when the suction was discontinued, was also fully de-
monstrated.

In conclusion, your committee arc truly happy in feeling as-
red that in the instrument invented by Dr. Pratt, the commu-
nity is presented with the means of both obviating, and removing
when present, all that incalculable sum of misery which women
have been accustomed to bear for a length of time, in conse-
quence of sore nipples ; and even of preserving the lives of many
infants. Who, in consequence of diseased breasts, and the want
of nipples, are turned over to hand-nursing a prolific source of
disease and death; for this instrument supplies the place of the
'natural nipple most admirably and perfectly."

Mr. Middlemore, in his annual report of the Birmingham In-
'firm, ry for diseases of the eye, which we find in the Medico-
Cnirurgical Review for July, briefly describes his usual plan of
operating on children from one to three years old, for complete

i sjineta] cataract. He fully dilates the pupil by the use of a
strong solution of hyosciamus. The child's body is securely
enveloped in a napkin, with the arms fixed to the sides. The
child is placed upon a table of convenient height, with the head
slightly raiseo". The head is firmly fixed by an assistant press-
in his hands on either side of it. If the right eye, he raises the
upper eyelid, and fixes the ball by pressing the index finger
upon the temporal, and the middle finger upon the nasal side of
it. Thus prepared, he rapidly passes a very fine needle through
the cornea, near its junction with the schlcrotica, and simply la-
cerates the capsule by slightly moving its point a little back-
Is, and to either side.

He directs the needle to be very fine and slender, sharp at
the point, a little flattened towards the point, having a cutting
edge on either side for a short distance from the point ; and gra-
dually becoming round towards the handle.

Mr. M. gives the following very rational description of this
mode of operating :

" The advantages of this mode of operating, arc neither few
nor unimportant.

In the first place, it is quite efficacious, and quite competent
to the removal of the disease, or, at least, only requires to be
performed a second time ; secondly, when properly performed,
:it involves no risk of injuring any important texture, except the
cornea ; thirdly, it gives r'se to scarcely any pain ; and fourthly,
it excites hardly an appreciable amount of inflammation."

09 Carcinoma of the Tongue. [Jkinc,

Having always had a great aversion to wounding the cornea,
wc have never operated through it, either for extracting, cr
causing absorption. But we have some reason b I r. M s.

experience, to believe in the superior claims of this particular
operation. In two or three oi' our last cases we have been
greatly perplexed with the severe and ungovernable inflamma-
tion which has superceded en redinatien b\ Scarpa's needle in
the common way, notwithstanding the inclination was easily
and effectually done, and the power of very distinct vision pro-
ved immediately after the operation. J hese operations were
effected with but Very inconsiderable pain. The subjects were
all old, but were as carefully prepared lor avoiding inflammation
as possible. The pupils in these cases were all dilated by the use
oi Belladonna, the long application of which was necessary to ef-
feel the purpose. The inflammation, however, in all of them, ran
high : and in one^asc, particularly, in which the ope ration appear-
ed to have succeeded very finely, and the patient had been pre-
pared under our own immediate attention, with great care, so
extreme was the inflammation for more than a month, thai when
it did subside, the power of vision was entirely destroyed ; aor
has it improved in the least, now ten months since the operation.

The pupil is perfectly clear, and the iris retains its natural
susceptibilities. Perhaps, too, the Hyosciamus may be a more
safe dilating power than the Belladonna*

In the same report, ?>Ir. Middlemorc earnestly entreats his
brethren to test the effects of Strychnia in Amourosis. With
those effects he is amply satisfied, and is a warm advocate of
(he value of this remedy. Yet he thinks it has been employed
in an indiscriminate manner, andhe feels convinced that all who
employ it with judgment and care, will form the same conclu-
sions of its qualities as he has done. Medical Cliintrgical /?-
\ for July, 1836, p. 254.

Carcinoma of the Tortgue, successfully treated with the Liga-
ture. In the American Intelligence contained in the American
Journal for February, we have an account of a case reported by
Dr. Donnellan, of Donaldsonville, Louisiana, of a large, ragged,
ill-conditioned ulcer of the tongue, \\ hich, :; >m its presenl charac-
ter and the history of the ease, he considered cancerous ; cured by
the ligature, as recommended and practiced by Sir Edward
Home, The ulcer occupied the righl anterior partofthe tongue
to a << extent, and was progressing very rapidly.

T*he subject w\ is very corpalenl woman, 25 years of age, and
m the 8th month of pregnancy; "when lie first saw hef: at which
4;tiic there was but a sued! ulcer on the party apparently of no
importance. On the 23d day alter, on being called to the case,

1 89&J GfoitreCure of by e i Hrpation. <: I

he found that the ulcer had made such fearful | . thai he

deemed it proper tOt operate, and risk its effects on her preg
in preference to allowing the ravages of the ^disease, even for the
short remnant of the gestation period.

A crooked needle armed with a strong ligature was passed
through the middle of the tongue* behind the ulcer. The liga-
ture was then cut at the needle, and one tightly drawn and. tied
en each side of the ulcer 5 thus cutting off the circulation from
the diseased portion which constituted a considerable sigment of
the right side and tip of the organ. The pain on tightening the
ligatures was very intense, which was soon relieved bv 00 drops
ofTr.Opii.

A few hours after the operation, a copious salivation super-
vened, which continued till the dropping off of the diseased part.
Five days after the operation 29th April, deep sloughs were
produced by the ligatures. On the 4th May, ten days after the
operation, a single ligature was applied in the fissures caused by
the old ones, so as to embrace the whole, which dropped off on
the 6th twelve days after the operation. On the 11th May,
the vacuity was found fast filling up with granulations, and .on
the 23d, was perfectly cicatrized the patient havinggiven birth,
some eight or ten days previous, to a fine healthy child. Her
articulation was but slightly impaired, and at the last observation
she continued in excellent health.

Goitre cure of by extirpation. Two cases of this disease
have been cured by Professor Graeefe, of Berlin, [n the first
case given, the tumour was of the -size of a goose's e^g, in the
middle and anterior part of the neck, which caused extreme dif-
ficulty in deglutition and respiration. These symptoms assured
the Professor that the tumour adhered closely to the larynx and
trachea, which fact he bore in mind during the operation. An
incision was made through the skin, commencing a finger's
breadth above the superior margin of the thyroid cartilage,
and extending down the median line, to the top of the eternum.
The subcutaneous ind sterno-mastoid muscles being then drawn
to the right and left, exposed the tumour, which presented a
shining aspect, The surrounding parts were detached with the
linger, and a bistoury, and some arteries were tied. The tumour
was nowr found to adhere closely to the larynx and trachea,
without the intervention of any cellular substance. The exci-
sion of the tumour was then performed with the greatest caution,
by small strokes of the knife; and the portion of it which adhe-
red to the air-tube was.not removed. Only eight arteries were
tied during the operation. The wound was tilled with lint, to
avoid adhesion, that the still adherent part of the tumour might be

(32 Reduction of Hernia, fy& Lithographic Plates. [June.

discharged by suppuration, which accordingly took place. The
lips of the' wound were afterwards closed, and placed in accurate
apposition, and the cure was complete at the end of six weeks.
In the second case, the tumour was much larger had ailiict^-
cd the woman from infancy, and was divided into three distinct
lobules. The immense size of this tumour prevented its entire
removal at one operation; it was, therefore determined to begin
with the middle lobe, which was the largest, and appeared to be
the nucleus of the morbid growth. The operation was conduct-
ed as in the preceding case, except that the tumour being attach-
ed to the larynx and pharynx only by loose cellular tissue, there
was no necessity for leaving any part of it adherent. The
wound was dressed for adhesion, and w7as cicatrized in six
weeks. The lateral lobes, instead of enlarging, as there was
reason to fear, diminished considerably, confirming the opinion
of EVi. Graeefe that the middle lobe formed the nuclus of the tu-
mour. Perhaps, also, the inflammation consequent on the ope-
ration, and the obliteration of the vessels that were tied, contri-
buted to the absorption of the remaining lobules. American
'Journal, from Ryan's London Medical and Surgical Journal.

Reduction of Hernia by the Air-Pump. Every efficient mea-
sure in surgery which is calculated to prevent resort to the
knife, we hail as an improvement of the first order. With Bell's
improvement in the operation for hernia, we are greatly deligh-
ted, because, severe, and dangerous as the bistoury sometimes
is, we had in it a most comfortable and composing hope, on
which we reclined in perfect case. But we rejoice to find in the
European Journals several reports since the year 1818 of the
successful application of the air-pump, for the reduction of stra-
mulated hernia, which had resisted all the practicable means be-
fore known except the operation, and when even this had been
determined on in the consultation of surgeons. In such cases
the exhausting pump has been applied over- the abdominal ring
with the effect of speedily and completely restoring the parts to
their natural portion.

A scries of twenty, folio, Lithographic plates, illustrating the
causes of displacement in the various fractures of the bones of
the extremities, has been recently published in London, by G.
W. Hind, M. II. C. S. Formerly House-surgeon to the Middle-
sex Hospital, late curator to the Museum of Anatomy in the
University of London.

The subject of this very meritorious scries of Lithographic
plates is, to exhibit, in a plain and striking manner, the causes

1836.] Pulsation of the heart of the Edtus. 63

pf displacement in .he various fractures of the bones of the ex-
tremities. The w^rk is appropriately dedicated to Sir Charles
Bell, vviiose pupil the author formerly was. Med. C/nryg. Iter.
Oct. p. 487.

The source, as well as the purpose, is a good one ; and as
Litpgraphs are now well and cheaply executed in the United
States, we hope it will not be long before Dr. Doane or some
other ' ntcrprising American will place this work in the hands
of American practitioners and pupils-

Pulsations of the heart of the Foetus. The Medico-Chirurgi-
cal Review for July, 1835, contains some observations on this
p iu in Physiology, by G. O. Fleming, M. D. of the Pancras
Jniirmary. Dr. F. feels authorized to consider Laenncc's and
Kir^aradec's double pulsations as erroneous ; because, in the
f. place, he listened to the foetal heart in Glasgow, and found
the number of beats to be 140, and pronounced them not double,
bat single beats ; and each two pulsations were one double beat
or pulsation. And in the second place, because he had an op-
portunity of counting the pulse in an infant just born, but which
had not breathed, and it was 70. The moment, however, at
which gasping and breathing took place, the pulse became
much quicker. It was irregular at first, but soon became 140
in a minute. He concludes, therefore, from these facts, that the
fcotal pulse is doubled immediately upon the perfect establish-
ment of respiration.

On this subject we are clearly of the opinion that Dr. F. has
mistaken the whole matter. We have often observed the fact
of the double beat as described by Kirgaradec, certainly less
loud, but not less distinct than the beat of the adult heart.
What we mean by double beat, is a pulsation of double the fre-
quency of that, of the mother. We have also often observed the
foetal pulse in that stage of semi- suspended animation which is
presented to our view on the decline of placental circulation,
and before the pulmonary route was well established. This wo
have found of various frequency, and in many instances, none
at all. for minutes. These, however, are only the temporary
effects of the change the circulation undergoes, and are generally
of short duration. For so soon as the new route is well esta-
blished, that frequency of pulse which is determined by the ex-
isting causes of frequency, is also re-established. We have seen
a foetus born at the end of the sixth month, in which the pulsa-
tion of the heart was not perceived at all until some time after
birth, and never became more frequent than 25 to the minute,
during the six hours of its life. Can this be considered as deter-
mining the frequency of its pulse whilst in utero 7 Certainly n^t.

04 Delirium Tremens, eye.

It docs appear to us that, setting aside all observation of facts,
by auscultation before birth, and feeling, after, no one can con-
template the foetal circulation, and find reason not to know that
the causes of frequency exist alike before as after birth, with
only this difference of circumstance, that the oxygenation is more
direct after than before. The size of the heart is the same, the
length of the circulating route shorter, and the delicacy of the
fibre and redundancy of irritability very much 1 he same as bef< >re.
These are, we apprehend, the chief causes which determine die
frequency;

Delirium Tremens. Dr. Cless, of Wurtemburg, professes to
have found Digitalis purpurea to be a specific in Delirium Tre-
mens. Ele\ en, out of thirteen cases in which he administered it,
recovered ; tlie other two relapsed. A table spoonful of a
strong infusion was given every two hours. American Journal.

Extradrdinary case of Childbirth in old age. Tn the Boston
Medical and Surgical Journal for April, 1836. we have the report
(dated, Whitehall, N. Y. 23d. Feb. 1836.) of a case of pregnancy
occuring in ihe person of Ann Cook, aged 64 or 65 years. She
had not menstruated for the last fifteen years, and her la<st child
was twenty-six years old. She was delivered of a female infant
the week before the 23d. of February, 1836, and both mother and
child are now doing well. Her husband is 63 years of age.

Aloes in Amenorrhea. Dr. Schonlein, late Professor of Me-
dicine at Wursburg, is of opinion that an injection of Aloes, (ten
grains in a small quantity of warm water,) thrown up the
rectum at the time when the menses ougjfl to make their appear-
ance, is more certain in its effect than any other emmenagoguc.
American Journal.

SOUTHERN MEDICAL

AND

SURGICAL JOURNAL

Vol. L] JULY, 1836. [No. 2.

ARTICLE I.

Observations on Ergot. By M. Antony, M. D., Professor of
Obstetrics, &c. in the Medical College of Georgia.

It is not a little strange that, in the republic of Medicine,
where demonstration is at the head of all evidence and authority,
there should exist such a contrariety of opinion on a practi-
cal point, as is manifested amongst physicians at the present day,
relative to the employment of Ergot. It is nevertheless the fact
that both its utility and safety have been, and still are, much
controverted, not only amongst practitioners generally, but in
some of the public Journals.

By scrutinizing the facts connected with its ordinary use, we
shall, however, find many other reasons than the actual demerit
of this article, why such difference of opinion should exist.

On commencing an enquiry into this subject, it is but right to
premise that when we speak of an article of the materia medica,
we mean a good one; and when of its effects, we relate to its
judicious administration under proper circumstances and, cor-
rect observation of its own effects when produced. No article
should therefore be allowed to suffer in character from the inef-
ficiency, or the ill effects of an impure, or adulterated prepara-
tion ; Or the injudicious prescription or improper administration
of a good specimen, or the partial or superficial observations of
very limited experience. I will name such of those reasons
above referred to as have come under my observation.

1. Pharmacy has not,, done enough for Ergot. This article
has, in consequence of the high price at which it was first sold.

6'tf Observations on Ergot. [July*

and without regard to the selection of that which wras good, or
the best means of preserving it from the changes to which it is,
on exposure in its natural state, so subject, been ushered into
commerce, and distributed to apothecaries and physicians in the
rude and careless manner in which it came from the granary
or the field. In order to shew the proper effects of the article,
much acquaintance with it is necessary, and great care should
be used in selecting it of a good quality. But without these,
he article is commonly ordered by name, and used.

2. The various preparations made for administration, such as
tincture, powder, chewing the grains and swallowing the saliva,
infusion, decoction, &c. all of which do not alike secure the de-
sired operation. To this paragraph I may add, the great vari-
ety of the quantity given, and the plan of administering it at a
single dose, instead of repeating to effect, &c. &c.

3. Idiosyncrasy. The stomachs of some women will never
retain it under any circumstances, and the nervous systems of
others alike forbid its use. These cases are rare.

4. Excessive exhaustion of the contractile energies of the
uterus, either permanently, or for a time,

5. The presence of insuperable mechanical resistance to the
passage of the child ; as locked head lodgment of the sagittal
suture of the lenea-ilio-pectinea a tonic spasm of the os uteri
scirrhosity of the cervex or os uteri, &c. Also, any mal-
position of the foetus or foetuses which may render the advance-
ment impossible, without manual or instrumental aid.

6. I may name as one, not very uncommon, the too long re-
tention of the liquor amnii, whereby the contractile energies of
the uterus are exhausted ; and by the timely discharge of which
these energies are often so recuperated as to give rise to pain,
without farther assistance ; but when the exhaustion is too
great for this, their discharge will often enable Ergot to act,
when it could not, during their retention. This is done by that
recuperation of passive power in the uterus by rest, which was
before too far exhausted by over distention.

7. Too great exhaustion from previous haemorrhage, as is
often the case when the placenta is attached to the os uteri.
In the early haemorrhages from this cause, it has been often
found to stop the flowing of blood ; but after great losses are
sustained, its powers are less available.

?836.j Observations on Efgot. 67

8. Limited experience ; or partial, careless observation on the
experience.

9. The cause of the slowness of the labour in which it is
grveiii Labours arc, cet. par. generally rendered more tardy
by the previous death of the foetus.*

10. The foregoing character and circumstances of the la-
bour ; as the too long resting of the head in the bones, or pressure
of the umbilical cord, &c. so as, in either case, to kill the child;
and the previous death of the child from any cause.

It appears only necessary to direct attention for a moment
to these circumstances, which every extensive practitioner must
have had frequent opportunities of witnessing, to perceive at
once how it is, that in some of them the power must often
Fail to produce its peculiar effects ; and how, in many cases, it
also occurs, that the child is still-born. Judging, therefore, from
the very nature and frequency of these circumstances, and the
reports and opinions of practitioners, together with my own
observation, I am led to the conclusion that most practitioners
prescribe the article only, or chiefly under some of those cir-
cumstances which contra-indicate its efficiency, and its success
in saving the child ; or, at least, in cases which, in their very
nature, render these ends physically impossible.

Another cause of the death of the foetus, which has been
attributed to Ergot, and which should not be passed over in
this brief notice, is the very common, and indeed fashionable
neglect of that manual assistance which is often abundantly
necessary for preparing the passage and removing its resist-
ances ; and that judicious selection of position for the woman
most calculated to expedite the passage of the foetus through
the second stage of labour.

Jalap as a cathartic, and Tartar Emetic as an emetic power,
are not, in my hands, more true to their several purposes than
is Ergot in the increase, or production of parturient effort, or
expuhory action of the uterus. After much observation on the
use of this article, I have fixed on administration in the form of
decoction. Always giving it in divided doses, I am not very par-
ticular as to the precise strength of the decoction ; which, how-
ever, I vary according to the circumstances of the particular

* This, and the next paragraph, are applicable t<? the charge against the
safety of Ergot.

68 Observations on Ergot. [July,

case repeating or enlarging the dose by my judgment at the
moment of giving each. This is, however, the strength at which 1
aim, without being particular to weigh the Ergot every time.
$ Ergot 3ij
Water Oj, put into a suitable vessel, cover and boil
four or five minutes. Dose 5 ss to siss every fifteen or twenty
minutes, increasing as need may be. When the stomach seems
disposed to reject the dose, I find it proper to reduce the propor-
tion of water to one half, and the quantity of decoction given at
each dose accordingly.

Under proper circumstances, after the administration of the
first or second dose, the whole extent of the uterus will be found;
to harden and assume its own globular form and prominence, in-
stead of the shape of the fcetus within. The membranes too, if
not previously ruptured, now become more tense ; and if they
have been ruptured, the presenting part of the child will be
borne forward with -more steady pressure. Soon after this,
distinct, but short pains come on. These gradually lengthen
until they nearly or entirely fill the space which ordinarily in-
tervenes in short, the last, long, effectual expulsory effort is
produced, and the child is born. These, I say, are the common
characters of its effects ; but sometimes, one, two, or three ex-
pulsory efforts are very promptly produced, and the second
stage of labour is completed.

This treatment, and these observations, are applicable to
those cases of labour in which the whole powers of Ergot are
needed. But my use of it is not by any means limited to such
cases. I prescribe it in almost all cases wherein there is less
promptness and energy of uterine contraction than is desirable ;
merely for bringing the efficiency of action up to that of ordi-
nary, natural, and prompt cases.

Excessive haemorrhage after delivery is a most fruitful source
of distress, alarm, and, with many, even of danger. In cases
where I have reason to apprehend this, (and which may be
often foreknown,) and in which depiction is not indicated, I ad-
minister Ergot in due time to secure its prompt effect, about,
the close of the second stage of labour, with the best effects.

In many cases there is a distressing hcad-ach, (differing es-
sentially, however, from that state of head and general system
which threatens puerperal convulsions.) and which seems to

1836.1 Observations on Er+ot. 61)

take the place of uterine contractions ; and the regular form
of labour pains is not marked at all. In these cases I have often
succeeded in so invigorating the uterine action, as to relieve the
distresses of the head, and secure prompt, regular, and efficient
parturient effort.

In cases wherein such a disproportion exists between the
foetal cranium and maternal pelvis, that the former must be
elongated considerably by uterine effort, or an appeal to instru-
ments become necessary for the accomplishment of the second
stage of labour, I often resort to the use of Ergot for the purpose
ot securing the little additional power necessary for this effect,
with tar iess danger than to instrumental delivery.

In ail oi" these cases, (which I only mention here to shew the
manageableness and utility of Ergot,) and many more which I
might name, I use the Ergot with the greatest confidence, ari-
sing out of perpetual demonstraiions of its safety and its utility.

The most prompt and regular effects which I have ever deri-
ved from Ergot, were from the use of that preparation which
wras first vended by the northern druggists about twenty years
ago, in the form of a fine dry powder, well secured in small
bottles of two or three drachms. Less of that was found ade-
quate than of the best which we now receive. This prepara-
tion is no more to be had of our Druggists ; and I now select
from the latest supplies, those grains which are dry and hard, and
free from rot, worms, mould, and very strong urinous odour;
and which, on being broken, exhibit a white amylous fracture.
The preservation, whilst fresh, in small close bottles, is so supe-
rior, that it never should be allowed to be found in commerce
in any other form ; and it is earnestly hoped that the College of
Pharmacy will take the subject into consideration. Attention to
this alone would cause Great benefit to be derived from its use in
thousands of cases which now suffer unnecessary misery, injur}'.
or death, from want of its valuable effects.

This powder I also used in decoction, but in much less quan-
tity than I now use the article.

So fully satisfied am I of its not injuring the child, (and this
assurance is not from abstract reasoning, but the facts of obser-
vation,) that in cases which require additional haste to relieve
the child's head, or the umbilical cord, from dangerous pressure
in the pelvis, I often administer it for the sole, final purpose of
saving its life.

?0 Remarks on Empiricism. [July

ARTICLE II.

Remarks cm Empiricism. By Joseph A. Eve, M. D. Pro-
fessor of Therapeutics, &c. in the Medical College of Georgia.

To such a fatal extent does empiricism prevail in this coun-
try, at the present day, that it becomes the duty, not only of the
physician, but of the philanthropist, to enquire into its causes,
and suggest methods for its suppression.

In this enlightened age, when such splendid achievements
have been made in the arts and sciences, and the state of medi-
cine so highly improved as almost to have arrived at perfec-
tion, incredible as it is, and disgraceful to this land of light and
liberty, where no shackle, no restraint is thrown upon the diffu-
sion of knowledge, empiricism, more grossly absurd and des-
tructive than ever disgraced the dark ages, still exists, in defi-
ance of legislative enactment.

Were the history of quackery, even in this State, faithfully
registered, its annals would be too black, too replete with horror,
too appalling for perusal they would record the cold-blooded
slaughter of hundreds, if not thousands, of persons, whose
lives have been deliberately and cruelly sacrificed, by the most
ignorant and presumptuous charlatans that ever infested any
country in any age !

In tracing the causes of this tremendous evil, much doubtless
is attributable to the incompetency and dishonesty of physicians,
many of whom, by their unskilfulness, negligence, and conse-
quent ill-success, bring contempt and reproach on the profession,
and compel their employers to resort to empirics for the bene-
fits they fail to afford, and the latter arrogantly but vainly pro-
mise : others, false to science and humanity, have renounced
their profession and adopted empiricism ; or, becoming all things
to all men, have, still more basely, declared themselves ready
to practise their profession, or quackery, as ordered by their
employers.

These physicians are divisible into two classes, the first
grossly ignorant the second criminally dishonest the former,
too deficient hi knowledge or intelligence to comprehend and ap-
ply theprinciples of medicine, become perplexed, embarrassed and

183G.] Remarks on Empiricisni. 71

dissatisfied with their unsuccessful attempts at regular practice,
and are therefore happy to adopt a method that requires nei-
ther sense nor learning; for the principles of medical science,
though to the learned and intelligent, lucid, beautiful and har-
monious, arc to the ignorant and obtuse, all darkness, inconsis-
tency, confusion and chaos.

Such practitioners, as well as their employers, arc objects of
compassion we pity, and pass them by.

The second class consists of those who, actuated by sordid
love of gain, are willing, taking advantage of popular prejudice
and credulity, to sacrifice principle to profit, Mq to lucre ! for
such deep, dark, demon-like depravity, words fail in expression
language has no adequate terms of horror earth no appro-
priate retribution !

But the ruinous prevalence of empiricism is, by no means,
wholly chargeable against the profession it is mainly to be
accounted for by the fact that the community are less informed
on medicine, than almost any other subject. With respect to
the other learned professions, they are incomparably more en-
lightened.

Divinity is more or less the study of all the great Text-
Book, containing all the principles and maxims of the science, is
in the hands of every one besides, ample instruction is afforded
from the pulpit, in the Sabbath school, and by religious periodi-
cals, which are extensively circulated and generally read.

People in general are much better acquainted with law than
medicine, a considerable knowledge of which is acquired by
attendance on Courts, which is at least equivalent to attending
lectures they read legal more than medical books, and arc more
assiduous in endeavouring to acquire the former than the latter
species of knowledge ; for such is human nature, strange and
inconsistent as it may appear, that most persons take more in-
terest and devote more attention to that winch concerns pro-
perty than health, except during sickness, when they are dis-
qualified for the pursuit or acquisition of knowledge.

As the soul is superlatively superior to the body, and its inter-
ests paramount to all others, divinity, as it involves eternal happi-
ness, is that study which commands the first attention of alL
men ; but certainly next to it, of all human knowledge, medicine
is that in which man is most deeply interested, and whficH

7~ Remarks on Empiricism. [July,

ought therefore to be neglected by none. We would not be un-
derstood to say that all men should become physicians ; but that
all men, as far as opportunity is afforded them, should read me-
dical books, attend lectures, and acquaint themselves with the
general principles of the science, so as to be qualified to become
to some extent, guardians of their own health, and to make a ju-
dicious selection of a physician, when medical aid is required.

Of the principles of medicine, people generally are totally ig-
norant ; few ever look into a medical book, unless it be some
popular work on practice, or some empiric production, both
of which are calculated to lead to error. It has often been
said, a little knowledge is a dangerous thing, that persons should
be profoundly learned or know nothing this is certainly true
as respects a little knowledge of practice, without the least ac-
quaintance with principles.

A little knowledge of practice derived from popular writers,
leads to arrogance and presumption, and is often productive of the
most dangerous and disastrous consequences ; whereas a knowl-
edge of the true principles of medical science, as of philosophy in
general, inspires modesty and diffidence : but while it prevents its
possessor from ignprantly arrogating the weighty and responsi-
ble offices of physician, to the destruction of others, it qualifies
him to discriminate between the scientific practitioner and the
vain pretender, whether in or out of the profession, and is thus
a source of much safety to himself.

Physicians have the best opportunities of observing, and are
best qualified to discern the ruinous effects of empiric practice :
and, moreover, as guardians of the public health, feel under most
solemn obligation to expose and prevent them : and different
methods have been suggested to deliver society from this evil,
more dreadful in its ravages than pestilence or war.

Although it is the duty of wise and virtuous legislators to enact
laws to protect the safety of the people, legal prohibition will al-
ways prove ineffectual for the suppression of quackery until the
public mind is enlightened on the subject. " Empiricism (says a
cotemporary waiter) must flourish until the mass of the people
are educated to a point or stage above it."*' We have long

*The same author further observes, "we have always considered as highly
complimentary to the general intelligence of our city, (Philadelphia,) 'that
the Thornpsonian follies, and perilous administrations of stewings, and "Num-
ber 6," together with the species of medical monomania, called Homeeopa-

1830.] Remarks on Empiricism. 13

thought that there should be attached to all colleges and univer-
sities, Professorships of Chemistry, Botany, Anatomy and Phy-
siology, and the Principles of Medicine; nor should instruction
in these sciences be confined to those institutions ; there ought
to be public lectures delivered on each of them in Lyceums, that
should be established in every town and county, for the pro-
mulgation of useful and salutary knowledge among all classes
of people. We should then no longer behold, as at present?
porsoas intelligent and well informed on other subjects, become
the unfortunate dupes of ignorant and contemptible quacks,
yielding assent to the preposterous and ridiculous absurdities of
Thorn psonianism, and submitting themselves and families as
victims to this barbarous system of immolation. So far from
enfightehed members of society being deluded by these pre-
sumptuous pretenders, even labouring men would possess too
much knowledge to be deceived by such vile impostors.

A very moderate knowledge of Chemistry and Botany would
disabuse the community of the false and ridiculous impression
which empirics constantly endeavour to impose on their credu-
lity, that is, the universal mildness and safety of all vegetable
substances, and the mortal potency of- all mineral medicines
they would soon learn that plants and flowers furnish some of
the most subtle poisons and violent remedies whilst many of
the simplest and gentlest are derived from the mineral kingdom.

Very little insight into the extremely delicate and compli-
cated structure of our organs, and the functions exercised by
them, could not fail to render obvious the peril of ignorantly
and carelessly tampering with them, and the necessity of the
most profound knowledge to enable a physician to comprehend
and correct the changes wrought by disease.

And but a slight acquaintance with the principles of medicine,
founded on a knowledge of the organs and functions, and the
modifying powers of medical agents, would be required to shew
the absurdity and danger of empiric practice.

We repeat, the only sure and effectual method to suppress
empiricism, is to enlighten the people. Legislatures would ac-
complish much more, indirectly, by establishing medical pro-

thic system, have made fewer inroads among us than in most other places.
Jit these and the like impositions on human credulity, seek for a refuge in
irts of ignorance and moononisnj.
10

74 AeTJi&rks oft Empiricism, [_ J ui y v

fessorships in all colleges and large schools, and by directing
attention to the dissemination of science, than by the most severe,
penal statutes. Indeed, so nugatory has legislative interference
proven, that many members of the profession, as much as any
opposed to empiricism, advocate the policy of removing al]
restraint, and allowing the evil to proceed unchecked until it
effects it's own cure, which they believe would soon be the
result, if all opposition were removed.

Physicians are placed in a peculiarly delicate situation, and
the part they are called on to act is difficult and embarrassing
duty and interest both require them to oppose quackery in
every form but it is necessary for them to exercise the great-
est caution, and moderation, or they will be accused of selfish
and sinister motives, and the cry of persecution be raised, to the
great benefit of the empiric ; and, on the other hand, without
the most uncompromising firmness, in refusing to acknowledge
his claims to professional courtesy, they will be justly charged
with sanctioning and approving empiricism .

It has been proposed by some physicians to obligate them-
selves to each other not to attend a patient that had been attend-
ed by an empiric this, however, is contrary to the plaincsf
dictates of humanity, and to the most obvious professional obli-
gation : if we are solemnly bound, when called on, to bind up
the wounds and assuage the sufferings of the guilty suicide, are
we not of him who has been unwittingly betrayed into the hands
of the assassin ?

But even did duty leave us at liberty to withhold our ser-
vices, we would be denying ourselves one of the very best
opportunities afforded of proving to the world the superiority
of science over empiricism, for a large number, if not a majority
of cases, given over by the empiric, may be cured by the
scientific physician.

The proper course for physicians to pursue is to labour
diligently and faithfully in their calling, considering their lives
as consecrated to the sacred service of humanity, and to deport
themselves with respect to empirics so as to avoid on one hand
the slightest appearance of persecution, and on the other, the
faintest shadow of sanction to their pretensions. But we con-
ceive it is their duty, on all appropriate occasions, to expose
errors that endanger life, and explain patiently and endeavour

1836.] Remarks on Empiricism. 75

to promulgate correct doctrines, relying confidently on the
power of reason, the omnipotence of truth, and the certain tri-
Limpb of common sense. We are aware that many of our pro-
fessional brethren are opposed to the plan we suggest of endea-
vouring by all means to disseminate medical knowledge, and
render all chsses more intelligent on the subject of medicine.
We regret differing with our brethren, but after much reflection
we are convinced that every method devised for the suppression
of empiricism, will be found altogether inadequate and futile,
until the people are enlightened. Empiricism, we say, is found-
ed and supported by ignorance, and when once the foundation
and support are swept away, however high-towering or wide-
spreading be the superstructure, it must fall before the light of
knowledge quackery will vanish as me sable shades of night
before the rising sun. To physicians the foregoing remarks
are addressed ; the object of which is to solicit co-operation ox
to invite discussion.

If we are wrong, we desire to have our opinions corrected ;
but if the views we entertain are correct, and we are fully per-
suaded investigation will establish their correctness, it is desi-
rable that they should be properly appreciated by the profession.

Physicians are the depositories of medical knowledge from
them it must emanate and be communicated to others. Physi-
cians must devise every plan, and move every enterprize for its
dissemination. Let physicians memorialize Legislatures for
the establishment of professorships in schools and colleges, and
the building of Lyceums. Let them deliver public lectures on
medicine, and labour to create in society a taste for medical
literature. Let physicians adopt this course let them speed
the diffusion of medical knowledge through all classes of people,
and the world will soon awake to its importance ; medical books
shall constitute a part of every library, and no person be consi-
dered to have received a liberal education who has not attended
jnedical lectures then and then only, shall our profession be
duly appreciated, empiricism receive deserved reprobation and
contempt, and empirics be no more tolerated than pirates 07.
xobbers in civilized lands.

'Flier momelrical Observations.

JmV,

ARTICLE III.

Thermomelrical Observations for April, 1836, kept in Burki
County, Geo. Extract from the Journal of a Geological
and Agricultural Survey. By Professor J. M. Cottixg.

Tf)

1

?7?

^ 1

C

*o

e

o
p

5

q.

S3

ir.

o

CD

3

a>

o

o

*r

*

REMARKS.

1

52

60

2

57

68

3

62

72

4

62

71

5

48

64

6

48

72

7

54

56

8

54

64

9

60

72

10

61

70

1)

51

72

12

50

58

13

64

68

14

59

74

15

62

81

16

61

70

17

62

60

18

53

64

10

74

72

20

64

61

21

63

73

22

50

68

23

58

78

21

54

82

25

61

82

26

68

82

27

63

85

28

64

84

29

68

84

3^

61

80

62

72

72

68

60

68

52

70

69

07

62

56

73

76

77

68

55

67

67

61

69

71

70

78

75

76

79

78

79

78

56

75

64

66

5

66

3

53

58

53

75

61

59

65

These observations have been made in
different parts of the county, where the
observer happened to be. In all cases the
thermometer was placed in the shade,
and with a northern aspect. The mean
heat was obtained from a variety of ob-
servations during each day.
Mean heat of April, - - - 62 61
Quantity of rain fallen during the

month, inches, 1.83

Number of cloudy days, - - - 3

Rainy days, - - 1

Foggy mornings, 2

Thunder showers, 7

Prevailing winds, E., SE., S. and SW.

In running the East and West section
line, from Shell Bluff, on the Savannah
river, to Jefferson county line, the same
formation was found on each extremity
of the line ; consisting of shell limestone
and the genus Ostrea, of different species.
On the extremities of this line, vegeta-
tion is nearly a fortnight earlier than on
the middle. The Buck-eye (JEsculus
pallida) was in blossom at the two ex-
tremities on the 29th of March, and in
no instance in the middle until the 10th
of April.

The tern pern lure of springs issuing
from the shell limestone formation, was found to be uniform at.

60
53

68
66
69
65
58
59
73
63
69
59
67
66
70
74
73
73
72
69

47

33

5

5
5

75
5
1
4
5

33

while tf

lose ]

ssuine from the marine sand or crag formation.

the temperature was between 54 and 58 degrees.

1836.] Thermomelrical Ob$erva3ofi&. 77

Li all cases, it has been found, in the survey of Duike co
that the forwardness of vegetation, and the high temperature of
the water of springs, indicate the existence of a bod of limestone
or calcareous marl. This fact is analogous to what has been
observed in England and other countries in Europe. Bakewell,
in his Geology, remarks that it is a well known fact, that the
vegetation of perennial grapes, is, at least, a fortnight sooner on
limestone and sandy soils, if not extremely barren, than on
clayed, or even deep rich soils. It is equally true, though not so
generally known, perhaps, that the difference is more than
reversed in the autumn. This effect may be ascribed, with
much probability, to the rich or clayed soils absorbing heal
slowly, and parting with it again more reluctantly than the
calcareous soils, owing to the greater quantity of moisture in
the clay, which is a bad conductor of heat.

[We take pleasure in presenting to our readers the above
Meteorological Ephemeris and remarks, from the journal of our
esteemed and scientific friend. Professor Cotting. This gen-
tleman, who is devoted to the natural sciences, has for some
time been engaged in making a Geological survey of Burke
County, and designs, as we understand, to extend those investi-
gations to some other parts of the State. The age, experience^
and extensive acquirements of Professor C. in the natural
sciences, of which he has for many years been a successful
teacher, fully warrant the belief that these researches cannot
fail to afford results of deep interest to the State, the natural
history of which has hitherto rested untold. We hope to draw,
from time to time, from the same source, matter of increasing
interest, as his investigations are extended; and indulge the
hope that our State will extend to this able and worthy indivi-
dual such patronage as shall secure to herself the incalculable
benefits of his services in making a general survey. Ed.]

78 Removal of a large fibrous Polypus^. [July

ARTICLE IV.

Removal of a large fibrous Polypus from the base of the Cranium.
By Paul F. Eve, M. D. Professor of Surgery in the Medical

College of Georgia.

Some of the particulars of the following case, having been
verbally reported at the last meeting of the Medical Society of
Augusta, a wish was expressed, to have them furnished the
Southern Medical and Surgical Journal for publication and
as they may not be devoid of interest to the profession, I have
consented to comply with the request.

Mr. Jonathan Stanford, now twenty-one years old, states that
from early life he could not breathe through his right nostril.
After having applied to several physicians of his neighbourhood,
and tried every thing that promised relief, he was induced to
visit the Faculty of our Medical College, in April, 1835. A few
days after his arrival, an attempt was made to remove the por-
tions of a Polypus projecting anteriorly into the naris of the
right side, as well as posteriorly and downwards upon the soft
palate, which latter portion could be readily felt by the finger
introduced into the mouth and passed upwards alongside the
uvula. By the use of forceps, &c. some inconsiderable portions
were torn away, which permitted the patient to breathe through
the nostril affected, after the slight inflammation produced by
the operation had subsided. The part of the tumour directed
backwards was found to be very large, and from the difficulty
experienced in seizing it properly, it wTas deemed inexpedient to
proceed further with the operation at that time, and the patient
returned home.

In October following, about six months after this very partial
relief was afforded, Mr. Stanford again visited us; having now
the antrum highmorianum of the right side very much distended,
the eye of the same side being somewhat protruded, turned
upwards and outwards, and the molar teeth depressed below
their natural level, the Polypus also projecting both anteriorly
and posteriorly in the nostril of the affected side. In the pre-
sence of the class then attending lectures, an opening was made
into the antrum, and a portion of the Polypus extracted from it.

I9te.| Removal of a large fibrous Polypus. 7<J

Tiic soft palate was next slit up for about three-fourths of an
inch, and as the united efforts of several could not draw away
that part of the tumour directed backwards, either with forceps,
ligatures or hooks, a considerable portion was removed with
curved scissors. In a few days, our patient had sufficiently
recovered to return home, the distance of about thirty-five miles.

About six months after this, Mr. Stanford again visited
Augusta. A large tumour now protruded out of the antrum
under the cheek, producing great deformity ; he had had an
attack of congestive apoplexy ; the sense of hearing on the right
side was diminished; the carotid artery of the same side was
pushed outwards from its natural situation ; and both nostrils
wTere closed up, the patient breathing through the mouth. Mr.
S. and his friends having been apprized of the nature and extent
of the operation required for the removal of his affliction, and
being persuaded from experience that nothing less promised
relief or even a continuance of life itself, gave their consent to
submit to whatever was thought necessary.

On the 19th of May, assisted by Dr. Dugas and Messrs.
Alfriend, Roberts and Byrd, Students of Medicine, the opera-
tion was commenced by making an incision from one inch
below the internal angle of the right eye, and extending it down
through the upp^r lip. The knife was then carried from the
angle of the mouth on the same side upwards and backwards to
the lower edge of the malar bone, dividing all the soft parts for
two inches or more. The flap made between the two incisions
was dissected up and reflected upon the right eye. The tumour
projecting from the antrum being thus fairly exposed, a very
strong tape as a ligature was put around it in this cavity, and
by very severe and forcible traction a large piece of it was torn
off from the mass in the nostril. The haemorrhage was very
great ; but in this, as in all other instances, except a few small
arteries in the lip which required compression, it was controlled
by injections of a strong solution of sulphate of zinc. Finding
it *iow impracticable to seize the Polypus either through the
opening already made, the nostril or the mouth, a peculiar
instrument was resorted to, with which it was proposed to cut
away the bones. With a small pair of pruning shears, the su-
perior maxillary bone of the right side was divided between the
first and second incisor teeth, then the nn sal pror*Pss of iho same

HO Remaval of a large fibrous Polypus. [July*

bone transversely by passing one blade of the same instrument
>into the antrum, after which the alveolar process with six
teeih, (the wisdom tooth not being developed;) was gradually
detached from the malar bone and the pterygoid process of the
sphenoid bone. Tiie palatine process of the superior maxillary
bone, and the palatine plate of the palate bone, were now re-
moved, and the soft palate completely divided through the
centre. It being evident from repeated efforts with forceps;
ligatures and hooks, that the Polypus could not even now be
dragged away, after separating its slighter attachments from
the surrounding parts, the curved scissors were employed, and
it was found intimately adhering to the basilar processes of the
occipital and. sphenoid bones, arrd also to the internal plate of
the pterygoid process.

The Polypus was of a very irregular shape, having several
projections ; one into each nostril, the large one into the right
antrum, which had been torn off, besides the large body resting
upon the soft palate and attached as already mentioned ; and
what was very remarkable, there was a small nipple-like pro-
cess, extending into the left antrum. It was filled with large
venous sinuses, and quite fibrous, particularly at its bony at-
tachments. It was about the size of a man's fist after being
macerated ten or twelve days, and deprived of all its blood, it.
weighed three ounces, three and a half drachms. It can be
seen in the Museum of our College.

In dressing the wound, three common interrupted sutures
were made in the soft palate, and five more with adhesive
strips to the two incisions on the face.

The patient, who bore the operation with great fortitude and
resignation, had fainted several times, and did not folly revive
until the third day, when he was considered out of danger. A
little more than three weeks after the operation he returned
home ; the external incisions had healed, but that in the palate
was still open. There was little or no deformity ; the right
cheek was neither depressed nor swollen. It is proposed to
attempt hereafter, the operation of Roux, called Staphyloraphy,
to remedy the defect in the soft palate.

Ausnistt^, June 1th, 1836.

1386.] Purulent Ophthalmia of Infants. 81

ARTICLE V.

Purulent Ophthalmia of Infants. By L. A.Dugas, M.D. Profes-
sor of Anatomy, &c. in the Medical College of Georgia, &c.

The obstinacy with which the purulent Ophthalmia of infants
not unfrequently resists the ordinary modes of treatment, in-
duces me to present a few cases in which the chloride of soda has
been most signally successful. I am not aware of its having
been hitherto used m this disease. The wrcll known anti-
suppurative properties of the chlorides suggested the prescrip-
tion, and its uniform success in the small number of cases I
have had to treat, causes me to regret that I have had so few
opportunities of testing it.

Case I. 15th of December, 1834. Mr. J. H.'s child,
when five days old, experienced in both eyes the ordinary
symptoms of Purulent Ophthalmia, which progressed and con-
tinued four weeks, notwithstanding the usual remedies. Mucila-
ginous poultices and washes, were first used ; subsequently, lead
water, alum curd, laudanum and water, breast milk, rose
water, &c. &c. I now saw the infant, and found her eyes
suppurating at least a table spoonful each in twenty-four hours.
Palpebral so much swollen as to overlap each other considera-
bly and render it impossible to separate them sufficiently to
examine the globe of the eye. Child well in other respects,
but cries very much ; ordered the eyes to be bathed every hour
or two with tepid diluted chloride of soda, ( I ss to a quart bottle
of water.) During sleep a bit of linen to be placed over each
eye, and kept moist with the same solution. The bowels to be
moved every other day with castor oil.

16th, the quantity of pus has notably diminished.

19th, child cried so much last night, as to cause the eye-lids
to become swollen discharge still diminished mother so un-
easy that she msists on applying blisters the size of 12 1-2 cts.
coin to each temple chloride continued.

20th, eyes rather worse blisters dressed with cerat. simp.
chloride solution.

23d, blisters quite well pus much diminished eye-balls maj
be seen somewhat inflamed over the sclerotica.
11

S2 Pvm^rJ Ophthalmia of Infante. [July;*

26u . still improving rapidly.

30lh, palpebral swelling entirely gone no evidence of in-
flammation in the eye no pus, nor agglutination case dis-
charged.

Note. It is worthy of remark that the disease was aggra-
vated during the active stage of the blisters, and that its subsi-
dence was in a direct ratio with the diminution of excitement in
the blistered surfaces. The temporary swelling of the eye-lids,
which led to the application of the blisters, was evidently caused,
by the excessive crying of the child the previous night.

Case II. 18th January, 1835. Mr. G. W. C.'s infant, six
weeks old, affected with purulent Ophthalmia of both eyes,
since the fifth daV after birth. Has had applications of mucil-
ages, breast-milk, calomel, laudanum and water, &c. to the-
eyes, with only temporary relief. The palpebral arc now very
much swollen and overlap ; the inflammation extends from them
over the eye-balls, as may be seen by separating them ; suppu-
ration at least a table spoonful per day from both eyes treat-
ment, chloride of soda and 01. Ricini, as in case No. 1.

27th. Have not seen the child since the above date, but am.
informed by the father that the chloride " acted like a charm ;'T
that the suppuration has entirely disappeared, that the inflam-
mation and swelling of the eye-lids i. r moved, and in short, that
the child is well.

Case III. 20th May, 1835. Nancy's infant, (belonging to
Mrs. B.) now thirteen days old, has had purulent Ophthalmia
six days, and has been subjected to the mucilaginous treatment
without benefit. Eye-lids now so much swollen as to overlap
considerably, and to render any separation sufficient to see the.
cornea impossible purulent discharge very abundant Ik al k
otherwise good ordered chloride of soda, as above, without
purgation.

23d, discharge much diminished.

28th, perfectly well.

Case IV. 20th March, 183G. Mr. L. P. D.\s negro woman
Pat, on the 5th inst. gave birth to a fine child, who, on the 13th,
was taken with purulent Ophthalmia. The disease has conti-
nued increasing to the present time. The eyes have been
bathed with breast-milk nothing else done. They are now
discharging immense quantities of pus eye-lids so much swollen

1836. J Mgftor Se?ato's Discovery. 8B

as to prevent their separation prescribed the chloride wash, as
above nothing else.

1st April, eves were well, but being neglected, have again,
-commenced discharging a little chloride re-applied.

5th, perfectly well.

Case V. 1st March, 1836. Mrs. P.'s infant, fourteen days
old, has suffered five days from purulent Ophthalmia of one eye.
T:ie palpebral and eye are both inflamed pus abundant. The
ofher eye slightly irritated. Breast-milk alone has been used.
The chloride of soda, applied a week to both eyes, gave complete
relief to the diseased, and prevented the development of thfi
affection in the other.

ARTICLE VI.

Signor Segato*s Discovery.

We are indebted to our friend, Dr. A. Cunningham, of this
^ity, for the following very interesting communication, from our
literary, scientific, and highly valued fellow-citizen, the Hon. R.
H. Wilde, now in Rome. Although a considerable part of
this paper is not strictly adapted to the pages of a medical
periodical, still, on account of its great interest, and its necessary
connection with that part which is of incalculable importance to
the naturalist, and to the anatomist, we have determined on not
interrupting its intigrity by publishing a part only ; and therefore
present it entire for the gratification of our readers.

To the Editors of the Southern Medical and Surgical Journal.

I have just received from our friend the Hon. Richard H.
Wilde, an abridged account of Signor Giromalo Segato's dis-
covery, by his friend the Avocate Pellegrini. And inasmuch
as it is one of great importance in the science of medicine, as
well as to the naturalist, I cannot do better than offer it for
publication in your Journal. Further proof I apprehend will
ot be required than is appended to the abstract* A. C

84 Signer ftcgato's Discovery. [July,

Giromalo Segato is a native of Yedano, a romantic village
situated about seven miles from Belluno, in the Lombard- Vene-
tian Kingdom. At the age of eighteen he attended the chemical
and mineralogical lectures of Professor Tommaso Antonio
Catullo, at Belluno, and accompanied that eminent person in
various excursions to the mountains, for the purpose of collect-
ing minerals and fossils. Even thus early, he gave indications
of his passionate love of science, by exploring, alone, the moun-
tains of Feltrino, and the environs of Agordo, returning laden
with objects for the most part deserving the attention of the
naturalist. In the short space of two years, 1812-1813, he col
lected above a thousand specimens, among which those of fossil
shells were the most valuable. He discovered a mode entirely
his own, of detaching them from the hardest rock, without
breaking, or leaving any part of the shell behind. His thirst for
chemical and mechanical knowledge was insatiable, but Belluno
was too confined a theatre for his genius, and he often lamented
that his lot had not fallen in some pla( c where he could have
executed some of the many experiments that occurred to him.
Impatient of these obstacles he at length abruptly quitted his
country and parents, and in 1820 his passionate love of travel
led him into Egypt. An interesting outline of his journey is
preserved in a letter to his brother, dated at Cairo on the 2Gth
of December in that year, in which he says :

" I will give you a sketch of my travels, of which you have
already heard something by my letters written from Cairo at
the moment of my departure, from the cataract of Assouan,
from the island of Philoe, and from Abki, if they have reached
you. 1 left Cairo on the 6th of May last, making part of an
expedition destined for the conquest of Sennaar. To me, among
others, was intended to be entrusted the superintendence of cer-
tain works at the second cataract, which the Pacha wished to
have constructed for the purpose of facilitating trade and the
passage of troops. Handsome rewards were proposed to me,
"but I declined them, desiring to avoid all restraints on my move-
ments, and having no good opinion of the folks I should have to
deal with; in which, as it turned out, I was not mistaken, for
at the second cataract, disgusted with the dishonesly of one of our
Italians, whose plan was plainly avowed by himself, I abandoned
the expedition. But let us quit this subject and return to my

1836.] Signor Segaio's Discovert/, 85

journey* Leaving Cairo then, I passed on to upper Egypt,
traversing the Tolcmaid, the Thebaid, and Sayd, and visiting
the remains of thirty magnificent ciiies, as Ginqpoli, Antiohq,
Ermbpoli Magna, Tani-Eptanomica, &c. &c. Arriving at
Assouan, I pitched my tents near those of his Excellency Kihia-
Key, with whom I partook of a repast. I visited the well of
the San, the sacred island of Philoe, the ancient and magnificent
place of initial ion- into sacred and sacerdotal mysteries, at pre-
sent involved in the deepest obscurity. After a few days stay,
I departed with his Excellency. I was the first who ventured
to ascend the first cataract, being drawn against the stream by
about two hundred men. The 20th and 21st we were at Qua-
labseh, a place precisely beneath the tropic, and with a tem-
perature under double tents of 49 to 49 1-2 of Reaumur. Ima-
gine to what a distillation we were subjected 1 By Heavens !
I sweated as much in a day as a chemist's laboratory in ten.

Quaiabseh, taken in a good point of view, is picturesque in
its way. The two mountain chains, the Arabic and Libyan
approaching each other, present walls forming a kind of theatre
of the width of about eighty geometrical paces, or rather a gate-
way or pass, which the Arabs call Bab-el-Nil, or gate of the
Nile. The mountains are black, ferruginous obsidian, of dif-
ferent varieties ; nature harsh and sterile ; the inhabitants
darkly bronzed ; mostly wretched fishermen, belonging to the
isles of the internal basin beyond the pass; the women full of
spirit, less repulsive than the Egyptians, but of the strictest
chastity. The girls go naked 'till the period of their marriage,
that is to say with nothing more than a piece of skin tied round
the waist, which is cut into thongs, like the fly-guard on the
heads of our oxen, and ornamented with various coloured bark
and shells. They are never more than a foot and a half long.
Every age and sex are lovers of song and dance, and accus-
tomed to them even in their daily labours. Only conceive that
each little company of labourers of every description has its
singer and musician, and does nothing without music. I visited
sixteen other splendid temples, and, especially those of Ebsam-
boul, excavated, like many others, in the mountain, but more
beautiful than any of the same description, being ornamented
with bas reliefs from the floor to the roof of every room. I
reached Abedunacti and then Abedurgam, the first with its

&6 Signor Segattts Discovery. ^July,

eighteen cataracts forming the second. I saw Soda and Amis-
chientino, on the west bank of the Nile, and ascended the peak
of Bak-bak, where I found the names of nine European travel-
lers, among which were two Italians. I made the third. This
peak overlooks a great part of the cataract ; a grand but
gloomy prospect. The Nile shoots its proud roaring waters
amid a thousand isles of -dark granite, presenting a surface
shining like glass. Some scattered palm and turpentine trees
deck this dark solitude, inhabited by a few Berber families, who
have a like disdain of clothing as -their neighbors, but a more
agreeable language and greater probity. Here, as I said before,
I left the expedition. Master of my own movements, I desired
to form, from personal observation, an accurate idea of the
desert. Accompanied by my faithful Berber servant, and pro-
vided with some dried dates, water, and a little bread which 1
got from the soldiers, I passed on from Abki to Abdon, then
traversed Colicombo, and ascended the intermediate Troglodyte
chain dividing Nubia from the great desert of the Abadi, into
which I penetrated in the direction of East, a quarter South-
East. Behold me a solitary wanderer amid an ocean of burn-
ing sand, precisely of the colour of melted metal, bounded only
by the horizon on all sides, without a sign of vegetable and few
of animal life, under a daily temperature of 64 to 65 of Reaumur,
in a desert into which I was the first to penetrate. My dress
was European, except the hat, which I exchanged for a red cap.
In the evening when I stopped, my kingdom was all around me ;
I ate my luxurious supper of dates, bread and water, and
wrapped up in a woollen coverlet, slept sweetly 'till the morrow,
without a sound to interrupt my slumbers. My own voice, my
servant's, and our camels, alone broke the silence of the desert.
Sometimes we saw Hocks of ostriches, but they fled like light-
ning. It was the twentieth day before we exchanged a word
with any human being. It was a wandering horde we met.
We approaehed each other, we spoke, I gave them some pre-
sents, they gave me some in return, and we parted. The
thirty-seventh day we arrived at some miserable huts, the sight
of which rejoiced me greatly. They wee formed of layers of
dog's grass, and inhabited by an Aba- Ion chief, two young and
pretty wives, and two beautiful children. I demanded hos-
pitality, stammering in their tongue, and it was granted

1836.J Signor frcrafo's Disco very. 87

me to an unexpected extent. The master of the house!.
invited me to sit down in the midst of them : the women
eyed me from head to foot, with great wonder, but withe
the least appearance of apprehension. The husband soon
brought me some dates, and water which, though not good,
was more delightful to my taste than the most exquisite
liquor I ever drank. I had a few trinkets and skeins of silk.
of winch I made presents to the females. This was sufficient
to establish me in favor. I passed seven days with these kind
people, who grew fond of me, and treated me with the greatest
affection. I became much attached to them, regarding and
behaving to those amiable women as sisters, kissing their chil-
dren as if they were my own, and envying their felicity. The
constant tranquillity, cheerfulness and harmony of this rustic
family, founded on the rigid simplicity of their habits and man-
ners, presented a contrast, I assure you, shameful to civilization.

The 45th day, considering my slender stock of provisions, I
resolved to return towards Abki, where I had left various ef-
fects. I took leave of my kind hosts, who kissed me a
thousand times, and commenced my journey. After tweny-two
days' travel, during which we saw no living thing, and not the
smallest plant, we fell in with a caravan of slaves going to the
market of Cairo. I travelled two days, in company with them.
for the purpose of becoming acquainted with the habits and cus-
toms of their different tribes, for which the master of the cara-
van, who spoke Arabic perfectly, gave me every facility.

The sixtieth day, we encountered two wandering hordes,
who did not molest us. These people were of tall stature, slen-
der, very meagre, with fierce looks, eyes full of fire, and very
little beard. They are tattooed in various parts of their bodies.
The women especially, who are very lively, trace handsome
drawings in blue-black upon the belly, under the breasts, and on
other parts of the person. They stain the gums black, and have
a spot of the same colour on the lower lip. All the men have
black hair, curled, and hanging down behind, resembling a long
wTig, cut straight across, about two finger's length below the
shoulders, and always greased, which defends them against the
heat of the sun.

They have no riches or ornaments, but a camel or two, (not-
all of ihem even this) a shield of crocodile or hippopotamus's kin.

88 Signor Segato's Discovery. [July,

and a lance, which they manage With extraordinary dexterity.
They have some peculiar superstitions, and practice circumci-
sion and excision, which they perform in a barbarous manner
with great solemnity. I had the good fortune to witness a mar-
riage, a funeral, and an excision, of which I have preserved a
minute description, as also of some other curious matters.
Although I have often found myself jn situations where others
would have been discouraged, my resolution never forsook me.
Anxious to penetrate still further, but prevented by the want of
means, indifferent to heat, hunger, and even thirst, the most
dreadful of all sufferings. If you knew, my brother, what it is
to travel on a dromedary, through" the desert, in the months of
July and August, more than nine hundred miles within the torrid
zone, for the most part without water, save such as is stagnant
and stinking, and that hoarded as the most precious of your pos-
sessions, since the want of it for one day only, were certain death !
Oftentimes I thought of the contrast between my situation in
Italy in the midst of my family and friends, with all the comforts
and amusements of life around me, in a temperate climate, and
that of roaming a boundless desert, among naked black savages,
where the whole of human desires are restricted to one want
water, and the daily heat is from 64 to 05 of Reaumur. Yet all
this is nothing compared with the pleasure of seeing unknown
places, and collecting interesting facts and recollections, which
you will one day hear.

Finally, on the eighth day, I arrived at Oudi-Alfa, thence I
went to Abki, at the second cataract, and descending Nubia,
reached Philoe, and Elephantina, where I remained some days.
From thence I departed for the Thebaid, to visit the magnificent
tombs of Biban-el-Moluk, etc. The 29th ulto. I arrived at Cairo
in thccvening,and experienced some moments of the greatest plea-
sure. At first, when I entered the Coffee- Room, black, ragged,
and with a long beard, six months old, no one knew me ; my
good host, however, soon remarked and recognized me, crying
out Se^ato ! Segato ! I cannot describe to you the salutations,
the embraces, the demonstrations of joy that on all sides greeted
my happy return. I can only tell you it was among the happiest
scenes of my life. I swear to you my tears fell profusely at re-
ceiving proofs of such sincere affection from persons on whom I
fcad no peculiar claims."

1836.] Signor Segato' s Discovery. 89

It was in the course of these travels that the first' hint of his
extraordinary discovery occurred to him. In going from Ouadi-.
Elfa to Wograt, in the province of Sokkot, across the Eastern
chain, he saw one of those tremendous phenomena, not uncom-
mon in the deserts, particularly those bordering on the Nile, in
upper Nubia, a whirl-wind of the desert, or terrene water-spout.
These terrible meteors sometimes continue in one spot, expan-
ded in an oblong form, where they touch the earth, thence assu-
ming that of a perfect cylinder, they reach high into the air, and
darken it with clouds of sand whirled about in every direction.
At the point where they touch the desert, so extensive and pro-
found is the excavation they leave, that it*might be taken for the
bed of a huge lake. At other times becoming moveable, and in
all other respects maintaining their ordinary character, they
fly through the desert, tearing it up in their course to an extent
in proportion to their width at the base, and leaving behind them
what resembles the bed of a torrent.

Segato fell in with the track of one of these progressive whirl-
winds, and unintimidated by the proximity of so dangerous a
neighbour, continued to follow the deep ravine it scooped out,
and to examine the wrecks it made or disinterred. Some frag-
ments of a carbonized substance, presented themselves to the scru-
tinizing eye of the philosopher. Subjected to more minute ex-
amination, he recognized animal remains, and especially those of
the human species. He at last found an entire body, the flesh
and bones completely carbonized, the one black as charcoal, the
other of a sooty hue, and both friable. He plainly perceived in
this corpse the human figure, though shrunk to a third of its na-
tural dimensions. That which to another, would have been
merely an object of barren wonder, became to Segato the first
hint of his discovery. He brooded upon it for years ; he ex-
hausted all his science upon various experiments ; often disap-
pointed, but never disheartened, he continued to interrogate na-
ture, until wearied as it would seem by his importunity, he has at
length extorted from her one of her mysteries. In the course of
his persevering researches, he effected with great labour, an
entrance into the pyramid of Abu-Sir. Remaining there six
day?, he contracted from the foul air of the catacombs, a tedious
and painful malady, which was pronounced incurable, and the
unfortunate Segato returned to his country, merely, as it was
12

90 Signer Segaio's Discover;/. [July-

believed, to die. After arriving at Leghorn, however, 1 he-
strength of his constitution triumphed over the disease. He-
resumed his experiments with fresh ardor. The first public
notice given of his success, was a very modest one, by the author
himself, in the Antologia, Vol. 44, No. 132, December, 1831, p.
74. At that time, he had not acquired the means of petrifying
animal substances so perfectly as at present ; and in employing"
the terms petrify and petrifa* tion, he warns his readers that he
uses them in a new literary sense, to signify an induration, resem*
bling and approaching that of stone, not a petrifaction in the sci-
entific sense of the world.

The process of Segato acts upon entire animals as well as
upon their separate parts. It endues them with a consistence-
perfectly stony, which is more or less hard in proportion as the
parts themselves are originally less soft and mucous. Skin*
muscles, nerves, veins, tendons, fat, blood, all undergo this
wonderful change, and what is most singular, is, that it is not
requisite to extract the viscera or intestines for the purpose of
effecting it : they themselves assume a like solidity with the
rest of the body, and some of them even greater. Nor is there
any material change of form, colour, or general appearance and
character, all of which are retained. Not the least disagreeable
smell is emitted from his preparations ; they are entirely inodor-
ous. Such is the power of the agents he employs, that putre-
faction already begun, is arrested at the very stage at which it
had arrived when his process commenced. He has even found
the means of rendering animal substances inalterable without
destroying their flexibility. The joints and articulations may
be bent, and when the force applied is removed they resume
their former position. His skeletons remain united of themselves*
by their natural ligaments, retaining their pliability, thus render-
ing useless all the clumsy contrivances heretofore necessary for
combining the bones together. So unalterable are the sub-
stances thus preserved, that they are not only unaffected by
atmospheric change, but even by a daily exposure to Water,
aid the action of worms. Their volume is but slightly decreased,
and their weight continues nearly the same. Even the spots
upun the skin remain visible, whether natural or produced by
disease. The hair adheres firmly ; not one drops from the
human scalp, where they continue fixed as freshly and firmly

f$3f>.j Signer Segau/s Discovery. 91

as in life. Birds do not lose a feather, nor fish a fin or scale-
both preserve their hue. Insects retain every extremity, antenna?,
and cartilage, however minute. Reptiles, besides their perfect
preservation, wear so strong an appearance of life, that it is
-difficult to believe them dead. With many of these animals even
the eye still glistens, and from their immobility only is their
death to be discerned. Many entire specimens, either petrified,
or rendered inalterable, with a consistence less rigid, are to be
found in Segato's cabinet. A few shall be enumerated which I
have myself seen and handled. A mouse, with the entrails pro-
truded, looking as fresh as if it were but that moment prepared.
A canary bird, one of Segato's earliest specimens, yet retaining
its life-like appearance. For ten years it has been annually
exposed to the attacks of water and worms, without the least
injury. During the first year thirty, in the next more than
forty days, it was immersed in water to test its incorruptibility.
For a longer time it was shut up in a box with worms, but
came out unhurt. Various other specimens have been subjected
to the same test with uniform success. A parrot, in excellent
-preservation. The frog in every state, from the egg to the
perfect animal, and thence through different stages of decompo-
sition to the skeleton. The land tortoise (Tertudo Greca, Linn.)
in every stage. Numerous spiders apparently retaining the
agility of life. A water viper, (Coluber natrix, Linn.) a toad,
(Bufo Viridis, Linn.) and a cameleon, (Lacerta Viridis, Linn.)
all admirable. In ichthyology there were many fine specimens.
1 will enumerate only, Tench, Flounders, the scorpoena scropha,
Jabrus julus, and Lophius piscatorius of Linnaeus, and the tor-
pedo narke of Riss.

The anatomical preparations of various parts of the human
body are exceedingly curious, arms, legs, feet, hands, &c. The
hand of a female, who died of consumption, in a state of extreme
emaciation. That of a man, flexible in all the joints. A foot ac-
tually marble, yet bearing every mark of the skin, even the
fine circular lines of the heel. On both hands and feet the nails
adhere perfectly. The intestines of a child of the natural colour
and form, from which even the fasces had not been extracted.
The liver of a confirmed drunkard, who died from intemperance,
browrn and shining like ebony. The entire human brain pre-
senting all its convolutions, but of extreme hardness. A female

92 Signer Segato's Discovery. [July

bosom, white and full, of the natural appearance, even to the fine
down of the skin, the roundness of the breasts, and the areola of
the nipple. A scalp, or hinder part of the head with long fair
hair, as bright and beautiful as in life. The head of an infant
subjected to the process, after putrefaction had turned it black,
and destroyed the eyes, yet by the power of the agent employed,
saved from farther change. The flesh and skin have become
hard, the cheeks continue full, the cars, nose, and even the fine
hair of the head are perfectly preserved, and the brain also, be-
ing equally indurated.

Segato has constructed a tablet, composed of different pieces
of the human body, indurated and inlaid in a tessellated form,
after the manner of those productions of art which are known in
Florence, by the name of works in Pictre Dure. It consists of
214 p eces of various shapes and colours, differently veined, and
of such hardness that all admit of polish, none are scratched by
the nail, few by the knife, and some scarcely by the file. The
Jasper of Siberia is imitated by portions of the spleen, kidneys
and heart. The Jasper of Sicily, Saxony, and Bohemia, by the
pancreas, the uterus, the placenta, and the upper part of the
toague. Almost every variety of siliceous and calcareous stone
which has been applied to the purposes of use or ornament,
except only the gems, finds in one portion or other of the human
body, when thus indurated, either in its healthy or some disor-
dered state, a singular and striking resemblance. So perfectly
natural is the colour and appearance of the specimens of morbid
anatomy thus preserved, that a most distinguished surgeon of
our country,* who recently visited Segato's cabinet, on being
shewn this tablet, named immediately various parts of the body,
and the particular disease with which they had been affected,
It was impossible, he said, to avoid recognizing them; they
were exactly such as he had repeatedly seen in dissections.

Warm and honorable testimony to the importance and
utility of Segato's discovery, has been borne by several of his
learned countrymen. His name has already acquired some
celebrity in Europe, from his admirable maps of Africa, Mo^
rocco and Tuscany, prepared and engraved by himself, for
among his other talents, he is an excellent chorographcr and
engraver, and from a work on Egypt, part only of which has

*Dr. Mott, of New York. ~ -

183C>.] Signor Segatrfs Discovert/. 9kA

yet appeared. Several literary and scientific journals have
mentioned his labours with the highest commendation. That
you may not suppose me misled by ignorance or enthusiasm, I
subjoin some extracts from communications on the subject of
Segato's discovery, premising only that they are written by
some of the most eminent anatomists and surgeons of Italy.

In July, 1833, Dr. P. Betti, at that time Professor of human
and comparative anatomy, and of practical surgery, in the Im-
perial and Royal chief Hospital of Santa Maria nuova in
Florence, says, " I have seen and examined, at different periods,
various anatomical preparations dissected by the eminent
Giromalo Segato, and preserved by him according to a parti-
cular method of his own invention, in which the neatness of the
preparation and the durability of the subject preserved, were
carried to so high an extent, as to leave nothing farther to be
desired in either of these particulars, for which reason I believe
the method employed by Signor Segato is by far more perfect
than any yet known and used."

In April, 1835, Dr. Antonio Targioni Toretti, a member of
the Medical College of Florence, Professor of practical chemistry
in the Royal and Imperial Academy of Arts, and of botany and
materia medica in the Imperial and Royal chief Hospital of
Santa Maria nuova of Florence, declares, that " having atten-
tively examined and observed the different anatomical and
anatomico-pathological preparations, made by Signor Giromalo
Segato, as well as others in comparative anatomy, and various
fish, reptiles, insects, and other animals prepared for collections
of natural history, I am enabled to assert : That besides the
high degree of anatomical knowledge, and great skill in prepa-
ration exhibited by him, he has discovered a method heretofore
unknown, and altogether peculiar to himself, by means of which
bodies and parts of animals are preserved, maintaining their
natural colour, and exhibiting all the peculiar appearances inci-
dent to certain pathological conditions. Besides this, they
acquire a hardness which may be called stony, since they
are not scratched without difficulty, and they resist the action
of the air, of humidity and of worms, so that they may be con-
sidered absolutely inalterable and incorruptible. Over and
above this invaluable property of incorruptibility, is that pos-
sessed by his preparations for exhibiting the natural form and

$4 Signer Segato's Discovery. L.TuIy,

colour, so that the most delicate specimens of anatomy seem
freshly made, such is their truth and nature. I therefore be-
lieve that the method practised by Signor Segato will be of
infinite advantage to science, as well for collections of human,
comparative, and pathological anatomy, as for those of natural
history and zoology, and therefore worthy of all praise and
encouragement."

In April, 1835, Dr. P. Ferdinando Zanetti, Professor of Ana-
tomy in the Iloyal chief Hospital of Santa Maria nuova of
Florence, states, that having already, in June, 1833. given to
the distinguished Giromalo Segato an attestation of his excellent
mode of preserving organized animal substances, he feels it a
duty, at present, in consequence of more recent and. repeated
inspections of preparations since made by Signor Segato accor-
ding to the same method, to certify the great utility of his dis-
covery, as well for the perfect preservation of the form, and the
identity of colour and lustre, as for the great solidity imparted,
securing to his specimens, with the most entire certainty, an
indefinite duration ; and this as well in reference to separate
pieces and organs, as to entire animals, whether reptiles, fish,
er others of more complicated formation."

In May, 1835, Dr. Betti, before mentioned, then become
Professor of Physiology, and Superintendent of the Public Hos-
pitals of Florence, attests, " that he has examined various spe-
cimens of parts of men and animals solidified by Signor Giro-
iumIo Segato, to such a degree as to assume a stony hardness,
similar to that of the finer marbles, and pietre dure : and more-
over, that Segato in his presence tried the experiment of filing
with an English file various specimens of marbles and other
hard stones, and with the same file his own preparations, the
latter not being touched by the file, which had more or less
scratched, or taken off, portions of the former. The hardest
pieces were muscle coats of the intestines and bladder
liver placenta testicles arteries veins and the blood itself.'7

It is well known even to those little versed in such studies,
that Nature has at all times exhibited specimens of animal and
vegetable petrifactions. Petrified branches and roots of trees
and shrubs, and pieces of the trunk half of wood and half of
agate or other stone, are not uncommon. Walnuts, pine cones,
and even peaches and melons, it is supposed, have been petrj^

1S38.] Signer Segaio's Discovery. 6!)

fied, though the latter are believed by eminent naturalists to be
only stones accidentally formed into the resemblance of fruit, as
the lapides Judaici of Mount Carmel are not olives, but a
species of marine shell fish. It is scarcely requisite to mention
the innumerable marine petrifactions, madrepores, corals, nau-
tilii, &c. found in almost every part of the world. Germany
and Switzerland abound in petrified fish. The Tyrol and cen-
tral Italy are rich in fossil remains, some of them extinct species.
In Asia, Africa, and Europe, as well as in America, huge bones
of various animals have been discovered. In Tuscany, those
of the Elephant, Rhinoceros, Mastodon, Tapir, Hippopotamus t
and others, have been found. In various caverns of France,
England, Germany and Hungary, those of bears, wolves, dogs,
foxes, hyenas, tigers and lions. The petrified remains of birds
are much more rare, but these too are said to exist. Fossil
bones of the human species are the rarest of any, yet the petri-
fied skeleton of a savage was found in digging the foundations
of the city of Quebec, two human skeletons by Rosenmuller in
the grotto of Geiss-knok, and one in the rocks of Guadeloupe
verified by Cuvier.

Nature, however, does not seem to have any where presented
the petrifaction of the entire human body, more especially not
of the softer and intestinal parts, nor of the blood. The tales
of a petrified man said to have been found at Aix in Provence,
in 1583, of those alleged to have been found in Switzerland
of the pretended city of Bidollo in Africa, and village of Rassem
in Barca, whose inhabitants with their cattle and utensils are
said to have been turned into stone, are all certainly fabulous.
A very few well attested instances of extraordinary natural
preservations of the human body have occurred ; as that of
Cristoforo Landino, one of the commentators on Dante, still
shewn in Casentino, (Tuscany) turned into a mummy, and un-
corrupted after the lapse of nearly five centuries. In the ceme-
tery of Venzone in the department of Passeriana, there is found
a narrow calcaro-siliceous stratum, in which dead bodies are
preserved for ages, but only superficially, for ail the internal
parts turn into dust. It is remarkable thnt the bodies interred
partly in this peculiar stratum, and partly in that above, or
below it, are partially preserved, and partially putrify-

96 Signor Segato's Discovery. [July*

There are obvious reasons why the natural petrifaction or
flesh should be much rarer than that of bones, in the different
properties of the two substances. The latter being calcareous,
have a greater analogy with the earths, winch replace them
particle by particle as they decay, while the former is so soft,
that it does not give time for the stony matter to insinuate
itself and form, before putrefaction commences.

Art has not heretofore succeeded better than nature. The
Egyptian mummies the embalming heretofore practised the
method of Ruyschius (unfortunately lost) the mummies made
by Chaillot, Capron and Boniface, much talked of in France
the preservations effected by Chaussier, 'and reproduced by Dr s.
Tranchlna and Giovacchino Komco the sepulchres of Sicily,
where bodies divested of the intestines and fluids are kept dry
for many years, all attest the wonderful ingenuity of man.
None of them however it must be confessed have arrived at
that degree of perfection evidenced in the discovery of Segato.
From an article obligingly communicated by the distinguished
Dr. Passed it appears, that being made acquainted with the
Creosoto*' discovered by Reichembach, and reflecting on its
chemical properties, it occurred to him, that it might be employ-
ed to render animal substances solid and inalterable. He men-
tioned this idea to several, and his wish to try the experiment.
Nor does his idea seem entirely unfounded, for about fifteen or
sixteen mouths since, the eminent chemist Signore Gaetan
Caramcsi having prepared an aqueous solution of Creosoto
placed in it a human finger and a small bird. Three days
afterwards they were exposed to the air to dry. They in fact
became hard, but as to their incorruptibility, though it might in
some degree be inferred from their solidity, it would not be
proper to affirm it, as they have not been exposed to the test of
humidity or worms, nor as yet, of sufficient time. Besides,
they had contracted a dusky colour by reason of the action of
the creosote, which becomes dark when exposed to the light.
These specimens are now in the hands of Scgato.

The ingenious Signore Carraresi imagined and tried another
experiment, He deprived some small pieces of animals of

*The Creosoto is a volatile oil contained in the Norwegian pitch, and is
produced along with smoke whenever vegetables are burned, li was dis-
covered not long- since by Reichenbach, and its most remarkable property
is that of preserving animal substances. W.

1836.] Skgnor Segato's Discover]/. 97

their aqueous particles, by means of pure alcohol saturated
with boracic acid, and that being effected, for the purpose of
solidifying the albumine, so that it might be secure from putre-
faction, he immersed it in the same alcohol, in a boiling state.
Subsequently exposed to the air, and dried, they became solid, so
as to be susceptible of some degree of polish. It must be admit-
ted, however, that these preparations are very far from the per-
fection of Segato's, as well with respect to colour as solidity.
Besides which, his having for ten years resisted the attacks of
moisture and worms, precludes all possibility of comparison
between them and pieces recently prepared. I have not seen
the specimens of indurated heart and blood, mentioned in an
anonymous article inserted in several Italian Journals, said to
have been prepared by Dr. Mori, of Piza, and of course have
nothing to remark upon them. I suspect, however, that the
observations of Dr. Passeri upon the experiments of Carraresi,
will be found equally applicable to those of Tranchini and Mori
also.

Florence, 10th January, 1836.

[It is now our painful duty to announce, on the authority of
.letters of a later date, from Mr. Wilde to his brother, the Hon.
John W. Wilde, the death of Signor Giromalo Segato. This
is an event greatly to be deplored. There was a lively hope
that Mr. Wilde would be enabled to induce him to come to the
United States ; where his genius, scientific attainments, and un-
tiring perseverance might have spread an influence around, the
value of which to this.country no one could estimate. With re-
gard to the process by which he effected those wonderful preser-
vations above described, it is greatly to be feared the world will
never be informed; for, at the date of the last communication
Jrom Mr. Wilde, no account of it had been found. Ed.]

1Z

i)S C nimilkier s Pathological .Anatomy, <fc.- [July

Part II. REVIEWS AND EXTRACTS.

Cruveilkiers Pathological Anatomy. Second edition of AliberCx
large treatise on, Cutaneous diseases. Bmirgcry's Anatomy.

Our medical college has just received a number of highly
interesting and valuable works from Europe, many of which,
from their high price, are unfortunately excluded from the
private libraries of the great majority of the profession. We
rejoice that we have amongst us an institution through the in-
fluence of which we are permitted to have access to the publi-
cations of our transatlantic brethren, however costly they may
be. This privilege is peculiarly valuable at the present period
of medical science, inasmuch as most of the improvements are
promulgated in foreign languages, and cannot therefore be re-
published without the slow and often inaccurate process of
translation. Indeed, many of the most useful works in medi-
cine have never been translated, and will probably never be
extensively known in our country, except through the medium
of periodicals.

Among the works received, are the two last fasciculi of Cru-
veilhier's pathological anatomy. One of these completes the-
first volume, and the other commences the second. The plates
are, as usual, of the most perfect finish, and a real treasure to
those whose opportunities of post-mortem examinations are
limited. These numbers are rich in specimens of affections >f
the bones, of the brain, of the stomach, and of the heart. M.
Cruveilhier having assigned no limits to his work, will, we
trust, continue with his accustomed judgment and zeal, thus to
treasure up the interesting cases which are continually pre-
sented to him at the Salpetriere, and at the Societe Anatomique.

The second edition of Alibert's large treatise on cutaneous
diseases, is at last completed. The. fasciculus just leceivcd
fully sustains the great superiority which has been claimed for
this over the former edition. The plates are incomparably
more perfect, many of the specimens better selected, and their
number greater than in the old work. It is much to be regret-
ted that such a work cannot be in the hands of all practitioners.
There is perhaps no class of diseases less generally understood
than that of which Alibert so ably treats. The reason is that
they are difficult to describe, and require to be seen to be un-
derstood. Alibert, in reprinting and improving his plates, has
therefore rendered a signal service to the profession, by placing
before the reader correct representations of every variety he
describes.

JS3(>.] C ruveff /tiers Pathological Anatomy ', <$-c. i)

An >incr work received is Bourgery's Anatomy, with plates.
It is the most extensive publication ever undertaken on any
branch of medicine, and has, we believe, never been surpassed
in magnificence and correctness. We hope that, notwithstand-
ing the heavy cost of the entire work, the mode adopted for its
publication will enable many to subscribe to it without serious
inconvenience. The following is an extract from the prospectus
handed us by Dr. L. A. Dugas, of this place, who is authorized
to receive subscriptions.

This great system of anatomy, then, will be comprised in eight volumes.
folio, and be embellished with from four hundred and fifty to five hundred
lithographic plates. It will consist of four parts : Descriptive anatomy ;
Surgical anatomy.; General anatomy ; and Philosophic anatomy.

The descriptive anatomy will be presented with all its details, and with
its physiological and pathological applications. This division will consist
of five volumes r the first containing osteology and syndesmology ; the
-second, myology, the aponeuroses, and the synovial bursas ; the third, the
nervous system, the organs of sense, and the larynx ; the fourth, the
apparatuses of circulation and of respiration ; the fifth, the digestive and
generative organs, and the anatomy of the foetus, or embryotomy.

The surgical anatomy will be composed of three sections, comprised in
the ixth and seventh volumes. The first section, or anatomy of inter-or-
ganic isolation, will show the organs apart from the ensemble, and some of
their diseases circumscribed mechanically and fixed in the interior of the
aponeurotic cells and bony confines of" the viceral cavities. The second
lection, or anatomy of inter-organic communication, on the other hand, will
exhibit the means of connexion between the organs, the pathological effect
of which is to facilitate the development and extension of disease. The
third section will present the anatomy of every important region of the
body in reference to the various operations of surgery, the whole of which,
and the different instruments, employed, will for the first time be system-
atically represented in the plates, and described in the text. Statistical
corollaries, deduced from results obtamed in an immense number of opera-
tions performed in different countries, under the most varied circumstances
it various epochs, will show the relative value of each plan of operation
pi; j-osed.

The general anatomy will present the study of every tissue under two
points of view, which form the connexion between histology, properly so
!, and pathology: 1st, as a whole, as one of the separate systems of
thy economy; second, as a part, in reference to the various places in which it
'is found, and as an integral item in the constitution of any particular organ
jdi- srstL-m of organs.

The philosophic anatomy will contain three sections : first, the laws of
the formation of the organism or economy, depending on which are the theories
of the vertebra and of monstrosity ; second, the influence of physical and moral
causes on the economy; third, the comparison of the economy of man with that
of Tic vertebrate animals; subjects extremely interesting not only to the

MEDICAL MAN, but to the MORALIST, the PHILOSOPHER, the LEGISLATOR, and

the political economist. The general and philosophic anatomy, together,
will form the eighth and last volume of the work.

The translation into English, now offered to the public, has been called
for by a number of subscribers to the work both in Great Britain and Amer-
ica. Undertaken by a gentleman familiar with the subject, and from a
copy with the latest corrections of the author, it is presumed that it will be
found in nowise inferior to the French edition. The plates for both the
'English and French editions are the same.

100 Tartar Emetic in Obstetric Practice. [July,

The complete work, as has been sai, will consist of eight volumes, folio,
and will appear in about fifty monthly parts, eacli containing from three t<*
four sheets of test, and eight lithographic plates,, with their explanations.

PRICE OF EACH NUMBER.

IN FRENCH.

The Plates uncoloured, on fine Vellum Paper,. - 8 francs,

do. do on China Paper, - - - 12

The Plates on fine Vellum Paper, coloured with the greatest care, 16 "

IN ENGLISH.

The Plates uncoloured, on fine Vellum Paper, - - - 10 shilling^

do. do. on China Paper, - , - - - 14 "

The Plates on fine Vellum Paper, coloured with the great- ) ,g

est care, \

N. B. The publication has reached the middle of the third volume,.

[From the Medical Journal of Medical Science.]

Observations on the use of Tartar Emetic in Obstetric Practice. By Evory
Kennedy, M. D. Master of the Lying-in Hospital, Dublin.

[CONTINUED FROM JUNE NO.]

Obstructed and Inflamed Mammae-. There .are two distinct states of
the mammae, occurring after delivery, which demand our notice. lit
both, pain and tenderness, tumefaction and hardness, are present ;
but one is an inflammation, the other merely an obstructed state of
the organ j though the latter generally precedes, and may produce
the former, yet it does not necessarily go in all cases. There is no case
within the range of obstetric practice so clearly under the control of
the medical attendant, as the tumified, lobulated and obstructed state of the
mamma?, and none so sure to terminate unfavourably, if improperly managed.
To treat it with effect, it is necessary to look to its cause. The immediate
state is a vascular determination to the glandules, together witli an accu-
mulation of the lacteal secretion within the ducts and tubes, and often in-
filtration into the connecting cellular tissue ; a state most frequently arising
from a disproportionate action between the secretories and excretories. We
can easily understand the frequency of the occurrence of this state of the
br fasts, when we consider how suddenly in most cases determination
occurs to them after delivery. Let us, then, bear in mind the function the
glandular part of the organ is so suddenly called upon to assume, and this,
perhaps, for the first time : thus rapidly converting the freely determined
blood into a nutritive fluid. Let us also call to mind the obstacles afforded
to the escape and extraction of the milk in impervious, ill-formed, or dis-
eased nipples, as well as the difficulty that opposes itself tp the transmission
of milk through ducts, perhaps for the first time ; or after a long suspension
of their action, called upon to perform the office of conduits ior thSe new

183&] Tartar Emetic in Obstetric FrachcK 101

and rapidly formed secretion. These considerations tend to explain a fact
observed in practice, that, with first children, or after long- intervals from
child-bearing-, more trouble is experienced with the breasts, on delivery.
When, in addition to what has preceded, we recollect the varying calibre
of the conduits, their ramifications, and the accidental obstacles occurring
in them, the effect either of present or previous disease, narrowing them, or
perhaps rendering them altogether impervious, and amongst the most com-
mon of these, determination to certain parts of the orga^i, from exposure to
cold, we need not wonder at trouble being so frequently caused by the
breasts, after delivery, but rather feel astonished that milk abscess is so
rare an occurrence. The rationale of the plan of treatment necessary to
adopt will appear from what has preceded, to be, simply, checking or pre-
venting too rapid a determination to the breasts, and relieving the ducts
and tubes by facilitating the transit and escape of the milk when secreted.
In effecting the first object, free saline purgation is necessary in the com-
mencement, after which nauseating doses of tartar emetic appear to act
almost as a specific in preventing inordinate determination. They also, no
doubt, act m producing absorption. Tartar emetic, however, appears to
eft*'ct the second object as well as the first, by its well-known power of
relaxing contractile tissues, thus rendering pervious the lactiferous ducts
and tubes, and accomplishing the double object specified. It is not to be
understood that tartar emetic has been had recourse to in all cases where
the breasts were hard and full after delivery, nor even that this medicine
would prove sufficient of itself to correct their obstructed state. The
general plan wis to administer saline aperients, rub the breasts mosl
assiduously, stupe them, extract the milk from them, if necessary, and im-
prove the state of the nipples, if they were diseased or indented. In the
freat proportion of cases, this is quite sufficient to produce softening of the
reasts with free discharge of the milk. It is only when this plan don't
succeed, or that symptoms are urgent, that it is deemed necessary to
nauseate the patient. The result of this practice is, that in the Lying-in
Hospital, where it is strictly enforced, a case of abscess in the breast is
scarcely ever met with. It is but right to state, that in private I have not
found the practice succeed so well; a circumstance ascribable simply to
the impossibility of having the necessary directions strictly and effectually
complied with. Ladies get fatigued with continued friction, and they do
not like the nauseating medicine. Where it has been fairly tried, however,
its results have been the same as in Hospital. Friction, to be attended
with benefit, must scarcely for an hour be desisted from, until the hardness
disappears and the ducts accommodate themselves to the secretions. The
usual orders to our nurses are, " to rub until the breast softens under the
hand." Warm oil is used to prevent irritation to the integument from the
friction. In inflammation attacking the breasts after delivery, either the
glandular or tubal structure, the investing sheath, or the connecting or sur-
rounding cellular tissue may be engaged in the inflammatory action from
the commencement, or the inflammation may occur consecutive upon the
state of the breast already described. In either case, throbbing pain,
general redness of the surface, with extreme tenderness to the touch, and
hardness at one part, will be present ; and these symptoms may be ushered
in with a rigor, or rigors may occur in their progress. When this attack
is observed, the patient is to be put immediately and freely under the influ-
ence of the tartar emetic. If purgation has not been previously attended
to, a grain of tartar emetic, given in a full dose of black bottle, is a good
commencement. This should be speedily followed by the nauseating mix-
ture, and if vomiting should be twice or thrice freely produced at the outset,
all the better, provided our patient can bear it. Warm stuping and fomen-
tations must be used, and the breasts drawn by a strong healthy child, or
by the exhausted bottle, and friction, if unattended with much pain, is to be
persisted in.. Leeches, under this plan of treatment, are seldom necessary

itru:2 ^Tartar Emetic in Ob&telric Practice. [July.

arid their efficacy, when used, appears very questionable. By a steady
persevererice in this plan, in cases even the most unpromising-, the inflam-
mation has been again and again subdued.

The child was generally applied to the breast early after delivery, at
least as soon as milk could be obtained. Ulcerated and fissured nippies,
which did not improve under slight stimulating lotions, as Sir A. Cooper's
spirit and borax wash, were touched with a solution of nitrate of silver, ten
or twenty grains to the ounce, a plan found particularly serviceable where
there were sprouting granulations or excrescences projecting in the fissure,
alto acted with excruciating pain. In obstinate cases of this kind, even
touching with solid caustic was necessary, and often relieved the patient
from immense protracted suffering.

Puerperal Mania. This form, which constitutes so great a proportion of
the maniacal cases met with not merely in the Hospitals for insane, but
in the incurable cells, when treated properly from the commencement of
the attack, is a very manageable disease. Were it only for its efficacy in
this distressing malady, the accoucheur should esteem tartar emetic as a
most invaluable article in his prescription formulary. In several years
observance of this medicine's application, in Hospital and private practice,
but two or three cases have been met with which held out against it, when
commenced sufficiently early. The moment a patient was observed to
exhibit any incoherence after delivery, attended, as it usually is, with rapid
pulse and wild expression of the eye, she was placed under its nauseating
influence, and retained so- for twenty- lour or thirty-six hours, or longer if
necessary. In almost every case the disease yielded immediately ; the
real ills produced by the medicine taking the place of the imaginary ones
previously occupying her attention. The only treatment in general
necessary, in addition to this, being the administration of aperients, and
ensuring sleep by free opiates, when the patient had been sufficiently sub-,
jeefced to the action of the tartar emetic. Diagnosis in puerperal mania
requires attention. The case most likely to be mistaken for it, is hysteria ;
an affection of no very Uncommon occurrence after delivery. An error in
diagnosis, between these diseases, is not, however, attended with any very
serious inconvenience in the treatment, as I have found from experience
the plan here recommended for puerperal mania proves most effectual in
curing hysteria ; although it is perhaps, somewhat more violent than the
nature of the case demands. It may be right to mention that two fatal
cases of peritonitis occurred in Hospital, which commenced witli all the
symptoms of puerperal mania, and Which were treated at first with tartar
emetic. In one case, in the course of a few hours from the exhibition of
the maniacal, symptoms ; in the other, after a lapse of two days from their
commencement, unequivocal -evidences of peritonitis set in, and in both the
disease ran rapidly to its fatal termination. A peritonitic tendency was
very r revalent at. the time. In puerperal mania peculiar care is necessary
to prevent the depressing effects of tartar emetic being produced, and with
this view a larger quantity of laudanum may be added to the nauseating
mixture. Patients labouring under this disease, are not able to bear the
same aetive treatment as some of the other cases alluded to where this
in. ine has proved efficacious. The pulse in puerperal mania, whilst it is
very rapid, is generally small and hard, often wiry, and here a medicine
possessing such depresting propensities, must be used with the greatest
^caution. A case occurred to me in consultation with Dr. Harvey, of this
city, some years since, strongly illustrating the necessity of caution in this
respect. We had placed our patient under the influence of the medicine,
with the usual directions to her friends of administering or withholding it-
as might be necessary. These, however, were unattended to, and on our
n< risit we found her in a most alarming state. The medicine having
reduced her to such a degree of debility as to deprive her of the power c*

.1836.] British Association. 103

motion, her pulse was barely perceptible, and the extremities and surface
quite cold. Stimulants were freely administered, and friction and warm
applications used to the surface and extremities, and she immediately
recovered, not merely from the remedy, but from the original disease.

In concluding' this paper, it may be mentioned, that it is not swelled out
with cases, (an abundance of which could have been furnished;) as it is:
neither wished to extend it unnecessarily, nor to put forward trie practice
recommended as that tried experimentally in a few eases, but as the ordi-
nary plan of practice adopted, as well in private as in an Institution con-
taining one hundred and forty beds, and where about two thousand fiv'3
hundred patients are annually admitted. As much of it was adopted by my
predecessor in office, Dr. Collins, an opportunity will shortly be afforded of
testing its success, and observing the proportion of recoveries in these
cases^recorded in that .gentleman's, report of his seven years' mastership.,
shortly to be published ; and it is confidently anticipated that in this report
will be exhibited a degree of success, not merely m the cases treated of,
but in midwifery practice generally, never before recorded. I ventured to
publish an expression of my opinion of Dr. Collins' talented, accurate, and
laborious undertaking two years since, how far correctly, the%*ecent vote
of hanks presented by the Anatomical Section of the British Asso
him, fbr this very report, has proved.

Dublin, 8eplember9 1835.

Extracts from that part of the proceedings' of the Medical
Section of the British Association in the session of August,
1835, which is detailed in the Medico-Chiriirgical Review for
October last.

First Day, 10th August. Internal use of Chloride of Sodium in Fever.

Dr. B. Graves read an interesting paper on the internal use of chloride
of sodium in fever, from which we make the following extract, as embodying
the pith of the practical portion of the communication.

" With respect (said Dr. G.) to the time for its exhibition, and the cases
to which it is adapted, the following remarks may be made. When the
early stage of fever is past, when all general and local indications have been
fulfilled, when there is no complication with local disease, when the patienf
lies sunk and prostrated, when restlessness, low delirium, and more or les.-
derangement of sensibility is present, when the body is covered with
macula?, and when the secretions from the skin and mucous membranes give
evidence of a depraved state of the fluids, it is then that the chloride of
sodium may be prescribed with the most decided advantage. The mode
in which I prescribe; it is in doses of from fifteen to twenty drops every
fourth hour, in an ounce of water or camphor mixture. How it acts I will
not attempt to explain ; it is sufficient to say, that there is no remedy from
which, in such cases, such unequivocal benefit is derived. It operates
energetically, though not veryrapidly, in controlling many of those symptoms
vrhich create most alarm. It seems to counteract the tendency to tympan-

104 British Association. L^tyi

itip, to correct the fetor of the excretion?, to prevent collapse, to promote a
return to a healthy state of the functions of the skin, bowels, and kidneys ;
in fact, it appears admirably calculated to meet most of the bad effects of
low putrid fever. To these who have witnessed its efficacy, it is unneces-
sary for me to say any thing. Of course it will fail, like all other remedies,
when the disease has reached a certain point of intensity hi individual cases.
There is scarcely any acute disease, to which the human body is liable,
which may not in some particular persons assume an intensity capable of
baffling ail the efibrts of medical skill. This, however, is no argument
against the employment of a remedy of extensive utility and unquestionable
value.

Although it is not my intention to give an account of what has been don
in France with respect to the exhibition of this remedy, yet I may mention
that it has been extensively tried in fever by Chomel, and as I have learn-
ed with great success. This excellent physician is still, I believe engaged
in making further clinical experiments on the subject. In the Gazette Me-
dicate de Pari?, published on the 28ii of last February, we have an accoi.it
of Dr. Dor, of Marseilles, of several cases of typhus, in which the chloride
of sodium was found beneficial in 18-33. He attributes a more rapid amend-
ment to the use of tins remedy than I have even seen follow from its exhi-
bition, and he also asserts, that if not given with great caution, it produces
a very tedious convalescence. In the latter remark, especially, I cannot
concur ; for all who witnessed this mode of treatment here, were struck
with the security and quickness of recovery which ensued in those cases
where it had been employed. Perhaps, the precaution we adopted of al-
ways diminishing, as soon as possible, the strength and frequency of the
doses, rendered the results in our hands more satisfactory than those ob-
tained by Dr. Dor."

Dr. Graves concluded his observations by reading a letter from his col-
league Dr. William Stokes, in which the use of this remedy is stated to
have been followed by the most satisfactory results. It gradually but stea-
dily removed all the bad symptoms, and in -ill cases the patients had most
favourable convalescences. Dr. Stokes remarks, that all these cases re-
covered without any evident crisis.

Second day, 11th August. Motion and Sounds of the Heart.

The motions and sounds of the heart occupied the whole of this sitting.
A committee had been appointed to experiment on this subject, and having
made their experiments and drawn up their report, they presented them
to the meeting. We cannot notice all, or many of the experiments per-
formed by the committee, but only one or two to elucidate the inquiry.

Experiments on the motions of the Heart.

" Experiment 1. A calf, two days old, having been secured on its back,
and prepared as above described, the sternum and a portion of the ribs on
both sides were removed, when the following motions were observed. The
heart was beating strongly, at the rate of one hundred and forty-four
pulsations in the minute, but in a short time fell to eighty. While still
enclosed in the pericardium, the heart was observed to have a slight vibra-
tory motion on its longitudinal axis, which motion, it may here be remarked,
may assist in explaining the phenomenon of frottement in disease. On
cutting open the pericardium, and turning it aside, both the auricular ap-
pendices were seen to project with a rapid motion upwards, or towards the
place of the sternum, and immediately afterwards to recede. When coming
forwards, they were swollen and soft to the touch ; when receding they
became hard to the touch, were diminished in size, and flattened. Imme-
diate! v after the recession of the auric idar appendices, the ventricles with

1836k J British Association. 105

a rapid motion assumed a somewhat globular form in their middle^ part, which
projected towards the sternum, and the apex at the same time was
pushed considerably in the same direction. During their continuance in
this state, the ventricles were hard to the touch, and if grasped by the hand,
at the commencement of the movement, they communicated a shock or
impulse, and separated the fingers. When the ventricles had remained for
a short time in the state just described, they suddenly sank downwards or
towards tire- spine, and became elongated, broad and flat, and soft to the
touch.

This succession of motions having been observed for some time, a small
glass tube was introduced through a puncture into the left auricular appen-
dix, and the blood was seen to rise in the tube during the recession of the
appendix, and to subside during its upward movement. A similar tube was
introduced through a puncture in the right ventricle, and a jet of dark-
coloured blood was thrown forth during the globular and hardened state of
the ventricles, and subsided when these became flattened and soft. A
puncture was made in the pulmonary artery, close to the ventricle from
which it arises, and through it a stream of blood issued synchronously with
the jet from the tube in the right ventricle. A tube having been introduced
through a puncture in the left ventricle, -and one of the mesenteric arteries
having been exposed and opened, the jet from the ventricles was observed
to .recede the jet from the arteries, by an interval easily appreciable. The
femoral artery was opened, and a similar observation was made as to the
interval between the jet from the left ventricle and the jet from that
artery. Previously to opening the chest, the committee had satisfied them-
selves, that the beat of the hearty felt through the sternum and cartilages
of the ribs, preceded the pulse, felt in arteries at different distances from
the heart by intervals of time which were proportioned to those distances :
and they were also satisfied, that the jets of blood from the mesenteric and
femoral arteries were synchronous with the pulses felt in those arteries.

Experiment 2. In a calf, prepared as the former had been, and placed
on its right side, a portion of the ribs on the left side was removed, the
sternum and part of the cartilages on that side being left in their natural
position, and the pericardium was opened. It was now seen that when the
ventricles assumed their hardened state, their apex, and a considerable
portion of their anterior surface were closely applied to the sternum, and
wiien the hand was interposed between the latter and the surface of the
ventricles, a strong compression was exercised on the fingers, during each
approach of the ventricles to the front of the chest. When the ventricles
were in their softened state, their interior surface, by which is meant the
one corresponding to that called anterior in the human heart, was some-
times in contact with the sternum, and sometimes removed to a little dis-
tance from it, and from the contemplation of this, and the preceding experi-
ment, the committee were satisfied that the situation of the heart in the
thorax is affected by the position of the body, as has been observed by
others ; for instance, that in the recumbent state, on the back, the heart
recedes somewhat from the sternum : if the individual lie upon the face, the
anterior surface of the ventricles is in constant apposition with the front of
the chest, the pericardium of course being interposed. The yielding-
texture of the lungs, and the mode of attachment of the pericardium and
the great vessels, are such, as to allow the gravitation of the heart to
influence its position in different postures of the body. These experiments
were repeated on different subjects, and the observations recorded above
were confirmed."

For the experiments on the sounds of the heart, we must refer to the
Dublin Journal, contenting ourselves with the conclusions to wliich the com-
mittee came from the said experiments.

"From the experiments on the sounds of the heart, it appears to follow :
1 . That the sounds are not produced bv the contact of the ventricles with
14

0t> British Association. \S\3bf9

the sternum or ribs, but are caused by motions witliin the heart and its ves-
sels. 2. That the sternum and front of the thorax, by their contact with
the ventricles, increase the audibleness of the sounds. 3* That the first
sound is connected with the ventricular systole, and coincides with it in du-
ration. 4. That the cause of the first sound is one which begins and ends;
with the ventricular systole, and is in constant operation during the contin-
uance of that systole. 5. That it does not depend on the closing of the
auriculo-ventricular valves at the commencement of the systole, because
such movement of the valves takes place only at the commencement of the
systole, and is of much shorter duration than the systole. 6. That it is not
produced by the friction of the internal surfaces of the ventricles against
each other, as such friction cannot exist until the blood has been expelled
from the ventricles, whereas the first sound commences with the beginning
of the ventricular systole. 7. That it is produced either by the rapid pas-
sage of the blood over the irregular internal surfaces of the ventricles on its
way towards the mouths of the arteries, or by the bruit musculairc of the
ventricles, or probably by both these causes. 8. That the second sound
coincides with the termination of the ventricular systole, and requires for its
production the integrity of the semilunar valves of the aorta and pulmonary
artery, and seems to be caused by the sudden check given by the action of
these valves to the motion of the columns of blood driven towards the heart
after each ventricular systole by the elasticity of the arterial trunks.

The Committee wish, in concluding this report, to express their opinion,
that although much light has been thrown on the subject of the Motions and
Sounds of the Heart, by recent investigations, here and elsewhere, the na-
ture of the enquiry is such as renders it difficult in many instances to arrive
at satisfactory conclusions. They also think that the subject, from its im-
portance, whether in a practical view, or as an object of philosophical in-
quiry, is deserving of further investigation."

As might be expected, a long discussion ensued, in which Dr. \ v illiamsr
of London, and Dr. Corrigan, of Dublin, were the most prominent orators.
Dr. Corrigan candidly confessed that he was wrong in some of his first con-
clusions, and was convinced that his character would not suffer by this
avowal. We are sure it will not ; but, on the contrary, be raised by such
honorable and honest procedure. The thanks of the meeting were voted
unanimously to Dr. Williams.

Third Day. Action of the Heart and Pulse.

Dr. M'Dormell, of Belfast, read a paper this day on the action of the heart
and pulse. Our author has some claim to antiquity, as well as to "priority,'''
mi such observations, having commenced as early as 1764," that is, rather
more than half a century back.

" He finds that in lying, sitting, or standing, there are three distinct num-
bers in the pulse, any one of which being given, the rest may be discovered
by inference. This variation amounts generally to twelve, fourteen, or six-
teen beats per minute, as its normal state, and therefore, that all observa-
tions of the number of the pulse, which have been made without reference
to +his principle, must be considered as nugatory, unless it be implied that
the person was in the horizontal 'position when the observation was made.
This rule for reducing the number of the pulse to a regular standard, applies
to health, but not precisely to disease ; the effects of posture must be inves-
tigated separately in each disease.

The differential pulse appears to be confined to man. It is not observed
in brutes, probably because from their form, their posture may be considered
as always horizontal ; but when placed erect, this peculiarity appears also
in them.

The variation, in the human species, is at its maximum in tall and feeble
subjects, particularly in convalescents from typhus ; the minimum is gene-

1836.] British Association. 105?

Tally found in children. These facts lead to the supposition, that this phe-
nomenon is connected with some hydrostatic law, and not depending entirely
on vitality. This, however, is merely thrown out as a conjecture, and re-
quires further investigation. But in whatever manner it may be consid-
erc d, it is plain that in all attempts to ascertain the effects of remedies, as
wr H as of natural causes, due allowTance must be made for these fixed dif-
ferences produced by posture. What avails it to say that a medicine, or
venesection, or heat, or cold, or a thousand other natural causes, raise or
depress the pulse by four, six, or eight beats per minute, when the mere
-change of posture would raise or depress it twelve, fourteen, or sixteen per
minute, and this merely in health, for in disease the differential pulse is
often double this proportion.

In tracing the connexion between the pulse and respiration in man and
quadrupeds, he finds that it ranges in health from four to six pulses for one
respiration. This he considers a new and material fact ; for if it be esta-
blished by further observation, that this is a general law, we shall be able
to infer the pulse from the respiration, and vice versa. This may be of
advantage in enabling us to ascertain the number of the pulse in ferocious
animals which we dare not touch, as well as in man during action or pro-
gression.

There is a coincidence between the number of pulses and steps in walk-
ing, at the common rate of progression in man, that is very remarkable and
iias not been hitherto noticed. His breathings are also singularly propor-
tioned to his steps, so that it is easy to deduce these numbers from each
other. But in hard labour or violent muscular exertion, as in running or
ascending heights, the proportions are greatly altered. The same thing
occurs in many forms of disease. There is reason to believe that the car-
Jx iization of the respired air has a great influence in all those cases where
the number of respirations is greatly disturbed.

Dr. M'Donnell finds that the number of respirations, and by inference
the number of pulses, are much the same in passing over the same space,
whether we run or walk, i. e. they depend as much upon the space tra-
veled as on the time. Thus he "finds, if he walks one thousand yards in
ton minutes or in eight, or runs over it in five minutes, the number of
breathings are nearly the same. It is to be observed, however, that this
rule does not apply to small portions of space, such as fifty or one hundred
yards. These facts, he thinks, are all complicated with carbonization and
muscular motion, so as to require separate investigations.

In quadrupeds, especially when trotting or cantering, he has found that
the steps, divided by the respirations, never give any fraction in the quo-
Ti"V, i.e. thai these are universally proportional without any deviation.
In man this does not occur, a circumstance which may arise from some
peculiar anatomical or physical law in the connexion between the respira-
tory and muscular construction of these animals."

" While engaged hi these enquiries, about thirty years since, he had
found that the pulse in the arteries of the foetus, before it breathed, was
sloteer than in those of the mother. He had found also, that if the child,
when born, remained for some time without breathing, the pulse continued
slow during that interval, and became accelerated only at the instant it took
its first breath. This fact appearing to him new, he had investigated the
circumstance in the cow, and finding the phenomena similar, he had commu-
nicated his observations to Dr. Clarke, Dr. Labatt, Dr. Stokes, and Dr.
Douglas in Dublin, none of whom had ever noticed it in any other. Dr.
Jeffrey mentioned it in his lectures, and in his * Observation on the Heart
and on the Peculiarities of the Foetus,' and thought it might hold true of
quadrupeds, and of all warm-blooded animals. He thought it probable that
the foetus before respiration was in the condition of a cold-blooded animal,
and partook of that slowness of the pulse which characterizes the tribe."

108 British Association. ^J uly ,

Dr. Collins observed that, from the experiments he had made on the
subject, he had come to a very different conclusion. "He had invariably
found the circulation of the foetus much quicker than that of the mother."
In this observation we concur. Why should the circulation be quicker in
children than in adults, if it were slower in the icstus than in the child.
Perhaps the respiration may account for this dhTerence.

Fourth Day. Bruit de Soirfflet, (Blowing Noise.)

" The sound to which bruit de soufflet has been given, is produced in va-
rious parts of the circulating apparatus. Its existence has been ascertained
within a comparatively short period, and is due to the inquiring spirit of
modern investigation. Few things are more interesting, as objects of pa-
thological curiosity, than the production of sounds in the vessels of the hu-
man body under certain circumstances. The nature of these sounds has
been examined with all the attention which the subject deserves, and not.
only has their existence been determined, but it lias been iound that they
constitute some of the most important signs of disease.

It is interesting to inquire, on what peculiar mechanism bruit de souffle!
depends, as unless we are properly acquainted with the manner in which it
is produced, we never can apportion to it its due importance, or estimate its
proper value as an indication of morbid change. The first part of this
communication I shall not read ; it consists of an analysis of the various
opinions of others, as to the mode in which this sound is formed. I shall
merely s^ate, that Laennec supposed it to arise from spasm ; and to Dr.
Williams, who has followed him in the same path of inquiry, we owe the
suggestion that it might be found to arise from the operation of physical
ca uses. Dismissing the examination of these and various other opinions, I
shall proceed at once to the statement of my own views on the production
of t iiis sound, remarking in limine, that it is heard under a great variety of
circumstances. We hear it in narrowing and in dilatations of the aorta, in
narrowing of the ventricular opening from disease of the valves, and in per-
manent patency of the aorta, in varicose aneurisms, in aneurismal varix, in
the vessels of the uterus during pregnancy, and even in vessels without
any appreciable disease. For the production of bruit de soufflet the simul-
taneous presence of the two following conditions are necessary: first, an
irregular current-like motion of the blood, (instead of its natural equable
movement,) tending to produce corresponding vibrations on the sides of the
art Ties or cavities through which it passes; and secondly, the state of the
art- ri^s or cavities themselves, by which, instead of being kept in a state of
tense approximation on their contained inelastic blood (and which would
necessarily prevent any vibration in their sides), they become free to vibrate
from the play of the currents within on their parietes, and by these vibra-
tions give to the sense of touch 'fremissement,' (trembling) and to the sence
of hearing 'bruit do soufflet.'

If you press on the femoral artery below Poupart's ligament, so as to di-
minish the calibre of the vessel, you necessarily diminish the supply of blood
to 'he artery below the point of pressure, while the outlet through its
branches continues as before. You do not interfere with the action of the
hi rt above or the artery below, you merely diminish the area of the vessel
at ho part where pressure is applied. Now if a linger be placed en the
artery, a short distance below the point of pressure, a fremissement
is Pelt, and if the stethoscope be applied over the same spot, bruit de
soufflet is heard. This BOi rid is present in a very roinarkabc degree in nar-
ro.vmg of 1 he auriculo-ventricular openings of the heart, In this disease the
free edge of the valves is most commonly the seat of morbid action, it be-
comes thickened and drawn in, and thus narrows the opening. Now the
ventricle after each contraction leav< s :{s Bides in a flaccid state, favourable
for being acted on by the next gush of blood from the auricle into the ven-

1836.] British Association. 109

tricie. The consequence of this is, that the fluid, passing through the nar-
rowed auricuio-venincular opening, is, in obedience to a well-known law in
hydraulics, thrown into diverging currents, and if the hand be applied to the
chest, a frennssement may be felt, and a loud bruit de soulhet heard.

Having mentioned the occurrence of bruit de soufflet in the narrowed
state of an artery, as also in narrowmg of the auriculo- ventricular ope sni
1 shall contrast with those a peculiar condition of the aorta, viz. permanent
Dcy of its mouth, in which the sound is heard without any narrowing
whatever. [Dr. Corngan here exhibited drawings of the disease in ques-
tion.] In some of these cases, the semilunar valves nave perforations or
holes in them; in others they are thickened and bound back to the sides of
the aorta ; in others they are ruptured. In some instances, however, the
valves remain healthy, the mouth of the artery becoming dilated, so that
they cannot close across its mouth ; and in these instances, how is this
sound produced ? It arises from the artery not admitting, hi these condi-
tions^ of being kept in a sufficiently tense state, so that at the next rush of
blood the blood sent in does not move equally, and this current-like motion of
the blood playing on its sides produces in them corresponding vibrations,
and the sound is heard.

I have noticed all these cases to show under how many various and see-
mingly contradictory circumstances it may occur. During pregnancy it
may be distinctly heard in the vessels of the uterus after the fourth or fifth
month. If we examine the state of these vessels, we shall find that the con-
ditions necessary for the productions ot bruit de soufflet are present. Their
free anastomosis with veins and sinuses permits them to become partially
flaccid in the intervals of the heart's contraction, their sides are thin, and the
rush of blood into these comparatively flaccid tubes at the next contraction
of the ventricle, gives rise to the current-like motion en which the sound de-
pends. The existence of similar conditions will explain its occurrence in
varicose aneurisms and aneurismal varix.

Having alluded to these cases in which it is heard in certain diseased
conditions of the heart and arteries, I may notice those cases in which its
occurrence is unconnected with vascular disease. If a patient be blooded
too much, or if an animal be dying from the effects of haemorrhage, this
sound is heard in the heart and great vessels. Here, in consequence of the
quantity of blood which has been abstracted, the equilibrium of the circula-
tion is destroyed, and the arteries not having a sufficient quantity to keep
them in a tense state, bruit de soufflet is the consequence. We also meet
with it occasionally in the healthy state of the heart, hi nervous and irritable
individuals. In this case the equilibrium ot the circulation is destroyed by
various causes of excitement, and the calibre of the vessels becomes dis-
proportioned to the quantity of contained blood, so as to give rise to a cer-
tain degree of flaccidity of their walls. It is a well known observation, that
this sound is never heard in plethora or inflammatory fever, for in these con-
ditions of the system, there is not room for the vibrations of the arterial
tunics.

Dr. Corrigan concluded, by detailing an expriment in proof of the fore-
going theory.

A small bladder in one instance, and a length of gum-elastic tube or gut
in another, were interposed between two cocks, the upper connected with
a water cistern ; the cock at the other or lower end being the discharging
orifice of the bladder or gut. On allowing the water to flow through, the
sound of bruit de soufflet and the sensation of fremissement were percepti-
ble in the intervening bladder or tube until (from the upper pipe pouring in
fluid faster than the lower discharged it) the bladder or gut became tense,
and then both sensations ceased, the discharge of fluid from the lower pipe
continuing all the time. This experiment was applied to explain the occa-
sional presence or absence of bruit de soufflet in aneurisms , the sound be-
ing present in an aneurism, if the parietes can from any circumstance be-

110 British Association. [July,

come at all flaccid in the interval of the heart's contraction, and being ab-
sent where the parietes are distended and tense."

The than!:? of the meeting were voted to Dr. Ccrrigan by Mr. Cramptcn.
Dr. Harty had observed bruit de soufflet in all the arteries where a polypus
of the left ventricle of the heart existed. Dr. Williams observed that his
views had not been stated quite correctly by Dr. Corrigan. He had attribu-
ted the bruit de souiliet to narrowing or obstruction of the vessels; but he
did not deny that circumstances might modify the course of the blood, and
have a share in producing it. Hr- thought Dr. Corrigan's explanation would
not apply to ossified aorta, in which the bruit is sometimes heard. But Dr.
C. was able to defend his doctrine against all objections.

" In reply to Dr. Williams' observations he would say, that he was aware
of the esistence of the bruit in ossification of the aorta. In such cases, when
the first current has been thrown back, the next impinges on a portion of the
tube most likely to be thrown into sonorous vibrations. This circumstance
had been already noticed by Dr. Wm. Stokes, and he had remarked that
where this intense musical sound occurs, you may guess fairly that the dis-
ease is ossification of the aorta."

A paper was then read by Dr. Perry, of Glascow, on typhus ; but no par-
ticulars are published. An ingenious curved drill catheter was shewn by
Mr. L'Estrange when the meeting was adjourned.

1836.] Pathological Anatomy of Phthisis. Ill

Part III. MONTHLY PERISCOPE-

Pathological Anatomy of Phthisis.

The plan of medical improvement which now occupies the
profession, of investigating with the knife in the most careful
and patient manner the seat of disease, preserving the morbid
specimens, and illustrating the views obtained, by paintings
and coloured engravings, is worthy of all attention. It cannot
fail to afford important aid to diagnosis, and consequently to
therapeutics and prognosis. Whilst, therefore, we should be
careful lest, by our observations on the mortal effects of disease,
we be drawn into improper theorizings ; and whilst we are
particularly cautious that we be not led to look to those effects
of disease as the only cause ; we cannot, on the other hand, fail
to derive great benefits in practice by as full a knowledge as
may be obtained of their pathological truths.

Few things, therefore, can be more valuable to us than minute,
candid and faithful accounts of these phenomena, as detailed by
those of ample talents, and who have no favorite doctrine to
sustain ; but only search for the truth as exhibited by nature
herself.

The excellent opportunities afforded M. Louis, in the Hospi-
tal of la Charite, during some years in the prime of life, with
the vast store of the most valuable acquirements of which he
was previously possessed, to which we may add his present
service in the Hospital of la Piete, and an independence of mind
and a spirit of honest research after truth, alike creditable to the
moral and intellectual man, have enabled him to determine the
fallacy of some of the fashionable and exclusive doctrines of his
late preceptor, M. Brous-.ais; and to establish many facts of pri-
marv importance in the pathology and diagnosis of Phthisis.

We shall direct our attention for the present to a few of
those results, which we have extracted from the Medico-
Chirurgical Review, the truth of which, says the English
Reviewer, M. Louis has the merit either of having first an-
nounced and proved ; or if they had been discovered before, of
having finally and irrevocably established.

1. The existence of tubercles in any organ or tissue of the
body, after the age of fifteen, indicates their simultaneous pre-
sence in the lungs*

2. Tubercles, when co-existent in the lungs and in other
parts of the body, are invariably more advanced in the former ;
whereas, in the latter, the developement is usually equal.

Whilst the experience of M. Louis in these is confirmed by Dr. S' acker,
C. Smith, Bonitus. Morfrasmi and others, it is contrary to M. Lienttoe's

112 Pathological Anatomy of Phthisis. [July,

3. Tubercular deposition almost invariably commences in
the upper lobes of the lungs; it is found mure frequently in the
left than in the right side, in the proportion, as far as his obser-
vation has gone, of five cases of the former to two of the latter.

4. Simple Bronchitis commences at the base of the lungs,
pursuing a course inverse to that of phthisis.

5. Chronic Peritonitis generally indicates pulmonary tuber-
cles.

0. Large vomicae are generally nearer the posterior than the
anterior surface of the lobes of the lungs.

7. Large excavations are almost exclusively formed in the
upper lobes ; and it is a very rare occurrence that when a very
small vomica is discovered in the lower lobes, when the upper
ones are altogether exempt.

8. Although tuberculous deposition more frequently takes
place on the left than on the right side, still, in a large majority
of cases, both lungs are simultaneously diseased.

9. Of eight cases of vomicae which had opened into the cavity
of the pleura, seven were observed on the left side.

10. The great tuberculous excavations of the upper lobe
were nearer the posterior than the anterior edge of the longs :
nnd in many instances their sides in the former direction wTere
found almost wholly formed by a false semi-cartillaginous mem-
brane from a line to a line and a half in thickness, enveloping
the summit of the organ, lnferiorly they were sometimes only
separated from the pleura of the interlobular fissure by a thin
layer of pulmonary tissue, more or less modified; or there was
a perforation of their parietes communicating with another ex-
cavation situated in the posterior part of the inferior lobe. In
no instance did M. Louis find extensive excavations in the cen-
tre of the lower lobes.

" These, and other results of M. Louis' researches," says the
reviewer, " speedily attracted the attention of his cotemporaries ;
and although they were contradicted and cavilled at on their
first announcement, their truth and value have since been very
generally admitted, and have tended to establish the reputation
of the author as one of the ablest pathologists of modern
times." Such are the merits of this acute and independent inves-
tigator, and such the power of truth, that, we are informed, "by
far the greater number of the advanced students in Paris, (prin-
cipals English, American, and German.) have of late deserted
the Clinique of M. Broussais, and now follow the visits and lec-
tures of his pupil."

The extremely accurate and minute observations of M. Louis,
on the whole one hundred and twenty-three cases of his inspec-
tion, do not confirm the observation of Laennec and others, of
the existence of cavities communicating with the bronchia, and
lined, as in tuberculous excavations of long standing, with a

1836.] Pathological Anatomy of Phthisis. 113

light grey false membrane, semi-cartilaginous and semi-opaque,
surrounded by healthy pulmonary parenchyma ; for he found
this in no one case. He also failed to meet with those masses
of condensed cellular tissue in which the bronchial ramifications,
more or less dilated, terminate ; and which Laennec considers as
the. cicatrices of tuberculous cavities.

We think it strange, but nevertheless not impossible, that the
observations of all may have been correct, and that in Louis'
one hundred and twenty-three cases, there may have been none
of those cicatrices which were observed by others. But we
would suggest a view of this phenomenon, which may perhaps
tend to reconcile these apparently opposite observations. We
are of the opinion that abscesses do form in the lungs, as simple,
and every way of the same character as those which form in
the superficial cellular tissue ; that they terminate by suppura-
tion, and discharge through the bronchii ; and entirely heal, and
the patient recovers from all appearance or evidence of disease.
This opinion is founded on actual observation of facts. The
fact relative to this matter, then, is probably this, that those
masses of condensed cellular tissue, and fibrocartilaginous
membrane which were by Laennec and others considered cica-
trices, were really those of obliterated or healed, but not of
genuine tubercular cavities that they were only the cicatrices
of abscesses which had been previously formed in the pulmonay
parenchyma, discharged and healed ; after which, and when
the strumous character of the case became more completely
developed, genuine tubercular cavities were formed.

11. In one hundred and twelve cases, M. Louis found but
one case in -which both lungs were free in their whole extent
from adhesions between the surfaces of the pleura. In eight
cases the right, and in seven the left lung did not adhere at any
point of their surfaces. It appears that the pleural adhesions
indicated, by their extent, firmness, &c. the number and size of
the tuberculous excavations of the lungs.

12. M. Louis observed in one-tenth of his cases, that pleuritic
attacks had been made in the last stage of pulmonary Phthisis,
as evinced by a layer of soft yellowish coagulable lymph on
points of the pleura, indicating its formation within four to
eighteen days preceding death.

13. The false membranes, formed by pleural inflammation,
were found in a few instances to have acquired quite a car-
tilaginous firmness, in consequence of the deposition of genuine
tuberculous matter in them.

14. An effusion into the cavity of the pleura of a clear fluid,
in quantity a pint and upwards, was found in one-tenth of the
cases. This, M. Louis believed, had taken place very rapidly ;
because he had found in two instances, that the thorax gave
<'Vcrv where a Very clear sound on percussion thirty-six hours

15

114 Pathological Anatomy of Phthisis, [July.

before death, in which, after death, he found two pints of fluid
in one side of the chest.

15. In thirty-one out of one hundred and two cases examined,
there was ulceration of the mucous membrane of the bronchia,
with or without inflammatory redness of its surface. These
ulcers were round or oval ; and when small, were scattered
throughout the circumference of the air-tube, and varied from
a line to a little more or less in diameter. These, we are told,
have, from their edges being flat, and their base formed by the
cellular tissue, slightly or not at all thickened, escaped the at-
tention of many pathologists.

16. The ulcerations are usually more numerous and large in
the lower than in the upper half of the trachea.

17. The large ulcerations of the trachea are more scattered
and apart than the smaller ones ; and are generally found on-
the posterior, fleshy part of the tube.

18. In two cases M. Louis found a certain number of the
cartilaginous rings completely denuded, diminished in thickness,
and either partially or entirely destroyed ; and in five cases
the complete destruction of the mucous membrane of the tra-
chea throughout almost the whole extent of its fleshy portion.

19. These anatomical investigations have proved that the
symptoms of ulcerated trachea are very obscure. Pain, with
a sense of burning, and of obstruction just above and behind the
sternum, was experienced in a few cases. These distresses
were sometimes referred by the patient to the larynx, whilst
this part was exempt from disease, and only the trachea ulcer-
ated.

There were no pathognomonic characters in the breathing,
cough, or expectoration. As an example, in one case wherein
the whole length of the wind-pipe, with the epiglottis, including
the appendages, to the termination of the trachea, exhibited
patches of deep and extreme ulceration, so that some of the
cartilaginous rings were denuded, and others more or less com-
pletely destroyed, no prominent symptoms were present during
the life of the patient.

20. Simple in^ammation of the trachea is more frequently
accompanied with pain, and a sense of heat in the part, than
ulceration.

21. Ulcerations of the larynx are more frequent than, but are
very rarely unaccompanied by, those of the trachea. They
were found in twenty-two out of one hundred and two cases.
They were generally more or less irregular, of a certain depth,
and from one to two lines broad, their edges of variable thick-
ness, sometimes lardaceous, and greyish or whitish ; the mucous
membrane was pale, and perfectly sound in the rest of its
extent.

22. The most frequent seat of laryngeal ulcerations was first
the junction of the vocal cords themselves ; especially their

183&.] Pathological Anatomy of Phthisis. 115

posterior part. Only once was a very small ulceration obser-
ved at the back of the arytenoid cartilage, the superior part of
the larynx, and the inferior of the ventricles. Sometimes one
or more of the vocal cords were completely destroyed, and the
base of the arytenoid cartilage laid bare ; the cartilages them-
selves remaining unaffected.

23. The signs which during life, characterize ulcerations of
the larynx, are much more obvious than those which accompany
ulcerations of the trachea. They vary according to the part of
the tube affected, and the depth and extent of the ulcers. When
the vocal cords, the ventricles, or the arytaenoid cartilages were
the seat of disease, hoarseness, more or less alteration of the
voice, pain, sense of heat, and pricking, and subsequent aphonia
were generally present. The pain was sometimes very acute,
pungent and lancinating, and in most cases exasperated by
coughing, speaking, &c.

24. Ulcerations of the epiglottis were almost as frequently
found in phthisical patients, as those of the larynx. Of one
hundred and two cases, eighteen were found to have ulcerations
of the epiglottis. i hese were sometimes found alone, but most
commonly associated with those of the larynx and trachea ; so
that twelve cases out of eighteen were thus associated. Only
in one case was the ulceration on the upper surface of the
valve. In four cases was the edge festooned by ulceration, and
in one was there complete destruction of the epiglottis.

25. In no instance were tubercular granulations found in the.
substance, or on the surface of the epiglottis, larynx, or trachea.
This led M. Louis to conclude that inflammation was the most
frequent cause of their ulcerations.

20. These ulcerations were twice as frequent in men as in
women. This M. Louis considers not the effect of hazard;
because the proportion was about the same in the three species,
viz. six examples of this state of the epiglottis in women, out of
eighteen, seven of the larynx out of twenty-three, and nine of
the trachea out of thirty-one cases.

27. The symptoms of ulceration of the epiglottis are often
obscure ; but may be stated to be a fixed pain in the upper
portion of, or immediately above the thyroid cartilage, soreness
of throat, hoarseness with greater or less dysphagia, increasing
with the progress of the disease, so as to cause fluids to be
rejected by the nose ; the pharynx and tonsils remaining healthy
at the same time.

As symptoms during life are more or less equivocal with
regard to those ulcerations which attend genuine Phthisis, we
feel it important to familiarize the reader, as much as possible,
with those which are more or less connected with such cases.
We therefore give the following case, in which the epiglottis,
fhc lateral ligaments, and tho superior vocal cords were found

1 10 Medicinal Leeches. [3uh'>

after death completely destroyed, and in which the succession
of symptoms was well marked.

At first the voice was hoarse, unequal and discordant ; a
lancinating pain was felt between the thyroid cartilage and the
os hyoides ; this was increased by any exercise of the vocal
organs, by flexion of the neck forward, and by deglutition ; the
latter being frequently so difficult as to provoke the rejection of
fluids by the nose. Towards the close of the case, the pain in
the neck became more severe, and the deglutition so destroyed,
that no solid food could be swallowed ; complete aphonia had
supervened. The progress of these symptoms had been slow
and constant the rejection of the liquids by the nostrils having
existed for four months preceding the death of the patient : and
the acute local pain had been felt during the whole of this pe-
riod. " It is however," says M. Louis, " to be remembered that
these symptoms are by no means invariable occurrences, even
when the destruction of the epiglottis is complete."

Magendie relates two such cases, in which deglutition was
not at all impeded.

Medicinal Leeches. We find, by an advertisement in the
Boston Medical and Surgical Journal, that the Massachusetts
Medical Society have, with a spirit and liberality becoming
Americans, offered a premium of jive hundred dollars, for the
best sample of not less than one thousand leeches from a foreign
stock, bred in that commonwealth the premium to be awarded
at the expiration of seven years, if occasion should be.

We are much pleased with the spirit which actuates that
respectable body to such a movement.

It appears to us, however, unnecessary to require that they
should be propagated from a " foreign stock." This requisition
is calculated to embarrass the experiment with unnecessary
expense and trouble.

Some of the varieties (of which there are a number,) of the
native leeches which abound in our creeks, branches and swamps
at the South, are, when well selected, found with us to answer
all the purposes to the fullest extent, of the best foreign speci-
mens. They arc brought in by the country people, and sold to
the apothecaries and physicians at six to twelve cents. Many
are of small size others are very large. Doubtless they would
be much improved by a system of management which a minute
knowledge of their natural history could afford. Last autumn
we had occasion to deplete from the dorsal region for the relief
of spinal irritation, which had produced colic and other neu-
ralgic distresses to a considerable extent. Knowing that there
wex*e no foreign leeches in tlie city, we prescribed forty domes-

18.36.] Cancer of the Lap. 117

tic. Our apothecaries sent us the remnant of their stock,
amounting to twenty-six, qll of which were applied on the dor-
sal vertebra). Not one of the whole number failed to operate.
They were allowed to remain until they dropped. The deple-
tion was afterwards encouraged by warm napkins for twenty
or thirty minutes, by which time the patient became very sick
arid faint. The circumstances render it reasonable to suppose
that between twro and three pounds of blood were lost by the
operation. The depletion was indeed excessive ; so much so
that our patient was troubled for a week thereafter with a cold-
ness of the extremities, and debility with oedema, such as ordi-
narily follow excessive haemorrhage. The same leeches have
been preserved during the past winter, with no more care than
daily changing the water in which they were kept ; notwith-
standing the bottles in which they were have been sometimes
broken by the freezing of the water, which was entirely con-
gealed. These leeches were left charged with the blood which
they had imbibed at their first application in October. They
have all been since used with the best effect, except two which
died in the beginning of spring, and two which are still on hand.

There was no selection of these they were the remainder
of a considerable supply which had been but a few weeks be-
fore received, and were probably the smallest of that parcel.
None of them wrere, however, less than six, and many of them
upwards of seven inches long, when swimming or suspending
themselves by one end in the bottle. They were larger than
most of those which are brought to this market ; but our
apothecaries inform us that there are certain streams in the
neighbourhood winch afford such samples abundantly.

An observation of the peculiar character of the streams and
places where they are found, would doubtless afford some use-
ful hints relative to procuring as well as propagating them.

The following very interesting case, serves well to illustrate
the wonderful resources of the system and powers of surgery,
for surmounting inveterate and otherwise mortal disease. We
scarcely know what we may not expect from the knife, with
good constitutional powers.

Cancer of the lip resection of the lower jaw. M. August. Marseille, in a
recent letter to Dr. Clot-Bey, gives an account of a very extensive opera-
tion on the lower jaw and the neighbouring parts. The patient had been
attacked three several times' with cutaneous cancer of the lower lip. Twice
the tumour was excised, but the third time, the disease had made horri-
ble progress before surgical aid was requested. When the case was pre-
sented to M. Marseille, the condition of the patient was as follows :
He was decidedly attenuated, his complexion pale yellow, with a slight

ILS Removal of Sequestra without an Operation. [Juh.

h aden hue, and there was no fever. The cancerous afi'ection invaded ex-
ternally al] the lower lip and parts about the chin, extending, in the shape
of hardened lump.--, to the region above the hyoides. All these parts were
in a disgusting state of ulceration, pouring out foetid pus. The lower jaw
lied and softened to within half an inch of the angles, the teeth dis-
ci and sticking here and there over the tumour, and the sublingual
cellular tissue in a decidedly cancerous condition. The operation being
demanded by the patient, and refused by the surge on, the former declared
his determination to commit suicide unless indulged in his wish, on which
the latter reluctantly consented. The mouth was dilated by cutting the
commissures to the right and left above the level of the diseased shin, and
from the extremities ot these incisions two others were carried down ob-
liquely, until they met each other at the little groove or centre of ihe cs
hyoides, thus enclosing all the diseased parts in one large V incision. The
lower i aw was then sawed through by a chain saw, within half an inch of
each of its angles, and the bone, with the mass of the diseased parte, v ere
then removed by the straight bistoury. The frenum lingute was next Fo-
rmed by waxed thread, and the tongue thus held aside by an assistant,
while the diseased sublingual tissures were dissected off by curved scis-
sors and forceps. Many vessels were secured seriatim, and the patient,
was imminently threatened with suffocation, but no actual cautery was ne-
cessary. The wound was nearly closed by six points of suture, one of
which held and drew forward the frenum linguae, and by a methodical ban-
da{*e. The shocking deformity was concealed by an artificial jaw7 or mask,
and the constant percolation of saliva was prevented by a sponge. The
patient departed for his native village two months after the operation, eat-
ing easily and speaking intelligibly. A/ii. Jour. Gaz. des Hopitaux,
May 9//(*1835.

O;? the Removal of Sequestra without cm Operation. Dr. Bouget has pub-
lished a new plan for the removal of sequestra without an operation, in the
Journal de la SactiM de Medecine de Bordeaux^ in an article entitled,
"Souvenirs de la Clinique de Delpcch."

M. Delpcch, discouraged at the unfortunate results in several cases of
necrosis of the tibia, turned his attention to measures which might remove
the sequestrum without having recourse to the painful operation which is
ary. In this search he was successful, for he found that,
by means of diluted sulphuric acid, lie could destroy the phosphate of lime
m the bone to be removed, which is then reduced to its gelatinous paren-
chyma, and can be easily taken away with the common dressing forceps.
D pech first employed this application in the year L814. At ihis period,
Dunded at the battles of Orthes and Toulouse, flocked in such i am-
bers to Montpelier, that the Hopital St. Eloi was soon crowded, and a
supplementary one was formed, at the head of which was placed M. U.Fa-
nce so well known by his valuable lectures on external pathology.
Hospital gangrene soon appeared in both hospitals, and caused such exten-
sive ravages that the majority of the amputations terminated fatally: even
in those cases which were the most successful, a greater or smaller portion
of bono was Left exposed by the destruction of the soft parts, A young man
who had undergone amputation of the arm, and had twice Buffered from hos-
pital gangrene, winch had been with difficulty arrested, had the humerus
projecting about an inch and a half beyond the flesh. According to the or-
dinary treatment the sequestrum would not separate perhaps for months,
bltt it happened far otherwise under M. Delpoelfs directions. He caused
i he external surface of the hone to be covered with a pledget of lint, soaked
in dilute sulphuric acid, and a wad of the same, equally wetted, to be passed
into the medullary canal, whence the reticular apparatus had been prove-

1830. J Treatment, tf Co lica Pictonton. 119

ously removed ; at the end of twenty-four hours the portion of denuded bone
was so softened that it could be easily detached : ton days after the extremit)
bfthe bone was covered with fleshy granulations, and a complete cure was
sjxv.'.'.ly accomplished.

In the year iyl(>, a man entered the clinical ward, having a necrosis
which extended through the whole length of the tibia. Although he evi-
dently possessed a good constitution, and was apparently capable of under-
going a serious operation, M. Delpech determined to have recourse to the
proceeding which had proved successful in the previous instance. He des-
troyed the soft parts at the upper part of the leg by means of the pot issa
fusa, and when the eschar, winch was about the size of a crown piece, had
sloughed, he applied a pledget of lint, soaked in the dilute sulphuric acid, to
iii i bone ; after two or three dressings, renewed every live or six hours, if
became .soft enough to be taken away by dressing forceps. This being ef-
fected, the application of the potassa, followed by the acid, was made lower
down ; the sequestrum was exposed to the extent of five or six inches in
length, and an inch and a half in width ; it was then extracted with the
greatest ease. It was more than six inches long, and constituted nearly
two-thirds of a cylinder. The patient left the hospital quite well one month
afl r his admission.

From that time untd 1822, when I left Montpelier, adds M. Bouget, I
have seen M. Delpech constantly have recourse to this plan of treatment,
both at the hospital and in private practice, and always with success. I
have also used it myself with advantage in a case of necrosis of the tibia in
a child. Amer. Jour, of Med. Sci.

Treatment of Collca. Pietonum. Lead Colic cured bu Hy-
drochloric Acid. M. Gendrin communicated to the Academy

of Sciences, at their sitting in December, 1834, some additional
observations on the treatment of Colica Pietonum. He has
ascertained that the administration of sulphuric acid does not
produce the same relief where the colic has been induced l>\
the deutoxide of lead, as when it has been caused by the car-
bonate. In white lead manufactories, the use of this acid has
always been attended with the happiest prophylactic effects ;
whilst, in those of red lead, it has proved powerless. He then
announces that he has found that diluted hydrochloric acid would
remove the poisonous effects of the deutoxyde, as rapidly and
certainly as the sulphuric cures those caused by the carbonate.

Am. Jour. Pharm. Jour. Hebdom.

It may be well to remark in this place, that the form in which
lead is found in the hydrant water conducted through leaden
service pipes in this place, and probably in all places, is that of
carbonate. According to the cxperienor then in the treatment
of this disease in white lead manufactories, the sulphuric acid
would be found prophylactic of lead colics and other forms of
disease liable to be produced by drinking hydrant water, and
curative, when they are produced.

The following is the formula of M. Foucat in the treatment-
of lead colic. " To a pint of water, add half an ounce of sulphuric

120 Correctives of Opium, <$-c. [July,

Alcohol, (Elixir of Vitriol) two ounces of Magnesia, and four
oupces of Syrup of Gum. This is to be used as a commi n
drink ; besides which, a draught composed of half an ounce of
Caster Oil, as much Lemon Syrup, and a quarter of a grain of
Opium, is to be given night and morning." Am. Jour. Pharm.
Jour. Hebdom.

Correctives of Opium. According to M. Puchelt, a German
physician, sulphate of soda is an excellent corrective of the
unpleasant effects of Opium, given in the proportion of a scru-
ple to half a grain of Opium. This dose may be repeated two
or three times a day. In combination with Glauber salts, he
says that Opium may be' administered when it would otherwise
be contra-indicated. In obstinate haemorrhages especially, this
mixture will produce the happiest effects. The author also
asserts that if this neutral salt prevents the congestion some-
times produced by opium, so castor prevents its narcotic effects,
without diminishing its sedative powers. Am. Jour, of Pharm.
Load. Med. and >Sur. Jour, and Am. Jour. Med. Sci.

Dignified Consistency. The governors of the London Fever
Hospital, an institution of high reputation, at a special meeting a
few weeks ago, at which four hundred persons were present,
removed Mr. Hentsch, the House Surgeon, from his office, in
consequence of his having given a written testimonial in favour
of a quack medicine. A resolution was brought forward, also,
to remove Mr. Tweedie from the post of Chief Surgeon, for a
similar offence; but before it was acted upon, the meeting
adjourned for one week. Mr. Bransbury Cooper was present,
and defended his professional brethren with considerable energy,
but to no purpose. The further doings will be narrated when-
ever the intelligence arrives. Boston Med. and Sur, Jour.

Antidote, for the poison of the Hygeidn (Morisoivs) pills.
A correspondent of the London Lancet makes known, for the
benefit qi those who are guilty of the folly of taking Morison's
pills, a remedy for the distressing vomiting and purging which
frequently follow their use, viz. copious draughts of luke-warm
water, which will assist the stomach in its attempts to dislodge
ihe poison. Muciliaginous and gelatinous drinks, such as bar-
ley water, linseed tea, mutton and chicken broth, will also miti-
gate the severity of the purging, and afford some protection to
the internal coat of the intestines from the acrid and irritating
effects of the gamboge, aloes, and eoloevnth. which are found in
the pills.- Ibid,

1836.] Butlers Aperient effervescing Magnesia, fyc. 121

Butler's Aperient effervescing Magnesia. Of all the frauds
practiced upon the public, in these times of nostrums and quack-
ery, this is one of the most shameful. It is called, forsooth, a
magnesian preparation, and recommended as serviceable in
heart-burn, acidity and the numerous ills dependent on acidity
of the stomach ; and yet in the state in which it is swallowed,
there is not a particle of alkaline property in the mixture; on
the contrary, there is a considerable quantity of free acid
remaining in the solution, after the effervescence has subsided.
We shall here give the true composition and qualities of this
fashionable absorbent, that those who are using it under the idea
of its providing them with an alkaline medicine, to correct the
dreadful inconveniences of Dyspepsia, may no longer continue
to use this saline and acid preparation. For although, by its
purgative properties, it may afford temporary relief to some of
these dist esses, yet its continued use cannot fail to injure the
stomach and lead to a stnte of hauitual constipation of the bowels.

It is simply a mixture of Sulphate of Magnesia, (Epsom
Salts,) Tartaric Acid, and super carbonate of Potash. So
that it purges by virtue of the Epsom Salts it contains. It is
analogous in its effects and composition to the Seidlitz Powders,
and far less pleasant to the taste ; for the neutral salt used in
the composition of these last, is the Tartrate of Potash and
Soda, (the tasteless purging salts.) In order to prevent the
Tartaric Acid and super-Carbonate to be mixed with the Sul-
phate of Magnesia, without exciting their mutual action upon
each other, all the water of crystallization must be driven from
it by he^t, which can be done without decomposing any portion
of the salt.

We object not to the preparation itself; it is useful in some
cases, and frequently very convenient ; but our objections are
against the imposing name which it bears, and the outrageous
fraud attempted upon the public. F.

Preservation of Anatomical Preparations. M. Le Reboulet,
conservator of the Museum of Natural History, at Strasburg,
has given the following formula, for a liquid for the preserva-
tion of anatomical preparations, &c. This fluid is peculiarly
applicable to the preservation of the brain. When any tissues
kept in this solution become hardened, as sometimes happens,
they can be restored to their usual flexibility by keeping them
in fresh water for a short time.
R Water, 16 parts.

Chloride of Lime, 4 parts.
Alum, 2 "

Nitre, 1 "

Am, Jour. Pharrn. Jmcr tf.c Pharni.
.16

122 Influence of different Professions on Consumption. [July

Influence of different Professions on Pulmonary Consumption. By II. C.
Lombard, M. D., Geneva. The following facts were derived from five
sources, viz. 1. The list of cases collected by the pupils of the hospitals
of Paris. 2. That of M. Julius, in his researches on the sanitary state of
the town and hospitals of Hamburgh. 3. The Medical Annuary, published
at Vienna in 1803, containing the sketch of the diseases treated in the
General Hospital during the years 1798, 1799, and 1800. 4. The results of
the recent researches of M. Benoiston de Chateauneuf, on the number of
patients furnished by each profession to the hospitals of Paris, with the
number of deaths caused in each profession by pulmonary consumption ;
and 5. The results of M. Lombard's own researches in the mortality re-
cords, from 1776 to 1830, of the city of Geneva, including the township of
Plain-Palais and Eaux-Vives. All these sources afford him records of the
death of 57,463 persons of various professions, 5,752 of whom died of pul-
monary consumption.

By ascertaining, in the several lists, how many of the professions of the
subjects of this disease were above, and how many were below, the average,'
in the number of cases of consumption which they furnished, and by subse-
quently comparing the results together, he was enabled to arrive at the
following facts :

Professions situate above the mean.

" A. In men.

"1. In all the lists. Sculptors, printers, hatters, polishers, gendarme*,
brush-makers, soldiers, jewellers, tailors, millers, quiltmakers, lacemakers,
lemonade dealers, domestic servants, and wigmakers.

"2. In the majority of the lists. Copying-clerks, cooks, turners, joiners,
barbers, cordwainers, and coopers.

"3. In a single list. [M. Lombard gives a great many professions, but
we select only those of our own country.] Ironmongers, commission agents.
brokers, tin smiths, pavers, engravers, design-painters, street-sweepers,
pastry-cooks, teachers, draymen, upholsterers, file-makers, chimney sweeps,
feather-dressers, lapidaries, &c. &c.

" B. In women.

"1. In all the lists. Laundresses, cordwainers, and embroiderers.

"2. In the majority of the lists. Polishers.

"3. In one list. Dress-makers, teachers, smoothing-ironers, knitters
flower-makers, lace-women, &c. &c.

"A. In men.
r "Students, plasterers, stone-cutters, saddlers, terrace-makers, clock-
makers, carmen, cellar-butlers, goldsmiths, stocking-makers, charcoal deal-
ers, gilders, musicians, sawyers, and glass-makers.

" B. In women.

"House-keepers, day-labouring-women, wire-workers, weavers, gauze-
makers, gilders, patchers, and mantua-makers.

" 3. Professions situate below the medium average.

" A. In men.

" I . In all the lists. Coachmen, quarrymen, carpenters, inn-keepers,
butchers, hall-porters, wharf-porters, street-porters, tanners, bleach* re,
watermen, confectioners, slaters, founders, infirmary-attendants, and nurses.

"2. In the, majority of the lists. Bakers, blacksmiths, farriers, locksmiths,
masons, and weavers.

" 3. In a single list. Surgeons, braziers, cutlers, different merchants,
wood-cutters, advocates, agriculturists, literary men, grocers, public officers,
ninders, druggists, annuitants, groojns, dyers, physicians, lawyers, candle*

1 836.] Influence of different Professions on Consumption. 120

makers, snufF-dcalers, book-sellers, harness-makers, professors, miners,
mercers, comb-makers, &c. &c.

"B. In women.

" 1. In all the lists. Wadding carders, infirmary nurses, bleachers, and
garden women.

"2. In the majority of lists. Dress-makers.

' -i. In a single list. Cooks, domestic servants, annuitants, laundresses,
grocers, midwives, bakers, appliers of leeches, door-keepers, &c. &c.

M. Lombard's next inquiry is into the causes which may influence the
frequency of Consumption in (liferent professions, and under the following
heads he has arranged the results of his researches :

I. State of comfort or indigence. His calculations show "that the more
indigent classes of society are twice more accessible to consumption than
the persons more elevated in the social scale."

II. Muscular Exercise. Of the eighty professions situate above the
average, fifty-eight, or nearly three-fourths, are almost completely seden-
tary. A fact showing that the sedentary life furnishes a much great r
number of consumptive cases than an active life. The proportion M.
Lombard found to be that of 141 to 89. He also ascertained that "con-
ditions completely sedentary produce a greater number of consumptive
patients than those which require a certain degree of muscular exer-
cise ; and from it may be inferred, that if the sedentary life augments
the frequency of consumption, muscular exercise is in some degree a means
of counteracting tins influence.

Concussions given to the chest by the continual motions of the arms,
which have been enumerated among the causes of consumption, he found
to have a tendency varying according to circumstances in slightly dimin-
ishing the frequency of consumption in sedentary occupations, and augment-
ing that frequency in active professions.

The constant exercise of the voice he statistically proves, is not an un-
favorable circumstance in reference to consumption. The mean number of
victims to this disease being one hundred and fourteen in one thousand
that of the professions in which the voice is much exercised is only seventy
five ; a result in accordance with the observations of M. Benoiston de
Chateauneuf, and with the experience of the celebrated Cuvier, who asser-
ted that the frequent exercise of his voice, consequent upon his appointment
to a professor's chair, was the means of curing him of a pulmonary affec-
tion.

The incurvated attitude is unfavorable in reference to consumption, but
is more so in those professions which are completely sedentary than in
those in which much muscular exercise is required, where this influence
is fully corrected by the exercise of the muscles. This conclusion is
strengthened "by the rarity of consumption among tanners, gardeners,
bleaching and washing women, who are constantly bent at their work."

III. Influence of the purity or impurity of the surrounding atmosphere.
An epitome of the results of liis comparisons and calculations under this
head^is as follows :

1. Those workmen who pursue their occupation in the open air are
twice less liable to consumption than those who work in shops, and the
degree of liability is in proportion to the smallness of the shop, or the im-
perfection of ventilation.

'2. Workmen surrounded by an atmosphere charged with watery vapour
for example, dyers, tanners, washer- women, &c. are much less liable to
consumption than the general average. In Geneva, the average number
in this class of workmen who are attacked with consumption is inferior,
cnore than one half, to tho general average.

124 Influence of different Professions on Consumption. [July,

3. On the contrary, workmen surrounded by a hot, dry atmosphere,
yield more readily than other workmen in the proportion of one hundred
and twenty-seven to one hundred and fourteen.

4. Workmen surrounded by animal emanations, butchers, tanners, can-
dle-makers, sick-tenders, &c, are about twice less liable than others to
contract pulmonary consumption. The exact proportion is sixty to one
hundred and fourteen.

5. Air loaded with emanations of living plants, (in day-time of course,)
is a preservative against consumption. The emanations, from fermenting
or decomposing vegetable substances, on the contrary, are injurious ; and
the volatile vegetable oils, as turpentine, the drying oils, &c, exert a very
unfavorable influence.

G. Among the mineral emanations, are the gazes arising from the
combustion of charcoal, wrhieh are unfavorable : the vapours of the mineral
acids, which are not as unfavorable as is generally believed : chlorine,,
which has been used as a remedy in consumption. M. Lombard asserts,
that consumption is rare among the workmen employed in the manufacture
of chlorine. He tested the statement as to the harmlessness of this gag
in a great manufactory of chloride of lime. "The only inconvenience
felt by a workman who had been employed in it for more than twelve-
years, is a transitory uneasiness, when one of the retorts, from which the
chlorine is disengaged, happens to break and to diffuse the vapours
abundantly in the manufactory."

Metallic emanations, he found, are not directly injurious to the lungsr
and notwithstanding their action on the nervous system, and the debility
which they produce, the production of consumption does not seem to be one
of their secondary effects.

7. Bodies suspended in the atmosphere are highly injurious to the lungs.
Mineral particles are more so than animal, and these more so than
vegetable particles. Coarse particles are less hurtful than minute ones,
and hard particles are more injurious than soft ones. Hence, "the
powders most hurtful to the lungs are those which proceed from very hard
bodies, and are reduced to an impalpable powder." The inhalation of the
dust of emery, steel, or flint, is well known as a frequent cause of con-
sumption.

" The workmen who employ emery, the hardest of all the substances
used in the arts, are also the first in the order of frequency of consumption.
Thus the watch-hand makers present fifty-five per cent., and the steel-
polishers furnish thirty-five per cent., of consumptive cases.

" Almost all the workmen employed at Sheffield in polishing steel, be-
come the prey of pulmonary consumption. It has been observed, that in
two thousand five hundred persons employed in this department, scarcely
thirty five reach the age of fifty years, and scarcely seventy that of forty
five years : while the majority die before the thirty sixth year. Dr. John-
son remarked, in 1799, the great frequency of consumption among the
workmen occupied in pointing needless on ground stones ;* and recently.
Dr. Knight, of Sheffield, published anew memoir on the same subject, aud
has added new facts to those already known. f He remarks, that no polish-
er of steel-forks reaches his thirty sixth year. Among two hundred and
fifty steel-polishers admitted into the dispensary of Sheffield, one hundred
and fifty four had diseases of the chest, and thirteen died within the year;
while of two hundred and fifty pursuing other professions than that of pol-
ishing, fifty six only had diseases of the lungs, and only one died within the?
year. The age of eight hundred and twenty seven of these patients deserves
to be remarked.

Memoirs of the Med. Society, London, vol. v.
(North of England Med. and Surg. Jour., Aug. 1830.

1836. J Influence of different Professions on Consumption.

St rcl- Grinders.

Oilier trades.

"Above 30 years

125

140

:35

83

11H

40

40

92

45

24

70

50

10

56

55

4

84

60

1

19

287 :m

" This table shows how much steel grinding abridges the lives of tho
workmen engaged in this occupation. Numerous attempts have been made
to render this operat:on less injurious, but all have been inadequate, and
the grinding of steel is at the present moment as hurtful to the health of
the workmen as it was thirty years ago."

The inhalation of silicious or calcareous particles is also injurious ; the
former much more than the latter ; the inhalation of light filamentous sub-
stances, as cotton, flax, hemp, is also very injurious, owing probably to
their flexibility, and the ease with which they may thus be introduced far
into the bronchi. The practical importance of these facts is evidently
great. We will give the author's conclusions in his own words :

" Reviewing, meanwhile, the preceding facts, we arrive at the following
conclusions.

"I. The circumstances which multiply cases of consumption are, indi-
gence, a sedentary life, and the absence of muscular exercise, the concussions
of the workshops, the bent posture, the impure air of shops and manu-
factories, the inhalation of certain mineral or vegetable vapours, and lastly,
air loaded with powders, coarse or impalpable, or with bodies light, elastic,
and filamentous.

"2. The circumstances which exercise a preservative influence are,
opulence, an active life spent in the open air, the regular exercise of all
parts of the body, the inhalation of aqueous vapours, or of animal or vege-
table emanations.

" But it is not enough to specify these different circumstances. It is
requisite to estimate the degree of influence of each in the production of
consumption. The following table, which gives the mean number of con-
sumptive persons among the workmen exposed to these several influences,
will serve to determine this question :

Mean number of Consumptive cases 114 per 1000.
1. Noxious Influences.

1. Mineral and vegetable emanations, 0,177

2. Various sorts of powders or dust, 0,145

3. Sedentary life, 0,140

4. Life spent in shops or manufactories, 0,138

5. Hot, dry air, 0,127

6. Bent posture, 0,122
^. Motions of the arms causing shocks of the chest. 0,110

2. Preservative Influences.

1. Active life, (muscular exercise,) 0,080

2. Exercise of the voice, 0,07.")

3. Life spent in the open air, 0,073

4. Animal emanations, 0,000

5. Aqueous vapours, 0,053"
Thus the most hurtful circumstance to the lungs is the inhalation of sun-
dry mineral and vegetable emanations; and the most important prophylactic
influence is the inhalation of aqueous vapour.

The author makes the following hygienic and therapeutic applications of
fhe foregoing facts :

126 New and successful remedy for the Croup. i_JuIy>

1. That from the influence of these circumstances in the production and
prevention of this disease, it may be inferred that consumption is the result
of general disease, and is not a primary local affection of the lungs; and

quently, in attempting a cure our means must be general.

2. The rarity of consumption among sick-nurses and infirmary servants,
shows that there is but little foundation for the belief that the disease is
contagious*

3. Attention to ventilation is of the highest importance in this disease.

4. The moisture in the atmosphnre exerting such a remarkable prophy-
fact ic influence in this disease, we should, in selecting a climate favourable
to consumptive persons, take the moisture of that climate into consideration ;
and workmen liable to be exposed to hot, dry air, should use means to
secure the presence of aqueous vapour in their shops.

5. Exercise of all parts of the body should be taken by all persons engaged
in sedentary pursuits, who wish to prevent consumption ; and

6. A judicious change of trade or occupation should be recommended by
the physician in suitable cases.

Comment on this memoir were useless. Every reflecting physician will
at once see its valuable practical application; and although M. Lombard
differs in a few circumstances from others who have investigated the same
subject, and possibly may be in error in some unessential particulars, yet,
the extent of his examination, and the ability with which it has evidently
been conducted, should ensure to the author of this valuable memoir, the
belief of his readers in his main and important conclusions. R. P.

Trans. Jour. Ed. Med. and Sur. Jour. <fyc.

New and successful remedy for the Croup. In the following note, from J.
D. Fisher, M. D. of this city, he speaks of a new and successful mode of
treating that alarming disease of childhood, the croup, which ought to be
made known through the newspapers, wherever they circulate. Should
subsequent observation establish the fact of the superiority of the rein; dy,
Dr. Fisher deserves to be remembered in the first class of public bene-
factors.

My Dear Doctor. I was called, at five o'clock last evening, to a child
which was laboring under a severe attack of the croup, consequent upon
a sudden disappearance of the eruption of meaz'- s. The croupy symptoms
appeared suddenly, and had existed one hour before 1 was called. The
child, on my arrival, was in extreme agony, struggling and gasping for
breath; and I thought the little sufferer was in danger of immediate suffo-
cation. The first means I employed was the application of very hot,
almost boiling, water to the throat and upper part of the chest, by means of
large sponges. These applications I repeated every two minutes, and
immediately the skin became coated and red, and in the course of a quarter
of an hour the little girl breathed much easier, and her croupy cough and
respiration became less shrill and tubular, and much modified. Soon ;f r
making the first application of the sponges to the throat, I wrappetk'he
child in a woollen blanket, wrung out in hot water, as a substitute Tcr a
warm bath, and gave it twenty drops ol the wine of antimony in a little
sweetened water, which she swallowed with difficulty. I persevered in the
applications of the hot moist sponges for an hour, when the child wrs so
much relieved that I ventured to leave it for half an hour ordering the
remedy to be continued. On my return, I found the patient br< ;ith vd
with comparative freedom, its respiration and cough less sonorous and
shrill, and its pulse softer and more natural. I recommended the applica-
tions to be continued until the child should be decidedly relieved, and pre-
acribedsix drops of ant.imonial wine to be given every hour in a little
water. The mother of the child informed me, this morning, that she-

1836.] Recovery from Asphyxia in a new horn Infant. 129

continued to apply the hot-water remedy for five hours, but not so often
as I applied them that the child continued to improve, and foil asleep soon
after 1 left it. This morning she is bright and playful, and asks for food.
Tne respiration is quite easy pulse soft and natural cough humid and
loose its sounds having lost the shrill croupy character.

I was induced to employ the above remedy, in consequence of having lately
read m a foreign journal, that it had been suggested and employed by a
German Physician with decided and uniform success. As the remedy is
simple, and is at ready command, and as its application in the present case
was attended with such decided and immediate happy effects, I would with
a good deal of confidence advise mothers and nurses in similar cases to
apply it early and perseveringly until medical aid can be obtained. The
sponges should be gently squeezed before they are applied, so that the
water shall not oosv from them, and should be gradually compressed du-
ring the time they are applied, so as to continue the temperature up to the
highes*: degree that can be sustained by the patient. Should sponges not.
be at hand, napkins wrung out in the boiling water may serve as good
substitutes. Tram. Jour. Bost. Med. and Sur. Jour.

Recovery from Asphyxia in a new born infant. The follow-
ing case, very remarkable and interesting from the length of
time animation was suspended, has been communicated to the
Edinburgh Medico-Chirurgical Society, by Dr. MacWhirter,
and is contained in our esteemed Edinburgh contemporary for
January, 1835.

" I was called, at about half past 11, P. M., to a lady who
had been several hours in labour. I found the os tincce expand-
ed to the extent of a crown piece ; the membranes pressed for-
ward by every pain, and the presentation ' breech,' pain recur-
ring regularly and forcibly every four minutes. About a
quarter before one, the membranes gave way, the liquor amnii
was discharged, and the labour, which was a iirst one, advanced
slowly, until half past one, when the breech was born. Sus-
pecting that resuscitation would be necessary, I desired the
nurse to have warm water at hand. The body and head were
long in transitu ; the funis was round the neck twice ; I disen-
gaged it, but could feel no pulsation. I got my fingers into the
mouth of the foetus, and succeeded in bringing it beyond the
verge of the perineum, but it did not breathe. In about ten
minutes, by management and the uterine action, the head was
delivered, and along with it the placenta.

" The infant appeared dead ; indeed, it was thrice felt con-
vulsed in transitu. The face was white as paper, but there
was some colour in the lips ; still no pulsation of the heart
could be felt.

" I placed the child, with the placenta attached, in a warm
bath ; gently inflated its lungs with my own breath, in the usual
way ; rubbed brandy on the chest, abdomen, head, spine, ex-
tremities, &c. As the funis when cut did not bleed, 1 therefore

128 Acute fain in the Vagina after delivery, c. [July,

tied it. After immersion of about half an hour, I took it out of
the bath ; dried, and wrapped it in a warm flannel, and made
the nurse carry it near the fire. I then continued the gentle
inflation from time to time, and the spirituous friction, to the
extent of nearly two bottles of brandy and whiskey, occasion-
ally slapping the bottom, when at length, about forty or fifty
minutes after birth, it gave a sob. This was indicative of ex-
isting life, and encouraged me to persevere. It continued to sob
or gasp at intervals of a minute or two, and I now found that I
could feel the heart beat.

" The above mean's were most perseveringly continued, until
the circulation and breathing very gradually increased. At the
end of an hour and a half, the child gave a whimper ; the
eyes opened ; the lips became red ; it breathed regularly ; cried
lustily. It lived and continues to live. Am. Jour, of Med. Sci.

Acute pain in the Vagina after delivery. Dr. Chopin, in an
an article in the Gazette Med. de Paris, (31st Oct. 1835.) states,
that shortly after delivery, and especially of first children, he
has discoved on the posterior surface of the vagina of the mother,
small excrescences of the size of a grain of wheat, rarely of the
size of a small pea, and of a deep red colour. They are easily
recognized by their saliency, their exquisite sensibility, and their
deeper colour than that of the vagina. The pain attending
them, he describes as more insupportable than that of labour.
His patients describe it as that of a hot iron in the vagina. He
says that the pain is relieved by the application of lint, dipped in
chloride of lime, to the tumours. Am. Jour.

Early Impregnation in the Cow. A writer in the London
Lancet states that recently a bull calf less than three months
old, and a quay calf of about two months, copulated ; and
within nine months the female brought forth her first born
she and the offspring being yet alive. In the Veterinarian, one
case is related in which impregnation took place in a calf of six
months, and another at four months. Boston Med. and Sur.
Jour.

Neuralgic Pains in the Stomach. The new article creosote
has been em ployed in London in the treatment of spasmodic
and neuralgic pain of the stomach. The dose was gradually
increased to seventeen minims every four hours, which entirely
removed the pain, and cured the patient. Ibid.

SOUTHERN MEDICAL

AND

SURGICAL JOURNAL

Vol. L] AUGUST, 1836. [No. 3.

Part I. ORIGINAL COMMUNICATIONS.

ARTICLE I.

Acupuncture as a remedy for Rheumatism. By Wm. Markley
Lee, M. D. of Indian Town, S. C.

Few diseases are reported to be cured by a greater variety
of remedies than Rheumatism, and few are subject to greater
disappointment in the attainment of the expected results. This
arises principally from the circumstance, that Rheumatism is of
a two-fold character, entonic and atonic, requiring the closest
discrimination in treatment, as the remedies proper for each
form are diametrically opposite in their action.

The detail of all the remedies for Rheumatism would occupy
much space, and convey little new information. My present
object will be, to give my experience in the use of one remedy,
in my opinion not sufficiently appreciated. It was about six
years since, after reading the practice of Churchill, Cloquet, and
others, I was induced to try this remedy on my patients, in
cases apparently suited to it, and, for the sake of brevity, will
give a sketch of a few of these cases.

Case I. I saw an old negro woman, the gardener of one of
my friends, limping at her work, who, on enquiry, stated that
she had Rheumatism of the knee. I had not at that time tried
acupuncture, but feeling disposed to make the experiment, told
her in a jocular manner, that I could cure her with a needle ;
to this she was extremely averse, fearing the pain, but after
17

130 Acupuncture as a remedy for Rlieumatism. [Aug:

some persuasion consented. Having lined the larger end of
two slender needles into small phial corks, 1 kept the skin of the
inner surface of the knee tense with the thumb and lore finger
of the left hand, and introduced them to a moderate depth with
a slow, alternate, semi-rotary motion. As their points entered
the skin, she complained of slight pain, which being pierced, she
scarcely felt them : after about ten minutes, I directed her to
bend the knee slowly : to her surprise, flexion no longer caused
pain, as it did previous to their introduction. The needles were
then withdrawn with the same motion as inserted ; not a drop
of blood was lost ; even the places of insertion could not be
seen, and what was infinitely more important, the pain had
vanished. A few minutes after, she complained of it at the
inner side of the ancle, whence, after about the same lapse of
time, it was routed as from the knee. The old woman was so
delighted that she danced for joy. For several days, she con-
tinued free from her old complaint, but after being again expo-
sed to the exciting cause, damp weather, it was renewed. The
experiment was not repeated.

Case. II. A lady was subject to Rheumatic stiffness of the
neck, after exposure to a damp atmosphere, particularly at
night. On one occasion I found her with her head so fixed, that,
rotation was impossible. After some persuasion, she consented
to the introduction of the needles ; of which two were inserted,,
one on each side of the vertebra?. As their points touched the
posterior fasciculi of cervical nerves, she complained of an acute
tingling sensation, like an electric shock, which induced me to
retract the needles slightly. After about fifteen minutes, I re-
quested her to make an effort to turn her head, which to her
surprize she did, with no pain except that which arose from the
pressure of the muscular fibres upon the points of the needles.
The relief was prompt and permanent.

Ca*e III. I had the misfortune some years since to luxate
my left clavicle, in consequence of which I have been occasion-
ally subject to rheumatism of the deltoid muscle on getting wet.
I have in repeated attacks, laid bare the shoulder, and requesting
some friend to keep the skin tense, introduced three needles
around the shoulder. Previous to their introduction, I could not.
raise the arm to a horizontal direction, unless aided by the other
hand, and suffering severely. The pain caused by the needle

1836.] Acupuncture us a remedy for Rheumatism. 13J

inserted into the anterior fibres of the muscle, was decidedly the
most acute, evidently arising from the contiguity of the nerves
which supply the arms. In fifteen minutes I was free from
pain, and could move the arm with perfect ease, upon which
the needles were withdrawn. Months elapsed before I expe-
rienced any return of the Rheumatism.

Case IV. An old seaman laboured under entonic Rheuma-
tism of the deltoid muscle ; the shoulder was sensibly hot, but
being a topical disease, at the request of the physician of the
Marine Hospital, of which he was a patient, I consented to try
acupuncture ; he, like myself, could not elevate the humerus to
a horizontal direction. The needles were introduced, and suf-
fered to remain two hours; extraction was found extremely
painful and difficult ; the corks were detached, and it was
accessary to thread the needles in order to extract them. Be-
fore insertion they were highly polished ; after extraction they
blackened and deeply corroded* completely around the
on at the surface of the skin ; the imbedded portion, irre-
gularly. It is well known that the nerves arc expanded as a
delicate net-work over the entire surface of the skin ; it is also
supposed that the nervous and galvanic fluids arc identically
the same. May not the greater abundance of this galvanic or
nervous fluid at the surface, account for this more complete
corrosion of that part of the needle ? The pain wras by no
I r ins removed; indeed he suffered so much from the extrac-
tion, that no persuasion could induce him to submit to any vari-
ation of the experiment. He was subsequently cured by other
means.

Case V. A young man applied to me, to try the effect of
acupuncture upon a chronic pain of the loins, which had been
treated unsuccessfully by some of the most eminent physicians
of Charleston ; cupping, blistering, rubefaciants having all been
tried with only temporary benefit. On the insertion of the
second needle, if I mistake not, he fell back into my arms in a
state of syncope. Having laid him on one side, I extracted the
needles. He stated, after reviving, that it was not pain, but a

* I recollect to have read in a French Medical Journal, to which I have
not access at present, that the same effect (corrosion) was produced upon
a needle inserted in a portion of flesh newly prepared for the table. Altho'
rather incredulous, I repeated the experiment, and found the statement
literally correct : the needle was furrowed, blackened? and excavated.

132 Acupuncture as a remedy for Rheumatism. [Aug;

sudden sickness, which caused him to faint. This uncommon
symptom would have caused me some alarm, had I not pre-
viously met with such a case in a French journal. I never
could persuade him to repeat the experiment, although the
lumbar pain was relieved for a few days.

These are a select few of many cases of Rheumatism which
I have treated by acupuncture ; they have led me to anticipate
the following results, viz.

In acute Rheumatism, the needle acts as an irritant, and is
therefore improper before inflammatory action has been reduced.
The effect produced in case 4th, will be a lesson to me in future
never to suffer the ordinary steel needles to remain for any
length of time. Under those circumstances they should be made
of gold or platina.

In sub-acute Rheumatism, I consider acupuncture a prompt
and efficacious remedy. I frequently employ it, much to the
surprize of my patients, from the trifling pain which it causes,
and the promptness of relief; and equally to the astonishment
of the attendants, who rarely have faith in the remedy, until
proved by positive demonstration.

In chronic Rheumatism, acupuncture will relieve promptly
and thoroughly, but the disease is liable to recur on the re-
application of the cause usually producing it.

It may be inferred from what has been stated, that I believe
acupuncture to owe its efficacy to the transmission of the gal-
vanic fluid. Such has long been my opinion, although I had no
opportunity to ascertain the fact by the use of the battery.
This point has been recently established by the experiments of
Dr. Stokes, of the Meath Hospital, as re-published from the
London Medical and Surgical Journal into the American Jour-
nal, No. XXXIII, p. 225, et sequent. As this periodical is in
general circulation, the reader will find the article referred to.

1 consider acupuncture entitled to far more attention than it
has yet received in the United States. It is not painful. I
have never introduced the needle without the patient expressing
the greatest surprize at the trifling degree of pain ; indeed some
have declared that if asleep it would not awake them. Of this I
have some doubts. // is not inconvenient. Every house can
furnish needles. It is prompt and effectual. I have never failed
to produce the desired effect, in appropriate cases, within the

1830.]

Meteorological Observations.

133

space of a quarter of an hour ; and in such cases, the relief was
permanent. I therefore repeat it as my opinion, that physicians
have not duly appreciated its therapeutical efficacy.

ARTICLE II.

Meteorological Observations for Burke and Richmond counties.,
Extracted from the Journal of a Geological Survey. By
Professor J. M. Cotting.

MAY.
Greatest heat at 12 o'clock, -

Least heat at do. - - ' -

Mean heat of the first half of the month,
Mean heat of the last half of the month,
Mean heat of the whole month, -
Rain Guage, 2 inches, 6 1

Cloudy days, 6

Thunder showers, - - 17

JUNE.
Greatest heat at 12 o'clock,

Least heat at 12 o'clock, -

Mean heat of the first half of the month,

Mean heat of the last half of the month,

Mean heat of the whole month, -

Rain Guage, * 7 inches,

Rainy Days, - 9

Thunder showers, - - 10

Prevailing winds, S. E. and SW.

June 20. First general appearance of blossoms on cotton on

many plantations in Burke county. Though in small patches,

in situations exposed to the sun, some blossoms were observed

as early as the 12th of the month. In all these latter situations,

the soil, by analysis, was found to contain from twenty to thirty

per cent, of lime, and much animal and vegetable decomposed

substance.

Note. The diurnal mean heat is obtained from a number of observations
made during the day ; the monthly and semi-monthly is deduced from the
diurnal means.

sr

63

64.25

74.62

63.91)

2 lines.

90
58

71.22

75.09

71.61

7 lines.

13-1 Case of extensive fracture of the Cranium. [Aug.

ARTICLE III.

Case of extensive fracture of /he Cranium, with injury of the
Dura. Mater ana' loss of Brain. By John M. Anthony,
M. I), of Augusta, Ga.

On the 9th of March, 1834, at 11 o'clock, A. M. a servant
boy belonging to Mr. Carswell, of Burke county, was found in
the stable, in a profound stupor, and apparently insensible to
all impressions. I visited him at 9 o'clock, P. M. of the same
day, still labouring under the same symptoms, with very slow
respiration and pulse, a considerable swelling over the left ear,
with a wound in the integuments, about the size of a buckshot
hole, from which some blood, and a small quantity of cerebral
matter had been discharged, evincing subjacent fracture of the
bone, and breaking up of the cerebral mass.

The patient remained in this situation until the forenoon of
the 10th, when Dr. M. Antony met me in consultation on the
case. We soon proceeded to a farther investigation of the in-
ternal condition of the wound by the knife ; whereon, when we
raised the flaps, which were made by an incision through the
integuments, commencing between the zygomatic process and
the auditory foramen, and extending up on the parietal bone :
and one transversely above the ear; the fracture of the cranium
Was fully brought to view. It extended from the posterior
inferior angle of the parietal, passing just over the zygomatic
process to the temporal portion of the sphenoid bone. This part
of the fracture was of a curved shape, with its convexity down-
ward. An inch and a half above, there was a similar fracture,
though less curved, chiefly in the external plate of the parietal,
corresponding in direction with the first, with which it united
anteriorly and posteriorly. The depressed part consisted of
many fragments of different sizes, most of which remained at-
tached to each other, and to the upper part of the fracture by
the inner table, which, instead of breaking, had bent under the
violent force which caused the fracture, (which we believed to
be the kick of a horse,) the separation being complete only
throughout the whole extent of the lower side of the fracture.

1836.] Case of extensive fracture o) the Cran 135

After removing some loose spiculae* we attempted to elevate
the depressed fragments to a level with the general surface ; but
in consequence of their haying been driven beneath the firm
bone ait the lower side of the fracture, we could no
notwithstanding a considerable lever power was used. W
then resorted to the use of the saw, by which, division of the
inner table was completed through the whole extent of the
upper, anterior, and posterior limits of the fracture.

The fragments were then easily raised, immediately on ac-
complishing which, the patient uttered a loud shriek, and there
gushed from the wound about two large table spoonfuls of cere-
bral matter, slightly and irregularly coloured with blood ; so as
to represent a thick, bloody, purulent discharge from a suppu-
rating depot. It seemed to be that portion of the brain which
had been broken up by the violence which had driven the whole
of the depressed parts deeply into that organ, as they moved
widi a hinge-like attachment to the upper edge of the fracture ;
and from which depression the resistance within Had forced
them back to lodge against the inner table below. The Dura
Mater was lacerated through nearly the whole autero*posterior
length of the fracture, on a level with the lower part ; from
about the middle of which, so soon as the pressure of the frag-
ment beneath was removed, a brisk arterial haemorrhage came
on, which, however, soon ceased spontaneously. The wound
being cleansed of all loose spicuke, saw-dust, &c. the integu-
ments were laid on the wound and secured by adhesive straps,
suitable compress, bandage, &c. leaving sufficient vents for dis-
charge. During the progress of the operation, considerable
re-action came on, and the sensibilities returned to a considera-
ble extent. On the morning of the 11th, his sensibilities were
very well restored ; but the power of speech had not been ftdly
recovered. His pronunciation was not very distinct ; but he
endeavoured to use some words mostly verbs ; but never
seemed to attempt the pronunciation of any noun. It appeared,
indeed, that he had no memory of the name of anything what-
ever. He continued to do well until the 14th, when some
spasms of the same side of his face and jaw appeared, and
lasted about twenty minutes. In the evening they re-appeared,
and were finally dissipated by an anodyne. On the morning of
the 15th. a yellow serous discharge issued from the wound;

136 Ca$ of extensive fracture of tlte Cranium. [Aug.

lho collection of which had probably caused the spasms of the
previous day. This discharge continued for several days, du-
ring which he gradually recovered his speech ; and with the
suitable use of means for preserving a due solubility of bowels,
lie was well at the end of six weeks.

The January following, the boy was attacked with symptoms
of Phrenitis, which readily yielded to the early application of
the lancet, and of cold water to the head.

It may be well to state in this place, that at the time he
laboured under Phrenitis, Pneumonia was so prevalent that
twelve other members of this family were suffering from it.

This boy had received, several years previous, an injury of
his head by a fall from a horse, which rendered him liable to
suffer much from exposure to great heat of the sun from
which, indeed, he was, at one time, so much afflicted that a
serious *and protracted course of treatment was necessary for
his restoration from considerable derangement of intellect. In
general, however, these turns were characterized by headache,
red eyes, &c. of which he was usually relieved by a purgative,
with abstinence.

Since his recovery from the fracture of the cranium, he is no
more liable to danger from exposure to the sun ; but sustains
as much exposure as other persons without the least inconve-
nience.

Note. This fracture was remarkable for the extent of injury-
There were ten fragments of bone removed, three of which
were about an inch and a half long, and one-half to three-fourths
of an inch wide ; the others of different smaller sizes. But the
chief importance of the case is the extent of injury of the mem-
branes, the extent of violence done to the cerebral mass, and the
large quantity lost, from which there was recovery. It is also
remarkable that the old morbid condition from a former wound
was cured by this. There is another observation, however, on
this case, which I think of more practical importance. On
contemplating the seat and extent of this injury, it will be seen
that the cerebral substance of the middle lobe was broken up
and compressed into almost the whole range of the great infe-
rior horn of the lateral ventricle. There was consequently an
undue pressure on all the parts of the cerebral mass bounding

1836.] Case of extensive fracture of the Cranium. 137

this part of this cavity ; through the whole extent of which is
the relief known by the name of Coram Ammonis. This pres-
sure continued with very considerable force until the bone was
liberated; as evinced by the sudden gush of broken cerebral
matter immediately on relieving the pressure. At this time,
too, it will be remembered that his sensibilities became very
considerably improved, and he soon recovered the memory of
many words. The serous effusion into the wound continued a
considerable pressure on these parts until it escaped freely,
several days after the dressing. During the whole of this
time, the loss of the memory of nouns continued things them-
selves were remembered, their qualities, &c. understood ; but the
name in no instance during my observation of the patient ; and
-as I understood, at no other time, until after the serous discharge
from the wound, above alluded to, when the power of using
nouns returned. Even personal pronouns were remembered.
We will illustrate his speech by an example. On desiring

coffee, he said " Give me some give me some ." On

b^ing asked what ? he said ?' some " putting his finger to

his open mouth. Some water? "No." Some tea? "No,
some ." Some coffee ? " Yes."

Some three or four weeks after witnessing this case, I visited
a lady in a neighbouring village, who was labouring under pre-
cisely similar derangement of the power of speech. On my
arrival, she soon desired some water. Her expression was

" give me some ." Water ? " Yes." On finding that

her husband had left the room, she enquired, "where is my

," repeatedly, until her husband returned. I was informed

that on desiring that I should be called to her, she said, " send

for away yonder," pointing towards Augusta. On

naming several physicians to her, she said " no," until my name
was called, when she replied, " yes." The messenger had not
been long despatched before she manifested a want of recogni-
tion of time, in relation to the distance to be travelled, a distance

of about fifty miles, by asking, " Is coming ?" " Has

come ?" On being asked what or who she meant, she

would reply, " Has come from away yonder ?"

pointing towards Augusta, &c. &c.

The lady had a few weeks before taken cold, on the third day
of her childbed confinement, the effects of which appeared to
1%

138 Case of extensive fracture of the Cranium. [Aug,

have been considered as milk fever. The febrile symptoms,,
however, continued ; with intense and increasing pain, near the
lower part of the middle lobe of the cerebrum. Various pre-
scriptions had been used with little or no good effect. The
febrile action had gradually moderated, the skin continuing dry
secretions generally torpid, with pale hydropic expression, &c.
Remembering the late demonstration of pressure in the same
part of the cerebrum, in the above case, which was called to
my recollection by the precise similarity of nomenal dementia
or hebetude, I was induced to offer the opinion to the consulta-
tion, that there was undue pressure on the same parts of the
cerebral organ. The history of the whole progress of the local
inflammatory action which had been manifested, about the lo-
cation of that part of the choroid plexus which extends down
into the inferior horn of the lateral ventricle ; the present aspect
of continuance, the remaining febricula, and the evidence of
pressure within this part of the ventricle, induced me to offer
the farther pathological view that the inflammatory action was
terminating by an hydropic effusion into this cavity, which ex-
erted the pressure.

A therapeutic course in strict relation with these patholo-
gical views, was adopted, on which the patient recovered in a
reasonable length of time for a case so chronic in its nature.

The sensation of pain in this case had pointed out very pre-
cisely the location of that part of the ventricle above alluded to-
and the whole of that part of the choroid plexus which extends
into the inferior and the posterior cornu of the lateral ventricle.

These observations may be useful in Phrenological enquiries

M. ANTONY

1830.] An Essay en Idiopathic Fevers. 130

ARTICLE IV.

An essay in answer to the question " are there any idiopathic
fevers ?" read before the Medical Society of Augusta. By
Edward A. Eve. M. D. of Richmond county, Geo.

Befpre entering on a subject, the discussion of which has for
a considerable time, more warmly than any other, occupied the
medical world, and which still remains " sub judice ;" it may be
well to come to a precise understanding of the terms used.
The strictly lexicographical definition of the word Idiophthic,
would be a peculiar affection, from W (peculiar) and tfaAog
(an affection). In a more medical sense, it would denote a dis-
ease independent of any other disease ; it seems, however, to be
used more particularly by medical writers, with reference to
the antagonal position it bears to the term symptomatic. It is
considered that in -this relation, the power of the term seems
most obvious. With these views, from the amount of evidence
that presents itself to my mind, I am compelled to believe that
there are fevers which may be properly entitled idiopathic.
Although, in a certain limited sense, fever may depend upon
local irritation, still I would not recognize by this the doctrine
that all fevers radiate from a local point of irritation, much less
that the " cohors febrium magna" (all the infinite diversity of
fevers,) depend on a pre-established gastro-enteric inflammation.
While we willingly accord to Broussais the honor of being one
of the greatest pathological writers of the present age, still we
regret to see, that, that saliency of genius, which, like " vault-
ing ambition overlaps itself" has led him far, very far into ul-
traism, the besetting sin of the day ; and while we acknowledge
that he has unmasked many hitherto occult gastro-enterites, and
by a more enlightened pathology, conducted to a better and
more judicious treatment, thereby conferring a lasting obligation
on our science, still we must urge against that doctrine, the
charge of too great exclusiveness, which attributes all fevers to
a pre-established inflammation of the stomach and intestines.
I am aware that in supporting the side of the question, which
the preponderance of evidence compels me to advocate, I shall

140 An Essay on Idiopathic Fevers. L^uo-

oppose the opinions of some members of this society, whose
medical attainments I hold in very high estimation.

The advocates of the Broussaian doctrine refer to post-mortem
examinations, and believe the truth of their doctrine established
by the phenomena developed by the dissecting knife. It is affirm-
ed that traces of inflammation in a more or less advanced state,
occur almost universally in the mucous membrane of the ali-
mentary canal of such patients as die of febrile affection. Ad-
mitting that these marks of previous inflammation do very ge-
nerally occur, it is reasonable to suppose, that in a very great
many cases, inflammation of this part, instead of being the
original- source of the disease, supervened after the develope-
ment of febrile action : that parts unaffected in the commence-
ment of fever, do in its progress become highly affected with
inflammation, is a fact of familiar observation, and when we
bear in mind, that the secretions poured into the intestinal canal
are vitiated, and sometimes of a very acrid quality; and more-
over, that from the almost entire proscription of purgatives so
strangely insisted on in the Broussaian practice, they are allowed
to remain an unmerciful length of time in contact with the de-
licate mucous membrane of the intestines ; is it strange that tra-
ces of inflammation, or even of ulceration should appear ? As
a still farther offset against evidences drawn from autopsic ap*
pearanccs, it is ascertained that so far as a mere redress, or an
injected state of the capillaries of the mucous membrane is con-
cerned, no satisfactory evidence can be adduced of the previous
inflammation of this structure ; for these phenomena often oc-
cur in articulo mortis or post mortem; as has been demonstrat-
ed by the observations of Yellowly and Seeds, founded on expe-
riments. The former of these writers observes, that from see-
in" these appearances of the stomach so generally exist, in
persons suddenly destroyed, while apparently in perfect health,
in whom he found the mucous membrane of the stomach highly
injected, he is induced to imagine that the opinion so usually enter-
tained of their being the result of inflammation is not well founded.
Drs. Seeds and Parish found that in animals bled to death, the
membranous structures frequently exhibited a state of injection,
which might readily be mistaken for inflammation; this may also
be accounted for by a power the arterial tubes have of contract-
ing to a considerable extent, by what Bichat calls the contract;"-

1836.] An Essay on Idiopathic Fevers. \ 11

lity of texture, and that this power is not limited to the period of
life, but continues for some time after death. It is equally a
physiological fact, that the capillaries are endowed during life,
with a peculiar kind of sensibility, which causes them to resist
the intromission of such fluids, as they are not, in the perform-
ance of their natural functions, designed to convey. This. pecu-
liar sensibility, by virtue of which, the serous capillaries refuse,
or contract against the intromission of red blood, it is thought,
depends on the regular influx of the nervous influence. These
facts are abundantly proven by experiments made on animals.
The following is one of M. Bunira's, quoted by M. Bichat :
He fixed the pipe of a syringe into an artery of a living ani-
mal, and on endeavouring to force the fluid into the vessel, he
found great resistance, the piston passing very slowly, and only
with the application of much force. On causing the animal to be
killed, by dividing the spinal marrow just below the occiput, the
fluid passed rapidly out of the syringe into the artery, although
very little force was applied. The application of the result of
this experiment to the post-mortem production of a red and in-
jected state of the membranous structures, is easily explained.
So long as the serous capillaries retain their vitality, they resist
the entrance of red blood ; as soon as their vital properties
cease, they lose the power of resisting the intromission of red
blood, becoming in fact mere yielding and passive tubes : and
as the arteries continue to contract on their contents for some
hours after the extinction of life, they necessarily force the red
blood forward into the now relaxed and unresisting capillary sys-
tem, and thus is produced the red and injected state of the more
vascular structures so often found on post-mortem examination,
where no previous inflammation whatever existed. Sir W. Philip
found that the lungs and stomach were covered with injected ves-
sels in animals, which died from the division of the par vagum.
Yellowly found that persons who died from hanging, exhibited
the mucous membrane of the stomach in a high state of apparent
inflammation. And the able Professor of Anatomy in this College,
while conducting the post-mortem examination of the last cri-
minal executed in this county, exhibited to the admiration of
all present, a most beautiful specimen of injected stomach. This
individual it was well known died of hanging, and not of fever.
If then this state of the stomach can, and does exist without fe-

11:2 An Essay on Idiopathic Fevers.. [.Aug.

ver being its attendant, and it' post-mortem examinations offe-
rer patients show equal traces of inflammation in other organs
of the body, as the brain, and thoracic viscera, it must in a great
measure abate the value of the evidence afforded by the dis-
secting knife in favor of gastro enteritis being universally the
first link in the catenation of febrific causes. Another evidence
oi the unsettled state of this doctrine may be predicated on the
fact that the advocates of fever radiating from a focal point of
irritation, locate that point in different organs. While Brous-
sais pronounces gastro enteric inflammation to be the " fons et
origo" of fever, the distinguished Clutterbuck, with equal confi-
dence asserts that all fevers emanate from a pre-established in-
flammation of the brain and its membranes ; and each appeals
to post-mortem examinations for the the truth of his posi-
tion.

A consideration of a few of the phenomena of fever will per-
haps reflect some light, by which we may distinguish idiopathic
fever from the febrile action consequent on inflammation. With-
out regarding the initial symptoms which usher in almost all
purely febrile affections, and which are very different from those
characteristic of inflammation, the whole course and phenomena
of intermittent fevers present insurmountable objections to their
identity with that febrile action consequent on a pre-established
focus of irritation in the gastro-cnteric membrane. The course
of treatment found most successful in the two diseases, will at
once preclude the possibility of their identity ; while quinine,
arsenic and piperine are the most successful remedies in arrest-
ing intermitting fevers, who would not turn away with horror
at the idea of pouring such phlogistic articles into the stomach
of a patient labouring under gastro enteritis, and in their stead
prefer leeches and the diete absolue.

If we dislodge the origin of fever from the location assigned to
it by Broussais and his disciples, it will be incumbent upon us to
give it a habitation elsewhere ; we would therefore define fever
to consist essentially in a nervous derangement of the arterial
system, caused by the impression of a specific poison, designated
malaria, arising from the decomposition of organic matter.
This derangement of the nervous, is imparted to the vascular
system ; hence we have the first and second link in the forma-
tion of a fever. A consideration of the manner ia wliich the

1830.] An Essay on Idiopathic Fevers. 143

febrile poison is communicated to the system, will, perhaps, in
some measure countervail the opinion that it is altogether of
gastro enteric origin, and tend to corroborate the positions ad-
vocated in the preceding remarks. It is well known that fever
depends upon a malarial constitution of the atmosphere. Those
who contend for the gastric origin of fever, suppose that the fob-
ritic poison becomes entangled in the saliva, and is thus applied
to the surface of the stomach. The quantity received in this
way, would scarcely seem sufficient for the effect produced.
The very delicate and extended surface of the air-cells of the
lungs, exposed to an impregnated atmosphere, would, it seems,
present a much more adequate medium of communication. And
when we reflect on the very extraordinary effect produced by
the inhalation of the nitrous oxyde gas, as witnessed in the philo-
sophic experiments of last Wednesday evening, we may well
infer that opposite and deleterious consequences may be produc-
ed more or less suddenly, by the continued breathing of a mala-
rial atmosphere. Neither the nitrous oxyde gas, nor the sulphu-
ric ether, will produce their peculiar exhilarating effects when
taken into the stomach.

Thus I have given in a rambling and desultory manner, as
they have been suggested to my mind, a few of the evidences
in favor of the existence of idiopathic fevers. The arguments
on the other side of the question are many and specious, and
well worthy of serious consideration ; but as we hope to hear
them fully and ably advanced and advocated in the course of
the evening, it will be unnecessary to offer them in this place.

Before dismissing the subject finally, we will endeavor to de-
fine in what fever really consists, and after this, institute a com-
parison between it and inflammation ; by doing which, it seems
to me, we may very clearly and satisfactorily disprove their
identity. In defining the true nature of fever, we must consi-
der what organs arc affected, in what manner they are af-
fected, and in what order the derangements of these organs suc-
ceed each other, " In fever there must be derangement of the
nervous and sensorial functions ; derangement in the circulating
function, and derangement in the secretory and excretory func-
tions. This is the circle of morbid actions." Thus says Southwood
Smith, to whom I am indebted for this definition of fever ; and the
substance of whose lucid diagnosis between inflammation and

I 1 1 An Essay on Idiopathic Fevers. I Aug.

lever, I will proceed to give in a very condensed form, interlarded
with such observations as will make it apply in the present dis-
cussion. There never was a fever in which all these organs and
functions were not more or less in a morbid state ; there never
was a concurrence of this morbid state in this complete circle of
organs without fever. It is not the invariable occurrence of a
particular number of events that is alone sufficient to constitute
fever ; to this must be added invariableness of concurrence in a
particular order. Derangement in the function of secretion and
excretion, never comes first in this series ; derangement in the
nervous and sensorial functions never comes last in the series;
derangement in the functions of the circulation never comes
either first or last in the series, but ahvays second in succession.
Thus fever consists in three successive morbid changes, occur-
ring in the following order : In the first place, derangement in
the nervous and sensorial functions ; in the second, derangement
in the circulating function ; and thirdly, derangement in the se-
cretory and excretory functions. With the acknowledgment
of these facts, wre may dispense with symptomatology, as
symptoms are only the external and visible signs of internal and
invisible conditions of the organs. Thus having the true char-
acteristics of fever, if no other disease presents the same charac-
ter, fever must be a disease sui generis. In inflammation,
some of the phenomena are the same ; but the order in which
they occur is different, and thus affords a clear and applicable
mark of distinction between fever and inflammation. In inflam-
mation there is a similar derangement in the secreting and the
excreting functions. There is also sometimes similar derange-
ment in the circulating function, but the derangement in the
nervous and sensorial functions is seldom, if ever, similar. The
derangement in these latter functions, while it is apparently
different in kind, is certainly and invariably different in the order
of its occurrence. In Pneumonia, Enteritis, and Hepatitis, the
nervous system is the last to be involved, and suffers the least.
While we acknowledge that it is of the utmost importance in a
practical point of view, to bear in mind the close connection
between inflammation and fever, we at the same time see clearly
that they are not identical. As the term fever is nrjeant to
designate a certain number of events, which occur in a certain
snries ; the term inflammation on the other hand, expresses ano-

] 8 ;<i. j A cass <>f misplaced action of Ergot. 145

tker series of events ; each event composing this train, succeed-
ing each other in a different order* We have now compared
infl immatioti and fever with regard to the series of events and
the order in Which they occur in each, and find that they differ ;
and as different terms are used to express different things, we
conceive that the term idiopathic is a very proper word to
designate such fevers, as we sec do not owe their existence to a
pre-established inflammation in some [.articular organ. Although
the state of the system in the primary attack of fever is not.
identical with inflammation, it is acknowledged that the morbid
condition into which the system is brought, in the progress of
lever, is for the most part that of inflammation : still, even in a
practical regard, though the remedies are the same in febrile as
in ordinary inflammation, they must be modified in the same
proportion that the febrile inflammation is modified by the pecu-
liar pre-disposing and exciting causes. Venesection is equally
necessary in each ; but the abstraction of sixteen ounces of
blood in febrile, will effect as much as double the quantity in
ordinary inflammation. Thus, though not for a moment deny-
ing the abundant existence of symptomatic fevers, wre insist,
that, whether we observe the causes, the phenomena, or even
the treatment of fevers, we are compelled to recognize also a
'-lass which arc properly termed idiopathic fevers.

ARTICLE V.

.1 case of misplaced action of Ergot. By Isaac Bowex, M. D.

of Augusta, Geo.

-

On the 17th of May, 1823, I was called to see a negro
woman, who had been in labour for more than twelve hours.
On examination per vaginam, the os tinea) was widely dilated,
and the vertex of the child's head nearly even with the Labia.
The presentation was strictly the first of Baudelocque. I
arrived precisely at 4 o'clock, P. M. at which time I was
19

1 ii A ease of nttsplacc^ action, of Ergot. L-^uc-

informed by a midwife then id attendance, that labour was
going on very favourably until 12 o'clock, M. when the woman1
was taken with a cramp in the right hip, and labour pains ceased
altogether. It will be perceived that she lay in this situation
during four hours, only complaining with a pain in the hip.

The case appeared to me one of the fairest for the administra-
tion of Ergot. Accordingly, I made an infusion of twenty-live
grains of this article, and gave it every fifteen minutes in broken
doses. It was all given in about one hour and a quarter, pro-
ducing no other effect than apparently to increase the pain in
the hip, which became so excruciating as to require some device
for a speedy relief. I ordered a brick to be heated, which was
quickly done, wrrapped in a woollen cloth, and placed to the
painful part. Almost immediately after this application was*
made, the pain of the hip was relieved, and labour then recom-
menced with unusual rapidity, and was terminated in a few
minutes by the expulsion of a living child. I have seen Ergot.
produce Asphyxia, in several instances, in which the pains were-
not so violent. From all. the circumstances of the case, it wasp
manifest to me that the action of Ergot was invited by the pain
in the hip to assist in its increase. The same Ergot has been
given since, in a great many cases, and has never failed to pro-
duce labour pains in less than twenty-live minutes. In all
other cases, in which I have seen it given where labour was
partially suspended by erratic pafhsr, it seemed to rectify thee
process by a direct actjon upon the uterus.

Note. The facts of the above case oflaj&our, our favourable
acquaintance with the author will not allow us for a moment to
doubt. But under the guidance of our rule for philosophising,
we feel bound to a different view of the sequence of phenomena,
and conclude that the rationale is. 1st. That as regular labour
existed; and 2d, a cramp or other severe painful affection.
seized the hip ; that 3d, this cramp overruled the actions of re-
gular labour ; and 4th, that when this overruling cause or
influence was removed, the regular actions of labour were
resumed, &c.

The two first points are admitted. They are declared in the
text. The third is supported by the fact of the proportion or
adequatcness of the cause to the cfloct. as is proved by constant

1836.] A case of misplaced action of Ergot. I4S

demonstration of this proportional power. Who has not often
witnessed the overruling of labour by spasms in the Lumbrici

1 is, or the Gastrocnemian, or other muscles of the lower or
upper extremities, or ether parts? Indeed much less powers,
or those which appear less, are very common retarding influ-
ences ; as bashfulness on the approach of the accoucheur, desire
to evacuate, &c. One of the most provoking causes of retard-
ation with which the accoucheur meets, (provoking because
generally avoidable,) is the disposition of the patient to talk, or
to change her position by voluntary effort at the approach of
regular pain ; either of these being quite competent in most
cases to the serious interruption of the progress.

But there is another view of the proportion of cause to effect
to be taken in this case, calculated to render doubtful the philo-
sophy advanced.

1st. The quantity of Ergot given Was very small, such as
often fails to exercise a controlling influence on the case, espe-
cially wh.:n of such impaired power as that ordinarily procured
of the druggists in the South for the last twelve or fifteen years.

2d. It is the common tendency of Ergot to operate contrari-
wise to this alleged operation give point to the pains by pro-
moting uterine action, and thus overrule what has been called
misplaced labour.

3d. Supposing the Ergot to have been better than usual, and
the quantity well adapted to the susceptibilities of the system ;
still the time, so far as we can form an opinion of it from the text,
was not more than what was about necessary to develope the ef-
fect of Ergot given thus moderately by the time the expulsory
efforts became efficient, which was immediately after the warm
application to the hip, the pain in which, from its intensity, hav-
ing demanded " a speedy device for relief."

The unusual rapidity of the labor, which " in a few minutes'*
terminated m the expulsion of the child, was very like Ergot
operation ; and if the article produced any effect itself what-
ever in the case, it appears to us imst probable that it was in
this part of the labour only. Ed.

148 On Amygdalus Persica Extract of Belladonna. [Aug.

ARTICLE VI.

On Amygdalus Persica Extract of Belladonna. By M.

Antony, M. D. Professor of Obstetrics, &c. in the Medical

College of Georgia.

Amygdalus Persica. (Lin.) Fol. Common Peach Tree. I am
not conscious of any difference in the medicinal powers of the
numerous varieties of this species of Amygdalus, but have for
many years used for their sedative powers the leaves of any of
those varieties which wre cultivate for their fruit.

During the summer of 1831, after the prevalence of East
winds for some weeks, a fever of unusual severity appeared here.
These fevers were of remittent type, and rendered peculiarly fa-
tal by their being generally attended with gastric irritation ; and
indeed in very many cases, a high degree of gastritis and gastro-
enteritis, with all their usual distresses and dangers prevailed.
No symptom was so uniform, especially during the first half or
two-thirds of the fever season, as a total inability to retain in the
stomach the lightest article of diet, or most simple drink, with
more or less tenderness of the epigastrium, on pressure. These
distresses attended early with a sallow pallor, shrinking of fea-
tures, and sometimes a pale leaden hue of skin, and general
prostration.

This state of the stomach at once, and as long as it continued,
precluded all possibility of internal administrations, adapted to
the treatment of bilious cases. Effervescing draughts even a
spoonful of cold water was often rejected. Sinapisms and
Epispastics were used in vain. The state of stomach reminded
me of some of those cases of plague in which this condition of
stomach is a regular and troublesome symptom, and in which
Laurel water has been found the chief corrective. Our
Apothecaries could not furnish that article. Believing its vir-
tues consisted mainly in the Prussic Acid which it contained, I
determined to substitute it by some other article from which I
could obtain the same power in a safe form, for ordinary use.
For this purpose the Prunus Padus (wild Cherry) and Amyg-
dalus Persica (common Peach) were presented to my mind.
The latter being always at hand in every garden, I determined

1 836.] On Amygdahs Persica "Extract of Btftado n nd. 1 1 9

on making my first experiment with it. The time for the petals
had past. I filled a small vessel with the fresh leaves from the
tree, loosely thrown in, then filled the vessel with boiling wa-
ter and covered it closely. Of this infusion I gave * ss. every
15, 30, or 60 minutes, according to the greater or less violence
of the symptoms. I rarely, if ever, used the 4th dose before
the distressing symptom was sufficiently removed to need no
more. That acute most distressing, distracting thirst, which
called incessantly for drink, and was in many of those cases
perfectly insatiable, was generally allayed with equal ease ; and
although the taste of the infusion was most bitter and disgust-
ing to the natural sense, in these cases it was' scarcely ever re-
jected ; but on the contrary, called for most anxiously after the
first taste of it ; even by children, to whom bitter drugs are gen-
erally so offensive.

I frequently applied to the epigastrium also with good effect,
the leaves taken warm out of the infusion ; but the infusion was
generally found far more successful. The gastric symptoms in
this fever were not so commonly met with towards the close of
the season ; but the distressing thirst was common to the end.
The efficiency of the remedy was almost hourly tested until the
close of the season, and my confidence in its uniformity of ef-
fect thereby continually confirmed.

One or two cases of ordinary Cholera Morbus came under
my notice in the latter part of the season, in which it was equal-
ly prompt in relieving the vomiting. Several sporadic cases of
Cholera Infantum occurred after the close of the fever season,
in which it was used with no less conspicuous benefit. Since
the above experience, 1 have often used this infusion with the
most marked benefit in that irritable stomach which often attends
Cholera Infantum, as well as gastric and gastro-entcritic fevers.

In addition to the above, I am happy in being able to state, on
the authority and observation of my colleague, Dr. Dugas,
Professor of Anatomy, that it has proved a convenient, prompt,
safe and uniform remedy in Pertussis. His prescription is t<>
give the patient one pint of a pretty strong infusion each day,
in divided doses, until the disease disappears ; and that, in fami-
lies having 12 or 20 cases, he very rarely has occasion to make
another prescription the disease generally disappearing within
four or five days.

150 On Amygdalus Persica Ediract of Belladonna, [Aug.

The power of Prassic Acid in actually curing this disease,
immediately on arriving at the full dose for the patient, was
abundantly demonstrated in my practice in 1822. But the dif-
ficulties attending the use of Off. Prussic Acid are such, owing
to the various strength, age, l&c, that it cannot ever become a
remedy in general practice, except near a competent and cor-
rect Chemist.

But we here have great cause of gratitude to an ever bounti-
ful Providence, for strewing around us a simple, safe and cheap
remedy, accessible to all.

I need say nothing of the efficacy of this medicine in the cure
of those cases of Hsematuria which depend on irritations in the
urinary passages, as it has been long known to the profession.

Extract of Belladonna. This article has been recently
brought before the medical public by several northern practi-
tioners, as a new discovery for securing an early and easy dila-
tation of the os uteri in certain cases ; and practitioners have
been requested to test its efficacy by experience. We also find
since the publication of Velpeau's Midwifery, that it has been
used for this purpose for a length of time in France.

I notice this article on the present occasion, not for the pur-
pose of claiming priority of discovery, or use of the article, but
simply for the purpose of bearing testimony to its virtues.

Some cases of rigid, iron-like hardness of the os uteri had,
in my early practice, greatly perplexed and called loudly on me
for some means for its relaxation. At length, about 18 years
ago, when labouring under such a perplexity, I reflected on the
power of Belladonna in dilating the pupil of the eye for cataract
operations, and determined on the propriety of resorting to it
for my present necessity. Considering it an article of much
power, my next difficulty was to determine on the manner of its
application. On searching for some preparation which might
answer the demand, 1 finally adopted that of Chaussiers oint-
ment, which I prepared and applied to the os uteri by menus
of a vaginal syringe, truncated near the round end. I filled
the end to the extent of about 1 inch with ointment, and after
introducing it to contact with the os uteri, whilst, my patient
was laying on her back, forced the ointment out of the syringe
into the most depending part of the vagina, where the os uteri
rested. The syringe was then withdrawn, and the ointment

1830.] On Amygdalus Perslca Extract of Belladonna, 1 r> i

more particularly applied with the fingers to the whole of the
os uteri. After two hours the opposing rigidity was found 1" In-
yielding, and the case progressed without farther difficulty.
Several cases have since occurred in which I have used it with
similar success. In only one, was the second application needed.
I have no fears in its free application in that way. after the libe-
ral use made of it in those cases in which I have witnessed its
safety and eificacy.

It will not be forgotten that its use to the eye for dilating the
pupil in cases of cataract is almost universal, and although this
organ is one of proverbial delicacy, still we have, heard no
complaint of its injurious effects : and I have myself often used
it in these cases to my very great convenience, notwithstanding
the great susceptibility of the part and the concentrated form
in which the solution of it was applied. I would, however, from
the fact of the unusual inflammation which attended my two
last cataract operations, in which its application was needed for
a long time before the pupil seemed to feel its influence, enquire
whether other practitioners have observed, after its application,
a degree of inflammation, out of all proportion to the good pre-
paration and other circumstances of the case, supervene ? The
extract used in these two cases, was procured of such as rould
be obtained at the time for those operations, and may not have
been of the best. Or, as both of these patients were old, and
were black, it is possible that it was the rigidity of old age,
which being hard to yield, required too long application of the
article.

For many years, I have been in the habit of recommending
freely its use to my private pupils, and for several years past in
my public instructions, under the name of Dilating Pomade ; not
only for* the relaxation of the os uteri in cases of a fixed hard-
ness thereof, but also for promoting its more pro?npt relaxation
in those cases of labour in which general convulsions arc re-
peated at every period for pain; also in those cases of that
rigidity of the os uteri which retards the progress of the first
stage of labour, and which is the most common, troublesome
resistance in the first stage. But it has not fallen to my lot to
have an opportunity, when it was at command, for using it in
these convulsions ; nor have I yet been informed of its success
or use in such cases. I think it worthy at least of trial.

152 Cases with observations. |A-Ug-

Chaussier's ointment contains 3 i.j- extr. Belladon. to ' i. sim-
ple ointment. Prepared Lard will be found better than the
simple ointment, especially in winter.

It should be remarked that none of the extracts are subject
to greater variation of power than that of Belladonna, as we
find it in the shops.

ARTICLE VII.

Cases with observations. By F. M. Robertson, M. D. of

Augusta, Geo.

Those who have devoted their attention, in any degree, to the
subject of Phrenology, are aware of the function assigned to the
cerebellum, in the arrangement of this system. The science
not only recognises separate and distinct elementary faculties,
but these faculties are manifested by means of separate and dis-
tinct cerebral organs. Appeals are made, by those who advo-
cate the science, not only to the physiological laws which gov-
ern the progressive developement and decline of the encephalic
mass, but also, to its anatomical structure, the pathological state
of the organs, and the derangement in the manifestations of the
functions dependent thereon. From these sources, a mass of
evidence may be accumulated, which will almost set opposition
at defiance ; for one fact is worth a volume of abstract reason-
ing; and, while the flimsy tissue, of which the latter is compos-
ed, is made to vanish before the superior light of truth and ob-
servation, the former stands Unaltered in its intrinsic nature.

Many cases, having the same bearing upon this point, as the
two we are about to relate, may be found in the surgical obser-
vations of Baron Larrey some of them arc so remarkable, and
apparently, unnatural, that they would at once appear question-
able, was it not that the veracity of the author stands "above
suspicion."

Case 1st. On the Oth of October, 1834. I was called to a ne-
gro man between thirty-five and forty years of age, who had
fallen through a dray while the horse was in motion. In de-
scending, the back of his head and neck struck one of the cross-

1836.] Cases with observation^. 153

bars of the vehicle with such force as to produce a severe con-
lion and fracture of the fourth and fifth vertebra; of the
':. The details of the case, so far as relates to the symptoms
sequent upon the fracture of the vertebra) and compression
of the spinal marrow, and the appearances on dissection, are
recorded in another .Medical Journal.* The patient lived thirty-
three hours alter the accident, occurred. On the day after the
injury was received, from his having voided no urine, a disten-
of the bladder was feared, to obviate which the introduction
of the catheter was proposed. On examining the parts, previous
to the introduction of the instrument, the penis was found to be
in a state of rigid erection. The catheter was introduced, but
no urine followed. The penis continued in a state of priapism
until the death of the patient, and though the instrument was in-
troduced repeatedly, not more than an onnce of urine came
away. Upon pressure above the pubes, no marks of a distend-
ed bladder could be observed. No twitching of the muscles, or
the slightest convulsion occurred during the progress of the case;
so that the priapism could not be accounted for upon the grounds
of a spasmodic action. Doctors Cunningham, Patterson and J.
E. Bacon visited the case with me, and the two last named gen-
tlemen witnessed the introduction of the catheter. Independent
of the fracture of the spine, a severe blow was received imme-
diately over the region of the cerebellum. It is to be regretted
that the examination, post mortem, could not have been carried
beyond the fractured portion of the spine ; but as this was per-
formed clandestinely, it was impossible, under the circumstances,
t > proceed further.

