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SOUTHERN

MEDICAL AND SURGICAL JOURNAL

VOL II

_,

A TRULY VIRTUOUS WILL IS ALMOST OMNIPOTENT.

EDITED BY

MILTON M. ANTONY, M. D.,

PROFESSOR OF OBSTETRICS, &c, L\ THE MEDICAL COLLEGE OF GEORGIA.

PRINTED BY W. T. THOMPSON.

TS38T

SOUTHERN

HBHOAIL All OTH(DAIL
JOURNAL.

Vol. II. AUGUST, 1837. No. 1,

PART I.

ORIGINAL COMMUNICATIONS.

ARTICLE I.

Report of a case of Extra-uterine Foetation, in the Sow; with
remarks on the nutrition of the Foetus, by Addison Bean,
M. D., of McDonough, Ga.

In studying the economy of nature, the human mind is aston-
ished at the beauty and simplicity of her laws ; at the peculiar
adaptation of the means to the ends ; and perhaps, above all, at
the stupendous effects which result from the operation of appa-
rently simple causes. For instance, the whole phenomena of
animal motion are produced by the simple contraction and re-
laxation of the muscular fibres. Perhaps a more astonishing
example is produced by the wonderful machinery of the plane-
tary system; where we discover the whole retinue of planetary
worlds, performing their ceaseless revolutions, with a velocity
that almost outstrips fancy herself; and the cause of the whole
is simple attraction and repulsion. But notwithstanding the
laws of nature, when understood, appear simple and intelligi-
ble ; notwithstanding the human intellect can generally trace
the cause from its effects; and from contemplating the cause
can, with great probability predict the result: yet. we occasion-

2 Extra-uterine Foetation in the Sow. [August,

ally meet with such extraordinary freaks of nature, with re-
sults so anomalous, that the utmost stretch of human ingenuity
has never discovered the cause, nor the means, used in their
production.

Among the irregularities of nature which the physiologist is
called to contemplate, few are more wonderful than extra-ute-
rine foetation. When we consider the functions of the various
organs subservient to conception, gestation &c, and the great reg-
ularity displayed by each, in the performance of the office assign-
ed it, were it not for positive facts, the utmost stretch of our cre-
dulity would hardly permit us to believe such a thing as extra-
uterine impregnation possible. But whether we shall ever be
able fully to comprehend it or not, the fact is notorious; and
perhaps there is scarcely a more singular case on record, than
the one which I witnessed in December last, in a sow.

My friend Mr. M. who resides a few miles from M'Donough,
when slaughtering his hogs, was surprised to find a pig of near-
ly the ordinary size of one at the full period of gestation, embed-
ed in the fat which surrounds the cardiac orifice of the stom-
ach of the sow. Being entirely unable to account for this phe-
nomenon, he, without removing the pig, cut out a good portion
of the fat which surrounded it, and brought the whole to me. I
enquired into the history of the case, and was informed by Mr.
M. that the sow was delivered of a litter about the last of Au-
gust. That she was thrifty as usual. At the end of the period of
lactation, she was fed with the intention of making pork of her.
When she began to thrive, she again became pregnant. About
a moiiih afteT she became pregnant, she was killed for pork, and
was in every reaped healthy: The extra-uterine pig had ne-
ver produced any appreciable inflammation nor disturbance of
any kind, as the s<u- had been perfectly healthy during the
whole period. I carefully removed the fat, which almost entire-
ly covered the fetus, in the presence of my friend Francis E. Man-
\\. D. and: several other gentlemen; and what is most sin-
gular, is the fact, thai there was nothing Like either placenta o*
funis* I endeavored to ascertain whether it was surrounded by
the usual membranes, but could not positively determine; but
if it was. lliey were very thin and in immediate contact with the
body, as I could seperate nothing with the scalpel and forceps,

1837.] Extra-uterine Foetation in the Sow. 3

but very small flakes of a mcmbraniform matter. There was
nothing like liquor amnii present.

The organization of the pig is not entirely complete : the poste-
rior extremities are not as well developed as the anterior. The
tail is wanting. The eyes and ears, deficient. The head is larger
than natural, and not exactly of the ordinary shape, being lar-
ger below the eyes than natural. Its teeth and hoofs are nearly
natural.

The dimensions of the pig are as follows;
Length of the body and head, 4 1-8 inches

,, ,, without the head, 2 5-8

From the first cervical vertebra to- the os frontis, 1 3-8
Circumference of the body about the middle, 4 5-8

Circumference of the head above the eyes, 4 15-16

From the dimensions it will be seen, that the foetus was near-
ly the full size of one at full period of gestation ; and the organiza-
tion, though not complete is not greatly deficient.

Physiologists, generally, agree that Eccyesis Abdominalis, or
abdominal fetation may occur in three different ways :

1st. The fallopian tubes may be impervious from fat, or the open-
ing into them be so small, that the impregnated ovum cannot
pass, or the fimbriae may not clasp the impregnated ovum, at the
moment it is detached, and in these cases the ovum falls into
the cavity of the abdomen,

2nd. The impregnated ovum may be unable to escape from
the ovarium, till its growth is sufficient to burst its envelopes, at
which time the ovum falls into the cavity of the abdomen.

3d. The ovum may, after entering the fallopian tubes, be ar-
rested in its passage to the uterus by fat, or the small diameter
of the tubes; in which case its growth continues, and, in some
instances, the parietes of the tube give way, and the embryo or
foetus is precipitated into the abdominal cavity. In each of the
two latter varieties, fatal inflammation is apt to occur, from the
combined operation of the inflammation, caused by the rent in
the tube or ovarium, and that, caused by the pressure of so large
a foreign body on the abdominal viscera. In the first variety,
the ovum, being very small, the parts accommodate themselves
to its intrusion, and its growth takes place without exciting in

4 Extra-uterine Fcetation in the Sow. [August,

inflammation. The latter is the mode hy which the present
case must have occurred.

The present case is interesting from its locality, as well as
from the entire absence of every thing like placenta, funis um-
bilicalis, and liquor amnii.

How the ovum performed the journey from that portion of
the abdomen, into which it must have fallen from the ovarium,
to the cardiac orifice of the stomach, where it was located, is a
question which I am unable to answer.

The source from which the ovum derives its nourishment
has long divided physiologists. And notwithstanding the most
able pens have been employed in the discussion, the subject is
not yet completely settled. It is not my object to notice, in de-
tail, all the facts and arguments which have been adduced on
this interesting subject. The most prevalent doctrine, at the
present time, is that which assigns the placenta as the source.
Some, however, maintain that the fetus is nourished from the
liquor amnii.

In speaking of the circumstances, proven, or rendered proba-
ble by extra-uterine foetation, Dr. Denman says that, "though
the child be placed in one of the fallopian tubes, or in the cavi-
ty of the abdomen, a placenta is formed, different indeed in
structure, but capable of supplying the child with sufficient
nourishment to bring it to perfection." Though this is perhaps
true in the main, it is certainly not always so, as is proven
})V the present case: and Dr. Good is more correct when, in
speaking on the same subject he says "it, in some instances
becomes surrounded with an imperfect kind of placenta, devel-
opes the general structure of its kind, &c." Though I admit the
placenta to be the usual source through which the fetus derives
its nutriment, 1 cannot admit that it is the only source; tor there
are many well authenticated cases on record, independent of the
one I have just detailed, m which there was either no placenta,
or no communication between it and the foetus. Dr. Good
quotes a case, from I loiiinaii. of a foetus "born in full health and
vigor, with the (inns sphacelated and divided into two parts"
from Vander Wiel, one where "a living, healthy child, was
exhibited without any umbilicus, as a public spectacle" and
from a foreign collection of literary curiosities, the case of a hare,

1837.] Extra-uterine Fcetation in the >SW\ 5

which was found on being opened, to contain three leverets, two
of them without placenta, or umbilical vessels, and the other
with both." And other cases are recorded by Ploucquet in his
Initia. In the history ot Dr. Good's case, which he witnessed
in 1791, and published in 1795, he says, " The labour was natu-
ral, the child scarcely less than of the ordinary size, was born
alive, cried feebly once or twice after birth, and died in about ten
minutes. The organization, as well external as internal, was
imperfect in many parts. There was no sexual character what-
ever, neither penis nor pudendum, nor any interior organ of gen-
eration : there was no anus or rectum, no funis, no umbilicus ;
the minutest investigation could not discover the least trace of
any." And in a short time, the rudiment of a shriveled placen-
ta followed, '-without a funis or umbilical vessel of any kind,
or any other appendage by which it appeared to have been at-
tached to the child. No haemorrhage, or even discolouration
followed its removal from the uterus."* In a short time, a healthy,
living child was born, attached to its proper placenta.

From these facts, we are compelled to admit, that though the
placenta be the organ through which the foetus derives its nour-
ishment from the mother usually, it is not indispensable to its
existence ; and that nature has other resources upon which she
can draw, capable of sustaining the foetus to the full period of
utero-gestation.

It is well known, that the ovum exists, both before and after
its arrival in the uterus, without a placenta ; and if nature has
supplied the means capable of supporting the ovum during part
of its stay in utero, without a placenta, is it not rational to con-
clude, independently of facts, that she has furnished means ca-
pable of sustaining it during the whole of its stay ? And facts
fully sustain the inference : for independently of the cases already
quoted, it is known to naturalists that the kangaroo, opossum
and woombat, all breed their young without either placenta or
funis. The embryos are not attached to the uterus, but are
enveloped in one or more membranes, containing a gelatinous
matter, from which they derive their nourishment, and apparent-
ly their air. What then are these resources? Mr. Gibson, in
the Edinburgh Medical Essays, has endeavored to prove that the

Good's Study of Medicine, vol. 4, page 21.

Extrauterine Floatation in (he Sow. [August

.

liquor amnii, and not the placenta, is the substance from which
the foetus is nourished. But I must differ with him for the fol-
lowing reasons :

1. The embryo, during the early period of its existence, does
not appear to be surrounded by the liquor amnii ; but by a gel-
atinous matter, like those of the kangaroo, opossum and woombat.

2. The liquor amnii is always in an inverse ratio to the de-
mands of the fetus : being relatively smallest when the foetus is
largest.

3. The liquor amnii is often found exceedingly impure ; some-
times acid, putrescent, feculent, bloody. (Caldwell.)

4. But the strongest objection is, that it is often deficient,
and occasionally, entirely wanting ; constituting what are call-
ed, "dry births."'

But whilst I cannot admit the liquor amnii to be the ordinary
source of nourishment, I am not prepared to deny that it ever
is, but on the contrary, I believe that the fetus is capable of draw-
ing nourishment, by cutaneous absorption, from that which
surrounds it, when the placenta or funis is wanting.

In the case I have detailed, the nutriment must have been
extracted from the fat of the mother, as this was the only sub-
stance with which it was in contact.

The whole of the facts then, taken together, I think justify
the following conclusions:

1. That neither placenta, nor liquor amnii, is essential to the
nourishment of the fetus.

2. That either may be the source, when the other is wanting.

3. That when the liquor amnii is the source of nourishment,
the nutriment is conveyed by cutaneous absorption.

4. That in extra-uterine fcetation, there is sometimes neither
placenta nor liquor amnii, and when both are wanting, the fetus
is capable of extracting sufficient nutriment, by cutaneous ab-
sorption, from the surrounding parts with which it is in contact,
to sustain it to the full period of utero-gestation,

1837.] Verminous Irritation.

ARTICLE II.

Verminous Irritation as simulating other diseases. By Wm.
Markley Lee, M. D.: of Indiantown, S. 0.

Intestinal worms are often improperly supposed to excite fever
in the human subject ; for every experienced physician can re-
call instances in which worms have been discharged, and in
which the friends of the patient have in consequence ascribed
the febrile symptoms to verminous irritation, whereas their dis-
charge was rather a consequence, than a cause of fever.

I have often been astonished, however, that so few instances
are recorded in medical periodicals, of worms as causing the
symptoms of other diseases. They may, and I am convinced
frequently do, irritate certain nerves, and produce symptoms
which are never attributed to their influence. To demonstrate
this position, I will describe certain cases which have occurred
in my own practice, to all appearance totally disconnected with
worms, but which were promptly cured by anthelmintics.

Sciatica. Soon after I commenced the exercise of my pro-
fession in Charleston, I was requested to attend a lad about nine
years of age, laboring under symptoms of Sciatica : Blistering
and the remedies usually employed, were tried in vain for several
days. At one of my visits, when at a loss what next to prescribe,
his mother informed me that he ground his teeth frequently in
his sleep ; this led me to suspect verminous irritation ; I there-
fore sent him anthelmintic -medicine, composed of calomel and
spigelia, and at my next visit I was truly gratified to see him
walking about the house, free from all pain, except the irritation
of the blister. I was informed, that immediately after he had
discharged a number of lumbrici, the rheumatic symptoms van-
ished. He was from that time restored to perfect health.

Phthisis Pulmonalis. I was soon after requested to visit
a young married woman, whose case was marked by symptoms
of the above disease cough so incesssant as to prevent sleep,
and was exhausting her strength ; remedies usually exhibited
in similar cases, here failed to afford relief, until one day she
mentioned some symptom which led me to suspect verminous

8 Verminous Irritation. August.

=>

irritation. After the exhibition of the anthelmintic already
mentioned, in the space of 40 hours she discharged an equal
number of lumbrici, and the symptoms of pulmonary disease
were relieved promptly and permanently.

Paraplegia. I was called during the last summer to a
young girl about 11 years of age, sick with bilious remittent
fever ; she had been bled and purged without material benefit ;
the febrile excitement was moderate, but in addition to consid-
erable pain and soreness about the prsccordia, there was a re-
markable loss of power over the lower extremities, amounting
even to a total inability to turn in bed without assistance. A
careful examination of the spinal column presented no symp-
tom of local inflammation. In reply to my interrogatories, I
was assured that she had received no blow, or injury of the
spine, but that the symptoms of paraplegia supervened at the
same time with the fever. Her friends united in stating that
she frequently ground her teeth during sleep. A blister to the
epigastrium was directed ; and as I had never seen nor read of a
similar case from verminous irritation, my treatment was adapt-
ed both to fever and worms.

ft. Nit. Potass. 3i.

Cal.

Ipecac. &

Camphor aa. 3ss. m.
of this compound, a frequent prescription of mine in billious re-
mittent, I directed 8 grs. every 3 hours during the paroxysm,
and that 3ss. calomel be combined with the first dose. I was in
hopes, from the well established efficacy of this preparation of
mercury, and the success which is reported to attend the exhi-
bition of camphor in Italian practice thai if this form of Para-
plegia was caused by worms, relief would he promptly obtained.
A dose of ol. ricini and sp. terebinthinae was also directed to be
administered the succeeding morning. At my next visit, I as-
certained thai she had discharged a large number of worms, and
was enabled to walk about : she soon recovered.

Such facts I consider interesting and important, and have
been astonished thai they have excited so little attention from
the profession. Have \ erred in attributing these cases to vermin-
ous irritation ? In the two former, the treatment usually insti-

1837.] Verminous Irritation, 9

tutcd, had failed to produce the results expected, and it was not
until worms had been evacuated, that relief was obtained.

I trust this hasty article may elicit the experience of my med-
ical brethren on this point.

In conclusion, I will describe a case which came under my
care while assistant physician of the (Charleston) Bispensa-
ry, in 1828 I was called to an elderly woman who for seve-
ral years had been troubled with Tcenia ; several eminent
physicians, in succession, had dislodged a portion of the worm ;
but in the course of a few months, medical aid was again re-
quired for as the head of the Tcenia had not been discharged,
new joints had been regenerated and morbid symptom renewed
the exhibition of calomel and gamboge, followed by ol. ricini
and sp. terebinth, in a few hours caused the discharge of a
toenia about 4 feet in length. Attributing the recurrence of the
disease to an atony of the alimentary canal, after the exhibition of
alkalies for the purpose of removing the tenacious mucus from
the mouths of the absorbents, I prescribed the solution of acet
of iron, formed by digesting the carbonate of iron in strong vin-
egar, to be taken in doses of a tea-spoon full thrice a day. But
a short time was necessary to demonstrate its efficacy, for her
health improved rapidly. By my directions, she persisted in
the use of the remedy for several weeks After all former at
tacks, a year had never elapsed without a renewal of the symp-
toms. Fully three years after, I again saw her, whe she stated
that she had never since perceived any symptoms of the worm.

A few months since, I attended a young negro, from whom,
in the space of a week, I succeeded in dislodging more than 70
lumbrici. The same tonic (acet. iron) was prescribed for him
and at the present time, his master has not a more healthy young
negro.

These latter cases, although not strictly connected with the
above article, are adduced to show the expediency and necessity
of following up the exhibition of anthelmintics by chalybe;i
or other tonics,

10 AnenccphaluS) or Human Monstrosity. [August,

ARTICLE III.

Account of an Anencephalus, or Human Monstrosity without
a brain and spinal marrow. By Alexander Y. Nicoll,
M. D. and Richard D. Arnold, M. D. of Savannah. Read
before the Medical Society of Georgia, on the Gth May, 1837.

On the 12th February, 1837, we were requested to examine
a female negro child, which had the night previous been pre-
maturely born at the eighth month, to give our opinions whether
violence had been used or not, which in consequence of the sin-
gular appearance it presented, was supposed by those who at-
tended at the delivery. Upon a superficial examination, we
pronounced that no violence had been used to destroy the child,
but that it was a monster of an interesting character, and re-
quested that it might be given to us for a more minute examina-
tion, which was readily granted. We have, with the assistance
of Dr. Lewis F. Nicoll, of New York, made as careful an ex-
amination of this case, as our means and experience would allow
us, and believe it is important in determining the question of
the evolution of the brain and nervous system ; not so much,
however, from the deductions which we ourselves have drawn
from the dissection, as from its affording additional facts to those
which have already been presented to the profession on this sub-
ject, by older and abler heads than ours.

A front view of the child exhibited to us the eyelids as two
round bodies placed upon the top of the head, as delineated in
fig. 1st, which previous to the dissection, we considered as defor-
mities in themselves. In this view, the chin was resting upon
the chest, bringing tli<' head so low down, that the ears not only
touched^ but were actually turned up by the shoulders. Upon
looking ;ti Mi'- 1m ad laterally, if appeared ;is it* cut oil" ly a plane
which intersected it just above the nose: thence passing down tp
the i<<;> of the ears and there exhibiting a slighl prominence, as is
Bhown in fig. 2d, occasioned by the sponginessof the membrane,
hereafter to be mentioned, the plane then passing down at a
greater angle to the shoulder.

Looking at the bead posteriorly, it appeared as if the whole

1837.] AnencephahiS) or Human Monstrosity. 13

scalp had been removed, with the exception of a small portion
just back of the eyes, which passed down on each side close to
the ears, and terminated directly upon the shoulders ; upon the
whole of which hair had been formed. The central portion, in-
stead of the convexity usually observed, presented a very irregu-
lar appearance, dark and bloody, as if violence had been used.
This central portion was covered by a thin membrane, which we
believed to be the Dura Mater. Upon pressing this with the fin-
ger, it appeared to be in direct contact with the bones beneath
with the exception of a small part in the centre, which felt spongy
to the touch, but at the same time of very little thickness.

Proceeding to the dissection and removing the scalp behind the
eyes, we were surprised to find not the least rudiment of the
frontal bone, except a portion of the orbitar plates which was at-
tached to a confused mass of bone, hereafter to be mentioned.
Upon dissecting the membrane from the central portion, we found
it closely adherent to the basis of the cranium, if we may call it
so, (with the exception of the spongy central portion tlrat appear-
ed to contain blood,) and traced it down to the spinal canal from
which it appeared to emanate. Underneath this membrane was
a confused mass of bone, very 'solid, without any marks of the
usual divisions of the bones of the cranium. Continuing on, we
found no trace of the parietal, the occipital, or the squamous
portion of the temporal bone. After an attentive examination,
we could not discover the least portion of the cerebrum or cere-
bellum. That portion of the foramen magnum, which is form-
ed by the sphenoid bone, and which is usually, more or less,
round, was in this case angular, the angle being formed by the
junction of the bases of two triangular plane faces, the vertrices
of which terminated behind the ears, and there formed some-
thing like the mastoid process ; which, however, instead of being
round, presented a sharp edge looking outwards and backwards,
as seen in fig. 3d. Believing that something might be contained
in the confused mass of bone which formed what might be con-
sidered the base of the skull, we sawed through it, but found it
perfectly solid. In examining the cervical portion of the verte-
bral column, we could not discover the atlas ; and found that it
was composed of four, instead of seven, vertebra?. On opening
the spinal column, there was no trace of the spinal marrow ; but

14 Anencephatus, or Human Monstrosity. [August,

the membranes were present from about the 2d dorsal vertebra,
From the position and great prominence of the eyes, we doubted
if there could be any antrui , maxillare ; which, upon dis-
section, we found to be the case. The eye had made itself a
socket in that portion of the upper maxilla commonly occupied
by the antrum. In our lissection, we were particularly struck
with the quantity of a dipcse matter we met with, as also the
abundance of hair, which, in this particular case, covered the
cheeks, the shoulders, the outside of the arms and fore-arms, the
back down to the nates, and the outside of the thighs and legs.

We next dissected down, to ascertain the appearance of the
axillary and popliteal nerves, and found them large and well
developed. We also dissected the neck, to ascertain the com-
parative size of the internal and external caroted ; but regret
that we were unable to determine this, in consequence of our
wanting the means of injecting them ; and the common carotid
Was so small, and not being injected, we lost all trace of the artery
in a mass of caseous matter, behind the angle of the lower max-
illa. With the exception of the head and neck, every other part
of the child, externally, was remarkably well formed and plump.

From the foregoing description, it will be at once perceived,
that the monstrosity described answers exactly to that known as
an Anencepiialus ; as that term lias been reserved to designate
such as have the brain partially or completely absent, "with a
corresponding defect of the parts by which it is protected." In
< asc the external organs of the senses were present.

< >ur object in bringing this subject before the Society, is not

lythat a "lusus naturce" might be brought to the cognizance

r medical brethren, and not be buried in obscurity But in

contemplating it, it cannot fail to strike every observer as being

i plant with interest, in a philosophical point of view. In the

ervations which follow, it is more our object to elicit re-

h than to provoke criticism. In the article Anencephalus,

in that excellent work "the Cyclopedia of Practical Medicine

and " Dr. Geddings, of Baltimore, has the following

(rations:

"In that rariety ofanencephalous monsters in which the defect

(,st con i here is a total absence of both brain and

spinal marrow: the peripheral portion of the nervous system ex-

1837.] Anencephalus, or 1 In man Mnji.siro.slti/. [5

ists and is well formed ; but the nervous centre, or cerebro-spinal
axis, is altogether defective. This is by far the rarest form
of this species of abnormal deviation, and is the only one to
which the term antnccphalus can be properly applied. So
seldom indeed does it occur, that only a few cases are to be
found on record"

In this, as in the case reported by Morgagni, and cited in
that article, the cerebrum cerebellum and medulla spinalis were
absent; and like that reported by Vaxhorne, "the deformed
bones of the cranium were so thick and closely grouped togeth-
er, that no cavity existed ; but the membranes of the medulla
spinalis were developed.

The membrane lying over the bones of the cranium was un-
doubtedly Dura Mater ; because, after lifting it up, the perioste-
rum was found adhering to the bones, and moreover the membrane
was continuous from the cavity of the spine. In relation to the
peripheral nerves, there are some facts worthy of attentive con-
sideration. All the nerves of the periphery were not present. -
To obviate misapprehension, we beg leave to state, that in nerves
of the periphery, we include those which establish a communi-
cation between the brain and spinal marrow and the organs of
the external senses.

1st. Of the Nerves to the orbit of the Eye. In the normal
state, no single organ is so well provided with nerves as this.
Anatomists reckon no less than six, viz : the optic ; the 4th pair,
or pathetic, (the respiratory of Bell); a branch of the 5th, or Tri^e-
ninus ; the 3d, or general motor of the eye ; the 6th, or external
motor ; and a branch of the sympathetic which joins it on enter-
ing the orbit. It will be recollected, that the ball of the eye rested
on the upper maxilla, and had formed a fossa for itself in that
part usually occupied by the antrum maxillare. A careful and
minute examination failed to reveal to us a single nervous fila-
ment about the bail of the eye, or in its vicinity. The foramen
by which the optic nerve passes through the sclerotic, did not ex-
ist ; and although every other part of the eye was satisfactorily
apparent, the Retina (if it had existence) could not be perceived
by us. The six muscles of the eye-ball were also deficient.

2d. The Nerves to the Nares. In the normal state, the Nares
are supplied from two sources, the olfactory and the trigeminus.
There was no trace of a single filament of either.

16 Anencephalus, or Human Monstrosity. [August,

3d. Of the Ear. There was no cavity in the mass of bone
which might be said to represent the petrous portion of the tem-
poral bone. Of course all the auditory apparatus usually con-
tained in it, must have been wanting. The external ear was
present, and a small depression represented the meatus auditor-
ius extemus. As might be inferred from there being no cavity
in which to pursue its usual course through the petrous bone,
the Facial nerve was entirely wanting. Indeed, the space
behind the angle of the inferior maxillary bone, was filled with a
kind of caseous matter, in which no muscular fibres nor nervous
filaments could be found Not the least interesting thing in this
dissection, was the anatomy of the nerves going to the tongue
and down the front of the neck. As all the nerves of the ence-
phalon which we had looked for, and which should have come
through foramina in the cranium, had proved deficient ; it was
with no little curiosity that we commenced a careful examination
of that part. The pneumo-gastric, the hypo-glossal, and the glos-
sopharyngeal, equally with the portio-dura, trigeminus, patheti-
cus, and motor-oculi, are in the normal state, involved in forami-
na in the cranium ; and analogy would have led us to infer their
absence. But, although from the shortness and imperfection of
the neck, and the small developement of the muscles in its front,
a little more than ordinary care was required in the dissection,
the pneumo-gastric, the hypo-glossal, with its descending Ramus,
and the glossopharyngeal, were distinctly visible. The prepa-
ration now before the Society will make it apparent to every one.
But they were lost above in the caseous matter which we men-
tioned as existing behind the angle of the inferior maxilla. The
common caroted and the internal jugular were also apparent,
though small, and they were insensibly lost in the same matter.

As all the other parts of the body, save the head, were well
formed, it remained to be seen what was the condition of the
nerves distributed in them. It was not deemed necessary to ex-
amine more than one for each extremity. For the arm, the me-
dian nerve was cut down to and exposed. It was of a full and
natural size. The popliteal nerve was exposed in the same
manner and with a similar result.

What the nature of the energy of the nerves is, will probably
always remain amattcr of .speculation. We can appreciate the

1837.] Anencephalus, or Human Monstrosity. 17

powers of life only by their effects. But let not uncertainty be
hence attributed to our profession, above others. Who has ever
approximated to the real nature of that wonderful law by which
the planets are made to revolve in their respective orbits, and the
harmony of worlds preserved? Yet, from a careful examina-
tion of its effects, laws have been deduced and made the basis
of unerring calculations So the diligent observer of nature at
the bedside and in the dissecting room, cannot fail to arrive at
a knowledge of the laws of life that will be of inestimable value
to him in the investigation of disease, which is a departure from
their natural course.

In this case, there could be no dispute as to the priority of de-
velopement, between the brain and spinal marrow. Is it not
then improper to speak of one taking its origin from the other ;
and is not this case a confirmation of Haller's opinion that
there is an evolution of the parts of the foetus without the addition
of any new part?

With the exception of the head, all the parts were well nour-
ished. Certainly they did not depend on nervous energy derived
from the cebro-spinal axis, for their nutrition. We must then
look to the arteries as the source of nutrition, and as the cause
of the developement of such nerves as did exist. It is evident
that the arteries which exist in the normal state, could not exist
in the confused mass of bone constituting the cranium in this in-
stance ; hence a deficiency in evolution of the nervous, muscu-
lar and bony matter of that part.

The nerves that were developed must have had an energy in-
dependent of the brain and spinal marrow.

The result of the researches of Tiedeman on the developement
of the brain in the foetus, is that the spinal marrow is the part of
the nervous system first formed, and most distinct in its early
months. The case before us, proves that the deficiency of the
spinal marrow did not prevent the formation of most of the peri-
pheral portion of that system ; and that such formation is not
dependent in any way upon that of the Spinal Marrow.

A few observations on monsters will close what we have to
say on the subject. Like the majority of monsters on record,
this was of the female sex. The observations of Meckel have
proved the "genital organs of the two sexes are formed primitive-

18 Case of Intussusception. [August,

ly in the same model, and that they should be considered only as
a modification of the same fundamental type ;" and that the em-
bryo is, in all cases, primarily of the female sex. The imper-
fect formation thus occurring more frequently in females, has
been supposed by Georget to be owing to a feebler eneroy of
the formative or organic powers in the female than in the male !
Why a deficiency should exist in one part in preference to anoth-
er, must remain a matter of speculation.

The history of the mother affords no clue in this case. She is
a woman about 30 years of age, well formed, and has been the
mother of eight children, all of whom, with the exception of two,
have been delivered at the regular time ; and her deliveries have
generally been easy, and her recovery rapid. There had been
nothing pecular during this pregnancy. In the delivery, there
was nothing to lead to a suspicion of any thing unusual, and it
was not until the child was fairly exposed to the light, that it was
discovered to be a monster. There was said to be a larger quam
tity than usual of the liquor amnii ; but this we are inclined to
attribute to the birth being premature. The child showed no
sign of life after birth. It had moved, sensibly, when in utero,

ARTICLE IV.

Case of Intussusception : by Dr. Judson ; communicated by
Dr. Bacon, of 8t. Mary's, Geo.

R. H. H., a fine, healthy boy, 3 months old, was attacked
about 10 o'clock on the evening of the 16th of June, with a slight
colic. The symptoms were so mild as to excite no alarm, A
little paregoric was given by the mother, and it slept as quietly as
usual all night. Next morning at 6 o'clock, violent symptoms
appeared severe vomiting, pain in the abdomen, and paroxyisms

1837.] Case of Intussusception. 19

of extreme distress. He had one natural stool after the first vo-
miting occurred. The mother soon became alarmed and ad-
ministered some magnesia, which was instantly thrown up.
Some castor oil was then exhibited, but no relief was obtained ;
and, except the small stool above-mentioned, nothing had passed
from the bowels but a few drops of pure blood This took place
several times, and always with great pain and straining. Dr.
Bacon was now called in. The child had become alarmingly ill,
and was vomiting matter of a stercoraceous colour and smell.
The case was at once recognised as Ileus of an aggravated
character. But as the child had been seized in perfect health
without exposure to any violence, or to any known error of diet
or regimen, the cause was involved in great obscurity. The or-
dinary remedies for Ileus were employed, but did not in the least
check the fearful progress of the malady. The spmptoms con-
tinued to increase in violence without other material change, till
6 o'clock in the evening, when (12 hours from the onset
of the complaint,) the child died. There was at no time much
apparent tenderness in the abdomen and the tumour, so often
noticed in cases of intussusception, was not observed at all. Du-
ring the last three or four hours, the bowels became tympanitic
and no tumour of the land could have been discovered, even had
it existed.

Post Mortem Examination. The body was examined 18
hours after death, by Dr. Bacon, in the presence of Drs. Church
and Judsox. It was not in the least degree offensive, as pu-
trefaction had not begun, except perhaps in the scrotum and
groin, where a slight discolouration appeared. On laying open
the abdomen, all the viscera except the intestines were found
perfectly healthy. The stomach and intestines were greatly dis-
tended with flatus, but devoid of all fsecal matter. From a point
a little above the sigmoid flexure of the colon, a portion of the
bowel six inches in length was found distended one-third beyond
its natural size, discoloured almost to blackness, nearly gangren-
ous and filled or rather bloated up with some soft substance. -
The intestines upwards from this point through the whole course
of the ileum and part of the jejunum, were intensely injected
and inflamed, the extreme redness and vascularity gradually di-
minishing with the distance from the immediate seat of disease.

20 Azalea, or Honeysuckle. [August,

Indeed it was agreed by all present, that they had never seen so
perfect and beautiful an injection as the intertinal coats exhibited.
On removing the parts for a closer examination, a large portion
of the ileum, the whole of the caecum, the ascending colon and its
arch were found invaginated in the descending colon, and the
whole so much displaced that the ileum seemed to be nearly
continuous with the sigmoid flexture of the colon. Considera-
ble effort was required to draw out the invaginated parts. They
had completely blocked up the whole intestinal cavity for the dis-
tance of three or four inches. Yet no adhesion had formed no
coagulable lymph was thrown out nor were any of the ordina-
ry products of inflammation seen, unless the blackness observa-
ble at the point of intussusception be considered as proof of gan-
grene. The inflammation produced by the unnatural situation
of the bowels seems to have destroyed the child in its very first
stage. The extreme pain accompanying such displacement and
such violent inflammation, may have accelerated the fatal issue.
It was made evident in the examination, that had the abdomen
been laid open during life (as has been sometimes proposed) with
a view to disengage the invaginated parts, they could not have
been reduced without a degree of force amounting almost to vio-
lence. I have seen no case on record that run so rapid a course.

ARTICLE V.

Letter from Dr. E. H. Macon, on the diuretic virtues of the
Azalea, or Honeysuckle.

Mercer Institute, April 5, 1837.
Mr. Editor It has been for some time my intention to make
known to you, and through your valuable journal, to the profes-
sion at large, a new article which has proved in my hands a

1837. J Azalea, or Honeysuckle. 21

most valuable therapeutic agent. I am not aware that it has ever
been introduced into regular practice ; and that its virtues may
be more fully tested by experiment, I wish to call the attention
of the faculty of the College of my native state to the article in
question.

Azalea Honeysuckle the Root. This shrub grows abun-
dantly on the banks of small rivulets. Its flowers are red, and
sometimes very pale. It yields a semi-transparent fruit* from the
size of a quarter dollar to that of the palm of the hand. Children
frequently pluck and eat it. It is a vegetable diuretic.

About four years ago, I heard a countryman urging the claims
of a strong decoction of Honeysuckle to powerful diuretic pro-
perties, and I determined on testing its virtues at the first oppor-
tunity. It was not long before an extremely distressing case of
hydrotherax was placed under my care. The patient could not
lie down, but was compelled to sleep in a sitting posture. He
could scarcely walk ; the feet, legs and thighs, as well as abdo-
men and face, being enormously swollen by anasaceous effusion.

In addition to various remedies as advised by different authors,
I ordered a strong decoction of the root of Honeysuckle to be
drank at all times, and in any quantity, instead of water.t With-
in ten days all the hydropic enlargements were entirely removed.
So rapid had been the abduction of the effused fluid that the skin
on the limbs presented a shrivelled and wrinkled appearance.
The patient, a robust negro man, was, in two weeks from the
time the treatment was commenced, enabled to go to his ordinary
labor; and within four weeks was discharged as perfectly well.

I have since treated a number of dropsical cases, in only one of
which have I failed to reduce the swelling forthwith. Some of
the cases were treated three years ago, and continue well.

I would not have it understood that I have not used other me-
dicines during the treatment of these cases. My success in the
first, made me unwilling to abandon the plan of treatment then

*"VVe should consider this an excressence, instead of a fruit. It is not found
on the fruit buds, but attached to the leaves, and other parts of the shrub. Ed.

tThe administration of the new remedy, in addition to the prescriptions recom-
mended by authors, leaves the truth unrepealed, whether the new or the old rem-
edies wrought the good in the case. There should be great precision in determining
the value of new remedies. lb.

22 Azalea, or Honcysvr [August,

adopted, and to which I have since, uniformly adhered, with on-
ly a few trifling exceptions.

According to my pathological views of dropsy formerly and at
present, thus, as there is no lesion, injury or mechanical imped-
iment to the proper performance of the peculiar function of the
absorbent system, dropsy must be owing to a want of energy, or
a state of atony or torpor in that system. With these views I pre-
scribed, after the exhibition of a brisk hydragogue cathartic, the
calomel and squill pill, and a strong decoction of honeysuckle
root. It is not my purpose to dilate on calomel as having the
virtue to stimulate and increase the power of the absorbent sys-
tem when sluggish, nor to discuss the question of the specific
influence of squills on the pulmonary system, nor that of its di-
uretic properties. My chief reliance however for a diuretic, is
the honeysuckle. I use such other remedies as the indications
of cure may seem to demand, but of all articles with which I
am acquainted, I repeat that the root of the honeysuckle is, for
diuretic purposes, the most efficient.

As I am not writing an essay on dropsy, I will proceed to no-
tice its successful administration in some other diseases.

In retention of urine from other causes than mechanical ob-
struction and paralysis of the bladder, I have used it with great
benefit ; so that in my limited practice, I have never had occa-
sion to use the catheter but in one case, and that was one of re-
tention of urine from paralysis of the bladder.

In all cases of strangury and gravel, and of inability to dis-
charge urine in gonorrhoea, gleet, &c, I uniformly prescribe the
Honeysuckle not, however, depending on this for the cure of
the disease which may cause or accompany this retention, but
simply for diuresis. In short, in whatever case a diuretic is in-
dicated, the honeysuckle may be be used freely mid with safety.
It has always proved perfectly con t rotable, its effects ceasing
when its use was discontinued.

The case of dropsy referred to in the former part of this let-
ter, wherein I failed to reduce the swelling, was that of a negro
woman who had been afflicted with ascites for three years, dur-
ing most of which time she had been under the treatment of ex-
perienced physicians. Her abdomen was enormously distend-
ed. After usinjr various remedies which seemed to be indicated

1837. J Azalea, or Honeysuckle. 23

in this case, at length, during an interval of phyalism, produced
by the use of the calomel and squill pills, I ordered her to make
a constant and free drink of the Honeysuckle, excluding all other
drinks and medicines for several days. I did not see her again
for a week, at which time she informed me that when sitting
down, she was afraid to get up if in company, because the water
would run from her on every attempt to walk ; expressing at the
same time great astonishment, that the quantity of fluid voided
far exceeded that taken in. She was at one time reduced in size
about two-thirds, and seemed for a time to promise continued
amendment ; but after a time the swelling again increased, alike
in defiance of this and all other remedies. In all the cases with
the exception of this, and one of hydrothorox attended with hy-
pertrophy of the heart, I succeeded in effecting permanent cures,
so far as has yet appeared, or in procuring such amendment as
to cause the patient to abandon the remedy too early, from the be-
lief of no farther existing necessity.

I might say much more on this subject, but consider that I have
said enough to introduce the article in question to the attention of
the profession. Will you and your colleagues adopt the use of
the Honeysuckle, and give the results in the Southern Medical
and Surgical Journal ?

Dr. Macon requests information on the following cases :
1st. A clergyman of Oglethorpe, whilst leading his horse by
the fore-top, was by a sudden effort of the horse, caused to suffer
great pain at the insertion of the deltoid muscle. He has almost
entirely lost the use of the limb, being unable to raise it higher
than his breast, or move it in any other direction except forward.
The limb has been examined by several physicians, none of whom
can detect luxation or fracture. All ordinary topical applications
have been made in vain,

2d. Mrs. L*****, in this vicinity, whilst stretching out a hank
of cotton yarn, suddenly felt pain about the middle of the humer-
us. In a few weeks, the biceps flexer cubiti became much con-
tracted and still remains so, bending the fore-arm up to the breast.
The limb is painful and almost useless. No dislocation or frac-
ture can be detected.

24 Azalea, or Honeysuckle. [August,

3d. In October, a negro girl was struck by the falling of a tree
in such a manner that her scalp was considerably lacerated and
her left shoulder bruised and violently strained. No fracture of
clavicle, scapula or humerus, nor dislocation, could be detected,
after the most careful examination. All topical applications from
the use of which benefit might be hoped for, were used to no good
effect. Six weeks after, the arm was entirely useless, but moved
in any direction without the least pain. The motion of the
shoulder joint was free and without crepitus. The paralized
state of the parts about the joint afforded a free examination of the
head of the humerus, which was always in place with the
glenoid cavity. The force which injured the shoulder was ap-
plied from above.

It is hoped that a clear and rational pathology of these cases
will be given by some of the readers of the Journal.

For the assistance of those who may be disposed to adopt the
use of Dr. Macon's diuretic, we append the following extract of
a letter from a scientific friend, on the subject of the Azalea :

" The Azalea (or < Bush Honeysuckle/ as contradistinctive to
the genera Caprifolium and Lenicera, which are called Wood-
bines, from woodbind, and are twining or trailing plants) is
arranged in the Linnaean class and order Pentandria monogynia,
and the natural order Rhoderaceoe. There are ten species de-
scribed in the 7th edition of Eaton 's Manual of Botany, and
full as many more set down as varieties or sub-species ; the
growth of the United States. Elliott has five indigenous to South
Carolina and Georgia, with three times that number of varieties,
but he quotes Donrts Hortus Kewensis for his subdivisions,
instead of resorting to the forests. If we pass to Europe and
embrace their garden varieties, which are the only true varieties,
we find in the collection of Messrs. C. Loddiges & Sons, near
London, twenty three species, one hundred and eighty-six varie-
ties and twenty-four sub-varieties ; seven-tenths of which are
derived from North American species.

"The Azalea nudiflora mid Azalea viscosa are the most abund-
ant and widest spread over the United States : beginning at the
borders of Canada and extending along the broken land, and par-
ticularly the mountain range, to their most Southern extremity ;
they often approach the sea board, but become more plentiful as
you recede to the midland."

1837.] Essay on Female Diseases. 25

As Dr. Macon has distinguished no particular species or vari-
ety, we presume he alludes to any or all the varieties of these
species. It would be well however, for those who adopt its use,
to observe the effects of the different species at least; the differ-
ence of which will, we presume, be found, if at all, only in the
degree, and not in the kind of power. Ed.

ARTICLE VI.

An Essay on Female Diseases, and the Use of the Pessary
in Uterine Displacements. By Dr. S. M. Meek, of Tusca-
loosa, Ala.

The present is an age of considerable speculation and enter-
prise, in sience and scientific pursuits generally ; and no de-
partment affords a more extensive and interesting field for inves-
tigation than that of medicine ; nor can any be found with which
the life and happiness of man (in his present state) is so closely
connected : consequently there is no subject more worthy of deep
thought and thorough investigation, by the philanthropist and
scholar. This, however, becomes the peculiar duty of the med-
ical profession.

The interest taken by medical men, both in Europe and in our
own country, indicates that they do not design the subject to
slumber, as the increase in the number of medical journals and
reviews, both in Europe and America ; and the general and sci-
entific character of most of those periodicals omen well an im-
provement in the healing art.

In the United States, the North and West are in advance on
this deeply interesting subject, nor have the Southern states kept
pace with their northern and western sisters, in proportion to

26 Essay on Female Diseases. [August,

the talent, wealth and medical science of which they could boast.

Our zeal in the good cause has recently aroused us from our
lethargy, and even as far south as the city of Augusta, in the state
of Georgia, we have a Medical Journal published, which in point
of interesting subjects and scientific and practical research,
(though but young) will not sutler by comparison with many of
those of more mature years.

Although on the healthy condition of the uterus, the health,
happiness and stability of mankind almost entirely depend, still
there is, in my humble opinion, no department of medical science
more generally neglected or noticed with less concern, than female
complaints, and especially uterine affections.

It is true we have some works of considerable merit on this
subject, both by ancient and modern writers ; yet I must insist
that the profession have not afforded their successors that light
on this subject which they could have done and which its impor-
tance demands.

I am happy, however to find that our southern physicians,
through the medium of our journals, have at length manifested a
consciousness of the thrilling interest which should be felt on this
subject ; as it must be obvious to every close observer, that a
southern climate and the constitution of females born and raised
in the south, render them peculiarly subject to diseases of this
organ, and should impose on the medical profession the duty of
attempting to afford them that relief which is not to be looked
for from any other source.

I am perfectly aware that in relation to this as well as to most
subjects occupying the attention of medical men, there will al-
ways be a diversity of opinion, not only in relation to the remote
and proximate cause of disease, but likewise as to the most pro-
per remedial agents and their modus operandi.

I would therefore beg leave to notice a few of the causes which
in my opinion, contribute to render the number and extent of fe-
male diseases much greater in southern than in northern lati-
tudes and

1st. The precocity resulting from climates, by which females
arrive at puberty from two to six years earlier than in northern
latitudes.

2d. The effect of the climate on the system producing greater

Is:-)?.] Essay on Female Diseases. 27

relaxation of the muscular fibre, and the parietes of the uterine
and genital organs in general.

3d. The effects of early parturition on the uterus and its liga-
ments and on the vagina, and the imprudent exertions made by
ignorant female accoucheurs to hasten the termination of labour.
4th. The delicacy felt by young, inexperienced females, in ma-
king known their condition with flour albus, prolapsus or proci-
dentia uteri, producing delay in making application to the physi-
cian for the necessary assistance.

These, together with other causes, contribute largely to aug-
ment the sufferings of females in southern latitudes beyond what
they suffer in colder climates.

The question then arises, what can be be done to relieve female
suffering and ameliorate their condition ?

In the first vol. of the Southern Medical and Surgical
Journal, being No. xi. for April, 1837, I perceive the use of the
Pessary in displacements of the uterus and vagina is brought up,
and to some extent examined ; but the conclusion to which the
author of the essay arrives from his own experience, and the au-
thorities to which he refers, on the first blush, was to my mind
perfectly astounding, and led me to enquire, can it be so 7 At
this day, illumined as we certainly are (or should be) by the
sun of medical science shall we be led to abandon to immedi-
ate sufferings, and finally to death, a vast number of the most
invaluable human beings on the face of our globe, by takino-
from them (shall I say) the sheet anchor of their hope, that, on
which hundreds have rested and found (or believed they found)
themselves delivered from some of the most distressing diseases
incidental to human nature, and that without proposing any ade-
quate substitute, on which to fix their hopes when laboring under
such peculiar affliction ? When we recur to the medical history
of gone-by ages, and enquire whether females then suffered as
they do now, and whether these diseases were then known, and
if so, how treated ? We are informed that as early as the days
of Hippocrates, Pessaries were in use, and almost every author
who has written on the diseases of females and on midwifery
from the days of the father of medicine, down to the present day,
not only speaks of their successful application in practice, but con-
siders them indispensable in many cases, as all other means resort

D

28 Essay on Female Diseases. [August,

ed to have failed, while Pessaries have proved successful. And
Dr. Devees speaks of their use and utility, in language and un-
der circumstances which cannot be mistaken or doubted even by
the most skeptical.

I am authorised to say that most of the practising physicians in
this city and vicinage, use the Pessary in their practice, and
some of them believe that cases occur of both prolapsus and pro-
cidentia uteri, in which neither a recumbent position, nor Hull's
utero abdominal supporter, nor any known remedy, will super-
sede the use of the Pessary.

For the last twenty-eight years I have been engaged in the
practice of medicine, in South Carolina, Georgia, and for the
last nineteen years in the state of Alabama, in or near the city
of Tuscaloosa ; during most of which time my attention has been
called to the treatment of-female diseases, and especially uterine
affections.

While studying medicine, I formed a predilection for the
sponge Pessary, not doubting, however, but that I should meet
with cases which would in all probability require Pessaries of
greater firmness ; and subsequent practice has produced no
change of opinion in relation to the use of the sponge. In the
course of my practice, I must have prescribed and used the Pessa-
ry in more than two hundred cases, and I can confidently assert,
that at least one hundred and fifty have derived evident benefit
from their use : and in more than fifty cases they have been restor-
ed to a healthy condition, and (suffer me to add) a large majority
of the cases have been prolapsus, not procidentia And here I
would offer a few reasons why I have been induced to prefer the
sponge Pessary.

1st. The sponge Pessary is softer and more yielding, so as to
accommodate itself to the parts without injury to the vagina, or
uterus, and on this account may be used when the parts are
somewhat inflamed and irritable.

2d. The sponge Pessary can be introduced and removed with
less difficulty than any other kind, and that by the patient herself.

3d. The sponge Pessary does not obstruct the ordinary excre-
tions, but absorbs them ; and unless they should be reduntant,
will imbibe the whole discharge when removed twice a day, as I
always direct.

1837.1 Essay on Female Diseases. 29

4th. The sponge Pessary is the best vehicle by which astringent
and refrigerant applications can be made to the relaxed and in-
flamed parts ; at the same time injections may be used when the
Pessary is removed : but this I have seldom found necessary
when the sponge Pessary is well managed.

5. The sponge Pessary is more easily suited in size and form
to all cases than any other kind of Pessary.

In many cases of displaced uterus, a recumbent position is in-
dispensable to enable the parts affected to recover their natural
position and tone, and in some cases this alone, or accompanied
with suitable injections, may be all that is required ; while
there are others (and especially when they have become chronic,)
which would never be restored by position, injections or other
means without the pessary. In such cases, when the Pessary is in-
troduced, the patient, with but little inconvenience, can go on foot
and attend to her ordinary business and the parts thus kept in
situ, the ligaments gradually recover their tone, the Pessary may
then be dispensed with. I have had a number of cases of this de-
scription.

I am on this subject, as I would be on all others of importance,
disposed to examine all the different bearings before I would at-
tempt to controvert the views and opinions of others.

This, however, is a subject which has long occupied my strict,
and I may add, my (almost) undivided, attention ; and although
" doctors" may " disagree," yet this disagreement should not ob-
struct, but accelerate the progress of medical science ; and Dr.
J. A. Eve, in his remarks on professional qualifications and cha-
racter, very justly observes, (in substance,) that the medical pro-
fession has fewer helps or way marks to assist and direct their
course, than have those persons engaged in any other profession,
and consequently they require stronger mental powers and more
extensive scientific and literary acquirements.

Much has been effected by a close attention to mechanical
principles within a few years past, in the application of steam
power, together with suitable machinery to facilitate the inter-
course between distant regions, and much animal labor has been
dispensed with, and incalculable advantages in mechanics, agri-
culture and commerce, have been the result. Shall men use such
physical and mental exertions to accomplish that which may add

30 Essay on Female Diseases. [August,

to our comfort as well as pecuniary advancement, but accomplish
nothing more ; while the medical profession, in whose hands are
placed the health, life and happiness of thousands, rest satisfied
with the attainments already made in the u healing art ;*' although
there has been so little accomplished for the relief of suffering hu-
manity for ages past. We have but recently discovered that our
predecessors in medicine were in error in some important parts of
their practice, while we ourselves are unable to furnish a desider-
atum in its place.

Should not every physician feel it a duty incumbent on him to
make some discovery or improvement in medicine, and never dis-
pense with former discoveries without the best reason for so doing,
and then only after proposing at least something which promises
more certain and permanent relief?

I presume no one would assert that in all cases of uterine and
vaginal displacements, a Pessary should be used, and that without
reference to the condition of the parts as to metritis and other af-
fections ; nor would any judicious practitioner prescribe or intro-
duce a Pessary without first ascertaining as nearly as practicable
the condition of the parts, and then determining as to the time
for application, the size and nature of the Pessary to be used ; and
even then he should not resolve to continue its use at all hazards,
but be governed by the effects produced and either remove or
continue the Pessary for the time being as circumstances may
direct.

In several cases of prolapsus uteri which have come under my
care (one of which has been within a month past) I have directed
the use oi the Pessary, believing at the same time the patient
prepared lor its use. But when on trial, it produced great uneasi-
ness, I have then had it removed for some days and directed its use
again when the irritable state of the parts shall have subsided;
and my hopes and expectations have been fully realized.

I am not at all surprised that many physicians have imbibed
prejudice againsl the use of the Pessaries, who acknowledge they
have never used them in practice, but have removed them when,
after having been introduced by others, they were doing great in-
jury to the parts. This is nothing more nor less than I should
expect, from the solid unyielding nature of many Pessaries now
in use, and highly recommended by some of our best physicians,

1837. J Essay on Female l)'is(<< 31

and from- the length of time they direct them to remain without
beixur removed.

But I presume none will make the foregoing assertion in rela-
tion to the sponge Pessary, when prepared of good line sponge, of
proper size, well introduced and removed twice a day.

When I commenced this essay, my design was to present my
views on the Pessary audits use in displacements of the uterus,
&c. in a concise and condensed form ; hut professional and other
business so frequently interrupted my progress, that to give
some general idea of uiy opinions I have necessarily been more
prolix than I anticipated.

In conclusion, I would observe that several of the reasons
offered by the essayist at the close of his essay, why " Pessaries
ought now to be abandoned,1' would never have occurred to my
mind, nor can they (in my opinion) have any weight, when the
sponge Pessary is used as I direct. The patient herself can in-
troduce and remove the Pessary, nor is it indispensable that it
should remain when in bed ; as the recumbent posture will be
sufficient to keep the parts in site ; but introduced before or when
she rises. The use of the Pessary may be suspended (as I al-
ways order it to be) during the catamenial discharge ; at which
time the patient should avoid great bodily exertion and keep as
much as convenient in a recumbent posture, nor should I appre-
hend any demoralizing influence from the use of the Pessary.

Note. Dr. Meek seems to have, in common with some of
the most respectable authors, used the terms prolapsus and pro-
cidentia somewhat differently from their general acceptation at
the present day. It is true, that the application of the terms either
way is arbitrary ; and consequently Dr. M. as well as those from
whom he adopted his nomenclature, had a perfect right to apply
them as he might please. Still a fixed nomenclature for these
cases is not of trivial importance ; as the want of it has tended to
unsettle the minds of pupils, and cause disagreements and mis-
understandings amongst practitioners. Some authors have spun
out. the nomenclature for this displacement to express several
different degrees thereof: as Parr, who by relaxatio, means a de-
scent of the womb down to the middle of the vagina. By proci-

32 Essay on Female Diseases. [August,

dentia, he characterises its descent to the labia ; and by prolapsus,
its falling through the labia pudendi. Charles Mansfield
Clarke says procidentia uteri has also been called prolapsus
uteri and descensus uteri ; the latter term being used to express the
minor degree of the disease the former, that in which the uterus
has fallen out of the body, through the external parts. Dr. Good
seems to use the terms procidentia and prolapsus uteri as synony-
mous with protrusion of the uterus into the vagina, and falling
down of the womb. It is one of the species of his germs, " geni-
tal prolapse, and includes three varieties, the first of which he calls
simplex. He then gives different degrees of this variety, thus :
" If the descent be only to the middle of the vagina, it is called
relaxation as by Parr ; if to the labia, procedentia ; if lower
than the labia, prolapsus, &c. There appears however no need,
either for practical or theoretical purposes, of making a distinc-
tion between the small variations of this displacement. It is
therefore now, almost by common consent, divided only into two
degrees, between which there is a plain and definitely marked dis-
tinction ; and which differing degrees in their nature afford fur-
ther distinction in occasional difference of treatment. According
to this plan, prolapsus uteri expresses any descent of the uterus
from its natural site, wherein it still remains above the os exter-
num; and procedentia, any greater descent in which any portion,
or the whole of the uterus is protruded through the vulva.

There is in favor of this nomenclature, at least some appear-
ance of propriety in the proper and (slight) distinctive acceptation
of these two words, which is not alike favorable to the other ap-
plication of them. The former, or prolapsus, from prolabor
means to slip, glide, incline, (fee, whilst the latter is from npowiima
procido, to fall down flat, <fcc. which is at least, a stronger expres-
sion, and measurably implies a greater degree. It is true that the
etymological ground for distinction of one from the other by these
words is slight ; but slight as it is, we think the nomenclature
had better be fixed on that little which may fix it, than continue
to fluctuate with authors to the great inconvenience of pupils
and practitioners, and of patients themselves. We should not
have felt so deeply the importance of this nomenclature, but for
a strong case, which often presents the fact of the ruinous tenden-
cy of different names for the same thing in pathology. Although

1837.] Essay on Female Diseases. 33

our note is much protracted beyond what was intended, we feel
it a duty to give a brief statement of this case, in this place.

A lady, on the eve of her marriage, ascended a chair placed
on a table for the purpose of fixing her parlour window curtains,
from which, by some unfortunate movement, she fell in such a
manner that her nates first struck the floor with great violence ;
and a very severe flooding was the almost immediate conse-
quence. This was, by various means, gradually moderated until
she was enabled to be brought to town. I was consulted on her
case, and decided, by the full current of external symptoms the
existence of prolapsus. Some female friends more nice than
wise, insisted that she should consult another physician, before
she consented to the diagnosis. This was accordingly done, and
the latter informed of my opinion. On being assured that the
womb did not protrude, but that the external appearance was
perfectly natural, he decided most positively that the former opin-
ion was incorrect, that no prolapsus existed ; assuring the pa-
tient that if it did, the womb could not fail to be visible externally.
It was therefore concluded that her distresses were only the re-
sult of that debility which necessarily followed the hoemorrhage
that her complaints were chiefly hysterical, and that a course
of tonic and antispasmodic treatment would speedily restore her.
This being a much pleasanter suggestion to the patient and her
husband, was accordingly adopted, and the patient remained
subjected to it for some six or eight weeks. At this time I was
recalled to her by her husband, who had discharged the attend-
ing physician, in consequence of having himself made an inves-
tigation which proved to him that the lower part of the uterus
was just within the vulva, and the discharges from it copious and
extremely offensive ; indicating the approach of the case to one of
the termination of this unpleasant disease when neglected, to
which I had directed his and his wife's attention. On the touch,
I found the anterior part of the cuvix of the uterus immediately in
the rear of the punctum urethras, where it was very firmly attach-
ed by the inflammation which had preceded the ulceration. The
posterior lip and half of the curvix, as high as the middle of the
great cavity of the body was lost by ulceration, and an extensive
ulcerated and suppurating surface presented, occupying the whole
internal surface of the uterus. I caused the discarded physician

31 Essay on Female Diseases. [August,

to be recalled, in order that he might be convinced of his error;
but he persisted in the opinion that there had been no prolapsus
in the case, but freely acknowledged that he knew there was pro-
cidentia, which he had hoped to cure by strict, attention to pro-
per position in bed. The lady was greatly emaciated, and in
that state of debility, and laboring under that dreadful train of
nervous distresses, which generally attends the extremity of these
cases when their proper treatment is too long delayed. By great,
unremitting effort and attention, with the excellent conduct of a
patient of good sense, the ulceration was perfectly healed within
about two months. But before the progress could be arrested,
not less than two-thirds of the whole uterus was destroyed ;
and on healing, a smooth cicatrix covered the posterior face of
the remaining portion. This was nearly five months after the
occurrence of the accident. No menstrual return had ever taken
place since the accident, nor had there been any sanguineous
discharge from the part after the suppression of the first hemorrh-
age, except at about two months after the accident, when the
ulceration was at its greatest extent, and probably, from the re-
turn of the menstrual impulse, a hemorrhage considerably copi-
ous appeared for a short time, but which was, from its excess,
promptly checked. The menstruating organization was destroy-
ed, and as the process of healing progressed, dull pains in the chest
acceded, with cough abcesses and ulcerations in the lungs ;
and death closed the scene in the eighth month after the accident.
All this was doubtless from the apparently trifling facts that the
attending physician called a descent of the uterus without the
vulva, jirolapsus, and that in which it does not appear externally,
procidentia ; and that he depended, for the cure of this latter,
solely on position in bed.

The exact dates of this case I have, with very accurate colour-
ed crayon speculum views illustrating the ulceration in its differ-
ent stages, and the final appearance in healing. Ed.

1837.] The Young Mother's Guide.

PART II.
REVIEWS AND EXTRACTS

The Young Mother's Guide, and Nurses Manual ; contain*
ing advice on the management of Infants, and conduct to
be observed by the mother before and after Child-birth. By
Richard S. Kissam, M. D. Second edition ; Hartford :
Belk?iap fy Hamersley 1837 ; small 12 mo. p. p. 152.

This is the title of a small volume which has issued from the
Hartford press during the present year. Its title page at once
attracted our attention, alike by the subject treated on and the
name of the talented and experienced author. There has always *
and every where in this country been a crying necessity for a
much greater extent of knowledge on the part of young mothers
and nurses, relative to the management of lying-in woman and
infants, than has been accessible to the proper reader. We say
proper reader, not because the contents of this rich little volume
would be unsuited to the eye of the best practitioner, or any one
else ; but. because, intended as it is for the instruction of mothers
and nurses, relative to such matters as do not ordinarily demand
the presence of the physician, its value would be measurably lost
if not diligently read by those classes themselves to whom it is
addressed. Indeed the want of so concise and judicious a col-
lection of instruction the result of long and extensive observa-
tion under the guidance of ample science, cannot fail to meet the
necessities not only of every beginning practitioner, but also of
most of those who have passed many years in professional life.
However closely general practitioners may have directed their
attention to the discharge of their duties, it is but with a very
small proportion that we find any thing like that thorough know -
ledge of the female economy, and the physiology of the infant to
enable them to reason correctly for the prevention of disease and

36 The Young Mothers Guide. [August,

the promotion of the best corporeal and intellectual develope-
ments. And of the small proportion who do by experience, come
to possess themselves of what may be, and is commonly consid-
ered by the physician, minor science, and useful chiefly in the
nursery, but a small proportion again of these are sufliciently
communicative, conscientious, and at leisure to enforce instruc-
tions on the too thoughtless and inconsiderate patients and
nurses. But the great sum of necessity for such a manual is in
the country generally, where even physicians cannot be conveni-
ently consulted, and in southern towns where there are no nurses
but such as are drawn from the rougher occupations of life by
the temptation of wages, with but little experience and less men-
tal cultivation.

The little volume before us is probably as unexceptionable in
all respects as is possible for a production of the kind to be.
The interest the practitioner takes in reading it may lead him to
lament its brevity on some, and perhaps all the subjects, until he
reflects that most of young married women and almost all nurses,
have not that forecast which should lead them to much reading ;
and if a volume of considerable magnitude, though replete with
matter of great interest, and concisely written, be placed in their
hands, it appears so great a task that it is entirely neglected, or
so superficially scanned as to afford only a few disconnected facts
and many of them of least importance a knowledge not unlike
that generally obtained by females and others who read treatises
superficially; and is much more calculated to do harm than good.
The reader then becomes satisfied that, as he could not consent
to omit a sentence and scarcely to alter the arrangement of one,
the plan of the work could not have been better laid for the great-
est usefulness.

Nor is the work a mere collection of precepts valuable in
themselves ; for whilst these are concisely and beautifully set
forth, the understanding is enlarged by an accurate and perspicu-
ous developement of their necessity and their reasonableness, an
example of which we give in the following extract. It will be
also seen therein, that the author has not failed fully to under-
stand a subject of greatest importance and generally neglected by
physicians, (i.e.) the proper adaptation of mental exercise to age
and constitutional powers, for securing the best mental and cor-

ornal perfection which is attainable.

1837.] The Young Mother's Guide. 37

The "subsequent management of the chiloV he arranges
under four heads :

I. Of the child's food.

II. Of the child's dress,

III. Of the exercise proper for the child.

IV. Effects of mentai cultivation upon the child's health.
The iii, and iv. of which we extract.

III. Of the exercise proper for the Child. As soon as the
child commences walking, the proportions of its body begin to
assume a more perfect character. Exercise strengthens the mus-
cles, and reduces the quantity of fat ; the limbs become stronger,
and the abdomen more flat. The child should not be forced to
walk. It ought to be allowed gradually and voluntarily to take
the erect posture. The legs may become crooked from too early
walking. The hip joints are easily injured at this tender age,
and I have no doubt that a large number of children laboring
under " hip joint disease," became so by being urged to walk
when too young. The exertion to their imperfectly developed
joints and muscles must be immense. As soon as the child
walks firmly, he should be taught to exercise carefully and to
avoid jumping, especially from such objects as chairs, tables, &c.

The open air is the only proper place for exercise. When
the weather is mild, children should spend much of their time
out of doors. The morning and evening air is to be avoided.
After the dew has left the ground in the morning, and before it
is formed in the evening., are the hours best calculated for their
exercise.

All violent exercise should be prohibited, such as very fast
running, jumping over fences, down steep banks, or climbing
up trees. It not only exposes the child to severe accidents, but
is positively injurious to the proper development of the frame.

The bones of young children are tender, and easily bent or
broken, and their joints are not fully developed ; hence any
violent exercise tends to injure them. I do not mean to say that
the free and unrestrained use of the limbs should notbe allowed,
but that children should not be urged by competition to deeds
beyond their strength. Let them frolic and play as much as
they please, but do not permit them to risk their limbs and lives
by "extraordinary feats of agility." Children accustomed to the
air are far less subject to catarrhal and inflammatory diseases.
They acquire a vigor of mind and body to which children im-
mured in a nursery are strangers. Their muscles aje more ful-
ly formed, their complexion more healthy, and their digestion
more perfect.

And again

38 The Young Mother's Guide. [August,

IV. Effects of Mental Cultivation upon the Child's Health.
The education of children cannot be too early commenced.
Even in extreme infancy, the moral character begins to develope
itself; and as man is naturally inclined to evil, so the first vol-
untary actions frequently require correction.

Childhood is the time for moral cultivation. It is the proper
season to impress elementary religious truths. The mind, al-
though naturally possessing a certain conformation peculiar to
each individual, is greatly modified by early education. The
sacred volume says, '-Train up a child in the way he should go,
and when he is old he will not depart from it."

This direction alludes to moral and religious cultivation, rather
than to mental discipline. No one who receives the word of
God as our unerring guide in duty, can doubt the importance of
thus early impressing the minds of children with religious truth.

It is otherwise with regard to mental cultivation in its more
extended sense. The brain, which is the apparatus of the mind,
does not arrive to complete organization until about the seventh
year. Before this period therefore, no task which requires any
great degree of mental effort should be imposed. Children have
a certain aptitude for learning the elements of all kinds of know-
ledge, far superior to the adult. This, no doubt, is the provision
which the God of nature has instituted to prevent, or render un-
necessary, a long continued effort of the child's mind. When
we consider the utter ignorance and helplessness of the infant
when ushered into the world, we are led to suppose that we can-
not too early commence giving it instruction, and urging it to
mental exertion. Children learn principally by imitation du-
ring the first few years of their existence, and the exercise of this
part of the mind dose not appear to produce any bad effects. If
the reasoning capacity of the child be urged to action, before the
mind has acquired facts to reason upon, then the exercise of the
reasoning faculty produces injury, because it is called upon to
construct without materials, or in other words, to arrive at con-
clusions without premises.

Whenever the mind is called upon to act, an extra quantity
of blood is sent to the brain ; and though this extra quantity is
very small, still a long continued flow of it to the delicate and
immature brain of the child, is apt to produce disease. A blister
applied to the skin will cause an extra quantity of biood to go
to the spot where it is applied, and this is caused by the stimula-
ting quality oi the blister salve. Thinking acts on the brain in
the same manner as the blister does on the skin. If a child be
allowed to think too long, the blood which goes to the brain will
produce a kind of irritation there, which is apt to lead to inflam-
mation, sometimes terminating in dropsy of the head. But the
irritation, even if it does not end in inflammation, if kept up

1837.1 The Young Mother's Guide. 39

a long time by the cause which produced it, dose not readily
subside. The Consequence is, the brain is soon worn out. This
is caused upon the same principle as blindness, when produced
by looking at a very bright light. The eyes lose their power of
vision, because their nervous energy becomes exhausted. They
were used so fast, that nature was incompetent to supply the en-
ergy as fast as it was lost.

The food we eat is converted into blood, which furnishes the
supplies necessary for restoring the lost energy of the system.

It is imposible to lay down rules for the regulation of all chil-
dren. The minds of all vary, and some come forward much
earlier than others.

Children generally prefer play to study ; and the reverse
of this is very rare. I am inclined to think too much has been
said on this subject of late, to induce parents to postpone their
children's education. The mind is active ; it must be exercised
on some subject. It cannot be folded in a napkin and laid aside.
Its province is action, and act it must.

Great care is necessary to direct this action into the channel.
If the parent discourage the enquiries of his child for knowledge,
he will seek it elsewhere. Knowledge he must and will have,
and perhaps he will draw it from a polluted source. This will
be destructive. It will encourage the passions to the detriment
of his reasoning faculties.

Those children who have a great desire for knowledge,
are indisposed to muscular action. Great muscular action or
continued exercise, is incompatible with much thinking, and
hard study. This is owing to the fact that the blood is sent to
the limbs, and retained there by exercise. The brain of course
cannot have an extra supply. The best course, therefore to be
pursued with children who are disposed to too much study: is to
induce them to exercise freely ; and in addition to this, they
must be furnished with simple food, and a hard bed. This will
restore the balance of circulation.

Children having a diseased brain, are very apt to exercise the
mind too much ; when this is the case, the family physician
should be applied to for advice.

But we must deny ourselves the pleasure of any thing like a
detailed analysis of the book before us, as we cannot republish
the whole, and know not what we could omit. Its contents are
arranged under four different parts. The first contains xxv.
concise chapters, on the subjects of the qualifications necessary
to constitute a good nurse ; engagement of a nurse ; her conduct
in the sick room ; her duties during labor ; treatment of the
mother immediately after child-berth ; treatment of the child

40 The Young Mother's Chiide. [August,

immediately after its birth ; washing the child ; dressing the na-
vel ; of the belly-band ; dressing the child ; feeding the child ;
putting the child to the mothers breast, &c. ; feeding the child
when the mother affords no milk, or only a partial supply;
management of the nipple before and after child-birth ; food of
the mother ; her general treatment during the month ; temper-
ature and ventilation of the room ; bed curtains ; management
of the child at night ; wants of the child ; on crying ; general
treatment of the child during the month ; on the mother's assum-
ing the care of the child ; its subsequent management, and the
conduct of the mother during lactation.

Part II. treats on the " diseases of the child,"

Part III. on the diseases of the mother, and

Part IV. on teething, weaning, administration of medicines,
signs of pregnancy, and conduct to be observed during gesta-
tion ; all of which are treated according to the soundest princi-
ples of physiology and pathology.

In concluding the pleasant task of noticing Dr. Kissam's
book, we feel that we cannot say less than that it is a cheap little
book, without the thorough knowledge of which no woman
should come to the bed of travail no nurse to the lying-in room,
and no physician commence, or (if he has commenced,) continue
the practice of his profession with females or infants.

Thymic Asthma* of Infants; a disease hitherto but little
knoivn, and imperfectly understood.

The thymic asthma of infants is a much more common dis-
ease than is generally believed. Every one has seen infants
born with a difficulty of respiration, and die in a few weeks, or
even months, without ever having been relieved, and without
their death being accounted for. Indeed, life is so uncertain in
the early ages of infancy, that the victim has been rather regard-
ed as a tender plant unable to take root in the new soil to which
it has been removed.

It was however, evident that the cause of death, whether re-
mote or proximate, was to be traced to the respiratory apparatus,
and that the disease partook of the character of the asthma de-

* Asthma Thymiquo.

1837.1 Thymic Asthma of Infants. 41

scribed by Millar, although more slow in its progress and
presenting paroxisms of greater frequency and shorter duration.
March, of Dublin, having seen an infant suddenly expire from
suffocation, attributed its death to spasm of the glottis ; but it
was a mere conjecture, which he did not attempt to verify by
autopic inspection. He did not think of the thymus, which, be-
ing subservient to foetal existence alone, should subsequently
dwindle away. March was in error, for Hood having opened
six infants who had perished from this spasm, found the thymus
preternaturally enlarged. The publication of these cases awak-
ened the attention of observers authors were consulted, and it
was found in the works Reicha and Vedries, published a
century ago, that the asthma of new born infants is frequently
caused by hypertrophy of the thymus. More recently, Dr.
Frank taught that infantile asthma is often occasioned by an
extraordinary enlargement of the brouchial glands and thymus.
In 1810, Dr. Brera confirmed this ascertion in an infant who
was suddenly suffocated when but a few weeks old. Such was
the analogy of this case to those related by Millar, that it would
have been considered the same had not the examination been
made ; but most of what we know satisfactorily of this disease,
we owe to Koop, who has collected a large number of cases in
his own practice as well as in that of his friends, in a memoir on
the subject, read before the Academy of Heidelberg. He gives
the following characteristic symptoms: 1st, periodical suspen-
sion of respiration, attended with piercing shrieks and anxiety ;
2d, a return of suffocation when the child awakens, cries, or at-
tempts to swallow ; 3d, the habitual projection of the tongue,
the extremity of which remains between the lips ; 4th, the tris-
mus which supervenes and produces death. Such are the phe-
nomena presented in infantile asthma. Koop looks upon the
main diseases as located in the thymus, whose enlargement
obstructs the air passages and the freedom of circulation.

Brera fully concurs with Koop, appreciates the symptoms,
details the organic alterations, and enumerates the remedies pro-
posed by clinical practitioners. He states that thymic asthma at-
tacks infants three weeks old, though more frequently those from
four to ten months, and sometimes even eighteen months of age.
It is indicated by either one or more pathognomonic signs. The
inspiratory sound is analogous to that of pertussis, but more
sharp and piercing. Five or six inspirations will be heard before
an expiration ; the latter is noisy like that of a violent paroxism
of asthma, and respiration remains entirely suspended ; should
the infant not perish immediately, the sharp cries will be contin-
ued at each short and interrupted inspiration, until free respiration
be restored.

Collateral symptoms. There is nothing peculiar in the other

42 Thymic Asthma of Infants. [August,

symptoms attendant on this disease. They partake of the im-
peded state of respiration, and resemble those of hysteria, asthma,
and other suffocations. For instance, the chest is thrown back-
wards, the countenance is anxious and oppressed, the face passes
from the livid to a state of paleness, the nostrils are in motion, the
eyes fixed, the hands cold, the thumbs contracted, and the excre-
tions sometimes involuntarily discharged, the paroxism continues
from thirty seconds to two or three minutes. After the paroxism,
the infant again moans and feels uneasy ; but soon returns to his
natural state. He nevertheless remains for sometime pale, lan-
guid, and disposed to drowsiness. On comparing one of these
infants with others in the enjoyment of good health, he will be
distinguished by the projection of his tongue more or less between
his lips, and by the indistinctness of the heart's action between
the paroxisms. Whenever the child exerts his organs of respira-
tion, either in crying, laughing, becoming in a passion, swallow-
ing with avidity or gaping, he will be threatened with suffocation.
In the beginning the attacks recur every eight or ten days ; but
they subsequently increase, become daily, and have even been
known to return twenty times in four and twenty hours. It is
not unusual to see the little patient fall, as though stricken by
lightning, at the moment he begins to laugh or to cry ; yet infan-
tile asthma most commonly assumes the chronic character, and
terminates in convulsions of an epileptic character. The lum-
brical muscles of the hands and the adductors of the thumbs, are
always contracted ; the period of danger may continue from
three weeks to twenty months ; and the signs of approaching
death are those of apoplexy and of asphyxia.

What then is the nature of this asthma ? Its symptoms alone
would never have revealed it without the scalpel. All the phe-
nomena of life proceed from the circulation of blood, respiration
and innervation ; the encephalon and its dependences exercise
an intimate influence on the heart and lungs at the same time
that it is itself subjected to the influence of these. These three
organs exercise their functions in a state of subjection to each
other ; they are united by compact.

Let us for a moment suppose the vital power to be located in
the encephalon ; it will be from this centre transmitted by the
nerves to the heart ; the blood thrown by the ventricles may be
considered the vehicle of life ; and the lungs provide air for the
renovation of this blood. Thus these three prime organs
produce and sustain life ; each calls into action the two othersT
and neither can act of itself. If therefore the air of the lungs,
the blood of the heart, or the nervous fluid of the encephalon, be
lacking, death is the immediate consequence ; the' being may
pass from life to death without gradation of transition. The
practitioner might then have predicted, on seeing an infant die

1837.] Thymic Asthma of Infants. 43

suddenly on awaking or attempting to laugh or to gape, that
either tiie primary or secondary cause of death wou.d Le iound
in the brain, heart, or lungs, The skin is livid, the bleed is
found stagnating in the 1 rain ar.d lungs ; the heart is flaccid, and
sometimes still perforated Lyihe foramen ovale; Lut the piinci-
pal and the most, constant lesion ishypeitrcphy of the thymus.
Here is the seat of the disease; the excessive development of the
gland extends longitudinally, laterally, and usually in thickness.
The lungs are compressed by it thrown back against the arterial,
venous, and nervous trunks, with which they contract adhesions
more or less extensive in the neck and chest ; the thymus has
repeatedly been found spreading like a fringe and firmly embia-
cing various parts. The tissue of this gland is sometimes nor-
mal, though most frequently hardened, reddened, more fleshy,
without being manifestly indurated, inflamed, nor carnified. ncr
indeed transformed in any way. When cut through its centre,
a mi ky humour is seen to flow. Its weight varies from six cr
seven drachms to one ounce. Dr. Brera has seen the thymus
two inches wide, and extending from the thyrcid Lcdy to the
diaphragm so as to compress the trachea, lungs, heart, vessels,
nerves, &c. in its way. In another instance be iound it adhering
to the thyroid gland and covering the whole heart in such a
manner as seriously to impede and almost prevent its action.
In a third child, the thymus presented prolongations entwined
around and compressing the jugular veins and carotids as well
as the arteria innominata.

The predisposing causes of this disease are constitutional de-
bility of the infant, diseases of the uterus previous to r.nd during
pregnancy, predisposition to glandular affections peculiar to cer-
tain families; there can be no doubt that bronchial catarrh, den-
tition and al dominal diseases, complicated wilh enlargements of
the mesenteric glands, may favor the development of thymic
asthma.

The prognosis is always alarming. There are no means of
prevention, and the disease left to itself is always fatal. The
author thinks however that by timely and diligent attention its
progress may be arrested. He indicates the course to be pursued
during the paroxysm: the chiTd ehou'd 1c seated and inclined
forward, whe l slight thumps should be made en his back to fa-
cilitate respiration; if the pulse is imperceptible, endeavors
should be madi to restore the circulation by the horizontal po-
sition and sprinkling the face with cod water; if the train be
congested, leeches are to be app'icd to the sides of the neck and
over the superior intercostal spaces. After the raroxysm, the
remaining spasms may be combatted with small closes of laurel
water, tincture of assa'feetida, musk, or cyanuret of zinc.

The radical cure of the disease may be attempted with some

F

44 Cataract Dislocation, $-c. [August,

hope of success when the infant is robust, by resorting to repeated
local depletion, active cathartics, alternated with laurel water or
hydrocyanate of morphia. The depletion and purgatives will
be more cautiously used when the patient is less robust, and anti-
spasmodics more relied on ; for instance, the twentieth part of a
grain of musk and as much of acetate of morphia may be given
three or four times a day. Regimen constitutes the main part of
the treatment for the reductiou of hypertrophy of the thymus,
but should be aided by revulsions and discutients. In this man-
ner good effects have been obtained from the ointment of tartar-
ized antimony applied over the sternum ; unctions made with the
muriate of barytes are still better ; whilst either of these oint-
ments are used, the arms should be alternately blistered, but not
with cantharides, antimonials combined with mercurials, iodine,
animal carbon, extracts of hemlock and of the garden marygold
(calendula officinalis, of L.) and the preparations of gold may be
administered internally. The Milanese physician cites three
cases he cured by this practice, two in 1831 and one the present
year. The title of this memoir should then express that the
thymic asthma though known was reputed incurable previous
to Dr. Brera's publication. Journal des Connaissances Me-
dico-Chirurgicales* 1837, p. 73.

Cataract.

During the last three years, M. Serres, of Montpellier, per-
formed the operation for Cataract seventy times, of which sixty-
two were successful. M. S. prefers the displacement of the lens,
and operates on but one eye, usually the left. The subsequent
inflammation has always been either very slight, or readily sub-
dued by depletion. The ascension of the lens has sometimes
necessitated a second operation, which has been equally easy
and successful as the first. M. S. recommends the anterior
portion of the capsule to be carefully lacerated before removing
the lens, for the partial or complete opacity of this membrane is
an occurrence he has not always been able to prevent. lb. p. 80.

Modification of the usual method of reducing Dislocation of
the lower jaw. By M. E. Bernard.

A man about fifty-five years of age, having dislocated his low-
er jaw by gaping, called in a physician who endeavored in vain
to replace it. The next day he went to the hospital, and submit-

1837.] Metoniioea, or Uterine Discharge. 45

ted again to new efforts without relief. It was endeavored to
overcome the muscular resistance by bleeding, when M. Ber-
nard was called and at first failed. He however determined on
a new method ; the patient being seated on the floor with his
head between the knees of an assistant, the surgeon sat in front
of him and placed his left knee under the patients chin. His
thumbs were then introduced into the mouth for the purpose of
depressing the condyles at the same time that the chin was ren-
dered immovable by resting on the knee. The resistance was
overcome, and the condyles carried backwards at the same time
that the chin was elevated by the knee. The dislocation was
thus readily reduced, although the usual methods had proved
unsuccessful. Journal Hebdomadaire, T. iv. p. 30.

M. Moreau's Report on M. Chassinat's work on Serous
Metorrhaia, or Uterine Discharge.

1st. Serous metorrhoea occurs at various stages of pregnancy,
and constitutes a real disease.

2d. In the great majority of cases, the fluid discharged is
secreted between the inner surface of the uterus and the foetal
membranes, after a separation of these membranes from their
attachments. This is invariably the case when the flow is
abundant and repeated.

3d. The most common causes of this secretion are geneal ple-
thora, and uterine irritation, such as most frequently succeeded
external violence.

4th. The pathognomonic symptom of the disease is a discharge
from the vagina of a fluid usually limpid and tenacious, of a cit-
rine colour, and sometimes attended with painful contractions of
the uterus.

5th. This disease leaves no anatomical lesion visible.

6th. This flow is usually dangerous neither to the mother nor
child. Pregnancy goes on as usual, and the liquor amnii is not
diminished in quantity.

7th. With regard to the treatment, there is usually nothing to
be done, unless the plethora should be excessive, in which case
vinesection should be resorted to. In no case should the pro-
gress of pregnancy be interrupted or labor be interfered with
from this cause alone. Parturition will not be affected by it.
Journal Hebdomad aire. T. iv. p. 29.

46 Remarks on Itinerants. [August,

Remarks on Itinerants Mercury.

We extract from the Boston Midical and Surgical Journal
for March. 1S37, the following remarks on Itinerants, as being
evicbntly the fruits of observation. We have only to regret that
the author did not append his name, that the weight of his cha-
racter for the experience we judge he must have had, might have
added its force to the power of the truths detailed.

"Pison Marcury done this,'" said the puffed-up empiric, while
dealing out his care-ail for the sore legs of a poor old man, who
had not been sparing in his younger days of the cup that ma-
keth the heart glad ibr a little while, but bringeth sorrow in the
end. Pison Marcury done this,"' said the aunts and cousins,
as they each in their turn came in to pity the old man for his
pain and inability to walk. Pison Marcury " and Mother Eve
have a great many sins to answer for, which they never knew
anything more about than the rock in the quarry, or the child
unborn.

We consider ourselves an exalted people, and a civilized peo-
p'le ; but we are not half so far in advance of barbarism as we
think. Tne eastern potentate, who makes it penal for his phy-
sician to meet with ill success in practice, is as reasonable as
we in many respacis are. Tne natives of the interior of
Africa, when they murdered Mungo Park for not being par-
ticular enough in his veneration to a particular kind of tree,
which they worshipped as a deity, were not more superstitious
and inconsistent than we in some instances are. Notwithstan-
ding we have light to direct us, we will not be guided by it.
Like some idolatrous nations, who deify and worship the most
loathsome reptile, we place confidence in persons of the least
acquirements, of the most mistaken confidence in their own
abilities, and the most ill-deserving of public confidence, allow
ing their knowledge to be as great as they would have people
think, it to be.

'; Pison Marcury," which there is so much said about, in skilful
hands is one of the best remedies which the medical practitioner
has hitherto become acquainted with. It is, like a great many
other things, denounced partly because it has merits. We sel-
dom behold a man of sterling merit without enemies. As those
are the best fruits which the" birds have been picking at, those
things are often the most worthy of being confided in, which
have the most strongly been spoken against.

The very persons who bestow so much contumely upon mer-
cury, if they know enough to distinguish one medicine from an-
other, use it themselves when they think they can do it without
detection. They slander it to bring themselves into notice. Like

1837.] Remarks on Itinerants. 47

the thief who mingled with the crowd, and cried "stop thief,"
thsy sometimes abase it to screen themselves from suspicion .
From some such way; and fcr this mere than for the benefit they
intend by it. they create for themselves a hobby upon which
they too often ride triumphantly over the heads of their more
observing brethren of the medical art.

I once knew a man by the name of Sprague, who was so
boastful a quack, that many people thought he was almost a
prodigy in the art he pretended to understand. One of his idol-
izers, after having vented his spite at "pison marcury" and
"poticaries," showed me a weed that Dr. S. used as a substitute
for "macury." I told him there was no virtue in that, and that
I could eat a hat full. " To make it more vartuous," said he,
"he adds a leetle corrose of sublimate." Corrosive sublimate,
you mean, said I. How much do you call a leetle? "Why
about five grains, or as much as you could take up on the pint of
a jack knife." That is enough to kill a dozen persons, said I.
Calomel, the preparation of mercury which is most generally
used, may be given in tea-spoonfuls without danger. Corrosive
sublimate, if given in the quantity of a grain of sand, would en-
danger a man's life. He was astonished. He could scarcely
be persuaded that I was not trifling with him. " Dr. Sprague
use marcury? It could not be. He talks more against it than
all the doctors lever know'd." He had a terrible load upon his
mind, until he saw Dr. Sprague, who made him believe that cor-
rosive sublimate was a vegetable.

We never see a person, good, bad, or indifferent, and the re-
mark is frequently made, who has not some friends. "Mercu-
ry," as those who are opposed to its use call the various prepara-
tions used as medicine, has its friends, and I am willing to be
ranked as one of them. Though anathematized by quacks and
their unconscious dupes, it is a valuable medicine, and could not
well be dispensed with in general practice. By those persons it
is asserted to be a poisoner of the blood ; but there is more evi-
dence of its being a purifier than a poisoner of this important
fluid. When a person is afflicted with an obstinate humor, the
common supposition is that the blood is in a bad state. Mercury,
in some form, is the best remedy of anything which has been
discovered. Syphilis is supposed to poison the blood. There
is, in all varieties of this disease no certain specific but mercu-
ry, and this seldom fails. In affections of the liver, which with
much propriety may be said to injuire the blood, mercury is
generally the best remedy that can be administered.

By its susceptibility (power ?) to operate upon every viscus and
every gland, it may almost be said to be a universal purifier.
When the bowels are loaded with impurities, it very readily
evacuates them. When the stomach wants cleansing, as it is of-

48 Remarks on Itinerants. [xlugust,

ten called, it is more effectually operated upon when calomel is
used in combination with some other emetic* (Cathartic?) In
combination with diaphoretics, it operates upon the skin, produ-
cing a most salutary diaphoresis. The biliary vessels are more
effectually emptied by calomel than they possibly can be by
anything else. Even the salivary glands, much to the sorrow of
the patient, if not to the physician, are very sensibly, perhaps too
sensibly, operated upon by mercury .t In fact it operates upon
every part, and all other medicines belonging to the Materia
Medica cannot be made to effect so many salutary purposes as
this abused and despised article. It has, to speak figuratively,
a sort of saponaceous quality, calculated to cleanse every part.
I have used it in several thousands of cases, and were I put upon
my oath to testify whether it had done good in every case, I
could not pick out a single case where it had done hurt, or left
the system injuriously affected at any time afterwards.

One case in which I used it was that of a little girl, five years
of age, so interesting on account of her beauty that she might
with propriety be compared to arose bud. She used it after all oth-
er remedies had failed, in doses of a teaspoonful heaped up, once
in six hours, for a week, as a vermifuge. The result was, the
worms (taenia) were expelled, to the almost incredible number of
one hundred and twenty-five ; restoration to perfect health fol-

*The propriety of the author's expression here does not strike us clearly, in say-
ing " in combination with some other emetic." This would seem to declare Mer-
cury to be an emetic. If so, it requires correction, because emetic operation is not
the characteristic power of the mercurial preparations in use in practice. The pro-
to-chloride (calomel) and the black oxyde (in the form of blue pill) are the forms
the operation of which is alluded to by the author. Again: If he mean the com-
bination of these with some emetic, which would have been better expressed by the
omission of the word " other," we must object to the correctness on another princi-
ple. Combinations of brisk cathartics with emetics are often very happy in their effect
first evacuating gently and to a limited extent by emesis, by the emetic, the quick-
er operating power; and then by purgation effected by the cathartic in combin-
ation with the secondary tendency of the emetic power. Such is the operation
of the very common emeto-cathartic of salts and tartar. But calomel, the favorite
cathartic form of mercury, is not generally more desirable as a brisk cathartic than
other hydragoge purges, (for this is one in large doses.) But the greatest excellence
of calomel is not in its brisk purgative operation or its action as a cathartic on the
first passages, which I have called its primary operation ; but in its secondary or
action on the liver whereby this viscus is made to throw an unusual quantity of its
secretion into the intestines which (secretion) pro\es cathartic. And again: If
the author has used the word "emetic," for "cathartic," the combination is not so
applicable to the "cleansing" of the stomach, as the former part of the sentence
would lead the reader to suppose. Ed. S. M. 4/ S. J.

tLong and close observation lias brought me to the conclusion that the action of
mercury in any form on the salivary glands is of very little curative value. 1 am not
able to believe that it has ever shortened a fever one hour. Its only utility then,
(which is more than counterbalanced by the severity of distress afforded) is limited to
its serving as an index to the state of mercurial excitement, which may be as well deter-
mined by other indices ; and were it in my power to deprive this invaluable medicine
of its sialogogue, without injuring its other powers, 1 should have no hesitancy in
doing so. Ibid

1837.] Pathology and Treatment of Dysentary. 49

lowed, and she has since grown to maturity and is now an amia-
ble young lady of exquisite beauty.

In two cases of melancholy, occasioned by hepatic affec-
tion, mercury effected a cure, when other remedies which had
been resorted to produced no benefit. In the most violent case
of mania I ever saw, after making use of all the more common
remedies to no purpose, I gave calomel, first in large doses to
produce catharsis, and then small ones, often repeated, to produce
ptyalism and effcted a cure. A very remarkable feature in this
case was the state of the skin. Without being affected with any
supernatural heat, it was dry, husky, and scaly. The scales
were large, sharp-edged, exhibiting, when the patient was enraged
a bristling and erect, form, reminding one of the quills of a por-
cupine. This affection was perfectly changed by the calomel,
and the skin assumed the pliability and softness of a little child's.
When the glands were restored to a healthful state, the mania was
perfectly removed, and since that period, which was three years
ago, the patient has remained hale in body and mind.

From the prejudice existing against mercury, and from its lia-
bility to affect the glands when this is not desired, I use it at no
time when any thing else will answer as well; and never,
unless the patient or his friends are willing. Like fire, water, and
everything else which has been subsidized to useful purposes, it
may do hurt, and ought not to be resorted to by those who do not
well understand their profession ; and not by those who do, when
anything else will do as well.

All that is designed or intended by these remarks is the remo-
val of the prejudices which ignorance and empiricism have pro-
pagated and fixed upon the minds of well-meaning people. One
thing is desirable in regard to it, and that is, that its effects upon
the salivary vessels could be prevented when desired ; but then
it would be too valuable a medicine for mortals to enjoy.

Pathology and Treatment of Dysentery.

[The following observations are from the pen of J. G. Davey,
M. R. C. S. L,j as taken from a late foreign journal by the Boston
Medical and Surgical Journal^

The prevailing notion is, that dysentery essentially consists
in an inflammation of the mucous membrane of the intestines,
more particularly the large intestines. This condition is look-
ed on as the cause of the symptoms of the disease, and the treat-
ment is directed to the removal of inflammatory action. In
protracted examples of the disease there are to be met with un-

50 Pathology mid Treatment of Dysentery. [August,

doubted evidences of the existence of inflammation, and inspec-
tion, post-mortem, very unequivocal] y demonstrates its usual
disorganizing effects ; Lut I fee: disposed to lock on the phlegmon
of tile mucous tunic of the alimentary canal as the resuit of a
continued and efficient cause, operating locally.

The presence of acrid, unwholesome, and indigestible sub-
stances in the primes vice excites an undue and irregular peristaltic
action of the muscular coat of the intestines, accompanied with
increased secretion, for the purpose of carrying off the offending
matter, and thus allowing the parts concerned'to re-acquire their
normal condition. Such are nature's efforts to relieve herself,
and in some mild cases it is possible that she will succeed without
any medicinal interference, but, in the greater number of cases,
the symptoms will become aggravated. "There will be a trouble-
some diarrhoea, loss of appetite, and general indisposition, which,
after continuing for a few days unrelieved, or being unattended
to, will often be succeeded by those of a dysenteric"character.
In the majority of cases, at the commencement, there will he little
or no febrile disturbance of the system, or local pain. If the ab-
domen be examined, no unusual sensibility of its parietcs, or
increased temperature, will be found. In those cases where the
quality of the ingesta has been of a highly offensive and irrita-
ting character, the symptoms will be proportionately severe, even
at their approach, and will, in a very short time, assume all the
characters of acute dysentery. An untimely saline, or a drastic
purgative, I have known to establish, very quickly, the severest
type of the disease; and thus are we led to trace the analogous
effects of different irritants on the mucous membrane of the in-
testines.

The treatment which I have so successfully adopted in a great
number of cases of acute dysentery has been this : On my first
seeing my patient I direct the following formula. R. Powder
opium, half a scruple ; blue pill, six grains ; tartarized antimony,
one grain; mix. Make six pills, of which one is to he taken
every alternate hour, in very severe cases more commonly every
four hours, and never without the greatest benefit. If the tenes-
mus, or strangury, be very urgent, an opiate suppository, or an
enema, may be prescribed, with much advantage. Alter some
hours the patient will invariable express himself as being much
relieved, and at the same time he may very properly take a tea-
spoonful or two of the milk of sulphur, or a small dose of castor
oil. The sulphur I have found to answer the purpose better
than any other medicine. A moderate perseverance for a couple
or three days, with these means, I have invariably found sufficient
for every purpose.

The daily administration of a mild laxative is highly necessary
and judicious, throughout the course of the disease, in order to

1837.] American Medical Association. 51

excite the functions of the excreting organs, and to evacuate such
morbid secretions as may have collected.

That the pathology of dysentery, in its early stage, embraces
something else than inflammation, is established, I think, by an
unprejudiced review of its symptoms, and by the particular treat-
ment above specified being so singularly efficacious, which few
would consider as other than extremely unlikely to combat acute
inflammatory action, occurring in any portion of the intestinal
canal.

If the disease have been, from its commencement, unattended to,
or ill-treated, we shall then speedily find inflammatory action set
up within the abdomen, and which, if not subdued, will lead to
incurable disorganization of structure.

We are much pleased with the above remarks, because they
comport well with observation. We have long practiced on the
same principle, as far as the primary inflammatory nature of
this disease is concerned. Formerly the dover's powder or
opium was our first prescription ; but latterly, opium and calomel.

PART II J.

VI 0 IN T H L Y P ERISCOPB

imerican Medical Association

By reading an account ofa convocation at Southampton, Eng-
land, for the purpose offorming ;i southern branch of the Provin-
cial Medical andSurgical Association, it brought strongly to mind
the importance of forming a great National Medical Society,
which we have repeatedly urged through the pages of this Jour-
nal, upon all true friends ofmedical science, in the United States.
If some manifestations of interest towards the accomplishment of
this desirable object are not made within the present season, we
shall be compelled to acknowledge that there is no spirit or en-
ergy remaining among us. Nothing could contribute so erfec-

G

52 American Medical Association. [August,

tually to a perfect system of professional good fellowship as
this ; and the good influence which would be exerted through-
out the union by a National Medical Society, cannot be calcu-
lated. Boston Med. and Surg. Journal, for March, 1S37.

We have been pleased to sec the anxiety of the editor of the
Boston Medical and Surgical Journal for the establishment of
a great National Society. It proves not only a laudable, but an
honorable zeal for the true interests of the profession and of hu-
manity. Our profession has always been too little fostered in this
country. It has been left by the state to work its way onward if
it could, through any embarrassments ; and not only so, but diffi-
culties of insuperable nature have been cast in its way, and its
benefits when on its own footing and responsibility, dragged from
it by state power. These influences have tended so to curtail
the income of the practitioner, as to cause him to seek fortune or
renown in some other occupation.

If we cast our eyes over France, we behold her, by virtue of
state patronage, now the medical emporium of the world, with
her thirty or forty thousand medical students from all parts, and
this in the face, and under the frowns of her ancient neighbors
who formerly led the van of mccical science. This state of
things is not only calculated to add to her fame an imperishable
nature, but to prove a source of wealth a fountain of plenty,
continually teeming into her metropolis the treasures of the world.
But it is altogether probable that whatever of value is to be effect-
ed for the profession here during the present generation, must be
commenced by individual effort, and continued and accomplished
by combination ofthesame.

It is strange that the cause of humanity should not be more
studied by legislators ; for then they might be able to see the pro-
priety, (the necessity, if they would preserve themselves from
the crime of being accomplices in the work of death and destruc-
tion,) of refusing to legalize manslaughter by a parcel of swindlers

the wmsi of swindlers, who can venture to strike in the dark,

for gain, the delicate nerves of life,in the hardihood and cool-
ness of then- perfeel ignorance of them, and of the force tiiey use.
We mean those who call themselves botanic doctors."* Our

*A title truly, which no numan being on earth would commit a more unjust.
usurpation in assutuing than steam doctors, as there are none who know less of the
of Botany.

1837.] American Medical Association. 53

estimate of the human intellect must be considerably lowered,
before we can be made to believe they are not sensible of their
high moral error. What " boots it" then, whether the blow be
struck with the dirk of the cold-blooded assassin, who is bribed to
kill, or by a poison, or a ruinous course practised on the powers
of life under the name of botanic medicines, of whose true power,
as well as of the structure and vital powers to which they are ap-
plied, the administrators are in absolute ignorance. Better more
noble it were to steal far more so to rob on the highway, or to
pirate on the seas ! Here man would meet man in some way
and risk immediately, retributive justice.

Legislators we say might not only see the necessity of refusing
such a cruel gratuity legalizing so horrible a crusade against
human life ; but also that of extending a fostering hand to true
science, and the true means of state independence. They might
come to remove obstaclest offer inducements, and patronize in
many ways those institutions which are truly necessary, and
thus make their country the boast of scientific, as it is of civil in-
stitutions. A country free of national debt, and able to pour forth
her golden streams of wealth from her overflowing treasury, back
to every tributary state, knows no limit to her means. What
indeed might she not accomplish? A grand National Medical
College, at any expense, would be but a handsome plaything for
her treasury but glory and independence would crest its lofty
domes, and wealth turn back its course from foreign lands.

Here should be the mark set before us a National College,
which alone should confer the Doctorate ; all other institutions
subsidiary ; limited in their honors to the first degree ; and com-
pelled to continue their annual course eleven or twelve, instead
of three or four months. But this cannot be done until the mem-
bers of the profession exert, by the resistless impulse of high worth,
an influence proportioned thereto. They must go on. Zeal
and enterprize must urge them onward in the sure road to pro-
fessional worth.

In its common details, the profession is a solitary one ; one which
favors but little association in the ordinary course of business.
The philosophy of it is boundless ; but each practitioner is limited
to what he knows when he first sets out, and what lie can alone

tThe suppression of practical anatomy. See Penal (\u\c of Georgia

54 American Medical Association. [August,

gather on his solitay way. Let us then plant our general associ-
ations in every state and territory, to be made up of representatives
from every society ; and if you please, a grand national conven-
tion made up of a suitable rate of representation from the state
associations. Or, if this be thought not advisable in connec-
tion therewith, let the results of the state associations be circulated
by the proper organ for disseminating the recorded intelligence
collected by these associations of the chiefs of medical science.
Such a plan adopted could not fail to organize speedily the whole
land into one beautiful, complete, and profitable system, whose
operations for the good of humanity would be incalculable.
Zeal would be awakened in every direction, and every state sup-
plied with " an able and faithful medical faculty ;" and the real
interest the public "have in the qualifications and character of
medical men'1 promptly secured.

The beginning point would be the establishment of associations
in every state and territory. This done, a periodical channel of
communication to every individual possessing one spark of pro-
fessional zeal would at once spring into existence and be perpetu-
ated ; and individual societies would be established in every set-
tlement where half a dozen practitioners could be found. And
if journals should be found insufficient for communication be-
tween states, let the association be represented in annual con-
vention after each meeting of the slate associations.

There is profit derivable from state associations, or national
conventions for our profession, which primary, local meetings, as
tin- individual societies would he. cannot afford. There is some-
thing in the pride, or self-love of men, amountingtoa party-spirit
view of sell' interest in this land of freedom of opinion, which for-
bids the profession, and even the practitioner, to succomb to the
voice of reasonand plainest demonstration. It often amounts to
a gross want of magnanimity. This self-party-feeling when
possessed, blinds one to the loudest voice of reason, and engross-
es every care u>v victory, even at the expense of true philosophy.
Unteachableness and sordid views of personal fame and fortune
are engendered, ami each retires to Ins home or desk of instruc-
tion to pursue his own errors with redoubled vigor, as if in proof
of the truth he advocated. This could not. at Least in any thing
Like the same degree, reach into state associations. Here the spirit

1837.] Thomsonitui Surgery.

of enterprise which would impel to the meeting would be found-
ed on the interest derivable from a fair exchange of scientific
commodities, the purpose of giving small and receiving great
gain, exchanging the solitary and domestic productions of each
individual alone, for that of all others collected, at par value.

We have had some experience in demonstration of the truth of
these remarks. In our state we have had for nine years a central
society which has had annual meetings. It was composed of
members of the state board for the time being, and such others
as pleased to meet with us. It is true that, there being no coun-
ty or primary associations, the meetings were never very numer-
ously attended; but the annual sessions generally occupied two
or three, and sometimes four or five long December evenings.
There was no envy no pride no conflicting interests to serve.
Arguments were fair, liberal and respectful ; and each seemed
anxious to improve, by the opportunity thus afforded, his fund of
useful theoretical and practical knowledge. Such was the steady
character of these meetings. But not so with the primary society
of which I have long had the honor of being a member. Here
each too generally espoused to the last, the position he first ad-
vanced deaf alike to reason and absolute fact.

It would seem only necessary to suggest the thought, to give
wings to the grand enterprise, which would enable it at once to
survey the whole land metamorphose the present confined, dan-
gerous and disgraceful state of things at once into a system, mov-
ing on with the regularity and brilliancy of the solar, and illum-
ining every spot with the lights of true science.

Thomsonian Surgery.

It has for some time been our purpose to notice the late repeal-
ing act of the Georgia Legislature in favor of Thomsonian prac-
tice ; but the delay of publication consequent on a change of
printers, and the accumulation of matter of more importance to
the profession have combined to enforce a procrastination of that
duty. We may attend to it on a future occasion.

We arc well aware of the fact that, on a former occasion when
the Thorns. >n mil memorials were laid before the legislature of

56 Thmnsonian Surgery. [August,

Georgia, praying a repeal of the license law, some of the most en-
lightened and respectable physicians of the state who were mem-
bers of the legislature, favored the bill. This was however on
account of the supposed necessity of such a course for bringing
the citizens to a due estimation of the gross fraud and imposition
which that practice exercises on them ; saying at the same time
that they had not failed to use all other means in their power to
save the people therefrom, not only without success, but to no
better effect than to draw upon themselves the illiberal charge
from those they would preserve, of acting from the impulse of
pecuniary views and of a persecuting spirit.

Although we were far, very far from admiring the humanity
of such a measure, by legislators who had in trust the sacred
rights of the citizens, we must in charity, hope and believe that
those who were in the last legislature who favored the bill, were
actuated by the same motive. We sny, " in charity we must
hope" so, for we cannot hope and believe otherwise without be-
lieving that they were actuated by a wrong principle, as we know
of no other which is more charitable to the honest and scientific
physician.

If then, such was the purpose of the more intelligent portion
of the legislature, now that the plan is adopted, it is important
for humanity that the desired end should not be retarded by the
fastidious silence of those who have facts in point.

As it is not less our duty to prevent than to remove evils
when produced, we therefore cheerfully insert the following let-
ter from Dr. Miller, not because the facts contained therein ex-
cite in us the sense of novelty or surprise, but because we conceive
that those developed in the operations of this blind, bold, danger-
ous imposition, should be laid before the public as speedily as
possible: for such facts have power that no logical demonstration
can display. "We give an instance in proof. Recently, Mr. A*****
of this place, a journeyman saddler and harness maker of Broad st.
who had been a most i and open advocate of Thomsoniari-

ism for some months, "and had indeed obtained the epithet of
"Doctor'' and was daily expected to Leave town for practice on
the country people, as some of our hatters^ gilders, constables,
&c\had before done, came to us in great distress. He stated to
us thai after havinsrso strongly advocated the steamers as he had

1S37.] Thouisoidan Surgery. 57

done, he felt ashamed to come to us for medical aid, but his ne-
cessities compelled him to do so. He stated his case as follows :
That on complaining a little of slight colics from bilious habit,
he had submitted himself to a steamer's prescription and had ta-
ken in systematic order some six or eight prescriptions princi-
pally lobelia, composition tea, No. 6, &c. and that he then found
his strength so exhausted, with abundant increase of his disease
that he felt that the treatment must, if persisted in, kill him. He
then labored under^a furred tongue, highly jaundiced skin, with
distressing nausea, great feebleness and severe colic pains. He
requested to submit himself unreservedly to our prescription, and
accordingly received 40 grs. calomel and 5 of aloes, made into 5
pills, of which 1 was to be taken every 3 hours, and effectually
carried off within the same 24 hours. Three days after he call-
ed to return his thanks for the signal benefit he had derived, de-
claring himself in as fine health as he had ever been, and utterly
astonished at the vast amount of black secretion which had been
constantly passing since taking the pills. He remains a thorough
convert, and is now greatly ashamed of being charged with ever
having advocated the Thomsonian practice. He was the other
day called on by one of the Thomsonian clan to subscribe for a
Thomsonian journal. His reply was that he " found error enough
in the world without reading for it."' On being asked if he had
ever tried the practice, he replied that he had to his sorrow ;
and that it must certainly have taken life had he proceeded fur-
ther. It was returned that regular practitioners sometimes kill
by an injudicious administration. " If then,' said he, ' even those
who have labored so much for safety and success in practice, are
found to kill sometimes by injudicious prescriptions, what better
is to be expected of those who have spent no pains in the acquisi-
tion of knowledge, but that they must be guilty of a fatal issue,
much more frequently ?" "But,' said the steamer, 'we do for the
best, and put our trust in Providence." "So,' he replied, 'do the
physicians. This is what any old woman in the country does
in all her undertakings with the sick. Pray sir,' continued he,
'tell me now if you think you could take this old saddle and repair
it as well as I can V " No, sir," replied the steamer. ' Why, sir ?"
" Because I have never made it a matter of thorough study."
The features of Dr. Miller"* case are perfectly familiar to

5y Thomsonian Surgery. [August,

any one who has taken the trouble to reason one step from the
premises. Such an one could only be surprised by a correct dis-
tinction of disease, or a correct, or even innocent prescription
deduced in any way from such a compilation of deficiency and
falsehood as makes up the compound known by the name of "The
Thomsonian System."

We speak not only in allusion to the operations of this practice
in the hands of the most experienced ; but to its various influen-
ces on the common people themselves, who are assured that all
regular science is a humbug and that on paying $10 or 20 they
are the best physicians in the world ; the consequences of which
are abundant and ruinous, not only to patients, but to operative
dupes themselves. I here allude to the inducement offered to
weak minds to decline a regular, creditable trade or occupation of
any kind which is honest, and whereby they have competence,
and sometimes wealth at command ; and which is at any rate, a
business quite coextensive with their genius and mental improve-
ments. But this they do, and give themselves up to practice a
daring, dangerous speculation on their lellow men, which is to be
worked out in darkness, on human life ! Our intercourse with the
sick has led us to the knowledge of frequent, and the worst of dis-
asters, from the use of several of the members as they are called,
or Thomsonian medicines. We have known of an instance in
one country neighborhood, and of recent date, wherein, by the
use of composition tea, or oilobcUa^ within three miles distance,
and in the short space of five or six months, three excellent wives
and mothers were torn from their affectionate husbands and
little children ; an industrious and affectionate husband and father
from the excellent companion of his bosom, and his numerous
and beloved offspring the young and tender bride but just
entered the blooming mead of early connubial bliss and the
tender infant, at once the joy and hope of fondest parents, and
but just weaned from maternal nurture, sunk into an untimely
grave !

But we hasten to give the account of Thomsonian Surgery
contained in Dr. Miller's letter, and which is from the mouth
of the father of the patient, who was himself a steamer.

It should be recollected thai surgical errors are external ob-
vious. Hence it is that they never attempt any thing in that

1837.] Thomsonian Surgery.

way ; and contend against the propriety of the most important
surgery because* attention to it would necessarily require some
philosophy which they have not at command, and the want of
which would be too palpable to keep up the sale of the twenty
dollar book. The business of internal administration, and simple
medication any way is done under such circumstances as
prevent detection by the vulgar eye. The cause of trouble is
hidden the arguments advanced are received as " moonum shi-
num" latin was by the father from his promising son; and
their effects as wonderful as the '-presto" of the conjuror,
or the "open seceme" of the bandit Hassarac. But although
not so obvious ; although the facts of the case have not power
to speak so plainly to the vulgar eye, still their common prac-
tice is, like their surgery, groundless, reasonless guess-work, as
it originates in the same ignorance and error.

Letter from H. V. M. Miller, M. D.

Cassville, Ga. 20th July, 1837.

The repeal of the law prohibiting the practice of empirics in
Georgia was not occasioned I conceive by any change in public
opinion in relation to them, but by the consent and by the direct
influence of the medical gentlemen throughout the state. They
well knew the great advantages which opposition to empiricism
in the form of statutes would afford to those who practice it ;
and believed that the sure and more speedy method of allowing
them to sink into the neglect, and contempt to which they are
destined, would be to place them upon equal ground with phy-
sicians, when from a succession of mismanaged cases the com-
munity would become convinced ol the absurdity of their theory
and the destructiveness of their practice. Hence a large propor-
tion of the medical public not only withheld their opposition to,
but strongly advocated the repeal of the statute of 1825, so far
as it had relation to the Thomsonians (or self-styled Botanists.)

Against the wisdom of these views of the physicians of the
state, or their ultimate advantage to the profession, I have noth-
ing to urge. The step has been taken and now we look to its
effects regardless of the inhumanity of the policy which dictated it.

But the anticipated end to be answered by the repeal of the
law will not be so early accomplished if we allow the account
of their murderous doings to spread only from neighbor to
neighbor by oral communication, and permit cases, the treatment
of which ought to heap unmeasured censure not only upon the
individual who manages it, but upon the whole system under

H

60 Thomsonian Surgery. [August,

the direction of whose false aphorisms he acts, to produce only
a local effect in the section where they may cljance to occur.
Let every physician contribute so much at least to the cause of
science and humanity as to publish a few of the cases which are
constantly occurring and must fall within the observation of
every one ; and but a short time will elapse before the people by
common consent, if not by legal enactments, will free themselves
from the curse which is now spreading its blighting influence
among them.

There are not many Thomsomans in the portion of the state
where my residence is ; but I recently met with the subjoined
case, which if the editor of the Journal concur in the above
views, he can submit to his readers.

In December last, a youth 14 or 15 years old, was riding rapid-
ly through the forest in company with some other boys, when
his horse took fright and he was thrown to the ground, from
whence he was quickly taken up and removed to the house in a
state of insensibility. His father, Mr. A., is himself a steam
doctor, as the phrase is ; but not liking to trust his own skill in
this instance, he called in his neighbor the Reverend Dr. Q.,
who examined his condition, and finding some deformity about
the shoulders, pronounced it a dislocation of the os boachii in
other words, he had "slipped his shoulder," and proceeded after
his own method to replace it. But alter every variety of pulling
and twisting which his invention could suggest, had been tried,
and the deformity still remained, he came to the conclusion that
he had erred in his diagnosis, and it was now unquestionably a
fracture of the humerus very high up. Again his surgical know-
ledge was held in requisition to bandage the limb and place the
bone in its proper position ; but again he was doomed to experi-
ence a failure. Immediately he transferred the fracture from the
humerous to the scapula or "shoulder blade/' and treated it as
such for a day or two, when he finally came to the conclusion
that (I use his own words) "the hour which joins the arm tothe
back heme had been knocked out of place, and he did not know
how to get it back again." So he threw off all his bandages and
directed his attention to the general treatment.

There was great pallor of countenance and oppressed breath-
ing soon after the injury ; to relieve which, or to "bring him
too," as the Doctor had it, stimulants were administered in large
quantities, as No. 6, brandy, &c. In a short lime the pulse be-
came full, the face Hushed, the patient frequently breaking: forth
with wild and incoherent expressions. This was regarded as ve-
ry favorable progress and certain indication ofhis being "brought

to." But ass days passed without the restoration of reason,

the Doctor thought that he oughl to take "some more No. 6,
some diaphoretic powders and be sweated ;" all of which was

1837.] Thomsonian Surgery. 61

done and Ihe same plan persevered in, subjecting the patient to
repeated " courses of medicine," as they bombastically term it,
for about three months keeping him all the while under the
influence of stimulants and sudorifics, alternately. Through-
out all this period, after the boy recovered from the stupor occa-
sioned by the fall, he was a raving maniac, continually singing,
halloing, swearing, biting and otherwise injuring those who
attended him ; sleeping very little, and his eyes wearing a pecu-
liar expression of wildncss and terror.

About this time the father of the boy began to entertain doubts
of the infallibility of his system and soon after, a friend upon
whom he relied persuaded him that it was necessary his son
should be trepaned, to perform which operation I was requested
to visit him. I addressed a letter to my friend Dr. Montgomery,
to meet me the next day at the patient's house, when we found
his condition as above described, and received the foregoing his-
tory of his case.

It was at once apparent that the deformity of the shoulder
which had so greatly perplexed his lobclial attendant, was pro-
duced by a luxation downwards of the scapular end of the cla-
vicle. From the present appearance of the patient from the
history of the case and its treatment, which Mr. A., the father of
the boy, was able to give us in detail, it was no less evident that
his brain had suffered from concussion, and that his present situ-
ation was the result of the improper treatment of that injury.

As there had been no fracture of the skull and no symptoms
of compression of the brain remained, we had of course no use for
the trephine. My residence is near 40 miles from our patient ; I
therefore left him in the care of Dr. Montgomery, who carried
out what we considered the proper treatment to which he should
then be subjected, viz. venesection, frequent purging, revulsive
enemata, spare diet, shaving and blistering the scalp. In two
weeks he was well.

It is needless to say what would have been the termination of
the case had he been sufficiently bled and an antiphlogistic treat-
ment adopted immediately upon the supervention of reaction
after the receipt of the injury.

In most inflammatory diseases, the injury produced t^r the use
of the Thomsonian remedies would be incalculable, did they not
excite a profuse perspiration which in some degree counteracts
their stimulant effect, but in the above case, from the situation of
the organ effected, this salutary provision of nature could not
produce its customary beneficial results.

62 Medieal Colleges. [August,

MEDICAL INTELLIGENCE.

I

Medical College of Georgia. This institution is now settled in its steady
course of usefulness, with an increasing class, and every facility which Europe and
America could afford for giving interest and usefulness to its ample course of an-
nual instruction. Its Museum and Laboratory are appropriate and ample its Li-
brary, now considerable and containing many of the most valuable and costly
foreign works, will soon be greatly enlarged by the adition of an extensive cata-
logue of works, selected from all parts of the world. Its splendid classical edifice,
chastely finished in Grecian Doric, stands on a beautiful plain, retired, yet con-
venient to the populous part of the city, and is so arranged as to afford convenient
accommodations for every important purpose. Its Laboratory and Library Rooms
are spacious, and its suite of Lecture Rooms is ample for the accommodation of
250 pupils, and affords the student the comfortable opportunity of changing rooms
between each lecture as constantly as the subjects will allow.

Two large rooms are appropriated to the Museum, another to microscopic obser-
vations with a Grand Solar, and a Superior Compound Microscope; and another
suitably capacious, to the purpose of a preparation room for the lectures on Anato-
my and Surgery.

A suitable fire-proof building has been recently erected in the rear of the College
edifice for the purpose of Practical Anatomy, whereby this business has been re-
moved from the college building, and complete arrangements made for its being
well supplied.

Since the completion of its last course, two additional professorships have been
created, and filled by gentlemen of the most approved qualifications.

Medical College op the State of South Carolina. The annual announce-
ment of the Trustees and Faculty of this institution for the course of 1837-8 in-
vites attention to the present state of its prospects, and justly urges the advantages
of southern over northern and western institutions, to those who are destined to
southern practice. After a somewhat minute statement of their preparation, &c.
for profitable instruction, they conclude with an analytical view of the course of
lectures by each professor.

The Faculty of this rising institution consists of

J. Edwards Holbrook, m. d., Professor of Anatomy.

John Wagner, m. d., of Surgery.

S. Henry Dickson, m. d., of Inst, and Practice.

James Moultrie, m. d., of Physiology.

Tiios. G. Prioleau, m.d., of Obstetrics.

C U. Shepard, m. d., of Chemistry.

Henry R. Frost, m. d., of Materia Mcdica.

E. Geddings, if. d., of Pathology and Jurisprudence.

Anotomical Demonstrations by F. Wurdemann, m. d.

E. Geddings, Dean of the Faculty.

Medical College of Louisiana. We have received the circular of this institu-
tion for the next course of instruction, which informs us that the course of Lee-

1837.] Transylvania University. 63

tures will commence on the last Monday in November, and close on the last of
March, making a course of about four months. The following gentlemen consti-
tute the Faculty :

Dr. Stone, on Surgery.

Dr. Barton, on Theory and Practice.

Dr. Harmon, on Physiology and Pathology.

Dr. Jones, on Obstetrics and Diseases of Women and Children, and Clinics.

Dr. Mackie, on Materia Medica and Therapeutics.

Dr. Stone, on Anatomy.

Dr. Riddell, on Chemistry and Pharmacy.
The circular is well written, and holds forth to the student great advantages
from the location of the school for the attainment of " all that is practical in the
profession;" particularly in practical anatomy and clinical instruction; and in ad-
dition to these, " a position remarkable for its salubrity, during those months to
which the lectures are assigned."

Accompanying the circular, is the Introductory of Dr. E. H. Barton, on accli-
mation. This lecture contains much wholesome advice on that subject. Dr. B.
lays it down as a rule for safe and ready acclimation, to conform to the customs of
those who are natives, or who have been acclimated. This is done by lessening
the atmospheric temperature, or avoiding exposure to it, and reducing the calorific
process. We regret not having room in our present No. for an extensive extract
from this lecture, on the subject of Temperance, of which the Dr. proves himself a
zealous and able advocate.

Medical Department of the Transylvania University. It appears from
various newspapers and other publications on the subject, that about the close of
the last course of instruction in this institution, a difficulty arose between the Trus-
tees and Faculty, and between some of the professors themselves, which resulted in
the entire dissolution of the Medical Faculty.

On organizing a new Faculty, professors Cook, Caldwell and Yandell were
excluded; and Drs. Dudley, Richardson, Mitchell, Eberle, Short and Cross,
were appointed to the six chairs.

Dr. Yandell's narrative of the dissolution and the causes which led to it is before
us. From this we learn that the difficulty arose out of a proposition by the Profes-
sor of Anatomy and Surgery to remove the school to Louisville, on account of the
impossibility of procuring subjects for practical Anatomy in Lexington ; and the
growing importance of the former place. In his address to the Chairman and be-
fore the Trustees in answer to the 1st charge preferred against him by Dr. Dudley,
which was for " secretly conspiring and perseveringly urging the removal of the
Medical Department from Lexington, &c." Dr. Yandell holds forth the following
language : " He (Dr. D.) has long complained of the ineligibility in many respects,
of Lexington as a site for a Medical school. He had habitually declared that its
prosperity was safe only so long as its present Faculty should live. It was his loud,
oft-repeated and alarming complaint of the impracticability of procuring a sufficient
supply of subjects, that caused his colleagues to think of a removal. Sir, he was
in the habit of avowing to his colleagues that he was obliged to discourage dissec-
tions lest the pupils should discover his scarcity of subjects." And that "so
effectually had he discouraged dissections,' that, as testified by his Dissecter be-
fore the Board, only one pupil dissected last winter .'" &c.

64 Jefferson Medical College. [August,

Dr. Y. then proceeds to the proof of his assertions by the evidence of Drs. Cook
and Short: the examination of the former of whom is given at length in an ap-
pendix purporting to be an ample confirmation of Dr. Y's. statement; and Dr.
Short's, which was verbal, is declared to be not less confirmatory. Much of the
documents are the transactions with the Trustees during the investigation; and
other parts declared to them with positive evidence or hast r fenmee annexed.

We have not seen the statements of the other side on like authority, and will
therefore decline locating the blame of this affair, (a blame certainly of no trivial
nature,) on either party.

It is understood that the ex-professors Cook, Caldwell and Yaxdell. are indus-
triously engaged in the purpose of establishing a new school in Louisville.

Annual Announcement of Lectures, fyc. in Jefferson Medical College, for the
Session of 1837-8, <$*c.

This annual publication is just received. It contains a very brief, but just allu-
sion to the late and present progressive improvements in the science of medicine, in
regard to their bearing on the duties of teachers and colleges. It is true that in the
former age. a brief course of collegiate instruction was sufficient to afford a general
and somewhat particular view of the state of the science then. But such have been
the changes and improvements in latter years, that no course of instruction by any
set of men, or under any kind of system, can at present do justice to the science in
the short space of three or four months much less to the pupil, whose mind cannot
in that time compass the matter which must now be taught. A ^reat variety and
quantity must under such a system, be crowded on the mind of the pupil, beyond
what he can comprehend or retain, or even have bodily powers to attend to. It fol-
lows therefore that the instruction actually obtained must, either from a want of time
to present in a proper manner the many topics which, should lie thoroughly under-
stood; or the want of powers in the hearers to comprehend and retain the same, or
both, be superficial in a very great and unnecessary degree. Hence the very con-
spicuous necessity constantly observed, for young practitioners to learn most ofthe
important practical details, as well as prove the truth or error of their theory, by ob-
servation exercised on their first and best friends.

We take leave, however, in our notice of this production, to correct one little error
which we observe on the 1th page. Whetherthis has arisen from the mere circum-
stance ofthe remoteness of our situation having prevented the Faculty of Jeffer-
son Medical College from learning the \\w\< appertaining to the Medical College of
Georgia, or whether they mean to affect a forget'fulness of a new institution which
is just rising into competition with them; or whether from some other cause, we do
not pretend to determine ; but the following language is found on the page above
referred to:

" The same cause the progressive improvement of medical science <had suggest-
ed to the | extend their course of instruction from four months the
longest term in other institutions to five."

Whether the gentlemen of 1 1 1 : t Faculty have chosen to receive the suggestion
from "the progn ssixe improvement of medical science1' alone1 and primarily, or from
the evidence of its utility and popularity with the most valuable members of th
class, who have experienced the salutary effects of a protracted course in the Medi-

1837] Jefferson Medical College. 65

cal College of Georgia, is not a matter of much moment. But we are perfectly
familiar with the fact that this institution has, i'rom the first reception of its charter (
6ome seven oreiu go, tu the conclusion of the last season, felt and acted

upon the necessity of extending its course of public instruction by lectures to the
term of six months viz. from the third Monday in October to the third Monday in
April. This was done from the indispensable demand for that length of time for
doing justice to their subjects, and meeting the capacities of students generally;
and some of the Faculty have, in consideration of the actual benefit to students,
and the absolute demands of science, desired and strenuously contended for its ex-
tension to ten or eleven months. It is also a fact of notoriety that the pupils from
this southern institution, who were thoroughly informed on the subject of the term
of the lectures here, have annually visited both the schools at Philadelphia. Xor
did it fail to be predicted that the northern institutions, although they refused to
form the convention requested by this college for the purpose of more effectually
regulating the study of medicine, would soon find themselves compelled to extend
their course ; not only by the reasons which impelled to it here, but also for the pur-
pose of continuing successful competition with the south. As it has been the cus-
tom ot the Medical College of Georgia to continue its course heretofore, for the
term of six months, and is now continuing the same, with only a reduction of a few-
days, it is alienor in fact that four months is "the longest term in other institutions."
There is another feature in this annual announcement which we would examine
for a moment b> . u subject. It is contained in the following extract

continuing the quotation from the same page:

" With this view, (ofthe progressive improvement of medical science,) lectures
have been delivered during the month of October for the last three sessions, &c.
There are _ and valuable topics aj i to each chair, which can-

not be fully discussed in the course of four months, but may be readily examined
during the additional period. The professors wish it however, distinctly understood
that the regular course of lectures will commence, as usual, on thefrst Monday in
November, and terminate on the last day of February:''

This is. to be sure, somewhat better expressed than on a former occasion when, if
our memory serve us, the Jefferson College advertised to commence lecturing on the
first of October, for the satisfaction of those who might desire a longer course than
four months ; but assuring the public that those who did not prefer attending until
November, would lose nothing by so doing. This was to us, at the time, a perfect
paradox. But in its present form it reminds us of those regularly instructed practi-
tioners of medicine who have taken what is called ; a steamer's patent" which is
nothing more nor less than the act of paying twenty dollars for Samuel Thomson's
Narrative and Guide; then give notice that they will practice on either plan, accord-
ing to thj desire of the patient. Xow this appears to be a very plain case to any
understanding. If regular medicine be a rational science, founded on the impreg-
nable basis ofthe truths of induction, then Thomsonianism which, like homoeopa-
thy, puts induction at defiance, is its antipode: and, founded on falsehood in the
very face and under the frowns of ail induction, cannot be used injustice to honesty
and humanity. But, on the other hand, if Thomsonianism be correct, (and if it be,
we bid adieu to inductive reasoning forever,) then it should not be foregone at the
option ofthe patient who has no judgement to decide. If Thomsoniasm be correct,
its opposite, or the inductive science must be the very extreme of error, and
consequently inadmissible in practice. But there are in every neighborhood those
who believe one correct, and others who believe the other only is; and still for the

Jefferson Medical College. 66

money of all, all shall be served out according to their choice: holding out at the
same time, to each, the distinct idea of his own correctness, whilst the two opinions
must in the very nature of things, be extreme opposites as truth and falsehood.
Such practitioners " run with the hare, and cry with the hounds." But to the case
before us.

If the lectures of the month of October be, as they are said to be, " on interesting
and valuable topics appertaining to each chair," they should never be omitted by any
student, because they are essential to the course of instruction : nor would it be
good faith to them to offer or afford them facilities for so doing. But if they do not
belong to the "regular course," (and every thing belonging to a regular course
should, as far as practicable, be in it.) they should not be offered as " interesting
and valuable topics appertaining to each chair." Bnt there are many students who
understand the merits of the six months course and arc perfectly familiar with the
fact that it is immensely more valuable than any four months course can possibly be ;
and these two are the most studious and valuable part of the class; with whom the
protracted course is extremely popular. There are others also in every class who,
looking at the end in view, and not at the means of attaining it, desire to arrive at
the diploma point by any possible means, and especially the shortest route, and least
study sacrifice what else they may. If therefore, one of the two plans will not
6erve some individuals, the other will : and whilst the October lectures are recom-
mended to the one as being on "interesting and valuable topics appertaining to
each chair," another is assured that if he omit them he will still have a " regular
course," and consequently one calculated to meet all his demands; or that he will
have lost nothing by so doing. This is well calculated to suit all classes, orders,
genera and species, it is still a paradox. Now we have no doubt but that the lec-
tures which occupy the month of October in that institution, are indeed interesting
and valuable as said to be. The difficulty is to know how, when they are so, they
may be about as well omitted as heard, if it be not merely the working of a plan to
endeavor to please the fancy of those students who will, and those who will not
atudy.

SOUTHERN
JOURNAL,

Vol. II. SEPTEMBER, 1837. No. 2.

PART I.

ORIGINAL COMMUNICATIONS.

ARTICLE I.

Case of Anomalous Hemorrhage and Spasms. By Hon.
Charles E. Haynes, M. D., of Sparta, Geo.

The peculiarities of the following case, and the apparent ben-
efit derived from two remedies not in very general use, (Extract.
Hyosciam. and Extract. Belladonna,) have induced me to place a
brief report of it at your disposal to be published or not, at your
discretion.

Miss S.G. is now just seventeen years old; the child of a fann-
er in moderate circumstances ; her constitution has been formed
by plain living and active exercise. She is of middle stature,
moderately muscular, without the round and perlect finish which
gives grace and beauty to the female form; complexion brown
and eyes dark. She began to menstruate early in the year 1S34,
then in the fourteenth year of her age, and after two periodical
returns, was attacked with spontaneous bleeding from the in-
side of the metarcarpal joint of the right thumb. The bleeding
continued about twenty to twenty-four hours, when it was final
ly stopped by a compress and did not return. Her mother re

A 1

2 Anomalous Hemorrhage and Spasms. [Sept.

presents that several quarts of blood were discharged, and that
the blood flowed in a stream like that issuing from a vein when
opened by the lancet.

But a short time elapsed before spontaneous bleeding com-
menced from the middle of the forehead and continued at short
intervals for about three months.

It is represented by the family that the whole quantity discharg-
ed could not have been less than four or five gallons. While
the bleeding continued, the lips of the orifice projected, perhaps
the fourth of an inch, of the color of blood, until the discharge
was suppressed by a compress. Since that time, no further
spontaneous hemorrhage has supervened. Not the least re-
markable circumstance is, that the catamenia returned with ordi-
nary regularity and quantity during the whole period of sponta-
neous bleeding.

About last February, shortly before the menstrual period, small
red ridges were observed upon her head and arms, which finally
burst and left marks in the skin, resembling to the eye and the
touch the scratches of briars, or of the claws of a small animal.
These have continued to recur in connexion with that period,
and always preceding it, until about the 24th of last month,
when they made their appearance a few days afterwards, accom-
panied with violent spasms and excrutiating pains of the wrists,
knees and ankles. As she had occasionally suffered with spasms,
and been relieved by moderate bleeding, anodynes, &c. the family
resorted to these remedies, but without effect, and I was called to
see her the day after. Here it may be proper to observe, that
formerly, whenever the cutaneous affection above mentioned
was fully developed, every other troublesome symptom subsided.

When I saw her at 4 p. m. on the 25th of July, I found her
laboring under violent and frequently recurring spasms, pain in
the joints, and the cutaneous affection imperfectly formed, com-
plaining at the same time of such gastric distress as usually at-
tends a suddenly suppressed eruption. Ordered sinapisms to
the stomach and extremities without any visible relief. During
that night and the next forenoon administered opium in almost
every form, Aqua amnion. Tinct. foetid, without any permanent
alleviation the large quantity of paragoric, laudanum, black
drop, Dover's powder, &c. procured four or five hours quiet

1837.] Anomalous Hemorrhage and Spasms. 3

sleep in the course of the night, which was followed with pain
and spasm as excrutiating as ever. On the morning of the 26th,
apprehending the existence of spinal irritation, applied an epis-
pastic ten inches long, which drew well towards the evening.
About 11 o'clock, a. m. took about twenty-four ounces of blood,
which was sizy without any apparent benefit. Late in the
afternoon, I left her with directions that I should hear from her
the next morning. No message was received until the 28th,
when 1 was informed that she was no better.

I then prescribed extract, hyosciam. in doses of two grains and
a half to be repeated every six hours, and an ointment made of
two drachms of extract, belladon. and an ordinary tea-cup full of
lard. I did not see, or hear directly from her until yesterday,
when I called at her father's and was informed that the spasms
ceased very soon after the first dose of hyosciamus was admin-
istered, but that two others were given as directed, and no more.
Although the spasms were relieved, she suffered severe pain in
one of the knees which was immediately removed by a single
application of the belladonna ointment.

She is now in ordinary health, but somewhat paler than usual.
The cutaneous affection has not returned. Not doubting that
her anomalous symptoms were connected with the state of the
uterine system, have placed her upon moderate doses of tinct.
aloe cum myrrh, and camphor.

Singular as her case has been, I should have forborne to state
it to you, had it not been for the effect of the hyosciamus and
belladonna. A single case does not furnish sufficient ground for
safe philosophical induction, but I offer the facts for what they
are worth.

Surgical Cases. [Sept.

ARTICLE II.

/Surgical Cases. By Paul F. Eve, M. D., Professor of Sur-
gery in the Medical College of Georgia.

SERIES No. 3.

Case 1st. Stangulated Hernia Reduction by Taxis after
11 hours duration. The 26th of February. 1836, 1 was request-
ed to see Adam, a negro man belonging to Mr. Samuel Clarke of
this city, who had been ruptured many years. The hernia was
a reducible bubonocele of the right side, and for which a com-
mon truss had been worn. About 1 o'clock in the day, the pa-
tient first experienced pain, and an inability to return the protru-
ded intestine. It was 6 in the evening when I saw him, and after
several unsuccessful efforts to reduce the hernia by taxis, I di-
rected the part to be kept wet with sulphuric ether and a current
of air to be applied with a pair of bellows. I returned at 8, renew-
ed the attempts at reduction with no better success, and left the
patient at 9. It should have been remarked, he was of intemper-
ate habits, and that there was no constitutional excitement, or so
little as not to require the use of general means for its reduction.
I was again sent for near 1 1 at night, and failing to reduce the
intestine a third time, desired counsel and assistance. Dr. Du-
gas was called in ; his efforts were also ineffectual, and before
resorting to other measures, he requested me once more to try
taxis, observing that Lisfranc believed that there were few
Oases of hernia that would not yield to it when properly applied
and long continued. By gradual and increasing pressure upon
the tumour with the fingers and hand in the direction of the en-
guinal canal, I had the satisfaction to feel the intestine yielding
and finally to slip up with the peculiar gurgling noise into the
abdomen, and this too in less than 15 minutes by the watch.

Remarks. Here is a case, offering it is true, nothing very
peculiar, but happily illustrating the importance of perseverance
in the application of our means for relieving diseases. Taxis,
the first, the most i simple and most important agent for the re-
duction ofhernia, had been employed in this case, and I really
thought to its fullesl extent, at least I know, until the fingers and

1837.] Surgical Cases.

hand were benumbed. But appealing to the watch, we were sur-
prised to find how soon we became fatigued by the operation,
and thereby deceived as to the true length of time it was contin-
ued. It is certain if taxis had been protracted a few minutes
longer when first applied in this case, it would have proved
successful. A little more perseverance then, would have saved
time and suffering ; and without it, the patient would in all pro-
bability have been subjected to a painful and hazardous opera-
tion with the knife. Do we always derive the full benefit from
remedial agents, that can be obtained by a judicious persever-
ance in practice ? Or are we not apt to become fatigued, and to
cease our efforts before carrying them to the proper extent 1 We
are pleased to contribute even one fact in support of the spirit of
the age, which is, whatever thy hand findeth to do, do it with
thy might." What may we not promise for medicine and sur-
gery by industry and perseverance ?

Case 2d. Peritonitis and Cystitis following an extensive
injury to the hypogastric region Death on the fourth day.
Jumba, an aged negro, then belonging to Judge W. W. Holt of
this city, while engaged in pulling down an old house, was
thrown upon his back by a piece of timber striking hirn across
the lower part of the abdomen . This occurred on the 28th of
February, 1837; and Dr. Cunningham was first called to see
him. The patient had eaten his dinner about an hour before
the accident ; and about an hour after it he complained of pain
in his back, and was unable to walk. There was no want of
sensibility in the skin of the lower extremities ; his feet were cold
and pulse rather weak. A dose of castor oil was ordered, he vo-
mited however, before taking it and had two dejections. On the
next morning, March 1st, the pulse was still very feeble, the pa-
tient had violent pain in the back, and the lower extremities were
cold. More opening medicine was given, which operated well,
and the loins and extremities were rubbed with a stimulating lini-
ment. At night he complained of strangury and had hematuria
by the use of the catheter a little bloody urine was drawn off.

The next day, March 2d, I saw him with Dr. C. at 3, p. m.
The patient was in a half bent posture, and complained of great
suffering in the hypogastric region. As he had passed no urine

Surgical Cases. [Sept.

for several hours and percussion strengthened our suspicions that
the bladder was distended, a catheter was introduced with great
difficulty, but no water flowed through it. Suction was applied
to its external extremity, still no urine was discharged we then
tried to inject warm water into the bladder, but could not succeed
in throwing in more than half an ounce. The bladder was ex-
amined per anum, but no distention remarked. We agreed to
give the patient an anodyne, and to make him as comfortable as
possible believing his death inevitable. He died the next day
at noon.

Examination 3 hours after death. The muscles of the ab-
domen and left thigh were very much contused and enfiltrated
with blood and serum. The peritoneum was extensively inflam-
ed, and in the pelvic region of a violet colour. The bladder
presented the same colour throughout its coats, which were thick-
ened and contracted to the size of a walnut. There was sufficient
effusion into the peritoneum and infiltration in the tissues of the
soft parts, to account for the deceptive sound of percussion.

Remark. We see by this case, that even the physical sign
of a distended bladder, the dull sound emitted by percussion over
the hypogastric region, (so often relied upon almost exclusively,)
may lead to error in diagnosis.

Case 3d. Death in ten minutes from a blow of the fist. At
8 o'clock in the evening of the of May. 1837, 1 was requested
with Dr. Dug as to examine the body of a man who had been
killed a few moments before. The evidence at the Coroner's
inquest was, that the deceased, Burke, and another Irishman,
while drinking in a grog-shop, began sparring, and he received
a blow just below the left ear, which knocked him down. A
vein in each arm was immediately opened by a by-stander, but
no blood flowed ; and in about ten minutes after he fell on the
floor and expired.

Examination an hour after death. A slight bruise was bare-
ly perceptible under the left ear. No dislocation of the cervical
vertebrae no external wound on head but extensive effusion of
blood on and in the brain, more particularly at its base on the
left side, but reaching also to, and filling the lateral ventricles.

Report of Coroner's Jury. " That the deceased came to his

1837\]

Surgical Cases.

death by a blow inflicted directly below the left ear, which rup-
tured a blood vessel in the head."

Case 4th. Laceration of the Liver from the kick of a horse
Death in less than 24 hours. We are indebted to Dr. Cun-
ningham for the particulars of this case, in whose practice it
occurred ; and by whose request the post mortem examination
was made.

Wm. Maddox, aged 25 years, of short stature and of intem-
perate habits, while engaged in his vocation, as ostler, received
the kick of a horse in the left hypochondriac region, on the af-
ternoon of the of May, 1837. He vomited soon after the ac-
cident, chiefly the dinner he had taken. Dr. C. saw him three
hours after it, and found him in great agony, with cramps and
spasmodic actions in the abdominal region, his pulse rather
weak, and upon examination no external appearance of injury
could be perceived. The patient directed the Doctors attention
to a hernia of the right side of some years standing, but which
could be even now easily reduced. He was ordered a drachm
of laudanum and an enema of salt and warm water. These were
repeated several times, the laudanum being invariably rejected
by emesis, and the enemata returning without fecal matter. Half
a grain sulph. morphine, and a mustard plaster quieting him, he
was left for the night. The next morning at 6 o'clock, he was
still suffering, though he had not vomited for some hours. The
pulse was very weak, and the abdomen quite tense. He took a
dose of castor oil, but did not retain it many minutes. At 9, he
was suffering much from cramp and spasm took 5l laudanum
and applied 2 dozen leeches to the epigastrium. At noon, as the
leeches had not bitten, he was cupped over the abdomen in four
places, but not an ounce of blood could be obtained. Two
drachms of tr. croton oil were now given, and at 4, p. m. a large
quantity of salt and water was thrown up the rectum to encour-
age evacuation. These afforded no relief he had no discharge
of fecal matter from the bowels. Slight delirium now superven-
ed, the breathing became short, the pulse ceased at the wrist, the
head and neck were bathed in perspiration, a livid colour was
observed about the anus, and the patient died about 5 o'clock
twenty-three and a half hours after receiving the kick.

8 Observations on Nepeta Catarla. [Sept.

Examination 19 hours after death. There was considera-
ble lividity about the head, neck, chest and back. The abdomen
was very tense signs of the scarificator and of the mustard
plaster were the only remarkable appearances upon its surface.
We could not define the print of the horse shoe or foot. Crepi-
tation was felt over the whole abdominal region, and the scrotum
of the right side was greatly distended with gas. Upon opening
the abdomen a large quantity of thin grumous blood rapidly
flowed out, and I mentioned my suspicions that the liver was
lacerated.

The quantity of blood effused into this cavity must have been
near a gallon. In pursuing the examination, a rent in the mid-
dle of the left lobe of the liver was discovered. It extended from
the anterior edge into the substance of that gland for about three
inches on its convex, and near four on its concave surface.
There were also two or three small fissures on its concave surface
distinct from the extensive laceration. The hernial sac contained
nothing but gas portions of the intestines were highly inflamed.

ARTICLE III.

Observations on Nepeta Cataria, by M. Antony, M. I).

j\rpCatncp Catmint Mentha, Felina, sen Catarla. CI.

DidynaniiaOrd. Gijniiinspermia. Gen. Nepeta. tSj). Nc-

l>c/a Oatariai

This plant is a native of most parts of America, as well as
Kniopo, and is not confined to chalky or gravelly soil, as J ias
been said, but flourishes well in almost any situation ; but affords
a stronger aroma (in which probably its virtue resides,) in dry,
gravelly and chalky situations. It is well known to the com-
mon people throughout the I 'nited States by the familiar name
( atnip, by its peculiar fragrance, by the attraction it has for cats,
which attack, cat, and otherwise destroy it ; and also as a com-

1837.J Observations on Ncpeta Cataria. 0

moii domestic herb used in the complaints of females and infants.
It is brought to the southern states in compact cakes of the leaves,
and sometimes of the leaves and flowers, as preserved by the
shakers; many parcels of which have lost alike their peculi-
ar odour and virtue ; whilst others retain a valuable power.
Whether this difference is attributable to its age, the time of
gathering it, or its being packed whilst too moist, or some other
cause, is not determined. But the fresh herb, which is from a
perennial root, may be had in almost any neighborhood, if pro-
tected from cats, or where they do not generally abound. In
the country, in old fields, along roadsides and fences it is found
in lafge quantities. It grows in bunches or clusters of bunches,
and is often passed for hoarhound, which it very much resem-
bles, when seen at a little distance. It blooms in the southern
states in July and August, and should be gathered when in full
bloom the leaves and the flowers stripped from the stalk, and
carefully dried in the shade. It should be kept closely packed
in a jar or a drawer and in a cool place.

My observation on its medical virtue assures me that the cat-
nep is entitled to much more consideration than has been bestowed
on it by the profession. It is an article in almost universal use in
amenorrhoea, and dysmenorrhoca ; and as an anodyne antispas-
modic in the diseases of infants and children jrcncrally. Its
nervine power is very decided and appears to consist in a purely
anodyne operation of the paregoric or hypnotic kind, without
the deleterious stimulating effects of opiate narcotics, It assua-
ges pain as other anodynes, and in increased doses, procures
profound and delightful sleep, from which the patient awakes
refreshed, instead of exhausted as from narrotic powers v, hich
stupify by their excitement.

It is used in the form of weak infusion, with infants from birth,
onward, as a light carminative aromatic with which they are
freely fed by the teaspoon. But when the tea is made stronger,
either from a better preparation of the herb, or a larger propor-
tion in the infusion, it proem. p of a profoundness and du-
ration in proportion to the medicinal power taken, with as much
certainty as opium. It is not, however, an apoplectic > ep, even
from Large quantity s ; but is ind with an appa-
rently entire suspension of volition . and, although it may last for

b2

10 Observations on Nepela Cataria. [Sept.

many hours, or one or two days, its manner is still that of a sleep
into which a person of the best health has just fallen. I have
often been called to patients from a few days only, to one or two
years old, on account of the alarm of friends from a continued
sleep and entire suspension of voluntary power from this cause..
The sleep is often so profound that the patient cannot be aroused
to capability of sucking, or of performing any other voluntary
motion until the effect of the anodyne has ceased ; and if aroused
in any degree, the instant the awakening means are suspended,
the sleep returns with all its completeness of character.

I have seen an infant only two weeks old, on being fed with
strong catnep infusion at five o'clock in the morning, for the re-
lief of gripings which had troubled it through the night, sleep
from a few minutes after taking the portion, until nine o'clock
of the following day a period of 29 hours. The alarm of the
mother, in consequence of not being able to get the infant to
nurse, or to arouse it from its sleep at all, caused me to be called
to it when it had slept 15 hours. The mother had given the
child seven drops of Bat email's drops at bed-time the previous
night with the effect of composing it for about 3 hours, after
which it became wakeful and afforded manifest symptoms of
griping distress until the catnep was given. By the profound
sleep the mother was induced to think the dose of Bateman's
drops had resumed its narrotic operation to a great and danger-
ous extent, and for which she wished a remedy. Knowing that
the catnep is commonly in domestic use, and believing the sleep
was of that character, 1 enquired if any had been given, and
was informed that the servant had been directed to prepare
some in the morning, of which the infant had taken freely.
On inspecting the tea I found ii containing an unusually large
proportion of the herb, and what had been given was ad-
ministered at one time. The symptoms of the child did not
seem in demand any prescription, and I made none; but advised
licit the little patienl be allowed to sleep until he awoke, which
was not until (.) o'clock the next morning, when he did so, as after
an ordinary sleep, took \\w br< as! freely, and remained well.

Another case is present in my mind whilst writing on this
subject, in which the child (IS months old) slept about fifty
hours: in the lattei pari <>f which time hi lie had been

1S37.] Remarks on the Cases of Br .E. H. Macon. 11

often aroused, by the anxiety of the mother, but never so as to
exert volition enough to drink or take nourishment. To this
child I was called after a sleep of about 30 hours. On finding
it to be the catnep sleep, 1 only recommended the use of a dose
of castor oil, and that the child be allowed to rest. She awoke
at fifty hours after the dose, with no other trouble following her
long sleep than a little apparent exhaustion, which was soon re-
lieved by nourishment which she took with good appetite.

As an herb tea it is a pleasant diaphoretic, for which alone it
is often used. But in those varieties of menstrual irregularity
which wetermdysmenorrhoea, deficient, suppressed and retained
menses, it is found fully equal, if not superior as an emmena-
gogue power to pennyroyal and savin, articles also in extensive use
in such cases. And in its entire adaptation to the case, especial-
ly of dysmenorrheoa, it is peculiar suited by its anodyne powers.
For this purpose it is used by females at and a little before the
menstrual periods, in the form of a pretty strong infusion, pre-
pared of two or three drachms to the pint of boiling water, and
this drank warm and freely.

I have no doubt but that the peculiar and valuable powers of
this plant might be retained in a spirit, distilled in the manner of
making essences of mint arid other fragrant herbs; and in a
syrup, the form most desirable, as it would be the more conveni-
ent lor administering to children, and exempt from the stimulus
oi alcohol.

ARTICLE III.

Remarks on the eases of Dr. E. II. Macon. By Paul P.
pvE3 M. 1). Professor of Surgery in the Medical College of
Georgia.

In tlie 1 ;t numb ir oJ the 2nd volume of the Southern Medi-
cal and Surgical Journal just received, at the conclusion of an

12 Remarks on the Cases of Dr. E. H. Macon. [Sept.

interesting article from Dr. E. H. M acon, information is request-
ed concerning three important surgical cases. Although much
occupied at present, still as these cases may be considered more
directly addressed to my attention, I cannot permit them to pass
unnoticed ; and would therefore, respectfully submit the follow-
ing brief remarks :

Case 1st. "A clergyman of Oglethorpe, whilst leading his
horse by the foretop* was by a sudden effort of the horse, caused
to suffer great pain at the insertion of the deltoid muscle. He
has almost entirely lost the use of the limb, being unable to raise it
higher than his breast, or move it in any other direction except
forward. The limb has been examined by several physicians,
none of whom can detect luxation or fracture. All ordinary
topical applications have been made in vain."

From the very few particulars here published relative to this
case, it is difficult to arrive at a very satisfactory diagnosis.
There is a want of facts concerning it, from which to deduce a
clear and rational conclusion. Several important particulars are
omitted in stating the case, arising undoubtedly from the brevi-
ty with which it has been presented. For instance, it would be
necessary to know in what direction the force was applied to the
arm ; what is now the actual state of the whole limb ; has its
sensibility been affected by the accident ; can the elbow be
brought to the side of the body ; is there any difference in the
upper extremities, in their length, &c; what is the history, pro-
gress, &c. of the case ?

But notwithstanding the few particulars given of this case, we
will venture in our very concise examination of it, to apply the
doctrine of exclusion. In the absence then of more direct and
positive evidence to the contrary ; 1st, it is not a disease of the
nerves of the arm, because the patient can. at will, still use it to
some, though it be to a very limited extent. 2nd, it cannot be an
affection of the muscles, because the limb can be raised ashigh as
the breast and moved lor ward an injury of the deltoid would
prevent any elevation of the humerus. 3d, it is not a fracture
of the humerus, because of its immobility it can be moved in
only one, or at most but two directions. If the injury in this
case be sustained and located in neither the nervous, muscular,
nor osseous systems, and we may safely conclude that the tegu-
mentary arid vascular, are not concerned in producing the symp-

1837.] Remarks on the Cqses of Dr. E. H. Macon. 13

toms as described, what then must be its true pathology? 1 am
inclined to the opinion that the shoulder joint must be affected.
The articulating surfaces, or the os humeri itself may be diseased,
but then motion ought in either supposition to be as free in one
direction as another. I am therefore brought to the conclusion,
that in this case there exists a dislocation at the scapulohume-
ral articulation. And moreover, I am strengthened in this de-
cision, from the three following circumstances, admitted in the
short narration already quoted. 1st, the arm at the time of the
accident was extended (leading the horse by the fore-top,) its most
favorable position for luxation. 2nd, the pain at the insertion
of the deltoid, may have been produced by that muscle having
been stretched by the elongation of the limb and 3rd, the abili-
ty to raise the arm as high as the breast, and to move it forward,
are the very movements which can be peribrmed, when the dis-
location is one of the head of the humerus into the axilla. It
may be only a partial luxation such cases are recorded.

Case 2nd. " Mrs. L**** in this vicinity, whilst stretching out
a hank of cotton yarn, suddenly felt pain about the middle of the
humerus. In a few weeks the biceps flexor cubiti became much
contracted and still remains so, bending the fore-arm up to the
breast. The limb is painful and almost useless. No dislocation
or fracture can be detected."

Similar remarks with respect to the want of particulars, &c,
in relating this case, are as applicable to it as to the one al-
ready noticed. The fore-arm must have been extended upon
the arm, u whilst stretching out the hank f the " sudden pain
felt about the middle of the humerus," may be referred to
the origin of the brachialis interims muscle; the contracted
state of the biceps flexor cubiti, and the flexed position of the
fore-arm, would induce me to suspect in this case, a dislocation
of the ulna and olecrannon process backwards upon the humerus.
If since the accident it be impossible to flex or extend the fore-
arm to its fullest extent, and should there also be an increased
ihicknes observed in the elbow joint in an antero-posterior direc-
tion, with a corresponding diminution of its latteral diameter,
then the diagnosis would be clear. By a singular coincidence
of circumstances, I have seen within the last ten months, no less
than four such dislocations as I suspect to exist in this case the

14 Remarks on the Cases of Dr. E. H. Macon. [Sept.

olecranon process of the ulna removed backwards from the greater
sigmoid cavity existing between the condyles of the os humeri.
The fourth case was presented yesterday in the person of Mr. J. P.
of Barnwell district, who received the injury by wrestling a year
ago, and who came to town to submit to an operation for a disease
of the eyes.

Case 3d. " In October a negro girl was struck by the falling of
-a tree in such a manner that her scalp was considerably lace-
rated and her left shoulder bruised and violently strained. ISo
fracture of clavicle, scapula or humerus, nor dislocation, could
be detected after the most careful examination. All topical ap-
plications from the use of which benefit might be hoped for,
were used to no good effect. Six weeks after, the arm was en-
tirely useless,but moved in any direction without the least pain.
The motion of the shoulder joint was free and without crepitus.
The paralyzed state of the parts about the joint afforded a free
examination of the head of the humerus, which was always in
place with the glenoid cavity. The force which injured the
shoulder was applied from above."

This case is stated more fully, and we have a greater number
of facts from which to make out an opinion. Its diagnosis too,
ought to be more clear and satisfactory, and if I have hesitated
in expressing an opinion concerning the nature of the injuries
sustained in the two cases already referred to, I feel much better
prepared to give a decided judgment on the one now under con-
sideration. This girl, from the falling of a tree, received a lace-
rated wound of the scalp and a severe contusion of the left
shoulder. The arm is now entirely useless, the parts about that
joint being paralyzed. The case I think a very plain one. The
nerves supplying the arm have evidently sustained a lesion from
the accident. The only question about it is, what part of these
nerves is affected does the paralysis of the left arm arise from
the injury which the head received or from that of the shoulder,
for both were struck by the falling tree and that too at the same
time. For this state of the arm to have been produced by the
blow upon the head, it must necessarily have been on the right
side, or in other words the lesion of the brain must exist in the
right hemisphere. In this event too, the intellect of the patient
ought to have been disturbed, and in all probability, the paralysis
would have amounted to hemiplegia. The cranium may have
been fractured, its internal table for instance driven in upon the

1837.1 Remarks on Debiliianis and Sedatives. 15

brain, or the nerves (the axillary plexus,) may have been com-
pressed or injured by some displacement, &c. near the shoulder
joint, without its being detected by the attending physician. Be
this as it may, we must admit, in this case a nervous affection.

I have thus briefly noticed these interesting surgical cases, and
I trust, in the spirit with which the information was requested ;
but whether I have been so fortunate as to point out their true
diagnosis from a correct pathological view of them, remains to
be determined.

Augusta, September, 1837.

ARTICLE IV.

Remarks on Debiliianis and Sedatives. By Joseph A.Eve,
M. D., of Augusta, Ga.

Inasmuch as in nearly every case of disease, in almost every
aberration from health, irritation or excessive excitement is pre-
sent, of higher or lower degree, of greater or smaller extent, in-
volving one or more of the tissues or organs, the most important,
the paramount indication in the practice of medicine, is the re-
duction of excitement, the depression of morbid action. It is
therefore of primary importance to know what the means are
that cause this depression and the principles on which they act.

The position first advanced by Brown, that all vital pheno-
mena are called into existence and maintained by stimuli or
excitants acting on the excitability of the system, is now, we be-
lieve, universally admitted and regarded as the fundamental
principle of all sound reasoning and correct theory in medicine.
Assuming then that the manifestation of the phenomena of life,
or in other words, excitement, is the result of excitants acting on
the excitability, we readily perceive that it must always be de-
depressed or diminished by abstracting the excitants or rendering
the system less excitable that is to say. to depress excitement,

Sept.] Remarks on Debilitants and Sedatives. 16

the agents employed must act negatively by abstracting orwith-
holdingthe stimuli that maintain it, or positively by diminishing
the susceptibility of the system to be excited. The first we would
denominate negative depressants of debilitants. the second posi-
tive depressants or sedatives. Besides debilitants and sedatives,
there are other means which, though primarily excitant, by an
indirect mode of operation conduce to the same end ; these are
revulsives and local excitants the former cause a depression
or diminution of excitement in one part by increasing it in ano-
ther of less vitality the latter, by increasing the action of the
secretory organs, lessen the amount of fluids in circulation and
thus secondarily produce depletion. We shall not, however, at
present consider those indirect methods of reducing excitement,
but proceed to institute an inquiry into the nature and mode of
operation of direct depressants ; these we have already said are
divisible into two classes: negative, or those which depress ex-
citement by withholding or abstracting stimuli, and jJositive, or
those that deprive the system of its excitability and render it less
susceptible of the action of excitants.

No therapeutist whose writings I have seen makes the proper
distinction between positive and negative depressants ; the term
sedative is applied indiscriminately to both, or if debilitant be
employed, it is in the same comprehensive sense, without regard
to any difference between them. But when we examine more at-
tentively the modus operandi, and the effects of the two kinds of
depressants and consider the different circumstances and states of
the system to which they are applicable, it is certainly very im-
portant that they should not be thus confounded together under
the same head.

Opposed to irritation or super-excitement, there are three states
of depression, resulting from very different causes : 1st, direct
debility which is produced by the ab I of stimuli : 2nd,

indirect debility, or exhaustion from overaction a, state in which
the excitability has been exhausted and will not respond to the
impression of stimuli: and 3rd. sedation depression induced by
die action of direct sedatives -a state in winch the excitability is
diminished or temporarily destroyed, of these, three varieties
of depression, it is the lirsl and thud only, that we endeavor
to induce artificially, in the tr< atmenl of disease . thai is, we en-

L837.1 Remarks on Debilitants and Sedatives. 17

deavor to reduce excessive excitement and control inordinate
action, either by abstracting stimuli or by lessening the excitabil-
ity the means employed for the first purpose we designate by
the term dcbilitants ; those used to effect the second we style
sedatives.

The general indication for the employment, of debilitants or
sedatives will be determined by the nature of the excitement,
whether it depends on redundancy of stimuli or excess of excita-
bility ; thus in some cases and stages of inflammatory diseases,
we observe the excellent effects of blood-letting and other meth-
ods of abstracting stimuli, and in other cases and stages the
greater utility of opium and other sedatives, and of revul-
sives which are; as already stated, indirect means of producing
sedation.

Debilitants are generally more applicable to the treatment of
the first, sedatives to that of the latter stage of diseases of ex-
citement ; but there are many exceptions to this rule, for the in-
cipience of some cases is characterized by symptoms ordinarily
observable only in the concluding periods of similar affections
In the commencement of febrile and inflammatory diseases, the
system is usually replete with blood and the other natural exci-
tants, debilitants are therefore indicated the indication is evi-
dently to reduce excitement, by withholding or abstracting all
the excitants that have produced it or that may tend to main-
tain it. There is, however, one physiological fact involved, that
should ever be borne in mind in the administration of Debili-
tants which is, that excitability always accumulates in propor-
tion to the privation of stimuli, hence the reaction, often violent,
necessarily consequent on the abstraction of blood,of caloric, etc.
the excitement thai succeeds the depression caused by all debil-
itant means to this principle is attributable the extreme excita
bility of the stomach in persons from whom food has been long
withheld, rendering perilous the ingestion of the very mildest
nourishment the very <*reat excitability of parts that have been
frozen or long exposed to intense degrees of cold and the danger
of suddenly admitting to them the ordinary temperature the
excessive sensibility of the eyes to light, after it has long been
excluded from them &c. &c.

When debilitants are not timely employed, and morbid excite-

3

18 Remarks on Debilitants and Sedatives. [Sept.

merit has been allowed to rage unrestrained, the natural result
is indirect debility or exhaustion, a condition in which neither
debilitants nor sedatives can be employed to much advantage, and
our chief reliance must be placed in the use of revulsives, and
those means that are most efficient in equalizing excitement. If
on the contrary, debilitants have been freely employed and se-
dative means entirely neglected, there will most probably ensue
a state, in which there is present high excitement with great de-
bility that is, we will find, although the patient's powers are
greatly reduced, and he cannot tolerate farther depletion, still
the excitement is excessive, not at all in correspondence with his
exhausted energies the case has assumed a typhoid type.

It is only by the judicious administration of sedatives and re-
vulsives, that we can hope to recover a patient from a state so
critical ; it is only by the employment of debilitant and sedative
means in proper association or succession, that is by repressing
the excitability as well as abstracting stimuli, that it can always
be prevented. It is upon this principle, by diminishing excita-
bility, that the preparations of opium wisely prescribed, manifest
such wonderful effects in inflammatory diseases, and are with
propriety ranked amongst our most valuable resources it was
for this property that opium was so highly esteemed by the saga-
cious Sydenham and our own illustrious countryman, the vene-
rable Rush and it was from observing its happy influence in
such cases that the late and justly celebrated Armstrong declared
that, if the lancet be termed the right hand of practice in in-
flammatory diseases, opium in combination with calomel should
be termed the left, so nearly do they correspond in efficiency
and applicability, in the management of such cases, the correct-
ness of which declaration the subsequent experience of the pro-
fession has most satisfactorily established. We shall now pro-
ceed to treat summarily of

DEBILITANTS.