Case 2d. This case occurred during the late Seminole cam-
paign, and was related to me by Dr. Ogleby, the Surgeon to the
Battalion of Volunteers under Major Cooper. In the
engagement with the Indians, in what is termed the cove of the
Ouithlacoochee, on the morning of lie 31st March, Mr. Robin-
lemberiofthe Louisiana A'oluntecrs, received a rifle ball
in the back of (lie head. It entered behind the car. immediately
over the region of the ce h, and penetrated through the

skull, and was supposed, by his medical attendants, to have
\\\ the substance of this portion of the encephalon.
His is were those usually developed by such injuries,

I. 1st, "" ' *>(^ .

154 Cases with observations. L^llS-

and contrary to the expectations of his friends, he lived seve-
ral days after the wound was received, notwithstanding the
unfavorable circumstances under which the army laboured
relative to hospital comforts and suitable transportation for
the sick. As the main body of the army took up the line of
march for Tampa Bay, on the 1st of April, he was left, under the
care of Dr. Ogleby, at Fort Cooper. In the progress of the case,
the Doctor found it necessary, in consequence of the accumula-
tion of urine in the bladder, to introduce the catheter ; and, to his
surprise, when the penis was exposed, for the purpose of per-
forming the operation, it was found to be in a state of rigid
erection. The instrument was introduced and the urine evacua-
ted, but the penis remained in a state of permanent erection un-
til the death of the patient. The reaction, of course, was consi-
derable after the reception of the injury, and it is reasonable to
suppose that the portion of the encephalon nearest the foreign bo-
dy must have suffered most, from the consequent inflammation.

In this case one might suppose that the priapism was occasion-
ed, partly, by the stimulus of the excessive quantity of urine ac-
cumulated in the bladder ; but, this supposition is completely set
aside by the first case, in which no urine at all was secreted for
nearly thirty-three hours, and yet the priapism was as complete
as in the second case ; and again, in the latter case, the evacua-
tion of the urine produced no change whatever in this singular
symptom.

Those who have any curiosity to look further into this sub-
ject, are referred to the work of Gall on the functions of the brain,
Spurzheim's system of phrenology, and Baron Larrey's surgical
observations. The object of this article is not to discuss the
principles of phrenology, or to enter into an elaborate defence
of the science, against the many unfounded and unjust imputa-
tions which have been brought against it, but merely to give
two cases, which certainly claim some merit as facts in proof of
the science. Many of our readers will be inclined, no doubt, to
underrate the bearing which these cases have upon the point in
question, but we feel assured that strict observation cannot fail
to render almost positive, even with the most skeptical, many of
the positions maintained by the advocates of the doctrine ; for
the truth of the fundamental principles of phrenology may iioav
be considered as established upon too firm a foundation to be

1 836.] Injury of the Head. 1 55

overthrown by the ridicule of its opponents. The science has
recovered from the momentary shock which was given to it by
this once powerful engine. Facts are now looked upon as more
important than opinions, though the latter may claim high sour-
ces as their origin, and appeal to the consecration of antiquity.
These are no longer a barrier to the investigator into the laws of
nature, and fashion now possesses no terrors to him, who seek-
ing for truth, resorts to the universal volume, in which the hand
of Infinite Wisdom has inscribed His immutable laws. The
science of phrenology is based upon observation, and our oppo-
nents must resort to the same course before they can hope to ar-
rive at their ultimate end. Ridicule we do not fear, and aa
appeal to observation is all we ask. If the science be contrary
to facts, let it perish ; but, ifsup.poi ted by the truths of nature,
its own omnipotence will vanquish every foe.
Augusta, July 1st, 1830.

ARTICLE VIII.

Remarkable case of fracture and depression of the parietal bone,
from which the patient recovered, without the operation of tre-
panning. By B. B. Strobel, M. D., Lecturer on Anatomy
and Surgery, Charleston, S. C.

I was sent for in haste on the 14th day of March, 1830, at 4
o'clock, A. M., to Mr. L * * * * *, on board of the French ship
Isaie. He was lying on the deck in a state of extreme pros-
tration, uttering a feeble cry. His extremities were cold, coun-
tenance pale, lips livid, and pulse scarcely perceptible.

The first indication under these circumstances, was of course
to produce reaction. I ordered off the crowd which had col-
lected, so as to admit the access of fresh air, and had the pa-
tient's head sustained by an assistant, whilst I dashed cold water
in his face. Reaction ensued, and the patient was conveyed

1 56 Injury of the Head. [ A ug*.

upon a litter to an adjacent house, and v i *1 in an airy

room upon a comfortable bed.

The patient being now in a situation where I could operate
advantageously, I proceeded to an examination of the injuries
which he had received. I observed an extensive lacerated wound
of the scalp, corresponding to the right parietal protuberance,
and by the introduction of my finger into the wound, ascertain-
ed the existence of a fracture and depression of the parietal
bone. The fracture was about fourteen lines in length, extend-
ing in an oblique direction from the anterior superior to the pos-
terior inferior angle of the bone. The depression, which was
very evident to the touch, was from six to eight lines in depth.
My attention was next directed to an injury of the right leg,
where I found both bones (the Tibia and Fibula) fractured. The
extremity of the tibia projected through the lacerated integu-
ments on the internal side of the leg, about four inches above the
ankle joint. The patient was about thirty-five years of age, of
good habits and sound constitution. The following statement
was. made to me of the accident by which these injuries had been
inflicted :

Mr. L # * ** * was first mate of the ship, which had been
"hove down" for the purpose of examining her keel. The ne-
cessary repairs being completed, she was righted, and two sail-
ors were ordered to unrcave the fall and send down the block
from aloft. They neglected to make it fast to a rope, and threw
it off from the main top, from whence it descended on the 1
of the mate who was walking on deck. He was immediately
struck to the ground, falling on his left side, and receiving the
mass on the outside of his right leg, both bones being fractured
by the concussion.

That symptoms of compression would ensue, was to my mind
almost certain, when 1 took into consideration the severity of
the blow, and the extent of fracture and depression. I therefore
prepared my instruments, and held myself in readiness to per-
form the operation of the trephine. Indeed, J was disposed to
proceed at once to the operation, as night was rapidly ap-
proaching, and it seemed better to operate by daylight in anti-
cipation, than to wait for symptoms of compression, with the
chances of an operation by night. A moment's reflection, how-
ever, and a reference to the opinions of the best authorities, de-

183G.] Injury of Ih U a '. 157

terminal me to defer it, until ito'genthj demanded by the necessity
of the case* In the mean time, I adopted such precautionary
measures as were calculated to keep down excitement, and to
prevent determination f;> the head. The wound of the sc:dp
was freejy laid open, and fomented with clodts wrung out in
warm water to encourage hemorrhage, and a stimulating in-
jection administered. The injury of the leg was m xt attended
to the hones were properjy adjusted, and easily kept in place
by the ordinary splint and bandage, the fracture being trans-
verse.

I visited the patient several times in the course of the evening,
and saw no material alteration, the hemorrhage from the wound
had been considerable, the injection had operated well. The

* We are principally indebted to Desaiilt for this improvement in modern
Surgery. By the ancients the operation was performed in all doubtful ca-
ses. Their practice was adopted and received without its merit being ques-
tioned, until that justly distinguished Surgeon was induced to doubt.its pro-
priety, from having remarked that it seldom succeeded at the Hotel Dieu
at Paris. lie therefore declined trepanning in cases of fracture, without
depression, or effusions of blood, and this practice, which in his hands was
attended with great success, is generally adopted now-a-days.

Sir Astley Cooper in his lectures commends this course.

Larrey, in his Surgical Memoirs, page 117, makes the following remark :
" The trephine should not be applied in wounds of the head, accompanied bv
fracture of the bones of the cranium, whatsoever may be the extent of the
fracture and the number of the radii, if the fragments of bone be not driven
inward?, no foreign bodies present, or symptoms of compression not i
evident."

Boycr in his Traite J"s Maladies Obnrurgicale^ entertains similar opin-
ions :

" ?.Liis lorsqu'il n'y a ni enfoncement, ni epanchemenl de san~, on no
tr. pane point ; on s'en tient aux moyens generaux, tels que les saignces du
bras et du pied, les purgatifs, surtout remetique en I Lvage, qui procure des
evacuations alvines abondantcs sans irriter bcaucoup le tube intestinal."
vol. v. page ?.">.

"The instances of death, after the setting in of inflammation from very
trilling causes, are of almost daily occurrence, and would induce us to anti-
cipate its certainty after all violent injuries : but it is a great mistake, now
acknowledged by the best Surgeons, to suppose thai every depression re-
quires an elevation, and every fracture the interference of art ; although it
is a common one fallen into by the juniors : and even among the older ciass
I have seen operations attempted on very unnecessary occasions." II- li-
nen's Principles of Military Surgery.

158 Injury of the Head. L^ug.

fomentations were continued to encourage the oozing of blood.
About 8 o'clock at night, however, a very evident change for
the worse occurred. The pulse had risen, was full, hard and
slow. The patient complained at first of a violent head-ach, which
was soon followed by drowsiness, stupor, and difficult and ster-
torous respiration. Notwithstanding the unfavorable state of
the case, I resolved to make one more effort for the relief of the
patient, before resorting to the operation. My impression was,
that the symptoms of compression were produced rather by a
fullness of the vessels, than by the depression of the bone. Had
the symptoms depended upon the latter cause, they would have
shown themselves, soon after the occurrence of the accident.
Four hours had, however, elapsed, before they began to be mani-
fested it seemed, therefore, reasonable to conclude, that the
subsequent determination of blood upon the brain, which took
place, when full and perfect reaction ensued, was sufficient to
account for their occurrence. The remedies which I proposed,
if they proved beneficial must be prompt and efficient in their
action but little time would be lost in giving them a trial, and
there was a possibility of avoiding a serious and dangerous
operation.

I tied up the arm and bled the patient until he fainted tap-
plied cloths wrung out in cold water to his head, placed his feet
in a tub of hot water, rendered more stimulating by the addi-
tion of mustard, and gave an injection composed of spirits of
Turpentine and Molasses.

The conjoined effect of these remedies was soon evinced. The
difficult and stertorous breathing, stupor, drowsiness and head
ach disappeared, and the pulse became soft and natural. I was
not, however, satisfied with having attained this much, but de-
termined if possible to prevent a recurrence of the unpleasant
symptoms. Cathartics were not only likely to keep up a con-
stant drain from the bowels, but were also calculated, by their
irritating impression on the intestinal tube, to counteract deter-
mination to the head on the principle of revulsion. The furred
condition of the tongue, also seemed to indicate the propriety of
their administration. I therefore ordered 15 grains of Calomel
to be given immediately, and in two hours after taking it, a
wineglass full of a saturated solution of Epsom Salt every
hour "pro renata."

1836.] Injury of the Head. 150

I visited the patient at 12 o'clock. His Medicine had operated
several times. No return of head ach pulse natural skin
warm and moist directed the solution of Salts to be continued,
the same dose, but at intervals of two hours.

March 15th, 5 o'clock, A. M. The patient doing well, pulse
natural, skin moist and warm, tongue clearing off, no uneasiness
about the head.- The medicine had operated ten or twelve
times, producing large watery stools, mingled with bile. Or-
dered the Cathartic to be discontinued, and the patient to be kept
on a diet of arrow root, rice or barley water, and cold water.
From this hour the patient complained no more of his head,
although he suffered much from his leg. I visited him several
times during the day, and observing no returning symptoms
of compression shaved the scalp and approximated the edges
of the wound with adhesive straps. It healed as kindly as
could have been expected, in part by granulation, and in part by
the adhesive process. The patient wras kept on a rigid system
of low diet for twelve or fourteen days, to prevent a recurrence
of the unfavorable symptoms. In the course of five weeks the
wound of the scalp, had entirely healed the depression of the
bone remaining very evident. The fracture of the leg had so far
united at the expiration of six weeks, that this individual was
enabled to return home in the vessel.

After the recovery of the patient, I had the curiosity to make
an examination of the block. It was what sailors term, "a three
sheave block," used at ship-yards for heaving down vessels.
It was bound with iron hoops or straps, and weighed two hun-
dred and fifty pounds.

It really seems surprising, (almost incredible.) that such a mass
should have fallen from a distance, upwards of thirty-five feet,
on the head of a man, without instantly killing him. Cut the
result is easily explained by a reference to mechanical princi-
ples. Had an iron ball or any hard irregular shaped substance
fallen from the same height upon the head of an indivi-
dual, it is more than probable, that the fracture and depression
which would have resulted, together with the consequent inju-
ry of the brain, would have been attended with fatal consequen-
ces, and the reason is obvious the whole momentum would
have been communicated at a given point. Here, on the con-
trary, we have a large mass of great weight, with smooth round-

*60 hiju LAl,,r-

ed surfaces slrHiing obliquely the momentum bei reat

as instantly to throw the body from the line in which i was
falling'. " Had th< sam< mass fallen frcm the same dists ? in
a straight lin ead of striking 6bliquely, the ce

vvhich the body would hafce offered, would probably
have shattered the cranium to>atams>hut would in all j tlity

have crushed the bones of the inferior extremities, ; well as
many of the bddy generally, f It is thus by the application of
the principles of Physical Science, that we are enabled to ex-
plain the nature of injuries, and not unfrequently to* deduce our
prognosis.

* Mr. Quesnay, in an essay od the use of the trephine in doubtful cases,
(published in the 1st volume of the ?! >,,';.- s de I'Academie Royale dc Chi-
rurgie,) slates "that a stone of twenty pounds weight tell perpendicularly
from a heighl on the head, and occasioned no fracture, whilst a blow from

t lie list on the temple produced a fatal eif Vision." There can be no doubt
that the force of the blow from the stone was greater than that inflicted by
the fist. How then can we explain the diilerent results, except by the angle
of incidence ? the blow from the fist being direct, or in a straight line,
whilst the stone must have struck obliquely. I once made a post-mortem
examination of a woman who died from a rupture of a blood vessel on the
brain, producing effusion within the cavity of the cranium. This injury fol-
lowed a blow on the top of the head from the fist of a man. The woman was
an habitual drunkard, and had brought on a condition of the vessels, which
predisposed them to rupture. It therefore became a very nice point of me-
dical jurisprudence to determine, whether such a blow under other and
favorable circumstances would have proved fatal.

{ By calculation the momentum may be ascertained with some degree of
accuracy. The following process may not prove uninteresting.

Let the quantity of matter (M) = 250 pounds. Space through which it
foil (S) = 30 feet. Space through which a body falls in one ,\ cond, (M) =
16 icet.

Then {Oh mics, An. 53.)

T (time of falling) = y/l = yj \[~- \ seconds nearly V (velocity acquir-
ed hi that time) 2 m x T = 2 X 1G x -A =40. This di \ for re-
sistance of atmosphere, etc. leav< s3*2 for the velocity.

T1;" momentum would th refore be equal to M x S = 250 x ''-
8000, a force sufficient to crush a man's skull to pieces, had it fallen upon
it directly. This however did not, occur m the preseni instance. Let
us th poi e that . from the perpi i 0 degrees, i.e.

at an angle of * I s. This by the resolu-

tion of forces would give for its momentum, the si ht angled

triai'/ i -

L330.] Injury of the Head. 161

[Cambri tge Trig.

Art. ' '.

BC - 8000

A = 30

n 60

As Radius

10,00000

ito BC. 8090

3,90309

jsin. C 30

9, 897

to AD -1009 3,60206

Vri: 18 of the same.)
Here the n a is reduced to just; one half of what it was at first.

Four ll . however have crushed the scull to all intents

and purposes, as effectually, as 8000, had the head been confined in its posir
by a force equal to tjie momentum. But as the resistance offered, was
only that of the muscles together with the inertia of matter, which in this
case may be estimated at 100 lbs., we have the. force of infraction greatly
Med. For action and reaction being equal itis evident that the force
of the stroke must have been equal to the momentum lost by the body (block)
in the concussion. This we ascertain as follows : (Sec Cavallo part 1,
art. 2.3, 24.)

A (Block) == 250
B (Head) = 100
V (velocity required to make the momentum of 250) = 4000

A B V 250 x 100 x 16 = 400000

= = _. 1143 lbs.

A -f B 250 + 100 == 350

Momentum lost, or force of percussion, supposing the block to have struck
with its center, but as it probably did not strike with its centre the force of
the blow would again be modified by this circumstance, and probably not
exceed a force of 5 or GOO pounds. This proposition may be rendered more
intelligible by supposing an iron or other metallic weight of 1000 lbs. to fall di-
rectly from a moderate height, upon a leaden ball resting on an iron floor
the effect would be to flatten the ball. If however both were freely suspended
and the weight made to impinge against the ball from a distance equal to
the height from which it had fallen directly upon it, the effect would be no1
to flatten, but to send it off with oreat velocity.

1G2 Grey Sulphur tyring*. [Ar-u-

Part II. REVIEWS AND EXTRACTS.

Account of the Mcdiccit I Properties of the Grey Sulphur Springs,
Virginia. Charles ton, printed by A-. ii. Miller, lbS&v.
p. p. 18.

It is not every bearing of our professional duties which is cal-
eulated to add directly, and some of them not eyen remotely to*
the dollars and. cents of our annual income. Indeed, some ot>
the most dignified and honorable duties those to which the
profession is largely indebted, for the respectable rank it enjoys-;
amongst the liberal and exalted callings* instead of ever tending,
to pecuniary gain, have only for their reward the happy con-
sciousness of having discharged duties to humanity at our own
expense of having done good to our friend* our neighbour >
not only by being accessary to his welfare, but also in effecting
this good at the least possible expense to him. Such arc the
duties of searching out and effecting the correction of local cau-
ses-of disease instructing the community on- the subject of in-
jurious customs, habits or fashions ; as imprudence in dress, in-
dulgence in the enervating, health-destroying luxuries of lifer

&LC. &LC.

These duties when faithfully performed', tend most certainly
to lessen, to a greater or less extent, the sum' of physical evil*
to which humanity is subject ; and thereby diminish the calls oru
the practitioner.. Their faithful and abundant performance i
properly considered as an indication of the in-dwelling of that
humanity and benevolence which are the diamonds and rubies-
among the jewels in the professional casket. If aught in man-
can be disinterested, such must be these noble deeds. And
here we would not withhold a tribute of respect due to the
medical men of the world, and particularly of the United States ;
not individually, but as a community, for the noble stand they
have taken in the temperance reformation.

Regardless of the effects of the wrath of those whose income
from the grossly immoral manslaughtcring custom of traffick-
ing in intoxicating liquors would be lessened by their successful
influence on the community, they have exercised a noble deci-
sion, and independence of character, most honorable to any fra-
ternity or class of men. They have, in many instances, know-
ing that their daily bread must come from the popular favour
around them : and, regardless of self-interest in the virtuous
hope of arresting the fatal progress of a mighty and devastating
torrent, filled with the worst of physical and moral enemies to
humanity, dared to bring forward the armamentary of their
conclusive testimonials and pathological science, and occupy
with unwavering firmness the posts i f greatest danger.

V836.] Grey Sulphurr Sjorings. MB

Nor have fbey been merely passive watchmen on the ram-
frizes of health and morality, but have led. the croisnde against
.a ruinous and mighty enemy to both, which was cherished, like
the frozen viper by I he husbandman, in the houses of their best
friends sanctioned, like all vice familiarized by universal ap-
probation ; and made strong and resisting, like the chains of
superstition, by the habit of centuries.

We have been led to these reflections by reading tlrc little
pamphlet described at the head of this article, and searching for
the reason for the infroquency of the prescription of mineral
waters by physicians. As medicinal means afforded by a kind
Providence for the relief of human afflictions, mineral waters
-should be regarded as amongst the most important. Nor are
there any good reasons why they should not be used in medical
(prescriptions with as much promptness as any other articles of
tthe materia medica.

We may say, and with truth too, that these are articles with
which, from their distance, and want of observation of their opera-
tion, we have not become so familiarly acquainted, as with the
articles of commerce which are found with the apothecary.
But this should not be so. These natural productions are not
less worthy of our attention than other mineral, vegetable and
animal productions, which make up the sum of our .ressmedieoa.
For when the whole assemblage of all things an&erreum stances
(brought into operation by a travel to some watering place, is
better calculated to imeet the necessities of our patients, than our
protracted and too often unsuccessful attempts to imitate by
art what nature has better prepared, it becomes our imperious
duty to prescribe them. Nor w'ffl that ignorance of them
which may prevent our knowing their superior powers, fully
excuse us ; for it is not only the duty of the practitioner to do
for his patient the best he knows, (a common, but not a very
.flattering recommendation by the way,) but it is to do the best
that can be done.

The infrequency of these prescriptions cannot be -attributable
to the desire of retaining the business of the patient in hand.
Such a charge cannot hold at the present day amongst those
who merit a place in a profession in which the purpose of ma-
king a fortune, or even a competence, must be secondary to that
of doing good to suffering humanity. And such is the profes-
sion of medicine ; and he who cannot subscribe to, and act upon
this principle, should be as promptly proscribed as one who
would traffic or indulge in the use of intoxicating drinks.

In the pamphlet we are presented at once with two most im-
portant medicinal powers ; the productions of no Swaim nor Mo
rison imposition or secrecy ; but of the pure and perfect labora-
tory of nature, accompanied with a qualitative analysis of their
'elements, and satisfactory attestations of their operations as
anedicinal powers.

164 Grey Sulphur Springs. [-^ll3

For the benefit of the profession, and through them, of the
community at large, we give a few selections from the pat
of the pamphlet itself: for we think these, as well as m >sl
other medicinal means, suffer great loss of good effect, and con-
sequently, loss of character to say nothing of the injuries they
effect, in consequence of a promiscuous and unscientific adop-
tion of their use. And we would here say in passing, to such
(if such there be) as would dislike too much the loss of their
daily attendance, to recommend their patients to a course
which would compel their absence ; that it were better to make
the prescription, and satisfy their thirsty avarice by a bold de-
mand at once on the pockets of their employers for the prescrip-
tion, than not to make it at all.

On the first page, the location of the Springs is thus de-
scribed :

"The Grey Sulphur Springs are situated near the line, dividing the coun-
ties of Giles and Monroe, Virginia , on the njain road leading from the
Court-House of the one to that of the other. They are three quarters of a
mile from Peterstown, nine miles from the Red Sulphur, and by the County
road, twenty and a quarter miles from the Salt Sulphur Spring. In travel-
ling- to the Virginia Springs, by either the main Tennessee or Goodspur
Gap Roads, and crossing the country from Newborn, by the stage road to
the Sulphur Springs, the Grey Sulphur are the first arrived at. They are
thirty miles distant from Newborn. The location is such as will admit of
many and varied improvements, which when completed, will render this
spot an elegant and desirable resort during the summer months, indepen-
dent of the high medicinal properties of the mineral waters."

On the same and following pages, we have a description of
the Springs :

"There are two Springs at this establishment, situated within five feet of
each other, and inclosed in one building. Although rising so near to i
otiier, yet they differ most materially in their action on the system. Both
appear to be peculiarly serviceable in dyspeptic cases, and in such as origi-
nate in a disordered state of the stomach the one, in those in which inflam-
mation exists, the other in such as proceed from torpidity. They have
hitherto been known as the large and small Springs ; but having succeeded
towards the close of the last season in procuring a much larger supply of
r at the small Spring than is afforded at the large, a change of names
ime necessary. The large will hereafter he known as the Anti-dyspep-
tic, and the small as the Aperient, winch names wdl serve to point out their
peculiar characteristics.

"Thei e Springs have been classed by Professor Shephard, as AVcalino
i\- so i- ' ly met with, that another is not known to
elsewhere in th( United States. The waters are beautifully clear;
ai i liighly charg< 1 v ith gas, which render them light and extremely plea-
sant, thei iti-dyspeptic Spring, which produces none oi

tho- unpleasant sensations so frequently felt on the first drinking of mine-
ral v

\V; . me f the water was submitted to a. chemist for

analysis ..the qua;" ' DO small for him to ascertain all its

I has been made by Professor C. IJ.
Shcnhard, who has famished us with the following abstract of an articlq

1836.] Grey Sulphur Springs. 103

which appears in the April Number (1836) of Professor Silliman's Journal
of Science and Arts."

"The following is the most satisfactory view which my experiments ena-
ble me to present of the condition of these water.- :
Specific gravity, 1,003.

SOLUBLE IXGREDir.VTS.

Nitrogen,

Hydro Sulphuric acid,

Bi-Carbonate of Soda,*

A Super Carbonate of Lime,

Chloride of Calcium,

Chloride of Sodium,

Sulpliate of Soda,

An Alkaline or earthly Crcnafe, or both.

Silicic acid.

INSOLUBLE INGREDIENTS. ' ,

Sulphuret of Iron,

Crenate of Per Oxide of Iron,

Silicic acid,

Alumina,

Silicate of Iron.

My experiments do not permit me to point out the differences between
the two Springs with precision. The new Spring appears to give rise to a
greater amount of hydro-sulphuric acid, as well as of iron and silicic acid.
Probably it may differ in still other respects. I have not examined it for
Iodine or Bromine.

As no regular analysis was attempted, the quantities in which these seve-
ral ingredients exist, still remain undetermined. That they are in different
proportions in the two Springs, is evident rot only from their depositee, but
also from their action on the system. The action of th anti-dyspeptic
Spring is diuretic and gently aperient, tending to restore the healthy per-
formance of the functions, and reduce or diffuse the local irritations or" dis-
ease. The Aperient Spring wThile it possesses all the alkaline properties
of the other, has an aperient and alterative action. Possessing more iron,
(of which the other has but a trace,) it acts more powerfully as a tonic,
whilst its other ingredients cause it to act in some cases as a very powerful
aperient.

As these Springs have been visited by invalids, only during the two last
seasons, it is reasonable to suppose that all their properties have not yet
been discovered, nor all the cases ascertained in which they can be bone
finally used. In fact, owing to the small quantity of water furnished hither-
to by the Aperient Spring, its qualities have been but little tested, and there
can be no doubt, (judging from its constituents) that it will be found equ
salubrious as the anti-dyspeptic Spring, only better adapted to another
class of cases. To give a general idea of the properties of these waters,
we might say that they are peculiarly serviceable in those diseases which
originate in a disordered state of the stomach and bowels, and also in he-
patic affections. It is proper, however, to enter more into details, and we
therefore submit the following synopsis of the medical properties of the
etntUdyspeptic Spring.

Medical Properties.

1. It relieves nausea and headachs, arising from disordered stomachs.

2. Neutralizes acidity, and if taken at meals, or immediately after.

* It cannot be determined whether free carbonic acid exists in tin
tors without going into a quantitative analysis. C. U. S.

1GG Roslan on Diagnosis* I Aug.

a tendency to prevent those unpleasant sensations so often experienced by
invalid?, from indiscretion in dieting*.

Jl> Is an excellent tonics exciting- appetite and imparting strength to di-
gestion.

4. Quiets irritation of the alimentary canal.

5. Controls and lessens the force of the circulation when unnaturally
excited by disease, and often in this way, is remedial in internal inflamma-
tion of the organs.

6. It tranquilizes nervous irritability.

7. Is a mild and certain expectorant, often allaying dyspnoea, and pro-
moting recovery from chronic ailments of the chest or wind pipe.

8. It alters the action of the liver where this has been previously de-
ranged, in a manner peculiar to itself, and under circumstances in which
the ordinary alteratives are forbidden by reason of their exciting, or other-
wise irrelevant properties.

9. It is also sudorific or diaphoretic ; and

10. When taken at bed-time, often proves itself soporific : apparently
stilling that indescribable, but too well understood inquietude, which so fre-
quently and unhappily interrupts or prevents the repose of the invalid, and
especially of the dyspeptic."

Next follow seventeen minutely and well detailed cases which
have been subjected to the powers of these waters, which tend
most satisfactorily to sustain the above account of their medici-
nal virtues : to which we may add, by looking over these cases,
a peculiar and valuable power of so allaying vascular irritation,
as to reduce with great promptness the morbid frequency of the
pulse, &c.

In addition to the testimonials of the medicinal powers the
pamphlet contains, the originals of which, with their proper
signatures, are in the possession of John D. Legare, of Charles-
ton, we have found in several instances corresponding evidence
in the accounts given by invalids who visited these Springs in
1835, and- with whom we have conversed.

The pamphlet concludes with the decided and favorable judg-
ment of Professors Moultrie and Dickson, of Charleston, from
the testimonials submitted to them : and the time has gone by
when such men as Moultrie and Dickson may be expected to
give their names to an expression of approbation which is not
fairly deduced from sound premises.

Rostan on Diagnosis.

We know of no better appropriation of a few of the pages
of this journal, than to the insertion of the following extract from
a work rarely found in the hands of the American practitioner ;

1836.] Rostan on Diagnos s. 1(>7

to whom it is of too much practical importance in every day's
business, to await the circulation and reading of an entire trans-
lation of the whole work, should it be ever offered to the Ame-
rican public.

We feel assured that a diligent attention to it cannot fail to
add greatly to the facility and clearness of Diagnosis, and con-
sequently to the correctness and value of therapeutic efforts.

On the mode of interrogating and examining a patient, and of recording cases.
Translated from Rostan's Work on Diagnosis.

Nothing is more embarrassing to the physician commencing the practice
of his profession, than the act of interrogating and examining a patient.
Indeed, this part of the art, of undoubted importance, since without it we
can arrive neither at a sure diagnosis nor a rational treatment, is so ne-
glected, that few practitioners, even among those of great experience,
acquit themselves in a creditable manner. We frequently remark the in-
coherence and disorder of their questions, their uncertainty and hesitation ;
losing sight of certain fixed principles, we see them passing without motive,
from one object to another, between which there is no connection. They
repeat unnecessarily the same questions, and those immaterial ; they forget
the most important points ; they confound subjects the most dissimilar, and
separate those having the greatest similarity ; and to crown the evil, they
are involved in obscurity, and by the merest accident, arrive at a just diag-
nosis and at a rational plan of treatment. All these disadvantages are the
result of a defective order of a want of method.

On first approaching a patient, we almost involuntarily examine Ins exte-
rior : his physiognomy first attracts our attention ; at first sight, we form
an idea of his age, his strength, his mcro-1 state, &c, circumstances of
great importance, connected as they are with the prognosis and the thera-
peutic indications. This first examination should not be confined to the head,
but extended to the whole surface of the body ; but unfortunately, this can
be done only in a very few cases, particularly in private practice. At least,
we must not dispense with the examination of the part affected ; if neglect-
ed, it is at the hazard of committing the gravest errors of diagnosis and treat-
ment. Some examples will illustrate the utility of this investigation. An
aged female, of limited intelligence, was brought to the infirmary, &c. She
complained of a violent pain in the abdomen, about the left iliac region.
The face was animated, the skin hot and moist ; the pulse strong and fre-
quent, tongue dry, thirst urgent ; otherwise the digestive functions in a na-
tural state : little or no change in the other organic or animal functions.
The abdominal pain was increased by pressure and by motion. Behold our
diagnosis ! The phenomena of reaction [the strong pulse, flushed face,
thirst, &c] indicate an acute state of disease, doubtless inflammatory; the
local symptoms point out the abdomen as its seat, but the digestive functions
being in a normal state, it cannot be in the organs of this function ; as the
slightest pressure is painful, the disease must be superficial ; and as the
slightest motion is painful, then the organs of motion must be affected.
Tlie muscles of the abdominal parietes must be diseased ; although rheumatism,
especially in old subjects, is not usually attended with such marked symp-
toms of general reaction. Satisfied with this reasoning we left the patient,
after prescribing a weak infusion of cumfrey, an enema, diet and rest ; when
a student, having exposed the part to view, discovered the existence of
zona ! This lesson impressed us more forcibly than ever with the necessity
of using mr senses, as tlie only means of positive knowledge.

A patient after a fall, experienced pain in the left side of the chest ; there
was also cough, and bloody expectoration, with symptoms of general reac-

IoS Rostan on Diagnosis, [A.ug.

tioa. One of the most experienced and attentive pupils was charged with
tha examination of the case, lie arrived at the conclusion that the diss ase
was - umonia, inasmuch as the cough and bloody expectoration in-

dicated the lungs as the seat of the affection; and although the pain, very
\ dent on pressure and on the motions of the chest, might possibly be seated
ia the pariet^s of the chest, yet the general symptoms indicated a more
profound affection of the lung itself; moreover, by the stethoscope the
orepitous rale was discoverable. Behold.' titers was afractur of it ribs.
uredly, an attentive examination of the diseased region would hav< se-
cured him from falling into so grievous an error.

The examination then of the exterior of the 'body, and especially of the
regions diseased, is of the utmost importance.

We should propose it to ourselves as the definite object of this examina-
tion of a patient, to obtain a knowledge of the'" disease and of the curative
judications, as promptly and certainly as 'possible. There are those physi-
cians who -continue this examination for a length of time. In some rare
cases this method maybe preferable. People generally love to receive our
attention to their cases they love to entertain their physician with the
least circumstances of their constitution, their antecedent dii , then*

manner of living, &c. The physician in listening to- these superfluous de-
tails, and even in encouraging them, secures the confidence of his patient,
and inspires him with the hope of relief at liis hands, and thus produces a
cerebral disposition favorable to the resolution of the disease; for the
brain, holding all the organs of 'the economy in dependence upon it, we
perceive that its state, whether good or bad, will exercise upon them an in-
fluence salutary or hurtful. But, how many circumstances there art. un-
der which this protracted method would produce unhappy results r In all
the diseases of the respiratory organs for example, haemoptysis, peri-pn* u-
monia, pleurisy, catarrh, phthisis, is it not very dangerous to encourage the
patient to speak for a length of time ? If a suffering organ is thus exercised,
shall not the disease be increased? Will not the spitting of blood be more
abundant, or if checked, will it not thus be renewed? Will not the inflam-
mation of the various tissues be thus increased in intensity? In such ca-
ses, the man whose office js to soothe and quiet pain, and heal the sick, may
thus by this method, become himself the cause of increased suffering, id
even of death. These same remarks are strictly applicable to the diseases
of the brain ; indeed, in these last cases, by multiplying your questions, you
act directly upon the diseased organ. It is then, in the great majority of
cases, of the utmost importance, to trouble the patient with as few ques-
tions as possible, and to accomplish, our object promptly.

The first question that we should address to a patient is this : Where is
your pain ! This question, which at first sight seems so simple, long ex] ,-
rience and reflection commend as the best. Patients are remarkably
prone to give their opinions about their diseases ; one will tell you he has a
nervous affection, another that the bile torments him; this one that, his
blood is diseased, and the other that the humours are disordered; and fe-
males are ready to refer to milk diffused and misplaced as the cause of their
diseases. We will not fail to receive souk- such answer, if instead *of the
question above, we ask How arc you ? Now, if the patient answers, I
have a nervous affection, &C., we have gained nothing, but in reply to the
other question, he will very generally indicate both the function and the or-
gan diseased, which is an important step towards the knowledge of the dis-
fsotwiihs-tanding the precision of this question, if is. frequently im-
possible to check this disposition to speculate upon their diseases. Some-
times they will mistake one organ for another, complaining of pain in hte
stomach; when the chesl is ' cted, &c. il istlien f< re-important, in order
ti tvoid all possibility of mistake, to insist on the hand being applied over the
painful region.

lvS.'U).] Rosffin on Diagnosis. 109

There is one other question not less important than this first one, which
will much abridge the labour of investigating the case. This question is
eminently analytical How long hare you been sick? If the disease be re-
cent, we then at ouce exclude from our attention all the chronic diseases to
which the organ now affected is liable if it has existed for a long time,
we then concentrate our attention upon its chronic affections. This ques-
tion then is scarcely less useful than the first.

After discovering what function is injured, we should pursue the examina-
tion, until we shall have passed in review, all the morbid phenomena which
it is capable of presenting. This object accomplished, we should then fix
our attention upon the organs most closely connected with the one diseased,
and examine their state with equal care : indeed, we, should then proceed
to examine all the organs and all their functions, without any exception.
This precept should never be neglected, for by this examination, thus care-
fully made in the commencement, we acquire an exact knowledge of the
sympathetic phenomena. When an organ is profoundly altered, it reacts
upon others, disturbing their action and altering their organization ; how
shall we be able in the progress of the disease, to recognise such alterations
as consecutive, if we have failed to acquaint ourselves with the state of
these organs at its commencement ?

Again, by this general examination, we inform ourselves of the existence
of concomitant diseases ; for it frequently happens that many diseases exist
simultaneously in the same individual. The patient then points out the
most prominent of these diseases, and if the physician be satisfied with the
diagnosis of this one disease, he will overlook the others, and may subject
his patient to a fatal treatment.

This, unfortunately, is not an unfrequent occurrence. Satisfied with dis-
covering the existence of one disease, we are disposed to forget that others
may exist. We cannot, then, insist too much upon this precept, that we
examine with the most scrupulous care all the organs of the animal economy
and the state of all their functions, at the commencement of every disease.

After examining the patient in this manner, we should acquaint ourselves
with the state of the organs in the various cavities ; for this purpose we
resort to percussion and auscultation for the chest, percussion and feeling,
for the abdomen, &c.

Percussion of the thorax is executed in the following manner : the patient
should be seated, and present most prominently the parts of the thorax to
be examined if we examine the back, the head sltould be bowed, the spine
curved, the arms folded on the breast ; in this attitude, the back is most
fully developed, and its muscular covering as thin as possible. If we would
examine the side, the arms should be alternately raised upon the head, and
the body inclined successively to the side opposite the one we are exploring.
For the anterior part, the recumbent position is preferable, with the arms
separated from the trunk. It is almost needless to add, that there should
be as little clothing as possible.

The physician, having united his fingers in the form of a cone, strikes
successively the different regions of the thorax, taking care to compare the
corresponding parts of the two sides only, and to strike these always at tli
same angle not comparing the sound which percussion renders, when
made upon the intercostal spaces, with that which it renders when made
upon the ribsand proportioning the force to the thickness of the thoracic
parietes, and especially to the degree of sensibility of the patient ; for there
are cases, in which the degree of pain forbids this mode of exploration.

On examining the chest of a sound man, by percussion, we obtain a sound
which we may compare to that of a tambour covered with a thick cloth.
This resonance is most remarkable at the anterior, superior and lateral part
of the thorax ; it is less in the back, upon the shoulder-blades, in the re-
gions of the heart and liver. In some thoracic affections, this reverbera-
tion, which depends upon the presence of air in the pulmonary cells, ceases,
22

HO Iioslan on Diagnosis. [Aug

_

and in others it augments. In the first case, we obtain a dull sound, on-
percussion, which has been compared to that produced by percussion of the
thigh ; we may then conclude, either 1st, that the air no longer penetrates
into the pulmonary tissue ; or 2d, that either a tumour or a fluid is inter-
posed between the lung and the side of the chest. If, on change of position,
the dull sound also changes its location, and occupies t! e- most depending
position, while the clear sound is heard in the most elevated part, we may
infer that the cause of dulness is a liquid body.

Percussion is one of our most certain and profitable means of examina-
tion. It seldom deceives those who practice it with skill. But it is neces-
sary to pronounce cautiously upon slight differences ; that this sign may be
valuable, it is neeessary that the ear be able to distinguish the difference of!
sounds from the two sides of the chest, that exists in numerous cases.

As to the increase of this resonance, it depends upon the fact that the?
thoracic cavity contains more air than natural. As we shah have occasion
to recur to this subject, we will confine ourselves to the remark, that this phe-
nomenon may lead us into a singular mistake it may induce us to believe
that the side which resounds most perfectly is the sound side, and the other-
side is diseased, which is the reverse of the truth.

But if percussion be thus useful, it is not without its inconveniences. lit
the first place, it compels us to throw the patient into fatiguing positions, and"
the efforts he thus makes, may exasperate the disease.. In the second placer.
the acute diseases of the chest in which we chiefly resort to this mode, hap-
pening generally in the winter season, it is to be feared, that the impression-
of the air upon the chest nearly naked, may coincide with the original cause
and augment the disease. Finally, we should dread dangers from the act
itself, since it is impossible to strike thus in the region of pain, without ex-
tending a hurtful shock to the suffering part itself. These inconveniences
are such as almost to balance the advantages of this plan; at least, we-
should resort to it only when the diagnosis is obscure, and when iL, may fur-
nish some important indication ; when the diagnosis is sufficiently clear, we
should abstain from it.

Recently, M. Piorry has contrived to effect percussion, by applying upon
the region to be examined, a thin plate of wood,, of metal, or of ivory ; by this
means he avoids the inconveniences of immediate percussion, and obtains^
more exact and precise results.

This mediate percussion is less painful than the direct ; the shock and
commotion of the organs are scarcely perceptible ; we may practice it over
the clothing and upon soft parts ; serous infiltration of the sides of the abdo-
men or thorax, excessive fat, even a blistered surface will not hinder this
mediate percussion. It is more easily practised, and the mode of applica-
tion being constantly the same over all the regions, there will result no dif-
ference of sound occasioned by the process itself which we cmplo)', so that
we can determine exactly the regions corresponding with certain organs,
measure their dimensions, estimate their consistence, &c. It is in abdomi-
nal percussion that these advantages are most conspicuous.

By means of this instrument, M. Piorry recognizes numerous varieties of
sounds, which he has endeavored to express by the terms femoral, jecoral,.
cardial, pulmonary, intestinal, stomachical, osteal, humoral, hydafic, <Jc We
shall not follow him in his definitions, nor in the divisions of the trunk rela-
tive to the sound of the organs, in the sound state ; these differences of
sound may be easily conceived of. By consulting his work,* we will per-
ceive the advantages which he proposes to attain, by this mode of exami-
nation. Admiring the zeal of M. Piorry, and felicitating him upon his ef-
forts at establishing with precision, the diagnosis of diseases, he yet seems

* De la percussion mediate et des signes obtenus a l'aide dc ce nouveau
moyen d'exploration, &c. in the College Library.

i$3(3.] Roslan on Diagnosis. 171

to us to attach too much importance to this mode of examination, and to deal
Touch in conjecture ; nevertheless, we could but approve this means, even if
it possesses only some of the advantages attributed to it, by this author.
Every thing- that sheds light on whatever affords any aid in appreciating
the different states of the viscera, should be eagerly welcomed.

Mediate auscultation gives us the knowledge of a great many phenome-
na, useful for diagnosis; this mode of research is so generally practised
now, that we need not describe the stethoscope, the instrument with which
it is performed. We apply exactly, one of the extremities <ef this instru-
ment upon the points of the thorax to he examinee!, and the ear to the other.
If we would examine the anterior of the chest, the patient should be on his
iback, and on the left side when we examine the right, &c. The patient
should sit up and lean forward when we examine the back.

By auscultation, we explore the voice, the respiration, the rale and the
circulation.

The stethoscope has been employed also, for appreciating more exactly
the crepitation, when obscure, produced by rubbing of the broken fragments
in fractures ; and, also, for detecting the sounds^which the foetal circulation
produces, which furnish an invaluable sign of the state of pregnancy.

Having spoken of the mode of practising auscultation and percussion, we
must dwell a moment upon that of exploring the state of the arterial circu-
lationof the feeling of the pulse.

The arrival of the physician generally produces some emotion, either of
fear or hope, &c, which disturbs or accellerates the circulation. We should
therefore wait until he regains a state of calmness.

In whatever situation arteries of a sufficient size are superficial, we may
feel the pulse. It is sometimes of importance to compare the pulsations of
the arteries in different parts of the body. We may feel the pulse at the
temporal, carotid, axillary, brachial, radial arteries, &c; it is at the
last that the examination is generally made. The crural arteries and
those of the foot may also be used.

Having assured ourselves that there is no obstacle to the free circulation
of the blood, the patient lying on the back, we place the fore-arm in a state
of pronation, we apply the extremity of four fingers over the course of the
artery, so that the ring-finger shall be towards the elbow, and the index-
finger towards the hand of the patient, i. e. feeling the puke f the Tight
side with the left hand, and vice versa. If the patient be up, we cause him
to be seated, and place his arm in the position above described. The fingers
of the observer being thus disposed, the hand is steadied by resting the
palm, or simply the thumb upon the posterior surface of the fore-arm ; we
thus conveniently exercise different degrees of pressure for determining
the degrees of resistance cf the pulse.

The exploration of the abdomen by feeling and pressure, merits special
attention, and furnishes important information. The patient should be
placed in the recumbent position, with'the head bowed upon the chest, by
means of pillows, the thighs and legs flexed upon the pelvis and thighs, the
knees separated, the arms extended at the sides of the trunk a position,
which relaxes most perfectly the muscles of the abdominal parietes, and
thus favors the examination of the viscera within.

In thus examining the abdomen, we should remember that we divide it
arbitrarily into many regions, to each one of which different organs corres-
pond. The knowledge of this branch of anatomy of relations, is indispen-
sably necessary to diagnosis ; for if we encounter in one of these regions,
phenomena, unobservable in health, we may, with probability, attribute
these to the organs corresponding with this region ; the probability amounts
to certainty, if the function of one of these organs is altered in a corres-
ponding manner. Thus we know that the stomach occupies the epigastric
region, extending partially into the two hypocondriac regions ; if we find a
tumour hi this region, there is a strong probability, that the stomach is the

172 Iiostan on Diagnosis. (Aug

seat of this tumour, but if the functions of this organ are disturbed, we are
certain of its location.

We should remember, however, that extraordinary instances of displace-
ment of the viscera sometimes occur ; we once, for example, found the py-
loric extremity of the stomach in the left iliac fossa. Having placed the
patient in a proper position, we apply the hands carefully at first, but after-
wards more freely over every part of the abdomen. We thus inform our-
selves of the degree of sensibility of these parts, of their suppleness, their
tension, their volume and the tumours they may present. All these symp-
toms are of the utmost importance in the diagnosis ; but the tumours of
the parts throw the greatest degree of light upon it. We should examine
with care, the seat, the form, the volume, the consistence, the sensibility
of these tumours ; we should remark whether they are moveable or adht-
herent, temporary or permanent, pulsative or not ; for each of these pro-
perties announces different alterations. The seat indicates the organ, the
consistence informs us of its contents, whether gas, liquid or solid ; the pain
indicates the nature of the tumour and the kind of change nature is effect-
ing in it ; its mobility encourages the hope that it is formed of matters
contained in the intestines ; in a word, if temporary and changing, it is either
a hernia or formed of matters capable of disappearing ; if pulsative, it h
connected with the organs of the circulation.

When the belly is considerably distended, and we suspect it to be either
by liquid or gas, we operate percussion in a peculiar manner. In the first
case, with one hand we strike against one of the sides, the other hand be-
ing placed on the opposite side ; we then feel a kind of liquid column
striking against the opposite side this phenomena is called fluctuation.
If the distension be occasioned by gas, on fillipping the abdomen, we obtain
a clear sound like that of a drum.

This abdominal pressure has been applied even to the investigation of dis-
eases of the chest.

Bichat suggested, that since distension of the stomach augmented the
difficulty of respiration in aneurism, in hydrothorax and hydropericardia,
&c, the elevation of the diaphragm by rapid pressure upon the abdominal
parietes, from below upward should afford some information important in
the diagnosis of thoracic diseases. He observed that, in pneumonia, this
pressure produced involuntary cough and a sense of suffocation; that in
pleurisy on the contrary, none of these phenomena were produced. In
effusion within the chest, he observed the same kind of difficult respiration,
the same suffocation, the same cough.

In hydropericardia, a disease so difficult to recognize, he asserts that this
pressure determines suffocation, sudden palpitations, irregularity of the
pulse, and sometimes dangerous syncope ; that in aneurism of the heart,
all the distressing symptoms are aggravated. At the present day, our
means of exploration being so singularly perfected, this one indicated by
Bichat is generally abandoned ; we should still have recourse to it under
some circumstances.

When the local symptoms occupy the mouth and the pharynx, we place
the patient before a window, or direct a strong artificial Tight into the throat,
and there are cases where we should introduce the finger into this part,
either to search for foreign bodies, or to examine the orifice of the larynx,
which in some affections is tumefied.

In examinations of the uterus, and even of the rectum, we employ the
speculum, which is made of various forms those which gradually dilate are
preferable, as they are easily introduced, and without pain.

There are some circumstances which render tin's examination of the pa-
tient difficult. In infancy, for example, it is frequently very difficult to arrive
at a knowledge of existing disease. The organs of relation being as yet
undeveloped, we are deprived of much information, which at other stages
of life the patient himself may give us. Moreover, the sensibility being

)83().] Rostan on Diagnosit. 173

excessive at this period, the sympathetic phenomena of disease are very
prominent, and are frequently confounded in an inextricable manner with
the idiopathic symptoms. In the decline of lite, opposite causes produce
alike obscurity. The wearing out of the brain .having singularly altered
those properties thai have beeu called vital, an organ may be altered, even
extensively, and the patient have no consciousness of it. This insensibility
prevents his complaints, and at death wo frequently find the most extensive
disorders, without ever having suspected their existence during life: it is
the age of latent diseases. This defective sensibility is the reason why the
sympathetic actions are so few and obscure, so that these general symptoms
of reaction, which m other periods of life lead us to the knowledge of the
disease winch produces them, or which at least indicate that the patient is
diseased, in old age do not furnish aid towards a diagnosis. We are con-
fined in such cases to slight alterations in the functions.

This difficulty of examining the patient is still further increased, if he has
not the use of his intellectual faculties. Complete deafness also is a great
obstacle ; and if blindness be added, we can rarely obtain any information
from the patient ; difference of language is a further obstacle to this inter-
rogation, &c.

There are still other obstacles which render diagnosis difficult. When
an organ is very deep-seated ; and especially if its functions are but little
understood, we can with difficulty understand its diseases. If the same re-
gion enclose many organs; if the sympathetic phenomena are very numer-
rous ; if the disease be latent ; if there are many concurrent diseases all
these circumstances are opposed to certain diagnosis.

Many circumstances may induce an individual to feign disease; as the
wish to attract pity and secure alms, to avoid some of the duties
which society imposes upon him to avoid the penalties of his crimes,
to prolong his residence in hospital, &c. &c. Diseases may thus be
feigned in two ways either by representing symptoms, which really do not
exist, or by exciting a disease, which previously did not exist: in the last
case, the fraud is most difficult to b8 detected. The sagacious physician
possesses many resources for discovering such imposture: after being assured
of the possibility of simulating the disease, which he observes, and of the
facility with which it can be done, he will enquire if there be sufficiently
strong inducements on the part of the patient, to prompt him to such im-
posture. He will not neglect to note the degree of intelligence of his pa-
tient. He will examine if the age, the sex, the exterior state of the bodv,
the constitution, the mode of life accord with the d'siase ; but judicious in-
terrogation of the patients is the best means of detecting the truth. Wo
should propose insidious questions inquire if he experience symptoms not
at all connected with his disease ; we will seldom fail to find him mentioning
symptoms that are contradictory, and contradicting his previous statements;
we should cause the patient to revert to the causes of his disease, to pre-
ceding circumstances, to the effect of remedies he may have employed. We
should in such cases, accomplish a most exact and rigorous investigation.
It is of the greatest importance to examine those functions not submitted
to the influence of the will : in those diseases which exert an influence upon
the circulation, (and there are few that do not,) the state of the pulse will
greatly aid us in detecting imposture.

If all these means are not sufficient, we may have recourse to painful
remedies, to a severe diet, sinapisms, caustics, blisters, moxa, &c, or to the
protracted use of disgusting remedies, &c.

On the other hand, feelings of self love, of shame or of pride, induce pa-
tients to conceal their suffering. In our Hospitals the desire for food is the
most common cause of this kind of dissimulation. In private practice this
dissimulation leads to many errors ; indeed, it is almost impossible to dis-
cover a disease, which is concealed from us ; but not so in the hospitals

*~*- Roslan on Diagnosis. [Auf.

where the patients are sxibjected so thoroughly and without reserve to ex-
amination.

When a patient presents one or more of these obstacles to an examina-
tion, the physician is reduced to the simple application of his senses. In
such caser, the reports of persons about the patient are of much greater
importance than under ordinary circumstances, because the only informa-
tion we can receive. If Che patient be not blind, we may still derive some
aid from sig] :: and g< stuies; a gesture imitating the act of vomiting will
generally make him comprehend that we would know, if he have a disposi
tion to vomit, &c. The sense of sight will inform us of the exterior habit
and diseases; the touch, of the temperature, consistence, and degree of sensi-
bility of the superficial and even of deep seated parts, of the state of the cir-
culation, &c The ear, of all those sounds discoverable by percussion and
auscultation.

Let us, take an ex? mile: An individual is presented in a state of com-
plete inconsciousness so that from him we can obtain no information. We
can learn only from those about him, that he enjoyed a state -of perfect
health, and that this accident has suddenly supervened. We resort then
to our senses and our reason. Wq discover him to be about sixty years
of age, of a strong constitution, that his. cavities are large and his limbs well
developed, that his face is red and flushed his eyes prominent ; the tem-
poral and carotid arteries beating violently that the lips are protruded at
each expiration, that the saliva is frothy, the extremities are cold ; one side
of the body immoveable, the pulse is strong and hard ; that the patient has
vomited and has involuntary dejections, that the respiration is laborious
and stertorous. Do not we see here at once, the seat, nature, and extent
of the disease, and the therapeutic indications it presents ?
)U Let us examine : There is complete inconsciousness. What diseases
produce this ] They are those of the heart, the lungs and the brain. Is
it the heart, in this case ? No, for he was previously well and the pulse is
ijow regular. Is it not syncope ? No, for the pulse is strong and the face
flushed. Is it asphyxia 1 No, for the respiration and circulation still con-
tinue, and he has not been exposed to any of its causes. The disease must
then be in the brain. But the diseases of this organ are numerous. It
evidently is not chronic; and in coming to that decision, we throw out of
sight one haif of the cerebral diseases. It remains therefore to be deter-
mined, whether it be cerebral congestion, arachnitis, ra7nollissei?ient, or
heniorrhnge. It is not cerebral congestion, for that is a general affection,
and in tins instance there are local symptoms. For the same reason it
cannot be arachnitis, and moreover,- it wants the regular course of an
inflammation in the membranes. It can only be then either ramollissement
or effusion. But ramollissement producing hemiplegia proceeds slowly,
hern the accident has occurred suddenly. Hemorrhage alone is thus in-
stantaneously developed. It then is a cerebral hemorrhage or apoplexy.
Let us determine its nature, &c. with still mere precision. As the hemi-
plegia is of the leftside, the hemorrhage must be in the right lobe. The
hemiplegia is complete, therefore the hemorrhage is general over the lobe.
Thus by the application of our senses alone, and our reasoning, we have
arrived at a knowledge of the nature, seat and extent of the disease before
us and that with almost mathematical certainty. What more could we
have obtained from the report of the patient himself.' Now we may de-
duce Hi*' indications of the treatment from our diagnosis, the strength of
the subject, the developement of the pulse, &c. Is it not wonderful and tru-
ly consolatory to humanity, that we can attain to a degree of certainty so
great, simply by means of our senses and reason?

After this examination, it remains to advert to antecedent circumstances
which may have acted as causes, or which may furnish some data for the
treatment. We should inquire to what cause the patient attributes his dis-
ease if it be hereditary or acquired if it had ever attacked him before, and if

ih:;6.]

Ruslan oa Diug/u l

so, what remedies were used and their effects, [naword, we shouldgive
our attention to the age, sex, constitution, idiosyncrasy, habits and profes-
sion of the patient. This constitutes what is called the commemorative

examination.

Diseases do not present the same aspect at all periods of the day we
must therefore examine the patient, both in the morning and evening, and
even in the middle of the day. Il is almost unnecessary to remark that this
kind of rigid examination must be maintained throughout the whole course
of the disease.

If the case terminate fatally, the duty of the philosophical physician is not
yet finished. Behold the moment that nature stands ready to test the judg-
ment of the physician to give the formal denial to his diagnosis jf hi were
mis'aken, or openly to confirm it if true.

The ignorant and those wedded to systems equally dread this proof; the
first because it exposes their mistakes the others because nature uncom.
plaisant does not minister to their vain systems, but overturns them hon-
est nun most heartily seek for it, because it so sheds the light of truth and
certainty upon medical observations. Of what consequence to the man
enthusiastically devoted to his profession, and to the happiness of his fellow
men, if he should be mistaken ) Is he a man and may he not err i It will
be but a satifaction to the philosophic mind, to have found the moans of re-
cognizing his error and of rectifying it, and of avoiding it in similar cases to
have established incontestably the value of a diagnostic sign, to have glanced
even at the possibility of introducing certainty into the practice of medicine,
and thus elevate this beautiful science above all other human sciences and
these are the results which may attend upon such examination of the dead
body. We say it in the face of the bitter raillery of the mediocrity, that
there is no certainty, but after such examination ; that the observation of
a case is not complete until it has received the seal of this test.

This examination of the dead body requires the same care, as the previous
examination of the patient nay, it should be more scrupulously execute;1,
for the organs once destroyed before making our observations upon them,
cannot be again subjected to our notice.

In France our very abundant resources for this kind of instruction, lead
us to estimate lightly the immense advantages of post mortem examinations.
We make them with indifference, and fail to derive from them all the in-
structions they present to us. With what eagerness and minute attention
do we see strangers, deprived of these precious resources, prosecute these
investigations! nothing escapes their observation. IJad Morgngni such
a variety of s jbjects at his command ? No, and yet how much instruction
did he draw from those he had ; he overlooked no organ, but examined all,
and accordingly, what a valuable collection of facts has lie left us ! But
when we have inspected the diseased organ, and given a passing glance
at the neighbouring organs, we leave the case, satisfied with such an ex-
amination.

If it be of importance to commence the examination of the patient's ex-
ternal state, it is of still greater to observe this precept in the autopsic
examination. The size, form, color, temperature, consistence; and often the
position of the body should be exactly noted. The expression of the face,
the wounds, contusions, ligatures, ecchymoses, the excoriations, &,c. even
the accessory circumstances of the clotliing, &e. should not be neglected in
a case of medical jurisprudence.

M. Chomel advises to commence this examination at the abdomen. For where
thi* cavity contains fluids, we can easily then appreciate their quantity and
quality; and if the chest contain fluids also, we can judge of their quantity by
the degiee of protrusion of the diaphragm into the cavity of the abdomen.
The examination of this cavity being completed, we can easily evacuate any fluid
it may contain. If on the contrary, we begin with the chest, any liquids it may
contain are sure to flow into the abdomen by the opening necessarily made into

170 Rostan on Diagnosis. [Auij.

this last cavity, and there is difficulty in appreciating its cha-
racter. There exists, during a great part of the year an incon-
venience, which induces us to neglect this precept, and to com-
mence the axamination with the head. The examination of the
brain when carefully made requires much time; now, if we
commence with the abdomen and thorax, during all tiiis pro-
tracted examination of the brain, we are inhaling the odour
from these splanchnic cavities not merely disagreeable but
sometimes dangerous.

All persons most devoted to these examinations feel the want
of some convenient instrument for opening the cranium, all be-
ing more or less defective, they all injure or tear the brain or
its membranes, and thus expose to view alterations which did
not exist, or destroy those which were present.

M. Amussat, (who has introduced many improvements into
vSurgcry, which have been unjustly contested,) struck with these
inconveniences, invented for this purpose a saw, on one side of
which is a stop or set, which prevents the teeth penetrating into
the interior of the cranium : it does not answer the purpose
well, because the thickness of the cranium varies at different
points of its circumference, and especially in different subjects.
But we still employ, in preference, a kind of hatchet a ham-
mer with an obtuse cutting edge, proper for breaking the bones.
The skull cap being removed, by a circular cut through the in-
teguments, and by sawing or breaking the bones and tearing from
the dura mater, we may then observe particularly the state of
this membrane ? we then make an incision into it at the distance
of a half-inch from the longitudinal sinus, and carry this inci-
sion parallel to the sinus, from the crista galli to the tentorium
on each side ; we afterwards detach the falx this isolated, by
cutting upon the crista galli; we separate the dura mater from
the sides, and expose the cncephalon still covered with the
arachnoid and the j ia matter ; we examine these membranes;
we expose the cerebral convolutions ; their colour, form, size,
consistence, their degree of moisture or dryness should fix our
attention. After this, we cut off by very thin layers, the whole
of the cerebral mass, and examine each of these parts with
groat care and note their physical characters. We thus pene-
trate cautiously into each of the ventricles.

The brain being examined, the cerebellum demands the same
degree of attention. We detach the tentorium which covers it,
we cut the spinal marrow as low as possible and remove it.
The spinal marrow should occupy our attention last in the ex-
amination.

To inspect the thoracic and abdominal viscera, we remove
the anterior wall of the abdomen, by an incision nearly circular,
commencing al onehypochondrium descending upon the os ilium,
following the course of this bone towards the pubis, and asccn-

1836.] Hostan on Diagnosis. 177

ding on the opposite side in a corresponding direction, to the other hypo-
chondrium. Subsequently we extend this incision over the junction of the
cartilages with their ribs, so far as the anterior articulation of the clavicle
with the sternum ; we cut through the cartilages ; we then elevate and
turn the abdominal covering and the sternum over the face, thus bringing
into view the organs of the chest and abdomen.

We mark the exterior of the lungs, their colour, consistence, form in
a word, all their physical properties. We regard attentively the pleuras,
the fluids they may contain, &c. after which we cut into the lungs, then into
the trachea, the bronchii, and the larynx. We then pass to the examina-
tion of the heart and its envelopes ; after observing its exterior, we cut
into its cavities to observe the thickness of its sides. We examine all its
orifices ; we enquire if any impediments to the circulation exist, and what is
their nature : with equal care we examine the auricles, and thence open the
aorta through its whole extent in the chest ; this operation is generally
neglected for the veins, but we cannot too strenuously urge it. We then
pass to the genito-urinary systems. Having satisfied ourselves as to
their external state, we should open the alimentary canal from the pha-
rynx to the rectum, by mea:.s of the enterotome of M. J. Cloquet. In some
cases we should carefully preserve the contained liquids. We should then
regard the size, colour, consistence, position, &c. of each and every organ
in the abdominal and pelvic cavities, and we should not neglect the exami-
nation of the organs of circulation in the abdomen, which may not have been
examined.

We then turn the subject upon its face for the examination of the spinal
marrow. We raise with ease the teguments and large mass of sacro-
lumbar and dorsal muscles : we then lay bare those portions of the vertebrae
forming the posterior wall of the spinal canal, and by means of the rachitome,
an ingenious instrument of M. Amassat, we divide these portions without
interfering with the spinal marrow ; thus removing all the spinous pro-
cesses, we bring into view the marrow still enveloped in its membranes ;
we observe these, cut into them, and remove them for the examination of
the vertebral pulp itself. There are cases in which the limbs should be
examined, as also the muscles, the bones, the articulations, the vessels and
the nerves. It should always be done.

The method of performing this examination is of little consequence, pro-
vided we neglect no organ, but examine them all, and particularly that we
do not ourselves produce accidental lesions, and then mistake them for pa-
thological developments.

Whenever we do encounter any morbid alteration, we should regard it
with the strictest attention, and not abandon until we have a perfect appre-
hension of it.

A physician should not confine himself to the interrogation of a patient
in order to obtain information to direct him in the particular case ; he
should record his observation, either for the purpose of preserving simple
notes of interesting facts, or for digesting a memoir for his future use, or for
publishing his observations for the benefit of the science, &c. The young
physician, unaccustomed to this exercise, must necessarity experience much
embarrassment, particularly as the masters of the science have merely left
us models, without accompanying them with precepts. The art of descri-
bing a case is a difficult one ; it requires the possession of some very rare
qualities. Independently of a profound knowledge of his profession, "which
depends upon himself the physician should possess great sagacity, and the
faculty of attention in a high degree, and should, moreover, be endowed
with sensibility, taste, and even imagination. None will deny the necessity
of sagacity and attention for the physician, but some may ask, why require
that he possess imagination that faculty which exaggerates and throws
such an illusion around its objects ? Because, a cold, unfeeling spectator
of the ills of his fellow-creatures, mavbe a very exact and attentive observer;
23

178 Rostan on Diagnosis. [Aug*

but one endowed with sensibility touched with the feeling of those evils,
which affect not the other, will he not record them with a spirit that vivifies
his description ! Compare the colourless image of the first with the ani-
mated picture of the second ! Whence the differing emotions with which
we receive the descriptions of different physicians ? Why is it that we"
read with indifference and ennui a history of a disease by one, and with the
most lively interest that by another; but that the first is destitute of sensi-
bility, taste, and imagination, for which qualities the other is remarkable?
No doubt every advantage is on the side of the last in the description of
their cases. Two pictures of the same object, by two different painters,
will bear the impress of the genius of each both may be just, but one may
be a chef-d'oBuvrey the other a work of mediocrity. In recording a case for
his own instruction, the observer cannot be too particular ; he should note
the negative as well as the positive signs. We must then note the morbid
state and the natural state of ail the organs of all the functions, and all
the changes which supervene day by day and hour by hour. But although
such a description be of value for the physician himself, will it not be tire-
some and repulsive to the reader ] As the object in recording a case for
publication is to give as directly as possible, the most exact and just idea of
the disease, in digesting a case he should commence by discarding all su-
perfluous details, and should present to the reader the most striking
features of the disease.

After a short commemoration as to the age, sex, constitution, profession,
habits, state of the menstruation, (in females), the suspected cause of the
disease, the antecedent affections, the exterior state of the body, the physi-
cian should present the symptoms furnished by the. organ and the function
disordered. Here we would ask Is it not preferable to preserve the same
order in the description of all cases 1 Will we not expose ourselves to con-
fusion in commencing our description sometimes in one way and sometimes
in another ] Struck with the prospect of this inconvenience, I at first
adopted this uniform method ; but I found subsequently, that thus the
general phenomena, of less importance, were frequently presented to the
mind, and occupied that first degree of the attention of the reader which
should have been spent upon the more important characteristic signs ; and,
therefore, as our object is to convey promptly a just and striking idea of the
disease, we cannot too soon expose those symptoms which give it individu-
ality. Of the two inconveniences, I have preferred the less, and adopt the
method of presenting in the first instance the local, organic and functional
phenomena, although it necessarily determines some repetition. Having
presented the principal local symptoms, we should then pass immedi-
ately to the sympathetic phenomena to those which the organs furnish,
that are most intimately connected with those diseased, and successively to
others more remotely associated. We should be succinct in our narration,
taking equal care to omit nothing of importance, and to reject everything
superfluous and unprofitable. When the disease terminates fatally, we
should follow the same course in our researches upon the dead body -
record every fact, positive and negative, for ourselves ; but for the public,
only what is interesting and profitable. We should note also, the succes-
sion of the symptoms day by day the course, duration, and termination of
the disease, and the results of the post-mortem examination.

We should always commence the examination of the patient, and the
description of the disease, at the organ and function diseased or attacked ;
if many organs be diseased, we commence with the one most seriously
affected.

The following table will be found useful in guiding our interrogation of
the patient, and recording the history of his disease. It is scarcely neces-
sary to say, that we will seldom or never be obliged in any one case to pro-
pose as many question- as are fiere

[The tabic alluded to above will be given in our next. |

I-S36.] Remedial Powers of the Ceanothus Americanus. 179

Remedial Powers of the Ceanctlms Americcnvs. Ey Dr. D. II. Kueeard.

I do not remember to have seen any reference made, (medicinally) to
the Ceanothus Americanus of Linnaeus, Its sensible properties led me to
use it in a case of aphttae, tnd subsequently in other derangements of
mucous surfaces, where I found it of seme importance. Professor Bigelow
describes the Ceanothus as follows: "Leaves heart ovate, acuminate,
triply nerved. Panicles axillary elongated. A small white flowering
shrub, net unfrequent in dry sandy soils. Leaves two or three inches long
and one broad, finely serrate, and tapering into a long point. From the
axils of the upper leaves come out leafless branches bearing crowded
bunches of minute white flowers. These are followed by dry three seeded,
and somewhat triangular berries. The leaves were used, among other
substitutes for tea during the American revolution." I might add that the
dLried leaves and seeds have an odour, when bottled, not unlike the impor-
ted tea. It has a slight bitter, and somewhat astringent taste. I first
used it in a case of an old lady of seventy, who had a severe thrush followT-
ing typhus. The usual gargles were tried without much effect. Every
second or third day a new 'coat of darker hue would cover the whole interior
of the fauces. The mucous membrane after its discharge presented a
a dark florid appearance, with extreme sensibility. I had tried borax,
alum, nitras argenti, vegetable astringents and tonics, as gold thread,
crane's bill, hardhack, oak bark, sumach, &c. without much benefit. The
Ceanothus growing hear, 1 directed a strong tea to be made of it, wThich
acted like a charm ; the thrush soon passed off, and without relapse.
Since then I have used it largely in aphthae of children, and find it highly
useful in cases following dysenteria maligna, as well as those of less debility
and disease, even after other gargles have been ineffectually tried. During
last March and April, scarlatina, attended in most cases with ulceration
of the fauces, was very prevalent with us ; I depended almost exclusively
upon the Ceanothus, with borax for a gargle, and in all but a single case of
very malignant character, this gargle was effectual. The form I used, and
which I found best adapted for the cases as. presented, wras prepared by
making a strong tea of the Ceanothus, and flowers of the Anthemis Cotula,
and to a gill add a piece of borax the size of a large pea. I think the borax
and Mayweed rendered it in many cases more effectual. 1 have also used
it with benefit in form of a tea in dysenteria of children, and found it fully
equal in many cases to the Spirea tomentosa. The tea I used was prepared
from the leaves and seeds. Boston Med. and Sur. Journ. Sept. 30th, 1835.

We are pleased to see such articles as the above, brought be-
fore the public by industrious and faithful observers articles
with which our country abounds ; and as valuable as, not to
say more so, in many instances, than those which are imported
at great cost and trouble.

Distance and cost seeming to place a peculiar value on others
of their kind, whereby we are often decoyed into a preference
for them ; the bounties of Providence by which wTe are sur-
rounded are but too often contemned or disregarded.

The Ceanothus Americanus is one of the most abundant of
the small shrubs found on our dry sandy soils. In this section
of the country it is known to all the country people by the com-
mon names, lied Root, Red Shank, &c. ; and were its virtues

280 Remedial Powers of the Ceanothus Americanus. [Aug.

well known amongst practitioners, it is sufficiently abundant to
be made an article of commerce, of comfortable profit to its pre-
servers.

In situations remote from medical aid, and, indeed, in most
families in the country, it is in constant successful use as a
styptic and astringent. The observations of many years ena-
ble us to confirm the remarks of Dr. Hubbard relative to its
virtues in aphthous affections.

In thrush in children, it is itself a remedy not inferior to borax,
which has been so long in universal use. In those cases of
Fluor Albus which are attended with aphthous eruptions, it has
been found as uniformly profitable as any remedy of its kind of
power; and as generally corrective, as abiding and still opera-
ting causes of this eruption would allow. In those cases of
Fluor Albus which depend on prolapsus, or descent of the womb
into the vagina, which constitute no small proportion, there is
probably not a better astringent lotion in use than its stronger
preparations, for permanently correcting that relaxation of the
vagina which exists in these cases.

In obstinate diarrhoea, the bark of the root has been long in
successful use. In the troublesome discharge and ulcerations
of the second stage of salivation, it has been long and success-
fully administered. The strong decoction of the bark of the
root, also the bark of the fresh root itself, have been found by
experience amongst the most valuable styptics in domestic use,
for restraining haemorrhage from wounds. A tea of the leaves
and flowers, sweetened with fine sugar, &c. which is not an
unacceptable offering to the palate and stomach, is finely adapt-
ed to diarrhoea and relaxation of the bowels generally, parti-
cularly in children, and those troublesome habitual cases unat-
tended with febrile action, in which we have reason to appre-
hend the presence of aphthae, or ulceration, in the mucous mem-
brane of the intestines.

It has also been found useful in those highly dangerous cases
of hypercatharsis induced by the ruinous power of Lobelia in
the hands of the Thomsonians, and which so often ends in per-
manent relaxation of bowels and loss of all powers of nutrition,
and consequent death.

In such cases, a tea of the leaves and flowers may be very
advantageously prescribed, more or less exclusively as a diet.
This tea will generally be found not only admissible, but reme-
dial in those cases of dyspepsia in which the bowels are perpetu-
ally relaxed, and the digestive and nutritive functions suspended.

1836.] Morbid effects of Intemperance. 18

Morbid effects of Intemperance. Extract from Dr. Hodg-
kins' Lectures on the means of -promoting and preserving
Health.

This work has been lately published in London, and to use
the words of the British and Foreign Medical Review, is " lite-
rally/m# of information." We are indebted to the second No.
of this new work, April, 1836, edited by Drs. Forbes and
Conolly, for the following valuable extract. Dr. Hodgkms is
well and advantageously known in England as a Pathologist,
and is therefore known to speak the language of the truths of
observation. He is not here advocating the cause of the " Tem-
perance Reformation" but pouring forth the stores of his obser-
vation and judgment directly for the 'promotion and preserva-
tion of health the noblest effort of the medical man.

His second lecture contains a great variety of information
concerning the different kinds of food and drink. The destruc-
tive effects of spirit-drinking are forcibly dwelt upon, without
exaggeration, and the following remarks will interest the me'di-
dab reader.

"The fatal influence of intemperance in drink, is occasionally seen a little
beyond the middle period of life, at which time persons are not very nnfre-
quently subject to what is called climacteric decline. Some are favoured
to recover from its attack ; but to the spirit-drinker it almost always proves
fatal. Premature old age is another result of spirit-drinking-. Hiave often
noticed, with surprise, in the course of my practice, that when I bad suspicion
of the habits of a patient, and have enquired his ape, that with aJl the
marks of age and decrepitude upon him, he was some years my junior.
The habit of spirit- drinking unfits its victimes to bear the wounds, fractures
and accidents of various kinds to which all are liable ;- and the skill of the
surgeon is often baffled, or foiled, by the ill condition of his patient, who,
by a long course of spirit-drinking, has destroyed the powers of his consti-
tution. It is also worthy of remark, that the spirit-drinker is peculiarly
susceptible of disease of all kinds, and, consequently, is likely to fall the
first victim to fevers, or other epidemic distempers. The ravages of the
cholera have confirmed this by unnumbered proofs.

" The heart and blood-vessels do not escape the injurious effects of ardent
spirits. The former is subjected to great varieties of excitement, and the
palpitations so produced may lead the way to permanent disease. Ossifica-
tion of the valves, and thickening of the lining membrane, are the probable
results. The arteries, both large and small, are very liable to become ossi-
fied ; and when this effect is produced, the individual is very liable to apo-
plexy and gangrene. In a former part of this lecture, I have hinted at the
injurious effects which improper drinks may produce on the lungs. There
is, perhaps, no error of this kind by which this effect is so strikingly produ-
ced as when ardent spirits are taken. Besides the obvious effect which
they must have in promoting and aggravating inflammation of the lungs,
whenever these parts suffer from irritation, at a time when the systenfis
under the influence of spirits, there are two other modes in which mischief
is produced, affecting these organs, which are less obvious. First, it has
been ascertained by experiment, that a greater exercise of respiration is
re"";red when the system is - -ited by spirit : hence, divers cannot remain

182 Morbid effects of Intemperance. [Aug.

so long under water after they have been taking spirits, as they can at other
times. Runners, also, find their wind shortened after drinking spirits.
Now those who take spirits in sufficient quantity to afYect the system, and
then, under the excitement which they have produced, apply themselves to
some laborious or active exertion, must expose the lungs, or organs of
respiration, to the chance of very serious injury. The other effect to
which I allude, may seem at first to be at variance with what 1 have just
related, as well as opposed to the vulgar or common opinion respecting the
effect of spirits. It is generalty supposed that they promote the warmth
of the body : on which account they are frequently taken by persons who
have no inclination to intemperance, when they are peculiarly exposed to
cold. This is a very fallacious practice. A transient glow may indeed be
produced by the quickened circulation which for a short time succeeds the
swallowing of the dram ; but this afterwards becomes proportionally more
languid ; in consequence of which the surface, and more especially the ex-
tremities, become pale and cold, whilst the internal parts are both stimulated
by the spirit, and loaded with the blood which has left the surface of the
body. The object of maintaining and equalizing the warmth of the body is
completely lost ; whilst the internal organs are exposed to the danger of
inflammation. This effect of ardent spirits is seen carried to its greatest
and most dangerous extent in Russia, and other countries where extreme
cold prevails. The inhabitants of these countries are apt to give way to the
temptation to take spirits to an amount which produces overpowering intox-
ication. If, in this state, they expose themselves to the cold air, or are
driven out of dram-shops and turned into it, the combined influence of the
benumbing cold, and the liquor they have taken, produces a profound degree
of torpor. Breathing, which is closely and necessarily connected with the
production of animal heat, is almost suspended, and the individual, unless
rescued from his dangerous situation, is soon frozen to death.

"The deleterious effect of spirit on the skin, is seen in the production of
what are usually called grog-blossoms. Spirits, likewise, promote attacks
of erysipelas, which are often severe, and even fatal, in persons whose con-
stitutions are shattered by the use of spirits.

"The Worst effects of spirits, as connected with bodily health, are those
which it produces upon the nervous system ; by which, I mean the brain
and nerves. The first effect of a large dose of spirits on this system, is
almost immediate, and quite notorious, causing swimming of the head, con-
fusion of ideas, and staggering gait. The late Dr. Spurzheim, who is almost
universally known, in consequence of the long continued and close attention
which lie paid to the brain, declared that he had found brains peculiarly hard
in this country, which he attributed to the general abuse of spirits. A stri-
king, and often immediate, effect of intoxication, upon the brain, is apo-
plexy. When this is not immediately fatal, palsy is almost sure to remain.
Epilepsy is another very serious disease of the brain, which, when not pro-
duced, maybe greatly aggravated, by the influence of spirits. In females, they
greatly promote a tendency to hysterics. One of the most serious diseases of
the brain, brought on by the use of spirits, is called delirium tremens. Per-
sons, wl lose age might induce one to suppose that they were in the prime of
life, arc Bometimes carried off in a few hours by this dreadful malady. Those
are the most liable to die from this affection, who have kept up an almost in-
cessant state of excitement by means of ardent spirits. It is not necessary
that the quantity taken should have been such as to produce an extreme
degree of intoxication. The individual may even have been able, in some
degree, to attend to the various concerns in which he might happen to be
placed ; when, after the sudden removal of the stimulus, or the abstraction
of blood, or some powerful influence on the mind, or sometimes without any
assignable cause, a state approaching to madness, and often marked with
tremors, muttering, and prostration of strength, suddenly comes on, and if
not pretty promptly relieved by well-directed medical aid, is very apt to
prove speedily fatal."

1830.] Medical application of Galvanism. 183

Part III. MONTHLY PERISCOPE.
Medical Application of Gahanism.

Wc learn by the Boston Medical and Surgical Journal of
29th Jane, that Dr. Page, of Salem, has lately contrived
a modification of Professor Henry's apparatus for obtaining
sparks and shocks from the Calorimoter, which, he thinks,
must supersede all other instruments at present in use for the
application of galvanism in cases of paresis, &c. He does not
give a particular description of the apparatus, but merely an-
nounces it, on account of the interest it promises to the profes-
sion. By a self-regulating apparatus, the shocks may be made
to succeed each other with almost any degree of rapidity and
strength. The sensation thus produced, he says, is quite unlike,
and less disagreeable than that from the deflagrator. He be-
lieves that it will also undoubtedly prove a superior instrument
for the application of M. Pakbrat's discovery for the transmis-
sion of medicinal substances through any part of the body, by
galvanism.

We look with pleasure to the day when galvanism will be-
come one of the most important and agreeable agents at the
command of the practitioner for the regulation of excitement.
especially local excesses and deficiencies. We have witnessed
for many years its decided power of lessening action at one
pole and increasing it at the other thus proving its power of
translation or revulsion. So decided is this power, that when
properly adjusted to two blistered or denuded points, the blister
at one pole will desiccate, whilst the other will inflame and
secrete copiously; and in some cases, finally sphacelate. In
view of this fact, the Medical Society of Augusta, at a recent
session, offered a premium of fifty dollars for an apparatus for
the convenient application of galvanism to the purpose of re-
vulsion in the treatment of disease. We can form no distinct
idea of the apparatus of Dr. Page, as he has given us no descrip-
tion. We trust, however, that the article itself, or a competent
description of it, will soon be forthcoming, and, for the credit of
the profession, unimcumbered by the price of a patent right ; or,
should the right of use be restricted by a patent, that the privi-
lege will not be offered at such a price as will amount to a pro-
hibition of its use in the service of humanity. Such is the case
with regard to several new inventions recently and at present
offered to the public amongst which we will name trusses, gal-
vanic apparatus for medical purposes, &c. &c. many of which
are put at from five to fifty times the value of the article from
the hands of the makers. This wc look on as an outrageous

184 Medical Application of Galvanism. I Aug.

ftbuse of patent protection, the object of which is mainly to hold
out an inducement to genius and industry, that divers good pur-
poses may be answered, as saving of labour, economy in the
expenditure of money, accomplishing new and important pur-
poses, &c. But there is an avaricious disposition in most men
which will make them reach just as deep into the pockets of
others as any device can enable them to do; and we regret that
there are instances to be found in the profession of medicine,
where charity and benevolence should characterize every move-
ment and purpose. O ! it is one of the most nauseating drugs
in all the routine of operations of medical men it operates by
the ears, and sickens the heart, to hear a medical man say, (and
we have more than once heard such,) " they will not hesitate to
give any price, when pain afflicts or death threatens," or " I
must put the price thus high, that I may be able to give to the
poor who cannot buy," and still the poor who are thus supplied,
are never to be seen or never heard of thus contending for
such prices as ten, fifteen, twenty, thirty, or perhaps one hun-
dred dollars for an article, the manufacture of which is only
worth from fifty cents to two or three dollars. Thus are the
very purposes for which patents wrere created, subverted.
The invention, suppose it the least in the world, is put beyond
the reach of all prudent and economical persons ; or they arc
forced by torture or danger to squander their fortune in search
of relief, and become tributary to the insatiable avarice of some
inventor, and perhaps impostor. Thus does state protection,
instead of securing to the good citizens the benefits of improve-
ments and discoveries, actually debar the benefits for fourteen
years, and protect the insatiable avarice of the patentee, even
notwithstanding the same discovery may have been made by
others. These remarks are applicable to the principle of patents
generally. But what shall we say of patents for the exclusive
right of things demanded in the service of humanity, used for
purposes of rankest extortion ? If life depend on the use of the
article, and the high price debar the use, (because it is unlawful
for any other than the patentee to vend or use, without satisfy-
ing the patentee,) then the patentee becomes the cause of death,
and the state the protector of his inhuman and criminal avarice.

It is a glorious truth, that such examples are rare in the pro-
fession, and never to be found with those highminded and honor-
able members who are properly classed in it. It is only a few
of the sordid and mercenary, who would sell alcohol by the half
gill, or spread the smallpox virus, if they could make money by it.
" The virtue that needs guarding is not worth keeping." The
truly benevolent cannot limit their usefulness in the cause of
humanity, by sheltering their own individual interest, against the
general weal.

We would suggest this improvement or amendment of the
patent law : that in all instances the patentee be compelled to

1836.] Extract of Belladonna. 185

forfeit his right, on being convicted of selling or offering his in-
ventions at more than double the price at which they are manu-
factured; or of pricing his right of use at more than the price at
which the article can be procured of the manufacturer. This
would afford an inducement as effectual in promoting industry
and the exercise of genius as the present, without legalizing
cruel and inhuman privations on one hand, or feeding an insa-
tiable and misanthropic avarice on the other. It is to be hoped
that it will not be long before those patents which are for useful
articles will be superceded by improvements on the present
patents, (a thing almost always easily done,) and the benefits
then taken into the hands of professional men of sound and
honorable principle.

Extract of Belladonna preventive of Scarlatina. A part from
Homseopatheia, the German physicians continue with increasing
confidence to look to the use of Belladonna for the prevention
of Scarlatina. They use it in the form of a solution of two grs,
of the extract to the ounce of water. Professor Fleischmann
has recently used it in fifty-two children, during the prevalence
of Scarlatina for about five weeks. Forty-eight of these esca-
ped the disease. It was given in doses of one drop for each
year of the age of the child in all cases ; and even in this small
dose, (which, however, seems Homceopathic,) the symptoms of
the action of Belladonna were observable in twenty-three cases.
It is believed by the professor to counteract the contagion,* di-
minish the susceptibility without entirely removing it; and
give a mild character to the cases which do occur notwith-
standing its use.

We regret that Professor F. did not state what proportion of
the children who did not use this prophylactic, suffered by the
disease ; for without this, the testimonial in favour of the pro-
phylactic virtues of Belladonna is nugatory. When a few hun-
dred cases of fever occur in a community of many thousands,
they strike the attention with great force. But the thousands
who escape are not thought of. A practitioner in full business
may lose half a dozen patients ; another of small business may
lose one or two. The latter plumes himself on his success, in
having lost but one or two cases, whilst the former has lost
several times that number; the positive number lost in each case
is only thought of, not the relative proportion; and the latter is ex-
alted in the community for his signal success, and the former pro-
claimed " very unfortunate ;" whilst the relative ill success was

* The existence of this kind of extrinsic cause is yet a subject of much
doubt.

24

186 Extract of Belladonna. L^ug.

with the former, as one to a hundred; and that of the latter, as one
to four or five. Thus it is, that improper estimates are often and
most unintentionally formed. We apprehend that it is not a very
easy matter to form a correct estimate of any active preventive
means. Certainly it is preventive, to withhold " causa? noxia3."
There are also within our knowledge noxious causes which are
susceptible of chemical correction, whereby their active powers
are neutralized and destroyed. We know also of the preven-
tive value of avoiding predisposing and exciting causes ; and
the great science of Hygiene consists mainly in the knowledge
of noxious causes ; and the practice of it in avoiding them.
It is, therefore, in a certain sense, rather a passive than an active
science. But here, causes, and their modes of acting, are
known, and their application generally avoidable ; and most
commonly indeed, require voluntary effort to secure their ap-
plication. The case is very different with regard to Scarlatina.
Even the fact of its contagiousness is by no means satisfactorily
determined. And certain it is, that if it depend upon contagion
for its cause, that contagion has laws entirely different from the
generally admitted laws of contagion ; or it has no laws at all ;
and if it has no laws, or peculiar characteristics in its mode of
action, it has no qualities at all ; for it is only by the effects that
wc have any knowledge of contagion whatever ; and there-
fore there is no such thing. If, however, it depend on a conta-
gion with peculiar laws, these laws are not known. There is
therefore no knowledge of the cause, and without some know-
ledge of the cause, no active means can be directed to preven-
tion on rational, or other than merely imaginary grounds.
In such a case, it is only accident, or unguided experiment,
which could be expected to develope the fact of a preventive
power in such a case. When done, the truth depends, for its
reception, on the strength of the evidence of the fact. If, there-
fore, professor Fleischman had made it appear that a conside-
rably greater proportion than eight out of one hundred children,
under precisely the same circumstances in all respects, except
the use of the Belladonna, took the disease, and this, in re-
peated experiments alike fairly made, then, and not until then,
could we have consented even to coincidence, much less to cause
and effect in the premises-. We believe in the possibility of pre-
ventive or ameliorating means for this disease ; but we believe
they are not likely to be revealed until the view of the disease
is extended to a plurality of causes the want of which gene-
rally, we look to as one of the greatest errors in pathological
reasoning. Certainly there are few, if any, effects without more
causes than one, and this doctrine is as applicable to pathologi-
cal as to any other phenomena. If, therefore, preventive as
well as curative indications do not embrace a proper relation to
all the causation in the case, they must be essentially and radically

1830.] Animal Magnetism. 187

defective ; as causes must be withheld if effects are to be pre-
vented ; and removed for their correction, if these have been
produced.

Animal Magnetism. M. Poyen, lecturer on Animal Mag-
netism in Boston, has lately translated the report of the Mag-
netical experiments made by the commission of the Royal Aca-
demy of Medicine of Paris, read in the meeting of 28th June,
1831, by M. Husson, the reporter. He has preceded the trans-
lation with seventy-one pages of introduction, or prefatory
remarks, which are said to add great interest to the work.
The whole taken together, forming a duodecimo volume, pub-
lished by D. K. Hitchcock, is said to comprise the whole of the
present state of knowledge on this curious subject.

It is not a little strange, that thosevery respectable physicians,
at the head of the profession, who have from time to time
observed the operations of magnetizers,and the phenomena which
are declared to have followed these operations, should not long
since have determined the fact of the truth or falsehood of the
matter. It does appear to us that there is something of scientific
cowardice, (if we may so speak,) prevalent in relation to this
avowed power. How should Cloquet, for example, agree that
the magnetizer should exert his powers in preparing a woman
to have her breast amputated, without any pain wrhich should
make her sensible of the operation then operate, without the
least manifestation of pain, or consciousness on her part, of what
was passing, and without knowing, after being de-magnetized,
that the operation had been performed, until told of it report
these things to the Academy as incidents which he had witness-
ed, and not determine whether there was in it the operation of
cause, and the production of effect, and give, at once, the whole
weight of his character to prove that there was, or that there
was not truth in the thing ? It may be considered noble, to ac-
knowledge before the Academy, (mainly a body of unbelievers
in animal magnetism) the facts he witnessed, being himself an
unbeliever. But this we cannot think, unless truth has become
a most rare commodity ; for it is the most common-place duty in
science to tell the truth. Could it be said that Cloquet acted
nobly because he did not tell a falsehood and deny the truths he
had witnessed, or, that he did not conceal them, when he that
would do either must be beneath all consideration ? For this,
he was entitled to about as much credit as the man would be
who should borrow his friend's horse, and return him with ac-
knowledgments of the favour, instead of stealing him and
denying having seen him. Was M. Cloquet a complete Dr.
Doughty ? If so, he should have said to the Academy, " I see?n

IS8 Animal Magnetism. [Aug".

to have operated for the amputation of a female mamma, and
the woman seemed not to know when it was done. And it
seemed to me that the magnetizer offered to bring her into a
state of insensibility, preparatory for the operation," &c. " but
all things are doubtful all things uncertain."

But we may come nearer home. Mons. Bugard, in Boston,
undertakes to so magnetize his pupil, a little girl twelve and a
half years old, as to prepare her to undergo the extraction of a
molar tooth, without the least pain. Dr. Ware extracts the
tooth the girl does not feel it, and is only conscious of it by the
blood found in her mouth afterwards, and by the vacancy in its
place. Present, Professor Tradewell, of Harvard University,
and Drs. Harwood, Lewis, Hodge, &c. &c. a long scene is
exhibited in which all play a part and the whole is left to be
told by a medical student only. Where are the Doctors ? Why
have they not ventured on this matter I Have they preferred
to have a man between them and the rope 1 Have they been
disposed to make the medical student the scape-goat ? Or a
pioneer, to fall by the first shot saving themselves ? Or is
Mr. West the only man of the party who has the independence
to declare what he has witnessed?

If there be truth in this thing, (and if there is not, why do not
those whose names are connected with these phenomena,
promptly and effectually correct misstatements ?) if there be
truth in the thing, we say, there is no necessity before we ac-
knowledge the truth of the power, that we understand the whole
minute philosophy of it. This unknown philosophy, remains a
subject of most interesting enquiry. We do not hesitate to own,
when we see the time indicated by the hands of a clock, that
the clock truly has the power of keeping and shewing the time,
although we may be ignorant of the precise mechanism whereby
this end is effected. When we see a man perform the various
functions of life, we believe in the existence of life, although we
may have no idea of the internal organization. We have ac-
knowledged the existence of life in all generations, and no man
has yet told us what it is ; but we have owned its existence
because we have witnessed its effects. For our own part, we
regret to say that we have never witnessed the operations of
the magnctizers, but think we could scarcely fail to determine,
on doing so, whether there was or was not cause and effect,
even if we could not comprehend or detect the cause. Events
themselves declare cause, with most unequivocal certainty.
There is no phenomenon cognizable to man, through the medium
of his senses or otherwise, which he docs not intuitively and at
once acknowledge as the effect of competent causation, however
it may be calculated to overwhelm his powers, by its grandeur,
or elude their search by its minuteness. Is the influence of one
man over another by the way of what are called magnetizing

1836.] Animal Magnetism. ISO

operations, more incomprehensible than the elementary constitu-
ents of those microscopic animalculse which are only broughl to

our perception by glasses which magnify a million times their
minute organization for locomotion, nutrition, sensation, &c. ;
or than the vastly incomprehensible universe ? And can we
extend even our imaginations to the contemplation of either,
without at the same time acknowledging the cause ofalll Oar dif-
ficulty is not here. When we place a man of one or two hun-
dred pounds on a table, and raise him on the points of the index
fingers of four men, without a sense of more weight than a few
ounces or pounds at most; or when, on thus raising him he
leaves the fingers and ascends higher, we know at once that
there is antecedent and sequent, and cannot hesitate to acknow-
ledge it. But if a like sequent uniformly follow this antecedent,
we are compelled by an unavoidable law in reasoning to ac-
knowledge causation, and competent causation ; for such is the
obtuseness of the human intellect, (at least of ours,) that we can
perceive or comprehend no more minute knowledge of cause
and effect than that of their being different phenomena which
uniformly occur in the same relative concatenation. This truth
established, and there is no resting place for mind, short of de-
termining the latter link consequential. But there is no effect
without cause ; therefore the existence of effect proves cause.
Our doubts on this subject, then, only extend to the history of
this concatenation ; and are only founded in the difficulty, com-
mon to the human mind, of allowing that of which we have no
distinct idea, or which differs entirely from any thing the mind
may before have comprehended or contemplated ; as of forms
or powers not before presented to our senses or intellect.
We hope to witness these things ourselves, or receive the
high testimony of men at the head of science then we shall
feel no difficulty in venturing our faith on the unerring laws of
rational argument.

Chloride of Soda for Sore Nipples. Dr. Chapm, in a memoir in the Ga-
zette Medicate de Paris, says, that of all the means recommended for the
cure of sore nipples, nothing has so well succeeded in his hands, as frequently
repeated lotions with Chloride of Soda. In one or two days, he says, it
will often effect a cure. Amer. Jour.

190 Morisorfs Hygeian Pills. L-A-ug.

Morison't Ilygcian Pills.

To the Editor of the Boston Medical and Surgical Journal.

Sir, Seeing an account, in one of your late numbers, of the death of a
patient from the use of Morison's Hygeinic Pills, I am induced to send you
the following notice of them from "Colton's Four Years in Great Britain."
Prom the closing observation it is not to be wondered at that numerous in-
dividuals have paid for their credulity with their lives. Is it not astonishing1,
that while the nations on the continent of Europe have suppressed by law
the vending or advertising of such patent medicines, Great Britain and the
United States, those two enlightened and liberal governments, should pa-
tronize them to an extent almost beyond human calculations 1 The auri
sacra fames seems to be here predominant over life itself.

S. W. Williams.
Dscrfeld, Mass. March 19, 1835.

"The celebrated empiric, Dr. Morison, pays to the government of Great
Britain upwards of 7000 pounds ($33,600) a year, in the way of tax of three
halfpence on each pill box. His boxes are of two sizes ; and retails one at a
shilling, and the other at sixpence. Suppose he sells an equal number of box-
es, which would make the average per box eight pence ; allow for tax, mate-
rials and making of the pills, and discount for the trade four pence, the net
profit to himself would then be 37,668, or $180,793 annually ! The pro-
fessional practice of Mr. Brodie, Saville Street, Serjeant surgeon to the king,
has been stated by creditable authority to be 15,000 or $42,000 a year.
In reputation as a surgeon, Dr. Brodie is only second to Sir Astley Cooper.
How much more profitable is empiricism than science and art, and some of
the greatest fortunes in Europe have been made by the manufacture of
boot blacking. What a quantity must have been sold in London, to afford
an advertising bill for Warren's blacking of 250,000, or 1,200,000 dollars,
annually. Yet such is the fact.

" Sir John Long's recipe was left sealed by him, price ten thousand pounds,
not being opened before bought. It has been taken on the terms of his
will ; a pig in the poke.

" It has been ascertained that the careless and imperfect mixing of the
ingredients of Morison's pills, often leaves the powerful agents in one part
of the mess, before it is made into pills, which kills those who happen to
have a box of that portion while the rest maybe swallowed with as much
impunity as so many bits of dough from the kneading trough."

[In connection with the preceding from our correspondent, we beg leave
to present the following remarks by Dr. Jolmson, editor of the Medico-
Chirurgical Review.]

Scarcely a day passes without instances occurring of a serious mischief
from the preposterous use or abuse of this quack medicine ! These
events, however, make but a very trifling and local impression on the few
who become acquainted with the facts of the case. It is only when a judi-
cial inquiry takes place, and the attention of the public is attracted to the
subject, that much check is given to the suicidal consumption of the nostrum
in question. We have good reason to believe that the manufacture of
'Morison's pills" has experienced a considerable diminution by the late in-
questand trial at Manchester. We are disposed to think that a blow of
no small force has, si ill more recently, been given to the preposterous man-
ifestos of the Ilygeist, by the inquest in Clarence Gardens.

There can be no doubt that this verdict was correct. Not that we sup-
pose there is any ingredient in this nostrum of a poisonous nature ; but that
the venal recommendation to employ the pills in all diseases, leads to such
an indiscriminate ingurgitation of tliem, that a certain per centage of death
must be the inevitable result.

183G.] Thomsmdan Practice, eye. 101

Here lies the great moral responsibility ! What a self-immolated host of
victims must greet the ilygeist on the banks of Styx, and deafen old Charon
himself, while wafting the affrighted ghost to the regions of Tartarus ! Poor
Mr. M'Kerrel narrowly escaped a verdict of Felo-de-se, for taking Prussia
acid ; and yet thousands of infatuated people, in this country, are not con-
sidered insane, although they swallow quack medicines which are certain-
ly fatal as, though far more painful in operation than, Prussic Acid !

" Quern Dcus vult perdcre prius dementat."

The verdicts on such occasions, ought, strictly speaking, to be "Suicide
committed during temporary insanity respecting Morison's pills." Boston
Medical and Surgical Journal.

TJwmsonian Practice. "A correspondent in Connecticut gives us the
following particulars of a case which recently came under his notice.

Miss E. Fox, aged about 30, had been subject to slight epileptic fits for
about two years, occurring irregularly, sometimes as often as once a month,
and sometimes not oftener than once in two or three months. She was
importuned to take the advice* of a Thomsonian in Hartford, and had been
under his care about a week, when she died, immediately or very soon after
coming out of the hot bath. Mr. Fox, her father, informs me that he saw
her on the day before her death, and that she expressed a wish to return
home, but concluded to stay and be cured, and that he could not learn the
particulars of her death, but the doctor said the fits killed her, for on coming
out of the bath she had six or seven in succession, till she died. It is re-
ported also, that after the bath she had the cold dash and the lobelia
emetic, and that she died in the operation of the latter. I believe she had
never persevered in a judicious course of medicine, though she had been
very much benefited last winter by taking stramonium seeds, recommended
by a person not a physician. She however took them in such large doses
as soon to cause confused vision, and they were consequently discontinued ;
but the fact itself of the improvement shows that she might very easily have
been cured under proper treatment. One of the many soi-disant philan-
thropists of the present day, who had had the ThomsGnian practice in his
family, and who was busy in recommending it to others, once told me
what he seemed to believe that the Thomsonians could give a man an
emetic immediately after he had eaten a hearty dinner of beef-steak, and
that the emetic would clear out all the bile from the very bottom of the sto-
mach, and yet the beef-steak should remain unmolested. This man was not
a fool, but knew enough to get a living in the town of East Windsor, Conn.
Such people seem to have for theirmotto, " Credo quia impossibile est." ib.

Illustrations of Surgery. A splendid set of Illustrations of
Surgery is offered to the public by A. S. Doane. We have
withheld a notice of this work for some time, in the hope that
we should be able to speak of it from our own inspection. But
as we are not yet so fortunate, we are only able to say that it
is compiled from the writings of Gerdy, Hard, Velpeau and
Blasius ; sources which, with the assurance the public possess
of Dr. Doane's zeal and talent in this mode of communicating
practical knowledge, may be considered surety for great use-
fulness of the work in the hands of every student, practitioner,
and teacher of surgery.

192 Mechanism of the Bruit de Soufflet. [Aug.

The first five plates are devoted to bandages. The next
twenty to fractures, and the remaining twenty-live or thirty to
illustrate the principal surgical operations.

Mechanism of the Bruit de Soufflet.

Ill the second part of Dr. Corrigan's Memoir, read to the
Medical Section of the British Association, at the Dublin meet-
ing, we are presented with his views of the Mechanism of the
Bruit de Sou!flot, which are as follows :

"The sound depends on the simultaneous presence of these two conditions,
viz: 1st, a current-like motion, of the blood (instead of its natural equable
movement,) tending to produce corresponding vibrations on the sides of the
cavities or arteries through which it is moving ; and, 2ndly, a state of the
arteries or cavities themselves by which, instead of being kept in a state
of tense approximation on their contained inelastic blood (which would ne-
cessarily prevent any vibration of their sides,) they become free to vibrate
to the play of the currents within on their parietes ; and by those vibrations
cause, on the sense of touch, "fremissement" and on the sense of hearing,
"bruit de soufflet." It was shown that these two conditions are present,
in the parietes of the ventricle, and the currents of blood striking against
them in cases of narrowed auriculo-ventricular openings ; in the enlarged
and tortuous arteries of the placental portion of the uterus permitted by
their very free anastomosis with veins and sinuses, and other causes, to be-
come partially flaccid in the intervals of the heart's contractions, and the
irregular currents necessarily assumed by the blood in rushing along these
comparatively flaccid tubes at their next diastole ; and that similar condi-
tions exist in the analagous state of the vessels in aneurismal dilations of
tortuous arteries. The presence of the two conditions was also applied to
explain the mechanism of the sound in permanent patency of the mouth of
the aorta, in the large arteries of animals dying of haemorrhage, and in va-
rious other instances. In conclusion,, two experiments were detailed, in
which, in one instance, a small bladder, and in the other a portion of the gut
of an animal, was interposed between two cocks, the upper or nearer being
the cock of a water-cistern, and the lower or further constituting the dis-
charging orifice of the bladder or gut, and water then allowed to flow
through from the cistern. The sound "bruit de soufflet" and the sensation
"fremissement" were perceptible in the intervening bladder or gut, untd
(from the upper pipe pouring in fluid faster than the lower discharged
it) the bladder or gut became tense, and then both sensations ceased, the
passage of the fluid through, nevertheless, continuing all the time. The
experiment with the bladder was applied to explain the occasional presence
and absence of "bruit de soufflet" 'in aneurisms, the sound being present in an
aneurism when, from any circumstance connected with it, its parietes can
become at all flaccid in the intervals of the heart's contractions, not being
heard if the parietes remain tensely applied to their contained fluid.

SOUTHERN MEDICAL,

AND

SURGICAL JOURNAL

Vol. I.] SEPTEMBER, 1836. [No. 4.

Part I. ORIGINAL COMMUNICATIONS.

ARTICLE I.

A case in which the Placenta was retained thirteen days after
delivery at the fall term with recovery. By Geo. R. Grant,
of Jefferson, Jackson County, Ga.

The separation of the placenta, is always considered by good
accoucheurs, as the most important stage of natural labour.
We will not trouble the reader with extensive quotations, or
multiplied references, to prove, what we are well aware, will
never be denied by those who fully understand the subject. We
freely accord with the following sentiment of Dr. Gooch ;
" You generally find (says he,) that patients estimate their dan-
ger only by their sufferings ; hence, as soon as the child is born
their anxiety ceases ; but if they knew the dangers attendant on
the separation of the placenta, their apprehensions for their
safety would scarcely terminate so soon."*

It is a strange and interesting fact, that so few females fall
victims to a process, confessedly fraught with dangers of the
greatest magnitude. In no one of the operations of nature is
the wisdom and the goodness of God more clearly illustrated,
or the wise adaptation of the cause, to the effect, more evident
than in the subject under consideration.

1 Gooch'tj Midwifery, page 146.

194 Remarkable Retention of the Placenta. [Sep?,

The principal danger to be feared from a retention of the
placenta is hemorrhage ; which may be produced by a partial
separation of it from the uterus, leaving open the mouths of a
few bleeding vessels ; or it may be entirely detached, and re-
tained within the cavity of the organ, from rigidity of the os
uteri, or other causes, its bulk preventing the degree of con-
traction necessary to close the extremities of the bleeding ves-
sels. A case of the latter description having lately fallen under
our notice, we offer it more for the circumstance of its long
continuance, than for any thing else new or surprising, connect-
ed either with the case, or its treatment.

Mrs. D., of this county, was delivered on the 12th of May
last, in the evening, of her first child. Nothing unusual occurr-
ed during the accouchement. The labour, for the first one,
was considered by the midwife, easy and expeditious. Imme-
diately after the child, followed the entire chord, which had
given way close to the placenta. The cord breaking thus early,
and the placenta not coming away, after waiting several hours,
the midwife being alarmed at an occurrence so unusual, advised
that a physician should be sent for ; and the services of Dr.
Wellborn, who resides in the neighbourhood were engaged.
The doctor made several efforts to extract the placenta, which
proving abortive, he had recourse to ergot, which was adminis-
tered regularly during the night, with the effect of inducing se-
vere and continuous uterine efforts, but without producing the
desired effect. On Friday, the 13th, Dr. Wellborn left Mrs.
D. with strict orders to the nurse the midwife to keep the
patient's bowels open with castor-oil, and to continue the ergot
at stated intervals. The ergot was continued, as directed, until
the pains became so intolerable, and the patient so restless, as
to induce the nurse to believe, " that the woman" to use her
own expression would go into fits ; and she discontinued the
medicine. Nothing more was done until Sunday evening, the
15th, when Dr. W. was again called in. Finding that the ergot
had not been used according to his direction, he again prescrib-
ed it, with the same effect as before, namely, severe uterine pain
without expulsion. Seeing himself foiled in this, his only seem-
ing resource, Dr. W. advised a consultation, and I was sent for
between midnight and day. I arrived early on Monday morn-
ing, the 10th, and the fifth day of the patient's suffering, and

IR3G.] Remarkable Retention of the Plaeenta. 105

learned from the doctor, the foregoing history, with the addi-
tional fact, that the patient had had a slow but continual he-
morrhage from the beginning.

Mrs. D's general appearance was truly alarming ; her coun-
tenance was expressive of severe suffering, the ergot produc-
ing almost constant grinding pains ; her pulse was frequent,
weak and corded, and her abdomen exquisitely sensitive. The
tumour produced by the retained placental mass, could be dis-
tinctly felt through the abdominal parictes; the slightest pres-
sure on it could not be borne without intense pain. To satisfy
myself of the condition of the os uteri, and to ascertain if ex-
traction were not still practicable, an examination was proposed
and consented to, not without great reluctance, however, on the
part of the lady ; and who could blame her ? as the parts
had become extremely tender from frequent examination, and
the irritating quality of the discharge. My left hand was placed
on the abdomen, immediately over the tumour formed by the
placental mass, and the pressure gradually and gently increased
until it was sufficient to push the tumour from the right iliac
fossa where it was situated, towards the symphysis pubis.
Having secured it there, the index finger of my right hand was
introduced, per vaginam, slowly and cautiously. The com-
plaints of the patient were boisterous during this stage of the
examination, and when my finger reached the os uteri her ago-
ny seemed very great. I examined it, however, in the most
gentle manner possible ; found it tumefied, its lips thickened,
closely approximated and rigid. My object was, if I had found
the os dilatable, to have gently opened it with the fingers of my
right hand, to have borne down the retained mass with my
left from the pubis, where I had it confined, towards the vagina,
and extract it if possible. The condition of the parts rendering
this impracticable, the examination was discontinued. As pu-
trid portions of the placenta were being discharged continually
with the blood, and other fluids from the uterus, the smell which
I encountered during the examination was, to say the least of
it, superlatively foetid.

I proposed to Dr. Wellborn, to give the patient a full dose of
laudanum to ease the pains produced, and still kept up by the
ergot which had been administered ; and that a broad bandage
which had been neglected should be applied to the abdomen ;

196 Remarkable Retention of the Placenta. [Sept.

gradually and gently tightened, as the patient could bear it, un-
til it afforded the necessary support. These means had a ma-
gical effect over the uterine contractions, and the abdominal
tenderness. Mrs. D. expressed her feelings of comparative
comfort, in strong terms, shortly after their application.

In the consultation we advised that no more ergot be used,
and no further efforts at extraction be permitted, at least for the
present. The course of treatment advised was the following,
namely : That the parts be kept clean by injections of strong
chamomile tea, containing half an ounce of chloride of soda to
the pint. These injections were to be frequently repeated, and
used moderately warm. The bowels were to be kept open by
pills composed of equal parts of aloes and rhubarb, with a small
portion of tart, antim. one-eighth of a grain to the pill one to
be taken three times a day; and if that number operated too
freely on the bowels, the dose to be reduced to two, or even one.
in the twenty four hours ; the object being to procure one or two
consistent evacuations daily. The tinct. sulphuric, acid, aromat.
was recommended in small and frequently repeated doses, to
betaken in sweetened water sufficient to moke a pleasant acid
drink. The diet to be light and nutritious. The patient's head
and shoulders were to be kept elevated to assist the escape of
the foetid discharges ; and her friends were requested to
give information on the slightest recurrence of unfavorable
symptoms. Dr. W. agreeing to this course, and the necessary
instructions having been given to the lady's friends, we sepa-
rated.

Dr. Wellborn examined Mrs. D. on the seventh day after the
consultation as I have been informed and from the entire
absence of putrid smell, and hemorrhage, and other attendant
circumstances, pronounced her clear of every particle of the
placenta. This, however, proved not to be the case, for on the
fourth day after his examination, a large mass, the remains of
the old placenta, was discharged: both mother and child are
doing well.

Remarks. The most remarkable circumstance connected
with the foregoing case, is the great length of time thirteen
days during which the placenta was retained. That it was
detached from the uterus, immediately after the birth of the

1836.] Fracture, $c. cf Cervical Vertebra. 197

child, we have every reason to believe. The midwife says she
could feel it before Dr. W. was sent for, but was afraid to ex-
tract it. Dr. W. says he felt it, and hooked his finger into it,
but could not bring it away, because of the crippled situation of
his hand, having lost most of the fingers from his right hand
when a boy, by the saws of a cotton gin. Might he not have
introduced his whole hand, into the uterus, and then been able to
bring away with it, the placenta ? " A man must have the hand
of a giant," says Gooch, "if it will not pass through the space
which has just admitted the descent of the child."

The danger which we apprehended most, was the superinduc-
tion of an adynamic state of fever; the consequence of the ab-
sorption of putrid matter. This state of things did not supervene,
and we think that to the chloride of soda, in particular, must we
look as the prophylactic. Never was its power in correcting
putrid effluvia more signal. To its use, therefore, we are dis-
posed, in a good degree, to ascribe the safe termination of the
case of Mrs. D.

article n.

Case of Fracture and depression of the fifth Cervical Vertebra,
with Paralysis. By B. B. Strobel, M. D., Lecturer on
Anatomy and Surgery, Charleston, S. C.

Sometime in the month of September, 1833, I received a

note from Drs. W and D , requesting me to visit a

patient, and to bring my instruments for trepanning. I imme-
diately complied with their request. On entering the chamber
I saw the patient lying on his back in bed, with his shoulders
elevated. He was a negro, named Billy, of about 40 years of
age. His pulse was full, soft, and slow. There was an exten-
sive lacerated wound of the scalp, a large portion being separa-
ted from the cranium. I introduced my finger into the wound

198 Fracture, $c. of Cervical Vertebra. [Sept.

but could discover neither fracture nor depression of the bone.
Respiration was slow and laborious, being carried on entirely
by the diaphragm, which caused an alternate rising and sinking
of the abdomen, as the air was inspired or expired. The pati-
ent was completely paralysed below the shoulders. Upon
pricking various parts of the body he experienced no sensation,
except just above the clavicles, and on the top of the shoulders.
He complained of no headache, his mind was calm and tranquil,
he conversed rationally, and said he felt no pain.

A single glance at the case was sufficient to satisfy me of the
nature of the injury. I, nevertheless, asked the physicians in at-
tendance, what operation they proposed, and with what inten-
tion? They replied, that it was their intention to remove a
portion of the cranium corresponding to the wound of the scalp,
for although there was no fracture or depression of the bone,
they thought the symptoms of compression on the brain, were
sufficiently great, to justify an operation. I dissented from
their judgment, and gave it as my opinion, that there was not
a single symptom present, indicating pressure on the brain, and
I was well satisfied that the cause of paralysis must depend on
pressure existing in the course of the spine.

In order to bring them to the same conclusions as myself, I
first requested the patient to give us a history of the accident.
He stated that u he was a seaman on board of a schooner, and
that his vessel had been employed in getting up an iron chain-
cable, with an anchor attached to it. To accomplish this, two
blocks and a tackle were used being attached on the one hand
to the mast head, whilst on the other, they were connected with
the chain-cable. Six or eight men were * bousing' at the fall,
whilst Billy took in the slack, around a elect, near the deck.
This required him to stoop low, with his head bent down tow-
ards his breast. A considerable quantity of chain had been
hoisted in, and by the approximation of the blocks towards the
fixed point, elevated nearly to the mast head, when suddenly
the strap of the block gave way, and the blocks, tackle and
chain descended with great violence. The patient received the
block on his head, whilst (I presume) a portion of the chain
struck him on the back of the neck. He further stated, that as
soon as struck, he instantly fell, and although he never lost his
recollection, was immediately deprived of all sensation, and
power of motion in4)is Jegs and arms."

1836] Fnrcturc, c)c. of Cervical Yvrlrhra. 199

I next proposed an examination of the spine. The shoulders
of the patient were carefully raised up, and I passed my finger
down the spinal column. On reaching the spinous process of
the fifth cervical vertebra, I discovered an evident depression,
the slightest pressure at this point induced the patient to com-
plain.

The Physicians in attendance were soon convinced of their
error of judgment, and satisfied that no good would result from
the operation of trepanning. Indeed, there appears to me to
be but little difficulty, in distinguishing between pressure on the
brain and spinal marrow. Independently of the symptoms
which indicate an interruption of the cerebral functions, we
rarely have paralysis of both sides of the body, occurring from
pressure on the brain. Were it possible for pressure to exist
on the brain to such an extent, as to paralyze the whole body
below the shoulders, death would instantly ensue, as well from
the interruption of the cerebral, as a cessation of the vital func-
tions.

What should be done under these circumstances, was the
next consideration ? The patient evidently could not live ma-
ny hours in his present condition. The prospect of relief from
a surgical operation, was hopeless, and the best surgeons are of
opinion, that any interference of the operator under these cir-
cumstances, would be useless and hurtful. I advised the appli-
cation of fifty leeches along the spine, and a stimulating injec-
tion. I again saw the patient after the expiration of a few
hours. The injection had passed involuntarily, and the bladder
having lost its contractile power, was distended with water. I
therefore introduced the catheter and drew it off. He was
insensible to the introduction of the Catheter, as well as to the
administration of the injection. There was no erection of the
penis, which according to most authors, usually takes place,
in such cases as the present.

I saw the patient early on the next morning. He manifested
not the slightest symptoms of returning sensation was incapable
of moving his limbs, but perfectly rational. His pulse was
slow and languid. The injection had passed involuntarily du-
ring the night it was repeated. Some thirst for the allay-
ment of which, he was directed to take cold water in small
quantities. The bladder had again become distended with wa-

200 Fracture, $c. of Cervical Vertebra. [Sept.

tcr, and was evacuated. A blister about two inches wide was
applied along the whole course of the spine. The condition of
the patient remained unaltered to the time of his death, which
occurred in about 48 hours after the accident.

It is worthy of remark, that this patient enjoyed the full, and
uninterrupted possession of his mental faculties, and conversed
rationally, until ivithin a few moments of Ms dissolution. The
whole of the body below the point of injury, was to all intents
and purposes dead, for forty eight hours, and yet the mind con-
tinued to think and reason, a most conclusive proof, that the
brain is the material organ, through which its manifestations
are developed.

Post Mortem Examination.
There was no appearance of inflammation about the brain,
but some venous congestion. The lungs were in a normal
condition, but of a darker colour than natural from congestion.
The other pectoral organs exhibited nothing remarkable. The
intestines as well as the liver were sound. The internal surface
of the stomach, was slightly tinged with a blush of inflamma-
tion, and contained portions of undigested food, which had been
eaten before the accident, evidencing a partial, if not a total
cessation of the digestive function. In examining the spine, I
discovered that the fifth cervical vertebra, was fractured at the
point where the roots of the spinous and transverse processes
unite to form the vertebral lamina?. The posterior portion of
the bone being forced into the vertebral canal, the upper por-
tion of the fragment had been driven in with such force, that it
not only ruptured the ligamentum dentatum, but had made its
way through the proper membrane of the spinal marrow, into
its substance. There was a considerable effusion of blood, evi-
dences of great inflammation in the spinal marrow.

1830.] The Secretions. 201

ARTICLE III.

Essay on the Secretions. By R. D. Moore, M. D. of Athens,
Georgia.

I am perfectly aware of the numerous difficulties with which
I have to contend, in arranging and placing before the profes-
sion the doctrines intended to be inculcated in the progress of
the present essay. Situated as I am, in the interior of Georgia,
deprived of access to extensive libraries, I may present ma-
ny thoughts which are old, yet they strike my mind as true, and
as such, I offer them, and hope that if they are not true, some
one possessed of more advantages and a better intellect, will
undertake the subject, and correct the impressions that now
prevail.

The science of medicine has within the last half century, im-
proved almost beyond the hopes of its most devoted followers,
and is still marching onwards, unfolding the mysteries that en-
circle many subjects of deep and lasting importance to the
practice of medicine. In physiology, by thorough and diligent
investigation, we have advanced on many subjects, almost to the
verge of perfection, yet the field is wide open, and much re-
mains to be done ; old theories must give way and new ones
spring up, and be perfected under more auspicious circumstances.

We generally imagine that the exposure of certain organs,
during the performance of their functions, will completely de-
monstrate their secret and mysterious nature ; but conclusions
derived from this developement, must necessarily be exceeding-
ly erroneous, because, many of these functions are greatly mo-
dified, nay, some entirely changed by the exposure which is
necessary for inspecting them ; yet, I admit that much has been
done in this way, that may lead us a considerable distance on
the path to improvement.

Amongst the most intricate and obscure of all the animal
functions, we find secretions perhaps the most obscure. I have
looked with diligence into the various works on the subject, but
have not been satisfied ; nor am I with my own observations,
although they have a strong tendency to convince me that the
ideas thrown out in the following pages arc founded in truth, and
26

202 The Secretions. [Sept.

probably are the true interpretations, though imperfect ones, of
the functions, yet I must acknowledge the diffidence with which
I offer them for the consideration of the faculty. To simplify
the subject as much as possible, I shall assert that all secretions
in the human body are the result of mechanical structure, or or-
ganization of the blood and vessels, aided by chemical affinities,
and the whole the result of the circulation.

It has been proven beyond a reasonable doubt, that the mass
of blood is composed of integrant particles, which particles pos-
sess a globular form, and float in an aqueous fluid. Richerand
says, "its colour is owing to a prodigious number of globular
molecules, which move and float in an aqueous fluid ;" and again,
the same author says, " they are solid and formed by a nucleus
or red point, covered by a membranous vesicle, which appears
to be readily formed or destroyed." Dr. Thompson, of Edin-
burgh, in his experiments instituted for the purpose of illustra-
ting the phenomena of inflammation, came to the same conclu-
sions. He says, that he distinctly saw the circulation going on
in the web of a frog's foot, which was sufficiently transparent to
allow him to observe the globules follow in quick succession one
another, through the capillary vessels. He speaks of these glo-
bules every where, and is firmly convinced of their existence,
and so may any member of the profession, if he will procure a
microscope and test the fact by ocular demonstration. Nothing
more need be said of the spherical shape of these particles of
blood, for it is the necessary result from the nature of their con-
stituent parts. There can be little doubt, that the red point is
nothing more than a fluid embraced and compressed on all sides
by a membranoid substance, which enveloping it in this manner
will give it the globular form.

When blood is drawn from the body we first observe the phe-
nomenon of coagulation which will take place under various cir-
cumstances of heat, cold, exposure to and exclusion from the
air. We next witness a still more remarkable fact, its separa-
tion into serum, coagulum and fibrin. This has been attributed
to various causes, such as gravity, and particularly to a vital
movement of the denser particles by which the scrum is separa-
ted, but I am convinced it depends on a cause utterly distinct
from this vital movement among the particles; on the contrary
it is the consequence of the destruction of a degree of organiza-

183G.] The Secretions. 203

tion which the blood possesses, and which will take place more
or less suddenly in proportion as that organization is affected
by the condition of the whole system. Now if these molecules
or particles do exist in the mass of blood, the enquiry arises, for
what purpose are they destined in the animal economy, if they
are to retain their globular form ? It is clear, since the parti-
cles of blood have a form and definite size, they are to a certain
degree divisible, and that their destination is to repair the rava-
ges committed on the system, by the daily and momentary de-
monstrations which take place in the phenomena of life.

All the solids are evidently derived from the fluids, and even
the smallest vessels which contain them, are supplied by the
destruction and consumption of the particles of the blood ; they
must, therefore, lose their globular form, before they can by the
process of nutrition become component parts of bone, tendon,
muscle or nerve: this I conceive to be clear and needs no further
investigation. The second enquiry then arises, how is this
change effected, and where? It is altogether unnecessary to
enter into a minute anatomical account of the circulating sj^stem,
but simply to mention, that its centre, the heart, is composed of
four cavities, each being well supplied with strong muscular fi-
bres, which by their contraction force the blood into the arteries
which is thus forwarded to every part of the system,and is brought
back again by the veins ; but not until it has passed through an
intermediate set of vessels called capillaries, partaking both of the
nature of arteries and veins. They are of various sizes, from
those whose calibers can be measured, to those which are invi-
sible to the eye ; moreover, many cannot be seen, even with the
a;d of powerful glasses. No anatomist has ever demonstrated
to the sight, that vessels circulating a fluid, exist in tendons, liga-
ments, or cartilages in the healthy state, but if either be cut
off from a communication with the heart, death is the inevitable
consequence at a period more or less remote. Who has not
seen an inflamed tendon freely injected with red blood and
consequently when rent, unite by granulation, similar to that
which we observed in granulating muscle ; an incontroverti-
ble evidence, not only of the existence of those vessels, but
also of the extreme minuteness of their caliber, showing con-
clusively, that the globular form must change, and also where
this change takes place. No one will contend, because these

204 The Secretions. [Sept.

tendons, cartilages and ligaments arc white, that they are nou-
rished by a matter only slightly annualized, but rather that the
red blood does not communicate its colour, yet they possess a
degree of vitality far superior to that of chyle, which has been
only under the influence of vital action for a few minutes. I do
not wish to be understood, that the whole mass of blood imme-
diately after it leaves the heart, is possessed of the same degree
of elaboration, for if so, how would it be possible satisfactorily
to account for the difference of excitability of organs ; as for in-
stance, between the cartilages and the retina the same material
will not produce these organs indiscriminately. The blood
which we see in an inflamed eye, is the result of the increased
capacity of the capillaries, not effusion, for if so, it could not be
removed only by absorption, which is not the fact. The same
is true with regard to some congestive diseases of the lungs and
the mucous tissues generally. If this is conceded, it follows as
a necessary consequence, that the accretory process is carried
on by a deposition from a highly vitalized fluid that when these
molecules reach these capillary vessels in a healthy body, they
must either be capable of passing through unchanged, or they
must suffer a diminution of their capacity ; they cannot remain
in the vessels and be stationary, neither can they recede, the con-
stantly advancing column behind preventing a retrograde motion.
A change therefore must take place, and we arc told by some
authors, that these molecules or globules can be seen changing
their diameters when compressed by the vital action of the ca-
pillaries, and become more or less elliptical, till finally the encir-
cling membrane gives way, allowing the contained particles to
be exposed to the action of the glands, or in other words to en-
ter in the composition of muscle, tendon, bone, &c. and the
parts unfit for such purposes to be excluded. I do not believe that
all the molecules arc thus broken in every revolution through
the arterovenous circle; on the contrary, many return to the heart
in the same form as when they left it, and it is very probable
that these molecules do not suffer this revolution until they have
gone through this circle several times, and it is presumable
that sanguification is not entirely perfect until then. It is very
unlikely that a fluid taken up but a few minutes before from the
various masses which arc found in the stomach and towels,
should after so slight a degree of elaboration in the lymphatic

1830.] The Secretions. 205

glands, be immediately constituted blood, fit to repair the waste
which is the consequence of every exertion. Where shall we
lay the distinction between blood and chyle, if this be the fact ?
We are told that out of the subclavian vein it is chyle, and can
it become blood simply by mingling with the blood in this vein ?
I imagine that no one will contend that it is, but that the change
is effected in the heart, and for this purpose is the peculiar ar-
rangement of muscular cords in the auricles and ventricles, and
not for their contraction, because this can be, and is, effected with-
out this peculiar arrangement. My ideas on this subject received
considerable corroboration from the fact, that colouring matter
is not detected in the bones of animals until they have been fed
for some days, but is immediately detected in the glandular se-
cretions, proving almost conclusively the fact, that these parti-
cles do go several times through the circulation, before they
are deposited.

The observations of Mr. Cruickshank strengthen this con-
clusion ; he says, that the absorbent vessels arising from arte-
ries and veins, never take up blood unless it be the result of
some violence. What then is the duty of the absorbents ?
Certainly to effect a change upon the unperfected fibrin, which
from its importance in the animal economy, cannot be so sud-
denly formed as is usually imagined. The existence of this fi-
brin in the blood does not depend upon any chemical act, that is,
it is not united to either serum or colouring matter, for simply
by agitation it will remain with either, and may, by violent agi-
tation, be separated from both, and can be washed white. Nor
is the fibrin diffused loosely through the blood, but on the con-
trary exists in the mass as the enveloping membrane, giving to
the globules their form. The third enquiry now arises : what
is the result of the change of this form ? We have shown that
by the contraction of the heart, and aid of the arterial sys-
tem, the blood is forced into every part of the body through the
capillary vessels ; some portion of the general mass to be taken
up by the absorbents, to undergo new elaborations ; some to conti-
nue the round of the circulation through the larger capillaries
into the veins and thence to the heart ; some to be forced to the
surface to be thrown off by means of the cutaneous exhalants ;
some to the mucous surface of the intestinal canal ; some to the
various cavities of the body, &c. &c, these being the excre-

20G The Secretions. [Sept.

mentitious parts of the blood, which from their superabundance,
or their having been rejected, are deemed unfit for the perform-
ance of any useful functions, and when thrown off, serve either
by their evaporation to diminish the temperature, or to lubricate
parts requiring lubrication, and finally the perfected blood yields
over to the body its component parts to form bone, tendon and
muscle with its appendages.

All these different arrangements and the results of their action
on the blood we know, but the precise manner in which it
takes place, cannot in the present stage of the science be satis-
factorily accounted for. I disclaim any belief in transudation
through inorganized parts as a healthy function, and am also
convinced that the mechanical influence which prevailed some
time since, is equally incorrect, in as much as chemical affini-
ties have to do in the act of secretion, and the system is amply
provided with the apparatus necessary for its action.

Having now gone through the observations intended to be
made on this subject, I conclude by stating in distinct proposi-
tions, the deductions which may be drawn from them.

1st. That the globular shape is essential for perfect blood.

2d. Before these globules can be subjected to the assimilat-
ing process, they must be broken.

3d. This change is effected by the vital action of the capil-
laries.

4th. Secretion is a process established by certain arrange-
ments of glands, to throw off from the body those substances
which are unfit for nutrition, or superfluous, or which are to be
used in other parts, and whose usefulness can only be acquired
by this process.

Whether these deductions be admitted or not, I can only say
they are founded on observation, and deduced from facts,
which made a strong impression on my mind. I repeat it again,
if they are not true, I will be much obliged to any one, who will
demonstrate their incorrectness.

1836.] Remarkable Osteo-sarcomatous Tumour. 207

ARTICLE IV.

Remarkable Ostco-sarcomatous Tumour in the person of II. A.
Franklin, late of Columbia County, Ga. with Remarks and
Notes. By George K. Holloway, M. D., of Warrenton,
Georgia.

Dr. Holloway has kindly presented us with a minutely de-
tailed history of the above named case, in the wTords of the un-
fortunate subject of it, Mr. Franklin himself; which being as
well drawn up as could be expected of an unprofessional man,
we shall give it entire.

Description of a singular Case of affliction.

I, Henry Augustus Franklin, was born on the 9th of Febru-
ary, 1800, and from my childhood up to manhood, enjoyed un-
interrupted health ; and being blest with a good constitution,
and having for the last 4 or 5 years been singularly afflicted,
am desirous of giving in my own language, a short history of
my case ; to wit:

In October, 1831, I was attacked with intermittent fever,
which continued about two months. After the fever had appa-
rently left me, I was troubled with a great enlargement of the
spleen until the following February. During this time I was
attacked with severe pain in the right hip, which I thought scia-
tic or rheumatic, and treated it accordingly, without finding any
relief. In January, 1832, my health somewhat improved ; I
began to work, and continued at work until May ; my health
continued to improve, but the pain still continued. In feeling
my spleen often, during this time, which I discovered was re-
ducing very fast ; about the last of February, of the same year,
I felt something of a hard substance of rough bumpy shape in
my right groin, which was firmly seated in the cavity of my
right hip. During the time from February on some months I
felt that the action of my right leg had failed, particularly when
lifting any thing; running or going up steps, &c.#

* About this time Mr. Franklin suffered very much from carbuncles,
which were very numerous on the whole of the right or diseased side, and
particularly so in the vicinity of the tumour, and some of them were quite
large.

208 Remarkable Osteo-sarcomatous Tumour. [Sept.

Feeling much alarmed, I made early application to Dr. David
Cooper, of Wrightsborough, who after examining the case, sta-
ted that he had no knowledge of it, and recommend me to go
and see Dr. Antony, of Augusta, whom I visited in March of
the year 1832. Dr. Antony after some reflection recommended
the use of Iodine Ointment, which I used constantly for two
months without receiving any benefit. Several of my friends
believing it to be rheumatic pains, recommended me to blister
plasters, which I applied, and kept it sore and running for seve-
ral wTeeks, which instead of benefiting, injured me very much.
The pain continued intensely, and my friends yet believing it
rheumatism, I was advised to visit the mineral springs. I went
to the Indian Springs and bathed and used the water for more
than a week, and receiving no benefit, I went to the Warm
Spring,* in Meriwether County, where I spent eight or nine
days, bathed frequently, but found no relief. I returned home
much worse than I left it, owing to the fatigue, hard lying, &c.
the pain in the hip joint still increasing ; so much so, that I could
not sleep. When at the Warm Spring, not being far from
Columbus, I went there and saw Dr. Cooper and Dr. Nicholas
Childers, a man of much skill in his profession, who examined
me, and was somewhat of opinion that an operation would prove
successful, if the warm season had passed. The pain still in-
creasing and the thigh shrinking a little.

On my way home, I called on Dr. White, of Milledgeville,
who very politely invited Drs. Fort, Boykin and Brown, to as-
sociate with him in an examination of the tumour, which had
very much enlarged by this time. After a careful examination
by them, Dr. White inclined to the opinion of cutting the tumour
out, and was of the opinion that it might be done with safety.
The others differing with Dr. White, and thinking it impractica-
ble, he would not undertake it without their assistance and con-
currence. From this time on to November, I suffered the most
excruciating pain, my leg gradually shrinking and the tumour
enlarging, yet I was enabled to walk without the aid of cane or
crutches, and my general health was good. About the last of
November, I determined to go to Augusta, as the Medical Fa-
culty were in session, to sec if I could get any thing done to

* The Warm Springs in Meriwether County, Ca. arc said to be useful
in .some cutaneous di

ISM.] Remarkable Osteo-sarcomatous Tumour. 200

relieve my pain, which was now almost insupportable. On my
way to Augusta, I called on Col. Z. Williams, and his son Dr.
R. Williams requested, (if the board of physicians should not
do any thing for me) to call as I returned and spend sometime
with him. When I arrived at Augusta, I was examined by
many of the medical men, who did not advise any course par-
ticularly for me to pursue.

I came to Dr. Williams very much disheartened, and suffer-
ing so much, that I did not think I should long survive.

Dr. Williams put me under a strict regimen or diet, restrict-
ing me in my food, and giving me gentle purgatives, until he
reduced me very low. Towards the latter part of January,
1833, I had lost the use of my leg, which was probably occa-
sioned by my lying in one position such a length of time ; the
tumour still increasing, yet I believe the pain was not so severe.
In February, I returned home, and began eating more, and my
leg began to gain strength, which was the case from January to
September. I did not restrict myself so much in my diet,
and was able during that period to walk about the neighbour-
hood, nevertheless, I was never a moment free from pain, and
it was very painful for me to sit any length of time. The pain
wTas all the time in the right hip joint.

Believing from the first appearance of the tumour that no-
thing short of an operation would relieve me; and having during
the summer become acquainted with Dr. Holloway, he wras of
the opinion that it could be taken from me successfully, by the
skilful surgeons of the north. Dr. Holloway immediately
wrote to Drs. McClellan and Hewson of Philadelphia, stating
the progress of the case, who promptly answered him that from
what he had stated, they believed it could be taken from me
successfully. He gave me letters of introduction to them, and
on the 11th of September, 1833, 1 started for New- York.

At Augusta, my friend Dr. Antony visited me, and advised
me as I had started, and as my mind was made up to get all
the medical skill in my reach, to go on, and accordingly gave
me a letter of introduction to Dr. Dickson of Charleston, also
one to Dr. Mott of New- York. At Charleston I was visited
by Dr. Dickson and several other intelligent medical men, who
examined my case strictly, and gave as their opinion, that no
surgeon having any regard for his professional character would
27

210 Remarkable Osteo-sarcomatous Tumour. [Sept

operate on me. I remained in Charleston 7 or 8 days, during
part of which time I was very unwell ; the tumour continually
increasing in size, but never painful. After I got over my sea-
sickness, I began to improve very fast in my general health,
and when I reached New-York, my strength was much greater
than when I left home, and the pain in my hip not so excrucia-
ting as before.

At New- York, Dr. Valentine Mott examined me very atten-
tively and was clearly of opinion, that an operation would pro-
duce certain death. His words were, " I would as soon cut
your throat to save your life, as to cut that tumour from you
with the expectation of saving you." At Philadelphia, Drs.
McClellan, Hewson and Patterson, examined my situation, and
all of them, except Dr. McClellan, were opposed to having it
cut from me. He stated, that he believed he could extract or
take it away without endangering my life ; but was of opinion
if taken away it would return again, that it was a disease of the
blood. I did not see the venerable Dr. Physick, although I had
a letter of introduction to him, and my brother called twice at
his residence, yet he was so closely engaged in an important
case from Missouri, that he never saw me. The pain in my
hip still continuing and the tumour enlarging. Dr. Mott wrote
to Dr. Anton?/ on the subject, in answer to his letter, which had
recommended the use of Iodine. From Philadelphia I went to
Norfolk via Baltimore, and was there visited by several medi-
cal men of the borough, who looked upon my case as an unpa-
ralleled one in the history of diseases.* Dr. Mott was the only
one who stated that an almost similar case had fallen under his
observation. From Norfolk we returned to Baltimore, and
from thence took passage in the brig Gen. Marion, to Charles-
ton, where I arrived with my health much improved, and In
three days after, reached home about the 20th of October. Du-
ring the fall and winter I enjoyed very good health, although

* Wc think wc have seen a case somewhat similar in its nature, it was
a tnmotU that imparted to the touch the same feeling. By the attending
physician it was thought to be an abscess, it was accordingly punctured se-
veral times and discharged a thin white healthy matter or pus. This tu-
mour was also situated low down in the right iliac region, and extended near-
ly across the lower pari of the abdomen, but was not near so large as Mr.
{franklin's. The subject, was a female, it eventually proved fatal. In this
ease no post mortem examination was made. G. K. II.

1830.] Rc}?iarkable Ostco-sarcomalous Tumour. 211

the pain continued very severe and the tumour continued to en-
large.

About twelve months previous to this time, I suffered much
pain in my right leg from my hip to my ancle at intervals so
severe, that it seemed as if some person had hold of the nerves,
jerking them.

My health continued very good until the 1st of September,
during which time I was able to walk about the neighbourhood,
by resting frequently ; my thigh and leg having shrunk to a
mere skeleton of a limb. About the 1st of September, 1834, 1
was taken with an ague, and fever succeeded it, and both conti-
nued on and off for two weeks ; at this time my thigh commenc-
ed enlarging at my hip, and my ancle also became swelled,
which would appear and then recede for several days, until- the
swelling passed over the whole limb, and has remained so ever
since. In the latter part of November, I had a severe ague,
and when the fever came on, from my ancle bone to my arm pit
on the right side appeared as if mortification would soon follow.
I called in Dr. McCraven during this time, who succeeded in
stopping the fever, and by poulticing the part inflamed, it at
length recovered its healthy appearance. All this time the pain
was intense and the place still enlarging. During the spring
and summer of '35, I became able to go about with my crutch-
es ; at this time the course of the tumour wras such as to throw
my hip entirely out of joint, which it effected slowly, but
attended with indescribable pain.* This was very apparent
from the twisted position in which my foot and ancle wTere
placed ; and during the summer Dr. Williams visited me, and
had no hesitancy in declaring that the hip was out of joint. I
continued pretty much in this situation, suffering extreme pain,
until about the 1st of ^November, when I was taken by another
ague which lasted for several hours and left me prostrate. Soon
after this, large blisters formed on my leg, and run much water,
then became sore and appeared like the worst kind of ulcers.
They however soon dried up. In the course of three weeks I
had another ague which carried me back to my former pros-
trate condition ; similar blisters formed and similar sores upon

* The head of the femur was to all appearance completely luxated ; and
in the fall of 1835, and up to the time of dissolution, the right limb was ge-
ncraJly several degrees colder than the left. G. K. H.

212 Remarkable Osteo-sarcomatous Tumour. [Sept

my leg, which in the course of two or three weeks would dry
up. In January, 1836, I was taken about one o'clock with an
ague, which continued on me till after three. From that time
to the present, I have been helpless ; my leg and thigh large,
apparently ready to burst, blisters formed and running sores
came in their places. The tumour has been constantly grow-
ing, and a few days ago some blisters formed near the rough
points of the tumour, and on pricking them with the point
of a needle, matter issued from them ; and now a hole suffi-
ciently large to take in the end of a walking cane has opened,
and large quantities of matter run from the place daily and
hourly, of a light cream color and not offensive to the smell.
For the last month or two the pain in my hip, knee and ancle
has not been as severe as it was previously. During the whole
of my severe affliction which has been upwards of four years, a
great many prescriptions have been given, and I have tortured
myself with many applications without receiving any benefit.
My only medicine, since I returned from New- York, in 1833,
has been opium and Laudanum, which I have used unsparingly,
and it is all that has in the least mitigated my sufferings : there-
fore, I would recommend it to -all who are similarly situated.

Dr. Holloway has also furnished us with an account of the
post mortem and autopsic appearances, together with some ad-
ditional facts appertaining to the case ; amongst which is a re-
ference to a slight injury of the anterior superior spinous process
of the ilium of the right side, previous to the appearance of the
disease, which he supposes to be, and we think very correctly,
the excitins: cause of this dreadful case. The rest of the addi-
tional facts will be found in the notes of Dr. H. appended to Mr
Franklin's narrative.

Mr. Franklin died on the 5th of March last. The following
is Dr. Holloway's account of the post mortem and autopsic ap-
pearances.

On the morning of the Gth of March, being eighteen hours
after death, we proceeded to the autopsic, in the presence of
Dr. Henry Lockhart of Warrcnton, Dr. Edward Jones of
Wrightsboro,' Mr. S. Ircy, a medical student, and several res-
pectable gentlemen.

External appearance. The countenance natural, with the
exception of being very much shrunk and wasted by disease.

1836.] Remarkable Osteo- sarcomatous Tumour. 213

The body appeared as that of a person labouring under dropsy,
only very much larger. The right lower extremity was enor-
mously swollen-the foot elephantiastic-the left limb was a perfect
skeleton in comparison the arms literally skin and bones.
The stench arising from the body was peculiar in kind, and ex-
tremely offensive ; for the correction of which we washed the
body, and injected the cavity of the tumour through the ulcera-
ted opening with a disinfecting liquor concentrated solution of
chloride of soda. The integuments for 12 inches around the
opening into the tumour, were sphacelated. Such were the ex-
ternal appearances.

Autopsic. A crucial, incision was made from the scrobiculus
cordis, to the symphysis pubis ; and from the anterior superior
spinous process of one side, to that of the other. When the
flaps thus made were turned aside, the tumour only was brought
into view ; the rest of the abdominal contents being completely
hid, except the omentum, which was very much shrunk very
small not more than one quarter of the usual size, and appear-
ed very much like that of a person who had for a long time la-
boured under chronic dysentery or some other chronic inflam-
matory affection of the abdominal viscera. Upon dipping down
and bringing into view the stomach and small intestines, they
presented an anomalous appearance, evidently shewing the ra-
vages of disease. The spleen was more than twice its normal
size the kidneys of more than three times their usual size the
pancreas very nearly obliterated the liver very much enlar-
ged and deeply tinged with bile the gall bladder more than
five times its ordinary diameter, and full of bile the blood ves-
sels generally, but more especially the larger, in a state of high
inflammation. Such were the phenomena presented by the
viscera of the abdomen.

The thorax was next examined : the lungs healthy the heart
very much enlarged the blood vessels very similar in appear-
ance to those in the abdominal cavity the villous or mucous
coat of the bronchia not injected.

The tumour completely filled the whole of the abdominal ca-
vity, except a very small space in the left hypochondrium.
It appeared to have originated and proceeded from the
anterior superior spinous process of the ilium of the right
side, and to be closely and firmly attached to the whole of the

214

Remarkable Osteo-sarcomatous Tumour.

[Sept

inner concave surface of that bone, dipping down and covering
the whole internal surface of the pubis, part of the ischium, almost
the whole of the sacrum, and adhering on the right side to the
whole of the lumbar vertebrae and from the centre of the dia"
phragm near the heart, protruding through the abdominal ring
below Poupart's ligament, and under the fascia lata of the thigh
to within a few inches of the knee.

Great care was not taken in dessecting out the tumour, con-
sequently all that part below Poupart's ligament was left un-
touched in the thigh, and in some places where it was dissected
it was certainly not less than an inch or two thick.

The tumour, if we may be allowed the expression, was what
might be denominated a fatly tumour, interspersed with ossious
granulations of the size of small squirrel shot, some larger. In
fact when cut into it had very much the appearance and firmness
of the fat part of a brisket of beef.

The following are the dimensions and weight of the tumour,
after excision, and the comparative size of the two limbs.

Transverse diameter of the Tumour, -

18} inches.

Longitudinal " "

a

24}

Diagonal " "

it

one way, 22} "

u u u it

St

the other way, 25} "

Circumference, -

-

61} "

Weight of the Tumour,

-

26} lbs.

Left or sound Limb.
Around lar^e trochanter 18 In.

Middle of the thigh,
Above the knee, -
Below the knee, -
Calf of the leg, -
The instep, - -
Middle of foot, -

12 "

10} "

11 "

9"

13}"

10}"

Right or diseased Limb.
Around large trochanter 29} In.
Middle of the thigh, - 25 "
Above the knee, - - 21 1 "
Below the knee, - - 19 "
Calf of the leg, - - 19} "
Above the ancle, - - 13} "

Instep, 16J "

Middle of the foot, - 13 "

The tumour, if neatly dissected out, would have weighed at
least from 30 to 35 pounds.*

* By the kind attention of Dr. Jones, the tumour, an enormous wet
preparation, which we understand Mr. Franklin requested should be pre-
sented to the Medical College of Georgia, has been forwarded, and may now
be seen in the valuable and extensive Museum of that promising institution.
Editors.

1836.1

Thermometrical Observations.

215

ARTICLE V.

Thermometrical Observations for April, 1836, kept in Cass
County, Geo. By H. V. M. Miller, M. D.

CassviHe, Cass County, July 16th, 1836.

Gentlemen, Believing that some of your readers may wish
to compare the range of the Thermometer in this portion of the
state, (which is considerably resorted to by persons from the
lower counties, for the recovery of their health,) with that fur-
nished you from Burke county, and published in your second
number ; I send you the following table for the month of April
of this year.

The thermometer was in a shaded situation during the time,
and the temperature noted as will be seen in the table, at the
hours of 10 A. M. and of 3 P.M.

Although not so complete as that of Professor Cotting, yet I
hope it may afford some satisfaction so far as it goes to show
the difference of mean heat between the two places, and the
more considerable and sudden variations in the temperature of
the atmospeere in this county.

t 1

t i

o

CO

CO

o

o

o

i_. o

>o-

*0n

>n

^n

to

*-<

^0
2

*%

p
<<

*%

>%

!^*r

r>r

FK-

***

REMARKS.

1
2

a

4

5

a

?

8
9

10

11

12
13

14
15

48
66
65
52
46
50
51
58
60
62
67
67
59
52
52

65
73

72
53
50
59
62
63
70
62
77
78
64
62
50

Cloudy.

Cloudy.
Rainy.

16

49

63

17

50

62

18

62

70

19

64

64

Rainy.

20

68

76

21

61

GQ

Cloudy.

22

63

74

23

60

68

24

63

78

25

71

78

26

70

78

27

64

70

Cloudy.

28

60

60

29

62

74

30

65

70

Rainy.

By this it will be
seen, that the average
temperature in Burke,
at sunrise, is about e-
qual to the average
temperature here, at
10 o'clock, A. M. and
that the average at 12
o'clock in Burke, con-
siderably exceeds the
average here at 3 P.
M. which is about the
hottest hour of the day.

21 G Medical Education. [Sept.

ARTICLE VI.

Medical Education. By Joseph A. Eve, M. D. Professor of
Therapeutics and Materia Medica, in the Medical College of
Georgia.

The present defectiveness of medical instruction in the United
States is acknowledged and deplored, by the most enlightened
and distinguished physicians of our country. But so long have
these defects and abuses existed, so sacred have they become by
age and custom, that it is believed innovation would be attended
with difficulty, if not danger, and that the necessary and much
desired reform must be the result of a gradual change of public
sentiment, the conquest of light and principle, the work of time.

No one can be more zealous for a radical reformation in our
Colleges than an eminent professor in the University of Phila-
delphia ; he recommends the creation of additional professor-
ships and the introduction of other newly originated branches of
science into a course of medical education, and observes farther
that " a prolongation of the term is essential ;" but he says it is
not for the present generation to undertake this reform. Whilst
we admire the, zeal which Professor Jackson displays on the
subject of reformation, we are compelled to differ from him al-
together in the sentiment, that it is not to be attempted at pre-
sent. We hold that the proper time for correcting abuses is
as soon as they have been perceived and acknowledged,
by those best qualified to judge respecting them. How long
would this distinguished professor delay this reformation?
How long would he defer a consummation so devoutly to be
wished ? Would he wait until these evils become more enor-
mous and flagrant than they are? To what more auspicious
period would he postpone the enterprise ? What generation
more meet than this what school more able than that to which
he is attached, to commence this reform ?

The spirit of the times calls aloud for reformation the rapid
march of intellect the numerous important discoveries and
improvements in the arts and sciences require it now, and ere
long the voice of a more enlightened people will demand it.

1838.] Medical Education. 217

But shall our colleges wait until an indignant people, pro-
voked by the ignorance and incompetence of their graduates,
demand it ?

Is not the wide spread of empiricism in our country indubita-
ble proof of the degradation of the profession, and of the necessi-
ty for improvement ? Where should be the origin and whence
the emanation of this reform ? in the colleges themselves? or
among the people ? With whom commenced the Reforma-
tion ? the priesthood ? or the people ? And the temperance re-
formation the glory of our age and nation with whom did
it originate ? Did the temperate-, the moral and the pious, with
folded arms and unavailing lamentations, bewail the awful ra-
vages of Intemperance, and wait for his victims to commence
the reform, or defer the glorious enterprise for generations yet
to come? No! It is not thus with the spirit of a Luther or a
Melancthon. When the light breaks in and the evil stands re-
vealed, the true reformer, with a noble daring and a heaven-
kindled flame of holy zeal, that danger cannot damp, and
nought but death extinguish, asks no further omen, but uncon-
querably firm, resolves on reformation, or a martyr's grave!
For the correction of evils we should certainly look to those
whose exalted position affords them the best opportunity to
perceive, and the greatest power to reform them ; and therefore,
this distinghished professor has not discharged his duty to sci-
ence and society, in merely " shewing the necessity of a radi-
cal reform," and waiting for " a rising generation" to under-
take it.
1/ Onward ! onward ! to improvement and perfection, is the
motto and watchword of the present age ! All around is press-
ing forward. Why then should medical colleges alone be con-
tent to tread the same antiquated path, and perpetuate the errors
and defects of darker days? Can the profession of medicine
ever assume or maintain the elevated position it ought to oc-
cupy, whilst the courses of collegiate instruction are so imper-
fect, and degrees conferred on such meagre attainments ?
\J How limited, how imperfect is the course of instruction in
the medical schools of our country compared with that of Paris,
in which the faculty consists of 24 professors and 24 agreges or
adjuncts, and the period of attendance on lectures requisite to
render a candidate eligible to a degree, comprises four years.
28

218 Medical Education. [Sept.

How defective, how small in comparison arc the provisions and
requisitions of the colleges in the United States? That medical
schools are on a better footing in France, than in our country,
or any other on the globe, is chiefly attributable to the greater
liberality of the French government, in creating and cherishing
literary and scientific institutions. In the annals of history, no
government in any age has ever been so munificent in the pro-
motion of science and literature. The professorships in the
Parisian schools, are endowed by government, and every pos-
sible facility, opportunity and advantage afforded for the pro-
secution of every department of medicine ; but we must not
attempt in this place to recount all that France has done to
facilitate the acquisition of knowledge, and advance the me-
dical sciences to the highest state of perfection. The abuses
and defects so deeply deprecated and deplored, are not how-
ever to be charged against our government. Had we the
industry, zeal and enthusiasm of our Gallic brethren in the cul-
tivation of science, we would not look to future generations to
undertake this reform ; nor would government be slow to lend a
fostering hand ; the acknowledgement of its necessity would
scarcely precede its accomplishment.

The principal defect that requires correction is the shortness
of the term, which in most of our colleges continues only from
three and a half to four months ; this at best merely allows time
sufficient for a very elementary and imperfect course, and re-
quires so many lectures to be delivered each day, that the stu-
dent, unless previously well prepared, cannot comprehend them,
and very little time is allowed for reading and reflection, or for
the prosecution of practical anatomy.

This which we regard by far the most important and radical
defect, has been partially but imperfectly corrected by the Me-
dical College of Georgia, \whose course continues six months;
fewer lectures, (three, at most four,) are delivered each day, all
in the forenoon ; the whole afternoon may be devoted to dissec-
tion and the evenings to reading. The trustees were so im-
pressed with the imperfection and inefficiency of the plan
hitherto adopted, that they determined to make this important
innovation, and the result has proven highly gratifying to them;
for all who have had an opportunity of testing the comparative
advantages of both, have uniformly expressed the most decided

183G.] .. Medical Education. 219

preference for the prolonged over the shorter course ; indeed, it
is their general declaration, that a student can derive at least,
double the benefit from the former that he can from the latter.
This is certainly correct as respects beginners in the study of me-
dicine. But the length of the term has deterred and doubtless will
always deter many from attending the lectures of this college,
whilst others pursue the old system ; for important and obvious as
are the advantages of the prolonged term, unfortunately, alas ! for
the honor of the profession and the good of humanity, too many
students desire no more-aspire no higher than to obtain a de-
gree in as short a time, and with as little exertion as possible
content to practise the honourable and exalted profession of me-
dicine, as a mere trade, or at most to attain to an ignoble medi-
ocrity, scarcely less disgraceful than professed empiricism.
Such will always go where they can procure a diploma, the
object of their highest aspiration, most easily. Such alumni
can only reflect discredit and disgrace on their alma mater, and
therefore should not be desired by any college.

The extension of the term to six months, although a very
great- improvement upon the shorter course, is still but an ap-
proximation to the proper duration ; lectures in medical as in
other colleges, ought to be continued through the whole year,
with the exception of one or two months' vacation ; the course
should comprise many more branches than are taught in the
schools of our country ; and at least four years' attendance
should be required to render a candidate eligible to the Docto-
rate. And certain requisitions should be adopted with respect
to preparatory education. No student should be allowed to
matriculate, or to be enrolled as an eligible candidate for a de-
gree who could not stand a creditable examination on the stu-
dies prescribed.

So desirous for reformation have the faculty of the Medical
College of Georgia been, (since the first establishment of this
institution) that they suggested the idea of calling a convention
of delegates from all the colleges of the union, to devise some
general plan, and adopt a system of education, which should be
uniform throughout the United States ; to accomplish which
great and desirable object, they addressed the following circular
to all the respectable medical institutions in this country.

220 Medical Education. [Sept.

MEDICAL COLLEGE OF GEORGIA, )

May, 1835. \

To the Faculty of the Medical College of, <J-c.

" The Faculty of the Medical College of Georgia, would pre-
sent to their fellow labourers in the cause of medical science, a
subject of great importance and of common interest.

We believe it is a subject of regret universal among the offi-
cers of our medical colleges, that the terms of admission into
the profession are so easy ; that young men do now present
themselves, and with confidence, as candidates for its highest,
honors, whose want of previous education and of mental disci-
pline disqualifies them to reap the advantages which may be
offered at our various institutions ; and that all unprepared as
such are for discharging the duties of so difficult profession, and
for contributing to its improvement, custom requires they must
yet be admitted into its ranks. Although some of our schools
may be peculiarly exposed to such evils, still we believe they
are sensibly felt, and will be acknowledged by all.

Thoroughly convinced that the profession, whose respectabi-
lity it is alike our duty and inclination to advance, requires that
the medical colleges of the United States, now, take some deci-
ded action upon this subject of Medical Education, we beg leave
respectfully, to solicit your co-operation in effecting a Conven-
tion of Representatives from the medical colleges, to be held at
Washington, for the purpose of establishing an uniform system
of requisitions for the degree of Doctor of Medicine ; of regulat-
ing the courses of professional study ; the extent of previous
education ; and counselling generally about the means of ren-
dering our institutions most successful in diffusing the benefits
of Medical Education.

We do not fix upon any time for holding this proposed con-
vention ; but in our communication to the University of Penn-
sylvania have proposed May 183G. This will allow ample
time for making all necessary arrangements and for that deli-
beration which the importance of the subject demands. We
would, however, suggest that the -determination of the time,
the number of delegates from each college, &c. should be
referred to the Faculty of the University of Pennsylvania, the
oldest medical school in our country.

1836."] Medical Education. 221

Should this suggestion meet your approbation and concur-
rence, we shall ever rejoice in having contributed to a reforma-
tion, which, though it may operate peculiarly to the disadvan-
tage of our own college, will yet promote the interests of the
common cause of medical science.

We solicit an early reply to this communication, which is
respectfully submitted by the Faculty of the Medical College of
Georgia."

(Signed) L. D. FORD, Dean.

From some few of these colleges, answers favourable to the
enterprise were received, others declined co-operation, a third
portion made no reply, evincing thereby no disposition for reform.
This affords an inauspicious augury for the cause of medicine
in our country, and we are apprehensive that some time will
elapse before the desired changes are achieved. Those schools
most able to make improvements in the system of instruction
seem generally less disposed, for enjoying already the fullest
tide of prosperity, they have least to hope from innovation.

We are happy to learn by the address of Professor Wood, to
the graduates at the last commencement of the University of
Pennsylvania, that it is proposed to extend the course of lec-
tures in that institution to six months ; but this though a decided
improvement on the former, falls so far short of the proper
term, that wTe would hail it rather as a practical acknowledge-
ment of the necessity, than as an accomplishment of the required
reformation. Among all the medical schools in the land, none
is more competent to lead the way in the correction of errors
and defects than that university. We regret to find that she
is so contented with her present elevation, but hope that this
may be the earnest of better things.

A convention of delegates is the only feasible plan by which
a general reformation can be effected, and unless general, it
would militate, at least for a time, to the disadvantage of those
first undertaking it, for many students will continue to go where
they may find most easy ingress into the profession. We hope
the unsuccessful attempt of the Medical College of Georgia in
calling a convention may not deter older and more pupular
schools from making similar efforts, to effect an object so desir-
able and important to the interests of science and humanity.

222 Medical Education. [Sept

But we apprehend that insuperable difficulties and obstacles
will oppose any plan that may be devised for a general refor-
mation, and that some individual school that may be willing to
suffer temporary sacrifice, with the prospect of ulterior benefit,
must commence the enterprise.

The medical college of this state has already commenced
this reform, in the extension of her term ; she has sustained much
sacrifice, and she is determined, if others do not, to lead the way
in the correction of farther abuses and defects.

With confident reliance on the munificent spirit of the legis-
lature, of which they have already received such noble proofs,
the trustees of this institution are resolved to remit no exertion,
to spare no labour, until they establish a school of medicine on
the proper footing a school worthy of the bright day, the great
and glorious nation in which we live.

What better use, what more profitable appropriation could
be made of a portion of the surplus fund soon to be poured into
the public treasury, than the liberal endowment of such a school?
What more advantageous disposition could the legislature make
of such money, than to endow the literary and scientific institu-
tions of the state, and especially one whose object is so closely
and inseparably associated with the welfare and happiness of
the people ?

The internal physical improvement of the state is certainly
important, and worthy the attention of the statesman and the
patriot, but not more than its intellectual advancement ; and we
fondly trust our wise and virtuous legislators in their zeal for
the former, will not neglect the latter. Would they enable their
college without sacrifice, at once to make the requisite reforma-
tion in medical education, beside the incalculable blessing thus
conferred upon the people by the improvement of medicine ; by
students attracted from abroad, there would be annually brought
into the state more money than the amount required to effect
the purpose.

We have intentionally confined our remarks to the four car-
dinal defects in the present system of medical education in the
United States, viz: the want of preparatory learning as a re-
quisite to matriculation ; the paucity of branches taught ; the
shortness of each session of lectures, and of the whole period of
collegiate instruction required before graduation. The whole

183G. ) Meteorological Observations. 223

plan of our colleges is altogether defective and requires re-mo-
delling. We deem it, however, unnecessary to pursue the sub-
ject farther at present, and will conclude by pointing to the
Medical School of Paris as a model,* and referring to a " scheme
of a full course of elementary medical instruction,"* proposed
by Dr. R. Coates of Philadelphia, who'has certainly suggested
a plan as perfect as the most sanguine of his cotemporaries dare
hope to see realized.

ARTICLE VII.

Meteorological Observations for Burke and Richmond Counties.
Extracted from the Journal of a Geological Survey. By Pro-
fessor J. R. CoTTING.

JULY.

Greatest heat at 12 o'clock, - - - - 9i

Least heat at 12 o'clock, ------ 74

Mean heat of the first half of the month, - - 78 2'

Mean heat of the last half of the month, - - - 75

Mean heat of the whole month, - - - - 73 5'

Rain guage, 5 inches, 3 lines,
Cloudy days, - - - - 1

Thunder showers, - - 19
Foggy mornings, - - - 4

Prevailing winds, N. E. and S. E.

July 21. There was a slight appearance of the aurora bore-
alis, which lasted from 9 to half-past 1 1 o'clock. The corrus-
cations were seen 30 degrees above the horizon, a little east of
north ; not a cloud was visible in any part of the heavens. The
21st was the coldest day of the month.

Curve of perpetual congelation as calculated for Burke and
Richmond Counties, Georgia, 10,193 feet. At this height water
would continue frozen in our hottest days, for terrestrial heat
would not effect aerial temperature at that height.

* * The reader is referred to the second part of this number. Editoes.

244 Dr. Smith's Philosophy of Health. [Sept.

Part II. REVIEWS AND EXTRACTS.

Dr. Southwood Smith's Philosophy of Health.

Dr. Southwood Smith, Physician to the London Fever Hos-
pital, &c. published in 1835, a most valuable work on the Phi-
losophy of Health; or an exposition of the physical and mental
constitution of man, with a view to the promotion of human
longevity and happiness. We give the following interesting
extract from the British and Foreign Medical Review.

" An advanced term of life and decrepitude are commonly conceived to
be synonymous : the extension of life is vulgarly supposed to be the protrac-
tion oi the period of infirmity and suffering; that period which is charac-
terized by a progressive diminution of the power of sensation, and a conse-
quent and proportionate loss of the power of enjoyment ; the " sans teeth,
sans eyes, sans taste, sans every thing." But this is so far from being true
that it is not within the compass of human power to protract, in any sensi-
ble degree, the period of old age, properly so called, that is, the stage of
decrepitude. In this stage of existence, the physical changes that succes-
sively take place clog, day by day, the vilal machinery, until it can no longer
play. In a space of time, fixed within narrow limits, the flame of life must
then inevitably expire ; for the processes that feed it fail. But though,
when fully come, the term of old age cannot be extended, the coming of the
term may be postponed. To the preceding stage, an indefinite number of
years may be added ; and this is a fact of the deepest interest to human
nature.

" The division of human life into periods or epochs is not an arbitrary
distinction, but is founded on constitutional differences in the system, de-
pendent on different physiological conditions. The periods of infancy, child
hood, boyhood, adolescence, manhood, and old age, are distinguished from
each other by external characters, which are but the outward signs of in-
ternal states. In physiological condition, the infant differs from the child,
the child from the boy, the boy from the man, and the adult from the old
man, as much in physical strength as in mental power. There is an ap-
pointed order in which these several states succeed each other ; there is a
fixed time at which one passes into another. That order cannot be invert-
ed ; no considerable anticipation or postponement of that fixed time can be
effected. In all places, and under all circumstances, at a given time, though
not precisely at the same time in all climates and under all modes of life,
infancy passes into childhood, childhood into boyhood, boyhood into adoles-
cence, and adolescence into manhood. In the space of two years from its
birth, every infant has ceased to be an infant, and has become a child ; in
the space of six years from this period, every male child will have become
a boy ; add eight years to this term, and every boy will have become a
young man ; in eight years more, every young man will have become an
adult man ; and, in the subsequent ten years, every adult man will have ac-
quired his highest state of physical perfection. But at what period will this
state of physical perfection decline .' What is the maximum time during
which it can retain its full vigour ] Is that maximum fxed I Is there a
certain number of years in which, by an inevitable law, every adult man ne-
cessarily becomes an old man? Is precisely the same number of years ap-
pointed for this transition to every human being I Can no care add to that

1836.] Dupuytreris Clinique. 225

number? Can no imprudence take from it 1 Does the physiological con-
dition or the constitutional age of any two individuals ever advance to pre-
cisely the same number of years 1 Physically and mentally are not some
persons older at fifty than others are at seventy 1 And do not instances
occasionally occur in which an old man, who reaches even his hundredth
year, retain as great a degree of juvenility as the majority of those who at-
tain to eighty]

"If this be so, what follows ! One of the most interesting consequences
that can be presented to the human mind. The duration of the periods of
infancy, childhood, boyhood, and adolescence, is fixed by a certain number
of years. Nothing can stay, nothing retard, the succession of each. Alike
incapable of any material protraction is the period of old age. It follows
that every year by which the term' of human existence is extended is really
added to the period of mature age ; the period when the organs of the body
have attained their full growth, and put forth their full strength ; when the
physical organization has acquired its utmost perfection; when the senses,
the feelings, the emotions, the passions, the affections, are in the highest
degree acute, intense, and varied ; when the intellectual faculties, complete-
ly unfolded and developed, carry on their operations with the greatest vigor,
soundness, and continuity : in a word, when the individual is capable of
receiving and of communicating the largest amount of the highest kind of
enjoyment.

" A consideration more full of encouragement, more animating, there
cannot be. The extension of human hfe, in whatever mode and degree it
may be possible to extend it, is the protraction of that portion of it, and only
of that portion of it, in which the human being is capable of receiving and

OF COMMUNICATING THE LARGEST MEASURE OF THE NOBLEST KIND OF ENJOY-
MENT."

Extracts from the Note Book of a Physician of this City, during
his attendance on the Parisian Hospitals.

DUPUYTREN'S CLINIQUE.

Case 1 . Disease of the Spine.

Our attention is called to two cases of diseased spine, produ-
cing extensive abscesses, which have made their way to parts
remote from their origin. One of the cases presents an exten-
sive discharge of purulent matter from the upper and inner side
of each thigh, whose passage may be traced up to the crural
arch. The discharge in the second individual issues from the
part corresponding to the ischiatic notch. The man first allu-
ded to, appears to be about 35 years of age, of a good constitu-
tion, is a baker, and of course much exposed to vicissitudes of
temperature, and recollects having received about six years ago
29

226 Dupuytrerts Clinique. [Sept.

a stroke in the small of the back, which, though painful at first,
was not afterwards noticed. About three or four years ago he
felt severe pains in the lumbar region and was treated two or
three years for lumbago. Six months since he entered the Ho-
tel Dieu, with an abscess issuing from the right thigh, and after
being interrogated, acknowledged the above particulars; and a
short time after, the second opening appeared in the left thigh
exactly corresponding in situation with that in the opposite mem-
ber. His spine presents not the slightest appearance external-
ly of disease. With respect to the second case, I will only say
that gibbosities were here very manifest in the lumbar vertebrae,
as it was on this point the lecturer laid most stress, in order to
warn us not to neglect cases of long standing affections of the
spine, (which generally assume the appearance of lumbago,)
merely because we see no gibbosities, or external evidences of
internal mischief. Mr. Dupuytren's treatment in these two
cases consists of issues along the spine, and restorative drinks.

Case 2. Disease of the Spine,

This case is noticed in order that we may observe another
instance of diseased spine, presenting no local evidence of its
existence. The patient wTas some years since much troubled
with a cough, and other symptoms of phthisis pulmonalis, which
finally subsided and were followed by a symtomatic abscess
making its appearance in the lumbar region. It is known to be
symptomatic principally from having produced externally no
pain or inflammation previous to the issue of the matter. The
patient having complained of rheumatic (as he thought.) pains
in the lower dorsal region, this place was selected for the appli-
cation of issues and moxa.

Case 3. Disease of the Spine.

We have here the existence of considerable disease of the
vertebral column, without the appearance of sympathetic ab-
scesses. Here the gibbosities, pains of the affected region, and
affection of the lower extremities are the existing symptoms.
The man's occupations were such as to expose him to frequent
and sudden vicissitudes of temperature, which may explain the
cause of his rheumatism of long standing. . The affection of the
spine may perhaps be accounted for by observing, that in order
to test his strength, he was attempting to raise himself from the
floor by grasping some elevated object, when he heard or felt
a cracking of the spine, about the situation of the present gibbo-
sity. The rheumatism was translated here shortly afterwards.
There is a scton applied on each side of the lesion.

183G. I Dupuytren's Clinique. 827

Case 4. Disease of the Spine and Hydrocele.

Tiiis man, aged 63, was admitted for hydrocele. Mr. D.
however, observing that he had a severe pulmonary catarrh, de-
layed any operation until this would be removed. The patient
was bled, &c. On a succeeding visit it was perceived that he
had a great curvature of the vertebral column, causing his chest
and pelvis to be considerably approximated anteriorly. His
spine on examination shewed immense gibbosities. Mr. D. at-
tributed his pulmonary affection to the contracted space of the
chest and thinks that an operation for hydrocele would be dan-
gerous under the existing circumstances. The patient will be
sent to the " incurables."

Case 5. Empyema caused by disease of the Spine.

This female (about middle age) was admitted about three
months ago with an affection of the spine. Shortly afterwards
her breathing became affected, and gradually the dyspnoea in-
creased to such a degree that suffocation was much dreaded.
At the same time it was observed, that her chest had expanded
enormously, and that the flesh seemed to protrude between
the ribs. Percussion and auscultation indicated the absence
of air in nearly the whole cavity. Mr. Dupuytren believed
there was a sympathetic abscess, which, by increasing very lit-
tle more, would certainly render the dyspnoea so great, as to
prove fatal. This being the case, he was on the point of mak-
ing a small puncture in the intercostal space, when he perceived
a manifest pulsation of the part. He hesitated, fearing the pre-
sence of an aneurism, but the urgency of the case and the pro-
bability of these pulsations being given to pus by the proximity
of the heart, determined him to attempt the puncture. This
was of course made very small, in order to prevent the admis-
sion of air or the too sudden discharge of the matter, which
proved to be pus. Since this, a natural and small outlet has
appeared between the clavicle and first rib, so that the empyema
gradually diminished daily ; the chest has assumed its natural
aspect ; but there will remain a collapsed lung.

Case 6. Disease of the Spine and Coxalgia.

This young man's history is curious; he says that having seen
a person in a nervous attack (probably epilepsy) he was so
much alarmed that he was taken sick and carried to Bicetre.
It seems that here he was treated for mental alienation which
continued six months, during which time he was confined to the
bed by a straight jacket. Very soon after being cured and lea-
ving the institution, he began to feel pains, apparently of a rheu-

228 DupuytrerCs Clinique. [Sept*

matic nature, in the upper part of the spine and at the coxo- fe-
moral articulation. He was admitted into the Hotel Dieu with
large gibbosities of the uppermost dorsal vertebra? ; and to a
shortening of the leg was added an inability to raise it from the
bed. All motions performed by the thigh seemed to be followed
by the pelvis. This is occasioned by the great pain produced
by motion. The shortening of the limb is produced by a caries
of the cotyloid cavity or of the head of the femur. Issues are
applied to the spine and to the environs of the trochanter.

Case 7. Vicarious Menstruation,

This female's sleeve having taken fire during her sleep, pro-
duced a considerable burn of the fore and middle parts of the
arm. This happened about two years since, and to date from
that period, her menstrual evacuations have never assumed their
natural course, but the time of their appearance is always
evinced by an increase of the inflammatory symptoms of the
diseased arm, and by the abundance of the discharge therefrom
of purulent and sanguineous matter; for some months that she has
been in this hospital, every means have been used in vain to
recall the uterus to its functions. At present, leeches (4 or 5
only) are ordered to be applied to the vulva for several days
previous to the menstrual period and during its continuance ;
each application to be followed by a hip-bath. The above re-
medies for recalling the menses, though strikingly successful in
the French hospitals, completely failed in this case, and I left
the woman unrelieved after watching her case about a year.

Case 8. Wound of the Abdomen.

A boy cleaning a table knife (sharp pointed) held the handle
in one hand and supported the point against his abdomen, whilst
he applied friction to the blade. In so doing he applied too
much force to the instrument and thrust it through the abdomi-
nal parietes. The omentum projected through the wound but
fortunately the intestines were uninjured. The membrane was
re-introduccd into the cavity and the wound healed by first
intention. A few days afterwards, an abscess formed in the sub-
cutaneous tissue surrounding the cicatrix, which being punc-
tured discharged much pus, and finally healed entirely.

Case 9. Concussion, fyc. of the Brain.

This is a painter who having fallen from his ladder, was
picked up senseless and brought to the hospital. His breathing
was extremely slow and soft; his pulse soft, small, and very un-
frequent ; his pupils widely dilated and unaffected by light ; his

183C] Dupuytren' s C Unique. 229

limbs perfectly flaccid, so that when raised they would drop as
if lifeless ; words and pinches were unheeded ; in this state he
remained I believe 5 or 6 days, afler which on being pinched,
he would withdraw the limb ; some days after, the retraction
was accompanied by a groan, and he gradually recovered his
faculties, so that now he converses though somewhat incoherent-
ly, raises himself on his seat, &c. Mr. Dupuytren explained
very lucidly the difference between a " commotion" (concussion)
a " contusion," and a " compression" The symptoms of concus-
sion have already been mentioned in the above case. Those of
contusion were illustrated by a case that lately presented itself
at the Hotel Dieu. The patient was at first stunned (to use a
vulgar expression) by a fall on his head. He had all the symp-
toms of concussion at first, but they soon disappeared, and the
next day he was walking about and indulging his appetite as
though nothing had occurred to him. On the fifth day, howe-
ver, all the symptoms of a most violent inflammation of the
brain manifested themselves and in despite of all remedies pro-
duced death in 24 hours. On dissection, one half of the cerebrum
was found of the consistence of pap, as though it had been tho-
roughly crushed. The symptoms of compression are those of
apoplexy and are well known to be stertorous breathing, hard-
ness and contractedness of the pulse, paralysis of a greater or
less portion of the body, &c. &c. Mr. D. also mentioned a case
of concussion complicated with compression. This is an old
woman (say 60 years of age,) who after falling into a quarry
was brought to the Hotel Dieu in a state of insensibility, &c. as
above mentioned. The symptoms of concussion have all disap-
peared, but there still remains a paralysis of the muscles of the
right side of her face. She is otherwise perfectly well.

Case 10. Abscess of the Mamma.

About three months ago, this woman gave birth to a child,
and a few days after had an abscess in one of her breasts. This
being opened discharged much matter, and in despite of all re-
medies the formation and evacuation of pus continues. The sound
breast secretes an abundance of good milk and this none at all.
Mr. Dupuytren attributes this to a vitiated state of the secre-
tion ; that is to say, that nature having made preparations for
the secretion of a certain portion of milk, and disease having
occurred, the discharge of pus is kept up by the disposition that
otherwise would have produced a secretion of milk.

Case 11. Predisposition to Disease.

Mr. Dupuytren in alluding to the persons who underwent
operations for fistula and cataracts, called our attention to that

230 Dupuytrens CUnique. [Sept.

peculiar state of the system denominated by him " constitution
medicale" By this he means an aptitude or disposition to par-
ticular diseases at particular seasons, or under certain conditions
of the atmosphere. He remarked that about two months ago,
he operated on six patients for cataract, and that notwithstand-
ing all the usual preparatory means to prevent the supervention
of inflammation, not one of them escaped its ill effects ; whereas
two days since, the same operation was performed on four pa-
tients, who had been prepared in the same manner as the former,
and not one has the least symptom of inflammation, but all are
doing quite well. Again ; there are in the hospital two cases
of stricture of the rectum, for which the patients have been
wearing a " meche" or pledegt of lint in the rectum without expe-
riencing the least inconvenience ; whereas the two persons opera-
ted on for fistula in ano on Wednesday last, are so much irritated
by the presence of the "meche," that diarrhoea has supervened
very much to their annoyance ; and strange as it may seem,
they were no sooner taken with this looseness, than the bowels
of those just mentioned as having strictures, were also similarly
affected.

Now Mr. D. thinks these facts good evidence of the justness
of his opinion, that at certain periods the system of almost every
one is predisposed to a particular affection, and that at another
period a different disease is more easily produced. He thinks
the subject deserves investigation, and that it would be very use-
ful as a guide for the performance of operations, when the parts
concerned are most free of morbid predispositions.

Case 12. Varicose Veins.

This man has suffered with enormous varices of the saphena
for many years, and about 6 years ago Mr. D. applied a ligature
to each extremity of this vein on the right leg. The result was
favorable, but the patient now has the other leg similarly affect-
ed, and other veins of the right limb have also increased in size.
Mr. D. thinks that the disease is rather aggravated than relieved
by placing a ligature at the upper end of the limb, without pla-
cing one also at the origin of the vein. The case before us had
proceeded so far as to render it very difficult for Mr. D. to de-
cide, whether the tumour about the crural arch was formed by a
hernia or a varix. After repeated examinations, he thought of
striking on the tumour, and at the same time observing if any
motion was thereby communicated to the vein below, when
finding this to be case he concluded that there was no hernia.
He then placed a ligature at the upper and one at the lower
extremity of the vessel. It is now about a week since, and the
patient (having been duly prepared) has experienced no symp-
tom of phlebitis. The blood has already " solidified in the vein''

1836.]

Rostan on Diagnosis.

231

Rostan on Diagnosis.

The following table (alluded to in our last number,) will be found useful
in guiding our interrogation of the patient, and recording the history of his
disease. It is scarcely necessary to say, that we will seldom or never be
obliged in any one case to propose as many questions as are here suggested.

Sex, age, constitution, menstruation, health, antecedent diseases and treatment
supposed causes, parentage, invasion.

EXTERIOR HABIT OF EODY.

HuDger

digestion. < Thirst

Taste

augmented,
diminished,

perverted,

increased,
diminished,
abolished,
perverted,

bitter,

clammy, acid,
sweet, &c.
mouth drv,

form,

position,

colour,

consistence,

temperature,

sounds.

of the head,
" neck,
" chest,
bellv,
" limbs,

teeth, gums,
f volume, form,
j position, con-
tongue^ sistence,
| colour,
Lfurr.
Mastication, deglutition,
(stomachal digestion, nausea,
vomiting, matters vomited,
epigastric pain, tumours, bor-
borygmi, flatulency, dejecti-
ons, constipation, diarrhoea.

'"frequent, rare,

quick, slow.

arterial large, small.

circucation. < stony, feeble.

pulse. hard, soft.

equal, unequal,

^regular, irregular, intermittent, confused, insensible.

heart. Its shock, palpitations, sound, rythm.

VF.XOUS
CIRCULATION.

RESPIRATION^

State of the veins,

Qualities of blood drawn from veins.

frequent, unfrequent, equal, unequal,
quick, slow, easy, difficult, anxious, suffocating,
deep, small, laborious, painful,
puerile, inaudible, sonorous, noisy, &c.
C crepitating,
rale, 2 mucous, guggling,

( sibilant, dry, sonorous, &c.
laughter, yawning, hiccough,
C frequent, unfrequent,
cough, 3 easy, difficult,

( laborious, painful, humid, dry.
^expectoration, matters expectorated.

232

Rostan on Diagnosis.

[Sept.

O

H
O

o

I I

c

pel
O

CHEST.

EXHALATIONS.

SECRETIONS.

ABSORPTIONS.

NUTRITION.

SENSATIONS.

sound

C dull,
f clear.

of the skin,

of the serous membranes,

of the mucous "

partial, general,
natural, morbid,accidental
increased, diminished,
abolished, vitiated.

tears,

saliva,

bile, pancreatic juice, sperm, urine.

augmented,

diminished,

resolution of diseases,

atrophy,

hypertrophy, &c. general, partial.

sensibilitv \ eneraJ' augmented,
sensibility, ^ partial> diminished,

pain.

z
o

o
fa

n

"vision, f

audition, | augmented,
senses. ^ smell, J

j taste, ] diminished, &c.
Uouch, (._
C augmented,
intelligence 1 diminished, stupor, idiotism,
I perverted, delirium, &c.
/ somnolence,

coma, /

carus,

lethargy, dreams, night-mare, &.c.

convulsions, contraction, rigidity, cramps?

numbness,

paralysis,

tremors, &c.

SLEEP.

MOTIONS.

ORGANS
OF LOCOMOTION.

VOICE,
SPEECH.

GENITAL
FUNCTIONS.

increased,

diminishd

abolished, mute, aphony, &c.
( pectoriloquy,

perverted, 1 egophony,
^ ( metallic tinkling,

C menstruation, ( augmented,
} lochica, ( diminished, &c.

( lactation,

1836.] The Doctor. 233

The Doctor. Republished by Harper & Brothers, New-York.

The above, is the title of one of the most incongruous, absurd,
and nonsensical publications, that was ever issued from the
press. We are glad it comes from across the waters ; and our
only regret is, that it was not quashed upon reaching our shores.
The Harpers ought not to have republished it ; and we, insigni-
ficant as we are, would not now notice it, were it not that some
sage critics have pretended to see wit and humour in it, and
that we have now before us a review of the Doctor in the Sou-
thern Literary Messenger.

While on our passage from Charleston to New- York, in a
steam-packet, a few weeks ago, our attention was called to the
Doctor, by a lady passenger who had been reading it with great
apparent gout. Upon replying negatively to the question, if
we had read it, the work was kindly put into our hands. A
few moments perusal and examination of it, satisfied our com-
mon sense, and it was laid aside with distrust. Subsequently,
circumstances forced us to become the owner of this work, but
we assure the reader, it was for only a very short period, du-
ring our passage from Norfolk to A ugusta.

But to the object of this publication the Doctor. No one
has pretended positively to know what is its meaning, what is
its purpose. Neither are we better informed as to its author,
or, as some imagine, authcrs. We are rather inclined to the
opinion, that it is a hoax ; and we perfectly coincide with the
reviewer in the Literary Messenger, that its meaning is precise-
ly nothing. We must also believe one man alone wrote it,
at least we hope so and another thing, that that man wras no
Doctor! To say the author is, would be a scandal to the pro-
fession of medicine.

The Doctor professes to contain two volumes in one cover.
We have only looked over some pages of the first, and from
them, together with extracts, &c. which we have seen, have
derived our impression of the nature and character of the pub-
lication. As the Messenger has it, volume one commences
with a Prelude of Mottoes occupying two pages. Then follows
a Postscript then a Tahle of Contents of the first volume, occu-
pying eighteen pages. Volume two has a similar Prelude of
Mottoes, and Table of Contents. The whole is subdivided into
chapters ante-initial, initial and post-initial, with inter-chapters.

The pages have now and then a typographical queerity a
monogram, a scrap of grotesque music, old English, &c. To
complete this description, we must add these figures, resem-
bling triangles, pyramids, or even the Egyptian hieroglyphics ;
and the book contains the life of Dr. Daniel Dove and his horse
Nobs. At least this is its profession.
30

234 French Medical Institutions. [Sept.

Now to some, all this may be wit or humor, but to our hum-
ble conception it is neither. The book may contain something
good or useful, but we never expect to derive either from it.
Certainly we shall never attempt to read it again. We feel
persuaded that much of the attention and the sensation said to
be created by it is owing to its foreign growth. We would not
even be surprised if it has beeir gotten up for the purpose, seeing
to what extent and to what success Jonathan can be gulled by
John Bull.

Be all this as it may, we venture to say the book is a libel
the Doctor, no Doctor. We repeat, such a work ought never
to have been published, it can answer no good end.

Although this is not a professional book, we have been in-
duced to make this brief notice of it, to save our readers the
expense of purchase, and the task of perusal. P. F. E.

[From the British and Foreign Medical Review.]

Extract from a review of Mr. Lee, on the Medical Institu-
tions of the continent.

French Medical Institutions.

" A clear and good account of the Parisian hospitals is given (in pages 2
and 3) : we think, however, that it is not correctly stated that all the hos-
pitals are attended by the sarnrs de la cliarlie as nurses : this, however, is
of small importance : the question of their efficiency is more material.
Few students see the wards of foreign hospitals except during the visit of
the physicians or surgeons. In the absence of these, the general service of
some of the French hospitals is, we know, performed in a very slovenly
manner. We have been surprised to see the house-pupils performing all
the minor operations, including venesection, unattended by any nurse, even
in the women's wards ; and in case a patient fainted, it was sometimes ne-
cessary to summon the aid of the man who was polishing the floor by rub-
bing a cloth over it with his foot. Not a sccur de chante was then to be
seen. Neither did it appear to us that these sisters were remarkable for
the gentleness of their manners. We made these observations with regret,
and in opposition to all our previous impressions ; and the conclusion to
which we came was, that ordinary nurses, with all their defects, were more
efficient hospital attendants, such offices "pour l'amour de Dieu" being
little better than certain tonsorial services recorded among authentic face-
tiae as performed for a like consideration.

The following is the prescribed course of study for those who take the
diploma of Doctor in medicine or surgery in Paris :

2d

ditto.

3d

ditto.

4th

ditto.

5th

ditto,

6th

ditto.

7th

ditto.

8th

ditto.

183G.] French Medical Institutions. 235

" Candidates for the diploma of Doctor in Medicine or Surgery, are re-
quired to have studied four years, during which period they have to take
out an inscription every three months for attendance on the lectures and
hospitals. Members of foreign colleges and universities may, however,
present themselves for examination after two years' study in Paris. The
scholar year begins on the 1st of November, and terminates on the 31st of
August. The expense of the course of study required for taking a degree
does not exceed a thousand francs (40.)

" The following is the prescribed order of study :

1st half year. Anatomy, Physiology, Chemistry.

Medical" Physics, Hygiene, Medical Natural History.

Anatomy, Physiology, Operative Surgery.

Hygiene, Medical Pathology, Pharmacy.

Operative Surgery, Medical and Surgical Pathology.

Clinical Medicine, Clinical Surgery, Materia Medica.

Clinical Medicine, Clinical Surgery, Medical Pathology.

Medical Jurisprudence, Therapeutics, Obstetricity.

" The examinations for the diploma are five in number. The first takes
place after the fourth inscription has been taken out ; the second after the
twelfth inscription ; the three remaining examinations take place at the
termination of the course of study,

" The subjects of the first examination are, natural history, physics, me-
dical chemistry, pharmacology ; 2d, anatomy and physiology ; 3d, general
pathology, medical and surgical pathology ; 4th, medical jurisprudence, hy-
giene, materia medica, and therapeutics ; 5th, clinical medicine and surgery,
operative surgery, obstetricity.

" Each examination lasts two hours, during which four candidates are
questioned by three examiners.

* For the anatomical examination the candidate is required to make a
preparation from a part of the body, which is indicated to him on the same
morning, and to answer questions proposed to him relative to the prepara-
tion. Candidates have also to write and defend a thesis on some point re-
lative to medicine or surgery. The clinical examinations take place in the
clinical hospital at the bedside of patients. The examination fees amount
to one hundred and fifty francs."

The examinations, we may add, are public, and searching and efficient,
but conducted with politeness.

In France the profession is divided into physicians, surgeons, and a low-
er rank of practitioners called officers of health (officiers de sante,) the
practice of the latter being nominally restricted to cases of minor importance:
we say nominally, for the restriction is plainly impracticable. Midwifery
is chiefly in the hands of women, and although they are regularly educated,
we think that a suspicion expressed by Mr. Lee, that this circumstance has
some connexion with the great frequency of uterine diseases in France, is
not quite unfounded. There are lying-in charities in our own country, in
which from a spurious delicacy, women only are employed as midwives,
and we have seen much of the bad effects of this regulation : it is however
to be considered, that our English midwives are uneducated persons.
" Apothecaries," says Mr. Lee, " are not allowed to prescribe, their busi-
ness being confined to the selling of drugs, and the preparation of prescrip-
tions, as with cliemists and druggists in England :" who, it may be added,
do not so confine themselves at all, but practise very extensively.

" Mr. Lee's account of the state of msdical practice in France is succinct
and interesting : it is evident that French physicians are becoming less go-
verned by theory, and more guided by symptoms : or, in other words, that
the practice among them is becoming more rational. Since the publication
of the opinions of M. Broussais, bleeding has been more boldly resorted to ;
but the French seem negligent of following up bleeding by medicines calcu-
lated to amend the secretions, or even to remove vitiated accumulations ;

286 French Medical Institutions. [Sept.

the consequence of which is that symptoms arise which appear to call for a
repetition of the bleeding, and patients are sometimes bled and starved to
death. We believe this even not to be very unfrequent in fever cases, and
Mr. Lee gives a striking case of typhus in illustration of it. M. Louis and
M. Andral should be mentioned, however, and are so, by Mr. Lee, as excep-
tions to this practice ; both of them employ saline purgatives and other me-
dicines in such cases. The more frequent and varied employment of baths
in chronic diseases appears to be advantageous in French practice, and is,
we think, beginning to be attended to in this country. Mr. Lee very pro-
perly thinks that " the practice of abstracting blood and applying irritants
at a considerable distance from the seat of the disease, on the principle of
revulsion, might be more frequently adopted with advantage in England,
especially in affections connected with cerebral irritation or congestion."
A small bleeding from the ancle, a few leeches applied to the thighs or arms,
especially to the latter, blisters to the legs, sinapisms to the feet, &c. arc
often singularly useful ; and it is certainly to be regretted that English
practitioners are often so inclined to condemn measures of this kind as tri-
lling ; we mean, of course, only in chronic cases.

" In the treatment of burns and scalds, stimulating applications are less
used on the continent than in England : bleeding, opium, cataplasms, or
emollient dressings, being the usual means employed. Whatever is the
seat of the injury, the application of ice to the head for an hour or two is
strongly recommended ; its effect being to cause a cessation of pain, and to
prevent cerebral symptoms.

" Under the head of each Parisian hospital, a concise account is given of
the practice of the medical officers, and this is illustrated by occasional ca-
ses. We can only find space for a few brief extracts from this interesting
part of the work.

"The hospital La Pitie has the advantage of the services of some of the
greatest men in Paris, MM. Louis and Andral being the physicians ; and
MM. Lisfranc and Blandin the surgeons. M. Lisfranc is well known to
English students for the boldness and dexterity of his practice, especially in
cases of diseased uterus."

" M. Lisfranc has charge of two men's and a women's ward, most of the
cases of the latter being marked as disease of the uterus ; many of these
patients are, however, young women affected with superficial erosion of the
cervix uteri, and are cured by a few days' rest and appropriate treatment ;
the means resorted to in these cases, as well as in ulceration of this part,
being chiefly confinement to the recumbent position, occasional venesection
to three or four ounces, on the principle of revulsion, small doses of cicuta,
and cauterization with a solution of mercury in nitric acid every six or eight
days : when the ulceration is of a cancerous nature and too deep to be re-
moved by cauterization, M. Lisfranc has recourse to excision of the cervix
Uteri ; this part being exposed by the speculum, and firmly seized by pimces
d, musmux, is brought down beyond the orifice of the vagina and excised
with a knife, as in cases of polypus. M. Lisfranc has met with more than
four or live cases of dangerous hemorrhage after this operation, the symp-
toms which supervene being mostly of a nervous character and sometimes
alarming, but mostly yield (yielding) to sedatives. Of ninety-nine cases in
Which he operated, eighty-four recovered ; many of these patients became
subsequently pregnant, and experienced no particular inconvenience in
parturition."

f Mr. Lee adds, whal few will doubt, that the operation has been perform-
ed in many cases in which it might have been avoided. M. Lisfranc treats
phlebitis (supervening on venesection) by emollient fomentations and cata-
plasms on the inflamed pari, with the repealed application of leeches be-
tween the point where the inflammation terminates and the heart ; and he
states, that since he adopted this practice, he lias not lost a single patient
from this disease; whereas when he employed other incans, and applied

1836.] Dr. Coated Scheme of Elementary Instruction, 237

leeches near the wound or over the inflamed vein, the majority of cases ter-
minated unfavorablv.

H MM. Alibert and Biet, the physicians to the hospital of St. Louis, are
also well known to English practitioners ; the first by a splendid publication
on diseases of the skin, the second by his enlightened practice in cutaneous
scrofulous, and malignant affections. The opinions of M. Biet on the use
of Baths in cutaneous diseases may be useful to the English reader."

" Simple tepid baths are most beneficial in the dry scaly forms, though
only as an accessory means ; their efficacy is less marked in the pustular
varieties : they are serviceable in vesicular affections when the inflamma-
tion begins to" decrease, and may be used with advantage in impetiginous
affections where incrustations have succeeded to the pustules.

"Alkaline baths are efficacious in the" papular and dry scaly forms, and
in the impetiginous and tubercular varieties. An alkaline bath may be
formed by dissolving in a simple bath from half a pound to a pound of car-
bonate of soda.

" Sulphur baths are most useful in the decline of vesicular affections ;
they are less useful than alkaline baths in the chronic stage of psora, and
if used in the inflammatory stage the symptoms are aggravated. Sulphu-
rous baths are composed of two ounces of diluted sulphuric acid and eight
ounces of hydro-sulphuret of potass added to each bath.

" Acid baths may be made by adding to each from four to eight ounces
of hydro-chloric acid ; they are mostly applicable in dry scaly eruptions."

" In the account of the Hopital des Enfans Malades, we perceive that
the mortality among the unfortunate children is stated to be one in four,
which we believe to be rather under than over the truth. According to
our own painful observation, this horrible mortality is to be ascribed, in a
great measure, to the expectant system of medicine ; to starvation, and
gum water, conjoined with the too free use of leeches.

" M. Civiale, whose name is familiar to us in connexion with lithotrity,
has a small ward in the Necker hospital, and the following is mentioned in
the account of his practice."

" Paralysis of the bladder, and vesical catarrh, in elderly people, are trea-
ted in the following manner : a stream of cold water flows from a reser-
voir fixed near the ceiling, through an elastic gum tube, having stop-cocks,
and terminating in a silver catheter formed into a double tube by a central
partition. The patient being in the recumbent position and the catheter
introduced, the water passes into the bladder by one side and out by the
other. A continued stream of water through the bladder is thus kept up
for about ten minutes, and repeated every second or third day : the quanti-
ty of water passing into the bladder may be regulated by the stop-cock, so
as to prevent undue distention. The beneficial effects of the method are
attributed to the clearing away of the accumulated mucus, and to the tonic
action of the cold water upon the bladder."

Sclieme of a full Course of Elementary Medical Instruction. By D. Ret.
nell Coates, M. D. of Philadelphia.

The following outline of the natural classification of the principal branch-
es of Medicine which should be taught in Collegiate and Subsidiary Schools,

238 Dr. Coated Scheme of Elementary Instruction. [Sept.

arranged according to their mutual dependence, and proper order of suc-
cession, is here given at the request of a few scientific friends. The scheme
is not founded upon the existing systems of this, or any other country, but
upon an analysis of the great divisions of the Science, and its collateral ra-
mifications.

COLLEGIATE STUDIES.

I. Natural History of Man in Health.

PhGStry' \ Two sll0rt Courses' " " " -One Professor.
These branches relate to the agents which act upon the living body ac-
cording to mechanical laws, and should be taught with special reference to
medicine. As a very large majority of students of medicine commence
their studies in this country while extremely ignorant of these subjects,
they cannot be regarded as part of their previous education, but must be
taught in the collegiate schools.

SpTckf An" tomy!' \ ne shor^ and 0ne lon2 Course' ne Professor.

Under the first of these heads should be included such a view of Compa-
rative Anatomy as is necessary for the student of the elements of medicine.

II. Science of Healthy Vital Operations.

Physiology. One great Course, - -- - One Professor.

III. Natural History of Disease, and Science of Diseased Action.

g^of fcttK^e.. \ e ^ <*u*e, - One Professor.

Pathological Anatomv, and J nna , n r* -n t

r> ,i i rr , i tv > Une long Course, . One Professor.

Pathology of External Diseases. $ fe ' .

It may be remarked that it is difficult to separate Pathological Anatomy
from Special Pathology, as is done in some European schools. We think
the effect of such a division injurious, if not unnatural.

IV. Natural History of Remedial Agents.

Materia Medica, One long Course, - One Professor.

V. Art of Healing.

Therapeutics of Internal Diseases. One long Course, One Professor.

Clinics of Internal Diseases. One long Course, - - One Professor.
Therapeutics of External Diseases. }
Surgical Anatomy and Operative >Two Courses, - One Professor.

Surgery. )

The two or rather the three last brandies arc properly thus arranged ;
because Surgical Anatomy cannot be properly detached from Operative
Surgery, unless mad.' a distinct, professorship, for which it is too limited.
Operative Surgery is obviously a Therapeutic branch, and the .Materia
Chirurgica cannoi be separated from Surgical Therapeutics and the Surgi-
cal Clinic ; it is therefore left for tacit division between them.

Clinics of Exlerna! I) One Professor.

Obstetrics, }

Diseases of Women and >T\vo Courses, - - One Professor.

Children within the year. )

I83G. | Dr. Coalcs' Schema of Elementary Instruction. 239

VI. Art of Preserving Health.

Hygiene. One short Course.

This branch scarcely deserves a separate professorship in tins country,
and may be associated with Medical Jurisprudence and Police, with which
public Hygiene is closely associated.

VII. Medico-Legal Relations.

Medical Jurisprudence, > Q Q _ . Q Professor,

Medical Police and Health Laws. C '

Number of Branches 17. - - Number of Professors 12.

Such an arrangement, we think, covers the ground of a good Collegiate
School, ami no more. If compelled to contract the list of branches, we
could part with none but Hygiene. If compelled to lessen the number of
Professors, we could only effect our purpose by associating the duties of the
Clinical chairs with those of the Therapeutical chairs ; by which means the
number would be reduced to ten, at the expense of imposing four heavy and
scarcely compatible tasks on two individuals, with the additional disadvan-
tage of being compelled to choose our teachers of the two most important
theoretical branches, from the slender list of Hospital Practitioners, whose
habits and engagements often render them incapable of executing such du-
ties. Moreover this contraction of the scheme would tend powerfully to
destroy the independence of opinion which should always characterize the
medical student.

The proper object of a Collegiate course is the inculcation of correct ele-
mentary medical knowledge, such as is necessary for every young practi-
tioner; but there are many other subjects of public medical instruction,
which are necessary or highly desirable for medical men in peculiar situa-
tions, and for persons prosecuting particular researches. These subjects
should be taught in Subsidiary and collateral schools. Some of the most
important of these are as follows :

Practical Anatomy. Subsidiary to the Anatomical, Physiological, and
Surgical Chairs.

Pharmacy, Pharmaceutic Chemistry, Chemical Manipulations, and Botany.
Subsidiary to the Materia Medica, and referable to the College of Phar-
macy.

Comparative Anatomy. Referable to the Academy of Natural Sciences.

Diseases of Children. Diseases of the Chest. Extensions of the Medi-
cal branches, and referable to the Clinical schools.

Diseases of the Eye and Ear. Diseases of the Skin. Orthomorphic Treat-
ment. Minor Duties of Surgery. Extensions of the Surgical branches,
and referable to the Clinical schools.

Transcendental Anatomy and Physiology. Medical Etiquette, and Medi-
cal Ethics. History of Medicine, and ^Medical Biography. Referable to
Private Lectures, under the patronage of the College of Physicians.

2 10 The Western Medical Reformer. [Sept.

The Western Medical Reformer.

Our printers placed in our hands the other day a printed pa-
per of eight leaves, purporting to be The Western Medical
Reformer called also by the editors A Monthly Journal of
Medical and Chirurgical Science. (!!!) This paper printed at
Worthington, Ohio, last July, and being the 7th number, ap-
pears to have commenced its career under the auspices of this
bissextile an ominous season truly. It is a year in which the
odd hours of the four last are manufactured into a new day, and
adopted on the last end of February ; and which makes the
year 1836. Now it has been generally understood, that a year
contained 365 mean solar days : and certainly it is true ; but
this peculiar time gives it of course 366 days.

Years of this curious kind have been observed before ; and
have been supposed to posses peculiar virtues, in the way of
reversing the common order of things. Some have believed
that waters have on those occasions reversed the laws of gra-
vitation and run up-stream, particularly about Whitsuntide.
Others say that Caesar made it by appointing that the 24th of
February should be twice numbered ; and thus was formed an
intercalary day, corresponding with the sixth of the calends of
March, long celebrated by the Romans on account of the ex-
pulsion of Tarquin. Others believe that it leaps over one day
in the week, so as to not alter the day of the week from that of
the month, as in other years. Others again have thought that
Venus sallied forth, wresting from its rightful owner the bow
and quiver, and claiming them for her own, dispenses the mis-
siles of love to Cupid's own heart, now made vulnerable to her
attacks by the wonderful agency of that which reversed the natu-
ral order of things. An easy transition from this, of only half a
step, has enabled young maids, by virtue of a superior elective
affinity which this year dispenses to them, of power to overrule
all prior affinities in exercise between bachelors and their books,
business, or fair ones, to become successful suitors for matri-
mony ; and old matrons, the menstrua for dissolving together
the heterogeneous elements of the two sexes into one homoge-
neous compound.

When we contemplate the wonders of leap year, in presiding
over the expulsion of the Tarquin family from Rome, to whom
she was so much indebted for her splendor, magnificence and
power ; and when we behold its wonder-working transposition of
the natural order of things rendering the weak strong, and the
strong weak, &c. we think we arc brought by the very easy
gradation of another half step to sec why some men beyond the
alleghany have been inspired to embark in the wonderful enter-

1S36.] The Western Medical Reformer. 241

prise of overturning all science. Why medical science has
sprung up on the impregnable basis of nature's truth risen
through seas of primeval simplicity, stupidity, presumption and
knavery, and stands like the Andes, in the midst of mighty wa-
ters, and crowned like these, with undissolving honors. And
do we see on the sea beaten granite of its wide base the vermin of
equivocal generation erecting their mucous domicils in the recess
of the surges which try the strength of foundations, and calling
them truths? Or do we behold the vampires of knavery, seek-
ing the treasure and the blood of the weak and unwary?

Now these men surely believe in their simplicity ; or pretend
in their knavery ; that stupidity will become philosophy and
philosophy will become stupidity that falsehood will become
truth, and truth become falsehood that sin will become righte-
ousness, and righteousness become sin, by the wonderful trans-
muting virtues of leap year ! They have herded themselves
under the wing of the literary institution of Worthington, (whose
trustees should have had more sense.) and tell us that medical
degrees will be conferred on the judgment of men wrho deny the
Jirst and all principles of science ; and not only so, but men who
either in their simplicity or knavery, prop up falsehood ruin-
ous falsehood, at the expense of all truth and humanity.

The first part of this redoubtable " Western Medical Reform-
er" is expended in telling us what Dr. Morrow told a committee
of students, he liked, and what he disliked ; and of course, the
same of his college* owning that the same medicines mainly
are used, but denying deriving their notions from the steamers.
Then we are furnished with a bird's eye view, condensed from
matter enough of the same kind, to make an octavo of 800 pa-
ges, of his reasons for differing from the old school.

We cannot spare room for quotations of such stuff, as only
tends to prove that the man knows nothing of the " old school,"
as he pleases to call scientific physicians ; but one short speci-
men taken from the beginning of a paragraph which strikes the
eye without selection, as we look from the pen, wTe beg indul-
gence of the reader for giving. After condemning all minerals,
he says :

" It is well known that the various preparations of mercury,
arsenic, antimony, iron, bismuth, &c. are regarded as the Samp-
sons of the materia medica of modern fashionable practice ; not-
withstanding the operations of these agents are evidently injuri-
ous to health and life." &c.

* A "committe of students, it appears, entertained a suspicion, and not
without much reason, that this "reformed college", were a mess of the
disciples of Thomson and Howard, and questioned the principal (whom we
suppose Dr. Morrow to be, as he appears to return the answer) on the
point.

31

242 The Western Medical Reformer. [Sept.

When thought gets to the boundary of knowledge, it requires
some energizing influence to arouse it to step beyond this terra
firma, into the next territory which is the terra incognita. In
all our perambulations in aetiology, we have found but two ac-
tive powers sufficiently potent for this purpose. One of these
is an ignorance, too profound to know that it is necessary to
look, before leaping. Another is a knavery which would em-
bezzle the very liv'ng, by entombing the mental energies of the
weak though honest.

There is a truism contained in the expression,

What can we reason from, but what we know V* .

which is a key admirably suited to the purpose of unlocking the
casement of a man of letters, and shewing the interior ; whether
the casement be an A. JVJ., or D. D.; or an L. L. D. or M. D.
With this key in hand we need, so long as truth is truth, and sci-
ence is science, no more help to know a little more of some
men, than they know of themselves; and determine pretty pre-
cisely their differential attitude, than only to see them publish
their views on some of the common place topics. We see at
once the overwhelming of Nubian sands, or the ingulfing of the
dark deep waters. And as effects prove cause, our conclusion
is unavoidable, that these arise from one of the two only com-
petent active powers ; for in reasoning from effect to cause we
can only reason from "what we know."

We should not have noticed so far, this miserable production,
but for observing a full page spent in lauding lobelia inflata as a
medicine of such virtues, as are calculated to call it into hourly
use. We know but few things of practical importance about
lobelia ; but we do know amongst these few things that long
since, physicians who have both knowledge, and feelings of hu-
manity, have laid it aside on account of its uncertainty, and its
dangerous power, to which they have resorted only under very
peculiar circumstances. Our chief practical knowledge of its
powers which have compelled regular practitioners to deprecate
its use, has been derived from observations on numerous cases
to which we have in these latter years been palled, for the pur-
pose of endeavouring to remedy its peculiarly ruinous effects on
the digestive and nutritive powers, and on the general constitu-
tion. These lead us to mourn over the manslaughtering use of
it which has become so common, whenever we reflect, as we
often do, on the scene of misery and ruin which we have seen
entailed on the bereaved husband, the disconsolate widow, the
orphan child, and the last hope of the parent.

This is no new article in the materia medica ; but a stupidi-
ty and hard heartcdncss which can kill yes, kill, often in twen-
ty minutes, any and all orders of mankind, and continue the
practice for years, and not be able to see, mourn over, and/07*-

1836.] The United States Medical and Surgical Journal. 243

sake the ruinous course, is a novelty in the profession which
has been reserved for the Thomsonians and the " reformers."

Lobeliv stands before the profession chiefly a beacon to tell
where danger lies. Its name is looked on by those who really
hnow its powers, almost as the poisonous atmosphere of the
Upas to be avoided ; or, if approached at all, with the greatest
circumspection.

The United States Medical and Surgical Journal.

The number of this work- for June 1836, is before us. Hi-
therto we have not been so fortunate as to have seen the United
States Medical and Surgical Journal.

We have experienced no small degree of surprise on seeing
this periodical not from what we would call positive faults,
but negatives. Before we saw it, we measured it in all res-
pects by the mighty state and city from which *it emanates.
We had often contemplated with pleasure the beautiful medi-
cal organization of the whole state of New- York, by county
and state societies ; and when we beheld the professional zeal,
and excellent police, concentrate their rich and abundant me-
dical commodities into one point the great state society, which
would provide means for dispensing the same to the medical
world.

We would not be uncharitable towards the constituents of
that great medical community, and we will cherish the hope,
that still some plan is in way of maturation, whereby the trea-
sures of medical observation, experience, and mental research,
which that extensive, enlightened, and well organized medical
community must possess, shall cease to be lost to the world.

But men are apt to form opinions, by the facts before ihem:
and should we judge by the specimen of the United States Me-
dical and Surgical Journal, which is before us, a small month-
ly (we suppose, for we are not told) of about forty pages, filled
with valuable matter surely but all foreign; and without hav-
ing attached to it the professional responsibility of any particu-
lar man or set of men, but said to be conducted by " a number
of respectable physicians," and left to a publishing agent, we

244 On the Chemical condition of the Saliva, eye. [Sept.

should be led to fear that the eye of the medical police of New-
York has been directed mainly to the cash income, instead of
medical science. We will hope that a new effort will be made,
that the societies will carry into effect the great purposes of
their organization, and set" a system in operation which shall
pour at once into the lap of responsible professional ed:tors,
their valuable matter; and that the United States Medical and
Surgical Journal, may soon appear before the world swelled
and enriched by an abundant store of medical valuables.

On the Chemical condition of the Saliva, as an indication of the
different murbid affections of the Stomach.

No one thing in the practice of medicine, or in the philosophy
of pathology can be of more vital importance than diagnosis.

The introduction of the physical signs of auscultation and per-
cussion is justly hailed in Europe, England and America, as a
brilliant era in medicine. We hail with joy of the same kind
the recent introduction of chemical evidences in aid of this im-
portant branch of pathology. Indeed if we contemplate the
practical utility of the diagnosis which we are about to notice,
should it be well confirmed by future experience, (which we
honestly believe will be the case.) we may look on M. Donne
as having bestowed on the science, a greater benificence than
Avenbrugger or Laennec. We say a " greater beneficence,"
not only because the diagnosis is m febrile the most extensive
class of diseases, which spares no country, and by which the
great sum of mortality is mainly marked annually; but also be-
cause this diagnosis is available for good. We would not
depreciate the value of auscultation, or percussion. The clear-
ness and accuracy to which they lead are in wortli beyond cal-
culation. But how often does it happen that the diagnosis to
which these lead, cannot furnish us with any new remedial
means, or only enables us to make more accurate prognostica-
tions, or withhold many useless doses ! It is available for good
in more ways than one. It places at once the practitioner in
the true road to success in a disease generally curable ; and
wherein the ill success has been chiefly attributable to errone-
ous views of the nature and seat of the disease, or the patho-
logical condition.

1835.] On the Chemical condition of the Saliva, $c. 245

Such is in our estimation the deep interest attached to every
effort for the improvement of diagnosis, and such the novelty of
the subject of the following, that we cannot withhold from our
readers any part of the notice of M. Donne's experience in the
testing of saliva for diagnosis.

[From the Mcdicc-Chirurgical Review.]