The privation or abatement of the excitants that are essential
to the production and maintenance of vital phenomena viz?
aliment solid and fluid, blood, caloric, oxygen, light, electricity
and the exercise of the organs, constitutes the class of Debilitants :

1837.] Remarks on Debilitants and Sedatives. 19

under this head therefore, are included abstinence, blood-letting,
cold, a deoxygenized atmosphere, exclusion of light, the means
of abstracting or diminishing the quantity of electricity in the
system or part affected and rest.

Abstinence The suppression or regulation of diet is of all de-
bilitants, indeed of all therapeutic resources, the most important ;
it is that by which we are enabled to accomplish most, in our en-
deavors to remove disease and reinstate the organs in the healthy
performance of their functions. Without being in the least degree
disposed to undervalue the efficacy of medicine, in which I have
the highest confidence, I do not hesitate to say that we may, by
the proper management of this mean alone, effect more in the
treatment of disease, without medicine, than by the whole ma-
teria medica, without due attention to diet. Diet must consti-
tute the basis of every remediate plan the judicious treatment
of no case can be commenced, until the quantity and quality of
the patient's diet has been determined.

"Aliment (says Professor Jackson,) furnishing the materials of
the animal solids, and differing so very greatly in its nature, in
its properties, and in its effects over the actions of the economy,
offers to the practitioner the most effective means of modifying
the condition of the organs. Of all the remedial agents at his
command, no other enables him with so much certainty to ac-
complish extensive and radical changes in the actual state of the
organs, as the aliment, directed on a thorough knowledge of its
properties, and mode of influencing the organic or nutritive ac-
tions. He is enabled through its agency, assisted by the various
regulations embraced in regimen and hygiene, to revolutionize
completely the whole organism, and to effect deep and lasting
mutations in the physical and even moral nature of man. This
result he can operate, by having at command the material ele-
ments of our composition, derived from external supplies, and
withholding, supplying or regulating them according to the ex-
isting indications."

Our design at present is merely to consider the modus operan-
di of abstinence in reducing excitement, with which view it
must be examined, with reference to its effects upon the stomach
and upon the general system.

The stomach is one of the most highly Vital of the organs and
enjoys the most numerous sympathetic connexions with the rest ;
hence when the stomach is excited or depressed, the whole sys-
tem participates in the excitement or depression : food is the natu-

20 Remarks on Debilitants and Sedatives. [Sept.

ral excitant of the stomach, which in health stimulates it to the
performance of its appropriate function but when irritable or
inflamed, food produces morbid excitement ; whereas abstinence,
on the principle of withholding stimulus, reduces the excite-
ment of the stomach, down to the healthy point when excessive,
and when previously normal depresses it below it, which de-
pression is by sympathy extended to the whole system.* It is
thus that much of the beneficial influence of abstinence is proba-
bly often displayed, before the system feels the need of fresh sup-
plies of chyle. But when alimentation has been suppressed a
sufficient length of time, the blood becomes impoverished less
nutritious and stimulating if aqueous fluids have been allowed ;
but if water be withheld during long continued abstinence, the
blood becomes morbidly thick and surcharged with effete and
noxious elements, in consequence of the expenditure of serum,
in cutaneous and pulmonary exhalation, and the consumption of
the more bland and nutritious particles in secretion and nutri-
tion ; the result of which is a low typhoid fever which always
ensues in those from whom aliment has been long withheld.

The plentiful use of diluent drinks is therefore necessary, all
the time the patient is subjected to severe abstinence, to supply
the absorbents with water, wherewith to dilute the blood which
being despoiled to a great degree of its stimulating and nutritious
qualities, becomes less excitant to the heart and all the organs
through which it passes the act of nutrition which takes place
in the areolar structure of the organs, the parenchymatous cir.
dilation and the intimate molecular movements in allthe tissues,
are reduced in energy and activity the consequence of which
is a lower grade of organic action generally throughout the sys-
tem.

[t is also necessary to relieve the pain of hunger when pre-
sent, by mucilaginous drinks and the least stimulating articles of
food, for if unappeased, it will not only irritate the stomach but
prove a powerful exciter of the brain. Those physicians who
push the starving system too Far, defeat their object, by subject-
ing their patient to [he stimulus of hunger, until it produces
excitement equal to or greater than that intended to be relieved.

Ventriculo lantfuido omnia languent."

1837.] Remarks on Debilitants and Sedatives. 21

The excitement thus produced is some what comparable to the
reaction that follows blood-letting and the depressing effect of
cold; both result from the accumulation of excitability conse-
quent on the abstraction of stimuli.

During the continuance of acute diseases, digestion is gene-
rally suspended, the sensation of hunger is not peiceived, and
abstinence may be advantageously borne a length of time that
would destroy life, in persons previously in good health. The
following rule will perhaps be found subject to few, if any, ex-
ceptions whilst the general excitement is above the normal
point, abstinence from food, with the free use of diluent drinks,
will prove beneficial, as long as the patient is not distressed with
hunger* In chronic affections, the same rule will not perhaps
so generally apply in cases attended with much debility, it may
be necessary sometimes to administer nourishment, although all
sense of hunger may be absent.

The modes of operation of abstinence as a remedial mean
may be summed up as follows :

1st. By a direct effect in reducing gastric excitement.

2d. By the sympathetic influence the stomach exercises over
the other organs, as the brain, heart, &c.

3rd. By suspending assimilation, thereby reducing and impo-
verishing the blood, the same effect being produced as by blood-
letting, only by a more slow and gradual process.

It would be an agreeable task, did our limits permit, to consider
these different modes of operation of abstinence, in its applica-
tion to the remediate management of various diseases ; but we
must hasten to the examination of other debilitant means.

Bloodletting -Next to abstinence in importance and extensive ap-
plicability as a remedial agent and superior in power,is bloodletting;
of all therapeutic resources it is the most potent ; it is that by which
we can effect the greatest immediate, and often the most happy,
results ; but its use is at the same time fraught with most dan-
ger. Its administration requires the most thorough knowledge
of physiology and pathology, and the exercise of the most acute
discrimination and profound judgment : when timely and judi-
ciously employed, it is mighty to the subduction of the most terrific
and overwhelming violence of disease, and the rescue of life
from impending death ; but when practised indiscriminately and

22 Remarks on Debilitants and Sedatives. [Sept.

and imprudently, without the guidance of correct principles,
it is the weapon of destruction, dangerous as a two-edged sword
n a madman's hand. Blood has been very appropriately styled,
life's sanguine stream, for it imparts strength and conveys nou-
rishment to every part of the system, and with its flow or ebb
life flows or sinks with equal pace it cannot therefore be safely
trifled with, or with impunity wasted.

While the remediate process of abstinence is slow, gradual
and safe, the changes wrought by the abstraction of blood are
rapid ; sometimes the most disorganizing excitement is instanta-
neously reduced, and perfect ease afforded from intense and ex-
crutiating agony this frequently occurs in peluritis and other
acute inflammations, while the blood is flowing from the arm ;
but by imprudent and excessive deperditions of blood, the pow-
ers of life may be irrecoverably depressed, or the consequent
re-action become violent and beyond control.

The proper employment of the lancet is one of the most diffi-
cult and embarrassing subjects in medicine ; for high excitemen-
is not always accompanied with exaltation of power, or com-
patible with the loss of blood, nor is a depressed state of the vas-
cular system always an evidence of debility, or a counter-indica-
tion to the farther abstraction of blood. Our prescribed limits
will not allow us to institute an inquiry into all the principles in-
volved in this interesting subject : our design is simply to make
a few cursory remarks on blood-letting as a therapeutic mean,
in which respect it must be contemplated, with reference first
to its influence over the heart and arteries, and secondly to its
effect upon the system in general. Blood is the appropriate
stimulus of the heart that excites it to contraction and maintains
the circulation ; its abstraction consequently, on the principle
of withdrawing stimulus, diminishes the force with which it is
impelled through the arterial system which is under the immediate
influence of the heart ; and as every part is pervaded by arteries
the effect is therefore felt throughout the whole organism, but most
conspicuously in those organs that are most abundantly sup-
plied with those vessels a and accordingly general bloodletting is
most efficient in subduing inflammations of the brain, lungs &c;
whereas when the menbranaceous viscera, as the stomach intes-
tines, &c, that abound in capillary vessels, are inflamed, the

1837.] Remarks on Debilitants and Sedatives. 23

same beneficial results do not follow the use of the lancet, and
local or capillary bleeding is found most efficacious.

The therapeutic agency of blood-letting is readily comprehend-
ed, by contemplating its effects upon the different organs and
systems. Its debilitating effect on the circulatory system is evinced
bythe pulse becoming feebler, softer, smaller and slower until syn-
cope takes place, during which it is nearly or entirely suspended ;
this state continues until it is relieved by the supervention of re-
action when, for a time, the excitement becomes as high, or
higher than before the bleeding.

The brain and nervous system very soon experience the de-
pressing influence of blood-letting the nervous centres failing
to receive a sufficient quantity of blood, the functions they ex-
ercise are performed with less energy and activity until they-
are suspended in syncope. The muscular system being un-
der the immediate influence of the nervous, muscular con-
tractability is very promptly and conspicuously diminished
by blood-letting. During the abstraction of blood, the ac-
tion of the lungs becomes more free and their secretion more
abundant, and as it continues to flow the inspirations be-
come more profound and less frequent. The stomach and in
testinal canal are greatly affected, either directly from not re-
ceiving their accustomed supply of blood, or by sympathy with
the heart, brain or lungs nausea and vomiting are of frequent
occurrence and sometimes diarrhea results hence the propriety
of the precept to avoid bleeding directly before or after a meal.
The effect of blood-letting on the liver, though not apparent
when that organ is in its normal state, is very conspicuously
manifested during inflammation, by the speedy cessation of pain,
and by the promptness with which its secretion is produced, all
though cholagogue medicines had previously been exhibited
without effect. The warmth of the surface and of the whole
body is reduced. The skin becomes relaxed and covered with
copious perspiration ; and most of the secretions are for a time pro-
moted. The action of the absorbents is increased the activity of
absorption being always in inverse ratio to the fullness and force
of the arterial system. By thus contemplating closely the influence
blood-letting exercises over the organs in their normal state, we

24 Remarks on Debilitants and Sedatives. [Sept.

will be able to appreciate correctly the beneficial effects to be de-
rived from it in disease.

Blood-letting operates immediately in reducing the excitement
of an organ, by lessening the quantity of blood sent to it, and
the momentum with which it is impelled into it by the heart
which reduction or depression is in proportion to the amount
lost and the suddenness with which it is abstracted.

It has been long remarked that the system is affected more by
the sudden abstraction of a small quantity of blood, than by the
protracted withdrawal of a much larger amount ; this is general-
ly accounted for, on the supposition that time is thus allowed for
the vessels to contract and accommodate themselves to the di-
minished volume of blood ; but this appears too mechanical and
not in accordance with correct physiological principles it is
much more rationally explicable, on the principle of the ac-
cumulation of excitability always consequent on diminution
of stimulus. We would explain it thus when the stimulus
of blood is withdrawn slowly, the excitability accumulates so
fast, that the excitement is maintained or subsides very slowly
and imperfectly, sometimes not until frightful losses of blood
have been sustained : whereas, when blood is drawn rapidly,
time is not allowed for the excitability to accumulate the
heart, deprived of its accustomed stimulus, contracts feebly and
ceases to afford the brain an adequate supply of blood to main-
tain its functions hence syncope, which continues until the ex-
citability accumulates and reaction is established, when the ex-
citement, as stated above, becomes as high or higher for a time
than before blood-letting was practised which temporary exalta-
ation of excitement* inexperienced physicians are liable to regard
as an indication to repeat the use of the lancet, which repetition
is generally injurious and sometimes fatal. We observe then
if blood be abstracted slowly, the proportional increase of ex-
citability maintains the excitement, or at least prevents the de-
bilitating effect from being so fully and promptly evinced, and if

This should be carefullj distinguished from the permanent rise and develope*
merit of the pulse, often observable in congestive diseases during the abstraction of
blood this indicates prompt and copious depletion. An oppressed pulse always
becomes fuller and stronger as the blood flows from the vein, but an attentive ob-
server will never mistake thir, fur the excitement consequent on reaction.

1837.1 Remarks on Debilitants and Sedatives. 25

drawn rapidly, although debilitation is very speedily produced
reaction soon supervenes and causes the excitement to rise as
high, or higher than before. The plan by which the best re
suit shall be ensured from the employment of the lancet, the plan
by which excitement may be most promptly and effectually re-
duced, is to abstract blood rapidly, to incipient syncope or until
sufficient depression is produced, and then to administer a seda-
tive which shall, by repressing the accumulation of excitability,
prevent reaction which, as we have seen, often obviates or great-
ly retards the good effects of bloodletting.

After the subsidence of reaction, that is, after the accumulated
excitability has been expended, the excitement will generally
be reduced in proportion to the amount of stimulus lost ; for al-
though the amount of fluid abstracted may be soon replenished
by external absorption, it is principally with water that serves to
dilute and render the blood less stimulating ; and even when
assimilation is not interrupted, the serous portion is renewed
long before the crassamentum is restored still time is always
required for reaction to subside, when bloodletting is practised
without the conjoint administration of sedatives, and the depress-
ing effect is much more slowly and imperfectly realized.

Professor Dunglison, in his '-General Therapeutics," appears
to estimate very correctly the importance of combining debili-
tants and sedatives in reducing excitement, although in his clas-
sification he does not make the proper distinction between them.

" The advantage," says Professor D. " attending a union of
copious bleeding with sedative doses of opium can thus be
readily appreciated. The abstraction of blood reduces the
amount of stimulus in the sanguiferous system, whilst the opi-
um keeps down the excitability of the nervous system."

And speaking of bloodletting in irritable habits, he observes :
" It is in such irritable habits, that we find the advantage of adopt-
ing other sedative agents : it is in such, that a combination of
bloodletting, short of producing syncope, with a full sedative
dose of opium, is often so serviceable ; the bleeding diminishing
the exaltation of the vital manifestations, by acting on the nerves
through the bloodvessels ; and the opium preventing the subse-
quent developement of the nervous excitability. This, I say, is
advantageous in irritable habits ; and, in strong individuals, the
same plan pushed to a still greater extent, is equally successful
and not the less philosophical, when employed for the removal of
4n

26 Remarks on Debilitants and Sedatives. [Sept,

internal inflammations. It is the plan, which, as I have before
observed, is adopted with so much success, in acute peritonitis ;
the bleeding being carried so far as to make a decided impression
on the system, and the opium administered in a full dose ; a se-
dative influence is thus exerted on the body generally, and on the
inflamed tissue in particular, under which the hyperasmia is
effectually subdued."

By thus employing debilitants and sedatives together or in im-
mediate succession, by abstracting blood and exhibiting the salts
of morphia at the same time, we will be able to depress action and
reduce excitement, much more effectually, more promptly and
with much less expenditure of vital power and waste of blood,
than by the employment of the lancet and other debilitant means'
alone. But we do not contend that this combination is always
necessary or proper there are cases in which it is not required
and others in which it may be counter-indicated : yet the most
excellent and happy results may frequently be derived from it.
The secondary, but more permanent and important mode, in
which bloodletting operates in depressing excitement is ascrib-
able to its effect in diluting the blood, depriving it of its nu-
tritious qualities and reducing its exciting power, in consequence
of which the vital phenomena throughout the whole organism
are manifested with less energy and activity, a general reduc-
tion of exctiement and depression of action being affected in all
the organs and tissues. The same effect is produced which we
spoke of as resulting from abstinence long continued, only in a
shorter time and to a greater extent. And to cause this dilution
of the blood, the liberal use of diluent drinks is equally requisite
to furnish the absorbents with aqueous fluid, when bloodletting
is frequently repeated as when abstinence is long enforced.

We have now concluded our remarks on bloodletting, short
and imperfect indeed, but it was not our design to treat the sub-
ject in all its details which would require volumes, instead of a
few pages which was all we proposed.

Note. In a future number we will continue our remarks on
debilitants and sedatives.

1837.] Case of Retained Menstruation. 87

ARTICLE VI.

Case of Retained Menstruation, with anomalous symptoms.
By Dr. D. F. Bailey, of Barnwell District, S. C, in a let-
ter to the Editor.

Mr. Editor : As your Journal is one of the most useful
organs in the Southern states, for the dissemination of medical
knowledge, I transmit to you the following interesting case
which occurred in our practice a few months ago. We were
called to this case on the 10th of May last. It was complicated
with a derangement of the uterine system. There was at first
no obvious cause, though on inquiry, we learned that it was
consequent to a fall, in which the gluteus maximus and latissimus
dorsi muscles sustained considerable injury. A bubo, about as
large as a common walnut, was discovered in the ingunial re-
gion, which in the course of time became so troublesome as to
require medical assistance! Dr. Tesser was called in, and
believing the statement above related, did nothing else than
treat it as an inflammatory swelling of a sympathetic nature.
Having relaxed the tumor, and suspecting from the softness of
its feel that pus had formed, he made an incision into it, in a
longitudinal direction with the glands, which gave issue to a
thick kind of pus mixed with blood, but did not answer the pur-
pose he anticipated. After trying various remedies and meeting
with no better success, he abandoned the case as incurable. In
the deplorable condition which <: a Dr's. desertion implies/' she
was carried to Professor Ford, who examined, but did not do
any thing for her, nor report her case. In this condition, she
was brought from Georgia to us. She gave us the same state-
ment as to cause and effect, and from the silence of those two
preceding gentlemen, we were much perplexed to discover the
pathology,* and apply curative means. On examination, we
were from circumstances, induced to believe its origin to have
been from a syphilitic taint ; but there was one circumstance
which militated against this supposition, and that was, how she

The patient was a girl, about 16 years of age, and owned as the property of Mr.
Brigham, of Georgia, Burke county.

28 Case of Retained Menstruation. [Sept.

possibly could have contracted that complaint at the early age of
twelve years. This is possible, I admit, but it is rare. The
complaint was one of three or four years' standing. Giving full
scope to our opinions, as regarded the cause and nature of the
complaint, we modified our remedies accordingly ; but mercury
did not the least good ; after continuing its use for an indefinite
length of time with no advantage, we altered our prescriptions,
substituted more active cathartics with a view to diminish the
plethora of her system, as well as to remove gastric impurities ;
with these we were more successful. Observing that she la-
bored under a suppression of the menses, we combined those
medicines with emmenagogues, with greater advantage, and it
is here the nature of the disease developes itself. Before the ad-
ministration of emmenagogues, the secretion from the ulcer in.
the groin was of a fetid pale colour, adhering to the sides of the
wound, and very rosy ; but after the system was brought under
their influence, the discharge became more copious, more healthy
and thinner in consistence ; and this was observed in three suc-
cessive trials. But as soon as they were laid aside and their in-
fluence suffered to wear off, the discharge would be greatly dimin-
ished in quantity and deteriorated in quality. Hence I ask, may
not the menstrual secretion have become absorbed and eliminat-
ed through this orifice, which may have become a vicarious
passage for it ? What manifestly renders this more probable is
the phenomena observed in the augmented or diminished dis-
charge of pus, in proportion as the dose of emmenagogues was in-
creased or diminished. 2ndly, other medicines, of a different
nature, not possessing this specific influence over the discharge :
3dly, there being no evacuation of any kind per vaginum, nor
ever having been, until within a short time after the bubo was
observed in the groin, when there was a slight show : 4thly, the
increasing dcvclopcmcnt of the mammae and pelvis, which was
still more perceptible at each period. The patient told me that
she had noticed some of the circumstances just enumerated for
two years, especially the increased size of breast, the augmented
quantity of the discharge from the sore at each menstrual peri-
od; but stated that the discharge then, differed from that which
appeared to be occasioned by the emmenagogues, owing pro-
bably to the imperfect state of the secretory process at that time.

1837.] Case of Retained Menstruation. 29

She also said, she never suffered any inconvenience from her
menstrual periods which were attended with as little trouble
as any other period of her life. From the progressive and uni-
form enlargement of her breasts and pelvis, she incurred the
suspicion of being in a state of pregnancy. But on examination,
this suspicion was found to be incorrect, besides her breasts had
preserved their fulness for three months, varying in size only at
the time already mentioned ; and it is well known, that after the
breasts are distended tooether with the other symptoms of la-
bor, it will not be long from that period, before a new being
is ushered into life. Her breasts have been, and still are much
distended, without any of the symptoms of pregnancy. She
is remarkably healthy. This sore must, by its long continu-
ance, have become an habitual drain to the system the menses
must have been evacuated by a secretory process, through that
source, or they certainly must have presented themselves per
vaginum while the system was under the influence of the most
powerful emmenagogues. But having very little time to dis-
cuss those points, I will proceed to notice some of the peculiari-
ties of the disease. When first brought to us, she was laboring
under a severe cold and debility. The ulcer was situated about
an inch and a half below the superior spinous process of the
ilium, and just over the femoral artery. It was three and a half
inches deep(?)4 inches long, and about 4 inches in circumference;
it presented 4 fungus protuberances one turned anteriorly, an-
other posteriorly, and the 3d and 4th laterally, with indurated
margins and of a highly phagedenic character. From those
protuberances, there sprung a great number of small papilla or
vesicles containing as it were, a semi-transparent matter, and
from these or the subjacent parts, there was continually exuding
that ropy irritating matter mentioned in a proceeding place. The
first indication in the cure of the local complaint was the remo-
val of those fungi so essential to the cure by the second intention.
We therefore resorted to ihe use of the most powerful caustics,
which in the course of a month or such a matter improved the
looks of the ulcer and entirely removed all those morbid growths
for a while. Believing the ulcer would now heal favorably, we
left off their use and endeavored to heal it up as a common sore,
but no sooner was the caustic discontinued than they would

1 1 Case of Retained Menstruation. [Sept

spring up with surprising rapidity. These we constantly re-
moved, and believing them to arise from a morbid state of the
basis of the ulcer, we had recourse to " tents ;" by tents, I mean
in this instance, a kind of bongie of a conical shape and with a
passage communicating from one extremity to the other. These
we introduced daily as low down as the ulcer would admit and
through them we poured in the caustic. This had the desired
effect of removing them almost completely. We then desisted
from their use. ISot long after their discontinuance, the patient
complained of a severe pain in the hip. This happened in the
evening. Next morning she sent for my father, but before his ar-
rival she had drawn from the ulcer a number of gland-like
bodies connected together by filaments all of which together were
4 or 5 inches long, round and excavated ; the hollow continu-
ing from one end to the other. The patient was much relieved
by their expulsion, but the discharge for 3 or 4 days was of a
reddish color resembling somewhat the washing of flesh. How-
ever she mended very fast, and in 3 or 4 weeks after it came out,
she was discharged perfectly cured. It having healed up very
favorably and without any ill consequences from the suppression
of the discharge, she is now performing her accustomed duties.
The most remarkable circumstance in this case, is the suppression
of the menses with such little inconvenience to the system, and the
healing up of the ulcer being attended with no danger together
with the spontaneous discharge of the gland. On examination
of the parts of generation, we discovered a laceration of the clitoris,
together with a displacement of the hymen, and this is all that
favors the suspicion of its being syphiltic. The passage from
the os externum to the uterus was unobstructed, which proved
undoubtedly that the menses must have been evacuated by a se-
cretory process through the orifice in the ulcer.

1837.} An Examination of Phrenology. 81

PART II.
REVIEWS AND EXTRACTS

An Examination of Phrenology, in two lectures, delivered to the
Students of the Columbia College, District of Columbia,
February, 1837, By Thomas Sewall, M. D. Professor of
Anatomy and Phisiology. Published by request. Wash-
ington city ; B. Homans printer, 1837.

This little volume of seventy pages, octavo, comprises two
lectures on the subject of Phrenology, a topic which has for many
years occupied much of the time and efforts of both the learned
and unlearned. Perhaps few individuals labored more zeal-
ously in the cause of true science during the last age than did
Drs. Gall and Spurzheim of Germany for the establishment
of the truth of Craniology and Phrenology. Nor should the
world be ungrateful to them for the benefits bestowed on the
neurological department of anatomical science ; for it is a truth
beyond controversy, that these determined and persevering in-
vestigations have given and preserved an impulse to anatomi-
cal research by which more truth has been developed relative
to the brain and nervous system and their connexions with the
phenomena of animal life, a part of science hitherto far in the
rear, than had been previously. Nor has the impetus thus given
lost its force even at the present day. We will say more that
we believe it will not be lost until the light of truth which now
glimmers in the vista with attractive beauty shall lead on the
lovers of physiology to the knowledge of the whole philosophy
of the nervous system in all its relations to and connexions with
human life. If, without this grand object mainly, or in any de-
gree in view, they shall have contributed that to this end, with-
out which, it might never have been accomplished ; or if ever,
certainly not so soon, Gall and Spurzheim will merit the grati-

32 An Examination of Phrenology. [Sept,

tude of all future ages. Indeed the anatomical truths which
they have established, in connexion with their favorite topic, are
contributions to science which can never be forgotten. Here ends
the meed of praise we purpose rendering to these indefatigable
pursuers of scientific research. But it was not our purpose to
review the works or the opinions of Drs. Gall and Spurzheim
as such, and we therefore turn to the consideration of Dr. Se-
wall's lectures purporting to be an examination of opinions
mainly set up, and circulated through the world by them.

Of the hundreds, perhaps thousands of essays and volumes,
some of which are ponderous tomes, which have been written on
this subject, we are decidedly of opinion that Dr. S. has in the
narrow limits of seventy pages, done more for the cause of true
science, on the subject of phrenology, than the whole of them
together. When we consider the proneness of human beings to
error and the intoxicating love of novelty, and the vigor with
which they seize whatever appears to them on a superficial view
to be a pretty thing ; and then their obstinate pride which forbids
retrenchment of opinions and sayings, we can venture to assure
Dr. Sewall, that with the most unequivocal demonstrations of
truth make it if he please, as plain as the axiom that " things
which are equal to the same, are equal to one another," he
cannot succeed in changing at once the current of popular
opinion which has been established. And now, truth has to war
not only against erroneous teachings, the attracting force of no-
velty and the pride of opinion, but also against a party spirit
which is almost wholly arrayed against her, winch often re-
quires an age in science, as it does in politics to cure. At least
time must roll on until some new tack can be found to cling to
with one hand, until the hold of the other can be gradually and
somewhat unobserved let go. Who ever heard of a disunionist
or a consolidationist quitting his ultra position and betaking him-
self to the medium ground of common sense and prudence, un-
til he found means of riding the hobby of abolition, or of rcgu-
Lating the exchan gi \ or some such thing. But party spirit mere-
ly is not the end of the gauntlet. Interest, an obstacle scarce-
ly less in the way has i<> be met and vanquished. The
books of writers and the tickets of lecturers, which are yet to
be sold, come up with fearful odds, to say nothing of the phre-

1837.] An Examination of Phrenology. 33

nologizing offices, and the fees thereof and the implantation of
a spice, if not a pungent sense of self-estimation in what of mind
occupies each cranium whose eminences and depressions are
subjected to the craniometer or the callipers, or the supposed sa-
pient touch. It is a species of fortune-telling which has curren-
cy given to it, not only with the vulgar, but also with the super-
ficially scientific the skimmers of science, by the virtue of a
gloss of science, which covers it as does the plate the base coin.
They do not set out with the recollection that " all is not gold
that glitters."

And there is another thing in addition to many others too
numerous to be named ; which is, that it has become introduced
into the parlour ; and here, in the dearth of science of all kinds,
as well as of valuable sentiment, which is but too common in
most circles at the present time, it is too great a convenience at
the command of vacant minds, for the entertainment of the ladies
to be readily surrendered. But we presume that the inculcation
of truth in all faithfulnsss to his class was the purpose of Dr.
S. and not that of at once changing a world from error to truth.

In his first lecture Dr. Sewall gives us first a brief but faithful
history of the subject, ascribing its origin, however, much to an-
tiquity, instead of the latter half of the last century. As this
may not have been made a subject of research by many, we will
give his own words :

" Whether he (Dr. Gall) was the originator of the science, or
derived his first intimations upon the subject from some previ-
ous writers, is a question which I shall not discuss. Certain it
is, that ideas, in many respects similar to those of Dr. Gall, were
entertained and promulgated long before his time.

Aristotle, the Grecian philosopher, who wrote more than three
centuries before the Christian era, considered the brain as a mul-
tiplex organ, and assigned to each (part its appropriate functions,
in the fore-part of the cerebral structure, he places common sense ;
the middle portion he assigns to immagination, judgment and
reflection ; the back part he makes the great storehouse or seat
of the memory.

In the 13th century we are informed that the Archbishop of
Ratisbon mapped out the head into regions in conformity with
the divisions of Aristotle and others. -In the 10th century this
5e

34 An Examination of Phrenology* [Sept,

was done more fully than ever before by Ludovico Dolci, a ve-
nitian. On this point the Dr. refers also to a work of Jo. Bap-
tists Ports, published in 1586, and which is now in the library
of Harvard College, " containing" so many of die principles and
illustrations of the phrenology of the present day, that it may
well be questioned whether hints have not been drawn from this
source by later writers. He proposes to discover the intellectu-
al and moral character of man, by his physical organization,
color," &c.

After coursing down the line of history through centuries and
ages, shewing the greafdoubt of the justness of Dr. Gall's claim
to originality in this matter, he comes at length to say ;

" Whatever may be the truth with regard to the origin of
phrenology, it is through the writings of Dr. Gall, supported by
the untiring labours of his pupils and disciples, that the science
has been widely spread through the civilized world."

We pass hastily over the remaining part of this lecture, in which
Dr. S. gives so faithful and liberal a detail of all that phrenolo-
gy claims, that we were on reading it, fixed in our opinion that
he was going to prove himself an able advocate of the justice
of those claims claims which the advocates of phrenology have
the vanity to tell us dignify it into a science so important to the
well being of society, that it looks down with compassion on the
shallow distinctions, and peurile speculations of Locke, Hume,
Berkley, Hartley, Reed and Stuart ; and that the disco-
veries of Newton himself were comparatively insignificant, &c.
Next, the principles on which the doctrines of phrenology rest
their claims, are briefly but fully given then a faithful de-
tailed account of the propensities, the sentiments and the intel-
lectual faculties, which with their thirty-four sub-divisions, or
particular organs make up the principal machinery of phrenolo-
gy all of which with a view of the craniomater and its appli-
cation to the head, are beautifully illustrated by a plate intro-
duced as a frontispiece.

Lecture 2. Having acquitted himself in the first lecture most
generously towards the claims of phrenology, Dr. S. here be-
comes the able advocate of true science, by proposing to show
how far phrenology is reconcilable with the anatomical struc-
ture and organization of the brain, the cranium, and other

I837v] An Examination of Phrenology. 35

parts concerned. This he does from two considerations : 1st.
" From a belief that the anatomy of the parts concerned is
the proper and only standard by which to ascertain its truth.
2d. That the metaphysical arguments on the subject, whilst
they have been urged with great power, have too often been
evaded, and that the public mind has not been enlightened
as to the real merits of phrenology, by the usual methods of
investigation even the lash of ridicule under which it has been
left to wither, having done but little in arresting its progress, or
exposing its errors." After thus advancing his purpose and the
considerations on which this purpose is founded, the doctor be-
gins his assault by removing the rubbish out of the way, that he
may fairly seize the metal and try its purity by unerring tests.
He notices the extent of the ground phrenologists assume the right
of occupying, and the numerous outlets for retreat with which
they have provided themselves, in order that they may plausibly
evade almost any objection to their science which may be ad-
vanced upon the common principles of reasoning. The ground
of these outlets is fully laid open and the sophistry brought clear-
ly to view. We have not room on the present occasion for a full
detail of their just exposure, but cannot deny ourselves the plea-
sure of presenting one or two.

"If an individual has a large head connected with unusual
powers of intellect, the case is brought in proof of phrenology ;
but if the manifestations are very feeble, it is said that the great
size of the head is attributed to disease, or that the brain is not
well organized, or that other circumstances have tended to dimi-
nish its power. If a small head is connected with a powerful
intellect, it only proves that the brain, though small, is well organ-
ized, and acts with uncommon energy, &c." Again.

" There is a celebrated divine now living in Scotland, equally
distinguished for his amiable disposition, gigantic power of mind,
and great moral influence which he exerts upon the christian world.
This individual, it is said, has the organ of destructiveness very
largely developed ; and not having any counteracting organ very
large, it is contended by those who are acquainted with the fact,
that he manifests his inherent disposition to murder, by his
mighty efforts to destroy vice, and break down systems of error.
In this way he gratifies his propensity to shed blood." Again.

" By a recent examination of the skull of the celebrated infi-
del Voltaire, it is found that he had the organ of veneration
developed to a very extraordinary degree. For him it is urged,

36 An Examination of Phrenology. [Sept.

that his veneration for the Deity was so great, his sensibility
upon the subject of devotion so exquisite, that he became shocked
aad disgusted with the irreverence of even the most devoted chris-
tians, and that out of pure respect and veneration for the Deity, he
attempted to exterminate the christian religion from the earth ! !"

Many such are the miserable subterfuges to which he shews
phrenologists are bound to resort in order to sustain their cause.
He next proceeds to an examination of the principles of phre-
nology on the following five grounds :

1. How far phrenology is sustained by the structure and or-
ganization of the brain.

2. How far facts justify the opinion that there is an established
relation between the volume of the brain and the powers of the
mind.

3. How far it is possible to ascertain the volume of the brain
in the living subject by measurement or observation.

4. How far it is possible to ascertain the relative degree of de-
velopement of the different parts of the brain by the examina-
tion of the living head.

5. Notice a few facts which have been used in support of phre-
nology, and conclude with some general remarks.

Under the first of these heads our author gives a brief and
accurate view of the anatomy of the brain, noticing in passing,
the fact that the weight of the brain, which is generally about
three and a half pounds, varies greatly, not only in different
heads, but in heads of nearly the same size that the mamma-
lary eminences and accompanying depressions of the convolu-
tions of the brain do not, in any respect, correspond in size, form
or position with the bases of the phrenological organs as mapped
out that the external part is pulpy, the internal fibrous ; and
that the brain is more vascular than almost any other part of the
body. It is to be remeeibered that professor Sewall is at least
one of the first anatomists of our country. We will give his
conclusions from the enquiry, is phrenology sustained by the
structure and organization of the brain?

" Neither," says lie, " the central (pulpy) or fibrous part of the
brain reveals, upon dissection, any of those compartments or
organs, upon the existence of which the whole fabric of Phre-
nology is based. No such divisions have been discovered by
the eye or the microscope. The most common observation is

1837.] An Examination of Phrenology. 37

sufficient to shew, that there is not the slightest indication of
such a structure. Indeed, no phrenologist, after the investiga-
tions which have been made upon the subject, from the fir? '
dawn of the science to the present time, not even Gall v x
Spurzheim themselves, venture to assert that such divisions of
the brain have been discovered." The absurdity of the idea of
the organs as described by phrenologists is illustrated by the
horizontal membrane, the arrangement of the lateral ventricles,
corpus collosum, fornix, and other parts. " The notion, then,
of the division of the brain into phrenological organs, is entirely
hypothetical, is not sustained by dissections, and is utterly incon-
sistent with its whole formation."

In the second place, he proceeds to substantiate the fact, that
there cannot be any proportion between the volume of the brain
and the mental powers. In proof of this position, he gives a
tabular summary of Baron Cuvier's investigation on this subject,
which shews that several species of monkeys have a considera-
bly greater proportion of brain to the whole body than man :
and if his opinions of the proportion of man's brain to the body,
which is less than Cuvier's, be correct, and that it is, we appre-
hend any anatomist will determine most easily, then all the nine
species of monkeys tested by Cuvier would be found more
intellectual than man, some having one pound of brain for every
twenty-two of the body, and none less than one in forty-eight ;
whilst man's proportion, according to Cuvier is one to thirty, and
according to our author one to forty or fifty. Again. The ele-
phant, remarkable for his sagacity, has but one pound of brain
to five hundred of body, the carp fish one to five hundred and
sixty, and the shark only one to two thousand four hundred and
ninety-eight. This tabular view shews that not only four
species of monkeys, but three kinds of birds, and the dolphin,
exceed man in the proportion of brain, <fcc. Other proof is
drawn from observations on the brain of men, by which the
fact is established, the number of large and small brains of men
of equal enlargement of intellect are about equal.

3d. Here our author controverts most completely, the possi-
bility of ascertaining the volume of the brain in the living
subject, by measurement or observation. In proof of the cor-
rectness of his position, Dr. S. presents views of the skulls of
different individuals, from one eighth of an inch to that of an
inch and a half in thickness, causing a difference in the central

51,72

u

46,21

u

34,79

u

25,33

it

4,50.

oz,

10,01

it

21,43

a

31,89

a

38 An Examination of Phrenology. [Sept.

cavity for the volume of contained brain in skulls of the sa me
volume, apart from the contents by measure of the skulls con-
taining, as follows : brain.
Plate ii. A thin skull, (though of a sturdy wa-
terman,) 56,22 oz.
" in. The skull of a delicate female, but
double the thickness of the former,
" iv. Very thick,compact,and well organized,
" v. Averaging nearly three quarters of an

inch,
" vn. A model from Spurzheim's cabinet,
making a difference in these five skulls, as follows :
Between n and in of

" II iv

ii v "

u n u VII u

making the greatest " difference in the volume of brain contained
in two skulls, of the same external dimensions, 31,89 oz.,
something more than one half." These experiments have been
most fairly made, in the presence and with the assistance of
" Dr. Thomas P. Jones, and Prof. William Ruggles, gentle-
men whose high scientifflc character insures the utmost accuracy
in the results. Nor were they confined to these, but were
" extended to a great variety of Crania," all tending to " show
that the external dimensions of the skull furnish no indication
of the amount of brain. The following conclusion is then
considered inevitable, that no phrenologist, however experi-
enced, can, by an inspection of the living head, ascertain whether
an individual has a skull of one inch, or one eight of an inch in
thickness ; nor whether he has 56,22 ounces of brain, in
volume, or only 25,33."

The fourth enquiry of our author is, how far it is practicable
to ascertain the degree of developement of the different parts of
the brain by measurement, or examination of the living head.
He here again reminds us, that phrenology and craniology are
professedly sufficient to enable the experienced phrenologist, to
judge of the natural amount <mdge?ieral character of the intel-
lects of individuals from an inspection of their heads. The
amount of intellect being estimated by the size of the head,

1837.] An Examination of Phrenology. 37

while its character is determined by the form? Here again,
i Anatomy interposes numerous obstacles to the practical phre-
nologist," only the more important of which he notices. Of
these, the separation of the internal and external tables, forming
sinuses is particularly noticed ; and his eighth plate is a view of
a horizontal section of the skull of an individual, well known
to the author, who had often remarked his head as eminently
displaying the external developement of the perceptive faculties.
" Hiseye was deeply ensconsed under a full projecting brow, and
the organs of form, size, weight, color, order, number, individu-
ality and comparison, were uncommonly well developed. His
locality was uncommon," and our author would, "upon the
principles of Phrenology, have pronounced him a Rubens in
painting, a Humboldt in arrangement, and in form, size, and
weight, a Wren, a Douglas, or a Simpson;" whilst "his
comparison and individuality would have placed him by the side
of Dean Swift, and the Earl of Chatham ; and his locality
represented him as quite equal to Columbus, Newton, Volney,
and Sir Walter Scott. But most unfortunately for phre-
nology, as well as for the individual, Prof. S. discovers, as he
clearly illustrates by the horizontal section of the skull, that
" the frontal sinuses extend over the organs of individuality,
form, size, weight, color, locality, order, time and comparison,"
by the separation of the two tables of bone at some parts to the
extent of an inch, and the cavity thus formed, so capacious as to
measure one and a half fluid ounces. So that instead of cerebral
dev elopements, it is most evident that there were depressions.

Having far transcended the limits which we intended occupy-
ing; by this article, we regret that we cannot accompany our
clear and rational author to the end of the second lecture, which
becomes constantly more and more conclusive, and finally settles
the matter, by the tests of the stern facts of anatomy, that had the
depressioriSjinstend of the eminences of the cranium,been declared
by phrenologists as the evidences of peculiar faculties &c, the
science would have been at least not less true than it is at present.
We will conclude this article by a recommendation that all
who are desirous of knowing truth and avoiding error on this
subject, if they have not time nor talent, nor opportunity for
investigating for themselves anatomically ; or even if they have,

W Royal Academy of Medicine. [Sep*

that they will read professor Sewall's two lectures, comprized
in seventy octavo pages. For ourselves, we have ever withheld
our confidence in the justice of the claims of phrenology, from
our conviction of its incompatibility with the stern truths of
anatomy. And we are, since reading Dr. Sewall's book, more
than ever convinced that there is no more difference between a
time and a tune bump, than there is between a " wine and a
brandy bump" both being about the same thing in cause?
conditition and consequence.

Royal Academy of Medicine.

Session of twenty-third January. Extraction of a tooth
during magnetic sleep. A Medical Journal had mentioned the
fact of the extraction of a tooth during a magnetic sleep, in the
case of a woman twenty-five years of age, feeble and so impressi-
ble that the least cause produced with her palpitation and synco-
pe. M. Oudet, a member of the Academy, and who had been
the operator, was interrogated on the fact. M. Oudet said that
he had extracted a great molar carious tooth of a woman who
appeared in a profound sleep ; that the operation had not caused,
nor seemed to cause any pain : at least she manifested no external
sign of it ; and, on awaking, appeared astonished at the question,
whether she had suffered, during the extraction of her tooth ?
thinking she yet had it.

The operator, however, declined drawing any deductions from
the fact which he merely stated.

This communication provoked, on the part of a great number
of academicians, energetic protestations against animal magnet-
ism. Archives General de Medicine.

Session of thirty-first January. Amputation of a breast
during the Magnetic Sleep. M. Jules Cloojuet, whose
name had been mentioned at the last session with respect to a
woman from whom he had excised a cancerous breast, during
the magnetic sleep, repented to the Academy the same details
which had been before submitted to it. In this woman, there
existed not only a cancerous mamma, but the axillary glands
were- found to have become affected. Two incisions, of from nine
to ten inches in length were made to circumscribe the tumour,
the vessels were ligatured, and the axillary glands extirpated.
The operation was long and severe, as great care was necessary
to protect the axillary artery from injury. The woman did not
utter the least complaint. M. Cloquet could not observe in the

1837.] Royal Academy of Medicine 1 1

expression of her features the slightest trace of emotion. When
interrogated at different times, she replied that siie did not expe-
rience any pain. The wound was healing, when in conse-
quence of a ride that had been recommended by the magnetiser,
she was seized with, a pain in the side, symptomatic of an effu-
sion, and died the twenty-eighth dry after the operation. During
all tliis time, the magnetic sleep had been interrupted but once,
and was then promptly re-prodi^-.d, the patient having, during
her state of freedom from the magnetic influence, expressed the
most intense astonishment at the results of an operation which
si le had unconsciously undergone. Tl e dressing had been made
without her knowledge. T.jc ride had occurred while she was
immersed in sleep ; and, in fine, it may be said with rigorous
truth, that she died while sleeping. Ibid.

Session of fourteenth February. Animal Magnetism. M.
Berna communicated to the Academy, that he was prepared to
shew the phenomena of animal magnetism to those who might
desire to observe them. After some opposition, the Academy
decided that a committee should be appointed to witness the
experiments of M. Bern a. This committee will he composed
of M. M. Bouillaud, Emery, Oudet, Roux, Cloquet, and
Frederick Dubois. Ibid,

Influenza. M. LAPELLETiERde laSarthe, occupyinga dou-
ble medical capacity, the one at the central Bureau, and the other
at the Hotel I3ieu, has had an opportunity of observing a great
number of persons affected with influenza ; the number amount-
ing in twenty days to one thousand and fifty. Besides the
occult cause, the epidemic predisposition, he recognises atmosphe
rical vicissitudes, and particularly cold humidity ,among the causes
of influenza. The disease, according to him, consists essentially
in an inflammation of the bronchial mucous membrane, but there
is a nervous element which distinguishes it ; it is a spasmodic
bronchitis. Influenza may assume different forms, but the same
characteristic symptoms may be always easily detected. M.
Lepelletier does not admit a benign and a malignant influ^
enza. In itself, it is always benign, and when serious accidents
occur, it is in consequence of some complication. In two hun-
dred cases, M. Lepelletier observed twenty-five complications
of pneumonia ; two of pleurisy, three of gastro-enteritis, two of
acute rheumatism, and two of parotiditis. He has seen a
phthisical patient suffocated by the invasion of the spasmodic
bronchites, and die in a state of asphyxia. He has made similar
observations in catarrhal old men. Influenza may also be a
very serious affection in apoplectic subjects, not only on account
of the cerebral congestions which the cough provokes, but also
in consequence of the general proscription of blood-letting.
6 f

42 Royal Academy of Medicine. [Sept,

Pneumonia or pleurisy is the complication that is most frequently
fatal, especially because venesection does not exert its usually
beneficial effects. He has found that the plan of Rasori, who
combines emetics in large doses with sanguine evacuations, is
the most efficacious. He has also derived advantage in catarrhal
old men from the administration of the white oxyde of antimony.
M. Lepelletier has remarked particularly the capacity to resist
the action of emetics. In eighteen patients, two only vomited.
M. Louyer Willermay, also regards influenza as a mild
disease, and has^ derived advantage from the employment of
venesection where the pulse was full and developed, and the
respiration oppressed. The duration of the disease does not then
exceed three days, the blood presents a consistent coagulum and
sometimes a buffy coat. M. Recamier refers to the epidemic
of influenza that occurred in 1803, and which was very fatal.
The progress of the disease was then marked by a cutaneous
phlegmasia. He regards influenza as a disease of the nature of
the eruption fevers, and for this opinion he relies not only upon
the coincidence 'of the cutaneous phlegmasia which character-
ised the epidemic of 1803, but also upon the totality of the
symptoms which he has found to be analogous in both cases.
The catarrh of influenza is,, in reality, similar to that which
occurs in scarlatina ; if, in 1837, the cutaneous eruption was not
general, erysipelatous redress was frequently observed, and
pustules of the lips almost invariably. It is known that even in
eruptive fevers, the eruption does not always exist, and that the
nature of the disease is not thereby chano-cd. Besides, this erup-
tion may be internal, for in 1803 it resided not only in the integ-
uments, but also in the digestive mucous membrane, and the
intestinal eruption possessed all the characters of the lesions so
well described by Roederer and Wagner. Whenever an
epidemic rages severely, it leaves indelible traces behind it.
Thus M. Recamier observed, that intestinal eruptions were
multiplied after the epidemic of 1803. After cholera, are not
algid symptoms and those of cyanosis observable ') He distin-
guishes in the phenomena of influenza three principal forms.
In the first, the (inflammatory form,) the individuals affected
being generally strong and robust, present a full and resisting
pulse, the cephalalgia is intense, the respiration, is embarrassed,
and a sensation of constriction as if by a bar exists at the base of
the chest. In this form, venesection is indispensable. He has
repeated it four or fl vo times, and has seen the blood become
more coagulable in proportion as the evacuation was renewed,
a character different from what is observed in pleurisy or pneu-
monia, and which to be peculiar to influenza. In the
second form (the bilious) the mouth is bitter, the tongue white,

1837.] Royal Academy of Medicine. 43

partly covered with mucosities, the pulse without strength or
resistance, and the morbid action transpires in the digestive
apparatus. Emetics are here indicated, and their effects are

immediate. M. IIecamier has seen all the symptoms disappear
in twentyfour hours alter this medication. Purgatives are much
less efficacious, which is easily explicable since emetics, besides
the evacuations which they occasion excite a diaphoresis, the true
crisis of influenza. The third form is called nervous by M.
Recamier, the nervous suffering is extreme, the patient enjoys
no sleep, fugitive pains traverse the extremities and the trunk, the
pulse is small and depressed, and the agitation considerable. In
these cases the lancet is absolutely contra-indicated. In this
form, the disease is very serious, and the patients sink before
any means can produce reaction. In these cases, the employ-
ment of baths has been most successful in his practice. M.
Piorry admits two phases in the epidemic ; he has seen the
pulmonary phlegmasia extend more and more profoundly, and
being confined at first to the first broncheal divisions, it reaches
in the end their ultimate ramifications. M. Piorry has employ-
ed, but without success, emetics in large doses, in those cases
complicated by pneumonia which he has particularly observed
in old men.

The loss of blood, even when practised copiously and at short
intervals, was not more successful. M. Bouillaud without
rejecting the idea of a special epidemic cause, finds in the exist-
ing condition of the atmosphere a sufficient explanation for the
disease and its propagation. He does not deny that epidemics
impress their character upon all the intercurrent diseases ; but
this opinion, however, has been exaggerated. He has not yet
seen a sufficient number of cases to authorize him in pronounc-
ing an opinion upon the nature of the pneumonia which is
developed in influenza ; but he is in the possession of some facts
which tend to prove that venesection repeated after his method
must be equally successful in pneumonia attendant upon influ-
enza, and in the more uncomplicated pneumonia. M. Bouil-
laud cites especially the case of a physician of sixty ei
years, in whom venesection repeated at short intervals, caused
the very rapid disappearance of the mischiefs of a very serious
pneumonia. He confesses, however, that since the invasion of
the epidemic, more deaths have occurred. in his wards, than had
taken place in the preceding eight months. Archives Gen
de Medicine, for Feb. 1837.

Spontaneous perforation of the left Ventricle of thi
Autopsy by M. Medic j, professor of physioloay in the Un
sity of Bologna. A saddler, aged sixty, of a good constitution,
robust, and enjoying habitual good health, was admitted April

44 Royal Academy of Medicine. [Sept*

21, 1830, into the hospital of Bologna, to be treated lor hemiple-
gia of the leftside. Energetic contra-stimulating remedies such
as copious sanguine depletions, drastic purgatives, alcoholic,
extract of mix vomica, (from a quarter of a grain to five granis
per diem,) antiphlogistic enemata were employed, but with very-
little advantage ; the half of the body remained paralyzed ; the
entire head turned toward <>ne side, speech embarrassed, &c.
Dr. Baccialli, who replaced M. Medici, seeing the inutility
of this medication, employed ammoniacum internally and ex-
ternally, blisters and moxas between the shoulders, but the
patient grew worse and worse. The 31st December, 1831, it
was necessary to have recourse to the lancet, and the next day
the patient was seized with an intense precordial pain, and upon
the ensuing day, he died in a state of general debility without
agitation. Autopsy. 1st. In the cranium, a pound of sanguino-
lent serosity between the dura mater and the right lobe of the
cerebrum ; the cerebral vessels were turgescent and full of bloody
the pulp of the same lobe very red anteriorly, yellowish, almost
diffluent, and without circumvolutions for the extent of half a
dollar. 2d. In the thorax, the pericardium was distended like a
bladder filled with urine, it was transparent and through its
substance a red liquid was discernible ; when opened, this liquid
was found to be composed of sirum and fibrine, mixed together
to the quantity of three pounds. The walls of the sac presented
no appreciable lesion. In the midst of this fluid was seen the
heart, whose volume, structure, figure, and color presented
nothing anormal. At its anterior and middle part, however, was
observed a spot of a reddish colour, and in the centre of which
existed a small hole, through which a .probe and afterwards a
writing quill were freely passed into the left ventricular cavity
by a pretty long passage. This passage was smooth and red.
The left ventricle was health I y throughout, with the exception
of its inferior part towards the point which presented a red colour,
like that, of the pomegranate. The other parts of the heart were
perfectly healthy. No softening, no ulceration or appreciable
lesion, except the perforation. Annali Universali di Medic'ma
{Gazette Medicate.)

After the exposition of the details of these interesting facts,
the learned physiologist of Bologna searched for ibe cause of
such a terion of the heart; but not finding it in the details, nor
in the traumatic cause, nor in remollisscmcnt, nor in ulceration,
he is obliged to declare that in the actual state of our knowledge,
the lesion he has discribed remains unexplained. The coinci-
dence, nevertheless, of the disease of the brain, and thelingcring
death of the subject, renders the observation worthy of the
consideration of the physiologist. Gazette Medicate.

y$7.1 Animal Magnetism. 45

Animal Magnetism.

6

The evidence in favor of animal magnetism accumulates on
all hands. Events which have lately transpired in a neighbor-
ing city, leave to ridicule no excuse to amuse herself with facts,
which reason cannot comprehend. The question is now, not
how to change the laws which govern human belief, but to show
how these surprising phenomena do not contravene anything
heretorforc known of the functions of the brain and nervous
system ; a necessity the more imperious, since, if the obsolete
notions that the soul leaves the body and wanders through the
earth, as in the Stygian shades, be revived, as there is reason to
fear from the tenor of some articles in the periodical press, it is im-
possible to foresee what may be the consequences, even in th
enlightened age, to the very constitution of civil society.

With the hope of removing the grounds of such an assump-
tion, and, in some degree, of obviating other difficulties con-
nected with this subject, the subjoined observations are offered.
Whoever is disposed to examine them attentively, though he
may think that a simpler and less abstruse method might be ta-
ken to account for the phenomena, will admit, it is believed, both
that the conclusion follows directly from the premises, while the
premises are the least exceptionable of any that can be adopted.

Supposing the nervous system to be the chief medium of a
subtle and elastic fluid, to which it maintains a relation analogous
to that which obtains between glass or any transparent medium
and light, regulating its vibrations, the white substance serving
as a conductor, and the grey and white together serving as an
excitor, when stimulated by the blood, all the phenomena of the
mind, as external sensations, internal ideas, and volitions, maybe
as readily conceived to be attended with an undulatory motion
in that fluid, as any other state of the brain. This ethereal fluid
would -then constitute the mind or soul, the brain being in all
animals but the material condition necessary for its manifesta-
tion. The existence of such a fluid has been rendered almost
certain by the experiments of physiologists. But I hope it will
not be considered out of place to add here a few considerations,
which appear to me new, and strongly confirmatory of the
hypothesis.

When we observe the image formed upon the retina by an
outward object, we are led to'infer that the image, thus painted
has some connection with the impression produced on the mind ;
but the inversion of the image overturns the hypothesis. When
we compare the eye of the eagle with the eye of man, in order to
discover on what depends the superiority of vision of the first,

46 Animal Magnetism. [Sept*

we perceive no essential difference, except that its retina consisJ
of a number of folds or lamellae, giving it a great extent of surface
compared with man's. Nor can we imagine a reason for this
structure, on the supposition of the image impressed on the retina
being the cause of the sensation or perception of the outwaid
object. But when we take into view the wonderful effects pro-
duced by the galvanic machine, owing simply to extent of
surface (supposed to enable it to accumulate a great quantity of
fluid,) by supposing a similar fluid to accumulate on the retina,
the harmony between the structure and function of the part is
evident. One class of philosophers say that the mind is in pro-
portion to the size of the brain ; another, that it is in proportion
to the number and depth of its convolutions. Both assertions
coincide with the opinion that it corresponds with the extent of
its superfices.*

It is an established fact, that the nervous chords of sensation
and volution increase in size in proportion to the function they
have to perform in different animals, and in different parts of
the same animal. The brain, the organ of thought, is larger in
man in proportion to the nerves that issue from it, than in any
other animal. The optic nerve is the largest in the human
body, and has the greatest number of filamentous threads. Man
is the most thinking animal, and vision is the highest and most
intellectual of the senses. Whatever sense is most acute, its
nerve is largest. Where muscular action is strongest, and often-
est called into exercise, there the muscular nerves are largest.
Mow a small nerve might transmit an idea, sensation, or volition,
as well as a large one, for anything that we can see to the con-
trary ; but when we see an electro-magnet increase in power
according to the number of wires that are wound around it (fac
similes of nervous filaments,) and arc told by the natural phi-
losopher that they serve to accumulate the fluid, the adaptation
for a similar structure in the nerves, to transmit a similar fluid,
is obvious.

Should we infer that this was the true function of the nervous
tissue, our inference would be confirmed by the fact, that the
powers of the mind, of sensation, and muscular action, are
strengthened by being tasked, as the strength of the magnet
increases by having weights attached to it. This fluid may also
vary in density, as well as quantity; or the number of particles
within a given space may increase, as well as the extent of

* Some assert that, the grey matter is the matrix or generator of the white ;
others, that it is I . the mind ; hut has not the attachment hetween the

two its analogy in the copper and zinc plate of the gaWanic battery; and may not

the extent of the superfices be for the purpose of exciting a great amount of fluid?

1837.] Animal Magnetism. 47

surface, giving rise to an accumulation of the fluid of the same
density ; and if so, the phenomena would correspond with the
effects of what is called, in electricity and galvanism, increased
intensity and increased quantity. What can be a more striking
evidence of the circulation of a fluid, which, if its existence
were presumed, would be invisible, than the state of Somnam-
bulism affords ? Here, one set of nerves act with unwonted
energy, while another is almost as inert as dead matter.

Believing, from such an accumulation of evidence, that we
are justified in assuming this hypothesis as a ground work of
reasoning, I would now proceed to show how far it is necessary
to presuppose the existence of an analogous fluid without, and
will first refer to the following paragraphs from Brewster's work
on Optics.

" In the undulatory theory, an exceedingly thin and elastic
medium, called ether, is supposed to fill all space, and to occupy
the intervals between the particles of all material bodies. The
ether must be so extremely rare as to present no appreciable
resistance to the planetary bodies which move freely through it.

" The particles of this ether are, like those of air, capable of
being put into vibrations by the agitation of the particles of
matter, so that waves or vibrations can be propagated through
it in all directions. Within refracting media it is less elastic
than in vacuo, and its elasticity is less in proportion to the refrac-
tive power of the body.

" When any vibrations or undulations are propagated through
this ether, and reach the nerves of the retina, they excite the
sensation of light, in the same manner as the sensation of sound
is excited in the nerves of the ear by the undulations of the air.

" Differences of color are supposed to arise from differences in
the frequency of the ethereal vibrations. * * *

" The theory of undulations has made great progress in mo-
dern times, and derives such powerful support from an extensive
class of phenomena, that it has been received by many of our
most distinguished philosophers."

Every step made in the progress of science tends farther to
generalize the laws which regulate the motions and affections of
matter. Gravitation, electricity, magnetism, light, heat, chemical
attraction, have approximated so far towards unity, that it is
easier to say in what they resemble each other, than to point out
in what they differ. Laplace demands but a plastic ether to
mould the nebulous matter, floating through space, into all the
conditions which his Celestial Mechanics require for their appli-
cation ; while Lamarck and Sir Humphrey Davy, by a simi-
lar agency, people the earth with all the forms of animate and
inanimate matter.

48

Animal Magnetism.

[Sept,

The number of undulations of an elastic medium, or of
different elastic media impinging on each other, in a given time,
increases in proportion to the density of the medium ; in the same
proportion, the extent of each undulation diminishes. If the
undulations of a fluid in immediate contact with the retina, of
which 37,640 occur in the space of an inch, and 458,000000,-
000000, occur in a -second of time,* create the sensation of
redness, the density of the undulating fluid without the eye may
diminish indefinitely, so long as that within increases in the
same ratio, and the same number of undulations be made by the
one medium impinging on the other, and consequently the same
sensation be excited. What is true of one is true of all other
sensations.

Now if we suppose thatetheral fluid, which Newton thought
the cause of gravitation, to be identical with that which Huygens
thought the cause of light, it must act through opaque as well
as transparent bodies ; but as its density is less in opaque bodies^
or its undulatory power weakened, the reason why it exhibits
the phenomena of light in one case, and the phenomena of weight
in another, would be, because the number of undulations in a

*The following table given by Mr. Herschel, contpms the principal data of the
undulatory theory.

Colors of the Spectrum,

Lengths of an Undu-
lation in parts of an
inch in Air.

Number of
Undulations
in an Inch.

Number of undulations in a
Second.t

Extreme Red - - -

0.0000266

37040

458,000000,000000

Red

0.0000256

39180

477,0000011.000000

Intermediate - - -

0.0000246

40720

495.000000,000000

Orange .---

0.0000240

41G10

506,000000,000000

Intermediate - - -

0.0000235

42510

517.000000.000000

Yellow - - - -

0.0000227

44000

535,000000,000000

Intermediate - - -

0.0000219

45600

555,000000.000000

Green

0.0000211

47460

577,000000.000000

Intermediate - - -

0.0000203

49320

600.000000.000000

Blue

0.0000196

51110

622,000000,000000

Intermediate - - -

0.0000189

52910

611,000000,000000

Indigo -----

0.0000185

54070

658.000000.000000

Intermediate - - -

0.0000181

55240

672,000000,000000

Violet

0.0000174

57490

699, 000000.000000

Extreme Violet - -

0.00001 G7

59750

727.000000,000000

"From tliirf table," says Mr. Herschel, "we see that the sensibility of the eye is
confined within much narrower limits than that of the car; the ratio of the extreme
vibrations being nearly 1.58 : 1, and therefore less than an octave, and about equal
to a minor sixth. Tnat man should be able to measure with certainty such minute
portions of space and time, is not a little wonderful ; for it may be observed what-
ever theory of light we adopt, these periods and these spaces have a real existence,
being in fact deduced by Newton from direct measurements, and involving nothing
hypothetical but the names here given them. Brewster's Optics, page 119.

tTokingJthe velocity of light at 192,000 miles per second.

1837.] Animal Magnetism. 49

given time were fewer in the latter, than in the former instance.
But admitting a fluid to occupy the interstices between the par-
ticles of the retina, or to cover its surface, on which the ether
impinges in its vibrations, giving rise to a second series of vibra-
tions on which the sensation immediately depends ; if its density
be increased (as we believe takes place in somnambulism), the
number of vibrations, as we have seen, will be increased in the
same ratio, and there is no inconsistency in supposing that the
slow undulatory motion of gravitation without, may produce
that precise number of vibrations within, which excites the sen-
sation of redness, or any other sensation. Since, then, gravita-
tion extends from Boston to Providence, with a power (like the
law of illumination) inversely as the square of 40 miles, when
it is asserted that a somnambulist in the latter place has the
panorama of our city before her, and can direct her attention to
any part she chooses, and describe it minutely, the fact may be
explained by combining two theories, which, if not established,
are at least regarded as the most plausible in physics and phys-
iology, viz. : that which assigns light and gravitation to the undula-
tions of a fluid pervading all space, and all matter, and that which
supposes a similar fluid to circulate in the nervous system of ani-
mals. For by the nature of the fluid without, its undulatory power
must be diminished, by diminished density, or what has the same
effect, by the irregular collocation of the particles of opaque mat-
ter, requiring, to produce the phenomena of light that increased
density and consequent vibratory power of the fluid within,
which all the appearances in the state of somnambulism compel us
to believe actually exist. It does violence to no established law,
but to our preconceived notions. And it is necessary that either
our preconceived notions should give way, or a mass of evidence
be rejected, the most positive and authentic in kind, and con-
stantly accumulating in degree.

It should be borne in mind, that animal magnetism is not the
only subject that is inexplicable on the common notions of the
animal economy. An extensive variety of facts, linked togeth-
er under the terms of sympathy, of fascination, of antipathy, of
irritation and counter-irritation, concerning which there is little
or no doubt of their authenticity, point to the nervous system as
the source of some unrevealed mode of affection. Nor should
hereditary predisposition be overlooked in this connection ; nor
even the question of embryotic influences, against which the on-
ly substantial argument is our own ideas how Nature ought to
demean herself in our presence, rather than the careful and
humble observation of what she does. These words are but gen-
eral terms, and, like the term inflammation, are expressive of
something that lies deeper. As they are now used, they con-
7 G

50 Animal Magnetism. [Sept.

vey no more real knowledge than do the names of the genera
of plants, of their properties. If we could forget these terms,
when reasoning about the conditions to which they refer, and
imagine the nervous chords to circulate a fluid, for which their
structure is as strikingly adapted as the vascular to circulate
blood, we could lose nothing of what we already know, and
might, possibly, learn something additional.

Will the adoption of the electro-galvanic fluid explain these
mysteries ? To assert that it will, unerringly and immediately,
would perhaps ht*ve no other effect than to expose one to ridicule.
The reasoning on which such an hypothesis must rest, is very
complex in its nature. Facts are abundant, but their relations
are intricate. Every argument must be grounded not on cer-
tainty, but on the greater probability. And at first, it will be
next to impossible to make due allowance for disturbing causes j
still, an approximation may be made towards estimating its bear-
ing on most, if not all of the functions of the animal economy.
The heterogeneous mass of facts, which physiological experi-
ments as well as pathology, have of late years brought to light,
can be simplified and reduced to some sort of order, if not ac-
tually reconciled, by this view. At present they are a " caput
mortuum" serving no other purpose than to perplex and dis
gust the student. Nor is he taught to regard them with a clearer
or more favorable eye, by the disputes and not unfrequent recri-
minations of different professors of the healing art. even in the
same college. What can afford greater evidence of the want of
a more comprehensive hypothesis as a guide to their researches?

A great deal of ink has been shed to prove the danger of theory
getting a-head of fact ; but comparatively little, to exhibit the
evil of facts getting a-head of theory. And if, by hasty general-
ization, science sometimes gels along too fast, can she not, from
want of it, creep at too slow a rate? Let the speculations about
ghosts, hobgoblins, witchcraft, disembodied spirits, and devils at
six and sevens, which somnambulism is calculated to revive,
if its phenomena cannot be referred to natural laws, answer this
question.

I cannot enlarge on these points. At some future time I may
advance some reasons, why what is called the manipulatory pro-
cess of magnetization is neither inconsistent with sound philoso-
phy, nor without its analogy in other sciences. Before closing
this communication, I would, however, add, that though what
lias been said above presupposes the fluid to exist in the nerves
only, it is not necessarily confined to that part of the system. It
exists in all the solids and fluids of the body, the nervous sus-
taining to the other tissues some such relation as the prime con-
ductor to bodies around it, or as transparent to opaque bodies in

1837.] Animal Magnetism. 51

optics, a medium for greater density of fluid, and greater free-
dom of motion, and the fluid itself may, like the cellular ti
represent the image of the whole body: and oscillating from
within outwards, and from without inwards (obeying in these
motions, the laws which in crystals regulate reflection, refrac-
tion &c. producing so many interresting phenomena,) may thus
be the secondary agent, in the hands of the Creator, of the form
of our bodies and bodily organs, as well as of the functions of
the mind. On this hypothesis the equilibrum of fluids explains
those experiments of Magendie, in which the crura of the cere-
brum being cut, the animal moves forwards ; the crura of the
cerebellum, backwards ; and the section of either one of them
gives a tendency to a latteral motion. It may serve also to re-
concile the views of Bell and Magendie on the one hand, and
Bellingeri on the other, in regard to the function of the anterior
and posterior of the spinal marrow. It accounts for the curvili-
near course of the fibres of the brain, in the mutual action of
counter-currents, and for the pons varolii, septum lucidum, for-
nix, mamillary eminences, the decussation of nerves ; assigns a
better reason for the ganglion of the posterior chord of the spinal
nerves, than any hitherto given ; and taking the beautiful curves
exhibited in crystals by polarized light as the analogical starting
point, it tells why organized beings are rounded in form, instead
of angular. In tetanus, palsy, catalepsy, and every variety of
nervous disease, it will be found to go far towards explaining
what heretofore has been considered inexplicable. Any one, at
his liesurc, can verify these stal -. It is sufficient here to

give them without tracing each individual fact to its relation with
this hypothesis. But lest it might seem, at first view, that these
are mere assertions, made without due examination, I will dwell
for a moment on one, which both on account of its intrinsic
beauty and because it occurred to the writer as an after-thought,
may be considered almost as a crucial experiment of the whole
theory.

This fluid, it is supposed, by its undulations to and fro, and
by its currents and counter-currents, moving through the parti-
cles of organized matter, and exerting an attraction or exciting
movement among them, disposes them in the forms of our bodily
organs. Now let us imao-ine, after the optic bed i and corpora
striata have been formed, two currents passing horizontally from
the sides of the brain towards the centre, on the under surface
of the corpus collusum; they would meet at the centre, and
be deflected perpendicularly down ward, in the direction of the
septum lucidum. Meeting with a repulsive surface on the optic
beds, the fluid would there accumulate for a moment, from the
fornix, fringing its edge by its vacillations against a counter- re-

52 Animal Magnetism. [Sept,

pelling fluid, with the fimbriated bodies, and be impelled as it
were, most easily in the direction of its four crura. Passing
down its anterior crura, and (ailing perpendicular upon another
part of the fluid more dense, it would by undulating upwards
and downwards, make a cupped depression, which would serve
as a mould for the mamillary eminences. An idea of this mould
one may have by blowing perpendicularly upon the surface of a
fluid through a small orifice. In like manner the formation of
the pineal gland, the infundibulum, the pons varolii, and the con-
volutions themselves, may be traced with almost mathematical
certainty.

It is usual for the person who advances a hypothesis, to give
his name in connection therewith. But as the publishing of
my name would add nothing to the weight of the arguments
which have been presented, I hope will not prevent their ob-
taining a hearing. A systematic form will be given to the views
which are here but indicated, as soon as time and circumstances
will permit. In the meanwhile, at the expense of being re
gardetl as a visionary and enthusiast. I commit them to the can-
did consideration of the medical public, with a firm conviction
that while the art of medicine progresses uniformly, but slowly,
by a rational empiricism, the science itself will be revolution-
ized, and re-constructed on the basis of these hitherto disregarded
phenomena : nay, more, that they will furnish a key to unlock
the inmost recess of the labyrinth of nature, and unfold the rich-
est field for scientific research that the mind of man has ever ven-
tured to explore, the one which is destined to lead him to a
just estimate of his rank in the scale of being, and of his rela-
tions to all things around him, and which will enable him to
unloose the seals of the last volume of the series of Natural
Religion, and read therein that Himself and the Polypus the Crys-
tal and the Lily, the Earth and Chaos, the Stellar Heavens and
the Nebulous Mass, are but links in one undivided chain of for-
mation and casuation, of which the different physical sciences
are but the names of its integral parts. Boston Medical and
Surgical Journal.

1837.] Nitrate of Silver. 53

PART III.
MONTHLY PERISCOPE.

Nitrate of Silver.

This article which has been hitherto considered as belonging
chiefly to the surgical pharmacopoeia has, of late been placed be-
fore the public as a therapeutic agent claiming the particular
attention of the general practitioner.

Dr. Boudin has lately called the attention of the profession
to it as an antiphlogistic of valuable powers in inflammation
generally, and more particularly that of the mucous membranes
He has also adopted its use with decided advantage in an
:mic fever of typhus character with follicular enteritis. Of
? of fifty patients treated by this medicine, only two died,
a^> ( i indeed. He considers that two important points

have been established by post mortem examinations of these
two fatal cases, viz. that the medicine did not add any irritation
to the inflammatory action of the disease, but had promoted the
cicatrization of the ulcers : and that on being administered by in-
jections (which are generally considered as not passing beyond
the ilio-caseal valve,) communicating its grey color to the lower
portion of the ill in m.

The formulae used by Dr. Botjdin was 3 or 4 grs. of the
crystallized salt dissolved in 5 vi. of distilled water and admin-
istered by injection : or crystallized nitrate of silver grs. vj.
water q. s. dissolve and saturate with gum tragacanth, or starch,
and make 24 pills. Dose 1 every half hour.

He considers it a common error to suppose that the action of
nitrate of silver is confined to the part with which it is in con-
tact, inasmuch as the same greyish color which was produced,
as its proper and ordinary effect in the large intestines with which
it was in contact was also observable above the ilio-caecal valve,
in the lower part of the illium.

54 Nitrate of Silver. [Sept

It is not less our pleasure than it is our duty to state thus the
valuable results of Dr. B's. experience with this medicine, as of
great importance in a certain kind and stage of action, with
which the practitioner occasionally meets, and who has been com-
pelled to trust in the virtues of means far more doubtful.

Nor is it less our duty to object to the principle which appears
to be claimed for the action of this valuable agent. Dr. Bou-
din it will be recollected, speaks of and testifies to the remedi-
al powers of nitrate of silver in " inflammation in general;"
thereby making it truly and decidedly antiphlogistic, or capa-
ble in small quantities, of weakening the system by diminishing
the action of the vital powers. A misnomer in medicine is often
productive of consequences over which humanity weeps. We
could name some melancholy instances : but we will illustrate
by a supposed example.

Had Dr. B. prescribed arsnic tinder the belief that it was a
febrifuge from its having the power of preventing the return of
aparyoxism, under circumstanhes which needed an emetic or a
bilious purgative, lie would have found his prescription fol-
lowed by a continuance, or increase of febrile symptoms, or
viscual obstruction, or hydropic disposition, or both thereby
proving at the expense of his patient, that he used a tonic when
an operative portion was needed.

Not less important is a misnomer in pathology. The exis-
tence of idiopathic fever is denied, and a general febrile action
called '-sympathetic fever,"' originating in lecal irritation of the
stomach or intestines or both, is advanced as the true pa-
thology of fever. The term gastritis^ or enteritis^ or g
tro-enlcritis is therefore given to it words which mean a
phlegmonous inflammation in those parts. These names then
as used of late in pathology make up the very Language which
declares pathological truth. What are the unavoidable conse-
quences of a fair reasoning from the premises thus settled? As
surely as anyjusl conclusions can be drawn by fan ing,

they are, nol only the careful and rigid avoidance of every effi-
cient medicine, on account of the apprehension of increasing by
it.> use, the gastric or enteritic inflammation; but a total neg-
lect, of the secretions, in I lie expectation that on withholding
from the pan, irritants of all descriptions, the inflammation will

1837.] Nitrate of Silver. 55

subside. Here, a word, as gastritis for instance, which means
an inflammation of the stomach neither more nor less. char-
acterized by symptoms of " pyrexia, anxiety, heat and pain in
the epigastrium, increased when any thing is taken into it, vom-
iting, hiccup, pulse small and hard, and prostration of strength,
&c."' is used to mean an ordinary pyrexia, without any specific
characters whatever : and which, when produced, exists for a
few hours only, and then intermits so completely that the most
powerful stimulants and tonics are comfortably borne in the sto-
mach until the regular period of return arrives ; a character
perfectly incompatible with the term gastritis. Such is, in
few words, the origin, and the sum and substance of ezpec l ant-
ism: and who can calculate the vast extent of mischief thus ef-
fected by the wide-spread and captivating doctrine of 'local origin !

Not less liable is a misnomer in therapeutics to lead to the
most injurious prescriptions. We are satisfied of the fact, that
the medicine under consideration is not, properly speaking, a
sedative, or refrigerant power, that is to say, it is not one of
those very few active powers whose operation is to weaken the
actions of the system by diminishing the activity of the vital
powers. Most of the antiphlogistic means at the command of
the practitioner are the withholding or withdrawing of the active
powers. Yet there is good reason to believe in the existence of
a few known powers which tend directly to the reduction of
action, as prussic acid, laurel water, and (perhaps) antimonials
&c. But all the phenomena of its operation on the living fibre
from its severest cauterization, down to its valuable efficacy in a
collyrium, tend to prove that nitrate of silver is uniformly an
astringent or styptic power, being in common with others of the
same class rendered corrosive when in a concentrated form.

In its prescription, therefore, we should be careful to determine
that state of the disease in which we may reasonably expect
good effects from styptic, and not confound it with that which
needs ': antiphlogistic" operation. These states are extremely
different ; the latter being the earlier, and the former the latter
stage of the same disease, the remedial means must therefore be
adapted to each with as distinct decision.

We do not believe in the gastric or enteritic origin of ordinary

56 Nitrate of Silver. [Sept,

pyrexiae. Nor do we believe in the existence of a genuine gas-
tritis or enteritis at all in ordinary pyrexiae, only as being them-
selves symptomatic or secondary. We do believe that these
inflammations can indeed exist primarily, from various causes,
as the impression of cold, worms, chemical and mechanical vio-
lence, as from worms, indigestibles, concentrated acids, alcoholic
drinks, large doses of acrid, irritating medicines, as nit. potass.
&c. &c, and that, these occuring in conjunction with suitable
predisposition, may, and do involve the general system in febrile
action. But when these do exist, their course is steadily, and
often rapidly onward, in the true character of inflammation,
until they arrive at some one of the various terminations of that
kind of disordered action, without the least tendency to intermit
or remit, more than a pleuresy or a pneumony uncomplicated
with any degree of bilious character ; nor are they found, in a
large proportion of instances, amenable to the most rigorous
antiphlogistic treatment.

Autopsy does, indeed, reveal much valuable truth truth
which should not, must not be disregarded ; but its develope-
ments require to be reasoned on. When we find ulcerations in
the mucous membrane of these, they do declare their antecedent
or cause, inflammation, to have existed; but if these ulcera-
tions are at the follicles they do declare an inflammation of these
follicles, or follicular enteritis to have existed. This, then, is
peculiar not in the character of ordinary or genuine gastritis
or enteritis, which extends itself with regular continuity to a
greater or less extent of surface, and which may, indeed, be said
to " radiate" from a beginning point in many instances, and
extend over a considerable surface. Who ever saw the intes-
tines of one who died from injuries inflicted on them by worms,
but observed a regular and uninterrupted extension of inflamma-
tion up and down the canal from each eschar. So it is with
enteritis from other causes, as cold or any thing calculated to
act on a greater extent of surface. But it is not so with the
inflammation which is commonly the result of pyrexiae. This
is follicular and the effect of other derangements of the system.
One, then, is comparatively general, whilst the other is local,
confined to the glands of the intestines. But both have their

1837.] Hahnemannism and Thomsonianism. 57

action and their declining or decreasing state of action as dis
tinctly as conjunctivitis ; and who thinks of applying alum
curd, or diluted alcohol, or solutions of the vitriols, or of nitrate
of silver to this membrane in the early stage of an active inflam-
mation ? Yet if we could be made to believe that cayenne is
truly an antiphlogistic or a simple dimulcent, surely we should
not hesitate to apply it. But in the subsequent stage, when the
vessels are debilitated by the continuance of excessive action,
and resolution is succeeding, or even passive congestion remain-
ing, a styptic power, as some of those just named, is fonnd to
greatly accelerate the cure. And if ulceration shall have super-
vened, and remains chronic, from that debility of the part which
is consequent to active inflammation, the same kind of power
exerted on the part will tend greatly to the lessening of that
deposition in the part whereby the ulceration is kept up. Hence,
the use of catechu, kino, kreosote, and other astringent powers
and hence the ulcers in Dr. B.'s two cases, which terminated
fatally, were progressing to cicatrization under the application
of nitrate of silver.

Thus it seems evident that the nitrate of silver is not antiphlo-
gistic, but phlogistic in its action, and that, as such, it is only
admissible in that state of action which is benefitted by stimula-
tion or styptic operation.

Hahnemannism and Thomsonianism.

In a late number of this work, we alluded to a recent meeting
of the London Medical Society, at which a discussion took place
on Dr. Uwin's paper in favor of the " homoeopathic doctrines."
We now give below, the statements of Drs. Ure aud Addison:

Dr. Ure had seen the practice of Hahnemannism in Germa-
ny, at the very fountain-head of the "art," and it was not
successful even there. The doctrine of " similia similibus
curenlur" was almost as old as the hills. . Theophrastus was its
advocate, but it fell into oblivion, and was only revived by
Hahnemann, whose disciples blazoned abroad their "cures," but
kept secret the deaths which occurred in their practice. Prince
Frederick of Swartzenburgh.died under the care of Hahnemann
though the " new light" gentleman said that his highness was
8h

58 Hahnemannism and Tkomsonianism. [Sept,

guided to his last home by the allopathists. An old lady also
died under^this treatment, in whom the globule of medicine was
found in a carious tooth, which circumstance was considered to
afford a reason for her death, the salvatory medicine not having
reached the stomach. He thought that one point in the practice
of Hahnemann had been overlooked the rigid enforcement of
diet. To many articles he strongly objected. Coffee was one
which, in particular, he anathematized, asserting that Napo-
leon and Byron both fell victims to the use of that beve-
rage.

Dr. Addison would not consent to argue on a subject which
was so utterly beneath notice, but wished the world to know in
what estimation that society held the practice of Hahnemann
that its followers were either fit for lunatic assy lums, or practised
with the most sordid motives. He ( Dr. A.) was a very loyal
man, and had always been so ; but he could not help saying
he considered that the profession of this country had been gross-
ly insulted in the highest quarters, by the preference there shown
to the employers of this foreign mystery. Did the court ever
send for lawyers who dealt out the law in Algebraic fractions, or
bishops who preached by the square root? He did not mean to
say that the blame was to be ascribed to the royol persons them-
selves who set this example in medicine; but those who were
about them deserved the severest censure, for aiding and abet-
ting Hahnemannism in the palace. [Boston Medical and Sur-
gical Journal.)

Hitherto we have said very little on this subject, 1st, because
we had nothing good to say ; and 2ndly, because it seemed unne-
cessary to say any thing bad or indifferent concerning such
Utopian, not to say absurd notions ; for we would not dignify
such stuff with the name of doctrines. But when such men as
Dr. Uwins present to the London Medical Society a paper in
favor of Homeopathy, and it is made a subject of serious discus-
sion by such men as Drs. Ure and Addison, it is time to take
sides on this subject ; for the London society is not without its
influence. It is true that in the discussion, Drs. Ure and Addi-
son gave the subject a good share of justice. But (en passant,)
by our credulity we are forced to enquire if this Dr. David
Uwins isthe same Dr. David Uwins who but the other year
(1825) published a very sensible "compendium of theoretical
and practical medicine ; comprising with the symptoms, diagno-
ses, prognoses and treatment of diseases, a general review of phy-

L837.1 Hahnemannism and Thomsoniauism. 59

siology and pathology," <fcc. &c. If tie be, as we are inclined to
believe, it may not be forgotten that he then declared that no one
qpnld be more sensible of the respective merits of such authors,
as Good, Gregory, Temple, and Thomas, than himself. He
then spoke of each in terms of ample justice, saying of Dr.
Gregory's Elements, " it is impossible to speak with undue
praise" of Dr. Temple's practice of Physic, it "has too long
enjoyed a high reputation to need any enconium from my pen,"
&c.

The principle claimed by Hahnemann is indeed, as Dr. Ure
very correctly observed, " almost as old as the hills." Traces
of it, have, in all times been found amongst practitioners as well
as the common people. Our own observation' on this subject
does not, however, go farther back than the last of the eighteenth
century. The medical maxim then, was " the hair of the same
dog is good for the bite." So strong, indeed, was the faith of
the country people in its truth, that we have known great pains
taken to procure the hair of the same dog ; and in some instances,
the dog was killed when it could not be otherwise obtained.
Even at different times in the present century, we have, on being
called to wounds from a dog-bite, found them dressed with the
hair of the same animal which had inflicted the wound. This
has always seemed to us a relic of the days of the seventeenth
century, when the wife of Wm. Hihbins was hung in Rhode
Island for a witch.

We have met, in later years with some (otherwise) respectable
practitioners, whose fixed principle as far as they found it prac-
ticable to carry it out, was "like for like," in all cases; as
miotics always for the cure of miosis, cathartics tor catharsis
bleeding lor haemorrhage, &c. &C. This was very good, "simi-
liashiiilibus curantur" stuff, as to the kind of remedy.

As to the discovery of the virtue of the inifinitissimal doses
of the medicines this class of practitioners use, we have not the
least objection, either on our own behalf, or that of any of our
friends to leave the whole of its glory to Hahnemann, or any
of his followers, now and forever. We can bear no testimony
nearer disproving his claim thereto, than the occasional observa-
tion in our early days, of pebble soup, for the cure of certain

60 Hahnemannism and Thomsonianism. [Sept,

diseases a preparation, the formula for which was to collect a
few white pebbles, wash them very clean, and boil them a certain
length of time in pure spring water. The history of medicine,
however, affords us some very near approximations to the imfin-
itissimal doses, as in the ancient usage of drinking water out of
a human skull for epilepsy the amulets of yore, as the abraca-
dabra, <fcc. This history affords us another approximation m
the practice and principles of some of the ancient physicians, to
a belief in the competency of nature to do all things necessa-
ry ; an instance of which by no means inconsiderable, is found
as late as the days of Stahl under the name of " Anima Medi-
ca f and still later under that of the "vires natural medicatrices"
and still later in the Diete absolnP and the " Medicine ExpectanteP
These, however, were the productions of men of science, but they
were erratic stars a kind of monomaniacs. But when the
totally illiterate attempt to display literature when fools attempt
science, we may well expect amonalies, prodegies, transcenden-
tials, and lots of as curious things as are contained in the little
old book called " Aristotles Master Piece," which, in our early
day, we have occasionally seen carefully kept by old country
matrons for their instruction in midwifery, and female com-
plaints ; and from which, doubtless, Thomson took his know-
ledge of the "four elements." We were not therefore in the
least surprized at the forth-coming of what is called ' Thomso-
nianism" or " Botanic Medicine ;" and which, had he pored
one month over Corderii, or Nepos, the author would have
called Contraria Contrariis. Our surprise in this case was ex-
cited by that curiosity in human nature, in obedience to which
it must always try a new thing ; and the more strange and
unaccountable, the more sure the trial. That this disposition
should have extended so far as to collect fifteen thousand memo-
rialists in one state, and eleven to fifteen in another, to pray the
Legislatures to legalize such stuff, already the most stupendous,
and, at the same time, absurd system of imposition and quackery
that ever pervaded the civilized world* and that there should
be occasionally a man found in the ranks of medical science,

* Indeed we nrc assured by Thompson himself, that what he knew of Midwifery
he learned in a few minutes conversation with ail old woman.

1837. J 1 Ink nc mannism and Thorn sonianism. ' 61

who should know better, and still is so lost to science, intellect, or
honesty as to offer to practice for his employers on either " sys-
tem.'' And still more, however, have we been surprised that
the Legislature of an enlightened state should legalize the
practice of such imposition and manslaughter on the unsuspect-
ing citizens whom it is their duty to protect. But we were
utterly astonished at the man himself ] with his character and
opportunities, when Hahnemann openly promulgated his "sim-
ilia similibus curantur principle and irtftnitissimalfoYmuiee.
These two "systems," both the productions of the present
century and age one in Europe, and the other in America,
we should consider, had we belief that their authors had knowl-
edge of each other's views the one, a counter-plot of the other.
We should, had not humanity so much at stake, feel disposed to
put them both together as great curiosities for the present age,
and call them Risibles. But for humanity, surely we should
not care how many thirty-cent books Thomsonians should
impose on the foolishly credulous for twenty dollars each ;* for
we should be perfectly content that those who are incapable of re-
ceiving wit otherwise, and gratuitously, should buy it at any price
they please. Bought wit is said to be the best, if not bought at
too high a price. But we do hold that the tears wantonly wrung
out of weeping humanity are worth too much for such a sacri-
fice.

But after all, it is said, and with much truth too, that they get
a great many patients. This is however, not a strange truth,
and the rationale of it is best explained in the brief dialogue be-
tween the London physician and quack, which was about as
follows : .

Physician. Pray sir, what is the reason that without any la-
borious study, or expense for education you are, thus unprepared,
enabled to have, as you certainly do, so much more practice than
I have? I have expended my patrimony, and the prime of my
life in preparation for the correct and useful discharge of my
professional duties.

* Wc understand that the book can now be bought for ten dollars. Thus goes
down this sinful Babylon ; and down down it will go, until the printer nor even the
porter will be paid for his labor.

G2 Inula Helenium in Leucorrhoea. [Sept,

Quack. Why doctor, Fm surprised at you to ask so simple
a question : surely you have not reasoned a moment on the sub-
ject.

Physician. Yes, I have often wondered at the fact, but could
never account for it.

Quack. Then I am the more surprised, and will make it per-
fectly plain to you in one minute. We live here, you know,
near together, and you are very well acquainted in our neigh-
borhood. Now, sir, pray tell me, what proportion of the heads
of families nearest around us do you consider both wise and
prudent in determining a choice of medical talent. Do you
suppose sir, that more than one in twenty is such?

Physician. About that proportion, I should suppose.

Quack. Very good, sir, you are about correct; the fact is that
for this reason, where one would, by his good sense be able to
determine on employing you, twenty would call on me l

Inula Helenium in Leucorrhoea.

This article (Elecampain) is spoken favorably of in the Revue
Medicale, by M. De Lens, in the treatment of Leucorrhoea, as
well as in some similar affections. He used it in a decoc-
tion of 3ij to 3iv of the root to four cups of water reduced to
three. Of this, the whole was taken a day, in three doses. M.
De Lens thinks an infusion may be as efficacious.

We should be pleased to find so simple and innocent an arti-
cle as elecampain root, prove very successful in this case ; and
hope it will be extensively resorted to ; as it may be tried in
safety, even from the loss of time in cases of this kind, which
are ordinarily not put under regular prescription, until the whole
routine of domestic means have been unsuccessfully resorted
to. Any definite successes with the remedy, accompanied with
an accurate history of the case, its cause, duration, kind and
manner of discharge, the menstrual condition, &c. &c, we
should be particularly please to receive ; as such might be the
means of giving us different views of the theory of those ca-
ses, from those we now entertain.

1837.1 Medical Intelligence. , 63

MEDICAL INTELLIGENCE.

Medical College of South Carolina. We regret that by some cause un-
known to us, the announcement of the annual course of Lectures in this institution
did not come to hand prior to the publication of the August No. of this journal. It
would have given us pleasure to have noticed it under our head of medical intelli-
gence, with others.

This institution is under the guardianship of the Medical Society of South Ca-
rolina, whose president is ex-officio, president of the college and its government is
vested in a board of trustees consisting of eleven medical gentlemen, who derive
their appointment from the Medical Society. Dr. J. B. Whitridge is now the
acting president. It has six professorships, filled as follows :

B. B. Strobel, M. D., Professor of Anatomy,

Elias Horry Deas, M. D., Professor of Surgery,

Thos. Y. Simons, M. D., Professor of Theory and Practice of Medicine,

Henry Alexander, M. D., Professor of Inst, of Medicine & Materia Medica,

Wm. Hume, M. D., Professor of Chemistry and Pharmacy,

Francis Y. Porcher, M. D., Professor of Obstetrics and Diseases of Women
and Children.
Demonstrations of Anatomy, by B. B. Strobel, M. D.

Dean of the Faculty, Thos. Y. Simons, M. D.,

Clinical Lecturers.
At the Aims-House, Edward Elfe, M. D.

At Marine Hospital, Wm. G. Ramsey, M. D.

In the " Announcement" by the Faculty, we are informed that the annual
course of Lectures for the ensuing season will commence on the second Monday
in November.

In addition to a commodious edifice for the purpose, its Museum and Laboratory
are said to be amply supplied, and a Library of about 2000 volumes, and opportu-
nities for clinical instruction are afforded for the benefit of pupils.

Medical Premium. The New York Medical Society, at a recent meeting,
passed the resolution that one hundred dollars be offered for the best dissertation
on the following subject:

" Diseases of the Spine, their causes, symptoms, and best mode of treatment."

Drs. Jno. B. Beck, Jas. R. Manly, Richard Pennell, Jno. C. Cheeseman
and Tho. Downing are appointed the Committee on Prize Questions for the ensu-
ing year. ,

Dissertations to be sent to the Committee before the 1st of January, 1838. Bast.
Med. fy Surg. Journal

Manslaughter by the steamers. John Morgridge a kind of chief among the
steamers, and the principal of a Thomsonian Infirmary at New Bedford, (Mass.)
has been arraigned for manslaughter in the case of Mrs. Eliza Howland of that
town.

Gi Medical Intelligence. [Sept

The unfortunate subject of this fatal quackery, was. with the exception of a pc
nodical head-ache, in pretty good health. This chief administered his " numbers,

lobelia, cayenne, &. &c., in the usual rapid succession. The patient died appo-
plcctic the corpse remained heated a long time was examined and every impor-
tant organ found congested with blood. These facta are given in the N. Y. Ga-
zette, the Evening Star, and the Saturday Evening Tost. The legal examination
was expected to be long and tedious: and as it is but the beginning of these prose-
cutions, may terminate in the exercise of mercy to the guilty wretch. But facts
will multiply, and the observation of them, as they daily occur will be duly regarded
and investigated. Then will the just indignation ot* an insnlted and injured com-
munity burst with retributive vengeance on the heads of these reckless impostors .

There are always those who, for a few shillings will step forward to " clear the
guilty and to varnish crimes," but the reign of reason will come. Judges, jurois, and
legislators will see the sad error of a toleration which spreads ruin on e\erv hand ;
and as in England with Morrison's pills, so will convictions of manslaughter, be
found after a little on every court docket.

This case reminds us of one which occurred very recently in our own immediate
neighborhood, in which death was produced in a very similar manner. The un-
fortunate subject in this case was a very worthy young mechanic from Baltimore.
He had been a little complaining from the effects of a slight cold and perhaps a
somewhat billious habit ; but was about the house on the morning of the fatal day.
The steamer prevailed on him to be taken through a " course of medicine" as he
is pleased to call his treatment. The day was one of the warmest in July or Au-
gust last (the mercury rising daily to 93 or upwards.) Blankets, hot rocks &c.
&c. were collected in abundance for the external "practice with caloric" in due
obedience to the bill of rights granted by the legislature : and what they call " warm
tea only," when the patient escapes death, (and which is well known to consist
mainly of African cayenne,) for internal heating also agreeably to their bill of se-
cured rights. They were liberally applied and administered, in a small close room,
a la mode de Thomson, during which the temperature of the room was considered
to have afforded a " caloric" power of about 200 degrees for the skin and lungs, in
addition to the internal administration of exciting means. In this state of things,
and doubtless, when thesteamer was indulginga full hope that the " caloric" would
operate to good effect, the unfortunate young man happened (strange to tell,) to take
a violent appoplectic fit which continued a length of time and terminated in death
We were summoned in great haste to him at 2 o'clock P. M. found him perfectly
li\ id from appoplexy ; and gasping in death, he breathed his last before his arm could
be bound for blecdinr !

SOUTHERN

MMIQ)3I(DA3L AM) STOI[(DA3L
JOURNAL.

Vol. II. OCTOBER, 1837. No. 3.

PART I.
ORIGINAL COMMUNICATIONS.

ARTICLE I.

Observations on the Pathology and Treatment of Enlarged
Spleen. By A. C. Baldwin, M. D., of Saint Clair, Burke
County, Georgia.

In those sections of the Southern states which favor the gen-
eration of fever, the spleen is peculiarly subject to disease. As
the result of neglected intermittent or remittent fever, its enlarge-
ment to a greater or less extent is almost inevitable. Be the
attack ever so mild, if the case is left to nature, the spleen will
measurably participate in the deranged state of the system, and
will be the last organ to recover a healthful condition ; and
even, under the most judicious method of treatment, such a re-
sult is by no means uncommon. Forming as it were the
second link in a chain of morbid action, and bcin<r itself a con-
sequence of prior disease, in its turn, it forms a foundation for
other and more troublesome affections. Passing over those of
minor importance, the number of dropsical cases which result
from it are too numerous to have escaped the observation of
practitioners generally. It is therefore a little surprising, that

1 A

132 Enlarged Spleen. [Oct.

enlargements of the spleen have been so much neglected. Re-
garding them as the effect of disease, physicians acting upon
the principle that the cause being removed, the effect must fol-
low, have contented themselves with merely prescribing for the
original fever, without remembering that the consequent engorge-
ment of the spleen is sufficient to keep up an excited state of
the heart and arteries, and thus, whilst it lasts, intail upon the
patient a perpetual state of fever. Of this last fact, any one
may satisfy himself by examining the pulse of a person in whom
there exists an enlargemsnt of the spleen. To the extent of
my observation, and that has been considerable, it is always
more frequent than in health. This condition of the pulse has
often induced me to suspect the existence of enlarged spleen,
whilst examining patients during the intermission or remission
of fever, the excited state of which I could not otherwise ac-
count for ; and the result of an examination has generally con-
firmed my suspicions.

Several varieties of enlarged spleen have been mentioned by
writers, but it is not my intention to notice any other than that
which results from intermittent or remittent fever, it being the
most common, and the one which I have most frequently met
with in practice.

With some individuals, the power of the spleen to resist the
incursions of disease, is much greater than in others, affording
them a happy exemption in a majority of cases from attacks of
the disease under consideration. Several persons of my acquaint-
ance, thus happily circumstanced, pass through protracted at-
tacks of fever, and finally recover without any consequent en-
largement of the spleen ; whilst others less fortunate from com-
paratively trifling febrile affections, uniformly have their spleen
enormously enlarged. To account satisfactorily for this differ-
ence of susceptibility to disease of the organ in the one and in
the other instance, is perhaps impossible; although we may rea-
sonably attribute the absence of enlargement in the one case, to
an unusual small ncss of the artery which supplies the organ,
thereby preventing an undue quantity of blood being forced into
its vessels in a given time ; or to a more powerful exertion in
the veins and absorbents in removing the supplies which have

1337.] Enlarged Spleen. 133

been furnished, and in this manner preventing accumulations
which would otherwise take place, by keeping up an equilibrium
in the circulation of the part threatened with disease.

To explain the pathology of the disease, but few words are
necessary. It consists in a simple congestion of the organ, the
production of which may readily be accounted for, when we
consider that the splenic artery is much larger than is requisite
for the mere nutrition of the spleen ; and that, consequently,
under a general excitement of the circulation, it must convey an
undue proportion of blood to its place of destination, where it
must remain producing congestion, or must be carried off by ves-
sels destined to this office. So long as an equilibrium is kept up
between the vessels collectively, no engorgement, or undue
accumulation, can take place ; but, on the contrary, if the reple-
tion is greater than the depletion of the organ, we at once have
a case of the disease in question.

The diagnosis is by no means difficult. The pulse and the
general appearance of the patient, may induce us to suspect an
enlargement of the spleen ; but, the most certain, and never fail-
ing criterion to determine the fact, is the presence or absence of
a hard body, commonly called a fever cake, in the left hypochon-
drium, to discover which nothing more is necessary than a slight
examination with the hand.

In the treatment of enlarged spleen, various methods have
been adopted. Emetics have been recommended by some, and
for all I know to the contrary, may have proved advantageous ;
but of this I know nothing from experience, never having pre-
scribed them. Various external applications, as iodine oint-
ment, mercureal ointment, blisters, &c, have had, and sail have
their advocates ; all of which, with the exception of the first
mentioned article, are more than useless, being calculated in
themselves to produce more or less uneasiness, without the pos-
sibility of their doing the least imaginable good. The same
may be said of the blue pill and other mercurials given with
the view of producing salivation; for no one, I am satisfied, has
ever been cured of an enlarged spleen by a salivation only ; nor
can I conceive of any case in which a salivation would be neces-
sary or proper. It may be stated, and ample experience will

134 Enlarged Spleen. [Oct.

bear me out in the assertion, that nothing more is necessary in
the treatment of this affection, than the judicious employment of
purgatives. In my hands they have always proved successful,
when fairly tried, and I can confidently recommend them to
those who may not have been in the habit of prescribing them.
I have known an enlarged spleen to become much softer, and
nearly one fourth smaller, judging from the appearance of the
patient, and an examination of the organ, from the free action
of a large dose, (sij.) of the compound powder of jalap. It is
not a matter of much importance what purgative is employed.
In this respect, the practitioner may please himself, provided he
selects an article which will purge actively, and causes its ex-
hibition to be repeated at proper intervals for a length of time.
With me no purgative is preferable to calomel. In all cases, it
is the one which I first recommend, and from it I have experi-
enced the most happy results ; giving it in doses of from ten to
foity grains ; and following each dose in from two to four hours,
with a large dose of castor oil, or some other certain cathartic,
which not operating well is repeated again, and again if neces-
sary. This purge of calomel and oil is directed to be repeated
every second, third, or fourth day, as circumstances, and the
strength of the patient may indicate, it being expected that the
general health is to improve under this periodical purgation,
which is to be kept up for weeks if necessary, or until the en-
larged spleen has been so much diminished as no longer to prove
a source of inconvenience. Although much attached to calomel
as a cathartic in these cases, I by no means confine myself to it
entirely. The blue pill in combination with aloes, using two
parts of the mass to four of aloes,I have frequently prescribed; and
this compound in doses of ten to fifteen grains, from its activi-
ty, has often been used with advantage ; although in a majority
of cases, it is necessary to follow it by some more prompt cathar-
tic, as oil, or the sulphate of magnesia. As the size of the
spleen diminishes, the interval between the exhibition of each
cathartic may be prolonged, until once or twice a week will be
often enough for their administrations. In many cases, the oc-
casional use of a tonic in addition to the purgative plan of treat-
ment is absolutely necessary. No tonic is preferable to quinine.

1837.1 Oil Menstruation. 135

It may be given on the days intervening between those of exhib-
iting the cathartic. No particular attention need be paid to the
diet such articles of food as suit the patients' appetite, being
generally allowable ; nor is it necessary to keep the house or
bed to insure a recovery.

ARTICLE II.

On Menstruation by M. Antony, M. D.o/ Augusta^ Geo.

" Propter solum uterum mulier est id quod est." Hoffman.

Passing by the special anatomy of the uterus, a brief account
of which was given on a former occasion,* with which every
reader desirous of comprehending the functions and diseases
of that important organ should be familiar ; and in order that
the pathology extensively connected with its structural and
functional derangements may be better comprehended, I pur-
pose considering in this place the character and phylosophy of
its primary function under the circumstance of good health.

The expression of Hoffman quoted at the head ot this article
is most true, and when duly contemplated in view of its truth,
becomes a most fruitful source of knowledge of the natural his-
tory of woman as well as of her pathology.

It is indeed to the uterus that woman is mainly indebted for
her peculiarities of character ; even her peculiarity of configu-
ration being determined in the latter part of the third epoch of
her life, in part at least, by the developements preparatory to con-
ception and child-bearing. Her peculiar softness and melody of
voice, together with the child-like simplicity and abiding confi-
dence which are part of the characteristics of her sex so calcu-
lated to command the tenderest cares of man the yielding soft-
ness of her nature, all, as I shall attempt to shew, owe to uterine

See Southern Medical and Surgical Journal vol. I. page 171.

I3G On Menstruation. [Oct-

ane! other peculiar female developments their value ; whilst her
peculiar acuteness of sensibility, exalted moral sense, and high-
er order of refined taste are no less the products of that change
of proportionate developement whereby the female conforma-
tion is mainly affected in the progress of the third epoch, and
the genital developements are fully completed.

But besides the concurrent peculiarities of the female, just al-
luded to, her various succeeding healthy peculiarities will be
found reflected on her natural character, by the structure and
healthy functions of the uterus and the various derangements
thereof.

I shall in the first place offer to the reader some received defi-
nitions in relation with the subject before us ; then proceed to
give the healthy phenomena of menstruation, and lastly, to shew
the phylosophy of the rise, progress and decline of this func-
tion ; all of which afford extensive data for the reasoning of the
pathologist.

In thus pursuing my subject I shall use freely of such mate-
rials as are before the profession ; and in some instances, (espe-
cially in anatomical facts,) without stopping to make direct re-
ference to the source ; as the facts which are known are made
public property.

I. Menstruation. This is a term 'which may be considered
as generally used to include every thing relative to the cause,
nature, appearance, duration, quantity, quality, use, successive
returns, final cessation, &c., of the menstrual discharge.

Menses. This word is used to designate that periodical, red
discharge which healthy women afford from the genital organs,
when not pregnant nor lactating ; ordinarily in temperate cli-
mates from the age of fourteen, to forty five years. Turton*
defines it the monthly purgations of women." Parr, "the
periodical discharge of blood from the uterus or vagina, or
both." Mm i: ici. Ac, "the menstrual is so called because it is
evacuated periodically every month, when the female is of sui-
table age and good health, if she is not pregnant nor giving
suck." MagendIEj "a periodical sanguineous discharge which

* Editor of the Linnacan system of nature, and author of the Medical Glossary.

1837.] On Menstruation. 137

takes place from the internal surface of the uterus, and is a true
sanguineous exhalation? Baudelocque. " a periodical deple-
tion which follows a sanguine phethora." J. Cloquet " a
periodical evacuation of blood from the female organs of gener^
ation, from the age of puberty to that of forty-five or fifty years,
and which ceases to appear during pregnancy and lactation-."
Mine. Boivin, " a sanguine excretion which women afford
regularly about every month from the genital organs, from
puberty to forty five or fifty years."

Various other names have been given to this discharge, as
catamenia, menstrua, e?nmeniar fyc. It has also been called
menses, flowers, flows, monthly discharge, show7 regular dis-
charge, time, epoch, m,oons, affairs, fyc. fyc~ and is often allu-
ded to with a nod. Before the days of Mauriceau, (seventeenth
century.) this discharge was called " monthly purgations" be-
cause, as was then believed, the whole habit of the body was
thereby purged of its superfluity of blood. This old, but emi-
nent practitioner and writer also informs us that it had, by a
beautiful allusion to vegetable nature, received the name of
" flowers of women." As trees do not bear fruit until preceded
by flowers, so likewise women do not ordinarily become preg-
nant of an infant before they have these flowers.

Madam Boivin, a scientific female, having enjoyed the most
ample opportunities afforded by her greater facility of access to
females under all circumstances in society, by her general inter-
course as a female practitioner in Paris, and by her situation as
chief superintendent of the Royal Mansion of Health, with all
desirable opportunities and capabilities for anatomical research,
all of which were well embraced, I cannot do more justice to
a statement of the phenomena of menstruation, than by giving
her own on this subject.

" Notwithstanding," said she. " I have sometimes seen infants
of five or six years, and even younger, discharge by the vulva a
sanguineous excretion more or less regular in its returns, still
in the order of nature, it is not until puberty that this excretion
is established in a regular and periodical manner. This epoch
which generally announces and characterizes the aptitude to
fecurdity, varies much, according to the constitution, climate,
education, exercise, and various accessary circumstances. Most
commonly, it is not until the age of fourteen or fifteen years,

138 On Menstruation. [Oct.

and when the mammoe begin to develope themselves, that the
menstrual flux appears and is established. Derangements in
the order and duration of this discharge commonly occasions
disorder in other functions.

" The quality of menstrual blood does not appear to differ
from that which circulates through the whole system when the
woman is healthy, well formed, and when she conducts herself
according to the requirements of health and propriety.

" The duration of this evacuation varies from three to six
days. There are women who have this discharge only one or
two days, and others, some hours only.

u The menstrual flux is generally suspended during preg-
nancy and lactation. When it does appear in the former case,
it is ordinarily a symptom of disease, indicating a partial sep-
aration of the ovum. Also when the blood does not appear at
the stated period which corresponds to the time when the woman
previously had her menses, it is a very good sign of disease,
except in pregnancy." * * *

" Causes of Menstruation. The opinion most generally re-
ceived is that a plethora, general or local, causes this evacuation.
Pinel said it would be found as difficult to answer this question
as to explain the cause which made certain plants crown them-
selves with flowers oftener than others. The causeof the peri-
odicity of the menses is not better known.

" Whatever may be the cause of menstruation, to it is gener-
ally attributed the virtue (propriete) of preparing the cavities,
which ought, in their turn, to furnish the blood destined to pass
into the radicles of the placenta. But the developement of the
placenta, and that of the fetus, without the uterine cavity proves
that menstruation is not essential to the preparation of these
cavities; or rather, that the placenta can do without (se passer)
this preparation. It appears that the fecundated vesicle is capa-
ble of developeing and enlarging itself every where when in
contact with a vascular and nervous part. In the many cases
of extra uterine pregnancy which we have seen, there was one
at the term, at which the infant weighed eight and a half pounds.

" Nevertheless, the influences of the menses on fecundation
will not be denied, since before menstruation, after its cessation*

* Not long since a case was related in the Boston Med. and Surg. Journal, in
which a woman was delivered of a child about 24 years after the cessation, and du-
ring the last year a case came under my own advice, in which the woman had
ceased to menstruate some 20 years, and whose youngest child was about 24 years
old. This woman had remained in health, and the wife of the same husband.
She was in her 8th month when I was consulted on her case, and has since passed
an easy and happy accouchment.

1837.] On Menstruation. 139

and even during any remarkable irregularity, conception does
not ordinarily lake place. On the other hand, we remark that
women are more apt to conceive at the approach of their menses,
or immediately after, than in the middle of the term between
the menstrual periods.

" With those whose mestruation is interrupted, this excretion
is commonly replaced by some unusual sanguine evacuation ; any
part of the body being capable of becoming a supplementary emunc-
tory for preserving the health of the individual/ Many examples
are cited of women who have brought into the world well sup-
ported infants, without ever having been regular, as well as others
after having ceased to be. Finally, " a woman, who on the ap-
proach of the menses proves to have pains in the head, and in
the lumbar regions finds herself relieved that instant at which
the menses appear, however small the quantity of blood which
is afforded by the uterus : neither the application of leeches to
the vulva, nor bleeding at the arm being able to produce an ef-
fect so prompt and salutary.t"

As I before observed, Madame Boivin's account of the phe-

* See at p. 767, vol. I. of this Journal, M. Bourgeois' case of anamalous menstru-
ation, in which it took place from the extremities of each of the ten fingers of a
young lady. A case occurred "a few years since, under the observation of a medi-
cal frL-nd, in which the discharge was vacariously effected through a sore on the

Im-
partial menstruation, in which the evacuation in the natural way is not so much
as it should be, is perhaps always 1 should say doubtless always compensated in
another way by some other part. But the phenomena are not always discoverable.
I now have a case under my direction in which the tonsels have so enlarged on the
approach of each menstrual period for several months, that the former attendant on
the ease contemplated the necessity of operating on them : but their enlargement
has subsided after each period. On promoting ample menstruation, which was done
by rectifying the prolapsed uterus, the enlargement has almost entirely ceased to
manifest itself.

I have another case of difficult and partial menstruation from prolapsus, in which
a pustule has occurred every monthly period with great regularity for many months
somewhere on the lips or face near the mouth. On the correction of the cause at
the period before the last, so as to secure a pretty good evacuation, the pustule which
arose was very slight, and did not mature itself, but passed off by resolution. At
the last period none appeared. In both of these cases, the mammae became very sore
and considerably swollen and hard on the approach of the period. This last phe-
nomenon is of very common occurrence in tardy and difficult, or partial menstruation
often affording a watery, and sometimes a milky discharge from the nipples. The
varieties ot vicarious phenomena for menstruation arc innumerable. This teaches
us the indispensable importance of investigating more scrupulously the condition oi
this function in our research for cause as well as nature of disease in females.

t See ars des accouchments p. 104.

2b

140 On Maiutruation. [Oct-

nomena of menstruation is worthy of high confidence. In re-
gard to the points in dispute amongst physiologists she, with
that prudence which generally characterises her conduct, avoids
entering into doubtful disputations, and has generally contented
herself by setting forth the existing doubt, or giving some of the
most respectable opinions on the subject in dispute.

Most of the facts of menstruation are too well known to jus-
tify the appropriation of much more time to them ; a bare reca-
pitulation, therefore, of those mentioned, and a brief reference
to a few not hitherto named, with some of the most common
anomalies shall suffice. In the notice of those facts, however,
it should be remembered that I describe the general course of
nature in relation thereto ; and to these, as general facts there
are exceptions, wanderings from the regular order of things,
which however, arise from very peculiar circumstances in the
nature of the individual, or some existing morbid condition or
propensity.

In healthy young females in temperate climates, the discharge
generally makes its appearance at fourteen years of age, or thir-
teen to fifteen. Its first appearance is generally indicated by a
sense of weight about the loins ; heaviness, and often more or
less pain in the head, leaden color of the skin within the orbits
of the eyes, pricking and pain in the nipples, shooting pains in
the mammae, pain and more or less sense of weight in the hypo-
gastric and inquinal regions. Some, if not most of these
symptoms, ordinarily indicate the approach of the menstrual
discharge. These, however, sometimes pass off for the present
period without being followed by the actual red, but a more or
less leucorrhaeal, or sero-mucous discharge,* and the subject re-
gains her usual state of comfortable feelings, in the enjoyment
of which she remains for about one lunar month, or twenty
eight or twenty nine days ; when, probably, if not before, the

* Those first sero-mueous discharges should he borne in mind, as they are, for
the present, the proper men- inn] discharges for the present state of developement
of the female proportions; and will serve to explain those cases of impregnation
which arc said to occur before menstruation. There is also a like manner of dis-
charge occasionally appearing after the final cessation of the dux of blood, which
will nlr.o account for those cases of post-menstrual impregnations which sometimes
take place early after cessation.

1837.] On Menstruation. 141

discharge called menstrual, makes its appearance from the geni-
tal parts, and continues, with a gradual alleviation of those
symptoms which have been named, for three, four, or five days,
by which time they become pale, and finally cease entirely for
another lunar month. Thus continues the woman, if healthy
and unimpregnated, until the age of forty five or fifty, when,
after becoming more or less irregular, they cease to appear
forever.

Besides the influence of climate on the periods of appearance,
and final decline of menstruation, various anomalies are some-
times observable, such as recurrence at a regular period of two,
three, six, or eight weeks the occurrence of a precocious peri-
odical discharge as early as three, four, five, or six years re-
currence as late as sixty or seventy years the limitation of the
period of flowing to a few hours, or a day or two ; or its exten-
sion, to eight, ten, or fourteen days menstruating regularly
during pregnancy and lactation as at other times menstruation
during pregnancy only* menses never occurring in pregnancy,
lactation, nor any other time.t &c.

But notwithstanding these and many more possible and actual
wanderings of nature, still, in good health, it is extremely regu-
lar in the periodical returns, as well as the time of continuance
and quantity of discharge at each period lasting from three to
six days, always the same in the same individual in health ; and
so regular in its periodical returns, that the female, if intelligent
and observing, can tell in some instances, not only the day or
night, but even the hour at which it will return with the exact-
ness with which the phases of the moon may be told, all of
which facts demand due consideration in the investig-ation of

* Deventer in his arts of accouchment, gives a case of this kind also other
authors.

t Gardien in his complete treatise on accouchments, says, that although some-
times the discharge of red blood appears at the very beginning, still it is more com-
monly the case that menstruation commences by a serous flux, and terminates in
like manner. He says also that Roudelet mentions a woman who was delivered
twelve times, and Joubkrt another who bore eighteen children, neither of whom
had ever menstruated. Doubtless these were cases of serous menstruation, similar
to that first menstruation described, after which it is possible for conception to taka
place.

142 On Menstruation. [Oct.

disease. Nor is it a matter of less importance in pathological
investigations, that it should be borne in mind that the anomalies
which have been mentioned are so rare that they are always to
be regarded as morbid phenomena until a rigid investigation has
demonstrated them otherwise.

I have noticed the general characters of this function, and
briefly referred to those anomalies which do occur and comport
with good health, with the design of reminding the reader of the
boundaries, or rather, the possible extent of physiology, in his
research after disease ; and although the design of this essay
was physiology alone, sail it may be well, by way cf applica-
tion of the preceding pages to practional utility, to observe in
this place that it is important to distinguish between the true
physiology of the case before us, and its pathology.

For instance, it may be a serious departure from health in a
particular case to menstruate three or four days, when the natu-
ral period was five days ; or five days, in one whose natural
period was three or four ; the former being excessive if the flux
be at the same rate, and the latter, deficient. Or five or six days
may be a deficiency, when the natural durations of the period is
seven or eight, &c. Or the anomaly in which menses appear
during pregnancy alone, or that in which they appear in preg-
nancy as at other times, may be simulated by the occurrence of
slight uterine hemorrhorage from other accidents than the physio-
logical nature of the individual ; but which tend to, and may
end in abortion. In this case, as in all others, we must observe
with great caution the real boundaries of physiological function,
not only generally, but in the particular case under investiga-
tion. We must recur to the pristine state of this function in the
individual, or its state at such times as her health was least ex-
ceptionable; and thus find what constituted her regularity partic
ularly. And, even by this index we may be deceived ; nor is
this deception so rare as may be supposed ; but when suffered, is
productive of no little perplexity. It is not unfrequently the
case that a woman is found to menstruate precisely at the period
of a lunar month, and have a continuance of the flux three or
four days at the ordinary rate ; and it may be, that she enjoy a
very satisfactory exemption from present pain of ally part : and
still the foundation is being gradually laid for the destruction of

1837.J On Menstrualion. 143

health by hepatic, pulmonary, or other derangements. Here
on the strictest examination of the menstrual functions alone,
the practitioner is compelled to pronounce the patient perfectly
regular. But there is a resort for the avoidance of this error in
physiology and pathology, which is, to the philosophy of other
morbid phenomena, to the thorough knowledge of which, the
knowledge of the true causes and nature of the menstrual dis-
charge is necessary.

Tnus much have I thought proper to state relative to the
facts of the primary function of the uterus. These facts are
calculated to have their practical use, as all other physiology, in
enabling us to judge, by a knowledge of healthy function, the
existence, the kind, the cause and the extent of disease. But it
was an additional purpose in commencing this essay, to attempt
the further elucidation of some physilogical points in connection
with this function. The enquiring mind is not content with
composure in indifference to the truths of nature, when so much
of the beauty of infinite wisdom is found at the end of all thorough
investigation in natural history, and particularly in the human
economy. We should not be satisfied with merely viewing this
function as an isolated phenomenon in the history of the hu-
man female. It would indeed be but a poor display of wisdom
and benevolence but a burthensome affliction intailed on those
who are the subject of it, ever driving their delicate sensibili-
ties to self-disgust ; and, were it not connected with the nobler
ends of female construction were it not arising in the first place,
out of those peculiarities which woman, in view of being the
mother of mankind is made to possess were it not connected
with her aptitude for that ripest perfection of organic sense by
which she is lendered capable of conception ; and finally, were
it not in connection with the support of the offspring in its most
dependent state, that is to say, whilst in the womb and soon after
birth, it would ever present a most loathsome phenomenon to the
other sex. I shall now proceed to the physiological elucidations
to which I have just referred.

1st. Of the nature of the menstrural discharge. Much has
been said by physiologists relative to the nature of this discharge.
The ways of nature are generally plain and simple when known,
and it is a fact which abundant observation proves, that nature

141 On Menstruation. [Oct.

is strictly economical in all her purposes and operations never
requiring more causes than are adequate to the effect; or rather she
seems to delight in effecting her purposes by the simplest and
fewest means possibly consistent with their well-doing. We
need not search for causes, the existence of which we cannot
determine, when we have adequate causes, known and pre-
sent. We should have to wander far indeed from the truth
of anatomical demonstration, were we to declare this discharge
a peculiar secretion. Yet such has been the course of some of
the greatest physiologists, and even of the present day. It would
be idle to occupy the time of the reader by repeating and con-
testing every opinion which the imagination of man has brought
before the world on this subject. It is thought sufficient to meet
some of the arguments and opinions which have, more than
others, withstood the withering blasts of reason and demonstra-
tion so as still to retain a place in the schools at the present day.
As such, we shall take for our review the doctrines taught by
the highly accomplished and justly celebrated late professor of
midwifery in the university of Pennsylvania, and which, so far
as there is reason to believe, yet obtain in that respectable insti-
tution. And I would here state once for all, that I know of no
professor or author of the day, in whose statements of facts I
have more, whilst there are many in whose I have not equal con-
fidence. But however unequal the contest may seem, I feel
bound to oppose his reasonings from those facts, and the conclu-
sions to which he comes ; resting confident in the power of
truth, and trusting to the end of the contest for my justification.
In all ages, from the time of Hippocrates and Galen, down to
the present, the idea that the menstrual is a genuine sanguine-
ous, (or in its less perfect state, a serous) discharge has found
abundant advocates in the ablest physiologists of the day. And
now it is plainly observable that all the most celebrated writers
of France seem to receive this as a settled fact beyond controver-
sy; and on this point, I would observe that when we consider
the advanced state of medical sciences, and the habits of famil-
iar intercourse the enquiring disposition and the facilities for
anatomical and physilogical investigations which Paris affords,
all of which combined tgive opportunities for the acquisition
of truth never before equalled ; these physiologists are entitled

1837. J On Menstruation. 145

to the highest respect. So much for long standing and high
privileged authority.

Still, however, the idea that the menstrual discharge is & pecu-
liar secretion, has been taught by Haller, Hunter, Saunders,
and others of former ages, and advocated by Dr. Dewees of
the present age.

In his preparation for the support of the opinion that the
menstrual discharge is the result of a secretory process, Dr.
Dewees attempts in the first place to draw preparatory support
from the " structure and diseases" of the uterus,* thus : inde-
pendently of considerations derived from tne structure and dis-
eases of the uterus, &c." To this assumption, or rather suppo-
sition, it must, in honest faithfulness be replied that the anatomi-
cal facts in point not only forbid such an idea by completely
demonstrating the want of appropriate structure, but actually
display every necessary construction and arrangement for a pe-
riodical discharge of just such blood as the menstrual flux ex-
hibits.

From his expression which we have just quoted, one would
suppose that a regular glandular arrangement of the uterus was
demonstrable, and that, so curiously supplied with sensibility, as
to be competent, once in a lunar month, to take on suddenly its
secerning action, and eliminate from the system from 3 to 6 or
12 ounces of secretion within a few days, then close its opera-
tion for a month, and so on ; and this too, to have its secreting
energies increased by a relaxed and debilitated habit, for it is
a notable fact that delicate habits generally afford 3 to 4 fold
more menstrual discharge than those of robust, strong and en-
ergetic habits. But no such " structure" will be found.

The Doctor next proceeds to derive " confirmatory sugges-
tions from the appearance of the fluid itself. One of these two
propositions he feels bound to receive : This discharge," he says
11 must be either a portion of the common mass of blood as it cir-
culates in the system ; or it must have undergone some change
during its separation from the uterus." If the former" he con-
tinues, " it should exhibit the appearance of blood detracted from
any other part of the body by opening a vien for the purpose ;

*Sce his systems of Midwifery page 50.

146 On Menstruation. [Oct.

which it does not do. If the latter, it is probable that it has been
eliminated by that process termed secretion." This last proposi-
ton or avowed probability, he then considers strengthened by
the following considerations of the physical properties of the
fluid itself.

1st. Its colour is between that of arterial and of venous blood ;
being less brilliant than the former and more so than tne lat-
ter.

2d. It never separates into parts as blood drawn from any
other part.

3d. It never coagulates,* though kept for years whilst other
blood, when free from disease and exposed to the air quickly does
this.

4th. Its odour is remarkably distinct from that of the circu,
lating mass ; and it is less disposed to putrefaction."

Here I would meet the doctor at the very foundation of his
two propositions, and shew that by them he has only spoiled
the truth by dividing it that his probability which he assumes
in the 2d proposition is but a petitio principii and which, when
assumed, instead of deriving substantiation therefrom, it only
tends to a false explanation of the four several physical pro-
perties of the fluid. By only exchanging his distributive or
for the copulative, and, we shall have a new proposition declar-
ing the truth thus : This discharge mast be a portion of the
common mass of blood as it circulates in the system, and it
must have undergone some change during the separation from
the uterus. This is, as a whole thus connected, a proposition,
the substantiation of which cannot fail to refute that adopted by
him and explain the phenomena of the "fluid itself" (by which he
attempts in vain to strengthen his opinion,) in another and more
rational manner.

In the substantation of this proposition which I have thus com-
pounded, I draw all desirable evidence, from the "structure"

* "We too often see it escape in clots from women when they got unto walk
about, after having been long in m sitting position, to be able to say with Dionis,
that menstrural blood never coagulates. According to all appearance, it contains
less fibria than that from other parte ol the body, but is not entirely without it.
Brinjr mixed with the mucous and serous mutters naturally furnished by the inter-
nal surface of the genetal organs, the menstrual blood is thus rendered more vis-
cuous, and ought not to exhibit the same characters as that which escapes from a
wound. Velpeaus Midwifery p. 86.

1837.] On Menstruation. 147

of the uterus. It will not be forgotten that the various arteries
which enter the uterus are very intimately connected with the
ovaries, so that the removal of these by excision or their destruc-
tion by disease, (which is said by the Doctor to destroy menstru-
ation,) must necessarily injure, and that to a great extent, if in-
deed it do not entirely destroy some of the most important
branches : therefore nothing can be fairly inferred from the re-
moval or other destruction of these organs. But the arte-
ries which do go to the uterus terminate variously as by anas-
tomoses, by exhalent extremeties opening on the inner surface ;
and other branches," &c. "pass to the uterine sinuses" which,
as I have before said in speaking of the lining membrane of
the cavity of the uterus, open into the cavity by the most con-
siderable openings which appear in the reticulated membrane.
Here, then, is abundant anatomical structure to indicate plainly
its purpose.

I next come to explain, from the facts presented, the whole
proposition which I have offered. The first member of the pro-
position considers the discharge as being a portion of the com-
mon mass of blood. Hippocrates, the most respectable author-
ity in ancient medicine, whose close and correct observation has
been constantly before the world the most worthy example
for immitation, and which has established so many truths which
have withstood the relentless hand of time and the revolutions
of centuries, says, " this blood is like to that of a victim, and
coagulates promptly if the woman be well."* The most per-
fectly healthy animals only were chosen foi the ancient sacri-
fices ; hence this comparison.

Maurice a.u, when Prevost of the company of Master Sur-
geon Jurors of the city of Paris in 1672 had, and embraced the
opportunity of examining the body of a woman who was hung
for a crime, at the time of actual menstruation. All that portion
of the cavity of the uterus about the fundus was plaistered over
with coagulated blood, and the vessels here were much larger than
those of the neck. He distinctly saw these coagula connected

*il Proccdit autum sanguis velut a victim*, ct cito congelatur, si sana fuerit mu-
lier." Vid. Oeuvrede Mauriceau, Tome 2 me, Deacrip. Anatoniique, &c.; chap. x.
page 47.

3(

148 On Menstruation. [Oct.

with those vessels about the fundus, which disgorged themselves
of the blood.*

Madame Boivin, to whose excellent opportunities and capa-
bilities I have before alluded, says she has had occasion to see
the uterus of many young females who died during the men-
strual epoch, in whom the internal face of the uterus was covered
with a coat of bright red blood ;t and this fluid she caused to
pass out of the vessels which afforded it, in small drops, by
simple compression, or plunging them into warm water. These
absolute facts should be considered highly satisfactory evidence
of the truth that the discharge, as it passes from the vessels,
which yield it into the cavity of the uterus, is but a portion of
the " common mass of blood as it circulates in the system." It
is caused to coagulate by the circumstances of the body in death,
before it undergoes those mixtures which will be presently
described.

It has been observed in describing the vagina, as well as the
neck and body of the uterus, that all these parts are generally
moistened by a mucous secretion for the purpose of lubrication
and the ordinary good condition of the parts for their functions.
This mucous is not coagulable by any ordinary temperature, or
atmospherical exposure. Nor is it readily susceptible of putre-
faction. It is in considerable quautity so much so that I have
several times observed it passing after death, from the vulva even
of girls, but a few years old, in consequence, as I presume, of
the contractions of the uterus in death, from the -cessation of
arteral action.

In the sinuses into which the blood is poured by the arteries,
those changes commence, which cause it to approach "more
nearly to the color of venous blood." In this state it is poured
during menstruation, into the cavity of the uterus, where'it enters
inio immediate and complete mixture with the mucus of the
jKirt. This mucus is so viscid that on ;m even mixture with
[|,(. blood, the latter will thereby be prevented from separating
into parts. It is rendered incoagulable in like manner, by being

* Ouvrc (k M.Hiii.v.m.

t " Couvcrtc d'une couche do sang d'un rouge vif." Memorial de l'art des
accouchemeiM.

1837.] On Menstruation. 149

in even mixture with this mucus, as it is in the usual healthy-
menstrual flux. But should the discharge of blood exceed the
usual quantity in proportion to the mucus, it then becomes coag-
ulable because the proportion of mucus is not sufficient to pre-
serve this quantity from coagulation.

This mucus is coagulableby astringents, as alum, tannin, &c.
So also is the menstrual fluid.* The peculiar odour which the
mucous secretion possesses is combined with the blood, and this,
added to the natural scent of blood gives the odour so " remark-
ably distinct from the common blood."

Here then are found unavoidable and competent causes for
all the phenomena of colour, of inseparability, noncoagulability
and odour ; the principal grounds on which the advocates of
peculiar secretion have relied. Here is found an explanation of
all the phenomena presented, in perfect and happy accordance
with that simplicity and economy in which nature ever delights :
and here, too, do we behold the kindness of Providence in the
happy arrangement so well calculated to preserve from pain in
ordinary menstruation, which would otherwise exist in conse-
quence of constant coagulation. Believing this error needs no
farther arguments for its final refutation to settle the true physi-
ology of the function, I shall next proceed to the consideration of
the causes of the beginning, the continuance, and final cessation
of menstruation.

Of the causes of the rise, progress, and final cessation of the
menses. From the view we have taken of the nature of the
menstrual discharge, we may well consider it as a periodical
hemorrhage the chief difference between hemorrhage and men
struation being that the latter is natural there being an organ-
ization especially constructed for this purpose, and for ichich,
when we consider the end for which woman was created, and
that state of the system necessary to that end. there is from the
beginning, a necessity : whilst hemorrage is unnatural and not
from structure organized for that purpose. The latter is the
effect of accidents which temporary causes create the former
the effect of wise design.

There are, at least in the earlier part of human life, certain

* These facts are constantly observed in the application of vaginal injections
containing alum or tannin.

150 On Menstruation. [Oct;

periodica] changes which take place, the precise cause of which
it would be dilficult to explain, unless it be merely a part of the
order of dcvclopeinent established to suit the being; to the differ-
ent relationships in life, to other beings of the species, and the
other circumstances and periods of that life. These periods
have been called septennial, as they have been observed every
seven years. In man these epochs are marked,

1st., By the dropping of the milk teeth at about seven years,
and their replacement with new and more substantial ones.
During the first epoch, that of infancy, he has the roundness of
form, softness of flesh, of voice, &c, which may be considered
as belonging to this epoch. Both sexes run very much together
in the marks of this epoch.

2nd. During the second epoch, the roundness and thick-
ness of childhood decrease, and the length of parts increases,
and the whole stature becomes more spare.

In early infancy, the head is much larger in proportion to the
other parts partaking still much of that extreme disproportion
which in the early foetal state, gave to the head nearly half the
weight of the whole ; and the proportion continues to decrease
until fullest maturity. During the progress of the first epoch
the body expands in greater proportion ; but in this, the second,
the extremeties, particularly the lower, extend in a much greater
ratio than the rest of the system ; and by the termination of this
epoch, become, by their more rapid proportionate growth, in very
good proportion to the other earlier dcvclopemcnts ; and, indeed,
rather transcend, as those of some quadrupeds, the proportionate
extent, and soonest acquire the proportion of the adult. By the
end of this epoch, in consequence oft lie determination of growth
to the lower parts, and the rapid accomplishment of the adult
proportion of the lower extremities, thegenital organs of each
sex become sufficiently developed to enable them to perform their
functions; although so far from that maturity of strength and
hardihood as to lender them, as yet, unlit for the exercise of
function.

3rd. The third epoch begins with signal changes. The
sexes now begin to wander from c-<n-\\ other. The voice of the
male begins to become more coarse and grave, whilst that of the
female changes but little. The pilous system now begins to be

1837.] On Menstruation. 151

developed on the pubis of the male and female, and the downy-
beginning beard on the former. The menstrual discharge of the
female, and the growth of mammae go on. In man, too, the
upper parts of the body the thorax and shoulders begin to
expand in greater proportion ; whilst the female growth is pecu-
liarly directed to the lower parts of the body the pelvs and
thighs ; and these proceed on to that fixed difference of propor-
tion which ever marks the two sexes during the period of matu-
rity. The genital organs likewise go on improving in strength
and full developemeut, the mammae increase in size, the pubis
becomes well covered with hair, and the finest proportions of
which the individual is susceptible are developed by the end of
this epoch. The appropriating powers seem to continue their
offices in the hips and mammas whilst they are mostly discon-
tinued elsewhere, especially in the shoulders and the other
standard masculine developements. Those parts grow and ex-
tend, as if for a much larger stature than the woman will ever
arrive at particularly the hips ; so that her pelvis, nates and
thighs are much larger in proportion than those of the male.
Her cellular tissue becomes more filled with adipose matter, which
gives to her the roundness and softness which perfect the beauty
of her sex- The cessation of the developements peculiar to
the male seems thus to leave the surplussage necessary to men-
struation to child bearing.

u During this epoch the amusements of childhood yield to
maturer enjoyments rational inquiry begins to be developed.
Capricious attachments give place to sincere, unaffected and
permanent friendship ;''* all of which changes are making grad-
ual progress to that maturity at which they are found at the end
of this epoch, or twenty-one years of age, the earliest period at
which Providence seems to have designed the union of the
sexes, or at which that union seems rationably commendable.
Theji, and not until then is woman that creature whose devel-
opement of mind, and perfection and strength of organic con-
struction combine to capacitate her for the efficient performance
of the purposes, and the rational and prudent enjoyment of the
pleasures of conjugal life.

* Cuvier.

152 On Menstruation. [Oct.

Thus we observe the fact in human nature, that different parts
are successively developed. We might have said that this is
oped in like manner to the close of the second epoch, at which
the developeing powers of the two sexes are differently directed ;
those of the male to prepare him for that superiority of stature)
that greater size and strength of muscle, that larger brain,
stronger bone, stronger and deeper voice, coarseness and thick-
ness of skin, and more full pilous developement, and that greater
harshness, firmness, and independence which both characterize
his sex, and fit him for the various purposes of his life ; whilst
those of the female leave her skin, and muscles, and bones, and
organs of voice, and hair, &c. &c, in all the delicacy, and soft-
ness, and roundness, and flexibility of childhood ; being weak
in body, comparatively feeble in mind and nervous energies, be-
ing variable, credulous, subject to tne influence of the imagina-
tion, and to nervous diseases ; whilst in disposition she is left
soft, gentle, gaining by address rather than by violence ; all of
which mark the peculiar sex. But in this we have only told
that the developeing powers have failed to continue the devel-
opement of some parts to that extent observable in the male.
Still, however, the developing energies are not discontinued.
They go on lastly to enlarge and perfect the organization neces-
sary for pro -creation and the support of the race. The organs
of generation are perfected. This done, the mammae, the organs
for future support are developed, and the hips and lower parts of
the body are brought out to that proportion which best suits her
offices in life. This done, and the same power which effected
the progressive developement of parts which we have noticed,
still, by a rule of action peculiar to female nature, continues
to bring appropriations, which constitute a surplussagc, which
is now held in reserve, ready to be applied to farther devel-
opements whenever conception shall render it necessary.
But such is the ratio of increase in the female system, as contin-
ued after the full accomplishment of her personal perfections,
that without conception, some kind of hypretrophy, or other form
of constantly increasing disease would be the consequence of the
retention of this surplussagc beyond a certain accumulation
This we see threatened in the evidences of the near approach of
the menstrual flux, which is indicated by head-ache, dullness of

1837.] On Menstruation. 153

most obvious from the earliest formation of the embryon. This
continues until the whole body is formed, and both sexes devel-
eyes, pain in the pelvic region, lassitude, whimsical appetite,
&c., with or without a variety of nervous symptoms, as ringing
in the ears, a sense of suffocation, palpitation, startings from
slight and sudden noise, convulsive twitches, chorea, &c, and
mournfully demonstrated in those organic diseases which seat
themselves in the liver, lungs, brain, spinal marrow, &c, which
we see constantly resulting from retained or suppressed menses
without pregnancy ; and in those diseases, the full developement
of which we witness at the critical period of female life.

These then must, in the wise economy of nature, be prevented,
which could alone be done by a timely elimination of this sur-
plussage from the female system. If then this be not gradually
and steadily done, by passing into the fcetal growth before its
birth, or into the mammae afterwards, it so fills, gradually, the
uterine vessels that they are at length obliged to yield it up front
the outlets of the uterine sinuses constructed for its reservation
for the nutrition of the offspring whilst in utero.*

Thus flows the menstrual blood from the uterus until the
evacuation is sufficient to relieve that local congretion which
requires it, and which, without it, would go on to the production
of disease in some other part, or the general system.

A brief view of the manner in which the developement of
the body is effected, may assist in exhibiting the rise, progress
and decline of this curious function in a fairer ligrht.

The vital fluid, it is truely said, is contained in corresponding
vessels called arteries and vains ; but the former only are active
powers. In the veins, the blood is propelled by the adventitious
aid of other muscular powers, assisted and secured at each step
by valves. It is evident, therefore, that for the necessary sup-
port of the body, the action must bear a certain proportion to the
resistance otherwise, infarction would take place, or the arte-
ries would be emptied. It appears to be a fact of observation,
that the proportion of arterial action to venous resistance differs
in different periods of life. Sir Clipton Wintringham has

* The fact of menstruation in the human female is an evidence of the design of
Providence that mankind should not be admitted to promiscuous intercourse as
quadrupeds, &c.

154 On Menstruation. [Oct*

shown by actual experiment, that the density of the coats of the
veins is greater in proportion to that of the arteries in young
than in old persons. This proportion which these bear to each
other is gradually changing, and after the acme of life, they are
more equal ; or the resistance of the veins is little, in proportion
to the action of the arteries. Now if we look to this curious
fact, we shall find the true philosophy of the progressive growth
of man for a certain portion of his life" his stationary condition,
during the continuance of the lull perfection of manhood, and
finally, his decline when the arterial power greatly preponder-
ates over the venous resistance.

This proportionate increase of power of the arterial system
is to be accounted for on the principle of the increased develope-
ment of muscular and fibrous parts by use as in the muscles
of laboring men. The moderate and prudent exercise of organs
or parts, gives strength and energy of construction and function ;
but the part or organ passively acted on suffers the overcoming
of its resistance, and a loss of power and even substance. This
is evinced in the increased powers of the muscles by their use,
whilst the frequent pressure of their bellies during their action
on the subjacent bone, flattens and attenuates the firm substance
of the latter ; even to the production of apertures sometimes
in the fiat bones. The arterial is the principally active organi-
zation in the circulation the venous, passive hence by action
and use, the former enjoys a perpetual increase of power and
developement, whilst the latter suffers a decrease of its re-
sistance.

Nutrition is distributed to the general system to each part
by the arteries. The veins in early life are small and contracted.
The resistance which they afford is sufficient to preserve the
fullness of the arteries, and thus forces these to the continued
elongation of their extremities, and the successive application of
nutriment to the developement of parts. This predominating
venous resistancs is no longer useful in man than during the
increase of the body, and maturation of its powers : and in the
wise economy of nature, it lasts until the whole formative pro-
pensity, or the outlines of the design for manhood are filled, and
no longer. Irteria] plethora, and venous resistance have thus
far prevailed ; these now become equal. This done, or when

1837.] Chi Menstruation. 155

the venous resistance ceases to excel the arterial action , the parts
cease to be developed, because the action and resistance are in
equipoise. What takes place beyond this in the way of enlarge-
ment, is only from the yielding of venous, and other soft and
containing parts, as the cellular tissue, &c. Now however,
arterial plethora no more exists, nor has venous plethora yet
commenced. This balance of power and resistance continues
for a time, during the prime of life, until at length the arterial
power, by continuance of exercise, increasing, whilst the venous
resistance, from being long acted on, gradually declines and
yields to the former, and the venous plethora prevails, as is plainly
evinced by the fullness and elevation of the superficial veins,
&c. Such appears to be the philosophy of the developement of
the bodily proportions and phenomena of mankind, without re-
gard to sexual peculiarity of arrangement and function. But
had such alone been the provisions of the human female, the
race had never been perpetuated. Man's proportion of increase
had only to be so arranged that his arterial plethora should effect
his developement to the full stature of manhood and maintain
it there. But to answer the functions so important to the per-
petuation of her race, woman needed a provision not only for her
own full developement to perfect womanhood, as displayed at
the end of her third epoch, or 21 years ; but for a farther sur-
plussage similar to that which prevails during the arterial ple-
thora of early life, which should still exist for the support of the
offspring. Instead, therefore, of that fullness of appropriation
which, in man, goes to the support of his greater stature and
other peculiarities, so expensive to the nutrition, and which I
have before pointed out, it is withheld from these appropriations
and kept as a reserve surplussage ready for use in her peculiar
functions as a mother. This surplussage, ceasing io continue
farther the developements of parts in woman, leaves her genital
system with all those peculiarities which we have named as
belonging to her sex, and is directed to the uterus, the place
where it is destined to be appropriated. Such is the structure
of the vessels and sinuses of the uterus, that they readily yield
to delutation for a time, and a tropical plethora is the conse-
quence ; which, when so great as to excite uterine resistance, is
relieved by a gradual discharge from the uterine semises, of that
4 D

156 Rhinoplastic Operation. [Oct.

blood which caused the topical plethora, and thus is menstrua-
tion commenced. (" The idea of a topical congestion or plethora
was suggested as far back as the days of Stahl, and had loosely
floated in the minds of physiologists before the time of Cullen ;
but to him are we indebted for its expansion into a system at
once elegant and correct."*)

Thus has nature wisely provided for and effected a union of
the delicacy and softness the roundness and flexibility the con-
fiding credulity and gentle yieldings of childhood, with the full
developement of female perfection and beauty, as displayed in
adult verginity : when, animated by the passions, emotions and
sympathies which belong to her nature, and crowned with the
sacred blush of modesty, woman is presented, full of charms and
graces, which unite to render her a being the most enchanting
prepared by infinite wisdom to wear the golden chain of love,
kneel at the hymenial altar, and become the mother of man-
kind.

PART II.
REVIEWS AND EXTRACTS

ARTICLE I.

Rhinoplastic Operation, communicated to the Boston Medical
and Surgical Journal, by J. Mason Warren, M. D.

The history oi the patient who was the subject of this ope-
ration, we shall give very briefly, as follows:

J. T. 28 years of age. Three years ago last spring, while
playing very roughly with one of his companions, he received
a violent blow on the nose, which dislocated the cartilage, driv-

Parr.

1837.] Rhinoplastic Operation. 157

ing it at the same time over to the left side. Some inflammation
came on in the nose at the time of the accident, which very
shortly subsided ; and as he was out of town, and at a distance
from medical advice, nothing was done to replace the cartilage,
which remained in the situation into which it had been driven
by the blow.

In the following spring, while pursuing his ordinary occupa-
tions, a small red spot appeared on the right cheek just below
the eye ; this very soon increased in size, the inflammation grad-
ually spread, first attacking the lip, and from thence extending
to the nose, which became red, swollen, and finally ulcerated.

It will be unnecessary to go further into the details of the
case ; suffice it to say, that in the course of eighteen months the
whole nose, cartilages, septum, bones, &c. were successively
attacked, and finally completely destroyed. The ulceration
had also extended to the cheek of the opposite side. Subse-
quently to this, cicatrization gradually took place, leaving the
patient in the state in which I saw him, six months after his
recovery from the disease.

At this period, having accidentally come across a description
of the Taliacotian operation in an old magazine, he applied to
know whether anything of a similar kind could be done to
remedy his frightful deibrmity. The following was his state
as he appeared on the first examination.

The nose, as described above, had entirely disappeared, leav-
ing in the place it originally occupied an opening about an inch
in diameter, bordered by a firm cicatrice ; the septum of the
nostrils was destroyed, and the two nasal cavities thus thrown
into one ; externally a small cicatrix descended from the lower
and left edge of this opening to the angle of the mouth. In the
course of the disease the four front teeth had been lost, and this,
together with the absorption of the alveolar processes, had caused
a sinking of the upper lip, which had fallen an inch below the
level of the lower one. An opening also existed between the
lip and upper jaw, through which a probe might be passed from
the mouth into the nasal cavity. The sense of smell was quite
lost, and he was subject to an occasional running of the tears
over the face, arising undoubtedly from the too sudden contact
of the air with the lachrymal ducts.

A thorough examination of his case having been made, and
finding there was no positive obstacle against the possibility of
the success of an operation, the difficulties of such an operation
as would be required were distinctly stated to him, the impro-
bability of its succeeding so as to restore the organ in such a
manner that the deformity should not be known, that the new
nose might become very much flattened, and perhaps on the
appearance of cold weather gangrene might take place, and

158 Rhinoplastic Operation. [Oct.

finally, that even his life might be endangered by it. I felt it
my duty to state the case plainly, having seen all these accidents
occur from the operation, and death in two cases being the con-
sequence, from severe erysipelatous inflammation of the scalp.

Notwithstanding all these objections, he said that he was
ready to incur any risk which would give him the least chance
of having the deformity under which he labored obviated, as life
in his present state was hardly desirable.

His case was certainly a hard one. A young man in the
prime of life, in other respects of a good face and appearance,
was, by this frightful calamity, not only entirely cut off from
society, but prevented from gaining the means of subsistence.

Having determined to submit himself to an operation, it was
thought expedient to delay it a few weeks, in order to watch
the case a little, and prepare him for it by a course of diet and
regimen.

At the end of six weeks his health had materially improved,
and as he still persisted in the determination of having an ope-
ration performed, preparations were made to do it as soon as
possible, as on account of the approach of cold weather, no time
was to be spared. At this period he was seen by my friend Dr.
Peace, of Philadelphia, who was present with me at one or two
operations of the kind practised by Uieffenbach in Paris, and he
declared, as his opinion, that the appearance of the patient
offered every chance of success. The favorable circumstances
were the healthy state of the integuments surrounding the
opening of the nasal fossa, the great height of the forehead, the
whiteness and delicacy of the skin, and, added to this, the good
state of his health. All the preparations having been made, the
operation was performed on the seventh of September.

A piece of pasteboard, cut in the shape of the letter V, that is,
of a triangular form, and with a projection from its base, corres-
ponding to the columna of the nose, was placed upon the fore-
head, and a trace made around it with the nitrate of silver ; this
being used in preference to ink, as recommended by Lisfranc.
in order that it might not be liable to become effaced by the
blood. A trace was also made around the opening of the nasal
fossa, at the points where it would be necessary to remove the
integuments for planting the new skin taken from the forehead.
This was done the night previous, in order to prevent any undue
delay on the day of the operation.

All unnecessary articles of clothing being removed, the pa-
tient was placed on a table in a recumbent position, his feet
towards the window, and the operator behind so as to have the
full command of the head. The traces made by the nitrate of
silver were about two thirds of an inch apart between the eye-
brows, each side of the triangular portion of skin was three inches

1837.1 Rluaoplastic Operation. 159

and a quarter in length, with a base of three and a half inches,
and the projection for the columna of the nose, which was to be
taken entirely from the scalp, previously .shaved, was an inch
and a half long and two tiiirds of an inch wide.

The head being firmly supported by two assistants, the incis-
ion was commenced between the eyebrows, and the flap of skin
dissected up so as entirely to isolate it from the skin of the fore-
head, except where, for the purpose of nutrition, it was left adhe-
rent at the root of the nose. The incision on the left side
between the eyebrows was extended a little farther down than
on the right, the better to facilitate the twisting of the flap. This
incision included the skin, subcutaneous cellular tissue, and a
portion of the occipitofrontal is muscle, care being taken not to
raise the periosteum, from fear of necrosis.

The flap thus dissected and twisted round to the left side, was
carefully wrapped in a compress of linen cloth, and before the
the operation was proceeded farther in, attention was given to
diminish the large wound made in the scalp. Little hemorrhage
had taken place, and the temporal arteries which had been cut,
very soon retracted and ceased bleeding. The angles of the
wound were first brought together by the twisted suture, two
pins being employed on either side. Its edges between the eve-
brows were also approximated in a similar manner ; by this
means the wound in the forehead was diminished at once to less
than half its original size ; it was still farther reduced by the
use of a few strips of adhesive plaister, and a little scraped lint
filled up the remainder of the wound. Some lint spread with
cerate was spread over the whole surface, a pledget, and the whole
secured by a bandage round the head.

The next object was to fix the borrowed skin in its place. In
order to do this, it was necessary to freshen the borders around
the opening of the nasal fossa, the traces of which, as stated
above, had been previously made with nitrate of silver. For
this purpose a short narrow knife, somewhat similar to a cata-
ract knife, was used, and a strip of integument a third of an inch
in breadth, removed, including all that portion which had been
at all indurated during the cicatrization of the ulcerations.
The knife was also passed between the lip and upper jaw, in
which existed, as before stated, an opening large enough to pass
a probe, and the adhesions between the two, for the space of an
inch, entirely cut away. This was done for the double purpose
of giving the columna of the nose a more deep and firm adhe-
sion, and, in the inflammation which would subsequently ensue,
to close up the unnatural communication between the mouth and
nasal cavity.

The flap was now brought down into its place, its angles a
little rounded with the scissors, the better to simulate the alee of

160 Rhinoplastic Operation. [Oct.

the nose, and the whole secured in its place by pins and points
of the interrupted suture. From that portion of the skin which
was to form the columna of the nose, the epidermic side was
pared a little, so that it might form an adhesion not only under-
neath to the jaw, but on its sides to the quadrangular wound
made for it in the upper lip.

A little scraped lint was now placed under the ends of the pins,
and a strip of oiled lint introduced into each nostril to prevent
adhesion ; another strip was placed upon the nose to preserve its
temperature. The dressings were secured by a band of adhe-
sive plaister fixed to the forehead above, and partially divided in
the middle, so that it might descend on each side of the nose to
the lip.

During the whole of this long and painful operation the pa-
tient kept up his courage, and not a cry was uttered, nor the least
struggle made that could at all impede the motions of the opera-
tor. Not much blood was lost, and his strength was so little
exhausted that he was able to run up stairs to his chamber. He
was ordered to go to bed immediately, to keep perfectly quiet,
and a watcher left with him, who had directions, in case of his
falling to sleep, to prevent him fiom either roiling over on his
side, or raising his hand to the nose so as to derange the dress-
sings ; also to wake him immediately should he breathe through
the nose. To have arrow-root or gruel and lemonade, for nour-
ishment.

On visiting him in the afternoon he was found comfortable ;
the new nose was warm, and had bled a little from the edges
which formed the nostrils, both showing the circulation was not
.at all impeded.

Sept. 10. Passed a good night, slept well, pulse seventy-nine,
-eomplains of no pain, the nose of about the natural temperature.
The gentleman who watched with him thinks that the lint on
-the right side of the nose was occasionally raised a little during
expiration, when the patient slept soundly; he awoke him once
or twice on this account. A purgative was ordered of the sol.
sulph. Magnes. and liquid farinaceous diet. A piece of cork was
confined between the teeth, so as to keep the mouth open, it being
hoped that this might prevent him from closing his lips during
sleep and breathing through the nose.

11th. Quite as well, passed a quiet night, has a good appetite,
pulse eighty. Watcher says that he occasionally made a motion
to raise his hand to the nose, but, as if instinctively aware of the
impropriety of it, withdrew it again without touching the dress-
ings. The introduction of the cork into the mouth had entirely
.effected its object, by preventing the passage of air through the
nose.

1837.] Rhinoplastic Operation. 161

12th. The first dressing took place four days after the opera-
tion, and the following was found to be the state of the parts.

The dressings on the forehead, after being well soaked, were
first removed. The angles of the wound were found to have
united throughout, so that two of the pins were at once dispens-
ed with. Union had also taken place in its lower part, just above
and between the eyebrows ; the remainder of the wound, that
is, its central part, in which union by the first intention could
not take place, was suppurating well, and filled with healthy
granulations.

The nose was next attended to. Upon the lint being remov-
ed, which had become very much hardened and caked in by the
coagulated blood, it was found that entire union had taken place
on both sides. The alae of the nose and lower edges could not
easily be seen without making use of too much violence in re-
moving the dressings, which at present was not thought neces-
sary. The columna was curved inwards, and the sutures
concealed. The nose was of the natural color and temperature,
and the circulation through it seemed uninterrupted.

Two strips of lint dipped in oil were laid over the cicatrix on
each side of the nose, and no other dressings used. The patient
was allowed to sit up a little, and to take any article of food of
the liquid kind he might fancy.

On the 13th he was quite as well, with the exception of a little
oedema of the upper eyelids, arising, undoubtedly, from the pres-
sure of the bandages and other dressings on the forehead. One
of the pins was removed from the forehead on the 13th, and*
another, the only remaining one, on the following day. The
dossils of lint which had been placed in the nostrils still remained
there, firmly caked in by the drying of the pus, blood, &c.
These were not removed until the 16th, when their places were
supplied by two pieces of hollow sound. Some difficulty was;
found in the introduction of the tube into the right nostril, which
had become partially filled with granulations.

On the 14th a quantity of hair began to appear on that por-
tion of the skin forming the columna of the nose, which, as will
be remembered, was taken from the scalp ; this hair, from time
to time, required to be removed with the scissors. He was put
upon a nourishing diet, with the caution to use the jaws as little
as possible. He stated that occasionally, when he swallowed,
he had a sensation as though he would "swallow his nose."

15th. The remaining pins were removed from the side of the
nose, and the two sutures which confined the alae ; and on the
17th, ten days after the operation, the two ligatures, which con-
fined the columna in its place, were also removed.

At this period, the following was the state of the parts. The
wound in the forehead, from the adhesion by the first intention

162 Rhinoplastie Operation. [Oct.

which had taken place, and subsequent contraction, had dimin-
ished to a third of its original size, and the small triangular space
which remained, together with that portion of the scalp from
which the cplumna of the nose had been taken, was filled with
healthy granulations. From the wound to the root of the nose
was a linear cicatrix two inches in length, and continuous with
the cicatrix on the left side. Adhesion of the integuments had
taken place on both sides of the nose ; at the right alae, however,
the union was not quite so perfect as at the left ; that is to say,
the whole thickness of the skin did not appear to have united.
To assist the union, the skin of the face which lay under it was
slightly scarified with the point of a lancet.

The columna of the nose was a little curved backward, and
its edges had retracted inwards upon themselves. The inside
of the nose was suppurating well, and at its upper part adhesion
seemed to have taken place between the two bleeding surfaces
which had been opposed to each other. The tip of the nose
was well defined, and its edges were curved inwards so as well
to simulate the natural appearance of the alee, and just above
the alse, apparently from atmospheric pressure, a depression was
taking place, forming their superior boundary. This was assist-
ed by the patient making an occasional pressure with his fingers
at these points. He feels well, has a good appetite, and sits up
all day. He breathes freely through the tubes placed in the
nostrils, which require to be daily removed in order to clear out
any obstructions which may collect in them.

At the end of a month the wound in the forehead had con-
tracted to about a quarter of its original size. Adhesion of the
nose was perfect at all its points. The openings of the nostrils
were regularly rounded, and simulated well the natural appear-
ance. The lip ol the nose is well preserved, and a regular curve
takes place from its root to the end of the organ.

At the end of six weeks he was able to go out and walk about
during the evening, but as the weather became cold he was ad-
vised to confine himself to the house, as cold evidently had
a very great effect in retarding the cicatrization of the wound
in the forehead. By reference to the second figure on the plate
which accompanies this paper, a pretty correct idea will be form-
ed of the state of things six weeks after the operation.

At the end of two months it was thought time to proceed to
the second operation, which was required to remove the twist
existing at the root of the nose. It will be easily conceived by
referring to the plate, that underneath the pedicle which con-
nected the nose with the forehead, a small portion of sound skin
existed, and that of course no adhesion had taken place between
this portion and the pedicle lying over it. The method usually
adopted by operators has been to cut the pedicle, after sufficient

1837.1 RJihwptasiic Operation. It3;>

union oi* the nose has taken place below to justify the separation
of it from its source of nutrition, and to fix it down at the root
of the nose, in a transverse incision made for it at that point.

To this method there arc some serious objections, first, the
danger of inflammation in separating the pedicle; second, of
sloughing of the organ on the vessels being cut which have
hitherto supplied it witli blood; and lastly, the very perceptible
transverse cicatrix left after the operation. The method resorted
to in the present case is liable to none of these objections, except,
perhaps, in the first one, in which the danger ismuch diminished.

This operation was as follows. An incision was made, com-
mencing at the internal angle of the eye, and extending to thai
part of the base of the nose where adhesion had. not been able;
to take place ; a corresponding incision was also practised on
the pedicle. The skin being well dissected up from its adhe-
sion, a small portion of integument was removed from the upper
angle of the wound, where it had become wrinkled from the
twist in the pedicle. The edges were brought together by three
points of the interrupted suture. The same operation was to be
performed at a future day on the other side, where, however, the
opening was of about half the size, and not so perceptible. -
Union took place, throughout, by the first intention. Some
trouble was experienced, however, by the formation of a small
abscess in the new cicatrix, which suppurated and discharged
itself.

The third drawing, executed four months after the operation,
when the cicatrization had become complete at all points, ^ives
a very good idea of his present appearance. He now declares
himself entirely well, no secretion takes place from the nostrils,
and on looking into those cavities a new skin is found to line
them throughout. The nose itself has contracted gradually, so
that by the first contraction of the integuments, and the subse
quent contraction from suppuration, it has decreased to almost
two thirds the size of the flap which was taken from the fore-
head. Contraction also seems to be going on in its longitudi-
nal axis, so that the distance between the tip of the nose and the
mouth, daily increases. This will be much more perceptible,
and the whole physiognomy of the nose much improved, when
the four front teeth, which have been lost, are replaced. This
will bring out the under lip, and at the same time raise the tip
of the nose. The cicatrix in the forehead has become very
small, and is gradually assuming the color of the surrounding
integuments. The scalp from which the columna was taken is
lost in the hair. The nose is quite firm, of a good form, and the
cicatrix on each side hardly perceptible ; at the root of the nose
on the left side, and at that portion which formed the pedicle, a
5 E

164 Rhinoplastic Operation. [Oct.

small fissure still remains, which is for the present, concealed by
a strip of court plaster.

The health of the patient has never been better, his sense of
smell is returning, and the tears no longer run over the face, and
he, as well his friends, congratulate themselves both on the moral
and physical effects of the operation. He is now able to make
his appearance during the daytime, which he has not done be-
fore during the last two years, and no person would observe any-
thing remarkable in the nose, without a minute examination,
when it would be difficult to explain the remarkable anatomical
changes which have taken place.

Remarks. In an operation like the present, of comparative
rarity in this country, it will not perhaps be considered amiss, if
a few remarks are offered on some of the most interesting points
connected witli its history, and of the chief difficulties which
may occur to prevent its success.

The operation of Rhinoplastie is originally of very ancient
date. For various reasons, however, it had fallen into most un-
merited disrepute until of late years, when it has been again
revived in Europe by the brilliant successes of Graefe, Dief-
fenbach, and Labat on the Continent, and Liston in Great
Britain. Uieffenbach, in his late visit to Paris, where, with
the accustomed liberality of the French, all the hospitals were
thrown open to him for practising his celebrated operations for
the restoration of parts, has, perhaps, done more than any other
operator towards giving it its proper standing in surgery.

In the most ancient operations of this kind, the lost organ was
restored at the expense of the integuments in its immediate neigh-
borhood ; advantage being taken of the extensibility of the skin
of the cheeks, the integuments were dissected up on both sides
of the nasal fossa, brought forward, and united in the centre by
points of the interrupted suture. In case of the extensibility of
the integuments not being sufficiently great, incisions were made
on bothsides in front of the ears, so as to diminish the tension
of the skin at these parts, the wounds thus made being after-
wards allowed to fill up by granulation. This operation, how-
ever, did not, as will be easily perceived, restore the form of the
lost organ, and the only advantage gained was a flap of skin to
coyer the existing deformity.

The operation which was afterwards adopted, and which at
present bears the name of the author, was that of Taliacotius,
whicM consisted in taking the skin required, from the arm, or,
in some cases, from the body of another person. The given
shape of the nose being marked out on the place determined
upon, the flap was dissected up, except at its base, and the inte-
gument thus taken was confined in a place prepared for it around
the nasal fossa. In this operation, it was required that the arm,

1837.J RJiinoplastic Operation. 1G5

in case it was taken from that part, should be confined in contact
with the face, for the space of ten or fifteen days, or until union
had taken place ; and it was not until then that the arm was
released from its situation. The disadvantages of this method
are at once manifest; the length of time required to keep the
limb in this painful situation, so as in some cases to produce
partial paralysis, and the danger that ensued in the too early
separation of the transplanted skin from its source of nutrition,
were, of themselves, reasons of sufficient weight to cause this
method to fall into disuse.

The operation which has attained the most celebrity, is that
which goes by the name of the Indian Method, in which the flap
is taken from the forehead. This has been most frequently
practised in France and England, and it is this method, which,
it will be perceived, has been adopted, with some modifications,
in the present case.

Having thus briefly referred to the history of the operation,
some remarks will now be made on the chief difficulties which
occur in the course of it, and the means taken to obviate them.

No operation, perhaps, requires more attention to the nice
points of detail, than that now under consideration ; and it is on
these that the ultimate success of the operation, in a great mea-
sure, depends. For information on this subject, we cannot do
better, than by referring to the work of M. Labat, one of the
most valuable monographs on rhinoplastie for reference yet pub-
lished. The author, after having referred to the occasional
trouble which he experienced from hemorrhage while dissecting
up the flap of skin from the forehead, goes on to state, "But an
inconvenience much more embarrassing, and to which it was
necessary to be resigned, from the impossibility of remedying it,
was occasioned by the great quantity of blood, which, entering
the throat, was violently expelled from the mouth every time
that the pain of the operation forced the patient to cry out. But
what was much more troublesome still, was its being repeatedly
received in my eyes, so as once or twice to oblige me to discon-
tinue the operation for the space of some seconds/'

The difficulty which the author here complains of, was reme-
died in the present instance by a very simple means. Instead
of placing the patient in an upright position, he was made to lie
upon his back on a table, the operator behind him; the blood
was thus conducted off on each side of the face, instead of pass-
ing over the nasal fossa and mouth, and entering the throat.
To guard against any possibility of this accident taking place,
plugs were confined in the opening of the nasal cavities, during
the dissection of the flap, and the time occupied in closing up the
wound on the forehead. When the operation was commenced

166 Rhinoplastic Operation. [Oct.

around this opening, and the entrance of the blood was unavoid-
able, the patient, who maintained sufficient coolness throughout,
was requested to keep the blood as long as possible in the mouth,
and an assistant directed to clear out, with a small sponge, what
had collected, as occasion required.

We give the account of another trouble, in the author's own
lively description, which, fortunately, was avoided in the present
instance.

"But an accident of much more gravity, and which placed
me in a very critical position, presented itself at a moment, when,
after having detached from the forehead the flap of integument,
I was about to bring it down into the place it was destined to
occupy. Previous to making this twist of the new flap, it was
thought necessary, as I have before stated, to prolong the incision
on the left side as far as the medium line of the root of the nose,
in order to facilitate the torsion of the pedicle ; the patient expe-
rienced, at this moment, such a violent pain by the inevitable
division which it was necessary to make of some of the ramifica-
tions of the frontal branch of the ophthalmic nerve of Willis,
that he escaped from the hands of the assistants, rushed towards
the door, and was determined not to undergo the remaining part
of the operation. At this moment, the physiognomy of L. pre-
sented a most frightful aspect ; his forehead covered by a large
wound, the borders of wnich. retracted by pain, had greatly
augmented its extent, and all the rest of the face, his neck, and
garments, inundated with blood. But a sight which was much
more horrible to behold was the flap of palpitating integuments,
which at every moment were jerked from one side of the face to
the other.*'

In the present instance, no particular suffering was observed
by the extension of the incision down between the eyebrows ;
and incase of any difficulty of this kind, the complete command
in which the patient was held, from the position adopted, would
have prevented any of the evils complained of by M. Labat.

One of the greatest difficulties of the operation, and that which,
in its consummation, occupied the most time, was the passing of
the pins which were to close the wound in the forehead, and to
confine the new nose in its situation. To remedy this as much
as possible, the pins to be employed, which were the long pins,
generally used by naturalists, were previously sharpened; and
for introducing them, a little instrument was constructed, some-
what similar to the aneurismal forceps of Dr. Piivsick, made
with a small groove to receive the head and upper third of the
shaft of the pin. With this instrument the pins were readily
seized, and pushed through the skin, and the ligature being ap-
plied, their ends were cut off by the scissors or cutting pliers.
At that part of the flap which was to simulate the alas of the

1837.] Rhinoplastic Operation. 107

nose, as it was necessary that the integuments should be directed
inwards, the pins, of course, could not be used, and here a plan
recommended by M. Lab at was adopted, which was followed
by partial success. A thread being passed first through the inte-
gument of the face, and then through the flap, at about two lines
distant from the edges, the ligature was so tied as to produce, as
it were, a fold at that point ; and the better to effect this object, a
small piece of adhesive plaister, rolled up into the form of a
cylender, was confined under the threads, so as to make a strong
compression on the wound and to force the edges into their places.
This succeeded completely on one side ; on the other, however,
the union, at first, was not so entire, the skin adhering only by
about half its thickness.

During the whole of the treatment, it was necessary to keep
the openings of the nostrils distended by small tubes. The sub-
stance which seemed to answer the best lor this purpose, was a
portion of the barrel of a quill ; the end which was to remain in
the nose, being stopped up with a little melted sealing wax, and
a small aperture cut in the side through which the air could
freely pass. These were ingeniously constructed by the patient
himself, who, after a time, was able to manage them without
difficulty. The tendency to contraction at these points was very
great, so that at one period, the tubes being left out during the
night, it required considerable force to replace them.

From the new nose being formed entirely oi skin, it will per-
haps be supposed, that the integuments composing it are flaccid,
and the form of it easily destroyed. This, however, from rea-
sons easily appreciable, is not the case. The integuments of the
scalp being naturally of great thickness, by the suppuration
which took place from the inner side were made to assume a firm-
ness almost similar to fibro-cartilage ; and at the root of the nose,
the internal surfaces coming in contact, contracted adhesions so
as to make the nose perfectly solid at that part. The size, also,
of the columna, which doubled upon itself and contracting deep
adhesions during the inflammation which took place, forms a
round and solid pillar to support the tip of the nose.

Great precautions had been taken to oruard against exposure to
the cold, which, by stopping the circulation, might at once defeat
the whole object of the operation. As soon, however, as adhesion
had taken place, it was perceived that no danger from this source
was to be apprehended ; and although during the winter he has
slept in a room in which water has frequently frozen, and has
been since repeatedly exposed during some of the coldest days,
he finds that the temperature of the organ is never greatly dimin
ished.

The cicatrization of the wound in the forehead was greatly
retarded by the cold weather, and less than half the time would

168 Broncholomy. [Oct.

have been required, had the operation been performed during a
warm season ; when it had diminished to a small size, and cica-
trization, as frequently is the case in the filling up of large
wounds, seemed to have been arrested, great benefit was found
from the use of an ointment composed of six drops of creosote
to an oz. of simple ointment. On the application of this to the
wound, the effects were at once apparent. A small pellicle form-
ed over its whole surface, which was shortly replaced by a firm,
consistent cicatrix.

In one or two cases operated upon by Dieffenbacii, much
swelling took place in the new formed nose the day after the
operation, arising from the difficulty of the blood, which had
entered by the arteries, being conducted off by the veins. In
one case the nose became so enormously distended, that it was
feared the adhesions would be entirely destroyed, and it was only
by the repeated application of leeches, 70 or 80 being employed
in the course of 18 hours, that this danger was finally avoided.
In the present case, from the extension given to the incision on
the left side, Gare being taken that traction should not be made
too forcibly on the part, so as to compress the pedicle at its base,
the circulation was, from the first, unobstructed.

In the account of the foregoing case, it has been attempted to
bring forward some of the most important points which might be
of service as a guide to future operators; and if the author has
been so fortunate as to throw any new light, however small, on
the operation, he will feel that he has rendered a service to sci-
ence and to humanity.

Boston, March, 1837.

ARTICLE II.

BRONCHOTOMY.

This operation was successfully performed in December last
by Dr. Calvin Jewett, of St. Johnsbury, Vt.* The necessity
for the operation was caused by the lodgement of an eight-pen-

-Boston Medical and Surgical Journal.

1837.] llronehotomy. 160

ny cut nail in the right bronchia, below the bifurcation of the
trachea. The subject was a child, three years old.

The symptoms manifested by the patient from the time of the
accident had been frequent irritative cough ; sometimes, though
seldom, approaching to suffocation. He continued to run about
the house and out at the door for two or three days ; his cough
and difficulty of breathing becoming now more urgent, it was
concluded he had taken cold. His appetite failed him from the
day of the accident ; and though he could now and at all times
swallow either fluids or solids without the least difficulty, his
principal diet was milk. Once, and once only, he had puked."

This accident occurred on the evening of the 10th December.
"Now," says Dr. Jewett, "full nine days since the accident,
he is cheerful, though unable or unwilling to walk : pulse one
hundred in a minute, breathing a little hurried, tongue clean, has
frequent paroxysms of coughing, which last from a few seconds
to one or two minutes. Breathing, or disposition to cough, not
affected by posture, yet he chooses to have his head elevated,
and to recline only on the right side. Sleep is frequently inter-
rupted by coughing. Cathartics, expectorants and anodynes had
been presented by Dr. Brown, the attending physician. Though
very intelligent for his years, he complains of no pain, and when
definitely inquired of, he acknowledges no pain or disagreeable
sensation in any point you refer him to. Placing the hand over
the region of the right lung, either anterior or posterior, it gives
a sensation like crepitus ; to the ear it communicates a peculiar
hissing sound, neither of which can be heard or felt over the
left lung. These sensations were communicated both sleeping
and waking, yet more distinctly when coughing."

Drs. Jewett, Brown, Newell, and Spaulding, the whole
consultation, concurred in the opinion that the nail had passed
into the trachea, and not into the oesophagus ; and that it was
below the bifurcation of the right bronchia.

December 21 (continues Dr. Jewett,) I was again called to
Mr. B.'s, where I met Drs. Brown, Spaulding, Alexander and
Densmore. The little boy's strength fails ; he has become rest-
less, and much more irritable than when I saw him before, not
willing to have his pulse taken or to submit to any examination.
All the physicians agreeing in opinion, the parents decided to have
the child submitted to the operation.

1^0 Bronchotomy. [Oct.

Being provided with a pair of long and very small forceps,
mad;' expressly for the purpose, of soft iron that could be bent to
any desired curve, silver wire m loops, and all the variety of in-
struments which it was thought possible might be needed, we pro-
ceeded to the operation. On a table of convenient height, suita-
bly covered, we placed the boy, his head being bent over a fold
of cloth, and projecting beyond the table. From the bloated state
of the neck, the smaliness of the trachea, and the enlarged veins,
the direction of some being such that they could neither be avoi-
ded or pushed to one side, some two or three ounces of blood was
lost, and one ligature had to be applied. A long time was occu-
pied in making the dissection and opening the trachea, of which
three or four rings were divided down as Tow as possible.

Should I say we were near one hour from the time of placing
our patient on the table, until I cut through the trachea, 1 should
not be far from the truth. Let those who think it a very easy
matter, and quickly to be done, once have the trial em the little
living subject, who has been breathing with difficulty, and
coughing nearly to suffocation for ten or twelve days, and after
such a trial they may speak with more certainty.

Not expecting the nail would be forcibly ejected, as may be
the case with light substances, a blunt probe was introduced
down into the right bronchia, and the nail distinctly felt at the
depth of about four and a half or five inches below the top of the
sternum. I now tried the forceps, but before I could fix on the
nail, the spasmodic action was so severe as to threaten immedi-
ate suffocation, and I was compelled to desist and withdraw the
forceps. Again and again I tried the long forceps, other forceps,
the wire loop, &c. but tried in vain. Drs. Alexander and Spauld-
ing ably seconded my efforts, and more than once and again tried
with various forceps and instruments,, and with the like result.

Near two hours had now passed since the little boy was pla-
ced on the table, having been raised up frequently to take Ins
drinks. During the whole process he made no resistance, and
never cried, though often threatening to tell pa if we would not
let him alone.

Our patient now appeared much exhausted, and we desisted
from any further attempts to remove the nail, for one hour, during
which time he rested quietly and slept some. We again made
repeated trials to remove the nail, but without effecting our pur-
pose, and were compelled, most reluctingly, to say we could not
remove it ; painful and humiliating as was this avowal, make it
we must.

When the opening was made into the trachea, considerable
viscid mucus was thrown out through the wound; and the night
following, I tarried with him and found his breathing much
freer than before ; he coughed less, and rested better than usual.
The dressings applied were simply strips of adhesive plaister.

Bron< hotomy. Wl

I now leave the history of this case, December 24th, expecting
to learn, in the course ot'a few days,, of his death, and the dissec-
tion, which will show the exact situation ofthe nail.
Sequel to Bronchotomy,

Under date of Feb. 6th, I received from Esquire Belden the
history of his son's case from the time of the operation down to
date.

1 le says, " The air ceased to escape through the incision in
thirty hours, and his breathing continued better than before the
operation. About the 20th of January he had the appearance
of having taken a cold ; his cough became more troublesome,
with much phlegm. On the morning of January 23d, about 6
o'clock, his cough was still more severe, giving a different sound
from that of any time previous; it was harsher, sharper, and re-
sembled the barking of a fox. I hastened to light a candle, but
before I could do this and return to the bed, William says, ' Pa
I have coughed the nail up/ I stepped to the bed with my light,
and in a streak of phlegm and blood lay the nail, directly be-
fore his mouth on the pillow, the head from him. I viewed it
attentively before touching to see if I could discover any matter
(pus.) but sow none."

Since the above date of February I have seen both father and
son ; the boy appears well and hearty, his cough has entirely
subsided, unless when he is much irritated, he coughs a little.
Contrary to what was the fact before, he now, since raising the
nail, lays on either side, or on his back, with equal ease, and his
head low : whereas, before, he could lay only on his right side,
his head very high, or occasionally for a short time he would lay
directly on his face.

That there is not a similar case, as it regards form, weight, &c.,
o( a child so young, having received such a weight into his lungs,
and thrown it up by coughing, I will not venture to assert, but
if such a case has occurred, it has escaped my notice if reported.

A few practical inferences may perhaps be drawn from the
foregoing case, and its, thus far, result.

Various instruments may, again and again, and repeatedly,
for the space of one whole hour, be introduced through an arti-
ficial opening in the trachea, into the lungs,. or rather into the
bronchial tube, without taking life.

It shows that a substance of most unpromising form, and great
weight (in reference to its bulk) may be thrown up by coughing.

It further confirms the safety, and expediency (because of its
safety.) of the operation when light substances are received into
the trachea, which being easily moved by air, would more likely
produce immediate suffocation if remaining, and are almost cer-
tain to be removed directly, when the operation is performed.
6e

172 Ccesarian Operations. [Oct.

ARTICLE III.

Ccesarian Operations, followed by success both for the Mother

and Child.

The following cases are of great interest, as they are fairly-
calculated to assure us of a degree of safety not generally ac-
corded to this operation in England and America. They also
cite our attention to the cause of the frequent ill success which
has attended them, and consequently enable us to avoid that
cause, if we have the tact and decision which should belong to
every surgeon -accoucheur. The compiler of these cases, Ven-
derfuhr, has shewn us that in these cases of signal success,
the operation has been performed early in the case, whilst the
greater fatality of this operation in England he very reasonably
ascribes to the delay of several days, during which the powers
of the patients have been " exhausted by useless parturient
efforts." This promptness cannot, however, be safely used
without that thorough knowledge which is necessary to enable
the operator to decide absolutely and correctly too, on the neces-
sity of this operation by the facts which render it necessary,
without awaiting the result of a long and unsuccessful labor to
prove its necessity. We are, however, thus far, fortunate in the
less frequency of its necessity in America than in England, or
on the continent. And this good fortune Americans will con-
tinue to have, until the American race is still farther deteriorated
by luxury and vice.

1st. Case by Yenderfuhr. This is the third time, says the
author, that in a practice of 18 years, I have had occasion toper-
form the Caesarian Operation, and each time with success. The
two first cases are contained in the Magasin de Rust of 1823.
In tliis, as in the other two cases, the operation was indicated by
the narrowness of the pelvis and was performed at the instance
of the mother. As in the other cases also I selected for the mode
pf the operation, the incision on the linea Alba, which I consider
the easiest and most advantageous.

Gerti de Holzapfel, aged 24, born of healthy parents, was
raised in extreme poverty. Affected with scrophula and rachitis
she did nol begin in walk until theageoi nine. I [er general health,
however, was tolerably good, and the catamenia appeared when
she was 18 years of age. She became pregnant for the first

1837.] CcBsarian Operations. 173

time in her 24th year. Her pregnancy passed pretty well, and
even during the last days she walked about seeking charity.
On the night of the 20th April, pains commenced, and I was call-
ed on the 21st, near noon. 1 found the unfortunate patient in a
miserable hut, clothed in rags and reposing upon straw. She
was small, her limbs but little developed, the legs much curved.
She presented all the signs of the rachitis that had existed. By
external measurement, 1 found eleven and a half inches between
the great trochanters, and the antero-postenor diameter to be six
inches. By the touch, the index finger soon discovered at the
left; a projection which the midwife had at first taken for the head
of the child, and which in reality had with the latter a deceptive
analogy. This projection was formed by the promontory. The
distance between the latter and the internal, face of the symphisis
pubis could be easily filled by the index and middle fingers ; so
that the antcro-posterior diameter which, according to the exter-
nal measurement would be three inches, was reduced to two and
a half in consequence of the projection of the promontory.
The right side of the pelvis presented a greater width, but not
however sufficient to admit the foetal head. The deformity was
increased because the horizontal rami of the pubis were more
elevated than the promontory. The head reposed upon the lat-
ter, the neck of the uterus was dilated, the membranes were
ruptured. Sanguinolent mucosity existed in the vagina. The
pains were intense, and the violent motions of the foetus estab-
lished its vitality. These circumstances induced me to propose
the Caesarian operation, which received the sanction of some pro-
fessional brethren.

After having first emptied the bladder and rectum, I made an
incision of five inches upon the linea alba, and soon perceived at
the bottom of the wound the reddish blue colour of the uterus,
A small incision was made in this organ at the place which
seemed most suitable, and enlarged by cutting upon the index
finger until it was four and a half inches in length. The pla-
centa was not touched, so that the effusion of blood was inconsid-
erable. The child, which presented its back towards the wound,
was easily withdrawn, and by its cries proved its vitality. The
after birth was delivered with difficulty, as the introduction of
the hand and the separation of the placenta were embarrassed by
the contractions of the uterus. I prevented the escape of the
blood into the abdomen by applying the abdominal parities accu-
rately against the surface of the womb, and thereby prevented
also the protusion of the intestines, but not that of the omentum;
a portion of which escaped during a convulsive paroxysm of
cough. Having reduced this part, I united the wound by the
twisted suture and strips of diachylum plaster in the intervals.
The operation was protracted by vomiting which occurred seve-

174 Crisarian Operation*. Oct.]

fal thrfes. Tlie wound was covered with drycharpie and com-
presses, and tire whole kept in place by a bandage around the
body. The night passed without sleep, but without any other ac-
cident except vomiting, which recurred several times during the
first hours after the operation. The next morning the abdomen
was neither swollen nor painful, the locheal discharges flowed
regularly. The patient urinated twice without pain; the pulse had
but little frequency ; thirst moderate, tongue clean alid humid ;
the skin moist. Towards evening some fever and pain's in th6
abdomen supervened, but these accidents subsided and were fol-
lowed by some hours of repose. The following days the fever
was only of moderate intensity, no sanguine depletion was ne-
cessary, although the abdomen was slightly swollen and painful.
The fifth day some diarrhoea supervened, and required the ad-
ministration of opiates. The same day I removed the dressing
and detached" the point of the suture. The wound had united
in its superior third ; it was slightly open at its inferior part, from
which a considerable quantity of Icetid secretion escaped. 'I'his
secretion continued for some time ; the wound cicatrised slowly,
a; circumstance which 1 believe to be advantageous, because it
p'revents the accumulation of the secreted matter. The lochial
discharge, so important in cases of this kind, continued more
than a month. Fifteeii days after the operation the fever had
entirely disappeared. From this period the patient began to re-
cover rapidly. &leep and appetite returned', and at the end of
two months, the mother and child were enjoying perfect health.
With regard to the latter, I may remark that for fifteen days we
entertained serious apprehensions of its safety. Born in perfect
health, it took the. breast the second day as soon as the secretion
of milk was established ; but the milk of the sick mother, though
of good aspect and taste, did not agree with it. It was troubled
by vomiting and diarrhoea, the mouth was filled with apthse, a
great part of its body was covered by excoriations, and a fright-
ful emaciation ensued. We were obliged to have recource to
artificial lactation. As the diarrhoea persisted, we employed broth
with yolk of e^gs, and some mucilaginous remedies. These
means succeeded the child recovered its strength, and at the
end of three weeks was again put to the breast of its convales-
cent mother.

2d. Case by Meyer. To the above case we add another of
Csesarian operation, remarkable for its success, in a, woman debi-
litated bv previous disease, and whose case seemed desperate.
We regret that the author has left us in doubt, which diminishes
the interest of the case, as he only remarks that the child was
alive when taken from the womb, without informing us whether
it continued to live.

1837.] Cccsarian Operations. 175

The wife of a shoemaker, aged 38, who had been healthy in
her youth, had suffered for two years with rheumatic pains, and
for the last year had scarcely left her bed, and could walk only
when supported by crutches. She became pregnant, and in the
evening of June 19 was seized with the first pains of parturition.
The deformity of the pelvis, in consequence of the rheumatism,
appeared to require the Caesarian operation, and the author being
called in, visited the patient in company with two surgeons.

The patient was in the most unfavorable circumstances : her
abdomen much developed, was covered by an eruption ; the in-
ferior extremeties were swollen up to the genital organs, and a
painful cough, nausea and vomiting existed. The pubic and
ischiatic bones were so much curved inwardly, that the finger
could with difficulty reach the promontory advancing to the
symphisis pubis.

The 20th June the operation was proposed and accepted as
the only means of safety. The patient was placed upon a table
covered with cushions ; the thighs could scarcely be separated
sufficiently to leave a free passage o the hand, and in conse-
quence.^' an anchylosis between the lumbar vertebre and be-
tween these bones and the sacrum, the trunk could not be
extended. In this semi-sitting position the abdomen was in
near proximity with the thighs. Notwithstanding this unfavor-
able circumstance, Meyer preferred the incision of the linea
alba, because he had made it successfully in three other cases^
because the latteral incision is accompanied by loss of blood
which it is important to avoid in a debilitated patient, and finely
because in the incision of the linea alba the wound in the uterus
always corresponds better with that in the abdominal parieties*
The patient having been arranged for the operation, and assist-
ants suitably placed, the surgeon made an incision through the
skin from the umbillicus to the symphisis pubis, embracing an
extent of four inches, the linea alba and peritoneum were incised
to the same extent, a great quantity of serosity^ the result of an
ascites escaped. The uterine parieties which the author had
found thin in the proceeding cases, were firm, three lines in
thickness and opposed some resistance to the instrument. The
incision fell exactly upon the placenta, which caused an abun-
dant sanguine effusion, and also diminished the space for the ex-
traction of the child. The placenta was rapidly detached with-
out producing hemorrhage, the child was found placed upon
its back and presenting the right knee, the two feet were with-
drawn, then the body, the arms, and finally the head, which
offered some resistance. During all this time the uterus was
kept fixed by an assistant. The blood and serosity were remov-
ed from the abdomen, and the uterus was seen to contract to
twice the volume of the fist. The lips of the wound were brought

176 Ccesarian Operations. [Oct.

together by the twisted suture. It was kept open in the space
of ;m inch above the pubis. Compresses were applied and main-
tained in place by a bandage. In half an hour the patient laid
tranquilly in her bed. The child was alive, cried continually,
but was feeble. Soon after the departure of the physicians, half
an ell of intestine escaped through the wound, bat was easily
reduced, and the opening was closed by compresses and adhe-
sive strips. The consequences of the operation presented no
peculiarities. The inflammatory phenomena which supervened
were only of moderate intensity, and were easily subdued, the
locheal discharge was regular, and the wound suppurated but
little. The patient soon took food and entered upon convales-
cence. The 15th July an inflammatory tumour appeared at the
inferior part of the wound, an abscess was formed, and the
wound which gave issue to pus, remained fistulous for some
time. The 10th of August it was entirely cicatrised, and the
patient completely cured. Repertorium de Kleinert, 1836.

3d. Case by M. Duchateau d' ] Arras. Stephanie Brassart
aged twenty-two and a half, and forty-three inches in height.
All her extremities present the marks of rachitis. The verte-
bral column is very convex at its anterior part. The scapulae,
especially the right one, in near proximity with the pelvis.

This woman whose menstruation commenced at the age of
18, and continued regularly presented herself at the Hospice
de la Maternite d' Arras to be bled in the 8th month of her first
pregnancy. M. Duchateau ascertained that the crests of the
iliac bones were placed in the same line, and that the distance
from one anterior superior spinous prosess to the other was eight
inches nine lines ; that the sacro-vertebral angle inclined towards
the symphysis and a little to the right ; that the'superior strait had
only two inches in its antero-posterior diameter. The 20th of
April, 1836, this woman having arrived at the full period of na-
tural gestation, returned to the hospital complaining of pain in
the kidneys. No other phenomenon appeared until 24th, five
o'clock, A. M. Then she began to experience more severe pains
which succeeded each other, however, slowly. At six o'clock,
the orifice of the womb presented itself turned to the right, and
anteriorly with a dilatation of from ten to twelve lines. The
membranes began to protrude, but no part of the child could be
felt by the finger. (An enema and a general bath.) At nine
o'clock she was in the same state. M. Duchateau and his col-
leagues perceived the necessity of an immediate operation. A
sound was introduced into the bladder, and this organ found to
be empty. _ An assistant placed between the inferior extremities
kept the womb fixed, while others exerted tension upon the ab-
domen. The operator, with a convex bistoury, made in the

1837.1 Ccnsarian Operations. 177

skin an incision, which, commencing at two inches above the
pnbes, was directed in the course of the linea alba, passing a little
to the left of the umbillicus, and terminating two and a half
inches from this part. The different aponeurotic layers were
incised in succession. The peritoneum was raised by the dis-
secting forceps and opened cautiously, and then divided in the
length of the primitive incision with a straight probe pointed
bistoury, directed by the index finger. The omentum which
covered the uterus and intestines was raised and kept above the
womb, as well as some coils of intestine, which the efforts of the
patient had driven to the superior part of the wound. The
uterus was found in the middle of the incision in the abdominal
parieties. It was still kept fixed by an assistant, and an incision
made in it with a slightly convex bistoury. The internal face
of the womb being divided, a jet of black blood disclosed that
the placenta existed at the place of the incision, which was di-
lated with a probe-pointed bistoury. The membranes of the
ovum being exposed to view were then divided like the perito-
neum, using, however, the necessary caution to prevent the liquor
amnii from escaping into the abdominal cavity. The placenta
was then detached to a small extent, and the child seen in the
first position of the head. The legs were seized by the right,
and the trunk by the left, hand of the operator. It was extract-
ed from the womb and uttered its first cry. It weighed six pounds
four ounces. In three minutes the uterus began to contract.
The umbillical cord and the membranes, the coagula and the
fluids contained in the womb were removed. The index finger
was introduced through the wound into the neck of the uterus,
which was soft and dilated to the size of a five franc piece. The
finger of an assistant introduced through the vagina, touched
that of M. Duchateau, proving that the fluids could escape, but
that the promontory presented the projection which had led to
the operation.

The uterus having contracted, the lips of the wound were
united by three points of the quilled suture, the parts were
washed- with a decoction of mallows. Strips of Diachylum plaster
were placed in the intervals between the sutures, and only a se-
ton smeared with cerate was placed at the inferior angle of the
wound. Charpie, compresses and a bandage completed the
dressing. The operation lasted 20 minutes and was well borne.
The patient was at first troubled by acute pain in the right iliac
region, vomiting, and cough which were relieved by venesection,
leeches, Cataplasms and mucilaginous drinks and enemata. The
ninety-second day after the operation she had entirely recovered
and the child was well. Presse Medicate 1837, No. 7.

A case analogous to the preceding, by Professor Stolz of

178 Division of the Arm by a Sabre Cut Reunion. [Oct.

Strasbourg-, is contained in the Memoiresdc l'Academic Royale
de Medicine, vol. 5, p. 91.

Caesarian Operation repeated 4 times loitli success upon the
same woman. By M. E. Charlton, President of the Medical
Society of Edinburgh. This case, which occurred in Germa-
ny, was seen by the author, who vouches for its truth. Cases
have been cited in which the Caesarian operation has been re-
peated six or seven times on the same woman, but these cases
want the necessary authenticity and details to ensure entire coiir
fldence. The subject of the case in question was a small rachitic
woman, whose pelvis was greatly deformed. The operation
was performed for the first time June 18th, 1826 ; the second
time 21st January, 1830 ; the third time 28th March, 1832 ; and
the fourth time 24th June, 1836. Ail these operations were per-
formed in public, and by different modes. The patient was well
with the exception of some fistulae at the place of the cicatrices.

The author gives the details of these different operations,#and
concludes by remarking that the Caesarian operation has very
often succeeded on the Continent, while it is almost always fatal
in England; the English, says he, do not operate till late, when
the strength of the patient has been already exhausted by use-
less parturient efforts for several days. Gazette Medicate, No.
25, extracted into} from the Edinburg Med. and Surg. Jour.

ARTICLE IV.

Almost complete division of the Arm by a sabre cut, re-union^
cure. By M. Stevenson.

The following is the most remarkable authentic case of re-un-
ion found in the annals of surgery :

An Arab, Abdoo Braheem, received a violent sabre cut in the
arm, immediately below the external margin of the deltoid mus-
cle, dividing obliquely all the tissues, the humerus and the entire
body of the biceps muscle. The blood was projected forcibly
to the distance of several feet. The assistants arrested the he-
morrhage by exerting compression on the wound by means of a
turban. Upon examination, M. Stevenson ascertained that the
arm was attached to the rest of the body only by a single strip
of skin at the internal part ; the bracheal artery had been divid-
ed at the same time with the biceps muscle ; the pulse at the
wrist had disappeared entirely. His first idea was to complete
the amputation : but this was opposed by the patient, and it be-
came necessary to attempt the re union, although but small pro

1837. j Retroversion of the Tongue. 179

bability of success existed. Assisted by M. Stevenson, M.
Pearson first desired to ascertain if the bracheal artery could
be tied ; this attempt was useless. A tourniquet was applied,
left loose above the wound, and confided to an assistant with the
injunction to tighten it if the hemorrhage reappeared. The
wound was cleansed, the parts brought in apposition, and an ap-
propriate apparatus with splints applied.

No hemorrhage the pulsation at the fist imperceptible until
the third day. At this period the pulse began to reappear very
slightly, and became more and more sensible. The wound was
perfectly cicatrised the 26th day, but the fracture had not yet
united. The arm was kept in the apparatus until the 45th day ;
then the cure had been completed. The extremity, however,
remained paralysed.

This case is worthy of interest ; it leads to practical conse-
quences of the highest importance. The reunion of a volum-
nious limb, like the arm, may then take place after the division
of its principal arteries and nerves. The contrary, however,
has been laid down as a principle a priori. Dtipuytren had
declared, (v. plaies d'armes de guerre,) that in the members whose
vitality is confided to an unique source, (artery and nerve,) as in
the arm and thigh for example, the reunion was impossible when,
this source was concerned in the injury. Besides, added he,
what would become of the divided artery without a ligature \
Thus he thought that the completion of the amputation was hir
dispensable in this case. Reunion had, it is true, been attempted
and obtained in an analogous case by Lamartiniere, but the
bracheal artery and plexus had not been injured, which changes
entirely the conditions of the lesion. The fact in question then
proves the contrary of what had been presumed : reunion of the
large members may take place notwithstanding the division of
the principal vessels. The circulation may be re-established as
after the operation of aneurism. Besides we can easily conceive
how a large artery may be entirely obliterated- Gazette M&
dicale, No. 25,

Retroversion of the Tongue,

M. Cros3e, in a speech at the fourth anniversary session of
the assembly of English physicians, at Manchester, mentioned
that he had known a young boy who could swallow his tongue
without any inconvenience, and that he frequently repeated it
with the greatest facility. A very curious case of retroversion
of the tongue has been recently published. A physician was
called to visit a young infant that had been suddenly taken with
7f

180 Case of Triplets and of Locked Heads. [Oct.

alarming symptoms of suffocation. Upon examining the mouth,
he discovered a retroversion of the tongue, whose point was en-
gaged in the pharynx. It was easily returned to its proper place,
but the accident recurred several times. La Presse Medicate,
No. 49.

PART III.
MONTHLY PERISCOPE.

Case of Triplets and of Locked Heads.

A case of this kind occurred in the practice of Dr. Joseph A.
Eve, of Augusta, on the 24th of September last.

The woman was a delicate negress, aged about 35 or 40
years. Her health had been bad during the whole period of ges-
tation, and particularly about the time of parturition.

The first birth was very easy and rapid ; the child having
passed, before the Doctor's arrival. He found the woman on her
knees on the floor, leaning upon a chair, ind the child suspend-
ed by the cord. As soon as he had made the ligature on and
cut the cord, she was put to bed, and he found, upon examina-
tion, the feet of another child presenting. The labor progressed
with the second child in this presentation until the body^ad
passed as far as the armpits, when, in consequence of the pains
becoming weak, and the fear of strangulation of the cord, the
ergot was administered, with the effect of increasing the force of
the p.uns. The next phenomenon worthy of remark was the
indication of undue pressure on the brain of the second child,
by convulsive contractions of its legs. At the same time the
woman complained of severe pain and numbness in her right
leg the same side at which the head of the upper child present-
ed. A farther examination was then instituted to discover the
cause of compression, and of the arrest; for the pelvis was unu-

1837.] Superfcetatiort. 181

sually large, and the child rather small, though not much below
the average size. On this examination the Doctor discovered
the head of a third child below the superior strait, whilst the
head of the second, whose body was delivered, was still above
the same strait, constituting a case of locked heads. His first
attempt was to dislodge the head of the third child ; but this
was soon found impracticable ; for it was immovably fixed be-
low the superior strait. Not approving the plan adopted by
some, of delivering the upper child by the forceps, before deliver-
ing the head of the lower, he determined to await the delivery
of both together, as long as he might think it safe to the mother,
and if necessary, ultimately to decapitate the lower child, press
the head up from the superior strait, and thus a.*ow the upper
one to pass, or assist it with forceps, as circumstances might de-
mand. Whilst awaiting the issue of this plan, he requested a
consultation ; but before the arrival ol another physician, and
within little more than an hour after the discovery of the true
nature of the difficulty, both heads passed. The superior child
made some spasmodic movements after birth, but could not be
resuscitated. Both heads were very much indented by the pres-
sure of the other.

Except the injury inflicted by the accident, the children were
all well formed, and very little below ordinary size. Two of
them were boys. The mother passed her accouchment as well
as could be expected under the circumstance of her previous
wretched health.

M.wy cis33of diffbulty and psrplexity in child-bearing arise
from the small dimensions of the pelvis ; but this was one which
may be fairly attributed to too large a pelvis ; for had this been
of ordinary capacity, the head of the third child could not, with
the good developements of both, have engaged the superior strait,
with the neck of the previous child engaged in it, and the head
at or near the superior plane.

Superfoetation in the Mare. Horse and Mule Issue.

Although supufoDtation is a thing of constant occurrence in
the lower animals, and several well authenticated cases are given
of women producing both white and mulatto children at the

152 Thomsonianism and the LeRoy Physic. [Oct,

same time, we do not recollect an instance before the following,
reported to the Farmer's Reporter, by Gen. Thomas Emory, of
Maryland, wherein both a mule and a horse colt were produced
at the same time.

Near Salem, N. J., June 6, 1837.

1 hereby certify that I have a mare, which, this spring, pro-
duced twin colts one of which was a mule, and the other a
horse colt, both having attained, before parturition, the ordinary
size. The mule is still living, and the colt died without getting
up ; having been] strangled by the caul or suck, from which the
colt was not able to extricate itself. The mule is brown, of the
ordinary appearance. The colt was a fine sorrel, with blaze
face and white feet. This circumstance is regarded in this neigh-
borhood as one of a very singular character in natural history,
and was seen after the death of the colt by several persons, to-
wit: my son Joseph, and Charles Slade.

The mare ran in my stable yard to foal by herself; and it was
next to impossible that the colt could have been brought into
the yard by any other means than by the mare which foaled the
mule. It was known last spring, that soon after the mare was
served by the jack, that a two year old colt of my son's got to and
served the same mare ; and as a further proof that this colt was
the fruit of this act of coition, the colt was of the same color, and
marked with white in the same manner as the supposed sire.

JONATHAN BILDERBACK.

Test : Thomas Emory,

Robert C. Johnson.

Salem, June 10, 1837.
I hereby certify that Jonathan Bilderback is a respectable
farmer in my neighborhood, and that I believe him to be fully
entitled to credit as a man of veracity.

ROBERT Y. JOHNSON.

Thomsonianism and the LeRoy Physic.

In the fate of the LeRoy Physic of France, we may see that
of Thomsonianism in prospective. The LeRoy Physic has been
out little known in America ; perhaps not much more than Thom-
sonianism has been in France. It was that of which Thomso-
nianism is, as near as may be well imagined, a true counterpart.
We will give a brief view of its history.

This LeRoy Physic, tolerated as it was by the state, had an un-

1837.] Thomsonianisni and thi LeRoy Physic. 183

paralleled run in France. It consisted of two books, and three
different medicines, instead of six numbers ; one, an emetic, an-
other a cathartic, and the third, we believe, was for a tonic.
Thousands and thousands of these sets of books and physic
were sold off under state patronage, amongst the dense population
of France. Its praises reverberated from the Pyrenees to the
Netherlands, and from the banks of the Rhine to the I Jay of
Biscay. That was the day of its glory. It was exalted to the
sky ; but it was for a brief season. " Murder will out." Rea-
soning from the facts of observation, will prevail. This noble
faculty will be exercised when the force of novelty passes away.
France was made up of a high minded and affectionate people,
whose sensibilities rebelled against the insult offered to their
understanding, and the injuries humanity was made to suffer.
She was a belligerent nation, and needed all her materials. She
had a Napoleon, whose espionage reached every where and
embraced everything ; and who himself had decision, always to
the purpose. Novelty passed away, and the sober, undisguised
facts were returned and accumulated at the Capitol, which
proved its course was, like the/etreat from' Moscow, marked
out by human victims on every side. The first step (with-
out parley, without compromise at the expense of humanity,
without the wretched policy of legalizing manslaughter for a
time, for the purpose of drawing decision from the voice of the
ignorant populace,) was the instant jjrohibition of its sale and
use within the realm.

The next manoeuvre of its proprietor was to try the imposition
in other countries ; and it was consequently shipped in large
quantities to America. It caught the eye of one in this place,
who deemed the chance of making himself a notorious doctor
too tempting to be unembraced. Its use was traced out by its
multiplied, sudden and unexpected deaths. But fortunately, it
had no friends more interested in its success than commission;
merchants, and consequently its false praises were not sung.
The books too were in the French language, and, unlike Thom-
son's, were a little too volumnious for the gulls and shallow-
pated knaves to read, and it could not get a footing here.

So let it be so will it be with Thomsonianism. It is now at
the zenith of its glory sounding its own false praises from

1S1 Thomsonianism and the LeRoy Physic. [Oct-

Texas to Maine, and from the Atlantic to Missouri the most
stupendous system of quackery, and the most insulting offering
ever tendered to the understandings of a free and enlightened
people littering its own banterin^s for proof of facts which
nobody doubts, not even themselves ; for such facts are too fa-
miliar to them.

Now should Thomsonians look ont, and spread the parachute
preparatory to the fall. We have no Napoleon; but we have
schoolboys in great abundance who know well the ridiculous
falsehood of their fundamental doctrine of the four elements.
We have women who know that the knowledge of midwifery,
which could be obtained " in only a few minutes conversation
with an old woman,"* will not answer the demands of humani-
ty. And we have men too \vho know death when they see it
men who know very well when the tall, lean, long-necked man,
is taken from his feet and subjected to a steaming heat of great
degree, with a perpetual drink of African pepper, &c, and dies
immediately in an appoplectic lit, what it was that killed.

It is true that Americans are wonderfully fond of novelties;
but they only need a little time for reflection on the observed
truths. No sooner will this be had, than the steamers will be
left as lonely as Sam Patch now is. This done, and they will
know most clearly the cause of death when they see the ruinous
effects of such a poison as lobelia, which, like arsenic, owes its
safety only to its almost instantaneous rejection from the stomach.

People who enjoy freedom of opinion and the right of action,
will not have so gross an insult offered to their understanding
such injuries to weeping humanity. Reason and prudence lead
to the sam3 results every where under like circumstances; con-
sequently, the rational and prudent course of the Connecticut
Legislature will be speedily adopted by other States, until the
degrading stain ot Thomsonianism shall no longer disgrace the
character of Americans.

* See Thomson's Narrative and Guide.

1837.] Diervllla Canadensis. 185

Diervilla Canadensis.

N. B. Pickett writes to the editor of the Boston Medical and
Surgical Journal to say that a plant in the vicinity of Great
Barrington, Mass. is held in high repute as a sped fide for the
erythematic inflammation* produced by Rhus Toxicodendron,
Rhus Radicans &c. An infusion of the bruised leaves and
twiggs is applied. The writer also understands that it is used
in calculous affections, and is known by the popular name of
Bush Honeysuckle,! and is the Diervilla Canadensis of Eaton.

We should be pleased to learn the sentiments of Professor
Tully and Dr. Hooker, to whom reference is made for infor-
mation. At the same time we feel it a duty to say, not only from
our own observation, but more confidently on the abundant ob-
servation and experience of a judicious medical friend, that there
is perhaps no disease, the small pox itself, which is in its periods
one of the most uniform of all diseases, not excepted, whose
course is more certain to be run, despite of all remedies, than the
erythematic or eruptive inflammation which arises from the dif-
ferent species of Rhus that it is uniformly stated in its periods,
exacerbating for the three first days, and being well by the termi-
nation of the seventh. The fact of its regular termination, as
well as its regular period for decline not bein^ generally observ-
ed, renders it probable that many articles have, from time to
time, been named as remedies, only from the fact of their having
been resorted to during the spontaneous decline, or termination
of the disease.

We have often observed, and for a long time believed that a
lotion of strong salt and water, or an alkaline lixive. seemed to
possess the power of gradually modifying, and promptly dispel-
ling the inflammation with its attendant distressing itching,
burning and swelling. But the character of the disease being
considered, we are left in doubt whether the improvements ob-
served, instead of being in the relation of effect, to the applica-
tion as cause, it is not a mere coincidence.

* See Boston Medical and Surgical Journal, vol. xv, p. 380.

"t This is entirely different from the Azalea, or Honeysuckle, a shrub very com-
mon in our forests, and spoken of in a former No. as a diuretic.

186 Tic Douloureux. [Oct.

In order then to deduce the truth as to the remedial virtues of
Dier villa Canadensis, or any other supposed remedy for this
disease, the period, and peculiar character of the disease should
be carefully marked in connexion with the administration of the
remedy.

As to <' specific" virtues, as understood in medicine an infal-
lible curative power, we have long doubted whether the term
had properly a place in regular medicine.

Tic Douloureux cured by the external application of Tartrate
of Antimony.

We are indebted to the valuable Electric Journal of Dr,
Bell, (from Medicinisch Zeitung of 6th January 1836,) for the
following interesting result, obtained by Dr. Hausbrandt :

A woman, more than sixty years of age, had suffered many
years from face-ache, the severity and long continuance of which
almost reduced her to despair. As soon as the pain of the face
ceased, the patient felt comparatively well : when the pain came
on, which was always suddenly and without ostensible cause,
the muscles of the face twitched, and the eye of the affected side
was closed ; the whole face became remarkably pale, and the
features indicated severe suffering. As no particular circum-
stance capable of inducing the attack, excepting perhaps taking
cold, could be discovered, the treatment was altogether empiri"-
cal. A considerable number of remedies, such as are usually
employed for this complaint, were tried, especially frictions,
vesicatories, narcotics, carbonate of iron, but the paroxysms
returned with greater frequency, and the patient not only lost
flesh, but her condition seemed desperate. Dr. H. prescribed
the following plaster, which was applied over the whole of the
affected side of the face :

R. Emplast. Resinse flavae, l\.

Resin a3 flavae, ss.

Terebinthinae venetae, iij. Liquat. adm.

Tart. Antimonii, gjss. fiat Emplast.
"When this had remained on the face twenty-four hours, the pa-
tient experienced an itching, burning sensation throughout the
spot covered by it, but the face-ache was relieved. At the end
of several days the plaster was taken off, when the entire half of
the face was found covered with pustules, which gave a good deal
of pain, but which were very bearable in comparison to the former
pains. The sores gradually healed by the application of simple

1337.] Ijpuchorrhaca and Menorrhagia. 1ST

dressing, and up to this time (three and a quarter years,) there
has been no recurrence of the complaint.

On Sulphur et of Lime hi Diseases of the Skin, by Dr. Sa-

vardan.

Dr. Savardan has employed the following ointment in chronic
diseases of the skin, for the last twelve years, with very great suc-
cess : eight parts of lard are intimately mixed with one part of
sulphuret of lime ; and one drachm is directed to be rubbed into
the palms of the hands for one quarter of an hour night and
morning. Dr. S. has given short notes of thirty cases of chronic
diseases of the skin of various kinds affecting different parts of
the body, all of which gave way to this ointment, used in the
manner specified. All were cases of long continuance, and the
treatment was of course protracted ; one or two yielding in rather
more than a month, others in three, four and seven months ;
whilst in others the frictions' were persevered in for one or two
years. Journal des Connaissances Medico-chi?'urgicales,Jan
vier, 1836. Eclectic Journal.

Leuchorrhosa and Menorrhagia.

b

In a late communication to the Boston Medical and Surgical
Journal, Dr. Thomas Close bears testimony to the use of ni-
trate of patassa, sulph. alum, and kino in Leuchorrhcea and
Menorrhagia. The basis of his prescription, taken fromDEu-
ees and Eberle, consists of ten grs. of nit. of patassa, and five
of alum, to which he has been induced by successes therewith,
in cases of failure of the above alone, to add a grain and a half
of kino. This dose is given three times a day, dissolved in a
sufficient quantity of water. He asserts, that for several years
he has not met with a single case of Menorrhagia or Leu-
chorrhcea which did not yield promptly to this remedy."

As these two diseases usually alternate with each other, Dr.
C. thinks that there is little difference in their nature leucorr-
hoea being commonly the mere sequel of menorrhagia " the
serous discharge escaping after the vessels have so far contract-
ed as no longer to give passage to red blood." With this patho-
logical view, he thinks it "not strange," (nor would it be, if
8g

1S8 Leuchorrhcea and Menorrhagia. [Oct.

the view were correct,) " that the same remedy should be found
to possess an equal control over them both."

But the interest of this prescription is not limited in his prac-
tice to ordinary cases of these diseases ; but extends with equal
advantage to leuchorrhosa accompanying gestation ; cases of
transparent discharge occurring before puberty ; to the most
aggravated cases of profuse menstruation, and great flooding in
child-bearing, &c. One case is given of overwhelming hoe-
morrhage recurring once in two or three weeks, afterwards with
a serous discharge so profuse, that the patient believed that more
than a pint a day escaped her, and sometimes, after a few hours
retention, that quantity was discharged at a gush." " So great
had become the morbid determination of fluids to the pelvic re-
gion" (in this particular case,) " that a serous discharge took
place several times a day from the rectum, while the sufferer
was constantly harrassed with a sense of weight, distension, and
bearing down, and often with great pain fullness in the lower
part of the abdomen, alarming prostration, skin leaden color and
countenance expressive of such great suffering and imminent
danger, that he became fearful of carcinoma, and proposed ex-
amination per vaginam." During some delay, however, this
prescription was ordered, but with little confidence in its ade-
quacy to the demands of the case. In this he was agreeably
disappointed, and in a few weeks these profuse discharges were
brought " within the limits of moderation and safety the leu-
chorrhcea in two months ceasing altogether." "It is proper
here to remark," continues Dr. C. "that the morbid current
which has been so long determined to the pelvic region, contin-
ued still to flow that way, after its outlet had become obstructed ;
causing at first such a sudden and violent distension of the ute-
rus, as to produce intense pain and soreness, and requiring the
loss of a considerable quantity of blood from the arm, with fre-
quent fomentations to relieve it. Before the recurrence of the
next menstrual period, however, the equilibrium of the circula-
tion had been so far restored that no farther difficulty arose, and
the patient was at length restored to firm health."

" It is difficult for me to believe that success so uniformly can
have been accidental ; and although others may not be equally
fortunate with myself in prescribing this formula, yet I think
that, upon a thorough trial, it will be found to possess a greater

1837.1 Medical Intelligence. 189

control over morbid uterine discharges than any other means now
in use."

We have long used, with very good success in suitable cases,
a kindred preparation the Pulvis Stypticus, or compound pow-
der of alum and kino in uterine haemorrhage. This we have
found succeed many times, when taken dry, after the acetate of
lead had failed, but we have never added the nitrate of potash.

We should be pleased to learn that Dr. Close's practice suc-
ceeds as well in other hands as in his own ; and we hope the
successes will be returned to us in connexion with exact his-
tories of the cases.

MEDICAL INTELLIGENCE,

Death by Tiiomsonian Practice. Indictment founded on evidence before
the Coroner's Inquest. We learn" by the Journal of Commerce, the Evening
Star of New York, and other papers, that T. G. Fkexch, a young man 18 years
old, and teacher in the grammar school of Columbia College, being afflicted with a
slight cold, went to the Infirmary and put himself under the treatment of Richard
K. Frost, a Thomsonian, or Steam Doctor in New- York.

It appeared in evidence that he was then provided with an apartment, and a dose
of " composition tea ;" and on the following day, " a regular course" of Thom-
sonian practice, commencing with lobelia and steam baths, which, on the 5th day
resulted in the death of the unfortunate and deluded young man. The body was
disinterred, and a Coroner's Inquest empannelled. Drs. CiiEESEMANand Rodoers
made a post mortem examination. Dr. Chilton, an eminent chemist in Broad-
way, analized the contents of the stomach, and one yard of the intestines, where
he found two teaspoonfuls of powdered lobelia ; and from a number of experiments
made with it, it was found to have the same active principle with tobacco. A vast
deal of testimony was adduced to shew the mode of treatment, and description of
medicines used, which, in a few words, consisted of vapor baths, washing the
patient with cold water immediately before he came out of them administering to
him large and repeated doses of lobelia in pills, emetics, and injections; and cover-
ing up the patient in bed with a great number of blankets, to keep up the perspira-
tion caused by the medicines. Physicians who were examined, testified that the
powers of lobelia are similar to those of tobacco tending to create great prostra-
tion of both mental and bodily faculties ; and in large quantities, most likely to pro-

!90 Medical Intelligence. [Oct.

duce death. All the physicians on evidence concurred in the opinion that the de-
ceased had been most improperly used.

At the end of a tedious and deliberate examination of the abundant evidence in
the case, the Jury returned the following verdict :

" It is the opinion of the Jury, that the death of the deceased was occasioned by
a general congestion of the internal organs a complete prostration of his natural
functions and nervous system, produced by the administration of deleterious medi-
cines and other improper treatment, while in the infirmary and under the medical
charge of Richard K. Frost."

Frost was then arrested under a coroner's warrant, and held in a recognizance
of $5000 to answer an indictment against him for murder.

It appeared on farther acquaintance, while detained in the police office for giving
bail, that this great Thomsonian doctor, was, by apprenticeship, a lock smith, but
had become manager of a Thomsonian Infirmary.

A circumstantial account of the death of Sylvanus B. S. Rhodes, which was
briefly alluded to in the last No. of this Journal.

About the 20th of July last, Sylvanus B. S. Rhodes came to my office desiring
to be bled, on account of headache, which he thought it would relieve. He had
no fever, but a pulse of healthy fulness and frequency. I advised him to take in
preference, a dose of calomel in divided portions; but he said he would be bled,
and do that afterwards if he did not get better. I opened a vein in his arm. He
had said he dreaded the operation very much, and immediately after opening the
vein, he appeared somewhat faint, and was reclined on a chair a few minutes, until
he felt better. He then went away, having lost not exceeding 6 or 7 ounces of
blood. The next day I saw him about his boarding house door, and was informed
that he went out to the workshops at the Rail Road Depot. I heard no more of his
case until I was requested to visit him at his lodgings, on Monday the 24th, when
I found him complaining of some headache, with a slight fever. His pulse was
about 90 to 95. Believing he was suffering the effects of a slight cold only, I pre-
scribed him a few portions of febrifuge mixture of acet. amnion, spt. nit. and ant.
wine in diaphoretic doses ; with a warm foot bath at night if the headache and dry
skin continued. Next day I saw Mr. R. passing the piazza of the Hotel, consider-
ed him relieved, and paid him no farther attention.

On Saturday, the 29th of the same month, at about 2 o'clock P. M. I was told
that Rhodes was dying, and my attendan %e demanded. I immediately attended
the call, and on arriving at the bedside where the unfortunate victim laid, and find-
ing him in the last moments of life which was evidently being terminated by a
profound appoplexy, I enquire! of those present, what had the patient taken, or
what had caused the present state of things ] On this enquiry, the person who
seemed to be endeavoring to serve him with care and assistance, and who was to
me a stranger, replied, :' I have civen him nothing, sir. but a little warn lea, and
a footbath.'1'' " You have given," said I " are you a steamer, sir V " I own the
patent," he replied.

Knowing that this treatment alone was not sufficient cause of the phenomenon
which was before me, (for Rhodes was the extreme opposite in all his habits and
bodily conformation to those things which dispose to apoplexy,) I pressed the en-
quiry. I knew that with steamers, when a patient, who had taken lobelia recover-
ed, it was No 1 which he had taken, which is lobelia; but when the powers of

1S37.J

Medical Intelligence. 10 1

life wen Irrecoverably destroyed by this dangerous articl i, il was only ila v*.ry r<
e?netic" that had been given; and. in like manner, composition tea is composition
tea, if the patient recovered; but "a little warm tea" when he is killed, and that
a steaming process, is in like manner a "steaming" or "a simple foot bath." On

pressing my inquiry, I was informed by Mr. J. M. Moom . who by this time I ob-
served at my side, and who was then serving as Bar-Keeper in the Hotel, that, in
the morning, Mr. Rhodes had been about the house that the steam doctor had
been telling Mr. R. of some of his great success in the steam practice, which had
induced Rhodes to conclude that, as he was not very sick, and the steamer had
cured himself of t; just the same kind of troubles" very quickly, he would submit
himself to his treatment that he had consequently had R. under his treatment for
some two or three days previous; and that on that day he had taken him up to his
room, (which was a small, close, well-ceiled room, about 8 or 10 feet square,) and
put him on the use of composition tea, and No. 6,* and applied a number of hot
rocks to him, and covered him well with -1 blankets. That on lying a while under
this treatment, the patient sprang up from his bed and exclaimed, " I am shot
through my head that the external heat and internal stimulation were then in-
creased on account of the aggravation of symptoms. The room was closed ; and
fearing that Rhodes might sutler from the want of something, he attempted to en-
ter his room; but on opening the door, found the heat so intense that he was unable
to enter. That soon thereafter, it became known that Rhodes was laboring under
a fit, and he (Moody) was dispatched for another steamer that on his return, he
found him in the large adjoining room where I saw him, whither he had been
brought for the benefit of fresh, cool air.

Mr. Moody made this statement openly, and in the presence of several persons
who had collected around; and again subsequently and fully at the house of Mr.
Dever, the nearest friend of Mr. Rhodes, and who had indeed brought him
from his friends in Baltimore, to this place.

Mr. Dever entered the room a few moments after me, with feelings of ardent
friendship, and a sense of responsibility to his friends at home ; and finding his
friend a livid, lifeless corpse, vented his distracting grief by alternately throwing
himself on the dead body, and shrouding it in his embrace; and briskly pacing the
room with all the extravagant manner of strongest grief: so that at this time, Mr.
Dever was incapable of attending to the circumstances above detailed.

I felt it a duty I owed to my fellow beings, to remark to the man who had con-
ducted the treatment above described, (and who still stood by the corpse vainly en-
deavoring to make the dead arm retain its position on the side of the corpse as if
alive,) that before him laid the lifeless body of one of the most estimable young
men in this community deprived of life by his ignorance and cruel temerity but.
that I need say no more, as the Legislature of the state had placed him at liberty to
go forth in the commission of such deeds as often as he could find subjects. I
then left the scene.

During the afternoon, Messrs. Deaves and Dever came to my office manifes-
ting great dissatisfaction with the management and result of the case, and asking

" Composition tea is made of composition powder; and composition powder [s made of Bay-berry
root bark, inner bark of hemlock, ginger, cayenne and cloves, all finely powdered and welt mixed
No. 6 is made of fourth proof brandy, or mostly of alcohol, myrrh, and No. 2 which is cayenne- Thom-
son directs them to be given during the steaming process, and previously to raise the inward heat
.(See Thomson's guide, p. 26.) This cayenne is an African pepper of peculiar powers.

199 Medical Intelligence. [Oct.

advice as to what they, as the friends of Rhodes, should do; desiring at the same
time that I should open the body and see if the injurious effects of the treatment
not so obvious as to sust.iin a prosecution against the man who had conducted
the treatment. I replied that the in my estimation, sufficiently plain,

from the facts already well known that there could be but one opinion on the
subject; but that if they insisted, I would request some half dozen medical gentle-
men to meet me, and make an anatomical examination if they should think it ne-
cessary to their judgment stating, however, that a proseeution would avail noth-
ing, since the Legislature had passed an act sanctioning that kind of practice ; and
that as yet the community had not learned enough of its ruinous tendencies, to en-
able them to get a special jury who would give a verdict of "guilty," however
plain the facts might be in a particular case. They insisted, however, that I should
call the Gentlemen's attention to the case. I then sent a written request of the
attendance of Drs. Ford, Dugas, P. F. & J. A. Eve, and Robertson only the
two last of whom however attended. These gentlemen visited the hotel, and made
for themselves the necessary enquiries into the facts of the case ; and felt bound,
from the facts ascertained, without dissection, to fully confirm the opinion I had
given. These gentlemen will not swerve from the opinion there deliberately made
upon the abundant evidence which was present.

It may be well to state in conclusion, some facts of Mr. Rhodes' person and
character, to which all who knew him will testify; and which tend to show that
there was nothing in his habits, disposition, or personal conformation, in the least
calculated to favor the production of appoplexy : and that such an event could only
have come from extraneous influences. Mr. Rhodes was a modest, pliant, intelli-
gent and interesting young man, of unimpeachable moral character, and habits of
the strictest temperance. His person was tall and slender, but very genteel and
well proportioned ; his eyes and hair were very black, and his complexion brown.

Augusta, 4th Nov., 1337.

I hereby certify, that on the 29th day of July last, (the time of the death of
Syxvanus B. S. Rhodes,) I was living in the Western Hotel as bar keeper that
the said Rhodes had been complaining for some days of slight indisposition that
on his being told, by a steam doctor who was also boarding at that time in the Ho-
tel, of the great cures he had made of himself and others, Rhodes was induced to
tell him that he might take him through a course of his treatment, as he was so
successful and expeditious that the steam doctor then commenced with Rhodes
such treatment from day to day as he thought proper That on the forenoon of the
day of his death, he was, as usual, about the house, and was taken up stairs by the
steam doctor to undergo the treatment for this day. That a number of hot rocks
and bricks, and four blankets were provided, and Rhodes put in bed and the rocks
and bricks placed about him, and all covered with the blankets; whilst the compo-
sition tea ;\nd No. (i were administered internally that the room wherein he was
placed was a small one, not exceeding, as I should suppose, eight or ten feet square
that the door and window were closed, which, with the close ceiling of the apart-
ment, rendered it as close as possible, and that the day was one of the warmest in
the month of July that after having been subjected to this treatment for some time,
I attempted to go into the room, to see if he needed any thing, and found on open-
ing the door for this purpose, the heat so intense, that I was unable to enter the
room.

Not long after this. Rhodes sprang up in his bed, and exclaimed, " lam shot

1837.1 Medical Intelligence. 193

through the head." Whereupon some alarm for him arose, and i was dispatched for
anot'i 'tor. On my return, I found him removed to a bed in the large

adjoining room, pulseless, and apparently i\\ Tel of water was then

provided andplaced in the small room from which he had been brought, and Rhodes
i backand placed therein : after a few breaths he seemed to die in the bath
was then removed again to the large room, alter which he gasped a time or two, and
breathed no more.

The above is the substance of the facts I related to Dr. Antony, who had just
been called in, and was enquiring what had been done to Rhodes. All of which
is substantially correct, as I attended to the administrations of the steam doctor when-
ever he needed assistance.

Dr. A. had visited Rhodes only once, which was on the [Monday previous to the
Saturday on the afternoon of which he died. On Tuesday, the day following Dr.
A.'s visit, Mr. Rhodes was better, and went out to the Rail Road Depot. Dr. A.'s
prescription on the above visit was a viol of fever mixture, which I administered in
broken doses, according to directions ; and a warm foot bath at bed time, in the
event of his head ache continuing with dry skin; but the circumstances not de-
manding it. the foot bath was not used. The next and only treatment which Rhodes
ever received after, was that of the steam doctor as described above. His death
was on a Saturday, which was the 29th of July last.

JAMES M. MOODY.

Augusta, 4th Nov. 1837.

I hereby certify, that on the day of Sylvanus Rhodes' decease, which I think
was on the 29th day of July last, on hearing that said Rhodks was dying, I went
to the Western Hotel to see him. and found him dead. This was a little after 2
o'clock P. M. On looking into the room in which he had been lying, I saw a large
vessel, being a half hogshead, containing water. There were rocks and wet blank-
ets lying about the place, which as I was informed by those present, had been used
in carrying him through the steaming process ; during which he had complained
suddenly, whilst in bed with the hot rocks and under the blankets, that he was shot
through the head. That on thus getting worse under this treatment, and the internal
use of composition tea and No. 6, these means had been increased that the room
had been closed as well as possible, and that whilst under this treatment he had taken
the appoplectic fit of which he died.

These statements were subsequently made several times to me, and in my pre-
sence, by Mr. Maddison Moody, who was at that time Bar-Keeper in the Western
Hotel, and who attended with the Steam Doctor to afford him occasional assistance
on his administrations.

A few days previous to this, the said Sylvanus had been to our house, and ob-
served that he had a notion to put himself under the steam treatment, as he did not
feel very well ; and asked me what I thought of it. I told him I feared for him to
do so, lest he might be killed by the violence of that course.

CAROLINE JANE DEVER.

Augusta, 4th Nov., 1837.

I hereby certify to the truth of what I state below, relative to the death of the
late Sylvancis B. S. Rhodes, to the best of my knowledge and belief.

I wa* called upon to visit Sylvanus B. S. Rhodes on the afternoon of Saturday,
the 29th July last at two o'clock P. M., and on doing so, found him in the most ex-
treme distress, and to all appearance dying ; and I expressed to Mr. Black, the man

191 Medical Intelligence. [Oct.

who attended him. my belief that he was dying. From my knowledge of facts re-
lative to his indisposition, I unhesitatingly declare the opinion that he had been too
much steamed ; for death was manifest in his countenance when Mr. Black remand-
ed him back into his room to the bath. I expressed a wish to have Dr. Antony
immediately sent for ; to which Mr. Black objected j saying there was no necessity
for my doing so. He seemed almost lifeless, as I thought, from the effects of steam-
ing and other treatment ; but I assisted Mr. B. in placing him in a bath, in which
he died. Mr. B. then agreed that I should call Dr. Antony, who instantly came,
and at once pronounced the man dead.

I farther state that his body retained such a degree of heat, that it was painful to
bear the hand on it three hours after life was extinct. It became putrid before in-
terment on Sunday morning.

1 farther state that Mr. Black seemed to have great reluctance to my calling any
physician in to see the said Rhodes; but said he had sent " for a doctor himself."
Rhodes was a young man of great worth, and unexceptionable habits and princi-
ples.

Witness mv hand. EDWARD F. DEAVES.

A Cholegocge Pill. The following formula for the preparation of a chole-
gogue pill has been sent us by Dr. E. Delony of Talbotton, for our opinion of its
merit. His uncle and preceptor, the late Dr. John R. Lucas, and since, Dr. Del-
ony himself have long used it, with the greatest success in chronic visceral de-
rangements, particularly of the liver, spleen, and uterus; also in bilious rheuma-
tisms, and all that train of indescribable afflictions so perplexing to the practitioner,
which arise out of those derangements of function ; such as dyspepsia, nervous-
ness or superscentiousness, ccc. &c.

ft. Extract. Colocynth. comp. si
Hydr. Sub-mur. 3ij

Tart. Aritim. gt. iij

Ol. Carui. gtt.j

Sapon. Hisp. siss

Make a mass and divide into 24 pills, common dose, 2 to 4 every night, or every
other night, at bed-time in chronic cases, continued as prudence may direct.

We have not used this formula precisely in any case, but have for the last twen-
ty years used one very analogous in the essential medicinal powers, with results
which have constantly tended to heighten more and more our confidence in its
peculiar suitableness for the correction of such derangements as are alluded to
above. We are, therefore, of opinion, that the formula is worthy the attention of
practitioners, as we think, not only from the extensive experience of Drs. Lucas and
Delony, two of our most respectable practitioners, but from the powers and propor-
tions of the formula itself, that it would be ioum\ peculiarly valuable in such cases.
We feel it a duty, however, to say, that the two leading ingredients, are of those
which should ever beprescribed by practitioners capable of comparing the medicinal
powers with the derangements of the functions to be corrected; and should never
become articles of common-place prescription.

SOUTHERN

MMBHOAIL AMID) TffMHA3L
JOURNAL.

Tol. II. NOVEMBER, 1837. No. IV.

PART I.

ORIGINAL COMMUNICATIONS

ARTICLE I.

Remarkable case of Biliary Calculi.

The following communication was addressed to Dr. Paul F.
Eve by Dr. S. B. Cunningham, a highly distinguished physi-
cian of East Tennessee :

Jonesboro', Tenn., Oct. 18th, 1837.

Dear Sir : Accompanying this you will receive two hun-
dred biliary Calculi, being a part of the number obtained on a
post mortem inspection of an individual (namely, the late Judge
E .,) of this place. We have retained about fifty as specimens
of illustration for the use of private students. I trust that what
I send may be added to your collection of mormid specimens,
and with your superior talents and opportunities, subserve in
some degree the philanthropic intention expressed in the dying
request of him who fell a victim under their influence.

I am able to glean but a few prominent facts from his previ-
a 1

196 Remarkable case of Biliary Calculi. [Nov.

cms history which bear relation to the disease, so as to aid in
illustrating its pathology.

First then I remark, he was by birth a Virginian, descended
from a family of rank and influence, of but ordinary strength of
physical constitution naturally, but endowed with uncommon
strength and vivacity of intellectual powers, with devoted and
untiring perseverance in literary pursuits. As a matter of course
his habits were sedantery. Of a sanguine bilious temperament,
and from his associations in life, he was tempted to partake libe-
rally of the indulgence and luxury of the table, (a thing com-
mon in his day.) The evils to be apprehended to such an one,
under such circumstances, have been too often experienced and
explained to need comment. He had suffered several attacks of
intermittent fever whilst a resident of Norfolk, which left him
with disease, (probably enlarged or indurated spleen,) from which
I am led to suppose he never entirely recovered. Some where
between the years 1815 and '20, he removed to Tennessee. He
was at that time from 45 to 50 years of age, and had become
quite corpulent rather oppressed with obesity, which rendered
him the more sluggish and inert. His superior talents soon de-
signated him as a fit character for the bench of the Supreme
Court. Looking over the geographical boundaries of the State,
and considering the arduous duties ol the office, we can perceive
at once that it must have been oppressive. Having to travel
over a boundary of several hundred miles of mountainous coun-
try, alternating with the confinement of official duties, it must
have broken down his already weakened powers. It was in one
of these travels that he was seized with the first of a series of
spasms of the stomach, as was then thought, which visited him
at irregular intervals until the close of life. These attacks were
supposed, by his medical attendants, to be gout in the stomach,
and the treatment corresponded with that pathological view.
The means employed were venesection, blisters, with a profu-
sion of revulsives, anodynes, &c. &c, but all to little or no pur-
pose the pains and spasm still continued. The warm bath was
the first application to afford relief, and this was his chief means
of reliance for many years when the pains returned. The wri-
ter was first called to administerto his relief in 1830, some years
after he had retired from office in hopes of regaining his health

1837.] Remarkable case of Biliary Calculi. 197

on his farm. On this occasion he was seized with pains in the
right hypochondrinm and with general abdominal tension, at first
supposed to be cholic further characterized by costiveness, full
tense pulse, furred tongue, and some thirst. To subdue these, I
find, by reference to my book, I had recourse to repeated and
copious bleeding, warm bath and purgatives. The last of which
measures had to be administered in unusually large doses ; about
30 or 40 grs. of calomel, with a large pill of opium, followed
by repeated and full doses of jalap and oil before they produced
any thing like full action of the bowels. This was usually the
case when he had occasion to take medicine at all ; but his
dejections when procured were of a healthy aspect, presenting the
appearance of a due admixture of bile ; and of healthy consis-
tence. This was their quality too, when not taking medicine,
which he rarely needed. But little gastric disturbance was ever
manifest : he could retain the most nauseous medicine with-
out vomiting, and eat heartily (if allowed.) when relieved of
the severity of the pain, at any time during his illness. Of
these first attacks, he complained much of debilitating sweats,
for which he took freely of vegetable and mineral acids, quinine,
acet. plumbi, (fee. without any advantage. About the first of Nov.
1836, he complained of dull and obtuse pain in the region of the
liver, with no other uncommon symptom, which was attributed
to hepactic derangement, superinduced by close confinement to
writing, &c. When describing it. he thought \\\p sensation referred
more to the muscles of the abdomen, or side as the seat than to
deep parts. Pressure produced little or no increase of the pain,
a portion of equal parts of cal. rhei. and a'oes was administered,
followed by oil, which brought away copious feculent stools, but
afforded no relief. At this time, and for some time after, except
when under the action of medicine or remedial agents, he was
able to attend to the editorial duties of his paper which he was
then conducting. Nov. 4th or 5th, he was bled and blistered,
5th, 6th, 7th, no better. Ordered to dress with tat. emet. oint, ;
but it became so painful as to occasion its abandonment after a
few hours. A poultice was now applied, and pills of cal. and
rhei, and oil ordered every 2nd day : diet light, bread and tea,
gruel and roasted apples. Sth, 9th, 10th, the ointment has pro-
duced extensive cuticular inflammation, and extended like ery-

Ir98 Remarkable case of Biliary Calculi. [Nov.

sipelas over twice the original surface. The pain and irritation
is almost insupportable. He cannot be persuaded that any thing
else now is the matter, as he can feel no deep seated pain in his
side. 13th, 14th, and 15th, The inflammation still extends,
some pustules, but no mitigation of pain. Ordered to bathe with
decoct, tan bark, and acet. plumb, two, three, or four times a day,
and take a pill of ext. cicuta, and repeat if necessary in 3 hours.
Next day no better, had no rest through the night. Thus it ad-
vanced for 2 or 3 weeks ; presenting a most perplexing erysipe-
las, until in the remedial search, a solution of lunar caustic in
the proportion of 2 or 3 gr. to the oz. suddenly healed it, to the
great comfort of both physician and patient, (for he verily thought
this alone was killing him.) But by and by, after it had gotten
well, the old pain returned with increased action ; he found out
his mistake. We now had recourse to mercurials, in order to
their full alterative effects on the system, stramonium, bella-
denna, &c. &c. The only relief he now obtained, was from
morphine. This article could not be substituted by opium,
laudanum or black drop. So sensible of its superiority did the
patient become, that he scarcely could be prevailed on at length,
to make trial of^bther substitutes. December He now under-
went a variety of treatment suggested by different medical gen-
tlemen. But as no regular journal was kept, and it was of the
miscellaneous order of treatment, I think it unnecessary to detain
you. Other organs within the circle of sympathy of the disease
became involved. The tongue lost in part the thick mucous
coat, and became tipped with red. The whole epigastric region
was painful at times ; but a prominent symptom was acute pain,
extending to the back in describing which, he said he could
cover it with his thumb or finger if he could reach it ; so much
was this the case, that we were led to attribute all the symptoms
to nuralgia of the spinal nerves. He could only lie on the back
or inclining to the right side. About the last of December, there
occurred acute pain in the region of the kidney, attended by
strangury and micturation, for which camphor, mucilages, bu-
chu tea muriated tinct. iron, &c. were used, and measurably
relieved him of those symptoms. Dropsical swellings in the
limbs, next followed, for which the bandages were applied which
held that symptom at beyance. But it now became evident, that

1837.1 Remarkable case of Biliary Calculi. 199

nothing but a paliative treatment could avail any thing, and
from henceforth it was nearly all that was attempted. He lin-
gered on, greatly emaciated, until sometime in July following^
when death came, a much desired messenger, to relieve his
agony.
Aud now as to the post mortem appearances :
On opening the abdomen, the first thing that occurred to us
worthy of remark, was the omentum highly injected with blood,
a part of which was thickened and of a dusky red colour, shewing
established inflammation, the missentary about the duodenum, and
the bowel itself was much inflamed externally, the stomach and
upper bowels were much distended with flatus. But on open-
ing the stomach or inspecting its outward coats, there was but
little perceptible derangement. Everything almost presented a
healthful appearance, excepting at its contiguity with the liver
and as it approximated the duodenum. The peritoneal coat of
the smaller bowels was filled with small vessels, but may this
not have been the remora of the blood from the atony of disso-
lution, their vascular capacity having been increased by previous
excilement ? The colon and rectum presented less ambiguous
marks of positive inflammation, but was accounted for, from the
circumstance of his having used to a great extent, stimulating
enemata, such as spirits of turpentine : solution of salts and soap,
and even tobacco. This was expected to be the case, as evi-
denced by slimy or mucous stools, tenesmus, &c. The left kid-
ney was enlarged, and its capsule contained several ounces of
whey colored lymph. The internal kidney was not farther ex-
amined, as our time was limited. The spleen was uneven, hard
and tuberous; but is it not fair to conclude that this was only the
legitimate offspring of his former intermittents. There was sit-
uated on the left crura of the diaphram or abdominal surface, an
abscess or collection of sero-purulent matter, containing about an
ounce, but could not be traced by any morbid connection to the
original disease of the gall bladder. The gall bladder was
completely impacted with the calculi even to the ductus commu-
nis choledochus ; several of the smaller size had made good their
way near the opening into the bowel, and others were lodged
part of the way ; but the coats were so thickened, that the pas-
sage seemed almost totally obliterated. The coats of the bladder

200 Rem ark all encase of Biliary Calculi. [Nov.

itself, were about the thickness and density of the cutis vera of
the hand, having rather a callous than vascular appearance.
Adhesion had formed pretty extensively around the neck and
bowel with thickening and increase of substance. The bowel
was still more extensively inflamed, involving most of its mu-
cous surface: part of which exhibited patches of ulceration.
There may have been about a teaspoonful of dark viscid bile, as
it were, percolating the stones which presented surfaces of such
perfect coaptation as to afford but very small interstices between
them. The volume of the liver was enlarged and filled with
grumous blood, and on the under surface considerably indurated.
The lungs and chest were normal so far as examined.

I have thus presented some of the prominent symptoms of this
interesting case, and will now conclude with the following inter-
rogations :

1st. Is it possible that the first attack was produced by calculi,
which have remained there ever since, harmless for the most part,
except on extraordinary causes co-operating and arousing tempo-
rary inflammation ? or did the first formation pass off, and a suc-
cession of them produce the different paroxysms under which
belabored?

2nd. Is it fair to presume that originally, there was but one
large one : and that it became broken and comminuted, and
smoothed by attrition as we see them ; or were they so many
separate formations ?

3rd. Could surgery afford any possible prospect of remedy in
such cases, provided our diagnosis of them were perfect?

Remarks on the foregoing case, by P. F. E.

1st Remark. Assuredly the calculi were formed separately;
each one, in all probability, having its own nucleus.

2nd. No surgeon would be justified in operating in such a
Case, though the diagnosis were clear. The gall bladder has
truly been punctured, and hepatie abscesses are opened, without
the loss of life; but to <u( for stones in the gall bladder, is an
Operation certainly not recommended in the present state of
medical science.

1837.] Mcrcureal Preparations in acute Fevers. 20 1

ARTICLE II.

Employment of Mcrcureal preparations in acute Fevers and
other diseases. By John B. Gorman, M. D., of Talkot-
tou, Ga.

Known to Paracelsus among the first, preparations of this
metal in his hands, we are assured, succeeded in curing some
obstinate diseases, irremediable before his time. It procured for
this great, but eccentric man, a wide spread reputation, anticipa-
ted him in the annals of his science a half century before his
time ; and gave early to the world, indubitable proofs of its
great medicinal powers. No article of the Materia Medica, ex-
cept the Peruvian bark, has been written on and discussed with
so much fierceness, as the subject of our paper ; and, on this
account, our services may be deemed a superfluity. Climate,
locality, whatever modifies constitution, must, however, modify
the use of all remedies. In the middle country of Georgia,
twenty years now we have been an eye-witness of the opera-
tions of this remedy on the economy, gathering up its history
and value. And the justness and truth of many of the remarks
about to be offered must, we think, meet the experience of many
of our cotemporaries. We know, however, that prejudice and
inability inseparable from us, prevent men from seeing the same
thing alike, and that there must exist difference of opinion.

The fortunes of this medicine, have been various in the ex-
treme. Its exploits in the field of disease, have caused it to be
esteemed a Divinity, and procured homage. Again like Vulcan,
it has been thrust down from heaven, and figured a tattered vag-
abond on earth; and more respectable, it has been received at the
court of kings, and refused at the beggar's hovel. Blasphemed
by some, adored by others, its friends and enemies warring
throughout the world, it became, at the same time the phantas-
Thagotia of human folly, monument of human weakness, and
the Boanerges of the Materia Medica. Its checkered fortunes
and history show the powerlessness of our art, and infancy of
its science. At the present day, by some parties in France, its
use is too much contracted ; in Italy, too much expanded by

202 Mercureal Preparations in acute Fevers. [Nov

the contra-stimulists, disciples of Professors Rasori and Tom-
masini; lavished in Spain, England, and the United States,
and their dependences ; it languishes in Germany in the great
shadow of the Imponderable Biotic of Professor Malthus ;
and assumes a spectors form in the airy nothing of the great,
but deluded, infatuated Hahnemann, and his busy book-noisy
homoeopaths. A general discussion on this subject, is not our
intention ; we have limited our observations to only a few dis-
eases, in which among us, its use is amazingly liberal and diffuse.

Since we have known the practice of the middle region of
Georgia and South Carolina, and we believe it is pretty much
the same in all the South Western States, in the form of calomel,
it has been very bountifully employed in acute fevers.

The character and essence of these fevers are esteemed bilious;
and calomel as a remedy against, bile, has passed into a proverb;
To this circumstance, in part, may be attributed the great and
often imprudent use made of it. The people and patients expect
calomel, and, at the peril of his popularity, should the case prove
fatal, the Doctor must not refuse it. The people help to make
Doctors.

In the first stage of the disease, it is used as a cathartic. But
should death threaten, the deck is soon cleared, all hands at
work, and its salivating powers invoked, and put in fidl and
desperate operation.

The Doctor gives his last triumphant look ; " if the patient
can now live until salivation take place, he is safe." " The
Lord send it," respond the weeping friends ; and the falling
shower of tears is staunched.

With aching hearts, they watch around the bed ; the watch
is set, the Doctor, the busy Doctor, pours in the drug, and
blacking the body with ointment, applies all his mighty art. sole
dependence now, and pivot on which all hope turns.

Night after night you behold the taper burning ; stillness
and silence reign, except a sob or a sigh unconsciously breaks.
The ticking of the watch and beating of hearts are only heard,
a w; tking a we and black fore ibodhi gs of death. The fai thful dogs
seem to lie still, and participate ill mourning.

By day, by night, on his cheek still burns this August's sun ,
the fever's dark red spot, thirst torments him; he sleeps

1837.] Mercurial Preparations in Acute Fevers. 203

he dreams, frightful visions are passing before him torment
him; he half-wakes and mutters delirium, which is responded by
a low, mournful groan. His virgin sister startles up, her beauty-
more tormenting by her flowing locks and neglected dress ;
she grazes with all her touching force, upon his parched face and
shrunken features, and bursts away to weep. The next mo-
ment her mother follows, but soon they both return to the seat of
action and sorrow. The father's firmness is in his manly soul ;
he feels, but remains as something firmly planted to the spot.

The Doctor, as a benefactor from the sky, again arrives, the
air is again breathed ; and joy springing, cramped by unsub-
dued despair, waves slightly through their features ; and is seen
through glistening tears. He examines very scientifically, and
pronounces " the looked-for harbingers are present" salivation
has commenced, his hope, his confidence, and safety ; " the
fever must now vanish" " He has conquered at last." With ev-
ery sinew they exert confidence. " The Doctor knows." But
alas ! The words he pronounced with the lips of Satan, inspired
by his own ignorance ; the promises he has made to sinking sor-
row, the hope he has excited and upheld by unworthy confidence,
soon reveal their reality, and his unblushing shamelessness.
It is putrefaction commenced ; horrible putrefaction ; where
health and recovery were sacredly promised and insured. Black-
ness covers the teeth, the tongue is thrust far out, the mouth
swollen ; the eyes, sunk deep and dewy : the throat, tumid ;
the soul's fair expression, lost forever in palsy ; the features
twisted, distorted, demon-shaped. Horrible stenchfulness and
dark cold night gather round him ; and nothing remains now
to distinguish the life, except the little dark red spot on the
cheek, which is now growing paler for actual dissolution. The
grave-clothes are finished the lights are put out ; and frittered,
exhausted nature drops into long and protracted sleep.

In this last scene and struggle, the Doctor has not participated.
His great work terminated in procuring salivation, passed this,
passed all hopes, except the grave. He meets, sees them again
clad in the dark livery of their sorrow and misfortune. They
press round him shake his hands ; their looks express kindness
and gratitude. "He did his best." "It could not turn as he
desired." " No one could have been more kind, assiduo?is, and
b2

204 Mercurial Preparations in Acute Fevers. [Nov.

faithful; all his looks, his language showed his concern.
Providence* had ordered it so."

11 Gluomodo tacuisse Dii Immortales Possunt."

The truths of this picture should excite horror for medical
stupidity and un worthiness. And we remark: than physi-
cians, no people on earth enjoy, for the services they render, an
equal weight of love, kindness and gratitude the flower, beauty
and loveliness of the human heart.

To be ignorant and be a physician, none but souls fallen ,
from Adam a second time, low, dastardly with the stain of a
second sin, can submit. Their whole life of practice can be no
other than a black tissue of hypocrisy, falsehood and deceit ;
hypocrisy, to conceal their ignorance ; falsehood, for they most
constantly speak of what they do not know the truth ; and de-
ceit, to keep up their trade. To be the means of ruin and death
to their best confiding friends ; and, in return, receive thanks,
gratitude and fortune inverting nature ; to be the firm reliance
of sacred hope at a holy hour between worlds, and, only its
wicked mockery. The thing exists, for the people can never
be correct judges of skill. O horrible ! Shocking !

" His warm blood the wolf shall lap,
The eagle, her wing shall flap
O'er the false-hearted " Doctor."

In the picture and case before us, the febrile excitement had
reached its maximum under depletion by calomel, and, perhaps,
some auxiliaries. The symptoms are unsubdued, the fever still
rages, and loss of confidence ensues in the course pursued.

Suddenly all depletion is stopped, and calomel combined with
opium, or some astringent is given with a different view to ef-
fect salivation quick as possible. Often considerable quantities
of opium are required, as the medicine is thrown in freely, to
prevent its passing off. Here then, the whole system is sud-
denly locked up, and at the very moment, when sedataion, cold
sponging, local sanguine emission, cautious alvine depletion,
free cooling diluent drinks, &c. are most loudly called for, and
would do more to calm the raging malady, than at any other
period before. But what ensues ?

* Pardonable blasphemy to sage the Doctor.

1837.] Mercurial Preparations in Acute Fevers. 205

The liver is active from the disease, rendered infinitely more
so by the constant stimulations of the previous calomel ; the
bile, which before had a free passage, now is clamorous for evac-
uation, and more opium must be given to save the salivatory
from passing.

A sudden and violent shock is thus given to all the systems,
inducing a new order of movements. The mucous alvine secre-
tions being suppressed solicits to action the organisms con
nected in dependence and subordination with this tissue revul-
sion. Shades of icterus tinge the skin ; copious exhalation
takes place from the serous membranes, as is proved by tension
and soreness of the abdomen, fulness and tightness of the chest
with some cough, of those who recover. Some effusion escapes
from the arachnoid, one of these tissues, and the brain is slightly
compressed, as is proved by these cases almost always manifest-
ing and terminating in what are called typhus symptoms. The
urinary secretion becomes scarce, thick and higher colored. The
skin is more parched, dry and rough, all manifesting a decided
diminution of secretory, excremential elimination.

Thus a new stimulus is offered to the circulating system.
The blood arrives at the right side of the heart more heteroge-
nous, loaded with more highly stimulating matters, which ad-
ded to the stimulations of calomel and opium so freely given,
augments its velocity of motion. Nutrition, so important* to
life, is nearly suspended. The powers of the cerebrospinal
functions, must participate in the exhaustion now inevitable
death horrible, or nature pitying, snatches tier tortured offspring
from the barbarous hands of its persecutors, and saves by her
own matchless skill. But to follow this practice out :

By a law of diseased action, all the alvine secretions sup-
pressed, the serous membranes are excited to secretion. The
malaise of the chest and abdomen, are not noticed ; that of the
brain, or slight compression of the arachnoid, engrosses all at-
tention. It is considered an actual inflammation of the brain
itself, the disease is changed into typhus, proved to be so by the
lesion of the mind's faculties thus assidiously procured by my-
opia, strabismus, $-c. The head is shaved, and a powerful

* Physiologic Compare, Tiedemann.

206 Mercurial Preparations in Acute Fevers. [Nov.

blister applied ; if action be sluggish, blisters over the body.
The patient rises from this typhus made and cured, as from
the fangs of a hyena, or grasp of a vampyre, to a long and te-
dious convalesence ; or disfigured, dilacerated, exhausted through
accumulated ills, sinks to the " long rest of Osiatfs narrow
house"

In the first case, the patient is rescued from the new disease,
typhus, unwittingly brought about by this hot, stimulating, in-
cendiary treatment, exhausting all forces, producing derange-
ment and congestion, calling forth secretions and compressions,
which would have remained quiescent under different manage-
ment, or nature left to herself undisturbed. But unfortunately
for humanity, tins typhus is considered only as a stage, and
natural part of the primitive fever, and never once is dreamed
of, as the offspring of art. This is the fearful delusion !

Since the antiphlogistic and sedative treatment of fevers has
increased in popularity, the annals of our science share and
prove, that this sort of typhus is fast banishing the world ; and,
as much warring as has been published on this subject, it has
not had its weight, where it has been our lot to live and observe.

Among us it seems to have been more or less confounded with
the typhus of European writers ; and their stimulating plans
have been employed. Yet nothing can be more distinct, than our
typhus or cerebrospinal exhaustion of our pleurisies and au-
tumnal fevers, and the typhus or jail fevers of Europe, propagat-
ed perhaps, by a peculiar infecting principle, of which all the
phenomena are the particular offspring.

But to resume : In the last case of our patient, he sinks
through nature outdone, the total subversion of the subordina-
tion of his living functions. Let us now attempt our explana-
tion of the mechanism of recoveries, in similar circumstances,
from this mode of modification, which, to some extent, may ex-
plain the prevalency of its continuance in use.

Salivation is the ultraism of medicine in the geographical
limits of our paper, and almost universally resorted to in all
diseases grown desperate, after other remedies have failed of
success. I believe we are very well established in this assertion,
although there may be exceptions. It has been so now for
twenty years, and how much longer before, is not known.

1837.] Mercurial Preparations in Acute Fevers. 207

Since, however, the introduction of quinine, many more cases
are cut short ; and much fever, we may suppose, fail to chal-
lenge its employment. Continued fevers chance the oftenest.

It is the last, solemn, farewell ceremony the Doctor performs
for his patient, something that can be done always, when noth-
ing else is known ; a forlorn hope, to which ignorance, blnck
ignorance, holds the torch ; in repute three fourths of a century
ago, whence our fathers came ; that long-since eradicated and
driven hence, now in the New World, puts forth its autumnal
bloom.

Among us, however, as it is not taught in our schools, and
has not the sanction of teaching, it is highly probable, it is born
of false experience the " experientia falax' of Celsus, who
calls it the Demon of medicine.

1st Resorted to, as it commonly is, in the latter stages of at-
tacks ; and, often at the very moment when nature is preparing
the crisis and sweet repose of the patient, being a stimulus of
pretty high powers, its stimulations were sometimes not unwel-
come, if of the right sort ; and the only material effect it will
have, is to make the recovery long and painful, and upon fu-
ture health.

Here, unfortunately, the recovery is attributed to salivation,
the only services of which, if any, were to stimulate at a press-
ing and necessitous hour ; to entail afterwards, sorrow and a
long catalogue of evils, especially if pushed in extenso.

Flushed by supposed success, the deluded physician tries it
again ; and, thus this idolatry this Juggernaut of medicine is
kept alive in the nineteenth century, against all the lights that
burn.

2d. It is administered when the case becomes desperate at an
earlier period, and, before prostration. Now it has the opportu-
nity of exerting its most deadly mischief, the prospect being still
fair and possible, by proper treatment, or powers of nature, for a
favorable termination.

It commences its work by the improper stimulation of its own
means ; by the opium combined with them ; by suppressing the
secretions, source of new stimulations, before its own can take
place ; by exciting, as we have said, revulsive secretions, which,
without its interference, would not have existed in the natural

208 Mercurial Preparations in Acute Fevers. [Nov.

order of the disease ; by consequent arachnoidel secretion and
compression, bringing about by the aid of hyper excitation thus
procured. Cardiaco-cerebro- spinal exhaustion, or which is
the same thing, this Georgia Typhus, and death, or something
like a spectral resurrection from it.

But it is never supposed, this salivation, deep, thrice deep,
killed. Death is always attributed to the typhus, inflammation,
compression, mortification, to any but the true cause, or the
Doctor's trade and reputation would be spoiled. Horrabile dic-
tu O luctum veritatis ! 1

3. Salivation is resolved upon, when the disease has main-
tained apparently its energy until a late period ; just before the
forces are about giving way ; the vital unity of action growing
weak ; and the system beginning badly to obey the helm of life.
Under any circumstances or treatment now, the case is desper-
ate. Salivation here must cut off all hope, and procure
death-
In this case the oxydizers or lungs are spending hsematosis,
imperfect, the circulatory enginery, exhausted, the tendency to
capilliary stasis, universal, nervous irradiation, partial, natural
chemistry, on the incipient failure of the vital, beginning to af-
fect the whole fluids and solids : life soon must flutter, strug-
gle, salutary secretions from any quarter, impossible.

The only effect mercury, as we have said, can have in such a
case, is mortification, to which there is an universal proclivity
and death. But it is given lavished in proportion to the case ;
its wonted secretions eliminating its force, impossible ; the tis-
sues wont to elect and appropriate its action, ramolesce and
blacken, hideous putrefaction and stench threaten away from
the couch, weeping sorrow, tenderness and love ; the pious
spirit pure clean loathes the binding fetter, which breaks,
and it rises/a/r the body sinking into a scathing mercurial Hell.
I write no fable ; again and again with the most pained sen-
sibilities, have I been compelled to witness such cases, which
I have said among us are common ; and a great number of
which, from much and long experience, and practice, would
have yielded readily to a different treatment. Our reasoning,
and the coloring given to these cases, may be doubted ; but the
facts must challenge experience and belief.

1837.] Mercurial Preparations in Acute Fevers. 209

\\ 'c remark on the fir.st of the three cases : Employed under
these circumstances, we have often known the patient to recov-
er, and get on his feet before the salivation came on. Now con-
fined to his bed again by the medicine, he struggles long through
suffering and horror more severe than his first attacks, to die
from exhaustion at last, when the stimulations of the salivant
begin to abate ; or rises from his bed exsanguinated, shrunken-
eyed, hollow-featured, with a troublesome cough, to recover
finally next year, or never regain completely his former health.

In the 2nd case : To salivate the antiphlogistic and sedative
treatment is abandoned, at a most precious time, when it could
do its greatest work, and turn the doubtful scale on the right
side. When the whole system has arrived at the greatest ex-
citement, hot, stimulating salivation is employed, helping out
disorganizing" inflammation already existing, dematurizing all
action ; producing ut supra, typhus and death ; or salivation
and the fever run on together, as we have often seen. Nature
triumphs over opposition at last, or mercureal exhaustion and
death come apace.

In the 3rd case : Salivation is open murder and death, as
has been seen tolerated homicide almost in the presence of na-
tural death. But does this paliate the crime ? a high offence,
against which there is no law, as if it were right to kill a man
likely to die.

If the patients die in China, the law puts all the Doctors* to
death ; if they kill in Georgia, the law protects. Which is the
most reasonable rather absurd and abominable?

In conclusion: In all acute fevers, salivation should never
be employed. This practice has ever been absurd, wrong;
arose from false facts and false experience at first ; and sustained
afterwards by prejudice and ignorance. Its apparent good with
a long train of evils, is most always, by its stimulations. But
these, in a very superior degree can be promptly procured by
opium, camphor, brandy. Could it be known and believed, the
good of salivation arises from its excitements, the delusion would
vanish forever ; and those of the opium, camphor, &c. substi-
tuted in its place.

* Staunton's Embassy to China.

210 Mercurial Preparations in Acute Fevers. [Nov.

What a renovation of good and comfort would it be to the
present practice, so much and so extensively pursued ; a practice
which has prostrated our art, and brought the whole of our
Materia Medica into disrepute among a great portion of the
illiterate world, which has mainly set up a new species of quack-
ery, and given it the most convincing and revengeful argument
against us, in the minds of the people. What but mercury and
its odious, hateful salivations, have given rise to so much talk
and noise about medicines purely vegetable ? and emboldened
its makers and venders ? It is mercurial vengeance the sin
of its unholy use revisited upon us 1

In final conclusion, we would consider mercureal purging,
and the, secondary effects of this drug in its altei^ative use.

Take now, especially about the approach of Autumn, the
healthiest man, and give him daily purgative portions of calo-
mel. Soon he will become quite bilious, throw it up of the
natural color, and pass it copiously by stool ; and soon, derang-
ing the natural healthy state, it will become turpid and black.
Fever will be declared; still purge him as before. It grows
desperate ; now touch him ; salivate him deeply \ typhus ut
sapra is declared : shave his head and blister him freely, and he
recovers. But he labors under the slight cough, feels the pecto-
ral and abdominal malaise. After some time he is attacked
with bilious colic. His liver is hypertrophied.

Again : The patient has some fever ; is sick ; his physician
carries him through as above. At length, he is troubled with
excessive bile ; suffers from abdominal pains. His physician
comes again, touches him now slightly to cure this bilious col-
ic : and recommends him occasionally to take a dose of calo-
mel when 'he feels it coming on ; and the more and the oftener
it is taken, the more it will be needed.

The drunkard wears his shame in the efloresence of his face ;
but the intemperate in mercury, his scar deep hidden in the liv-
er, the glands, the mucous and serous tissues. Thus, he who
was once free, has made a thorough bilious constitution thus
procured. His liver, etc., is hypervrophied ; he tends to dropsy
and wasting death. Nothing but a change of climate and coun-
try, and abandonment of the medicine which brought it on,

1837.] Mercurial Preparations in acute Fevers. 211

can redeem and save him from his own unconscious impru-
dence, and his Doctor's folly.

A great number of cases purely of this character now actu-
ally exist within our knowledge, and some under our care.

Again : The patient has fever, but not bilious. Calomel is
lavished ; the quiescent liver becomes irritated ; its irritations
may now operate with the original cause to aggravation, or sup-
plant it entirely, and become itself, the focus of universal irrita-
tion or fever, which will run on to destroy the patient ; or he
recovers exhausted, making this of what would have been a
very light and mild case, a mortal or desperate and frightful
one.

Again : The patient has fever, is bilious and of the bilious
temperament. A large dose of calomel might be of great ser-
vice and the best remedy ; but keep it up, and it is sure, like the
rest, to become a bad one, but with a little more certainty.

In any of the cases above, calomel might be admissible, nay,
the very best for the patient, but must not be repeated or per-
sisted in. But in the following, a single dose might ruin all
hope and the brightest prospects. The patient, with great de-
pression has repeated spontaneous bilious dejections ; his gastro-
intestinal mucous tissues, highly phlogosed, the valvules conni-
rentes developed, closing up greatly the passage.

Now touch him with a good dose, (common practice,) and
you may touch a magazine to blow him up ; or he escapes, a
tattered relic of what he was, or of what, under other treatment
he might have been.

I will mention here a great truth : Calomel as well as the
bile, is very apt, very commonly excites the developement of
these valvules closing or narrowing up the passage ; which,
now it is lavished to force, urging on ruin by ruin.

We know from Moseley, Hillary, Jackson, Cleghorn,
Johnson, Bancroft, from a host of such from French and
Spanish writers, from our own experience, that in tropical and
citratropical climates, the liver figures and reigns the most con-
spicuously tyrannizes in this great theatre of disease. It is the
same in our country.

Why, then, in our treatment, have we considered, do we
provoke wontonly and unmerciful I y the anger, and rage, and
c 3

212 Remarks on Debilitants and Sedatives. [Nov.

opposition of the liver, the lion, by universal consent, of this
great austral hemisphere of sickness and death? Rather let us
quiet it when it can be quieted, and as soon as possible ; when
quiet and in its proper place of action, not provoke ; when out
of place, torpid and the economy in need, arouse it to effort.
As soon as possible for it is true as we have said, by improp-
erly exciting it, for it is generally and almost always too active
under our autumnal sky, it can easily supplant the primitive
febrile irritation, and become itself the burning focus of the
fever leading on unquenchably to the tomb. Not to provoke it
when its function is straight with the economy ; because we
get rid of great perplexities, difficulties, and prospective danger.
To arouse it, because its influence is natural.

But we are not writing on practice. We avow it : we have
no interest but the profession to serve. You ask for proof. We
must refer you to the symptoms while living ; and the truth as
it is recorded in the dead man's body, and we will not fear. We
ask pardon of our coternporaries ; and by those who are making
up their opinions, we would be heard.

ARTICLE III.

Remarks on Debilitants and Sedatives. By Dr. Joseph A.

Eve. [Continued.]

Cold. The abstraction of Caloric is the next subject that
demands attention under the head of Debilitants.

Of the stimuli that are essential to the production and main-
tenance of vital phenomena, caloric is one of the most active,
universal and constant in its operation ; hence its abstraction
must be attended by a correspondent depression or diminution
in the manifestation of those phenomena, or in other words it
must necessarily lessen organic action and cause debility.

Caloric is essential to organic action, the former appearing
to stand with respect to the other, mutually, in the relation of

1337.] Remarks on Debilitants and Sedatives. 213

cause and effect, and of effect and cause : for we observe increase
of action is always followed with augmention of heat, and de-
pression of action with diminution, and on the other hand we
invariably find elevation of temperature increases action, and
reduction depresses it. It would certainly be superfluous to ad-
vance arguments to prove that cold or the privation of caloric,
in its direct effects, is most decidedly and eminently debilitating
its depressing and torpifying influence, on man and the whole
animate creation, is too obvious to require proof the actions
both of animal and vegetable life are suspended without an ade-
quate supply of caloric. Abstract caloric from the system, and
immediately " this sensible warm motion becomes a kneaded
clod."

It is true persons feel stronger and are not so soon fatigued
in moderately cold, than in warm weather ; hence some physi-
cians consider a moderate degree of cold, as exciting and strength-
ening : but this is unphilosophical, cold being nothing in itself,
but simply the absence or privation of heat, cannot possess any
stimulating property. The reason that we feel weaker during
a hot. day, is becanse the excess of caloric stimulates too much,
and induces indirect debility it is because a moderate degree of
caloric, not a moderate degree of cold, is more congenial to
strength and muscular exertion, than the excessive degree of
the former, which constitutes what we term a hot day.

The temperature most conducive to strength, and compatible
with active exercise, is altogether relative, depending greatly on
the circumstances, habits,&c. of individuals; those recently accus-
tomed to severe cold, feel oppressed and overcome by heat in
weather which is at the same time distressingly cold to those
accustomed to intense heat.

"The effects of cold, (says Begin,) have been the theme of
endless discussions, on which a proper study of the laws of the
organism has alone been lble to shed some light. According
to the state of vigor or debility of the patient, and the extent,
intensity, and duration of its action, cold is either an useful
tonic, a powerful irritant, or a great debilitant. Its impression
may even cause death, by checking all motions in the organs."

The action of cold as a tonic or irritant depends on the prin-
ciple of reaction. When the body or any part of it has been

214 Remarks on Debilitants and Sedatives. [Nov.

exposed for a length of time to a very low temperature, the ex-
citability accumulates to such a degree, during the privation of
the accustomed stimulus of caloric, that on its sudden restora-
tion reaction takes place with such violence, that intense irrita-
tion and not unfreqently disorganizing inflammation is the
result, as exemplified in frost-bitten limbs, &c.

Reaction is always proportionate to the degree of subsequent
depression. If the system be subjected to a moderate degree of
cold, and restored to the natural or ordinary temperature as soon
as reaction commences, the tonic effect will be evinced, as dis-
played in the employment of the cold bath for its tonic influ-
ence on the system. As the patient enters the bath he shivers
and continues benumbed and torpified until reaction is estab-
lished, when he experiences a sensation of warmth as though
the water around him had suddenly become warm, and feels a
genial excitement pervading his whole system : if at this mo-
ment he should leave the bath, he will feel excited and invigor-
ated, and enjoy in the greatest degree the tonic effect ; but should
he remain in it longer, this pleasant excitement will subside,
and the depressing effect of cold be again realized without any
farther alternation of reaction.

Cold depresses excitement by abstracting caloric, which as
an excitant produces and maintains it : it is upon this principle
that it is employed so extensively, and with such beneficial re-
sults, both in medical and surgical practice, for subduing action,
allaying pain and restraining hemorrhage. The operation of
cold water, ice, and other cold applications in abstracting caloric
depends on the disposition this subtle fluid has to diffuse itself
equally through all bodies in contact or proximity the warmer
or those that have more caloric imparting to the colder or those
that have less, until an equalization of temperature is established
between them. When in the treatment of disease the abstrac-
tion of caloric is indicated, availing ourselves of a knowledge
of this principle, we fulfil the indication by means of cold ap-
plications to the part or organ whose excitement we wish to
reduce. For this purpose we usually employ water, ice or snow,
because they are generally most convenient, but a great number
and variety of means are practised for the abstraction ot calo-
ric : exposure to cool air, cold cataplasms, mud, clay, cold metal,

1837.] Remarks on Debilitants and Sedatives. 215

evaporating lotions, &c. Nor are we confined to the external
surface, in the administration of means to reduce excitement by
the abstraction of caloric, the stomach and intestinal canal may
with equal convenience be treated on this principle, through the
medium of cold drinks and cold enemata, which often prove
very efficacious resources, in high grades of gastric and intes-
tinal phlogosis.

The following paragraph from M. Begin's work on Thera-
peutics, is most graphically descriptive of the effects and lucidly
explanatory of the principles involved in the operation of cold
applications.

u The primary object, (or rather effect) of cold is to condense
the tissues, draw their elements closer, and increase their thick-
ness and solidity. The skin is clutched and covered with asper-
ities occasioned by the projections of the bulbs of the hairs and
that of the sebacious follicles. The parts covered with cold
topics turn pale, owing to the contraction of the vessels which
cease to admit as many red particles of blood, and in which the
circulation becomes less active. iVccompanying these phenom-
ena, the local nervous action is diminished, sensibility lessened,
and a notable numbness felt in the parts that have grown cold.
We must not think however, that this state is continued, during
the whole time of the application ; for soon after the first im-
pression has been received, and though it may still continue to
act with equal force, a reaction always takes place in all the
parts submitted to the operation of cold, the blood is propelled
toward them with renewed and increased vi^or, the parts become
more or less red and painful, and experience a sensation of in-
tense and even burning heat." "But these sensations are not
of long duralion ; they disappear gradually and the debilitating
action is soon reproduced. Then the tissues remain pale, cold,
and hardly sensible ; the action of the capillaries is diminished,
the irritation is suspended and soon disappears entirely." To
the action of cold is then subjoined the emollient and relaxing
effect of water which serves as a vehicle to the former. These
changes produced by cold applied to the tissues or to the skin
which covers them, appear diametrically opposed to those deter-
mined by stimulants. In this respect, cold applications consti-
tute one of the most efficacious debilitants we possess. They
are employed in two opposite circumstances; the one where
there exists no tumefaction nor irritation in the parts, and when
it is only necessary to prevent those accidents, as in contusions,
sprains, &c. ; the other, when the irritation and the phlegmasia
have already made their appearance. In either case, we may

216 Remarks on Debilitants and Sedatives. [Nov.

cover the parts with pounded ice wrapped in a bladder, piece of
parchment or oiled cloth or rather plunge them into a vehicle
rilled with cold water, if the shape, function or situation of the
parts will permit/'

From not properly understanding the principles concerned in
the operation of cold as a therapeutic agent, there is much diver-
sity of opinion on the subject, and much contrariety of report
upon its efficacy. Some regard it simply as a debilitant, whilst
others look upon it as a stimulant or tonic, and others again view
it in the light of an energetic astringent ; whereas when we
properly comprehend the true principles involved, all difficulties
immediately disappear or admit of easy explication.

We have already seen that the modus operandi of cold is that
of a direct debilitant. acting on the principle of abstracting
stimulus, and that its action as a stimulant or tonic is only sec-
ondary and temporary, depending on the principle of reaction :
little reflection will convince us that its effect in condensing the
tissues is not attributable to any astringent property possessed
by water, or by cold, which is nothing but the absence or priva-
tion of caloric ; the condensation produced by the application of
cold water is the result of depressed action, the excitement being
reduced in the part, less blood is attracted to and retained in it,
in consequence of which the capillaries collapse which renders
the tissues more solid. Let us for a moment contemplate the
modus operundi of cold water in arresting hemorrhage, which
is generally, though erroneously, ascribed to its astringent pow-
er. Under the influence of irritation, an afflux of blood is deter-
mined to the organ from which the hemorrhage proceeds, cold
water by withdrawing the stimulus of coloric reduces the excite-
ment ; the blood therefore is no longer attracted to it in undue
quantity, the vessels contract and the effusion ceases.

We have the administration of cold so much under control,
and can regulate its action with so much precision, the conjoint
exhibition of sedatives is not so essentially necessary, as in the
employment of bloodletting ; for reaction being always in corres-
pondence to the degree of depression produced, it can always
be regulated, by commencing with a moderate degree of cold
and by making, after reaction has subsided, applications of more
intense degrees which may be continued as long, or repeated as

1837.] Remarks on Debilitants and Sedatives. 217

frequently, as the case may require, without any of the remote
dangers consequent on blood-letting. Hut the combim d admin-
istration of sedatives is often productive of very marked benefit,
as exemplified in the superior efficacy of cold saturnine lotionsT
solutions of morphine, of prussic acid. dec. to that of simple cold
water, in subduing inflammation and allaying irritation.

Bloodletting and the application of cold, both act upon the
same principle, the reduction of excitement, by the abstrac-
tion of stimulus ; their comparative advantages may be thus
explained : In a violent fever or inflammatory affection, when
there is redundancy of blood in the system, and the strength of
the patient previously unimpaired, nothing can prove a substi-
tute for copious sanguine depletion ; the lancet stands unrivalled
in efficacy ; it is our chief reliance, the anchor of hope, the tal-
isman of safety : until blood has been freely abstracted, the relief
afforded by the employment of cold applications must be tem-
porary and ineffectual, somewhat comparable to the temporary
smothering of a flame by heaping fresh fuel upon it, which soon
bursts forth and blazes more furiously than before ; thus the ex-
citement allayed, not subdued, will reappear and rage with in-
creased violence. But when, notwithstanding copious sanguine
depletion, there is still violent action and intense pain, with
determination to some part, especially if it be to the head, and
the case do not justify farther loss of blood, cold may often be
employed with signal benefit. It reduces excitement without
expense of the vital fluid, the debilitation produced is conse-
quently less permanent, though it may be continued long enough
for a suffering or^an to recover its normal state. Bloodletting
and cold act both on the same principle : the difference in
their effects depends on the difference there is in the nature of
the excitants they abstract, both of which are equally essential
to life and the maintenance of excitement. When blood is taken
away, it is replaced slowly by assimilation, which process is often
interrupted by the disease for which the bloodletting has been
practised or by the debility consequent on the loss of blood, or
it may be restored by transfusion which operation is attended
with much difficulty and uncertainty; whereas, when caloric is
abstracted, it is soon renewed by the system itself, or by external
means if necessary.

218 Remarks on Debilitants and Sedatives. [Nov.

Inflammation acts as a stimulus, exciting the action of the
heart and arteries, but excessive action always exhausts the vital
powers, and induces indirect debility, so that when it subsides
or is subdued, the energies of the system are greatly depressed.
Now it is certain, if we can reduce inflammation and prevent
the inordinate, exhausting action consequent upon it, by cold
applications or the conjoint administration of sedatives, with the
expenditure of less blood ; in the same ratio will the powers of
the patient be preserved, and the typhoid type less likely to ensue,
and the patient sooner recover his accustomed strength.

When it is deemed expedient to employ a very intense degree
of cold, it will be proper to avoid a sudden and vigorous reac-
tion, by commencing with an application of moderate tempera-
ture, and gradually reducing it down, even to ice itself if desir-
able.

The necessity of keeping cold steadily applied, or of renewing
cold applications as often as maybe required to keep them from
becoming warm, is too obvious to need even an allusion to it ;
were it not that a neglect of this caution too often obviates en-
tirely the good effects of this valuable remedy. It will of course
be necessary that the application of cold be continued long
enough, not only to extinguish the irritation in the parts to which
it is applied, but to destroy their disposition to react against its
impression, otherwise the consequent reaction will very proba-
bly increase the irritation and congestion intended to be re-
moved. Snow, ice, or a degree of cold as low as zero, which if
general would soon extinguish life, may be applied to parts of
more or less extent, constantly for days and even weeks, not
only without danger, but with the happiest effects.

Thus have I endeavored to explain the modus opearndi of cold
as a therapeutic mean, and to set forth the most important prin-
ciples that appertain to its employment ; it would be an agreea-
ble task to elucidate and illustrate those principles more fully
by a practical application to the treatment of disease, but that
would be incompatible with the limits I have prescribed myself
in my remarks on debilitants and sedatives.
[to be continued.]

1837.] Medical Statistics. 219

PART II.
REVIEWS AND EXTRACTS.

Medical Statistics.

The following paper, by M. Double, on the question of the
inapplicability of statistics to the practice of medicine, contains
much ood sense and fair reasoning. The results at which he
arrives are true and unavoidable, and it is most unfortunate in
medicine that so few can come to realize these truths, and adopt
"the only methods admissible in practical medicine, analysis,
logic, and induction" in each particular case under all its present
circumstances.

We give the essay in full, as extracted from the London Med-
ical Gazette by the American Journal, with the editorial of the
latter.

This question has been recently brought before the Royal
Academy of Medicine at Paris, and been very elaborately and
fully examined. The following paper read by M. Double, in
the discussion, excited considerable attention, and we shall lay
it before our readers, as the subject is one of great importance.
For ourselves, we have already expressed our opinions on the
subject, (see our No. for August 1836, p. 489,) and need only add
that it is our continued conviction that until some new problem
in transceudental mathematics shall be devised, the numerical
method can never serve to guide us to a positive method of treat-
ing individual cases of disease. At the same time we disclaim
all wish to invalidate the general usefulness of statistics in med-
icine. But we will not detain our readers further from the ob-
servations of M. Double.

" The science of statistics, is in these days, one of the most
fashionable; and in the ardor of their zeal, its disciples have
applied it indiscriminately to medicine. They have attempted
to substitute mathematical for logical analysis to make arith-
metic take the place of induction and calculation that of rea-
son. Let us, then, consider what some expect from statistics
d4

220 Medical Statistics. Nov.]

applied to medical practice. In mathematical analysis, the pro-
bability of future events is calculated from the observation of
preceding facts, but always under the rules of the universal
laws of large numbers, and without any individual application.
"In medical statistics, on the other hand, the numerical
method is expected to determine from the observation of preced-
ing facts, and according to their number, the best method of
treatment in each individual case which may occur. This,
however, is quite impossible ; and I may remark, that were it
ever affected, medicine would cease to be either a science, an
art, or even a profession ; it would become as mechanical as the
employment of the shoemaker.

" What is called in geometry the universal law of large num-
bers, is the rule and the foundation of all calculations of proba-
bilities. One of the conditions of this law is, that the causes of
the events calculated, though some are constant and others vari-
able, yet can in no sense be said to vary progressively. From
this law it results, that all the differences and irregularities
which balance each other disappear in the quotient : and in this
way the calculations of lotteries, of maritime insurances, &c.
are made.

"But this is evidently not applicable to medicine : neither our
successes nor our failures balance themselves in large numbers,
as in the case of marine insurances. Each of our problems
embraces but one individual ; and besides, diseases always have
their prevailing character, varying progressively according to
an infinite variety of causes.

" M. Poisson, in his new work on the Calculation of Verdicts
given by Juries, writes thus "In most questions of eventuality,
the a priori determination of the chances of events is impossi-
ble, and it is only from observed results that we are able to cal-
culate them. Thus we cannot a priori, calculate the chance of
a vessel being lost in a long voyage, but we must compare the
number of losses with that of voyages when the number is
large, the result is pretty constant, at least in each sea and in
each nation ; but if the calculation be founded on a small num-
ber of facts, there can be no certainty in the reckoner's results,
if it be founded on a large number, the results are almost sure."
Besides this, it must be remarked that mathematicians them-
selves are not all agreed as to the value of mathematical analy-
sis applied to the calculation of probabilities.

"The calculation of probabilities, from its very nature and
professed scope, only makes approaches to the truth; yet its
results have often some degree of apparent certainty. Never-
theless, the facts on which such calculations are founded, are
so vague, uncertain, and variable, that the results are not to be

1837.1 Medical Statistics. 221

depended on, and sometimes the most inconceivable mistakes
take place.

" The numerical method at once supposes and sanctions one
of the greatest errors in therapeutics namely, the adoption of
absolute and exclusive measures. The celebrated problem of
Pickairn "For a given disease to find the remedy" is only
reasonable when understood in this way "For a given indica-
tion, to find the best method of fulfilling it," Each individual
malady is not a simple phenomenon that can be represented by
unity ; it is not certain and fixed, but constantly varying. Thus
the pneumony of to-day is not the pneumony of yesterday, and
the pneumony of Peter is not that of Paul.

As an illustration, consider how disappointed the young phy-
sician is in passing from a lecture or a didactic work to the bed-
side of the patient ; and this because he is transferred from dis-
ease in the abstract to its reality. Take any large collection of
cases: consider the epidemics of Hippocrates, the constitu-
tions of Baillou, the letters of Morgagnj; the consultations
of Hoffmann, the ratio medendi of Stork, &c. how many
cases will you find alike ? The universally admitted law of
idiosyncrasy and of individuality, so infinitely variable, cannot
be included in any calculation of probabililies. Let us first ex-
amine how the numerical method applies to a man in a state of
health. Let us take two hundred healthy adults, of the same
sex, age, profession, and condition : how many shall we find in
exactly the same condition, so that we may say, "this health
and that health make two V Or let us take their powers of in
tellect or of digestion : how many are alike in their intellect?
how many have identical digestive powers ? When the differ-
ent series of uniform intellects and digestive powers have been
made out, a separate and universal method of treatment for
each series has to be invented; and how will you succeed in
this?

" Let. us again suppose that there are in childbed, under the
same circumstances, say a thousand women, and that the news
of some grievous calamity is brought them ; five of them may
become deranged, and the other 935 not have their reason affect-
ed. In calculating probabilities, it is an easy matter to deter-
mine this. But will any physician be therefore satisfied that he
may announce apiece of bad news to a lying-in woman without
danger 1 Or let a thousand men, in a state of violent perspira-
tion, drink a given quantity of ice-cold water : ten are seized
with pneumony, five with gastritis, and five with dysentary,
while all the rest remain in perfect health.

" But from theoretical grounds let us come to facts, and take
the typhoid fever, of which term, by the by, I do not at all ap-

222 Medical Statistics. Nov.]

prove ; for, under it, gastric affections, bilious fever, entero-me-
senteric fever, mucous fever, catarrhal fever, &c. arc confound-
ed. It was this that led to that inextricable chaos of difficulties
in your late discussion on that subject. The mistake was, that
by the name of typhoid fever was designated a certain peculiar
morbid state, which may be a dangerous termination, or a trou-
blesome complication, of almost all other diseases. Thus pneu-
monia, appoplexy, peritonitis, uterine phlebitis, phthisis in adults,
surgical operations, &c. occasionally terminate with typhoid
symptoms.

" Still more so is this the case with bilious, catarrhal, and
inflammatory fevers, which, according to my experience, all
commence the typhoid fevers ; and, though I have seen a great
many cases, I have never seen typhus come on primarily, but
always preceded by nervous or febrile reaction, such as bilious-
ness, an affection of the stomach, &c.

" And here I may remark, that I think it one evil of the pre-
sent state of medicine, that our experience is too exclusively
that of hospitals. We thus only see one condition of life, and
the disease already established, and can seldom retain the pa-
tient long enough to see all the steps by which health is gradu-
ally re-established. It is in these patients, in whom we never
see the commencement of the disease, that we meet with the
most marked cases of typhoid fever.

" Well, then, in this same typhoid fever, can any unique, ab-
solute, and exclusive treatment be assigned ? If the practice of
medicine did not already do so, sound logic would give a nega-
tive reply. Wlp^nwe consider the infinite modifications of cir-
cumstances, the degree of strength, the state of the nervous
system, the moral condition, the idiosyncrasy, the age, the sex,
the country of the patient, the nature, period, and prevailing
character of the disease, &c. &c, we see how impossible it is
that any employment of figures, any calculation, however nicely
balanced, should lead to any uniform method of treatment- I
have in another place shewn, that, in the opinion of Lacroix,
Laplace, and Condorcet, reasoning, logic, and induction, are
in medicine not less useful, or less certain, than numerical cal-
culations : even in geometry, in almost all points, calculation
has hitherto only proved what reasoning has already suspected.
" Theory," said Laplace, "is only common sense applied to
calculation.'' The different influences modifying disease, to
some of which I have alluded, are no less numerous, for exam-
ple, than the letters of the alphabet. Yet, consider the richness
and variety of language formed out of these letters : by that
you may form an idea of tin; variety of the circumstances attend-
ing disease ; or, to push the analogy still farther, there are in the

1837.] Medical Statistics. 223

alphabet certain elements of more importance than the rest ; in
like manner disease has, so to speak, its vowels and its co.
mints.

" For myself I must say, that the morel see of disease, the
more does eacli case appear to me a new and a separate prob-
lem. When they see a new case, how many physicians can
put down in figures the number of cases exactly similar which
they have treated? I therefore think, that the useful results to
be obtained from statistical calculations, in the treatment of ty-
phoid fever, must be reduced to this : that we may usefully reg-
ister the relative indications in cases within our own practice,
and under given circumstances, of blood-letting, evacuants, ton-
ics, (fee. But the numerical method can never point out the
treatment to be adopted in any one given case.

" But the numericalists, finding the subject of typhoid fever
difficult ground on which to fight, have taken the case of inter-
mittent^. With regard to intermittent fevers, however, we must
not judge by those of the capital: first, because cases are rare
in this country; and, secondly, because they yield easily under
almost any means that are employed. It is in countries to the
south that they are violent ; and I may remark, in passing, that
this is another instance of the complexity of disease in general.

"But even in this country I have cured intermittents by the
most different modes of treatment ! by local and general bleed-
ing, by emetics, by purgatives, &c. : and if we examine the his-
tory of medicine, which, when well understood, is the best
instruction that a physician can receive, we shall find that in-
termittent fevers, whatever may be their type, vary constantly
in nature and in character, and yield to many different modes of
treatment.

"From all this it by no means follows that there are not in
medicine certain general views, and fixed principles ; on the
contrary, in the treatment of every case we act upon them.
They are precisely the views taught by the beautiful doctrine
of indications, (inductions?) which can alone guide us in the treat-
ment of fevers, and of diseases in general. The doctrine, then,
to which I have been led by my own experience, and by the
history of medicine, and which I have always held and advo-
cated, is that of eclectism.

" Its methods are analysis and induction ; its aim, the wide
and complete interpretation of facts, its result, the understanding
of indications, with the knowledge of the best modes of fulfill-
ing them. In short, it is the logic of facts, enlightened by the
logic of thought. Yet to many this method is unpalatable :
some are too impatient, some too indifferent ; while others are
incapable of pursuing continued trains of reflection. I am led,

224 Imperforate state of the Uterus. Nov.]

then, by my long and unwearied labors on this subject, to the
following results :

1. Individuality is an invariable element in pathology. A
disease is not a simple, fixed, and uniform entity ; it is a series
of varied and changing actions ; therefore every exclusive the-
ory is absurd in pathology, and every absolute method repugnant
to therapeutics.

"2. Numerical and statistical calculations, open to many
sources of fallacy, are in no degree applicable to therapeutics.

" 3. The only methods admissible in practical medicine are
those of analysis, logic, and induction." Gazette Medicale, <$*
American Journal.

Imperforate state of the Uterus. Pregnancy at full period.
Delivery. Cure. By Mr. Tweedie.

Eliza P***, aged from 23 to 24, in the ninth month of her
first pregnancy, entered Guy's Hospital the 14th November
1836. xMr. Roe, the physician of the ward, saw her at 7 o'clock
A. M. The preceding evening the pains of parturition had
manifested themselves with great force, and remained very vio-
lent at the moment of the visit. After waiting some hours, Mr.
Roe touched the woman but was unable to discover the neck of
the uterus. Mr. Tweedie was called at 2 o'clock P. M. Upon
examination he found in the vagina a solid, uniform, globular
mass, pushing this canal before it at each pain. No irregularity
could be perceived upon the surface of this tumor, every attempt
to reach the neck of the uterus was useless. The woman hav-
ing been constipated for some days, a dose of oleum ricini was
prescribed, and some hours suffered to elapse.

In the evening the expusatory pains were of extraordinary
force : the purgative had operated. Touching per vaginum
was again practised, but without any result. At each pain,
however, could be felt before the tumor above indicated, a glob-
ular body forming a prominence like the head of a child in an
imperforate uterus. By touching with great attention, a small
point thinner than the surrounding parts, but smooth, uniform
and without any orifice could be felt at the place which the
neck of the womb should have occupied. By pushing the mass
towards the abdomen, the head of the child was distinctly felt,
by its movements in the liquor amnii.

The previous history of the case furnishes the following de-
tails. The woman was married the 4th February 1836 : from
the age of 14 she had menstruated every three or four weeks ;

1837.] Imperforate stale of the Uterus. 225

the blood was always pale, in small quantity, and continued
only two or three days. The menstruation had never been
painful. From the period of her marriage, the catamenia had
disappeared. The woman had always enjoyed robust health
both before and after marriage, but coition had always been
painful to her. Two or three days before the commencement
of labor, she had experienced hemorrhages from the vulva by
which she had been frightened.

The following diagnosis was made : pregnancy of nine
months shewn by hypogastric auscultation, (the pulsations of
the foetal heart doubly as frequent as those of the mother's,)
complete absence of the neck of the uterus ; very violent expul-
satory pains.

In this state of things, Mr. Ashwell was called in. He con-
firmed the preceding diagnosis, and thought it was necessary to
practise immediately an artificial opening in the thinnest part of
the tumor. The pulse was from 120 to 130 per minute and
very irritable ; the pains violent ; the skin alternately hot and
cold ; the countenance expressive of anxiety and despair.

Mr. Ashwell operated in the following manner. The woman
having been suitably placed and the bladder emptied, the ac-
coucheur introduced the index finger of the left hand into the
vagina, along this finger a curve pointed bistoury was glided.
The tumor was first punctured at its thinnest and most promi-
nent part, and then incised from below upwards, and next from
above downwards, or from the rectum towards the bladder, and
vice versa. After the latter incision, some drachms of fluid and
black blood escaped, followed by the liquor amnii. The head
was instantaneously presented to the opening that had just been
made; this opening presented one and a half to two inches in
diameter, and about one line in thickness.

Mr. Ashwell was unwilling to incise transversely, from the
fear of wounding the branches of the uterine arteries. After
the operation, the pains were somewhat appeased, but soon re-
turned ; the head, however, did not advance. Three or four
hours afterwards a laceration of the opening occurred, and the
woman fell into a syncope. (Ether, ammonia, opium, prescrib-
ed.) In two hours the pains resumed their former vigor. By
touching, it was ascertained that the laceration was confined to
the uterus, that it did not affect the vagina ; the head engaged
more and more in the opening, and the woman was delivered
happily at 11 A. M., 24 hours after the operation. The child
was of the male sex, and in a state of asphyxia, but was soon
resuscitated. Abundant, uterine hemorrhage, extraction of the
placenta, contraction of the uterus, cure.

By touching subsequently it was ascertained that the neck of
the uterus was entirely absent. At the superior extremity of

226 Imperforate state of the Uterus. Nov.]

the vagina existed after the operation, an orifice puckered and
irregular at its circumference, soft, with thick margins, irregu-
larly circular, denticulated ; it might be compared to the base
of an apple, or rather to the summit of a pear, represented by
the uterus itself. By passing the finger around the circumfer-
ence of the orifice, three rays or seams like the lines of adhesion,
could be felt, one directed anteriorly, toward the right ilio-pu-
bic articulation, and reflected upon the vagina the second di-
rected posteriorly toward the left sacro-iliac articulation, and
reflected also toward the vagina, and the third shorter than the
preceding, presenting only an inch in length, was directed to the
right and posteriorly.

This case though not unique, is nevertheless rare and inter-
esting-. The author remarks with propriety, that the artificial
opening should be practised soon before the spontaneous lacera-
tion of the womb occurs. By art we make an orifice in the
most suitable place without invading either the vagina or the
peritoneum, and the accouchment takes place successfully, both
for the mother and child, while every thing is uncertain and
dangerous if the formation of the new passage be left to the
blind efforts of the pains, the woman would then be placed in
the same perilous condition as in lacerations of the uterus in
general. It would be curious to know what was positively the
state of the womb before conception, and how the woman could
have been impregnated without an uterine orifice. Whence
came the menstrual fluid ? Was not the os uteri obliterated
probably after conception ? These are doubts which the author
has not sought to dissipate. Gazette Medicate.

Not having received the English announcement of the above
case, we have extracted it from the Gazette Medicate. Al-
though from the highest British authority in obstetrics Roe,
Tweedie, and Ashwell, we give it only as a possible case, as
regards the actual occlusion of the os tincee; but it may be use-
ful in demonstrating, in connexion with other similar operations,
as well as those which have been frequently employed for dilat-
ing the natural orifice of the uterus in cases of extreme and
fixed ridgity, the safety of delivery by incision of the os, or
cervix uteri.

The editor of the Gazette Medicate seems to "be curious to
know what was possitively the state of the womb before con-
ception, and how the woman could have been impregnated with-
out an uterine orifice ? Whence came the menstrual fluid ? and
if the os uteri was not probably obliterated after conception ?

1837.] Imperforate state of the Uterus. 227

It is evident from the first of these inquiries, that the flimsy,
irrational, sympathetic doctrine of conception, as well as that of
the absorption of seminal matter from the vagina by absorbent
vessels, which anatomy cannot demonstrate, are alike and justly
without a footing in Paris.

We cannot take to ourselves the right to deny things which
rest on such human testimony as we would receive freely in other
matters, however strange the alledged facts, merely because they
were not presented to our own senses. Such an assumption,
would, if adopted by men, always clog the wheels of science,
so as at least to make it stationary if not retrogressive. But
whilst experience and observation may in many cases prove
fallacious, sound reasoning from well established premises is
productive of mathematical certainty. We repeat, that we give
this case as one which we will not deny as possible because we
did not witness it, and if we had, we might have been deceived
perhaps, more easily than the surgeon-accoucheurs of St.
Gutfs. But we have many reasons for doubting the correctness
of the diagnosis so far as relates to the occlusion of the os uteri,
in any such case, and particularly in that which is before us.
Amongst them are the following, which we deem sufficient to
justify the view we have taken :

1. We consider the doctrine of conception now settled, at
least so far as to establish the fact of the admission of the male
element into the uterine cavity. This being the case, concep-
tion could not have taken place without a competent opening
from the vagina into that cavity : but conception did take place,
therefore the existence of the os uteri at the time of conception
is established.

2. If the os uteri existed at the time of conception, and did
not at the completion of gestation, it must have closed itself
sometime during the pregnant state. But every one who is fa-
miliar with the diseases of the uterus must be aware, not only
of the want of tendency in the os uteri to adhere and close its
opening ; but of its exhibiting, on healing, after wounds and
ulcerations, something of a formative propensity, whereby it
seems inclined, like the lips of the mouth, and indeed, like most
parts, to re-develops itself more or less in its original character,
This is a physiological fact, arising out of the office of the ap-

e5

228 Imperforate state of the Uterus. [Nov.

propriating powers. It is however, an office sometimes over-
ruled by certain peculiar circumstances, such as great extent of
injury peculiarity of location, (fee. &c, an example of which we
have in burns, &c. But the propensity tends to unite severe d
parts which were naturally in contact, when well disposed, as
in incised wounds; and by the assistance of art, parts originally
separate may be brought to unite, as in the harelip operation
the Rhinoplastic operation, &c. And we should not doubt the
practicability of uniting the denuded edges of the os uteri by the
twisted suture if the percolation of secretions should not pre-
vent, nor the practicability of joining two individuals together
as effectually as the Siamese brothers, by the intervension of art.
This indeed was formerly the plan of making Talliacotian
noses. But parts originally and properly separate, unless influ-
enced by some of those peculiar circumstances tend to reinstate
themselves more or less perfectly to their pristine formation, and
to heal separately. We have occasionally treated and cured
ulcerations occupying a part, or the whole of the os uteri, both
in the unimpregnated state, and that of pregnancy wherein
there is always a supernormal, and in a certain sense, morbid
degree of excitement : in no instance of which has there been
the least manifestation of a disposition to unite and obliterate
the natural cavity. Indeed the great difficulty with these ulcer-
ations is that, either in consequence of the peculiarity of struc-
ture, or the irritation common to the pregnant state, or undue
irritation of the uterine substance from other causes, as prolap-
sus, (fee, or from some or all of these jointly, there is a tendency
to loss of substance during the continuance of disease. We
have now in our notes, a drawing, taken from a speculum view
of the cicatrix at the upper part of the vagina, where at least
the lower half of the uterus had been lost by ulceration caused
by prolapsus, before it could be healed. Even with this destruc-
tion of the labiated part and cervix, the lower extremity of the
remaining fragment of the uterus healed even with the plane
of the vagina at that part, leaving a round hole in the otherwise
smooth vagina, corresponding with the cavity of the neck, and
about the size of a large swan quill conforming itself very well
to the natural opening at this part of the uterus.

We have the drawing of another specular view of a case in
which the posterior wall of the uterus was destroyed nearly to

1937.] Imperforate state of the Uterus. 229

the fundus, and the anterior, to about the middle of the neck;
thus leaving1 an eschar in an oblique longitudinal direction, from
above posteriorly and near the fundus, downward and forward
to the fore and middle part of the neck, exposing all the remain-
ing portion of the uterine cavity. The fragment of the uterus
healed over in this shape, leaving the inner face of the uterine
parietes a little excavated, and assimilated to the adjoining healed
edges of the parietes. It is therefore not in the least probable
that the orifice was obliterated after conception and during ges-
tation. The conclusion therefore appears to us very evident
from the weight of these facts, that the occlusion declared, did
not exist.

3. The anterior obliquity of the uterus, in some degree, by
which the axis of this or^an is thrown at an anele more or less
considerable in that direction, with the axis of the superior strait
of the pelvis, is one of the most common circumstances met
with in the practice of midwifery. This is often in a very small
degree ; but in most cases sufficient to retard more or less, the
second stage of labor, and to render the correction of this obli-
quity by drawing the os uteri forward, necessary to the most
prompt and favorable result. But we often meet with cases in
which the os uteri cannot be found by manual examination, be-
cause it is too high in the posterior region of the pelvis, ren-
dered so by an extreme anterior obliquity ; and the head of the
child, having descended low in the cavity of the pelvis, carry*
ing before it the anterior paries of the cervix, greatly extended
and attenuated by the powerful impress of the expulsive parturient
efforts giving to the touch a very good resemblance of a large
pouch of the waters, or membranes covering the foetal head in a
complete delatation of the os uteri. In such cases we have some-
times been utterly unable to find the os uteri until the protrud-
ing part of the uterus, and of the foetus were returned suffi-
ciently through the superior strait, to enable us to find the os
uteri about the sacro-vertebral junction. In this case, all the
expulsory efforts are expended against the wall of the uterus
which is presented to the cavity of the pelvis, instead of the os
uteri which is turned towards, and against the upper and poste-
rior part of the bony pelvis. This, in various degrees, is one of
the most common causes of tardy labor, and of the loss of pains;

230 Imperforate state of the Uterus. [Nov.

and the correction of which will render almost any labor more
expeditions, and preserve the energies of the patient from more
or less unnecessary exhaustion. But with a proper understand-
ing of its nature, and the condition of the parts it is susceptible
of almost instant correction even in most of those cases in which
it exists in an eminent degree, by drawing forward the anterior
part of the os uteri and retaining it so with the finger until the
bag of waters so protrudes as to supply the place ot the finger,
which is generally soon the case.

4. The appearances of the part after recovery, such as the
absence of the neck, &c, afford pretty conclusive evidence that
the part incised in the operation was that part of the parietes
of the uterus which is so often protruded into the cavity, and
even to the perineal strait by the head of the child in anterior
obliquities.

Much more might be said on this subject, but we trust the
present will suffice to guard practitioners against the hasty per-
formance of a dangerous section of the substance of the uterus,
when both safety and expedition are better secured without it.
This is another of those cases, but too common in hospital
practice which tend to assure us of the great inhumanity attend-
ing that hasty and generalizing practice commonly pursued in
extensive infirmaries.

Since preparing the above article for our pages, the November
No. of the American Journal has come to hand, detailing the
same case from Guys Hospital Reports. We cannot repeat the
article, although it may possibly be more correct in some partic-
ulars. But we give below an extract from the London Medical
Gazette, subjoined to the above case in the American Journal,
which is valuable and interesting.

John North, Esq., in an interesting article in the London
Medical Gazette of the 10th of June, 1837, expresses some
doubts of the real nature of the above case, as there are so many
cases on record in which the uterus has been supposed to be
imperforate at the time of labor, but, upon subsequent examina-
tion, it has been ascertained that the os and cervix uteri, had
escaped detection, in consequence of their mal-position. In
some of those cases after delivery had been effected by incisions
into the uterus, upon the presumption that there was no os uteri,
both the os and cervix uteri have been found in their natural

1837.] Imperforate state of the Uterus. 231

situation, and naturally constructed. Mr. North observes,
"that tliere are some circumstances connected with this case,
which I confess I cannot comprehend, and which seems to ren-
der the assumed fact of the uterus being imperforate scarcely
conceivable. The complete closure of the os uteri must of
course have taken place after conception, and as far as 1 know
could only result from some disease, some active inflammation
of the os or cervix uteri at some period of pregnancy, which in
this instance could not have existed, inasmuch as it is stated
that the patient " both before and subsequent to her marriage
has had robust health." The doubts that have been expressed
by the highest obsterical authorities as to the fact of the absence
of the os uteri in many of the cases in which this rare anomaly
had been presumed to exist, apply exactly to this case, as far as
can be judged from the report given of it. For example, Bau-
DELOCQ.UE asks,* "A quoi pourroit-on l'attribuer, (l'obturation de
l'orifice de la matrice) chez lez femmes ou l'on a cru la rencon-
trer au moment de l'accouchement 1 a l'inflammation, sans
doute, et a ^alteration du col de la matrice. Mais rien ne fait
pr'sumer qae chez elles de telles affections aient lieu pendant
lagrossesseP DesokmeauI says. " Pour que l'orifice de I 'ute-
rus s"oblitare et s'efface pendant la grossesse, ilfaudrait qu'il se
fat d jveloppa une inflammation assez vive, cequi ne pent arriver
que tres rarement ; or dans la plupart des cas on ne parte pas
d'inflammation." Lastly, VelpeauJ thus states his opinion upon
the subject: "II n'y a evidemment qu'une maladie grave, une
inflammation aigue, qui puisse fermer ainsi le sommet de la
matrice entre la fccondation et le terme de l'accouchement.
Dans ce cas, les parties sont necessairement le siege d'altera-
tions concomitantes propres a lever tous les dontes. Les signes
anamn stiques aur aient oVavance eveill- f attention. r In these
quotations, I have taken the liberty of italicising the opinions
of the distinguished writers which are directly opposed to the
closure of the os uteri at the time of labor in a patient who
" had not had a day's ill health," and who was always fit for an
" unusual degree of laborious exertion." The report of the case
states, that " for two or three days before labor came on, she
noticed a rather copious discharge that continually drained from
her." From whence, if not from the uterus, and through its
natural opening, the os uteri, is it probable that this "rather
copious discharge" proceeded '?

" The whole description of the case," he adds, " is exactly
similar to many I have seen, and to still more described by vari-

* Journal General de Med. t. 25, p. 42.

t Diet, de Med. t. 15, p. 190.

% Accouehcmens, 2nde edit, t. 2, p. 216.

9Q9

Imperforate state of the Uterus. Nov.]

ous writers, where the os uteri could not be detected by any ordi-
nary examination, oreven by the introduction of the hand, until
after many hour's duration of severe labor pains, in consequence
of there being1 so great a degree of anterior obliquity of the
uterus as to throw tlie cervix and os uteri back towards the sa-
crum, or even above the sacro- vertebral an^le. I confess that
more than twenty years ago I was much perplexed by two of
these cases that occurred to me. In the words of Velpe.Vu,
"I dreamt of anomalies, and knew not what to think.'5 In sev-
eral such cases I have subsequently known other practitioners
at fault, and who fancied from "the firm, uniform, globular
mass forcing down into the vagina" upon which no orifice could
be detected, that there really was no os uteri. By patience,
however, and proper management, the efforts of nature, and
sometimes, though very rarely, manual assistance, which in
such cases is seidom required, the os uteri has been brought into
a more favorable position, and the delivery has been safely,
though very slowly terminated.

" If the pelvis is large, the uterus is in such cases forced into
its cavity by repeated and violent pains, which have little or no
effect in dilating the os uteri, in consequence of its being out of
the line of direction of the expulsive force. The anterior and
inferior part of the body of the uterus may even approach the
os externum ; the head of the child, or any other part that pre-
sents, being distinctly felt through the thin and distended ute-
rine parieties. In such instances, either of two mistakes have
often been committed. In the first place, it has often been
thought that there was no os uteri, because it could not be detected
by any ordinary examination with the fingers, however carefully
conducted. Secondly, it has as frequently been supposed that
the labor would be speedily terminated when it had scarcely
commenced, for the head of the child is felt so distinctly, al-
though still covered by the thinly expanded uterus, as to lead to
the belief that the os uteri was entirely obliterated, although it
was little, if at all dilated. I will refer to a few authorities for
the purpose of corroborating the opinions I have given ; of
showing how cautious we should he in presuming the uterus' is
imperforate, .and also of showing how completely the most ex-
perienced practitioners have been deceived in their diagnosis of
such cases. Denman* says, "Cases have been recorded, in
which it was said that the os uteri was perfectly closed, and in
which it has not only been proposed with a pair of scissors to
make an artificial opening instead of the closed natural one, but
the operation has been actually performed.'' " 1 am persuaded
there has been an error in some of these cases, and that what

* Midwifery, 7th edit, by Waller, p 341.

1837.] Imperforate state of the Uterus. 233

has been called a perfect closure of the os uteri has not been
such, but that the practitioner has. at perhaps an advanced pe-
riod of the labor, been unable to discover it by reason of its
obliquity.'" Dewees* thus strongly expresses himself: '; Within
onr own knowledge, this case (anterior obliquity of the uterus)
has been mistaken for an occlusion of the os uteri, and where,
upon consultation, it was determined that the uterus should be
cut to make an artificial opeqing for the foetus to pass through.
They thought themselves justified in this opinion, first, by no
os uteri being discoverable by the most diligent search for it ;
and secondly, by the head being about to engage under the arch
of the pubes, covered by the womb. Accordingly, the labia were
separated, and the uterine tumor brought into view : an incision
was now made by a scalpel through the whole length of the
exposed tumor, down to the head of the child. In due course
of time the artificial opening was sufficiently dilated to give pas-
sage to the child. The woman recovered, and to the disgrace
of the accoucheurs who attended her, was delivered per vias
naturales of several children afterwards, a damning proof that
the operation was most wantonly performed.-' Desormeauxt
gives evidence to the same effect. Kiliax? remarks, that in
cases of supposed closure of the os uteri, the practitioner must
be very much upon his guard, and very mistrustful of himself,
for the diagnosis is by no means easy. Jorg, in commenting
upon - der schief heit des gebarenden uterus," obliquity of the
pregnant uterus, observes, that it often causes great perplexity to
the practitioner, who, in consequence of not being able to feel
the os uteri after many hours' duration of severe labor painsr
commonly believes that the uterus is imperforate. Baudelocqe,!!
in a very instructive paper on the subject, gives several cases in
which mistakes were committed, and needless operations per-
formed by experienced practitioners. VelpeauI says, that he
has so frequently known tolerably experienced practitioners
affirm that there was no os uteri, when it was merely raised to-
wards the sacro-vertebral angle, that he has no difficulty in
referring to this mistake the majority of cases of supposed ob-
literation, and that for beginners the anterior obliquity of the
uterus is very embarrassing ; ''- ne trouvant pas de col, ils r vent
des anomalies, ou ne savent que penser." He mentions the fol-
lowing case, which is quite in point. It happened to one of his

* System of Midwifery, p. 90.

* Diet, de Medecine, t. 15, p. 189.

i Die Operative Geburtshulfe. Erstf.e Band, 259.
Krankheiten des Weibes, ZweTTI Acflaoe, 690.
II Journ. Gen. de Med. t. 52, p. 34, et seq.
IT Loc.cit. 216 and 229.

231 Imperforate state of the Uterus. [Nov.

friends, who had practised three years, " avec distiction dans la
capitate." Tne account was transmitted by letter to Velpeau.
I do not presume to offer this as the counterpart of any other
case, although, no doubt, its fellow might be found. I will not
spoil it by translation. "J'ai passe la nuit pivs Madame de 8.;
le travail parait marcher regulierement ; m us je ne trouve point
forifice ; j'ai porte le doigt vers le promontoire, puis du cote des
fosses iliaques, puis en avant derriere le pubis; partout je suis
arrive jusqu'au culde-sac forme par l'extremite sup.rieure du
vagin ; mais je n'ai point trouve le col ; qu'ai-je a faire, qu'est-ce
que cela veut dire?'1 Velpeau thus clears up the mystery:
" C'est qu'en erfet I'oriflce etait tellement porte en arrive et en
haut sur la tumeur, que pour l'atlendre, il fallait recourber le
doigt en crochet tout-a-fait en avant."

" The patient whose case is related in the Guy's Hospital Re-
ports was in labor with her first child. It is true that so great
a degree of anterior obliquity of the uterus, as to lead to an er-
roneous diagnosis at the time of labor, occurs much more fre-
quently in women who have borne many children, in conse-
quence of the abdominal p.irieties having lost their power by
frequent distension, of supporting the gravid uterus. But it may
and does happen occasionally in first labors, either from a
natural fiaccidity of the abdominal parietes, from the brim of the
pelvis being inclined more forward than usual, or from an un-
usual convexity of the Jumbar portion of the spinal column. It
is stated in the case I refer to that a careful investigation was
made about a month after delivery, and that there was no cervix
uteri. In a case related by Lauverjat,* in whicli he and many
other practitioners fancied there was no os uteri, and in which,
consequently, an incision was made into the uterus, neither the
os nor cervix uteri could be detected for two months after the
operation. L'un et l'autre alors etoinet dans l'dtat le plus
naturel."

The doubts expressed by Mr. North, concerning the nature
of Mr. Tweedie's case, may he unfounded ; but at all events,
the facts mentioned by the former, may tend to guard young
practitioners against hastily assuming that the uterus is imper-
forate at the time of labor, and to impose upon their minds the
difficulty of the diagnosis in a description of cases which are
generally not sufficiently dwelt on by medical teachers.

* Ncue M. thole den Cayserchnitt iu raachen, 188. Gtuoted by Baudelocque,
loc. cit. p. 45.

1S37.] Cancer of the Lung. 235

Cancer of the Lung. By M. Heidelfer.

Cancer of the lung is a very uncommon disease in compari-
son with other affections of this organ. But of all the cases of
this disease, none present more indubitable characters than the
following. We believe that a taberculous infiltration, may be,
and has been more than once mistaken for cancer of the lung ;
in this case a similar error could not have existed.

A peasant a^ed 24, strong and robust, who, except the diseases
of infancy, had never been affected by any others except the
itch, was attacked towards the autumn of 1834 by pleurisy,
which yielded to an antiphlogistic treatment. In the month of
December a similar attack occurred, of which he was not so
completely relieved by the same means.

A new exposure to cold and improper diet aggravated his con-
dition. The left side of the chest became the seat of very intense
and apparently electric pains, which the patient felt from the
shoulder to the false ribs, and from the sternum to the vertebral
column. Sanguine depletion, both local and general, revulsives
and soothing means were once more employed. The following
was his state at this period : decubitus upon the back ; the left
side of the chest somewhat elevated ; frequent, dry and short
cough accompanied with dyspnooa ; the left side of the chest
immovable in inspiration and expiration. The sternum was
elevated and pushed towards the right side, a very observable
difference existed between the right and the left s,ide of the tho-
rax, the latter presented a considerable dilatation immediately
above the mammilla ; sound upon percussion, dull on the left,
and very clear on the right-side, no respiratory sound on the left
side, where the pulsations of the heart were also inaudible, but
were heard with great distinctness but unequally on the right
side. The face of a livid color, with an expression of agony,
the breath pure, or at least without any bad odor, the emaciation
inconsiderable.

A month later the state of the patient was greatly changed ;
the anterior part of the left side of the thorax presented a con-
siderable tumour, of the volume of two fists ; it was hard and
tuberculated. The patient could not repose upon the right side ;
the left was immovable during inspiration ; the color of the face
still more livid, leaden, and the expression of agony more pro-
nounced.

Two months before death, the axillary glands of the left
side began to enlarge and be indurated ; at the same time two
tuberculated tumours were formed above the left clavicle ; the
symptoms of general dropsy supervened and the patient died,
having to the last a cough with a glairy expectoration.
f 6

236 Cancer of the Lung. [Nov.

Autopsy, externally, a considerable arched prominence of the
left side! anteriorly, and containing several tumours soft and hard ;
the mammilla was engorged and mllated.

Nothing remarkable m the Encephalon.

The right side filled with water ; the right lung adherent to
the diaphragm and pericardium contained no tubercules. The
heart ratner small than large, was adherent to the pericardium
in all its dimensions, was flaccid, softened, and almost orelati-
nous. The left lung adhered to the ribs, presented no distinct
lobes, but formed a single mass which filled entirely the left side
and even a part of the right side of the thorax. The pleura
could not be distinguished. This lung was transformed entirely
into a compact, lardaceous mass, of a dirty white color, in which
could be perceived no trace of bronchea or of vessels. Near
the center this mass was softened, encephaloid, ol a greyish
white color, and within it was seen an opening arising from the
non-consolidation of a large broncheal tube. The arteries and
veins were obliterated and transformed into ligaments as they
proceeded from the heart. An incision in the external promi-
nence of the left side presented besides the skin and a thin layer
of cellular tissue, a compact and lardaceous mass, softened near
the centre and converted into a soft and encephaloid matter,
which communicated with the interior of the lung through the
intercostal spaces, the ribs having been pushed from above
downwards. Here existed no trace of pectoral or intercostal
muscles and the ribs of the left side were in a state of complete
atrophy.

The liver, spleen, pancreas, kidneys and bladder were in a
normal state, the mesenteric glands engorged, and through the
digestive mucous membrane were disseminated red and softened
spots, but without any ulceration.

The left testicle and epididymis presented an incipient schir-
rous induration.

The author informs us that in the cases recorded by M. M.
Andral, Velpeah, and Begin, the disease was not detected
until after death. However, it seems to us, that the prominence
of only one side with dullness of sound, the lancinating pains,
the livid and leaden color of the skin, and the presence of two
tumours above the clavicle should at least have directed the
attention to the possibility of a cancerous affection of the lung.
The author informs us that the schirrous state of the testicle
and epididymis was not ascertained until after death. Is it ne-
cessary to say with him that the etiology and treatment of this
kind of degeneration are at the present day beyond the power
of the art? Ed. of Gazette Hedicale de Paris. Gazette Mid-
icalc. Archives de Medicine.

1837.] Fisk fund prize Dissertations. 237

Fish fund prize Dissertations of the Rhode Island Medical
Society. No. 1. By Thomas H. Webb, M. 1)., Provi-
dence.

(Communicated for the Boston Medical and Surgical Journal.)

What are the causes and nature of Rheumatism, and the best
mode of treatment to be employed therein^

It is not a little strange that the credulity of men, and of phy-
sicians particularly, should manifest itself in believing little evi-
dence, or partial testimony, where the facts of multiplied and
long continued observation are also in review. We are induced
to attribute this result however, more to the present, unprecedent-
ed reign of novelty mania, than to the operations of credulity
itself; for this alone, we think would, from the very nature
of things, although readily captivated by small or weak, be
still mare easily, by greater or stronger evidence. But the
operations of the rage for novelty, for we can call it nothing
less, is most unaccountable, if we set out on the investigation,
with adue contemplation of the natural organization, if we may
so speak, of the human mind ; for here Are find such an ill pro-
portionate relation between the perception and the judgement
that, when sufficiently removed from the intellectual process of
ratiocination to contemplate it abstractly from the interest we
take in the result, we are forced to consider it within the proper
scope of the term mania.

We see this strange evidence of ill-balanced intellect exhibited
in a thousand ways ; and in some way, by almost every body.
We see it in the most common concerns of life, as in the servile
following of fashion in the destruction of the beautiful sym-
m3try of the female form, and the more valuable possession of
the ruddy glow of fine health, by the criminal (if slow suicide
be criminal,) use of corsettes in the imbibition of wine and
other form? of alcoholic drinks into the human stomach without
necessity imposed by disease ; and all this, with the perpetual
observation of the injurious effects of the former and the
latter, and the ruinous almost certain demoralizing tenden-
cies of the latter. And when we witness these things, and
reflect on the eventful and important nature of those legitimate

238 Fisk fund prize Dissertations. [Nov.

inductions to which the human mind is by nature entitled the
happy consequences of correct, and the ruinous tendency of
incorrect or unfair ones from the whole promises, we are led to
conclude that, in a science like that of medicine, every step in
the correct theory, as well as the practical operations of which
must, in order to be profitable, be at the expense of a fair and
proportionable deduction from the whole of the real promises,
there is no branch of study so essentially collateral, or perhaps
we should say adjuvant or auxiliary as logic, or the correct use
of the reasoning faculties. There is as due a proportion between
effect and cause in the science of medicine, as in any thing else
which comes within the perview of mental operations. But it
is alleged that we may not know all the premises,,.. To this we
reply that we should see a due proportion, which always exists
between one set of phenomena and another which we have rea-
son to believe stand in the relation of cause and effect, before
we draw our deductions ; and if we do not see this proportion,
search for it alone, or with assistance until we find it. And
again : if in some matters, the whole elements of a process of
reasoning cannot be precisely determined, still it is no less the
duty of the physician, under the necessity of the case, when
human powers ultimately fail, to use in his ratiocinations, all
that are known, than it is not to neglect any part of the whole
which may be well ascertained.

It is not so strange that men should reason widely, or rather
put induction entirely out of their catalogue of mental operations
when they undertake to tamper with those sciences of which
they know nothing from which to reason, as is unavoidably the
case with imposters who attempt the practice of medicine with-
out a knowledge of the anatomy, the principles of life, and the
healthy and diseased functions : for there is no true reasoning
but from true and well ascertained premises ; and " what can
they reason from but what they know ?" And this, we may re-
mark is constantly done by the impostors of the day, who mea-
sure well the intellects of those whom they mean to gull, and
calculate the success of the imposition as accurately as did the
London Quack, who upon the same ground explained his own
success. They know well that when men are drawn out to
make actual conclusions on a topic with whose elements they

1837.] Fish fund prize Dissertations. 239

are perfectly ignorant, that the reasoning must result in error
proportionate to the ignorance of the premises then may they
clearly determine their own chance of success, twenty, forty, or
one hundred to one, according to the true intellectual character
of the community with whom they seek favor. But with men
of science, it is passing strange that a solitary, fallible man
should make a'declaration in the very face of the best experi-
ence and most enlightened observations of thousands not of
one age but of a hundred ages, and still this solitary declaration
will be seized and tried. And not only so, but all must try ;
and instead of reasoning fairly beforehand to determine what is
right, they reason, if at all, afterwards to ascertain why the results
were not according to desire.

We have been led to these reflections by our deliberate con-
templation of the Fisk fund prize dissertation on the nature and
treatment of rheumatism, by Thomas H. Webb, M. D. This
is a well written essay, and we have no possible objection to the
manner in which it has been got up. We therefore pass over
the whole of it until we come to the mode of treatment which
is advocated by the author, the discovery of which stands to the
credit of Dr. Cazenave.

It is true that in all times, opium has been more or less used
by practitioners in the form of opium pills, laudanum, Dover's
powder, &c, and by the common people in the form of Bate-
mans drop, (fee. &c; but it has remained for Dr. Cazenave to
recommend to the world the use of pure opium hourly in large
doses, and these persisted in to the end for the cure of rheuma-
tism. It will be recollected by those who have read this essay,
that the author adopts, in extenso, the bold, electic practice of
Dr. Cazenave who, knowing well the physical effects on the
system in small doses, presses its use to the production of those
immoderate effects which have long been, to other men, beacons
of danger from the exciting powers of opium that is to say,
doses which produce nausea, giddiness, headache, palpitation,
<fec. But "these effects," said Dr. C. "are of course but mo-
mentary, and should form no solid objection to the remedy if it
be found beneficial in other respects, besides relieving pain."
And he proceeds, " To the above effects of opium, (if it be con-
tinued,) succeed others : the patient does not sleep, but he expe

240 Fisk fund prize Dissertations. [Nov.

riences a kind of delightful ecstacy,* forgets his sufferings, &c.
The action is then excitant like wine. In some cases an abun-
dant perspi ration is the result but in both events, that is, with
or without the sweating process, the radical cure of lhcuna-
tism is effected." It is obvious here that the exciting powers
of opium are carried beyond the sleeping point even to the
ecstacy the stupor of intoxication, and the bold prescription
persevered with until the rheumatic form of disease disappears.
Electism, as well as system in medicine has its extremes, and
consequently its dangers ; and we should be ever watchful of
that disposition in man whereby he tends to extremes to ultra-
ism in whatsoever he embraces. These ultraisms in electism,
generally arise from a process of reasoning instituted on partial
premises; a fact which is finely illustrated in the case before
us. We need not deny that Dr. Cazenave cured every case
of rheumatism which came under his care at the foot of the
Pyrenees, where no other form of disease is known a location
disposing to nothing but good perfect health, but where tem-
perature, nevertheless, has its effects, which are that assemblage
of symptoms we call rheumatism. And we will venture this
opinion, that under the circumstances inseparable from this loca-
tion, the cases of this disease are much more alike, in male and
female, old and young, sanguine, phlegmatic, or nervous temper-
aments, &c. than in any other less favored place. Nor need we
deny that Dr. Webb and his medical friends may have met with
a like success in Rhode Island ; notwithstanding we should
think it somewhat strange if none of the injurious chronic effects
of opium, at least, were subsequently exhibited in those cases ;
or if a mere mctastisis instead of a cure were ngt the result.
But we may contend that the best observation of all ages, has
been long since brought to bear on the too promiscuous use of
opium, to which some practitioners have in all ages been in-
clined ; and that, more especially since the days of Dr. Brown
it has been necessarily a great point of duty with the profession,
to bring the practice of medicine down to the point of prudence
in the prescription of this drug. The principle will ho'.d good
as long as opium continues to be an excitant, that its safe and

* Dr. C. should have known that so far from this heing a uniform result from
opium, it id only an occasional one in certain temperaments, states of systems, &c-

1837.] Fish fund prize Dissertations. 241

prudent prescription must always be subject to the various mod-
ifying influences which c:innot be left out of the estimate. These
modifying influences must then not be neglected, but taken into
the calculation if found existing, in every individual case. The
most es cntial of these are the temperament of body and mind ;
the kind and degree of morbid action present, the organs most
tenth ng, or liable to congestion, the operation of predisposing
causation as found in occupation, age, sex, climate, particular
location, (fee. (fee. Nothing, therefore, can be more obvious than
that a general formula, consisting of opium, one grain every
hour until the tendency to hilarity is produced, and the still
farther exciting effects h:ivr3 cirriad the patient, to the calm
which folLow* this excess of excitement, and which is caused
by still farther stimulation, must be extremely unsuited to cer-
tain many cases, according to the influence of these modifiers
causes ol effects which must and will have their influence in
the result. It should be recollected that it is not alone Xhe
secrecy of quack medicines and ptactices that is objectionable.
This alone might probably begotten over by practitioners when
they come to see the result of the physical agent what medi-
cinal operation it is its power to effect on the system : but the
worst part of quack medicines and practices, as for as they have
safe and efficient physical powers at all, is the universality of
application, regardless of the particular circumstances of the
cases. Now the same objection is unavoidable in the case be-
fore us. Hepatic derangements, impaired digestion, torpid bow-
els, fatal congestions, appoplexy, (fee. (fee must result in a large
proportion of such cases as ours in southern climates. Nor does
it seem less evident to us, that upon the common acknowledged
principles ol excitement alone, this valuable medicine cannot
be alike applicable to the extremely different states of acute and
chronic rheumatism. Here it will not be denied by the impar-
tial, that the states of excitent are extremely different. This is
too plainly evinced by the whole assemblage of symptoms pres-
ent. Nor is it less evident from another source of truth availa-
ble in pathology, which is a posteriori reasoning. No oue will
deny but that in one case of rheumatism the most powerfully
stimulating diaphoretics will prove beneficial, whilst in another
these will prove injurious, and nothing short of depletion, local

242 Fish fund prize Dissertations. [Nov.

or general, will meet the demands of the case. If, therefore,
there be any truth in the principles of excitent, it follows that
the general excitement at least is extremely different in these
two cases.

But when we come to consider, and allow due weight in the
reasoning process to the complicating influences of other modi-
fiers, as occupation, temperament, &c. &c. we find still addi-
tional physiological, as well as pathological phenomena which
necessarily influence the deductions. Let us take for example,
a climate not only as well calculated as that of the Pyrenees, or
of New-England to cause simple rheumatism, but which also
affords a long and hot summer with a moist, atmosphere. Here
is an influence calculated to torpify the general energies of the
body, and of the liver particularly. This is a truth of constant
observation. If we reason from cause to effect, or from obser-
vation of the facts generally presented, we shall find that, (in
whatever way,) there is a greater or less predisposition to bilious
disease, and consequently, when an occasional cause is applied,
as cold, instead of a simple inflammatory fever or rheumatism,
an inflammatory bilious fever or rheumatism is the result. And
why, but that another cause has operated in the production of
the phenomena; and to which, as well as to the other causa-
tion, the resulting phenomena must bear a reasonable propor-
tion.