M. Donne is well known in Paris as one of the most zealous and intel-
ligent vouno- physicians there. For several years he was clinical clerk to
M. Louis, as our readers may have learned from the foreign Periscope of
our Number for July last ; and subsequently he attached himself very en-
thusiastically to the service of M. Bouillaud" in the wards of the great H6-
pital La Charite.

" The pages of the Journal Hebdomadaire for the last three years attest
his great activity as a diligent and enlightened observer of disease. For
some time past he has been engaged in collecting materials for a work on
the Chemical Properties of the Animal Fluids in Health, and also during
the progress of various morbid affections.

One branch of the subject appertains to the investigation of the changes
which the saliva undergoes in disease, and more especially in that form of
it, which has been of late years far too indiscriminately designated gastro-
enteritis. Although a devoted disciple and admirer of M. Bouillaud, (who
is generally considered as one of the most ardent and able followers of the
physiological or Broussaian doctrine,) he candidly admits that a multitude
of stomach affections, differing greatly in their characters, and requiring
verv different m -des of treatment, have been most erroneously grouped to-
gether under this very much abused epithet. Numerous are the cases,
where patients have been tortured with the long continued but ineffectual
use of antiphlogistics and refrigerants, and where a few doses of emetics
and purgatives' subsequently have dissipated all distress in the course of a
dav or two. The diagnostic symptoms between the genuine " gastro-en-
terite," and mere embarrass gastrique," hitherto pointed out by medical
writers, are indeed, it must be confessed, often unsatisfactory and even de-
lusive and it has been owing in a great measure to this very uncertainty,
that the exclusive doctrines first promulgated by Broussais have been car-
ried to so extravagant a pitch by one party, and condemned so indiscrimi-
nately bv another.

" It is with the hope of dispelling part at least of this uncertainty, that
M. Donne has ingeniously proposed the chemical state of the saliva as the
means to determine the real character of various stomachic diseases.

"He premises his remarks by alluding to those excellent observations of
M. Andral, wherein he states "that no relation can be established between
the existence of nausea and vomiting, occurring during the progress of fe-
vers, and any lesion of the stomach appreciable on dissection ; for, on the
one hand, these symptoms have been often absent, when the stomach has
been found le plus rouge et le. plus gravement affecte ;' and on the other
hand, when they have been present, often no morbid change of the viscus
is discoverable after death. The mere existence therefore of these symp-
toms in fevers is no proof of even irritation, far less of decided inflammation
of the stomach.

" Unless the vomiting be accompanied with epigastric pain, redness of
the tongue and thirst, we have no good reason to predicate the existence of
gastritis. What M. Andral says of the state of the stomach in continued
fevers is equally applicable to many other cases of less serious importance,
where the physician is not a little perplexed to determine whether there
exists a mere" "embarrass gastrique" (in the language of Stoll "saburrcs

2i6 On the Chemical condition of the Salica, <<c. [Sept.

gastriqucs") or a decidedly irrirafive or inflammatory condition of the sto-
mach. In alluding to the treatment he adds : " unfortunately there must
always remain some uncertainty as to the actual morbid state of the sto-
mach in those cases, where the symptoms have been relieved by the use of
emetics and purgatives : and to add to the difficulty the symptoms which
have been supposed to indicate the use of such remedies, are by no means
uniform and constant." The object of M. Donne's Essay is to endeavour
to remove some of the difficulties, which environ this interesting department
of Semeiology, and to point out a method by which the physician may be
enabled to ascertain the various "modifications morbides," in which the
employment of emetics is or is not appropriate : and first with respect to
the inflammatory irritation of the stomach, he directs our attention to a
system hitherto unnoticed by medic al men, and derivable from the chemical
state of the saliva. Before alluding to the pathological modifications of this
fluid, it may be useful to glance at the opinions of different authors as to
its chemical properties in a state of health.

" M. Magendie regards the saliva as being sometimes acid, sometimes
neutral, and sometimes strongly alkaline : when the stomach is empty it is
usually acid ; during mastication it is alkaline, the acidity disappearing
sometimes "des la premiere bouchee d'alimens." (A tolerably fair speci-
men of the vagueness of this physiologist's assertions.)

" According to MM. Tiedemann and Gmelin, the saliva and the mucus of
of the oesophagus are alkaline in all cases, not only in man, but in every
other animal, which they have examined.

" M. Donne's experiments have led him to the same conclusion. He
has found that the saliva is constantly alkaline before, as well as during ta-
king food, and also during digestion, provided the stomach is in a healthy
condition. He assumes it therefore as a position beyond all doubt that the
normal state of the saliva is decidedly alkaline. Any one may readily sa-
tisfy himself of its truth by merely moistening with the saliva a slip of litmus
paper which has been reddened by a weak acid : the blue colour of the dye
is quickly restored. The saline contents are chiefly lactate and muriate of
soda, and muriate of ammonia.

" It is quite true that the saliva will be found not unfrcquently to be acid;
but this change of chemical property is always coincident, according to our
author's experience, with a morbid state of the stomach ; and it is on this
very change of character that M. Donne founds the diagnosis of several dis-
eases of this organ. He repeats the assertion, that he has never met with
a single instance of the saliva being acid, when the functions of the stomach
were healthily performed ; and he assures us that whenever it is so, he has
always found it to be characteristic of irritation or inflammation of the mu-
cous coat.

" Hitherto there have been only two methods by which the existence of
such a morbid state in doubtful cases has been deducible ; viz. either by
attention to the effects of the remedies, antiphlogistics or tonics, refrige-
rants or irritants, sedatives or evacuants, which may have been adminis-
tered ; or secondly by post mortem examinations. If the axiom "naturam
morborum ostendit curatio'' be not always rigidly true, it must be admitted
that its principle has guided, and still guides many excellent physicians, and
serves as a basis for most of the reasonings which we daily make in appre-
ciating the value of different therapeutic means. We are willing to admit
that it is an essentially empirical and often a misleading guide ; but we are
not to reject its assistance merely from the abuses which some have made
of it. Medicine is in an especial degree a science of minute observation ;
and our observations to be practically useful are not to be confined to one
pet of phenomena to the exclusion of any other. Morbid anatomy acquaints
us with one set ; semeiology, or the study of symptoms, teaches us another ;
and therapeia or the doctrine of the action of remedies furnishes us with a
third.

1830. 1 On the Chemical condition of the Saliva, <>c. 217

"The chemical examination of the secretions during life belongs to the
second of these great branches of medical science. Hitherto it has been
too much neglected ; for, with the exception of urinary complaints, there id
scarcely a class of diseases, in which its assistance has ever been invoked.

" Without further details, we shall now narrate briefly a few cases which
will illustrate the good effects of attending to the chemical properties of the
saliva in disease.

" It may be necessary to state, that the only testing means, which M.
Donne recommends, is the use of slips of litmus paper, such as are gene-
rally employed in examining the urine. Some of them are to be reddened
by immersion in a weak acid, to serve as tests of alkalinity.

" The saliva of a man, labouring under intense bronchitis, was uniformly
found to be acid. On dissection, the mucous membrane of the stomach
was found " pointillee et ramollie" in some points, and red and highly in-
jected in others.

" A young woman, when admitted into La Charite Hopital, was labour-
ing under a severe attack of bronchitis, attended with great tenderness of
the abdomen, excessive irritability of the stomach, diarrhoea, ardent thirst,
&c. The saliva was strongly acid.

" The disease assumed in its progress a marked typhoid character, the
tongue was parched and coated with a brown crust ; the abdomen was al-
ways very tender ; delirium and coma supervened, and the patient died on
the 10th day after admission. The saliva was acid during the whole course
of the illness.

" Dissection. The mucous coat of tfys duodenum and jejunum was highly
injected ; the intestinal follicles were enlarged, and many of them ulcerated.
The stomach exhibited "une injection pointillee" in its large extremity, and
its mucous coat was soft and easily lacerable in several places : in other
piaces it was very vascular, and of a dark colour.

" A young man was received into the La Charite Hopital as a fever pa-
tient. All the symptoms of ataxic fever soon developed themselves. The
saliva during the first days was only slightly acid ; but later it became more
strongly so. He died comatose. The saliva remained acid to the end.

" Dissection. The mucous coat of the stomach was healthy in four-fifths
of its extent ; its large extremity, however, exhibited " une rougeur poin-
tillee avec ramollissement pulpeuse de cette membrane."

" In a patient who died of severe pneumonia, complicated with great irri-
tability of the stomach and with diarrhoea, the saliva had been found to be
unusually acid, so that it reddened the litmus paper " comme le ferait du
vinaigre." Besides serious lesions of the thoracic viscera, the inner sur-
face of the stomach presented in different places a state of high injection, of
partial softening, and of complete disorganization of the mucous tissue.

" The preceding cases are intended to illustrate the coincidence between
a permanently acid state of the saliva and the existence of inflammatory
irritation of the stomach, as ascertained by dissection. We shall now de-
tail somecases, where the saliva was acid at first, but gradually lost its
acidity and recovered its alkaline properties, as the patients were restored
to health.

" A young man was received into the hospital as a fever patient. The
symptoms were not serious : there was a yellow hue of the skin ; the epi-
gastrium was rather tender on pressure ; there were however, neither vo-
miting nor diarrhoea present ; the tongue was white, and the saliva was
alkaline. During the progress of the case the saliva became acid, conti-
nued to be so for three days, then became neutral, and as the patient reco-
vered, gradually assumed its alkalinity.

" A student of medicine, who had been but scantily fed for several months
was seized with shivering, pains in the loins, loss of appetite, &c. The epi-
gastrium was tender on pressure ; the tongue was covered with a thick
white coating ; the saliva was strongly acid. As the feverish symptoms

248 On the Chemical condition of the Saliva, <J-c. [Sept.

subsided, the saliva became neutral, and during convalescence, it recovered
its alkaline properties.

" A young woman Was attacked with the symptoms of gastro-enteritis.
The saliva was decidedly acid. Antiphlogistic remedies were used with
happy effects, and the saliva gradually showed itself less and Jess acid, un-
til it became neutral, and at length normally alkaline.

"In the case of a young man, who exhibited the symptoms of gastritis,
viz. great tenderness of the epigastrium, thirst, tongue red and parched, &c.
the saliva was found to be decidedly acid. By repeated leechings of the
abdomen, and the use of demulcent and refrigerant drinks, the symptoms
were speedily relieved, and in a few days the saliva was quite neutral, hav-
ing no effect either on the simple litmus paper, or on that which had been
previously reddened by an acid. It soon regained its alkalinity.

" This patient had two relapses of tiie complaint ; and on both occasions
the saliva was acid at first, and became neutral and then alkaline, as the
symptoms disappeared.

" From the preceding data, M. Donne deduces the important (if verified
by future enquiries) conclusion, that in all cases of gastric disturbance, where
the saliva is distinctly acid, we have reason to believe that an inflammatory
irritation of the stomach is present, and therefore, that an antiphlogistic
treatment is required.

" With respect to the converse of the proposition, he candidly admits that
his facts are not yet sufficiently numerous and definite to warrant him in
laying down any therapeutic indication ; and he only suggests that, when-
ever the saliva remains alkaline in gastric complaints, the most appropriate
remedial means will be found to be emetics and purgatives, He promises
to continue his own researches, and invites others to follow the same path
of inquiry."

1S3G.] On Broussaiism, Expectant plan of Cure, <$-c. <J-c. 240

Part III. MONTHLY PERISCOPE.

Broussaiism. Dr. Thorburn says " Broussaiism, as it if in 1835, is not
Broussaiism as it was. It has received from "various sources" a much
more bearable shape, and seems less exclusively calculated for the meridian
of Paris. Not that " the only true doctrine" was ever destitute of what the
critics of the legitimate drama call ' points,' for exclusive of egotistical at-
tacks on its honorable opponents, as Professor Chomel rather cynically ob-
served, it has three cardinal points gastritis, gum-water, and leeches ! Voi-
\k, toute la medecine physiologique !" American Journal, No. 35, May
1834; ^elSO.

Expectant plan of cure. In Mr. Lee's notice of the Hopital des Enfans
Malades, it is declared that the mortality among the unfortunate children in
this Institution, is one in four ! The British Reviewers, Forbes & Conolly,
believe from their own "painful observation, that is rather under than over
the truth ;" and that "this horrible mortality is to be ascribed, in a great
measure, to the expectant system of medicine ; to starvation, and gum-water,
conjoined with the too free use of leeches." British and Foreign Medical
Review.

Sciatica and Rheumatism. The general system of medical practice in
Germany, approaches much more nearly to that of England, than in France
and Italy : bleeding is less frequently had recourse to, but active internal
medicines are employed, as well as enemata and baths; whilst tisans and
infusions of herbs are now but little prescribed.

When speaking of Stutt^ard, Mr. Lee mentions that Sciatica is treated,
in that Institution, not by blisters applied over the trunk of the Sciatic nerve,
but below the knee, so as to encircle the leg ; a method which is said to
produce a speedy cure in most cases. In the general hospital at Prague,
Rheumatism is treated by the administration of large quantities of warm
water : both acute and chronic cases appear to be treated in this manner,
and it is said with success. British and Foreign Medical Review.

Clinical Lectures of Sir B. Brodie. 1. On Epulis* This disease, ac-
cording to Sir B. C. Brodie's experience, occurs usually in women ; but he
has seen it in men. The following is the history of the complaint presented
us by this excellent practical surgeon.

" When you look at the disease in its early stage, it appears as if a part
of the gum were more prominent than the rest ; the prominent part is cov-
ered by a membrane like the gum, and when cut into, it is not very different
in appearance from the consistence and structure of the gum itself; at least,
so far as the eye can discern. On these accounts, as it looks like the gum
on the surface, as it cuts like the gum, and as it is connected with the gum,
so it is supposed generally to have its origin in the gum, and 1 cannot say
that that is not its source in some instances ; but yet I must own that in ca-
ses which I have had an opportunity of examining, it has appeared to me
that the disease originated in the alveolar processes. I have observed that
the disease is always situated by the side of one tooth, and generally a tooth
is pushed out of the socket as the disease advances. The history of the
present patient tends to confirm this opinion, for she says that the teeth be-
came loose and dropped out, and then grew up the tumor. Here is a spe-

* Lancet, November 21, 1535.
32

250 Clinical Lectures of Sir B. Brodie 1 . On Epulis. [Sept ,

cimen {presenting it) of the disease, attached to the jaw, and in which it
evidently appeared to have originated in the alveolar process. In the ope-
ration, I removed with the tumour the portion of the jaw belonging to it ;
and I found in that part of the jaw which was sawn through, and where it
was not supposed that any tumour existed, that there was a substance ex-
actly like the tumour itself, in the alveolar process. I sawed through the
bone where I thought it was healthy, and there I found the socket of an
alveolus, in which the structure was so exactly like that of the large tumour,
that I thought it right to destroy this part. The tumour is at lirst small :
as it advances the teeth drop out, and the tumour at last extends from one
side of the jaw to the other. If the disease go on it will ulcerate and in-
crease in size, and although in this woman it remained stationary, as any
tumour may, yet it may go on to attain any magnitude. I have seen a tu-
mour occupy the entire half of the lower jaw, so that the patient could not
close the mouth ; and it may go on further still, and run the course of any
malignant tumour. Consider what any malignant tumour of the jaw will
do, and that is what this tumour also may do. It may occupy the cavity of
the mouth itself, press upon the cheek, and ultimately produce destruction
of the face, so that you have a large ill-conditioned ulcer, with a tumour at
the bottom of it. In short, it may run the course of any malignant disease."

Sir B. Brodie proceeds to state that although the tumour, if left to itself,
will ulcerate, slough, and produce destruction of contiguous parts, just as
scirrhous or fungus hasmatodes, yet it is only so far malignant; for it will not
contaminate the constitution like those truly malignant disorders. If a scir-
rhous tumour is removed, the probability is, that another scirrhous tumour
will appear in the cicatrix, or in some other organ or part. But Epulis is
one of those half-malignant diseases, which, although not capable of a natu-
ral cure, and ending in the destruction of the textures with which they are
immediately involved, do not seem to produce that condition of system which
gives rise to the formation of similar tumours elsewhere. This is a very
consolatory fact, and exerts, of course, an important influence on our views
of treatment.

If tumours then like Epulis are removed, they do not re-appear. But they
must be removed entirely. When the tumor is taken away at a late stager
the disease does occasionally return. The reason is, not that the disease is
then more malignant, but the eradication by the operation has not been quite
complete. The same thing occurs with the tubercles which form on the
checks of old persons. Remove them early and remove them perfectly, and
they do not grow again. If removed late, they may not then be removed
so perfectly, and so under these circumstances they do grow again. The
following is Sir B. Brodie's method of operating in the instance of Epulis.

The mode of proceeding must depend on circumstances on the size of
the tumour on its extent and, partly, on its position. In the greater
number of cases of this kind that I see in private practice at least the
disease is in the early stage, and, of course, then, the tumor is of small sizer
and may be easily destroyed in the following manner : First of all, all .the
teeth which seem in any way to interfere with the disease must be drawn.
This step must be taken before you can do any thing else. You thus expose
the tumour completely, and then, in ordinary cases, you may proceed in the
following manner. If the teeth, where the tumour is formed, have been
dropped out for some time, the alveolar processes have become absorbed ;
otherwise, of course they remain, and this circumstance you must bear in
mind. I am now speaking of cases where the tumour is small. I place the
patient before the light, and then cut off the excrescence, so far as I can get
at it. If the alveolar processes remain, of course I use such a knife as can
be carried to the bottom of them ; but if they have been absorbed, a straight
common knife will do. You then wait for the bleeding to subsidy and if
there be a great deal of hemorrhage, you may postpone the next step of the
operation to another day, when it may be done quite as well as on the first

183G.] Clinical Lectures of Sir. B. Brodie 1. On Epulis. 251

occasion. The next step of the operation is to apply the caustic potass to
the surface of the bone from which the tumor arose. You may apply the
actual cautery, or nitric acid ; but I prefer the caustic potass, which answers
the purpose fully as well as the actual cautery, and frightens the patient
much less. I think, moreover, that you know more exactly how far you go
with the caustic potass than you do with the actual cautery : and be as-
sured, also, for I speak from having employed it many times, that it answers
the purpose perfectly. You should have a piece of caustic potass, with a
point so as to enter the alveolar process. It should be cut in the shape of a
pencil, and be a piece of a tolerable length, and it should be fixed, at right
angles, in the end of a pair of dressing forceps. Do not trust to your hands
to hold it tight in the forceps, but let it be fastened on by a ligature, passed
round several timss ; apply it to the surface from which the tumour had been
removed ; but if the alveolar process remains take care that the caustic pen-
etrates to the bottom of the process. Many prefer the caustic potass to any
thing else, because it does not coagulate the blood, and does not prevent the
caustic from acting, and because also, it will penetrate somewhat into the
substance of the parts ; whereas the nitric acid coagulates every substance
with which it comes in contact, and does not sink into it; it is more limited
in its effects. You may conceive that the caustic potass is very likely to
run about, to surround the cheek, to burn the tongue, and to injure parts
beyond those which it is your intention to injure. It will dissolve in saliva,
In the blood, and in th urine, and if it were to run about it would produce
very great evil. How, then, are you to obviate the effects of such an acci-
dent] Why, just as you always would avoid the effects of its application
where you do not want it to operate. Whenever you employ it for the de-
struction of living parts, have something at hand that will act as an antidote
to it, and stop its operation. If you use caustic potass, you need only have
some vinegar within reach, with bits of lint to dip into the vinegar and apply
to the neighbouring texture, If you employ nitric acid, have some carbo-
nate of potass, or chalk and water, ready to apply to protect neighbouring
parts. You should never use caustic without having something by you that
will destroy its properties, when the caustic is in danger of interfering with
the neighbouring textures. There are some cases in which you apply the
nitrate of silver (which is not a powerful caustic, and not much used for the
destruction of parts) to the inside of the eyelids. Always have something
at hand on such occasions to stop its operation, and the best antidote with
which I am acquainted, is common oil, which stops its action presently. But
to return.

Having removed the part with the knife, apply the potass to the surface,
by which you will make a slough of the neighbouring parts, and destroy the
surface of the bones. If the disease has descended to the alveolus, and the
alveolar process is not absorbed, a narrow pi ce of caustic is to be introduced
into the bottom of the process. This may be done at the time of excising
the tumour, if there be not too much hemorrhage ; but if there be, then it is
better to defer the application to another day : no harm arises from waiting,
and you never can apply the caustic to much advantage when there is much
hemorrhage ; that was the reason why 1 only appliedthe caustic slightly to-
day You should always examine tho part afterwards, in order to ascertain
if you have left any portion of the tumour undestroyed. If you have, it may
be removed by a knife, or by the caustic potass, afterwards. It is not often
necessary, but still, where the comfort or the life of the patient is at stake,
you should exercise this precaution."

In cases where bone enters into the composition of the base of the tumor
Sir B. Brodie employs a pair of bone-nippers, a modification of the common
stump-bone nippers, but constructed with a double lever by Mr. Weiss.
The double lever gives great additional power to the operator. Sir B. Bro-
die particularly cautions the operator not to leave any disease in the jaw.
It may be necessary to remove very large portions, or the whole of it.

252 <)n Corigreen, or Irish Pearl Moss. [Sept.

Corigreen, or Irish Pearl Moss. In the American Journal
for May, we observe a notice of this article, which is now ex-
tensively used on the western coast of Ireland, as a dietetic for
various disorders, especially consumption, dysentery, rickets,
scrofula, and affections of the kidneys and bladder. It makes a
fine and digestible jelly, more pure and more agreeable to the
stomach than many others, by being dissolved in water by boil-
ing. It is said to agree better with the stomach than animal
jellies. It is also used in decoction, by boiling Si of it in aiss of
water, or milk, down to one pint, as a food for children brought
up by hand, or after weaning, or when laboring under rickety
or scrofulous affections, and is found highly nutritious, bland and
easy of digestion. It is said to be without the unpleasant flavor
of Iceland moss. This article has not become common at the
south, but we have met with it occasionally, and have been de-
lighted with it as a dietetic. Indeed, we have found nothing
which seemed more suitable as aji?^st diet, after gastric or intes-
tinal irritation, or after great debility, and tympanitic states of
these important organs. It seemed to fill a place for which we
had nothing else being receivable by the stomach before we
could allow other light articles. We hope apothecaries and
druggists will enable themselves to supply the article.

Mr. Bass, Pharmaceutic chemist, directs its preparation for
medieinal use in the following manner: " Steep 3 ii of the moss
in cold water for a few minutes, then withdraw it, (shaking the
water from each sprig,) and boil it in one quart of new or un-
skimmed milk, until it attains the consistence of warm jelly
strain and sweeten it to the taste with white sugar or honey ;
or if convenient, with candied Eryngo root. If milk disagree
with the stomach, or be inadmissible in the case, water may be
used in its stead. The decoction made with milk is recommend-
ed for breakfast to consumptive patients ; and that prepared with
water will be found a most agreeable kind of nourishment, taken
at intervals through the day ; the flavour being varied with le-
mon juice, or peel, sweet orange juice, cinnamon, or wine of any
sort most congenial to the palate. The decoction in water, is
also taken for the relief of cough, at any time in the course of
the day, when it is troublesome ; and it is, for this purpose sim-
ply sweetened with honey.

In dysentery, the decoction, cither in milk or water may be
administered with equal advantage, and in addition to the sweet-
ening matter, if a tea-spoonful of tincture of Rhatany be added
to each cup-full, a tone will thereby be given to the intestines, at
the same time that nourishment will be conveyed to the system
and irritation prevented. A large tea-cupfui of the decoction
may be taken three or four times a day.

As a pleasant strengthening food, boiled with milk, strained,
with the addition of a little sugar, it is unrivalled for infants,

1836.] Treatment of Mercurial Sail cat Ion, <J-c. c 25.3

Delicate persons take it in this way for breakfast, with the hap-
piest effects."

Treatment of Mercurial Sal nation by concentrated Muriatic Acid. M. Vel-
peau is of opinion, that mercurial salivation is connected with some altera-
tion of the mucous cryptas in the mouth, and not with inflammation of the
salivary glands, for he remarks, " when a gland is inflamed it no longer se-
cretes : besides which, the patients do not refer the pain they feel to the
glands, but to the interior of the mouth.

" What is the progress and effects of mercury ! By its extreme subtlety
it is introduced into the system, saturates it as it were and inflames it ; for
most generally the gums, the internal lining of the cheeks, the edges of the
tongue are covered with a thick layer of lymph, and this is most probably
owing to an irritation, generated by sympathy or continuity, and it is there-
fore essential to look to the cryptae rather than the glands. This view of the
subject induced M. Berard to make use of muriatic acid, and myself to em-
ploy it alternately with a mixture of honey, the acid in question, solution of
lunar caustic, and several other remedies. For the last two years I have re-
turned to the use of the acid, but I now prescribe it in the pure or even con-
centrated state. In a patient who had been labouring under severe ptvalism
for four days, and to whom I applied the acid by means of a hair brush pen-
cil, the good effects were immediate. I was afraid, however, lest it should
produce mischief, but was deceived : a pellicle forms over the mouth, but
there is no inflammation. Of three patients treated with concentrated mu-
riatic acid, one has left the hospital : of the two remaining the second recov-
ered in a few days. In these cases the patients were touched with the rem-
edy four times in two days, and this sufficed. In the third patient the in-
flammation was less acute, and the effects less marked : moreover, the sal-
ivation was of some standing; from all which it may be inferred that the
muriatic acid is beneficial in proportion to the intensity of the inflammation.
To this patient, therefore, I applied alum, and the symptoms were almost
directly ameliorated ; alum, however, to be useful, should be used in sub-
stance, and in large quantities." Lancette Francaise, 2nd June.

Nitrate of Silver for tlie Cure of Chilblains. Dr. Gamberini recommerds
the following remedy to prevent the ulceration, and even to disperse chil-
blains ; they should be moistened with a piece of linen slightly soaked in
water, so as to keep the skin soft and moist, without being exactly wetted ;
and when thus prepared, a piece of nitrate of silver is to be rubbed on the
chilblain ; moderate pressure should be used, and it should be slowly passed
several times over the part. In a few minutes the epidermis becomes very
slightly whitened ; at the end of some hours, and generally when the part
is exposed to the light, as in the chilblains of the hands, the epidermis be-
comes brownish, and presents a greater consistence to the touch. The ef-
fect is just the same as that produced on the fingers when a piece of this
caustic is handled without precaution. A strong pressure, or more pro-
longed application of the remedy will denude the part; the same thino- will
happen if the surface be too much wetted before cauterization. But, in gen-
eral, we may say that when the cauterization is maintained within proper
limits, it causes no pain, and rarely a slight pricking.

This simple treatment relieves the patient from all inconvenience, in the
course of a few days. It may, however, become necessary to re-apply it
once or twice. London Medical and Surgical Journal, Feb. 20, 183(5.

Case of Local Pulsation By Elisha Bartlelt, M. D. I was invited, a few
days since, by Dr. Duesbury, of this town, to see a patient sufferin<r with
violent throbbing of the temporal arteries. The patient is a chlorotfc giri.
All that could be ascertained of her previous history, in regard to disease^

254 On Flannel in Hot Climates, fyc. fyc. [Sept.

was that she had been repeatedly bled for what her physicians had called
brainfcver. At these times, she says, the beating in the temples was pre-
sent. On examining the temporal arteries, I found them pulsating with a
very powerful expansive throb, like that of an aneurism. The strength of
the arterial beats was not uniform. The vessel seemed to swell up under
the touch, like an artery as large as the little finger, with its circumference
indistinctly defined. It resembles, somewhat, the swelling out of the tempo-
ral muscle when the lower jaw is strongly pressed against the upper. Eve-
ry pulsation was painful, and the action of coughing, although instinctively
suppressed by the patient, was accompanied by great aggravation of the pain
in the temples. But the most curious circumstance in this case remains to
be stated. The pulsations in the temporal arteries were not synchronous with
those of the heart. The average number of pulsations at the wrist, repeat-
edly counted, was one hundred and six ; the average number in the temporal
artery was eighty. The pulse at the wrist was feeble and soft ; the action
of the carotids corresponded in force and frequency with that of the radials.
By firmly compressing the temporal artery, low down and anterior to the
ear, where its action was very much less violent, the powerful throbbing of
the temples wras arrested, and the artery flattened away like an aneurism
emptied in the same manner. I say nothing of the general symptoms, as I
mention the case to you chiefly as a striking and unequivocal instance of
pulsation in an artery independent of the action of the heart. American
Journal, May, 1836.

Flannel in Hot Climates. In the United Service Journal for August, 1835*
there is a very valuable paper by Dr. Ferguson, on the "Health of Troops,"
which we strongly recommend to our military medical readers and, indeed,
to all military men, whether medical or not.

We were gratified to find our own opinions, respecting the use of flannel
next the skin in tropical climates, corroborated by a talented army physician.
Dr. F. observes : "I, for one, protest against it (flannel) as an enervating
habit, of which the healthy, hardy soldier can never stand in need. To the
feeble and valetudinary it is most useful ; and, as an hospital indulgence,
highly proper ; but, when worn in the crowded barrack-room, with, too of-
ten, bad washing and insufficient change, it becomes a deposit of filth even
of contagion, irritating to the skin, and incompatible with health and clean-
liness." Dr. F. very properly makes some exception, such as in bivouacs,
and when the soldier is encamped, and in a rigorous climate. " With the
above exceptions, it should never be seen either in the barracks or quar-
ters." Medico- Chirurgical Review.

On the different offices of Lacteals, Lymphatics and Veins in the Function of
AhsorptionS Dr. Handyside, of Edinburgh, presented to the Medical Section
of the British Association, at the Dublin meeting, an interesting paper on
this subject, in which, after starting with the proposition, now generally
admitted, that these three set of vessels are one and all of them endowed
with the faculty of absorption, he proceeds to lay down, as a general posi-
tion, that each of these three systems of vessels is endowed with a peculiar
office in the general function of absorption :

1st. That the lacteals absorb aliment, and refuse entrance to all other
matters.

2nd. That the lymphatics remove the elements of the body which have
become useless or noxious, to make room for the deposition of new matter.

3d. That the veins, besides returning the blood to the heart, absorb vari-
ous foreign matters.

1st. Function of Lacteals. This appears to be decidedly to convey nutri-
ment into the system, and that no other class of vessels can exercise that
function, would appear almost proved to demonstration by the experiments

1836.] Treatment of Itch, Sulphuret of Potash in Asthma. 255

of Dupuytren, in which it was ascertained, that by applying ligatures round
the thoracic duct of horses, death from inanition followed in all instances.

2nd. Function of Lymphatics. Closely as the lymphatic system resem-
bles the lacteal, even in the most minute details of anatomical characters,
the vessels composing it nevertheless appear to have for their peculiar func-
tion the office of removing the debris of the body. After noticing the argu-
ments of Dr. Hunter and Mr. Hewson as to this function being performed
by the lymphatics, Dr. II. ingeniously observed, that in vegetables, the de-
bris, instead of being removed by vessels, are detached from their surface,
as in the falling off of their leaves and the scaling off of their bark, or they
are piled up in the interior of the individual, (as heart wood,) and preserved
during the whole period of its existence ; which circumstance, taken in con-
nexion with the absence of a system of vessels in vegetables corresponding
to lymphatics, may be regarded as affording a negative proof in support of
the opinion here stated.

Dr. H. next alludes to the supposed communication between the veins and
lymphatics, which he maintains does not exist except where great lymphat-
ic trunks empty themselves into the venous system ; thus showing an inde-
pendent existence of the lacteal system, which argues in favour of their ha-
ving to perform a separate function.

3d. Absorption by Veins. Several experiments were detailed, proving
that the absorption of fluids from the surfaces of serous and mucous mem-
branes, and from the surface of the skin, was accomplished by the veins and
not by any other vessels. These experiments consisted in the exposure of
fluids containing ferro-cyanate of potass and prussiate of potass to the serous
and mucous surfaces, and to the skin stripped of its cuticle. Absorption of
the fluids so applied took place, and by the application of suitable tests, the
sulphate and deuto-sulphate of iron, the presence of the salts above men-
tioned was discovered in the blood, but never in the fluid contained in the
thoracic duct.

The results of these experiments were similar to those of Flandrin, Tie-
demann and Gmelin, and Magendie, and prove that absorption from the sur-
faces of the various organs is affected by the veins. American from Dublin
Journal.

Treatment of Itch. Dr. Lison, physician to the hospital of Donzi, lauds,
in a communication in the Journal Gen. de Therapeulique, the efficacy of
the following ointment for the cure of Itch.

Rs. Litharge ^ 1.

Olive Oil, % iv. Mix, place over a moderate fire, and stir until the li-
tharge is well dissolved, and the ointment acquires a slight blackish tint.

Half an ounce is to be used in friction to the hands, feet and armpits,
morning and night. American Journal.

Sulphuret of Potash in Asthma. An individual, labouring under a severe
attack of spasmodic Asthma, applied to Dr. Carusi, who having ordered the
Aqua Lauro-cerasi internally, and frictions with tartar emetic ointment,
without success, directed 16 grains of the sulphuret of potash, rubbed into
a paste with honey. This quantity was divided into four portions, one of
which was given three times a day. After the administration of the last
dose, the Asthma entirely disappeared, and the cure was complete. Amer-
ican Journal. London Medical and Surgical Journal.

Sulphate of Quinia and Lactucarium in Cholera. Dr. Hal-
phen of New Orleans, in a memoir on Cholera Morbus compli-
cated with Yellow Fever, as it appeared in New Orleans, during
the epidemic of 1832, seems to prove by a number of cases and

256 On Phloridzine ; a new organic substance, c. [Sept.

observations, that the epidemical constitution predisposing to
Yellow Fever, is overruled by that of Cholera. He found that
the disease would supervene on cases of Yellow Fever, the
symptoms of which would meliorate immediately on the occur-
rence of Cholera. He also observed, that strangers in a yellow
fever region failed to take this disease, as they were otherwise
wont to do, if Cholera prevailed ; and that, when its attacks were
suffered, they were much more benign than under other circum-
stances, they were with unclimatized citizens: His observations
were made in New Orleans during the years 1832, '33 and '34.

" The remedy upon which Dr. H. chiefly depended for the cure of Chole-
ra, in the cases which fell under his care, was Sulphate of Quinia combined
with Lactucarium : and the facts which he has adduced, would all certainly
appear to prove it superior in efficacy to all other remedies that have been
proposed for this disease. It was administered either in pills, composed each
of three or four grains of Sulphate of Quinia and half a grain of Lactucari-
um ; and administered every five, ten, fifteen or twenty minutes, until reac-
tion took place ; or forty grains of sulphate of Quinia and from six to ten
grains of Lactucarium, were dissolved in six ounces of fluid, of which a spoon-
ful was given at intervals more or less short, according to the circumstances
of the case. Six to twelve grains of Sulphate of Quinia and from two to
four of the Lactucarium, in a pint of mucilage, were also injected per anum
every fifteen minutes, until the diarrhoea was suspended. Sinapisms and
stimulating liniments, to the surface, were at the same time frequently em-
ployed.

" By this plan of treatment, we are assured by M. Halphen, that a general,
moderate, and regular reaction was almost invariably established, and the
speedy convalescence of the patient ensued '' American Journal.

Phloridzine; a new organic substance. (L'Institut. No. 143.) This veg-
etable principle was obtained by MM. de Koninck and Stas from the bark of
the root of the apple, pear and cherry trees. It may be procured by boiling
the roots for four or five hours in water, decanting the liquid and continuing
the ebullition with an addition of pure water for two hours, and again decant-
ing. The decanted liquid, in each instance, after twenty-four or thirty-six
hours repose, will deposite small crystals of a more or less brown color. It
may also be obtained from an alcoholic solution.

Phloridzine is but slightly soluble in cold water, but more so in warm. At
188 C. it is dissolved in every proportion. It is more soluble in cold alco-
hol than cold water, but equally in the two liquids at their boiling tempera-
ture. Heated above 100 C. it slowly melts, at 177 boils, and at 107 is
decomposed, producing benzoic acid which sublimes. It is decomposed by
the sulphuric, nitric and hydrochloric acids. Ammonia and the other caus-
tic alkalies in solution dissolve it without alteration. The deutosulphate of
iron colors the solution of phloridzine a deep brown, causing at the same time
an ochre-yellow precipitate ; no change in the color is effected by the pro-
tosulphate. Its composition is carbon 14, oxygen 9, and hydrogen 18 atoms.

The author, M. de Koninck, suggests in his memoirs, that phloridzine may
be ranked with the most valuable febrifuges and will rival in utility the sul-
phate of quinine.

CORRECTION \n the notice of tho medical properties of (he Amygdalus Persiea,
on the 149lh page, 1st Volume, of this Journal, it is stated on the authority of Professor
Dugas, Ih'it under its use "the disease / per!. issis) generally lisappenred within four or
five days." Dr. D. does not wish to have heen understood precisely in this way ; but
that, the disease generally disappeared within about half the usual time; all the symp-
toms being mitigited forthwith.

SOUTHERN MEDICAL

AND

SURGICAL JOURNAL

Vol. L] OCTOBER, 1836. [No. 5.

Part I. ORIGINAL COMMUNICATIONS.

ARTICLE I.

A Letter to the Editors. By Edward Delony, M. D. of Tal-

botton, Georgia.

Gentlemen, I was much gratified to see the announcement of
the Southern Medical and Surgical Journal having commenced
its career in the medical world long, long may it prosper. The
benefits which will result from it, to the profession of the South,
will be felt and acknowledged for years to come, it must be sus-
tained, and I confidently believe, that the highminded liberality
of Southern medical gentlemen will sustain it.

I propose, in a plain and brief manner, to advance a few rea-
sons to shew the necessity and importance of a Southern medi-
cal periodical. When we take into view the various influence
of climate, especially on the human constitution, even in the lim-
its of the United States, and the consequent variation and pecu-
liarity of symptoms which characterize disease, brought about
by this powerful agency, in connexion with other local causes,
over which it operates, we do not hesitate to declare our firm be-
lief, that a successful course of treatment for almost any disease,
in the northern part of the American continent, or even the U-
nited States, would in the State of Georgia, Alabama, or Louisi-
ana, in the same disease, not only prove unsuccessful, but, in all
probability, dangerous to the life of the patient.
33

258 A Letter to the Editors. [October.

In order to bring to your view a striking example of the influ-
ence of climate, with other local agents, in propagating diseases
peculiar to itself, I would cite you to the history of that most
frightful scourge, Asiatic Cholera. When and on what part of
this continent, has this disease ever penetrated into the pure and
healthy climate of the highlands, or among the hardy yeomanry
of the country, distant from the moist atmosphere of the coasts,
or large rivers, and low flat countries commonly covered with
water one half of the year ? I think no instance of the kind can
be pointed out, our recollection does not serve us as to a single
one, at least in the United States.

Again, in a case of common Pleurisy, arising in a northern
climate, do we discover no difference in the treatment of a simi-
lar case, arising in the south ? . In the former case, free blood
letting, a few saline cathartics and a good sweat, would proba-
bly be sufficient to cure the patient. But is this all we have to
do in the south? No. We would have barely commenced.
Here, we find a complication of symptoms, altogether out of the
ordinary routine of a common attack of pleurisy. We have an
inordinate excitement in the liver to control, in consequence of
which an obstinate continued fever prevails, and the pain in the
side remains unsubdued, although we have bled our patient as
much as we dare to do ; extensive blistering has now to be re-
sorted to, and the patient almost exhausted, has frequently to be
supported with stimulants ; the harrassing and painful cough, is
frequently, most frightfully aggravated, in consequence of an
enlargement of the liver in short, with all the symptoms of a
Pleurisy, we have combined, those of a violent bilious fever.
And where now shall we look for correct information in the man-
agement of such a case? surely not to the pages of a northern
periodical or amongst the writings of northern physicians?

So also in Rheumatism, a physician, when this disease occurs in
a cold climate, will merely, by bleeding and sweating his patient,
often effect a cure ; while a southern practitioner will find two-
thirds of his cases of Rheumatism, connected with and dependent
on a diseased condition of the liver, with an additional variety of
symptoms. Will the same treatment answer in both cases?
common sense would teach us otherwise, and yet the treatment
for this disease is laid down in the books, the same, whether it
occurs in Georgia or in Maine, whether it is dependant on a

1830.] A Letter to the Editors. 259

morbid action of the liver, or from other causes. I have cured a
patient of a violent attack of Rheumatism, by directing my rem-
edies entirely to the correction of a highly diseased liver.

So also in Typhus Fever where is the physician in Georgia
who has seen a well marked case of Typhus Fever, according
with the symptoms as laid down by northern writers ? It is very
true, we have typhoid diseases some years our summer and
fall diseases are ushered in and wear throughout the garb of
a typhoid epidemic; whilst other years, they are of a highly in-
flammatory grade. Again I would ask, amidst all this variety
and peculiarity of disease, where shall we look for the correct
treatment, but among that portion of the faculty where they occur?

I might increase this part of my communication to an almost
interminable length, even without going into the minutiae of the
subject ; but under this head, I have adduced sufficient reason, I
think, to satisfy every one, that among ourselves we must look
for the most proper, correct and successful treatment of those
diseases which prevail among us. The experience and talents of
the profession of the south, will compare with that of any other
portion of the world, and their judgment is as sound and correct,
although they are not in the habit of entering into those fine spun,
refined theories, that would lead them to the administration of a
thousandth part of a grain or drop, with the least confidence in
its producing any impression on the most susceptible organ in
the human system.

The profession at the south are too much in the habit of looking
to the north for medical light and knowledge, and what does it
profit them after they obtain it they find after all their trouble
and expense, they have to avail themselves of their own resour-
ces ; their own judgment and experience soon teach them the
fallacy of suffering themselves to be governed and guided by the
views and opinions of those, who can know nothing of the diffi-
culties which we have to encounter in the management of the
diseases which occur among us. Then, let us come freely
forward, as we have now a medium through which we
may kindly interchange our ideas, and present to each other our
experience. I trust for the honor of our profession and for the
benefit of mankind, we will not neglect so favorable an opportu-
nity for the improvement of medicine, and the mitigation of the
sufferings of our fellow creatures.

260 A Letter to the Editors. [October.

There are other strong reasons why it is important that a
southern medical periodical should be published among us. The
prevailing attempt that is now making to introduce among the
credulous and superstitious part of the community, a " system of
practice? which must tend more to the destruction of human life,
than the sword or the bottle is well calculated to arouse the
philanthropic feelings of every physician, and arm him with re-
newed zeal in the dissemination of those true and correct princi-
ples of medicine, which must and will speedily overwhelm, with
shame and disgrace, so daring and disgusting an attempt to im-
pose on the human family what can be considered, in no other
light than an organized system of murder.

Humanity weeps at the many instances of suffering and death
which almost daily occur, brought about by the ignorant and
imprudent administration of Lobelia, or by the still more barbar-
ous process of stewing or boiling human beings alive ; and will
the medical profession look silently on, and make no efforts to
rescue their fellow creatures from the death-like grasp of such
bold and reckless imposture, or break the fatal spell that seems
to have seized upon them ?

The medical profession desire not to keep the people igno-
rant of the principles of medicine, on the contrary, they would
fain give them all the information in their power. They would
rejoice that every household could be possessed of the true prin-
ciples and knowledge of the healing art and how shall this desir-
able end be obtained? Let every farmer subscribe for a medi-
cal work, he will find it but a small tax, and of incalculable ben-
efit. Why should the circulation of medical periodicals be con-
fined alone to the medical profession ? much urcful information
can be gained from them even by the most ordinary capacities.
We would beg leave then to suggest to the people of the South,
the great propriety of liberally encouraging the " Southern Med-
ical and Surgical Journal," it is a work published among you
by your own people, and is deserving your encouragement. It
is a work, in which every farmer may at once find the experi-
ence of the ablest physicians of the south, in the diseases which
daily occur around him. It is truly a southern work, in which
every southern man ought to take a deep interest.

In conclusion, I would respectfully suggest to every physician
who may be a subscriber to this journal, and all others who feel

1836.] Surgical Cases. 201

a desire to encourage southern enterprise of this kind, to use his
exertions in procuring subscribers, it will be a noble duty, and
he will be contributing a lasting benefit to his neighborhood, and
the people at large, by increasing those means which must give
a foundation and circulation to the work, commensurate with
the improvement of the arts and sciences, and as lasting and du-
rable as truth.

EDWARD DELONY.
Talbotton, Ga., August, 1836,

Surgical Cases. By Paul F. Eve, M. D., Professor of Surgery
in the Medical College of Georgia.

SERIES NO I.

Case 1st. Amputation of the Thigh Scrofula Operation
successful. ^,

This was an old aggravated case of Scrofula. The patient
was a negro woman, about 38 years of age, who had borne chil-
dren ; but who for several years had been so afflictdd as to be
unable even to wait upon herself. The disease had apparently
affected the whole constitution. She had ulcers on several parts
of her body, but more particularly on the left foot and leg. In
fact, the whole ankle-joint and foot of that side formed one im-
mense ulceration, from the surface of which there was periodical
(I cannot say regular) hemorrhages. The patient had been sub-
jected to a variety of treatment, while under the care of the late
Dr. Anderson Watkins of this city. For the last ten or twelve
months, the case being considered incurable, this woman was
allowed to place herself in any position, and at the time of the
operation the left leg was permanently flexed upon the thigh.

At her own suggestion, an operation was agreed upon, the ob-
ject of which was to prolong her life, now endangered by the

2G2 Surgical Cases. [October.

repeated copious bleedings from the large ulcer about the left
ankle, and by removing an useless limb to relieve her sufferings,
&c. On the 5th of August, 1828, the circular flap amputation
of the left thigh was performed, which the patient bore remark-
ably well, both morally and physically. The muscles were
pale, flabby and cedematous ; so that the skin reserved for cov-
ering the stump was found to be too long, and a portion conse-
quently was removed ; the bone was a mere osseous shell, offer-
ing very little resistance to the saw ; and the principal artery
was so altered that when tied, the internal and middle coats ad-
hered to the forceps, and were brought away as a plug out of
its calibre. The stump was dressed in the usual manner of the
day, and afterwards with fine powdered charcoal, under which
application it healed in about 30 days. It never re-opened,
though the patient still had ulcers on other parts of her body.
She lived nearly two years after the amputation, and it is said
died of colic. In all, she was afflicted 19 years.

Case 2nd. Amputation of the Arm Ulceration of a portion
of the flap, from pressure upon the bone by the adhesive strips.

This occurred in one of the wounded at the battle of Ostro-
lenka, during the revolution of Poland in 1831. Amputation of
the right arm was performed in June, in one of the military Hos-
pitals of Warsaw, and Dr. Placer, chief surgeon, assisted and
applied the adhesive plaster. The strips were placed accu-
rately over the stump, but drawn so tight and with so much
force, that at the next dressing a portion of the skin which came
in contact with the circumference and sharp edge of the bone,
had sloughed. This of course retarded the healing of the wound
for several days, though the bone did not protrude.

Remarks. As it is an axiom in Surgery, that skin and not
muscle is the proper covering for a stump, the inconvenience
above alluded to might have been avoided, either by using only
the necessary degree of pressure in applying the dressings, or
probably by rasping or paring the rough edge of the bone, before
laying down the flaps. This case also exhibits the importance
of each Surgeon attending to his own dressings : but acting as
I was then, under a superior officer, submission was proper.

1830.] Surgical Cases. 263

Case 3rd. Protrusion of the Bone after Amputation of the
Thigh.

This was also one of the unfortunate wounded at the battle of
Ostrolenka, and though placed under my care, the operation had
been performed by another, and whose apology for the nature
of the stump, was that he had been compelled to perform it at
night and without proper assistance. This may be regarded a
case of peculiar interest; one at least of rare occurrenee in the
present enlightened state of Surgery. It had been upwards of
30 days since the operation, when I first saw it. The soft parts
adhered intimately to the bone, and the stump was conical or of
the sugar loaf shape. The extremity of the femur projected
about an inch and a quarter beyond the skin. Its periosteum
was destroyed, and a line of separation was well marked just
beyond the point embraced by the soft parts. The protruding
bone seemed to be in a fair way of being removed by the ab-
sorbents, when by a change of situation, I lost sight of the case.
But no doubt the separation was completed.

Remarks. Granting the circumstances under which this ope-
ration was performed, (during the night and without proper as-
sistance,) were a satisfactory excuse for the protrusion of the
bone, ought not the projecting portion to have been removed the
next day ? The muscles might have been easily dissected up,
the bone sawed off higher up, and then properly covered by the
skin. The absorbents were truly sufficient for the separation,
but besides the difference of time between them and the saw in
effecting the same object, which is as three or four months, to fif-
teen or twenty seeonds, and in the pain, &c. ; it is well known
that to a sugar loaf or conical stump, an artificial leg cannot be
applied and worn with comfort by the unfortunate sufferer who
loses a limb.

Case 4th. Amputation of the Leg Reunion on the third
day.

This operation was performed upon a healthy soldier, in the
barracks near Warsaw, in July, 1831, who had received a mus-
ket ball through the right ankle joint, which was succeeded by
necrosis of its bones. The skin exactly met over the face of

264 Surgical Cases. [October.

the stump, and many circumstances conspired to favour reunion
of the soft parts by the first intention. It being mid-summer,
the dressings were removed on the third day, and upon exami-
nation the opposite edges or lips of the wound were agglutinated
together, the whole line, except where the ligatures came out.
This case also passed from under my care by a change in the
army. But I do not pretend to present it as a case of perfect
union after amputation the ligatures undoubtedly produced
some suppuration.

Case 5th. Amputation of both Legs below the knee Patient
in the street on the fourteenth day after the operation.

In an article on the subject of the chlorides of lime and soda,
published in a late number of the American Journal of the Med-
ical Sciences, Philadelphia, this case was alluded to. The pa-
tient was a negro boy,* about fifteen years old, who had his
feet destroyed by gangrene, the effects of frost-bite. Amputa-
tion was performed at the usual place below the knee of both
legs, on the 30th of January, 1834. The stumps were dressed
on the eighth day ; on the morning of the 10th after the opera-
tion, the patient rode in a buggy several squares of our city, and
on the fourteenth day, he went into the streets of his own accord.
This at least equals Sir Charles Bell's case of amputation of the
arm, in which the patient was able to go into the streets of Lon-
don, the 7th day after the operation.

Case 6th. Amputation of the Fore- Arm But two dressings.

In April last, 1836, a little girl had her right hand terribly shat-
tered by the bursting of a powder-flask, which she had opened
over some live coals on the hearth. The thumb was entirely
torn off and thrown out at the top of the chimney, into the
the yard. Amputation was performed near the wrist, and the
stump healed so kindly, that it was dressed but twice with ad-
hesive strips, the ligatures ofFeringthe only obstacle to complete
reunion.

Augusta, August, 1836.

* This boy now belongs to Mr. Houslcy, where he has been learning sad-
dlery for the past six months, and in losing his feet and legs has certainly
lost nothing to disqualify him for the acquisition of a valuable trade.

1830.] Remarks on, Idiopathic Mortification. 265

Remarks on the Pathology of Idiopathic or Spontaneous Morti-
fication ; with cases. By L. A. Dugas, M. D., Professor of
Anatomy, &c, in the Medical College of Georgia.

That the true Pathology of Idiopathic or Spontaneous Gan-
grene is hut imperfectly understood, may justly be inferred from
the various and vague views emitted by writers on the subject.
Most of them, confining themselves to the consideration of its re-
mote causes, have enumerated old age, the use of unsound wheat,
or ergot, and several morbid conditions of the system, as scro-
fula, syphilis, infection, &c ; whilst but few have studiously
observed the organs of innervation and nutrition, in the affected
locality. It is true that ossification of the arteries of the extrem-
ities has been assigned as a probable cause of some cases of gan-
grene of the fingers and toes, but I am not aware that the nerves
and lymphatics have ever been minutely examined in such ca-
ses.

If the functions of innervation and nutrition, in general, be im-
paired, every part of the system should simultaneously suffer,
and simultaneously cease to live, if the impairment be sufficient-
ly great. But it is difficult to understand how such a general
disorder can be exclusively evinced in a special locality. To
admit that putrifying fluids, or deleterious agents, are forced by
the vis medicatrix to a certain point, and permitted to wreak de-
struction where it can be borne with least injury, (usually in the
extremities,) appears preposterous. By what agency can the
offending matter be collected from all parts of the circulating
medium, and accumulated in a finger or toe ? We know that
no part of the body, can retain life without nervous influence and
nutrition, and, consequently, that the loss of either must necessa-
rily induce death of the part. Moreover, we know of no inter-
nal cause by which local mortification can be produced, unless
the hypothesis just rejected be admitted.

That the condition of the general system may have some in-
fluence in the development of gangrene, in parts already dis-
posed to it, I do not deny. Such a degree of arterial ossifica-
tion, or of local compression, for example, as would present but
a slight obstruction to the circulation in a young, strong and ro-
34

2G6 Remarks on Idiopathic Mortification. [OcV

bust individual, would prove ample cause of mortification in one
whose general energies were much impaired, either by age or
disease. Such cases too are the most unmanageable, for the ill
condition which permits the origin of mortification is rapidly
aggravated by the very existence of the putrescent locality.

We are now speaking of that kind of mortification which oc-
curs with little or no previous inflammation; but in what res-
pects does this differ from that preceded by a high degree of in-
flammation? In inflammation, are not the vessels diseased?
Is not nutrition impaired? And may not the effusion of lymph
in the cellular tissue, produce such a compression of the nerves
and vessels as to affect innervation as well as circulation ? Car-
ry these phenomena of inflammation beyond a certain limit, and
gangrene will be the result gangrene from excessive inflam-
mation.

Our knowledge of capillary action, as well as of innervation,
is extremely limited ; yet these are the operations we should
study, in order to scan the mysteries of inflammation, and avoid
the dangers of gangrene. Let us confine our investigations to
the condition of the circulatory vessels and nerves, and I hesitate
not to predict that the pathology of Idiopathic Mortification will
very soon be properly understood. It is of the utmost practi-
cal importance that it should be determined whether this disease
depends on a constitutional, or a local defect ; for the treatment
entirely depends on the decision. If the disease, or rather death,
be of local origin, the sooner its scat is severed from the body,
the greater will be the promise of recovery, since the system
confessedly suffers exceedingly by the presence of a mortified
member ; whether by absorption of noxious particles or not, I
will not discuss. If, on the other hand, gangrene recognizes a
constitutional cause, we have nothing to gain from local appli-
cations, but must direct all our efforts to the regeneration of the
impure fluids.

These reflections were suggested by a case I attended, in con-
junction with several distinguished practitioners, and the treat-
ment, of which proved extremely embarrassing, from our imper-
fect knowledge of its pathology. I will subjoin a brief history
of it.

Mr. * *, about 45 years of age, of a strong, robust constitution,
though rather corpulent, perceived about the 1st of March, on

183G.] Remarks on Idiopathic Mortification. 267

the dorsum of tho toe next to the little one, a small reddish spot,
attended with very slight sensitiveness, and which occurred with-
out appreciable cause. Referring it to the pressure of his boot,
he paid but little attention to it, and merely wore an easier shoe
for a few days, when he accidentally observed that the spot had
spread over the toe, and assumed a dark hue. He immediately
called in his physician the toe was dead. It was removed
with very little pain, and the mortification was found to have ex-
tended above and beneath the metatarsal bone sustaining the toe,
and to furnish a sanious discharge through fistulous openings at
the distal extremity of this bone. The disease now seemed to
subside ; the place of amputation healed kindly ; but the dis-
charge continued. A few weeks after, the integuments over
and beneath the metatarsus, gradually became oedematous, and
of a deep red, and this extended to the toe next to the great,
which died six weeks after the first. I was now called to see
him, and found his countenance very much altered and anxious ;
he was very nervous and desponding ; pulse small and frequent,
(120) ; corpulency much diminished ; but no functional derange-
ment; little or no pain in the affected foot. The case had been
treated, locally, by poultices, and generally, by various prepara^
tions of sarsaparilla, mercury to ptyalism, and low diet. There
never had been any fever. The body, especially the affected
limb, has presented small greenish patches, referred by the at-
tending physician to remains of syphilis, which the patient had
some 12 or 15 years previous. It was then treated by nitric
acid ; subsequently appeared in the throat, skin and tibia ; was
again removed, by mercurials and diet drink. He has had no
symptom of it since.

We now determined to apply leeches, and to make free inci-
sions through the skin and cellular tissue. From twenty to thir-
ty leeches were applied five or six days with only apparent ben-
efit ; the incisions were made wherever the disease seemed dis-
posed to extend, and the cellular tissue was invariably found
dead, although the skin scarcely presented signs of inflammation.
The regimen was made generous ; diet drink continued a short
time, then substituted by porter and bark ; poultices to the foot.

The disease, however, gradually increased, so that by the first
week of May, the oedema had gained the ankle, and some signs
of it were perceptible in the gastroencmii. All the soft parts

268 Remarks on Idiopathic Mortification. [Oct.

beneath the metatarsus, and some above it, were in a state of
gangrene ; all the toes were dead, with the exception of a part
of the great toe ; some difficulty in voiding urine ; frequently
restless at night, and requires opiates ; general energies very
gradually failing. Two more physicians were called in consul-
tation on the 7th May, when amputation was proposed, but de-
ferred in order to give another trial to a free mercurial course,
in hopes of correcting the constitutional malady. The foot and
leg were rubbed and covered with unguent; hydrarg; and large
doses of calomel administered internally ; the Bark and Porter
continued.

May 12th. Gums slightly touched ; an incision a little above
the inner ankle gave issue to nearly a half-pint of pus, which is
discharged by pressure of any part of the leg, up to within four
inches of the knee ; leg very cedematous and somewhat sensitive
on pressure. Calomel discontinued ; costiveness removed by a
small dose of sulphate of magnesia.

16th. (Edema increasing ; discharge very abundant ; nausea
and diarrhoea ever since taking the aperient ; no appetite ; rejects
the bark and porter ; has fever occasionally ; opiates.

17th. Stomach and bowels much relieved; some appetite; pu-
rulent discharge half-pint per diem ; Consultation again called,
and amputation recommended, as the only resource left. I accor-
dingly removed the limb above the knee, on the next day. The
operation was borne with unusual fortitude ; the femoral artery
was found, on taking it up, to be partially ossified ; the stump
wras dressed in the usual manner, with adhesive strips, &c.
The patient felt much relieved and cheerful for several days ;
when nausea and diarrhoea returned, with more or less fever dai-
ly, and were subsequently attended with copious clammy sweats,
sleepless nights, vomiting, hiccough, and gradual sinking of the
pulse. Death ensued on the fifteenth day after the operation.
The stump never evinced the slightest disposition to heal ; but
discharged a great quantity of brown, putrescent matter, and
finally assumed the gangrenous aspect throughout nearly its en-
tire surface. On examination of the amputated limb, the artery
was found ossified down to its division; the posterior tibial was
also ossified in its whole length, and formed at the malleolus a
complete bony cylinder. The other branches were not traced;
the dorsal artery did not exist.

183G.] Remarks on Idiopathic Mortification. 209

The questions which present themselves, in the consideration
of the above case, are 1st. What was the immediate cause of
the disease. 2nd. If constitutional, could life have been saved ?
3d. If merely local, could life have been saved. To the 1st query,
I would answer that sufficient cause is to be found in the ossifi-
cation of the arteries, which, being also very much thickened,
manifestly impeded the circulation. The individual was, more-
over, in the enjoyment of excellent health at the time the disease
manifested itself; was a man of steady habits, and one who led an
active life. His general health became impaired only after his
mode of living had been changed, his system subjected to the
action of medicine, and, above all, to the destructive influence of
a gangrenous member. In reply to the second question, I have
already adduced some reasons for doubting very much that a
condition of the system so depraved as to cause the spontaneous
death of any part of the body, can, by any means in our power,
ever be corrected with sufficient promptness and effect, to arrest
the progress of mortification, or to heal the wound made by am-
putation. In answering the last inquiry, I must observe that in
the case before us, the ossification existed, not only in the foot,
but also in the thigh, and indeed partially in the radial artery of
the same side, so that, although the cause of the mortification
was to a certain extent local, it could not be entirely removed
by amputation the only remedy. Suspecting ossification to be
the cause of the disease, I early endeavored to satisfy myself on
the subject, by feeling for the vessels about the foot and leg. I
could never perceive any pulsation, but the oedematous state of
the parts prevented me from considering the absence of this sign,
sufficient evidence of ossification. The continuation of the an-
terior tibial, it has already been stated, did not exist on the tar-
sus. In this case there was manifestly a lesion of the organs of
nutrition in the whole limb. It was inevitably fatal.

The following extract from my note-book, will furnish Du-
puytren's views on the cause of Gangrena Senilis, illustrated by
specimens of morbid anatomy.

" Mr. D. exhibits to the class, portions of the arterial system of a man who
died at the 69th year of his age, of Gangrene of the toes. He takes occa-
sion to state, that in his opinion, the cause of Gangrena Senilis is not old
age, but essentially an affection of the arteries leading to the parts diseased.
This lesion is generally ossification, attended with thickening of the coats
of the vessels and redness of their internal membrane. The case under ex-

270 Remarks on Idiopathic Mortification. [Oct.

amination fully demonstrates the correctness of this explanation ; for the
crural artery presents particles of ossification, some degree of hypertrophy,
redness of the inner coat, and an obstruction formed by a bloody concretion.
This coatrulum is, however, very different from what is occasionally found
in healthy vessels ; in these, the obstruction is not complete, but formed by
a cylindrical mass of fibrine, the diameter of which is smaller than that of the
artery ; the mass causing the obstruction in cases of inflammation of the
vessel, is very different from fibrine, resembles burnt currant jelly, is of the
same consistence throughout, and fills completely the caliber of the artery,
being adherent to its inner surface. When scraped off, this surface is found
quite red, and the coats thickened. These lesions increased as the exami-
nation was carried nearer the extremity of the vessels or near the foot.
There were in some parts ulcerations of the inner coat. The arteries of the
other leg were perfectly healthy. Mr. D. is willing to admit, that the de-
bilitated state of the constitution, brought on by old age, may favor the ossi-
fication, and this ossification cause the inflammation and consequent obliter-
ation ; but contends that these effects might be produced independently of
old age."

M. Sanson also admits the occurrence of Spontaneous Gan-
grene to be dependent on a lesion of the sources of nutrition, as
will be seen by the annexed history, also from my note-book.

"Mr. Sanson, in his Clinical Lecture, related the following history of a
curious case. A man of middle age and delicate constitution, experienced,
about a month since, in his left hand, a sense of numbness, which gradually
spread over the whole arm, and increased so as to give him a kind of prick-
ing pain. He consulted a physician, who applied frictions with Tr. Cam-
phor: brandy, &c. The symptoms, however, instead of yielding, became
aggravated, and about a week ago the patient's fingers became of a livid
and gangrenous color, which induced him to enter the hospital. When Mr.
Sanson first saw him, the fingers and nearly the whole hand, presented the
color and shining appearance of the dark blue grape ; but on examination he
perceived, that though the temperature of the hand was lower than natural,
yet it was not that of a dead limb. On feeling the pulse at the wrist and at
the brachial artery, he found it extremely feeble, whereas in the healthy arm
it was quite full and natural. After pressing the brachial artery a little and
removing the finger, it was perceived that the circulation was completely
suspended for several seconds, when it would reappear gradually, and ex-
tend to the hand. None of these curious phenomena appeared in the un-
diseased limb. To use his own words, it appeared that by a little pressure
on the artery, its sides were glued (colle) together, until the force of the cir-
culation, already very feeble, would press them asunder." The hand was
perfectly insensible, and the arm not painful, though both were a little tume-
fied. Not knowing the true nature of the case, it occurred to Mr. Sanson,
that it might perhaps be an inflammation of some of the blood vessels, not-
withstanding the absence of pain ; he accordingly applied leeches about the
wrist and along the course of the brachial artery. On the next day, to his
great surprise, he found that the black colour had left the hand, and only oc-
cupied the fingers. He ordered leeches to be reapplied, and on his third vis-
it the dark colour was perceived only on the extremities of the fingers.
Thirty or forty leeches were applied several days more, when the line of
separation was formed, and scvern; of the extreme phalanges removed.
The patient soon recovered his health."

1836.] Phrenological Analysis. 271

Phrenological Analysis of the Character of Allen Pace. By F.
M. Robertson, M. D.

" One fact is, to me, more positive and decisive, than a thousand metaphy-
sical opinions." Spukzheim.

Owing to the restrictions of the government of France, there
was no Phrenological Society in Paris, until after the late revolu-
tion. Many may be disposed to consider this an evidence of
the slow progress of the science on the continent ; but this is not
the case, for no sooner was a society formed, for the purpose of
investigating its claims to rank among the sciences, than some
of the most distinguished men, both medical and non-medical,
enrolled themselves among the disciples of the illustrious Gall
and Spurzheim. Those who have not had access to the differ-
ent Phrenological Journals of this country and Europe, will pro-
bably be surprised to learn that the celebrated Andral is the Pre-
sident of the Phrenological Society of Paris.

In the Journal de la Societe Phrenologique de Paris, in the
April number for 1835, may be found, among other highly in-
teresting matter, a discourse from Andral, delivered at the gen-
eral annual meeting of the society. " In this discourse," observes
the editor of the Edinburgh Phrenological Journal, "he endeav-
ors to remove existing prejudices, by showing that Gall's leading
ideas are in strict harmony with the principles which have al-
ways been followed by Physiologists, in endeavoring to discover
the functions of the bodily organs, and that their truth is estab-
lished by a body of evidence, direct and indirect, which it is im-
possible to resist. He states that his aim is to prove that the
science, of which Gall is the founder, must henceforward be in-
cluded among the grave and serious studies of physiology."
The translator concludes by the following very just remark :
" His professional reputation and labors may be put in the scale
against any of our living teachers."

We have made the foregoing remarks and quotations, before
entering, directly, upon the subject of this article, to show the
importance which is attached to this science by one of the most
distinguished pathologists of the age, and, also, for the purpose of

272 Phrenological Analysis. [Oct.

refuting the charge, that none of the eminent professors of Eu-
rope are found among the advocates of the system. Did our
time and space permit, we could bring forward a list of the mem-
bers of the different societies in Europe, that would astonish
many of our opponents.

The subject of the present communication, committed a mur-
der in Barnwell District, S. C, for which he was tried, con-
demned and executed. Some of the particulars of this case
were related in an article over an anonymous signature, the au-
thorship of which we feel no hesitation in acknowledging. The
skull of Pace was obtained by a professional gentleman, who
has been so kind as to permit the writer of this article to retain
it in his possession. The developements of this skull afforded
such a striking illustration of the doctrine of Phrenology, and ha-
ving heard some of the particulars of the murder, casually and
verbally, from persons who had received their information se-
cond-hand, we were induced to make further inquiries into the
case. In order to get at the most authentic information, we re-
quested the gentleman who procured the skull, to communicate
any information he might possess in relation to the character of
the individual. He mentioned this request to a friend of his a
member of the bar and shortly afterwards, the following letter
was received, enclosing the subjoined document :

"13th July,. 1835.
"Dr. F. M. Robertson:

"Sir My friend, Dr. James O. Ilagood, of this place, has in-
formed me that you have expressed a wish to know the partic-
ulars of a murder committed by Allen Pace, who was hung, and
whose skull is now in your possession. In examining some old
law papers, I casually found the original notes of testimony giv-
en on the trial, and which, in a leisure moment, and for a differ-
ent purpose, I had arranged and digested. To the testimony I
have added some particulars in relation to the arrest, appear-
ance, trial and execution of Pace, as furnished by a professional
friend, who was foreman of the Jury of Inquest, and saw Pace
in the Court House and under the gallows.

I have also had access to the finding of the Coroner's Inquest,
the Indictment, Conviction, and other matters of record, togeth-
er with an act of the Legislature of 1824, giving a reward to
those who pursued and captured Pace.

1836.]

Phrenological Analysis.

273

Trusting that the enclosed narrative, though brief, will prove
satisfactory, I remain, very respectfully, &c.

EDMUND BELLENGER, jr. Attorney at Law,

Barnwell Court House, S. C"

Before giving the document alluded to in this letter, we will
say a few words in relation to the phrenological developements
of the skull. The following scale will exhibit the measurement
of Pace's cranium by means of the Callipers. We regret that
a craniometer could not be obtained, as it would have enabled
us to have been still more minute. The skull is remarkably thin
over the organs of Destructiveness and Secretiveness, which
shows that the relative size of these organs was greater than
represented by the measurement, as less allowance must be
made for the thickness of the tables of the skull at this point than
over the other organs.

Greatest circumference, measured horizontally over In-
dividuality, Destructiveness and Philoprogenitiveness,

From Occipital spine, over the top of the head to In-
dividuality,

From ear to ear over the top of the head, -

From Philoprogenitiveness to Individuality, in

a right

line,

From Inhabitiveness to Comparison, -

From ear to Philoprogenitiveness, -

From ear to Individuality, -

From ear to Benevolence, -

From ear to Reverence, -

From ear to Firmness, -

From ear to Conscientiousness, -

From Destructiveness to Destructiveness,

From Secretiveness to Secretiveness, -

From Acquisitiveness to Acquisitiveness,

From Cautiousness to Cautiousness,

From Ideality to Ideality, -

From Constructiveness to Constructiveness,

From Mastoid process to Mastoid process,

From ear to Occipital spine,

35 .

Indies,
20 1-2

11 3-8

12 3-8

6 7-8
5 7-8
1-4
1-8
7-8
3-8
7-8

5-8
1-2
1-8
1-8
1-8
3-8
1-8
5-8

274 Phrenological Analysis. [Oct.

In examining this skull, we must take into consideration, not
only the magnitude of each organ, separately, but particular re-
ference must be had to the proportionate developement of the dif-
ferent regions of the head. In consequence of not attending to
this simple rule, many persons have arrived at conclusions unfa-
vorable to the science. Upon examining the head of a murder-
er, and that of some eminent individual, if the organ of Destruc-
tiveness be found equally developed in both, they at once con-
clude, without advancing a step further, that the science is false.
They forget to examine the moral organs, which, in all cases,
exert an influence, proportionate to their relative developement,
in controlling the action of the inferior propensities. Destruc-
tiveness, in a head like that of Spurzheim or Sir Walter Scott,
merely imparts force and energetic action to the intellectual fa-
culties in their writings and investigations, while the same de-
velopement of the organ might exist in a criminal, though we
should find a vast difference in the intellectual and moral region.
Phrenologists divide heads into three classes. The jirst includes
those in which the organs of the propensities predominate over
the organs of the faculties peculiar to man. Those of the second
class are of an opposite nature, and exhibit a preponderance of
the organs of the moral sentiments and reflective faculties. The
third class is composed of heads in which these two orders of
organs are nearly equally balanced. On referring to the above
scale, it will, at once, be perceived, that the head in question will
fall under the jirst class. We find in it the organs of Amative-
ness, Destructiveness, Secretiveness, Acquisitiveness and Cau-
tiousness, much larger than Benevolence, Conscientiousness,
Reverence, Ideality, Adhesiveness, and the organs of the Intel-
lectual Faculties, all of which are very small. The forehead is
low, narrow and shallow, from the anterior border of Construc-
tiveness forward. In truth, the animal nature appeared to pre-
dominate completely over the human.

Upon examining this skull, a Phrenologist would readily per-
ceive what would most likely result from such a combination,
particularly in an individual of the habits and mode of life of
Pace.

1836.] Phrenological Analysis. 275

The following is the document alluded to in the foregoing re-
marks :

" Trial for Murder, in the Court of Sessions for Barnwell Dis-
trict, in the State of South Carolina, before the Hon. John S.
Richardson. Fall Term, 1824.

' The prisoner's name was Allen Pace, and he was charged
with murdering Marvin Holbert, on the night of the 9th of Au-
gust, 1824. The body of the unfortunate Holbert, as was sup-
posed, was found in the woods, behind a log. The body was in
a state of putrefaction, and the face so bruised that the features
were not distinguishable ; nor were there any weapons of death
near the spot. The defendant was arrested in North Carolina,
and as no positive proof could be adduced, it was extremely dif-
ficult to identify the body, to show the mode of commission, and
to fix the guilt on the party charged. But

" Murder, although it hath no tongue, will speak
With most miraculous organ."

The body was identified by the colour of Holbert' s hair, his
clothes, his suspenders, his shoes, the attendance of his dog, his
being seen near the spot on the previous evening, and his other-
wise unaccountable disappearance.

A trail was observed, as if the body had been dragged to the
place of concealment. This was followed for seventy yards,
and then it became evident, on examination, that arrangements
had been made for spending the night, and that, while the de-
ceased was lying on his back, his skull had been battered with
lightwood-knots and pieces of timber. And, that the prisoner had
perpetrated this foul and revolting deed, was evidenced by the
following facts :

1st. It was proved that the prisoner and the deceased had been
well acquainted ; they were both strangers in the district. Hol-
bert had control over the other ; regulated his movements, and
made contracts for his work.

2d. On the morning of the 9th, they started, in company, from
a certain house, came to the Village, remained there for some
time, departed together, and, late in the evening, were seen to-
gether near the scene of the murder.

276 Phrenological Analysis. [Oct.

3rd. They called at a house in the neighborhood for accom-
modations the prisoner urged his companion to go on.

4th. Holbert was in the possession of a large sum of money,
which had been exhibited frequently in the prisoner's presence.

5th. When they left the Village, they travelled downwards
and on foot On the 10th, Pace was seen hastening towards Au-
gusta, Ga. on horseback.

6th. Before that time, Pace was not worth more than 12 1-2
cents was dependent on Holbert for clothes. On the 10th, and
afterwards, Pace exhibited a profusion of money purchased a
horse, saddle, &c for ninety-five dollars, and laid out sixty dol-
lars at one store.

7th. Holbert kept his money in a black silk handkerchief on
the 10th, Pace was seen with a great many bills rolled up in a
similar handkerchief.

8th. The prisoner's saddle-bags, his hat, his coat, and his pan-
taloons the last bloody were found on the spot.

9th. When Pace was arrested, he had on Holberfs hat, iden-
tified by a private mark put on by the merchant ; and his boots,
identified by a nail driven through the heel of one of them.

1 0th. On the morning after the murder, the prisoner was dress-
ed in a suit of clothes which had been carried by Holbert as dress-
clothes ; and endeavored to pass off a note of twenty-five dol-
lars, the property of Holbert

11th. When arrested, the prisoner had Holbert' s watch in his
fob. A witness on being asked how he knew the watch, said, if
it was the same, a peculiar piece of paper, which he described,
would be found in the case. The watch was opened in court,
and there was the paper.

Such was the evidence on the part of the prosecution. In it-
self, each fact was unimportant, or, at most, could furnish no
more than a ground of suspicion ; but, when taken in connection,
and unexplained by the prisoner, they proved too strong for his
escape. He was found guilty, and suffered on the gallows. He
had been pursued and arrested in North Carolina. Though
seized when armed and surrounded by his friends, he submitted
in silence, and without asking the cause of his arrest.

lie had a dark, sullen, downcast countenance;
"A villain, by the hand of nature marked,
Quoted and signed^ to do a deed of shame."

1836.] Phrenological Analysis. 277

Such was his appearance and demeanor at the time of his cap-
ture, during his imprisonment, at the trial, and under the gallows.

He was visited while under sentence of death, by clergymen
of different denominations ; but the offers of religious consolation
were received with thankless and sulky indifference.

He denied his guilt ; but either would not or could not ex-
plain a single circumstance, of the great many that were brought
against him. Under the gallows could be seen the same sullen,
villainous aspect. Immediately previous to the execution, he
whispered in the ear of the attending minister, that Holbert' s
papers might be found under a log where he did not distinctly
describe. A slight search was made at a subsequent time, but
the papers were never recovered. Unless this could be called a
confession,

" He died and made no sign."

And, perhaps, never did a more cold-blooded, remorseless vil-
lain meet his appropriate fate. " It was a cool, calculating, mo-
ney-making murder." For vile trash, had he, in the lonely
depths of the forest, at the dead hour of night, risen on his com-
panion, his friend, his benefactor, and wrung from him, at once,
the hard earnings of his honest industry, and his life. But, bitter
was the retribution! The wretched pelf, for which he had
stained his soul with blood, proved one of the chief means of his
detection.

One other circumstance added to the deep, agonizing interest
with which the horrible details of this case were heard a cir-
cumstance which might seem to impart an air of romance to this
narrative; but it is fact and not fancy: The corpse of Holbert
was discovered through the means of his dog, who attracted the
notice of a passenger, and led him to the fatal spot. And when
the dead body was buried, this faithful and affectionate animal
far more humane than the brutal Pace laid down in silence on
the grave. He subsequently returned, a distance of fifteen miles,
to the individual at whose house Holbert had last resided ; and
who, struck with such an instance of fidelity, offered a very
large sum to the mother of Holbert for his dog. But it was re-
fused. She would not, she could not part from this last living
memorial of her murdered son. Unlike the treacherous friend

278 Phrenological Analysis. [Oct.

he had been true ; perhaps had striven to repel the assassin's at-
tack. It is certain, that for three days and three nights, did he
guard from birds of prey, the butchered and mangled body of
poor Holbert :

"Not quite deserted, though lonely extended,
For, faithful in death, his mute favorite attended ;
The much-loved remains of his master defended,
And chased the hill-fox and the raven away."

We would invite those who are sceptical on this subject, to
examine the developements of this skull, and compare them with
the history of the case a history which was drawn up in 1824,
without any reference to Phrenology. They cannot but admit
the murder to have been most cruel and atrocious, having been
committed upon a benefactor and friend. Refer to the skull and
mark the deficiency of Benevolence, Reverence, Conscientiousness
and Adhesiveness. They will also agree that it was to gratify
an unhallowed thirst for money We point to the large devel-
opement of Acquisitiveness. They will doubtless add, that it
was perpetrated in a most secret, cowardly and brutal manner.
Behold the enormous developcment of the organs of Secretive-
ness, Cautiousness and Destructiveness, in proportion to the intel-
lectual faculties and superior sentiments. In this skull the organ
of Combativeness is decidedly small, and his cowardice v , evin-
ced as well by the manner in which he committed the ed, as
by the fact that he made no resistance when apprehended, " tho*
armed and surrounded by his friends." Persons are too apt to
confound the functions of the two organs, Destructiveness and
Combativeness ; but by referring to the metaphysical analysis of
these organs, this mistake will be corrected. In fact, the devel-
opcment of all the organs, go directly to establish the truth of
Phrenology. A stronger case could scarcely be found.

Circumstances formed the tissue of evidence which may be
regarded as strong as positive testimony that led to his convic-
tion. A similar chain of circumstantial evidence, presented by
the history of the transaction and the phrenological develope-
ments, constitutes testimony equally strong in favor of the truth
of (he science. It has been remarked by an eminent writer,
"that in the administration of justice, circumstantial evidence is
often preferred to positive. It is deemed more probable, that a

1836.] Phrenological Analysis. 279

witness may swear falsely, cither through intention or mistake,
than that a large number of authenticated facts, connected with
no interested motives, should concur in supporting an unfounded
accusation. In science, the same is true. An experimenter or
an observer, may be honestly mistaken; or a preconceived hy-
pothesis may tempt one to distort facts, or to prevaricate as to
results. But a host of well-known and acknowledged phenome-
na, harmonizing in their drift, and throwing their undivided
weight into the scale of controverted doctrine, while neither fact
nor analogy is adduced to counterbalance them, would seem to
be conclusive."

Perhaps the oft-repeated objection may here be reiterated:
"Admit your science to be true ; then this individual was neces-
sarily impelled to the commission of the deed, as he possessed
the bad organs, and therefore should not have been held accoun-
table for the act." But this is begging the question. Phrenolo-
gy does not recognise any bad organs or faculties. They are
all good, and intended to serve some wise purposes, within their
proper spheres ; and only become bad in their effects, when suf-
fered to transcend their legitimate bounds of action. Neither
does the doctrine lead to the conclusion drawn in the above ob-
jection. We only say, that out of any number of individuals,
those who possess an organization similar to the one in question,
will be more likely, under given circumstances, to yield to the
influence of temptation, in consequence of the preponderance of
the animal propensities, than those who possess developements
that would bring them under the second class where the moral
sentiments and reflective faculties predominate over the animal
nature. We do not speak of what ought to be, or of what we
should like ; nor pretend to inquire into the justice of the econo-
my of the moral constitution of man. This is alone the preroga-
tive of the Creator. We must take tilings as they are, and ex-
amine "xcts as they are revealed in nature. Do we not find, in
our d: y intercourse with society, individuals who arc invaria-
bly the same who do not yield to temptations, which, under the
same circumstances, overcome others immediately I These, as
it has been said, "arc a lam unto themselves'* We always find
them pursuing the same just and equitable course. But there
are others again wTho require all the rigor of the lex scripta, du-
ring their whole course through life. Do wc not come in con-

280 Phrenological Analysis. [Oct.

tact with those who are proverbially bad ? who are kept in
bounds, only by the rigid enforcement of the laws of the land ?
Does not every one repose more confidence in the word of honor
of some men than in that of others ? Who ever thinks of trust-
ing a thief? A man who will commit fraud, in one instance, will
seldom be found to suffer an opportunity to pass unimproved,
when he can over-reach his neighbor, or swindle his creditors.
What says the law on this subject ? A Judge who is impeach-
ed and convicted of mal-practice in office, is not only removed
from his responsible post, but rendered ineligible, ever afterward,
to any office of honor or trust. A man once convicted of per-
jury, his oath is never afterwards admitted as evidence in a court
of justice. How seldom is one cold, deliberate, calculating mur-
der, the last committed by one who has taken the first step in his
career of destructiveness, unless conviction and the penalty of
the law arrest his murderous course. For the truth of these re-
marks, we appeal to the annals of crime in all ages. These are
facts in nature, independent of Phrenology. Whether this doc-
trine be true or false, they stand as facts beyond dispute. In
accounting for them, it is immaterial, so far as accountability is
concerned, whether we assign them to native goodness of char-
acter, in the one case, and natural depravity in the other, or to
the relative degrees of developement of the different organs of the
faculties. Take it which way we will, the accountability is
neither lessened nor increased. The results are invariably the
same.

It is to be regretted, for the sake of truth and justice, that those
who attempt to disprove Phrenology, do not resort to the exam-
ination of facts. Few investigate for themselves ; the majority
simply depend upon the assertions of the enemies of the science,
and content themselves with the knowledge thus obtained, in-
stead of consulting authentic works on the subject, and testing
its truth by an appeal to facts.

Augusta, August, 1836.

1836.] Fracture of ike Os Femaris. 281

Cases of Fracture of the Os Fentoris Adjustment by weigM and

fulcrum : 13 y M. Antony, M. D. &c. &c. of Augusta, Ca.

My purpose in this paper is to call attention to the treatment
of fractures of the femur, by weight and fulcrum. In doing this
I will illustrate the practice by a brief account of live cases, se-
lected from amongst others.

Case 1. A negro man, aged 40 years, whilst engaged in dri-
ving his wagon, fell from his horse, and the wheel of the wag-
on passed over one of his thighs. The accident terminated in
the dislocation of the knee-joint, and a simple fracture of the fe-
mur of the same side, at the upper end of its lower third. I vis-
ited him on the road where the accident occurred ; reduced the
dislocation, and adjusted and confined the fragments in place with
temporary bandage and splints, to prevent irritation whilst be-
in^ brought to town.

So soon as he arrived at lodgings, I put him on his back on a
firm bed of planks, covered With blankets ; and placed under the
upper third of the tibia a cylindrical billet of wood about six
inches in diameter, wrapped with several coverings of cloth.
This was so far from the thigh, as barely to touch it, without
pressure. A short roller bandage was then passed around the
ankle and the bottom of the foot, where a string was attached,
which, passing over the foot of the bed or platform about six inch-
es beyond the heel, suspended a piece of brick, weighing about
two and a half pounds. After adjusting the fragments by exten-
sion and counter-extension, made by the hands of assistants, four
short splints made of veneering, were then placed on the thigh
and secured by a many-tailed bandage, as snugly as possible,
without being uncomfortable. The thigh had swollen consid-
erably, and was directed to be kept wet with a suitable solution
of acetas plumbi in water and vinegar. The toes were proper-
ly directed by a small slip of bandage, and secured to the bed
on each side of the foot, at a distance of 18 or 20 inches, whilst
the foot rested on the heel. Another slip of bandage was passed
over the breast and under each shoulder, and pinned to the bed
above his head, for the purpose of counter-extension; but the
weight <>1 the bod} being soon found sufficient, it was dispensed

282 Fracture of the Os Fcmoris. [Oct.

with. This case required no farther assistance, except occa-
sionally tightening the many-tailed bandage as the tumefaction
of the thigh decreased. After two weeks, the weight was laid
on the foot of the bed, except when the patient was asleep. At
three weeks, the short splints were removed and the limb re-
freshed by gently rubbing with a wet cloth ; after which they
were re-applied, for a week or two, and the patient discharged.
Six months after, I met this patient in the road walking and dri-
ving his wagon. He stopped to manifest his gratitude, when I
requested him to perform several exercises for my inspection,
such as walking, running, leaping and dancing; all of which were
performed without the least imperfection of the limb being man-
ifested.

Case 2. This was a lad, about 11 years of age, one of the
most rude, uncontroled and uncontrolable, in the city ; who had
by a fall from a cypress tree, suffered a fracture of the femur, a
little above its middle. The patient was laid on his back on a
firm mattrass placed on a table. A fulcrum for the upper part of
the leg was prepared by rolling a soft pillow transversely on it-
self, so as to render it very firm. A half brick was suspended to
the foot, by a string passing over the lower end of the mattrass,
some six or eight inches from the foot the fragments adjusted,
and short splints applied as in the other case. A counter-exten-
sion bandage was, on account of the ungovernableness of the pa-
tient and lightness of his body, thought necessary and applied in
this case ; but this restriction from movements, he used every
opportunity afforded by the absence of his attendants, to rid him-
self of; until after a few days it was dispensed with. Such was
his impatience of restraint from motion, that so soon as the great
soreness in the wound began to abate, he was often found sitting
on his bed, having raised his body by pulling the pavilion which
was suspended over him to protect him from flics in the day
and musquitoes in the night. The patient was however dis-
charged well in the fourth week : no untoward circumstance ha-
ving occurred.

Case 3. This was a very rude and ungovernable girl, in her
seventh year, who in attempting to slide down the hand-rail of
the stair -way, as she was wont to do, fell from near the top of
the first flight, to the floor ; fracturing the femur a little above its
middle. She was placed on a mattrass, which was laid on the

1836.] Fracture of the Os Femoris. 283

dining table, and a fulcrum made of a pillow, placed beneath the
upper part of the leg as in the other cases just described, and a
weight of one pound and a half suspended to the foot and pas-
sing over the end of the table; with a counter-extension bandage
passed over her breast, short splints, &c. as before described.
This patient was of strongly marked sanguineo-nervous tem-
perament, and was much disposed to spasmodic twitchings du-
ring sleep, from irritation in the wounded thigh, for the first 48
hours. As this irritation subsided, she became free and slept
quietly. During her waking hours she became very restive, so
that her arms and sound leg were perpetually engaged in some
exercise or other for expending her super-excitabrlity. The
counter-extension bandage was necessarily retained in use to
prevent her from rising, and from sliding too near the foot of her
bed. 'In the course of a week or ten days, however, she had
become so subdued by its eontroling influence, and so desirous
to be released from its use, as a means of restraint to which she
seemed to abhor subjection, that she was easily retained in her
place without its use. The wounded limb having ever remained
still since the subsidence of the first irritation, it was found safe
after eight or ten days to rest her, when awake, from the little
pressure of the one and a half pound weight which hung to her foot,
by placing it on a chair, or on the bed during her waking hours.
All went on favorably in the case until four weeks had elapsed
when she was liberated from all the apparatus and allowed free
motion on her bed. On comparing the length of the wounded
with that of the sound limb, before she began to walk, the for-
mer was found four or five lines longer than the latter, from the
extension of the articulations during the suspension of muscular
action in the limb. On walking, the limb at once resumed its
proper length, and like the other cases left no deformity in gait
or shape.

Case 4. This was a negro boy, about 10 or 11 years of age,
who fell from a wagon heavily laden with nine bales of cotton,
which ran over his thigh on very hard ground, leaving a com-
minuted fracture of the femur, extending from about the middle
of the bone upwards, the full extent of between four and five
inches, with considerable swelling, and a small external opening
which constantly discharged blood. This patient was treated
in the same manner as those above, except that the swelling was

284 Fracture of the Os Femoris. [Oct.

gently compressed so as to cause a discharge of the blood effused
within, as effectually as possible ; and the bandage and splints
so applied as to afford convenience for daily dressing the
external wound. This case, occurring during the medical lec-
tures in this place, was exposed to the frequent observation of
the pupils of the class and daily dressed by some of them, and
was discharged well at four weeks ; three short splints being
however retained on the limb until he should arrive at home, a
distance of more than 70 miles, whither he had to be conveyed
in a common wagon. No difference was perceptible between
the wounded and sound limbs, except the hardness at the scat of.
this comminuted fracture, of about double the diameter of the
bone of the other thigh, and a little increase in the length of the
limb. He was sent home and did well in all respects.

Case 5. This is the last case which I shall give. It was in a
little girl nearly 3 years old, who caused a garden gate to fall on
her, which fractured the left femur, a little above its middle.
For this, a small pillow was rolled so as to make a fulcrum about
three and a half inches ill diameter, and a pound weight suspend-
ed to the foot by a string passing over the end of the table as be-
fore. The counter-extension bandage was applied; but this was
a sprightly, active cjiild, who would not submit to its continued
use ; it was dispensed with after the first day, and its place sup-
plied by the hand of an attendant being kept almost constantly
on the lower part of the abdomen and pelvis ; and when by her
various little muscular movements, she was brought too near the
end of the table, she was gently drawn back by the hands ap-
plied to the axillae. This case was managed in all respects as
the rest. No extension and counter-extension were needed in
adjusting the bones, the limb being found on measurement after
applying the weight, to be restored to its proper length, and the
bones well adjusted. At the end of three weeks, the weight was
finally dispensed with, and the splints taken off for the refresh-
ment of the limb, and reapplied to guard against accidents from
the sprightly, actfve disposition of the child. She was then re-
moved to a bed and left to the attendants, to be kept on bed a
week or ten days longer continuing the splint-'.

In giving the above live cases, I have made a selection from
all the cases which have occurred in my practice for the last
eleven or twelve years, all of which have been treated on the

1830.] Fracture of t lie Os Feinoris. 285

plan herein detailed, and with like success. My purpose in se-
lecting these, has been to present the greatest variety which my
practice has afforded, in different respects interesting, in proof
of the merits of this plan of treatment. The first case presents
an athletic laboring man, of rigid fibre, and aged 46. years, whose
voluntary and locomotive muscles, (the displacing powers) were
overruled by the trifling weight of about two and a half pounds,
in steady action. The second and third present Sanguine and
sanguinco-nervous temperaments at the most irritable and un-
governable age, and both of them having never been subjected to
government when well. The fourth case is selected on account
of its being one of extremely comminuted, and of compound na-
ture ; and the fifth, a child less than 3 years old. In the man-
agement of fractures on this plan, the excretions are easily dis-
posed of by the use of cloths and oil-cloths, and of urinals or
sponges, according to the age, &c. of the patient ; and no distress
whatever is suffered by painful compression of any of the dres-
sing confinement from exercise constituting the chief source of
affliction attending the recovery.

Duty to the science of Surgery, as well a^ to the cause of hu-
manity, seems to demand of me this exposition of my practice in
cases of fracture of the femur, whjch establishes in the most sat-
isfactory manner, the propriety of a plan of management at once
calculated to ensure the best success, with the simplest appara-
tus and the least distress.

Of this invaluable improvement in surgery I can speak the
more freely, because it is not an invention of my own. The
course of management herein detailed, is so rational, and at the
same time so simple, that I am not only surprised that the pro-
fession did not lay hold on it when first suggested ; but that my-
self, or any one else, should ever have contemplated the condi-
tion of a fractured femur, the displacing powers, and the cura-
tive resources of the system, without having it at once suggested
to his mind. One would suppose that even necessity, the parent
of so many discoveries, would, on some occasion, nave sugges*-
ted it very early in the practice of surgery. During the first
fifteen years of my professional life, I was in the habit of applv-
ing the various apparatus under recommendation by different
eminent surgeons, as Dessault, Physic, &c. &c., having for their
chief merit, adaptation to the purpose of preserving juxtaposition

280 Fracture of the Os Femoris. [Oct.

by great extension and counter-extension. Such was, however,
the severity of pressure on the points where extension and coun-
ter-extension were made, that I often found my patients most
ungovernable, or more or less severely afflicted with excoria-
tions, and sometimes with alarming ulcerations. Indeed, so dif-
ficult, troublesome and painful, was "the setting of the bones" as
it is called so distressing was the treatment, and so doubtful
the result under the most approved plans from time to time in
use, that I became exceedingly averse to encounter a fracture of
the Os Femoris, on account of my feeling for the unavoidable
sufferings of the patient, or his chance for a crooked or a short
limb.

In the early days of the Boston Medical and Surgical Journal,
I first observed on its pages, (if my memory be correct,) an ac-
count of the experience of my friend, Dr. Wm. C. Daniel of Sa-
vannah, with this mode of practice, which was to me perfectly
new, and so evident an improvement, that I determined on adopt-
ing its use in the first case which should occur. Soon after-
wards, however, I observed some suggestion of the same plan,
of a much older date ; but which had of course escaped Dr. Dan-
iel's observation, as it had my own. I adopted its use, however,
with the exception of the pully, over which he advised the cord
suspending the weight to pass. This I found unnecessary ; as
the motion was sufficiently free over the end of the mattrass, or
of the table.

The principle on which this plan of treatment operates, must
be evident to all. In the first place, the inconsiderable weight
attached is often sufficient to adjust the bones ; and always suf-
ficient by its steady action, to exhaust the active energies of the
muscles of the limb, long before union commences, and before the
soreness of the part is so removed as to render the patient wil-
ling to effect any motion of it. The constant, though gentle trac-
tion secures the proper length and straightness of the limb, and
the short splints, bound on with moderate and easy force, is a con-
stant safeguard against accidental movements of the fractured
ends, which would tend to irritate the soft parts, and render union
doubtful. From my experience with the retaining power of this
dressing, I feel assured that no plan is so well calculated to se-
cure success in cases of fracture of the neck of the Os Femoris,
(a case always produced by violent motion of the pelvis down-

1836.] Meteorological Observations, c. 287

ward, relative to the femur,) as it would, with the help of the
muscles of the part, very securely retain the fragments in appo-
sition with great steadiness, especially if the pelvis were well
fixed to the mattrass; whilst the weight of the body would af-
ford counter-extension, without the pressure of a counter-extend-
ing bandage, which might tend in any degree to displace the up-
per fragment.

In conclusion, I will observe, that from the excellent adjust-
ment preserved, I have ho doubt the splints and weight might
have been removed still earlier than they were; but I was un-
willing to risk any thing in experimenting, to determine how ear-
ly they might be safely dispensed with.

Augusta, August, 183G.

Meteorological Observations, fyc.for Burke and Richmond Coun-
ties* Extract from the Geological Survey of the two Counties.
By Professor J. R. Cotting.

Greatest heat at sunrise, - - - 74

Least heat at sunrise, - - 62

Greatest heat at 12 o'clock, - - - - 92

Least heat at 12 o'clock, - - - 78

Mean heat of the first half of the month, - 80.68

Mean heat of the last half of the month, - - 75.5

Mean heat of the whole month, - - - 77.2

Coldest day, August 31. Warmest day, Aug. 5.
Rain Guage, 6 inches 8 lines. Foggy mornings, 7.
Cloudy days, 6. Rainy days, 3. Thunder showers, 11.
Prevailing winds, NE., S. and SW.

From the 19th to the 31st, there were no thunder showers, the
longest interval that has elapsed since May ; still the air has
been very serene, and the Counties remarkably healthy for the
season.

The mean temperature of these Counties for August, differs
about 4 from that of Cambridge, Massachusetts. The form-
er being 77 2; the latter 72 16.

288 Analysis oft species of Clay, tyc. [Oct.

Analysis of a species of Clay found in Richmond County, which
is eagerly souglU after, and eaten, by many people, 'particular-
ly children. By Professor J. 11. Cottixg.

100 1-3 grains Troy

Silox,

31

Oxide of Iron,

- 12

Alluniina, -

34

Magnesia,

- io

"Water, -

12 1-3

Loss in Analysis, -

- 1

100 1-3 grains.

This substance, in its external characters, resembles Litho-
marge, or Hock Marrow. Colours, dark red, yellow, yellowish
red, yellowish white, purple and reddish white. Occurs massive
and stratified, strata undulating, opake, fracture conchoidal and
earthy; texture, fine grained; soft; may be polished with the
linger nail ; adheres slightly to the tongue ; gives a faint argilla-
ceous odour when moistened, or breathed on ; has the feel of
hard soap ; falls to powder in water, but docs not form a ductile
paste. Spec. grav. 2.53.

But its chemical characters and geological position, rank it
with the talcose family. It appears to have resulted from the
decomposition of talco-micaeous slate, which is found in the vi-
cinity. It underlies the ferruginous sand [formation , and silici-
ous rocks called pitchstone, resting on light sandy clay. I have
not been able to detect any organic remains of animals in the
formation. It sometimes contains vegetable remains in the state
of petrifaction and lignite. That it must have been the result of
the decomposition of older rocks, is evident from the above an-
alysis, its geological position, and from the fact of its containing
fragments of older rocks notinpla.ee. I found it associated with
other minerals in many parts of the survey, in both the Coun-
ties of Burke and Richmond, but the purest and most abundant
was on land of David F. Dickinson, Esq., near M'Bean Creek,
Richmond County, on the east side of the great road leading
from Augusta to Savannah, about fourteen miles from the for-

1 836.] Analysis of a species of Clay, <$-c. 289

mer place. Here large excavations have been made by ignorant
dirt-eaters to obtain it.

It has a slight sweetish taste, not unlike calcined magnesia ;
which property, combined with a certain morbid state of the sto-
mach, has probably induced to the unnatural, filthy and danger-
ous use of it. Its action is mechanical on the stomach, as it con-
tains nothing capable of being decomposed, and nothing on which
the gastric juice can act. This juice, although it is capable of
corroding iron and steel, as is found by experiment, has no action
on silex. It is a well known property of silex, that it will wear
away, or polish the most obdurate metal. It is an extremely
hard, brittle substance, in minute divisions, this adheres strongly
to the coats of the stomach, causing irritation of that organ, de-
rn nging the appetite for wholesome food, inflammation ensues, and
if persisted in, death. I am informed by respectable people liv-
ing in the vicinity of localities of this mineral, that many deaths
have occurred from no other perceptible cause, than from per-
sisting in the use of this dirt as a luxury.

We find it universally the case with these habitual dirt eaters,
that their countenances present a sickly, palid, cadaverous hue,
not unlike those mechanics whose constant occupation is polish-
ing metals, who are generally afflicted with disorders of the chest
and sooner or later fall victims to consumption.

A boy about fifteen years of age, whom I met at the above
locality, taking his favorite repast, informed me that he was in
the habit of eating daily of that substance, "as much as he could
hold in his hand." Admitting his statement to be true, and judg-
ing from the specific gravity of the substance, he must have swal-
lowed daily, nearly an ounce of pure flint ! He might, with
greater impunity, have swallowed as much white sand of the
pine woods, because in that the particles are rounded by attri-
tion, and in this they are angular, and the angles very sharp,
like the edges of broken glass. I asked the boy if his parents
did not inform him better ! He said, " he had only a mother and
she ate it too, when she was well, but she was almost always
sick."

This peculiar species of clay is said not to be found north of
the Potomac ; a species in some respects similar, is found at
Bare-hills, Maryland. That, however, is deficient in the pro-
portion of iron and magnesia.

37

290 Note to Professor Cotting's Piece. [Oct.

This substance may be employed as an excellent substitute
for Fuller's earth, in the dressing of woollen cloth.

Note. A very general error has, in our opinion, always pre-
vailed to a great extent, on the subject of the location of this
practice of dirt eating, in the series of phenomena which consti-
tute the chain of cause and effect. Nor is this an error of trivial
importance, so long as effects depend on causes for their produc-
tion. In medicine it is peculiarly dangerous, inasmuch as it
tends to conceal, or divert attention from primary causes, by
which, whilst they continue, subsequent effects must be perpet-
uated.

All-important as it is considered, diagnosis itself is less indis-
pensable than causality, in connexion with morbid phenomena.
The reason of this is, very obviously, that in the institution of
new causes, (which is the purpose of therapeutics,) the effects of
which are to be the correction or removal of some cause or
causes present in the concatenation of disease, the new causes
or powers thus instituted, must be endowed with some character-
istics peculiarly adapted and proportioned to the effects in view,
viz. the removal or correction of the present noxious cause. It
is as plain as that an alkali must be possessed of the peculiar
powers and qualities of its nature, to be calculated for the cor-
rection of an excess of acid introduced into the stomach. But if
an excess of acid abound in the stomach in consequence of func-
tional lesion of the stomach itself, whilst an alkali will tend to the
palliation of the symptoms and distresses, it will not be calcula-
ted for the correction of that organic lesion, which caused the
acidity. The best consequence then which may be rationally
expected from the use of an alkali, would be a temporary palli-
ation of the distresses of sour stomach : whilst in the other case,
or that which supposed acid introduced, it would effect curative
ends which nothing else could. But let us illustrate with the
case directly in point.

If dirt-eating be looked to as the cause of the attending phe-
nomena, as curative indications must have a peculiar adaptation
to the end to be effected, all attention and effort must be directed
to the purpose of confining the patient from the supposed nox-
ious power. Now it is certainly true, that the unnatural articles
taken into the stomach in cases of Bulimia, or depraved appe-

1836.] Note to Professor Cotting's Piece. 291

tile, often, perhaps generally exert noxious influences on the
system in some way or another. The withholding the patient
then, from the use of such unnatural and injurious articles, is
right, and calculated to palliate some of the troubles in the case
which arise secondarily ; but still the health of the patient, with-
out the operation of other causes or influences, not only fails to
recover, but continues to decline, just as surely as that a man
would continue to be wet who should stand in a shower of rain,
and constantly wipe away the water to make himself dry, in-
stead of spreading his umbrella over him. In this case, he must
do both. He must remove the water already on him and ward
off from him, by the use of his umbrella, that which would con-
tinue the wetting.

1 have never succeeded in curing these cases by directing my
indications solely to the taking in of unnatural articles: for with
this alone, the disposition continues. I have removed from the
primae viae the indigestible accumulations which have been found
there, and withheld the article for the future ; but the patient
would resort to others, as paper, rotten wood, bark, old rags, &c. ;
and in one instance, I recollect that a youth of about 14 years of
age, consumed for his last precious morsel, a whole pair of Os-
naburg pantaloons, with the exception of the waistband and
some small part of the seams. Thus it is, that although purga-
tives often remove those offensive things, they cannot, simply as
such, essentially and radically benefit the case. The truth of
this case is, that the habit, as it is considered, of dirt-eating, or
any of the displays of depraved appetite, is to be looked on
mainly as a phenomenon consequent to and perpetuated by its
own peculiar cause ; and whilst it is the duty of the practitioner
to remove from the system unnatural ingesta, with as much cer-
tainty as if they had been accidentally introduced, it remains his
paramount, and consequently indispensable duty to correct the
cause whereof this is the effect. A new set of causes have then
to be searched for. They are those which wrought out the im-
pairment of the normal condition of the stomach, &c, and plan-
ted in its stead a desire for things indigestible, unprofitable and
deleterious. Such a case is very analogous in its philosophy to a
case of dropsy. If an hydropic accumulation take place acci-
dentally, the cause of which is not continuous, as simply a check
of perspiration, or the compression of pregnancy, its removal is

292 Note to Professor Cotting^s Piece, [Oct.

a matter of trivial concern nothing being more easy than to
cure such a case, by removing the obvious effect, the cause of
which is not now operative for its renewal or perpetuation. It
is just so when we contemplate the effects of Bulimia, produced
accidentally, or without that depraved condition of stomach,
which is so calculated to perpetuate them. But if dropsical
phenomena be perpetuated as fast as they'are corrected, the mind
must, if it have not before determined this point, go in search of
other anterior lesions, structural or functional, which, although
themselves the effects of other and more remote causes, become
the cause of the phenomena of dropsy. Precisely similar is the
case of the dirt-eater. He feels as absolutely compelled to eat
improper substances, as the healthy man does wholesome food.
This act is as legitimate a consequence of the state of his system*
as the act of eating wholesome food is of that of the healthy in-
dividual. Each eats that to which his stomach most strongly im-
pels him. But the two individuals eat things diametrically op-
posite one partaking of nutritious, digestible and salutary arti-
cles, whilst the other, of such as are perfectly indigestible, innutri-
tious and injurious. Like causes produce similar effects. It is a
healthy condition which alone impels to the eating of wholesome
diet. Every appreciable deviation from health is disorder : there-
fore, as in the other case, unwholesome and unnatural articles
are commanded by the appetite, it follows that the organ of ap-
petite deviates from healthy condition, and is therefore disor-
dered.

We remember the days when that mighty corrector of visce-
ral derangement, calomel, was weighed out with all the care and
nicety that gold would have been, and was in but little use ei-
ther by practitioners or the common people. In those days
there were twenty dropsies for one now ; and although our ac-
quaintance was then limited to a very small circle, comparative-
ly speaking, still it is obvious that there were twenty, if not dou-
ble that number of dirt-eaters then, for one at the present day
when calomel is in universal use. Eds.

1836.] Stricture of the Urethra treated by Excision. 203

Stricture of the Uretlira, successfully treated by excision of the
indurated portion of the canal. Reported by William Henry
Robert, Student of Medicine.

Ellick, a negro man about 40 years of age, belonging to Mr.
J. P. Setze, had been afflicted with Stricture of the Urethra fif-
teen years, during which period he was treated by several phy-
sicians of this city and its vicinity, and repeatedly relieved by
the application of caustic and bougies. The disease, however,
always returned soon after the abandonment of the bougies.
The man says he has never had gonorrhoea, but was troubled
with gleet a long time. He was placed under the care of my
preceptor, Professor Dugas of this city, who, on examination,
found the stricture situated about three inches from the orifice of
the Urethra; the induration was easily felt externally, and^ex-
tended nearly an inch along the course of the canal. Attempts
to introduce a bougie, even of the very smallest dimensions, were
made in vain during several days ; the urine continually oozed
o,ut by drops, the patient being unable to empty his bladder. He
had been in this aggravated state one month. The impossibility
of introducing any dilating instrument, and the fear of inducing
total occlusion by the use of the caustic, together with the re-
flection that the latter remedy had already several times failed
to give permanent relief, determined Dr. Dugas to remove the
indurated portion of the Urethra with the knife. The operation
was performed on the 7th of June last. A longitudinal incision,
made through the integuments on the median line, exposed the
canal and permitted the excision of its diseased and thickened
portion, through which it was found difficult to pass a wire the
size of a common bristle. A gum elastic catheter of the largest
caliber was introduced into the bladder, and the lips of the wound
drawn together with adhesive strips.

June 12th. Wound healed by adhesion ; the patient has suf-
fered no pain from the catheter, which still remains introduced ;
urine slightly tinged with blood ; cream of tartar and nitre for
common drink ; catheter to be drawn half out, in order to relieve
the bladder.

1 5th. Catheter being bad was removed, and another intro-

294 A Case of Monstrosity. [Oct.

duccd four hours after, without difficulty or pain ; urine limpid;
some appearance of two very small fistulae, through which a
little pus escapes from the wound ; adhesive strips renewed dai-
ly, and catheter continued.

20th. Small fistulas entirely closed ; urinates without cathe-
ter, and without pain ; purulent discharge from the orifice of the
urethra pretty free ; metallic (pewter) bougie substituted for the
elastic, and kept introduced only through the night.

July 1st. Is apparently quite well, wears the bougie two or
three hours daily, as a precautionary measure.

Sept. 1st. Discontinued entirely the use of the bougie about
a month ago, and has felt no inconvenience since. Urinates now
in a bold stream, and savs he " is as well as he ever was in his
life:'

Augusta, Sept. 1836.

A Case of Monstrosity. By D. Waties M'Junkin, M. D., of

Tyrone, Georgia.

The object of the present short communication, is simply to
relate a singular case of Monstrosity, which occurred in my prac-
tice a few years since. Those who believe in the influence of
the mother's mind over the child in utero, would certainly regard
it as a strong proof of the truth of their doctrine. To say the
least, it is a remarkable coincidence and can not be satisfactori-
ly accounted for on any other principle.

Mrs. was threatened with miscarriage about the sixth

month of gestation, which accident was determined by the vio-
lent and ridiculous interference of an ignorant midwife, such as
attempting to thrust her hand through the parietes of the uterus,
mistaken for the membranes ; making her ride on a hard trotting
horse, <fec. I was called in time, not to prevent or repair the dam-
age committed by the foolish old woman, but to officiate in the
accouchement and observe the product which, from its peculiar
formation and the magnitude of its several dimensions, can not be
regarded otherwise than as a monstrous birth.

1836.] A Case of Monstrosity. 295

The admeasurement was made as particularly as the place
and circumstances would allow. Its length was 19 inches ; from
one acromion scapulae to the other, 7 inches; its feet 4 inches in
length. There was absolutely no neck, its head being placed
upon the shoulders similar to that of a toad. The bones of the
head were deficient in number. The parietal bones and the front
part or edge of the temporal, being all that were present. The
internal concavity of these was not manifest, they appeared to
stand almost perpendicular from the base of the cranium, leav-
ing a triangular space between them unoccupied by bony mat-
ter, but by a dense membrane of a velvet feel, and the colour of
coagulated blood; which inclined downwards and backwards,
from the root of the nose, or where the ossa nasi should have uni-
ted with the 05 frontis. From the superior anterior portion of the
right parietal bone were five cysts, running in a straight line to
the internal angular process of the right orbit. These cysts con-
tained a fluid, of a bright purplish hue. The middle one of these
cysts was the largest, which was about the size of a common
bullet, and from this they gradually decreased in size each way
from the centre. The hair was very thin over the parietal bones ;
the eye swere prominent and situated upon the sides and near the
superior portion of the parietal bones. Its nose was very small
and in some respects resembling the human nose, but more like
the nose of a frog. Its ears were uncommonly small and very
thick, and destitute of the helix. The mental portion of the an-
terior maxillary bone was contracted to a mere line and the body
of the same very deficient properly speaking it had no chin at
all. There were evident signs of life for about three minutes
after the funis was divided. Taking a general survey of the head,
the peculiarity and deficiency of the several portions, the appear-
ance almost exact of the Tarus Rana, or bull-frog, was presented.
There was no other part of the body deformed.

I regret much the opposition of the parents prevented a more
minute investigation. It was difficult to overcome their preju-
dices sufficiently to make any examination at all. I could not
obtain a minute history of her case during gestation. All that
she was willing or able to say was, that during pregnancy she
desired, or in her language, " longed for fish, and that while she
was one day devising means to catch some small fish that were
sv aiming in shallow water, a large bull-frog suddenly presented

290 A Case of Monstrosity. [Oct.

itself. She imagined herself soon after conception to feel much
heavier than in her former pregnancies at the same period ; and
as gestation advanced, she was evidently more prominent 'than
usual. The sensation of heaviness was so great that she was
incapacitated to attend to her domestic duties. She frequently
remarked that the " child lay so heavy, and across her back, that
she could not get about."

Whether the above circumstance had any influence upon the
contents of the gravid uterus, or whether it can be more justly
attributed to some other cause, I leave for others to determine.

If the foetus were so large at six months, what a monster would
it have been at nine !

Imagine two thin pieces put on the sides of a frog head, or
rather on the eyes, forming a kind of fork by the parietal and
temporal bones, and you will have almost the exact appearance
of this monster's head.

I have finished the task I proposed, in recording the case the
mother was frightened early in pregnancy by a frog and the
foetus had a head very similar in form to that of a frog. These
are the facts, let our wiser elders explain them.

1836.] Surgery Illustrated, $c. 207

Part II. REVIEWS AND EXTRACTS.

ISurgery Illustrated. Compiled from the works of Cutler, Hind,
Vclpeau and Blasius. By A. Sidney Doane, A. M., M. D.,
with two hundred and eighty Illustrations in fifty-two Plates:
pp. 200. Published by Harper <$> Brothers, N. York; 1836.

We have carefully examined this new publication, in order to
give it a full and candid notice in the Southern Medical and Sur-
gical Journal. There is one characteristic feature about its au-
thor which all must admire that deserves our highest encomi-
ums it is the industry he displays in his profession. Few in-
deed exhibit more ambition to be useful in getting up new pub-
lications in medicine than Dr. Doane. On an extra sheet attach-
ed to the Surgery Illustrated, we find his name connected with
no less than ten works, eight of which have already been publish-
ed within a few years, and two are now in the press. Notwith-
standing they consist of translations, compilations or new edi-
tions, still they are the result of great industry and patient labor.

The work now under consideration, professes to illustrate the
operations of Surgery by plates. Of these there are fifty-two in
number, containing no less than two hundred and eighty figures.
They are intended to exhibit the dressings, bandages and splints
now employed in surgery; then follow the appearances of the
different fractures of the extremities, the positions of the bistou-
ry, sutures, ligatures to arteries, amputations, operations on the
eye, for the removal of stone in the bladder, &c. with the various
instruments for performing each. This work is of royal octavo
size, and contains a text of 200 pages the price of which, at
Richards & Stoy's in Augusta, is 85 50.

We cannot speak very highly of the execution of this work.
The plates and figures designed to give it value are very poorly
gotten up. Those on dressings, bandages and splints, add noth-
ing to what we have had already, particularly from Gerdy. We
seriously object to those on fractures of the extremities, be they
even exact copies of the originals. They fail in the object intend-
ed they do not illustrate the subject of fractures. We ac-
knowledge this to be a very difficult task to execute; but these
plates might have been better shaded. Here too is a very im-
portant omission in surgery ; we have nothing on dislocations,
no illustrations of a class of the most frequent and interesting of all
surgical afflictions. We do not understand the figure, nor the
directions given for the continued or glovers suture, nor do we
acknowledge the importance ascribed to it in this work. The
description and the preparations for applying ligatures to arte-
ries, though taken from Velpcau, are very obscure in the trans-

38

298 Surgery Illustrated, c. [Oct.

lation. The frontispiece, which also serves for the sixth regular
plate, is a very meagre affair, and of little or no use in illustra-
ting the subject to which it refers. In plate 37, in both opera-
tions the saw is held in the left hand, and is represented as work-
ing from left to right, across the chest of the operator, instead of
forward and backwards. In plate 38, the position of the bistou-
ry in making an incision in the scalp for the application of the
trephine, is certainly a novel one; so also of the position of the
elevator, which by the by is a very queer one. Plate 48 we de-
fy any one to recognize what is meant by the figures ; not even
with the text can we comprehend the operation for fistula in and
as there described. Finally, we have never known lithotomy
performed, as a friend at our elbow remarked, without the pa-
tient being properly secured ; we think in all instances he ought
to be tied, except when the arms and hands are wanting, as is
represented in plate 50. There are also many errors in num-
bering not only the figures, but the plates. This necessarily
produces great confusion and ought to have been carefully cor-
rected.

It is very evident that the author of this compilation, is not a
practical man ; nor indeed can it be expected of one so much en-
gaged in writing. On the very first page he commits himself
He says nothing of patent lint, now so generally used, but speaks
of charpie made by scraping fine linen rag with the back of a
knife. Those who scrape lint will find it sufficiently slow in
accumulating even by using the edge of the knife. Pessaries
are made not only of ivory, wood and elastic gum, as stated in
the text, but also of metal, glass, wool, &c.

The instruments generally are badly selected; we must par-
ticularize the amputating knife and saw. We cannot conceive
how any one prefers the shape of the French to the English or
American Instrument. Whoever has used one of Weiss' knives
of English steel, will never go to Paris to look for a better, or if
he does, will assuredly be disappointed ; and certainly every one
must select the firm bladed saw with the teeth widely set apart,
and not the bone-like saw of the French case.

At page 159, we read, " The operation of trephining is requir-
ed in simple fractures, with depression, on symptoms of com-
pression continuing after depletion ; in compound fractures, with
depression, unattended with symptoms of compression." We
know not whether Dr. Doanc derived this last idea from Cutler,
Hind or Blasius, (we know he did not from Vclpeau) ; but it is
most assuredly at variance with modern experience in Surgery.

No one has done more to simplify the instruments and opera-
tions of Surgery than Lisfranc, yet his name is not mentioned in
the whole work.

Altogether, we apprehend this book has been gotten up more
for effect than for practical utility. The plates are of little val-

1830.] Extracts from the Note-book of a Physician, fyc. 299

j >

ue, the figures arc unnecessarily multiplied. They arc both too
numerous for the accompanying explanations, which are very
unsatisfactory.

Whatever may be the opinion expressed of the Surgery Illus-
trated, and we assure its author it is given from honest motives,
we cannot conclude this notice of it, without again commending
the zeal and industry of Dr. Doane. His example, his great
efforts to be useful, particularly to students of medicine and those
unacquainted with foreign languages, ought to be imitated and
deserves our thanks. P, F. E.

Extracts from the Note-book of a Physician of this City, during
his attendance on the Parisian Hospitals,

LISFRANC'S CLINIQUE.

Anatomy. The vulva is sometimes found so very small that
it is almost impossible to introduce a speculum. This does not,
however, invariably indicate the same narrowness in the vagina,
for it may be produced merely by the integuments of the perin-
eum, extending higher up than they should. It would be advi-
sable when women thus constituted become pregnant, to resort
early, say the fourth or fifth month, (for earlier might cause a-
bortion) to the slight operation of dividing this part of the perine-
um, in order that it should not be torn too much during labour.
If it be necessary to introduce the speculum, the incision should
be performed without any fear, for the parts contain no blood
vessels capable of affording a spoonful of blood.

Ruysh mentions having sometimes seen the hymen double. M.
Lisfranc says he saw one instance of the kind. The membrane
is not, as is generally thought, very thin ; it is on the contrary
nearly two lines thick, and as tough as leather. When imper-
forate, it should be entirely removed, and a dilating pledget, or
meche applied.

In individuals arrived at the age of 40 or 50, and who have
not cohabited for several years, the vagina becomes, as it were,
atrophied, and as narrow as that of a virgin. The parts are then
dry and hard; it is therefore necessary to be very cautious in
such cases, not to introduce the speculum too large, nor with too
much force and haste.

Very corpulent females have their labia pudendi considerably
thickened, and as this does not diminish during hbor, they can-
not be completely effaced, and impede the exit of the child.

STOO Extracts from the Note-book of a Physician, <-c. [Oct.

It is ridiculous to say that the nymphae are destined to direct
the flow of urine. It is evident that their office is to afford ma-
terials for dilatation during labor. As they are in some measure
connected with the clitoris, it may be that they enhance the ve-
nereal orgasm during coitus, and thereby tend lo insure impreg-
nation.

It has been lately proposed, in cases of rupture of the perineum
during labor, to make, previous to the sutures usually practised,
an incision on each side and at a small distance from the rupture,
so that the contact of the torn surfaces may be facilitated.

In women habituated to coitus, the uterus is not beyond the
vagina, but actually projects in it. There is an erectile tissue
in the perineum, which assumes the appearance of a tumour
when efforts at stool are made. The direction of the pudic ar-
tery should be carefully studied, for its course is very different in
females from what is seen in males. The vagina is generally
longer in tall women than in those of small stature. The pubes
are more prominent in southern than in northern females ; and it
will probably be found that the pelvis is also deeper and the va-
gina higher in southern women.

The attachment of the vagina to the cervix uteri, is six and a
half lines thick anteriorly, and seven and a half lines posteriorly,
so that the amputation of the cervix may be carried much high-
er up without injury to the peritoneum than is generally thought.

Introduction of the Speculum Uteri. For the introduc-
tion of the Speculum, the patient should be placed in the same
position as if she were to undergo the operation of Lithotomy,
save that her hands are not to be fastened to her feet, nor any
ligatures applied. The legs, or rather knees, arc to be held by
two aids if admissible ; if not, the feet must rest on chairs of an
equal height with the bed. The back must be horizontal, and
but a small pillow placed under the head. The size of the spe-
culum used should be proportioned to the dimensions of the va-
gina ; this may be judged of from the length of the vulva, for the
vagina is generally proportioned accordingly. M. Lisfranc
mentions a case in which the vulva was only an inch in length, but
very dilatable. The extent of the perineum varies exceedingly
in different individuals, and Mr. L. has seen it occasionally two
and a half inches. The labia? are to be separated with the lin-
gers of the left hand, and the speculum, previously smeared with
sweet oil, gently introduced with the right hand according to the
axis of the vagina. As soon as the instrument has passed the
external orifice, the labia arc to be left to themselves, otherwise,
the dilatation of the vagina would be impeded. The speculum
should be urged forward with the utmost caution, lest, by sud-
denly overcoming some slight opposition, the instrument be for-
pibly thrust against the os tinea:. The eye should be kept as

183C] Extracts from the Note-book of a Physician, <J-c. 301

much as possible in the speculum, in order to detect any devia-
tion from the axis of the parts, and to engage the os tinea? in its
extremity. This last part of the operation is not always free of
difficulty, for the os tincae is scarcely ever in its natural position,
especially in females who have indulged much in sexual inter-
course. It is generally turned downwards and backwards;
hence it is necessary always to touch, before introducing the
speculum, in order to ascertain the exact state of the parts.
This, however, should be done very gently, for fear of causing
a discharge of blood from any diseased surface that might chance
to exist, and thereby prevent the possibility of seeing. Care
should be taken not to mistake mere folds of the paricties of the
vagina for the uterine orifice, for this is often remarkably well
imitated, and the parts might be pronounced healthy, when in
fact they were not seen. It is in such cases that a long specu-
lum, and one made so as to open, becomes very useful, for by
pressing up a little firmly, the fold may be removed, or this may
be done by gently opening the instrument. The os tinea? being
exposed should be carefully and very gently wiped of its mucus
gr other discharges, by the aid of a kind of brush made with rav-
elled linen. A candle, of course, must be used; it is held in front
of the speculum, so that the rays of light may be directed to the
s tincae. If the uterus be high up, it may be lowered very con-
siderably, by telling the patient to bear down as if at stool. The
rectum should have been previously evacuated by an enema.
Look at the ulcerations as obliquely as possible, in order to judge
correctly of their depth *

General Symptoms of Uterine Disease. The symptoms
that should lead to suspect the existence of disease of the uterus
are: pains or twistings of the stomach, unattended with other in-
dications of gastric affection, and especially if they have resisted
the antiphlogistic treatment, whether there be uterine pain or not;
gastro-cnteritis resisting ordinary means: increase of the mamma?,
or else pain with or without this increase, during the interval of the
menstrual periods, are almost positive indications; ptvalLsm with-
out pregnancy : heaviness or pains about the loins or pelvis, whe-
ther occasioned or not by walking, riding, a false-step. &c, during
the intervals of menstruation; pains in the inguinal region, or
spleen, without increased size of this organ ; pain solely in the
rectum, or at the umbilicus, or along the sciatic nerve in the thigh,
without any other symptom of disease ; sensation of internal
hoemorrhoids; painful coitus always indicates at least inflamma-
tion of the os tinea-, and will then yield to rest and narcotics; ob-
stinate palpitations; uterine hc&morrhage as surely indicates a

* [Wo intend in our next number to make some remarks on this subject,
syhich the want of space forbids in the present. Eds. |

302 Extracts from the Note-book of a Physician, fyc. [Oct.

diseased state or morbid tendency in the uterus, as hcemoptysis
does that of the lungs; discharges per vaginam.

Particular attention should be paid to the insidious march of
some cases, which suddenly take off the patient when least ex-
pected. In some cases the pains cease entirely a few weeks pre-
vious to death, so as to induce the patient to think herself cured,
but this relief is suddenly interrupted, by hemorrhage, diarrhoea,
or stupor, the most excrutiating pains and death. The disease
may run through all its stages without the knowledge of the pa-
tient, so slightly is the system affected in some instances. Dis-
charges long continued may cause cancer, as well as pulmonary
catarrh does tubercles.

Cases of Uterine Disease Examined with the Speculum.

M. Lisfranc exhibited to-day the diseased uteri under his charge,
by means of the speculum. I examined sixteen cases, and was,
as usual, surprised to find the affections apparently so slight.
The great majority of them appeared to be merely hypertrophy
and a little redness ; generally a whitish and thick discharge from
the orifice ; in a few cases the red surface seemed to be excoria-
ted, in others strewed with small vesicles; I could discover true
ulcerations in no case, although Mr. L. mentioned it to exist in
several. It seems to me that he must confound excoriation with
ulceration. Among the cases, was that of a female, whose os
tineas was amputated by Mr. L. three years ago; the cicatrix
is quite visible and the parts healthy. The patient is here for
tubercles of the lungs.

Diseases of the Uterus. The diseases to which the uterus
is subject, may be enumerated as follows: 1st. Chronic inflam-
mation either of the body or neck of the organ, or of both, or
parts of both ; it is always attended with hypertrophy, and then
the tissue resembles that of the womb during pregnancy hy-
pertrophy may be considered the first step of inflammation of
this organ, whether acute or chronic. It must be remembered
that there is here no transformation of tissue.

2d. Transformation of the tissue, which becomes white, but
not schirrous. It is the same condition as that often observed
in mammas, and which may be made to disappear entirely by
compression, as practised by Kecamier; this process will never
dissipate a schirrus of the mamma. It occasions pains similar to
those of a schirrus, but these occur very early, which is not the
case with schirrus.

3rd. Schirrous stale of any part, or of the totality of the womb,
should be distinguished from ossification, or from calculi situated
in its substance, &c.

4th. Tumours occurring on the surface of the uterus Mr.
L. relates a case in which the uterus presented three firm bodies,

1836.] Extracts from the Note-hook of a Physician, $*c. 303

similar to cocks' spurs. Tumours of the uterus should be dis-
tinguished from those not attached to, but merely situated in the
vicinity of the uterus. Mr. L. has dissected eight cases pre-
senting tumours near the uterus, and in every instance the neck
of the uterus was thrown up so as to lodge behind the pubis, and
the body of the uterus pressed downwards in the pelvis. It
seems that tumours of the uterus have a tendency to project out
of the pelvis, and that those in the neighbourhood, on the contra-
ry, always press on the uterus and till the pelvis before they
leave it.

5th. Simple ulceration of the os tineas.

6th. Small polypi of the os tincae.

7th. Carcinomatous ulceration.

8th. Fungus of the os tineas ; this is not the fungus hematodes ;
it may occupy the vagina; is not ulcerated, but soft, spongy;
furnishes a sero-mucous discharge in great abundance ; the tu-
mour is very easily torn with the finger, and by pressure a fluid
may be obtained similar to that just mentioned.

Chronic Metritis, or simple Hypertrophy of the Ute-
ri's. Chronic Metritis, or simple Hypertrophy of the Uterus or
of any of its parts, unconnected with any degree of ulceration.
It is more common in the body of the uterus than in its Cervix,
and is generally very insidious in its progress, especially about
the critical age. It should then be termed latent metritis. The
hypertrophy is sometimes carried so far as to give the uterus the
size of the head of a six months foetus. This is not the kind of
enlargement caused by the production of a white tissue, resem-
bling the schirrous, though very 'different from it ; but it is a mere
increase of healthy tissue, and therefore should be distinguished
from all others, as being much more readily cured. In simple
hypertrophy; touching is always a painful operation, and the
consistence of the uterus is found normal, though rather soft;
To the feel it gives the same impression as an uterus in early
pregnancy, or shortly after abortion.

Treatment. Absolute rest is among the most influential
means, and one, without the strictest observance of which, it will
ever be impossible to effect a cure. The patient should not even
walk from h et bed to the sofa, nor even move about roughly in
her bed. She must be carried to her sofa, if she wishes to occu-
py it during the day. These precautions are recommended in
order to prevent the irritation kept up by the friction of the ute-
rus against the adjoining parts, whenever the patient makes the
least motion. (Is this friction really produced, as Mr. L. be-
lieves, by ordinary movements?) Abstinence from venereal
gratification is also absolutely necessary. Small quantities of
blood should be daily taken from the arm, as long as the patient's
state will permit By commencing with only 4 ounces, or even

304 Extracts from the Note-book of a Physician, c. [Oct;

less, according to circumstances, a spoonful if no more, it may
be continued for some time. It is here desired to obtain the re-
vulsive effects of the remedy, and these effects are much more
marked than is generally admitted. For instance, it is a certain
fact that leeches applied repeatedly and in large numbers to the
mamma, often occasion puenmonia, by calling the blood to the
chest. Again, it is very dangerous to continue the application
of leeches to the arms or chest, in individuals predisposed to ap-
oplexy, for in such cases, the disease will often be occasioned.
Mr. L. never applies leeches to the pelvic region, except in some
cases of chronic induration of the uterus, when it may be desir-
able to increase the action of the parts diseased, in order to dis-
cuss the induration. It is impossible to determine a priori, how
much blood a woman may safely lose. This must be decided by
careful proceedings, and regulated accordingly. If the nervous
system be found to suffer, resort to antispasmodics. Baths made
merely tepid, and often used, are very serviceable, unless there be
hemorrhage. Baths of the pelvic region only, should never be
employed. Tepid enemata are often very useful, as it is by no
means uncommon for persons in this state to be costive, and the
collection of foeces can be but a source of irritation. The baths
and clysters are recommended merely tepid, in order to produce
as little excitement of the organs as possible. Injections per va-
ginam, also tepid, are very useful ; should be made three times
a day, and the position be such as to retain the injection in the
vagina at least fifteen minutes. One s}Tinge full should always
be used for cleansing the parts, before the other be permitted to
remain. The introduction of cataplasms is filthy, disagreeable,
and more irritating than the kind of fomentation with mucilage
of flax-seed just directed. The injection should be made by
means of an elastic and small canula, which should be introduced
with caution, so as notrto wound the diseased parts.

Chronic Metritis, when slight and without pains, or merely
such as are intermittent, should be treated by revulsives to the
pelvis, as dry cups, moxas, blisters, issues, &c. Regimen should
be low, and strictly observed, for this is absolutely necessary to
ensure recovery ; no coffee, but mild vegetables, milk, &c. The
quantity of food should be gradually diminished to one-half that
\\sca\ in health. Idiosyncrasy should never be overlooked in the
regulation of the quantity,as well as quality, of food to be taken;
when vegetables disagree, let them bc.dressed with chicken juice,
fish, and white flesh. Walking should be carefully avoided as
long as ii causes the slightesl pain about the affected region, Un-
less it he absolutely necessary to the healthy performance of
digestion, or i<> the' amelioration of the nervous system ; at the
menstrual period, the patient, however, should always take more
or less exercise on fool. The state of the digestion and of the ali-
mentary canal should be very strictly attended to, for when dis-

183G.] Extracts from the Note-book of a Physician, c. 306

cases of the uterus become complicated with an affection of the
digestive tube, the chance of success is very much diminished.
Leeches may, sometimes, be applied to the os tinea;, when the
case is positively ascertained to be merely hypertrophy, without
schirrus ; and then, with the intention to stimulate the vessels,
and thereby bring about the removal of superfluous matter. If
the case be schirrus, there is great danger of producing as many
carcinomatous ulcerations as there arc leech bites, as has been
repeatedly seen in cases of schirrous mamma. Frictions with
Iodine may be useful ; the " Douches de Vagin" are highly ben-
eficial, as are also those of the uterus. They may be made sul-
phurous when there are also discharges. They should be con-
tinued at first about five minutes, and the length of time gradu-
ally increased. They are administered by means of a tube
communicating at one end with the vagina or uterus, and at the
other with a reservoir of water, placed in an elevated position ;
the atmospheric pressure throws in the water with considerable
force.

IlYrERTRoniY of the Uterus, with transformation of
tissue. The increased size of the uterus does not always ne-
cessarily indicate a schirrous state, for there may be simple hy-
pertrophy without alteration of tissue, or else hypertrophy with
transformation of tissue. This kind of hypertrophy may be
compared to the state of the mamma when said to be "engorge."
It is characterized by the almost total absence of pain ; the ra-
pidity of its progress; it very soon becomes chronic; does not
yield as readily to remedies as cases of simple hypertrophy.
The antiphlogistics should not be carried too far, for the disease
continues acute but a very short time. An excellent remedy is
compression, applied by the use of the pessary, of the shape of a
"bilboquct;" this instrument being well placed, the uterus, by its
tendency to descend, especially whenever the patient moves,
takes exercise, or goes to stool, is pressed against it, and thus
produces the effect desired. The pessary is to be removed when-
ever it occasions the least pain, and reapplied when the irrita-
tion has ceased. It may be left applied or not during menstrua-
tion, according to circumstances, for it often happens that the
uterus at this period is sensitive and necessitates its removal.
Injections should be continued, and cleanliness strictly attended to.

Tumours of the Uterus. These should be treated pretty
much as the preceding diseases, viz: by ant iplogistics, regimen,
rest, abstinence from coition, &c By such means, the progress
of many very voluminous tumours, although of a schirrous na-
ture, may be arrested, and the patient permitted to live a great
number of years, especially if she attend strictly to the reduction
of every symptom of irritation that may return

39

306 Extracts from the Note-book of a Physician, fyc. [Oct.

Milliary Folypi of the Os TiNCiE. Milliary Polypi about
the os tinea?, cither on the internal or external surface of its lips,
frequently exist and pass unnoticed for want of careful examina-
tion. They are extremely small, semi-transparent, not very
hard, roll under the finger, and do not increase in size. The
pain is excessive and similar to that of cancer ; no hemorrhage ;
no enlargement ; irregular menstruation ; such are the ordinary
symptoms. These increase and are attended with emaciation,
diarrhoea, and even death. If situated externally, they may be
readily seen ; but if within the orifice, the finger must be intro-
duced in order to feel them, or the double branched speculum
used so as to permit the orifice to be opened and inspected by
the eye. Unless the physician be very particular, he may not
notice them, so small and unimportant do they seem. The treat-
ment consists in taking hold of them with a pair of forceps and
twisting them off. Should they return, cauterize with nit. ar-
gent, after their removal. It is worthy of notice that the pain
ceases at the instant they are extirpated, and returns no more.
This operation should be followed by antiphlogistics and such
diet as will prevent imflammation of the parts, also cleanliness.

Tubercles of the Uterus. Tubercles may exist in the pa-
rietes of the uterus and also in the cervix. Lasnnec has an excel-
lent article on the subject in the great Diet, des Sciences Med-
icales. M. Lisfranc says he first detected them in the mamma?.
The inflammation of uterine tubercles, may be prevented by
proper means. It may remain latent, and then become cither
acute or chronic. The tumour produced, may be easily mista-
ken for hypertrophy with white tissue, or for schirrus ; but its
progress will evince its nature, for, according to the intensity of
the inflammation, it will assume either the form of a cold or a
warm abscess, suppurate, and discharge the kind of matter pecu-
liar to such tumours. The nature of the discharge will prevent
its being mistaken for an ulcerated carcinoma, as it is very dif-
ferent from the ichor of the latter ; is whitish, cheesy, ("caseeusc")
floculent, (floconneux,) as is the case with suppurating tubercles
of any other part of the body. By pressing the cervix uteri,
this peculiar matter is sometimes abundantly discharged. In
carcinoma we sec ulcerations simply ; but here an abscess. Ex-
tirpation is necessary in cases of carcinoma, whereas tubercles
may be cured without, as is often seen in cases of tubercular
testicles. The proper remedies are antiphlogistics, baths, injec-
tions with infusion or decoction of bark, the chlorides, &c.
The granulations should be touched with the " proio-nitraie-
acidc liquids de mercure" Rest and abstinence from venery, are
absolutely necessary. It is perhaps impossible to establish pos-
itively the diagnosis before suppuration takes place, hence tu-
mours of the womb should always be suspected to be of this na-

1830.] Extracts from the Note-hook of a Physic urn, $c. 307

turc, and treated accordingly. The abscess may open into the
vagina, rectum, perineum, &c, and produce more or less mis-
chief. When long continued, these ulcerations may degenerate
and become carcinomatous.

Ulcerations of the Os Tinc^e. The simple ulceration of
the mouth of the uterus is generally difficult to cure, even when
unattended with loss of substance. This may be owing to the
peculiar nature of the uterine tissue, and also to the irritation
kept up by the continual friction of these parts, at every motion
of the body, especially walking and riding. The irritating qual-
ity of the matter secreted by these ulcerations, may, by coition,
communicate to the man a species of gonorrhoea. These ulcera-
tions may eventually become carcinomatous.

Simple ulceration of the cervix is most frequently met with in
females from 20 to 35 years of age, and not, as some have thought,
at the critical age. This may be accounted for by the increased
action of the parts at this age, for excesses of venery, and preg-
nancy, are more common at this than at the age of 45 or 50.
Whenever a female complains of discharges from the vagina,
suspect ulcerations or redness of the os tinea? ; the slight degree
of redness very frequently observed, is not of much importance,
and should not be confounded with ulcerations. It is true, how-
ever, that when neglected, this redness often passes to the state
of ulceration.

The posterior lip of the os tincse is much more commonly af-
fected than the anterior ; perhaps because it is more exposed to
the action of the acrid humours which pass from the uterus and
collect in the most dependant parts of the vagina. This affec-
tion consists, in the first stage, of a merely denuded surface, which,
when exposed to the air, appears free of any discharge ; at the
second stage, a bloody fluid is discharged when the part is ex-
posed to the air by the speculum, or wiped with a soft lint brush.
By a side view, a slight loss of substance may be perceived, but
it is as yet extremely superficial, and seems scarcely to penetrate
beyond the external membrane. In the third stage, the ulcera-
tions arc much more evident, and true ulcerative granulations,
("bourgeons charnus?) as well as slight vegetations, may be seen.
The parts increase in size, become softened, are easily torn by
the least violence, feel soft to the touch, and soon degenerate
into complete carcinoma. It may, however, advance very far
without partaking of the cancerous nature, and this will always
be detected by the kind of discharge, which, if there be no can-
cer, is rather of a mucilaginous (glaireux) nature, than of that
of ichor.

Simple ulceration produces nearly all the symptoms of can-
cer; it causes as much constitutional disorder, and often death.
The paia is excessive, the discharge sometimes profuserand often

308 Extracts from the Note-book of a Physician, fyc. [Oct.

has the peculiar odour of that produced by cancer ; the consti-
tution undergoes that change called a cancerous diathesis. The
increase of pain during the progress of treatment, should not
always cause alarm, for this is often the case when the disease is
fast yielding, and has, in fact, nearly disappeared. Instance a
patient completely cured a year ago by amputation, but who
still suffers very much. Are these dependant on habit ? In this
affection, the cervix is almost always found inclined strongly
towards the rectum, and, in many cases, the patients complain
more of the rectum than of the uterus. These ulcerations may
complicate all kinds of hypertrophy ; they may be stationary
change places, or extend to the entire uterus, its attachments, &c.

Strict attention to regimen and rest, is absolutely necessary.
Cauterization may prove fatal when carelessly employed; but,
otherwise, it can be considered perfectly innocent and free of
danger. First abate the irritation or inflammation, in order to
prevent metritis from supervening. Never cauterize when there
is pain, but then order baths, emollients, low diet, and even ven-
esection if necessary. The caustic should never be used when
the ulceration is combined with tumefaction, (engorgement]) but
act as if this existed without ulceration ; order emollient injec-
tions and antiphlogistics. Hypertrophy of the os tineas, compli-
cating ulceration, should counter-indicate the use of caustic. In
order to apply the caustic, the speculum should be used, and the
cervix alone included in it. If this cannot be sufficiently well
done by the instrument alone, small pledgets of lint should be
wedged in between the os tinea; and end of the speculum, so as
to isolate this part from the vagina, and thereby prevent the ac-
tion of the caustic from spreading too far. This being done,
wipe the os tinea? clean, with a small lint brush, in order to re-
move the mucus which might prevent the action of the applica-
tion; touch wilh the caustic very lightly and repeatedly ; but
only in a small surface. This remedy acts by changing the na-
ture of the diseased action. After cauterization, the parts should
be well washed by injections, to prevent too much action. The
cauterization should be repeated every six or eight days, unless
circumstances prevent. The disease is sometimes aggravated;
then cease its use. It may be applied advantageously even in
cases of mere redness.

Injections of diluted chloride of soda, decoction of cinchona,
cau de Barrrgc, and douches, may be used for months, either with
or without the assistance of cauterization. The engorgement of
the ovaries, when chronic, is not an objection to cauterization.
The proto-nitrate-a.c'uh liquide de mercure, may not unfrequent-
ly be substituted with advantage for the lunar caustic.

Diseases of the uterus are extremely liable to return after ha-
ving been cured ; hence the necessity of attending particularly
to the state of the menses ; resort to venesection whenever they

183G.] Extracts from the Note-book of a Physician, tyc. 309

are disturbed. The continuance or return of pain after cessa-
tion for some time, is not always a symptom of a return of dis-
ease, but is often nervous, and will yield to narcotics. When
the ulceration, however simple, continues to spread, notwith-
standing the use of these means, and produces or threatens great
constitutional disorder, amputation should be resorted to, for
otherwise death may be occasioned. Why not amputate the
os tineas as well as a limb, when its diseased state affects the
general system and threatens life ?

Leucorriicea. M. Lisfranc considers leucorrhcea sometimes
an endemic affection, or dependant on atmospheric influence,
(constitution medicate). It is very often occasioned by the use
of foot-stoves, (chauffrettes) so common in this country; by a
humid season; occasionally by excessive venery; sedentary ha-
bits, especially if warm chairs are used; but perhaps the influ-
ence of hot climates tends more to produce it than any other
'known cause. The discharge may proceed either from the va-
gina or from the uterus, or at the same time from both. Chronic
inflammation of the vagina may gradually extend to the uterus,
and, if neglected, may give rise to a schirrous condition, polypi.
&c. It should be borne in mind, that w7hen these discharges have
long continued, they are true emunctories, and must therefore
not be suddenly suppressed. The organs of the chest should al-
ways be carefully explored previous to arresting this discharge,
for Mr. Lisfranc has known this neglect prove fatal to a great
number of females, whose lungs, being tubercular, ulcerated very
rapidly after the successful treatment of Leucorrhcea. It will,
when the lungs are the least suspected, be prudent to establish
-setons or issues previous to such suppression. The general
state of the system should be attended to, and tonics or antiphlo-
grstics used accordingly. The use of the speculum will decide
whether the discharge be from the vagina or uterus If from the
vagina, Mr. L. has used the " Potion de Chopart," (a mixture of
Bals. Copaiba, Spirits ^Ether, Nit. &c.,) or Bals. Copaiba and
opium internally or by enemata. The doses should be gra-
dually increased until either costiveness or diarrhoea be produced.
The opium may be carried to six grains daily, with advantage.
Injections of claret and wratcr, gradually made stronger, and even
carried to pure wine ; rose water; sulphate of zinc, &c &c.
Injections of chloride of soda, (diluted.) very rarely fail to arrest
it; their strength should be gradually increased. The posi-
tion of the patient's pelvis should be such as to retain the injection
in the vagina, at least ten or fifteen minutes, and thereby render
the injection rather a hath than a lotion. This injection cannot
be used for men, because of its liability to cause false membranes
to be formed in the urethra, and consequently strictures. This
objection might, in some cases, be obviated by the introduction of
a bougie immediately after the injection.

310 Extracts from the Note-book of a PJiysician, fyc. [Oct.

When the discharge proceeds from the uterus, its suppression
is more difficult to obtain. After the flow of the usual menstru-
al fluid, there sometimes succeeds one of a serous nature, almost
limpid, and so abundant that it soaks through thick folds of linen,
and even leads some to believe themselves affected with inconti-
nence of urine, or dropsy of the uterus. This flow, in some ca-
ses, appears but a few days after the cessation of the menses, and
continues a week more or less. The discharge may be thick,
opaque, acrid, &c. Here also the general state of the system is
to be carefully attended to, and prepared for the injections. If
these, made in the vagina alone, will not suffice, they should be
carried directly into the uterus, by means of a catheter intro-
duced into the orifice of this organ. This may be done without
the least pain, as was proved by Mad. Lachapelle, Mr. Dume-
ril, &c. Emollient injections should be tried before resorting to
those of an astringent nature. The decoctions of Elder flowers,
and Marsh mallow roots, are very good. It is necessary, during
the treatment of these discharges, to abstain from coitus. When
using the astringent injection, beware of metritis ; watch the
whole system.

On Amputation of the Os Tinc^. M. Lisfranc has just re-
lieved a female of the most troublesome palpitations, by the am-
putation of an ulcerated os tincoe.

It is wrong, he says, to think that the neck of the uterus should
be amputated, only when it is the seat of a cancer. Certainly
no one would hesitate to take off* a leg or arm, if either were
occupied by an ulcer of such a nature as to seriously in-
jure the whole system ; he does not see why the same rule
should not be applied to this organ. It must therefore be borne
in mind, that whenever the ulceration covers the whole os tincoe,
and threatens to spread to the vagina, no time is to be lost, else
the disease will rapidly degenerate into- cancer, and probably
render an operation impossible, by extending to the body of the
uterus. When the neck of the uterus is very short, as is seen
occasionally, the danger of the body of the uterus becoming dis-
eased, is very great. We should never be frightened by the
phantom of " cancerous diathesis," for it is impossible to say
positively that it exists, until the patient is nearly exhausted.
Moreover, the books are full of cases in which Extirpation has
proved successful, when there was every reason to believe in the
existence of the diathesis.

M. Lisfranc has now [1830,] amputated the os tinea? about
sixty-five times, and lost but very few patients ; the cicatrix is
generally complete in from four to six weeks.

Treatment after Amputation of the Os Tincoe. I wit-
nessed this operation performed the day before yesterday, by M.
Lisfranc. The patient (".'meed no pain, and indeed remarked

1836.] Extracts from the Note-book of a Physician, tyc. 311

that she had experienced none whatever at the moment of the
excision. Mr. L. observed, that the uterus resembled, in this
respect, the liver, testicle, <fec.; that it was insensible to the ac-
tion of the knife whilst compression, or torsion, produced intense
pain. Mr. L. takes occasion to make the following remarks.

" The patient has, since the operation, been affected with vom-
iting, syncope, nervous tremors, and even spasms. The sangu-
ineous discharge from the wound has not been sufficiently great
to occasion these symptoms, and they should be attributed to the
shock of the nervous system. They should excite no alarm,
being usual after this operation. The vomiting continued until
this morning ; there is some epigastric tenderness, probably ner-
vous ; her courage, so remarkable on the day of the operation,
has entirely vanished, and she now believes herself doomed to
die. Narcotic and antispasmodic enemata have been adminis-
tered ; leeches have been applied to the abdomen, it being pain-
ful on pressure. I never dread the haemorrhage, unless it be
very great, for it tends to relieve the organ, and to prevent the
development of too much inflammation. Narcotics (opium)
should always be administered, when the pulse is sufficiently
strong to bear them, for if it were very feeble, they would be
dangerous. They should be given in enemata, in order to spare
the stomach, which is then so irritable as scarcely to retain gum
water. If the habit be plethoric, take blood from the arm.
Should the hemorrhage become too abundant, the tampon must
be resorted to, and applied near the orifice of the vagina, in or-
der to avoid irritating the wounded surface by its contact. In
twelve or twenty-four hours, at most, remove the tampon and
coagula with the finger, for were they to remain longer, decom-
position would begin and cause serious irritation. I have been
obliged to resort to the tampon but six times in sixty operations.
There are usually pains in the abdomen and about the pelvis
three or four days after the operation ; venesection should then
be practised, if the pulse will permit, and the vagina be well
bathed with emollient fluids. Rest and abstinence are strictly
to be enjoined. In about a fortnight, the uterus should be exam-
ined, and the granulations cauterized with nit. argent., after
which, injections with tepid solution of mur. soda, will hasten
the cure. The cicatrix being complete, attention should be di-
rected to the causes which produced the disease the menses
should be restored ; &c.

"Females frequently complain that the disease is returning; a
careful examination will then generally prove that the pains, &c,
they experience, are merely nervous, and will readily yield to a
little opium. "

Amputation of Carcinomatous Os Tincs. "The patient in
question is thirty years of age. of a lymphatico-sanguine tamper-

312 Extracts from the Note-hook of a Physician, fyc. [Oct.

ament, is feeble, emaciated, dry ; her flesh feels flaccid ; no part
of her system, save her uterus, appears to be affected. It is an
erroneous opinion, entertained by many authors, that whenever
the neck of the uterus is seriously diseased, the other parts of the
body must suffer. From the present condition of the patient,
and the influence exercised by the uterine tumour on her system,
I am confident, that if left to nature, she must die in six weeks.
We should therefore operate, even were the cancer to extend be-
yond the neck of the uterus, to the parietes of the vagina ; nay,
were we compelled to remove a portion of the peritoneum.
Ambrose Pare and others, have successfully removed the entire
uterus; why should I not remove one-half of it ? Mr. Blundel,
of London, assured me he had several times removed the whole
with complete success."

Having premised these observations, M. Lisfranc proceeded
to the operation. The carcinoma being too voluminous to per-
mit advantageously the use of the speculum, this was dispensed
with, and the mass seized with a pair of hook-forceps, (erignes,)
in order to draw it near the os externum. The tumour was,
however, so soft, that the forceps repeatedly tore their way out ;
he was then obliged to place the hooks at the junction of the dis-
eased and healthy parts. Having thus seized it with a number
of these forceps, and placed some of them in the hands of assis-
tants, very gradual traction was made until the tumour was
brought to view. The disease was then perceived to occupy,
not only the cervix, but also the superior and posterior portions
of the vagina. The whole was removed, consisting of a circular
bit of the mucous membrane of the vagina, about two inches in
diameter, with. the os tinea? in the centre. The vagina was im-
mediately and carefully filled with lint, in order to arrest and pre-
vent hoomorrhage, and the patient put to bed. She appeared to
suffer extremely during the traction necessary to bring down the
tumour, but not so much whilst under the action of the knife.
She was much agitated for two or three hours after the operation ;
when nausea and nervous tremors supervened. M. Lisfranc
then saw her, but did not consider these symptoms alarming.
She was very soon after taken with violent convulsions and ex-
pired.

The autopsic examination threw no light on the cause of the
event ; a very small coagulum was found, on removing the tam-
pon ; no organic lesion detected. M. Lisfranc considers her
death occasioned by the spasms alone, and observes that the is-
sue could not have been foreseen, and may happen when least
expected. lie feels perfectly justified in having performed the
operation, and would not hesitate to repeat it, under similar cir-
cumstances.

.1830.] American Journal of Medical Sciences. 313

Part III MONTHLY PERISCOPE.
American Journal of Medical Sciences.

In the commencement of our editorial labors, we disclaimed
all unfriendly feelings toward our co-temporaries, and declared
our design and desire to bo harmonious co-operators to achieve
the same great and desirable object, the improvement of medi-
cine. We were sincere in our professions, and if we entertained
more regard for one than the rest, it was for the American Jour*
nal of Medical Sciences. We have been pleased to extract free-
ly from its valuable pages and give it full credit for all we re-
ceived.

It is true, had we vanity enough to constitute ourselves liter-
ary censors, or had we been disposed to endeavor to enhance our
own consequence by exposing the defects and faults of others,
we might have found something to condemn, notwithstanding the
editor's great experience ; but always despising that ignoble spirit
that delights in disparaging and speaking ill of others, we pre-
ferred rather to contemplate the useful and interesting matter
contained in his numbers and select therefrom for the benefit of our
readers. We were not disposed to quarrel with him for loving his
friends and neighbors to excess, and pushing the puffing system
beyond the bounds of discretion, or because he sometimes seem-
ed to run aground in his panegyrics and be entirely at a loss for
new modes and forms of eulogy this we regarded as an amia-
ble weakness and few, alas, err on the side of amiability !

But we were not a little surprised to see the following ill-
natured and illiberal criticism of the Southern Medical and Sur-
gical Journal among his bibliographical notices.

"Art. XXII. The Southern Medical and Surgical Journal. Edited by
Milton Antony, M. D. Professor of Obstetrics in the Medical College
of Georgia, and Joseph A. Eve, M. D., Professor of Therapeutics and
Materia Medica in the Medical College of Georgia.

Tins is another new candidate for public favor. It is to be published
nioul lily al Augusta, Georgia, and the first number was issued in June last.
Ii is divided into three departments, viz: 1. Original Communications.
2. Reviews and Selections. 3. Periscope. Each number is to contain 64
pages, and seven numbers will comprise about as much matter as one of this
journal. The price is five dollars per annum.

In the June number, the only one that has reached us, there are two or
three interesting original articles, which we shall notice particularly hereaf-
ter. The reviews are meagre and manifestly from inexperienced hands;
the selections are for the most part interesting.

It has been considered the high prerogative of literary and sci-

40

314 Acetas Plumb i in Cholera. [Oct,

entific men, to occupy a glorious pre-eminence, far above and
unaffected by the low strifes and petty animosities that agitate
vulgar minds, and even to maintain inviolate the strictest bonds-
of friendship and the most harmonious intercourse, whilst their
respective nations have been engaged in all the horrors of war.
But the conduct of our brother of the American Journal, cer-
tainly seems to savour of a participation in those sentiments of
jealousy and unkindness, unfortunately too generally felt and
cherished between the North and South of our own country.

What could be more ungenerous than such an attempt, by one
who enjoys so full a tide of editorial prosperity, to crush others
who though confessedly inexperienced, honestly aim to do well?
Would it not have been more charitable in him to have waited
at least until we had tried our " hands" a little longer before he
indulged in quite so much severity towards us?

Relying on the intelligence and magnanimity of our profession-
al brethren, to whose judgment we are willing fo submit, we
would have passed this invidious and unmanly attack with the
silence it deserves, but we thought it proper to correct a false
statement which might perhaps, as it was doubtless intended, mil-
itate somewhat against us, as the American Journal has an ex-
tensive circulation at the South. He says seven of our numbers
will comprise about as much matter as one of the American
Journal, and the price is the same: As the latter is published
quarterly and the former monthly, it ought of course to com-
prise three times as much the number of the American Jour-
nal that contains this dignified criticism, comprises 260 pages*
exclusive of table of contents, list of callaborators, advertise-
ments, &c. which are not included in the 64 of our monthly num-
bers whereas to be equal to seven of ours it should embrace 448
(7 times 64). There is certainly some difference between 260
and 448. The present number of the American Journal is about
equal to 4, instead of 7, of our numbers and we are warranted
by the encouraging increase of our subscribers and contributors
to hope, that before the Southern Medical and Surgical Journal
has been published as long as the American Journal, we shall be
able to extend its magnitude considerably without farther ex-
pense to our readers.

In conclusion we say to the editor of the American Journal,
he has been disposed to show no courtesy and we ask of him no
favour we take his Journal and we will make the best use we
can of it, but will always give him credit for all wre take it is
well worth $5 it is well supported by able collaborators and
is certainly, after making all deductions, a very respectable and
useful Journal.

Acetas Plumbiin Cholera. Dr. Graves of Dublin has for some
years used the Acetas Plumbi in cases of Cholera, with such sue*

183G.] Acelas Plumbi in Cholera* 315

cess as enables him to say, that in all cases where there was the
least hope of beneficial effects, this article succeeded in checking
the serous discharges from the howcls and terminating the vom-
iting. His formula for its ordinary use is, Acet. Plumbi ai, Opi-
um gr.i, made into 12 pills, of which he gives one every half
hour, until the rice-water discharges from the stomach and bow-
els begin to decrease.

The ordinary effect of these pills is that of gradually checking
the serous discharges from the stomach and bowels; the impor-
tance of which will be duly appreciated, when it is recollected
that it is the continuance of this discharge which conducts on
the disease to its incurable state. Although this diarrhoea ises-
sentially a stage of the disease itself, still in practice it should
serve as premonitory of those horrible phenomena which, with-
out its arrest, must soon supervene, and which constitute the
h ttcr stage of the disease. Any remedy then which may be
possessed of competent power for stopping those exhausting dis-
charges which are characteristic of the early stage of the disease,
is eminently worthy the prompt attention of the profession.

When the vomiting and diarrhoea were suspended, Dr. Graves
advised the gradual discontinuance of the pills. In this way, he
gave large quantities in a day, with great benefit, and without
bein^ followed by any injurious consequences.

This arrest of progress in this stage of the disease, secures at
once to the practitioner, that, of which he has been heretofore too
often deprived, viz. an opportunity for the effectual administra-
tion of mercurial or other medicines, according to the dictates
of his judgment.

We have seen in the Western Medical Journal, some account
of the use of sugar of lead in cholera, by Dr. Price of Montgom-
ery County, Ohio. Notwithstanding he succeeded to a consid-
erable extent in confirming the observations of Dr. Graves, rela-
tive to the efficiency of this medicine in the first stage of Cholera,
still it is observable that this practice was, with him, not so de-
cidedly successful as with Dr. Graves. All Dr. Price's account
of the use of the Acetate of Lead, appears to be marked by th; t
candor and honesty which at once display the honest man, tl e
practitioner of great merit, and the narrator who has for hisso'e
object, truth, and the interests of humanity. But we hope that
neither Dr. Price, nor any of his readers will be discouraged
thereby, in the use of an article, which, from its known medicin-
al powers, we should suppose adapted to the purposes herein
designed ; and that, with the excellent authority by which its use
in this disease has been introduced to the profession: for we are
bound to consider Dr. Graves of Dublin, at least, as one of the
most substantial practitioners now in the exercise of the profes-
sion. We will further remark, that we think the cause of the
difference of result in the practice of these two gentlemen is very

316 Acetas Plumbi in Cholera. [Oct.

obvious; and is not calculated to impair the confidence which
Dr. Graves' experience has created.

In the first place, the opportunities afforded Dr. Price, as to
the number of cases, have not been at all comparable with those
of Dr. Graves. And, in the second place, we should look for a
different result, from the different doses adopted by them the
dose used by Dr. G. being 3grs. acct. plumb, with 1-12 gr. opium ;
whilst that of Dr. P. was 10 grains of the former, with 1 grain
of the latter.

" That the secretion of bile will return, if that of scrum be ar-
rested, is established by the above facts," says Dr. Price, after
speaking of two cases in which the sugar of lead and opium had
effectually constipated the bowels and checked the vomiting, and
in which he had then produced bilious discharges by cathartic
medicines, " In both of these cases," continues the Dr., "pur-
gation was with great difficulty brought about, after the use of
lead and opium ; and in one case, was only effected with Croton
oil, after the use of a variety of cathartics to no effect." By
these candid statements of Dr. Price, we have reason to believe
that the increased dose which he used was out of proportion to
the demand of the different latitude, climate and locality of Mont-
gomery County in Ohio, (which borders on the 40 of N. L.
and ranges with Philadelphia.) for the use of those articles: rind
that consequently, the effects were too severe for the best inter-
ests of the cases.

Of the peculiarities of that locality we are not able to speak ;
but latitude does (cet. par.) exert a material influence on cli-
mate. This influence varies, however, by the different expo-
sures of the tract of country ; as remarked on the different sides
of the Alleghany Mountains.* Whilst on the subject of the in-
fluence of climate, which always bears a close relationship to
latitude, it may not be amiss to remark, that our observation
leads us to the opinion that the susceptibility of the system for
the action of different medicinal powers is not varied alike by this
influence; but that whilst the susceptibility for some articles is
materially decreased, or increased, that for others is not appre-
ciably altered.

Wc have remarked that the susceptibility for mercurial and
antimonial powers decreases, with considerable regularity, with
the decrease of latitude, and that the local peculiarities engen-
dered by a southern clime still farther influence, more or less,
this proportion between the varying susceptibilities of the sys-
tem and the differing latitude! "For example, in the use
of those articles in (.'corgi;,, we add about 100 pr. cent, to the
dose necessary in New York and Massachusetts, which range

*We arc aware oft lie fact, that the higher latitude? west of the AUeglia,
ny, arc more temperate than the same on the cast.

18,30.] Acelat Plumhi in Cholera, <$-r. 317

about 42 N. L., a difference of about 10 . In Louisiana the
increase of dose, for the same kind of operation, is still more:
and the experience in that part ofHindoostan which lies between
Bombay, and the Coromandel and Malabar coasts, and other
parts of India ranging with it, extending mainly from the 10th to
the 20th degree N. L. proves an increased demand of more than
double the portions necessary for the same manner of effect in
this latitude: Georgia and Louisiana being about a middle lati-
tude between Boston in the north, and Bombay and Aracan in
the south. At Madras, Seringapatam and Tanjore, the quanti-
ty for the same still increases. The increase in these southern
parts of India is still greater than the ordinary effects of the dif-
ference of climate, or latitude alone, owing to the peculiarities in
their localities, &c.

It is not, we believe, a fact of observation, that narcotic and
anodyne powers, lose their influence at, or near the same rate,
on approaching the equator ; although they do vary in an ap-
preciable degree. But styptic and astringent powers have not
been found to vary in any perceptible degree, unless indeed, as
there is some reason to believe, their power be increased.

The southern practitioner is never found to excede 2^ to 5 gr.
doses of ace t. plumbi, unless on some very extraordinary occasion
indeed; whilst the dose at the north is generally 5 to 10 grains.
Compound powder of alum, is generally found to display its full
powers in the south, in doses of 8 to 12 grains, and larger doses
are generally rejected by the stomach, whilst the northern dose is
5 to 20 grains.

More minute and extended observations on the change of sus-
ceptibility for the action of different medicinal powers, would be
of great interest to the profession, and would tend to heal the
thousands of errors in prescription, which are daily made in one
climate, from the books, instruction, or even the experience of
another.

If these views be correct, we should be inclined to believe,
that even the precise dose of Dr. Graves, repeated pro re nata,
would have been the most appropriate for the cases of cholera
in the west. After each dose, as was the case in the hands of
Dr. Graves, spontaneous bilious secretions might have been af-
forded, or these might have been easily produced by mercurial
purgatives, instead of needing Croton oil, after many other pur-
gatives, to overcome constipation.

When we presented to our readers Dr. Graves' remarks on
the use of the Chloride of Soda in fevers, in the second number
of this Journal, we intended to append a note, correcting an er-
ror in nomenclature, which pervades the whole article as it ap-
pears in the London Medico-Chirurgical Review, and which
also occurs in the British and Foreign Medical Review. It is

318 Alum in Typhoid Fevers, c. [Oci.

very evident that Dr. Graves has reference to the Chloride o{Soda,
(that is, the Chloride of the Oxide of Sodium,) and not the Cltlo-
ride of Sodium, which is common salt. We were more desir-
ous that this error should have been corrected, because we had
known a druggist in this city send common salt to a physician at
a distance, who had inadvertently in writing an order for drugs,
written for the chloride of sodium instead of soda ; but in the
hurry of business it was neglected and forgotten until the pre-
sent number. We beg leave to call the attention of our readers
again to Dr. G's. valuable observations, and request them to
read Chloride of Soda, in place of Chloride of Sodium.

We have, since the publication of the article referred to, em-
ployed the Chloride of Soda according to the directions and un-
der the circumstances, as recommended by Dr. Graves, and in
some cases have been very much gratified with its effects.

Alum in Typhoid Fevers. Professor Fouquier, one of the physicians of
La Charite is in the habit of prescribing alum, with considerable success, in
certain cases of typhoid fever. When the inflammatory symptoms which
generally mark the commencement of fever are succeeded by the symptoms
peculiar to typhus, such as weakness of the pulse, fixed and dull expression,
diarrhoea, acrid heat of the skin, &c. alum is advantageous. If inflamma-
tory symptoms should re-appear, its use is again counteracted ; so it is if the
bowels (which rarely happens in the second stage,) are constipated ; but
with these exceptions it may be confidently given, although the most seri-
ous nervous symptoms are present. In the stage of collapse, when there
is excessive prostration of strength, colliquative diarrhoea, sordes covering
the mouth, and foetid excretions, alum, either alone or with other remedies,
acts very beneficially. The diarrhoea diminishes, the tongue becomes moist,
and the strength improves. The dose is twenty-four grains daily for three
or four days, then increased to half a drachm, and after the same interval to
a drachm. When its good effects have been produced, the dose is to be di-
minished in the same proportion. Gum-water is a suitable vehicle : it may
be given in pills, but a solution is preferable. British and Foreign Review,
Bulletin general de Therapeutique, Novembre, 1835.

On the proper Temperature of Sinapisms. The volatile oil, on which the
stimulating properties of the powdered seeds of mustard depend, is not dis-
engaged or formed unless water is added to them ; but it has been imagined
that very hot water was preferable to cold. M. G. Faure, senior, has
proved, by many careful experiments, that this is not the case, but that wa-
ter, when heated to 192 (F.) and upwards, prevents the disengagement of
the volatile principle of mustard : consequently, that sinapisms should be
made with cold water, and for foot-baths the powdered mustard should be
first mixed with some cold water, to which boiling water should be added,
to raise it. to the necessary temperature. By one of those coincidences
which are not uncommon, the same facts have been simultaneously discov-
ers! by MM. Geiger and Hesse in Germany. The most satisfactory ra-
tionale is, thai the sudden heat coagulates the vegetable albumen which
form to each molecule, that prevents the water acting upon it.

All causes which coagulate albumen produce the same effect, such as alco-
hol, strong acid-, &c Cold waler, on the contrary, dissolves the vegeta-
ble albumen. British and Foreign Review. Journal de Pharmacie, Sep-
tembrr, 1835.

1830.] Hydrated Tritoxide of Iron an Antidote to A rsenic. 3 1 9

Hydrated Tritoxide of Iron an Antidote to Arsenic. This antidote is eas-
ily prepared and should be always in readiness. An ounce of iron filings,
with lour ounces of nitric acid and four ounces of muriatic acid, wore intro-
duced into a large ghss vessel, and subjected to a gentle heat until the iron
Was dissolved : to this solution sixteen ounces of cold distilled water were
added, and after some minutes the metal was precipitated by introducing
two or three ounces of liquid ammonia. The vessel was then filled with
common water, agitated, and the whole filtered-. This left about twelve
ounces of Hydrated Tritoxide of Iron. A teaspoonful weighed about an
ounce. The process occupied about an hour, and it was immediately re-
peated.

A very strong case is given by M. Geofiroy in the Journal de Mt'decine et
de Chirurgie pratiques, in which 3 i. of arsenic was deliberately taken by a
hair-dresser, labouring under delirium tremens. After several glasses of
sugared water, four or five pints of warm or cold water, charged with the
Hydrated Tritoxide of Iron, were given in a quarter of an hour. Copious
vomiting and a large stool were produced. For the next seven or eight
hours this treatment was continued, and the patient vomited and was purged
three times. There was neither colic, heat in the throat, nor any symptom
of poisoning. He complained of cramps in the fingers ; but was delirious
the whole time, talking and gesticulating. The quantity of the drink was
diminished he slept well, and in the morning was well.

It should be observed, that after the arsenic was swallowed, and the
friends ascertained it was arsenic, M. GeofFroy was sent for ; and after his
arrival, which was very soon, twenty minutes were required to obtain the
tritoxide.

MM. Bineau and Majeste, of Saumur, relate the following cases, to prove
the efticacy of the hydrated peroxide of iron as a counter-poison to arsenic
in the human subject. On the 13th of August last, about two o'clock, five
little girls, on leaving school, ate part of a cake, containing one-fifth of its
weight of white arsenic, which had been prepared to kill rats.

L. D., a3t. 7, who had eaten a piece weighing about two drachms, had,
half an hour afterwards, pain in the throat, a sensation of strangulation and
vomiting, succeeded by pains in the belly, great thirst, faintness, incessant
restlessness, and spasms. Dr. Bineau saw her at four o'clock : she had then
vomited five times, and rejected sugared water and milk which she had
swallowed. He gave her one grain of tartar emetic, which produced vomi-
ting and two stools. In an hour he had prepared the tritoxide of iron, and
by nine o'clock he had given five ounces, in divided doses. During this pe-
riod she vomited five times, and had one black foetid stool : there were stu-
por and slight convulsions of the limbs. At ten o'clock these symptoms
were relieved ; she slept quietly, and was well the next day.

M. G., act. 5i, swallowed about three drachms of the cake, and a quarter
of an hour afterwards vomited. Between this time and five o'clock she
vomited twenty times, and rejected all fluids. After vomiting, faintness and
depression, followed by extreme restlessness, pain over the whole body,
(particularly in the belly and legs,) cold perspirations, livid face, great thirst.
At four o'clock there was great and constant stupor, without loss of intelli-
gence. At five o'clock, M. Bineau administered five or six drachms of the
hydrated tritoxide of iron, and repeated the dose frequently at first, and
gradually increasing the intervals until ten o'clock. During this time she
vomited only three times, and the pain ceased ; but there were constant and
alarming stupor and depression. At ten o'clock the pulse rose, and at four
she slept naturally. In the morning she had two stools. No subsequent
symptom.

The other three cases were treated by M. Majeste.

Marie B., aet. 7, and Louise, her sister, set. 5, each ate about two drachms
of the cake. At four o'clock M. Majeste saw them : the face of the eldest

3&0 Fumigations in Hooping-Cough, <>c. [Oct.

was contracted, pale or livid, eyelids injected, great thirst, very hot skin,
pulse T-iO, belly tympanitic and painful, particularly the epigastrium, gener-
al depression, and constant vomiting and purging, since the poison had been
taken. The symptoms of the younger were rather milder. M. Majeste
returned to his dispensary, and in less than an hour prepared twelve ounces
of the hydrated tritoxide of iron, and he gave to each two ounces at four
doses, in twenty minutes. The vomiting ceased, but returned in an hour,
when he gave two ounces more at longer intervals, and a lavement with
half an ounce. At eight o'clock the vomiting returned with colic, and an
ounce was given to each, with half an ounce in a lavement: the vomiting
ceased, and did not return. They passed a good night. W ith the excep-
tion of some little intestinal irritation, and an~eruption in the eldest, which
yielded to simple treatment, there were no other symptoms.

The other child, aged 9, was less violently affected. The vomiting ceased
on taking the antidote, and in eight hours after the attack all danger was
over.

The action of the tritoxide as an antidote was evident. The dose in each
case was very large, above thirty grains of arsenic ; and, although vomiting
took place, yet a much smaller quantity has been often known to kill, al-
though there was vomiting. The symptoms were always immediately re-
lieved by the iron. The antidote itself appears harmless, as from four to six
ounces were given to each child without any ill effects; and, as this is the
case, it is advisable, even long after the poison has been taken, to estimate
the quantity rather by its effect on the symptoms, than by any proportion to
the poison, It is advantageous that this antidote is tasteless. British and
Foreign Review. Journal des Connaissanccs Medico- Chirurgicalcs, Novem-
bre, 1835.

Fumigations in Hooping- Cough. Dr. Dohm, of Heide, in the duchy of
Holstcin, has accidentally discovered a remedy for hooping-cough, that pro-
mises to be of considerable use in that too-oftcn obstinate and dangerous
disease. Two of his own children, a boy and a girl, (the former one, and
the latter three years old,) had been suffering from hooping-cough for be-
tween two and three months ; during which time several remedies, inclu-
ding belladonna, had been tried m vain. The paroxysms were very frequent
ami extremely violent, so that the faeces and urine used sometimes to be ex-
pelled involuntarily. An accident of this kind occurred one evening during
the absence of the father ; and, to remove the ill smell thereby occasioned,
the bedroom was fumigated, and that to such an extent that the child was
enveloped in the smoke. Contrary to the expectation of the doctor, the
child had not another attack that night; the cough became much milder,
and the repetition of the same treatment soon cured it. This encouraged
him to try it in other cases, and he invariably found the paroxysm greatly
relieved by it, if not completely stopped. The fumigation was made with
the common species of fumales of the Pharmacop. Slesvico-llolst. (Olibani
hbr. dins, BenzoeB, Styr, Calamitffi, sing. libr. dimid., Flor. Lavendul., Ro-
sar. rub., singul. unc. qoatuor.) lie [we think, very justly,] considers the
benzoin to be the most efficient ingredient. British and Fori ign Review.
Pfqff's MUiheilungen.

ERRATA.

Page 208, line 11, for fistula in and, read fistula in a\o.
Same page, second paragraph, last line, fur bonc-likc, read

BOW-LIKE

SOUTHERN MEDICAL

AND

SURGICAL JOURNAL

Vol. L] NOVEMBER, 183G. [No. 6.

Part I. ORIGINAL COMMUNICATIONS.

ARTICLE I.

Medical reflections, with two cases of Spinal Irritation, Simula-
ting Colic and Gastro-Enteritis. By J. W. Heustis, M. D.
of Mobile.

The enterprising and indefatigable researches of the physiol-
ogists and pathologists of the present day, and we may say of
the medical profession generally, have greatly extended the scope
of observation and inquiry, and produced more enlightened views
m relation to the functions, diseases, and influences of the ner-
vous system in all its phenomena, bearings and relations, as well
in health as disease, than were ever anticipated in the days of
Cullen and Brown. This is as it should be. No physician,
who properly estimates the exalted dignity and responsibility of
his profession, can consider any labor and assiduity too devoted,
that have for their object the alleviation of the amount of human
suffering, of mitigating the pangs of disease, and of contributing
to the restoration and health of the afflicted. An office so be-
nevolent and god-like, when undertaken with the true spirit.
confers a dignity upon human nature, and gives a character of
respect and veneration to the enlightened and successful prac-
titioner, alike calling forth the admiration and esteem of the civ-
ilized and barbarian. And what feelings can be more congenial
to the heart than those produced by the overflowings of grati-

11

Medical Reflections, tyc. [Nov.

tude, greeting the physician wherever he goes, as the messen-
ger of comfort and the disposer of blessings to possess such a
hold upon the confidence of the sufferer, relatives and friends,
that the very appearance of the familiar and cherished counte-
nance of the physician, lights up the beams of hope upon the vi-
sage of anxiety, suffering and despair? True, we sometimes
meet with unmerited and ungenerous treatment and mortifica-
tions, from the fickleness and caprice of those who should have
considered themselves under permanent obligations. Cases of
this kind, however, are so common, that they should cease to leave
any permanent impression on the mind of the more experienced,
satisfied in himself in relation to the correctness and propriety of
his conduct. The payment of an account is generally consid-
ered the liquidation of all obligations : with respect to the medi-
cal profession, however, such an idea is illiberal and unjust. It
is rare with us that the fees are larger than are necessary to
cover the expenses ; so that without other resources, the physi-
cian must be content to drudge on through years of penury, well
satisfied, if in the decline of life he is placed beyond the reach of
want and apprehension. And is such a perquisite a full equiv-
alent for all assiduity, solicitude and care? Is it thus that our
services are considered in the light of mere mechanical or mer-
cantile employments ? To a sentiment so unworthy, it has been
my good fortune to know many and honorable exceptions ex-
ceptions, affording a satisfaction more pure and genuine, than
any that could be yielded by mere pecuniary reward and com-
pensation. With these remarks, I enter upon the more imme-
diate subject of consideration.

The connexion of rheumatism and various painful affections,
with existing irritation in the spinal origin of the nerves of sensa-
tion and volition, has shed a new light upon the former disease,
promising to be of essential practical utility, as well in this as in
other affections which it may resemble in character and symp-
toms. As serving to elucidate this subject, I submit the two fol-
lowing cases, much abridged and condensed.

Case 1. I was called, Sunday, July 10, to see Mrs. W.
During my absence, Dr. B. had been called in, and had bled her.
As I, however, was the attending physician in the family, the
case came more exclusively under my care. The attack had
very much the appearance of a violent colic, viz. excruciating

1830.] Medical Reflections, fyc. 323

pain in the bowels or abdomen, and a strong spasmodic undula-
ting heaving of the thorax and abdomen at every inspiration, by
which the latter was thrown convulsively and violently forwards.
These symptoms were relieved by bleeding and the subsequent
free use of laudanum and other antispasmodics. There were
still, however, great soreness and tenderness of the abdomen on
pressure, for which the lancet was used twice, besides the free
bleeding at the commencement of the disease ; the warm bath
was also used, and also warm fomentations. On the third day
of the disease, to open the bowels, a moderate dose of caster-oil
was exhibited ; as this operated too freely, an opium pill was gi-
ven. From this time she was seized with convulsions, which
would frequently recur at irregular intervals, perhaps as often
as eight or ten times in the course of the day. At night she wras
generally composed, and rested well with the aid of an anodyne,
given either by the mouth or injection. She also took infusion
of valerian, as there was little or no excitement. Pills composed
of the blue mass , calomel and camphor, were also exhibited.
As she complained much of her head, this was repeatedly cupped
and blistered, as was also the region of the stomach. As there
was tenderness about the lower portion of the dorsal vertebrae,
a cup was applied to this portion of the spine, and subsequently,
a blister.

July 16. The blister drew well, but notwithstanding this, and
the various other means, she has had several severe convulsions,
and now lies in a state of stupor.

July 17. Had the cuticle removed from the blistered part,
and the surface dressed with cerate, containing about one grain
of the acetate of morphia : took an anodyne injection last even-
ing, and has been taking to-day, every two hours, about the sixth
of a grain of the acetate of morphia, and two grains of the blue
pill : took also, this evening, an anodyne enema, as there were
symptoms indicating the return of spasms. The opiates have
produced nausea and some vomiting; let them be discontinued:
has had no return of spasms since the evening of the 16th.

The pains, spasms and convulsions now, became much miti-
gated, and their return protracted to longer intervals. Great
relief appeared to be afforded by dressing the blistered surface,
with simple cerate, containing about half a grain or more o( the
acetate of morphia to each dressing. As there were pretty dis-

324 Medical Reflections, <$. [_N ov.

tinct intimations given of the threatened attack of convulsions,
by the appearance and sensations of the patient, these were pre-
vented by enemata of starch, containing two or three drachms
of laudanum. Under this treatment she soon recovered.

The first decided impression was made by the blisters and the
application of morphine to the denuded surface. The anodyne
injections were also of essential benefit. It is worthy of remark,
that the cupping of the temples, and all the applications that
were made to the head were entirely unavailing, clearly showing
that this was only sympathetically affected.

From all the circumstances connected with this case, I was
convinced that its seat was in the spinal origin of the nerves of
the lumbar vertebrae, or in the cord itself; and with this view the
treatment was finally directed. And it is proper to mention,
that previously to each attack of convulsions, she would be
seized with intense pain in the spine, sympathetically affecting
the head at the same time.

Case 2. Mrs. D. had been confined to her bed a number of
days, with what was called a bilious colic, and for which she had
been treated accordingly, by her attending physician. As hey
case continued without improvement, and the symptoms became
alarming, it was deemed expedient to hold a consultation. She
complained of severe abdominal pains, subject to frequent exa-
cerbations, for which her only relief was in the free use of mor-
phia. As there were some symptoms resembling those of the
case above related, I suspected an affection of the lumbar or
dorsal nerves, or of the cord from which they originate. Upon
pressing upon the spinous processes along the four or five lowey
dorsal vertebra), and the upper portion of the lumbar, she shrunk
from the touch, making great complaint of the tenderness and
pain therefrom : and, indeed, she referred the origin of her ab-
dominal pains to the spine, radiating from thence as a common
centre. 1 suggested to her physician, the propriety of exciting
counter-irritation of the spine, by blisters or tartar emetic. He,
however, appeared rather to lake a different view of the case,
considering it as chronic enteritis, originating from an attack of
bilious colic; and so we compromised, directing the warm bath
occasionally, morphia to allay the pain, enemata to keep the
bowels free, and food of the mildest and least irritating kind, as ar-
row root, crackers and tea.drv toastand things of that description.

183G.] Hfedical Reflections. $c. 325

She was already in a state of salivation, and the cheeks and
fauces were considerably ulcerated. In nearly the same situa-
tion she remained several days, under similar treatment, occa-
sionally a little better and then worse, without any permanent
improvement. The pulse was rather full and strong for a person
in her debilitated state, although she had been bled the day pre-
vious. As the case belonged more exclusively to the former
physician who had previously attended her, I saw her but seldom.
On the 18th of August, I was particularly requested to visit her
again; there was but little alteration; she was still confined to
her bed. She complained of great tenderness and soreness of
the abdomen, along the tract of the colon, for which I cupped
her, but without any permanent relief, as she was attacked the
next day with pain and spasm as violent as ever. Agreeably
to my original idea, I now applied a pitch-plaster, strongly im-
pregnated with tartar emetic, to the affected portion of the spine.
She still found it necessary to use the morphine. Her former
physician saw her, in company with me, and from his represen-
tation of the previous good effects of mercury and salivation in
her case, she was put upon the use of the blue-pill night and morn-
ing. On the 23rd of August, four days from the application of
the plaster, I found her sitting up for the first time, attending to
some light domestic employments, quite cheerful, saying that she
was getting well that she could now put her feet to the floor
without that dreadful pricking and stinging sensation that she
before experienced in her feet when attempting that movement.
Upon enquiring whether the plaster had produced any uneasi-
ness of the back, she said it had, and that it was very sore and
raw, but that she did not regard that if it would only assist her
recovery. Her former physician had, a day or two previously,
suggested the propriety of putting her upon the use of the blue-
pill, with ipecac and opium, every two hours. She wished to
know of me whether the object was to produce salivation, I re-
plied that was, in part, the design ; she thereupon strongly pro-
tested against the prescription, and against the use of mercury in
any quantity or form, having already, as she said, suffered so
much from salivation. The prescription was not insisted on, and
her rapid convalescence rendered it unnecessary.

I consider the tartar emetic plaster, as the sole efficient agent
in the relief of this case.

326 An Account of Cholera, fyc. [Nov.

The probability is, that were cases of supposed colic and en-
teritis more closely analyzed, they would frequently be found to
proceed from spinal irritation ; and, indeed, so important is the
relation which the medulla spinalis bears to the general system,
that in all painful, spasmodic and convulsive affections, its exami-
nation should never be neglected.

Mobile, August 31, 1836.

ARTICLE II.

An account of Cholera, as it prevailed in the City of Savannah
and its vicinity, in the Fall of 1834. By P. M. Kollock, M.
D., of Savannah, Georgia.

Since the subject of Cholera began, more particularly, to at-
tract the attention of European and American physicians, its
history, pathology, treatment, and in fine, every circumstance
relating to the disease, as presented to the observation of those
who have witnessed it, have been so minutely and voluminously
discussed, that it might appear rather supererogatory and per-
haps presumptuous, to attempt at this time to present any thing
which could be considered original, or at all interesting in regard
to it. But, however minute have been the descriptions, and how-
ever voluminous the essays on the subject, every man of judg-
ment and candour, every one interested in the establishment of
truth, and in the advancement of science, is compelled to ask
himself the question How much good have they done ? how
much have they contributed towards the establishment of the
pathology of the disease, and more particularly of its treatment?

In considering the first part of this query, the philanthropic
physician has much cause of triumph and rejoicing. The scal-
pel of the pathological anatomist, particularly of our own coun-
try, has revealed to us most satisfactorily, the condition of the

1836.] An Account of Cholera, fyc. 327

organs, which is the result of the operation of this most mysteri-
ous agent and taught us that cholera is not to be considered a
disease of extreme debility, in any of its stages, and demanding
for its cure the administration of the most powerful stimulants
known to us ; but rather that it is to be classed with those disea-
ses which exhibit the phenomena of the most intense phlogosis.

Far less reason, however, has the profession to exult in their
success, in having established a sure and uniform course of treat-
ment, deduced from a pathology, which seems so clearly and sat-
isfactorily ascertained. Notwithstanding the apparent certain-
ty which exists in regard to this point, the treatment of the dis-
ease in general is as fluctuating and unscientific as can well be
conceived; and consequently its success is proportional. On
this account, when it makes its appearance, practitioners, as well
as patients, are panic-stricken their unsettled notions lead to
failure in practice the community lose confidence, and are rea-
dy and anxious to plunge into the vast ocean of empiricism.

Having had cause to feel most forcibly the truth of the above
remarks, I have been induced to offer the following paper to the
notice of the profession in this section of country, not with the
hope of presenting, in any strikingly original point of view, a
subject, about which so much has already been written, or of
adding any thing very important to the mass of information on
the subject. But believing that the disease on its irruption at this
place, exhibited features differing in some respects from what
were observed in other parts of the country, particularly at the
North ; and consequently that it required a modification of treat-
ment accordingly, my object has been to invite the attention of
Southern physicians to these points, in order that they may test
the correctness of my observations, and with the hope that my
hints may not be found altogether without utility.

This fell destroyer of human life had visited almost every
part of the American continent, before it reached Savannah.*
Early in the Summer of 1834, it broke out in Canada and New
York, and we could not hear of its being nearer Savannah than
Washington City, when about the 1st of September, it was re-
ported by the health-officer of the port of Savannah, that some

*It had approached in October, 1832, within 100 miles of Savannah ha-
ving been carried to Folly Island near Charleston, in the brig Amelia, from
New York, which was wrecked on Folly Island.

328 An Account of Cholera, fyc. [Nov.

cases very much resembling in their appearances, Cholera As-
phyxia, had occurred on the plantation of Maj. Wightman, about
12 miles above the city, immediately on the Savannah River.
These cases were soon followed by others. The disease con-
fined itself to this plantation for, some little time, and the number
of cases was large, before it extended itself to other adjacent
plantations. It at length progressed, and after attacking one or
two places above Maj. Wightman's, pursued a downward course,
until it visited every plantation on the river, even the last below
the city. This occupied about three weeks, and during this in-
terval there occurred but six or eight deaths in the city, and
most of these cases originated in the country.

A very few days after the disease broke out at Maj. Wight-
man's, we heard that it had made its appearance on the River
Ogeechee, 15 miles from Savannah, and without any of the in-
termediate places being affected.

Cases of the disease continued to occur in the city and along
the course of the Savannah river, until late in the Fall. Since
1834, cases have occasionally been met with, resembling the
disease under consideration, more or less nearly ; but usually
they have proved very manageable.

In the year 1832, when Cholera first made its appearance in
America, and prevailed to such an extent in our northern and
western cities, there was observed a very strong predisposition
to bowel affections among the inhabitants of this vicinity, in com-
mon with those of all other parts of the United States. So much
was this the case, that we were obliged to administer cathartics
with the greatest possible caution, in the treatment of our ordin-
ary fevers. But in 1834, previous to the appearance of the dis-
ease at Maj. Wightman's, it is remarkable that there was no
strong epidemic tendency to bowel affections observed. As the
disease advanced, the predisposition accompanied it, and three-
fourths of our population were affected with cholerine or chole-
raid. It was remarked, however, by other physicians, as well
as by myself, that other diseases did not so far assume the "liv-
ery" of the reigning epidemic, as to render any material modifi-
cation of their treatment necessary. In the treatment of our or-
dinary fevers, we were enabled to prescribe cathartics with the
same freedom as in ordinary seasons.

According to the accounts of writers on the subject, it will be

1830.] An Account of Cholera, fyc. 329

observed that Cholera, among us, differed in this respect from
the disease which prevailed elsewhere. The symptoms of the
disease which raged in this vicinity, were at variance in many
respects with what it assumed in other places. According to
my observation, the cramps in the extremities were not as much
complained of as is generally stated nor do I think that the
discharges from the stomach, bowels, and skin, were usually as
profuse. It was not always possible to ascertain with precision,
the quantity which had been discharged from the stomach and
bowels; but I judged of the lesser profuseness of these discharges,
by what I could gather from enquiry, and from the extremely
phlogosed condition of the mucous membranes, which remained
after death, as discovered by dissection. When the dischar-
ges have been very profuse, the inflammation is relieved, and
there are no traces of it observed in these membranes, excepting
such as are indicated by their diminished consistence, &c. In
every case it could be ascertained on enquiry, that the patient
had been affected with diarrhoea, accompanied with more or less
pain in the bowels, for some days or hours previous to the su-
pervention of collapse; and this diarrhoea was always at first
bilious. With greater or less rapidity, the stools lost their bil-
ious appearance, became almost perfectly transparent, or semi-
opaque, like water in which rice has been washed or boiled and
often the same matter was thrown up from the stomach. The
patient soon became as cold as marble ; lost his pulse ; the skin
for the most part was dry, and not always shrivelled ; but inelastic.
The tongue wTas sometimes blue and cold at other times warm,
always moist sometimes clear, then again foul: The patient
in the cold stage complained of no pain, merely of weakness and
fatigue. Sometimes when not disturbed, he lay in a stupor, with
his eyelids half closed, and the balls turned up ; at other times
there were great restlessness and tossing from side to side. The
voice in some cases was very weak, and reduced to a whisper ;
in others, where the collapse was confirmed, the voice continued
nearly as strong as natural. Although great weakness was com-
plained of, the muscular strength was retained to a surprising
degree. I have been informed by other physicians, that they
observed the sensibility impaired to so great a degree, that boil-
ing water poured on the skin was scarcely felt. I did not notice
this in any case. I poured boiling water on the legs of a negro

42

330 An Account of Cholera, $c. [Nov.

man in confirmed collapse, which he felt so acutely, that he leaped
up instantly and appeared to be in great agony.

In those cases which were fortunate enough to pass through
the stage of collapse and react, a pretty severe bilious fever suc-
ceeded, attended in some instances with violent gastritis, as
manifested by the blood-red and furred tongue, and with great
determination to the brain, producing coma more or less intense.
Sometimes this reaction rose so high, as to require very profuse
and frequently repeated bloodletting, to protect important organs.

My personal acquaintance with Cholera, commenced at the
plantations of the estate of Thomas Young. On the 6th of Sep-
tember, 1834, 1 visited the place on the upper part of Hutch inson's
Island, called " Ham." Two negro men had been attacked with
the disease, while cutting rice in the field, and were found dead
on my arrival. It is most probable that these individuals had
laboured under diarrhoea some days or hours previously, which
had been neglected by them the fact, however, could not be
ascertained.

On the 7th of September, I visited the back river plantation*
called u Fife." I found two men collapsed one with very little
pulse, the other with none. Not having seen any case previous-
ly, I prescribed the treatment which I understood had been suc-
cessful at Wightman's, and which was as follows: R. Calo-
mel, gr. x. ; Gum. Camphor, gr v.; Gum. Opii. gr. i. : every
hour. Sinapisms to the extremities and abdomen. I endeav-
ored to excite vesication by pouring boiling water on the ex-
tremities ; but found it productive of such extreme distress, even
in the deepest collapse, and attended with no perceptible good
result, that I very willingly abandoned it.

Uncertain as to the treatment best adapted to the disease, as
presented to my notice, 1 determined to avail myself of the first
opportunity of post mortem examination, in order to ascertain,
if possible, the true pathological condition of the organs. Ac-
cordingly two cases presented themselves both had passed into
the stage of collapse before I saw them. The treatment above
detailed was prescribed death supervened in from 12 to 24
hours after they took to their beds, although I have no doubt a
diarrhoea must have existed previously. At the time of their
death, they had taken about xl. grs. Calomel, xx. gr. Camphor,
iv. gr. Opium,

1830.] An Account of Cholera, fyc. 331

In the first case examined, the mucous coat of the stomach was
found intensely inflamed throughout the Calomel had not pass-
ed from the stomach. There was a slight inflammatory blush
throughout the mucous coat of the small intestines, which con-
tained a tenacious creamy matter. The large intestines exhib-
ited no traces of inflammation, they were entirely empty, with
the exception of the Coecum, which contained small particles of
hardened feces resembling gall stones. The vessels of the ex-
ternal coat of the intestines were much injected, and the whole
exhibited a bluish tint. The liver was pale and exsanguine ;
gall bladder distended with bile; kidneys pale and bloodless;
spleen rotten ; bladder contracted and empty ; mesenteric glands
enlarged. The abdominal muscles, when cut through, exhibi-
ted an unusual stagnation -of blood in the small vessels.

The second case examined displayed the same intensity of
gastric inflammation as the first; but in this case, the inflamma-
tion of the intestines was quite equal to that of the stomach, and
in the colon blood was effused in several spots. The intestines
and stomach were filled with the rice water effusions In this
case, the bladder contained some urine. The appearance of the
liver, kidneys, mesenteric glands, and external coat of the bow-
els, was similar to what was observed in the other case. In both
cases, the fat of the omentum, as also that surrounding the kid-
neys, was entirely absorbed. In the last case, the spleen was
natural as to size and consistence.

As the result of this examination, I became averse to the em-
ployment of active stimulants and narcotics, in the treatment of
a disease which presented so many and such decided appearan-
ces of intense phlogosis. The idea of applying camphor, opi-
um, capsicum and alcohol, to such surfaces as the scalpel had
brought to lijjht, was revolting in the extreme. I therefore en-
deavored to adopt a practice as strictly sedative as possible.

Bloodletting was accordingly resorted to at the commence-
ment of the attack, when the subject was robust and the pulse
active a blister was applied to the abdomen and gum-water
the only nourishment allowed.

In some slight cases, unattended with vomiting, a few grains
of pulv. dover. were prescribed with benefit; soda-water was
given to check vomiting; sinapisms and stimulating frictions,
with an infusion of capsicum iu alcohol, or spiritus terebinth.

332 An Account of Cholera, $c. [Nov.

were employed to favor determination to the surface, where a
centripetal tendency was observed.

These means, in a vast number of instances, were sufficient to
check the disease, even in some cases where collapse had com-
menced.

As the disease advanced in its career. I was induced to modi-
fy the treatment and adopt a course still more antiphlogistic and
depletory.

Hitherto, I had refrained from the use of cathartics at every
stage of the disease, and every thing calculated to increase the
peristaltic action of the bowels being governed by the injunc-
tion of northern physicians, who asserted that instances were
frequent, where the disease was aggravated, and the patient pre-
cipitated into the stage of collapse, by the injudicious adminis-
tration of a cathartic. And accordingly my efforts were always
directed to arresting the frequency of the discharges, and for
this purpose, as has been stated, the narcotics were occasionally
employed. I found, however, that the first stage of the disease
could be treated with more certainty, and much better effect, by
the speedy removal of bilious accumulations, which usually ex-
isted J?t that time, and by a total abstinence from narcotics.

The following course was therefore pursued : The patient
being attacked with cramps in the bowels and diarrhoea, with
frequent and profuse bilious dejections, he was bled from the
arm until the commencement of syncope, or until the pulse be-
gan to yield a large blister was applied to the abdomen and
as soon as the effects of the bleeding had subsided in some mea-
sure, xx gr. of calomel were administered and succeeded by a
table-spoonful of castor oil, in two hours ; gum-water the only
drink allowed.

When vomiting has supervened, and the discharges have as-
sumed the rice-water consistence and hue, the cathartic is a
doubtful remedy, and I think, should be avoided. The vomi
ting will usually soon cease, if the patient is not allowed to take
any thing into his stomach, even the smallest quantity of drink,
and a sinapism applied to the epigastrium. When the collapse
has commenced, venesection should be practised with great cau-
tion, as I have seen it obliterate the pulse entirely, and confirm
the collapse.

The cold stage of the disease, -or as it is usually called, the

183G.] An Account of Cholera, tyc. 333

stage of collapse, was regarded here as elsewhere, the moribund
condition. The patient has parted with an important portion of
his vitality ; the hand of death is upon him. The vital spark is
nearly extinguished, and we know not'with certainty, " where is
that promethean heat, which can again its light relume."

If the profession here cannot boast of more success in the
treatment of this stage, than occurred elsewhere, I do not believe
that they have to reproach themselves with less. Recoveries
from collapse arc pretty nearly as rare, as from the black vomit
stage of yellow fever; the community, therefore, should be
deeply impressed with the importance of commencing the treat-
ment of the disease with energy in its forming stage. Many
lives have been lost by neglecting a midnight attack, until morn-
ing light exhibited the hopelessness of their condition.

The stage of collapse has generally been described, as induced
by exhaustion from the immense effusions of the serous portions
of the blood. Doubtless this explanation will suffice in many
instances, and in such, the mucous coat of the stomach and in-
testines is found free from all traces of inflammation, it having
been reduced by the excessive effusion. But in a great number
of cases which came under my notice, it did not strike me that
this cxplanat:on was altogether satisfactory. It did not appear
that the discharges had been as profuse, as were usually repre-
sented ; and in most instances, the skin was dry, instead of being
bathed in perspiration, and not shrivelled. This was the fact in
regard to the two cases, the post-mortem examination of which
has been detailed and it was to the comparatively small amount
of effusion, that was to be attributed the intensity of the mucous
inflammation exhibited by them. It seemed as if the general ex-
citement of the system, was wholly absorbed by that of the in-
ternal organs, which induced the collapse.

It would be difficult to say what course of treatment was not
essayed by our physicians, during the stage of collapse. One
plan was very nearly as successful as another. Some pushed
the diffusible stimulant practice to the utmost extent ; others ex-
hibited an incredible amount of mercury in an equally incredible
short space of time. According to my observation, the patients
under both plans, sank with more rapidity, than when they were
left almost entirely to nature. Nor could it have been reasona-
bly expected to be otherwise, considering the pathology of the

331 An Account of Cholera, $c. [Nov.

disease. For is it not more probable, that when the balance of
excitement is so much in favor of the central organs, the appli-
cation of active stimulants and irritants to them, will serve to fix
this hyper-excitement more firmly ; and that it. will be much more
difficult, if not impossible, to diffuse the excitement, however
much we may stimulate the surface and extremities?

Very soon after the appearance of Cholera among us, I tried
during the cold stage the emetic practice, as recommended by
Drs. Chapman and Hopkinson of Philadelphia.

I visited a plantation below the city, where I found two ne-
groes collapsed ; one a young girl, the other a middle-aged man.
The girl was pulseless the man not entirely so. The salt wa-
ter emetic was administered to each, which vomited them ac-
tively. The puking having ceased, xx. grs. of calomel were
given, and it was directed that it should be repeated in x. gr.
doses, every hour, until they had taken 3i. At my next visit,
on the following morning, I found that the girl's system had react-
ed completely the man was in articulo-mortis, and died in a few
minutes. The girl labored under the usual fever of reaction for
some days, and slowly recovered. This was the only instance
in which I observed this practice successful, although I em-
ployed it repeatedly.

I have siace, however, had reason to believe that the emetic
would be followed by good results in many instances, if it is not
succeeded by the calomel and would therefore recommend, that
when it be employed, every thing calculated to irritate the sto-
mach and bowels in the smallest degree, should be withheld,
and that the patient be allowed to take nothing but mucilagin-
ous drinks in small quantities, of which gum-water is best. At
the same time, the excitement should be invited to the surface,
by the application of sinapisms and stimulating frictions.

The emetic appears to act beneficially in some instances, by
means of the shock which its operation communicates to the sys-
tem, and the centrifugal impulse which it occasions. It is pro-
bable that the emetic is better adapted to those cases, where the
inflammation of the mucous membranes has been in a great mea-
sure reduced, by the excessive profuseness of the; discharges.
Where there is much inflammation remaining, its utility is ques-
tionable.

I do not think that calomel should ever be given except in the

I83t>.] On Intermittent and Remittent Fevers, c)-t\ 3J35

forming: stae;e of the disease, and then as a cathartic. I consider
it a doubtful remedy after the discharges have assumed the rice-
water character.

I am aware that the remarks, contained in this paper, may net
escape the cavils of a portion of the profession. I give them,
however, as the result of my convictions, and they must stand
or fall by the test of subsequent experience.

ARTICLE III.

Remarks on the Pathology and Treatment of Intermittent and
Remittent Fevers, with cases. By Lewis D. Ford, M. D.,

Professor of Chemistry in the Medical College of Georgia.

I have united these two forms of fever in the following remarks,
because of the striking resemblance of their features generally,
and under the conviction of the great similarity, if not identity
of their pathology. They resemble each other strikingly in the
symptoms precursory of the formal attack, and in the first dis-
tinct paroxysm so closely, that the most expert ob>erver will not
pretend to foretell which of the forms the disease will subse-
quently assume; also in the progression of the symptoms of a
paroxysm and in its duration. We infer their general similar
nature further, from the fact of their simultaneous appearance
in different individuals under similar circumstances of exposure,
and from the fact that they mutually run into each other.

Taking it for granted, that they both arise from an external
cause, which cannot be doubted, whatever difference of opinion
may exist as to what that cause is, what it should be called,
&c, the question naturally occurs Can we render an account
of the fact, that under the agency of this identical cause, one

336 On Intermittent and Remittent Fevers, c. [Nov.

form is determined in one individual and the other in another?
for if we can, we may be confirmed in the opinion of their gen-
eral similarity and deduce from this explanation some useful
practical directions. On exposure to this external cause, an in-
dividual suffers a regular paroxysm of fever. After a certain
intermission, comes another and another ; we may infer, that the
cause, at the moment of becoming efficient in producing each
paroxysm, finds the organs of the system generally in the same
state, as at the commencement of the first or if previous par-
oxysms had produced alterations in some of them, they are not
such as to counteract the regular succession of the phenomena of
the paroxysm. But, while under the same external circumstan-
ces, this case becomes remittent, when we will generally be able
to discover some physical or functional signs of disorder of some
of the organs of the head, chest, or abdomen this morbid change,
at first slight, not of a degree to produce danger, under a
state of quietness approaching to that of health, but liable to be
increased to a dangerous degree by the agitations of succeeding
paroxysms; and it is matter of observation, that if these super-
added disorders of the organs be not relieved, they are increased
by every succeeding paroxysm, and disturb more and more the
regular periodicity of the fever ; which in its progress to a fatal
termination, exhibits more and more distinctly, the marks of this
local affection. Hence we conclude, that if of two individuals
under similar exposure, an intermittent be determined in one,
and a remittent in the other, that there is some visceral irritation
in the last, either pre-existing the attack and increased by it, or al-
together determined by the first paroxysm itself, and that as long
as the fever preserves its periodical character, even in this mod-
ified degree, it does so under the influence of the same organic
condition on which the perfect and regular periodicity of an in-
termittent depends.

What then is the pathology of this intermittent fever ? which
from the time of the earliest records of medicine, to the physi-
cians of all ages, has presented in its different forms, one unva-
rying character a character so uniform, that the description of
the simple disease by Hippocrates, would graphically represent
those cases seen by ourselves. For it is worthy of remark, that
the practical history of intermittent fever was perfected by Hip-
pocrates himself; that is, its external dcvclopcmcnts accurately

1830.] On Intermittent and Remittent Fevers, fyc. 337

marked and even the names of its various forms, imposed by
this great father of the science, are retained to this day. The
question then, as to the pathology of this disease, becomes one
of peculiar interest to the philosophical physician, since from this
uniformity, it has presented a subject so favorable for investiga-
tion allowing the science of each succeeding age, to hold fast
and establish those principles as to its nature, which were true,
and gradually to discard those that were erroneous. In this
point of view, its history is calculated to illustrate the powers
and resources of the science. It may be interesting to trace its
history in a very general manner, and to connect the opinions
entertained as to its nature, with the prevailing philosophy of the
most prominent systems ; for the fact, that we do not now under-
stand its pathology, is well calculated to produce doubt as to the
certainty of the science of medicine, after all the confident and
boasted pretensions of these various systems to have explicated
its nature ; which doubt will be removed by the conclusion to
which we must necessarily arrive, that the science has not at-
tained to this knowledge of its nature, because of the defective
modes of its investigation.

Hippocrates, with his admirable principles of forming medi-
cine into a science of observation and of facts, with wonderful
exactness, recorded the phenomena of this disease ; and if he had
applied the same scrutiny to the interior of the human body, his
theory might have been valuable but what could be expected
as to its pathology, from him, who understood not the difference
between a ligament and a nerve, nor that these were the chan-
nels of sensation ; who attributed motion to the agency of the
tendons; who was ignorant of the circulation of the blood, and
understood not the functions of the brain ? The philosophy of
his age, had established the dogma of the existence of the four
elements of nature, and in accordance with the spirit of the times,
which was seeking for comparisons and strained analogies be-
tween the universe and the human body, he established the dog-
ma in medicine, that the body wras composed of four humours, &c.
and that diseases depended upon a super-abundance or deprava-
tion of one or other of these.

Author of the excellent principle of ever having some definite
and specific object in view in the treatment of disease, his indi-
cations in this instance, wTere founded upon his pypothetical views

43

83S On Intermittent and Remittent Fevers, c. [Nor,

of its proximate and occult causes viz. : to aid nature in the
concoction and expulsion of the peccant humour. Such is the
conclusion of him, who set out with the declaration, that obser-
vation and just deduction are the only true means of advancing
medicine. What a conspicuous example of the uncontrollable
tendency of the human mind to vain and unprofitable speculation,
do these views of this great man exhibit apt prototype of the
medical philosophers of all succeeding ages !

Galen, 500 years after him, his admirer and commentator,
with greater exactness, attributed the quotidian form to the pre-
dominance of the phlegm, tertian to that of the ordinary bile,
quartan to the black bile. The opinions of Hippocrates, thus
extended and stamped with the seal of this great master, contin-
ued to control the minds of their successors to the time of the
introduction of the system of chemical medicine. To give but
one single example of their pathology : A celebrated partisan
of this school, had determined very exactly, the composition of
the globules of the blood to consist of phlegm, salt, sulphur and
earth that fever in general consisted in an unnatural fermenta-
tion of these and that intermittent fever especially, was gen-
erated when the salino-acid and acrid principles, happened to get
into the small vessels !

Whatever credit is due to the celebrated German reformers
of the commencement of the 18th century, for overturning the
chemical and humoral doctrines, their pneumatic system was
calculated to establish nothing certain with respect to the inti-
mate nature of this and other fevers. Stahl distinctly discoura-
ages the application of physical and chemical science to medi-
cine, and especially denounces the study of minute anatomy,
lest it might lead men to the belief that disease sprung from
changes in these delicate parts, and thus draw them away from
the study of the great laws of the organization, and from an ex-
amination into the alterations of the vital principle. We are
not surprised at the deductions of this system as to the nature of
fever fancifully representing it to be a commotion of the sys-
tem, excited by this active principle this soul, thus roused to
this extraordinary effort to free itself from an offending cause.

In the " First Lines," the text book of the elder of the present
generation of medical men, we find this same mysterious agent,
under the name of the vis medicatrix naturae, raised up to explain

1830.] On Intermittent and Remittent Fevers, tyc. 339

some of the changes in a paroxysm of intermittent. It is there
characterized as "an agent," as "making efforts," and we
would suppose from the peculiar phraseology, that all the instances
in which this supposititious power exerts itself, and even the modes
of its operation, were well known to, and exactly apppreciated by
the Edinburg professor for there is this remarkable sentence,
occurring too by way of argument in favor of his peculiar theory:
" Because, in almost all the cases in which an effort is made by
the vis medicatrix, a cold fit and a spasm of the extreme vessels
are almost alu:aj/s the beginnings of such an effort"! And after
making this agent bear so conspicuous a part in his pathology,
he arrives at the flattering conclusion, that "this doctrine will
serve to explain the nature of fever in general," &c, and mod-
estly congratulates himself upon having thus been led into "the
proper train of investigation."

An American critic* upon Dr. Cullen's theory of fever, ex-
pressly avows his belief in the "existence" of this hypothetical
agent, formally assigning to it functions; and he too, is well ac-
quainted with its various offices, for after mentioning some, such
as the knitting of fractured bones and the healing of wounds, he
adds, " and many other processes which we cannot now enu-
merate"! He speaks of it as "a curative cause" In his opin-
ion, it controls every thing, medicines and all " were it not for
its action, recovery from disease would be absolutely impossi-
ble." After declaring that the reasoning of Dr. C. is " forced
and artificial, unsatisfactory and confused," he asserts his belief
with the fanciful Darwin, that fever is a disease of association
that it is formed alone through the medium of " sympathy."
We are irresistibly tempted to apply to this criticism, the re-
mark of Dr. Johnson, upon some of Mr. Travers' speculations:
"this is like casting out devils by Beelzebub the prince of devils."