Now although the same causes must, under like circumstances,
always produce the same results, still it does not follow that
causes differing in name may produce phenomena not unlike
each other. This is a fact of observation relative to the influ-
ence of alcoholic drinks as brandy, wine and opium, as also of
opium and heat on the biliary apparatus that is to say, that
opium readily induces, in a southern climate i hat state which
the southern heat itself ordinal iry produces. Under these facts
then it would be as absurd to think of curing a rheumatism
which is most commonly, (though not always,) what southern-
ers would call a bilious rheumatism, by a free use of opium, as
it would be to remove a patient from Augusta to Mobile, or
New-Orleans with the expectation of lessening the tendency to
bilious diseases.

willing to condemn with undue precipitation a practice

1837.] Fisk fund prize Dissertations. 243

so respectfully and so ably advocated, we determined, on read-
ing the essay, to adopt the practice urged by it in the first case
of rheumatism in which, as in not a few heretofore, we should
be foiled in our ordinary course of treatment according to the
best judgement on the true pathological condition. But before
just such a case came to hand, we found a patient so severely
affected with the excruciating pains incident to this disease that}
in our absence, and over the head of our prescription, he was
forced to resort to doses of laudanum to lull his sensibilities and
lessen his pain. With the manifestation of this disposition, and
with the hope of regulating the use of opium to a safer course
than might be adopted at the impulse of his distress, we laid
down the course in all respects according to Cazenave's plan.
It was pursued until forty pills were taken. By this time we
found great tendency to cerebral congestion from the direct
action of the opium, with hepatic obstruction, evinced by
sallow skin, brownish yellow tongue, with hard, frequent, con-
tracted pulse. &c. amounting to a very complete and highly
bilious rheumatism, had resulted. Unwilling to press further a
plan which reason, as well as the experiment thus far condemn-
ed, we discontinued the course, and in its stead adopted the
use of a pill of six grains of calomel, one grain of aloes, and
half a grain of kermes every six hours. This restored the
wonted hepatic secretion, preserved a steady perspiration, and the
patient was speedily restored to health.

With these experiments then, and the reasonings which we
have had on the subject, we have been brought to the language
which Dr. Cullen appli?d to the use of cinchona, that we
"hold it to be manifestly hurtful, especially in the beginning,
and in the truly inflammatory state" at least; and probably gen-
erally in southern climates and bilious temperaments.

We will observe, in the conclusion of this article, already
greatly extended beyond the intended limits, that depletion was
liberally used, and in the early part of the case ; and that great
spinal irritation existed in all the extent of the dorsal and lum-
bar spine, and most severe in the dorsal. This received the
counter-excitation treatment usually enforced for this symptom,
but without being corrected. It disappeared with the rheumatic
symptoms.

g 7

244 Clinical Observations on opening Abscesses. [Nov.

Clinical Observations on opening Abscesses, delivered at La
Pitie. By M. Lisfranc.

If you consult those books which treat of abscess, you will
find it laid down as a general rule, that where the abscess is of
small size, it ought to be left to nature to effect an opening, be-
cause this, it is said, will be small, and consequently leave but
an inconsiderable cicatrix. According to this view, small ab-
scesses are to be left to themselves, provided they be not too
indolent, and do not advance too rapidly. But I reject this
method ; for if the aperture made by nature be small, why
should not that made by art be made small likewise ? It is only
necessary for this purpose that we use an instrument with a
narrow blade, and that we make a simple puncture.

Again, before opening an abscess, it has been thought that we
must wait till the matter be well formed, or in other words, till
the abscess be ripe, although to this some exceptions have been
made, as with regard to abscesses in the abdominal and thoracic
parietes, and those situated in the neighborhood of 'tendons and
joints. I have opened such abscesses before they were well
formed, and what has happened ? As long as I confined my-
self to the method recommended in books, I did not reach the
root of the malady. Convinced of its insufficiency, I attempted
to combat the inflammation excited by the pressure of the pus
on the surrounding soft parts, by fomentations and local bleed-
ing. Immediately after opening the abscess. I applied leeches,
which were more efficacious in proportion as the swelling was
recent.

This first satisfactory result soon led me to another ; some-
times the leeches partly failed, and the induration passed into a
chronic state. In conformity with the principles which I laid
down in treating of white swelling, I allowed this state to re-
main undisturbed three or* four days, after which I successfully
attacked it by means of frictions with ointment of hydriodate
of potass and ioduret of lead, as well as by compression, when
necessary.

One objection only remains to be refuted that of the pain,
which was supposed to be greater in this than in the ordinary
method. It is true that the pain of the incision is a little more
acute when an abscess is thus prematurely opened, but it only
continues a few moments, and accordingly I hold that abscesses
ought to be opened as soon as the existence of pus can be de-
tected. I have followed this practice for fifteen years, and I
need not remind you that you have yourselves been witnesses
of its success.

If you have to open an abscess of small size, as for instance

1837.] Clinical Observations on opening Abscesses. 245

that of an egg, and if the skin be thinner at the centre than any
where else, yon must make your opening there for two reasons;
first, because the integuments being thinner, the instrument
passes through a smaller extent of integument, and consequently
gives less pain, and also because the incision gives to the integ-
uments a slight decree of stimulus which facilitates their ciea-
trization : it is also very easy to prevent the pus from stagnating
in the abscess by making pressure on its parieties. For larger
abscesses it has become an established rule to open them at the
most dependent part, unless there be some important blood-ves-
sel or nerve in that situation.

If, in order to arrive at the abscess, you have to pass through
a muscle, the incision ought to be made in a direction perpen-
dicular to the action of its fibres that is to say, that when the
muscle is broad, you must cut across ; but if, on the contrary, it
be narrow, your incision must be parallel to the fibres, to avoid
the risk of dividing it altogether. If in the case of a broad
muscle, such as I first supposed, your incision were parallel to
the fibres, it would almost always happen that the aperture
would be completely closed by their contraction. You have
lately witnessed a remarkable case, which I may quote here. A
patient, in the ward of St. Louis, had a large tumor on the
thigh, which not only afforded the ordinary signs of fluctuation,
but evinced a distinct gurgling. I practised an incision parallel
to the axis of the thigh, at the most dependent part : nothing
was evacuated. I introduced a hollow sound into the wound,
but still nothing came out. I then made another incision, at a
point where the fluctuation was still more evident, but with the
same negative result. The patient was very nervous, and his
muscles contracted with force. Astonished at the circumstance,
I next introduced a grooved sound along the blade of the bis-
toury, which yet remained in the wound ; but still no pus made
its appearance. My next proceeding was to make a movement
with the two instruments, in such a manner as to separate them
and prevent the contractile action of the muscular fibres : then,
at length, the pus found an exit. I request yonr attention to
this point, which is a very important one, for I am persuaded
that it happens very often, particularly when the fluctuation is
not very evident, that the surgeon, after having made his inci-
sion, erroneously supposes there is no pus, merely because the
opening having been made parallel to the direction of the mus-
cular fibres, their contraction again closes up the aperture.

Abscesses of the neck ought to be opened by means of a sim-
ple puncture. I do not now allude merely to small abscesses : 1
have opened, in this manner, purulent depots of considerable
size, and, although the extent of the incision was not in propor-
tion to the collection of matter, yet was all the pus evacuated,

24G Cli?iical Observations on opening Abscesses. [Nov.

while the cicatrix which remained did not exceed that of a leech
bite. This precept is of great importance, not only to the wel-
fare of the patient, bnt to the reputation of the surgeon, and. in
this double view, merits your attention. The following is an
illustration in point: I was called, three years ago, to Belle-
ville, to open an abscess on the neck of a young lady, which I
effected in the manner above recommended. In the same house
was a child, having an abscess similar to the other in situation
and nature. A practitioner there opened it by an incision of an
inch in length, and had reason to repent having done so ; for
the comparison of the two children, after the healing of the
wounds, was very disadvantageous to him ; the wound in his
patient having healed slowly, and left a large cicatrix.

In abscesses of the neck, owing to the small n ess of the aper-
ture, the want of freedom with which the pus flows, and its re-
maining about the cellular tissue, there may be a little lodge-
ment at the lower part, forming a kind o{ cul de sac, whence
compression is insufficient entirely to dislodge the matter. In
such case it is necessary to make a small counter opening, cut-
ting upon the grooved canula, so as to make a second incision,
no larger than the first, and thus the two look like leech bites.
The same precepts apply to those parts generally which are
habitually exposed. In the neck, as on the forehead, the inci-
sion ought to be transverse, that is, in the direction which the
folds of the skin naturally assume in those situations.

In those parts, however, where the appearance of the cicatrix
is not an object, modern surgeons make incisions of several
inches where the abscess is large ; and experience has proved
the advantage of this practice. The bistoury is to be held in
the first position : the two last fingers, separated from each other,
and extended, are to be placed, if possible, beyond the tumor, as
a point (Tappiil : the tissues which are penetrated must be di-
vided in a perpendicular direction : the middle finger, placed on
the blade of the instrument, serves to rogulate the depth of the
incision. This is very important, for if the instrument cuts i 1,
or if the texture be hard, we are under the necessity of pressing
mire strongly on the parts to be divided ; and without the pre
caution of having the finger as I have described, we should
incur the risk of plunging in the instrument too far. Besides,
it is easy to push the bistoury farther in if necessary, by draw-
ing back the finger on the blade of the instrument. We must
do all gently : thus, when the blade arrives in the collection of
pus, the hand will perceive the fact, because the knife is now
passing through a less resistance than before. The only excep-
tion to this is where there are muscular contractions of a nature
to interfere with the resistance. I cannot well give you a mea-
sure of the slowness necessary in this proceeding ; but always

1837.] Clinical Observations on opening Abscesses. 247

remember this fundamental principle in operative surgery tnte
is better than cilo.

I have advised you to make the instrument penetrate the in-
teguments perpendicularly : this rule applies to all such punc-
tures, and it is proper that I should point out its nnpoitance. If
the bistoury traverses the textures obliquely, it will have to pass
through a greater extent of them, and hence, consequently,
there is more pain ; hence, also, the exit of the matter is less
free, and probably we may have infiltration of the surrounding
parts in consequence. Besides, in abscess on the parietes oi the
abdomen, there may be a hernia without any indication direct-
ing our attention to it. 1 was called by Dr. Piorry to a wo-
man who had received a kick on the belly, in consequence of
which an abscess had formed there. The patient was carefully
interrogated, and assured us that she had never suffered from
any symptom connected with the digestive organs, there had
never been any thing indicative of hernia. However, I opened
the abscess cautiously, when a gush of purulent matter es-
caped, and I then saw that there was a knuckle of intestine
floating in the tumor. What would have happened had I thrust
the instrument into the tumor with that degree of brusquerie
which some affect on all occasions ?

An abscess deep in the parites of the chest or abdomen may
be actually in contact with the pleura or peritoneum, while that
in the neighborhood of a joint may reach to the capsular liga-
ment. If,"lhen, you open abscesses of this nature with no more
precaution than what is generally adopted and especially if
the muscular contraction prevents you from judging when you
have passed from the more into the less resisting part or, if
the abscess be not entirely filled, I repeat, that under such cir-
cumstances you incur the risk of penetrating the pleura or peri-
toneum. It is therefore imperiously necessary to open the
abscess as carefully as if it were a hernial sac.

I mu^t not forget to add, that in proportion as the incision is
made, the fore-finger being introduced into it, enables us the
better to appreciate the depth at which the collection of matter
is situated. I know that this is painful to the patient, but the
suffering is not of a nature to have any effect upon his health,
and we must above all attend to his safety.

If the abscess be in the course of a large nerve or artery, you
are told to make the incision so as to avoid it. But the tume-
faction and induration of the parts are such, that you cannot
recognise their relative situation ; and although anatomy tells
us the natural situation of the vessels, yet the developement of
an abscess often changes the relative position of the surrounding
parts. If the artery and nerve in question always retained their
wonted place, there would be no difficulty ; but, as I have said,

248 ( finical Observations on opening Abscesses. [Nov.

they are frequently displaced, and it' yon cannot ascertain their
new position, what are you to do ? Certainly, not to imitate
those practitioners who, in order to conceal their embarrass-
ment, declare the abscess to be not yet mature, and so postpone
opening it. This delay may be attended with the worst conse-
quences. If, for instance, an abscess be situated in the neck,
near the carotid artery, the jugular vein, or the eight pair of
nerves, or great sympathetic, in the midst of the fine loose tissue
of that region, the matter may find its way into the chest, or,
according to Desault, even into the abdomen. It is, therefore,
urgently necessary to open all such abscesses very promptly,
and it is now twenty years since I have adopted this method.
Take the neck as an example : I there make an incision parral-
lel to its axis, and which divides layer by layer successively the
skin, the cellular membrane, and, if necessary, the superficial
aponeurosis. I next take a blunt probe, and limit the extent to
which it is to penetrate the textures, by holding it between the
thumb and fore-finger. I then introduce this to the bottom of
my incision, and make it pass on by separating or rather push-
ing aside, the fibres of the parts beneath. Whenever the instru-
ment has entered the abscess, there is a cessation of resistance,
besides which I perceive drops of pus oozing along the sides of
the instrument. I then push it upwards and downwards, so as
to enlarge the opening, and thus the matter finds a ready exit.
Such is the result of twenty years' experience, and I have
never yet met with any accident from hemorrhage ; I am there-
fore inclined to believe that those surgeons, otherwise very able,
in whose hands such occurrences have taken place, have either
been ignorant of, or neglected, the precautions here laid down.
American Journal, from Gazette des Hopitaux.

Cure for Drunkenness.

A native of Norway, aged forty, who had from his youth
been accustomed to dram-drinking, was attacked with delirium
tremens. His medical attendant, to cure him of his dangerous
propensity, prescribed the daily use of a mixture of two drachms,
of sulphric acid and twenty-four ounces of whiskey. The result
was remarkable : in three month s1 time he got such a dislike to
all kinds of spiritoUB Liquors, that he could not bear to swallow
a drop of any thing stronger than beer. The dose of the above
mixture taken was four wine-glasses daily, and the cure had been
of a year's standing at the time of the communication of the
case. Eyt. Tiendc Bind, andet Hefte. Eclectic Journal.

1837.1 Belladonna in Ileus. 249

PART III.
MONTHLY PERISCOPE.

Belladonna in Ileus.

We have, on former occasions noticed some of the important
uses of Belladonna. Its safety mid benefits continue to bemore-
and more developed by the enterprizing practitioners of the pre-
sent age ; and important and extended as they now are, it is still
difficult for the mind to contemplate a limit to its application to
disease. Nor is its worth to be estimated by considering it
merely as a convenient substitute for other things, or as a gen-
eral prescription, or one ordinarily resorted to in cases wherein
other articles of less power or less danger under circumstances
of abuse or misuse in any way, would answer the demands of
the case ; but is most signally displayed when brought into use
as a kind of forlorn hope a dernier resort. It is in those cases
wherein other medicinals fail of the desired end wherein they
have been used ineffectually ; or for purposes wherein their use
is precluded by the circumstances of the case it is in short, in
the earnest demand of the otherwise hopeless necessity of the
case, that its signal virtues are brought to the aid of humanity.
A few instances amongst many such, are many rheumatic and
neuralgic pains, constriction of the urethra and of the rectum,
obstinate resistance of the os uteri in labor, inflammation of the
iris threatening obliteration of the pupil, &c. with its use in the
operation for cataract.

The preparations in which this medicine is used are various,
and afford great facilities in prescribing it. Indeed, the practi-
tioner has little to be watchful of in its use, but to avoid exces-
sive doses in internal use. Those mostly in use are the extract.
(Extr actum Belladonna, U. S.) The leaves, however, are re-
tained by most of the Colleges, and the root also by the Dublin.
It is given in infusion, substance, and extract. The leaves are

259 Belladonna in Ileus. [Nov.

generally used when it is given in substance ; the leaves or
root, when used in infusion, and the extract is given internally
in substance or solution, and applied externally in solution,
plaster, and ointment. This extract, (Succus inspissatus Bel-
ladonna, Dub.) is a variable preparation, owing probably to the
different proportional results of the preparation in different
hands and perhaps at different seasons ; as in Brande obtain-
ing four to six pounds of extract from one cwt. of fresh Bella-
donna, whilst M. Recluz obtained nearly ten parts from one
hundred. It is probable that the difference consists, not so much
in the quantity of extract afforded, as in the other substances
extracted with it from the Belladonna, making the increased
result of the latter : consequently, until the particular prepara-
tion used is well known, it becomes prudent to begin with under
doses, as one quarter to one half grain three times a day, and
increase to decided effect. The infusion is made of 3i of the
leaves to x of boiling water. The ointment, as first directed
by Chaussier, and which has continued in use, is made of 3 i j
of the extract to i of simple ointment, (for summer, or gj pre-
pared lard, for winter.)

The plaster, (Emplastrum Belladonnae) is made of 1 part ex-
tract, and two parts of soap plaster.

We have again turned our attention to this valuable article,
in consequence of noticing in the last No. of Dr. Bell's inval-
uable Electic Journal of Medicine, a work which should be in
the hands of every medical man, an interesting account oi the
use of Balladonna in Ileus, with cases illustrative, reported by
Dr. Wagner, district physician at Schlieben. We will give
the substance of the cases, as they alone can best illustrate the
decided power of the medicinal agent under consideration.

" Case 1. On the 2 1st April, Dr. Lohrenz of Schonewalde
visited a man aired 23, who had been complaining, since the
19th, of violent pains in the umbilical region. Pains came on
periodically, and were so excruciating on pressure that the patient
screamed out when touched. Incessant retchings, belly hard
and tense, and had been several days without an alvine evac-
uation. Venesection, leeches, enemata and various other exter-
nal and internal remedies were employed without any effect.
Symptoms increased in intensity, and on the 22d, had subsul-
tus, syncope, and vomiting of feculent matter. Belly tympani-

1837.] Belladonna in Ileus. 251

tic, hard and painful ; bowels obstinately costive, pulse scarcely
to be felt, anxiety intolerable, and body covered with a clammy
sweat.

Under these circumstances, Dr. Lohrenz had recourse to a
clyster of Belladonna. One half of this lavement was first in-
jected ; and unlike the other enemata which were almost in-
stantly rejected, this was retained, with a marked effect in calm-
ing the violence of the symptoms. The countenance became
more cheerful, and the abdomen softer, but the pupils became
greatly dilated. Half an hour afterwards the second half was
injected, and produced a most decided improvement. It was
speedily followed by copious evacuations from the bowels, the
pulse rose, pain and vomiting ceased, and next morning the pa-
tient felt quite restored, and had no return of symptoms.'1

Case 2d. On the 14th June, Dr. Wagner visited a labor-
er's wife, aged 40, spare habit, but otherwise robust and healthy.
She complained of a violent cutting sensation in the bowels,
with obstinate costiveness, and incessant vomiting. She had
had repeated attacks of the same description before, but much
milder, and of brief duration. On examination there was found
a hernial tumour in the right groin about the size of a walnut,
and so excessively tender on pressure, that she could not bear
the slightest touch. Belly tympanitic and tender, pulse small
and rapid, face pale, body moderately warm. A large venesec-
tion, and all the usual internal remedies, (except quicksilver,)
tried without any effect ; as well as clysters of all kinds. Pa-
tient refused to submit to a second venesection or the application
of leeches, and rejected altogether the proposal of an operation.
On the 5th all her symptoms were increased, thirst excessive,
fecal vomiting, and suppression of urine. In this state of things
Dr. Wagner had recourse to Belladonna clysters. He infused
3i of the root of Belladonna and i chamomile flowers, (he does
not say how long,*) in xij of water, and divided the infusion
into three parts. The first part was administered by himself as
soon as it was sufficiently cold, and produced very remarkable
effects. Nausea and vomiting instantly ceased, and half an
hour afterwards the belly was soft, and without much tenderness
or pressure, hernial tumour much less tender, though still pain-
ful. No secondary bad effects were observed. At noon she
was found quite easy and contented, but with dilatation of pu-
pils. She told him that she had been threatened with a repeti-
tion of the attack about half an hour before, but that she had
stopped it by drinlcing a few spoonfuls of the clystric mixture.
In the evening Dr. W. found her complaining of a return of the

* We consider this instruction sntTicient ; an infusion was made, and of course,
according to the ordinary rules for making infusions.

h8

252 Belladonna in Ileus. [Nov.

abdominal pain and tension ; and as there was no indication of
the secondary effects of the Belladonna, except some dilatation
of the pupil, he administered the remainder of the infusion.

The patient passed a quiet night with the exception of some
troublesome dreams, and, on the following morning the abdom-
inal symptoms were mild and inconsiderable, except that the
hernial sac remained extremely tender on pressure, and the in-
carcerated portion of intestine could not be replaced. At noon,
the soreness and tension of the belly increased again, and as no
alvine evacuation had as yet taken place, and there were no
apparent bad consequences from the belladonna, Dr. Wagner,
repeated the infusion as before. The first dose produced the
usual tranquilizing effect, but no farther change ; and as the
constitutional effects were limited to some increase in the dila-
tation of the pupils, with unpleasant dreams, he administered
the second portion, and towards the evening the third and last.
On the morning of the 7th, the hernial sac had disappeared
loud borborigmi were heard in the abdomen. But the patient
after having been annoyed the whole night by frightful dreams,
was suddenly seized with such furious delirium that several
strong men ware required to hold her. Her eyes were fixed
and sparkling, pupils excessively dilated, conjunctiva injected,
cheeks of fiery red, pulse small and rapid and scarcely to be
felt deglutition impeded. She saw nothing but strange phan-
toms, which she saught to drive away by abuse and threats, and
searched for concealed enemies under her bedding, cloathes, and
furniture believed herself perfectly well, wished to resume her
labors, pulled on her clothes with furious violence, and would
have rushed out of the house but for restraint by force. Dr.
Wagner ordered enemata of vinegar, (which were followed by
copious evacuations,) and gave vinegar with strong coffee inter-
nally, of which she drank large quantities with much desire.
Cold lotions applied to the head, and the limbs washed with
vinegar, an operation which the patient herself performed with
much apparent satisfaction, washing herself with vinegar from
head to foot.

This state of things continued until the morning of the 8th,
when the patient became rational and composed, but complained
of flashes of light, and various other optical phantasms, with a
sense of great weight and pressure in the head, and a general
feeling of soreness and exhaustion particularly in the feet. She
recollected distinctly every thing she had done during the pre-
ceding day and nijrht, and said the horrible phantoms around
her, compelled her to act as she had done. On the 9th, she
complained only of weakness, which soon disappeared, and she
recovered rapidly without any further unpleasant symptoms."

" Case 3rd. On the third of July a smith, aged 59. was at-

1837.J Belladonna in Ileus. 253

tacked with enterodynia, vomiting, tympanitic swelling of abdo-
men, and constipation. Dr. Wagner found an incarcerated
hernia of the left groin, about the size of a hen's eff, and ex-
tremely sore to the touch. All external and internal remedies
repeated local and general bleeding and frictions over the abdo-
men with extract. Belladonnae and ext. hposciami, proved
wholly ineffectual. Every thing was instantly vomited up, and
the clysters immediately returned. Patient would not submit
to an operation. Dr. Wagner threw up an enema compound
of a scruple of belladonna herb, and half an ounce of chamo-
mile flowers in four ounces of water, which arrested the vomit-
ing immediately, and produced such a diminution of pain, that
the patient was able to enjoy several hours sleep. The abdomi-
nal symptoms, however, returned every six or eight hours, and
were four times allayed by the use of the same enema. On the
5th, relieved of the pain and tenderness. Dr. Wagner was
afraid to have recourse to the belladonna, as in addition to great
dilatation of the pupils, frightful dreams, sinking and an altera-
tion of pulse, and dryness of the tongue had taken place, and
he prevailed on the patient to submit to the operation. This
was performed on the sixth, and in fourteen days the patient was
perfectly well.

"Case 4th. July 5th Dr. Wagner saw a woman, aged
47, who had labored for two days, under violent pains in the
abdomen, obstinate constipation and excessive vomiting. On
examination he found an incarcerated hernia of the right side,
about the size of a small walnut, which was excessively tender
to the touch ; diffused abdominal tenderness, and tympanitic
distension. Bleeding, leeching, frictions on the abdomen with
belladonna and hyosciamus were employed without any effect.
Patient refusing the operation, Dr. W. had recourse to bella-
donna clysters, which produced the usual tranquilizing effects;
but the hernia remained considerable. Patient exhibited some
of the symptoms of the poisoning, as dilatation of pupils, &c.
Blood was drawn from the arm, small doses of calomel and lax-
ative salts given internally, and the belladonna clysters contin-
ued until six lavements, (each composed of 3i belladonna and
iv water) were used. Hernia continuing irredecible, Dr. W.
discontinued his visits on the eighth. On the ninth, however,
the greater part of the hernial tumor had disappeared, the pa-
tient had several copious stools, and in the course of two days
found herself quite well.

251 Ergot preventive of Uterine Hemorrhage. [Nov.

Ergot administered in anticijjation of Uterine Hemorrhage.

The Lancet of the loth of April last, contains some observa-
tions from Dr. Bradley, on his successful administration of
ergot of rye in a case of uterine hemorrhage, immediaely suc-
ceeding the expulsion of the child, which he concludes by ask-
ing whether, when such an event is apprehended, it might not
be prevented altogether by giving the ergot immediately before
the birth of the child ?

In the subsequent No. of the same journal, (April 22nd,) T.
Abraham, Esq. bears testimony to the successful administration
of the remedy under the circumstances indicated, in six cases,
and I. Kisch, Esq. states that he has been accustomed for some
time past, to administer the ergot in similar cases, and with the
most happy results. So satisfied is this last practitioner of the
powers of ergot in preventing uterine hemorrhage, that he in-
variably enquires, he states, whether the patient has been in the
habit of flooding after delivery, and if so, of using the ergot as
suggested by Mr. Bradley.

The utility of this practice is unquestionable, but if it has
any novelty on the other side of the Atlantic, as we suppose it
has from the stress laid upon it in the communications just no-
ticed, it certainly possesses no claim to such distinction here.
The practice is pointed out by Dr. Stearns of New- York, in
his pamphlet on the ergot, published upwards of fifteen years
ago, and as employed many years since by our venerable and
esteemed friend, Dr. Dewees, and is distinctly and strongly re-
commended by him in his valuable system of midwifery.

American Journal.

We refer ihe reader to the first volume of the Southern Med-
ical and Surgical Journal, page 68, for our former notice of this
article as a mean of controlling and preventing uterine hemorr-
hage. We should have been more full on this subject, had we
not been writing especially with another view, that is, to give
our experience with this article in opposition to some opinions
published about that time, impeaching the powers, and the safe
use of ergot. In addition to what we then stated, we now say
that for twenty-five years we have been in the constant practice
of using ergot for the suppression of uterine hemorrhage, when

1S37.] Vaccine and Variola existing concurrently : 2oo

it occurred consequent to delivery in such a degree as to need
internal administrations; and in all instances in which we have
had charge of causes on account of the reasonable fear of he-
morrhage, or cases in which there was any reason to apprehend
this unpleasant occurrence. We have diligently adhered to the
practice of administering ergot during the labor, even when not
demanded on account of deficient parturient action, in order to
secure safety from hemorrhage, and with the most satisfactory
results, constantly confirming the propriety of the practice.
We have used it in two of those cases of dangerous hemorrhage
from attachment of the placenta to the os uteri. In one, the pa-
tient being twelve miles in the country, was in art iculo mortis.
On our arrival cold and pulseless, neither the ergot nor any
stimulant power could produce reaction, and she expired imme-
diately on the delivery of the child by extracting force, which
was done as soon as it was found that she was inexcitable.
The other case was attended with happier results. Although
the loss of blood had been very great before the administration,
yet the system was susceptible of the action of the ergot the
hemorrhage promptly restrained, and the child turned and de-
livered by the feet. It was a birth at eight months the woman
recovered. Our experience with the article in this relation, jus-
tifies the assertion that we have no anti -hemorrhagic power for
internal use, combining more uniform efficacy and safety than
ergot.

Vaccine and Variola existing concurrently.

The following circumstances detailed to the Editor during
the last summer, by Mr. S. B. Parkman of Savannah, seemed
to afford such conclusive evidence of the fact of the concurrent
existence of these two diseases, that the Editor was induced to
request of Mr. P. a written statement of the particulars which
evince this truth. Mr. Parkman's well-known character for
veracity, intelligence, and minute and strict accuracy of obser-
vation is sufficient to insure the fullest confidence in all the
facts detailed. The following is the statement which Mr. P.
politely furnished.

256 Vaccine and Variola existing concurrently. [Nov.

" Summersville, August 3rd, 1837.
Dear Sir:

The facts of the case I mentioned to you yesterday were, to
the best of my recollection, as follows :

In the summer of 1830, we left with our friends in Savannah,
three young servants who had all been vaccinated some years
before at the same time. On our return about the first of No-
vember, we found the small pox prevailing to a considerable
extent, and that our three servants had been again vaccinated.
On two of them the vaccine matter produced no effect but
one, a girl about fourteen years old, named Peggy, had a full
vaccine pustule on her arm. On the second day after our re-
turn, two negroes came to our yard from my sister's plantation
on May River, and we had them both inoculated from Peggy's
arm, though they had both been formerly vaccinated.

On the third day after our return, Peggy, who had been very
sick from the day we returned, broke out with an eruption,
which the health officer* pronounced to be small pox, and she
was removed to the public hospital at Cattle Park, where she
remained until she recovered.

On her return, I found a number of deep scars from the small
pox I think the number did not exceed twenty a considera-
ble portion of the pustules having disappeared without filling.
Her symptomatic fever, and the progress of the disease, so far
as I could learn at, the time, were all very similar to the ordinary
progress of small pox by inoculation. There seemed to be no
doubt in the mind of the health officer but that Peggy had the
genuine small pox, although much modified ; for the general
character of the disease was very severe, many cases confluent,
and several deaths.

Of the two negroes who were vaccinated from Peggy's arm,
on one, the matter produced no effect ; on the other a full
vaccine pustule from which all the negroes on the plantation
were vaccinated ; and from which nearly all those who had not
been previously vaccinated received the genuine vaccine disease.
The small pox was on the plantation adjoining my sister's
but none of her negroes took the disease.

I think the vaccine pustule on Peggy's arm was full when
the symptomatic fever commenced, and the eruption appeared
as soon as the pustule began to dry. I have always believed the
girl had the two diseases concurrently.

An infant also had been vaccinated in Augusta, which failed.
It was again vaccinated in Savannah on the arrival of the fam-
ily, which took effect. Peggy was with the family four days
before she was sent to the pest house the small pox pustules
not mature. The infant had kine pox, and not the small pox."

Dr. IIabf.rhu*m.

1837.1 Medical Intelligence. 257

This history goes to establish, as far as one set of incidents
can,

1st. That kine and small pox existed concurrently in the
same individual.

2nd. Small pox was taken in the natural way by Peggy, after
kine pox had taken locally, but before the constitutional effects
were developed.

3rd. That when taken in this way the vaccine modified the
virulence of small pox, (fee.

4th. That (as evinced in the case of the infant.) the small
pox is not communicable before the maturation of the pustules.
These points tend to remove much of the doubt attached to the
preventive efficacy of the vaccine disease.

MEDICAL INTELLIGENCE.

Wc arc often pleased by the evidences of the sound practice of our professional
brethren throughout the interior of South Carolina and Georgia, and particularly
in the latter, as our personal acquaintance is more extensive. Little of the fash-
ionable fancies which float on the superfices of the profession finds its way to the
bed-side in retired country practice, and the destructive waves of ultraism, raised
and kept up by counter-currents and adverse winds in science, are not fostered by
the safe moorings of country life. Here the mischievous ultraism into which be
may have run, and the errors of some ephemeral theory he may have been taught,
soon succomb to the facts of demonstration ; and the controling power of his only
master, Reason, governs him henccfoith in the even tenor of successful practice.
Thus it is, that with a good stock of medical science, he soon comes to that matu-
rity of judgement which renders him a prize of high value to his community.

Previous to theyear 1825, that, in which the license law, or medical bill of Geor-
gia was passed, it was a rare thing to meet with a medical practitioner of real sci-
ence in the interior. It is true that one of great merit was occasionally found in
some of the more prominent towns ; but by the wholesome operation of this law
during a short life of only ten years, quackery was scouted out from the whole
country, and true science so pursued, that on the repeal of that law, (which was
effectually done by the last Legislature by legalizing at one " fell swoop", a legion
of imposters*) that in no section of the country where there was any considerable

* An instance of retrograde legislation perhaps never equalled in the United States.

258 Medical Intelligence. [Nov.

population, was there a distance of more than a few miles, without a practitioner of
true science.

Every experienced and judicious Southern practitioner will see, in the comparison
of the following formula; of scientific practitioners in different sections, the harmo-
nizing and regulating influence of deliberate observation and reason on the southern
country practitioners, A pill will be found to have become in general use in cer-
tain bilious disorders, in different sections of the country, between which there is
no professional communication no consultation by which these results would be
communicated from one to the other. Nor is there much disposition amongst our
practitioners to follow the prescriptions of one another ; but rather to go forward
on deductions from their own facts of observation, or those facts of others in whose
impartial observation they can confide.

We noticed in our last No. the cholegogue pill in use by Dr. Dhlony, and for-
merly by Dr. Lucas. It is a pill, the good adaptation of which to the general de-
mand of chronic bilious cases, every southern practitioner of much experience, and
unbiassed by erratic theories will at once perceive. We now give an extract from
a letter from Dr. Holloway of Warrenton, as follows, on the treatment of inter-
mittcnts;

8

Comp. ext. colocynth.

Calomel

gr. xxxvi

Pulv. gumgaurboug. aa.
Ipecac.
Anise oil
Spanish soap

gr. xvnj

gr- VJ

gttij

gt. xxiv

Syrup q. s. Make twelve pills dose two or three at night ; or one every night
as occasion may require.

II. Precipitated ext. of bark
Piperinc
Sulph. quinine, of each equal parts.

Make a mass, of which a pill of three grains is to be given every two hours. If
the ague should return add one quarter of a grain sulph. of copper to each pill."

With this course of cholegogue and tonic treatment, Dr. H. informs us that he
rarely fails to cure the most obstinate intermittents ; and that they are " particularly
beneficial on chronic, habitual cases." The formula for cholegogue pills, he has
used for the last twelve years with great success. It is not a little remarkable that
we find the cholegogue pill of both these gentlemen almost identical, not only in
the ingredients, but the quantity to the dose.

Dr. Hum, of Athens has for many years, when in full practice depended for his
choWotTue, mainly on a pill almost identical with these, and with the most satisfac-
tory success. The following is his formula :

ft. Ext. of colocynth

Calomel aa 3 j

Tart, antim. one eighth to one quarter gr.

Mix and make twenty four pills. Dose thrc"! to four pills.

From another source we have received another formula for a cholegogue pill,
differing from this last only in the tartrate of antimony being three grains, instead
of one eighth to one quarter, and the dose two to four pills.

SOUTHERN
JOURNAL.

Yol. II. DECEMBER, 1837. No. V.

PART I.
ORIGINAL COMMUNICATIONS

ARTICLE I.

-4 paper on diseases mistaken for Hernia, with cases. Report-
ed/or the " Southern Medical and Surgical Journal". By
Heber Chase, M. D. of Philadelphia, Member of the
Academy of Natural Sciences of the Franklin Institute
of the State of Pennsylvania, for the promotion of the Me-
chanic Arts Honorary Member of the Philadelphia Med-
ical Society, fyc. fyc.

Among those diseases most frequently met with and often
mistaken for hernia, are varicocele, or a varicose state of the
veins of the cord. Buboes, or glandular swellings in the groin
from any cause. Hydrocele, or dropsy of the tunica vaginalis.
Hydrocele of the Cord. Enlargement of the Cord from any
cause, and Fatty Tumours.

Variocele or Cirsoccle. Within the last three years I have
been consulted in several hundred cases of hernia,* and by

* A tabular statement of two hundred cases of hernia will shortly be laid before
the profession.

Al

260 Chase on Diseases mistaken for Hernia. [Dec.

many patients, who, upon examination, were laboring under
varicocele, and frequently wearing trusses applied by trass-ma-
kers and druggists. Patients of this description are constantly
falling under my observation. It has heretofore been almost
universally the custom for practitioners to send their patients to
instrument-makers for trusses, and it is by no means uncommon
to hear some of those gentlemen boast of the number of trusses
they have u put on." Should they be able to distinguish an
enlarged vein, a firm tumour, or a bag of water, from a bowel,
the knowledge appears of little moment to them, provided they
effect their object, the sale of a truss, even at the risk of the
health and life of the patient.*

It is not unusual for surgical writers to censure the profession
for mistaking variocele for hernia ; and there can be no doubt
that such mistakes do sometimes happen ; but it may safely be
said that in those cases where trusses are thus improperly em-
ployed, there is seldom ground for believing that they were ap-
plied by those whose extent of surgical knowledge and acumen
have equalled their desire for such acquirements.

Glandular Swelling in the Groin.
Tumour in the Groin mistaken for Hernia age of patient, 6
years application of poultice to the part ; discharge of
contents cured.

Case 1st. April 24th, 1837. A lady called at my office ac-
companied by her little son, aged six years, whom I had cured
of an inguinal hernia of the right side. She informed me that
she thought " the disease had returned." Upon examination I
found a tumour about the size of a hen's egg located near the
seat of the internal ring, but a little outward and upward there-
from ; and upon further examination, I was convinced that it
was not a return of the bowel. The mother fearing there might
still be something wrong in the case, I requested Dr. R. Coates
to see the patient, who coincided with me in opinion. I ordered
the parts to be poulticed. In five days the abscess opened spon-
taneously: the contents were discharged, leaving a smooth cav-

* Truss. This is an instrument employed by Surgeons. Surg. Die. article
Truss.

1837.] Chase on Diseases mistaken for Hernia. 261

ity, the edges of which were drawn together by adhesive strips,
and in ten days the patient was well.

Not nnfrequently, fatty tumours are found to occupy the seat
of crural herniae, which should not be mistaken for this disease.

Femoral Hernia mistaken for an inguinal gland age of 'pa-
tient about 45 years operation for Strangulated Hernia
death of the Patient.

Case 2nd. A few months ago I was requested to visit a pub-
lic institution near this city, to apply a truss in a case of hernia.
On examination, I found the patient laboring under irreducible
femoral hernia. The tumour was of the size of a filbert, and
could not be returned into the abdomen. The surgeon and at-
tending physician of the house thought the existing tumour to
be a lymphatic gland ; that the bowel had been returned, and
wished the instrument to be applied. Satisfied that such was
not the case, I refused to comply with their request.*

On the third day following, the symptoms of strangulation
came on. An operation was performed for his relief, but the
patient died a few hours after.t

Hydrocele, or Dropsy of the Tunica Vaginalis.
Case 3rd. In the early part of the year 1837, I was called
to visit the son of a clergyman of this city, who was supposed
to be laboring under double inguinal hernia. He was wearing
a single truss. On examination, I found that whatever might
have been his former condition, he had at this time no protru-

* I employed taxis to considerable extent in endeavoring to reduce the bowel in
this case ; but had no opportunity for instituting other means. I could not learn
how long the bowel had been protruded.

See an interesting, and instructive case of strangulated hernia with the employ,
mentof taxis ; successfully treated by Drs. P. F. Eve and Dugas of Georgia, with
remarks by Paul F. Eve, M. D. in the September No. of this Journal for 1837.

t This species of hernia is liable to strangulation, even before it can be felt ex-
ternally. Hence it is obvious that we must establish our diagnosis principally on
the preceding and concomitant symptoms of the case. Some fatal effects hare re-
sulted from mistaking strangulated crural hernia for inflammation of someof those
lymphatic glands which lie in the vicinity of the crural ring. The deep situation
of the hernia, together with its very small size, hare contributed to render the mis-
take more frequent. In some instances the difficulty of discriminating is consider-
ably increased by an enlarged lymphatic gland lying anterior to a very small her-
nia. Cones' Surgical Anatomy.

62 Chase on Diseases mistaken for Hernia. [Dec,

sion of the bowel ; but he was laboring under hydrocele on both
sides, which, by a superficial observer, might be mistaken for
ruptures.

This watery effusion could be readily returned into the abdo-
men, showing that the necks of the sacs were not closed. Upon
further examination, I found a general dropsy of the system,
and that the patient had labored, not long before, under an at-
tack of scarlatina, the dropsy being one of the sequelae of this
disease. 1 requested that the family physician might be called
in attendance, which was done. The patient died, however, of
hydrothorax, in a few days.

Hydrocele of the Cord.

Case 4th. On the 11th of August, 1837, a gentleman and
his wife, from the interior of this state, called on me (by the
advice of their physician,) with their little son aged three years,
to consult me in relation to an inguinal rupture, to which it was
supposed their child had become recently subject.

After a careful examination, I found the disease to be dropsy
of the cord. The fluid could not be returned within the ring ;
but the tumour presented at all times the appearance of a her-
nia. Under appropriate mild treatment, the affection disappeared
in about a week. As the physician whose patient the child had
been, thought there was at times a protrusion of the bowel, I
furnished the parents with an instrument to be employed in case
the bowel made its appearance, but under no other circum-
stances. The parents returned home with the child, and I have
heard nothing- further of the case. Dr. Warren of New-
Orleans, has met with two similar cases.*

From the connexion which inguinal hernia has with the spermatic cord, vou
must expect thai those diseases to which the cord is subject, will boar a resemblance
more or less strong, to this form of hernia. Thus, when water collects in a cyst
onthat part of the spermatic cord which lies in the inguinal canal, forming encysted
hydrocele of the chord, the appearance and feel of the parts will not be such as to
constitute a satisfactory distinction between these diseases. Wo must then depend
a good deal upon the history of their origin and growth, and also upon their atten-
dant symptoms. Collet Surgical Anatomy.

A sac of fluid formed upon the cord, or the cellular hydrocele of the cord, may
be mistaken for this kind of hernia. If lar<je, t lie tumour may bo known from its
transparency, its uniformity, and elasticity; it docs not receive the impulse from
COUghing, as the hernia does. SfrCHARLES BELL.

1837.] Chase on Diseases mistaken for Hernia. 263

Enlargement of the Cord.

Case 5th. August 10th, 1837. I was requested to see Mas-
ter , aged five years, who had an inguinal hernia, which

had passed only into the upper portion of the inguinal canal.
This was easily reduced, leaving a tumour which resembled a
bowel, and, on examination, was found to be attached to the
whole length of the cord between the external ring and the tes-
ticle. Strong efforts were made to detach the tumours, but
without effect. The hernia being reduced. I applied the Ingui-
nal truss, which perfectly retained the bowel, the tumour re-
maining in the same situation.

12th. I requested Dr. R. Coates to see this patient. On
examination his opinion corroborated my own. We judged the
tumour to result from a deposition within the substance of the
cord.

13th. The patient wears his truss without any inconven-
ience.

17th. Since the application of the truss there appears to be
an evident diminution of this tumour.

Sept. 15th. On a careful examination of this case to-day, no
appreciable difference could be observed between the two cords
by the eye ; and a very slight thickening could be felt between,
the testicle and abdominal ring.

Ventro-inguinal Hernia, which had passed into the scrotum ;
occurred while fox-hunting mistaken for Hydrocele pa-
tient objected to the operation for Hydrocele.

Case 6th. January, 1836. H. S , an English gentle-
man now resident in Philadelphia, has been subject to ventro-
inguinal hernia of the left side for ten years. This accident
occurred in fox-hunting.

This patient consulted Dr. Hartshorne, who referred him
to me. The hernia was easily reduced, and was perfectly re-
tained by the ventro-inguinal truss. He had never worn any
instrument previous to this application. The tumour always
retired at night, and reappeared during the day. About five
years ago he consulted a Danish naval surgeon, then on the

264 Chase on Diseases mistaken for Hernia. [Dec.

West India station, and the case was pronounced hydrocele.
Two different hours were appointed on different days, for the
operation of tapping and stimulating injections ; but fortunately
the fears of the patient in both instances prevented the execu-
tion of the design ! No attempt at reduction had been made by
the surgeon, as there was not even a suspicion of hernia in the
case ; and the diagnosis was thought to be so perfectly plain
that great offence was taken at the unwillingness of the patient
to submit to advice ! The reading of a medical work at length
convinced the gentleman that he labored under hernia, which
induced him to apply to Dr. Hartshorne.

Varicocele mistaken for Hernia case of four years1 standing
application of Dr. Hull's Truss afterward of Mr.
Stagner's instrument.

Case 7th. A Y , Esq., a gentleman of high stand-
ing, from one of the southern states, came to Philadelphia for
the purpose of consulting me relative to a supposed "scrotal
hernia," with which he had been induced to believe himself
affected.

About five years ago he consulted a gentleman, not of the
profession, who acted for the sale of a celebrated truss invented
in New- York ; who, under the belief that the case was one of
genuine hernia, applied die truss. The patient continued to
wear it for some time ; but finding the disease greatly aggra-
vated under its use, he at length relinquished it.

His disease still continuing, he applied for relief to a gentle-
man in Washington, D. C, who furnished him with Mr. Stag-
ner's truss. This instrument he continued to wear for several
months, until the distress resulting from the complaint became
al 1 ogpther insu p] >ortal >le,

On examining the patient} I found that he labored under an
unusually extensive enlargement of the veins of the spermatic
cord ! He had cirsocelc, and there were no signs whatever
th.ii hernia bad existed in the case at any time!

This information being communicated to the patient, his joy
and gratitude were as great as could well be imagined under
such circumstances ; for he had been harrasscd and annoyed

1837.] Chase on Diseases mistaken for Hernia. 265

for years with even an exaggerated dread of strangulated her-
nia and the knife 1*

Inflamed Inguinal Gland mistaken for Hernia age of pa-
tient about 30 years injury from the improper use of a
Truss Fistula cure.
Case 8th. March 25th, 1S37. 1 was requested to see Mr.

, from Virginia, a gentleman of a corpulent habit, good

constitution, and who had heretofore enjoyed general good
health. This gentleman's attention was first called to a tumour
in the right groin, near the seat of the internal ring, about two
years ago, when he consulted a physician, who applied one of
Dr. Hull's trusses. This instrument gave him no material
inconvenience. He wore it about two months, when, the tumour
not disappearing, he threw it aside. Shortly after, he applied a
second instrument, with a stronger spring, but with no better
success.

Soon after the trial of the last named truss, he met with the
instrument called Semple's truss, (the late Dr. Hull's spring,
with Price's leaden conoidal block.) This truss is now in my
possession ; he wore it for a {ew days with the leaden conoid
placed directly on the site of the internal ring, but was confined
to his bed by the pain produced by that instrument. His tu-
mour not disappearing, and his groin having received great
injury from the pressure, he threw aside all trusses.

I found him able to walk about, but with his right inguinal
region very much swollen, of a bluish color, with two small
suppurating orifices on a line with Poupart's ligament, and near
the site of the internal ring. I ordered a large poultice to the
groin, and left him in the recumbent position.

26th. On the removal of the poultice to-day, two more ori-
fices were observed : one, above those before mentioned, and
about an inch nearer the anterior superior spinous process of
the ilium : the other was situated a few lines nearer the os
pubis than those first spoken of.

A communication could be traced between the first three
mentioned, by which they were united from twelve to eighteen
lmes below the surface.

I have more than once known a truss applied for this disease, (varicocele,) and
in one instance, to the son of a medical man, by his father. Cooper1!: Lectures.

266 Chase on Diseases mistaken for Hernia. [Dec.

The upper one communicated with still another orifice further
to the right, and at the outer side of the thigh : while the lower
one penetrated almost to the angle of the pubic bone.

27th. Dr. R. Coates was called in consultation. Poultices
were removed, but re-applied.

28th. Poultices removed ; matter of a greenish color es-
caped on pressure. Ordered injections of sulphate of copper
grs. xxx. to the ounce of water ; enjoined rest in the recumbent
position.

30th. The poultice re-applied.

April 1st. Professor Gibson met us in consultation this day.
On the removal of the poultice, a fifth abscess was discovered
situated a little below that last mentioned, extending down the
thigh the distance of four inches. Injections were also thrown
into this extensive opening.

It was suggested that a seaton should be introduced from the
upper orifice to that next adjoining, and that the remaining fis-
tulous communications should be treated by the injection of
sulphate of copper, reduced one half in strength.

2nd. Professor Horner met me in consultation this day. I
now applied graduated pressure over the abscesses indiscrimi-
nately by means of cloth of elastic webbing and compresses;
attention was also paid to his diet, which was ordered to be mild
and nutritious. Two grains of blue pill were directed to be
taken every night, and mild laxative medicines when required.

Cold applications to the parts were also occasionally employed
where the heat of the parts was increased.

12th. Upon examination it was found that the abscesses were
closing at the bottom ; treatment continued.

15th. No material change having taken place where the
seaton was employed, it was removed, and the injection of
sulphate of copper substituted.

20th. No material change.

25th. The abscess where the seaton was employed, is now
uniting under the use of the copper.

29th. The part of the abscess extending towards the os pubis
is now perfectly closed.

May 9th. The abscess which passed down the thigh is com-
pletely healed ; the other fistulae admitting a probe to the depth
of two or three lines only.

1837.] Chase on Diseases mistaken for Hernia. 267

18th. Fistulas entirely closed ; patient permitted to rise and
walk about the room.

20th. Patient rode out for the first time.

25th. Compresses removed.

30th. Mr. left the city for Virginia.

We saw no indication that hernia had ever existed in this
case.

Varicocele mistaken for Hernia, after cure of hernia age of
patient 28 years test of cure, two and a half years discon-
tinuance of the instrument.

Case 9th. Common inguinal hernia of the right side. Mr.

, a gentleman aged 28 years, accustomed to much exercise.

Accident of more than two years standing. The patient had
never worn a truss before he placed himself under my care.

In January 1835, my common inguinal truss was first applied.
I saw the patient frequently for the two first months ; after
which he regulated the instrument for himself. He continued
the use of the truss for two months longer, and then relin-
quished it without my advice.

June 10th. I saw the patient again. There had been no
protrusion in the interval, but he complained of slight pain and
a sensation of weakness in the part, when he rode on horseback,
or was driven rapidly over the pavement in a carriage.

May 20th, 1836. The patient came to me stating that he be-
lieved there was a relapse of the disease, and that the bowel
was in the scrotum. I examined the parts very carefully, and
found the cure complete. The rings were perfect, but he had
labored under a slight cirsocele on the right side, which had
been considerably aggravated by active exercise and the heat of
the weather.

July 20th. The patient continues well of the hernia, and the
cirsocele has been diminished under the usual treatment. He
has never been examined by any other surgeon, having steadily
refused to submit to such an exposure.

* See on the 247 page of this volume, first paragraph, a case of abscess with
hernia. The abscess was opened by M. Lisfranc before the hernial protrusion
was detected. Editor.

b2

268 Observations on the state of oar Medical Epoch. [Dec.

ARTICLE II.

Observations on the actual state of our Medical Epoch. By
John B. Gorman, M. D., of Talbotton, Ga.

Error is natural and easy ; but truth, hard and difficult.
The former seems to move by the impetus which originates in
itself; while the latter passes from age to age with a heavy,
draging, motion ; its tendency is to be stationary, and its trans-
port through time, accomplished only by the hard toil, the com-
bined efforts of the real thinkers of our species. Error moves
through time noisy as down an inclined plane, generating its
own velocity ; truth is pushed steep-upward, and disputes with
obstinacy every inch of ground it is compelled to traverse. Its
real friends in all times have been few, its false patrons, all our
race : and its travelling place, far out of sight in the rear of
error.

In Egypt, Phaenesia, and Greece, the infant sciences wept
over this unequal struggle between the two. To turn the scale
of victory on the right side, they built temples to truth, called
Hermes in bodily shape from Heaven, invoked Appoilo and .
brought Minerva out of Jupiter's brain. But these temples are
in dust, the tomb of Jupiter is in Thrace, Hermes is forgotten,
and our sciences, in their old age, still mourn this unequal
struggle against them.

In no department of knowledge has this state of things been
so deeply felt in all times, as in medicine. Religion has its
teachings from the sky to guide and govern ; its fundamental
principles, the ideas of another world. On a few infallible, self-
evident propositions, mathematics has reared the edifice of her
stupendous science. For the other sciences, we may say, the
five senses labor with facility, and furnish materials. But for
medicine, in many respects, their operations are embarrassed ;
much that is essential lies beyond them ; they yield not their
full product, and the mind arriving at the ultimate boundary of
their lights, reaches the truth now lying before it, by a route of
thick and perplexing darkness. But how deplorably often it
has failed, the history of our science, but too plainly shows. Its
essential ideas are scattered throughout the universe. Vast time

1S37.J Observations on the state of our Medical Epoch. 2G9

more than has yet transpired is necessary to collect them ;
and, in the future history of our race, medicine must be the last
to arrive at perfection. And we should think, if death be the
greatest misfortune, and life and health the greatest blessings,
all wise legislators ought to stimulate to its cultivation, supply
the means ; and, on our part, however difficult, the neglect of
its profound study ought to be esteemed profanity and blasphemy
offered to human nature. This has been attempted in many of
the older states of Europe. Medicine under the patronage of
government there, for the last twenty years, has for outstripped
all its flights in former times : and, in the actual epoch, never
before have arisen so many illustrious professors in every depart-
ment, nor the world deluged with an equal number of false
pretenders. Let us discuss a little this matter. The happy in-
fluence the modem sciences have exerted upon the arts in abridg-
ing labor, and arriving at the desired results by short and inex-
pensive routes, has contributed to it. The principal operation
of this influence is upon vulgar, popular opinion, inducing the
belief, that, since what was formerly accomplished by vast time,
labor and expense, is now effected almost without any trouble
at all ; and, that since the world has become generally enlight-
ened, all this mighty study about medicine, if not an imposition
upon the good sense of mankind, is, at most, but little better
than useless, idle stuff. Thus upon the purturbed face of
modern society, has been erected a vast emporium for empiri-
cism, whose turrets outtop all the former world. Misled by
their ignorance, judging wrongly what they do not understand,
the people have opened a market for doctors of their own taste
and stamp, and patronized a medicine they can understand ;
a medicine, which to nature, falls short even of the merit of a
real mockery. Naturally enough physicians of this easy and
spontaneous elaboration, incubated by the mere warmth of pop-
ular breath have multiplied, of every shape and form, pleasing
in the people's eyes, and crowded full up to the public demand.*
In our own country, and otherwise happy epoch, men from
all ranks and conditions of life, are clamorous to practice the
divine art of healing; and, what few restraining laws existed

* A most faithful description affile Thonnonian cohort.. En.

270 Observations on the state of our Medical Epoch. [Dec.

among us are blown away before the popular breath. To the
eager enterprizers of this art, the gates are thrown wide open,
and liberty reigns again.*

When the laws banished all the physicians from Rome, t their
art was entrusted to the hands of the Priests of Apollo. These
Priests possessed the learning of their time, which places our
medical nineteenth century behind the shadow of Rome, for
our unlettered have become our Priests.

But the most deplorable feature in this state of things is,
among those who would regularly cultivate the profession,
slight and superficial attainments are encouraged. For, if the
people, among whom our art is to be practised, believe that la-
borious study, profound research, have but little or no influ-
ence upon its success, the most powerful stimuli to support
the student's painful toil the hope of fame and reward are re-
moved. And this must ever be the case, since nature forms but
few to be delighted only with the pleasure which study and
meditation impart. The impulse, therefore, among the vast
majority who study medicine, must ever supply the place of the
inborn love of study. And if the people believe that all learn-
ing is a humbug, and calculated only to give the profession an
imposing air and aspect, and are willing, nay, prefer to patron-
ize and support the illiterate, the short and the bye-ways to
practice, must be the most frequented. Those who travel the
route of study, will be the few, the scanty few, whom nature
brings forth sparingly, and scatters through ages to think and
speak of her, to whom she unbosoms herself, and whose thoughts
she wings with fire to beat up, and grasps at the feet of her
Creator. They are born in a sea of thought, and live only to
think. On these hang all the hopes of medicine, and the other
sciences.

It cannot be denied, in many parts of our country, the opin-
ion prevails, that much study in medicine is useless : it is an

* Sec Oeuvres completes <!< Cabanis, tome 1. ct Hietoire de la Medecine par
Spreugel, for a lull account of this affair and the result? of it.

+ In some of the states of the. German empire, in France, the laws are very bind-
ing on the physician. If the patient suspects he has not. been treated correctly ac-
cording to the regular rules of the art, and he has sustained injury thereby, he may
sue hisrlortor ana" recover imprisonment and heavy damages. How different the
government of Georgia and our country.

1837.1 Observations on the state of our Medical Epoch. 271

art which requires but little thought or preparation ; nay, that
learning mystifies the mind, makes a foo 1 of its possessor, and
disqualifies him for practice. Were such opinions and views
entertained and cherished only by the weak and the vulgar, it
would not be so deplorable. They infect and lay hold on strong
natural minds, nay, many of the highest cultivation ;* and have
for their prosperity and support the sanctions of information,
strong, good, common sense, respectability and high standing
in society. And there are not wanting those, a busy, restless,
artful band, who with all their strength and ingenuity, dress up
these opinions with pleasing, winning contours, teach the un-
suspecting and strive for universal proselytism ; making of the
world a vast work-shop, where their lortuues are to be manu-
factured.

" Flap on the skirt of night your raven wings,
Ye black, ye fetid, hungry death's I'll feed,
With entrails of a thousand living men,
Yourcrops, if I but two pence gain."

It is easy to believe what we desire ; if we could arrive at
the possession of goods and fortune without labor, it is the way
we would prefer. The subject before us is in the same predic-
ament. Thousands would make a livelihood of medicine, did
they possess the knowledge. In the distance, we may say, they
behold its vastness, and the mighty acquisitions which it has
recently gained. They are deficient in its auxiliary sciences,
may not possess courage or abilities for its prosecution ; its
boundaries appear frightful ; the space to be travelled over,
great; it is a world which must ever be concealed from them
and their enjoyment. They despise what nature, by placing
beyond, has refused to their acceptance. Without sagacity or
qualification to understand, they proscribe ; without reason,
they condemn reasoning ; without knowledge and experience,
they condemn the knowledge and experience of all ages. All
libraries, all colleges, institutions all the most august and
venerable labors and monuments of our species are insignificant
rubbish. " Et simulacra l magnai] temporum percussa, et
statuce veterum hominam dejecta sunt."11

* In a conversation the writer once had with a professor of our University, he
declared his belief that duaek Doctors frequently cured where the regular art
failed ; and had placed his sick under a root monger, who professed to salivate with
roots. Every one knows I. I. Rosseau has noised his contempt through all ages.

272 Observations on the state of our Medical Epoch. [Dec.

They affect to despise all wisdom, all teaching every thing
of the kind which existed before they began to think ; or rather
a growth of mind without thought But all this would avail
nothing, if the people who are to pay them for their services
have no faith. The next labor is to make the people, who trou-
ble themselves with but little thinking, except in their own line.
They apostleize ; every newspaper is their minister. They
tell of their Arabian knight cures. If you doubt, they strike,
and the rest cry out, " lay on Macbeth," shoot their porcupine
quills, and make common cause. They are fond of trying
their new-born skill on the old incurables those mountain
rocks that did not fall when the storms of other times were
passing; which now, with a tremendous crush, are pretended
to be swept away.

" Ruat coelum, terra de his cat."

But is the world so weak, silly, credulous ? In religion, mor-
als, the science and art of government, the social, domestic and
industrious arts, in civilization, argentation, or money-making, the
public mind has attained to a knowledge unknown to all former
times. But in medicine, as in astronomy and some others, the
superstitious bigotry and the midnight darkness of the worst, of
the most barbarous ages, tyrannise over it, and hold it in fetters.
It has made no advancement, never can : the general interests of
mind will never be attended to on our planet. The views of
Barthez,* Goodwin^ Helvetia's,} of the advocates of Iiu-
man perfectibility, are but lonely dreams. The elegant arts,
argentation whatever administers to the organic wants, and
the passions, will still advance. The causes are forbid in our
discussion. Scientific, popular medicine is among those which
must remain nearly stationary for all ages. It is true the unlet-
tered, the uninitiated man might calculate an eclipse, but would
be sure of detection ; while the same might prescribe a dose of
medicine without detection ; nay, with success and applause.
Not that he has more knowledge and skill of the one than the
other, for this he is supposed not to have ; but because different

Nouveaux elcmens dc la science dc l'hommc.
i Political Justice.
t Traite de rhorarao.

1837.] Obser cations on the state of our Medical Epoch. 273

laws govern in the two things. All the aether co-dynamical
movements arise from the operations of one great law or inex-
haustible, changeless force, of whose modes of action he being
ignorant, mi^ht calculate forever without hitting an eclipse.
While in the dynamical system of living organology, where all
nature conspires to modify not only the actions, but likewise
the sources whence they arise, he might chance prescribe that
is, offer a modifier ', which affecting some of the systems, might
superinduce a new order of living movements, and tend to san-
ification. And were the laws which govern the two systems,
the same, both straight onward, every sickness would be death ;
and nothing but sheer skill, as in the eclipse, could save the pa-
tient. Here, then, is the great fountain head of all empiricism,
medical, irredeemable, popular ignorance. Here is what has
cloaked the false pretenders of the art for all ages past from de-
tection, and screened them from merited anathema and detesta-
tion ; nay, in place, has enabled them to receive the good will
and benedictions of those their wicked ignorance and audacity
were stabbing to the heart. And, salarous illuctabile scriptu !
here will be forged chains strong enough to hold all our future
race a despotism where, unlike as in others, no rebellion will
ever come to fling off the yoke. For mankind can never be
enlightened generally on their health, disease and treatment.
Our sublunary condition forbids it; these are topics of vast im-
port, and demand great time and study to give but a moderate
knowledge. The endless ramifications or departments of life
argentation with its thousand active streams must go on, must
occupy the time, the thoughts, and industry of ninety-nine hun-
dredths of our race, leaving no room for their study. These,
therefore, and more who possess not the ability, must ever be at
the mercy of the few who make, or pretend to make, a business
of the art.

There is no hope that knowledge can ever become so gen-
eral, that mankind in mass may judge correctly of the skill and
abilities of medical practitioners, and detect the dupery and
falsehood practised upon them. And the more so, since it is
undoubtedly true, the torches, which the other sciences holdup
of themselves, although so essential, fling but a dim light on
medicine. To be understood it must be studied with them, and

274 Observations on the state of our Medical Epoch. [Dec.

by their lights. Ignorance, bigotry, medical superstition and
credulity will continue to be associated, and the tales of mar-
velous medicines and cures, unknown to truth and to nature,
will continue to be listened to, and read with interest and appro-
bation. A reform, therefore, from the general diffusion of
knowledge, can never be looked for ; and as it always has been.
Empiricism must exist onward, a most disastrous evil and mon-
ument of our common frailty. In proof: While most of the
other sciences have advanced, and a deeper and wider interest
been felt for them, popular medicine has remained nearly sta-
tionary ; in despite still, in the winter of barbarous times, stand-
ing alone in the solitary horizon, whence all other knowledge
has emigrated. There it stands, in the forlornness of a dila-
pitated world, while among its cultivators, at the very moment
we are recording this memoir of the actual epoch, it is shedding
the most brilliant glories, that any part of its history has ever
manifested. But this light falls only on the profession, in the
people it meets a permanent barrier. And, at this period, even
of its professional prosperity and brilliancy, public esteem and
admiration for it seems rather to have retrograded than ad-
vanced. For, we know the Ancients created it into a Divin-
ity, associated it with the worship of their Olympic gods,* paid
their homage to its most illustrious professors, and, to their
memories after death, erected statues. But for its gift we wise
moderns thank not God nor Providence, believe it the growth
of our own minds may flourish by the side of stupidity that
wisdom comes not from thinking and thought's materials, and
conclude

" Darkness enough to cover thrice
This double hemisphered world."

" Aevum miserabile /" in which the majesty of reason and
truth can never hush the noise of quackery. Public incurable
ignorance, we see, is the vital air it breathes, in which it is en-
gendered and kept alive as infusory life. Of reptile vitality
and prolific in the extreme, it deposits its germ in the shady
places of men's minds, where it grows up to consume the orph-
an's substance, it has made an orphan. Its footsteps are seen

* Diodorus Siculus, Opera. Cudworth's Intellectual system.

1837.1 Observations on the state of our Medical Epoch. 275

about fresh graves ; in its intercourse affected by modest, cau-
tious and circumspect ; and its voice is heard consoling amid
the death screams of the unsuspecting, dying a vampyre
that clings fast to the revolving orb of generations, marking the
whole clean web of time as it is unrolled with its filthy trail.
It does not walk in the back-ways, \n the bye-paths, in the sha-
dow of night ; it does not ply its busy industry in the mean
hovel, on the dirty, honest peasant, stretched on his sick bed.
Charity freezes its efforts. It flies from poverty as from sin, ex-
cept it can use it to deceive and make its trade. It loves to dec-
orate itself and walk in meridian light, conscious that its hid-
eous form is concealed. It is fond of splendor and show and
noise ; loves high places, and the houses of the great and the
rich. In its manners so affable, so accommodating, so subduing;
it finds easy access, flatters vanity, and lulls suspicion. It is so
artful, none but the medical learned are free from its attacks.
Upon minds possessing all other sorts of science, it fastens as a
deadly superstition ; and reigns and tyrannises almost over the
universal mind of our species, furnishing extra width and depth
to the common natural grave. Power Incubus Upas-born !
irradicable !! General scientific knowledge opposes to it but a
feeble barrier, as experience shows ; its only efficient obstacle is
the learning and teaching of real medicine, which, as before,
must ever be limited to the few. And the pressing occupations,
wants of life, natural inabilities again, must always restrain
within certain limitations this diffusion of general information
to contract or expand a little with the accidents of ages and
governments. Therefore, we repeat, quackery is an enduring^
irradicable evil, flourishing in our age, hoarding up its millions
which is its genius and instinct.

" Le charlatan, au contraire, a besoin de hors qui frappent le
peuple etqui previennent V examen. II," again says M. Biot,
" y vante au contraire," meaning to the true physician ; "haute-
ment, il y fait vanter ses pretendues decouvertes : il en parle
continuellement avec assurance ;" and then the delusion is
sustained.

The lesson this fact should teach, the influence it should
exert, ought to arouse honorable ambition, stir up to more vig-
orous effort those in the profession and those taking it on, that
c3

276 Observations on the state of our Medical Epoch. [Dec.

they may raise higher the standard and character of its excel-
lence. And although they mast often honestly admit its insuf-
ficiency, and cannot promise to cure always, yet, with all the
perfection of which it is susceptible by effort, endeavor to ren-
der it worthy and acceptable to the world. Excepting by gov-
ernment, in this way only can effectually be ameliorated the
horrors of the empiric's art. While our people have erected a
tribunal for even the most trifling crimes, even for insulting or
speaking evil of a healthy man : yet by abusing, maltreating
and Jailing a sick one, no legal offence is committed, and, as
in Europe, no tribunal erected. It is then a most heinous crime
to become sick : and does a man by so doing forfeit the pro-
tection, the right of law ? These are great questions, and much
time must pass, being too much in infancy, before they will
meet with a correct solution among our people. But in evolv-
ing light, the day must come, when future legislators will erect
in our country, an altar of justice, before which, the wrongs
and abuses done to the sick and the dying, will be redressed.

" Osccula! currite, currite

' Nobis' regna referte ' medicinarum'

Saturnia. !"

To this great end, and to suppress the evils of empiriciuiSj
we are called upon by every principle of honor, by all the vir-
tues, by patriotism, by philanthropy, to make the effort. Quack-
ery is the war of falsehood against truth, of dishonesty against
honesty, of deceit and hypocrisy against sincerity ; of auda-
cious ignorance and stupidity, against truth and intelligence ;
of wickedness against uprightness ; of inexperience against ex-
perience ; of foolishness against wisdom. On the one side
stand arrayed all the vices and the great inconscions world ;
on the other, the virtues and wisdom, born of time and experi-
ence weeping. Unhallowed warfare !

Remark it, empiricism is not one ; it has its modifications to
accommodate the assailable points of our nature ; has a color
for every eye, excites curiosity, originates novelty to please. It
imports the name of its medicinal agents from afar. They
come perfumecTwith oriental sweetness cure prodigiously !
The same remedy searches every avenue of the economy ; dis-
ease is its game, and attacks any it may chance to perceive or
meet. A thins: not at all incredible!

1837.] Observations on the state of our Medical Epoch. 277

It issues its proclamation. " Nature offers a vegetable reme-
dy for every disease ;" and the Grecian mother and mistress of
flowers is profaned to give the report dignity and acceptance.
It is believed. But how was it ascertained that nature has
deposited all the proper curing agencies in plants. Who knows
whether the eleven millions of species on the globe will cure
"all flesh is heir to ?" Why as well not believe she has en-
trusted these sacred powers to minerals exclusively? All dead
men are mineral substance. Why can she not medicate with
such l Because they are all poison ; and are plants not poison
far excellence ? But do not the Japanese, the Kiagou, and
many of the Asiatic tribes feed largely on mineral food ? and
are they all dead ? Has not experience ascertained and reason
approved it, that every agent in nature, may act medicinally?
But reason and experience are proscribed, for they would tear
off this incubus which sticks, hanging to the Jugulars of na-
tions. The reason is obvious. The regular practitioners use
remedies derived from all the kingdoms of nature. This fact
is generally known. These remedies, therefore, must be con-
demned will not answer the purpose. They are devoid of
the charm of novelty; public opinion must be intrigued on this
point: triggered up to suit the sale and employment of the arti-
cle and its makers.

" If to her children, the mute earth could speak,
Through their crammed ears no sound would reach."

But what is a greater calamity, we have said, that among the
practitioners called regular, slight study and superficial acquire-
ments, encouraged by the ignorance of the people, are the order
of the day, constituting a species of quackery more full and
destructive than the former. This may be considered in the
light of a domestic enemy, the other a foreign foe. The one is
supposed and trusted as going forth with all the panoply of the
art, being regular ; therefore more universal and mortific.
The other labors under suspicion, and its mischief is trammelled.
Our science, great in the transatlantic schools, among us has
dwindled down to the little blind art of a few simple manual
operations that of knowing how to purge, bleed, blister, and
above all, how to salivate a sick man in a fever. Many of our
practitioners far too many, popular too, without the ability to

278 Observations on the state of our Medical Epoch. [Dec.

write their prescriptions grammatically, seem to aspire no farth
er, than to be able to do this bit of druggery, as some machine,
and possess only an ambition to do and receive, and not to
know. They learn to pronounce a few hard names to distin-
guish them from other men, talk a word or two about mortifi-
cation to explain consolingly inevitable death, and support their
name for skill. They cannot read to grow wise, for they feel
every proposition is an overmatch for their qualifications, and
reading growing disgusting, is abandoned. With these, physic
is a mere trade, and is followed only because it is the easiest sort
of work in proportion to the gains.

Unfortunately for the interests of humanity, those who study
and learn to bleed, blister, and salivate this oligarchy of med-
icine of all who make a business of the art, are far the most
numerous class. Their services are in demand : for egotism
causes men every where, to place a high value on their own
opinions and judgments ; and their medical ideas and views
correspond exactly enough with those entertained by men gen-
erally, to be approved ; and if there be outside crust enough to
conceal the interior make of these mock doctors, patronage will
be extended. Their services are always at hand, because of
their cheap and easy manufacture and elaboration. A few
days absence from any other trade less profitable, puts the aspir-
ant in possession of all the craft, and there is a new doctor.

" Tridente, sic, pulsat Neptunus."

So with his mighty trident Neptune struck
Thegellid earth, and from its bosom cleft,
Sprung up the war-horse, down Numidia's plains
Thundered along.

But do you assert what is credible, and allow common sense
to mankind ? Exactly so. " Practice makes perfect ;" and
experience is esteemed every thing in medicine. Here is the
spell, the fatal delusion and throat of death unwittingly pro-
cured. These venerable axioms so true in every thing besides,
but in physic, as the good Zimmerman* long since remarked,
exactly false. There is such a thing as " having ears, and hear
not," " eyes, and see not." The eyes and ears of our science
are the offspring of study and profound learning. Without

* Treatise on Dysentery. See Jackson Prof. Inaugural Address, 1834.

1837.1 Observations on the state of our Medical Epoch. 279

them, experience is a dead power and can avail nothing. I
assert it, from the nature of things, there can be no experience
without theory. Behold him the illiterate, unsanctified pres-
ence and audience of nature, gazes on his patient, as she unfolds
to him the mysteries of the morbid operations she is carrying
on ; points out to him her remedies, beckons to him to look at
her struggles. He listens, but hears not her consoling voice;
he looks, but sees nothing tangible ; or if he sees, he knows not
what. He is a blind man ; his mind is not informed, he cannot
know and read the language of disease and nature. He is in-
capable of experience, can never grow wiser by practice, must
end about where he began his career, in utter darkness. For
there can be no experience without theory, nor theory without
learning. But the world supposes he has gained experience
and skill ; thrice fatal delusion which fattens the sepulchre, but
makes money and fame for the doctor.

Again : Has the illiterate lover of star-light, who may have
gazed on the heavens until he is old before whose eyes the
s<ime nature has been continually presenting the secrets, fair
and fully, of her celestial motions, gained any thing ; and who
has witnessed a thousand times all the most skilful astronomer
ever saw ? Can he tread the zodiac round, walk with the stars,
converse with them ? Does he know, tell me, the great cycles
of time, the parallaxes, the relative weights, distances and magni-
tudes of the sun's wandering train, their parabolic movements ;
Luna's loop-formed orbit ; where Aquarius holds his court,
where the head of Andromeda rests ; where wanders Orian
holding the lion's head, and the horn of Monoceros ? Has he
gained experience from what he has seen ? Can he foreknow
what he will see? He has been present, but unconcerned. He
has eyes, and has seen nothing ; his mind has not been fecund-
ated ; he has no theory, therefore, can have no experience. He
does not understand the Divine language in which Urania re-
cords her history, that is, without theory. Therefore, he knows
nothing, has been an idle spectator, and is where he began
in utter darkness !

I remark : Nature makes only impressions on the senses ;
her doings, her ways, and her truth she reveals only to our long-
ing, our eager immortality within. And could this truth be

2S0 Observations on the state of our Medical Epoch. [Dec.

generally felt, it would operate the moral redemption of the spe-
cies from all tyrrannies ! ! But let us resume in summary. This
class of physicians is the most numerous, because of their cheap-
ness ; are the most dangerous and mischievous, and the degrada-
tion and dishonor of the real scieuce and profession. The most
dangerous, because no distrust or suspicion bars them, while the
painted quack may be distrusted, and kept at arms length ; and
his attacks upon public health be restrained to certain limits
The most dangerous, because they can get practice : their views
be thoroughly understood, and easily gain acpess to the common
people, whose taste they suit, and who believe every where the
letheal error, " practice makes perfect? and experience is all.
The most dangerous, because they profess to be what the peo-
ple believe regular, clothed with all the powers of the art, are
welcome guests, and the most desperate, and all diseases are
readily committed to their charge and treatment. To get along,
at first, they have sometimes to make wise faces, and put on
great looks ; at last seem to fall dupes to their first deception
and believe really, themselves, they are doctors. And consider-
ing that talents are generally cultivated for towns and large vil-
lages which possess the best physicians, the writer ventures the
assertion, that these doctors do seven eights of the practice of
the world. This holds pretty true as regards our states ; and
according to the calculations of city and rural population by
Malt De Biiun,* holds nearly true with the civilized world.
Let us contemplate the real Peiysician.

What are the views, pretensions, and advantages, which dis-
tinguish him from these others ? He beholds the constitution of
man as an integral part of the great surrounding universe ; not
acting isolatedly, but participating in the actions, and general
concern of universal existence. Beholds it under the government
and dominion of laws especially adapted to it by its Divine
Creator ; and, at the same time, subjected to be modified and
influenced by the general laws. He looks on it as an individual
thing, and, at the same time, as only apart of a greater design.
He pulls at the chords which tie it to surrounding existence,
and discovers that they extend through and interknit with the
whole starry frame ; and, what he might have supposed to be

* Physical Geography.

1837.] Observations on the state of our Medical Epoch. 281

one, is really a part of the whole. Now he invokes the aid, for
he needs ir, of the universal mind, thought and experience
which have lived before him, the life and being of which are
in books. Now he is on the vast arena of medicine ; his tor-
tured soul struggles by the dim taper of midnight ; the field of
interminable thoughts before him ; and the turbid waves of half
thought, half seen truth, or blackness of error dashing round
him. Years pass, and he struggles up to the dawn of his Cre-
ator's truth the truth of all science. His soul has acquired
a new and a more excellent shape ; the ideas he has felt, have
created for him a new existence ; he has lost his local habita-
tion ; and lives every where in the things he has seen. In this
study, he examines first the actors or instruments of these special
laws separately, then, as a whole ; anatomy ascertains their
mutual relations and adaptations ; the sources whence move-
ments spring ; their universal subordination and dependence,
forming the mysterious circle of vitality. This is the human
economy which he is now to consider no longer as a whole,
but as a part, an inconceivably small part of another greater
economy, that of things. Again he studies the relations, the
universal dependence and subordination of the two which con-
stitutes another circle, that of all existing entities, general phy-
siology. He sees the eye formed in relation, and acting in
concert with the millions of torches that burn above. The eye
is now a part of the starry frame participating, nay, an actor in
its action. The gravity, which binds his body to the earth,
operates in the sun and earth to sustain their relative positions.
The same gravity which produces motion in ail worlds, may
produce frightful varicoceles and incurable dropsies, in the
lower extremities of a man. Gravity, empiric, may be used as
a successful remedy in asphyxia from too great loss of blood,
and in other diseases where not all your vaunted vegetable
stuffs, nor any other on earth could succeed, may be employed
in various doses in the prevention and cure of disease.

Next come under his review, the heterogenous or abnormal
movements. He scrutinizes their phenomena and their order ;
examines their effects on the tissues, indurescence, ramolles-
cence their propagation, irradiation and subsidence ; and, as
before, their universal subordination and dependence, constitut-

282 Observations on the state of our Medical Epoch. [Dec.

ing a circle, admitting the denomination mortality. This is
pathology, born in France. Here he learns that disease is noth-
ing but movements of no new actors, but of the same whose
tendency being unsuitable to their make and subordination is
to destroy. His mind frets up no spectral form from beneath,
which he is called upon to combat. He sees what is, and learns
to interpret the awful language in which our common mortal-
ity is exhibited and recorded by nature.

Lastly comes the application of the modifiers, therapeutics,
leading in its train natural history proper, or mineralogy, bota-
ny, chemistry. In his study of othe r beings, worlds, he saw in
all their actions they did not exhaust their forces, which con-
tinued always changelessly the same. Hence no disorder* or
derangement can ever take place in them ; can be no disease or
death but that they must ever act onward uniformly through
space, in their own natural immortality. But, in the system of
life, he has seen exactly the reverse is true. Living bodies in
their actions, expend their force : they diminish, increase ; there
is no uniformity, they are never exactly the same. Here, then,
is the natural function of all disease, death and the chances of
life. Immortality is impossible and unnatural ; and here origi-
nates the necessity of all medicine to keep out these chances.
What then, I ask, can the real physician do ? He can keep
steady and regidate, to a certain extent, this ever tottering,
vascillating scale of force, on which all life hangs, by prop-
erly removing, supplying, diminishing its accumulations ; by
diminishing, increasing, removing, varying its excitors. The
ground alloted him by nature, it must be perceived, is extremely
small, his interference vastly limited, yet of infinite value and
importance to the human race. It is then entirely certain, if he
know not these special laws, and the adaptations and relations of
the modifiers to them, the chances of every interference he

* Before completing his great instrument of calculation, the differential calcu-
lus, we would remark, Newton made some slight blunder in estimating the apsides
of the parabolic curve, and concluded the world would run into disorder every hun-
dred years, and was preserved by Divine interference. With the same calculus af-
terwards, La Place proved the world to be self indestructible and corrected the
error.

Vous, vou^ voiyezle Svsteme du mondc.

1S37.1 Medical Magnetism. 283

a

makes, must tend equally to death as to life and health. But
deplorable ! Mankind will remain forever incapable of this
truth, rushing upon destiny and the winding sheet while aiming
for life; their physician's services, their funeral sermons, mistaken
by them for the banquet of health.

Officious

Man, death will be mad with thee.
For doing in his absence what
Was his own work to do.

This is written for the younger part of the profession ; and
should it excite one to study, the dearest object we had in view
will have been accomplished.

PART II.
REVIEWS AND EXTRACTS.

Medical Magnetism.

Although mankind have availed themselves of the use of
magnetism for purposes deemed of capital importance, as in the
magnetic needle &c; and notwithstanding we believe in the
discovery of a new faculty, or properly of that which we call
magnetism, that is to say, a meridional, as well as a polar attrac-
tion, which will become at some future day, subservient to the
purpose of determining longitude on any parts of the globe;*

*It is possible the reader may not be aware of the fact, that some thirty-five or forty
years ago, Dr. Joel Abbot, a highly scientific physician of Washington, Wilkes
County, Georgia, during a series of experiments in magnetism, relating to the dip of
the needle, &c, discovered a new law of magnetism, whereby it was found to exert
a Meridianal, as well as polar attraction. This discovery was so satisfactorily
demonstrated, that he felt himself fully entitled to the premium of forty thousand
pounds then offered by the Board of Admiralty, for the discovery of longitude, to
which purpose it was at once evident that this new law was as subservient as the
polar attraction before known was to the other purposes of navigation. But that
scientific gentleman, like most men of deep science, was more negligent of the hand-

d4

284 Medical Magnetism. [Dec.

still we venture the opinion that one of two results of first rate
importance is yet to be arrived at relative to this agent. Either
will it be discovered to be itself a non entity, as to its own indi-
viduality as a thing of nature, and only a habitude, or mode of
action, or the offspring or phenomenon of another principle of far
greater universality ;* or that, if it be found to be an indepen-
dent principle or agent, its powers are yet to be applied success-
fully alike to purposes of humanity and convenience of even
more importance than all its present uses. Of this we see evi-
dence in the authentic truths below stated, displaying its reme-
dial powers in some of the most intractible distresses to which
the human body is subject. Tic Douloureux particularly, has
never found a uniform remedy, unless it be in the magnet.

some pecuniary reward than of the purpose of discovering a new law in philosophy.
In addition to this, he had great -difficulty in procuring the mechanical construction
of the simple little apparatus which was to subserve for the mariner the very im-
portant purpose of a constant index of longitude at every day and every moment.
During the embassy of Mr. Crawford to France, that gentleman was commis-
sioned to procure a part of the mechanical construction fiom the hands of some
competent artist in Paris, which, I think, from some cause never came to hand. It
was to consist of a perfect globe of steel equally hardened, and impressed in one
particular position with magnetism, and graduated with 360 degrees on the equa-
tor, and inscribed with meridianal lines; and which when floated in quicksilver, in
which it was estimated there could be no impeding friction, would turn relatively to
the quicksilver eastwardly in travelling to the west, and vice versa. Around this
was to be floated an artificial horizon, with a meridian attached with an index to
point out the precise degree and difference of longitude, or distance sailed from the
point of departure to that of observation. I am not certain whether it was or not,
alike calculated to point out the latitude with the same precision by turning relatively
to the quicksilver southwardly in sailing northwardly, &c.

The globe of Dr. A. was subsequently substituted by a section of the globe con-
taining its greatest diameter, or a wheel, alike impressed, with an index springing
up from the frame which supported it. This was found to traverse well at sea for
several clays after leaving Savannah lor England, under the management of a Capt.
Stickney; and again on his return voyage, until he came in the neighborhood of
the Banks of Newfoundland ; and again on his arrival at Savannah and travelling
to Washington in Wilkes, the index pointed out with great definiteness the differ-
ence of longitude. All these experiments proved the truth of the law of meridi-
anal attraction, for tin- wheel did traverse; but from some imperfection in the con-
struction, it did not continue to do so through the whole of either voyage at sea.
This however, the doctor attributed to the influence of the cargo on the metallic
axis, in one, if not both instances, and which he suggested the correction of, by
substituting non-corrosive axe s as of glass or stone.

* Electrhitv.

1837.] Medical Magnetism. 285

These facts were published in the London Lancet some time
ago, when we had not the opportunity of laying them before the
public ; but they are of such interest that we are unwilling they
should be overlooked by the profession, at least until further
experiments verify or condemn the power of the mineral magnet
over sueh diseases.

" Some experiments which seem to promise results of consider-
able interest and practical importance in medicine, are at present
being pursued in certain of the metropolitan hospitals on patients
afflicted with neuralgiatic douloureux, tooth-ache, and other
immediate affections of the nerves. We allude to the applica-
tion of a magnet to the parts suffering pain from those diseases.
We abstain from communicating to our readers at present,
any thing more on the subject than we have had satisfactory
means of ascertaining to be rigidly exact on the score of truth.
Three instances only have, in fact, as yet occurred under circum-
stances which enable us to speak without hesitation of the power
possessed by the instrument alluded to, over diseases of the hu-
man frame. These we shall give, observing, that the employ-
ment of the magnet has nothing to do with the art denominated
" animal magnetism."

Our readers will remember the interesting case of neuralgia of
the finger, at St. Thomas's Hospital, upon which Dr. Egleston
stated in a clinical lecture, reported in our 48th No., that he had
exhausted his store of remedial agents. A more severe case,
probably, was never subjected to treatment. The man left the
hospital for a time, totally unrelieved, but soon afterwards re-
turned, when, in accordance with a suggestion, as Dr. Elliot-
son has since observed in one of his clinical lectures, of a cor-
respondent of this Journal, the colchicum autumnale was tried in
the case, without, however, the slightest benefit being derived
therefrom. The sedative powers of the lobelia inflata then sug-
gested to the Doctor the propriety of giving the patient the
chance of that medicine. The grounds on which it was em-
ployed, proved to be in a great measure correctly founded. The
man took the lobelia, in increasing doses, every hour, beginning
with seven drops of the tincture, and adding a drop to each pro-
gressive dose ; until as large a quantity had been reached as
could be taken without deranging the functions of the stomach.
Great amelioration of the affection followed this treatment. The
patient who was before unable even to cross the yard, or bear
the slightest cutting of his finger nails, and had become emati-
ated to the extremest degree from pain and sleeplessness,was soon
enabled to walk out of doors, and enjoy many hours of rest, re.
covered his good looks, and became comparatively cheerful.

286 Medical Magnetism. [Dec.

The relief, however, was very far from being either perfect or
permanent. The continued exhibition of the medicine was de-
manded to secure any portion of rest.

A short time since, however, anew remedial agent presented
itself, in the form of the magnet. The hospital was visited by
(we believe) Dr. Kyle first, and subsequently by a physician of
the name of Blundell, a friend of the former gentleman, who
followed up the application of Dr. Kyle. The lobelia infiata
was allowed by Dr. Elliotson to be suspended, and the effect
of the magnetic tried. That effect was, we learn, a very decided
one ; the pain was on every application of the instrument, re-
moved, and continued absent for several hours. The distance,
however, at which the operator resided from the hospital, pre-
vented, and still prevents, the daily use of the instrument, or, the
impression on the patient's mind is that, it would perform a
cure.

On Tuesday last, the Dr. Blundell already mentioned, re-at-
tended the hospital at the hour of Dr. Elliotson's visit, when,
in the presence of the pupils and our reporter, he drew forth the
magnet, and commenced its application to the patient's finger.

The instrument is of the horse-shoe form, about ten inches in
its long axis, and five in its short, composed of five layers of
metal, the central being the longest, and the whole bound with
stout riband. The patient wis at the time apparently suffering
considerable pain, and unable to use his hand. The north pole
of the magnet was gently passed five or six times down the sides
and back of the middle finger, and then rested on the central
joint. The result was, such a cessation of suffering that he
could gnash his fingers into the palm of his hand with ease and
comfort, and he declared himself to be entirely relieved. The
power of the instrument, however, did not cease here. Dr.
Blundell showed that it possessed the means of re-producing
the pain in the most intense fcrm. The south pole of the mag-
net was directed along the finger. At the third pass, the patient
began to bite his lip and close his eyes with an expression of
pain. At a few passes more his chin was involuntarily buried
in his breast, and his wrinkled features evinced the acutest suf-
fering. This was allowed to continue for a few seconds, when
the north pole was again presented to the finger, and the agony
speedily subsided. The spectators then left the man with a
countenance perfectly tranquil.

At the extremity of the ward lay an elderly lady, a martyr to
tic-doulourcu.r in the lower jaw, extending to the ear, and affect-
ing a large portion of the head. The disease, she stated, was of
more than nine years duration, and had never ceased to afflict
her for a day during that period, up to her entrance into the

1837.] Observations on the Treatment of Typhoid Fever. 287

hospital. Her appearance was proportionably miserable. The
magnet had also been applied in her case, and with similar ad-
vantage as she stated. On the present occasion, it was found
on approaching her bed, that she was that morning free from
pain, and the aid of the magnet was not needed. "But cannot
you show its power by producing the pain V inquired a by-
stander. The suggestion was acted on. The south pole of
the magnet was passed from the centre of the chin along the
lower jaw-bone up to the ear. At the third pass, the pocr wo-
man indicated that the tic was commencing, and in a few seconds
more the affection was experienced intensely. The process was
then stopped, as the experiment was carried far enough to satisfy
all present of its consummation, and after a brief space the pre-
sentation of the north pole wholly freed the sufferer from pain.
The operator subsequently stated that by continuing the passes,
he could have carried the pain on to the production of delirium.

There is a female patient in another ward, who had suffered
intense tooth-ache for three months, when, a fortnight since,
according to her own evidence, which we have no reason to
doubt, it was instantly cured by one application of the magnet,
through the medium of a key, and had not returned in the
slightest degree up to the period of the visit on Tuesday last.

These are very interesting facts. We present them to our
readers unaccompanied by comment. The specific name given
to this instrument by Dr. Blundell, is that of a " mineral
magnet." How far its application to disease admits of exten-
sion, we are at present ignorant. London Lancet.

Observations on the Treatment of Typhoid Fever by purga-
tives. By M. De Larroque. Report to the Royal Acad-
emy of Medicine by the following committee : M. M. Louis,
Bricheteau, Bouillaud, Double, Bailly, and Andral,
Reporter.

Gentlemen : The committee charged by you with the ex.
amination of the work sent to the Academy, by Dr. De Lar-
RoauE, upon the treatment of typhoid fever, by the evacuating
method, make through me, the following report upon the re-
searches of that physician, and the results to which he has been
led. If, indeed, the pyrexia, called at the present day in France
typhoid fever, be only a gastro intestinal inflammation, if the
numerous symptoms which occur during the course of the dis-
ease be only the sympathetic effects of a primitive irritation of
the digestive passages, the therapeutic question is most simple ;

288 Observations on the Treatment of Typhoid Fever. [Dec.

the antiploglestic method is the only one which should be em-
ployed, more or less actively, according to circumstances which
the experience and tact of the practitioner may enable him to
appreciate.

If typhoid fever having still its point of departure in a phleg-
masia of the digestive passages, nevertheless presents this partic-
ularity that the follicular apparatus of the intestines is the special
seat of the inflammation, if, in a certain time after the appear-
ance of the lesion of the digestive tube, other symptoms super-
vene which are not exclusively, as supposed by the preceding
theory, the sympathetic result of the intestinal phlogosis, but are
attributable to the circumstance that putrid matter within the
intestines absorbed, and, like septic poisons, infects the mass of
the blood, and consequently the entire economy ; then the thera-
peutic problem presents a greater complication. Independently
of the therapeutic treatment which would be still indicated, we
should endeavor either to evacuate the injurious matter contained
in the intestines, and then the utility of purgatives will be ad-
mitted ; or, to contend against the infection of the blood, and for
this purpose the chlorides, or even tonics might be employed.

Lastly, if in typhoid fever, the intestinal lesion be considered
only as one of the elements more or less indispensable, a disease
which, differing from true typhus only by a less degree of inten-
sity, attacks like it or like variola, the entire organism, then, the
therapeutic questions occupies a new ground. Then, according
to the time and the prevailing spirit, two sorts of problems will
be formed. In one of these problems, they seek in the midst of
the general disorder for some great modification from which
they suppose that all the rest is derived ; they admit that this
modification is always identical, and they consequently employ
always the same treatment. Thus, according to some, a super-
excitation is the predominant fact, and the debilitating method
the only one which should be employed ; according to others,
on the contrary, an asthenic state, primitive or consecutive, to
use the language of Brown, is the chief pathological condition;
the indication is to support the strength of the patient and the
tonic medication the most powerful and certain. According to
others, the disease consists chiefly in an alteration of the fluids,
in the presence of a morbid principle in the alimentary canal, or
even in the blood, and the most useful treatment is that by evac-
uants to expel this morbid principle

Others form for themselves an entirely different problem ; they
do not seek to learn the intimate nature of the disease; but they
ask if the symptoms which accompany it are not sufficiently
distinct from each other to authorize us to unite them under dif-
ferent groups, to each of which, we may be led by experience to

1837.] Observations on the Treatment of Typhoid Fever. 289

oppose a different treatment. They admit, consequently, an
inflammatory form, a bilious form, and an adynamic form, each of
which they recognize by the admirable features by which Pinel
has depicted them. In each of these forms they employ a spe-
cial treatment; they declare that, according to age, tempera-
ment, constitution, according to the infinitely varying influences,
whether physical or moral to which individuals have been ex-
posed, or according to the epidemic character of different times,
the one or the other of these forms may be more common than
the others, and may require a special therapeutic plan. They
observe also a certain number of cases in which from the ab-
sence of the symptoms that seem to require an active treatment,
they have confined themselves with suceess to the simple meth-
od of expectation, and to the cases of cure thus obtained, they
apply this fine passage of Sydenham, "Natura enim sibi per-
missa negotium suum suo tempore exsequitur ut nostra ope,
nostris artificiis a que auxilitis, non indigeat ; suis viribus op-
time instructa, suis opibus locuples, suo denique in genio satis
docta."

It is always by following one or the other of the routes which
I have just indicated, that physicians belonging to different
schools have treated the different forms of pyrexia designated at
the present day under the name of typhoid fever. During the
last fifteen years, the disease has been almost exclusively treated
by the antiphlogistic method which varied only in the degree of
activity. However, some practitioners during this period, pro-
tested against the universality of this practice, and they pro-
fessed that there existed certain forms of the disease in which
other modes of treatment could be employed with great proba-
bility of success, and in the first rank they placed the treatment
by emetics and purgatives. One of the most prudent and learned
practitioners of the capital, M. Lherminier, employed very
frequently this plan at the Hopital de la Charite. This was
the commencement of a reaction which has since continued to
increase, until returning to a truth whose abuse had obscured its
importance, it was ascertained that the proscription of emeto-ca-
thartics from the domain of therapeutics deprives the practitioner
frequently of an immense resource, and that these agents may
fulfill important indications which cannot be fulfilled by any
other.

It is in the midst of this prevailing spirit to return to a certain
kind of ideas too completely abandoned, that Dr. De Lar-
ROQ.UE generalizing in his turn the evacuating method, and not
restricting it only to certain cases, employing it during the con-
tinuance of the pyrexia ; taking no account of the diversity of
symptoms, or of lesions, or of the difference of individual pre-

290 Observations on the Treatment of Typhoid Fever. [Dec.

dispositions, endeavors to establish as an invariable treatment in
every typhoid fever, the daily use of an evacuant, first of one
or two emetics, afterward purgatives administered every day
from the beginning of the disease to its termination. M. De
Larroque endeavors to explain the constant indication of evac-
uants in typhoid fever, by attributing to the bile a great agency
in the production of this disease. Collected in the intestines it
becomes says he, a powerful cause of irritation to the mucous
membrane, and thus the latter experiences phlogosis and ulcer-
ations. If the most serious lesions ordinarily occur near the
end of the ileum and in the caecum, it is because the matter
accumulates especially in this part of the digestive tube, which
may be shewn by the sound or gargouillement that may be pro-
duced by exerting a certain degree of pressure on the ilio-caecal
region ; if, at a more advanced period of the disease, those gen-
eral symptoms supervene which seem to denote on one hand an
alteration of the bowel, and on the other a profound derange-
ment of innervation, it is because the bile and the other matters
contained in the intestines have been absorbed, and like true
poisons have infected the mass of the fluids, and consequently
the entire economy.

These ideas were professed by Stoll in the last century,
ideas which he applied not only to the fevers which he called
bilious, but also to a great number of other diseases, and hence
he inferred the utility of vomits which he so frequently em-
ployed. This theory once admitted, would justify perfectly the
employment of evacuants as the general method of treatment
in typhoid fever. But against this theory, several objections
may be urged ; and in the first place, it has not yet been suffi-
ciently demonstrated that the bile is so altered, and produces so
much irritation as to determine the serious lesions which are
revealed by anatomy. There are many diseases, during which
the patients remain for a long period without any alvine evacu-
ation, and in which although we observed some injurious conse-
quences, we perceive nothing analogous to what occurs in
typhoid fever ; it would be necessary then, to admit, that in the
latter, the- bile and other secreted humours of the intestines pos-
sess particular acrid qualities imparted to them by the disease ;
but this requires demonstration. The intestinal follicles have
been found swollen and diseased as early as the fourth or fifth
day of typhoid fever. But at this early period of the infection,
especially when a more or less considerable diarrhoea had oc-
curred from the- beginning, we cannot suppose that the bile has
remained in the intestine sufficiently long to be altered and pro-
duce the disorders. In cases which terminate unfavorably after
the daily administration of purgatives which do not permit the

1837.] Observations on the Treatment of Typhoid Fever. 291

bile to remain in the intestines, we find the same follicular lesions
as in those cases which terminate fatally without the use of any
means to procure evacuation.

Thus, then, the theory of Stoll which refers to the presence
of the bile in the intestines and to the alteration which it there
experiences, either the fever itself, or the most serious acci-
dents which accompany it, is at least very contestable.

The cases contained in the different memorials which M. De
Larrociue has sent to the Academy, are more than one hun-
dred. They have been collected under his eyes, by the pupils
attached to the Hopetal Necker; they present almost all the
possible forms which typhoid fevers can assume from that in
which it resembles a simple gastric derangement or embarrass-
ment, or a slight enteritis to that in which it is accompanied by
the most serious ataxic, or adynamic symptoms. In all these
cases, a uniform treatment was employed ; at first he adminis-
tered one or two grains of tartar emetic, which he prescribed in
every form of the disease, and whether the tongue was moist or
dry, red or pale, &c. The next day M. De Larroq.ue gives a
bottle of seidlitz water, and repeats it as long as the febrile state
continues. If the patients take a dislike to this kind of purga-
tive, he gives cream of tartar, calomel or castor oil. Toward
the end of the disease, when the febrile state has almost entirely
disappeared, he gives tonics to support the strength, and is not
very slow in allowing food to his patients. Barley-water or
lemonade is the common beverage during the disease. No acci-
dent induces him to modify this" treatment except it be pulmon-
ary engorgement, when he employs kermes mineral. He de-
clares that sanguine emissions should never be employed in
typhoid fever, and that the cases which he has seen terminate
fatally, notwithstanding the evacuant plan had been treated at
first by more or less abundant venesection. The abstraction of
blood according to M. De Larroque, places the patient in a
condition the most unfavorable for a cure ; he cannot, however,
be ignorant that many typhoid fevers are combatted by sanguine
emissions, with an energy justified by incontestable success.

As to the influence exerted by the evacuating plan repeated
each day upon the mode of termination of the disease, it is in-
dicated in a statistical table which he has annexed to his work.
In one hundred cases, ninety were cured ; ten only had died,
and among the latter the treatment had been commenced in
several only under desperate circumstances, while others had
been bled more or less copiously. This mortality of patients
with typhoid fever treated by the plan of M. De Larroque, is
certainly smaller than that of patients treated by any other
method. This result is confirmed by the testimony of M.

e 5

292 Observations on the Treatment of Typhoid Fever. [Dec.

Be all. We may observe that in England, the majority of
practitioners treat- the continued fevers, which answer by their
symptoms to our typhoid lever by the daily use of emetics, and
particularly of purgatives. Lastly, M. Bretonneau, a few
years ago advocated the use of saline purgatives frequently
repeated as the best treatment of dothinenteiitis. M. Piedag-
nel has treated by M. De Larroque's method, one hundred
and thirty-four cases of typhoid fever ; he has not however, em-
ployed this method in all its exclusiveness, thus sometimes he
has practised venesection and has seldom provoked vomition.
In these one hundred and thirty-four cases, he lost nineteen, or
one seventh, a remarkable result, but not as satisfactory as that
obtained by M. De Larrocuje. M. Louis has employed the
same plan upon thirty-one patients manifestly laboring under
typhoid fever ; twenty-eight were cured and three died, or about
one death in ten. The reporter of your committee has subjected
forty-eight patients to the same mode of treatment within the
last three years. In all those patients, without exception, who
at the beginning of the treatment presented only slight symp-
toms, such as those which answer to the inflammatory bilious
or mucous forms, the termination was favorable. The number
of such patients was thirty ; eleven others were subjected to the
same treatment. When they had already reached a very serious
state, nine were restored and two died. Upon seven other pa-
tients, the treatment was commenced when the ataxo-adynamic
symptoms had acquired a high degree of intensity, and six of
them died. Thus, then, in forty-eight patients, eight died, which
brings the mortality to one in ten.* If we unite the cases of M.
M. De Larroque, Piedagnel, Louis, and those of your
reporter, we have a total of two hundred and thirteen patients,
of whom forty died, making the average mortality a little less
than one seventh.

From the facts above exposed, we may say that many serious
cases were benefited indubitably, while the evacuants were
daily administered, and that in the light cases the disease did
not get worse in consequence of the administration of the evac-
uants. And, indeed, thus treated, all the latter cases terminated
favorably. We must therefore conclude, that if the evacuant
method have not a well demonstrated eflicacity in the cases
which were already serious when the treatment was com-
menced, at Least it does not most commonly transform the slight
into serious cases. 'This would certainly not have been admit-
ted a lew years ago, when most physicians believed that the
administration of an emetic or of a purgative in typhoid fever
would necessarily aggravate the disease, and hasten the super-

* Nearly two in ten. Ed. Smith. Med. Jou.

1837.] Observations on the Treatment of Typhoid Fever. 293

vention of the adynamic and ataxic symptoms. We have how-
ever, seen things occur differently under our eyes we have
seen during thedaily administration of seidlitz water, the tongue
preserve its moisture, to be cleansed, the bad taste of the mouth
disappear, the thirst diminish rapidly, the epigastric pain cease,
the frequency of the pulse diminish, the cutaneous transporation
diminish, the cephalalgia and vertige lose suddenly their inten-
sity, the expression of the countenance revive, &c.

We should therefore be indebted to M. De Larrogiue for
having recalled attention to one of the most important therapeu-
tical questions of which so many different solutions have been
given. Your committee thinks that the work of this gentleman
ought to be taken into serions consideration, but at the same
time it believes that it would not be consistent either with the
dignity of the Academy, or with the interests of the science to
pronounce a definite opinion upon the treatment, employed by
him in every case of typhoid fever. Before this treatment can
be thus adopted as the best in all cases, it will be necessary not
only to have collected one or two hundred cases which testify
in its favor, but to have observed such cases for several years,
and under those different atmospherical influences which by
succeeding each other produce such remarkable changes in the
gravity of diseases, and consequently vary the statistics of our
success in therapeutics. Who does not know that in certain
years all the cases of pneumonia arc mild, and recover, whatever
may be done ? While another year they have a singular char-
acter of gravity, and produce a frightful mortality. Who does
not know that in some months all surgical operations succeed
in our hospitals, while at another time they are all fatal ? Hence
the danger of solving therapeutic questions by the numerical
method, if we do not weigh all the cases at the same time that
we count them, if we do not analyze scrupulously and minutely
the value of each of the facts to which we are to give the value
of a unit.

To prove the necessity of precaution in apply i 112: statistics to
therapeutics, permit me to cite another result published in Lon-
don in 1780 by Clark, in a collection of cases of continued
fever. From 1777 to 1779, he treated in#the Dispensary of that
city, two hundred and three cases of continued fever, with all
the characters of our typhoid fever, mild and severe. In this
number he lost only six patients, or one in about thirty-three, a
greater success than occurs in our modern statistics.

How did he treat them? None were bled, except two
of the three who had a complication of pulmonary phlegmasia.
All took at first one or two emetics ; they were afterwards sub-
jected to the use of simple diluent drinks, and subsequently all
without exception took quinine. If we regard only the statis-

294 On the Use of Digitalis in Dropsy. [Dec.

tics, this, without doubt, would be the best treatment. But it is
not reasonable to proceed in this manner. Although numbers
should assert the contrary, we could not be convinced that the
same mode of treatment suits all the numerous varieties of
typhoid fever. We agree with most of the great masters who
have preceded us in our difficult and laborious career, that in
every malady, whatever may be its seat and whatever its nature,
certain general states of the organism may supervene, which by
changing the physiognomy, complicate the nature and modify
the therapeutics. In each case wo may find special indications
to be fulfilled. Thus there are cases, in which instead of treat-
ing pneumonia by sanguine emissions, we may be led to the use
of quinine or of opium ; in such cases, the disease remains the
same for the scalpel of the anatomist, but not however for the
physician, in whose eyes the anatomical lesion can be only one
of the numerous elements, the notion of which directs him in
the determination of the therapeutic means. Shall I refer to
those different diatheses, those idiosyncrasies, those special modes
of feeling and of reacting which each new patient in some sort
presents. If this be true, if there be no morbid case which
resembles absolutely all those which have preceded it, and all
those which will follow, what precaution should be employed,
and how much are we exposed to error, if to appreciate the value
of this or of that treatment, we take as the only element of
judgment, the more or less considerable number of cases in
which it has been employed. We apprehend that in this cir-
cumstance as in many others, the majority is not always right.
By this mode we operate upon quantities which are not of the
same nature, and if this circumstance be neglected will not the
most complete deception ensue ? Journal des Connaissances.

On the use of Digitalis in Dropsy. By Dr. Sigmond.

Some years ago we read some remarks in the Boston Medical
and Surgical Journal, (perhaps before its name was changed,)
on the use of digital is,, with which we were greatly interested ;
not less by the important information they contained as the
results of experience, than by the noble ingenousness which
dictated the plan of communicating that information. It is
common enough for practitioners to tell of their brilliant suc-
cesses with their plans of practice. Indeed, it is too often the
case that the eye of observation is jaundiced sees nothing but
its own peculiar color ; or sees no beauty in any other, if it

1837.] On the Use of Digitalis in Dropsy. 295

perceive it at all. And we know of no worse promise of suc-
cess no more certain presage of a career of ill success, or no
success at all, for a time, than that which is found in an unwil-
lingness to be taught by the truths of nature and of experience,
and in its stead, a determination to adhere to a previous opinion
with an unwillingness to see it tortured by a rigid rational analy-
sis. This becomes no age nor individual even in his own pri-
vate business ; but is perfectly inexcusable in any business
where the public weal is at stake ; and in none more so than in
medicine.

But in justice to the present day we must say that the spirit of
eclectism now prevailing to some extent, if it go not to ridiculous
ultraism as every thing else seems prone to, has in its elements
the power, and thus far promises well for arresting the wild
vibrations of science at a proper equipoise between erroneous
extremes, and settling it, at least upon many points, on the firm,
honest basis of truth. The author to whom we have related
above, (and we regret, for his honor's sake that we have forgot-
ten his name,) came to the conclusion that science and human-
ity would be more benefited by his pointing out his ill successes,
and candidly acknowledging their causes thus serving the pro-
fession, as a wreck, or beacon, or a chart does the mariner, than
by a narrative of the most brilliant successes. We see a similar
spirit now manifested in some of the greatest men of the day, as
Andral, &c. But to the point.

The writer to whom we have alluded, selected digitalis as
the first article, on whose powers he should tell the tale of his
misfortunes. At that time this article was lauded for its powers,
(powers too, which every body wanted,) of depressing the pulse,
directly (was the idea,) as a sedative power ; and it had become
not uncommon to prescribe it for this purpose alone, instead of
real sedative and antiphlogistic powers. In this state of things,
and if our memory serve us, when used with these views, those
observations went to prove that it was, in general use, a most
hazardous power that sometimes sudden deaths occurred from
the first dose of ten drops of the tincture ; and that again, the
dose might be increased to thirty or forty drops or more, without
the least obvious effects of any kind, until, suddenly, and with-
out any premonition, an accumulated power would be manifested

296 On the Use of Digitalis in Dropsy. [Dec.

overwhelming with sudden death, as if a tenfold dose of the
poison had been taken at one time all proving at least, that its
powers, the most desirable in some (uncertain) circumstances,
nevertheless in others, (and equally uncertain why,) were those
of a most deadly narcotic poison.

But gravitation, which precipitates the mighty cataract to the
depths below, or the frozen . avalanche, or the floods of burning
lava from the mountains' top to the plains below ; or the lighten-
ing of the clouds, with power immeasurable, and which have
produced so much destruction of human life these have been
tamed by the benign influences of science, and turned into life-
preservers at the order of man. And who can tell but that lo-
belia, the present great slaughterer which, like a ruthless torrent,
is now running its devastating course over the whole land, may,
in the course of time, become, under the auspices of true sci-
ence, a safe antidote for many ills. But we have been pleased
to see the following observations by Dr. Sigmond, on the article
of digitalis, which we insert below from the Boston Medical
and Surgical Journal. A spirit of perfect candor and honesty of
purpose pervades them which cannot fail to please, and to excite
the confidence of the reader, whilst they at least afford a rational
discrimination of the circumstances calculated to favor the safe,
and even useful employment of this active medicinal agent.
We hope Dr. Sigmond has at least opened the way to observa-
tion, that its injurious effects may be prevented, if he has not
rendered it a safe and useful article in the hands of the pro-
fession.

" You must be made aware that dropsy is to be considered as
the prominent symptom of some morbid condition of the body.
It is not an idiopathic disease, but it is the result of some un-
wonted action, into the nature of which, before you search for
your remedy, you must carefully inquire. To obtain a relief
from the discharge of the fluid is of course an object of anxious
consideration, but beyond this you must ascertain what has been
the predisposing, what the exciting cause, whether any other
remedy may not be more effectual, whether the constitution of
the individual is such that you may prescribe an agent which,
when it does not produce good effects, may become the source
of mischief, and, indeed, be more detrimental than the disease
which you undertake to cure by it.

Nosologists have applied the name dropsy too indiscrimi-

1837.] On the Use of Digitalis in Dropsy. 297

nately ; they have merely taken the striking symptom, and the
locality in which the hydropic effusion has occurred, as the sole
objects of their attention. The disease is, however, anything
but uniform in its character, in the causes from which it arises,
or in the effects which are consequent upon it. The states of
the system in which it makes its inroads, the various diseased
organs which produce it, the morbid conditions of which it is a
sequela, the variations apparent in the urinary secretion, the
diversities of tissues liable to its influence all demand the most
earnest attention, and must, in every individual case brought
before you, be the subject of your inquiry before you can employ
to advantage the remedies which have been placed in your
hands.

Since the days of Aret^eus, we have gained great experi-
ence ; and we cannot, at the present hour, coincide altogether
with the remark with which he commences his chapter on drop-
sy, that " very few recover from this disease, and those rather
by good fortune, and the kindness of. the gods, than by our sci-
ence, for the gods alone watch over great events."1 We must
attribute all we know to a supreme power ; and it is by examin-
ing and availing ourselves of all by which we are surrounded,
that we best show our gratitude, and we have been taught that
there are conditions in which relief can be decidedly afforded
by the art that we have studied.

To remove simple effusion, where no diseased viscus is pre-
sent, is by no means a difficult task ; but we have other objects
in view. Sometimes we are called upon to alleviate the most
acute suffering, which arises from water in the chest and in the
abdomen, where we know that no effectual cure can be contem-
plated, and therefore we require to have in our possession varied
means of action, to know when each is to be employed and when
it is to be avoided. In some instances, a combination of medi-
cines will materially assist us, and, as Dr. Ferriar has shown,
a mixture of many liquid diuretics will be found eminently use-
ful, and where digitalis is properly united, it is invaluable. It is
one of those medicines which prove the fallacy of the homoe-
pathic doctrine, for, prescribed with other drugs, its beneficial
consequences are oftentimes more striking than when alone. Dr.
Ferriar has upon this point somewhat a fanciful idea, but there
appears, in the general principle, much soundness of judgment.
He says, that he has been led by observation to suspect that there
exists, in the relative effects of medicines, something similar to
the harmony of colors and sounds, and that the impulse requisite
to the living powers of the body, which cannot be produced by a
single impression, may be effected by a concurrence or succes-
sion of impressions, in some measure dependent on each other.
His " Observations on the Treatment of Dropsy," and his com-

298 On the Use of Digitalis in Dropsy. [Dec.

parison of M The Remedies of Dropsy," two admirable papers,
which are to be found in the three volumes which contain his
medical reflections and histories, fully bear him out in his prac-
tice, if they do not in his theory. His prescriptions are well
combined, and discriminately applied. They are not, as Cra-
shaw has very fairly termed some of those " farragos" which
are occasionally seen in chemists' shops, " certain hard words
made into pills," but they are compositions which deserve atten-
tion and imitation.

With regard to the peculiar state of an individual who is labor-
ing under effusion, you will find that digitalis will not only, gen-
erally speaking, be useless, but occasionally injurious, when
there is great natural strength and vigor, which have been unim-
paired by the ravages of disease, where the muscular fibre is
tense, the skin hard and dry, if the individual be inclined to
corpulence, if the countenance be at all indicative of determina-
tion to the head, or venous retardation, or if the habit of the
bowels be slow and difficult to be called into action."

This last sentence of Dr. Sigmond is invaluable. It should
be written in capitals across every treatise on digitalis. It is
the only rational approach we have seen to correct therapeutics
in the prescription of digitalis, and being observed in prescrip-
tion is one great step in the first place, towards preventing the
injurious effects of the article in question, and in the second,
towards securing its valuable operation with great uniformity-
In the next sentence, on the other hand, we find, alike perspicu-
ously set forth, and again proving a clear discrimination, those
states of the system in which the happy effects of digitalis as a
diuretic, may be expected.

"Dr. Withering first drew the distinction of the cases of
hydropic effusion in which digitalis would be found unsuccess-
ful, and. I believe, the great majority of medical men who
have been in the habit of employing it, coincide with his view,
and the experience of the most acute and intelligent practition-
ers has, on the other hand, satisfactorily demonstrated that there
are states in which it is pre-eminently efficacious. In weak,
delicate, irritable constitutions, where they may be present much
laxity of fibre, a thin, soft, smooth, pale skin, which in the anas-
arcous limb seems to be transparent, when upon pressure by
the finger on the surface there appears to be no elasticity what-
ever, but the impression sinks in deep, and there is no evident
power of resistance ; when the emaciation of the other parts of
the body is very striking, where the countenance is pale, where

1837.] On the Use of Digitalis in Dropsy. 299

there is feeble or intermitting pulse, when the constitution has
been much broken down, more particularly if it were originally
strong, sound, and robust, where any indulgence in spirituous
liquors, bad habits of life, the action of mercury, or any debili-
tating cause, has produced the mischief in such states digitalis
will be indicated in preference to most of the diuretics, of which
I shall hereafter have to speak. You must remember, however,
that it is merely the evacuation of the hydropic fluid that you
will effect ; but you have not advanced more than a step in the
cure of disease, more particularly if that disease be connected
with disordered state of the viscera, or if it be attended with
paralysis. It, however, will do that which sometimes is of as
much importance as any object you can have in view ; it will
alleviate the most distressing symptoms, and you will gain time,
during which the system may be enabled to rally, and then sus-
tain the impression of well-directed energetic remedies. Many
have been the contradictory statements made of the diuretic
effects of digitalis, in consequence of the want of attention to
these principles, which you will find to be of vital importance to
you, and you will not fail in giving relief where you judiciously
employ digitalis. You will frequently be astonished at the
quickness with which the fluid is evacuated ; but you must not
be surprised at the rapid accumulation which may again take
place, when you remember what I have told you, that you do
not influence the disease which caused it.

The man whose name 1 scarcely ever venture to pronounce
without expressing my admiration Sydenham gives, with
that sincerity and love of truth which distinguishes every word
that fell from him, a very happy illustration of prescribing for
the name of a disease without inquiring into its causes. He
was called on to attend Mrs. Saltmash, of Westminster, who
had the dropsy in the greatest degree he had ever seen, her belly
being swelled to an incredible size. He gave her an ounce of
syrup of buckthorn before dinner, according to the custom of
the time, and it brought away an almost inconceivable quantity
of water, without causing any disturbance or faintness. En-
couraged by this, he gave her, every day, interposing a day or
two occasionally, a smaller dose until she recovered. He says,
this was twenty-seven years before he wrote his treatise, and the
lady was his first dropsical patient. Being young and inexpe-
rienced, he could not help thinking that he was possessed of an
infallible medicine for the cure of any kind of dropsy ; but in a
few weeks he discovered his error, for, being soon after called on
to attend another woman afflicted with the dropsy, which suc-
ceeded an inveterate quartan fever, he gave the syrup, and re-
peated it frequently, increasing the dose by degrees ; but having

300 On the Use of Digitalis in Dropsy. [Dec.

ineffectually attempted to evacuate the water, inasmuch as the
medicine did not operate, and the swelling of the belly increased,
she dismissed him ; and he adds, " If my memory do not fail
me, she recovered, by the assistance of another physician, who
administered more powerful remedies.'5

It is upon the heart and arterial system that digitalis acts ; it
decreases the irritability of the constitution, it diminishes the
frequency of action of the heart, and hence the circulation
through the system is so slow, that the kidneys have more time
to take from the blood the watery portion which they excrete,
for we have no reason to believe that those organs are stimulated
to any increased action by the herb. The physiological reason-
ing upon the action of digitalis has been considered to be ob-
scure, from its having been supposed that it diminished action
in one instance, and excited it in another ; but I should attribute
the apparently newly-acquired energy of the kidneys, not to any
stimulus imparted to them, but to their having a longer period
to act upon the fluid which is detained in the renal vessels.
Some authors have contended that digitalis is a powerful stimu-
lant, that it produces flushed face, hot skin, restlessness, and all
the symptoms of febrile action: and this you will find to be the
case where, from a diseased state of the kidneys, the due separa-
tion of the fluid from the blood does not occur, or where, from
pulmonary disease, the due transpiration does not take place ;
for the system of circulation is slowly carried on at first, but if
no elimination from the blood occurs, the whole frame is thrown
into disorder, and a febrile state is produced.

Some believe that digitalis only acts as an indirect sedative,
and only when it accumulates in the system, and the experi-
ments of Jorge, at Leipsic, are referred to ; the herb was given
to individuals in a state of health, in doses of a quarter of a
grain of powder increased to three grains. It produced upon
the alimentary canal marked effects, and this also occurred to
Sandra rt in his trials, when the digitalis was administered in
powder ; but I have before observed to you, that, in this form,
it is liable to produce considerable irritation of the stomach : it
likewise influenced the brain, a state resembling intoxication
coming on. Upon the generative system its power was strongly
marked, even to the excitement of seminal excretion in the male,
and symptoms similar to the premonitory sensations which
females experience at particular periods.

All these phenomena may depend upon the retardation, in the
capillary vessels, of the blood ; Dr. Mossman, in the year 1806,
was the first who drew the conclusion, from its influence on the
minute arteries, and the diminution of vascular action, that it
was strictly a sedative ; lie went so far as to state that he could

1837.] On the Use of Digitalis in Dropsy. 301

obviate pneumonic inflammation with as much certainty by it
as he could arrest the progress of an intermittent fever by means
of the bark of cinchona. To his other observations I may, in
my next lecture, draw your attention when we come to notice
the effects of digitalis in inflammation and in phthisis.

I cannot, either with justice to myself or to this very impor-
tant disease, detain you much longer upon the influence of this
herb on dropsies, more especially as I shall hereafter have fuller
opportunities of explaining to you the effects of diuretics, but I
must observe that, in hydro thorax arising from any obstacle to
the circulation, such as hypertrophy of the heart, when it is the
termination of long protracted diseases of the thorax, if they be
not accompanied by disordered conditions of the valves of the
heart, digitalis may be employed. In ascites, in anasarca, de-
pendent upon disordered states of the exhalent vessels, which
throw out a larger quantity of fluid than can be absorbed, you
produce good effect by diminishing the impulse with which the
blood is directed to the capillaries, and you present that fluid to
the kidneys for a greater length of time, in consequence of
which they can take up more to excrete than would otherwise
be the case. In ovarian dropsy it seldom is found that digitalis
succeeds ; in hydrocephalus, in infancy, it is highly noxious.
Few states of the system have had more diligent inquirers.
Amongst them, Wells, Blackall, Parry, Abercrombie,
Ayre, Yeats, Bostock, Bright, Golis, Cheyne, have most
indefatigably labored, and the analysis of the urinary fluid has
been of late years looked to with the hope of obtaining a fresh
source of information. Many prefer ample depletion before the
exhibition of this remedy, but I think you will generally find
that when you must lower the system previously, other diuretics
will be more serviceable, and I would strongly urge upon your
minds, as I think it a matter of deep importance, to avoid, if
possible, the junction of these two means of cure. It is true
that after venesection digitalis is more diuretic, but the most
fatal effects have occurred from giving the herb, where blood-
letting has taken place. To use an expression which I have
somewhere seen " It kills the heart."

During the action of digitalis for the cure of dropsy, the re-
cumbent position is preferable, for, from the experiments of Dr.
Baildon, detailed in the " Edinburgh Medical Journal," for
the year 1807, we learn that it decreases the action of the heart
most when an individual is lying down. He observed in his
own case, and he repeated the experiment several times, that
after digitalis had taken its effect, as long as he stood erect, his
pulse, which was upwards of 100, had not lessened in frequen-
cy ; when he sat down it became about 75 ; but when he lay

302 On the Use of Digitalis in Dropsy. [Dec.

upon his back, it fell very considerably, and became as low even
as 40. Dr. Baildon found that the same effect was produced
upon all those patients to whom he had thought it proper to
administer the herb. This effect is one of the most astonishing
facts in our history of this sedative; it is very singular that it
has not excited more attention, and led to some decisive experi-
ments. Although Dr. Baildon's trials of this interesting sub-
stance have been detailed by a vast number of authors, there
does not seem to have been drawn from them that result which
minute investigations would most probably afford to us in our
practice.

There is almost always some degree of nausea, of hunger, of
uneasiness, of general irritability present, whenever digitalis is
given ; indeed it would almost appear to be necessary for its
salutary influence to be produced, and Dr. Paris has a very
judicious and a very practical remark upon this point, which I
think will be fully borne out. by all those who use it, that every
attempt to prevent these unpleasant effects, or to correct the
operation of digitalis, by combining it with aromatic or stimu-
lant medicines, seems to be fatal to the diuretic powers of the
remedy : he has likewise quoted Dr. Blackall, who objects, in
some cases, to the union of mercury, digitalis, and squill ; to
the combination of the two latter, however, I do not think the
same objections arise as to the first.

In some individuals the miserable train of sensations that
follow upon the employment of this remedy, precludes the pos-
sibility of persevering in it, even when we perceive that it has
been successful ; nausea, vomiting, excessive depression of spir-
its, and fainting, often prevent us from proceeding further with
it, and as any attempt then to combine it with any drug that
might be supposed to obviate its bad influence destroys its effica-
cy, we are obliged to abandon it altogether.

There is a point at which we can no longer administer digita-
lis ; this is generally ascribed to its accumulation in the stomach,
but it seems to be rather dependent upon the very low tone to
which the vascular and muscular symptoms have been lowered,
for neither by vomiting nor by purging lias any portion of the
digitalis been thrown off, and the same effects are visible if the
endermic mode of acting upon the system have been pursued.
It is generally at about the eighth dose that the baneful influence
of the herb is visible, and this often happens whether the dose
have been large or small, whether it have been diminished or
increased, whether it have been given twice or three times in
the course of the day ; some curious examples have been quoted
by Sanduat in two papers which appeared in the "Bulletin
G6n6ral de Thetapeutique," in the year 1 833. They present
some very extraordinary results from its continued use; his

1837.] On the Use of Digitalis in Dropsy. 303

cases were principally diseases of the heart ; out of 57, 31 had
maladies of that organ, 13 being hypertrophy without dilata-
tion, eight hypertrophy with dilatation, and eight dilatation
without hypertrophy ; they fully bear out the great necessity of
caution which the wisest and most experienced men of our own
country have so strongly inculcated ; he seems, with Dr. Hal-
lor an, Dr. Hamilton, and others, to consider it as a narcotic,
first stimulating, and afterwards acting as a sedative. When
the poisonous effects are produced after the symptoms of disturb-
ance of the alimentary canal (indicated by the vomiting and
purging, then vertigo, drowsiness, and frequent faintings) come
on, the skin is bedewed with a cold sweat, the tongue and lips
swell, profuse salivation occurs, sometimes the action of the kid-
neys is totally suspended, at others it is increased, with frequent
desire to expel the urine, or at others inability to retain it is felt ;
the pulse intermits and is slow, and delirium, hiccoughs, cold
sweats, confused vision and frequent faintings follow, till death
closes the scene.

Dr. Henry gives us an instructive example, in the eighth
volume of the " Edinburgh Medical and Surgical Journal :"
A female, laboring under dropsy, took an over dose of a decoc-
tion which had been made by boiling two handfuls of the leaves
in a quart of water, then pressing the mass so as to express the
whole of the liquor. At seven in the morning she drank two
tea-cupfuls, amounting to not less than ten ounces by measure.
In an hour's time she began to be sick, and vomited part of the
contents of her stomach. Enough, however, was retained to
excite vomiting and retching throughout that and the whole of
the following day, during which everything that was taken was
rejected. In the intervals of sickness she was exceedingly faint,
and her skin was covered with a cold sweat, the tongue and
lips swelled, and there was a constant flow of viscids saliva from
the mouth; very little urine was voided on the day she took the
digitalis, and on the following days the action of the kidneys
was entirely suspended ; when Dr. Henry saw her, which was
48 hours after she had taken the poison, the tongue was white,
the ptyalism continued, though in a less degree, and the breath
was foetid ; the pulse was low, irregular, not exceeding 40, and
after every third or fourth pulsation an intermission occurred
for some seconds ; she complained also of general pains in the
limbs, and cramps in the legs. By the use of effervescing
draughts, and ether with ammonia, she gradually recovered
from her imperfect health. Dr. Henry states that she had
taken no mercury, and that the ptyalism was the effect of the
digitalis.

Professor Brande, in his " Elements of Pharmacy," gives an
instance of that carelessness which is sometimes met with in

304 On the Use of Digitalis in Dropsy. [Dec.

our public institutions, where tfyose who order an important
drug, forget to give the necessary caution, and the patient con-
tinues to take daily, without having any one to watch its effects,
an energetic poison as a remedy. He says that he knew an
instance of a person who suffered under anasarca of the legs,
and who applied for relief to a dispensary, where he received a
box of pills, one of which he was directed to take three times a
day ; on the evening of the third day, he complained of great
debility and faintness, and in the course of the night vomiting
and fainting came on ; in the morning he died upon attempting
to get out of bed. This sudden death, from the influence of
digitalis, is by no means an unusual event ; and hence, it is ad-
visable, that when it has been administered for a short time,
exertion should be avoided, and the patient kept in a recumbent
position ; the slightest movement may prove fatal, for the pulse
instantaneously quickens, the heart throbs and labors excessive-
ly, and fainting occurs from which there is no recovery ; not
only have there been such instances of sudden death during the
administration of the medicine, but even two or three days after
it had been discontinued. It has been very properly described
by my late valued friend, Professor Burnett, in one of the
best works on botany that we possess, his " Outlines of Bota-
ny," "as one of our most beautiful native plants, and one of
our most active indigenous medicines and insidious poisons.
Its influence over the action of the heart, and its power of
reducing the rate of the sanguineous circulation, would alone
render it an important remedial agent, but when to the above
are added the collateral effects on the kidneys and salivary
glands, and its peculiar characteristic of lying, as it were, for a
time, latent, and accumulating the power of repeated doses, so
that by one fell swoop the heart is in a moment palsied, and
life at once extinct, it must be acknowledged that it is a most
fearful as well as useful drug."

Few medicines have been more fairly tried as an iatraleptic
or cutaneous medicament in France, than this has been in the
cure of dropsy, and it has answered the most sanguine expecta-
tions that had been formed of its efficacy. Dr. Chrestien, to
whom we are much indebted for his experiments, has given us
a fair narration of the cases in which he was successful, and
those in which he failed. He is borne out in his practice by M.
Cros Rogery, of St. Geniez ; by Bernard, of Bezieres ; by
Blavet, of Monthozin ; by Rougher, of Montpelier ; and by
Archibold Aspold. Under M. Rogery's treatment by the
friction with digitalis, a case of dropsy of the abdomen, which
followed upon a repelled eruption, was cured. Under Dr.
Chrestien, dropsy, the sequla of scarlet fever disappeared^
and dropsies consequent on vascular inflammation, and on splen-

1837. J New Doctrine of Erysipelas. 305

itis, after intermittent fever, have yielded to friction upon the
hypogastrium, with tincture of digitalis, three times in the course
of the day. The tincture is made by macerating, for a quarter
of an hour, an ounce of the leaves in three ounces of alcohol.
The method employed by Brera, which was the first intro-
duced, and therefore somewhat rude, consisted in macerating
the digitalis in saliva, and then applying it by friction on the
abdomen. I drew the attention of the profession to what had
been done in this way, in France, three years ago. I have tried
the system, but do not find it as successful as the internal admin-
istration. Boston Medical and Surgical Journal.

Clinical Surgery. New Doctrine of Erysipelas. By M.
Blandin, Surgeon at Hotel-Dieu^ of Paris.

In reasoning upon the nature of this disease we must inquire
into its cause for it does not commence in the wards of the phy-
sician in the same manner as in those of the surgeon. There
exists then, an etiological nature. This may be internal, and
then the disease exists in the entire economy before it acts local-
ly or may be external, and arises most commonly from a con-
tusion, a wound or an operation. Here the affection is altogether
local at its commencement. This cause is easily appreciable.
It is not so with the other. We frequently see epidemics of
erysipelas. These, for want of greater precision, have been
referred to a miasmatic constitution. But we find also in the
wards of the physician, isolated cases of erysipelas, which are
truly sporadic, and for which no special cause can be assigned.

These two kinds of erysipelas pursue a course whose differ-
ence depends upon their etiological nature. The erysipelas
which arises from an external cause, and which is at first local,
has a tendency to become general. The fluids being altered by
the disease, and having a concentric direction, are soon dissemi-
nated throughout the economy, and excite a violent reaction.

The erysipelas which arises from an internal cause, on the
contrary, and which is at first general, tends to localise itself.
It is a critical effort of nature which directs towards a single
point, the disturbing element that had created a derangement at
once in the entire system. Would it not result from this theory,
that the febrile reaction should predominate from the commence-
ment in the erysipelas of internal cause, and at a later period in
the erysipelas of external cause ? It must be confessed how-
ever, that as the latter occurs almost always in consequence of
wounds, contusions, ulcers, operations, the traumatic fever must
mask that which is excited by the erysipelatous complication.

30(5 New Doctrine of Erysipelas. [Dec.

Anatomical Nature.

Most pathologists admit that erysipelas is an inflammation ;
but this word, so vague in its nature, does not specify any thing
with respect to the seat. It is a cutitis, say almost all authors.
But there is much more than a cutitis ; the pre-existing, domi-
nant element is an inflammation of the lymphatic radicles of the
skin.

Such is the opinion of M. Blandin. It had however, been
surmised partly by other authors. Mr. Rtbes had perceived in
erysipelas something of a capillary nature. He was howeverr
more inclined to believe in an inflammation of the venous, than
of the lymphatic radicles.*

Dance has observed them in erysipelas of the head, nothing
is more advantageous than the application of leeches over the
lymphatic glands at the base of the maxilla. Was not this
admitting in practice, that the inflammation affected more par
ticularly the system of white vessels ? M. Chomel is still more
formal. Whenever, says he, an individual is affected with chillsr
nausea, horripulatio, red lines under the skin, and pain in the
sub-maxillary glands, he will have erysipelas of the head. The
lymph itis then, not only predominates but it pre-exists. Another
proof of the lymphitis is that in patients convalescent from ery-
sipelas, there often supervenes an oedema, which must be the
consequence either of a venous or of a lymphatic inflammation,
or of the obliteration of the vessels which carry the lymph.
We have then in erysipelas, first a capillary lymphitis, and sub-
sequently a cutaneous inflammation.

But these two elements are not in equal proportion. In ery-
sipelas, which arises from an internal cause, it is the cutaneous,
and in traumatic ersypelas, the lymphatic inflammation which
predominates. It is this circumstance which determines the
difference of their gravity. The former is most commonly
produced by a miasm, which disturbs the entire economy, but an
erysipelas like that of the face exhausts the morbid cause.
Traumatic erysipelas, on the contrary, invades the organism
instead of quitting it, and the lymphatic vessels convey to all
the tissues, according to their course the fluids which have been
altered by the influence of a violent phlegmasia, at first local,
and afterwards concentric. These are positive facts, says the
author, and how frequently do we see women die with the ute-
rine, inguinal, and femoral lymphitis described under the name
of phlegmasia alba dolens !

M. Rims declares that he !';<* found pus in the venous radicles. But this
fact is rarely met "'it'1 '> erysipelas, ami besides may it not bo attributed to imbibi-
tion. Ed. of Journal des Connaissances.

1837. 1 New Doctrine of Erysipelas. 307

It is for this reason that erysipelas is generally regarded as a
much less serious affection by physicians than by surgeons.*

Erysipelas arising from an internal cause is most generally
stationary ; the other, on the contrary, extends almost always
concentrically towards the trunk, and when situated on the
trunk, is directed sometimes superiorly, sometimes inferiorly.

The phlegmasia extends in the lymphatic net work, follow-
ing the direction of the vessels ; thus we see red lines, before the
redness and tumefaction of the skin.

There are however, some cases of traumatic erysipelas which
pursue a course towards the extremeties, and the wards of M.
Blandin recently presented an example of this fact. It is
because lymphitis does not always proceed concentrically. The
same is true sometimes of phlebitis. But these cases are ex-
ceptions.

Prognosis.

This can be readily inferred from what we have already said.
Thus traumatic erysipelas, or that arising from an external
cause is much less serious than the other variety. There are
some cases which are owing both to an internal and an external
cause, as when the disease supervenes around the wound of an
operation performed during an erysipelatous epidemic, the pa-
tient will most commonly feel the effects of the lymph conveyed
to all the tissues, and also the effects of the atmospherical con-
stitution. This is a most serious complication, and was most
probably the case in a man who died recently in consequence of
an erysipelas which supervened after the amputation of a toe.

Treatment.

The treatment employed by M. Blandin is peculiar to him-
self, and is based upon his theory. As to the erysipelas from an
internal cause, little is to be done. We know not the nature of
the miasm which has produced it. Every treatment directed
against it is purely empirical.t But as we are acquainted with

* May not erysipelas \rhich arises from a simple internal cause, be considered an
an eruptive lever and treated as such, by respecting the eruption, by favoring it
by means of moderate perspiration, by recalling it to the surface when metastasis to
an important organ exists, by observing tne symptoms and employing venesection
and baths to modi-rate them when too violent? Ed. of Jour. Conn. Med. Chir.

t It is perhaps gratuitous to assert this pretended benignity of erysipelas which
arises from an internal cause; for according to his own avowal it occurs almost
always at the face, and too often terminates tatally. Besides, the extension of ery-
sipelas from the face toward the neck, that is to say, along thocourse of the glands,
is much loss serious than its extension to the scalp.

Ed of Jour mil de& Conttaissances Med, Chir.
u7

308 New Doctrine of Erysipelas. [l^ec.

the nature of the erysipelas which arises from external causes,
we should abstain from all compression of the wound, from all
irritating applications, and especially from the use of adhesive
strips which exert a tonic and exciting action ; we should have
recourse to the lightest and mildest dressing. So much for the
local traumatic surface, and thus far all practitioners agree.
But the same harmony of opinion does not exist with respect to
the rest of the treatment.

Some have thought it advisable to act upon the altered fluids
by means of tonics. But this is pure empiricism ; for what
proves that quinine, for example, corrects the alteration. Tonics
seem much better calculated to increase the inflammation, and
should be used only in cases of well marked adynamia. Others,
and at their head are Cullen and Dessault, have advised
emetics and purgatives. M. Blandin has not obtained much
success. from their administration. Blisters have been recom-
mended. Dupuytren sometimes employed them in the centre
or at the margins of the diseased surface ; sometimes he used
leeches, sometimes emetics. Expectation has also been advised,
and chiefly by physicians. Such a practice may be justified in
most of the cases which arise from an internal cause. But
what surgeon would confine himself to simple expectation in an
affection that would destroy three fourths of his patients. Unc-
tions protect the inflamed surface from the air, they lubricate the
skin, make it pliant, permit its free extension, and thus prevent
the kind of strangulation caused by the inflammatory fluxioxi ;
but they are only palliative. They cannot prevent the progress
of erysipelas, and much less that of lymphitis, and never exert
any considerable influence except in the simplest cases of ery-
sipelas.

M. Ricord and some other practitioners have extolled mercu-
rial ointment moderately employed. M. Serres D' Uzes
thinks it should be carried as far as to cause salivation. M.
Blanden has used mercurial frictions only in seven cases of
traumatic erysipelas. Three of these patients died, of whom
two were salivated, and the fatal termination was most probably
thereby accelerated.

M. Velpeatj has advised compression upon the erysipelatous
surface. This practice might be useful in the very incipiency
of the disease, if there existed certain precursory signs before
the eruption, and the red lines. But the rapid propagation of
the inflammation to the lymphatic glands, makes it almost im-
practicable. It is however, U3eful at tin; moment of the disap-
pearance of the disease, when there is a tendency to oedema.
Finally, cauterisation above (lie limits of the erysipelas has been
proposed. This plan is powerless in arresting the cutaneous
inflammation, and how then can we conceive it to have the
power of arresting the lymphatic inflammation.

1837.] New Doctrine of Erysipelas. 309

M. Blandin's Treatment. If the lymphitis be the pre-exist-
ing and predominating affection : if after its destruction only a
simple phlegmasia of the integuments remains, it follows that
the former of these affections should be first attacked, and as
the disease is propagated to the lymphatic glands, it is here that
we should first act. This mode of treatment is the more easy,
as each gland is a point which serves to arrest the course of the
inflammation, as well as that of the lymph, and we should profit
by the sojourn of the fluid in this point, to attack it by leeches
in order that it may be freed from all irritation when it resumes
its course towards the visceral glands. If on the contrary, we
apply the leeches to the erysipelatous surface, we debilitate the
patient uselessly ; this is demonstrated by practice as well as by
theory. M. Blandin has employed his method two years, and
has scarcely lost a patient ; he has treated more than sixty cases
during an erysipelatous epidemic, without losing a single case.
He believes that this plan, though less imperiously demanded,
is also useful in erysipelas, which arises from internal causes.
It is also serviceable in erysipelas, both of the extremeties and
of the trunk, but more in the former than in the latter case.
Because the glands of the extremities are more simple, more
sparsely situated, while lymphitis of the trunk may affect at
once the inguinal and the axillary glands, and those of the
intercostal spaces. The employment of leeches is here more
difficult. That this therapeutic may succeed, it must be insti-
tuted before the inflammation has passed higher than the supe-
rior glands of the extremity as those of the groin or axilla, for
how can we act upon those of the viscera. It must be confessed
that this method is much less efficacious in those cases which
depend both upon an internal and an external cause, for here
the miasm acts necessarily, and we know of nothing by which
it may be opposed. But even here leeches applied over the
lymphatic glands constitute the most rational remedy. Journal
des Connaissances Med. Chir.

310 Indigo. [Dec.

PART ITT.
MONTHLY PERISCOPE.

Indigo.

This article, hitherto of interest only in the arts, has become
a subject of investigation in a therapeutic point of view. To
this end it has been subjected to physiological and therapeutical
experiment, and to chemical analysis. It is pleasing to see a
course of investigation in progress, bringing to view a portion
of the fundamental elements on which a rational practice must
be based, or from which it must be deduced. We give below, a
brief notice of the chemical analysis, shewing the elementary
principles this substance contains, its operation on the different
functionaries of the human body, and its influence in a curative
point of view in cases of epilepsy, chorea, &c. We have often
heard of its utility in croup, pertussis, and other coughs ; but
the only scientific experience with which we have met, is of its
use in epilipsy, and a few other spasmodic diseases.

M. Duma3 presented to the institute a memoir, in which he
states that he has repeated the analysis of Indigo, and has ob-
tained exactly the same results as those obtained by him five
years since :

Carbon 73.0

Hydrogen 4.0

Azote 10.8

Oxygen 12,2"

American Journal Pharmacy. Jour, dc Phar.

Physiological Operation of Indigo. In almost all patients,
the use of indigo is succeeded first by squeamishness and vom-
iting, though the substance itself be tasteless and inodorous.
The violence of the emetic efforts appear to be regulated by the
individual irritability of the gastric nerves of the patients. Fe-
males vomit more readily than males. The vomiting is at first
continuous, that is, during the continued use of the agent, and
often so violent that the indigo must be given up ; but after sev-
eral days it ceases. It has otherwise the peculiarity that the

1837.] Indigo. 311

contraction of the abdominal muscles and the diaphragm is
much less violent, and the debility is less considerable than after
vomiting induced by other means. The contents of the stomach
present nothing unusual, even in respect to taste, only they are
of a very dark blue color, and the fluid is intimately mixed with
the indigo, from which it may be inferred that the gastric juice
contributes very much to the digestion of the indigo.

Diarrhoea, the second physiological effect of indigo, takes
place in general first when the vomiting ceases ; yet from this
many patients remain altogether exempt. In general, diarrhoea,
when once commenced, continues as long as the patients take
the indigo, and increases in intensity during the continued use
of the remedy. The motions are generally soft, semifluid, and
of a dark blue-black color. The vomiting and diarrhoea are
frequently accompanied with slight colicky pains in the stomach
and bowels, which, however, may be so violent as to require the
indigo to be given up. Those patients who are exempt from
vomiting, appear to be attacked with more violent colicky
symptoms. By the continued diarrhoea there is formed a spe-
cies of gastrosis (irritation of the mucous membrane of the
stomach and bowels,) with a loss of appetite, headache, and
giddiness, and sometimes the sense of dazzling lights in the
eyes.

The third physiological operation of indigo is seen in the
urinary secretion. The urine assumes a dark violet color,
deepest in the morning. On the quantity of the urine, the
agent seems to exercise no influence.

Dr. Roth did not observe colouration of the sweat. But it
is remarkable, that one patient, after the use of indigo for several
weeks, fell often into slight convulsions, similar to those which
ensue on the employment of the nitrate of strychnia. Amer.
Jour. Pharm. Edinburg Med. and Surg. Jour., from Neuc
Wissenchoftliche Annalen.

Therapeutic Applications of Indigo. This substance was
first employed as a therapeutic agent in the treatment of epilep-
sy, by Lenhossek, and afterwards by Grossheim and others.
Its efficacy was afterwards tried by Ideler, a Prussian physi-
cian ; and among twenty-six patients, in whom indigo was
experimentally tried, six individuals recovered completely ; three
were dismissed cured, who had after intervals of from eight
to twelve months a relapse, under the operation of causes which
might have induced epilepsy ; of eleven patients, the condition
underwent an essential improvement ; and in six individuals no
change took place. At first, the patients were wont frequently,
though without effect, to vomit ; after some days this ceased,
and in its place diarrhoea occurred, which at first caused

312 Indigo. [Dec.

from six to eight motions daily, and was occasionally accompa-
nied with moderate colicky pain, but afterwards moved the
bowels only two or three times daily, but with fluid motions, and
continued so long as the indigo was used, but without impair-
ing the appetite or digestion. The curative reaction of the
nervous system upon the agent was principally indicated by
this circumstance, that the epileptic symptoms in the first period
returned more frequently, and attained a higher degree of inten-
sity, but afterwards became less frequent, milder, and at length
entirely disappeared.

Most usually the indigo was exhibited in the form of electu-
ary, with a proportion of the aromatic powder, because, alone,
it is very disagreeable to the patient. At first it was administerd
in the dose of one scruple ; this was quickly increased to a
drachm and more, so that daily from half an ounce to one ounce
might be used for a series of months without difficulty.

In a paper in Graefe and Walther's Journal, entitled
Contributions to Casuistics, by D. Moritz Strahl, of Berlin,
are some observations on the operation of the same remedy in
spasmodic diseases. In the trials made by Dr. Strahl with
this agent, in ten cases of inveterate epilepsy, in which it was
given in progressively increasing doses, of Irom one scruple
three times a day, to half an ounce daily for the space of ten
weeks, it produced not the smallest effect. During its employ-
ment the stools became blue, and the urine assumed a dark
green colour. Excepting slight inconvenience of the stomach,
no operation of the remedy upon the organism could in general
be observed. On the other hand, indigo, in four hysterical
females, one of whom was already in the age of decrepitude,
evinced the presence of very remarkable phenomena. In all,
after about two drachms daily had been taken, violent pain in
the region of the kidneys, like colic, took place ; the urine
assumed a deeper intensity of colouring than in male patients,
and at the bottom of the vessel was observed no trifling quan-
tity of fine indigo powder. The intense renal pain continued
for four days, and at length subsided under the continued em-
ployment of an oily emulsion. In one case only did there ensue
a remission of the spasms, and the patient was not entirely well
three months after the cure was completed. The operation of
the indigo, further, on the womb, was very remarkable, since, in
two cases, an amenorrhoca was radically cured, while the spasms
were throughout undiminished. In two cases of St. Vitus's
dance, in a boy of twelve and a girl of nine years, the indigo
was throughout unavailing.

The different clinical trials made with indigo by Dr. Roth,
furnished the following results. In epileptic cases, the remedy
evinces almost always the same immediate operation ; but its

1837.] Indigo. 313

subsequent consequences are regulated by the degree of vitality
of the nervous system of the patients, and the kind and duration
of the epilepsy. These effects are beneficial in all idiopathic
epilepsies, curative in those of this class which have not been of
long continuance; and in very chronic idiopathic epilepsies,
only afew are alleviated by the use of indigo, none are cured.
Amer. Jour. Pharm. Edinburg Med. and Surg. Jour, from
Neue Wissenchaftliche Annalen.

It will be seen by the above that, thus far there is only an
approximation towards the elements of rational prescription of
Indigo as a remedial power. For, however conclusive these
investigations may be, and for aught we know, or suppose, the
chemical analysis may be perfectly correct and conclusive ; and
the physiological actions, (so to call its operation on the stomach,
intestines, kidneys and skin,) all the phenomena of its physical
powers on the system ; still, all these are, as we before said, but
a small part of the elements of rational prescription. Indeed,
successful practice may be had by only a knowledge of the
medicinal powers of a remedy, without knowing how the chem-
ist prepares it, or what are its constituants when prepared, (e. g.)
Calomel, known by its power of purging, promoting secretions,
salivating, <fcc. may be used as a simple, untested article, as
cinchona, ipicacuanha, &c. before they were subjected to analy-
sis, with as good effect ordinarily, as with a perfect knowledge
of all its chemical nature, &c. Yet these items of knowledge
are necessary to the scientific practitioner, both for the known
power of the constituents, or the neutralization of these powers?
and for avoiding the impairing effects of incompatibles given
simultaneously, or found in the system, &c* Whilst therefore,
these have their importance, still the indispensible elements of
rational prescription lie in the philosophy of the disease the
true pathology of the case to be subjected to prescription. Hence
the importance of pathological anatomy. But in the prosecu-
tion of this study, great care and good unbiased judgment are
necessary to discriminate between morbid phenomena which

* As lime water for example, an article whose affinity for the muriatic acid is
greater than that of the mercury, the consequence of which would be the decompo-
sition of the calomel and the formation of the muriate of lime, whilst the oxyde of
mercury is left a power materially different from calomel. So likewise, the carbon-
ate of ammonia is found to decompose this muriate of mercury, and form muriate of
ammonia, leaving again the oxyde of mercury, and so on.

314 Indigo. [Dec.

are merely the effects of disease in its approximation to fatal
termination, and those which are causes ; the want of which
dissemination has been of late, an error but too general.

Here then is a field of enquiry which we desire to see occupy
the minds of medical philosophers. The inquiries are, what
is the intrinsic nature of those spasmodic diseases for which
indigo is desired to be found a remedy? What predisposition?
What exciting, what perpetuating causes ? Where seated ?
What functions are disordered, and in what do they differ from
the healthy? What is the tendency of the pathological state ?
Does it tend to, and will it, with the powers of nature alone,
return to health, and that as quickly and easily as with the
assistance of science, and may therefore be entrusted to the
medicine expect ante ? Or does it tend to idiocy, or other per-
manent impairment of the functions, or to death, and therefore
imperiously demanding the aid of science ? These are inqui-
ries of paramount importance, and which must be answered
before a radical treatment can be determined. We must know
what causes are to be removed the mode of operation of these
causes the extent of their effects. We must know the general
physiological state of the system, as well as the physical powers
of the medicinal agents, their adaptation to the removal of
these certain causes to the correcting of their remaining effects
the means for combining, or avoiding, (as need may be,) modify-
ing influences, &c. &c. In short, the pathological, as well as
physiological, chemical and therapeutic elements must all be
known and duly appreciated in deducing, what many practition-
ers think a very little matter, a prescription.

It will be observed that the therapeutic researches herein
noticed, seem to have partially determined one important point
the inutility of this article in other than idiopathic cases, or at
most its only alleviating temporarily, some of those which are
symptomatic, or attended with organic lesions. But here Ave
are arrested by the want of pathology, for who can say that
there are any such cases as epilepsy, chorea, &c. truly ediopa-
thic who say that they exert only as phenomena of organic
Lesions. Indigo may not therefore be expected to be used to
greater or more uniform advantage than many other remedies
which have had their day of praise and fallen into disuse ; until

1837.J Dr. Cooper on Chronic Bronchitis. 315

the pathological elements of the spasmodic diseases, particularly
epilepsy, to which the medical mind seems to direct this prescrip-
tion, is more successfully studied.

We should be pleased to see a generous premium offered for
(not the best, but) an essay which should set forth the rational
philosophy of this, too often, uncontrolable and mischievous
disease.

Dr. Cooper's Observations on Chronic Bronchitis.

We insert the following observations which are going the
Tounds of the newspapers, not with approbation of the manner
in which Dr. C. has thought proper to allow his observations to
come before the public; for such a plan is more calculated to do
harm than good, by throwing into the hands of the public a
valuable power to be ill-judged of, or rather, to be indiscrimi-
nately used, without any judgment at all. Nor have we arrested
it in its flight in company with the nostrums and catholicons in
the gazette curricle, on account of our estimate of value we
place on the observations on consumption which fill up the first
two paragraphs; but because "the course of treatment is evi-
dently one which ought only to be adopted and pursued under
the direction of a skilful medical adviser ;" and because we know
that the remedial power which is the leading article in the pre-
scription is calculated, under such circumstances to deserve a
better fate than consignment to popular and indiscriminate use.
It will be recollected by the profession that the leading power in
this treatment, the good success of which Dr. Cooper has said
so much about, is also the leading article in the pill of Dr. Sen-
ter,* which at one time possessed great celebrity as a dry vomit

* The following is the formula for making Dr. Senteu's dry-vomit pill

ft. Sulphate of copper

Ipicacuanha, each 7 to 10 grs.

Make into a pill to be taken into the stomach in the morning fasting, without
drinking any thing after, until the operation is free. He also used a solution of 3
to 12 grains in 2 or 3 ounces of water. What has been called Senter's emetic, is the
following :

ftf Sulph. cupr. gr. vi

Pulv. ipicac. rad. grs. x., vcl xv. M.

Dr. Marryatt was probably the first individual who made extensive use of this

h8

31G Dr. Cooper on Chronic Bronchitis. [Dec.

in the treatment of pulmonary affections. Jt is also a kindred
power to the " emetic mixture," or " vitriolic solution" of mosely,*
which is given in nauseating doses, or as a dry vomit ; both of
which we have occasionally used with decided success.

" The late lamented death of Dr. Bushe from that form of
consumption known as chronic bronchitis, painfully reminds
the subscriber of a duty he owes to his profession and to society,
of making known a simple form of treatment that has never
failed him in curing this form of consumption, so destructive to
the clerical and literary professions. This treatment is of
nearly equal efficacy in catarrhal phthisis, and is a valuable
remedy for consumption in all its forms when in its chronic
stages, and free from any inflammatory symptoms. It is based
on the pathology of consumption as the generic name for the
disease.

Under the name of consumption are included that variety of
diseases of the lungs attended with expectoration of purulent
matter from the breathing surface of the lungs, connected with
emaciation, hectic fever, and its concomitants, night sweats, col-
liquative diarrhoea, &c. All the powers of consumption act on
the general health from one common cause the presence of
matter acting upon absorbing surfaces, and thus producing those
symptoms known as hectic fever. It is the presence and vio-
lence of this symptom of consumption that prostrates the pa-
tient, until it more or less slowly ends in death. It is the con-
sequence of hectic fever, and not the immediate disease of the
lunjrs, causing it that forms the source of fatality from consump-
tion.

article as an emetic, and a nauscant in phthisis. He advised it combined with
tartarised antimony as follows :

\l. Sulph. of copper

Tartarised antimony, each grs. vij.

Rul> well together and divide into '5 equal papers, one of which he gave every 2
or '.\ days. The jill is, for several reasons, the must eligible form.

* Dr. Mobeley'a emetic mixture, or vitriolic solution is made as follows: and is
also treated as a dry vomit when given as an emetic.

iif Sulph. zinc. 3iij.

alumin. 3i.

Pulv. cocc. cac. gr. iv.

aq. bullient. gviij. M. Dose 3fs every
hour to vomit, or every 3 hours to nauseate.

1837.] Dr. Cooper on Chronic Bronchitis. 317

The treatment I now with reluctant diffidence submit, I have
used successfully, and for more than twelve years; and during that
period of medical practice, 1 am not aware of having lost more
than four or five patients from all the various forms of consump-
tion ; and these were mostly passed to that stage of disease
where the structure of the lungs had become so extensively
diseased as to preclude the use of more than palliative treat-
ment. Cases of chronic bronchitis were, in every instance,
cured by it, even when the purulent expectoration amounted to
pints daily, with hectic fever, diarrhoea, cold sweats, and intense
physical prostration.

The treatment is the administration of sulphate of copper in
nauseating doses combined with gum ammoniac, given so as to
nauseate, but not ordinarily to produce full vomiting. The
usual dose for this purpose is about half a grain, and five grains
of the respective ingredients, in a teaspoon ful of water, to be
taken at first twice, and in the convalescent stages, once a day.

In cases of chronic bronchitis, a gargle of the sulphate of
copper alone is superadded. In this latter form of consump-
tion, this treatment almost invariably suspends the hectic symp-
toms in a few days, and the disease rapidly advances to its final
cure.

In cases of the more proper forms of consumption, the treat-
ment must be intermitted frequently, and again returned to ; and
whenever soreness of the chest, or other symptoms of inflam-
matory action exist, the treatment must be suspended : as it is
in the chronic state alone that the remedy is indicated or useful
that state in which the condition of the general system, as
sympathetically involved, becomes the more prominent symp-
tom ; and the success of the treatment depends chiefly on the
breaking up of the sympathetic action of the diseased lung, on
the more healthy tone of the stomach, increasing the digestive
powers, and likewise causing, during nauseating action, a more
active and healthy circulation through the lungs. Its curative
powers are more immediately attributable to these effects of its
action. But theory apart, the treatment prescribed is based on
more than ten years experience of its curative advantages, in
the proper treatment of muco-purulent, and purulent expect-
oration.

Having left a profession that more nearly than any other
approaches the pure duties of humanity ; but which has nearly
ceased in this country to be honorable or profitable, I have
little motive in exposing myself to that certain ridicule that
follows the annunciation that consumption may be cured, but
the assurance of practical experience, and the desire of making
public, the means of saving life in one of its most frequent and
unwelcome exits. EDWARD C. COOPER.

318 Carburet of Sulphur. Cantharidin Plaster. [Dec.

Resolutive Effects of Carburet of Sulphur vpon indolent

Tumours.

Lampadius in 1826 extolled the employment of this com-
pound, for rheumatism, chronic gout, paralysis, cutaneous erup-
tions and burns. Since this period, this liquid has been fre-
quently made use of in the north of Europe. Dr. Krimer
has employed it anew with happy results in divers affections,
and principally in the treatment of indolent tumours which had
resisted all kinds of medications. Under this plan of treatment
he has administered internally 16 grains of animal charcoal,
mixed with the extract of cicuta ; whilst externally he has
caused to fall from a certain height upon the tumour, from 40
to 50 drops of carburet of sulphur, repeating it three times
daily. The effected part was enveloped during the interval in
wool or swan's down, and twice a week warm baths slightly
alkalized were directed. This method of employing the car-
buret of sulphur was completely successful in his hands. The
external use of the same compound was equally successful
with M. Krimer in the case of a young lady who labored under
goitre.

Finally, in several cases of strangulated hernia, the author
found that no application so much facilitated reduction as the
carburet of sulphur. Some drops applied to the hernial tumor,
reduced it promptly without any manipulation.

M. Otto, of Copenhagen, has also employed with success, in
obstinate rheumatic and arthritic affections, the carburet of
sulphur according to the following formula:

Take of Carburetted sulphur, 3 ii.

Spirit of wine, i. M.

The patients are to take four drops every two hours, at the
same time that frictions are made with the following liniment ;

Take of Carburet of sulphur, 5ij.

Olive oil, l\. M.

By these means a persistent rheumatic affection of the feet
accompanied with swelling of the extremities and knees, was
removed in a short time. Amcr. Jour. Phar., from Jour, de
Pharmacie.

Cantharidin Plaster. Charles Ellis* & Co., druggists
and chemists, No. 50, Chesnut street, Philadelphia, have pre-
pared a new blistering plaster from cantharidin, or the active

* Secretary of the Philadelphia College of Pharmacy.

1837.] (/////in Capsules of Copaiva. 319

principle of Spanish flies. It is spread upon silk, or glazed
cloth. Being ready prepared for use on silk cloth, it is said to
be exceedingly convenient and easy of application, possessing
the adhesive quality, as well as cleanly appearance of court-
plaster that it will excite a blister with equal certainty with
the fly ointment, without the unpleasant consequence of a por-
tion of it adhering to the blistered surface. It is also said to be
free from the liability to cause strangury.

It is used by applying a piece of it, of proper size upon the
skin, with sufficient pressure of the hand to make every part of
it adhere closely to the surface. It must be allowed to remain
in application the usual period of 10 or 12 hours, unless it
should draw sufficiently in a shorter time.

For taking it off, a wet cloth or sponge is to be passed over
the back of it, after which it may be removed without pain.
The blister is then dressed in the usual manner.

In case of the plaster having become dry by age or exposure,
a little sulphuric ether rubbed over the surface of the plaster,
will cause it to act more speedily. In all instances of applying
it, care should be taken to make the plaster stick closely to the
skin. This article will be found particularly convenient for
application in those cases of spinal irritation now so constantly
observed, and to which it is very inconvenient to bind on the
common blistering plaster with sufficient accuracy for its con-
stant adjustment.

Glutin Capsules of Copaiva. M. Gueneau Dc Mussy
read to the Royal Academy of Medicine the report of the com-
mittee appointed to investigate the merits of a new kind of
copaiva capsules invented by M. Raquin, a pharmaceutist.
The capsules were formed of a slight layer of pure gluten. The
copaiva, before being made into pills, is incorporated with one
twenty-fourth part of magnesia. The committee have seen
them prepared, and tried them in many cases at the Venereal
Hospital. They prefer them to the gelatine capsules of M.
Mothe, which have already acquired the approbation of the
Academy. This preference is founded upon the following rea-
sons: The size of the copaiva pills enveloped in gluten may
be varied, which is not the case with the gelatinous capsules.
In a small volume, the glutinous contain more copaiva than the
gelatinous capsules; and do not, like the latter, allow the copaiva

320 Urinary Calculi covered by a kind of gildtng. [Dec.

to exude. When immersed in fresh water, or in some odorifer-
ous water, the odour is communicated to them, and they are also
more easily swallowed. The capsules of gluten can be taken
in larger doses than those of gelatine, and without the nauseous
eructations which the latter cause when dissolved in the stomach.
The small quantity of magnesia combined with the copaiva
prevents this inconvenience, and facilitates the digestion. Ar-
chives Generate de Mid., July,

Internal Strangulation of Intestine, taken for Puerperal
Perctonitis. One year after marriage, Madame N. was deliv-
ered without accident, of a child which she did not suckle.
The 10th day the mammae were not even swollen, but the
lochial discharge existed. The 12th day she felt, suddenly in
her right iliac fossa a severe pain the next day she was pretty
well. " On the 14th, hiccough, vomiting, (fee. The patient pre-
sented an umbilical hernia which was soft, and without pain.
No tumour could be perceived in the abdominal rings. An
active antiphlogistic treatment was commenced, but the patient
died in eight days the 20th after delivery. When the body
was opened, the ca3cum was found strangulated by the appen-
dicula vermiformis which embraced the intestine. The uterus
and peritoneum were in a normal state. " The error of diagno-
sis in this case," says M. Baffos, " was unimportant, as the
same treatment must have been indicated. Archives General
de Med., July.

Urinary Calculi covered by a kind of gilding. M. Sega-
los presented to the Academy three calculi, one as large as a
bean ; the two others, smaller, which resembled gilt porcelain.
The large one was found in the kidney of an ox ; the other
two, in the bladder of a cow. By scraping with the nail, the
gilding was removed from one point, and the calculus found to
be white; but when the same point was rubbed with the pulp
of the finger, it was again covered by a gilt coat. A chemical
examination was to be made, in order to ascertain the principle
to which this gilt envelope is owing. Archives General de
Med., July.

We presume it would not take much of what Dr. Johnson
calls " strong, hard, round-about common sense1' applied as a
test to these calculi to determine, that the " gilt envelope," is no
envelope at all, and is but the hue which is reflected by the pol-
ish which these calculi very easily receive. Let us see, when
the chemical analysis is reported, what better will be determined
thereby.

1837.J Obituary. 321

OBITUARY.

It is with feelings of filial sorrow that we are under the ne-
cessity of announcing the death of the venerable Father of
American Surgery, Dr. PHILIP SYNft PIIYSICK,

There is no section of our happy land which is without those
who mourn his loss. Thousands unite to praise his merits,
reverence his memory, and ascribe to him the honor of our
Father in Surgery. But we are only his episodes ; his
higher praises are registered in the grateful hearts of tens of
thousands who, during his long and useful life, have enjoyed
the ameliorating influence of his superior surgical talents.

He was not of those who are driven up by the force of cir-
cumstances ; but persevering zeal, and originality in many the
most important respects were peculiarly his. Like his cotem-
porary Dupuytren, he justly possessed the credit, of his own
growth to fame and usefulness. When his hand was first ap-
plied, American Surgery had not even a name ! Now, what
is it ! Behold a prolific tree which overspreads the whole
land, and justly claims honors equal with the foremost ! It was
a plant, germinated at his feet, cultivated by his hand, guarded
by his care, and nurtured, pruned and extended by his counsel.

But it is not our purpose to write an eulogy. With his own

hand he has created an imperishable monument, and inscribed

thereon, the unfading honor he has bestowed

on his country, in giving dignity and

true worth and usefulness to his

profession.

Tribute to the Memory of Dr. Physick.

At a meeting of the Faculty and Students of the Medical Col-
lege of Georgia, for manifesting their high respect for the late Dr.
PHILIP SYNG PHYSICK, Dr. Milton Antony was called
to the Chair, and Dr. George M. Newton appointed Secretary.

On motion of Dr. Paul F. Eve, the Chairman appointed
Drs. Paul F. Eve, Alexander Cunningham, Charles
Davis, George M. Newton, and William L. Alfriend, a
committee to draw up resolutions suitable for the occasion.

After a few moments the committee made through their chair-
man, Dr. P. F. Eve, the following report :

322 Obituary. [Dec.

The Faculty and Students of the Medical College of Georgia
having heard, with the deepest regret, of the death of the vener-
able Dr. PHILIP SYNG PHYSICK, feel themselves called
upon to give public expression of their sorrow at this afflicting
dispensation of Divine Providence.

Truly has a great man fallen in our profession. One who
had, by his zeal, talents, and arduous devotion to our science,
secured the entire confidence of the American public; and
whose teachings and signal improvements in surgery can never
be forgotten by his numerous pupils in every state and territory
of our eountry.

He was associated with Rush, Shippen, and Wistar, in
establishing the first medical school on this side of the Atlantic
himself a pupil of the celebrated John Hunter, and by his
fame as a scientific and successful surgeon, he attracted patients
from all parts of our Union.

If Dr. Rush was the father of American medicine, Dr. Piiy-
sick is no less entitled to the appellation of the father of
American Surgery. Appreciating then the great loss which
has been sustained in the death ot our venerable Father, Dr.
Philip Syng Physick, late of Philadelphia, be it therefore

Resolved : That we deeply sympathize with the community
at large, mingle our sorrow with our professional brethren
throughout the Uuited States, and offer our sincere condolence
to his distressed family.

Resolved: That as a tribute of respect for the worth and
character of the deceased, we will wear the usual badge of
mourning for the space of thirty days.

Resolved : That we respectfully request that the next number
of the Southern Medical and Surgical Journal be issued in
mourning.

Resolved : That the Secretary transmit a copy of the
proceedings of this meeting, signed by himself and the Chair-
man, to the family of deceased ; and to the editor of the South
crn Medical and Surgical Journal, and the editors of each of our
city papers.

On Motion of Dr. P. V. Bve, the report was unanimously
adopted. On motion of Dr. Die as, the meeting adjourned.

Milton Antony, Chairman.

George M. Newton, Secretary.

SOUTHERN

mmmmML akb hjieii ail

JOURNAL.

Vol. II. FEBRUARY, 1838. No. VII.

PART I.

ORIGINAL COMMUNICATIONS.

ARTICLE I.

Remarks on the Pathology and Treatment of Bilious Fever,
read before the Medical Society of Augusta, by L. A. Dug as,
M. D.j Professor of Anatomy in the Medical College of
Georgia.

There is perhaps no subject connected with the advancement
of science, of more importance than nomenclature, for, on the
correctness of names, depends, in a great measure, the correct-
ness of our ideas relating to the facts they represent. A name
should, as far as practicable, always convey a correct, and distinct
idea of the leading features or properties of the subject to which
it is applied, and any deviation from this principle must tend to
complicate the attainment of knowledge, by requiring of the
student not only the recollection of unmeaning technicalities,
but also the correction of their original interpretation. It were
always better that a name convey no definition, than an incor-
rect one.

A 1

383 Pathology and Treatment of Bilious Fevers. [Feb.

The inappropriateness of the appellative at the head of these
remarks is striking. The term fever is now applied to a peculiar
assemblage of symptoms, without reference to cause; yet, when
qualified by the adjective "bilious," it is assigned to an extensive
class of diseases prevalent in our section of country and in most
warm climates. We should, from the above designation, expect
to find this class of diseases always characterized by a derange-
ment of the biliary secretion; such, however, is not invariably
the fact, as I shall endeavor to establish in the sequel.

The system of localization, which has already accomplished so
much in continental Europe, has been too much neglected in our
country, and especially with regard to the diseases of this cli-
mate. Still adhering to the theories of the humoralists and of
those who look upon fevers as specific affections of the entire
system, the great mass of our practitioners are found to direct
but little attention to the condition of individual organs.

When, fresh from the benches of the school of organic medi-
cine, I was called on to examine and to treat cases of "bilious
fever," I instinctively interrogated in succession every organ of
the body, in search of the seat of the disease, or in other words,
of the cause of so much constitutional disturbance. In some
cases, despite of all my investigations, no trace of disordered
function (the best evidence of a diseased organ) could be detect-
ed elsewhere than in the stomach ; in others the bowels -were
alone distempered ; other sets evinced the disturbance to be lo-
cated in the liver, in the brain, or in more than one of the prin-
cipal viscera. The bilious modification, implied by the name
of the affection, though very frequently manifest, was often en-
tirely wanting. Yet, each of these cases presented certain cha-
racters peculiar to all. Their onset was always marked by loss
of muscular power, by pains in various parts of the muscular
system of animal life, &c; their early y inter mittency or

decided remissions; their duration and termination presented a
strong analogy ; in short, it. was evident that, although modi-
fied by the affection of some, special organ, all these cases
were under the predominance of an original and common
affection. The seat of this original and common affection
cannot be mistaken if we adhere to the principle already al-
luded to, that of regarding vitiated function as the best indica-

1S3S.] Pathology and Treatment of Bilious Fevers. 3S9

tiou of diseased organ. If an organ be healthy, its function
must necessarily be normal; consequently; if a function be ab-
normal, the organ presiding- over it cannot be in a physiological
condition. I am aware that it will be urged that certain secre
tions may be vitiated by an altered condition of the fluid whence
they are derived, without disease of the secerning organs. For
example, the urine may present various aspects according to the
.substances taken into the circulation ; or, the composition of the
bile may depend on that of the blood. But this cannot affect our
position, for, the condition of the blood itself, depends entirely on
that of the organs which form it, and of those whose office it is
to eliminate its impurities. If it remain impure, the cause must
be found in the vitiated action of the emunctories.

But, whether these principles of diagnosis be admitted or not,
it is presumed that no one would, on reflection, refer the morbid
condition of the contractility and sensibility of the muscular sys-
tem, to any other locality than the nervous centres. We have
already stated the earliest symptoms of our fevers to be lassitude,
loss of muscular power, and pains in the muscles of animal life ;
also, that intermittency, more or less complete, always marks
their early stage. We are, therefore, led to the conclusion that
the nervous system is the original and common seat of this
class of affections. I trust I will not be misunderstood ; the
term original being here used expressly to indicate that these
fevers subsequently undergo rerious modifications, from the su-
pervention of other derangements. It is to these complications
we must look for the explanation of the various forms assumed by
the fevers misnamed "bilious" so that the proper definition of
them should be an original affection of the nervous centres,
subsequently com plicated by j>hlogosis of some other organ or
organs, which secondary disorder may either gain the ascen-
dancy of the primary, or merely mask and modify it.

Let us now examine some of these complications : and in do-
ing so, it is scarcely necessary to premise, that, in point of fre-
quency, they vary exceedingly indifferent seasons and in differ-
ent years. The most simple may be classed under the head of
hepatic, gastric, enteritic, cerebral and pulmonic ; the more
complex forms are those m which there are more organs than
one. implicated secondarily.

390 Pathology and Treatment of Bilious Fever. [Feb.

The Hepatic complication will, in addition to the general
symptoms, already mentioned as common to all the forms of this
class of fevers, present the characteristics of hepatitis, more or
less acute ; and this is, perhaps, the most obscure form of these
fevers, inasmuch as the indications of hepatic disorders are less
marked and less understood than those of any other of the vis-
cera. In the present state of our knowledge, an hepatic affection
can only be inferred either from an increase or diminution of
bile, from the volume of the liver (which may be determined by
percussion) or from the mere absence of disease in any other
organ, sufficient to account for the general disturbance of the
circulation. Pain in the region of the liver, though occasionally
pointing to the seat of the disease, can only occur when the pe-
ritoneal investment is affected (the liver itself being insensible),
and is too inconstant to be relied on. The quantity of bile can
only be estimated by the appearance of the matters ejected from
the alimentary canal, and by the colour of the eyes and general
surface. To admit, on any other grounds, the existence of dis-
ease in the fever, would be proceeding beyond the limits warrant-
ed by our actual knowledge of the pathology of this important
gland. If there be an increased secretion of bile, it will be found
proportionably thrown from the stomach and passed off with the
alvine evacuations. The yellow hue of the eyes and skin may
accompany this state, as well as that in which the evacuations
evince a decided paucity of bile ; hence, this cutaneous change
indicates the mere fact, that the colouring matter of the bile has
passed into the blood, without pointing out the cause of this oc-
currence. It is well known now, that jaundice often results from
duodenitis, without any affection whatever of the liver itself.
If these circumstances be home in mind in the investigation of
these levers, it will he found that a large number of cases will
present no trace of hepaiic derangement.

The Gastric Complication is characterized by the well known
symptoms of acute affection of the stomach : viz. loathing of
food, nausea and vomiting. The pulse in this is never so much
developed nor so resisting as in the hepatic complication, and
yields more readily to venesection, which not unfrequently oc-
casions syncope. The countenance is also more anxious and
the face less flushed. Pain, on pressure of the epigastrium,

1838. 1 Pathology and Treatment of Bilious 391

though oflate much insisted on as peculiar to gastric irritation,
would, perhaps, more properly be regarded as indicating disease
of the subjacent peritoneum, whether lining this region, or re-
flected over the stomach or the depending edge of the liver.
This membrane is known to be highly sensitive when in a state
ot irritation or inflammation, whereas we may yet doubt that
this is the case with regard to the other coats of the stomach.
The inflammation of the peritoneum in this region alone, how-
ever, might be produced by an extention of disease from the other
coats of the stomach or from the parenchyma of the liver, and
should, therefore, always be considered in connection with the
state of these organs. That the tenderness of the epigastrium is
occasioned by the condition of the serous membrane, may, inde-
pendently of the above considerations, be inferred from the readi-
ness with which relief is afforded by revulsive applications to
the cutaneous surface, whilst the other symptoms remain unmit-
igated.

The Enteritic complication is that in which the bowels are
most obviously in a state of phlogosis. The mucous surface of
the intestines pours out an immense quantity of thin muco-serous
fluid, which, either passes off spontaneously, or is expelled by
the action of cathartics. It will be marked by copious diarrhoea;
or by the fact that the slightest laxative will be attended with
excessive purgation, which, instead of subsiding with the effect
of the remedy, as usual, will continue indefinitely. The small
are much more frequently affected than the large intestines, and,
consequently, diarrhoea is more common than dysentery. Pres-
sure over the abdomen will be occasionally attended by pain,
probably arising from the extension of the disease to the perito-
neal investment, as already explained with regard to the stomach
and liver.

The peculiar torpor, or obstinate constipation of the bowels,
so often observed in our fevers, is considered by some as indi-
cating a degree of inflammation so high as to arrest the secre-
tions of the mucous surface, whereas others regard this condition
as induced by a want of the accustomed stimulus of the bile.
Both of these explanations appear to me exceedingly objectiona-
ble ; the former, because I cannot admit so high a degree of ex-
citement simultaneously invading the entire length of the canal j

392 Pathology and Treatment of Bilious Fever. [Feb.

and also because all post-mortem inspections testify that in cases
of death daring the existence of diarrhoea or dysentary, the mu
cous surface may be found presenting every ^rade of disease
from mere irritation even to destructive ulceration. Inflam-
mation of the mucous membrane cannot then account for obsti-
nate costiveness. nor do I think these two states can exist together.

To admit that such a state of torpor can result from the want
of biliary stimulation, would be to concede that the hepatic se
cretion is more irritating than the most drastic cathartics in ma
teria medica, for, we frequently find it resisting them, not only
individually, but in the most potent forms of combination.
Again: the passage of white or clay colored faeces occasionally
observed in jaundice, at trie same time that it proves indubitably
the absence of bile in the alimentary canal, also establishes the
fact that such absence does not cause obstinate constipation. I
would look to the intestinal muscles, and through them, to the
nerves which control their action, for the explication of the phe-
nomenon. The peristaltic motion is arrested because the mus-
cles do not act, and these are torpid, because of some derangement
of innervation. This lesion of innervation may be traced either
to the concentration of irritability in some organ seriously im-
plicated, (the liver for example) as is most frequently the case, or
it may be found to depend on the peculiar condition, probably
congestion, of the nervous centre. The correctness of these
views is most strikingly illustrated by the efficacy of the treat-
ment of obstinate constipation, in the one case by copious bleed-
ing, and in the second by revulsives to the spine. In the great
majority of instances, a few cups or a blister to the spine will
enable laxatives to act when the most active drastics have pre-
viously failed.

The Cerebral complication is one that occurs alone, much
more rarely than those already described. It is always, however,
recognized by a predominance of encephalic disturbance, as head
ache, intolerance of light, tinitis aurium, delirium, wakefulness,
and sometimes subsultus tendinum and coma. The symptoms
developed in this form of the disease, and which indicate phre-
nitis, should not be confounded with the slight manifestations
presented in most cases of bilious fever. Head-ache, for exam-
ple, will be found in the great majority of instances, but may, in

1838.] Pathology and Treatment of Bilious Fever. 393

many of them, be referred to some kind of sympathy implicating
the nerves of the scalp which frequently becomes very sensitive
to the touch, and in which the pain is certainly then located.

The Pulmonic complication is still more rare than the last
mentioned. Here the respiratory apparatus will be found more
or less distempered ; pneumonia may sometimes be detected, but
the mucous membrane of the bronchi is the most common seat
of disease. .Respiration will be more or less impeded: expector-
ation at first slight, but subsequently copious, and occasionally
some soreness about the chest; coryza not un frequently exists.
This form usually occurs either in the spring, or very late in the
season of our fevers, and is seldom fatal.

I have thus far described the mildest forms of our fevers ; the
simple complications of the original type. But there are double
and treble complications, in which two, three, or more organs
are simultaneously or consecutively diseased. If the diagnosis
of the simple complications be well understood, that of the more
numerous will be equally so, and consequently needs not be now
dwelt upon. Indeed any considerations on these would lead us
far beyond the limits assigned to this paper, for, the five forms
enumerated, might, by various combinations, be carried to an
immense number. The gastro-hepatic, gastro-enteritic, and
gastro-entero-hepatic are by far the most common of the plural
complications we encounter.

Let us now turn our attention to the treatment of these affec-
tions We have already stated that neither of the above compli-
cating phlegmasia?, alone or unattended with spinal disease,
could produce the phenomena common to all the forms of our
"bilious fevers," and we have furthermore stated the primary
lesion to be that of the nervous centre, or, i 2 other words, of the
spinal cord. If this primary affection remain uncomplicated,
then we have a disease of the mildest form known ; one which
retains its peculiar characteristics, its paroxismal form and its
periodicity. In short, we have a plain case of ague and fever,
such as we daily see. With these views of the pathology of our
autumnal fevers, the treatment must necessarily be divided into
that proper in the first or uncomplicated stage, and that required by
the subsequent modifications, for, if the first stage be promptly and
energetically met, the progress of the disease may be arrested.

3'J4 Pathology and Treatment of Bilious Fever. [Feb.

So long as the nervous system is alone affected, our medication
should be entirely directed to it, and such remedies used as are
known to possess the most decided anti periodical properties.
Quinine, our most potent anti-periodical, should be given with
a liberal hand during the very first intermission, and persisted in
until the disease be vanquished, or its administration be prohibit-
ed by the supervention of settled phlogosis of some organ, which
fact will always be indicated by the continued form then assum-
ed by the disease. It is as impossible that a complete intermis-
sion should occur during the existence of inflammation in an
important organ, as it is that the said inflammation should alter-
nately invade and disappear suddenly from a tissue, without
leaving any vestige of its existence, until the recurrence of ano-
ther paroxism. Inflammations are always more or less perma-
nent; they have their periods of progress, maturity and declen-
sion well marked, and cannot suddenly disappear and reappear
with intermissions of perfect health, as do our intermittent fevers.

The action of quinine will always be most happily seconded
by revulsive applications to the spine, which is frequently found
painful on pressure or percussion. Indeed these will, alone, in
many instances, be found sufficient to arrest the disease. For
evidence of their very decided effect, I would refer to the inter-
esting and able paper published by Professor Ford, in the sixth
No. of the Southern Medical and Surgical Journal.

But, although the treatment of our fevers at their onset, be of
the utmost importance, the services of the physician are rarely
requested before the localization of irritation in some organ of
more or less importance. He is then called on to treat a disease
much more unmanageable. Inflammation has supervened, and
the whole antiphlogistic battery must be put in requisition. In
so doing, however, too much care cannot be directed to the se-
lection of agents. It is not a mere abstraction, inflammation, we
have to combat ; but inflammation of special organs; audit is
the neglect of this consideration which accounts for the wretch-
ed routine practice inculcated in many works and followed out
by the people at large. It is this neglect that causes irritating
emetics to be given in the gastric form of the disease, drastics in
the enteritic, and calomol in the hepatic, whether attended with
increase or diminution of bile.

1S3S.I Pathology and Treatment of Bilious Fever. 395

The general action of the circulation must be reduced; but it
must be brought down by those remedies best calculated to abate
the local inflammation which keeps it up. Early and free de-
pletion from the arm, from the spine, and from the vicinity of
the affected or^an, will be proper in all cases ; emetics in all,
save the gastric ; and cathartics in all, save the enteritic. Em-
etics are most signally beneficial in the early stages of the hepa-
tic and enteritic complications, not only by emptying the sto-
mach, but also by their revulsive operation, and by the general
relaxation and diaphoresis they induce. In the enteritic form,
antimonial emetics should be avoided, from their strong tenden-
cy to act on the bowels, and preference given to ipecac or lobelia.

Of cathartics I cannot speak too highly in all those forms un-
attended with enteritis. They, not only evacuate the contents
of the intestinal tube, but also establish from this extensive sur-
face an abundant drain, both depletory and revulsive. They
unite all the advantages of local depletion and of the most pow-
erful revulsives, a combination of results not to be obtained by
any other medication. If energetically and repeatedly used,
they may advantageously supersede the lancet, whose effect is
merely depletory, whenever the intensity of the disease is not
such as to demand a more sudden reduction of the circulation.
In such cases their advantage will be explained by the fact that,
if revulsion be added to depiction, the extent of the latter need
not be carried so far, and, consequently, the resources of the
system will be less impaired and convalescence rendered more
speedy. Let the modus operandi of cathartics be properly un-
derstood, and their high value will be justly appreciated. They
excite to increased action and increased secretion the vessels of a
great surface, situated in the proximity of and connected by
vascular communication with the organs most frequently phlo-
goscd ; the liver and stomach. Their derivative and depletory
effects must, therefore, necessarily be immediately felt by the
diseased organs : the morbid concentration of the fluids will be
diverted from viscera, unable, from over-excitement, to relieve
themselves, and directed to a surface prepared to throw off any
superfluous accumulation. \ ion is often necessary in

our levers, but it can never be carried sufficiently far to com-
pletely subdue excitement, without seriously endangering the
n 2

39(3 Pathology and Treatment of Bilious Fever. [Feb.

recuperative powers of the system. Hence the vast superiority
Kf cathartic depletion in many cases, and their positive necessity
in the great majority.

In alluding to the treatment of "bilious fever/' it would seem
unpardonable to take no notice of a remedy thought indispensa-
ble by the great majority of our practitioners; a remedy which,
according to them, possesses the wonderful property of adapting
to almost every condition of thesystem and form of disease ;
of all id regulating whether increased or diminish-

ed, of correcting the tciting the al . 5, of

equalizing the circulation, and, in short, of rectifying the iiuids
and renovating the solids. An agent oi' such multiform
virtues should certainly not pass unnoticed, in considering the
treatment of any malady, and, especially, of that of which it is
so generally regarded as the antidote. The limits of this paper,
however, already extended beyond my original design, will per-
mit but a brief allusion to calomel. I am, moreover, disposed
to be brief, because I rarely use this agent in the class of diseases
under consideration. If the excitement be great, I prefer more
active depletory and revulsive means, and, when it is reduced,
I still resort to antiphlogistics of a milder and less objectionable
kind, confident that the secretions will be restored and the cir-
culation equalized, without calomel, whenever the organs are
restored to their normal condition. If experience be appealed
to, I will fearlessly challenge a parallel of my success, with that
of the most strenuous advocate of the mercurial medication, and
endeavor to prove that "bilious fever" may, in genera], be more
readily and more safely cured without, than with calomel.
The above remarks, hastily thrown together, in reply to a
I for discussion by the Medical Society, are ne-
>id of those r s and acknowledgments usual-

n an elaborate treatise. They contain the simple

,! the subject of debate, and arc not in-
claim to originality than may be

:, ui liar with the literature of our pro-

P. S j aarks on the use of

calotni I, in Lhe above article, have U en misunderstood by som<

L838.] Pathology and Treatment of Bilious Feper. 397

of those present at the meeting of the society; 1 will be more ex-
plicit. 1 have stated that "I rarely use this agent in the class of
diseases under consideration/' and not that I never use it. Nor
is my objection to it founded on the belief that it is an irritating
or drastic remedy. So far am I from entertaining this opinion,
that I give it the decided preference in such rases, as are attended
with a disposition to enteritis, and whenever I wish merely to
evacuate the bowels, without incurring the risk of occasioning
debilitating purgation. Hence it is peculiarly adapted to the
last stage of our fevers, and not to the early, when active deple-
tion is requisite. In the last or convalescing stage of tire hepatic
form of the disease, when excitement has been fully subdued, it
may also have some tendency to relieve the liver by exciting it
to secretion, but whether this be done by a specific action or mere-
ly by revulsion on the contiguous duodenal surface, is yet a
matter of doubt with me. My principal objections to its general
use are, in the early stages, its want of energy, and in the latter,
its strong tendency to produce salivation with its frightful con-
sequences. None but those familiar with the practice in our
southern and south-western states can form any idea of the ha-
vocs of this useful but much abused remedy. It is scarcely cre-
dible, yet 1 have ascertained the fact by special inquiry of our
druggists, that there are annually vended in this small city no
less than one thousand pounds of calomel, besides a proportion.
ate quantity of blue pill mass, mercurial ointment, corrosive sub-
limate, &c. ! Is it then surprising that the steamers, the vegeta-
ble quacks and nostrums of all kinds should find countenance by
those whose loss of teeth and shattered constitutions have warn-
ed them against the abuse of mercury !

39S Case of Fistula cured by Coffee, [Feb.

ARTICLE II.

Case of Fistula cured by Coffee. By .VI. Anthony, M. D.

J. S. C, aged about 40, of medium stature, black hair and
eyes, round make and active in body and mind, between 3 and 4
years ago became afflicted with hcemorrhoidal tumours. The
swellings were soon very painful, and were chiefly within the
sphincter ani ; soon however, tumours arose as usual around
the verge of the anus. The swellings were never as large as
they are m many cases, but were so painful that on the failure
of other ordinary applications, he was compelled to resort to
warm bathing of the part almost incessantly for keeping the
extreme pain in moderation for the present. The symptoms,
after being palliated for a while, readily returned on taking
cold, or on any cause of the slighest morbid excitement. After
a few months, an aching induration was observed, extending,
along the cellular substance on the right side of the anus in the
direction of the ischiatic tuberosity, to the extent of about one
inch ; at the outward extremity of which there appeared in the
superficial integuments a little pimple, which finally opened
and discharged a small quantity of matter. Soon after this, the
subcutaneous induration on that side of the anus shrunk away
until it appeared like a small cord about the size of one's little
finger, and the hcemorrhoidal tumefactions all around the anus
disappeared, except one small point on the left margin. This
remained, subject to some1 swelling and tenderness on any unu-
sual excitement, but ordinarily m pain or peculiar sensi-
bility : only exhibiting the appearance of a small shot under the
integuments of the part. Meanwhile however, the littleopening
on the right continued steadily to yield a small discharge, not
exceeding probably, half a I iful a day. The opening
was so minute as barely to admit the end of a common probe.
This was however, used in the examination, and an incomplete
fistula found, which was about one inch in depth.

After inspection by a physician, it was operated on, so as to
divide the septum between tbe sinus and the anus. After this

L838.1 Case of Fistula 399

operation, the incision was regularly dressed bythe interposition
of lint, etc. It soon healed, leaving a superficial ridge in the
direction of the sinus, and a considerable tumefaction within.
After a few weeks the sinus again opened at the outward end of
the incision. This opening continued to discharge about as h
did before the operation.

Mr. C. was as before stated, a very active man in business,
often riding on horseback, and often walking much: All these
habits have continued regularly to the present time. About
three months ago he took boarding at the private boarding house
of a relative, where he was served every night at 9 or 10 o'clock
with a cup of coffee about three gills in quantity. Mr. G. had
been habitually a tea drinker at breakfast and supper. Thus
continued the fistulous opening until three weeks since, when,
having remarked that he felt no inconvenience, and that his
cloathes had ceased to indicate any discharge from it, he then
examined, and found that the fistulous opening had healed, and
the eschar in the direction of the cut, shrunk below a level
with the external integuments, whilst the cord within had en-
tirely disappeared.

The coffee used by Mr. C. was a cheap West India, and was
kept standing in a tin coffee-pot from supper until 9 o'clock at
night.

Notwithstanding this is a solitary case of the kind, there is
much reason to believe that it stands as a demonstration of the
curative power of coffee in such a case.

And whilst it is admitted that the recovery, and the use of the
coffee, an unusual article of diet with this individual, may have
been a mere conjunction of circumstances, or a coincidence, hav-
ing none of the relation of cause and effect, still, observations on
the use both of tea, which this patient had habitually used, and
coffee, which was accidentally adopted, tend to encourage the
idea that the use of the coffee was the cause of recovery from the
fistula.

Almost every mother has observed the different influences of
tea and of coffee on the function of lactation ; and mothers
abounding in excess ol this secretion have found that the liberal
use of coffee has not only failed to produce, like tea, an increase,
but on the other hand has with great uniformity tended to les-

400 Case of l\ hy Coffee. [Feb.

sen the quantity. So well observed has this fact been, that
nursing women wishing to dry or to lessen their lactation have
learned to adopt the use of coffee as a diet ; and on the contrary
to live liberally on tea when they desire an increase. The fact
of the influences of different articles of diet on this function,
none will be disposed to controvert. If this be a fact, why may
not this opinion among the people, founded on the observation of
facts, relative to the use of tea and coffee be correct also? If
this opinion be founded in fact relative to the use of coffee hi
genera], it is by no means less probable, if not more so, that the
use of the Cuba or Jamaica coffee1, much stronger in the peculiar
powers of that article, is calculated to produce signal effects.

It would be well for physicians to institute a course of exam-
ination on this subject, which may enable them to determine if
this article, in such universal use as a beverage, whilst its mod-
erate use is both wholesome and agreeable, is not at the same
time so medicinal as to entitle it to a place amongst the articles
which promote absorption. Or, if they should not find thiib idea
confirmed by observation, they may ascertain that as an article
of diet, it is mainly valuable on account of its peculiar stimula-
ting powers, and that it, apart from the sugar and milk com-
monly used with it, is not calculated to afford nutrition. And
on the other hand, they may find, what is probably the fact, that
India tea with the usual accompaniments is both exhilerating by
virtue of its peculiar stimulating power, and either fails to pro-
mote absorption, or contributes more or less liberally to the end
of nutrition. Observations in point may be made by investiga-
ting the habits of diet of patients laboring under hceinorrhoidal
or fistulous afflictions. The same may be extended to lactating
females, dropsical persons, &c.

Remarks on Snip kale q) ine. 40 I

ARTICLE [II.

Remarks on Sulphate of Quinine. By M. Antony, M. I).

In the last number of this Journal we noticed the cure of a
periodical hemorrhage by the Q,uinine: remarking at.

thesame time, ma , not forthe purpose of having

it immitated, but with the inten to it on a future

occasion. We now proceed to give below the remarks which,
but lor want of time, would have been appended to that article.

Formerly cinchona was looked on as a kind of specifick for
intermittent fevers ; and so, from its power of often arresting that
form of disease, it may well have been. Now it has passed into
disuse ; its place being occupied by the same active principle in
the more elegant and convenient form of Sulphate of Quinine.
As experimental medicine progressed, the important fact was
discovered, that other afflictions, observing like periods with
intermittent fevers, were but these in disguise, and could, with
equal ease, be arrested by the same active principle. Amongst
these afflictions were periodical hemorrhage, periodical head
ache, rheumatism. &c. &c, and hence the Quinine, in the early
days of this article, obtained some celebrity in France for the
cure of Megrin ; and the French-American citizens who, from
fear of calomel here, had become subject to sick head ache, were
occasionally found returning from France with a parcel of Qui-
nine powders, under the name of Megrin Powders. It is easy
to conceive of very efficient causes of the perpetuation of this
practice, however unreasonable in itself it may be. Most of the
observations published on this subject, whether in periodicals or
in standard works, have been the productions of cold climates,
by the tonic effects of which, together with the less confirmed
nature of those hepatic derangements in the higher latitudes,
the system has, more frequently than in the south, possessed an
energy sufficient to regulate the functions, the derangement of
which had been the predisposing cause of disease, so soon as
the peculiar morbid actions and phenomena, which constituted
the i of dis< *3 By the ie greater

402 Remarks on Sulphate of Quinine. [Feb.

resources of nature, and the less degree of predisposition, there-
fore, the sequela; which, under the other circumstances that
obtain in warm or tropical climates are found to follow, have
been prevented. Observers, however minute and accurate,
have not probably therefore, had occasion to witness such fre-
quent sequelce as jaundice, chronic hepatitis, bilious colics, dis-
pepsia, dropsy, &c; or if these have followed, it may have been
at so much later a period, that the previous form of disease had
been lost sight of, and they have been (improperly enough, no
doubt,) attributed to other, and more recent causes. Such over-
sight, we may conclude, is very easy, when we remember how
common it is for the most serious hepatic derangements and
disorganizations to arise and continue for a long time, without
even the suspicion of the patient, or of his physician. Such
results are, in consequence of the low sensibility of the liver,
not so uncommon as may, at first thought, be supposed. An
illustration of this fact may be seen in Faitiiorn's treatise on
the liver, in which a case is given of an enormous quantity of
vitiated secretion, perhaps ten or eleven pints, being found in
the biliary vesicle, and still the hepatic disorder had not, for a
great while, been suspected by the patient or physician. But
we need not go so far for an illustration : Every man's practice
in a bilious climate, would afford to the close and experienced
observer, perpetual demonstration of hepatic derangements, far
beyond what might be suspected from any conspicuous external
evidence.

We have intimated that the practice of resting the cure of
bilious intermittents on Quinine, or on bark alone, is unreasona-
ble. We repeat that it is so, however well that practice may
comport with the fancies, or the high authorities of the present
time. Reasoning apart, facts demonstrate this truth ; but facts'
must be observed, before they can be known. To reason ab-
stractly on this point in therapeutics, would require space not
afforded in this place ; and would demand the arraignment of the
high-sounding theories, at present too much in vogue, and their
subjection to a little sound logick very little of which would
be sufficient to shew that they are founded, 1st, On the subver-
sion of cause and effect ; and 2d, On assuming the production
and continuance of effects^ without competent causes. Under

1938.] Remarks on Sulphate of Quinine. 403

such circumstances, the quinine may only be expected to act
on some of the effects of the combined predisposing and exciting
causes, so as to produce a metastasis, leaving diseases far more
serious, in their ultimate tendencies, than the primary form; for
the intermittents should be considered the primary form of the
whole train of abnormal phenomena, but the antecedent of those
sequelae, which too often beset the patient, after a cure of inter-
mittent by means only calculated to change Xheform of disease.
But what are the facts to which we have alluded? Forty
years ago, Jesuit's bark and port wine, red bark, Huxham's
tincture of bark ; and, in some obstinate and inveterate cases,
the shower bath, or the ague drop,* were almost wholly relied on
for the cure of intermittents ; and what were the consequences ?
Dyspepsia, with diarrhoea, or obstinate constipation, bilious colic,
cholera morbus, jaundice, chronic enlargements of the liver and
spleen, with general inturmiscence, and a long train of nervous
symptoms, called by the common people, -cachexy- ; and 'cachexy
drinks' were got up in turn for their cure. These were common-
ly made of chalybeates, as sulphate of iron in water, acetate of
iron, made of vinegar and iron, steel dust, scales of iron, &c. in
powder or electuary these, with some diuretic vegetable, when
any oedema was observed, were next administered. This was,
however, often six or twelve months after the primary form of
disease had been changed ; and who then ever thought but that
these were new diseases, entirely new, without the least connex-
ion with any other. It was thought a very hard, though com-
mon case, that a new, and more formidable disease, should attack
the patient so soon after recovery from another the previous in-
termittent. The ' cachexy drinks,' used for these secondary dis-
eases, had generally the effect of giving a little more energy to
the appetite and the digestive powers for a time, which did not
fail to perpetuate confidence in their use, until at length, another
new disease supervened, which was called 'dropsy,' having, like
the former, no obvious connexion with the antecedent series of
evils, and to which the patient was most commonly, after all, to
succomb. It was often impossible that he should withstand

* Fowler's Solution of Arsenic, was, at tiiat time, ague drop, as Uuinine Solu-
tion has since been.

c 3

404 Remarks on SulphateDf Quinine. [Feb.

such a succession of the worst of ills a new one always suc-
ceeding the cure (as he thought,) of the former.

Notwithstanding all this error in the history of disease, and
the pathology too, it was indeed sometimes the case, that this
energizing plan of treating what was called the 'cachexy,' (and
which was nothing more nor less, than the assemblage of those
symptoms which attend chronic visceral obstructions,) was found
to impart such healthy vigor to the system, (as we have said, is
sometimes done by colder climates.) as to enable it, by this re-
newal of its energies, to perform the necessary elimination of
noxious predisposing or perpetuating causes, so as gradually,
but ultimately, to restore the system to good health ; especially
with the help, which was ordinarily looked to, the invigorating
and purer atmosphere of winter. But no old scientific and un-
prejudiced practitioner, can now be found (alas, few have
withstood the practice of those days,) who observed the progress
of diseases forty years ago. but can testify, that he then saw twenty
or more cases of dropsy, from visceral obstructions, where he did
one, ten years ago ! And Bulimia, and its kindred forms of dis-
ease, which were then, almost as common as hernia is now, are,
at the present day, rarely seen, at least, in the same location.
And to what may this comfortable change of the lot of humanity,
in the southern section of country, be attributed ? In order to
answer this inquiry, let us look for a moment at the history of
the pathological and remedial departments.

Thirty yeare ago, calomel, with all its evils, became the com-
mon-place medicine in families; and it was soon the case, that
it was rare to find a family throughout the country, without an
adequate supply ; which, by the way, we should remark, is an
article that ought, elf, and humanity, never to be

administered, but under the sound judgment of a competent
medical man. Bui I vith all its evils, we say,

which were not a littl by the combination of jalap,

being brought inl :e in less-

ening livers and an Dr. Rush's lancet did, in the

treatment of fever in Phila ; and which was indeed, noth-

ing mor?- nor less, than li is This medi-

cine, in lessening, or rather prev< nting, I | ermanent visceral

obstructions, lias likewise prevented their almost certain etfects,

1838.] Remarks on Sulphate of Qui?ii?ie. 405

in all their variety. And the dirt-eater, who was then soundly-
castigated for the correction of this loathsome practice, when
forsooth his father or his physician should have been, is now, if
found at all, speedily cured by a due course of visceral correction.
This is mainly effected by the occasional use of slow mercurial
purgation, and a change of location to an atmosphere less dele-
terious than those which continue perpetually to renew the pre-
disposition to bilious disease.

It will not be denied that bark, quinine, and other tonics, and
counter stimulants, have, in injudicious, as well as judicious
hands, cured bilious fever ; but the cases are rare in which these
cures, if they may be so called, are not followed by more or less
troublesome or dangerous sequelae. But the cases in which
they have not, have, we think, been more common under do-
mestic, than under physician's presumptions: and why, but that
in domestic practice, the solution being looked on as the ague
drop, its use has been often adopted, at the first intermission of
fever ; whilst, on the other hand, the physician was rarely called,
until the force of the disease had been for days impairing more
and more the healthy condition, and functions of particular
organs, and of the constitution generally. Those cases only
will be found to yield to this course, and be followed by good
health, wherein there are good reactive energies, competent,
when the peculiar effects of the exciting cause are removed, to
overcome finally the task imposed I fault of healthy

function, and thereby remove ; predisposition. And

this result will be the more pro! sted by the early

accession of cold weather, removal to colder climates; or a per-
petuation of tonic edect. until this auxiliary is available. But
such is not in I, nor can be the tact, in regular practice,

in safety from secondary diseases, worse than the primary, until
physicians become to be called at the very onset of the disease :
and only then, with energetic 1st it is well known,

that these are not the most frequen cts of this disease, but

the contrary. Let us suppose c of some, or several

of the organic derangements, attached to, and made by some,
the chief nature of biliou . Is it not, according to one

notion, a phlogosis of the both ; or ac-

cording to others, that of the cerebral, or the spinal centre, or

406 Remarks on Sulphate of Quinine. [Feb.

both ? These are contended for by some, as cause, by others,
as concomitants ; and may be more reasonably by others again, as
effects. But as to this, it matters not. Suffice it to say, that some,
or all of these, do often exist with bilious fever, and make a
part of its pathological nature, or condition. How then, can a
direct and powerful tonic be admitted with this nature ? The
stomach will reject it, the intestines will pass it off cathartically,
or it will give headache, vertigo, &c, and aggravate the febrile
and inflammatory actions. But Quinine and other tonics do,
in good constitutions, arrest the progress of the present type of
disease. It, therefore, follows that these local derangements do
not exist, either as causes or concomitants, in the beginning
stages of bilious fever. It is true, that these, or some of them,
do not unfrequently complicate, and give varieties to bilious
fever of any of the usual types: but it follows in course, that
when this is the case, the patient is not a suitable subject for
the tonic treatment, as will be found on experiment ; until
the case is reduced to the simple state of bilious fever, which
primarily existed; or the inflammatory phlogosis, so overcome
as to exert but a local and partial influence, and allow, without
detriment, the general action of the tonic. But these concomit-
ants, or secondary phlogoses, are not all the difficult secondary
lesions, whose natures are opposed to the action of tonics. Ma-
ny others may, and do arise, and there are none so uniform, in
genuine bilious fever, as either a phlogoses, or a functional tor-
por of the liver, and the consequences of either of these on the
spleen, &c. all of which alike forbid the hope of prompt and
permanent benefit from the use of tonics. Indeed, the hydropic
disposition finds here its principal causation ; and here, likewise,
is the origin of most of the chronic nervous derangements.
which so often follow tlie un philosophical treatment of these
febrile diseases.

It will be asked then, how does quinine, or the other tonics :
or cutaneous exciters, as sinapisms, blisters, stimulating embro-
cations to the surface, &c, ever cure bilious fever, if not by sup-
porting the nervous energies, or deriving action from the seat
of phlogosis, to the surface, and so forth ? We will answer, that
they do operate by imparting that energy to the whole system,
or to certain parts, whereby they are enabled to resist the acces-

1S3S.] Remarks on Sulphati of Q

sion of the introductory features of the bilious ; for

it is not the stomach, nor the intestines alone, on nics

act, nor the surface over the spleen, or the epiga: trium alone,
on which the counter-stimulant powei it the wrists, the

legs, the thighs, and many other parts, with equal benefit. So,
also, will a stimulant draught, or an anodyne pill so, likewise,
the cobweb, than which, there is not to be found a surer iuter-
cepter of bilious chill : and these two last, operate on very differ-
ent principles, from simple stimulants and tonics. Again, we
find that mental, as well as corporial impressions, as anx
fear, surprise, anger, joy. and indeed, almost any thing; which
shall counteract the tendency of disordered nature to bring
around her train of morbid actions, may be used with a good
degree of success, for the interception of bilious chill. Bi
this is elfeeted, we have gained nothing but the overcoming the
exciting cause ; the systemin genera!, as well as some particular
organs, being left with all their original predisposition, and that
actually increased bv the past existence of febrile paroxisms.
For when these periodical actions are suspended, every one
knows how easy it is, by subjection to the action of debilitating
causes, at the period for the bilious chill, or even at some other
period, to cause its return.

A close observation of nature should be sufficient, whether
it have the effect or not, to convince the most skeptical of this
one fact, that there is a bilious chill, and a bit ions fever, of char-
acter, type, and nature peculiarly their own. These peculiar
characters should be familiarly understood by every practitioner.
They are effects in direct and proportionate relation with the
several causes concerned in their production, and like all other
effects whose removal or prevention is desirable, call for reme-
dies which are in good proportionate relation, in power and kind,
with the noxious causes. This view cannot fail to reveal the
nature of the deficiency which attached to the plan of cure
above examined. We have seen that its tendency was at best
only calculated to bring back the system to its state previous to
the effects of the exciting cause leaving it, however, with its
predisposition, aggravated by febrile paroxism. Here then is
the great error ; the obvious symptoms which certify plainly the
existence of disease are overcome, but a fatal predisposition is

tlphate of Quinine. [Feb.

still I thus increased, to work out its disordering influ-

nidation. The resulting phenomena will vary
as exactty ir; proportion to the unity or the combination of mor-
bid force; , the production of then- effects, as in the direction
o' moving body from a single force, or a combination of for-
,; as m a ehemical process in which sub. super, and neu-
tral salts vary m proportion to the proportionate relation of the
influencing , or as a tripple sak m(]st be ^ ^ q{

certain otheK additions to the causation. In the first of these
illustrations, if the single force be allowed to operate, the body
ilfed thereby will move in a direct line wit!, that force any
rceptmg means must then :::so in this same direction

Mt te,nds U <j teaHy different from those resulting from

coummat.ons of .iUj in ,Jl0 other illuEtrJion ,

S ' Sl'rei'n a metallic salt will differ in its

ln,m'Ca 01 rencies, according to the circumstances of

the coml : and ail these, again, vary exceedingly in their

T,fSUhmS P! ' from t!ie chemical or physical powers of

'b'ple elem mts of which thev were composed. The acids
i or metals, have their own appropriate phe-
nomena proportionate, in kind and extent, with their powers as
ad their effects and to intercept their powers, then
we may look lor brent phenomena, and meet them with

agent, winch bear a reasonable relation to the natures of the
'a,!': e expect to correct an alkaline element

' n;l alkal,ne aSent, merely because it would neutralise the
d in the formation of a salt with that alkaline ele-
' that the treatment peculiarly adapted to the
ting cause, must correct also the predispos-
ing- Ls the alkali, in this case, uncorrected, would continue to
7":v' ; :li ^<* "> <"' the future chemical process, without
t..e iimuence of its proper corrective, so does the predisposing
cause of fi ver continue to work out its peculiar phenomena
which are only correctable by proportionate means. The pre'
d,Sr';':'";,!; * correction, as well as the exciting

I the cure is incomplete, and never effected, unless by
"P """'< <>f nature, if this be ,|. And here is the

pla<e for expec.anusm. When it is clearly evident that the
tircesol the system are sufficient for the correction of the

1S3S.1 Remarks on Sulphate of Quin

morbid predisposition, tliis correction may be left tl
no less sound judgment is necessary in determining this ]
than in determining the use of mercury or of arsenic, for it is
not less dangerous to leave a work for nature to perform, out of
proportion to her powers, than it is to give a powerful :
not proportionate to the exact demands of the case. But when
it is not clearly evident, that the system is capable with its
own resources to he entrusted with the correction of predis-
position, it should of course not be more readily confided to
than to any other inefficient agent. Nor is it so often (he case
as the friends of expectantism may be inclined to think or to
hope. This truth is evident, not only in the observations of
nature in such cases, but it may be logically established with
great precision, thus: 1. Here is a given human system in
health, consequently in possession of all its natural physical and
moral endowments. 2. Here are predisposing causes of bilious
disease. 3. Here remark that, notwithstanding the primary
good health in all respects, predisposition or a predisposing state
of the system supervenes, proving the power of this cause to
invade fhe system in defiance of all its vires naturae medicatrices
in full perfection. 4. An exciting cause is applied, and the
phenomena of a bilious fever developed, as the legitimate result
of the action of these causes in the system. 5. The influence
of the exciting cause is overruled by a powerful tonic, as qui-
nine, steel, arsenic ; leaving the system with its predisposition
actually aggravated by the existence of febrile paroxism ; or, if
you please, without this aggravation. In the sixth place we
will ask, how, if the law be true, which nobody disputes, that
similar causation in all respects must be followed by like results.
how, we ask, if these things be so, can it be possible for the
resources of a system the vires medicatrices, undoubtedly im-
paired by the actual invasion of disease, effect the final extermi-
nation of a cause whose invasion it could not. with all the
advantages of fine health, prevent? As well might we expect
the physical resources of a country might conveniently expel
her invaders from her centre, after being beaten down and pros-
trated by their superior force, when, with all preparation, and in
the fullness of her powers, she could not at first repel the inva-
sion. But if she form allies of sufficient power, she may be

410 Remarks on Sulphate of Quinine. [Feb.

expected to effect the expulsion, and restore the commonwealth
to peace and safety. Just so is the reasoning in the case of the
predisposition. Remedies only which can measure powers with
the invader, will be able to secure the desired renovation of
perfect health: whether they be such as shall increase the natu-
ral energies permanently, and lessen the application of predis-
posing influences, as winter, a better climate. &c, or such
as shall more directly attack and exterminate the enemy by a
physical force competent to the end desired.

We will remark here, in conclusion, that periodical hemorr-
hage, as here related to. is an accident, so far as its cause is con-
cerned, of the same nature as topical congestion ; and is indeed,
nothing more nor less than the effect of topical congestion in the
part whence the hemorrhage comes, which is a part easily re-
lieved by spontaneous topical depletion; or in some more distant
part which cannot be thus relieved, but which determines an
unusual afflux to the part which becomes the seat of hemorr-
hage. Its cause is, therefore, the same with the cause of conges-
1 ions, infarctions or engorgements of the spleen, stomach,
intestines, and the parts generally whence the portal branches
originate, as well as of the great nervous centres. These,
however, are, like the hemorrhage, secondary, and have gener-
ally for their cause, obstructed hepatic circulation, with conse-
quent induration and tremefaction of liver and spleen fruitful
sources also, of those gastric and intestinal inflammations,
which have received the names of gastrite and interite, so
commonly believed to arise in bilious pyrexiae ; as well as the
spinal congestion and irritation, which affords such a distressing
variety ol* neuralgic symptoms.

These hemorrhages are generally from the nose, lungs, stom-
ach and intestines, hemorrhoidal regions, or the uterus. These
parts are easily relieved temporarily, by spontaneous depletion.
Not so with the spleen, mesentery, spinal and cerebral cen-
tres, &c. Now, we consider all these caused by an unusual
determination to, or retention of blood in them, in conscqence of
some obstruction to its wonted and important circulation through
some other parts of its route. The primary seats of dangerous
obstructions, are generally theliver andthe uterus. This brings
us to the point we had in view. No one will contend that

1S38.] Report on the Radical Care of Hernia. 411

Quinine is possessed of those deobstruent powers, which should
justify our trusting to its operation for the removal of these
primary visceral, or organic obstructions now to become, unless
removed, the cause of numerous sequelae, such as congestions
in various parts, with or without irritations, hemorrhages, lym-
phatic obstructions, &c. What then, we would enquire, is it
calculated to do 1 Only, at best, by meeting the demands of the
exciting cause of that state, with some energising influence, to
change the periodic exacerbational tendency, and thereby check
t n prj33it for/n )f t n.l:>)i^ ; and leave caii3S3 present, and
still in operation, to prod ice their more serious effects, on other,
more vita!, and less relievable parts. Hence then, a dread-
ful train of afflictions too often follow, not all in the same case,
but some of them sooner or later, in almost all thus treated;
amongst which, we may name hemorrhois, fistula, follicular
ententes, bronchitis, dyspepsia, constipation, diarrhoea, colic,
hepatic derangements, with all their consequents; spinal irrita-
tion, with all its numerous afflictions and mischiefs, &c.

PART II.
REVIEWS AND EXTRACTS.

Report on the Radical Cure of Hernia. Extract from the Mi-
nutes of the Philadelphia Medical Society. April 29th) 1S37.

The valuable paper above named, is contained in the Amen
can Journal of the Medical Sciences, for Aug., 1837, and should,
injustice to its merits, have been noticed last year ; but we have
rested in the hope of being able to see a specimen of the im-
provements of Dr. Chase, that we might exercise a closer judg-
ment on their merits, than we could by merely reading the
n 4

412 Report on the Radical Cure of Hernia. [Feb.

several reports, and Dr. Chase's book on the radical cure of
Hernia. We regret that although we have made no inconsidera-
ble effort to effect that end, even to the present time, the truss of
Dr. Chase has not, so far as we arc able to learn, reached the
shores of Georgia. Dr. Chase's treatise on the radical cure of
hernia, with a valuable essay by the same gentleman, which
appeared not long since in this Journal, intended to guard
against ^ho abuses of the truss, together with the preliminary
report of the committee of the Philadelphia Medical Society
afforded satisfactory evidence of the valuable talent concerned
in the improvements and the examination of the same. And the
final report, the document now before us, is as satisfactory and
conclusive as couM be desired; still, in noticing the article, we
have hoped to be able to speak from observation, in addition to
the extensive and satisfactory evidence of the worthy committee,
on the subject of this valuable improvement. We feel unwilling,
however, longer to delay laying before the profession, a brief
notice of its merits, as contained in the final report of the patient,
persevering, faithful and talented committee.

It will be recollected, that as lon^f asm as the session of the
Philadelphia Medical Society in December, 1834, Drs. Coates,
Parish and Ashmead were appointed a committee for the
investigation of the merits of Stagner's Truss, and other
proposed means of radical cure of hernia. This committee
have faithfully labored in the premises, with experiments and
observations on numerous cases in point, until the 29th of last
April ; an instance of persevering zeal, industry and faithfulness,
highly creditable to the gentlemen who compose it, and meriting
the obligation of the community. After laboring one year in
the discharge of the duties assigned them, they read a partial,
or preliminary report to the society, at the sessions of the 5th and
12th of Apri', 1835.. This preliminary report was published
in the xvii. vol. ofthe American Journal of the Medical Sciences.

In this preliminary report, aluahle conclusions were

arrived at, which were all important; for the investigations seem
to have been pursued with great care and accuracy, and the con-
clusions not hastily drawn. Amongst the most important of
them, we will name the following:

1. -That the nn-t ;< apparatus, is that which

affords the strongest probability of radical cure; and that long-

183S.] Report on the Radical Cure of Hernia. 413

continued or considerable irritation in the parts, 'as contended
lor in the use of Stagner's truss,' so far from being an advan-
tage, in reality, opposes the successful treatment; that there are
no tacts in 1 >n which tend to prove indisputably,

that even slight irritations of the superficial tissues are trans-
mitted to th of the abdominal muscles in such a man-
ner as to accelerate the cure ; and that radical cures are some
times effected without any other irritations than such as are
altogether fugitive in character."

2. "That the retentive power of .solid blocks exceeds, cceteris
paribus, by considerable difference, that of pads composed of soft
materials."

To this, the final report adds, that " The whole current of
the evidence since presented to them, most fully substantiates
the corrrectness of this position ; as the number of cases has
been large in which the various instruments with soft pads,
have failed in effecting1 accurate and permanent retention, and
in which the more perfect apparatu leeks of proper form,

have been substituted with complete cuccess."

The committee have demonstrated, in their various investjga-
gations, the impropriety of substituting even "firm, but elastic
materials, for the absolute solids in the construction of the arma-
ture of trusses: and the inadmissibility of caoutchouc, as a
direct and permanent application to the skin," they consider as
established by the well known fact, that "the irritating effects
of this substance are so well known in the neighborhood
of the caoutchouc cloth manufactory near Philadelphia, that it
is extensively employed there, as a popular remedy in cases of
chronic rheumatism."

We remark, in passing, that this observation, relative to the
fact of the irritating powers of caoutchouc, having brought it
into popular use as a remedy in chronic rheumatism, is a valua-
ble corroborative of Dr. Chase's essay on the caoutchouc as an
endermic application for the purpose of counter irritation.*

Excluding much of their investigations from the report, by
their conclusions, that the most retentive means offered the best
promises of cure; and that absolute solids offered the best arma-
tures for effectual retention, the committee next proceed to
consider onlv "the r rith solid blocks, now in use or

recommended by inventers." These, they divide into twa
classe

9outhera Medical urnal, vol i. p 663

414 Report on the Radical Care of Hernia. [Feb.

"1. Those which are constructed for the express purpose of
producing irritation, in order to effect a condensation of the skin,
cellular tissue, and the fascia supreticialis, or the abdominal ten-
dons about the hernial orifice, into one common mass of adhe-
sion."

" 2. Those which are designed to secure the constant, perfect
and safe retention of the bowel, without the attempt to create
intentional irritation in the parts pressed by the instrument."

"The first class includes the truss of Stagner, and the various
apparatus of Dr. Hood, for the treatment of common inguinal,
ventro-inguinal, femoral and umbilical hernia; also Price's
and Sample's improvements, of conoidal truss-biocks of lead,
tin, and other metals."

" The second cla=s contains the old and well known instru-
ment introduced to the notice of the society by Dr. Perrine,
during the debate which followed the presentation of the prelimi-
nary report, in 1335. Tne specimen presented to the society
was armed with a wooden block; and since making their pre-
liminary report, the committee ascertained the fact, of which
they were not before assured, that thj, wooden block had been
in use twenty years, and probably for a much longer period
before its improvement by Mr. Stagner. This class also
embraces all the instruments invented by Dr. Chase, which are
five in number, it will be spoken of in detail hereafter."

"The arguments of the committee on the first of these classes,
naturally arrange themselves under two heads. 1st. Comments
upon the supposed establishment of adhesive inflammation; and
2ndly, an estimate of the retentive power of the apparatus."

On the first of these topics, the committee, after many, patient,
and fair experiments and observations, necessarily conclusive in
their nature, came finally to the following unavoidable result?
that they "feel compelled to regard these facts" (their own
experiments and observations.) "as conclusive against the truth
of the doctrine, that the trusses, or blocks of the first class
produce a real condensation of, or adhesion between the skin,
the sub-cutaneous cellular tissue, and the fascia snperficialis, or
abdominal tendons." They "therefore entertain decidedly the
opinion, that the hypothesis of condensation and adhesion is
mtenable."

On this subject, the committee go further ; and being, very
properly, unwilling to give heresay evidence, they give an in-
stance which came under their own observation, (case xii,) veri-
fying their fears that the continuance of the pressure of this

1838.1 Report on the Radical i Urmia. \\

first class of trusses, might endi itegrity of the tendons

themselves. In this case, this result had actually taken place;
and the patient was still, at the time of the 6nal report, under
treatment for this serious misfortune. While the bowel is,
however, perfectly retained by one of Dr. Chase's large ventro-
inguinal trusses, time alone can determine the ability of the
the tendons to recover their original structure.

The committee next '-proceed to examine the retentive power
of the trusses of the first class, so far as this subject remained
unfinished in their preleminary report ; alledging, at the same
time, that whatever of retentive power trusses of this class may
possess, to it alone is attributed the good attendant on their use.
This brings us to the 2nd, and last head under which the argu-
ment on the first class of trusses was arranged.

For the purpose of testing the retentive power of this class pf
trusses, the committee have again labored with great patience,
fairness and perseverence, alt of which, together with their rea-
sonings on the subject, result in the following conclusions:

" 1st. That the trusses of the first class d o not secure the
complete permanent retention of the bowel with all the certainty
which may be obtained by mechanical means/'

"2nd. That although it is extremely probable that radical
cures may be occasionally effected by the use of such instru-
ments, it has not been proved that the success following their
employment, exceeds that which has been obtai the better

kinds of trusses previously in use."

"3rd. That the action of these instruments is orten attended
with serious and unnecessary inconvenience, uneasiness and
pain," and

"Lastly. That their employment for too long a time, when the
degree of pressure exerted by them is considerable, sometimes
produces absorption of the tendons, dilatation of the hernial
orifice, and an extension ot the evils they are designed to re-
move; and that any attempt to obviate this danger, while the
support of the instrument continues to be required, will diminish
the security of the retention."

From all which reasons, the committee do not feel warranted
in making a favorable report on the claims of this class of trusses,
upon the confidence of the society.

Eberle's, or the Rachet truss having been examined with
the first class, the committee next pass to the only remaining
part of their duties, which is the consideration of the six instru-
ments of Dr. Chase.

4 10 Report on the Radical Cure of Hernia. [Feb.

In considering Dr. Chase's trusses, which make up the whole
of the second class, the committee commence with setting forth
their alledged claims.

"The object of these instruments is to secure the perfect and
permanent retention of the viscera in hernia, in order to permit
the powers of nature to effect a radical cure, after the removal
of the misplaced parts, which are supposed to offer the greatest
obstacle to her success."

They then proceed, in the first place, to investigate "how far
they fulfil the all-important purpose of retention; leaving their
effects upon the tissues, the modus operandi of nature in effect-
ing the cure, and the extent of the results to be discussed in the
sequel under distinct heads, which they subsequently proceed
to do in the most thorough manner.

"The inventions and improvements of Dr. Chase, many of
which have been adopted since the presentation of the prelimina-
ry report, extend to all pares of the truss and its appendages ;
and his attention to minute, but highly important details, has
been carried to an extent, never equalled by any of his predeces-
sors in this branch of surgery. The complete instruments em-
ployed by him, are 1st. The inguinal, or common inguinal
truss. 2nd. The ventro-inguinal truss. 3rd. The femoral
truss. 4th. The umbilical truss. 5th. The umbilical belt. 6th.
The double truss."'

To each of these a separate section is given, in which each
partis particularly considered, viz : The block ; the block at-
tachment : the spring and strap-attachment ; and the appenda-
ges, and all illustrated by wood cuts. After duly explaining
every part of the inguinal truss of Dr. Chase, the committee
have been pleased to say, that they

"Feel bound honestly to state their convictions, that this in-
strument surpasses all others known to them, in the accuracy
and permanence of its retentive power in common inguinal her-
nia; a conviction fully sustained by all their practical observa-
tions on the action of trusses. The instrument is worn with so
much comfort, that patients generally relinquish it unwillingly,
and sometimes absolutchj refuse In do 80, even when pronounced
well by the surgeon. The committee find themselves unable
to suggest any improvement, or to point out any defect of prin-
ciple or construction in this truss, as now employed by the
in venter."'

Of the Ventro-inguinal Truss of Dr. Chase, they say:

"To the complete instrument, as it has been actually employed

1S3S.] Report on the Radical Cure of Hernia. II

during the last year, the committee may safely apply the same
language used in concluding their remarks on the inguinal
truss."

Of the Femoral Truss. The committee having been very
limited in their opportunities of testing its value, are not pre-
pared to say much definitely on its absolute perfection. "How
far it may answer the special purpose of its construction, by
entering under the fold of poupart's ligament, and acting almost
directly on the femoral ring, the committee will not venture to
judge from a single case. The report of Dr. Chase as to its
result in other instances, is favorable ; but neither that gentle-
man, nor the committee, regard it as having acquired the highest
degree of perfection of which it is capable."

Jt is expected to undergo farther modifications.

Of the Doublk Truss, the committee presented a new article,
the invention of Dr. Chase since the preliminary report, and
now for the first time laid before the society.

" It is an association of two single trusses, so combined as to
be perfectly independent in their action, without the slightest
interference ; yet so associated by means of the straps and loose
spring covers, that they present the appearance, and act with all
the convenience of a single instrument. * * * The com-
mittee cannot speak too highly of this beautiful invention, but it
may be safely permitted to speak for itself."

Of the Umbilical Truss. "This truss has secured the
perfect and constant retention of the bowel in all the cases seen
by the committee, two of which were of a peculiarly unfavora-
ble character."

u The committee deem it, therefore, almost unnecessary to
state their decided preference of this instrument."

The Umbilical Belt. The committee concluded their
brief observations on this instrument in the following words:

"In condemning the umbilical belt of Dr. Chase, together
with all its predecessors, the committee feel much pleasure in
stating that after practical tests, which they did not deem neces-
sary, it has been frankly relinquished by its inventor, although
it has effected radical cures in two cases. (See cases xx. and
xxix.)"

In concluding their comparison of the two classes of trusses,
and after amply testing the actual merits of each, they

"Deem any further comment on the retentive power of the
trusses of the second class (made up of those of Dr. Chase,)

418 Report on the Radical Cure of Hernia. [Feb.

altogether unnecessary. These instruments certainly fulfil to
admiration the two grand requisites winch they consider neces-
sary to bring the chances of radical cure of hernia to a maxi-
mum.*'

"After all that has been stated, the committee feel themselves
fully warranted in the following conclusions :

"1. The retentive power of solid blocks is. cateris j?aribus,
superior to that of soft pads in the treatment of hernia, as has
been already stared in the preliminary report.

"2. The chances of radical cure depend upon the perfection
and permanence of the retention.

"3. The perfection and permanence of the retention depend
first, upon t.ie mechanical action of the instruments; and, se-
condly, upon the power of the parts affected to hear that action
without danger of physiological accidents of suliicicnt import-
ance to interfere with the treatment.

"4. Ail the instruments with so.id blocks contrived before the
recent inventions of Dr. Chase, are decidedly liable to import-
ant mechanical objections, and ail of them, with the exception
of the Iiaehet truss, are moreover capable of producing physio-
logical accidents ot sufficient impoitance to interiere with the
treatment.

"5. The construction of the Rachet truss is such as to render
retention uncertain even in veatro-i 1 ruinal hernia, to which
form of the disease alone, it is tolerably well adapted.

" 0. The instruments of Dr. Ciia.se have elfected the perma-
nent and accurate retention of the intestines in every case of
hernia observed by the committee, without material inconven-
ience to the patient, and often under trials more severe than are
usually ventured upon by those who wear other trusses ; trials
which would be imprudent witli any other apparatus known to
the committee.

u7. If we except the femoral truss, these instruments have
stood the test of much practical application without superindu-
cing any physiological accidents of sufficient importance to in-
terfere with the treatment.

"8. The mechanical principles upon which the femoral truss
^constructed appear highly ingenious and promising, and unless
this instrument should he found hereafter to be productive of
important physiological accidents, it must take precedence of all
other modes of treating this variety of the disease. No such ac-
cidents arc vet known to have been produced by its employ-
ment ; but the committee have not. enjoyed the opportunity of
personal inspection in a sufficient number of cases to determine
general results, nor do they deem it proper to receive evidence
from any other quarter in discharging the trust reposed in them
by the society."

1838.] Report on the Radical Cure of Hernia. 419

The committee, on this important subject, consider

"A cure is radical, when the tendinous and fascial barriers to
the egress of the bowel are brought or restored to their normal
or original firmness and power of resistance. The only means
by which such a result can be tested, are the firmness and resis-
tence of the orifice when placed where it is subject to examina-
tion, and the absence of all appearance of protrusion after the
truss has been relinquished for some weeks or months, and after
the patient has pursued his usual avocations, resorting frequently
to more severe exercises, such as coughing, leaping, fatiguing
walks, swimming, lifting, dancing, riding on horseback, &c."

" The time required ibr the radical cure of an ordinary case
of ventro-inguinai or direct hernia, in the adult, appears to be
from twelve to eighteen months. The common inguinal hernia
is believed to become secure at an earlier period, and the umbi-
lical, later; all varieties, however, recovering much more rapidly
in childhood, in which cases the committeee have found, since
their preliminary report, and contrary to the opinion then ad-
vanced, that this class of trusses is "borne without inconven-
ience in infancy."

We have but one regret on the subject of this report, and that.
is that it is not in our power to give it entire ; for it is so fair,
conclusive and well drawn up, we feel that scarcely can a
sentence of it be omitted without withholding something valua-
ble from our readers, and doing injustice to the commitlee.

We cannot now take our leave of it, however, without giving
two or three more of the latter paragraphs entire. It wiil be
remembered that the great object of the late improvements in
this department of surgery was to effect radical cures in these
cases, without resort to the knife. After all, then,
the improvements must be determined by their practicability,
their safety and their unequivocal success. It should be
borne in mind that time, considerable time, only can deVel
the final success. The following paragraphs give us the re-
sults of the practice, so far as they could be accessible to the
committee.

"A variety of causes have tended to reduce the number of
cases in which the whole history of the accident, the treatment,
and the result have been placed within reach of the committee.
Among the most important of these may be mentioned the ex-
treme unwillingness of many patients to relinquish the use of
the truss, even when urged to do so by the united advice of their
surgeon and the members of the committee ; the removal of many
i. 5

420 Report on the Radical Cure of Hernia. [Feb.

patients to a distance, alter having been a long while under
treatment, but before it has been deemed perfectly sale to lay-
aside the instrument; and the unwillingness of some persons to
submit to the necessary examinations ; yet, notwithstanding
these difficulties, the amount of indubitable evidence actually
furnished on the question of radical cure has been considerable,
though none has been relied upon as basis for conclusions, ex-
cept such as has been furnished by the actual examinations of
one or other of the members of the committee, and the testimony
of the patients themselves.

VII the individuals who have relinquished the use of the
trusses approved by the committee, after having worn them for
six months or more, and who have been afterwards examined
by a member, or members of the committee, have been subjected
to the necessary tests, and are believed to be radically cured in
Ike sense of the foregoing definition. A still larger number
who are yet under treatment, give promise of a similar result,
and those who refuse finally to'relinquish the instrument on the
advice of their surgeon, present, in the firmness of the rings, and
in the absence of protrusion under exertions performed when
the trusses are temporarily removed, very strong grounds for
believing the cure to be radical in them also. Two cases only
of old ventro-inguinal hernia, occuring in persons of nearly
sixty years of age, and so large that the orilices admitted of the
free passage of two or more lingers within the reverted skin,
have been deemed incurable ; but even in these, the contraction
of the rings, and the resistance to protrusion when the trusses
have been removed by the patient for a few hours, render the
impossibility of cure by no means certain : and it is deemed
improper ever to subject the patients to the tests necessary to
determine the question.

\n appendix follows the report, detailing upwards of thirty
cases. Case xix in this appendix, which is an umbilical hernia
of many years standing; enormous orifice, is completely retained
by CfffSE's umbilical truss, with a block six inches indiamater.
This patient is restored to usefulness, but is deemed incurable."

Finally,it is d< clared, that "the cases observed include all the
usual forms o Lai hernia, whether resulting from mechani-

cal or ph; i! cjiuses: and also, some instances of double

and triple hernia."

1838.] Electricity. 421

Human Electricity.

Wc extract the following narrative, extraordinary in degree,
hut not in kind, from Silliman's Journal for January, 1838,
with the fullest confidence in its truth. We arc aware that
the statement of Dr. Hosford will be looked on, by many
who are at a distance from him, as a hoax, or at least as an ex-
;e ration, or an unfair narrative of facts : nor do we suppose
that Dr. Mussey's statement will have the power of wresting
it from the fate of skepticism with some readers. In their full-
ness of pride, human beings are wont to disbelieve, especially in
philosophy and religion, that which they do not understand.
This is the case to almost as great an extent as the disposition to
disbelieve whatever is counter to their party views or their pre-
viously avowed notions. We know nothing of Dr. Mussey but
his character as a professional man : the same may be said of
Dr. Hosford. Professor Silliman, all the world know to be,
in literature and philosophy, amongst the stars of the first mag-
nitude. But, we are told that he is so credulous as to be very
susceptible of tricks of imposition. Perhaps he may be. Hon-
est men, and men of profoundest science, do often become so fa-
miliar (so to speak,) with the wonders of nature, that, with the
predisposition their own honesty gives them, it becomes easy to
believe there aie still things which their own intellects can
neither analyze nor comprehend. It is the effect of profound
knowledge to humble the heart and generate reverence for that
matchless wisdom which is found displayed in the heights and
depths of Nature's domain: and to teach this truth, which seems
to be neither known nor believed by all, that neither the know-
ledge nor the comprehension of all things is yet given to man.
It is a very small part of the great golden rule of virtue which
requires that we should do unto others as we would that they
should do unto us," to consider all men honest until found other-
wise all men true, until proved false. But. there arc other
grounds for credence in this case. When human evidence which
we should not dare to doubt in other matters is afforded, our
own want of powers to analyze the subject, is no justification of
our skepticism.

Electricity. [Feb.

-

We are not content with less. than an entire extract of the

ment made by Dr. Willard Hosford, at the instance of

Professor Sjlliman : with the preliminary remarks of the latter

gentleman, from the American Journal of Science and Arts, for

January, 1S3S, page 394.

Extraordinary case of electric excitement, with preliminary
arks by the Editor. The facts stated below were, by my
request, kindly communicated for this Journal by Dr. Willard
Hosford, a respectable physician of Orford, New Hampshire, the
place where the occurrence happened. Being in that place in
September, and finding the belief in the facts to be universal,
particularly on the part of persons of judgment and science, (as
at the neighboring University, Dartmouth, at Hanover, eighteen
miles south,) I became desirous of preserving a record of them.
Dr. Hosford remarks in the letter accompanying his commu-
nication, that abundant evidence from the most intelligent per-
il; hand for the support of every point in the case. He
( also, that the appearance of the aurora during which

rical excitement of the lady took place, "was precisely
the Jame as that described by some gentlemen at New Haven."'
of it Dr. Hosford adds, that "the heavens were
i a crimon aurora of such uncommon splendor, as
no ordinary emotions in every observer, and we had,
in addition, an electrical exhibition much less daz-
ig, but more singular and to the parties concerned more in-

A lady of great respectibillity, during the evening of the 25th

of January. 1837, the time when the aurora occurred, became

Suddenly and unconciously charged with electricity, and she

hibition of this power in passing her hand over

brother, when, the astonishment of both, vivid

passed to it from the end of eacli finger.
immediately mentioned, but the company were
that each in succession required for conviction, both
and feel the spark. On entering the room soon afterward,
I'the company was not sufficient to coh-
fact until a spark, three fourth of an inch long,
nuckle to my nose causing an involun-
tary recoil. This power continued with augmented force from
i of January to tl f February, when it began to

;iin< t by the middle of May.

ted during sonic days was
nt hours were often mark-
red, that under favora-
tanees, f] i January to the first of the

following April, there was no time i hen the lady was incapi ble
of yielding electrical sparks.

L838.1 Electricity. 423

The most prominent circjBftnstances which appeared to add to
her electrical power, were an atmosphere of about 80 Fah.3 mo-
derate exercise, tranquility of mind, jind. social enjoyment;
these, severally or combined, added to her productive power,
while the reverse diminished it precisely in the same ratio. Of
these, a high temperature evidently had the greatest effect,
while the excitement diminished as the mercury sunk, and dis-
appeared before it reached zero. The lady thinks fear alone
would produce the same effect by its check on the vital action.

We had no evidence that the barometrical condition of the
atmostphcrc exerted any influence, and the result was precisely
the same whether it were humid or and.

It is not strange that the lady suffered a severe mental pertur-
bation from the visitation of a power so unexpected and undesir-
ed, in addition to the vexation arising from her involuntarily
giving sparks to every conducting body that came within the
sphere of her electrical influence : for whatever of the iron stove
or its appurtenances, or the metallic utensils of her work box,
such as needles, scissors, knife, pencil, (fee. &c. she had occa-
sion to lay her hands upon, first received a spark, producing a
consequent twinge at the point of contact.

The imperfection of her insulator is to be regretted, as it was
only the common Turkey carpet of her parlor, and it could sus-
tain an electrical intensity only equal to giving sparks one and
a half inch long ; these were, however, amply sufficient to
satisfy the most skeptical observer, of the existence in or about
her system, of an active power that furnished an uninterrupted
flow of the electrical fluid, of the amount of which, perhaps the
reader may obtain a very definite idea by reflecting upon the
following experiments. WJren her finger was brought within
one sixteenth of an inch of a metallic body, a spark that was
heard, seen, and felt, passed every second. When she was seat-
ed with her feet on the stove-hearth (of iron) engaged with her
books, with no motion but that of breathing and the turning of
leaves, then three or more sparks per minute would pass to the
stove, notwithstanding the insulation of her shoes and silk hosie-
ry. Indeed, her easy chair was no protection from these incon-
veniences, for this subtle agent would often find its way through
the stuffing' and covering of its arms to its steel frame work. In
a few moments she could charge other persons insulated like
herself, thus enabling the first individual to pass it on to a se-
cond, and the second to a third.

When most favorably circumstanced, four sparks per minute,
of one inch and a half, would pass from the end of her finger to
a brass ball on the stove: these were quite brilliant, distinctly
seen and heard in any part of a large room, and sharply felt
when they passed to another person. In order further to test

44 Electricity. [Feb.

the strength of this measure, it was passed to the balls by four
persons forming a line; this, however, evidently diminished its
intensity, yet the spark was bright.*

The foregoing experiments, and others of a similar kind,
were indefinitely repeated, we safely say hundreds of times, and
to those who witnessed t\ie exhibitions they were perfectly satis-
factory, as much so as if they had been produced by an electrical
machine and the electricity accumulated in a battery.

The lady had no internal evidence of this faculty, a faculty
sui generis; it was manifest to her only in the phenomena of its
leaving her by sparks, and its dissipation was imperceptible,
while walking her room or seated in a common chair, even af-
ter the intensity had previously arrived at the point of affording
one and a. half inch spar)

Neither the lady's hair nor silk, so far as was noticed, was ever
in a state of divergence : but without doubt tins was owing to
her dress being thick and heavy, and to her hair having been
laid smooth at her toilet and firmly fixed before she appeared
upon her insulator.

As this case advanced, supposing the electricity to have
resulted from the friction of her silk, I directed (after a few
days) an entire change of my patient's apparel, believing that the
substitution of one of cotton, flannel, &c. would relieve her from
her electrical inconveniences,! and at the same time a sister,
then staying with her, by my request, assumed her dress or a
precisely similar one ; but in both instances the experiment was
an entire failure, for it neither abated the intensity of the elec-
trical excitement in the former instance, nor produced it in the
latter.

My next conjecture was, that the electricity resulted from the
friction of her flannels on the surface, but this suggestion was
soon destroyed when at my next visit I found my patient, al-
though in a free perspiration, still highly charged with the
electrical excitement. And now if it is difficult to believe that
this is a product of the animal system, it is hoped that the skep-
tics will tell us from whence it came.*

In addition to the ordinary appurtenances of a parlor, it may

It is greatly to be regretted that the spark had not been received into a Leyden
bottle until ii u ould accumulate no longer, and then transferred to a line of persons
to receive the shock. Ed.

tThis could hardly have been expected from non-conductors; we are informed
thai the lad) was relieved of the electricity by a free communication with the earth
l.\ a ;u>><! conductor, iii the manner of a lightning rod, as by touchingthe stove and
inaction with the earth through the medium of the chimney. Ed.

t It appears to be Dr. Bo&jford's opinion, thai the electricity was not caused by
the aurora thai was coincident with its first appearance, but that it was, in
way, an appendage ofthe animal yst m. Ed.

1S38-] Electricity.

be proper to add. that the lady's apartment contained a beautiful

cabinet of shells, minerals, and for< ign curiositii

This lady is the wife of a very respectable gentleman of this
place; she is aged about thirty, of a delicate constitution, nerv-
ous temperament, sedentary habits, usually engaged with her
books or needle-work, and generally enjoying a fine flow of spir-
its.

She has. however, never been in sound health, but has seldom
been confined to her bed by sickness even for a day.

During the past two years she has suffered several attacks of
acute rheumatism, of only a few days continuance, but during
the autumn, and the part of the winter preceding her electrical
development, she suffered much from unseated neuralgia in the
various parts of her system, and was particularly affected in the
cutis vera, in isolated patches ; the sensation produced being
precisely like that caused by the application of water heated to
the point a little short of producing vesication ; in no instance,
however, did it produce an apparent hyperemia, but about the
last of December a retrocession took place of this peculiar irrita-
tion, to the mucous membranes of the fauces, oesophagus, and
stomach, there producing a very apparent hyperemia, and at-
tended, during the exacerbations, with burning sensations that
were torturing indeed ; and it was for the relief of these symp-
toms that medical means were used, but it was found no e
matter to overcome this train of morbid action.

It was nearly immaterial what medicines were used ; no per-
manent relief was obtained, and no advantage resulted from the
use of the alkalies, or their varied combinations. In a few in-
stances, a dose of the acetate of morphine w to secure a
night's rest, but she seldom made use of an anodyne.

The effervescing soda draught being very acceptable was freely
given from which, in addition to a rigid system of dietetics, the
influence of the opening spring and the vis medicatrix naturae,
relief came of her electrical vexations, of most of her neuralgia,
and other corporeal infirmities, and to this time, a much better
state of health has been enjoyed than for many years.

Orford, N. H., Nov. 16, 1837.

The only strange fact in this case, is the coincidence (for we
consider it nothing more) of the first displays of unusual electri-
cal developments in the person of the lady, and the occurrence
of the Aurora Boreal is. The Aurora Borealis we well remem-
ber, as its beautiful displays were very obvious at this place.
It was remarkable for its conspicuousness thus far south ; but
we hold it impossible that the electricity afforded by the lady
could have been owing to a charge from that electrical phenom-

426 ctricity. [Feb,

enon. It is a cause constantly occurring without the production
of such effects : it is also a cause perfectly incompetent to
their production, as is evident to any one familiar with the
most, common laws of electricity. A charged prime conduc-
tor, or a powerful electrical battery, would have been incom-
petent. The phenomena clearly evince that the source of the
electricity displayed was within the body. AVe are surprised
that Professor IS i lliman did not give an unequivocal decision
on this point instead of stating in a foot note that Dr. Hosford
thought "that it was, in some way an appendage to the animal
system/7 But great men are sometimes rather scrupulous of
giving their own opinions on points, for the proper reception of
which they think the world is not fully prepared. They are
generally afraid to venture their belief in a fact, the rationale of
which they may not be fully prepared to set forth. Such has
been the case with many : ii is indeed generally with men who
wish to be considered philosophers. AVe believe this to have
been the case with M. Dupuytren when, on a certain occasion
not long after the free introduction of acupuncture into France,
lie introduced fifteen or sixteen needles into a rheumatic knee
to the entire relief of his patient. He felt, on touching the end
of one needle, a peculiar sensation which, by its strong resem-
blance to a slight electrical sensation, attracted his particular at-
tention. Determined to ascertain if possible its nature, he con-
nected the ends of all the needles with a small wire, thus forming
them into a kind ot' battery, and procured obvious sparks of
electricity ; still, however, notwithstanding he was lbrced to
acknowledge the fact that electricity actually passed off from the
diseased knee in this case, he took care to pronounce the de-
cided opinion that this discharge of electricity had nothing to do
with the curative effects of the operation. And full of theorising
without facts or competent causes as are some of the gentlemen
of dignity at the great French metropolis, they have had very
little to say of many palpable facts which have been before them ;
such for instance as the relief of some acute pains and inflam-
mations by simple acupuncture, and the reliefof chronic ones on
infusing into the part, by the needle, the charge of an electric or
galvanic battery.

We arc pleased with the ease with which Professor Siluman

1838.1 Electricity. 427

has favored us, not only on account of our implicit belief in the
truth of the facts declared, and our ad niration of the wonderful
amplitude of Nature's resources which these facts reveal ; but
because they offered a strong illustration of the truth of a doctrine
which we have long entertained, and which we consider of par-
amount importance in the science of animal and vegetable life
and disease. It is. that the human system has within itself
resources adequate to the generation of free electricity, com-
petent in quantity, as well as to the proper insulation and ap-
plication of (he sam physical agent; for the development of
all the functions of lifey and the phenomena of disease.

This we consider no population, but the declaration of a doc-
trine, the truth of which is as demonstrable as the circulation of
the blood : and which, in its abundant resources, is calculated to
render plain and intelligible, most, not to say alt of the phenom-
ena of life, health, disease and death. This we are aware will
also be viewed askance, and indeed rejected, because its truths
are not. at first view, strikingly intelligible to those who may not
have investigated them. But this matters not, when truth is
concerned.

We regret that some one of those friends who are in the habit
of borrowing rare books and retaining the loan, has deprived us
of the opportunity of giving, in connexion with this case, an ex-
act extract from Brydone's Tour in Sicily and Malta, of a case
precisely similar in its philosophy, and very much so in its lead-
ing facts. In the absence of that volume of this little work
which contains the statement alluded to, we will endeavor to
give the leading facts of the case by memory, from a reading
some eighteen or twenty years ago. This work has been little
known, and less read, because early stamped with a want of
confidence in its entire truth, which we consider chiefly or soleiy
owing to the disposition to doubt the truth of this case.

Somewhere amongst the Alps, we think, he met with a lady
of rank, of high sanguine, or sanguineo-nervous temperament,
who when in full dress, emitted sparks of electricity to any con-
ducting body near her. as regularly as the charged prime con-
ductor of an electrical machine. The displays were very evi-
dent to the sight and feeling, the sparks passing a considerable
distance. Her full dress amounted to a good silk insulation.
f 6

428 Compression of the Carotid 'Artery . [Feh

Bat we need not <jo farther than our own firesides for evidence
of the internal development of electricity. Here, without other
insulation than common shoes, we find on a cold, dry morning}
that oar children's hair is divergent, from the repulsive power
of electricity, as if charged on an insulating stool. We find the
same phenomenon in tiie tail and mane of our horses on a cold
dry day. There are, it will be admitted, but two possible re-
sources for this charge; these are either without or within the
body. It is reasonable to conclude that it is net from without ;
for the only exterior sources are electrical generators, or a char-
ged atmosphere. In this case, the former of these is not pre-
The latter, to have imparted it, would be of the same electricity
and would, according to a well known law of electricity, that
positive repels positive, repel, instead of attracting it. The con-
clusion is then inevitable, that the electricity thus displayed
arises from the animal organism.

Of the compression of the Carotid Artery in the treatment of
Convulsions: By A. , Physician to the Hospital

St. Antoine, and agr< gt of the Faculty of Medicine at Paris.

When a therapeutic fact is isolated, it possesses in general no
value; bat vv i m of a new plan has been so
evident that it is irnpi icacy, when this plan
is of easy employment and does not produce the slightest in-
convenience, it i the consCientous an to in-
troduce it to the atte . ssional brethren,

( >n Monday, 1 1th e did me
the honor of j illation with Pro-
fessor ( '. tor Toirac, : of a
young Oar y i nt had suffered
much nd dentition.
Towj rds thi iad an attack
of scarlatina, wh ch > u d and required only hygienic
regulati< the invasion
of the e i d al thai time* in p< i
health, requi walk in the garden of the
Thaileri's. The^ d the request granted.

At first no injury rd day afterwards the

weather became sudi child took cold and the

following da) rhal swollen, especially in the
ion oi the parotid gland.

LS38.] Compression of the Carol id Artery. A2lJ

An oedema, not however considerable, took place promptly in
the entire body. At the same lime the urine was suppressed

for sixty-two hours, and was al'terv. <l only in

small quantity and of a deep brown colour. But as the patient
lived near the Thuileries, he was frequently conducted to the
garden for the purpose of recreation. The cedema bad some-
what diminished on the 10th September, and in the evening the
patient complained of a slight pain in the head. He passed a
restless night, and on the following morning complained of a
violent cephalgia and manifested an unusual loquacity.

At 3 o'clock P. M. he was seen by M. Cerise, who observed
in the patient so extraordinary an appearance and a pulse so ir-
regular, that he remained in attendance three quarters of an
hour, anxiously watching the progress of the symptoms ; when
suddenly, the child felt a very intense pain in the head, carried
his hand to the part with a cry of agony, and experienced a
violent epileptiform convulsion which continued only a few mo-
rn -iits and was followed at first by stupor and afterwards by a
true delirium: it was then 3 3-4 o'clock.

M- Cerise applied immediately 10 leeches behind the mas-
toid process, and covered the arms, the legs and the entire abdo-
men with large sinapisms. At half-past 4 o'clock another attack
more violent and longer than the first, occurred. At quarter-
past 5, a third epileptiform paroxysm. At three-quarters past 5
o'clock, a fourth convulsion which remained continuous.

M. Chomel had named 9 o'clock P. M. for the consultation,
but as the symptoms became more serious I was sent for in haste.
It was quarter -past seven when I saw the young patient. He
was str :d upon the bed, the head carried forcibly backwards
and towards the right side. ids, the eye-balls,

the muscles of the neck, the a the right side, were

agitated with convulsive mov a most frightful kind.

The muscles of the left side were in a stare of complete relaxa-
tion. The head had been covered with ice. but the convulsions
continued, cold water had been d in the face, a handker-

chief wet in iced water had been applied to the cheeks, but the
symptoms were not moderated. r: e, however, acquired

an extreme frequency, 160 per minute, and was tumultuous.
The respiration was embarrassed and rattling, it was evident
that an fngorgement was taking place1 in the lungs and that the
bronchial tubes were beginning to be filled with a spumous
fluid The pupils were excessively dilated. In this conjunc-
ture I proposed an affusion of cold water, to continue only half a
mmule. which was administered, thg child having been placed
naked in a bathing tub.

No change ensued, The child was enveloped in a blanket,
put in bed and supported in a sitting posture, so as to keep the
head in an elevated position.

430 Compression *f tke Carotid Artery. [Feb.

Tins convulsion had continued two hours, it seemed to us that
life would soon he extinguished, when 1 conceived the idea of
preventing the blood from passing to the brain by some mechan-
ical means and the only mode was that of compressing the
primitive carotids upon the side of the trachea.

It will be recollected that the convulsions existed on the right
side. By a negligence scarcely excusable in such urgent cir-
cumstances, I compressed the right carotid. The convulsions
continued, and the compression had been made two minutes
when L perceived my error. I placed immediately the index
finger upon the left carotid, and belbre fifteen seconds had elaps-
ed the convulsions ceased suddenly and the child fell into an
apoplectic stupor. The compression was continued one hour
without interruption, and not the slightest convulsion returned.
The respiration, previously rattling and stertorous, became more
and more regular and in a .quarter of an hour was performed si-
lently. After half an hour the child opened his eyes, and the
pulse had fallen to 116. The patient crave signs ol intelligence,
by attempting to answer questions that were proposed. The
sensibility was evident on all the left side of the body, but very
obscure on the right ; no lesion of the muscular movements on
the left side, but on the right the paralysis was complete. The
pupils had returned to their normal state. We determined that
compression should be continued through the night ; that a d*op
of Croton oil should be administered to produce a derivation
to the abdomen, and that cold water should be used as a bever-
age. We tiiud however the effect of remaining a minute with-
out compressing the vessel ; the compression was then renewed
for ten minutes, suspended anew for ten minutes, renewed for
ten, suspended for five, renewed for ten, and we then allowed a
repose of a quarter of an hour, hx half past 11 P. M. conscious-
ness and voluntary motion had been restored. The child would
not permit any further compression of the vessel, and demanded
drink and food with a vivacity which evidently indicated delir-
ium.

The patient slept during the night, but with some restlessness.
The convulsions did not re-appear. The next morning there
was still some degree of loquacity, but the cerebral excitation
ceased during the day and the convalescence proceeded without
interruption.

Remarks. The influence which the compression of the car-
otids exerted over the convulsions in this case cannot be doubted.
The spasmodic movements had continued two hours, and by the
compression they ceased in a few seconds as evidently as the
same mean would have arrested an arterial hemorrhage.

Let us endeavor to specify the cases to which this plan will
probably be applicable. I believe that it will prove useful in

J838.1 Compression of the Carotid Artery. 131

iill cases of congestive convulsions, meaning thereby all those
convulsions which have lor their cause only an afflux of blood
towards the brain. I do not believe in the efficaciousness of the
plan in those convulsions which depend upon an effusion of
blood into the cerebral substance upon rainollisseinent, or lacer-
ation or contusion of the brain.

The congestive convulsion ^and, under this head we include
the eclampsia of women in parturition, that of dentition, that
which often attends the incipient stage of the acute diseases of
infancy) the congestive convulsion, we say, has for its anatomi-
cal characters an engorgement of the cerebral vessels, a slight
infiltration of the pia mater and effusion into the ventricles; it
may indeed happen that the cerebral substance may be lacerated,
that effusions of blood may take place in the medullary sub-
stance, that the parenchyma and membranes of the brain may
be inflamed ; but these accidents are only secondary in the ca-
ses of winch we now speak and will be averted if the congestion
be prevented.

The compression of one of the primitive carotids produces
anemia (!) in the corresponding hemisphere of the brain much
more rapidly and certainly than blood-letting or an application of
leeches, and if it be continued lor some time the cerebral circu-
lation will be almost entirely annihilated, and the local irritation
which caused the sanguineous afflux will be extinguished by
the absence of the blood, without whose stimulus every flux
ionary irritation must cease. We may remark also, that if the
cerebral congestion be the cause of the convulsion, the convul-
sion becomes of itself a cause of the congestion with this differ-
ence, that the congestion is active in the first and passive in the
slecond case.

The co npression of the carotid prevents then in the first place,
the primitive active congestion, and opposes still more effica-
ciously the secondary passive congestion.

The immediate effect of this compression in a healthy person
is very remarkable. The face becomes pale, a sensation of
chilness is experienced, and sometimes a certain perturbation
in the intellect occurs. the>e disappear as soon as the blood is
permitted to resume its course to the brain.

Hitherto we have spoken only of the compression of one of
the carotids. Indeed, it will not be necessary in <reneral to in-
terrupt the cerebral circulation except in one of the hemispheres;
for we know that convulsions, even epileptic convulsions, affect
almost always only one side of the body, the other side experi-
encing only very slight convulsive movements. Hut if both
sides of the body were equally convulsed, together or alternately,
would there be any inconvenience in compressing at the same
moment both of the primitive carotids ? By making the cxper-

432 Compression of the Carotid Artery. [Feb.

iment upon ourselves we may be easily convinced that the sim-
ultaneous compression of the two carotic \ will not be attended
by the inconvenience which we might at ilrst apprehend. The
experiment should be made while we are in the horizontal posi-
tion. Vision becomes obscure, the ideas are somewhat confused
an indefinable sensation of nonentity, but by no means threat-
ening life, is experienced : by degrees th se phenomena cease,
because the anastomoses enable the vertebra] arteries to supply
the brain with sufficient blood for the maintenance of its func-
tions.

"We should not then fear to compress the two primitive caro-
tids simultaneously when necessary. It is not however necessary
to do this immediately, and it is better to compress at first only
the vessel of the side opposite to the one in which the convulsions
are most violent, and interrupt the circulation a lew minutes af-
terwards in the other hemisphere.

It may not be necessary to mention the place where the com-
pression should be made. I prefer the interval between the
sterno-cleido-mastoid muscle and the side of the larynx: for at this
point the artery is free and may be easily readied and pressed
against the anterior surface of the vertebra! column, and if the
artery should divide lower down the neck than it usually does,
into the two principal trunks, no inconvenience would hence
arise, as the internal carotid would then be compressed and the
same effect produced. The compression should be made with
the thumb or with the index and middle fingers united, the finger
is placed parallel with the axis of the vessel or perpendicularly,
the palm of the hand turned outwards so as not to press upon
the larynx or trachea. We should commence by ascertaining
the situation of the vessel by means of its pulsations, and it should
then be pressed gently against the vertebral column, taking care
that, it does not escape from the finger.

I may ask if in acute hydrocephalus of infants, if in the inci-
pient stage of cerebral inflammation, the compression of the
carotids would not cure these terrible diseases I I would not
be rash enough to advise the ligation of the carotid in an epilep-
tic patient, whose life might be threatened ; bill ill were afflicted
with this horrible disease, I would certainly demaud ihe opera-
tion for myself When a surgeon is applauded for applying a
ligature around the carotid Tor the purpose of curing a tumour
of the orbit, he should nol be accused of rashness if he were to
employ the same operation for the cure of epilepsy. This is
what I have to say respecting the comipression of the carotids in
the treatment of convulsion. I hope sincerely that the plan may
succeed in the hands of my professional brethren, for it is simple,
of easy application, without inconvenience and does not exhaust

[ike the energetic treatment to winch children and women who

have attacks of ei lampsia, are generally subjected.

1938.] / opia of the Aorta. 438

If by sub experience the utility of this plan be estab-

lished, it will be a happy triumph In therapeutics : if it be proven
to be inefficacious, those who employ it will have no cause of
regret, as the patients will not be thereby injured. Journal des
Con no issam -es . ! / klico Chirurgicales.

Ectopia of the Aorta reported by M. Key, of Bordeaux.

In the following case the aortia arises from the right ventri-
cles, the pulmonary artery is nearly obliterated, the two ventri-
cles communicate, and the brachiocephalic trunk is inverted.

A little srirl (J yeans of aire, born of young and healthy parents,
was brought from the village of Charente to the hospital of Bor-
deaux. The skin of the whole body, as well as the conjunctiva
and clerotica, presented a decided blue hue, and the nails and
lips a deep blue colour. By auscultation the heart was found to
beat against the sternum like a hammer : the pulse was small
and not of a strength corresponding with the action of the heart.
The chest was well developed, sonorous on percussion, though
respiration was laborious and attended with constant anxiety.
The child was extremely irritable and provoked to violent pas-
sion by the slightest causes, during which suffocation seemed
imminent: indeed it was in one of these paroxisms, shortly after
her admission to the hospital, that the patient suddenly died, as
though some mechanical cause had arrested circulation and res-
piration.

The most remarkable peculiarities revealed by autopsy relate
to the heart and its vessels. It should be observed, however,
that the accumulation of blood in the cerebral vessels was suffi-
cient to have induced a true case of congestive apoplexy. The
lungs did not seem to be developed proportionally to the volume
of the heart ; they had been however, when examined, some-
time macerating in alchohol ; they were engorged and did not
crepitate.

The volume of the heart was greater than usual at this age;
its globular form assimilated it to that of the heart of a Chelo-
niau : the inter-ventricular groove was less oblique than usual ;
its weight four ounces; the auricles presented nothing peculiar.
There was no trace of the foramen ovale, save the slight depres-
sion termed the fossa ova! is. and which was more evident in the
left than in the right auricle. The right ventricle was some-
what globular, not collapsed, and presented an excentric hyper-
trophy of its walls, the thickness of which, at the base, was four
lines.* Its coiumnae oarneae were so much enlarged as to re-

The thickness of the same region in an adult hearl is usually about 2j linos.

431 Phrenology . [Feb.

semble those of the left ventricle. The auricula- venticular ori-
fice was natural, and gave attachment to a normal tricuspid
valve. The aorta and pulmonary artery arose from the anterior
andsuperior part of the right ventricle.' Theaorta very singu-
larly arose from the left side of the right ventricle, and at about
the place of the usual origin of the pulmonary artery ; it passed
over and compressed the pulmonary artery, curving this vessel
to the left ; it projected posteriorly an inch and a half, and then
descended along the left side of the spine; its orifice was sup-
plied with the semilunar valves. The order in which the
branches were given off by the arch of the aorta was inverted,
so that the innominata was situated to the left, the right carotid
and subclavian having distinct origins.

The pulmonary artery originated in the right ventricle, and
was so much inclined to the left that it seemed, at first sight, to
come from the interventricular septum. This vessel was nearly
obliterated at its origin in the ventricle,* presenting a diame-
ter of only a line; it was surrounded with irregular calcare<>u<
calculi. Its sigmoid valves were found above the narrowed
orifice and placed one above another ; at this point the vessel
resumed its dimensions, but did not exceed the femoral. Its in-
ternal and middle coats were softened and of a dark red colour ;
it contained coagulated blood, and presented manifest evidences
of artensis. This artery bifurcated as usual. No remains of
the ductus arteriosus existed.

The left ventricle appears to have diminished in muscularity
in proportion to the increase of the right side, though its capacity
exceeded that of the right; its auricular aperture and mitral
valve were normal; its columhse carnese small ; and no aortic
opening perceptible. An oral aperture existed in the upper part
of the ventricular septum sufficiently large to admit the little
finger. The circumference of this communication between the
two ventricles was polished, indicating its congenital origin, and
precluding all idea of an accidental or pathological perforation.

Archives Generates, T. 11, p. 426.

Phrenology.

This name means, in strictness, the doctrine of the mind, and
is far more applicable, according1 to the principles of nomencla-
ture, to metaphysics in the sense of some of the disciples oi the

This obliteration led to the examination of the bronchial arteries, "which were
found iioi t<> be increased in ealiber.

1S38.] Phrenology. 435

Aristotellian school, than to the eminences and depressions of the
brain or of the cranium. But the brain, being- the grand nervous
centre, derives a capital importance from being at once the seat
and organ of the mind, so far as the location of this important
constituent of man can be determined, and so far as physics are
concerned in its existence and operations. As such, this organ,
anatomically and physiologically considered, is worthy of the
strict attention of medical men. We have however, but limited
means of locating the intellectual nature or constituent of man.
They seem to be limited to a few facts some positive, and
others negative. These are mainly that the entire absence of
brain is always accompanied by an entire want of intellect
that important lesions of this organ are often attended with in-
tellectual impairment that the detectable existence of intellect
declares the existence of brain, &c. But the law of this relation
does not prove itself by working proportionably to the amount
of each ; for the intellect, and this part of the organization, rank-
ing mind with matter, are not always, nor even generally co-
ordinate. Nor does it prove itself by displaying an adaptation,
each to the other ; for imperfection of intellect does not necessa-
rily imply an obvious or ascertainable organic lesion of the brain,
as that does often appear without any detectable existence of
this. And if the existence of organic lesion is not obvious or
ascertainable, we have not the right to suppose its existence.
Nor do even very considerable lesions of the brain always de-
clare impairment of intellect. AVe are authorized by pathologi-
cal as well as healthy anatomy, to assert that the vital import-
ance of the existence and integrity of the brain to the animal
economy, is not so definite and invariable as may be generally
supposed ; as we have seen the human being live, pulsating and
breathing sufficiently for the perpetuation of animal life for many
hours, without one atom of cerebrum, cerebellum, or of the ra-
chidian bulb ; but at the same lime, without the least manifesta-
tion of intellect ;* whilst again, we have seen that some of the

* A case of ancncephalus. noticed sometime since in this journal, which lived 27
hours, in the possession of all the natural powers, so far as could be ascertained
except the intellectual. And Ribes notes a case of the same kind, which was s*en
by Bayle, which lhyd a week.

G 7

436 Phrenology.

most severe wounds of the brain have not, of themselves, been
accompanied by immediate intellectual impairment.*

But it is net our purpose on the present occasion to enter upon
a dissertation on the anatomy or the physiology of this import-
ant organ whose good condition is generally essential to the
well-being of the economy- We think it a subject for regret
that the former name under which Dr. Gall commenced his
investigations has not been retained. With the aid of physiog-
nomy, it might have been used, under the name ofcraniology in
peddnng around the country the pretended fortunes of the weak
who are always ready to bestow their confidence on any novelty,
and reward it with their (often) scanty means: without prostitu-
ting a good nomenclature. And moreover, the assertions of
cranial depressions, eminences and magnitudes, would have
been truth ; whereas, we have seen beyond all fair controversy,

* Case of Henry Singleton, a soldier, who in one of Gen. Floyd's battles, re-
ceived a bail nearly as large as tbat of a musket, just above the right ear. tbrough
the squamous portion of the temporal bone, which passed obliquely backward and
to the left Idle of the cerebrum and lodged against the yaietal

bone of the left side. This man suffered no other sensible impression than a feeling
of percussion, which he thought was from his own gun, as it occurred at the mo-
ment he attempted to lire. Tic staggered a little out of line, but resumed his place
instantly and obeyed promptly the next quick command, or rather the latter part of
the command to fire and charge t>,e enemy. He ran in the charge many paces and
returned; never having suspected he had been shot, until subsequently, when his
companion, observing a little blood about bis ear. told him of his wound. He then
retired to the hospital for dressing, and the surgeon general, on examining the
wound superficially on account of the absence dfi !1 severe symptoms, pronounced
it a " spent-ball wound" and dr< Lly, or not at all. He remained bow-

ever on the list of wounded until the measles appeared on him some ten or fifteen
after the battle, out three weeks after the wound

was receivi himself nor his surgeon ever having doubted but that the

I.

AUtei ign being near its close, and his

health appearing \o ren ler him i!;i;i: forimm . he rode on horseback to

the interior, a di to rain, hig '.Mer getting

home, lie soon i and a measle-likc eruption

s increased for a Jew days and abated.
After : ubject to partial

the who! bodj . and he
died, som< turn. In: nation alter his return, and during

histi reely, without the least

irough the brain as far as the
kind.

1838.] Phrenology. 437

in Dr. 8ewall's second lecture, as well as elsewhere, the inap
plicability of the external cranial marks (and none but the ex-
ternal can possibly be available for practical purposes,) to the
end of determining with the least certainly the cerebral mass or
its proportional part saying nothing of the unsoundness of
the notion of a proportionate relation between certain intellectual
faculties or animal propensities, and the cerebral developements.
On this subject, the common sense views which would avail
much in regard to any matter not qtiite so well calculated to
titillate the fancy or the vanity, have been again and again urged
by the friends of truth; but these cannot avail much in the face
of that -'self esteem'*' which prompts almost all men and women
to desire to hear some comment on their peculiar virtues, ac-
quirements or prowess. Whilst this subject rested as a mere
quere, whether or not, phrenology was a science? it was a matter
of little consequence whether any one believed the one or the
other opinion. It was a mere physiological question, very ab-
stract from medical practice or therapeutical utility, and its de-
cision not calculated to damage any one. But when taken up
as a practical science and retailed around the world under the
declaration of its being a fair '; mirror of nature" in which men
and woman may see reflected their animal, moral and intellect-
ual faculties, and thus for the purpose of draining from a confid-
ing community who cannot be supposed to know any thing of
its inapplicability to the truths of nature, an unfair support from
their well-earned competence, it is time for the community of our
country to open their eyes to tne imposition practiced on them,
and be brought to see the grossness of the insult which is offered
to their understandings. But common sense will, sooner or
later, bring out the community on the side of truth.

We have been led to these remarks, on the present occasion,
by noticing in the last No. of the lied. Chirug. Rev., p. 507 and
following, an extract from the facts about to be published by Dr.
Lelut* on the subject of the average and the proportionate
weight of the human brain, and its relation to the development
of intelligence. The following facts relative to the cerebral
mass, arc a part of the contributions to the work of Lelut, as in-

NouYu'fl Rapporto du physique at thi nalfral."

439 Phrenology. [Feb.

serted in a late No. of the Gazette Medicale de Paris. We copy
from the Med. Chirug. Rev. for October 1837. Dr. Lelut has
neither declared himself an advocate or an opposer of Phrenolo-
gy. Several useful views may be taken of these facts to which
the truth must ultimately bow, after the intoxicating charm of
novelty shall have subsided, and the ridiculous tricks of gliding
over the palpable incompatibilities of the doctrine shall have be-
come old things. These views are, the smaller average of the
female brain, the equality of the encephalic mass in ingenious
accomplices in high crimes, and the speechless and absolutely
senseless idiot, &c.

" The average weight of the encephalon (including the cere-
brum, cerebellum, and tuber annulare or rachidian bulb,) after
the meninges have been stripped off is, in the healthy adult male
about 1346 grammes, or three pounds and a half,* of which the
cerebri] m weighs 1170, and the cerebellum 176 grammes. In
the female the weight of the encephalon is about l-13th less
than in the male. The following are the measurements of the
encephalon in certain individuals, "dont la triste celebrite a jete
quelque jours sur leur psychologic"

1. Lhuissier, who murdered his-, mistress, and then cut the
body up and threw the pieces into the Seine. Intelligence be-
low the ordinary standard, and not cultivated 45 years~of age
middle stature.

The encephalon weighed - 1496 grammes,

cerebrum - - - 1305

cerebellum - - 191

2. Belard, murderer of one of his relations ; a tradesman in
the Temple. Intelligence below the ordinary standard, and not
educated 29 years of age middle stature.

The encephalon weighed - 1290 grammes,

cerebrum - - - 1130

cerebellum - - 160

3. Bardon, an accomplice in a murder. Intelligence ordi-
nary, and not cultivated 39 years of age midd. stature.

The encephalon weighed 13S4 gram,
cerebrum . - 1204
cerebellum - - 180

4. Chandelet, the assassin of his uncle; a porter in the Rue
de Charonne. Reason lively and exalted ; propensities brutal
and licentious 31 years of age stature short.

The encephalon weighed 1192 gram,
cerebrum - - - 1010
cerebellum - - 182

An English pound of avoirdupois weigh! is equivalent to 423 gramme*.

1938.] Phrenology. 439

5. Avril, the accomplice of the notorious Lacenaire. Intelli-
gence ordinary, and not cultivated 27 years of age middle
stature.

The encephalon weighed 1310 gram,
cerebrum - - - 1130
cerebellum - - 180

6. David, murderer of his sister-in-law, who was the wife of
a servant at the Hotel des Invalides. Intelligence ordinary, but
somewhat eccentric, and partially cultivated 34 years of age
statnre rather tall.

The encephalon weighed 1420 gram.

N. 8. It has been preserved in spirits, and the weight of the
cerebrum and cerebellum, separately, cannot be stated.

7. Fieschi. Intelligence ordinary, but not cultivated, but ac-
tive and proud 46 years of as^e middle stature.

The encephalon weighed 1365 gram,
cerebrum - - - 1200
cerebellum - - 165

8. Guerin, accomplice of Chandelet (No. 4). Reason rather
acute, developed, and somewhat educated 42 years of age
stature rather tall.

The encephalon weighed 1384 gram,
cerebrum - - - 1240
cerebellum - - - 145

9. Lemoine, the assassin of the chamber-maid of Madame Du-
puytren. Intelligence developed and cultivated 40 years oi
age middle stature.

The encephalon weighed 1310 gram,
cerebrum - - - 1140
cerebellum - - 170

10. Lacenaire. Intelligence developed and cultivated 34
years of age stature short.

The encephalon weighed 1355 gram,
cerebrum - - - 1205
cerebellum - - 150

Remarks. If we cast our eye over the preceding ten measure-
ments, it will be seen that the medium or average weight may
be stated, as we have said at first, at about 1340 or 1350 grammes.
The heaviest on the list is that of Lhuissier (No. 1), and the
lightest is that of Chandelet (No. 4); the former weighing 1496,
and the latter only 1192 grammes.

If we endeavored to establish any relation between the mental
development or character of these criminals, and the weight of
their encephala and of its two great divisions, it might be re-
marked that Bardon, Lhuissier and David, in whom the ence-
phalon or the cerebrum was the most heavy, were not the most

4-10 Phrenology. [Feb.

intelligent ; that in Lacenaire, on the other hand, the brain
weighed considerably less than in them, and that ifin Chande-
let, with his brutal passions, the cerebellum was large, the ce-
brnni weighed as low as it does in many idiots, and yet he indi-
cated no want of intelligence.

But we have no intention to discuss this most difficult question,
as we most willingly admit that a number of considerations
ouffht to be taken into account, in such an enquiry. It might,
for example, be objected that we have not sufficiently attended
to the size and weight of the whole body in reference to the
weight of the encephalic mass; nor to the relative weights of its
two great parts, the cerebrum and the cerebellum ; nor to the
education ol the individuals ; and, even if we were provided
with accurate data on these topics, phrenology might then step
in, and remind us that we have forgotten to attend to the com-
parative size of the different convolutions ; and, then supposing
that we had done this, that we have neglected to take into ac-
count the temperament oi each individual, and the activity of
the cerebral functions.

Our intention therefore at present is only to afford accurate
observations of what we ourselves have examined and ascertain-
ed ; and we now, in pursuance of this plan, shall proceed to
give some other measurements of encephala, such as we have
found them in idiots and lunatics.

1. Gobinot, 24 years of age, and of middle stature, hliotlsm
of the lowest grade ; no power of speech, but only inarticulate
sounds and cries. He seemed not to have even the natural in-
stinct of hunger, and would not eat, unless induced to do it.

The encephalon weighed 1320 gram,
cerebrum - - - 1135
cerebellum - - 185

2. Inconnu, deaf and dumb, 43 years of age. and of a, stature
somewhat above the ordinary. Idiot ism of the lowest degree.
No speech, and scarcely any sign of intelligence.

The encephalon weighed 1370 gram,
cerebrum - - - 1205
cerebellum - - 105

3. Darvoz, 39 years of age, and of middle stature, ldiotism
which places the individual below the brute. No speech ; sen-
sations dull ; a slight degree of memory ; incapacity of clothing
himself, or of defending himself against any external injury.

The encephalon weighed 1250 gram.
cerebrum - - - 1064
cerebellum - - 102

4. Courtois, 46 years of acre, and of middle stature, ldiotism
of the lowest degree. Physiognomy almost simian. Incapable
if answering to any question, or of faking care, of his person.

183S.] Phrenology. 441

The encephalon weighed 1045 gram.

cerebrum - - - 907
cerebellum - - VoS
The anterior cerebral

lobes - - - 226

5. Boulot,37 years of age, stature rather tall. Idiotism of a
very low degree. The intellect is almost quite abolished ; to
all questions he answers, " ma tete, mot) front sont egarCs," or
"dans la province de Joiny, on a fait do moi un pauvre fou pour
me perdre." lie is often much excited and very turbulent. He
has no regard to his animal feelings, and his life is almost entire-
ly vegetative.

The encephalon weighed 1380 gram,
cerebrum ... 1188
(its anterior lobes) 192
cerehellum - - - 300

6. Rollet, 46 years of age iind of large stature. Idiotism very
confirmed. His intelligence was almost at zero. He said, for
example, that he was only three years old, and it was only -with
extreme difficulty that he could pronounce a few words. His
physiognomy was quite idiotic. He was employed at the Bice-
tre to turn the wheel of the great well there.

The encephalon weighed 1025 gram,
cerebrum - - - S96
(its anterior lobes) 2.50
cerebellum - - - 135

7. Cresson, 23 years ofa^e, and of large stature. Imbecility
very strongly marked. S;)3ech embarrassed and stammering
physiognomy dull and heavy; although capable of manual
work, never cruld be taught any art.

The encenhalon weighed 1105 srram.
cerebrum - - - 920
cerebellum - - 185

8. Mallebranche, 54 years of age ; stature rather tall. Idiot-
ism quite confirmed. Speech scarcely intelligible. Extreme
chorea of all his limbs.

The encephalon weighed 975 gram,
cerelrum - - - 825
(its anterior lohes) 240
cerebellum - - 150

9. Favel'.e, 57 years of age ; middle stature. ImbecelitywitK
irregnlari/y of muscular movements. He was admitted into
the Bicetre as an idiot at the age of 12 ; and the only work he
was enabled to do, was to assist in turning round the wheel of
the well. His speech and his walk were embarrassed and difri-
cult. His arms were in a constant trembling. His intelligence
was correct, but very inconsiderably developed.

442 Phrenology. [Feb.

The encephalon weighed 1235 gram,
cerebrum - - - 1077
(its anterior lobes) 300
cerebellum - - - 15S
10. Chambin, 67 years of age, middle stature, hnbecelity only
partial. He was never however, able to gain his livelihood by
any occupation ; and, in consequence of this, he was put into the
Bicetre at the age of 24. His intelligence was very small, but
correct as far as it went. His speech was stammering and un-
certain. Being capable of considerable bodily exertion, he was
employed at the hospital to assist the servants in various ways.
The encephalon weighed 1365 gram,
cerebrum - - - 1215
cerebellum - - 150."

Phrenology in the vulgar sense teaches that the brain is the
organ of the mind, and that "in proportion to the volume of the
organ, other things being equal, will be the power of mental
manifestations." That the organic developements arise from
the medulla oblongata, and radiate to the surface; and that
there is, in the source of these developments a congenital tenden-
cy to impart a vigor of growth in these several organs, which
will in future manifest by their size the grade or power of mental
developement, whether of propensities, sentiments or intellect.

It follows therefore as an unavoidable consequence, the legit-
imacy of which is not to be slipped over by phrenologists, that
when all these sub-organs progress on, so as to afford an
unusual developement of the whole assemblage of any one, or
of all of these classes of functionaries, the faculties of these
mental functionaries are consequently and proportionably
developed. That is to say, if one developement be large or full,
it indicates the possession of an unusual natural faculty of that
name; as for example No. 11, or " love of approbation." But
if No. 12, or "cautiousness" be also unusually developed, it
cannot destroy or impair the former, but leaves it with all its
powers or merits, adding to the mind eminent "cautiousness."
So of "conscientiousness,"' "ideality," "hope,'1 and so forth to
all the cerebral developements ; each not actually impairing the
former, but adding to it another and another, until the whole as-
semblage of mental developements, including "propensities,"
" sentiments" and " intellect/' are brought up to an unusual dig-
nity --an integnal organ which must needs partake of the whole

1838.] PhrenMgy. 443

nature and degree of its numerous integrant constituents. There
appear to be but tew fundamental propositions proper to this
doctrine, the otheis being simply anatomical or physiological
facts, which cannot, of themselves, sustain the superstructure.
Those fundamental principles however, which must exist to
make phrenology a practical science, are the following:

1st. The shape of the skull must precisely correspond with
that of the contained brain, in order that the size and shape of
the brain itself may be at once absolutely determined by as-
certaining those of the skull.

2nd. The larger the brain, the greater must be its powers, with-
out temperament being held as a modifier*

3rd. The more active an organ is, the more conspicuously
will it be indicated by the cranial proturberance supposed to
cover it ; or, in other words, the more exalted the cranial pro-
trusion, the more active will the faculty be found which it is
supposed to cover. These are indeed necessary to its support ;
they are its chief fundamental propositions; for unless they be
true, there is no foundation to the science as a practical one.

The unsoundness of the first and second have been abundant-
ly proven by Dr. Se wall's second lecture. As to the modifying
influence of temperament, this belongs to Physiology, abstractly
from Phrenology. It belongs to natural language, if we may
so speak ; being that by which individuals may discern the
taste, disposition, propensities, &c, as if by intuition. It belongs
also to Physiognomy, with more propriety, for this has an earlier
claim to it. It is a petitio principii to say that the state of the
body always corresponds with the quantity of the brain. It
cannot therefore be allowed in support of Phrenology as a prac-
tical science. It must therefore remain unmolested with the rest
of Physiology, or be yielded up to Physiognomy ; a thing
which has had its great day, passed its age of novelty and delu-
sion, and is now settled down to the proper level of its own
intrinsic merits. To the 3rd of these fundamental propositions,
we apply the stubborn facts of anatomy, cerebral staticks, and
their necessary bearing on psycological physiology. This must
end in the total subversion of this proposition, and in establish-

* Temperaments aro a separate ]>art of science, and are therefore unjustly brought
into ai& phrenology and heal its dei cien '. - in i rtune telling.

ii 8

441 Phrenology. [Feb

ing the fact, that there is indeed no fixed relation available for
practical purposes, between the cerebral developments and the
mental faculties and propensities.

It will be borne in mind that the average nett weight of the
healthy, ordinary, adult encephalon. (including the cerebrum,
cerebellum and rachidian bulb) is

1346 grammes.
The cerebrum of which is 1170
cerebellum - - - 176
The first case given by J)r. Lelut was, in point of intelligence
below the ordinary standard, without cultivation, and the per-
son of medium stature. In this

The encephalon weighed 1495, more than com. av. 156 gram.

cerebrum - - 1305, 135

cerebellum - - 191, 15

The second case, guilty of the same crime, both being mur-
derous, the same grade of intelligence, being below the ordinary
standard person the same, being of medium stature.

The encephalon weighed 1290 less than com. av. 56 grain,
cerebrum - - - 1130 ------ 40

cerebellum - - 160 ------ 16

Now, if we add the deviations both ways, above and below
the standard of the cerebrum, the great seat of intelligence and
sentiment, we have 175 grammes difference in the weight
of the cerebrum of individuals of the same known character of
mind, stature, and so forth. AVe are indeed not told the tem-
peraments in these cases, but can no more allow the practical
phrenologist to say that in one, the temperament was of one
kind, and in the other, it was the opposite, merely because the
brains were so different, than we could grant him gratuitously
the main tiling he wishes to establish. It was as well to grant
him one petitio principii as another.

In the 3d case Intelligence ordinary medium stature.
Ihre the difference from each of the others is, that the intelli-
gence is ordinary, instead of being below the ordinary standard.
Crime the same.

The encephalon weighed L384, more thanord. average 3S grm.
cerebrum - - - 1204, ------- 34

cerebellum - 1 80, 4

1S38.1 Phrenology. 44!

Here all the dcvelopements of the brain were over ordinary,
particularly the intellectual, 34 grammes; still the intellect was
ordinary.

In the 4th case the reason of Chandelet was lively and exalted
the propensities brutal and licentious stature short. In such
a case can we expect from Phrenology that

The encephalon will weigh but 1192, less than the aver. 154
cerebrum, with lively and

exalted reason, - - 1010, 160

and the cerebellum - - - - 1S2, more than ord. av. (V?

Remark here that the lively and exalted reason of the indivi-
dual Chandelet has the extreme opposite in the organ to which
it belongs, whilst his brutal and licentious passions have a deve-
lopement of cerebellum of only 6 grammes above the ordinary
average ; the first fact, (and but a nominal one, as it is only 6
gram.) in favor of this proposition of Phrenology.

We will now place by this case, Guerin, the accomplice of
Chandelet, which is the 8th case of Lelxjt. These persons were
engaged in the same crime, that is to say the assassination of the
uncle of Chandelet. The reason of Guerin was acute and de-
veloped, stature rather tall, and it is fairly presumable from the
peculiar crime in which they were concerned, that their real sen-
timents and powers of mind generally, as well as their propen-
sities, were very similar. But instead of 154 grammes less than
the ordinary weight of the encephalon, Guerin had 38 more,
making a difference in their whole brain of 192 grammes. And
instead of the 160 less of cerebrum, as with Chandelet, Guerin
had 70 more, making a difference in the organ containing the
reasoning faculties of which both might boast, of 230 grammes.
And instead of the 6 grammes more of the cerebellum which
contains the brutal and licentious propensities, which Chandelet
had, Guerin had 31 less, which, added to the 6 more of Chande-
let, makes a difference between them in this organ of37 grammes.

We leave to the reader to make the same observations for him-
self on the remaining 5th, 6th. 7th 9th and 10th cases, as they
continue to illustrate the severe truth, that the assumptions
of practical phrenology are not the science of nature.

Dr. Lelut next gives ten cases of idiots. In the first, the
encephalon was 26 grammes less than the average, ldiatism
was of the lowest grade no speech and without even the

446 Phrenology. [Feb.

natural instinct of hunger, whilst his cerebrum was only 35
grammes less than average.

The 2d case was one of idiotism of the lowest degree. ]No
speech, and scarcely any sign of intelligence.

Encephalon 24 grammes more than average, and cerebrum 35
more, whilst the cerebellum was about 11 less.

We here take leave of the subject, leaving the reader again to
examine the remaining eight cases of idiocy and compare them
with the ordinary average. lie will find some above and some
below ; bat the average of the idiots' heads given, is rather below;
proving the proposition with which we set out to review this
table, that " there is no fixed relation available for jjractical
purposes, between the cerebral developements and the mental
faculties and propensities. Whilst therefore, the subject is one
which should be freely and fully investigated, in physiology,
whilst, physiological speculations should be as free on this, as on
any other subject, and whilst, like the " language of flowers.'1
it may be admissible for amusement in the parlour, and whilst
its doctrines may, without impropriety, be thrown before the
public for their investigation ; still not being consistent with the
truths of nature, and consequently not being founded thereon,
it is morally wrong for it to be applied to the purpose of gain,
by its practical application for the end of divining or foretelling
the intellectual or other fortunes of a mixed community, whose
ignorance of a study so much out of their way as the anatomy
and physiology of the brain stands as a barrier to their judge-
ment on its truth or falsehood.

1S3S.] Editorial Remarks on the Primitive Carotids. 4 AT

PART III.

MONTHLY PERISCOPE

Nothing is received with more grateful salutations by the
practitioner who duly feels the burthen of humanity, than the
knowledge of efficient remedial means for those dangerous dis-
eases over which he has been obliged to weep with folded arms,
or exert himself often in the face of despair. The cheering in-
fluences of hope are cast around him by even a solitary fact
which creates confidence in something, for the benefit of human-
ity, which has not before been found unworthy of confidence.
But we call the attention of the reader to the following subject
on more substantial grounds than the mere fact of its success in
the treatment oi one case. Reason has suggested and fact de.
monstrated its proportionate adaptation to the etiology and pa-
thology of the cases for which it is believed to be a remedy ; and
its physiological action or influence is calculated to substantiate
the opinion formed of its efficacy. In short, it is consistent with
all the philosophy of the cases to which it is proposed to be ap-
plied as a prophylactic or as a remedy. The subject to which
we allude is the communication of M. Trousseau, on the sub-
ject of the compression of the primitive carotids, as a remedy for
certain convulsions ; which we have given in the II. part of the
present No., from the Journal des Connaissances Medico-Chi-
rurgicales.

It will be remarked that the cases to which this remedy is con-
sidered applicable are congestive convulsions, or those which
have for their cause, an afflux of blood towards the brain : such
are a large majority of the convulsions of women and children,
as well as the epileptiform, and many of the apoplectic convul-
sions of men, which we are called to treat. There are no cases
which make such sudden and agitating demands on our prompt-
ness and immediate efficiency, as attacks of this kind. This re-
medy has two high recommendations, if accompanied with effi-
ciency: these are its convenience and its safety. We trust that

413 Blenorrhagia and Lcucorrhcea Fractures. [Feb.

n profession which is accustomed to writhe under the sudden
dcstructiveness of these cases, will not hesitate to adopt a prac-
tice, at once so safe and rational, and report the results for the
benefit, of the community.

It is most obvious that in the case given by M. Trousseau,
compression of the primitive carotids relieved the active conges-
tion most promptly, and then quickly subdued the remaining
apoplectic, passive congestion. It should be remarked that both
the primitive carotids may be safely compressed if necessary, as
the anastomoses will enable the vertebral enteries to afford to
the brain a sufficient supply ; but when the convulsions are en-
tirely, or mainly on one side, the artery of the opposite side should
undergo the compression.

New injection for the treatment of Blenorrhagla and Leu-
corrhoea. The aromatic tincture of gall nuts is employed with
success in the treatment of the above named diseases, in the new
hospital, in the Reu de Poursine. It is prepared in the follow-
nner : ,

ft. Nux. Gallae contus. lb. j.
A. Pura ft.
Maceriate 12 hours, and decant the fluid ; add to the resdue ano-
ther pint of water ; and after 12 hours maceration it is also de-
canted. Add to the liquor 2 pints rectified alcohol and gvj. com-
pound alcoolate of citron, and filter.

This tincture, diluted with 6 to 8 pints of water, is used as an
injection. Jour, de Pharm. Am. Jour, for Feb. 1837.

Treatment of Fractures. We find in the Archives Gem' rales
(Tom. 11, p. 438, 1837,) an interesting article by M. Fleury,
on the causes tending to the consolidation of fractures. The
writer, after premising1 that, the ordinary treatment consists prin-
cipally of reduction and retention of the fractured extremities in
apposition, remarks that the attention of M. Tobf.rt has been
directed to the state of the circulation in the affected part.

" It is," observes M. F., "to the blood we should look for the
formation of cicatrices ; every one knows its influence on the
surface of wounds, on the form, colour, consistence, dcvelope-
inent, and vessels of false membranes. The researches of Du-

1838J Medical Intelligence. 449

puytren having established the correctness of the principle
advanced by Duhamel, that the periosteum and cellular tissue
are the principal agents in the formation of osseous deposits, it
might have been inferred that the circulation was greatly con-
cerned in the accomplishment of this work. Observation has
fully confirmed the correctness of these deduction, and proven to
M. Tobert that among the causes which oppose the consolida-
tion of fractures, impediments to the circulation and a vitiated
state of the fluids should be considered some of the most potent.7'
Mr. Fleury then expatiates on the evils attendant on the
tightness with which the bandages and splints are generally ap-
plied to fractured limbs, and cites several cases in which union
had been delayed several months under the ordinary treatment,
but readily took place on removing the compressing fixtures, and
exciting the circulation by stimulating frictions.

Auscultation for the detection of Urinary Calculi. Messrs.
Moreau de St. Ludger & Behier had in 1836, proposed to adapt
a stethoscope to the handle of the sound in exploring the bladder
in search of calculi, but this was attended with some inconveni-
ence, inasmuch as it was difficult to retain the ear well applied
to an instrument which it was neeessary to move about consider-
ably, especially in striking against the resisting body to detect its
sound. M. Leroy, d'Etioles, has recently presented to the French
Academy an instrument remarkably well adapted to this mode
of examination. It is formed by the connection of the stethoscope
and handle of the sound by means of a flexible tube of gum elas-
tic kept open by a spiral wire within. With this simple contri-
vance the ear may remain applied to the stethoscope, unmoved
by the catheter, whose shocks against a calculus will be distinct-
ly heard.

MEDICAL INTELLIGENCE.

Medical College or Georgia. At the late annual meeting of the Trustees of
the Medical College of Georgia, several important changes were made in the course
of instruction in this Institution. The Faculty of the College consisted of eight
Professors; but believing that a reduction of the number would be for the interest
of all concerned, Dr. Cunningham tendered his resignation of the Chair of the
practice of Medicine. The trustees, coinciding with that opinion, accepted the re-
signation; and Dr. Ford, the late Professor of the Institutes of Medicine and Medical
Jurisprudence, was appointed Professor of the Institutes and Practice of Medicine.

450 Medical Intelligence. [Fob-

An exchange of Chairs was then made between Dr. Newton, late Professor of
Physiology and Pathological Anatomy, and Dr. Di gas, late Professor of Anatomy ;
whereby Dr. Newton was made Professor of Anatomy, with the duties of Demon-
strator; and Dr. Due as, Professor of Physiology and Pathological Anatomy. The
Faculty therefore now stand as follows:

Dr. L. D. Ford, Protessor of Institutes and Practice of Medicine.
P. F,Eve, ' " " Surgery.
G. JVI. Newton, " " Anat;>

J. A. Eye, " Ci Materia Mcdica and Therapeutics.

M. ANTONY, " " Obstetrics and Diseases of Women and Children.
L. A. Dugas, " t: Physiology and Pathological Anatomy.
C. Davis, " " Chemistry and Pharmacy.

Dr. Newton will serve as Demonstrator. By connecting the Demonstratorship
with the Anatomical Chair, there will be a free admission of the whole class to the
demonstrations, without a separate ticket.

The engagement of Dr Newton's superior abilities in the Demonstratorship>
with the abundant supply ol materials for which ample arrangements are made,
cannot fail to add greatly to the benefits of this Institution, in special and practical
Anatomy.

An alteration was made at the same meeting, whereby the term of the course of
lectures was reduced to four months, the period announced by the other colleges.
This arrangement will cause the course to commence in future on the first Monday
in November, and terminate on the first Saturday in March.

It will be remembered that, several years ago, the Medical College of Georgia
proposed to the other colleges in the United States, to meet a convention, for the
purpose of adopting certain general regulations and plans for the improvement of
the present system of medical education, and elcvatiug the standard of medical sci-
ence in the United States : but the proposition was rejected by the otner colleges;
each preferring to maintain its own peculiar views, and establish its own plans of
operation for its individual interest. One of the most important purposes which the
Medical College of Georgia had in view, was to urge the propriety of establishing
throughout thecollegcsa longer term of annual instruction than had been generally
adopted. That College had always acted on their opinion of the importance of this
their course having been six, instead of the common term of from three to four months.
But their proposition not being met by the other colleges, the Georgia College found
it impossible to compete successfully with the popularity of a short and cheap course
with students. If there be error therefore in the adoption of four months as the
term of annual instruction, the blame is fairly attributable to the retention of the
short course by the other colleges, and to the ridiculous and disgracetul practice of
some of them, of boastfully circulating in every neighborhood of the union, state-
ments of the small amount of money required for attending a course with them. We
speak freely on this subject, because we have known the truth of such decoying
temptations put to the test of experience by some ofthe most prudent and economi-
cal young gentlemen of Georgia, whose pari nts have been compelled to more than
double the amount stated cases wherein the items of expenditure were faithfully
n .! and exhibited in good proof of the true economy exercised.

SOUTHERN

M3EBIKDA3L AMID) MII(DAIL
JOURNAL.

Vol. II. MAKCH, 1S3S. No. VIII

PART I.
ORIGINAL COMMUNICATIONS.

ARTICLE I.

Remarks on Fever, more especially that form of it usually
denominated 'Yellow Fever. By J. B. Whitridge, A. M.
M. D.j President of the Medical Society, and ex-officio, of the
Medical College of South Carolina ; in reply to certain
interrogatories by Chervin, D. M. P., a celebrated French
Philosopher and Physician.

The subject was thoroughly investigated by Dr. Chervin*
for who.M the following epistolary essay was prepared, and by
him deposited in the Archives of the Royal Academy of Paris,
for the use of the French Government.

Although the essay has been sometime written, the experi-
ence which it embodies and which is confirmed by subsequent
observation, may perhaps be useful, and the remarks which it
contains, not uninteresting to some of the readers of the South-
ern Medical and Surgical Journal.

* Sec Petition addressee a la Chambre Des Deputes Par >T. Chervin membre
titulaire del' Academic Royale de Medicine.
A 1

452 TMiitridge on Yellow Fever. [March

INTERROGATORIES.

u Have you ever seen any case of yellow fever which origi-
nated from contagion )

"Do you believe this disease under any circumstances, to be
contagious ?

"What do you consider to be the most common causes of
yellow fever )

"Hive you seen any person attacked with the yellow fever a
second time ?

Do you believe the human frame liable to be attacked with
this disease more than ouce?:,

To Dec tor Chevik

Sir: Fever is a unit I have long been of opinion that
there are various forms and modifications of fever, or in the lan-
guage of the illustrious Rush, that there are various symptoms
and states of fever, but, that there is in fact, but one fever.
Hence the nosological arrangement of levers, according to their
various forms and modifications, is calculated to bewilder the
mind and to mislead the unwary.

There are three forms of fever, viz: intermittent, remittent
and continued : theseare subject to various modifications, accord-
ing to circumstances, and constitute what is commonly called
tertian, quartan, quotidian, &c. The remittent and continued
forms of fever, have also their characteristic symptoms, but
which, it is foreign to my present purpose to detail.

There are regular gradations of fever, from the simple inter-
mittent, up to the highest grade of bilious or yellow fever. The
latter is not confined to, but is more frequently found in, tropical
climates. In the climate of Carolina and Georgia, the human
constitution at some period of life, from infancy to decrepitude,
is liable to every grade of lever. And these take place, accord-
ing to the greater or less juscepitibility of the subject, or accor-
ding to the greater or less intensity of the predisposing and exci-
ting causes. Persons accustomed to warm climates, or to the
atmosphere of those places which are surcharged with the
mephitic gasses, which arc principally instrumental in the pro-

183S.] Whitridge on Yellow Fever. 453

duction of the higher grades of fever, are less susceptible than
strangers. Persons from high northern latitudes, are more sus-
ceptible than those within the tropics. In this climate. Europe-
ans aro mare than Americans, and persons from the
northern section of the United States are more susceptible than
Carolinians. Strangers iire much more susceptible than natives,
or those who have been lomr resident. Native children, are
more susceptible than native adults.

That modification of fever usually demonstrated yellow fever,
is what now claims our more particular attention, and this is
generally of the continuous form.

The yellow fever is not a disease sui generua This then
being conceded, there are no diagnostic symptoms by which
(in popular Language) the yellow fever can be distinguished from
other fevers. It can only be known by a strict observance of its
symptoms.

The term yellow fever is objectionable, in as much as it does
not express that particular modification of fever, which is usually
described under that name, nor is a yellowness of the rete muco-
sum a symptom which invariably attends this modification of
fever. It depends in a great measure on the mode of treatment
pursued. Probably in seven-eights of the cases which occur, if
left to the operation of nature, this symptom would manifest
itself; but if an active and vigorous mode of treatment, upon the
mercurial plan, were pursued, in seven-eights of the cases, it
would be prevented. The same may be said of the black vomit,
which is generally considered a diagnostic symptom of yellow
fever.

The nosological arrangement of this modification of fever,
under the name of typhus icterodes, is also objectionable, in as
much as the word typhus, according to the Greek original, im-
plies a disease of low action. If it admitted of any classification!
it might with more propriety be arranged under the genus syno-
chus of Dr. Cullex, in as much, as it is a disease of a mixed
character, and in the southern section of the United States
generally partakes of the nature of those modifications of fever,
which he terms synocha and typhus. As the term yellow fever
is familiar to all, and as the symptoms which characterize this
modification of fever, are generally well understood, for the soke

454 Whitridge on Yellow Fever. [March

^ .

of perspicuity, I shall adopt the term, in the subsequent remarks,
according to its usual acceptation. The limits prescribed to
these remarks, will not admit of my giving a description of the
disease, nor is it necessary, as it has been so often and so well
described by medical writers.

This being premised, I proceed to answer your interrogations,
in as cursory a manner as possible, and

First. * Have you ever seen any case of yellow fever which
originated from contagion ?'

I answer, from the experience of several years practice in the
city of Charleston, where the yellow fever has frequently pre-
vailed, no evidence has ever been presented to my mind, to pro-
duce a conviction, that the disease is of a contagious nature.
I have often seen persons predisposed to fever, under all circum-
stances of exposure to the yellow fever, breathing the deoxi-
genated atmosphere of close apartments, both day and night,
often in contact with the sick, the dying, and the dead, in the
performance of the sad offices of duty or of friendship, and this
too without the least indisposition. To those subjects who are
predisposed to the disease, breathing the impure air of a sick
room, watching, fatigue and anxiety of mind, especially when
conjoined with the debilitating effects of fear, these may,
and no doubt often have proved, the exciting causes of yellow
fever. This combination of circumstances, will, in some meas-
ure, account for the erroneous opinions of those, who suppose
the yellow fever contagious. To those who have any experience,
the real character of the yellow fever is too clearly developed,
ever to be mistaken ; and to those who have not, (if they are
open to conviction, and will reason fairly and candidly on the
subject,) the facts and arguments before them are incontrovertible.

Second. ' Do you believe the yellow fever under any cir-
cumstances to be contagious V

From the foregoing statement, I certainly cannot believe it to
be so under any circumstances ; because, if it were contagious,
it would be a different modification of fever, or in other wordst
it would not be yellow fever, but some other fever.

Such, however, is the vague and uncertain use of language,
especially in regard to the use of the terms contagion and ivfec
Hon. and these, though words of very different signification,

1838.] Whitridge on Yellow Fever. 455

are so often confounded ; in order that I may not be misunder-
stood, it will be necessary for me here to introduce a few remarks
for the purpose of explaining what I understand to be the true
import and meaning of these terms, respectively. And this I
will do by the adoption of the woids of a friend, an accom-
plished and elegant writer, in preference to the employment of
language of my own upon this long mooted and vexed question,
which I trust, your laborious investigations, your indefatigable
exertions, will erelong settle forever.

Is it not remarkable, that the word contagion, a word of so
frequent use in professional writings, and in books of science,
should never have acquired a definite or precise meaning; that,
instead of being stamped with technical precision, as its impor-
tance demands, it should so long have been suffered to pass, as
a fluctuating and uncertain currency of common language?

From the indiscriminate use, the words contagion and infec-
tion, contagions and infections, as applied to diseases, would
seem to be synonymous or convertible terms ; yet no respectable
philologist, I think, will admit that they really are so. It is true,
we cannot resort to etymology, in all instances, for the best
authorized acceptance of words ; because long use, or, perhaps
it may be said, abuse, often renders that arbitrary. The particu-
lar use of words and terms, acquires, in this way, a sort of secon-
dary, and indeed, an obsolute legitimacy. But where this
has not been fully attained, where words continue to be used
in different senses, by different writers, and even by the same
writers, at different times, it would seem desirable to limit
their technical use, to accord, as nearly as possible, with their
radical meaning. But to give technical precision to a term, it
will often be found necessary to restrain its meaning, within
limits, somewhat arbitrary. Thus, the word contagion, in an
unlimited sense, might mean whatever, by coming in contact
with the body, is capable of producing disease. And as there
are probably few diseases which are not produced, either direct-
ly or indirectly, by some noxious principle, foreign to the body
itself, and applied either to its external or internal surfaces, it
would follow that, in this loose sense, a large proportion of our
diseases might be said to be contagious. A somewhat similar
remark would apply to the word infection. Without technical

456 Whit ridge on Yellow Fever. [March

limitation, it would perhaps, be nearly synon ;mous with conta-
gion ; except that the former would convey the idea of a poison
mingled with, or attached to, or imbuing some oilier body. And
as contagion must be supposed to be generally communicated,
through the medium of some body which, in common language,
is said to be infected with it, (for a body, in this sense, as well as
the atmosphere, may be infected with contagion.) it is not cl i 11-
cult to see the origin of the loose and indiscriminate employment
of the terms, infections and contagious diseases.

But, it appears to me, and I think it corresponds, in general,
with the usa^e of the most correct modern writers, that, to give
precision to medical language, the word contagion should be
applied to such poisons only, as originate in a diseased animal
secretion ; and are capable of reproducing themselves by exci-
ting, in a. sound body, the same specific action, in which they
themselves originated ', such poisens as were, originally, by
Mr. Hunter, and subsequently by Dr. Adams, denominated
morbid poisons. A contagious disease, the//, would be such
only, as is produced by exposure to those morbid- emanations,
which are generated by a specific vascular action, in one
labouring under a like disease.

"On the other hand, the term infection should be applied, I
think, to such poisons as are produced by the changes taking
place about inanimate matter, either animal or vegetable, during
their decomposition. And the circumstances, which seem most
to favour this process, are heat, moisture, and confinement ;
though the latter may have no further influence than to give
effective intensity to the poison. Infection, then, differs from
contagion, in this, that although the former may occasionally
arise from animal secretions, such as the matter of sensible, or
even insensible perspiration, or from the accumulated filth of
numerous individuals, crowded into small and uncleanly apart
ments, yet there is not, as in the production of contagion, neces-
sarily a morbid vascular action. Infection may be constituted
by deleterious miasma or poisonous emanations from the surface
of the earth, in certain situations; or it may arise from foul
matter, at various depths beneath the surface, decomposing under
the influence of long continued and intense heat, and thus, more
or less extensively, impregnate or infest the atmosphere. So, it

183S.] Whitridge on Yelloio Fever. 457

may sometimes be generated locally, as even in an empty hold
of a ship, or about, the persons and beds of the sick on shore, or
ill filthy apartments occupied by the sick; yet healthy individ-
uals, from abroad, who sicken by being- exposed to such infection,
do not necessarily sicken of the same disease as that about which
it originated. And of the individuals exposed to it, probably but
an inconsiderable proportion will sutler from its influence; the
relative number depending on the condition of body, and other
circumstances, in which the persons 'exposed may happen to be,
it the time. The same individual, therefore, will contract an
infectious disease, by an exposuie at one time, which at another,
precisely similar in all circumstances external to himself, he had'
escaped with impunity. Not so with contagion, its source is
uniform and certain ; of whatever kind it is, its origin is invari-
ably a specific morbid secretion ; and of those coming within its
active sphere, rarely one escapes its specific effect; this too,
scarcely influenced by circumstances of health,- habit of body,
temperature, or climate. It may be remarked, further, that in
comparing infectious diseases, all of which are acute in their
nature, with that class of contagions, which are also acute, the
former appear at irregular and uncertain periods, after exposure
to their cause ; whereas the latter are, in this respect, uniform
and certain."

Under this view of the subject, as well as from my own obser-
vation and experience, I do not believe the yellow fever under
any circumstances to be contagious.

Third. ' What do you consider to be the most common
causes of yellow fever?'

In answering this question, I shall divide the causes into two
kinds, viz: remote and exciting, and briefly enumerate the
principal. Under the first head, I shall include the predisposing,
and to the last, I shall add the proximate.

A combination of causes generally conspire to produce yellow
fever, especially that aggravated form which sometimes becomes
epidemical ; these may be divided into two kinds, viz : general
and local. I do not mean to be understood to say, that local
causes alone are not sometimes sufficient for the production of
yellow fever; but I do say, that a combination of both general
and local causes produces a more aggravated form of disease

45S Whitridge on Yellow Fever. [March

than either separately, and this combination will generally, per-
haps always, be found to exist in large cities and towns, when-
ever the yellow fever prevails as an epidemick.

The influence of the latter is limited, but the former spreads
far and wide.

Local causes may produce sporadic cases, and sometimes
endemial diseases ; general causes may assist in the production
of these, but a combination of both, or of the latter only, are
necessary for the production of epidemical diseases.

These observations are strengthened, by the fact, that when-
ever the yellow fever makes its apppearance in any of the large
towns and cities in the United States, (and the remark is particu-
larly applicable to the city of Charleston,) it usually commences
in the low, crowded, and filthy parts of the city, or wherever the
local causes act with the greatest force.

REMOTE AND PREDISPOSING CAUSES.

1st. Vegetable and Animal Miasmata.

Either of these, in a concentrated form, is sometimes suffi-
cient for the production of yellow fever ; but when combined,
they produce a higher grade of fever, or a disease attended with
more violent symptoms.

2d. Excessive Moisture.

This is manifest from the well known fact, derived from the
history of the diseases of Charleston, for the last half century,
that in very wet and rainy seasons, the yellow fever has been
more prevalent than in any others.

3d. Excessive Dryness.

It has been observed also, that in very dry seasons, the yellow
fever has prevailed much more, than in those seasons attended
with a due degree of moisture.

4th. Cold.

This may sometimes operate, both as a predisposing and ex-
citing cause, according to the manner of its application.

5th. Heat.

This may also operate, both as a predisposing and exciting
cause, according to the manner in which it is applied.

6th. Bad regulated Police.

183S.] Whitridgeon Yellow Fever. 459

7th. The prevalence of particular winds.

As for instance, the prevalence of easterly winds, is one
among many causes which conspired to produce that aggravated
form of disease, with which the inhabitants of the city of Sa-
vannah were scourged, during the season of 1811). This gene-
ral cause, operated, by bringing into action a greater portion of
the noxious effluvia from the swamps of Carolina and Georgia,
than could have been effected, by the prevalence of any other
wind. On the contrary, for the same reason, a general preva-
lence of westerly winds, besides being hotter, are more mis-
chievous in their consequences, and more productive of evil to
the citizens of Charleston, than any others. To us in the city
of Charleston, easterly winds in the summer and autumnal
months, are not only a great luxury, but a genera] prevalence of
them, is almost a sure guarantee of a healthy season.

8th. The debilitating passions of fear, grief and despair.

9th. All excessive evacuations.

The two last may also sometimes act as exciting causes.

10th. A constitution unaccustomed to the climate, or to the
remote and predisposing causes, tj'C. fyc.

EXCITING CAUSES.

1st. Excessive stimuli of every hind, such as intemperance
in eating and drinking, $*c.

2d. Cold.

This is a very frequent exciting cause, especially at night,
it operates by producing a sudden check, either of the sensible
or insensible perspiration, or both. The yellow fever ^has been
twice excited in my own system by this cause.

3d. Heat.

I have known several cases produced by exercise, under the
influence of the intense heat of the noon -day sun.

4th. Unusual labor or exercise.

5th. Violent emotions and stimulating passions of the
mind, tj'c.

B 2

460 WJiitridge on Yellow Fever. [March

PROXIMATE CAUSE.

A morbid excitement of the liver and stomach, producing a
morbid, increased secretion of those organs, and a sympathetic
action in remote parts of the systeiiv.

This, I think, maybe supported by numerous facts and argu-
ments especially those derived from dissection, but which my
present limits preclude me from advancing. I shall, therefore,
proceed to your fourth and fifth questions, which may both be
comprehended under one head.

Fourth. ' Have you seen any person attacked with the
yellow fever a second time?'

'Do you believe the human frame liable to be attacked with
this disease more than once V

In reply to these questions, I have only to observe, that, I my-
self have twice had the yellow {ever, to-wit : in 1817 and
1819. On both occasions, I suffered severely, under the cala-
mities of this formidable disease, and to the energetic powers of
medicine, alone, sitb providentia, I owe my life. My sufferings
on the latter occasion, were to me a convincing argument, of the
susceptibility of the human constitution, to receive the disease
" more than once." And further, the idiosyncrasy which had
been by four years residence in the climate of South Carolina,
(to which in 1S15, I was a total stranger,) and by once having
the disease, could not have been changed, because, I had not
slept a single night out of the city of Charleston, during the
two years which elapsed between my first and second attack.

Several cases have come under my observation, of persons
having the disease twice. Captain Boyle, late of the United
States Army, told me he had had the yellow fever several
years successively, in the city of New-Orleans; and 1 have no
doubt of the susceptibility of the human constitution to repeat-
ed attacks of this disease. But il must be admitted, that by a
long residence in a climate or place subject to the yellow fe-
ver, and especially by the disease itself, the constitution is ren-
dered less susceptible of a second or third attack, than of the
fust. It requires, therefore, a greater combination of causes, or
the same causes concentrated, so as to act with greater inten-
sity, to produce the disease in a constitution assimilated to the

1838.] Whitridgem Yellow Fever. 461

climate, than to a stranger, more especially one assimilated by
the disease itself. After the first, it requires an increase of force,
to produce every subsequent attack, exactly in the ratio of the
diminished susceptibility.

Having briefly answered your interrogations, I will now con-
clude my observations, which I cannot do without expressing
the high sense I entertain of the noble object of your pursuit,
and the pleasure it would afford me, could 1 contribute more to
the advancement of science and of truth.

Too much honor and too much praise, cannot be conferred
on that man, who so nobly hazards life, and expends fortune, in
the acquisition of truth, who undauntedly exposes himself to
all the dangers arising from an exposure to the remote and pre-
disposing causes of the highest grade of fever, who enters the
abode of the wretched and the distressed, from city to city, in
order to seek out the occult causes, and to ascertain the true na-
ture and character of yellow fever.

It is a pursuit important to the commercial, to the moral, and
to the scientific world.

It is a pursuit, in every respect worthy of the attention, the
zeal, and the indefatigable industry, of the philanthropist and
the philosopher.

That your life may be long preserved, and that you may be
enabled incontrovertibly to establish the true nature and cha-
racter of the yellow fever, is the sincere wish of,
Dear Sir,

Your obedient.

And very humble servant,
[Signed] J. B. WHITRIDGE.

Charleston. S. C.

402 Essay on Cancer. [March

ARTICLE II.

An Essay, read before the Medical Society of . 1 ugusta, on
the question, " What are the CI tar act eristic or Diagnostic
Simptoms of Cancer, whether in the state of Schirrus or of
open Ulceration." By Paul F. Eve, M. D., Prof of Surgery
in the Medical College of Georgia.

The importance of the above question, propounded to me at
the last meeting of the society, will readily be acknowledged by
every one at-all familiar with the various and very different
morbid appearances, which have been confounded with schirrus
and cancerous ulceration. It is confessedly no easy task, to
determine how carcinomatous affections are to be distinguished
from all other diseases. Even with the light thrown upon the
subject by the recent investigations in pathological anatomy, and
which has effected so much in the diagnosis of our diseases in
general, still a dark and heavy cloud obscures the one now under
consideration.

In order to answer definitely the question before us, I propose
a thorough examination of the different symptoms of cancer, as
recorded by the most distinguished writers on the subject ; for
it is alone by comparison that we can arrive at an enlightened
conclusion. And that our judgement may be correct, and the
views of no author misrepresented, I shall not hesitate when con-
venient, to employ the language of each, to whom reference may
be made. I do this the more willingly, as the opinion of
foreigners will be quoted to illucidate the subject of carcinoma.

Jt is proposed in the first place, to examine the symptoms of
cancer, whether in the state of schirrus or of open ulceration, in
connection with the pathological anatomy of these two condi-
tions of the disease ; and then to consider what is its peculiar,
characteristic nature.

Cancer is a Latin word and derived from the Greek carcinos,
signifying a crab, and is so called according to most authors
from the distended or ^aricosed veins existing over a schirrus
tumour, which the ancients compared to the claws of this animal ;

183S.] Essay on Cancer. 163

but some writers suppose it was employed on account of the
disease extending" bv whitish bands into the surrounding soft
parts, which resemble the feet of the crab. Without stopping to
enquire into the etymological derivation oi" cancer, or of
even questioning the propriety of the expression as applied to
disease, I proceed at once to its symptoms ; employing it or
carcinoma as a generic term, and intending by schirrus and
cancerous ulceration, the two very distinct varieties of this affec-
tion. So great indeed are the differences in the appearance of
this disease in its two states, that it is necessary to consider each
separately. In one we have a tumour, and in the other an ulcer.

In the classification of tumours, Laennec has very properly
admitted two distinct orders of accidental or adventitious produc-
tions. In the first class, are embraced those which have an
analogy to the natural tissues of the body ; and in the second,
abnormal productions which have none. It is among these lat-
ter tumours that schirri are placed.

A schirrus tumour is generally considered the forerunner of
open or ulcerated cancer. By the author of the article on this
disease in the Dictionary of Practical Medicine and Surgery,
published in Paris, 1830, schirrus is described as being compos-
ed sometimes of a perfectly white substance, at other times a
little blueish or grayish, slightly transparent, of such a consisten-
cy that ordinarily when cut it grates, and which varies from the
fat of pork to a hardness approaching that of cartilage. Com-
monly homogeneous, this matter appears to be divided in masses,
which are subdivided into loblues. united by compact cellular
tissue of a very variable form according to Laennec, but some-
times of a regularity like that of the honey comb. Many schirri
moreover, have a great resemblance to the substance of the
turnip, others to that of the chestnut.

Boyer, both in his Surgery and in his article on the subject,
in the 52d vol. of the Dictionnaire des Sciences Medicales, says,
a schirrus is a hard, moveable, circumscribed, resisting tumour,
ordinarily indolent or a little painful on pressure. Its almost
constant termination is in cancer.

Abernethy in the account of various tumours in his Surgi-
cal and Physiological Works, states that schirrus sometimes
condenses the surrounding tissues so as to form a capsule ; and

404 Essay on Cancer. [March

at other times the organ in which it originates seems to be a
nidus for the diseased action. In either instance the carcinoma
commences in a small spot and extends like rays from a centre.
This, says he, is a feature that distinguishes it from other disea-
ses, which generally involve a considerable portion at their first
attack. Another distinction is, that schirrus does not recede like
other tumours to medicinal treatment. It also destroys the skin
before it acquires any great magnitude.' Abernethy agreed
with Baillie in his pathological anatomy of the tumour ; parti-
cularly in his discription of the peculiar hardness, and intermix-
ture of the firm, whitish bands, having interposed between them
a brownish substance, or cells containing a pulpy matter of
various colours and consistence. As a carcinomatous tumour
increases, it generally becomes unequal upon its surface ; and a
lancinating pain is commonly felt, though it is not experienced
in every case.

Richter says, it is an inadequate and erroneous difinition of
schirrus, to call it a hard and painful glandular swelling, having
a disposition to become cancerous. He even denied the disease
to be regularly attended with swelling. But Sir Charles
Bell observes, that though the organ in which the disease
originates, (as the mamma for instance,) may diminish, yet this
is not true of the tumour itself. The general bulk of the breast
may be contracted, still the disease is a tumour ; there is an in-
creased mass, a preternatural growth, or new matter formed, cor-
responding to the old definition, morbosum augmentum.

Samuel Cooper, in his Surgical Dictionary, says, the puck.
ering of the skin, the dull, leaden colour of the integuments, the
knotted and uneven feel of the disease, the occasional darting
pains in the part, its fixed attachment to the skin above, and
muscles beneath and in the breast, the retraction of the nipple,
form so striking an assemblage of symptoms, that when they are
all present there cannot be the smallest doubt that the tumour is
a schirrus. lie also states, that without risk of inaccuracy, we
may set down the backwardness of a schirrus swelling to be
dispersed or diminished, as one of its most confirmed features.

When a section, said Sir Edward Home, is made in a schir-
rus tumour in its early stage, the centre is more compact, harder
to the feel, and has a more uniform texture than the rest of the

Essay on Cancer. 465

swelling, and is nearly of the consistence of cartilage. From
this, in every direction like rays, are seen, ligamentous bands of
a white colour passing to the circumference, as also others of a
fainter appearance in a transverse manner : the whole forming a
kind of net work in the meshes of which a softer substance is
enclosed. In a more advanced stage of the tumour, the diseased
part has a more uniform structure, and no central point can be
distinguished. According to Sir C. Bell, it is these ligamen-
tous bands which produce the retraction of the nipple in the
breast, by extendiug between the ducts and destroying its spongy
texture.

Sir Astley Cooper says, the swelling of schirrus gradually
grows from the size of a marble until it acquires two or three
inches in diameter ; for it rarely happens that the true schirrus
turbercle increases to a very considerable bulk, and this circum-
stance is one of its criteria.

In the article Cancer, by Bricheteau in the Dictionnaire
des Sciences Medicales, the physical characteristics of schirrus
are denned to be, a demi-transparent tumour, having a linear
disposition, often lobular, of the consistence varying from lard to
cartilage or fibro-cartilage, and composed of tissue which seems
to be of celluar production penetrated with albumen of a white,
blueish or greyish colour.

Dr. Gibson, understands by schirrus a preternatural density
or induration of the soft parts, not easily resolved and very prone
to ulceration. It is also recognised by certain external marks,
and by a peculiar internal structure. The whole tumour is
unequal on the surface, and uncommonly heavy: the pain is
vehement and of a peculiar kind at first prurient, but after-
wards lancinating and compared by many patients to the gnaw-
ing of an animal.

Besides these characteristic symptoms of schirrus, and the
peculiar pathological changes in the tissues affected, hydatids
are sometimes found existing in great numbers, and of different
sizes. This circumstance has probably given rise to the theory
ol the animalcular origin of carcinoma, which was entertained
by the late Dr. Adams, and which is still insisted upon by Mr.
( Jarmichael of Dublin.

Mr. Pearson declares he has never vet met with an une-

466 Essay on Cancer. [March

quivocal proof of a- primary schirrus in an absorbent gland.

He thinks it always commences in the secretory glands, as the
mamma, the pancreas, tisticles, &c. Should this idea be con-
firmed by experience, it would assist much in the diagnosis of
the disease in the state of schirrus.

By a comparison now of the descriptions given by the distin-
guished authors refered to, we find but little discrepancy in their
enumeration of the symptoms of cancer in the state of schirrus,
or of the pathological condition of the tissues affected by it.
All agree there is no one pathognomonic sympton or sign of it ;
but they also concur in an assemblage of them, which when
taken together, clearly and distinctly characterize a schirrous
tumour. Thus Bayli? and Cayol state that out of a hundred
tumours of the breast, all of which are hard, unequal, insensible
to pressure, and which have existed for more than a year, about
ninety nine are cancerous. Again, if a tumour presenting these
signs of schirrus, has resisted a treatment for chronic phlegmasia,
for scrofulous engorgement, &q. then is it certain that such a
disease is cancerous.

With respect to cancer in the ulcerated stale, it may be
remarked that writers generally coincide in representing it to be
an ulcer opening spontaneously, with hard, jagged and reverted
edges, of a very disagreeable aspect, from whose surface there
flows a foetid, acrid discharge, excoriating the surrounding skin,
which becomes of a purple colour, that of the sore itself being
M'a dark red. The patient complains of darting pain and of a
burning sensation over the whole ulcer, and which when exam-
ined presents no trace of cellular tissue, nor of vessel, nor of any
other normal structure, whatever may be the organ attacked.

Boyer however, . slates, that notwithstanding Che

!if. inequality , rough irregular shape of the ulce-

ration, the nature oft! tion and the pain, the indiscrimi-

nate d ion of all tissues, &c. yet they do not exclusively

chari It is only \ known by its return

when once operated upon ; this says he, is iheonly circumstance
which can remove all doubt on the subject of its disease.*

An iliat when-

ever pressed for a tlcci tal urc of a disease supposed to be cance-

rous, his uniform reply w.i i, " ij it returns after I cut il out, thru il is a cancer."

183S.] Essay on Cancer. 467

A question has originated of some importance in connection
with the characteristic symptoms of this disease, and which it is
well to notice at this place ; it is whether cancer ought alone to
be restricted to schirrus degeneration. Authors generally admit
that certain ulcerations may become carcinomatous, without
being preceded by the state of distinct tumour. The question
too, is I think decided by the admission of two separate classes of
cause producing cancer ; viz : an internal and an external.
For if an external injury or impression can develope a schirrus
tumour under the skin when entire, certainly a similar cause can
the more readily produce a like effect upon an ulcer. Be this
however, as it may, a genuine cancer in the state of open ulcera-
tion, is generally preceded by o schirrus degeneration.

As regards now the nature of cancerous disease, it may be
stated that we have nothing very satisfactory on this subject-
If it be an affection sui generis as it certainly is, this nature is not
as yet well denned. It is however, a subject bearing too much
upon the diagnosis of cancer, to be omitted, notwithstanding its
difficulties, in the present essay.

Cancer is to all intents and purposes a highly malignant
disease. None destroys more indiscriminately all the tissues of
the body, than it and fungus nematodes, with which it has often
been confounded ; and they are even to the present day, consid-
ered by nearly all French writers, as only a modification of one
and the same disease. Cancer, and fungus are placed by them
in the same arlicle, and treated as partaking of the same general
characteristics ; differing only in one being in a state of crudity
and the other in the state ot ramolissement. But this is certainly
a very great error.

Cancer, in its nature, differs essentially from fungus nema-
todes, in its seat, its progress, the contents of the tumour, and the
liability of the period of life to an attack. Cancer most fre-
quently affects the female mamma, uterus, testicle or the secre-
tory glands fungus, the extremities, internal organs, &c. Can-
cer is generally chronic in its course fungus is rapid. Cancer
commences with a hard, uneven, knotted tumour, which never
acquires any great size before ulcerating ; and when opened, the
contents are of a cartilagenous durity, even turning the edge of
a knife fungus is a soft, smooth, elastic tumour at its begin-
c3

46S Essay on Cancer. [March

ning, generally attaining a great magnitude, and when opened,
found to contain matter resembling the structure of the brain.
Cancer has a central point harder than the circumference of the
tumour fungus has nothing similar to this. Cancer is almost
peculiar to old age fungus to no particular period of life.
Cancer, in its progress, contaminates the neighbouring lymphatic
glands fungus never, but affects the internal organs, as the
lungs, liver, brain, &c. Two diseases having such differences,
cannot be of the same nature.