And even in the latest of those " Practices of Physic," with
which our medical literature so much abounds ; in which one man
attempts to develope the nature of all diseases in a general and
superficial manner, instead of confining himself to the critical and
philosophical investigation of one those books that tell " Baith
the disease and what will mend it," and the popularity of which
books we believe to be one of the causes of our lean and meagre

* Professor Caldwell.

840 On Intermittent and Remittent Fevers, <$-c. [Nov,

attainments in medical science, by discouraging the printing and
reading of Monographs the " Practice of Physic" of M'lntosh,
contains an illustration of the difficulty of putting down and
keeping down this volatile serial spirit, which from Hippocrates
even till now, under the names of "Nature," "Archeus," " The
soul," "The vital principle," the "Vis medica,"and the "Vis med-
icatrix naturae," has been called up, to cover with its imposing
veil, the ignorances of the science. He says, "It is best to at-
tribute the reaction of fever to the Vis medicatrix natures, which
is ever in action to prevent injury and to remedy the evil after
it has occurred." This remarkable sentence follows the formal
declaration in the same paragraph, of "Acting upon the princi-
ple of not enquiring into occult causes "!

To those in and out of the profession, who are disposed to
undervalue it from an examination into the history of opin-
ions upon the nature of this disease, w7e would say : Shall it bear
the reproaches, which are justly due only to those, who have so
far departed from all true philosophy, and indulged themselves
in this idle hypothesis-making? Who, instead of frankly and
unreservedly acknowledging that they could not render a just
and true account of it, have resorted to the agency of fanciful
fictitious principles, thus contributing to the perpetuation of
this false philosophy of occult causes, and to the stifling of judi-
cious enquiry, by leading the minds of the young to rest in these
false explanations.

But the times of this scientific magic have passed away. The
severe medical philosophy of the present day, basing itself upon
the principle which lays at the foundation of both the science of
physiology and pathology that there is no action of the human
system, healthy or morbid, that does not. result from the appli-
cation of material agents acting upon the tissues of the system ;
rejecting with utter abhorrence, the agency of any of these fan-
ciful abstractions ; refusing to spend its high powers in investi-
gating diseases of elementary properties and qualities ; question-
ing the validity of every dogma, ancient or modern ; studying
medicine as a physical science ; is seeking for the nature of dis-
eases in the alterations of the tissues ; is patiently collecting facts,
declaring that we arc not yet ready for the deduction of general
principles to form a system. The celebrated disciples of this
true philosophy in France and other countries, warned anew by

1836.] On Intermittent and Remittent Fevers, cj-c. 341

the ephemeral history of the commanding physiological system,
of the danger of being too hastily betrayed into generalization,
seem disposed to adhere with increasing faithfulness, to this only
rational method of investigation And accordingly one of the
most eminent of the present French physicians, M. Rostan, au-
thor of organic medicine, classes this intermittent fever among
those affections, whose pathology is unknown; and calls it "the
despair of organic medicine" ! considering it hopeless ever to
arrive at any certain and definite knowledge of the cause of in-
termittence. This last conclusion, however, we cannot but re-
gard as unphilosophical it is a denial of the omnipotency of the
philosophy of observation ; for who shall limit its discoveries,
that regards the present state of the physical sciences, attained
under its happy guidance ?

We should not doubt that the accumulated observations of
the present age, will discover some fixed and uniform physical,
organic changes, upon which this singular disease depends, and
thus arrive at a knowledge sufficient to guide us with a steady
and satisfactory light, into correct principles of its treatment.
For we anticipate that this disease will claim in an eminent de-
gree, the attention of the present generation; the pride of the
science is concerned in explicating the nature of an affection
treated so empirically, yet so successfully.

Convinced of the importance of recorded facts, I have been
induced to make from my note-book, a brief abstract of the fol-
lowing cases, observed from the 23th July to the 1st of October.

1. First visit, Ju.iy 2S. A negro woman, a3t. 40, of good habits,
a washer with a regular quotidian : suffering during fever, with
distressing nausea and oppression of the precordia, sighing, and
hurried, irregular respiration. Having suffered in December
last an attack of colic, with excessive pain over the whole peri-
toneal surface, but without effusion, and treated by cupping and
blistering the spine, 1 was induced to examine it now, and
found a remarkable degree of tenderness on pressure, at the 2nd,
6th and 1th dorsal vertebrae pressure there increasing the nau-
sea and labor of respiration. She was cured by calomel pur-
ging, and subsequent use of quinine; sinapisms to the spine re-
lieving nausea, when applied during the fever.

2. August 4th. A negro waggoner, aet. 30, suffered with bil-
ious fever, according to his account, at Macon ; has been lip for

342 On Intermittent and Remittent Fevers, $c. [Nov.

a fortnight. Now has fever at night ; pain in the bowels and
stomach ; pain on pressure over the whole abdomen ; regular
stools; tongue slightly furred white ; diminished appetite; pulse
not increased in frequency; general languor and anxious coun-
tenance ; spinal tenderness at superior of the back. By gruel
diet and a blister to the spine, the following day he was entirely
relieved from pain, bearing the freest pressure of the abdomen ;
appetite returned, and tongue clean ; countenance cheerful.

August 10. After severe exercise, had a chill last night, fol-
lowed by fever, which has declined. Now, same soreness of ab-
domen ; yellowish-white furred tongue ; pulse 90, and soft ; some
tenderness of dorsal vertebrae. After being purged freely with
calomel, the soreness of abdomen unrelieved, on the evening of
11th, had another chill with fever but a lighter paroxysm than
the first; the spine still tender on the 12th. A blister then re-
lieved all soreness of abdomen and checked the chill without fur-
ther medicine. On the 27th, while at work, was again taken
with fever, and took calomel, &c. On the 28th, at 4 p. m., a se-
vere ague, followed by fever. On the 29th, saw him the ver-
tebrae still sensitive on pressure ; a blister again checked the
chill and he has had no further return.

3. August 6. A negro boy of 9 years ; irregular fever, after
eating much fruit; no spinal tenderness. Relieved by emetic
and purging.

4. Negro woman, set. 25, of good constitution, uniformly
healthy. Case of quotidian intermittent, accompanied during
the paroxysm with great depression of spirits, weeping and sigh-
ing, and distressing nausea and vomiting, with general soreness
of the abdomen ; exquisite pain of the upper and middle dorsal
vertebrae, on pressure. After purging with calomel, &c. ; cups
with scarification of spine during a paroxysm, entirely relieved
the nausea, vomiting and soreness, restoring her cheerfulness;
and a blister to the spine arrested the disease.

5. August 8. A white boy, set. 16; delicate; six weeks
since had chill and fever, which was checked by quinine. Six-
teen days ago, was suddenly seized with violent pain in the right
knee, which was relieved by stimulating applications ; the fol-
lowing day, a chill, and since a regular double tertian. The
7 or 8 superior dorsal vertebrae distinctly tender on pressure.
On the decline of paroxysm to day, was purged with magnesia

1836.] On Intermittent and Remittent Fevers, <$*c. 343

and salts, and freely scarified and cupped on the spine, which
was repeated on the 9th; and the chill, without the use of other
means, was arrested. On the 17th and 18th August, he suiTered
a paroxysm each day ; the spine still sensitive ; a blister checked
the disease promptly, and he has since continued wTell.

6. August 15. A mulatto boy, act. 16, a painter. This was
a case of double tertian, characterized by excruciating pains du-
ring the paroxysms, in the limbs and epigastric region. Ex-
tremely offensive breath and heavily furred tongue ; and very
great tenderness of the spine, from the third vertebra down.
Treated with calomel and oil, and cupping and blistering the
spine, which brought it to the simple tertian form and much mit-
igated the violence of the symptoms during the paroxysm ; the
quinine was finally used, and on the 19th, he was discharged.

7. August 14. A female, set. 60 ; full habit ; has within the
year past, suffered frequent attacks of colic, which have been
uniformly relieved by blisters to the spine, which wras always
found sensitive. On the 12th, under strong moral excitement,
was seized with a chill at 12 M., which was followed by intense
fever. Took magnesia and salts, on the 13th, which operated well,
and had no chill. 14th. Ague at 8, a. m. ; at 10 a. m. found her
with flushed face, very loquacious, great fullness of head and
confusion, tongue clean, bowels open, great oppression at the
epigastrium, frequent sighing, pain in the shoulders, sides and
bowels generally ; epigastrium very tender on pressure ; exqui-
site pain on pressing 4th and 1th dorsal and 1st lumbar vertebrae.
Three cups, with scarification to the spine, relieved the oppres-
sion of the stomach and head signally, before the end of the oper-
ation: which was followed by copious perspiration and relief to
all pain ; she passed the night sleeping and waking alternately,
in unusually quiet sleep, and great calmness when awake. Sin-
apisms being repeatedly applied to the spine, and quinine taken
for the two following days, there was no return of fever, and her
general health since is very much improved.

8. August 17. This was a case of protracted remittent, a
girl of 14; subject to monthly epistaxis, never having menstru-
ated ; of a feeble constitution, &c. ; frequently renewed by im-
proper diet, lasting to the 1st of September. Early in the dis-
ease there was acknowledged sensitiveness of the 4th dorsal ver-
tebra, but in frequent subsequent examinations it was not mani-

#14 On Intermittent and Remittent Fevers, fyc. [Nov.

fest. It disappeared after copious diarrhoea, produced by eat-
ing a tart.

9. August 24. Negro boy, aged 15 ; a race rider; has had
repeated attacks of quotidian intermittent ; a paroxysm to-day,
but he is now up and in good spirits; no tenderness of spine.
Toast-water and gruel ; blister to spine drew before the usual
hour of attack, and he has since escaped the chill.

10. August 24. Negro man, aged 30 ; carriage driver ; stout
hearty looking fellow, enjoying ordinarily, perfect health. Chill
and fever 22d ; 23d, fever at night ; 24th, at noon, slight fever ;
head-ache and back-ache ; furred tongue white ; no tenderness of
epigastrium ; very great tenderness of 4th, 5th and 1th dorsal
vertebrae; was purged freely to-day; 25th, no tenderness of
spine ; chill at 12 m. ; 20, still fever continued, increasing in the
afternoon ; 6th and 1th dorsal vertebrae very sensitive ; oil as fe-
ver declined, and blister to spine at n'ght. 27th, blister drew ;
no fever. 28th, had light chill, (it was a cold rainy day.) follow-
ed by very little fever. 29th, took quinine ; and subsequently
had but one light paroxysm of fever.

11. August 24. Stout, healthy field negro, aged 25, has had
from the 19th a double tertian, and on 22d took large doses of
calomel and oil, which operated copiously ; this the day of the
lighter paroxysm ; now 1 p. m., slight head-ache, tongue covered
with thick, white furr, moist, no appetite; great tenderness of
epigastrium, producing panting on pressure ; bowels open : great
tenderness of the wltole dorsal spine, particularly of the lower re-
gion and of the last cervical ; free pressure produces great dis-
tress, and particularly, irregular respiration. No medicine, nor
*ood; blister six inches long to spine. 20th, blister drew well ;
pain of abdomen on pressure, none, except at the epigastrium ;
expresses a sensation of great relief from the time of drawing of
the blister. Toast water, and a small blister to epigastrium.
The following day his appetite was imperious ; tongue clean ;
no pain, and walking about.

12. August 28. A gentleman, aged 50, of good general health
and habits; unwell generally on the 24 and 25; fever on night
of 25 ; 26, chill at 5 p. m. and yesterdny at the same hour ; suf-
fered a violent paroxysm of fever last night, has dieted closely ;
oil yesterday, producing great prostration after each stool ; this
morning, at 10, is setting up; no pain, no cough, no tenderness

1S3G.] On Intermittent and Remittent Fecers, <J-t\ 345

of epigastrium; pressure upon the 5th, 6th, 7th dorsal vertebrae
producing exquisite pain, forcing groans from the patient ; no
medicine ; gruel diet. Blister immediately to spine, six inches
by three, which drew in four hours. No chill or fever to-day,
but comfortable night and sense of great relief generally. 29th.
Sinapisms were ordered to spine, above and below blistered sur-
face at 3 p. m. but the chill returned at 12 m., the fever being'
much lighter than formerly, and underwent the operation of oil
on the decline of this paroxysm without any unusual debility.
He subsequently took quinine and had light paroxysms in the
nights of the 30th and 31st. The tongue becoming very foul,
on the 31st, took calomel, which operated freely. Sept. 1. This
morning, without fever, the tongue was furred and the !eft half
very dry ; but this was evidently owing to the loss of the left
lateral incisor and stomach teeth, at which aperture the air en-
tered in breathing. He took quinine freely to-day, and had af-
terwards but one light paroxysm of fever without chill.

13. Aug. 30. Negro boy, set. 12; has had Intermittent fever
for three successive summers. Has now had four paroxysms.
Second and sixth dorsal vertebrae tender slightly ; a blister and
quinine after a cathartic relieved him promptly.

14. Aug. 30. A hale, strong negro man; chill yesterday at
12 m. ; second, sixth and seventh dorsal vertebrae sensitive on
pressure. Oil and a blister to the spine. No more chill or fever.

15. Sept. 1. A young man, set. 20, a close student. This
was a case of remittent fever, with daily exacerbations in the af-
ternoon, preceded by a momentary chilliness sometimes accom-
panied with severe head-ache, but without any trace of spinal
tenderness. Treated by bleeding ; calomel and oil, and quinine
in the remissions, terminating on the sixth ; the durations and vi-
olence of the paroxysms gradually diminishing.

16. Sept. 3. A gentleman, act. 30; of full habits, dark skin,
and phlegmatic temperament, good habits; has had three par-
oxysms of anticipating tertian; suffering with the paroxysm to-
day, most distressing nausea ; fifth and sixth dorsal vertebrae
quite sensitive: having taken calomel yesterday, the bowels were
open. Blister applied to the spine drew well, and he took qui-
nine the following morning. He had no more chill, but irregular
fever until 8th having been treated in the intermissions with
calomel and quinine.

44

346 On Intermittent and Remittent Fevers, $c. [Nov .

17. Sept. 3. A single female of bad habits, get. 21 ; but good
general health, and regular menstruation. Has had a paroxysm
of intermittent to-day ; one yesterday. Saw her in the sweating
stage ; eighth and ninth dorsal vertebrae sensitive on pressure ;
was purged freely to-day and blister applied to spine ; the fol-
lowing day no paroxysm, was ordered quinine ; but did not take
it with any regularity ; had return of chill for two or three days,
when finding it impossible to make her take medicine, the case
was abandoned.

18. September 4th. A negro woman of good constitution
and general health; had a chill yesterday followed by fever;
saw her without fever ; the dorsal vertebrae from the second to
eighth sensitive on pressure. A mercurial cathartic acted brisk-
ly on the bowels, and she had no return of chill ; some fever the
following night.

19. Sept. 5. A boy, set. 10, in the country. Chill on the 31st,
followed by fever remitting daily ; every second day the fever
more violent, but represented as never entirely free from it.
Took 10 grs. calomel last night, six copious black stools; com-
plete apyrexia to-day ; fifth, sixth and seventh dorsal vertebrae
very tender on pressure. Blister to spine ; saw him on the 8th,
at 8 a. m., has had two severe paroxysms of fever, but no chill :
involuntary micturiction ; stupid, with difficulty aroused ; pulse
110; skin pallid and damp; bowels have been kept open by oil:
tongue very dry and red; took 10 grs. quinine during the day,
and at evening was less lethargic ; the tongue moist, red at edg-
es, white in the middle. 9th, 12 m.; no stool ; this morning was
reported to be free from fever, and took 5 grs. quinine ; now ve-
ry restless and sighing; pulse 120; skin hot and dry; tongue
very dry and hard ; has coughed once or twice to-day ; evidence
of bro- ' iti.3, on examination with stethoscope ; no tenderness of
epigastrium ; 1-8 gr. tart, antimony every hour, to be discontin-
ued on purging. From this time this patient began to improve,
the fever gradually abating, and was discharged on the 14th con-
valescent.

20. Sept. 5. Boy six years old; has had a quartan inter-
mittent for four weeks, the chill coming on exactly at sun-down.
No fulness of abdomen ; good appetite ; regular bowels ; com-
plexion fresh; no spinal tenderness on the freest pressure; chill
expected 4o-morrow ; no medicine ; blister six inches long to

1836.] On Intermittent and Remittent Fevers, $c. 847

dorsal spine to-morrow at 11 a. m. It drew speedily ; he had
no chill, but a very light fever for two or three hours during the
night. The following day of attack, sinapisms were applied to
parts of the spine not occupied by the blister; and he had only
a light fever. Subsequently he has taken quinine, and recov-
ered.

21. Sept. 5. Boy 12 years of age; a dirt-eater, white skin,
transparent ears, tumid abdomen, enlarged spleen; has had sev-
eral paroxysms of a tertian; has considerable tenderness of the
5th and 6th dorsal vertebrae ; has taken oil. A blister to spine
did not arrest it; and quinine was added to the treatment.

22. Sept. 5th. A girl, aet. 13; of good general health; has
had two paroxysms of fever, without chill; slight chill to-day,
and two light chills on the following successive days ; treated
with cathartics and quinine. Examined on the 6th, there was
no spinal tenderness ; but on the 8th, there was slight uneasiness
felt on pressing the fifth dorsal ; and on being discharged, the
same degree was still perceptible.

23. Sept. 9th. A dirt-eating girl, about 9 years old; apyrex-
ia now ; is represented to have had irregular fever, with one chill,
for six days. Has taken castor-oil ; sixth and seventh vertebrae
very sensitive. Blister and quinine to-morrow. Instructions
being neglected, the following day dismissed myself from the
case.

24. Sept 12. A carpenter, set. 25 ; robust and strong, and
generally healthy. 8th, chill at 4 p.m.; 9th, fever rising at noon,
without chill; 10th, up early, without fever; at 7 a. m., severe
ague ; 1 1th, perspiring in the morning; fever rose at noon, with-
out chill ; ague to-day at 7 a.m.; has taken pills to-da} , .oba-
bly of lobelia, sent by the Steam Doctor, which haio vonited
him copiously. Fever now declining ; fifth, sixth and seventh
dorsal vertebrae extremely painful on pressure. A blister to the
spine and quinine in two grain doses, checked the disease after
one more light paroxysm.

25. Sept. 12. A married female, aet. 30 ; of good general
health. A case of irregular intermittent, with no remarkable
symptom ; tenderness of dorsal vertebrae. Fever checked prompt-
ly, by blister and quinine, after a dose of oil.

26. Sept. 14. This was a case of irregular tertian in a girl
of 1 1 years of age ; fourth, fifth and sixth dorsal vertebrae ex*

. 348 On Intermittent and Remittent Fevers, <$-c. [Nov.

tremely painful on pressure ; promptly relieved by oil, a blister
and quinine.

27. Sept. 14. A girl 11 years of age. To-day had second
paroxysm of a tertian ; fourth, fifth and sixth dorsal vertebrae
very tender; oil, blister-plaster and quinine, &c. Directions
were disobeyed ; had a paroxysm on the 16th, when blister was
applied and quinine irregularly taken ; only one more paroxysm.

28. Sept. 16. A strong athletic negro man, 25 years of age.
After two days of indisposition, has had two paroxysms of chill
and fever on successive days; exquisite tenderness of fourth,

fifth and eleventh dorsal vertebrae ; a blister and quinine in 2 gr.
doses, put a period to the disease immediately.

29. Sept. 16. A widow, aged 50; hysterical, habitually co-
pious urine and pain in region of kidnics. On the 10th had an
eruption of urticaria, with nausea; oppression of epigastrium;
has since been feverish at night. This morning an ague of an
hour's continuance, followed by fever, and the most excruciating
pains in all the limbs and sides and back ; compared to the ham-
mering of Jhe bones. Great oppression of stomach and chest;
frequent sighing; fourth, fifth and twelfth dorsal vertebrae exqui-
sitely painful, on pressure and percussion. Sinapism to spine,
during fever, abated the violence of the pains ; oil on decline of
fever. Two blisters to spine at night, and quinine in 3 gr. doses,
prevented a return. She sufFered intense head-ache on the night
of the 18th, which I attributed to the use of quinine during the
day.

30. Sept. 16. Negro boy, aged 14. This was a case of re-
mitting fever, in which there was no sensitiveness of any part of
the spinal column. Treated by V. S. and calomel purging and
quinine in the first remissions. About the sixth day, the fever
increasing in violence, with intense head-ache and delirium, dry
tongue, &c. After a second bleeding, and blister to dorsal spine,
the case was soon terminated favorably.

31. Sept. 18. A widow, aot. 50 ; general health not very
good; hysterical. Has had three paroxysms of a tertian; one
this morning. Fever now declining ; fifth dorsal vertebrae very
tender. Calomel and oil, and blister and quinine, prevented ano-
ther paroxysm.

32. Sept. 18. A single female, ast. 25 ; of regular menstrua-
tion ; but for four years has sulfered pain in the left hypochondri-

183C] On Intermittent and Remittent Fevers. <S,c. 349

urn, which has been greatly increased during every paroxysm of
fever. Fever every afternoon since 15th ; chill to-day at 1 p. m. ;
fifth, sixth and sevenlh dorsal vertebrae very tender on pressure.
15 grs. calomel; blister to spine at night and quinine in the morn-
ing. There was no return of chill ; the fever preserved a re-
mitting form ; and under the use of quinine in two grain doses,
during the remission, with oil occasionally, the fever gradually
became lighter and of shorter duration, until the 23d, when she
was discharged. She continued well until the 29th ; had a chill
in the morning after a feverish night ; saw her in decline of fever ;
found the third, fourth and seventh dorsal vertebrae, (examined by
percussion,) exquisitely painful. Scarified and cupped the spine
freely at 9 p. M., the fever having entirely abated. Ague on the
morning of the 30th, at day-light, followed by fever, which de-
clined in three hours. Tongue moist and but slightly furred,
yellowish white ; foul taste in the mouth ; bowels open. Cups
reapplied to spine, and enjoined rest and low diet ; at night had
high fever, with distressing pain in region of the spleen. Octo-
ber 1st. In the morning without fever ; eyes very yellow, and
bowels confined. Prescribed three calomel and aloes pills, of 7
and 2 grs. each ; one every three hours ; these produced very
black consistent discharges, and since the fever has ceased. Ten-
derness of spine still continuing, was discharged with advice to
apply a blister thereto.

33. Sept 19. A healthy young man, of active habits, has suf-
fered a daily paroxysm of intermittent since the 16th, and has
taken much simple cathartic medicine. The seventh dorsal ver-
tebrae is sensitive, manifestly, on pressure. Declining the blis-
ter, the quinine relieved him speedily.

34. Sept. 4. A negro woman, set. 45. After three or four
days of irregular feverishness. with loss of appetite, had chill to-
day, followed by fever. Xo\v great depression of spirits; fre-
quent sighing and weeping; nausea; great oppression at the
epigastrium ; tongue thickly furred white ; seventh, eighth and
ninth dorsal vertebrae extremely sensitive. Copious draughts of
warm water to produce vomiting, with sinapism to spine, soon
relieved her most distressing symptoms. I saw her onlv in this
emergency, in the absence of the family physician.

35. Sept. A robust female of short stature, act. 22 ; of
regular habits and good health. She suffered four paroxysms of

350 On Intermittent and Remittent Fevers, tyc. [Nov.

quotidian, of a malignant character ; during the fever the whole
of the limbs remained cold, and the hands red ; the pulse very
rapid and compressible ; great oppression of epigastrium ; labo-
rious, hurried respiration ; great anxiety and thirst ; tongue dry ;
warmth gradually returning to extremities at the end of parox-
ysm, when the pulse became more full, but always very com-
pressible. She was blistered on the spine ; took large and re-
peated doses of calomel, with quinine in 4 gr. doses, during the
imperfect remissions, with blisters successively to spine, legs,
stomach and arms ; and after the bowels were opened by the
calomel, morphine in 1-8 gr. doses, every two hours during the
fever. After these four paroxysms, the reaction became general
in the next paroxysm of fever, which was without chill on the
28th ; took no more quinine, still complaining of great oppres-
sion of epigastrium and hurried respiration. 28th and 9th, took
40 grs. of calomel in divided doses, with morphine after its ope-
ration. 39th, 5 p. m. Skin very hot, with exception of the fin-
gers, which are cold, the ends extremely cold; pulse 128 undu-
lating, full, very compressible ; tongue rough and dry ; blister to
spine well, sufficiently to allow examination by percussion ;
light percussion as well as pressure of the first to fourth dorsal
vertebrae produces instantly a hacking cough which is renewed
by every examination and at intervals of two or three minutes,
was frequently repeated. Examination with stethoscope disco-
vers respiration natural ; two scarifications on spine, and cups
applied for half an hour, drew about 2 ozs. blood. Before the
cups had been on ten minutes, the fingers were as warm as other
parts of the surface ; at the end of the operation, expressed a
sense of relief to the distressing oppression of the epigastrium.
The night was passed generally in quiet sleep, without anodyne.
October 3. Distress in stomach still continuing, was cupped and
blistered at the epigastrium on the 2d, and bowels opened by oil ;
and to-day is much relieved ; asks for some nourishment and is
impatient at its delay. Discharged on the Gth convalescent.

3G. Sept. 28. Negro boy, a?t. 8. Is represented to have had
fever every afternoon and night since the 25th, without chill ;
has taken oil ; at 8 p. m. to-day, skin universally hot ; tongue
heavily furred, yellowish white ; pulse frequent but soft ; fre-
quent sighing and spasmodic breathing when awake ; head con-
fused on being waked up ; second, third, sixth and seventh dorsal

1836.] On Intermittent and Remittent l'f.vers,<yc. 351

vertebrae exquisitely painful on pressure ; which produce* griev-
ous complaints, and increases the difficulty of breathing ; oil;
blister to-night on decline of fever, and quinine in morning; 2 gr.
doses. 29th, 10 a. m. Many stools ; blister drawn ; has taken
four doses quinine : has no liver. This patient in the afternoon
was removed to his owner's house and passed from my care.

37. Sept. 26th. A boy of 10 years, with large head and exer-
cised brain ; has had remitting fever for three or four days ; has
taken oil, which has operated but slightly. 7 i\ m. Head-ache,
ear-ache, flushed face ; pulse 100, full and compressible ; skin hot ;
lips very red ; tongue furred, brownish white and moist ; breath
offensive ; slight uneasiness at epigastrium on pressure ; second,
third and seventh dorsal vertebrae very sensitive, the patient shrin-
king from pressure and percussion. 16 grs. calomel in two doses,
followed by oil in the morning, with blister plaster at bed time to
spine and quinine the following day, arrested the fever.

39. A female of delicate constitution, about 30, nursing an in-
fant of six weeks old. Had cholera morbus on the 22d, from
some improper article of diet, and fever at night. After the op-
eration of 15 grs. calomel, taken in three doses, on the 23d had
fever at night. During morning of 24th, took five grs. of quinine,
and in the afternoon and night had a paroxysm of fever, with most
distressing nausea and vomiting, and excessive arterial excite-
ment ; the nausea was relieved by peach-leaf tea. After this,
the bowels being kept open by magnesia, the quinine being taken
freely during the remissions, the paroxysms gradually became
lighter until the 30th., when she was discharged. The paroxysm
every other day was much more violent. The tongue was per-
fectly clean throughout. Examined twice, the dorsal spine was
sensitive. This patient experienced the greatest relief from the
use of ice during the fever.

40. Oct. 1. Laborer, act. 40, of intemperate habits, but ro-
bust and healthy. Fever at noon of the 29th ; 30th, nausea and
vomiting all day : fever at night ; this morning ague at day-light.
Fever now declining ; violent head-ache ; tenderness of epigas-
trium ; tongue much furred, yellowish white ; no stool to-day.
The lower cervical vertebrae, and five or six upper dorsal, and

fourth and fifth lumbar vertebrae, very sensitive on pressure and
percussion. No other medicine at hand, took 20 grs. calomel.
Blister plaster six inches long to spine : quinine in 2gr. doses to-

353 On Intermittent and Remittent Fevers, fyc. [Nov.

morrow. Medicine operated freely, and in the morning was
entirely free from fever, taking quinine without inconvenience.

The foregoing are not selected cases ; but they are all, the par-
ticulars of which I have recorded, within the above named dates.
Besides these, I have memoranda of other cases of fever, sim-
ply with respect to the presence or absence of this particular
spinal tenderness, viz. : Seven cases of remitting fever in which
it was present ; two in which it was absent ; and four of inter-
termittent, present in all. I cannot forego the satisfaction of ad-
ding the two following observations furnished me by my friend,
Dr. Joseph Milligan, illustrating so conspicuously the influence
of spinal irritation in remitting fever, and the happy consequen-
ces of directing the treatment to its reduction.

" Bob, a stout negro fellow of 24 years, was attacked with re-
mittent fever, about the middle of June, 1836. When I sawT him,
about twenty hours after his attack, his pulse was full, strong and
hard (about 100 in frequency,) and the tongue was red and furr-
ed. He complained of great pain in the back, intolerable head-
ache, and the conjunctiva was much reddened by the fulness of
its vessels. He had taken a dose of castor oil before I saw him,
which had operated, without relieving him in any degree. I bled
him from the arm immediately, in a recumbent posture, (a severe
vertigo preventing him from sitting up.) and was surprised to
see him faint from the loss of not more than three or four ounces
of blood. I prescribed twenty grains calomel, which was fol-
lowed next day by a dose castor oil. No other medicine than
the oil was given on that day. But on the next, finding no abate-
ment of the head-ache, nor other change for the better, in this con-
dition, I bled him again as he lay in bed and had his feet plunged
in hot water. Again he was about to faint, when no more than
three ounces of blood had been drawn, and I stoppedthc flow.
I was perfectly at a loss to conceive, how under the existing ex-
citement of the brain, syncope should follow so light an abstrac-
tion of blood ; for on former occasions I had bled him, and he stood
pretty large bleedings very well. The pain in the back was so
great that he could not turn himself in bed but with great effort;
and he chose the supine posture as affording the greatest relief
to the spine. I resorted to a variety of means to mitigate his
sufferings for two days longer, at the expiration of which time he

1836.] On Intermittent and Remittent Fevers, <J*. 853

did not seem to be a whit the better for all that I had done for
him. It now occurred to me that it would be well to examine
the spine, for the purpose of discovering whether or not there
w< re any tenderness, in any part of the column. I commenced
at the back of the neck, and seizing each vertebra successively by
the spinous process, moved it laterally with a slow but firm mo-
tion, until I arrived at the lumbar region. He did not experi-
ence any p iio (Turing this operation, until I had reached the first
or second lumbar vertebra, as well as I remember, when he shrunk
in great pain, from beneath my hands; and as I repeated the ex-
amination at the sensitive spot, to be assured of the condition of
the parts, he cried out that the motion gave him great pain, "ve-
ry severe." I scarified the skin deeply on each side of the pro-
cess of the vertebra affected., and succeeded in drawing, proba-
bly, two ounces of blood. The part was then covered with a sina-
p'sm, wliich was allowed to remain there for a half hour. In a
few hours the pain in the back and head-ache were gone. Next
day, the tongue began to clean off; and in forty-eight hours he sat
up, comfortably. From tliis time his convalescence was rapid.

Mrs. , in the seventh month of her pregnancy, was ex-
posed to a shower of rain on the 4th July, and a week after, was
attacked with remittent fever. The exacerbations, as usual,
occurred at noon, and the remissions towards morning. The sto-
mach was irritable during the progress of her disease, and only
ceased to be so, when she became decidedly convalescent, but
the tongue was soft and almost clean, and exhibited none of the
appearances which we are accustomed to see, in most cases of
gastric excitement. The matter vomited was generally a de-
praved bile, often bearing a striking resemblance to the acet. cop-
per, in colour. On the first day of the attack, there was consid-
erable head-ache, which was promptly relieved by a moderate
bleeding. She was treated with calomel, followed by laxatives
pro-re-nata. After the removal of the head-ache, no local pain
was complained of, until about the tenth or twel th day, in the
forenoon, when she suffered severely from a pain in that region
of the right side, comprehended between the mamma and the last
of the false ribs. A sinapism over this part did not mitigate her
suffering in the slightest degree; and as there was no reason to
believe, from existing circumstances, that the liver was specially

45

354 On Intermittent and Remit tmt Fevers, <$*c. [Nov,

implicated, the vertebrae were examined, for the purpose of deter-
mining the condition of the spinal chord. At the third dorsal ver-
tebra, a good deal of soreness was experienced by the patient,
upon pressing its spinous process. A sinapism was applied over
this part, and its action on the skin was followed by the instant
departure of the pain in the side. It recurred however, in the
evening, as the sinapial excitement diminished. The part over
the vertebra affected, was then freely scarified, and an ounce or
two of blood extracted by cupping. This operation was succeed-
ed by immediate, complete and permament relief.

The fever began to abate soon after; and had not the condi-
tion of the uterine system kept up a certain degree of irritability,
the patient would undoubtedly have experienced no further incon-
venience from fever. She was perfectly restored to health on.
the 10th August, s

J. M."

It thus appears, that of these forty cases of intermitting and re-
mitting fever, this tenderness on pressure, of same portion of the
spinal column, was present in all, but four cases of remitting fe-
ver, viz : Nos. 3, 15, 22, 39 ; and in two cases of intermittent,
viz. : Nos. 9 and 20 ; but of these, however, one was arrested by
a blister to the spine, without other m^ans used, but dieting ; and
the other was modified materially, in its character, in like man-
ner. Although I would not presume to estimate the degree of
influence of the topical applications to the spine, when used con-
jointly with other remedies of acknowledged power in these dis-
eases, still we cannot but conclude, from the very conspicuous
relief afforded by them, in many of the cases, when used alone,
that in the other cases they must have exerted no inconsiderable
influence; and I think I am warranted in the assertion, that un-
der this treatment, the cases of intermittent were more promptly
arrested, than they generally are when treated with quinine
alone.

On the statement of these cases, with so remarkable uniformi-
ty of this one symptom, the first question which naturally pre-
sents itself to the mind of every one, is Have the observations
been justly made? Not implying any suspicion of the honesty
of the observer; for strangers shall account him honest, upon the
general consideration, that he is a member of an honorable pro-

1830.] On Intermittent and Remittent Fevers, ^-c, 355

fession ; but he may have been deceived his method of exami-
nation may have been defective pressure of the skin between
the finger and any bone, may produce pain and uneasiness. I
therefore state particularly the mode of examination. Commen-
cing at one or other extremity of the column, I press with an
equal degree of force, directly upon each spinous process, calling
the attention of the patient forcibly, to the degree of uneasiness
felt upon the application of the finger to each point, and begging
him to compare these sensations together; where practicable, as
it is in the majority of cases, depressing the skin on each side of
the spine, as low as possible by the thumb and finger, so as to
include the spinous process between them, and move it alter-
nately, in one and the other lateral direction. But the most sat-
isfactory mode of examination is by mediate percussion, to
which I was led by the desire to examine the vertebrae, over
which a sinapism or a blister had been recently applied, and pro-
duced an inflammation of the skin, thus rendering the examina-
tion by pressure, manifestly improper ; because the results could
not be fairly compuvd with those obtained by pressure upon
other vertebrae, over which the skin was entire. The medium I
have used is the middle finder of the left hand; placing the ball
directly up m the process, and making the impulse upon the nail,
with the middle finger orthe right hand. I say upon the nail
thereby conveying the assonance, that the impulsive force has not
been unduly violent. I would here suggest the caution, not how-
ever by way of heightening and magni y a? the importance of
this subject, but from a conviction of the practical importance of
the suggestion, that this percussion be made upon each vertebra
at first, very gently, for in many instances, the distress to the
patient produced by it, is extreme. Other media might be sug-
gested, but I consider the finger superior to every other in this
respect, that we judge with the most unerring exactness, when
the impulse is and is not communicated directly to the whole
vertebrae ; and if we discover that it is applied obliquely, with the
m >st perfect case we can, by varying slightly the position of the
finger, accomplish our object Another advantage of this exami-
nation by percussion, I have already hinted at, that it may be ac-
complished even upon a recently blistered surface.

Another question naturally presents itself what is the force
and value of this symptom ?-~ whence this uneasiuess ?-r-what

356 On Intermittent and Remittent Fever*, fyc. [Nov.

does its existence indicate? Certainly not that the skin at these
particular points is sore and tender ; I have endeavored careful-
ly to verify this fact, by taking it up between the thumb and fin-
ger and compressing it with more force than was applied by the
direct pressure; uniformly receiving the assurance of the patient,
that the uneasiness was of a different character from that pro-
duced by pressure upon the bone. But if this might be the cause of
pain, in the method by pressure, it cannot be in that by percus-
sion ; for it is well known to those who make use of mediate
percussion, that it may be employed freely, even upon a blistered
surface, without producing pain. It as certainly does not indi-
cate that the bone itself is tender and diseased; for we cannot
conceive why pressure upon a diseased bone, should be followed
by sighing, coughing, increased oppression of the precordia, nau-
sea and faintness. It is as unsatisfactory for the same reasons,
to attribute this symptom directly, to a diseased state of the liga-
ments of the vertebrae.

Having thus excluded these three parts from any participa-
tion in the production of this phenomenon, we next enquire Can
it proceed from a diseased state of the dura mater lining the bo-
ny channel? We answer unhesitatingly, that the symptoms a-
bove referred to, developed in distant organs by the examination,
cannot arise directly, from an inflammation or anv degree of irri-
tation of the dura mater, for reasons assigned already; but we
can conceive very readily, how the dura mater, being in a swol-
len state, might produce such symptoms, by compressing t\n> or-
igin of nerves supplying these distant organs, when an unusual
degree of motion is communicated to the vertebrae by percussion.
But we perceive that this unusual motion oi'lhe v( rt; l.ra would
produce the same degree of pressure, if the dura mater were in
its normal state, and the substance of the chord il self enlarged.
We therefore must, necessarily, adopt the conclusion, that this
phenomenon indicates a diseased state, either of the medullary
substance of the spinal chord, or of its investing membranes.
I am not prepared to infer from th< se few cases, that this local
affection of the spine always exists, nor that it is the primary irri-
tation upon which these fevers depend; but if subseqm n! obser-
vations shall establish the uniform existence of this spinal irrita-
tion, at the commencement of intermitting and remitting fevers,
it will confirm the* opinion now almost universally held by the

1836.] On Intermittent and Remittent Fevers, $e. 3 37

profession, of the local origin of all fevers, and the equally uni-
versal persuasion, that this location is in some part of the nervous
system.

I shall barely, in conclusion, suggest some considerations cal-
culated to raise the presumption at least, that this local disease
may account for many of the phenomena of these fevers.

First. I consider it established beyond all controversy, both by
direct facts and reasoning, that rheumatism is of spinal origin.
Without entering into any particulars, I take great pleasure in
referring to an article on this subject, by Dr. Dugas, in the first
number of the Southern Medical and Surgical Journal.

Second. Ordinary colic is uniformly attended with the evi-
dence of spinal irritation, and I am ready to assert from my own
experience, that more conspicuous relief is obtained in this dis-
tressing affection, from topical applications to the spine, than
from any other mode of treatment.

Third. Colica Pictonum, it is certain, is not a disease of in-
flammation at the seat of pain, for it is treated with success by the
most violent and drastic cathartics a course well calculated to
aggravate the disease, if it depended on local inflammation.
On the records of La Charite, there are more than five hundred
cases treated in this manner, and five fatal cases in neither of
which, were there but slight traces of local disease in the bowels;
and two in which there was a collection of fluid in the arachnoid
of the spine, and in one of these, softening of the dorsal portion of
the marrow. In the record of these cases, no mention is made of
examination of the spine during their course, this mode not then
being in use. M. Andral establishes the conclusion, that this dis-
ease depends upon lesion of the spinal marrow and abdominal
plexus of the great sympathetic, and that the- constipation de-
pends either on paralysis of the muscular coat of the intestines or
suspended secretion of intestinal mucus.

Fourth. Asthma This affection for 3 years past, I have found
almost constantly, accompanied with spinal tenderness, and
promptly relieved by cupping and blisters.

Fifth. I can apply the preceding remark to Hysteria, with
its almost infinite variety of symptoms.

Sixth. The records of medicine, recently, contain many cases
of intermittent neuralgia in distant parts, co-existing with spinal
irritation, and promptly relieved by topical applications to the

358 On Intermittent and Remittent Fevers, tyc. [Nov.

spinal column. I refer to two conspicuous cases in Teale's work
on neuralgic diseases.

Seventh. The same work contains cases in which pulsations
in the epigastrium, tightness across the epigastrium, great mus-
cular debility, disorder of the secretions, palpitations, tremors,
flatulence, pyrosis, &c. &c. &c, existed simultaneously with the
evidence of spinal irritation, and were relieved by its treatment,
even when there was reason to believe, they were accompanied
with a diseased state of the sympathetic gauglia.

These considerations, shewing the intimate connection in par-
ticular cases, between spinal irritation and diseased function of
almost every tissue in the body, together with the fact of the in-
termittency of those diseases called nervous, are calculated I say,
to raise the presumption, that the phenomena of these intermitting
and remitting fevers depend upon a local or general diseased con-
dition of the spinal marrow.

If this local affection of the nervous system does exist in these
fevers, can the fact be established by autopsic examination, and
why has it not been thus ascertained before this ? I answer that
possibly, in this way the fact of this disease and its nature may be
revealed, by the dissection of subjects that die of casualties, while
in the early stage of these fevers; but it is very obvious, that the
absence of organic lesion of this portion of the nervous system, in
cases fatal after a protracted course, is no evidence whatever
against its existence at their commencement ; because, on the
presumption that the most distinctive, characteristic feature of
these affections, their intermittency, depends upon this local irri-
tation, it would be unreasonable to expect to find it, after the fe-
ver had lost this character universally the case, as it advances
towards a fatal termination. Again. These fevers are treated
by some practitioners, with drastic cathartics, by others with re-
peated doses of calomel, on the belief of their hepatic origin ; both
we suspect, relieving this local affection, on the principle of revul-
sion ; in the same manner, it may be, and no doubt is resolved by
the predominance of serious affections of other organs arising in
the course of the fever. My limits will not allow to add but a
tingle illustration of this principle. How often do we see gastri-
tis existing in fever, so unequivocally, that the judicious practi-
tioner withholds all active and irritating medicines from the sto-
mach, and uses his utmost endeavors to arrest it, believing that

1836.] On Inteiinittent and Remittent Fevers, fyc. 359

upon its reduction depends the safety of his patient we see this
gastritis often, relieved in the course of twelve or twenty-four
hours, by the development of bronchitis so entirely cured, as to
permit the free use of antimonials,to overcome the bronchitis ; but
if this patient should die of suffocation, from bronchitis, who ex-
pects to find organic lesion in the stomach? Will the practi-
tioner doubt the fact of the previous existence of gastritis, from
its absence?

I must add on this subject, the declaration of M. Andral, that
in fevers called essential, there is no nervous symptom but may be
manifested without appreciable alteration of the brain and its ap-
pendages.

I have so far transgressed the limits assigned me, that I add
but one or two remarks on the treatment of these fevers.

In the first place, we infer the propriety of the early use of re-
vulsive applications to the spine; leeches, cups, sinapisms or blis-
ters one or other of these, according to the wrell established
principles regulating their use.

If this affection of the spine be the original irritation upon
which all the other phenomena of intermitting and remitting fe-
vers depend which determines their individuality then we
may with the more confidence, at their commencement, make
free use of cathartic medicines in general, and particularly of
calomel, a medicine of so much power in correcting the disor-
dered secretions of the abdominal and thoracic organs: for in-
stead of being deterred from their use, by the apprehension of ex-
citing infl lmm ition in the stomach and bowels, alreadv exhibiting
functional dcra lgement. this pathological view will sanction their
use, to accomplish a two-fold intention to relieve the original
affection, by their revulsive operation, and to remove the conges-
tion and those depraved secretions of the abdominal organs,
which are generated by every paroxysm of fever which conse-
quences, if long neglected, may determine a pathological condi-
tion of these organs, and destroy the periodicity of the fever.
So far (rem being led to a treatment directed only to the spi-
nal column, to the exclusion of ordinary modes, we consider this
legitimate deduction from the pathology we have suggested, of
the highest practical importance.

The unvarying experience of nearly two hundred years attests
the eilicacy of Peruvian bark and its more valuable, refined, mod-

300 Remarks on use of Quinine in Bilious Fevers, fyc. [Nov.

era preparations, in the treatment of intermittent fevers; this
view of the general similarity of the pathology of intermittents
and remittents, suggests the early and liberal use of quinine in
the latter form, even in the faee of the objection, that the diseased
condition of some of the organs, (constituting the very differ-
ence between these two forms) forbids it; regarding this state
dependent on the original local nervous irritation, it suggests, that
it is far more prudent to run the risque of increasing the succeed-
ing paroxysm, than to leave this original focus of irritation unat-
tempted by this heroic remedy, so likely to reduce it ; for this
once subdued the paroxysmal return of fever dependent on it,
prevented the disordered -state of the organs may be more safe-
ly corrected, afterwards, by appropriate remedies. It thus con-
firms a practice formerly more in vogue here, than at present,
the value of which was attested by the experience of our prede-
cessors.

ARTICLE V.

Remarks on the use of Quinine in Bilious Fevers. By D.
Hooke, M. D.

1st. The instantaneous and certain cure of intermittent and
remittent bilious fevers, depends upon promptitude. The proper
remedies should be applied as soon as the attack commences.
There is no danger except in delay or improper treatment.

2nd. They are ushered in with lassitude, stretching, aching of
the bones, chill or ague. For these symptoms, nothing is necessa-
ry but warm drinks and warm applications ; but when to these,
there are added, anxiety, restlessness, great distress about the
stomach, or retelling and vomiting, and inequality of the circula-

1836.] Remarks on use of Quinine in Bilious Fevers, qc oul

tion, indicated by great heat on the forehead and stomach and
little or none at the extremities, then besides warm teas, warm
applications and frictions, mustard plasters, and these very large,
should be applied over the stomach, and if the symptoms are
v ry argent, on the extremities also, and kept on until they pro-
duce a deep scarlet redness in the skin, which they will usually
do. in from fifteen to thirty minutes. If this redness disappears
after they have been removed, they should be reapplied. As
soon as the redness remains permanent, the danger for that pa-
roxysm is over, because the circulation has been equalized, and
the dangerous congestion thereby overcome or removed. In ad-
dition to the foregoing. I would suggest, in very alarming cases
of collapse, the extensive use of frictions with red-pepper and
salt.

3d. After this cold, comes the hot stage, or what is properly
called fever. If it be the first paroxysm, and the patient former-
ly of good health, a dose of castor oil, or if this is not at hand,
one of calcined magnesia and epsom salts combined, should be
given to cleanse the stomach and bowels, and aided if necessary
by injections one of the best is a table spoonful of salt in a pint
of warm water. To this course, add diluent and cooling drinks,
and if the excitement is very great, occasionally bathe the hands,
face and feet, with cold water, A towel wet with cold water
may too, be laid over the stomach. If it be a second paroxysm,
or if the disease be still further advanced, or if the patient la-
bored previously under some bilious affection, a dose of calomel,
followed in three or four hours by one of oil, is to be preferred
to the oil alone.

4th. When the fever has gone off by perspiration or other-
wise, quinine, the true remedy for these affections, should be gi-
ven in one, two or three grain doses, every hour, until at least
fifteen or twenty grains have been taken, if the patient be an adult.
It may be given in solution or in pills in any way, so it is giv-
en, and that largely. I have in very alarming cases, given it in
five grain doses every fifteen minutes; and have seen it thus gi-
ven, even restore to health, those who were supposed to be dying.

[L/~ No remissions of lever should be suffered to pass without
the quinine, even if purgatives have been neglected during the
exacerbation of the fever. C/JQ

Injections, however, should be used in a case of this kind, as

46

362 Remarks on use of Quinine in Bilious Fevers, $c. [Nov .

an important adjuvant, and also in cases of great irritability of
the stomach. Sometimes the quinine does not set well on the
stomach, even after the bowels have been evacuated, in such a
case a mustard plaster should be applied over that organ.

5th. The above course may always be pursued, and will
always cure, if commenced before the disease has continued long
enough to produce local inflammations ; but when these take
place, they must be subdued before the quinine would be ad-
missible. But as there is no necessity for this state of things, if
the above treatment is pursued, I will not now take room to say
how it should be remedied,

6th. Should a remission be so short, that quinine could not be
given in sufficient quantity to arrest the disease, the cold and
hot stage should be treated again as above advised prefering
calomel as the purgative, and as soon as the remission is again
apparent, commence with the quinine. Let it only be remem-
bered, in order to induce every one to give the minutest direction
all due attention, thct these fevers, which can be thus so easily
arrested, destroy more human life than any other whatever.

7th. The quinine does no lasting injury it sometimes pro-
duces a ringing in the head, some giddiness, and occasionally a
little deafness, all which disappear in a short time, generally in a
day. To compensate for these temporary evils, it cures without
any waste of flesh or strength, or constitutional energy. This
ought to he constantly remembered.

8th. The drinks throughout the attack should be of the mild-
est kind, such as water, toast water, gruel, chicken water, rice
water, or the like. Every thing heating and irritating should be
carefully avoided ; and so also, should all drastic purgatives,
narcotics and blisters. Drastic purgatives never fail to do mis-
chief, and narcotics and blisters so seldom, that they should never
be used in these fevers, except under the advice of an experi-
enced physician.

9th. Occasionally, after the fever is cured, the patient con-
tinues to feel dull and disinclined to action here the diet should
be light, and the bowels kept moderately open until these sympr
fjoms disappear.

1830J On Hcemorrhoids. 833

Part II. REVIEWS AND EXTRACTS.
Hcemorrhoids.

We are much pleased with the remarks of Dr. Salmon
of London, on this important subject. Of all the diseases
that afflict human nature, there are few more common, attended
with more suffering, or followed by more disastrous consequen-
ces, yet there is none oftener neglected, or treated on erroneous
principles or no principles at all 'empiric nostrums and patent
remedies, being the means generally resorted to for relief, until
too frequently irreparable injury has been sustained.

" A just consideration of the causes of any disease, (says Dr. Salmon,) will
be our best guide not only to prevent its occurrence, but likewise as to the
method of treatment we should adopt for its removal or alleviation ; let us
therefore briefly inquire into the causes of piles.

Various as these will be found, they all tend towards the same results ; viz.
deposition in the cellular tissue, which unites the mucous and muscular tunics
of the rectum ; distention of the minute vessels of its mucous coat, and mere
or less enlargement of the hemorrhoidal veins. Piles may therefore be pro-
duced by any circumstance, constitutional or mechanical, which preternatu-
rally excites, or mechanically obstructs, the circulation in these particular
parts. Thus they not uncommonly arise from an injudicious perseverance in
the use of peculiar or violent purgative medicines, or excessi\ e bodily exer-
tion, particularly horse exercise ; hence, also, results the prevalence of the
disease in persons accustomed to a sedentary mode of life, the warmth exci-
ted from the constant sitting position of the body promoting an inordinate ac-
tion in the vessels of the lower part of the rectum ; while the want of proper
exercise induces a torpid and confined state of the bowels, in a great degree
assisted by a deficiency in the biliary secretion.

I believe the disease is often caused, or much increased, from the fashiona-
ble, yet pernicious custom of sitting upon chairs having hair or stuffed seats.
Persons, especially those whosp occupations are of a sedentary description,
should accustom themselves to use chairs, the seats of which are composed of
cane, formed into a net work.

The soft blue hsemorrhoidal tumor, which may be said to be the true pile,
will always be found in conjunction with an enlarged, or otherwise diseased
condition of the liver, which circumstance is physiologically explained, when
wo consider the immediate connection that exists between the vena porta
and the hemorrhoidal veins. From this cause, these veins will sometimes
become distended to so great a degree, as to form tumors of a very consider-
able size ; and I have seen an instance, in which from extreme enlargement
of the hemorrhoidal veins, the fore-finger could not be introduced into the
rectum beyond the first joint ; the patient was likewise the subject of fistula
in ano.

Another effect of irritation in the rectum is, that coagulable lymph is from
time to time thrown out upon the inner coat of the intestine, but more partic-
ularly in the cellular tissue which connects the mucous and muscular portions
of the bowel. This deposition organizes and gradually increases, till at last a
huge mass of superstructure is formed, which is productive of extreme annoy-
ance and exquisite suffering.

But another and extremely prevalent cause of the disease will be found in i

364 On Haemorrhoids. [Nov.

contracted condition of some part of the rectum, which causes an accumula-
tion of faeculent matter in the bowel ; this necessarily irritates it, and sooner
or later produces ulceration of some portion of its mucous surface ; while the
perpetual straining which accompanies the desire to relieve the bowels, the
result of the accumulation, injects the minute vessels of the intestine, distends,
and finally causes them to rupture ; from which sources arises the haemorrhage,
more or less expeiienced by those who are subject to piles. Now it is not al-
ways judicious, suddenly to correct this effect, for although it is a diseased
action, it, not unfrequently, is the mode by which nature relieves herself, and
it thus, perhaps, .prevents the formation of a more serious disease.

Dr. Salmon's observations on the treatment of piles, are not
less philosophical and judicious as they are too concise for far-
ther condensation and too valuable for any omissions. We will
present them to our readers in his own words.

" This, (the treatment, says Dr. S.) in a great measure, must necessarily
depend upon the cause from which the disease arises. Should it be connect-
ed with any hepatic affection, we of course principally direct our efforts to re-
store the healthy state of the liver. Surprising relief will often be imparted
from the loss of four or six ounces of blood at intervals repeated according to
the discretion of the medical attendant. This may be taken either from the
arm or by the application of cupping glasses to the region of the liver ; the
latter is, perhaps, the most preferable mode. The application of leeches to
the orifice of the bowe'i is a valuable remedy, in those instances when the
tumors are situate within the sphincter; but when they are external to it, I
have often found that more irritation is nrodticed from the bites of the leech-
es than benefit from the quantity of blood which they abstract. Not unfre-
quently they mance great tumefaction of the parts, which seriously aggra-
vates the patient's sufferings. But in the cases of internal piles, especially
those which are attended with any hepatic disease, the use of leeches will be
found of great sen ice, for they not only diminish the general volume of the-
blood, but, by unloading1 the vessels at the inferior portion of the alimentary
canal, operate move immediately upon the affected parts.

I have lately been in the habit of puncturing that description of pile which
is almost wholly produced from distension of the hcemorrhoidal veins, with
the acupuncturation needle ; by this method some ounces of blood may be
abstracted, which will afford instantaneous relief to the patient. This plan
may be adopted almost ad libitum by the medical attendant, and is entirely
free from that apprehension of real, or imaginary danger, which by some is
considered to belong to dividing these veins with the lancet ; which latter
practice I have often adopted with great service ; neither have I ever found
any untoward result from it. Furthermore, I am acquainted with an indivi-
dual who was in the habit of performing this operation on his own person, a
practice which, notwithstanding its successful issue, cannot be too strongly
reprobated.

Evaporating washes* are of service, not only by alleviating the inflamma-
tion in the piles, but also that irritability of the sphincter which almost inva-
riably accompanies the disease, to a greater or less extent. I prefer using
these in a tepid state, for when they arc applied cold, patients are oftentimes
not sufficiently cautious respecting their use ; either from inattention, or dis-
like to the momentary feeling produced from the application of cold, they
permit the linen rag to get dry; hence an increase instead of a diminution
of the local action ensues.

r- * I have been in the habit of using the following formula : Recipe, Spirit.
Rorismar. 1 ii.; Aquce Am. Acet. 5 iv.; Mist. Camph. I x.; Misce. Fiat lotio.

1830. J On Haemorrhoids. 865

A gentle stimulus by anointment applied to the sphincter twice or thrift'
in the course of the day, will, in the milder attacks of the disease, not uncom-
monly be of essentfal. benefit ;j tins plan will not, however, agree with all
constitutions, and shoul 1 1 1 1 ( *:- r be adopted with caution.

Th administration of medicine forms a most, essentia] part of the treat-
ment of the disease. It i- well known that particular drugs, as for exam-
ple alo^s, exorcise a peculiar action upon the intestinal canal ; such descrip-
tion of m die i nee are therefore to be avoided; large doses of any kind of
purgatives adopted as a habit arc improper; nevertheless, as the disease is
often connected with extreme costivenesBj it is best at the commencement of
an acute attack, to give a brisk dose of medicine, so as fully to unload the
intestinal canal, and by such means facilitate the pro.'' ss of the circulation
through the rectum. In the milder forms of the complain*, the bowels may
be kept regular by the use of small doses of castor oil, the confection before
described, milk of sulphur, or any mild aperient.

Th? use of enemas, when the situation of the tumors admits of the ready
introduction of the pipe, ought never to be omitted ; they not only lessen the
local irritability of the parts, but sometimes, by removing the feculent collec-
tions in the intestines, supersede the necessity for any kind of aperient me-
dicine. All violent exercise, particularly riding, must be abstained from.
Tnese, together with a reasonable attention to diet, constitute the principal
features to be observed in the ordinary treatment of piles. With the most
cau'ious attention, however, the disease will not unfreqaently progressively
increase, tiil at last we are compelled to relieve our patient's affix' ion by the
mans of operative surgery ; and this brings me to the next division of my
subject, viz : the removal of the Hemorrhoidal Excrescence."

Dr. S. has not mentioned two remedies, which we hnve found
most beneficial in those cases of piles accompanied with hepatic
disease, and which we believe is a very frequent association in
southern climates.

We have long been convinced that one of the most usual cau-
ses of haemorrhoids, was the obstruction opposed to the free re-
turn of blood from the hasmorrhoidnl veins, through the portal
circulation, and that our curative efforts should be directed main-
ly and primarily to the liver and portal system. In our hands
no remedial means have proven more efficacious in removing
portal engorgement, and restoring the liver to its healthy condi-
tion, than calomel or blue pill and the external use of nitro-
m una tic acid. We do not object to any of the remedies pro-
posed by Dr. S., we would only recommend the occasional em-
ployment of mercurials and nitro-muriatic acid, in chronic and
obstinate cases.

After discussing at some length the question of the removal
of hoemorrhoidal tumors by excision or ligature, arraying the
principal authorities in favor of each plan, and summing up their
respective advantages and disadvantages, he gives most decided
preference to the former.

The succeeding paragraphs are too important to be passed by.

f Recipe, Pulv. Gum. Camphorse, 3ss. ; Gallse, 3i. ; Opii, 3i. ; Ung.
Flor. Samb. 5 i- ; Misce. Fiat Unguentum.

S63 Extracts from the Note-book of a Physician, tyc. [Nov.

" I can only say, that I have for many years been in the habit of perform-
ing tha operation by excision, and that with the most perfect success ; occa-
sionally, I have had to encounter haemorrhage ; but never, save in one in-
fetance, to such an extent as to endanger the life of the patient. I am in-
clined, therefore, to believe, that when bleeding ensues to any material ex-
tent, the tumors are accompanied with an enlarged or otherwise diseased
condition of the liver, with stricture of the bowel, or such an unhealthy con-
dition of the constitution, as may give rise to an hsemorrhagic disposition in
the vessels at the lower part of the alimentary canal; and, in the neglect of
the due observance of any of which circumstances, not only the danger, but
the unsuccessful issue of either description of operation is very likely to
originate.

And here I think I should be guilty of no inconsiderable dereliction of duty,
was I to omit adverting to the careless manner in which these tumors are
frequently removed. Not only are the causes of the disease altogether lost
sight of, but its extirpation decided upon without the slightest degree of con-
stitutional preparation ; indeed, were we to judge from the observations de-
livered in some of the medical schools of this metropolis, it might reasona-
bly be supposed that the excision of piles was an operation, altogether so
simple, that it might be performed at the convenience either of the surgeon
or his patient. More thin once have I known fatal results to arise from this
mistaken confidence, this injudicious, not to say rash proceeding ; which,
though it may be practised perhaps many times without any untoward re-
sult, is certain eventually not only to end in the compromise of the surgeon's
reputation, but in what is of much greater moment, the loss of human life.

Prior to the removal of the hemorrhoidal excrescence it is the duty of
every surgeon carefully to survey the various points to which I have allu-
ded; and, above all, cautiously to examine into the condition of the rectum ;
for, in the early stages of piles, where the disease is accompanied with any
contraction of the bowel, we shall often be able to mitigate the former by
the removal of the latter ; I have seen many instances which confirm this
observation."

Extracts from the Note-hook of a Physician of this City, during
his attendance on the Parisian Hospitals.

Sub-cutaneous Fibrous Tumours. Mr. Dupuytrcn enter-
tained the class this morning on a case truly interesting, and il-
lustrated his observations by the performance of an operation,
trifling in its nature, but important in its results. The patient is
a woman, fifty-five years of age and of a good constitution, who
experienced for the first time, about two years ago, slight pains
in the right thigh, which in five or six months became very se-
vere. The pains were irregularly paroxismal. She observed
that the pain always commenced in a certain part of the outside
of the thigh, and from thence radiated, as it were, to the knee,
the hip, the glutcei muscles, the pubis, &c. Her sufferings wTere

1836.] Extracts from the Note-boook of a Physician, <J-c. 367

always greatest at those parts than at the place of their origin,
and were excruciating. She consulted a physician, who, on ex-
amination, perceived a small tumor beneath the skin, and situa-
ted at the spot from whence originated the pains. He applied
poultices, leeches, blisters, &c, in vain. The disease was not in
the least subdued, and tiic tumour that had been concealed by
the tumefaction of the surrounding parts, reappeared as soon as
this was removed. She continued thus in torment until this
morning. Last week she was admitted into the hospital, and
prepared by baths, laxatives, &c. for the operation, which con-
sisted merely in the extraction, by a small incision, of the little
tumour. This was no sooner done than she said she was com-
pletely relieved, and felt only the sensations occasioned by the
incision.

The tumour when examined, was found encysted in condensed
cellular and adipose membranes. This envelope being removed,
exposed a body of a globular form, of the size of a horse bean,
of a white color, and of a fibro-cartilaginous texture. When
dropped on the floor, it bounded like a piece of gum elastic; ac-
cording to Mr. Dupuytren's observations, they generally re-
bound about two inches for each foot of elevation. This en-
lightened and experienced gentleman, during the course of his
lecture, related the history of several cases of this curious dis-
ease, all of which yielded as instantaneously to the operation.
He saw the first case about twenty years ago, and since that
about twenty-five more. He says he is the first who gave any
account of it, and that it is always taken for rheumatism or tic
douloureux, which it imitates very much. He had several op-
portunities of dissecting individuals who had these tumours, and
as often made use of all his art in vain, to discover any nervous
communication by which we might account for the great decree
of pain produced by them. It yet remains with him a problem.
He also mentioned, that when left to themselves, they degenerate
into schirrous or cancerous tumours of the worst kind, and
which return in despite of the surgeon's best effort to remove
them by the knife. Observe that he uses the word "degenerate"
meaning thereby, that until then, it was but a simple tumour
and possessed none of the specific qualities of the cancer.

Case 2d. The patient is a married woman, of good constitu-
tion, and about 40 years of age. She has had since her child-
hood a small tumour, about the size of a pea, situated just be-
neath the skin and a little above the external ankle, which, how-
ever, never occasioned the slightest pain until the period of her
first pregnancy, about five years ago. She says, that as soon as
she became pregnant, (the first fortnight, to use her own terms,)
she experienced a most excrutiating pain, commencing at the
tumour and radiating over the leg, and which, after continuing
perhaps a couple of hours, would cease. These paroxysms oc-

63 Extracts from the Note-book of a Physician, tjc [Nov.

curred two, three, and occasionally four times a day. She was
not exempt from them at night, but they were nearly always
produced by getting out of bed in the morning. This state 'of
things continued until her delivery, notwithstanding the attention
of several physicians of repute, some of whom, considered it
rheumatism, others, an affection of a nerve that was not to be
troubled, lest it should become wrorse. She now remained well
during 18 months, after which time she again became pregnant,
and was as soon reattacked by her intolerable pains. I should
have mentioned that during the 18 months that she suffered no
pain, she was always apprized of the approach of her menses by
a sense of pricking or itching at the tumour. Her second deliv-
ery did not, as the first, free her of both child and pain, but left
her still subject to her paroxysms, until about ten days ago, when
Mr. Dupuytren extracted the tumor. She thinks it had almost
doubled in size since her first attack. The operation has pro-
cured an instantaneous and radical cure.

Cataract with Carious Teeth. An individual operated on
sometime since for cataract, had at the time a carious tooth,
which commenced aching a few days afterwards, since when
chronic ophthalmia has supervened. Mr. Dupuytren says that
he has seen at least iifty cases of this kind, and that the patient's
mouth should always be examined, and carious teeth removed
previous to the operation, for as soon as the eye is irritated by
the knife, the tooth will become affected sympathetically, and by
a kind of second sympathy, produce ophthalmia. As soon as the
tooth is extracted, the ophthalmia disappears.

Dislocation or the Thumb. This man, having made a false
step, fell forward, and in endeavoring to protect himself with his
hand, dislocated his thumb, so that the bone of the first phalanx
was thrown on the dorsal side of its metacarpal bone. This ac-
cident occurred 23 days ago, since when, however, several ef-
forts have been made in vain to produce a reduction. The pa-
tient, now admitted to Mr. Dupuytren's ward, was the subject of
a very interesting dissertation on the causes of the great difficul-
ties encountered in the relief of an injury, at first sight, so trifling.
Mr. D. first stated that the dislocation of the thumb might take
place in four ways, namely: with the bone of the phalanx on the
dorsal, palmar, radial, or cubital side of its metacarpal bone.
In the two last cases there is scarcely any difficulty in the reduc-
tion, whereas in the two first this is almost always a very diffi-
cult task. Now, dissection has clearly proved to Mr. D. that
the lateral ligaments are always ruptured in the latter, and very
rarely in the former. This being ascertained, the cause of the
great difficulty of replacing the bones in their natural position, is
rendered quite evident, when we reflect on the shortness, the

1830.] Extracts from the Note-book of a Physician, fyc. 309

thickness, tlie" strength, and especially the inelasticity of the late-
ral ligaments of the thumb. In the natural state the ligaments

arc in a direction parallel with the axis of the hones, whereas
th >y becom i p jrpendicular to the axis so soon as dislocation on
t!if palmi r or dorsal surface takes place; hence it is evident that
their length must be diminished by this kind of twisted position.
Besides this di ficulty, must be overcome that produced by the
head of-one bone slipping behind that of the other. This last
consideration caused Mr. D. to deviate from the ordinary meth-
od's adopted for the reduction of such cases. He therefore takes
hold of the thumb, and, acting on it as a lever, throws it back so
as to hring the phalanx perpendicular to the axis of the metacar-
pal bone, and at the same time causes traction to be made by the
means of a ligature placed at the proximal end of the phalanx.
So soon as the traction has brought the head of the bone of the
phalanx sufficiently forward, the reduction is completed by a
sudden flection of the thumb, until now kept drawn back.

In the case of the young man alluded to, he tried this method
for some time, bui just as he was about to succeed, he perceived
that considerable excoriation had been produced, and thought it
would be imprudent to continue any further efforts until this was
cured. Hut, the next morning (to-day) it was perceived that
reduction was nearly complete, and that nothing more was re-
quired but a splint and bandage. Mr. D. did not attempt to ex-
plain how such a change could have been produced spontane-
ously, but merely observed that it was an evidence of the supe-
riority of his mode of proceeding over all others.

On measuring, this morning, the. length of the thumb that has
been dislocated, and comparing this with the length of the unaf-
fected thumb, they were found to correspond exactly, so as to
leave no doubt of the reduction. Motions of flexion and exten-
sion can now be executed with but little pain comparatively.

Schirrous .Mamma. Mr. Dupuytrcn disapproves very much
of the use of leeches and compression, to affections of this nature,
as only tending to deteriorate the patient's system and to allow
the disease to become more inveterate. He says, that it is not
the size of the schirroUs that is diminished by these means, but
merely that of "its atmosphere," to use his expression; that is to
say, of the surrounding tissues that have become swelled by the
irritation its presence causes, and that whenever the pressure
and use of leeches are suspended, not only these tissues swell
again, but the schirrous enlarges with increased rapidity. There
is now in his ward, a case that has been submitted to that treat-
ment, and for which he will have to use the knife.

47

370 Notice of Lisfranc's Clinics. [Nov

Notice of Lisf rands Clinics.

In the October number of this Journal, we were 'favored with
a continuation of the valuable "Extracts from the Note-book of
a Physician of this City, during his attendance on the Parisian
Hospitals." It will be found by reference to that number, that it
contains under this head, much of the unpublished practice of
M. Lisfranc, one of the most eminent surgeons of the French
metropolis. Much of this matter is new, and all of it, on subjects
too much neglected ; both in instruction and in practice. In a
note to that article, we promised some remarks on one of the to-
pics ; of which promise we now purpose the fulfilment ; toge-
ther with some notice of the rest.

The paramount object of this Journal is usefulness to the me-
dical profession, and through it, to the cause of humanity.
Whilst therefore, we feel thankful to the friend who has been so
obliging as to furnish us with liberal extracts from the notes
which his most commendable Zealand industry have accumula-
ted, and trust they will continue to enrich the pages of the Jour-
nal, we may remark, that they are given as a faithful account of
the views, instructions, and practice of some of the first prac-
titioners and teachers of the day. And whilst they serve the
purpose of informing the- profession, of the views and practice
of such persons, as a matter of medical intelligence, they Can-
not, emanating from such a source, fail to be of great utility to
those of the profession who have not been favored with the op-
portunity of witnessing the same themselves.

But we are not of those who are disposed to think that every
thing which is brought from alar, is to be valued according to its
distance, and the cost of procuring it. Nor are we willing to a-
dopt the opinions, or practice of any man ; however loudly the
trumpet of fame may have sounded his name, unless such opin-
ions or practice be found not wanting before the lawful tribunals
of truth, reason and propriety. Gold is not precious according
to that by which it may have been mineralised, or the country
from which it came ; but according to its intrinsic purity : nor do
the richest stones produce the most. It is often \'o\\)u\ alone, or
mineralised by clay and sand. A Georgia or a Carolina speci-
men then, if it stand the furnace of purification as well, will
make as fair an ornament, and as rich a treasure as that of South
America or of Ophir. But the unwary are too apt to be deceiv-
ed by the glare of a reflected hue; or to receive as gold, that
which is made to shine by the hands through which it lias passed.
In America, where we have learned to put crowns and sceptres
under our feet as little toys, where indeed, we contemn them,
and where mere merit may accede to the highest honor, we arc

1836.] Notice of. Lis francs Clinic?. 371

pable of r * into our hands the productions of

men, as I j not with .the wildness theintoxi

cation of menials wh scended to by their superiors, but

I tamely, as freemen : independent alike, of all

the s of authority, and the honori-Qi knighthood : And

them, we can sit down to their contemplation

an 1 examination, re thought which had been presented to

p ir rain I : and this to >. with a consciousness that we stand be-

m humanity and error the protectors of the former and

of it!(> latti r.

The teach r,1 to 3 of whose instruction are now before us,
has long since des Tvedly been before the world as an eminent
surgeon; His practice in many cases has been detailed in the
journals of the day, and much of it has been valuable. But the
m )i i hi> rank, and the more influential his name, the

more cl >s !\ sh >uld his movements be scrutinized.

We have however, occasionally found, as we have thought,
m >s1 insuperable objections to some of his capital surgery. For
instan '. his proposed improvement on amputations, offered to
the world some 12 or 15 years ago, which consisted in allowing
th ! woun I made by an amputation, to remain open and exposed
to the atmosphere for a few hours, in order, the better to secure
adhesion. We felt bound to object, without ceremony, to the
propriety of this practice, on the ground of its cruelty to the pa-
ti it ; esp "ially when the same end, (i. e.) the suppression of the
oozing ofb] i i I from the small vessels, might be most perfectly
implish I within ten minutes, by the application of a solution
of the sulphate of alumen, or of zinc. In evidence of the truth of
this, we are able to state, that so long ago as 1812, we amputa-
ted the thigh of an adult immediately below the trochanter minor,
secured but two arteries by ligatures, and suppressed all other
dissh irg the wound by the application of a sponge with

a solution of alum, so completely, that although the wound was

sed and dressed for adhesion within fifteen minutes after the
bone was sawn, the wound never discharged enough of blood,
s aam an 1 pas. to wet through the ordinary dressing. On the
fifth dav. ta" dressing was removed down to the adhesive strips,
which v. i i left. On the eighth, these were removed, and the
wound found most completely united; and by the twelfth, the
ligatures having passed away and their places healed, the patient
w is dis iharg I. But we hasten to notice M. Lisfranc's prac-

{' ' l;\ I IS Of til ! UlerUS.

T i !ir- topic in that part of his clinique now before us, is a
n lie anatomy, which he seems to think necessary as
a nail ! to the student an I practitioner, in the examination by the
speculum. Those remarks are well enough for those who are
already possess?;! of a good knowledge of the special anatomy of
the parts.

872 Notice of Lisfranc? s Clinics. [Nor.

The next topic treated is the "introduction of the speculum
uteri:'' " For the introduction of the-speculum.the patient should
be placed in the same position as if she were to undergo the op-
eration of lithotomy, save that her hands are not to be fastened to
her feet, nor ligatures applied. The legs, or rather knees, are to
be held by two aids, if admissible; if not, the feet must rest on
chairs of an equal height with the bed the back horizontal, &c."

We are compelled to dissent entirely from M. Lisfranc's plan
of introducing the speculum uteri; and we are forced to the con-
clusion, that nothing could have suggested such a plan, or retained
such a man as Lisfranc in its continued use, but a kind of gen-
eralizing in practice, and entire disregard of delicacy in female
practice, but too common in hospitals, and which cannot be too
strongly reprobated. Certainly M. Lisfranc never gave a
thought to the additional afflictions of the female, which never
fail to be added by the unnecessary wounding of her modesty.
The exposures which their necessities unavoidably demand are
severe, and nothing can justify an unnecessary extension of them
in any instances. Even the fact of the inmates of public hospi-
tals being often persons of loose morals, docs not justify the prac-
titioner in allowing the least unnecessary exposure. But in view
of the convenience and the utility of the speculum examination,
we have, ever since our first attempt, adopted the reverse posi-
tion to that of Lisfranc ; and we venture to say. that if the prac-
titioner will place his patient on her knees, with her breast and
head on a pillow, and the abdominal muscles preserved in perfect
relaxation, he will find neither difficulty nor danger in the intro-
duction of the instrument, or of mistaking any other part for the
os uteri. In this position, if the natural; or any Considerable mo-
bility of the uterus remain, so soon as the os externum is dilated,
and the air passes into the vagina, instead of that fullness which
prevents the easy introduction of the instrument, and contin-
ually presses the folds of the vagina before if, a large space is
often formed, of severaj inches in every direction: extending
from the vestibule tot lie os linear, and from one side of the vagi-
na to 1 lie other, large enough to contain a man's fistj and with
some, as large as a child's head at term. The uterus -will gener-
ally bo found to have passed from the vagina, and strait ol* the
pelvis to its greatest elevation, in the direction pf the axis of the
superior strait : and if it have not done so, it is easily caused to do
so by the pressure of the fing< rs in that direction, The reader
will at once perceive the gnat, safety ol' the os uteri from I eing
easily wounded by the speculum, and the greal facility to thefree
motion of the inner part of the instrument, in the large space thus
afforded by the vagina proper. Even its walls may lie freely in-
spected by ebanging the direction, or by partially withdrawing
the instrument.

In cases of great immobility of the uterus, the advantages of

1830.] Notice of Lisfranc s Clinics. .H3

this position arc not so conspicuous still the convenience in eve-
ry way, isa decided improvement on that which Lisfrancs' posi-
tion affords, Lastly, in this p jsitibn it is perfectly convenient fo
perform this examination without the exp >sure of any portion
of the ext irnal surfaceof the patient ; or any part whatever,
except the precise point of insp Kstioti a thing impossible in the
plan of Lisfranc. For this, tin* manner of usin5 the. speculum
is, in th;* first place, to clothe il With a piece of calico or other
lighj clothof ordinary width, and two yards long, by passing the
speculum two thirds or three fourths of its length through a
small hole made in the cloth ahout half a yard from one end.
The cloth is fixed to the speculum at this place by a string, if
necessary, then reflected over the large end and handle, and the
bodv of the instrument properly greased. The instrument is
then passed under the cover, to the vulva, and is easily intro-
duced after gentle dilatation with the fingers of the other hand.
So soon as it is introduced, (which should be in the direction of
that part of the axis where the small end is at all times.) the
short end of the cloth is spread over the sacrium and back of
the pelvis, and the Long end over the thighs, legs and feet, so as
completely to cover the woman. The sheet or blanket with which
she will have been hitherto covered, may now be removed, and
the internal parts lobe inspected, fully exposed to view. The
speculum should be the simple tube speculum ; the inner surface
of which should be kept in good polish. M A candle, of course,
must be used," said Lisfranc. This is not a thing "of course."
No candle or taper of any kind is necessary in the day-time ;
the reflection from the instrument being sufficient to display the
part as fairly as the palm of the hand at noon-day.

M. Lisfranc has advised that touching be practised before the
introduction of the instrument, in order to determine the precise
position of the os tineas; as this part the common subject of the
examination, is often turned downward and backward. Xow
in M. Lisfranc's position, it is barely possible that the os tineas
can be inspected in these cases. It will be found no very easy
matter to rectify this uterine displacement in this position, which
the reader of the filth number will remember, is on the back;
on account of the general fullness and pressure of parts which
are afforded; and against which, the elevation of the uterius has
to be made. If corrected by the touch in this position, the ute-
rius most commonly follows the fingers as they are withdrawn,
carrying the vagina m transverse folds before it. which constant-
ly impede the introduction of the speculum, and obstruct the
view. In the position herein recommended, all pressure and
fullness are taken off, and the uterus most commonly restored
to, and retained in its proper place, at least during the continu-
ance of the position. Moreover, the uterus is carried so high
in the pelvis that there is no danger barely a possibility, of
touching it by the means of the inner end of the speculum.

o* 1 Notice of Lisfr one's Clinics. [Nov.

tm the next paragraph, M. Lisfranc gives the "general symp-
toms of uterine disease." Under this head he has giyeji us most
of the symptoms i \ which we may he led to apprehend uterine

se.
We conceive there is not a class of diseases, the elear diagnosis
of which is more important than that which includes the various
uterine :>!ii c'tions. The importance of these diagnoses docs not
stop at the accuracy neccssnry merely for the purpose of correct
prescription. This is an interest common to all diagnoses. But
i is the relationship of the uterus and its functions to the fe-
male economy, that many of the most serious secondary troubles
and dangers are often, nay, almost certainly produced by the ill
condition of one, or irregular or imperfect performance of the
other. Amongst these we may name habitual abortions, exhaus-
ting leucorrhcea. barrenness, bronchitis, phthisis, chronic hepati-
t's, dyspepsia, hysterica, hypochondriasis, chlorosis, bulimia, va-
rious afflictions from spinal irritation, mania, chorea, general and
obstinate disorders of the nervous system, colics, hormorrhois, fis-
tula?, &c. &c, any of which in the female, should direct inquiry in-
to the condition and functions of the uterus. The importance of
diagnosis extends in these cases to the delicate nature of these dis-
eases, Which', on this account, more than in any other diseases,
should be made plain, and well defined by external evidence, be-
fore either examination, or operation per taxis can be justiiicd.
In this class of troubles, it is always possible to locate the disease,
if not to distinguish in every instance its specific character,
previous to manual examination. Some of the symptoms
named by M. Lisfranc, are certainly very foreign to the pur-
pose of diagnosis; such for instance as " gastro-cnteritis resisting
ordinary means"' "pains in the spleen, without increase of size"
"pains at the umbilicus without any other symptom of dis-
ease." Whilst strangury, involuntary urination, pains in the di-
rection of one or both of the lateral ligaments, dysmenprrhoea,
leucorrhcea, hysteria, abortions without pth< r obvious cause, &c.
&c, should by no means have teen omitted. His remark, that
" uterine haemorrhage as surely indicates a diseased state or mor-
bid tendency in the uterus, as haemoptysis docs that of the lungs,"
is most correct and important; not only for its truth as to the
fact of disease, but its very sure testimony of actual ulceration of
some kind, or that condition which consists in a serious tendency
thereto. Of like value is that of (unnatural ?) "discharges per
vaginam." And here should not have been omitted, nil irregu-
larities in the menstrual discharge: any and every deviation ot
which from the natural quantity , therate of flowing, iho case, and
the period of occurrence, may be considered to constitute.

1830.] Treatment of Urinarp Calculi,!)!/ LUhutrity eye. 375

Part III MONTHLY PERISO

Extracts translated for this Jour:!;-', from the Journal i: ire of 3rd

September, 1S3C>.

Parallel between the Tret f Urinary Calculi, hy Lithot-

Cystotomy,

following statistics are d iew of the in-

ly published by M. Civiale, on the relative
success of the various methods employed for the removal of cal-
culi deposited in the bladder. The value ofsu h numerical state-
its must he obvious to all: they c invey irrefragable refuta-
tion 6f'the vain theories and opposition of the bigoted adherents
to the use of the knife.

' Of 1915 patients subjected to Lithotomy at Luneville. at the
Hotel-Dieu, and.at La Charite, from 172:) to 17-27,371 died, say
1 in 5,12. 1335 individuals underwent the lateral operation in
various countries, of whom 275 died, or 1 in 4,S5. The Recto-
vesical op 'ration, performed 157 times, proved i'atal in 29 instan-
ces, 1 in 5.41. Even- the Bi-lateral operation, the advantages of
which have been so much eraggeratedj does not present better
r. <i!ts. Ms Civiale had stated, in 832, that out of 32 opera-
tions \) (rformed by M. Dupuytreh, there were 8 deaths, 21 cures,
and 3 imperfect cures; a mortality of 1 in 4. Subsequently, M.
Dapuytren declared that he had lost only 8 out of 70 cases.
The discrepancy in these statements has been reconciled by the
testamentary Executors of M. Dupuytren, and the correctness
of M. Civiale's assertion established. In a table appended to the
memoir recently published by them, it may be seen that in 42
operations, there were 9 deaths and 33 cures, or 1 in 4 2-3 ; but
nothing is said of imperfect cures. It should also be observed,
that among the 42 patients. 19 were under 10 years of age, and
that there were 8 deaths among the 23 others. The same pro-
portions may be deduced from the practice of several other sur-
geons of Paris.

The results obtained by the Hypogastric operation are still
less favorable. 175 cases, derived from a table published by M.
Belmas and other sources, present 60 deaths, or 1 in 2,91.
It should be remembered, however, that this operation is seldom
resorted to except under the most unfavorable circumstances.

' Now, With regard to Lithoirity. },L Civiale, in a table con-
tained in his work, shows that of 506 persons who applied to him
for relief, 307 were found proper subjects for Lithotrity, of whom
209 were cured, 7 died, 3 remained with cystic disease, and one
was lost sight of. Let these facts be compared with those of
Cvstotonw.

S7G Method of detecting Pus in the Blood, <^e. $c. [Nov.

"It has been asserted that the disease was more apt to return
after Lithotrity than after Cystotomy. M. Civiale states, that
among 88 patients subjected to the knife, the disease returned in
9, whereas among 244, on whom was practised Lithotrity, there
were 14 in whom the calculi were reproduced."

Method of detecting Pus in the Blood.

M. Donne read the following note to the Societe PJiilomatique,
at its last meeting.

The peculiar property that concentrated ammonia possesses
of transforming pus into a glutinous and tenacious substance,
might, to a c< rtain extent, serve to distinguish pus from
the other animal fluids, inasmuch as none of these are thus affec-
ted by this alkali. But this test cannot be applied to admixtures
of pus with blood, for ammonia communicates to the latter some
degree of viscidity. The only means by wfiich M. Donne has
been enabled to detect the existence of pus in the blood, are the
following: He first examines the blood with the microscope, in
order to determine whether it contains any foreign globules; if
not, it is probable that the blood contains no pus; if, on the con-
trary, it contain globules resembling those of pus, it cannot yet
be inferred that the blood do ;s contain pus, for the purest blood,
taken from individuals in perfect health, will occasionally contain
a small number of globules difficult to distinguish from those of
pus ; but, in such a case, a drop of ammonia should be added to
one of the blood. Should the blood be pure, all the globules will
be dissolved, and no trace of them be perceived with the micros-
cope. If, on the other hand, the blood contain pus, the puru-
lent globules will not be acted on by the test, and may be detec-
ted with the microscope, for ammonia dissolves but very slowly
globules of pus. M. Donne considers this the best method af-
forded by the present state of the science for detecting the exis-
tence of pus in the blood.

Animalculcc in the Pus of Syphilitic Chancres.

M. Donne* states, with regard to the existence of animalculre
in the Pus of Syphilitic, Chancres, that although he has never
detected them in any other kind <>f Pus, he has uniformly found
them in thai of Chancres; also, that having inoculated with this

pUS the thigh of ail individual affected with chancres, he exam-
ined the pus derived from the pustule produced by the inocula-
tion, and found it idled with animalcule, He observes, that in
this instance, the pus had not yet been exposed to the action of
the air, being covered by the epidermis. M. Donne adds, that he

183G.] Chances of Life, $C. 377

has not yet detected animalculffl in the pus of buboes, lie has
not yet sufficiently studied the form of these diminutive beings to
determine it, but they appear analogous to the infusories. M.
D. is inclined to consider these animalculae, rather a medium of
transmission of the syphilitic virus, than active agents in the
contagion of this disease.

In a number of cases, the admixture of a little diluted vinegar
with the pus of chancres, has sufficed to prevent the success of
its inoculation.

Chances of Life.

The following summary of statistics relating to the chances of
life, is chiefly from the lecture of Dr. Robert Graves, of Dublin,
on Medical Statistics.

It is stated and admitted as a general fact, that of a given num-
ber of children born in Ireland, one-third die before one year,
one-half before the cigth year, two-thirds before the thirtieth
year, and three-fourths before the fiftieth year. But such gen-
eral facts are necessarily drawn from data in the mass, and av-
erages like this include opposite extremes. For example, on
Patrick's-day, 1782, nine students walked from Trinity College,
Dublin, to Bulloch, where they dined. In 1833, eight of them
were still alive, and it is believed, are to the present time, a pe-
riod of more than 54 years. Again : Of a certain company of
grenadiers of 59 men, who served in the Irish volunteers in 1782,
only one is now living. It is evident from these, that the above
general conclusion as to the rate of life, can only be useful in point
of political economy of life, and not a ground for estimate in life
assurance. But if we carry the inquiry down to the physical
causes influencing in each of these parties, we shall find instruc-
tive and useful facts in a medical point of view, and for estimate
for life assurance.

It should be remarked, that the party, of whom 8-9 have
lived 54 years, were students in Trinity College, and doubtless
were dedicated to a literary life. The party, of whom only 1-59
lived the same time, (and indeed in the very same years, and
country, so that there was no peculiarity of season or climate
influencing in one case more than the other,) were Irish volunteers,
subject to a very different course of physical influences. Here
it is evident, that the physical causes peculiar to the different

48

378 On the Chances of Life. [Nov.

occupations of each, are to be looked to, in the estimate of chan-
ces of life, and the cause of the difference in each.

Another fact of the same kind may be advanced. It is re-
markable how long a certain set of men, holding the same office,
often live in succession. It is believed that the steady policy of
the imperial court of Vienna has been partly, at least, owing to
the extraordinary length of time the modern prime ministers of
Austria, including Metternich, have lived. A similar succession
of longevity on the part of the rulers of Prussia, is believed to
have aided other circumstances in aggrandising their territories.

Dr. Graves mentions the following as a calculation of the
chances of life, approaching the truth.

The chances are equal that every healthy adult will live half
the difference between his own life, and eighty-one. This, which
is the mode of computation generally employed, is very near the
truth. Thus, if a man is forty years of age, the chances are e-
qual, that he will live half the difference between it and eighty-
one years, that is, twTenty and a half years ; and therefore, that
the duration of his life will be sixty years and six months.

The total number of male and female children brought into the
world are very nearly equal, a small excess only existing on the
side of the males. In Germany and England, the proportion of
males to females is as 21 to 20 ; while in Ireland, it is generally
as 21 to 19. The slight excess is, however, ultimately corrected
by the greater mortality of the males before the age of puberty;
after which the excess is slightly on the female side.

M. Giron divides individuals into different classes. The first
consists of individuals whose employments tend to develope their
bodily powers. He found that in this class, the number of male
births exceeded the average proportion of male and female births
throughout France.

The second class consists of those whose business tends to en-
ervate. In this, the number of female births exceeded the aver-
age proportion of female to male births throughout France.

The third class consists of those whose employments are of a
mixed description. In this, the proportion of male and female
births was nearly the same as the average proportion throughout
France. Hence the conclusion arises, that the pursuits of agri-
culture tend to the increase of the male population, and that the
habits of commerce and manufactures favor an augmentation of
the female population.

On the subject of the proportion of births to marriages, Dr. G.
observes, that the fecundity of marriages, is not, as has been sup-
posed, in proportion to the comfort and independence of the com-
munity, and that fewer children are not horn from a given num-
ber of marriages, in countries which an; deficient of agriculture,
industry, and the blessings of civil liberty. In England, the pro-
portion of births to marriages from 1800 to 1810, was as 4 to 1,

18 3G.J

On the Chances of Life.

379

and from 1810 to 1821, as 4.22 to 1. In Scotland and Holland,
it is as 4.2 and 4.20, while in Russia and several Italian States, it
is as 5.25 and 5.45 to 1.

It is here observed, that in the degree in which a nation advan-
ces in prosperity and civilization, premature and imprudent mar-
riages will become less frequent, and the number of births be pro-
portionately diminished. The lateness of marriages should gen-
erally stand as a good test of an improved state of society, and as
an evidence of the prevalence of reason and good sense over the
otherwise controlling passions of mankind. Contrary to the
generally entertained opinion on this subject, it may be given as a
fact, having an important bearing in the estimate of the chances
of life, and consequently of importance in the business of life as-
surance, that the cultivation of science and literature appears to
be favorable to longevity. He who is chiefly engaged in mental
labour, has a fairer prospect of length of years, than he whose
occupations consist exclusively in bodily toil.

Of 104 Italian mathematicians enumerated by Franchini, the
ages at which 70 died have been ascertained. Of these 70, eigh-
teen had attained the age of 80 and two of 90 ; and this in a cli-
mate not generally considered favorable to longevity.

In France, 152 men of science and letters, have been taken at
random about half of them cultivated science, and the other half
devoted themselves to general literature. The average life of
these 152 was upwards of 69 years.

Longevity of female authors of the last century from the
Quarterly Review, No. 99 :

Lady Russel, 87

Mrs. Rowe, 63

Lady M. W. Montague, 73

Mrs. Centlivre, 44

Lady Hervey, 70

Lady Suffolk, 79

Mrs. Sheridan, 47

" Cowley, 66

" Macauley, 53

* Montagu, 81

663

The average life of these literary ladies is found to be 71 9-20
years. The extremes are 44 and 93

Out of 120,000 who insured their lives in the Equitable Insu-
rance Office, the number of suicides in twenty years was only

Mrs

Chapone,

75

a

Lennox,

84

U

Trimmer,

69

U

Hamilton,

65

a

RadclifFe,

60

a

Barbauld,

83

u

Delany,

93

it

Inchbald,

68

Piozzi,

80

it

H. More,

89

766
663

-

20)1429(71 9-20

380 Curious Case of a Wound Healing, fyc. [Nov.

fifteen. Countries and cities vary from peculiarities of circum-
stance Dr. Graves thinks France affords five times the suicides
that England does that the Irish are the least suicidal nation in
Europe, and that Dublin and Naples afford fewer suicides than
any other cities. At the same time it may be remarked, that
murders are in an inverse ratio. There were forty murders in
Ireland for one in Prussia, and forty suicides in the latter, for
one in the former.

It is believed, that there is no one fact entitled to more consi-
deration, in estimating the chances of life, than the temperance of
a community, or an individual no one circumstance more cal-
culated to limit or extend the longevity in a country, and conse-
quently in an individual. This is a truth, firmly fixed in the
facts of the physical effects of excessive stimulation on the hu-
man organization, the moral evils which it entails, or with which
it is associated, and of which it is at least a fair index, and the
various accidents to which it is accessary, and which increase
the chances of death.

When we consider the many diseases which are produced by
any of the various intoxicating liquors, the various dangers to
which the intoxicated state subjects the individual who is thus
deprived of Reason and Judgment his great protectors, and
the increased fatal tendency which the habit of their use gives to
most diseases, the fact of habitual use of intoxicating liquors
alone, even supposing the external evidences of health to be
good, should (cet. par.) enhance the price of the risk somewhere
between five and ten fold.

Curious Case of a Wound Healing over an Extraneous Sub-
stance.

A letter to the Editors from Dr. Benjamin Aycr, of Columbia
County, Ga., gives a well authenticated account of the extraction
of the blade of a knife, from the nostril of a Mr. Murphy, on the
14th July, 1831, where it had been left in an affray which oc-
curred on the 4th January, 1830. a period of more than 18
months. Dr. Ayer found on examination, the lower end of the
blade within the nostril, about 3-4ths of an inch from the aper-
ture. On announcing it, Mr. M. denied the possibility of such a
fact; whereon, the doctor called in a number of most respecta-
ble witnesses, and proceeded to the extraction of the blade, which
proved to be that of a dirk knife, 2 3-4 inches long and 3-4 of an
inch wide at one end, and weighing half an ounce. It was found
on extracting it, to have passed through the base of the septum
posteriorly and extended laterally into the nasal cavities. The

1S3G.] Tincture of Copaiba, Properties of Aconite, fyc. 381

external extremity was in the right nostril, and was seized by
strong forceps, and after several efforts, was removed from its
lodgment. The patient had made no particular complaint of it,

and was unconscious of its presence in the nose, until, as he
thought, he discovered an unusual bone on his nostril.

Tincture of Copaiba.

The London Medical Gazette, gives us the following formula
for the preparation of a tincture of copaiba. Rub twelve ounces
of copaiba with six ounces of calcined magnesia. Digest this in
a pint of alcohol, filter, and add half an ounce of sweet spirits of
nitre. This is said to be the best form of administering copaiba.
The dose is one drachm twice or thrice a day ; increasing if ne-
cessary, to two, three, or four.

Emmenagogue Properties of the Aconite. Dr. West of Soultz, extols, in an
article in the Archives Gen. the remedial properties of the Aconite in
amenorrhea, arising from chronic engorgement, or spasmodic condition of the
uterus. He administers the aqueous extract, commencing eight days before
the expected period of menstruation, in doses of one grain, and gradually
augmenting the quantity, until eight grains are taken daily at the ordinary
day of menstruation. Am. Jour. Phar. Am. Jour. Med. Sciences.

Chorea. The following mixture is said to have proved successful in the
treatment of this disease, but the quantity of the cyanide is too great for
most cases ; it would be safer to commence with half the quantity, and in-
crease it gradually.

I. Tincture of Castor 3ss. ; Musk ; Nit. Potass, aa. gr. iv. ;

Cyanide Potassium, gr. ij.

To be mixed with eight ounces of orange flour water, and taken in spoon-
ful doses, in twenty-four hours. Am. Jour. Pharm. Bull, de Thcrap.

Tlydrochlorate of Quinine. Dr. Spielman asserts, that the mu-
riate of quinine is a more speedy and effectual remedy for inter-
mittent fevers, than the sulphate. It is more soluble also than
the latter. The dose is from half a grain to a grain. Am. Jour
Ph. Jour, de Conn. Med.

The great solubility of this article, with even the same medi-
cinal virtues as the sulphate, should give it a decided preference,
for the practitioner would not be under the necessity of adding,
tor its solution, a superabundant acid, as is commonly done for
the solution of the sulphate, whereby, as our observation informs
us, its virtues arc impaired in a very appreciable degree.

382 Freezing Mixture Prussic Acid, tyc. [Noy>

Freezing Mixture Prussic Acid.

Freezing mixture. " Four pounds of pulverised sulphate of
soda, (not efflorescent,) and three pounds of cold dilute sulphu-
ric acid, (seven parts of strong acid to five of water, mixed the
day before using.") Am. Jour. Sciences and Arts.

This will prove a convenience in the distillation of Prussic
Acid, when ice cannot be obtained for condensation. It is cheap,
and always at the hand of the practitioner or chemist.

Prussic Acid should, from its unequalled power as a sedative,
be ever ready to fill the prescription of every practitioner. But
this can only be effectually done when it is fresh from the recei-
ver. Consequently, the practitioner must, if he would avail
himself of its benefits, unless he have a competent and willing
chemist at hand, be always prepared for the distillation of small
parcels of it. It is an article which deteriorates in consequence
of many circumstances, and of none, with more certainty than
that which is of all others most remote from our control, which
is time. Were this article furnished fresh, and of a standard for-
mula, to the practitioner, it would be to him at once, one of the
most indispensable of his remedial agents. This we are fully
justified in saying, by our extensive experience with it for many
years.

Stimulus of Light. Another most powerful natural stimulus, which has
been generally overlooked, or underrated as a sanatory power, is light, or
the direct rays of the sun. One of the most common causes of the loss
of health, and the establishment of morbid irritability in the systems of
children, females, students and mechanics, is living in the shade. Like
plants, growing in similar situations, a large portion of those who do not
labor in the sunshine, are feeble, pale and sickly. The solar bath, properly
used, I am persuaded would more benefit a large portion of our patients
than the best selected articles of materia medica. Boston Journal.

Composition of Hygeian Pills. No. 1. R. Gum. Aloes. ; Crem. Tart,
partes equalis. Pills of common size. No. a. R. Aloes ; Crem. Tart. aa
3 i. ; Gambog. and Colocynth ua ^ i. Pills of common size.

Boston Journal.

Poisoning by Datura Stramonium, or Jamestown Weed. An Irish fami-
ly was taken suddenly ill, after eating a dinner of corned beef and boiled
greens. The family consisted of five persons, Mr. T. his wife, and three
children, the eldest about eight, the youngest about five years of age. I
saw them about an hour after dinner, when the symptoms were immediate-
ly recognized as the effects of the Datura. The countenances had a wild
idiotic expression the pupils widely dilated the sensorial functions per-
verted fed the muscular system subject to an irregular agitation some-
what resembling that of chorea. The appearance of the family was ex-
tremely ludicrous. The children were laughing, crying, singing, dancing,

183G.] On the Treatment of Croup by Sulph, Cupri, tyc. 883

and playing all imaginable antic pranks. They had no correct estimation
of distances, or the size of objects were reaclung their hands to catch
hold of objects across the room, and again running against persons and
things which they appeared to view as distant. The nail heads in the floor
were pieces of money, which they eagerly tried to pick up. A boy, ap-
parently fancying himself undressed, caught a hat belonging to a student,
thrust his foot into it, pulled with both hands on the brim, and began to fret
that he could not " get on his trowsers." The parents frequently called on
the children to behave themselves ; but, their own actions being equally
eccentric, they alforded a ridiculous exhibition of family government.

Sulphate of zinc with ipecac brought from the stomachs a large quantity
of the Datura plant with other green vegetables ; and under the use of
Camphor, Carb. Ammonia?, and a warm aromatic infusion, the narcotic
symptoms soon subsided."

On the Treatment of Croup by Sulphate of Copper. By K. G. Zimmer-
man, m. d. The sulphate of copper was first recommended in croup by
Hoffmann, (1821 ;) who prescribed it in the dose of a quarter to half a grain
every two hours, and during sixteen years did not lose, according to his
own statement, a single patient. Serlo treated from forty to fifty patients
with sulphate of copper, and four only died : after venesection, he gavo
three or four grains as an emetic ; following this with a quarter of a grain
every two hours. Such was also the treatment adopted by Dr. Zimmer-
man, except that he generally applied leeches, and only bled from the arm
when inflammatory symptoms ran high. He gave the sulphate of copper
to fifteen children labouring under well-marked symptoms of croup ; and,
although the disease in some was very intense, in others far advanced, only
two in the fifteen were lost.

Cases. 1. A boy, aged three years, was seized with symptoms of croup,
March 9th, 1830. He had had a cough and hoarseness for several days ;
after exposure to a north-east wind, the symptoms became more severe,
and on the evening of the 9th respiration became " crowing." Twelve
leeches were applied to the neck, and a quarter of a grain of the sulphate
of copper, with sugar, was ordered every two hours. On the 10th, twelve
more leeches were applied in the morning. The danger increased, so that
in the evening the dose of copper was augmented to half a grain, and twelve
more leeches were applied. 11th. One grain of sulphate of copper was
given every two hours. 12th. The child died at nine o'clock in the even-
ing, on the fourth day of the disease.

2. A boy, six years old, seized on the 19th of March, took a quarter of a
grain of sulphate of copper every two hours, till, after repeated vomitings,
all the symptoms of croup disappeared on the 20th. On the 23d, the fifth
day of the disease, the boy was perfectly recovered.

3. A stout boy, one year old, was attacked by croup on the 4th of April :
1m '('lies were applied to the neck ; a quarter of a grain of Cupri Sulph. was
given every two hours, and although this was followed by vomiting every

time, eight doses were administered, when t lie respiration was relieved.

The hoarseness gave way on the 13th, the tenth day of the disease.

4. A blond, scrofulous boy, aged three years, had an attack of croup on
April 13th: there was a sudden invasion of laryngitis, and the cough was
crowing rather than barking. Six leeches over the trachea, and a quarter
of a grain of Cupri Sulph. every two hours, were ordered : each dose ex-
cited vomiting, but the disease did not yield till the 15th, the fourth day.
The hoarseness continued till the eighth day of the disease, when the re-
covery was perfect.

5. A strong boy, four years old, seen at the commencement of the dis-
ease, recovered by taking the sulphate of copper, without previous bleeding.
The medicine was, as usual, followed by vomiting.

384 Salutary Effects of Small Pox, $c. |_Nov.

6. A lively boy, aged six years, seized in the night of the 27th of April,
1831?, was not seen till the evening of the 26th, when the symptoms were
very intense, these of laryngitis and tracheitis combined. Venesection
to three lasses, (cups), twelve leeches, and Sulph. Cupr. live grains, were
perscribed immediately. At eleven o'clock, sixteen more leeches and a
blister were applied ; Cupr. Sulph., a quarter of a grain, was administered
every two hours : the first powder was followed with relief. On the 30th,
the third day of the disease, all the symptoms, except the hoarseness, were
gone, which only remained till the ninth day.

7. The same boy had another attack of laryngitis on the 12th of Janu-
ry, 1634; he recovered, under the same treatment, on the 16th.

8. April 27th he had a slighter attack, cured by Cuph. Sulph. alone.
20th. He \vas quite well, and has not had another attack.

\). A weakly boy, aged six years, had been unwell a week, probably with
measles ; had a decided attack of croup on the 11th of October, 1833. On
the 13th, twelve leeches were applied to the neck ; four grains of the sul-
phate of copper were prescribed, and given afterwards in half-grain doses;
in the evening, twelve more leeches and an emetic were prescribed. The
Cupr. Sulph. was omitted on the 14th, and five of sulphur were prescribed,
&c; the copper was resumed in the evening. He died on the evening of
the 15th, the sixth day of the disease. The trachea and larynx were exa-
mined : the mucous membrane was pale, soft, and a few of the vessels were
injected ; the bronchi appeared filled with, a purulent mucous. A younger
brother had measles five days afterwards.

10. On the 20th of April, 1834, (a year afterwards,) this brother, now four
years old, had an attack of laryngitis. Leeches and the sulphate of copper
were employed, and in a few days he was restored.

11. A red haired strong boy, four years old, seized with croup at 10 p. m. on
the 28th September, too~k the sulphate of copper, and had leeches applied
twice : he re-covered on the third day of the disease.

12. A delicate blond girl, four years old, had a sudden seizure of laryngi-
tis, from which/she recovered in twenty-four hours, after taking four grains
of sulphate of copper.

13. A child, one and a half year old, recovered on the second day, after
six leeches, Cupr. Sulph. four grains as an emetic, and a quarter of a grain
every two hours, had been employed.

Dr. Zimmerman concludes that the sulphate of copper is a very valuable
remedy in croup, particularly when conjoined with leeches and blisters.
Where there are bronchitis and tracheitis, calomel is preferable ; but, in
simple laryngitis, the sulphate of copper is advantageous in the majority of
cases. British and Foreign Review. Hvfeland < Osann's Journal.

Salulaiy Effects of Smallpox. This case is related by Professor Lionello
Polletti, of Ferrara. A girl had for a considerable time complete loss of
sense and motion of the right leg, with permanent contraction of the right
arm, which had been succeeded by what has been called paralysis agitans ;
all the usual remedies had been tried, but without success, so that she re-
fused losubmit 1<> more, when she was seized (although previously Vaccina-
ted,) with confluent smallpox. She recovered, however, from the attack,
which was very severe and alarming in all its stages, and at the same time
lost the paralysis of the arm, and regained the motion and sensation of her
leg. BuUettmo (telle Scienze Mcdichc. Bologna. Fcbbrcjo, 1835.

SOUTHERN MEDICAL

AND

SURGICAL JOURNAL

Vol. L] DECEMBER, 1836. |_No. 7>

Part I. ORIGINAL COMMUNICATIONS.

ARTICLE I.

Surgical Cases : By Paul F. Eve, M. D., Professor of Surge*
ry in the Medical College of Georgia.

SERIES NO. II.

Injuries of the Fore-finger. To a proper and easy com-
prehension of the following cases, it may be well to preceed them
by a definition of the manner in which the bones and joints of the
fingers are here distinguished. The first bone of each finger,
which articulates with the metacarpal row, is called the proximal
phalanx, because the nearest ; the second, the middle, for a very
obvious reason ; and the third, the distal, because the most dis-
tant from the body. So also of the articulations of the finger.
The first is the metacarpophalangeal; the second, the proximal
phalangeal; and the third, the distal phalangeal articulation.
With this necessary explanation, I proceed to relate five cases
of injuries of the fore-finger, which are chiefly interesting by de-
monstrating the fact, that a mutilated part may be often saved
without benefiting the individual. For I now believe that am-
putation, in a majority of these cases, would not only have shor-
tened the sufferings of the patients, but in the end have left a more
useful hand to them. Knowing, however, the great importance
of the fore-finger, and acting upon the principle that it is better
surgery to prevent one operation than to perform a hundred skil-
fully, I, in each instance, attempted union of the divided parts.

49

Surgical Cases. [Dec.

Case 1st. About the 1st of September, 1832, a negro man,
aged 35 or 40 years, and belonging to Mr. J. L. Coleman, was
placed under my care. He was a brick-layer by trade, and \ry
Using the trowel to cut bricks, had materially injured the fore-
finger of the right hand. He had been under the charge of ano-
ther physician, and when I first saw him, suppuration had com-
menced. The finger was freely and repeatedly lanced on its
palmer surface, near the distal phalangeal articulation. Under
the use of flax-seed poultices, a considerable quantity of matter
was dischai'ged, and with it some shreds of the flexor tendon.
After the openings healed up, the finger was diminished in size
and remained stiff'; the proximal as well as the distal phalangeal
articulations being partially anchylosed. Several months after
this, the patient, finding his fore-finger useless, and believing the
middle one would supply its place, requested its removal, and it
was amputated at the proximal phalangeal articulation. He, as
well as his employer, now state that the right hand is not half as
useful as it was before the injury was received.

Case 2nd. Dick, aged about 40, and belonging to Mr. Wm. J.
Eve, had his left fore-finger very much mutilated while attending
his master's cotton-gin, September 19th, 1835. The saws had
cut it in three places ; half an inch of its most distal extremity,
including half the nail, was entirely lost; the proximal phalan-
geal articulation was completely laid open on its palmar surface,
dividing of course the flexor tendon, and the third incision was
over, but not into the metacarpophalangeal joint. The edges
of the two latter wounds were brought together; the parts healed,
and on the eighth day after the accident, the patient left for the
plantation. I saw Dick the other day at the gin, and upon ex-
amination of the hand, I found the left fore-finger much diminished
in size and permanently extended. He said he wished I had
taken off the finger at the time of the injury, for it was now use-
less to him.

Case 3rd. On the day of the above accident, 19th Septem-
ber, 1835, a boy about 10 years old, belonging to Maj. G. L.
Twiggs, was brought to my house, having received the follow-
ing injury of the right hand, also from a gin in motion. The lit-
tle finger was much mutilated up to near the proximal phalan-
geal articulation; the ring-finger from above its metacarpal
joint, had the skin torn off from its whole dorsal surface, inclu-

1836.] Surgical Cases. 38?

ding the nail ; the middle, like the little finger, was greatly lace-
rated and its bones fractured ; and the fore-finger, from its prox-
imal phalangeal articulation, was divided longitudinally nearly
in the centre, through skin, tendon, bones and even nail. It pre-
sented the appearance of a bifurcated finger, up to the above
named joint, which was freely opened. The little finger was
amputated at the proximal phalangeal articulation, the middle one
at its metacarpo-phalangeal, the ring-finger was simply covered
with lint, and to the fore-finger a bandage was applied after the
divided tissues were brought together. It unexpectedly reunited.
The finger is now permanently extended and much diminished in
size, its only motion being at the metacarpo-phalangeal articula-
tion.

Case 4th. On Sunday, 17th September, 1836, a boy about
10 years old, belonging to Mr. Wm. J. Eve, while using a hatch-
et, nearly cut off his left fore-finger. The incision extended di-
agonally through the proximal phalangeal articulation, laying
open the joint, cutting off a portion of the cartilages and bones,,
and, though received upon the dorsum of the finger, the convex
edge of the hatchet had penetrated the palmer surface. The lat-
eral ligaments, at least the external one, and a portion of the skin
on each side were all that remained undivided. The parts were
brought together, without even removing the partially detached
cartilages or bones, and although there was considerable inflam-
mation and discharge of matter, the wround healed in about two
weeks, and the boy returned to the plantation. Two days after-
wards, there was a very severe change in the weather, when from
exposure, the little patient took cold, the finger and whole hand
became very much inflamed, the wound re-opened, and when he
presented it to me, I at once removed the portion of finger now
lying pendant in the palm of the hand. By subduing the inflam-
mation, the stump, though the incision was made diagonally to
correspond with that of the wound, regularly healed, and the
patient again returned home, the 24th October.

Case 5th. On the 13th of O * 1836, Nathan, a negro

man belonging to Mr. John Moore, while opening goods, had an
anvil to fall upon his right fore-finger, which fractured its distal
phalanx just behind the nail and also laid open the distal phalan-
geal articulation. Notwithstanding the nature of the accident,
a severe contused wound, a fracture, and a compound disloca<

388 Essay on Recuhwii, $c. [Dec.

tion, with simple dressings and the use of chloride of soda the
parts entirely reunited in a week. At this time, the nail is com-
ing off, the finger is still somewhat swollen, but the patient can
bend a little, even the distal phalanx.

Remarks. It will thus be seen that of the five cases, ampu-
tation was performed in two, numbers 1 and 4 ; but, in each
case, after the injury had healed; in one it was from choice and
in the other from necessity. In numbers 2 and 3, the fingers are
permanently stiff and reduced in size. In number 3, there is no
middle finger to supply the place of the fore-finger, and even the
ring-finger cannot be flexed from the injury it also sustained by
the accident ; but I think it questionable, whether it would not
have been more useful to have amputated it at the proximal pha-
langeal articulation, and whether it ought not even now to be
performed. In the other, number 2, I do not hesitate to say,
that amputation at once would have been preferable, the injury
being on the left hand, and the middle finger of the same side be-
ing entire. Finally, the 5th case, produced by an accident cal-
culated to be as serious in its results as any other, seems to be
the only one of the five where saving the finger was of decided
advantage.

Augusta, October 27///, 1836.

ARTICLE II.

Essay on Revulsion : By Joseph A. Eve, M. D. Professor of
Therapeutics and Materia Medica in the Medical College of
Georgia.

Although the history of Revulsion may be considered coeval
with the earliest records of medical science, the principle of its
operation having been evidently referred to by the Coan Sage,
in his invaluable aphorisms, still its almost universal application
and its paramount importance in medicine appear to be, by no

183C] Essay on Revulsion,

means, fully recognised and appreciated by the profession in gen-
eral, even at the present day.

In the whole range of medical philosophy, there is no subject
more interesting none that involves so many important consid-
erations, both in pathology and therapeutics.

In all the language of medicine, there is no term more beauti-
fully expressive of the idea intended to be conveyed than Revul-
sion, owing its derivation to the Latin verb revellere, to draw
away, thus signifying a drawing away or abstraction of excite-
ment from one part to another.

Without delaying time to examine the opinions of the ancients,
or to consider the difference between revulsion and derivation,
which Bouchard has satisfactorily proven to be imaginary and
futile, we would simply signify by revulsion, an augmentation of
excitement in one organ, part, or system, which causes a suspen-
sion or depression of excitement elsewhere whether this aug-
mentation be spontaneous or the result of artificial means.

The object of revulsion is to create a centre of fluxion which
shall interrupt the tendency of the fluids towards a diseased part,
"where there is a focus of irritation with exaltation of the vital
properties," that is, to cause a diversion or abstraction of ex-
citement, or irritation from one point to another, w7hereby to ar-
rest haemorrhage, remove congestion, or relieve pain.

By restricting the signification of Revulsion, merely to the op-
eration of external revellents, physicians have generally conceiv-
ed a very limited and imperfect idea of the importance of this
principle of revulsion and its almost unlimited applicability, in
solving the mysteries of disease, and explaining the modus op-
erandi of therapeutic agents. There is indeed, scarcely one
mean in medicine, whose effects do not depend more or less on
this principle. Emetics, cathartics, dinretics, diaphoretics, and
all local excitants, operate not only by the secretion and conse-
quent depletion they cause, but by effecting a revulsive determi-
nation of excitement and afflux of blood to the organs whose func-
tions they excite. Cupping glasses and leeches are as unequiv-
ocally revellent in their operation, as blisters and sinapisms the
only difference being, that the irritation caused by the latter is
more violent and persistent, whilst that made by the former is
resolved as fast as formed by the afflux of blood, from the bites
and scarifications, thus approximating more nearly, in their

390 Essay on Revulsion. [Dec.

mode of operation, to those medicines that promote the secre-
tions; in the action of which, the same phenomena are 'observa-
ble, in the same succession stimulation, irritation, afflux, con-
gestion and effusion which last event, producing immediate res-
olution, prevents the irritation from affecting sympathetically
the rest of the economy. In the employment of general blood-
Jetting, more than is generally supposed, is attributable to the re-
vulsive determination of blood toward the part from which it
flows; this is particularly conspicuous in the effect that venesec-
tion, practised on the foot, exercises over the brain, especially if
the foot be immersed in hot water, and the patient be sitting or
standing erect syncope results, under such circumstances, from
the loss of a very small quantity of blood; a quantity, which,
taken from the arm, would not sensibly affect the head. Inas-
much as the object of revulsion is the production of sedation or
depression of excitement in the part affected, some authors have
styled revulsives indirect sedatives, but as their mode of opera-
tion is essentially stimulant, and the sedation caused, only an ul-
terior consequence, the appellation is inappropriate and should not
be retained.

Our knowledge of revulsion is based upon an observation
of the most ordinary and obvious phenomena in physiology
such as the reciprocal concentration and abstraction of excite-
ment the suspension of some processes, whilst others are exal-
ted, and the numerous reverse sympathies or antagonistic rela-
tions that exist between different organs and systems, by virtue
pf which, an exaltation of excitement in one is attended by a cor-
responding depression in another which principle is also beau-
tifully displayed in pathological facts of every day occurrence
the metastasis of disease from one point to another, and the miti-
gation or entire subsidence of one affection by the supervention
of another, in a different part.

By a wise and happy provision in the animal enconomy, irri-
tation has a constant disposition to extend itself from the part
first attacked to other parts of the system one part or organ
invoking, as it were, the sympathetic aid of others, in sustaining
or resisting an injury, which, otherwise becoming more and more
intense and insupportable, would produce disorganization and
death. Pathologists designate this law or principle in the econ-
omy, very appropriately by the term sympathy: upon it depends

1830.] Essay on Revulsion. :*D1

reaction, .-without which every irritation of much intensity, or in-
volving an important organ, would prove inevitably fatal ; for
the suffering part becomes a focus <>f attraction and concentration
of the excitement and of the fluids \'vo\n all parts of the organiza-
tion, until it is overwhelmed; or other parts beginning to sympa-
thize and share the irritation, the excitement becomes diffused and
reaction established ; as we sec admirably exemplified in the cold
and hot stages of intermittent fever.

In the cold stage, the excitement and the blood forsake the
exterior of the body and concentrate upon the interior, which is
oppressed and deluged with the most intense irritation and con-
gestion ; which are overcome, after a shorter or longer duration,
by reaction, which causes an equalization of excitement, if the
sympathies be sufficiently active alone, or by the aid of artificial
revellents, to cause its diffusion, thus constituting the hot stage.
But if the sympathies fail, the irritation and congestion still in-
creasing, the balance of excitement is irrecoverably lost, and the
patient succumbs in the cold stage. Thus, we perceive without
the play of the sympathies, constituting reaction and causing a
revulsion of excitement from the interior to more superficial and
less vital parts, no patient could survive the cold stage of fever ;
but the equilibrium of health is not restored, until the hot is suc-
ceeded by the sweating or critical stage.

Irritation and inflammation frequently extend, by sympathy,
to remote parts, without materially relieving the primary loca-
tion such sympathetic affections are very common attendants
on all inflammatory diseases, both acute and chronic thev are
generally regarded as symptoms and often serve as diagnostic of
the original malady. But when the sympathetic replaces, that
is, proves revulsive of the primary affection, it constitutes a me-
tastasis if to a more vital part, it is attended with more danger
and its cure is to be effected as promptly as possible, by re-exci-
ting the first. If a depuratory organ, such as the skin, kidneys,
&c, be the seat ofirritation thus sympathetically transmitted, and
the irritation be such as to remove the primary disease, but not
so intense as to suspend the functions of these organs, the sympa-
thetic irritation will, in turn, be resolved by increased secretion
from them, and entire resolution of the disease be the result,
which in medical language is styled a crisis ; thus physicians
ppeak of critical sweats, diuresis, &c ; and it is thus on the prin-

392 Essay on Revulsion. [Dec*

ciple of revulsion, that we can comprehend the philosophy of the
mode of operation of medicines addressed to the secretions, in the
treatment of febrile diseases. But every determination of ex-
citement to a secretory organ, causing copious secretion there-
from, does not invariably prove critical, because the sympathetic
is not always sufficiently intense or persistent to replace the o-
riginal irritation, and the crisis is therefore not effected the dis-
ease is only temporarily or partially relieved. There is then,
only this, though by no means an unimportant, difference between
a metastasis and a crisis in each there is a transmission of irri-
tation from one part to another, which proves revulsive of the
original affection; but in the former, we have only the substitu-
tion of one disease for another whereas, in the latter, the secon-
dary irritation is resolved, immediately, by secretion from the
organ that receives it : thus for example, if a gastritis be transla-
ted to the brain or its meninges, a disease is developed more
grave and dangerous than the first ; but on the contrary, if the
skin be the part to which the translation is made, the direct re-
sult will be a free perspiration which will most probably prove
critical of the gastric inflammation, unless the reflected irritation
be of such intensity as to suspend secretion, and then the conse-
quence will be an erysipelatous or phlegmonous inflammation,
which may still be revulsive of the gastritis, and the patient will
have exchanged a dangerous internal, for a comparatively mild
and safe external disease. Innumerable examples might be ad-
duced of similar sympathetic transmission of morbid excitement
from one organ or part to another, constituting metastases or cri-
ses; and it is by attentively contemplating these, that we are
enabled to derive correct views of revulsion, and deduce proper
principles and precepts for its employment. Keeping always
in view the grand principle of revulsion and the sympathetic con-
nections of organs, but never losing sight of the importance of
the humours in the pathology and treatment of disease, the sci-
entific practitioner endeavors, in the management of fever, to
excite the secretions with the double purpose of eliminating effete
and injurious matter from the circulation, and of causing a re-
vulsive determination of excitement and afflux of blood to the
secretory organs, with the hope of effecting thereby a crisis:
and he only resorts to the more violent and unnatural method
of inflaming the surface to produce revulsion from the interior,

183G.J Essay on Revulsion. 99$

when milder resources are inadequate and the danger to be a-
verted, threatening.

When the secretory organs arc in a state of excitement too
high for secretion, any means calculated to excite them must, of
course, not only be nugatory but hazardous, instead of produ-
cing critical evacuations they would cause inflammation. It is
therefore always proper, in diseases of high excitement, to em-
ploy direct debilitants to reduce the forces of the system, before
having recourse to exciting medications, either to promote se-
cretion or cause revulsion; otherwise they will not only fail to
accomplish the object intended, but exasperate the disease by in-
creasing the general excitement.

Some modern authors proscribe altogether the use of revul-
sives during the continuance of fever, except when an important
organ, as the brain or heart, is violently and dangerously affected,
in which cases nil agree that the most powerful revulsion and
copious depletion should be, immediately and simultaneously,
practised. The employment of the more active or inflammatory
revellents should certainly be deferred, during an exacerbation
and until violent excitement has been moderated ; but they may
often be very advantageously employed long before the entire
subsidence of fever; and the gentler revulsive means may be
beneficially resorted to, in the very commencement.

The principle of revulsion is, indeed, as applicable to the rem-
edial management of the incipient as of the final stage of fever:
but during high excitement, while the sympathies are active and
the vessels replete with blood, direct depletion is necessary be-
fore any appliances that would increase excitement are admissi-
ble. Energetic revulsives arc not therefore to be postponed, in
the first stage of fever and in acute inflammations, from a fear
that the artificial will be translated and added to the original in-
flammation; but because they will aggravate the disease by aug-
menting the general excitement.

We should then commence the treatment of such affections
with the mildest revellents, such as fomentations, cataplasms,
baths, frictions, leeches, cups, &c. ; and should these fail in effect-
ing revulsion, resort to the more violent epispastics, as the vio-
lence of excitement subsides or is reduced by depletory mea-
sures. We are aware that what we have said impugns a prop-
osition very generally received as an axiom in medicine, and par-

50

394 Essay on Revulsion. [Dec.

ticularly insisted on by the author of "the new medical doctrine;"
that is, " that revulsive irritations must be stronger than those
they are intended to replace, otherwise they turn certainly to the
benefit of the latter" that there is no medium between extin-
guishing and exasperating the original affection: but we consid-
er this to be a dangerous error in theory, which has led to very
prejudicial results in practice causing on the one hand an un-
necessary and injurious postponement of the employment of re-
vulsives, or on the other determining the selection of those unne-
cessarily severe. If this proposition were true, the most acute
inflammation would require the most intense revulsion ; whereas
we know that acute inflammations are often greatly mitigated,
by very gently revellent means, as for example, gastritis by fo-
mentations over the epigastrium pleurisy by warm applications
to the side croup by warm wet cloths applied to the throat
even the physiological excitement of some organs will, frequent-
ly,moderate or suspend the sufferings of others thus we contend
that irritations and inflammations may be relieved without being
entirely extinguished, and that grave affections may be mitigated
and sometimes entirely replaced, by very mild revulsive excite-
ments, even by such as may be attended with no pain and not
even transcend the normal point. Were the position assumed
by our opponents correct were there in the employment of re-
vulsives, no medium between exasperating and extinguishing the
original affection did the more intense always overcome and
appropriate to itself the lighter excitement, we should never suc-
ceed in producing revulsion; for the primary would always at-
tract to itself the artificial irritation in its incipiency, and as fast
as formed, and thus never fail to be aggravated by it. But of
this observation constantly declares the fallacy ; for we fre-
quently sec blisters fully drawn without either removing or in-
creasing the inflammation, for which they were prescribed,
which remains unaffected, and sometimes requires a succession
of blisters or a perpetual blister for its final extinction.

We would by no means contend for the exclusive use of the
gentler revulsives, we know very well that they will not always
suffice; we would only argue that they may often be, advantage-
ously and safely, employed in the first stage of acute diseases,
when the more potent would be altogether inadmissible. We
can generally, with oxcellent effect, commence the treatment of

1836.] Essay on Revulsion. 506

acute inflammations of the thoracic and abdominal viscera, by
employing gentle rcvellents that will not sensibly increase the
general excitement, and as it becomes moderated, substitute
those that are more active, until the strength and activity of the
system having been sufficiently reduced, the most energetic may
be employed, not only safely, but with the effect of causing com-
plete revulsion and preventing the inflammation from becoming
chronic, and terminating in disorganization.

A very important consideration, in the administration of re-
vulsive medications, is the adaptation of the means employed to
the indication to be fulfilled in different cases. As a general rule,
subject however to some exceptions, the revulsive irritation ought
to correspond to that which it is intended to replace ; for exam-
ple, in haimorrhagic irritations, as hoemoptysis, &c, cups and
leeches will be most appropriate and beneficial ; and if the dis-
ease to be treated have resulted from the suppression of a period-
ical or habitual sanguine discharge, the proper revellents are
those whose operation involves evacuation of blood : in nervous
irritations, rubefacients and such other revulsive medications as
excite the surface, without producing inflammation, are generally
preferable in colic, while the affection is confined to the nervous
tissue, the sanguine not involved: that is, before inflammation
commences, warm fomentations, cataplasms, stimulating fric-
tions, sinapisms,. &c, are much better adapted to the case, than
the more permanent epispastics ; but when inflammation has been
developed, the latter are much more efficient, it is however often
necessary to premise or accompany their employment with free
sanguine depletion. When it is desired to recall a superficial af-
fection, such as erysipelas, &c, whose disappearance has been
attended with injurious results, sinapisms are the most proper
remedies; but if the malady we design to relieve, depend on the
sudden healing of a deep ulceration, or if the indication be to cure
an internal abscess, such rcvellents will be required as shall cause
and maintain an artificial suppurating ulcer, setons, issues, moxa,
&c.

The choice of the means to be employed should, in a great
measure, be determined by the duration and obstinacy of the
disease: recent and light affections generally yield easily, and
seldom require more than the most simple and transient revul-
sives ; but the more chronic a malady is, the more intense ahd

396 Essay on Revulsion. [Jjec.

permanent will be the revulsion demanded for its extinction.
In the incipient stage of croup, warm fomentations to the throat
are, often, sufficient at once to dispel all the symptoms: in the
same stage, affections of the lungs and liver are frequently re-
moved, promptly, by the revulsive operation of an emetic or ca-
thartic, which later in the same cases would prove ineffectual if
not injurious. In sudden metastases to important organs, as the
brain, heart, &c, the selection of a revulsive should be governed
by the power and promptness of its action; such cases demand
the immediate application of the most prompt and energetic sina-
pisms, actual cautery, scalding water, concentrated mineral
acids, &c. the same speedy and powerful revulsion is requisite,
in congestive fevers, to equalize the excitement and determine
the circulation to the surface.

One of the most important points to be regarded, in the em-
ployment of revulsion, is the selection of the place upon which
it should be practised. As a general rule, external revulsives
should be applied to the surface directly over the suffering part ;
as to the side in pleurisy to the breast in pneumonia, &c. ; but
there are many exceptions to this rule. Active revellents ap-
plied very near sensitive organs, instead of proving revulsive,
often aggravate irritation in them, by causing toward them a
determination of excitement and consequent afflux of blood.
In affections of the brain, for example, revulsives applied to the
scalp woulJ prove highly prejudicial, if not fatal, except in ex-
tremely low states, when the vascular system is so exhausted of
blood, the sympathies so paralyzed and the excitability so nearly
extinct, that inflammation of the cutaneous covering can. extend
its influence no farther than to cause a feeble afflux thereto from
the cerebral mass within. In acute gastritis, the same danger
attends the action of blisters on the epigastrium, before the general
excitement has been sufficiently reduced by blood-letting, and
that of the stomach by appropriate means, not on account of any
direct or intimate sympathy, as Goupil asserts, between the skin
and digestive mucous membrane, by which one constantly par-
ticipates in the affections of the other. According to this author
there exists, between the skin and pulmonary mucous membrane,
an inverse sympathy to which he attributes the success of revul-
sion in inflammations of the lungs and between the skin and
digestive mucous membrane, a direct sympathy, and consequently

1836.] Essay on Revulsion. 397

that " revulsives can only have an injurious effect in ^astro-intesti-
nal inflammations. Yet with the strangest inconsistency, he recom-
mends the application of leeches to the epigastrium," and says,
"we should not hesitate to range these animals amongst the re-
vulsive means," and that " to be convinced that they can not act,
except in this manner, it is sufficient to recollect the effects which
they procure in gastro-entcritis, when applied to the epignstrium."
The skin then, according to M. Goupil,- sympathizes directly,
under the influence of one revulsive mean, and inversely when
acted on by another. Who can listen to such reasoning such
extravagant assertions? And farther, is it not equally absurd to
suppose, that the skin over the thorax entertains an inverse sym-
pathy with the gastro-pulmonary mucous membrane and over
the epigastric region, a direct sympathy with the same mem-
brane? or, that the gastro-pulmonary mucous membrane, de-
scending into the lungs and into the stomach, should hold differ-
ent relations with the cutaneous surface ? But with the same
inconsistency, this author tells us again, "in cases where gastro-
enteritis is the result of the disappearance of inflammation of the
skin or subjacent organs, it is necessary to(employ revulsives to
recall it," and concurs with his preceptor, Brousshis, in direct-
ing blisters to the abdomen in cases of intestinal haemorrhage,
but condemns the application of a vesicatory to the thorax in the
commencement of pneumonia or pleurisy, as an incendiary prac-
tice. We object more to his fanciful theories, than to his prac-
tical precepts. The same principles are applicable, the same
effects attend the employment of rcvellcnts, in thoracic and ab-
dominal inflammations. The gastro-pulmonary mucous mem-
brane bears the same relation to the skin, over the thorax and
over the abdomen: in the acute inflammations of either cavity,
violent revellents are improper, because they increase the gen-
eral excitement and augment the force of the circulation, which
affects in an especial manner the inflamed organs.

Blisters may generally be applied somewhat earlier, in inflam-
mations of the lungs than of the stomach, inasmuch as the form-
er are less excitable than the latter and not situated so near the
surface. When inflammatory revulsives are applied very near
inflamed organs, that is where there is but little substance inter-
posed, there is danger of the revulsive inflammation, by sympa-
thy of continuity, as it is termed, extending to and aggravating

'08 Essay on Revulsion. [Dec.

the original affection. This danger, however, is seldom to be
apprehended from blisters to the epigastrium :* and we appeal
without the least hesitation, to the experience of American physi-
cians, for their beneficial effects in gastric fevers, after the first
violence of excitement has been subdued by bloodletting and
other proper measures ; and in debilitated subjects at the very
commencement of an attack ; for in such patients the general
system is very little if at all disturbed, by the excitement of a
blister and perfect revulsion is effected, from the gastric mucous
membrane to the external surface. But generally, in cases of
gastric fever, it is more safe and efficacious to apply them, first,
to the arms and legs to abstract the excitement as far as possible
from the point of concentration, and in the latter stage, after the
system has been much reduced, to the epigastrium should it then
be necessary ; it will, however, seldom be required, at least such
is the result of my own experience : but milder revellents, such
as fomentations, cataplasms, cups and leeches, may be advan-
tageously employed at the very first and simultaneously with
blisters to the extremities. Besides the greater efficacy of epis-
pastics thus applied at a distance from the suffering organ, a blis-
ter to each leg and arm will not cause one-fourth as much dis-
tress to the patient, or one-fourth as much disturbance of the
system, as one to the epigastric region; and they will heal in
half the time. So far from exciting much pain, in some cases of
intense gastritis, the extremities suffer such a distressing numb-
ness from the excitement being concentrated on the stomach, that
the drawing of blisters is sometimes even pleasant to the pa-
tient, seldom the source of much complaint. In cases of acute
gastritis suddenly occurring in persons previously much enfee-
bled, it will often be proper to employ blisters or sinapisms sim-
ultaneously to the. extremities and the epigastrium, or in very
quick succession.

With respect to the choice of place for the application of re-
vi llents if the disease to be combattcd supervene on the retro-
cession of an external inflammation, or the disappearance of some

* Applied too near the diseased place, if the parts are thin, we run the
ri&que of causing the external inflammation to unite with the internal, and
consequently augment the evil. In the eu i where the affection we wish
to displace, is without inflammation, this inconvenience docs not exist any-
more than if the mean employed does not produce inflammation, as blood-
letting, cups, &c." Diction, des Sciences Medicates.

183G.] Essay on Revulsion. 399

other affection, revulsion must he exercised on the part or organ
originally affected ; a much slighter irritation, excited there, will
prove more certainly and effectually revulsive, than a much
more intense degree elsewhere, hi proof of this position, many
interesting cases might he adduced, did our prescribed limits ad-
mit: the following very curious one must suffice. A patient
admitted into the Hotel Dieu of Paris, complained of a most vi-
olent pain in the tendo achillis of the left leg, without either red-
ness, heat, or swelling. After many curative means were em-
ployed in vain, it was discovered that some days previous to the
attack, the patient had suddenly suppressed a gonorrhoea, and
the affection could not be removed but by establishing the dis-
charge from the urethra by the aid of ammoniacal injections.*

If the prominent affection be sympathetic of some other more
obscure disease, it will be necessary to direct our attention pri-
marily to the latter, on whose removal that which was sympa-
thetically produced will subside. Pain in the right clavicle and
shoulder is a symptom of hepatitis, and only to be relieved by
means addressed to the liver. Headache generally depends on
gastric disorder, and is removed by remedies that correct the
state of the stomach. Distressing irritability of stomach and
obstinate vomiting are, frequently, caused by sympathy with the
uterus and requires remedies directed to that organ in such
cases, we have found a blister over the sacrum more effectual
than any other remedy. Abortion may often be prevented and
doubtless many of the distresses incident to pregnancy greatly
mitigated, by revulsion practised on the same part. A host of
oral affections, some anomolous, others simulating colic, he-
patitis, gastritis, pleurisy, &c. &c, are produced sympathetically,
by irritation of the spinal marrow, and demand for their cure,
leeches, cups, sinapisms, blisters, &c, along the course of the
spine. f

Two very important considerations, in the administration of
revellents, are duration and extent of surface. We often fail in
our attempts to produce revulsion, by not continuing the appli-
cation of revulsives long enough, and by not persevering to repeat

* Diet, des Sciences Medicales.

f See Teale on Neuralgic diseases, and Essays in the 6th No. of this
Journal by Dr. Heustis of Mobile and Dr. Ford of this city.

400 Essay on Revulsion. [Dec.

them when the first does not succeed. Blisters, though much
less violent than sinapisms, generally effect much more, because
they are more permanent in their operation. On the same prin-
ciple, more benefit may frequently be derived even from cata-
plasms and fomentations long continued than from si lopisms.
Much benefit may be effected by the proper manage ment of
warm pediluvia, but to evince their best effects, they should im-
merse the legs nearly up to the knees, be continued from one to
two hours, frequently repeated, and in the intervals substituted by
bottles of warm water, warm bricks, warm cataplasms, &c. to
the feet.

A comparatively mild revellent, long continued and applied to
an extensive surface, will produce much more revulsion, than
one much more intense, of less duration and extent: hence the
efficacy of the general warm bath, of stimulating frictions of the
skin and of diaphoretic medicines, whose beneficial effects depend,
chiefly, on their causing a revulsive determination, to a part of
such immense extent as the external tegumentary system. Cer-
tainly one of the greatest improvements, in modern medicine, is
the more frequent substitution of external for internal medication.
The steam bath is doubtless a potent mean, for causing revulsion
to the surface and relieving the super-excitement and congestion
of internal organs, and may be often very advantageously em-
ployed by scientific practitioners, in the treatment of congestive
diseases ; but its ignorant and ill-timed exhibition, in the hands of
empirics, especially when immediately followed by cold appli-
cations, is unfortunately, too frequently the instrument of death.

In persons of nervous temperament, much caution is requisite
in the administration of active revellents, as distressing and even
dangerous results not unfrequently attend their application in
such subjects; their use should, therefore, be avoided, except in
very urgent cases, and the most gentle employed in their stead ;
but the state of the system, or the nature of the disease may afford
a paramount indication for their employment, when the influence
of temperament will not be felt as exemplified in the following
instance: A sinapism applied to a lady of nervous temperament,
for the relief of a local affection, was followed the third day by a
most tormenting secondary irritation which continued several
days, notwithstanding all the remedies that could be suggested to
allay it; subsequently, when in most imminent danger, caused

1836.] Essay on Revulsion. 40b

by repercussion of measles, the same individual derived, from the
application of eight large sinapisms, the most signal benefit, with-
out the slightest ulterior discomfort. These different results,
under different circumstances, are easily explained. When the
first sinapism was applied, the skin enjoyed its accustomed de-
gree of excitability ; at the time of the second application, the
excitement was abstracted from the surface and concentrated on
the interior, and the most powerful stimulation was demanded to
restore the equilibrium.

Notwithstanding so much has been written on revulsion, so
commanding is its importance and universal its application in
medicine, and so confused and vague the views generally enter-
tained by physicians, that if these remarks afford any useful sug-
gestions to the young and inexperienced members of the profes-
sion, or even serve to direct their attention more forcibly to it,
my labor will be amply rewarded. We have endeavored to set
forth, plainly, a few of the most prominent principles concerned
in the operation and employment of revulsion ; it would be an
agreeable task, did our limits and engagements admit, to pursue
the subject farther and consider the application of these principles
to the remedial management of all or nearly all diseases, and to
the modus operandi of at least a majority of our therapeutic a-
gents ; but this would be little less than to write a system of
practice ; for it will be found, on an attentive and philosophic ex-
amination, that this grand principle of revulsion is almost uni-
versally involved in the pathology and treatment of disease.

*1

402 Cases of Colica Pictonum. [Dec*

ARTICLE III.

Cases of Colica Pictonum: By L. A. Dugas, M. D., Professor
of Anatomy, &c. in the Medical College of Georgia.

Case 1st. M. J., about 12 years of age, apparently of a good
constitution, and an apprentice printer, was taken in July
last with pain in the bowels, which gradually increased in in-
tensity until it became excrutiating. It had continued thus
more than a week when I saw him, and learned that the most
powerful cathartics had, during this time, been administered lib-
erally without the slightest alvine effect. I found him writhing
with agony ; the pain had extended to the lower extremities, but
especially to the feet ; his system evinced no febrile action ; his
tongue was normal; in short, he presented every symptom of
colica pictonum, to which his avocation exposed him. Having
long since considered this a nervous affection, although the effect
of a specific agency, I examined carefully the condition of the
spine, but detected in it not the slightest tenderness when sub-
jected to pressure, percussion, and lateral motion of the vertebra?.
This circumstance deterred me from immediately directing my
treatment to this region, and a few cathartic pills and a sinapism
to the abdomen were ordered. On seeing him the next day, I
found lh :t the pills had not operated and that his sufferings were
unmiti^j-teJ, notwithstanding large doses of laudanum had been
added to my prescription, during the night, by the lad's mother.
I now ordered a blister to be applied to the spine, extending from
the middle dorsal to the last lumbar vertebra?, and three inches
wide ; also another dose of the cathartic pills to be given when-
ever the vesication should commence. On my next visit, the
following day, I had the gratification to find my patient perfect-
ly free from pain ; the blister had drawn finely, and the cathartic
had acted kindly. Convalescence was rapid, and the boy return-
ed in a few days to his former occupations, without any other
remedy.

Case 2d. M. B., an apprentice printer, about 15 years of
age, has had several attacks of colica pictonum, at intervals of
about six months. Called to him on the 0th August last, I found

1 036.] Cases of Colica Pictonum. 400

him laboring under a violent return of this disease. The feet
were also affected in this case. No tenderness of the spine. A
dose of oil and a sinapism to the abdomen were ordered, and re-
mained without effect. On the 10th, finding the pulse full and
resisting, at the same time that a tendency to stupor and deliri-
um were manifested, 20 ounces of blood were taken from the
arm, and the oil repeated. No diminution of pain having taken
place, in the evening the dorsal and lumbar spine were freely
cupped 1 1th; passed a much better night than usu?l and feels
much better, though not entirely relieved. A blue pill to be ta
ken morning, noon and night. 12th ; pains have returned with
redoubled violence, delirium and slight convulsions from excessive
suffering; bowels have been slightly moved; cups reapplied to
the spine, and a blister over the cupped surface at night; blue
pills continued, 13th ; blister has drawn well ; relief is complete.
The bowels were now opened with oil, and the ca'e discharged
the next day.

Case 3d. This is a leturn of the disease m die subject of the
first case. It occurred on the 20th October, with precisely the
same symptoms it had before presented. The costiveness had
been endeavored to be removed by oil, &c. on the /irst day of the
attack, but in vain. I immediately ordered a blister to the spine,
which gave relief as soon as it acted a cathartic then c.dminis-
tered, acted without difficulty; and the case vns dischaiged well
the second day. Here the spine presented no tenderness.

Remarks. It will be noted that the spine in neither oi' hese
cases, evinced the slightest sensitiveness ; yet revulsives applied
to it were invariably and promptly followed by the most decided
relief. We may infer from this circumstance that the poisonous
effects of lead are principally manifested in the sympathetic
nerves, and that it is because of their free communication with
the spinal marrow, that revulsives applied near this column act
so advantageously. Indeed it would seem that the disease may
in some instances extend, by continuity of substance, or other-
wise, from the sympathetic nerves to the spinal marrow itself,
thus accounting for the pains of the extremities, and even loss of
motion, which so often complicate colica pictonum.

Augusta, November, 1836.

404 Amussafs Lessons on Retention of Urine, <$-c. [Dec.

Part II. REVIEWS AND EXTRACTS.

Amussafs Lessons on Retention of Urine, caused by Strictures
of the Urethra, and on the Diseases of the Prostate. Trans-
lated from the French, by James P. Jervey, M. D., Charles-
ton. Page 246.

The work before us is the substance of a course of Lectures
annually delivered by M. Amussat, in the amphitheatres of the
Faculty of Paris. Professional rectitude and zealous industry
have long since characterized this gentleman's labours and im-
pressed on them a practical importance far above the visionary
productions of the closetted book-makers of the day. M. A. is
essentially a practical man ; one whose observations are all made
at the bed-side and in the dissecting room, with an eye solely
directed to the detection of truth and one whose purpose is the
good of humanity. The writer of this notice, from his personal
acquaintance with Mr. A., takes much pleasure in thus testifying
to his claims at least to public confidence.

It is not our design to enter upon an elaborate Review of this
work the limits assigned will not permit it. We desire merely
to call the reader's attention to the subjects on which it treats,
and to point out some of the views peculiar to the author. The
first chapter is devoted to the consideration of the several varieties
of stricture of the male urethra, their pathological anatomy, and
the means of diagnosis ; the second treats of catheterism with
curved and straight instruments; the third relates to the means
proper to relieve retention caused by strictures; the fourth in-
cludes the treatment of strictures ; the fifth enumerates the acci-
dents complicating strictures ; and the last refers to diseases of
the prostate.

M. Amussat divides strictures into three kinds, viz. : the organ-
ic, the spasmodic, and the inflammatory. Of the organic he es-
tablishes four species: first, frocni; second, valvular strictures ;
third, those produced by a chronic swelling of the mucous mem-
brane ; fourth, callous strictures. The froeni he considers formed
in some cases by an acute inflammation of the mucous membrane
of the urethra, passing into the chronic state at different points
of this surface, and depriving it at these points of its natural ex-
tensibility. In other instances they appear to result from the
cicatrization of ulcers, and arc then met principally about the
fossa riavicularis. M. A. denies that they are ever formed by
falsi; membranes, as has been supposed. With regard to the
valvular strictures, which he thinks more common than all others,
he views them as nothing more than frceni which occupy the
whole circumference of the Urethra.

1830.J Amussat $ Lessons on Retention of Urine, $c. 405

Mr. A. denies that strictures ever exist beyond the bulb, and
states that they are most frequently located about the junction of
the bulbous and muscular portions, and at the origin of the fossa
naviculars. His " exploring sound" is intended for the purpose
of*" examining the urethra from behind forwards, a direction in
which the strictures arc always more appreciable." Its mechan-
ism is simple, and well adapted to the end proposed. In the
chapter on cathetcrism, the author advances his claims to the
discovery, or rather to the practical application of straight ca-
theterism. Although many passages may be found, in authors
who preceeded him, which allude to the possibility of this oper-
ation, it must be conceded that the attention of the profession was
not forcibly drawn to its advantages prior to M. Amussat's pub-
lication in 1822. There are strong grounds for the belief, that
M. A's. researches had no inconsiderable influence in the perfec-
tion of the instruments subsequently invented tor crushing urin-
ary calculi, for nothing useful had been done on the subject until
it was demontrated that the bladder could be penetrated as read-
ily by straight as by curved sounds.

It will be perceived, (p. 77.) that it* is to M. A. we are indebt-
ed for the valuable suggestion of 'forced injections," in the treat-
ment of retention. " Convinced of the difficulties often presented
by catheterism and the introduction of bougies in cases of reten-
tion of urine from stricture, as well as of the dangers to which
the patients are exposed, M. Amussat invented forced injections,
a process still too little known, and which was unjustly at the
time endeavored to be attributed to a German surgeon." This
operation consists in forcing water into a catheter introduced as
far as the strictured point; the urethra being pressed against the
catheter prevents the reflux of the fluid, and this gradually pen-
etrates the narrowed passage and finally makes its way to the
bladder, after having sufficiently dilated the canal to permit the
flow of urine.

After exposing the difficulties of obtaining a faithful impres-
sion of the stricture in the manner recommended by Ducamp,
M. Amussat insists that, in certain parts of the canal, impres-
sions may be left on the wax bougie whether the urethra be
strictured or not. " The bulbous portion of the urethra is so
arranged, that an impression can always be taken with the ex-
ploring sound, when the canal is healthy or diseased, when the
experiment is made upon the living or the dead subject. When
the extremity of the instrument has arrived at the bulb it is ar-
rested by the cul-de-sac formed by the fibrous membrane which
envelopes this body. However slightly the exploring sound be
then pushed forwards, the spongy tissue which is thicker at the
bulb than any where else, allows itself also to be more easily
depressed, and then forms a kind of hollow in which is moulded
the inferior part of the end of the wax with which the bougie is

406 Amussat's Lessons on Retention of Urine, fyc. [Dec.

armed, whilst above the wax enters into the area of the canal.
Thus whenever an impression is taken at the bulb, if the operator
be guided by this impression, he will believe that the stricture is
more projecting below than above, and consequently will be in-
duced to cauterize especially in the former direction.

" To how many false passages has not this error given place !
It is so true that the cul-de-sac of the bulb can impose upon the
operator, that the majority of these accidents occur at this point."

M. A. gives the decided preference to the cutting instrument
over the use of caustic, in cases of valvular strictures. Indeed,
cauterization is attended with so much risk, that we are not sur-
prised to find it avoided as much as possible by so prudent a prac-
titioner as M. A. His instruments for scarification, though good,
are not described with sufficient lucidity to be understood by one
unacquainted with them. Whether this defect should be attrib-
uted to the translation or to the original, we cannot determine,
not having the latter by us.

The chapters on the accidents attendant on strictures, and on
the diseases of the prostate, are replete with interest. M. A's,
work is one in which the reader will find neither rhetorical nor
pedantic display ; containing no theories, nor metaphysical spec-
ulations ; it may appear dry and uninteresting to those who pre-
fer fiction to truth ; its merits will be duly appreciated only by
the man of practical experience.

The translation we doubt not is faithful, for in his zeal to ren-
der it so, the translator has but too frequently been led to give us
rather the words than the ideas of the author. These Gallicisms,
however, being rather more disagreeable than injurious to the
sense of the phrase, will not be uncharitably censured by those
who are aware of the difficulty of translating a language, with-
out being so much imbued with its genius as to confound this
with that of their vernacular tongue.

The translator will, we trust, not lay down his pen after this
effort ; if he will favour us again with some of the many trea-
sures locked up in the French language, we promise no more to
notice the peccadillos of inverted and foreign phraseology. The
judicious notes interspersed through the body of the work, by
Dr. Jervey, will be duly appreciated by the profession.

Augusta, November, 1836.

1836.] Extracts from the Note-book of a Physician, c. 407

Extracts from the Note-book of a Physician of this City, during
his attendance on the Parisian Hospitals.

M. Piorry's Remarks on the Blood. M. Piorry thinks it
pretty certain, that most, of" the cases of softening of the substance
of the heart, now so often met with, are occasioned by protracted
abstinence. He says, that independently of his having observed
this very often, the analogous effect being produced on the other
muscles, even during life, will strengthen his assertion. He con-
siders coagulable lymph and the serum of blood as the very
same fluid, and founds this opinion on experiments made by M.
Serres and himself. The buffy or inflammatory coat that ap-
pears, on permitting blood to coagulate, is, according to him,
nothing else than the deposit of a certain quantity of fibrine, held
in solution in the serum. Thisonceadmitted.it is very easy to ac-
count for the formation of a greater or less quantity of buffy coat,
according to the manner in which the blood is drawn, and the
shape of the vessel in which it is received. If the orifice in the
vein be made large, the quantity desired will be drawn in so short
a time that the coagulation will commence in the entire mass at
about the same moment, so that all the serum will separate from
and cover the crassamentum, and deposit on the surface of this
a thick buffy coat; but if on the contrary, the orifice be small,
the discharge will take place so slowly that coagulation will
have commenced long before the necessary quantity be drawn, and
consequently, the deposit of fibrine from the serum will be made
throughout the mass of cruor, instead of on its surface. With
respect to the form of the recipient, it is obvious that if it be shal-
low and present a large surface, the coat will be thinner than if
the same quantity of blood be allowed to deposit its fibrine on
a smaller surface. Mr. P. adds in support of this opinion, the
fact that by adding a small quantity of distilled water to the se-
rum, a deposit will be produced precisely similar to that just al-
luded to.

Mr. P. confirms the experiments of M. Baruel, who says that
the aroma evolved by pouring sulphuric acid on blood, is so
strong and so different in that taken from different individuals,
that he can thus very readily determine whether it has been ob-
tained from a man or a woman.

Lastly, Mr. P. speaks of the effects produced on the quantity
as well as quality of blood, by long fasting. Death from fasting,
is caused by the diminution of its quantity and its almost total
disappearance from the body. What is formed in such cases
contains but very little fibrin. Reference is made to the experi-
ments of Collard de Martigny on the subject.

408 Extracts from the Note-book of a Physician, c. [Dec.

M. Boijillaud's Remarks on the Liver. He considers
hypertrophy of the liver to be caused, in most cases, by irritation
and not inflammation. M. Piorry attributes it for the most part,
simply to congestion ; whereas Mr. Bouillaud seems to think the
substance of the liver actually increases. The softening of the
liver is characteristic of inflammation. He thinks many of the
cases of suppuration of the liver reported, especially after surgi-
cal operations, are nothing more than the deposit of pus brought
here by the veins, and previously absorbed from the suppurating
surfaces. He makes the same observation with regard to the
brain, &c. ; but remarks that this deposit may, by its presence,
induce the inflammation observed, and erroneously considered as
the cause of the presence of the pus. If even an abscess be found
without a softening of the parenchyma surrounding it, the pre-
sumption should be very strong that the pus was deposited by
the veins. Pain may either exist or not, in hepatitis. Care
should be taken not to confound the want of sound and of respi-
ration in the lower part of the region usually occupied by the
lungs, and usually owing to pleurisy, with that occasioned by
hypertrophy of the liver, causing it to elevate the diaphragm and
occupy the place of the lower portion of the lungs. The liver
in its healthy state is perfectly insensible to the knife. The in-
flammation of the liver may extend by continuity of substance
and cause peritonitis, pleuritis, &c. In hepatitis, the secretion of
bile is generally increased; the stools are bilious; icterus often
supervenes. Mr. B. thinks hepatitis often caused by irritating
ingesta and all remedies which irritate the gastrointestinal canal.
These arc absorbed and carried immediately to the liver, and
consequently affect it also. He alludes especially to irritating
cathartics; mercurials; alcoholic drinks. He thinks many of
the cases attributed to the warmth of tropical climates, are due
to the immoderate use of stimuli of all kinds, so freely used in
those countries.

M. Dupuytren on Chorea. M. Dupuytren exhibits to the
class, a young girl, about 1 1 years of age, who was affected with
chorea to such a degree, that she could not without much diffi-
culty, carry food to her mouth. The only treatment has been
cold affusions used daily ; and in the course of about a fortnight
she has so much improved as to be able to use the needle with
facility. Mr. D. insists upon the great efficacy of this remedy.

Encysted Tu^or of the Wrist. M. Lisfranc mentions
the history of an encysted tumor, situated beneath the radio-
carpal ligament, whicn was laid open, and discharged a quanti-
ty of mat tor somewhat analogous to milk curd. In order to
prevent the violent Inflammation that usually supervenes in cases
of this kind, and not unfrcquently injures the movements of the

1836.] Extracts from the Note-book of a Physician, tyc. 409

joint, he ordered the application in the vicinity of the wound, of
one hundred leeches after the operation, and a daily application of
fifty until all danger of inflammation had subsided. Through
mistake only fifty were applied the first day, which permitted the
development of a slight degree of inflammation ; but the succes-
sive employment of the depleting animals soon allayed this, and
the patient is now well. Mr. L. thinks this p I*appy application
of the physiological principles, to the treatment of a disease here-
tofore no less difficult to manage than rare in its occurrence.

M. Louis on Expectoration. M. Louis contends that the
appearance of the expectoration can seldom lead to a certain
diagnosis in cases of pulmonary consumption. In fact, that there
are very few diseases of the lungs that can be characterized by
the expectoration. These are pneumonia and gangrene. The
former by the rusty, semi-opaque, or reddish expectoration ; and
the latter by the peculiar gangrenous odour which occurs in no
other case. Mr. L. is aware that it has been said that in cases
of pleuritic effusion, attended with perforation, the expectoration
is of a peculiar nature, perfectly similar to the liquid pus found
effused in the pleura in such cases, and easily distinguishable.
He however has never met but one case of pleuritic perforation,
and in this he could not discover the kind of expectoration de-
scribed. He thinks it probable, from the scarcity of the disease,
that many of the cases reported have been done so through error
of diagnosis.

Blushing. M. Louis remarks, that Bichat was in error when
he thought the skin of the face different from that of the rest of
the body, inasmuch as it evinced by blushing, the emotions of
the mind. Had he ever uncovered a person at the moment of
blushing, he would have perceived that the whole surface of the
body partakes of this phenomenon and becomes flushed. It is
so marked in the patient before us, that he seemed at first to have
scarlatina.

Vaccine. M. Gucrsent mentions the singular fact, that it is
with the utmost difficulty that vaccine can be made to take effect
in this hospital, (Hopital des Enfans). Mr. G. recommends the
matter to be taken from the arm as early as the seventh day, for
when taken later, or when the fluid becomes opaque, it produces
in this hospital no eruption. Is there no danger of destroying
the antivariolous effects of the vaccine in the individual whose
arm is robbed at so early a period?

Rheumatism, &c. M. Trousseau recommends as very effec-
tual, the introduction of morphia, or of belladonna, into the skin ;
this being previouslv deprived of its cutis by hot water, or aqua,

52

410 Extracts from the Note-book of a Physician, <$-c. [Dec-
ammonia. Its known efficacy in tic-douloureux, led him to try it
in rheumatic pains, gout, and obstinate head-aches, with the most
signal success. The remedy should, of course, always be applied
as near as possible to the affected part.

Buffy Coat. M. Rostan refuses to yield to the reasons as-
signed by Piorry and others, in proof of the want of coincidence
of the buffy coat with inflammation. He thinks it not only indi-
cates this pathological condition, but also its intensity.

Sudden Death. M. Rostan remarks, on speaking of sudden
death produced by rupture of the heart or aorta, that it is a
great error to believe that apoplexy ever produced instantaneous
extinction of life. It is impossible for any haemorrhage of the
brain, unless it be situated at the protuberautia annulare, which
very r?rely occurs, to cause sudden death. There is always
more ov less lingering. We should therefore always suspect a
rupture of the heart or aorta in such cases.

Cancer. M. Trousseau considers cancer a living tissue, be-
cause it contains blood vessels, is subject to ulceration, granula-
tion, &c. ; but especially because it is neither expelled nor encys-
ted, as are all foreign bodies.

Diluents. M. Piorry says, the term Diluents, (Delayans,}
applied to a certain class of remedial agents is highly correct, for
by their use the blood is actually diluted and rendered less stim-
ulating to the parts to which it is sent.

False Membranes. M. Ducrotay de Blainville states, that
false membranes never become organized, and that, consequent-
ly, inflamed membranes never form adhesions with each other
when separated by effusions or other substances, nor unless they
be in^immediate contact.

This assertion is in direct opposition to what I this morning
saw in the dissecting room ; for on opening the body of a woman
whose chest was the seat of an immense collection of pus, (say a
gallon,) the lung of that side was found compressed against the
mediastinum. Between the lung and the mediastinum there
was a considerable quantity of albuminous looking matter, (coag-
ulable lymph?) through which an immense number of capillary
vessels could be very distinctly seen running from one pleura to
the other. It was impossible "to determine whether they origin-
ated in the plura pulmonalis, that of the mediastinum, or in the
centre of the interposed substance,

1830.] Review of Eclectic Journal. 41)

The Select Medical Library and Eclectic Journal of Medicine:
Edited by John Bell, M. D., Lecturer on the Institutes of
Medicine and Medical Jurisprudence, Member of the College
of Physicians of Philadelphia and of the American Philosophi-
cal Society, &c. &c. Philadelphia.

The above is the title of a new periodical, the first number of
which, published last month, we have just received. This work,
as its title implies, is intended to furnish its subscribers with re-
prints of the most valuable foreign works, with the accompani-
ment of a portion of Journal matter. At the end of each year
the subscriber will be in possession of about 2450 large octavo
pages of choice medical works, printed on the best of medical
book paper and with new type, so arranged as to be bound in
complete and separate works, with title page and index to each.
In addition to this, he will also have a volume of 432 pages of
Journal matter, consisting of " histories of cases which have a
definite bearing and application, summaries of opinions and prac-
tice, criticisms brief and pertinent, circumstances which exert an
influence over the health of individuals and of communities," &c.
&c. ; making in all 2870 pages per annum for the very moderate
priee of $10 something less than half the cost of the same
bought otherwise.

We fully agree with Dr. Bell, that "a periodical publication
so deservedly and obviously beneficial," and we will add, econo-
mical, " to the profession, for whose use it is intended, as the Select
Medical Library and Eclectic Journal of Medicine, needs little
to bo said in the way of explanation and eulogy."

We are pleased to see such an undertaking in the hands of
Dr. John Bell of Philadelphia, whose well known professional
worth is a satisfactory warranty of the most judicious selection
of works and the best editorial management of the Journal.

The first number commences with the republication of Arm-
strong's Practice of Medicine, and comprises the first twenty
lectures. It is not our purpose in this place, to notice the med-
ical writings of Dr. Armstrong. They have been ably review-
ed, and their merit established. Our space is too limited for an
analysis which would do justice to a work, which should cer-
tainly be possessed, without abridgement, by every lover of med-
ical science and usefulness.

We feel it due to our readers, however, as well as to the Edi-
tor, to notice, briefly, the Journal portion of the first number.
And in approaching this duty, we are disposed to say, that in
addition to the promise of usefulness which the able editorship
affords in this department, the very name, Eclectic, (and names,
in modern nomenclature, mean the very nature of the things

412 Review of Eclectic Journal. [Dec.

named,) points to the solid basis of those truths, whereon alone
can the edifice of true science be erected. It seems happily por-
tentous of a faithful record of those truths from which alone
the general laws or principles may be deduced, which like the
sun's rays in discovering to us the beauties of nature, shall dis-
pense the light of true science around us, on all morbid phenom-
ena. We rejoice at every signal of the approaching day, when
physicians shall be teachable enough to receive the truths of na-
ture, as facts which must govern their reasonings and their prac-
tice when they will acknowledge that effects have causes, and
that these bear a due proportion to those ; and farther, that there
are generally, in medicine, several causes, without either of which
the effect could not exist. We see, in these signals, reason to
hope that time past may suffice for us to have mourned over the
desolations of systems which never had a solid foundation in truth ;
systems which sprang only from the phrenzied imaginations, tho
vanity, or the false reasonings of their authors. But we hasten
to the contents of the Journal.

The number before us opens with Retrospection in Medi-
cine. This is a subject which every candid physician will be
ready to acknowledge has been too much neglected in almost all,
and strangely and peculiarly in the latter ages. Such has been
the intoxicating charm of novelty, and such the captivating sway
of indolence, and we may add, such the servility of man, that he
has only needed the phantastic trappings of novelty, with the
prospect of exemption from mental toil, to induce him to follow
superfici?Jly in the wake, to the neglect of every thing like pro-
fundity in science. And these things have been peculiarly grate-
ful to the medical student who was delighted in being able to
combine pleasure with the pursuit of fortune, " and gain the re-
wards of industry without suffering its fatigues," & therefore fixed
his eye on the printed parchment, rather than on that of which
it should be the faithful testimonial. The idea of digging, deeply
and toilsomely in ancient professional lore, has been spurned from
him at the very onset. The name of Hippocrates, or Boerhaave,
or even of Mauriceau or Cullen, has been scoffed at as out of
date as unfashionable. They have not reflected that truth is
not, like an almanac, useless when out of date that fashions have
nothing to do with true science, and that, of all sciences, truth is
of most importance in that of medicine. The whole article is so
full of merit, proving the importance of retrospection, that we
will not attempt to epitomize it, but refer the reader to it in its
place, with the urgent request that every one will read it.

The second article is headed Clinical Medicine. With the
spirit of building up science on the foundation of truth, the author
very evidently purposes drawing the attention of the profession
to the subject of clinical observation, and shews, by an able re-
view of the subject, the value of a close and minute attention to

183G.] Review of Eclectic Journal. 413

the characters of disease, at the bedside, and the indispensable ne-
cessity of a knowledge of anatomy and physiology, in order to be
able to determine wherein, and to what degree the former may
have deviated from healthy structure, or the latter from healthy
function, under the influence of disease; as well as to be enabled
to make those nicer specific distinctions, without which a correct
-diagnosis cannot be had.

" We must not only use, (says our author, p. 11,) but train our
senses and intellect into the habit of patient attention, and learn
to guard against the illusions of the former, and too hasty deduc-
tions by the latter. A preliminary acquaintance with the natu-
ral mechanism and healthy function of the human body, whose
deviations from these states we propose to notice, is of course,
Indispensable."

" If (continues he, most correctly,) we know not the standard
of health, how can we measure the deviations from it which
should designate disease? This is almost a self-evident proposi-
tion, and for repeating which an apology would be due to the
reader, were it not a matter of every-day observation, that hun-
dreds, professing to pursue a regular course of study, hurry on
at once to an investigation of morbid phenomena, and engage
with ardour in disquisitions respecting their causes and seat, and
the changes of structure by which they are accompanied, with-
out the smallest preliminary knowledge of healthy organization
and function. It is impossible for the most skilful and conscien-
tious teacher of clinical medicine to put students, thus ignorant,
in the proper path for accurate and independent observation on
the phenomena of disease. They may learn to group symptoms,
and to apply their information thus obtained after a nosological
fashion ; but for a due appreciation of the true changes, probable
result, and indications for cure, they must be incompetent."

The whole of this article is one of great interest in the present
attitude of the profession -just awaking to a sense of the neces-
sity for the knowledge of the truths of nature, in order to the es-
tablishment of rational and sound therapeutics. For, as by the
great law of inductive reasoning, pathological phenomena, con-
templated as effects, determine by their analogy to other known
phenomena the causation concerned, and, by a comparison with
healthy structure and function, its kind and degree ; so, reason-
ing from cause to effect, does the general law established deter-
mine the new powers or causes to be introduced into the concat-
enation of phenomena for the correction of morbid effects, which
new causes or powers are the remedial means or therapeutic
agents. And here is at once demanded for therapeutics, in
general practice, as anatomy and physiology were for diagnosis,
a knowledge of these powers, which is only found in materia
unedica and chemistry: and for surgery, all are required both for
diagnosis and therapeutics.

414 Review of Eclectic Journal. [Dec,

The next article, is under the general head of Pathology and
Therapeutics, and is on the subject of Acute Rheumatism. The
subject of this article is one of great importance, because it is
one of the most common, painful, tedious and uncontrolable af-
flictions one which has but too often foiled the most faithful
and talented of the profession.

In this we have M. Bouillaud's announcement, as a dis-
covery worthy of note, of "the almost constant coincidence
with acute articular rheumatism, of inflammation of the lining
membrane of the heart (endocarditis,) or pericarditis, or both
conjoined -endo-pericarditis." The editor is not struck with
the novelty of M. Bouillaud's announcement, though he is fully
satisfied of its truth. We are confident that we have, many
months since, seen the announcement of the accompaniment of
endo-carditis in these cases ; and a demonstration of the fact has,
we are sorry to know, occurred in our own practice during the
present year. We did regard it, as the editor says, as a metas-
tasis, instead of apart of the primary disease, and we confess we
are yet inclined to the same opinion, both from the general char-
acter of rheumatism, and the want of conspicuous endo and peri-
carditic symptoms, until the wane of the primary affection of the
arm. According to M. Bouillaud, " the true seat of articular
rheumatism is in the synovial membranes ; the ligaments and
parts external to the joints being only secondarily affected." In
proof of this position he gives the fact, that in some fatal cases
the synovial membrane has been found covered with coagulable
lymph.

The treatment recommended is precisely such as the patholo-
gy of the case would suggest, viz.: "antiphlogistic, and above
all, bloodletting." As the formula of M. B. goes to mark out to
an extent proportionate with the nature of the lesion, a rigid an-
tiphlogistic course, a point too often neglected in practice, we
shall give our readers a concise view of it.

The first day of admission, the patient, if strong and of good
constitution, is bled to 1 6 ounces. If very plethoric, 20 to 24 are
taken 16 being, however, the usual quantity.

Second day. Two bleedings from the arm of 12 to 16 oun-
ces each, and in the interval, leeching or cupping, (the latter pre-
ferable,) to the extent of 16 to 20 5. The cupping glasses are
applied around the affected joints, or to the pre-cordial region, if,
as usual, the heart be implicated.

Third day. One bleeding from the arm and the abstraction of
12 to 16 1 , by cupping the joints, or the region of the heart.

Fourth day. Fever, pains, swelling, &c. have sometimes com-
pletely subsided ; in which case, no more blood is drawn. But
if otherwise, the patient is to be once more bled to the extent of
12 or 165.

Fifth day. Generally, the disease is in full progress towards

1636.] Review of Eclectic Journal. 41 5

resolution. But should the fever, as is sometimes the case, con-
tinue well marked, depletion to 121, or cupping to the former
extent becomes advisable.

Prom the sixth, seventh, or eighth day, the patient convalesces
rapidly, and may now begin to take food.

In case of relapse, which however M. Bouillaud thinks less
common than after the usual method of treatment, bleeding
may be again and again necessary. Slight relapses may be
treated by emollients, abstinences, baths, anodynes, &c. the dis-
ease wearing itself out in a few days. To avoid relapses, the
patient should guard most carefully against the slightest breath
of cold.

As auxiliary to the above plan, M. B. resorted to abstinence,
dimulcent drinks, blisters, compresses with mercurial cerate for
resolution, emollient cataplasms, baths, opium in moderate doses,
internally, or by the endermic method. To the last of these,
the editor very properly enters his protest until the disease has
been somewhat subdued by depletion.

The next subject under this head is the Difference between
Acute and Chronic Rheumatism. Dr. Johnson of London, and
M. Parise of France, have endeavoured " to separate acute from
chronic rheumatism" considering the former as arthritis, and
the latter as a peculiar affection, probably neuralgic, of the in-
vesting sheaths of the muscular fibres, or perhaps the neurilema
of the nerves themselves. The former of these opinions, we
consider at least as old as the " Eau Medecinale d'Husson ;" and
as to the latter, we freely' join with Dr. Bell in considering that
there is no great novelty in them, and we design, on some favor-
able occasion, to give some views which we believe peculiarly
our own, and of the truth of which we have been satisfied ever
since we first saw Ten-Rhyne's account of acupuncture.

Connexion of Hypertrophy of the Heart and Apoplexy. Lal-
lemand, Broussais, Andral, &c, but more fully, Bricheteau and
Hope, have all conceived (the very evident fact) that the heart,
particularly the left ventricle, exerts a very great influence over
the brain, and have given cases illustrative of the position. M.
Bricheteau gives twenty-two cases of apoplexy, in all of which
hypertrophy of the left ventricle of the heart existed to greater
or less extent.

M. Bouillaud found that out of fifty-four cases of hypertrophy
of the heart, there were eleven in which cerebral disease, six in
which apoplexy, and five in which ramollissement was found on
dissection.

Dr. Hope gives twenty-nine cases of apoplexy, in twenty-
eight of which, disease of the heart was found co-existent. He
thence "concludes that the periods of life at which fatal apoplexy
is most prevalent, are those in which hypertrophy of the muscu-
lar substance, or ossification of the valves and vessels of the

416 Review of Eclectic Journal. [Dec.

heart is of most frequent occurrence namely, between forty and
fifty, and between seventy and eighty," In some cases the lesion
of the heart eluded suspicion. "The practical deductions from
this pathology are clear viz. : avoidance of all severe bodily
exercise and all exciting emotions of mind. And as pointed out
by M. Bricheteau, we should direct the occasional application
of leeches over the region of the heart, instead of the temples, or
any other part of the head, the internal use of digitalis, hydrio-
date of potassa, and other diuretics.

The next article contains Dr. Rennes' account of thirty-two
cases of Frontal Neuralgia. Neuralgic affections have for
several years occupied so large a portion of the journaJs, and be-
come so familiar to most reading practitioners that we shall pass
this article without farther attention.

The next article gives us an account of Dr. Barrea's ease of
Hemiplegia, which was cured by a formula, which it would be
rather beyond the province of our apothecaries to supply, and
which moreover is beyond the command of the whole Philadel-
phia College of Pharmacy : viz. " heavy thunder and lightning."
Still, however, the case may have its uses. It may make a loud
and forcible impression of a truth on man, which he has too long
and too much neglected, that electricity in its various habitudes,
is of infinitely more importance in the philosophy, as well as the
practice of medicine than men have been willing to suppose.
For it seems that our old friend Magendie has taken the hint, and
made the application of galvanic electricity to the chorda tym-
pani of a young Polish officer, who lost his hearing at the battle
of Ostralenka, which, after seven or eight applications, enabled
him to hear the sound of a drum, then of clocks, bells, and finally
speech. "It is, M. Magendie thinks, essential for the success of
the plan, that there be direct contact between the nerve and the
conducting wires" which opinion is confirmed by two corrobo-
rative cases given by M. Roux.

We next have the use of Magnetism in Gout. We have here
a narrative from the Bulletino delle Scienze Mediche of Bologna,
which informs us that the cx-Dey of Algiers communicated, in
1831, to a Catholic clergyman, (Father Campagnati,) who was
suffering under the gout, that the application of the loadstone
was an Oriental remedy for the disease, and one of certain effi-
cacy. The patient immediately procured a piece of loadstone
and applied it in the next paroxysm, which was entirely removed
by it ; since which, he has always had recourse to it with the
effect not only of invariably relieving the paroxysms, but of les-
sening both their frequency and severity. Similar results have
followed its use by his friends, to whom he has advised it. Fa-
ther Campagnati had been subject to the disease since 1805. On
the first symptom, he goes to bed, and places the loadstone in
close contact with the painful part; he soon falls asleep, and
awakes free from pain and able to walk.

1S3C] Review of Eclectic Journal 41 fr

The next article is on the subject of the Fever, typhoid and
continued, described by Chomel. This is an article of great in-
terest too long and too valuable to be condensed in this place,
and we must refer our readers who have not the Lecon de Clin-
ique Medicale, &c. of Professor Chomel, to the first number of the
Eclectic Journal of Medicine, or the third number of the British
and Foreign Medical Review, article, second.

It may be profitable to our readers to observe, however, in pas-
sing this article, that the p ist summer has afforded us a number
of opportunities for using the chloride of soda, as noticed by Cho-
m 1, but the use of which was more definitely and accurately
established by Dr. Graves of Dublin, and have found it, thus
used, a most invaluable acquisition to our remedial resources
C >ming happily into a place where all other resources had failed.
As an anti-tympanitic in such cases, we hold it, at once entirely
u.iri vailed. For its successful use, we refer the reader to
the state of the system in which Dr. Graves found it most signal-
ly beneficial, which will be found in the Southern Medical and
Surgical Journal, vol 1, no. 2.

The next article given us in this number, is on Obstetrics.
Having already taken more space than we designed, we should
piss this article by without comment, especially as it contains lit-
tle of practical value; did we not feel bound to dissent from the
position assumed by the Editor on some points in obstetrical in-
struction. Dr. Bell seems to object seriously to the time and
spice taken in lectures and in books, on the subjects of violent
remedies, the use of instruments, dangerous incidents, unfavora-
ble positio s, menstruation and the generative function, formation
of the deciiua, &c.

It ;s most true that the knowledge of these matters is of com-
paratively rare use in practice ; but if the consideration of violent
remedies, or the use of instruments, or the occurrence of haemorr-
hage, convulsions, faintings, and such incidents ; or if a bad po-
s'tion. were to occur but once in an age, the practitioner would
be who 1 v inexcusable, who had not the means of decision in the
cisc. And as some of these have their dangers as well as uses,
great pains are necessary in instructing in their use and manage-
ment. Xor are the functions above named, unimportant, either
as facts of the natural history of man, or as to the light which a
knowledge of healthy texture and function is calculated to shed on
diagnosis, as well as treatment of female cases.

We must piss over the extracts from Drs. Davis and Hamil-
ton on the subject of prolapsus uteri, with the observation only
that the frequency and importance of this disease are such, that it
demands much more close observation and reasoning on its na-
ture and treatment, than we are inclined to believe they have gi-
ven it. We have not the opportunity in this place of enlarging
on the subject.

53

41 $ Use of the Cochlea in the Organ of Hearing, $c. [Dec

i i i . i i

We pass over the subject of Hygiene in this number, as con-
taining nothing of practical importance to us. A notice of Dr.
Graves' lecture on the Chances of Life, we have given more at
length in a former number.

Under the head of Medical Jurisprudence, we have a case of
Suicide of a boy 12 years old, by Hanging. The case affords
nothing of peculiar interest.

The efficacy of Hydrated Per-oxide or Tritoxide of Iron, in
cases of Poison by Arsenic, we have before noticed more fully.

Under the head of Surgery, we find nothing to attract our at-
tention but the use of the Belladonna Ointment in cases of re-
tention of urine, spasmodic constrictions of the uterus, and in
strangulated hernia. The ointment for these purposes is as usu-
al made of 3ij. of the extract, to I i. of Lard. Thus we close
our notice of a beginning undertakmg, the first number of which
has afforded us much pleasure, and which has our most cordial
wishes for its success.

[From the Medico- Chirurgical Review.]

On the use of the Cochlea in the Organ of Hearing. We need scarcely
observe that the functions of the various parts that compose the internal ear
in man, are imperfectly understood. That so complicated an apparatus
should be essential to the perfect sense, is consistent with analogy and rea-
son. But physical science has not hitherto informed us, what part is played
by each component section of the mechanism, nor what is the individual
office of the cochlea, the semi-circular canals, and so forth.

Weber, a physiologist of no mean rank, has laboured to prove that the
office of the cochlen, is to appreciate those sounds which are transmitted
through the cranium as a solid. The opinions and the reasoning of Weber
on this subject are presented to the English public by Dr. Graves, the able
Editor of our Dublin contemporary. We shall introduce such portions of
his paper in that Journal, as will put our readers in possession of the main
points which are urged in favour of the hypothesis in question.

"It is evident," says Weber, "that the propagation of sound to the inter-
nal ear, takes place not merely through the meatus auditorious cxterniis, but
also through the bones of the cranium; by the former we receive notice of
sounds from without, by the latter, we more readily hear our own voice.
The vibrations produced by our own voice are indeed also heard by the route
of the external ear, but they are conveyed with greater distinctness through
the medium of the bones of the skull. Thus, if you stop both ears firmly
with your fingers, so far is your voice from being rendered inaudible, that
you hear it more dislinctly and louder than before. If now we remove the
finger from one ear, immediately we find that the sound of our voice appears
stronger in the other. / shall now nuieavor to prove that sounds propagated
by and conveyed through the bones of the head, arc heard chiefly by means ofths

1836.] Use of the Cochlea in the Organ of Hearing* 410

cochlea, whereas sounds coming from without by way of the meatus auditorius
externus, are not so readily received by the cochlea, as by the route of the ves-
tibule and the semi-circular canals "

Weber observes that in almost all animals, the vibrations on which sound
depends are communicated to the extremities of the acoustic nerve, by the
two-fold means of a vibrating1 solid and a vibrating fluid. Why it should be
so, is not at present clearly understood, but M. Weber asserts that it is the
fact with regard to the greater number of animals.

Sounds lose comparatively little of their force by propagation through an
uniform medium; but the contrary is the case when they pass from one me-
dium to another, as from a solid to a fluid, or from a fluid to a solid. Thufl
sounds transmitted through water may be heard at great distances, while
the head is under water; but they become inaudible the instant that the head
emerges above its surface.

"Now it is found," continues Weber, "that solid bodies communicate
their vibration to fluids, with a facility proportioned to their extent of sur-
face, and that solids receive vibrations from aeriform media more easily
when the solid is shaped in the form of a membrane. A tense cord does
not easily communicate its vibrations to the air unless it be fixed to some
flat body, which being of a like nature solid, receives the vibration of the
string without difficulty or loss, and propagates them to the air through the
medium of its own extensive surface. It is an observation of these phe-
nomena which has led to the adoption of sounding boards in those musical
instruments, when the vibrations causing sound proceed from strings as in
the case of the violin, the piano, and the harp, whereas sounding boards are
not required in the various species of wind instruments. The reason of this
difference is sufficiently obvious, in the one case a solid with an extensive
surface must be brought into connexion with the vibrating string in order to
diffuse its vibrations more energetically through the air* whereas in wind
instruments the vibrations being derived from the air itself, no such provi-
sion is necessary."

The two preceding facts may be considered as the premises of Weber's
argument. The conclusions follow thus.

The sonorous vibrations of the air in the mouth pass to the internal ear
through the medium of the cranial bones. They impinge by preference on
that portion of the acoustic nerve which is distributed upon the cochlea, ta-
cause on it the nervous expansion is in intimate relation with its walls,
which are themselves connected with the cranial bones. But the acoustic
nerve where distributed through the vestibule and semi-circular canals is
not so favourably circumstanced for receiving the vibration of the cranial
bones, for here the nervous expansion is separated from the bony panetes
either by means of a liquid secretion or of a loose cellular membrane. In
accordance then with the law that sound is transmitted with most facility
when the medium is not changed, M. Weber supposes that the acoustic
nerve in close connexion with the bony cochlea, is more readily affected by
vibrations of the cranial bones, than in the vestibule or semicircular canals,,
where another medium separates it from the bone.

With the following remarks, which we cannot materially abridge, we
conclude.

"The preceding observations," concludes Weber, "render it sufficiently
apparent, that the membranaceous vestibule and membranaceous semicir-
cular canals, differ in structure from the osseous vestibule and the osseous
semicircular canals, in such a manner, that vibrations travel through the
bones of the cranium with more facility to the cochlea and round sac, than
they do to the membranaceous portions of the internal ear.

The next question is, whether the sonorous vibrations that are derived
from the external air and proceed through the meatus externus to the ear,
are propagated with greater facility and strength to the nerve of the vesti.,

429 t7se of the Cochlea in the Organ of Hearing. ^Dee.

bule than to the nerve of the cochlea. In the first place, it is evident that
the vestibule and the semicircular canals directly connc ctcd with it, must
receive a stronger impulse from the aerial vibrations than the coch'ea, for
the former have a solid communication by means of the chain of ossicula
with the membrana tympani, whose vibrations are consequently imparted at
once to the membrane of the fenestra ovahs, whereas no such direct com-
munication exists between the membrana tympani, and the fenestra rotun-
da. The membranes of the semicircular canals and the vestibule toe, seem
to be more easily set in motion by the fluid which invests and surrounds
them, than is the case with the lamina spiralis of the cochlea. The latter
is, nevertheless, furnished with provisions calculated to enable it to receive
impulses from the external air also : for the fenestra rotunda, being closed
by a membrane, must impart the vibrations that occur in the cavity of the
tympanum, while another opening', by forming a communication with the
vestibule itself, must place the cochlea in connexion with the latter, in such
a manner that the vibrations which the chain of ossicula have imparted to
the fluid of the vestibule, must through that fluid be at once propagated to
the cochlea.

T have next to prove the assertion which I made at the commencement,
viz. that nature has so constructed the ear in man, and various other animals,
as to make a provision for the reception of the sonorous vibrations in a two-
fold manner, by means of the acoustic nerve, which is so disposed in the in-
ternal ear as to presenf, for receiving these vibrations, a double surface of
contact; the one consisting of a soft, pultaceous, nervous expansion, sur-
rounded by a fluid, the other formed of a reticulated net-work ot extremely
minute, but firm, nervous, ramifications. The former receive the sonorous
vibrations through the medium of a fluid, the latter of a solid. In mail the
cochlea is the portion of the organ where the firmer extremities of the acous-
tic nerve are disposed for this purpose. Fishes and amphibious animals
have no cochlea, but they have an arrangement which answers the same
purpose; for in osseous fishes we find that the membranaceous lal yrinth
contains three white little stony bodies, of great specific gravity, very hard,
and much resembling vitrified argillaceous clay; two of those are enclosed
with a sac full of fluid, adjoining the vestibule, "aid lodged in ihe 1 r.silrr por-
tion of the occipital bone; these lapilli are furnished with fine nervous fila-
ments, fastened to rough depressions and elevations on their surface; thus
vibrations are imparted from the lapilli to the acoustic nerve s ; tie third la-
pillus is situated in tho anterior portion of the membranaceous vestibule, and
receives no nervous filaments. It has, however, another mode of communi-
cating with the acoustic nerve, for it lies against a very large branch of 1 hat
nerve where it expands on the membrane of the vestibule, and thus eempres-
ses this nerve between itself and the cranium. In cartilaginous fishes and in
amphibious animals, in the place of these lapilli, we find certain little lodiYp
consisting eiiher of concrete gelatine or of a chalky pultaccous matter, rrdio
which both Scarpa and myself have traced ramifications of the acoustic
nerve; neither is the lamina spiralis of cochlea in man formed without rea-
son of two structures, anosseoUs, and a cartilagino-coriaccous tissue; for P.fl
the same nervous branches pass from the osseous to the oartilrgincus portion
of the lamina spiralis, it is natural to conclude that receiving ser.orous im-
pulses from both, those impulses are communicated by means of a difTerent
mechanism in the two cases. This idea is confirmed 1 y an exrminalicn of
the calcareous fragments found in tho labyrinth of Flays, and which are com-
posed of two portions; one pellucid and rescmblirg a tremulous jelly, the
other white and chalky, seem to discharge tho same function in thrse ani-
mal1-', that the cochlea does in m-\n. These fragments arc so divided, that
their gelatinous and chalky portions lie in contact by means of extensive
smooth surfaces. Nature has so disposed the extremities of the auditory
nerves in the semicircular canals of all aniraaKthat these extremities receive

1836.] Comparative Mortality of Male and Female, <$-c. 421

the sonorous impulses directly from a fluid. This is very phin, even in map,
where the dilatations termed ampullar and which correspond wi h a simi] >r
enlargement of the nerv , are both filled with and surrounded by a fluid. In
fishes it. is still more eviden*, for in R ay , a nervous filament can be traced
to each ampulla, which i' enters and forms within a crescent like septum."

We fear that in renious as the m* c aling reasoning must be owned to bo, it
La still extremely speculative. When we reflect on the facility with which
soporous vibrations are commun'ented through the whole bodv, composed as
it is of m dia differing much more in nature and exten*, than the nervous ex-
pansions ou the cochlea and the semicircular canals can do, we are almost
involuntarily led to pause berore we yiey implicit confidence to M. Weber's
conclusions. Unfortunately, in the case of the internal ear?, decisive experi-
nmn* cannot be perform id, and the observation of pathological changes in
connexion w'th alterations of the functions, is attended with nearly equal
difficulty. T le amount ofconfidence pxtended to M. Weber's opinions will
varv wi h the turn of mind of tjje individual who peruses them. One man
y:e\l-- assent -o the evidence o^ probabilities, wi^h much less difficulty, than
another. Whatever m"v be the actual truth of M. Weber's suppo'i'ioo, it
i= certain that it is ingenious, and Dossessed of plausibility. We think Dr.
G-av3s entitled fo many thank", for bringing1 this a* well as o'h?r Continen-
tal papers before the proe^ion in this country. TIrs is not the first time,
no-, we are sure, will it be the las% that we have had or shall have occasion
to express our sen=e of the Z3al and the talents of that gentleman.

Cnrninra'ivi Mwr'ality <>f Ma1", and Femrfe Life. Mr. R-'ckman has been
publi"Vu7 come ela'^ora'e remark-: on thi", as indeed on othnr subjects con-
nected wi*h medical statistic8, in the Medical G'.zette. We shall notice
soth of th? general r^ul^s wh'ch M*. Rickman draws, or which may be
oVawn from fh? data that hefurmshes. Mr. Rr.kman deserves great credit
for+h? inlusfry he has evned in collecting materials, and the zeal he has
d'snhy .r] h\ communra*ing bis observations and conclusions to the public.

T' i=? no" ne^e^sarv for us to repeat that the longov;'y of females exceeds
that dc males. This was fir"* systematically she vn by lOraboon in a trea-
tise o ibbsh d in tin year 1742, and founded on the mortality of o-overnment
ana ptanf in H ifaani. It is not th/m to nrove this fact, already ful'v proven,
that Mr. R'ckinu writes" or that we condense -his observations. His object
is *"o sbo v the varlo is d?gr3es of female longevity in the various classes.

He exhjVts several tables. In thi first are shewn the results of a tonfin-\
established unler"lhe MMliou Aof," in the year lr>9">; the last ef the 1003
annuitants un pier which died in the yew 178-5. Ii the second table aro the
reS,t'<5 of var"o is too'mes an 1 olior government annui-ies, cnrrenf from 1785
to 18"! \ the ra^e of mor'ality <or forty years being d^playod. In the next
table a -a the P"rish R3is*cr R 'turn5; of the ages of those buried in eighteen
yoar-, to the extent of ne^rl?four millions of persons. AM finally we have
a tabta oM80f) burials in Carlisle, between the years 1770 and 17*S7 ; and
on"1 of tho E mi'a'^e Life Assurance Socie'v, containm* 'he ages at death of
51 \\ persons in 07 vt", that is, from I7f5"2 fo 18*2?). 7\hese tables we need
not ir^)r% as *be:r principal value must, be to those engaged in actual calcu-
la'ions. We therefore proceed 'oMr. Rickman's conclusions.

From the accurate investigation of th^ ages at death of'n^rsonsin England,
of all clXB83s, for eight or nine years hefor, as well as af*cr, the year 18*21,
it aoaears that the advantage in favor of the life of females amounts to tour
per cnt. B it in tha classes who purchase government arnui'ies, classes
neca^sarily above the reach of hardship and privations* the advantage of the
female is actually as high as thirteen per cent. A remarkable fact. Mr.
Rikman observes in reference to this circumstance :

"That the increase of civilization should have protected the female sex
from hardships of all kinds, especially from exposure to inclement weather,

433 Mortality of Doctors, $c. [Dee.

and that this advantage added to their habitual estrangement from excesses
in diet and exercise, should have lengthened life ten per cent beyond that of
the male sex, is not incredible, nor very surprising; but that this advantage
(for long life is but another word for comfortable life) should have been in-
creased to thirteen per cent by the progressive refinements of the last centu-
ry, is a fact which nothing but ample experience could have established.

The advantage of the female sex in the aggregate, is found to be four per
cent in longevity, a difference sufficiently explained by their comparative
exemption from hard labor and bod weather; and this graduated diminution
of advantage, as compared to that of the select classes, leads to a persuasion
that no advantage whatever existed in favor of the uncivilized human female.

Physically as well as statistically speaking, an investigation of this ques-
tion is of s'orni importance; and the Parish Register Returns of the ages of
the buried, may throw some light upon it. I ask your attention, therefore,
to the fact, that although the females are double the number of males alive at
100 years of age (129 to 60 in the year 1S21), yet the deaths of the females
during the next teu years of life are in such proportion, that at the age of III
the sexes are equal in number, viz. nine of each sex exceeded that age in
eighteen years (1813 1830); and beyond that age the females died earlier
than the males ; so that the two last survivors were a female, who died at
120, and a male, who died at 124 years of age."

Mr. Rickman presents in the Gazette several tables illustrative of the in-
crease and decrease of mortality, at particular years, at decennary periods,
and in the two sexes. But as the laborious nature of the calculations is
heightened by the obscurity of Mr. Rickman's style, not one medical reader
out of six would be otherwise than mortally puzzled, at hunting the meaning
of the zealous and amiable dealer in deaths. Leaving many tables and some
most formidable diagrams to actuaries, we must content ourselves with pick-
ing out a fact or a conclusion here and there, for our edification or amuse-
ment.

Mortality of Doctors. We are naturally deeply interested in the question :
are we longer or shorter-lived than other classes of the community 1 There
is necessarily much difficulty in ascertaining this point. No distinct records
of the births and deaths of doctors are extant; and those who arrive at con-
clusions on the subject must take for data the lives of physicians and surge-
ons of eminence. But such data are very likely to prove erroneous. For,
in our profession, those who attain eminence are probably longer-lived than
the bulk of their brethren.

However this maybe, Professor Casper, of Berlin, affirms that the medica.
prac'itioners of G rmany arc shorter-livtd than the members of o*her pro-
fessions. M. Du Bo's, has arrived at the opposite conclusion. Of 850 med-
ical practitioners, he ascertained that 7 died between 20 and 30 years of age ;
57 between 30 and 40 ; 83 between 40 and 50 ; 136 between* 50 and 60 ;
202 between 60 and 70 ; 213 between 70 and 80 ; 110 between 80 and 90 ;
31 between 90 and 100 ; and 4 between 100 and 106. In fact, 305 of the
850 attained to 70 and upwards, which even exceeds the proportion allotted
to the long-lived theologians, of whom, according to Caspar, 42 per cent at-
tain the age of 70." The material of these statements is taken from Eloy's
Dictionnaire Ilistorique.

The anxieties of the medical practitioner, his midnight watchings, and the
contaminated atmosphere ho often breathes, must be sources of disease and
of mortality. But then, on the other hand, he Ins one great source of safety
open to him, which must tend to render the balance between him and his
patients even he takes monstrous little physic Whatever may be the real
state of the case, one practical rule is quite clear we must all try to live as
long as we can, were it only for the honor of the profession.

1836.] Mortality of Married and Unmarried, <$-c. 4tS

Comparative Mortality of the Married and Unmarried. Dr. Casper of Ber-
lin, himself, we suppose, a married man, lias published an Essay to prove that
the married are much lunger-lived than the single are. He' asserts that, in
the case of females, the mean duration of life for the married woman of 25, is
about 36 years : while for the unmarried it is 30 1-2. At 30, there is a dif-
ference of four years in fayor of the married ; at 35, two years, and ro on.
With respect to men, he asserts from D^pareienx'sandthe Amsterdam ta-
bles, that the mortality of those from 30 to 45 years of age is 27 per cent for
the unmarried, while it is but 18 for ihe married; and that for 41 bachelors
who attain the age of 40, there are 78 married men. The dilference be-
comes still more striking as age advances : at the age of 60, there are but 22
unmarried men alive for 48 married : at 70, eleven bachelors for twenty-seven
married men ; and at 80, for the three bachelors who may chance to be alive,
there are nine benedicts. The same proportion very nearly holds good with
respect to the female sex; seventy-two married women, for example, attain
th.3 age of 45, while only fifty-two unmarried reach the same term of life.
M. Casper, in conclusion, consid?rs the point as now incontestibly settled,
that, in both sexes, marriage is conducive to longevity.

Mr. Rickman has very properly and ably exposed this libel on bachelors
and maids. He has shewn, satisfactorily that no material difference is ap-
preciable in their respective longevities. The whole of M. Casper's conclu-
sions are based in miscalculation and error. So let our younger readers take
heart. At the same time, practical experience convinces us that, in the fe-
male sex, many diseases result from the inability to obey the dictates of nature.
Who does not every day witness the thousand forms of hysteria with its ma-
ny consequences, in unmarried women. Am] can any one believe that this
is not prejudicial to longevity and health. The statisticians may, from cir-
cumstances, be unable to determine the numerical differences in the deaths
of married and unmarried females, but the surgeon and physician who see
human nature in detail, cannot shut their eyes to the obvious fact that
whether the unmarried can be proved to be as long lived as the married or
not, they are certainly subject to more miserable maladies, and their health is
impaired, if their existence is not shortened.

With males the question is widely different. Fortunately or unfortunately
for themselves, they are not restrained from sexual gratifications, like the
weaker sex. Marriage then, in their case, cannot be sexually very impor-
tant, and its influence must be exerted on their general habits and feelings.

Professor Mueller'' s Account of the Arteries that produce Erection of the
Penis * Professor Mueller of Berlin, has lately discovered, or, at all events,
described the arteries of the penis which produce the phenomenon of its erec-
tion. We will present the most essential portions of his statements on the
subject.

We need not remind our readers that the penis is almost exclusively sup-
plied from the internal pudic artery. This ultimately splits into two branches,
the artery of the corpus cavernosum penis, and the dorsal artery of the penis.
The former penetrates the corpus cavernosum at i*s root, and ramifies within
it ; the latter, after sending twigs to the fibrous envelope of the penis, its fas-
cia, outer skin, and prepuce, terminates by ramifying in the glans.

"The distribution of the principal branch of the arteria penis was all that
was hitherto known of this important vessel ; it is in the more minute distri-
bution of its branches through the corpus cavernosum penis that the secret of
the cause of erection has remained concealed. It is not a lucky accident,
but a systematical arrangement, and investigations proceeding from certain
combinations that have guided me, in this instance, to an important discove-

* Medical Gazette, January 9, 1836.

424 Professor Mueller on Erection of the Penis, $c. [Pec.

ry. It is generally thought that the arteria profunda penis, which nouriches
the substance of the penis, is at the same time capable of filling the cells of
the corpus cavernos. with blood during erection also ; that the nutritive blood,
as well as that serving for the purpose of erection, proceeds from the fine
twigs ofthe same vessel into, the tine (capillary) veins; that it passes in-
wards from these into the sinuous veins, and again from th 'se to the vena
dorsalis penis ; and that the stare of erection distinguishes itself from the or-
dinary state of circulation in this organ, partly in the quantity of blood cir-
culating in its vascular net- work, and p crtly in an impediment off red to the
return of the blood through the veins of the penis. The older writer*, on the
other hand, considered the sinuous veins or ike corpora cavernosa to be cell ;
imagined that the nutritive blood supplied by the ordinary circulation did net
at all reach these cells, or pass through them, bul was carried offby appro-
priate veins; and that still, during the state of erection, the cells of -he cor-
pus caveriioaum were filled with blood. . Both views are, as we shall see,
incorrect. Tite opinion of the old writers is proved to be unfounded, ns we:l
by investigations on the dead holy as by the vivisections of beas's. In ma-
ny experiments performed on the living horse, dog, ram, ccc. I have observ-
ed, that upon making an incision in the corpora cavernos;), these bodies were
not, in their unexci ed state, much charged with blood, but that blood is con-
tamed in their sinuous veins, although certainly in less quantity than in the
corpus cavernos. urethne, which bleeds freely when cut across. Far her, in
the majority of human subjects blood is found in the sinuous veins ofthe
corpora cavernosa penis."

M. Mueller, it appears, had long thought that erection did not depend on
the arrest of the flow of blood in the dorsal veins of the penis. He had also
thought that different branches of the artery of the corpus cavernosum
served for the purposes of nutrition and erection. It was "oue ot the hap-
piest days of his life," when he found this, Ins conjecture, true, and "the
wonderful difference" between the two sets of twigs, alluded to as described
by the Professor as follows :

1. " The nourishing Twigs (Rami nutntii Arteria jrofwJco Pevis.)
When an injection of the arteries cf the penis is made wi'h rize and vc i mil-
ion, a considerable portion ofthe inject* d mass is always forced in o t! e cj v-
ities ofthe corpora cavernosa, as well in the human < rgan as in that ofthe
horse and dog. W hen t his mass o1- injection (of which I am s>i 1 uncertain
as to the means by which it enters in'o the cellular structure) is washed out,
the rami nutritii will become evident. The rami nutri'i of tie ppongy
substance (which, since they are upon the walls of the sun ens veins
in the interior of the perns, may be also .called the ^asa vast rum)
are found to be as minute as the arteries of any other part: they
distribute themselves upon the pilars of the spongy subs' ance, until
they become too tine to be perceived by the naked eye. As in the arteries
of other parts, they anastomose; and lastly they form, as in o'her pi r's, 'he
capillary net-work which is so difficult to be injected in the penis owing to
the facility with which the injection escapes into the cavities of the corpora
cavernosa.

2. Arteri.c HeUciruB Corporis cavernosi 'in man). In order to see these
arterial branches satisfactorily, an injection conn ne< d of si/e i n 1 verm 1 on
must be thrown into a separated perns, through the arteria profunda, fin
the horse the pudendal and obturatoriaJ ar'ery ue to he injerted together.)
As before mentioned, a part will escape into the caviti< s of he cor] ora ca-
vernosa. When the injection has become, cold, the corpora cavernosa must
be cut open longitudinally, and that, portion ofthe injection winch has es-
caped into the cells is then to be washed out wit h great car*. If asiz-ofa
greater degree of consistence has heen employee1, it will be found to have
become solid on cooling. In this case the penis must be soaked in water,
and the mass squeezed out softly and carefully, until the cellular tissue is

1836.] Professor Mueller on Erection of the Penis, <$-c. 425

emptied. When a thin size lias been used this will, of course, not occur;
then washing- alone will be sufficient

If the tissue of the corpora cavernosa be now examined with a magnifying
lens on its posterior third, it will he seen that, in addition to the distribution
of the arteries already described, there is another class of vessels, having
an entirely dilferent form, size, and distribution; these branches are short,
being about a line in length, and a fifth of a millimetre in diameter; they are
given off from the larger branches, as well as from the finest twigs of the
artery. Although fine, they are still easily to be recognised with the naked
eye ; they come off from the artery mostly at a right angle, and projecting
into the cavities of the spongy substance, they either terminate abruptly, or
olse swell out into a club-like process, without again subdividing."

Omitting the reference to these vessels in the stallion and the dog, we may
proceed with M. Mueller's description of them in man.

"These twigs branch off from place to place, sometimes alone, sometimes
in greater number : little bundles will be seen, in which from three to ten
twigs stand together ; these, as well as the former, project constantly into
the cells or venous cavities of the corp. cavern, penis. When the arteries
thus form a tuft, they arise by a common stem, which immediately divides
itself into the separate branches. Sometimes such a vessel, wmether it pro-
ceeds from the artery as a single branch, or forms part of a cluster, divides
itself into two or three parallel branches, which also end either abruptly, or
else swell out near their extremity.

Almost all these arteries have this character, that they are bent like &
horn, so that the end describes a half circle, or somewhat more. When such
a branch so divides itself, there are formed doubly bent twigs, inclined one to
the other. I have before observed, that many of these arteries enlarge to-
wards their end ; this enlargement is gradual, and is greatest at some little
distance from the extremity, so that the end is somewhat conical. This
cone, however, is rounded at the point, and giving off no branches, termi-
nates immediately. The diameter of these twigs, in their middle, is from
the fifth to the sixth of a millimetre : they preserve a great similarity : thus
those which branch off from the large trunk of the artery, are not thicker
than those which take their origin from the finest subdivisions."

Although these vessels project into the venous cavities, yet they are not
entirely naked, but possess a delicate membranous covering.

"The arteries have no openings which can be detected, either on their
surface, or at their extremities ; and if the blood, as it is probable, proceeds
from them during erection in greater quantity into the cells of the corp. ca-
vernosa, so it must either pass through invisible openings, or at least through
openings which only become enlarged by the great extension of the vessels.
If the great number of these tcndrd-like branches which are given off from
the art. profunda penis be considered in comparison with the many fine nu-
tritive twigs of the same vessel, it must be evident that when the former are
filled, they must take up by far the greater portion of the blood conveyed by
it. The "diameter of the art. profunda, therefore, not only includes the nutri-
tive twigs which arise from it, but also the tendril-like branches, which like-
wise deriving their blood from it, yet it is probable, allow none to pass except
during erection ; therefore the blood in the unexcited state of the penis only
pervades the nutritive branches, and thus only reaches the commencement
of the venous cells in smaller quantities ; whereas during erection, it is proba-
ble that the blood passes in quantitv through these tendril-formed vessels in-
to the cells."

M. Mueller states that these vessels are most numerous in the posterior
part of the corpora cavernosa penis, and in the bulb. In the middle and an-
terior portions of the former, they occur but seldom, and in the anterior part
of the corpus spongiosum uretlira) they are less frequent; in the glans, M.
Mueller has not distinguished them.

54

426 Treatment of Inflammation of the Testicle, fyc. fyc, [Dec.

Such is the account of M. Mueller. These minute anatomical investiga-
tions can be prosecuted by so few, that the statements of a discovery must be
taken for granted, until some industrious injector or dissector arises to con-
firm or to confute them. As the phenomenon of erection is by no means
confined to the posterior part of the corpus cavernosum, it appears rather
anomalous that there only these vessels, so essential to that phenomenon in
the opinion of our author, should be numerous. This difficulty may perhaps,
be more apparent than real, and we shall congratulate M. Mueller on his dis-
covery, if it is supported by the examinations of others.

On the Treatment of Inflammation ofilie Testicle by means of Compression :
By J. C. F. Fricke, Surgeon to the General Hospital in Hamburg.

[In presenting to our readers the following important document relative to
a new mode of treating Hernia humoralis, or swelled testicle, we shall for
the most part make use of the author's own words, merely omitting phrases
and brief paragraphs, here and there, which do not seem essential. It may
be well to inform the reader, that Dr. Fricke is a surgeon of great reputation
and of most extensive experience, and the author of some surgical works of
much practical value.]

I had long meditated (says Dr. Fricke,) on the discovery of some means
to obviate the tediousness and other numerous inconveniences attending the
common mode of treating inflammatory affections of the testicle, by leeches,
poultices, &c. ; and at length it occurred to me that compression, which I
had found so very serviceable in some analogous cases, offered the fairest
prospect of a favorable result. The event completely answered my expecta-
tions ; and I had soon the pleasure to perceive how, by means of this, the
disease could be removed, in a simple, easy, and surprisingly rapid way.

Generally speaking, compression may be employed in every kind of inflam-
matory enlargement of the testicle, and from whatever cause produced.
We have found it equally useful in cases arising from gonorrhcro, whether
springing from sympathy in the inflammatory stage, or originating in what
is called suppressed claps, and in such as have arisen from external injuries.
The degree or period of the inflammation makes no difference.

The only contra-indication to the employment of this treatment, worthy f
consideration, has been found in an affection of the genera] system. For
instance, if the local inflammation had arisen from errors in diet, such as a-
buse of spirituous liquors, or if, contemporaneously with it, considerable dis-
order of the gastric system had shown itself, it was found necessary to re-
move this state before recourse was had to compression ; as, otherwise, the
usual result was not obtained, and the employment of compression was o-
bliged to be postponed for a period.

In many cases the compression at first increased, in some degree, the pain
of the inflamed testicle ; in some cases (particularly when applied too forci-
bly,) it produced great pain ; but this never continued long : the patient, af-
ter a short time, often in a quarter of an hour, and even in cases where the
pain had been extremely severe, finding himself so completely relieved as to
be able to leave his bed and to walk about in his room.

In inflammatory swellings of quite recent origin, a single application of
the compression was found sufficient, in many cases, to remove the disease.
"When it was of longer duration, (say, from three to eighl days,) it was found
necessary to repeat the compression two or three times. Swelling of the
spermatic cord, if it was not very considerable, did not at all contra-indicate
compression; nor yet did other contemporaneous local affections, such as
buboes, ulcere, &c. When a general febrile state was produced by the or-
chitis, compression was found the best means, speedily to remove it, at least
where the vascular reaction was not too great ; although, in extremely rare
casce, this was produced by the compression itself.

183G.] Treatment of Inflammation of the Testicle, jjc, 437

The unpleasant part of the treatment by compression was, as I have said,
its occasioning pain in some cases. This result was observed chiefly in the
early period of my practice, and I considered it as owing1 to our making the
compression too st rong. J n my latter practice, on avoiding this, we heard no
more of pain being produced by it. In some cases, in which the affection
had been previously treated by cataplasms, &c, and where we had only
made one application of the compression, there still remained for some time
a slight painful swellirtg of the testicle; but it gradually disappeared.

In several cases I had occasion to observe, as the consequence of compres-
sion, nausea, inclination to vomit, and bitter taste in the mouth, coming on
without any other evident mark of gastric disorder. When this was the
case, compression evidently was of no avail; the pain remitted little or not
at all, and the swelling did not decrease. On removing the compression,
giving an emetic, or applying a poultice to the stomach, the symptoms of dis-
turbance soon disappeared. In the few instances in which this affection of
the stomach was observed, the compression had been for the most part too
strong ; in two of them, however, it seemed to depend on previous disease in
the abdomen. It is however to be observed, that the cases in which this
sympathy exists in such a degree as to give occasion to gastric disorder are,
generally speaking, so rare as no to be regarded as any drawback on the
superiority of this mode of treatment. It is necessary, however, in all cases
where such a disposition shows itself, immediately to put an end to the com-
pression.

The ood effects of the compression show themselves very soon after its
application, and the speedy abatement of the pain is always the surest sign
of its efficacy. If the pain continues some hours in any considerable degree,
a general disorder of the system may be looked to as explaining the failure
of the treatment-

I will now give a comparative statement of the results of the treatment of
orchitis by leeches, cataplasms, &c, and of that by compression, taken from
the journals of the. Genera] Hospital, since the commencement of the prac-
tice in 1832. In all, we have compared seventy-four cases : of this number,
fifty-one may be regarded as acute cases, or cases in which the symptoms
of inflammation were strongly marked, and twenty, three as chronic cases,
or cases in which the inflammatory symptoms had more or less remitted.
Of the first division (of fifty-one), eighteen were treated with leeches, cata-
plasms, &c, and thirty-three by compression ; of the second division (of
twenty-three), nine were treated with poultices, leeches, &c, and fourteen
"by compression. The following are the results of the two different kinds of
treatment, as regards the time occupied during the case : Of the thirty-
three cases of acute orchitis treated by compression, the average period of
treatment was nine days ; of the eighteen acute cases treated without com-
pression, the average was thirteen days : of the fourteen chronic cases
where compression was employed, the average period of treatment was
twelve days ; of the nine cases submitted to other treatment, the average
was fourteen days. Such were the average results; some of the compara-
tive results of the two kinds of treatment, in reference to individual cases,
were ;is follow.' : Of the thirty-three acute cases treated by compression,
five were cured in three days ; five, in five or six days ; six, in seven days ;
of the eighteen acute cases treated by other means, one case was cured in
three days; one, in five days; two, in from seven to eight days, seven, in
from eight to eleven days. In regard to the chronic cases, out of the four-
teen treated by compression, one was cured in two days, and the greater
number in ten or twelve days ; while, of the nine cases in which cataplasms,
leeches, &c. were used, the cure took place in no case in less than eight
days.

Latterly, when experience had enabled me to treat the disease with more
circumspection, the results of compression were much more favorable. In the

428 Treatment of Inflammation of the Testicle, <$c [Dec.

present summer (1835,) I treated in this way seventeen cases, which are
not included in the above statement. Of these were cured in one day, one ;
in two days, four; in three days, four; in four days, two ; in five days, three ;
in nine days, one ; and two in ten days. The three last were severe and
unfavorable cases. In nearly two-thirds of the whole of the above-men-
tioned cases, no hardness or swelling of the testicle remained behind.

I will now describe the manner in which I apply compression. At first I
attempted to compress the testicle against the thigh and pelvis, by passing
over it long and wide strips of sticking plaster, from the nates up to the ab-
domen. I was soon forced to give up this plan, as well because the com-
pression produced by it was neither secure nor equal, and the patient was
forced to keep himself in bed, and, even while there, to avoid all considerable
movements. After many other unsuccessful attempts by means of tempora-
ry bandages, &c, I at length adopted the following, which is proved by ex-
perience to be the best.

For the purpose of compression, I employ strips of sticking plaster ; the
plaster being made very adhesive, but not of too irritating materials,* and
spread on linen the breadth of the thumb. No preparatory measures are re-
quired ; no leeches, cataplasms, &.c.

In slighter cases the patient may stand before the surgeon, leaning against
the wall, or he may rest on the edge of the bed or sofa, in such wise that the
scrotum may hang freely down. If the scrotum and neighboring parts are
much covered with hair, this must be removed ; but, generally speaking, this
is unnecessary.

The surgeon takes the scrotum in one hand, and separates the diseased
from the sound testicle, while with the other hand he gently stretches the
skin of the scrotum over the former ; the spermatic cord is isolated in the
same manner. If the testicle is much swollen, it must be held by an assis-
tant; otherwise, it suffices for the patient himself to keep the sound testicle
somewhat separate from the diseased. The surgeon now applies the first
strip of plarter over the isolated spermatic cord, about a finger's breadth a-
bove the testicle, holding the end of the strip with his thumb, and passing it
round the cord. He proceeds in the same way with the second strip, which
must either in part or altogether cover the former. The first part of the
process must be carefully done; the strips must compress the cord closely,
(and for this purpose it must be kept approximated to the skin, which is to
be tightly stretched over it ;) otherwise, when the other extremity of the
testicle is compressed, the upper end will be apt to slip upwards through the
loose rings of sticking plaster; a circumstance not only occasioning pain,
but rendering the whole operation abortive. In this manner we proceed,
laying strip after strip, the last always lying over the former by a third of its
width, until we have reached the thickest part of the testicle, and where it
begins rapidly to decrease in diameter. The surgeon now changes his
mode of proceeding, and, laying hold of the testicle already covered, passes
his strips from above downwards over the lower portion of the testicle, and
up over the back part. In this way the whole remaining portion of the tes-

* The following composition, contained in our Codex, is the plaster which
I have employed for some years, and has been found preferable to all oth-
ers:

.ty. Emplastri Lithargyri, partes sex:

Colophonii pulverati (Picis nigra',) partem imam. Seorsim liquata
commisceantur.
The Emplastrum Lithargyri employed is made as follows :
I. Lithargyri subtuissime teevigati, lib. v.

Olei Oliv. lib. ix. M. Coqoe igne moderate, spatula lignea semper
agitandoet pauxillum aqiue subinde instillando, donee Lit ha r-
gyrum perfecte solutum sit, &c.

183C.J Employment of Belladonna in Injection, $C 439

tide is closely enveloped and compressed. I have already said that the
compression must not be too great ; and in most cases the surgeon will be
able to judge as to the proper decree by the speedy disappearance of all the
pain which had previously existed.

If both testicles are affected, we proceed to envelope one in the manner
now described : when this is done, it will be found that there is not room left
for applying the circular strips in the same manner to the other; we are
therefore under the necessity of including both testicles in the circular strap-
ping, the testicle already covered serving as a point of support for the other.
Over the lower portion of this second testicle the strips are passed, as in the
former case, from behind backwards.

In some cases where the skin is irritable, ulcerations take place ; in this
case small slits m ist be cut in the plaster, and a goulard lotion applied, which
soon heals them.

Generally speaking, the patients can leave the bed immediately after the
strapping, and walk about the room ; and, in cases where the inflammation
is not very great, or has been taken early, they may even go out and work a
little.

The renewal of the straps must depend on the decrease of the swelling
and other symptoms. In many cases one application suffices ; otherwise,
we remove the plasters when they have become so loose as to admit the
introduction of the scissors between them and the skin.

Any other treatment the patient may require must depend on the compli-
cations of the disease : the orchitis, as such, needs nothing besides the com-
pression.

In those inflammations of the testicle which originate from blows or pres-
sure, &c. compression has proved the best treatment. Here, if the inflam-
mation ran very high, I have usua31y applied leeches in the first instance,
and kept on poultices for one or two days ; but in slighter cases I had re-
course immediately to compresion.

The following are the principal advantages which the treatment of orchi-
tis by compression possesses over other methods :

1. The speedy removal of pain.

2. The quick removal of the disease itself.

3. The simplicity of the method, and the slight trouble thereby given to the
patient.

4. The small expense of the treatment.

5. The comparatively slight care and attendance required on the part of
the surgeon. The two last points are of considerable importance in the hos-
pital practice. British and Foreign Medical Review. Zeitschrift fur die
gesammte Medic in. B. i. h. 1. 1830. Hamburg.

On the e?nployment of Belladonna in Injection, and Mercury in
the metallic state in Ilius.

M. Hanius has had recourse, with three patients affected with
Ilius, to the following lavement:

K. Fresh Root of Belladonna 3j. Pour upon it a sufficient quantity of
boiling water and digest in a close vessel for one hour. Add to I ij of the
strained liquor, Infusion of Chamomde 2. s. for an injection.

The administration of this injection was almost always imme-
diately followed by a cessation of vomiting and the evacuation of
stercoraceous matter by the natural way. Once only was ob-
served pretty profound narcotism, which was nevertheless
promptly dispelled. The same medication has been crowned
with success in a case of colica piclonum.

430 Continuation of Notice of M. Lisfranc's Clinics. [Dec.

With respect to the treatment of Uius by mercury, M. Hanius
alleges, 1st. It is not correct to say, as M. Ebers recently has,
that the metal passed promptly and by its own weight, from the
stomach into the intestine. 2. Supposing that had taken place,
and that the metal had accumulated against the obstruction, we
cannot conceive how the antiperistaltic movement, provoked by
obstruction of the digestive canal, will be overcome by an obstruc-
tion more considerable. 3. Still more inconceivable is it, that
the intestine is not torn by the weight of metal accumulated in
one point alone ; weight which, according to HaufF, has been
borne, in certain circumstances, even to three pounds. 4. That
when the continuity of the intestinal canal is re-established, the
mercury, instead of being passed together, as it ought to be, is,
on the contrary, expelled by small parcels. 5. That the hori-
zontal disposition of many parts of the digestive canal, will not
allow us to suppose that the mercury will run through them, by
the power of gravity alone. M. Hanius has proven the correct-
ness of this reasoning by experiments directly in point, on dogs,
and he has seen that the mercury is arrested in the stomach, that
it remains there a shorter or longer time, that it passes into the
intestines only by little particles, and by virtue of the peristal-
tic motion; finally, that it attaches itself strongly, in separate
globules, to the surface of the intestines. If then the injection of
this metal soon causes a cessation of the vomiting, it is because
accumulated in the lowest part of the great curvature of the sto-
mach, it opposes, in that point, by its weight, to the antiperistaltic
motion an obstacle equal, if not superior to that which is op-
posed to the peristaltic motion in the intestines, by the invagina-
tion or accumulation of fecal matter, &c. Journal der Praktis-
clien Heilkunde von Hufeland and Osann. Journal des Con-
noissanees Medico- Chirurgicales.

Continuation of the Notice of M. Lisfranc's Clinics.

We now come to the subject of "Chronic Metritis, or Simple
Hypertrophy of the Uterus. It appears evident from this par-
agraph, and the next, which he denominates "Hypertrophy of
the Uterus, with Transformation of Tissue" that M. Lisfranc
uses the term Hypertrophy generically, as including two species,
viz. simple hypertrophy and hypertrophy with transformation of
tissue, &c.

We are compelled to dissent from such a view of the cases
herein detailed by M. Lisfranc. We consider the name hyper-
trophy, eminently calculated to lead to error in pathology, and
consequently in therapeutics. We are also disposed to find fault
with that looseness of nomenclature which confounds metritis,
or any species of inflammation with hypertrophy. We should

1836.] Continuation of Notice ofM. Lisfranc's Clinics. 431

have been pleased to see the first term, metritis, continued alone
in application to the cases on which M. L. pave this clinical lec-
ture, as, with the assistance of a prefix, it is calculated to point
with great precision to the pathology in the different varieties of
these cases. But the instant things so different in themselves are
made synonimes, each confounds the other, and the definite bear-
ing of either or of both, is destroyed. But this subject enlarges
so much on our attention, that, for want of room in this place,
we must refer the reader to the first part of the next (January)
No. of tins Journal, where we intend to notice it at greater
length.

The next subject noticed by M. L. is what he calls " hyper-
trophy of the uterus, with transformation of tissue." This sub-
ject we must also refer as above. This paragraph does not af-
ford us any pathology of this case. It contains a good descrip-
tion of a certain case of diseased uterus and without any satis-
factory reference to causes. Certainly there are causes of effects
which are only momentarily in application on the production Of
continued effects. Such are not necessarily required for correct
indication, if that their manner of operating be well understood ;
and the principle use we have for a knowledge of such, is that,
knowing their mode of operation, we may the better understand
their effects, which are presented to our view in the character of
morbid phenomena, or ciisease. But often some of the causes are
abiding, and are continually renewing and extending their effects.
Such must be both detected and well understood, before we may
hope for rational indication in the case. The treatment, as far
as it goes, is well adapted to the state of things in the case de-
scribed. But the modus operandi of the principle remedy the
pessary in the shape of a bilboquet,*' which he considers is by
compression, we think entirely defective. We should surely not
expect prompt, or certain effects from compression alone on any
one point in diseases elsewhere, and especially when that pres-
sure is only made occasionally and for a short time. Yet such
we perceive to be his views by the following sentence.

" An excellent remedy is compression, applied by the use of a
pessary of the shape of a bilboquet ; this instrument being well
placed, the uterus, by its tendency to descend, especially when-
ever the patient moves, takes exercise, or goes to stool, is press-
ed against it, and thus produces the effect desired.,,

We shall pass over " Tumours of the Uterus," " Miliary Po-
lypi of the Os Tincae," " Tubercles of the Uterus," and " Ulcer-
ations of the Os Tinca3," which contain so much that is valuable,

* Bilboquet, is a term which the reader may not be able to understand even
with the assistance of his French Diction ary, unless he be familiar with the
French toy of that name. The hour-glass shape, with which all readeis are
familiar, will be about as descriptive.

432 Continuation of Notice of M. Lis franc's Clinics. [Dec*

that every one should read these notes ; though they are not ex-
empt from errors in pathology, nor from some in practice to
which these lead.

On the subject of Leucorrhaea, we find renewed evidence that
M. Lisfranc is a practical, rather than a reasoning man.
Whilst we are bound to consider him as having taken most shal-
low etiological views of this case, his practice for its correction
is well calculated for good eflect stopping short, however, as it
must necessarily do, of that extent to which a rational pathology
would have led. We intend to allude to this subject, however,
in the next No. The following remark of M. L. is worthy of all
attention. ** It should be borne in mind, that when these dis-
charges have long continued, they are true emunctories, and
must therefore not be suddenly suppressed. The organs of the
chest should always be carefully explored previous to arresting
this discharge, for he has known this neglect prove fatal to a
great number of females, whose lungs being tubercular, ulcera-
ted very rapidly after the successful treatment of Leucorrhcea."
He recommends, that in those cases in which the lungs may be
suspected, setons, or issues, be established previously to their sup-
pression.

The next and last subject we shall notice in this place, is the
Amputation of the Os Tincce. This is an operation which has
become very common in the practice of M. Lisfranc; his num-
ber of cases amounting now to more than one hundred, within
the last few years. The operation is an important one, and has
surely been performed with great success by M. L., but we are
forced to the conclusion, that like most other new or rare things,
when brought into use, the frequency of this operation has been
extended far beyond the bounds of necessity or prudence : and
that the cause of these boundaries being thus transcended, is the
error in the etiology of the cases. If we judge from all the au-
thentic accounts of his operations of this description, we cannot
fail to be convinced, that he has amputated in very many cases,
wherein the disease for which the operation was performed might
have been easily and speedily cured by duly liberating the ves-
sels of the part, and suitable washes and application thereto.

Nevertheless, the operation is doubtless one which will some-
times be not only prudent, but indispensably demanded by the
necessity of the case ; and for a knowledge of the best manner of
performing it, we refer the reader to the u Notes of a Physician,"
&c. ; Southern Medical and Surgical Journal, No. 5, pages 311
and 312.

183G.] On Fracture of Inferior Extremity of the Radius. 433

On Fractures of the ln(< rior I '. qf the Radius: By G. Goyraud,

M. D., of Aix.

A frequent consequence of a fall on the hand is a painful swelling of the
wrist, hand, and lower extremity of the forearm. This tumefaction is ac-
companied by a deformity consisting in an unnatural projection of the lower
extremity of the ulna ; a change ot form in the forearm, which is rounded in-
feriorly ; inclination of the wrist outwards and generally backwards, and of
the hand in the contrary direction. Generally the only treatment consists in
emollient applications. The swelling slowly declines, and the motions are
not free for a long period. Six months after the fall, the wrist-joint has not
recovered its suppleness. As the swelling disappears, the projection of the
lower end of the ulna is more" apparent: inequalities are felt on the palmar
surface of the inferior extremity of the radius. Eventually the joints regain
their mobility, but the deformity remains throughout life.

This accident has been considered by some to be a diastasis of the inferior
radio-ulnar articulation, by others as a sprain ; by Petit and Boyer as a dis-
location of the wrist : but no external violence could separate from each oth-
er the lower ends of the radius and ulna ; no sprain could change the direc-
tion of the hand ; and, if the possibility of luxations of the wrist are admitted,
(which Dupuytren doubts,) still they must be very rare, whilst this accident
is very common. It can only be accounted for by a fracture of the radius.

Fractures of the carpal extremities of the radius are generally oblique from
above downwards, and from the dorsal to the palmar surface. Out of forty-
seven instances of fractured radius, forty-three were in this direction ; two
others were oblique fractures from above downwards, and from the palmar to
the dorsal surface ; in one other the inferior fragment was fractured vertical-
ly, and in another there was a star-like fracture into many pieces. In the
most common variety, the obliquity was of various degrees, sometimes near-
ly transverse. In the common oblique fracture the inferior fragment is
forced, by the violence of the blow, and the action of the muscles passing
from the forearm to the hand, from below upwards and from before back-
wards. The superior fragment is drawn towards the interosseous space by
the action of the two pronator muscles. The consequence of this displace-
ment is a diminution of the breadth of the inferior part of the forearm and in-
terosseous space ; a depression on the external side of the radius, some lines
above the wrist ; an inclination of the carpal articulatory surface of the ra-
dius outwards and backwards. Cline and Cooper have attributed the pro-
minence formed anteriorly above the wrist to the displacement of the inferi-
or extremity of the upper fragment by the pronator quadratus ; but M. Goy-
raud is convinced, from numerous dissections, that the inferior fragment is
displaced, producing the prominence. The more oblique the fracture, the
greater the displacement : in transverse fractures the violence only causes
the displacement, and this may be so great as to simulate luxation of the
wrist ; an error which may be strengthened by the fact, that, after reduction,
there is no tendency in the parts to become again displaced. The carpus
follows the direction of the articular surface of the radius, so that the articu-
lation of the wrist takes a direction separating it trom the inferior extremity
of the ulna, which consequently forms a projection remarked by Petit and
Boyer, who believed it to be a consequence of luxation of the wrist. The
hand would follow the same direction, if it were not for the internal lateral
ligament of the joint, which prevents the hand turning outward; the flexor
muscles, rendered tense by the wrist being thrown backwards in the com-
mon oblique fracture from behind forward, draw the hand forwards ; in the
fracture in the opposite direction, the extensor muscles draw the hand back-
wards. In the great majority of cases, the hand is fixed in the state of ad-
duction and a little inclined forwards ; sometimes, but rarely, backwards.
If the violence has ruptured the lateral ligaments, or separated the styloid pro-
cess of the ulna, the hand and wrist are in a state of abduction.

55

434 On Fractures of Inferior Extremity of the Radius. [Dec.

These oblique fractures of the radius are extremely frequent : they gener-
ally are caused by falls on the palm of the hand, but sometimes on the dorsal
surface, the hand being strongly bent forwards. The indications of this frac-
ture are an unnatural projection of the lower end of the ulna, a depression
on the radial border of the forearm some lines above the wrist-joint, a little
increase in the dorso palmar diameter, and a little diminution in the radio-
ulnar diameter of the forearm, at a point corresponding to the depression on
the radial edge ; pain in the lower extremity of the radius, augmented by
pressure at this point, but not by the motions of the joint ; pain also beneath
the lower end of the ulna, from the dragging or rupture of the internal late-
ral ligament. In the commonest oblique fracture from above downwards
and behind forwards, the wrist is inclined backwards, its axis forming an
angle, more or less marked, with the forearm. From thence a depression on
the dorsal face of the forearm, over the radius, and ten or twelve lines above
the wrist, and a large prominence, convex from above downwards, on its
palmar surface. The hand is bent forwards ; and this inclination is more
considerable in proportion to the deviation of the wrist. In the rare fracture
from above downwards and before backwards, the wrist is bent forwards and
the hand backwards. The inequalities arc felt before the swelling begins,
and w7hen it is partly dissipated. Transverse fractures with great violence,
and separation of the epiphyses, may be mistaken for dislocations ; but, as
Dessault remarked, in luxations the styloid process of the radius loses its re-
lation to the carpus ; in the other two accidents it is no longer in the same
line as the radius, but it preserves its relations with the hand. Crepitation
is often [absent, from the want of mobility in the fragments and from the
swelling. To sum up : the diagnosis is formed on the change in the direc-
tion of the axis of the wrist and that of the hand ; the swelling characteristic
of fractures ; the pain seated not in the joint, but in the lower end of the ra-
dius, and the unusual projection of the lower end of the ulna. The absence
of rotation in the end of the radius during pronation and supination has been
dwrelt on ; but, from the large surfaces of the fracture and intimate connex-
ion of the two bones, must not the motion of one be necessarily communica-
ted to the other? This fracture is without danger : it leaves behind a de-
formity previously described, but M. G. has never known it produce obliter-
ation of the interosseous space, nor loss of the motions of pronation and su-
pination, which Dupuytren describes as a consequence of its being over-
looked. Under such circumstances, the joint remains for a long time almost
without motion.

Treatment. To reduce the fracture, the forearm must be bent and placed
in a position between pronation and supination ; an assistant produces coun-
ter-extension by seizing the lower part of the forearm, whilst another ex-
tends the limb by drawing the hand gradually outwards, and slightly incli-
ning it towards the ulnar border of the forearm. The surgeon pushes the
flesh of the two sides of the forearm into the interosseous space, and then
puts the broken surfaces into apposition. The fracture is easily reduced,
but retained with difficulty in its situation. The apparatus employed by M.
Goyraud consists of two splints, about the breadth of the lower end of the
forearm, one of which is from eighteen to twenty lines shorter than the oth-
er, and its inferior extremity cut off obliquely ; two graduated interosseous
compresses ; and two pads, one between three and four inches long, and the
same thickness as Ihe middle of 1 he graduated compress ; the other an inch
in length, and like a wed^o, its base being about as thick as the anterior in-
terosseous compress. The interosseous compresses are applied on the two
faces of the forearm, parallel to the inti rosseous spare, and descending to an
inch above the joinl ; below ibis point they are replaced by the pads, the
larger one over the dorsal aspect of the wrist, and the Wedge-like pad on the
paJmarside, with its basenexl to the graduated con id its apex to the

carpus. The 1 'orsal graduated compress and

183G.] Surgical Observations, tyc. 435

pad, is to descend to the posterior surface of the metacarpus; the shorter
splint is placed over the palmar compresses and pad, its oblique extremity
being inferior, rndthc acute angle of this extremity towards the radial edge
of the limb, so that it is applied with the interposition of the cuneiform pad a-
gainst the superior part of the prominence formed by the os pisiform and os
scaphoides. A tight roller confines the whole. The advantages of this me-
thod are the following : As the interosseous space terminates an inch above
the wrist.joint, the long graduated compresses generally used to prevent the
bones coming in contact are of no use; but, by substituting pads whose sur-
fac3 corresponds (as these do) to the shape of the lower end of the radius,
this bone is evidently acted upon. The effect of the oblicpie extremity of
the splint is to change the direction of the line formed by the prominence of
the os pisiforme and scaphoid process, which is almost horizontal, into an o-
blique line running from above downwards and from the ulnar to the radial
border of the limb ; that is to say, to fix the hand in the state of abduction,
and to oppose more certainly the reproduction of the displacement ; an indi-
cation which Cline and Sir A. Cooper attempted by the weight of the hand,
winch they allowed to hang out of the sling. During the last two years, this
treatment has been adopted by M. Goyraud in eleven cases with complete
success. British arul Foreign Review. Journal Hebdomadaire des Sciences
Medicates, No. (5, Fevrier 6, 1836.

Surgical Observations : By Professor Chelius, of Heidelberg.

[In the first number of a new series of the Heidelberger Klinische Anna-
len, recently published under the name of " Medicinische Annalen," this em-
inent surgeon has given an elaborate and highly interesting Report of Ins
Surgical and Ophthalmologic al Clinical Practice in the Heidelberg Hospital,
from 1830 to 1834 inclusive. We regret that our limits will only permit us
to give a brief notice of some of the more important surgical observations
contained in it ]

1. Amputation. Professor C. mentions that, out of twenty-nine cases of
amputation, he lost only two patients. The circular incision was in every
instance put in practice, and ligatures employed to secure the bleeding ves-
sels ; in no case torsion. Two alone required the removal of the dressings
for after-hemorrhage ; in all the rest they were allowed to remain untouched
as long as possible ; in some till the third week, at which period the wound
was found perfectly closed.

2. Lithotomy in the Female. After discussing fully the merit of different
plans that have been proposed, Professor C. adopts the method of incising
perpendicularly downwards, (a modification of Bromfield's operation ;) and
for the following reasons : The urethra, throughout its whole extent, lies
immediately upon the anterior wall of the vagina, as is likewise the case with
the bladder. By the incision so directed these two points alone are impli-
cated ; the execution of the operation is simple, nor is it likely to give rise to
any considerable loss of blood. The extraction of the stone will be attend-
ed with the least possible difficulty ; and, should the large size of the stone
demand it, the incision can be commodiously prolonged. Owing to the ex-
act apposition of the vagina to the urethra and to the neck of the bladder,
there exists a constant parallelism between the wound of the vagina, of the
urethra, and of the cervix vesicae ; the urine finds a ready way of egress, and
no danger need be apprehended from infiltration. From being able, in case
of need, to carry the incision along the neck into the body of the bladder,
every risk from pinching or tearing the cervix vesicae is removed ; lesions
much more apt to produce subsequent incontinence of urine than the mere
section of the neck!

As disadvantages resulting from this mode of operation, are enumerated
the danger of vesico-vaginal fistula and permanent fissure of the urethra.

436 Surgical Observations. [DcC.

The first of these objections must be opposed by the various arguments ad-
duced in support of the vesico-vaginal section generally. In this respect the
conditions here are much more favorable than in the instance of recto- vesical
lithotomy ; for here the vagina is empty, and the entrance of foreign matters
into the cavity of the bladder, as fasces from the wounded rectum, rendered
impossible. Nor is any inconvenience to be apprehended from the remote
chance of the influx of fluid during the flow of the catamenia. The second
objection is supported neither by anatomical nor physiological grounds, and
is directly refuted by Professor C's. own proper experience.

Operation. The grooved staff is introduced with its handle sustained ver-
tically by the assistant, and its concavity pressed up against the pubic arch:
in this manner the parts to be incised are more securely fixed, the entrance
of the vagina somewhat widened, and the finding the groove on the staff fa-
cilitated, and, lastly, the section downwards of the urethra and vagina accom-
plished without trouble. The incision may be performed with a probe-poin-
ted bistoury introduced to the requisite depth along the groove, and then
made to cut its way outwards, dividing in its course the neck of the bladder,
urethra, and anterior wall of the vagina, to the full extent wanted : or it may
be executed by means of the lithotome cache of Frere Come. Should the
incision of the bladder be too small, it must be enlarged by means of the
probe-pointed bistoury, conducted along the left index-finger.

Reports of three cases are related wherein the above plan answered.

3. Scrotal Calculus. This case is remarkable from the multitude of con-
cretions removed, amounting to twenty-seven in number. The patient was
fifty-five years of age, and attributed the origin of the complaint to a fall upon
the perineum, about twenty years previously.

4. Bronchocele, (Struma Lymphat lea.) Professor C. is of opinion, that in
every case of this disease where the nutritious vessels are much enlarged
and easily to be felt, their obliteration by means of ligature is equally indica-
ted, as in the aneurismal form of the affection ; for, although the diminution
of the swelling in Struma lymphatica, after the supply of blood has been
checked by tying the superior thyroid arteries, does not proceed with such
rapidity, nor to the same degree, as in the vascular goitre, still however such
a decrease in the bulk of the tumour will be obtained, that the inconvenien-
ces it had created will be in a great measure lessened or altogether re-
moved.

The operation is of the simplest description. The rule given is to make
the incision correspond, in direction and situation, with the course in which
the arterial pulsations are most distinctly perceptible to the finger of the
operator. This will most frequently be found to be between the omo-hyoi-
deus muscle and the point at which the vessel is entering the gland ; often,
however, between its origin and the same muscle. An advantage attending
this method is, that, if it should not fulfil the desired end, diminution of the
morbid growth, other means can, with greater confidence, be put in practice.
Four cases are reported in which it proved of great service, and in no one
was it productive of the least bad consequence.

5. Erectile Tumours. Creosote was tried as a topical application in sev-
eral cases of this affection, and especially Ncevus maternus in infants. The
only effect its continued application seemed to produce was the formation of
a superficial dry crust, which came away, leaving the tumour in statu quo :
indeed, in one case, the volume of the nawus appeared to have augmented
under the use of the creosote. From its jnefficacy, he was obliged to have
recourse to caustic, which he pronounces unfailing in its effects, and prefera-
ble to the knife, from the danger of mortal hemorrhage from the latter.

6. Removal of an Abdominal Tumour. This is another addition to the
eepulchretum of operations in that cavity. The tumour was of a fibrous
texture, of considerable magnitude, attached by a pedicle to the uterus.
The patient never recovered the shock of the operation, which she outlived

183G.J Surgical Observations. 437

seventeen hours. It is justice to state, that its performance took place at
the earnest solicitation of the patient, in opposition to the advice and opin-
ion of her medical men.

7. Tetcaugiectasia Lipomatodes. Under this strange name is detailed the
history of a singular case of mixed tumour, partly erectile, partly lipomatous,
occurring in the hand of a tailor, chiefly between the thumb and the meta-
carpal bone of the index-finger. As its presence interfered with the use of
the needle, Professor C. determined to try the effect of tying the radial ar-
tery. Soon after the operation, so great was the amendment that he was
again able to resume his handicraft. It is worthy of remark, that, in conse-
quence o? the supply of blood being diminished, it gradually lost its erectile
character, assuming more and more that common to lipoma.

8. Stricture of the (Esophagus. For the permanent cure of stricture of
the oesophagus, Professor C., taking advautage of the principle introduced
by Ducamp for strictures of the urethra, employs an oval ivory dilatator, at-
tached upon a common oesophagus bougie, about an inch and a half from its
extremity. An ordinary oesophagus bougie is first inserted, to ascertain the
existence and situation of the stricture. Should this fail to make a passage,
a thinner bougie must be used. Where the coarctation is considerable, it is
sometimes necessary to use middling-sized urethra bougies. The bougie is
left in ten or fifteen minutes each day, gradually exchanging it for one of lar-
ger caliber, until the dilatator is permitted to enter, which patients are found
to endure quite as well as the ordinary sounds. Under this plan there is ra-
pid improvement ; and, after the lapse of a few days, a second thicker dila-
tator may be substituted for the former, until perfect dilatation is effected, and
deglutition rendered free. For some time after the cure it is advised to in-
troduce the instrument once every five, eight, or fourteen days, to prevent
relapse. All instruments for the cure of stricture are always to be intro-
duced by the mouth. British and Foreign Review. Heidelberg Medicinisclie
Annalen, Band. i. H. i. 1835.

438 Medical Society of Augusta. [Dec.

Part III MONTHLY PERISCOPE.
Medical Society of Augusta, 9th November, 183G.

The Society convened at 7 p. m. Dr. Bowen, the essayist for
the evening, not having his essay present, the members were
called on for medical intelligence. Whereon, Dr. Antony rela-
ted a case of typhoid fever, in which salivation had supervened
on the use of forty grains of calomel, in 8 grain doses, three hours
apart, with 1 gr. aloes in each. This occurred about the sev-
enth day the disease having hitherto observed an intermittent
type, and in the early stage had, from the symptoms of a tenden-
cy to cerebral congestion, required the free use of the lancet
once, an emetic, and continued use of nauseating portions of an-
timonials, previous to the use of the calomel, but could not bear
quinine. The salivation continued several days, the calomel had
operated as a purgative, without evincing any change of hepa-
tic secretion. During the continuance of the salivation, the fe-
ver gradually assumed a remittent, and finally a decidedly con-
tinued type, and typhoid character ; during the progress to
which, and within three or four days, the salivation, which was
at first severe, gradually decreased and finally ceased altogether
by the fourth day after salivation. The tongue was covered with
a thick brown fur, thickened, with crimson colour of the apex,
edges, and under surface. Litmus paper applied to the tongue,
which was moist with saliva, promptly assumed a pale pink
colour. Pulse small, week and fluctuating through the twenty-
four hours from 90 to 100, with frequent intermissions. Con-
tinued coma, eyes half open, without expression ; countenance
hippocratic; jaw fallen ; constant and considerable typanitis.
Carbonate of soda was administered in doses of 10 grains every
two hours, and every four hours 15 drops of chloride of soda, as
suggested by Drs. Graves andChomel, in g i. mixtura camphora,
for forty-eight hours; during which time, the epigastrium hav-
ing been previously vesicated, blisters were also drawn on the
legs.

At the end of this period, the thickness and redness of the
tongue had greatly abated, the saliva no longer produced the
pink colour of the litmus paper, the intermissions of the pulse
were less frequent, its tone decidedly improved, the tympanitic
condition of the bowels was entirely removed, and the bowels,
which had been disposed to looseness, became less relaxed.
IJnt the thick fur on the tongue, the coma, the want of expres-
sion, the falling of the jaw, with dry skin and cold extremities,
continued. Calomel G grains, with com p. powd. of ipicac 3 grs.
were now directed every three hours, alternated with I ss. port-

1830.] Medical Society of Augusta. 439

Wine and I ij. decoct, cinchon., with serpentina infusion. By the
next day, the calomel secretion from the liver was evident.
The use of the calomel was however continued for two days
longer, with the effect of a gentle evacuation of very black se-
cretion about every three or four hours. During this time, per-
spiration made its appearance on the face, and gradually extend-
ed, with increasing warmth, to the rest of the surface ; the ir-
regularity and weakness of the pulse were corrected, and at last
she awoke from her coma as from a sleep, knowing nothing of
what had passed for the last twelve days. Her mouth now be-
gan to swell and evince the salivating effect of calomel, and soon
became very sore, with/ the prompt abatement of the febrile
symptoms. This case was given, as one amongst many, mainly
in illustration of the fact, that mercurial salivation has little or
no agency in arresting the progress of fever. Attention was
also called to the fact of the abounding acid in the saliva, and
the tympanitic state of the bowels, in connexion with the other
typhoid symptoms, which were so promptly corrected by the
alkali and" chloride of soda. Dr. A. remarked that this dis-
play of acid and tympanitis had been frequently found during
the season in connexion with these symptoms, and which had
been very uniformly corrected by corbonate and chloride of so-
da. He also alluded to the fact of its almost universal preva-
lence some years ago, in an epidemic influenza which prevailed
in Augusta, as was plainly evinced by the taste of the perspira-
ble matter being nearly as sour as that of lemonade ; and in
which the pulmonary and the typhoid symptoms were much
more promptly relieved by the addition of a little clean ashes, or
carb. sod. or potass, with linseed and seneka infusion, than by
all other means without the alkali.

Dr. A. stated, that during the past summer, he had deliv-
ered an ancncephalus, wherein the whole brain and mudulla ob-
longata were deficient. How much farther down the spinal
column the deficiency continued was not determined, from want
of opportunity to continue the examination. The child lived in
the full and regular -performance of the functions of circulation
and respiration, (witli the exception of occasional short intermis-
sions of the latter.) for (he full term of twenty-seven hours. It
was very strong and remarkably sensitive to the touch, so as to
exhibit, when touched, somewhat of that convulsive effort pro-
duced by cold water thrown on one asleep.

Dr. Bowen stated a case of intermittent fever, to which he had
been called, in which the pulse intermitted every eighth pulsa-
tion. The patient was then under the operation of what the
family called " sandhill physic," a specimen of which the Doctor
had not been able to obtain, and therefore could say nothing of
its botanical character, but observed that its operation was
very similar to that of tartrate of antimony. The regular inter-

440 Medical Society of Augusta. [Dec.

mission of pulse continued through the use of purgatives and di-
aphoretics

This case was treated with calomel, nit. potass, and tartrate
of antimony ; with arsenite of potass. A fine relaxation of skin
was procured and the chills arrested. The patient relapsed, and
sulph. quinoe was resorted to, but was abandoned because of the
increased dryness of the skin and fever. He died on the twen-
tieth day from the attack. The privilege for autopsy could not
be obtained.

Dr. B. gives this case on account of the remarkable facts of
the great regularity of the intermissions of the pulse, and the
great dryness of the tongue at the same time that the skin was
in a fine state of relaxation. The spleen was obviously very
much enlarged. For several months previous to the attack,
complained of considerable pain in the precordial region.

Dr. B. did not think an intermitting pulse a necessary accom-
paniment of great hepatic derangement ; and therefore thought
this symptom dependent on some alteration of the heart, the
prime mover of circulation.

Dr. B. proceeded to give another case illustrative of the oper-
ation of lobelia. This article he said was given to a boy 10
years old, laboring under a bilious fever, at one o'clock in
the afternoon. Soon after taking this dose, he was found to be
in a stupor, with that general helplessness and extreme flexibili-
ty, which immediately precedes death, the eyelids half closed,
eyes rolled back, and great difficulty of breathing. In this situ-
ation he continued for nearly twelve hours, when he vomited and
was relieved.

Dr. Dugas then related a very extraordinary and interesting
case of chronic hydrocephalus, which he had treated by tapping.
This was a male child, born without accident, and enjoyed ap-
parent good health until one month old. His head was then
perceived to increase in size more rapidly than is usual in health ;
and subsequently, the cranial bones separated, the eyes became
spasmodically turned downward, and at four months of age the
child experienced slight general spasms, which in a few days
amounted to convulsions. He appeared in other respects per-
fectly well, was fleshy and had been subjected to no treatment
whatever. The circumference of the head was now 21 inches,
and the fluctuation could be distinctly felt at the forehead, which
was puffed up by the contained fluid. In this condition he had
found the patient, on the 25th of June, laboring under convul-
sions which had commenced several hours before. Dr. Antony
happening to be present, it was at once determined in consulta-
tion, to draw off a portion of the effusion ; but having no more
suitable instrument at hand, Dr. D. made the puncture with a
couching needle, penetrating about one inch deep, in the left an-
gle of the fontanelle. On withdrawing the needle, an ounce and a

18 30.] Medical Society of Augusta. 441

half ( ^ iss.) of limpid yellowish fluid oozed out, and no more
could he obtained. The head was then bandaged; the convul-
sions continued during the operation, and two or three hours af-
ter.

On the 5th July, the operation was repeated with the same
instrument, and the application of a cupping glass, when ^ij.
more were drawn.

Aug. 12. Head had very much enlarged, and on the use of a
very small trocar, made expressly for the purpose, I vij. of fluid
were removed.

Aug. 29. Head larger than previous to the last operation.
Drew off 5 xi.

Sept. 12. Head full, but not distended strongly. Drew off
I xv.

Sept. 30. Head again filled. Drew off I xiiss.

Oct. 16. Drew off I xiv.

Dr. D. remarked that the convulsions subsided shortly after the
first operation, and did not return, except very slightly, a short
time before the third and fifth puncture, although the accumula-
tion continually increased. Indeed his general health appeared
unimpaired until the 15th October, when he became dull and
stupid. The stupor gradually increased and he became insensi-
ble of the nipple when put into his mouth. On the 16th he ap-
peared as if in a profound sleep, and had swallowed nothing for
two days.

After the removal of the 1 xiv. on that day, he again readily
noticed and swallowed several teaspoonfuls of milk poured into
his mouth. He expired quietly on the 18th October.

The operations were never attended with the least change of
pulse, nor symptoms of prostration the only visible effect being
the subsidence of the tumefaction, and of the tendency to spasm.
Iodine, calomel, bandages, &c. were prescribed, but never attend-
ed to, from the unwillingness on the part of the mother to annoy
the child, as she thought, unnecessarily. The fluid was, after
several of the operations, exposed to heat, without coagulating
in the least.

The Dr. then gave the following full and minute account of
the autopsic examination:

Autopsy. The cranium was opened longitudinally, by an in-
cision made in the membranes connecting the two sides of the
frontal and the two parietal bones. The brain was found ex-
panded like a sack, lining the dura mater, and filled with fluid,
which did not escape until the brain was punctured. The con-
volutions were entirely unfolded, and the walls of the sac thus
formed were about a line or two thick. The corpora strata and
thalami were not affected, and the third ventricle was nearly
normal ; the fornix, velum interpositum and plexus choroides
existed; the septum lucidum was not found. The corpus cal-

96

442 Medical Society of Augusta. [Dec.

losum could not be recognised, although the cerebral substance
forming the walls of the sac was as firm as usual at this age.
Cerebellum normal as also the medulla oblongata and encepha-
lic nerves. The membranes presented nothing peculiar, save a
great want of blood in the vessels of the pia mater. The inner.
surface of the cerebral sac resembled very closely a healthy mu-
cous coat of the stomach. It was in some places covered with
thick flakes resembling dense mucus ; some of these were yel-
lowish, some brown, others of a cream color and like thick pus.
The yellowish patches were at the bottom of that portion of the
sac corresponding to the anterior lobes of the brain, and were
not very unlike the appearances left after the absorption of apo-
plectic effusion. The left hemisphere being the first opened,
permitted the escape of the fluid contained in both, after which,
on looking into the right cavity through the hole of communica-
tion with the left, a kind of longitudinal septum, though lacerated,
was seen hanging from the upper part of the sac and reaching-
its floor. It resembled the cineritious substance, but was so
pulpy as to be readily torn and thus to prevent a satisfactory
examination. It may possibly have been formed by flakes anal-
ogous to those already alluded to.

On examining that part of the sac which corresponded to the
external marks left by the punctures, the cicatrices of the seven
perforations were distinctly seen in the cerebral substance, which
at this, place with its other membranes slightly adhered to thc-
dura mater.

The contained fluid measured sixty-four ounces, was limpid
and of the colour of pale urine.

The above case, although unsuccessfully treated, may, by con-
firming the practicability and harmlessness of tapping the brain.
lead to its more frequent trial. The plan has proved successful
in one or more instances, and therefore merits more attention
than it has hitherto received. In this case the brain was punc-
tured seven times and sixty-three ounces of fluid drawn off, yet
not the slightest unpleasant effect ever followed the operation.

Dr.. Joseph A. Eve, then made some observations on irregu-
larity and intermittence of the pulse, which he was disposed to
attribute to sympathy with the liver generally, when not depen-
dent on organic affection of the heart at least this was the con-
clusion to which he had arrived from observing intermittence
frequently attendant on, or accompanying hepatic disease. He
related the case of a lady of bilious temperament, and previously
the subject of hepatitis, who, after long continued and repented
exposure to cold, was attacked with a most intense pain in the
region of the liver and other symptoms of hepatic disease ; and
whose pulse during the attack was extremely irregular and in-
termittent, and reduced to a mere thread were it not that it did
not correspond with the muscular strength, voice, expression of

1 836.] Medical Society of Augusta. 413

countenance, and tlint he had seen cases somewhat similar, he
should have supposed, judging by the pulse alone, that she was
then moribund. Notwithstanding the pulse was scarcely per-
ceptible and like that of a person in articulo mortis, recognising
it to be a < i litis, lie did not hesitate to prescribe a large

blister to the side and purgation with calomel and aloes, after
the operation of which, the pulse gradually recovered its natural
tone and rhythm and the patient was restored to health.

Dr. Antony remarked, that intermitting pulse, as well as pal-
pitation, was a very frequent attendant on chronic bilious habits';
very often observable and generally yielding more or less prompt-
ly to the correction of the habit, by evacuating the bile and im-
proving the hepatic secretion by slow purging with calomel and
aloes.

Dr. P. F. Eve gave the following case, evincing the danger-
ous effects of hygeian pills. He had been called on the 5thinst.
to a married lady, whom he found laboring under a most severe
attack of acute dysentery.

She had been complaining of irregular action in the bowels
for two or three days, and during the day on the evening of
which he was called in, she had had about 20 operations, attend-
ed with distressing tormina and tenesmus, the discharges being
chiefly blood and mucus. She said she had taken no medicine
whatever, and had no appetite for food or drink. After stating,
however, his surprise at the want of a satisfactory cause for such
serious effects, his patient admitted she had taken only six hy-
geian pills. The box was on examination found marked "Mor-
rison's Pills, No. 2"

This proved to be the most violent case of dysentery he had
ever seen. It resisted laudanum in large doses by the mouth and
anus, a large blister over the abdomen, (there being no fever,)
sixty grains of Dover's powder and three grs. of acetate of mor-
phine in twelve hours, combined with absolute repose in the
horizontal position, (the patient usi '-pan,) diet, <tc. Af-

ter taking one hundred and eight] powd and

eight grains morphine co it, a mixture of 1 oz. tr.

catechu 9iij sub-carbonate s grains sulphate mor-

phine, and 4 grs. morphine in starch injection, (suggested by Mr.
Hewson, apothecary.) it was finally subdued on the sixth day of
the attack. The patient had slow! red, and was that day

discharged.

Dr. E. would not positively assert that the pilii produced the
disease. They should not, he thought, as they were professedly
hygeian; but the facts of the c fated.*

* We recoDect that a lew years since, when the Steamers applied to the
Georgia Legislature for an act to legalize their practice, that some of the
physicians then in the Legislature voted for the bill, as the best means of

444 [D

cc.

Dr. Cunningham stated as a remarkable fact, that in no pre-
ceding season had he found with his patients so great a suscep-
tibility of salivation by the moderate use of calomel, as in that
which had just passed. He had usually prescribed it with a view
to its cathartic operation, and that it had been not. unfrequently
the case, that salivation was produced within twenty-four hours.
Although a remarkable susceptibility was thus manifested, Dr.
C. did not recollect that in any instance, it had been violent, al-
though some cases lasted more than a week. Dr. C's. impres-
sion was, that the intermittents which had prevailed the past
season were of a mild grade, except in a small proportion of
cases which were attended with gastritic symptoms, and that
these readily yielded to the use of quinine, after the gastric symp-
toms were removed.

He had met with one case of hooping cough, which was ush-
ered in by a violent attack of croup the spasmodic cough soon
developing itself after the removal of the first symptoms. The
case required no peculiar treatment afterwards.

Dr. Antony corroborated Dr. C's. observation of the unusual
susceptibility to mercurial salivation. His practice had been to
give from 16 to 40 grains in broken doses of 8grs. each, with 1
of aloes, 3 hours apart ; following them, after two hours from the
last dose, with a purgative portion to evacuate the bowels ; and
he had observed the salivation occur after the first day, with un-
usual frequency, even in the remitting type of fever.

convincing the community of the error alleging that they believed nothing
short of the demonstration which they would make, by being set at liberty
for a few years, could convince the community of their error. The policy
may have been good, but we did not admire the humanity of the measure, as
there was no antidote to death. We do not believe that any man ever made
or sold the Morrison pills for the purpose of preserving or restoring health,
we think it possible, the traffic, as well as their unjust praises, may cease, if
the mystery of their composition be divulged, so that any one may make
them.

We will therefore refer to No. 3, page 190 of this Journal ; but at the
same time we give the bane, we offer an antidote, which is, observe the pros-
ecutions still going on in England, and the frequent convictions oj man-
slaughter, for the administration of the Hygeian pills.

1836.] Carbonate of Soda hi Large Doses. 445

Carbonate of Soda in large doses : By Mr. Neville.
Mr. Neville has recently published a small, but very well written, volume
on mental derangement. But as the greater part of it is eclectic, or, in oth-
er words, compiled from the best authorities, it is unsuitable for a review
being itself, indeed, an analysis. There are several original remarks, howev-
er, and observations scattered through the volume, and the following pas-
sage contains some curious matters which we deem worthy of selection.
It is on the exhibition of soda, as a corrector or preventive of indigestion and
its multiplied horrors.

" We selected two healthy young monkeys, nearly of an age. We pre-
ferred them to any other, in this instance, for experiments, on account of
their similitude to man in their omnivorous capacities, as also in their pas-
sions. These creatures we had placed precisely in the same circumstances,
and treated as nearly as might be in the manner in which we are accus-
tomed to treat ourselves in society; that is to say, we had them placed in a
comfortable warm room, gave them little opportunity for exercise, dieted
them, according to the fashion of the times, with an abundance of the staple
articles which constitute the food of an Englishman : they had tea, bread and
butter, with some animal food, for breakfast ; meat, vegetables, fruit pies,
raw fruit, beer, and wine for dinner ; and tea and supper as these meals are
taken among the middling classes of society. In short, they were treated
every way alike ; save that to the one, and not to the other, a drachm and a
half of the carbonate of soda, dissolved in water, was regularly administered
in three doses during the course of every day. At the end of six months
the two animals presented a very different exterior, and were evidently in'
dissimilar states of health. The one to whom the soda had been given was
plump and lively ; the other was thin, spiritless, and obviously diseased. We
had this creature killed ; when, upon examining its body, we found the mus-
cles to be shrunk and pale, the stomach and alimentary canal congested,.
the mucous coat of the former especially thickened, the right lobe of the liv-
er indurated, and the mesenteric glands much enlarged.

For fear the above result might have been occasioned by circumstances
with which we were not acquainted, or over which we had no control, the
same experiment was repeated, with precisely similar effects, on two other
animals of the same species ; and also a third time, upon two strong whelps
of the Newfoundland breed of dogs, without any material difference being
observable. The carbonate of soda appeared to prevent the accession of
disordered function in each instance the animals that were pampered and
over-fed, without having it administered to them, became sickly and pined ;
those who took the salt three times a day throve, and enjoyed to all outward
appearance the best state of health ; nor, upon dissection, could any trace
of disease be found in their bodies, which was always very apparent in those
of the others."

The author relates some instances of the beneficial effects of soda in chil-
dren. The following is an example.

" Twin boys, very healthy children, were placed, as nearly as might be, in
similar circumstances, with two different and excellent dry nurses. One
child was observed to thrive amazingly; but the other looked puny, and was
evidently in indifferent health. Upon expressing our particular satisfaction
at the appearance of the robust infant one day, the nurse, with a very com-
placent look, begged to assure us that " it all came of her bottle." On ana-
lysis of this medicine, we found it to contain a mixture of liquor potassa^,
infus. rhei, aqua anethi, and simple syrup. This mixture she was in the ha-
bit of giving to her little charge in the dose of a tea-spoonful night and morn-
ing, and more frequently still when he did not seem quite himself; though
the original instructions prescribed only a few drops."

A gentleman, aged 40 years, had suffered so long and so severely from in-
digestion, that his life became a burthen to him. He was persuaded by our

4 10 Detection of Sulphate of Quinine in Urine, fyc. fyc. [Dec.

author to take "two drachms of carbonate of soda, twice or thrice a day, in
a bitter infusion." Though startled at the magnitude of the dose, he made
the trial. Five months afterwards, Mr. Neville learnt from this gentleman,
that on the very first day of the trial, he felt himself a new man. At the
date ol the latter he was eating and drinking ad libitum, having recovered
liis strength and grown hale and stout.

" A lady of distinction, whom we visited for some time, along with her or-
dinary medical attendant, a practitioner of eminence, suffered from indiges-
tion nearly or altogether in as great a degree as the gentleman whose case
we have mentioned above. AJ1 dietetic means, combined with the exhibi-
tion of alteratives, aperients, small doses of the alkalies, &c. had also proved
utterly unavailing in this instance. At our earnest request, the patient was
prescribed an ounce of carbonate of soda, divided into five equal portions, in
the course of the four and twenty hours. Under this medicine alone she ra-
pidly and completely recovered, regaining all her former spirits, and once
more presenting the plumpness and bloom of perfect health."

There is no doubt that acidities in the stomach and duodenum are pro-
ductive of singular irritability in the mind and the whole of the nervous sys-
tem. But we much doubt whether the carbonates of soda and potash can
be taken in the above doses with impunity. We have known several in-
stances where much smaller doses taken regularly have appeared to render
the mucous membrane of the bowels more instead of less irritable. The
constant use of it appears to us to clear away the mucus which is the natu-
ral defence of these parts against foreign matters that must pass along their
surfaces. Medico- Chirurgical Review.

Detection of Sulphate of Quinine in Urine. M. Piorry, one of the Clinical
physicians of the Hotel Dieu, has published the following novel observations
on this subject. " Finding that the urine of patients who were taking qui-
nine was sensibly bitter, I requested M. M. Vallee and Fcrmond to analyse
it. The subjoined is their report. The urine of several patients, who had
taken about half an hour previously a large dose of quinine, we acidulated
with diluted sulphuric acid, and then evaporated the fluid to three-fourths of
its original quantity. When cool, it was filtered, and then treated with
quick-lime in powder, in order to decompose the sulphate of quinine and re-
duce it to the state of the simple alcaloid, which was precipitated along with
the insoluble sulphate of lime. The precipitate collected on a filter was well
washed, then dried and reduced to a fine powder. This powder was treated
with alcohol, and allowed to digest for twenty-four hours : it was then filtered
and evaporated, and the residue was treated with water accidulated with
sulphuric acid : the solution gradually deposited a crystallized sulphate of
quinine, which was readily recognisable by its well known characters."

[Medico- Chirurgical Review. Bulletin Clinique.

Odoriferous Exhalation from the Skin. There was a case lately in the
wards of La Charite, under the care of M. Raycr, of this pathological curi-
osity. A woman, 38 years of age, was admitted in a state of extreme ma-
rasmus, and laboring under chronic peritonitis. During the eight days pre-
ceding her death, the surface of the arms and of the trunk exhaled a very
strong odour of musk.

Strict inquiries were made to ascertain whether any musk, or other simi-
lar perfume, had been introduced into the wards by the nurses or friends of
the patient, "el tout lemonde, ainsique la malade elle-meme, nous la repon-
du par la negative." Thetreatment of this woman hadconsisted in the use
of antiphlogistic, emollient, and revulsive* remedies, such as leeches to the
epigastrium, blisters and sinapisms lotlie legs, and demulcent drinks.

The post-'mortem examination did not very satisfactorily account for the
disease which proved fetal. The only lesions found in the abdominal viscc-

1830.] Endermic use of Quinine in Agh 117

ra were some old adhesions of the rectum to the posterior surface of the ute-
rus, and of the colon to the liver ; the ovaria and kidney- exhibited traces of
inflammation; the intestines were at different points congested with blood,
but did not present any well marked or very serious lesion.

These alterations do not certainly account for the extreme tenderness of
the abdomen during life, for the very obstinate diarrhoea, the excessive ex-
haustion and tendency to coma.

In a late number of the Annali Universali di Medicina, Dr. Sporanzahas
reported a case, somewhat analogous to the preceding one : but in this pa-
tient the extent of surface, which gave out the odoriferous effluvia, was much
more limited ; for it was confined to one of the fore-arms.

lie has collected the particulars of most of the cases which have been re-
corded ; and among these, we observe that there are three, in which a strong
musky smell was emitted from the arm pits. Medico- Chirurgical Review.
Lancette Francaisc.

Endermic use of Quinine in Agues. The endermic use of quinine, in ca-
ses of intermittent fevers, has been adopted by several of the best physicians
in Paris. It is well known that, in many agues, the mucus membrane, not
only of the stomach, but also of the large intestines, is in a state of conges-
tion or of actual inflammation. The exhibition of quinine or of any other
tonic by the mouth, or in the way of enema, must, under such circumstances,
be positively injurious, and it has been with the view of avoiding any aggra-
vation of the intestinal distress, and yet overcoming the peculiar and un-
known state of the system on which the periodic recurrence of a morbid pa-
roxysm, in intermittent disease, depends, and which is so generally controll-
ed and removed by bark in all its forms, that the endermic use of quinine has
been so strenuously recommended, especially by those physicians whose
minds are ever haunted with the dread ofgastrite or gastro-enterite.

Five cases, treated by M. Chomel at the Hotel Dieu, are reported by Iff.
Raciborski.

The first was certainly a very mild case. A man 23 years of age, robust
and hitherto in perfect health, was seized with a febrile paroxysm which
lasted for four or five hours, after exposure to cold and damp. The par-
oxysm returned regularly every second day, and on the intermediate days
the patient was quite apyrectic. On the morning when the sixth paroxysm
was expected, eight grains of sulphate of quinine were applied on the
epigastrium, which had been previously denuded of ite cuticle by strong
ammoniacal pommade. The paroxism was quite checked, and, although
the patient remained in the hospital for another week, there was no re-ap-
pearance of any agueish symptoms.

The second case occurred in a middle-aged man, who had suffered from
tertian fever in the preceding Autumn, and in whom the recurrence of the
disease at the period of his admission seemed to have been induced by a vi-
olent mental emotion. He had already experienced eight paroxysms within
the last 16 days. When admitted, he was quite free from any feverish dis-
turbance ; a light demulcent diet was ordered. Two paroxysms occurred
m the hospital. Two grains, therefore, of quinine were ordered to be ap-
plied on a blistered surface of the epigastrium. On the following day, the
paroxysm returned, but at a later period of the day than hitherto, and it last-
ed only one hour, instead of four or five, as on former attacks.

The application of the quinine was repeated daily, and all disposition to
any recurrence of the intermittent illness ceased entirely.

The third case was similar. Only four paroxysms had occurred before
the endermic use of the quinine was tried. The application of four grains
daily effected a complete cure.

The fifth case, one of tertian fever, like all the preceding exampL
more severe ; the disease had been of longer duration : nl had suf-

448 Remarkable Case of Hemiplegia, <-c. [Dec.

fcrcd from ague before ; and moreover the spleen was felt to be perceptibly
enlarged, Six grains of quinine applied to a small denuded surface on the
epigastrium an hour before an expected paroxysm, caused it to be much less
severe and less prolonged than any preceding one ; and by repeating the
application once or twice again, there was no recurrence of any feverish at-
tack. Medico- Chiruniical Review.

Remarkable Case of Hemiplegia. "Francis Joseph, age 35 years, of sal-
low unhealthy complexion, a seaman on board an Indiaman, just arrived
from England, was admitted into the General Hospital on the 27th of Janu-
ary, 1833, with hernia humnralis, which in a few days was relieved by free
local bleeding and the exhibition of a solution of salts and tarter emetic to
nausea and purging.

On the evening of the 6th of February, the patient called my attention to
a sensation of numbness, and imperfect muscular power of the left upper ex-
tremity, and a drawing of the mouth to the right side, which he said had
been gradually increasing during the two preceding days; the expression of his
countenance was uncomfortable, and his pulse, tho' small, was quick & hard.

Bleeding to syncope, and a brisk mercurial purgative were prescribed.

At G a. m. the following day, I found him hemiplegic; the muscular power
of the left half of the body being completely paralyzed. Sensation imper-
fectly continued, whilst the circulation and temperature of the affected parts
were natural. He passed evacuations involuntarily, and the urine was re-
tained. He was heavy and drowsy, but complained only of pain in the scia-
tic nerve ; percussion in the course of the spinal column caused no uneasiness.

The head was shaved and cold applied, 30 leeches to the occiput, calomel
purgatives and low diet prescribed.

8th Feb. The paralytic symptoms unrelieved ; frequent dark stools pass
off in bed.

Thirty leeches to the cervical spine, and calomel purgatives continued.
Catheter passed, and oz. iv. of foetid ammoniacal urine drawn.

9th. No change for the better. Thirty leeches to the base of the head
and cervical spine ; calomel purgative and catheter passed.

19th. He appears somewhat exhausted by depiction, and the smart ac-
tion which has been kept up on the alimentary canal. Pulse small and
quick, countenance anxious ; paralytic state of the left half of the body con-
tinues complete. Mouth affected by mercury.

Blister from the back of the head to the sacrum. Pul. Jalap, comp. zi. at
7 a. m. Strychnine gr. 1-4 every 3 hours ; milk diet and sage. Urine
drawn off.

11th and 12th. The same remedies continued without advantage.

13th. During last night he passed a small quanlity of urine, and he can
now retain the faeces until a bed-pan is placed under him ; he can also raise
the extremities from the bed. Remedies continued.

14th. Passed 4 oz. of fsetid urine in the night, and three voluntary stools ;
has more power over the extremities, and the features are less distorted.

Kith. Gradually; improving under the same treatment; can now carry
his arm up to his head.

21st. Has been progressing since the last date. He can at this time
walk, drawing the limb awkwardly after him, and raise the aim over the
head : the muscles of the face have recovered their action, and the angle of
i.jic mouth is scarcely observed to incline to the right side when he speaks.

Medicine continued. Chicken diet.

March 13th. Has perfect use oi the whole of the lately paralyzed parts,
buthc feels weaker on thai I ban on ihe opposite side. Strychnine discon-
tinued. A mild aperient evi ry morning.

April 33d. Discharged perfectly cured, and in good health. No tetanic
or apparent nervous ls occasioned by the internal exhibition of

Strychnine.

SOUTHERN MEDICAL

AND

SURGICAL JOURNAL

Vol. L] JANUARY, 1C37. [No. 8.

Part I. ORIGINAL COMMUNICATIONS.

ARTICLE I.

Essay on the Modus Operandi of Medicines, read before the
Medical Society of Augusta : By Joseph A. Eve, M. D. Pro-
fessor of Therapeutics and Materia Medica in the Medical
College of Georgia.

The subject of the Modus Operandi of Medicines, is one of
intense interest, but of insuperable difficulty. Whilst nothing
can be more curious and interesting, nothing can be more ob-
scure oiid difficult to explain, than the manner in which medi-
cines act in modifying the living tissues, the mode in which sub-
stances of different qualities and properties derived from all the
kingdoms, animal, vegetable and mineral, introduced within or
brought in contact with our bodies, operate in subverting disease
and restoring health.

As respects the essential nature of the action of medicines
that is the immediate or proximate cause of the effect produced,
all is speculation, hypothesis and vague conjecture. How for-
eign matter can affect and modify the condition of the vital tis-
sues and organs, is a question still unsolved our investigations
have been made in vain our enquiries have all returned unan-
swered the mystery still remains veiled in impenetrable dark-
ness.

57

450 Essay on the Modus Operandi of Medicine. [Jan,

' reverse the problem and ask
how does the livii s. for it is'said " med-

tcamina non agnnt in cadaver*" that medicines do not act in the
dead body, but' that the living body acts on them, no advantage
is gained there is no solution of the difficulty our ignorance is
still unenlightened as to the proximate mode, the rationale of the
intimate changes that take place.

All that we can perhaps ever know respecting the mode of
operation of medicines, is a knowledge of the organs or parts pri-
marily acted on, the medium through which their impressions
are communicated to other parts, the order or succession, and
the effects or consequences, of the changes and modiricati< n>
thus induced. Some medicines, as emetics, cathartics, enemata,
&c, produce their effects by a direct and local impression on the
part or organ to which they are applied thus sal epsom in
solution stimulates the inner surface of the intestinal canal and
can.:e; an increased secretion therefrom this mode of opera-
tion, however, is limited a very large majority of therapeutic
agists display their effects in parts distant from that to which
they ar ; first addressed.

There are three modes in which medicinal action may be com-
municated from the part first impressed to others more remote :
the 1st, by continuity of tissues ; the 2nd, by the sympathies; and
the 3rd, by absorption into the circulation, the remedies being thus
conveyed directly by the blood to the organs over whose func-
tions they exercise a specific influence, or for which they have a
peculiar elective affinity, as diuretics for the kidneys, abortives
for the uterus, &c.

With respect to the first of these modes of communication,
there is perhaps little diversity of opinion among physicians all
agree that irritation of much intensity, whether spontaneous or
artificially produced, has a natural tendency to extend itself to
contiguous parts, especially in the same tissues, and few, if any
would dispute the physiological fact, first inculcated by the illus-
trious Bichat, that if the mouth of an excretory duct be irritated,
the irritation is propagated along the duct into the gland itself,
causing an augmentation of its secretion, as exemplified in the
effects of masticatories in promoting the flow of saliva, stimu-
lants to the mouth of the lachrymal gland producing an effusion
of tears, &c. This, however, is the least important medium of

1537.] Essay on the Modus Operandi of Medicines. 451

communication, and is comparatively of but limited application,
in explaining medicinal operation.

As to i! . the propagation of the action of medicines

through the medium of sympathy, there is, I believe, perfect una-
nimity among therapeutists no one disputes the very impor-
tant agency of sympathy in communicating affections from one
part of the economy to another. It is principally through the
sympathetic and antagonistic relations that exist between the
different organs and parts of the system, that impressions, mor-
bific and curative, are transmitted through the organism: upon
these relations depends the principle of revulsion a principle of
almost universal application in explaining the operation and ef-
fects of medicines. The sympathies direct and inverse, consti-
tute a bond of union, by which all the organs and particular sys-
tems in the general system are bound together, in one consentient
and harmonious whole by virtue of which the affections of one
part are conveyed to and felt by others, by which the organs feel
and suffer together. The cerebro-spinal and ganglionic systems
are the seats and media of the sympathies; as they are the organs
of sensation, we cannot rationally conceive an idea of sympathy
independent of them, therefore we shall employ the terms sympa-
thy and nervous communication as synonymous. It is with re-
ference to the third mode of operation, by absorption into the
circulation, that there is some discrepancy of opinion among med-
ical authors some denying this medium of communication al-
together and accounting for every thing on the principle of sym-
pathy whilst another party contend for both these modes of
operation.

The principal authorities in favor of sympathy exclusively,
are Professor Chapman in our own country, and Drs. Addison
and Christison in Europe on the other side of the question might
be arranged a large majority of the most respectable medical
writers, European and American.

We will state as succinctly as possible, the theory of Dr.
Chapman, in his own words, and then adduce some of the prin-
cipal facts and arguments in proof of the absorption of medi-
cines into the blood.

" The theory I shall propose of the operation of medicines,
(says Dr. Chapman.) alleges that they all act by exciting a local
action which is extended through the medium of sympathy."

452 Essay on the Modus Operandi of Medicines. [Jan.

" Conformably to the theory I have adopted, whenever a me-
dicinal substance is applied to a susceptible portion of the body,
externally or internally, an action is excited, which is extended
more or less according to the diflusibility of the properties of the
substance, or the degree of sympathetic connection, which the
part may maintain with the body generally. Thus a set of ac-
tions is raised, every one of which is precisely similar ; provided
they are confined to the same system, by which is to be under-
stood parts of an identity of structure. If, however, the chain
runs into other systems, it loses its homogeneousness of charac-
ter, the actions being modified by the peculiar organization of the
parts in which they may take place. These arc principles of
universal application. In every case, whether it respects the
operation of remedies, or the production of disease, the spot pri-
marily acted upon is a point, from which is diffused the radiated
impression."

"This is a mode of action peculiar to living matter, and is re-
markably distinguished from all other processes. An impres-
sion is made and extended without mixture or combination, or in
any degree disturbing the order and constitution of the part in
which it takes place."

Inasmuch as we do not deny the influence of sympathy and
the communication of medicinal action through the medium of
the nerves, it is unnecessary to state the arguments in support of
this position. The transmission of the effects of some medi-
cines and poisons, is too instantaneous to admit of any other
mode of communication than that through the nerves the sud-
denness of their effects precluding altogether the idea of absorp-
tion into the blood, such as prussjc acid, &c.

Without considering with Dr. Chapman the stomach to be
"the throne of the vital power," it enjoys the most numerous
and the strongest sympathies with the organs generally, inso-
much that when the stomach is languid, the whole system lan-
guishes* and on the contrary, when this organ is excited by
food or drink, the whole system participates in the excitement.

As soon as food is received into the stomach of a person i e-
ble and faint from fasting, strength and animation are imparted
before the first process of digestion commences, which can only

*"Vcntriculolan*ruido omnia langnent."

1837.] Essay on the Modus Operandi of Medicines. 453

be accounted for on the principle of sympathy the vigor thus
restored, would however soon subside, were it not rendered
more permanent by the subsequent conversion of the aliment
into chyle and its absorption into the blood. But to multiply
arguments to prove a fact so evident, so well established, and so
generally acknowledged, would be a useless task.

Professor Chapman's denial of the operation of medicines
by absorption, is founded on two opinions that are in direct op-
position to experiment and observation: First, that "chyle,
however diversified the materials may be out of which it is
formed, whether animal or vegetable, has essentially an identity
of nature." And, secondly, " that it is incompatible with animal
life, that such active substances (medicines) should be received
into the circulation, since milk and other bland fluids have been
known, when injected into the vessels, to occasion immediate
death."

It has been satisfactorily proven by the experiments of Dr.
Marcet and others, that chyle resulting from the digestion of an-
imal food, differs essentially from that derived from vegetable,
in composition, appearance after standing, and in disposition to
putrefaction, which takes place in three or four days in chyle
from animal, and in not less than as many weeks in that from
vegetable diet.

With respect to the second assumption " that no substance in
its active state can be received into the circulation," it is a fact
abundantly proven, that many medicines can be injected into the
veins, and that thus introduced into the blood they evince the
same specific tendency or elective affinity for certain organs,
precisely as when received into the stomach, except that their
effects are evinced with much greater rapidity and in much
smaller doses. Castor oil, rhubarb, emetic tartar, ipecac, &c,
have been the subjects of these experiments, to the safe perform-
ance of which, two precautions only are necessary that the
substances be gradually introduced into the circulation, and that
they be not too viscid or thick to pass through the pulmonary
capillaries, by which the circulation would be prevented and
fatal consequences result. Bichat thought that a bubble of air
introduced into the veins, would be destructive to life, but more
recent experiments have shewn, that if introduced slowly no
injury may be apprehended. These experiments have been

454 Essay on the Modus Operandi of Medicines. [Jan.

nsidered more interesting in a physiological point of
view than of imp >rtance in practice, as a physician would scarce-
ly think of injecting medicines into the veins, which could be so
much more conveniently administered by the mouth or in ene-
mata. But that terrific scourge which has of late years called
into requisition all the resources of the profession, and the ut-
most efforts of human skill and ingenuity? has proven not only
the safety, but the nr utility of the copious transfusion of

saline medicines directly into the blood. It is thus proven most
conclusively, that medicinal substances may enter the blood and
that through that medium they are conveyed directly to the or-
gans with whose excitability they are in relation.

It is true the artificial introduction of medicinal substances
into the blood, and their operation when thus introduced
there, do not prove their absorption into the circulation in other
movies of exhibition still they go far in corroboration; but they
are not necessary to the establishment of the fact. Medicines
administered by the mouth and by the endermic and iatraleptic
methods, have been frequently detected, not only in the secre-
tions and excretions, but in the blood itself. Camphor has been
found in the blood of the vena cava. Mercury has been detect-
ed by Jourdan and others, in the urine of patients who had taken
it; and Dr. Colson has detected it in the blood itself by introdu-
cing plates of polished brass, which came out coated with mereu-
rv. Another proof that mercury is absorbed into the blood and
passes out by cutaneous exhalation, is, that a gold watch worri in
the pocket of a person whose system is under its influence will
exhibit a white mercurial coating. Iodine has been discovered
in the blood and in many of the secretions and excretions, even
in the milk of persons that had taken it for sometime. Children
are often affected by medicines their mothers have taken, as
though they were taken by themselves. This is a fact so well
known, that some physicians give to the mother the medicine
designed to operate on the child. Professor Dunglisson in his
"Genera! Therapeutics," relates a case in which the most alarm-
in^ degree of narcotism was produced in an infant by a large
dns-' of morphine administered to the mother. Is this to be at-
tributed to sympathy between mother and child? A very fa-
miliar example is the effect of sulphur in imparting its odour to
the perspiration and in turning silver coin, knives, &c. worn in

1837.] Essay on the Modus Operandi of Medicines. 455

the pockets of persons who have taken it, of a black colour.
Spirit of turpentine is soon manifested in the urine by its smell,
&c, and affects the kidneys much more in small doses than in
large, because when exhibited quantities it proves pur-

gative and is not absorbed. Sulphate of quinine has been detec-
ted in the urine by M. Piorry, half an hour after its exhibition.
Calomel given in one large dose, say 15 or 20 grains, will gener-
ally irritate the small intestines and operate actively as ahydro-
goguc cathartic whereas, when administered slowly in divided
doses, until 40, 50, or 60 grains have been taken, allowing time
for its absorption, the evacuations will consist of thick dark bil-
ious matter, and longer retained without purgation, the mouth
and salivary glands will become affected. What imagination
vivid enough to explain all these phenomena by sympathy ?

Passing by the very obvious effect that the food of cows has
upon their milk the smell, taste and colour of many medicinal
and alimentary substances are, constantly, observed in the urine,
perspiration and breath some, as garlic, &c, even when ap-
plied to the surface. Dr. Chapman supposes that these substan-
ces are all perfectly assimilated, and their characteristic quali-
ties completely lost, before they enter the blood, and that their
elementary particles thrown beyond the sphere of the circula-
tion, claim kindred, reunite again, atom to atom, in the secretions,
and exhibit afresh all their pristine properties in this new existence.
This fanciful supposition is too far-fetched, too un philosophical
too absurd, to deserve a serious refutation. That the presence of
medicinal substances is more of; en recognised in the secretions and
excretions than in the blood, depends upon their greater dilution
in the latter fluid. The secretions and excretions are the out-
lets provided in the economy for the elimination of all foreign
matter from the blood hence they are found frequently more
concentrated in the former than in the latter. Dr. Christison
does not deny a fact so often and satisfactorily demonstrated, as
the absorption of medicinal substances into the blood, but still he

contends that all medicines operate through the nerves alone.

If the rapid and instantaneous transmission of the effects of some
remedies be proof of the agency of the nerves, certainly the very
slow operation of others is as strong against it, and affords pre-
sumptive evidence mat their effects are propagated through
some more circuitous route, or by some more gradual process ;

456 Essay on the Modus Operandi of Medicines. [Jan.

that is, by being communicated through the medium of the
blood to the organs acted on, or by modifying the exciting power
of the blood itself. The methods of medication, by applying
medicinal substances to a part of the surface from which the
cuticle has been removed by a blister, and by friction or inunc-
tion, prove the absorption of medicines into the blood. If iodine
be applied to the surface for a length of time, the mammae testi-
cles or some other gland become absorbed: who will attribute
this to sympathy ? A miner employs quicksilver in collecting mi-
nute fragments of gold and becomes salivated : is this to be at-
tributed to sympathy between the palms of the hands and the sali-
vary glands ?

Nitro-muriatic acid rubbed on the surface causes the liver,
previously torpid, to secrete bile. Nitrate of silver taken inter-
nally, imparts a blue colour to the skin. Not only may the
smell of alcohol be perceived in the blood, but it has been found
in the ventricles of the brain of a man who had died suddenly
after drinking a quart of rum ; and it is stated on good authority,
that the blood of a drunkard was so impregnated with this in-
flammable fluid as to ignite and burn on the approach of a can-
dle.

"Is the chemistry of the animal fluids, (says Dr. James John-
son,) to be placed entirely to the account of the nervous sys-
tem ? We have turbid urine, with deposition of uric acid. A
few drachms of soda change the state of the renal secretion, and
render it clear: Is this from sympathy, alone, of the nerves of
the stomach with those of the kidneys ?

Were it necessary innumerable instances might be adduced
wherein the operation of medicines cannot be satisfactorily or
rationally accounted for, unless by admitting their absorption
into the blood.

From a careful and candid examination of all the phenomena
displayed in the operation of medicines, it appears to us the una-
voidable conclusion is, that while the effects of some are com-
municated more directly through the medium of the nerves,
others are first absorbed into the circulation, but that, except
when the impression is most sudden and evanescent, whether
the sanguine or nervous system be primarily affected, the other
becomes secondarily involved that is, if the nerves be first im-
pressed, the impression extends from them to the blood vessels

1837.] Remarks on Hypertrophy, fyc. 457

and consequently to the blood ; and if the medicine be received
into the blood, it not only affects the nerves of the vessels, but is
conveyed through that medium to the brain and nerves every
where throughout the body.

As in all physiological and pathological processes, we observe
the joint operation and involution of the nervous and sanguine
systems, in those that are curative also, they are both mutually
and reciprocally involved.

The modes of operation of medicines may be summed up as
follows: 1st. By a direct and local impression. 2dly. By
sympathy of continuity. 3dly. Through the medium of the
nerves, or sympathy direct and inverse. And 4thly. Through
the medium of the blood.

It would be an agreeable task did our limits admit, to institute
an enquiry into the nature and effects of the impressions which
medicines make on the system, which we believe are of three
kinds, besides those whose operation is mechanical or chemical,
viz : debilitation, sedation and excitation that is, by abstracting
stimuli, by diminishing excitability, and by stimulating or increa-
sing excitement ; but we respectfully submit to the society the
remarks already made, as time will not permit us at present to
enter upon the consideration of that interesting and important
subject

ARTICLE II.

Remarks on Hypertrophy, fyc. : By M. Antony, M. D.

As truth is the foundation of all moral, so is it of all scientific
excellence. And in no branch of science is tins virtue more de-
sirable than in medicine. This is a science which, when its
claims arc duly considered, demands the most unerring judg-
ment, not only for the well doing of its professor, but on account
of the important interests of humanity. Not only comfort, but
human life rests its hopes on those truths which are the physi-
cian's data for sound reasoning. Without these, the practition-
er must be as the mariner in the raging tempest, with helm in
hand, but without sun, stars, log. or compass. And as the latter

458 Remarks on Hypertrophy. [Jail.

most probably guides his barque to the wrecking shoal, so does
the former without the sound premises of truth, guide to destruc-
tion the frail casket of humanity.

These reflections have been suggested by contemplating the
love of novelty and the spirit of ultraism which pervade the
profession in the present age. One of the great causes which
drove our own immortal Rush to untenable ultraism in the sim-
plification of disease, was the falsehood of nomenclature, arising
out of the errors of classification. Two elements are essentially
necessary to nomenclature, without either of which, the very
name given is pregnant with mischief. The first is, a name
which shall itself declare the nature of the tiling named, and the
second is the real facts of the nature of the thing to which the
name is applied. Nomenclature, therefore, so long as it contains
these elements, is most convenient and unobjectionable : In a
word, it declares to us the philosophy of the thing. The name
of a disease or a disorder, or any unusual physiological or pa-
thological phenomenon, must, in order to answer the purpose of
nomenclature, declare the nature and condition of that disease or
disorder, or unnatural occurrence; and the knowledge of the facts-
which justified the name must furnish us with the whole of the
causes, and the present condition of the phenomena. It must
declare the state of the system, or that part of it concerned, and
the causes operative in the production of that state. If then a
name of phenomena, which result from one cause or set of cau-
ses, be given to those phenomena which have resulted from ano-
ther, we find ourselves at once plunged into all the dangers of
erroneous diagnosis ; or if we fail to discover our error here, we
are soon overwhelmed in the more immediately dangerous one
of erroneous prescription ; for our prescriptions must generally
bear a relation to causation, as well as to the present phenomena.

We perceive in the Clinical Lectures of M. Lisfranc,* the
term hypertrophy, used synonymously with metritis. For ex-
ample, " Chronic metritis, or simple hypertrophy of the uterus."
The state which M. Lisfranc alluded to by this name, is well
defined to be a mere increase of healthy tissue in distinction from
schirrous and the white tissue resembling, but very different
from it. This state " is generally very insidious in its progress,

''See Southern Medical and Surgical Journal, page 303.

1837. J Remarks on Hypertrophy. 459

especially about the critical age," but less so as we approach the
greater irritability of earlier life. " Touching is always a pain-
ful operation, and the consistence of the uterus is found normal,
though rather soft. To the feel, it gives the same impression as
an uterus in early pregnancy, or shortly after abortion, and is
sometimes as large as the head of a six months' fetus," and
sometimes much larger, and generally, perhaps always main-
tains very nearly the shape of the uterus when enlarging in the
different months of pregnancy. But so soon as the name "hy-
pertrophy" is given to it, the value of those truths which entitle
it to some name is lost, because hypertrophy means a state of
deviation from ordinary physiological, or rather anatomical con-
dition, consisting of an increased growth of the hypertrophied
part, differing however in causes and condition from what we
should call metritis. It cannot therefore fail, if confided in, to
lead to much mischief in all diagnosis, and therapeutics, and
consequently in prognosis. If compared with hypertrophy (of
the heart for example,) it will be found essentially different.
Nor is it unimportant to mark the distinction ; for there is some-
thing of obscurity, nay much, in the pathology, (if I may so speak
of hypertrophy,) which repels enquiry into the cause, and its
manner of producing its effects. And without mere accident, the
indications of cure must be defective in proportion to the error
in etiology. This is, but for chance, just as sure as that effects
depend for their production on their causes ; which should be con-
sidered, as it is, self-evident. It is therefore our purpose in this
paper, to illustrate more plainly and definitely, the subject of hy-
pertrophy.

Hypertrophy should be distinguished from swellings the ef-
fect of recent, subacute, or chronic inflammation. These cause
swellings, acute or chronic, in certain parts, attended with in-
creased sensibility, redness, &c* as the necessary consequents
of a law of irritation, whereof increased fluxion is the result.
The greater the constitutional irritability, the quicker these swel-
lings are developed, according to the same law ; and the quicker
they are developed, the greater is their sensibility. Hence, what
have been by M. Lisfranc called hypertrophy of the uterus, are
generally very insidious in their progress about the critical age,
and are, cet. par. less so in earlier life. But the slower the pro-
gress of the case, the less is the sensibility exalted ; consequent-

460 Remarks on Hypertrophy. [Jan

Iy, the tenderness to the touch does not so readily characterize
the disease.

The acute case of this kind affecting a viscus, is a proper phleg-
monous inflammation and will be found more rapid and strong-
ly marked not only in early life, under the same circumstances
otherwise, but also in the sanguineous temperament, because in
this the hematosin of the blood is greater in proportion to the
other ingredients, and the circulation therefore produces greater
excitement in just proportion, as evinced by the peculiar irrita-
bility of that temperament under any exciting cause. This true
phlegmonous inflammation of a viscus, is one extreme ; and as
we consider this nature becoming, in obedience to the whole in-
fluencing circumstances of the case, as age, temperament, &c,
&c, more and more chronic, it approaches the other extreme, as
in advanced life, phlegmatic temperament, &c. And thus are
produced chronic phlegmasia? : but they are all phlegmasia) still.

We would illustrate hypertrophy in the following manner :
All the actions of health are merely series of excitements. But
so long as these actions do not exhibit the characters of disease,
they arc properly considered physiological.

If by any means these excitements become so increased as to
cause an increase of growth in any organ or tissue, stopping
short however of morbid phenomena, except increased size, such
increase of growth should be called Hypertrophy.

This is a word of Greek etymology, Meg and to*j, and literally
means super-nutrition, unnatural, or excessive accretion. Nor is
there good reason in necessity or elsewhere for altering the literal
signification. It is fairly applicable to the whole system, or any
of the organs which enter into its composition, or any particular
organic system.

A muscle is enlarged by use to double its natural thickness.
This is sometimes observable in the features of the face, often in
the legs of dancing masters and pedestrians, and almost always
in the biceps flexor cubiti and other muscles in the arms of
axe-men, blacksmiths, &c. This is a growth of the natural
structure, effected in the same manner that the arterial system,
by acting, increases its power of action during the first half of
life, until it exceeds the veinous resistance, and throws the ple-
thora from itself into the veins. Exercise of a faculty exalts and
perfects that faculty. It is so, not only in the corporeal, but al-

1830.] Remarks on Hypertrophy. 401

so in the mental faculties. This enlargement of muscle may be
considered a hypertrophy. It is an enlargement of the natural
structure beyond what is natural or ordinary, and which, as a pe-
culiar effect, has its peculiar cause. This cause is action. For
if instead of giving the organ increased action, its actions be re-
strained by avoiding exertion, or by compression, as by a band-
age, &c, the organ not only fails to be exceedingly developed,
but actually becomes atrophied. The brain of Baron Cuvier
may be considered as hypertrophied, and by the same cause,
great exercise, as every one must acknowledge who is acquain-
ted with the immense intellectual labor of that man.

The heart becomes hypertrophied in the course of a long time,
from the occasional, though more or less frequent excitement it
undergoes from the exhilarating passions, &c, and more quickly
when produced by causes which are more steadily in operation,
whether mental or physical ; as by the exciting passions, or by
daily liberal potations of wine and other fermented liquors.
Hence the great frequency of hypertrophy in apoplectics and
paralytics. Here then is a very obvious difference between hy-
pertrophy and that swelling which is produced by the fluxion
consequent on irritation ; but the difference is still farther re-
markable : this tends to phlegmonous inflammation, and through
it, to some of its terminations, according to the peculiar circum-
stances of the case ; as suppuration, schirrous, gangrene, &c. ;
whilst hypertrophy has no tendency to either of them.

These states may be still farther distinguished by the reme-
dial measures appropriate for each. If you would palliate hy-
pertrophy, or prevent its ill consequences ; or if you would hope
for its removal you would rely on withholding its peculiar causes ;
and even where applications might be practicable, go to the ex-
treme opposed to its causation ; that is, not merely suspend ex-
ercise, but compress the organ, or otherwise promote the action
of the absorbents of the part : and here is the sum of resourses
in a remedial point of view. But in the case of phlegmonous in-
flammation, when the increased action has been the effect of
vascular irritation, we have at command the various antiphlogis-
tic means which operate mainly by lessening the vascular action
of the centrifugal powers (the heart and arteries), as well as
promoting the action of the centripetal, (or absorbents,) the re-
moval of local irritants, &c, all tending to resolvent effect.

462 Remarks on Hypertrophy. [Jan.

Here will be found causation which is approachable with thera-
peutic means ; and we should examine, study and detect, that we
may attack it.

These considerations lead us to the conclusion, that M. Lis-
franc's cases of hypertrophy of the uterus, are to be considered
more properly phlegmonous inflammations of that organ; and
that they are in that state and period in which they exhibit swel-
ling, with more or less increased tenderness, heat and redness,
and that they demand the removal of all causes of irritation in
the part, as well as all obstructions to a free transmission and
return of circulation. These may be very chronic, according to
the peculiarities of the general system, the habits of the individ-
ual, the previous treatment of the case, &c. &c, and may tend
to any of the other terminations of inflammation than that in
resolution ; as suppuration, or the white tissue so much resemb-
ling schirrus. We need not expect to compare it in all respects
with a phlegmon situated in the cellular tissue for example, for
like the liver and the lungs, the tissue of the uterus is very pe-
culiar, and this peculiarity, like that of the other organs just
named, is calculated to come into the chain of cause and effect,
and produce its proportion of peculiarity in the resulting phe-
nomena. Thus we see these tumors last sometimes for years,
and sometimes for almost an age and again, we see them de-
generate into those conditions which have their other names, and
thus are produced ulcerations, enormous white enlargements,
&c. &c.

It is not a little remarkable, that a man of M. Lisfranc's intel-
ligence and experience should have allowed an error thus intro-
duced, as it appears to have been, by a mere name, to have gone
its wayward course in all the succeeding details of medical phil-
osophy, and finally into a practice most inert and deficient in
some respects, and most imprudently bold in others, when con-
sidered in relation to true cause and pathological condition.

There is, as we have often observed heretofore, no error more
prolific of mischief, passive or active, than that of connecting ef-
fects with causes which did not produce them. To this error we
must consider M. Lisfranc indebted for his failure in relation to
therapeutics in the disease in question. He has described a true
sub-acute or chronic inflammation of the uterus, under the ap-
pellation of "simple hypertrophy," which means merely "<o>%

1837.] Remarks on Hypertrophy, 463

increase of healthy tissue :" and so little has been known of gen-
uine hypertrophy, that the word has carried with it in its appli-
cation to metritis so much of its own deficient etiology, as to
obscure the view of causation in this latter affection. Thus it is
that his prescriptions appear certainly to be the result of partial
observation of this disease, with an eye jaundiced by hypertro-
phy, and not that legitimate deduction from the whole premises
which constitute the fundamental philosophy of the case ; for
these include at least the whole causation, and the true patholog-
ical condition.

We have before alluded to the treatment rationally determined
for genuine hypertrophy ; we will now endeavor to show the
difference between these affections by exhibiting the demands of
true metritis. It is passing strange we say, that even the action
of some of his remedies had not informed M. Lisfranc more of
the causation, as well as the pathological state in this disease.
But whilst he considers, and very correctly too, that absolute rest
is amongst the influential means of effecting a cure, and that the
patient should not be allowed to walk even to her sofa, nor move
roughly in bed, he at the next instant declares "these precau-
tions are recommended in order to prevent the irritation kept up
by the friction of the uterus against the adjoining parts." Well
may his discerning annotator ask the question, " Is this friction
really produced, as M. Lisfranc believes, by ordinary move-
ments V No. Were this the cause of the existing irritation,
the prescription would then bear a good relation to it. But this
being not the fact, the prescription, though in part necessarily
demanded by the rationale of the case, is inefficient alone, being
only secondary in importance at most. Hence the necessity for
the next error, depletion for its revulsive effect, which although
sometimes perhaps correct, is not generally so, because there is
an abiding cause, the removal of which is demanded by the fair
reasoning in the case, and with which, the effects will almost
always cease; especially if the other appropriate, more prudent
and safe auxiliaries be simultaneously and consecutively in ope-
ration: and not only so, but it would be in opposition to all sound
reasoning to expect a given effect to cease, whilst its causes con-
tinue in operation.

We have thus instanced one or two of the therapeutic errors
arising out of views of the causation but too limited. This

464 Remarks on Hypertrophy. [Jan.

train of errors continues on the same principle to the prescrip-
tion of and reliance on antispasmodics, if the nervous system be
found to suffer the use of tepid baths tepid enemata, because
the bowels tend to constipation, and the fecal collections increase
irritation tepid vaginal injections three times a day with linseed
fomentations a small elastic canula introduced with caution
for the administration of injections, to prevent wounding the dis-
eased parts dry cups moxas blisters and issues, as revul-
sives to the pelvis regimen, as avoiding coffee, reducing the
quantity of food to half the general allowance exercise at the
menstrual period leeches to the os tinea?, to stimulate the ves-
sels and bring about the removal of superfluous matter frictions
with iodine douches de vagin, &c. &c.

Does M. Lisfranc or any one else believe that this metritis is
produced, continued and increased, by no particular cause or
causes ? Did it merely arise from an increase of the healthy
growth of the part by nutritious accretion? Or if according to
his description of the facts of the case, which constitute chronic
metritis, irritation exist, did that irritation arise spontaneously,
making the first link in the chain of morbid phenomena, and there-
fore only needing revulsive powers? Surely this cannot be be-
lieved by any one. Even hypertrophy must have its causes;
but they are in good relation with their effects, which exhibit no
more of the characters of inflammation than did Mr. Daniel
Lambert, whose adipose tissue was so hypertrophied that al-
though but five feet eleven inches high, he arrived at the enor-
mous weight of 704 pounds, with a girth of body of nine feet
four inches and of the leg of three feet one inch ; and who,
though convivial, was temperate in all things, being a cold water
drinker, and eating only of one dish at a time. He scarcely
knew what indisposition was was cheerful, intelligent, free in
respiration, not disposed to drowsiness, was able to walk up
stairs with great case, and believed, says his biographer, that he
could walk a quarter of a mile. So also must metritis have its
causes, and these must be in good relation with their effects.
What then arc these effects which make up the phenomena of
the disease, whether acute or chronic? These phenomena are
swelling, tenderness to the touch, pain and heal, (if acute,) and
doubtless redness, & tending to some of the terminations of inflam-
mation. And here, we doubt not, may be found the true source

1837.] Remarks on Hypertrophy. 465

of those ulcerations of the os tinea) and cancerous degenerations
for which M. Lisfranc has so freely and frequently amputated
the os tincse, to be that the disease, being considered hypertro-
phy, has been subjected to a treatment, (if any at all,) but par-
tially adapted to its necessities. Here the nobler talent of the
surgeon should have been displayed, in preventing these or curing
them when produced, instead of amputating. Any tyro can
amputate a leg, but the best surgical talent is often needed for the
cure of that lesion which seems to render amputation necessary.

Differing essentially then from hypertrophy, chronic metritis
is explicitly this, that the circulation through the blood vessels,
both veins and arteries become obstructed by the undue pressure
of the displaced uterus on them. This being the case, no anato-
mist who will contemplate the immense and curious distribution
of arteries to this viscus and its appendages,* and the corres-
ponding veins and lymphatics, will be surprised at the appear-
ance of that irritation and tumefaction which must be consequent
to such obstruction. Nor will any surgeon be astonished at the
increase of size, tenderness to the touch, &c. &c, which are ac-
knowledged characteristics of this disease. With this view then
of cause and effect in this case, what curative indications are ra-
tionally suggested ? They are

1st. To remove the impediment to the free transmission of
blood and lymph.

2d. To correct the effects of this obstruction.

In the fulfilment of the first indication, we are unavoidably
led to enquire into the cause of obstruction of circulation, that we
may direct our attention to its removal. Had cold been the
cause of this obstruction, then indeed most of the means prescribed
by M. L. would have been in relation therewith ; as revulsion,
avoiding irritating causes, &c. &c. Nor would these have been
less applicable to such a case produced by lacerations and other
kinds of violence inflicted on the substance of the uterus: but
these causes are rarely in proximate connexion with chronic
metritis their effects being generally acute, although there may
be rare instances of its existence from this cause. Yet if JVI.
Lisfranc has had these or similar causes in view, in the chronic
metritis described by him, under the name of "simple hypertro-
phy," he has greatly erred in omitting a cause, twenty, perhaps

*See Tiedeman's Plates.

59

466 Remarks on Hypertrophy. [Jan.

a hundred fold more common, which omission must, as it actu-
ally does in his details, extend a most important influence
throughout the whole of the subsequent views taken in the case.
In truth, there is generally, on fair and thorough investigation of
these cases, no such cause alleged by the patient. If she state
that she has taken cold, it will generally be ascertained that this
statement is founded merely on the fact of some menstrual irreg-
ularity commonly a retained, suppressed, deficient, retarded or
painful menstruation, of which she believes cold the only compe-
tent cause ; but to which she had suffered no particular expo-
sure. On diligent enquiry it will be found that she suffers bar-
renness, fluor albus, &c. ; spinal irritation, in the lower lumbar
or dorsal vertebrae, sacrum, or whole column will be very com-
monly found in connexion with hysteria and other nervous phe-
nomena nervous symptoms with the nervous temperament, he-
patic with the bilious, and pulmonary with the sanguine ; and
these variously mixed and diversified according to the mixtures
of temperaments, and the joint or collateral influence of other
accidents, &c. ; but these are to be looked on as effects or symp-
toms, and not as causes. Whilst therefore they need corrective
means, we are still impelled to the investigation of cause. On
farther inquiry it will be found that she has suffered menstrual
irregularity in some respect, preceded by abortion, difficult la-
bour, too soon quitting child-bed, over exertion, a fall, the use of
eorsettesf &c. and that she suffers pain about the sacro- vertebral
junction, the sacrum, the ganglion impar, the round or broad lig-
aments, burning, or obstruction, or incontinence of urine, or con-
stipation from obstruction of the rectum, or tenesmus or dysen-
teric distresses from irritation of the part, &c. These and the
like, point to the fact of uterine displacement, and justify the
touch. On this mode of enquiry, the displacement will be found
to exist, and the uterus generally lower down than natural, with
its lower orifice towards or at the vertibule, or fossa scaphoides ;
and often in cases which have been long existing, accompanied
with various degrees of tenderness, mobility, &c. This fact dis-
covered, we have at once a cause adequate to the production of
all the phenomena, primary or secondary a cause immediately
proximate to the effect, the removal of which is the object of our
first indication ; a cause at once calculated to produce, under or-
dinary circumstances, just such effects as we observe, and a

183G.] Remarks on Hypertrophy. 467

cause, the removal of which will be speedily followed by the a-
batement of all the local phenomena.

The replacement and retention of the uterus in its proper site
become therefore the legitimate prescription ; nor is there within
the whole range of remedial means, one more uniform in accom-
plishing the intended object. So soon as the prescription is ful-
filled, if the case be not very chronic in its nature, the arteries
which arc abundant, are enabled to effect a free transmission of
the blood ; and the veins and absorbents commence the work of
resolution. This is all accomplished with surprising rapidity, on
the good retention of the uterus and a well regulated regimen.

Frequently in the course of a week or two, have I observed
these enlargements of the uterus, which had been of many months'
duration and of considerable size entirely disappear. But most
commonly the process is tedious, requiring many^ weeks, and
sometimes many months for its entire removal ; and occasional-
ly the assistant means of alterative medicines, as iodine, mercu-
rials, antimonials, guaiacum, &c.

The bilboquet pessary, made of soft elastic material, we have
proven by the experience of the last twenty years, to be the best
retentive mean for the uterus ; not operating, as Lisfranc be-
lieves, by promoting absorption on the principle of compression ;
but simply by retaining the uterus so as to liberate the vessels,
and allow them their free action. It is true, that from the great
enlargement of the uterus, and the extension of the disease to the
circumambient attachments, the uterus is sometimes so immova-
ble, as to require very considerable pressure by a pessary made
more firm and impacted between the perineum and the os tincae ;
but even this cannot act mainly by promoting absorption on the
principle of pressure ; as its pressure is only exerted on one
point.

Thus have we imperfectly accomplished the hasty sketch of
the nature of hypertrophy and of metritis, which we designed ; and
we hope that the practical bearing of the errors in nomenclature
and reasoning, may at least be so apparent, that humanity may
not suffer from such errors.

In conclusion, it is but justice to remark, that so far as the ob-
servations we have made bear on the instructions of M. Lisfranc,
the writer has been actuated by no motive or feeling apart from
those directed to the cause of truth and humanity. It may be

468 Remarks on Hypertrophy. [Jan.

objected that the arraignment of unpublished doctrines and in-
structions of an individual for the purpose of exposing and cor-
recting the errors of the same, is unjust and illiberal.

So far as we are informed, M. Lisfranc has never published
the instructions above alluded to, in a book ; but they are doubt-
less published annually in a more impressive and effectual man-
ner that is, to an immense class in his course of extemporane-
ous clinical lectures, and with an influence of character calcula-
ted to inspire the fullest confidence in the truth and accuracy of
every .word which falls from his lips. These instructions are
taken down by most of the industrious, faithful and zealous hear-
ers, and thus are disseminated those instructions, in a way best
calculated to give them their full influence, whether good or bad,
on the practical details of the profession. We hold him there-
fore, at least, not less accountable for error thus inculcated, as it
is alike calculated to retard science, and operate injuriously to
humanity. Nothing is more calculated to regulate and improve
genius than scrupulous watching and diligent chastisement; for, as
with the percussion of flint and steel, its brightest scintillations
are excited by attrition.

1837.] Treatise on the Radical Cure of Hernia, tyc. 4G9

Part II. REVIEWS AND EXTRACTS.

Treatise on the Radical Cure of Hernia by Instruments, fyc. $c.
By Heber Chase, M. D., Honorary Member of the Philadel-
phia Medical Society, &c. pp. 195. Philadelphia, 1836.

The American public has been much agitated on the subject
of Trusses, recently invented for the radical cure of Hernia or
rupture. Two or three years ago, a Mr. Stagner of Kentucky,
it is said, accidentally relieved himself permanently of a rupture,
by placing a piece of wood between the spring of a truss and the
skin covering the protruded bowel. He subsequently modeled
a block for which he obtained a patent, established agencies in
several States, and realized from his invention an immense for-
tune. We at a distance from these operations, anxiously looked
for a professional notice of this truss, in some of the periodicals
of the day ; but it was in vain. During the winter of 1834-5,
several of Stagner' s instruments were placed in our hands by an
agent, and after their application in six or eight cases without
benefiting them in the least, they were laid aside, with the con-
viction that further improvement was needed to effect what was
promised by them, viz. : a radical cure. One of our patients,
the Rev. Mr. Reid, then of this city, added a new spring to
Stagner's block, for which he obtained a patent, and submitted
it to the Medical Societies of Georgia and South Carolina.
The following are extracts from the report made by the commit-
tee appointed in this city.

" The committee have had placed in their hands the certificate of two of
Mr. Reid's patients, and the statements concerning the application of the
Truss to five others, making in all seven cases. From some of the patients
residing out of the city, we have been able to examine and collect the partic-
ulars of but 5 cases out of 7, to whom the truss has been applied. Mr. M;
who was ruptured on both sides, believes himself permanently cured on one.
He has left off the truss for more than 24 hours, and notwithstanding consid-
erable efforts were designedly made, no protrusion took place."

" Mr. Martin, now in his 95th year, and well known as the oldest inhabi-
tant of Augusta, has been afflicted with hernia for more than 40 years and,
after having tried every truss that he had ever heard of, expresses his entire
satisfaction of the relief afforded, and thinks he yet may be cured by wearing
the one applied by Mr. Reid."

* Mr. S. after wearing the new truss about six weeks, writes ' I am now
satisfied of the benefit it will afford the afflicted. It has given me relief, and
I am now quite easy while wearing it \ and would recommend it to any per-
son afflicted with hernia."

" The negro man Isaac, belonging to Mrs. Rowell, has already been pre-
sented to the Society, and all have had an opportunity of examining him per-
sonally, and of judging of the operations of the truss in his case."

" The fifth case, which we have investigated, is that of the Inventor and
Patentee himself, who has been afflicted with inguinal hernia on both sides,

470 Treatise on the Radical Cure of Hernia, fyc. [Jan.

on one for more than 35 years, and on the other for several and, after ex-
periencing the defects of the trusses, which had been recommended to him,
is now relieved, by the one which lie has invented or improved."

"Of the five patients that we have examined, one believes himself entirely
cured on one side ; and all are satisfied of the truss' maintaining its proper
situation independently of any other apparatus and of the entire relief it af-
fords.

" The greatest improvement, however, which occurs to the committee, is,
that this truss operates in maintaining its position without the aid of belt,
strap, buckle or any other appendage whatever, the chafing and disagreeable
effects of which, cause patients so generally to complain."

" We believe Mr. Reid entitled to full credit for all he claims in his patent ;
that the Independent Spring Truss is an improvement ; that it operates and
retains its situation, when applied, independently of any other apparatus ; that
it does prevent the protrusion of the abdominal contents ; that it thus affords
relief, and that if any other truss will produce a permanent cure, this one
will."

Mr. Reid's truss was also approved by the Medical Society of
Charleston.

In a recent conversation with Mr. R., he admitted that during
a visit to the north, he had experienced some difficulty in having
his instrument properly made, but that he had finally succeeded
in Baltimore his agent here, however, is still unsupplied with
them.

The name of Dr. Hood has also been associated with that of
Mr. Stagner, as an inventor of improvements to the truss for the
radical cure of hernia. And finally we have that of Dr. Chase,
who seems to have devoted himself almost exclusively to the sub-
ject of hernia, and the product of his labour and inventions is
contained in the work, the title of which is placed at the head of
this article.

Dr. Chase's publication has forcibly impressed us with one
idea that he is honest in the improvements now presented to
the public. Unlike hundreds around him, he has come forward
and candidly submitted his inventions to his professional breth-
ren, the proper, if not the only tribunal capable of pronouncing
a correct decision upon them. The same credit we have given
to the Rev. Mr. Reid. En passant, what would be the effect of
placing Chase's block upon Reid's spring ? Might not the " In-
dependent Spring" and the "Surgeons Truss" be combined with
advantage ?

The Treatise on the Radical Cure of Hernia by Instruments,
is dedicated to Drs. R. Coates, Ashmead and Parish, members of
the committee of the Philadelphia Medical Society, appointed to
investigate the subject of the radical cure of hernia. It is design-
ed for those affected with hernia or rupture, and the language is
adapted to the comprehension of every one it is a popular and
at the same time a scientific work. It is embraced in eleven
chapters, and illustrated with numerous figures.

Chapter I. contains a minute and popular description of the

1837.] Treatise on the Radical Cure of Hernia, fyc. 471

various ruptures occurring in the human body. We have read
this chapter with much pleasure. The description of inguinal,
scrotal, femoral and umbilical hcrniae, is decidedly the best we
have ever seen. His observations concerning the careless man-
ner in which trusses are daily applied and constantly worn, are
confirmed by every practitioner. It is true, " a large majority
of those who die of hernia, or are subjected to severe surgical
operations for its relief, are persons in the constant habit of wear-
ing the trusses heretofore employed." His remarks too about
patients wearing the truss day and night, will be responded to by
every one knowing the importance and even the absolute neces-
sity of keeping the intestine within the abdomen, when a radical
cure is proposed.

Chapter II. is taken up with the symptoms of hernia not stran-
gulated.

Chapter III. contains the directions for reducing hernia. We
would suggest in addition to the means mentioned in this chapter
by the author, the good effects resulting from the evaporation of
ether. As an application for reducing strangulated hernia, it
cannot or is not so liable to be abused, in the hands of common
people as cold directly applied. It never produces mortifica-
tion.

Chapter IV. is on the retention of hernia by trusses. Inclu-
ded in which we have the different kind of trusses heretofore in-
vented, and the different parts composing the truss page 52,
line 12, the word "ruler" should be rule. The most important
section of this chapter is the one on the materials for pads or
blocks. We agree with Dr. Chase in condemning the india-
rubber or gum-elastic, as a substance entirely inapplicable for
this purpose. We have seen a case where it produced not only
a blister but an ulcer. Our author, of course, selects a block of
wood.

Chapter V. is the history of the progress and present state of
the improvement in the construction of wooden truss-blocks.
In this, we have mentioned, the names of Stagner and Hood, and
also an account of our author's association with the latter. It
concludes with a description of the wooden blocks invented by
Dr. Chase for the radical cure of inguinal, femoral and umbilical
hernia?.

Chapter VI. on complete trusses containing the explanations
and figures of the application of Dr. Chase's truss for the differ-
ent kinds of rupture.

Chapter VII. contains the modus operandi of the instruments
for the radical cure of hernia. This is the most interesting and
important chapter in the work before us. In what manner does
the instrument operate in effecting a radical cure of hernia ? Mr.
Stagner and Dr. Hood attributed it to adhesive inflammation, ex-
cited by the pressure of their instruments upon the neck of the

472 Treatise on the Radical Cure of Hernia, c. [Jan.

sac. Dr. Chase thinks, that though the pressure of his truss pro-
duces redness of the skin in the great majority of cases, it would
be premature in him to attempt to decide, at present, how much
the production of local irritation accelerates the radical cure, in
the treatment of hernia by wooden blocks. The committee ap-
pointed by the Philadelphia Medical Society, expressly state
that the excitement of local irritation was a matter of " secondary
importance" And Dr. Chase addressed a letter to Dr. Reynelf
Coates, the chairman of said committee, on this subject. Dr. C.
in his reply, has reviewed the different modes which have been
proposed for the radical cure of hernia. His conclusion is, " that
in most cases of the radical cure of hernia by means of trusses,
the neck of the hernial sac is obliterated either by adhesion or
more rarely by absorption. In reading the lengthy answer of
Dr. Coates, we were not a little surprised to find no notice of the
method recently proposed by Gerdy of Paris, for the radical cure
of this affliction. We allude to the operation of pushing the
skin into the place occupied by the herniary tumour, and per-
manently securing it by exciting adhesion. Several successful
cases from this new operation have been reported in the journals
of Paris, and we think they have been noticed in Johnson's Re-
view.

Chapter VIII. on the manner of applying the different instru-
ments, and some precautions necessary to be observed in using
them. The remarks contained in this chapter are judicious and
excellent. We learn from it that Dr. Chase has applied his truss
with good effect, on a child only six weeks old, and frequently to
those of the age of six months.

Chapter IX. is taken up with cases and the results obtained by
the use of the improved instruments. The cases contained in
this report are not selected, but are those only which have been
most regularly noted. They number 32, and to judge from the
entire and complete success obtained in many of these cases, all
must now admit of the radical cure of hernia, and that Dr. Chase's
truss is decidedly the best yet invented to effect that object.
This chapter concludes with a tabular statement of 100 cases of
hernia.

Chapter X. is occupied with the diseases mistaken for hernia.
This is not an uninteresting chapter. Not only patients, but
too often for the good of the profession, men professing to be
doctors, if not surgeons, are deceived on this subject, and many
an one has worn a truss who never had a rupture.

Chapter XI. the last, is on the subject of hereditary hernia ;
and from the author's experience he believes this to be a cause
predisposing to this affection.

In concluding this lengthy review of Dr. Chase's Treatise on
the radicul cure of hernia by instruments, it is unnecessary to add
more to what has been already said, to recommend it to every

1837. J Remarks on Chronic Fluxes of the Bowels, fyc. 473

one afflicted with rupture, and to the profession generally. We
are pleased that our author has placed this subject in its proper
light before the public, and doubt not but that he will be amply-
rewarded for all his labour and expense. We hope moreover,
he will continue his investigations, and that his success will en-
courage others to similar undertakings. Not indeed in writing
popular treatises on medical subjects, but that talented and enter-
prising men may direct their undivided attention to one object in
medicine, so that after due and thorough investigation, it might be
properly estimated by the profession. P. F. E.

Augusta, December, 183G.

Remarks on the Chronic Fluxes of the Boiuels: By N. Chapman, M. D.

Not a little diversified are the symptoms of this pathological condition,
though in nearly all instances the bowels are very irritable, and consequent-
ly excited by the slightest causes. The stools may be small and of mucus,
sometimes tinged with blood, or containing fragments of lymph, or are glairy
or gleety or exceedingly copious, and of a light clay colour or dark and
granulated like coffee grounds, or resembling greasy water, and of a cadaver-
ous odour or are seemingly of putrid chyme, or pulpy, mixed with ingesta,
very frothy, and of divers hues, though usually of an ashy or slaty aspect, and
are attended by more or less tormina and tenesmus or straining, or come a-
wav at once in a gush, or by a sudden ejection or squirting without any un-
easiness.

The mode of evacuation depends much on the character of the stools slow
and difficult when they are small and tenacious, and the reverse if large and
watery. Little appetite exists, or it is very capricious, and the food taken is
seldom thoroughly digested. The tongue is heavily furred in the centre and
at the root, with florid tip and edges, or red and raw throughout, as if scalded;
or with scattered superficial ulcers on it, and the inside of the cheeks and
lips, or down into the fauces or it is pallid, attenuated and flaccid. The
skin is dry, furrowed, and of a dingy white or sallow, or leaden hue the

eyes sunken, with a shrivelled and meagre expression of countenance.

Tenderness of the abdomen is felt on pressure, though not uniformly, and it
is tumid or the contrary, lank, relaxed, or even collapsed. Borborigmus is
very troublesome. The pulse is often contracted, hard and accelerated,
with an irregular febrile movement, especially in the evening but it may be
natural, or very diminutive and feeble, with low temperature of the surface,
or while the extremities are cold, the belly is preternaturally hot. Emacia-
tion advances rapidly, with corresponding debility, till finally the individual
sinks from absolute exhaustion, death being preceded by oedema of the low-
er limbs, apthae of the throat and mouth, redness and ulceration around, or
within the verge of the anus, and the Facies Hippocratica strongly marked.
The duration of an attack is very various, from a few weeks to months or
years, subject, when long continued, to alternate remissions and exacerba-
tions.

Chronic fluxes may be an original affection, or the consequence of an acute
attack, protracted by neglect or ill management and when of the former
or primary nature, are assignable to many of the causes of the latter, opera-
ting less actively.

60

(

474 Remarks on Chronic Fluxes of the Bowels. [Jam

They are undoubtedly induced by malaria, whether the vitiation of the at-
mosphere be owing to the effluvia of vegetable or animal decomposition, or
other offensive impregnations scarcely less so by the excesses or variations
of temperature, particularly moist, austere weather, and by the occupancy
of cellars and other damp confined places.

As much, perhaps, may be ascribed to the direct irritation of the prima?
vise from aliments or drml^3, such as tainted or tough indigestible meats, sour
or mouldy bread, or crude or decayed vegetables or fruits, the intemperate
use of ardent liquors or bad water, putrid, or charged with adventitious mat-
ters.

They result, too, from the long persistence in purging w7ith drastic arti-
cles, as is practised by some for the removal of diseases, and above all drop-
sy, of which I have seen repeated instances, and by whatever indeed is cal-
culated thus to worry the bowels into a state of exasperation, or to destroy
their tone, or otherwise throw them into derangement. It is in this way, I'
have little doubt,- that the horrible abuse of mercury throughout a consider-
able extent of our country concurs in the production of similar mischief.
Nothing is more irritating to the alimentary tube, the liver,, and to the wmole
of the abdominal viscera, than this very article, unless cautiously regulated
and when we advert to the indiscriminate and exorbitant employment of it
by confessedly too many of the practitioners in the region to which I have
alluded, the conjecture advanced, seems scarcely to require any confirma-
tion.

Nor must the exanthemata be omitted in the enumeration of causes.
These have their origin in the mucous membrane of the alimentary canal
and the translation to the skin not perfectly taking place, leaves behind an
irritation productive of this effect, as is strikingly exemplified in scarlatina,
measles, &c. Chronic eruptions of different kinds receding from the cuta-
neous surface, occasionally operate also in the same mode, two instances of
which I have seen.

Certain sections of our country ere singularly liable to the disease, and it
prevails to a great extent, especially at or near Richmond and N. Orleans-
Cases of it I have annually from each of these cities, and am assured that it
Is one of the most terrible of their maladies : no age, sex, or condition of life
is entirely exempt from it, though it rarely occurs before puberty. What
occasions it, is not ascertained : nothing peculiar about Richmond exists to
which its production can be referred, but at New Orleans the popular notion
connects it with the use of the turbid waters of the Mississippi. Never ha-
ving seen a case in the early stage, I am not able to describe it from any
knowledge of my own, but I learn that it usually commences with the symp-
toms of dyspepsia. As it has come before me, the disease was far advanced,
and only distinguishable from more common diarrhcea, by less emaciation,
the flesh and integuments being rather flaccid than wasted, and by a peculiar
sallowness of skin, more of the light lemon than the orange hue, and by the
number and copiousness of the discharges, which invariably resemble pale
clay or Fuller's earth dissolved in a quantity of water.*

Chronic fluxes are moreover of a secondary nature, from the extension of
irritation to the bowels of other diseased organs,, as the stomach, liver, spleen,
pancreas, kidneys,, uterus, the lungs and I have seen it occasioned byhae-
morrhoidal tumours or ulcerations at the termination of the rectum.

1 Diarrhoea of a somewhat different kind appears to be hardly less frequent
among our Eastern population, especially that of Boston, the source of
which is as little intelligible. But the individuals whom I have attended
with it, in their passage through this city to the South, all concurred in sta-
ting that the attacks were ushered in as dyspepsia, followed after a long in-
terval, by the bowel affection, then cough and other pectoral symptoms, ma-
rasmus, hectic fever, &c.

1837.] Remarks on Chronic Fluxes of the Bowels. 475

No perplexity can prevail in the recognition of diarrhoea. It were highly
important, however, in a therapeutic and practical view, could we discrimi-
nate the several states of the bowels on which the discharge depends but I
am apprehensive we cannot do this with any uniformity or precision. Nei-
ther the symptoms nor the appearance of the stools may be relied on under
all circumstances. Generally, however, inflammation is denoted by pain in
the abdomen, hot skin, corded, frequent pulse, and by slimy, membraniform,
or bloody dejections. But on the contrary, how often is there pain without
phlogosis, and ulcerations and other lesions are to be met with, where no ex-
pression had been given by this or any more distinctive sign of their exis-
tence ]

Genuine mucous or serous discharges, though ordinarily indicative of sim-
ple irritation or phlogosis, are occasionally found in every variety of case
and even the most copious effusions of blood, the common product of phlogo-
sis, maybe owing to merely a turgescence, or perhaps relaxation of vessels.

Gleety stools usually denote a subdued state of previous inflammation
though not always, they sometimes proceeding from an ulcerative condition.
Chymous dejections are more uniformly significant of an imperfection in the
digestive powers of the colon, or in other words, the process of foecation.

Evacuations thin, greasy, and of a cadaverous odour, mixed with sanious,
purulent, or fibrinous matter, are to be deemed, in my opinion, the least un-
erring criterion of organic mischief. But this test is also fallible, having seen
-extensive lesions of the same kind, with stools of the earth-like solution I
Jiave just mentioned.

In a disease so various in its character, and occasioned by such diversity
of causes or conditions, the grounds of prognostication must necessarily be
vague and uncertain. Not much more can be determined, than that in pro-
portion to the duration and severity of the attack, the degree of constitu-
tional disturbance, emaciation, and debility, is the prospect of a cure or oth-
erwise. What is to be deduced from the aspect of the stools, I have previ-
ously stated. Cases with mucous or gleety discharges are usually the most
curable, and those earthy or watery, and of cadaverous smell, the least so.

From autopsic inspections, evidence is afforded of inflammation in its sev-
eral gradations, in the mucous coat especially, confined to a part, or embra-
cing a considerable extent, and sometimes every variety of organic injury,
from the simplest to an entire change of structure, the most common of
which, however, is ulceration. This consists of a single ulcer, or a few on-
ly, though often innumerable. Cases have repeatedly been examined by
me, where it was as impossible to count them as the stars in the firmament.
.Large portions of the bowels are, indeed, sometimes found cellulated like a
honey-comb. The ulcers are of various sizes, from that of the head of a pin
to an inch or more, and have a close similitude to the venereal chancre.
Connected with these or independent of them, mere vegetation, or fungous
excrescences are occasionally to be met with. I once opened a subject who
died of the disease, where a fungoid growth in the colon was discovered, nine
inches in length, two in breadth, and half an inch in thickness. But in oth-
er instances, the mucous surface seems to be scalded, as it were, here and
there a vesicle or superficial sore, or more decidedly apthous, in the whole,
analogous to the state of the tongue, mouth, and fauces, which I have no-
ticed.

An extreme attenuation of the intestinal parictes is a further occurrence.
Bonnet tells us that he has seen the bowels as thin as a cob- web ; and, in
one instance, I found the ileum and part of the colon so wasted away, that
with a delicate arachnoid peritoneal covering, a few fibres of the muscular
tissue were only left, pallid and widely separated. This atrophy oftener
happens than is suspected. Moreover, though sometimes the mucous coat
may appear sound, tubercles are concealed in the cellular texture under it,
by which it is irritated to undue secretions, precisely as such extraneous bo-

476 Remarks on Chronic Fluxes of the Boiuels. [Jan.

dies in the same tissue of the lungs provoke their mucous surface to inordinate
discharges. But though some of these lesions are usually to be detected, it
can scarcely be doubted that the intestinal fluxes may prevail independently
of them or any others appreciable.

JVJorgagni has transmitted the history of several cases without the slight-
est phlogosis, the individuals sinking, as it were, in a very short time, from
the exhaustion of excessive serous effusions, in one of which, forty pounds of
limpid fluid were evacuated in a day. The same kind of testimony is borne
by Louis, who states that he had several times found the mucous coat only
changed by becoming preternaturally pale, flabby, and relaxed. Confirma-
tory of all this, it is reported by Andral, that he has frequently noticed the
mucous membrane of the intestines, especially in children, perfectly white,
with its natural thickness and consistence, both in acute and chronic diar-
rhoea. But it is highly probable, in most ol the instances where the bowels
have been represented as exempt from organic derangement, that the irrita-
tion productive of the discharge was sympathetic only derived from contig-
uous or remoter parts, one or more of the abdominal viscera or the lungs,
these organs, or some of them, being often found deeply affected.

Of the diarrhcca which I have represented as incident to sections of our
southern country, the prominent appearances are, so far as 1 know, softenings
of the mucous texture, an infinity of ulcers, and, perhaps, diminution in the
size of the liver. Three subjects only have I had opportunities of inspecting,
and such were the lesions chiefly observable. The liver in two of them was
exceedingly reduced, and of a dingy white in another, the stomach exhibited
a partial ramollescence, and, in the third, with extensive ulceration, principal-
ly of the ileum, the mesenteric glands were enlarged and indurated.

The pathology of the disease might, perhaps, be sufficiently collected from
what has now been detailed, and my further reflections on it will, therefore,
be very brief.

Touching the immediate seat of the affection causing these fluxes, there is
some division of opinion. By some, it is insisted that constipation is uniform-
ly dependent on phlogosis of the small intestines, purging only occurring
when the colon becomes implicated. True in the main, this is erroneous as
a universal proposition. Even irritation of the stomach, much less of the up-
per portion of the intestinal tube, simply from ingesta, is productive of it, as
is particularly exemplified in Licntery. Louis maintains that the seat is most
frequently in the ccecum, next in the colon, and least in the rectum. It
would seem, according to our own dissections in this city, to be in and about
the ileo-ccecal valve, in the largest proportion of instances.

The discharge in all the profluvioe was once considered as constituting the
disease itself, occasioned either by a depuration of certain peccant humours
through the solids, or a colliquation of the latter into a fluid. But such hypo-
thetical crudities are no longer entertained, and to them has succeeded the
doctrine, that all these discharges are owing to a vitiation of the secretory
process, immediately dependent on some change of condition in the organ, and
which change may be functional or structural, and of divers gradations and
kinds. Granting the general correctness of this doctrine, it still remains to
inquire more precisely into the conditions affirmed.

That a vast increase of a discharge may take place from the mucous mem-
brane, independently of any apparent lesion, is shown by the post-mortem
evidence I have cited, and as certainly, from the cutaneous cellular and se-
rous tissues. As the skin sweats, so may these eliminate their respective
fluids in excess. But, here there is usually some excitement and tume-
scence of vessels. The discharge happening from metastasis, the same con-
dition probably exists. Thus, when the skin, under the influence of cold,
ceases to perspire, and the bowels assume vicariously the office, there is in
them an exaltation of action, corresponding to the loss sustained by the der-
moid membrane. Exactly what the one loses, the other gains, to be added

1837.] Remarks on Chronic Fluxes of the Bowels. 477

to its natural portion of excitement. This may be deemed irritation only
and of the connexion of these fluxes with phlogosis and organic lesions, no one
doubts. Do they, however, occur in the absence of these several states'?
The theory of haemorrhage and dropsy will equally embrace the present case.
Like the sanguineous or serous discharges, that from the mucous coat, may
be referred either to an active or passive state. But, perhaps, a still more
pertinent illustration may be had in the analogy of colliquative perspiration.
A haemorrhage or hydropic effusion, or such cutaneous transpiration, is met
with in the lowest prostration of vital energy, and so is diarrhoea, each caused
by relaxation of the exhalents, and all requiring for their cure astringents,
tonics, or other means of invigoration.*

Establishing this distinction as a leading principle, its exceptions and limi-
tations will hereafter appear in the treatment of the disease. But previously
to entering on this, I wish to remark, as a conclusion, from all I have said, that
the discharge itself is merely an effect of an abnormal condition of the bowels,
the ascertainment and rectification of which, constitute the real objects of
cure. To determine, however, the exact pathology of the case, we have seen
is very difficult, and, so long as it remains in such obscurity, the practice
must be somewhat tentative and empirical. Nevertheless, in the want of
more perfect information, we may be guided, in part, by the character of the
stools, and still more, by the general state of the system.

The pulse being tense or corded, with pain and tenderness of the abdo-
men, aggravated by pressure, florid tongue, and not extreme weakness, we
can scarcely err by a resort to venesection, the propriety of which, indeed, is
attested by ample experience. To Sydenham, in his account of the diarrhoea
of measles, we are indebted for this great practical improvement, and which is
not the least of his valuable contributions. Claimed recently as a discovery,
it may have been overlooked or disregarded by others, though not by the
practitioners of this city. From the time of my connexion with the profes-
sion, such, at least, has been the plan of treatment of every description of in-
flammatory bowel affection, chronic or acute. Nor, will a single bleeding,
however copious it may be, always, or even generally suffice. Chronic in-
flammation, though not so immediately dangerous, has a much stronger hold
of a part than recent, and accordingly proves more difficult to dislodge or sub-
due. Not discouraged, then, if no very striking advantage accrues from the
first bleeding, in such cases, let it be repeated every two or three days, while
the pulse and strength warrant the continuance, and we cannot fail ultimately
to be well satisfied with the consequences. Certainly, in some instances, I
have bled from ten to fifteen times, taking away four, six, or eight ounces of
blood, each operation, and found it essential to the cure. Topical bleeding is
a very important auxiliary to venesection, sometimes superseding altogether
the necessity of it, where the means of accomplishment, which is seldom the
case in country practice, can be conveniently obtained.

The inflammatory state having been overcome, gentle emetics of ipeca-
cuanha, exhibited occasionally, may be useful. They are not prescribed here
as evacuants, though not always without advantage in this respect, as to ren-
ovate, by instituting a series of new actions, the condition of the whole ali-
mentary canal. Nor in their immediate operation, by arresting the peristal-
tic motion, are they without good effect, and perhaps not less so by inducing
a determination to the dermoid surface. In the management of this disease,
it is of the last importance to restore to the skin its healthy functions, for, till
this is accomplished, no decided and permanent impression will be made.
Great benefit accrues Irom the frequent use of the warm-bath with this view.
To command, however, its full effect, where the skin is dry and the capiUary

*The work of Andral on Pathological Anatomy, has a chapter on this sub-
ject, abounding in facts and the most interesting views, which may be con-
sulted with the greatest advantage.

478 Remarks on Chronic Fluxes of the Boicsh. [Jan.

circulation torpid, some stimulating1 article should be added to the water, as
salt, and, on the patient entering his bed, he is to be rubbed with a flesh-
brush, till a universal glow is diffused over his body. The bath being not
readily commanded, a stimulating pediluvium or friction with fine warm salt,
may be employed as a succedaneum and further to promote the effect, a
small dose of Dover' s powder will prove serviceable. During the day, a pill
may be given, every two or three hours, composed of a small portion of tor-
refied rhubarb, ipecacuanha and opium. The ipecacuanha, on every ac-
count, is singularly valuable in this disease, though there are some who pre-
fer the antimonials, and especially the cerated glass of antimony, with opi-
um a preference, I suspect, without any just foundation.

These medicines having been tried unavailingly, we may next resort to
alum, which is much prescribed in the form of whey. My mode of directing
it, however, is in the dose of two, three, or four grains, to a quarter of a grain
of opium, several times in the twenty-four hours. In some instances, a small
portion of ipecacuanha may be added, and especially if the skin continues
dry, and the bowels harassed by griping or other uneasiness. By Mosely, a
combination of alum and white vitriol, called by him the vitriolic solution,
has been greatly extolled in chronic dysentery and diarrhoea. Of this, 1 can-
not say a great deal, from my own experience, having been discouraged
from any extensive use of it, by its very disagreeable taste and nauseating
effects. Entitled to greater regard, is a union of alum and the sulphate of
iron in equal portions, say a grain or two of each, occasionally repeated, with
or without opium, as the indication maybe.

The acetate of lead, with opium and ipecacuanha, has strong claims to
attention, and the camphorated mixture, with nitrous acid and laudanum, is
of late strongly commended, though, [ think, undeservedly.* In some in-
stances, particularly where the liver is concerned, the nitro-muriatic acid
internally or as a pediluvium, or by frictions, has certainly proved of service.
It ought, however, to be cautiously used, and its effects carefully watched.
Even when endermically applied, I have known it, in several instances, to
bring on the most distressing dysenteric affections.

Contrary to common opinion, by which they are forbidden, I have seen the
vegetable acids eminently beneficial. Diluted vinegar I allude to especially,
though lemon juice sometimes also answers.

Much the most, on the whole, however, may be expected from the use of
mercury. This is an indispensable remedy, when the case is associated
with hepatic derangement, and even if such do not exist, it proves servicea-
ble. Calomel or the blue pill is given in minute doses with opium, and some-
times ipecacuanha and prepared chalk, to attain the alterative, and not the
salivant effect.

By the unanimous voice of practitioners, blisters are declared to be of the
greatest utility at this conjuncture, which are applied to the abdomen or the
extremities, and may be alternately put on the ankles and wrists. The prin-
ciple on which they act, in the latter instance, is that of revulsion.

Chronic fluxes, with such discharges as to constitute merely a gleet of
the bowels, are most successfully managed by the balsamic and terebinthi-
nate preparations. The copaivae I have often used advantageously ; also
the spirit of turpentine, and sometimes, even more so, common rosin, in the
dose of four or live grains several times a day. Cubebs, repeated in the same
dose and manner, I have known to be serviceable.

The bowels being ulcerated, which may be suspected from the appear-
ance of the discharge, the balsams and terebinthinates are thought also pe-
culiarly adapted. Not a little has also been recently said of the nitrate of

* This is called Hope's mixture, from the author of it, and is prepared as
follows the dose of which is a table-spoonful, several times a day : R .
Mist, camph. 5 viij., acid, nitrous. 3j., tinct. T. tieb. git. xl.

18#7.] Remarks on Chronic Fluxes of the Bowels. 479

silver, as well as the sulphate of copper. But, whatever may be their utili-
ty, the principle on which they are applied, is surely erroneous. It having
been found that ulcers of the external mucous surfaces when touched by ei-
ther of these articles, are disposed to heal, it is presumed that given internal-
ly, they might have a similar effect, by coming in contact with the intestinal
ulceration. This is sheer nonsense, and it is really inconceivable how the
notion came to be entertained, that the fourth of a grain, which is the ordina-
ry dose of these articles, covered up as they are in some other matter, in a
pill, the only mode of exhibition, could thus operate, and especially on so
wide a spread surface as usually exists in the case.

Not much is to be expected from any treatment in this ulcerated state.
Except in two instances, never have I seen a cicatrix in the bowels, exten-
sively as post mortem examinations are conducted in this city. But facts of
the kind are leported by Latham, of London; and among the French, by
Petit, Billard, Andral, and Troillet, the latter of whom has presented an ex-
ample of ulceration, where there were marks of incipient, advanced, and com-
plete cicatrization.

Next I am to make a few remarks on that species or variety of the disease
supposed to depend on debility or relaxation of the intestinal exhalents. It
may be the final stage of the inflammatory flux which I have already de-
scribed, and it is to be met with, as a primary state of the bowels, among
very emaciated and infirm people, either from age or other causes, or as"
symptomatic of consumption, &c. These cases, however, are exceedingly
deceptive. Much general weakness may exist with a high degree of local
irritation or phlogosis, or even ulceration. To determine this point, previ-
ously to entering on the treatment of the case, is of great consequence.
Being satisfied, however, that no such conditions exist, the indication be-
comes simple, pointing directly to the restoration of the tone of the prima?
viae, and to this end, the whole catalogue of tonics and astringents is some-
times exhausted. The use of them, however, is hazardous, and for the most
part inefficient, so that they are comparatively seldom employed by me, and
uniformly with the circumspection which a distrust of their propriety cre-
ates, though undoubtedly, a state of the bowels may prevail, to be cured by
this description of means. Experience teaches this, and we have the fur-
ther evidence of their efficacy in similar atonic affections of the mucous sur-
faces of other parts, as of the urethra, vagina and lungs, gleet, leuchorrea,
and some varieties of bronchitis. Nevertheless I repeat, that the course
must be experimental in a considerable degree. There is one source of il-
lusion, which ought not to be overlooked. It happens that the evacuations
may be suddenly checked, and relief presumed to be effected. The remedy
here excites the muscular coat of the bowels into spasmodic contractions,
preventive for a time of the escape of the fluid, soon followed by tumidity of
the abdomen, a distressing sense of distension, often some colicky pain, and
ultimately the discharge bursts forth with increased violence. An occur-
rence of this sort, ought to be received as an admonition of the impropriety
of the practice, and of course to its discontinuance. But the effect being
otherwise or really beneficial, then any or the whole of the astringents,
mentioned under a preceding head, may be recurred to, and these not suc-
ceeding an appeal must be made to some of greater power.

An infusion of galls alone, or in various combinations, particularly with
prepared chalk and laudanum, is much prescribed in this atonic state of the
bowels. The Syrup of galls made in the following mode, is also occasion-
ally directed. Two drachms of the powder of galls, are to be infused in a
gill of brandy sweetened, and then set fire to the liquor, and let it burn out, of
which a teaspoonful is the dose. Nearly of equal power is the kino. It may
be given in powder, or watery solution, or in tincture though it is most effi-
cient in tincture, with prepared chalk and laudanum. The dose is a table-
spoonful occasionally. Nearly of similar properties is the catechu, which
may be exhibited in a similar manner.

480 Remarks on Chronic Fluxes of the Bowels. [J an,

As a mere astringent much has been said of logwood. It is given in de-
coction or infusion. The tincture of rhatany, however, has a still higher
reputation, An infusion of the bark or flowers of the pomegranate is wor-
thy of trial. Equally so is the cinnamon, and particularly the clove tea.
I have also, sometimes witnessed very good effects from the compound tinc-
ture of rhubarb with laudanum in small and repeated doses.

By our own country we are supplied with several active astringents.
The only one, however, I have employed, and which 1 think is equal to any
of the vegetable astringents, is the dewberry root, Rubus irivialis, in decoc-
tion. Combined with astringency it has an aromatic flavour, which recon-
ciles the stomach to it, and hence is rarely rejected. The bowels, however,
are commonly very much ulcerated, and under such circumstances little is
to be hoped. As a palliative, an opiate injection occasionally renewed, is
here more effectual than any other remedy.*

Regarding the diarrhasa in those districts of our own country, formerly
mentioned, I have to make only a single suggestion. The preceding reme-
dies, so far as I have remarked, are equally adapted to it, the one or the
other to be selected according to the existing condition. But since it seems
to originate in local influences, the propriety of an immediate removal beyond
their noxious sphere is obvious.

This is the medical management of primary fluxes, having hitherto only
referred incidentally to the secondary form of the affection. But there is no
difference so far as concerns the bowels, the main object being to detect and
remove the parent disease, whence is derived the intestinal irritation, of
which the discharges are the consequence. The treatment, however, of the
lesions of the organs to which I allude being foreign to the present occasion,
I shall not at present expatiate on the subject. It must suffice to mention
singly, which I am induced to do, as perhaps less apt to attract attention,
that these fluxes are far more frequently than suspected to be found in con-
nexion with some irritation at the extremity of the rectum, operating either
as the original or aggravating cause and that whatever may be its nature,
it is very important to get rid of it without delay.

We come now to the consideration of regimen, on the due regulation of
which every thing depends.

As to diet, it is usual to select those articles supposed from their astrin-
gency to bind the bowels, which I think is a mistaken notion, derived from
the false doctrine that the discharge constituting the disease the great pur-
pose in the cure is to restrain it. The indication, on the contrary, is to soothe
irritation by the blandest nutriment, thus making it harmonize with the oth-
er parts of the treatment. It is customary, as having this property, and by
which they are so well adapted, to commence with the mucilaginous or far-
rinacious matters that of gum arabic, the slippery elm or the benne, and
tapioca, sago, sallop, arrow root, rice, flour, &c. Gruel and thin broths,
though usually proscribed, from an apprehension of their running through
the bowels, I have found, on the same principle of allaying irritation, very
appropriate. We direct them in cholera morbus, and why not in the pre-
sent case ] Milk, on some occasions where the stomach is not sour, an-
swers very well and perhaps no article more uniformly agrees with the pa-
tient than buttermilk. f

* But the application of a blister over the abdomen, so long as merely to
produce rubescence of the skin, will sometimes mitigate the irritation, and
temporarily suspend the discharge.

f Milk may be given alone, or thickened with some of the farinaceous
matters mentioned above, the best of which is wheat flour, thus prepared :
Enclose in several folds of linen half a pound or more of it, drawn tight into
a ball, and then boil it for several hours in a pot of water. On cooling it be-
comes hard, and must be grated into a powder.

1837.] Remarks on Chronic Fluxes of the Bowels. 481

Digestible solids, as mutton, or fowl, or game, or oysters, raw or slightly-
roasted, may subsequently, on the abatement of irritation, be allowed and
lhave seen benefit from an occasional indulgence in a small portion of ham
or salt fish under similar circumstances.

Crackers or stale leaven bread are only proper. Fruit I have sometimes
known to be appropriate, particularly peaches. The dew or blackberry has
a large share of popular confidence in this respect, to which it is not more
entitled than strawberries. These, and I may add oranges, habitually and
almost exclusively used, have cured the disease. Mentioning on a former
occasion some cases to this purport as regards the latter, the physician-gen-
eral of the British forces in Canada, who happened to be present, informed
me that his wife, having suffered from diarrhoea for a long period, during
which she had visited Europe and received there the best medical advice
without avail, was finally cured by living entirely on oranges, to which she
was prompted by an irresistible instinctive desire. Yet generally fruits dis-
agree, or prove as injurious as the common vegetables. The best drink at
first is rice or barley-water, or some similar article, and brandy and water or
port wine in the advanced atonic stages. Neither much food nor drink
should be permitted at a time, it being very apt at once to run through the
bowels, nor the latter be very cold for the same reason.

Many of the cases of diarrhoea, and especially of long standing, may be
considered as materially dependent on dyspepsia, and hence all the dietetic
rules in relation to that affection are to be observed, together with a recur-
rence to the ordinary remedies for its removal.

No one questions the necessity of preserving an equable temperature on
the surface in the intestinal affections, and among the best means of secur-
ing it is a flannel roller, while at the same time by its compression, further
and more decided effects are attained. Equally important is it carefully to
protect the feet these, when cold, hardly ever failing to revive or exasper-
ate the affection.

Exercise has been greatly insisted on as a curative measure : but whe-
ther it operates for good or evil, will depend on its being properly timed.
During the continuance of any activity of phlogosis it must be avoided ab-
solute rest, even in the recumbent posture, having the most beneficial influ-
ence under such circumstances. It is indeed, in many instances, the sine
qua non, or without which every thing else will prove nugatory while in an
opposite or atonic condition, taken in any mode it is eminently serviceable,
though more so on horseback, and particularly if it be extended to a long jour-
ney. More than one of our watering places, the White Sulphur and Warm
Springs of Virginia especially, are deemed very efficacious, and hence may
be worthy of trial.

Even, however, if all these expedients fail, we are not to abandon the pa-
tient. As a last resort, a sea voyage to some temperate climate should be re-
commended. This is a very important measure, and will sometimes succeed
when all others have proved unavailing.

It is matter of great moment to remove these fluxes. Exhausting as
they may be in their immediate effects, they are connected with pathological
conditions, which become aggravated by delay, leading too often to the sad-
dest catastrophe. Looking at some of the results only, "the bowels," says
a late writer rather quaintly, "being unfaithful to the stomach, and, instead of
playing fair, let go their hold of the pabulum vita before the lacteals have pro-
perly performed the process which that grand organ has prepared for them,
nutrition must be deficient, and the consequences of inanition ultimately
take place. Nor," continues he, " does the mischief stop here. Locke tells
us that people with relaxed bowels have seldom strong thoughts or strong
bodies. To a certain extent this may be true, and it is one of the numerous
instances illustrative of the ultimate dependence of our moral on our physi-
cal condition. Am. Journal of Medical Scie?ices November, f

482 Editors1 Remarks on the forgoing article. [Jan.

Editors' Remarks on the foregoing article.

The age and experience of Professor Chapman, have furnished
him with the means of giving, in the foregoing communication,
a most copious and excellent account of the phenomena of Chro-
nic Fluxes of the Bowels. This would have been no easy task
for one less experienced and familiar with their varying charac-
teristics. As we desire that every practitioner should study and
be familiar with those characters, as well as every thing else
valuable in the subsequent details, of which we honestly con-
ceive there is much, we have given the entire treatise. But
whilst we are unable to boast an extent of observation equal to
that of Dr. C, we still feel not only the right, but the duty, as
southern practitioners, of exercising judgment on his opinions of
a disease, almost exclusively of southern origin ; or rather, hav-
ing in its nature much of that pathology which is peculiar to*
southern climates.

Our observation leads us to confirm the views of Dr. C. on
many of the causes of this disease, and agree with him, that al-
most all things which will irritate the primse viae excessively*
and especially if habitually indulged in, may produce chronic
fluxes of great obstinacy. But these when they become chronic
are generally connected with dyspepsia. They arise most com-
monly from the abuse of ordinary articles of diet, good in them-
selves ; or from articles unsuitable for human digestion and nu-
trition.

But we must necessarily pass over much of the discussion
which this essay demands, and come to the few points on which
we designed to comment in this note.

In speaking of the use of protracted purgation with drastic
articles, he remarks, " It is in this way, I have little doubt, that
the horrible abuse of mercury throughout a considerable extent
of our country, concurs in the production of similar mischief
Nothing is more irritating to the alimentary tube, the liver, and
the whole of the abdominal viscera, than this very article, unless
cautiously regulated and when we advert to the indiscriminate
and exorbitant employment of it by confessedly too many of the
practitioners in the region to which I have alluded, the conjec-
ture advanced, seems scarcely to require any confirmation."

The indiscriminate or exorbitant use of any thing, even the
most wholesome article of diet, must doubtless always be wrong.
But the whole aspect of the paragraph is such as to impress the
reader with the idea that a large proportion of the practitioners
of the south, (for this is the region alluded to,) are unacquainted
with the judicious use of mercurials, or that they are so empiri-
cal as to employ them indiscriminately: and it stands before the

1837.] Editors' Remarks on the foregoing article. 483

reader as a beacon against the use of calomel, the most common
form of mercurial medicine pointing it out as not only unsuc-
cessful but as a common cause of diarrhoea.

However extensive may be the inroads made on southern prac-
tice, by the fashionable ultraism of the so styled physiological
doctrine, which, thanks to a kind providence, has passed by as a
meteor, having arisen, attained the zenith of its glory and fallen
in half an age, thus compelling its author to procrastinate the
hope of its farther cultivation and renewed approbation to ano-
ther age; still practitioners who arc habituated to observation
of southern diseases, have most commonly some independence
-of mind which they freely indulge: they 'daily observe that this
medicine is not to be judged for them, by practitioners who are
not habituated to observe its effects on the human system, under
the modifying influences of a southern clime. They well know
that instead of considering that " nothing is more irritating to the
alimentary tube," that scarcely any medicine is better calculated
to arrest diarrhoea, especially with the assistance of such an
anodyne power as will so retard gurgation as to allow it to ope-
rate on the secretions of the prima? viae and of the liver. In
cholera infantum, the first dose is often found competent, with-
out the aid of anodynes, to arrest the morbid discharge,, and in-
deed all discharges for a time, and until a new and salutary evac-
uation is effected by an entire change of secretion. And this
is a case in which a kind of local irritation is generally consid-
ered as existing, from which a more general morbid action may
be expected to arise. Calomel certainly possesses great ener-
gy : But it is also certain that in moderate doses, and in cases
of moderate excitement in the intestinal canal, unattended with
very high general excitement, its power is not calculated so to
co-operate with the morbific causes as to increase, in proportion
to the power abstractly considered, the quantum of morbid ex-
citement, but to produce a new one. in the primre viae, which
new action tends to the subversion of the old. They are not
prepared so far to reverse the order of cause and effect as to
believe all that has been said about the gastritic and enteritic
origin of all fevers and so forth; or that the various- ulcerations
in the first passages which are observed in autopsies, and which
there is good reason to believe often exist sometime before death,
are always indicative of a primary irritation there ; but that these
are more generally dernier effects of disease primarily located
elsewhere. They have learned, in short, to free this medicine
from its dreaded irritating powers, and this done, frequently to
relieve effectually by its use the most irritable stomach and
bowels, by correcting that hepatic action on which these depend
and apply it to the irritated conjunctiva, and all cutaneous
excoriations and chronic eruptions, with the effect of promoting
the action of the absorbents so as to procure an early removal of
the existing irritation.

484 auditors' Remarks on ilie foregoing article. [Jan.

In saying these things, we mean to refer to that judicious use
of this article, the knowledge of which is usually obtained, only
by close observation and much experience in the diseases in
question ; and with a mind not trammelled by false theories of
the origin of disease, as in gastric or enteric irritation ; or the
nature of the green, blue, black and other secretions, produced
by the peculiar action of calomel ; or of its modus operandi ; as
considering that this medicine only irritates the first passages,
and without going elsewhere, issues from this highway its sove-
reign mandates to distant parts, through the medium of an invis-
ible and indemonstrable and unknown agent called sympathy.
The doses alluded to are of such size as carefully to avoid too
prompt and rapid purgation, but at the same time as large, and
often repeated as may be necessary to effect the desired altera-
tion of secretion.

We are free to acknowledge that this article has very consid-
erable cathartic power operating not unfrequently in large do-
ses, as perfectly as a hydrargogue, as the compound powder of
jalap ; but nature has placed such a guard around it, by giving it
a salivating power, as to prevent the frequent habitual use of it
as a prompt purgative or a laxative. Whilst therefore we per-
fectly agree with the learned and experienced professor in con-
sidering that its "indiscriminate and exorbitant" use maybe a
competent cause of chronic flux of the bowels, we are compelled
to differ so far, as to the fact of its being a frequent cause, as to
conclude that the want of its use in a proper manner is by far a
more common cause. And this opinion is founded on our views
of the pathology of these affections, in connection with the results
of its employment in their treatment.

The professor seems evidently to have labored in this essay
under two difficulties, which he should have determined most
conclusively before either prescribing for, or treating on these
cases. The first is a clear and definite diagnosis between the
different varieties of chronic fluxes. This must necessarily have
relation to cause, as well as the subsequent considerations in the-
rapeutics. It happened that during a few weeks residence
in New Orleans, we witnessed the effect of the water of the Mis-
sissippi in producing twelve cases of flux from the bowels, in a
family consisting of the same number of persons, and perpetua-
ting the same against the efforts of two of the most accomplished
practitioners of the place, for several weeks, and indeed until
they were corrected by crossing the lake and obtaining an entire
change of water. Here was a simple purgative power, for
which that water appeared to be notorious, at least so far as re-
lated to its use by those not habituated to it. It was not unlike
that of a moderate dose of salts taken several times a day. This
was in December and January. Again: In autumn doubtless
this simple disease would have been complicated by that dyspep-
tic state of the primae via: which sometimes attends hepatic tor-

1837.] Editors' Remarks on the foregoing article. 485

por or other obstructions. Those however of the liver, skin and
uterus are the most common. Again : This complicating cir-
cumstance may, and doubtless does more or less, in miasmatic
regions, prove sufficient alone for the production of a chronic
dyspeptic diarrhoea, instead of constipation so that scarcely
any article of diet is properly digested on account of deficient
hepatic secretion ; or in other cases there often appears a diarr-
hoea or other form of al vine flux, arising from that irritation of
the first passages produced by excessive fullness in the beginning
branches from obstruction of portal circulation in the liver, &c.
Hence the "sallowness of skin, of light lemon hue the invariable
resemblance of the discharges to pale clay, or Fuller's earth dis-
solved in water," &c. All these and other varieties do exist, and
should, we say, be clearly distinguished before the pathology is
declared, and still more, before the prescription, can be rational-
ly made.

We cannot enter in this place on a formal therapeutic treatise
on the various cases, as we have already protracted this article
greatly beyond the intended limits. But we feel that we shall
not be able to stop our remarks short of citing the professor and
his readers to another cause of embarrassment under which he
has been compelled to labor. It is this. After declaring that
"no perplexity can prevail in the recognition of diarrhoea," he
says, " It were highly important, however, in a therapeutic and
practical view, could we discriminate the several states of the
bowels on which the discharge depends but I am apprehensive
we cannot do this with any uniformity or precision." The state
then has afforded a perplexity and want of decision which ex-
tended its confusion into all his subsequent philosophy.

He appears in his pathological investigation not to have duly
distinguished between the acute and chronic state not to have
considered that chronic in medicine is not, as in chronology, de-
termined by days, weeks, months or years; but rather the state
of the disease, and the word should therefore be in its technical
use, considered chiefly as qualifying the nature instead of marking
the time. Its use however is not strictly apposite, as it really has
in this sense no other relation to time, (from which it comes,) but
that the state intended to be described is most commonly in con-
nexion with more or less considerable duration. Nor does the
professor seem to call in to his aid much of the influence of sea-
son, climate, sex, age or temperament ; some of which almost
always give peculiarity of caste to the resulting phenomena.
But so soon as he arrives at the part for which all the rest was
intended, by the dint of long observation, and the assistance of
Sydenham, light seems to have shone forth on the subject, and
very considerable accuracy to be arrived at, both in diagnosis as
to state, and therapeutics.

In speaking of the cause of this affliction, we should have re-

486 Obstetric Institute of the U?iiv2rsity of Pavia, fyc. [Jan.

ferred the professor as well as his readers to one which has of
late become more common than all others together the exorbi-
tant and indiscriminate use of Lobelia, No. 6, and Composition
Tea.

Review of the Practice of the Obstetric Institute of the University
ofPavia : By Dr. Ant. Trezzi.

One hundred and one females were admitted to the institute
during the year 1833-4, of whom sixty-eight were in their
first pregnancy, and were delivered of one hundred and two
children, there being twins in one instance. Ninety-eight of these
children were born at full term. There were ninty-five natural
labors, of which thirteen only were difficult ; of the six remain-
ing, four required manual assistance, one the use of forceps, and
one the cesarian section.

The presentations were as follows :

~ . , (1st. position, 72

Occiput, 2nd.Pdo. I .... 18

Breech,

Face,
Shoulders,

2nd,

, do.

-

-

3d.
4th.

do.
do.

-

:

1st.
3d.
4th.

do.

do.
do.

-

-

1st.
2d.

transverse position,
oblique do.

2d. position,
1st. do.
2d. do.

right,

left,

do.

-

1
1

2
1

1
1
1
1
1

Uterine Phlebitis preceding delivery.

One of the females experienced on the 30th January, a chill,
loss of appetite, lassitude, head-ache, thirst, lateral uterine pains,
especially on the right side, pains increased by pressure, and at-
tended with uterine contraction presenting nothing peculiar.
The active movements of the foetus were sensible and sometimes
painful ; the cervix was long, soft, indolent ; os tincae closed ;
pulse frequent, full and vibrating. She was immediately bled
and purged with oil ; the antiphlogistic treatment was vigor-
ously pursued, but without more than temporary relief; the
uterine phlebitis gradually progressed until the 16th February,

1837.] Obstetric Institute, of the University of Pavi a. 487

when she was delivered without assistance. The infant was
apoplectic and could not be restored to life. She experienced
some relief after delivery, but very soon presented every symp-
tom of intense puerperal fever, which terminated fatally on the
nineteenth.

Autopsy twenty-six hours after death presented the thoracic
viscera healthy ; in the abdomen a puriform effusion had taken
place, as also adhesions of the omentum and intestines to the
walls of the cavity ; inflammation of the uterine connexions,
particularly in the right side, where these parts adhered by a
purulent plastic lymph. The spermatic veins were very much
developed though healthy ; the uterus being opened, those vessels
at their entrance into the uterus were found filled with pus ; the
cellular tissue surrounding them in their way through the broad
ligaments was also infiltrated with pus ; the suppuration howev-
er was confined to the larger venous trunks. The same morbid
conditions were found in the other side, but in a less degree.

Among the Natural Labours, the difficulties encountered were:
from spasm of the uterus, uterine inaction, resistance of os ex-
ternum, and presentations of the breech and feet. There were
five instances of uterine spasm, especially of the cervix, which
yielded to blood-letting. In another case, the waters having
come away, three bleedings, emollient poultices to the abdomen,
and oleaginous injections per vaginam, became necessary. The
child was born apoplectic, but was saved by umbilical bleeding.
The delivery was natural.

One of the cases of face presentation was sufficiently remark-
able to be further noticed. When the head descended to the in-
ferior strait, the position was the following : The forehead oc-
cupied the centre of the strait, the vertex rested against the right
ischium and the chin against the left, the left temple under the
arch of the pubis and the right in the sacrum. The right tem-
poral region, yielding to the uterine contractions, slided over
the perineum and escaped at the inferior commissure of the vul-
va, whilst the left remained stationary. All the right side of the
head having passed out, the clavicle resting against the left side
of the pubic arch, the head rotated from right to left, the vertex,
then the occiput, successively escaped from behind the right side
of the arch ; and the head thus liberated assumed the position of
the second occipital presentation ; the remainder of the body
soon followed. The labour continued thirty-two hours ; the
child was apoplectic, but was restored; his forehead, eye-lids,
nose, and upper lip were very much bloated ; the other parts of
the face normal. The delivery was effected without instrumen-
tal assistance.

This case although extraordinary evinces the great resources
of nature in completing her greatest work, and Professor Lova-

488 Obstetric Institute of the University of Pavia. [Jan.

ti took occasion to impress on his pupils the necessity of with-
holding the use of instruments as long as possible ; and also to
allude to the error of those who believe assistance indispensable
in all cases of face presentation. This quastion has been argued
in the Academy of Medicine of Paris, M. Capuron admitting the
possibility of spontaneous delivery with such presentations, if the
foetal head be small and the pelvis very large.

Cesarian Operation. The cesarian operation was performed
by incision in the linea alba. Many obstetricians have advised
the incision of the uterus to be made as high up as possible; but
this viscus being always affected more or less with lateral- obliqui-
ty, the section of its anterior wall would always be oblique in-
stead of vertical ; moreover, the section of its upper part would
favour the introduction of portions of intestines between the edges
of the wound, as well as extravasation. Professor Lovati there-
fore prefers making the incision lower down, in order to avoid
these dangers as well as to facilitate adhesion by the application
of the bladder over the wound.

In the case before us Baudelocque's Pelvimeter indicated the
following dimensions :

Antero-posterior diameter, 5 inches 2 lines.
Left oblique do.. 7 7

Right oblique do. 7 9

Further examination proved the vertebral angle to project ve-
ry much into the pelvic cavity ; the sacrum presented no cur-
vature ; and the pelvis was strongly inclined downwards. The
section being made the child was removed alive, the placenta
was expelled through the wound by the uterine contractions, the
wound was well stitched, but the patient expired twenty-fou?
hours after the operation.

The external wound was found well united ; at its superior
angle a portion of the omentum was found adhering by plastic
lymph; a noose of small intestines, red, and covered with puru-
lent matter, adhered in the same manner to its left lip -r the peri-
toneum in general was inflamed; the uterus was voluminous
and open on its left side ; its incision was oblique from left to
right, was four inches long, beginning two inches below the fun-
dus and extending to the point at which the peritoneum passes
from the uterus to the bladder, and slightly open. The uterine
cavity was empty ; the os tinea? soft and dilated. The follow-
ing were the dimensions of the pelvis :

/Antero-posterior diameter, 2 inches 4 lines.
Left oblique, do. 3 4

. Right oblique,
(^Transverse,

T r . .. C Antero-posterior,

Inferior strait, j Transve'rse>

do.

3

9

do.

4

2

do.

3

8

do.

3

4

1S37.J Medical Education in South Carolina. 489

The bones of the pelvis were small but not altered in their
form: the sacrum was perfectly flat; the coceyx very much
curved and its point inclined to the left; the promontory not
prominent ; the left acetabulum turned inwards towards the sa-
crum.

The length of the incision not being more diminished by the
contraction of the uterus, might be urged as an argument against
M . Lovati's method of making it as low down as possible, for
inasmuch as the distension of the uterus is especially produced
at the expense of its fundus, so will the contraction be greatest
in this portion; indeed observation teaches us, that incisions
made in the upper part arc found to lose half their length by the
subsequent contraction of the organ. Annah Universali di
Mcdicina. Gazette Medicale.

We have received and read with much pleasure " A Memo-
rial on the State of Medical Education in South Carolina ; deli-
vered by James Moultrie, M. D., in the Representative Hall,
December 5th, 183G."

Medical education is a subject that has engaged us heart and
hand for some time passed, and we are truly gratified to see it
advocated as it has been by such a man as Dr. Moultrie. We
hope the effort made by the Medical College of Georgia, to call a
Convention of Delegates from all the Medical Colleges in the
Union, to devise some general plan of reforming the system of
Medical Education in the United States, although unsuccessful,
may yet prove not to have been altogether unproductive of ben-
eficial influence in promoting the interests of the profession.

It would be an easier task to say very much than too much in
commendation of the paper before us suffice it to say the man-
ner and matter are worthy the learned and talented author. We
have only space for a few of the concluding pages, but we re-
commend our readers to obtain and peruse the whole memorial,
which has been published in Charleston by Burges and Honour,
No. 18 Broad-street.

"It cannot be doubted, but that the establishment of medicaJ uistitutions in
the United States, has been of much service to the country. It may be
questioned, however, whether their multiplication has been followed by good
always unmixed with evil. We might even go farther, and say, that it is to
be lamented, that this has not seldomer been the case. If they have served
to cheapen education to keep our resources in the country to make us in-

oJ

400 Medical Education in South Carolina. [ Jar^v

dependent of foreign nations and render the vocation accessible to many a
worthy candidate who otherwise would have sought, or been driven to seekr
some occupation less suitable to his nature they have operated not less as in-
ducements to multitudes who otherwise would never have dreamed, or should
never have been permitted to dream, of embarking in the pursuit; and who,
bnt for the facilities thus offered, would have turned their thoughts to some
other occupation, more compatible with their circumstances or capabilities.
Uncontrolled, as they have been, by the wholesome restrictions of legislative
enactments, our colleges of medicine, actuated, too unfortunately for science,
by a spirit of aggrandizement, have thrown open their portals with but too
little discrimination to all who have thought proper to enter them ; and the
consequence has been, the nurture of a generation, which, in the main, have
conferred little honor either on themselves or their Alma Mater. The diplo-
mated quacks far cut number the legitimately initiated ; so that the catalogue
of the former has been swelled to an incredible extent, and thus mischief and
evil have been perpetuated and disseminated, in opposition to public confi-
dence and expectation, by the very means which were originally intended to
prevent their promulgation.

A question very naturally arises, then What is to be done? I fear, how-
ever, that no reform will ever take place, either immediately or remotelyr
Which is to have its origin in the institutions themselves. All may be placed
Upon an equality with respect to plans of instruction, requisites for gradua-
tion and so forth ; but unless the same equality can be made to obtain with
respect to charges, and proper security be given against the continuance or
t epetition of the present systems of underselling, and of simplifying when the
progress of the science calls for a stilt further subdivision of labor, than ha^
yet obtained in any of them, in order to facilitate graduation and procure
large classes, every effort to this effect will be made in vain. The necessity
for preliminary instruction is so little apprehended, and the means of afford-
ing it SO' imperfectly provided, at the same time that the pecuniary state of a
large proportion of our population is in so humble a condition, that for a long
time to come this latter consideration will largely operate as a reason in favor
of those institutions, which shall continue to avail themselves of it. For this
reason, the plan of allowing regular salaries as a basis, in addition to the usual
fees, of the medical faculties, as pursued in France, appears, under all circum-
stances, the best that can possibly be devised. It insures to the government
the right of enforcing, both on professors and students, a compliance with
whatever regulations are deemed proper to be adopted for the good of the
public, as well as for the institution, and of providing, by law, a surveillance,
and the institution of a concours, the effect of which cannot fail to be ulti-
mately beneficial.

It would be but half accomplishing the work, however, to stop even at this.
As professorial celebrity, ceteris paribus, must depend upon the success of
the efforts to secure the attainment of ante-professorial requisites and these,
again, upon college acquirements, and college acquirements upon academic
discipline and instruction it is evident that the remedies for present evils
should be applied deeper still than this, [t should go beyond the mere re-
sults. And to effect this, we must go back to the primary links of the length-
ened catenation. We must begin, as it is said, from the beginning. And
while we endeavor to correct the ills attendant upon the present laxities of
our professional seminaries, try to lay the foundation for a simultaneous and
entire revolution in the disciplinary exercises of our academics and eollr -gos.
These must be made to take ihrir proper relation^ to r
ert, in their natural order, the influ< i

Medicine has been too mu lated branch

of human knowledge. It. has been too much considered I in myste-

ry. It has been too commonly viewed as a subjeel bj p< rial irfquiry, with
fixed, secret, and determinate Jaws, and surrounded by circumstances be]

1837.] Medical Education in South Carolina. 4D1

ordinary ken ; and too seldom as a science of observation and induction,
complex and comprehensive in its nature, having its basis, extensively laid in
the truths of the more common and popular. To become acquainted with
these truths has been considered, by those, too, who should have known
better, a matter, to say the least, of very questionable utility ; and it has
even been urged as an objection to it by others, that it detracts too much
from time which should be devoted to objects more professedly professional.
This idea should no longer be permitted to prevail. - It is time that such rea-
soning should cease to be listened to. It . is unquestionably true, that no
one can study the extremes of any general system at once. He cannot at-
tend to the exercises of an academy, those of a philosophical seminary, and
those of a professional institution, simultaneously* He cannot seize them at
a grasp. But besides that this is attempting what is not only impracticable
and should not be encouraged, we know from experience that, when properly
conducted, the results which are aimed at are perfectly attainable. What
has been reached in Germany, France, or Italy, can easily be reached in the
United States, and should be attempted ; and I would fain leave the de-
grees of perfection at which we may arrive, to be discussed by those who
deem it a matter of sufficient importance to limit or restrict them. Of one
thing 1 feel assured, that we have less cause to fear the maximum will be
overreached, than that we shall fall short of the minimum.

The principle can hardly be considered a questionable one, as to what or-
der should be pursued in the culture of the human understanding, or the stu-
dy of the different departments of philosophy. There is a time for all things ;
and this maxim is as true in reference to the education of the powers of the
mind, as to any of the events to which it has been applied. Each faculty has
its allotted period of development, in the fulfilment of which there is a time
of opening, when education exerts its most successful and happiest effects ; a
time of maturation ; and a time of decay ; and to interrupt or disturb this
order, is either to impair its natural vigor, or to occasion it to fall far short of
the end for which it is destined. The effect of such a perversity of method
can only be to introduce discord into the mental constitution, or to touch
notes, upon the same instrument, which have no natural or harmonious re-
lation. And this principle, and these remarks, are not less true of the order
in which, in reference to any particular avocation or profession, the sciences
are studied. The understanding of some, notwithstanding they have been
generally represented as constituting a circle, is necessary to the knowledge
of others. If we begin with those at, or after, graduation, which should
have been accomplished before it, what can be expected but disappoint-
ment or failure 1 How can we look for any other result than the formation
of a being of diminutive stature ? Can the judgment or the understanding
be at ease amidst the objects of any particular department of human knowl-
edge, whilst it is distracted by the presentation of numerous others ? Can
either be free to examine their respective principles, and mutual influences
and relations ? It would be but a needless expenditure of reason, to argue
about the connection of the sciences, with those who have not the acquired
perceptions to understand the very terms of the proposition. But can it be
doubted that upon the putting of the same question to different individuals
as for example, whether the study of botany, zoology, and comparative anat-
omy, are of any value to that of physic different answers would be returned
according to the modes and measures in which each has been instructed?
That with a German or Parisian, it will be one thing with an American
another? And yet, who wouM , Knowing these differences, to pro-

nounce which has the belter right, or better reason, to determine ? Which
would be the more competent witness in the courts of an enlightened philos-
ophy 1 There, we hear of no misgivings as to want of time ; no whining as to
the length of art or shortness of life. It is here only, where they are least
understood, that we find the greatest nnwillingnesp, and hear I h

492 Medical Education in South Carolina. [Jan.

of the apprehension of difficulties. Obliging every one to begin where he
should, and to adopt, throughout, the course which an enlightened experi-
ence has shown to be the best to be pursued upon the whole, it seems to be
the object of the best European systems, to open all of the capacities of the
intellect, and to fill them with all of the tieasures of knowledge, which a self-
correcting and self-improving philosophy, has been able to gather from the
ample fields of nature and of art ; and to leave it to aftertimes, or the dictates
of accident, or the steady operation of the natural laws of the constitution, to
settle the mode in which they shall be employed practically and individually.
Discarding, as impracticable, the unphilosophical conception of a mode of in-
struction to be endlessly adapted to individual peculiarities, strengthening
those faculties which are already too predominant, and suffering those to lie
idle which are already too much endangered by the activity of their more
powerful neighbors, in other words, fitting a man, as the plirase is, for the
profession to which he is inclined, or adapted, by the force of his genius a
system which never has been, and never can be, carried into general or suc-
cessful execution it appears to be their object to carry out the more tangi-
ble or feasible expedient of disregarding those peculiarities wherein the facul-
ties are already sufficiently active to struggle for themselves, if not to require
restraint, and to supply the objects in the proper order, and with the corres-
ponding exercises to each and all of the powers of the understanding ; ad-
justing the extent and degrees of each, by that common admeasurement
which trial, actual trial, has shown to be both practicable and proper. That
the standard which is adopted should sometimes prove too exalted for some,
is what may have been anticipated, perhaps, from the accidental, as well as
natural, inequalities of the race. But this is their misfortune, not a fault of
the system. The inherent inequalities of the race can never be wholly era-
dicated or removed. Modification is all that we should aim at. It is all that
we can accomplish. What nature lias sown, philosophy must reap. Where
she has established distinctions, intending them to be permanent, art may
vary, but she can never wholly set aside or supersede the law. To those
who fall below the level, the higher occupations in life should be as a tree of
forbidden fruit, which they may be permitted to behold and approach, but
upon no account either to pluck or eat.

But, after all, there is no system which can be considered perfect none
we can imagine which is wholly free from difficulty or objection. Of all
those that have been adopted, the models of France arc the freest from cith-
er. One of their fundamental excellencies is, that while the votC6 of the fa-
culty are allowed to predominate in the judgments or decisions of the con-
cours, thereby rendering the grounds on which they arc made wholly profes-
sional, the judicious exercise of the governmental authority, which is also an
element therein, preserves them from the pernicious influences of motives
which are private, personal and mercenary. The chief, if not only liability
to abuse from this circumstance, is the opening it leaves for political influ-
ence and intrigue, than which, in the republic of letters, there is nothing more
to be deprecated.

It may be, however, that we arc not yet, in this country, in a situation for
1hc entire adoption of the concours a fact of which I am far from being con-
vinced. It may be that the degree, as well as the extent, of mental culture
in this State, does not warrant its immediate adoption that the mass of our
physicians, us well as of the community at large, have not that fulness and
readiness of knowledge, or of practical interchange of thought, necessary to
sustain if. Hut we can at least prepare lor it. We can do much, in anti-
cipation, by fostering those; preliminary branches of study, and encouraging
those primary institutions, from which are to spring up the elements of its
completion. We may make the departments ol human learning harmonize
more thoroughly than they have hitherto done We may adapt them more
effectually one to the other, and incorporate into all the same leaven of im-

1837. J Medical Education in South Carolina, 196

provcmcnt. We may bring them all under the Bame authorized inspection,

and make them but different states and stages of one unique and entire
whole.

1 know it lias been said thai Germany is indebted for the eminence of her
scientific and literary institutions, in a great degree, to the spirit of rivalry
ompetition which prevails among* individuals. Of the truth oft his. how-
ever, I may he | I to doubt. Germany owes every thing to the hab-
its of application, and emulation after distinction, w hich has been, by a course
of well directed and uninterrupted discipline, long identified with the intellec-
tual existence of her sons. The tendency of such a spirit, amidst corpora-
tions where pecuniary interests are involved, is to make them venal; and 1
would appeal to the experience of Germany even, for the truth or confirma-
tion of this observation. That of our own country will corroborate it.
France has wisely shunned it. She, prudently and patriotically, confines the
exercise of this principle to individuals ; and the Results have shed a lustre on
her name, which will prove as enduring as her existence.

Profiting by these examples, the plan which I would propose, then, under
existing circumstances, would be this : Let the Legislature take the whole
subject of education under its paternal care ; and let the system be regulated
in accordance with the views and principles which have been exposed. Let
the medical department be made a branch of that system, and a college be es-
tablished by its authority ; and let all other grants be abrogated, or expire
naturally, at the end of the term for which they were given. Let there be
granted by it, for the erection or purchase of a suitable building, a suitable
sum of money ; and let the professors, in addition to the compensation now
received for then- tickets, bo also suitably salaried. This last would make
amends for the reduction of the members of the class, which in the outset of
the undertaking, and from the higher requisitions of the applicants, may be
expected to be made in their incomes ; in return for which the State might
receive the amounts accruing from the matriculation and graduation fees, to
be expended in necessary repairs. It is well known to this society and to the
public, that since the disagreements which have eventuated in the establish-
ment of the second Medical College of the State, and the unparalleled en-
couragement and success which have attended the labors of its Faculty, the
liberality both of that body and of the municipal authority of Charleston, has
been not only rendered nugatory, but unless a speedy re-action take place in
favor of its unfortunate competitor, these must soon be scattered to the winds.
The outlay is composed of perishable materials, and like an organized body
requires composition to sustain decomposition. Something may be done
perhaps towards the prevention of further losses, and the reclaiming of the
materials which remain, and the appropriation of them towards this object.
I have no authority for even hinting it, but from the zeal and public spirit
which I know to be the sole actuating motives of the trustees and faculty of
the other school, 1 am disposed to think that arrangements might also be made
with the authorities of that seminary, for the devotion of all that they possess,
and all that they are capable of doing, towards the accomplishment of what
seems to me so desirable and glorious an undertaking. The proper equiva-
lents being given, the Legislature might thus at once possess itself of a fund,
which would go far towards the immediate execution of this plan, with per-
haps but little additional expenditure on their part. The details of such an
arrangement I forbear, however, to enter into now. They may safely be left,
should the scheme seem feasible, to future adjustment or agreement. But it
may not be inappropriate to remark, that the two latter considerations the
giving of salaries and erection of a college edifice by the State were parts of
the scheme submitted years ago to the consideration of the Legislature and of
the community by Dr. Cooper, in the Address to which, in the commence-
ment of this inquiry, I took occasion to allude.

These preliminaries being established, ! should in the next place say, I I

494 Anatomy of the Nerves of the Perns, fyc. tyc. [Jan.

the period of lecturing be extended to six or eight months, and let each stu-
dent be compelled to attend three or four courses. Let there be a substitute
provided for the concours, or the concours itself be established, in which each
applicant for a professorship shall give a 'practical or demonstrative proof of his
abilities and competency to fill the situation. Let the number of professor-
ships be increased, and the order determined, by conference and council of the
faculty, in which the studies shall be pursued. Let there be several exami-
nations also of the student in the course of his studies, in which he may be re-
manded to further preparation, or be advanced to others that are ulterior ; and

a final one, in which the ordinary written testimonials shall be included.

The carrying out of this plan would render it necessary, perhaps, that some
distant day be fixed upon, in which no other diploma than that of this college
should be considered valid, or should entitle its possessor to practice within
the jurisdiction of the State so as to avoid inflicting injury or injustice upon
those who already prc-occupy the field.

The crisis we have reached in the mental progress of our affairs is an inter-
esting and important one ; in which the public mind is at once in that state
of solicitude and fortunate equipoise, the most favorable, as it seems to me, for
establishing what is right and sound ; in which much moral and intellectual
good may be accomplished ; and in which, if rightly managed or guided, its
onergics may be directed and impelled to the performance of a work compat-
ible with the enlightenment of the present generation, and worthy the perpet.
nation of that which is to come.

Anatomy of the nerves supplying the cavernous structure of the renis, and their
connexion with ike hypogastric plexus of the sympathetic : By Professor
Mueller, of Berlin.

After 1 had discovered the fact that the xirtcriae hclicincc the branches of
the arteria profunda penis producing crectionwcre different from those
branches of the same vessel which served for nutrition (see this Journal, No-
vember, 1835, p. 179,) I put to myself the question, whether the nerves of
the penis were of the same or different properties, whether they belong to
the system of nerves of animal life alone, or whether they also included or-
ganic fibres'? Do those nerves upon which the sexual gratification depends,
differ in their nature from those which produce the accumulation of blood in
the corpora cavernosa ]

I have been so fortunate as to find, both in man and the horso, that the
nerves of the cavernous bodies are made up both of branches proceeding from
the organic as well as the animal system, whilst the nerves of animal life
alone provide the nerves of sensation of the penis.

Since, by the discovery of the arteriae heHcine in the corpora cavernosa
penis, the immediate source of erection is found to be in these bodies them-
selves, 60 will it be also proved, if such a connexion exists between the ncr-
vus sympathicus and the nervi cavcrnosi, that the sympathicus perforins the
principal part in the phenomenon of erection. \ have observed that by far
the greatest number of the nerves which penetrate the corpora cavernosa in
man, derive as considerable fibres from the organic as from the animal ner-
vous system, and that the same takes place throughout the nerves supplying
at least the posterior half of the corpora cavernosa of the horse, whilst the
anterior half is supplied only by nerves arising from the animal system, and
entering anteriorly to the pubes viz. the branches of the nervus pudendus

1837.] Anatomy of the Nerves of the Penis, fyc. 495

given off whilst passing along the dorsum of the penis. Therefore the pos-
terior nerves, which penetrate the corpora cavernosa behind, and enter the
symphysis pubis, are composed as well of branches of the nervus sympathi-
es, proceeding from its plexus hypogastrics, -as of the branches which come
from the nervus pudendus communis.

Upon the side of the urinary bladder in the horse, and proceeding towards
its neck, are many fine twigs of the plexus hypogastrics, which often join one
another on their way, and separate again, forming a net work. In this part
of the plexus hypogastrics, upon the side of the middle and anterior part of
the bladder, lie several email ganglions, separated from one another, more or
less, but often by a considerable space ; they measure from one-half to two
or three lines in diameter. From these ganglions, twigs pass into the urina-
ry bladder, by which means the gray nervous fibres destined for the corpora
cavernosa pass from the hypogastric plexus thither, and they then unite again
in the same reticulated manner. Before these nerves arrive at the posteri-
or surface of the pubes, they unite in the neighborhood of the neck of the
bladder with branches of the nervus pudendus. Through this anastomosis
are formed many strong nerves the posterior cavernous nerves; it is of these
alone that I now treat.

Many of the nerves formed in this manner, of which, in the instance now
before me, I reckon four large and two smaller, pass under and behind the
symphysis pubis, and penetrate the corpora cavernosa, in part accompanying
the arteria profunda penis, and partly in other places.

I remark particularly, that neither the posterior cavernous nerves, nor the
anterior branches of the nervus dorsalis penis, form any swellings in their
passage through the fibrous coat of the corpora cavernosa. In man, a much
greater portion of the cavernous nerves are in connexion with the hypogas-
tric plexus, and the number of twigs wliich come from the nervus dorsalis
penis alone, is much smaller than in the horse. Hitherto, only the-cavernous
twigs of the nervus dorsalis have been known.

The demonstration of this communication in the horse is so easy, that the
principal points may be clearly made out in a few weeks ; but the preparation
of those of the cavernous nerves, which anastomose with the hypogastric
plexus in man, requires an extraordinary degree of patience, and a satisfac-
tory demonstration of them, together with the hypogastric plexus, can only
be perfected in the course of some months. The larger of these cavernous
nerves can be found easily before and under the symphysis pubis, after these
bones have been very carefully cut away ; but the difficulty is, to demonstrate
their connexion with the plexus hypogastrics.

In the summer of 1834, I was following out the twigs given to the penis by
the nervus dorsalis, which I, as well as other anatomists, thought were the
only nerves this organ received, and by this means I discovered, upon the
root of the penis, a considerable number of gray nervous fibres, which passed
forwards in a kind of lace- work between the vasa dorsalia from the right and
left side, in order to unite themselves almost immediately to the branches of
the nervus dorsalis ; some, however, pierced the root of the penis directly.
As I prosecuted the dissection of these gray fibres backwards, I was quite as-
tonished to find that the stems did not arise from the nervus dorsalis, but
were continued in a diverging direction backwards to the sides of the com-
mencement of the prostate gland, and underneath the venus plexus situated
here one of these nerves is especially strong in this place. Before the
prostate gland, these nerves are continued in a weak and still finer plexus
of organic fibres, wliich partly lies concealed in the fleshy coats of the pars
membranacea urethrse, and in part passes backwards between the prostate
and the M. levator ani. This plexus stands also in connexion with branches
of the nervus pudendus, within the fleshy coat of the membranous pnr;
the urethra ; but the greatest number of the twigs <>f this ,
organic nervous system.

496 Anatomy of the Nerves of the Penis, fyc. [Jan.

These, then, arc continued (divided into many filaments) backwards be-
tween the side of the prostate and the levator ani ; still hanging together in a
plexus, and passing upon the side of the bladder, where the fibres are very fine
and soft, until they at length reach the plexus hypogastrics, with winch they
unite.

Close behind the prostate, and by the side of the cervical portion of the
bladder, there are in these plexuses, many ganglions, some longish and some
more rounded (ganglia pudenda seu prostatico-vesicalia) ; to which, also, may
be traced some line filaments from the third or fourth sacral nerves. These
ganglions cannot well be considered to belong to the hypogastric plexus,
since they arc widely separated, and are only connected with it by long and
weak filaments. From these ganglions, twiggs pass into the neck of the
bladder and the prostate gland; but the greater number pass forwards to
form the cavernous plexus. The preparation of the nerves in question will
be conducted best in the following manner first, the cavernous nerves must
be sought after upon the root of the penis, in that part where the greater
number of them sink into the corpora cavernosa, that is, immediately before
and under the symphysis pubis. Some gray nerves may be very soon found
before the symphysis, and lying between the dorsal vein and arteries ; these
are to be followed backwards after the root of the penis has been separated
from the pubes, wrhich must then be sawed away this must be done very
carefully. When the stems of the cavernous nerves are arrived at, they
must be followed through the fibrous mass which envelopes the venous plexus,
underneath and behind the symphysis, until they reach the commencement
of the prostate, where they begin to subdivide still finer, and form the plexus
which has been already described. It will be advantageous to allow the pre-
paration to macerate for some time in spirit, as," by this means, the fine nerves
will be more easily distinguished from the surrounding parts. Now, before
the most difficult part of the dissection, it will be better to commence the
plexus hypogastrics, so that the plexus of the cavernous nerves may be
prepared from behind forwards. The preparation of this union is very diffi-
cult, and requires the greatest patience ; for although the connecting fila-
ments between these two plexuses are numerous, they are very fine and
weak.

The nervi cavernosi, consisting of many fine branches, and one large one,
will then be found to spring from the plexus cavernosus, which is composed
of the roots proceeding from the nervus pudendus on the one hand, and the
plexus hypogastrics on the other, and which lies partly between the levator
ani and the prostate, and partly in the fleshy coat of the membraneous portion
of the urethra, but is strongest on the anterior part of the prostate gland.
All these stand in connexion with one another, and pass partly under the
symphysis ossium pubis, partly immediately before it into the corpora caver-
nosa ; sometimes accompanying the arteria profunda penis, but sometimes
through peculiar passages in the fibrous envelope. Some twigs unite with
the nervus dorsalis itself, others with the cavernous nerves of the opposite
side, and others again with branches of the nervus dorsalis of the other side,
and by these means a plexus is formed which accompanies the vasa dorsalia,
and from this also twigs proceed, which, penetrating the fibrous coat, range
in the corpora cavernosa. Some of the filaments of the plexus cavernosus
on the otlicr hand, uniting with twigs of the nervus dorsalis, pass over the
corpora cavernosa, and descending into the furrows formed by the two roots
of these bodies and the corpora cavernosa urethrte, are distributed into the
last named body.

The nervi dorsales penis are, in distinction to all these nerves, quite white :
they pass on the side ofihe arteria: dorsalis forwards, and send many, for the
most part fine, twigs into the corpora cavernosa. Their anastomosis in the
.niddle line, through communicating branches, occurs generally in such a
manner that fil imente proceeding from the plexus cavernosus participate in

1837.] Observations and experiments upon the Cozcum. 497

forming it. By far the greatest number of the branches of the nervi dorsales
are destined for the glans ; a small number only is distributed to the integu-
ments and prepuce. Upon these it is that the sensation of the parts de-
pends. London Medical Gazette, 23d April, 1836. Am. Journal.

Observations and experiments upon the function of the Ccec.um : By Dr.
Schultz, Professor of Physiology in the University of Berlin.

The objects of the learned Professor in making his experiments were to as-
certain first, the function of the ccecum ; second, the digestibility of the
different articles of food; third, the manner of the dissolution of the fleshy
fibres in the stomach, according to microscopical observation ; fourth, the
degree of acidity in the stomich and coecum; fifth, the degree of alkales-
cence of the food in the stomachs of ruminating animals ; sixth, the nature of
the acids in the stomach ; seventh, the coagulation of milk by the saliva, sto-
mach, &c. ; eighth, the saliva; ninth, the nature of the bile.

He maintains that there are two digestions, one in the stomach, the other
in the coecum, and that the latter is more especially active when vegetable
food has been ingested. From the first experiment he learned that the de-
gree of acidity in the ccecum is not always the same, that it is not always pre-
sent, and that the food may even become alkalescent. From the second,
that this acidity was neutralized by long fasting, and thus allowed pure bile
to enter the coecum and neutralize its contents. ' From the third, that there
is always bile in the course of the small intestines. From the fourth and
fifth, that all the bile secreted by the liver during fasting, is by no means con-
tained in the gall bladder, and that that part is very small compared with the
large quantity that flows int6 the intestine during the empty state of the
stomach. From the sixth, that though bile is always flowing, it never pasl
ses the coecal valve during fasting, but collects on the upper side of it ; it is
only after perfect acidification, and at the beginning of the peristaltic motion
of the intestines, that this bile flows into the coecum. From the seventh,
eighth and ninth, that the degree of acidity and alkalescence of various parts
of the digestive canal, vary with the length of time that has passed after feed-
ing, and the degree of perfection of the gastric digestion, as also with the
length of time which animals have fisted before freding. From the tenth,
that the quantity of digestible matter which is contained in the food has a
great influence upon the degree of acidity in the ccecum. From the eleventh,
that in carnivorous animals, when the coecum and colon are but little devel-
oped, the. food is for the most part digested by the stomach and small intes-
tines, and the acidity in the coecum is in general very weak, since the food,
when it is here collected, contains little or no digestible matter.

The general results from the whole of the experiments we give in the au-
thor's own words; they are of the highest interest and importance.

" Results of the experiments upon the coecal digestion. It may, therefore, be
gathered from my observations and experiments, that the food in the ccecum
becomes not only a seconjl time sour, but that the acid chyme is there neu-
tralized by the access of bile, in the same way as in the duodenum ; so that
after the employing of the intestines very different reactions may be pro-
duced according to pleasure. On account of this twofold consumption of bile
in the stomach and ccecum, there is an antagonism between the two diges-
tions ; for when the bile is consumed by the digestion in the stomach, the
coecal digestion cannot be perfected, and, on the other hand, when the bile
flows into the coecum, the neutralization of the acidity in the duodenum can-
not take place. In those animals in which the coecal digestion is most per-
fectly developed, this antagonism appears to be so arranged, that each diges-
tion has its particular period of action, so that when the one is in action, the
other is either lessened or at rest. In ruminating animals, it is verv evident

63

4Q& Observations and experiments vpon the Caecum. [Jan,

that the gastric digestion takes place more particularly during the clay, and
the coecal at night, so that I think the gastric may very properly be called the
diurnal, and the ceecal, nocturnal digestion,

"In carnivorous animals, however, the ccecum is so little developed, that
the stomach alone furnishes nearly the whole process of digestion. These
animals, therefore, have a preponderating diurnal digestion. This agrees
with the fact, that carnivorous animals rest for the most part during 'h J day,
and at night become hungry, and seek their prey, and are, therefore, noctur-
nal animals, since their digestion takes place during the day.

"As the formation of the feces follows the perfected caeca] digestion, her-
bivorous animals are accustomed to discharge the greatest quantities in the
morning and evening, a- d but very little di ring the day, and the healthy
course of digestion. There appears to be something similar to this in man,
in those ages where the ceecal digestion is most developed; in childhood, on
the contrary, when the d:gestive apparatus resembles that of carnivorous an-
imals, repeated discharges of excrement take place at indefinite periods of
time.

" The use of the valvula cccci in c<scal digestion. That the ceecal digestion
may take place, it is necessary that the still digestible remains of the food
should be rendered acid and changed into chyme, as in the stomach, before
its mixture with the bike. This couM not happen if the bile flowed continu-
ally into the ccecum, and it is therefore probable, that its opening into the
small intestines is closed during chymificatior, as the stomach is closed du-
ring its digestion, only with the difference w' ich the different state of the
matter required. The stomach is closed during dig< stion at the pyloric ori-
fice, to prevent the egress of the feed, and the coeci m at. its iliac opening, to
prevent the ingress of the bile. This is ray view of the use of the valvula
coeci. I have not only found in general at the lower end of the ileum, an al-
kaline reaction, while the upper is still either sour or neutral, but at certain
periods of digestion, a collection of pure bile at the iliac orifice of the coecum.
The contents of the coecum are at this time nevertheless sour. This would
be impossible if the mouth of the coecum were not cosed during ehymifica-
tion. After the collection of the food, therefore, in the cocci m, its ope ning,
like that of the bladder, uterus and stc ma' h, appi avs to be strongly contract-
ed by its muscular fibres, and with the help of the valvula coeci, to be perfect-
ly closed. The contrary is the case at the b< ginning of 'he peristaltic mo-
tion of the coecum, and upon the opening of its iliac orifice the collected 1 ilo
flows in. This agrees with the sensation of the ceasing of the peristaltic
motion after the collection of the food in the coecum, whi< h I observed upon
myself, and have described in ray work (a'r Alunciitcruvi Concoctione Exper-
imental Nova.) It appears to me, therefore, that the generally admitted ex-
planation of Fallopius, accordingto which, the use of the valvula coeci is to
prevent the return of the food from the coecum into the ileum, is quite unfoun-
ded ; for it may be easily seen that during excretion <h:s backward motion is
very possible.

"Concerning the timesfor eating corresponding to the ] eriods of digestion.
The simple rule to eat as often as one is hungry, appears no doubt, the most
natural. I shall be able, however, to show that this rule is by no means uni-
versal, and in many instances even pernicious. 1 shell succeed best if I
prove that one is often hungry, without having the least real need of food,
and that this hunger is belter allayed by fasting Mian by eat

"Hunger is the feelingof need of the nourishing pArts of the blood, and is
situated in that organ through which it is satisfied the stomach. This ap-
pears to be the reason, why, when the stomach IS empty, we hunger, and not
When it is full, even when it is filled with perfectly indigestible matter, which
cannot satisfy the true feeling of hunger. We cannot judge from hunger
whether the food be digested, and the proper omve of hunger satisfied ; and,
therefore, this feeling cannot be the only rule for eating, since a perfect and

1837.] Observations and experiments upon the Caecum. 499

iindisturbea ! stion is necessary for iho true allaying of hunger, and, there-
fore, w'u m dig hion would be disturbed thereby, it would be improper to eat,
notwithstandm r hanger may !> Felt,

" li w consider cinder this point of view the antagonism between the gas*
trie am! coecal digestio i, it followfe, that, if both be excited at the same time,
they will reciprocally disturb a^ch other, and that for perfect digestion, and
the proper formation of the blood, they must take place at different periods of
time. My experiments show that, for the completion of the coecal digestion,
the bile flows through the small intestine into the coecurn, and the whole
intestine becom ts th ir (by more or less alkaline; but they also show, that if,
during the coecal dig sstion, the stomach be put in action, the flowing of the
bile to the coecurn is stopped, and its digestion consequently hindered, since
the chyme cannot be neutralized, and all the contents of the canal as far as
the excrement become sour The formation of the blood in the lower parts
of the canal is hereby disturbed, and the .gastric digestion is also rendered
imperfect; so that the two digestions cannot take place in their integrity at
one and the sums time: The completion, therefore, is indispensably neces-
sary to perfect digestion in general, and it becomes very important so to reg-
ulate the periods tor eating, that the activity of the stomach may not disturb
the digestion in the coecurn.

"If now, the coecal digestion be considered more particularly as a noctu-
ral digestion, the meals should be so regulated, that,, when this begins, the
stomach may no more be put into action, or at least not overfilled. It is gen-
erally admitted that, a mm digests a moderate meal within three or four
hours My experiments, however, upon carnivorous animals, which digest
much more quickly than the omnivorous, to which class man belongs, show,
that six or seven h >urs are r squisite for the digestion of a moderate meal, and
that when dogs are allowed to eat as much meat as they will, twelve to four-
teen hours are hardly sufficient for perfect digestion. The animals must
even then bo allowed to r ist, for if they are made to exert themselves, the
digestion is still further d< live.!, at least half the "time longer. The obser-
vation:; which I mad i upon myself during intermittent fever agree with this
fact, and ir maysaf ly be assumed, that six hours are necessary for perfect
digestion, thr is till-all sour chyma has disappeared from the stomach. If
now it be ad nitl i ', that; in the common mode of life, the noctural digestion
begins about from s wen to eight o'clock in the evening, the last meal ought
to b ! bv this time it may be for the most part digested

in the stomach. Ingm r re, one should not eat after four o'clock

in the afternoon, and -v- Is should be altogether avoided : for,in

proportion to the la hour and the' quantity eaten in the evening,

the more will I !i coec i1, and th o the gastrin digestion, be disturbed,

seeing that both n place nearly at the same time.

"Tint this nil i is nol ible in youth, (as long as the gastric diges-

tion lesemMoa tin' of c trnivorous an'm l-\ and for the most part, finishes the
process or digestion alone,) as in riper year?, follows from what has been al-
ready observ d.

"The more the feionis disturbed by con'inued large and late evening

meals, the less perfect willbeths preparation of the blood, and the more will
the need of its nourishing prts,*or hunger, be feU, particularly in the even-
ing when th ! stomach is empty. This is the reason why those people who
should eat leas >ning are most hungry at this time, and heie mere

particularly does the feeling of hunger no! correspond with the period of di-
gestion ; for th i more such people eat in the evening, the more imperfect is
their sanguification, and the greater the consequent hunger, since the food
goes almost entirely unchanged through *he alimentary canal, and the nour-
ishment it contains is lost to the body. The only means, therefore, by which
this hunger may be properly appeased, is that by which the digestion may be
restored, and sanguification amended, and that is, notwithstanding hunger.

500 Observations and experiments upon the Ccecum. [Jan.

to abstain from food in the evening, that the gastric and coecal digestions
may not reciprocally disturb each other.

" The source of hunger will ever increase, by continually appeasing it by
late evening meals, and in this way, therefore, it is as easy to starve from too
much eating as from fasting ; and no doubt in this way has many a person
eaten himself to death, and most probably will still. We find in general that
the meagerest and most sickly persons are the greatest eaters, and, on the
contrary, the well-nourished and powerful eat less. That in the different
condition of the digestive organs of different people, and according to the
quantity of food which is taken during the day, there may be various chan-
ges and exceptions to this general rule, is self-evident. Where the youthful
condition of the digestive organs is still vigorous, and the coecum not as yet
much developed, it is not necessary to be so particular about the smallness of
the evening meals ; and where there is in general but little taken during the
day, and the quantity of food in the coecum, therefore, small, more may be
eaten in the evening, as there still remains a quantity of bile sufficient for the
perfection of the coecal digestion. The longer the fasting after meals, the
more bile can flow into the coecum after the ending of the gastric, digestion,
and the less fear need there be of evil consequences." London Medical and
Surgical Journal, October 1, 1835. Am. Journal.

1837. J New Treatment of Primary Syphilitic Ulcers, Cyc. 501

Part III. MONTHLY PERISCOPE.

New Treatment of Primary Syphilitic Ulcers : By Dr. Carust.

This very simple method consists in exposing the affected
parts a minute to the vapour of vinegar, twice a day, and then
covering them with dry lint, until the cure be complete. The
healing progressed very rapidly, but only in primary ulcers,
whether old or recent ; the secondary are never benefitted by it.
After the cicatrization, the D>ctor administered anti-syphilitics to
destrov the constitutional effects. H^ rep >rts already eight suc-
cessful cases. // Filiatre Sebezio. Gazette Medical?..

New method of wealing Strictures of the Urethra, : By M. Jo-
bert de Lamballe, Surgeon at the Hopital Saint-Louis.

Having ascertained the existence and situation of the stricture
with an elastic bougie, the instrument is to be smeared with
sweet oil, and then covered with finely pulverized calcined alum ;
if the stricture be considerable, the bougie is again to be dipped
in oil and coated a second time with the alum in order to increase
its quantity. The bougie thus doubly coated, is to be introduced
and carried up to the stricture, care being taken to dilate the ori-
fice of the canal so as to convey within as much of the coating as
possible. Having reached the obstacle, the instrument is to be
gently pressed against it and secured in its place in the usual
manner. In some instances two hours will suffice to overcome
the obstruction and to render urination practicable. But if re-
lief be not obtained thus readily, it will, in most cases not be de-
ferred beyond twenty-four hours. It will be necessary to repeat
the application daily until the instrument can be carried into the
bladder.

M. Jobert relates cases which go to prove that the most in-
veterate strictures yield to this treatment. The inflammation
excited is but slight and the increased discharge soon ceases.
This remedy acts by increasing the secretion and thus relieving
the mucous membrane. The mucous membrane of the urethra,
like the pituitary membrane, is tumified by inflammation, but re-
turns to its normal thickness by an increased secretion as the lat-
ter does by that attending coryza. Journal Hebdomadaire, 10th
September , 1836.

Epilepsy treated by Indigo.

M. Noble, Physician in chief of the Royal Hospital at Ver-
sailles, recently sent to the Academy of Medicine a detailed ac-

502 Epilepsy Treated by Indigo. [Jan.

count of the use of Indigo in Epilcnsv. The following are his

results.

Three individuals were subjected to the treatment. The first
was a youth 18 years oi'age, who. had been subject to epilepsy
twelve years, and who was never more than eight or ten days
without experiencing one or more well characterized paroxysms.
Having been subjected to the use of indigo, he had had no return
of the disease for two months at the time of the communication.
He had taken the remedy in doses of a drachm daily, which
were gradually increased to four drachms. This increased
quantity produced at first slight vertigo*, dimness of vision, and
finally involuntary contractions similar to those resulting from
the use of strychnine. These symptoms ceased on the discon-
tinuance of the indigo, but were always reproduced when the
was again increased to three or four draehms.

The second individual was a girl 20 years of age, who had
been epileptic since her fourth year of age. She menstruated at
eighteen, since which time her paroxysms, that had previously
occurred once, -twice, or thrice daily, had increased to a frightful
degree, especially about the menstrual periods, and, since her ad-
mission to the hospital, she had never experienced less than ten
or twelve paroxysms in twenty-four hours. On being submit-
ted to the indigo treatment, in doses increased from one to four
drachms, the freo^.ency of the paroxysms rapidly diminished.
They even ceased entirely on the sixth day of the treatment,
which howrever was continued a month.

The last case related is that of a female in her fiftieth year, and
who had had epilepsy twenty years. She had been several
rs in the institution under M. Noble's direction, and had not
only weekly attacks, but occasionally four or five in a day.
Treated as the above two cases, the paroxysms have never re-
turned since the fourth day, although she still experiences the same
uneasiness and stupor which usually followed each paroxysm.
She is yet under treatment, but the dose is not now carried be-
yond two drachms.

The two last individuals experienced no involuntary contrac-
tions, but were affected with much diarrhoea whenever the dose
reached four drachms. The diarrhoea ceased on suspending or
merely diminishing the dose. Neither of the cases presented
any other functional disorder. They will tend to confirm the
efficacy attributed to this remedy, although they do not prove,
as do those reported by M. Idelcr. that the disease will not re-
turn. They are nevertheless sufficient to authorize further at-
tempts, especially when the disease returns at short intervals. ,

[Ibid*

1837.] Solid Carbonic Acid. 503

Solid Carbonic Acid.

The Gazette Mvdicah de Paris of the 8th of October last, con-
tains the proceedings of a meeting of the Academy of Sciences,
on the 26th September, 1836, from which we derive the following
extract, announcing the interesting discovery of the means of
solidifying carbonic acid.

M. Tiiilorier, after relating a series of experiments made wTith
Uquid carbonic acid, proceeds as follows to state the particulars
of his more recent, discovery :

"When, in 1832, 1 directed for the first time a current of li-
quid carbonic acid on the bulb of a thermometer, the glass vessel
in which rested the bulb was almost, rilled with a white powder
of a peculiar character, and whose grains were finer than those
of snow ; it ivas solid carbonic a'cid. Many persons have seen
this substance, which was so abundantly foi med as to prove an
obstacle to the frigorific effect of the current on the thermometer.

] will now state why the nature of this substance was not soon-
er detected. The iirst apparatus 1 used for the- production of
liquid carbonic acid, served both as a generator and receiver;
that is to say, that the liquified gas would float over the solution
of sulphate of soda resulting from the chemical action. The ex-
tremity of the tube through which issued the liquified gas," being
near the surface of the saline solution, I was led to think that the
liquified gas carried with it aqueous particles in the form of snow,
and it was in order to avoid this inconvenience that I determined
to convey the liquid carbonic acid into a separate receiver.

The necessary apparatus had just been completed when the
committee met to repeat the various experiments I had made with
the liquid carbonic acid. On turning the cock, I perceived with
much surprise that this substance formed as abundantly as it had
done before; and when one of the committee observed that it
could be nothing else than solid carbonic acid, I wras already
convinced of the fact, for I alone knew positively that the appa-
ratus contained nothing but carbonic acid. I may then state
that the committee determined with me the fact of its solidifica-
tion, and 1 trust that their justice will acknowledge my claims to a
"discovery unconnected with the ordinary processes of the labor-
atory, and which required mechanical means of the greatest pow-
er and utmost precision, as well as a degree of scientific zeal,
which the committee have appreciated/'

After the reading of this statement, a vessel filled with solid
carbonic acid, resembling snow, in the middle of which was a
block of solidified mercury weighing upwards of a pound, was
presented to the academy. The frozen mercury was broken in-
to pieces with a hammer, and presented a crystalline fracture.

504 Proceedings of the French Academy of Medicine. [Jan.

Extracts from the proceedings of the French Academy of Medi-
cine on the 4th October last.

Treatment of Itch.

M. Malapert objects to the usual method of treating Itch, as
disagreeable and uncertain. He therefore sought for another,
and thinks the causlics will combine the advantages of prevent-
ing the disease from being translated to the more important in-
ternal organs, and of radically effecting its cure. He prescribes
them in the form of frictions or of lotions. The caustics he enu-
merates are potass, soda, muriate of mercury, sulphuric acid,
and sub-carbonate of potass, but gives the preference to the mer-
curial preparation as the most certain and expeditious. Accor-
ding to M. Malapert, the mean duration of the treatment with a
solution of mur. hyd. (12 grs. to 3j. water,) is fifteen days.

Essay on the relation existing between the symptoms of primitive
and secondary Syphilis : By M. Martins.

The first question proposed by M. Martins is which of the
symptoms of the primitive disease are most commonly followed
by secondary syphilis? The consecutive affection sometimes
follows gonorrhoea, though rarely, and its complication with or-
chitis or buboes adds nothing to the danger. Chancres lead to it
much more frequently, especially if they be accompanied, pre-
ceded, or followed by other symptoms of infection.

The most common of the sequela? are papular eruptions,
whereas the most rare (in adults) are the pustular forms of the
disease.

The more inveterate forms, or syphilitic tubercles and ulcer-
ations follow gonorrhoea as often as chancres; and more than
one half the cases of secondary syphilis are first manifested in
the face and scalp.

Nothing is more uncertain than the period at which the second-
ary symptoms may appear; they are however more tardy after
gonorrhoea than after chancres. One half of the cases succeed-
ing chancres occur in the course of seven months. Among the
causes which predispose to secondary syphilis, M. Martins ranks
heat as first ; but admils that extremes of temperature have al-
most as much influence.

Taliacotian ()j>rrations.

M. Blandin presented to the Academy, two individuals on
whom he had practised the operation of "Autoplastic," one of

1 837.] Proceedings of the French Academy of Medicine. 04

them, a lad about 12 years of age, had nearly the whole of the
left side of his face torn away by the accidental discharge of a
gun. The buccal cavity was laid open so that the saliva con-
tinually dripped out. M. Bland in detached a bit of skin from the
forehead and formed with it the lost side of the nose ; with ano-
ther brought down from the temporal region, he replaced the
cheek and left commissure of the lips. M. B. remarks, that he
retained the temporal artery in the latter flap, notwithstanding
the opinion of Diffenbach, who advises that large arteries should
never be used in such operations.

The other individual was a man, perhaps fifty years of age,
whose upper lip had entirely been removed with a cancer. M.
Blandin replaced the lip with skin derived from the anterior part
of the neck.

Lithotrity.

M. Segalas presented a child two years old on whom he oper-
ated for the stone, by lithotrity, when only 33* months of age.
The cure required six sittings and was completed in six weeks.
The case is one of interest, the child being younger than any
hitherto subjected to the operation. Gazette Medicate de Paris,

Cancer of the mouth removed successfully by a new process : By
M. Roux, of the Hotel Dieu.

The tumour was situated between the tongue and the right
branch of the inferior maxillary bone, and extended from about
half an inch in the rear of the last molar tooth, to half an inch on
the left of the mental symphysis. Its upper surface, ulcerated,
greyish, fungous, and bleeding on the slightest touch, was ele-
vated a little above the level of the teeth ; but the jaw was not
affected. None of the teeth on that side were missing, and none
were pressed aside ; the two incisors alone were slightly moveable.
The tumour was separated from the root of the tongue by a deep
fissure. The tongue was perfectly sound, but pressed to the
left, and elevated towards the soft palate, so as to render speech
almost unintelligible. By the finder introduced beyond the tu-
mour, it was ascertained that it did not extend quite to the root
of the tongue, and that it terminated abruptly by a vertical sur-
face. The parts beneath were depressed so as to project below
the lower edge of the branch of the maxillary about a half inch.

M. Roux having previously ascertained, by experiment on the
dead body, the extent in which the branches of the inferior max-
illary could be separated without injury to its ligaments, after the
division of the symphysis, and finding that it could be carried to

This must be a typographical error.

06 Period for Hare-lip Operation, $c [Jan,

an inch and a half or even to two inches, resolved on the opera-
tion, which he performed on the 4th of May.

The patient being seated in a chair in front of the surgeon, a
vertical incision was made through the lower lip, on the median
line, and extended to an inch below the chin. A fine saw was
then introduced between the incisors, and the jaw severed at the
symphysis. The branches of the bone were now by gentle la-
teral traction, separated about two inches at the symphysis, the
soft parts readily yielding, and held in this position by the hands
of an aid standing behind the patient. The surgeon then, with a
convex scalpel, detached the tumor from the internal face of the
jaw-bone and from the root of the tongue. During the last inci-
sion, a pretty large artery coming from the tumour was opened,
but immediately tied. A double hook (airigne double) carried
into the posterior part of the tumour, served to draw it forward,,
and the operator making tractions, with its handle between the
teeth, detached the posterior adhesions, leaving it connected only
inferiorly. The tumour was now readily separated from the
Subjacent muscles, which were found perfectly normal. Another
artery was opened and tied.

The tumour being thus entirely removed, the bones were
brought together ana maintained by a silver wire carried around
the four incisors ; the soft parts were united by the twisted su-
ture ; and no other application made. With the exception of
small fragments of bone coming away from the internal face of
the mental portion of the inferior maxillary, there were no un-
toward circumstances attending the cure of this case. The
bones united kindly, and the patient was discharged on the 4th
of July following. The mouth had healed, but the tongue ad-
hered to it in such a manner as materially to impede pronunci-
ation and mastication. There was no evidence of a disposition
in the disease to return. The lymphatics of the neck were nat-
ural. Journal des Connaissances Medico-Clnrurgicales*

Period for Hare-lip Operation.

The Boston Medical and Surgical Journal for 14th December,
1836, furnishes us with some observations on the operation for
hare-lip, by Dr. Peirson. In this essay, the author, after array-
ing and inspecting the opinions and practice of the principal sur-
geons, from the time of Cclsus to the present, on the subject of
the age of the patient best suited to good success, concurs finally
with the late Dr. Rand, senr., of Boston, on recommending the
operation immediately at birth. This concurrence of opinion is
founded on the facts of observation, of himself and others, as well
as the reasoning against other periods of life, as the time of den-
tition and after that is over, the most ungovernable period of life,
in which there is not a sufficient development of the reasoning

1837.] Period for Hare-lip Operation. 50?

faculty to overrule the pcrvcrsencss of disposition, or the dread
of pain and so forth. After stating the success of Dr. Rand's
last case, in which "the child was put to the breast a few days
after (the removal of the pins on the fourth day), sucked as well
as any child until she was weaned ;" and became a fine healthy,
handsome girl, with scarcely a trace of a scar in her lip. He
proceeds:

" I cannot help concurring with these views, and recommend-
ing the operation at the very earliest age, provided the child is
in good health and well constituted. Many of the objections
made to this operation at this early age arc certainly groundless.
It is not true that there is not consistency and firmness enough in
the lip to bear the pressure of the pins or sutures. And com-
pared with any other period, anterior to teething, I do not believe
the danger of convulsions or death is any greater. There is,
doubtless, a degree of danger, which must be encountered in all
such operations during infancy ; but ought this to weigh against
the parental distress and anxiety, the risk of defective nutrition,
the imperfect ossification of the maxillary bone, and the defective
pronunciation, which are the probable, or certain consequences
of delay?"

Dr. P. then gives two cases in point. In the first he operated
for a simple fissure of the lip, on the next day after birth. The
operation was performed in the usual manner, with hare-lip pins.
Three days after, the pins and all the dressings were finally re-
moved. On the eighth day after birth, the child was put to breast,
and nursed as well as any infant. The cicatrix became so ef
faced, that there was scarcely a perceptible deformity left

He states as one of the advantages of this early operation, the
fact that the deformity being in the first instance kept secret, the
parents were saved from annoyance by the officious enquiries of
their friends and neighbors. This is a matter of no trivial con-
sideration with most parents; but there is a more valuable fact
than this in the case, and it is that the deformity was so com-
pletely removed as not to lead to the discovery of the part after-
wards.

In his second case, which was last February, he operated on
a child born the previous day. The fissure in this case extend-
ed through the superior maxillary bone and soft palate. In three
days the union was completed and the pins removed. In this
case, the child was well nourished by feeding, but could not suck on
account of the extent of the fissure in the palate. He considers
the early operation peculiarly important in this case for facilita-
ting the ossific union of the palatine bone.

Dr. P. then advances other reasons in favor of the operation
the next day after birth ; as the fact of the removal of the fissure
preventing, by the regular and moderate pressure of the lip on
the part, the projection of the anterior part of the maxillary bone

598 Bad Surgery, $c. [Jai.

through the fissure; a circumstance-which not unfrequently oc-
curs at and after dentition; also the fact that the infant is more
generally free from all diseases during the first week ; and that
" it is perfectly practicable to keep the mother ignorant of all the
circumstances, until she can be informed that the steps necessary
to remedy the deformity have been completed."

On the subject of the mode of performing this operation, the
Dr. asks, "can it be said that the mode of performing the opera-
tion is better settled than the time? Dr. P. for many good and
insuperable reasons adopts the use of thejstraight silver pins with
polished steel heads (points?) and the twisted suture ; and the
scissors are preferred to the bistoury for removing the sides of
the fissure. The difficulty which commonly occurs in the use of
the scissors, of holding the edge of the lip to the instrument, he
overcomes by adopting the expedient of Dubois and Roux, of
passing a thread through the angle of the lip by means of a curved
needle. In all ordinary cases, he advises the removal of the pins
after 72 hours, as he considers that nothing is gained in point of
longer co-aptation of the edges, as the ulceration which is apt to
take place around the pins after this time prevents their effects,
as well as increases the mark which they leave on healing disa-
greeably large.

After they are removed, the uniting bandage should be applied,
and the retracting powers of the cheeks prevented from action,
as far as practicable.

Bad Surgery.

The following is a very striking illustration of the old plan of
treating fractures of the thigh of a good patient, with a box for
extension and counter-extension.

We are free to acknowledge, that whilst we practised in these
cases on the Dessault and the Physic plan, that our sympathies
wen; ah. ays more or less excited, by the actual suffering which
the treatment alone inflicted; and occasionally we have had the
mortification to witness, in those patients who were most amia-
ble, and patiently submissive to orders, most extensive ulcerations
at the points of pressure. Nor were these the worst of the evils,
but, as is too often the case with people in other matters, we
found ourselves like great men in bad things ; and as was the
fact with the celebrated Boyer and Deschamps, in the case of the
illustrious La Fayette, we were not unfrequently chargeable
with that mal-surgery which entailed on our patients lameness
and deformity for life. Whilst the case is important in a bio-
graphical point of view setting forth beautifully as it does the
extreme amiableness of him whom Americans so much revere,
it is no less useful in exhibiting a proper comparison between the
old plan of treatment, which is yet chiefly in use, nnd the treatment

1837.] Want of the Sagittal Suture, $c. <$<;. 509

by weight and fulcrum as illustrated by a number of cases in the
5th No. of the Southern Medical andSurgical Journal, page 281.
We are of the opinion that, one of the causes, (and not the least,)
which tend to retard not only surgery, but medicine generally,
is the concealment of bad practise, or ill success. When we had
the honor of beholding this great and virtuous lover of freedom,
this bosom friend of our own Washington, as our " nation's
guest," so bright was the halo of glory that shone from his heroic
deeds, that no thought entered our mind but that his decripitudc
marked his sacrifice on the altar of American liberty. Had it
then been known as publicly as his misfortune was, that it was
the result of bad surgery, surely the inventive genius of freemen
would not have rested short of a remedy which would have
saved from such afflictions.

44 Maltreatment of a Fractured Leg in Gen. Lafayette. M. Jules Cloquet,
relates the following instance of bad surgery on the part of the celebrated
Burgeons Boyer and Deschamps.

44 During his last illness, Lafayette related to us more than once the partic-
ulars of the treatment he underwent in 1803, for the fracture of a thigh,
caused by falling from a height ; Deschamps and Boycr, whose memories I
respect, and under whose care I was educated, were called in, and enclosed
the limb in a machine constructed so as to maintain it in a state of continual
extension. Lafayette having promised his surgical friends that lie would pa-
tiently endure the pain and inconvenience necessarily attendant on the treat-
ment, did not give utterance to a single complaint, and did not betray the
least sign of being in pain for the whole of the twenty days which elapsed be-
fore the apparatus was for the first time removed ; when it was removed,
however, his surgical friends could not conceal their consternation ; Des-
champs turned pale, and Boyer appeared thunderstruck. The bandages of
the upper portion of the apparatus had, by their pressure, cut deeply into the
flesh, and exposed the femoral artery, while the skin of the dorsum of the foot
was rendered gangrenous by the inferior bandages, so as to lay bare the ex-
tensor tendons of the toes. More than five weeks were required to heal
these wounds, and when the cure was completed, an almost complete an-
chylosis of the hip joint had taken place, so that he was lamed for life."