Cancer differs from gangrene. This latter, as has been said,
kills the parts it attacks, or deprives them of their vital proper-
ties ; while cancer, on the contrary, consumes, devours the tis-
sues still living. Abandoned to itself, cancerous disease never
recovers. It often does remain stationary, but when it changes, it
is always to increase and never to diminish. These general
characters, with those already mentioned, would seem to prove,
that cancerous disease is the effect of one and the same cause.
In the language of Bayle and Cayol, it remains to be establish-
ed, what is this cause. Is it black bile, according to Hippocrates
acid black bile, according to Galen a coagulable lymph be-
come acrid, after Boerhaave a foetid oil, alkali or acid or is it
a gas, according to some modern writers ? The truth is, we are
absolutely ignorant what is the cause of cancer.

Boyer supposed that cancer is formed by lymph, arrested in
its passage, and in the neighbouring cellular tissue, and that it is
the product of an internal constitutional cause. Abernethy
said it arose from a disordered state of health, and agreed with
Hunter that there is always a predisposition first in the system,
before the appearance of the diseased action. Bayle and Cayol
declared the disposition to cancer or cancerous diathesis, is the
true and only cause why the disease returns after an operation.
According to Andral, the fibrine coagutatcd in blood vessels,
constitutes, sometimes in the organs, a whitish mass, resembling
tumours called cancerous. Velpeau having had occasion to
observe some facts of this kind, concluded that cancer could be
developed primitively in the blood. But all this is little satis-
factory, and assists us very feebly in answering the question,
what is the true nature of cancerous action ? Were it true, that
cancer depended upon a constitutional diathesis, as these and

1S3S.] Essay on Cancer. 469

other authors, even Sir Astley Cooper, would have us be-
lieve, no operation could ever be permanently successful.

While I admit a predisposition to schirrus and cancer, result-
ing chiefly from old age, still I cannot believe that carcinoma
arises in all instances from an internal cause, or that like scro-
fula, the constitution is primarily affected by it. I must still con-
tend for the local origin of this disease, and that the system is
only secondarily invaded by its progress. All that has been
well established on this subject, the peculiar nature of cancer,
are the chronic induration with hypertrophy of the parts at-
tacked, the difficulty, if not the impossibility, to discuss or re-
solve such a tumour, its great tendency to malignant ulceration,
the destruction of all the tissues indiscriminately of the body,
and the occurrence of these circumstances at the age of about
fifty years.

Of all diseases, schirrus is most difficult to be distinguished
from inflammatory indurations and fibrous tumours. From the
first, it has been remarked, that chronic indurations are more or
less of a red colour, from the presence of blood invited by irri-
tation, into the part inflamed. They are, moreover, preceded
and accompanied by symptoms of inflammation. A fibrous
tumour differs from schirrus, in being more isolated from the
tissue of the organ affected ; in acquiring a large size without
ulceration ; in its fibres passing in every direction ; in the fibrous
disorganization being well supplied with blood, bleeding freely
when cut into or torn, which is never remarked in schirrus ; in
never giving pain, producing only inconvenience from its mag-
nitude ; finally, in its never degenerating into cancerous ulcer-
ation.

The last peculiarity of the disease under consideration, which
I shall notice, is its affecting chiefly the white tissues of the body,
as the breast, testicle, &c. Now it is this very structure which
approaches, in appearance, nearest the schirrus disorganization.
Who, for example, does not know that the female mamma, in its
healthiest condition, will turn or fracture the ed^e of the best
tempered knife ; or who, after a minute examination of its ducts
and anatomical arrangement, has not seen some parallel to the
whitish bands, &c, of a true carcinomatous tumour ?

In conclusion, I define the characteristic or diagnostic symp-

470 Essay on Cancer. March

toms of a schirrus to be, at its commencement, a small, hard,
moveable, circumscribed, and indolent tumour, ordinarily lo-
cated in a secretory gland, and occurring most frequently after
the forty-fifth year of age. It may remain stationary for years,
but cannot be dispersed ; generally in about twelve months the
tumour increases in size, becomes heavy, unequal or knotty on
its surface, forms attachments to the skin and surrounding
parts, which are converted to a leaden colour, and the patient
will experience darting, lancinating pain through the part affect-
ed. So malignant is the disease, that before attaining a diameter
of two or three inches, the tumour will have ulcerated. Origin-
ating like a local affection, the system soon becomes involved in
its progress.

A true schirrus dissected, will present a centre of a cartilagin-
ous hardness, with whitish bands seemingly composed of con-
densed cellular tissue, proceeding towards the circumference, in-
terposed by others passing in a circular direction, and the whole
enclosing a brownish pulpy matter, which exudes or may be
scraped from the cut surface.

I define the characteristic or diagnostic symptoms of cancer in
the state of open ulceration to be, an ulcer seldom less than two
or three inches in diameter ; commonly the result of schirrous
degeneration ; of highly malignant character, destroying every
tissue which it invades, and uniformly progressing. The surface
of the sore is very uneven, its edges are jagged, very hard, irregu
lar and prominent, the discharge is a foetid, acrid matter, and
the pain is acute and lancinating, or described by patients as a
burning, gnawing sensation. The neighbouring lymphatic
glands are sure to become affected ; and the ulceration when
removed is very apt to return, especially if it proceeds from an
internal constitutional cause.

The anatomico, pathological appearances of such an ulcera-
tion are, an indiscriminate disorganization of all the tissues
involved by it, and their conversion to an homogeneous, hard,
greyish or red, irregular substance.

IS3S.J Treatment of Anchylosis. 471

PART II.

REVIEWS AND EXTRACTS

A new treatment in a Case of Anchylosis. By J. Rhea
Barton, M. D.

In the North American Medical and Surgical Journal for
April, 1827, I published an account of a new and successful
operation at the hip, which had been undertaken for the two-
fold purpose of remedying a most serious deformity and lame-
ness, and of establishing an artificial joint, as a substitute for
the natural articulation, which had become obliterated by disease,
terminating in true anchylosis.

The principles upon whicn this operation was founded, as
well as the circumstances justifying the performance of it, were
fully detailed in the publication at that time.

In prosecuting my views for remedying lameness and deformi-
ty from the mal-position of limbs in cases of true anchylosis, I
have been enabled to present another case successfully treated,
under circumstances suggesting a practice of a peculiar char-
acter.

In the case of anchylosis at the hip joint, it is to be recollected
that the neck of the femur was sawn through, and the distorted
limb straightened. The wound of the soft parts was then healed,
whilst the reunion of the divided bone was prevented by subjec-
ting it, from time to time, to motion ; such as gentle rotation,
flexion, and extension, abduction and adduction. After continu-
ing this treatment for a few weeks, the ends of the bones lost
their disposition to unite, became obtunded and smooth, and were
held attached to each other by provisional bands or ligaments,
and in this manner forming an artificial joint, whose move-
ments were regulated by all the principal muscles by which the
original joint had been controlled : thus fulfilling the ends of
my operation, and rewarding my patient for his fortitude.*

* The patient, upon whom this operation was performed, enjoyed the use of his
artificial joint for six years; during which period he pursued a business (trunk-
making) with great industry, earning for himself a comfortable subsistence, and a
small annual surplus. Pecuniary losses, however, through the reverses of those in
whose hands he had confided his means, sunk him into a state of despondency and
desperation. followed by habits of intemperance. This. with all its train of evils, abuse
of health, &c. was, no doubt, the cause of the change which afterwards took placo
in the artificial joint. It gradually became more and more rigid, and finally all
motion ceased in the part. With this exception, the benfitfl of my operation wrere

472 Treatment of Anchylosis. [March

In the case now to be described, no attempt was made to
establish an artificial joint ; as the attending circumstances did
not admit of such a consideration. The object of my treatment
was to remove deformity, and to restore to usefulness a limb
which had unfortunately been suffered to become anchylosed in a
mal-position. The following will, I trust, satisfactorily explain
the operation and the after treatment of the case, as well as the
principles by which I was guided in the management of it.

S D 's, M. D., formerly of Charleston, S. C, but now

a resident of Alabama, when a youth of about nine years of age,
unluckily had his knee joint involved in inflamation and suppu-
ration so extensively, as to occasion the destruction of the syno-
vial membranes, the ligaments, cartilages, and, in short, every
structure peculiarly appertaining to the joint. After a protrac
ted suffering he finally recoved with the loss of the joint ; the
tibia, femur, and patella having become united to each other in
the form ot a true anchylosis. The loss of the articulation of
knee, however, though a misfortune, did not constitute the sad-
ness of his case. It was caused by the mal-position of the limb ;
th.3 leir having b^en flexed upon the thigh to a dagree somewhat
less than a right angle. Hence the only alternatives of which
he could avail himse.f to aid him in walking were, either to use
crutches, or to employ a very high block-sole boot, and to lower
his stature by flexing the sound limb in order that both feet
might: reach the ground. The latter expedient lie adopted.
The long continued pressure and weight of the body sustained
by this defective limb, acting under such great mechanical dis-
advantages, had at length caused some projection of the instep,
and other irregularities, which it is unnecessary to particularize.
This supposed irremediable condition of his limb, with all its
ills, the young gentleman endured during the period of about
sixteen years. In the mean time he graduated in medicine, and
became a successful and highly respectable practitioner ; but as
his professional labours increased, he found the condition of his
limb to be an obstacle not only to his further success, but also a
source of unceasing annoyance and vexation. Whereupon, with

retained and lull;, appreciated until the period of his death; for as the. limb had
been freed from deformity and restored to a useful position, he had no occasion even
for a cane t<> aid in walking. During an attack of the Asiatic cholera, he express-
ed a desire thai I should be sent for, in order that In- i iiiuJi t renew his bequest to me

ofthe parts interested in the operation, lie recovered from the cholera, but subse-
quently died of phthisis pnhnonalis. The autopsy exhibited the parts as described
in the published case, but with the artificial joint anchylosed; a change which had
been effected within two years previous to his death. With ordinary care, in all
probability, this would not have taken place.

The final history of this case presents now the important fact, that benefit had
resulted, which fully requited the individual foT the pains he had endured, and
were considered by him, even after the closure of the joint, yet an ample reward for
the operation he had undergone.

1S38.1 Treatment of And tylosis. 473

a resoluteness not surprising to those who knew the strength of
his mind, the firmness of his character, and the abundance of his
manly courage, he repaired to Philadelphia in order that some
relief might be obtained, if it were possible. When consulted by
him I found him fully prepared to learn that no benefit was to
be expected from any heretofore known practice, and that if he
could be relieved it must be by some novel expedient and treat-
ment.

After a candid and full disclosure of my views of his case, and
of the means by which I thought he might be benefitted, his
own judgment accorded with mine; and believing in the feasi-
bility of the plans, he became urgent for the undertaking. It
was accordingly commenced on the 27th day of May, 183o, and
pursued as follows :

Two incisions were made over the femur, just above the patel-
la. The first commenced at a point opposite the upper and
anterior margin of the external condyle of the femur, and, pass-
ing obliquely across the front of the thigh, terminated on the
the inner side. The second incision commenced also on the
outer side, about two and a half inches above the first ; and pass-
ing likewise obliquely across the thigh, terminated with the
other in an acute angle. By these incisions were divided the
integuments, the tendon of the extensor muscles of the leg, at its
insertion into the upper part of the pattella, and some of the con-
tiguous fibres of the rectus and crureus muscles themselves, a
greater part of the vastus internus, and a portion of the vastus
externus muscles. A flap, composed therefore of this structure,
was elevated from the femur close to the condyles. The soft
parts were next detached from the outer side of the bone, from
the base of the flap towards the ham, by passing a knife over
the circumference of it, as to admit of the use of a saw. The
flap then being turned aside a triangular or wedge-like piece of
the femur was easily removed by means of a small narrow bladed
saw ; such as was used in the operation at the hip. This wedge
of bone did not include the entire diameter of the femur at the
point of section ; so that a few lines of the posterior portion of
the shaft of the bone remained yet undivided. By slightly
inclining the leg backward, these yielded, and the solution was
complete. This mode of effecting the lesion of the bone was
designedly adopted, and constituted what I conceive to be a very
important measure in the operation. Important, because it ren-
dered the popliteal artery free from the danger of being wounded
by the action of the saw, and subsequently the interlocking of the
fractured surfaces tended to retain the extremities of the divided
bone in their positions until the harshness of their surfaces had
been overcome either by the absorption of their angles, or by the
deposition of new matter upon them a change essential to the

474 Treatment of Anchylosis, [March

ety oi the artery during the subsequent treatment of the case.
Not ;i blood vessel was opened which required either a ligature
or compression. The operation, which lasted about tive minutes,
being thus ended, the reflected flap was restored to its place, the
wound Lightly dressed, and the patient was put to bed, lying on
his back, with the limb supproted upon a splint of an angle cor-
responding to that of ike knee previous to the operation. This
position was maintained until it was believed that the asperities
of the bone had become blunted, and were not likely by their
pressure to cause ulceration of the artery beneath them " This
iirst splint was then removed, and another having the angle
slightly obtuse was substituted. In a few days a third splint,
with the angle more obtuse than that of the second, supplied its
place. Others, varying in degrees of angularity, in like maimer
came in their turn to support the limb until it had attained a
position almost straight. It was then unchangeably continued
in that line until the contact surfaces of the bone had united and
securely fixed the limb in this the desired direction.

During the treatment of the case, especial care was bestowed
in protecting the popliteal vessels against any injurious en-
croachment upon them. With that view, all antagonizing pres-
sure on the soft parts in the ham was carefully avoided. The limb
was rested on two long bran bags, laid upon the splint, with their
ends apart a vacancy of four or five inches being left between
them opposite the lesion of the bone. This interspace waslighly
filled with carded cotton, so as to afford a safe support. Every
symptomof pain or uneasiness in this part was promptly attended
to. The occasional issue of a drop or two of blood from the
corner of the sore, during the process of dressing the limb,
caused me some solicitude in this case; whereas, ordinarily I
should have considered it as a matter of no moment it being so
frequent an occurrence during the dressing of wounds, owing
to the disturbance of the granulations, especially in compound
fractures. The wounded soft parts finally healed and quieted
his anxiety. The straightening of the limb having been very
cautiously and by deg cted, the iirst two months elapsed

during the accomplishment of this object. Having then reduced
it to the desired position, means were carefully observed to retain
it so until the re-union of the bone had been fully completed;
which occupied two months longer. The constitutional symp-
toms were such as usually occur in compound fractures some-
what severe, but at no time alarming. Throughout the whole
treatment it was not found necessary to bleed him, or to have
recourse to any very active constitutional measures. He was occa-
sionally indisposed from irregularity in the digestive functions,
but was always speedily relieved by resorting to mild and appro-
priate remedies.

183S.] Treatment of AncHylo 475

At the end of about four months from the date of the operation
my patient stood erect, with both feet in their natural position,
and the heels resting alike upon the lloor, although a slight
angle had been designedly left at the knee, in order that there
might not be any necessity for throwing the limb out from the
body in the act of walking, which is always the c.
knee is quite straight. After this period, the use of shoes of the
ordinary shape was resumed, and the limb was daily exercised
with increasing strength and usefulness. On the 19th of Octo
ber, the Doctor took his departure for the South, bearing
with him the injunction to continue the support of a small
splint and the aid of a crutch or cane, until he should ac-
quire sufficient confidence in the strength of the limb to justify
him in laying them aside.

I was subsequently advised of his improvement ; but was
resolved not to give publicity to the case until the full and entire
benefit of the operation could be ascertained. The wide distance
which afterwards separated us prevented me from obtaining the
necessary and direct information until within a recent period.
I have the pleasure now not only to afford this intelligence, but
to present it in the most satisfactory manner. Having written to
the doctor for the information, and to learn from him in what
manner it might be agreeable that I should refer to him as the
subject of the case the following clear, satisfactory, and well
written answer was promptly received. As the letter is full
of interest in the case, I must be excused if I publish it
almost entire, even though it contains some flattering sentiments
for the one to whom it is addressed. That part only has been
omitted which is in courtesy to my family.

Charlestox, November 6th, 1^
"My dear sir, Your letter of the 8th October, directed to me
at Mobile, has just reached me at this place, where I am on a
visit to my parents. I received a letter from you last winter,
some months after its date, and availed myself of the opportunity
of a friend going to Philadelphia, and who promised me that he
would see you, to send you a full communication of my situation
then. I preferred this to writing by mail, as he had been with
me, and could answer any particular inquiries you might make.
On his return he mentioned that he had arrived in Philadelphia
only a few days after you had sailed for Europe. Your letter of
the Sth is the first information I have had of your return. I
have the satisfaction and pleasure of savins: to you now, that the
operation you performed on my leg has been completely suc-
cessful, and has more than realized my most sanguine anticipa-
tions. The small abscess, which you dressed the day before we
parted at Norfolk, continued open, and threw out. from time to
d 1

476 Treatment of Anchylosis. [March

time, small pieces of bone, until the August after, when the last
piece was discharged ; the orifice then closed, and I have suffered
no material inconvenience from it since. From the January-
previous, however, I was going about and attending to my pro-
fessional business; and early in the summer, when our sickly
season commenced, I was on horseback daily, riding from thirty
to fifty miles a day ; without more than the ordinary fatigue or
inconvenience. I am at present well ; the wound sound ; and
I feel no other inconvenience in riding or walking, than what
arises from my knee joint being stiff, which was the case before
you performed the operation. I walk without a stick or other
aid, with the sole of the foot to the ground, and my friends tell
me, with but a slight limp; and I have great pleasure in adding
that the leg and foot have increased considerably in size, so as
now to be nearly equal to the other. When I think of what I
was, and what I am ; and that to your firmness, judgement, and
skill, 1 am indebted for the happy change. 1 want words to
express adequately all that I feel. I will not attempt it, but
believe me, my dear sir, I feel it not the less. I shall remain here
a week or two longer, and if you wish any further information
on my case, do write me and I will give it most cheerfully.
After that period I cannot say where a letter would reach me.
Adieu. * * * * *

and am, my dear sir, very sincerely, your friend,

Seaman Deas.
To Dr. J. Rhea Barton.

P. S. In the statement you propose publishing of my case, I
am quite willing you should refer to me in the manner you sug-
gest, using my initials in the body, and my name at length in the
note you propose appending to it."

Remarks. In the case just recited, several difficulties of a
peculiarly embarrassing nature presented themselves as obsta-
cles to the restoration of this disabled limb ; namely, the true
character of the anchylosis, the extreme angle at which the joint
was fixed, the changes of structure which must have taken place
during the past sixteen years, and the probable condition of the
flexor muscles of the leg. As these had not been called into
action since boyhood, it was questionable whether nature had
contributed to their growth in proportion to the development of
the other parts of the body ; or if she had, whether their contrac-
ted and inactive state for so long a time had not rendered them
functionless and unyielding. It was not improbable, also, that
the blood-vessels had acquired adhesions and an organic angular
form at the bend of the knee. The operation was devised, and

1S3S.J Treatment of Anchylosis. 477

the treatment pursued, with due regard to all these .chcum
stances.

It must be apparent that, if the tabia and femur could have
been disengaged from each other at the point where the original
joint had existed, this should have been the selected spot ; but it
was forbidden by the bulk of the condyles, the adhesion of the
patella, by the extent to which the incisions would have been
required, and by the disadvantageous position of the popliteal
artery, as it lies embedded in the recess between the condyles of
the femur.

The most eligible spot for the section of the bone is that availa-
ble point which is nearest the original joint, and is at the same
time free from these objections. Hence the choice which was
made.

The flap elevated from the bone was composed of parts which,
in a natural state of the knee-joint, it would have been improper
to have divided ; but as the articulation had been annihilated,
the functional importance of the parts appertaining to it had
ceased; consequently no material disadvantage was to be appre-
hended from a division of them. The shape and direction of
the flap were believed to be those best suited to the necessary and
convenient exposure of that portion of the bone which was to be
exercised, and with the least possible injury to the adjacent parts.
The profile of the piece of bone which was removed formed a
tolerably accurate equilateral triangle. Its shape was of impor-
tance to the success of the case ; and the angle at which the sec-
tion should be made became a matter of calculation. If it had
been cut at too acute a degree the new surfaces would have reach-
ed each other before the limb had been sufficiently extended ;
if at too obtuse an angle, the leg won Id have borne full extension
without entirely closing the gap. The reunion, consequently,
might have been prevented. If a single transverse section of the
bone had been made, instead of the above, there would have been
a necessity for great elongation of the flexor muscles of the
leg and yielding of the other soft parts behind the knee, and if
accomplished, there would have been left between the divided
surfaces of the bone a large triangular gap or chasm, which
would most probably have occasioned a false or artificial joint,
without the requisite muscles to control its movements. By the
excision of the wedge-like or triangular piece in front, the axis
upon which the bone turned was brought so near to the muscles,
or their agents, the tendons in the ham, that a slight deviation
from their direction only was required, instead of an elongation
of their fibres. In proportion, also, as the limb was extended,
the chasm in the bone, occasioned by the removal of the piece,
became diminished; and upon the restoration of the limb to the
nearly straight line, the gap was closed by the approximation to

478 Lithotomy. [March

contact of the sawn faces of the bone, in a manner resembling
the corresponding surfaces of an oblique fracture, when accu-
rately adjusted.

It is not the least interesting circumstance connected with the
history of the case, that the subject of it was an enlightened phy-
sician one capable of appreciating our profession as a science
and for the undeniable proof which he has afforded of his confi-
dence in it, he fully merits: our thanks, as well as all the special
benefit which he has derived from the operation. Amer. Jour,
of the Medical Sciences.

Lithotomy.

.On contemplating any surgical operation which has proved
as dangerous on the hands of the ablest surgeons, as Lithotomy,
the practitoner who has been no more accustomed to its perform-
ance than the generality of those who are distributed throughout
our widely extended country, feels the necessity of something
like a practical formula which will afford a clearness of view,
and decision and confidence in every point appertaining to ulti-
mate success. However dexterous and successful he may have
been in other operations, he feels that, in Lithotomy, surgery has,
with the best practitioners, effected a smaller proportion of good
success than in almost any other operation. Peddling Lithoto-
mists who have had their day in Europe, have indeed operated
boldly by a rote formula, without science, and with various, but
not very good success boldly, because like the steamers, they
were most stupidly and culpably ignorant of the dangers into
which they plunged. Their formulae have been taken up and
adopted by men, accomplished in anatomical, physiological and
pathological knowledge and surgical dexterity; with but little bet-
ter success. The ill success which has too generally attended this
operation, has been so much believed to be inseparable from the
nature and importance of the anatomy concerned, as to lead to a
thorough anatomy of the seat of the operation, and finally to the
efforts of Civiale and others for avoiding entirely the dangers
of the gorget, by substituting other plans of operation on the
stone, which have hardly equalled the first expectation. Yet
they are more freely ventured, because the dangers of the knife

183S.] lAtholomy. 479

or gorget are not in array before the practitioner. But Dr. Dud-
ley's success in this operation has been such as is calculated to
impart confidence in the general contemplation of lithotomy;
and as this operation, apart from its dangers is calculated to be
more thoroughly successful, and even less painful than those
which spare cutting instruments, we think it important that the
whole management of this operation should be fixed in the
mind of the practitioner. We are aware that the best showing is
made of Dr. D"s. success in this operation, and that all kinds of
cases which may be numbered for increasing the numerical
showing of success have been thrown in and counted ; but still,
peculiar circumstances have thrown a larger proportion of cases
of this kind into the hands of Dr. D. than fall to the lot of most
surgeons ; and he has consequently become more familiarised to
their treatment in this way, and more confident in the underta-
king. It should be remarked however, that he who will under-
take the management of all cases of urinary calculi, may not
expect a nominal success equal to this reported of Dr. Dudly,
because, like many other practitioners who have a special eye to
fame in naming his proportionate success, he has only operated
on favorable cases, or such as he was able to render so by pre-
vious treatment. Still we are pleased with his formula, and feel
that it is one calculated in its nature to inspire a more than usual
confidence in the operation. And in all this, we think there is
no point of more special importance than that of due preparation
of the patient, and the fact of his being absolutely free from all
other pathological conditions.

Dr. Dudley's operation is of itself, simple and easy having
nothing new or peculiar ; and from the effect of due preparation
of the system, and exemption from other diseases, in many other
cases as catarrhal affections, amputations, accouchement, &c, we
are bound to attribute whatever little success which may have fol-
lowed Dr. D's. operations for the stone, more to the due regard to
preparation and the excellent nursing and subsequent manage-
ment, than to all other particulars of his practice : that is to say,
that altho his operation is unobjectionable, it is not new, and
could not produce a greater proportion of good results than it has
before done, without due regard to the previous state of the sys-
tem, and to the subsequent gocd management. The importance

480 Lithotomy. [March

of due preparation of the system cannot be too strongly pressed
on the attention of all practitioners. It should be borne in mind
that cet. par. a due and judicious regard to this will give better
success in the practice of midwifery : and that the immense differ-
ence in the result between cases of small pox by inoculation, and
those from its reception in the natural way, is attributable, not
in the least to the fact of inoculation, as this is only another way
of applying the same cause ; but to that preparation of patients
which is duly attended to before the disease is voluntarily com-
municated.

We cannot do so much justice to this subject in any other way,
as by giving the entire formula contained in Dr. J. M. Bush's
paper on Dr. Dudley's operation, contained in the Transylvania
Journal of Medicine.

"Whether the deranged state of the stomach, in the patients,
who come to Lexington for surgical operations," says Dr. D.,
" be the result of irritation or any other morbid action, (we
have not seen a case of inflammation of the organ,) Professor D.
has secured his unparalleled success chiefly by the liberal use of
emetic medicines. To see the paramount importance he attaches
to a perfect preparation of the general system, of all his patients,
who are to submit to the knife, is to witness his seemingly te-
dious course, under such circumstances. While we have known
a patient arrive on one day, with cataract, or a tumour, or hy-
drocele, "or stone in the bladder, or any disease small or great,
and put upon the table the next day for operation ; we have seen
another remain several months, undergoing treatment all that
time, to change morbid actions of the digestive apparatus to
healthy."

Professor Dudley " condemns most earnestly the use of the
lancet, as a preparatory mean for the performance of operations ;
a practice that is reprobated now, we believe, universally, by the
most intelligent surgeons of every country."

Professor Dudley does not consider ulceration of the bladder
as forbidding the operation, provided, by proper treatment.

"The digestive organs are restored to their natural actions,
the agonizing paroxysms of pain retire, the discharges of blood
and muco-purulent matter subside, and clear inoffensive urine
appears in more copious and natural discharges."

Under such circumstances he has successfully operated.

The following is the course of treatment pursued by Prof. D.,
as detailed by his friend :

'; When a patient applies to Professor D. with the ordinary

1S38.] Lithotomy. 481

symptoms of stone ; to ascertain its existence, the first step of
course is to explore the bladder with .a metallic sound. This
simple but indispensible operation, however, he never performs,
in any case, for several hours after the arrival of the patient ; and
not even then, if there be pain in the organ or the slightest fever.
For it is considered highly detrimental to the sufferer, to disturb
the constitution while thus deranged, even with an instrument
usually so harmless. Should the general condition of the pa-
tient's body not otherwise forbid, the day after his arrival, he is
sounded, having taken a general warm-bath the evening pre-
vious. But if he be suffering with paroxysms of the stone, and
his blood-vessels exhibiting febrile action, with a deranged state
of the alimentary tube, more energetic treatment is required be-
fore the instrument is passed into the bladder. Nauseating po-
tions of ipecacuanha or tartar are exhibited, and should these
fail to reduce the pulse and restore cutaneous action, or a proper
condition of the bowels, aided by the bath, an emetic, or cathar-
tic, or both, are then superadded, with light and abstemious liv-
ing. By these means two objects are effected. The first, is a
prevention of any irritating results from the examination of the
bladder ; the other is that so much is gained in the preparatory
management of the general system. Until he is completely sa-
tisfied that all the organs are in the healthy performance of their
various functions, he will not operate. When, however, it is be-
lieved that the patient is ready, having been one or more times
sounded, he is placed on the table and tied ; immediately the
staff, being oiled, is introduced into the bladder, and left resting
upon the stone ; when the assistant grasps it firmly, to maintain
it in the bladder, at the same time holding it perfectly perpendi-
cular to the table, carefully avoiding any inclination of it to the
right or left. The convexity of the instrument being distinctly
felt in the mesial line of the perineum, the operator, seated in a
convenient chair, with his instruments spread on his right, pro-
ceeds to the operation. While the left hand controls the scrotum
and perineum, the right makes an incision, with a middle size
convex-edge scalpel, beginning a little below the root of the
scrotum, and terminating an inch, more or less, behind the verge
of the anus, in a straight line, through a point midway between
the verge of the anus and the inner edge of the left tuber ischii.
This cut divides skin, subcutaneous tissues, and pereneal fascia.
The second stroke of the knife is not so extensive, it divides only
the posterior fibres of the accelerator urince, and transverse peri-
nei muscles. Always at this stage of the operation, if the perine-
um be remarkably concave, presenting an inclined plane, or if
the arch of the pubis be much contracted, Professor D. introduces
the left middle-finger into the rectum, and draws off the bowel
to the right. The fore-finger then placed in the wound conducts

482 Lithotomy. [March

the scalpel through the membraneous parts of the urethra into
the groove of the staff, cutting from the rectum towards the bulb.
The scalpel is now laid aside and the gorget is taken up, the
beautiful instrument of Mr. Cline ; with its cutting edge towards
the pubic arch; its beak is made to engage the groove of the
staff, while the assistant resigns the latter to the surgeon's left
hand, who for an instant playing the two instruments against
each other, lateralizes the former, turning its cutting edge to the
left, poises it for a moment, perfectly horizontal, beibre he plun-
ges through the prostate into the bladder. At the same moment
the gorget is passed with the right, the left hand depresses the
handle of the staff; the bladder being opened, the staff is with-
drawn, and the surgeon's fore-finger of the left hand, directed by
the gorget, is passed into the bladder, and the instrument with-
drawn ; the wound in the neck is dilated, forceps introduced,
the calculus seized, and by steady, firm, and dilatory movements,
from below upwards, and from side to side, the operation is com-
pleted by the extraction of the stone. The bladder is now cau-
tiously explored with the scoop, and if found clear is filled with
warm water from a syringe ; the patient is untied, turned to his
left side and thus put to bed, and is required to maintain the posi-
tion for from two to four days. We have seen professor D., in
making this operation, release his patient in forty seconds from
the first incision, while upon other occasions, twenty minutes
were consumed before the extraction of an enormous calculus
could be safely effected. He makes it a principle never to operate
in any case against time, but always firm, deliberate and dexte-
rous, he goes through what, is before him with a rapidity compati-
ble with circumstances and the safety of his patient. In the
operation of lithotomy especially, his incisions are made with the
greatest expertness and brilliancy ; and notwithstanding we have
repeatedly assisted him, we have not realized the moment when
the gorget was passed, the staff withdrawn, and the finger thrust
into the bladder ; these three different points of the operation,
always seem to be the work of an instant.

" In all his operations, he has used but two sizes of the gorget,
the smaller seventenths, the larger eight-tenths of an inch broad
in the blade. With the latter instrument, ho has made an inci-
sion through which was safely extracted a calculus, three and a
half inches in its long diameter, two and a half in the short, and
eleven in the circumference.

" It is evident that the larger size of the two is not wide enough
to divide completely the prostrate laterally, in the adult, or even
at any age from twelve years to maturity ; while with the smaller
gorget, the prostrate of the child from three to twelve is entirely
safe from the invasion of its capsule. Certainly the opening made
into the bladder, by cither of the two instruments, is often very

1S38.] Lithotomy. 483

disproportionate to the size of the stone, still in one hundred and
forty-three cases, in which those identical gorgets have been
used, calculi varying from the size of a pea to that of the magni-
tude just cited above, have been extracted, with complete success
and safety to the bladder, in all cases ; and in but four did the
subject die before he had time to enjoy the happiness of a cure.
Yet in those four cases, which failed to realize the benefits of the
knife, in consequence of the supervention, or aggravation, of
other diseases, beyond the control of remedies, the bladder healed
before death, or they passed the usual period of closing.

"Some surgeons when they have cut into the bladder, and
ascertained that the stone is very disproportionate to the extent
of the incision, prefer using cutting instruments a second time,
with the view of extending the cut in the prostate and neck of
the bladder. This practice our teacher has never adopted ; but
on the contrary always condemns. He contends, it is more phi-
losophic surgery, in such cases, to extract the stone by increased
attractive force, risking even a certain degree of larceration. No
surgeon estimates more highly than he the advantages of a clean,
smooth incision ; but his extensive experience, in the operation
of lithotomy, has entirely satisfied him, that the danger so gene-
rally ascribed to violence done the deeper tissues, in larceration,
is not at all comparable with the beneficial consequences of such
practice. Indeed the results of his mode of operating, under cir-
cumstances of a large calculus, induce him to inculcate the prin-
ciple, that it is better, safer to extract by force, according to the
size of the stone, than to resort a second time to the knife. In
every instance, where he was required to remove a stone, which
he commanded with forceps in the bladder, he had uniformly ex-
tracted by gradual dilatory and tractive force, without in a single
case dragging away any of the soft parts.

"Every surgeon understands the great facility with which a
calculus may be taken from the female bladder, so dilatable are
the parts concerned in the operation. Unless the accretion be
of unusual magnitude, Professor D. does not in the female use
any dilating means previous to the moment of commencing the
operation. After the patient is throughly prepared, and it is as-
certained that the calculus is moderate in size, he proceeds
directly to the operation. The same position is required as in
lithotomy. With a graduated supply of forceps, he first intro-
duces the smallest size, and gently expands the blades, in various
directions, until the urethra and neck of the organ will admit the
next size instrument ; so on until with forceps of a proper kind,
he can grasp and remove the calculous body. We have wit-
nessed this operation, made upon a little girl six years of asfe,
completed in forty minutes by the removal of a stone of the size
of a pigeon's egg, and the pain did not seem to equal that caused

E 5

4S4 Descriptive Anatomy. [March

by the extraction of a similar size body in lithotomy. This
patient was perfectly well in five days after the operation, with-
out the loss of the powers of the sphincter vesica:. If the urethra
and neck of the female bladder is so extremely relaxable, under
the influence of instruments, without the aid of incision, why not
expect to find the same accommodation in parts similar in the
male, with the addition, to be sure, of the prostrate body ; a piece
of anatomy, that Nature seems to have constructed with a pecu-
liar fitness to facilitate extraction, doing away the necessity of a
dangerous encroachment with the knife, beyond the point of its
fibrous envelope. The prostrate gland appears not only to pos-
sess the property of ready and innocent larceration, splitting of
its tissues, but also of extensive dilation ; and indeed it would
appear that its strong capsule was also accommodating in relax-
ing character.

" The operation completed, the patient is put to bed without
the slightest dressings of any kind, but required to remain on the
left side, until suppuration is established. He is not disturbed,
even with sponge and warm water until twenty-four or thirty-
six hours after the operation. From his long experience Pro-
fessor D. does not fear infiltration of urine ; nor has he any rea-
sons to adopt means, such as catheter and sponge, or any materi-
al for the purpose of plugging the wound, since such a result
never has followed his operations. Infiltration unquestionably
does occur in many cases, and sometimes terminates in slough-
ing or mortification of the parts involved, and even in the death
of the patient. But we do not believe that either of those unde-
sirable effects do follow, (unless in very rare cases,) as a mere
result of the operation. We should rather ascribe such a state
of things, nine times in ten, to the ill condition of the general
system previous to and at the time of the operation. Under such
circumstances serious wounds of any description, are, most assu-
redly, far less manageable than in the opposite state. Then
when the perineum, the urethra, prostrate body and neck of the
bladder have suffered a solution of continuity, when morbid
actions arc existing in the economy, nature too often must fail
in her restorative attempts, while healthy progressive inflammation
cannot develope itself sufficiently to erect barriers to the diffusion
of urine; adhesive lymph is not thrown out in sufficient abun-
dance along the incised parts, thus to restrain the limits of the
urinary discharges."

Anatomy of the Lymphatic System.

It is a sign of a healthy condition of the professional mind;
when wc observe a disposition to cultivate anatomy, and to ex-

1S38-] Descriptive Anatomy. 485

tend the knowledge of its facts. The accurate determination of
the latter is so inseparably connected with the science of medi-
cine, that the increase of our acquaintance with them must ne-
cessarily lead to its improvement.

The diffusion of such knowledge is a great desideratum. It
is not, however, very readily effected, for the majority of per-
sons are prone to seek for the minimum, not the maximum, of
attainments which will keep them afloat in their respective oc-
cupations, and far too many medical men, who have studied
anatomy as a task, are apt to regard it with disgust, and to hug
the idea that a small quantum of it will serve them in the prac-
tical part of their profession.

It is not necessary for us to combat such a notion with elabo-
rate arguments, nor to bring the heavy battery of reason against
so obvious a fallacy. One consideration is sufficient of itself to
overthrow it. The signs and symptoms of disease are no more
than altered states or functions of the organs or the tissues : it
therefore follows as a necessary consequence, that the more in-
timately we understand the normal condition of those tissues and
organs, the more accurately, we shall understand their disor-
dered states, more accurately, in short, we understand disease.

If the man who is content to be a routinist, could calculate on
always meeting with routine cases, there might be some sort of
petty and contemptible rationality in his election. But, in the
simplest case, contingencies may supervene, and complications,
more or less obscure, may arise. Will any man of honour, will
any man of prudence, voluntarily set out in life, with the deter-
mination to do just as little as possible, towards making "himself
master of such complications and contingencies?

If we appeal to experience, every-day experience, we must be
satisfied of the de facto superiority in practice of the surgeon or
physician who is thoroughly versed in anatomy. Of course we
do not say that an excellent anatomist may not be a deplorable
practitioner. That is not the point. The position we contend
for is, that cseteris paribus, the better the anatomist the better
the practitioner, and that the reasonable cultivation of anatomy
does not tend in any way to incapacitate persons for practical
pursuits. We admit that men who spend all their time in the
dissecting-room, who think of little else, work at nothing else
we admit that such men are conversant only with the dead, and
cannot be expected to be otherwise ; but that is not the kind of
anatomical study we are talking of. We wish every surgeon
and physician to continue to take an interest in anatomy after
his collegiate examinations are over to look at the bet anatomi-
cal works to keep himself at the level of advancing anatomical
knowledge. We do not urge the high consideration, that it is
pleasant ^o feel we are not mere laggards in science, but merely

486 Descriptive Anatomy. [March

hint the more homely, but perhaps the not less potent one, that it
is useful to know as much as other people.

It has been generally stated in most works, on descriptive anato-
my that lymphatic vessels may be discovered in every part of the
human body, except in the substance of the brain, spinal marrow,
eye and placenta. The recent researches however of M. Fohmann,
Panizza, Arnold, and some other continental anatomists, have
shewn that this assertion is not strictly correct, and that it is to
be received with certain limitations. The first of these authors
has described and represented with great care numerous lym-
phatics in the membranes and on the surface of the brain, and
also those of the umbilical cord and of the placenta. Arnold
says that he has detected lymphatic vessels in several of the tis-
sues of the eye ; but this annoncement has not certainly been
confirmed by the dissections of others ; and, in the opinion of
many, even the authority of M. Fohmann has not been deemed
sufficient to establish the existence of lymphatics in the placenta.
M. Panizza, for example, certainly one of the ablest writers on
the absorbent system, confesses that he is not satisfied of the truth
of this statement.

Leaving therefore these points of dispute, we shall now very
briefly detail some of the most interesting and best ascertained
facts, relative to the lymphatic system.

According to M. Breschet, the cellular tissue is the principal
source or ground work whence the lymphatic vessels take their
origin ; it is the soil, so to speak, in which their extreme roots
strike and ramify.

If we observe lymphatics proceeding from, and seeming to arise
out of, the substance of many organs of the body, it is because
cellular tissue constitutes the basis and elementary component
of these organs ; and hence we find that those very parts, into
which the cellular tissue does not enter, are destitute of these
vessels as, for example, the nails, horns, the epidermis, the hair,
and the enamel of the teeth. Mascagni long ago announced
the opinion that all the white tissues of the body are actually
formed or composed of innumerable lymphatic vessels an opin-
ion too vague and general to be received as quite correct and
more lately M. Cruveilhier has stated in his descriptive anatomy
that he deems it very probable that the cellular tissue and serous
membranes primarily and chiefly consist ot a meshwork of these
vessels.

There are two methods in which the lymphatics of serous
membranes may be exhibited either by inserting the sharpe
point of the usual apparatus, used for injecting these vessels and
filled with mercury, into the substance of the membrane, or by
introducing some colored liquid into the cavity lined by it, during
life, or immediately after death. Those of synovial membranes

1S3S.] Descriptive Anatomy. 4S7

may be discovered in the same manner. The lymphatics of the
dermoid tissue have of late years been examined with great care
by Lauth, Fohmann, and by M. Breschet himself. He has des-
cribed them minutely in his work on the structure of the skin
published at Paris two years ago. They are exceedingly nume-
rous, and appear to be, for the greatest part, more superficial than
the vascular capillaries. No trace however of any open orifices
on the surface of the dermis can be discovered, even with a
strong magnifying glass. Some anatomists indeed have stated
that they have observed globules of the mercury ooze out, when
pressure was made on the skin at the same time ; but this
phenomenon is ascribed by Breschet and others to rupture of the
lymphatics, and not to simple exudation from them. He con-
tends therefore that there are no discoverable open extremities of
the lymphatics on the surface either of the skin, or indeed of any
other tissue of the body.

M. Panizza takes the same view of the subject. He details
several experiments, in which he made a very successful
injection of the superficial lymphatic plexus of the glans penis,
and wherein, on carefully removing the epithelium, no trace of
any exuded globule of mercury could be found.

The mucous membranes, like the skin, give rise to numerous
lymphatics ; so numerous indeed, that they, along with minute
blood vessels and nerves, appear to constitute the villosities on
their surface. Although no open orifices have ever been disco-
vered in mucous membranes, MM. Cruveilher and Magendie are of
opinion that such do really exist.

They allude to the results of several experiments, in which
the abdomen of a living sheep was opened, and milk introduced
into a part of the gut. When the distended portion of the o-ut
was compressed with the hand, the lacteals were immediately
filled with the white fluid. M. Breschet however is not satisfied
with the details of these experiments ; and he very justly says that
all forcible compression -of the gut should be avoided in conduct-
ing such experiments, as it may possibly cause a rupture or
laceration of the extreme ends of the tender vessels. However
this may be, no person has ever seen the open orifices of the
lacteals on the surface of the villi ; and our author is therefore
quite correct in condemning the practice of assuming the rationale
of physiological phenomena, merely because these may be ex-
plained in a particular manner. It is exceedingly probable that
imbibition or some similar process, has something to do with the
introduction of the chyle and lymph into the extreme absorbents.
But in truth all that we know with certainty is, that we know
nothing certain on the subject. It remains a problem for future
anatomists to solve.

Equally gratuitous is the doctrine, that the lymphatics are

488 Descriptive Anatomy. [March

continuous with, and arc derived from, the extreme capillary
branches of the blood-vessels. It is well known to anatomists that,
by pushing a fine injection into an arterial trunk, the lymphatics
of the part sometimes receive a portion of the injection. This
experiment has been deemed quite sufficient by many writers to
establish the reality of a direct inosculation of the two sets of
vessels ; nay Lippi has gone so far as even v to represent such a
connection in one of his engravings.

M. Breschet however, and, we believe that wc may add, almost
all the best anatomists of the present day do not admit the truth
of this doctrine. They attribute the passage of the injection in
the above experiment to extravasation from the minute arteries,
and to consecutive absorption or rather impulsion of it in the
lymphatics. Our author closes his remarks on this subject by
adopting the opinion of Panizza, that "anatomy has not. hitherto
succeeded in determining, with physical certainty, in what rela-
tion the sanguiferous and lymphatic systems stand to each other,
at their extreme ramifications." If we suppose that the cellular
tissue itself is in fact made up of a mesh work of lymphatic
vessels, we perhaps get rid of the difficulty ; but even then we
cannot state, with any degree of precision, in what manner the
lymph and chyle do enter into the vessel themselves. We
know that the lymph and chyle contain numerous globules of
considerable size, larger even than those of the blood. The
question comes to be, How do those gain admission ? or are we
to suppose that they are developed within the tubes of the lym-
phatics themselves ?

We thus encounter fresh difficulties at every part of the in-
vestigation ; and it is therefore much wiser to confess our total
ignorance of the subject.

Nothing is of greater importance in all physical researches
than to acquire exactitude at every step of our investigation.
Whenever we begin to frame hypotheses, unsupported by actual
observation, merely for the purpose of giving a probable expla-
nation of certain phenomena, we are almost sure to be bewil-
dered in the mazes of our own making. We shall therefore
leave the subject, on which we have been discoursing above,
merely repeating our own former statement that no anatomist
has yet seen any open orifices of lymphatics m any structure of
the body, either in man or in the lower tribes of animals.

We now proceed to another topic, in the history of the human
lymphatic system, which has given rise to much difference of
opinion. We have confessed our ignorance of the relation
which exists between the capillaries of the sanguiferous and of
the lymphatic systems. It now remains to be detemined what
knowledge we have respecting the conection between the larger
v^sels of these two systems.

1S3S.] Descriptive Anatomy. 489

It has often been conjectured by anatomists, that there are
some other communications between the lymphatics and the
veins, in the human body, in addition to the thoracic duct, and
the lymphatic trunk which proceeds from the right arm and
usually terminates in the right subclavian vein. That such
communications do. exist in the lower classes of vertebrate ani-
mals is proved beyond doubt by the researches of Fohmann,
Lauth, Panizza and Miiller. They are obvious on the intestines
and the mesentery in fishes, on the thigh in the frog, and on the
lower extremities and the intestinal canal in birds. INo such
communications however are discoverable in any part of Mam-
mals. Still the question has often been mooted whether any
inosculations between the two sets of vessels, besides those above
mentioned, do really exist in this class of animals.

Many of the older anatomists believed, that they had traced
lymphatics to their terminations, not only in the vena cava, and
v. azygos, but also in the hypogastric and lumbar veins ; and
even as late as 1S25, M. Lippi of Florence has maintained that
the lymphatics of the digestive organs in men, as well as in other
mammals and also in birds, communicate directly with the
venae caveae, the vena portae, the vena azygos, and with the renal
and internal pudic veins. But all the best authorities, the more
ancient as well as the very recent, have denied the accuracy of
these statements ; and it has been clearly proved that the error
of Lippi has arisen from his mistaking branches of veins them-
selves for lymphatic vessels.* Fohmann says distinctly that,
during five years most laborious investigation of the absorbents,
he has never detected any direct communication between the
veins and the lymphatics, except in the glands, (this, we shall
afterwards mention, is a doctrine not admitted by all anatomists)
and in the immediate neighbourhood of the termination of the
thoracic duct.

But although no communication can be traced with the larger
veins, some authors have contended that the lymphatics inoscu-
late directly with the smaller venous branches in different parts,
and especially with those of the mesentery.

M. M. Fohmann and Panizza however expressly assert that
they have in no instance been able to detect such a connexion.

The only other hypothesis on the subject of venous and lym-
phatic communication, which remains to be mentioned, is that
which supposes that the two sets of vessels inosculate with each
other in the substance of the absorbent glands. This opinion
was adopted by the first Meckel, and also by Caldani.

*Rossiii has shewn conclusively that Lippi's error was that of mistaking veins
for lymphatics, by demonstrating that the vessels believed by Lippi to be lymphatics
had no valves, a fact which proves them veins; as all lymphatics have valves, and
all veins less than one line in diameter are destitute of them. Ed.

490 Descriptive Anatomy. [March

Monro Secundus and Mascagni were opposed to it; but, of
recent years, it has been again very ably advocated by Fohmann,
Tiedmann, Lauth and Panizza.

It has been long known that, when mercury is injected into
those lpmphatics which proceed on to a gland (vasa inferential
part of it passes more or less freely into the neighbouring veins,
as well as into the lymphatics leading out of "the gland (vasa
efferentia). This transmission is sometimes so very free, that, it
is actually necessary to put a ligature around the veins, in order
that the lymphatics may be well filled.

Various explanations have been given of this occurrence.
Some writers have supposed that it was always the result of
rupture of the glandular tissue ; others have attributed it to a
direct communication between the two sets of vessels ; and lastly
it has been conjectured that it might be owing to a mere transu-
dation from one set of vessels to another.

It cannot indeed be doubted that, in not a few of the experi-
ments, there has been an actual rupture of the substance, of the
gland, and that the quicksilver has escaped into the cellular sub-
stance, and been forced into the lacerated vessels. But this has
certainly not been the case in all. The greatest delicacy has
been used by the anatomists last mentioned to avoid all force or
compression in their experiments; and we cannot therefore
fairly presume that extravasation of the mercury has always
taken place. No traces of such extravasation have been observ-
ed ; and moreover it has been often remarked that the veins
were filled with the quicksilver even before the lymphatics,
which issued from the gland, were injected. It may also be
added, that, if an extravasation had occurred, we might reason-
ably expect that the small arteries as well as the veins should
receive a portion of the injection ; and yet this is never the case.
M. Fohmann considers these arguments quite conclusive; and
he has supported with great ability the doctrine, that there is in
truth a direct communication between the lymphatics and veins
of an absorbent gland. It must however be admitted that al-
though there are some very plausible arguments in favour of this
supposition, no direct observations can be adduced in its support.
M. Panizza has mentioned one fact which seems to be very unfa-
vorable to it. He says that he has never succeeded in injecting
the lymphatics, when he reversed the mode of performing the
experiment viz. That, when the mercury was injected by the
veins, none ever entered the lymphatics. This result might
certainly have been expected, if there is really so direct a commu-
nication between the two sets of vessels, as M. Fohmann main-
tains.

Panizza therefore and Miiller also are inclined to believe that
the passage of the mercury, in the substance of the absorbent

1838.] Descry atomy. 491

glands, from the lymphatics into the veins, is probably effected
hy means of minute pores in the sides of the vessels, analogous
to those which permit the atmospheric air to act upon the
blood in the pulmonary cells.

Breschet however, without giving a decided opinion, appears
to lean to M. Fohmann's hypothesis that there is a direct com-
munication between the lymphatics and the minute veins within
the substance of the absorbent glands a doctrine that receives
considerable suppoit from the results of comparative anatomy,
and also from the carefully performed experiments recorded by
Meckel, Fohmann, and many others.

Whatever view we take of this subject, there is every reason
to believe that during life, fluids may pass somehow or other
from the lymphatics into the veins of the glands. If we admit
this doctrine, we can readily understand in what manner certain
substances may pass very quickly from the stomach and bowels
into the mass of circulating blood, and be appreciable at different
emunctories, within a very short time after they have been intro-
ced into the alimentary canal.

"If," says M. Breschet, "after all the facts now detailed, we
must admit that the lymphatics seem to have very little action
upon substances introduced from without (the chyle excepted),
they most unquestionably exercise such a power over those
which are generated in the body. The bile, for example, may
be absorbed by them a fact indisputably proved by the re-
searches of the two physiologists named above."

In concluding his review of the conflicting opinions on the
subject of venous and lymphatic absorption, our author adds that
the solution of the problem is perhaps less obscure, than has
often been supposed. He supposes that the veins and absorbents
communicate with each other in the substance of the glands, as
they are seen to do in some of the lower vertebrate animals in
various parts of the body. The chief point of doubt is, as to the
manner in which this communication is effected. M. Breschet
does not think that it can be by direct communication with each
other by open mouths; but rather "par une force absorhante,
analogue a celle dont jouissent les radicules lymphatiques, que
les veines doivent absorber le1 contenu de ces derniers vaisseaux
dans les glandes."*

In fine, he supposes that the veins of every part have the pow-
er of absorption, as well as the lymphatics ; but he is unable to

* The doctrine that there is a free communication between the veins and
the lymphatics in the of the aborsorbent glands is maintained bj

that admirable anatomist, M. Fohmann; and certainly the comparative anatomy
of the lymphatic system, as we ha.ve described above, affords considerable shew
of confirmation to it.

f6

492 Descriptive Anatomy. [March

specify the limits and the circumstances in which each set of
vessels exercises this function.

He alludes to a question of great obscurity, and which in all
probability will always elude the search of our best-directed
enquiries viz. how and in what part are the globules of the
chyle formed ? We cannot suppose that they are already formed
before the chyle is absorbed from the food, as they are known to
be of considerable volume, and as no open mouths of thelacteals
have ever been discovered in the villi of the intestines, even with
the aid of the strongest magnifying glass. It is an utter loss of
time to form mere idle conjectures on this subject. " Ne craig-
nons pas de dire,'' says M. Brcschet, "que Ton ignore complete-
men t !" There are many other points in the anatomy and phy-
siology of the absorbent system, which are little, if at all, accu-
rately understood : and we are therefore compelled to confess
that we know but little, and that little only imperfectly, of one of
the most important functions of animal lile.

The following statement of the chief conclusions, to be drawn
from the preceding remarks, may be useful to the reader.

1. In no part of the body have any open extremities or orifices of
absorbents been discovered.

2. No direct communication between the arterial or venous
capillaries and the absorbent vessels have been distinctly proved
to exist.

3. Fohmann and some other anatomists assert that a commu-
nication exists between the absorbent vessels and the veins,
within the substance of the alveolar glands. This doctrine,
although probable, is not admitted by all.

4. The absorbents in fishes are not provided with valves, or
with glands. They communicate freely, in different parts of
the body, with the adjacent larger veins.

5. In reptiles the lymphatics have imperfect valves ; but there
are no glands. We discover however along their course certain
dilatations which are seen during life to pulsate, and which ap-
pear to force the lymph into the adjacent veins.

6. Rudiments of absorbent glands are discoverable in birds;
and in them there are several other direct communications be-
tween the lymphatics and the veins, besides the chief one at the
root of the neck.

7. In mammals, the lymphatic system is more complicated;
the valves, -ire more numerous mid more perfect; the glands are
more numerous ; and the communications between the lymphatic
vessels and the veins appear to be fewer in number and much

direct.

8. The veins seem to have the power of absorbing foreign
substances admitted into the body, as well as the lymphatics;
but it is still doubtful whether they ever absorb chyle or any
oilier tin id generated within the system.

1S3S.] Descriptive Anatomy. 193

The Anatomy of the Skin.

The next of the works upon our list is still from the pen of M.
Breschet, an able anatomist and on the structure of the skin,
an important subject. Unfortunately its difficulty is commen-
surate with its importance, and the discrepancies of observers
have corresponded with its difficulties.

M. Breschet, and his colleague in the work, M. Roussel de
Vauzeme, have used all the means in their power for arriving
at the truth. Tune has been consumed and labour expended on
an inquiry which all must acknowledge to be intricate, and
which they confess to be on their part incomplete. They depre-
cate criticism, indeed they may be said to defy it, for they pro-
test in limine that they will pay attention to no strictures but to
those which emanate from persons who have made the structure
of the skin a subject of their special investigation. This is a bold,
but perhaps it is not altogether an unexceptionable determination.

They treat their subject in the following order. They first
give a summary of the constituent parts of the skin, and then
examine each in detail.*

Constituent Parts of the Skin.

1. The Derma (cutis vera corium true skin) a dense,
fibrous, cellular web, enveloping and protecting the sanguineous
capillaries, the lymphatics, the nerves, and the other organs con-
tained in the skin.

2. The Pap ilhe the organs of touch, in which the nerves
are finally distributed. They are small nipple-like projections,
slightly curved, their spices blunted, and concealed beneath
several envelopes.

3. The Diapnogenous Apparatus, (the organs of the secre-
tion and excretion of the sweat from ^a^of,. traspiratio perspi-
ratio) is composed of a glandular parenchyma, and of sudori-
ferous or hydrophorous canals.t

The parenchymatous or secreting organ is enclosed in the
derma, and gives origin to the excreting canals ; the latter are of
a spiral form, pass between the papillae, and open obliquely on
the external surface of the epidermis.

4. Apparatus of Inhalation, or Absorbent Canals. These
resemble, in many respects, the lymphatic vessels'. They are

* We shall chiefly select such facts, or such opinions, for notice as possess some
claim to novelty, or arc otherwise important. We must presume that our readers
have read Beclard's, or Craigie's, or some other work, which contains what is
generally known or believed in regard to the cutaneous tissue.
tFrozn fopurj sudor.

491 Descriptive Anatomy. [March

situated in the corpus mucosum, which forms the most external
layer of the skin, for the cuticle or epidermis is only a depend-
ence of the mucous body. The inhalent canals appear to be
unprovided with mouths or with absorbent openings. They
commence in the most superficial layer of the cuticle, but their
mode of origin is very difiicult to be determined. By their other
extremity they communicate with a net-work of vessels, which
our authors believe to be lymphatics mixed with veins.

5. The organs which form the Mucous Matter, or the Blcn-
nogenous Apparatus* This is composed of a glandular paren-
chyma, or organ of secretion, situated in the thickness of the
derma and of excreting canals, which issue from ihe preceding
organ, and deposit the mucous matter between the papillae.

6. Vhrom>atogenous Apparatus, or that for producing the
Colouring Matter. This is composed of a glandular or secre-
ting parenchyma, situated a little below the papillae, and present-
ing particular excreting canals, which pour out on the surface
of the derma the coloring principle. This mingles with the soft
and diffluent mucous matter, and it is their mixture that produ-
ces the "pretended reticular body of Malpighi," and the epider-
mis or cuticle. We must attribute to this double apparatus the
production of horns, scales, prickles, hairs, nails, hoofs, and so
forth.

Our authors have ascertained, that of all the cutaneous expan-
sion in man, the skin of the heel is the best adapted for anatomi-
cal examination, on account of the thickness of the derma and
the mucous matter. To this part, therefore, their observations
must be understood to apply. The anatomical causes of the
difference displayed by different portions of the skin will be
discussed at a future opportunity.

Such is the sort of table given by our authors of the anatomical
elements which constitute the skin. The enumeration will at
once convey to the well-informed anatomist the essential differ-
ences which exist between it and the ordinary descriptions of
the cutaneous apparatus. On this point we need not dwell, but
proceed to display the opinions of our authors in detail.

The body ol the work is divided into six chapters. The
first is on the derma the second on the papillae the third on
the diapnogenous appparatus the fourth on the apparatus of
inhalation the fifth on the blenogenous apparatus, or organs
which secrete the mucous and the horny matter the sixth on
the chromatogenous apparatus, or organs for the secretion and
excretion of colouring matter. Appended to these chapters
are some remarks on the pathology of the skin, and some con-
clusions.

* From BXti'va, ^vn, mucus-

1S3S.1 Descriptive Anatomy. 495

On the Derma.

On this head our authors say little that is new ; and we shall
confine ourselves to stating that the result of their observations
amounts to this that the derma is a membrane, the fibres of
which, firmly interlaced with one another leave interstices,
areolae, or cellules, which protect and insulate a great number of
organs. On its external surface it insensibly merges into a
membrane, which appears to be confounded with the parenchy-
ma of the colouring and papillary organs. The derma, accord-
ing to our authors, is by no means the inextricable net-work of
fibrous tissue which some authors have represented it to be. It
contains and supports organs, the precise description of which
will come by-andby.

In serpents, the derma has a remarkable disposition : it is
raised into imbricated prominences, covered by a thin layer of
epidermis, and their whole constitutes the scales. In fish, on the
contrary, the surface of the derma is uniform, and the scales are
entirely composed of horny matter.

On the Neurothelic Apparatus, or the Papillary Bodies.

There is no doubt that the filaments proceeding from the
different nervous trunks in the subcutaneous cellular tissue
divide to extreme minuteness on approaching the derma. How-
ever carefully we endeavour to dissect them, we most commonly
lose them in the structure of the derma, by reason of its opacity
and their delicacy. The only chance of distinguishing them, in
the midst of the vascular net-work of the derma and of its excre-
tory canals, is to observe very carefully the point where they
enter and to which they tend, and with practice and dexterity
the nervous filaments may be picked out as they approach the
mucous body, where they are delicate, almost pulpy, and pene-
trate the base of the papillas.

The papillae themselves are ranged in rows, generally bifid
or trifid, separated transversely by the interval in which the
sudoriferous canals are lodged, and longitudinally by the grooves
from which the horny or epidermic matter proceeds.* Their
form is that of a small cone, the base of which is lost in the
derma, while the summit ends in a blunt point. Each papilla
penetrates the horny matter, as a sword enters its sheath, and the
internal surface of the epidermis exactly represents, by its sym-
metrical depressions, the number and disposition of the papillae.

* The terms "mucous mattei," "horny matter," are used almost indiscriminate-
ly, because the horny epidermis is supposed to be formed by a kind of inspissation
of the external surface of the mucous matter. We beer our readers to bear this in
mind when they find the term " horny matter"' occur.

496 Descriptive Anatomy. [March

The attachment of the papillae to the derma is firmer than that
to the epidermis, so that if a little force is used, the papillae sepa-
rate from the latter, but remain in connexion with the former.

The direction of the papilla: in the epidermis is oblique, and
slightly inclined. Besides a sheath which they get from the
derma, the horny matter supplies them also with a sheath, which
covers them in the manner of a hood. This is very dense in
the heel. The summit oi the papillae is not perforated by any
opening.

Our authors refer to the structure of the papillae in the whale,
which they say resemble those of man so closely as to make
the same description applicable to both as exhibiting their form
and structure on an intelligible scale.

The papillae of the whale, then spring from the derma in
innumerable quantities, piercing the horny matter like a sieve, or
rather making it resemble a series of organ pipes, perforated to
give them passsge.

Their length varies with the thickness of the skin in the
different regions of the same animal, or in animals of different
species.

The nervous twigs, though united sometimes in twos and
threes on a common base, are always contained in a particular
sheath furnished by the horny matter which is moulded on them.
In its thickest part, the body of the nerve presents across the
neurilema slight undulated stria?, which proceed from the base,
become less distinct, indeed become confused, and wind to a
kind of button-like termination, where they appear to unite in
concentric semi-circles. This surface is smooth and uniform,
and has no communication with neighbouring parts. Exami-
nation under the microscope, or in any other manner, discovers
in the papillae a white dense tissue, more easily torn than broken,
analogous in all respects to the nervous. It is not possible to
separate into fasciculi the strice or undulated linos apparent on
the exterior ; but our authors have distinguished the opening of
a nutritious vessel in the interior. In the papillae of man they
have found two, which appear to unite and form an arch. These
vessels are distinctly perceived, when the papillae are injected,
and divided by a transverse section. Besides this, in the centre
of the neurilema or sheath, there appears to be a whitish pulpy
substance.

From these circumstances discoverable in the papillae of the
whale, our authors think" that it is not possible to entertain a
doubt with respect either to the structure or the sensorial func-
tions of these bodies.

The papillae of the tongue are usually considered as peculiar-
ly adapted lor the sense of taste, and, consequently, as essentially
nervous. But if the papillae of the tongue of the ox be carefully

183S.] Descriptive Anatomy. 497

examined, it will be found that they arc enclosed m a homy case

of greater or less thickness, which must be opposed to the exer-
cise of such a function as that of taste. In the interstices, how-
ever, between the papillae, there exist below a very fine epithe-
lion true nervous papillae (tiges nerveuscs), similar, or nearly
similar, to those which have been already described. The num-
ber of these latter is considerable, and it is in them, according
to our authors, that the sense of taste exclusively resides. The
common papillae of the tongue are thought by them to be rather
devoted to the function of touch, and even to that of triturating
the finer molecules of the alimentary mass, and to render it, in
consequence, of more easy appreciation by the papillae of taste in
their intervals. On this point our authors have not made up
their minds, but intend to examine it with more attention here-
after.

On the whole, our authors conclude that it would be difficult
to form any opinion but the one they have advanced on the na-
ture of the tactile organ. On the surface of the derma there
are elevations and intervening furrows. The former correspond
to the nerves ; the latter to the sudoriferous and inhalent canals,
while the source of the horny matter is at their bottom. If the
papillae are not the organs of touch in the skin, what are?

The mode of termination of the nerves occupies the attention
of our authors. We see the nerves under three points of view :
1. In the subcutaneous cellular tissue they have the usual cha-
racters of spinal nerves ; 2. In the substance of the derma they
become soft, flexuous, and capillary ; 3. On the external sur-
face of the derma they are transformed into symmetrical papillae.

The question What becomes of the neurilemaof the nerves,
on their entrance into the derma ? naturally forms a subject of
enquiry. Our authors suppose that the nerves become divested
of it, and that it becomes blended with the derma. It is proba-
ble, however, that some sort of envelope still invests the nervous
matter. What it is, if any, is dubious, nor is it necessary to fol-
low our authors through their analogical speculations on the
subject.

The essential organ of touch, then, consists of

a. A principal part the nerve of touch, terminating in a
blunt point.

r. Of accessory and protecting parts 1, the derma, en-
closing the nerve in its interior ; 2, the papillary neurilema, fur-
nished by the derma ; 3, of a proper sheath, of peculiar and
horny tissue; 4, of a fine layer of epidermia, covcrinof the
sheath, and indispensable for the exercise of the function oftouch.

If any one of these conditions should be absent, or modified in
a certain manner, the sense of touch cannot be exerted. It is
evident that the derma, the dermic sheath, the proper sheath of

498 Descriptive Anatomy. [March

epidermis, are to the nerves of touch what the complicated ap-
paratuses of sight and hearing are to the optic and acoustic
nerves.

If we compare the senses of taste and smelling with that of
touch, we must perceive a greater delicacy in the apparatus of
the former, and a predominance of the horny covering for the
nervous terminations and expansions in the latter. Touch, too,
is exercised by nervous bundles, unclosed in a. tissue which in-
sulates each, whilst the nerves of sight and hearing are expanded
at their termination.

Our authors examine the hypotheses which are entertained
with regard to the ultimate disposition of the nerves. AVe need
not go into a subject so intricate, and, we may add, so unsatis-
factory. Their observations on the papillae bear out, in some
measure, tfie conclusions of MM. Prevost and Dumas, who
have conceived that nerves end in a loop. In the papillae, the
microscope, if it may be trusted, represents the nerves as pre-
serving their filamentous disposition till they arrive at the top
of the papillae with its horny covering, where they form con-
centric loops.

On the Diapnogemms Apparatus^ and on the Sudoriferous or
llidrophorous Canals.

This exhalent apparatus occupies the thickness of the derma,
and extends from its interior to the most superficial layer of the
epidermis, where it presents an opening.

It is composed of a secreting parenchyma and of an excretory
duct.

The parenchyma is situated in the thickness of the derma,
and is surrounded with numerous capillaries attached to it. The
form is that of a sac slightly swollen, from whieh issues a spiroid
duct, which pursues its course in the derma, and issues from it
by the inl'undibulum, or transverse fissure, situated between the
papillae; the duct then proceeds obliquely through the horny
substance, in a corkscrew form, to without the epidermis, where
its termination is indicated by a slight depression, or kind of
pore, which may be remarked on the prominent epidermic lines.

The duct, as it passes through the epidermis, is rounded.
The structure closely that of the horny tissue, from

which it is difficult to distinguish it. Its spiral form causes it
to open externally by a very oblique opening, almost parallel to
the plane of the skin; the opening itself closing by the mutual
application of the superior and inferior wails of the tube. If we
look at ;i drop ofsweal as it .; shall sec it preceded by

an elevation of the epidermis, like a pump valve,

W a piece of skin be macerated, so that the epidermis can be

1833.] Descriptive Anatomy. 499

separated from the derma, we may see, with the naked eye, these
excretory ducts indefinitely lengthen, like th reads ofspider's web.
These are the spirals unrolled. When examined by the micros-
cope, they present a surface covered with horny matter, which
seems disposed in an imbricated manner on a central canal. We
may distinguish very well, in this way, the issue of these canals
from between the papilla, and their penetration into the horny
matter, which tills the funnel-like depressions between the papil-
lae. At their exit from the derma', the spiral tubes are accompa-
nied by an inhalent vessel, which enters into the infundibular
depression. The spiral, filiform tubes, when taken up with a
pair of forceps and placed upon a moistened piece of glass, roll
up, and form a sort of homogenous mucous mass, elastic and
trembling like a piece of jelly. On stirring them, there are de-
tached a great number of irregular polygonal scales. The sweat
found in the secreting organ issues through the sinuosities of
the excretory dm t, which must also give exit to the insensible
perspiration. Probably, say our authors, were we to watch the
external orifice of one of these ducts when the body is heated in
cold weather, we should find it smoke like the pipe of a stove.

This corkscrew disposition of the sudoriferous ducts in man,
explains the anomaly of the epidermis transmitting the excre-
tions, and yet appearing imperforate when examined separately.
If the membrane is raised in the living body cr the dead, the
sudoriferous tubes are torn from the derma, retract, and close the
opening in the epidermis, the spiral coiling on itself. If the epi-
dermis is detached in several layers, each contains a fragment of
the spiral tube, with its two openings, lying almost para. lei with
the plane of the layer, and not correspending with one another.

The walls of the tube come into apposition, and in this case,
as in that of the entire epidermis, an opening is no longer dis-
coverable.

If the horny layer be sliced off, and if, before arriving at the
papillae, we squeeze the skin between the fingers as we squeeze
a piece of orange-peel, we may perceive drops distilling from the
pores, which correspond to the infundibuliform depressions be-
tween the papillae, that is, to the situation of the sudoriferous
canals.

Another experiment is mentioned by our authors, as evidence
of the tubular nature of the spirals. If a hole is made in the
horny matter of the heel, in a direction parallel to the plane of
the skin, and if a little mercury is poured into it, and if then a thin
slice of the exterior of the epidermis is taken off with a razor,
and the mercury pressed over with the handle of the scalpel, the
metal may be seen issuing by all the sudatory canals in the spot.
We see the same thing in the palm of the hand and end of the
fingers, when the sweat oozes from them.
c 7

500 Descriptive Anatomy. March

Our authors have carefully examined the epidermis of the
whale, in order to discover how liquids traverse it from within.
Pressure of the fluid out of the sudoriferious tubes, always occa-
sioned the elevation of a little valve of epidermis before it escaped
externally. Our authors insist upon these facts, because, al-
though exhalent vessels have been talked of, they have not been
sufficiently described nor satisfactorily demonstrated.

After stating and commenting on the various opinions that
have been expressed in reference to the sudatory canals, our
authors remark that tne recent observations of Eickhorn are
amono- the most interesting and most satisfactory. Yet he has
committed several mistakes. He believes them, for example,
conical, with an infundibulifoim opening and of sufficient diame-
ter to admit of the introduction of a hair.

Our authors themselves allow that it is extremely difficult to
ascertain the exact disposition of the sudatory canals, and that it
has cost them much time and trouble to obtain the knowledge
they have communicated on the subject. It is possible that they
may hereafter be proved to be in error; but mere criticism,
without a careful examination of the skin, and a repetition of
experiments, will be insufficient to do so.

On the Cutaneous Apparatus of Inhalation.

In order to examine this most satisfactorily, we must remove
a thin slice of the epidermis/ taking care to select a soft and
white portion. The slice which has been removed is to be
placed on a piece of glass with a few drops of water, and after
we have satisfied ourselves that there is no extraneous substance
along with it, we may proceed to dissect it with curve-pointed
instruments.

The inhalent canals appear to be situated below the most
superficial layer of the epidermis. They present the form of
separate radicals spread out in the horny tissue, where they
anastomose several times, and then penetrate the derma by the
infundibulum of the papilla:, near the sudoriferous canals. All
these. vascular trunks, symmetrically arranged in the fissures
between the papillae, which they traverse, communicate in the
derma below the papillae with canals, forming a common plexus"
Our authors confess that they have seen tins termination of the
inhalent canals very seldom ; yet they feel confident that they
have seen it.

Our authors consider all external to the derma as epidermis. The most ex-
ternal layer of it, which v | to remove, is ihe cuticle, or epidermis
nfm-.st authors. When the most superficial layer of the epidermis is mentioned,
the epidermis, of common parlance, is m< .,,.t.

1838.] Descriptive Anatomy. 501

These vessels are of extreme tenuity, and ramify in the form
of loops in a hard, elastic, resisting substance. They themselves
break with great facility. When examined in the microscope,
their colour is white and silvery, and they are crossed by dia-
phragmatic septa ; a circumstance which establishes their analo-
gy with the veins and the lymphatics. Sometimes they are
knotty, at others they are smooth. They may be distinguished
with a very weak lens, and even with the naked eye, on scra-
ping the surface of the epidermis. They are occasionally long,
and resemble very line hairs.

In order to perceive the entrance of the inhalent vessels into
the derma, we must lightly raise the epidermis. We may then,
with the assistance of a magnifier, observe all the hidrophorous
canals, accompanied with an inhalent vessel, the two being very
intimately united near the derma, although they speedily sepa-
rate.

With the microscope we may distinguish the difference be-
tween the two sets of vessels- The sudoriferous canal is the
larger, covered with small imbricated lamina?, serpentine in form,
and elastic. The inhalent vessel is smooth, silvery, straight or
slightly curved, and traversed by a visible central canal, imper-
fectly interrupted by small septa. If the epidermis is separated
too violently from the derma, the inhalent vessels are broken,
and only the sudoriferous canals, which are capable of conside-
rable elongation, remain. Another mark of distinction is this:
the inhalent vessels have anastomotic ramifications, and a plexi-
form arrangement, which the sudoriferous canals have not.

Our authors mention an experiment which appears to them to
indicate the existence of a direct communication between the
vascular capillary system and the inhalent canals. If an in-
jection is thrown into the main artery of a limb, it always stops
at the derma. If, then, the skin is removed in thin slices, while
pressure is made with a scalpel on the part that has been inject-
ed, the inhalent canals may be seen coloured in the horny tissue,
as they ramify and anastomose beneath the most superficial epi-
dermic layer. The sudoriferous and inhalent vessels cannot be
dissected throughout their entire extent, on account of the re-
sistance offered by the horny tissue, but the one may be seen in
fragments by the microscope, and the other entirely by means of
injections.

Whatever may be the colour of the horny tissue, the absorb-
ent canals, the nerves, and the sudoriferous canals are always
white.

Our authors have been unable to discover external orifices to
these inhalent canals. They are disposed to think that fluids
are first imbibed by the horny tissue, and then absorbed by the
inhalents. Our anatomical readers need not be reminded of the

502 Descriptive Anatomy. [March

contradictory statements that have been made with respect to the
orifices of the lacteal vessels. The difficulty of distinguishing
the apertures of the cutaneous inhalents (should there be any,)
must be very much greater. Our authors engage deeply in the
examination of opinions on the nature of intestinal villosities,
and of the lacteal apertures. But we need not follow them.

We may mention, however, the method of injecting the lym-
phatics of the skin adopted and recommended by our authors.
Sometimes they have introduced the mercurial tube into a lym-
phatic vessel of the leg, and the mercury has run into the cuta-
neous lymphatics of the groin. This plan frequently fails. In
other instances they have introduced the mercurial tube directly
into the cutaneous tissue, at the point where they desire to ex-
amine the lymphatics, and to be certain of not mistaking the
sanguineous capillaries for them, they have previously thrown
very fine injections into the arteries.

On the Blennogenous Apparatus the Source of the Mu-
cous Matter*

In order to examine this apparatus properly, it is necessary to
select recent skin, injected and reddened with its blood. If the
derma is white, either naturally or by maceration, nothing can
be learnt from it.

The mucous matter of the skin becomes blended, soon after its
secretion, with coloring matter, which occasions the various tints
of horn, hair, scales, feathers, and so forth. The mucous matter
and the horny matter .are, as has already been observed, the
same, the horny being originally mucous.

On examining the skin from within outwards, we find

1. In the derma

a. A Blennogenous apparatus, composed of a secretory gland,
and of a canal which excretes the secreted matter, the mucus,
which becomes horny matter by desiccation.

b. A Chromatogenous apparatus, composed of a secreting
parenchyma, and of canals which excrete the product of secre-
tion (squamous corpuscles).

2. External to the derma, and the joint effect of both these
apparatuses.

a. The horny matter, or epidermis.

b. The hair, feathers, horns, hoofs, &c.

1. The Blennogenous Apparatus. At the base of the derma
we may distinguish small reddish glands, which, under the mi-
croscope or a common lens, appear knotted, irregular, and
grooved by blood-vessels. They are enveloped in loose cellular
membrane, and surrounded by small, transparent, adipose vesi-

* Blennujenou*, from BXt^a, mucus, and yewdw, to produce.

1S3S.] Descriptive Anatomy. 503

cles. From the summit of each of these glands there issues a
canal or tube, which traverses the derma, and opens at the bot-
tom of the furrows remarked on it. The tube is invested by a
prolongation of the thin cellular membrane which envelopes
the gland. Capillary vessels or filaments may be seen adhering
to the tube and to the glandular organ, into which our authors
have seen a vessel of some size enter. The canals usually form
a regular colonnade in the thickness of the derma. Sometimes
the glands are placed at unequal heights, and appear to commu-
nicate with one another by means of intermediate canals. The
ranges of excreting canals correspond to the furrows in the
derma ; they are perpendicular to the plane of the parenchyma
secreting the colouring matter, to which we shall next direct at-
tention.

2. The Chromatogenous Apparatus* This is situated on the
external surface of the derma, at the bottom of the furrows seen
upon it, below and between the rows of papillary eminences.
Superficially it gives rise to a great number of short excreting
tubes, which end and pour out a peculiar matter at the bottom of
the furrows. On its deep surface it is in relation with capillary
vessels, and with the excreting canals of the blennogenous
glands.

Its structure is areolar, spongy, and tough. The parenchyma
itself, as well as its excreting canals, easily redden on account of
their vascularity. Here the arterial system stops; this paren-
chyma forming, in the natural condition of the body, its limit,
though the vessels of the papillse, strictly speaking, do advance a
little further.

If we lacerate this tissue, we find in it innumerable little fila-
ment, from which escape scales or colourless corpuscles in abun-
dance. This is the only reservior of such scales in the derma,
and this parenchymato-glandular tissue may therefore be regard-
ed as a peculiar organ, peculiarly constructed, penetrated by
arterial and venous capillaries, and giving rise to excreting
canals. The latter terminating at the same point as those of
the blennogenous gland, pour into the mucus formed by this
gland granules of pigment or colouring matter.

3. Excreted Products of these Apparatuses. The joint
product of the blennogenous and chromatogenous apparatus is
the epidermis, or the horny matter. Our authors examine it as
it occurs in the heel.

The inferior or deep surface of the entire epidermis presents
inequalities which correspond to the inequalities on the external
surface of the derma. It exhibits, indeed, a cast of the latter.
This surface of the epidermis has received the name of the reticu-

Chromatogenous, from *?*>ita, colour and yewaw, to produce.

504 Descriptive Anatomy. [March

lar web of Malpighi. Two divisions (cloisons) may be distin-
guished in it. One fills the furrows of the derma, mid adheres
to it by prolongations which issue from the excreting blenno-
genous and chromatogenous canals. ISy this it is that the horny
tissue is produced and renewed. When we attempt to separate
the h >rny matter from the derma, we always experience a certain
degree of resistance from this attachment to the furrows of the
derma. Sometimes we may perceive the sort ot' roots sent into
them, but, more commonly, they are indistinguishable, the horny
matter coming off cleanly, as if only laid in the furrows. On
the sides we may abserve small holes, which give passage to the
lymphatic vessels.

The other division of the horny layer, named by our authors
inter-papillary, occupies the interval left by the bifid papillae, and
is prolonged into the hifundibuliform depressions around the
sudoriferous and inhalent canals. We may remark on the edcres
of these ridges of the horny matter, a lacerated appearance, occa-
sioned by loose fragments of the sudoriferous canals. On the
right and left may be found the holes and sort of sheaths into
which the papillae penetrate obliquely.

On the external surface of the epidermis there are visible
prominent lines, slightly concentric or parallel, and separated
by grooves. Examined with a lens, these lines present alter-
nately small papillary eminences and tissues, or slight depress-
ions, containing the orifices of the hidrophorous canals. A line
contains usually from four to six. It may easily be ascertained
that the prominent lines have an imbricated disposition, so that
in the motions of contraction, more particularly of the hand,
they advance over one another, like the scales of a fish or of a
serpent, whilst in the motions of extension they separate and lay
open the bottom of the grooves. This imbricated appearance is
very manifest where the skin forms folds, as at the bend of the
elbow, the groin, &c.

The horny matter in man is whitish, clastic, transparent, and
highly hygrometric. Its examination is extremely difficult, for
it gives under the scapel, like caoutchouc; when soft it swells,
and nothing can be made out of it, and when dry, it scales off at
the least touch or pressure.

The epidermis ot the whale is more adapted for anatomical
study. The horny matter is secreted by a special apparatus,
and organized like false membranes. It seems then to deserve
the designation of tissue, accorded to it by Bichat.

The epidermic tissue then of the whale* is smooth, spongy,
and generally of a deep slate colour. Proceeding from without

* Again we must observe, that epidermic, in our authors' phraseology, si(jifie
all tho horny matter above the derma. Cuticle is only its external layer.

183S.] Descriptive Anatomy. 505

inwards, there may be detected in it with the naked eye two
layers one external, and parallel to the plane of the derma;
the other consisting ol straight fibres, extending perpendicularly

between the derma and the external layer. We may see through
this dark tissue the summits of the white nervous papillss envel-
oped in their sheaths. The internal surface is dotted with aper-
tures for the passage of the little papillary cones.

The respective thickness of the two layers is as follows : that
of the external or horizontal layer, one line ; that of the deep
or perpendicular layer, three lines. As the thickness of the der-
ma on the head of the animal is ten lines, the diameter of the
whole skin is about fourteen lines.

In order to analyse the epidemic tissue, we must take a per-
pendicular fibre, and place it under a magnifier, or a slightly
moistened glass.

The tissue is thus found to be composed of small scaly imbri-
cated bodies, on a fine cellular web. The scales are readily
detached, and stain water black under appearance of gran-
nulations. A fibre is found of a series of these scales inser-
ted one into the other. The fibre is elastic and resistant.

The origin of the homy matter may be well seen in the whale,
on account of its black colour. It fills all the space unoccupied
by the papilla?. The black matter is excreted a little prior to its
appearance on the outside of the derma, about half a line inter-
nal to which point we find it inclosed in a capsule or dermic
membrane, at the bottom of which may be remarked little whi-
tish or filamentous projections, which the capsule embraces ;
these are the excreting canals of the chromatogenous paren-
chyma.

The horny matter is formed within, and has then almost a
mucous consistence. It is protruded Irom within outwards, and
pushes before it the previously-formed layers, which gradually
solidify.

Our authors hang a good many observations on these facts ;
but we may waive the consideration of them, and having ascer-
tained so much of the horny matter of the whale, return to its
examination in man.

In order to examine the horny matter in man, the best plan
is to place under a magnifier, in a little water, a portion of the
most external epidermis, or of the mucus which is formed on the
surface of the derma. If we then separate its component parts
with the point of a scalpel, we may observe floating, in the midst
of the fragments of inhalent vessels and sudorifcrious canals, a
number of apparently shapeless corpuscles. They are not really
amorphous, this appearance depending on the violence employed
either breaking them up, or leaving them partially agglutinated.
In general the scales affect the form of an irregular trapezium,

50G Descriptive Anatomy. [March

arc of a certain thickness, white, transparent, more or less striated,
and disposed on a fine areolar web, in an imbricated order. We
may easily recognize, say our authors, in the scales, the product
of the chromatogenous or colouring organ ; and, in the pellucid
web which supports them, the mucus of the glandular blenno-
genous organ.

The horny matter, excreted in the first instance in a fluid mu-
cous state, moulds itself layer by layer on the papillae, and envel-
ops and protects the sudoriferous canals and the inhalent vessels,
acquiring greater density as it becomes placed externally.

The horny tissue in the n >gro is black every where, excepting
on the palm of the hands and the sole of the feet, where there are
only slight traces of that colour. Its structure is the same as in
the white race of men. On the heel of tho negro the scales are
colourless. In the rest of the body, the skin, when examined by
a magnifier, is not so black as it appears to the naked eye, Over
the papillae it is white, in consequence of the white nervous
matter shewing through it. The areolar web which supports
the scales is always white.

On the Chromatogenous Apparatus, or Organs of the Se-
cretion and Excretion of the Colouring Matter.

The mucous rete of Malpighi has been regarded as the sole
seat of the colouring matter, which was said to be secreted by a
vascular net-work, and collected and preserved in a semi-fluid
form. Our authors adopt and present a very diifercnt view of it.

They have observed that if the skin is black or white, the free
border of the scales is coloured black or white. The attached
part of the scales and the cellular web into which it is implanted
are always white, as are the parts accidentally contained in the
epidermis, the nervous papilla?, the sudoriferous canals and the
inhalents. The scales then are the only parts in which colour
resides. They were led to compare this with the wings of the
lepidoptera, and to examine the colouration of flowers. They
discover and dwell on both as analogical cases ; but we may pass
these considerations by.

Their observations on the colouring organs in man are the
following:

1. They presume that the form of the scale plays some part in
the production of the phenomenon. Have the negro and the
cetacea, or should they have, a scale of similar form? That of
the European is trapezoid. The little articulated pieces which
compose the petals differ according to the colour they present and
the kind of flower to which they belong.

2. The scale is in more or less intimate communication
through its pedicle with its secretory organ, and is nourished by

1S38.J Descriptive Anatomy. 507

a true circulation. It may therefore be considered as acting in a
special manner on the fluid which is in contact with the pedicle
by means of the areolar web to which it is attached.

It is certain that the colours are arranged with art in little
compartments, so as to produce their optical effect. Our authors
presume that the scale of the Negro is different in form from that
of the European. Of course it ought to be so, to sustain their
speculations. This consideration makes us wonder greatly that
they have not found it so ; for really, they have seen so much
and so minutely that they might as well have seen this too.
Indeed it is inexplicable, if they can determine the exact form of
thejscale in the white man, in which the corpus mucosum itself
is seen with comparitive difficulty, why they cannot determine
the exact form in the black man. They have shown, we think,
a little squeamishness in this instance. The coloring matter
itself they admit to be formed by the glandular parenchyma to
which reference has been previously made.

Thus the epidermis is not mere inorganic matter, or mucus
mechanically expelled, but a tissue of complicated organization.
It is connected with the important functions of exhalation and
absorption, by the property which it possesses of suffering pene-
tration by liquids ; and this imbibition or endorsmosis would seem
to be the rudiment, or simplest degree of absorption in cutaneous
and mucous surfaces.

The surface of the skin is marked with lines affecting geomet-
rical figures, which have a fixed relation to the motions of the
particular part. Thus, on the pulp of the fingers they form
concentric circles sinuosities in the palm of the hand lozenge-
shaped figures on the wrist, &c. These forms are such as are
best adapted for the movements of the parts where they occur.
As all the organs placed on the surface of the derma have an
oblique direction, the disposition of all the epidermic coverings
must of necessity be imbricated. We may remark this in the
mode of implantation of the hairs.

If we look back on the anatomy of the skin, we may give the
following brief sketch of its functions.

1. The blood carried by the arterial capillaries to the paren-
chyma that secretes the sweat, and returned from it by the veins,
gives rise to the sensible and insensible perspiration.

2. Inhalents imbibe on the surface of the derma and in the
epidermis extraneous fluids, and pour them into the lymphatics
and the veins.

3. Nerves placed like sentinels on the surface of the body
receive the impressions of touch.

4. Horny matter is secreted and moulded around the papillae
and the inhalent and sudoriferous canals. It is part of the appa-
ratus of touch, a means of ornament and of defence, and.emi-

h 8

60S Descriptive Anatomy. [March

nently hygrometric. By virtue of the latter property it is pene-
trable more or less, according to its density, by the fluids with
which it is brought into contact, and so performs an important
part in the (unction of absorption or imbibition, which it regulates.

5. The derma is the tissue which supports, insulates, and pro-
tects the delicate instruments of these various functions.

A short section, or, rather, a few observations are devoted to
the Pathology of the .skin. They are not of sufficient impor-
tance to detain us. Nor need we enter on the critical expose of
what other authors have written. All that we shall add before
quitting the subject are the conclusions of our authors.

They believe they have shewed that :

1. There exists an apparatus of exhalation, composed of hy-
drophorous or sudoriferous canals, which have a spiral disposi-
tion, and open on the surface of the skin by one extremity, while
their other extremity is in connexion with a parenchymatous or
glandular body, the diapnogenous apparatus, in the derma.

2. The inhalent canals are situated in the mucous body ; they
appear to be unprovided with orifices at their external extremity

3. The medium in which these exhalent canals are dissemi-
nated is on the external surface of the derma.

4. The mucous matter, which by its induration forms the
different epidermic layers, is the product of a particular appara-
tus ; this is composed of a principal organ comparable to a gland
and deeply placed in the derma, and of an excreting canal. The
whole constitutes the blennogenons apparatus.

5. The epidermis or horny tissue resulting from this secretion
and from its mixture with colouring matter, is traversed by the
sudoriferous canals. The inhalent canals and the nervous
papillae enter it, but do not open externally.

6. A second apparatus, situated near the superficies of the
derma, is devoted to the secretion of the colouring matter or
pigment. This apparatus is composed also of minute glands and
excreting canals. It constitutes the chromatogenous apparatus.

7. The matter secreted by the latter apparatus is mingled with
the horny matter and its dependencies, and colours it.

8. The epidermis resulting from the secretion of the mucous
or horny matter, and its mixture with the colouring matter, is
disposed in successive layers. From this disposition results the
scales of the superficial layer, or the epidermis, of most authors.

9. The apparatus of sensation in the skin, is composed of
papillae or conoidal eminences essentially formed by the extremi-
ties of nerves, enveloped in epidermic layers. The nervous
filaments arriving at these new sheaths, throw aside their neuri-
lema, and terminate by anastomosing with one another in order
to form arches.

10. A blood vessel, very inferior in size to the nerves, pene-
trates the papillae.

1S38.] Signs of Death. 509

11. The nervous filaments, although they lose their neurilema
when they enter the epidermic sheaths, still preserve a proper
membrane.

12. The derma is a fibrous and vascular web, which contains
the organs of secretion, and the commencement of their excreting
canals, the origin of the exhalent canals, and many lymphatic
and sanguineous vessels. The latter are chiefly found on the
two surfaces of the derma especially upon its inner, and lorm
numerous networks, constituting a sort of erectile tissue. The
blood-vessels do not penetrate the mucous body, and beyond the
derma we only observe Them in the papillae, where they are
delicate, not numerous, and difficult to be distinguished. We
may observe, however, by the aid of injection and of magnifying-
glasses, lymphatic vessels on the external surface of the derma,
in the deepest layers of the mucous body, and around the papil-
lae. They are arranged in net-works, rather close ; their termi-
nating apertures cannot be recognized.

This closes the memoir before us. It is the first of three, and
the only one which has yet appeared. The ser-ond will be ap-
propriated to the description of the accessory parts of the skin
hair, wool, feathers, scales, nails, horns, follicles, &c. The
third will be occupied with the structure of the mucous mem-
branes, and with physiological observations on the functions of
them and of the skin.

It is not necessary tor us to pronounce an opinion on this
work. None, can deny to its authors the merit of great labour,
research, and ingenuity. Whether their statements are strictly
accurate whether they have seen more or less than nature
offers, we do not feel ourselves competent to determine. Those
only can pronounce an opinion, who have subjected the skin to
very close microscopical observations, which we have not done.

Signs of Death. At the session of the French Academy of
Medicine (7 Aug. 1837) a letter was received from M. Donne,
who has of lnte devoted much attention to the microscopic study
of animal fluids, stating that the most positive indication of death
previous to putrefaction is derived from the change in the form
and appearance of the globules of the blood. M. !\T. Breschet
and Magendie were appointed a committee to examine into the
subject and report to the Academy.

510 Enderrnic and Inoculative Treatment. [March

PART III.

MONTHLY PERISCOPE

Intermittent Fever treated by the Enderrnic Method.

A man aged 38, was received into the Hotel Dieu, on the 21st
March. He had an interment fever which had lasted seventeen
days ; the first attack was caused by witnessing the sudden death
of one of his companions. The fever came on towards eleven
and lasted till lour.

The 25th March, at nine in the morning, two grains of sul-
phate of quinine where spread on a small blister applied to the
epigastrium. The fit returned, but was delayed two hours and
a half, and only lasted an hour and a half instead of five hours.
Two grains more of sulphate of quinine were applied to the sore.
The 27th and 28th March, no attack; sulphate of quinine was
however given internally, and there was no further appearance
of fever.

Another patient with a similar complaint was admitted into
the Hospital the 21st April ; two grains of sulphate of quinine
were applied the 25th, three hours before the supposed time the
attack came on. No fever appeared. Two more grains were
applied the following day, and four grains the day after; the
medicine was then administered internally, and the man was
cured. In several other cases a stronger dose of quinine has
been applied, and the effects obtained have been nearly similar.
M. Chomel has always concluded by prescribing a few grains of
sulphate of quinine to be taken internally. Med. Chi. Review.

Cancer of the Uterus treated with Acetate of Morphia ap-
plied Endermically.

Madame Detty, aged 53 years, having all the attributes of per-
fect health ; married at five and twenty ; mother of five children ;
her labours were always severe ; at the birth of the last child
forceps were employed, and the infant was still-born. At the
age of 51, she had a dartre (herpes) on the left fore-arm ; sulphu-
reous baths were ordered, and brought on an irritation in the
interior of the womb, and an abundant menorrhagia. The treat -

183S-] Endermic and Inoculative Treatment. 511

ment at the hospital Necker proved fruitless. The womb was
explored through the speculum, in the course of July, 1824;
there was hard scirrhus unequal congestion on the neck of the
uterus, it bled on the slightest pressure ; there was a white dis-
charge, with a faBtid odour ; great difficulty in voiding the urine ;
the skin was yellow, and the flesh turgid and bloated. The
patient grew worse in November, she was in agonies, rolled in
her bed, and loudly invoked death as her only relief. Narcotics
and the most powerful antispasmodics, strong doses of spirit of
morphia, had no effect. The cruel sufferings were only allayed,
and the blessing of sleep procured, by putting two grains of ace-
tate of morphia on a seton. The application proved so soothing
that her existence was prolonged till the 20th December, 1824,
without any further sufferings. This observation proves that in
cases where a cure cannot be hoped for, great advantages may
nevertheless be found in external applications. Ibid.

Rheumatism cured by the Application of Acetate of Morphia
to a Blistered surface.

A young man, named Choubert, aged 24, a baker by trade,
was seized with such violent pains in his limbs, that he could
neither move nor sleep. The patient attributed his complaint to
excess of fatigue in kneading the bread, intense perspiration, and
sudden cold after his hard work. On the fourth day after the
appearance of the disease, the pains settled in the shoulder, the
arm and left elbow, the limbs affected were perfectly motionless,
a continual burning pain, the patient lost his appetite, and his
countenance bore an expression of sorrow and suffering.

The 10th March, a blister was applied to the arm, but gave
no relief. The 13th, the surface of the blister was covered with
half a grain of acetate of morphia. Spent a good night, slight
pain, no function disturbed. The 14th and 15th, same medica-
tion, same effect. The 16th, one grain of morphia, complete
relief, no change in the functions, excepting slight contraction of
the eyelid. The 17th and 18th, the applications having been
omitted, the patient spent two bad nights, and suffered conside-
rably. The 19th, one grain of morphia, the patient quite calm,
but cannot raise his hand. The same means continued until
the cure was complete. Ibid.

512 Endermic and Inoculative Treatment. [March

On y the Action of certain Medicines on the Heart.

Dr. Lombard of Geneva makes the following observations on
the action of several of our most common Medicines ;

1. Assafoetida. This is one of the most potent remedies
against the irregularities of the heart's actions, when they
depend upon a nervous or functional cause. Even when there
is organic disease present, the internal use of assafoetida is often
produciive of very decided benefit, by checking, or at least mode-
rating the palpitations, and by inducing a state of calm. When
we prescribe the internal use of the medicine, we may administer
it either in the form ot pill or mixture. Three grains or there-
abouts, taken twice or thrice a day, will be a sufficient dose in
most cases. The most convenient form of employing it exter-
nally is that of a plaster applied over the region of the heart.
The formula recommended by Dr. Lombard is as follows :

Assafoetida, 3ij.
Gum ammoniac, 3j.
Turpentine, gutt. vj.
Yellow wax, q. s. Misce.

2. Camphor. Given in doses of from three to twelve grains
has a very decided influence in moderating any violent action of
the heart. It also assists the heart in expelling its contents,
when it is overloaded with blood, and cannot easily discharge
it at each contraction of its ventricles. Hence in many cases of
dilation, it is of great and very decided benefit. The following
observations are so good, that we shall extract them in the au-
thor's words: "This state of discomfort from the heart not
being able to expel the blood from its cavities, in consequence of
their imperfect contractions which is sometimes temporary,
sometimes permanent, appears to be properly modified by cam-
phor. A few days, even a few hours, have sufficed under this
treatment to regulate the most violent ventricular contractions
and shortness of breath, and irregular circulation ceases after the
administration of a few grains of camphor. Is the action of this
medicine sedative, or stimulating ? This is a question on which
I cannot presume to decide ; but it is evident, after the researches
I have made on the treatment of diseases of the heart, that care
must be taken not to prescribe lowering medicines ; and that
the heart hypertrofied, but with obstacles at the orifice, or with
dilatation of its cavities, must be considered as a muscle fatigued
by the continual efforts requisite to maintain an equilibrium
between the arrrival and departure of this circulatory fluid; so
that it should be strengthened, and its weakness counteracted by
tonic medicines, and its action regulated by anti-spasmodic stimu-

1838.] Endermlc and Inoculative Treatment. 513

lants. Thence the indication of steel and quinine in the first
case, camphor and assafoetida in the second.

3. Digitalis. The sedative action of this drug is, at best,
most uncertain and unsatisfactory. Its successful administration
seems to depend upon attention to a multitude of circumstances,
such as the state of the stomach, the mode of living, the amount
of the dose exhibited, and so forth. If the stomach is in a state
of irritation, digitalis seems to exert little or no influence on the
the action of the heart. Under these circumstances it very often
induces sickness, nausea, and even vomiting. If this disagreea-
ble effect is induced, we should try to arrest it by effervescing
draughts ; but if these fail, the use of certain antispasmodic, such
as aether, oxide of zinc, the nitrate of bismuth, or even opium
itself, may be found necessary.

If digitalis is administered with the view of subduing palpita-
tions of the heart, the doses should be rather large, than small and
frequently repeated. A grain, for example, of the powdered
leaves, or three spoonfuls of an infusion, (a scruple of the leaves
to six ounces of water,) may be oiven three or four times a day.
The infusion is certainly the most potent preparation, and the
one on which we can best depend. It is however more apt to
induce nausea than the dry powder in the form of pills. As
respects the corrigents of digitalis, we find the following remark
of Dr. Lombard. "What best succeeds to avoid or allay the
symptoms of saturation is calcined magnesia, subnitrate of bis-
muth, subcarbonate of steel, and oxide of zinc. Several English
practitioners have prescribed powder of calcined magnesia. I
have always employed it with subnitrate of bismuth, so that
I am unable to remark on its action when administered alone.
Subcarbonate of steel is the best adjuvant of digitalis; to this me-
dicine may be attributed the absence of accidents to persons who
have taken digitalis daily, during several months. Oxide of
zinc also arrests the symptoms of saturation of digitalis.''

4. Polygala Senega. This drug is perhaps too little used
by medical men. Taken as an infusion, says Dr. Lombard, it
appears to diminish the circulation, and regulate the ventricular
contractions.

In persons affected with disease? of the heart, dilatation of its
cavities, polygala has corrected the irregularity of the heart's
pulsations, and has lessened the sanguine stasis which seemed to
threaten the dissolution of the patient. The doses given, vary
from twelve to twenty-four grains of polygala in the course of
the day ; an infusion prepared with a drachm, and four ounces
of water, has been given in four-and-twenty hours.

514 Endermic and Inoculative Treatment. [March

Nervous Headache cured by the Inoculation of Morphia.

A woman admitted into the hospital Beaujon, was very subject
to nervous headache. On a former occasion she had experienced
great relief by the application of a blister to the temple, the blis-
tered surface being afterwards dressed with anointment contain-
ing some muriate of morphia. J)r. M. Solon made trial of the
endermic use of morphia in a different form this time. He made
eight punctures in the temporal region with a lancet impregna-
ted with a strong solution. The patient was speedily cured, but
felt inclined to sleep during the day.

It is chiefly to the researches of MM. Lembert and Lesieur
that the profession are indebted for having illustrated the good
effects which may be derived from the application of various
medicines lo the skin deprived of its epidermis. One very great
advantage of the practice is, that the most potent remedies may
be sometimes used in cases, where the judicious physician might
be unwilling to introduce them, even in the most minute quanti-
ties, into the stomach or rectum. Moreover the direct application
of anodyne medicines to the seat of a painful affection will often
succeed, when constitutional or general means fail of relief. It
has been v^ry well remarked "Why have medicines always
something uncertain in their action? It is because they reach a
surface ever varying in its condition, or the intestinal mucous
membrane is irritated and covered with mucosities, or perhaps
the stomach and bowels are full. In subcutaneous absorption
on the other hand, the absorbent vessels (and perhaps also the
capillary veins) are always in a free state, when the skin has
been recently deprived of its epidermis.

Hitherto the endermic, or, as some call it, the inoculative
method of treating diseases, lias not been much attended to in
this country. The most potent and available remedies are per-
haps the vegetable alkalies ; more especially the salts of mor-
phia, strychnine, veratrine, &c.

We are indebted for the facts in this article to the late num-
bers of the Continental and British Medical Review, edited by
Dr. Ilioffrey, of which we have already spoken favorably. We
trust that Dr. R. meets with the encouragement, which he de-
serves. Ibid.

SOUTHERN
JOURNAL.

Vol. II. APRIL, 1838. No. IX

PART I.
ORIGINAL COMMUNICATIONS.

ARTICLE I.

Spontaneous Care of a Case of Amaurosis. Reported by
Lawrence L. Cohen, M. D., of Charleston, S. C.

The treatment of Amaurosis must depend on the causes that
have produced the disease and be regulated accordingly. The
great improvements and advantages of the modern plan of prac-
tice, is to.be ascribed to the advancement of physiological and
pathological science. The physician of the present day when
called onto prescribe for any particular disease, gives such reme-
dies as are consistent with the acknowledged laws of the func-
tions of the animal economy. Not so, with the empiric of old;
he, like the dogmatist of the ancient school of philosophy, had
certain remedies and sayings that like the bed of Procrustes was
adapted to any emergency. The "empirics of old saw without
discerning, administered without discriminating and concluded
without reasoning." Or how else can we account for and excuse
their many follies. Thus history records the & of Yogel who
" recommends a roasted toad as a specific for the gout ; and that
one may secure himself from angina by eating a roasted swa.-

A 1

516 Spontaneous Care of Amaurosis. [April.

low. Yet how many have done both and been martyrs to these
diseases. The propagation of opinions like these is the best
evidence of the credulity of the age in which they lived. The
ancient manner of treating Amaurosis was by taking an ox or
sheep's liver, roasting it and imbibing the fumes through a fun-
nel ! How altered is the mode of proceeding in these days !
We have no panaceas. The age of specifics is gone, and the
same remedies cannot be applied to the different forms of the
same disease. Calomel and blood-letting are the means most
relied on for the cure of the Amaurosis, yet no oculist will issue
his dictum and say that these will effect a cure, for although he
knows very well in some cases they would have a beneficial ten-
dency, in other forms of the same disease they would be the
most pernicious agents he could employ. Thus we say in regard
to this disease, that we can offer no remedy that has an aptitude
for all its varied forms, but that rather we must discriminate and
give such remedies as are adapted to each individual type. This
is the only plan of proceeding with a due regard to science, for
we find " all sorts of persons amongst the amaurotic, from him
whose vessels seem on the point of bursting with plethora and
who has long revelled in the solid luxuries of the table, down to
the emaciated victim of famine and intemperance, in all ages and
ranks, and not unfrequently it happens, that by directing our
attention to the history of the patient's mode of life, his previous
pursuits and habits, we are enabled to detect the exciting cause
of this complaint and by the avoidance of which for the future
the cure may be greatly promoted."

Case. Mr. , aged 21 Student of Medicine general

health good pre-eminence of temperament, sanguineous

January 3r/, J S3G. Attacked with severe inflammation of the
conjunctiva of the left eye, which continued till

January oth. When the inflammation extended to the right
eye, so that vision was suspended in both eyes. The appear-
ance presented was that of an enlargement and great degree of
excitement in both eyes the membrane abuginea was covered
with blood vessels that appeared as completely engorged as if
they were on the eve of bursting their confines. Used a wash
composed of n. acet. plumbi gr. xx. -sulph. zinci gr. x. aqua
pluvia gviij. V>. the object of this was to reduce the pain and
heat of the parts and subdue the excitement.

1838. J Spontaneous Cure oj imaurosis. 517

January ID///. Finding the pain still intense used in combi-
nation with the above lotion R pulvis opii gr. x. aquapluvia =viij.
M. The patient continued to take in addition to the proceeding
pil. hydr. grs. vj. at night sulph. magnes. ?,']- in the morning.

January 14///. The patient used the above remedies in the
intermediate time and about this period all traces of the disease
had departed the inflammation had been completely overcome,
the eyes assumed a healthy appearance, and the vision returned
in a perfect state patient resumed in good health his previous
avocations.

December 1st. An interval of 11 months had now elapsed
since the patient had experienced any inconvenience in his
health lie had in the interim been engaged at his studies which
he pursued with considerable energy. The over use of the vis-
ual function we regard as the proximate cause of this disease.
conjoined with a hereditary predisposition of a determination ol'
blood to the head. At this period he complained of a constant
giddiness in the head a feeling of engorgement in all the cere-
bral vessels attended with severe pain over the frontal sinus and
superciliary ridge.

But the eyes preserved their healthy appearance and the pa-
tient continued his studies, finding the optic organs executing
with integrity their offices. In order to relieve the apparent con-
gestion that had taken place applied 2D leeches over the super-
ciliary arch placed the patient on a course of pil. hydr. et. sulph.
magn. for one week. December 10///. Finding no amendment'
in the painful symptoms this day 20 leeches were again applied
over the same place as heretofore. December 12///. Pain still
continued with unabated violence applied leeches to the tern
pies back of the ears, and along the cervical region of the neck.
December 15///. Patient now felt a diminution of all those disa-
greeable symptoms, and appeared perfectly well during this
attack the eyes evinced no undue sensibility to the stimulus of
light nor was there any orbitar pain. At this period the eyes
were examined with magnifying glasses but no deviation from a
healthy hue could be discerned. January -It//, 1S37. Patient
had a return of all previous symptoms but in a more aggravat* d
form the pain over the superciliary arch was intense, that in
the head constant and severe the left eye appeared weak, and

518 Spontaneous Cure of Amaurosis. [April,

evinced a keen susceptibility to light to such a degree that no
act of volition could open it on light being brought near there
was also considerable inflammation apparent externally in this
eye the sight of it seemed to be imperfect as if a dark cloud
was before it 20 leeches were applied as heretofore the eye
kept moist with a solution of the acetate of lead ; and hydr. sub.
mur. grs. vi. given at bed time directed to be followed in the
morning with sulph. magnes. gj. The patient's comfort required
that he should be placed in a dark room which was accordingly
done. January 5th. No material alteration continued the
above. January 6th to lith. Finding no improvement in
the patient's vision directed blisters to be applied over the tem-
ple and behind the ears placed the patient on a light diet ab-
staining from all stimulus. January 15th to 20th. During
this interval repeated the above kept the blisters open with the
use of savin ung. the pains had in a great measure subsided and
the vision much improved. January 25th. Patient having
returned to his usual diet had a recurrence of pain which ceased
on a return to a vegetable regimen. January 28th. Much
pain over the superciliary Tidge but the vision perfect gave as
before sub. mur. hydr. et. sulph. magnes. January SOth. Symp-
toms relieved. February 5th. Constant, dull, uneasy sensation
about the head acute periodical pain over the eyebrow a dis-
tended feeling in the vessels of the eyeball and much evidence
of biliary derangement which induced the opinion that the di-
sease was primarily located in the digestive organs and acted on
the head sympathetically, therefore prescribed emetics for six
days consecutively, conjoined with local and general blood- let-
ting. February \2th. Pains were now periodical and of great
intensity. The vision was imperfect, thus, for example, if the
patient looked directly forward at a person before him he would
see his head from above the sternum and his lower extremities
from beneath the pelvis, but the intervening space was misty and
darkened. In Brewster's Letters, p. 36 we find a like case re-
corded, that of Dr. Wallaston; " he says lie suddenly found he
could see but half of a man whom he met on the street and that
on attempting to read the name of Johnson over a door, he saw
only son the commencement being wholly obliterated from his
view.1' It would be out of place to give the cause of these eccen-

1838.1 Spontaneous Cure of Amaurosis.

tricities of sight, as our limits do not permit it. The ob-
ject of treatment was now to diminish the lorce of circulation ,
therefore bled the patient in the arm cupped over the temples
and leeched behind the ears also gave the tr. digitalis and pul-
vis antimonialis in order to decrease the force of arterial excite-
ment the patient still on low diet. February 16lh. Bled
leeched and cupped again continued the p. antimony. Febru-
ary 25th. Having without advantage treated the disease as
located in the circulation stomach blood-vessels of the head
I determined to ascertain what advantage would accrue from
directing attention to the nervous power to fulfill this indica-
tion 1 used the conium maculatum andhydr. sub. mur. combined
commencing with gr j. of cicuta and cautiously increasing until
ss. per. diem. wa3 taken, the calomel was not increased in the
same proportion as the indication was not to produce ptyalism
the patient's system now having been brought under its influence
to such a degree that nausea, vertego and constant drowsiness
was produced discontinued its further use. March 20th.

Mr. was now attacked with an intermitting pain that

appeared to have the superciliary arch for its centre, and which
radiated in all directions the spasmodic action associated with
this pain was intense the attacks were most severe at night,
coming on with increased violence after an hour's rest the
patient was unable to sleep after the first attack as these symp-
toms generally continued all night Leeching venesection
purgatives emetics were prescribed without benefit, and relief
was only obtained from the administration of morphia. No
change in vision either one way or another the appearance of
the eye still continued healthy, so that it was difficult to deter-
mine which was the morbid eye the right eye still continued
free of pain and the vision perfect the patient had long since
discontinued his studies and ceased to exercise the visual faculty.

April 1st. No amelioration of the sufferings of Mr.

or change in the stale of vision continued the morphine.
April 10th. The spasmodic pains continued with unabated
energy and as no benefit was derived from the various remedies,
(besides those previously named) directed a change of air and
diet and the mode of life and to remove from a marine to an
inland atmosphere also to arouse an action in the whole system
by stage and horseback riding. April to May 5th, Mr.

520 us 'Cure of Amaurosis. [April,

remained in the country and derived much benefit although the

vision was not improved the exacerbations of pain were less
violent and the paroxysms at longer intervals during this time
daily exercise on horseback was continued.

May 10//.'. Mr. returned to Charleston no improve-
ment in vision, but the recurrence of pains were seldom and they
of slight intensity in comparison with their previous violence.
May 20th. The spasmodic pains now returned with more than
usual violence they appeared to have been only gathering
strength to make their attack's with increased energy only rest
procured was by the use of morphia. May 30th. No mitiga-
tion of previous sufferings. Mr. having obtained advan-
tage from change of air, directed him to travel. June. During
this month Mr. visited the northern states which pro-
duced no improvement in vision the eye still continued to
exhibit a normal exterior the spasmodic pains were frequent as
ever on the return of pain he took morphia gr. ss nightly.
July. No material change worthy of note, except about this
period the vision became more incomplete than heretofore he
being unable to distinguish a male from a female form.

The disease was by an eminent physician of the north consid-
ered as the result of debility and Mr. took the carb. ferri,

the sulph. quinine as well as other tonics having been previ-
ously employed in vain discontinued its use after giving it a
fair trial.

August. No material alteration this month in the vision

Mr. visited the Saratoga Springs and drank freely of the

waters in combination with pil. hydr. The pains had now nearly
departed and when they returned they were oi short duration and
moderated in their grade of violence.

September. Pains had now left the patient and his general

health was go )d no improvement in vision. October. Mr.

now returned to Charleston rgeneral health perfect no return
of spasmodic pains lor months the eye presenlcd a healthy
appearance so much so that when medical gentlemen examined
it they were unable todiscern the healthy from the diseased mem-
ber inspections again made with glasses, nothing could be
discovered indicating a departure from a natural condition.

The sight of the left eye was completely suspended, but Mr.

declared he lilt no inconvenience as he found the sight of

LS38.1 Vital Propensities of Arteries. 521

one eye ample (or the discharge c-i' the offices of life. Made
attempts with electricity but derived no advantage from them.
November. Patient in good health resumed his studies in pari.
thinking that perhaps a moderate hut not a prodigal exercise ol
the eye would be advantageous. December J 15th. Without
any change in mode of lite, diet or the use of any new remedial
agent the complete use of vision in the former diseased eye return-
ed. The right eye from the commencement to the termination
of this disease has never been implicated.

^ARTICLE II.

Vital propensities of Arteries leading to inflamed parts.

Professor Alison has, with the assistance of others, made
extensive observations on the subject of the tonicity, or vital
power of contraction in arteries, "which acts in all cases when
a living artery is emptied of blood determines the degree of
contraction observed in arteries for some hours after death, and
is the only vital power ascertained by unequivocal experiments
to exist in the arterial coats. His experiments have been made
by actual measurement on arteries ot sufficient size for this mode
of investigation, and by the microscope in the minute vessels of
inflamed points themselves. The experiments by measurement
were, for example, such as this: Sections of the axillary and
humeral arteries precisely corresponding to one another and
about 2 1-2 inches in length were taken from a horse which had
first been bled to death, but which had for eight days suffered a
violent inflammation attended with great pain and swelling of the
right knee-joint of one of his fore legs. These sections of arte-
ries were examined as soon as they could be taken from the body.
" The artery of the diseased limb, when taken out of the body
was, as in all the other cases, found to be decidedly the largest,
measuring at the lower extremity of the portion taken 12-8 of an
inch in circumference of the arteries from the sound limb at the
corresponding points were 11-8 and 5-8 only." &c. Hence Pro-
or A. concludes that the tonicity, or vital power ol' tonic con-
traction is absolutely diminished in all the vessels leading to an

522 Vital Propensities of Arteries. [April,

inflamed part ; and lays "it down as a general fact that all the
vessels concerned in any local inflammation, are in a state of relax-
ation and distension, as compared with their natural condition."
Of the truth of these experiments, we cannot for a moment
allow ourselves to doubt. The facts, we feel no disposition to
scrutinize. And, whilst we would not deny the possible correct-
ness of the deductions thence drawn, we must be allowed to
consider that they are neither necessarily correct, or true results
of the reasoning in the case ; nor conclusive, either for physi-
ological or pathological purposes. If the vasa vasorum of the
arteries of an inflamed part were engorged, or in a state of con-
gestion, what would be the effect on the caliber, and conse-
quently on the circumference of the artery ? It is evident that
these must both be increased. Nor v^ould this be all. In con-
sequence of the increased compactness of the coats of the artery,
they would also be rendered more fixed having their elasticity
altered from their healthy condition by their greater firmness
preventing that attenuation which elastic substances undergo on
distension or extension, as a bag or strip of india rubber, or in-
deed as the coats of the arteries themselves when put on the
stretch. And we would ask, if another experiment of Professor
Alison does not go far to justify the doubt we express of the
correctness of the conclusion, that in all the vessels concerned in
local inflammation there is relaxation, &c. We must be excused
for scrutinizing somewhat closely the conclusions in point, be-
fore we receive them as correct, when the bearing of the princi-
ple on pathology and on therapeutics, if established, is duly con-
sidered ; for it is most obvious that if " a diminution 01 vital
power," or "a state of relaxation" of vessels in common inflam-
mation be established, there must be at once a subversion of
most of the therapeutics in such cases, and the sum of treatment
be made to consist of tonics, stimulants, astringents, &c. to the
exclusion of antiphlogistic and depletory means now universal-
ly in proscription.

The experiment to which we just alluded as tending to justify
the doubts we have expressed, is the following :

In the experiments of Professor A. bent tube and stop-cocks
were used in the manner practised by Poisseulle to try the
contracted power of the vessels.* Professor A. tried "the

: Physiologic vol. viii.

Vital Properties of Arte/

strength of the arteries by their reaction on water distending
them in two ways : First, the second limb of the tube was filled
with water, and the space occupied by the quantity expelled
on the contraction of the artery was measured. The artery of
the sound limb was found to expel just five inches of water ;
that of the diseased limb .35 inch only. Secondly, .what ap-
peared to be the more accurate mode, the water was made to fill
the second tube only to a given point, and the rise of its level,
on the expulsion of that contained in the distended portion of the
artery, was accurately measured, and amounted to 1.75 inch in
the case of the artery of the sound limb ; and 1.25 only, in the
case of that of the inflamed limb. The column of mercury used
to make the distension was exactly the same in the trials/'
Hence it seems proved, as well as any experiment could be devis-
ed for that purpose, that the inelastic, or fixed state of the diseased
vessel, and not its "relaxation" nor "its loss of vitality " is
the true pathological state.

We refer to another experiment, of professor Alison for the
justification it affords, of our doubt :

" Two portions of the axillary arteries, (of a horse having an
inflamed leg,) each eleven lines long, were successively fastened
between two bent tubes, and distended with water, by the press-
ure of a column of mercury of about ten inches, introduced into
one tube, and then allowed to react on the water distending
them, so as to raise the level of a column of water in the other
tube, to a degree which could be accurately measured. The
result was, that the reaction of the artery of the sound limb raised
its level by sixteen lines, and that of the artery of the inflamed
limb raised it only ten lines." Hence we consider the inelastic
state of the vessel only is proved.

Another experiment made with great care and accuracy by
Dr. Spittal, one of the assistants in Professor A?s. investiga-
tions tends, not less, if not considerably moie perfectly to estab-
lish the position we have taken, than either of those to which we
have referred. It was an experiment for determining " the rela-
tive circumferance of these portions of arteries at this time, and
again after a lapse of about twenty-eight hours, when the post
mortem contractions dependent on the last exertions of their to-
nicity were over. The artery of the sound limb was then found

524 Vital Properties of Arteries. [April,

to have dilated itself again from 33.24 to 41.21 ; while the artery
of the inflamed limb had dilated itself only from 36.24 to 42.24,
at the corresponding point ; so that the difference in the artery
in its contracted state immediately after death, and its perfectly
dead state, was 8.24 or 1-3, or 1-3 in the sound limb, and only
6.24, or 1-4 in the inflamed limb : and in other parts of the arte-
ries it was obvious, that the difference of caliber between the ves-
sel in its concentrated state immediately after death, and its sub-
sequently dilated state, (which is the measure of its last exertion
of tonic power of contraction,'' or rather its entire loss of power,)
" was considerably less in the inflamed, than in the sound limb
the vessels approaching more to equality of caliber at the second
examination.

The final sum of the investigation, Professor A. believes to
be as follows :

"It appears, therefore, as the the uniform result of all the
modes of examination we have been able to devise, that the ac-
tions of inflamed parts, examined at different parts of their course,
and at various periods of the inflammation, and when they are pul-
sating apparently with unusual force, are in fact relaxed or
weakened arteries, transmitting, in consequence of their weaken-
ed condition, the impulses given by the heart with less modifica-
tion than it receives in passing through the arteries of sound
parts, but themselves exerting a less power of contraction on the
blood than they do in the sound state/'

But whatever may be the physiological, or pathological errors
into which the Professor may have been drawn, his honesty and
good sense, and his unwillingness to sacrifice truth on the altar
. of self-love, are fairly set forth in the following very sensible
observations, which we take great pleasure in giving place.

" This being ascertained, that is to say " the relaxed" and
" weakened" state of the arteries in inflammation, the question
immediately presents itself, whether this weakened state of the
vessel? is an adequate cause for all the changes, as to the move-
ment of the blood, which takes place in the inflamed state, i. e.
whether inflammation consists simply in a weakened action of ves-
sels. I formerly mentioned one striking fact, on which I think
there can be no doubt, as sufficient to indicate that this question
must be answered in the negative, viz. that two distinct and
nearly opposite changes are ascertained to take place in the
movement of the blood through an inflamed part, a retarded

1838.] Vital Properties of Arteries. 525

movement in the vessels most immediately concerned, and an
accelerated movement and greatly increased transmission, in all
the surrounding vessels.

"I shall take the liberty oLaddin^ one or two considerations,
in confirmation of the opinion, that this diminution of the con-
tractile power of the arteries, although the only change percepti-
ble in their mode of action, is quite inadequate to explain the
simplest and most essential phenomena of inflammation.

1. If we suppose inflammation to consist only in an altered action
of vessels, and this alteration to be of the kind which these, obser-
vations indicate, we make no attempt to explain the difference
between inflammation, with effusion of lymph, and simple deter-
mination or congestion of blood, where no unusual product is-
sues from the vessels. Now this appearance of the peculiar
products of inflammation, exuding from the vessels, is what the
pathologist regards as most truly characteristic of the inflamed
state ; and I believe it to be certain, that in the usual effusions,
consequent on healthy inflammation, the fibrin is both in much
larger quantity, and shows a greater attraction of aggregation,
than in any effusions from uninflamed vessels. Of this we have a
familiar example in the case of the lungs, which we often find
not only infiltrated with effused serum, but so far condensed by
congestion of blood, as to be impervious to air, and not crepitate
when cut, without being so far increased in density as to sink in
water ; but so far as I have observed, whenever we see the gran-
ulations of decolorized lymph in the air cells, truly characteris-
tic of inflammatory effusion, then we are certain of seeing this
decisive proof of the increased density of the lungs.

2. If we suppose inflammation to consist merely in that relaxed
condition of vessels which is indicated by these observations, we
must suppose the usual causes of inflammation e. g. mechanical
injury, to produce, very rapidly, in all the vessels adjoining and
approaching to the part to which they are applied, this state of
relaxation or weakness, and to be effectual in exciting inflamma-
tion, only inasmuch as they diminish the vital power of those
vessels. Now tins depressing or sedative effect on vital power
is not only just the reverse of the effect produced by such agents
on the living parts, whether irritable or sensible, but is just the
reverse of the effect produced by such agents on arteries them-
selves, when they are applied in such a manner as directly and
exclusively to irritate their coats ; as in the experiments of Ver-
schuir, Dr. Thomson, Dr. Hastings, Wedemeyer, and others,
where the contractile power of arteries was decidedly excited by
irritation, their calibre in consequence lessened, and the trans-
mission of blood through them impeded.

"The more this subject is considered, the more distinctly,
1 think, must it be perceived, that the only way to escape from

526 Hematics on Convulsions. [April

these various difficulties is to suppose, that the causes which
excite inflammation do so by really exciting or increasing a vital
action, but not an action of the nature of contraction ; that the
idea of the vessels of inflamed pag taking on an increased ac-
I ion is a delusion ; that what is truly excited is an action not of
the vessels but within the vessels of the part effected ; that it is
an increased exertion of powers by which the blood is moved, or
its motion influenced, in the capillaries, but which powers are
inherent in the blood itself, dependent on, or influenced by, its
relation to the surrounding textures, but independent of any con-
tractions of Jiving solids; and the increased exertion of which
'powers leads always to distension," and to more or less diminu-
tion of t.he tonic power of contraction, of the vessels, within
which it takes place."

ARTICLE III.

Remarks on Convulsions, by L. A. Dug as, M. D., Professor,
fyc. in the Medical College of Georgia; contained in a
Letter to the Editor,.

Dear Sir The seventh number of your useful journal,
(vol. ii. p. 428,) contains an article of considerable interest, not
only because it suggests a new treatment for a dreadful class of
diseases, but also because an attempt is made to generalize from
the single met it contains. \ allude to M. Trousseau's "com-
pression of the carotid artery in the treatment of convulsions."
There are Jew physicians for whose views I entertain more re-
gard than for those of M. Trousseau. lie is a man ofindustry,
erudition, and genius, and a teacher of great tact and ability ;
all of which circumstances give weight to his observations.
Yet the article be lore us is, to me, too exceptionable to pass un-
noticed.

in order to discuss this subject, it is necessary to admit the
correctness of the inference, that the cessation of the convulsions
was a consequence of the means employed; an inference which
cannot be too captiously made with regard to the action of a new

1833.1 Remarks on Convulsions. 52'

agent in an isolated case, and especially in the treatment of
infantile convulsions, which frequently cease spontaneously,
whereas they much more rarely continue unto death. But the
admission may be made, and a very different rationale offered
than that suggested by M. T. Our author states that he com-
pressed the primitive carotid against the side of the trachea, and
in this manner prevented the accumulation of blood in the left
hemisphere, and, consequently, diminished the congestion, which
he regards as the cause of the convulsions. Kow I would ask
if it be possible to compress the carotid, without at the same time

(compressing the internal jugular vein? nay, is it not more proba-
ble that the sluggish circulation of the jugular would be thus
arrested, than that the great force of the heart's contraction should
be overcome in an artery so near it ? Indeed the proximity of
these vessels is such that it would seem impossible to exercise
any pressure on the one without at the same time compressing
the other, and, inasmuch as the venous circulation is more readily
impeded than the arterial, it is but fair to conclude that in this
case there was rather a suspension of the former than of the latter.
Such being the fact, it follows that so far from congestion being
prevented, it was actually increased ; and this leads us to the con-
sideration of the pathology of convulsions.

It is efident that M. T. in common with most writers, regards
congestion of the brain as the great cause of convulsions, vet we
have seen that the means proposed and affirmed to have arrested
them, must necessarily have increased this state of things. This
result fully comports with my views of this disease, for I have
long since entertained the belief that the congestion, so apparent
during convulsions, is the effect, and not the cause of the muscu-
lar contraction. Observe the sequence of phenomena, wheth-
er occurring in an epileptic sufferer, a hysterical female, or a
teething child : the patient will most generally be seized with

f convulsions without the least previous indication of cerebral con-
gestion ; the violent contractions of the muscles propel towards
the heart the venous blood contained between them, at the same
time that the function of respiration is impeded by the deranged
action of its muscles; the heart beats violently, but cannot re-
lieve itself of the great afflux ; the veins of the brain, like those
of the general surface; uncompressed by muscles, become en-

528 Remarks on Convulsions. [April

gorged, and congestion is the result. When this has been car-
ried sufficiently far materially to compress the brain, the convul-
sions cease, the patient is left comatose, with stertorous breathing,
and indeed with all the symptoms which characterize compress-
ion under other circumstances ; nor will the convulsions return
so long as this state continues. When they do recur, it is only
after the brain has been relieved, the coma and stertorous breath-
ing have disappeared, and consciousness has been more or less
restored. It really seems to me impossible to contemplate a suc-
cession of convulsions in the same individual, without being
impressed with the influence exercised by congestion, or rather
compression, of the brain, in the arrestation of muscular contrac-
tion. But, independently of this kind of observation, we have
the testimony of all the experimental and pathological facts at-
tending unequivocal compression of the brain, all of which con-
cur in proving that compression never occasions, but always
arrests or annihilates muscular contractions.

Will it be urged that a slight degree of congestion will occa-
sion convulsions, whilst a degree sufficient to produce compress-
ion will arrest them 7 Were this the case, convulsions would be
one of the most common occurrences of life, for there is perhaps
no organ in the body whose circulation is more fluctuating than
the brain. .Every man of ordinary observation must be familiar
with the symptoms which indicate a rush of blood to the head,
and which vary from mere giddiness to apoplectic stupor. Con-
gestive apoplexy is never attended with convulsions ; the whole
muscular system, on the contrary, is in a state of relaxation, bor-
dering on paralysis, and this continues until the equilibrium of
the circulation be restored. The fact that the congestion is in-
creased by the convulsions, did not escape the observation ot M.
T. ; and, in order to make this accord with his theory, he infers
that the congestion which causes convulsions is active, whereas
that resulting from the convulsions is passive (p. 431.) It is
difficult to perceive the difference between these two states.

What then is the pathology of convulsions? The question
though one of difficult solution, should not be abandoned. We
know the normal contractions of the muscles to depend on a cer-
tain influ tnsmitted by the nerves of motion, and that in
the healthy state this transmission is subject to volition. The

1838.] Remarks on Convulsions. * 529

mly difference then between the normal and morbid contractions
is to be found in the cause of the transmission of the nervous
influence. This cause in the one case, is volition ; in the other
it is more obscure. Convulsions arise from a vitiated transmiss-
ion of the motor fluid, if we may use the expression. It be-
comes a matter of importance to determine the causes which lead
to this vitiated innervation. In epilepsy and the majority of in-
fantile convulsions, the derangement affects but one side of the
body; whilst in hysteria &c. the entire muscular system of
animal life is convulsed. There are cases again in which the
vitiated innervation is manifested alone in the upper or lower
extremities, or in but one of them.

Among the remote causes known to produce such derange-
ments of innervation, the most prominent is the hereditary ner-
vous susceptibility, so often and manifestly transmitted by parents
afflicted with epilepsy, hysteria, &c. The proximate causes
are as numerous as the irritations to which the various organs
may be exposed. The nervous susceptibility being most exalted
in infants and adult females, we find that these subjects are the
most prone to convulsions. The reverse obtains with regard to
adult males, who are most disposed to cerebral congestions. It
has been remarked by the physicians attending the insane hos-
pital of Charenton, that congestive apoplexy scarcely ever occurs
among the females, though it is very common among the males.
The same observation has been made at Bicetre and at La Sal-
petriere. In the former institution, containing males alone, con-
gestive apoplexy is of very frequent occurrence ; whereas in the
latter, the inmates of which are exclusively females, it is seldom
ever seen.

If cerebral congestion be the cause of convulsions, how can we
explain the production of these by excessive hemorrhage ?*They
may be induced by immoderate venesection under a variety of
circumstances, but especially after prolonged intoxication. All
practitioners know that they not unfrequently occur during the
most profuse hemorrhage in child-bed.

1 am aware that post-mortem inspections reveal, in some in-
stances, great cerebral congestion and even effusion, but, in the
majority of cases, no lesion of the brain can be detected. Were
congestion observed in every inspection, it would only prove that

530 * Remarks on Convulsions. [April

there had been a great increase of bl^od in the brain, and not
that this congestion occasioned the convulsions. It is but a nat-
ural consequence of these.

Convulsions have been divided into idiopathic and symptoma-
tic ; but this division should be regarded merely as distinguish-
ing those whose imme.diate cause eludes our researches, from
those whose immediate cause is more apparent. To the former
class belong epilepsy, hysteria, chorea to the latter, puerperal
convulsions, those occasioned by the irritation of dentition, by
the presence of worms or indigestible substances in the alimentary
canal, and, in short, by any acute affliction.

In order that prescription be beneficial, it is absolutely neces-
sary that they be predicated on correct pathology and unerring
diagnosis. In the class of diseases under consideration, if con-
gestion of the brain be the correct pathology, there can be but
little uncertainty in the diagnosis ; but if the pathology be such
as I have endeavoured to prove it, the diagnosis must be as dif-
ficult as it is important; for, instead of one exciting cause, there
will Be many, and no correct treatment can be instituted until
the acting cause be determined. Our bed-side investigations
should be minute in proportion to the difficulty of the diagnosis,
and in none more so than in cases of convulsions. If the method
of interrogating in succession each organ, as advised by Host an
in his able treatise on diagnosis,* be adopted, the task will be
materially facilitated, and it will be found that the treatment
should be oftener directed to other organs than to the head.
The brain, instead of claiming our primary attention, will only
need be watched, lest it suffer secondarily.

I would not be understood as affirming that affections of the
head, either acute or chronic, never occasion convulsions, but
mere|jr that these do not and cannot result from mere congestion
or comnression. If a blow be received on the head, fracturing
the cranium and plunging spiculas into the membranes or the
brain itself, convulsions will very frequently be induced ; but
the same may be said of irritations of any other organ or tissue.
As I have already observed, the mere irritation of a tooth making

* Sec an extract of Rostan's work, transited for this journal, vol. 1 p. 1G6.
et. seq.

1838.] Hydrocele. 531

its way through the gums, of the presence of worms or indigesti-
bles in the alimentary canal, &c. may induce them in a subject
of intense nervous irritability. Remove the spiculse, scarify the
gums, or expel the offenders from the bowels, and the convul-
sions will cease.

PART II.
REVIEWS AND EXTRACTS

Hydrocele.

This disease seems to have attracted of late the consideration
of surgeons with unusual effect. In times past, it baffled the
efforts of the surgeon on every hand; frequently recurring after
tapping, and requiring frequent repetitions of this operation.
As the spirit of improvement was extended to its treatment, sea-
tons, and the introduction of extraneous substances, as balls of
dough, clay, &c. for exciting inflammation and obliteration of
the cavity were used. These tedious processes, though often
ultimately successful, were soon superseded by the more expedi-
tious plan of puncturing with a trocar for discharging the con-
tents, and introducing through the cunula a suitable mixture of
wine and water to excite adhesive inflammation. This practice
has continued, with little variation, until the present time, and
has been found efficient with great uniformity. Moreover, it is
expeditious. The only difficulty attending its adoption, has
been that of effecting a good injection into the sac ; infiltration
into, and violent inflammation of, the cellular layer of the scro-
tum, being sometimes unavoidable. Still a very partial injec-
tion into the sac generally effected its entire obliteration. But
even this difficulty has been completely met in the finely adapt-
ed canula and elastic baa: now sold in the hydrocele cases. With
this apparatus, and a proper state of the patient for the opera-
c 3

532 Hydrocele. [April,

tion; doubt of expedition, safety and success may not be enter-
tained in the least degree. It is the real merit of this operation
which has kept the profession so quiet on the subject for the last
twenty or thirty years, and there is much reason to doubt whe-
ther any plan of treatment has been, or will ever be discovered,
calculated by its real merits to supplant the present operation.

But many new plans of operation have lately been suggested
and adopted with more or less success. The following are the
principal proposed improvements :

New Treatment of Hydrocele^ with cases by Professor Vel-

peau.

Having learned that the preparations of iodine have been em-
ployed successfully as topical applications in hydrocele, I
thought of trying them as an injection in that disease. For
this purpose I uSed a solution or a mixture of water and the al-
coholic tincture of iodine, (one or two drachms of the tincture
to an ounce of water). After having emptied the cyst by the
ordinary puncture, 1 injected from one to four ounces of the
mixture, just mentioned. It is not necessary to fill the tunica
vaginalis, since by pressing the tumour we can force the fluid
in contact with every part of its internal surface. The mixture
is then withdrawn immediately, without, however, fearing to
leave a small quantity of it. As it is not necessary to heat this
remedy, nor to fill the cyst, nor to withdraw the fluid entirely,
the syringe generally employed for injections into the urethra
will answer. After the injection, the patient may not be con-
fined to his bed. The part is swollen for two or three days,
without causing fever or any serious pain ; resolution then com-
mences, proceeds generally with rapidity. I have employed this
method in twenty cases ; none of the patients experienced the
slightest accidents. Eighteen of them were cured in less than
twenty days ; in one the resolution was only half accomplished
on the thirty first day, I recommenced the operation and the cure
then took place rapidly. The twentieth case remained in the
hospital six weeks, in consequence of an engorgement of testicle.
Two cases had been operated upon unsuccessfully by the vinous
injection and by cauterisation ; two had an encysted hydrocele
of the chord; in three the tumour contained about 12 ounces of
serosity ; in ten the testicle was in a state of hypertrophy, was
nodous, and had been diseased for some time; in all, except two,
the disease had existed for more than six months ; two had been
affected for more than 15 years, and one for more than 20 years.

The 2d and 3d cases prove that under the influence of this

1838.] Hydrocele.

injection, an encysted hydrocele of the cord may be radically
cured in ten days, and that five days are sufficient to effect a cure
of certain cases of hydrocele of the tunica vaginalis.

It will be seen, by the following facts which I have selected
from the twenty cases, what are the consequences and the result
of this new method in the different varieties of hydrocele.

Case 4th. Hydrocele of tunica vaginalis : vinous injection.
Relapse, iodine injection : an ounce of the fluid left in the cyst.
No previous preparation. Cure in fifteen days.

A young man aged 19 was brought to me at La Charite by M.
Artaud de Beaufort in the month of October, 1836, for a disease
of the scrotum which had existed two or three years. A tumour
had arisen without any appreciable cause and slowly, in the left
scrotum ; it was indolent, tense, moveable, heavy, more volu-
minous than the first. The fluctuation was obscure and a
transparency was seen only at the external and anterior half.
The testicle and epedidymis were placed internally, were the
seat of some lancinating pain, appeared hard, much swollen
and altered. Every thing however indicated that the disease
was entirely local. The" young man was unwilling to remain
in the hospital. He was operated on fifteen days after, by a phy-
sician who employed the vanous injection. An inflammation
and intense reaction ensued and confined the patient to bed for
fifteen days. The swelling diminished subsequently for fifteen
days, and from that period remained stationary. Various discu-
tent applications were employed but unsuccessfully until the
end of October. The patient returned to me in the month of
November : the tumour was rather larger than the fist and pre-
sented the same characters as before, except that the transparen-
cy was no longer complete and that the weight was less conside-
rable. He consented to an operation on condition that I would
suffer him to return home immediately afterwards. A tumbler
full of serosity escaped from the tunica vaginalis. 1 injected an
ounce and a half of water containing two drachms of the tinc-
ture of idoine. After having exerted pressure upon the scrotum,
I allowed about half the injection to escape. The other half
remained in the cavity. The canula was withdrawn, the patient
went home and returned to me the sixth day. xVt that time
the swelling began to subside, no fever had supervened, the pa-
tient had not been confined to his bed, and had not changed his
habitual regimen. He wears a bag-truss and makes use of satur-
nine compresses. The 15th day no fluid can be perceived in the
tunica vaginalis. The tumour exceeds only by one third the
volume of the right testicle. At the present moment, January
15th, 1837, the cure remains complete.

Case 5th. Hydrocele of tunica vaginalis, caute risation, re-
lapse, iodine injection. Cure in fifteendays.

531 Hydrocele. [Apri 1

M. Sylva, a Brazilian, aged 22 years, student of medicine, of
a good constitution, had five years ago a hydrocele of the right
tside, for which he underwent an operation by means of caustic,
s wo years since, but which re-appeared soon after on the same
1 de. When I examined him the tumour had the volume of the
head of a foetus in the sixth month. The testicle and epedidy-
mis were flattened, slightly knotted posterierly and in their natu-
ral place. A transparency perceptible in 4-5 of the mass which
is light and pyriform. The cord and all the abdominal organs in a
healthy state. The cyst was very thin, entirely indolent, and
embarrassed the patient only in consequence of its weight and
volume.

The operation was performed December 8th, 1836. I intro-
duced the trocar at the point of selection. Eight ounces of serous
fluid escaped through the canula. I ascertained that the epe-
didymis preserved nearly its natural thickness, but was twice as
large as usual. The volume of the testicle was on the contrary
sensibly diminished, but without any other evidence of alteration.
A mixture of six drachms of the alcoholic tincture of iodine to
four ounces of water, had been previously prepared. The cau-
terisation having already failed, I resolved to inject a larger
quantity of the liquid than in the preceding case. I injected at
first two ounces, and then one ounce more after having with-
drawn that which had been first injected, and before the tunica
vaginalis was entirely emptied. The young man scarcely com-
plained during the operation and felt no pain in the lumbar region;
wet compresses were applied to the scrotum, and the latter be-
came the next day red, sensitive and swollen, but without exci-
ting any fever until the fifth day. Then the tumour appeared
to be distended by a new effusion, and had acquired the volume
which it had before the operation. The eighth day the swelling
had diminished one third. The patient had not left his bed
until the sixth day. His alimentation had not been suspended.
Examined the fifteenth day, the scrotum was still twice as large
upon the left as upon the right side, but without the slightest
appearance of liquid in the tunica vaginalis and the turmour
presented no symptom of pain. M. Sylva went out the tenth
day and is now perfectly cured. *

##### ## ##

The tincture of iodine substituted for wine does not require to
be heated, nor is any particular syringe, nor any previous prepa-
ration necessary. Since we are not obliged to distend the tunica
vaginalis, we do not run the risk of causing the fluid toregurgi-
late or of forcing it into the thickness of the scrotum. As it is
an absorbable substance, its infiltration docs not, like wine, expose
to gangrenous inflammations, it does not require to be retained

1838.1 Hydroc 535

in the cyst more than five or ten minutes. 1 have left purposely
an ounce in the tunica vaginalis, and the success was only mope
prompt. The developement of pain in the lumbar region is un-
necessary. The patients sutler but little; they may walk with-
out serious inconvenience, the day after the operation. M. de
Ch., upon whom 1 operated in presence of MM. Parent and Ni-
cholas, walked every day without retarding the cure. The cure
is more prompt, and equally permanent, as by the wine. Will
it be as constant? Nothing thus far has induced any doubt in
this respect. Let us not forget, however, that these are only a
few essays. It remains yet to be determined, what proportions
of the tincture are most suitable, whether it is better to with-
draw entirely the liquid, or leave a portion of it behind in the
sac, whether it is indispensable that the patient should remain
in bed, whether it is useful to make some topical applications to
the tumour, and whether the results will be the same in the
different kinds of hydrocele. Time alone can decide these
points, but the success 1 have obtained, is sufficient to justify
other attempts of the same kind, and to produde the supposition
that the tincture of iodine will probably be substituted advanta-
geously for the vinous injection in the treatment of hydrocele.
One of the first patients treated by this plan, and who was cured
the tenth day, died subsequently in consequence of an amputa-
tion of the leg. The scrotum was dissected with care; cellular
adhesions had been established between all the points of the
tunica vaginalis, so that a relapse would have been impossible.
With this liquid, a syringe of the capacity of three or four ounces
is sufficiently large for all cases; it should, however, be made of
a substance which is not acted upon by iodine. Thus far lhave
employed ivory syringes. Archives Generates de Midi cine.

Account of a Method of Operating for Hydrocele. By Ben-
jamin Travers, Esq.

This is essentially the same operation described in the pre-
ceding extract, but somewhat modified. The following is Mr.
Travers's own account of his mode of proceeding, and the re-
sult of his experience of the practice.

"In the spring of 1836, I commenced the practice of the ope-
ration ; first, making a single puncture with a trocar ; second-
ly, with a fine sharp-pointed probe ; thirdly, with an acupunc-
ture needle of the largest size; and then planting several punc-
tures at equal distances, according to the bulk of the hydrocele.
A drop or two of fluid escaping at the several needle orifices, a
rag dipped in cold lotion was laid on the part, and the general

536 Hydrocele. [April.

result was more or less oedema of the scrotum, and in three
days a total disappearance of the swelling. I soon ascertained
that it was not by adhesive or any other mode of inflammation
that, the change was effected, but that the tunica vaginalis was
left perfectly free and natural in its relation to the testis, and the
scrotum of its proper weight, size, and figure, so that relapse was
more to be apprehended. I was at first impressed with the idea
that the tense condition of the tunic was essential to the curative
effects of the puncture, and thus explained the difference of re-
suit from that obtained by complete evacuation and collapse of
the sac. But this opinion I have had occasion to modify, find-
ing that a freer discharge than could be obtained by the round
needle, and the consequent partial collapse of the sac, was on the
contrary more immediately and certainly productive of the infil-
tration of the cellular membrane, and consequent absorption of
the fluid. 1 have, therefore, since employed a very fine trocar,
smaller than any in common use, as the preferable instrument.
My mode of proceeding is to put the scrotum on the stretch, in
front of the testis,by embracing it with the extended thumb and
fore-finger of the left hand : and placing the patient opposite a
window on which the sun falls, or at all events a strong light, I
command the view of the transparent bag so perfectly as to avoid
veins and any point of accidental adhesion or thickening, which
is always marked by a corresponding opacity. The punctures
are made in a perpendicular direction and in quick succession,
about equi-distant from each other, while the tunic is kept tense
by graduated compression. Of several cases thus treated, some
have remained cured ; others, apparently cured, have relapsed
after a fortnight or three weeks, and one after three months ; but
I do not. consider this a fair criterion of the value of the prac-
tice, because from the shape and size of the acupuncture needles
chiefly used in these cases, the points on which I believe the
success of the operation mainly depends, were not accomplished.
These are, a freer collapse of the sac by the removal of a suffi-
cient portion of the fluid which the trochar puncture ensures,
and the more complete diffusion of the remainder into the sur-
rounding cremaster and cellular tunics, obtained by the multi-
plication of the punctures, while the tension of the sac is pre-
served. On the third day the fluid is absorbed, and the two
sides of the scrotum arejuniform : indeed, this is sometimes the
case on the second day ; but if the punctures are so small as not
at once sensibly to reduce the bulk of the swelling, a single drop
only exuding at each orifice, the reduction is generally much
slower, or even fails altogether. Med. Gazette, Feb. 11, 1837.

1838.] Hydroa 537

Mr. Travel's imagined that lie had anticipated Mr. Lewis in
this mode ot' treating" hydrocele ; as he says he first conceived
the idea of it in 1835, and mentioned it in "his surgical course of
lectures, previously to the publication of Mr. Lewis's first letter.
In a subsequent communication in the Lancet of February 18th,
Mr. Lewis informs us that he had performed the operation two
years before the time mentioned by Mr. Travers. However, a
letter in the Medical Gazette of the same date, from Mr. Keate, of
Albemarle street, deprives both these gentlemen of the honor of
having first employed this practice. The following extract from
Mr. K.'s communication leaves no doubt on this head.

" While I do not mean to intimate any doubt of the same
ideas having occurred to each of these gentlemen without any
knowledge of the other's theory or practice, or of any previous
operation of the kind, I trust it will not be offensive to either of
them if I assure you that the plan and the practice have been
known and acted on for very many years by myself, and I dare
say by others. By one other person I know it was performed I
dare say twenty years ago, namely, by a friend of mine, who for
some years practised as a physician in this town, and is now
living in retirement in the country. This gentleman performed
the operation on himself, as he was nervous about the injection,
and fancied, as he said, that if he could convert ascites into ana-
sarca, absorption from the cellular structure might cure the ma-
lady ; and in his own case it was perfectly successful. At his
suggestion 1 tried it frequently, both at the hospital and in pri-
vate practice; sometimes successfully, but more frequently the
collection of fluid in the sac returned, and I generally found the
patients impatient of the numerous punctures, and of the time
required for the absorption. 1 remember talking to Sir Astley
Cooper on the subject, and, as far as my recollection serves me,
the plan appeared not to be new to him." Med. Gazette, Feb-
ruary 18, 1837, Brit, and For. Review.

On the Treatment of Hydrocele by Acupuncture. By D.

Leavis.

In the Lancet of May 7th, 1S36, Mr. Lewis communicated the
interesting and important fact, that hydrocele might be cured
by a single puncture with a fine needle. He says "a drop of
fluid oozes out on withdrawing the needle, and in three days the
swelling will completely disappear, no matter in what quantity
the fluid may have been collected." It appears that the effect of
the operation is not to evacuate the fluid through the puncture,

538 Hydrocele. [April,

but to cause its absorption. He informs us that, out of upwards
of fifty cases, there has not been a single instance of failure, nor
any consecutive inflammation. It appears that this mode of
treatment is applicable to other cases of circumscribed dropsy ;
and Mr. Lewis informs us, that Dr. Thomas Davies finds it suc-
cessful in removing fluids from the chest. Mr. L. says that the
needle used in this operation "cannot be too fine, provided it be
strong enough to penetrate through the integuments: for, the
smaller the puncture, the less pain and inflammation ensue."

Lancet, January 14^A, 1837.

We noticed in the 1st. vol. Southern Medical and Sursrical
Journal, under the head of hydrocele of the neck, the use, by
O'Beirne, of the single thread in effecting adhesion in cases of
hydrocele of the neck, and we have no doubt but that its appli-
cability to r^drocele of the tunica vaginalis would be followed
by like success.

The following plan of operating for the radical cure of hy-
drocele, which was successfully adopted by Dr. Deblois, is
the only other improvement of latter days, which we shall give
in this place ; and it is one which we should not hesitate to re-
commend, had we found any fault with the plan of injection hi-
therto in general use. It may be conveniently practised with the
same apparatus now in general use for the vinous injection ;
that is to say, a small trocar and canula, with an elastic gum
bag and stop-cock, adapted to the canula. It would be more
convenient, however, to use a bladder, or a very thin elastic
gum bag, than those used for injecting a liquid, as they have
sufficient elasticity to imbibe the liquid into their cavity after
being compressed.

Chlorine Gas as an Injection for the Care of Hydrocele. By
M. Deconde.

Dr. Deblois, of Tourney, was in the habit of performing the
radical cure of hydrocele by injecting chlorine gas, instead of
red wine. His premature death prevented him from making
known the plan ; but M. Deconde, who has seen its advantages,
has described it. The chlorine gas is contained in a bladder, to
which is fixed a pipe and stop-cock, adapted to the canula of the
trocar, into which it is fixed after the fluid has been evacuated :
the stop cock is then turned, and the bladder pressed so as to
force the gas into the tunica vaginalis. When this is distended,
the pipe and bladder arc removed, and the thumb placed over

1833.] Tartar Emetic and Opium in Delirium.

the mouth of the canula, so as to prevent the escape of the gas
for the space of two minutes ; it is then allowed to escape, and
two or three repetitions of the injection are made, which is suffi-
cient for the cure. The advantages are the simplicity of the
apparatus; and the whole sac, being equally distended and ex-
posed to the contact of the gas, which is not the case with fluid
injections, which always gravitate. The danger also which
sometimes occurs from the fluid being forced into the cellular
tissue of the scrotum is avoided. M. Deconde proposes that the
same remedy should be used in the cure of other diseases, cha-
racterized by the secretion in various cysts. Bull. Med. Belg.
Brit, and For. Med. Review.

Tartar Emetic and Opium in the delirium of' Typhus.

Every practitioner of experience has observed the composing
efficacy of opium in small quantities in certain fevers, as used
in combination with diaphoretics, such as, saline mixtures and
sudorific draughts of different kinds with antimonials ; as well
as the more stimulating sudorifics as camphor, seneka, different
sudorific ptisans, &c. The Dublin physicians, some of whom
may now be ranked with the foremost practitioners of the present
age, are making valuable additions to therapeutics in many res-
pects, and particularly in extending the valuable and safe use of
antimonials and opiates. In the 1st vol. of this journal we no-
ticed the use of tartar emetic by Dr. Kennedy, in some of the
most important cases in obstetric practice, to which, from the great
value of the experience of Dr. K. with this article, we beg leave
to direct the attention of the reader. On the present occasion
we give from the American Journal, the experience of Drs.
Hudson and Graves in the use of tartar emetic and opium in
the delirium of typhus, cases in which every practitioner has
but too often felt the want of remedial means which were not at
his command.

Dr. Hudson, in an interesting article in the Dublin Journal
for July last, on the use of certain remedies in typhus fever and
its combinations, states that lie has tried Dr. Graves' mode of
giving opium, viz : in combination with tartar emetic, for the
relief of the delirium of typhus, in six cases. In one, a case of
furious delirium, this treatment, as well as every other, failed :

D 1

540 Tartar Emetic and Opium in Delirium. [April

in the others, and in numerous cases since the period comprised
in this report, he says that it has succeeded admirably. It
seems, he adds, best adapted to that restless kind of delirium re-
sembling delerium tremens, in which the patient cannot be re-
strained from attempting to leave his bed and walk about the
ward ; when every muscle is tremulous, the eyes red from want
of sleep, the tongue dry, and the patient presenting that kind of
spurious excitement which might induce the attendant (injudi-
ciously, no doubt.) to order the local abstraction ot blood, by
leeching the temples, or opening the temporal artery. In pre-
scribing this medicine, Dr. Hudson thinks it is advisable to use
caution in two ways : 1st. Not to give it after it has produced
sleep. 2d. To follow it up by the prompt and frequent exhibi-
tion of wine, and such nourishments or cordials, as the more or
less advanced stage of the disease, and debility of the patient may
require; as it seems to him that there is increased risk of the
patient's sinking, unless timely supported after sleep thus in-
duced.

The following are some of the successes of Dr. Graves allu-
ded to by Dr. Hudson, in cases of a similar pathological condi-
tion. So valuable in a practical point of view on the observations
of Dr. Graves in his chemical lecture in the Meathe Hospital
at Dublin, on some points connected with the treatment of fever,
and especially with regard to tartar emetic and opium, that we
shall extract his observations on tartar emetic, and their appli-
cation to the treatment of a few cases, before giving those in
which the combination of these two capital medicines, were so
signally useful. We refer to the American Journal, for ex-
tracts from the London Medical and Surgical Journal for 1S35.

"I come now gentlemen," said Dr. Graves, "to speak of a
matter of great importance in the treatment of fever. I allude
to the indications for exhibiting, and the mode of giving tartar
emetic at different periods of the continued fever of this country.
For some time I have been in the habit of employing tartar emetic
with very remarkable success at various periods of fever, but
principally towards its termination. I am therefore anxious to
lay before you a brief statement of my experience of this admi-
rable remedy, and I ehall take leave to illustrate this by a re-
ference to several very remarkable cases in which its adminis-
tration was followed by the most decided and satisfactory results.

You are well aware that tartar emetic has been long and just-
ly valued by the profession for its manifold and energetic prop-

>

1838.] Tartar Emetic and Opium in Delirium. 541

erties. Without referring to its importance in the treatment of
pulmonary diseases, and almost every form of local inflammation,
I may observe, with respect to our present subject, that tartar
emetic in small portions, dissolved in a qirantity of whey or
water, lias been for a considerable time a popular and successful
remedy in the commencement of febrile symptoms. Whether it
is by its action on the stomach and intestinal canal, or by produ-
cing diaphoresis, or by some peculiar influence on the nervous
and circulating systems, that it produces its favourable effects,
we cannot exactly say; but we know that it frequently succeeds
in cutting short or removing febrile symptoms. All these mat-
ters are, however, sufficiently well known to every student and
require no comment.

In a preceding lecture, when speaking of the best means of
procuring sleep in various forms of acute disease, I alluded to the
peculiar narcotic power of the preparations of antimony, and dwelt
on the benefits derived from a combination of antimonials with
those medicines which are strictly termed narcotics. I told
you in that lecture, that the good effects of tartar emetic in deli-
rium tremens seem to be totally independent of its action on the
stomach ; for we had witnessed thoss effects when it had not
excited either nausea or vomiting. I referred also to many in-
stances of delirium tremens, in which opium in every form had
failed in procuring sleep, and where a combination of tartar
emetic and laudanum had succeeded in tranquillizing the pa-
tient, and producing sound, refreshing sleep. Bearing this im-
portant fact in mind, we shall proceed to an examination of the
circumstances which require the tartar emetic in fever.

There is a particular stage in one form of fever, and that ex-
ceedingly dangerous and threatening, in which I have derived
most signal benefit from the use of this remedy. A patient, sup-
pose, gets an attack of fever, he has all the ordinary symptoms,
as thirst, restlessness, heat of skin, quick pulse, and head-ache.
You are called in about the 3d or 4th day, and find that he has all
the sympoms I have mentioned still present ; his face is flushed,
his head aching, his pulse from 100 to 110, but not remarkably
strong ; you find also that he has been sweating profusely from
the commencement of his illness, but without any proportionate
relief to his symptoms, and that he is restless and watchful. You
are informed that his perspirations are so great that his linen has
to be changed frequently in the day, and that, notwithstanding
this, the pulse has not come down, the head-ache is undiminish-
ed, and the patient has become more and more sleepless. Here
comes a very important practical question, namely, How are
you to treat such a case? The patient has no epigastric tender-
ness, no cough, no sign of local disease in either the thoracic or
abdominal cavities ; he has been purged, used diaphoretics, and
perhaps mercurials ; every attention has been paid to regimen,

6 VI Tartar Emetic and Opiwfn in Delirium. [April,

ventilation, and cleanliness ; but still he lies there in a state of
undiminished febrile excitement, with persistent head-ache, quick-
ness of pulse, and sleeplessness.

In such a case as this you have nothing to expect from the
sweating; it will never produce any relief. I was called some
time back to see a young gentleman in fever, who was placed
in similar circumstances to those which I have just detailed. It
was about the sixth day of his fever, and I found him with a
pulse of about 110, with considerable restlessness and head-ache,
and was informed that he had perspired profusely from the com-
mencement of his illness. On hinting the necessity of more ac-
tive treatment than that which had been employed, his physicians
appealed to the perspirations as decidedly contra-indicating de-
pletion. They said that the profuse sweating pointed out the
impropriety of active measures, and that it was a symptom which
would be speedily followed by relief. I was convinced that
they had taken a wrong view of the case, and stated as my opin-
ion that nothing was to be expected from the perspiration ; that
when co-existing with a persistent febrile condition of the system,
when accompanied by quick pulse, head-ache, perspirations al-
ways indicated the necessity for antiphlogistic measures, and in
particular for the use of the lancet. I instanced the case of pa-
tients labouring under arthritis with profuse perspirations not ac-
companied by relief, and said that it was well known that such
cases were most successfully treated by a full bleeding from the
arm. 1 accordingly stated, that although the disease was of five
or six day' standing, and the pulse not ^ery strong I would ad-
vise immediate bleeding. Sixteen ounces of blood were there-
fore abstracted, with some relief to the patient, and without in-
creasing his debility ; and it was then a question what further
steps were to be taken. The young gentleman had been actively
purged ; he had no cough or abdominal tenderness ; his symp-
toms were head-ache, sweating, and sleeplessness ; and to these,
nervous agitation had now become superadded. I proposed here
what surprised my colleagues very much, and this was, to give
our patient large doses 01 tartar emetic. They said the practice
was very strange, but consented to o-ive it a trial, on laying be-
fore them the reasons which induced me to prescribe it. I said,
that in such cases the tartar emetic forming as it were a part of
the antiphlogistic treatment, which commenced with general
bleeding, would have a tendency to cut short instead of increas-
ing the perspiration, by reducing the inflammatory state of the
system on which it depended. The reasoning seemed rather
paradoxical, nevertheless it turned out to be correct. I ordered
the tartar emetic to be taken in the quantity and mode in which
it is generally prescribed in acute pneumonia : that is to say, six
ins of tartar emetic combined with a little mucilage and tin-

1838.] Tartar Emetic and Opium in Delirium.

namon- water in an eight ounce mixture, to be taken in the course
oi* twenty-four hours, After taking live or six grains, the sweat-
ing began to dimmish ; on the second day he scarcely perspired
any, and his head-ache was greatly relieved ; he began to im-
prove rapidly in every respect, sleep returned, nervous agitation
ceased, and convalescence became soon established.

The next case in which I employed tartar emetic with signal
benefit, was one of a very insidious character, as many of them
are at present ; they exhibit no prominent or alarming symp-
toms, and yet continue to run on day after day without any ten-
dency to crisis. The gentleman who was the subject of this
case got an attack of fever unaccompanied by any remarkable
peculiarity, except that he was very nervous, and alarmed about
his situation. His fever went on, day after day, without any deci-
ded symptom ; he had no distressing head-ache, no cough, little
or no abdominal tenderness ; there was no vomiting or diarrhoea ;
and his pulse was not much above the natural standard. He
had been leeched over the stomach at the suggestion of some
medical friends, but this was done rather by the way of precau-
tion than for the purpose of combatting any actual disease. About
the eighth or ninth day the pulse began to rise ; he complained
of head-ache, and became restless and watchful. On the eleventh
day the head-ache had greatly increased, he was in a state of
great nervous excitement, and had not closed an eye for the two
preceding days and nights. This state of insomnia and nervous
agitation was immediately followed by violent paroxisms of de-
lirium ; his eyes, never closed in sleep, wandered from object to
object with unmeaning restlessness ; his limbs were in a state of
constant jactitation, and he raved incessantly ; his voice being
occasionally loud and menacing, at other times low and mutter-
ing. His friends became exceedingly alarmed, and every re-
medy which art could suggest was tried his head was shaved,
and leeched until they could leech no longer ; cold lotions were
kept constantly applied with unremitting diligence, and he was
purged freely and repeatedly. At this period, that is to say,
about the eleventh day of the fever, I was requested by this gen-
tleman's medical friends to visit him. On examining the pa-
tient, I found that he was constantly making violent efforts to
rise from his bed, and that he had a great deal of the expression
of countenance which belongs to a maniacal patient. Under
these circumstances, I advised the use of large doses of tartar
emetic, in the mode already detailed, except that, in this case, in
consequence of the violence of the delirium, I ordered the quan-
tity prescribed for a dose to be taken every hour. The patient
took about ten or twelve grains during the course of the night,
and next day his delirium had almost completely subsided. Un-
der the use of the remedy he became quite calm, fell into a sound
sleep, and began to recover rapidly.