[Boston Medical and Surgical Journal.

Want ofth* Sagittal Suture. Mr. Wallace, surgeon in the British navy,
lias lately had the opportunity of examining the heads of four negroes from
the western coast of Africa, in all of which the sagittal suture was wanting.
This can hardly be thought an accidental occurrence, and leads to the con-
clusion, though exceedingly remarkable, that sucli is the usual cranial confor-
mation in this race of blacks. Ibid.

Cinnabar Fumigations. Dr. Venot employs with success the following
mode of fumigating venereal ulcers of the throat with cinnabar. After soak-
ing sage-leaves in strong gum-water, the sulphuret of mercury is sprinkled
over them, and they are dried in the sun ; they arc afterwards smoked in a
pipe instead of tobacco, and the vapour is thus directly and conveniently ap-
plied to the diseased surface. Several cases are reported to prove its rfnea-
oy. Jwr, rf# Med. Pra'iqve dela Snr. Boy. d Bordeaux, Ftvrier, 1836.

510 On the nature and mode of action of Cantharides. [Jan,

On the Nature and Mode of Action of Cantharides : By Dr. Domenico Nardcx
of Venice, and Dr. Tommaso Pullino of Alba.

[We regard as most valuable every fact that tends to illustrate and estab-
lish the physiological and therapeutical action of medicines on the animal sys-
tem ; and we are rather disposed to direct attention towards the more ex-
tended and closer investigation of the properties of our old remedies, than to
hunt after new ones of doubtful efficacy. We have yet much to learn res-
pecting our best known medicines, and certainly respecting that which is the
subject of the following pages which contain the more essential parts of two
long memoirs.]

First Memoir. By Dr. Nardo.

1. Cantharides, when chewed, have not that acrid taste which has been,
assigned to them, solely from analogy.

2. They will act in an entire state or in powder.

3. The green portion is the only active part of the fly.

4. In this green portion alone is found the cantharidin.

5. There is no other poisonous principle existing in the fly.

6. The green principle is analogous to that found in the involucra of other
insects having no vesicating powers.

7. The other principles, as the black and yellow substances, are produced
by other insects, and are modified by the process followed in their extrac-
tion.

8* Cantharidin is a neutral body, unchanged by acids or alkalies ; soluble
in cold sether, creosote, oils and fats, and in boiling nitric acid and alcohol.

9. It has neither smell nor taste ; but, if a small quantity be laid upon the
tongue and pressed against the palate, it produces after a time a scalding sen-
sation. The same thing occurs if it be dissolved in aether or oil, which, by
aiding its absorption, increases its powers.

10. A very minute quantity of cantharidin is sufficient to excite vesica-
tion : for its farther action is arrested the moment that the elevation of the
epidermis by the serum removes the absorbents from their contact with it.
The vesication, therefore, is not increased either by a larger quantity or lon-
ger application of the cantharidin.

11. Cantharidin does not vesicate by irritating or producing any sensible
inflammation ;(]) its action upon the cutaneous system appears to be limited
to the lymphatics, or to a slight stimulus confined to the cutaneous layer be-
low the epidermis, so that the nervous and sanguiferous systems do not suffer
at all during the process of vesication. (])

12. 13, 14. Cantharidin applied to the denuded cutis induces a serous ex-
udation, followed by an atonic suppuration ; and acts in the same way that
it does on the outer surface, its action is most speedy and painful upon parts
most supplied with sebaceous and mucous follicles.

15, 16. Cantharidin is not decomposed when absorbed, and its absorption
ceases as the vascular action of the cutis is excited.

17 20. Being carried through the system in an undecomposed state, the

cantharidin is eliminated like other foreign matter ; but, if the quantity be
great, it accumulates in certain parts, and produces its effects according to
the nature and susceptibility of the organ. Its stimulating effects upon the
urinary passages, and its boasted aphrodisiac powers, are not peculiar pro-
perties, but result from the effects of its primary action. Thus, carried along
with the urine, it attacks the prostate follicles, producing a state approaching
to vesication ; and the urine, by increasing this irritation, produces the symp-
toms of priapism, ischuria, &c. Its poisonous action upon the alimentary
canal is produced in an analogous manner, but gives rise to more extensive
sympathies.

1837.] On the nature and mode of action of Cantharides. 511

21. Camphor has no power as an antidote to cantharides.

[Dr. Nardo lias given cantharides in various kinds of dropsy, but could
never perceive any effect from them. The effects as an aphrodisiac are very
uncertain, and usually are only exhibited when they are taken in dangerous
doses. The author rather prefers in paralysis of the bladder and incontinence
of urine, a weak injection of cantharides.] British and Foreign Review.
Antologia Medica.

Second Memoir. By Dr. Pullino.

1. Two grains of cantharidin, given at once to a middle-sized rabbit, pro-
duced paralysis, coldness, and death in three hours.

2. A grain and a half dissolved in milk caused the same symptoms, and
death in an hour and a half.

3. The same dose with m. xv. of cherry-laurel water caused instant death.
The rabbit had five hours previously taken m. xx. without injury. Heart
empty and flaccid, stomach pale.

4. A fourth rabbit took two grains in solution, with the same symptoms and
convulsions of the hind legs. It then took a few drops of ammoniated aether,
and one grain of acetate of morphine, at two doses. It revived, but was not
lively, and died in twelve days. Stomach reddish here and there ; menin-
ges injected.

5. Two dogs of the same age and size, took, the one ten grains of cantha-
rides in decoction ; the other twelve grains in powder. The former was
paralyzed, and died ; and, on examination, presented no inflammation of the
stomach. The other tried to vomit, was distressed, writhed, and moaned.
He was killed in six hours, when the poison was found undigested, and the
stomach reddish.

6. Three more rabbits were killed with cantharidin, and two with cantha-
rides. The stomachs of those that drank after taking the poison were unin-
jured, and the inflammation in those that did not drink was too slight to ac-
count for death.

7. The author took two grains of cantharidin at two doses, fasting, and felt
a universal shivering and chill down the spine, skin pale, head oppressed, and
in one minute the pulse fell five beats. Urine copious in a quarter of an hour
afterwards.

8. A fortnight subsequently, he took two grains at four doses. After the
second dose he felt a dull pain in the head, and at the next a little vertigo, the
skin being cold and clammy. The pulse, after violent, action, lost seven beats
in a minute. Urine scalding and copious, although but little fluid had been
drunk. In the afternoon he took some alcohol, and then ten drops of ammo-
nia in water, when the vertigo ceased and the urine by midnight no longer
scalded. Unusual weakness next day.

9. The following are notes of some cases of disease in which cantharides
were exhibited :

(1.) Pleuropneumonia . After two bleedings, the pain continued with bloo-
dy sputa of unhealthy consistence. Three grains of cantharides in solution,
gradually increased to ten, were taken daily. Continued sweats, urine not
increased ; sputa healthy, pain gone in sixteen days , eighty-five grains ta-
ken.

(2.) Carditis. One hundred and twelve grains taken in twenty days ;
urine scalding at first, very copious and turbid afterwards;

(3.) Beating of arteries of the left side of the head preventing sleep ; had
been treated by many bleedings. The patient took one grain of cantharidin
in four doses at short intervals. Vomiting, pulse small, rapid, rigors, ver-
tigo, torpor of lower extremities, and other signs of depression. iEther, opi-
um, wine and generous diet, produced a cure.

(4.) Intermittent Fever threatening suffocation. Bleeding during the pa-
roxygm, and quinine, were followed by ardent and continued fever, dryness

ol2 Influence of the Nerves on the Muscular System, <Jc. [Jan.

of skin, pains in loin?, and ischuria. Fifteen grains of cantharidin taken in
eight days, at first increased the pain, bu1 not the fever. At first, urine bloo-
dy, afterwards bluish, then turbid and abundant. Sweat came on soon af-
terwards, and a cure followed.

(5.) Lumbago. Cantharides rendered the pulse hard. The patient had
had gastritis just before. Cantharides applied to the epigastrium denuded
of the cuticle did not lower the pulse. Bloody urine, but no improvement.

(6. Phlegmasia dohns in a girl with amenorrhea. Cantharides cured the
swelling, but did not restore the uterine functions.

(7.) Puerperal metroperitonitis with lumbar pains and dysuria, cured by
cantinridin, baths, and mercurial frictions. Urine copious, with some clots
ofbloo.1.

(8.) Anasarca with congestion of the spleen, of three years standing, cured
by mercurial frictions and cantharidin, carried to six grains per diem. Urine
copious, much viscid perspiration, very slow pulse. The patient fell into a
very weak state, which was removed by the use ofsetherand sherry. Bri-
tish and Foreign Review. Annali Universali di Medicina.

On the influence of the Nerves on the Development of the Muscular System:
By Professor Antonio Alessandrini.

In 1829, Professor Alessandrini published an account of the dissection of a
calf whose medulla spinalis terminated about the tenth dorsal vertebra, and
in which all the voluntary muscles were absent which are usually supplied by
those spinal nerves which were wanting. Thus there were no muscles to
the hinder limbs, and some of the muscles of the trunk were but half devel-
oped. On the other hand, all those parts essentially composed of cellular
tissue, the integuments, adipose tissue, vascular system, aponeuroses, bones,
&c. of the hinder extremities, were natural.

The conclusions which, he then came to on the influence of the nerves in
the growth of muscles were strengthened by the following case of monstrosi-
ty which has recently fallen under his notice. The vertebrae and spinal mar-
row of a young pig, removed from the uterus of a sow killed for food, who had
gone with young her full time, were found to be deficient below the fifth dor-
sal vertebra. The head, neck, anterior part of the chest, and fore-legs were
natural and muscular; but the posterior part of the thorax and abdomen had
the appearance of a large ovoid bladder with strong aponeurotic walls, to
whose fundus and lower extremity were attached the ossa innominata, which
sustained the hinder limbs. All those parts of the thorax and abdomen, as
well as of the hinder limbs, which were deprived of nerves, had no voluntary
muscles. The viscera of the thorax and abdomen were natural, as well as
the par vagum and grand sympathetic. The muscular coat of the intestines
was very visible. Another instructive peculiarity was, the existence of an
isolated portion of the vertebral column of the coxygeal or caudal region, con-
taining a small cylindrical piece of the medulla spinalis, from which sprang
some delicate nervous filaments distributed to muscular fibres, representing
some portions of the caudal muscles.

From these two cases the Professor deduces the following propositions :

1. That the nerves contribute to the formation of muscular fibres more than
the blood-vessels, as the latter were regularly formed in the hinder limbs.

2. Muscular fibre is not only formed by the influence of the nerves of animal*
but also of organic life. 3. The existence of an isolated portion of the spinal
marrow in the pig demonstrates that the various nodi or centres of the cere-
brospinal axis are formed independently of each other, so that it cannot be
said that one is the production or prolongation of the other. British and
Foreign Review . Bulletino delU Science Mediche.

SOUTHERN MEDICAL

AND

SURGICAL JOURNAL.

Vol. L] FEBRUARY, 1837. |No. 9.

Part I. ORIGINAL COMMUNICATIONS.

ARTICLE I.

Case of Hydrocephalus, with Operations: By J. B. Whit-
ridge, M. D., President of the Medical Society of South Car-
olina*

Susan, a plantation servant of mine, was sent to town on the
28th of August, 1832, with her child three months old laboring
under Hydrocephalus. She states that the birth was attended
with less than ordinary suffering (being the mother of several
children.)

One week after birth, the child was affected with spasms, which
continued three weeks, and finally subsided under the domestic
treatment of the midwife, nurse, and overseer, aided by an occa-
sional prescription of a physician.

The mother states that about the time the navel string dropped,
spasms supervened, and that when the spasms subsided, the en-
largement of the head suddenly took place. From that period to
the time the child was sent to town, nothing remarkable occurred,
except that the child was uniformly subject to constipated bow-
els, and was generally fretful, but became less so as the head en-
larged always urinated freely, nursed well, and in other res-
pects enjoyed good health.

On the 29th, I consulted my experienced and valued friend,
Dr. Joseph Glover, who concurred with m* in opinion *r 4l f

514 Case of Hydrocephalus, with Operations. [Feb.

expediency and necessity of having immediate recourse to the
'operation of Paracentesis.

On the 31st of August, in presence of Dr. Glover and his son,
I performed the operation by puncturing the internments of the
cranium through the anterior font anelle, about three-fourths of an
inch to the right of the longitudinal sinus introduced a common
director, the groove of which served to conduct the serum from
the brain, which was evacuated in a gradual manner to the
amount of nearly a pint hy weight upwards of fourteen ounces.
The child cried of course, from the pain of the operation, but
"seemed to be relieved by the evacuation, and before the close of
the operation actually went to sleep. A piece of adhesive plas-
ter was placed over the orifice, and the head bandaged so as to
approximate the bones which were open at all their sutures, (ex-
cept the lower portion of the squamous suture,) and to make
some pressure upon the brain, perhaps nearly equal to what
existed before. The strabismus which had previously been a
prominent symptom, was now in some measure relieved. Im-
mediately after the operation the child sucked heartily but was
somewhat fretful during the afternoon towards evening there
was a considerable increase of pulse. With a view to promote
absorption from the brain and to determine to the skin and kid-
neys, I directed a mixture of two parts sp. aether, nitr. and one
part tine. dig. pur., three drops to be taken every two hours and
gradually increased to six. This acted very pleasantly, not only
upon the skin and kidneys, but as an anodyne, produced tranquil
sleep during the latter part of the night.

Sept. 1st. Apparently very comfortable all day had three
spontaneous evacuations from the bowels. Medicine continued
in doses of six drops.

Sept. 2d. Child in statu quor except that the head had dis-
charged considerably during the night, and the bowels were
somewhat constipated. Continued the drops until 12 o'clock,
then ordered, sub. mur. hydr. gr. vi. In the afternoon rem ovci I
the bandage and found the head much diminished in size. Soon
after, (allowing a little time for an equilibrium to be restored in
the circulation,) firmly re-applied the bandage so as to make con-
siderable compression. At 6 o'clock, directed ol. vol. pini lar.
?ss., there having been but one al vine discharge during the day,
and no other operation from the bowels since the exhibition of

1837.] ( 'ifsc, <>f Hydrocephalus, with Operations. 515

the calomel. The turpentine having no effect, ordered oleum
ricini 5ss. to be given in two doses, one half at 9 o'clock, the oth-
er at half-past ten if necessary.

Sept. 3d. Medicines operated five times in the course of the
night, but was succeeded by pain, griping and tenesmus and it
was thought too by pain in the head, which might have been oc-
casioned by crying or perhaps by cold. The latter, however,
was not indicated by any marked febrile symptoms. Ordered
enemata of starch and laudanum. Two of which were admin-
istered and two drops of laudanum per orem. Several doses
were given before relief was obtained. The child became quiet
in the afternoon and slept tolerably well. Resumed the diuretic
mixture.

Sept. 4th and 5th. Child quite comfortable nursed well .
bowels acted on once or twice each day apparently free from
irritation and pain. Diurectic mixture continued in doses of six
drops every two or three hours.

Sept. Gth. In the morning the child had convulsions the
head gradually enlarging and strabismus increasing. Directed
calomel gr. vi. to be given, which operated but three times du-
ring the afternoon and night

Sept. 7th. Calomel operated once during the day. Child
continues much the same as yesterday. Drops continued.

Sept. 8th. The little patient remains the same, except thai the
head is rapidly increasing. Diuretic mixture continued.

Sept, 9th. Child tolerably comfortable in the morning. At
mid-day had two or three convulsions these occurred again in
the evening. Child rather fretful when awake, but sleeps much.
Ordered calomel gr. vi. to be given, and the laced cap upon the
head, which had been substituted for the bandage, to be loosed.
The diurectic drops have been continued as usual about xxxvi.
drops in twenty-four hours.

Sept. 10th. The calomel operated but once during the night.
Directed sub. mur. hydr. gr. iij. mixed in ol. ricini I ss. which
operated freely five times in the course of the day and night.

Sept. 11th. Child somewhat better. Increased the dose of
the tine. dig. and sp. sweet nitre to eight drops every three
hours.

Sept. 12th. Child continues better evidently improved by
the cathartic. Drops continued as yesterday.

516 Case of Hydrocephalus, with Operations. [Feb.

Sept. 13th. The little patient continued tranquil all day. The
drops which were given as yesterday, acted freely as a diurec-
tic.

Sept. 14th. Child's head had attained precisely the same size
it was before the operation, but the strabismus had almost entire-
ly ceased, and the child seemed in other respects much better.
At one o'clock repeated the operation near the place it was per-
formed before, and drew off seventeen ounces of serous fluid, con-
siderably more than a pint. Child bore it well. Cried hearti-
ly, and evinced very little inclination to syncope. Drops con-
tinued.

Sept. 15th. The child had a convulsion in the morning, but
has been in other respects quite comfortable during the day.
Medicine continued.

Sept. 16th. Continues much the same as yesterday.

Sept. 17th. Had a convulsion in the morning was fretful
during the day. Had another in the evening, was very restless,
cried much, and required to be held in an erect posture. Di-
rected twelve drops tine, camph. opiata to be given, which pro-
cured some rest.

Sept. 18th. Directed sub mur. hydr. gr. vi., which operated
three times in the course of the day and evening. Had a severe
convulsion about one o'clock, but was tranquil in the evening,
pulse and skin in good condition.

Sept. 19th. Child fretful and cried much in the morning.
Directed tine, camph. opiata to be given, which procured relief.
The bowels were acted on once during the day. The child urin-
ates freely under the use of the drops in the dose of eight every
three hours, as before. Skin in good condition.

Sept. 20th. The little patient has had a more tranquil day -
has been free from convulsions bowels and skin in tolerable or-
der. Drops continued.

Sept. 21st, 22d, and 23rd. The child during this period in
statu quo. Case marked by no peculiar symptoms of irregular-
ity or uneasiness. Diuretic mixture continued as usual.

Sept. 24th. Had a convulsion in the morning with some fe-
ver and apparent derangement. Ordered sub mur. hydr. gr.
viij. Other convulsions during the day. Calomel operated but
twice. In the evening gave pulv. con. jalapii, gr. v., sup tart,
potgr. xv., which produced two more dejections.

1837.] Case of Hydrocephalus, with Operations. 517

Sept. 25th. Child very fretful cried much, apparently from
pain. Directed tine, cam ph. opiata, gtt. xv, which gave relief.

Sept. 26th, 27th, 28th and 29th. No material alteration in the
child during the last four days. A 11 the emunctories of the body
seem to have been pretty well open, and no other medicine given
save the diuretic mixture.

Oct. 8th. No material alteration in the child since the 29th
ult. until yesterday, except that the child's head had gradually
enlarged, and during the last three days had become very turgid.
It was much less irritable, and for the last two days ceased to
cry entirely. The bowels as usual were constipated. One or
two doses of calomel only had been given, and the drops con-
tinued.

Yesterday morning (7th,) it was taken with cascading and
vomited much through the day. A little magnesia was given it
once or twice with only partial relief. In the night the vomiting
returned severely, and was then relieved by xv drops of elixir
paregoric. The bowels being still constipated, gave this morn-
ing (8th,) sub mur. hydr. gr. vi, which operated once in the
evening. At 4 o'clock, in presence of Dr. Waring, I again op-
erated upon the head, which was now very turgid, and enlarged
to nineteen and a quarter inches, measuring over the os occipitis
and os frontis, and nineteen and three-fourth inches measuring
under the chin and over the posterior part of the ossa parietalia,
near the apex of the lamdoidal suture. The quantity of serous
fluid which was now evacuated amounted to fourteen ounces by
weight. The puncture was made three-fourths of an inch fur-
ther back than the former some small blood vessel was woun-
ded, in consequence of which the serum was tinged with blood ;
perhaps a table spoonful was discharged, the flow of which,
however, ceased before the serum was all evacuated. The child
which had been so senseless and so constantly inclined to sleep
for three days before the operation, did not appear to suffer at all
from it. It was evidently more sensible, animated, and brighter
afterwards. Although there was not much strabismus previ-
ously, it looked better about the eyes after the operation was
performed.

Oct. 9th. The night though a tranquil one, was passed with-
out much sleep. To-day the child seems brighter and better
sleeps very little has had four voluntary stools, or else the effect

518 Case of Hydrocephalus, with Operations. [Feb..

of the calomel taken yesterday morning. The diuretic mixture
resumed this afternoon, winch had been suspended during the
last thirty hours. No material alteration in the child during the
10th, 11th and 12th, except that the head seemed to be filling up
rapidly. On the thirteenth, the child had several convulsions
was fretful and sometimes cried severely bowels somewhat
constipated had been acted on but once during the day. Di-
rected the laced cap to be removed and the child's head bathed
in cold water the cap to be reapplied, but not so tight as be-
fore. Ordered, sub mur. hydr. gr. vi., which operated but once
next morning. Drops continued.

Oct. 15th and lGth. The cathartic operated several times
freely, producing at first dark, afterwards mucus and stringy or
fibrous stools. Head rapidly swelling. To-day, (16th,) has
some fever, is fretful and apparently in pain has had several-
convulsions and although two discharges from the bowels, or-
dered a dose of cal. magnesia to be given, (say a small tea-spoon-
ful) at 6 o'clock in the evening.

Oct. 17th, 18th, 19th and 20th. No material alteration in the
child, except a gradual enlargement of the head, not only from
its rapidly filling up, but apparently from natural growth. The
child nurses heartily is fat, and grows well. The only incon-
venience which it seems to suffer, is, occasional slight convul-
sions, and constipation of the bowels. The head had again be-
come quite turgid, its circumference now (20th,) being nineteen
and a half inches and twenty and a quarter inches, measuring
under the chin. At four o'clock I repeated the operation, and
drew off thirteen and a half ounces of serous fluid reapplied
the laced cap directed the diuretic mixture to be continued as
before, and sub mur. hydr. viij. grs. to be given every fourth
day, to be followed with sup. tart. pot. if necessary. On the
21st, the mother and child returned to the country to remain a
fortnight.

Nov. 3d. From the account given by the mother, it appears
the child continued in statu quo, until Wednesday the 31st of
October. Previous to that time, it was comfortable, nursed
well, and she thought had lost no ground. It however had fits

occasionally, or was convulsed and the overseer, Mr, A

thought it quite ill. On Wednesday, as before stated, it became
very much worse. Its head had now become quite enlarged, so

is;*?.] Case of Hydrocephalus, with Operations. 519

as no doubt to occasion much compression of the brain. Fever
ensued, and the convulsions were increased.

On Friday afternoon, my boat left the plantation for town, in
which the mother and child took passage. Distance by water,
about fifty miles. The latter, however, was so ill, that the over-
seer thought it inexpedient for the child to come, but as it had
been directed, permitted the order to be complied with. While
on the passage, and when about half-way to town, the child died.

About twelve or fifteen hours after, I made a post mortem ex-
amination, the head at that time was nineteen and three-fourth
inches in circumference, measuring over the os frontis and os
occipitis above the ears, and twenty and a half measuring over
the ossa parietalia and under the chin ; just a quarter of an inch
larger each way than at the last operation.

I first plunged in a small trocar and drew offwhat water would
readily flow. I then made an incision through the scalp and
through the meninges of the brain, in the direction of the longi-
tudinal sinus, and along the sagittal suture, by means of which, I
evacuated the balance of the serous fluid in all two pounds and
a quarter.

The autopsy in this case, exhibits the following interesting
and singular phenomena. The medullary substance of the brain
was very small in quantity, being separated into two parts at
the ventricles, and attached to the parietes of the cranium the
substance of which was found principally upon two sides, and
upon the base of the cranium, arising with a thin edge near the
top of the parietal bones, and descending thence to the. base, not
more than six or eight lines in thickness in any part. The pa-
rietal bones were separated about two inches along the course
of the sagittal suture, and with the os frontis and os occipitis,
formed very large openings at the fontanelles. The dura mater
and the other cerebral membranes (viz. the pia mater and tunica
arachnoidea,) were very thick and strong, especially at the ante-
rior fontanelle. The falciform process extended to the base of
the brain, having a round opening in the centre, of about one
inch in diameter, which of course admitted of a free communi-
cation of the serous fluid from one side to the other. The ten-
torium cerebelli had also an opening in it similar to that in the
falciform process, which admitted of a free ingress and egress of
serous fluid, so that all parts of the cavity of the cranium were

520 Case of Hydrocephalus, with Operations, [Feb.

subject to dropsical effusion. The cerebellum was somewhat
smaller than usual, but in other respects it appeared quite natu-
ral and healthy. And upon the functions of this organ no doubt
depended the exercise of the powers of life, for so long a timer
and the apparent health and flesh of the child. The pressure
upon this organ as well as the cerebrum, previous to each oper-
ation, no doubt wras the principal cause of the convulsions. And
had the operation been repeated on the Wednesday or Thurs-
day preceding the child's death, it is probable its life would have
been prolonged. But that a sound and healthy action would have
been produced, or that a cure could have been effected by a rep-
etition of the operation, is not at all probable. The oftener the
operation was repeated, the more rapid would have been the
accumulation the more distressing the symptoms, and conse-
quently the greater the necessity for relief.

The first case which came under my observation, in which the
operation of paracentesis capitis was practised for the cure of
Hydrocephalus, and the first of the kind of which at that time I
had any knowledge, was the case read before the Medical Socie-
ty of South Carolina, on the first of July, 1818, by Joseph Glo-
ver, M. D. of this city, and subsequently published by the Soci-
ety in pamphlet form. In this case the operation was repeated
eight times, with great relief to the patient and with great hope
of success seven times by the Dr. and once by myself. The
first operation was performed on the 3d of March, and the last
on the 21st of June, 1818. The subject was a female child born
on the 21st of November, 1817. Six and three-quarter pints of
serous fluid were drawn off in the course of the several opera-
tions. The case terminated fatally on the 21st of June. After
death, three pints more were subtracted from the inter-cranial
sac formed by the dura and pia mater. Reviewed in the Ar-
chives Generates de Medecine, a Paris.

In the London Medical Repository and Review, for January
183G, another instance of tapping for hydrocephalus is reported,
by Mr. Sym, with an unfavorable termination. Noticed in the
Archives Generates de Medecine, Mars, 1826.

It is stated in the London Medical Gazette, for April,
1830, that Dr. Conquest had, in t\yo cases, performed the opera-
tion of puncturing for the cure of hydrocephalus, with success
in both.

1837.] Case of Hydrocephalus, with Operations, 521

Professor Gracfc of!3crl in, repeated this operation eleven times
in the course of six months, upon the head of a child, (a hoy be-
tween four and ten months old,) which resulted in a perfect re-
covery. Reported in Gracfe and Walter's Journal der Chirur-
gie, and copied into the Archives Generales de Medccine, a Paris,
Mars, 1832 Into the London Medical and Physical Journal
and into the American Journal of Medical Sciences, Nov. 1832.

This operation was subsequently performed for the cure of
hydrocephalus, by Mr. Russel of Aberdeen, with a successful
issue an account of which may be seen in the Edinborough
Medical and Surgical Journal, July, 1832.

Mr. Russel says, " with the exception of Dr. Conquest's two
cases, I am not acquainted with another in which the ventricle
has been punctured for the relief of water in the head. In the
cases of Rossi and Dr. Vose, the water between the membranes
only was evacuated.,,

In the London Lancet for June, 1835, a case is recorded in
which the operation was twice performed by Francis Cooper,
Esq., upon the same subject, and a large quantity of water evac-
uated, but with an unsuccessful termination.

In the Southern Medical and Surgical Journal, for December,
1838,* a case is stated by Professor Dugas, of the Georgia Med-
ical College, in which " the brain was punctured seven times, and
sixty-three ounces of fluid drawn off, without the slightest un-
pleasant effect from the operation," yet the case unfortunately
terminated fatally.

From the formidable character of this disease, and the gener-
ally fatal termination of it yielding to the power of no article of
the Materia Medica reasoning a priori, one could scarcely
come to the conclusion that the trocar would prove so important
a remedial agent. Although a majority of the cases which have
hitherto been reported, terminated fatally, as might have been
reasonably expected, yet, if the operation of parancetesis capitis
has proved successful in a single instance, it is a fact which ought

*Just as this article was about to bo closed, and placed at the disposal of
the Editors of this Journal, (though not originally written for publication,)
and just in time to be here noticed the seventh number of the Journal came
to hand, containing a description of Dr. Dugas' interesting case, which, in
many of its features bears so strong a resemblance to mine, as perhaps to
lessen in some measure the interest, which might otherwise have been felt,
in the details which are now presented to the public.

66

523 A short account of Master S. K. G. NeUis, $c. <c. [Feb.

to be duly appreciated by the profession, and one which I have
little hesitation in saying is sufficient to lead to a more genera 1
adoption of the operation in this intractable disease. To be suc-
cessful, it should be employed early before there is much func-
tional, and certainly before there is much structural derange-
ment of the delicate fibre of the brain that source and fountain
of all intellectual emanations. And to prevent compression,
which immediately impairs the functions, and sooner or later
brings on an organic affection of the cerebral mass, this remedy
should be had recourse to early in aid of which, all the other
means should be employed, that science and skill can suggest.
Charleston, S. C, December 20th, 1836.

ARTICLE II.

A short account of Master S. K. G. Nellis, born without arms,
and of his performances with his toes : By Paul F. Eve, M.

D., Professor of Surgery in the Medical College of Georgia.

While witnessing the wonderful performances of this youth,
during his visit to our city, I thought some notice of his deform-
ities, &c, would be interesting and acceptable to the readers of
the Southern Medical and Surgical Journal.

Mr. Nellis was born in Johnstown, Montgomery County, N.
York, in March, 1817. At birth he was of the natural size and
well formed, with the exception, he had no arms. During in-
fancy, he sucked his toes as other children do their fingers. At
nine months he creeped, drawing his body forward by his feet-
At eighteen months he commenced walking, and shortly after
this period, about two years of age, his spine became affected
with rickets. This disease he laboured under until a year or
two ago, and it has left great deformity of the spinal column. All
the dorsal or thoracic vertebra} must have been much diseased,
and no doubt this affection was aggravated by the want of arms.
He must have received many falls while learning to walk ; the
only support for the head and body while sitting being the spine.

1837.] A short account of Master S. K. Q. Nellis, 623

Through the kindness of Mr. Nellis, I am enabled to give the
following description of his present condition. He has permitted
me to examine all his deformities, congenital or natural and ac-
cidental or acquired. He is five feet four inches high. Head
well proportioned countenance very pleasing and intelligent.
Neck natural ; (wears a common size stock,) chin covered with
beard. Body very short, owing to great curvature of the spine,
which is inclined to the right side and projects posteriorly, pro-
ducing quite a hump-back. Felt through the clothing, or even
through the skin, this deformity of the spinal column, is not un-
Jike an arm bound down closely upon the posterior and right la-
teral portions of the thorax. It is not improbable that from this
circumstance, Mr. Xellis has been often accused of being an im-
postor, that he in reality had his arms and hands tied to the chest
under his clothing. On each side where the arms should have
been attached to the body, there is a small nipple, not unlike the
nipple on the male breast, but without an areola, and the place
for the axilla or arm pit, two to three inches below the acromion
processes, is covered with, black hair an inch or more in length.
The clavicles and scapula3 appear to be natural, the acromion
processes projecting considerably outwards and anteriorly.
The chest is not well formed, owing to the deformity of the
spine. Mr. Nellis wears an abdominal supporter, or common
belt, and which he cannot well dispense with, particularly in
walking. His inferior extremities appear long when compared
to his body ; they are well developed, as might be expected.
The right foot is from a half to three-fourths of an inch longer
than the left, which approaches somewhat the club-foot This
Mr. N. attributes to the left foot being turned on its external
edge, in cutting paper, &c. and to ins employing it to hold the
objects upon which he operates with the right. Also to the cur-
vature of the spine throwing the greater weight of the body upon
the right side. With the big toe of either foot, however, he can
throw a 56 pound weight live yards. He can also raise 160
pounds with his teeth. He says he now enjoys excellent health.
Appetite very great, takes free exercise, but cannot walk as far
as common persons.

As to his performances with his toes, they are truly astonish-
ing strikingly exhibiting to what extent by art, they can be
adapted to the offices of the fingers. To prove this, I cannot do

524 A short account of Master 8. K. G. Nellis. [Feb .

better than present to the reader the variety of these perform-
ances, and with which I conclude this article.

"1. With scissors in toes, Master Nellis will cut Valentines and
watch-papers, very ingeniously ; and will also cut the likeness of
any person very correctly.

2. He will make a paper fly-box-, and fold a letter in the true
love style.

3. With pen in toes, he will write a very Fair hand, and exe-
cute several drawings of animals, birds, fish, &c.

4. He will open and wind up a watch, take out and put in the
crystal with perfect safety, open penknives, screw up his ink-
stand, lock his desk, &c.

5. With bow and arrow, he will shoot at a quarter of a dol-
lar. This performance invariably astonishes the beholders, by
the almost unerring aim with which the archer uses his bow and
arrow.

6. On the violincello, Master Nellis will perform an accom-
paniment truly astonishing.

7. He will sing a number of songs, and conclude his exhibition
with dancing a favorite hornpipe.

The skill and dexterity with which Master Nellis uses his
toes as a substitute for hands, is a most striking example of the
manner in which human ingenuity will seek out the means of
supplying the deficiences of organization, to which some unfor-
tunate individuals of the human family are subject.

1837.] Anatomical Anomalies. 525

ARTICLE III.

iriatomical Anomalies: By B. B. Strobel, M. D., Lecturer on
Anatomy and Surgery, Charleston, S. C.

Va a .' iows from the regular standard, in the arrangement of
the structure of animals, are of so frequent occurrence, that they
have not failed to attract the notice and consideration of those
who devote themselves to the study of their organization.

*[*he different classes of animals vary from each other, not only
in their peculiar modes of formation," but also present peculiari-
ties in respect to the frequency and character of organic devia-
tions. As a general rule, the inferior order of animals present
fewer examples of these occurrences, than those of a higher class.
This has been explained upon the supposition, that the former,
being more simple in their arrangement, possess a smaller num-
ber of parts, and from this cause are less liable to depart from the
rule. Independent however of this, the power which presides
over their formation, is not disturbed in its regular action, by
the multiplicity of directions which it is compelled to take in cre-
ating a large number of organs; nor by the excessive exaltation
of other powers co-existant with the formative.*

It is not my intention to enter into a consideration of the cau-
ses which it has been supposed influence and determine these
variations. However plausible and ingenious the theories which
have been advanced, we arc still left a prey to conjecture and
doubt. Nor can we ever reasonably expect to unravel the se-
cret operations of nature, which are not for the most part cog-
nizable by our senses. It is not destined for mortal hands to lift
the veil behind which she performs her mysteries.

But however fruitless the search after ultimate causes effects
are evident and within the scope of our perceptive powers, and
it is a matter of vast importance that we should carefully note
these observations, which are calculated to embarrass us in the
discharge of our professional duties. The human frame pre-
sents us with innumerable instances of departures from the nor-
mal standard. No two individuals are formed precisely alike, if

* Meckel Anatomic Comparec.

526 Anatomical Anomalies. [Feb.

we consult the minutiae of their arrangement, and it would fill a
volume to collect and arrange all the anomalies which have been
noticed by different authors. Nor indeed are they of much prac-
tical importance, when they occupy certain organs, but they be-
come highly so when they exist in positions within the compass
of surgical operations.

Of all the organs of the human body, those of circulation and
locomotion present the most frequent-examples of all kinds of
deviations, especially in regard to form They seem to mani-
fest a disposition to ramify and divide.

Meckel has seen ten anomalous origins from the arch of the
aorta. It has been remarked, though rarely, that the arteries
are blended into a lesser number of parts, which but for this ac-
cident would have remained separate. Certain portions of the
nervous system, particularly the central, are often wanting, con-
stituting acephali. Some glands, particularly the testicles, pre-
sent peculiarities in regard to their positions. The eyes have a
tendency to form but one, on the median line.*

During the last four years that I have been engaged in anato-
mical pursuits I have had occasion to remark several anoma-
lies I may safely say that I have never carefully dissected a
whole subject in which I have not found some deviations, and I
have thought it advisable to communicate the following through
the medium of your journal. Let it not be supposed, however,
that I am disposed to claim the credit of being the first to dis-
cover and describe them ; on the contrary, I have no doubt that
they have been seen and described by others, and 1 merely give
the result of my experience as confirmatory of their observa-
tions.

And first of the Muscles. I once saw the first or superior di-
gitation of the scrratus major anticus, arising from the first and
second ribs, and passing upward and outward to be inserted into
the superior angle of the scapula, opposite the insertion of the
levator anguli scapula: ; the aponeurotic fibres of the two mus-
cles being in connexion at their insertion. The second digita-
tion of the scrratus arose from the third rib, so as to leave a dis-
tinct interval between it and the first, the interval being filled
with cellular and adipose tissue. The superior portion of the

. ' ' *

* Meckel.

1837. J Anatomicul Ano?nalies. 527

scrratus was thus constituted into a separate muscle, and fair!}'
entitled to he called the depressor anguli scctpulce.

On another occasion, the two recti muscles of the abdomen, a-
rose from nearly the whole length of the anterior part of the
sternum, the apeneurotic fibres being in connexion with those of

the stcrno clcido mastoid muscles, which descended on the anterior
part of the bone to meet them.

e ill my possession a preparation showing the two sterno
del I muscles, uniting at an acute angle to form a com-

it the upper part of the sternum. This tendon pas-
on the anterior part and median line of that bone, to termi-
nate in a point, opposite the fifth rib, and gives attachment on
either side, to the apeneurotic fibres of the corresponding peetc-
ralis major muscle.

Secondly of the Arteries. During one winter's dissection, I
met writh the high division of the brachial artery, in three suc-
cessive subjects, and in one this distribution existed only in one
arm, the other presenting the usual arrangement.

My friend Dr. B. B. Simons, has a preparation showing a
large branch, (nearly equal in size to itself,) given off by the
profunda femoris soon after it separates from the femoral artery.
After leaving the profunda, on its internal side, this artery di-
vides and sends branches to the rectus femoris crurcus, vustus
externus and internus muscles. The usual distribution exists in
the other limb. From the fact of this artery having been first
seen and described by Soemmcrring, it has been called arteria
descendens Socmmernns-i.

In one of my preparations, the aorta gives of one renal artery
on the right side, and three on the left. The inferior being sep-
arated from the two superior, by an interval of more than an
inch. In the same preparation, the coeliac artery originates but
two branches, the coronary and splenic ; the hepatic being sub-
sequently derived from the coronary.

The last anomaly which I shall mention is the one which I
have endeavored to illustrate by a drawing, and which, through
the liberality of the Editors, has been lithographed for the South-
ern Medical and Surgical Journal.

" It is not uncommon to meet with two hepatic arteries, of
which one comes from the coronary artery of the stomach, and
the other from the superior mesenteric. Sometimes the number

528 Anatomical Anomalies. [Feb

of hepatic arteries is even increased to three; a first arising from
the coronary, a second from the superior mesenteric, a third
from the coeliac trunk.* Murray mentions the following ano-
malies of this artery. That it sometimes arises from the coro-
nary, in which case the left hepatic is commonly wanting.
Sometimes also it comes from the superior mesenteric.^ In my
preparation there are two hepatic arteries, one arising from the
coeliac, the other from the superior mesenteric. It will be seen
by reference to the lithograph, that after giving off at its upper
side, the inferior diaphragmatic arteries, the coeliac divides into
three branches, the left hepatic, the coronary and splenic. The
peculiarity of the left hepatic, consists in its origin, and in its
giving off the pyloric artery, which usually comes from the com-
mon trunk of the hepatic previous to its division into right and
left. After originating the pyloric and some small branches, the
artery passes up to the inferior surface of the liver, enters the
left extremity of the transverse groove, and terminates by rami-
fying throughout the left lobe. The peculiarity of the right
branch consists in its origin from the superior mesenteric, and in
its giving off the right gastro epeploic and cystic arteries. Ha-
ving reached the inferior surface of the liver, it buries itself in the
left extremity of the transverse groove of that organ, and ter-
minates by ramifications in the right lobe.

* Cruveilhicr Anatomic Descriptive.
f Murray on the Arteries.

***Hn

Ormwn *y J>' Jtr.n

^SwV.yVIO^

A. Stcfc oftiuMd/rnu-Md (icrtih

D. Jnferwr JD^phT^niAte^rTertM

F. Sflwje ^Tfery
. CTon/ryJ*f1fcrij
JTX;tlfepaJtt .Artery

LPyforicfl/rfcri/.
:K. Superior MwtiStrieArX
~L Bight Hepatic d"'
M. Bight Gv.**rt>f*f>hM &>
H.SuptncrByhtColic d.
O . RznalJlrtima
P . iS'pwtn'ji.tic do
9 Jk/erwr .Mesenteric 1

JVumJ&en.ttwXf/.hojfrap'iie-Pw*

M,.U V , Ck.rUU.

1837.] Hysteritis Chronica with Cases. 529

ARTICLE IV.

Hysteritis Chronica with Cases: By Isaac Bowen, M. D.

Although the disease under consideration is a chronic affec-
tion, as observed in this and tropical climates, still the fever
which accompanies it, is a cauma, sometimes, however, in minia-
ture, as will appear from its description and treatment.

The penultimate and final syllables of the class of diseases, to
which hysteritis belongs, viz. itis, is derived from the Greek word
ae(aai, which is a ramification ofsw, and implies not merely slug-
gish action, but " violent and impetuous action."

It is imperfectly described in Good's study of medicine, under
the name ofhysteritis simplex, but the best description which I
have seen, is to be found in " Dewees' Treatise on Females," un-
der the appellation of " irritable uterus." I could not pretend to
give a better account of the diagnostic symptoms than is laid
down in that excellent volume ; but as my observations have
been in a climate many degrees warmer, where the cornplaint
occurs oftener, and as I have sometimes varied from his treat-
ment, although perhaps not essentially, it will not be considered
fastidious, that I should attempt to describe the disease as it ex-
ists in this climate. Another reason is, that the complaint is
oftener mistaken in the southern States for prolapsus uteri, than
in Philadelphia, and oftener still for gravel. The reason of such
mistakes is, undoubtedly, because it has many symptoms in com-
mon with those maladies.

The attack ofhysteritis chronica is not, like many other local
inflammations, often, if ever, ushered in by a chill, although it
frequently comes on quite suddenly, and is attended with more
or less fever. Sometimes the fever is so slight that it can scarce-
ly be noticed, except by the increase of frequency and fullness of
the pulse, and flushed face in the afternoon. The uterus lies
somewhat lower in the vagina than usual, is enlarged, particu-
larly at the neck and os tincae, and is so sensible to the touch as
frequently to cause the patient to distort the countenance by the
operation. In severe cases, the whole uterus is enlarged, but
.generally the inflammation only extends to the mouth and neck

67

#30 Hysterias Chronica with Cases. [Feb.

of the organ. One lip is generally more swollen than the other.
There is an obtuse pain in the back, which often extends to the
hips, and sometimes produces the sensation of heaviness or grav-
itation. The os tincoc is sometimes open, so that often the point
of the finger can easily be introduced, although not without, pain
to the patient. . f The stomach usually sympatizcs with the ute-
rus, so as to give rise to a train of very harrassing, dyspeptic and
nervous symptoms." (Eberle.) The part of the uterus, which
is inflamed, may be known by the region in which the suilering
is felt. Astruc says, " Cette douleur de la matricc estrapportee
par les malades a differcns cndroits du bas ventre, suivant le plus
ou le moins de proximite de ccs cndroits avee 1c siege dc Pin*
flammation, ou suivant la communication plus ou moins grande,
qu'ont ces endroits avec la partie enflammee de la matricc, soit
par les vaisseaux sanguins, soit par les ligamens de la matricc,
soit par les expansions du peritoine, qui attachent la matricc par
les cotes. C'est ainsi que les malades.se plaignent de la douleur
des lombcs quand ^inflammation occupc la partie postcricure du
fond de la matricc ; de la douleur du nombril, quand l'inflmma-
tion occupe la partie anterieurc du meme fond, dejjla douleur du
pubis ou de Fanus quand l'inflammation est au col de la matrice
en devant ou en derriere, de la douleur dc l'une ou de l'autre des
aines, des hanches, des cuisses, quand rinflammction est a Tune
ou a l'autre des parties laterales dc la matricc, d'ou naissent les
ligamens ronds,&c." (Maladies des Femmes Tom. 3. liv. 2.
p. 20.) The same symptoms have since been described by ma-
ny writers, both European and American, but not differing es-
sentially from tills author, who wrote about eighty years ago.-
Menorrhagia or leucorrhcca frequently accompanies or precedes
this disease. The bowels arc generally costive, or alternate with
looseness and constipation. The pulse is preternaturally full,
and is at its acme in the early part of the afternoon, at which time
a hectic flush may be seen upon the face. The patient com-
plains of pain in the hinder part of the head, and sometimes in the
anterior part ; the tongue is of a pale white colour, and as De-
wees justly remarks, " towards evening it reddens and becomes
clearer." When the irritation extends to the neck of the bladder,
it products strangury and sometimes an inability to urinate.

The patient is much the most easy in a recumbent supine pos-
ture, with the lower extremitjefc slightly drawn up. as the pros-

1837.] Hysteritis Chronica xoith Cases. 531

sure of the other viscera docs not interfere so much with the.
uterus.

As it regards the cause of this disease, there exists some ob-
scurity. In most of the eases, which have come under my obser-
vation, the patients have assigned cold as a cause. This may
often have its eilects, where other causes catenate in the com-
plaint. In man} cases which I have attended, menorrhagia has
preceded chronic inflammation of the uterus, and in some -for a
long time. I think the relaxing state of the climate, together with
the sudden changes which often take place, has a predisposing
influence ; so that the exposure which females often undergo on
account of thin clothing, tends to throw the blood upon the in-
ternal organs with mure force than natural. This being fre-
quently repeated, may produce the effect upon those females who
are very susceptible. In slight cases, the uterus is capable of
impregnation.

No disease can require the antiphlogistic method more steadi-
ly applied, than the one under consideration. Tonics of no de-
scription will agree with the patient, until the disease is com-
pletely at an end.

The first step to be taken is the abstraction of a sufficient
quantity of blood to relieve the pain, which is seated in the head.
In cases that are not severe, fourteen ounces or less of blood will
be sufficient ; but frequently if the health is not restored in a few
weeks, smaller quantities must occasionally be taken. In gener-
al the application of a blister above the pubis, will be an excel-
lent auxiliary ; but sometimes one applied to the sacrum will
have a better effect, particularly if the posterior part of the ute-
rus is principally affected. As a local application, cupping or
leeching will have a powerful influence, and, in some cases, su-
persede the necessity of blisters. When these topical applica-
tions fail to restore a sound state of the uterus, a seton, inserted
in the inner side of the thigh or in the sacrum, will be highly ben-
eficial, and sometimes perfect a cure. Demulcents applied to the
os tincce, by introducing them into the vagina, will produce a
very fine effect, and ought never to be neglected. For this pur-
pose, a mucilage of llax-seed will generally answer the purpose,
but I have always found that made of the root of comfrey (sym-
phitum officinale) preferable to any other mucilage I have used.

Many physicians, on account of the fallen position of the utc-

532 Hysteritis Chronica with Cases. [Feb,

rus, have thought the intervention of a pessary proper, mistaking
the real nature of the case for prolapsus, or procedentia. This
fact cannot be better illustrated than by inserting the words of
Dr. Dewees on the subject. He says, " the irritable uterus is
however more frequently confounded with prolapsus uteri, than
with any other complaint, as the local symptoms of the latter are
a miniature representation of the former. And as the womb is
almost sure to descend more or less in the irritable uterus, this
precipitation has been supposed to be the cause of all the incon-
veniences experienced ; and hence, the frequent failures of the
pessary, when it had been applied for the relief of the prolapsus.
Nay, sometimes serious and permanent injury has been done by
this instrument in these cases, without the practitioner being ex-
actly aware why mischief should be caused by a machine that
has been so often successful in cases so apparently alike."

Nevertheless, I have in some instances made use of a pessary r
or rather poultice formed by filling a little bag with the muci-
lage of symphitum officinale, and applying it as a pessary. I
have often found this mode of applying mucilage preferable to-
that of administering it by injections.

After a proper reduction of the system by venesection, opium
or the sulphate of morphia, will tend greatly to diminish the
painful or uneasy sensations, which are felt in the uterine region,
and calm the whole system. I have found the extract oflettuce
to answer a better purpose, given in doses of three grains, than
opium, because it did not affect the head at the same time that it
gave quiet and repose to the patient.

During the whole progress of the complaint, the patient ought
generally to remain in a recumbent posture.

It was thought by Frederick Wilhelm von Hoven and Bocr-
haave that this disease was sometimes of a typhoid nature, be-
cause it could be successfully treated with camphor and opium,
which they very properly considered stimulants ; although some
other physicians would make a different decision, by considering
them contra-stimulants. The first says, " Bey der esthenischen
Gebarmuttercnt-zundung ist allein die asthenische Methode an-
gezeigt, und die Hauptmittel sind innerlich das Opium und der
Kamqher, und aiisserlich Kataplasmcn, Fomentationen von aro-
inatischcn Krautcrn. Einreibungen hingegen von dem fliichti-
gen Linament, Vcsicataricn, wnrme Bader keunen nur mit der

1837.] Hysttrilis Chronica with Cases. 53:4

grosten Vorsicht angewcndet werdcn." (nt2undung der Cc-
barnuuter erster Band, scitc2i)0.)

When we take into consideration thai tonics never fail to do
mischief, we may naturally conclude that the above opinion of
the Professor of Wurtzburg, is erroneous. All medicines which
increase the tension of the fibres are injurious.

In conclusion of the above plan of treatment, it is necessary
to state that it will be important to attend to the state of the
bowels, by giving occasionally mild purgatives, in order to over-
come the constipation that often attends hysteritis chronica.
For this purpose magnesia and epsom salts will be a good selec-
tion.

Case 1. On the 20th of February, 182t3, I was called to at-
tend Mrs. L., who was laboring under an affection of the uterus.
She had been previously attended by a physician, who had ad-
ministered the arsenite of potass as a tonic, which had produced
an aggravation of the symptoms. On examination, digito j)er
vaginam, the mouth and neck of the womb were found consid-
erably enlarged, flabby, and somewhat sensible to the touch.
The organ was completely prolapsed from its natural location,
with the os tincce nearly or quite resting upon the perineum.

Conformably to the advice of a highly reputable physician, a
pessary was introduced to retain the uterus in its natural posi-
tion. The pessary remained until the twenty-second, when it
was withdrawn, and after a few hours re-introduced. On the
twenty-third, the patient complained very much of the pain and
irritation which it had caused, and declared that she could not any
longer bear it. I became confirmed in the justness of her com-
plaints, and, accordingly, withdrew the instrument. After the
abandonment of the pessary, injections of the mucilage of sym-
phitum officinale were thrown into the vagina, and a blister ap-
plied over the prccordia which seemed strongly to sympathize
with the uterus. After that had healed, it was applied immedi-
ately above the pubis, which naturally produced a better effect.

The symptoms of the disease were now less violent, and as the
uterus was prolapsed again, a linen bag in the form of a pessary,
filled with the mucilage of comfrey-root, was introduced, after
reducing that organ. This article was used instead of the al-
thaea officinalis or guimauve, recommended by Astruc in his
iS Maladies des Femmes.'' It seemed to act as a soothing poul-

534 stertHis Gtironicit with Cases. [Feb

lice, and on account of its lubricity, was easily introduced and
withdrawn i y i! it. After venesection had been resorted

to, the pulvis Doveri, in doses of live grains, was found a very
useful auxiliary, but after, sometime was increased in dose in
order to procure repose. At length one grain of opium alone
was given, As th'e opium had some tendency to afieot the head,
the inspissated juice of lettuce was substituted in doses of three
grains. This seemed equally to calm the irritation ofthe uterine
Eegioflj without producing any unpleasant effect upon the senso-
jium. Under this treatment, the patient gradually although
slowly ipproxfmated toward health, and was completely restored
by the introduction of a seton.

Case 2. In the month of June, 1832, I was consulted by a
lady, who said she bad been for a long time troubled with a dis-
ease, which her physicians called the gravels, but she had not
experienced any relief from the treatment, which they had di-
rected, and she thought they might have mistaken her complaint.
By interrogation, I soon discovered that she was suffering under
chronica hysteritis, and directed her as much as possible to remain
in a recumbent position, and to use mucilaginous injections per
vaginam, &c. I afterwards learned that she was relieved by
those means.

Case 3. In the month ofSeptemher, 1832, I was consulted
by Mrs. F., complaining of uterine irritation, who had been using
a pessary without experiencing any relief. On examination,
digltd per vaginam, I discovered an enlargement oftheoset
cervix uteri, with tenderness to the touch. Some arterial ex-
citement, with flushed face, occurred in the evening. After ven-
esection to the amount of twelve ounces, I ordered injections of
the mucilage of flaxseed, as the root of the symphitum officinale
could not be obtained. Her case was gradually ameliorated.

Case 4. March 6th, 1833, 1 was called to visit Mrs. B., who
was complaining of misery in the pelvic region. She said she
had been troubled with 'prolapsus uteri, for more than a year,
and had at the time an infant several weeks old, that her physi-
cian said, after her delivery would be the most favorable oppor-
tunity, for reducingthe prolfep sus* that she had since used a pes-
sary, but thought, it bad done her injury, and had accordingly
fallen out with her physician.

On examination :n.nn, the uteius was found

1837.] HytteritU Chronica with Casts. 5&5

considerably lower than natural. 'I'll- i upon

the os tineas gave sacli pain as to can >rtion of the

countenance. As was to l,c supj.- enlarged

and considerably inflamed, rtorfice were tnuch flushed in the
evening, and she complained at that time with some pain in the
head,

She was for a few days restricted to a Uv diet, a recumbent
position, and mucilaginous injeoti< n; per nagtnam. In a w<
although contrary to my ad vie-, she was seen " battant le pave
et courant Ics boutiques."

Case 5. June 11th, a negro woman came to my office
saying that she was not well, but that her master and mistress
thought she complained without a cause. On interrogation. I
was suspicious of an irritable state of the uterus, but refused to
do any thing for her relief without permission of her owner.
The same day she brought word, that her master desired me to
prescribe for her.

On examination, 'digitoper vUginum,vC\y suspicions were con-
firmed. '! he inferior parts of the uterus were considerably en-
larged, and quite tender to the touch. I advised mucilaginous
injections per vhginam, and the recumbent posture as mueh as
practicable. As these cases are generally slow of recovery, her
master was not satisfied with the treatment, and called in another
physician, who introduced the pessary a much better mode of
making a large bill and of adding fuel to the fire, but it evident-
ly proved detrimental to the patient. She was, in consequence
sold for less than her real value.

Case G. April 2, 1834, I was called to visit Mrs. P., about 45
years of age, who had been for several years complaining of
hysteritis chronica. The inferior parts of the uterus were en-
larged and tender to the touch. She said she had consulted sev-
eral physicians, who generally agreed that she would find much
relief from the use of a pessary. Afterwards another was called
in, whoconcurrred with his predecessor's m the use of a pessary.
Accordingly a silver one was introduced, (I think about twelve
o'clock M.) and at two or three \\ M. the pain it occasioned was
so intolerable, that she was compelled to send for her phvsieian
to take it away.

Her face was much flushed and head painful. On examina*
tion per vainnam. the uterus appeared mueh enlarged and very

530 Rf marks en Pneumonia BiUosa, $c. [Feb.

Sensible to the slightest impression* of the finder. I immediately
abstracted sixteen ounces of blood from the arm, put her upon a
low diet, advised mucilaginous injections per vaginam, and. strict-
Iv enjoined the recumbent posture. Her case gradually im-
proved, so that she was able to qui! the bed, and attend to domes-
tic concerns. I do not know that she is entirely well at this
time, but she has received great benefit from the course advised.

From my own experience in uterine diseases, I doubt if simple
prolapsus, i. e. unaccompanied with hypertrophy, or uterine irrita-
tion, and enlargement of some part of the organ, often takes place.
Vvrhen it does become irritable or sensible, in consequence of its
fallen position, I have no doubt that a pessary, made of comfrey-
root in the manner described in the first case, would fulfil every
necessary indication, unless the disease had produced general ar-
terial excitement.

Augusta, January 11, 1837.

ARTICLE V.

Remarks on Pneumonia Biliosa: By Ignatius P. Garvin, M.

D., of Waynesborough, Georgia.

Although the inhabitants of malarial regions are in a Great
measure exempt from those subacute and chronic inflammations
of the respiratory organs, which arc common and so fatal in
higher latitudes and in a purer atmosphere, yet they are by no
means free from a liability to the more acute forms of pulmona-
ry disease. During the winter and early part of the spring, a
very severe and often fatal form of thoracic inflammation, pre-
vails to a considerable extent. The ordinary fevers of these
sections in acclimated subjects, when compared with this form of
disease, are but trifling indispositions, and a large proportion of
the deaths which occur amongst the adult population, happens
during these seasons, and from this cause. This modificotion of
pulmonary inflammation from some symptoms which usually

1S37.] Remarl:s on Pneumonia B'dioan. 537

accompany it, lias received the name of bilious pneumonia.
Yet as the hepatic disorder is by no means the primary modify-
ing cause, and as it is to the gastric irritation which always ex-
ists, and to the symptoms thereby sympathetically produced, that
the disease under consideration owes most of its peculiarities, the
term gastric pneumonia, would seem more consonant to sound
pathology.

It is to be regretted that a disease so violent in its nature so
fatal in its consequences, and of such frequent occurrence, should
not have excited such attention among the physicians of the
South, as would have induced some of those most experienced
in its management, to furnish their views of its nature and treat-
ment. Some of the older European writers have noticed this
modification of disease, but their works are in the hands of but
comparatively few7 members of the profession. The elementary
works, with but one excepti on that we can call to mind, at this
time, arc silent upon the subject. Eberle has given it a brief no-
tice, but it is neither so full nor so minute, as the importance of
the subject demands. The writer is not so vain as to imagine,
that the imperfect observations which are to follow, will supply
this deficiency in our medical literature, but they are offered with
the design and hope that they may elicit the views of others bet-
ter qualified for the task.

No age or sex is entirely exempt from the attacks of bilious
pneumonia, yet females and children, probably from less expo-
sure to the inclemencies of the weather, seem to be less liable
than males. Negroes seem to be less subject to its attacks than
the whites, though they are more liable to the simple form of
pneumonia partly from greater exposure and partly from their
physical constitution. The peculiarity in their organization
seems to consist in an inferior sensibility in the cutaneous sur-
face, and a less degree of activity in the capiliary circulation,
and consequently in the same degree that it exempts them from
the diseases generated by heat, renders them more liable to those
which are produced by cold. Individuals who have labored
under malarial fevers, during the autumnal months, seem to be
more liable than those who have escaped, and these last if they
have been constantly exposed to the action of malaria, seem to
be more subject to an attack than those who have resided in a

dry and healthy Location* - , the 5eason when febnfic exha-

6ft

538 Remarks on Pneumonia Biliosa. [Feb*

lations are most rife. This greater liability among the sufferers
from fever, seems to result from the disordered state of the di-
gestive organs, which seldom recover their usual healthy tone,
immediately upon the subsidence of the fever. It is a fact that
but very few of those who suffer from severe attacks of autumnal
fever, entirely regain their usual health and strength for some
months, and this proves that the organs have not during that
period, recovered their healthy tone, else ordinary strength would
sooner be restored. Even in milder cases, a protracted conva-
lescence of these organs occurs to some extent. When, there-
fore, an individual, with his digestive organs thus predisposed to
disease, is attacked with pulmonary inflammation, it is not at all
surprising that the symptoms which characterize bilious pneu-
monia, should present themselves. We think it highly probable,
that the previous fever which generates this predisposition to
gastric disorder, also leaves a predisposition to inflammation of
the respiratory organs. The impetuous flow of blood through
the pulmonary vessels, during the continuance of the fever, and
of that excited condition of the circulatory organs which often
continues for some time after its subsidence, necessarily produ-
ces a pulmonary irritation, which though it may not be of suffi-
cient magnitude to excite much attention, nevertheless renders
the lungs more than ordinarily liable to inflammation.

The ordinary causes of simple pulmonary inflammation, act-
ing in combination with such circumstances, as tend to produce
gastric irritation, or upon a system where such irritation already
exists, are the usual causes of bilious pneumonia. Eberle at-
tributes the disease to the combined action of atmospherical vi-
cissitudes and malaria. It is highly probable that it is sometimes
thus produced, yet such cases must be comparatively rare, as
miasmatic exhalations do not occur to much extent, during the
season when the disease most frequently appears. Some of the
older writers state that it has prevailed as an epidemic, but such
an occurrence has not come under our observation.

Bilious Pneumonia is usually ushered in by chills or rigors.
In some cases there are premonitory symptoms, such as usually
precede an attack of fever, whilst in others, the chill or ague is
the first notice of the invasion of the disease. In some instances
the patient has labored under catarrh, or intermittent fever, for
some days previous to the attack, and under these circumstan-

1837. J Remarks on Pneumonia Biliosa. 53'J

ccs, the pneumonic symptoms come on more gradually. The
cold stage is not usually of great duration, and as it subsides,
the patient experiences pain in some part of the thorax. The
pain is of a dull, obtuse character, and suffers considerable ag-
gravation from the cough which accompanies it. During the
first few hours the c< dry, but soon there is a

scanty discharge of tenacious mucus, often stained with blood,
and expectorated with some difficulty. The breathing is hur-
ried, though the patient does not usually complain of any pecu-
liar difficulty in respiring. The stomach is irritable, and vomi-
ting is a frequent, though not an invariable occurrence. The
matter rejected from the stomach is in some cases mixed with
bile, but in others, it appears to consist of the depraved gastric
secretions alone. The bowels are usually torpid, until laxative
medicine is administered, and then it frequently happens that
diarrhoea appears. Sometimes this symptom is present from
the commencement of the disease. Soon after the development
of the disease, the middle of the tongue becomes covered with a
brownish coat, whilst the tip and edges are clean and red. The
appetite entirely disappears, and the thirst is very considerable.
In almost every case there is pain in the forehead, but the mental
faculties are rarely disturbed during the earlier stages of the dis-
ease. The skin is hot and dry, and the pulse frequent and full,
though it rarely offers much resistance upon pressure. Its fre-
quency is seldom less than 120 beats in a minute, except during
the remission. Indeed we consider this frequency of pulse as
almost characteristic of the disease, as we have very rarely found
it so frequent in the unmixed form of pneumonia. There is usu-
ally a morning remission, more or less distinct, as the gastric
or pneumonic symptoms predominate. In some few cases, there
exists from the commencement of the disease, a degree of cere-
bral congestion, evinced by a red, swollen face, and stupor,
which entirely masks the ordinary symptoms. When the pa-
tient is roused, though apparently rational, yet he generally de-
nies the existence of any pain. Yet we will gen-rally find upon
enquiry, that the patient has a slight c il has scarce-

ly been noticed previous to the inv i n, and the puJse pre-

sents a frequency which can only be accounted for on the pre-
sumption of some other considerable irritation. When in such
a case, the cerebral congestion is removed by the application of

MO Remarks cm Pneumonia BiUosa. [Feb

proper remedies, the usual symptoms of bilious pneumonia speed-
ily manifest themselves.

The most common duration of the disease is from seven to
ten days, yet we have seen a fatal termination occur in forty*
eight hours, and other cases, where it continued to a much longer
period. It sometimes happens when the pneumonic inflamma-
tion is inconsiderable in extent and degree, that it will subside
before there is much reduction in the gnstric disorder; but most
commonly they proceed pari passu. It rarely terminates sud-
denly and by a sensible crisis, the symptoms in most cases sub-
siding gradually.

The gastric disease which exists in bilious pneumonia may
also accompany bronchitis, or pleuritis, and it not unfrequently
happens, that the modification under consideration, is blended
with some degree of these affections. When this occurs, the
disease will present symptoms differing somewhat from those
usually exhibited by bilious pneumonia. Yet to distinguish be-
tween these various modifications, is not of much practical im-
portance, as in all these cases our treatment is to be governed
by the same principles.

As cases of bilious pneumonia present many shades of modifi-
cation, from the various degrees of relative intensity of the pneu-
monic and gastric disorder, a corresponding modification will be
found necessary in the treatment. In a large majority, indeed
we may say in every case, in the early stage of the disease, ven-
esection may be practised with safety and benefit. We are
aware that a different opinion prevails to a limited extent, but
we feel nt that in the sentiment we have advanced, we

shall 1) ! sustained by the great body of the profession. The
lengths of the stage in which bleeding will prove beneficial, va-
ries according to the relative intensity of the gastric and pulmo-
nary disease. When the former predominates considerably,
this stage is much shorter than where the contrary obtains.
Indeed in the former case the use of the lancet may be omitted,
with less hazard, than one not familiar with the disease might.
suppose. Yet we would by no means advocate its omission in
such cases, as its judicious use even there will materially expe-
dite the cure. It is impossible in this, as in many other diseases,
to affix the precise limits to. the stage in which venesection may
be beneficially practised. It is, we believe, never shorter than

18.37.] Remarks on Pneumonia Bdiosa. 541

one day,aad sometimes continues through several. In most ca-
ses one full bleeding will suffice. The blood should be suffered
to flow until a decided reduction, and softening of the pulse are
effected. In some instances, a repetition of the remedy will be
necessary, but wc are persuaded that such cases are rare, or in
their nature approach very nearly the simple form of pneumonia.
We are under the imnression that negroes in general do not bear
considerable sanguine depletion so well as whites, and when
from any cause we are unable to apply this remedy in their ca-
ses, we feel more confident of success from our other remedial
means, than we would in the case of a white man, under similar
circumstances. Whilst a few may be disposed to consider us as
advocating too general irt to the lancet, there will probably
be many others, who will dissent from an application so moder-
ate. In simple pneumonia, we have no fears in relation to its
free use. With Gregory we believe, that " the danger of a large
bleeding is less than the danger of the disease," yet in the com-
plication under consideration, we are fully satisfied, that very
large and repeated abstractions of blood, are likely in many ca-
ses to prove highly injurious, and have tended much to bring the
remedy into disrepute.

Although bloodletting is a remedy of so much power in the
simple forms of thoracic inflammation, and is so necessary in
most cases of bilious pneumonia, yet it rarely affords such full
and prompt relief to the pain in the latter, as in the former, nei-
ther does it seem to exert much influence upon the gastric symp-
toms. We are therefore compelled to resort to other means to
arrest the progress of the disease; and among these the most im-
portant is calomel. From the acknowledged action of this medi-
cine upon the liver, and from its beneficial effects in the disease in
question, we doubt not, have sprung those pathological views,
which have given to it the epithet bilious. But as we hold that
the gastric irritation is the primary modifying cause, and that the
hepatic disorder is only incidental, and yet unite with those who
hold the opposite opinion, in recommending the use of calomel, it
may be well briefly to explain our views of its modus operandi
in such cases. We believe that in this disease, the liver is usu-
ally in a torpid condition, at least that its functions are partially
suspended, and that this suspension is not the product of hepatic
irritation. This peculiar state of the liver is the result of the

542 Remarks on Pneumonia BiHosa. [Feb,

concentration of the vital powers in the stomach. Under these
circumstanc< inistered in large portions,

docs not increase the irrii iting in the stomach,

for we know that externa tees it has

no such effect, but it is absor : carried in some form or other

into the circulation", and then excites those organs on which its
principal powers seem to be expended. The liver in particular
it stimulates powerful!}', and from the great size and vascular
structure of that organ, its effect is strongly revulsive. If its use
be too soon discontinued, the benefit will prove transient, and the
organs will speedily relapse into their former condition. Under
no other view of the state of the liver could we feel fully justified
in expecting benefit from the use of mercurials ; for if that organ
was in an irritated state, how could we rationally expect, that
the addition of more irritation, would remove that which already
existed. We are aware that the opinion has been advanced,
and has its advocates, that when the liver is irritated, calomel
will remove the irritation, and when it is in a sluggish condition,
that it will excite "it. Such an opinion reminds us of the man in
the fable, who blew hot and cold with the same breath, and for
an exhibition of this faculty was summarily ejected from his
quarters by his indignant host a treatment well worthy of the
notion in question. We. are aware that the "physiological doc-
trine'' affirms that hepatic is a necessary consequence of gastric-
irritation, and consequently that the symptoms of hepatic de-
rangement must be the result of irritation. In conformity to
this theory, they reject the use of mercurials in such cases, yet
the most ample observation, in almost every quarter of the globe,
by men of various powers and conflicting views, has demonstra-
ted that they are the most effectual remedies we possess in this
particular state of the digestive organs. Either the theory of
Broussais is founded in error, or all observation is to be disbe-
lieved and forgotten. Many arguments and facts might be ad-
duced in favor of the view we have taken, did the occasion per-
mit so considerable a digression. Whether the views we have
advanced in relation to the modus operandi of calomel in such
cases be correct or not, ample observation has proven it to be one
of our most important remedies in the; treatment of bilious pneu-
monia. After bloodletting, and in small doses combined with
ppium or Dover's powder, and repeated at intervals until the

l'S.'tt.] 7i

evacuations shew that it has exerted its peculiar stimulation upon
the liver, it will powerfully c ixtinction of the

gastric dison most of its

peculiaril ve rare-

ly know., h often follow its use,

to fail in being succeeded in a few hours, b; ided amend-

ment. In. this, as in all ol we desire its stimula-

ting action upon the liver, we should prescribe it in doses of such
six", as will not pass rapidly through the bowels, but act if at all,
merely as a laxative. After the small doses have been contin-
ued for some hours, the bowels should be gently acted upon by
castor oil, or some other mild laxative, if the calomel itself has
effected no evacuations. This course may be repeated daily,
should the violence of the symptoms demand it, until the gastric
disease seems subdued. Salivation is not of such frequent occur-
rence in the disease under consideration, as it would be in fever
under a similar administration of mercurials.

Blisters are also important remedies in bilious pneumonia, but
their application must be delayed until the excitement is materi-
ally reduced, else little or no benefit can be derived from their
use. When, however, this reduction is effected, we have no more
powerful means of removing the inflammation, some degree of
which always remains, even after depletion has been carried to
its fullest extent. Some difference of opinion exists as to the pro-
per place for their application. Dr. Mefiadec Laenhec, in a note
to the work of his illustrious kinsman, asserts that "good practi-
tioners nevrr apply them in the first instance to the chest, but to
the legs, thighs, and inside of the arms." Notwithstanding the
declaration will bring us under the censure of this learned anno-
tator, we feel no hesitation in expressing the opinion, that the
chest is the very best place for their application, and this we be-
lieve is the sentiment of a great majority of the good practition-
ers in our country. Even the great author to whose work this
sentiment is appended, though not very favorable to blistering,
points out no place as preferable to the chest. We are persua-
ded that but few persons will be found to agree with another sen-
timent contained in the note from which we have just quoted,
which is, that when blisters fail to act as derivatives in cases of
pneumonia, "they still operate beneficially by exciting tempo-
rarily the powers of the system j and thereby rendering admit-

544 Remarks on Pneumonia Biliosa. [Fob.

sible further bleedings." Our observation has satisfied us, that
where they fail to act as derivatives, they very rarely fail to
prove injurious. Before the inflammatory action is sufficiently
reduced to permit the application of blisters, considerable benefit
may be obtained by a long continued use of warm poultices to
the scat of the pain.

Drastic purgatives arc seldom admissible, but laxatives are
important auxiliaries in the treatment. Such articles as act
without producing much intestinal irritation, will be found most
beneficial.

Emetics are recommended by Eberle and others, but except
in a few instances, and in the forming stage of the disease, we
have found but little benefit from their use. In many cases, they
are highly pernicious. We have known the nausea and vomi-
ting induced by an antimonial emetic, to continue during the
whole course of the disease, in defiance of every application for
their relief. Tartar emetic, given in the mode recommended by
Laennec in simple pneumonia, though truly a "heroic" remedy in
that form of the disease, will generally be found inadmissible in
the complication under consideration, as it always increases the
gastric irritation, and thereby enhances the difficulties and dan-
gers of the case.

Expectorants are usually considered valuable remedies in
pneumonic disease, but as we are compelled to exclude antimo-
nials from the treatment, our choice of expectorant remedies is
reduced within narrow limits. During the early stage of the
disease, mucilaginous drinks, such as flax-seed tea, gum arabic
solution and infusion of slippery elm, should be used as freely as
the stomach will permit. In the latter stages, particularly when
the gastric disorder is abated, much benefit may be derived from
the decoction of polygala seneka.

The preceding remarks briefly point out the general course of
treatment, which we have found most useful in bilious pneumonia.
We might have added to the list of articles which are sometimes
prescribed in such cases, but we have been content to indicate
those means of cure which are of primary importance, and those
which are most likely to prove injurious.

1837.] Cliomal on Typhoid Fewrs. G45

Part II. REVIEWS AND EXTRACTS.

Chomcl on Typhoid Fever.

In a former number* we referred our readers to the third num-
ber of the British and Foreign Medical Review, and to the first
number of the Eclectic Journal of Medicine, for Professor Cho-
mel's observations on this important subject. Since observing
the applicability of these observations to the fevers amongst us,
during the past autumn and first half of winter, we have conclu-
ded, that, lest many of our readers should not be able to make the
reference, we would give a condensed view of the same, which
we take pleasure in doing, in the summary contained in the first
and second numbers of the Eclectic Journal.

" Fever, Typhoid or Continued, described by Chomel. The term typhoid
fever, is that used by M. Chomel, in his Lecons Cliniques, published two
years ago, to express the continued fever of English writers, and includes
both their synochus and synocha, as well as typhus. Whilst he regards fe-
ver to be a disease of the whole system, he admits its local complications or
lesions. Of these some ate constant, viz. alterations of the follicles of the in-
testines and of the mesenteric glands. The follicles are known anatomically
by the name of the glands of Brunner and those of Peyer : the first are scat-
tered, the second are in groups. At what time these follicles are first changed,
or in what order, we cannot well say. The earliest state at which Chomel
had an opportunity of examining their diseased state was on the seventh day,
or that on which death took place. Out of fifty-five cases noted by Louis,
the most recent was on the eighth day. They are seen at this time, like
opaque spots, through the distended and almost transparent intestine at vari-
ous parts along its course. The larger patches are seen in the ileum and
termination of the jejunum, being most numerous towards the ileo-ccecal
valve and in the upper part of the large intestine. Death during the second
"period of fever allows of our seeing the follicles changed by ulceration of the
mucous membrane, which is the result of the morbid state of the follicles, as
it commences over the follicular patches and is confined during this period to
these parts. In ninety-two cases closely observed by Chomel and Louis,
ulceration commenced from the eighth to the twelfth or fifteenth days from
the first attack. The ulceration proceeds from the ileum upwards. More
rarely do the isolated follicles ulcerate. In some cases during this second
period, the mucous membrane covering the patches becomes of a dark colour,
separates from the subjacent tissues, and is observed to be perforated with a
largo number of holes, giving it a reticulated appearance : these holes are the
orifices of the enlarged follicles. Beneath this the sub-mucous tissue is found,
or a thin layer of white deposit. If death occurs at a later period, there is
sometimes no trace either of the ulcerated or reticulated patches, but merely
ulcers, whose edges have no traces of the whitish deposit. The duration and
symptoms of the disease will indicate whether these ulcers be the accompan-
iment of typhoid fever. M. Chomel thinks that in the present state of our
knowledge, the ulcers which are formed in the intestines after an acute dis-
ease are the result of lesion of the follicles, and not a primary affection of
mucous membrane.

*See Southern Medical and Surgical Journal, vol.i., page 417.

09

546 Chomel 07i Typhoid Fevers. [Feb,

The ulcers are of two varieties the first with very slight depression be-
low the mucous surface and without any appearance of inflammation ; the
second are deep, with prominent edges of a slate colour, and extend even so-
far as to sometimes perforate the peritoneal membrane. The disease of the
follicles may after a time disappear either by resolution, or by cicatrization of
the ulcers, and the mesenteric glands, which were enlarged, resume their
natural size.

There are three other diseases in which diseased follicles have been found,
viz. Cholera,* Phthisis and Scarlatina.

Of the forty-two subjects dead of the typhoid fever, and examined by M.
Chomel, all were found to exhibit follicles more or less diseased.

The connexion between the symptoms and the diseased state of the folli-
cles has been carefully studied by M. Chomel. Headache was observed in
all but one of the forty-two fatal cases ; but as it precedes the lesions we can-
not well admit any connexion between them. Stupor, an important symp-
tom, cannot be referred, as some suppose, to the formation of ulcers of the in-
testine and the absorption of pus, any more than to the exhaustion of the
constitutional powers. But between diarrhoea and diseased follicles there
seems to be a closer connexion the former being present in forty out of fifty-
two cases of the latter.

Among the changes not c- nstantly met with are alterations in colour and
consistence of the mucous :. mbrane of the stomach and intestines. Soft-
ening of the gastric mucous membrane occurred in fourteen cases. But we
cannot attach much importance to this fact, since, of twenty-four subjects
dead of pneumonia, and examined by M. Chomel, there was softening of the
stomach in eight. Similar appearances and proportions were observed in
peritonitis, small-pox and other diseases. Softening of the mucous coat of
the intestines is not common. Neither the colour of the stomach nor intes-
tines is distinctive.

Vomiting and sensibility of the epigastrium were not greater where there
was softening than where there was none. Sanguineous infiltration was not
distinctive of the fever.

Next to the follicles, the spleen is most frequently diseased, being either
enlarged, as in the acute stage, or softened, as in the more advanced and
sometimes harder and drier. The liver was sometimes softened. Louis
observed this in about half of his cases.

Organs of circulation. The heart in seven cases out of thirty was soft-
ened, a state coincident generally with a similar state of other organs. In*
seven other cases out of the number thirty, the walls were flaccid. The
softening was attended with paleness. Sometimes the inner membrane was
of a lively or deep red ; but in no case were there inflammatory depositions.
The red condition often observed of the inner membrane of the aorta was
probably owing to imbibition of the red particles dissolved, since it was in
general in proportion to the putrid state of the blood.

The blood is often deficient in fibrin. Air has been found in the blood-ves-
sels, particularly in the veins. Petechias and ecchymoses were observed
during life in cases, so that the decomposition of the blood probably com-
menced before death.

In the lungs, congestion of the posterior and inferior parts was noted in
eighteen instances out of fifty-two : in eight cases, there were marks of
pneumonia, and in two, pleuritic effusion.

The hrain, although its functions arc most disordered, suffered fewest ap-
preciable organic changes. Delirium present in half the cases, is not ex-
plained by the pathological changes. (Edema of the meninges and bloody

* For a very full and authentic account of the follicular changes in cholera
as observed by himself, we would refer to J In' paper by Br. Horner, in the
American Journal of Medical Sciences, for May, 1835.

1837.] Chomel on Typhoid Fevers. 347

points are found, it is true ; but these are met with as often in cases where
there has been no affection of the cerebral functions as when they have been
present, and also as frequently in other diseases as this. In thirty-eight care-
fully observed cases there was

Injection (venous) of the meninges - - - - in 4
CEdema of the meninges ------ "7

Genera] but slight softening "6

.Serous effusion in the ventricles (from a tea-spoonful to a des-
ert-spoonful) -- "12

Bloody points -------- " 5

Increased density "2

Healthy state "15

Causes of Fever. The exciting causes of the one hundred and sixteen
cases which came under M. Chomel's notice are given, as far as could be as-
certained by inquiry. But unless the physician have the added testimony
of the friends and companions of the sick person, he cannot receive with much
confidence the statements of the latter, liable as they are to be distorted from
the real facts by ignorance, bad faith, or forgetfulness. In the respect of
causes, hospital records are therefore less valuable than those of private prac-
tice. The following is the table exhibiting the results of M. Chomel's in-
quiries :

5 patients attributed it to sudden cold when heated,

6 to deficient or bad food,

4 to mental depression,

5 to debility from other diseases,

3 to the action of a purgative taken for some indisposition,

1 to excess in drink,

5 to excessive fatigue,

2 to a violent physical shock,
1 to the effects of the sun,

5 were exposed to circumstances favorable to contagion.

37

Of the remaining seventy-nine, in the whole number of one hundred an3
sixteen cases, no cause could be ascertained. However much we may be
disappointed at this deficiency of information, we cannot but see in it addi-
tional proof of the good faith of the author, and his freedom from any bias of
system.

The age at which this fever most frequently attacks is, according to M.
-Chomel, between eighteen and thirty. It is rarely observed after forty, and
perhaps in no case after fifty-five. Under ten years of age it is rarely met
with.

Of the whole number of patients more than two-thirds had lived in Paris
less than two years, and only two were natives of that city. We well re-
member, when attending at the Charite, being struck with "the uniformity of
the question proposed by M. Lerminier to patients with this fever of how
long they had lived in Paris'?

M. Chomel, in common with most of the French school, is opposed to a
belief in the contagion of typhoid fever.

To describe well the symptoms and progress of this fever, it must be divi-
ded into different periods or stages, into the details of which we cannot be
supposed to enter on this occasion. The preliminary symptoms of dimin-
ished activity of the mind and ienses, feebleness, loss of appetite, foul tongue,
altered expression of countenance, &c, are well known. But in a great
majority of cases recorded by the author, the attack was sudden. There
were no premonitory symptoms in seventy-three out of one hundred and
twelve cases; although we must take this statement with the customary al-
lowances required for hospital patients, whose accounts of their attack, never

048 ChoTJtcl on Typhoid Fevers. [Feb.

very clear, are rendered still more confused by the fever. The disease is
divided by M . Chomcl into three periods, of a week in each, in which a pecu-
liar set of symptoms are said to be exhibited.

First Period. Marked change in phosiognomy,- diminished intelligence,
apathy, muscular debility and consequent supination, constant wakefulness,
or dreams so vivid as to induce in the patient the idea that he has not slept ;
headache, generally confined to the forehead; thick and glutinous secretions
from the mouth and tongue ; lips and edges of the tongue red, with a small
white border on each side, sometimes preceded by otl>er appearances of this
organ. A3 the mouth dries, there is a uniform red colour of the whole mu-
cous membrane, the lips crack, and the teeth have a brilliant look. There
is anorexia, sometimes with nausea and vomiting ; dysphagia, great thirst,
diarrhoea, almost universally, amounting to from four to eight evacuations
daily ; in many cases gaseous distension of the intestines evidenced by per-
cussion. A gurgling sound is heard when the lower part of the abdomen,
and particularly the right iliac region, is pressed with the hand ; a state pro-
bably connected with a morbid condition of the ileo-ccccal valve ; and most
common in the second and third stages. Generally, there is increased sen-
sibility on pressure of the bowels, but often not unless strong pressure have
been used : it may be confinpd to the right iliac region, to the whole hypo-
gastric or epigastric regions, or it may extend over the whole abdomen.
During the first days there is, generally, an active circulation, with marked
inflammatory symptoms ; pulse full, and sometimes resisting and frequent ;
skin red. These symptoms diminish towards the end of this period ; the
pulse becoming more rapid, but softer, and the skin, which was covered with
abundant acid perspiration, becomes dry and hot. The urine is scanty, high-
coloured and fetid. Early epistaxis is common, and is a valuable diagnostic
symptom ; the bleeding is rarely copious, but often occurs several times.
The state of the lungs is important in diagnosis ; often from the first there is
a general sibilant rattle over both lungs more evident inferiorly and poste-
riorly. The cough is rarely in proportion to the rattle ; the expectoration is
scanty, viscid and transparent. Obstruction of the nostrils by dried mucus
or blood, and extreme meteorism often produce dyspnoea. Death rarely oc-
curs during this period.

Second Period. The eruption which is peculiar to typhoid fever usually
appears between the seventh and ninth days. It consists of small rose-
coloured spots, disappearing on pressure, from half a line to two lines in di-
ameter, round and hardly elevated ; scattered over the abdomen, sometimes
on the breast ; more rarely on the thighs, arms and forearms. Their number
varies ; in order to be characteristic, there should be at least fifteen or twen-
ty. They do not all appear at the same time : their duration is uncertain ;
they ordinarily disappear in two or three days; in other cases they remain
twelve or fifteen days ; but it is probable these are successive eruptions.
Out of seventy cases occurring in 1830-1-2, where attention was paid to
this point, there were only sixteen in which the eruption did not appear.
Of these fifty-four cases presenting the eruption, there were none in which
it appeared before the sixth day, and in two cases it appeared as late as the
thirty-sixth day of the disease. This agrees with the larger number of cases
noticed by Louis. This eruption, so common in typhus, and so unfrequont in
other acute diseases, is distinguished from petechia? and flcabite/, by its co-
lour disappearing entirely under pressure, and returning as soon as it is re-
moved. A similar eruption was observed by Ilildebrand, in the typhus of
camps ; and in 1H14, M. Chomel had an opportunity of verifying his obser-
vation in Paris. The extent of this eruption in some epidemics, gave rise to
the term petechial fever. Sudamina are sometimes observed at a later pe-
riod, but they are not so intimately connected with this disease as the erup-
tion just described ; they are small, demi-hemispherical, transparent vesi-
cles ; when viewed obliquely, they have a brilliant appearance, but when

1837.] Chomcl on Typhoid Fevers. 549

looked at perpendicularly to their a:; is, they escape observation. We can
understand from this, why they have been so seldom noticed or mentioned by
authors. Th iy arc readi lished bythetouch appearing at first on

the sides of the neck* and is tfie folds of the arm-pit and groin, and extend*
ing thence, in some c&ses. to toe trunk and limbs. The symptom is of some
importance, aa re frequent In this disease than in any other

with which it m ij be confounded ^ on the hips, Bacxum, heel, and back of
the hairy scalp. Si tybe caused by pressure; but it sometimes

occurs spontaneously and inner surface of the thigh, or

upper part of the foot; and may follow the application of sinapism or a blis-
ter, or the irritation of urine and feces. Debility and stupor may remain as
in the first period, in the least serious cases ; but in the most serious&rms,
the prostration of strength is complete^ and the patient lies on his back an
inert mass. The muscles of the throat partaking of the debility, deglutition
becomes impossible ; the liquids being rejected through the mouth or nose.
Dysphagia may depend on inllammation about the epiglottis, or on ulceration
of the mucous lining of the fauces and oesophagus. Involuntary discharge of
is regarded as another symptom of muscular debility: though we are
ri' d - ure of the correctness of this view, especially when a retention
u'eged to be evidence of paralysis of the bladder. If the respira-
tory muscled share in the deficiency of muscular power, the patient i3 in
a c of suffocation. It is not uncommon, at the same time, to find subsul-
tus tendinum, convulsive twitchings of the nose and upper lip, and carpology.
General and permanent rigidity of the limbs is almost always a fatal symp-
tom. In mild cases the headache ceases, and to constant wakefulness suc-
ceeds drowsiness, from which it is impossible to arouse the patient, except
for a few moments. This is the Coma somnolent urn of authors, and often
lasts many days. When this stupor is so great that the patient cannot be
roused by any excitement, he generally dies in a few days in the same state.
Instead of stupor, some have delirium, coming on in the evening or at night,
or constant ; and either violent or of the tranquil and muttering kind.
Deafness, in most cases independent of stupor, is very frequent. The senses
of sight and taste are commonly weakened. The pulse is small, weak, trem-
bling, jerking, or intermittent ; generally from 100 to 120; in others, from
80 to 90; in a few, it falls as low as 40 or 50 at the termination of this peri-
od. There is an increase of fever in the evening, sometimes hardly percep-
tible, at others violent, and more rarely preceded by rigors, and terminating
by sweating, than in the first stage. The skin is of a more acrid heat, drier
and rougher; thirst less urgent; the nostrils having become impervious to
air, the patient breathes wholly through his mouth, and the mucus covering
it becomes dry, and changes from a brown to a brilliant black colour: this
has been mistaken for effusion of blood. Diarrhoea continues; sometimes
less frequent. Hemorrhage from the bowels, which, if abundant, speedily
destroys the patient: this symptom is important in the diagnosis, as it is
much more common than in other diseases. Meteorism continues or increa-
ses ; abdominal pains are not complained of, except in the mildest cases ; the
breath and perspiration have an offensive smell, peculiar to fever. Of 42
fatal cases, 9 deaths took place during this stage.

Third Period. The symptoms either improve and lead to convalescence
or become aggravated, terminating in death. Thus, thirty-two patients, out
of forty-two who died of fever, died in this stage; and, of ninety cases of re-
covery, convalescence commenced in one only during the first period ; and
when the symptoms were severe, there were no instances of improvement
before the end of the second. Improvement of expression, and attention to
what is passing, are often the first signs of amendment ; or the comatose
state is exchanged for peaceful sleep, on waking from wltich the patient part-
ly recovers his intelligence: he is able to move himself a little ; the tomrue
and mouth become moist ; meteorisrn diminishes ; the evacuations are of a

550 Lhomel on Typhoid Fevers. [Feb.

more yellow colour, less fluid and foetid. Sometimes, at the moment when
the first amendment of the symptoms commences, solid and formed stools are
passed ; sometimes black, dry, and in prodigious quantities ; they had pro-
bably lain hidden in the cells of the colon. The patient becomes aware of
the passage of his evacuations ; respiration more free ; skin more supple or
moistened. At this period it is not unusual for abscesses to form in parts of
the body, which do not appear to have been irritated ; and the patient or his
friends become alarmed at that which is a sign of beginning convalescence.
The face becomes thinner, and the features and expression more marked.
Of 66 favorable cases, the convalescence commenced by one or more of the
previous symptoms on the following days :
In 1 patient, the 8th day after the attack.

1 9th.

4 patients, the 12th.

3 " from the 12th to the 14th days.

10 " from the 15th to the 16th.
15 from the 17th to the 20th.
14 " from the 21st to the 25th.

11 " from the 26th to the 30th.
8 " from the 31st to the 40th.

It will be seen by this table, although the days on which the improvement
commences are very variable, yet that, in fifty cases out of sixty-eight that
is, nearly three out of four, the improvement commenced from the fifteenth to
the thirtieth day.

In fatal cases, the stupor augments, expression more changed ; the mouth
is drier, or, if moistened, it is only by the secretion of grey, viscid mucus,
mixed with blood, and foetid. Respiration more difficult, stertorous ; some-
times, towards the last days, crepitation is heard posteriorly and inferiorly,
which is replaced by complete absence of respiration. Pulse more feeble ;
heat diminishes ; skin dry, covered with cold, glutinous sweat ; emaciation
general and rapid ; eyes hollow ; features drawn down with a fixed expres-
sion, (facies hippocratica.) If the patient can speak, it is with difficulty and
with a trembling voice ; the answers are unintelligible, even if the words are
understood. The exhaustion of strength is complete, and the comatose de-
bility is speedily followed by death. In some few cases, either at this period
or during convalescence, the patient is suddenly seized, if his sensibiJity is
sufficiently excitable, with extremely acute pains in the abdomen, sensation
of sinking, alteration of expression, nausea and vomiting ; and the symptoms
of typhoid fever give way to those of partial or general peritonitis. The
pulse is small and thread-like, the abdominal pains are excessive. This sud-
den attack of peritonitis, depending on no apparent external cause, is owing
to perforation of the coats of the intestines and effusion of faeces into the pe-
ritoneal cavity. It is almost inevitably fatal. Two out of forty-two fatal
cases died from this cause. Erysipelas of the face is a very fatal complica-
tion : it was observed in four cases out of 130, and all four died. The con-
valescence from fever is not rapid ; in some cases it is extremely prolonged.
Satisfying the appetite, which is often voracious, frequently leads to very se-
rious consequences. CEdema of the lower extremities sometimes follows
fever ; so does mental derangement in some few cases, but it generally dis-
appears when the patient resumes his previous habits of life.

JVI. Chomel's testimony is adverse to the doctrine of crises and critical days.
Of ninety-four cases, there were two in which copious perspiration was fol-
followed by benefit ; and two others where an abundant discharge of fecal
matter coincided with an amelioration of the symptoms; in the remaining
ninety, nothing similar was observed, so that these four cases can only be
regarded as rare exceptions. The only phenomena which really appeared
to precede improvement were abscesses, in six cases out of eighty. The
list given of the days in which improvement took place, shows that it hap-
pened many times in each day between the 15th and 30th.

1837.] Chomel on Typhoid Fevers. f>f>l

We find that our limits will not allow of our completing the analysis of M .
Chomel's excellent work. This will be done in our next number, in which
will be found, also, a notice of the use of chlorides in fever. We must not
close this article, however, without acknowledging our obligation to the Bri-
tish and Foreign Medical Review, No. Ill, for its admirable digest of Cho-
mel's work.

Varieties of Typhoid Fever. The sketch of fever which has been given
embraces all the symptoms, but in no one case do they all meet ; some symp-
toms excluding others, or being constantly united. The concurrence of par-
ticular symptoms constitutes varieties of fever, to which distinct names have
been given by authors, as if they were distinct affections.

1. Inflammatory Typhoid Fever. This is frequent, particularly in winter :
those of a sanguine temperament, and from twenty to thirty years old, and
subject to hemorrhages, are liable to it. When well marked, the peculiar
symptoms occur early ; such as fulness and frequency of the pulse, hot skin,
dryness of the throat, thirst, loss of appetite, oppression, and other general
symptoms common to inflammatory affections ; but, besides these, there are
constant headach, muscular debility, disposition to hemorrhages, dry tongue,
diarrhoea, typhoid and miliary eruptions. The form changes generally to
the adynamic and ataxic about the seventh or eighth day, sometimes earlier.
In two cases only out of forty-two fatal ones did the inflammatory form con-
tinue throughout the disease, and in one of these cases death was produced
by perforation of the bowels. During five years, during which these cases
were collected, M. Chomel saw no other instances of inflammatory fever
which were fatal, and he has never met with inflammatory fever which was
not a variety of the typhoid affection.

2. Bilious Typhoid Fever. Most frequent in summer and autumn. In
two cases out of forty-two fatal ones, there were bilious symptoms at first,
giving way to more serious ones. Five others were cured where these
symptoms continued throughout. The symptoms are yellow skin, especi-
ally around the lips and alae nasi ; frequent nausea, and vomiting of bile ; bi-
lious stools ; bitterness and dryness of the mouth ; yellow or greenish coat-
ing to the tongue ; tinnitus aurium ; depravation of taste, smell and touch.
The duration of these symptoms is seldom beyond the seventh to the fifteenth
day.

3. Mucous Typhoid Fever. This, like the bilious, seems to depend much
on localities: it is seldom well marked in Paris. The symptoms are great
debility; pale or swollen face ; muscles soft; mouth pasty; breath, saliva,
perspiration, and urine, of an acid odour ; stools mucous or glairy : after a
short period it is replaced by the adynamic or the ataxic form. Two out of
forty-two fatal cases had these symptoms.

4. Ataxic Typhoid Fever. One of the best marked, most frequent, and
most generally fatal forms. Ten out of forty-two were ataxic : four of these
were unmixed throughout, and death ensued on the eighth, ninth, and twelfth
days ; two were preceded by the inflammatory, and two by the adynamic
symptoms. This variety is distinguished by a remarkable disturbance of
the functions of relation ; as delirium, cries, threats, efforts to strike or es-
cape ; sometimes by mild delirium, heaviness, alteration or perversion of the
senses, twitching of the tendons, convulsions, rigidity, &c. In other cases
there is a remarkable discordance between the symptoms : thus, whilst the
pulse is rapid, the skin is not hot, or one part is cold whilst the rest is very
warm ; or, whilst the face expresses a disease almost inevitably mortal, the
pulse is hardly affected. Frequently the delirium is not in proportion to the
other symptoms, either less or greater. Sometimes a sudden improvement
leads the practitioner to doubt his diagnosis : the benefit is, however, tempo-
rary only. In some cases the patient is perfectly restored to his senses be-
fore death. Ataxic symptoms do not belong exclusively to fever, but may co-

552 Chomel on Typhoid Fevers. [Feb.

exist with visceral inflammation, puerperal, eruptive and other acute disea-
ses.

5. Slow Nervous Typhoid Fever. The symptoms are a general indif-
ference, great lassitude, heaviness, dejection; slight headach; pulse fre-
quent and weak; constant wakefulness; no thirst, although the mouth is
dry ; if there is delirium, it is not violent, and consists of a confusion between
thought and action ; the patient mutters ; in unfavorable cases the strength
diminishes, and the stupor increases, with other adynamic symptoms ; in
favorable ones, the patient gradually throws off the drowsiness or suddenly,
as if awaking from sleep.

6. Adynamic Typhoid Fever. The most frequent form, adynamic being
marked in twenty-six out of forty-two fatal cases: in ten of these, adynamic
symptoms were present throughout, and in sixteen at the termination only.
The predominant symptom is muscular debility, which may gradually simu-
late paralysis. These patients, with every appearance of strength, can nei-
ther lie down nor rise up in their beds without help, or even turn on one side.
Towards the termination they lie immovable, and after many hours are found
in precisely the same position in which they had been left. There is com-
monly great mental debility, commencing with early stupor. In bad cases,
or at an advanced period, the patient does not answer questions which are
put to him, and his unmoved features show that he lias not understood them :
after a loud question he may direct his eyes momentarily towards the speak-
er. Headach diminishes as adynamia increases, and is replaced by wakeful-
ness, or constant unquiet dreams. The mouth is covered with a thick layer
of dry mucus ; great meteorism ; often no sensibility on pressure ; stools gen-
erally foetid and involuntary ; sloughing of the parts pressed upon ; urine and
sweat foetid; petechia?; skin at first warm and dry, afterwards cold; pulse
feeble, trembling, at first rapid, latterly slow. This state sometimes lasts
long.

Diagnosis. This is sometimes extremely difficult. It is prudent not to
give a decided opinion during the first three or four days ; for, when the
symptoms are not very decidedly marked, they differ little from the precur-
sory fever of many eruptive diseases, as small-pox, scarlatina, measles, of
some catarrhal affections, or latent visceral inflammations. The long dura-
tion of the febrile condition is an important characteristic. Whenever febrile
symptoms, which cannot be referred to any appreciable lesion, last eight or
ten days, there are strong grounds to presume that the glands of Peyer are
diseased, and when, on the other hand, a febrile disease, the nature of
which is doubtful, it is not this affection. Between the sixth and twelfth
days, symptoms which clear up the diagnosis generally appear, such as me-
teorism, typhoid eruption, stupor, epistaxis, hemorrhage from the bowels.
At a later period still, there is less difficulty ; for, even if the symptoms du-
ring the first and second periods have been absent, those which belong to the
third remove all doubts: these are intestinal hemorrhages, sloughing, invol-
untary stools, and other marks of adynamia.

Prognosis. Few diseases are so fatal. Out of 147 cases in the clinical
wards of the Hotel Dicu, between 1828 and 1832, forty-seven died, or one in
three. Though a mortality of one in three is a very large proportion, any
inferences unfavorable to the treatment of fever should for many reasons be
made with caution and charity. The mode in which patients are distributed
to the various hospitals in Paris, is brought forward as one excuse for such
fatality. All the hospitals being under the direction of government, a central
hoard of medical men is appointed to examine the patients who apply for re-
lief, and to distribute them among the different hospitals. This board meets
near the I [otel Dieu, so that the sevi resl cases of fever are often sent there,
as it is the nearest plaice. M. Chomel is also the professor of clinical medi-
cine, and the most serious cases are sent to the clinical wards. These rea-
sons would account for a greater apparent mortality than under other circum-

1837.] Chomel on Typhoid Fevers. 55^

stance?, if we did not find that during several years, whilst M. Chomcl was
physician to La Charito, the mortality in about the same number of cases
was rather greater. M. Louis founded his " Recherches sur la Gastro-
enteric" on 138 cases of fever treated by M. Chomel, and out of these there
were fifty deaths.* The average of one in three seems to be therefore inde-
pendent of these local causes.

Fever is less dangerous in patients under eighteen years of age, and more
dangerous after the age of forty. No appreciable difference is observed in
regard to sex. Previous feebleness of the system does not appear to act un-
favorably. Two out of four patients who attributed fever to moral causes of
^repression died. Of sixteen patients who admitted that they had taken stim-
ulating drinks at the commencement of the attack, three only died, M.
Chomel concludes that those cases are most dangerous where the attack was
sudden. The tables given, however, indicate the opposite, the mortality
being rather less than one in three where the attack was sudden, and slight-
ly above one in two where there were premonitory symptoms. (P. 433).
There is probably some numerical error. If during fever there is a decided
remission, followed by an aggravation of the symptoms, the termination is
generally fatal. There is less danger when the form of the disease does not
change : the ataxic is in such cases the most fatal. Complicated cases are
very fatal: thus, of thirteen cases of inflammatory adynamia," eight died.
Many symptoms, when they become intense, are important in the prognosis.
When delirium is early and violent, it is very unfavorable. Of forty-two
fatal cases, twenty-two were violently delirious. When it consists in a
dreaming state from which the patient can be roused, there is less danger.
Of eighty patients who recovered, twelve had this mild delirium. Involun-
tary evacuations, when passed without consciousness, constitute a bad sign.
Of thirty cases, in which this symptom was present, thirteen died. Constant
and general twitching of the tendons is highly unfavorable. In five cases
with general convulsions death was speedy. Coma is one of the most fatal
symptoms; it should be distinguished from stupor, in which the patient's at-
tention can be roused. Of seven patients with intestinal haemorrhage six
died. M. Chomel does not think deafness unfavorable. The expression of
the face is important : when emaciated and shrunk, (facies Hippocratica,)
death is at hand ; whilst improvement in intelligence of expression is often
the first sign of amendment. If the pulse exceeds 120 or 130 it is bad, when
150 or 160 death is near. When it becomes slow after having been rapid,
without symptoms of improvement, it is a fatal symptom, unless proper means
to relieve the patient are not employed. Perforation of the intestines, and
erysipelas of the face, are generally fatal complications. The danger of
inflammation of the lungs is in proportion to its extent and to the general
condition of the patient. When it occupies a considerable portion, or the
whole of one lobe, and is not arrested, it is fatal, even before it passes into
the second and third stage. Circumscribed pneumonia is often discovered
in those who have extensive suppurations on the sacrum, and is dangerous.
As pneumonia is often latent, considerable attention should be paid to the
lungs. In three patients inflammation of the larynx and epiglottis took
place, and was fatal. The injurious effects of sloughs on the sacrum, heels,
&c, have been exaggerated. In seven cases, only three died, and in those
which recovered the extent of the ulcers was truly alarming. Abscess in the
external parts was observed in six, all of which recovered. They were not
found in parts subjected to pressure.

Treatment. M. Chomel employs the rational mode of treatment, in
which the disease is treated according to the symptoms which may be pre-
sent, and not according to any uniform plan. By this mode, none of the

* Recherche:; cur la Gastro-enterite, &c par P. Louis-.- Vol. 1. p. be.

70

554 Chomel on Typhoid Fevers. [Feb.

specific modes of cure is excluded, though none is exclusively adopted. The
antiphlogistic, the antiseptic, the tonic plans are not individually adhered to
in every case, but are applied according to the" form which the fever may
assume. This is called rational treatment, as it supposes that the practition-
er reasons on every case ; it is also called symptomatic, from the attention
which is necessarily paid to symptoms.

In the simple uncomplicated forms, M. Chomel prescribes refreshing drinks,
such as lemonade, orangeade, solution of syrup of currants, pure water taken
at short intervals, emollient fomentations and poultices to the abdomen, if it
is painful ; washing the body with vinegar and water, or simple baths, if there
is much heat; mucilaginous lavements repeated many times daily ; cold
compresses to the forehead, if there is much headach, and warm or mustard
poultices, if there is any tendency to drowsiness or forgetfulness. He also
commences by taking some blood from the arm, as he agrees with M. Louis
that this has a favorable influence on 4he duration of the disease. If the
headach is intense, or if there is much abdominal pain, leeches may be ap-
plied behind the ears or to the anus. If the stools are scanty, mild laxatives,
such as whey with tamarinds, neutral salts, &c. If there is diarrhoea, it
should be restrained by mucilaginous drinks, gum or rice water, small lave-
ments of starch. Free air and absolute cleanliness are indispensable : great
care should be taken that the urine and fa)ces passed involuntarily should be
immediately removed. When amendment commences, the emollient drinks
may be exchanged for aromatics and gentle bitters : diet improved, such as
vegetable jellies, weak broth, wine and water, &c. When the symptoms
are more urgent, this expectant treatment is replacechby a more vigorous
one.

Treatment of Inflammatory Typhoid Fever. This requires the antiphlo-
gistic treatment according to the age and strength, but by no means with the
same vig*or as in simple inflammations ; for it must be remembered that ady-
namic symptoms frequently follow inflammatory ; there is therefore a neces-
sity of husbanding the powers of the patient. Another reason for the same
caution is, that inflammation frequently springs up in the most debilitated
subjects. Therefore, after taking blood once or twice, generally and locally
by leeches, these means must be laid aside, and complete abstinence, with
the remedies just mentioned,, trusted to. The only cases where general
bleeding is indicated in the second and third periods, would be when inflam-
mation attacks patients who are not greatly debilitated. Great caution is
required in all such cases.

Treatment of Bilious Typhoid Fever. The bitter taste in the mouth,
great thirst, &c, cause the patient to request cooling drinks, ripe fruits, &c.
which should be allowed. M. C. has not found emetics and purgatives so
useful, nor bleeding so dangerous, as the physicians of the last century state.
Emetics may be used at the commencement of a sudden attack, if the sto-
mach appears to be loaded, but cooling drinks and fruit generally relieve the
bad taste in the mouth.

Mucous Typhoid Fever. This is treated like the simple, except that acid
drinks are given instead of emollients, and slightly bitter and aromatic infu-
sions of indigenous plants, such as are made no use of in this country except
by the poor, and therefore not at all equivalent to our pharmaceutical bitters
and aromatics.

Treatment of Ataxic Typhoid Fever. The treatment of this variety is ve-
ry difficult: the antiphlogistic, tonic, and antispasmodic plans have all had
their exclusive supporters. The treatment however must vary. If inflam-
matory symptoms are present, the antiphlogistic treatment, and if Hie ady-
namic, tonics must be recommended. When there is no precise indication,
the expectant treatment is to be followed.

Treatment of Adynamic Typhoid Fever. When there is stupor, unusual
ppottration of itrength, weaknose of the pulse, faintness in the sitting posture.

1837.] Chomel o* Typhoid Fever$. 655

and involuntary passing of stools and urine,' we must use bitters and aromatics,
such as bark, chamomile, and Bage in draughts, lavements, baths, and exter-
nal applications ; with wine, camphor, and ether: if the symptoms increase,
the doses must be] _ . Spain given instead of those of

France. Extract of bark, by the mouth and in lavements, in doses of one
to two ounces a day, is given by M. Chomel in preference to quinine, if the
stomach will bear it, as he doubts whether the sulphate of quinine contains
all the tonic powers of bark equally with its febrifuge and antiperiodic princi-
ples. In this state tonics and excitants, instead of aggravating the lesions
of the intestines, exercise a favorable effect upon them. The intestinal ul-
are analogous to cutaneous ulcere sets, which are im*

proved by g applications. In three instances where the patients

died during the tonic treatment, the ulcers in the intestines were evidently
cicatrizing. The tonic treatment was followed in nine patients, all of whom
when it was commenced were in an alarming state of prostration, and six of
these recovered. It is important that tonics should be given before the
strength is too much exhausted, and yet not during reaction. The exact
time must be determined' at the bed-side, as no exact rules can be laid down.
If delirium or other signs of cerebral congestion exist, wine should not be
given, as it almost inevitably aggravates the symptoms. M. Chomel com-
monly gives wine in spoonfuls, at first once or many times daily, increasing
the quantity as debility increases. The lighter wines he gives with other
drinks, in the proportion of a 'fourth, a third, or half; the stronger wines
pure. In some cases the benefit is immediate: the pulse rises, the heat of
the skin increases, and the expression improves. Ether is particularly use-
ful when it is necessary to raise the powers rapidly, but. its action is transient ;
it should bo given with bark. Camphor is only employed by M. C. in lave-
ments with bark, when debility is great. Bark in infusion, decoction, or
still better only macerated in water, and sweetened with syrup of lemon, is
one of the best drinks. Also infusions of serpentaria, cascarilla and sage. ^
The tonic treatment is rarely necessary in the first stage, and should never
he tried then except with great reserve. In the second and third stages we
may employ it with more confidence and energy. Several excellent cases
are detailed in which success followed this treatment in apparently hopeless
cases. M. Chomel mentions the application of revulsives and of warm and
cold baths, but states nothing decidedly as to his own opinion of their effi-
cacy.

Treatment of Particular Symptoms and Complications. Haemorrhages are
rarely so profuse as to require special treatment. Epistaxis may render
plugging the nostrils necessary, and if the discharge of blood from the bow-
els is great, cold or iced water in draughts, lavements, and external applica-
tions, extract of rhatany, &c. should be tried. Great care should be taken to
prevent the formation of sloughs : when the fever has listed any time the
parts pressed on should be examined, and if there is that redness over the
sacrum which precedes sloughing, the patient should be so supported as to
lie on the side or even on the belly. When the eschar has formed, it should
be covered with diachylon plaster; when it has fallen, tlie wound should be
dressed as an ordinary ulcer. M. C. has not tried Dr. Arnol bed.

The treatment of local inflammation- attacking a d
difficult. Local bleeding, particularly cupping, must be cautiously emplo;
if the strength will permit. !'> lition forbids it,

and the tonic treatment must b .. whilst the local disease is combated

with epispastics, as blisters and rubefacient plasters. In erysipelas of the
face, the blood should be directed towards the feet by sinapisms, or very hot
flannels covered with oiled silk. All the cases of perforation of the intes-
tines which have fallen under M. Chomel's immediate observation have been
fatal. Perfect rest and abstinence were the treatment adopted, but if other
<cases should occur lie propose* to try the plan" suggested by Dr, Grave

556 Belladonna. [Feb.

Dublin, and put into execution by himself and Dr. Stokes, of giving large and
repeated doses of opium, so as to preserve the intestines in a complete state
of rest, in order to prevent the further escape of feecal matter into the perito-
neum, and to allow nature to close the opening by adhesive inflammation.
Opium is admirably calculated to fulfil this intention, by putting a stop to or
weakening the peristaltic action of the bowels, and by soothing the excessive
pain. These accomplished physicians have had some cases to justify the
utility of the practice, and although it has not often succeeded, yet it has ne-
ver wholly failed to assist nature under this distressing accident. We would
refer those who desire complete information on this important subject to the
original paper of JVJ . Louis on perforation of the intestines in his " Memoires
ou Recherches Anatomico-pathologiques," p. 136, et seq. ; to the 5th vol. of
the Dublin Hospital Reports ; or to an able article, embracing both patholo-
gy and treatment, by Dr. Stokes, in the Cyclopedia of Practical Medicine,
(art. Peritonitis.) The state of the intestinal tube will explain the frequency
of tedious convalescence, and the accidents to which those are subject who
are recovering from this disease. When the heat of the body diminishes,
even although the frequency of the pulse continues, some liquid food maybe
given, such as veal and chicken broth, "le lait de poule," milk and water, &c.
augmented gradually until solid food can be digested. If the appetite does
not return, and the patients are very weak, bitters should be given. Coun-
try air is very favorable to convalescence.

Belladonna.

Being assured of the fact, that the medical virtues of this im-
portant article are too little known, or estimated by the profes-
sion, we give the following extracts from foreign journals, con-
tained in the third number of the British and Foreign Medical
Review.

On the use of Belladonna as a topical application in retention oj 'urine, spas-
modic contractions of the uterus, and in strangulated hernia. The well-
known relaxant effects of belladonna on the iris, &.c. has naturally led to its
use in cases where spasm was known or assumed to exist in other parts.
M. Guerin, of Bourdeaux, was the first, we believe, who employed it in spas-
modic strictures of the urethra, in the form of ointment spread on a bougie ;
and he states that he found the same remedy, applied in the same manner,
effectual in the case of strangulated hernia. Since then, belladonna has been
frequently used topically in similar and analogous cases ; and we shall here
extract the heads of a few of the more recent which have met our eye in
some of the foreign journals.

/. Efficacy of Extract of Belladonna in Retention of Urine : By M. GEHAR&,
late Chief Surgeon of the Hospital at Avignon.

Case 1. A lady, mi. 36, was delivered of her first child, after a long and
severe labour, at 1 A. M. on the 16th November, 1834. Nine hours there-
after it was discovered that the urinary bladder was immensely distended and
painful, no water having been passed since the commencement of the labor,
and there being still an incapacity to do so. No attempt seems to have been.

1837. J Betfadonna. 557

then made to introduce the catheter; the surgeon contenting himself with
ordering "vegetable lemonade, and an emollient poultice to the hypogastri-
um." At 9 I*. M. no urine having beea passed, (now three days,) matters
were ofcour.se worse, and then the surgeon seems tor the first time to hare

thought of the catheter, hut he could not succeed in its introduction, owing
to what he terms ;i manifest coarctation of the urethra." Being deterred
by the patient's debility from the use of general and local bleedings or the
warm bath, M. Gerard prescribed an ointment composed of two drachms of
Extract Bellad. to one ounce of lard, and ordered it to be rubbed on the hy-
pogastrium and labia. The first friction was made at midnight, the wext at
3 A. M. ; and shortly after this last the patient began to make water in small
quantities with much pain. The frictions were continued through the day,
and the urine at length flowed plentifully.

Case 2. A man, cet. 49, was attacked with retention of urine, accompa-
nied with fever, for which lie was copiously bled and leeched on two succes-.
sive days, without relief. On the third day, frictions with the belladonna
ointment were used on the hypogastrium and perineum. After the third
friction there was a slight discharge of urine ; and on the following day, the
frictions being continued, the patient was completely relieved.

Case 3. A man, act. 24, suffered very acute pains in the region of the blad-
der, attended with retention of urine for three days, the consequence of a se-
vere blow. After the failure of general and local bleedings, and the warm
bath continued for four hours, the belladonna ointment was had recourse to,
and the urine flowed after the third application.

Case 4. A man, affected with stricture of the urethra for six years, called
in M. Girard in consequence of a suppression of urine, which had lasted four
days, notwithstanding the employment of general and local bleeding,, bathing,
anodynes, &c. The belladonna ointment was ordered: after the first fric-
tion a slight flow of urine took place, and the relief was complete after the
continuance of the friction for thirty-six hours. Journal des Connaissances
Med.-Chir., Mai, 1835.

II. Employment of Belladonna in Spasmodic Contractions of the Uterus, Ure-
thra, and Inguinal Ring. By M. Carre, Chief Surgeon of the Military
Hospital of Brian con.

F Case 1. A lady was in labour of her third child ; the waters had broken,
and, as no progress was gained, the midwife attempted to dilate the os uteri
by her fingers. This proceeding increased the irritation and contraction, and
produced general convulsions. M. Carre, being called in, bled the patient
and used the warm bath, but to no purpose. He then ordered the os tincae
to be rubbed with belladonna ointment every half-hour : and, after the third
friction, the uterus became sufficiently dilated to permit the operation of turn-
ing, and the child was delivered, and lived. The ointment was made by rub-
bing up eight grammes of Ext. Belladonna with sixty-four grammes of cerate,
and of this from two to four grammes were used each time.

Case 2. A woman, a?t. twenty-one, was prematurely taken in labour at
the eigth month. The waters had broken for some time, and, when M. C.
was called, he found the os uteri so strongly contracted upon an arm of the
fcetus, that he could not introduce his hand. Having first had recourse to
bleeding, &c. the same ointment was applied, and, after the fourth friction, the
dilatation was sufficient to permit the operation of turning, and the extrac-
tion of a dead child.

Case 3. A man had suffered from retention of urine for twenty-four hours,
without any relief from bleeding and baths. The catheter could not be in-
troduced beyond two inches, on account of the spasmodic contraction of the
urethra. As the patient had been able to make water freely previously to
the attack, M. C. believing the case merely spasmodic, prescribed tl;e bella-

558 Belladonna. [Feb.

donna, which lie applied by friction with the ointment on the glans, and by
applying to the perineum a poultice made with decoction of the leaves, and
further moistened with a solution of the extract. In an hour or two the
urine began to flow slowly, and he was completely relieved in three hours.

Case 4. A man suffered a protrusion of voluminous inguinal hernia in at-
tempting to lift a load. After ineffectual attempts at reduction, the use of
bleeding, baths, &c. M. C. had recourse to M. Guerin's practice, introducing
into the urethra a bougie covered with equal parts of cerate and extract of
belladonna, and in half an hour's time he was able to reduce the hernia.

Case 5. A soldier, subject for some years to a hernia, and for which he
used a truss, had the misfortune to break this in leaping a ditch, and his her-
nia protruded and became strangulated. lie had been ill twenty-four hours,
suffering great pain, vomiting, &c. when M. C. saw him. Bleeding, baths,
and the taxis were tried in vain. The tumour was tlien rubbed with the bel-
ladonna ointment, and a cataplasm applied. The pains ceased in from half an
hour to three quarters, and, the taxis being then admissible, it proved readily
successful.

Case 6. Another soldier suffered in the same way, and was relieved by
the belladonna ointment after the failure of other means. Ibid.

III. Two cases of Incarcerated Hernia cured by the i^se of Belladonna Oint-
ment: By Pietro Porta, M. D. of San Zenone.

Case 1. A stout healthy man, set. 50, upon lifting a heavy weight, was
seized with a sudden pain, attended with tumour in the right iliac region.
A medical man having recognized a crural hernia, bled the patient, and pre-
scribed warm fomentations. The next day Signor Porta was called in, when
the intense pain, meteorism, hiccough, vomiting, and obstipation, unrelieved
by a second bleeding and the taxis, determined him to resort to the use of
the belladonna, in the form of dried leaves 3j. to lard 3vj. This however
could not be procured for a whole day, during which delay all the symptoms
became much aggravated . nevertheless a few frictions with the ointment
over the tumour caused it to disappear, with all its attendant symptoms.

Case 2. This was supposed to be a case of omental inguinal hernia, and
occurred in a child of five years old. The tumour was inelastic, doughy, and
irregular, giving rise to no prominent symptoms of suffering, but still, after
several days, remaining irreducible by the taxis and warm baths. The bel-
ladonna ointment, applied every two hours for three days, succeeded in ef-
fecting the reduction, after the failure of every other means.

[Although the majority of the foregoing cases are far from presenting pos-
itive evidence of the efficacy of belladonna as a relaxcr of the spasm present
or presumed to be present in them, since similar cases terminating in like
manner, without the use of this remedy, must have occurred to most, surge-
ons of experience still they cannot be repudiated as unworthy the notice of
the practitioner, according to the law of evidence commonly received in phy-
sic. To remove all doubt, a much greater number of successful cases must
be adduced, or an equal number of similar cases must be treated with and
without belladonna, and the majority of favorable results proved to be on the
side of the treatment with this remedy. In respect of hernia, we must
strongly protest against the adoption of any measures attended with loss of
time and delay of the surgical operation, in acomplaint of so urgent a nature
as incarcerated hernia. When however, as sometimes occurs, through the
strong opposition of the patient or his friends, an operation is impracticable,
no mode of treatment which offers a chance of success should be neglected;
and in such cases frictions with belladonna, harmless in themselves and soo-
thing to the patient, are not only admissible, but are to be recommended, as
supported by experience at least, if not by sound pathology.

Dr. Motard, of Turin, ha^ found thai a solution of belladonna, introduced

1837. J On (he Physiology tf Vomitings $c. ^^

into the nose, dilates the pupil i ffectually: ami he ia inthehabil
ing a pinch of snuff with a solution, by v. bich means the pupil next to the nos-
tril in which it is introduced is dilated in a minute or two. The dil
lasts about two days. This hint is worthy of trial in those cases of cataract
where the patients are in the constant habit of using belladonna to improve
in some degree their imperfect vision; as it is a more convenient, process
than the common one.] (Horn" iGo-Chirvrgteke, No. a*

Apr ile, 1835.

On the Physiology of Vomiting ; and on the Causes of its Difference in Adults
and Children: By Professor C. H. Schultz, m. d.

The great frequency of vomiting in infants at the breast, and the sponta-
neousness and facility with which this process takes place, are well known.
It seems to occur without any previous nausea, as the infants, generally spea-
king, exhibit no signs of uneasiness. The case, as is well known, is very
different with adults, in whom nausea and retching will, in certain cases, exist
in a great degree for days, or even wTeeks, without any evacuation of the
contents of the stomach. The facility of vomiting in general remains with
children for some years after weaning, although this is effected with some-
what greater difficulty than durfrig the period of nursing. The causes of
this difference in the readiness to vomit at different ages have not, as far as 1
know, been yet closely investigated.

To enable us to prosecute this inquiry with advantage, it is necessary that
we should have a perfect understanding of the causes of vomiting in general ;
and to this point I shall address myself in the first place.

The opinion first advanced by Boyle, that, in the act of vomiting, the sto-
mach is passive the evacuation of its contents being effected by the con-
temporaneous contraction of the abdominal muscles and diaphragm has
been adopted and powerfully advocated by physiologists of the greatest
name,- more especially of late years. Chirac confirmed the fact stated -by
Boyle, that no convulsive motions are felt in the stomach during vomiting- in
the case of dogs, when the hand is placed in contact with the organ through
a wound made in the abdomen. Van Swieten, Scnac, and others, adopted
the opinion of Boyle on other grounds ; and, in later times, Magendie has
proved beyond question, that, in the case of dogs, not only are no convulsive
motions of the stomach felt during vomiting, but none are seen when, the
stomach is laid bare; and, moreover, that when the abdominal muscles are
removed, and the contractile power of the diaphragm destroyed, the act of
vomiting in dogs, if not entirely prevented, is, at least, rendered extremely
difficult. It accords with this view of the process that, in man, vomiting be-
comes easier in proportion as the stomach is distended, and is thus more ex-
posed to compression between the above-named muscles.

The objection to this explanation, derived from the fact that vomiting takes
place in birds and amphibia which have no diaphragm, as also in certain ca-
ses in the human subject in which an abnormal position of the stomach had
removed it from the pressure of this muscle, is not valid, since in such c
the thoracic viscera, during inspiration, present sufficient resistance to allow
the stomach to be compressed between them and the abdominal muscles.
It is indeed obvious, that the same muscular action takes place in the act of

560 On the Physiology of Vomhing, tyc. [Feb.

vomiting as in labour, cough, and the evacuation of the bowels and bladder,
&c. ; and that the discharge of the contents of the stomach by repeated fits
or impulses, corresponds exactly with the spasm-like contractions of the ab-
dominal muscles and diaphragm.

It has not, however, escaped the opposers of Magendie's theory, that if
vomiting were effected exclusively by the abdominal muscles and diaphragm,
it ought to be a purely voluntary act ; whereas, it is known that only very
few animals, such as frogs and birds of prey, can evacuate the contents of the
stomach at pleasure. It results from this fact alone, that the before men-
tioned muscles are not exclusively those which arc active during vomiting;
and we are hence led back to the old doctrine of the anti-peristaltic motion
t>f the digestive organs. Maignault and Beclard have attempted to prove
that, although the stomach is not spasmodically contracted, still that the oeso-
phagus is thus affected, by fits, during vomiting in the dog ; and every one
who has experienced vomiting in his own person must have felt that these
reverse spasmodic efforts of the muscles of deglutition commence in the pha-
rynx. These gentlemen were further of opinion that, in the act of vomiting,
no antiperistaltic movements take place in the stomach, but that this organ
presents a state of equable tonic contraction, and that it is only by means of
the fitful contractions and expansions of the oesophagus, aided by the action
of the abdominal muscles, that the stomach is emptied of its contents.

While acknowledging our obligations to the French investigators, we must
admit that there are many phenomena attending the act of vomiting which
prove their theory to be at least insufficient. If the oesophagus and abdom-
inal muscles are the only parts active during vomiting, how is the phenomena
of faecal vomiting to be explained? I consider this morbid state sufficient
proof in itself that an antiperistaltic action both of the intestinal canal and
stomach does exist, while, on the other hand, no one can deny that there
may and do exist contractions of the abdominal muscle?, diaphragm, and oe-
sophagus, without any vomiting. This is evident in the case of the horse,
rabbit, hare, guinea-pig, and several other herbivorous animals, which can-
not be made to vomit even by the strongest emetics, although the strongest
retching and contractions of the abdominal muscles take place, and although
they possess the same organs as the dog, which vomits on the slightest occa-
sion. It is the more important to investigate the cause of this difference in
animals-, as it will lead to the explanation of the much greater facility of vom-
iting in children than in adults.

The cause of these differences lies in the particular shape of the stomach
in different animals, a circumstance, as far as I know, hitherto unnoticed by
comparative anatomists; and the same cause operates in producing the dif-
ference in the facility of vomiting in the infant and the adult; since there ex-
ists the same analogous difference of form between the stomach of the child
and the adult man, as between the stomach of animals which vomit with facil-
ity* su^h as the dog and cat (and we may say carnivorous animals in general)*
and the stomach of those which vomit not at all or with extreme difficulty, as
the horse and rabbit, (and herbivorous animals generally).

Before proceeding further in the enquiry, I think it necessary to state that
my experiments and observations lead me to decide positively in favor of the
existence of antiperistaltic motions of the stomach during the act of vomiting.
Boyle, Chirac, and the recent observers in France, hastily concluded that.
because they could discover no convulsive movements of the stomach that
therefore there were no antiperistaltic movements of any kind : they found
the stomach contracted and motionless. I admit that there are no convul-
sive movements, but I cannot concede that in the dog, for instance, the sto-
mach is at rest during the act of vomiting. On the contrary, I maintain that
decided antiperistaltic movements are perceptible, but these are not stronger
than the ordinary peristaltic motions of the same organ. They are, more-
over, not very distinct in the middle portion and fundus of the sicmach, but

1837. J On the Physiology of Vomiting, fyc. 501

only at the two extremities near the cardia and pylorus. The whole pyloric
portion is strongly contracted -when the cardiac portion expands ; and, while
this is going on, there is no perceptible motion in the fundus and larger cur-
vature, and assuredly no convulsive one. But, it may be asked, what consid-
erable effect can so slow an antiperistaltic motion have in vomiting? The
answer is briefly this that, by this antiperistaltic motion, (no doubt assisted
by the abdominal muscles,) the direction is given to the food which is to be
ejected by the act of vomiting, or which is to be forced from the intestines into
the stomach in the case of fascal vomiting. If the abdominal muscles alone
acted on the perfectly passive stomach, the food might, by this pressure, be
driven into the intestine as well as into the oesophagus; if, then, the contents
of the stomach are to be ejected in a particular direction, it is requisite that
the cardiac and pyloric portions should possess a distinct active motion.

I now return to the various forms of the stomach occasioning the differen-
ces in vomiting; and here I may take for granted as understood what I have
detailed in the work "De Alimentorum Concoctione" concerning the forms
of the stomachs of carnivorous and herbivorous animals. It is demonstrable
that a child's stomach is as different from that of an adult as a pole-cat's is
from that of a rat; and, if the difference between the form of a child's sto-
mach and that of an adult has not been sooner recognised, it is only because
their very different functions and importance in the preservation of life had
not previously been suspected ; for this difference will not fail to strike every
one as soon as his attention is directed to it. But, to make these differences
still more conspicuous, I will introduce an outline of the form of a child's sto-
mach, and that of an adult.

The stomach of a child is more of a conical form, drawn out lengthwise,
and gradually narrowing towards the two extremities, inferiorly towards the
pylorus, superiorly towards the cardia. The oesophagus is inserted into the
fundus at the left extremity, and at a distance from the pylorus ; the small
curvature is stretched out lengthwise, the large curvature is less developed,
and runs almost parallel with the small ; in short, the stomach of a child re-
sembles that of the carnivorous mammalia.

The form of the stomach of the adult is very different : it is more circular ;
the oesophagus is not inserted into the left extremity, as is the case with the
child's, but into the middle between the left extremity and the pylorus.
The pylorus itself is drawn back towards the cardia, and both brought very
near to each other; on this account, the small curvature is very short, while
the large curvature, on the contrary, is disproportionately extended, forming
not only the entire lower circumference of the stomach, but also surrounding
that part of the fundus situated between the cardia and the left extremity ;
so that the large curvature alone forms about four-fifths of the whole circum-
ference of the stomach. It must, also be added, that the fundus does not
pass into the pyloric portion gradually and gently, as is the case with the
child's, but that the latter is separated from the former by a sort of neck or
contraction, sometimes more, sometimes less, strongly marked. In conse-
quence of this the left part of the stomach assumes an almost circular form,
and the whole very much resembles the form of the stomach of the rat or
rabbit, although in a less marked degree than in these animals.

To each of these different forms of the stomach, an entirely distinct mo-
tion, peristaltic as well as antiperistaltic, has been given. In the child's sto-
mach, where the small curvature is extended almost parallel with the large
one, the food is expelled with nearly equal power by the undulating motion of
both curvatures, and forced towards the pylorus by the peristaltic and to-
wards the cardia and oesophagus by the antiperistaltic. In consequence of
this, vomiting in children is very easy, because the oesophagus is situated at
one extremity of the stomach, towards which the food is forced, at the same
time thai the pylorus closes and the cardia opens. But the pepjsess is very
different in the stomach of the adult : in thi*, the small curvature is so much

71

5G2 On the Physiology of Vomitijig, tyc. [Feb.

shortened, and the large one. so much extended, that the food is not equally
propelled from both sides, but the motion is almost confined to one s-ide, and
is effected principally by the large curvature, which embraces almost the
entire circumference of the contents of the stomach ; by this partial action,
the contents of the stomach are moved rather in a rotary direction, which
completely stops towards the contracted pyloric portion, turning round in the
fundus from the left side to the right when urged by the peristaltic motion,
and from the right to the left when by the antiperistaltic. In consequence
of this, during the act of vomiting, the antiperistaltic motion does not direct
the food towards the cardia and oesophagus, but merely communicates to it a
motion contrary to that given by the peristaltic; and herein the reason is to
be sought why, notwithstanding the pressure of the abdominal muscles and
the diaphragm, the contents of the stomach are so difficult to be voided, and.
that, in many herbivorous animals, where the small curvature is still more
shortened, the evacuation is impossible. The evacuation of the contents of
the stomach of an adult can be effected only by a strenuous effort, produced
by the strong pressure of the diaphragm and abdominal muscles, at the same
time that the oesophagus-opens and shuts alternately; the stomach itself would
be incapable from its antiperistaltic motion alone to discharge its contents
upwards. In this respect there exists a completely different state of tilings
in the pyloric and cardiac portions of the stomach. The pyloric portion from
the point where it is so much reduced in diameter, exhibits a more regular
or intestine-like form of both curvatures, and the contents are on that ac-
count easily urged forwards into the duodenum ; but, in the other direction,
the contemporaneous motion of the two sides ceases beyond the contracted
part, becoming, as already stated, rotary, in the cardial portion.

These details satisfactorily explain the differences so often referred to be-
tween children and adults. The former can discharge the contents of their
stomachs by the antiperistaltic motion alone, without any perceptible assis-
tance of the abdominal muscles ; and the least pressure from these will in-
crease the discharge. Animals whose stomachs are cylindrical, and in which
consequently, the ordinary relation between two curvatures entirely ceases,
such as frogs or fishes, can, as it appears, with facility empty their "stomachs
by means of the antiperistaltic motion alone, without any cooperation of the
abdominal muscles ; and it is thus that they often throw up pieces of food
merely on account of their inconvenient position in the stomach, and swallow
them again in a more acceptable direction ; even dogs after having swal-
lowed a piece of bone frequently adopt a somewhat similar method. The
human stomach in the earlier stages of its formation puts on the cylindrical
form of the stomach of fishes and amphibious animals ; in the embryo it ap-
pears only as a slight enlargement and elongation of the oesophagus in the
abdominal cavity, with the cardia directed upwards and the pylorus down-
wards, as is the case with frogs. The stomach assumes its horizontal posi-
tion only at a later period when the curvatures become developed.

There are naturally an endless number of transitions and intermediate sta-
ges of development, between the cylindrical, conical form of 1 lie stomach of
the infant and that of the adult; and these numerous transilieiis will be ac-
companied by as many degrees of facility or difficulty in vomiting. What
appears to me particularly interesting in a medical point of view is, that t ho
round stomach of the adult is frequently seen in children oi a diseased or
merely of a disordered condition at a much earlier age than usual, and that
such children also generally vomit with much more difficulty. I have had
opportunities of making this observation in several post-mortom examine-
tions of scrofulous children; and in one instance was able to describe before
death the probable form of the stomach, from the i^w raordinary difficulty with
which the child vomited. On the other hand, the fundus ofthe stomach of
adults is not always found to extend, in a like degree^ beyond the insertion
ofthe oesophagus towards, the left side. There are human stomachs *

1837.] On the Physiology of Vomiting, <$>c. 5tf3

the fundus so much developed, as to be with difficulty distinguished from
those of herbivorous animals : and others, again, which approacli nearer to
the form of the dog's stomach from their imperfect development.

The question naturally here suggests itself What is the cause, not only
of these difference^ but of the changes in general, to which the stomach is
subject at different periods of life 1 To me it appears that the cause is prin-
cipally to be sought in the nature and quantity of the food. The cylindrical
form of the stomach in children continues only while they arc fed on milk,
Consequently on purely animal food ; as soon as they receive vegetable food
in any quantity, the fundus begins to develop itself. On that account, even
in the first year, a strong development of the fundus is found to have taken
place in such children as have been weaned immediately after their birth and
fed on soft pap made of flour, potatoes, or bread. The influence of the food
on the form of the stomach is distinctly observable in older persons. The
stomachs of such persons who live principally on potatoes and other vegeta-
bles are found to resemble most those of herbivorous animals ; while the fun-
dus in individuals who live more on rich animal food is less developed. I
have shewn in my paper, "De Alimentorum Concoctione," that the stomach
of dogs and cats (animals purely carnivorous,) will assume the circular form
after they have been fed for some time on messes of potatoes, meal, and
bread ; but that their stomach will retain its original oblong form if fed on
animal food alone. On this account, the round form 6f the stomach observed
in the domesticated carnivorous animals is never found in wild animals of
the same class, such as, for example, the pole-cat.

Man, as an omnivorous animal, certainly possesses the type of the more
rounded form of the stomach ; but the extent of the development until it at-
tain the form of the stomach of animals purely herbivorous, will, however, in
a great measure, be determined by the degree of preponderance of vegetable
over animal food ; and the development may be increased till it become mor-
bid. The reason why. vegetable diet should develop the fundus to such a
degree that the stomach assumes the circular form, (and the rotary motion
be inconsequence given to its contents,) is, I believe, the following: 1 have
shewn elsewhere, in speaking of animals, that vegetable food is of much more
difficult digestion, and consequently is retained much longer in the stomach;
The food requires to be moved, about longer, and not immediately propelled
into the intestine ; hence the rotary motion, by which it is agitated in the
stomach without being directly emptied into the pylorus. By this action the
digested part of the vegetable food is gradually separated by layers on the
surface of the mass, and is conducted into the pyloric division, in order to be
passed into the intestine, while the undigested part continues in rotary mo-
tion in the centre of the stomach. In carnivorous animals the process is very
different: the animal food, being soon digested, is directly propelled towards
the pylorus by the united action of both curvatures, and does not require to
undergo a prolonged rotary motion ; whereas, if vegetable food be received
in a stomach so constituted, it will necessarily pass into the intestine in a
raw or only partially digested state. On the other hand, herbivorous ani-
mals cannot perfectly digest animal food unless the form of the stomach un-
dergo a change, as, by long detention in the organ, the food, instead of being
digested, becomes putrid. The attempts-, therefore, which have been made
in some places to feed sheep, horses, and oxen, on fish or other animal mat-
ter, must ever fail. The enquiry whether the stomach of these animals
might not be transformed by gradually accustoming them to animal food, is
foreign to the present subject. But, even with dogs and cats, experience
shews that purely vegetable food does not succeed, as it almost invariably
renders them subject to the mange, (raude.) But, to return to the cause of
vomiting in children and adults. '

Although the form of the stomach plays the principal part in vomiting, there
seems to be another agent strongly co-operating with it, namely, the sensi-

564 On the Physiology of Vomiting, fyc. [Feb.

bility of the organ itself, particularly in respect of the nausea or sickness
which produces the motions of the stomach in the act of vomiting. This is
the reason why I do not assert that lunatics, who generally vomit with so
much difficulty, experience this difficulty only because they have a herbivor-
ous stomach ; in such a case, we must consider the state of the brain as well
as the sensibility of the stomach ; the torpidity of the brain being often such
as not to admit the perception of nausea : these persons, perhaps, frequent-
ly do not vomit because they do not experience nausea.

We have been endeavouring to shew that the food is detained longer in
the stomach of the herbivorous form, because it is kept longer in action there,
without passing directly into the intestine, and that this form is adapted on-
ly to the more indigestible quality of vegetable food. If a stomach so consti-
tuted be suddenly filled with animal food, this food will be detained longer
by the rotary motion than is necessary for the purpose of digestion, and the
consequence will be, that the whole process will be disturbed, and the food,
instead of being digested, will undergo a chemical decomposition. From
this we may also conclude, that nothing will disorder the stomach sooner
than-sudden repletion with animal food after long use of a diet in which the
vegetable preponderated. Excess of vegetable food is much less injurious in
such cases, as indigested vegetable matter is, in the intestine, not so easily
decomposed, and excites peristaltic motion more than animal food. It fol-
lows that we ought carefully to avoid sudden change of diet from vegetable
to animal. To this may be ascribed the greatest part of the gastric diseas-
es prevalent in the summer, and still more in autumn, when the stomach, af-
ter having been accustomed to vegetable diet, is suddenly charged with large
quantities of animal food.

The only remaining question is, whether we can produce excessive retch-
ing by larger doses of emetics, as a substitute for the want of peristaltic ex-
pulsory motion in persons having stomachs of the herbivorous form ? On
closer observation, however, we shall be induced to believe that large doses
of emetics in such cases would fail in, producing the intended effect. There
are persons in whom very powerful emetics would sooner produce death than
vomiting, as is the case with rabbits. In such cases, I think, the greatest as-
sistance will be afforded by such means as will facilitate vomiting, by in-
creasing the pressure of the abdominal muscles on the stomach, such as fil-
ling it with fluids particularly gelatinous fluids, or any thing calculated to in-
crease the elastic tension of the parts : perhaps, after all, the best means of
facilitating vomiting in stomachs of such a conformation will be starch-flower
or arrow-root boiled to a paste, as formerly recommended by Hufeland.
Hufeland and Osann's Journal. Mdrz, 1835.

1837] StiUingut Sylvatica in Scrofula and tinea. 505

Part III MONTHLY PERISCOPE.

Stilhngia Sylvatica in Scrofula and tinea. Wc have just re-
ceived a familiar letter from our highly valued and scientific
friend, Dr. Wm. M. Lee, of Indiantown, S. C, from which we
take the liberty of extracting the very important observations it
contains on the medicinal properties of the Stilling ia Sylvatica.
Every practitioner will feel deep interest in facts which tend to
enhance his usefulness, in attempts to cure these diseases
which have so often resisted every effort of the physician.

" You request some information in relation to the medicinal
properties of Stillingia Sylvatica. I have not kept any register
of the cases in which I have administerd it ; but two occur to
my mind at this time interesting : One of Scrofula, the other of
Tinea Capitis. The former was a lady who had been under the
care of several physycians, with little or no benefit. I endeav-
ored to ascertain from herself and husband, what kind of medi-
cines had been given her, but received no clear and satifactory
information ; although I am inclined to think she had used either
the nitric or sulphuric acid. When I first saw her, her face was
disfigured by plasters of citrine ointment covering unsightly
ulcers, supposed by her friends to be cancerous in their nature,
and considered incurable ; as some healed, others would suc-
ceed them. The first glance satisfied me that the disease was
scrofulous. To restore the general health, I prescribed 4 grs.
Pilul. Hydr. every alternate night, and during the day three
wine-glassfuls" of the decoction of Stillingia, prepared by sim-
mering a double handful of the recent root in four pints of water
down to two. The effect was almost magical. In a very short
time, perhaps a fortnight, the ulcers began to dry up, and were
not, as formely, succeeded by a new crop. In the course of two
months they were all healed, the general health greatly improv-
ed; and except from the cicatrices, no one would suspect that she
had ever been diseased.

The case of Tinea was in a negro infant, about six months
old, belonging to a gentleman with whom I then boarded. I
never saw a more aggravated case. The scalp was almost one
mass of disease. An infusion was made by pouring two pints
of boiling water upon 1 oz. of the sliced roots of Stillingia. The
dose was a tablespoonful It was tried by the consent of her
owner, as an experiment, and in three or four weeks, my success
was complete. No external means were used except daily
ablution.

Asa therapeutical agent, T consider the Stillingia infinitely
superior to the expensive and often inert Sarsaparilla."

568 Medical Society of Augusta. [Feb.

MEDICAL SOCIETY OF AUGUSTA.

Wednesday, Jan. 4th, 1837.

After the annual election of officers, which was held this eve-
ning, the essayist for the evening being absent, the discussion of
the regular subject was postponed until the next meeting.

On the call of the meeting for the relation of facts of practic-
al importance, Dr. Antony related a case of accelerated men-
struation. Until the last two years the habit of this patient had
been regular menstruating at four weeks, and for five days at
each period, and at the usual rate. But since that time, the pe-
riod, had gradually accelerated to three weeks, shortened in du-
ration to three days, and attended with more than usual pain.
She was eighteen years of age, and had been married about
a year and a half, lie first saw her four days previous to her
three weeks' period. Finding the cause of her irregularity to
be a gradually increasing prolapse of the womb, this organ was
removed from the fossa scaphoides, into which it had descended,
and placed properly in the upper part of the pelvis, and in the
axis of the superior strait; and the patient, placed on her side
with her hips elevated by a thick pillow. On the second day
after, being two days before the expected menstrual discharge,
(according to the three weeks' period,) a bilboquet pessary, made
of soft elastic materials, was so applied as to occupy the [place
in the vagina before the lower part of the rectum, from which
the uterus had been removed, and sustain the organ in its proper
site. The patient was allowed to leave her bed at pleasure.

No other treatment was was prescribed, nor any particular
regimen; but the patient directed. to wear the pessary until after
the close of the approaching menstrual, which was her Novem-
ber period. The result was most happy. The menstrual flux
was retarded to the precise time of four weeks from the first
day of the last period, and continued without more uneasiness
than attends ordinary healthy menstruation for the term of five
days, at the ordinary rate of flowing in health thus securing to
her for this period at least, a perfect restoration to regularity
in every respect, which had not been the case for the last two
years.

The next day after the decline of the menstrual flux, the pes-
sary was removed. So complete had been the correction of
every irregularity at this period, that it was resolved to rest the
case for the next period, on daily replacement, with the use of
vaginal lotions. These were used every day, after a few hours
refreshment from bed in the morning, after which recumbence
for eighteen hours, with the hips on a pillow was enjoined. On
the twenty-seventh day from the beginning of the November pc-
riod, the menses made their appearance and continued four days

1837.] Medical Society of Augusta. 567

only being a deviation from health, of acceleration one day,
and duration one fifth less, but attended with no peculiar distress.

She was at this time on the same treatment as the last month,
and it was intended to reapply the pessary immediately pro-
ceeding the next period.

He gave this case as one fairly illustrating the efficacy of a
plan calculated to ensure the positive restoration of the uterus in
its proper place, over any other plan without this. The patient
was of -full and round habit, in the vigour of youth, and carrying
in the face the aspect of high health. Under all the circumstan-
ces, therefore, styptics or astringents, as well as tonics, were
counter-indicated.

Dr. Dugas said, as menstruation had been referred to, he
would give the Society the results of a case, wherein the
menses had not appeared for six months.

He had sinapisms- prepared of equal parts of mustard and
flour, made into a paste with water, and applied them over one
half of each breast simmultaneously, alternating the places of
application on each mamma, and repeating them frequently for
three days ; at the end of which the menses made their appear-
ance.

Dr. A. said he was happy in hearing of the favorable result
of a practice so suited to the convenience of females, and from
which he had expected so much, and found so little success. On
theiirst announccmnet of this remedy, he had subjected some six
or eight cases to the use of sinapsisms, in the same manner, com-
mencing about two days in anticipation of the monthly period,
and continuing the repetition as often asthetendernessoi" the sur-
face would bear, for three or four days, with no better results
than partial success in. one case only. He hoped, however, that
as our remedial resources were very limited in such cases, the
favorable result obtained by Dr, Dugas, would afford encourage-
ment to the members to give further trial to the remedy, and re-
port the result to the society.

Dr. D. said he had succeeded fully with this remedy in but
one case ; but that in all the cases in which he had used-it, mens-
trual pains and other symptoms of approaching discharge had
been produced, without the actual flux , thus manifesting the
power of the remedy on the uterus through the mammas; but
that at subsequent periods in the same cases, he had not found
the same results.

Dr. A. confirmed by his own experience the observation of
Dr. D., relative to the evidences of uterine excitement thus pro-
duced, notwithstanding the finally unfavorable issues which had
followed his use of this remedy.

Dr. P. F. Eve asfced if cither Dr. D. or Dr. A. had, on fail-
ing with this application of sinapisms, ever applied them to the
uppei and inner part of the thighs?

368 Medical Society of Augusta. [Feb.

Dr. Dugas said he had constantly done so, and with consider-
able success.

Dr. Antony said he had often used sinapisms in this latter
way, before and since their applicatiou to the mammae had been
recommended, but with such limited success in proportion to
their severiiy and disagreeableness to the patient, that he had
measurably abandoned the practice.

Dr. E. A. Eve said he had used sinapisms in both ways, but
always in connexion with other means, and with a reasonable
proportion of good results in his cases ; but could not say what
part of such results was fairly attributable to the use of sinapisms,
as he had in no instance depended on them alone.

Dr. Jos. A. Eve observed that cases of this kind were so va-
rious in their nature that this remedy could not be expected to
succeed in all cases, but whilst it would prove serviceable in some,
it would be productive of much mischief in others ; as exciting
measures only are properly adapted to those cases in which
there is a want of excitement in the uterus ; and contrary means,
as rcvellents to the sacrum, &c. in the opposite state of the organ.
He considered that before truth can be arrived at in this practice,
we must know more of physiology, relative to the association or
nature of the connexion of action which exists between the mam-
ma) and the uterus whether the sympathy, (if he might so
speak,) between them were direct or inverse- whether excitants
applied to the mamma) acted on the principle of revulsion, in les-
sening the excessive excitment of the uterus, or as a direct stim-
ulus to the latter by its association with the former.

Dr. Dugas was not prepared to say whether sinapisms to the
mamma), act as revulsives, or as direct exciters of the uterus, but
was much inclined to the latter opinion. Pregnancy, even in the
first weeks, he considered, irritates the mamma) so also on the
approach of the menstrual period, the mamma) become irritated.
He considered that in these and such cases, the uterine irritation
is directly extended to the mamma) ; therefore he was not dispos-
ed to consider the modus operandi to be by revulsion.

Dr. J. A. Eve repeated that until we can determine the mode
of sympathy between the two parts, it is impracticable to deter-
mine the modus operandi. If direct, then the sinapisms to the
mamma) can only prove useful in cases where more action is
required in the uterus, and injurious, if operative at all, in cases
of too high excitement in this organ, and vice versa if the sympa-
thy be inverse. He considered that the only way to determine
the relation of these parts is, by physiological observation. In
pregnancy the mamma) doincreasc,but the great excitement in the
womb would seem. to keep back the excitement in the mamma).
But after pregnancy ends, the excitement of the uterus is daily re-
duced, and the breasts become developed from excitement and
fluxion, nnd lactation commences. He pave as an evidence

1837.] Medical Society of Augusta. 56$

favorable to the opinion that the sympathy was reverse, the fact
that some women keep from conceiving as long as they please,
by keepingup lactation, and that the former (conception) is retard-
ed by the latter more or less in all women. If a woman miscarry,
or if, in consequence of the death of her child or any other cause,
except bad health, she do not lactate, she generally conceives in a
short time after parturition ; whereas, when a woman nurses her
child, it is not usual for her to conceive in less than twelve or eigh-
teen months. Many more arguments, he thought might, be deriv-
ed from an observation of physiological and pathological phe-
nomena, in favor of the existence of an antagonistic relation or
inverse sympathy between the Uterus and mammae.

Dr. E. A. Eve considered that lactation did not disprove
uterine excitement, but tended tc relieve it when it existed.

Dr. Antony advanced the opinion that the physiology of the con-
nexion of the uterus and mammae was very peculiar, and not to be
explained on the common principles of excitement alone. He
Was not sure if there was not a peculiarity in the vascular con-
nexion of these parts, (alluding to the anastomoses of the mam-
mary with the hypogastric arteries,) sufficient to account for the
peculiar phenomena, which are presented by these organs, in the
differrent states in which they are synchronously or successvely
found relative to each other. He instanced the accession of
lactation after delivery, when the contractions which the ute-
rus undergoes, necessarily, close up the great vascular sin-
uses which constitute, at least, much of its increased bulk
in pregnancy 5 and by which contractions the lochial discharge is
constantly moderated for several days, and until it ceas-
es almost entirely, whereon the mammae swell and become
painfully irritated, until free secretion takes place. Here, he
asked, might it not be reasonably supposed that the prompt sup-
pression of the free and copious transmission of the* blood
through the uterus, as well as of the red lochia, would
tend to the increased fulness of all that part of the sanguifer-
ous system most immediately connected with the uterus,
and therefore, of the hypogastrics which anastomose with the
mammary; and hence these organs enlarge and become irrita-
ted from unusual repletion ? Again.

In pregnancy, the uterus and its appendages labor under a
greater or less (but considerable) irritation, which causes an in-
creased fluxion to the part. And here he felt bound to depart
from some opinions which had been advanced, and to conclude
their stead, that the mammae do not ordinarily evince irritation
in the very first weeks of pregnancy ; but that, if altered at all,
they actually become more soft and flabby than usual, and that
this evidence of withdrawal of excitement and repletion is man-
ifested not only in the mammae, but also in every feature of the
face, making what are called the "shrinking of countenance," "the

78

570 Medical Society of Augusta. [Feb.

loss of looks," " the sharpening of features," &c. &c, which
makeup the prominent early symptoms of pregnancy. And
that these phenomena are owing to the focus of irritation exist-
ing in the uterus and its appendages, and which irritation, tho' lo-
cales tothegeneral system,is still suflicientlyextensive.as by a well
established law of excitement, to cause so considerable a fluxion to
the part, as to produce those external phenomena, so much re-
sembling a chill, and in which, the heart and large arteries arc
unusually charged with blood. He had observed that it is not,
generally, until after four weeks from the last menstrual visita-
tion, prior to conception, that the mammae become sensibly en-
larged; and even then the ratio of enlargment is in inverse pro-
portion to the degree of uterine irritation enlarging more rapidly
the less the uterine irritation, and remaining longer relaxed un-
der the circumstance of greater.

He was disposed to trace the manner of connexion still farther,
by calling the attention of the society to the facts of abortion, Or
of premature labor from uterine irritation; an occurrence by no
means unfrcquent. Here, he had found that, as after ordinary
delivery, the mamma) filled very soon after the irritation
was removed from the uterus, which had hitherto kept the
mammae more relaxed than ordinary, at least in proportion
to the period of pregnancy. The same principle, he considered
still farther illustrated, by the very conspicuous revulsion from
the mammae, in those serious cases of hysteritis, and its complica-
tions with puerperal peritonitis, in which lactation, after being
regularly established, is caused to cease almost instantaneously;
and which cessation is looked to as an evidence of most destruc-
tive and monopolizing intlammation The breasts here become
soft and flabby. There is nothing in this case to excite the least
idea that the change is, from any repellent effort produced in the
mammas ; for, at the period of confinement at which these dis-
eases are most likely to occur, we use, with perfect safety, the
most powerful repellents to the breast, which we can bring into
operation, as litharge plaster, &c.

Still farther facts, he said, might be adduced in evidence of the
agency of direct vascularity. In unmarried or unimpregnatcd
females, who labor under retarded or deficient menstruation, the
mamma; are found to swell and sometimes lactate at the men-
strual period. Why, he asked, should this fluxion and irritation
arise, in this distant part in preference to any other, but for vas-
cularity ? This is ordinarily the very next change in the sys-
tem, to deficient menstruation, and stands as a kind of monitor
to point US to future dangers (under continuance of the cause,) of
hepatic derangements in the phlegmatic, pulmonary in the san-
guineous and strumous,, nid nervous in the nervous temperaments.
If this be not the true physiology and paihology of the instan-
ces advanced, we have to conclude that these are to be acknowU

1837. J Medical Sqci iugusia. 57 i

edged laws of female nature, that her deyelopements cease in
some resp -ds short of that which lakes place in males that her
increment must so eixcedc as to amount to surplusage^ period-1
ically, tor thirty her life, for die purpose of her being

prepared for her offices, in the perpetuation of the species, and
that she must menstruate for that period, more or \c^, if not
pregnant nor laetatin.r: or suffer disease. So is it another law
peculiar to her nature, t<> undergo this change of determination
of the fluids, and theexclt i'her system, to lit her for the

same purposes ; and thus is beta t ion produced for the nourish*
ment of the offspring, when uterine excitement can no longer
continue. In obedience to the same law the determination leaves
the uterus when no longer needed there, but is necessary at the
breasts for the sustenance of the offspring ; and when this, in
turn, is no longer necessary, itreturns to the uterus, again to pre-
pare it for a renewal of its functions.

He would here leave the physiology of the case under consid-
eration, and give his practical views of those menstrual irregular-
ities whose treatment had been so .mexpectedly brought under
consideration. The pathology on which he practised in these cases
might be considered a vci'y mechanical one, but nevertheless
he would five his views of it, and the practice founded thereon.
He believed that a common error of pathologists was to look
with too much abstraction, on the principles and state of action or
excitement for the full solution of every problem in pathology. As
in other cases, lie was not disposed to conclude that, in menstru-
al irregularity, excitement dlojie was all that is to be considered.
He wished to avoid being too exclusive on either side. He was
not disposed to deny that momentary and transient causes which
demand, in consequence of their nature, no special effort for their
removal, may and do produce menstrual derangements which
continue after the first causes have passed away. Such are
certain strong mental impressions, cold, &c. But if the gentle-
men would contemplate the very peculiar vascularity of the
uterus, the distribution of the spermatic and uterine arteries to
the uterus and its appendages, the wonderfully varied anasto-
moses and inosculations with their own branches, with the
branches of their fellows in the symmetrical arrangement, and
with those of each other, with veins, 0c together with the cor.
responding veinous arrangement, it will not be difficult to con-
ceive of the great liability to obstruction to which many of these
vessels arc exposed: arid they would be able to realize, for
themselves, the fact that these derangements constitute by far
the most common aadse <>f menstrual irregularities. These im-
portant anatomical facts may be easily contemplated, by a visit
to the anatomical boards, or opening the large. folio of Tiedeman,
on the arteries, at the xxvii table.
In view of the vascular arrangements of this part, he had been

572 Medical Society of Augusta. [Feb.

n i I.. .

in the habit of considering that obstructions of different orders of
vessels, and these in various degrees might be fairly looked to as
the cause of a very large proportion of menstrual derangements.
In amenorrhoea and dysmenorrhea, the easy and sufficient dis-
charge of function is prevented by the tortion or compression in
some degree, which the arterial branches entering the uterus suf-
fer inconsequence of some degree of obliquity or depression of
the organ to which they are destined. All acquainted with the
anatomical connexions of the uterus, or its functions, must be
aware of the fact of its great and necessary mobility with the sur-
rounding part.-?. This is an indispensable part of the design in
the arrangement of its attachments to allow the great functional
exspansibility of the uterus. Keeping in view this fact, in con-
nexion with the abundantly tortuous course of the arteries pas-
sing through these loose media of connexion, no effort of the im-
agination is needed to perceive not only the probability of such
tortion or compression, but the almost unavoidable necessity for
its occurrence, on the existence of any considerable obliquity or
depression. But the truth, he considered, did not rest its sup-
port on the great probability which is, on contemplating these cir-
cumstances, found to exist ; but the seat of the principal distres-
ses or sensations attending these cases seemed to him, plainly
to indicate the fact, by referring to the parts of the vessels im-
mediately at and posterior to the obstructed points, that is to
say, about the round, broad and posterior ligaments. Thus he
considered that the necessary distribution to the vessels, within
the uterus, for the purpose of menstruation, whether it be a pe-
riodical discharge of blood, or a peculiar secretion (and he was
decidedly of the opinion that the former was the fact,) was pre-
vented, whilst pain from unusual fulness attended at the points
of mechanical obstruction.

He considered that the only cause of the difference between
amenorrhoea and menorrhagia, so far as regarded their pathol-
ogy was that, in the former the arterial, and in the latter, the
veinous branches suffered the obstruction; and that thus were pro-
duced the differing phenomena in the latter case, as excessive dis-
charge, less pain, &c. In farther evidence of the truth of this
opinion, he would state that on due investigation, he had rarely, if
ever, been disappointed, in finding the displacement alluded to
as cause of vascular obstruction : and that the two diseases
yielded with like promptitude to the same treatment, so
far as this was dictated by a reference to cause ; the chief dif-
ference being in the treatment of some of the symptoms in each,
for the removal of present distress, as the pain, for example, in
the former, and the haemorrhage in the latter.

The same theory of causation, he considered, equally applica-
ble to accelerated and to retarded menstruation ; in the latter
case arterial, and in the former veinous obstruction, existing.

1837.] Literary Sacrilege. 573

All these things, he considered, entirely consistent with the anat-
omy and physiology of the parts concurred, as well as the ill
success and* great uncertainty ordinarily attendant on other
means, without such as are adapted to the cause in this view. So
great has been this uncertainty, that not long since it was a point
of serious doubt amongst the profession, whether there was, in-
deed, such a virtue amongst medicines as emmenagogue ; and
this doubt still exists in the minds of many excellent practition-
ers, from the evidence afforded to the negative side of this ques-
tion, by their continued failures in protracted experience. Al-
though he was himself on the affirmative side of this question,
still, his experience had been attended by results much of the
same character during the first eight or ten years of his practice ;
and even to the present time, so far as he depended on the ad-
ministration of emmenagogue medicines alone. But for the last
twenty years, he had been pretty generally able, any time prior
to alteration of uterine texture, to succed in retarding accelera-
ted and accelerating retarded menstruation, to the proper peri-
od, by the same general course of treatment, with wThich he had
been most successful in procuring ease in painful, and abundance
in deficient menstruation. This treatment had mainly consist-
ed of strictly preserving the uterus in its proper site, proving
thereby not only the truth of the cause, but its identity in both
cases.

He was fully aware that there were cases of menstrual
irregularity in both ways from other causes, and in these cases,
he had met with reasonable success in the use of ordinary em-
menagogue powers for difficult, deficient or retarded menstrua-
tion; such as camphor in large doses, asafoetida, savin, &c. &c,
and incases of haemorrhage, styptics, as acet. plumb., pulvis,
alumina? comp., ergot, &c. But he had found these cases of rare
occurrence.

His trials of the sinapisms had been made in such cases as
from long continuance, and probably vascular disorganization,
had refused to yield to his ordinary treatment; and he was,
therefore, happy in being able to hope that they would, in gener-
al use, be found more successful than they had proved in his cases.
But whilst their use might in some measure stay the progress of
mischief for a time, still they might not be expected alone to
effect a final cure in any of those cases, depending on the mechan-
ical obstruction, to which he had alluded.

The Society then adjourned to the next Wednesday.

The following account of Sir Edward Home's flagitious con-
duct, with respect the invaluable manuscripts of the late John
Hunter, is taken from one of the daily papers in New York.
Comments are unnecessary every honest man and friend of
science will unite, in condemning to everlasting disgrace, a rob-

7-i Literary Sac r lit [Feb.

bcr so base as to steal from tli'e t omb of the dead his hard earned
laurels.

Literary S.vchi!,ec,i:. Some two. or tl . a statement ap-

peared in tho London papers, that? the late emuimi Surgeon, Sir Ever ard
Home, Jiad derived all ilie valuable portions of Jus celebrated Lectures on
Comparative Anatomy" from the manuscripts of the great John Hunter,
which had been confided to him for a special purpose by the Directors of the
College of Surgeon?, and then, to conceal the robbery, destroyed the manu-
scripts. The statement was copied into many papers in this couutry, but
here, too, it was not belived, and the charge was unhesitatingly pronounced
an infamous libel.

The charge appears to have been made the subject of a parliamentary in-
vestigation, and the London Courier gives the i'oiio wing as the substance of
the testimony given by tne accuser, Mr. Ciift, who was at one time, me
believe, an assistant of Sir Everard Home, and afterwards conservator of
the books and manuscripts in the museum of th of Surgeons.

"The museum of the late John Hunter was purchased by Government in
1800, who gave for it in all the sum of X*'-2700. This museum was given by
Government to the College of Surgeons in trust for tho Public. To then-
care were also cimlidod Mr. Hunter's papers and manuscripts referring to
the collection. Without any one interposing to prevent it, these manu-
scripts were allowed to be separated from the collection, and were taken
in a cart to Sir Everard Home's house, who was considered the only person
who could made a catalouge of the collection, and who expressed his inten-
tion to do so. Year after year, however, was permitted to pass away with-
out the preparation or the catalouge, and without any supervision of the
manuscripts from which aleue an account of the museum could be derived,
ami -without the slightest care being taken to ascertain that these valuable
documents were in safe custody^ when one day in July, 1824, that is, twenty
three years after the collection had been iri possession of the College of Sur-
geons, Sir Everard Home informed Mr. Clilt, the conservator of the muse-
um, that he (Sir Everard Home) had just been employed in burning all the
papers! Mr. Clift thus describee the relat ion oi' th. e.v.i .-uudinary circum-
stance before a Parliamentary committee : Sir Everard Home began by tel-
ling me that an accident had very nearly occurred at his house ; that it had
been nearly on lire ; that, the engineers came, and the firemen insisted in
taking possession of his house. They saw the flames coming out of the
chimney. He did uot wish to admit them, but they insisted upon being ad-
mitted. I asked how it happened, and then he told me it was in burning
those manuscripts of Mr. hunter. V> hei\ did thi: c; nversafion pass ? On
four road to Kew. That was the first intimation you ever had of the des-
truction of any of the manuscripts ! Yes. I said to him 'I hope Sir Eve-
rard, you have not destroyed those ten volumes relating to the gallery it He
said 'yes.' And then 1 mentioned perhaps? twenty fibers that J had a per-
fect recollection of. Will you go on and describe the state of your feeJmgs.
and what passed ! 1 can hardly describe then', because \ felt that all those
hopes that I had entertained, were entirely frustrated i nd destroyed. I con-
sidered that my life had been spent iti the service1 oi' that collection, and I
hoped to live to sec t hose papers honoliciaily employed. When I had made
inquiry respecting the principal of them, and lie told me they were all gone,
1 said to him, ' Well, Sir Evnard, there is only one more thing to be done.'
He said ' W'hal is that .'' I said -To burn the conecnon.4 Tn the course of
this conversation did you a k Sir Everard what had led him to take this step ?
I knew that that week Sir Everard had received back from the printer the
last proof of his second volvmo of ' Lectures on Comprrative Anatomy,' and
that lie had used fchoge papers \ cry largely in the composition of that

work.
Can you state, from the knowledge you obtained of i he manuscript,!?

188"/. j An inquiry inU itpnjoJLciicorrhcea. 5*75

while you bad accosi tot!; Sir Everard II >m i bad lately u jed tlicir

contents inthe e n of the volumes which he issuea under his own

nam;'!' l Yes.' [Then. follows! ao< ki ol ;lu letters and mmu-

Fcrip- . : a ^viewer observes:] *A

range . iinperft* \ I is admitted lo be,

investigated with the orig id tha woujdotful U^oustry: of this extra-

ordinary mm, would proba giveu a new aspect to the sciences of

anatomy and physiology in this . aad there, is not wanting evidence

that tli ' ! T himself, really had anticipated

discoveries which hi .c.kuduringfame to men of other

countries.' "]

An Inquiry info somi Points of ike History of Lit'.corrhcsa.
By Dr. M*RC LftSsrrwE.

Th il facts which form (he basis of the present essay were col-

lected in the Venereal Hospital of Paris. 1 \'ie author insists on the necessi-
ty of employing- the speculum, as the only means of acquiring a correct
knowledge of the disease. In several females, who stated that they never
had any leucorrhoea, he found a discharge from the os uteri, on employing
th? speculum. The cases which he has collected of -uterine discharge are
the most important, and the connexion which he has found to exist between
the matters secreted and the condition of the os ut sri are worthy of a short
analysis. Of 19.3 cases of uterine discharge which were examined with a
speculum, there were twenty-three in which the os uteri was dry, and the
vagina was equally free from any matter which could be traced to a uterine
origin. In forty eases, there was only a single drop pendent attheos uteri.
In the remaining 130, the discharge was more abundant. This discharge
is not necessarily stopped during pregnrncy. In a large proportion of cas-
es in which the menses were somewhat retarded, the discharge is also
found wanting. The fluid is either watery or more or less viscid, and in the
latter case of various characters; sometimes transparent, at others opaline,
streaked, opaque, white or yeilow. The condition of the cavity of the ute-
rus is neccsarily unknown ; but its orifice may be either healthy or surround-
ed by a rosy circle ; this circle may be of a deep reu colour or bloody, or the
redness may be granular without erosion ; or, lastly, the circle may be erod-
and ulcerated, with a. smooth or granulated surface. The fact of all these
cases having been assembled in Use the Venereal Hospital renders it doubt-
ful how far these discharges may be dependent on a syphilitic cause, or orig-
inate in simple chronic inflamation. But, as illustrating the connexion be-
tween the condition o! the parts and that of the discharge, the facts are
still of some interest. From a numerical comparison, the author found that
the waters and transparent albuminous discharges existed in the majority of
cases in which Ihe orifice was healthy, in one half of those where it was sur-
rounded by simple redness, and only in a fourth of the cases in which there
was vivid redness or ulceration. The opposite maybe said of those dis-
charges which were . -emitransparont and opaque. However, the
nature of the discharge is not soiely dependent on the condition of the ori-
fice, nor does a similar condition always produce a similar discharge ; for an
ulceration of the cer\i\, which coincides most frequently with the opaque,
coincides occasionally with the aqueous or albuminous discharges, and those
which are opaque and striated are sometimes met with when the cervix is
perfectly healthy. It is probable that the aqueous and albumuious dischar-
ges belong properly to leucorrhma ; whilst the addition of streaks of pur-
ulent opaque white fluid, depends rather on an inflammation which is either
simple or syphilitic. So little that is important can be concluded from the
author's examination of the vagina audits discharges, that it is scarcely
worthy of notice. British and Foreign Review. Archives generates Mcdc-
rinc, tome x. Fevrtsr, 1 83< i

S76 Chloride of Soda in Intermittent Fevers, fyc. <$c. [Feb*

On the use of Chhride of Soda in Intermittent Fevers. By Dr. Gouzee,
First Physician of the Millitary Hospital at Anvers.

Dr. Gouzee was induced to try this medicine, first recommended by Dr.
Lalesque, as its cheapness would render it (if efficacious) very valuable to the
poor inhabitants of marshy districts, as a substitute for quinine. The dose
prescribed was a half a drachm of chloride of soda in four ounces of distilled
water, to be taken by spoonfuls between the fits, and so that the last doses
should be swallowed shortly before the next paroxysm was expected. The
patients were restricted to a light diet, and confined in their beds, or at least
their chambers. Ten cases are reported of ague: in two the intermittent
yielded immediately ; two others were cured after a slight return ; m One
there were four attacks, gradually diminishing; in two cases the severity of
the paroxysms abated, but it was thought necessary to have recourse to
sulphate of quinine ; in two others no effect was produced, and in one the
disease was aggravated. Dr. G. thinks these cases prove the febrifuge
properties of the chloride of soda to be less marked than those of sulphate of
quinine, and therefore that it should not be trusted to except in the slighter
cases, and where the patients are readily susceptible of the effects of medi-
cine, as women and children. British and Foreign Review. Revue Medi-
cate. Fevricr, 1836.

On Incontinence of Urine. By M. Mondjere.

M. Mondiere has employed the extract of nux vomica in cases of noc-
turnal incontinence of urine, with beneficial effects. The case in which
its efficacy was most strongly shown is that of a young woman, aged twen-
ty, who* from the age of six years, had constantly voided her urine involun-
tarily during the night. The use of twelve of the following pills put an end
to the incontinence : they were continued until twenty-four grains of the ex-
tract had been taken, and** during the year following this treatment, there
was no return of the disease. Other successful cases are mentioned.

Extracti nucis vomicae, gr. viij.

Ferri protoxidi, gr. j. M. riant pil. xxiv.
British and Foreign Review. Gazette Medicate. Ao, 10. 1836.

Formnlafor an artificial Chalybeate Water.

fy . Ferri Sulphatis, 3 ss.

Sacchar, albi, 3 iss. Misce, et divide in chart, xij. eeq.
D. S. No. 1,

ty. Sodce Carbonatis, 3ss.

Sacchar. albi, 3 iss. M. et divide in pulv. xij. acq.
D. S. No. 2.

One powder from each of these packets is to be dissolved in a small quan-
tity of water, then mixed and drunk whilst effervescing. Each draught con-
tains about a grain of the carbonate of the protoxide of iron, dissolved in
water impregnated with carbonic acid gas, with a little Glauber's salt and
carbonate of soda ; the carbonate of soda being designedly a little in ex-
cess. This is a good substitute for ferruginous mineral waters, where the
natural ones cannot be obtained. British and Foreign Review. Summa-
rium des Nuesten in der Heilkunde. 1835.

SOUTHERN MEDICAL

AND

SURGICAL JOURNAL.

Vol. I.] MARCH, 1837. [No, 10.

Part L ORIGINAL COMMUNICATIONS,

ARTICLE I.

Cases of Traumatic Tetanus. By Jos. F. Lee, M. D., Ab-
beville District, S. C. (late of John's Island, S. C.)

There is, perhaps, no disease that falls under the attention of
the physician more generally fatal in its termination than Te-
tanus.

So generally fatal has it been considered, that Dr. Thomas,
a West India practitioner, of high standing, when speaking of
this disease, observes : " When Tetanic affections arise in con-
sequence of a wound, puncture or laceration, they are almost
sure to prove fatal, as I never, but once, met with a recovery,
under such circumstances, during a very extensive practice, and
Jong residence in the West Indies." Any plan of treatment,
therefore, calculated to produce a different result, in a disease of
so formidable a character, should be hailed with joy by the med-
ical philanthropist. Cold water "in Tetanic affections is no new
remedy. It has been employed for centuries past. Hippo-
crates, himself, was an advocate for the use of it. It appears,
however, surprising, that an agent of such extraordinary pow-
ers in this disease, should not be more generally used ; and,
fhat the warm bath should in most cases be substituted for it

73

578 Cases Traumatic Tetanus. [March,

My object in the following communication is, to relate two
cases, and the only two cases of Tetanus that have fallen under
my notice within a few years, in which a favorable termination
was effected by the cold affusion with other auxiliaries. I am
fully aware that I advance nothing new in the treatment of the
disease ; my sole object is, to endeaver to rescue, from undeserv-
ed neglect, one of the most potent remedies in the management
of it.

The first case that was treated by the cold affusion, was in
December, 1829. The patient was a negro woman, about forty
years of age. She had received an injury on the internal mal-
leolus of the ri^ht foot. The wound was considered of a trifling
nature, and neglected until the incursion of Tetanic symptoms.
I was now sent for. I found her, on my arrival, laboring under
opisthotonos, and upon inquiry into the cause of the disease, the
wound, as before stated, was shown me. A warm corn poul-
tice was directed to be applied to the wound, well moistened
with Spts. Turpentine, and to be renewed three times- in the
course of the day. She had taken, before my arrival, a dose of
the ol. ricini which 1 was informed, had operated well. Carded
cotton was next applied the whole length of the spinal column^
moistened with Turpentine and set fire to, which had the effect
of producing a very extensive eschar.

The cold bath was directed to be used every two hours, com-
mencing immediately. The manner of using the cold water
wa^ as follows: The patient was placed in a large tub, and a
bucket of cold water dashed over her ; she v/as then wiped dry
and placed between blankets. Fifty drops of laudanum was giv-
her in warm brandy toddy, and directed to be repeated every
three hours. On my visit the next day I was informed by the
master of the woman (before I saw her,) that he considered the
woman much better, that the interval between the spasms was
much longer, and the paroxysms much less violent than they
were the day before ; and that the woman herself was so satis-
fied of the salutary effect of the cold affusion, that she had called
for it herself. Upon seeing the patient, I was convinced of the
correctness of the statement received from her master. I did
not see her again for two days, on account of the distance of
my residence, and then found her progressing as well as could
be wished. The soreness of her .back from the cautery distres-

1937.1 Cases of Traumatic Tetanus. 579

sed tier at this time very much. Her pulse was, as is common
in the disease, but little affected. I did not see her again after
this visit, on account of the distance, but directed, should the
spasms recur in a violent degree, to be informed of it. I did not
again hear from them. About three weeks after, I saw the
master of the woman, who informed me that she had gradually-
improved under the cold affusion and laudanum, and he spoke in
the most rapturous terms of the cold water. At this time, she
only labored under debility. He was advised to administer to
her Peruvian bark three or four times a day, which completed
the cure.

The second case, was a girl, about twelve years of age, a
slave also. She complained, on my arrival, of great stiffness in
her back, some difficulty of deglutition, with a distressing pain
shooting from the sternum to her back. Her master was with
me, and I unhesitatingly pronounced it a case of Tetanus, which
he had not suspected, and had given her a dose of Glauber's salts,
which he informed me had operated well. Upon inquiry into
the cause of the disease, I was informed that she had run a splin-
ter in her foot about two weeks before, and that it had not been
extracted. A crucial incision was made over the punctured
place, with a view to extract the extraneous body, if possible.
The foot was carefully examined, but no splinter was found.
A poultice of corn flour and Turpentine was applied as in the
former case,and twenty drops of laudanum were administered to
her every three hours in brandy and water. The cold affusion
to be used every two hours. On my visit the next day, I found
her with confirmed Tetanus. The poultice that had been ap-
plied the day before, had caused the discharge of a fishbone about
an inch in length. In consequence of the successful termina-
tion of the former case, I was loath to omit any part of the treat-
ment pursued in that, hence I resorted again to the use of the Cau-
tery to the spine as in that case. The cold water and laudanum
were directed to be seduously used, and on my next visit, which,
in consequence of my being attacked with fever, was not until a
fortnight had elapsed, I was gratified to learn that after five days
the symptoms had entirely subsided, and that at this time she only
labored under debility. Bark and wine were directed for her,
and in a few weeks she was permanently restored.

680 Remarks on Spinal Irritation. [March,

ARTICLE II.

Remarks on Spinal Irritation. By M. Antony, M. D.

The publication of Teale's Book on Neuralgic Affections
may be considered a new era in medicine. To the experi-
enced practitioner, worn down with unprofitable cares exercised
for a series of years, on unaccountable, not to say indescribable,
distresses, this little book was as a cool stream to the weary pil-
grim in a thirsty land. It pointed at once, most plainly, to the
immediate cause of the obvious and distressing phenomena, and
to the most effectual means for their removal. It dispensed a
cheering light over many dark places in medicine, and brought
to view a new link in the chain of morbid phenomena, and in
that part too, the knowledge of which was calculated to effect
great amelioration of human miseries, hitherto uncontrolable.
And not only so, but to the inquiring mind, the local irritation,
thus clearly and beautifully displayed, cannot fail to reveal an-
other truth, which is, as this is but an effect, there must be
another cause in the series of phenomena, which must have re-
sulted in this effect, and therefore points to the necessity of far-
ther research in the train of previous phenomena in the direction
suggested by the very nature of this phenomenon : for there
must be & proportionate relation, at least of proximate cause and
effect. Therefore, an effect well understood, as morbid irrita-
tion, or sub-acute or acute inflammation, points by its own nature,
as it is understood in relation to its manner of production, to its
own appropriate causation, with almost as much certainty as
the letters and words on this paper at once declare, or point to
the fact that a pen in hand has been engaged in their causation.
But when the weary and thirsty plilgrim comes to the cool
fountain, clear and decisive reasoning is necessary to lead him
to the exercise of that self-denial, without which, his refreshing
fountain becomes to him the minister of death. Like a well
proportioned and delightful atmosphere, it is invigorating and
health-giving, imparting at once to the imagination, a steady
brilliancy, and to the reasoning faculty a clearness, and an en-
ergy competent to its due control, But if charged with an addi-

1837.] Remarks, on Spinal Irritation: 581

tional dose of the vitalizing principle, it gives to the inhaler
the bright scintillations of the former, which exhibit to his sen-
ses delusive visions of wealth, honor and glory ; whilst it forces
the latter into a wild and intoxicated luxuriance, out of all pro-
portion to its own formative laws, and no longer capable of exer-
cising its own wonted sovereignty.

Such appears to us to be the course which every good thing in
medicine is destined to take. Such has been that of the
humoral doctrine such, that of excitement ; such, the course of
nosology, and such, that of the simplification of disease. To
counteract one imprudent extreme, another has always been ap-
proached. So free is the human intellect and, most unfortunately
too, so partial, (should I not say selfish ?) that, whilst its inherent
vanity is wholly captivated by novelty, or enamoured of its own
beautiful creations, it lavishes, prodigally, on them its whole
treasures with one hand, whilst with the other it tyranically re-
jects all the premises which should in sober justice influence the
result. And such, it apppears" to us. is the course to which the doc-
trine, (if I may so call it.) of spinal irritation is destined. A new
medicine which, on its first introduction, has made some favor-
able impression, is directly considered and praised as a catholi-
con, until, by its universal, use it has numbered its thousand victo-
ries over human life. Novelty becomes supplanted by familiar-
ity and observation, it loses its charm and the medicine is doom-
ed to exile for a century, then brought from the rubbish of gener-
alizing error and allowed its proper rank. Thus, is spinal irri-
tation wrested from its proper rank in the concatenation of pa-
thological phenomena, and made a first and only efficient cause
of all accompanying and succeeding phenomena.

But there is a difference between therapeutic, and patholo-
gical errors ; that whilst a little time serves amply to expose the
former, the latter are more disguised, and a greater grasp of
intellect is necessary for their detection.

Because spinal irritation is, indeed, the true cause of the most
conspicuous phenomena, as is evident on the soundest principles
of physiology, and proved by their correction by its removal, it
so captivates the thoughts not sufficiently chastised by time and
experience, as (although itself an effect,) to be considered the pri-
mary and efficient cause of all, to the neglect of all concomitant
or antecedent, phenomena, and even its own etiology. Inquiry,

582 Remarks on Spinal Irritation. [March.

I say, stops here at the detection of the fact of spinal irritation,
satisfied that here is the real here, the first independent and sole
cause. The indication of its removal, and that alone is there-
fore plainly drawn from the premises. And so stongly does the
spell hold its sway over the rational mind that, although no evi-
dence of the fact of spinal irritation can be apprehended, it is still
believed so intimately connected with the other phenomena in
the relation of cause, as to have its existence inferred from these.
Here, are the errors I would expose.

The discovery of the connexion of spinal irritation with many
distressing phenomena, and its suggesting the means for their re-
lief should not thus limit its utility.

To the enquiring mind, I say this local phenomenon, so clearly
and beautifully displayed, cannot fail to reveal another truth.
Could this spinal irritation have occurred without having its own
peculiar and appropriate cause ? Certainly not, as there is no
effect without competent causation. If then it have a cause,
is it abiding ? Or has it been momentary, and, therefore, left
only its effects to be corrected. If the former, surely nothing
can justify the neglect of such abiding cause of any train of phe-
nomena, when our object is the removal of that train. As well
mi<mt we expect to heal a wound, whilst the thorn which caused
it continues to rankle there. Our experience justifies the belief
that spinal irritation generally, though not always, is dependent
on an abiding cause, for we have very often detected such causes,
and removed them, correcting thereby their effects, without any
prescription for these. And if, in contemplating, what are cal-
led neuralgic phenomena, we generally determine that this irrita-
tion, which we find truly to exist, is primaryand sole cause, and
that only which merits our regard and do, therefore, neglect
any, and all others which may be connected with this train of
phenomena, it will be as generally in opposition to the principles
of sound reasoning. It follows, therefore, only where the
cause is truly known to have been transitory, that our thera-
peutic views'can be generally limited, with prudence and safety,
to spinal irritation.

We would not be understood, as inculcating the propriety of
neglecting, when it exists, this irritation which is, certainly, a
cause of other and most distressing phenomena, merely because
its cause is still abiding, any more than we would, if it had

1837.] Remarks on Spinal Irritation. 583

existed but a moment ; for being itself, a cause of its own
peculiar effects, its speedy removal is necessary for their cor-
rection. The same propriety exists for its removal as for that
of pleuritis, or any other inflammation which was induced by
cold; for when produced, it is not always the case that the re-
moval of cause, will alone, and at once, remove or correct all
the effects it may have produced. And, if the resources of the
system be competent to this, they will be greatly expedited and
facilitated by the assistance of remedial means, well adjudged.

But our object is to caution the practioner that of the fact, whilst
he attends to this, as one cause of some of the phenomena, he neg-
lects not a due consideration of the fact that this cause is itself
an effect of some other that that other is necessarily, either still
abiding, or has passed away ; and that it is indispensable to sound
practice, to determine which of these is the truth in the case.

The whole, (not a partial.) history of the case, and this, with
a consideration of its whole facts and nature, apart from, as
well as in connexion with, the facts of the spinal irritation, and the
phenomena dependent thereon, can alone give us correct views
of the subject for our contemplation ; and by this, alone, shall we
be able to determine whether we may content ourselves with
only prescribing for the spinal irritation, as a cause of certain
phenomena ; or whethcr,in addition to this, we find other grounds
for prescription in the abstract consideration of the case as above
alluded to. Allow an illustration by a few examples.

False pains are produced in a case of pregnancy which, from
their intensity, seem to threaten delivery ; and on examination
of the spinal column, what is called spinal irritation, to greater
or less extent, is detected ; and such cases, we frequently meet
with. A sinapsism is applied over that part of the spine where
the inflammation exists. The effects of this irritation, or sub-acute
inflammation cease very speedily ; and so conspicuous is
the relief from distressing pains, that she at once consid-
ers herself as well as usual. But the same manner of distress,
or some commensurate evil will soon return. Now, if we
consider the fact of pregnancy, and that of the irritation ordina-
rily suffered by the uterus, in that state, with various other facts
of the case, we shall find it probable that there is an irritation
extraordinary at the organic extremities of the uterine nerves ;
and,as inflammation is in some way extensible along a continuity of

>S4 Remarks or Spinal Irritation. [March ,

of substance, the spinal centre, at the central extremity of these
nerves, has become the seat of inflammation from the primary
source. Pursuing this plan of enquiry farther, we shall con-
clude that pregnancy alone, and considered abstractly, could not
have produced the spinal phenomena, because if this were the
case, it would occur in every instance, which is not the fact.
The mind is then led to enquire for other, or additional cause, as
we have not yet in view a competent one. On examining for its
detection, we may find a peculiar irritability of temperament, suf-
ficient to render a cause, ordinarily inoperative, productive of
the morbid action. If this be all, we shall proceed to di-
rect our attention to the moans necessary for the correction of
this morbid irritability. But this, which, when found, may be
considered a predisposing cause, may not exist in the present
case. On farther investigation, we may find an active one, in
an undue pressure or bearing down of the gravid uterus, afford-
ing more or less obstruction to the circulation through the tor-
tuous and meandering branches of the uterine, spermatic or other
arteries, which would be additionally calculated to serve as a
cause, not only, of local irritation in and about the uterus, but
also of an unusual determination of blood to other parts ; and as
well to the vessels of the neurilema,or of the nervous substance
at the spine, as elsewhere ; and more probably than to some
others, as this is, mainly, a non-resisting organ. With these
facts, and the evidence of their existence found in considering
them, even as abstractly as possible, from the fact of spinal irri-
tation, shall we not find cause of farther prescription, such as
taking off the obstructing and irritating uterine pressure, by
horizontal position and other means, if necessary, and correct-
in"- the oxtraordinary irritation of the uterus, by general and lo-
cal depletion, abstinence, &c? But again. We find an assem-
blage of those distressing nervous symptoms, of which women
often complain, in common with amenorrhoea. On farther in-
vestigation, we detect a spinal irritation at the sacrum or lower
lumbar vertebra, and perhaps about the sixth or seventh dorsal.
We shall surely, under these circumstances, not hesitate to cor-
rect the spinal irritation ; but if we consider the other phenom-
ena, presented by the case, we do not find the suppression of an
habitual discharge from the uterus, which, according to a fixed
law of her nature, shall take place, unless pregnant or lactating,

2 837.] Remarks on Spinal L I J^5

during about thirty years of her life, and tho want of which,
dom, if ever, fails to produce i rcsscs, even ^

out spinal irritation, and which we are compelled to remove, by
prescriptions directed to uction of "natural discharge ?

And again.

We find an intermitting fever attended with some degree of
irritation about the spinal marrow. As spinal irritation seldom,
if ever, exists idiopathieally, shall we not rather look to it as an
index, pointing to other disorder ? In this case, an enquiry is ne-
cessary into the pathological condition of the general system,
or the various organs, under the existence of an intermitting fever.
And here, we find that the liver and the spleen, sometimes* are
laboring under an obstructing torpor, which prevents that free
transmission of blood through them which the great portal sys-
tem demands. This is a fact, that we know to exist ; and if
we did not, it is susceptible of plain proof. Now, suppose a
given quantity of blood m the system a1 ment of consid-

eration, as 24 pounds, and that one u, or 2 pounds, pass

the portal system whilst the other 22 do the other circulation.
The abdominal fulness evinces the obstruction. If, now, we al-
low any obstructing cause in the route of the portal circulation,
the liver is the only organ where we may suppose it located.
Let us suppose that this obstruction is such, as to transmit only
half the ordinary quantity of blood, in a given time. The una-
voidable consequence and proximate effect of this,, must be an
increased fulness of the portal vessels. This accomplished to
its utmost, and the next consequent must be their refusal to im-
bibe or receive, more than half their natural quantity in a g:'
time, or one, instead of two pounds, and consequently, if the
health were perfect in the former state, there is, to say nothing
about, the quality of the blood, a redundance of about four per
cent. Following this inquiry, we perceive, therefore, local phe-
nomena, and especially in non-resisting parts, and consequently a
cause of irritation or of oppression.

We would not exclude by an ultra humoral philosophy the
whole nervous pathology. Obstruction in a part, is generally fol-
lowed by irritation and inflammation of that part. This is, howev-
er, various in kind and degree, according to many circumstances:
we will name but one as necessary for our present illustration,
and that is, the different irritability of the different parts. ' *

7-1

W6 Remarks on Spinal Irritation. [March,

liver is an organ of very remarkable peculiarities having
in its structure, a large proportion of its bulk, made up of vein-
ous branches from the great portal, and an arterial arrangement,
only proportioned to the support of its 'secerning organism, whilst
it is less supplied with irritability, as its irregularities arc more
frequently and easily induced than most others. Therefore
should we conclude that, however great and acute an inflamma-
tion in some other parts might be from a given offending cause,
it will be proportionately less in this, and consequently less effec-
tive of secondary and distant effects it would be more chronic,
or of that character at most which is designated by the term sub-
acute. Hence, when phlegmonous inflammation does exist and
continue in this organ, it is slow in arriving at the suppurating
stage, and instead of doing so at all, it more frequently termin-
ates in schirrous degeneration. Not so, however, with the uterus,
with whose irritations the lower fourth part of the spinal marrow
is first found in relation. This, although as peculiar an organ in
some respects, and indeed, much more so, is very differently in-
nervated. Consequently it is much more susceptible of the vio-
lent and acute forms of inflammation. But an observation on the
connexion of some of the diseases of this organ will be useful in
satisfying the enquiring mind of the fact, that both the principles
above alluded to, assist in causing spinal irritation from the or-
gans. It is a fact of observation, that the spinal irritation, and
consequently, the great sum of neuralgic symptoms, are gener-
ally found to be more considerable in cases of difficult, suppres-
sed, retained, or retarded menstruation, whilst with accelerated,
or excessive, it is generally in a small degree and extent, and of-
ten not existing at all.

In all these cases, therefore, we are bound to direct attention to
the first seat of obstruction and of irritation. Let the partisan in
medical doctrines have his choice of the horns of the dilemma,
still is he bound to look to it as cause whether it be the local
irritation alone acting through the medium of the nerves, or
merely the effect of the sanguine plethora, already described.
And in case of the combination of both, he must look to the remo-
val of the obstruction to circulation, as well as (he subduction of
irritation in the primarily obstructed and irritated part. Fortu-
nately for the practitioner, it is often the case that the means
test adapted to the correction of one of these primary difficulties

1837.] Remarks on Impeded Respiration. fiST

is tributary to the relief of the other. For example, a uterine
flux contributes to the reduction of its irritation ; and as irrita-
tion increases obstruct! Auction of the former often con-
tributes in no mean <3 s removal of the latter. Not
so much so, however, in tl ! of the liver whose innervation
is less conspicuous, and irritation, consequently, more sub-acute,
or chronic. In this case, expeciallv in that grade of action com-
monly attended by spinal irritation, the irritation in the primary
organ is not such, but that mercurials are generally found, not
only safe, but peculiarly happy in so increasing the secerning ac-
tion as to cau^c the burthen of labor awaiting the actions of the
viscus to be dispatched, and the obstruction removed.

The same principles and reasoning, which we have applied to
the case of spinal irritation, in connexion with hepatic derange-
ment, is alike applicable to rheumatism. Here we shall find
cause of local obstruction and local irritation.

ARTICLE m.

Remarks on some of the causes of impeded Respiration :
By L. A. Dugas, M. D., Professor, &c. in the Medical Col-
lege of Georgia.

There are no functional derangements, the immediate causes of
which, should be more clearly and distinctly understood by
practitioners, than those of respiration, yet, until a few years
since, the attention of the profession had been called perhaps
less to this than to any other class of diseases. It is to the tow-
ering genius of Laennec, we owe nearly all our knowledge on this
interesting subject, and, although, much has been contributed by his
immediate followers to carry out his principles, the desired
bourne of perfection has not yet been reached. There still re-
mains much to be done in diagnosis as well as in treatment, ere
we shall be enabled to detect the true cause of many cases of
impeded respiration, and to snatch th victim from impending
suffocation.

xrks on Impeded Inspiration. March,

The art.' -0j action of a piece of

mechanism, should come toils examination with a thorough

ion these boar to each
other in the accomplishment of regular and unimpaired action.
So with :ologist ; before he can inquire into the cause* of

morbid functions, lie must be acquainted with those functions in
ir normal condition, and with the structure which contributes
to their performance. Anatomy teaches him that the parts be-
longing to the apparatus of Respiration, are lungs pervaded,
not only by air passages, but also by bloodvessels, lymphatics,
and nerves; that the air passages result from the subdivisions of
larger conduits coming from a distance, and so disposed as to sub-
serve other functions than those exclusively of respiration, viz:
voice ; that these lungs are expanded and contracted by muscles
situated about the chest, the abdomen, and the larynx ; and
lastly that the action of these muscles is subservient Jo a 'pecu-
liar influence transmitted by appropriate nerves. Physiology will
teach him that the performance of healthy respiration requires
healthy pulmonary tissue, unobstructed circulation in the blood-
vessels and lymphatics, the free admission of atmospheric air
through the conduits and into the pulmonary cells, unimpaired
action of the muscles of respiration, properly so called, and
finally a normal supply of nervous influence, both to the lungs
themselves and to the muscles presiding over their motions.

With this knowledge before him, the pathologist will at once
perceive that the process of respiration may be impeded by le-
sions, not only of the parenchyma of the lungs, but also by lesions
of each of the tissues entering into its structure; by lesions of
the air passages* by lesions of the serous membrane lining the
thorax ; by lesions of the muscles of respiration, whether situat-
ed about the chest, abdomen, or larynx ; by lesions of the cir-
culatory apparatus ; and finally, by lesions of innervation in ei-
ther of the parts just mentioned.

Although our knowledge of the respiratory derangements con-
sequent on 'affections of the pleura, of the pulmonary tissue, and
of the circulatory system is considerably advanced, we cannot
say as much with regard to those dependant or vitiated innerva-
tion and on the condition of the larynx. The effects of vitialed
innervation are, or may be presumed to be, manifested in the con-
dition of the air cells, which may cease to be permeable to the

1837.] Remarks qnlmpeded Respiration. 689

air, but principally in the action of the muscles of respiration.
Smart) is and the action ofmai

of them < A ! ?*>es exceedingly diffi-

cult to determine to what extent impediments of respiration de-
pend on their imperfect or total want of action. I am not aware
that the attention of any path > - been strongly directed

to this inquiry with regard to any other than the muscular fibres
supposed to bronchial ramifications. The perfect-

ed means of invc. . instituted by Laennec enabled him to

ascertain beyond doul cases of impeded respiration

are entirely unattended with any lesion of the pulmonary paren-
chyma or of its tubes. Hence, we find him admitting the exist-
ence of the muscular fibres alluded to, and explaining the, mor-
bid phenomena on the principle of spasm of these fibres. He
seems to have taken but little account of the condition of the ex-
ternal respiratory muscles. The free and easy expansion and
contraction of the chest, are necessary to free and easy respiration ;
and in this alternate increase and diminution o'f the capacity of the
thorax, we find concurring the muscles of the chest, properly so-
called, the diaphragm, and the abdominal miisclesv Now it is
evident that cessation, or even a diminution ofthe-actioa of either
of these sets of muscles must tend to lessen the freedom and ease
with which the capacity of the chest is alternated, and, conse-
quently, with which respiration is effected. The impaired action
of the whole would be fatal. May not then, many of the cases
of asthma, regarded as dependant on spasm of the minute air
passages, be with some propriety at least, referred to spasm or
vitiated action of the muscles termed respiratory ? That there
is such a disease as spasmodic asthma, independent of any pul-
monary lesion, is no longer a matter ofdoubt. It only remains
to locate the scat of the spasm, and to determine the diagnostic

signs.

But there is yet another apparatus, the integrity of which, is
of the highest importance in the respiratory process. I mean
the larynx, which, in order to subserve the vocal functions/is so
disposed as to leave its comparatively small aperture more or
less under the dominion of muscular power. The ingress and
egress of air through the larynx, may therefore, be seriously
affected by the action of the muscles about, the glottis, whether
voluntary or spasmodic.

590 Remarks on Impeded Respiration. [March,

Respiration may also be impeded by the diminution of the

caliber of the larynx, and especially of the rima glottidis, oc-
casioned by abscesses, false membranes, or by the mere thick-
ening of the mucous lining. The thickening of this mucous coat
may depend either on congestii mmation, or infiltration, all

of which may be acute or chronic. It is one of these conditions
of the laryngeal membrane to which the attention of the profes-
sion was called by Bayle i servations on oedema glot-
tidis, (Diet, des Sc. J\icd. T. 18,) but which have, I apprehend,
been too much overlooked by practitioners. Of all the causes of
impeded respiration we have enumerated, there are none whose
-diagnosis is more important than those occurring in the larynx.
It is peculiarly important in these cases, because they are fre-
quently fatal, and because they require local as well as general
treatment. We have stated that the diagnosis of the difficulties
of respiration dependant on lesions of the pleura, pulmonary pa-
renchyma, and heart, might be readily established by ausculta-
tion and percussion. Withregard however to the lesions of in-
nervation, and to those of the larynx, the physical signs afforded
by auscultation and percussion can only be negative. They will
enable us merely to ascertain that the disease is located neither
in the lungs, pleura, or heart. How then shall we distinguish the
vitiated innervation or spasmodic state, from that resulting from
other causes ? The question is of difficult solution. Yet should
not all cases resulting from spasm alone present more or less of
the intermittent character so peculiar to nervous affections, and
vice versa, should not the absence of intermittency establish the
existence of a more permanent lesion ? Indeed I do not hesitate
to regard intermittency in cases of impeded respiration, whether
termed asthma or otherwise, as a positive indication of spasm.
If these premises be admitted, it will only remain to distinguish
the several forms of thickening of the laryngeal membrane from
each other as well as from the existence of an abscess in the la-
rynx. This is extremely difficult, inasmuch as they not (infre-
quently exist simultaneously, and that in the progress of an ab-
scess the symptoms may simi those of congestion, inflamma-
tion, or infiltration of the mucous membrane. The lesion of the
mucous membrane, in order to impede respiration, must be about
the rima glottidis and vocal cords; hence the alteration of the
voice accompanying this disease. The effects of congestion are

1837.] Remarks on Imp . :. 'ion. M]-

usually more or less i loss so and

attended with more or ma

progresses rather slowly and is unattended with any excitement
whatever. The followin will serve to illustrate two of

the most dangerous forms of laryngeal obstruction; viz. by oede-
ma and by abscess.

JVed, a negro man aged about 40 years, was in good health
when in 1835, he experienced some uneasiness about thethroajt,
attended with h and difficulty of breathing. Having

no other symptom of disease, he paid but little attention to his
situation for several days. The disease however gradually pro-
gressed ; the difficulty of breathing incr ' and the sensation
in the larynx was such as to induce him to think there was some-
thing in it strangling him. He also complained of intense pain
in the nasal bones. On examination nothing could be perceived
either in the fauces or nose to account satisfactorily for the symp-
toms. 1 was called to sec him about a week after the invasion
of the disease, and on the occasion of his having a slight convul-
sive attack, which appeared to 'rom suffocation. I found
his'pulse very small and feel rface cool; respi-
ration resembling that which attends asthma or croup; voice ex-
tremely hoarse; deglutition difficult; muscular power barely
sufficient to allow him to walk and sit about the room ; great
depression of spirits; 'other functions normal. The pain in the
nose was intolerable, and the sensation of the larynx extremely
annoying. No treatment had been instituted before. An emetic
was now prescribed, but before it had 'time to act he fell back
with another violent convulsion, during which suffocation seemed
inevitable. He however recruited sufficiently to swallow a
large dose of spirits turpentine and oil, but without benefit.
Respiration became more and more impeded, and he soon ex-
pired in convulsive throes and violent attempts to tear open his
throat with hi iqgers.

I had early explored the chest by. auscultation and percussion,
and satisfied myself that there was in the lungs no impediment
to the ingress of air, and consequently that the obstruction was
in the larynx; the uneasiness felt at this region also pointed it out
as the seat of disease. Several physicians having been called
in, I proposed laryngotomy, but it was thought too late and I met
with no concurrence. I nevertheless, when death approached,

592 Remarks on Impeded Respiration. [March,

attempted the operation, but the movements of the fiuyi
so rapid that I found it extremely difficult withe
abandoned it.

The autopsic examination being made a few hours a

the lungs were found in a normal condition ; the tr; I la-

rynx contained a considerable quantity of frothy mucous-, but
evinced no traces of inflammation. The lining membrane and
sub-mucous cellular tissue, from the cricoid cartilage to the epi-
glottis, were in a state of complete serous infiltration, and so
much thickened that the rima g] ' irely

closed. The epiglottis was double its nor The

whole of the diseased surface presented the pallid aspect peculiar
to oedema. Nothing was found in the nose. The other organs
were not examined, it being perfectly evident that death had been
caused by the partial occlusion of the larynx. The occlusion
being produced gradually and partially, life was destroyed by
degrees. The debility resulting from insufficient respiration
may be regarded as the immediate cause of death.

The other case to which we have referred is that of a man
about 40 years of age, who entered the city hospital, in No-
vember, 1836, with dysentery. He was treated by calomel and
opium in small doses, and soon relieved of his enteritie nflbction.
But he soon became profusely salivated, and his gums assumed
a gangrenous- appearance. The disease of the mouth resisted
several weeks every means instituted, but finally healed. He
was then taken with every symptom of cramp, hoarseness, diffi-
culty1 of respiration, &c. &c.; ami presenting every symptom of
croup for several days, was treated accordingly. The diffi-
culty of breathing increased, and the fatal issue seemed in-
evitable. He was found dead in his bed, having expired sud-
denly during a momentary absence of his nurse. Autopsic ex-
amination evinced that lie died from suffocation produced by the
bursting of an abscess in the larynx. This tube was filled with
pus, and the abscess found to proceed from a carious state of the
cricoid and arytenoid cartilages. There was no oedema nor in-
flammation of the mucous membrane elsewhere lungs sound
no otter organ* examined. The pathologic. d specimens of these
two cases arc preserved in our college museum.

The history of the two above cases shows the great importance
of correct diagnosis in the treatment of diseases, for had the di-

1837.] Remarks on Impeded Re upi ration. 593

agnosis been perfectly established in cither instance, life might
have been saved. Had the true nature of the affection been
known in time, laryngectomy or tracheotomy would unquestion-
ably have been immediately performed. But unfortunately the
cases were both regarded and treated as croup, a disease not ve-
ry often fatal, and consequently one in which the operation is
rarely performed In the treatment of this disease, and of those
which from their resemblance to it are often mistaken for it, the
hope that relief will be obtained without recourse to the knife, is
indulged so long that laryngotomy is rarely proposed until it is
too late for it to be beneficial. Hence the small number of cases
in which this operation has proven successful. The wrant of suc-
cess has doubtless in many instances been owing to the small-
ncss of the aperture made. Some surgeons have recommended
the use of a trocar, but the canula of no instrument of this kind in
ordinary use, is sufficiently large. The correctness of this belief
may be tested by endeavoring to breathe exclusively through
one of these tubes placed in the mouth. It will soon become ev-
ident that it will not permit free respiration. The opening intc
the larynx or trachea should be made as large as prudence will
permit, and kept well dilated. It is difficult to determine how
long an individual may exist when affected with impeded respi-
ration. The necessity for oxygen varies exceedingly in differ-
ent individuals, and perhaps in the same person at different peri-
ods. The energies of life are seriously and rapidly impaired by
an insufficient supply of air. It is of the utmost importance
therefore, that whenever bronchotomy becomes necessary, it be
performed before the system has materially suffered from this
species of inanition. The operation is extremely simple, and if
performed with but a moderate degree of care, can scarcely ever
be attended with serious consequences. If practised above the
thyroid gland, no vessel of magnitude can be encountered; be-
low this body a little more caution is required. When we con-
sider the many instances in which individuals, especially chil-
dren, have been permitted to expire from suffocation without any
attempt to avoid the fatal issue by laying open the wind-pipe,
it is at once a matter of surprise and regret that practitioners
should still be so reluctant and dilatory in the performance of
this simple operation. I am fully convinced that I have had cog-
nizance of at least live fatal eases of impeded respiration, in which

75

54 On the Congestive Fever of Chattahoochee, fyc. [March,

life might have been saved by timely resorting to laryngotomy.
The history of only two of them has been presented because no
post-mortem examination was made in the others. The object
of these desultory remarks is merely to awaken the attention of
practitioners to the investigation of the causes of impeded respi-
ration, to the importance of correct diagnosis, and to the urgent
necessity of a more frequent resort to laryngotomy or tracheot-
omy. I have unreservedly stated the errors of my practice, and
of that of some of my distinguished friends, with the hope that
they may be a warning to others in similar cases.

ARTICLE I\\

On the Congestive Fever of Chattahoochee : By William J.
Johnson, M. D. of Fort Gaines.

I would beg to call your attention and that of physicians gen-
erally, to an alarming species of congestive fever which prevails
to a considerable extent among the negroes on most of our Chat-
tahoochee plantations. In order for you to arrive at just and cor-
rect notions of the nature and character of the disease, I will first
describe its symptoms and pathology, and afterwards detail some
eases which have come under my own observation, together
with the plan of treatment generally adopted, <fec. <fec.

The disease as it makes its appearance here, is characterized
by the following symptoms. The attack is generally as sudden
as the cold paroxysm of an intermittent fever, and resembles it
very closely with this exception, that the stage of febrile excite-
ment or reaction, never completely, nor but seklom partially es-
tablishes itself. The most urgent symptoms are an overpower-
ing lassitude, deep and fixed pain in the enccphalon and right
hypochondrium, giddiness, anxious and laborious respiration,
with heavy sighs and horrid moans; the pulse is low, struggling
and inordinately slow ; the extremities are cold and covered with
a profuse clammy perspiration. The speech is altered insomuch

1837.] On the Congestive Fever of Chattahoochee, MK>

that the patient cannot distinctly articulate his words. In most
cases it is so thick and invnlublc that the patient cannot be un-
derstood. One would suppose at first sight that the patient had
been stunned by a blow. The eye is generally vacant, heavy,
watery and suffused. The vessels of the conjunctiva arc gen-
erally tinged and red as if the patient had been intoxicated or
lost much sleep. The tongue is moist and thickly coated with
a slimy white or brownish fur. The bowels arc torpid, and on
this account I have always found it exceedingly difficult to pro-
cure alvinc evacuations, and when procured they are most intol-
erably foetid and as thick and nearly of the colour and consis-
tence of tar.

The symptoms become more and more aggravated. The stu-
por and delirium continue to increase with an augmentation of
sensorial oppression. The respiration becomes more anxious.
The pulse seems as if it were nearly or quite obstructed. The
skin colder and more flaccid. The countenance vacant, gloomy
and unmeaning. The patient becomes suddenly insensible to
pain, not appearing to feel the application of the most potent and
active stimuli, such as pinching and the pouring of boiling hot
water on the surface. The patient now presents a cadaverous
appearance, having the eyelids thrown back and the balls immo-
vable and fixed. He picks at the bed clothes and constantly mut-
ters to himself. These symptoms frequently terminate the pa-
tient's life and suffering within twelve hours from the commence-
ment of the attack. I consider this as one of the endemial scour-
ges of our climate. It usually prevails during the summer and
autumnal months, particularly the latter, when the cool and damp
evenings succeed to the oppressive heat of summer. My own
observation of the symptoms, together with the postobit ex-
aminations I have had the opportunity of making, impress me
with the belief that the cerebral and hepatic organs are most
frequently congested. The first shock in this fever seems to be
communicated to the brain and nervous system, and the heat of
the surface being reduced the blood retires into the deeper seated
veins, from whence it is impossible to invite or force it, not-
withstanding venesection, the warm bath, frictions, vesicatories,
rubefacients, capsicum and the most active stimuli, both inter-
nally and externally, be resorted to for that purpose. The bal-
ance or equilibrium of the circulation is entirely destroyed after

59G On the Congestive Fever of Chattahoochee. [March'

the following manner. After the blood has retired into the deep
seated veins, it must be returned in preternatural abundance to
the right side of the heart, the powers of which had been previ-
ously oppressed from the first shock to the nervous system, and
it cannot throw offor rid itself from the superabundance of blood,
and hence its action continues to be disturbed, and hence the re-
turn of venous blood from the brain, liver and other organs, must
necessarily be so retarded as to engorge the vessels of those
parts, and indeed when the shock has been severe, almost to stag-
nate in them. The idea of the blood staimatin^ in the veins of
a living animal seems to be a novel one, but I am sustained in my
statement by the immortal Haller. This admirable physiologist
has positively declared that the blood may actually coagulate in
the veins of living animals. The treatment in this disease vcrv
naturally resolves itself into the three following indications of
cure :

1st. To restore the lost balance of the circulation. 2d. To
give calomel with a view to its specific action ovor the secretory
glands. And 3dly. If the febrile excitement can be established
to moderate it and treat the disease as any other disease of ex-
citement ; but unfortunately I have seldom had the pleasure of
seeing the reaction take place, and when it did it was only par-
tially, and I have almost always had the mortification to sec a
fatal collapse succeed to it. As it appears among us, I am per-
suaded that it is the most fatal, the most alarming, and the most
unmanageable complaint of which I have any experimental or
professional knowledge : It would be one of the greatest desid-
erata in medicine for this part of the country, could a success-
ful plan of treatment be devised for its management. Had
I my choice of professional achievements, either as respects the
present or future good to this section of my country, there is none
I would prefer to a knowledge of an infallible remedy for this
miserable and distressing complaint.

The plan of treatment I have generally pursued, in relation to
the first indication, (to wit.) to restore the lost balance of the cir-
culation, has been 1st. To open a large orifice in each arm, and
if the blood will flow at all, to bleed the patient ad deliquium ;
but it is seldom, perhaps not once in i\[ty cases, that the surgeon
can be successful enough to obtain blood. After the orifice has
been made, the blood will drop and sometimes slowly trickle net

1837.] On the Congi stive Facer of ChnWihoochca. Wl

for a few moments, when it will obstinately refuse to drop or fl< m.
I generally allow the arms to be corded and the orifices kept
open until I can immerse the patient in a hot salt bath, while
at the same time I give internal stimuli, such as camphor and
aether, capsicum, cognac brandy* ammonia, turpentine, &c, and
make use of gentle frictions and rubbing with flannel, and from
time to time, I tease the orifice by patting the vein above the el-
bow to make it bleed if possible. When the patient is removed
from the bath, I order frictions with flannel cloths dipped into an
ointment composed of capsicum, turpentine, brandy and hogs-
lard, or sweet-oil and afterwards- sinapisms to the extremities
and spine. I have sometimes prescribed emetics in this com-
plaint, but generally with no manifest advantages. It has been
suggested to me that a solution of tartarized antimony in warm
cognac brandv, would overcome the congestion, bv the shock
the emetic would communicate to the system and by the stimu-
lating effect of the brandv combined. I intend to try this remedy
with the first case that presents itself to me.

Having tried all the means above stated with no good effect,
I next resort to the use of calomel, given in large doses and at
repeated intervals, and endeavor to assist its operation with stim-
ulating enemas ; but the powers of the system seem to be so sud-
denly exhausted and so perfectly torpid, that like the stage of
collapse in cholera, medicine does no good.

The following cases will show the suddenness with which it
makes its attack, and the obstinacy with which it refuses to be
conquered. About sun-rise on the morning of Sunday, in the
month of August, 1S35, a negro boy, aged 30, belonging to one
of my patrons, was attacked with pain in the head and shivering.
He was ordered to bed and w rapped up warm, and a bowl of
hot sudorific tea was given him. The boy complained no more
and lay in bed perfectly quiet until eight o'clock, when his master
became alarmed, he said, at his breathing, approached the
bed and called out to him. The boy returned no answer. He
threw the covering from his head, and was still more alarmed
at the boy's appearance. His eyelids were thrown back; his
eye balls immovably fixed; his extremities cold and clammy,
and his pulse slow and struggling. The boy seemed to notice
nothing. 1 was immediately called in with Dr. Hcnson. We
<ad the boy immersed in a hot salt bath, and crave him camphor,

598 On the Congestive Fever of Chattahoochee. [March,

octher, and cognac brandy, and a strong infusion of capsicum
internally ; made use of frictions and sinapisms to the extremities
and spine ; warm stimulating fomentations to the epigastrium
and clysters. Notwithstanding this plan, together with a large
vesicatory over the region of the liver, the boy appeared to get no
better and died in a few hours. Permission was granted me to
make a post mortem examination of his head, and I was not pri-
vileged to extend the examination further. On opening the skull,
the only unnatural appearances of the brain were the enormous-
ly distended and engorged state of its vessels clearly proving
to my entire satisfaction the cause of his death.

Case 2nd. Not long after this occurrence, another similar
case took place on the same premises. The subject was a ne-
gro woman about 30 years of age. She was attacked in the
same manner and with the same symptoms as those above de-
scribed. I was called in a short time after the disease developed
itself, and as soon as I ascertained the nature of it, requested Dr.
Brown to be sent for as a counsellor. Before he arrived I had
her immersed in a warm bath, and had endeavored to bleed her,
but to no purpose. As soon as he arrived, Dr. Brown advised
the propriety of resorting to the use of stimulants, and of giving
her lar^e doses of calomel at short intervals. We did so, and
cupped her over the spine; applied sinapisms to the inside of her
thighs and to her extremities, which were cold and clammy;
blisters over the right hypochondriac region and epigastrium,
frictions with the flesh brush and turpentine injections. The girl
was speechless from the time we first saw her ; with her eye-
lids thrown wide open and the eyeballs fixed. A reaction never
could be established and she died in a few hours.

Case 3d. A negro boy aged about 30, belonging to John Wil-
kinson, Esq., of Wilkes County, who had a negro quarter about
five miles from this village, was suddenly attacked in the morn-
ing with pain in his side and stomach. Dr. Brown happened in-
cidentally to be passing the plantation immediately after he was
attacked, and alighted and endeavored to bleed him from the arm.
lie made several attempts to bleed him, but they were all unsuc-
cessful, lie then prescribed calomel for him and passed on.
In a few hours he returned the same way and called to see the
boy ; his situation alarmed him. I was sent for and arrived about
oighl f>und Dr. Brown with the boy's arm corded and an ori-

i*;j7.] On the CvngestiveFeterofiJhalttihoockee. 699

lice made, from which occasionally a drop of black blood would
ill II . I saw that it was one of those violent attacks of congestive
fever which were so prevalent in this section. Advised the plan
of treatment pursued in similar cases; but before we could use
the bath he died. These three were cases in which it had been
impossible to establish a reaction. The two following will show
that even after a partial reaction has taken place, that the pa-
tients arc not free from danger.

Case 4th. Caroline, a servant girl belonging to Thomas Tow-
son of Randolph County, aged 19, had never menstruated, though
well grown and active. At the time the catamenial discharge
should have established itself, she was attacked with acute artic-
ular rheumatism. All plans of treatment were adopted for her
relief, but to no purpose. Emmcnagogues were given in order
to establish the menses, as it was my opinion that if this could be
accomplished, a cure of the rheumatism might reasonably be
expected. She took nearly every article of this class without
any manifest relief for a great while. At length the symptoms
gave way and she appeared much better, insomuch as to be able
to work in the field. No appearance of the catamenia had yet
been seen. She imprudently allowed herself to be caught in a
shower of rain, and still more imprudently lay down in her wet
clothes, after she arrived at home. The next morning she a-
woke with excruciating pain in the head and neck. She was
neglected for awhile on account of the indisposition of her mis-
tress, until her case became alarming. I was called in, and
found her labouring under all the symptoms of congestive fever.
I bled her from the arm ; applied some cups to the spine ; made
use of frictions over the spine with hot turpentine oil and capsi-
cum ; applied sinapisms to the inside of the thighs and a blister
plaster around the rheumatic joint ; ordered the warm bath, ene-
mas and cathartic medicines. Under this plan of treatment she
seemed to grow better; became sensible; spoke rationally, and
to all appearance was out of danger. I advised the use of spir-
itus mindereri in hot teas, and left her, thinking the next day to find
her better but unfortunately I laboured under a false delusion.
I found the girl much worse than ever, and in fact she died not
many hours afterwards. This might be called a case of repelled
rheumatism, as that disease is known to attack the muscular fi-
Bres u( delicate organs and membranes, but the bvmptoms so

000 Gn the Congestive Fever of Chattahoochee. [March

closely approximate these of the common congestive fever in this
climate, that I am compelled to class it with those complaints.
The question might be asked May not all these cases of con-
gestive fever arise from some obscure repelled disease? If so,

1 defy any physician to make a correct reply as there are no
symptoms, unless they are latent ones, to warrant such a be-
lief

Case 5th. Thadcus Hervcy, a respectable young lad, aged
about 14, was a pupil of Mr. Le Grand's, rector of the Fort
Gaines Academy. I attende*.! the school with the examining
committee on Friday evening, and was pleased to see him look
so well and so readily answer questions put to him. I parted
with him in apparently good health, and was astonished the next
day at being sent for in great haste to see him, as I was informed
he was dying. I hastened to him and indeed found him exceed-
ingly ill. He was labouring under all the symptoms of conges-
tive fever. I bled him and gave him an emetic of tartarized an-
timony. He threw some putrid, half digested substance from
his stomach, which I found on examination to be chesnuts. He
was insensible to the venesection and to the operation of the
emetic. I then cupped him and applied sinapisms to his extrem-
ities and a blister over the cervical vertebra. He still continued
to be collapsed, and I endeavored to force down him a bowl of
hot negus, with other stimulants, but was unable to do it. I
then called in Dr. Brown, and we determined on giving him cal-
omel, as usual in such cases, together with enemas, cupping and
stimulants. By persevering in this plan of treatment, we suc-
ceeded in opening his bowels and unloading them of a large quan-
tity of dark offensive vitiated bile. After this he became sensi-
ble and expressed himself better. There was a pretty consider-
able excitement in the arterial system, and we treated him for
several days on the depletory and evacuant plan. His friends
entertained the strongest hopes of his recovery; when on a sud-
den he complained of acute pain in his head went delirious and
seemed for a time to be labouring under an attack of phrenitis.
These symptoms were attended with convulsions and other ner-
vous symptoms. Blisters were reapplied to the head and be-
hind the car, but notwithstanding this he went into a fatal slate
of collapse frottl which he never recovered. The pupils of his
3 wen widel) dilated and insensible to the stimulus of light,

837.] Topography and Diseases of Talbot County, c. 601

picking at the bed clothes, low muttering, delirium, incoherent
speech, subsultus tendinum, involuntary evacuations, were the
symptoms which closed the scene with him.

tn this case the congcstion%was evidently seated in the cere-
bral vessels, and the brain was unable completely to recover
from the shock at first communicated to it, by the inordinate
fulness of its vessels.

ARTICLE V.

Topography and Diseases of Talbot County, Ga. : By Edward
Delony, M. D.

The centre of this county is about 32 , 30 ' north latitude.
It is bounded on the east by Flint River, on the south by the
County of Marion, on the west by the County of Harris, and on
the north by the County of Meriweather. The south, or lower
part of the county, bieaks off suddenly into very poor sand hills,
and on the north the whole extent of the line runs on a highly
elevated country, known as the Oak Mountain; the western sec-
tion is composed of broken lands, wTith numerous rocky hills.
1* he interior of the county is generally broken ; there are some
districts, however, of level, handsome country. The soil is gen-
erally good, some large portions of it are exceedingly fertile. In
the upper part of the county the soil is a stiffmulatto, in the low-
er it is grey and light, requiring much less rain for agricultural
purposes ; that in the upper part of the county is best adapted to
the culture of corn, though the cotton crops yield abundantly
and richly repay the industrious farmer; that in the lower part,
however, is better adapted to the production of cotton. The
whole interior of the county is well watered with fine bold
streams some one or two of considerable size all of these
streams abound, more or less, with marshy grounds, perhaps-
more so than is common in other sections of country as broken
as this is. And there is vet a great quantity of forest land: of

76

602 Topography and Diseases of Talbot County. [March,

the whole county, nearly three-fourths are a growing forest
of stately oaks, still the haunts of the bounding deer. The
lands which are cleared, or rather cultivated, are covered with
abundance of dead trees, left standing in the fields, which have
been chopped around sufficiently to cause their death. These
trees, from their continued decom position, deposit a considerable
quantity of matter around, which seems to increase the fertility
f the soil and render vegetation more luxuriant in- their vicin-
ity.

The population of this county at this time is not accurately
known. There are some sixteen or seventeen hundred voters ;
a number equal, perhaps, to that of any other county in the state,
and will soon be greater. Our citizens are generally industri-
ous, active, enterprising and in good circumstances ; few, very
few, who know the want of the necessaries of life. Their habi-
tations are generally wanting in comfort, most of them having
fceen put up in a hurry by settlers, moving into the coun>1?y and
commencing in the woods, with but little time to devote to ele-
gance, convenience or comfort about their dwellings. Our coun-
ty is now, however, assuming a new aspect, and the rude abodes
of the emigrant are fast giving room to the elegant and beautiful
mansions of the established and prosperous farmer.

Our population, almost entirely, is composed of citizens from
She older counties of the state, hence a predisposition, in many of
them who have settled among us, to attacks of the diseases which
prevail in those districts of country from whence they emi-
grated, and the unhealthy constitutions which we find among
many of them, usual in such sickly sections.

Until recently, however, the inhabitants of Tahbot County
have been generally healthy, at least until about two years past,
when bilious diseases began to make their appearance. Before
this time, such attacks seemed to be more casual than otherwise,
and were no doubt dependent on a condition of the system, con-
tracted before emigration to the county. The increase of bil-
ious diseases with us, may be very properly attributed to^ an in-
crease of those causes, usually attendant on a newly settled fer-
tile country, (viz.) the opening of lands after the usual fashion in
Georgia, with an abundance of deadened timbers left standing
ki the fields the accumulated obstructions in the streams, cau-
sing an increased quantity of stagnant water, and a greater over-

1S37.] Topography and Diseases of Talbot County. 60 3

flowing of the low marshy grounds, &c. ; to these may be added
innumerable minor causes, having a similar influence, &c.
But the frequently peculiar character which our summer and
fall diseases assume, cannot be attributed to local causes, certain
uncontrolable atmospherical laws and influences over which we
can have no control, seem to exercise a superior power in giv-
ing them character and novelty of appearance. Let it not be
forgotten, however, that whatever character or peculiarity un-
der which they may appear, they arc bilious diseases ; an eye
single should be continually directed to this important truth
let other symptoms indicate what kind of treatment they may,
whether the use of the lancet or the brandy bottle. The bilious
fever cannot he correctly or successfully treated, without the aid of
calomel. My chief reliance is in the lancet, calomel and good
port wine remedies that have stood the test of ages passed,
and whose reputation will be established and confirmed by the
experience of future generations, while the ephemeral imposi-
tions of the day, lobelia, No. 6, and composition tea, will be for-
gotten, with the base charlatans that now employ them as means
to impose upon the credulity, destroy the lives and rob the pock-
ets of a too credulous and unwitting community.

So far as my observation extended, the bilious diseases which
made their appearance during the last summer and fall, wore
decidedly a different garb of symptoms from those which pre-
vailed the year preceding, I very well recollect how frequent-
ly I was compelled to bring to my aid the use of the lancet, be-
fore I could subdue many of the attacks which came under my
care. In these it was used in the outset, sometimes repeatedly:
but during the last summer and fall, I did not unsheath my lancet
in a single case of bilious fever, during the whole sickly season ;
nor did I meet with a solitary case in which the loss of blood
could be admissible and yet I did not lose a patient with this
disease. I say this not as a boast of my good success, but as the
strongest evidence and argument in justification of the opinion
which I have formed of the character of the diseases of the last
season, and the correctness of my treatment founded on that
opinion.

The diseases of the last season were evidently of a typhoid
character. Assuming as they did, this low grade of symptoms.
they were rendered much mora obstinate and dangerous ; and

GOi Topography and Disease? of Talbot County. [March,

this danger was increased by the supervention of a highly irrita^
ted state of the bowels, which made its appearance in a great
many cases some two or three days after the attack. This pe-
culiar symptom I attributed to the great abundance of rain which
fell during the spring and summer months, and which was con-
sidered the cause of a prevalence of bowel complaints to some
considerable extent during that time. In fact, some more or less
disposition of this kind manifested itself in almost every case
which occurred, especially in the early and middle parts of the
season, at least which came under my observation; and I would
here take occasion to remark, that if such was the character of
the diseases throughout the state, I do not hesitate to say, that
the physician who resorted to the use of the lancet and the too
popular tartar-emetic plan of treatment, during the last summer,
was an unsuccessful practitioner.

In my general plan of treatment, 1 found it necessary to com-
bine opiates with my remedies. T hree or four evacuations from
the bowels during the day arjd night, I found entirely sufficient,
and deemed it unnecessary and unsafe to carry them further.
These I procured by ,the administration of about 30 grains of
calomel every night at 9 or 10 o'clock, combined with a sufficient
quantity of Dover's powder to prevent its running oil' too soon
by the bowels ; this was carried off next morning with castor
oil. When the irritation of the bowels was found severe, and the
Dover's powder with mucilage insufficient to its relief, the appli-
cation of a blister plaster over the abdomen always had the de-
sired effect. If during the day or night there occurred much fer
vcr or thirst, and this was rarely the case at night, an occasional
draught of effervescent soda water was found a sufficient febri-.
fuge and remarkably agreeable to the stomach. If, however, I
desired a more effectual febrifuge, I directed the saline mixture.
When there was a sense of heat at the extremities and about the
forehead, I permitted my patients to use cold water and vinegar
combined, as freely as seemed pleasant to them, and this was fre-
quently done ; for although in some cases the accession of fever
was considerable, yet the pulse was small, quick and frequent.
The quinine and wine were never omitted when the skin was
soft, with a sufficient abatement of the febrile paroxysm, espe-
cially in those cases which were marked by a regular distinct
Chill.

JS37.] Topography and Diseases of Talbot County, (>;>

By these general means, my patients seemed to do well, and
although the portions of calomel and Dover's powder were repea-
ted every night, as long as the alvinc discharges appeared unfa-
vorable, yet not one of my patients was salivated, and their
convalescence was speedy. Extreme cases of course required
a more particular treatment, and the general plan above de-
scribed was, in some peculiar cases, a little varied.

Here I wrould fain close this article ; but my task is not done.
From uncontrolable circumstances connected with the settle-
ment of this section of country, as perhaps with that of all others,
the fairer portion of our population is more frequently afflicted
with diseases, which, if not more alarming in their character, are
at least far more obstinate and disagreeable in their nature, than
that which we have already commented upon: I allude to pro-
lapsus uteri and jluor albus. It has been twelve years since I
commenced my professional career, and I have never met with
so many cases of these diseases in all the balance of my prac-
tice, previous to my residence in this county, a term of three
years. I was somewhat at a loss to account for such a greater
number of those cases which I met with here, than I had else-
where ; but on reflection and observation, I became fully satis-
fied in my owrn mind as to the causes of their origin. Our pop-
ulation in this county, is composed generally of emigrants from
the older sections of Georgia, many of this number having re-
moved from the most sickly parts of the state, brought writh them
all those predispositions and effects which such a situation was
calculated to produce on the human system, a shattered consti-
tution, liver disease, indigestion, general debility and relaxation
of the whole systcrn. Hence the predisposition, (if in fact those
diseases do not already exist.) in females, to prolapsus uteri, fluor
albus, &c. But the question will be asked, why under such cirr
cumstances, are these diseases more prevalent in this section of
country? The answer is at hand : the causes are more numer-
ous, as observed in a former part of this article the settlers in
our new country undergo more frequent and severe exposures
to vicissitudes of weather they have been, and are now, fre-
quently compelled to settle in the woods, without even a shelter
for some days, more than is afforded them by their travelling
tents. Their first object is to throw them up such temporarv
log buildings as the hurry of the time will permit These build-

fiOG Topography and Diseases of Talbot County. March,

ings, open as they are on every side, exposing their inmates to
all kinds of severe weather, arc extremely uncomfortable, and are
generally occupied some three, four, or five years : hence, from
the severe exposure of females beyond the strength and durability
of their more delicate constitutions, result the frequent attacks of
inflammatory diseases to which they are liable, the frequent inter-
ruptions and obstructions of the catamenial flow, with all its dis-
agreeable train of symptoms, general debility, fluor albus, pro-
lapsus uteri, &c. &c. How much more severe, and how much
more fruitful of such complaints, must these exposures be to fe-
males of previous bad health and enfeebled constitutions females
who have borne children and who feel the effects of repeated la-
bours and of age, at a time when they should be least exposed.
It is unnecessary to comment upon the effects which such cir-
cumstances are calculated to produce; hundreds have been hur-
ried to an untimely end.

Independent of these, female emigrants to a newly settled coun-
try, especially the poorer classes, have more arduous duties to
perform and much greater fatigues to undergo, such as their
delicate frames were not formed to encounter ; hence also the
frequent occurrence of abortions and miscarriages another
fruitful source of prolapsus uteri and fluor albus.

These diseases have proved obstinate and unyielding in their
treatment, no doubt in many instances, in consequence of the
wretched condition of the constitution and a continued exposure
to the causes which brought them into existence.

From the circumstances connected with our population and
the diseases consequent thereon, as hinted at in the foregoing re-
marks, I have anticipated other complaints to which they are
particularly liable: various inflammatory attacks, such as pleu-
risies, inflammation of the lungs, throat, bowels, &c, and among
children, croup, catarrhs, bowel affections, &c. &c.

I am fully aware that I have presented nothing new to the
profession, but if my remarks shall tend in the least to lessen those
distressing diseases, that so frequently and painfully afflict the
most interesting part of society, by directing attention more for-
cibly to their causes, my labour shall have received most ample
and grateful compensation.

1837.] On Pneumonia of the Old. 007

Part II. REVIEWS AND EXTRACTS.
On Pneumonia of the Old: By Sf M. Hourmann & Deciiambiue.

[This is a continuation of the researches made at the Salpc-
triere on the diseases of the aged. The previous memoirs on
the natural changes of structure and functions of the lungs, on
the pulse, &c, we have analysed.

1. Anatomical characters. Pneumonia is the most frequent
and dangerous of the acute diseases to which the old are subject.
Its diagnosis, so evident in the adult, is difficult, as the affection
is often overlooked from the apparent mildness of the general
symptoms ; or obscured from the utter prostration caused by the
attendant adynamic fever. The changes it produces are pecu*
liar. Independently of inflammation, the vessels of the lungs' of
the old are always more or less congested, so that it is always"
difficult to establish the existence of pneumonia, in its commence-
ment or even progress, in the dead body, if the symptoms during
life have not been carefully observed.

I. Simple congestion. There are three degrees : in the first,
the lungs, which arc intensely red, both crepitate and swim com-
pletely ; they contain a great quantity of bloody, frothy serum ;
there is no change of consistence : in the second degree, their co-
lour is deeper: in the third, they are livid, the lobules are nearly
confounded; there is an increase of volume; their cohesion is
diminished ; a blackish fluid with bubbles of air escapes from an
incision ; they slightly crepitate, and float less high in water.
Dried sections of congested lungs show that the cells are still per-
meable, but contracted in proportion to the congestion ; this is
much less marked when the cells are torn and irregular. Ccete*
ris paribus, the arborizations on the sides of the cells diminish
in proportion to the rarefaction of the tissue, as might be expected
from the previous observations on structure.

II. Congestion with imperviousness of the pulmonary paten-
chyma. There are two varieties : one in which the granular ap-
pearance, regarded as peculiar to pneumonia, is absent, and ano--
ther in which it is well marked: 1st form. The pulmonary
tissue is of a dark colour, often blue or black, and a section is
homogeneous, and remarkably polished ; sometimes it is elastic
like caoutchouc ; at others easily broken up. On cutting the
lung, a fluid or viscid liquid escapes, often reddish, but not frothy.
Compression increases the suppleness and elasticity of the first
portions, and, if after compression they arc dried, the cells reap-
pear, without having experienced any other change than con-
traction, which is seen by a lens to be produced by congestion >{
the vessels running in the intervals, separating the cells, thick-

COS On Pneumonia of the Old. [March,

ening the membranes dividing them, and less evident in the cells
themselves. 2d form, (lied hepatization.) The granulations
arc cither regular, well marked, and much larger than in the
pneumonia of adults, or less defined, running into one another.
Generally there is less friability than in adults ; the lung being
resistant and easily cut into thin and flexible slices ; it is not so
heavy, nor does it sink so deeply. This lightness may be owing
to the rarefaction which the lungs undergo with age.

III. Suppuration of the Lung. There are two varieties ; one
without granulations, and the other granulated. In the first form
mere are two varieties : (1.) lines or patches of a greyish white
colour are seen in the middle of the congested lung, which ap-
pear to be pus beneath a fine membrane ; on making pressure
with the nail, the pus can be deplaced, and made to pass into the
pulmonary tissue as far as the surface where it appears to tran-
sude ; the texture then regains its suppleness, and on drying it
the cells reappear. (2). The texture appears like granite, be-
ing a singular mixture of red and dull white ; the pus being de-
posited in spots of one or two lines in diameter. Pressure with
the nail does not displace it, but it is removed easily on the point
of a lancet, and is of the consistence of coagulated albumen, and
never fluid. When thus extracted, it is evident that it is con-
tained in irregular cells whose walls are of a deep red colour.
It is never prolonged into the small bronchial ramifications.

Suppuration with granulations {Grey hepatization) is much
more frequent. The granulations are larger than in the adult,
though less than in the red stage* The granulations may disap-
pear and be replaced by small abscesses, but extensive abscesses
of the lungs are excessively rare. The lung is extremely fria-
ble, the slightest pressure reducing it to a pulp, from which pus
flows in abundance ; it also escapes from a simple incision. In
some lungs there were small groups of grey granulations, not
mixed with red, and surrounded by healthy tissue. This was
the general description of changes in pneumonia, but there were
some peculiarities worth noticing. The diseased lung, espe-
cially if it belonged to the first type, generally was consider-
ably increased in size. The disease, whether consisting of
congestion, hepatization, or suppuration, occupied generally a
very large portion of the lung, so that it was extraordinary how
life could have been carried on. In one body, the right lung and
inferior lobe of the left were throughout in a state of grey hepat-
ization, whilst the upper lobe of the left lung was gorged with
blood and frothy bronchial secretion. The granulations were
often in groups towards the posterior border of the lung.

The deposition of semi-concrete matter without granulations
was never observed except in lungs of the third type, and in these
rfed or grey granulations were never observed. They only ex-
isted in^ungs of the firs! and second type, and in these they va-

1837.] On Pneumonia of the Old. 600

ried, being regular and distinctly circumscribed in tbe first, which
is characterized by the regularity and rounded form of the cells,
and irregular and almost confluent in the second, where the cells
are of a more irregular figure.

From these facts it may be inferred, 1st, that the pus, which
is capable of being displaced by the pressure of the nail, is sea-
ted externally to the air-cells; otherwise, instead of its passing
into the interior of the parenchyma, it would escape in isolated
drops from the incised surfaces. It is in a situation analogous
to that of the air in intervesicular emphysema of the lungs. The
sanguineous congestion which attends it (as desiccation proves,)
consists of engorgement of the vessels ramifying between the
cells. 2d. The granulations, on the contrary, appear to be sea-
ted in the cells themselves, as they are rounded or irregular ac-
cording to the peculiar change in the anatomical structure of the
cells, and are not observed in the third type, where the cells are
completely disorganized. Compression and desiccation give
further proofs of this fact ; for by these means the granulations
cannot be changed, and the cells cannot be made to reappear,
except in those cases where the grey granulations are not fria-
ble; where, when compression is employed, small drops of pus
escape from the nearest bronchial tubes, and the granulation dis-
appears; thus again proving its situation. The impossibility of
removing the red granulations and those grey granules which are
friable, by means of compression, &c, shows that they are not
merely produced by cells distended with fluid, but that they are
solid. The next enquiry is as to the nature of these changes.

1. Hepatization without granulations. M. Piorry has demon-
strated that, owing to the diminution of the vital contractility of
an organ, and in proportion to its spongy parenchyma, the blood
abandoned partly to the laws of gravity may, notwithstanding
the motions of circulation, accumulate in dependent parts, and
stagnate there. This can be constantly verified at the Salpe-
triere. It renders it difficult to judge whether congestion is ac-
tive or passive. Friability is not a proof that the congestion is
active ; for, although it is an effect of inflammation, yet it is suffi-
cient that a patient, or even a corpse, should lie some time on one
side to produce both congestion and friability of the correspond-
ing part of the lung. Even among old asthmatics, who prss the
last days of their life in a sitting posture, the base of the lungs is
very commonly congested and friable. The idea of inflamma-
tion must not, on the other hand, be rejected from the situation of
the lesion, as granular pneumonia undoubtedly occurs in some
instances at the posterior edge of the lungs. The congestion
may be determined to be of an inflammatory nature when it oc-
cupies the anterior surface on the whole extent of the organ,
particularly if no obstacle to the circulation exists in the heart
or great vessels, But, under such circumstances, MM. H. and

77

610 On Pneumonia of the OlcL [March,

D. have only seen the first degree of congestion, and never im-
permeability without granulations. The nature of this hitter
change must then be judged by the symptoms ; and, in many
cases, their sudden attack and acutencss left no doubt of the in-
flammatory nature of the lesion. When suppuration and friabil-
ity are united, there can be no doubt that they are the effect of
inflammation.. The deposition of semi-concrete matter is also
a-n inflammatory change.

2. Impermeability with granulations. Both. the red and grey
granulations are undoubtedly the result of inflammation, as is
proved by their situation and mode of formation.

From the preceding remarks it appears established that. among
the old, there are two kinds of pneumonia. The first, marked
by congestion and impermeability without granulations, followed
by the secretion of pus in the interlobular spaces, is seated exter-
nally to theJ}ronchial canals in .the laminated tissue separating
them. The second kind occupies the canals themselves, and is-
owing either to a granular engorgement of their sides, or to a de-
position of pus in their cavities. If the cavities are very irregu-
lar, granulations cannot be formed. The first kind of pneumo-
nia may be called intervesicular, and the second vesicular.

Frequency of Pneumonia in the Old. The difficulty of dis-
tinguishing the disease renders rigorously exact statistics impos-
sible, but the following calculation shows that it is the most fre-
quent and dangerous of the acute diseases of the aged. Of 0c6
cases of all kinds occurring in the Hospital of the Aged during
the periods of these investigations, there were 1 10 dissections in
which there was merely congestion of the base of the lungs pro-
duced after death, the patients having had no symptoms of pneu-
monia, but dying of other diseases ; 370 patients were cured af-
ter having had symptoms of congestion, recognized both by aus-
cultation and percussion ; but, it is true, at the dependent part of
the chest, and almost always after prolonged decuhitus, so that
the inflammatory nature of the congestion might sometimes be
contested : fifty-three patients recovered from pneumonia attend-
ed by such marked symptoms that it was impossible to doubt its
nature; fifteen patient? had well marked svmptoms, but no ex-
amination could be made: in eighty-ei^ht fatal cases, dissection
displayed sanguineous congestion of the lungs reaching the de-
gree of complete impermeability or of suppuration.

Of these eighty-eight cases, there wrnre eighteen only of non-
granulated or intervesicular pneumonia, and purulent infiltration
in five. The remaining seventy had well marked granulations
or vesicular pneumonia ; so that the vesicular was in proportion
to the intervesicular pneumonia as four to one. With regard to
situation, if those cases are omitted where it was not observed,
and where the base of the organ only or the whole lobes were
invaded, it appears that the non-granulated engorgement (inter*

\S37.] On Gangrene of the Lungs i?i the Insane. 611

vesicular.) occupied constantly the posterior border, whether
with or without suppuration, and that the granulated form (ves-
icular pneumonia.) occupied the anterior border twelve times,
and theup >steftor twenty-tire times. Of these twenty-five cases
there were fifteen of pneumonia of the inferior lobe, eight of
double pneumonia, and only two confined to the upper lobes;
whilst all of the twelve cases were of the superior lobes, except
two divided between double pneumonia, and pneumonia of the
lower lobe. This will be considered fully under the head etiol-
ogy-

State of the Bronchi. In all cases of pneumonia of the old,

the bronchial tubes are red from the epiglottis to their minute ra-
mifications, the tint augmenting- as they approach' their termina-
tions. There are but few old women whose bronchial mem-
brane is not reddened, whatever may be the kind ' of death.
The quantity, often enormous, of mucus which fills the trachea
and even obstructs the larynx is worthy of notice. It is thick,
viscid, opique, of a dull white or grey, sometimes yellow or
greenish, and occasionally bloody. This latter colour was chief-
ly remarked in the months of April of the two years during which
the investigations were conducted.

State of the Pleura. Of sixty cases of vesicular pneumonia,
there were marks of pleurisy in thirty-eight. Of these thirty-
eight, there were eighteen in which the left pleura was inflamed,
coinciding sixteen times with pneumonia of the same side, and
twice with double pn2umonia; fourteen times the pleurisy was
in the right side, in thirteen of which there was pneumonia of the
right side, and in one on the left. Six times there was double
pleurisy ; of these there was double pneumonia in five cases, and
pneumonia of the right side only in one. Archives Generates de
Jledecine. Mar,, 1833.

On Gancrren* of the Lungs in the Insane: By J. Guislun, M.
D., Senior Physician to the Hospital for the Insane atGand.

M. Guislaix's attention was called to this disease by observ-
ing that the breath of a patient, who obstinately refused his food,
smelled exactly like the cavity of the chest of a former patient
whose lungs were gangrenous; and. after death, the same lesion
was discovered. He thus connected together the obstinate refu-
sal to take food, fetor of the breath, and gangrene of the lung; and
subsequent experience proved that the two former were symp-
toms of the latter. Fetor of the breath is also the consequence
of prolonged abstinence, and of pulmonary suppurations, but the
smell from gangrene of the lung is altogether peculiar. The ob-
stinate refusal to eat, Al. G. considers as an occasional cause of
gangrene ; it occurs in one-ninth of the insane, and, in more than

61% On Gangj-ene of the Lungs in the Insane. [March#

a thirtieth part of these patients, no care or management will
conquer the repugnance. They live twenty, thirty; fifty, sixty
days w'thout any food, drinking only cold water; some last the
first days of the week and eat on the others. In but few instan-
ces does this arise from a notion that the food is poisoned ; it is
generally owing to some caprice of the will, dependent on a pain-
ful impression. Various fancies confirm this ; a child when sul-
ky, and a woman when jealous or spiteful, will not eat: even
animals, after Josing their master or companion, occasionally re-
fuse all food, and starve. To the debility arising from impover-
ished blood M.G. attributes the pulmonary disorganization, and
he illustrates the influence of a supply of poor blood on the lungs
by the effects of the rigorous fasting which some religious com-
munities undergo, the defective and insufficient food of prisons
and some charitable institutions, and prolonged abstinence after
acute diseases, in producing numerous chronic pulmonary com-
plaints, which (if curable) will only yield to nutritious food and
tonics.

The following case illustrates the progress and symptoms of
this disease.

Case. In the late political disturbances, an intelligent wo-
man, aet. fifty-four, leading a retired life, was much affected by
seeing some armed men fighting below her window. The shock
was followed by mental alienation, and she refused to take food.
During nine days no persuasions of her family, who put before
her food of all kinds, could induce her to eat. From the altera-
tion in her features, her emaciation and melancholy, her family
were alarmed, and she was placed in the Institution, the 4th
February, 1831, a month after the disease commenced. During
this time she had only taken a little milk-soup and weak broth.
By the colour of her face only, M. G. recognized her refusal to
take food It was of a brick-red ; the cheeks, end of the nose,
and lobules of the ears were of a deep brown,; pupil dilated;
sclerotica of a brilliant whiteness, approaching blue; hair, pre-
viously unctuous, was dry, and its colour deteriorated, as well
as that of the iris. By force alone, a cup of milk or broth was
occasionally taken ; but she passed from a state of melancholia
to mania ; the emaciation frightfully increased, and the face be-
came brown, and the lips, hands, and feet livid as in cyanosis.
The smell of the breath was unbearable; expectoration brown,
reddish, and streaked with clear blood in considerable quantity,
but without pus. The face was so changed that she appeared
like a decrepit old woman. She gradually sunk, but during tho
last few days took the food which was given to her.

Examination of the Body. Brain and membranes, and ab-
dominal viscera, healthy; gall-bladder filled with black bile, and
tho spleen and mesenteric vessels full oi very dark blood. In
taking out the left lun?, M. G.*a fingers penetrated its substance,

ISft7.] On Gangrene of the Lungs in the Insane. 613

and there was an insupportable smell. Its posterior surface,
towards the upper lobe, was very black, with green ami brown-
ish spots: the tissue beneath was so degenerated as to be broken
down with the least force: it was infiltrated with a black fetid
cruor, like that exhaled from a mortified limb, with here and
there purulent flocci. A spherical mass of five inches diameter
was reduced to this putrid condition. The bronchi were filled
with a reddish, frothy, fetid f]i;id. Right lung not afFectcd.

M. G. has examined thirteen patients who died of inanition,
and in nine of these there was gangrene of the lungs. In one
case both lungs were affected ; the left lung in seven ; and the
right in two. Once the gangrene was confined to the anterior
surface, but in all other cases to the posterior and upper part,
nearer the spine than the lateral region of the thorax. The pul-
monary tissue around the gangrene was injected, but it appeared
to be rather the effect of the irritation than the cause of the mor-
tification. In no case was there pain, cough, or dyspnoea ; the
temperature of the skin was rather cool than hot, and the pulse
slower. In all the patients who abstained from food for any
length of time, the peculiar hue of the skin was observed which
was described in the above case, together with the appearance of
premature old age. In no case was the stomach found to be
inflamed ; it presented no morbid appearance.

Physiologists all agree in stating thai, in ordinary cases of
starvation, the stomach is inflamed, as if reaction took place :
but, among the insane who voluntarily starve themselves, there
is no such reaction, no pain, no cardialgia, and, as they affirm
when convalescent, no sensation of hunger. There is none of
that debility which comes on invariably in the other cases.
Thus, maniacs enter the hospitals after having fasted twenty,
thirty, forty days ; they walk about, and exercise themselves in
different ways, and, although extremely emaciated, live for
months, or even years, only swallowing from time to time some
mouthfuls of broth. Not only is there no sensation of hunger,
but food is either not at all or very imperfectly digested One
patient who had thus refused food, took some at eleven o'clock,
and committed suicide at seven; the contents of the stomach
were found to be unchanged. The absence of prominent symp-
toms in this gangrene of the lungs is owing probably to the same
want of sensibility as is seen in the digestive organs. The lungs
do not transmit to the brain the expression of their sufferings ;
L-nd there is none of that oppression in breathing, violent cough,
and dangerous general symptoms which are observed in ordina-
ry individuals suffering from the same local disorganization.
The torpor of the par vagum will explain the absence of symp-
toms both when the lungs and stomach are affected. It also ex-
plains the enormous doses of medicine which are tolerated by
the insane, and the obstinate torpidity of their bowels. The

614 On Gangrene of the Lungs in the Insane. [March.

nerves of sense arc equally torpid. They bear without incon-
venience the extremes of heat and cold, and the actual cautery
hardly is felt: loud sounds in their enrs do not disturb them, and
they can look at the sun without blinking.

- In this inert state of the stomach, very light food is alone suit-
able. j\ either wine nor soup agrees ; but milk, either bv itself or
with the yolk of e.ugs, is very useful: on this food M. G. has pre-
served life for two years. Sometimes whey or barley water
should be given at first. The patient's obstinacy more than once
has given way after taking a few spoonfuls of milk or broth.

It is an important practical fact that the privation of food hns
a bad influence on the minds of the insane ; they become more
and more taciturn, and melancholia often passes into mania. In
general a restorative diet produces an amendment*

Too much conciliation is injurious. Persuasion is useless and
loses time, and energetic measures are necessary at the least
opposition, Very frequently, in a few days, such measures com-
pletely remove the disgust for food. The following cases are
valuable as regards prognosis, corroborating the opinion of La-
ennee, that gangrene of the lungs is not always beyond the pow-
er of medical skill.

Case. Marie de L , ret. twenty-eight, whose father, uncle,
and two brothers were insane, was in a state of confirmed mel-
ancholia. After two months she refused all food: after three
days' abstinence, force was employed, and. by means of a tube
passed down the oesophagus, a very little liquid food was given.
The peculiar colour of the face appeared; the strength declined,
and, after two months of complete abstinence, she had fetid ex-
pectoration of a reddish and thin brown colour, without previous
cough or dyspnoea. She then spontaneously began to eat, and
gradua'ly recovered her health and sanity. Two years after-
wards she was readmitted; she refused to eat and had symp-
toms of pulmonary disease, of which she died. There was gan-
grene of the left lung.

Case. A young man affected with melancholia refused all
nourishment: if force was used he swallowed the food, but im-
mediately excited vomiting by thrusting his fingers into his pha-
rynx; and, when that was prevented, he managed to vomit by
contracting the abdominal muscles. He continued these practi-
ces for manv months, and gradually sunk. Face of a brown
colour, lips livid, breath smclled unbearably ; a pint daily of red-
dish expectoration. When almost at the point of death, he sud-
denly determined to take some milk and broth after a threat to
burn his pole with a red-hot iron. Gradually but very slowly
he improved, and eventually was completely restored to bodily
and mental health. Gazette Mtdicak de Paris, 16 Janvier, 1836.

1837.] Case of Aneurism of the Thoracic Duct. 615

Case of Aneurism of the Thoracic Duct: By Dr. Albeks, of

Bonn.

The patient, a man of fifty-one, died of abscess of the liver.
On examining the body after death, Dr. Albers found, in the re-
gion of the solar plexus, amongst several hard cartilaginous tu-
mours, an elastic soft one, with a half-transparent tegument. It
was knotty, and about the shape of a fig. At first he took it for
an hydatid; but it was soon discovered that it was bound by
membranous bands in several places, and that a canal led into it,
both above and below. It contained a quantity of fluid lympht
in which flaky matter was suspended. The internal surface of
the tumour was smooth and uniform. A sound could be passed
up the canal, both superiorly and inferiorly. In the latter direc-
tion its course was followed, and it soon became evident that the
tumour was an aneurism of the thoracic duct. Its parietes were
thicker and firmer than those where the duct had not lost its nor-
mal caliber.

Dr. Albers has only seen one similar case. viz. a dilatation of
the cystoma chyli, found at the examination of a dropsical pa-
tient.

It is singular that the thoracic duct is not oftener affected by
the diseases of the surrounding organs How often it is com-
pressed in the scrofulous and consumptive, by enlarged glands,
tumors, &c. ! But these compressions are not attended by cor-
responding dilatations, as is the case with arteries and veins.
Dr. A. has seen a case in which the thoracic duct, in the middle
of its course, had been reduced by pressure to such a small cali-
ber, that it would not admit even a bristle. In another case the
canal was altogether obliterated ; but in neither was the caliber
of the canal below the narrowed part altered by the compression.
(See alsoRokitanski, Austrian Annals, vol. xvii. p. 441.) The
cause of this absence of dilatation hfeases of compression lies,
doubtless, in the nature of the fluid, in the weakness of its cur-
rent, and also in the fact that there must be more branches of the
thoracic duct anastomosing with the venous system than is gen-
erally supposed. A proof of this is, that in children in whom
the caliber of the duct has been materially narrowed, no emacia-
tion has followed in consequence. Wutzer ha-s discovered a
branch of the thoracic duct leading into the vena azygos. The
most frequent cases of dilatation of lymphatic vessels are those
in which thev contain tuberculous, scrofulous, and cancerous
matters. Numerous descriptions of such cases are found in the
works of Cruveilhier and Cars well. Hannoversche Annate n, B.
ii. H. I. 1830.

(51 6 On External Application of Croton Oil, fyc. c. [March,

On the External Application of Croton Oil in Affections of the
Larynx : By Dr. Romberg.

The following cases prove the peculiar efficacy of this species
of counter-irritation in affections of the organs of voice; a facf.
observed by many.

Case i, A fisherman, a3t. 34, lost his voice after exerting him-
self greatly in saving some individuals from drowning. There
was no reason to suspect any disorganization of the larynx. -
Blisters, vapour baths, &c. were tried without effect. Frictions
of croton oil were directed over the larynx, to be repeated as soon
as the eruption declined. On the twenty-first day of tins treat-
ment he began to recover his voice, and regained it completely.

Case ii. A girl, aged 18, suffered during seven weeks with
hoarseness, succeeded by aphonia, the consequence of a sudden
chill. Leeches. emetics, and irritating frictions produced no re-
lief; but, after the third application of croton oil, an eruption ap-
peared, and she immediately regained her voice.

Case hi. . A woman, ast. 38, complained for twelve months
of a sensation of pressure in the pharynx, as if the neck were
squeezed, rendering deglutition difficult: there were no other
symptoms. Many remedies wTere tried without benefit. Three
drops of crotou oil were rubbed in, and, after the third applica-
tion, an eruption appeared on the neck, nucha, chest, and face,
which was followed by erysipelas. The patient entirely recov-
ered.

Dr. Romberg never found that the external application of cro-
ton oil had a purgative effect, but he never applied it to the ab-
dominal integuments.

Dr. Otto reports, in the same journal, the case of a woman af-
fected with sciatica, for which frictions with croton oil were
made on the thigh, and the whole body became red and covered
with vesicles. Dr. Otto never observed its purgative effect
when thus applied. Wochenschrift fur die gesammte Hei/kun-
de. 1835.

Expectoration of Bronchial Polypus, independent of Croup : By
Professor Casper.

Dr. Cheyne has described two kinds of bronchial polypus, un-
connected with croup; one of which appears to be but a coagu-
lum of blood, and is associated with haemoptysis; the other symp-
tomatic of a chronic disease, of an inflammatory character, af-
fecting secreting surface : this inflammation, however, never
reaching to the extent observed in croup. The following case

1837.] New Casc9 of Ccesarian Operation. 017

appears to lead to the conclusion, that inflammation and the for-
mation of a false membrane observed in croup arc by no means
necessarily connected. In tin's view of the subject alone is the
action of many remedies explicable. Dr. Casper justly main-
tains that the clanger of croup is not simply dependent on the me-
chanical impediment produced by the false membrane, but that
it is to be ascribed likewise to a specific inflammation, which, in
respect to its symptoms and its resistance to the usual remedies,
stands in the same relation to common inflammation as do many
forms of abdominal inflammation, &c.

A girl, twelve years of age, of a lymphatic scrofulous consti-
tution, was affected, on the 2d o[ May, by inflammatory catarrh,
which yielded to a few leeches and a mixture containing nitre.
She left her bed on the fourth day, and expectorated occasional-
ly and without difficulty. On the afternoon of May 7th, a vio-
lent cough and suffocative paroxysm unexpectedly occurred,
and the patient expectorated a whitish-yellow polypous body,
which appeared externally very like Concrete fat, was of a firm
and tenacious character, was with difficulty torn, and corres-
ponded to the ramifications of the bronchi. During the follow-
ing twelve days, two and twenty similar substances were ex-
pectorated. The first ten were accompanied with violent cough
and paroxysms of suffocation; the expectoration of the remain-
ing twelve was very easy, long after the patient had left her bed,
when she Was quite free from fever, had a good appetite, slept
well, and had only a slight hoarseness of voice. This hoarse-
ness had existed mnny years previously, and still continues.

Two of these bodies were generally expectorated daily ; one
in the morning, and the other towards midnight. The health of
the patient being otherwise good, very little medical treatment
was employed. Wochcnschrift fur die gesammte Heilkunde.
No. 1. 1836.

New Cases of C^sarian Operation : By Professor Stoltz, of

Strasbourg.

This is the most serious and dangerous of all obstetrical op-
erations ; in which both the abdomen and uterus are extensively
opened for the extraction of the fetus. Whatever be the origin
of this operation, it is certain, that from the sixteenth century to
our own times, it has been many times performed and frequently
with success. It is certain, also, that this operation has been
performed frequently upon the same woman. The number of
successful cases is now so consideraBle, that it is no fonger a
question; whether it be possible to save the life of both mother
and child, it is no loir. irded as necessarily fatal to

the mother. Nevertheless, its most enthusiastic advocates* ac^

78

616 New Cases of Ccesarian Operation. [March

knowledge, that in the great majority of cases, the mother per-
ishes; and yet, the proportion ot" favorable cases is much great'
er at the present day than formerly. Baudelocque, for example,
who, in the second and third editions of his treatise, declared it
scarcely possible to save one woman often, proves, in his me-
moir published in 1799, that at the most, one of three now dies.
The difference is immense. We may reasonably hope that the
danger of this operation may still further be diminished, either
by determining the most appropriate time for performing it, or
by discovering means to counteract the immediate dangers and
accidents of the operation itself, and new means of combatting
more successfully the frightful consequences of such extensive
incisions.

In this first part of his work, M. Stoltz, after some general
considerations, details, very particularly, four cases of the Caesa-
rian operation, not before published, two of which were crowned
with complete success both the mother and child being saved.
He proposes subsequently to examine the true indications and
counter indications to this operation.

Case 1. Jeannette Half, aet. 26, a dwarf of delicate consti-
tution, lymphatico-sanguine temperament, eyes and hair brown ;
was, at the eighth month of her first pregnancy, admitted to the
Civil Hospital of Strasbourg, Nov. 12th, 1834. Her parents are
healthy ; her mother has had nine children, of which she was the
sixth, and was delivered with the forceps, on account of the ex-
traordinary size of the head the others were delivered without
aid. She was early attacked with rickets, and at ten years of
age her growth was arrested, being as large at that age as now.
Height 44 inches from the top of the head to the coccyx 26
from the coccyx to the heels eighteen. Her head is large, limbs
short and slightly curved near the joints, the vertebral column
perfectly straight, the body well proportioned. The pelvis is
small but well proportioned, inclination 58 * There is no de-
formity, but only a want of development.

External measurement. From one to the other anterior-
superior spinous process seven inches six lines. From one to the
other iliac crest eight inches. From the middle of the base of
the sacrum to the superior part of the symphisis pubis, five inch-
es nine lines. From one to the other trochanter ten inches three
lines. From the middle of the crest of the ilium to the tuberosi-
ty of the ischium six inches three lines.

The labia slightly prominent, orifice of the vagina narrow,
vagina contracted and short; the finger readily touches the
sacro-vertebral angle; deducting fr< m this length, (that is the
sacro-sub-pubic diameter.) a half inch, there is obtained two inch-
es and four or six lines for the antcro-posterior diameter of the
superior strait.

The fundus of the uterus had reached the epigastrium and wa*

1837.] New Cases of CcrsuriaiL Operation. 619

ordinarily prominent. The functions of respiration and diges-
tion were uninjured, because there was no want of space. The
motions of the infant were vigorous. The inferior segment of
the uterus made a slight projection into the vagina, and the head
of the foetus was moveable.

M. Ehrmann, on examination, coincided with M. Stoltz in his
estimation of the case. They accorded in their opinion of the
impossibility of delivery by the natural passages and of the in-
dispensable necessity of the Caesarian operation.

On the night of 19th of December, labour pains commenced.
In the morning the pains are of short duration and not very in-
tense; the motions of the foetus on the left side strong. The va-
gina moist, the lower segment of the uterus relaxed and fluctua-
ting ; the neck completely effaced ; the orifice undilated, directed
backwards and to the left side. Behind and above the pubis, the
head was discovered large and very resisting. During the day,
M. M. Ehrmann and Stoltz, endeavored to introduce the entire
hand into the vagina, the better to explore it neither could in-
troduce more than four fingers, on account of the narrowness of
the vulva and vagina; which was a sufficient proof of the state
of the parts above detailed. It was then determined to resort to
the operation, when the os tincae should have dilated to the ex-
tent of an inch and a half the patient consenting to the opera-
tion.

M. Stoltz operated in presence of many physicians, commen-
cing by evacuating the rectum and bladder. The patient being
conveniently placed, an assistant on the right side causes the fun-
dus to become prominent upon the median line of the belly, by
means of two fine, large, flat sponges: these sponges being first
moistened in warm water, were applied upon the sides of the su-
perior part of the abdomen and maintained there by pressure.
A second assistant, placed at the foot of the bed, between the
thighs of the patient, caused a prominence of the inferior part of
the uterus by applying his two hands upon the hypogastric re-
gions, at the same time drawing the skin tense.

The operator, on the left of the patient, having assured him-
self that no folds of intestine arc between the abdominal walls
and the uterus, with a convex bistoury, makes, an incision thro'
the skin, commencing two and a half inches from the pubis and
extending alonjr the linea alba two and a half inches above the
umbilicus, leaving this on the left of the incision : to avoid wound-
ing the epiploon, which sometimes covers the uterus, the inci-
sion is made first through the skin, then through the adipose tis-
sue, which is seven or eight lines in thickness ; at the centre of
the wound, he divides the aponeuroses of the abdominal mus
and in like manner the peritoneum, carefully raising it up first.
with the forceps, as in opening a hernial sac ; the escape of a
definite quantity of serosity, announces the opening of tli

fi*20 New Cases of Ca-sarian Operation. [March,

tonial cavity; then with a concave blunt- pointed bistoury, he
opens the peritoneum and the aponeurosis, first at the lower, then
nt the upper part to the whole extent of the external wound.
He then extends the incision at the two angles, so as to make its
length about seven inches. As the section of the skin is cxtend^
ed, the edges of the wound are separated, and when the belly
was opened the wound formed an ellipsis of about lour inches at
its shorter diameter, exposing the anterior face of the uterus, of
a rose colour, marked by serpentine capillary vessels highly in-
jected. r\ he external pressure, upon the abdomen above and
below had augmented the spontaneous separation of the lips of
the wound. Notwithstanding the care taken to keep the uterus
and the abdominal parjetes in close contact and the efforts made
to force the uterus into the wound, a portfon of intestine escaped
on the left side and inferior of the wound, which was easily re-
turned and its escape prevented by greater pressure from the
assistants.

To ascertain if the uterus had rotated upon its axis, the oper-
ator introduces his left hand under the right lip of the wound near
its superior angle ; it had suffered no rotation. With the convex
bistoury, lie divides the uterus layer by layer, upon the median
line ; as tjiey arc divided, the uterine fibres retract. The uterine
parietes were four or fwc lines thick. The last layer is torn
rather than cut, and exposes the membranes of the foetus, cov*
ored with the decidua rellexa. The operator then with the fin-
ger for a director, passed between the uterus and the membranes,
extends the incision in the uterus with the curved guarded bis-
toury. Before rupturing the membranes, the operator instructs
the assistants to keep the uterus firmly closed upon the wound,
by their pressure, to prevent the effusion of the waters into the
cavity of the abdomen. On opening the membranes with the
bistour three or lour ounces of water escape; the right side of
the fetus then presents with the left hand, the accoucheur seizes
the feet, which are backward and to the right side, and brings
them out with case and then delivers the bod}' and head without
any difficulty, it being necessary only to disengage the aims as
in natural delivery by \\\v, feet The infant immediately began
to cry, the chord was tied and cut; the infant was strong and
well grown, eighteen inches in length, and weighed five pounds
and three quarters*

Alter lite extraction of the foetus, gnat attention and address
were necessary on the pari of the assistants to prevent a hernia
<!' the intestines through the wound. The) succeeded also in
preventing tin effusion of the remaining water and blood into the
peritoneum; after waiting a lew moments, the placenta was de-
livered entire, by gently drawing the chord, at the moment when
the openfng in the uterus began to diminish, by its contraction.
Both liquid and doited blood followed Ihe delivery, as in ordina-

1A37.J New Qaxes of (Ursanan Operation. 021

ry cases, from the vagina. The uterus contracting itself, was

soon hid in the pelvis. A portion of small intestine then ap-
peared through the inferior angle of the wound, which was easi-
ly reduced subsequently, the epiploon escaped through the su-
perior angle, notwithstanding the precaution of covering it with
sponge. Having pushed hack the epiploon rather rudely with
the fingers, there succeeded violent spasmodic efforts of the dia-
phragm; this hiccough, .however, did not fbrce the intestines
through the wounds, but it soon subsided. After this the lips of
the Wound were drawn together, the surface cleansed and four
sutures applied. A scton was left in the inferior angle of the in-
cision and extended into the uterine cavity, to direct thither the
effused fluids. Adhesive bands of three fingers bfpadth and
three i"cct in length, served as uniting bandages, the centre being
placed upon the loins and the ends crossing the wound. Over
these lint, compresses and a bandage. The patient was laid upon
the bed in a horizontal position, the thighs gently fixed and the
knees brought together. The operation lasted half an hour, the
patient bearing it with fortitude. No artery required the liga-
ture and the blood lost was inconsiderable.

The consequences of the operation were very violent fever
and excessive thirst, violent abdominal pain, tympanitis, watch-
fulness, delirium, oppression at the prccordia, diarrhoea, intense
headache; these symptoms successively were combatted, by
leeches to the thigfis and hypogastric regions, opiates, enemas
nd appropriate drinks, for forty flays ; from which time the
improvement has been uninterrupted and the result completely
successful both mother and child doing well.

This beautiful operation requires no comment it testifies to
the practical judgment of the young professor of Strasbourg.
In this case, the operation became necessary from the want of
proper development; in the other successful case it was resorted
loon account of obstruction from deformity. In the other two
cases, the patients died from peritonitis one the fourth, the other
the eighth day after the operation. Gazette Medicate de Paris.

622 Cholerifcrous Insects. [March,

Part HIMONTHLY PERISCOPE.
Chohriferous Insects.

We find the following in the Diario of Rome:

"Dr. Viale, one of our most eminent physicians, sent by the
government to Ancona, has established the fact of the presence of
Insects in Cholera; whose existence has been conjectured by
some physicians. Dr. Viale, remarkable for his perseverance
and skill in such researches, has given a description of the insect,
in a letter to Dr. Matthias, of the University of Rome, accompa-
nied with a drawing ; it. would seem to belong to the order
Diptera. He says it may be seen with the naked eye, the
microscope being necessary only to examine it in detail. If this
discovery be confirmed, it may be of valuable application in the
treatment of Cholera. M. Viale will shortly publish a memoir
upon this subject."

The opinion of the existence of an animated principle in the
developement and transportation of Cholera, was expressed some
time since by Professor Mojon, in his memoir upon this disease,
in which he insisted upon the existence of this principle. He
admits the existence of clouds of winged insects transported by
the winds in various directions, and explains by their action the
phenomena of the disease. He cites in support of this opinion,
many respectable authorities and probable analogies.

M. Figari, professor of botany in the faculty of AbuzabeL in
a letter to professor Mojon, assures him that he has observed,
during the prevalence of cholera in Egypt, many families of
graminiferous plants, exposed to the influence of a north wind,
suddenly smitten with a kind of gangrene and exterminated
through large districts of country. The leaves of these plants
were at first covered with a viscid matter, in which were ob-
served by the microscope, myriads of insects. M. Figari con-
siders these insects as constituting the miasmatic principle of
cholera.

Dr. Taverner, of Jena, also affirms that during his travels in
the south of Persia, at Schirey, Erisan and Bussora, he lias seen
these insect-generators of cholera, travelling in column, or as
clouds, of animated moveable atoms, through the air. Dr. Mil-
lau, of Vienna, gives a description of these choleriferous insects,
as seen through the excellent microscope of Schnvder. Gazette
Medicate dc Paris. 12th Nov. I83G.

1837.] Cinnabar Fumigation. 623

Cinnabar Fumigation.

Tins is not a new remedy in the treatment of obstinate vene-
real ulcers. It has been long since in considerable use for the
purpose of checking more early than by other means, the pro-
gress of this loathsome disease ; and for the early production of
the specific effects of mercury.

Its use has not been unattended with signal success ; but like
almost all valuable remedies, and none more especially than the
kindred preparation calomel, its imprudent, excessive, or promis-
cuous use has had the effect of almost expunging it from the phar-
micopoeins.

The great evil attending its use has been the sudden induction
of excessive mercurial excitement and ptyalism. This is an
evil to which the imprudent use of mercurials in every form is
subject. But it affords no just ground of objection to their pru-
dent and judicious use. If we discountenance entirely the use of
every article, the imprudent use and management of which have
been productive of the most serious consequences, our remedial
resources will indeed be at once reduced to such a nullity as to
be truly adapted to the purposes of the medecine expectante.
The exclusive Broussaisist would be deprived of his ice, and his
apparatus for general and topical depletion, and of abstinence it-
self, as well as regimen and all prophylactics. There is no rea-
son in the fact that the imprudent or unskilful use of the lancet
has occasionally cost tt>3 patient his arm, or even his life, that
the lancet should bcexpjmged from the catalogue of instruments*
The same observation Is applicable to the use of calomel. If
some practitioners have never learned the importance of regular
secretions, to the well-being of the human economy, and the pe-
culiarly happy virtues and best manner of using this medicine in
relation to these functions ; or if others have used it imprudently
and produced the worst consequences, it does not follow that the'
teachable should not learn, and the experienced and judicious
avail themselves of its proper use in combatting the ills which
beset humanity.

The powers of cinnabar fumigations have been abundantly
proven and acknowledged. The next point is so to learn its use
as not to abuse it. The experiments of Dr. Venot are, we
think, to this point. The three cases he men:ions in verification
of its efficacy, serve also as proofs of its safety in prudent hands*
Should it be found safe and useful, only in chronic, or in vene-
real ulcerations in the throat, (a disease so often resisting all
other remedial means, and the embarrassments and perplexities
of which must have been deplored by most practitioners of ex^
perience) it will eminently merit a respectable rank in our ma

624 Cinnabar Fumigations. [March,

teria mcdica. But it will doubtless be found, on experiment and
observation, prudently and carefully made, to be both safe and
efficacious in a considerable variety of chronic affections, a-
mongst which are found those which too often baffle the other-
wise best efforts of the practitioner.

We are pleased to find the use of cinnabar in fumigation, the
only practicable manner of using it on account of its insolubili-
ty, become a subject of observation in the profession.

We give, as well in point, the following extract from our res-
pected friend, P. Melvin Cohen, M. D , of Charleston, S. C,
in which its safety and success in the only two cases he has sub-
jected to its use are detailed. We hope to hear of farther suc-
cesses attending its use in inveterate cases.

"CHARLESTON, S. C, February, 1837.

To the Editors of the Southern

Medical and Surgical Journal :

Gentleman. In the last number of your interesting Journal. I
notice an article on the utility of Cinnabar Fumigations, and the
method of using them, by Dr. Venot.

I have recently treated two interesting cases of ulcerated sore
throat, in patients of a cachetic habit; in both of which great
benefit was derived from the use of cinnabar.

In the first and most alarming* case, which baffled every oth-
er remedy, and in which the patient's life was in the most immi-
nent danger, a perfect cure has been effected. The second is
still under treatment, but rapidly convalescing. From the sig-
nal success which has attended the use of cinnabar fumigations
in these two cases, I cannot too strongly recommend its use to
the profession in all cases of chronic cynanche maligna.

The mode in which I administered it was more simple and
equally as efficacious, as that recommended by Dr. V. On an
iron plate heated to redness, P. Cinnabar was sprinkled, and the
vapour inhaled through a tin tube passing into the mouth.
Practitioners need not be deterred from using cinnabar in this
form, as the oppression and dyspnoea caused by it are transient,
whilst the benefit is permanent.

Very respectfully, gentlemen,

vour obedient servant."

To the skiBbf those scientific and distinguished practitioners, Dos. B. B.

and Thomas Y. Simons, of this city, am 1 indebted for the success of this case.

H337.] '., iputation alike. SJioulder, $c. 62U

imputation at the Shoulder, Sudden death from ingress of air
into the veins.

Tins operation was performed by M, Roux, for the removal
of the right upper extremity that had been severely burned and
was in a state of sphacelus. The preliminary incision, extend-
ing from the acromion to two inches below this point, had been
made; the external and posterior flap was formed, and the op-
erator had raised it and was opening the capsular ligament in
order to turn out the head of the humerus, when the patient's vi-
sage was seen to become pale ; he appeared as about to faint,
notwithstanding he had lost but a few drops of blood. These
symptoms not being deemed alarming, the surgeon merely has*
tened to complete the operation; the joint was opened, the ves-
sels compressed and the anterior and internal flap was made.
But the syncope continued ; two or three convulsive motions
seemed to indicate a return of sensibility, but in despite of the
usual means resorted to in such cases, life could not be restored ;
the man was dead.

It was after the incision for the posterior flap that the symp-
toms of syncope were observed. Some thought, on seeing the
convulsive contractions of the limbs and sudden flexion of the
head, that an epileptic attack was coming on. Others, who were
nearer, heard distinctly a hissing noise, similar to that produced
by air penetrating an air pump : indeed M. Roux himself heard
this sound but thought it produced by the joint.

Autopsy, twenty-four hours after death. The anterior wall of
the thorax and abdomen wTas removed with the utmost care, the
pleural membranes and pericardium being left entire, and no
veins of size being divided. On opening the pericardium, the
mht ventricle presented to the touch a peculiar softness and
elasticity indicative of contained air. The surface of the heart
being carefully examined, distinct globules of air were seen di-
viding the blood contained in the coronary veins. It was now
determined to endeavor to collect and analyze the air presumed
to be within the heart, but previous to opening this organ, it was
desirable to examine some of the lar^e veins. The inferior cava
was accordingly carefully dissected and yielded the same sen-
sation as the right ventricle. A portion of it was included be-
tween two ligatures, after being filled by pressure on its contig-
uous parts. Water was then poured into the abdomen, in order
to see if any bubbles would escape on opening the vein. As the
incision was made a considerable number of bubbles were seen
to arise. The thorax was now in the same manner converted
into a trough, filled with water, and containing a receiver placed
over, the heart; inthis manner eleven cubic centimetres of air
were collected on opening the right ventricle. A few bubbles

79

G-2G On the Cure of Intestinal Fistula3, $c. [March,

were lost. The examination was now continued ; no air was
detected in the veins of the neck, superficial or deep seated ; the
axillary and sub-clavian veins of the right side were filled with
blood. The left lung was entirely bloodless, unusually light,
crepitating, and without emphysema. The right lung contained
a little blood, but resembled in other respects the left. The ab-
domen presented nothing worthy of remark ; the contents of the
cranium were morbid in several respects, but indicated nothing
calculated to induce sudden death. The gas obtained from the
heart, was on analysis, found to be atmospheric air.

This case is interesting, inasmuch as it demonstrates that the
air must have penetrated by a vessel of very small calibre, the
accident having occurred during the dissection of the posterior
flap. The compression of the large vessels, on making the ante-
rior sections, would have prevented it on this side. In Delpech's
case, the fact was more readily understood, for the vessels were
morbidly dilated. Theautopsic examination in this case seems
conclusive. It is true that gas is frequently found in the vascu-
lar system. We have, however, recently repeated the exami-
nations made to enlighten this subject, and we have almost in-
variably found air in the heart, especially in the right ventricle,
also, though in less quantities, in the cava and jugular veins.
But we have never been able to collect.it in sufficient quantity
to be analyzed. We have in no instance, however, found the
heart and cava to present the peculiar elastic tension, nor the
coronary veins the admixture of air and blood, observed in the
above case. British and Foreign Review. Journal dts Con-
naissances Medico- Chirurgicales.

On the Cure of Intestinal Fistulce by the Actual Cautery : By

Dr. FlNGERIIUTH.

The success attending the employment of the hot iron in the
cure of artificial anus, already recommended by DiefFenbach, is
confirmed by two cases related by Dr. Fingerhuth.

In both, abdominal inflammation, caused by violent blows, had
been followed by external abscess, to which succeeded discharge
of faecal matters. Various cauteries were employed to destroy
the membranes lining the fistula?, and to convert them into gran-
ulating surfaces, but without producing their complete oblitera-
tion. The fistulous openings, although somewhat diminished by
imperfect granulations, showed no tendency to become closed.
Cauterization was then adopted by means of an iron, correspond-
ing in diameter to that of the fistula;, and the temperature of
which was scarcely elevated to that of red heat. Luxuriant
granulations soon covered the cauterized parts, the fistula? dimin-
ished, and the surfaces being again destroyed by a heated iron
corresponding in size to the apertures which remained, they were
eventually cured. Wochcnsch rift fur die gesammte Ileilkunde.

1837.] On the Cure of Erectile Tumours. 027

On the Cure of Erectile Tumours: By Frofcssor Lallemand, of

Montpellier.

M. Lallemand was led, by observing tbe rapid cicatrization
of an incision made in an erectile tumour during the partial re-
moval of the lower jaw. and by reflecting on the complete oblit-
eration by inflammation of portions of the corpus cavernosum
and spongiosum, (to which erectile tumours are precisely analo-
gous,) to attempt the cure of an erectile tumour, which from its
situation could not be removed, by incisions and immediate union
of the edges of the wounds. This tumour occupied the upper
lip and extended into the nares ; the first step consisted in remo-
ving, with two strokes of the scissors, a portion from the centre,
of eight or ten lines in breadth : the wound bled freely, but the
bleeding was immediately stopped by bringing the edges of the
wound together, and fixing them with needles, around which
thread was twisted as in the hair-lip operation. The wound
healed favorably : the needles were removed on the fourth and
fifth day, and the thread was detached on the twenty-fifth, lea-
ving a solid cicatrix.

In about two months afterwards, M. Lallemand removed ano-
ther portion in a similar way. As a proof of the success of the
first cicatrix in partially obliterating the erectile tissue, it was ob-
served that the blood merely oozed from the incision nearest to
the first cicatrix, whilst it gushed freely from the opposite side ;
and the needles were passed with difficulty into the erectile tis-
sue, near the old cicatrix. The needles this time produced
more abundant suppuration, but the wound healed, and its cica-
trix, as well as those produced by the needles, looked like fibrous
tissue. As the division of the nares, as well as the adjoining
mucous membrane, remained tumefied, and as the needles pro-
duced a similar obliteration of the erectile tissue as the incision,
M. Lallemand introduced them alone ; and they produced the
change he expected.

In a third case where incision was also employed, the effect of
the needles in* transforming the erectile into fibrous tissue was
still more apparent, so that he employed in the next case needles
alone.

An erectile tumour of three inches in length, two in breadth,
and three lines in thickness, situated over the left scapula of a
child of three months old, had been subjected to compression
without advantage, and had doubled its size since birth. As the
child was irritable, and very delicate, and the tumour was large,
M. Lallemand was afraid to treat it by incision: he therefore
introduced into the lower part of the tumour twelve fine pins, and
covered the space which separated them with numerous circum-

02S Oil the Cure of Erectile Tumourp. [Mavciv..

volutions of waxed thread. The child cried but little. Three
days afterwards he made a similar application to the upper part,
and attacked successively the whole circumference, leaving the
pins for about seven or eight days, or even more, until they had
produced sufficient inflammation. This occupied about forty
days, and he was about to attack the centre, when he found it
violet, tumid, and very hot; the general health was disturbed,.
and he suspended all treatment. To his surprise, the central
part suppurated and collapsed, and in a fortnight was complete-
ly changed into a flat cicatrix. As some points of the circum-
ference had escaped inflammation, it was necessary to repeat the
introduction of the pins. After two months and a half of treat-
ment, during which time 120 pins were introduced, the whole
was converted into a pale fibrous tissue: not a teaspoonful of
blood was lost, and the health of a delicate child was only slight-
ly deranged for a few days.

Compression cures in a similar w.ay, by producing inflamma-
tion : when compression is impossible or useless, this plan should
be tried: it should also supersede the removal of the tumour,.
even when such an operation might be performed without dan-
ger or deformity. The stationary condition of such tumours
does not warrant their not being operated on. The kind of op-
eration must depend on the seat and extent of the disease.
Where, as in the first case, the tumour arose from the alveolar
border of the lower jaw, nothing better could be done than a re-
moval of a portion of the bone, leaving undivided its lower border.
to prevent deformity, &c. Where the disease is very exten-
sive, and occupies prominent and moveable parts like the lips,
as it did in the second case, excisions and needles should be em-
ployed; but, where the erectile tissue is not free and moveable,
the cure is best performed by exciting acute inflammation in it.
Pins of a medium size are better than needles, as they can be
cut with scissors, or their ends covered with forceps : the waxed
thread is useless. Nitrate of silver, and probably nitrate of mer-
cury frequently applied, keeps up the inflammation, which is the
essential agent. Archives Generales de Medecinc. Mai, 1835..

[Although our countryman, Dr. Marshall Hall, is fully entitled
to the credit of priority in treating erectile tumouw according to
the principle advocated by M. Lallemand, (See Medical Gazette,
Vol. VIII. 679,) it does not appear that the French Surgeon
was acquainted with the practice recommended by Dr. Hall.
At any rate the clear way in which he explains the steps by
which he was led to substitute the insertion of needles for extir-
pation, renders his paper both valuable and instructive. Consid-
erable credit is due to Mr. Abernethy for having recommended
the simpler treatment by wet compresses and pressure, at the time
when complete extirpation with the knife was practised general-
ly. It is cunou" that ho con sidi r< d the incrj a ;e of these tumours

1837.] On certain Modi) alment of Hernia.

depended on inflammation, and that they were to be cured by

subduing it.] British and Foreign Medical Revt

On certain Modifications in the Treatment of Hernia: By JI.

hdy.

Professor G trdy recommends the following plan of applying
tlie taxis when the hernia) tumour is so large that it cannot be
grasped and pressed in its whole circumference ; for in such ca-
ses the partial pressure does not become concentrated at the her-
nial opening, but pushes the whole mass in front of the ring.

He seizes between the extremities of the fingers of each hand
that portion of the tumour nearest to the ring, at about an inch
from the orifice, and, pressing the fingers together, he isolates
this small portion from the rest of the tumour ; he compresses it
in its whole circumference, and by lateral movements he endea-
vours to return it. It generally requires only slight efforts to
succeed, and the tumour is a little diminished ; he then leaves the
fingers of one hand applied to the ring, to prevent the reduced
intestines from again protruding, and with the other hand seizes
another portion in the same manner, and, abandoning the open-
ing, he performs the same manipulation, but with greater facili-
ty : he continues in this manner until the hernia is so far reduced
that he can grasp it with the hands, so as to compress it in its
whole circumference, and thus reduce it as he would treat a
smaller hernia. By this manipulation he has many times reduced
hernias which have resisted the common methods^ even when
practised by experienced surgeons.

M. Gerdy also recommends the following modifications in the
operation which he has practised as surgeon to the Hopital^Saint-
Louis. After making the first incision through the integuments
with a knife, he often completes the first part of the operation
with straight probe-pointed scissors. The advantages consist in
his operating more quickly, as he uses no director ; in being able
to distinguish better the parts raised on one of the blades of the
scissors; in being more certain of cutting what he has seized,
whilst, with a bistoury, the movement of the patient or assistant,
or his own want of address, may cause the incision to be deeper
than was intended. Scissors cut, as well and clean as a knife,
and, as it is only required to divide cellular or thin fibrous lay-
ers, there is no fear of that contusion which scissors are said to
cause, the importance of which has been exaggeral

M. Gerdy wTas induced by the following operation to invent a
new form of knife for dividing the stricture. In operating for
strangulated hernia, he found, after opening the sac, that the stric-
ture was so narrow as to prevent iiis passing a director with the"
bistoury. He did not dare to pass a probe-pointed bistoury, flat,
for fear of wounding the intestine. He then benl at a right ui-

630 On the Treatment of White Swellings, $c. [March,

gle to an extent of two or three lines, the end of a silver director,
and introduced its point. When he had passed the limits of the
stricture, he depressed the body of the instrument perpendicular-
ly to the trunk of the patient, so that the bent end of the sound
was crooked round the posterior part of the ring, which lie seized
as by a hook. Then, whilst drawing the director gently towards
him, he introduced into its groove a straight and acute bistoury,
without fear of wounding any thing, as its point was lodged in
the angle of the bent director, and the division of the stricture
was easily effected. In consequence of this operation, M. Gerdy
constructed a straight bistoury, about two lines wide in its whole
length, terminated by a small cylindrical tongue, rather flattened,
about one line in length, and united at a right angle to the end
of the blade. The point of union was carefully rounded. No-
thing can be more simple than the way in which it is used.
The end of the tongue of the bistoury is introduced, guided by
the finger, between the stricture and the strangulated mass : it
passes as easily as a probe ; the handle is then depressed, and the
curved end of the bistoury passes up behind the ring. If, on de-
pressing the handle, the instrument is instantly drawn towards
the operator, it is impossible to wound the epigastric artery, even
if it is in the wTay. To make more sure that the artery is not
between the hook and the ring, the finger, whilst the operator
draws the instrument to him, may be placed in the ring to ascer-
tain if the pulsations arc to be felt. The bistoury is then to be
elevated, so as to divide by pressure the ring and corresponding
portion of the sac. British and Foreign Medical Review. Ar-
chives Gcnerales de Mcdecine. Avril, 18,36.

On the Employment of Muriate of Barytes in the Treatment of
White Swellings: By M. Lisfkanc.

The "Gazette Medicale" reports a clinical lecture of M. Lis-
franc's, in which he relates the results of his experiments with
this medicine, which has been long known, but has been recently
brought into notice by M. Pirondi, of Marseilles.

Six grains of muriate of barytes are dissolved in four ounces
of distilled water, of which one spoonful is taken every hour,
except one hour before and two hours after each meal. In or-
der to tolerate the medicine, the patient must abstain from wine
and meat, taking only water and vegetable food. The bottle
should not be exposed to the sun, or the salt will be precipitated,
and the last spoonfuls contain a greater quantity: to avoid this,
it should always be shaken. Sometimes the medicine produces
slight pain in the stomach or a feeling of weight; but, if other
symptoms do not follow, the stomach gradually becomes accus-
tomed to the remedy, and the pain ceases. If, on the other hand,
nausea, vomiting, or even some slight symptoms of poisoning

1837.] New treatment of diseases produced by Lead. 631

come on, the medicine should be suspended, and cautiously re-
sumed. The climate has some influence ; for, although at Mar-
seilles two drachms have been given, M. Lis franc lias never
been able to increase the dose in Paris beyond forty-eight grains,
and often he has been unable to reach that. The unpleasant
symptoms have been removed by whites of eggs. Numerous
patients have been submitted to this treatment, and the following
are the conclusions which M. Lisfranc has arrived at.

1. Generally the white swelling has been much amended, and
sometimes cured. 2. The benefit has been greatest amongst
the scrofulous. X. In some very few cases the muriate alone
has cured. 4. After a certain time, the disease having become
stationary, it was necessary to employ another method. At a
later period, the renewed use of the muriate has produced ex-
cellent effects. 5. It may be employed both in the acute and
chronic stage of white swellings. 6. Serious accidents have
never resulted from its use ; the slight symptoms before men-
tioned have always yielded readily. 7. A frequent effect is a
diminution in the frequency of the pulse ; this falling from sixty
or eighty to forty or fifty, or even to twenty-five. 8. In some
circumstances the medicine, continued at the dose of twelve
grains during the month, has produced as much amendment as
in other cases where the dose has been gradually augmented.
9. Where the patients have been slightly inconvenienced with
the medicine, it has been most useful. 10. Compression and lo-
cal abstractions of blood have been often combined with this
treatment, and with extreme advantage.

M Lisfranc considers muriate of barytes, given according to
M. Pirondi's method, as a truly valuable acquisition to surgery,
("une vraie conquete chirurgicale.") Gazette Medic ah de Par-
is.

New Treatment of Diseases produced by Lead.

The liver of sulphur has been proposed since 1777 by Navier,
as a counter-poison to lead ; but he did not confirm its efficacy
by actual experiment, and Orfila having shown its inapplicabili-
ty, it fell into oblivion. In 1811, M. Chevalier, having con-
vinced himself that sulphurct of lead had no action on dogs,
whilst carbonate of lead was injurious, inferred that hydrosul-
phuric acid might be advantageously employed as a counterpoi-
son to the salts of lead; and four years afterwards, being in a
manufactory where two men were attacked with violent lead
colic, he gave them about a pint of hydro-sulphuretted water,
which he found in the laboratory, with immediate relief. He
subsequently found similar benefit in his own person. M. Ratier
has since confirmed these facts by many trials at the Hospital
of La Charite, and gives the following directions. Three indi-
cations p"" ' ' ''-'ri^-J

632 New treatment of diseases produced by Ijead, [March,

1. To neutralize the poison, by giving internally a quantity of
hydro-sulphuretted.water, proportioned to the known or sup-
posed quantity of the salt or oxide of lead absorbed. 1\] . Raver
has used the " eau d'Enghein," but either of the following'artifi-
cial preparations may be substituted :

(No. 1.) Take nineteen pints of water, and add one pint of
water saturated with sulphuretted hydrogen, in which twelve
grains of carbonate of soda had been previously dissolved.

(Xo. 2.) Dissolve five grains of sulphuret of potash in a pint
of water.

The more recent the colic, the more marked the effect. Many
obstinate attacks have yielded to this treatment only.

2. To relieve constipation where it exists. For this purpose,
M. Raver prescribes forty-eight grains of scammony and the
same quantity of jalap in twelve pills, the patient to take from
two to six until they operate. If the constipation continues, a
lavement, containing an ounce of senna and two or three ounces
of castor-oil.

3. To relieve pain and to procure sleep. For this purpose,
one grain or one and a half grain of extract of opium is given at
night.

By these means, M. Rayer lias rapidly relieved the effects of
the salts and oxides of lead, sometimes on the second day, often
on the third or fourth, and rarely beyond the sixth. He has
never seen a relapse.

M. Lefebvre has communicated by letter the particulars of
four cases of colica pictonam in his manufactory, all of which
yielded to the sulphuretted hydrogen treatment alone. Half a
drachm of sulphuret of potash was dissolved in a pint of water,
half of which was taken in two doses each day. Three were
cured in two days, and one in one day.

From the injurious effects which white paint made by carbo-
nate of lead has on the healths of painters, as well as occasional-
ly on the inhabitants of recently painted houses, it has been pro-
posed to substitute carbonate of zinc for the lead. From a re-
port of commissioners appointed by the Academy of Architec-
ture in Paris, it appears that the paint made from carbonate of
zinc is not unwholesome, and that it preserves its brilliancy and
whiteness. At present, however, it is more expensive than car-
bonate of lead, which would prevent its general adoption ; but,
as M. Chevallier suggests, it may be very useful in painting the
rooms when- sulphur-baths are given, or privies where sulphu-
retted hydrogen is evolved, which blackens white-lead paints.

[The general circulation of information tending to the preven-
tion of complaints produced by employments to which large bo-
dies of men are necessarily exposed, is one of our most useful
and gratifying duties. Indeed, the value of precautionary mea-
sures promisi nrity will be gratefully acknowledged by

1837. J Inflammation of the Testicles, <$<\ <J-<\ G33

those who have at all reflected on the task they may have fre-
quently performed of urging a man who has a family dependent
on him, to leave an occupation which is prejudicial to his health,
but for which alone he is properly qualified, from having spent
his whole life in its acquisition, whilst, at the time they give this
advice, they arc conscious that the secession of one will only sub-
stitute another equally liable to suffer.] Annales oV Hygiene pub-
liquc. Janvier, 183(5. No. 20.

Mercurial Unctions in Chronic Inflammation of the Testicles :
By M. Dubreuilii.

The happy effects obtained for several years past, from the
mercurial pomade, have been highly extolled in many cases of
phlegmasia, both external and internal. Every practitioner
knows what great benefit this article has afforded, and is daily
affording in the treatment of puerperal peritonitis, when the em-
ployment of repeated venesections, and all the other means pre-
scribed in similar cases have been given up as hopeless. This
medicine is sometimes used on a large scale, and M. Serres of
Uzes, has published a memoir on the happy effects which he has
obtained from its use in a multitude of external inflammations.
M. Dubreuilh, in his turn, praises the antiphlogistic efficacy of
this remedy. I have often had, says he, occasion to use mercu-
rial unctions, sometimes in the treatment of opthalmia, at other
times in reducing phlegmons, in which suppuration seemed in-
evitable, &c. I confess that I have been astonished at the speedy
relief which has followed its employment in these cases. The
author is aware, however, that its use requires discretion, as it
cannot be employed in all cases. It is in chronic orchitis that
M. Dubreuilh has obtained the most salutary effects from mer-
curial frictions long continued. He reports three cases in de-
tail.

Chronic Orchitis, Mercurial Unctions. Cure.

Case. M. S. was taken with gonorrhoea in Nov. 1829, but
after treating it for two months, he became nearly cured of it.
At this period he engaged in a hunting party. In leaping a ditch
the breech of his gun struck with considerable force against his
left testicle, he experienced acute pain at the time, but did not
return till evening, when he came back in much pain. The
next morning the testicle was much swollen, hard and painful.
The discharge had disappeared. I advised him to keep perfect-
ly quiet to be bled from the arm to apply twenty leeches to
the affected side, and make use of emollient poultices. All these
means were employed. The bites of the leeches bled profusely.
The use of the cataplasm1: and the horizontal position were per-

80

631 Chronic Orchitis, Mercurial Unctions. Cure. [Ma

sisted in for about three weeks. The patient was nearly well
the discharge had not returned, and he could^ attend to his busi-
ness. Some days after ihis.an accident renewed his complaint ;
a hard body struck with violence against the testicle lastly woun-
ded. Excruciating pain was again experienced. But the swel-
ling, the hardness and1 heat did not yield to the repeated applica-
tion of leeches or cataplasms, to cold bathing or rest. The tes-
ticle became very hard and sensitive ; the patient complained
of its weight, the surface became rough, and .many veins fur-
rowed it. on every side.

M. S. continued in this state for sometime; he became emaci-
ated ; his countenance assumed a yellow tinge. I then com-
menced the use of the mercurial unctions to tlie swelling, which
I covered with a flaxseed poultice. The family desired a con-
sultation. Contrary to my opinion, the physician called in for
consultation, considered the disease to be sarcocde, and that no
good would result from topical applications, as the tumour had
not been benefitted from all those which had already been used
up to the present time, and that the only hope of cure was in
amputation of the testicle, This opinion, although it came from
a man of extensive observation, -did not alter my belief, especial-
ly with my knowledge of the. previous history of the disease, of
which I did not fail to inform him. As there was no danger in
delaying the operation, should it be necessary, I requested the
continuance for one month of the means which had just been
commenced, and that in case there was no change for the better,
other measures might then be resorted to. This was agreed to.
The patient continued the mercurial unctions. Two drachms
were rubbed over the swelling morning and evening, which was
then immediately covered with a cataplasm.

After this treatment had been continued for fifteen days, there
was a perceptible diminution in the size and hardness of the tes-
ticle, and the pain almost entirely ceased. In fifteen days more,
from the same treatment, this organ returned by degrees to its
normal state, only a small tubercle remained near the bottom of
the scrotum, which I have very often observed in engorgement of
lhe testicles. There was no salivation, notwithstanding the
large quantity of mercury made use of.

The two other cases were similar to the preceding. Resolu-
tion took place after about two months treatment. These re-
sults are very satisfactory, and merit the confidence of every
practitioner. We ought, however, in truth to say, that we have
seen Boyer treat testicular engorgements in the same manner,
but without success, although continued for a long time. It
must be observed, however, that in the cases of M. Dubreuilh,
the complaint was always recent and of an inflammatory nature.
And besides this the mercury was not employed in so large a

[h, Journal , Tdi< \m

; , atiyue.

1837.] 35

Venereal Cory za cov to neglected Blr.norrkagia : By? I.

Priori, Physician at Nantes.

Case. In August, 1831, M, R. aged 24 years, contracted a
blennorrhagia, which was treated with Van Swieten's liquor,
Bellosti's pills and light diet. This treatment was continued
only a fortnight, the discharge continued, but varying in quan-
tity as is usual in this disease. In November, the patient was
seized with a pulmonary catarrh and acoryza. The mercurial
remedies were again made use of, but the patient became dis-
gusted with them. Fever then made its appearance, which
called for repeated bloodletting. In the meantime, the nose be-
came swollen and the secretion of the nasal cavities became very
abundant. It consisted of thick mucous matter, generally har-
dened, and resembling the matter which is produced in impetigo
Jigurata^ Mercurials were again resorted to, but the patient re-
jected them. After this, the corvza made such progress, that the
patient found difficulty of breathing in the morning, so great was
the obstruction of the nostrils from the mucous matter, which
collected during the night. The features of the face became
changed, the complexion yellowish, and a tumour of the size of a
small nut formed on the left side of the nose, near the angle of
the eyelids ; which excited fear of a caries of that side.

At the close of the year 183.2, the patient was no better. The
discharge was dried up, but an eruption had spread over the
whole extent of the cutaneous system. He came to Paris and
consulted M. Broussais, that physician advised the application of
three of four leeches to the entrance of the nostrils every week.
About forty leeches were applied, which caused a partial re-
duction of the tumefaction of the face and head, but the nasal ir-
ritation continued. Recourse was again had to the advice of M.
Broussais, who again directed local bleeding and rigorous diet.
In the meantime, a tumour made its appearance on the arch of
the palate, which excited fears of necrosis. The patient was
now directed to use Rob de Boiveau-CafFecteur (four spoonfuls
in soup every morning, fasting), sars.pariUa diet drink, four glas-
ses a day, in the proportion of an ounce to a pint of water ; and
an appropriate regimen. This last course of treatment was
continued for two months precisely; at the end of which the pa-
tient was restored to perfect health.

The author of the above case deduces the following conclu-
sions from it: 1st. The identity of t!:e nature of the blennorr-
hagic and syphvlitic virus. 2d. That if the patient had persis-
ted from the commencement in the use of mercurials, he would
not have had the consecutive symptoms of general venereal in-
fection. 3rd. That the antiphlogistic treatment alone will

636 Gate of Suicide. [March,

cure syphilis, but allows the syphilitic poison to act with all its
violence.

Without attempting to decide the question as to what are the
different species of urethral blennorrhagia, susceptible of impart-
ing secondary syphilis, we can assert, that with us it is rare to
see ordinary blennorrhagia treated with mercurials at the com-
mencement. Daily experience teaches us, that light diet, dilu-
ent drinks and repose of the part, (we mean the avoidance of
erections,) will generally cure the disease in the course of about
two months. When the disease is treated with balsams, cubebs,
the different potions which are made use of, &c, the disease gen-
erally is no sooner cured. We have treated some patients many
times for the same disease, who had contracted it on different
occasions, sometimes by diet and copious draughts of cool wa-
ter, sometimes with balsam of copaiva and cubebs in various
doses. The progress and termination of the disease have al-
ways been the same. The mercurials themselves have no val-
ue in the acute stage of this disease, unless it happens to be
accompanied with ulcers in the canal, which is rarely the case.
At Naples, where gonorrhoea is very common among the peo-
ple, they usually cure themselves by drinking profusely of the
sulphur waters for sometime, which they obtain from a spring
in that city. Rarely, if ever, does secondary syphilis succeed
it.

M. Priori appears to adhere firmly to the advocates for the
mercurial treatment, the conclusions, nevertheless, which he
would deduce from this interesting case, would not be regarded
as strictly correct by those physicians who adopt the contrary
doctrine. Ibid.

Case of Suicide : By Dr. Nobell.

This case, the title of which presents nothing remarkable, ap-
pears to be especially interesting to us, inasmuch as it affects
the important question concerning the functions of the brain, a
question which at present attracts much of the attention of the
physiologist, the metaphysician, and the medical practitioner.

The subject was a young man, aged 16 years, habitually mel-
ancholy, reserved, and of an obtuse intellect. Without cause he
believed himself to be deceived by the woman whom he loved,
and by whom he believed himself to be loved; naturally timid,
and not being able to revenge himself, he resolved to commit sui-
cide and make use of the pistol. Two balls penetrated the an-
terior part of the brain, by the same opening, and made such de-
struction as to bring away a quantity of cerebral matter, equal
to two cupfuls of the ordinary size, and to permit the introduc-
tion of a gum elastic probe to the depth of four inches, wjthout

1S37.J C<we of Hydrothprax of the right side, C)(- t'.';7

meeting with any obstacle. The patient was unconscious of any
thing that passed for twenty-four hours, when he revived, was
able to move himself and sensible of what passed, but had lost
his sight. The wound readily healed, a large quantity of cere-
bral matter coming away at each dressing. On the 27th day,
the wound was entirely healed, although neither of the balls had
been extracted. But what was most extraordinary in this case,
was the change wrought in the character of the young man.
He became intelligent, gay and loquacious ; he seemed to have
forgotten his misfortune, and often played the wag with his
guides. With this subject the sense of odours had lost none of
its acuteness, but he never regained his sight. He returned to
his parents, but on the fifth month after the injury he was taken
with convulsions, of which he was relieved by bleeding. Con-
vulsions now occurred frequently, and he died at the end of
about two years.

The frightful destruction of cerebral matter in this young man,
caused no manifestation of mental derangement. And it is cer-
tain that the balls penetrated not only very deeply into the brain,
but that the wound was situated in the middle of the frontal
bone, and beneath the left frontal protuberance, the direction of
the wound was such as inevitably to destroy the left anterior
lobe. How can phrenologists, who consider this part as th ex-
clusive seat of the understanding, properly so called, explain
these facts ? It is true, that the anterior lobe of the right side
might have been sufficient to supply the office of the diseased
side, as it probably was not injured. But even adopting this
idea, which has been promulgated by Gall and Spurzheim, and
adopted by many since their time, it is still necessary to account
for the evident improvement which took place in the intellectual
functions. We sometimes see individuals, who, after pleurisy,
live with one lung, but their health is feeble and attended with
suffering, and never is respiration more vigorous in these sub-
jects. Bulletin de la Societe de Medicine de Gand.

Case of Hydrothorax of the right side, Paracentesis, followed by
almost complete restoration to health, which continued for many
years: Case by M. Roux.

M. Ch., aged 32 years, having a constitution apparently lym-
phatic, although really of an irritable character, has experienced
very acute pains in the right side of the breast, which he be-
lieved to be rheumatic. After delaying fifteen or eighteen
months, he came to Paris in order to consult M. Roux. This
physician stated, that he never saw the symptoms of thoracic
effusion better characterized. Such was the fulness of the side
of the breast, as to swell out very considerably, and the interco-
stal spaces were sensibly enlarged. Percussion of the lower

638 Case of Hydro thorax Of the rigkl side, tyct [March,

two-thirds of the chest yielded a dull sound ; the anterior and
superior part yielded a natural sound, and the respiratory mur-
mur was distinctly perceived. In other places, the respiration
was so short and straitened, as to prevent the least exercise with-
out suffocation ; most of the nights were passed sitting on the
bed.

All therapeutic means were made use of in vain, and the only
resource left was to give vent to the effused liquid. At first, M.
Roux thought of making a puncture with a trocar, in order to
permit the fluid contained in the cavity of the pleura to flow out,
then close the lips of the wound perfectly tight, so as to prevent
the introduction of air, and repeat the operation until the water
was all drawn off. But being obliged to go to Fontainbleau for
the purpose of operating, and consequently deprived of seeing the
patient as often as he wished, M. Roux abandoned his first in-
tention. He then made an incision between the fourth and fifth
ribs, counting from the lowest, so that the trocar passed only
through the intercostal muscles in order to pierce the pleura.
Hardly had the instrument been withdrawn, when there came
through the canula, a serous fluid, somewhat turbid and contain-
ing floccula?. From twelve to fifteen ounces of the fluid was
permitted to flow out, when a gum elastic probe was introduced
through the silver canula, and every two days, on being un-
stopped, there was an evacuation almost equal to the first. The
patient felt relief soon after the operation and every thing pro-
ceeded favorably till the tenth day. At this time, the patient,
without any apparent cause, wTas suddenly taken with a sharp
pain in the same side, followed by loss of appetite, fever, dry and
parched tongue, difficult respiration, prostration of strength, &c.
The effused fluid then changed its nature and became milky, pu-
rulent, and of a disagreeable odour.

Soothing drinks were now made use of instead of the diuretics
previously prescribed. Injections of decoction of barley, mixed
with a little honey of roses, were introduced into the thorax.
On the sixteenth day after the operation, more than six pints of
liquid were taken from the chest. I forgot to mention, that M.
Leblanc, the attending physician, had often made use of a syringe
to facilitate the evacuation. In the meantime, the barley decoc-
tion had a calming eflect ; the effused liquid lost its disagreeable
odour and became entirely purulent. Two or three ounces
were discharged at each dressing, besides what was retained by
the clothes and lint used to prevent the reunion of the lips of the
wound. The patient lived more than four years after the oper-
ation ; was sufficiently Well to attend to his business, but his
health required a degree of caution in his hrA at illy spreed

with the violence of his temper.

M. Cruveilhier stated, that this interesting case awakened s
practical suggestions which he wished to present to the Acacle-

1 837. J < n'n. CHO

my. He agreed thai theory favor induct of AJ. Roax;

but thought that experience was against him. He asked the
question: hit b best at one operation, or

to do it at different times ? I Ie had heard this question discussed,
by MM. Pelletan and Dnpuytren who did not agree in opinion
on this subject. mself he preferred the first plan, and

painful experience led him to this preference. He should always
with pain, recall to mind a young lady, sixteen or seventeen
years of age, who suffered from ascites ; he performed paraccn-
tecis, but took only two pounds of water, the next day two more,
and the third evacuation was followed by peritonitis, which
caused death.

The puncture of the thorax of itself is of little importance.
He had performed this operation in the case of a female who
had a cancer of the pleura, and had performed it also in four or
five other cases.

The Academy was obliged to defer the further discussion of
this subject until its next meeting. Gazette Medicale, \2th Nov,
1836.

Case of Local Hereditary Relaxation of the Skin : By Dr. Graf,
of Konigsberg.

In his forty-seventh year, a strong man, the only exception to
whose perfect health was a slight hemorrhoidal complaint, first
noticed a relaxation of the skin of the left side of his neck, and of
the lower eyelids and the parts beneath them. The malady in-
creased to such an extent, that in a few months the skin in these
parts hung in the form of sacks ; the skin being thin and covered
with transverse and longitudinal furrows. The patient (a Rus-
sian) said that the malady was hereditary in his family. His
grandfather, a year after his return from an imprisonment in
Turkey, in which he had been exposed to great bodilv and men-
tal sufferings, began to be affected with the same disease, situa-
ted in the lower eyelids ; and the deformity was so great, that he
was obliged to confine himself entirely "to the house. In his
case the affection commenced in his forty-seventh year. He
died at an advanced age, leaving two sons'and a daughter. In
her forty-fifth year, the daughter became the subject of the same
malady, and, as she was unwiiling to submit to an operation for

its removal, she entered a nunnery, where she died very old.

The elder brother was similarly affected in his fortv-third vcar,
the deformity being seated in the lower eyelids and left sfde of
the neck. The parts were removed, and the disease did not re-
turn. The younger brother continued entirely free from the
disease, and died in his seventy-first year. He left one ^on. the
subject of the case which isl ited,

f>10 Parturition of a Child at full lime, <\-c. [Marclif

The relaxed skin situated in the lower eyelids was operated
on. in the same manner as a case of entropium. The wround
healed by the first intention, and the deformity was removed.
As the deformity of the neck could be conveniently concealed by
the patient's dress, it was not removed by the knife. The pa-
tient was simply advised to apply to the part strong astringent
remedies : and, in order to increase the tone of the whole skin,
to use mildly astringent baths, as cool as possible. British and
Foreign Review. Wochcnschrift fur die gesammtc Heilkundc,
No 15. 1830.

Parturition of a Child at full time and of a blighted foetus.

Mr. L. Owen Fox records in a late number of the Lancet,
(17th September, 1836,) an example of this. The mother, aet.
30, had previously had two children. Mr. F. was called to her
28th May, and shortly after his arrival a large healthy child was
born, and the uterine efforts continued very severe, but the pla-
centa was not expelled. After wTaiting a short time, he passed
his finger along the cord to the uterus, when he discovered a
soft mass, not unlike distended membranes, protruding from it.
During a strong pain he made slight extension on the cord, when
the placenta, together with the mass, immediately came away.
On examining the latter, he found it to consist of a small male
fetus, about five inches in length, surrounded by about three
ounces of fluid. The integuments of the foetus were softened,
and presented just such an appearance as might be expected from
long maceration; it did not give off any unusual odour. On in-
quiry Mr. F. could only learn that his patient expected to be
confined at least three months before the event happened.

[American Journal.

Erratwn.

Tagc 592, line 26th, erase the words "every symptom of
ip."

SOUTHERN JIEDICAL

AND

SURGICAL JOURNAL

Vol. I.] APRIL, 1837, [No. IT

Part I. ORIGINAL COMMUNICATIONS,

ARTICLE I.

An Essay on the question, Ought not the use of Pessaries to b&
now abandoned? Read before the Medical Society of Au-
gusta, Georgia, by Paul F. Eve, M. D. Professor of Surgery
in the Medical College of Georgia.

In answering the question, ought not the use of pessaries to be
now abandoned? we propose to consider, 1st. In what cases
are these instruments now employed? 2d. What is their mo-
dus operandi? And ?rd. What are the reasons for or against
their application ?

First then, in what cases are pessaries now employed? Pes-
saries are instruments composed of various materials, as wool,
lint, sponge, wax, glass, different kinds of wood and metal, and
are of different sizes and shapes ; they are introduced into the
vagina to support the uterus when it has descended from its nat-
ural situation. There are commonly reckoned two degrees of
uterine displacement; one known as prolapsus and the other as
procidentia. To these have been added a simple relaxation of
the sustaining parts of the womb, and which degree is embraced
under the first division or prolapsus By this term then, pro-
lapsus uteri, is meant any descent of the womb within the vagi-
na, from a simple relaxation of its sustaining organs to its mouth,

resting upon the internal face of the perineum ; and bv prociden-

81

sn j^ssay, yc. LAPnl

tia, a projection of the os tineas beyond the os externum. By
these technical expressions we wish only to indicate different
decrees of the same affection.

It is an interesting and important question and intimately con-
nected with the subject under consideration, to decide what is
meant by a descent of the womb from simple relaxation of its
attachments. Dr. Horner in his Anatomy, states the length of
the vagina to be from four to six inches, and also that it is muck
shorter in women who have borne children than in virgins. H.
Cloquet in his work, sets it down from six to eight inches. We
may clearly infer from this that we are not to judge of prolap-
sus simply from the os tineas being more or less distant from the
os externum. When we consider the loose attachment of the
uterus, the nature of its ligaments, and the character of the oper-
ations now performed upon its neck, I think it may be safely as-
sumed that the womb often descends an inch or more, as in the
first months of pregnancy, &c, without its being manifested by
any unpleasant symptoms. I believe the finger applied to the
os tincae in the unimpregnated state, can produce a displace-,
ment to the extent of an inch, and in females who have borne
many children, particularly in warm climates, to a much greater
degree. A physician not aware of this mobility of the uterus,
or who does not admit it, finding it existing upon an examination
per vaginam, may set it down as the pathognomonic symptom or
absolute sign of prolapsus uteri.

I find upon inquiry of several physicians, that pessaries are
now restricted by them to procidentia, some few employing them
in certain cases of prolapsus ; but their most strenuous advo-
cate in all cases of uterine displacement, is the Professor of Ob*
stetrics in the Medical College of Georgia.* Anxious to obtain
all the information I could on this subject, I addressed a letter to
several distinguished gentlemen of the profession, and made a
personal application to every physician in our city. The result
of these enquiries has been very satisfactory to me, and has
tended much to strengthen my conclusions, that pessaries have
been greatly abused, that a revolution is now actually occurring

* Dr. Joseph A. Eve, Professor of Materia Medica and Therapeutics, was
originally included with Professor Antony as entertaining similar views with
regard to the pessary he, however, declares that, in his practice, he usee
these instruments inleM than one tenth of the c&s?e? of prolapsus uteri.

1SS7.] An Essay, $c 04*

in their use, and that in all probability they will soon be entirely
abandoned.

Dr. Samuel Henry Dickson, the Professor of Theory and
Practice of Medicine in the Medical College of the State of So.
Carolina, expressly says in his reply, " pessaries ought to be
employed very rarely if ever. While I entertain any hope of
a cure, I should regard them as absolutely forbidden."

Dr. Hugh L. Hodge, Professor of Obstetrics in the University
of Pennsylvania, though an advocate for pessaries, writes, "they
are often productive of mischief."

Dr. Cunningham, Professor of Theory and Practice of Medi-
cine in the Medical College of Georgia, states that he once em-
ployed pessaries, but that for the last five years he has become
convinced from experience (and I may add an experience of 28
years,) that they are injurious in prolapsus uteri. He has aban-
doned their use entirely.

Drs. Dugas and Ford, both professors in our Medical College,
report that they have never applied a pessary. They have re-
moved them in supposed cases of prolapsus, for which they think
them not necessary, and can only be required in procidentia, even
for which, however, they do not recommend them.

Dr. Hook, during a practice of many years, has employed
pessaries in prolapsus, but thinks them uncalled for in the great
majority of cases. He would restrict them to about one-tenth
of the cases of prolapsus and to procidentia.

Dr. Carter has applied pessaries in about half a dozen cases,
but without any advantage. He says he has repeatedly removed
them when applied by others for prolapsus, and the patients have
recovered by the use of other means. He has abandoned them
entirely.

Dr. Robertson has never applied a pessary, but has been called
to remove them, and did so with decided advantage to the cases.
He thinks they ought never to be employed for prolapsus uteri,

Dr. Kennon has used pessaries for procidentia, sometimes with
and at other times without any advantage. He says they ought
lo be restricted to procidentia.

Dr. Bowen applied once a pessary with such decided aggra-
vation of symptoms that it was soon withdrawn. He has known
them applied by others, but generally without advantage to pro-
lapsus uteri. He censures their application in this affection.

644 An Essay, <J-c. [April,

Dr. Clarke has applied a pessary in two cases of procidentia,
but without any advantage to either. He condemns their use in
prolapsus uteri.

In my own practice I have never applied a pessary, but have
been called to remove them. I once owned pessaries, but have
long since deposited them where I think they properly belong,
in the museum of our college. In a practice of seven years, and
in a course of observation in several foreign countries, in 1829,
'30 and '31, I have met with few cases of uterine displacement.
I have been physician to some large families, to some extensive
plantations, to some of the common women of the town, and all
the cases in which I suspected a prolapsus have readily yielded
to other means than the pessary.

So far then, the united testimony often physicians of our city,
I may say of all but one or two, with that of Dr. S. H. Dickson,
goes to establish the fact that pessaries are now seldom required,
and that they are injurious when applied for prolapsus uteri.
How common is it for doctors to disagree. Where, I would ask
on any subject, be it political, moral or religious, will there be
found a greater unanimity of opinion ? Ten to one, or at most
to two. Really it would seem, that, if on any subject in medi-
cine, truth is here obtained*

If it be said I have decided the first division of my subject with-
out a reference to books, even to those whose authors are still on
the theatre of action, I reply that I have set out with a proposi-
tion that a revolution is being effected in the use of pessaries, and
in proving this, as well as declaring under what circumstances
these instruments are now employed, we must necessarily rely
upon the testimony of the living and not of the dead. But there
is ample proof on record, to satisfy every one, that pessaries are
too often injurious, and that they ought not to be relied upon for
effecting a radical cure even of prolapsus.

In the forty-first volume of the Dictionnaire des Sciences Me-
dicates, article Pescaire, by Merat and Patissier, they observe,
"whatever may be the form or substance of which pessaries are
composed, they always excite a degree of inflammation of the
internal membrana of the vagina and neck of the womb, produ-
cing thereby a great secretion of muccus which they alter and
decompose. We are often obb'ged to suspend their use on ac-
count of the violent irritation they ocension. Pessaries $nuse

18.17. J An Essay, $c. 845

serious accidents and we ought not to have recourse to them for
a descent of the womb, until all other means have failed."

Dr. Allen, in the hist volume of the Surgical Department of
the Encyclopedia, uses the following language on the subject of
pessaries : 4i we will engage to say we have seen no less than fifty
models of pessaries, all differing one from the other, all very
much recommended, and scarcely one fulfilling the object of
maintaining the womb or even the vagina in its proper place.
Humanity will be much indebted to him who will discover the
secret of rendering this palliative means of an easy and support-
able application to women, who are obliged to have recourse to
them."

In Madame Boivin's work on the Maladies de L'uterus et de
ses annexes, published in connection with her nephew Duges,
pessaries are placed under the head of palliative means for pro-
lapsus.

In Boyer's Surgery, 10th volume, it is remarked, that in re-
commending pessaries, after astringent injections, &c. have been
employed, these instruments ought not to be applied when the
neck of the womb is either engorged or painful.

Dr. Dewees in his work on Diseases of Females, says " before
I employ the pessary, I always make use of astringent injections
for two or three weeks, with very decided advantage."

The late Dr. Dorsey in his Surgery, published under the in-
spection of Dr. Physick, observed that pessaries become exceed-
ingly /oe/id after remaining a very short time in the vagina.

In fact all must consider the pessary as the last resort in ute-
rine displacements; and I may add all do, with one or two ex-
ceptions. After a careful examination of about thirty works, I
find no one recommending- them for metritis or inflammation of
the womb ; to this there is but one solitary exception on the
contrary, all dread this very pathological condition of the uterus
being produced by pessaries. May we not then conclude, in
answering the question, In what cases arc these instruments now
employed ? that they are seldom required, and are indeed used
in practice only by a few physicians.

Having thus disposed of our first, we pass to the considera-
tion of the second question proposed, which is, What is the mo-
dus operandi of pessaries? All will admit that the action of a
pessary in temporarily relieving prolapsus or procidentia uteri,

646 An Essay, c. [April,

is purely mechanical. They do sustain and will continue to sus*
tain the womb in its proper place when they are judiciously ap-
plied. But what else do they not produce? Is not a pessary a
foreign body? Beits material or shape what it may, is it not a
source of irritation?

That we may fully comprehend the modus operandi of pes-
saries in prolapsus uteri, let us for a moment enquire what is the
true pathological condition of the parts in this affection. In an
article entitled "Remarks on Hypertrophy, &c." by Professor
Antony, in No. 8, of the Southern Medical and Surgical Journal,
we are told, that ' chronic metritis, (for with this writer, metri-
tis and prolapsus uteri are one and the same complaint, or at
least that in metritis there is prolapsus, and both relieved by a
pessary.) is explicitly this, the circulation through the blood ves-
sels, both veins and arteries become obstructed by the undue
pressure of the displaced uterus on them:" i. e. in metritis and
prolapsus, the womb, from its displacement, presses upon its
own veins and arteries, and thus produces its increased size, ten-
derness to the touch, &c. Admitting the obstruction to the free
circulation of the blood in prolapsus, and that though both arte-
ries and veins are compressed, still the womb increases in size;
are not the vaginal and uterine secretions augmented, amounting
in nearly all cases to fluor albus ? Would this be the case if the
blood vessels had undue pressure upon them ? I had thought
until.I noticed this article, that the theory of Boerhaave concern-
ing obstruction to the circulation as a cause of inflammation and
disease, had received its quietus from the veteran Boyer. Again
says the same Professor, this deranged state of the circulation of
the blood is best removed by replacing and retaining the womb
in its proper place; and mark the means employed, nothing less
than a pessary. In reducible hernia, the bowel, though forcibly
protruded through an unnatural and very small opening in the
abdominal wall, retires of its own accord when the patient lies
down. And will it be necessary, I candidly ask, to apply an in-
strument to effect a reduction in prolapsus uteri, or even to retain
the uterus when reduced? Does the horizontal position produce
no change, or will not placing the female upon her knees and el-
bows reduce the womb when displaced ? Professor Antony, in
the article referred to, says, "frequently in the course oi*a week
or two, have I observed these enlargements of the uterus, (from

1637.] An $ssay, <}-c. 647

metritis and prolapsus,) which have been of many months' dura-
tion and of considerable size entirely disappear." What female
would not submit to a proper position for weeks, yea months at a
time, rather than have a pessary even introduced into the vagina,
to say nothing of its frequent removal and application? If a
foreign body removes obstruction to the free circulation of the
blood in the womb when displaced, is not greater relief afforded
when the prolapsus is counteracted by proper position, i. e. when-
ever the woman retires to bed? If position can reduce uterine
displacements, a fact admitted by all, why then resort to pessa-
ries ?

But what is the true pathological condition of the womb in pro-
lapsus? All will admit that "the uterus is usually more or less
engorged with blood slightly enlarged and heavier than natu-
ral. After a time it becomes somewhat tender to the touch, and
if allowed to project at the vulva or injured by friction in any
manner, may ulcerate." Besides this, the upper portion of the
vagina is reflected inwards ; there is a relaxation of its attach-
ments to the surrounding parts, the peritoneum, bladder, rec-
tum, &c, more blood is determined and retained in the parts than
natural ; and there is an increased, sometimes vitiated secretion
from the mucous membrane of the vagina and womb. Are not
organs thus circumstanced prone to inflammation and ulceration ?
Now 1 would ask, what necessarily must be the effects of a pes-
sary introduced into the vagina for prolapsus uteri ? While it
counteracts the descent of the womb mechanically, does it not
from its very presence increase the existing irritation or even
excite inflammation? Is there not a principle in the animal
economy by which it loathes every thing foreign to it? Does
not the urethra reject the bougie introduced into it? Does not
the bladder make attempts, though in too many instances they
are in vain, to expel the caculus deposited in it? Does not the
rectum discharge the suppository or foreign substances placed in
it? Again, is not the vagina closed ; does not the mucus mem-
brane of one side lie in contact with that of the other ? The pes-
sary then must distend it ; and as we have seen, it would be
rejected spontaneously, or slip out in the various movements of
the female, to be retained it must have a point of support. This
is usually the internal face of the perineum. It acts upon the
sides of the vagina, theos tinea? and the fossa navicular

Gi9 An Essay, <>c. [April,

Pessaries, says a modern distinguished writer and practitioner,

" effect a forcible distinction of the vagina ; the elasticity and con-
tracting disposition of this canal they tend to destroy, while by
their irritation they keep up an active congestion in the uterus
itself. These are the necessary results even of the judicious em-
ployment (so to speak) of pessaries, but of their rash and pro-
miscuous application the consequences are truly harrassing and
sometimes destructive." They certainly cannot restore tone to
the vagina, but on the contrary they tend necessarily by their
presence to destroy it. They do not shorten the ligaments of
the womb, nor do they promote the attachments of the uterus
and vagina to the surrounding parts. They increase and never
diminish the discharges from these organs. How then can pes-
saries cure prolapsus uteri?

There is one degree of uterine displacement for which it is gen-
erally supposed pessaries are still required ; I allude to proci-
dentia. Here it would seem their good mechanical effects in
keeping the womb within the vagina more than counterbalances
their irritation, &c. of the soft parts. But is it necessary even
in these cases to resort to pessaries ? If an instrument be re-
quired, I hesitate not to assert that Hull's Utero- Abdominal sup-
porter, or some similar external application will be found far
more preferable, and decidedly more efficacious than the pessa-
ry, and moreover, free from all its objections. Whether this in-
strument will answer for simple prolapsus, can alone be deter-
mined by experience.

Before abandoning the use of pessaries, it would be well to en-
quire if we have a substitute for them. Sound policy would, in-
deed, teach us to retain even a doubtful remedy until we obtain
a better. Prolapsus uteri is not a rare disease in this climate.
The physicians whom I have consulted, and whose names have
already been mentioned, have treated cases of uterine displace-
ment. If pessaries had been useful they certainly would not have
abandoned or restricted their application, and if the practice
which they now pursue for this affection were not successful,
they as certainly would not continue it. The ample experience
of Professor Dickson also attests the fact, that prolapsus is not
only best cured without pessaries, but that these instruments
ought rarely if ever to be employed in the treatment.

With these facts before us, Ave are now prepared for -the rr?a-
so is for and against the use of pi sarics,

1837.] An Essay, $c. 649

The only reason why these instruments are still employed and
recommended in practice, is that they do keep the uterus within
the vagina or even in situ, if well adapted to the case. But this
they do at such an expense that they arc highly injurious and
properly forbidden by a great majority of physicians at the pre-
sent day.

1st. Pessaries ought not to be applied for procidentia uteri,
because we have a much better substitute Hull's Utero- Abdom-
inal Supporter.

2d. They ought not to be employed for prolapsus uteri, be-
cause they can never cure the disease. Their operation is purely
mechanical ; negative to counteract relaxation of the soft parts
sustaining the uterus, but positive in their injurious and destruc-
tive effects to these parts.

3d. They are not necessary other means succeed best in
curing prolapsus. Experience on this subject among physicians
of this city is as 11 to 1.

4th. They are highly injurious and destructive if long contin-
ued. They promote vaginal relaxation, excite fluor albus, may
produce prolapsus uteri itself, and by irritating the os tincae oc-
casion ulceration or even cancer, the most fatal of all female dis-
eases. They may also call forth afflictions of the surrounding
soft parts in the bladder, rectum, &c.

5th. They are in their application exceedingly unpleasant to
both physician and patient. The very idea of a pessary is revolt-
ing to the female. They are to her a source of great moral as
well as physical suffering.

6th. They interfere with the periodical menstrual discharge
from the uterus.

7th. "They interrupt sexual intercourse."

8th. Their use may lead to immorality.

For these reasons I think the use o^ pessaries ought now to be
abandoned.

62

050 Medical Statistics, $c. [April,

ARTICLE II.

Medical Statistics : being Tables, c. relating to the mortality
of Augusta: By L. A. Dugas, Professor of Anatomy, &c.
in the Medical College of Georgia.

In presenting the result of my examination of the Records kept
by the City Sexton, during the preceding nineteen years, I feel
that the work is in many respects deficient. Imperfect as it isr
however, I am deterred from withholding it by the reflection,
that it contains all the facts in our power to obtain on the sub-
ject, that the tables and deductions, so far as they go, are correct,
and that the deficiencies are attributable not to any want of la-
bour on my part, but to the rude and careless manner in which
the records have been kept. Enough is collected to evince the
importance of such statistical observations, and to call the atten-
tion of the authorities to the regulation of the manner in which
such facts may be collected. The age in which we live is one of
positive research ; one in which facts are loudly called for, and
theories laid prostrate. Let us then not be reluctant to contri-
bute to truth, by yielding up our store of/ac/s, however scanty it
may be.

Table No. 1, exhibits the state of the population of Augusta, as
taken by order of the Ceneral Government, in June, 1830. The
character of the gentleman employed for this purpose, (Mr. J.
S. Beers.) is a sufficient guarantee of its accuracy. It will be
remarked that the census was taken in summer, when a large
number of inhabitants leave the city ; that the whole population
was then 6710, of whom 3052 were whites, and 3658 coloured.
Among the whites the number of males was 1680, whereas that
of females was only 1372, a disproportion of sexes not existing
among the blacks, of whom 1800 were males and 1858 females.
The disproportion observed, exists only with regard to adults, a
circumstance to be attributed to the mercantile character of this
community, which gives employment to a large number of young
men as clerks.

- The present population of Augusta is estimated to be about
7500. We regret that the census recently ordered to be taken
by the City Council is not yet completed.

1837.] Medical Statistics, $c. GoT

Tabic No. 2, presents the number of deaths, (still-borns inclu-
ded,) that occurred in Augusta in each year from 1821 to 1836.
It is, as well as all the subsequent tables, derived from the records
kept by the city sexton.

Table No. 3, is a statement of the mortality in each month,
during a period of sixteen years, from which we are enabled to
deduce the following tables.

Tables No. 4, 5 and G, exhibiting the average number of deaths
in each month. From these it wiil be perceived that there is
but little difference in the mortality of the months of July, Au-
gust, September and October, and that the fatality of these is
nearly double that of the other months. In taking the average
from the column of whites, the number of deaths is greatest in
October, whereas if it be taken from the blacks, July will present
the greatest mortality. The two last averages, however, differ
very slightly, and prove conclusively, notwithstanding the opin-
ion recently advanced by a southern writer of distinction, that
the causes of disease in our climate, without regard to season,
operate with equal intensity on the white and black race. On
referring to Table No. 2, it will be seen that in sixteen years,
there were among the whites seventeen hundred and eighty-one
deaths, and among the blacks only sixteen hundred and twenty-
nine ; but the relative proportion of the two races during that
time is not known. That this proportion must have changed
very materially, I think more than probable. It is well known
that the number of free negroes and of those who hire their own
time, has very materially increased of late years. The number
of artisans, (who are generally negroes,) has also manifestly in-
creased; moreover, on examining the Table No. 2, I find that
during the first eight years of the series, the deaths were, whites
nine hundred and forty-six, blacks seven hundred and five.
Whereas the eight last years show the majority of deaths the
reverse : whites eight hundred and thirty-five, blacks nine hun-
dred and twenty-four. I am aware that the gentleman to whose
opinion I just alluded, is not alone in support of the doctrine that
our prevailing fevers are more fatal to the Caucasian than to the
African race ; but I doubt very much that facts alone, without
prejudice, have ever furnished sufficient data for its establish-
ment. I am unwilling to admit, without better evidence than
we possess, that the mortality is greater among the whites than

fiSS Medical Statistics, <$-c. [April.

the blacks, when situated and living under similar influences.
With regard to the statistical observations of this city, it should
be remembered that the white population is such as to render it
extremely susceptible of disease. A large number of the inhabi-
tants are only temporarily located, and each business season is
ushered in by an accession of strangers. The mercantile com-
munity is almost entirely changed every live years not so with
the blacks. These are generally permanent residents. Their
masters may remove, but they prefer remaining with their friends,
and usually request to be sold at home. They do not spend one
season at the north, another at the south, a third at the east, and
then go to the west ; thus continually being exposed to changes
of climate, customs, &c. These are reasons why they should
withstand the climate better than the whites. But I repeat, I am
not prepared to admit the fact.

The following table will show the most fatal as well as the
least fatal months in several cities. (Diet, des Sc. Med. torn.
34, p. 362, et seq.)

Maximum mortality. Minimum mortality.
St. Petersburgh, May, October.

Stockholm, August, January.

London, January, June.

Paris, April, July.

Berlin, March, November.

Vienna, March, ^ October,

Montpellier, August, - May.

Padua, January, June.

Milan, December, April.

Table No. 7. Number of deaths in each month during a pe-
riod of four years, (1833, '34, '35 and '3G,) with averages deduced
from~the column of whites, from that of blacks, and from the
total.

Table No. 8. It is much regretted that this table, showing
the ages of those who died in Augusta, during a period of nine-
teen years, is incomplete as respects the coloured population.
During this period 21 15 whites died, the ages of 1941 of whom
I found recorded; leaving 174 unknown. The records having
been more carefully kept for four years past, I am enabled to
give the ages of the blacks who died during this period. It should
be noted, however, that their age is generally extremely uncer-

1837.] Medical Statistics, $c. 053

tain. Their desire to claim the privileges of the super-annuated
leads them to great exaggeration, and it is rare that their mas-
ters, keeping no record of their ago, can state it accurately from
memory. This will probably explain why the number above
fifty years of age is so much greater in the table of blacks than
in that of whites. It is well known that longevity is in general
greater in the higher than in the lower classes of society ; We
should therefore not admit, without more positive information,
the vulgar belief that negroes live to a much more advanced age
than whites. N

Tables No. 9, 10 and 11, represent the average number of
deaths per annum at different ages, deduced from the foregoing
table (No. 8.) The first is the average taken from nineteen
years* and the two others that taken from the four last years
('33, '34, '35, '3G,) still borns and casualties included.

Table No. 12, exhibits the proportion of deaths at different
ages to the population, as established by the census of 1830. It
is the result of a comparison of table No. 8. with said census,
and refers to whites alone. The ages of the blacks being stated
in the census differently from those of the whites, the same esti-
mate could not be made with regard to them. Fractions are
omitted.

If the proportion of deaths per annum to the present popula-
tion [7500] be deduced from the mortality of 1834, '35, '36,
(those recorded as still-born being excluded, as never having ex-
isted,) it will appear that it is as 1 to 40.32. In this estimate,
whites and blacks are of course included. It is a matter of some
interest to compare this with the mortality of other places. Ac-
cording to Emmerson's Tables, (Am. Jour, of Med. Sciences,
No. 1, 1827, p. 138,) the mortality of the coloured people in
Philadelphia is astonishingly great, 1 in 11), whereas that of the
whites is comparatively small, 1 in 50.8. The aggregate would
give an average of 1 in 34.0.

The following is a table taken from Dr. Gregory's Dictionarv.
The data on which it is founded are not stated.

Proportion of inhabitants dying annually
In London, - - ' - 1 in 20 3-4
" Edinburgh, - - - 1 " 20 4-5
" Dublin, - - - 1 " 22

" Stockholm, - - 1 " 19

651 Medical Statistics, fyc. [April,

" Vienna, - - - 1 " 19 1-2
" Rome, - - - - 1 " 21 1-2
" Amsterdam, - - 1 u 24

" Norwich, - - - - 1 " 24 1-2
u Northampton, - - 1 26 2-5
M Liverpool, - - - 1 " 27

" Manchester, - - - 1 " 28
" Savannah, (Georgia,) - 1% 317-10

" Wirtemburgh, - - 1 ' 32
" Sweden, - - - - 1 " 35
u Kingdom of Naples, - 1 " 37 1-3
" Parish of Brandenburgh, - 1 " 45
" Pays de Vaud, - - 1 " 45
" Philadelphia, - - - 1 <; 45
" Ackworth, (Yorkshire,) - 1 " 47
" Salem, (Massachusetts,) - 1 " 47
" Island of Madeira, - 1 " 50

" Corfe-Castle, Dorset, - - 1 " 50 1-3
M. Friedlander, in his very able memoir on mortality, (Diet,
des Sc. Medicales, t. 34, p. 391.) states the proportion of deaths
to the population, to be in London 1 in 21 Dublin 1 in 22
Edinburgh 1 in 21 Amsterdam 1 in 22 Berlin 1 in 26 Vi-
enna 1 in 20 Montpellier 1 in 28 Rome 1 in 23. According
to Heberden, the proportion in London was in 1700, 1 in 25 in
1750, 1 in 21 in 1801, 1 in 35 and since, 1 in 38.

In an article on the "Health of Charleston," (Southern Litera-
ry Journal, July, 1836.) Dr. Logan quotes the following table
from an Edinburgh periodical.

The number of deaths compared with the population was:
In London in 1828, 1 in 55

" St. Petersburg " 1828, 1 in 48

Geneva

M

1821, 1 in 43

Berlin

1827, 1 in 34

Paris

M

1829, 1 in 32

Rome

M

1828, l in 81

Amsterdam,

M

1828, 1 in 29

Stockholm,

U

1827, 1 in 26

Vienna,

u

1821, 1 in 25

The discrepancies evinced by these tables establish sufficient-
ly the difficulty attending their construction, and consequently

1837.] Medical Statistics, 4'c- fl5*

the little degree of confidence to which they are entitled. The
London bills of mortality are proverbially inaccurate. In Swe-
den they are better regulated than in any other country. Can
we then for a moment credit the statement of such an immense
difference in the mortality of London and Stockholm? In ma-
king such estimates, authors should always state the sources of
their information. Fortunately for us, Dr. Logan has stated the
manner in which he determines the mortality of Charleston. He
tells us that "Charleston is decidedly one of the healthiest cities
on the face of the globe." I do not deny it. But how does he
prove it ? By a reference to the above table, and by stating that
in Charleston in 1835, 1 in 45 1-2 died. Certainly no one can
presume to establish the mortality of a city upon the facts of one
year alone. This may have been the manner in which some
have made their estimates, relating to London and other places.
Were we to adopt this method, we might, by selecting particular
years, make Augusta either the most insalubrious or the most
healthy city on earth.

Table "So. 13, is a summary of the number of deaths from each
of the most prevalent diseases. The records are extremely im-
perfect prior to 1833, and indeed totally deficient from 1826 to
1833, the sexton having kept no account of diseases during that
time. From 1833 to '36 inclusive, the records have been kept
with much more accuracy. This table exhibits a large number
of deaths from scarlet fever in 1833, prior to which year this
disease was scarcely known amongst us. It then prevailed epi-
demically to a dreadful extent, but has since gradually disap-
peared. This table also presents ten cases of Asiatic cholera
among the blacks, all of which I believe originated on the river,
or occurred in boat hands shortly after their arrival. Under the
head of fever are included those reported as bilious, malignant,
typhus, intermittent and nervous fevers. The small number of
deaths from fever is worthy of notice. It is believed that the
fatality and indeed frequency of these affections, are rapidly de-
creasing. The small number of cases of cholera infantum will
also attract attention ; but I have no doubt that most of those
reported as dysentery should have been placed under the former
head. In 1833, as well as in 1835, the infantile affection was
unusually rife, and it is in these two years we find the largest
proportion of dysentery reported.

f>56

Medical Statistics, fyc.

[April,

In the column of " casualties," are included burns, drowning,
murders, and external injuries. The great proportion of deaths
from old age recorded as occurring among th: blacks, is the re-
sult of error, as has already been hinted.

Table No. 14, exhibits the relative proportion of the sexes
among the deaths in 1833, '34, '35, and '30, by which it will be
seen that the- mortality of the males far exceeds that of the fe-
males.

Table No. 15, contains the place of nativity of those who died
of consumption and of bilious fever during the same period. It
is worthy of remark, that whilst the deaths from phthisis are al-
most equally divided by *he northerners and southerners, that
those from bilious fever should be much more numerous among
the natives of the south, than among the natives of northern lati-
tudes ; 46 southerners, and 17 northerners. If to this majority
we add the number of blacks, who are all southerners, the result
will be truly surprising.

TABLE No. I.
Census of Augusta, taken by order of the General Government,
June, 1830.

*n

"J

^

M

a

*d

H 1

TS

>*J

g

*J

HI

P

o

o

o

o

O

c

S o

sr

3

3

3

3

5

3

B

3

3

3

5,3

Ol

O

Ol

ft

K

&

8

S

3

3

g

Whites.

V\

o

O

o

o-

S

c

o

o

s

o

^ o

250
240

o
19G

M0

c

o

4*.

B*

s

8

o

8

8

3-S

w O

1
Males,

154

418

333

128

42

15

3

1

1

1680

Females,

159

151

176

279

199

94

46

22

5

1372

1

3052

a

"3

3

3
3

i*

g

Cu

3

3

B

3

K

8

Slaves.

o

o

o

443

M

413

387
390

5i

326
339

8
107

V

Males,

2

~

1708

Females,

470

437

1

126

1

1763

3471

Free col.m.

30

23

16

14

92

Females,

26

24

J9

16

10

95| 167

-

b/10

1837.]

Medical Statistics, <$

657

TABLE No. II.

Whites

Rlacks

Tut.l

9(J

2-J7

82

231

76

185

78

1G8

82

208

99

216

97

231

92

182

104

193

L83U

1831
1832
1833
1834
1835
1836

TABBE No. Ill

TfoHl

164
284
230
272
177
225
209

3410

< S

1821, Jan.

5

12

17

Feb.

8

8

16

March,

5

11

16

April,

6

4

10

May,

7

8

15

June,

12

8

20

July,

24

15

39

Aug.

11

10

21

Sept.

11

7

18

Oct.

25

8

33

Nov.

8

4

12

Dec.

6

4

10227

1822, Jan.

5

7

12

Feb,

9

4

13

March,

11

6

17

April,

6

6

12

May,

2

9

11

June,

14

8

22

July,

25

6

31

Aug.

23

5

28

Sept.

20

10

30

Oct.

16

10

26

Nov.

13

7

20

Dec.

5

4

9231

1823, Jan.

7

3

10

Feb.

3

4

7

March,

3

5

8

April,

7

6

13

May,

6

7

13

June,

10

4

14

July,

25

13

38

Aug.

14

7

21

Sept.

9

10

19

Oct.

13

5

18

Nov.

4

2

6

Dec.

8

10

18185

1824. Jan.

7

7

14

Feb.

6

7

13

March,

5

o

7

April,

8

4

12

May,

6

4

10

June,

9

8

17

July,

12

13

25

Aug.

6

11

17

Sept.
Oct.
Nov.
Dec.

1825, Jan.

Feb.

March,

April,

May,

June,

July,

Aug.

Sept.

Oct.

Nov.

Dec.

1826, Jan.

Fob.

March,

April,

May,

June,

July,

-Aug.

Sept.

Oct.

Nov.

Dec.

1827, Jan.

Feb.
March,
April,
May,
June,
July,
Aug.
Sept.
Oct.
Nov.
Dec.
IS2S, Jan.
Feb.
March,
April,

11

6

5

9

5

6

4

2

6

12
17
22
12
18
12
10

9

6

8
12
10
12

6
10

7
12
12
13
13

4

7
10

9

18
13
11
14
15
12
11

3

4

7
10

83

2

9

4

7

6

8

6

3

5

4

8

7

9

8

12

6

3

9

11

7

7

14

11

10

5

8

5

9

6

7

3

10

6

10

17

14

6

7

4

7

7

6

7

2

13
15

9
16168
11
14
10

5
11
16
25
29
21
26
24

16-208
12
15
19
19
17
2S
1
20
12
20
17

22-216
19
11
10
20
15
28
30
25
20

n

16

18-231

10

10

14
12

658

Medical Statistics, tyc.

[April,

<

a

t^

>

S

3

3

K >

5 5

m

c

2

JO

c o

May,

9

5

14

Sept.

16

20

36

June,

5

13

18

Oct.

14

15

29

July ,

9

5

14

Nov.

5

15

20

Aug.

13

8

21

Dec.

5

6

11230

Sept.

12

11

23

182

Jan,

8

a

10

Oct.

9

9

18

Feb-

10

10

20

Nov.

6

13

19

March,

20

24

44

Dec.

3

6

9

182

April,

12

24

36

1829, Jan.

5

9

14

May,

7

12

1

Feb.

3

4

7

June,

6

17

23

March,

3

7.

10

July,

10

10

20

April,

1

9

10

Aug.

10

Ii

21

May,

6

5

11

Sept.

15

11

26

June,

5

9

14

Oct.

16

7

23

July,

10

9

19

Nov.

G

9

15

Aug.

20

14

34

Dec.

7

8

15273

Sept.

12

13

25

1834,

Jan,

3

8

11

Oct.

14

11

25

1

Feb.

8

4

12

Nov.

8

8

16

March,

1

9

10

Dec.

7

6

13-

198

April

4

9

13

1830, Jan.

4

5

9

'

May,

o

9

11

Feb.

3

6

9

June,

8

9

17

March,

2

8

10

July,

6

3

9

April,

8

6

14

Aug.

8

5

13

May,

13

11

24

Sept.

10

21

31

June,

5

6

11

Oct.

16

10

26

July,

4

15

19

Nov.

6

8

14

Aug.

7

3

10

Dec.

4

G

10177

Sept.

5

6

1L

1835

, Jan.

7

11

18

Oct.

11

6

17

Feb.

9

5

14

Nov.

4

8

12

March

2

7

9-

Dec.

5

13

18-

-164

April,

3

11

14

1831, Jan.

6

13

19

May,

8

4

12

Feb.

6

11

17

June,

7

9

16

March,

8

6

14

July,

18

18

36.

April,

2

7

9

Aug.

20

17

37

May,

9

10

19

Sept.

15

9

24

June,

10

5

15

Oct,

11

7

18

July,

11

19

30

Nov.

3

7

10

Aug.

18

11

29

Dec.

2

15

17225

Sept.

27

11

38

183C

, Jan.

G

12

18

Oct.

34

19

53

1

Feb.

7

7

14

Nov.

15

12

27

March

, 6

9

15

Dec.

6

8

14-

-284

April,

15

3

18

1832, Jan.

12

9

21

May,

2

5

7

Feb.

12

6

18

June,

7

7

14

M arch

, 5

7

12

July,

6

8

14

April,

9

6

15

Aug.

15

10

25

May,

4

8

12

Sept.

5

8

13

June,

G

7

13

Oct.

19

14

33

July,
Aug.

3

12

15

Nov.

10

8

18

12

1G

28

Dec.

9

11

20209

1837.] Medical Statistics, fc 659

TABLE No. IV.

Average Mortality of each month ; deduced from a Series of
sixteen years, (from 1821 to 183G,) Whites and Blacks in-
cluded.

January, 14,06 J.^v, 23.80

August, 23,68

September, 22,49

October, 25,12

November, 15,03

December, 14,74

February, 13,12

March," 14,06

April, 14,49

May, 13,80

Juno, 17,71

TABLE No. V.
Average Mortality in each month, among the Whites alone.

January, 6,56

February, 6,50

March, 6,06

AdhI, 7,18

May, 6,62

June, 9,12

July, 12,43

August, 13,75

September, 12,56

October, 15.56

November, 8,06

December, 6,87

TABLE No. VI.

Average Mortality in each month, among the Colored alone,

January, " 7,50 July, 11,37

February, 6,62 August, 9,93

March, 8, September, 9,93

April, 7,31 October, 9,56

May, 7,18 November, 7,87

June, 8,62 December, 7,87

TABLE No. VII.
Number of deaths in each month, during a period of four years
(1833, '34, '35 and '33,) with averages deduced from the
column of Whites, from tliatof Blacks, and from the total,

January

February,

March,

April,

May,

June,

July,

August,

September,

October,

November,

December.

White

Black

Total

Whites,

Blacks,

Total,

rrerafo,

avenge,

average

24

33

57

6

8*

14*

31

26

60

84

64 .

15

29

49

78

7*

12*

194

34

47

81

84

HI

90*

19

30

49

4|

74

12*

23

42

73

7

104

174

40

33

79

13

9.}

19*

53

43

96

13*

10|

24

45

49

94

11*

12*

234

62

33

100

15*

94

25

25

32

57

6i

8

w*

22

40

62

SJ

10

154

mo

Medical Statistics, tyc.

[April,

TABLE No. VIII.
Ages of those who died.

Whites, 1

Under!
5 years

From 1 | |
5 to 10[l0tn20|20to30l

M) to 40 40 to 50159 to 00|GO to 70

TOtoSO

over 80 1 Tot.i]

1818

18

6

7

5

8

8

5

3

3

63

1819

39

6

6

18

12

5

7

4

1
3

3

101

1820

36

12

4

30

12

15

1

1

o

116

1821

46

9

3

27

12

8

9

o

3

1

120

1822

45

8

10

21

13

7

7

7

1

119

1823

34

8

8

18

11

9

4

1

2

95

1824

25

6

8

14

10

7

4

1

3

78

1825

30

14

10

20

16

7

3
3

1

107

1826

49

3

3

18

14

6

3

3

1

103

1827

46

9

8

22

16
15

6

5

5

3

1

121

1828

36

o

7

12

6

7

4

5

1

1

83

1829

45

4

4

10

16

4

7

5

1

99

1830

31

4

3

18

7

1

1

1 1

70

1831

61

15

14

18

17

8

6

3

3

3

151

1832

33
56

o

8

15

20

9

4

3

o

101

1833

16 13

i

12

15

8

4

3

127

1831

32

r,yr

17

6

3

3

1

4

74

1835

44

\

6

15

14

11

6

0

3

105

1837.]

Medical Statistics, <$

001

1836

II

7(53

13S

133

ID

320

1*

249

10

130

91 I 57

36

13

102

1011

Blacks,

Uiidei

j yean

Fr nn
> to 10

0to20

20 to no

30 to 40

10 to 50

>0 to GO

<iO to TO

:o to eo

lovorPOl Total

1833

71

14

It

7

13

13

3

3

5

o

145

1834

38

3

7

11

11

6

7

10

5

3

101

1835

57

3

4

10

9

10

6

6

8

5

113

1836

50

5

10

7

5

3

6

7

3

99

216

20

30

33

40

34

19

25

25

13

~463~

TABLE No. IX.
Average number of deaths per annum, among the Whites at dif-
ferent ages, deduced from a series of nineteen years, {from
~1818tol83G).
Under 5 years 40,15 From 40 to 50 6,84

From 5 to 10 years, , 7,26, " 50 to 60 " 4,79

" 10 to 20" " 7,00] " 60 to 70 " 3,n0

16,84| " 70 to 80 " 2,05

0,68

20 to 33
30 to 40

13,10 Over 80 years,
TABLE No. X:
Average number of deaths per annum, among the Whites of dif-
ferent ages, deduced from a series of four years, (from 1883
to 1836).
Under 5 years, 43,25 From 40 to 50 years, 8,00

From 5 to 10 years,
" 10 to 20 "
20 to 30 "
30 to 40 "

7,50

" 50 to 60

7,50

" 60 to 70

13"50

11 70 to 80

13,25 [Over 80 years,

4,75
2,50
2,25
0,03

TABLE No. XI.
Average number of deaths per annum, among the Blacks of dif-
ferent ages, deduced from a scries of four years, (1833, '34,
"'35 and'Zti).

8,50
4,75
6,25
6,25
3,25

This

Under 5 years,

54,00

From 40 to 50

From 5 to 10 years,

5,00

" 50 to 60

10 to 20 "

7,50

" 60 to 70

" 20 to 30 "

9,50

" 70 to 80

30 to 40 "

10,00

Over 80 year*.

TABLE No. XII.
Proportion of death* to the ^population at different ages.
table refers to the Whites alone.

Under 5 years,

From 5 to 10 years,
" 10 to 20 "
" 20 to 33
" 30 to 40 "

1 in 12

1 in 50
1 in 90
1 in 41
t in 4J

From 40 to 50 years,
" 50 to 63 "
60 to .70
" 70 to B0

1 in 32
1 in 17
1 in 12
1 in 4

Over 80 years,

1 in 3

Whole >*o. of deaths,

1 CO

1

i

z

,2

i

!l

Disease stated,

P|P

Disease unknown.

~

- 1 *

2

CO 1 CO I t"-
CO Tf 1 CO

Sundries,

i w

-

V

1 CO

CO

CO

-

1

"

Mortification,

1

Dyspepsia,

Casualties,

-*

~

*<

a

a|-

1

co Still-born,

co

i>

m j o

1

2 J 1 El 2

g Old age,

1

1

OS ' t^

i

j o

"'-

n Childbed,

~l

*

H

11

*^

-^ Rheumatism,

CO

-> Worms,

-v

"1"

i

1 1

1 i 1

CO _

OD Intemperance,

CO

1

7

"1

jo Palsy,

~

pf Dropsy of Brain,

"~co"

Q

mi

TP

1 1 o

f^ Dropsy,

CO

1

1 *

~c7

1

co

~00

i

p .w

CO

CO

1"

W ^ Liver affections,

JS |

<j Measles,

*h

rl

S3

co

"1

'1

W "S Scarlet Fever,

"77

1 i

n | co i in

P io" Teething,

< ^

^ Fits, Spams, and Cramps,

-|

CO

1 | CO

o Inflammation of bowels,

"TT

w

"*

o"

CO

-

eo Dysentery,

"1

1 ~l

q , 1

^ Cholic,

"1

1 "* 1

-> ....

J3 Asiatic Cholera,
41

1

c

1

V^ Cholera Morbus,

Of

35

M

i

in

<--

1

1

% Cholera Infantum,

"1

^ Sore Throat and Quinzy,

~

"

1

c*

5T

Hooping Cough,

-1

~l

Croup,

CO

co

CO

00

|

"r

M

Affection of the Lungs,

!
"1

1-1

rr | SO

P>

Pneumonia and Pleurisy,

" l'

JO.

o

-ar
1

Consumption,

3

"l

"1

-|

Brain Fever,

1

__:!

* i

Fever,

8ft

^ | CO

J2 w

col

as ! on

1^3?.] On the Physiological effects of Caoutchouc, fyc. 603

TABLE No. XIV.

la 1833 there died (Whites,) Males 76, Females 4G, sex unknown S

In 1831 do do 15, do 31, do

In 1 B35 do do do 53, do 47, do

In 1635 do do do 7G, do 31, do

In 1>33

do

(Blacks,)

do

64,

do

66,

do

15

In 1831

do

do

do

56,

do

33,

do

6

In 183.5

do

do

do'

65,

do

51,

do

4

In 1836

do

do

do

55,

do

44,

do

3

435

355

33

TABLE No. XV.

Place of nativity of the Whites who died of Consumption and of

'Bilious Fever, in the years 1833, '34. '3 5 and '36,

OF CONSUMPTION.

North of the Potomac,

9

Europe,

817

Georgia,

4

Other Southern States,

913

OF BILIOUS FEVER.

Xorth of the Potomac, 7

Europe, 1017

Georgia, 28

Other Southern States, 1846.

ARTICLE III.

A paper on the Physiological effects of Caoutchouc as an ender-
mic application for the purpose of Counter Irritation. Read
before the Philadelphia Medical Society, November, 1836: By
Heber Chase, M. D. of Philadelphia.

Gentlemen. The short space of time which has elapsed since
my escape from the walls of Alma Mater, together with my at-
tention having been directed to other and more engrossing pro-
fessional occupations, has rendered the investigation of the sub-
ject of the paper which I have the honor of offering you on the
present occasion, less extensive than might be desired : the facts
however, though not numerous, may be considered striking, and
perhaps not wholly unworthy of attention.

The application of remedial substances to the skin is by no
means of modern date. Its origin was coeval with the history

064 On the Physiological effects of Caoutchouc, <$-c. [April,

of surgical means for the relief of disease, and it has, I believe, at
all times and in all ages been regarded as a powerful auxiliary,
in combatting a very large class of diseases tojvvhich the human
family is heir.

The long list of agents suited to this species of external treat-
ment, ranked under the general head of revulsives, and divided
by writers and teachers into various classes, embracing the chain
from the potential cautery down to the mildest irritant which
produces an erythematous blush, may, and I dare say in your
opinion does afford the practitioner an ample field from which to
select remedies for every state and condition of disease under
which our patients may chance to suffer.

I purpose, however, to call your attention to the employment
of a new remedy which may be placed in this class, and thus to
add another to the above named list, viz. : Caoutchouc or India
Rubber, used as a revulsive or counter-irritant.

I shall in these remarks enter so far into the commercial his-
tory of the article, as to give some idea of the resources in ob-
taining it, and the vast quantities^ now consumed. I shall also
offer a slight notice of the different modes of preparing it, in order
to give the practitioner a few hints in selecting the genuine arti-
cle, and such of its varieties, as are best adapted to the dhTerent
forms of disease.

India rubber trees are found very abundant on the north coast
of Brazil, in the province of Para they are about sixty feet in
height, and from eighteen to twenty-four inches in diameter, and
are almost devoid of branches, except towards the top. They
grow indiscriminately among trees of all kinds, and in a thick
dense forest. The milk (as it is there called) is procured by the
Indians ; and over this tract of country there are no less than
from ten to twelve thousand persons employed in collecting it.

Young specimens of this plant may be found in the botanic
gardens near this city.

It is asserted that the health of the tree is improved by the
abstraction of its juice, and that upon this, its longevity greatly
depends. The quantity of gum elastic obtained from each tree
varies generally from one hundred to one hundred and fifty
pounds.

The specimen of the sap or milk of the caoutchouc now ex-
hibited, was originally of a cream colour, but from the action of

r837.] On the Physiological effects of Caoutchouc, fyc. 60&

the air and light, has become of a darker hue. This specimen
belongs to the Philadelphia College of Phnrmacy, and was
brought from the province of Nicaragua in Central America, in
1831. A part of the specimen as then imported was analyzed.*

Originally, they were in the habit of felling the tree for the
purpose of obtaining the juice, but more recently it is procured
by tapping (a process similar to that employed by our farmers
for obtaining the juice of the maple or sugar-tree, for the manu-
facture of sugar.) The juice of the Seranga or India rubber
tree, is caught in small clay vessels and is then poured off into
small vats.

The first notice of the employment of caoutchouc was in 1770,
by Dr. Priestley, in a note to his treatise on the theory and prac-
tice of perspective, in which he says, M since this work was
printed off, I have seen a substance excellently adapted to the
purpose of wiping from paper the marks of a black-lead pencil.
It must therefore be of singular use to those who practice draw-
ing."

There are now exported annually from the province of Para
alone, 1500 tons of India rubber.

At present there are. I believe, in this country, but two estab-
lishments for the manufacture of this article. One is located at
Roxbury, Massachusetts, and is called the "Roxbury India Rub-
ber Company." The other at Lynn, Massachusetts, and is
styled the "Boston and Lynn India Rubber Manufacturing Com-
pany." The former of these, (the Roxbury company,) posses-
ses a capital of 8500,000, which is all employed in the manufac-
ture of this article in its numerous forms. This company was
established about seven years ago, and from that period up to
within a few months, the caoutchouc was dissolved in spirits of
wine, or spirits of turpentine, and then laid upon cloth of suitable
fabric, and allowed to become hardened. The cloth here seen
by the society, is from the agencies in this city. The several
pieces, as will be observed, are of different texture; and from
this are manufactured various articles for surgical purposes, as
well as for those of dress.

The process for dissolving the caoutchouc is as follows :
Large vats capable of containing several pipes, are rilled with

*8se Journal of the College of Pharmacy, No. xii, for 1832, p. 2OT.

84

666 On the PJiysiological effects of Caoutchouc, fyc. [April

the India rubber cut in pieces: upon these is poured the solvent,
and after the lapse of a few days, the preparation becomes fit for
use. It is then spread upon the cloth. The proportion of the
solvent employed to the caoutchouc is kept secret by the pro-
prietors, and its original discovery was accidental.

There is, however, an article in the market which is entirely
worthless ; it is rendered so by the change which the prepared
caoutchouc undergoes after being laid upon the cloth. Here is
a specimen, of the article under consideration : it presents an un-
even appearance on the surface, adheres to the fingers, or when
brought in contact with itself, if not obviously liable to this ob-
jection when purchased it soon becomes adherent on pressure or
exposure to warmth, and consequently unfit for use.

Within a few months past, a gentleman connected with the
Roxbury company, has invented a machine for rolling the
caoutchouc into sheets, by which process it is said, the sheets may
be extended with perfect facility, to any degree of tenuity re-
quired. The pieces of rubber are placed between rollers, and
carried through a sufficient number of setts to reduce it to a ne-
cessary thickness. While under this process, it is brought in
contact with the cloth and made to adhere, by a part of the same
machine through which it has passed. This is a very beautiful
preparation, and it is one that promises to be of great utility ; at
present it is obtained with difficulty, but will no doubt be exten-
sively employed hereafter.

The experiments of Dr. Mitchell of this city, upon caoutchouc,
have shown, that when this substance is submitted to the action
of ether for a short time, its susceptibility of extension is greatly
increased ; that ba^s of several feet, may be inflated by the
breath to such an extent, that when filled with hydrogen and
placed at liberty, they will ascend against their own gravity.
It may be doubted whether mechanical apparatus is capable of
producing the same extreme expansion without the aid of a sol-
vent ; but the dilation of caoutchouc bottles has been carried very
far by the action of hydrostatic pressure, by Mr. Rehrer, a sur-
geons' instrument-maker in this city.

Another form of caoutchouc to which I wish to call the atten-
tion of the society, is in the India rubber sheet. This, as I ex-
hibit it to you, is also brought from Brazil, and is prepared in
the following manner. The juice of the I-Ioeva Caoutchouc, or

/.] On the Physiological effects of Caoutchouc, <c. 667

Jatropha Elastica, as it exudes from the tree, is caught in vessels
or cups, as before mentioned, from which it is poured into cis-
terns of eighteen inches, or two feet square ; and while in its fluid
state, boards of about eighteen inches square, and one inch in
width, are dipped into it, the caoutchouc adhering to their sur-
faces. They are then removed, and in twenty-four hours the
caoutchouc hardens, the board is removed, and an India rubber
bag or sac is produced.

Sheet India rubber as obtained from the Roxbury manufacto-
ry, by passing the caoutchouc through the newly invented ma-
chine alluded to above, is free from all foreign substances, as the
flasks or bottles from which it is made, are imported filled only
with potter's clay. On their arrival in this country the clay is
removed, the bags filled with shavings, tow, or similar materials,
and thrown into the market. These bottles are made by dipping
a piece of clay, resembling them in shape, three or four times into
the milk, before hardening. India rubber shoes are prepared in
a similar manner, by dipping the last in the milk while yet in a
fluid state.

The sheet India rubber is also free from that unpleasant odour
which always accompanies it when prepared by the aid of either
of the solvents.

Within the last few years, and more particularly during the
time that my attention was called to the construction of instru-
ments for the radical cure of hernia; and while testing experi-
mentally the action of substances, possessed of different degrees
of density, upon the various hernial openings, I was led to ob-
serve the peculiar action of caoutchouc when applied to the skin.
I had remarked this peculiar pathological action in a number of
instances, when a gentleman presented himself for surgical ad-
vice, wearing an instrument, the cover of which wras made of
this material. This gentleman, desirous of avoiding the unplea-
sant effects of the perspiration, had resorted to the following con-
trivance. He had on several occasions attempted to wear his
instrument next the skin, the result of which was, in a few days,
a very thick crop of vesicular eruptions beneath it, and conse-
quently he was obliged to abandon the instrument.

The same effect followed the employment of pads of India rub-
ber, when used for the retention of the bowel in hernia.

This defect lias been looked upon by some as a misfortune,

058 On the Physiological effects of Caoutchouc, Cyc. [April,

but this is not the case ; for ample experience has abundantly
shown, that wood is by far the better substance for retaining the
bowel in hernial openings : because, while it escapes all the ob-
jections urged against caoutchouc pads, it possesses many advan-
tages which the latter do not.

This result of itself was sufficient to debar this substance from
an introduction into general use; aside from the fact, that it will
not retain its original shape when worn for any length of time
that it is rendered more flexible from the warmth of the body
and that in some instances, a destruction of the mass of the gum
itself takes place.

Moreover, a committee of this society, in their report on the
radical cure of hernia, while speaking of the direct application of
caoutchouc to the skin, use the following language " The com-
mitte are decided in the opinion, that the retentive power of solid
blocks exceeds, ca>1 eris paribus, by a considerable difference, that
of pads composed of softer materials. If there could be any ex-
ceptions to this rule, it would be in favour of pads formed of very
firm, but highly elastic materials; but the only substance of the
latter character now employed in the construction of truss-pads,
is gum elastic; and against the direct application of caoutchouc
to the skin, there are strong physiological objections."

While digressing thus from my main subject, I will remark,
that during the last six months I have employed India rubber
cloth to a very considerable extent, in the treatment of hernia.
Instruments covered with this material, the prepared side turned
next to the spring of the instrument, serves not only to protect
the spring, but is invaluable, and altogether indispensable to pa-
tients under treatment, while visiting the sea-shore, or bathing
under any circumstances whatever, when throwing aside their
truss would endanger the retention of the bowel.

I had these instruments prepared last summer for several gen-
tlemen, who visited Philadelphia from the south, in order to be
treated for this disease : and I have now three patients from the
Island of Cuba, two of whom were labouring under double rup-
tures, who prefer instruments of this character for constant use,
during the treatment. The only objection that has been found
connected with these instruments, is the unpleasant odour arising
from the employment of some of them ; but hereafter this will
be obviated entirely, from the fact that the cloth oan now be

1837.] On the Physiological effects of Caoutchouc, <jt\ 6G0

manufactured from the newly invented machine of the Roxbury
company, without employing any solvent from which the smell
originated.

From the observation contained in the foregoing remarks, I
was led to the employment of caoutchouc in cases of local chronic
pains, in gout, rheumatism, etc., and I will now introduce to the
notice of the society, a few cases in illustration of this practice.

Case i. On the 10th of April, 1830, I was requested to sec a

lady, Mrs. , whom I found laboring under a very severe

pain, situated about three inches below and a little within the in-
ferior angle of the scapula. This lady is about 29 years of age,
was originally very robust, but from the constant suffering ari-
sing from the pain, which is of two years' standing, her general
health has gradually given way. She is now unable to attend
to her domestic affairs without difficulty, and at times the pain is
so great, that relief can be gained only by laying her hand over
the part, and pressing against the corner of a sideboard, bureau,
or similar piece of furniture. It was with difficulty that she rest*
ed at night, the recumbent position increasing the pain. She
leads a somewhat sedentary life, to which she attributes the cause
of her complaint.

April 12th. I prepared and furnished her with a portion of
gum elastic sheet, the identical piece which I here exhibit to the
society. This she confined over the spot before mentioned, by
means of two pieces of tape attached to the upper angles of the
India rubber and carried around the body.

April 15th. The plaster, (if I may so term it,) now adheres
very closely to the skin it has produced a good degree of
warmth when partially raised, the pans beneath are very red,
with slight eruptions upon the surface.

17th. Eruptions very numerous.

19th. Vesicles are well rilled with serum, and varying in size
from one to three lines in diameter.

21st. Some of these vesicles have been ruptured patient
says, " the water as it runs down my back is very warm, produ-
cing a slight sensation of burning," and in fact, redness of the
skin was produced by it. The itching, irritation, and I may say
smarting, is now very considerable.

Patient wishes to remove the plaster ordered it to be contin-
ued.

070 On the Physiological effects of Caoutchouc, <yc. [April,

2Cth. The pain has been gradually subsiding for the last few
days was not felt yesterday. Patient has removed the India
rubber ordered it reapplied.

May 10th. Patient has no return of the pain has not felt
any symptoms of it since the last date plaster removed re-
maining vesicles ruptured parts dressed with simple cerate.

Nov. 21st. (Monday of the present week). I saw this lady
to-day her general health is improved the parts became re-
stored in live days after the last date, and no return of her affec-
tion lias taken place. I will only add, that in her habits of life
there is no material change.

Case ii. Miss , aged 22 years, of a dull phlegmatic tem-
perament, enjoying good general health, and accustomed to much
exercise. Her menstrual discharges, however, for the last two
or three years have seldom been regular, and very slight expo-
sures have sometimes caused a suppression of the evacuation.

This young lady had also laboured for several years under a
fixed local, and at times very severe pain, situated in the neigh-
bourhood of the two last lumbar vertebras and the upper portion
of the sacrum. She was at no time entirely free from it ; but at
periods more or less distant, the pain was intense almost beyond
endurance.

May 20th, 1838. I saw her for the first time, when she gave
me an account of her case. She is now within a few days of
her expected menstrual return. Bowels not having been moved
for the last 30 hours, ordered a mild cathartic pain in the back
comparatively easy requested to see her again in a few days.

May 28th. She is now unwell, and has been so for two days
past. Bowels freely opened dorsal pain greatly increased since
the last date.

I now procured a section of the sheet India rubber, of about
eight inches in length and six in width, directed her to apply it so
as to cover the seat of the pain, and confine it if necessary by a
few turns of a roller.

June 3rd. The India rubber having been applied as directed,
has kept its place without the aid of a roller. Some considera-
ble redness of the skin was produced, followed by itching of the-
surface of the skin beneath and around the plaster menstruation
ceased ordered a saline cathartic.

June 8th. A vesicular eruption i^ now exhibited, following

1837.] On the, Physiological effects of Caoutchouc, <\c fi7l

the erythematous appearance of the skin of the last date, accom-
panied by the same itching as before.

June 12th. Vesicles exhibiting the appearance of water blis-
ters, are very thickly and uniformly spread over the surface
they are of a reddish hue, varying in size from a pin's head to
that of half a small pea, filled with a transparent fluid, which es-
capes on the rupture of the vesicle. These vesicles do not often
break of themselves, but are very readily broken by pressure or
friction.

20th. Patient has no pain in this region, it having graduallv
subsided since the eighth instant.

25th. No material change since the last date no pain has
been experienced in the parts patient continues to wear the
plaster by my request.

Oct. 18th. The patient informs me that she discontinued the
wearing of the plaster about a month since, having experienced
no return of her former complaint.

Nov. 19th. I met with this young lady she believes herself
well..

I have no means of judging whether this pain was in any way
connected with her menstruation : since her relief, however, she
informs me she has been more regular than formerly. Washes
of different kinds had been resorted to in this case, and in one or
two instances blisters, but without any effect.

Case in. In consequence of the happy termination of the case
above related, a friend of that patient called to consult me in re-
lation to herself.

July 25th. This young lady is about 20 years of age. and to
all appearance very healthy. Her complexion is florid cheek
rosy hair, eye-brows and eyes, dark walks anxl sits remarka-
bly erect. Her general health is good, but she has laboured for
the last eight months under an almost constant pain, situated just
below and within the mammary gland of the left side. This pain
is by no means insupportable when the patient is at rest ; never-
theless, it always reminds her of its existence. Coughing, laugh-
ing, sneezing, or any sudden motion, increases it ; and frequently
while walking, she is obliged to stop and press her hand over the
part for relief. She has little or no cough.

The pain in this instance is confined to a limited extent of sur-
face, and over this T prepared for application a picee of India

672 On the Physiological effects cf Caoutchouc, c^c. [April,

rubber sheet, about six inches square. This was applied by the
patient herself, and required for a short time the aid of a roller to
keep it in its place. The action of the plaster was similar in all
respects to the cases above related, and therefore docs not re-
quire a minute account of appearances, day and date, to arrive
at the conclusion. On the sixth day the roller was removed, the
rubber adhering ; vesicular eruptions had then formed, and on
the loth of August, she did not suffer either pain or uneasiness in
the part affected.

Sept. 4th. She threw aside the plaster, and up to this date,
Nov. 19th, she has had no return of the complaint.

Other cases of a similar nature have been equally successful,
but no regular notes have been preserved: the general result,
however, has been the same or nearly so, leaving a strong im-
pression on the mind, that this substance, when judiciously em-
ployed, will be found of very decided benefit in cases where a
mild revulsion is required in chronic local pains.

In rheumatic and gouty affections, I have applied the caoutch-
ouc in a few instances ; the cases, however, are of a limited num-
ber, and a sufficient length of time has not elapsed to warrant a
detail of them, from which authenticated conclusions might be
drawn.

About the fifteenth of August last, I applied a quarter sheet of
caoutchouc to the knee of a female, aged nearly 70. Her knee
is very large and fat, and the rheumatic pain was seated in the
inner side. The application enveloped the whole knee. Five
or six days after, I saw this patient she was relieved from the
pain, which had usually continued from four to five weeks du-
ring an attack. Whether she has experienced a re-attack I am
unable to say.

In gouty affections caoutchouc has been employed with some
advantage at present, I am not in possession of many facts that
would interest the society, but I hope hereafter to be able to speak
more satisfactorily upon the subject.

In the cases above related, I have remarked, that the sheet
caoutchouc was confined by means of the roller, and to this it
may be added, that the adhesive strips may sometimes be found
useful in retaining the plaster.

As the eruption will depend upon the manner in which the
plaster is kept in its place, it is highly important that those means

i$37.] On the Physiological rf its of Caoutchouc, <$-c. 673

should be adequate to the end in view ; and like almost all other
surgical manipulations, some tact and experience will be found
necessary, to enable the practitioner to accomplish his purpose
in all the different positions in which he may be called upon to
apply this remedy.

The form of the caoutchouc employed, must always vary ac-
cording to the disease in question and the part affected ; and here
the judgment of the surgeon is again called in requisition. It is
wrong to trust the application to the patients, as their awkward-
ness will inevitably lead to continual blunders.

In local pains I direct the constant use of the plaster to the part
for a longer or shorter period, according to the more or less ag-
gravated character of the case. In rheumatic or gouty affec-
tions, I do not find the constant employment of it desirable, but
direct it to be used alternately with buckskin or flannel ; thereby
preventing the undue severity of the vesicular eruption, a caution
essentially necessary when the disease is not confined to any
particular spot.

I now come to speak upon the physiological action of caout-
chouc.

It has been thought by most of those whose attention I have
called to the subject, that India rubber owes its property of vesi-
cation, and its consequent advantages as a revulsive or counter-
irritant, to the various solvents which have been from time to
time employed in its manufacture from the bottle, as spoken of in
the earlier part of this paper : and that by resorting to these sol-
vents, all the good effects that could possibly arise from caout-
chouc itself might be gained. This, however, has been clearly
disproved by the fact, that the article employed in these cases
was the sheet India rubber, imported directly from South Amer-
ica to this country taken immediately from the milk, without
having undergone any chemical change whatever, farther than
that produced by the action of atmospheric air in hardening.

My experiment were begun with the India rubber cloth,
which had little or no effect upon the skin; notwithstanding I
employed that which was prepared by the solvents, and which
can always be known by the smell it emits. I was obliged to
resort to the caoutchouc in sheets, which gave the results detailed
above.

The vesicular eruption produced by caoutchouc, is different

85

674 On the Physiological effects of Caoutchouc, $c. [April,

from that which follows the employment of other endermic rem-
edies. When properly applied, the vesicles are regular, cover-
ing the surface nearly uniformly, and not varying very consid-
erably in size.

Its use is attended with less pain and unpleasant feeling, than
other remedies of a similar nature. Its action is not so prompt
as that of the mustard, fly, and many other agents; but I may
hazard an assertion, that it is as important in its ultimate results,
as even tartar emetic, when employed endermically.

In all cases of local pains of whatever nature, where a counter-
irritant is desirable for any length of time, it is fair to presume,
that caoutchouc will be found a very valuable remedy.

Thus, Gentlemen, I have given you in as clear a manner as
possible, all the information I possess upon this subject, hoping
that it may lead to still further investigation. The field is great,
and the many valuable purposes for which this substance may
be employed in the treatment of disease, are yet but partially
known.

I shall continue to employ caoutchouc, and to pursue the in-
vestigation, whenever I meet with cases warranting its use; and
shall communicate my observations to the society.

I ask in return that the results of its employment in the hands
of other members, may also be communicated to the society;
for it is by this procedure alone that we can arrive at correct de-
ductions and definite results.

In this, as in all other labours, my chief design has been, the
advancement of the limits and the promotion of the interests of
the profession, with which I have the honor to be affiliated.

March 4th, 1837. Since this paper was read, I have em-
ployed caoutchouc in several cases, in all of which relief to the
patient was obtained. In some of them I first used the more
common plasters, and even tartar emetic, to no effect. The re-
sult of these cases will in due time be laid before the profession.

1837.] Case of Tumour situated in the Groin, fyc. 675

Part II. REVIEWS AND EXTRACTS.

Case of Tumour Situated in the Groin and filled with Worms I
By M. Vanderbach.

A female, aged 36 years, of a bilious temperament, was afflic-
ted with a tumour in the left groin, which had no known cause,
and which gave her much trouble. Although it was not pain-
ful, still it was the seat of a peculiar species of incessant trem-
bling, which tormented her and obliged her to keep her hand con-
stantly applied to it ; having remarked that this allayed the pain.
On examining it, the tumour had no more than usual warmth,
was not red, nor was there any unusual tenderness of the sur-
face; in a word, there were none of the symptoms which gener-
ally attend inflammation. On the contrary, its solidity and po-
sition, (a little external to the abdominal ring), assured M. Van-
derbach that it was not a hernia, or of a lymphatic nature. He
directed bathing, a light diet, and gentle frictions to the part.
Eight days after, the tumour reddenedjn the centre, and the pa-
tient felt a degree of pulsation in it. Maturating poultices were
then used.

A slight fluctuation soon became perceptible, and the tumour
became slightly opened. With much surprise, it was discovered
that it contained lumbrici entwined together in a knot. The
opening was enlarged, and fifteen large worms were drawn out.
Of these, ten were long and very large, three were a little smal-
ler, and two of the size of a crisping pin, and all full of life. On
attentively examining the cyst, in order to discover the source of
these worms, M. Vanderbach was not able to discover any
communication leading from it. The cyst, far from appearing to
depend upon an intestinal rupture, was, on the contrary, a com-
plete sac, very smooth, contained no serous matter and bore no
marks of inflammation. Cicatrization was efFected and the pa-
tient was perfectly cured, without afterwards experiencing any
return of the swelling.

In reporting this case to the Medical Society of the Lower
Loire, M. Vanderbach proposes the two following questions :
1st Were the worms engendered in the same place which they
occupied? In that case what was the cause and principle of
their developement? 2nd. Could they possibly have passed the
coats of the intestines, and the walls of the abdomen, in conse-
quence of some latent inflammation, and their openings after-
wards have cicatrized? These questions caused a discussion in
the society above mentioned, the substance of which is sufficient-
ly interesting to be related.

M. Menard related three remarkable cases, of abdominal ab-

670 Case of Tumour situated in the Groin, <Hyc. [Apn

s:css. From these tumours, which were situated in a triangle
formed by the umbilicus, the anterior superior spinous process of
the ilium and inguinal ring, in the most projecting part of the ab-
domen there came out a great number of living ascarides lum-
bricoides. He then gave the following details of the patient
whom he saw with M. Bacqua. The mam aged 40 years, was
attacked with a severe intestinal affection, and also had a hard
tumour, for which he applied leeches and emollient poultices.
The patient became better, the tumour softened, and eight days
after. M. Manard, perceiving an emphysematous crepitation, felt
assured that the tumour contained worms. M. Manard made a
small puncture, which gave vent to a sanguineous and milky
scrum, followed by many ascarides la "ribricoides. Two days
after this, brought away two other anal worms. This physician
believed that the abscess had a communication with the intesti-
nal canal, and that the close connection with the surrounding tis-
sues had closed the opening, and this, he thinks, is the reason that
M. Vandcrbach could not find any communication between the
tumour and intestine.

M. Marcschal stated, that he thought the pulsating sensation,
which had been mentioned by M. Vandcrbach in the case which
he had reported, was worthy of notice. M. Mareschal did not
recollect, that this symptom had been mentioned by any writer,
but which ought to be noticed, since the worms were alive:
With reference to the presence of intestinal worms being found
out of the alimentary canal and collected together in the groin,
or any similar place, this physician was not satisfied with the
explanation generally given namely, ulceration of the intestine
and its union with the walls of the abdomen. A lesion of this
kind is very serious, said he, and ought to be preceded by re-
markable symptoms, notwithstanding this, in the case given by
M. Vandcrbach, no previous symptoms were observed. In ad-
dition, continued he, We might expect, occasionally at least, the
passage of fcecal matter and we ought not to expect that living
anal worms would he found in the tumour, because they re-
mained too short a time in it to admit of the communication be-
ing closed, which gave passage to them. He found much diffi-
culty in accounting for verminous tumours in a satisfactory man-
ner, and without rejecting the cases wherein the membranes of the
intestines had sustained previous injury, and had become united
to the walls of the abdomen, he thought there were other cases
similar to that of M. Vanderbcch, in which it must he admitted
that there existed alteration and adhesion of the intestine. These
verminous tumours moreover are not common, although many
authors give examples of them. Schenkius mentions several
cases. Zacutus Lusitanus gives a case in which they came from
a tumour at the umbilicus, and according to Feruel, ascarides
have sometimes crawled through the tissues, nnd hn vc been found

1837.] Case of Tumour situated in the Groin, <$c. 671

under the skin of the scrotum and thighs. la Sweden, more-
over, these diseases are frequent, according to the memoirs of

the academy of S ;n. M. Mareschal believes th^se ani-

mals to be able to t rce themselves through the walls of the in-
testine, and concedes to them the power of insinuating their poin-
ted extremities into the folds of the mucous membrane and the
loose fibres of the muscular coat. It may be supposed, lie adds,
that they make their way between the folds of the mesentery in
the same manner as foreign bodies, and having arrived at the ex-
ternal coat of the peritoneum, they penetrate the cellular tissue
and arrive at the groin or other parts. lie cited, as evidence of
the power of worms, the case of a patient whom lie treated at
tiic Hotel Dieu, for pleuropneumonia of which he died. On
post-mortem examination, lie found an ascarides lumbricoides in
the chest, which bad made an opening through the (esophagus.
He closed bis remarks by citing a very remarkable case from
Duverney, who found a living ascaris lumbricoidis in the su-
perior longitudinal sinus. M. Mareschal thought that in this
case the worm must have passed through the cribriform plate of
the ethmoid bone.

M. Marehand observed, that many physicians had found worms
out of the intestinal canal, but having neglected to give an accu-
raie description of them, there. was obscurity in many of these
cases. Every species of worms, says he, seems to have a pre-
ference for a particular organ, or some one part of the same or-
gan. Thus in the intestinal canal, we find the oxyuris vermicu-
Jaris in the rectum, the tricocephalus in the coecum and large in-
testine, and the ascarides lumbricoides in the small intestines. It
is said, continued he, that intestinal worms are not provided with
pointed extremities, and cannot perforate the intestinal canal.
It is many years since, some writer inserted into the journal of
M. Gaul tier, of Claubrv, cases in which worms were found in the
peritoneal cavity. The intestinal canal was perforated many
places; and what proved that the worms had passed through
these holes, is this circumstance, many of the worms were still
engaged in these round oriliees. which were just large enough to
admit of their passage. It is known that the gum elastic sound,
the extremity of which is round, when thrust too far into the
bladder, readily perforates the part on which it bears. Could
not a worm penetrate in the same manner the intestinal canal ?
Journal de la S> ction de Medeciite dc la Socteti Acadcmiquc de la
Loire In fir ie urc.

680 Ccrebro-Spinal Fluid. [April,

good deal ; but that, said M. Magendio, is an inevitable effect of the presence
of a foreign body in the vertebral canal.]

Third Experiment. The cerebrospinal fluid supports a certain pressure
in the interior of the rachis, and that pressure is not without having some in-
fluence on the functions of the nervous system. We sh;)]', therefore, endea-
vour to see how far this influence can be demonstrated ; and for this pur-
pose we shall inject a certain quantity of fluid into the vertebral cavity, and,
as a necessary consequence, augment the pressure of the fluid on the con-
tained nervous mass. The water we employ for injection is at the tempera-
ture of 25 Reaum. We must also take care that the point of the syringe
does not touch the nervous substance of the spinal marrow, which, as you
know, possesses a very high degree of sensibility. I now introduce the tube
of the syringe into the original opening made into the dura mater, and throw
in not a very large quantity of water. The animal has already lost the pow-
er of vision, and he has now fallen into a state of complete prostration.
These phenomena are, as you must be aware, easily explained by the pres-
sure which the fluid exercises on the whole cerebrospinal axis. You m^y
observe the same fact in diseases of the nervous system : as soon as ever
serous effusion takes place, the patient is thrown into a state exactly similar
to that of the animal now lying before us. The prostration, however, dis-
appears with its cause ; remove the fluid artificially introduced, and you re-
store the functions of the animal ; if you leave a free issue, the movement? of
respiration are sufficient to remove it. Here then, you see how the intro-
duction of scarcely half a small syringe full of fluid was sufficient to deter-
mine a state very nearly approaching apoplexy.

Fourth Experiment. We have just seen the effect" which would result
from any considerable augmentation of the cerebrospinal fluid ; but let ua
now consider the influence of changes in its temperature. H itherto we have
employed liquids at the same temperature as those of the animal experiment-
ed on ; we shall now try the effects of a fluid of a different temperature on
the same animal.

[Here M. Magendie injected some water at the temperature of 5 Zeait-
mer; but a few drops were scarcely thrown in when the little dog began to
moan, as if suffering excessively, and was seized with a convulsive shudder-
ing, very similar to that of a person in intermittent fever.]

Thus you see how the study of experimental physiology may lead to pa-
thological applications ; and this is the only manner in which we should pur-
sue the study of phenomena which, beyond all doubt, are nothing but physi-
cal phenomena, that, nevertheless, throw the greatest light on the nature and
cause of those denominated exclusively vital. I confess that experiments
on the living animal have many inconveniences attached to them, and are
opposed by many humane men ; they are, besides, extremely expensive, but
they are indispensable to the advancement of the science, and the interests
of humanity.

Now, gentlemen, with regard to these experiments relative to the pheno-
mena connected with the existence of the cerebrospinal fluid, you have seen
how the evacuation of this fluid commonly plunges the most furious and ac-
tive animal into a state of complete prostration a condition which continues
until the fluid has been reproduced. We have also examined the movement
of ascension and descent observed in this fluid, and seen it fall anfi mount in
the cavity of the vertebral canal according to the movements of the respira-
tory apparatus. Finally, we have demonstrated, in a direct manner, the
well-marked influence of the fluid's temperature on the functions of the ner-
vous system. These facts are highly interesting to the practical physician,
for unless he has acquired correct notions on the seat, nature, and modifica-
tions of the cerebrospinal fluid, it is impossible for him to estimate the phe-
nomena of serous effusion in the ventricular cavities of the brain, or in the
membranes of the pin:i' marrcv. You caw the change almoet injrtantane-

1 9S7.J Ccrcbro-Spinal Fluid* 6* I

ously operated by the removal of a portion of the fluid through the opening
practised in the spinal membrane. Before that was done the animal appear-
ed lively and active; after the operation he exhibited an insurmountable
tendency to sleep. This result is seen in all animals, without exception, and
would, probably, also occur in man, for in certain diseases of the nervous sys-
tem its removal is absolutely necessary. It is a fact which observation and
experience have placed beyond all doubt, that augmentation of the fluid, and
the consequent pressure, produce serious results. We see constant exam-
ples of this in the animal economy, and should hence ever keep in mind that
the functions of the cerebro-spinal axis are suspended as soon as ever the
nervous pulp becomes pressed on by an increased quantity of fluid.

This is a physiological fact of the highest interest. I repeat again, that
day after day our hospital practice affords examples of the same phenomena
being developed in man which I showed were produced in animals by com-
pression, from an increased quantity of fluid. Thus you perceive how ne-
cessary it is to make yourselves acquainted with the normal state and pro-
perties of this liquid. You also witnessed the phenomena which resulted
from elevation or depression of temperature of the fluid, independently of any
change in its quantity. You saw the animal in which we injected water at
a temperature of 5 thrown into a state very similar to that of a person la-
bouring under the cold fit of intermittent fever. Finally, you saw the man-
ner in which the functions of the whole nervous system were modified by the
introduction of fluid at an elevated temperature. I shall not insist at further
length on the importance of your studying these facts, both in a physiologi-
cal and a pathological point of view. You are, I hope, fully convinced of
this. Let us rather pass to matter more immediately connected with our
subject.

[Here the Professor desired the assistant to bring in the body of a dog on
which experiments precisely like those described in this lecture had been
performed, and which died yesterday evening.]

Here, gentlemen, is a pathological fact of some importance to notice ; you
may observe, in the animal before us, how the relations of the cerebro-spinal
axis have been modified; the nervous pulp is no longer in contact with its
normal fluid ; the whole surface is covered, as you see, with a purulent ef-
fusion, similar to that produced by inflammation of the membranes, or of the
nervous substance itself; in a word, the cerebro-spinal fluid has been trans-
formed into a purulent liquid. Hence any change in the nature or qualities
of the fluid may be attended with dangerous or even fatal consequences.
If you remember, during the course of this lecture, we injected a small quan-
tity of fluid tinged with ink, and connected with a glass tube, in order to de-
monstrate the alternate ascent and descent of the fluid, according to the res-
piratory movements : it was a similar change in the quality of the fluid,
brought into contact with the cerebro-spinal axis, which produced the pa-
thological phenomenon I have just shown you. The alterations, as you
may observe, are less manifest in the vertebral canal, because the greatest
part of the fluid was thrown up towards the brain ; however, you can dis-
cover a thin layer of altered fluid lining the whole surface of the spinal mar-
row. Here an important question, connected with the history of the cere-
bro-spinal fluid, presents itself. Is the composition of the fluid identical with
that of serum, or is it a fluid sui generis 1 The liquid, in its normal state, is
transparent, and inodorous : its taste is slightly saltish ; the idea prevailed,
for a length of time, that it was pure serum ; at length, however, more exact
observations were made the fluid collected from the living and from the
dead animal was submitted to the test of chemical analysis, and the latter
means soon demonstrated the difference of its cfcmposition from that of se-
rum. One of the most remarkable poiat6 of distinction consisted in the pre-
sence of an animal matter, in considerable quantity, which the chemists re-
gard as osmazome a rubotancr not to be found in ccrum. Since the latest

C>&2 Cerebrospinal Fluid. [April,

analysis of M. Conerbe, tending to show the exact composition of the brain,
we have acquired the conviction that this fluid differs essentially from serum
in its composition. M. Conerbe has lately communicated to me a note up-
on this subject, and although his experiments were performed on a small
quantity of fluid, his skill and accuracy of investigation have enabled him to
determine the composition of the cerebro-spinal fluid in a positive manner.
He says, that when a portion of the fluid has been evaporated on a glass-
plate, the microscope demonstrates the presence of cerebral matter in very
feeble quantities ; it seems, in fact, partly composed of a kind of net-work,
containing irregular globules, analogous to those which enter into the com-
position of the nervous pulp. This, however, is a fact which should not, in
the least, astonish us ; you can all understand the possibility of the cerebro-
spinal fluid containing some cerebral or nervous globules, for the fluid em-
braces the nervous substance on all sides, and may easily carry off with it
some of the particles of the brain, or spinal marrow.

The density of the cerebro-spinal fluid, compared with that of water, is
1,0110,00; when pure it is colourless, limpid, and inodorous: it acquires a
slightly salt taste when abstracted for any length of time from the body.
The residue, obtained by evaporating the fluid, is tenacious, elastic, and of a
yellowish colour, and contains a deposit similar to that left by the brain. It
also contains an animal matter, which is insoluble in ether, or alcohol, but is
dissolved by the alkalies. It contains cholesterine and albumine, the chlo-
rate of sodium, and phosphate of lime, with the salts of potass and magnesia.
Finally, a new element, whose precise nature is not yet exactly made out.
Thus you see that the analysis of the chemist whom I have mentioned, has
brought to light two new facts of a remarkable kind. The first, and most
important, is the fact, that the composition of the fluid bears some analogy to
that of the brain itself; the second fact is the presence of the fatty matter of
the cerebral substance being contained in the residue of the fluid. From the
above observations we are fully justified in concluding that the cerebro-spinal
fluid is not identical with common serum, but is a fluid sui generis.

Having established this point, we come to a question not less interesting,
though more difficult, viz. What organ or organic apparatus produces this
fluid ? It is not a serous membrane, for the fluid differs, in the first place,,
essentially from serum ; and, in the second, it is not contained in the cavity
of the serous membrane, but that of the vascular one ; hence we conclude it
is this latter membrane which produces the cerebro-spinal liquid, as a secre-
tion from its vessels ; you shall presently see the facts which prove this, and
you will be convinced that the secretion lakes place from the pia mater.
Keflect on the way in which serous membranes separate fluids they tran-
sude rather than secrete ; besides, in a normal condition, the serous mem-
branes never present any trace of vessels from which secretion could take
place. In cases of inflammation, when they seem to be vascular, the arte-
ries really exist beneath the membrane, and you can always detach a serous
surface from the false membranes by which it is covered, without any rupture
of continuous capillaries, such as we observe in cases where a mucous tissue
may be engaged.

So far as concerns the secretion of the cerebro-spinal fluid, the pia mater
seems evidently the organ which separates it from the blood : unlike the se-
rous tissue, the pia mater is highly vascular, and if you take the trouble to
examine the cerebro-spinal axis of the animal before us, you will convince
yourselves that a modification of capillary action in that membrane has pro-
duced the fluid called pus, instead of its normal transparent secretion. It is
still more difficult to connect the fluid contained in the ventricles of the brain
with a serous membrane. In spite of what Jiichat has said, we persist in the
opinion, that the ventricles are not lined with serous membrane ; yet those
cavities are often filled with fluid. It appears to me probable that this fluid
il not secreted in tho place where it is found after death, but gradually accu-
mulates there from the surface of the brain, or spinal marrow.

1S37.J Cerebrospinal Fluid. G )3

If you expose the dura mater in a living animal, incise it, and introduce a
coloured fluid into the subarachnoid cavity, you will find that it mounts from
the spinal marrow to the cavity of the cranium, and from this latter passes
into the cavity of the ventricles; hence there is evidently a means of com-
munication between the external and internal fluids, and a possibiJity of the
former, by a change of place, being transformed into the latter. In most
animals there is no free communication between the surface of the cerebel-
lum and the fourth ventricle, and, consequently, no opening, or membrane,
like those we find in man ; the transmission of the fluid takes place through
a kind of sieve-like apparatus, which permits its passage. This passage docs
not take place in certain pathological conditions ; in certain others it is very
evident.

We also possess very convincing proofs of the fact, that, in the human sub-
ject, this fluid may pass from the external surfaces of the cerebro-spinal axis
to the internal cavities. I have had frequent opportunities of verifying this
fact in one case, in particular, that of a man cutoff by inflammation of the
pia mater lining the spinal marrow. I found the whole cavity of the rachis
nearly filled with pus, and, on further examination, observed that the latter
fluid had passed up from the vertebral canal, as far as the cavity of the fourth
ventricle. Hence it seems highly probable, that the fluid secreted at the
surface of the brain and spinal marrow makes its way into the ventricle of the
cerebellum, and thence passes into the different cavities of the brain ; and,
in support of this opinion, I could cite several cases in which the symptoms
cf cerebral effusion were considerably ameliorated by derivation practised
along the traject of the spinal marrow.

Thus you see we have every reason for adopting the opinion, that the
cerebro-spinal fluid is secreted by the pia mater on the surface of the nervous
centres, and then passes, by a mechanism unknown to us,, to the cavities of
the brain. Let us now resume the consideration of other facts connected with
the fluid.

When we introduce any foreign substance whose nature is easily recog-
nised, such as a salt, into the current of the circulation, we find a portion of
the substance deposited in the cerebro-spinal fluid. There are two animals
now in the laboratory which have just been destroyed by an experiment of
this kind. A solution of prussiate of potass was thrown into the veins, but I
am at a loss to account for their death. The foreign substance introduced
was not a very active one, we might even have thrown in 20 grains without
expecting any inconvenience from the injection. However this may be, even
in five minutes after the introduction of the prussiate of potass, if the cerebro-
spinal fluid had been drawn off, the usual tests would have demonstrated the
presence of the salt in it.

Fifth Experiment. Thus every substance which is in our fluids may be
brought into contact with the whole surface of the brain and spinal marrow
a fact, gentlemen, of the highest importance in a therapeutical point of view;
for, if it be true, and we have just demonstrated the fact, that various sub*
stances pass from the circulation to the cerebro-spinal fluid* a great number
of medicaments must follow the same law, and be capable of being brought
into immediate contact with the nervous substance.

[Here M. Magendie proceeded to examine one of the two dogs above-
mentioned, in which a solution of prussiate of potass had been injected ; but
as the result of the examination was not conformable with what he assured
us he had frequently obtained, he announced his intention of again repeating
it on the living animal. The fluid drawn off from the vertebral cavity was
perfectly clear and transparent.]

The phenomenon just alluded to, gentlemen, depends on the circulation of
the blood ; a foreign substance is mixed with the circulating fluid, and carried
to all parts of the body ; it necessarily arrives at the smaller arteries of the
pia mater, and by them is thrown into the cerebro-spinal fluid. Hence, it

8841 Cerebrospinal -Fluid* [April,

you replace the solution of the prussiate of potass by opium, alcohol, or ex-
tract of nux vomica, the momtnt these latter substances come in contact
with the surface of the brain and spinal marrow, you are struck with the poi-
sonous symptoms immediately dcveveloped. YVhen we come to treat of
these questions we will show you that the surface of the spinal marrow, and
particularly its posterior surface, is the part which feels most quickly the
action of substances thus introduced into the circulation an action that'may
readily give rise to fatal consequences.

Thus you see how authors who neglect the cerebro-spinal fluid, or are un-
acquainted with its existence, properties, &c, not only overlook an important
fact in anatomy and physiology, but. also render themselves incapable of com-
prehending several pathological phenomena of the utmost importance. A
Knowledge of this fact is absolutely necessary for every one who investigates
cerebral disease ; without it, we constantly fall into uncertainty and hypothe-
sis, the fruits of our ignorance, and we do nothing but multiply the already
immense number of pathological questions, without contributing anything
towards their solution. You will frequently hear pathologists assert, that ef-
fusion has taken place into the cerebral substance on the same side as the
hemiplegia, or on the opposite side, according as the influence of the com-
pressing cause may be intercrossed or not ; but it is probably the condition
of the cerebro-spinal fluid which determines the nature and seat of the para-
lytic symptoms in a great variety of cases. It is very possible, that while an
effusion of blood exists at one side of the brain, there may be an effusion of
the fluid at the other ; the latter, then, should account for what the older
pathologists called serous apoplexies ; and, perhaps, in this respect, their
ideas were much sounder than many modern writers appear to think. The
increased quantity of the fluid, beyond what is consistent with the cerebral
functions, will cause alterations of movement and sensibility exactly similar
to those which result from an effusion of blood.

These considerations might be carried much further ; but the objects of
our course do not permit us to dwell too long on facts which are purely pa-
thological. However, I shall not terminate the lecture without showing you
an experiment, at least in confirmation of what I have just advanced, and
showing you the effects produced by the introduction of a foreign fluid into
the vertebral canal.

Sixth Experiment. [Here the professor had a small guineapig brought
in.]

I told you before that it was difficult to open the sac containing the cere-
bro-spinal fluid in these little animals, and that the puncture should always be
made between the occipital foramen and the first cervical vertebra. I now
divide the muscles of the neck, but the little animal does not present the pe-
culiar trembling motion generally produced by their section. The cavity is
now opened, and I hope you will distinguish the jet of the cerebro-spinal
fluid ; it issues forth rapidly, as you see, but somewhat tinged with blood,
and in small quantity ; indeed, the fluid is generally not very abundant in the
guinea-pig.

The tincture of nux-vomica has the remarkable effect of producing tetanic
contraction of the muscles, and it is this substance which we now propose
introducing. [Here the Professor injected a very small quantity into the
opening he had practised in the vertebral canal. Scarcely were a few drops
thrown in, when the animal was seized with violent convulsive movements,
and fell dead before the tetanic symptoms had time to develop themselves.]
You see the sudden and violent effect of this medicament when brought into
immediate contact with the surface of the cerebro-spinal axis ; a few tetanic
coninjleions have barely appeared, and the animal has ceased to exist. It is
unnecessary for me to dwell on the various consequences that might be
drawn from the experiment which I have just shown to you.

1837.] On Schirrous and Cancerous degenerations, fyc. (>R5

Remarks on Schirrous and Cancerous degenerations of the Uterus: By Dr.
Stefano Bamalari, of Chiaviri.

With good right may modern surgery boast of possessing means capable
of conquering diseases which, on account of their nature and situation, were
considered by our predecessors as exceeeding the resources of art and aban-
doned to their fate as incurable.

The ligature of the iliac artery, of the subclavian and of the carotid, for the
cure of aneurisms, the useful precepts resulting from incessant anatomical in-
vestigations, for the different operations of which the numerous varieties of
hernia admit, the perfection of the greater part of operative processes, the
invention of new methods, are to be numbered among the happy discoveries
with which surgery has been enriched in the present age. Of not less benefit
than these, and those of former times, is the operation designed to remove
the morbid disorganizations of the uterus, an operation practised, the first
time, in the beginning of the present century.

There were already recorded, in the annals of the science, operations per-
formed and crowned with success on the prolapsed uterus. It was reserved
for the most sublime Italian genius, for our immortal Monteggia, first to pro-
pose to extend the knife to parts so concealed and to make known the possi-
bility of obtaining fortunate results.

If Monteggia does not for the first put his suggestion in practice on the li-
ving subject, it is because a suitable occasion does not present itself, for so
exact is the picture he draws of this disease, and so precise and useful his
instructions, that he is properly considered not only to have discovered the
possibility of performing such an operation, but supported by substantial ob-
servations to have scientifically proposed it. Ossiander of d'ottinga, is the
first who performed it on the living subject, and after this epoch similar
observations were repeated in various parts of Europe; in the intoxi-
cation caused by frequent good success, it was tried in extreme and des-
perate cases, whence not few were the operations performed that had an
unfortunate result, and the operators that undertook them weFe disappointed
in their expectation. It happened therefore with this, as with many other
useful inventions and discoveries in medicine and surgery, that the opinion
of practitioners was divided with respect to the utility of such an operation ;
there arose not a small numher of modern writers to discredit it, and to de-
clare the operation to be most daring and very seldom successful.

Seeing authors yet disagreeing with respect to this important point of prac-
tical surgery, I think the cultivators of this science ought to make known the
facts which occur in practice, and which may be of some utility in illustrating
this still controverted subject.

Moved by such a principle, I render, as of public right, the history of an
operation of this kind which I made; and it is my design to demonstrate it,
the excision of the neck of the uterus to be not only a most useful operation,
but the sole mean capable of curing a disease which in its nature inevitably
produces the death of the patient.

Maria Vaccari, a widow of Lavagna, aged 47 years, of sanguineo-bilious
temperament ; visited by me the first time the 20th of June, 1835; informed
me that she had been many years ago affected with puerperal metritis and
that she had had five births. It was eight months since the commencement
of her disease, which made its appearance with irregularity of menstruation,
debility, anorexia, sense of pain in the vagina, hypogastrium and loins at
irregular intervals she suffered leucorrhrea and monorrhagia; the day pre-
ceding that on which I visited her, she sustained a frightful loss of" blood
which ceased spontaneously; there was great prostration of strength, ca-
chectic habit, continued fever, with very marked evening exacerbation^, map.

686 On Schirrous and Cancerous degenerations, <$c. [April,

petence, a sero-sanguineons discharge from the vulva of most offensive odour.
On manual examination, there was discovered a tumour at the neck of the
uterus, hard, knobby, painful to the touch, extending over all the inferior lip
of the os tincae, readily dropping blood. Introducing Recamier's speculum,
I observed this tumour to be of a dark-red colour, of an irregular surface, of
the size of a hen's egg, and of considerable hardness. The surrounding parts
were in a sound stale, except the posterior wall of the vagina, which was ex-
coriated and inflamed.

The invalid consented to subject herself to an operation, which was per-
formed by me, the 30th of June, in the presence of my distinguished friend, L.
Sanmichele and A. Solari, surgeon.

The patient being situated as is usual for the operation of lithotomy, the
assistants being conveniently arranged, I introduced Recamier's speculum,
and conducted it so that the superior smaller extremity joined the superior
part of the vagina, and the tumour which was quickly turned back was con-
tained in the hollow of the instrument which I trusted to an assistant. This
being done, I prescribed a strong injection of tepid water to wash the parts
on which the operation was to be performed ; then with the left hand I took
the double hooked forceps and with the right the curved scissors ; 1 held the
tumour fast with the first and with the latter, by several cuts, made the exci-
sion.

The operation, which was not very severe, occupied a very short time, and
the patient assured us that she had suffered very little.

The dressing was with simple dry lint.

The extirpated tumour being examined, presented all the characters of can-
cerous tissue ; in the interior it was divided by various whitish bands, shining
as cartilage, and shewed some points of fusion, containing a humour of vari-
ous color and consistence, and the walls, where such fusions appeared, were
softened.

Nothing remarkable occurred during the cure ; the febrile reaction was
light; frequent washing, dressings often renewed, consisting of soft lint, and
two applications of nitrate of silver perfected her recovery.

The natural opening along the neck of the uterus remained pervious, and
Mrs. Vaccari regained her original state of florid health. Having visited her
four months after the operation was performed, every thing convinced me
that I had found her in a state of permanent restoration to health.

It is not my intention here to extend a treatise upon cancerous degenera-
tion of the uterus, others who have preceded me have, by their labours, left
little to be desired : I will not then enumerate the opinions advanced on can-
cer and schirrus, nor agitate questions so often discussed ; whether cancer-
ous affections be local or constitutional diseases ; whether they ought to be
considered as critical or metastic maladies, according to the idea of Ques-
nay, to which Scarfa still appears to adhere ; but my design is, in making
6ome remarks on cancerous and schirrous affections of the uterus, to restrict
myself to true experience, the great instructress in all things.

In many cases of cancerous ulcer of the uterus examined in hospitals, and
in those that have occurred to me in my private practice, I have constantly
seen that the disease first attacks the neck of the uterus, the so called os tin-
cae ; therefore, supported by these facts and many others related in the works
of the most correct observers, I doubt very much whether this disease can,
in its commencement, invade the fundus and the body of this organ. The
cancer of the neck of the uterus does not present itself with the aspect of can-
cer, with schirrous base, as that which occupies the glandular tissue of the
mamnrue, of the parotids, but assumes the appearance of cutaneous cancers,
and has the greatest analogy to cancerous affections that attack the dermoid
tissue of the face ; similar to this* it has its origin in the integument, on which
small tumours or knots arc developed, which ulcerate, extend in depth and
size, unite together and render, in a shorter or longer time, the neck of this

J 637,] On Schirrous and Cancerous degenerations, <Jr. 0$7

viscus, affected with a vast cancerous ulcer, which thus deep invades the
whole organ, not sparing the surrounding parts, the vagina, the urinary blad-
der and the intestinum rectum.

That this disease has this course is certain, it is indeed regarded by the
incomparable Scarpa, as one of the best established facts in the practice of
surgery. The other diseases that affect this viscus do not evince such a pro-
cess, the induration and the hypertrophy of the neck of the uterus, the stea-
tomatous affections, polypi, fibrous bodies and other diseases of which this
organ may be the seat, remain for years and years, without ever degenerating
into schirrus.

Cancer is of such nature, even at its first appearance, and when it pro-
ceeds, that if the surgeon be consulted in time by the patient, he will not find
it difficult to determine with precision and certainty, upon the nature of the
disease to be treated. Experience has already decided in what estimation
remedies for the cure of cancerous affections, internally as well as externally
administered, ought to be held. The inutility is known as well as the injury
that results, in such affections, from the mercurial preparations, so lavishly
used by A. Monro, cicuta so lauded by Stoerck, arsenic proposed again by
Adams, the acids vegetable as well as animal, compression brought into fa-
rhion by the moderns, and especially by Young, and many other remedies,
during the administration of which the patients, by the progress of the disease
and the disorder produced by the drugs, proceed to an incurable state. It
is a law which now admits of no contradiction in surgery, if schirrous and
cancerous affections can be cured, this can only be accomplished by the aid
of operative medicine actively and diligently employed.

The unfortunate practice of some, otherwise celebrated surgeons, in the
cure of cancerous diseases, depends upon the custom of attributing the name
of cancer to the last stage of the malady, a period in which it has become in-
curable, when the so styled cancerous cachexy is already developed, an epoch
at which every operation is unavailing and only serves to accelerate a fatal
termination.

Surgical operations, I say with my illustrious fellow-citizen, Professor
Mongiardini, are undertaken too late or imprudently neglected.

With respect to the method of performing this operation, I believe the
knife preferable in the generality of cases to caustic.

The operation with the first is promptly performed and allows a discharge
beneficial to the condition of the uterus, relieving it from the humours with
which it is oppressed. The surgeon limits at his pleasure the extent of the
part occupied by the operation, and should the loss of blood be considerable,
it is not difficult to arrest it by means of pressure applied with the tampon.
The caustic, on the other hand, requires repeated applications for the de-
struction of the whole morbid mass, from which result new courses of irrita-
tion and inflammation, by which the disease is often aggravated. Besides
it is not practicable in all cases to limit or to extend the action of this remedy,
which more frequently destroys a smaller part than is necessary, but some-
times extends beyond what is required; moreover the detachment of the
eschar takes place slowly, which prolongs the cure, and the swelling of the
parts proceeding, from the inflammation re-excited, prevents the diligent rep-
etition of these topical applications, for the inflammatory tumefaction renders
difficult and painful the introduction of the speculum ; finally the repeated
burnings exasperate the ulcer and render the practice necessarily uncer-
tain.

As respects the removal of the entire uterus from its natural situation, its
enclosure in the cavity of the pelvis, I regard the operation not only most

hazardous, but I should say, as not performablc with prospest of success.

All the histories of patients subjected to this operation, as well in Italy as
elsewhere, that have come to my knowledge, besides inspiring little confi-
dence in readers, relate cases "l" subjects who, with very few exceptions,

088 Case of ExcLlon of the Elbow Joint. [April,

have fallen victims, either during the performance of the operation or a short
time after. I am very happy to find this opinion agrees with that of a dis-
tinguished surgeon, Baron Larrey, as expressed in a report, made by him to
the Royal Academy of Medicine of Paris, on the operations performed by
Delpech.

Surgery has its limits, beyond which the laws of life oppose its extension,
and to pretend to perform that which is contrary to the principles of the or-
ganization, is not to advance the science, but indeed to cause a retrogres-
sion.

These feeble observations are submitted to the examination of my col-
leagues, with no other motive or aim than to invite them to direct their use-
ful studies to the subject of cancerous degeneration of the uterus, the most
terrible malady with which this most noble organ can be affected, and very
frequent in populous cities, and to fix their attention upon the practical re-
sults of excision of the neck of the uterus, with which to enrich the science
with new facts concerning an operation, that seems by some at the present
day not to be held in deserved esteem and considered as one of the most useful
and important operations in surgery.

I hope the cultivators of the science who have kindly received my former
humble labors, will excuse these reflections by a consideration of the circum-
stances in which I am placed, practising the profession in a small city, where,
thanks to God, cancerous diseases of the uterus are not frequent. Annali
Universal! de Medhcina.

A Case of Excision of (lie Elbow Joint: By Thomas Harkts, M. D., Sur-
geon U. S. Navy, and of the Pennsylvania Hospital.

Mary Plunkett, aged 26 years, married, a native of Ireland, and has Jived
in the United States seven years.

She was admitted into the Pennsylvania Hospital on the 6th of August,
1834, with a severe inflammation of the elbow joint. Six months previously
to her admission, she fell with great force on her left elbow, which at the time
gave her great pain, was much aggravated by motion, and followed by the
usual symptoms of inflammation. After the lapse of three months, the pain
diminished, the use of the arm was in some degree regained, without the ben-
efit of surgical assistance. About this time she received a kick from a cow
on the wrist of the injured limb, which reproduced the inflammation of the
injured articulation, and caused much subsequent suffering.

Some months afterwards she was brought to the Pennsylvania Hospital,
and, on examination, it was found that the internal condyle had been broken,
but had partly reunited. The joint appeared in a state of suppuration, and
was pointing between the olecranon process of the ulna and internal condyle
of the humerus. The abscess was opened by a bistoury, which afforded
some relief from the pain; and, as the cartilages lining the articulation were
not removed or even roughened, hopes were entertained, that by proper man-
agement, the joint might be saved. In the course of six weeks or two
months this hope proved illusive the joint became worse, being greatly
swelled and severely painful. She became deprived of rest, could not per-
mit the slightest movements of the limb several new abscesses formed,
which were opened in succession, caries commenced in the bones which en-
tered into the composition of the joint, and fungous degenerations formed,
which required the frequent application of caustic to repress. In this state
she remained until the following spring, when she became hectic, attended
with a frequent cough.

Observing these alarming symptoms, 1 proposed to her the alternative,
either to have the arm amputated, or to have the joint excised. She pre-
ferred the latter, and nibmittcd to the operation on the 5th of June, 183?>.

18^.] Case of Excision of the Elboic Joint. 689

Tiie operation was performed in the presence of my colleagues, Drs. Bar-
Ion and Randolph, the house physicians, Drs. Kirkbride and Gerhard, and *
large class of medical students.

The operating table was covered by a mattrass, and she was placed on it
With her face downward?, by which the back part of the r.rm could be more
readily commanded. The operation was performed according to a plan pro-
posed by Moreau, and afterwards successfully practised on by Mr. James
Byrne, surgeon to the Edinburgh Surgical Hospital. The figure II gives an
outline of the first incisions. The transverse cut was made by passing the
point of a strong bistoury above the olecranon process, and parallel with its
inner edge, by which the skin, cellular texture and tendon of the triceps mus-
cle were divided. It extended to the radial side of the tuberosity of the hu-
merus, and at such a distance from the inner one as to avoid the ulnar nerve.
J then cut upwards and downwards for the space of an inch and a half from
ejther end of the transverse incision, so as to form two flaps, which, when dis-
sected off the joint, fully exposed the olecranon process. The soft parts, in-
cluding the ulnar nerve, were drawn aside by curved spatuke, and then, by
means of a common amputating saw, the process was readily removed.

The condition of the joint was now carefully examined, and all the articu-
lating surfaces were found to be in a state of caries. I first divided the lig-
amentous connexions, and then, with the aid of nippers and the oblique cut-
ting pliers, the head of the radius and the diseased surfaces of the ulna and
humerus were perfectly removed. After securing two branches of the artic-
ular arteries, the joint was neatly cleansed, exposed to the air for a short
time, until the oozing of blood ceased, then the flaps were laid down, main-
tained in their position by 6Utures, and afterwards dressed in the ordinary
way.

The chief difficulty which I experienced in this operation was in avoiding
the ulnar nerve. In the natural condition of the parts, as for example, in op-
erating on the dead subject, the nerve can be easily placed without the reach
of the knife ; but when the soft parts are altered in their nature, when the
structure becomes thickened, dense, and unyielding, it is necessary, in order
to avoid wounding this important nerve, to observe the greatest precaution.

The operation being severe, gave no inconsiderable shock to the nervous
system, which was evinced by stupor, difficulty of articulation, deglutition,
and respiration. These symptoms were removed, however, in 24 hours, by
sinapisms to her extremities, and stimulating enemata.

On the 7th, the symptoms were improved the pulse 34 in a minute, and
the skin cool and moist.

On the 9th, the wound was dressed, and exhibited a healthful appear-
ance.

On the 10th, secondary haemorrhage supervened, preceded by intense pain
in the joint. The flow of blood was arrested by compression,* but not until
she had lost about sixteen ounces. Neither the bleeding nor pain ia the
wound was renewed, but she occasionally Buffered excruciating pain about
the umbilical region, which, however, was always speedily relieved by lauda-
num injections.

July 25th the patient is walking about her ward, with her arm in a
eling, and secured by angular splints. Hectic fever and cough have disap-
peared; appetite good; strength returning, and her health in all respects
rapidly improving.

July 80th patient has a considerable degree of motion in the joint, tie
wound is nearly healed, and she has every prospect of having a useful arm
and good health. Being poor, and lacking comforts at home, she was per-
suaded to remain in the hospital until her health wis entirely recruited, and
her arm so completely restored, that rhe would incur no risk in resuming her
rough and laborious duties.

87

690 Case of Excision of the Elbow Joint. [April,

-- - - M i ,. .

Dec. 4th, 1836, this patient called at the Pennsylvania hospital, was ex-
amined by Drs. M'Crea and Kirkbride, and found not only in good health,
but her arm very little deformed, considerable motion in the new joint, and
perfectly able, according to her own account, to work in the hard way to
which she had been accustomed.

The result of this operation, which, so far as I know, is the first of the kind
performed in the United States, is in every respect gratifying. It is the
more so, as our amputations in the Pennsylvania Hospital have terminated,
in so many instances, fatally. During the last two years, we have lost at
least one in four cases, by the formation of metastatic abscesses, either in the
brain, lungs, or liver. It has been reported by the surgeons of the .Hotel
Dieu, that more than half their amputations terminate, in the same discoura-
ging manner. Nor ought this effect to excite our wonder, since by lopping
off a considerable portion of the body, the equable action of the system is, in
some degree, destroyed, causing thereby more or less disturbance in its func-
tions.

The objections to this operation consist in the difficulty in performing it,
and the great suffering which it causes. These objections, however, are
more than counterbalanced by placing the life of the patient in less jeopardy
and by the preservation of a useful limb.

Of fourteen cases of diseased elbow joint on which Mr. Syme operated,
eleven perfectly recovered.

IS 37.] Medical Society of Augusta. 001

Part III. MONTHLY PERISCOPE.

MEDICAL SOCIETY OF AUGUSTA,

February 22nd, 1837.

The Essayist read the essay which constitutes the first article
in the present number of this Journal.

We refer our readers to the essay for the question for debate.
The essayist states that he has conversed with all the physi-
cians of Augusta, and that they are as seven against pessaries to
one in favor of them it will appear, however, that of the mem-
bers of the society, a large majority were only opposed to the
indiscriminate use or abuse of pessaries, and not to their judicious
employment.

Dr. Bowcn stated he had known pessaries, in one or two ca-
ses in the practice of other physicians, do harm that he had him-
self applied pessaries in many cases and certainly without inju-
ry he could not say but that these cases might have been re-
lieved as well by other remedies; recommended a bag of com-
phrey to be introduced into the vagina, to serve as a pessary, to
maintain the uterus in place when irritated or inflamed this he
considered to act both as an emollient poultice and a support :
esteemed the woollen pessary employed by Dr. Antony superior
to all other kinds or forms. In conclusion, believed that pessa-
ries are sometimes productive of good and ought not to be aban-
doned.

Dr. Antony observed, that he differed widely from the essay-
ist on so many points, that much more time was required than
could be allowed him, in the debate, to express his views. He
conceived that very important principles were jeoparded by the
essay, and that he disliked to enter upon their discussion, unless
he had at least several hours 'before him.

He regretted that this subject had been chosen for this even-
ing's discussion a question which he conceived directed pecu-
liarly to his own views arid practice, and which had, one way or
another, been so often before the society that every member
ought, by this time, to have become fully possessed of his opin-
ions and testimonials on the subject. Nor would he say a word,
but from the dictates of a sense of duty to those present,' who
were here for the purpose of being taught, and whom it was his
duty to guard, as far as opportunity oh. . ,aist the reception

of unwholesome doctrines which, if received, must necessarily
lead to practical errors, cither active or passive ; the result of
either ot which could be entitled to but little choice with those

* The medical class.