544 Tartar Emetic and Opium in Delirium. [April,

In the two preceding cases, gentlemen, I was guided by ordi-
nary principles, recognised by all ] >hysicians, and according to
which the exhibition of tartar emetic is recommended in fever
whenever there is undoubted evidence of determination of blood
to the head, producing head-ache, loss of sleep, and delirium.
In the cases which follow, tartar emetic was exhibited at a period
of fever, and under circumstances that were, with respect to the
exhibition of this remedy, not less novel than important. The
principles which led me to this practice have been long estab-
lished, but, nevertheless, the practice is entirely new, and (I say
it with pride, for it has already been the means of saving many
valuable lives,) it is entirely mine.

Shortly after the commencement of our present session, Mr.
Cookson, a pupil at this hospital, and remarkable for his dili-
gent attention to clinical pursuits, caught fever while attending
our wards, in which many cases of the present epidemic were
then under treatment. His fever was of an insidious nature,
not characterized by any prominent symptom, not exhibiting
any local disease to combat, or any tendency to crisis. For the
first seven or eight days, with the exception of head-ache, which
was much relieved by leeching, he seemed to be going on very
well ; his skin was not remarkably hot; he had no great thirst,
nausea, or abdominal tenderness; his pulse was only eighty-
five ; and he had sweating, which was followed by some relief.
About the eighth or ninth day, the pulse rose, and he began to
exhibit symptoms of an hysteric character. Now, in every case
of fever, where symptoms resembling those of hysteria come on,
you should be apprehensive of danger. 1 do not recollect having
ever met with a single case of this kind which did not terminate
in nervous symptoms of the most formidable nature. I pre-
scribed at the time the usual antihysteric medicines, but without
any hope of doing good, knowing that these symptoms were
only precursory to something worse. I also, as a precautionary
measure, had leeches applied to his head. The fever went on,
the head-ache became more intense, h grew nervous and sleep-
less, and fell into a state of great debility. On the fourteenth
day of fever, his tongue was black and parched, his belly tym-
panitic; he was passing every thing under him unconsciously:
he had been raving for the last four days, constantly attempting
to get out of bed, and had not slept a single hour ior five days
and nights. Dr! Stokes, with his usual kindness, gave me the
benefit of his advice and assistance at this stage of Mr. Cookson's
illness, and we tried every remedy which experience could sug-
gest. Blisters were applied to the nape of the neck, the head
was kept cool by refrigerant lotions, the state of the belly at-
tended to, and, as we perceived that the absence of sleep was a
most prominent and distressing symptom, we were induced to

1&3S. I Tartar Emetic and Opium in Delirium. 545

venture on the cautious use of opium. It was first given in the
form of hydrarg. c. creta, with Dover's powder, with the view of
relieving the abdominal symptoms as well as procuring sleep.
This failing in producing the desired effect, we gave opium in
the form of enema, knowing its great power in the delirium
which follows wounds and other injuries. This was equally
unsuccessful with the former. He still was perfectly sleepless.
We came again in the evening, and, as a last resource, prescribed
a full dose of black drop, and left him with the conviction, that if
this failed he had no chance of life. On visiting him next morn-
ing at an early hour, we were highly mortified to find that our
prescription had been completely unsuccessful ; he had been
more restless and delirous than ever. Here was the state in
which we found him. on entering his chamber at eight o'clock in
the morning on the fifteenth day of his fever. He had universal
tremors andsubsultus tendinum, his eyes was suffused and rest-
less, he had been lying for some days entirely on his back, his
tongue was dry and black, his belly tympanitic, his pulse 140,
quick and thready, his delirium was chiefly exhibited in short
broken sentences and in a subdued tone of voice, and it was now
eight days and nights since he had slept. Here arose a question
of great practical importance. How the nervous agitation was
to be calmed and sleep produced? Blisters to the nape of the
neck, cold applications, and purgatives had failed ; opium in
various forms had been tried without the slightest benefit ; if
sleep were not speedily obtained he was lost. At this emergen-
cy a mode of giving opium occurred to me which I had never
thought of before. Recollect what his symptoms were at this
period: quick failing pulse, black, dry, tremulous tongue, great
tympanities, excessive prostration of strength, subsultus tendi-
num, extreme nervous agitation, constant muttering, low delirium
and total sleeplessness. I said to Dr. Stokes that I wished to try
what effects might result from a combination of tartar emetic and
opium; I mentioned that I had given it in cases of delium tre-
mens with remarkable success, and thought it worthy of trial
under the circumstances then present. Dr. Stokes stated in re-
ply, that he knew nothing with respect to such a combination,
as adapted to the case in question, that he had no experience to
guide him, but that he would yield to my suggestion. We there-
fore prescribed a combination of tartar emetic and laudanum in
the following form, which is that in which I generally employ
these remedies in the treatment of delirium tremens. R. Anti-
monii tartarizati grana quatuor, tinct. opii. drachmam, niisturae
camphorae, gviij. Of this mixture, a table-spoonful to be taken
every second hour. The success of this was almost magical.
It is true that it vomited him; after taking the second dose he
threw up a large quantity of bile, but it did him no harm. After

546 Tartar Emetic and Opium in Delirium. [April,

the third or fourth dose he fell asleep, and awoke calm and re-
freshed ; he began to improve rapidly, and soon recovered.

The next case to which I shall direct your attention is that of
Mr. Stephenson, a pupil of Mr. Parr of this hospital. This
young gentleman, as many of you will recollect, was attacked
with lever about the middle of January. On Thursday evening
he complained of languor and malaise, and on the following day
felt himself feverish, but without any prominent or decided
symptom. At night he took a dose of calomel and antimonial
powder, which had no sensible effect, and the following day com-
plained of shivering, violent head-ache, pain in the back, thirst,
prostration of strength, and sleeplessness. He was ordered to
take a combination of tartar emetic and nitrate of potash in cam-
phor mixturej which produced a few loose stools and some dia-
phoresis ; but in consequence of its effect on the stomach, and
his complaining much of thirst and epigastric tenderness, the
tartar emetic was omitted and effervescing draughts prescribed.
Two days afterwards, the epigastic tenderness still continuing,
twelve leeches were applied over the pit of the stomach, followed
by a blister, which gave relief, and the bowels were kept open by
enemata. He commenced a second time the use of the tartar
emetic and nitrate of potash, with the addition of five drops of
tincture of opium to each dose, but was obliged to give it up
again in consequence of the increase in his gastric symptoms.
He now became exceedingly restless, and his delirium began to
assume a very intense character. Leeches were applied behind
the ears, his head shaved and his temples blistered ; he had also
a large blister over the abdomen, which gave him considerable
relief, but the cerebral and nervous symptoms became much
worse. The delirium went on increasing, accompanied by sub-
sultus tendinum, and picking the bed-clothes ; he was perfectly
sleepless, raved incessantly, and had to be kept down by force.
On the seventeenth day of his fever he was in the following con-
dition, tongue brown and rather dry, no remarkable thirst or
abdominal tenderness, eyes red and ferrety, no sleep for five
nights, constant muttering and delirium (which had now assum-
ed the character of delirium tremens), subsultus tendinum and
jactitation extreme, urine and faeces passed under him uncon-
sciously. I directed the combination of tartar emetic and lauda-
num to be immediately given, carefully watching its effects. He
had only taken two doses when a degree of calmness set in,
bringing with it relief to all his symptoms, and before a third
dose could be administered, he fell into a profound sleep, from
which he awoke rational and refreshed. The mixture was con-
tinued every four hours with increasing benefit, he slept long
and soundly, and began to improve in every respect. On the
second day after he had begun, to use the tartar emetic, he took

1S3S.] Tartar Emetic and Opium in Delirium. 547

a little porter, which was changed the next day for claret and
chicken broth. In about a week lie was able to sit up in bed, and
seven days afterwards he was able to leave the hospital and go
to the country for change of air.

The last case to which I shall direct your attention is that of
Mr. Knott, also a pupil of this hospital, a gentleman remarkable
for his unremitting attention to clinical pursuits, and from whom
I derived much valuable assistance in conducting various post-
mortem examinations. This gentleman was attacked with fever
about tne latter part of January, which went on for some time
without any particular symptom, except considerable restlessness
and nervous excitement. He then became perfectly sleepless,
complained of violent head-ache and thirst, raved, and became
exceedingly irritable. Opium in various forms and repeated
doses, either alone, or combined with musk or camphor, totally
failed in producing sleep, and his condition became daily worse.
On the thirteenth day he was in a very dangerous condition ; his
nervous agitation had risen to an alarming height, and for many
days and nights he had never closed an eye. At this period.it
appeared obvious that if something were not done to calm ner-
vous excitement and restore sleep, he had but little chance of
life. Under these circumstances I proposed to my friend, pr.
M'Adam, who attended with me, to give tartar emetic and opium.
After he had taken about three table-spoonsful, he had a copius
bilious evacuation, and immediately afterwards fell into a sound
sleep, during which he perspired profusely, and awoke in about
twelve hours, with every bad symptom gone. The nervous irri-
tability was completely allayed; his thirst and head-ache reliev-
ed; his tongue moist and cleansing ; and his reason quite restor-
ed. From that period every thing went on favorably, and he
rapidly regained his health and strength.

Since the foregoing lecture was delivered, I have met with
several cases of fever in which I employed the tartar emetic and
opium, with tire same remarkable success. A man named
Christopher Nowlan was admitted into Sir P. Dun's Hospital, on
the 3d February last, labouring under fever. He had been ill
ten days, had raving, subsultus tendinum, and appeared unable
or unwilling to answer questions. His wife stated that he had
diarrhaia lor the preceding three days, and that he dozed occa-
sionally, but never slept. He appeared exceedingly low and
prostrated, and lay constantly on his back. A succession of
flying blisters were ordered to be applied to the chest and stomach,
and wine and chicken broth prescribed. He also got the follow-
ing draught every third hour : u. Mist, cam] pint.
ris olei Spirit, ammoniac aromatic >chi,
Under the uso of tl > re-
r from his prostration, delirium

548 Tartar Emetic and Opium in Delirium. [April,

still continued, I ordered him to take the tartar emetic mixture
in the usual way. It produced at first two or three full discharges
from the bowels, and after he had taken the fourth dose he fell
into a sound sleep, from which he awoke much better, and soon
became convalescent.

In the case of a patient named Michael Murray, who exhibited
the same remarkable nervous irratability and sleeplessness, this
remedy was also employed with very striking effects. This man
had been ill of fever for ten days before his admission into Sir
Patrick Dunn's Hospital, and appeared so much prostrated, that
I ordered him arrow root, with beer. He raved a little on the
night of his admission, and remained without closing an eye
until morning. The same symptoms were observed on the fol-
lowing day, and his nervous irritability became increased. On
the 14th of February he had been five days in the hospital, and
had not enjoyed a single hour's sleep. I ordered the tartar emetic
mixture to be given : three doses produced sleep : he had no oth-
er bad symptoms, and recovered completely.

In another very bad case of maculated fever, the same results
were obtained. The patient, Mary Farmin, had got an attack of
fever after a fright. She had been eight days ill, at the date of
her admission, February 25th. She had irregular pulse, sleep-
lessness, head-ache, and suffusion of the eyes ; moaned and sighed
continually, and appeared greatly prostrated. She was blistered,
had foetid enemata sand took the chloride of soda internally with
some benefit ; but the sleeplessness and nervous excitement con-
tinued. In this case, though the tartar emetic was not followed
by speedy convalescence, still it produced remarkably good ef-
fects ; after taking four doses of it, she fell asleep, and did not
awake until next morning.

There are many other cases which I could adduce to prove the
value of a combination of tartar emetic and opium in the nervous
sleeplessness of low fever ; the foregoing I trust will be found
sufficient.

I forgot to observe, that all the cases I have spoken of as suc-
cessfully treated by means of tartar emetic combined with opium,
in the advanced stage of the disease, were cases of maculated or
spotted fever. I shall take a future opportunity of entering more
fully into a detail of its symptoms. Lond. Med. fy Surg. Joum.,
May 1835.

1838.] Compression of Arteries. 549

Compression of Arteries.

In the last February No. of this journal we gave, from the Jour-
nal des Connaissances Medico-Ohirurgicales, the observations of
M. Trousesau on the compression of the carotid artery in the
treatment of certain convulsions. In the first part of the present
number we insert a letter on the same subject, from Professor
Dugas, in which it will be found that the remedial mean ad-
vanced by M. Trousseau is ably and critically examined in re-
lation to the anatomy of the part, &c. ; and its useful practica-
bility doubted. We hope however, that as it is a plan suscepti-
ble of immediate application, and not calculated to interfere ma-
terially with any other plans of treatment which may be thought
necessary, that its use will be adopted as opportunities may offer,
and its effects accurately observed and reported to us, whether
favorable to one opinion or the other : for it is sometimes the
case, in the practice of medicine indeed often the case, that
practical results are extremely different from the suggestions of
the best a priori reasoning from the known facts of anatomy and
physiology.

The remedy of compression of arteries is far from being new
in the hands of M. Trousseau, as will be seen by the following
letter of M. Dezeimeris to the Royal Academy, which we ex-
tract from the Archives Gen. de Med.

M. Dezeimeris writes to the Academy for the purpose of pro-
testing against the pretensions of several physicians to the dis-
covery of this mean employed as a therapeutic agent, and to
which he has for several years directed the attention of practi-
tioners.

"It is neither these gentlemen, nor I," says he, "who have
invented the compression of the carotial arteries, for before us,
Preston tied these vessels in cases of epilepsy reputed incurable.
Before Preston, M. Blaud compressed the carotid in cerebral
fever ; before Blaud, Autheuricth employed the same plan in
convulsions ; before Autheurieth, Liston had recourse to the
same plan in a case of neuralgia ; before Liston, Earle employed
the method advantageously in epilepsy ; before Earle, Living-
ston and Kcllie used arterial compression in rheumatism ; be-
fore the two last physicians, Ludlow employed it in gout, and
before all, Parry, of Bath, the true inventor of the compression of
the arteries, and particularly of the carotids, fiad not only per-
ceived the utility of the plan in all the cases mentioned above,
but also in many others.

Aneurism Cured by Ice. Muscular Fibres. [April;

Aneurism of the Iliac Artery cured by the application of Ice.
By l)rs. Reynauld, (of Toulon,) and Labissal.

The patient, a seaman, aged 34, had presented for six months
a very large tumour in the inguinal region, the circumference of
its base was 22 inches ; it was divided into two parts by Pou-
part's ligament, and seemed to extend nearly to the umbilicus,
under the form of a hard and voluminous cord. The pulsations
were obscure, the summit presented fluctuations and appeared
to be upon the point of breaking. The extremity of the same
side was enormously tumefied. The tumour then occupied the
crural and the internal and external iliac arteries and extended
so low down that it was impossible to employ the method of
Brasdor.

February 16/A, 1834. The patient was subjected to the appli-
cation of ice contained in a bladder which was kept constantly
upon the tumour ; the regimen consisted of panado, rice, sweat-
ened with honey and acidulated with sulphuric alchohol and
subsequently acidulated barley. In the month of November,
1834, we were desirous of substituting compression for the ice,
but the pain experienced by the patient compelled us to renounce
this plan. In January, 1835, the extremity had returned to its
normal state, it was not however until a year after, that the pul-
sations re-appeared in the inferior third of the crural and in the
tibial and pedal arteries, and that the patient was enabled to walk.
Before the cure of the aneurism two years elapsed, during which
time, except the few days when the compression was attempted,
the application of the ice had been continued during the two last
months, the ice had been placed in a tin box, slightly concave
at its inferior face and which exerted a slight compression upon
the tumour Arch. Gen. de. Med.

Structure of Muscular Fibres.

On the Elementary Structure of Muscular Fibre of Ani-
mal and Organic Life. Frederick Skcy, Esq. has present-
ed to the Royal Society an interesting memoir on this subject.

The author conclu< i his microscopic examinations of

the structure of" muscular fibres, that those subservient to the
functions of animal life have, in man, an average diameter of
one 400dth of an inch, and are surrounded by transverse circu-
lar stria) varying in thickness, and in ihc number contained in a

striae as constituted by actual
elevations on the surface of the fibre, with intermediate depres-

1838.1 Electrical Phenomena of the Blood. 551

sions, considerably narrower than the diameter of a globule of the
blood. Each of these muscular fibres, of which the diameter is
one 400dth of an inch, is divisible into bands or fibrillse, each of
which is again subdivisible into about one hundred tubular fila-
ments, arranged parrallel to one another, in a longitudinal direc-
tion, around the axis of the tubular fibre which they compose,
and which contains in its centre a soluble gluten. The partial
separation of the fibrillar gives rise to the appearance of broken
or interrupted circular stricc, which are occasionally seen. The
diameter of each filament is one 16,000dth of an inch, or about a
third part of a globule of the blood. On the other hand, the
muscles of organic life are composed, not of fibres similar to
those above described, but of filaments only ; these filaments
being interwoven with each other in irregularly disposed lines
of various thickness ; having for the most part a longitudinal
direction, but forming a kind of untraceable net-work. They
are readily distinguishable from tendinous fibres, by the fila-
ments of the latter^ being uniform in their size, and pursuing in-
dividually one unvarying course, in lines parallel to each other.
The fibres of the heart appear to possess a somewhat compound
character of animal life ; while those of the oesophagus, the sto-
mach, the intestines, and the arterial system,- possess that of inor-
ganic life. The determination of the exact nature of the muscu-
lar fibres of the iris presented considerable difficulties, which the
author has not yet been able satisfactorily to overcome. Trans-
actions of the Royal Society, for 1836.

Electrical Phenomena of the Blood.

On the Causes jof the Motion of the Blood in the Capillary
Vessels. By Dr. Poiseuille. When the globules of the blood
in the capillaries of the mammiferso are examined, they are found
to possess different velocities, even in the same vessel. Some of
them have two simultaneous motions one of rotation, the other
of translations ; while others remain motionless for a time. Two
globules, presenting at first the same velosity, only preserve by
accident the distance which separates them, and, if the motion be
such as to permit us to follow the same globule, we can observe
it sometimes in the same capillary vessel presenting these differ-
ent phases of motion. The velocity of the globules in the capil-
laries is less than in the arteries and veins ; it is seldom greater.
This remark extends also to capillary vessels which rise imme-
diately from an artery, or which proceed directly into a venous
trunk. These different phenomena lead to the conclusion that
the globules are endued with a spontaneous motion, or, rather,

552 Electrical Phenomena of the Blood. [April,

that the cause of the flow of blood through the capillaries is differ-
ent from the cause which regulates the motion of the blood in
the large vessels.

Dr. Poiseuille has endeavoured to examine with great atten-
tion the causes of the motion of the blood in those parts of ves-
sels which have been isolated from the action of the heart by
means of ligatures, or separated from the body by cutting instru-
ments, and then to study the influence of the heart and arteries
upon the capillary circulation.

He has established, by a great number of experiments, that the
calibre which the arteries and veins present, proceeds from the
pressure of the liquid which they contain ; that their coats are
constantly distended by the blood which they receive ; that these
vessels tend to collapse suddenly, in consequence of the elasticity
of their coats, as soon as the cause of their dilatation is removed.

The large arteries and veins, as well ' as the small ones, pos-
sess this property ; but, besides, the diameter of the last gradual-
ly diminishes when they cease to receive blood. This retrac-
tion is sometimes so great, that the mysenteric vessels of the frog,
salamander, young rats and mice, are reduced to two-thirds of
their original diameter. He has also ascertained that, cceteris
2Jaribus, this reaction is more decided in the arteries than in the
veins. These facts being known, it is easy to determine the mo-
tions of the blood in parts which have been separated from the
trunk either by ligature or by a cutting instrument motions
which even yet are designated by the title of circulation.

In fact, an attentive examination of this pretended circulation
shows us, that the part being in a horizontal plane, the motion
of the globules in the capillaries is totally at an end ; that all
the vessels, arteries and veins, carry the blood from the extremi-
ties to the amputated surface ; that this motion, becoming more
and more slow, ceases after the expiration of some time, and at
the same time the organ presents a much smaller quantity of
blood. These motions result, then, simply from the approxima-
tion of the coats of the vessels towards their axis; they necessa-
rily, therefore, drive the blood towards their open extremities.
The tail of the frog, the foot of the same animal, the mysentery
of very young rats,uof young mice, separated from the trunk by a
cutting instrument, have presented constantly the same phe-
nomena. This pressure which he has established with regard
to the blood of animals, exists also in the liquids of vegetables ;
lie also believes that this kind of circulation, which may be ob-
served in the stipula of the Ficus elastica} detached from the
trunk, is due to the same cause.

The action of gravity, as well as that of heat, are also causes,
but confined within more narrow limits of the motion of the
globules in parts separated from the trunk, especially when the
blood has not yet coagulated in the vessels.

193S.] Electrical Phenomena of (he Blood. 553

._ , , __ __

Numerous experiments made, 1st, upon the heads of the sala-
mander and frog, animals in which the circulation is, as it were,
suspended at pleasure, show that it is established gradually from
the centre to the circumference ; 2nd, upon the foot of the frog,
dividing the crural vessels ; 3d, upon the mesentery of the frog
and salamander, by cutting the heart ; 4th, upon the mesentery
of young rats and mice. All these experiments, of which several
are confirmed by those of the two celebrated physiologists, Haller
and Spallanzani, have convinced Dr. Poiseuille that the heart
and elasticity of the arterial coats are the sole agents in the
capillary circulation in question.

In resting upon the preceding facts, that is to say, the action
of the heart and arteries, and the tendency which the latter have
to collapse when they are not sufficiently dilated by the tide of
blood projected from the heart, the constant jerking, intermittent,
and oscillatory circulation, which precede the death of an ani-
mal, are easily explained ; the cause of the retrogade circulation
presented by the arteries after the death of the animal and that of
the heart is similar.

Having cleared up these points, the author passes on to the
examination of the causes of the irregular motions of the globules
which he has observed in the capillary vessels..

If we study the course of the blood in the arteries and veins
ot the frog, of very young rats and of young mice, we observe,
in proceeding from the axis of the vessel to the coats, that the
velocity of the globules is totally different. In the centre, their
velocity is at a maximum ; it diminishes gradually as we ap-
proach the coats. In the immediate neighborhood of the coats,
a very transparent space can be observed, which is generally
occupied by serum; this space is equal to about the 1-Sth or l-10th
of the diameter of the vessel. This transparent part of the ves-
sels observed by Haller and Spallanzani as being occupied by
serum, has been again noted by Blainville.

Since some of the globules, rubbing against each other, are
projected into this transparent part of the vessels, the globules
placed in the middle possess a very slow motion, and they cease
to move when they are almost in contact with the coats of the
vessel. The globules which are nearest to this transparent part
have a double motion of rotation and translation ; they roll, if
the expression may be used, over this part of the serum.

From these observation, the author concludes that the interior
of the vessels is lined with a layer of serum at rest. Since this
layer is immoveable in its immediate contact with the coats of
the vessels, every time that a globule is placed there it will be at
rest, or rather, its velocity will be more or less diminished, ac-
cording to the portion of the globule immersed in it. Now, in
the capillaries the globules move between two layers of serum.

554 Electrical Phenomena of the Blood. [Api

Hence, their motion ought to be less rapid than in the large ves-
sels, since they require to overcome the inertia of this layer.

If a globule is partly in the layer, this portion of the globule
will be at rest, while its remainder, placed in the axis of the
vessel, will acquire a certain velocity ; then the globule will
move round its own axis, in order to acquire its normal velocity
in following the centre of the vessel. If of two globules, one is
placed in* advance of the other in the layer, the former will pur-
sue its course, and the latter will be delayed, and the motions
described will be presented.

The labours of M. Girard upon the flow of liquids in tubes of
tail diameter have established, in most tubes susceptible of *
being softened by the liquid moving of them, the existence of a

similar layer. The author passed through tubes of very small
diameter, liquids holding in suspension opaque bodies ; and,
having examined this current by a microscope, he found this
layer, immovable, and of a thickness much smaller than that
obtained by the calculations of Girard.

Hence, the author concludes, that the blood transported by the
vessels of the heart to all parts of the body does not impinge
against the coats; that a layer of serum, by its state of rest,
guards the coats* from any such effects. Besides, we can con-
ceive the importance of this immovable layer of serum linjng
the coats of the vessels in the act of nutrition, since the recent
experiments of Mtiller of Berlin have demonstrated, that the
fibrin is held in solution by the serum.

Dr. Poiseuille has further studied the influence of cold and
heat upon this layer of serum. The following experiment shows
the result. At the temperature of 77, he examined the circula-
tion in the foot of a frog, and, in the vessel where the foot was
placed, he deposited pieces of ice. In the large vessels, the
transparent part of the serum obviously increased in thickness ;
the globules in immediate contact with it moved more slowly ;
the three orders of vessels, arteries, capillaries, and veins, pre-
served their diameters sensibly ; the velocity in the capillaries
was considerably diminished, and in some of these vessels it be-
came insensible ; during six or eight minutes, for example, the
circulation in the capillaries of the other foot of the frog preserv-
ed its normal velocity: and it was not till a quarter of an hour
after the submersion of the first Ekt in the iced water that the
velocity of the blood in the second foot, placed in the atmos-
phere, was diminished, in consequ the temperature of the
whole mass of blood being sun];. T in the vessel was
replaced by water at the d the velocity of
the globules became then [r form could
be diminished. In young rats, th If , nh
nunu ,. (j1(J

1838.] Electrical Phetwmena of the Blood. 555

tery. It gradually resumed its powers, and acquired its normal
rhythm after the ice was withdrawn.

Thus the diminished velocity of the capillary circulation by
cold, and greater rapidity by the action of heat, are naturally
interpreted by the increase in the thickness of this layer in the
first place, and its diminution in the second.

These results completely correspond with those of M. Girard
on the variation in the thickness of the layer which lines the
coats of inert tubes, when the temperature increase or dimin-
ishes.

We know that certain animals, such as fishes, and some am-
phibious mammalia, are sometimes immersed nearly 262 1-2
feet (80 metres) beneath the surface of the water, and then sup-
port a pressure of from seven to eight atmospheres. It is impor-
tant, therefore, to know how this layer acts, and at the same time
to observe the modifications of the capillary circulation under
such pressure. With this object in view, the author has con-
structed an apparatus, to which he has given the name of Porte-
object -pneiimatique. A short description will afford an idea of
it, and develop the results which may be derived from its use.
It consists of a strong box of copper ; the top and bottom are
formed of crystal, fitted into grooves placed in the sides. One of
the extremities of this box carries a copper tube, which contains
sometimes a barometer tube, and sometimes a manometer for
compressed air ; the other extremity presents a large opening by
which the animals are introduced. To this extremity sometimes
a suction pump is adapted, and sometimes a forcing pump. The
animal, prepared in such a way as to allow the capillary circu-
lation to be seen, is placed in the instrument, and the apparatus
placed under the microscope. We can then observe the modifi-
cations which may introduce in the capillary circulation a more
or less considerable pressure. In salamanders, frogs, tadpoles,
young rats and mice, the arterial, venous, and capillary circula-
tion have not presented any remarkable change, even when rais-
ing the pressure rapidly to 2, 3, 4, 6, and 8 atmospheres, and re-
ciprocally. Farther, the circulation has continued to preserve
the same rhythm even under a pressure of some centimetres
(39 inches) in salamanders, frogs, and tadpoles. On placing in
the apparatus very young rats and mice (it is well known that
the mammalia, during the first days of their birth, may remain
some hours without breathing) the circulation can be seen per-
fectly, in vacuo. How absurd, then, is the opinion of these phi-
losophers who consider that, without atmospheric pressure, cir-
culation cannot go on ; but atmospheric pressure combined with
the motions of respiration, are accessory causes of the flow of the
blood, as Dr. Poiseuiile has shown in another memoir.

From these experiments, he infers, that the thickness of layer
F 6

556 Electrical Phenomena of the Blood. [April,

of serum, the existence of which is due to the affinity subsisting
between the coats of the vessels and the serum, a thickness which
varies so remarkably from heat and cold, is independent of sur-
rounding pressure, that the contractions of the heart preserve
their normal rhythm, whatever the pressure is.

Several tubes of char a, placed in this apparatus, had present-
ed under a pressure, varying from 209 (7-8 inches) to 600 centi-
metres (23-6 inches) the same modes of circulation ; and the
motions of some infusorii contained in the water of the chara,
such as vorticelli, potifera, $%c. were executed with the same
facility as under the influence of the atmosphere. Records of
General Science from Bib. Univ. for November ', 1835.

We perceive in the above extract, that Dr. Poiseuille has
observed that the globules of the blood, in the capillaries of the
mammiferse, possess different velocities, even in the same ves-
sel ; and that some of them have two simultaneous motions ;
that is to say, one of rotation, and the other of translation. That
other globules remain motionless for a time; and that two
globules, presenting at first the same velocity, only preserve by
accident the distance which separates them ; and if observed,
the same globule will be found to present, sometimes in the same
capillary vessel, three different movements.

He farther observed, that the velocity in the capillaries, is less
than in the arteries and veins ; and seldom greater, even in ca-
pillaries which arise directly from an artery, or which proceeds
directly into a veinous trunk.

Hence he concluded that the globules of the blood possess a
spontaneous motion." This is the point on which we wished to
remark. This conclusion was, reasoning from the known facts,
a very logical one ; still, however, it does not establish the fact
that the blood is endowed with the power of spontaneous mo-
tion. Only one additional fact to those already known, is suili-
cient to carry through the whole process anew aspect, and bring
us at last to a conclusion essentially different. If we knew no-
thing of chemical affinity, we might, when looking on the phe-
nomena attendant on the union of an acid and an alkali, or a
saline solution evaporated to the point of chrystalization, be in-
duced to suppose that the inanimate substances before us pos-
sessed the power of spontaneous motion. The same may be
said with regard to the influence of magnetism. The child who
knows nothing of magnetic attraction, is at once easily induced

1838.1 Electrical Phenomena of the Blood. 557

to believe a metallic duck or fish in water swims of its own ac-
cord, and by virtue of its own powers, although lie may see the
magnet near the side of the vessel which contains it. But if the
fact of an invisible agent which we call magnetism, be brought
into the calculation in the latter case, or that of the agency of
chemical attraction in the former, he at once finds himself un-
willing to call the phenomena the spontaneous productions of
the matter, simply considered, but perceives a new agent of
power, competent to the effects produced, and to which he feels
bound to attribute the results. The same may be said of the
movements observed in the tolling of the electric bells, or
the performances of the electric theatre, if we knew nothing of
the attracting and repelling powers of electricity.

Again, and lastly, the phenomena presented by the electrical <
hail storm would, but ibr the knowledge of the fact, that elec-
tricity is the actual cause of the various movements of the pith
balls, be readily considered as spontaneous movements of those
small bodies. There can scarcely be imagined a greater like-
ness in the manner of events or phenomena, than the play of
attractions and repulsions observable in the pith balls of the
electrical hail storm, to the movements of the globules of the
blood, as described by Dr. Poiseuille. If, therefore, like
causes produce like effects, we may fairly conclude that the
movements of the globules of the blood which have led Dr. P.
to believe in the existence in the blood of a power of spontane-
ous motion, are purely and simply the effects of electric attrac-
tions, repulsions, &c. This i-3 a conclusion from analogy of
effects, and determining the cause in obedience to an inflexible
law of philosophy. It is, if the analogy be good, a fair conclu-
sion from a posteriori reasoning. But the truth of the conclu-
sion, that the phenomena of the various movements of the glo-
bules of the blood are electrical phenomena, and dependent on
the attracting and repelling powers of this wonderful agent, does
not rest on this reasoning alone for its establishment. The po-
sitively changed state of the blood, taken en masse, is itself,
evident ; and this becomes the case in the arterial system. This
being the fact, as ascertained by the comparative electrical states
of the blood in the contrimgal and contripetal departments, it is
evident that it positive charge from the arterial sys-

558 Acute Articular Rheumatism. [April,

tern, for there is no other source. The mass of blood is consti-
tuted partly of globules, and partly of a liquid medium in which
they move. If the constituent globules of the blood receive their
charge from the arteries, those first in contact with the arterial
surfaces must first become charged. These then are in a posi-
tive state relative to others. By a law of electricity, these are
repelled to other parts oi the mass to restore equilibrium, and
others are attracted. These influences, with the smaller attrac-
tions and repulsions of different globules, according to an infi-
nitely varying electrical charge of different globules, are suffi-
cient to account for all the phenomena observed in the move-
ments of the globules. These equalize the entire electricity of
the mass, as light bodies do the electricities of two bodies be-
tween, which they play; or as the ball suspended between two
electrical bells. Such effects might, therefore, have been deter-
mined by a priori reasoning. But both the phenomena the
cause and its effect are observable ; either being sufficient to
determine the fact of the other, if not observed, and both toge-
ther evidently harmonising in all respects as proportionate cause
and effect. The truth, therefore, appears plainly established by
all observation of facts, and by fair reasoning from those facts,
that the motions of the globules of blood are electrical phenome-
na, which we set out to demonstrate.

Acute Artimdar Rheumatism.

The following lecture of Dr. Gerhard will be found inter-
esting in several particulars. It is a graphical description of
the disease on which it treats, which is one of serious considera-
tion, as it often involves a highly dangerous affection of one of the
most important organs of the body the heart. It is worthy the
imitation of others, for the display of that candor which gene-
rally accompanies fine talents, and which honesty dictates.
Whilst some would declare confidently in favor of some very
certain specific remedy, or the certain results of their theory,
Dr. G. has very candidly acknowledged the truth, that although
many facts are known relative to this disease, still much re-
mains unknown, and particularly in the remedial department.

1838.1 Acute Articular Rheumatism. 559

nali

The diagnosis between rheumatism and neuralgia should be
particularly remarked spinal irritation distinguishing the latter
from the former, (fee.

On the subject of the opium treatment of Cazenave, reiter-
ated by Dr. Webb, the experience of Dr. Gerhard is particu-
larly worthy of the notice of all practitioners, and more especial-
ly of those of warm climates. His experiments have been car-
ried quite as far as prudence could allow, notwithstanding the
bold and confident manner in which this practice has been urged
on the profession, and its reiteration by Dr. Webb, crowned
with a premium. And with these experiments his results have
been such as reasoning from the known nature of things would
dictate, for the place where they were made ; and compare well
with our own, except in the additionally deleterious influence of
that practice in warmer, and what are considered more bilious
climates. At best then, the remedy is not to be depended on
even in cold climates, for a radical cure, and will be found ab-
solutely deleterious in warm regions. But we give to the reader
the whole lecture.

Tuesday, April 17th. Dr. Gerhard remarked : I shall to-
day, gentlemen, take up the subject of acute articular rheuma-
tism, as it is especially prevalent at this season of the year, when
the number of other acute diseases is very limited. In summer
we have acute abdominal inflammations, and in winter affec-
tions of the pulmonary organs, while, during the spring and
early summer months, serous inflammations, both of the inter-
nal and external membranes, are most common. Acute rheu-
matism bears some striking relations with the inflammations of
internal serous membranes, from the similarity of the mode of
treatment which often becomes necessary in both affections, and
from the frequent complication of the latter with the former dis-
ease. In almost every severe case of the disease under notice,
there co exists inflammation of the covering of the heart, or of
the serous membrane lining its cavities. Since this connection
between the pathology of articular rheumatism and that of diseas-
es of the heart and its membranes, has been clearly traced, the
disease has attracted much interest. I say clearly traced, for the
general fact had been long since pointed out, although the sub-
ject was not precisely understood. That is, it was in the same
situation as many other parts of pathology ; affording an indis-
tinct view of the truth, but without that well defined character
which is now required, according to the rules of rigid logic ap-
plied to the study of pathology. The line of connection has

560 Acute Articular Rheumatism. [April,

only been drawn in a definite manner, for a few years past, be-
tween acute articular rheumatism and endocarditis, or inflamma-
tion of the lining membrane of the cavities of the heart, and pe-
ricarditis, or inflammation of the membrane surrounding it. Dr.
Bouillaud, of Paris, has paid particular attention to this subject-
he tells us that at least one-half the acute articular affections are
complicated with pericarditis. In this estimate he is probably
wrong, unless with pericarditis we are permitted to include en-
docarditis. A large number of mild cases doubtless run their
course, vvithout any complication of the kind, but it is usually
otherwise when the disease appears under a severe type. Mild
cases are slow in their action upon the heart, but, in the severer
forms, the advance is rapid, and disease of the heart succeeds al-
most immediately after the first appearance of the articular
symptoms. In chronic cases, the progress of the cardiac affec-
tions is slow, and an individual not well acquainted with the
disease might be deceived as to the fact of its existence.

We have thus traced two forms of the disease, and I propose
bringing under your notice two cases now under treatment in
the Philadelphia hospital, to exemplify them.

The first is that of John Robb, who was admitted into the
ward No. 2, on the 11th of April. Previous to his admission,
he had been ill but a short time, being an inmate of the Aims-
House, he was able to resort to medical assistance, quite as soon
as is usual in private practice. He had been working on the
farm of the establishment for eight months previous to his at-
tack, and had enjoyed. good health. On the morning of the
sixth, he complained of slight pains in his shoulder, but conti-
nued at work ; at eleven, P. M., he was taken with severe pain
in the hip, which lasted four or five hours, and then, diminish-
ing in the hip, went to the knee. On the seventh it ceased in
the right knee and went to the left.

Now, from the character of the affection, thus shown, we can,
without going farther, make our diagnosis. I allude to its me-
tastatic character, as exhibited in its leaving one joint and set-
tling in another. This is distinctive of rheumatism.

There was no pain in the ankles, but there was slight pain
near the toe. You here mark the course of the disease onwards;
it has reached the toe, and, showed a disposition to attack the
foot. There had been pain in the right wrist, from an hour be-
fore the man's entrance into the hospital. On the ninth and tenth
he h;id pain in the breast, which he referred to a spot below the
pnecordia, in the region of the diaphragm, and which lasted
twenty-four hours, and was increased by couching. Such pain
is usually owing to disease of the heart, which may be merely
muscular, but is more frequently caused by inflammation of the
snrous membranes, lining or covering tl

183S.] Acute Articular Rheumatism. 561
1

This man had been exposed to no causes of disease, other
than those which he was in the habit of encountering. He had,
it is true, been wet while working on the farm, but this was not
uncommon with him ; he had been long- accustomed to working
in the rain. This shews how cautious we should be in admit-
ting causes of disease ; some physicians might be disposed to at-
tribute the attack of rheumatism to the last wetting, which could
manifestly exercise no greater influence upon th man than a
series of previous exposures to the same cause, of no recent
standing. 1 look upon the particular season of the year, as the
immediate excitant of the disease, and it is for this reason, that 1
have thought it a fitting subject to bring before you, at the open-
ing of my course. If you take the trouble to inquire, you will
find, that at this time the prevalence of rheumatism and rheu-
matic pains is remarkable.

The case before you being of an acute character, its previous
history is not nearly so important as the present state of the in-
dividual. It is otherwise in chronic affections, in which the
whole anterior history is all-important.

The condition of the patient, at the time of his admission on
the eleventh, was as follows : The face was slightly flushed, and
presented an expression of pain. This pain, in acute rheuma-
tism, is remarkable ; it usually prevents all exercise and confines
the patient to bed.

There was slight soreness in the shoulder, but without swell-
ing or heat : no pain or swelling in the left arm, slight soreness
in' the right elbow and severe pain, swelling and heat in the
wrist. The same pain, swelling and heat extended to all the
joints of the hand and fingers, excepting the thumb. There
was some pain in both knees, especially in the left ; none in the
ankles; a little in the right hip, no tenderness of the spine, no
cephalalgia; tenderness on pressure along the region of the ribs;
this was probably the remains of the diaphragmatic pleurisy.
The impulse of the heart was feeble, the second sound nearly
lost, the first much roughened, a dulness on percussion nearly
natural. Treatment, one grain of opium every four hours. The
digestive organs were healthy.

Now, let us analyze this case. The first fact worth recollect-
ing, is the absence of tenderness of the spine. This establishes
the diagnosis between rheumatism and neuralgia. Hence, the
mode of treatment which proves so excellent in the latter affec-
tion, may here fail. The state of the heart indicated merely
slight valvular disease, and some muscular impediment ; there
was no effusion, the dulness on percussion being natural, and
no creaking sound being heard.

The treatment to this case was after a plan of practice in New
England, fiom which quarter it has been lately strongly recom-

562 Acute Articular Rheumatism. [April,

mended ; the internal administration of opiates, pushed till felt
by the patient.

During the twelfth, six grain pills of opium were exhibited,
but there was no diminution of pain. Neither sleep nor cephal-
algia had been induced by the opium. This is an important
therapeutic point, demonstrating the antagonising action which
pain exerts in regard to the effects of opium. The first sound
of the heart was still rough, but the impulse rather less ; no in-
crease of flatness. The state of the heart was, therefore, slightly
improved. Pulse eighty-four, of moderate size and regular ; a
grain of opium was ordered every two hours, and a laxative
enema administered.

On the evening of this day, there was some cephalalgia, al- A
though no deviation of the pupils from the natural state. The
dose of opium was diminished to a grain every three hours.
Sleep was interrupted by twinges of pain ; sweating at night.
Eruption ofsudamina; pulse seventy-two; pain in right arm
increased and extending to the shoulder. Less pain and swell-
ing in the knees, but increase of both in the feet. The action of
the heart was more regular and feeble, and the sound less rough.
The disease, you perceive, was not in any manner arrested, al-
though you note a decided improvement in the condition of the
heart. There was costiveness from the opium, but this, you
will soon see, disappeared. Same prescription of opium conti-
nued during the thirteenth ; hop poultices to most of the painful
joints; laxative enema.

On the fourteenth, the pain, having diminished throughout
the right arm, began in the left hand and wrist. Here is another
point of interest :"the translation of the pain from the right to the
left limb by metastasis. This is a common thing in articular
rheumatism, and, as in this case, the pain does not usually quite
cease in one joint, before it begins in the other.

There was slight pain between the shoulders, and diminution
ofthepainin the knees and feet ; pulse seventy-six, fuller and
regular ; this is somewhat an exception to its usual condition in
the disease, it being frequent, small and quick. Skin warm and
dry ; sleep very irregular ; tongue moist, with a yellowish coat ;
appetite bad ; thirst ; three or four stools since the enema ; the
opium had, therefore, induced no costiveness. No cephalalgia
or dizziness ; slight flush ; eyes natural. Opium continued, hop
poultice and laudanum to the left wrist.

On the fifteenth, the left hand was worse, and there was pain
in the sole of the right foot. The other pains were better, mois-
ture rather than sweating. Opium continued.

The sixteenth, less expression of pain, and less flush ; sore-
ness in both shoulders, with slight swelling, but not much con-
stant pain. Slight soreness of the. left elbow ; much swelling,

1838.1 Acute Articular Rheumatism, 563

pain, and heat of the left hand; right hand nearly free from
swelling, still slightly painful, but motion returned; pains much
diminished in the legs; pain at the ensiform cartilage; palpita-
tions frequent after slight exertions ; pulse seventy-two, and soft ;
decided roughness, almost rasping in the first sound of the heart,
which was not very loud, and heard most distinctly to the lelt of
the nipple, second s^und nearly lost. Under the sternum, both
sounds of the right side distinctly heard and clear, the 'first only
a little roughened. The precordial dulness commenced only at
the left margin of the sternum, and extended to the nipple. The
morbid alteration was therefore confined to the left side of the
heart, implicating the valves ; there was besides effusion into the
pericadium. The opium pills were continued during yesterday
and last night e^ery three hours. Hop poultices.

Last night the pupils were somewhat contracted, and little sen-
sible to the light. To-day, the face was flushed, and presented
an expression of stupor. Disposition to sleep,; pupils rather
large; no cephalalgia; sleep interrupted by pain, shooting from
the swollen joints. Pulse eighty-eight softer. Swelling less
marked in the left hand. Slight swelling and pain in both knees.
No pain in the breast. Impulse of the heart almost lost; both
sounds very feeble, without roughness. The disease of the
valves is therefore diminished. Percussion slightly dull, at the
upper portion of the left side; flat, down from the third rib to
the same extent as yesterday. Prominenoe obviously increased.
These latter signs are explained by the increased effusion into
the pericardium. Still slight diarrhoea ; three or four stools in
the twenty-four hours.

This case, gentlemen, of acute disease of the heart, occurring
in articular rheumatism, may serve as a type of the affection,
which I shall now make the subject of some general remarks,
and have occasion to refer to hereafter. There are several pecu-
liarities to be alluded to. In the first place, the changeable char-
acter of the affection, shifting, as you have seen it, from joint to
joint, denotes the nature of the disease. This is well under-
stood, and universally admitted. But I would have you remark,
that there was no metastasis td the heart. The disease of the
heart appeared, during the most acute stage of the rheumatic
fever, which afterwards continued with unabated severity. By
physical examination, we ascertained that the pain in the pre-
cordial region proceeded, first, from disease of the valves, indica-
ted by the roughness of the sound ; secondly, from effusion,
shown by the unnatural dulness on percussion, imperfect action
of the heart, &c.

Another symptom to be noticed, is the sweating, which was
very slight from the first or second day, although it is generally
very severe in acute rheumatism. It is this sweating in rheu-
g 7

564 Acute Articular Rheumatism. [April,

mutism, which has suggested the employment of Dover's pow-
der, and other sudorifics, in its treatment. In this case, opium
was alone resorted to, to alford a better test of the powers of the
remedy.

The diarrhoea is another feature worth remarking, co-existing,
as it did, with the lar^e doses of opium. It was a purely acci-
dental complication, but its occurrence demonstrates that opium,
in very large doses, does not produce the same effects as in ordi-
nary doses," thus illustrating a therapeutic law, that remedies, in
over doses, do not act upon the system in the same manner, as
when administered in the usual quantities. Were it not for this
law, patients would die from the action of certain remedies now
frequently prescribed. How could tartar emetic be given in th(
high doses required by the contra-stimulant practice, in pneumc
nia, or calomel, as it is prescribed in the diseases of certain sec-
tions of our country?

The pathology of the disease under consideration is still very
obscure, although its symptoms are well understood. How
much of the disease is like neuralgia, or connected with an af-
fection of the nervous system, and how much belongs to local
inflammation, are points that are still unsettled. It is, in this
respect, analogous to whooping-cough, and some other diseases.
We are just as much in the dark, as to effectual curative means
for arresting the progress of the affection, though we have any
number of palliatives. For the present, I refrain from express-
ing an opinion as to the pathology of rheumatism, but shall con-
sider it partly as nervous and partly as inflammatory in its char-
acter. Certain inflammation of internal organs which occur in
rheumatism, such as pericarditis, lose this doubtful character, and
become decided phlegmasia ; they are accordingly treated with-
out reference to the disease of the joints. When the complica-
tion of pericarditis proves fatal, and the opportunity, otherwise
rare, of examining persons who die with rheumatism, is obtain-
ed, there is almost a total absence of lesion in the joints : but the
pericarditis offers the same characteristic appearances, as if it had
been induced by exposure to cold, or injury, or some other ordi-
nary cause. The affection of the joints depends so much on a
nervous cause, that it presents very slight, traces of inflammation.
It never terminates in suppuration, or the other usual termina-
tions of inflammation. Dr. Chomel states, that pus is not
found in rheumatic joints ; the very rare cases in which it
is met with, he considers to be mere accidental complica-
tions. This opinion, if somewhat modified, is probably the
correct one ; that is, rheumatic differs from ordinary inflamma-
tion in the absence of pus, and its want of fixedness of position.
Not so with the accompanying internal inflammations ; they re

1S3S.J ute Articular Rheumatism* 5b5

suit in the secretion of pus, and effusion of lymph, and are fixed
in their locations.

[f the pathology of the disease is obscure, equally so are the
therapeutics, it being more than doubtful that we possess any ex-
clusive available method of treatment. This subject is very
clear, no doubt, to some authors ; but, unfortunately, practition-
ers generally are in the dark. Thus Bouillaud, who regards the
affection as merely inflammatory, depletes to the utmost possible
extent ; and for this exaggerated depletory practice claims great
success. His success may have been great, but others who have
followed the practice, perhaps without the same enthusiastic con-
fidence, have not been so fortunate. I have given the practice
a very fair trial, with every disposition to see it succeed, and,
although I have afforded relief by one or two moderate bleed-
ings, if persisted in, the result was unfavorable; if pericarditis
was present, it was only partially relieved, while the rheumatic
affection of the muscular substance of the heart always increased.
We thus merely return to the old practice of one or two bleed-
ings at the commencement of the affection ; a practice, the utility
of which is sanctioned by long experience.

Another practice, originating, I believe, in New England, and
recommended by Dr. Webb, of Providence, is that which has
been followed in the present case consisting in the administra-
tion of very large doses of opium. I have tried it in two cases,
in both of which it failed. It succeeded in stupifying the pa-
tient, and rendered him less sensible of pain, but produced no
decided impression on the disease. It did not prevent the change
of place, nor did it remove the pain or swelling. These symp-
toms persisted, and retained their usual mutability of character.
Last summer, 1 pushed the- remedy to such an extent as to in-
duce decided narcotism, yet it failed to cut short the disease.
The remedy may occasionally obtain the success which is claim-
ed fojr it, but is is clearly no specific.

Sudorifics are the treamcnt adopted by some, from a notion
that artificial sweating is but an imitation of the curative process
of nature. This is certainly not the case; for the sweating is
most profuse, while the violence of the disease is persisting. If,
however, this discharge be suppressed, from cold or any other
cause, it will be proper to resort to sudorifics, to revive this na-
tural secretion, and to restore to the patient what he has been
deprived of.

Other remedies have been recommended, as narcotics and pur-
gatives, particularly the colchiqum, and, what is analogous to it,
the veratria. The colchium is used in this country and in Eng-
land, but is not much employed in France. It is very useful as
a paliative, though far from being absolutely curative. I have
seen it stop the severer symptoms of the disease for as much as

566 Acute Articular Rheumatism. [April,

five or six successive days. I used it at the hospital, in an un-
combined form, preferring, as I do, the administration of simple
remedies, particularly in hospital practice, to ensure their accu-
racy of administration, and to enable us to judge of their effects.
By giving the wine of the roots or seeds, alone, we may avoid
the severe purgation resulting from Scudamore's mixture. Purg-
ing may be of service, if the patient can readily bear the motion
necessary for the evacuation of the bowels. But the disadvan-
tage, attending frequent rising, is apt to more than destroy the
good arising from the revulsive effects of the purging. In medi-
cine, as well as in surgery, inflamed parts must be kept at rest.

These views, as to the effects of remedial agents in rheuma-
tism, differ but little from those of Dr. Chomel, who, perhaps,
has more than a due share of skepticism, in relation to therapeu-
tics. It is true, however, that, when diseases, after running a
certain course, get well of themselves, they are apt to deceive us
as to the value of the remedies employed in treating them. This,
I think, is the case with Drs. Bouillaud and Webb. For the
opinions of the former of these physicians on this subjeci, I refer
you to the Select Medical Library; and for Dr. Webb's, to the
Boston Medical and Surgical Journal, for last year.

I am not disposed to enter into a history of all the different sorts
of medications, which have been recommended in rheumatism.
Of external applications, cups to the spine, as a counter-irritant,
is a most valuable palliative ; and, if the neuralgic element of the
disease predominates, cupping along the spine will sometimes
produce a real arrest of rheumatism. But, when the joints are
the principal seat of the disease, in most cases much is not to be
expected from cups or leeches to the spine ; they do better near
the joints. Other applications to the parts are directed for the
benefit of moisture and warmth. For this purpose, anodyne pou 1-
tices are useful ; none are better than one of hops, steeped in hot
water, or vinegar and water, sprinkled with a little laudanum.
These are very convenient applications, but cannot be accom-
modated to all the joints. Opiate frictions may be used, as with
a mixture of warm oil and laudanum. I refrain from lead- water,
or spirituous, or other stimulating embrocations, as the danger of
the internal affections, endocarditis, or pericarditis, is somewhat
increased by driving the affection from the joint. This practice
must be reserved for the sub-acule variety of the disease.

Other local applications of a soothing character may be resort-
ed to, such as the experience of every practitioner will suggest.
In the North, there are other remedies, the virtues of which are
much extolled, such as the greeri hellebore, acfaea racemosa, &c.
These plants have been tried here, but without the success
which is claimed for them. This want of success may depend
on our obtaining them only in the dry state, in which their vir-

1S3S.1 Acute Articular Rheumatism. 507

tues are impaired. But I cannot believe that this is the sole
cause of failure ; for the most decided action of the remedies will
sometimes be produced, without curing the disease.

Though not immediately dangerous, few affections are ulti-
mately more mischievous than acute rheumatism. Diseases of
the heart are so apt to originate with it, and to continue after its
cessation, that we must hail any plan of treatment, likely to
exercise a curative influence over it. I have therefore tested tfie
opiate practice, as the last which has been recommended, watch-
ing very carefully its effects. I certainiy pushed it as far as was
prudent ; I was not warranted in giving more than one grain
every two hours, particularly, as I could not see the patient after
each dose, a precaution which is always advisable when giving
high doses of opium.

In other cases of the disease, I am willing to try other modes
of treatment, which are highly recommended, although I fear
that they are all merely palliative, and as such only, may do good;
at last we may find some one more efficacious than the others.
I am doubtful as to immediate success, though strong in hope.
I cannot help agreeing with Chomel, sceptical as he is Generally,
in believing inflammatory rheumatism an affection not to be cut
short by remedies, after having seen so much protracted suffering
from it ; even in the case of physicians, who were treated under
the most favorable circumstances, it has been prolonged to four
or five weeks and upwards.

What is the natural duration of acute rheumatism ? It is not
precisely fixed, but it is scarcely ever less than two weeks, and
may last five or six months; at least, the immediate effects may
continue so long. Like most diseases that run a determined
course, it averages two or three weeks.

Of the second patient, whom I mentioned, my time will allow
me to say little or nothing. He offers signs of the disease of the
heart, different from the last, chronic dilation and slight hyper-
trophy, without disease of the valves, the sounds not. being at all
roughened. There is effusion in the pericardium, indicated by
the increased dullness on percussion. Further details I reserve
for another occasion.

568 ( Correction. Hydrops. Articuli. [April

PART III.
MONTHLY PERISCOPE.

Correction. We take great pleasure in correcting an error
in our last (March) No., which is in the fifth line of the second
paragraph, under the head "Lithotomy," page 479, where it will
be found that our printers have made us to say, "we are bound
to attribute whatever little success which may have followed
Dr. Dudley's operations for the stone, <fcc." It should be read,
as written, " whatever better success, (fee," for neither truth nor
justice, would have allowed, nor inclination induced us to speak
contemptuously of a success so creditable as Dr. Dudley's has
been in the practice of Lithotomy ; or pluck one leaf from the
laurels he has fairly won by his achievements in this hitherto
formidable, but now safe operation. We wished to hold up to
the view of others, Dr. Dudley's real success, tmd the means
by which he arrived at it, for their imitation. It was for this
reason that we gave the whole of his very expert, dexterous and
complete operation, as given by Dr. Bush; and attempted to im-
press on the attention of the reader the importance of " due pre-
paration of the patient," and " good nursing and subsequent man-
agement."

Hydrops Articuli.

We are informed by a slip in the British and Foreign Medical
Review, from the Medicinische Zeitung, that "a musketeer"
had been affected with dropsy of both knee-joints for a period
of five months, and the disease had resisted a variety of treat-
ment which had been employed for its removal. At the end of
this time he became the subject of a violent inflammatory fever,
a consequence of which was the cure of the effusion into the

1838.1 Ili/drops Articuli 569

knee-joint; for on the day following the appearance of the fever,
there was no trace of fluid in either knee-joint. #

It will be iresh in the mind of the reader after seeing the ope-
rations of Velpeau, Travers, Keatr and Lewis, for hydro-
cele of the tunica vaginalis testis, which we have noticed in the
second part of this No., as well as Mr. O'Beirn's operation for
hydrocele of the neck, and with the chlorine gas, of Deblois
and the vinous injections of others for this disease, that by the
time a certain degree of increased^iction may have been produc-
ed, a new set of phenomena in the part is to be expected. In
some cases, (those of vinous injection after/ complete evacuation)
adhesion ensues and obliterates the sac. This of course would
not be suitable to hydrops articuli. But in other cases, as the
puncture with one or more needles, or very small trocars, or the
seaton of a single thread, when the fluid is not evacuated from
the cavity ; or even after the operation of Velpeau, in which a
considerable part of the injection of the tincture of iodine and
water is left in the sac, an effectual absorption takes place, where-
by the fluid contained is promptly removed, and this removal is
followed by a healthy condition of the part. What is the ra-
tionale of this, but that by a certain increased action in the ves-
sels of the part, absorption is effected, whereby the morbid
accumulation is removed, and the secretion or deposition and
absorption of the part left in equilibrio. It is not to be supposed
that the single puncture with the finest acupuncture needle
which will be able to reach the cavity, or the passage of a seaton
of a single thread will ever, merely by the opening in the part,
evacuate the contents. The operation of these must, therefore,
only produce an increased action sufficient for effecting absorp-
tion, and not such as affords the means of adhesion, and conse-
quent obliteration of the cavity. Such a remedy would there-
fore be suitable to our purposes in the case of an hydropic joint,
in the treatment of which we should wish to avoid adhesion be-
cause this would probably be followed by anchylosis. It appears
to us that the same doctrine is declared by the case now under
notice, in which " hydrops articuli" was cured by the " violent
inflammatory fever' which supervened ; and that the suggestion
of the adoption of the single puncture, or single thread seaton in
hydrops articuli, is abundantly strengthened by the result of
this case.

570 Hydriodate of Potash. Chloride of Soda. [April,

It should, however, be borne in mind that, as in many other
things, just enough, and neither more nor less, is the only proper
quantity of action which may be calculated for answering the
desired purpose : for in operations for hydrocele by vinous in-
jections, which are retained until certain pains evince a certain
degree of excitement, the cure is not effected always, unless the
injection be so full as to be applied to all the sac ; and even the
numerous punctures have been thought to not answer so good
a purpose as a single one ; nyr did the large seaton once used
prove so uniformly successful as the single thread of Mr. 6'-
Beirne. This was because the adhesion was partial, and the
proper action not left in the other parts. But in the use of the
dilute iodine injection, the pains which characterize an irriU
tion sufficient to end in adhesion and obliteration, are not expect-
ed ; and in the single puncture, and the single thread seaton,
they are not known still the pathological state of action, as
well as its effect, the accumulated fluid, being removed, the phy-
siological condition of the part is permanently restored.

Hydriodate of Potash in secondary Syphilis.

M. Bullock has reported in the Edinburgh Med. & Surg.
Journal, " the particulars of eleven cases of secondary syphilitic
diseases, of formidable character, relieved by hydriodate of pot-
ash, administered internally, in doses of eight grains, three times
daily, in camphor mixture. The symptoms were distinction
of the uvula and soft palate,- or nodes,nvith nocturnal pains, on
the tibia, ulna, frontal, and malar bones, and affection of the
bones of the nose, or rupia and other tubercular eruptions. The
period of cure was from one to two months. The patients were
treated by Dr. Williams, at St. Thomas' Hospital. They were
all adult males/' British <$ Foreign Review.

Chloride of Soda in Typhoid Fever.

On a former occasion, (South. Med. & Surg. Jour. vol. 1st.
p. 103.) we noticed the interesting paper of Dr. Graves, read
before the medical section of the British Association, on the sub-
ject of the " Internal use of Chloride of Soda in Fever," in which
was contained the experience of several other most eminent prac-
titioners as Drs. Chomel, Dor, Stokes, (fee. We have also

1838.] Chloride of Soda. 571

mentioned the limited experience, but satisfactory success of our
own practice with the article which heads this paragraph. We
now take great pleasure in referring our readers to the experience
of Alfred Hudson, M. B. T. C. D., physician to the Navan
Fever Hospital. " As a routine practice," says Mr. Hudson, " I
think the solution of chloride of soda is to be preferred to any
other, provided that it be given as soon as possible after the type
of the fever is known, which, in many cases, means, of course, as
soon as the fever has set in. I cannot say that I have seen such
good effects from its use in more advanced stages, though I have
prescribed it in a large number of such, and still do so; not, how-
ever, to the exclusion ot any one of our tried and approved reme-
dies." But he has noted forty-seven cases of typhoid fever, in
which he commenced its use as, soon as the patient was admitted)
or the type of the fever was evinced by the appearance of pete,
chiae, &c. and in every instance, with the best effects ; this being
(in many cases,) the only medicine given. His doses were from
ten to fifteen drops. " In some cases, the effect of the chloride
was evinced by the change of color and diminution in number
of the petechias, ' taches rosees,' within twenty-four hours, shew-
ing, I think, that its action is exerted directly upon the blood,
and not as a stimulant of the nervous system, as a late writer in
the Dublin Journal seems (erroneously surely,) to have inferred
from Dr. Graves' paper on this subject." "For myself," con-
tinues Mr. Hudson," while my limited experience leads me to
place the fullest confidence in the chemical effects of this medi-
cine, given early, I have not the least reason to attribute any
stimulant powers, nor indeed any good effect whatever to it, in
that stage of prostration and adynamia, which Dr. Graves has
so graphically described, and in which he considers the chloride
a remedy worthy of confidence."

The typhoid character of fevers is generally less perfectly
formed, and prevails less frequently in this section of the United
States, than in France, England, or our northern states. Conse-
quently our experience in these fevers is comparitively very limi-
ted ; but in a considerable number of cases, we have adopted the
use of this chloride in that stage of them only, in which Dr.
Graves found it peculiarly beneficial, and with a very satisfac-
tory success. In its use, as in that of all other things, great care
should be given to the quality of the article.
h 8

5T2 Amputations. [April

Amputations.

lily

We request that we may not be misunderstood by our high
respected Boston cotemporary on the subject of amputations, or
surgical improvements in any respect. We had several points
in view in offering our animadversions on the essay on the sub-
ject of amputations, over the signature X. X. One, and not the
least of these, was to disapprove of the practice of communicating
for, or inserting in medical journals, essays or medical intelli-
gence of any kind, without a sufficiently plain reference of the
public to a sourse, responsible for its truth a custom, of which,
if our memory serve us faithfully, our Boston friend has been
compelled to complain. We would not be understood to insinu-
ate that the alledged facts in the case of the amputation of the
toes of the young lady of Pembroke were not as stated ; but that
as there is no good reason for withholding the personal evidence
of the truth of such cases, there was not only a want of evidence
of, but a reasonable latitude for skepticism relative to the truth
of such communications : for the delicacy in such cases is always
relative to the patient the physician being at liberty to report
facts of almost every description calculated to benefit the profes-
sion, provided alwaysa due regard to professional secrecy to-
wards the patient be observed. During our short editorial ser-
vice, we have not been without some perplexities from this
source ; but we have not been willing to offer to the readers of
Medical journals, matter which, although highly interesting
and important, if duly set forth with responsible references, is
accompanied by none of that personal responsibility to which we
must look as the best evidence the nature of the case admits ; and
without which, we are not justified in adopting views essentially
different from previous, and perhaps, pretty well approved usage.
These remarks relate of course to those communications or es-
says, the worth of which rests on the alledged facts of experience
or observation. They cannot be used in inductive medicine
without they possess some obvious and reasonable claims to cre-
dence.

Logical disquisitions, or rational discussions of subjects ab-
stracted from facts not generally admitted, arc essentially differ-
ent. Here the merit of the piece rests on the fairness and accu-

1S38.] Amputations. 573

racy of the reasoning process, and this is fully exposed to in-
spection.

Ideas purely theoretical, and not the legitimate deductions of
true premises are different again needing, for their admission
to serious examination, some knowledge of the character of the
mind from which they emanate. But, for these productions, we
have little use in inductive medicine. These have been, and
still are, the great fons et origo mail in medicine equalled by
nothing, unless it be by inductions from false premises.

Another purpose we had in view in noticing the anonymous
communication referred to ; and this was, to endeavor to guard
the mind of the young practitioner against the dangers of routin-
ism, of which, there is danger in surgery, as well as in general
practice ; and to point him to the charter of his liberties, in the
wide range of our rational science. The treatment of every case,
whether surgical or not, must be regularly and accurately de-
duced from the premises it affords ; and no man, whatever may
be his other claims to confidence whatever may have been his
good opportunities, or whatever the honors which favoritism may
have heaped upon him, who has not the industry to accumulate
a knowledge of fundamental facts and established principles, and
the intellectual faculties for their proper use in inductive reason-
ing, should ever presume to pollute the sanctuary dedicated
by humanity to inductive truth.

Nor would we be supposed to object to having the profession
put in possession of the surgical opinions and experience of the
best surgeons in the union." Far otherwise indeed ; for we feel
little disposed to go beyond the 7th degree of longitude east of
Washington, in search of the best surgical tact and judgment.
We solicit such " opinions and experience ;" but when they do
come, we wish to know the source from whence they come,
more than we do that of the Nile. And furthermore, we wish
every opinion which is founded on good reason, and every fact
ascertained by enlightened experience, which can tend to useful-
ness in surgery, as well as every other department of medicine
laid before the profession ; and of course, a well written " trea-
tise on amputations." But we do not wish to see in any country,
and more especially in this land of freedom, where intellect is
bounded only by the limitation of its own powers, a fixed formula
laid down by authority, to which all must servilely bow, or be

574 Epilectic Fits cured by the Trephine. [April,

chargeable with mal-practice; and this too, for application to ca-
ses as various as human physiognomy. We have witnessed
too much of the injurious effects of the passionate extremes of
solidism and Humor alism too much of the violence of Bru-
7iomia?iis?nj and the ruinious tendencies of the gum tea and
other expectant fungi of the exploded physiological doctrine, and
too much of the culpable lethargy of the medical mind in all
matters demanding the exercise of the rational faculty, to be dis-
posed to tolerate the least surrender of the powers or privilejes'bf '
a sound intellect, well stored with facts, to a* formula for ciases,
the valuable nature of which must needs require different in-
ductions from a rational view of their facts.

We are free to reject the doctrine of identity of venereal and
other excitements the identity of gonorrheal and syphilitic
poisons, and the only gastric and enteric origin of pyrexiae ; and
we are no less free to reject the high example of Lis Franc, of
leaving a wound open for hours, in order to secure adhesion.
But why dare we do these things, but that we know better, and
feel at liberty to do according to our knowledge. The same
right have we, to exercise on the manner, location, dressing, &c.
of an amputation reasoning fairly from the premises in the
case, perfectly regardless of any authority or custom, except so
far as it affords us facts from which to reason.

Epileptic Fits cured by the Trephine.

In a late number of the Boston Medical and Surgical Journal,
we have the result of the very interesting case of the Rev. E. W.
Sewell. This was a case in which there was a diseased con-
dition of the bones of the skull, on the left and upper surface of
the head. The patient had not only been in pain, more or less,
for twelve years, but was subject to sudden and violent fits, as
they are commonly denominated, which sometimes continue
without interruption, nearly two hours. He had been several
times of late, deprived of consciousness, and thrown into violent
spasms while officiating in the church, of which he was pastor.
Under these circumstances, Dr. George Ha yward, his surgeon,
determined on attempting to relieve the obvious pressure on the

1838.] Liquor Opii. Liquor Cinchona. Polypus. 575

brain by the operation of the trephine at the point which peemed
to be the focus of the disease. He accordingly removed a button
of bone about three quarters of an inch in diameter ; when, on
the instant of raising the bone Irom the brain, the patient said he
had not been so free from pain in twelve years before. There
has been no return of epilepsy ; the wound is nearly healed, he
feels well, and there is every reason to believe he will soon re-
turn to his church and society in perfect health. The pulsations
of the brain are now seen on his head, precisely as we notice
them in young children. By compression of the brain, the
whole machinery of the body was thrown, at times, into irregu-
lar spasmodic action, destructive and increasing.

The result of this case is highly creditable to the judgement
of the surgeon, Dr. Hay ward. We have the promise of a
full report of the case.

Liquor Opii JSedativus of Battley.

This preparation, which has been made according to a secret
formula for many years, is said to be formed simply by macera-
ting opium in distilled water for a given time, at an equable tem-
perature (that of the laboratory.) with free access of light and air.
About a seventh part of alcohol is added at. the end of the process,
in order to preserve the liquor.

M. Battley's " Liquor Cinchona?" is prepared by mace-
rating seven pounds of coarsely powdered bark in seven gallons
of distilled water for twenty-four hours, straining and evapora-
ting, to a certain extent, in wedgewood dishes. About four
ounces of spirit may be added to preserve the liquid. It is said
to be a preparation equal to quinine. Seven or eight drops are
a sufficient dose. American Journal from the Lancet.

Polypus within the Uterus, removed by Ligature.

Dr. Buck of Liibeck, narrates a case of successful treatment
of polypus within the uterus by ligature. He professes to
have been taught by experience that, contrary to the generally
received opinion, polypi arising even from the fundus of the

576 Polypus. [April,

uterus admit of the application of, and removal by the ligature,
notwithstanding they are still retained within the cavity. He
says that when the as tinea is open, it is practicable to apply a
ligature to the polypus thus situated, and that this operation is
always indicated when the inactive state of the organ renders it
incapable of protruding its contents into the vagina, especially
when the constitutional disturbances endanger the life of the
patient. Although it is fortunately the case that this state of
things rarely occurs, yet the case of Dr. Buck proves both the
possibility of occurrence, and the practicability of successful
treatment. It is possible indeed, that these cases are of much
more frequent occurrence thaa has been supposed ; and the case
in point should lead to a more ample investigation of those cases
of uterine affections which we too often consign to their fate as
hypertrophy, carcinoma, corroding ulcer, &c. And it should be
further remarked, that in consequence of the disagreeableness to
the practitioner, and his impatience, in such investigations, to-
gether with the feelings of delicacy on the part of patients, uterine
diseases generally are shamefully mistreated, and their bearings
relative to other affections, as cause or effect, so little understood
as to leave the practitioner, most commonly, without the knowl-
edge necessary for sound induction, and consequently, the pa-
tient, to a loose, imperfect, and unsuccessful treatment, or no treat-
ment at all.

In January, 1S34, I was called to see a poor woman, who
gave me the following account of her sufferings : She was 46
years old, had previously enjoyed good health, and was the mo-
ther of six children. Since the death of her husband, which
took place nine years before, she had abstained from sexual in-
tercourse. Two years previously, she was seized, in place of the
ordinary menstrual discharge, with a violent haemorrhage, which
ceased after a duration of eight days, and for the space of a year
did not return. In this interval she began to suffer from an op-
pressive sense of weight in the belly, pricking pains in the side
and in the pelvis, difficulty in voiding urine, and a dragging
sensation in the sacral and lumbar regions.

These symptoms gradually increased in severity, and about
Whitsuntide, 1833, haemorrhage from the uterus again took
place and continued to recur at short intervals until about six
weeks before the period of my visit, when it ceased altogether,
and a fluor albus, having an offensive smell, appeared in its
place. I found the patient in a state of extreme emaciation, ca-

1838.] Polypus. 577

chetic in her appearance, and so weak as to be scarce able to
leave her bed. She complained of violent pains in the iliac re-
gion, which were augmented by pressure, and from time to time
of slight pains resembling those of labour ; her appetite was bad,
her pulse small and quick, she coughed a good deal and vomited
occasionally.

On making a manual investigation, I found the uterus in its
normal situation, the lips thin and flaccid, and the os uteri itself
open, so that it admitted the index finger with facility. Within
the organ, and apparently arising irom its fundus, a polypus was
clearly to be felt; it had" the circumference of a large pear, was
insensible to moderate pressure, and did not quite reach to the
external orfi.ee of the uterus. The parts were covered with a
mucous exudation streaked with blood, and of an offensive smell.

I directed a plain treatment calculated to improve her general
health, in the hope that the labour-like pains would at length
expel the polypus from the cavity of the uterus. Deceived in this
expectation, I prescribed 24 powders, each of which contained
half a scrupel of secale cornutum, and these failing to produce
any effect, nine others containing one scruple each ; the latter
were all taken in 36 hours ; nevertheless, the uterus still remain-
ed in a state of inactivity, and even the stomach, an injurious
action upon which has been attributed to this medicine, was not
in any way affected by it.

Dreading the difficulty of applying a ligature to a polypus so
situated, and as there was no dangerous haemorrhage, I still wai-
ted, hoping that the powers of nature would finally effect the
desired protrusion. But the health of the patient daily grew
worse, the mucous secretion became more and more copious, and
the cough, which had hitherto been dry, was now accompanied
by an abundant and ill-looking expectoration, together with pains
in the breast. Frequent though slight febrile paroxysms, noctur-
nal sweats, and a watery diarrhoea, added to the prejudicial in-
fluence of many privations, and the want of proper attendance,
soon reduced my unfortunate patient to a state of complete ma-
rasmus, so that I already believed her end near, and certainly
under these cirenmstances should have desisted from all opera-
tive proceeding, had I not convinced myself from previous expe-
rience, that now, the speedy removal of the polypus alone afford-
ed a chance of recovery.

With the assistance, therefore of Dr. Pabst, T undertook to ap-
ply a ligature around the root of the polypus, selecting for this
purpose J6rg's double canula.* The patient being placed upon

* I chose this instrument on account of its length, but found that the curvature
at its upper end rendered the operation more difficult, and I now employ in prefer-
ence, two straight silver canulas which separate and unite with great ease.

578 Polypus. [April,

a cross bed in a half-siting position, I introduced the instrument
previously oiled, and provided with a thread upon the left index
finger, and pushing it carefully through the os tinea?, between
the polypus and the yielding uterine parietes, carried it as near
the root of the tumour as possible. One canula being firmly
held in this position, I at length succeeded, after many fruitless
attempts, in passing the other one. with its cavity always turned
towards the polypus, fairly round the pedicle, and I now joined
the two together. The pain occasioned by the unavoidable fric-
tion on the inner surface oi" the uterus, was trifling, nor did this
stimulus provoke the organ to the slightest contractile effort.
On tightening the thread, I was convinced by the insensibility
of the parts, that 1 had not included any portion of the uterus, a
circumstance the more to be dreaded, as the point where the
ligature was applied, was quite out of the reach of the finger.
During eight days, I daily drew the thread tighter, it then broke,
and on examination I discovered that only half of the polypus
had sphacelated away. A re-application of the ligature was
successfully effected, though not without considerable difficulty,
as the body of the tumour had much diminished in size and
firmness, while the pedicle seemed proportionally thick and
sinewy. In the mean time, the injurious influence of the copi-
ous and highly fostid discharge was, as far as possible, counterac-
ted by the frequent use of antiseptic injections.

In the course of a few days, the last ligature came away, and
at the end of a fortnight no remains of the polypus were discov-
erable ; the uterus, too, had contracted, and the os tineas soon
after assumed its normal form.

The patient, who had hitherto been lying in an almost hope-
less state, now recovered strength surprisingly fast ; the diarr-
hoea, fever, nocturnal sweats, and puriform expectoration quick-
ly disappeared, and at the expiration of two months, with the aid
of tonic medicines, she was restored to perfect health." Med.
Chirutg. Rev. July, 1836, and Rust's Magazine.

SOUTHERN

MMBWAJL AMID) TOH(DAIL
JOURNAL.

Vol. II. MAY, 1838. No. X.

PART I.

ORIGINAL COMMUNICATIONS.

ARTICLE I.

Case ofe xtraordinary enlargement and ossific transformation
of the (fvaria. Communicated by E. Geddings, M. D.

The utility of publishing isolated cases of disease has been
much questioned, and at the present time especially, when efforts
are every where being made to substitute observation for specu-
lations, it must be confessed, that there is too great a propensity
to swell the Archives of medical science with detached facts
and observations, many of which are too devoid of interest to
repay the labor of giving them publicity. The case I am about
to offer, rrfay perhaps be considered by some, more as a patho-
logical curiosity, than as a fact capable of admitting any useful
induction. I will not pretend to claim for it the highest
rank in the scale of importance, in regard to therapeutics ; but
think, nevertheless, that it possesses some interest in relation to
pathological science. For the few details I shall be able to fur-
nish, relative to the previous history of the subject of the case,
and the origin of the disease, I have been indebted to my friend

A 1

580 Enlarged and Ossified Ovaria. [May,

and colleague, Prof. H. R. Frost, to whose kindness I also owe
the interesting opportunity of examining the body* after death.

The subject of my remarks was a black woman, aged 60 years,
the mother of two children. Her occupation was that of a field-
hand, in which situation she was able to perform her task. Her
general health was good, and her principal complaint was occa-
sional pain of the abdomen, sometimes followed by convulsions,
which generally yielded to a dose of castor oil. She became
pregnant of her second child at the age of twenty years was
delivered safely at the usual time, but had a painful parturition.
Shortly after delivery, a swelling was observed in the lower part
of the abdomen, which increased so rapidly, that she soon be-
came as large as before her confinement. She continued to men-
struate, and had no children afterwards. This circumstance,
together with the tumor of the abdomen, induced her to believe
that she was tricked (bewitched.) All attempts to influence
the tumor by medical treatment, were unavailing, and for some
time before death, her abdomen presented the appearance of that
of a female in the last stages of pregnancy. She continued to
be useful to her owners almost to the last, and finally died sud-
denly of convulsions.

Necroscopy. The body presented no appearance of emacia-
tion. The large abdominal tumor was round, hard-to the touch,
and slightly uneven on the surface. It reached from the pelvis
to near the ensiform cartilage of the sternum, and was slightly
inclined to the right side. On laying open the abdomen, the
tumor was found to occupy the right ovarium. The whole of
the anterior part of its circumference adhered so closely to the
inner surface of the abdominal parietes, especially at the um-
bilicus, that considerable difficulty was experienced in separating
the attachment. In the right iliac fossa, it was adherent to some
of the convolutions of the small intestines, and in its circumfer-
ence, from right to left, it was firmly united with the ascending,
transverse, and descending colon. Behind the line of this latter
adhesion, the posterior surface of the tumor, equal to about one
half of its extent, was perfectly free and smooth upon the surface
most of the convolutions of the small intestines resting be-
tween it and the posterior part of the abdomen.

The tumor was detached from the parts with which it adhered,

1S3S.] Enlarged and Ossified Ovaria. 5S1

and removed from the abdomen, with the uterus annexed. It
was of an elliptic, or ovoid shape ; somewhat uneven upon the
surface ; was covered by the thickened peritoneum, and upon its
anterior part, with the false membranes by which it had been tied
to the neighboring structures. The uterus was healthy, and
presented the right fallopian tube extending to the body of the
tumor, in which it was lost. The entire weight of the latter
was fifteen pounds. In its longest diameter it measured nine
inches : the transverse diameter was seven inches and a half: the
lateral diameter eight inches. The portion which adhered to
the umbilicus was somewhat soft, and presented evidences of
fluctuation. When cut into, about eight ounces of curdy matter
was discharged. All the rest of the tumor was so hard and re-
sistant, that it could only be divided with a saw. From three
to four fifths of its substance was composed of bone, part of which
existed in form of homogenious solid masses, possessing the or-
dinary properties of bone, while in other portions, the osseous tis-
sue was deposited in form of plates and spiculse, united by a firm,
tough, fibrous tissue. The ossific transformation was not con-
fined to the external fibrous envelop of the organ, but was dis-
seminated through its entire substance, and had supplanted
every vestige of its natural structure.

Partial ossific transformation ol the ovaria, is by no means of
rare occurrence ; but 1 know of no instance in which it was as
extensive as in the case just detailed. In most of the examples,
indeed, that have been reported, it was either confined to the
fibrous envelope of the organ, or if it occurred in the proper sub-
stance of the ovaria, it was merely in form of small isolated par-
ticles. It is proper, nevertheless, to remark, that calcarious de-
posites of considerable size are occasionally found in the same
situation, many of which, have doubtless been described by per-
sons not accustomed. to make pathological investigations, as ex-
amples'of ossification of the ovaria.

As some of the readers of this journal may be anxious to know
some of the cases of osseous and culcarious deposite in the ovaria
which have been recorded, I shall subjoin a brief synopsis of such
as I have been able to find, by a hasty reference to the materials
of my own library, premising, that the list might be extended by
more extensive research.

582 Enlarged and Ossified Ovaria. [May,

Drelincurtius reports the case of a lady of noble birth, the
mother of five children, who died ot a disease of the left ovarium.
It contained fifty pounds of fluid some limpid some albumi-
nous and meliceric, and,- besides, a gypseous material, through
which many rough, hard, spicule were disseminated.* Two
instances of more extensive ossific transformation have been des-
cribed by Morgagni. In the ovarium of a female, who died of
ari affection of the chest, besides several small vesicles filled with
fluid, we found two large empty cells, the tunic of one of which
was composed partly of bone: that of the other was entirely
osseous, and presented upon its surface numerous inequalities,
similar to the convulutions of the intestines.! The other case
was that of a hystericy female, who died a few hours after deli-
very. In one ovarium, an osseous cell was discovered, contain-
ing a grumous fluid. J Stork has reported a case in which an
osseous concretion, as large as a pea, was formed in the lower
part of one of the ovariall ; and in one instance observed by
Walter, a hard ossious concretion, as large as a nut was sit-
uated beneath the membranous envelope of the ovarium. The
individual was a female, aged 32years. Le Clerc found the
right ovarium of a female, aged 60 years, as large as two fists,
and disseminated through its substance,! there were numerous
small points of ossification. In the case of an old woman, whose
body was examined by Nicolai, the right ovarium was as large
as a goose-egg, and the inner part of it was ossified.* Frank
also mentions the instance of a barren female, in whose ovarium
a small bone was discovered after dcath.f The following case,
reported by Chop art, is more interesting. A female, aged thir-
ty years, who had enjoyed good health, experienced an unusual-
ly copious flux of the menses, which continued beyond the ordi-
nary time. She had no subsequent recurrence of this evacu-
ation, and as her abdomen soon began to enlarge, she fancied

* Bonetus. Scpulchrot. Anat. Tom. II. p. 491.

I De. Sed. et. Cans. Morb. Lib. iii. I 28.
t lb. Epist. xlviii. 1 1

II Annus Med. ii. p. 266.

Obs. Anat. Cap. iii. p. 54.

IT Roux. Journ. de Med, Tom. zii. p. 5150.

* Decaa. Observ. Argmt. 17-25 In Haller. Disp. Anat.
t Sammulung. Bd. >. p. 179.

1838.1 Enlarged and Ossified Ovaria.

herself pregnant. At the fifth month, she e . mod she felt

the motions of the child, and the same sensations were expe-
rienced up to within a fortnight oilier death, which took place
nine months after the period of her last menstruation. The
house surgeon of Hotel Dieu, who was called upon to perform
the Caesarian operation, found in the abdomen a tumor, which he
at first mistook for the uterus containing a fetus. It proved to
be an ovarian tumor, which on being opened, discharged a san-
guinolent serosity, and seemed to be composed, in part, of an ino-
dorous parenchymatous substance which occupied the two up-
per thirds of the tumor. The other third was occupied by an
osseous concretion, which was extremely hard, of the shape of the
cranium of an infant, concave within, and so intimately adherent
to the walls of the cyst, that it was with difficulty separated by
dissection. This mass of bone was more than an inch thick in
the centre, extremely hard and rough on the surface, and weigh-
ed twenty one ounces. The walls of the cyst also contained
several lamina3 of bone in their substance.* In a case. observed
by Schlenucker, the left avarium was hard and stony, weighed
three ounces.t VoigteU refers also to Graafe, Cavallini, Lud-
wig, Saviard, De Haen, Sandifort and Chambon de
Montaux, for other examples of osseous and stony concretions
of the ovaria ; and Muckel mentions, that he has not unfre-
quently found ossious concretions in the substance of the ovaria
of young females of pleasure.*!! In a very interesting case des-
cribed by Hooper, in which an ovarian dropsy burst through
the walls of the abdomen, and discharged a large quantity of
gelatinous fluid, the surgeon in passing a bandage round the body,
heard a rattling noise within, and passing his fingers through
the opening, he easily detached and pulled out, several portions
of bone, of angular shape, some two inches long, and about one
in thickness, others smaller. Still the rattling was occasionally
repeated : another surgeon was sent for j and it was determined
that the opening should be enlarged, which was done, and seve-
ral more of larger size were extracted. The wound healed, and
the lady lived many years.

* Chopaet. Maladies des Voies Urinaires Tom. 1. p
1 Haller Disput. Med. Tom. iv. p. 419.
t Handbuch der Pathologischen Anatomic Bd. iii. p. MO.
IT Handbuch der Pathologischen Anat. Ed. iii. p. 255.

584 Enlarged and Ossified Ovaria. [May,

The origin of these osseous transformations of the ovaria must
be explained upon the same principles that influence analogous
changes in other organs. In consequence of the operation of
causes, often diverse m their character, a perversion of nutrition
takes place in the component structures. They require an
increase of developement; new materials are deposited in their
substance ; and their proper texture becomes either notably al-
tered, or it is transformed into one of a totally different character.
The fibrous tunic of the ovaria seems to be the part most prone
to take on ossific transformation; but in undergoing this change
it first becomes thickened and indurated then cartilaginous,
and finally bony. The pathological condition in question is not
however, confined to this structure. There is some reason to
suspect, that the delicate membranes surrounding the graafian
vesicles, which we know are very liable to become the seat of en-
ormous watery accumulations, as in the encrysted forms of ova-
riam dropsy, not unfrequently participate in similar changes to
those which take place in the external fibrous covering. Hence,
it is common to find large watery cysts in the ovaria, the valves
of which, very thick and resistant, are very frequently cartila-
genous and osseous in certain portions of their extent.

In the cases quoted above, and the remarks offered, no refer-
ence has been made to those pathological states of the ovaria, in
which bones and teeth have been foundjn these organs. Such
instances are entirely different from those which form the sub-
ject of this communication, as they originate from causes of a to-
tally dissimilar nature. Such bones and teeth, when found in
the ovaria, owe their origin, either to an extra uterine concep-
tion, or to a conception by inclusion, one germ being included
within another, the one including only, coming to perfection.

As regards the influence exercised by the tumor, in the above
case, upon the surrounding organs, and the system generally, it
is not easy to offer any very satisfactory explanation. Whe-
ther the convulsions to which the individual was liable,
were owing to the encroachment of the diseased mass upon the
abdominal aorta, and the consequent determination of an in-
creased quantity of blood to the head, or to pressure upon the
abdominal nerves, cannot be satisfactorily determined. Be this
as it may, it is not easy to conceive, how a tumor of such great

183S.] Dr. Barratfs Anniversary Address. 585

size, and immense weight, could be carried for so long a time,
without erivine rise to greater disturbance of the functions of the
organs exposed to its influence, than was manifested during the
life of the individual. Had its nature been ascertained during
the early period of its growth, it might have been extirpated
with considerable prospect of success. But after it had attained
its full developement, and become extensively attached to the
intestines, and surrounding part, any attempt to remove it by
an operation, could scarcely have failed to destroy the life of the
patient. Its perfect freedom from attachment throughout the
whole extent of its posterior surface, would, however, have ren-
dered extirpation less difficult than it would be when the tumor
is adherent by the whole of its circumference.
Charleston, May 7th, 1838.

ARTICLE II.

An Address delivered before the Medical Society, of Abbe-
ville District, S. C. at their Second Anniversary, in May,
1837. % Dr. John P. Barratt.

Mr. President, and Gentleman of the Abbeville Medical
and Philosophical Society At youi call, I stand before you to
address you, on this, the second anniversary of your existence
as an associated body:

Two years are now gone, since you formed yourselves into a
society, and now is the time for the interrogatory : what have
you done individually, or as a body, for the advancement of
science, the improvement of your profession, or the benefit of
your fellow man ?

Have facts accumulated from your united efforts, or individual
observation ; have you interrogated the arcana of nature, traced
visible effects to their hidden causes? If these are and have been
your pursuits, then are you pursuing the legitimate objects of
your association. The field for exploration is immense ; a vast
terra incognita lies before you ; there is no barrenness ; every
inch of matter teems with objects worthy of your attention. The
inorganic and organic world woo you to examine the design
and harmony that exist through the whole of the Great Creator's
works ; the same Almighty plan developes, in every atom of

58(3 Dr. try Address. [May,

inorganic, and in every fibre of organic being that presents itself
to our senses and intelligence.

If each individual member of your society contributes the
thoughts, feelings and results of what has fallen under his own
observation, a mass of intelligence will be brought to one cen-
trethe whole will be instructed, and good will clearly be the
result of united minds, which have been variously employed in
the great school of Nature, each bringing into the common trea-
sury, the stores he has gathered.

From the vast improvements of the present age, in morals, in
physics and organic philosophy, the profession of medicine is
now becoming a science, depending upon physical and organic
philosophy for its base. So broad are its pretensions, that the
whole regna natura must be brought within the circle of its le-
gitimate pursuits. The blind routinist and empirical follower
of other men's theories, unsupported by facts, must fall into
shade. The sun of truth, with beams effulgent, bursts through
the accumulated clouds of superstitious darkness and ignorance,
dispels from the fair face of nature the fogs and vapoursby which
she has been enveloped as with the mantle of Egyptian darkness.
The profession of medicine must be no longer a trade, but a
noble science, guided by principles, founded on facts, widely ex-
panded, elevated, pure, with universal benevolence for its day
star, and truth, ti nchor of the whole; then will its prac-

tice yield that which money cannot purchase a calm of the
soul, a consciousness of having done right,. none of the torturing
misgivings arisii; fie doubts consequent upon ignorance.

From these the intelligent and benevolent practitioner will be
free, and the bed side of the patient will be peace.

From the earliest a^es to the present time, there have been, and
now are, in all professions, heads, and in our profession, a reat
many, and each one (with a pride legitimate when guided by cor-
rect principles,) has promulgated to the worldsome favorite theory.
Grasping a few facts, and then generalizing the whole to fit con-
veniently; the effect of diseased actions in organized beings, call-
ed fever, has been, and now is, a rich source of theoretical spe-
culations; volume on volume has been written to establish the
favorite theory of each leader in medicine* With a systematic
nicity, symptoms have been grouped together, and the learn-

1838.] Dr. BarraWs Anniversary Address. 587

ed nosoiogists have presented us with genera and species, ar-
ranged into regular order : thus a long black catalogue is pre-
sented to the world, of the ills of man. Quackery is being now,
and has been encouraged in all ages of the world, but more par-
ticularly at present in our own country, regularly organized ;
and is in some of the states sanctioned by legislation, a system (as
it is called by its promulgators,) of practice of high pressure in
all its bearings. The delusion spread far and wide, prevailing
in a greater or less degree, in almost every section of our coun-
try, and finding supporters in every grade of society. But this,
as others, not having truth for its foundation, and facts for
its superstruction, will crumble into its primeval nothingness,
and leave not a trace behind. On a glance at the history of all
ages of the world, the acquisitiveness of man, destitute of moral
influences in the general, has caused him to fatten on the guli-
bility of the world, but these are but the fmgi of a day, of rapid
growth, but soon to die.

Let us now look at our history as a profession. From the
writings of Herodotus, we learn that when an individual be-
came diseased, the friends placed the patient at the corner of the
street, or on the side of the road, to attract the sympathies and at-
tention of the passers by, in the hope that some one might hap-
pily come, who had been similarly diseased, and had got well,
and who would thus be able to prescribe remedies from expe-
rience, by which means cures were frequently made. These
practices prevailed in Italy, Spain, &c. &c. The priests, for a
long time, were in possession of all the medical knowledge of
the world. The certain and natural influence of being a vene-
rating being, caused men, when laboring under disease, from
which they knew of no retreat, to fly to the temple of their
Gods, and invoke their aid. From these daily exhibitions of
suffering humanity, the sympathies of the priests were excited,
and an attempt made to relieve. Care brought about a great
many cures, and it is likely the priests were the most intelligent '
and benevolent, and hence with them originated the profession
of medicine as a part of the priestly office.

Alchemy, physics, mechanics, metaphysics, and chemistry,
have each one had the ascendency. The Greeks, with a Job
like patience, carefully watched their patients, and noted down
' b2

58S Dr. Barratfs Anniversary Address. [May,

with precision every symptom of suffering and expiring nature.
They made nice distinctions as symptomatologists but in this
their skill consisted. Effects they saw, but never thought or
dared to interpose a single remedy to arrest the progress of death,
nor did they once glance at the causes producing those groups
of symptoms so carefully treasured up. When the last vital
throb was over, and the icy hand of death had seized its victim,
their enquiries were at. an end. Of what advantage was all
they had done? Let the millions of trophies of untimely death
answer. How humiliating to the philanthropist, and how de-
grading to the profession.

A new era in our profession has commenced. By the lights ema-
nating from tracing effect to cause, the modern physician, skilled
in the physiology of organized being, is now able, in many in-
stances, to hold the fell destroyer, death, in abeyance. It is now
that prejudice has to succumb to the active desires of the medical
philosopher, the still chambers of deatli are lighted up, the re-
mains of the pale animate lords of creation are interrogated, the
hidden causes of his death, are laid open to the senses. Answers
are obtained, and though answered in silence, are answered in
truth.

Here the knife of a Beclard discloses the changeful effects
of diseased actions, and triumphantly displays the secrets of fe-
ver. The organs that once suffered are bared to the scientific
eye of the general anatomist. It is here the relations of organic
life are to be traced, examined, studied ; the texture and condi-
tion in health and disease strictly and clearly compared ; it is
here that most of the learned and studied theories of fever as an
entity, crumble into atoms. Facts as stubborn as true, are here
presented, and he whose soul delights in truth, grasps, with avi-
dity, the facts presented by the examination of the diseased or-
gans. A Biciiat, a Beclard, a Broussais, have been given
to the world; ignorance and error are now trembling, tottering;
falling ! Truth, eternal in its origin, and so in duration, bursts
through every cranny of intelligent being, passing from land to
to land. The flimsey theories and un philosophical writings of
many from the time of Hippocrates, to the present, arc now
being exploded and consigned to the depository of the antiquary.
Nature, and nature only, is the book in which to look for tru-

S38.] Dr. BarratCs Anniversary Address. 589

isms. Every page we turn in that vast volume, developes facts
firm as the pillars of Heaven. Nature's laws or rules of action,
are immutable and without exceptions, and will so remain till
the Almighty Author of all, shall issue from the throne of his
glory, a return to chaos or the mandate of change.

The relation that exists between the physician and those whom
professional services bring frequently together, makes it a legi-
timate duty, and clearly within his province to point out, and
show to man, his physical constitution, the laws of organic
life, together with the rules of hygiene best calculated to pre-
vent infringements of his organs. Your duty is constant, active,
and vigilant. You are the guardians of health and life ; your
discriminating intelligence is the aegis that surrounds the lives
of your fellow beings. To those with whom debauchery and
every other deviation from the path of moral rectitude, has made
breaches of the organic constitution, you must administer them,
and show how best to restore the harmony of their organs; and
thus smooth the path of human suffering, and light up on the
diseased and darkened brow .of your kindred man, the glow
of health and pleasure. Your duties bring in a rich harvest,
not alone of the "trash," but that eternal balm of the soul, a
consciousness of having done good, by doing your duty. You
thus become the true benefactors of your race, and will receive
your rewards here and hereafter.

Were every human and intelligent being, truly and clearly to
understand the laws by which he is governed, physically, organ-
ically and morally, and act in full accordance with the constitu-
tion of his nature, a thousand diseases that now sweep through
the land as with the besom of destruction, consigning to untime-
ly graves, millions of victims, would cease to have names, and
organic man Vould live till he died, though an apparent contra-
dictory expression, for few do so, but either kill themselves, or
are killed by ignorance and quackery.

The influence of anatomical research on medical science in
pointing to a correct pathology has already extensively been felt.
Physical exploration points out clearly the changes and lesions
in diseased organs, without these aids, we grope in the dark,
launch into an unknown ocean without charter compass, or play
a child's game of shooting in the bush, bird or no bird. To

590 Dr. Barratfs Anniversary Address. [May,

Bichat the medical philosopher and the world owe much. It
was Bichat who laid the foundation of true medical science, new
to the world, but of immense importance. By the efforts of this
individual, intelligence and impulse was given to the world of
thought in our profession, and a train of earnest investigations
into the vital forces and the various modifications of action in
the organs of man. Bichat took the hint from Pinel, for
Pinel spoke of the possibility of a peculiarity of structure pro-
ducing a peculiarity of action of life and sensibility. But to
Bichat of right, belongs the science of organization in general.

A knowledge of general anatomy applied to a pathological
state, uproots all our notions of specifics in medicine. Diseases
as entities are no longer tenable, on exploring the diseased or-
gans, and comprehending the relations existing through the
whole series. The true cause of all the symptoms we may have
noted, and to which we have given names, are clearly developed.
Truth now sheds a ray of light, and we regard medicines as
modifying agents only, and these have a value in a ratio to their
capacity for producing changes in the actions of the system, spe-
cially and generally.

Broussais, with that daring that conscious greatness gives to
its possessor, concentrated and arranged into system, and by
the strength of his genius, gave a most powerful impulse to
medical science. Organic sympathies and the sympathies of
relation, are by the labours of this great man, being now better
understood. The lights of philosophic truth bursts through the
accumulated mists of ages, and sheds its genial influence on our
too long and too much benighted profession.

A true medical philosophy is now lighting up the darkened
chambers of intellect ; a knowledge of organic man in health and
disease, is progressing onward ; arts and science/ are progress-
ive, from the rudest notions of the savage in the construction of
his hut and instruments of war and the chase, to the refinements
of the civilized world.

However humiliating to our pride, it is true we are yet but
hal f civilized ; do we startle to hear ourselves called semi-sa-
vages? let us for a moment examine the position, see what has
been and what still is our state. Delusions have been promul-
gated in a continued series, ruled man's intellect, aroused his

183S.1 Dr. BarratCs Anniversary Address. 591

passions, and brought millions of our species into collision and
deadly combat, to support the ambition of tyrants aspiring for
empire : the blood of our species has flowed in profusion o'er
every land in their barbarious conflicts : millions on millions of
money has been expended either for defence or aggression by
the natives of the earth. The savage propensities of our nature
cause man to spill the blood of his fellow man ; the knife or the
deadly ball, settle what intellect ought to do. Man has battled
to sustain dogmas that are now crumbled into dust and covered
by the fallen fragments of successive follies. From whence say
ye come the secret arms now being carried in our own times l
'Tis the foul dregs of savagism that buckle on the murderous
Bowie Knife, or arm the walking cane with the deceitful spear,
and causes the glittering dirk to lurk in the bosom where honest
indignation ought to spurn such a contact, and exulting in the
pride of intellect, dash from him the insignia of barbarism.
There is a fault somewhere. An error in education, a neglect
of the social law of our nature, the propensities, lawless, rule
where the intellect ought to be enthroned ; the individual is
not taught to rely on his own thoughts and feelings. A few
daring individuals have governed the whole mass ; the indivi-
duality of the species is lost, and the many have become but the
component parts of the few.

The history of Rome gives you an example in her Caesar.
Bonaparte is another example of our times, as witness the Vive
le Emperor shouted by the millions of France when he escaped
from the water bounded prison of Elba to deluge her land in
blood, and dissolve every tie of nature in death, causing thou-
sands of matrons to mourn the loss of their children. This state
of things has to be broken, though slowly, as every inch on-
ward presents a shackle of antiquated obscurities, rendered sa-
cred by age, ignorance or predjudice, which education and the
cultivation of our better feelings, must and will break down.
Our race is on the high road to improvement, each successive
age makes nearer approaches to a better state; the twilight of
morning is brightening to the light of day, and as time rolls on,
man will be developed as a civilized, intelligent being.

About the year 1790-95 the immortal Gall began to develope
the physiology of the brain, new lights sprung up all around,

5<>2 Dr. Barratfs Anniversary Address. [May

and man began to investigate and study the sources of his own
thoughts and feelings.

Gall in this matter stands alone and original in bold relief
from all the world. It was Gall who dared to say to the phy-
siologist, that thought was dependant on material organs, that on
the integrity of the brain depended the integrity of thought.

Since Gall first promulgated to the world his observations on
those delicate tissues, the nerves, which till then were measur-
ably in the arcana of nature, have received great attention from
the most intelligent anatomists and physiologists of the present
age. From such investigations much light has been thrown on
the matter, and much valuable information has, from such a
union of effort of the master spirits of our profession, come in
upon us from different quarters of the world.

Broussais has pointed out the causes of diseased actions, and
wiped out from the pages of medical science, diseases as entities,
distinct from organic derangements. And for this he has been
assailed, abused, traduced. But by whom? Not surely, by those
who have carefully investigated his writings, or entered into his
thoughts. No gentlemen, to r^ead and understand, is to believe
the principles for the most part which he has laid down.

Those who are loudest in the abuse of Broussais, are for the
most part, men who are naturally destitute of those powers of
thought which so eminently characterized this modern prodigy
of medical philosophy. Many of his abusers have never read a
single page of his writings, but have abused from the bare say so
of, they don 't know who. To all such I would say, read, think,
play the man, and then; in the place of being the abusers, you
will become the admirers of him who said, " to think is to feel,
sensibility is the soul of man."

Gall and Spurzheim in developing the physiology of
the mind, have been represented to the world by their opponents,
as German fanciers, fools, &c." but truth prevailed, and though
" passed through the volley and shadow of death," they live on
the pages of their country's glory, and will live till the order of
man's organization shall be changed by the Manas Deibemg
stretched forth to arrest the present order of things.

In our own country a Godman has lived his country's glory
deeply imbued with the philosophy of the age and pursuing a

1838.] Dr. BarratCs Anniversary Address. 593

course of investigations in the great school of nature, with a
vigor of intellect scarcely every excelled and but seldom equal-
led. The flame of vitality that lighted up his brain to exalted
thought, burned with splendor. But alas ! ! ! for science and the
world, the grim tyrant death marked him as an early victim
the thread of life too tensely drawn was snapped asunder. The
monster grasped him in his icy arms, and bore him in the morn-
ing of life to the cold damp chambers of the grav%. Philosophy
mourns her votary, science weeps her lover, and the world
has lost a benefactor. ADungiAsson still lives to adorn a seat in
the scientific halls of our country's greatness. One of our sons
now fills a conspicuous place in one of the schools of medicine,
and we have the pleasure to hear of his returning to his native
state, to give increased tone and vigor to her institutions.

The University of Pennsylvania has her Jackson, the author
of the principles of medicine ; he has added mnch to the develop-
ment and improvement of medical science, and bids fair to rival
the most eminent in the old world.

Let us for a moment glance at the practice of a medical man
educated in the school of nature, taught to look on man as an
organized being, and who understands the organic relations ex-
isting between each separate organ. To him it is matter of
fact and not of mere speculation, that peculiarities of texture
wherever found, are assuredly governed by the same laws, and
possessed of the same susceptibilities ; and when in a deceased
state or condition, show clearly, similar phenomena. He is one
who has discarded fever as an entity, but looks upon it as a sana-
tive radiation to relieve the suffering organ. The functions of
digestion, circulation and nutrition, are what he who has been
taught the physiology of the organism of man, will endeavor to
influence with remedial agents. The physician is called (for
example,) to a case generally called billious fever. On explora-
tion and analysis, he finds the patient in the following situation :
The tongue somewhat pointed, red or scarlet on its edges, and
covered with a dirty yellow coat on ite median portion. Pulse
strongly developed and frequent. Skin burning hot, compari-
tively speaking, intense thirst and a strong desire for cold water,
and acidulated drinks, respiration hurried, with a yellow color
of all the "mucous tissues.

591 Dr. Barratt's Anniversary Address. [May,

Thirst is a certain sequence oi exalted actions in the stomach
or other organs, when the whole organism responds to the suf-
fering portion of the catenated whole. In most patients, we
witness an instinctive call for those drinks that arc acid in their
character.

To sum up the result of his observations, from physical obser-
vation and analysis, he unhesitatingly comes to the following
legitimate conclusion of the case the land marks in his chart
are all marked and numbered, and he reasons thus : Here is be-
fore me a primary and certain affection of a mucous texture, in-
flammation and irritation to a certain extent, and through the
nerves of the ganglionic system, extending and influencing the
brain, heart, lungs, spleen, liver, &c. &c. the original irritation
is in the stomach the symptoms are sequences only.

Now we come to the point of application of principles to prac-
tice. Bearing in mind the fact " ubi stimulus, ibi fluxus," the
line of practice is now plain. Cups or leeches are applied over
the suffering organ or organs, and blood is thus abstracted. Cold
mucilaginous poultices over the parts affected. The blood ves-
sels over the stomach are supplied or receive nervous influence
from branches of nerves immediately connected with those
branches that supply the texture of the stomach. By thus ab-
stracting the blood as above, almost direct completion of the organ
is obtained. To save or prevent any further irritation, nutrition
is modified by the use of the mildest and best stimulating articles
of diet. All stimulus will be positively withheld from the gastro
pulmonary mucous texture. Centres of irritation will be estab-
lished on the extremities of textures, the same in character as
those primarily effected. And if necessary centres of flusion are
established in texture at a distance from the suffering organ, cold
drinks, lemonade, orangeade, mucilage, sugared water, &c. &c.
If the brain becomes engaged, blood is taken from the temples or
the base of the brain, emolent enemnta the tongue loses its fire
and clears respiration slower the skin becomes clear and
cool, circulation returns to its normal state, and health is restored
without the routinists ordeal of emetics, purges, salivations, death,
or what is worse than death, a chronic state that renders life but
a miserable reality.

1838.1

PART ll.

REVIEWS AND EXTRACTS.

Dr. Jackson1 s Clinical Lecture on Epilepsy.

Saturday, 10th February. Dr. Jackson commenced:
Epilepsy, gentlemen, is one of the most formidable affections,
which you will be called upon to treat ; and you will find few,
in which all the resources of your art will so frequently fail. It
has been looked upon in this light, from the earliest period. The
ancients had so little control over it, that they designated it by a
term signifying the malice of the demon. Hippocrates contin-
ued the title 'morbus sacer, or the sacren disease, though he com-
bated the superstitions from which it was derived. Various other
terms have been applied to it. By the Romans, it was called
morbus comitialis, from the fact that its victims were often struck
down with it in the forum, probably owing to the excitement
arising out of public discussions, and political warmth.

Many illustrious and eminent characters of ancient and mo-
dern times have been subject to this infirmity. Julius Ca3sar*
was an epileptic sufferer: it is very certain, therefore, that it is
a disease, which does not necessarily interf3re with a high devel-
. opment and exercise of the intellectual faculties. On the con-
' trary, this very exercise of them is often productive of the di-
sease. Perhaps the most distinguished pulpit orator this country
has produced, Buckminsier, fell a victim to repeated attacks of
this affection, brought on by intense mental application. On
the other hand, futurity is not an unfrequent attendant upon
epilepsy, as you will have occasion to notice, in numerous spe-
cimens of the disease, that will shortly be presented to you.

Epilepsy is vulgarly called the falling sickness, from the cir-
cumstance of the patient's falling suddenly to the ground, upon
an attack of it. From th 5, they are liable to numerous

h, an<J
'V like: ho hath

590 Epilepsy. [^Iay,

accidents ; in several in this house, that will be brought before
you, you will see traces of the effects of lire, and other injuries.

Epilepsy is a convulsive affection, attended with loss of con-
sciousness. This latter feature I am anxious to impress partic-
ularly upon your attention, as it is not considered by some wri-
ters, among them Vogel, Sauvages, and even Cullen, as essential-
ly characteristic of the disorder. For my part, I never saw a
case, certainly never in this house, in which it was wanting.
The symptoms of epilepsy then I consider to be, convulsive
movements, with loss of consciousness and of the intellectual
faculties. As the loss of the powers of motion in palsy depends
upon pressure acting upon the thalamus and corpus striatum, so
I think we have evidence from the convulsions of epilepsy, com-
bined with loss of consciousness, that in it, the cerebral structure
must be involved. But the convulsions I do not look upon as the
most important symptom ; that I consider to be# the loss of the
intellectual faculties the muscular symptoms being the first to
pass off, and frequently very slight. In some cases, the muscu-
lar convulsions and loss of the faculties are followed by complete
coma. The suspension of the intellectual faculties, and the con-
vulsive movements are evidently the effects of sudden and violent
disorder in the cerebral circulation. There is, it appears to me,
a raptus of the capillary circulation, terminating in a congestion,
more or less intense, of the brain. This is usually well marked,
the face swelling up, and becoming turgid, and almost purple,
affording striking evidence of determination of blood to the head.
Occasionally, so forcible is this raptus, that ecchymosis occurs
from the effusion of blood out of its vessels. This fact, it strikes
me, is strong evidence, that the movement is attended with force,
is one of activity, and that the accumulation of blood, as has been
conjectured, is passive and secondary. I had an illustration of
this fact, in the case of a gentleman, who was under my care
some years ago, in whom the disease suddenly showed itself.
Attention was first called to him, by his family being struck with
the appearance of petechia}, or livid spots upon his face. A doc-
tor was sent for, who pronounced it a mere affection of the skin,
which would disappear spontaneously, as in fact it did ; but, in
a week or two, it came back again ; and this continued to be
repeated for some months, without a suspicion of its cause, or of
the true nature of the disease. A young man, for some accidental
reason, happened to sleep in the same bed with him, and was
awakened in the night, from I ation in a convulsion. It

was then ascertained, that the periodical appearance of spots on
the face proceeded from attacks of epilepsy in the night, of which
the patient was unconscious.

The patient, in lion, is totally unconscious of the ex-

istence of an attack, lie rouses up gradually from a state of

1S38.] Epilepsy. 597

profound somnolency, with an expression of astonishment upon
his countenance, with simply an unusual feeling of soreness,
from the great muscular exertion which he has undergone.
This, to an epileptic, is the principal indication that he has had
an attack.

The attack varies in character. Sometimes the patient falls
suddenly down, without any previous admonition. At other
times, he is able to anticipate the approach of the complaint.
Most frequently it is preceded by an uncomfortable sensation
about the head, as vertigo, dimness of sight, &c. Again, the
warning may take place in the abdominal viscera, which is or-
dinarily indicated by a sensation about the region of the stomach,
gradually moving upwards to the head. Often, however, the
patient has no consciousness of his approacning fate : he sud-
denly cries out and foils prostrate to the ground.

The symptoms of an attack are not always of this extreme in-
tensity. Sometimes they are so mild that you can hardly call
them epilepsy, though I think they still belong to this class of
affections. They are often exceedingly local in their character.
A gentleman of the medical class, some years ago, was affected
in this maimer. He had been recommended to study medicine,
as a mode of getting rid of the disorder, which, by the way, was a
very ill-judged recommendation. He would at times in conver-
sation, suddenly repeat over some unconnected words, or an
oath, or he would sing a little, being all the while in a state of
total unconsciousness of what he was doing, and then resume
the thread of his discourse, ignorant, unless informed of it, that
any thing had occurred.

The disease was limited to the production of the above symp-
toms, except on one occasion, when he imprudently fatigued
himself with exertion, and ate a large quantity of nuts, (a quart.)
he then had a complete epileptic convulsion. This accident in-
dicated the true character of the disease.

Another case in which the disease showed itself in this slight
local form, was that of a gentleman, who had a daughter also la-
bouring under the disease of a most strongly marked character.
I have often seen this gentleman stop, while in conversation, and
repeat his words; sometimes he would merely move his lips
without articulating, and then resume his discourse, without be-
ing conscious of what had happened.

I have met with one case that appeared to me, if it may be so
called, epilepsy affecting the spinal marrow. The general char-
acter of the symptoms evidently connect it with epilepsy. This
case was that of a boy, seven or eight years of age, who laboured
under monthly attacks, of a ibrrh which I shall presently des-
cribe, brought on by an obstinate intermittent fever, when an in-
fant. Epilepsy supervened, and had continued.

69 S Epilepsy. [May

These attacks were also of an intermittent character ; indeed
I might here mention that the disease always takes on a type
more or less intermittent.

The paroxysms would continue to recur for three days, and
often amounted to twenty or thirty, in the twenty-four hours.
At the end of three days they disappeared, until the expiration of
a month, when they would be again renewed. In all other res-
dects his health was perfect. He was seized every month, with-
out any loss of consciousness, however, with spasms, affecting
all the muscles of the trunk and extremities, proceeding of course
from an affection of the spinal marrow. It was a case of cramps,
more than convulsions. They were attended, as all cramps are'
with violent pains.

This boy is now fourteen years of age, and with the appear-
ance of puberty, the affection is disappearing. 1 cannot well
rank this affection any where in a system of pathology. It is
not epilepsy, because the brain is not affected, nor can it be cal-
led tetanus. I think I may perhaps with propriety, designate it
epilepsy of the spinal marrow.

After this general outline of the symptoms and character of
the disease, I will now introduce to your notice some cases of
patients who are labouring under it. I will only add previously,
that the most common period for it to show itself is childhood,
and that it is more apt to attack the female than the male sex.

This girl is twenty-two years of age, and enjoys general good
health. You notice the vacant expression of her countenance.
There is idiotism combined with epilepsy : this is not unfrcquent.
She menstruates irregularly; the menstrual function was not
established, till three years since ; the secretion is now scanty,
but the discharge occurs more or less every month. Epileptic
fits first appeared seven years ago, when she was fifteen years of
age ; up to that time, she had been quite well. At first, they
were periodical, recurring every three weeks; subsequently,
after the menstrual evacuation was established, they became
more and more frequent. At present, epileptic paroxysms pre-
cede and accompany the menstrual period. The patient is sen-
sible o( the approach of the fits, by the sensation of a bright light
before the left eye which precedes the attack: during the attack,
she is insensible. All the functions are performed with reo-ular-
ity except the menstrual. The girl has never received any ex-
ternal injury. You learn that she lias a premonition of the ap-
proach of an attack. This is often the case. The patient usually
feels a rising up from the epigastrium to the head, like a flame,
termed the aura epileptica. When it has reached the head, con-
sciousness is gone. This girl tells me that her attacks corres-
pond with changes of the moon. It has been a favourite theory
with many writers, that lunar influence is felt by individuals,

183b.] Epilepsy. 509

suffering under this and other affections. Balfour has written a
.work in favour of this hypothesis. I however have no sort of
belief in any connection epilepsy, and changes of the

moon. In this case, from the intermittent character of the affect
tion, it occurring every three or four weeks, the attacks must
correspond in many cases, with some one of the four quarters of
the moon.

In this case, the appetite is normal. It is sometimes exceed-
ingly voracious, and cases of this sort I never could cure : I
believe tnem to be totally incurable. A regulation of the diet is
a most important element, in the successful treatment of epileysy ;
and, as this morbid appetite prevents any control over the diet, a
cure is hopeless.

The memory in this girl is impaired. I have gathered how-
ever from her that she has dysmenorrhea, and menstruates with
pain. I speak thus freely before her, as the faculties of her mind
are impaired. Delicacy on this subject to the sex, gentlemen,
should never be out of mind. The uterus then, in this case, I
consider the seat of the disease, the point from which morbid
action is reflected to the brain. Nutrition is. you see, not affected
by the disease : this girl's flesh is firm, and her digestive powers
appear to be in excellent condition. The cerebrospinal system
may be affected, without, impairing the constitution : and you
see how the life of nutrition is independant of the brain itself.

Here is another case, an old inmate of this house, a girl aged
2G, of very obtuse intelligence : although you see she recollects
my face and ntime. Notwithstanding this great pallor of coun-
tenance, which you notice, she enjoys pretty good general health.
She menstruates regularly though with some slight pain. The
first fit of the disease occurred at the age of eighteen. She was
attacked suddenly whilst engaged at her ordinary occupation, and
does not recollect that she had any pain in the head or unpleas-
ant feelings about that time: she says that she understands that
she had not. At first the fits occurred almost daily. Her attacks
now are usually preceded at night by fulness of the head, and a
state of insensibility, attended by a blackened turgid face, but
without convulsive movements: these are succeeded the next
morning by regular fits of epilepsy, to the number of fifteen, du-
ring the 'twenty-four hours. Now these previous nightly pre-
monitory attacks were called fainting-fits, but they arc quite the
contrary. Fainting takes place fron^want of action in the heart ;
the blood does not get to the brain, and you have feeble pulse
and respiration and jwllidface. Whereas, here, you have evi-
dent determination of blood to the head, full pulse, and quick
respiration.

This third case presents an example of the voracious appetite
of which I spoke. S: id has been

COO Epilepsy. [May.

subject to the disease from the age of five. Her mental imbecili-
ty is very great. Menstruation regular. The paroxysms are of
daily occurrence ; during them, her face becomes exceedingly
flushed, and she froths at the mouth. Some time ago, she says,
she felt queer when the fit was coming on, but she lias now no
admonition of its approach.

Here is another case, in which the disease is of seventeen
years standing, and showed itself first when the woman was be-
tween sixteen and seventeen years of age. It has proved very
intractable, every description of treatment having failed to make
an impression upon it. The intelligence, however, as you per-
ceive remains very perfect. The paroxysms are preceded by
dysmenorrhea, which gives the affection an uterine type.

Here is a case, the general character of which does not differ
from the others, which have been under your notice, except that
the disease first appeared after an attack of scarlatina, in which
the head was much affected. The girl is sixteen years of age,
and has never menstruated. You see the total imbecility of her
mind ; her memory is gone. The nurse tells us, that the attack
of scarlatina occurred five years since, and that her mind was
perfect before. The paroxysms of epilepsy are now becoming
more frequent, occurring almost daily. They come on now at
night, although formerly she had them in the day time. When
on the history of the disease, I should have mentioned, that many
individuals have the fits only at night, and never during the day,
the only manifestation of the occurrence of the attack, being a
sorenees in the muscles next morning.

You have next before you a man, aged forty-seven years, in
whom the disease has existed for thirteen years, caused by a blow
on the head from the fall of a tree. Several pieces of bone were
taken out at the time, and the wound had nearly healed, when
he had the first paroxysm of epilepsy, about three months after
the injury. At first the paroxysms were very severe : he thinks
they now grow lighter. They were more severe when he was
in the habit of taking his dram. He says that they are now
brought on by his " taking cold," and that he never has them
when his health is perfectly regular. You see then that the
disease is clearly here under the influence of exciting causes.
The last paroxysm the man had was about three months ago.
His memory is much impaired, as to events which have trans-
pired since the injury ; but he can recollect well whatever took
place before.

I have met with many such cases as this, in which the memory
totally failed in events subsequent to the appearance of the di-
sease, although it retained perfectly facts antecedent to this epoch.
I had some years ago a boy from Virginia under my care,
Strong, vigorous lad, in whom epilepsy had been brought 01

183S] Epilepsy. C01

from excessive mental application. He was a very ambitious lit-
tle fellow, always striving to be at the head of his class, and his
tutor, instead of repressing-, injudiciously urged on his efforts.
His recollection of things that had happened previous to his at-
tack was perfect, and of all that he had learned, but he was in-
capable of acquiring or retaining an idea subsequently. I took
him home to live with me, and I was never able to communicate
to him a new idea. I could not even make him nnderstand that
the Virginia penny and our cent were the same coin.

I perceive that the man, of whom we were just now speaking,
lias a depression of the bones ot his skull of a quarter of an inch.
This may be the local cause of the affection. I may add, as re-
gards this, that the man knows when an attack is coming on,
by the appearance of a black spot before his right eye, three or
four minutes before he falls. He always lies down, when he
finds the fit coming on, and it is never so sudden as to prevent
this.

I present to you another man, aged twenty seven, in whom the
disease has existed say for ten years. It was brought about by
excessive intemperance. Here then you perceive another exist-
ing cause of the disease. You observe that in this man, the
muscular movement is affected. This is by no means necessa-
rily the case. All the others you saw walked well. On the
contrary, I have generally seen considerable muscular develop-
ment and muscular power in epileptic patients.

Here is a case complicated with mania, the general health
being otherwise excellent, another illustration how little the
functions of nutrition are affected in the diseases of the cerebral
organs. I have here another case complicated with mania, in
which the disease has existed for three years. The patient was
scalded in a steamboat just before the epilepsy appeared : this
may probably have had some connection with the production
of it.

In this boy, whom I now show you, the paroxysm often mani-
fests itself with simple loss of muscular power. The boy, I am
told, will fall without any accompanying loss of consciousness.
In some cases, there is merely a slight vertiginous movement, the
patient not losing his consciousness and instantly recoverino:: the
paroxysm is not then complete. It is a case of incomplete epi-
lepsy.

The train of cases, which I have exhibited to you, affords a
melancholy proof of the inefficiency of all the resources of art
and science. Epilepsy appears to have the same incorrigible
character now, as at the earliest periods.

These cases have shown a succession of exciting causes of the
disease. I shall not however divide it into different species, ac-
cording to the local origin that makes an impression un the brain.

002 Epilepsy. [May,

The essential character of the disease I hold to be a highly irri-
table erythematic state of the brain, which if you strike away,
you have various local affections, but .no longer epilepsy. By
analysing the several distinct movements, which take place in
the animal economy, in the affection, I think we may find a
rational pathology of the disease and system of treatment. The
treatment of epilepsy, as generally directed, is empirical. There
is no one remedy upon which we can rely, but we must adapt
our therapeutics to the features of the case. These may be as
various as the causes of the disease.

By analysis, then, I think we will find three perfectly distinct
features in epilepsy. The first is an irritable state of the cere-
bral structure possibly an. erythematic condition of the brain.
This condition of the brain proceeds from various causes. It
may be occasioned by some local affection of a painful or irrita-
tive character, with which the brain is ultimately brought into
sympathy, or, it may be induced by a variety of exciting causes,
such as excess of venereal indulgence, masturbation, exostosis of
the cranium, spicula of bone or tumours upon the arachnoid.
You readily see, how these latter must keep up a constant state
of irritation within the cranium. The race of Indians, who flat-
ten the head by artificial means, and force in the bone upon the
brain, are said to be epileptic. Cases of exostosis, spicula, and
depression of the bone are difficult of management, though I will
not say they are utterly intractable. Professor Dudley recom-
mends the trephine, in such instances, and he has been remark-
ably successful, in relieving some cases by this operation.
Winter before last, Professor Gibson performed an operation of
this sort, in this hospital, in a case, where depression existed,
caused by an accident, but without beneficial result. This case
appeared to me to promise a favorable opportunity for testing the
influence of this proceeding : it did not even suspend the pa-
roxysm.

The next element, which I consider a component of the dis-
ease, is, the extreme mobility of the capillary circulation, and
the facility with which its regular distribution is deranged. If
you prevent this, you prevent the formation of the paroxysm.
The essential feature of the disease is, a sudden congestion of
blood on the brain, apparently produced by a raptus or rush on
that organ. The symptoms that result are dependant upon the
intensity of this raptus. In some cases, it is so violent, that
petechial effusion of blood in the skin of the face occurs ; and the
attack varies from a slight loss of consciousness, and a light con-
vulsion, succeeded by p, to pr< pro-
ud coma, that will last for iwo or throe horn

The nexl and ! f some permanent

local affection, which acts as a thorn in the flesh, or poinl of

1838] Epilepsy. 603

irritation, worrying the nervous system into excitement, and pro-
ducing an irritable or erythematic state of the brain. This may
be, as you saw in many of the cases to-day before you, dysme-
norrhea, or other uterine disease. When on the subject of neu-
ralgia, I told you, that these might act as excitants of that disease.

Another local cause of epilepsy is intestinal irritation. The
existence of worms has frequently been the exciting cause.
Your remedies then are anthelmintics : you purge with turpen-
tine or something of the kind, and cure the patient. Derange-
ment of the stomach may also act as a local cause of irritation
upon the brain. Ordinary convulsions are, you know, often
produced by the functions of digestion being impaired: this sort
of reflex action may take place through the medium either of the
ganglionic system, or of the eighth pair of nerves. I could recall
several instances of fatal convulsions from the action of indiges-
tible food. Such a one occurred in rny practice, in the case of a
young child, two years of age, from a large quantity of fried eggs.
It was destroyed in four days. You perceive here, that a simple
article of food may produce convulsions, a violent congestion, or
other disorder of the brain, from a cause that can act only on the
stomach. You can understand, then, how a morbid state of the
stomach, reflected upon the brain, may produce a state, produc-
tive of epiletic paroxysms. The congestive raptus, the imme-
diate cause of the convulsion and unconsciousness takes place by
a sort of appel, if I may use the word, upon the grand capillary-
circulation, which is the means of the circulatory communica-
tion between the organ locally affected and the brain.

These then, gentlemen, are my views of the pathology of epi-
lepsy. I do not look upon it as a single disease, in which there
is but one element, but as consisting of several combined elements:
first, as erythematic irritability of the brain, secondly, a morbid
mobility, through the action of the nervous system, of the capil-
lary circulation by which its equal distribution is easily disturbed ;
and thirdly, a local affection, a point of irritation in some distant
organ, which, by a reflex action upon the brain, excites and
keeps up the disease. If these views are correct, and, if you
analyse the phenomena of the disease with care, I think you will
find it resolves itself into the elements I have enumerated, we
have at once a national plan of treatment, based upon the differ-
ent component parts of the affection. For each element, we must
have a different mode of treatment. Our efforts must be directed
in the first place, to get rid of the erythematic or irritable state of
the brain, secondly to give tone to the capillary system, and,
thirdly, to remove the local cause of the disease.

The first thing to be done is, to place your patient upon the
lightest possible diet, so as to have the stomach completely under
your control. Of course alcoholic liquors, tea, coffee, and the

d4

G04 Epilepsy. [?day,

stimulants generally are to be utterly prohibited. As a general
rule, the food is to be exclusively vegetable. 1 have never known
a case to recover, when animal food was continued. We then
direct our treatment to the brain. I commence by having the
hair cut short, and by a course of chronic leeching. One day
I apply a leech to one ear, then another to the temple, a third day
behind the other ear, and so on. This I keep up for months :
in fact, you must prepare your patient for a long period of pro-
bation, holding out no prospect of relief, before one or two years
have elapsed. Cold water is to be applied to the head, two or
three times every day, with at the same time, warm or stimular-
ing foot-baths. When the patient is asleep, keep warm bricks or
warm water consantly to the feet. He is besides to sleep upon
a hard pillow, without a night-cap, upon a mattrass and not a
feather-bed. All this is to keep down cerebral excitement and
prevent the flow of blood to the head. Setons at the back of
the neck, or an issue on the arm, as a diverticulum, are useful.
Your next object is, to give security to the capillarly system.
For this purpose, you must employ tonics, of which the best for
your purpose are the mineral tonics. I prefer the preparations
of zinc. Begin with a quarter of a grain of the sulphate of zinc
and one grain of the oxide, two or three times a day, and gradu-
ally increase the sulphate to one grain. Emetics have been re-
commended and tartar emetic has been employed, just before the
paroxysm is about to occur : if you can foresee this, this treat-
ment may be of advantage. But I prefer to vomit with the
sulphate of zinc. By persisting with the use of the metallic
preparations, the capillary system gradually acquires vigour :
through its means, the brain can no longer command and con-
centrate towards itself the circulation of the entire system. The
preparations of iron are also to be employed to effect this end.
You may vary them with the zinc, administering the two on
alternate days. The phosphate and carbonate of iron are the
best preparations. Small doses long continued are to be used.
Large doses may disturb the organs. The sulphate of quinine,
in small doses, used as a tonic and not as an anti-periodical, in
doses of a quarter or half a gram, is likewise useful. It may be
combined with the oil of turpentine, in morbid states of the
stomach, accompanied with the voracious appetite of which 1
have spoken. Upon the whole, however, I decidedly prefer the
metal ic preparations.

You must never permit constipation of the bowels to take
place. To obviate this, rhubarb is an excellent remedy. Avoid
the drastic purgatives, winch irritate the nervous system, and
destroy the digestive powers, which of course is not your object.
Open the bowels daily with an injection: this acts upon the
lower bowels, which have less connection with the brain, than

183S.] Ep 605

the upper portion of the intestinal canal. Some of the vegetable
tonics as Gentian, Cascarilla, and the tonic anti-spasmodics as
valerian may be commonly resorted to.

The next point in the treatment is to ascertain the seat of the
local affection. This varies exceedingly. In some instances, I
have known a tubercle upon a nerve act as an exciting cause of
epilepsy. Again, 1 have seen it proceed from the point of the
finger. Desault cured a case by cutting off the toe. In these
cases, a peculiar sensation is felt, commencing at the point of ir-
ritation, and ascending apparently along the nerve, until it
reaches the brain, when the paroxysm takes place. It has been
named aura epileptica. When the aura or sensation goes up
slowly from the point of origin, the paroxysm may be often ar-
rested, by applying the tourniquet or a light ligature. Cases are
on record, where a piece of glass was the excitant ; by cutting
it out, the disease terminated. A diseased testicle has acted in
the same manner, and relief was afforded by extirpating it. Most
frequently, however, some internal abdominal or pelvic visceral
affection is the local exciting cause of the disease. This is par-
ticularly the case with the uterus, in the female. In the majority
of the temale epileptic patients, whom I have had under my
care, the womb was prolapsed, or enlarged, or carcinomatous, or
there was dysmenorrhea from simple nervous irritation of the
organ. Unfortunately, after you have completely got rid of the
uterine affection, epilepsy will sometimes continue, when the
disease has been of long duration. The brain and nervous
system have become so much drsordered by the long continu-
ance of the disease, that numerous light derangements of the
functions are capable of exciting the paroxysms.

Cases of uterine complication, I treat with leeches to the
neck of the uterus and to the vulva, cups and blisters to the
sacrum, hip baths, in short with the class of remedies, adapted
for the relief of dysmenorrhea and uterine irritations. There
are cases, in which menstruation is unattended with actual pain,
there being simply a sensation of uneasiness or of dragging.
Tonics are here of service, particularly the chalybeates. But
local depletion, after all, is the remedy upon which you are most
to rely. I had a case in this house of a very remarkable char-
acter illustrating the view of the subject. The patient labored
under maniacal paroxysms, connected with uterine derangement.
She was the wife of one of the theatrical orchestral corps, who
forced her to travel, a week after an accouchement. This
brought on first hysteria, and afterwards maniacal excitement
with convulsions. These were preceded, as she told me after-
wards, by the sensation of a flame of fire rising from the uterus
to the brain. The occurence of the menstrual , avat-

ed her symptoms. She had been treated, before T saw her, by

606 Epilepsy. [May,

bleeding and purgatives. I directed the application of leeches
to the vulva, a day or two before the menses were expected.
They were applied, and the consequence was a severe monorr-
hagia. I was suddenly sent for, and found her lying on the
floor, almost in a state of syncope from loss of blood. A large
chamber vessel was filled with blood, and a considerable quantity
on the floor of her cell. The application of cold water, arrested
the hemorrhage, and the results were most gratifying.

Since that period, the patient has never had another attack ;
she is now perfectly well, a fine looking, large, fat, healthy
woman as you would wish to meet. This case is a fine illustra-
tion of the influence of a local affection in determining convul-
sive paroxysms, and of the advantage of local depletion in re-
lieving and curing them, when dependent on inflammatory
irritation. Along with the preceding treatment, leeches or
cups along the vertebral column, with setons or caustic issues,
according to particular circumstances, are often to be used as
adjuvants. Such, gentlemen, is a systematic plan for the treat-
ment of epilepsy, founded on the rationale of the phenomena, of
the disease. No doubt it will often fail, and you will feel
tempted to resort to empiricism. There is an almost endless
variety of empirical remedies, many of which I have tried in
the course of my practice, but without beneficial results. I will
enumerate some of them, as, when a systematic method fails in
the treatment of any disease, we must then resort to a tentative
practice or empirical remedies.

Equal parts of mustard seed", ginger, and sage, is a remedy
for which great success is claimed. I have heard of one or two
reputed cures from its use, but it uniformly failed in my hands.
The mustard seed produces daily movements of the bowels, the
sage exercises a tonic influence, and the ginger is an agreeable
stimulant.

Baron Sloet, of Holland, who has great repute for his success
in the treatment of epilepsy, has given the following as his re-
medy. It consists of one pound of the dictamus albus creten-
sis, or white fraxinella, and of the pulvis zedoaria sjss. There
are two kinds of the dictamus, one Italian and the other Cretan;
Sloet says the Italian is of no use. The dose of the mixture is
about two scruples, more or less, according to the case. It is
given in the water of linden flowers. Four doses, in bad cases,
have been given in a day, but the Zodoary is then reduced to one-
half. Immense success is claimed for this prescription. I can
say nothing of its value, from my own experience, as I have
never been able to obtain the dictamus from any of our apothe-
caries.

The internal use of lunar caustic as a remedy for epilepsy is
now pretty nearly abandoned. I have often administered it

1838] Epilepsy. GOT

here, and never saw it do any good. It is besides exceedingly-
injurious to the stomach, in the large doses recommended. Jt is
given in doses of from lour or five to ten, twenty, and even
thirty grains, but I should think it very dangerous in doses of
this quantity. 1 once carried it up to these excessive doses in
an old case of epilepsy, in this establishment ; shortly after-
wards, while I was absent from the city, the patient died, with,
it was said, symptoms of inflammation of the stomach, but no
post mortem examination was made. There are many fatal
cases reported as having occured in European practice from
this cause. I have told you frankly of my own mistake, from
a sense of duty ; for, in books, you are very seldom warned of
the bad effects of remedies. Let me then impress it upon you
that lunar caustic pushed to high doses, may destroy the mucous
membrane of the stomach.

I need not run over any further this list of remedies ; I sup-
pose there are at least a thousand of them, and of the most dis-
similar characters. I will only add, that, since I have adopted
'the plan of treating epilepsy, which I have detailed to you, I
approach it, if the case be recent, with confidence. The majori-
ty of my patients, in private practice, get well ; in this house,
they are, as you have seen in the history of the patients that
were before you, hopeless cases of long standing, which are
brought here more for an asylum in their misery, than with
any hope of relief.

Remarks by the Editor. We are highly gratified in
giving place to Dr. Jackson's, whole lecture on Epilepsy, as
containing the most clear and accurate etiology we have seen, of
this hitherto too obscure and intractible disease. In the want of
sound pathology, Epilepsy has rested for its cure, on gross empiri-
cism and superstition. As Dr. Jackson correctly observes, there
are a thousand reputed remedies, and these might, on the same
plans which instituted them, have been extended as far as tricks
and guesses could have been made to vary. Amulets, human skull
bones, and living toads with many other such nonsensical things
have been brought into requisition, and each has had its un-
merited praise. If nothing else had, the fact of such a number
of remedies, as well as their unreasonableness should have con-
vinced physicians of the fact of their ignorance of true patho-
logy in this case.

The point urged by Dr. Jackson, and which his cases tend .
well to illustrate is the primary existence of local irritation and
perhaps inflammation, somewhere; it may be almost any where.
This is the great secret in this uncontroled affection. It is a

60S Epilepsy. [May,

disease, not necessarily uncontrolable in its nature. It is true
that there may be primary or secondary causes of it which are
not removable by any known power at command ; for worms as
a cause of intestinal irritation, or disordered action of the vessels
of the brain, or hydrocephalus in conseqence of some primary
irritation, may not prove amenable to our remedial means ; but
we venture the assertion, that the greatest portion of the misfor-
fortunes resulting from epilepsy has been in consequence of a want
of knowledge of the " local affection" which was its cause.

Warm bath, sinapisms, (fee. whilst they have tended to in-
crease fluxion to the superficial capilleries have done well in
acute cases, although the whole rationale of their operation has
not been understood, nor the " local affection' they were calcu-
lated to correct, ascertained.

The nature and location of the primary affection being ascer-
tained, indications become easily fulfilled, so far as our materia
medica will supply the means. And here we wish to add to
Dr. J acksons's remedial resources in this disease, the benefits of
our own experience and reasoning on this disease. For nearly
twenty years we have been in the use of galvanism in acute and
chronic cases of epilepsy, and generally, not always, with the
most happy results. This remedy is available both for the cor-
rection of the primary irritation, and the cerebral excitement. It
is also a remedy, susceptible of application as extensively as the
variety of cases, or condition may demand ; and which is easily
conceived, when its modus agendi is understood. The manner
of operation alluded to, is that of lessening excitement at the pos-
sitive, and increasing it at the negative pole. This is an estab-
lished fact of our own frequent experiment and constant observa-
tion for twenty years past. Nor do we apprehend that more
than one experiment will be needed to convince any observer of
the fact, that whilst the former will effect the deseccation of a
blister on one part, the latter will produce a tough coagulum of
lymph, or a deep gangrenous slough in one on another part. This
principle we have successiully applied to the cure of chronic epi-
lepsy which had resisted all other remedies ; and we have
generally exercised a complete control over perpetual convul-
sions in children from various causes.

We design to treat this subject more fully at some early day,
when opportunity may be afforded.

1S38] Physical Action of the Capillary System, fyc. 609

On the Physical action of the Capillary System. Identifi-
cation of the force jiroducing motion with the Chemical force.
By John W. Draper, M. 1)., Professor of Chemistry and
Physiology in Hampden Sidney College, Va.

It has been alleged, as a bar to all physiological investigation,
that the phenomena of life are of so peculiar a nature, that we
must necessarily forever remain ignorant of their causes ; that,
unlike physical phenomena, which are of a simpler caste, and
more within the reach of human understanding, there is some-
thing in these, inherently mysterious and incomprehensible.
This unphilosophical impression exists not only in the minds of
the vulgar, but has extended itself to men well trained to scien-
tific research : it is to be found in the writings of the most emi-
nent physicians, and often affords a plausible screen ibr profes-
sional ignorance. Of all the sciences, medicine is the last to
profit by the analytic method a method which has raised other
departments of knowledge to their present rank. Its cultivators
pursue the same course of synthesis which was pursued in the
days of the Greeks they reason from hypothesis to fact, instead
of from fact to hypothesis.

It may, however, be boldly averred, that the science of life is
not more occult than any other of the sciences. We may, by
proper investigation, carry it as far ; and in the pursuit we shall
only stop short at the very same point which has proved impas-
sable in them. Of final causes we know nothing ; the immedi-
ate agent of life is not more obscure than any of the remote phy-
sical agents. If we cannot assign any reason why a seed ger-
minates, can we tell why a stone falls to the earth? is the one
phenomenon any more comprehensible than the other ? If we
cannot assign any reason why a seed germinates, we can tell
why a stone falls to the earth ? is the one phenomenon any
more comprehensible than the other ? If we cannot tell how it
is that one parent should produce a countless offspring, each of
which has the power of reproducing beings like itself, neither can
we tell how a spark produces an extensive conflagration. It
avails us little to say that the principle of life, like the principle
of heat, possesses a radiant character, or has a power of self-pro-
duction. We are equally ignorant how the wide spreading
flame results from a spark, and how countless myriads of seeds
have originated from one primordial germ.

Some parts of the science of physiology are doubtless within
the reach of scientific investigation. Most of the functions of
organic life are of this character. Absorption, secretion, circu-
lation, and respiration are carried on through the medium of tu-
bular arrangements of different kinds, endued with specific pow

610 Physical Action of the Capillary System, fyc. [May-
ers. We are not well informed of the nature of these actions, or
of the force giving rise to them. The changes taking place in
organic structures partake partly of a mechanical, partly of a
chemical aspect, bearing some similarity to other physical
changes effected by known agents, yet not identical with them.
Some have supposed that the attraction of affinity, or the force
of capillarity, was the power in question, operating in an un-
usual manner, under unusual circumstances; but the majority
of medical writers have cut the knot, instead of untying it, and
assert that it is a peculiar force, recognised under the title of
vital force, life, or nature.

It is, however, most unphilosophical to resort to these vain ex-
planations, which after all afford us no information, substituting
only obscure terms as the causes of . events not more obscure.
Had we approached the problem of pore-action in the same spirit
that has led to the development of the causes of magnetic action,
a similar and equally striking advance would have been made.

Capillary attraction, considered simply as a mechanical force,
is not competent to produce those changes which the pores and
narrow cylinders of organic structures give rise to. The pro-
ducts of glandular action are chiefly compounds of a definite
number of equivalents, bearing a strong resemblance to the pro-
ducts of ordinary chemical action ; but still the operation of
capillarity as a force producing motion is undeniable. Can it
also produce chemical changes ? Is it simply a manifestation of
the electric chemical relations of matter 1

Previous to entering at large into an examination of the laws
of pore-action, this query will demand an answer. We shall
find from what follows that capillary attraction is a force nearly
allied to, if not identical with, chemical affinity. Now, the inves-
tigation of the problem of pore-action fiaturally divides itselfinto
two parts. 1st. The mechanical conditions of equilibrium and
movement of fluids residing in tubes of narrow diameter, but of
any length. 2nd. The chemical changes which fluids so situa-
ted undergo.

The identification, therefore, of the force producing the mechan-
ical effect, with that producing the chemical changes, is a most
important point, and to this I shall direct my attention in the
present communication.

There are two phenomena of capilliary attraction, the conditions
and circumstances of which are well known the rise and de-
pression of fluids in tubes of a certain diameter, and the adhesion
of flat solid plates to the surface of fluids. From the former of
these this kind of attraction has derived its nahie ; the latter fur-
nishes us with the means of making researches, devoid of ambi-
guity, in reference to the physical cause ofcapiliarity.

If a circular disk of glass, or any other solid substance, be

.S3S] Physical Action of the ry System, fyc. 611

placed on the surface of any fluid, by means of a handle, it will
adhere thereto with a certain force, which may be measured by
means of a balance, but which is sufficiently evident when at-
tempts are made to lift the disk with the hand. This force is
known under the name of capillary attraction. An investigation
of its physical cause, and the laws representing it, involve the
fundamental propositions of pore-action and passage through
tissues.

The phenomena of capillarity arc brought about by electricity,
operating under peculiar circumstances. They are due to a
disturbance of the electric ium, and hence are intimately

allied to all kinds of chemical and vital changes.

Place a glass plane on the surface of mercury contained in
an insulating v< rcury be connected with an

electrometer by means of a wire. Now, so long as the glass
plane and the mercury are in contact, the electrometer evinces
no disturbance ; but aS soon as the plane is raised by its insula-
ting handle, electricity is instantly developed, and the gold leaves
diverge. As there was no electrical excitement whilst the plane
and the metal were in contact, it is a legitimate inference that
the electricity now developed was the cause of their strong at-
traction or adhesion ; and this is corroborated on taking the glass
plane to another electroscope, when it will be found that it is
electrified positively and the mercury negatively ; and that con-
sequently when they are brought into the vicinity of each other.
a powerful attraction must result.

A cause of attraction being thus developed, it would be very
unphilosophical to seek for other agencies where one so compe-
tent to produce all the effects i d to exist. For in every
case where a solid plane on the surface of a fluid not
wetting it, a large amount, of electricity of very high tension is
produced, the electricity of the surface of the plane being always
opposite to that of the liquid. They must therefore attract each
other. I express here only a fact, not involving any disputed
hypothesis whatever, as to whether that development of electri-
city originates in the mere contact of the bodies, their chemical
action, or any other cause ; but it is a fact, that when any solid
reposes upon any fluid, provided its surface does not become
wetted, a development of electricity uniformly takes place, and
a powerful degree of attraction must necessarily ensue.

The postulate here introduced requires explanation, for elec-
tric excitement is not observed if the solid surface is wetted. So-
lids bear a peculiar relation to liquids, being wetted or not wetted
by them. Most sol ids, by water, and but

few by mercury ; the surface of the glass is readily moistened by
alchohol or oil, but not by melted sulphur or mercury : hence
the latter, from its not adhering to the skin, was called by the

612 Physical Action of the Capillary System, ij'c. [May,

older chemists aqua non madifaciens maims. The circum-
stance, that no electrical excitement is observed when a solid
surface is wet, might appear at first sight contradictory to the
hypothesis here assumed. A more accurate examination, how-
ever, places it in a very different light, and shows that the phe-
nomena observed are exactly such as they ought to be hypothe-
tically. If a disk of glass is placed on the surface of water and
then removed, the gold leaves of the annexed electroscope are
not affected, for, strictly speaking, no rupture has taken place
between the solid and the fluid ; the thin film of the latter in
contact with the former still remains so: it is only the cohesion
of the watery particles that is overcome, not the adhesion of the
solid to the fluid, and hence no electrical developement appears.

Geometers have shewn the exact relation a solid must bear to
a fluid to be wetted by it. It results from the mathematical in-
vestigations of Clairault, that if the attraction of the particles
of the solid for those of the fluid is more than half the attraction
of these last for each other, the solid will be wetted; but if it be
less than half, the solid will not be wetted. An experimental
proof of this may be obtained by counterposing a disk of glass at
the end of one of the arms of a balance, by weights in the scale,
and then lowering it on the surface of some mercury in a cup ;
it will be found that a certain weight must be added in the scale
to detach it. Next in place of the disk of glass, substitute a plate
of amalgamated copper, of the same size and weight, and ascer-
tain the force required to detach it ; this will uniformly be found
more than double the former weight. The first weight expressed
the attractive force existing between a surface of glass and mer-
cury ; the second the cohesion of a cylinder of mercury of the
same diameter, and the numbers obtained experimentally corro-
borate the investigations of Ceairault.

I dwell on this part of the phenomenon because it is of no
small importance ; the same conditions that determine whether
or not the surface of a solid is to be wetted, determine also wheth-
er a liquid shall pass through a pore, and move forward in a ca-
pillary vessel.

The difficulty arising from the non development of electricity,
where the solid surface is wetted, being thus dismissed, we next
enquire whether the hypothesis here assumed will give numeri-
cal results analogous to those procured by experiment. In other
words, if two solids which adhere to a certain fluid, with forces
differing in amount, devclope upon rupture, quantities of electri-
city in the same ratio. Asa general result, the balance and elec-
trometer prove that this is the case. Beeswax, which adheres
to mercury with much less force than gum lac, developes like-
wise much less electricity. Gum lac, which adheres less strongly
than glass, likewise developes much less electricity ; but when

183S] Physical Action of the Capillary System, fyc. 613

we attempt to run a comparison in this manner along a series of
substances, wo find there are many disturbing causes, which in
most, cases incapacitate us entirely from making comparable re-
sults. Much depends on the relative conducting power of the
surface employed. A plate of iron may be separated from a sur-
face of mercury, which does not wet it, with very small distur-
bance ot electric equilibrium, arising from the high conducting
power of the metalic plate, which enables a transfer of any free
electricity to take place if the plate should tilton one side, or any
thing affect its horizontally during the act of separation. In
proportion as the conducting power increases, although the force
of adhesion may remain the same, the total effect on the elec-
trometer should diminish; and this is agreeable to experience.
Again, the presence of moisture on any part of the touching sur-
faces will vitiate the results ; partly owing to its high conducting
power, hut chiefly to the circumstance that it hinders the surfa-
ces under trial from ever coming into contact.

The circumstance of this great variability in the amount of
developed electricity, is in itself strong evidence of relationship
between the supposed cause and the effect. Gay Lussac found
that it required a weight sometimes of 158 and sometimes of 296
grammes, to detach a certain disk of glass from mercury, de-
pending on causes which were not very apparent. An effect
thus differing in amount indicates a cause of like variability, or
subject to many disturbances.

I assume, therefore, that the agent bringing about capillary
phenomena is identical with that producing chemical action, and
that both may be referred to electricity. The force of cohesion
bears the same relation to both, acting on both as a disturbing
power. Nay, we may even take a much more extensive view
of the matter ; and from the ratio these forces bear to each other,
predicate the effect of their combined action, which may be
classed under three distinct heads.

lstly. If the force of attraction of the particles of a solid, for
the particles of a fluid, exceeds half the cohesive force of the
latter for each other, but is not equal to the whole force, the fluid
will pass through a pore formed of that solid substance ; and in
capillary vessels consisting of it, will be depressed below its hy-
drostatic level.

2ndly. If the force of electric attraction of the particles of a
solid, for the particles of a fluid, exceeds half the cohesive force
of the latter for each other, but is not equal to the whole force,
the fluid will pass through a pore formed of that solid substance,
and in a capillary tube of it, will rise above its hydrostatic level.

3dly. If the force of electric attraction of the particles of a
solid for the particles of a fluid, exceed the whole cohesion of the
latter, chemical union ensues.

614 Physical Action of the Capillary System, fyc. [May,

In thus assimilating the force producing- pressure on planes,
and motion in narrow pi} the force producing chemical

changes in the constitution of bodi: t advantage is gained

in simplifying physiological investigations in respect of the ac-
tion of capillary systems. It is an electrical force that deter-
mines all kinds of constitutional changes developed in bodies by
the chemistry of organic life, and it is a manifestation of the very
same force that carries some fluids alons: the almost invisible
vessels of living structures, and denies to others a passage. All
the phenomena of inorganic chemistry are the result of the ba-
lancings of the force ofcohesion on the one hand, and electrical
attraction on the other. If Berthollet was wrong in supposing
that chemical affinity as an acting force had no existence, other
chemists have equally erred in supposing that all kinds of
changes, without any limitation, were clue to it. Whether we
investigate the phenomenon of chemistry or oi capillarity, we
have the same forces to deal with, acting as antagonists to each
other ; and hence the whole effects imputed to capillary attrac-
tion may be regarded as belonging to that extensive class which
the science of chemistry considers.

There is a variety of tacts recorded by writers on capillary at-
traction, which an application of these principles readily explains,
though hitherto they have been regarded by philosophers as re-
markable anomalies. Such is the observation of Huygens, that
it was possible to cause mercury to stand in a barometer seventy
inches high ; or that of P. Abat, of a single deviation in the hy-
drostatic level of the same fluid in difierent branches of a syphon.

The force of attraction vduch produces pressure, when plane
solids repose on the surfaces of fluids, under other circumstances
produces motions of various kinds. If a tube of small diameter
be plunged into a liquid, the level within the tubes does not cor-
respond with that outside, except under very peculiar and very
unusual circumstances ; but sometimes the liquid rises far above
its level, and sometimes it is depressed, the amount of distur-
bance taking place in both cai averse ratio of the
diameter of the tubes. All fmids which can wet the surface of a
narrow pipe rise in it; those which cannot wet it are depressed.
Geometers I;; . n, that \ e force exerted by the
pipe upon the Liquid be more than half the cohesion of the parti-
cles ol the latter for each othei . ill be a rise ; if it is equal,
the level of the fluid inside and outside of the pipe will be the
same; and if it be less thou half, there will be a corresponding
depression. Now, extensive observation proves that these three
cases are always accompanied with certain peculiarities, as res-
pects the surface of the fluid in the tube, as is represented.

In every case where the fluid rises, it is observed to be termi-
nated with a surface concave upwards. If the level is the s<

1838] Physical Action of the Capillary System, fyc. 615

as it should be hydrostatically: ' e terminating surface is

a plane ; and if there be a depression, then the surface is con
upwards. Whenajrer, tin a tube of narrow diarnefl

placed in a fluid, if the action of the particles of the tube on the
particles of the fluid be less or more than the attraction of these
last for each other, motion :md the fluid falls or rises to a

height determined by the diameter of the tube.

If the tube be perfectly cylindrical, and there be conveyed into
it a short column of fluid, it will be found that thisiluid rests in
any position, provided the tube be horizontal. But if the tube
be conical instead of cylindrical, and a little column of fluid, be in-
troduced into it, then a motion of the whole drop ensues, the pro-
gress being made towards the narrow extremity. In this way
capillary attraction is pompetcnt to produce motions of various
kinds.

All these disturbances of ordinary level, and these motions,
are found to result from the action of the surface of the liquid.
From a consideration of these disturbances, Laplace deduced his
theory of capillary action ; a theory which, with a little modifi-
cation, is now generally adopted. The thickness or thinness of
the tube has no effect whatever on the phenomenon ; nor does
the substance of which it is composed exert any influence. Every
thing is made to depend on the figure of the bounding surface,
which neccessarily acts more and more powerfully as the diame-
ter of the vessel becomes narrower.

Capillary attraction does not take place only between solids
and fluids ; it is exhibited when solids alone are made use of. In
virtue of this power, two pieces of lead cohere with great energy
to each other, as also is the case with two planes of polished
stone, or plates of glass. When glass is used, electricity of
very high tension is readily detected, one of the pieces being
positive and the other negative, it would, I suppose, hardly be
denied, that the force operating in the case of glass is also the
force that operates in the case of/Stones. Is it not, then, a legiti-
mate supposition, that the adhesion of two pieces of lead is
brought about by the same agent, whose presence is masked by
the high conducting power of the metal?

Between solids and gases capillary action likewise takes place.
On the surface of all kinds of solids atmospheric air remains in
a state of condensation, as is made evident when such bodies are
placed beneath water under an exhausted receiver ; the air ap-
pearing in copious bubbles, studding the surface of the metal.

Now, having a power, the operation of which over inorganic
masses is so extensive, it is for us to enquire how far the pheno-
mena of organic systems depend upon its working. Those nu-
merous pores and pipes, and capillary vessels, which abound in
all kinds of living structures, but of whose action we are so igno-

G16 Physical Action of the Capillary System, fyc. [May

rant, point out to us capillary attraction as one of the great
forces in play, determining all kinds of motions and physical
changes. To identify the force producing m^ion of a chemical
character, with tha4 effecting physical change, gives a unity to
the action of powers which have hitherto been multiplied without
avail, and stamps simplicity and symmetry on actions that are
very diverse.

Hitherto we have treated of capillary attraction as a force pro-
ducing certain simple results, as the adhesion of pieces of metal,
or of plane solids to the surface of fluids, or the rise or fall of
fluids in tubes. All these consist of binary arrangements ; and
it is probable, as will hereafter be shown, that certain simple pro-
cesses in the organic kingdom are example of similar simple
forms of action. But, arrangements of a more complex character
may be imagined, and are known to exist, where, instead of there
being two, three or more elements are concerned. Ternary ar-
rangements lead to the consideration of the doctrine of endosmo-
sis, by which we understand the passage of two fluids or gaseous
bodies through a narrow channel, in opposite direction, at the
same time.

The law of horizontally of fluids meets with a remarkable
exception when the containing vessel is a capillary pipe, as has
been already stated ; for a change of level ensues, according as
the fluid will or will not wet the walls of the tube. Laplace has
shown that the immediate cause of this rise or fall is the peculiar
figure of the surface of the liquid in the pipe- The theory em-
bracing these facts will be found in the supplement to the tenth
book of the Mecanique Celeste. M. Poisson, from a considera-
tion of the heterogenity of the liquids in ternary arrangements,
has endeavoured to refer all the phenomena of endosmosis and
transundation through tissues to common capillary attraction,
but with a want of success not usual to the labours of that ex-
cellent mathematician ; not that we are to deny the result to
which he has arrived, for that is only the expression of a fact,
but the steps of his investigation are unquestionably faulty, for
the same reasoning will apply to tubes of all diameters, and it
does not satisfy the condition that both liquids shall pass in op-
posite directions at the same time.

It is not necessary to proceed here to discussion of the remoter
data of the mechanical part of this question, nor to refer to the
elementary conditions of pressure upon a surface, nor to the ac-
tion of solid bodies alone; though in each of these cases the in-
vestigation might readily be carried out to the conditions of mo-
tion and repose. Let us proceed to investigate the case where
two fluids are adjacent to each other, but do not communicate,
except through a pore. This case involves the theory of tissue
action. Taking for granted the theory of Laplace, of the equili-
brium of liquids in capillary tubes, we may assert,

1838J Physical Action of the Capillary System, ij'c. G17

lstly. That if two fluids A, and B, whose attraction for each
other is greater than the cohesion of the homogeneous particles
of either, communicate with each other through a pore, the walls
of which attract the one more than the other, motion through that
pore will ensue, both liquids passing at the same time in opposite
directions.

2ndly. If we take particles receding from the axis of the pore,
the forces soliciting any o'ne of them to move in a direction with
the axis, gradually decrease, whilst the rectangular forces in-
crease in intensity.

3dly. In the axis of apore and two molecules, a and b, situated
in the fluids A and B respectively, are acted upon by two sys-
tem of forces one tending to produce motion parallel with the
axis, and the" other at right angles to it. The forces which tend
to produce motion parallel with the axis, and the other at right
angles to it. The forces which tend to produce motion parallel
with the axis are not compensated, but all the rectangular forces
compensate each other.

4th ly. Here the surfaces of the fluids A B are described by a
figure representing a pore, by two parallel lines, with a curved
line passing from one line to the other, to represent the conical
shape of the fluid B, the axis of which is the axis of the pore ;
and to that of the fluid A} a corresponding concavity and pass-
ing up the sides of the pore to where the cone of the fluid B
leaves them. In this figure, b marks the apex of the cone of the
fluid B, a and c, the points where this fluid leaves the sides of
the pore, and to which the fluid A rises in contact with the sides,
and lastly, a line is drawn transversely to the pore, representing
an imaginary plane, and marked cf, and dividing the fluids A
and B, where they pass each other. This figure is thus described
by Dr. Draper :

Now, the forces which act on the side A of the plane tending
to produce motion in B, are much greater than the forces on the
other side tending to restrain it. Moreover, the action of these
forces is at a maximum at the point b. The figure of contact,
therefore, becomes changed, the point b advancing along the axis,
and making the opposing particles retire in the directions of least
pressure ; the fluid B continuing to pass down the axis of the
pore ; and the very same reasoning shows that at the same time
A will pass in the opposite direction. If, therefore, two fluids
are on opposite sides of a barrier, and only communicate with
each other by a pore through it, motion in that pore will ensue,
both liquids passing in contrary directions, simultaneously and
co-axially.

6 IS Physical Action of the Capillary JSystem, fyc. [May,

5thl.y. And the same reasoning which applies in the case of
a pore, will also apply to a cribriform plate or tissue, whose
apertures are all capillary tubes.

30. In the view of the subject, as is evident, I have imputed
the phenomena of tissue action to the force of capillary attrac-
tion, taking into account the heterogeneity of the system of
fluids. I have not spoken of the relati rence of cohesive

force, which, as might be shown, aids* in producing the very
same results. From these considerations we can deduce the
condition of equilibrium, for it is evident that as soon as the
chemical composition of the fluid on * i of the pore be-

comes identical, the forces soliciting motion each way, antago-
nize each other completely. It was the heterogeneity of the
fluids that gave rise to the first movement, and kept it up ; but
so soon as the media on each side became homogeneous, motion
ought to cease ; and that this is the case, is abundantly proved
by experiment.

With respect to the diameter of pores, there are some impor-
tant conditions. Let a circle a b c be a pore, whose diameter
exceeds double the radius of the sphere of sensible attraction of
its own particles ; or, in other words, whose axis is beyond the
influence of the attractive force of its own walls. If a cylindrical
column of fluid, efg% of a certain diameter, moves through it,
the circumferential parts of that cylinder will be brought under
the direct influence of the walls of the pore, but its axial portions
only indirectly through the intermedium of the cohesion of the
fluid itself. We may say, therefore, that the axial portions of
such a cylinder are unaffected by the pore itself; but if the
diameter of the pore be supposed continually to diminish by de-
grees, all parts of. the cylinder will at last be brought within the
influence of the walls of the pore. Another mode of viewing
this condition of things may place it in a still clearer light.
When a liquid rises in a capillary tube of certain diameter, only
those portions are under the direct influence of the attractive
force of the tube which are nearest to it, the central columns
being entirely unaffected ; as, when water jets out through a
narrow pipe, it is only those portions that are directly in contact
with the sides of the pipe that are subject to its resisting in-
fluences, any disturbance which the central particles feel arising
only indirectly from their cohesion. A pore in a piece of char-
coal may suffer a column of water to go through it without in
anywise affecting the central portions of that column, by reason
of its size; but should the diameter of the pore be made to
decrease, it is obvious a limit ;ched, when

every particle thai ild come und rect influence

of the physical force of the pore, and none pass by mere leakage
The importance oft, :it, viz: the varia;

1838] Physical Action of the Capillary System, tyc. G19

of the diameter of the pore, is greatly to be insisted on. It has
heretofore been pointed out in tins Journal, and in the Journal
of the Franklin Institute, but does not seem to have attracted
that attention which it deserves. Chemists are still in the habit
of co-ordinating the passage of liquids, through stucco plugs
and pervious barriers, with that through tissues and liquids.
Physiologists carry out the same error, in supposing that there
is no essential difference in the motion of fluids in the capil-
laries and through the pores of tissues.