602 Medical Society of Augusta. [April,

whom they might be called to serve. He would therefore use
the present occasion for observing, that the essayist was radi-
cally wron^in many particulars touching the question under dis-
cussion. He was wrong in forestalling the minds of his hear-
ers by what may be considered, begging the question, which he
does throughout, on what he is called to argue. He was wrong
in considering the pessary as an exclusive treatment, in opposi-
tion to and separate from all other plans, or parts of treatment.
He was wrong in treating on it as applied indiscriminately to
all cases of uterine displacement. He was wrong in so gener-
alizing pessaries, as not to distinguish between one kind and ano-
ther. He was wrong and unjust in advancing the opinions and
expressions of his correspondents, or of those with whom he had
conversed, which opinions were evidently in relation to the pes-
saries in general use, as applicable to all possible forms and con-
structions of pessaries ; particularly such as they had never seen,
and perhaps never heard of. Essays and opinions he said, were
written, and opinions expressed, relative to such pessaries as
were contemplated at the time of offering such opinions; for he
would not accuse practitioners of offering condemnatory opin-
ions, or any others, the least decisive, on such as they had nei-
ther seen nor used. Nothing, therefore, could in his estimation
be more unjust to those whose opinions had been brought for-
ward by the essayist, than to take these opinions and apply them
to an apparatus which could not have entered into the minds of
those who had advanced them. The essayist was wrong in ap-
plying even the experience of practitioners with some pessaries,
to the use cf others which, in construction, materials, mode of
operation, &c, are essentially different. He was wrong in en-
deavoring to withhold from suffermg humanity the wholesome
influence of the truths of extensive experience, by interposing his
own opinion, which is professedly v/iihoutany experience in the
use of the practice. He was wrong in denying the compatibil-
ity of their use with what Li^franc considered hypertrophy, but
which he (Dr. A.) considered chronic metritis ; and in asserting
their positively injurious and destructive efl ects on those parts ;
effects of which, with his own alleged entire want of experience,
he could not possibly be allowed to have any idea except mere
supposition. Dr. A. said that he, whom the essayist regarded ns
the most strenuous and almost only advocate of pessaries, does
not employ them in every case; nor does he depend exclusively
on them in any. With respect to the pessaries in general use,
he was prepared to say that having, on ample experience, found
them altogether inadequate to the fulfilment of the indication, h*
had long since abandoned them-^-that he would not, for practical
purposes, give one cent for sli the pessaries in the museum, be-
cause he knew they could effect very little, if any good, except
possibly in some cases of procedentia, where they might palliate

1537.] Medical Society of Augusta. (VJ3

the distresses by retaining the uterus within the vulva. He em-
ployed a woollen pessary only, and whieh was so constructed as
to retain with great certainty the uterus at its proper site during
its use ; and whieh, although the essayist might be never so much
surprised at the statement, when properly impacted yes, im-
pacted between the uterus and fossa scaphoides, has the power
of gradually restoring the uterus to its proper site, when, from
chronic metritis or other causes, it has become so fixed below, as to
defy the efforts of the fingers for replacement, to say nothing of
the powers opposition. And that, in such cases of great immo-
bility of the uterus, a two day's use of a small pessary, well im-
pacted, was often found sufficient to prepare room for a larger one,
and so on, until one of three or four inches could be received,
which was sufficient, with females of ordinary stature, to retain
the uterus at its proper place, and allow an efficient action of the
absorbents for the removal of swelling, or M. Lisfranc's " simple
hypertrophy."

But, he continued, the essayist might be still more surprised
to learn, that so far from "obstructing the menstrual flux," his
choice time for their application was immediately in anticipation
of and during the period, and with the happiest effects in restoring
and regulating the discharge generally rendered more or less
irregular by that state of things which so much demands the use
of pessaries. And the essayist would surely be astounded to
hear, with his dreadful apprehensions about chronic metritis,
that he had often used them with the best effects, made of wool
of the coarsest fibre, selected for this quality, for the very pur-
pose of producing a- general irritation of the relaxed and debilita-
ted vagina, the effect of which was, on recovery, (the uterus be-
ing kept strictly from descending into it again.) to leave the va-
gina of much smaller dimensions, and more effectually resisting
the descent of the uterus by its better contraction the main
purpose to be effected in all cases, and which cannot be in some,
by other mean>\

He granted that authors had been very defective on this dis-
ease, not only in regard to the treatment, but also the diagnosis ;
hence it was, he said, that but a few years had elapsed since
even the physicians of this place, for whom he had high respect
as general practitioners, rarely distinguished a case. And whence
it was, that on removing to this city eighteen years ago, and de-
claring the existence of a few cases, so little had females heard
of such cases, that it appeared to be for a time the current belief
that a new disease had appeared amongst them ; and as to the
practitioners, many of them denied r.ny thing like a frequent oc-
currence of prolapsus in any, and positively denied the possibili-
ty of it in unmarried ferm!e<?. Now, however, physieians do
admit the fact that it h a disease of frequent occurrence, but
they appear almost as reluctant in adopting rational plans of

694 Medical Society of Augusta. [April,

treatment, as they had formerly been in acknowledging the fre-
quency of its occurrence, lie said, the profession generally ap-
peared to know less, both of the diagnosis and treatment of this
disease than of almost any other affection that he had frequently
known such cases entirely overlooked, and their effects on the
constitution, or on other organs, treated as primary diseases, to
the great damage of females.

The essayist, he said, had referred to the Southern Medical and
Surgical Journal for his treatment of chronic metritis, &c. It
was true, he said, that he did not there dwell much on astringent
lotions, &c, because, (as will be perceived by every reader of that
Journal,) that he was writing with reference to Lisfranc's prac-
tice, and preferred to give his approbation to these means, as
recommended by that distinguished professor. He said a good
pessary, well applied, was indeed calculated to cure irritation,
(not violent acute metritis,) by relieving pressure, a cause of
much more irritation than that which the contact of the pessary
ordinarily excites.

The essayist, he said, had referred to Hull's Utero-Abdominal
Supporter, as a substitute better calculated than pessaries, for
service in these cases. Dr. A was not prepared to pronounce
fully on the merits of this invention, without much more obser-
vation on its effects. He had hoped, from the very favorable re-
port given him by his friend, Dr. Peck, of St. Augustine, to find
in that invention a retentive power which would supersede the
necessity of subjecting females to manual operations in these ca-
ses. With this hope he had caused a supply to be brought to
this place, and still designed to test their virtues fairly, as oppor-
tunity might oiler. His object was to find, if possible, a treat-
ment which could be conducted by the patient herself when fully
instructed. He could only therefore experiment with them fair-
ly, with the must enlightened patients! Should they succeed vyith
these, their true merit will be established. But if not, it is not to
be supposed that they can with the less intelligent. From the
experiments he had already made, he was however decidedly of
the opinion that they would at least reiard the progressive' in-
crease of the disease, and so relieve from abdominal pressure as
to afford much respite from* the most distressing and dangerous
symptoms in many instances. ( IreaM circumspection will, how-
ever, be necessary in fairly testing the merits of the supporter1;
for he was well aware of the very uniform disposition of females
to make the best of their eases, and suffer them as far as possible,
in the hope of avoiding a dis ..ment.-

And for the same reason which induces- them in the first instance
to 'Conceal as long as possible, the knowledge of this disease,
they constantly incline to avoid subsequent treatment whenever
they enjoy such palliation of their distresses as to enable them to
do 0-

1837.] Medical Society of Augui 693

Dr. A. concluded by expressing his regret that the " interrup-
tion of sexual intercourse" by the use of pessaries, or " their use
leading to immorality," should be advanced as arguments against
the use of pessaries articles never resorted to but by the com-
pulsion of the absolute necessities of the case, in view of the
danger of life, or of perpetual increase of the most afflicting trou-
bles and distresses. As for the first its temporary interruption
would be by no means an important consideration, were it not
already forbidden by the condition of the patient. The second
only shows, if it be earnestly advanced, a want of acquaintance
with the treatment of such cases ; for of all conditions of the fe-
male, there is probably none which tends more to allay and final-
ly destroy all appetency on her part for venereal indulgence ;
and with the exception of that of labouring under an infectious
disease or the state of travail, there is perhaps no state in which
she may be imagined, so much calculated to repress all such ex-
citement in others ; and more especially under the pessary treat-
ment. A disease altogether so disgusting to the practitioner,
that no inducement, but an insuperable sense of duty and an un-
avoidable sympathy with the sufferings and dangers of that sex
which alone suffers it, can bring him to encounter the task so
repugnant to every comfortable feeling, as to induce the practi-
tioner, when brought to determine on a clear and rational diag-
nosis and treatment, to wish himself ignorant of every thing ap-
pertaining thereto, that he might honestly decline such service.

But the error of advancing this unfounded argument stops not
here. It is a trouble far beyond what falls to the lot of men, to
suffer this affliction, without adding to it those fears of ill opin-
ion or slander which, with the feelings and the peculiar value of
character with females, is generally dreaded more than death.
This sentiment has operated most severely on those afflicted, and
forced its thousands into a course of submission to one degree of
physical evil after another, until the very foundation of life is
sapped, and the secondary diseases become irremediable, rather
than risk the moral evil. And with those who have by intensity
of distress, or the exercise of more rational views in overruling
their native diffidence, been induced to yield to timely treatment ;
it has, from the influence of this sentiment, only been submitted
to at so advanced a period of the disease as to require manifold
the treatment which would have been needed at an early period;
and this too, with as much circumspection for the sake of secrecy,
as if the submission were a criminal one. He farther declared
his regret, that in the discussions in this society, so little respect
was sometimes manifested for the statement of facts, by gentle-
men, whom no one has a right to doubt. In this case the essay-
ist was only authorized to speak for himself. He (the essayist)
had never applied a pessary doubtless, therefore, he had never
found it accessary to a cure; He (Dr. A.) had used the pessary

COO Medical Society of Augusta i [April,

' -.- . -....

in his treatment, for the last twenty years, of some hundreds of
cases, with a very satisfactory degree of success, and in many of
which all the other ordinary means had proved inefficacious with-
out it ; and when he stated such facts, he had a right to claim for
his statements the respect due to truth.

Dr. Dugas observed, tiiat he concurred generally in the views
taken by the essayist that lie had however never applied a pes-
sary, and was therefore not prepared to say any thing from ex-
perience, with regard to the effects of pessaries. On being re-
quested to give a positive answer to the question before the so-
ciety, Dr. I), said, that although he had never seen, nor ever ex-
pected to see, a case in which he believed a pessary could be
used with advantage, he did not feel disposed to deny the posi-
tive asseverations of those, who, viewing the use of the instru-
ment in a different light, insisted that it had been beneficial in their
hands. He would therefore not vote for its absolute rejection.

Dr. Hook considered the pessary applicable to cases of simple
prolapsus, unattended with irritation or subacute inflammation ^
has seen entire relief afforded by the pessary ; prefers a pessary
of sponge, long and soft ; employs pessaries in about one case
out of ten ; believes that cases of irritation of the uterus and
chronic metritis, are often mistaken for prolapsus.

Dr. Kennon rose to address the chair, but whilst making some
preliminary observations on the anatomical arrangements, at-
tachments, support, &c, of the uterus and vagina, was obliged to
leave in haste to visit a patient. Dr. K. being requested, since
the adjournment of the society, to answer the question, replied*
that although he believed pessaries may do good in some cases*
their employment requires so much judgment and caution, that
he was not prepared to give a decisive answer ; he is in doubt
whether more good or injury would result were they entirely
banished from practice.

Dr. J. A. Eve, considered it incumbent on him to state his
views relative to the use of pessaries, as he had been alluded to
by the essayist, although he had already done so on a recent oc-
casion. He considered, that gentlemen who had never applied
a pessary, whether they had been deterred by prejudice, indo-
lence, or a want of resolution, to encounter a task so extremely
disagreeable to the operator and every way painful to the patient,
were not qualified to pronounce upon its merits that he was
not surprised that such gentlemen should be disposed to denounce
pessaries that although they might reason on the subject and
give an opinion, they certainly could not be prepared to decide
the question of their utility. He did not regard the fret, that
several physicians said they had removed pessaries, as affording
any argument at all against their use. They might perhaps have
been applied by an ignorant woman they might have remained
as long as was intended- or what -was very probable, their re-

1&&7.J Medical Society of Au guild. 097

moval might have been improper. Although a zealous advocate
for the pessary, and able to say most confidently that he had
derived the most unequivocal benefit from its application in his
own practice, insomuch that he regarded its value beyond cavil
or controversy, still lie did not consider it necessary in every
case, not perhaps in more than one in ten he scarcely employed
it as often himself, although he might perhaps have done so often-
er to great advantage-; for he was very much inclined himself to
shrink from applying pessaries whenever he could that their
employment with him was always a matter of necessity and not
of choice that he never used a pessary when it could be dis-
pensed with, and he was happy that most cases which came un-
der his observation could be managed without it that in cases
of prolapsus uteri, he relied principally on replacement, recum-
bence and the use of astringent or roborant injections, frequently
administered, and only called in the assistance of the pessary
when these means proved inadequate, or the patient could not or
would not endure the prostrate position long enough that if the
prolapsus were accompanied with irritation or inflammation of
the uterus, he restored that organ to its proper position, confined
the patient to bed with her hips elevated by a pillar, applied a
blister to the sacrum (the effects of which have been most con-
spicuously beneficial in his practice) and employed demulcent
and sedative injections flaxseed tea and morphine or opium
and as the excitement became reduced resorted to astringent
injections, commencing with the mildest first, (saccharum satur-
ni,) and applying the more energetic gradually when the state
of the uterus admitted of their administration that generally
these means succeeded very satisfactorily without the aid of the
pessary ; but sometimes patients will not submit to the requisite
confinement sometimes their health cannot sustain it without
material injury in such cases he considered the pessary an in-
valuable mean, maintaining the womb in its natural position and
allowing the vagina and uterine ligaments to recover their tone,
while the patient could take exercise without any inconvenience,
generally without the slightest sensation referrible to the presence
of the pessary in the vagina he had reference to the woollen
pessary recommended by Dr. Antony, which is, in his opinion,
preferable to every other that after allowing the pessary to re-
main from five to eight days, he removed it and prescribed as-
tringent injections again for several days, and reapplied the pes-
sary again, and as often as necessary after the same procedure.
Such, he stated, was his usual plan of treatment, always paying
due regard to the re-establishment of the patient's general health.
Other means, he observed, are occasionally indicated : venesec-
tion, cups, leeches, purgatives, tonics, &c. It was requested that
every member present should give his opinion relative to the ques-
tion before the society,

608 Dr. Linddfs Case of Retained Placenta. [April,

Dr. Douglas said he had no practical knowledge on which to
base a decision, but from reading and reasoning on the subject, he
was decidedly of opinion that -pessaries are usefu] instruments,
and that they should be retained in practice until superseded by
the discovery of some better remedy. ;

Dr. Cloud replied that his experience was limited, not having'
practised more than two years, that he had however treated two
cases of prolapsus successfully by pessaries that he wished in-
deed that a less disagreeable mean could be invented, but at pre-
sent he was not prepared to abandon the use of the pessary.

Drs. Cunningham and Ford being absent from this meetingv
were interrogated since the adjournment of the society. Dr. C,
answered the question in the affirmative. Dr. Ford replied, that
although he had never met with a case in which he considered a
pessary necessary, he was unwilling to vote for the banishment
from practice of this or any other resource that others had found
useful.

The conclusion then, from a review of all the opinions ad-
vanced, is, that no one contends for the general or exclusive use
of pessaries in the treatment of prolapsus uteri, and that with the
exception of Dr. Cunningham and Dr. P. F. Eve, no member of
the society is prepared to renounce them.

We have not heard the opinions of the members of the society
residing in the co.untry.

Dr. Lindslfs Case of Retained Placenta.

We republish from the last number of the American Journal
of the Medical Sciences, the following case of finally retained
placenta : not with the motive of abating the anxieties of the
practitioner for the timely delivery of the placenta, but merely
as truths of record, on good authority, which may serve not only
to console the practitioner, when the most ardent anxieties, com-
bined with the best science, have failed to effect deliverance ;
but also as a source of consolation and of hope, such as it may
afford to her, to whom hope is so important under such circum-
stances. As in a former number of this Journal, we feel bound
to declare again, not our disapprobation of the publication of such
a case when it occurs, but our fears of the license such facts may,
without due caution, afford to practitioners, whereby they may
feel authorized to approach too nearly the fatal extreme of omit-
ting the necessary, safe, and every way proper efforts for obtain-
ing the placenta. So prone is human nature to carry, even
right, to an extreme which converts it to wrong, that we have
thought it not proper to repeat such facts without a word of sal-
utary caution relative to practice, as likely to be founded on such
facts". And in the first place, whilst we are far from denying
the possibility, and indeed the actual occurrence of cases which

1S37.1 Dr. Lindsly* Case of Retained Placenta. 609

put at defiance all the resources of science for deliverance, and
which must be finally abandoned to nature; and while the pla-
centa has been thrown offat'as late a period as 12 or 15 days, or
never at all, in the form of placental substance ; we would urge
the sentiment, that such cases are really so rare, that no prac-
titioner need ever expect to meet with such a misfortune. In
evidence of the truth of this, we may, in connexion with many
others whose experience is to the same point, state that in nearly
thirty years of constantly increasing attention to this branch of
practice, we have never left a patient, excepting for a short time
for our own convenience, and never more than two or three
hours, without deliverance. During, this time, however, we
have found difficulties,, but never insuperable, although often
called exclusively on account of the retention of the placenta, at
the period of many hours after confinement.

It should be remarked, in giving the successful issue of such a
case, however, that almost all such are doubtless made public ;
but the business of publication of cases of unfavorable termina-
tion, being more unpleasant is seldom attended to.

We have occasionally witnessed deaths from the long reten-
tion of placenta, and in the early years of our practice, when the
employment of physicians was more rare in villages and in the
ountry, so frequent were these misfortunes, that we felt com-
pelled to offer to such a community, our services gratuitously
in such cases, fur 12 months, in order to effect a correction of the
evil.

We will suppose our readers to be acquainted with what is
called "deliverance," or at least, all those means which the best
practitioners bring into use before abandoning the case finally to
nature. Now in regard to the line of demarkation between sci-
ence and nature in this particular point of practice, we should
not be disposed, as some of the old writers, to make it so wide
as to reach from almost entire inaction on one hand, to the lace-
ration of the substance of the uterus on the other ; and thus make
the latter the immediate alternate from the former ; but to place
it precisely at the extremity to which those means may be car-
ried, stopping short of lacerating the substance of the uterus , and
exhausting too far the recuperative energies of the syslm by fa-
tigue, fyc. And again we would say, that as there is an infinite
difference in the judgment, tact, and common sense of physician?,
as wrell as other men, and such are the dangers attendant on the
final abandonment of deliverance to nature, that no one or tivo
physicians alone should feel justified in thus consigning a patient
to danger, when there are others of experience and good sense
timely accessible. So desirable indeed is deliverance at an early
period of confinement, that all hope in assistance within reach
should be exhausted before it is relinquished.

We would not have this last remark considered as reflecting

700 Dr. Lindshjs (Jass of Retained Placenta. [April,

blame on those concerned in the following case ; for we have
long since been familiar with the character of Dr. Sewall, and
consider that Dr. Lindsly could not have made a more ample
resort for science and good sense ; and that the judgment and
humanity of Dr. Sevval! would not have allowed him, in the con-
sultation, to have consented to the final abandonment of the case
to nature, on Jess than the absolute knowledge of the impossibil-
ity of deliverance by assistance.

"In looking over the medical periodicals of the last few years, I find, what
had never been noticed by obstetricians of former times, (so far at least as I
am acquainted with their wirings,) several examples of placenta which
have never been delivered, and where the patients have recovered their
health perfectly -menstruating and bearing children afterwards as usual.
As these cases are very rare, not more than one or two, I believe, being on
record as having occurred in this country, 1 have thought that a brief account
of one which took place in my practice about a year since, would not be un-
interesting to the readers of the American Journal.

On the 17th of November, 1835, 1 was called to see Mrs. K. aged sixteen
years and a half. I was merely wanted to bleed her, she being under the
care of a midwife. She had then been in labour about twelve hours ; the
head had descended low in the pelvis, and there remained until the next even-
ing, (November 18th,) when the head was born without artificial aid. About
twenty-four hours after this period (viz. Nov. 19th,) I was called to see her
because the midwife had been unable to bring away the placenta. She had
had little or no pain since the birth of the child ; her pulse was but slightly ex-
cited, and she was tolerably comfortable. I pulled gently at the cord, ac-
cording to my usual practice, and at the same time directed frictions over the
abdomen. In. a few minutes, to my surprise and regret, the cord broke sud-
denly, without there having been any intimation that such an accident was
about to occur by a gradual yielding of its insertion, and although I had not
exerted nearly as much force as I generally do, as I was apprehensive it
would give way in consequence of its having been used by the midwife in her
efforts to extract the placenta.

As she had had nothing like labour pains since the birth of the child, and
the os-uteri was somewhat relaxed, I determined to give the ergot a trial.
This was accordingly administered in full doses : in a short time free emesis
was produced, tut without any contractile effort of the uterus. Whether
this deficiency was owing to the inertness of the ergot made use of, or not,
I could not ascertain, as it was thought advisable to make a second trial of
the aiticle.

Having been disappointed in this attempt, I resolved, without further de-
1 ly, to introduce my hand into the vagina for the purpose of bringing down
the afler-birth. This?, however, was no easy matter; the os-uteri was now
csntracted with a considerable degree of firmness, and after this difficulty
was overcome, and the hand fairly within the uterus, as the rupture of the
cord had deprived me of the usual guide to the placenta, it was extremely
difficult to distinguish it from the uterus itself. After some dela)% a portion
was fully recognised, but its connexion with the uterus was so intimate, that
the slightest attempt to separate them gave the patient exquisite pain, and
in a few moments she positively insisted upon the effort being relinquished.

I now directed a gentle laxative, to be followed in two or three hours by
an injection. As the patient lived at a considerable distance from my resi-
dence I did not see her again until the next morning, when I again attempted
to introduce my hand into the vagina. This operation was, however, now
more painful than it had been the evening previous, for a good deal of irrita-

1837.] North London Hospital. 701

tion, pain and inflammation had come on, and after a few attempts the patient
absolutely refused to permit me to proceed.

Professor Sewall was now called in consultation. He also attempted to
introduce his hand, but on account of the severity of the pain and the oppo-
sition of the patient, with no better success than myself. Her pulse was ra-
pid and rather small, and weak ; she complained of great pain and irritation
in the whole of the uterine region, and considerable swelling of the abdomen
had taken place. Upon consultation, leeches were directed, but these being
objected to, the pain and inflammation were assuaged by warm fomentations
with hops, assisted by purgatives and diaphoretics. It is unnecessary to
detail the minutise of the subsequent treatment, as it was conducted entirely
on general principles. The patient continued in a very .critical state for se-
veral days, when her unfavourable symptoms gradually abated, and in the
course of three or four weeks she was able to leave her room. During the
whole of this period, no part of the placenta came away, at least, so I was
assured by the patient, and her nurse, a very intelligent and respectable wo-
man, and I have no reason to doubt the correctness of their statement.

March 10th. Saw the patient again; she declared that no part of the
after-birth had yet come from her. Her health is now good : but I neglect-
ed to inquire whether she had menstruated since her confinement, which I
particularly regret, as she has since left the city and I have not been able to
hear from her."

NORTH LONDON HOSPITAL.

Albuminous Sarcoma of the Superior Maxilla. W. B. aged 24, was ad-
mitted, Nov. 17, under the care of Mr. Liston. His occupation is that of a
shoemaker. States that he was always healthy previous to the present af-
fection. His family are healthy. Two years since he received a smart blow
on the left side of the face, from a cricket ball, which was followed by much
swelling, pain, and ecchymosis, all of which, however, soon disappeared.
Ten months since, the last molar tooth loosened spontaneously, and was ex-
tracted, after which the gum became much swollen and tender ; the swelling
increased rapidly, and extended to the side of the face, and in a few weeks
it attained to half of its present size. Subsequently the three teeth adjoining
became loose and were extracted. After the extraction of the second molar
tooth, not many week ago, there was some haemorrhage, but it was soon ar-
rested by pressure. The growth of the tumour was rapid at first, but of late
it has been less so. During its development there has not been much pain.

At present, a tumour of about the size of a very large orange, occupies the
left side of the face, involving the superior maxilla. The integuments of that
side are much stretched over the projecting tumour, and were of a .ed co-
lour. The nose was pushed to the right side, and the lower eye-lid was
prevented from descending properly. Within the mouth the tumour extend-
ed backwards, in a line with the hard palate, and near to the mesial line,
projecting downwards, much below the gum of the opposite side. The left
nostril was completelely filled, and the tumour at this part was particularly
firm. The other parts of the tumour were moderately firm, and at some
points elastic. All the places from which the teeth had been extracted are
heale'\ except that from which the second molar was taken, which remains
open, but is not ulcerated, nor does any fungus protrude from it. A probe
can be passed a short way into the socket, but not into the tumour. The
first molar tooth remains, but is loose; there is no tenderness, or pain, in the
part at present.

Operation. Nov. 18. Previous to the patient being brought into the the-
atre, Mr. Liston said : "The present operation is not one which I undertake
from choice, but on account of the urgent solicitations of the patient. I do
not think that the tumour is of the same benign character as the one which

702 North London Bospitdt. [April,-

you lately saw removed ; and although by no means so formidable a looking
tumour, in fact, not being a sixth part of the size, yet I anticipate much great-
er difficulties in accomplishing its extirpation, both as regards its attachments
and its vascular action; consequently, I cannc t speak favorably of -the ulti-
mate result. There are, however, some points about this tumour which are
not unpropitious such as its having followed a mechanical injury the ab-
sence of ulcerations or fungous protrusions in the situations from which the
teeth have been extracted the great firmness of the part within the nostrils,
from which there hns been no discharge and our inability to pass a probe
into the tumour. The removal of the growth thus early, before malignant
action is developed, or the surrounding parts- become contaminated, gives the
patient the only change of its non-appearance."

The patient, on being brought into the theatre, was seated in a chair, and
his head was supported on the breast of an assistant. The operation was
commenced by the abstraction of the first and second incisor teeth of the left
-side. The first incision was commenced over the malar prominence, the
operator cutting down to the bone, and through the integuments into the
mouth, continuing the incision, in a curved line, to the left commissure of the
mouth, the convexity of the curve being backwards The second incision
extended along the side and alEe of the nose, to the median line of the lip.
The flaps so formed were dissected up from the tumour, which was exposed,
together with part of the malar bone. The malar bone was now cut through,
near to the superior maxilla, with Iley's saw, and the ascending nasal pro-
cess of the superior maxillary bone was divided with the cutting fcrcepe.
With the same instrument, a notch was cut out from the border of the su-
perior-maxillary bone, at the point from which the teeth were extracted ; and
.the hard palate was divided along, near the mesial line, with a strong pair of
scissars, to the. palate bone ; with the left hand, the tumour was depressed,
and the remaining adhesions in the orbit were divided with the knife. The
mass was then removed with great facility. The cavity having been sponged
.out, some of the morbid growth was found adhering to the ascending plate
and cell of the palate bone, and slightly to the pterygoid process of tl e sphe-
noid bone. This was removed by cross-cutting forceps. The cavity was
again sponged out, and, upon a careful examination, no more of the morbid
growth was found remaining, or any vessel discovered bleeding. It was then
rilled with dry lint, and the flap brought down, and fixed by means of two
twisted and interrupted sutures.

The patient was now conveyed to bed, a good deal exhausted. Half a
grain of muriate of morphia, with some wine, were given to him. Bottles
of hot water were applied to the feet and epigastrium, and water dressing was
used over the face. No vessel required ligature, nor was the loss of blood
great. The first part of the tumour was removed in eight minutes, and the
operation completed in fourteen minutes. Soon after his removal to bed, he
became convulsed, continuing so for a few minutes. The pulse was very
quick and feeble, the extremities were cold, and the expression of the eye
was very wild. After the convulsions ceased, he continued restless.

3, p. m. Has not rallied ; pulse 120, weak ; extremities cold ; slight bleed-
ing from the mouth, which ceased on the application of cold water to the
wound. Muriate of morphia, half a g rain, directly ; carbonate of ammonia
and wine at short intervals.

4, p. m. He has siept for a short time, during which he appeared to be
restlesse ; pulse rather fuller. He awoke up slightly convulsed, DUt the efTect
soon passed away. Respiration slow and regular.

10, P. m. Awoke, and asked for something to drink. Somo cold brandy
and water was given, this having been substituted for wine. He then fell
asleep, and continued in that state until a quarter past 11, p. m., when ho
awoke, violently convulsed. This state subsided, but he continued exceed-
ingly rostlrfv ; the putee erased to be felt at the wrist; the extremities be-

183?.] Plates of the Cerebrospinal Nerves, ($<c. 70S

came colder ; a cold sweat broke out on his forehead, and he expired, slowly
and convulsively, ceasing to breathe at about half-past 11, p. m.

The tumour was an albuminous sarcomo, consisting of cartilage, with spi-
cule of bono, and a glairy matter, coagulable by heat. On examining the
cavity, a clot of blood was found in it, upon the lint. The whole of the pal-
ate bone, and the root of the pterygoid process, were removed, leaving the
internal and external pterygoid prqeess with the soft palate. The sphenoi-
dal cells were entire, the" opening into which was easily seen, with a well-
defined margin, covered with its proper lining membrane. A small portion
of the ethmoid was renvved. The cells of this bone, together with those of
the sphenoid cell?) were quite free from disease. No further post-mortem was
allowed.

Since the death of the patient, it has been ascertained that he had led a
most dissolute life, which, before the operation, he most strongly and repea-
tedly denied.

Although the result of the operation performed in the above case, was un-
fortunate with regard to the suffering patient, it furnishes a useful lesson of
admonition to students and young practitioners, i ften does it happen that
a surgeon who has just emerged from the portals of the college, seeks for op-
portunities to display his skill in operating, that he may, thus establish his
reputation as an operating surgeon. Is it not evident from the report of the
case before us, that the first attempt of the juvenile aspirant might be made
on apatient whose constitution, weakened and broken down by dissipation,
could not recover from the shock thus inflicted upon his feeble powers ] Ever
should it be recollected, then, by young practitioners, that success after op-
erations cannot be ensured. Advantageous as must be the result of this case
to the student, and to the youthful members of the profession generally, it
must prove of still greater value to Mr. Liston himself. The reputation of
that gentlemen as an operator stands unrivalled, and the dexterity which he
possesses is a subject of astonishment with surgeons who have visited the
continental hospitals. The public, therefore, en discovering that an opera-
tion may occasionally be followed by fatal consequences, even when it is per-
formed by the most distinguished of our surgeons, will shrink in dismay from
the thought of entrusting their lives, in diseases requiring operations, to half
instructed bunglers, who^under the pernicious influence of the system of ne-
potism, obtain the office of surgeon in our old endowed hospitals. The issue
of the case of the patient, E. B , proves, beyond qurstion or dispute, that cap-
ital operations in surgery cannot be undertaken, with safety to the reputation
of the practitioner, unless by such a man as Mr. Liston a surgeon of un-
doubted skill and established fame. The Lancet.

Plates of the Cerebro-Smnal Nerve?, wilk References for the use of Medical
S/.udenis: By Paul B. <<oddard, M. D., Prosector of Anatomy in the U-
niversitv of Pennsylvania ; Member of the Academy of Natural Sciences,
of the Philadelphia Medical Society, &c. Philadelphia, J. G. Auner, 331
Market-street. 1837.

This contribution to anatomical study by Dr. Goddard, is both valuable
and seasonable. It supplies to the student a reference on minute parts of
Btructure which it behoves him to become Well acquainted with in the begin-
ning of his career, and to well remember in his subsequent course. The au-
thor very truly says "The nerves have always been a stumbling block to
the student, in consequence of the difficulty of "dissecting and studying them
in their various relations."

The plates are twelve in number, which contain in all twenty-nine figures ;
beginning with a view of the base of the brain and the twelve pairs of nerves
implanted in it, and ending with the nerves of the lower extremities. The
divisions and distributions of the fifth nerve are clearly exhibited in platen

704 Chloride of Soda in Amenorrhoea, fyc. fyc. [April,

fourth and fifth. Its functions, and the morbid phenomena of which it. is so
often the seat in various affections of the eye and teeth, and in neuralgia of
the face and temples, render a knowledge of its anatomical relations not only
agreeable but absolutely necessary to guide us in the employment of suitable
therapeutical agents.

The connexion of the optic nerves with the tubercula quadrigemina, their
approximation and partial junction, or Chiasm, and their passage through the
sclerotic coat, are well seen in plate third.

Plate fifth, exhibiting the ramifications of the portio dura over" the side of
the face and head, reminds us, forthwith, of Sir Charles Bell and his view of
the functions of this nerve ; those of motion and expression of the muscles
of the face, and of respiration, as far as the movements of the nostrils and
lips are concerned in this process. Figure second, in the same plate, shows
the termination and expansion, in the cochlea and semicircular canals, of the
portio mollis.

Again are Bell's representations and arrangement of the respiratory nerves
turned to account in plate sixth, which is, mainly, an exhibition of the par
vagum or pneumogastric nerve. The glossopharyngeal and the ninth or
hypoglossal are seen in plate seventh ; in the second figure of which, the
nervous distribution to the tongue is beautifully displayed.

The thirty-one pairs of spinal nerves and the structure of the medulla spi-
nalis are shown in plate eighth. The ninth and tenth plates, each having
two figures, exhibit the nerves of the upper extremities ; as the eleventh and
twelfth, each having three figuras, do those of the lower extremities.

In addition to the letter-press references and explanations, there is a copi-
ous index. These plates by Dr. Goddard, and Manec's representation of the
sympathetic published with some corrections and a translation of the text in
a single sheet by Dr. Pancoast, place it in the power of every student of
common industry to become thoroughly acquainted with the course, divisions,
and distributions of the nerves both of relation and of nutrition. Without a
knowledge of this nature no man can pretend to act as a surgeon, or to speak
and reason as a physiologist or a physiological physician. Select Medical
Library and Eclectic Journal of Medicine.

Chloride of Soda in Amenorrhcea. M. Chailly states that the liquid chlo-
ruret of the oxide of sodium, given in the dose of from 30 to 60 drops in a
pint of wine and water, in the twenty-four hours, promptly brings on the
menstrual discharge when suppressed, and renders it abundant when defi-
cient. Revue MHicale. American Journal.

Inula Helenium in Leucorrhcca. M. De Lens extols the efficacy of the
Inula Helenium (elecampane) in the treatment of chronic leucorrhcea, and
in lymphatic affections. He employs the root in decoction, in the dose of
from 2 to 4 drachms for four cups of water reduced to three, which the pa-
tient takes during the day, in three doses. He thinks that an infusion of the
root may be as efficacious as this preparation, and it seems the most rational
one from the aromatic nature of the article. Ibid.

Sore Nipples. Dr. Allard has successfully employed for the cure of this
troublesome complaint, a solution of the nitrate of silver, (two grains of the
salt to one ounce of distilled water). The nipples were washed with this
every time after taking the child from the breast. Jour, de Med. <$rc Am.
Journal.

SOUTHERN MEDICAL.

AND

SURGICAL JOURNAL

Vol. L] MAY, 1837. |No. 12.

Part I. ORIGINAL COMMUNICATIONS,

ARTICLE 1.

Professional Qualifications and Character: By Joseph A. Eve,
M. D., Professor of Therapeutics and Materia Medica, in the
Medical College of Georgia.

The profession of medicine, above all others, requires a com-
prehensive mind, the most acute and quick perception, the most
calm and correct judgment, and an active and retentive memory,
richly stored with knowledge.

In no profession or occupation in life, is a combination of all
these qualities so essentially requisite as in medicine, and in none
are such various literary and scientific acquirements necessary.

The clergyman has his bible, his creeds and forms of faith, for
guidance and direction ; and for decision in difficult questions and
on disputed points he has a reference to the synod, the conven-
tion, the conference, or the council. The lawyer has written
laws, decrees, and statutes, to which his knowledge must refer,
and by which his arguments must be determined; and even in
cases wherein the law admits of different constructions, each
reasoner has an equal right to his opinion, and although the court
may decide against him, as human judges are fallible and often
reverse each others decisions, he may lose his case, but not yield
his judgment. In these professions, a good memory with great

89

70G Professional Qualifications and Character. [May,

application and a happy delivery, will often succeed well, with-
out superior powers of perception and judgment.

But not so in medicine ; the physician has no statutes, no fixed
criteria; no tribunals for appeal and decision every thing de-
pends upon himself hence perception and judgment of the highest
order are indispensable, as in his decisions are involved the health
and life of his patient in his ratiocinations and inductions, doubt
and error arc fraught with danger and death.

The most varied and extensive learning is required in a phy-
sician. It will not suffice that he be well versed in those sciences
strictly medical, those at present taught in our colleges.

In the first place, a thorough knowledge of the English lan-
guage is indispensable, as preparatory to medical education.
It might be deemed superfluous to advert to this, as too elemen-
tary, were it not that the most conspicuous and deplorable defi-
ciency in this respect is too often observable, not only in students
but physicians. Next to the vernacular tongue, the Latin and
Greek languages are most important as preliminary to the study
of medicine ; as nearly all our technical terms and the language
of all the sciences, are derived from them : a knowledge of these
languages is of incalculable value to the student, and can not be
dispensed with but at the expense of one or two additional years
of hard study.

So high at present do the French stand in medicine, so many
important discoveries and valuable improvements are they daily
making, so many excellent books are they constantly publishing,
that a knowledge of their language is indispensable to all who
aspire at eminence in their profession.

The Germans too are so industriously engaged in the cultiva-
tion and improvement of medicine, that their literary and scienti-
fic treasures should be immediately accessible to us through the
medium of their own copious and expressive language, not the
remote intervention of uncertain translations.

Italy too at present numbers so many eminent writers, and
her medical journals contain so much interesting and valuable
information, that a physician should not be satisfied without a
knowledge of the Italian language, especially as it is of such easy
acquisition to those whose classical acquirements have rendered
them properly qualified to commence the study of medicine.

The science of metaphysics is generally too much neglected

1837.] Professional Qualifications and Character. 707

by our profession: It should cither be made a part of the pre-
paratory education of a medical student, or be comprised in the
collegiate course. This subject is replete with considerations of
the highest moment and most absorbing interest, as it treats of
the most noble and exalted faculties of man, faculties that place
him at the head of creation, that elevate him above all other ani-
mals enable him to subject them to his dominion endue him
with his highest attributes, and qualify him to hold converse with
God himself. Some persons, from want of industry to investi-
gate, or genius to comprehend, aflfect to despise metaphysic lore,
and condemn it as an incomprehensible and unprofitable study ;
but abstract from the abstruse, absurd and futile speculations of
some authors, this science is one of the most useful and exalted
in the whole circle. It not only sharpens and invigorates the
mental faculties by the exercise it affords them, but it enlarges
our knowledge of human nature, which knowledge is of highest
importance to man.

This science treats not only of those faculties which are refer-
red to the head, but of those in common language styled faculties
of the heart, the sentiments, affections and passions it teaches
what man is. Such knowledge cannot fail to augment our use-
fulness and our happiness, by rendering us better acquainted with
ourselves and others, instructing us how most advantageously to
do them good, and to defend ourselves against their machinations
and aggressions. He that is ignorant of human nature, how-
ever accomplished in other respects, is the unsuspecting dupe of
unprincipled and designing men : And often, owing to the same
ignorance, we observe the most benevolent persons offend in
their endeavors to be kind, and wound the feelings of those they
seek to relieve. To no one is a knowledge of human nature
more necessary than to a physician, whose avocations bring him
constantly in association or collision with people of all kinds and
under every variety of circumstance and trial.

But in the practice of medicine, a knowledge of mind is still
more important, on account of the intimate union of mind and
body, which causes each to be mutually and reciprocally affected
by the affections and operations of the other. I have made no
separate allusion to phrenology, which I consider included under
Ihe general head of metaphysics.

The importance of the study of mathematics to physicians,

708 Professional Qualifications and Character. [May.

must be admitted by all. Some knowledge of the mathematical
sciences is indispensable in the study of anatomy and physiolo-
gy, as the latter cannot otherwise be properly understood ; but
they exercise a no less happy influence on the medical practi-
tioner, by disciplining his judgment and accustoming his mind to
habits of greater closeness, perspicuity and precision in reason-
ing. Nevertheless, an overweening fondness for mathematics,
is liable to lead to a dangerous error, that of being satisfied with
nothing short of demonstration or mathematical certainty in all
our conclusions ; whereas all subjects are not susceptible of this
kind of proof, though they may be equally true, and established
by sufficient rational evidence.

Natural philosophy constituting the basis of the natural sci-
ences, is of course essential to the education of a physician, as the
medical sciences cannot be comprehended without a knowledge
of its principles. In osteology and myology, constant reference
is made to mechanic powers the humours involve the science
of hydraulics hearing that of acoustics sight of optics, &c.

Natural history in all its branches is subservient to medicine,
and must be embraced in the pursuits of the scientific physician.
The almost boundless extent of country we inhabit, is rich in pro-
ductions of every kind, animal, vegetable and mineral ; many
valuable articles have already been discovered, and doubtless
many more still remain to reward future industry.

These departments of literature and science have a more im-
portant and direct bearing on medicine. There are other branch-
es of learning, which though appertaining rather to the orna-
mental part of education, and no,t to be cultivated to the neglect
of the more useful, may well employ a physician's leisure hours.
Such are history, biography, belles lettres, and the fine arts, es-
pecially painting, which is not only an elegant accomplishment,
but a valuable art that has often been usefully employed in med-
icine to exhibit morbid appearances, of which words could not
afford a satisfactory description.

It is not to be expected that a physician will become proficient,
in every branch of science and literature we have enumerated:
It would require more time than those can devote to study who
are actively engaged in the practice of their profession but he
should endeavor at least to acquaint himself with their general
principles, and pay more minute attention to those to which his

1837.] Professional Qualifications and Character. 709

taste and genius may incline him, or to the prosecution of which
his situation and circumstances may be most congenial.

But though superior intellectual endowments and high literary
and scientific attainments arc necessary, there are yet other in-
dispensable requisites to qualify a man to exercise the liberal and
exalted profession of medicine. The most sublime genius and
extensive acquirements will not suffice alone. Humanity and
benevolence are essential to medical character, devoid of which
no man is qualified to practise this godlike vocation. A physi-
cian should be gentle, kind, charitable, patient, without pride and
austerity. Occasions are continually occurring that call for com-
passion or require forbearance. He should consider the poor
with peculiar care and tenderness kindness is due to them
they require it to soften the asperities of their lot, and he that is
not merciful to them " shall seek for mercy and not find it in his
turn." A physician has to bear much from the faults and frail-
ties of mankind, but for his own and their good he must exercise
charity and patience toward them. A sick man anxiously antici-
pates the visits of a humane physician as of a ministering an ^el,
whilst he dreads the approach of the unfeeling as of an execu-
tioner.

Presence of mind and decision, which arc by no means incom-
patible with gentleness of manners and kindness of disposition,
are qualities essentially requisite in the character of a physician :
Nor are the strictest temperance and the most unsullied and un-
impeachable integrity less essential. It is folly in the extreme to
suppose that a person whose mind is stultified and debased by
intemperance, can be competent to the duties of a profession that
requires the nicest discernment, the most lucid reason and the
most correct and vigorous judgment.

Without integrity, by which is understood soundness of prin-
ciple, moral correctness, truth, candor, honor and every virtue,
a physician cannot maintain the dignify of the profession or ren-
der himself extensively useful.

A disingenious physician can never be a safe practitioner he
will either deceive his patients concerning the nature of their dis-
ease or the remedies he prescribes, or make false statements to
other physicians with whom he may consult.

A physician sees people under the most unfavorable circum-
stance, and has frequent opportunities of observing thnr defects

710 Professional Qualifications and Character. [May,

and foibles thus many things come to his knowledge, the expo-
sure of which might affect the reputation of an individual or the
happiness of a family hence the necessity of the nicest sense of
honor and propriety.

Arguments might be multiplied were they necessary, to prove
the indispensable importance of every species of moral excellence
to capacitate a man for the weighty and responsible offices of
physician. He should then most seduously cultivate and prac-
tice those benign and heavenly virtues that ennoble and adorn
human nature, and without which he can never be loved and res-
pected as a man or highly esteemed in his profession. As means
of nurturing and cherishing them, he should attend divine wor-
ship, and read the holy scriptures and other pious books, espe-
cially on the sabbath. So far from disposing to scepticism,
which has been falsely charged against our profession, its natu-
ral tendency is to incline the mind to religious contemplation,
and to awaken sentiments of reverence, love and gratitude to-
ward God, by the evidences of infinite wisdom and goodness dis-
played in the anatomy and physiology of the human frame, and
for the innumerable means provided in nature for the relief of suf-
fering and the restoration of health. It has been said, "an un-
devout astronomer is mad," the same may, we think, with more
force and propriety, be said of an undevout anatomist or physi-
cian.

Medicine has been elevated far above its former position, by
the labors of the present and the preceding age, and is rapidly
hastening toward perfection. Higher honors and richer re-
wards await the profession; but more will be expected of phy-
sicians henceforth than heretofore. Moderate attainments will
no longer suffice ; greater labors and sacrifices will be required ;
more time devoted, to science, more application to study, more
diligence in research, more untiring industry and perseverance
in the museum, the anatomical room, the laboratory and the in-
firmary.

Let him not hope to grasp the prize before he pays the cost
placed upon a lofty eminence of steep ascent, it must be by toil
and care attained. He must renounce inglorious indolence and
ease, turning away from the blandishments of pleasure, the de-
lightful converse of friends, the enchanting fascinations of the
social circle, to trim this lonely (midnight) lamp, to inhale the

1837.] On Menstrual Irregularities. 711

noxious air of the charnel room, or to toil and watch in the a-
bodes of disease and wretchedness. With such sacrifices, such
devotion, such industry and enterprise, the field is wide and fruit-
ful, the harvest rich and inviting without them, he must sink to
a degrading level with the empiric, or at best never rise above a
humiliating mediocrity, a mark far below the lofty aspirations of
a virtuous, enlightened and noble mind.

O that we could draw a perfect picture of professional excel-
lence, and inspire the minds of young physicians and students
with adequate conceptions of the dignity and importance of the
profession of medicine, and the necessity it imposes of the high-
est attainments and the most exalted intellectual and moral en-
dowments ! A physician should be " the highest style of man"
in all respects "the true sublime" in manners, mind, character
and qualifications. He exercises a vocation in which, as an illus-
trious Roman has said, "man approaches nearest to the Gods,"
and in which it may be truly said, he may follow most closely
the footsteps of his Divine Exemplar, "who went about doing
good !"

On Menstrual Irregularities : By M. Antony, M. D., Augus-
ta, Georgia.

In treating on this subject, which I do on the present occasion
at the special request of a distant reader of the Southern Medical
and Surgical Journal, 1 shall explain previously, so much of the
anatomy concerned, as seems necessary to a correct view of the
functions of the uterus. This done, I shall attempt such a view
of the physiology of the uterus as may be in point, in order that
clear views of the disease in question may be received. This is
considered the more important, because of the truth constantly
observed, that there are few, if any sources of more errors in pa-
thology, than the want of familiarity with the anatomy and phy-

712 On Menstrual ff regularities. [May,

siology in connexion. And another fact of observation, perhaps
of no less importance to philosophy and humanity, is that, when
men are once possessed of error, which is often the case from
partial knowledge of the fundamental truths from which alone
they could reason for their correction, it is frequently found im-
possible to correct those errors to unteach what they so confi-
dently think they know. That magnanimity is rare, which ena-
bles them to acknowledge and to retrench errors of youth, how-
ever clearly and indisputably the truth of the contrary is placed
before them. Did the evil end merely with the fact that such
persons have an error in their minds, nothing would suffer but the
cause of abstract truth. But in the teacher, or the practitioner of
medicine, the evil is not thus limited. An error in the first princi-
ples, or any succeeding part of a reasoning process, must, as in a
mathematical calculation, be continued and magnified throughout
the sequel. This is not less the fact in medical than in other reason-
ing. It is true that the empiric may learn the symptoms which en-
able him to determine the name of a disease, and may learn to ad-
minister certain remedies for a disease thus detected ; and the rercv-
cdies may, perchance, be the cause of the restoration of health.
But he alone can prescribe rationally and safely, who understands
the fundamental truths of the anatomy and the healthy functions
of the parts concerned; and comparing them with the present de-
viations therefrom, can determine the degree and kind of aberra-
tion of what causes it is the effect the remaining salutary re-
sources of the system the physical powers and other means com-
petent to the removal of such causes and the correction of their
effects, &c. This kind of knowledge alone can enable him to
meet exigencies with that correctness and confidence which are
the fruits of accurate reasoning from sound premises, and when
death must come, to sustain its dread approach with a conscience
void of guilt ; for it is not an exemption from guilt, to think, or so
say, that one has done the best he could ; but he must be sure
that he has done the best the science of medicine could have
afforded the case. And if he have not learned what this
could teach relative to the case, and called not to his assistance
the best help which is accessible, he stands a guilty culprit before
the tribunal of his own conscience, if indeed such a practitioner,
sbch a ruthless vampire, have a conscience left suited to perform
its legitimate office.

1837.] On Menstrual Irregularities. 713

Of the Uterus. This is a fibrous, vascular and membranous
viscus, which is situated in the upper part of the female pelvis,
between the rectum and the bladder, with both of which it has
connexion ; and is pear-shaped and a little flattened antcro-pos-
teriorly. It is placed in the direction of the median line, but is
almost always a little inclined to the right, on account of the rec-
tum inclining to the left at the upper part of the pelvis, as it ap-
proaches the sigmoid flexure. This varies, however, according
to the fullness of the intestine about this part. " Quoique place
dans la direction de In ligne mediane du corps, Puterus est pres-
que constamment incline a droite; ce que Pon pourrait attribuer
a la disposition de Pintestin rectum, a la circon volution iliac du
colon, au degre de force et d'energie que Pon observe generale-
ment au cote droit du corps^ et auquel participe peut-etre le cor-
don sus-pubien de ce cote." &c* It is two and a half to three
inches long, the latter being the usual length after having borne
children. Its direction in relation to the pelvis, is precisely the
same as that of the axis of the superior strait; deviating a little
hy the pressure of the bladder and rectum in their different states
of fulness. In the replete state, of either the bladder, or the rec-
tum alone, its direction is obviously changed ; but in the ordina-
ry state of the parts, it forms the same angle with the vagina, that
the axis of the superior and inferior straits form at their intersec-
tion.

The length of the vagina is fixed by Madame Boivinat about
five inches. *' Sa longueur est d'environ crnq pouces." It is at-
tached at its internal extremity to the cervix, immediately above
the labiae uteri. The os uteri is held posteriorly towards the up-
per part of the sacrum by the short ligaments which extend from
the cervix uteri to the sacrum. f Mauriceau determines its length
in women of good height and well formed, eight inches from the
vulva to the fundus ; which is the same, allowing three inches
for the length of the substance of the womb. After speaking of
the differences caused by age, disposition of body, abundant men-
struation, habitual coition, <fec. &c, he says, " mais aux femmes
de bonne taille, et qui sont bien formees, sa longueur depuis Pen-

* Memorial de l'art des accouchemens. Page 62.

B si

f And We appeal to no one with more confidence in such a case, than Ma-
dame Boivin.

714 On Menstrual Irregularities. [M;\yr

tree de la partiehonteusc jusqucs a son fond, est ordinaircment
de huit pouces ou environ ct non de onze (coirfnie la pluspart des
Anatomistcs Ton! ecrit apres Galien,)" &c

Of the Attachments of the Uterus. The uterus is not attached
immediately to any part, of the bony structure of the body. Its:
attachments are mainly cellular and sincurotlc ; and very loose
on account of the necessity to its functions for it to yield to disten-
sion, change of place without immediate injury, &c.

Of the Vascularity of the Uterus, and the adjoining Genital
Organs. The genital organs, external and internal, have a great
number of vessels, sanguineous and lymphatic; of the principal
disposition of which it is important to have Knowledge,

The principal arteries are four in number, and derive their or-
igin from others of larger size. Some distribute themselves to
the ovaries, and to the body of the uterus ; others to the body and
neck, vagina and vulva. The spermatic, or ovarian arteries, are
two in number ; one on each side. They arise from the anterior
part of the aorta, a little below the renal brandies. They are
slender, long, considerably tortuous, zigzag, and in approaching the
ovaries they divide into many branches. Some of these penetrate
into the substance of the ovaries one turns to the fallopian
tubes, and goes to the fundus uteri. Two others reunite into one
short trunk, and enter into the superior portion of the uterine ar-
tery on- either side. Many of these branches run upon the round
ligaments, rendering them very vascular. Those which enter
the uterus laterally and at its fundus likewise, pass within the
duplicative of the peritoneum which forms on either sidethe lat-
eral or broad ligaments.

The uterine arteries, one on each side, are formed by a branch
from the trunk of the pelvic or hypogastric pass with many
sinuosities through the adjacent cellular substance and approach
the lower part of the uterus. When they arrive at the superior
side of the vagina, they divide into two principal branches, which
penetrate into the muscular structure of the vagina, ascend along
(he sides and are finally lost in the substance of the uterus. In
their course they form zigzags, which approach very near to
each other divide into smaller branches, penetrate into the sub-
Itance of the tissue of the uterus, constantly making turns and
tfexuosities, and terminate in very line ramifications, some of
which communicate with their fellows from the opposite side

137.] On M.-ustfual lrnxjulart ?I*

others with branches of the spermatic or ovarian others with
veins others, the most minute, form on the internal face of the
uterus, the :. are presented to view in

cavity.

It ir,->\ be i ^marked, that those ramifications which make an
infinite number of convol around themselves, run back-

ward, forward,, and in every direction, forming a great number
of areola? and anastoi with all other vessels about them,

and with themsel' ?e have just described, are, in the ordin-

'i- vacant state of the uterus, extremely delicate; as they
must be to be indosed in so small a space and dense a body as
ihe uterus ; but become, by the tern nancy, a line

or more in diameter.

It is believed by Madame Boivin, that the greater redness ob-
servable at the fundus than in the rest of the uterus, is owing to
the stronger and more direct impulsion of blood from the larger
and higher parts of the aorta, through the branches of the sper-
matic, by which that part is mostly supplied.

The veins of the uterus, like the arteries, form spermatic and
uterine trunks. The spermatic vein is much larger than the ar-
tery. It ramifies as in the male, and forms a very large plexus,
which constitutes on the forepart of the psoas muscle, what has
been called the corpus pampiniforme, Many of the veins which
form the body, originate near the ovaries, but a considerable num-
ber arise also from ihe tubes and the uterus. But the most im-
portant veins of the uterus, are the branches of the uterine veins.
These are extremely numerous, and form a plexus on the side of
the uterus, from which two or more uterine veins proceed in the
course of the artery, and join tho hypogastric. All the veins of
the uterus are greatly enlarged during pregnancy, some becom-
ing large enough to receive a common-sized quill, and others, the
end of the little finger. These latter have received the name of
uterine sinuses. Pax ton says., "the veins of the uterus follow the
arteries very much in their course, but are more tortuous, and
become so large in the progress of pregnancy, as to receive the
term uterine sinuses.'' The elder Baudelocque says, "the most
considerable of the openings which constitute the reticulated ap-
pearance of the lining membrane of the uterus, lead to winding
cavities called uterine sinuses."' Cruikshank said the lymphatics
.of the uterus become, by pregnane rge as a goose-qoill,

?I6 On Menstrua! Ir regularities. [May,

- > i . , . . . . i ., i ii i >

and appear so numerous, that the uterus seems to be nothing but
a mass of these vessels.

The vessels of the uterus are said to be enlarged in like man-
ner during the menstrual discharge, though not to such an ex-
tent.

Now the truth is, the uterus is a very peculiar organ not
less wonderful in its anatomy than in its physiology. Its fibrous
and vascular structure have constantly perplexed anatomists;
and to the present day, they are undecided as to the muscular or
non-muscular structure of its substance but they have latterly
determined distinctly its fibrous organization, from observations
during gravidity ; and conclude that as they could not be sup-
posed to be produced de novo, during each pregnancy, and non
exist again in the unim pregnated state, that they really exist
at all times in the uterus, but in so compact a state, as to be un-
distinguishable. The same extent of doubt or indecision has
existed about the lymphatics in the uterus. This question has
likewise been decided by observations on the gravid state, by
which Cruikshank, on finding them become as large as goose-quills,
and so numerous, said that the uterus seemed to be nothing but a
mass of these vessels. (Were it in place here we should have
occasion to use this fact of anatomy, to the explanation of some
interesting points in obscure pathology ; but it would be devia-
ting from the particular purpose of this essay, and could only be
proper in a treatise on the pathology of schirrous degenerations,
as they arc called, or chronic metritis; or on the secondary af-
fections from prolapse of the uterus.) The same difficulty might
have been before the anatomists relative to the vascular arrange-
ments, at least in regard to their extent. Nor could the neurol-
ogy be decided, to its true extent, until the observations were
extended to the pregnant stair. Here every thing becomes
magnified, as by a powerful lens the mystery of organization
made clear, and the nerves in the organ found extremely numer*
ous. " Les nerfs des organes genitaux sont extremement nom-
breux."* The same difficulty, we continue, still exists to some
extent relative to those winding canals called uterine sinuses ;
and their very existence denied by some, because forsooth they
are not always visible as such, in the vacant uterus.

*Boivio.

1837.] On Menstrual Irregularities. 717

The secret of this matter is just this: that all these parts are
most wisely and beautifully arranged by perfect wisdom, (acting
by the impulse of the final cause, the perpetuation of the species,)
to answer the demands of both the pregnant and vacant state of
the uterus. The vessels anastomose and inosculate and abound
with flexions and tortuosities, as in no other part, in order that their
purposes may not be lost to the necessities of the uterus in any
state that when necessary, they may all transmit blood copi-
ously through all their branches, as the uterus enlarges in preg-
nancy, and be extended by the growth of the foetus not only
without injury, but even, by straightening their course increase
the facility of circulation just in proportion to the ratio of increase
of the foetus, as it advances in growth. And the vacancy of vir-
ginity, or that which follows childbearing, a sufficiently abundant
passage for the blood exists by way of the anastomoses, under
that contraction of the contractile fibres of the uterus which
closes or obliterates for a time many of the branches whereby
circulation through the substance of the uterus is abundantly ef-
fected during pregnancy. The absorbents too, become conspic-
uous, according to the increasing demand for their function, and
recede again from view when this becomes unnecessary. But
it is a fact of observation, that the vessels of the substance of the
uterus become evidently enlarged on the approach of the men-
strual period no matter whether general or local plethora, or
lunar influence, or something yet unnamed, tend to cause the
menstrual returns. This is observable, not only in the appear-
ances of the part under the knife, as witnessed abundantly by
Mauriceau, Madame Boivin and many others, but also by the
touch. The experienced touch will readily detect, if there be
no disease of the substance of the uterus, by the appearance of
the organ to this sense, the period for menstruation, or the length
of time that it has passed, &c, and the characters it exhibits are
those which declare an increased fulness of blood ; which must,
of course, arise from an increased fulness of its vessels. It is
farther illustrated by collateral symptoms; as when a woman
approaching the menstrual period, is troubled with pains in the
head, loins and pelvis, finds herself relieved the instant the men-
ses appear symptoms and circumstances which would, in re-
lation to any other part, be taken as satisfactory evidence of in-
crease of blood in the part from which the haemorrhage came:

71 8 On Menstrual Irregularities. [May,

as when headache is relieved by epistaxis, <&c. A very similar
state of the os tines? is indeed observable on the approach of the
menstrual period, as is presented early after conception. It is a
state of increased vascular repletion, evinced by tumefaction and
sometimes tenderness. This increases until the uterine sinuses,
(a most wise and beautiful, arrangement, but not without its an-
alogy in the system.) begin to pour out their contents through
the largest reticular openings of the lining membrane into the
cavity of the uterus. Thus is menstruation effected, by the dis-
charge of pure blood. "Procidit autum sanguis velut a victima,
et ceto coagulatur, si sana fuerit mulier.'1* " La qualitedu sang
des menstrues ne parait pas differer de celui qui circule dans tout
\e systeme, lorsque la fern me est saine, bien conformee, et qu'elle
fait usage des moyens que la sante et la proprete exigent."!

This blood of menstruation here becomes immediately incor-
porated with the non-coagulating mucus, which ever (in a heal-
thy state.) lines the uterine cavity, and is distilled from the os
tinea?, when it mixes again with the secretions of the next pas-
sage, the vagina, before it finally escapes the vulva, and thus com-
pletes the formation of its whole character as a menstrual dis-
charge.

Were this the proper occasion, there would be little difficulty
in proving that so far as regards the uterus, the menstrual dis-
charge is simply a periodical haemorrhage, to which nature, ever
strictly and most wisely economical in all her purposes and oper-
ations, has adapted the organization; notwithstanding the con-
trary opinion has been given by high authority.

With the preparation of mind which the foregoing summary
of anatomy and physiology is calculated to afford, for a due re-
ception of those etiological views which were the object of this
essay, I shall now proceed to state my views relative to the pa-
thology of " obstructed menstruation ; and this may be done in
lew words.

It is most true, that a certain impression made on the system
by cold, has the power of obstructing the menstrual discharge.

* Hippocrates.

jBoivin. Also, when speaking of having had opportunities of seeing the
uterus of many young females who died during the menstrual epoch, she
said, the internal face of the uterus was "converte d'une couche de sang-
cTun rouge vif.

LHM.] On Menstrual Irregularities. 1lO

This is most easily and commonly done by cold, if moisture be
combined ; as by wetting the surface, wearing a damp linen, ta-
king off flannel from the skin, wetting the feet with cold water, &c.
These are causes which give men, and women at other times,
and sometimes in connexion with menstrual obstructions, pleu-
risy, rheumatism, catarrh, &c. &c. On the subject of the man-
ner in which cold operates on the susceptibilities of the system
in the production of these effects, we cannot be allowed room on
the present occasion. The result, no one denies. The treat-
ment is as simple as the pathological facts. The same treatment
timely adopted, that is ordinarily recommended for the restora-
tion of perspiration when suppressed by cold, will generally prove
competent to the purpose desired here, that is to say, the restora-
tion of the menstrual flux. It consists ofpediluvium,semicupium,
sudorific ptisans, as of sage, pennyroyal, thyme, catmint, savin,
camphor in large doses, opium with antimonials, local relaxing
applications, &c. &c. When the symptoms are more severe,
and an inflammatory action discoverable, a full antiphlogistic
treatment in proportion to the state of the system becomes ne-
cessary. Should the time have passed at which nature's tenden-
cy to this topical depletion exists, (for there is some influence
which determines a periodicity,) and the means used, come short
of the desired end, the evils of the present suppression on the
system are to be guarded against, by depletion, &c, if need be,
and the next menstrual period awaited. When this occurs, a
diligent course of such treatment is to be again adopted, which,
if no organic injury shall have been sustained, by the uterus or
some other part, will generally be found adequate to the end in
view. Should other diseases occur consequently, they are to be
treated according to their specific character, always bearing in
mind the peculiarity of cause which produced them. Is it pleu-
risy, bronchitis, hepatitis, colic, &c. &c? With all the appro-
priate treatment these specifically require, they may change lo-
cation, but may not be expected to be cured, without the correct
tion of the prominent and peculiar cause, the obstruction of the
menses.

The lighter parts of the treatment here advised in cases of
obstructed menstruation from cold, operate by effecting alike
in the skin and uterus, that state of action which favours the free
and easy transmission of their appropriate discharges. This

720 On Menstrual Irregularities. [May,

cause, (cold), is that which is generally alleged by the patient at
(he onset in giving the account of her case ; which on close and
pointed enquiry will be found not to be the fact in a very large
majority of cases. Her declaration is however made in the
spirit of truth, for knowing no other ordinary cause, she really
believes she suffers these effects from cold, without knowing
when or how it was applied; or she perhaps ascribes the case
to some trivial exposure which made no particular impression on
the system, merely because it may have been the only irregu-
larity of temperature to which she may have been exposed.
There are other causes which operate in a very similar manner
to cold, in causing this obstruction. Amongst these we may
name the severe influence of fear.

But there is another cause, by far more common than all oth-
ers collectively, and which operates on principles entirely dif-
ferent from others to which I have alluded, and will generally be
fpund to have produced the various irregularities, and some-
times the entire obstruction of menstruation. This cause is some
degree of pro'apsus, of the uterus ; a cause from which, when we
contemplate the attachments of this organ and the functions for
which it is peculiarly adapted, we are rather surprised on find-
ing any exempt. This displacement is produced by a great va-
riety of causes.* And amongst the naany, I will name one which
is perhaps more apt to deceive in the case than any other. It is
the violent bearing-down; pains which sometimes attend cases of
obstruction from cold, as a well known cause of the beginning
of the case. But 1, would be careful not to limit the reader's
mind to this cause of prolapsus. The other causes should be
easily detected by the practitioner ; or when no particular cause
which appears adequate can be remembered, still it does not fol-
lpw that it has not existed. Every practitioner who even dares
prescribe for the diseases peculiar to females, should be able to
detect the existence of prolapsus, in any degree, by his familiar-
ity with the symptoms it produces.

* See various authors on this subject, and then make great allowance for
the superficial views of most writers on prolapsus. It i& not a little surpri-
sing that a source of so much affliction and danger, and a prolific cause of so?
many secondary diseases and dangers to females, should have been so disre-
garded by authors and systematizers, when they know that many of their
readers look to their words as the ullima thule, or as the truth, and the whole
of the truth in medicine ; and think that it is medical heresy to doubt their
statements, or to say that there are more truths than they have given.

1837.] On Menstrual Irregularities. 721

Perfect regularity only is compatible with perfect health.
Menstrual irregularities are, however, frequent and various.
They are mainly :

Jst. Difficult, or painful menstruation,

2nd. Deficient menstruation,

3rd. Retarded menstruation.

4th. Obstructed menstruation.

5th. Excessive menstruation.

(6th. Accelerated menstruation,

7th. Protracted menstruation.

The first four of these are believed to be dependent on arterial,
and the last three on veinous obstruction, when arising from any
displacement of the uterus.

Most women will, on being asked if their monthly visitations
are regular, answer affirmatively, notwithstanding some one, or
many of these features, or species of irregularity, exist ; and it is
an examination not at all to be relied on under such an answer,
without specific interrogations on all of these features of irregu-
larity. Some women really believe that any occasional return
of menstrual discharge, no matter how various in quantity, man-
ner, &c, cox^stitutes regularity of this function. Others, and in-
deed a large majority in good society, and even amongst the
blacks, are compelled by their native modesty and diffidence on
this subject, to avoid every word which they can. The most
they can say is the monosyllable yes, or no; and the latter is of-
ten avoided when it should not be, lest it should lead to the ne-
cessity of farther expression on the subject : indeed the answer is
often expressed by a nod or shake of the head the former being
an affirmative and the latter a negative reply. Nothing is more
common, on direct interrogation to the point, than to find, after
this affirmation, by which the patient expects to prevent all fur-
ther direction of attention to this subject, that she suffers unusual
distress in some way, before, during, or immediately after the
menstrual discharge ; or that it is deficient in quantity, or exces-
sive in the rate of flowing, retarded several days, or even a week
or two beyond the lunar month, from the beginning of the last
flux ; or that it appears some days, or a week or two earlier
than the lunar month from the commencement of the former pe-
riod ; or that, although flowing at the proper rate, the continu-
ance of the flux is extended some days bevond the ordinary lim-

91

?22 On Menstrual Irregularities. [Mayr

itation in pristine health that it ceases for a time and recurs
after short and irregular intervals, &c. That which is common-
ly the first and ordinary interrogatory in these cases, that is tc*
say, " are your monthly visitations regular V is therefore not only
useless, but very liable to mislead. I will define each of the
usual species of irregularity, in order that by bearing them in
mind, a greater degree of precision and accuracy may be con-
veniently and certainly arrived at, both in the detection and the
diagnosis of disease.

1. Difficult menstruation. This is a case in which the pain,
or other unusual distress attending the monthly period, is the
chief or leading feature of the case, or the particular point of
deviation from the healthy flux.

2. Deficient Menstruation. This may be either from partial
retention or suppression. In this case the leading feature is a<
deficiency in the quantity of menstrual discharge during the pe-
riod ; of which there are two varieties : First, from too slow a rate
of flowing or, secondly, from, too early a cessation, although*
the flux be sufficiently free whilst it continues*

3. Retarded menstruation. In this case the leading feature is
the retardation of the flux from half a day to two or three weeks,
after the end of the lunar month.

4. Obstructed menstruation. Under this head is included all
those cases in which there is no coloured discharge ; whether
from undue retention at puberty or after childbirth; or from stop-
page occasioned by other causes.

5. Excessive menstruation. In this case there is a greater
quantity discharged each month than is natural. Of this species
there are likewise two varieties: first, from too long a continu-
ance of the monthly flux, or its occasional recurrence ; and se-
condly, from so transcending the ordinary rate as to cause the
loss of an excessive quantity each month.

6. Accelerated menstruation. In this species the leading fea-
ture of the case is the too early accession of the menstrual dis-
charge, varying from a few hours to many days.

7. Protracted menstruation. In this the quantity discharged
each month is natural, but requires a longer period than in the
healthy state of the individual, differing from a few hours to ma-
ny days even the whole lunar month.

It is not unusual for two or more of these species to be com-
bined in the same -case.

1837.] On Menstrual Irregularities. 723

j - i , j

When we contemplate the manner and extent of the vascular
arrangements of the part,* no difficulty need be felt in determin-
ing the mode of operation of this cause in the production of the
irregularities in question. Whether the menstrual be considered
a, true sanguineous discharge, or a peculiar secretion, no one will
contest the fact that the blood from which it comes is brought to
the uterus by the arteries, which are chiefly the uterine branches
of the spermatic, and those of the hypogastric, generally noticed
under the name of the uterine arteries. The former of these
enter the uterus laterally, near its upper part, after passing
through the lateral, or broad ligaments formed on either side
by duplications of the peritoneum ; the latter, approaching at the
cervix and distributing themselves, as they pass upwards, to the
whole substance of the uterus. The functions of these proceed
with beautiful regularity and exactness during the continuance
of the uterus in place, or its extension upwards in the progress
of gestation. But no- sooner do we contemplate the flexure of
the latter on themselves, as it must almost necessarily be by the
descent of the uterus ; or the compression of these, or of the for-
mer, by the bearing-down of the uterus, with, or without ante*
version, retroversion, or some lateral obliquity, than we see a
competent cause of arterial obstruction and a resistance of great-
er or less extent, to the free transmission of blood to the extreme
branches of each or either, and into the uterus; and consequent-
ly a failure of that free diffusion of blood in the organ, by which
alone can the menstrual discharge be afforded. The consequence
of this obstruction of some of the ramifications- must necessarily
be an increased fullness, and in many instances, a painful disten-
sion of others into which the obstructed blood may pass. Hence
arise the pains of the first, second, third and fourth species the
scantiness and tardy appearance of red flux, &c. And hence also
arise, other effects which, in their nature, produce series of other
troubles and dangers, as spinal irritation about the junction of the
last lumbar vertebra and the sacrum, or the whole of the sacral
portion of the rachedian centre. Hence arise also congestions,
tending to hemorrhois, fistulse. abscesses, recto-vaginal ulcera-
tions, pulmonary or hepatic affections, cerebral oppressions tend-
ing to epilepsy, catalepsy, chorea, mania, &c. Of these, I could
cite some hundreds of cases directly in point, and well illustra-
ting some one, or several of these views. I will give three or

* See Anatomy ; also, Tiedman's Tables of the Arteries.

724 On Menstrual Irregularities. [.May,

four by way of illustrating some of the more difficult views, or
some of those most liable to be doubted by those who are unac-
quainted with this part of pathology.

The first case I shall give, was one of a coloured woman, who
had laboured many years previous to my seeing her, under the
following, which is a very common succession of these species :
first difficult or painful menstruation, then deficiency, and finally,
total obstruction. When I first saw her, which was as far back
as the year 1821, she had not had the least appearance of men-
strual discharge for the four last months ; but in its stead, as I
believed, and certainly, at or about each period for menstruation,
a copious purulent discharge from the rectum was effected. I
saw her soon after her fourth discharge of this kind. This case
had been for several years under the management of the late Dr.
Brux of this city, after whose death it was placed under my
care. Consequently I was dependent on her own account for
the chief history of the past part of her case. On examining the
uterus by the touch, I found it extensively prolapsed, and con-
siderably swollen. I replaced it and enjoined suitable position
for a few days, or until the purulent discharge should cease.
Daily the ordinary distresses of prolapsus returned, in conse-
quence of her necessity of rising from bed to obey the calls of
mature, and allow the free evacuation of purulent matter per
ano. On the cessation of this discharge, I applied a pessary
made of soft materials, and of such size and shape as to retain
the uterus at its proper site. After several days, this was re-
moved and a strong solution of alum was used twice a day, as a
vaginal injection after replacement. About a week before the
next menstrual period, another pessary was applied and worn
through the period, which instead of producing a purulent dis-
charge as a the last four months, was attended with a pretty
good menstrual discharge. The same treatment was con.tinned
about two months longer, when the patient was discharged well,
and in the enjoyment of a fine increase of corpulence, and has
been ever since, an able washer-woman in this place.

The second case I shall give, was one of recto- vaginal open-
ings, two in number and one of them of considerable size, and
which afforded a free transmission of fecal matter through the
iower part of the vagina, and out at the vulva. This had been a
well marked case of prolapsus for about three years, which was

1837.-] On Menstrual Irregularities. 72f>

brought on suddenly to some extent, by a fall down the stairway.
The patient was a coloured woman. On tiie touch, I found a
prolnpsc in which the os tincce was resting with considerable
pressure on the rectum at the fossa naviculars, when the recto-
vaginal openings existed, and through which the intestinal evac-
uations made their escape almost continually, instead of forcing
the sphincter ani. I replaced the uterus, and applied a pessary,
and committed the case to the charge of a nurse for the present.
Forthwith, the evacuations passed the natural way. On the
removal of the pessary, position, astringent vaginal injections,
with gentle relaxation of the bowels. After a few days another
soft pessary was applied, in anticipation of the menstrual peri-
od. The menstrual flux, which had become almost entirely ob-
structed, now appeared, almost to a satisfactory extent On
its cessation, the injections and position were again resorted to,
and she was committed to the nurse again. A few days in anr
iieipation of the next period, I found on examination that the
openings had closed. Another pessary was applied and general
advice given for the future management of the case. Soon after
this I met her in the street, when she declared herself entirely
weh. The following year, on being called to her again, I found
that her proiapse had returned, and again deranged her menses
by greatly lessening the discharge ; and no less than three dis-
tinct fistulee existed around the anus. She had become extreme-
ly emaciated and desponding, and utterly refused to allow the
use of the bistoury. I abandoned the case and she died eight or
ten days after, of mortification.

The third case which I give was of an unmarried woman, in
whom the menstrual discharges had been deficient and very pain-
ful from the beginning, about five years before I saw her. This
deficiency increased until she came under my care, when the
monthly evacuation was in but very small quantity and only for
a few hours. The pains were extremely severe, extensive spinal
irritation, and a regular recurrence of epilepsy every month, fol-
lowed by great insensibility, and indeed entire loss of conscious-
ness for many hours and sometimes for a day or two. In addi-
tion to these monthly returns of epilepsy, it occasionally occurred
at different times in the month, on the appearance of colic pains
or headache ; to both of which she was very subject.

On examination of the uterus immediately after the supervene

726 On Menstrual Irregularities. [May,

tion of the state of insensibility which followed the fit, the uterus
was found prolapsed to the lower part of the vagina proper.
It was replaced and a small pessary applied, which, in her state
of insensibility, could only be done with the assistance of her
friends. Not more than fifteen minutes elapsed after the replace-
ment, and application of the pessary, before she aroused from
her insensibility and was perfectly comfortable, conversed free-
ly, and after about two hours left her bed. She was unconscious
of the application or presence of the pessary, until informed of it
on the succeeding day. Her menstruation was slightly increased
in the rate of flowing, and continued nearly two days. Several
months elapsed before these epileptic returns could be entirely
arrested; but they were finally, by the monthly application of a
pessary the day previous to the expected menstrual difficulty,
with various success in the correction of the menstrual irregu-
larity : sometimes the discharge amounting nearly to the natu-
ral quantity, and at other times only a scanty discharge for 24
to 30 hours. Hepatic derangement existed, which demanded oc-
casional mercurial purgations by small doses. The spinal irri-
tation was treated by blisters and sinapisms, by which means it
was kept measurably corrected ; but never more than a month
or two at a time, without appealing again to its appropriate rem-
edies. She had an occasional hacking cou^h. Various other

O CD

remedies were used in turn, without conspicuous benefit. For
the next three years, a pessary was applied at the approach of
every menstrual period, and astringent injections used in the in-
termediate part of the month, by which the pains of prolapsus
were prevented, and those of the menstrual period gradually
moderated, but never with the entire restoration of sufficient
menstrual discharge. The hepatic symptoms decreased so that
in the last of those three years not more than one mercurial pur-
gative was required on their account, and her general health was
habitually comfortable, suffering only more or less headach for
a few hours every month. Thus she continued, until, from the
circumstances of her family, she was obliged to leave the city
for several months ; and when she returned was so situated that
she could not make it convenient to be subjected to a renewal of
the regular treatment, on which she depended for the perpetua-
tion of the degree of health she enjoyed. This circumstance, ad-
ded to a hope on her part that she would continue better with-

1837.] On Menstrual Irregularities. 727

out treatment, caused her case to be neglected as to uterine treat-
ment. After a few more months, the menstrual obstruction be-
came complete ; which she still suffered without treatment, be-
cause her pains did not now increase with the decline of men-
strual discharge, and she allowed herself to hope that the sys-
tem had become accommodated to the deficiency, and that she
would henceforth remain well, without menstruating. But an
obstinate and increasing violent and harrassing cough was soon
established, and pulmonary ulceration supervened* of which she
expired about 16 months after. This case afforded a clear dis-
play of what might have been considered merely metastases, by
anyone not aware of the great source of all the troubles in the
case. In the first place, the injuries sustained by the encephalon ;
in the second, by the spinal irritation ; third, by the liver ; and
fourth and lastly, by the lungs.

The fourth and last case we shall give here, was one of reten-
tion, after giving birth to a still-born child. Many months after her
accouchement she came under my care, without having menstru-
ated, and was labouring under chronic derangement of intellect,
with aggravation of the, symptoms at every monthly period.
She had suffered extreme difficulty and bad management during
parturition. On examining the condition of the uterus, it was
found prolapsed, and a replacement effected and a pessary ap-
plied during sleep, by the assistance of a. female friend. Em-
menagogues were added to the pessary treatment in this case,
both of which were monthly employed for about three months ;
during which the discharge became established, nearly natural
in all respects.* Her intellect improved and the distress of head,
of which she gave the strongest intimations, mitigated. Her
powers of speech, of which she was entirely deprived, began to
return, and she is now able to use a number of words very dis-
tinctly and accurately.

When I turned aside to illustrate by a few cases which I thought
would be useful, I was about to shew that the four first species
of irregularity, viz. difficult, deficient, retarded and obstructed
menstruation, depend on arterial obstruction, for it is evident
that these arise from a deficiency of arterial function in the or-
gan in these cases.

* The same emmenagogue powers had been previously used for several
months without success.

728 On Menstrual Irregularities. [May,

We have said that no one will contest the fact, that the blood
from which the menstrual discharge is produced is supplied by
the arteries of the uterus. Alike impossible is it for any one to
deny the fact, that the blood in the uterus, or flowing to it, is
borne away again in the healthy state, by the corresponding
veins; but in this disease, these are in as much danger of com-
pression as the uterus. Now we find three other species of ir-
regularity which are not less evidently the result of a deficiency
of venous function at the part. These are excessive, accelerated
and protracted menstruation. It is most easy to comprehend the
modus agendi of this cause in these cases. We have only to al-
low the possibility of the uninterrupted continuance of arterial
distribution in and about the uterus, whilst the returning veins
suffer obstruction, from distortion, compression, &c, as the arte-
ries in the former four species, and we find at once a state of
things which must produce excessive, accelerated or protracted
menstruation, or even that copious discharge which has received
the name of flooding. This view is unavoidable when we con-
template the abundance, the office, and the situation of the venous
branches, plexuses, anastomoses, sinuses, &c. &c. An interest-
ing case, finely illustrating this pathology, has just passed from
my care. The woman, in the absence of her menstrual period,
exerted herself severely in lifting a heavy weight. The effort
was soon followed by increasing pains in the back, pelvis and
thighs. At the end of two days, a copious hemorrhage was af-
forded by the uterus. On seeing her, the prolapsus was at once,
determined by the history and symptoms of the case. On the
touch, the uterus was very sore and considerably swollen.
The vestibule, to the upper part of which the uterus had de-
scended, was also quite tender. The uterus was replaced as
nearly 'to its proper site as the swellings would allow, and the
patient placed on her side, with a pillow under her hips. Doses
of the compound powder of alum and kino, were left to be taken
hourly, should the hemorrhage not cease, or should it recur in my
absence. The following night I was compelled to visit her again,
on account of recurrence of profuse haemorrhage, after having
almost entirely ceased, from her having risen from her bed.
The styptic powders had been taken for several hours, without
the least effect. From her having been up, and the recurrence
of the pain and flooding, it was the belief that the uterus had

1837.] On Menstrual Irregularities. 729

again prolapsed, which was on examination found to be the fact.
It was again replaced, with the good effect of checking the hae-
morrhage. Powders of the acet. plumb, with pul v. ipecac, com p.
were left for use in the event of another recurrence, which was
the case on again leaving her bed the following day. Several
doses of the powders were administered without any obvious in-
fluence on the discharge. The uterus was again replaced and a
pessary introduced and properly adjusted. The discharge con-
tinued in a very inconsiderable degree for three days, at which
time the pessary, having become very offensive, was removed,
and a strong styptic lotion used with the womb syringe twice a
day, with strict regard to position. -Constipation followed the
use of the compound powders of acet. plumb, and Dover's pow-
ders. The haemorrhage gradually decreased for several days
and then entirely ceased. The lotion was continued once a day
for a week longer, and the patient continuing well and impro-
ving in strength, was allowed to leave her bed, and has now
continued well three weeks. I have not been informed whether
she has menstruated since her recovery ; but presume from her
recent very excessive haemorrhage she has not.

Thus have I attempted to give a hasty sketch of my views on
the various menstrual irregularities, with a few of many hun-
dreds of cases which are well calculated to confirm their truth.
1 might have made up this article by detailing many cases, and
giving their pathology and treatment, but for the knowledge of
the fact, that but few readers are disposed to follow out the de-
tails of numerous cases alone in search of truth ; and to have
blended with them a sufficiency of explanatory matter, would
have protracted this essay, already far exceeding the intended
limits, to a much greater length.

My purpose has not been to draw off the attention of the rea-
der from those cases of menstrual irregularity which are known
to be fairly ascribable to cold and similar causes; but to ex-
tend it to another and a far more fruitful, but generally neglect-
ed, cause of these distresses.

It will be seen by the very nature of the cause alluded to, and
the anatomy in connexion, that the treatment for the whole of the
seven varieties I have given, must be very much the same.
The same treatment which would remove arterial compression
would remove venous also. It may at first view be considered

02

730 An Essay on Gangrcnopsis. [May,

paradoxical to say that the same remedies which would be cal-
culated to promote menstrual discharge when deficient, are also
well calculated for decreasing it when excessive that treat-
ment, well adapted to the acceleration of retarded menstruation,
is also rationally depended on for retarding accelerated menstru-
ation, &c. And this opinion of unreasonableness will be the
more confided in, on the recollection of the fact that such is not '
the case with those irregularities which result from cold, &c.
But the problem is solved, the instant the peculiar nature and
power of this cause are contemplated, in connexion with the anat-
omy and physiology of the part concerned. The same treat-
ment which removes arterial, is also cnlculated to remove venous
compression in like situations. When all the premises are fair-
ly reasoned from, the conclusion is unavoidable, even if abun-
dant observation on these cases did not set the truth beyond dis-
pute. But the truth is, that the popular doctrine of exclusive
excitement, has swept like a torrent over a large portion of the
medical world, carrying before it, for the present, every vestige
of humoralism, so that it has become almost sacrilege to say that
the blood circulates in the sanguiferous system, or that variations
of its constituents have any thing to do with a' change of excite-
ments. But it were puerile, it were base, to suppress a truth
of nature, or allow her truths the purest of all to be obscured
by the false glare of theory, erected on partial premises, which,
although it attract the vision for a time, must soon flicker and
expire like the exhausted taper. Nor is it less objectionable to
conclude that the boundaries of the science have been set that
its ultimate limits have been reached, and that no more truths of
deepest interest exist but those which have been arrayed before
us. Such an exclusion is alike calculated to inspire an unjust
confidence in errors of expression or of omission, and dampen
philosophical research for farther truth to say nothing of the
noxious vanity which infests the minds of such exclusives and
such systematists.

Every honest practitioner must acknowledge his repeated em-
barrassments and disappointments, in depending on what are
called emmenagogue powers alone, in the first four varieties of
these cases, and on styptic powers or astringents, for the final
cure of the thrrr* last. After vainly hoping for the discovery of
bettrr emmenagogue means than his science had afforded himr

1837.] On Menstrual Irregularities. 731

he has doubtless been brought to wish, that he might never again
be required to prescribe for such a case. He has also, if much
experienced, found cases in which the local symptoms demand
medicinal powers which the state of the general system forbade,
and vice versa, &c. There is here offered such an etiology
which will be found applicable to a large proportion of cases,
and which will enable them to remove from their way most of
the impediments hitherto insuperable.

ARTICLE III.

An Essay en Gangrenopsis, read before the Medical Society of
Augusta : By Edward A. Eve, M. D., of Richmond County.

Before commencing the essay which it has been my duty to
provide for the present occasion, I would premise, that my hav*
ing selected the question, "Is Gangrenopsis a separate and dis-
tinct disease, or is it identical with Salivation?" is not from a
supposition, that 1 have any novel or important views on the
subject, but rather because, from the very slight notice I have
seen of this disease in systematic works, and from having heard
some respectable members of our profession say they have ne-
ver seen it, I fear it is less recognised by the medical community,
than its actual importance deserves: And it is for the purpose
of eliciting the knowledge of such as may have had experience
with this affection, and of directing to it the attention of such oth-
ers, as either may never have met with it, or passed it by unno-
ticed, or "en mas?e" with salivation, and the various cankerous
affections of the mouth, that I now agitate the subject: And if
by so doing I shall call inquiry to it, and produce the ulterior ef-
fect of conducing to a more systematic and efficient practice m
this truly loathsome and deplorable disease, I shall feel satisfied
that I have chosen a subject, about which the imagination can.

7 32 -47i Essay on Gangrenopsis. [May,

exercise no pleasing cogitations, and from which, if any satisfac-
tion be derived, it must be that of a reflective character, the con-
sciousness of performing a duty. As all that is known of this
disease is of a very vague and indefinite character, being treated
of in medical journals' under different name?, and the same being
applied to different diseases, I will be compelled in giving its pa-
thognomonic characters, to be governed more by the little 1 have
seen of its actual existence in our own climate, than by the con-
fused though in some instances very learned treatises, I have
read in the medical journals of our country. The confusionv
however, appears more in the aggregate of these treatises, than
when taken separately, and seems to arise evidently from differ?
ent diseases being treated of by authors under the same name.
To give an analysis of these essays, particularly those by B. F.
Coates, of Philadelphia, Samuel Jackson of the same place, as
well as Richter of Berlin, would be highly interesting, were it
not that it would be travelling beyond my prescribed limits.

Among the great variety of names by which this disease has
been described, I would prefer to designate it by the term Gangre-
nopsis, first proposed by Dr. S. Jackson, derived from yayy.caiva,
gangrene, and oi'is, the iace. From what I have seen of this af-
fection, and I think I can gather some coincidence of opinion from
some treatises I have read, I would pronounce this affection a
putrescent, or sphacelating fever, attacking children for the most
part between two and eight years of age, forming one of the
varieties of our bilious autumnal fever, or in oilier words, it is a
low grade of bilious remitting, or intermitting fever, which seems
to have a strong tendency to terminate in gangrene of some
part, generally of the face. Although this disease selects the
face as the point, of attack, sufficiently often, to entitle it with
some justice to the appellation of gangrenopsis; still, lest those
who are more than usually sensitive about the perverted action
of calomel, may be indue ribute it to tlje use of that min-

eral, from its spending its violence on that part, for which mer-
cury has peculiar affinity, it may be well to state, that the gan
grenous development of this disease is by no means confined to
this part, but occurs in parts sufficiently remote and distinct, as
altogether to remove such a suspicion; as, indeed, wherever
the excitement seems invited, by any extraneous or accidental
irritation, there the disease seems first to develope itself. I have

1837.] An Essay on Gangrenopsis. 733

known the soft parts covering the lumbar vertebrae affected with
this gangrene ; probably produced by the irritation consequent
on the pressure on this region, from lying on the back. I have
known blistered surfaces affected in the same way. This dis-r
ease is also said not unfrequently to develope itself on the labia
pudendi of young girls, where, from the want of strict attention
to cleanliness, acrimonious accumulations may have made these
parts a centre of irritation. The principle contained in the
maxim, " pars dolens trahit," which seems to preside in the above
instances, can be used with equal propriety to account for the
force of this disease being directed to the mouths of children from
two to six or eight years old ; as the process of dentition going
on at this age can reasonably be supposed to make a focus of ir-
ritation sufficient to concentrate the action of the disease in this
location. The part of the cheek in which this mortification most
usually makes its first appearance, is the part most liable to be
bitten in convulsions from worms and intestinal irritation from
other causes. And in lying on the side, as children frequently
do, with the cheek resting on the hand or arm, the internal sur-
face of the cheek being pressed against the molar teeth, may
prove another source of injury or irritation to this pnrt : and it is
perhaps in proportion as this part is more liable to be injured or
irritated, that the force of this disease is directed to it oftener than
to any other.

As the symptomatology given by Dr. Jackson in his excellent
essay on this subject, accords so well with my own observation,
I will extract it for our present purpose, in the place of giving
an original sketch.

"Whenever in the course of our attendance on children debilitated by fe-
vers, we perceive the least swelling of the cheek, it is time to take the alarm.
According to our very limited experience, a little cineritious spot will be
found on the inside oflhs cheek. This, as Van Svvieten observes, is nothing
less than a true gangrenous eschar. If the case is not seen till it lias made a
progress of two or three days, the face will be found pale, the cheek tume-
fied, hard and shining, the mouth distorted, the lower eye-lid cedematous, the
saliva sometimes profuse, in some cases not at all increased. In some cases
the odour of the mouth is altogether peculiar. At this time the gums and
teeth are to human eyes, entirely unaffected, but the gangrene will even now
be found to have made alarming ravages in the cheek ; and spreading sooner
or later through the contiguous parts, the gums are seized, the teeth become
loose, and necrosis involves the socket. The farther progress of the spha-
celation can be more easily conceived than described. There is no general
inflammation of the mouth, none very evident even at the margin of the gan-
grene, the parts seem to pass immediately from life to death. The spot of

731 An Essay on Gangrenopsis. [May,

gangrene appears cineritious, or even whitish, but in the progress of the dis-
ease the dead parts are nearly black. The patient appears to suffer very lit-
tle, he lies quiet, desires to be left to himself, in fact he appears both in body
and mind to have passed into another slate of existence."

Having now m a very brief and concise manner given the
symptoms nnd pathognomonic characters, by which we may in-
dividualize this disease; we will next endeavor to give our rea-
sons for believing it not to be identical with salivation. In the
first place, if we observe the regular occurrence and progress of
the symptoms, we can I think even in this way distinguish such
a difference as will tend, in a great measure, to destroy the iden-
tity of this affection with salivation: In the early stage of this
disease, or even after the gangrene has been making ravages for
several days, there is no tenderness of the teeth and gums, which
it is well known is recognised as one of the earliest symptoms in
salivation, and in a great many cases, the odour from the mouth
of a patient affected with this malady, is very different from the
breath of a salivated person, and seems to resemble more the
stench of a grave-yard, or that arising from any putrifying ani-
mal matter, and indeed while salivation is a highly inflammatory
and painful affection, gangrenopsis seems to be attended with
neither pain nor inflammation. And in the next place, we have
many well authenticated cases on record o( this disease, in which
little or no calomel had been given ; and those most in the habit
of treating this disease, aver that they find a liberal use of calo-
mel the most efficient mode of treatment. We have many well
authenticated cases, I have in my very limited experience seen
some, where this disease has occurred, in its most malignant
form, after a very moderate quantity of calomel had been given,
perhaps a single purge, or a lew doses combined with such ac-
tive cathartics as would carry it off speedily. Now when we
take into consideration how much greater quantities of calomel
adults frequently take, almost with impunity, notwithstanding
their greater susceptibility to salivation than children, we scarce-
ly can think it a fair course of etiology to attribute the severe af-
flictions these unfortunate little sufferers experience, to a few
grains of calomel, notwithstanding the great resistance they seem
generally to offer, to the salivating influence of mercury. But
as still stronger proof, and sufficient we think to satisfy the most
sceptical, Dr. Jackson has recorded two well marked and very

1837.] -in Essay on Gangrenopsis. ?35

severe cases of gangrenopsis, one of which ended fatally, in which
not a particle of any mercurial preparation whatever had been
taken by the subjects. In one of these cases, a little girl of four
or five years of age, after gangrene had commenced, he gave a
hundred and fifty grains of calomel. This child, although she
suffered severely from the disease, was cured, and the eschar
healed perfectly, leaving no deformity. Dr. Milton Antony of
this citv, has not only seen cases in which no mercury had been
given, previously to the gangrenous development, but has found
it the very best mean for arresting the disease. Dr. A. related
to me a history of a family, of which, very recently after having
removed to a marshy situation in the neighborhood of this city,
three members were attacked with this disease. As incipient
gangrene had made its appearance in some of these, when they
were first seen by him, he as well as the physician in attendance
with him, abstained from the administration of calomel; the fe-
vers continued, and in about a usual period for such a crisis, these
patients perished with gangrenopsis. Several others of the same
family, were taken apparently with the same fever this fever
has diagnostic characters by which it may be recognised before
the gangrenous development in these cases calomel was em-
ployed liberally, and they recovered in good time, whether be-
fore they passed through the gangrenoptic stage or not, lam not
able to say at this time, having forgotten what the Doctor stated
on this subject. 1 understand also, that Dr. L. D. Ford of this
city, has witnessed more than one case of gangrenopsis, that su-
pervened on fevers, in the treatment of which no calomel had
been used. I regret not having had an opportunity to converse
with him, since I have had this subject under consideration; if
present, I hope he will give the result of his experience with this
disease; and also let us have the benefit of his views of its pa-
thology, and the relation it bears to salivation. The few cases
that I have seen, although highly interesting in a practical view,
a narration of them here would be irrelevant, as they would have
no direct bearing on the question in point as calomel, although
in some instances in very moderate quantities, had been given
previously to the development of the cheek disease. There is
one, however, which from one circumstance connected with it,
may not be altogether unprofitably referred to. This case oc-
curred in the autumn of 1831, the subject of it was my nephew,

736 An Essay on Gangrenopsis. [May;

a boy about eight years of age, the gangrene supervened on a
severe attack of bilious fever. As it was a regular case in eve-
ry respect, I will only state the fact that bears upon the ques-
tion before us ; which is, that fever remained unabated even after
the gangrenopsis was developed. I was at this time but little
acquainted with this disease ; Dr. Antony and my brother at-
tended this case with me, and it was at the suggestion of the
former, in this dreadful dilemma fever raging and gangrene al-
ready making rapid ravages in the cheek that calomel was
given with the happiest results, apparently both as regards the
fever and the local mortification. It must be acknowledged,
however, that the very earliest opportunity was embraced for
the most vigorous exhibition of general tonics, as well as the
most unremitting application of antiseptics and stimulants to the
gangrenous parts. If in passing, I will be indulged in digressing
so far as to venture one remark of a practical nature, it would
be, that while I fully appreciate the good effects of calomel jn
the above cases, as well as other cases of this disease in which
it has been errvployed, I still do not believe that it acts as an an-
tidote, or dfjerfs any directly curative agency on the gangrene ;
but acts ffftermediately by arresting the fever and removing that
condition of the system which precludes the administration of
quj-ninV, and such other tonic and antiseptic remedies as are most
potent in correcting the gangrenous diathesis which characteri-
zes this*" fever.

From the evidence that a candid, though hasty and imperfect
investigation' has brought before my mind, I aver that I am de-
cidedly of the opinion,%at calomel has no direct agency in pro-
ducing gangrenopsis, and .that this affection exists as a disease
distinct from salivation. And as reasons for this decision, I will
repeat, that if we examine the symptoms, those diagnostic char
acters which give individuality to a disease, we will find tho
which characterize gangrenopsis Widely different from those
which indicate salivation, which fact alone gives a separate exis-
tence to gangrenopsis. A great part of the treatment also, found
beneficial in the one, wouM-be highly detrimental in the other.
And now, in conclusion,' as farther reasons for this decision, I
will recapitulate but two arguments, one from the positive and
the other from the negative side of the question ; and I have no
doubt that every unprepossessed mind will perceive the force of

nil
>se

Kc37.] Of Antimonial Suppositories, $c. 737

the reasoning. The one is, that mercury is frequently given in
very large quantities without. producing this affection, showing
that it has no direct agency in generating it ; and the other is,
that gangrenopsis frequently occurs where no mercury what-
ever has been taken.

Part II. REVIEWS AND EXTRACTS.

Of Antimonial Suppositories as a mean of restoring the He-
morrhoidal Flux.

The physicians of past ages have, perhaps, too much exagger-
ated the importance of haemorrhoids in the scale of pathological
phenomena, while those of our own time are fallen into the con-
trary extreme.

It cannot be denied, that the suppression of the hemorrhoidal
flux, when habitual, may be productive of general disorders a-
mong men, almost as serious as the suppression of the menses in
women. Moreover, it is as generally admitted, that with cer-
tain persons who have, not only regularly, but at indeterminate
periods, a draining or hemorrhoidal flux, the existence of this
pathological condition is attended with a state of general good
health y although it may remain for a long time uncertain and
variable, provided the hemorrhoids do not manifest themselves as
soon as usual. Observation shows also, that persons who have
had hemorrhoids for a long time, suffer generally if this flux en-
tirely ceases. And it often happens that there is a call for its
restoration.

Many means have been advised to effect this indication. The
warm local baths, mustard foot baths, leeches to the part, suc-
tion applied to the lower part of the large intestines, purgatives
and cupping glasses to the part. Of all the means which we
have made use of, only one has succeeded in any satisfactory
manner. This is the application of cupping glasses. Tnis
mean was entirely forgotten, when a student of the Medical
Faculty of Paris restored it to honour, and I am able to bear wit-,
ness to its effects on him.

93

738 Of Antimonial Suppositories, fyc. [May,

He had had hemorrhoids till the age of twenty years, and al-
ways enjoyed good health. This 'flux now ceased", when he be-
came subject to violent pains in the stomach, and continual disor-
ders of the digestive organs. He consulted M. Andral, while
attending the Hospital de la Pitie, and this physician made use of
every mean advised by authors for restoring this flux. Noth-
ing succeeded and the disease remained stationary. The young
patient then conceived the idea of applying a cupping glass to the
part. During this application the circumference oi the anus en-
veloped the hemorrhoidal tumours, which Tor eight days were-
swollen and painful. From this time his health was re-estab-
lished. A month after this he experienced a slight return of
gastric disorder; and one day, while attending my visit to the
hospital he spoke tame of the relief which he had obtained the
previous month from the sufferings which he now began to feel
again, and offered to let me witness the prompt appearance of
the hemorrhoids under the operation of the cupping glass. I
accepted the invitation with alacrity, and at the same time I
placed him upon the bed of one of the patients, and in the pre-
sence of more than forty physicians and students, 1 applied a
cupping glass to the fundament. A minute did not elapse when
the tumours made their appearance, and becoming united, they
acquired the size of a small pigeon's egg ten minutes after the
application of the instrument. The same means were made use
of the following day, and the hemorrhoidal flux continued for a
week and wras followed by a cessation of the disorders of the
stomach. M. Andral also saw this young physician, and can
testify with me to the great rapidity with which the tumours be-
came swollen.

After this, I had only one opportunity of locally applying cup-
ping glasses for recalling the hemorrhoidal flux. This was with
a female afflicted with erratic rheumatism, which to me appeared
to be caused by the suppression of habitual hemorrhoidal flux.
I succeeded in puffing up the hemorrhoidal vessels by means of
the cupping glass ; but the tumours disappeared soon after the
application of the instrument. What prevents my using this
remedy more frequently is this. In the first place, patients, es-
pecially women, have a great aversion to it. Secondly, I have
conceived that a much more simple remedy, and the employment
of which can never be the subject of serious objection, will an-
swer the same end, I allude to antimonial suppositories.

As I had never succeeded with aloetic suppositories, I thought
by substituting in the place of aloes one of the most energetic
irritants, I might attain the desired end. Now, tartrate of anti-
mony, applied locally to the skin or mucous membrane, creates
an inflammatory action very powerful and persisting, I therefore
preferred this article. I mix with a drachm of butter or lard
from two to six grains of tartrate of antimony. The supposito-

1837.] Of Antimonial Suppositories, <$c. 739

ry, being introduced within the sphincter of the anus, melts quick-
ly, and the tartrate of antimony remaining in contact with the
mucous membrane, excites a lively local irritation, a species of
tenesmus, as a necessary consequence. When the suppository
contains only a grain, or half a grain, of the tartar, it can be re-
tained for twelve hours without any necessity for going to stool ;
but when a greater quantity of it is made use of, the patient ex-
periences a heat at first slight, but afterwards scorching and at-
tended with painful pulsations at the part, there is a necessity of
frequently going to stool. The arterial pulsations increase at
the same time that the circumference of the anus protrudes, and
pustules similar to those excited by tartar emetic on the skin,
now appear ; bluish tumours arise, hard and painful, permitting
occasionally a large quantity of blood to transude. These are
the true hemorrhoidal tumours, perfectly evident with those who
have had them already and only apparent with those who have
not had them.

I have often advised this remedy, in consultation, in my pri-
vate practice and in the hospital. I have taken notes of only six
patients who have used it. With five of these the hemorrhoidal
flux was re-established; in the sixth, who had never had hemorr-
hoidal tumours, I wTas unable to excite them. I will briefly re-
late these six cases, as they afford some practical interest.

Case 1. A man 36 years of age, had had an hemorrhoidal flux
until his thirty-fourth year. The flux appeared at irregular pe-
riods four or five times a year. At each time it lasted at least
five days. He took a cold, which at first seemed to be of little
importance ; but during the continuance of the cold, haemoptysis
came on and the hemorrhoides disappeared. The cold still con-
tinued, and the hemoptysis was repeated and lasted for several
days without any means being able to arrest it. Soon after this,
symptoms of phthisis pulmonalis were manifested and he con*
eluded to enter the Hospital Dieu.

There was considerable emaciation and slight hectic fever.
Resonance less at the upper part of the right lung, both before
and behind ; murmur in inspiration scarcely perceptible in ex-
piration it was very strong; slight broncophony; rale sub-crepU
tant sufficiently frequent : some humid crackling and a trace of
pectoriloquy; expectoration muco-puriform and often streaked
with blood; but little appetite. These were the symptoms of
tubercles beginning to be formed in the lung. Nevertheless, ha-
ving regard to the suppression of the hemorrhoids, I conceived
that there might exist in the respiratory organs a point to which
there was an undue flow of blood, similar to that which latelv
existed in the pelvis, I determined on recalling the hemorrhoids.
I made an application of a suppository of tart, antim. It exci-
ted a glow of heat around the anus, and the following night, large
hemorrhoidal tumours appeared, which continued six davs and

740 Of Antimonial Suppositories, fyc. [May,

discharged abundantly. A great amelioration of the thoracic
symptoms took place; the expectoration immediately ceased to
be bloody and was much diminished, so that, five days after-
wards, he coughed but little and respired almost as strong as
usual. Soon after this, the piles appeared without solicitation,
and the threatening symptoms which had been manifested in the
breast, were completely dissipated. Indeed, I do not imagine
that I cured phthisis pulmonalis. but merely an obstinate conges-
tion of the lung, which probably would have ended in inducing
tubercles.

Case 2. A cook, aged 50 years, entered the Hospital Dicu, in
order to be treated for a chronic disease of the stomach. This
man stated, that three years previously to his entering the hos-
pital, he had been afflicted with piles, which returned every
month, and which at that time became suppressed. Since then
he had lest his appetite, the little which he did eat gave rise to
pains in the stomach, attended with obstinate constipation.

He had made use of local bloodletting, opiates, laxatives, mag-
nesia, &c, in vain. I thought that the hemorrhoidal flux ought
first to be re-established if possible. For this purpose, I applied
a suppository containing the tart, antim. The first suppository
gave rise to a diarrhoea and tenesmus, but no tumour. The next
day, another suppository containing three grains of the tartrate
antimony to the drachm, (a little stronger than the previous one,)
was made use of. This caused very sharp pain at the anus, and
on the third day we found that very large and painful hemorr-
hoidal tumours had arisen. These tumours remained swollen
for several days, without applying any suppository, but did not
discharge. His health was improved, but was not completely
established. A month after this, a new application of the sup-
pository caused the piles to discharge, and at the same time his
stools became bloody. This discharge continued for six days
and then ceased. The health of the patient became much im-
proved, and after using the waters of Vichy for three weeks, his
cure became confirmed. I have not since seen the two patients
whose cases I have just related, so that 1 am unable to say what
their present state of health is.

Case 3. A woman, aged 40 years, was attacked with obsti-
nate erratic rheumatism. I imagined that by provoking hemorr-
hoids, she might obtain some relief, I therefore applied two an-
timonial suppositories. The tumours appeared ; continued two
days and then disappeared; but the rheumatism was not miti-
gated. This case, apparently of no consequence, proves that
hemorrhoids can be excited in those who have never had them.

Case 4. A young man, aged 30 years, contracted a gonorrhoea,
which was treated and cured with emollients and balsams.
Soon after this he experienced all the symptoms of syphilis. The
velum palati was destroyed by a large ulcer; the nasal fossa

1837.] Of Antimonial Suppositories, fyc. 711

and even the larynx, were not exempt from alteration. The
prot. iodide of mercury, bathing with a solution of corrosive sub-
limate, and local cauterization with nitrate of silver, improved
the character of these disorders. As the patient had formerly
had bleeding piles, which returned many times yearly, but had
disappeared during the last year, I applied for two days in suc-
cession the antimonial suppositories. The piles appeared again
and discharged abundantly but there was no abatement of the
disease.

Case 5. In September, 1835, while attending the hospital, a
patient aged 45 years, came under my care. He had a very se-
rious attack of sub-acute hepatitis. Hepatic enlargement was
very distinct, and there also existed an effusion of the peritone-
um and the cellular tissue of the pelvic organs. As he had a high
fever, I took blood from the arm, but without any relief. I also
applied leeches to the right hypochondrium and over the whole
seat of disease, but without any mitigation of the malady. The
patient had had in the course of his life three or four attacks of
piles. Knowing how much importance modern practitioners
attach to hemorrhoids, especially in diseases of the liver, I deter-
mined on exciting in the pelvic vessels a derivation which might
be salutary. The application of an antimonial suppository,
produced on the second day very painful hemorrhoidal tumours,
which discharged much blood. Nevertheless, the disease in-
creased in a frightful manner and the patient died.

Case 6. M. R., aged 52 years, during his whole life had been
subject to bleedings from the nose, which returned many times
during the month, particularly in the spring. His father, who
died at 2 years of age, was subject during his life to hemorrhoids,
which flowed regularly every month.

The epistaxis had now been suppressed for 3 years, during which
time he was subject to affections of the head two or three times a
year, especially in the spring. He also had a species of cerebral
excitation similar to that which marks the commencement of
drunkenness. The application of leeches to the part moderated
these symptoms considerably, but they soon retarned and gave
much uneasiness. The regularity of the hemorrhoids in the fa-
ther, caused me to think that a monthly congestion in the rec-
tum would be of great service. During one year, M. H. applied
for three days every month, an antimonial suppository. This
application excited a violent irritation, and an eruption which
evidently did not differ from the ordinary eruption produced by
antimony. The inflammation lasted only a few days.

Although hemorrhoids, properly so called, did not supervene,
the cerebral affections have not given any uneasiness, and his
whole health would have continued to improve, if the patient had
patience to continue the use of the means.

742 Discovery of a work attributed to Hippocrates. [May,

Let us recapitulate the facts contained in this brief account.
Antimonial suppositories in six cases, in order to provoke he-
morrhoids. In five the hemorrhoids appeaaed two days after
the employment of the means. Four were truly hemorrhoidal ;
one was not. In the four first, the eruption was persisting ; in
the other it lasted only two days. In one of the patients it was
impossible to produce the tumours. Of the six patients, three
were cured, probably in consequence of the appearance of the
flux. One of these three might have been cured, although the
hemorrhoidal tumours, properly so called, were not produced.
Three experienced no alleviation, although the hemorrhoids were
reproduced easily and abundantly. It would be too hasty to
draw general conclusions from so small a number of cases, I wish
only to make known to the faculty a therapeutic mean, by which
they can fulfil indications which may sometimes be presented to
their notice. Journal des CoinnaissancesMedico-Chirurgicalcs.

Discovery of a work attributed to Hippocrates, and hitherto sup-
posed to be lost.

The Gazette Medicale de Paris, (24 Dec. 1836,) contains an
elaborate and exceedingly interesting article from the pen of M.
E. Littre, on the discovery of a Latin translation of the Hebdom-
adal Treatise attributed by some of the ancients to Hippocrates,
the original of which (in Greek) was lost at the destruction of the
Alexandrian Library. M. Littre was led to this discovery by
his researches preparatory to the translation of the works of the
father of medicine. The treatise is found in one of the ancient
tomes of the Royal Library of Paris, where it had remained con-
cealed for centuries. The volume contains no date by which its
age can be determined; but judging from its barbarous Latin and
from its imperfect execution, its antiquity is undoubted.

M. Littre's researches into the history and tenor of this work
have led him to the following conclusions :

1st. The Hebdomadal Treatise, though lost in Grepk, still ex-
ists in Latin ; it was referred to by various ancient authors, from
Philonius to Moschopoulos. 2d. Galen, who is high authority in
this matter, considered it erroneously attributed to Hippocrates ;
and the inspection of the work tends to confirm this opinion.
3rd. The Hebdt madal Treatise is a work on fevers, founded on
two opinions, viz. that all nature is governed by the number se-
ven, and that the vital principle is a compound of elementary
heat and cold, the variations of whose proportions constitute fe-
brile affections. 4th. Two considerable passages, the one con-
tained in the Treatise on Critical days, and the other constituting
the second part of the eighth section of the Aphorisms, belong to
this work. This fact had never been suspected until the exami-

1 837.1 Discovery of a work attributed to Hippocrates. 74$

nation of the Hebdomadal treatise. 5th. We possess in Greek,
and as specimens of the original, the two passages alluded to ;
also a passage quoted by Philonius, detached expressions and an
entire sentence related by Galen, and a sentence contained in
iEtius. The dialect is Ionian, and the style, as far as it can be
discerned by these fragments, is studied and obscure, though not
entirely devoid of elegance. 6th. This work is from the same
author as the Book of Principles, and probably also the Treatise
on the Heart. It is interesting not only for these reasons, but
also because of the care with which it unfolds the treatment of
certain acute diseases, and especially of ardent fever or causus.

The following is a translation of JVT. Littre's analysis of the
work. "Such is the constitution of the world and of its parts,
that all things are regulated by the number seven." With this
position the author of the treatise enumerates all the phenomena
which seem to be under the influence of this number : the moon's
phazes ; the seven winds; seven seasons ; seven ages of human
life; seven principal parts of the body ; seven requisites for ex-
istence; viz. inspiration of cold, the exhalation of heat from the
body, sight, hearing, smell, deglutition of water and food, and
lastly, taste; the articulation of the seven vowels. The author
goes on to slate that the earth itself has seven parts; the head,
or the Peloponesus, the residence of great souls ; the neck and
chest, which correspond to two countries whose names are omit-
ted by the scribe ; the thighs, or the Hellespont ; the feet, or the
Bosphorus and Thracia ; the long intestine and the lower belly,
an obscure word which appears to be Cimmerian Bosphorus, and
the Pal us Moeotides.

After having thus established the predominence of the number
seven, and having remarked that the knowledge of the world is
necessary to the understanding of diseases, he explains his opin-
ion of the nature of the soul, which according to him was a mix-
ture of the elements of heat and cold. Then follows a compari-
son of the animal body with the world. The innate heat repre-
sents the sun ; the fluids of the body, water ; innate cold corres-
ponds to the air ; and the flesh and bones, to the earth.

The body, like the year, has a period of growth, one of ma-
turity and one of decay. It must necessarily be under the in-
fluence of the year itself, and be modified by its periods
When winter brings cold, it makes the leaves drop from the trees,
and compels animals to take refuge in their retreats. The heat
of the body, dreading the cold, secures itself by rushing to the
centre. This heat acts on the humours, or rather on the humour,
for, according to the author, there is but one humour, which has
received many and inappropriate names ; as there is but one
humour in the world so there is but one humour in the body ; all
those fluids termed bile, phlegm, urine, &c, result from changes
of heat into cold and of cold into heat, as do all the fluids of the

744 Discovery of a work attributed to Hippocrates. [May,

earth, wine, vinegar, milk, honey, dew, snow and hail, which are
derived from one humour, water. He adds, however, that this
heat, when its influence is salutary, cures diseases ; it therefore
preserves and destroys the body, cures and produces fevers.

But they are produced by heat in a different manner when the
temperature of the world becomes mild. The season of flow-
ers and of fruit brings animals from their retreat, and recals from
Egypt those that were driven thither by the cold. The sun sets
in motion the humours, which in their turn enkindle fevers, un*
less evacuations be produced or occur spontaneously, or that the
influence of the season be combatted by a cooling regimen.
Summer brings high fevers, ulcerations and eruptions ; for then
the humours of the body are heated, active and venomous. Still
later, tert;an, quartan and quotidian fevers come on. It is there-
fore necessary that the physician should not only be acquainted
with fevers, but also know to what extent the body is subject to
the influence of the world ; the practitioner will never err, if he
will oppose these influences.

As long as the heat and cold of the soul remain in a state of
equilibrium, health is the consequence, but fever manifests itself
as soon as this equilibrium is disturbed. If the onset of the fever
be cold, the very excess of this cold, by reaction, brings on heat
and perspiration. If the onset of the fever be hot, cold and chill
will succeed. Whenever the chill and perspiration occur on a
critical day, the disease will cease ; but if, on the contrary, they
occur on a non-critical day, they will necessarily recur again.
The author endeavors to explain the rationale of these crises by
considering the heat as attracting from the centre to the surface
and vice versa. If the patient be deprived of the proper regi-
men, the flesh attracts the humours, and ardent fevers are devel-
oped. To these accidents physicians have erroneously applied
the epithets ofdeirium, coma, peripneumonia, hepatitis, &c.

Fevers terminate on the 7th day, or on the 9th, 11th and 14th
in the second week, on the 21st in the third week, on the 2th in
the fourth week, on the 35th in the fifth week as it does on the
fifth day, on the 42nd in the sixth week, on the 49th in the sev-
enth week as it does on the 7th day, on the 56th in the eighth
week, and on the 63rd in the ninth week as it does on the 9th
day. The diseases that exceed this period become chronic.
Quotidian, tertian and quartan fevers, may have a crisis in the
5th, 7th, 9th and 14th month, as other fevers do on the 5th, 7th,
9th and 14th days.

The humours drawn into the viscera and into the veins by the
heat of the soul remain sometime without undergoing coction.
When the coction has been accomplished, the crisis takes place
on a critical day. The phlegmonous humours undergo coction
slowly, but the bilious more rapidly. Observation teaches that
a crisis is frequently brought about by a very slight evacuation.

1^37.] Discovery of a work attributed to Hippocrates. 745

The author explains the pathology of ardent levers, ofpletfK-
sy, of pcripnoumony and piquartan fever, and it is here that may
be found the passage quoted by ^Eiius, on ihc subject of the last
fever. We here give his treatment of quartan feVeft In the
first plaee, make the patient sneeze repeatedly ; rub his inferior
extremities up to the middle of the thighs, and the superior up to
the shoulders, so as to make them red and hot ; rub the body and
the head with a mixture of laurel, myrrh, castorcum, cassia, ni-
tre, rosemary and pepper. The blood being thus warmed, cover
the patient with clean, soft and heated garments; place near
him vessels filled with hot water, and allow him to go to sleep.
All this must be done before the paroxysm.

The author gives the treatment of some other forms of fever;
and here we remark the correct observation, that at the onset and
during the progress of fevers, the practitioner must be guarded
against the inflammations that may supervene. " They are dan-
gerous," says he, "in proportion to the degree with which the
disease has exhausted the vital heat, for then it requires but a
breath to extinguish it." The remark is a good one, in despite of
the explanation.

The author details at considerable length the treatment of ar-
dent kver, a disease much dwelt upon by Hippocrates and the
Greek physicians, and which appears to be one of the forms of
the bilious fevers of hot climates. I will not here attempt to
substantiate this opinion, but will in my translation of Hippo-
crates, present the symptoms of this I'vvc.v and compare it with
those familiar to us. The basis of the treatment recommended
by the author is antiphlogistic ; mild diuretics, cooling medicines,
an elevated head, a darkened room, silence, quiet, friciions to the
extremities with warm oil, sternutatories, which according to the
author, tend to diminish morbid heat, cataplasms to the swollen
precordium, &c.

His general pathology rests on two principles: the first of
which is that the number seven, which rules all nature, which
determines the movements of the principal heavenly bodies,
which presides over the development of the human body, also
determines the course of diseases and fixes their limits ; the se-
cond is, that the soul, the vital principle, is an admixture of ele-
mentary heat and cold, and that diseases result from the inequal-
ities which supervene between these elements

The special pathology of the He' domadal. Treatise, is limited
to a few fevers. The signs of these diseases are not enumera-
ted ; but, at the same time that the author omits details consid-
ered in our days of the utmost importance, he does not (Jirgrt to
refer the origin of those fevers to the composition of the vital
principle he has created. He dwells more particularly on treat-
ment and prognosis. Ofdiagnosis, piognosisand treatment, the
first is alwavs neglected for the two latter in the Hippocratio

94

740 Operation for Empyema New Febrifuge. [M ay.

works. Whilst the d stinctive characters of diseases are exposed
in an imperfect and confused manner, (hey are the objects ofno
research, of no scientific deductions, of no importance in ,|le es-
timation of the author, he very carefully details the trea.meni, and
turns ail hmattention to the study, not of the seat and nature of
he disease, but ol the signs l,y which crisis or issue mav be lore-
ol l. 1 he therapeutics and prognosis were much more studied
than nosology .tself. Tins preference of prognosis and neglect
of diagnosis is characteristic of llippocralic medicine.

The author of the Trent,*, bestows onc-fourlh of it on the
consideratton of the signs which precede the crises of diseases
J hese signs applicable to fee, rs and acme diseases, are deduced
from the colour of the whole body or of any of its parts, from
he tongue, the eyes, dreams, the urine, the alvine evacuations,
the voice and respiration.

Operation for Empyema.

*f:jL*fBEY presented to the Academy of Sciences, one of the
individuals on whom he bad succ. ssfully' performed an operation
of this kind. Louis Giarie. a soldier of the imperial army, re-
ceived in the last Russian campaign, a hall which pencl rated the
chest ana remmned lodged in the inferior p,rt of .he right lung
in the midst of a purulent collection. He was four veals aft, ,"-
wards put under the care of Baron Larrev, who found a fistu-
lous opening; hut th,s side of the dust beina collapsed, it was
impossible lo remove .he l,all through the orifice i had made
and ,1 became necessary to rem,, a ,,.,,,; of ri|, j:|, |
pointed knife, such as is used in lreplin,r. The ball was. like
all .hose ol .he Russians, vary large, weighing one oi nee where
JS ours weigh but six drachms, but was seizfd and < Zr'Ju d -
The cure was .protracted, though as complete as possible, and
he subject still enjoys perfect health. The loss of substance
the lung has caused a contraction of the chest on that side the
projection of the heart and mediastinum to the ri<dit and the el
cvation of the diaphragm and liver of the same side. Gazelk
Medicale, tome in. p. b27.

New Febrifuge,

Messrs. Cognon and Leroux. have presented to the Academy
of Sciences, a memoir on LefMine, a sul stance extracted from
the Lepiducm Iberts, which they consider an useful febrifuge.

[Ibid.

1837.] On the Skin of the American .l \c. e. 747

On the Shin of the American Savage, the Negro, and the Mu-
latto.

M". Flourens read to the Academy of Sciences, the result of
his researches on this subject, and alluded to the works of the
anatomists who had preceded him in the investigation. The an-
cients knew but twocoats t;> ;he skin, the dermis and the epider-
mis; Mafpighi discovered in the negro a third, situated between
tho^e, the corpus tnucosum; "Albinus and Meckel specially stu-
died this corpus muenxum; Mitchell detected two strata in the
epidermis; and finally Cruikshank and Gaultier distinguished
also others in the corpus mUGosum.

Notwithstanding these brilliant discoveries, continues M. Flou-
rens, the structure of the corpus mUcosum was far from being
known; hence it is we find the attention of the most celebrated
anatomists directed to its investigation, since Gaultier; in France,
Blainville, Dntrochet, Beclnrd, Breschet and Roussel de Vau-
zeme ; and in Germany, Weber, &c.

The researches of Jf. Flourens, have led him to detect be-
tween the dermis and epidermis, exclusive of the corpus papil-
lire, of which he will subsequently treat, four distinct layers:
the first applied to the dermis, the second on which rests the
pigment urn, the pigmentum itself, and the fourth (or rather third
membrane, for the pigmentum is a layer and not a membrane, as
has been correctly observed by M. de Blainville,) placed between
the epidermis and the pigmentum. Ibid, p. 82$.

Living Caterpillars in the Human Intestines.

M. Dumeril and M. de Blainville reported to the Academy of
Sciences, on a memoir presented by M.. Rebineau Desvoidy on
the above subject. The facts are thus related by M; Lechin. a
physician of Len^ny : A female, aged 57 years, was left af-
fected with abdominal dropsy after an attack of (evew On the
3d of March, 1836, she took (5 drops of croton oil, and in the
substances rejected by emeses. four living caterpillars were per-
ceived at first and subsequently ten others. 7\vo of these were
carried of]" alive by the physician, but List on the way : two oth-
ers were sent by him to a professional acquaintance, who trans-
ferred seven of them in alcohol to M. Desvoidy, of which four
have been forwarded to the Academy by this Xatural'st.

31. Roblneau perfectly recognised their ideality with the cat-
erpillars termed hv Linueus pi/mfis rin uinalis. by Fabricius
crambus. and by Latreilie ouJf>ssa. - The history of these insects
being well known. M. Robineau | s that the ggs were

deposited in adipose food and introduced with it into the womau's

748 On the Uterine Syphon, <$-c. [May,

digestive apparatus ; that here the larvae were developed and
nourished. Ibid.

On the Uterine Syphon, SfC : By Professor MoifTADf, of

Lyons.

It not un frequently occurs that accouchements become diffi-
cult from the rigidity and dryness of the foetal head and uterine
passages, consequent either on the too early escape of the amni-
otic fluid or on a state of irritation, such as to deprive this fluid
of its usual lubricating properties. The pains then dimmish, the
parts become swollen and inflamed, and delivery is distressingly
procrastinated. Having observed a. considerable number of such
cases both in my service at the Charite of Lyons and in private
practice, I have resorted to the following expedient, with uniform
success. The operation is perfectly simple, and this is perhaps
the reason it has hitherto escaped the attention of practitioners ;
but its simplicity cannot diminish its value, since its usefulness is
fullv established.

The instrument is a silver canula. from five to six inches long,
slightly curved, terminated by a flattened oval extremity, very
thin and perforated on both surfaces by a great number of small
holes; the other extremity is constructed so as to receive the
end of the canula of an ordinary syringe.

This instrument, which I denominate an uterine syphon, is
well oiled and directed so as fo introduce the flattened extremity
between the foetal head and the uterus, winch may be done with-
out difficulty and without pain, and, with a syringe, tepid olive
oil is injected so as to anoint the head and passages. The ca-
nula is successively carried around the head, the passages soon
become soft and yielding, and the head escapes without difficulty,
I might relate a great number of cases on this subject, for the
accouchements susceptible of relief by the syphon arc of frequent
occurrence. 1 will at present give but two.

Casel. Mrs. L. had been in labour more than twenty-four
hours, when I was requested in consultation with her physician.
The pains were severe, but the waters had long since escaped.
I proposed injections by means of the syphon, but yielded to the
desire of the attending physician, who preferred the forceps.
The application of these, however, was attempted in vain; in-
jections were used and the head immediately passed out.

Case 2. Mrs. C. had strong pnins, and was extremely ner-
vous; the waters had passed off three days before; the parts
were dry and apparently inflamed ; according to the midwife,
the pains had been strong for several hours, hut had effected no
change in the position of the child. Injections were made around
the child's head, and it almost immediately came through with
the greatest case Ibid, 771.

1837.] On Laceration of the Urethra. 749

M. Montein als > recommends the inj cii >n, by me'aiis of the
syphon, of a tincture of er^ot into the uterus, as preferable in
many instances to its administration by the stomach. The pre-
paration he uses is made by digesting half an ounce of ergut in
three or four ounces of alcohol and keeping the bottle well slop-
ped. Of this, one or two ladle spoonfuls may be mixed with
tepid water and thrown into the neck of the uterus; to be re-
pealed if necessary. If the aelion be too powerful, it can be
moderated by sedative, and subsequently by demulcent, injec-
tions. M. Montain relates two cases in which this medication
was signally successful.

Laceration of the Urethra from a fall tm the Pennxum, with consequent reten
lion of wins, for which the opera/ion if puncturing the bladder was verform
ed: By Thomas F. Betton, M. D.

The rarity of the following case, and the conflicting; opinions of manydis
tinguished surgeon?, as to the propriety of the operation selected for its re
lief, have induced me to present it to the medical public. Without the mos'
remote wish to presume to decide on so important a question, the case with
all the facts, as they occurred, shall be given. Ir is not my desire to write a
paper, but merely to state the case candidly, and wi'h the view to el,,,;4
farther information on this, to me, an exceedingly interesting topif

Gist. On rtie23h of October, 1834, Mr. 1 1.' R. fell from a ladder direct-
ly astride of a cart- wheel, through a space of four or five teet. The acci.
dent happened berween 10 and 11 o'clock, a. m. 1 was sent for that night
at 12 o'clock to see him, in conjunction with his attending physict***, l)r
ShehnerJine. He was then labouring under all the symptoms of retention
of urine. The introduction of the catheter had been fruitlessly attempted,
previously to my arrival; and his physician had used in vain all the mean*
usual in such cases, as a warm bath, fomentations to the abdomen and peri-
naeum, leeches to t lie perinseum, anodyne enemata, etc. From the nature of
the accident, and subsequent symptoms, laceration of the membranous por-
tion of the urethra was to be suspected, and such indeed proved to be the case,
Cn attempting to introduce the catheter, the peculiar fee] indicating that ac
cident, wis plainly distinguishable. There was a peculiar sensation, as if
the end of the instrument had passed over a piece of tense cat-gut, which
was easily perceptible, but which I am at a loss to compare with any thing
analogous. The poriiueum was much bruised and ecchymosed, and the pat
tient, as m'ght be expected, greatly distressed.

29th. 9 o'clock, patient more distressed than at our previous visit, in con,
sequence of the distension of the bladder, the fundus of which had ascended
as high as the umbilicus. As a 1 our endeavors had proved unavailing, noth-
ing remained but to evacuate the water contained in the bladder by some ar-
tificial means. Further advice was obtained, and the operation "above the
pubes being decided upon.it was performed at one o'clock of the same day,
twenty-six hours after the accident.

It was done in the following manner: Hiving previously shaved the
pubes, I mode an incision in the abdominal parietes of about an inch in
length, the base of whk h rested on the symphysis pubis, passing between the
pyramidal muscles, il i to the fascia lining the abdomen. As is well

known to. the anatomist, a pc? ion of the bladd -r isnot invested by peritone-
um, and by keeping the trocar as gIobc as possible to the pubes, and direct-
ing it towards the axis of the viscus, the peritoneum is not in danger of being
wounded, when the bladder is much distended. These rules were observed

759 On Laceration of the Urethra. [Mny,

in the present care, and a female silver catheter left in the aperture.- The
patient was greatly relieved.

30th. Patient easy. Ordered minute portions of calomel, rhubarb and
opium, With mucilaginous drinks. Urine f'ews freely I y the catheter.

31st. Some tenderness of abdomen ; 100 leeches were ordered to he ap-
plied. Continue remedy.

Nov. 1st. From some exertions made during the eight, to our great re-
" greU the catheter slipped out, despite of its tapes. The wound in the blad-
der/had healed, and it was necessary to puncture i! sgain, which was tfone at
half-past 12, p. m , to his great relief.

2d. Seems easier, but has pome fever; gave him a very weak solution of
sub. h. magnes. cum. vin. antimon. etepts. ail her. nit.

3d. The solution has acted en the bowels. Discontinue and substitute
neutral mixture.

4: h. Succeeded in presirg the catheter without any difficulty by the nat-
ural passage, very mi ch to my satisfaction, as it affiirds me some hope of the
patient's life, although his situation has suddenly become, since yesterday,
much more dangerous. The catheter in the artificial opening was removed,
and the orifice cics d. No infiltration n'o the celluli r tissue i f the abdom-
inal partete's had taken place; the irritation of the u nine had excited adhe-
sive inflammation, and thereby condensed the sides ot the incision, so as to
form a cana1, which, but for the closing of the orifice in the bladder, would
have required no canula. H s strength is sinking, and he was ordered miik
punch with chicken water. ' His spins also seem depressed, and 1 ferr.bis
recovery is hopeless. In fact, on my vifitmgh'm next morning, after a lapse
of about fi teen hours, lie was no more. His-skilful and attentive physician,
who had visited him very late at nigh4", and di.1 not live very far from him,
informed me that he appeared to have, ded from mere exhaustion and debil-
ity, added to anxiety of mind. Stimuli were freely administered, but they
were productive of no good.

Autopsy. The membranous portion of the urethra was found lacerated
for about the space of two and a half inches, a. great deal ol Mood effused in
the cellular tissue of the perinBBum The wounds in the bladder had healed
entirely, and that viscus, throughout, was perfectly sound. The peritoneum <
and intestines very carefuHyand minutely examined, evinced not. ihe slight-
est mark of disease, so that we could find no apparent cause for his death,
save the general shock Jtfl a man whose mind was naturally active and anx-
ious. The morbid specimen is in my possession, and it will gratify me to
show it to any one desirous of examining it.

A case precisely similar to the above in every particular, except the attempt
to tap the bladder from the rectum, is related in Dr. Parish's Surgical Ob-
servations, p. 24\ and had great influence in inducing me to venture to pub-
lish the one occurring under my own rot ice. That the accident is not of
frequent occurrence must Ik1 from the circumstance of its having

occurred only twiee in this vicinity. i lapse ol many years ; at least

I have been able to meel with but one on i shed by Dr. Par-

rish. In the case of Mr. It no attempl was made to tap the bladder by the
rectum, as it was deemed most advisable to perform that operation above
the pubes. This operation, ii done, ca& be productive of no ill con-

sequent s ; the peritoneum is not liable to he wounded, if t ho bladder, as it
must be to render the operation urgent, he exceedingly djstended with wa-
ter: the operation is performed in a sound portion of the yisc_us, the irritation
of the urine exc iye inflammation in, and condenses the eel )61ar tis-

sue ot tie- a! domm ' p ir etes, forming ihe track of the canula, and no risk of
inriltrat'on is incurred. Care must be taken that the canula be neither too
k>ng nbr too short, but a (- mtion of this kind it is un ." to make here,

as it must arise uaturally in the mind of every' surgeon. The wound heals
Siery readily, and the chances of a fistulous opening being le;tare very few.

1837.]

On Laceration of the Urethra. 751

h> i v in such cases is d u ' id we should nevi r allow ourselvesai .-

wards to rcgr.pt that the operation had not been performed soo

Observations ott the preceding case by Dr. Isaac Hays,

Rapture of the urethra from externa] injury, ol which the rrecedin
affords an int< res in . , though by no < . ry rare occurrence,

Jias been either entirely I by authors of ^y<' ma-tic ir

surgery, or so cursori ', as to furnish the | ractitioiier v i li but >c\v

principles to ^u'd,' him m the n n1 ol the accident. A brief sketch,

therefore, ot' i s principal nd of Hie best ma: hod ohrea>ing i, may

n>' prove uoacc p'.a'de to rs, and may, perhaps, aid m saving th'e'm

from tli!" m >rtificat.ion of fail ire in thi ireffbr'.s to afford relief, and their pa-
tterns from unnecessary suffering and even losstiflife.

T,ie most frequent rauses ol the accidenl in qy< stion are, falls astride pome
firm body, as a bar, edge 0f a boat, pommel of a -saddle, &c., a Jdek on the
perinaeum, injuries of the pi lvis, &c.

The immediate efinseyuencrs arei severe pain in, and effusion of blood i To
th ' perinaeum, prod icing usu illy tumefaction of this part, and sometimes pro-
fuse haemorrhage through the urethra. A catheter cautiously itf'roduced in-
to the canal ju t named, when it reaches 'he seat rtf rupture, gives the sur-
geon the impression of its being out of the canal, fbr its point is wholly un-
supported and falls from si I.1 to *.d\ On withdrawing the catheter or stilet
afresh haemorrh ige gjNerally ensues If the solution ofcontinui y be com-
plete, and sometimes even \vhep partfa), gj*eat difficulty may ba experienced
in conveying- a catheter into the blad !er, and in soms cases this will be im-
possible. After the la| s i <>:" some time, the patient experiences an urgent
desire, with inability to ; iss his urin*1, and this fluid either escapes by lie
breach in the urethra, and insinuates itselfin'o the cellular tissue of- the peri-
neum and scrotum, enormo isly distending thesn parts and causingthem to
slough, if proper m^ans of re' c\' he not adopted, or there is an absolute reten-
tion of urine, the bladder becomes visibly and painfully distended, and if this
organ is not emptied by the introduction of the catheter or by puncture, it
ulcerates or sloughs, th? urine is effused into the peritoneum; or perineum
andscrotum, constitution il symptoms manifest themselves", and the patient
di 's after great suffering.

Tiie treatment of th. se cases seems to us very obvious. When the ca-
theter can be introduced into the bladder; this sho aid be d me.* Venesec-
tion, leeches, "he warm ba h. poultices, saturnine lotions, and 7\\s/, will then
generally complete the cure. But if the perineum and scrotum .be much
distended with blood; it is generally most prudent to make a/reeinct6ion into
the former part to - . is fluid; and if there be also infiltration of urino,

this operation will be always necessary.

Where much difficulty is experienced in introducing the catheter into the
bladder, the attempt should not bo persevered in, by which the injury is open
increased, without, the object being attained; but a free opening must be
made into the peruueum, by which a ready exit for the urine, biood and
matter is at once secured, and an extension of the mischief prevented^ It is
justly remarked by Mr Earfc, that 'kin many of tb , wh< re there is

no external wound, and where the patjent is ignorant of the nature of the in-

*Dr. Macfarlane states that when the lncerahon of the uret bra is not so
extensive as immediately to give rise to extravasation, lie has succeeded in
preventing it in two cases, by introducing a large elastic catheter into the
bladder and retaining it for several days until the dinger was warded off b+
the sides of the lacerated opening becoming consolidated. (Clinical Re-
ports, p. 139.) Where there is little or no extravasation of blood this will no
doubt be sufficient.

752 On Laceration of the Urethra. (.May,

jury, and the danger to be apprehended, it is of;en difficult, to persuade him
or his friends of the necessity for such an operation. Much decision and
firmness are required on the part of the surgeon, who should act at once, or
he may be too late to prevent extensive or even fptal effusion of urine. No
possible danger is to be apprehended from the performance of the operation,
which places the patient in a state of security, and enables nature to set
about her process of reparation. The wounds always heal readilv, if proper-
ly treated, and the external incision be of sufficient extent." London Medi-
cal and physical Journal, April, 1828, p. -U7.

The operation is best performed by placing the patient on a table in the
same position as for lithotomy. An incision should be made along the line
of the raph.1 of the perineum, and the coagulated blood removed. A cathe-
ter introduced through the glans penis may then be passed into the bladder,
the urine evacuated, and the instrument fixed in its situation by a T bandage.
Simple dressings are to be applied to the wound, which usually heals without
difficulty, and the canal is restored.

This upc-rat/on is far preferable to the puncture of the bladder, either above
thepubes or from the rectum. The latter is, indeed, often impracticable in
these cases, as is fully exemplified by a case presently to be related, and it
should never be attempted. The former, though much less objectionable
than the latter, is attended with more danger than that we have recom-
mended, and is calculated only to relieve one of the consequences of the in-
jury without directly contributing to its cure ; and in many cases would not
supersede the necessity for a free incision into the perineum.

These observations will be illustrated by the following cases :

Case 1. The subject of this was a man 25 years of age, wh*n received a vi-
olent contusion in the perina?um, by falling with his thighs separated upon the
end of the axletree of a carriage. The severe pain which he felt, did not at
first prevent him from continuing his work, but he soon had retention of urine,
and in a little while there appeared at the bruised spot a tumour, which in-
creased rapidly. The swelling extended to the penis and scrotum, and ties
last was swelled so considerably that, in the evening, it acquired the size of
an adult's head, and was already of a black colour. In this state the patient
was admitted into the Hotel Dieu, 10th January, 1790. As he had not made
water since morning, and as he suffered much, the bladder was first emptied
by means of a catheter, which passed easily, and which was withdrawn after
the operation. Dessault then made an incision from the left side of the an-
terior part of the scrotum along the perineum to the spot where the urethra
was ruptured, and which left naked the vagina] coat of the left testicle. The
cellular tissue was found infiltrated with urine, and there was much coagula-
ted blood along the canal of the urethra. This incision afforded much relief.
Mild dressings w ere applied to the wound. The urine at first flowed through,
the incision in the perineum ; on the sixth day a few drops passed through
the urethra The wound'gradually healed, so that on the 29th day the urine
principally passed through the urethra The "cicatrix, however, contracted
this canal, and it was necessary to dilate it. by the introduction of a catheter.
The urine ceased to flow through the artificial opening on the 58' h day, and
the patient left the hospital cured on the 85;h day. DessauWs Surgery,
Vol. II.

Case 2. "A man 20 years of age, fyll from a height across a ladder upon
the perineum. Much swelling and tension of the parts from the anus to the
scrotum succeeded, with great discoloration. Leeches were applied and the
bleeding encouraged by warm fomentations ; afer which a poultice was em-
ployed and a saline purgative given, which operated largely during the day.
In the evening he took an opiate draught with tartarized antimony, which
procured alleviatfon of his pain, and produced some sleep. The next day he
had much tension of the abdomen, and was unable to void his urine. The
catheter was introduced without much difficulty, and a large quantity of

1837.] On Laceration of the Urethra. 753

urine, dear nnd untinged with bload drawn off, and the operation was repea-
ted as often as the patient expressed much uneasiness from distension of the
bhd ler. A similar plan was pursued with little variation for seven or eijrht
days, during which the symptoms were not materially arrested. The dis-
coloration at this time had extended to the se.rotum and penis, which were al-
most buried in the swelling, and which had now become somewhat aei'ema-
tous. in the bight of the eighth day, during a pressing effort to make wa-
ter, he was seized with a pain of a much more acute kind than what he had
before experienced, and on attempting to pass a ca'heter it met with consid-
erable resistance, and could not now be got into the bladder as usual. -

" Unavailing attempts. were agam made to introduce ca'heters ot different
sizes and curves but the obstacle could not be surmounted. The point of
the instrument seemed, when it had arrived a little beyond the bulbous part
of the urethra, to quit the canal and get into a pouch on the left side of the
raph j

"The man's health was now becoming much disordered from constant
pain. The pulse was rapid, tongue furred, much thirst, universal heat on
the skin, appetite lost and sleep disturbed. It was determined to pass the
cafheter as far as possible, and to make an incision upon its poin\ which
might be felt externally on the left side of the seam in ptriruto. This was
accordingly done to the extent of more than two inches, through the integ-
uments, much in the same direction as in li hotomy. A large mass of coia"-
uiated and grumous blood was pressed out by the fingers, which was fol-
1 wed by a discharge of watery fluid to the extent of a quart at least, of a
strong urinous smell, ar.cl highly tinged with blood. The catheter might
then be distinctly felt and seen, having found it's way through the newly
formed aperture in the membranous part of the urethra. The patient's suf-
ferings became immediately relieved. A largs quantity of water drained off
during the night, which reduced the parts nearly to their ordinary dimen-
sions. On the following day, when the dressing was removed, the patient
was directed to exert an effort to make water, when the whole contents of
the bladder escaped through the wound.

44 A flexible elastic gum catheter was then introduced, and left in the blad-
der, through which the man voided his urine, which, however, came away
partly by the external opening, but chiefly by the catheter, till the wound
began to heal. The urine then gradually resumed its natural course, rnd
he perfectly recovered in about a month from the time of the accident, wi4h-
out any other bad symptoms." London Medical and Physh al Journal^ Sep.
tember, 1812.

Case 3. 44 A man aged 42, fell across the edge of a door upon his perineum.
Considerable bleeding took place from the ureter1, and effusion into the scro-
tum and perineum opposite the bulb. When admitted into St. Bartholo-
mew's Hospita', he had not passed any urine for many hours. An attempt
was made by the dresser to pass a catheter, without success ; and Mr. Stan-
ley, who was passing through the ward, was requested to see him. After
some time he succeed d in passing a small Plastic gum catheter into the
bladder, and some water mixed filth blood was drawn off. Mr. S. distinctly
felt the rupture in the urethra in passing the instrument, which was directed
to be left in the bladder.

Mr Earle saw the patient the following day, and found a tumour of the
6ize ot a large walnut rather to the left of the bulb. The scrotum was black
with effused blood, but not much distended. Urine mixed with blool con-
tinued to flow through the catheter. He was largely bled from the arm, and
twenty leeches were applied to the perineum.

44 He continued to go on favourably for some days, but on the 2oth the ca-
theter slipped out, and the patient attempted to reintroduce it, which caused
some return of arterial bleeding. He had suffered during the preceding
night with severe rigors and fever. Mr. Earle introduced a large catheter

S3

734 On Laceration of the Urethra. [May

without difficulty, in doing which the laceration in the urethra was distinctly
felt about the bulbous part. The shivering and fever returned at night, ar.d
the patient removed the catheter, which was followed by considerable he-
morrhage.

'On the following day he was very i!1, with frequent deposition to shiver,
and the tumour in the perineum had increased in size. A free incision was
made through the tumour, and extended downwards towards ihe anus. The
membranous part of the urethra was distinctly fJt, but not opened, as the
lacerated opening communicated directly with the upper part of the incision,
and afforded a ready exit for the urine. The wound bled freely, and gave
the patient much relief From this time he was able to pass water without
the assistance of the catheter, partly through the wcu id, but principally
through the natural passage. The wound suppurated kindly, and speedily
healed.

"It was necessary for some time to pass bougies, to counteract the effect
of the contraction ax the cicatrized portion of the urethra." Ibid, Airi/t
18-28.

Case 4. "A man, aged '3d, was admitted into St. Bartholomew's Hospi-
tal, September 13th, 1&27. He stated, that on the previous evening, he had
fallen about fifteen feet and struck the perineum across an iron bar. Vio-
lent haemorrhage took place from the urethra, and the scrotum and integu-
ments became distended with blood, accompanied wil h severe pain. H^ sent
for a surgeon, who made many attempts to pars a catheter without success.
He was bled, and leeches were applied to the part ; but he passed an'ght of

freat misery, and the following day was admitted into the hos i'al. His
ladder was at this time to be felt above the pubes; no urine had passed
since the accident, (sixteen hours,) nor for some hours befon*. His counte-
nance was anxious, and expressive of much suffering; pulse 100 and full;
perineum and scrotum much distended; and of a dark livid colour; there
was no external wound.

Mr. Earle cautiously introduced a full-sized silver catheter* which pursed
readily down into a cavity filled with coagulum, between the rectum and
membranous part of the urethra. The finger, introduced into the rectum,
readily detected the point of the catheter in this situation. Mr. E. imme-
diately made a free incision opposite to the bulb of the urethra, and extend-
ed it parallel to the rupture to the extent of two inches. A quanlity of co-
agulum and fresh blood escaped, and the catheter became apparent, passing-
through the ruptured opening at the upper p^rt of the bulb. Mr. Karle at-
tempted to introduce an elastic gum catheter from t Irs part into the bladder,
but not readily succeeding, he desisted from any effort. The finger, intro-
duced into the wound, passed into a large cavity filled with coagulum. It
did not appear that any urine had been effused. He was place;! in a warm
hip-bath, which encouraged the bleeding from the wound, nnd loosened some
of the coagulum. Whilst in the bath, some urine flowed through the wound.
He now became very faint, and was removed to bed ; and the bleeding waa
restrained by the application of lint and cold cloths. Urine mixed with : lood
continued to dribble away. He passed a tranquil night, without any return
of bleeding.

On the 15th, he pissed about half a pint of urine voluntarily through the
wount', which relieved h;m much.

On the 17th, he experienced difficulty in passing h:s water through the
wound, and the dresser endeavored to remove a coagulum which presented
itself. This was followed by a return of ar'crial blec d'rg, which continued
to flow through the greater part of the nigh*, until the patient was alarm-
ingly faint, requiring the administration ol brandy and ammonia, with opi-
um.

On the 18th, no urine had passed, but the bladder was not d stended. He
continued very faint, with a feeble intermitting pulse. On raising him upon

1337.] On Laceration of tho Urethra. 7W

a night-chair, he was able to pass water through the wound. Suppuration
now began to take place, and no farther alarming symptoms occurred.

Oc'o'j?r 2J. A good sizel metallic bougie, No. 12, was introduced. On
reading the (situation of the woun'l, it met with some resistance, which was
readily overcom?, and the instrument passed or! without difficulty into tho
bladder. On withdrawing the bougie, the patient passed sonic water through,
then itural passage.

"The boug'e was introduced every second diy. The wound in the peri-
neum How r ipidiy healed, and was closed by the 8th of October." Il>id.

Case 5. A gentleman, in consequence of tjjs horse taking fright and run.
ning away, Ion bis stirrups and seat at the same time, and was forcibly
thrown forward on the pommel of the saddle, whore he remained <*ome time,
t ie horse piu.iging and galloping violently. The gentleman being a good
horseman* several tunes attempted to regain his sea', but was as often thrown
forward; when finding himself much injured he threw himself on the ground,
whence he was carried home. The surgeon who saw him first, found that
there was a very considerable contusion a'ong the course of the urethra, and
that, the peni3 en! scro'.um were much tumefied; the latter, indeed, filling
fast wir>- extravasated blood and urine. The patient was bled, look an ape-
rieet, and" a saturnine lo' ion was applied to the injured parts; several at-
tempts were made to explore the urethra, but in vain. In the evening the
appearance of the parrs was still more formidable; the scrotum at this time
\va> enlarged to h s ze of a ch 1.1's head, and perfectly black. Under these
circumstance?, iMr. Cline, w o was then called in, ten hours aft^r the acci*
dent, made a lateral incision in the perineum, (as for lithotomy, but with*
out the usual guide of staff or sound) and having punctured the bladder,
urine issued from the wound. An opiate was then administered and the
patient put to bed. I a the morning the appearances were more favorable,
'the urine flowed through tha wound, and the scrotum had not increased in
size. All inim 'dire danger had subsided, and it was hoped that when ab-
sorption of the fljid contained in the scrotum took place, that an opportunity
m gat present itself of discovering the passage into the bladder by the ure.
thra ; all attempts at which, under the present circumstances, proved com-
pletely abortive. Ti;e-o expectations were verified by the event. The pa-
tient was enjoined a strict regimen, due attention was paid to the bowels, and
an opiate gra ;rally administered at night'. In the course of a fortnight, the
absorbing prozess pr 'settled a curimis fmennmerfn. T>ie whole surface of the
abdnmsn% nni imm the pubis in Vie dim, displayed extravasated fluid in all Us
shahs upwards. No untoward svmptom had occurred, the urine continued
to piss by the puncture. A portion of the urethra was discovered, and eve-
ry day morn of that passage was found ouf ; till at length, before a month had
expired from the time of ihe accid ev, a few drops of water discharged itself
through the urethra, and afterwards continued to pass through that channel ;
the external opening was allowed to heal, the parts wore reduced to their
nVural size," and in another mouth the patient was entirely well. lbia\
May, 1809.

Case 6. The subject of this case was a lad sixteen years of ag-e, admitted
into SL. Thomas' Hospital, 1"> h July, 1826, with retention of urine, accom-
panied with severe scalding pain in the perineum, and earnest desire to
empty the bladder.

" On examina' ion, the bladder was found distended and rather painful, and
I ha perineum much swollen and very tender: from this part the cuticle
W s partially abrad yd, as it was also from the inside of both thighs, where
ecchymosis to a considerable extent had taken place, producing great d's-
coloration, in which the scrotum and penis participated. Tlio lad walked
with ranch difficulty, bending forward the body and" separating thsle^pa, and
J>o complained that this exertion aggravated the pain*

V.

759 On Laceration of the Urethra. l_May,

"On inquiry, it was ascertained that, at 6 p. M.t while standing on form
rr.ils to take down the blinds from a window, his foot slipped, and he fell, the
legs crossing- ihe railing-, and the whole weight of the body and force of the
fall being concentrated upon the perineum. Ke immediately felt an urgent
desire to void urine, but was unable to pass a single drop, and, rot having
passed water since the morning, the repeated ineffectual attempts produced
considerable pain. The swelling and pain in thep rineum came on at the
same time, and, continuing to increase, he was brought to the hospital ; and
an attempt was made to introduce a catheter, which however passed no fur-
ther than the bulb of the urethra, and there appeared to enter a carry, in
which the point, readily moved in every direction: during this operation, a
small quantity of blood escaped. Mr. Travers was now sent for, who on his
arrival repeated the attempt with no better success ; and he therefore re-
solved upon laying open the perineum and endeavoring to find the continu-
ation of the urethra, as no doubt was now entertained as to the fact of lace-
ration having taken place.

"July 16th, at half-past 3 a. m. The lad being placed on a tabic, in the
same position as in the operation of lithotomy, a d.oep incision was made
along the line of the raphe of the petineum, and a large quantity of firmly
coagulated blood removed. A catheter was then introduced at the glans
penis, and the poixit of the instrument was seen in the wound, surrounded by
the torn urethra, which appeare I to have been completely divided at the
bulb, one-third of its length from its termination in the spongy portion of the
urethra. Alter a short but attentive examination, the continuation of the
canal, having a clean cut edget was found retracted about hah an inch, and
thrown to the left side. Into the vesical portion a silver female catheter was
passed till it entered the bladder, when two pin's of clear urine were drawn
off. No urine appeared to have escaped previously ; nor did a droo pas?,
notwithstandi g the repeated efforts of the patient by Mr. Travers' direc-
tion, preparatory to the introduction of the catheter. The female catheter
being withdrawn, a gum elastic catheter was introduced along the whole
line of the urethra. Simple dressings were then applied to the wound, and
retained in position by the T bandage, to which the catheter was attached.
The lad was now removed to bed.

44 10, a. M. Ho has slept one or two hours. Has but little pain. The
bladder is not distended, but there is slight tenderness of the hypogastric re-
gion on the left side. Neither faeces nor urine have been passed since the
operation. The face is flushed ; pulse 110, full and firm ; tongue white and
dry, slight thirst.

Ifr. 01. Ricini %ss. statirn suraend. ; et post duas horas repetend. nisi
tlvus prius respondent.

44 2, p m. The bowels have been freely relieved, and he has passed half
t pint of clear urine, r ither high coloured ; since which the pulse has become
leas rapid and his general appearance more tranquil.

"For two days a little urine escaped through the wound, but on the 19' h,
the whole pafsad through the catl. e'er, and the wound was healthy and gra.
nulating. On the *22d, the catheter became partially plugged, and, no' with-
standing the injection of warm water, the obstruction daily increased, and by
th? middle of August none of the urine escaped 'hrough i\ hut took its courr e
principally through the urethra, by the side of the instrument ; wh;lea small
<j lantity passed in drops from the wound. Th*J cn'heter was, however, suf-
fered to remain as a director to the urine, and for the purpose of obtaining a
eomnlete re- establishment of the canal of Us proper dimension.

44 In the beginning of September, the bladder becoming rather irritable, and
the wound in the perineum painful, the catheter was removed, and found
coated and lined with a thick deposit of uric acid, for about two inches from
the extremity which had lodged in the bladder. The removal was followed
by a little hcoaorrhage from the urethra, which soon ceased.

1837.] On Laceration of the Urethra. 757

44S?pfember 9;h. Tho irritability of the bladder his subsided, and the
wound is healthy and granulating; nearly one-half has cicatrized. Less
urine passes through the wound since the removal of the catheter.

Oc'ober 11th. Tin1 wound b u n >\v completely cicatrized, except at a p:n's
po:nt opening?, through w uch twej or thr >e drops of urine, at The moss es-
enp j during the day. T.^e stream of urine from the urethra is as large, and
pass >s as freely as before the op ration.

14 By ih; applicition of lun at caustic to the openmg, it heilod in a few
days; and on October 25th he waa discharged." Ibid* Jan 1827.

Cmsp7. "A^'ox, muscular man, aged 41, admitted in'o St Thomas*
Hospita', 10th Aug isr, 18*26, with retention of urine, of 48 hours duration,
the consequence of an injury to the perineum.

"It appeared, r h it on the evening of AtlgustStb, he was occupied in the
ch line of a vessel lying off Rotherhithe, when, by some accident, he lost his
hold, and fejl about six or seven tee*, with one leg on each tide of :he edge of
a bo it, so that the perineum was severely bruised : considerable swelling and
tension were the immediate consequence ; but having passed his urine two
or fliree hours before, he felt no desire to evacuate the bladder During the
night he slept we!', as usual, and was quite easy till the morning of the 9 h,
whn, on attempting 'o make water, h^ found that merely a small quantify
of blood passed from the urethra, unmixed with urine. The retention con-
tinuing, and *he desire to void the urine becoming more urgen% in the even-
ing he applied to a snrgeo", who attempted to introduce a catheter, but was
foiled by the arrest of the instrument at the bulb of the urethra. About half
a pin* of blood flowed 'h rough the catheter. The surgeon then directed the
application of twelve leeches and a poultice to the perineum. On August
10th, !he urgency was srill greater, and the lower part of the abdomen bo-
cam painful; hut his health was not disordered, and he was able to walk
three or four hundred yards to consult an h^r surgeon, who applied six-
leeches. On *h ! evening of the 10 h, he was brought to the hospita1, when
the permeum was found en ire, but much swollen and tend r to the touch s
the penis and scro um, and the inside of both thighs discoloured by effused
blood; and the hi id ier evidently much distended, producing considerable
pain in the lower part of the abdomen. The desire to emp'y the bladder was
very grea\ an I gave an anxious expression to the countenance; the pulse
was hut s?'ghtly q'uekened.

"Mr. Green, nfrer a'temo'ing to introduce a catheter without success,
(pro hieing on'v a flow of blood,) directed -he pa'ientto be placed in the same
posture as in the operation of lithotomy, and then made ail incision in the
line of the rapht of the perineum, the knife passing into a cell of blood, part-
ly fluid, par ly co gul ited, extending towards the arch of the pubes. On in-
troducing 'he catheter from the glans penis, it passed into this cell, protru-
ding win it th^ ragged edges of the ure'hr >, which was lacen'ed to the ex-
ten' of arnnch. probably < lose to the prostate gland, as no diffi ul?v was ex
perienced in pissing the catheter on to the bladder. If was a'so "distinctly
seen that the triangular ligament was partially lacerated. Three pin's of
urine, highly tinged with blood, wore drawn o ~ and the silver catheter left
in 'he bladder, an I fixed i i i*s si uation >y a T >and ge.

44 A g ist 11 h. II is passed a comfort ible night, and is easy and qui'e free
from pun, eteeptaag :ha smirting of the wound. Pulse, sixty. five, fall, soft,
and r'gtil r; the tong io is fou', and he has slight thins*; tiie bowels have
been moved twice ; the urine passes through the catheter in tolerable quan-
tity it is, however, mixed with b'o"d : a sma'l portion passes from the wound
in the perineum. The tenderness of the abdom n has subsided.

uThe urine continued to be bio dy till the 14th, after which it became na
tural. The bowe's were rather CO *ive, and he was ordered to take ()1. Ri.
cini 5 ss. pro re nata. S^rec the urine continued to pass by the

wound till the 19tb, after whri :b Use whnk passed through the catheter.

,'oS On Laceration of the Urethra* [May,

"August 20th. The catheter having become partially plugged, it was re-
moved, cleaned, and again introduced. The wound is healing rapidly, tho
granulations at the bottom having inosculated.

September 4 h. The granulations have filled the wound, and are now on
the same level as the per.neum. Cicatrisation to soma extent, has taken
p'ace at U12 extremity of the incision, and the same process is going on at the
edges

M As the vessel to which he belonged was on the eve of sail'ng for Rgi,
and as the captain was unwilling to go without him, the patient was allowed
to leave the hospital; havi jg first exchanged the silver for an chstic gura
catheter, which he was directed to wear till the wound was quite healed."

[Pnd, Mmj, 1837.

Case 8. "A robust man, 40 years of age, whilst in the act of mounting a
horse, (4 h March, 1837,) was, in consequence of the strap of the stirrup gi-
ving wa -, thrown upon the ground ; whilst 1 lag upon h:s back, with h's b >t
entangled in the stirrup, he made several violent but ineffectual efforts to re-
g iin h:s footing. The bystanders asserted, that whilst the patient lay on Hie
ground, he was trod 01 by the horse; but {here was no mark of external
contusion, not even the slightest scratch or bruise. Being disengaged from
the horse, he was able to walk a considerable distance, to his home; wh m
he arrivtl there, he discovered that blood was flowing profusely from his
penis. Dr. 1). F. Condie, the narrator of the case, saw the patient, about
half prist nine, p m. A full stream of bright coloured blood was flow i ig from
the orifice of the urethra, and the amount of blood which had been discharged
was considerable. He was dieted to goto b-d, to have cloths wrung out
ot cold water applied around the penis, and to the pubes, and to take a dose
of sulp. magnes. in divided portions. Eirly the next morning, (9:h,) the
patieut was found in great agony, from a coas'ant desire, without the ability,
to void his urine. The bladder was grea'ly distended : he had never before
been affected with a s'oppage of urine, and had, a few minutes previous to
the acciderr, passed it in a full and fr.je stream : during the night he h:id
discharged, at. intervals, a small quantity of b'o>d. A catheter was readily
passed uito the bladder, and through it was immediately discharged about a
pint of blond, mixed wi h a small quantity of urine, followed by a few coig-
ula: th; discharge ceasing, the catheter was withdrawn, and found to be
completely filled with roagul t *d blood, br. C. attempted to introduce an-
other of the same size and curvature, but without success; after en'ering
the urethra about an inch, the instrument appeared to escape from the natu-
ral canal, when its further progress was immediately arrested ; by a sligH
change in the direction of the point of the instrument this first impediment
was, without much difficulty, overcome, and the catheter could be passe dor,
until it arrived at the arch of the pubes, where it was found to enter an un-
natural opening at the inferior part of the ur thra ; its point being felt al-
most immediately beneath the skin. The patient was put. into a warm bath ;
o: i im gr. i. given, and cloths wrung from warm water app!i d over the blad-
der. With the assistance of Drs. R. Coates and J. H Barton, attempts
were ae-ain made to introduce the catheter, varying the size, form, and diree-
ton of the instrument, in every possible manner, but with no better s: c-M ss;
and every attempt produced considerable haemorrhage The attendan e
Were satisfied 'that the urethra had been torn across at two different places ;
one about an inch within the eX'ernal orifice, the other at that part of the
canal corresponding to nearly the centre of the scrotum About twenty
hours had now elapsed since the occurrence of the accident. The patient
complained of m ;ch pain in the bladder, which latter was greatly distended,
and rismg considerably above the pubes. The propriety of an operation to
evacuate the bladder was suggested, 'as, however, the general system of
the patient had, as yet, suffered but little, his pulse, strength, and spirits con-
tinuing good, this, taken in connexion with the very doubtful resuJJ. of any op-

1837.] On Laceration of the Urethra. 759

erafi/tn that could be ff.rfarmed, and the earnest en'rea'ies of the patient to
delay as long as was possible, induced us to wait, the appearance of ;he case
on the next day, before coming to any decision. In the mean time, the
warm bath, warm fomentations over the pubes, and internally opium gra. i:j.
were directed.' During the night the patient passed a considerable quanti-
ty of very dark coloured blood, mixed with urine ; and the next, morning the
distension o! the bladder was somewhat reduced, and nearly all uneasy sen
Bations were gone the scrotum and penis were somewhat swollen, and to-
gether with the perineum, were of a dark colour, from an injection of blood
in the cellular tissue. The patient being costive, directed an enemata.
During the day, he continued to pass, at interval.-, a large quantity of blood
and urine, and during the night f the 7th, after a violent effort to empty the
bladdi r, a coagulum escaped from the urethra, two or thr^e inches in length
and nearly of the thickness of the little finger ; it was fo, lowed by a very i o-
pious di charge of extremely dark coloured, somewhat foetid urine.

"8th. Nearly all swelling and uneasiness of the bladder removed: the urine
passes i>tT in voluntary Bowels being costive, directed a dose of castor oil.
The patient appeared from this time to be gradually recovering from I he ef-
fects of the accident, until the 14fh, when he complained of tenderness along
the course of the urethra, with heat and smarting in the act of passing his
urine. Skin hot, pulse quick and frequent, thirst considerable. In the
course of the day, the pain in the urethra greatly augmented ; on examina-
tion, found the fatter, particularly in the perineum, swollen mid hard : the
scrotum was also greatly enlarged, tense and painful, presenting many of the
appearances of hydrocele : directed twenty-four leeches to the urethra, and
a dose of sulph. sodee. From continued neglect on the part of the patient,
the leeches were not applied until the 17th. The pain, hardness and swell-
ing of the urethra, were greatly relieved by the topical depletion. In the
evening, the discharge of ur.ne was again entirely suspended: the bladder
somewhat distended, bowels costive ; directed the leeches to be repeated to
the same extent as before, and the patient to take, occasionally, a dose of the
compound powder of jalap ; the scrotum and region of the bladder to be kept
constantly fom ntedwith cloths wrung out of warm water: from these the
patient, evperienced very great relief ; and, on the morning of the 19 h, he
passed a coagulum, four inches in length, and about the thickness o* a com-
mon quill, perfectly white, and rounded at the extremities ; the coagulum was
followed by about a quart of dark coloured urine: swelling and pain of the
urethra, and distension of the scrotum, greatly diminished; in which state
they continued, the patient, passing his urine naturally, until the evening of
the 21p\, when the inability to evacuate the bladder, with the pain and swel-
ling of the scrotum, again returned: every attempt to introduce the catheter
was ineffectual. By the 22nd, the tumefiction of the scrotum extended half
way to the knees ; a very considerable swelling was also discovered in the
perineum, soft, and without pain On' attempting now to introduce the ca-
theter, the instrument, after continuing in the course o/ the urethra for a few
inches, suddenly dipped down within the scrotum, and from thence gave die-
charge to a very considerable quantity of thick, ropy, deep coloured urine.
At this period of the case, Dr. Hewson had the kindness to see the patient
with me; it was concluded, that in order to give a free passage to the urine,
an incision should be made into the urethra, at the anterior part of the peri-
neum: this was accordingly done, and through this opening, the urine con-
tinued to he entirely discharged, until about the 30th. From the period of
the operation, the swelling and inflammation of the scrotum very rapidly di-
minished, and were entirely removed by the end of the month, at which time
the patient was able to walk out. The urine was now occasionally passed by
the natural outlet ; and by the 13th of April, the opening in the perineum
was entirely closed, and the patient discharged cured." iV. A. Medical and
Surgical Journal, OcU 1827.

760 On Laceration of the Urethra. [May,

Ca?e 9. A man, aged 22, on the evening 0f 17th July, 182-3, received a
violent kick on the perineum from a man's foot. "A profuse hemorrhage
immediately took place from the urethra, and lie nearly fainted from the ex-
cessive pain which 'ho blow occasioned. On the following morning, the
18th, he was brought to St. G urge's hospital, having been unable to make
water since the accident, and suffering much uneasiness from ihe dimension
of his bladder. There was a good deal of discoloration a! out the perineum,
from ex'r.nasat.ion of blood ; but very li:tl swelling', and not so much ten-
derness as might have been expected. Tnc house-surgeon passed a silver
catheter into the bladdor, and drew off a pint and a half of urine, mixed with
dark coloured blood. The i jb lorrhage had previo. sly ceased, and there w s
now only a slight oozing of blood from the urethra

" He was directed to have some hot'se-physie ; to keep the contused par's
constantly wet with compresses soaked in cold spirit lotion ; and a flexible
gum catheter was placed in Ihe bladder, in order to prevent any effusion of
urine from taking place through the ruptured per ion of rhe urethra.

"In the evening, it was found that no water I ad be en voided through the
cathe:er, the eyes of it having b -en Hocked up w i-tjn coagi laied blood ; and
there was a good deal of pain at d distension aboul the W dder in consequence.
The instrument was therefore taken out and . oduced, and twelve

ounces of urine drawn off.

'.Inly 19th. -The water had flowed freely t; eter dur ng the

night ; and tins morning early he took a Senna d] ch operated well.

In the last portions of urine voided to-day were a f< Irops of blood He
said he was free from pain ; he had no fever, and there was scarcely any
swelling in the perineum.

"In the evening, he complained of pain in the head, and had made no water
since the middle of the day ; he had a dry, furred tongue, and a small, weak
pulse. A fresh catheter was passed, but there was no urine found in the
bladder, and only a few drops of blood came away. He was ordered a
draught with thirty drops of laudanum and a drachm of tSp. Mther. Sulph.
comp.

"20;h. Had a restless nigh1, but did not complain of pain. H? h"d made
no water, and was much in the same state as on the preceding evenirg.
'I he catheter was again passed, but no urine was found in the bladder
There was no particular heat of skin or thirst, or urinous smell about his
person, as is sometimes the case where the secretion of urine is suppressed.
He was directed to be put into the warm balh, ?nd to take the following
draught every two hours: 1^. Pulv. Ipecac, co. gr. v.; Fo^asse Nitr. gr.
x. ; Pulv. Tragse. co. 3ss. ; Aqua Piment. gjss.; Sp. M'h. Nitr/3j. M.
fiat haustus.

u In the evening he became comatose, and the skin over the whole body
completely jaundiced ; and on the following day, at 1 1 o'clock, he died.
About two hours before he expired, the catheter was passed, and two ounces
of dark-co'oured offensive urine were drawn off.

"At the examination of the body after death, the urethra was found to
have been extensively ruptured between the bulb and the prostate giand ;
and the cellular structure surrounding that parf, and in the perineum, was
loaded with a profusion of dark-coloured coagulated b'ood, but without any
admixture of pus or urine in it. The bladder was quite empty, nnd in a per-
fectly healthy state ; nor Could any disease be observed in the kidneys, or in
any of the viscera of the abdomen. The gill-ducts were not obstructed.

"In this case the suppression of urine probal ly depended on nervous sym-
pathy, or consent, between the kidneys ard .he urethra. It came on at the
expiration of nearly forty-eight hours after the receipt of the acciden% at a
time when every thing appeared to be going on in the most favourable way,
and destroyed the patient at the termination of about forty hours. * London
Medical and Physical Journal, May, 1827.

1537.] Medical Society of Augusta. 761

Taut III.-MONTHLY PERISCOPE.
MEDICAL SOCIETY OF AUGUSTA,
Addendum to the Argument on the Abolition r>f Pessaries.

L\ our notice of the proceedings of the Medical Society of
Augusta, on the 2'2(\ of February,* l>y inadvertence, which cs-
Capad our noiice in reviewing the proof which we did not com-
p:ire with the essay, we made the essayist say, ''that he had
conversed with all the physicians of Augusta, and that they are
as seven against passaries, to one in favor of them." We should
have said "the united testimony often physicians of our city, I
may say of all but one or two, goes to establish the fact, that
pessaries are now seldom required, and that they are inj irioui
when appl'ed for prolapsus uteri." The statements made by the
essayist will be seen on reference to the second p:ige of the essay,
or (>44 of the journal.

It should be recollected that having no stenographer, we have
been obliged to take down the proceedings <f the society in
great haste, or by memory alone. We take pleasure in correct-
ing the error of inserting seven for ten. especially as taj.th in
medical science is not always determined bv numerical force.

We had no intention whatever of weakening the argument
acrainst pessaries in that way. Nor had we in omitting the re-
plications of the essayist to the object! >ns made to his arguments
in the debate. We omitted these, because we recollected no
particular argument ofiered in them, beyond those contained in
the body of the essay, which we considered covered all the
ground the essay"st wished to occupv. Rut as we are now ad-
vis xi to the contrary, it affords us pleasure to make amends for
this omission, by publishing the following replications of Dr. P.
P. Eve.

In reply to Dr. Antony, the essayist said, if he had begged the
question throughout, as slated. Dr. A. was unnecessarily solici-
tous about guarding the medical class against the reception of
unwholeso no. doctrines. ''Begging the. question throughout an
essay, he said, was certainty a new m de of instilling doctrines
into the m:n Is of students.'*

2d. He had not, a* Dr. A supposed, considered the pessary
as an exclusive treatment, but had laid particular stress on the
penological condition of the parts in uterine displacements, in
relief of which his object was to exclude that instrument.

3rd. He acknowledged he had supposed tint Dr. A. applied

* See Southern Medical and Surgical Journal, Vol. 1, p. 691.

90

762 Medical Society of Augusta. [May,

pessaries in almost, every case of uterine displacement. It" in
error here, he could, lie said, plead for excuse Dr. A's. declara-
tion that he had treated upwards of a thousand cases of prolap-
sus uteri wit!) the pessary an 1 that the rep'acement and reten-
tion of die uterus in its proper site is the lei;imatc prescription,
and the bilboqnet pessary the best retentive means.

4th. He said Dr. A. had overlooked the fact that he had men-
tioned in the second paragraph of the essay, the difF rent mate-
rials, form, &c, of which pessaries had been and are still m-ade
even that of wool.*

5th. He was unconscious, he said, of doing; his corrrspon 'ents
the injustice ascribed to him by Dr. A. ; for he had proceeded up-
on the presumption that they had heard of 'wooden pessaries"
since wool is one of the oldest materials of which these instruments
were maclp.f

6th. With respect to the fact that authors bad been verv de-
fective on this disease (prolapsus utrri), and that the pro ft ssion
appeared to know less, both of the diasjn >sis and treatment of
this disease than aim' st any other affciion, the essayist sail he
could not but think that Dr. A. was brought to this conclusi n by
the very peculiar views he entertains on this subject. With all
due deference, he said, to his extensive experience in this disease,
he could not believe Dr. A. alone correct, and all other practi-
tioners wrong in the treatment of prolapsus uteri.

7th. In answer to Dr. A's. remarks on the interruption of sex-
ual intercourse, and the immorality consequent on the fr< quent
use of the pessary viz. that the first is forbidden by the condition,
of the patient, and the second is prevented by tin4 tendency of
the disease to alia v. and finally destroy all appetency for vene-
real imiulirence, the essayist deduced the f >ll >wing[ dilemma
that Dr. A. is in error in calculating that 9-10 of le mates die of
ibe (fleets of prolapsus uteri; or that sexual intercourse is not
forbidden in this d'sease. If nine-tenths of women labour und< r
prolapsus uteri, and even die of its effecls and this dsease forbids
sexual indulgence, the world surely would soon be d( p^pulated.J
We would syn paihize. lie said, not only with ihe pitiable cr nei-
tion oj heaven's best gift to man, but must mourn over our own
sad and solitary condition on earth.

In reply the essayist said he had stated that the result of his

* There will be found on the reference here made, no account of \hcform
of a wool'en pessary ; on which its superiority greatly depends. A. .

f Docs the essayist believe, that his correspondents had present in their
minds, when writing, wo- lien pessaries, of an hour.-glaFs Fhrpe .' A.

| See first part of the last paragraph on page ( 95, Southern Medii al and
Surgical Journal* where " this sentiment," alluding to the u^o of the pessary
lending 1o immorality, is said to have "operated most severely on those af-
flicted, and forced its thousands into a course of submission to one degree of
physical evil after another," &c. A.

1837.] Georgia Medical Society. 703

inquiries, was a conviction on his part, that pessaries had been
greatly abused. He had given the testimony (if more than leu
physicians, nearly in their own language, and had thereby estab-
lished the tact, that pessaries are P >w seldom required, and that
thev are inj irious when applie I fr pr lapsus ut ri. And that
the evidence here, is as ten to one. or at most, to two. Finally,
Chat in the treatment of uteri le displacements, pessaries are not
necessary other means succeed best. Experience on this sub-
ject among physicians of this city, is as eleven to one.

Georgia Medical Society.

This is the oldest Medical Society in the State of Georiia, ha-
ving been originally chartered m the latter part of the last, or
the first of the present century. It holds its meetings in the
C.ty of Savannah, where its members most I v reside, with the
exception of corresponding members in different parts. For-
merly this society held interesting sessions with regularity, and
pressed on in the investigation of medical science with much ar-
dor. IJut in consequence of the want of convenient means for
Communicating the results of their labors to the world, their ben-
efits were limited to their own community, which was not a little
profited thereby, and the professional character of the place
elevated to the rank of the most respectable, which it has e<or
since maintained. In consequence, however, of the omission of
certain formalities, the charter of the society became void, and
with the want of the stimulus of the hope; of benefitting the pro-
fession more extensively, by a ivc.c and ready communication of
their labours to the public, the society lapsed into inaction for a
time. But a zeal remained with those who knew so well the
value of scientific researches in tin's way, which would not suf-
fer restraint, and a successful application was made to the last
Legislature to revive the charter.

Under this act, a re-organization has taken place, and officers,
consisting of a President, Vice President, Secretary, Treasurer,
and Librarian, ha e been elected, and the firmer constitution of
th society, with some wholesome modificafi< ms. Ins been ado p-
ted. Its objects are the advancement of medical science, the
promotion of good wall, and a proper attention to medical ethics
among the; members of the profession, the restriction of abates in
the practice of mediHne, &c.

The regular meetings of the society are held on the first Sat-
urday in every month, at which time it is the duty of each mem-
ber, in turn, to read an essay on some s ibject connected with the
objects of the association, a copy of which essay is to be deposi-
ted with the Secretary.

We R. Waring, JM. D. is President, and P. M. Kollock, hC
P. Secretary.

If 4 Extraction of a Bone from the Nates. [May,

It must affirJ a high degree of sitisfaction to the friends of
medical science at the south, to find I he highly respectable med-
ical commun ty of Savannah, thus directing I hi ir active energies
t<> the advancement of a scit nee so dear to humanity and phil-
nuthr py. From our high estimation of the professional abili-
ty s o' that community, we, as journalists, look to the Georgia
Medical Society, lor much to enrich the pages of the Southern
Medical and Surgical Journal. We hope they will not only
lupp'y us with their well written essays, but also with the inter-
esting debates on the subjects before them, and eases of interest
which will, from time to time, be presented by the members.

Extraction of a Bone from the Notes.

The following case was communicated to us by our friend
Dr. A. Cunningham. We consider it valuable because it is cal-
culated to afford us a useful hint for the better management of
some d seases of the rectum. We have occasionally met with
strictures and other disorders of the rectum, arising from the re-
tention or, and mechanical injury from, some extraneous sub-
stance in the rectum, in which the afll.ction was mo&t severe and
pro:raeted.

We have also not long since, seen accounts of a number of
cases, in wh;ch wood, bone, &c, in the rectum had produced the
most distr< ssing (fleets.

"The following ca.se is worthy of record in your journal, if
for nothing more than to shew what the system is capable of en-
during; and in what way it sometimes runovi s ex:raneous
matte r which the process of digestion was unable to modify.

"A negro man, aged about 50 years, formerly very hit rn-
prrate. had for the last ten or fifteen years, been subject to both
anal and perineal fistulyc having the space around the anus as
far as each ischium, present a series of cicairicc s and fistulous

0 enings. A little way down the back part ofihe scrotum, and
i i the raphe scroti, is a fistulous opening through which a portion
tfthe mine escapes. I counted three strictures along the ure-
t irnl cana .

On the projecting point of the right isclvum,the patient direct-
ed my at lent on to a p'ece of b ne which had come through the
fkin about two-tenths offttl inch, and of a dirty dark brown co-

1 >iir. An attempt to extract it with the thumb and finger, gave
him considerable pain.

< *n dividing the adjouvng skin, I easily drew out a piece of
b ne of the following shape,
measuring one in h and efght
tenths in length, and three in
breadth.

It appears to be a portion of hone which is sometimes found in
a piece of beef-steak, which has been cut with a saw.

1837.] Hydatids developed in the Gums. 765

The pntient states that some six or eight months ago, he first
felt somethin i within the anus which he was unal)le to void w.th
his natural evacuations.

M ly we no! presume that this, piece of bone entered some of
the fistulous openings above the sphincter ani, and from thence
passed along it to the ischium?

The patient has experienced so much relief since the extraction
of the bone, that he has thus far preferred the enjoyment of his
present ease to a lvsort to the knife, die, for permanent relief."

Hydatids developed in the Gums: Reported by M. Lefoulon,
Surgeon Dentist at Paris.

On the 15th of July las?, I was consulted by Col. de C., aged
56 years, who had always hitherto enj >yed good health. He
stated that about twj years ag >, the third molar tooth of the
right side, in the lower jnw, was extracted by a Parisian dentist
on account of an o'd cries whicli became exceedingly painful.
The operation was attended with nothing peculiar, and was fol-
lowed by no inconvenience until three months after, at which
time he began to feel at the rejrion from which the tooth had been
removed, a small tumour, situated in the gum and which was
painful whenever irritated by food during mastication. The tu-
mour gradually mereased, until it piojected into the mouth, pre-
venting it from bring closed and impeding mastication. It is in
this state I ex imined I iin, and found that the tumour was oblong,
in the direction of the j iw bone, and about the size of a partridge
eg:*. It was hard, with the exception of its middle portion, in
which a slight fluctuation could be felt; a considerable pressure
was required to give pain; the mucous membrane covering it
had undergone no change; the fourth molar tooth was pressed
backwards and outwards, arid the second forwards and inwards;
the second was also carious and highly sensitive to the touch.

I proposed the immediate extraction of the decayed tooth, as
preliminary to doing any thing for the tumour, whose nature I
did not understand. The operation was performed, when, to
my astonishment, the tumour was no longer to be seen, having
been lacerated and emptied by the extraction of the tooth. A!y
surprise increased, when I found floating in the basin in which
tl.e pitient had rinsed his mouth, three small globular and per-
fectly transpirent bodies. They were about the s'ze of a large
pea, of a gelatinous consistence, and contained a liquid as limpid
as water. I at onee recognised them as hydatids (acephalocvsts)
and exhibited them to several physicians who concurred with mo
with regard to their nature.

On examining the mouth. I ascertained that the tumour was
evidently formed in the gum in a state of hy pert rop' y; that the
interior of the sac was lined bv a whitish membrane, somewhat

7G3 Inoculation of Morphine. Medical College, c]c. [May,

resisting, and presenting every appearance of a cyst, No acci-
dent followed ; the wound healed kindly ; and Col. de C. has

sin^e experienced no pain.

This case is one of interest, for I have met with none like it. and
it would have been difficult hi' any one to determine its charac-
ter a priori. I kn w of n > cases of hydatids fou id in the mouih,
save those of the tonsils. Jour/utl Hebdomadaire, p. 151. 1836.

Inoculation of Morphine.

M. Lafargit, lias been and is still engaged in a series of ex-
periments on the inoculation of various medicinal agents. He
has ascertained not only that the narcotic eff-cts of morphine are
readily developed, locally and generally by this process, but al-
so that itoccasi >ns a papular eruption at the point at which it is
introduced, which presents characters different from those occa-
sioned by the inoculation of other substances. M. L. considers
this method of introducing narcotics preferable to other endermic
modes, because much more speedy and certain. The peculiar
eruption alluded to is, uniformly, produced by all the preparations
of opium ; and hence may assist very materially in medico- legal
investigations. After relating his experiments, M. L. comes to
the following conclusions : "Whenever a suspected fluid does
not, on being inserted under the cuticle, develope the peculiar
papular eruption already described, it does not contain opium,
(or its preparations) : whenever the eruption is produced, the
presence of opium should be strongly suspected." M. L. has ( x-
perimented with tartarized antimony, crotnn oil, strychnine. &c.
[Bulletin de VAcadbmie de Medcane, p. 40. 163(5.

Medical College of Georgia.

At the annual Commencement of the Mcd'cal College of Geor-
gia, held on Wednesday, April 19th, ihe degree of Doctor of
Medicine was conferred upon the following graduates, viz:

B. L. Thompson, of Crawford vi He. Oa . Thesis, Modus Op-
erandi of Medicines, Bryant Walton, of Putnam County. Ga.,
Cause and Pathology of our Autumnal Fevers. Joseph Tay-
lor, jr. of Anderson, S. (\, Opium. Win. L. Al'riend, of Greene
County, Ga., Pneumonia. James M. Darnall. of Jasper Coun-
tv, Ga., Pathology of Remitted Fever. S. H. Sanders. of Butts
County, Ga., Typhus Fever. C. W. W< st. of Liberty Co.. Ga.
Detection of Arsenic. John G. Byrd, of Augusta, Ga.. Remit-
tent Fever. Joseph Shannon, of Augusta, Ga., Injuries of the
Head. Oliver Walton, of Lincoln County, Ga., Pathology of
Svphilis. I ). F. Adkins, of Warren County, Ga., Enteritis. ' Jo-
seph M. Gardner, of Augusta, Ga.. Pleurisy, A. R. Kilpitrick,
of Burke Countv,Ga., Prolapsus Uteri.' C. L. Holland, of Mon-
ticello, Ga., Peritonitis Puerperalis. And on application, John

1837.] On Lithotripsy Anomalous Menstruation, <$c. 767

H. Pope. jr. M D., a graduate of the University of Pennsylva-
nia, was admitted aleundemgradum.

A highly interesting and impressive Address was delivered to
the Graduates by Professor L. D. Ford, and which was also lis-
tened to with manifest pleasure, by a very large and respectable
audience of both ladies and gentlemen. We are much plei-ed
with the interest that oar .Medical College is now exciting in our
community, and with the influence it is beginning to exercise
over our State. We feel persuaded that its advantages, its
splendid Museum, extensive Laboratory, increasing Library, Ac*
need only to be known, to be propeily appreciated by the med-
ical student.

We are happy too to learn, that at a meeting of its Trustees,
it was contemp'ated to create two new Pn)ressorsh:ps: one of the
Institutes of Medicine and Medical Jurisprudence, and the other
of Physiology and Pathological Anatomy. We doubt not that
competent gentlemen will receive these anp )intments, which
will increase the numbrrofPr )fess >rs in our Medical Ceilege t<>8.

The- number of students atten ling the lectures in this institu-
tion the past season wis 47, being a considerable increasj over
that of any former period.

Lithotripsy. At a meeting of the Royal Academy of Medicine, in Paris,
M. Segalas introduced a child thme years of ag\ on whom, when vet two
years ami nine mm h< old, ho performed the operation of hibotricy. The
entire time of cure wis six weeks; in which period the instrument had been
in'roduced and used six !imes.

This is probably the youngest subject yet operated upon in this manner,
and will form an evcenrion to the prevailing rule, that naither lit.otricy nor
lithotripsy can he norformed at so tender an age.

Anronos Dr. G bson inform- u?, that all the rasps m^n'ionod in his com-
nvmication to ?h j American Journal of the M 'dical Sciences, for Au-. 1833,
as having been opora'ed on by him, are entirely cured.

Mr. List op, in his Elements of Surgery, a copy of which we have ju't re-
ceived, and shall put to press, for insertion in the Library, expresses himself
as no* verv sanguine i" suppoing that the breaking up of the stone in the
bladder will ever supersede lithotomy. At. the same lime he admits that, this
operation is very advisable in certain cases, and may be resorted to with
evory prosooct of a safe, speedy and successful conclusion. Eclectic Jour-
nal ol Medicine.

Anomalous Menstrua/ion. - M. Bourgeois lias met with a curious exam-
ple of this. A young 1 idy of 15 or Hi years of age, commenced some time
since to menstruate trom the extremities of each ol her ten fingers. At the
second menstrual epoch, the hemorrhage was renewed from the sam place
and at the period when M. B. communicated the tact to the Medical Society
of Paris, the menses had not appeared in the natural manner. Boston Jour-
nal.

Treatment of Influenza. The London Lancet, in speaking of the late pre-
valent epidemic influenza, thus alludes to the treatment.

"In the severe cases, the most effectual treatment was found to consist
in the administration of an aperient, containing two or three grains of pro-

76S Iiiti-orluction of the Catheter, $c. <$*c. [May*

tochJoride of mercury, generally combined with aloes. This, in all case*,
was foun I essentia] ; and here we may no'ice H13 Riga*) relief which all such
cases as small po*\ scarlet fever, under treatment, at this period, derived at
their commencemen', esp-'ci illy from pnrgatives, or which pro'ochloride of
mercury, and rlmbarb or jalap, followed by castor oil, &c, were the most use-
ful.

*A saline mx'er^, composed of tar*^r ome'ie and s<dphite of maffnPH*\
generally produced in a nigh' or two a di -phoresis, wh'ch was always attend-
ed wi'h re!i**f: in tha artnritic varies, snnll dp p* nf v;,i. se'-n. coYh., in
the above mixture, gave great and immediate relief." Boston Journal.

Introduction of the Catheter. In lerfnrinM- lately on some cre^ of s're-
ture of Hie urethra under treatmen', Mr I^'on made rmr remark" on he
mode which he had lon'_r observed in introducing the ca'he'pr, er bnngfi*% in
all cases in which th obstruction was no^ spnffd np~r*he onf<ce of*he ere
thn. H preferred the emp'ovm^n^ of onn h nd onlv, the ure'liT' bpinp \( ft
perfectly free; by persuing 'ha1 meil od the ir!F*ri"men1 wos less l'kelyfohe
impeded, the natunl obstacles mMt wi'h shou* the si-mc of the urelhn being
mo-e effecfual!v and cer'amly avoided, fhepa'ieri* sufferj-gWs "readiness,
and the operation being altogether more easi'v nnd jlextero'isly offered 'Inn
when the member was pui'ed ou% and the urethra was put unnaturally upon
the stretch. Boston Journal.

Oneratiovs for Cataract At a meeting of the Academy of Science?, in
Paris, in December las*, M. Roex stated, that, wi'hin ibe 1. ft 'Irr'y verrp,
he had operated for cataract 4,500 times ; no*, of course, on <lrc nember of
patients, as in nn ny instances 'lie afFec'ion was presen4 in both pves. At
the commencement orhis practice, M. Roux bod no prejudice i.i favor ef e;-
therof the t\fo methods commonlv emploved ; he viewed f'ppressmn wi'h as
much favor as extraction, and submitted both to ihornurj] trial during a po-
r'od of ten years ; he then examined the results of all 4l:p opera-tionr, ->morn*-
ing in number to abont 600. This comparison led bin to fo*m a conchsion
decidedly favorable to ex* ration, and he hW, since then, adopted this as lifs
ordinarv practice, reserving the o'h'T mod ^ for tfie few discs wlrcb rppear
peculiarly adapted for its application ; the pronpr'ion of wbic.K "crord'nfftt
M. Koux, does not exceed one in twenty. Eclectic Journal <f Medicine.

Oxygenated Soao. For some time we have bad it in mind fo make men-
tion of this excellent, article, manufactured by Mr. Eliph-tlet Dnv;s, orCam-
bridgeport. Something of this kind has been wanted in hospitals h a sort
of prepnratorv, before wounds, ulcere and abraded gr-nul itinjr surfaces re-
ceive the;r appropriate dressings. Iss'ric'lv detergent properties rp"A< r it
a decidedly useful wash in all this class of ex'ernn] nrdndif s. Mr. Davis
has gone to work like a chemist in the composition of the ovy/renated f^o^p,
with reference to i4s introduction in*o infirm r;es ; and we c;in W.i*h pleasure
speak decid d'v in its f;ive-, ^p meeting- with the approbation of surgeons in
this region of country. Boston Journal.

ffahnemanmsm. At a late meeting of the London Medical Roc'o'v, rf'er
Dr. Uwins had read a paper in favor of the homoeopathic dbctriner, the sub-
ject was discussed by the numbers. Ibid.

INDEX TO VOL. T

A.

Abdominal Tumours, removal of, by Professor Chelius,

Academy of Medicine, French, proceedings of the
" a Treatment of Itch, .

' " Primitive and Secondary Syphilis,

" Taliacotion operations,

" " Lithotrity,

Acetas Plnmbi in Cholera, ....

Aconite, Emmcnagogue properties of

Acupuncture in Rheumatism, by Dr. Lee,

Air Pump, use of in Hernia, . . . .

Alum in Typhoid Fevers, ....

Aloes in Amenorrhoea, .

Amputation, by Professor Chelius, . . .

Amennorrhcea, Chloride of. Soda in

Amussat on Retention of Urine,
11 on Diseases of the Prostate,

Amputation at Shoulder, ....

American Journal of Medical Science, notice of

Amennorrhcea, Aloes in ... .

Anatomical Anomalies, by Dr. Strobel,

Animalculse in Syphilitic pus,

Analysis, physiological and chemical, of Portal Blood,

Anatomical preparations, preservation of

Anomalous Menstruation, ....

Antimonial Suppositories, ....

Antony, Dr. M. on Menstrual Irregularities,
" Remarks of, on Hypertrophy,

" " on Puerperal Convulsions,

" " on Ergot, ....

' " Observations on Amygdalus Persica,

" " on Extract of Belladonna, .

" " on Ccanothus Americanus

" . " on treatment of fractures of Os Femoris by
" on Spinal Irritation,

Apoplectic Eclampsia, ....

Apoplexy, connexion of with Hypertrophy,

B.

Bad Surgery, (Lafayette's ease.)
Belladonna, Extractor, Dr. M. Antony on

Preventive of Scarlatina, uoiu-e of
Injection ofin lliu.>.
in l!i tcntjon ofl] rine
ioUterus,

StrananlninH I l.-nn.i.

436

504

504

504

504

505

314

381

129

62

318

64

435

704

404

404

. 625

313

. 64

525

. 376

46

. 121

767

. 737

711

. 457

24

. 65

148

. 150

179

weight and fulcrum, 281

580

. 24

415

509
150
185
129

557
556

Benedict's opinion on operation for Cancer,
Blighted Foetus at term, ....

Blainville, M. de, on False Membranes, .

Bone, extraction of, from Nates,

Bow en, Dr. 1. on Hy stent is Chronica, .

" on Ergot, ....

" Editors' note on.
Brodie, Sir B., Clinical Lectures of, on Epulis,
Bronehocele, by Professor Chelius,

" Case of, successfully treated by Dr. W. M.

Broussaisin. .....

Bruit do Soufflet, mechanism of

Lee,

Caterpillars in the Intestines, .....
Catheter, introduction of .....
Catcract, operation for .

" Dr. Middleton's plan of operation for,
Cantharides, nature and mode of action of

" 1st memoir on, by Nardo,

" 2d memoir on, by Pullino, .

Carusi, Dr. on Syphilitic Ulcers,
Carbonic Acid, solid, ......

Cancer of the Mouth, cure of, ....

" Remarks on Professor Benedict's opinion of operation for .
' of Lip, resection of lower jaw for
Cautery, Actual, in Fistulas, .....

Carcinomatous tongue, Ligature on, by Dr. Donnelan,
Carmichael on Sleep, ......

" on the Blood of the Vena Porta, .

Cases with observations, by Dr. Robertson,
Caoutchouc, physiological effects, of, by Dr. Chase,
Ccecum, experiments on the functions of, ...

Ccrebro-Spinal Fluid, ......

Cervical Vertebra?, fracture and depression of, by Dr. Strobel,

Caesarian Operations, new cases of .

Ceanothus Americanus, medical properties of, by Dr. M. Antony,

Chapman, Dr. on Chronic fluxes of the bowels,

Chorea, .

Chase, Dr. H. on Caoutchouc, .....

" on Radical cure of Hernia, notice of,
Chalybeate Water, artificial, .....

Chloride of Soda in sore nipples, ....

Chomel on Typhus Fever, .

Cholera in Savannah, Dr. Kolloch on,

" Sulphate ofCtuininc and Lactucarium in,
Cholenferous Insects, .....

Chloride of^Soda, use of in fevers, .

Chronic Fluxes of the Bowels, Dr. Chapman on,

" Editor's Remarks on,l
Cinnabar Fumigations, ......

" Dr. Cohen's letter on,

Clinical Lectures of Sir Brodie on Epulis,
('l.i\ of dirt-eaters, analysis of, by Professor Cotting,
Convulsions, Puerperal, Dr. M. Antony on,

" Tartar Emetic in, . ,

Corigeen, or Irish Pearl Moss, . . . .

( 'oehlea. use of in hearing .

Cohen, Dr. Philip Meivin, Letter of, on Cinnabar Fumigations,

Cory/.a, venereal, .

CoUcaPktonum, treatment of, .' . . 1 1!>

Consumption, pulmonary, influence of professions on, . . 122

( !opaiba, Tincture of, . . . . . . . 381

Getting, Professor J. M. Thermometrical observations of, 7(i, L33 2

" Extracts from a Geological Survey, &c. . ... 76

" Analysis of Clay, bj ...... 988

Creosote, physical properties of, ...... '>!>

" chemical properties of, . . . . . .39

" preparation of ....... 3!)

" physiological action, of, .... .40

" medical employment of, ...... 41

" mode of administering, . . . . . .42

Croup, sulphate of copper in . . . . . 383

" new remedy for, ....... 12(5

Croton Oil in Laryngeal affections. ..... 616

Cranium, extensive fracture of, by Dr. I. M. Antony, . . . 134

" Note on the same by Dr. M. Antony, 13(5

Cruveilhier's Pathological Anatomy, notice of . . . .98

Cystotomy and Lithotrity, parallel between, ". . ... 375

Datura Stramonium, poisoning by, ..... 382

Delony, Dr. E. Topography of Talbot County, by .... 601

" Letters to the Editors, ...... 257

Delirium Tremens, Digitalis in, . . . . .64

Diagnosis, by Rostan table of, . . . . . . 231

" Rostan on, ....... 166

Dignified consistency, . . . . . , . . 120

Doctor, notice of the ........ 233

Doctors, mortality of ....... 422

Donnella n's case of Carcinomatous tongue, . . . . .60

Dugas, Dr. L. A., Medical Statistics of Augusta by, . . . 650

" Strictures of the Urethra treated by excision 293

11 On Colica Pictonum, . . . 402

" " On Impeded Respiration, . . . .587

" On Idiopathic Mortification, ... . 265

" " On Rheumatism, . .... 15

Case of Hydrocephalus, .... 440

" " On Purulent Ophthalmia, . . .81

Dupuytreu on Chorea, ....... 108

Dupuytren's Clinique Sub-cutaneous Fibrous Tumour . 366

" " Cataract with Carious Teeth, . . 368

" Dislocation of Thumb, .... 368

" " Schirrous Mamma1, .... 360

" " Case 1. Disease of Spine, .... 205

2. Disease of Spine, . . . 806

11 " 3. Disease of Spine7~ .... 336

" " 4. Disease of Spine and Hydrocele, . 327

" 5. Empyema caused by Disease of Spine, . 227

" " 6. Disease of Spine and Coxalgia, . 227

" " 7. Vicarious Menstruation, . . . 228

" " 8. Wounds of Abdomen, . . 228

" " 9. Concussion, &c. of Brain, . . 228

" " 10. Abscess of Mamma-, . . 239

11. Predisposition to Disease, . . 908

12. Varicose Veins. ... 230

Editorial Remarks on Lisfranc's Cliniquc, .... 370

Elbow Joint, excision of, ...;.. 088

Elementary Medical Instruction, by Dr. Coates, . . . 237
Empiricism, Remarks on, by Dr. Joseph A. Eve, . . . .70

Empyema, operation for, ....... 257

Epilepsy, treated by Indigo, ....... 501

Epulis, . . . k 249

Ergot, Observations on, by Dr. M. Antony, .... C5

misplaced action of, by )r. I. Bowen, .... 145

'Erectile Tumours, cure of, \ 627

" by Professor Chclius, ..... 436

Eve, Dr. Joseph A.; on Professional Qualifications, &c. . . 705

" " On Empiricism, ...... 70

" On the Modus Operandi of Medicines, . . 449

On Revulsion, 388

" " On Medical Education, .... 216

Eve, Dr. Edward A. on Gangrenopsis, ..... 731

on Idiopathic Fever, .... 139

Eve, Dr. Paul F., Operation for Polypus by, . . . . . 78

" " Essay on Pessaries, ..... 641

Surgical Cases by, .... 261,385

Expectant method, ....... 249

Fever, Typhus, Alum in, ....... 318

" Chloride of Soda in, . . . . . . 103

" Intermittent and Remittent, pathology and treatment of, by Dr.. L. D.

Ford, 335

" Bilious, Quinine in, by Dr. D. Hook, .... 360

" Congestive, of Chattahoochee, by Dr. Johnson, . . 594

Febrifuge, new, ........ 746

Flannel in Hot Climates, . . . . . . 254

Ford, Dr. L. D., Analysis of Hydrant Water of Augusta, by . .22

" " On Intermittent and Remittent Fevers, . . 335

Fractured Os Femoris, treated by weight and Fulcrum, by Dr. M. Antony, 281

French Medical Institutions, account of, by Dr. Lee, . . . 234

Fumigations in Whooping Cough, ...... 320

Cinnabar, 509,623

G.

Gangrenopsis, Essay on, by Dr. Edward A. Eve, . . . 731

Gangrene of the Lungs in the Insane, ..... 611

Galvanism, Medical application of, ..... 183

Garvin, Dr. J. P., on Puerperal Pcritonotis, . . . . .5

" on Pneumonia Biliosa, .... 536

Gerhard on Diagnosis, notice of, ...... 29

Georgia Medical Society, ...... 763

Gout, Magnc tism in, ....... 416

Goitre, cure of, by extirpation, ...... 61

Grant, Dr. George R., on Retained Placenta, .... 193

Grade, cases ol'Goitre, by ....... 61

Groin, Tumour in, with worms, ...... 675

Gray Sulphur Springs, Medical properties of, . . . . 162

H.

Harelip, period for Operation, ...... 506

Hemiplegia, remarkaole cose of .... .448

i

Hemiplegia cured, ......

irrhoidal Flu*, Antimonial Suppositories for .restoration of
Hemorrhois, notice of Dr. Salmon's] markBon,

us iii the i:< afcmi ml > f

Heart, moti< nsarj i . *

. . .....

* and pulse, action of,
" pulsation ofin Foetus, .
Heustis, Dr. J. W.j remarks by, on Spinal Irritati< a.

" " " Medical Relic;

Hind's Lithographic PI
[ [ippoerati i fa work of, . .

Holfoway, Dr.G. K., cat Sarcoma, by

Home, Sir Everard Literary Sacrilege,
Hooping Co ts in,

Hook, Dr. D. on Quinine in Bilious Fever, .
Hypertrophy, Remarks on, by Dr. M. Antony, .
Hydrothorax, case of,
Hydatids in the Gums, ....

n Pills, composition of,
" antidote for,
Hydrocele of the Neck, by O'Beirne, remarks on
Hydrocephalus, case of, by Dr. Whitridge,
" case of, by Dr. Dugas,

I.

Illustrations of Surgery, by Dr. Doane, notice of

Intermittent Fever, Chloride of Soda in,

Intemperance, morbid effects of, .

Influenza, treatment of,

Indigo in Epilepsy, ....

Itch, treatment of, .

410

7:57

363

. 629

104

. 104

106

. 63

322

. 321

69

. 742

207

,

. 573!

320

. 360

457

. 637

76&

. 382

120

. 17

513

. m

0

i<>i

. 570

181

767

. 501

255

K.

Kennedy, Dr. on Tartar Emetic in Obstetric Practice,

L.

34. 100

Lactcals, offices of ....

Lafayette. Dial-treatment of fractured leg of

Lactucarium in Cholera, ....

Labour, tedious from rigidity, Tartar Emetic in
" " " note on by the Editors

" Irritable or Violent, Tartar Emetic in

Leucorrhoea. enquiry into,

Inula Helenium in,

Lee, Dr. J. F., Cases of Traumatic Tetanus by

Lee, Dr. Wm. M. on Acupuncture,

Lead, new treatment ofthe disease of

Leeches Medicinal, Editorial remarks on

Lithotomy in the female, by Professor Chclius,

Lithotripsy, .....

Lithographic plates of fractured bones, by Dr. Hinds

Light stimulous of

Life, Chances of ...

Listranc, on Encysted Tumour of Wrist,

Li* franc's Clkiique Anatomy,

" Introduction of speculum uteri,

" General symptoms of uterine disease,

.

254

. 509

255

. 35

, . . . 37

. 37

575

. 704

577
129
G31
116

435
767
62
382
377
408
390
300
301

Lisfranc's Cases of uterine diseases speciilum,
" Piseases of the uterus,

" Chronic metritis, or simple hypertrophy

" Hypertrophy ot'uterus, with transformation, &c.

" Tumours ofthe uterus,

" Miliary polypi of os tineas,

" Tubercles of the uterus,

" Ulceration of os tincae,

" Leucorrhcea, ....

" Amputation of os tinea), .

of carcinoma of os tinea?,

" Editorial remarks on,
Louis M. on Expectoration, ....

" on Blushing, ....

Lymphatics and Veins, offices of ...

370,

302
302
303
305
305
306
306
307
309
310
211
430
409
409
254

M.

Mammae Obstructed, Tartar Emetic in
Mania Puerperal, Tartar Emetic in
Magncsian Aperient, analysis of
Magnetism, Animal, editorial remarks on
Medical Society of Augusta, proceedings of, .
Medical Education, by Dr. Moultrie,

" by Dr. Eve,

Medical College of Georgia, commencement, .
Medicine, Retrospection in,
Metritis, Chronic, ^^
Mercury, MeWlic, iAs,
Middlemore's ope i ongenital Cataract,

M'Junkin, case of Monjfcrosity, by
Mixture, Freezing, its me in Prussic Acid process
Morphine, Inoculation w^
Moore, Dr. R. D., on Secretions,
Morrison's Pills, ....
Mortality, comparative, of Males and Females,

" " of married and unmarried,

Muscular System, influence of Nerves on,
Muriate of Barytes in White Swelling, .

438, 566, 691

101

102
121

187
761
489
261
766
412
313
429
59
294
382
766
201
190
421
433
512
630

N.

Nerves, Cerebro-spinal, plates of,
Nervous System, physiology of,
Neuralgia, Frontal,

" of stomach,
Nellis, Master S. K. G., short account of
Nipple Shield, (Pratt's) .
North London Hospital,

O.

Odoriferous Exhalation from Skin,
Opium, correctives of
Orchitis Chronic, mercurial inunctions in,
Osteo- Sarcoma, case of, .

703
678
416
128
522
58
701

446
128
633
207

Parietal bone, fracture of
Penis, arteries concerned in erection of,
" Anatomy of .

155

422
494

INDEX.

Peritonitis, Puerperalis,

Phrenological A nalysu

PhUoBoph) of i [ealth,

Phloridzine,

Phthisis, pathological anatomy of,

Piorrj . notes mi the blood by, .
" on diluents,

Pneumonia Bifiosa, . . :

Senilis,

Polypus, Bronchial, .

" removal of from base of Cranium,
Pulsation, local, case of]

Pus in the blood, method of detectin<r.

Placenta, adhorsion of, by Dr. Litchfield remarks on.

" retained, by Dr. Grant, .

" " by Dr. Lindslcy, .

Quinine, detection of in urine,
" hydrochlorate of
M in Ague, endermic use of

R.

Radius, fracture of

Reid's Truss, ....
Respiration Impeded, cause of,
Red Shank, .

Rheumatism, acute and chronic, difference of,
Roberts, W. H., case of excision of urethra,
Robertson, Dr. F. M. Phrenological Analysis,
Cases with observations,
Rostan on Buffy Coat,

S.

Saliva, chemical condition of Editorial remarks on,

Salivation treated by muriatic acid,

Sarcoma, albuminous,

Sagittal Suture, want of,

Scrotal Calculus,

Scrofula, Stillingia Sylvatica in,

Sciatica and Rheumatism,

Segato Signor, discovery of,

Secretions, essay on, by Dr. Moore,

Select Medical Library, by Dr. Bell notice of,

Sequestra, removal of without operation,

Sinapisms, temperature of, .

Skin, local hereditary relaxation of,

Small Pox, salutary effects of

Soda, Carbonate of, in large doses,

Sore Nipples, .....

Stomach, Neuralgia of, .

Strictures of Urethra, newjtreatment of.

Stricture of Oesophagus, by Professor Chelius,

Strobcl, Dr. B. B. Anatomical Anomalies

Fracture and Depression of Cervical V
" " Parietal Bone,

Surgery Illustrated, notice of, .
Suicide, case of . . .

5

271

224

256

111

407

IK)

536

607

616

78

253

376

54

193

G(J8

446

381

447

433

57

587

179

415

293

271

152

410

244

253

701

509

. 436

565

. 249

83

201

411

118

318

. 639

384

445

189

128

501

r;:

595

m

197

i ,

297

636

Substance, extraneous, healing over,

Syphon Uterine,

T.

306

7-1 S

Tartar Emetic in Obstetric Practice,

" Restoration of Pilea,

Teleangiectasia Leopomatodes, by Professor Chelius, .
Testicle, Inflamed, treated by compression,
Testicle, Chronic inflammation of, mercurial unctions in.
Tetanus, Traumatic, by Dr Lee,

Thoracic Duct, Aneurism of, ....',*

Thompsonian Practice, ....

Thermometrical Observations, by Dr. Miller,
Trousseau on Rheumatism, &c.
" Cancer, .

34, 100

COO
437
426
633
577
615
191
215
. 409
410

U.

United States Medical and Surgical Journal, notice of,
Urethra, case of Laceration of, by Dr. Betton,

" Dr. Hays' observations on the same,
Urine, incontinence of, .
Uterine disease, general symptoms of,
University of Pavia, Obstetric practice of,
Uterus, schirrous and cancerous degenerations of,

243
749

751

576
301

486
685

Veins, sudden death from ingress of air into
Venereal Ulcerations of the Throat, fumigations in,

w.

625
509

Whitridge case of Hydrocephalus,

513

X?

Date Due

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Cat. No. 1137

Southern
journal

Vledioal and

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Surgical

fS

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1383

Southern Medical and Surgical Journal

Vol. 1, 1836