It is not alone in the vital functions that we meet with appli-
cations of the principles of capillary action ; the mechanical
functions furnish numerous instances. The organs of pro-
gression of some animals which delight to walk upon water,
are provided with an apparatus of hair, calculated to repel that
fluid ; hence gnats and certain other insects have no difficulty
in passing over the surface of water. By the same means the
hydra suspends itself, without effort, in that element ; for having
exposed for a time the extremity of its foot to the air, so that it
may become dry, it, by repulsion, forms a cup-shaped hollow
around it, the head of the insect hanging down in the water
beneath.

Organs of exhalation and absorption are unquestionably
capillary systems. The stomata of plants, which botanists sup-
pose to discharge these functions, are of this character ; they
furnish a well marked instance of the accommodation of apparatus
to suit physical conditions. Plants growing beneath the surface
of water have no stomata ; but if, by any means, they reach the
atmosphere and vegetate in it, these organs are produced for the
purpose of discharging, under the new order of things, offices
which were accomplished by other means. The spongioles of
roots, acting as capillary systems, drive the fluids they absorb
from the earth, through the tubular vessels of trees, with a
forre of several atmospheres, extending themselves at a due
distance from the trunk, where they may meet with the water
that falls from the leaves. In some orders of living things, which
are not accomodated with distinct orifices for the reception of
food, nutrition is accomplished by capillary systems. In this
manner the porifera expose a wide surface to the seas, and
draw in nutrient matter through their microscopic pores, dis-
charging the surplus as excrementitious matter through their
papillary orifices.

Like the lungs of the mammalia, the leaves of trees arc res-
piratory organs, composed of capillary systems; their mechanical
functions are not so complete, though their chemical functions
may be identical. They demand no nervous cords to be spread
upon them to give them motion and keep up their play; the
breezes in which they tremble perform the office of carrying off

p 6

620 Physical Action of the Capillary System, cj-c. [May,

the exhaled impurity, and the rays of the sun furnish them with
their vital force, enabling them to effect the decomposition of
carbonic acid, and provide a store of carbon for the purposes of
the economy.

In identifying the mechanical with the chemical force of or-
ganic structures, we see another proof of that unity of design
existing through the entire range of living things. Functions of
all kinds are accomplished by arrangements of every sort in
different classes, yet no one will deny that they all follow one
original type. Digestion, as it takes place in the stomach of man,
appears a highly complex phenomenon, depending, as some say|
partly on the tissue action, partly on nervous and partly on
other powers. But are not analogous changes wrought without
all this complexity of apparatus in the hydated, which may be
taken as the elementary type of the stomach ; or in the taenia,
which is a colony of stomachs? The polygastric infusorials,
some of which have hundreds of these organs, and even the
mammalia, do not digest more perfectly than the hydra, a carni-
verous polypus, which may be turned mside out without detri-
ment. The laws of digestion, followed by the one, are followed
too by the other. If the organ of the one respects the presence
of living matter, and refuses to act on it, so does the other ; yet
the one is furnished with a highly complicated assemblage of
muscular bands, of glandular apparatus, of blood-vessels, of
nerves, and the other is not.

In the higher orders of life processes arc carried on by mul-
tiplied apparatus, without, however, deviating from the principle
of the original simple type. The gift of a new faculty, or the
addition of a new organ, brings with it a corresponding change
in the arrangement of the whole plan. An engineer, who
wishes to adopt a machine to the execution of some new task,
alters every part, no matter how remote it may be from the acting
point, until every wheel and lever executes its work co-ordinately
with all the others; the prime mover remains unchanged,
though the general character of the machine may have under-
gone a renovation ; and as all machines, no matter of how many
parts they are composed, nor of how many wheels they consist,
nor how intricate soever may be their resulting motions, may
have their power reduced to and represented by a simple lever,
so also organic functions, though often brought about by highly
complex arrangements, find simple representatives in the lower
orders of life. A concentration, or a developement of any organ,
is often demanded by change in a remote part of the fabric,
when even the connexion may not be very evident. Animals,
consisting simply of digesting cavities, require no vascular
system for propelling or containing a nutritious fluid ; they are
not in need of separate tissues, devoted to its oxygenation, nor

1S3S] Physical Action of the Capillary System, fyc. 621

of an insulated respiration, nor do they demand distinct biliary
organs; when the nutritious chyle is produced in the stomach
of zoophytes, it finds its way into the intercellular spaces, and
there circulates without vessels, undergoing through the ex-
ternal tegument the chemical changes. In many insect tribes,
the bronchial tubes are spent upon the peritoneum, and respira-
tion takes place directly upon the alimentary canal. With,
modification of functions, change of external figure is always
involved ; and as these progress together, systems of living
things are constructed, referrible to one common original type.
It is thus, in the echinodermata, we trace up successive steps
from the sea urchin to the asterias, and from that to the penta-
crinite ; a developement of the same parts of the structure con-
tinually taking effect, until the extremes bear no sort of re-
semblance to each other.

Had the production of living things been effected by the ope-
ration of second causes, we might look with Lamarck, for some
law of successive developement, which should contain the
origin of each order and species. We might regard the rudi-
mentary teeth of whales, or the subcutaneous feet of the ophidia,
as abortive results of such a law. Considering, the brain as a
developement of the spinal axis, we might trace in the form of
the cranial bones, a developement of a system of vertebrae,
brought about as a consequence of the very same laws. We
might run a parallel of analogies, between the crustaceous and
vertebrated animals, and exogenous and endogenous plants;
we might take the cephalopodous mollusks, as furnishing the
first rudiments of an internal skeleton, and trace its increasing
complexity to meet certain ends, until its perfect developement
in the mammalia. In this latter class, we might dwell upon the
uniform existence of seven cervical vertebras, as giving evidence
of a persistence in the plan of structure,^ in species so remote
from each other, as the cameleopard. the whale and the mole.
Parting from the dorsal vessel of insects, the first rudiments of
an aorta, we might follow out the complications of the higher
arterial systems. In all the varieties of respiration, whether
acquatic, aerial, or mixed, we might see the reproduction of one
original chemical design, and in every instance of a concentra-
tion of machinery or functions, we might find an impress of
the action of externa] formative agents. Hampden Sydney
College, November 20th, 1837.

622 Phagedenic Paste. [May,

Dr. Canq,uoin's Formula* for Preparing the Phagedenic

Paste.

No. 1. Chloride of zinc one part, wheat flour two parts.

2. Chloride of zinc one part, wheat flour three parts.

3. Chloride of zinc one part, wheat flour four parts.

4. Chloride of zinc one part, chloride of antimony half a
part, wheat flour two parts and a half.

Twenty four to thirty drops of water are to be added for each
ounce of chloride.

The preparation of the phagedenic paste requires the utmost
care and attention ; hence to procure it properly, the following
instructions must be scrupulously followed. The chloride of
zinc, reduced to powder, is to be mixed, as quickly as possible,
on a slab, with the given quantity of flour. One half of the mix-
ture is immediately to receive its proportion of water, and to be
worked up progressively with a spatula, until it forms a homo-
geneous honey-like paste. This paste is to be brought to the de-
sired stiffness by trituration with the remainder of the dry ingre-
dients, well beat for a few seconds, and then rolled out into cakes
or wafers, of from half a line to four lines in thickness.

The quantity of water must be proportionally augmented, ac-
cording to the increased amount of flour in the second and third
formula?.

The antimonial paste, No IV., is to be moulded into a crayon
shape; because, as it preserves constantly the consistence of
soft wax, a suitable thickness can also be given to it, so as to
adapt it to the form of certain cancerous tumours, presenting ine-
qualities of surface.

As, however, the flower employed in the above formulae con-
sists of starch, gluten, and vegetable albumen, it will produce a
complex combination with the chloride in the phagedenic paste,
which may blunt or interfere with its erosive action ; or possibly
undergo some fermentative change when applied to anillcondi-
tioned ulcer, and the viscidity of the compound give rise to more
or less difficulty in the manipulation. It therefore occured to Dr.
A. Ure, of Glasgow, that if some inert, inorganic powder were
substituted for the vegetable matter, capable of absorbing and re-
taining a sufficient quantity of moisture to form a paste, which
should be a simple mechanical admixture, it would then be pos-
sible to turn to account the full escharotic powers of the chloride.
The anhydrous sulphate of lime, in impalpable powder, will be
found to realize the above conditions. Mixed with the chloride
of zinc, in the proportions already indicated, a putty-like paste

1838] Phagedenic Pa 623

may be obtained, after these have been well incorporated together
with a few drops of water.*

The paste so prepared is perfectly plastic. h\ its composition
the calcareous sulphate seems to perform the part of a porous
medium, which allows the escharotic gradually to exude into
the morbid texture. In proportion as it is abandoned by its de-
liquescent ingredient it acquires a firmer consistence, until at
length it becomes concrete, and constitutes an impervious case
for the eschar. London Medical Gazette, 19th Dec., 1835.

Method of using Dr. Can quoin's Phagedenic Paste.
Where the integuments are sound, the epidermis should be re-
moved by means of a blister ; and on the following day one or
the other of the preparations described in the preceding article,
corresponding to the thickness of tissue to be destroyed, is to be
applied to4the cutis of the diseased part. The sensibility of the sur-
face must also be considered ; tor should it possess but a feeble
degree of vitality, the most powerful form is to be preferred.

The paste No. l. four lines thick, applied during four days, is
capable of producing an eschar of from one and a half to two
inches in depth. The same paste, three lines thick, applied du-
ring three days, will furnish an eschar of one inch, at least, in
depth ; the same compound, two lines thick, will in two days de-
termine an eschar of not less than half an inch. The paste No.
I., of one line, will yield, in twenty-four hours, an eschar of three
lines. Finally, the paste, No. I., of half a line, will produce, in
the same time, an eschar of at least one line.

These changes will manifest themselves with the above pre-
cision only on tissues endowed with a considerable share of sen-
sibility, and of which the consistence is nearly normal. In the
gristly (lardace,) almost fibro-cartilaginous degeneration, about,
one-third is to be deducted from the thickness of the eschar above
mentioned.

No. II. is employed in case of cancerous ulceration and super-
ficial carcinoma, which are attended with much pain.

No. III. is eligible in every species of cancerous affection, oc-
curring in nervous subjects who are incapable of supporting the
violent pain which the preceding more concentrated escharotics
might occasion. It is so much less productive of suffering, as
it is slower in its action.

Lastly, No. IV. the antimonial paste is best adapted to nodula-
ted cancerous tumours, for which a most decided escharotic ac-
tion is required.

* Special care must be taken to pr< pare a pure sulphate, by calcining the crys-
tallized gypsum at a gentle heat in an oven ; fop the Paris plaster of the shops is
often sophistrieated with chalk or whitening, which would immediately decompose
the metallic chloride, and impair its qualitu s in a greater 01 l<

621 Phagedenic Paste. [May,

These preparations, applied over a denuded surface, excite, in
a few minutes, a feeling of heat, which, ere long, rises to a burn-
ing heat ; which unpleasant symptoms may be relieved by an
opiate enema.

When the operation of the paste is complete, it may be gently
taken off. and the eschar covered with an emollient poultice until
its separation, which usually happens, as formerly stated, from
the eighth to the twelfth day, according to the thickness of the
layer employed. The application is to be repeated again and
again till the whole morbid structure is removed ; after which
the surface is to be treated with simple digestive ointment j or,
in case of an acute cancer, with cataplasms, until the cure is
finished.

In certain modifications of carcinomatous tumours that are
voluminous and prominent, Dr. Oanquoin, instead of applying
the caustic on the anterior segment, surrounds the base with a
ring of paste two lines broad and four deep.

Should the carcinoma present a central depression, its destruc-
tion may be accomplished by using the phagedenic paste in a
spiral form.

The chloride of zinc will probably form a valuable means of
curing incipient cancerous ulcers of the uterus. These, in their
early stage, may be looked upon as purely local affections, since
Bayle has demonstrated, by numerous dissections, that the tis-
sues of the organ are perfectly sound at the distance of two or
three lines above the solution of continuity. In some instances
it is reported that they have been healed by the topical use of the
acidulated nitrate of mercury, as also by the caustic potash: but
as both have been objected to in practice, the former from its ten-
dency to spread over the healthy parts and excite inflammation,
the latter because it is too uncertain in its effects, corroding too
profoundly, and giving rise to fatal infkimmation, amputation
of the cervix has come to be regarded, by many, as the sole alter-
native for eradicating the disease. Now, the chloride of zinc,
liable to none of the inconveniences that have been imputed to
these other caustics, emyloyed in its most concentrated form,
will furnish its characteristic dry, easily definable eschar, destroy-
ing the morbid parts and leaving behind a healthy surface, which
will rapidly cicatrize ; thus saving the patient the necessity of
submitting to an operation which, although unaccompanied by
much pain, is yet most repungant to her feelings.

Cauterization with the chloride must likewise prove advan-
tageous in carcinomatous affections of the tongue, lips, and of
the rectum, where arsenic, from its powerful poisonous qualities,
is totally precluded. Ibid.

Dr. CANauoiNS Resolvent Pomade. The following oint-
ment is recommended for effecting the destruction of extensive

1338 J Sleeplessness and Us Treatment.

scirrhous surfaces, previously flattened by long-continued metho-
dical compression, as also of certain dense scirrhi. Take of oxy-
genated pomade, prepared by triturating eight parts of boiling
axunge with one of nitric acid, one ounce ; melt this by a gentle
heat, and add to it three drachms of the acid subdeuto-nitrate of
mercury. Increase the heat a little, till the nitric acid becomes
decomposed, so as to proxygenate the pomade, and bring the salt
into intimate union with it. The ointment, when, well prepared,
is very hard, and of an orange- yellow colour.

Dr. Canquoin describes the case of a woman affected with a
scirrhns of one half of the face, who had been previously treated
for it, but without benefit ; and she seemed doomed to become, ere
long, a victim to the frightful malady. However, thirty-five days'
application of the above ointment sufficed to work a cure, without
the slightest trace being left. Ibid,

Dr, CAxauoTN1s Malurative Ointment. Dr. Canquoin has
procured in two or three months time, and even less, a softening
and suppuration of indolent scirrhous tumours of a violet-red
hue, by the following application. Take of the acetic infusion
of the bark of spurge laurel, giss. ; of molasses, iss. ; olive oil,
3j. ; ox bile, ij. Mix together, and reduce, by the aid of heat,
to the consistence of an ointment. Withdraw the heat,and add,
unguent, basilic, giss. ; cerati fusci,* ^iss. Mix the whole well
together, and incorporate with each ounce a drachm of the sub-
deuto-nitrate of mercury. Ibid,

On Sleeplessness, and its treatment. By R. J. Graves, M.
D. Extracted from a clinical lecture delivered at Meath
Hospital^ Dublin.

Sleeplessness is a very curious result of disease. It accompa-
nies certain morbid conditions of the system brought on by actual
disease, or by grief, care, and various other forms of mental dis-
turbance, continues to harrass the unhappy sufferer night after
night, and frequently resists the most powerful and decided nar-
cotics. I do not intend to enter into any inquiries respecting the
different states of the constitution in which it occurs ; my pur-
pose is merely to offer a few practical remarks on the more obvi-
ous and striking examples, with the view of illustrating the cases
to which I have directed your attention.

There is a form of sleeplessness which is frequently the pre-

* Or Onguentde la Mere, prepared with litharge, axunge, butter, and mutton
*uet, of each 25 parts, yellow wax IS, and black pitch 8,

02(3 Sleeplessness and its Treatment. [May

cursor of insanity, and which lias been well described by my
friend Dr. Adair Crawford. The watchfulness in such cases is
accompanied by the well known symptoms of incipient mental
derangement, and its treatment is therefore inseparably connected
with that usually resorted to in cases of threatened insanity, and
embraces employment of means moral as well as physical. Of
these it is not my intention to speak; I may observe, however,
that Dr. Crawford has found opium, gradually increased to very
large and frequently repeated doses so as to produce sleep, the
best remedy.

In the case of jaundice, the patient passed several nights with-
out any sleep. He was just beginning to recover from the jaun-
dice when this new symptom appeared, and I directed your at-
tention particularly to the circumstance, because every manifes-
tation of nervous derangement connected with jaundice should
be carefully watched. It frequently happens that jaundiced pa-
tients sleep too much, and in some cases the disease is accompa-
nied by convulsions, succeeded by coma, most alarming symp-
toms, and almost invariably the harbinger of a fatal termination.
Dr. Marsh was the first who directed our attention to the
great fatality of those cases of jaundice in which convulsions
occur : I have seen but one instance of recovery. It was in the
case of a gentleman labouring under icterus, very considerable
hepatitis, with enlargement of the liver and anasarca, with as-
cites. He was treated by Dr. Osborne and myself, and had at
least a dozen long and violent convulsive paroxysms, ending in
coma, succeeded by temporary forgetfulness and fatuity. Re-
peated leeching of the right hypochondrium, active purgation,
and mercurialization of the system removed all the symptoms of
disease, and he slowly but perfectly recovered. A very able
and original writer, Dr. Griffin of Limerick, has detailed the
particulars of some interesting cases of this nature in the Dublin
Medical Journal. You perceive, therefore, that in jaundice
every thing denoting an unusual state of the nervous system,
whether it be too much sleep, or too little, demands your atten-
tion.

In this man's case the jaundice was the result of an attack of
hepatitis. We treated it with leeches, blisters, and the use of
mercury, and in the course of a few days the stools became copi-
ously tinged with bile, and symptoms oi improving health ap-
peared. At this stage, the dejections being bilious, but the jaun-
dice still remaining, he began to exhibit symptoms of restless-
ness and nervous irritability, and finally became perfectly sleep-
less. Here, gentlemen, wo had to deal with a new symptom,
extremely harrassing to the patient, and likely to react unfavo-
rably on the original disease. As a preliminary step I deter-
mined to evacuate the bowels, and for this purpose I prescribed

S3S] Sleeplessness and its Treatment. 627

a purgative draught, consisting of five ounces of infusion of sen-
na, half an ounce or sulphate* of magnesia, a drachm of tincture
of senna, and a scruple of electuary of sammony. My object,
was to purge briskly, and then give a full narcotic. In all cases
of jaundice depending on hepatic derangement, after you have
succeeded in producing bilious evacuations, you should never
omit prescribing an active aperient every second or third day for

;pace often days or a fortnight, with the view of carrying
off the remains of the disease so as to prevent the occurrence of
a relapse. Hence you will find such cases very much improved
by the use of Cheltenham water, taken every day for three or
four weeks after the reappearance of a bilious tinge in the
alvine discharges. The stimulus of the purgative causes an
increased flow of bile in the intestines, which removes the hepa-
tic congestion, and carries off what is popularly termed the dregs
of the disease, and promotes a rapid and complete recovery. It
is a simple but successful practice, and I would advise you never
to omit its employment in cases of this description.

With respect to purgative mixtures, I may observe that you
should prescribe a larger quantity of the infusion of senna than

nerally ordered, if you wish to secure its certain and deci-
ded operation on the intestines. Hospital nurses, who reason from
facts and experience, know this, and when directed to give a
senna draught they always givea small tea-cupful. They ad-
minister from four to six ounces at' a time, and I have observed
that, in this way the action of the medicine is more certain, and
the benefit derived from it more extensive. I am convinced
that the usual mode of giving this valuable purgative in private
practice is bad ; the quantity given is too small, and consequently
it is necessary to repeat the dose several times, a mode of proceed-
ing apt to occasion much nausea and griping, I would therefore
recommend a quantity varying from three to six ounces, to be

mistered in all cases where the patient's condition will admit
of free purging. A most accurate observer of the effects of me-
dicines, Mr. Kirby, is in the habit of ordering purgative mixtures
in the chronic cases to be taken at bed-time, and not, as is usually
done, in the morning. He asserts that their action is milder and
less irritating to the bowels when the patient lies in bed and is
asleep until the period of their operation, than if he were up and
about.

After the purgative had produced four copious discharges, 1
f black drop, to be taken at a late hour
in the evening. Whenever '1 give opiates to procure sleep, I
always observe the rule laid down by Dr. M'Bride, (a celebrated
physician of this city) to select tiie period at which nature usually
brings on sleep, and which varies according to circumstances
and the habits of the patient. Whenever you have to deal with

62S Sleeplessness and its Treatment. [May,

watchfulness in patients labouring under morbid states of the
constitution, as for instance, hectic, inquire when the tendency to
sleep usually occurs, and administer your narcotic about an hour
or two before its occurrence. It is between three and five o'clock
in the morning that the inclination to sleep is strongest ; it is
about this time that sentinels are most apt to slumber at their
post, and consequently attacks upon camps or cities, made with
the intention of effecting a surprise, are usually undertaken about
this period of the morning. How well marked is the periodic
tendency to sleep at this hour in all patients labouring under-
hectic fever produced by whatever cause. How often do we
hear the poor sufferer complain of restlessly tossing about in his
bed until three or four o'clock in the morning, when at last sleep,
welcome although uneasy, for a few hours separates the patient
from his pains. If given at an early hour in the evening, the
effect of the opiate is not coincident with this periodic attempt of
the constitution, and it fails in producing sleep, but if exhibited |
at a late hour, it begins to produce its soporific effect at the very
time when nature inclines the harrassed sufferer to repose, and
the result of these combined influences is a deep, tranquil, and
refreshing sleep. By observing this simple rule, I have often
succeeded in producing sleep in cases where various narcotics
had not only pailed, but even added considerably to the irritation
and discomfort of the patient. *

In cases of sleeplessness, where you have administered an
opiate with effect, be careful to follow it up for some time, and
do not rest satisfied with having given a momentary check to the
current of morbid action. To arrest it completely, you must
persevere in the same plan of treatment for a few days, until the
tendency to sleep at a fixed hour becomes decidedly established.
You must give an opiate the next night and the night after, and
so on for five or six nights in succession, and where the watch-
fulness has been of an obstinate and persistent character, narco-
tics must be employed even for a longer period and in undimin-
ished doses. I do not allude here to' the sleeplessness which
accompanies confirmed hectic and other incurable diseases ; such
cases require a particular mode of treatment, and generally call
for all the varied resources of medicine. But in those instances
of watchfulness, which are frequently observed towards the ter-
mination of acute diseases, it is always necessary to repeat the
opiate for some time after you have succeeded in giving a check
to this symptom. You need not be afraid of giving successive
opiates lest the patient should become accustomed to them, and
a habit be generated; for the rapid convalescence and renewed
health, which are wonderfully promoted by securing a sound
and refreshing sleep, will soon enable him to dispense with the
use of opiates.

< r.eplessness and its Treatment. Cl^9

Another disease in which sleeplessness is a prominent symp-
>m, is delirium tremens. We have had an example recently in
>ur wards, and you have seen the means employed to overcome
The patient came into the hospital with symptoms of ex-
?me nervous excitement and watchfulness, which had contin-
ied for some time, and were brought on, as is most commonly
le case, by repeated fits of intoxication, succeed by a pause of
;rfect sobriety in Irishmen the result of necessity or accident.
En this man you must have remarked the signal benefit which
attended the use of tartar emetic and opium, and how rapidly the
-ntchfulness disappeared. I shall not enter into the details at
>resent, as I purpose to return to this subject on a future occasion.
There is, however, one form of nervous irritability, frequently
observed in persons who are in the habit of drinking freely, but
without running into excess, and presenting, as it were, a shadow
r>f delirium tremens, on which I shall make a few remarks.
Tli is curious state of the nervous system is generally found to
in men about the middle period of life, and who consume
i larger quantity of spirituous liquors than they are able to bear.
Such persons, without suffering in appearance, or losing flesh,
yet into a chronic state of disturbed health, manifested by nausea,
and even dry retching, in the morning, loss of appetite, and im-
paired digestion ; but, in particular, by a deranged and irritable
state of the nervous system, and by watchfulness. This forms
Dne of the most distressing symptoms, and the patient generally
complains that he cannot get any sound and refreshing sleep,
that he lays awake for hours together, and that when he slumbers
bis rest is disturbed by disagreeable dreams, or broken by slight
noises. How are you to treat this affection ? I can give you a
valuable remedy for this deranged state of constitution one
which I have often tried, and which, from experience, I can
strongly recommend. It is a mixture, composed of tincture of
Columbo, quassia, gentian, and bark say an ounce of each ;
and to this is added a grain, or even two, of morphia. A com-
pound tincture, somewhat analogous to this, is much in use
fimon^ military gentlemen and others, who have resided for a
considerable time in the Indies, where, from the heat of the
climate, and the prevalence of intemperate habits, the stomach
becomes relaxed and the nervous system irritable, so as to repre-
sent, in a minor degree, the symptoms which characterize deli-
rium tremens. You perceive I combine several tonics to form
this mixture, because they are well known to produce a more
beneficial <Mlect when combined than when administered singly ;
and I add to these a narcotic, which has the property of allaying
nervous excitement without deranging the intestinal canal.
The dose of this mixture is a tea-spoonful three or lour tin*
day, and the best time for taking it is about an hour before meals.

630 Sleeplessness and Us Treatment. [May,

It gradually removes the nausea and debility of stomach, lessens
nervous irritability and watchfulness, and, with a proper and
well-regulated diet, and attention to the state of the bowels, I
have seen it produce excellent effects. In such persons much
benefit is derived from the use of the tepid shower-bath.

Fever is another disease in which sleeplessness is a symptom,
frequently of an unmanageable character, and pregnant with dan-
ger to the patient. You witnessed this in the case of the boy
who lies in the small Fever Ward, next to the man who is at
present labouring under general arthritis. This boy had fever
of a mild description, and unattended by any bad symptoms.
His case scarcely required any attention, and he had almost ar-
rived at a state of convalescence without the aid of medicine,
when he began to lose his rest, and absolutely became sleepless
for several nights. I beg your attention to this case, for many
reasons. In the first place you have seen that we tried many
remedies without success, and afterwards fortunately hit on one
which answered our purpose completely. Let us examine the
nature of the medicines prescribed, and our reasons for m vino-
them.

In the first place, we gave, as in the case of jaundice, an ape-
rient, followed by a full dose of black drop. It foiled in produ-
cing any sleep ; we repeated it a second and a third time, but
without the slightest benefit. I then remarked to the class, that;
as I had noticed the gocd effects resulting from a combination of
tartar emetic and opium in the'case of delirium tremens, where
opium alone failed in procuring sleep, it would be proper to o-ive
this remedy a trial. I observed at the same time, that 1 was
convinced that the preparations of anatomy have a distinct nar-
cotic effect, and that I had seen patients in fever whose watch-
fulness had been removed by antimony given in the form of tar-
tar emetic or James's powder. I said that it was my firm im-
pression'that tartar emetic, along with its other effects, exerts a
decided narcotic influence on the system, and that it is this which
makes it so valuable a remedy in treating the sleeplessness of
fever and delirium tremens. Hence I have been in the habit of
giving tartar emetic combined with opium in fever, and, I must
add, with very great success. Our predecessors were much in
the habit of using antimonial mixtures in the treatment of fe
and they did this because they knew, by experience, that tl
remedies worked well. It is at present too much the fashio
decry their practice, and in this instance I think with very little
justice.

In this boy's case, however, the combination of tartar emetic
and opium did not succeed in producing sleep. Having thus
failed in our first and second attempts, we had recourse^ to the
liquor muriatis morphia-, a preparation first brought into use by

1S3S] Sh

Dr. Christison. nnd which, ii rm usually employed, is

equal in strength to laudanum. It is an < valuable

preparation for many reason?, and one which I
claims to your notice. Being of the same ' Lidanum,

it saves the trouble of learning and rememl . and,

in addition to this, it possesses the more ii
of inducing sleep with more certainty, and i s an

astringent on'the bowels, or affecting the head so frequently as
laudanum. You observe that I say so frequently \ I do so be-
cause cases now and then occur in which even moderate doses
of the liquor of the muriate of morphia produce quite as much
head-ache as laudanum. I prescribed the former in doses of
fifteen drops every six hours, so as to give sixty drops in the day,
and continued this practice for two days, but without the si;
est effect. Here you see three modes of inducing sleep com-
pletely failed. The boy remained for a few days without taking
any medicine, and then we made another attempt, which
more successful. We first prescribed a purgative enema, nnd,
'after this had operated, he was ordered an opiate injection, con-
sisting of four ounces of mucilage of starch, and half a drachm
of laudanum. He fell asleep shortly after using the opiate iniec-
tiori, and did not awake until the next morning. The following
night the opiate was repeated in the same iorm and with equal
success ; convalescence went on rapidly, and the boy's health is
now quite re-established.

Here, then, is a singular fact; attested by this case, that opiates
in the form of injection will succeed in producing sleep, where
they have completely foiled when administered even in large
and repeated doses by the mouth. Baron Dupuytren was
first who made this important < ion, and proved that narco-

tics applied to the mucous surface of the rectum exercise a pow-
erful influence on the nervous system, always equal, and very
often superior, to the effect produced by taking them into the
stomach. He maintains, that in delirium traumaticum and de-
lirium tremens a certain quantity of opium, when prescribed in
the form of eiien: ith more decided effect in allaying

nervous excitement, than the same or even a larger quantity
when taken by the mouth. I have no hesitation in giving full
credit to this assertion, as the results of my experience tend
strongly to confi; ith. I have, not Ions: since, published

in the Dublin Medical Journal, the case of a patient in Sir P.
Dun's Hospital, who was reduced to the Inst stagfe of debility and
emaciation from the combined effects of mercury and syphilis.
The torture which this man endured from nocturnal pains and a
total deprivation of sleep, was such that he swallowed enormous
doses of opium : in fact, he had. previously to his admission into
Sir P. Dun's Hospital, exhausted all his means in purchas

Sleeplessness and its Treatment.

LM;

opium. While in hospital he used to take 150 drops of]
drop m the course of a day, and yet notwithstanding- these ex-
cessive doses, he could only get a .few minutes unrefresl
hTthf. i tCf some1tlme.1 ch^ed the plan of treatment, and
had the black drops administered in the form of enema. It suc-
ceeded introducing a decided soporific effect, and m a short
n;ae he ' etW a sufficient quantity of repose, from

taking only one tenth of the quantity used by the rnouth. I ha*2
. also, m the same paper, adverted to the case of a medical gentle-
man who laboured under an affection of his joints, which was
accompanied by spasms of the limbs, and most excruciating

s pains. His agony was so intense that he used to swallow o-rain
after grain of opium, until he had taken to the amount of thirty

f or forty grams, with the view of procuring some alleviation of
ms sufferings. He was prevailed on to give up altogether the

"I6 l 0i?m? J'7 th,Q mUth' and emPloy il m the form of enema
which he did with the most striking advantage, the quantity
which succeeded m giving relief in this way being scarcely the
twentieth part of what he ordinarily used. '

It is unnecessary for me to enter here into any discussion with
respect to the nature and treatment of delirium traumatism and
the sleeplessness which always accompanies it, as you will find
this subject very ably treated in M. Dupuytren's works and in
a very instructive and elegant lecture delivered by Tilr Cramo-
ton (the Surgeon General) in this hospital, and published in the
last volume of the London Medical and Surgical Journal
I here is, however, one kind of sleeplessness arising from irrita-
tion of the skm produced by blisters, which frequently assumes
a very serious character, and on which it may be necessary to
offer a few observations, as the subject has not been noticed suf-
ficiently by practical writers. Trifling as the irritation resulting
from a blister may seem, yet, under circumstances, it is a symp-
tom of highly dangerous aspect, and becomes a source of just
alarm. I have witnessed the loss of some lives from this cause
and many patients have, to my knowledge, been rescued from
impending danger, by an early and proper share of attention
beins: directed to its phenomena and treatment.

The bad effects on the nervous system occasionally produced
by the application of blisters, are somewhat analogous to th
which result from wounds and other external injuries, and to be
accounted for on the same principle. Wounds and injuries
-times make an impression on the nervous system by no
means proportioned to the importance of the injured organ to*
life or to the extent of the mischief. An injury produced 1
body which strikes the sentient extremities of the nerves with
great force, will sometimes produce very remarkable effects on
the system. Thus a musket hall striking a limb may, without

Hiding any great artery or ; any part of

rtance to life, produce a train of rien iptoms of an

aordinaly character. The person, without feeling much
pain, and scarcely knowing that lie has been wounded, without
being terrified, or having his imagination excited by any appre-
hended dangers, turns pale, gets a tendency to faint, and some-
s actually dies from the impression made on the nervous
em. In the same way an external injury reacting on the
nerves may bring on high mental excitement, delirium, and a
total privation of sleep, as we exemplified in delirium traumati-
cum. I mention this with the view of establishing the proposi-
that impressions made on the sentient extremities of the
res are sometimes reflected on the nervous centres, producing
the most alarming effects. In this way we can understand how
the irritation of blisters may produce sleeplessness, mental aber-
ration, and a train of symptoms analogous to those which char-
acterize delirium traumaticum.

The delirumand sleeplessness arising from irritation of blisters
is by no means an uncommon disease. I have seen many ex-
samples of it in private practice, and I am anxious that you should
be acquainted with its nature and treatment. It is generally met
with in cases of children, in whom the cutaneous surface is ex-
tremely tender and irritable. I could relate several instances in
which I have been called on to visit children labouring under
fever, where symptoms of high nervous excitement were present,
and where I found the little patients delirious, screaming, and
jctly sleepless from this cause. I have found this alarming
affection generally occurring at an advanced stage of fever,
and exhibiting a train of symptoms which closely resemble
hydrocephalus. I have observed that after the application of a
blister to relieve some suspected cerebral, or abdominal, or thora-
cic affection, jactitation, restlessness, constant application of the
hand to the head, and delirium have appeared, and that these
symptoms had been mistaken for incipient cerebritis or hydro-
cephalus, and treated with leeches and purgatives. "When the
blister had been applied to the nape of the neck, the soreness and
irritation of the skin on that part cause the child to roll its head
from side to side on the pillow, with that peculiar motion and
scream supposed to prove to a demonstration the existence of
hydrocephalus. I have learned also, that the above measures,
so far from giving relief, have only tended to produce an
exacerbation of the disease, and that the medical attendant has
given up the case in despair. Now, gentlemen, if called to such
a case what should be your practice ? In four cases of this kind
I gave my opinion frankly to the medical attendant, and told him
that he was pursuing a wrong course, that the was ana-

logous to delirium traumaticum. and not to be treated by leec

mess and its Treatment. [May,

or purgatives, and least of all by blisters. I observed to him
that these symptoms had made their appearance shortly after the
child had been blistered for suspected disease of the belly, or
head, or chest ; and that it was useless to attempt to remove the
disease by leeches, or purgatives, or blisters. The remedy I
always proposed was opium, and it was acknowledged in four or
live cases, that this remedy had succeeded not merely in reliev-
ing the existing symptom, but in saving the patient's life. In
such cases, particularly in young children, the opium must be
given in small but frequently repeated doses, so as to ensure its
energetic, but safe action, and the greatest care must be taken to
soothe the irritated portion of. the skin, by ointments, poultices,
<fcc, while unwearied dilligence must be bestowed upon the task
of preventing the child from scratching the blistered surface.
To effect this the child's hands must be muffled in appropriate
gloves, and must be secured in the sleeves of a shirt made lor
the purpose.

I beg your attention still further to this subject of sleepless,
ness and delirium. 1 wish to mention the case of a gentleman
who was a pupil of mine. This gentleman studied hard, attend-
ed lectures regularly, and was constantly in the dissecting room.
While thus occupied, he happened to wound one of his toes in
paring a corn, and afterwards wore a tight shoe on the injured
foot. A small imperfect abscess formed in the situation of the
corn, which was opened by one of his fellow students : the in-
cision gave very great pain, and was not followed by any dis-
charge of matter. Next day he was feverish, and the lympha-
tics of the injured limb became extensively engaged, the inflam-
mation ascending towards the gland of the groin, and having a
tendency to form a chain ol insulated patches in different parts
ol the leg and thigh along the course of the lymphatics. This
you will generally find to be the case in inflammatory affections
of the lymphatics ; the inflammation is seldom continuous, but,

ajority of cases, is developed at certain insulated .points,
e small diffuse suppurations form very rapidly. After a

:. this yo in's fever increased to an alarming

ht; he became completely sleepless, and had incessant deli-
ed briskly, leeched extensively and repeat-
!. and co!d applications so constantly ap-
plied, that h ed half drowned and collapsed. Nowith-

itmeiit, not the slightest relief was

: neither toms mitigated by incisions t

made in the inflamed ;iie purpose of evacuating mat-'

sleeplessness continued, and the delirium was as wild as
him on the ht day, when all anti-

quite in
[ stated that I looked upon

Sleeplessness and its Treatment. 635

/ ,

the case as one of delirium, not proceeding from any determina-
tion to the held or inflammation of the brain, but depending on
a cause analogous to those which produce delirium trauma-
ticum, and that instead of antiphlogistics I would recommend a
large dose of opium and some porter to be immediately given.
Mr. Gusack, who visited the patient after me, concurred in this
view, and a full opiate was administered in repeated doses. It
succeeded in producing sleep and tranquillizing the nervous
excitement. I may here observe that a few days afterwards this
gentleman had a return of the symptoms of cerebral disturbance
with sleeplessness, in consequence of omitting his opiate, and
that the opiate and porter were again administered, and again
succeeded in removing thq/ielirium and watchfulness. By per-
severance in the use of the same means, the disease was com-
pletely removed, and convalescence established.

The last kind of sleeplessness to which I shall direct your
attention, is that which is frequently met with in persons of a
nervous and irritable disposition, in hypochondriacs, and hyste-
rical females. You will find such persons, although of active
habits, and with tolerable appetites, complaining of a total priva-
tion of their natural rest, and it is astonishing to think how long
they may continue subject to this harrassing watchfulness. I
have frequently observed this affection among females of nervous
habit, who possessed strong feelings of attachment to the interest
and welfare of tlfeir families, and who were remarkable for an
exemplary and over anxious discharge of their domestic duties.
It is also very often met with in the upper classes of life, where
the susceptibility of the nervous excitement is morbidly increased
by fashionable habits. I shall not enter into the various moral
causes which tend to produce this state of the nervous system,
and will content myself for the present with giving you some
hints for the treatment of this obscure affection. As yet I have
not any distinct and accurate notions of the disease, and can only
guess at the treatment, but this much I may state, that such cases
are not to be cured by the means which I have already detailed.
If they are to be cured by any means, I think it is by antispas-
modics, and remedies which have a gently stimulant, and, if I
may so express myself, alternative effect on the nervous system.
I have cured two cases of this kind by musk and assafcetida,
where every other remedy had failed. To one of these I was
called by my friend, Dr. iSeason Adams ; the patient was a lady
of delicate constitution and hysterical habit ; she was emaciated,
and suffered from a total loss of rest, but had had no other disease.
All kinds of narcotics had been tried unsuccessfully, and opium
in all its forms had failed in procuring sleep. I advised the use
of musk in doses of a grain every second hour, and this means
proved eminently successful. In another case I succeeded by

y

C36 Sleeplessness and its Treatment. ^Wlay

_______ 1 __ .

administering the same remedy in combination with assafcetida-
I have also remarked that assafcetida alone, given _n doses of two
or three grains three times a day. lias very considerable effect in
calming nervous irritation of this description, and restoring the
patient to the enjoyment of more prolonged and refreshing sleep.
In all such cases the physician must be most careful to have the
appearance of not thinking the loss of sleep as a matter of much
consequence, and the family of the patient must be directed to
speak as little about the matter in his presence as possible ; nay,
so powerful is the operation of moral impressions, that in one
case which I attended along with Mr. Halahan, I succeeded in
procuring sleep by ordering a musk pill to be given every second
hour night and day, and by desiring jthe patient to be awakened,
should she be asleep, at the time the pill was to be taken. I laid
great stress on the importance of so proceeding, and thereby pro-
duced so strong an effect on the patient's mind, and inspired so
great a confidence in the efficacy of the medicine, that she
went to bed, not so much afraid of lying awake as afraid of
being asleep at the hours when she ought to take a pill. The
idea which had hitherto fixedly occupied her mind was displaced
by a new impression, and relief was obtained the very first night.
To conclude, gentlemen, I may observe that sleeplessness in
a chronic form is often produced by dyspepsia, and can only be
relieved by the means suited to indigestion. Here it is that small
doses of blue pill and tonic purgatives are of infinite service,
combined with change of air, of scene, and an appropriate diet.
In many females, sleeplessness is combined with menstrual
irregularity, and can only be cured by means calculated to invi-
gorate the health and restore the catamenial discharge to its
natural periods and quantity, for the nervous system suffers
equally whether they be suppressed or overabundant. It is sin-
gular how long sleeplessness often continues in chlorosis without
inducing those serious consequences that are produced by this
symptom in other morbid states of the system. In such cases
much is sometimes accomplished by means of the common pre-
parations of morphia, or by the use of Hoffman's liquor (liquor
sethereus oleosus), camphor and other medicines that act upon
the nervons system. It must be confessed, however, that these
and every other expedient to obtain sleep often fail in chlorotic
and hysterical females, in whom relief is only obtained by a
gradual improvement of the general health and menstrual
function. London Med. and Surg. Journal, 21st March, 1835.

1838] Report on Lunatic Hospitals. 637

Abstract of the Report of M. Desportes on the Service of
the Salpe trier e and Bicetre Lunatic Hospitals.

The work of M. Desportes consists of two sections. The first
exhibits a series of eighteen statistical tables, giving an account
of the number of patients for each year, the name or character
of each form of the disease, the occupation of the patient, the
causes of the insanity, the relapses, the length of time each
patient was under treatment, and lastly the issue of each case.
The second comprises the practical and philosophical deductions
which may be drawn from these tables.

These tables are arranged in three classes. Jn the first class
are grouped the cases; which were observed during the years
1825, 6, and 7 ; in the second, those observed in the year 1828,
9, and 30, and in the last, those observed in the following years,
1831-2-3.

Number of Patients admitted, discharged, and cured, during
Nine Years fropi 1825 to 1833 inclusive.

Admitted 8,272 lunatics.

Discharged cured 2,763

not cured 1,863

Dead o,854

The relative mortality to the number of cases admitted may
appear at first sight, to be extremely high ; but we are to remem-
ber, "que la mort frappe surtout les incurables."

The number of admissions during the last triennial period
was greater, than in either of the preceeding periods. The cause
of this increase is most probably to be found in the agitation of
the public mind induced by the revolution of July, 1831. In
the following year too, the epoch of the cholera, there were more
admissions than usual. A similar increase in admissions was
noticed also in private lunatic establishments, during these two
years. In an article published by Dr. Belhomme in the bul-
letins of the Medico-practical Society, he has particularly alluded
to the influence of stirring political and public- events on the
developement of insanity. " It seems to me," says he, "well
established, that not only great political events exert an influence
on the developement of insanity, but also that the number of
insane persons must necessarily have increased in France during
the last forty years, in consequence of the violent commotions,
which have succeeded each other during that period. That
such has been the case, is clearly proved by the uniform in-
crease of admissions into our great lunatic establishments after
any violent exciteinent of the public mind.

638 Report on Lunatic Hospitals. [Mtay;

During the nine years, to which the report of M. Desportes
alludes, the number of admissions of female patients has been
more numerous by about one-fourth.

M. Desportes observes that, by a singular coincidence, the
number of insane patients under treatment and in a state of con-
valescence, which amounted to 31S on the 31st December, 1827,
and to 3,127 on the 31st December, 1830, was exactly 318 on
the 31st December. 1833.

In what months of the year have the admissions been most
numerous ? The following is a table in M. Desportes' report.
Of 8,272 admissions during nine years, there were

281 during June.

268 July.

255 May.

237 April.

From this table it would appear that the month of June, when
the hot season commences, is the period of the aggravation of
insanity.

Now as to the influence of the weather on the curability of
the patients, we have the following data:

Of the 8,279 patients, the months in which there were the
greatest number of cures, were

1st Series.

In March .... 36.

October .... 44.

June 43.

August 42.

May .... 42.

v 2d Series.

In October 40.

July 44.

August 47.

June 48.

In other months the cures were less numerou 3.

3d Series.

In September.. 7G.

February . . 59.

May 56.

July 58.

August ;... 60.

October 67.

"We see by these tables, that it is at the trimestral epoches,
which are marked by a change of season, that the cures have
been most numerous ; and especially in the month of October,
in which alone there were 151 cures.

M. Desportes furnishes us with the following average relative
to the cures effected.

First Series.
Of 2956 there were 881 cured 1 in 335

Second Series.
Of 2869 there were 884 cured 1 in 324

Third Series.
Of 3354 there were 902 cured 1 in 361

183S] Report on Lunatic Hospitals. G39

We are next informed that the female patients were kept
longer in the hospitals than the males. The reason of this is,
that the former may be more effectually and permanently cured.
The men, having more means of subsistence, are of themselves
generally more anxious to be discharged, when they once begin
to feel themselves better. But it may be with propriety argued
against this plan, that the danger of relapse must be the greater;
and such, in truth, we find it to be the case.

Relapses are more frequent nmong the men than among the
women. The following are the results of M. Desportes' report.
In the first series, mentioned above, there was one relapse in
every 12 men ; whereas among the women there was one in
every 16. In the second series, the proportion was one in every
10 among the men ; and one in every 13 among the women. In
the third series, the proportion was one in every 19 among the
former ; and among the latter one in every 22. He attributes
this difference, in a certain degree at least, to the greater irregu-
larity of life among the men, than among the women.

M. Belhomme is not quite inclined to agree with M. Des-
portes in this particular. He attempts to explain the difference
by alluding to the difference in the cause and in the character of
insanity among the two sexes. Among men, he says, it is most
frequently idiopathic ; whereas among the women J it is much
more often merely sympathetic. Now the former, or the idio-
pathic insanity, is very frequently associated with lesions of the
encephalon ; while in the sympathetic form of the disease, there
is generally no organic mischief, but only a morbidly excited
state of the nervous system.

He adduces, as a proof of the correctness of these statements,
that paralysis is much more frequent among insane male than
female patients. This reasoning is certainly very plausible, and
confirms, to a certain extent, the opinion of M. Belhomme, that
idiopathic insanity affects men rather than women. We are
thus furnished with a satisfactory explanation of the greater
frequency of relapses among the male patients.

The following results, as to the mortality of the insane patients,
are afforded us by M. Desportes' memoir. In the first series,
there was one death in every six of the men, and one in every
ten of the women. In the second and third series, the advantage
is still more decided in favour of the women. The medium
age of the deceased was, in the first series, between 40 and 50
among the men, and between 50 and 51 among the women : in
the second series, the medium age among the men was 48 years,
and among the women between 53 and 54 ; and in the third
series, it was between 47 and 48 among the former, and between
50 and 51 among the latter.

As to the months in which the mortality chiefly occured,
January seems to have been the most fatal.

040 Report on Lunatic Hospitals, [May,

The observation of other physicians agrees with this state-
ment. The severe cold of winter appears to be very hurtful to
the insane.

M. Desportes next proceeds to give an analysis of the occu-
pations of the insane, their ages, and of the diseases from which
the patients usually died.

The following table presents us with a view of the ages of
8272 patients admitted during nine years.

From 10 to 19 years of age 626

20 to 29 1568

30 to 39 9024

40 to 49 1683

50 to 59 1051

60 to 69 782

70 to 79 484

80 to 90 8

90 to 99 2

Age unknown 15

The greatest number, therefore, was from 30 to 39 years
of age.

The professions or occupations also seem to have a very
marked influence on the developement of insanity.

It has been remarked by many observers, that there are always
a number of insane sent from the army to the public lunatic
hospitals. All persons too who have been subjected to strong
mental or moral excitement, as love, ambition or interest ;
merchants who have suffered reverses of fortune, or persons
who have left off business, without betaking themselves to some
active employment, are very frequently the victims of derange-
ment.

The following table of the occupations of the patients, whom
M. Desportes examined, may be interesting.

Among the male patients there were
445 day-labourers,
124 tailors,
161 shoe-makers,
101 cabinet-makers,

81 masons,

97 clerks,

62 domestic servants,

17 washermen,
1 embroiderer,

23 cooks,
1082 occupations unknown.
Among the women, there were
924 semestresses,
397 domestic servants,
503 day-work-women,
188 washerwomen,
133 embroiderers,

88 cooks,

50 shoemakers,
3:59 occupations unknown.

The jrrcat frequency of insanity among females, who have
been milliners and semstresses, is perhaps not to be wondered

183j Report on Lunatic Hospitals. Oil

at, when wc remember that so many of these poor creatures are,
from their personal charms and other circumstances, more ex-
posed than others of their sex to seduction and ultimately to
destitution and poverty. The grief which follows, their anxiety
and distress it* they become mothers, the anguish of disappoint-
ment, are unquestionably the causes of the frequent occurrence
of insanity among them.

M. Desportes remarks that insanity is more frequent among
female, than among male cellbataries. The following state-
ment is very interesting, as it shews, that the unmarried life is
decidedly more exposed to the misery of mental derangement,
than the "dual state," as the poet Cowper terms matrimony.

The cellbataries of the two sexes were in the proportion of
47:16 in every hundred cases admitted into the hospitals ; married
persons in the proportion only of 3:55 in the 100 ; widowers
and widows in the proportion of 13-27 in the 100; and those
who had been divorced, or whose civil condition was unknown,
in the proportion of 4-7.

The most frequent and powerful predisposing and exciting
causes of insanity, among the patients examined by M. Des-
portes, will be seen by the following table :

Predisposing Causes.

Hereditary predisposition in 73G cases.

Defect of intellectual developement in 642

Premature or natural old age 753

Physical Causes.

Cerebial congestions or haemorrhages, inducing paralysis or delirium 65G

Epilepsy and convulsions 492

Efforts of menstruation, critical period of life 383

Consequences of parturition 218

Pregnancy 48

Hysteria 100

Abuse of spirituous liquors 414

Poverty and destitution 100

Syphilitic disease 51

Misconduct and debauchery 216

Moral Causes.

Domestic distress 392

Reverses of fortune 150

Ambition 1 39

Disappointed love Ill

Fright 124

Unknown causes 1

The influence of hereditary predisposition is strongly shewn
by the preceding table. The number of patients, so situated,
amounts to an eleventh of the whole number of admissions,
viz., 8972. The author very properly alludes to the great im-
propriety of marriages in certain families ; but it is very doubt-
ful whether most people will be willing to adopt his advice,
c< less medicin seuls pen vent etre consultes avec a vantage dans
ces sortes de cas." N

Report on Lunatic Hospitals. [May,

Dr. Belhomme directs the attention of his readers particularly
to the marked influence of the uterine functions, as one of the
most frequent causes of insanity among females. The above
table shews that not fewer than 982 cases are attributable either
to the efforts of menstruation, the suppression of the catamenia,
their cessation, or to pregnancy, the sequelae of parturition, suck-
ling, &c., or, lastly, to hysteria and other nervous affections,
which are, more or less, obviously connected with the state of
the uterus.

We shall now proceed to state the result of M. Desportes'
inquiries as to the most frequent causes of death among insane
patients.

1st Series, 1825-6-7, out of 1146 deaths,

253 were caused by organic diseases of the encephalon.

395 by organic diseases of the thoracic viscera,

445 by organic disease of the abdominal viscera,

108 by cachectic diseases.

2d Series, 182S-9-30, out of 1200 deaths,

237 were caused by diseases of the encephalon,

390 by diseases of the thoracic viscera,

393 by diseases of the abdominal viscera,

119 by cathectic diseases.

3d Series, 1831-2-3, out of 1408 deaths,

270 were caused by diseases of the encephalon,

468 by diseases of the thoracic viscera,

485 by diseases of the abdominal viscera,

15S by cachectic diseases. Hence there was a total of 760
deaths from encephalic disease, 1258 from dioracic, 1322 from
abdominal, and 385 from cathectic disease.

It is however, more than probable that, in very many of the
cases arranged under the thoracic and abdominal sections, there
was co-existent cerebral disease the cause of the insanity, al-
though not of the fatal termination. The influence, which
disease of other cavities has frequently on the state of the cere-
bral functions, is strikingly exemplified in many cases of in-
sanity. M. Belhomme alludes to several cases in illustration of
this remark, and more particularly to that ofa phthisical patient,
in whom the paroxysms of madness regularly alternated with
the free flow of the purulent secretion, or its suppression.

On account of of our desire to get before the reader as much
matter of practical bearing as possible, our Periscope and Medi-
cal Intelligence are necessarily omitted in the present No. Ed,

SOUTHERN

MMB3K0AIL AMID) OTMMDA3L
JOURNAL.

Vol. II. JUNE, 1S38. No. XI

PART L

ORIGINAL COMMUNICATIONS.

ARTICLE I.

Surgical Cases. By Paul F. Eve, M. D., Professor of Sur*

j hi the Medical College of Georgia.

SERIES NO. IV.

Case 1st. Successful removal of a large Schirrous Tumour
from the Neck, attached to the left Tonsil. This operation
was performed upon a negro man, named Middlcton, brought
to me by Dr. Joseph Wa unlaw, a very intelligent and promis-
ing young physician of Abbeville village, S. C. A small tumour
was observed on the left side of the neck several years ago,
and which had resisted all kinds of treatment. Within the last
few months, it had rapidly increased in size. When removed, I
suppose it would have weighed nearly half a pound, the largest
schirrous tumours attain. The operation was performed in the
Augusta hospital on the 1st December, 1S37, in the presence of
the medical students, and assisted by Drs. Waiidlaw, Antony
&c. The incision in the skin extended from about an inch
below the left ear, and was continued for four inches obli-
quely downwards and forwards towards the thyroid gland.

A 1

646 Surgical Cases. By Paul F. Eve, M. D. [June

of cataract, and passed thence through the iris into the globe.
The day after the accident, a section was made in the cornea as
in the ordinary operation for opacity of the lens, with the view of
extracting the ioreign substance, and on completing it the lens
immediately escaped. Whether this latter body or its capsule
was injured by the piece of cap, it is impossible to say, it came
however, through the pupil and section of the cornea, without
any undue pressure'upon the globe of the eye. Since the opera-
tion, the pupil has become obliterated, the iris being puckered
up where the foreign body entered it, and has become adherent
to the cornea. I know not if the piece of copper was extracted,
it was not seen at any time. The other eye remains entire ; the
patient suffers now no pain whatever, and attends to his ordinary
business.

Case 5th. Gun-shot wound of the xorist-joint Limb pre-
served. On the 20th of January last, a gentleman of this city
while out gunning, in stepping over a fence with a double barrel
gun, (percussion locks,) accidentally received a discharge in his
left wrist-joint. As the thumb, fore-finger and middle finger,
were uninjured, while the other two with the ulnar side (nearly
the one half,) of the hand and wrist joint were dreadfully lace-
rated, it was determined in consultation, to attempt to save the
limb, even with the risk of tetanus, and the certainty of articu-ar
inflammation. The ring and little fingers, with their metacarpal
bones, and about one half of the two carpal rows, the unciformc,
the pisiforme, cuneiformc, and one half of the os magnum, were
removed, (in presence of many of the students,) and the wound
covered as far as it could be with the remaining integuments.
The hand was placed upon a splint and first dressed with adhe-
sive strips and simple cerate, and afterwards with chloride of
lime. The inflammation in the joint ran its course without
much suppuration, but it was not until the 29th of March that
the case was dismissed* This 1 attributed to the constitution of
the patient not being very good, and to the very cold and un-
pleasant weather during the time of his confinement.

I saw Mr. JM. a few days since : he is Hist recovering the use
of his thumb and fore-finger, but the middle one is still very stiff.
The patient is well pleased thai (he whole hand was not sacrificed.

Case Gth. Aneurism from Anastomosis on lite head Suc-
cessful excision of //.--Peter, aged about 45 years, belonging

1838.] Operations on thc^ Bye. By Prof. Dugas.. G47

to Mr. Angus Martin, received three years ago, a blow over
the left posterior inferior angle of the parietal bone of the crani-
um. Soon after this he discovered a small tumour which gra_
dually increased to the size of a turkey egg, there being also a
second one attached to it, about as large as a pigeon's egg. They
were situated in the course of the occipital branch of the temporal
artery. Being well covered by the scalp, no extraordinary pul-
sation was remarked in them. I was requested to remove them
on account of their inconvenience and continual growth. In a
hasty dissection of them in the anatomical theatre of the College,
the patient having arrived after the hour appointed, the knife
penetrated the largest tumour, when the blood gushed forth in a
large stream. The finger of an assistant immediately controled
the hemorrhage, and the tumours were hastily removed, without
of course cutting into them again. But two arteries required
the ligature, and the wound healed rapidly. The tumours ap-
peared to be made up of a congeries of dilated blood-vessels
emptied of blood, the two were[scarccly larger than the end of the
thumb.

ARTICLE II.

Operations on the Eye by Professor Dugas. Reported hy
W. II. Robert, M. D. late Demonstrator of Anatomy in
the Medical College of Georgia.

Affections of the eye may be either confined in their effects to the
organ of vision, or extended by sympathy so as to implicate the
general health. It therefore becomes necessary in the treat-
ment of affections of this important organ to direct our attention
not only to the eye itself, but also to the influence of the local
disease, on parts more remote. By so doing, instances will oc-
casionally be presented in which it will become the duty of Sur-
geon to remove the organ already incapacitated for vision, and
even to destroy one not yet entirely lost, in order to render life

048 Operations on the Eye. By Prof. Dugas. [June,

comfortable. These reflections are induced by recalling several
operations I witnessed performed by Professor Dugas, during
the past year, and whose history I will briefly narrate.

Case 1. Destruction of the Eye by Hooping-Cough. In
April 1S37, the daughter of Col. II. G. L., of Macon, about six
years of age, was brought to this city and placed under the care
of Dr. D. She had some years previously, when affected with
the hooping-cough, and in a violent paroxism, ruptured some
of the blood-vessels within one eye, by which vision was entir
destroyed. From that time the eye gradually increased to double
its natural size, became highly painful, protruded to such a
degree as to prevent the closing of the eyelids, and was frequent-
ly attacked with intense inflammations, requiring the most ener-
getic treatment for its subjection. The other eye, sympathizing
strongly with it, was also occasionally affected with symptoms
of ophthalmia, and the child's general health was continually
kept delicate. There being no other alternative than the remo-
val of the diseased organ, either in totality or in part, Dr. D.
determined to evacuate its contents by excising its anterior sur-
face. He accordingly passed a tenaculum through the cornea,
the whole of which was then removed with a straight bistouri,
without touching the schlerotica. Dr. D. prefers the use of the
tenaculum to either of the methods usually recommended. The
aqueous humour was found very abundant, the lens reduced to
a soft pulp, and the vitriour humous amalgamated with a dark
bloody matter. About one half of the contents immediately
flowed out ; the balance gradually escaped in the course of a few
days, and in a few weeks the case was discharged. The coats
of the eye had contracted and cicatrized, leaving a small tuber-
cle, to which may be appended an artificial eye. No unpleas-
ant effects supervened, and, save the first and second nights, the
patient had but little pain.

Case 2nd. Destruction of the Eye by Purulent Ophthal
mia. A negro child about four years of age, belonging to Col.
J. McK. had in her infancy suffered a severe attack of purulent
ophthalmia, which terminated in opacity of the cornea, and con-
sequent loss of sight. The eye increased in volume enormously,
and presented a similar appearance to that in the above case.
The child was brought to town in August 1837, and was sub-
jected by Dr. D. to excision of the cornea, and evacuation of Jhe

humour. No unpleasant symptoms supervened, and the patient
was sent home in a well.

-se 3d. Staphyloma following acute Ophthalmia. In this
individual, (Susan, a colored woman about thirty years of age,
belonging to S. H., Esq.) alter a violent and obstinate attack of
acute ophthalmia, occurring without evident cause, was presented
to Dr. D., who found vision entirely destroyed, the body ot the
eye about the natural size, but the cornea protruding like a nipple
between the eyelids. The patient suffered almost continual
pain in the eye, which frequently ed to the divisions of

pain of nerves, at their exit from the supra and infra
orbitar foramina. Inflammation would frequently be developed
I ie conjunctiva of the affected eye, and implicate by sympa-
thy, that of the other.

On the 20th of November 1S37, Dr. D. operated in like man-
ner as in the two above case, and with similar and complete suc-
cess.

Case 4th. Ossification of the Capsule of the Lens, Chro-
nic Iritis, fyc. Nace, a field hand, about twenty-five years of
age, the property of J. HI., Esq. was sent to Dr. D. in January
1838. He had been incapacitated for work during the last three
or four years by pain in one eye, as well as above and below the
orbit, which occasionally became excrutiating; light was utterly
insupportable, and the conjunctiva was frequently much inflam-
ed and infiltrated, at which times the other eye would become
more or less red and watry. Dr. D. found him in the follow-
ing condition : size of the globe normal; cornea perfectly trans-
parent and very slightly flattened when compared with the other;
conjunctiva much injected ; lens opaque and white; pupil ex-
tremely contracted and unchanged by alternate exposure to light
and darkness, although light was extremely painful ; secretion
of tears profuse whenever the lids were separated ; the pain such "
as scarcely to permit sleep at night.

Leech; ral bleeding, blisters, poultices, mercurials,

iodine, &c. had been used without relief. Dr. D. now applied
belladonna to the eye, in order to ascertain whether the iris was
attached to the capsule of the lens. It was repeatedly applied
without occasion^ lightest dilatation of the pupil. What

was to be done in such a catu .' To persist in the use of medicinal
preparations promised nothing ; to operate for cataract, either

650 Operations on the Eye. By Prof. Dugas. [June,

by depression or extraction, when the iris was adherent, and the
fifth nerve as well as the delicate tissues to which it was distri-
buted, had been affected several years, was equally unadvisable.
Yet the patient was unwilling to endure his suffering any longer, .
if possible to avoid it, and, moreover, there was some danger of
the other eye becoming impaired by further delay. The only
alternative was the destruction of the eye. I^r. D. accordingly,
on the 20th January, removed the cornea. The auqeous hu-
mour escaped, but the lens still remaining, a cataract needle was
introduced to break up its attachments. The iris adhered firmly
to the capsule of the lens, the anterior portion of which was
completely ossified, and the posterior considerably thickened and
opaque. The lens itself was of a pulpy consistence. The ve-
trious humours escaped, the eye sunk, and cicatrization readily
took place without further trouble. The servant in a lew weeks
returned to his usual labour, and has not since experienced any
uneasiness in either eye.

It will be remembered that in this case, vision was not entirely
lost, for light was always perceived and attended with pain ;
yet the operation was determined on as the only means which
promised comfort to the patient, and the removal the danger of
losing the other eye. It is true the ossification of the capsule of
the lens had not been recognized, nor are there any indications
by which such a state can be distinguished from ordinary opacity
of this membrane. The existance of the ossification served
however, to confirm the correctness of the practice. It cannot
be denied that much circumspection should be exercised in de-
termining on the destruction of so important an organ, yet the
case before us is unquestionably one in which such practice was
the legitimate deduction ol sound principles, and the result has
been the restoration of ease to one who had led a wretched exis-
tence during the scveraUprcceding years.

Before closing this paper, I will take occasion to relate the
history of a case of " Congenital Cataract," in which Dr. D. ope-
rated successfully on both eyes. The subject was a negro child
about three years of age, (the property of Maj. W. P. D.,) who
was born with a cataract in each eye, and consequently had
never seen. The pupils contracted readily when exposed to a
strong light, and the child was in fine health. A mild cathartic
and the application of belladonna as usual, were the only prepa-

1838.] Operations on the Eye. By Prof. Dugas..

ratory means used, and on the 8th of June 1836, Dr. D. operated
on the left eye. The cataract was found fluid, the capsule was
thoroughly broken up, and the needle withdrawn. With the
exception of a slight conjunctivitis, which readily yielded to
laxatives, saturnine lotions, &c. there were no unpleasant effects.
Belladonna was occasionally applied in order to prevent the pos-
sibility of adhesion of the iris.

The right eye was operated on, on the 21st of the same
month ; the lens was here foitnd soft, and was readily crushed
with its capsule, and portions pressed into the anterior chamber
of the eye. On the 5th day no inflammation had supervened.
Absorption was still proceeding rapidly in the left eye, and the
child was sent back to the country. Her vision continued to
improve as absorption advanced, she was soon enabled to run
about without a guide, and to amuse herself with playthings.
She now can readily see and pick up a pin thrown to her ; thus
evincing as complete a restoration of vision as is ever obtained
under similar circumstances.

One of the most inveterate obstacles to the use of the new
function, was a spasmodic and incessant agitation or vascillation
of the eyes, which prevented the child from directing or fixing
them on any object. Never having been before subjected to the
influence of the will, the muscles of the eye had assumed this
kind of involuntary action, and it was not without the utmost
difficulty, and the lapse of many months, that volition assumed
its empire over them. Even to this day, (two years after the
operation,) it has to contend with the spasmodic action, although
it more readily vanquishes it than formerly. It is presumed that
the ascendancy of volition will ultimatety be complete.

652 Inductive Medicine. [June,

\

PART II.
REVIEWS AND EXTRACTS

Inductive Medicine.

We regret that Dr. Craigie's "Elements of the Practice of
Physic, presenting a view of the present state ot special Patholo- .
gy and Therapeutics," a large and valuable octavo volume has
not yet come to hand. From the reviews of the work, Dr. Cn a i-
gie appears to be a talented and independant writer, and, so far
as his subject allows, original. We extract from the Medico-
Chirurgical, the following definitions, which seem clear and
explicit, and calculated to subserve the purpose of Inductive
Medicine, and prove its handmaids in the detection of the elements
of sound reasoning, and in leading to clear and^accurate conclu-
sions.

Medicine he defines to be "the art of distinguishing, pre-
venting, and curing diseases."

Disease, he makes "to consist in that change in the proper-
ties, or structure of any tissue or organ, which renders it unfit for
the performance of its actions or functions, according to the laws
of the healthy frame."

Etiology, is " the doctrine of causes." The formation of
diseases is understood to depend on the presence, or previous
operation of certain circumstance which are classed together
under the general name of causes. The department which un-
dertakes to investigate the nature and operation of these agents
is denominated Etiology"

Remote causes arc "all those circumstances which are
observed to produce in animal bodies, sickness or morbid action .
These are distinguished intopn disposing causes^ or those which
induce a disposition to disease ; and exciting, or occasional ca
or those which, when the disposition is already established, rouse
it into action and give rise to actual disease." The former, Dr.

1S38.1 Inductive Medicine, 653

Johnson observes, include what are denominated internal causes,

and the diatheses morboscc of the schools. The latter comprise
"all those circumstances or accidents, the operation of which
upon the frame is followed, more or less directly, by the estab-
) ishment of definite morbid action." Every occasional or exter-
nal cause, may, by habitual, continued or repeated operation,
give rise to effects which constitute morbid predisposition, and
hence may become at once an occasional, exciting or external
cause, and a predisposing or internal one. The best examples
of the combination are presented by the effects of terrestrial or
miasmatic emanations of marshy, insalubrious and malarial dis-
tricts, the effects of residence in tropical and hot climates, whilst
the solar heat is intense ; and the effects of the habitual use of
spirituous, vinous and fermented liquors." Dr. C. thinly it
would be best to banish the term "proximate cause of disease"
from the usage of physicians, and to substitute in its place the
term "pathological cause, or simply pathological character of
the disease, which would have been a definite signification."
To this Dr. Johnson objects. "If," says Dr. J. "causes are
divided into remote and proximate, the change of terms by the
banishment of one and the substitution of another, does not
render the signification one whit less vague and erroneous, &c."
But it appears to us that Dr. J. begs the question in saying " if
causes are divided into remote and proximate" Dr. 0. dis
tinctly proposes to banish the term proximate from the usages
of physicians, and does not divide into remote and proximate,
and doubtless for very good reasons. Dr. J. asks "if there are
no proximate causes of disease then?" certainly there are proxi-
mate causes of all events. That which is without the interven-
tion of any other phenomenon between it and the effect is, in
truth, the proximate cause, and there should never have been
any other difficulty in settling this matter, but that of ascertain-
ing the fact of causation ; nor would there ever have been, but
for the folly of going into the facts of those changes of properties,
or structure of organs or tissues which render them unfit for the
performance of their functions according to the laws of health.
It is true that the whole train of causation and of morbid phe-
nomena, Hs but a concatenation of cause and effect; and in the
phenomena of disease, whilst one phenomenon is the effect of a

054 ictive Medicine. [June,

Ciause of disease, it may itself also be a cause of another link in
the chain of morbid phenomena. But it is true, that the moment
that structure of function deviates from the true physiological
state or kind, that moment is disorder or disease produced, and
is not to be considered, in distinguishing the proximate cause of
an event called disease, as the cause, but as the primary effect
of the cause. Let us illustrate this idea a little farther. A man
resides for a sufficient time in a malarial district, and becomes
predisposed to fever. The predisposition alone is not apt to
produce fever. But if, with this predisposition, he be exposed to
cold, fever is produced, and of that type to which the predispo-
sing cause disposed him. In this case, the cold is the occasio-
nal, exciting, or if Dr. Johnson please, the proximate cause of
the^iisease, or whole train of morbid phenomena which follow
under the name of bilious fever, without the intervension of any
other cause, or even obvious phenomenon. The spasm of the
capillaries, if such be the first obvious morbid phenomenon or
effect, is not therefore the proximate cause, as has been said, but
is in truth the primary effect the first known link in the chain
of actual morbid phenomena. The cold, is, in this case, actually
proxime, and therefore is the cause of the next, and through
it the succeeding phenomena which are the disease itself,
consisting of the various derangements of functions, &c. in
the system. But the character of these derangements will be
modified by the peculiarities of the existing predispositiou. If
there be a bilious predisposition, bilious will be the character of
the succeeding disease, unless there be other modifiers concern-
ed, in which case, these will also share influence in the effects.
Thus if the man be greatly predisposed to bilious' disease, with
a slight cold as an occasional cause, he has a fever decidedly, or
entirely of bilious type, and more or less malignant or benign,
according to the circumstances of the predisposition, because
effects are proportionate to causation. But if, labouring more or
less under this predisposition, he suffer violent effects from cold
as an occasional cause of disease, he will probably suffer an in-
mmatory attack, and if slightly, or not at all predisposed to
bilious disease, the occasional cause, cold, will be found to have
produced the inflammatory lever unmodified, or not materially
dined by any other predisposition than that which belongs to

1838.] Inductive Medicine,

the true physiological state. Hence the difference in the pre-
vailing diseases of summer, autumn, winter and spring. The
same may be said of those epidemics which often prevail, as
scarlatina, influenza, &c.

But Dr. J. as well as Dr. Craigie and all others of old observa-
tion, must have witnessed ;the perplexities and the disputations
amongst the profession, in endeavouring to determine and dis-
tinguish the proximate cause of disease, and must well know
in order to retain some where in use this pretty anglicised latin
word it has been changed from place to place, and from one
meaning to another, until, in order to avoid the possibility of
contesting its proximity by the interposition of some otner be-
tween it and the effect, disease, it was at length, as it yet contin-
ues to be defined, the disease itself; thus actually translating it
altogether from the whole catalogue of causes contradistinctly
considered, and making it the primary effect of noxious causes,
or the actual disease, the cause of which was the object of
pursuit. Thus it became nothing but a perplexity. There is
probably no small matter, or rather, definition in medicine, more
certain to be enquired about by the pupil, than the meaning of
(C proximate cause" And when this enquiry comes, what can
the preceptor reply that conveys intelligence ? If he answer ac-
cording to the present acceptation of the term, he must say < it is
the disease itself;' which leaves the pupil with words surely,
but with no more ideas of causation, than does the definition of
life in the language of a certain author : that " life is the totality
of those function which resist death." We think therefore Dr.
C. has acted most wisely in dropping its use, for it had become a
most nonsensical encumbrance, as it is in use. We see no objec-
tion to Dr. Craigie's devision of causes: perhaps a little differ-
ence of nomenclature might have been more agreeable to the
common usage in reasoning process ; as predisposing and ex-
citing, or passive and active, &c.

Nosogeny, or the formation of diseases, ^0(roT r^or. "The only
legitimate mode of forming a correct theory of the formation of
diseases, is to study the operation of remote causes generally
to observe their effects on the human body and its organs, and to
endeavour to trace the connexion between the operation of these
causes and the morbid changes induced in the course of various
disease."

Inductive ^Medicine. [Juno,

This remark of Dr Craigie is very correct and important, as
the remote predisposing- cause is generally, as before observed,
the modifier of the type of fever.

Nosology. "With the view of communicating just ideas of
the resemblances and affinities, as well as the differences of di-
sease, and exhibiting correct views of their mutual relations, it is
usual to distribute diseases in a certain method or order. The
general principle of pathological distinction, is to arrange diseases
into certain tribes or assemblages, according to their resemblan-
ces and their dissimilitudes, in imitation of the arrangements of
natural history, &c. In distributing diseases in this manner, it
is nec%ssary to distinguish each class, order, family genus, and
species, by a certain number of characters by which it may be
known from those which most closely resemble it, and to desig-
nate'each, thus distinguished, by an appropriate character or
appellation. Nosology may therefore be distinguished into two
divisions :

" Nosotaxy, or the distribution and classification of diseases ;
and

Nosonomy, or the nomenclature of diseases."

Dr. Craigie adopts for himself, as the basis of classific dis-
tinction, the pathological nature of the different morbid processes,
and subdivides these as nearly as may be, according to the ana-
tomical arrangement of the textures and organs Of the animal
body. These bear a very close analogy with Dr. Good's ar-
rangement, and less liable than any other arrangement, to over-
rule the rights of induction, or the true philosophy of each indi-
vidual disease rights which belong to every practitioner, and
which should be freely exercised in dcterming the diagnosis,
the pathology and the prognosis, as well as the general and special
therapeutics of every individual case, no matter to what class,
order, genus, or species it may have been said to belong.

"Nosogbaph, or Semeiograpiiy, the department of practi-
cal medicine which describes diseases according to their symp-
toms these being divided into essential, pathognomonic, or
diagnostic ', general jand accessory, but not necessary; and
secondary or supervening, the symptomata symptomatum and
symptomata supervenientia of authors," "It is of the utmost
importance for the physician to observe carefully, aud distin-

1S38.1 Inductive Medic 057

guish accurately the different classes of symptoms; arid as this

cannot be accomplished without very just and accurate ideas on
pathology, general and special, it becomes impossible in practical
application to disjoin the knowledge of morbid processes from
that of their characteristic symptoms ; and the whole subject of
the study of symptoms is to connect them with their appropriate
morbid or pathological causes, &c. If we could repose confi-
dence in the accuracy of our observation, and in the constancy
of the relation established between these diagnostic si^ns and the
pathological state of the organs, that part of medicine which con-
sists in recognizing and distin^uishino: diseases would then be
a perfect art.'5 Though pathological researches have tended
greatly to diminish the number of uncertainties and obscurities
between symptoms and other causes, still Dr. C. acknowledges
that perfection in this department is still remote ; and that "the
physician has still daily occasion to remark the fallaciousness of
some of his most usual diagnostic means ; and the progress of
various diseases affords examples of complication and obscurity
which make him feel forcibly the conjectural nature of his art,
until symptoms so unequivocal have taken place, that diagnosis
is no longer practically useful."

" Pathology The science which enables the practitioner,
in any given case, or number of cases of disease to form, from
the attentive consideration of the external signs and symptoms,
an idea as accurate as possible, of the nature and extent of the
morbid action or actions in the tissues and organs of the living
body a science of great extent, and embracing several subdi-
visions. These are,

Pathological Physiology, or the assemblage of facts obtained
by the study and comparison of the actions and functions obser-
vable in the healthy body, and their variations in the different
morbid states of particular organs, or of the system at large."
And " Pathological Chemistry, which from the knowledge pos-
sessed^ the natural conditions and chemical constitution of the
different fluids of the animal body, and of the changes which
take place during disease, enables the physician to determine
nature of those changes. And

Pathological Anatomy, a third species of information, derived
from the careful inspection of the organs of the bodies of those

658 Inductive Medicine. [Juno,

cut off by disease; regarding the effects, and occasionally re-
garding the nature of the morbid action."'

" Pathology and symptomatology are so closely and necessarily
allied, that neither can properly exist alone, or be cultivated apart.
Every fact and principle of pathology derives its value from the
explanation which it affords of any symptom or set of symptoms ;
and it is totally impossible to establish a rational symptomatolo-
gy, without a collection of such facts and principles. Hence the
great object of pathological inquiry is to enable the physician to
distinguish between essential, or pathognomonic, and general, or
common, or accessory symptoms ; and above all, to determine
from the presence of each, the stage, degree, intensity and effect
of the morbid process, with the view of treatment."

Therapeutics, comprehends two great divisions. One, Pro-
phylactics, relating to the means of maintaining health and pre-
venting disease ; the other, therapeutics, properly so called : each
tracing

The prophylactic or preventive department, containing

a. Hygiene.
' b. Medical Police.

The Thereapeutic, or curative department, including

a. General Therapeutics.

b. Special Therapeutics.

Hygiene, relating to the general rules established by physiolo-
gy, etiology and pathology, for the preservation of health.

Medical Police, refering to those measures either of precau-
tion, prevention, or rectification, which are adopted, to counter-
act the operation of deleterious principles or morbific agents
generally on the human frame.

General Theraputics, the mode of applying these general
principles to the treatment of individual diseases.

If, in all instances, the pathological cause or causes were per-
fectly known, and if, at the same time, we were perfectly ac-
quainted with agents which could operate on these causes direct-
ly, and efficiently, and remove them entirely, the principles of
therapeutics would rest on a sure and immutable foundation, the
curative indications would be simply to remove the pathological
cause, or causes of the disease, and the healing art would be
reduced to great certainty and precision. This perfection, how-
ever, pathology has not yet attained ; and the principal lesson

183S.] Cases of Laceration of the Iris. 659

which it has taught, is that which is named cure, consists not in
the positive removal or extinction of a morbid processby direct
means, but in the gradual subsidence of the morbid action un-
der a favorable combination of circumstances, and the restora-
tion of the actions of health. The cure of disease by direct
means is indeed very rarely practicable ; and though pathologi-
cal causes are known, our means do not operate on them ; while
in the diseases in which the causes are unknown, curative indi-
cations must be derived from symptoms. While healthy prop-
erties are impaired, we know no agent by which they can be
directly restored; when vital action is perverted or deranged,
we possess no means of immediately rectifying it, but must be
satisfied with using those means under which it is most likely to
rectify itself ; and when morbid processes are established, they
pursue a certain course, and tend to a particular termination, and
all that the physician can do, is to moderate and restrain the
violence of the process so much, as to prevent it from injuring
important and essential organs."

Cases of Laceration of the Iris.

Dr. Davenport has favoured the pages of the Boston Med.
fy Surg. Journal, with some interesting cases of laceration of
the iris ; the first of which is beautifully illustrated by a colour-
ed engraving. He offers this case "as an illustration of lacera-
tion and prolapse of the iris,-' whilst at the same time, it presents
a remarkable instance of the power of nature in restoring the
eye from the effects of a severe injury. This accident was occa-
sioned by a severe blow upon the left eye, from a fragment of
stone. Dr. D. "saw him soon after the accident occurred, and
found an oblique and irregular wound about four lines in ex-
tent, of the inferior and inner part of the cornea : a considerable
portion of the inferior and nasal part of the iris lorn from the
ciliary ligament which protruded through the wound and hunor
down upon the eye ball ; the anterior and posterior chambers of
the eye filled with blood, so as entirely to conceal from view the
pupil and remainder of the iris. The cornea was prominent,'
from the contents of the globe, particularly at the wounded part,
c 3

6G0 Cases of Laceration of the Iris. . [June,

The conjunctiva was somewhat injected, great pain in the eye
ball; vision in this eye, extinct, at least for the present."'

The protruding portion of the iris was removed with forceps
and curved scissors, in order to prevent additional irritation from
exposure and friction. Some bloody serrum escaped from the
anterior chamber, after which, the edges of the wound were
carefully adjusted, and compresses wet with cojd water secured
by a light bandage. Arenesection, a brisk cathartic and antiphlo-
gistic regimen were adopted. This operation was performed on
Tuesday, the 2Sth September. Dr. D. did not see him again
until Saturday, during which time he had been visited by an
irregular practitioner who had treated the eye with belladonna,
and the frequent application of a powder of calomel and white
sugar, blown into the eye through a quill, (perhaps as the farm-
ers do their horses, to "cut the film? from' the eye.) When
seen on Saturday, the inflammation had of course, considerably
increased, with evidences of deep seated ophthalmia pain
severe, but not constant; and was confined chiefly to the brow,
temple, and cheek bone. The intolerance of light, and the lach- .
rymation were moderate. Notwithstanding \he severity of in-
flammation which had supervened, the absorption of the effused
blood in the chambers of the eye* hud gone on so extensively that
the superior point of the iris, and a small portion of the dilated
pupil could be seen, and the patient could distinguish the outline
of large objects. On Monday, two days after, the absorption was
found to have brought to view nearly all the superior half of the
iris and pupil, and the iris was found of a light greenish instead
of its natural blue colour. The circum-orbital pain had dimin-
ished and the power of vision improved. ' The use of purga-
tives and cold wet pledgets was continued. On Wednesday
shrcads and patches, of blood were visible in the pupil, and also
red spots on the surface of the iris, and a portion of coagulated
blood remained above and below the corneal wound, and the
accidental pupil had become visible at the lower part of the
anterior chamber, though somewhal obscured by acoagulum of
blood. On Friday, the 9th day alter the accident, "scarcely a
trace of blood remained in the anterior chamber. The false,
accidental pupil, (as illustrated by the accompanying plate,)
presented the appearance of being a continuation or enlarge-

1S3S.] es of Laceration of the Iris. GG1

ment of the natural pupil, forming with thai, a large and
irregular aperture, by the Separation of one half of the cir-
cumference or external margin of lite iris from the ciliary
ligament. A point of the pupillary margin of the iris, of a
triangular shape had become^ engaged in, and ad fared firmly
to the opaque cicatrix, left by the wound of the cornea. The
cicatrix formed a point of attachment for this pari of the iris,
by which the inferior boundary of the natural pupil was in
some measure preserved. This cicatrix is shown in. the plate
by a while opaque line, crossing the cornea obliquely just below
the axis of vision, and peeping through the substance of that
tunic. On Saturday, the entire pupil was found black and
transparent, or nearly so ; the iris however, not manifesting* any
contraction or dilatation on changes of light. The patient could
distinguish large print with the injured eye, but not without a
misty appearance. There had not appeared at any time, mus-
cat volitantes, nor luminous spectra. In a few days he returned
to his work,' guarding the eye with a pasteboard shade.

On the 12th of November, the wound of the cornea had be-
come firmly cicatrised, the cornea retaining its natural size and
convexity. The superior half of the iris dilated and contracted
well ; the inferior being attached to the cornea, was of course,
without motion. By contracting the lids very slightly, vision
was equally as perfect as in the sound eye."

Dr. Davenport- has had three other well-marked cases of
laceration of the iris, the result of injury ; the first of which was
complicated with opacity of the lens and may be seen in a form-
er number of the Boston Med. fy t$urg. Journal. The second,
when first seen was accompanied with complete amaurosis, and
the iris had nearly disappeared. The third was that of a young
blacksmith, who was struck by a piece of iron upon the right
eye with such violence, that the cornea was ruptured transverse-
ly, with a loss of part of the contents of the globe. On recovery,
'; the greater part of the cornea was found opaque, with closure
of the natural pupil and obliteration of the anterior chamber,
except at the upper margin of the cornea, where a false pupil
had been formed by the detachment of the iris from the liga-
ment. Through the pupil, he can see large objects pretty dis-
tinctly. Luminous bodies, as the flame of a candle, to this eye

062 Nature of Inflammation. [June,

appeared to be greatly multiplied ; so that he could at any time
amuse himself with an illumination by the aid of three or four
common lights. The central image was, however, the most dis-
tinct; those extending horizontally on either side becoming
more faint until they ceased to make any impression on the reti-
na. It is worthy of remark, that, within a few months after the
above mentioned accident, the left eye, without any other as-
signable cause, was attacked with aquo-capsulitis, or inflamma-
tion of the lining membrane of the anterior chamber, involving
finally the iris. This eye recovered chiefly under, the use of
depletory remedies, followed by an active course of calomel and
opium."

Nature of Inflammation.

In writing on this very interesting subject, Ur. M. Hall, in
his book on the principles of Theory and Practice of Medicine,
" institutes an inquiry into the condition of the true capillary,
the secretory, absorbent and newly-formed vessels, the minute j
arteries and veins, the large vessels, the heart, and blood." The
result of these inquiries is his conclusion " that each cause of
inflammation induces such a physical effect upon the internal
surface of the capillaries as leads to the adherence of the globu-
les of the blood to it, and to its ultimate secretion. This stag-
nation augments as the inflammatidn increases and becomes
more diffused ; and seems t.o constitute the essential character of
the disease. Any augmented or diminished action, on the appli-
cation of stimuli, he has never been able to detect.

"Obstructed capillary circulation leads to enlargement of the
minute arteries arteries being muscular organs, and muscu-
lar organs always augmenting in the ratio of the opposition to
be overcome by them in the performance of those functions.
The condition of the minute veins is not ascertained.

The secerning vessels are variously affected by the various
degrees of inflammatory action an effusion of scrum, marking
the lower ; a secretion of albumino-librinc, the higher degrees ;
and pus, the highest of all.

The functions of the absorbent vessels are not less modified
than those of the secerning vessels.

After lymph has been long poured out, it becomes organized,
and numerous vesssels carrying blood, are observed in it, pur-

1838.1 Nature of Inflammation. G03

suing a various course: those have been delineated by Monro,
Hunter, and Lobstein, as seen in cicatrix, in portions of pendu-
lous coagulable lymph, in layers of lymph, and in coagula of
blood.

The enlargement of the blood-vessels is not confined to the
minute arteries the larger arteries, in the immediate vicinity of
the inflamed part, also enlarge. It is not certainly known how
far this enlarged condition of the arteries extends from the seat
of inflammation, but that the inflammation of a part affects, not
only the arteries and veins in its vicinity, but also the heart, is
gathered from facts like these: The pulse of the radial artery,
leading to an inflamed hand, is more forcible than that of the
other wrist ; the veins leading from the inflamed hand, yield
their blood more freely than the similar veins of the other arm ;
the heart also beats with an augmented impulse and greater
frequency.

'The blood is well known to undergo considerable changes in
inflammation: the appearances of cupping and of buff, of the
blood drawn from a vein, are sufficient evidence of this fact; if
the same appearances have not been observed so familiarly upon
arterial blood, it is probably because arteriotomy is much less
frequently performed than venesection.' Hall.

In Dr! Hall's chapter on this very interesting part of the sub-
ject before us, he has equally aimed to preserve facts and to dis-
card conjectures, rightly observing, that The condition of
medical science still requires this separation of what is ascertain-
ed from what is only imagined of the true from the false : to
discover the former, and to detect the latter, are equal benefits
conferred upontour profession. A sentence, which it would be
well for every medical student to carry with him throughout his
curriculum and one, which every medical author would do well
to set before his eyes whenever he takes the pen into his hand.
Medicine, perhaps, more than any other science, if we except at
the present time political economy and divinity, is inundated
with conjectures and vain imaginations, and crude and undiges-
ted fancies, the abortions of prolific but feeble minds and facts,
comparitively few, come to be disregarded because of the super-
fluities of fiction, than which, there is nothing more evil, more
dangerous, or more destructive of true science. Medico-Chi-
rurgical Review.

The changes in the condition of Inflammation. According
to Dr. Hall, these are eight :

"1. Resolution is the mere subsidence of inflammatory ac-
tion, and the only proper termination of the process. It is effec-
ted by the absorbent power of the minute veins, and the contrac-
tile power of the capillaries."

GGi Nature of Inflammation. [Jane,

2. QMcma. " The interstitial effusion of limpid albumen or
serum, viewed distinctly from the repletion and enlarged size of
the capillary and minute vessels constitutes a>demay the white
swelling ofififlamed parts, sometimes accompanying, sometimes
following, the actual inflammation. It frequently remains in
the form of a pale and colourless swelling, alter the vascular
repletion and the consequent redness having disappeared. In
one case inflammation of the larynx it is frequently the cause
of death, obstructing the upper orifice of the tranchea and sus-
pending respiration.

3. Adhesion is affected by an intervening deposite of coagu-
lable lympth, or albumino-fibrine. When this takes place, un-
interrupted by other processes, it is what surgeons designate
union by the first intention. When other processes intervene,
the effect is slower and modified, and cicatrization takes place.
Both these occur in all the tissues of the body alike, whether
internal or external, whether canals or cavities.

4. In softening, or ramollissement, the opposite adhesion takes
place the natural cohesion of the inflammed part is destroyed ;
it, likewise, occurs in all the tissues; most, in the parenchyma-
tous substance and mucous membranes ; least, in serous mem-
branes. In certain tissues, as that of the lung, it is analogous
to mortification of other tissues. In others, the brain, for in-
stance, it corresponds to suppuration.

5. Induration belongs to chronic, softening to acute inflam-
mation, and depends upon the interstitial deposit, probably of
cOagulable lymph, or albumino-fibrine.'

6. Ulceration. "Interstitial obsorption, whereby the* super-
ficies of a part is removed, produces ulceration, which is simple;
6r healthy ; spreading, or phagedenic ; and destructive, or
sloughing. In the external cutaneous, internal mucous, and
synovial membranes, it is common ; in the serous membranes,
rare; and it obtains the name of suppuration when it takes
place in parenchymatous substances ; and caries, in bony tex-
< ures. It may proceed from, or it may yield to an opposite process,
as cicatrization. And, as an ulcerating is always an absorbing
surface, it may give rise to enlargement of neighbouring glands,
and to inflammation of the absorbent vessels. The affection
of the inguinal glands in chancre, and also in gonorrhoea, is a
fact familiar to us all. .Is there ulceration in all cases of the
latter malady ihus complicated with biibp?" Hall.

7. Suppuration, The observations oi Burgmarin, Hunter; &c.
prove that purulent fluid may be formed without any breach of
surface. This is suppuration, and one of the most frequent
results of inflammation -exhibiting itself in the four varieties of
abscess, where the.pus is enclosed in an orbicular cavity ; fistu*
la, where it fturrdws between th$ adjacent textures ; and infil-

iite of Inflammation. 665

[ration and diffusion when it gets into the meshes of the cellular
membrane, or is spread over the surface upon which it is formed.
8. Gangrene. Inflammation sometimes leads to gangrene^
and to sphacelus ; terms, conventionally employed to designate
the former, the condition of the part when on the point of
losing iis Vitality the latter, that of a.part absolutely dead, and
ready to pass into a state of decomposition.

"Nothing can illustrate the varied phenomena of inflamma-
tion, on a minute scale, better than the variolous pustule; at
first, we have simple inflammation inflammation of a seba-
ceous gland redness and tumor; on the third and fourth days
we have the effusion of serum, a vesicle, the duct of the gland
tying down its centre ; on the fifth day, we observe the effusion
otpus around this central point, and within the external margin
of the vesicle, the intervening space being occupied by transpa-
rent serum, and appearing of a red, flesh-colour, well contrasted
with the opaque pus, and there is a surrounding areola of deep
inflammation ; on the seventh or eighth day, the serum is entire-
ly replaced by pus ; and on the eighth or ninth, the central duct
has been absorbed or has sloughed, and the pustule is orbicular.
There is also the early effusion of lymph : and, at a subsequent
period, it is found that a portion of the cutis vera has sloughed.
The whole of this series of the phenomena of inflammation is
followed by cicatrization, again implying the effusion of lymph."
Hall.

"The Modifications of Inflammation, are most impor-
tant and interesting, as these arise out of the varieties of texture,
or are produced by differences in the conditions of the system.
Inflammation of the serous membranes is marked by redness,
and found to consist in points, stars, and arborescent forms,
arising, 1st, from enlarged vessels, and, 2d, from cxtravasated
portions of blood. Dryness, from checked secretion, is rare ;
augmented effusion from the surface of the membrane, more
general. This effusion consists of serum, coagulable lymph,
albumino-fibrine hi layers, or adhesions, pus or puriform fluid ;
sanguineous scrum. An important, although negative charac-
ter of inflammation of the serous membrane is, that it seldom
leads to ulceration.

In inflammation of the mucous membrane there is redness,
injection, enlarged blood vessels, increased secretion of mucus,
at first transparent, afterwards opaque and puriform, re-assuming
its transparence as the inflammation subsides. The exudation
of coagulable lymph is rarely seen, although we have instances
of it in the trachea in croup ; and in the uterus, in dysmenorrhea,
when it forms, in each case, a false membrane.

Corresponding as inflammation o( the mucous membranes
does in these respects to that of the serous membranes, it is, in

666 Nature of Inflammation. [June,

others, as. diametrically opposed. Inflamed mucous membranes
soften and 2ilccrate:-~evems happily uncommon in inflamed
serous membranes."

"Suppose an abscess in the liver. It enlarges ; it proceeds to
evacuate itself; this may be effected externally, in the hypo-
chondrium; internally, into the intestines, or through the lungs
into the bronchia. In the first case, adhesive inflammation unites
the two contiguous portions of peritonaeum, and the subsequent
ulcerative process pierces through these two folds of membrane
with the intervening layer of albumino-fibrine and then
through the external integuments. The cavity of the abdomen
is protected and preserved from an effusion of pus, which would
immediately induce a terrible and fatal peritonitis! In the
second case, similar phenomena occur, and the abscess finds an
issue into the intestine, the abdomen being still protected and
preserved as before. In the third case, the two contiguous peri-
toneal surfaces first, and then the two adjacent pleural surfaces,
unite by albumino-fibrous adhesions ; and, lastly, the ulcerative
process proceeds to open a way for the pus through these adhe-
rent membranes, the intervening diaphragm, the cellular tissue,
and the bronchial parietes, and the pus is eventually expecto-
rated, the cavity of the abdomen and that of the pleura being
equally preserved !" Hall.

Mr. Travers tied the duodenum of a dog, so as completely to
^obstruct the passage. On the two following days the. animal
was sick, and his respiration hurried. On the fifth day he
passed a copious stool of the same appearance as the fluid dis-
charged by vomiting. From this time the sickness ceased, the
breathing became natural, he fed and digested his food the cure
was established by the fifteenth day, and he was then killed. On
examination, the lacteal system was well displayed. The folds
of a portion of omentum contiguous to the strictured intestine
adhered to it. A slight depression was observed in the circum-
ference of the gut which was then carefully laid open the
villi were turgid with chyle the villous surface more vascular
and deeper-coloured than usual. A transverse fissure marked
the seat of the ligature. The edges f the section were distinctly
everted, and the appearance corresponded with that of the union
by suture.

In another dog, a fold of ileum was strangulated, a little above
the angle. The strangulated piece below it was then cut off,
and the cut extremities joincM by ligature. The wound was
sewed up, the animal not appearing" to suffer materially the
second and third days lie was sick and vomited bile, but drank
a little milk and water. On the fourth day, passed a solid
stool. In a month, was perfectly well, and shot. The exter-

1S3S.] Naturi of Inflarwm 667

nal wound was healed. There was no appearance o/ disease in

the abdomen and but few adhesions of the peritoneum. The

ileon lay thus ^^"^>upon tlie vertebrae. At the internal .-m
gles the sides adhered to each other. The opposite was closed
by adhesions to the omentum and neighbouring intestine. I p.
on laying open the tube, it appeared that the ligature at the ends
of the gut had been discharged through the canal. At one
point, the line of union was scarcely completed ; and there ap-
peared a .little cyst, like an abscess, communicating with the
tube, in which the tied ends of the gut had been lodged previous-
ly to their being voided.

"In all these cases," and in the similar ones of hernia, and of
intussusception, <;thc contiguous points of serous membrane
unite by the effusion of albummo-librhie; the interior tissues,
with the mucous membrane, are served by the ulcerative pro-
cess. The cavity of the peritoneum is guarded from the irrup-
tion of the faecal matters by adhesive inflammation ; whilst the
canal of the intestine is presetted entire by the ulcerative ! Now
let us suppose these properties of the serous and mucous mem-
branes reserved ! Every inflammation of the former would tend
to ulceration and abscess ; every inflammation of the latter, to
close a canal !" Hall.

Inflammation is also modified by the different conditions of the
system. In rubeola, for instance, the phlogistic diathesis pre-
vails. In scarlatina, the character of the local inflammation and
its attendant fever, is frequently typhoid. And changes take
place corresponding to these differences. The changes which
take place in inflammation occurring in the phlogistic diathesis,
as has already been shown from Dr. Hall's work, are aptly illus-
trated by the varioloid inflammation, in the distinct form; that
which takes place when the: typhoid type is present, receives a
similar illustration from the pen of our author in the confluent
Variety the papula1, are less hard and and elevated; the serum
and pus are less distinctly characterized, and resemble an unde-
fined, and sometimes bloody, .sanies] the progress, the circular
and orbicular forms, the periods, the termination of the eruption,
are less marked, less distinct ; and .there is a great disposition to
slough, and consequently, to scars.

We have been led into so full an analysis of this subject, as
treated by l)rs. Hall and Craigie, that we have little space left for
considering the chapters devoted by the former to "the distinc-
tions between inflammation. and irritation and congestion'' " the
influence of inflammation" and "thediil'iision of inflammation?3
and must very briefly notice that which treats of .inflamma-
tion as a airalirc means. Without'il. the art of surgery could'
not exist. Every operation implies the resources of Nature in
u 4

G6S On Blood-letting. [June.

healing divided parts. As a curative measure it is employed by
Nature and Art. By the iormer, in apoplexy, in the formation
of an artificial anus, and in conducting pus from an hepatic ab-
scess to the; surface; by the latter, in the cure ot artificial anus
as devised by Dupuytrcn, in the cure of hydrocele by injection
in that of prolapsus uteri and in the treatment of nanus, &c, -
the two latter applications of it are claimed by Dr. II. as inven-
tions of liis own.

On Blood '-fatten

-

The following' observations of Dr. Hall, as affording a rule
for blood-letting in all cases in which it requires to be fully insti-
tuted, a rule for guarding at once against inefficient and undue
blood-letting, and a source of correct diagnosis, are worthy of
the close attention of every practitioner. We give them, with
Dr. Johnson's remarks which accompany them in the Review.

It is a remarkable fact, that " if several patients of similar
strength and constitution, but affected by dissimilar diseases, be
respectively placed in the erect position and bled to deliquiuin,
they will be found to lose very various quantities of blood," one
will bear the loss of 50, GO, or even 70 ounces, without syncope
another will not endure to lose four ounces.

The rationale appears to be, that, "different diseases induce in
ihc constitution different powers or susceptibilities in regard to
the effects of loss of blood. Each disease seems to have its own
virtue in this respect: this is determined by placing the patient
perfectly erect, and bleeding to incipient syncope: the quantity
of blood which Hows is the measure of the protective influence
of the disease in one class of cases, and 'of its influence in super-
inducing a susceptibility to the effects of loss of blood on the
other. In cases in which it is doubtful whether the pain or oth-
er local affections be the effect of inflammation or of irritation,
the question is immediately determined by placing the patient
upright and looking upwards, and bleeding to incipient syn-
cbpe : in inflammation much blood flows ; in irritation very little,
The violence of the disease* the powers of the system, and the
due measure of the remedy, are determined at the same time.
There is, pi my opinion, too single fact in pin/sic of equal im-
portance and value*, in the diagnosis of acute diseases? and in
the use of a powerful remedy." Hall.

An interresting scale of diseases may be formed representing
these properties.

Persons in health, of moderate strength, will generally faint
if bled in the erect posture, on taking fifteen ounces of blood.
Dr. 11.. has known 70 ozs. to be taken in a sitting posture, in the

1838.] On Blobd-lcttiv 669

tendency to apoplexy without Syncope ! but tliera.se is na ex-
treme one. I'.itients with meningitis^ encephalitis-, pleiiritis, or
pneumonia, frequently lose 35 ounces of blood without fainting!
In bronchitis, kttle more is borne to be lost than in health. A
stout person in fever will frequently faint on losing 10, 12, or 14
ounces of blood. In intestinal irritation, with urgent symp-
toms, even the abstraction of nine or ten ounces will generally
induce deliqujum. In delirium tremens. or puerperal deliri-
um, the patient soon faints. . And the same thing is observed in
eases of violent reaction, arising from loss of blood. In dyspep-
sia, hysteria, and chlorosis, the susceptibility to syncope is very
great, and Dr. 11. has known a patient, of good strength, affected
with cholera, faint on taking four, ounces of blood, who had pre-.
viously lost, under the influence of inflamed mamma, 20 ounces
without faintness: Paralysis from laceration of the brain and
apoplexy from concussion, before reaction takes place, or inflam-
mation is established, are cases also of diminished tolerance. It
must also be carefully noticed that cases of accident do not bear
the loss of blood like those of inflammation.

These facts afford : 1. A rule for blood-letting, in aU cases hi
which it requires to be fully instituted. 2. A guard at once
against inefficient aridjundue blood-letting. And 3. A source of
diagnosis.

The rule is suited to the degree as well as the duration of the
disease; and is not Iqss adapted to those most frequent of all
events, mi&efycases inflammation and irritation conjoined.

"It is difficult to'say whether more injury has been done by
an undue or by an inefficient; use of the lancet.' In inflamma-
tion we must bleed fully in irritation we must bleed cautiously.
Inefficient blood-letting in the former, and undue blood-letting
in the latter, arc alike dangerous or even fatal to the patient:
from both extremes we arc guardefl by the rule which I propose.
By directing the patient to be placed in the erect position, and
bled to incipient deliquium, we shall often take much, more blood
than we should have ventured to prescribe to be taken in inflam-
mation, and very much less than we might be supposed. to direct
in irritation ; and in both these cases the rule conducts to the
only safe mode of treatment. And, if much blood has flowed
before the occurrence of syncope, inflammation must be suspec-
ted ; if little, we must suspect that, however similar the symp-
toms, the case is in fact of a different nature perhaps irritation
perhaps exhaustion/' Hall.

He has also found that, in every case in which early syncope
occurs from blood-letting, the more remote effects of loss of blood,
as reaction, or sinking, arc also very liable to occur: and it is in
these cases that sudden dissolution has always followed the
use of the lancet. There is, in every point of view, intolerance.

670 On Eloed-letting. [June,

ofloss of blood. The reverse of all this obtains in inflammation,
which seems to be incompatible, to a certain decree, with the
effects ofloss of blood; these are, on the other hand, very apt to
supervene as the inflammatory action subsides.

Dr. Hall very wisely solicits the .co-operation of the profession
in the further investigation of this subject, not imagining his
"rules1 to be without exceptions, and rightly deeming it "as
important that these should be pointed put, aft that the rule itself
should be established."' He makes mention, himself, of two
such. \\\ some cases of fever requiring blood-letting, the patient
cannot support the erect position : in such a case the arm must
be first prepared ; the vein should then be promptly opened ;
and then the patient should be gently' raised and supported in
the upright position, carefully avoiding all muscular effort. On
the other hand, in the case of congestion of the brain from ex-
haustion, there is not such early syncope from blood-letting as
might be expected ; and yet it is obvious that the system cannot
bear the loss of blood.

"Two objections have been made in reference to this rule for
the administration of blood-letting: the first is,, that in some
cases not inflammatory,, more blood might be taken than the
patient could bear to lose in order to institute the test ; my reply
is, that such cases are not included in my proposition, which
only relates to cases in which blood-letting is required to be
fully instituted." The second is, that- in some cases 'more
blood ought to be taken than would flow before syncope is in-
duced. I greatly doubt this assertion ; I think it replete with
peril ; but if it be true, let the patient be replaced in the recum-
bent posture, wait a lew minutes, and again let the blood tlow ;
we have at least ascertained the state of tolerance ofloss of blood,
and this fact will guide us in determining how much more blood
may be withdrawn ; it is a fact added ) it is knowledge substi-
tuted for what must otherwise be ignorance

The results of Dr. Hall's investigations appear in a* table,
which we shall add. to the pages of this review, fully agreeing
with its very able author, thai No one can pass the eye over it
without behlg impressed with the value and importance of the
facts it displays; with the diagnostic, the guide, the guard, which
it aflbrds.

I, A.ugIekted Tolerance. -Represented bj the mean quantity oi blood which
flows before incipient syncope.

Congestion <>f the brain. J

I. Tendency to apoplexy /

2 Apoplexy from congestion *

Inflammation of the serous membr;

Retraction of the Leg cured by art Operation. 671

'elllliti.-: ^

kJ. Henritis |

3. Peritonitis ). :\xx. l.x.

'[. Inflammation of the synovial membrane, |
ami ofthc fibrous textures oi the joints. J

III. Inflammation of the parenchyma of organs.

1. Of the substance of die brain ")

2. Pneumonia r.

::. Hepatitis j" ^%x v

1. Inflammation ofthc mamma, &c J

IV. Inflammation of the skin ami mucous membranes.

1 . Erysipelas 1

2. 15 roue hit is > ?XVI.

I >\ senteria )

II ] If: v r/ntv Tolerance. This deperids on the age, )

strength, &c., and on the degree of thickness ot' > ^xv.
the parietes of the heart, and is about )

III DIMINISHED TOLEKANpE.

1. Fevers iatid eruptive fevers 5XH- X1V-

2. Delirium tremens and puerperal delirium gx. xu.

3. La(K'ration, or eoucussion of the.brain . : J

1. Accidents before establishment ofinflam- I

mation \?

I ntestinal irritation J

(i. Dyspepsia. Chlorosis s vm.

7- Cholera iv.

Retraction -of the Leg cured by an Operation,

We arc Imppy in having it in our power to remark, that a few
days previous to that on which the Gazette Medicate came to
hand, which contained the following case and operation of M.
J iUTenSj a case of similar nature was presented for the inspec-
tion of the professor of Surgery in the Medical College of Geor-
gia, T)r. P. F. Eve. who at once decided on the operation for
extirpating the diseased and disorganized muscle, and his patient
is now under preparation for the operation. The muscle- affect-
ed in lli is case is the adductor longns femoris, causing an incon-
venient and distressing adduction of the left lower extremity.
The particulars of this case we hope to afford our readers in a
future No. of this Journal. Dr. Eve has not yet seen the March
No. of the Gazette Medicate.

Brilat (Gerard,) a sailor fell from the top of the mast and
lodged with the posterior part of the right thigh on the yard arm.
For sixteen days he was treated on board the ship for a contu-
sion of the soli parts, and sent to the Hospital of Antwerp the
29th July, 1836. For three months., warm baths and camphora-

072 Retraction of the Leg cured by an. Operation. [Juno,

ted frictions were employed. In the month of October, the pa-
tient was confided to the care of M. Lutens, surgeon of the same
hospital. On examination he found that the right thigh present-
ed no traces of ecchymosis or of inflammatory swelling; it was
more meagre than the left, pressure on it occasioned very acute
pain, and extending from the ischium to the knee, were felt a
insistence and hardness analogous to the tension of a large hem-
pen cord. The leg was flexed upon the thigh and could not he
extended. In endeavouring to extend two bridles would be
developed which passed evidently to the- lateral parts of the knee
and were incorporated with the tendon of the semitendinosus to
which they communicated a great degree of tension. In what-
ever position die extremity was placed, and notwithstanding all
the care to divert the attention of the patient, the slightest
relaxation of the muscles could not be obtained. The patient
was able to raise the limb in totality and flex it upon the pelvis :
in order to march he was obliged to make use of a cane or a
crutch, to carry the point of the right foot outwards, the heel in-
wards and ilex the leg on the right foot.

The coxo -femoral and femoro-tibiai articulations were exempt
from lesion.

The patient declared that the flexion of his leg supervened
slowly and insensibly.

M. Lutens endeavoured first, but unsuccessfully, to straighten
the leg by means of Dessaut's apparatus arid afterwards by the
application of a straight splint with padding in the hollow of the
.ham.

Cupping, emollient cataplasms, warm baths, solution of hydro-
chlorate of ammonia, handling of the muscles, blisters, moxas.
repeated tractions by the hands of assistants were tried, but with-
out success.

"1 had not, up to that moment," says the author, c formed a
precise idea of the nature of the disease. I thought, however,
that by making two lateral incisions upon the sides of the knee
and incising the most tense parts, it would be possible to extend
the leg. * * * * * * * * *

Two months elapsed without, making any farther attempts,
when M. Lutens determined to carry his idea of making the
incisions on the sides of the knee into execution.

Operation. A straight bistoury was slipped under the tendon
of the semi-tendinosus, two fingers breadth above its inferior
attachment, and with a single cut I. incised the tendon, the femo-
ral aponeurosis and the skin.

Externally. I made a horizontal incision above the externa]
condyle opposite to the direction 'of the fibres of the biceps mus-
cle, the aponeurosis which envelops this muscle and forms a
sheath for it. was divided, and the muscle exposed extensively
to view.

183S.J Retraction, of the Leg cured by an Operation. 673

The operation was performed in a few moments and gave rise
to no accidents, the tendon of the semi:tendinosus was forcibly
retracted upwards, and the patient requested to make efforts to
extend the leg-. The next day no hardness was felt in the thigh,
pressure no longer occasioned the slightest pain, and the leg could
be placed with the greatest facility in a state of perfect extension.
The patient passed a good day; not the slightest tendency to
retraction recurred, and no injurious consequences resulted from
the application of the bandage to retain the limb in an extended
position*.

From that moment he was enabled to walk in the wards with-
out support. The bandage was removed the 30th day after its
application. Three months subsequently the patient walked
with sufficient regularity and without a cane ; he had some dif-
ficulty in flexing the leg on the thigh in which he succeeded
only by contracting the muscles slowly. Every hope may be
indulged that exercise and a few baths will restore to the soft
parts their usual pliency.

No doubt can exist respecting the cause of disease in this case ;
the patient having experienced a violent contusion on the poste-
rior surface of the thigh, the flexor muscles of the leg were by
degrees contracted in a permanent manner so as to keep the leg
constantly extended.

The medication employed was based upon the true indications
of the disease. We have, however one capital observation to
make respecting the mode of its accomplishment. The elonga-
tion of the tendons of the biceps, semi-membranosus and semi-
tendinosus muscles presenting in this case the same conditions as
that of the tendo achilles in club-loot, the operation should have
been performed in the manner employed by Stromayer for the
section of the latter tendon. In this way the section would have
been simplified, and the operator would avoid the serious reac-
tion which is always to be apprehended when the operation is
performed in the manner followed by M. Lutens. The same
operation has been performed recently at Paris, by M. Duval,
with success, and in the mode we have just indicated, but that
of M. Lutens has the merit of priority and is worthy of fixing
attention.

674 New mode of operating for lite cure of Cirsocdc. [June,

VJ W mode of operating for the radical care of Cirsocdc by
Dr. I1ai\ \.\i).

It would be too tedious to describe all the modes which the
ancients and moderns have employed in the treatment of Cirso^
cele, we proceed to mention only the principal ones by grouping
them according to their resemblance with each other*

The most recent operations that have been employed for the'
radical cure of this disease may be referred to the two following
methods. _ In the first which may be called the method by punc-
ture, are included the modes of operating by the seton and by
acupuncture proposed by M. M. Friche and Davat. They have
the inconvenience of being of difficult application and of expo-
sing -to phlebitis by acting at once on the internal surface of the
vessels.

The second method or that by compression is preferable and
includes the plan which Delpcch employed with agglutinative
strips after the previous incision of the integuments, the twisted
suture of M. Velpeau and the pincers of M.^Breschet. Of ll
the two former modes labour still under the disadvantage of re-
quiring the application ofsurgical means to several vessels at one
time. The pincers of M. Breschet, which arc intended to em-
brace only the dilated vessels seem to him to have succeeded
miraculously. To these methods which do not yet possess the
guaranty of complete success. Mr. Ilaynauld has proposed a third
from which he has just obtained a complete success. He prac-
tised it in the following manner. He seized with both hands
the spermatic Cord of the diseased side, pushing externally the
vas deferens which can be easily recognised by its hardness,
then pinchingup the scrotum with the index finger and scrotum
of the left hand so as to embrace the spermatic vessels and
nerves he passed a curved needle threaded with a waxed thread
through the base of the fold dins formed. The scrotum aban-
doned to itself left a space of about an inch between the point of
entrance and of escape of (be needle. The pails (bus comprised
are then tied with the thread upon a thick cylinder of linen o[
inconsiderable length placed previously between the thread and
skin. The ligature should be tied over the cylinder with such
a knot as to be able to augment or diminish the compression ac-
cording to the indications. Small pledgets smeared with cerate
for the punctures and a simple compress complete the dressing.
The patient should remain m bed, the testicles being supported
by a cushion and a diet as inleculent as possible and emollient
enemata prescribed.

The inflammation which results is very slight and after two or
three days the thread may be drawn more tightly over a new

1838.] Tubercular Affections of the

cylinder. If a too intense inflammation supervene the ligature
should be loosened and again tightened after having employed
emollient cataplasms lor two or three days. . In proportion as
the parts situated before the ligature are divided and those situ-
ated behind it cicatrize, it should be drawn tighter by degrees.
On the fourteenth or fifteenth day nothing remains except the
skin, which M. Raynauld divides with a bistoury passed along
a director. The patients are generally cured in about twenty-
five days.

The vessels obliterated are transformed into a fibrous imper-
meable cord. The circulation is interrupted by the obliteration
of the two branches of the spermatic artery, but \Ve know that
the epigastric artery furnishes always a branch which passes
along the inferior face of the vas deferens and which adhering
to its fibrous envelop has followed it in its displacement. This
branch anastomoses with those of the spermatic artery below the
point where this artery is ordinarily tied at its divisions, on the
other hand the artery of the .septum furnished by the internal
pudic may also concur in the re-establishment of the circulation.
However this may be, the atrophy of the testicle has not taken
place in any of the cases cited by the author. The venous cir-
culation takes place chiefly by the communication of the sper-"
matic veins with the vesical plexus and by the dorsal vein of
the penis. The author thinks that the nervous influence is
reestablished through the same nerves, cicatrisation immediate-
ly succeeding their section.

M. Jules Roux cites two important cases of cure. In one of
the patients whom he saw six months after the cure, the testicle
was in a normal state and the veins formerly dilated were con-
verted into cords sensible to the touch. As to ourselves we thin'k
these facts arc encouraging but they are not sufficient to author-
ize us to pronounce upon the excellence of this method, or upon
its complete harmlessness. Journal des conn. Med-Chir.

So?ne considerations on the Tubercular Affections fo the
Lungs by Louis Delabergf, Aiifege of the Faculty of
Medicine of Paris.

(2d articl.

We pass now to. other considerations, for the subject of the
case not beinof the same, gives rise to different observations. A
woman aged 32, a native of Savoy and a pamphlet stitcher by

* Src vol. II. No. '/> of this Journal.
e5

67(5 Tubercular Affections of the Lungs. [June,

profession, was admitted into the Hopital des cliniques 13th of
last November. She had black hair, black and sparkling eyes,
long eyelashes, meagre face, cheeks coloured, especially towards
evening, the nails* well formed and her body obviously emaciat-
ed. The patient had a child presenting all the appearances of
good health; she belonged to a family which though numerous
had never presented in any of its members the marks of a scro-
phulous disposition. She had been affected eight months previ-
ously with a catarrh, without any appreciable "cause.

From this period the patient coughed habitually, the cough
being more frequent at night, and occurred sometimes with such
intensity, (the paroxysms then succeeding each other so prompt-
ly as to resemble the whooping-cough), that the contents of the
stomach would be. rejected by vomiting. A pain somewhat in-
tense existed under the sternum and extended on the right to the
sub-clavicular region the patient did not complain of dyspnoea.
but it was evident that she did not correctly appreciate her own
condition, for the respiratory movements were rapid, the sputa
were thick, yellowish, some of them striated with opaque matter
and some slightly transparent, the latter well defined at their
margins, the former slightly viscid, and running together into a
common mass : the patient has never had haemoptysis.

The chest seemed to be well formed, except that it presented
a slight depression in the .sub-clavicular region on the right'and
left. Percussion revealed an evident dullness in the right sub-
clavicular region. When the patient was requested to open her
mouth and a brisk percussion performed on the thoracic wall, the
sound of the cracked pot (bruist de pot fele) was manifestly pro-
duced. On auscultation were heard the gurgling sound, the
cavernous respiration and pectoriliquy when the patient spoke.
She complained of palpitations which took place at intervals in
the precordial region : the pulsations. werelOS, equal, small regu-
lar and but little resistent, she was much debilitated, complained
of some cephalalgia- and towards evening of a burning heat of
the skin, when the cheeks were coloured of a vivid red." In the
morning a slight, cutaneous transpiration, the perspiration not
abundant, urine flowed easily, and the catamenia had been sup-
pressed for two months. .' The tongue thin, pointed, without fur,
tolerably intense thirst, a] petite weal;, digestion difficult, abdo-
men slightly prominent ana somewhat painful in the epigastric
region and towards the sides, diarrhoea- occurred at intervals
and caused a remark;. ciation.

Gum water, a julep with a. grain of opium, enemata with the
addition of a grain .of tli >hfectioppii) repose m bed, rice

cream, constituted- the | mi ordered for the patient.

For several days the symptonis remained stationary, but in the
month o{ December, an apthoud eruption occurred in the mouth.

1838.1 Tubercular Affections of the Lungs. 077

vomiting recurred with considerable frequence, the diarrhoea
increased, the patient in of marasmus and debil-

ity and died 6th December. TJie autopsy was made thirty-six
hours after death. The, body presented the most marked emaci-
ation, no rigidity of the members ; percussion still developed a
dull sound in the right subclavicular region.' The superior
lobe of the' lung was hollowed into a large, anfractuous, multi-
locular cavern, anteriorly the excavation was limited only by a
thin condensed, firm, resistent portion of the pulmonary tissue
which adhered strongly to the pleura costalis; the viscus was
infiltrated with tubercles more or less voluminous and thus pre-
sented an unusual volume. The left lung was less seriously
affected although, it was the seat of tubercles agglomerated at the
root of the bronchi and in the thickness of the interlobular fis-
sure. The liver was voluminous, and depressed by a large sul-
cus on a level with the costal cartilages, it descended on the
right side, its tissue was yellowish and it greased the scalpel
which penetrated into it.

The mucous membrane of the great extremity of the stomach
was soft and thin without any trace of the deptheritic inflammation
of the mouth. The intestines presented ulcerations with eleva-
ted margins in different, points and particularly towards the low-
er end of the ilium. Such were the cheif alterations which we
observed in the cadaver of this woman.

This case cannot excite curiosity to the same degree as that
which we have previously reported : it belongs evidently to the
category of facts which have been so well stifdied, so well ana-
lysed in modern times by M. M. Louis and Andral. We have re-
ported it here only to serve as a text for a few considerations. In
the circumstances just related we find some facts which deserve
to arrest the attention of the physician. This obstinate, parox-
ysmal cough, which, by the frequent concussions that charac-
terised it, determined vomition, the dyspnoea, which, though
pronounced, was not perceived by the patient, the sound of the
cracked pot in the sub-clavicular region, an anormal sound
which for a long time we considered as the pathognomonic sign
of a pulmonary excavation, the eruption of the buccal mucous
membrane which denotes a great period of the disease, and lastly,
the amenorrhoea which requires some consideration in the treat-
ment of the tubercular affection of the lungs. Such are the inte-
resting facts which we desire to analyse and to which it appears
to us useful that the attention of observers should be directed.

There is no physician who does not feel the necessity of know-
ing some signs by whose aid the first manifestations of pulmon-
ary tubercles may be detected.

It is indeed generally believed that by opposing tli disease
in its incipiency we will triumph more easily over the accidents

u/S Tubercular Affections of the Lungs. [June,

which it develops and have more power in arresting a lesion
which must inevitably produce death. It was with the view of
elucidating science upon this subject that Mr. Piorry has per-
fected the means employed in the percussion of the chest that
. M. M. Aridral, Louis and Jackson have specified a singular al-
teration in the sound of the pulmonary expansion, an alteration
which gives some rudeness to tin's sound and Which is particu-
larly characterised by a sound more marked at expiration than
at inspiration ; while the contrary takes place in a normal state.
It was with the same object that M. Hirtz has specified a con-
traction of the osseous caoe of the thorax, a contraction which
had been before indicated by M. Hopeins-Ramadge and on
.which the English physician has founded- the most singular,
therapeutic indications. Can we admit at the present day that
these different data are capable of leading to a precise diagnosis
of the tubercular affection in its nascent state ? When we attend
the visits of M. Louis We are astonished at the precision of his
diagnosis, and each person is tempted to believe that he may
arrive at the same result of astonishing exactness. But unfor-
tunately this is not the case with the great majority of physicians,
who want the vast experience which results from a scrupulous
. attention directed for a long time to the same phenomena ; and
we would willingly believe ourselves more skilful if we possess-
ed some new light in diagnosticating the tubercular affections of
the lungs.

. It is upon a fact of this' nature that we believe it necessary to
insist in these remarks. The paroxysmal cough, with convul-
sive concussions characterised by numerous expirations, inter-
rupted like those of whooping-cough ; this cough causing an
expulsion of "the gastric contents seems to us to possess some
value m the diagnosis ;of the tubercular affection at its origin
especially when it has persisted for a considerable time. * * *
* Such a cough is found in most of the subjects attacked
with pulmonary tubercles as revealing the first manifestation of
their disease. Physicians are frequently astonished to see pa-
rents having the tubercular affection in a high degree of devel-
bpement, and labouring under jrreat difficulty of respiration, who
do not however complain of dyspnoea. It is difficult for them
to conceit how the pulmonary parenchyma can experience a
disorganisation so profound as to cause great difficulty of respira-
tion, without painfully affecting the patients, and yet it would
not be impossible to account for the difficuly they have in appre-
ciating their own condition.

When a modification of our health supervenes progressively,

we are but little qualified to appreciate its danger and import-

doubtless to the slow progress of the tubercular af-

lerfjon thai we must attribute the calm state enjoyed by phthisi-

183$ Tubercular Affections of the Lungs. 679

cat. patients who? have arrived at the most advanceel period of
their disease, and that disposition to hope which we observe in
most subjects suffering with pulmonary turbercles;

' We have Cor a long time considered the sound of the cracked
pot as the pathognomonic sign of the tubercular affection. We
heard once in a young child the gurgling sound, the cavernous
respiration and pectoriliquy, we supposed the existence of a
cavern in the pulmonary parenchyma ; the results of our investi-
gation were confirmed by a man whose skill could not be ques-
tioned, by Dr. Constant who lias just died in the flower of his age
leaving many precious labours unfinished: every thing induced
us to believe that our diagnosis was correct, the child died, no
tubercle was found in the lungs or in the bronchial glands but
a chronic bronchitis and a dilation of the bronchi. We re-peru-
sed attentively the works of M. M. Louis and Andral and ascer-
tained that they had seen cases analogous to the one which had
deceived us. Since that period we have performed percussion with
great attention upon all the phthisical patients submitted to our
observation, and we have remarked that in all of them the sound
of the cracked pot is manifested when a cavern of some volume
exists, when it is situated superficially in the sub-clavicular re-
gion, when the percussion is strong and brisk and when the pa-
tient keeps his mouth open; This sound may be perfectly com-
pared to that which is produced by bringing the hands forcibly
together, so that their palmar faces look towards each other
and then pressing a sudden movement upon one of them; the
air imprisoned between the two faces which constitute a cavity
and being expelled produces, while passing through the narrow
openings, a slight metallic sound. This sign we repeat appear-
ed to us to be constant and we experienced a satisfaction in be-
lieving that we possessed a pathognomonic sign by which to de-''
tect the presence of excavations in the sub-clavicular region.
Kecently we have discovered that this sign may lead to error.
A patient was admitted into the Ilopital des cliniques, with a
delicate deteriorated constitution ; he was affected very severely
with rubeola and with the special bronchitis which complicates
almost always the rubeolic affection. The exanthematous dis-
ease ran regularly through its periods, the cough remained ob-
stinate and painful the matter expectorated was opaque, whi-
tish swimming in a transparent serosity the respiration was fre-
quent and the fever continued presenting exacerbations towards
the evening Some purgatives were administered but nothing
relieved this serious pathological state. Mucous rales existed
throughout the entire chest, the patient was much oppressed, the
skin was warm, burning, a copious diarrhoea supervened and
the marasmus became extreme. A new exploration of the chest
was made by auscultation and percussion. The mucous rale

680 Tubercular Affeclwns of the tnings. [.Tunc,

existed in the \et\ su6-clayiciilar region j this rale was displaced
by cough and the the effort of respiration, the -respiration was
somewhat tubular or blowing at this place, purcussion o-ave
rise to no dulness of* sound but very evidently to the sound of
the cracked pot. Hie frail constitution of the patient, the path-
ological disorders which existed, the important commemorative
circumstance of the rubeola whose traces still remained, and
which has the singular property of Hastening the progress of the
tubercular affection, and especially the sound of the cracked pot
induced us to diagnosticate in this patient a cavern situated in
the left sub-clavicular region. The tjisease advanced and the
patient succumbed in a state approaching asphyxia. The au-
topsy was carefully made, the lungs were very much engorged
the principal divisions of the bronchi red and their capillary
divisions inflamed; no appearance of tubercles or ofbroncheal
dilatations or of a cavern was found. The error is here evident
the pathognomonic sign has deceived, the sound of the cracked
pot can no longer be regarded as the unerring index of a tuber-
cular excavation and henceforth it-is indispensable to invoke
another proof. We should not- however reject too hastily the
value of the sign in question if we reflect that percussion denoted
only a very slight obscurity of sound in the left sub-clavicular
region, and if we agree with M. Louis that this circumstance
ought to prevent the supposition of a tubercular agglomeration
or cavern, we will perceive the necessity of associating the re-
sults of a gentle percussion with those of a strong percussion,
before pronouncing upon the semeiologic value of the sound of
the cracked pot. This phenomenon then cannot be of any
value to us unless when it coincides with an obscurity of sound
developed, by a gentle percussion, and already we have had oc-
casion to verify the correctness of thissio-n.

The diptheritic modification of the mucous membrane of the
mouth- is a serious accident in the tubercular affection of the
lungs, it is manifested generally in young subjects, when the de-
bility is pronounced and is almost always accompanied with a
continual febrile movement tolerably intense. The cause which
presides over the dcvelopement of this alteration has not yet been
much insisted upon it has been omitted in the descriptions of
many observers. AVould it not be important to know the exact
condition of the patients who are affected with it? Would it
not be useful to study the sympathetic derangements which oc-
cur under its influence, the lesions which accompany it, the prog-
nostic value which it may have, and the means suitable to arn
its progress? Should we not establish the particular-indications
which its treatment demands/ We would be well pleased to
undertakethis task, but as we possess only a few facts upon this
subject we defer its consideration to another moment.

L838-] Tabi

Amenorrhoea ofi to particular indications in the

treatment of the ti ctions of t!i

'practitioners believe that in order to arrest tiie progress of pul-
monary consumption it is important to recall the menstrual flux.
Tins therapeutic rule should be discussed: if. at the comm
ment of phthisis when the signs of the malady ai t little

marked, asuppression of the menses occurs suddenly from some
external modification or from any other cause, if, in consequence
of this suppression the phenomena of pulmonary plethora are
suddenly developed, if the dyspnoea become more evident, the
cough more frequent, if pain arise in different parts of the chest,
Ave should not hesitate in the treatment, it is necessary to repro-
duce the menstrual evacuation. Do we not know that by caus-
ing a habitual congestion in the pelvic organs we afford great
relief to phthisical patients ?

It is not known that M. Trousseau by provoking the formation
of hemorrhoidal tumours and flux has obtained an obvious
amelioration in the accidents and arrested sometimes the pro-
gress of the malady ? But at an advanced period of the d ;
when diarrhoea, colliquative sweats and an abundant, expector-
ation prostrate and debilitate the patient, would we still desire
the production of the menstrual flux? He who attempts to
ameliorate the condition of a patient in an advanced stage of
pulmonary consumption by recalling the menstrual flux which
had been suspended will most frequently accelerate the progress
of the disease. The amenorrhoea is in such a case truly benefi-
cial, at the moment when so many .morbid evacuations exhaust
the unfortunate patient it is useful that the normal flux should
be suppressed; and although this doctrine does not conform
with the opinions of some practitioners, wc nevertheless persist
in repeating it.

To terminate these considerations by giving them some prac-
tical interest, we ask permission to relate the facts upon whose
faith Professor Rostan advises the employment of the seton in
the treatment of the tubercular affection of the lungs. We have
frequently heard this rigorous observer describe tli3 history of
five patients in whom the application of the seton produced an
obvious amelioration and sometimes even retarded definitively
the accidents of phthisis. As these important facts ramain yet
unpublished we believe it will be useful to give a summary of
them.

1st Fact. A lady was taken with intense pains in the right
side of the chest. After a violent chill and a high fever, dyspnoea
and cough soon supervened M. Rostan detected the existence
of pleurisy with effusion. An antiphlogistic treatment suited to
the strength of the patient was employed, and, after six v
an obvious amendment had taken place ; the re-establishment

Tubercular Affections of this Luty [Jiiur.

the patient was complete. Some months passed without the
occurrence of any pathological disturbance. Subsequently, how-
ever, some painful points were manifested anew in the right
side of the chest : cough, expectoration which became every day
more abundant and thicker, a fatiguing dyspnoea and general
debility with emaciation supervened. M. Rostan being again
called in discovered by auscultation and percussion all the
sjgns of a pulmonary excavation. He' proposed a seton in the
right sub-clavicular region the advice was adopted. The
dysphnoea yielding, the cough partly disappeared; the expecto-
ration was less frequent, the sputa lost their opacity, the physi-
cal signs themselves became less distinct and hopejwas entertain-
ed for several years that the patient was 'advancing towards a
perfect recovery. The amelioration however was not sufficient
to lead to a perfect cure, and the patient perished in consequence
of die progress of the tubercular affection.

2nd. Fact. A young physician of Paris was taken with hae-
moptysis at periods more or less distant, he was troubled also by
a cough ; he came to consult M. Rostan. The chest was explor-
ed with the greatest care and no evidence of the tubercular al-
teration found. Demulcent drinks freedom from fatigue and
an antiphlogestic alimentation were recommended. However,
the hasmoptysis, and the cough became more frequent, an habit-
ual dyspnoea excited anew the apprehensions of the patient and
he presented himself again to M. Rostan, desiring, another ex-
amination. Auscultation denoted a slight diminution in the
sound of the vesicular expansion in the left sub-clavicular re-
geon. A consultation of experienced physicians was called who
diagnosticated the existence of tubercles in a state of agglomeiv
ation in the region indicated, The patient then suspended all
labor went to Saint-Mande near Paris and a seton was put in
the vicinity of the diseased part. In 1834 M. Rostan met the
young man who had resumed his professional occupations and
who no longer presented any pulmonary symptoms. Since that
period his respiration has remained perfectly normal and physi-
ological : ths patient is affected at the present time with a white
swelling of the knee joint.

3rd Fact. The wife of a person employed in the Royal Li-
brary had for a long time experienced attacks of a pulmonary
affection which threatened her lite. Alan y physicians saw her
and agreed in recognising the existence of the cavern in the
superior part of om of the lungs ; hectic fever and an abundant
diarrhoea exhausted the patient and it was only thought neces-
sary to employ those palliative means which are generally used
when the patient seems devoted to certain death. M. Rostan
was called in consultation, he ascertained also the desperate
condition of the patient; he proposed however the application of

Tubercular f the Lu,- 6S3

a seton the remedy was Hot accepted without some hesitation,
the progress of the disease was at first suspended, and-iri a short
time hope of care could he indulged.

4th Fact. A Labourer of tolerable robust constitution was
admitted into Hotel Dieu about the year 18^2. He had been
troubled for some time with cough, expectoration, and lisem-
optysis and complained frequently of pains in-the left sub-clavi
cuia'r region. The exploration of his chest was made with
great care, and it was not difficult to ascertain the existence of a
tolerable vast excavation m the left sub-clavicular region and
whose presence was recognised by the following signs : dullness
of sound, cavernous respiration, cavernous cough, gurgling
sound during the cough, pectoriliquy. This man appreciated
the danger of his condition and repeated frequently that his dis-
ease was incurable. Diarrhoea, however, took place only at
intervals and the emaciation was not extreme. M. Rostan advis-
ed a seton which was accordingly applied in the left sub-clavi-
cular region. After a residence of a month and a half in the
hospital, the- patient left without any obvious amelioration. A
year ago he presented himself again before M. Rostan to ask
some relief for a periodical dyspnoea (pulmonary emphysema)
with which he had been affected for several years. We explor-
ed his chest attentively. We observed the cicatrix which result-
ed from the application of the seton in the left sub-clavicular
region which seemed to have experienced a slight depression ;
the sound appeared less distinct towards this region, .but was
augmented on the opposite side : the respiratory murmur of the
affected side not very distinct, but we perceived none of the signs
which had previously revealed the existence of a tubercular af-
fection. Except the periodical dyspnoea he seemed to enjoy ex-
cellent health. His embonpoint was considerable his colour
fresh, the muscular system well developed no fever, appetite
good, and his strength sufficient to perform his labour without
difficulty ; we believe with M. Rostan, that this patient was cur-
ed by the "seton of a tubercular affection which had already
reached its third period.

5th Fact. A woman in the Passage Choiseul, was in the
most advanced stage of pulmonary tubercles without having
derived any benefit from medical assistance. M. Rostau recognis-
ed a considerable cavern in one of the sub-clavicular regions. A
seton was applied in the* vicinity. All the accidents disappeared
as if by enchantment. M. Rostan has not seen the patient sub-
sequently and therefore is ignorant whether the amelioration
persisted or the tubercles were developed.

Journal des Conn. Med. C/tir.

K

684 Correction. Compression of Arteries. [June,

PART III.
MONTHLY PERISCOPE.

Correction.

We are truly grateful to the editors of the Medical Examiner
for promptly informing us of our having failed to give credit to
that excellent and useful periodical, for the first publication of
the lectures of Drs. Jackson and Gerherd, on Epilepsy and
Acute Articular Rheumatism which were reprinted in our two
last numbers. It was undesigned of course, as those courteous
and talented editors mustat.once suppose ; but care should have
prevented such a circumstance. Our printer has general in-
structions to credit every work from which we extract, and all
others through which the extract may have come. Trusting to
his attention to this duty, which has general ly been pretty well
attended to, we have foiled to give that attention to the revise,
which we should have done. We embrace this occasion to re-
new the expression of our approbation of the Medical Exami-
ner, and our gratification in the opportunity it is so well calcula-
ted to afford, of many valuable extracts, for a Journal [intended
chiefly for practical benefits, as the Southern Medical & Surgical
Journal is. Editor.

Compression of Arteries. Letter from A. Petel M. D. to A.

Trousseau.

I request you Sir to insert in the next number of your jour-
nal this letter in which the compression of the carotids which
you have recently proposed, will receive confirmation by two
facts, one of which occurred about 5 years since ; the other is
recent and subsequent to the publication of the article of which
you are author, in the last October number of your journal.

1st Fact. While a student of medicine at the Hospital St.
Louis, I was induced after serious reflections upon apoplexy

183S.] Compression of the Arteries.

and cerebral congestions, to investigate the practicability ofthe
compression of the carotids as a direct therapeutic mean. J re

examined carefully the anatomy ofthe artery on the cad;
and found no place more suitable for the purpose, than the nar-
row space situated between the os hyoides and the thyroid car-
tilage. Here, indeed the internal jugular vein which it is so
important to avoid, the pneumo-gastric .nerves and the great
lympathetics are more separated than at any other spot, from the
carotid artery. The experiment upon myseli confirmed the pos-
sibility of its accomplishment. I ran immediately to my honor-
able instructor, M. Biett, to inform him ofthe plan and enquire
if it had ever been proposed. "The English, said he, have, I
think, proposed, but have not adopted it in consequence of its dif-
ficult if not imposible application. It was with an uncertain
recollection that M. Biett seemed to give this response. 1 observ-
ed that as to the obstacles I could remove them all, and if I re-
collect correctly immediately compressed both the carotids. M.
Biett requested me to make the necessary experiments for the
publication of a memoir upon the subject, or at least to embody
them in my thesis. I formed the latter resolution.

During the year 1832, while I was ac Salpetriere a favoura-
ble opportunity permitted me, for the first time, to compress the
carotids. The case was that of a woman under the influence
of a cerebral congestion with loss of consciousness which had
continued about half an hour, accompanied with lesion of sen-
sation and motion, unequal on both sides of the body. M. Bois-
sy my colleague being present, I exposed my plan to him which
he found new and rational. The compression had scarcely
lasted a minute when consciousness began to return and was soon
re-established. Sensibility and motion returned in less than an
hour, but the side on which the lesion was most appreciable did
not regain its primitive state till some time later. I immediate-
ly bled the patient, and the next day a new attack was arrested
immediately by compression ofthe carotids, which was followed
by a second venesection, and six months afterwards the patient
was discharged without having had any subsequent attacks.
This case you will find in my thesis defended in 1825, 17th
March.

I will add that it is important to make a fold of the skin by
pinching it up before the place where we design to make the
compression, in order that at the moment when the fingers com-
press, the relaxation of this fold may enable the larynx to re-
main free.

2nd Facts. The 13th of last October I was called to visit
the young daughterof M. Facon Elie. This child aged 3 years
is of a lymphatic temperament, the colour of the hair however
b?mg brown. After the occurrence of several sudden vomitions

OSG Academy of Sciences. I Jim

die had been taken with frightful convulsions, the two arms
'twisted upon their axis from without inwardly, the eyes rolled
in their orbits, the pulpils very contracted, the pulse quick;
Sinapisms to the legs setherial potion. The next day, in the
morning new convulsions supervened in consequence of which
the child remained in a comatose state.

Two leeches behind each ear. If the coma persist, two more
leeches will be applied in the evening. In the mean tune I
compressed one of the carotids ; no effect was produced. I com-
pressed borth carotids and in less than a minute the pupils dila-
ted and consciousness returned. This effect continued only dur-
ing the time of the compression which was not persisted in for
want of assistants sufficiently intelligent. Another application
of leeches produced no obvious amelioration. JNo more convul-
sions ; on the contrary the coma and contraction of the pupils
persist, the eye-lids half closed, the eyes turned upwards, the
pulse remains quick.

On the morning of the 15th I withdrew the patient from her
insensibility by compressing the carotids, but it returned how-
ever several times. I endeavoured to instruct the father and
other assistants in the proper mode of making the compression.
They succeeded in dissipating the coma several times during the
day. I arrived in the evening and found the child in the dan-
gerous condition described above. Attempts badly made having
deceived the expectations of the parents, they abandoned them-
selves to despair and inaction, persuaded that nothing could res-
cue their child from the doom that awaited her. However, I
again compressed both carotids with exactness, and hope was
again excited, for the pupils which were always extremely con-
tracted, dilated in less than a minute, the eyes regained their
usual expression, the child raised herself briskly in her cradle,
sat down and asked for her toys. Compression was made from
time to time, coma returned no more, and at the present moment,
after the lapse of a month, the child is healthy. Journal des
Conn. Med. Chir.

Academy of Sciences Comp/cssion of ^Arteries hy M. Mi:-

LA PERT.

M. Melapert has derived great advantage from this mean?;
applied to the carotid arteries in inflammations of the brain.
He believes also, that it may be employed to prevent epilepsy
when announced by precursory signs. By this plan also, may
be diminished the volume of an hypertrophied organ ; and even
a scirrhous degenerescence may be arrested. This means haft

1S3S.] Occlusion of the Vagina during Parturition. 078

the advantage of removing the organ from the influence of the
blood, without exhausting the strength of tin; patient. He con-
cluded by exhibiting a carotid compressor and announced also
Compressors for all the principal arteries which are accessible by
the therapeutic plan. Ibid.

A young woman of Douai was recently delivered, says Le
Liberal du Nurd, of a child, who, like the Torpedo Ele'ctricus,
gave a kind of electrical commotion to the accoucheur. This
electrical child is of the male sex, and of a robust constitution.
lie was placed immediately after birth in a wicker-cradle sup-
ported on an isolating stool with glass legs, and then gave indu-
bitable signs of electricity. He preserved this remarkable prop-
erty for the space of twenty-four hours, and to such a degree that
the physician was enabled to charge a Leyden jar, obtain sparks,
and perioral many physical experiments. La Presse Medicate.

Ca.se of complete occlusion of the Vagina during Parturition,
by Dr. Steinbrenneil

Catherine * : * aged 27, of sanguine temperament and
good constitution, had menstruated regularly from the age of
.sixteen, and was delivered of her first child two years ago;
This delivery, according to her own account, was very labori-
ous, but terminated naturally without the assistance of art. She
declares, however, that the midwife who assisted her, pro-
duced, by means of her nails, some erosions upon the vaginal
parietes. At the time of her first delivery the woman was
unmarried ; she married about eleven months ago : her catame-
nia continued every month until the period of the second con-
ception. Her husband confesses to us that he has not been able
to approach his wile completely, and that the act was always pain-
ful to her. She conceived however a second time and no acci-
dent occurred during her pregnancy. The 28th February, 1-838.
she began to experience the first pains of labor. The midwife
who was called in, attempted to touch, but her finger was arrest
ed in a cul-de-sac near the middle of the vagina, and she could
not find the os tinea?. This was attributed to an anteversion of
the womb, and the patient placed in a suitable position to remedy
the supposed displacement. But the pains becoming stronger
and more frequent without producing any change in the state of
the parts, I was sent for at nine o'clock, P. M. At my arrival 1
found the woman very restless, complaining of intolerable pains
at the lower part of the abdomen; the contractions of the uterus
strong and frequent, the face animated, the pulse very much

6SS Occlusion of // \a During Parturition. [June.

developed, hard and frequent. The finger when introduced into
the vagina was arrested about two and a half inches from the
entrance of the vulva, by a kind of cul-de-sac without any ope-
ning, at the bottom of which was distinguished by the touch a
kind of raphe or linear cicatrix direeted from before posteriorly,
and which was evidently the result of the adhesion of the vaginal
parietes. The adhesion of these parietes was complete, for a
female catheter could not be made to penetrate beyond the cica-
trix. By pressing the cul-de-sac posteriorly in the direction of
the axis of the inferior strait, I could feel a fluctuating mass owing
to the liquor amnii which could not escape externally, and to the
head of the foetus which was free at the superior strait. The
thickness of the posterior wall of the cul-de-sac was perhaps two
or three lines. During the pains the head engaged in the strait,
but ascended after each pain to the place which it previously oc-
cupied. The woman was much agitated and the pains being
strong and frequent, I only bled her to the extent of twelve or
sixteen ounces, ordered an injection for the purpose of evacu-
ating the rectum and waited for a certain time, hoping that the
efforts of nature would be sufficient to overcome the obstacle by
lacerating the adhesion. Two hours after J re-visited the patient,
she appeared to be much fatigued, but no remarkable change had
supervened. The thickness of the cicatrix was perhaps slightly
diminished. 1 believed delay to be useless and even injurious
both to mother and child, and determined to make an incision of
the cicatrix. I was preparing to perform the operation when a
very strong pain supervened and produced at the superior. ex-
tremity of the cicatrix, a rupture sufficiently great to enable me
to introduce the extremity of the little finger; the liquor amnii
escaped immediately through this opening, and the head de-
scended. I enlarged the opening with my index finger; and,
aided by the pains which succeeded each other rapidly, I de-
stroyed easily all the unnatural adhesion of the vaginal parietes,
and, after a few moments, the woman was delivered without
further difficulty of a healthy child. No inflammatory symptom
of the vagina supervened. For fear of obstructing the locheal
discharge, 1 did not introduce charpie into the vagina for the
purpose of preventing new adhesions between the parietiesof the
canal. But by touching from time to time, I ascertained that
the adhesion was not reproduced. The woman was delivered a
few months since of a third child without the slightest obstacle.
****** Journal des Conn. Med. Chir.

1S38.] Gonorrlicca* with l\lal formation of the Urethra. 689

Supplementary Menstruation, by Dr. Cowan.

A robust woman, aged 49, the mother of five children, and
whose menstruation has been regular, having experienced a
sudden fright during her menstrual period, her catamenia disap-
peared entirely for the space of five years, without affecting her
health in any appreciable manner. Two months after, she had
a considerable discharge of blood from the anus. Two or three
months from this occurrence she experienced for the first time, at
the inferior part of the left mamma, a pricking pain, which soon
terminated in a sensation of heat, manifested externally by the
redness of the integuments. These local phenomena termina-
ted finally by an evacuation in the same place, of a serous, colour-
less fluid, which resembled the menstrual secretion only by its
odour. The discharge continued twenty-four hours, when the
surface of the mamma became dry gradually, desquamation en-
sued, and in a few days the skin had resumed its natural appear-
ance. A series of similar phenomena took place immediately
after at the corresponding point of the opposite side, and for four
years this double evacuation has constantly appeared at the men-
strual periods, without any sensible alteration. The nipple is
soft, but no fluid has escaped from it. The woman complains
only of the itching and of the odour, sometimes intolerable, of
this singular evacuation. Ibid.

A curious case of Gonorrhoea, with Malformation of the

Urethra.

A man aged 36 years, the father of four children, was admit-
ted into one of the Infirmaries of London for a urethral blennor-
rhagia which he had contracted by an impure coition. On ex-
amination the urethral canal was found to open inferiorly two
and a half inches behind the gland. A kind of gutter existed
from this point to the gland. The prepuce was entirely defi-
cient posteriorly, the penis destitute of the fraenum, but in its
place existed a small cutaneous band, extending to the place of
the meatus urinarius ; the gland well formed, except that it did
not present the orificium urethra:, a kind of depression indica-
ting the point where the urethra usually opens. The patient
was cured of his blennorrhagia, but the details he furnished re-
specting his generative power are not without some importance
in legal medicine.

On first view of this malformation, it might have been said
that this individual was unfit for genration. The semen could

090 Secale Cornut&m in Amenorrhea. [Jum

be deposited only at the inferior and posterior pari ofthe vagina,
instead of being forced into tlie womb. It was certain, however,
that the four children were Ids. the perfect resemblance between
them and him, leaving no doubt upon this subject. Ibid'

Thymic Asthma by M. William Hughes,

A child of eight or nine months, affected with whooping-
cough, experienced frequently sudden and alarming paroxysms
of suffocation, but which continued only a few minutes. When
I arrived at the place, the child seemed to have recovered. I
supposed that the asthma was owing to some viscid mucus
which adhered to the opening ofthe glottis, and that it was the
disappearance of this mucus which had afforded the sudden
relief. The child continued to improve, the cough diminished
greatly, when a new attack supervened and carried off the little
patient. On opening the body I found a hypertrophy of the thy-
mus gland which filled the anterior mediastinum entirely, and
compressed the bronchcal tubes. Tiie inferior pnrt ofthe gland
covered the summit of the heart and adhered strongly to the
pericardium", the latter contained more fluid than ordinary. The
mucous membrane of the trachea was slightly infiltrated. The
gland weighed eight drachms and five grains: its colour was
natural. Ibid.

Secede Cornutiun in Amenorrhoea . By 1). En&iotti, Phy-
sician of Biclla.

Secale cornutum is not only useful in parturition by stimula-
ting the uterus when in a state of inertia, but is equally efficacious
m amenorrhoea when caused also, and maintained by. a debility
ofthe same organ. In proof the author reports four cases drawn
from his practice ; we shall be content to give the first one.

A. B.. aged 25 years, of a lymphatic temperament and delicate
complexion, married at the age of 17, was delivered favourably
four times, during the three first years of her marriage; four
years after her last delivery, she was tormented with violent
pains, with regular intermissions about, her menstrual periods,
the menstrual discharge being very scanty. This state of suffer-
ing continued six or seven days, after which her health would be
good for the rest of the month. Recourse was had frequently to
leeches, purgatives, baths. &c. but always without success.
The Italian physician tired by the inutility of all these mean ,

1838. J Academy of Sciences. r>(.L

prescribed two drachms of secalc cornutum, mixed with sugar,
to be divided into eight equal doses and taken in two days ; it
was necessary to renew this prescription only once. The fol-
lowing month the menses appeared spontaneously and without
pain. . Since that period she has been free from all embarrass-
ment in menstruation. The use of the secale cornutum is inno-
cuous, and only produces slight nausea, but the author cautions
that the remedy would not succeed, if the slighest phlogosis of
the uterus existed, and other physicians, among whom are Spaj-
rani, Marshall, and Hall, disapprove of it in the membraneous
or parenchymatous inflammation of that organ.

Dr. Enriotti has also twice cured leucorrhoea, by means of
secale cornutum, and he observes that the disease was invete-
rate. This success is by no means astonishing. We know that
certain chronic phlogoses, particularly/ ophthalmia, yield to the
employment of tonic remedies. Journal des Conn. Med. Chir.

Congenital division of the his by Dr. Mesnel.

The author relates three cases of this kind of malformation
described by writers under the name of Iridoschima, and by
Walther, under that of Coloboma Iridis. It may be complete or
incomplete, single or double ; it may also be hereditary. Most
frequently vision remains at first in a normal state, but in some
cases it is finally deranged, because the luminous rays are too
strongly reflected on thei retina.

Professor Walther attributes this malformation to an arrest of
development, and to a retardation experienced in the closing of
the anterior opening of the choroid coat. Journal des Conn.
Med. Chir.

Academy of Sciences Centripetal development of the Os-
seous System; Applications to Pathology by M. Ser-

RES.

According to the new theory of centripetal development, the
appearance of osseous nuclei, instead of occurring from centre to
circumference, always takes place on the contrary at the lateral
parts whence the ossification proceeds progressively towards the
central parts of the bone.

From this principle results
' 1st. The law of symmetry or the primitive quality of the cen-
tral, and impar pieces of the skeleton.
g7 .

592 Manner of detecting Pus in the Blood. [Jane,

Indeed, if like all modern anatomists, we consider a vertebra
as the osteogenic type of the osseous system, we observe that
ossification commences at first in the lateral masses and does not
appear Until some time afterwards in the vetebral body by two
corresponding points of ossification, the one on the right, the
other on the left side.

According to the most recent labours, the head and the face
are considered as a repetition of the vertebral type. If we con-
sider the cranium as a single vertebra, we observe that all the
lateral parts are ossified, while the central part or the body of
the sphenoid remains cartilaginous. If we regard, and with
more reason, the cranium as composed of several vertebrae, we
see on each of them the repetition of the same centripetal labour.
Thus on the os occipitis the basilar- portion is cartilaginous,
while the lateral parts are already ossified. The same reason-
ing may be applied to the bones of the face.

2d. From the same principle results the law of conjunction,
or the invariable rules which the primitive osseous nuclei obey
ill their coalescence.

3d. Hence results also the explanation of the diseases of which
the osseous system may become the seat, if the general rule of
ossification be arrested or disturbed in its progress.

Indeed, the central parts being formed from without inwardly
there are at first two halves which advance to join each oth-
er, and before the junction takes place they are separated from
each other by an interval the greater, the younger the embryo
may be.

But if these two halves be arrested, in their course by any
cause whatsoever, the impar bone will not assume its normal
form, and in its stead will be found an unusual opening, through"
which may escape the organs which the osseous system was
destined to contain. It is in this manner that anterior and pos-
terior spina bifida are formed, and also hernias of the encepha-
lon. By applying the same principle to the face, we explain the
formation of the different kinds of hare-lip, and to the pelvis, the
changes of situation which the bladder experiences. Journal
des Conn. Med. Chir.

Manner of detecting Pus in the Blood.

M. Mandl read a memoir on this subject to the Academy of
Sciences. He remarks in the first place, that ammonia, which,
according to the experiments ofseveral Physiologists, transforms
pus into a thick transparent jelly, cannot fu rnish a means ode-
tocting it in the blood, because it acts on the latter in about the same

1838.J Effects of different Diets on Infants. 593

manner. The jolly, according to M. Mandl, results from a com-
bination of the ammonia with the iibnne, for it is formed when
this test is applied to the fibrine isolated, whereas it is not formed
when the ammonia is brought to act on an isolated coagulum.
Ammonia is not therefore more useful in detecting pus in coagu-
lated, than in nncoaguiated blood, especially as it acts upon the
serum of blood mixed with pus after the separation of the coagu-
lum in the same manner that it does upon the serum of pure blood.
M. Mandl did not obtain more satisfactory results in keeping the
fibrine dissolved in the sernria by means of a solution of subcar-
bonate of potass.

The process by which M. Mandl succeeded was by beating
the blood with a glass rod to separate its fibrine. If the blood
which is about to be submitted to the test, upon being drawn from
the vein and before it has coagulated, be pure and not. mixed with
pus, there will' form in a few minutes upon the rod a long elastic
membrane, without filaments or ragged edges, causing when
pressed between the fingers the same sensation as moist gum
elastic, and whose colour, though red, becomes yellowish by
washing. If, on the contrary, there exist but a small quantity
of pus, say 1-60, instead of a membrane, there will be formed a
filamentous, ragged accumulation, devoid of elasticity, and
whose softness will be proportioned to the quantity of pus mixed
with the blood. These filamentous flakes are red, but by wash-
ing become whiter than pure fibrine. If the quantity of pus
mixed witn the blood be greater, there will be formed neither
membrane nor filamentous flakes, and if the blood be left to itself
no coagulum will be formed. M. Mandl regards the membrane
formed by beating blood which contains a small quantity of pus,
as a combination of pus and fibrine. The transformations that
the globules of blood undergo when the quantity of pus is super-
abundant in it, or when the globules are separated from the
fibrine by agitation and they are in contact with pus, are equally
useful in detecting the presence of pus. La Presse Medicate
T. h P. 12S.

.Comparative View of the effects of different Diets on Infants.

We have thought that the mercy and wisdom of Providence
were never more conspicuous than in the manner of nourishing
the infant. We have always observed that as a general rule,
there was no diet, nor plan of nourishment calculated to impart
to the child under ten or twelve months old, so much safety as
that afforded by the female breast. We do not say that of the

594 Effects of different Diets on Infants. [Jinac,

mother of the child,*al though it is an ascertained fret that in gene-
ral the milk of the mother is hetter suited than that of any other.

The following statistics of two extensive foundling hospitals,'
(i. e.) one in which the infants are nourished by the breast, and
the other, in which they are sustained by the hand, confirm, in
the most satisfactory manner our observations of many years,
and exhibit fairly the difference in the chances of life. In the
former, in which nurses milk is always secured, the deaths were
thirty-five out of one hundred ; and in the latter, eighty out of
qne hundred. Nothing can be more important to those having
the care of infants than these facts. They are constantly need-
ful not for foundling hospitals in this country, but in every
family; for the practice is almost universal, of stuffing the sto-
machs of infants with much of various compounds, as well as
simples which arc perfectly unsuited to their appetite and devel-
opements, as they can contain ; and often much more. This
custom, so prevalent, may be looked to as the most fruitful source
of infantile distresses and dangers. There are more ways than
one. by which non-naturals (for such we may call the spoon
diets of infants) tend to produce disease and death. Truly it
is often the case- perhaps most commonly, that, sooner or later
the diet thus introduced into. the child's stomach fails to be pro-
perly digested, and a diarrhoea a fatal diarrhoea is too often the
early consequence. This is, however, often correctable, by the
prescription of the physician, if obtained early. He changes
the contents of the bowels by suitable correctives, and by change
of diet. But this is a less danger than another course this cus-
tom results in, which though not so common, is insidious, unsus-
pected, and the cause of the most sudden and irremediable dan-
ger. I allude to those cases in which the infant is found to
digest promptly, and appropriate to its rapid developement, a full
diet of gross non-naturals, (for the infant at least.) The child
appears well, grows rapidly, and is thought to afford a fine evi-*
dence of the superior excellence of hand nursing. Such a case
is often held up as a conclusive argument against the rigid exac-
tions of breast milk, by the physician. These are cases^f great
danger. They sometimes pass the critical periods of infancy

and childhood- dentition and the usual time for worms with
safety, and all is well. Hut when they do, they should rather

1838.] Effects of different Diets on Infm 595

be looked on as those who have escaped with life from a wreck,
far at sea, than the boast of prudence and correct management.
The general health of such is good ; but there is a state of re-
pletion and of high irritability, predisposing to the most violent
acute attacks. Under this, the excitement of dentition, wcrms,
cold, or iudiirestibles, (if perchance the digestive powers should
become a little impaired,) presses up the action to convulsions,
ending in apoplexy and death. Hence we often see such chil-
dren most suddenly and unexpectedly lost in a few hours.

But the table is useful in other respects, and we therefore in-
sert it entire, from the Boston Med. <$ Surg. Jour. from the
" Recherches stir les Enfans trouves, par M. IS' Abbe Gaillard*

High mortality of Foundlings brought up by the hand, com-
pared with the mortality of those suckled.

Number of foundlings, at Parthenay, 153 ; died in one year,
54 ; deaths out of 100 born, 35.

Number of foundlings at X -, 244 ; died in one year, 197 ;

deaths out of 100 born, SO.

Of G55 children received at X , only 66 lived 12 years.

Struck with the ertormous mortality at X , the Abbe Gail-
lard ascertained that the children were equally well attended at

the two places, but that at X the children were brought up

by hand, instead of being suckled, as at Pathenay. The greater

number of deaths at X took place in the first month after

birth ; and the mortality was at a maximum in autumn, a fact
confirmed by many years observation at X , and other estab-
lishments, where children are not supplied with natural food.

Deaths,
Months. * Births. 0 30 days.

December - 17 - - - 7

Januarv - - - 17 - - - 5

February - 28 - - - 3

March - 23 - - - 9

April - - 20 ' - - - 6

May - 18 - - - 7

June - - 13 - - 3

July - 18 -' - - 10

August -.- 30 - 26

September - 7 - - - 4

October ... 29 - - - 22

Novemner - ' - 20 - - - 14

From this table it appears that of 244 children brought to the
hospice in live years, 116 died in the course of the first month

oil 6 Erysipelas. [Juno.

, 48 per cent.; that of 123 children born between January and
June, 33 died in the first month ; while 83 died out of 121, born
between July and December. In the first months of the year
the mortality was 27, in the last six months 62 per cent.; of 106
children born between January and June, 73 survived the first
month; between July and December only 31 survived.

The mortality is raised by extreme cold; in November and
December, 1829, out of 29 children admitted, 19 died in the first
month after admission ; in July and August of the same year, 11
died in the first month out of 25 admitted.

These facts show very decidedly the evil consequences of de-
nying infants their natural food, and furnish another argument
against the fatal practices of those heartless mothers who aban-
don, or refuse to suckle their own offspring.

Erysipelas.

Every fact relative to erysipelas is important, and whilst its
pathology is not properly understood, and its etiology but little
known, and consequently its treatment of little more curative va-
lue than its entire neglect, a greater value is attached to every
thing relative to its prevention. The last Boston Medical and
Surgical Journal contains the following observations relative to
the occurrence and perpetuation of this disease in hospitals :

Hospital Erysipelas.

In nearly all the hospitals in which the law of cleanliness re-
quires that the floors of the wards, occupied by the sick, shall be
frequently washed, erysipelas seems not only to have been speedi-
ly generated, but also, after its first developement, to be always
present, and continually showing itself on patient after patient
where it was least expected. As its origin has been generally
referred to the period when frequent floor-washings were consid-
ered necessary, or, rather, when the greatest amount of surface
had been thus habitually wetted for* a considerable time, why
would it not be well to cover the floors of hospitals with painted
carpets, such as are manufactured at Roxbury, of any size, which
might be taken out daily to be washed, and when thoroughly
dried, returned again and re-spread over the floor? The expe-
riment seems to promise well in two respects, viz. the annoyance
of floor cleansing would be done away with, and the now sup-
posed cause of erysipelas, from the evaporation of water, holding
filth of some kind, perhaps, in solution, would certainly be obvi-
ated. Boston Medical and Surgical Journal.

1838. Erysipelas. 597

The writer of the above article intimates that in these cases
the water which evaporates from the floor after or during the
washing, holds in it filth of some kind, a cause of erysipelas. This
idea is not only a superficial one, but if received is calculated to
dampen the spirit of research for the true causes of the disease.
When we labor under ignorance, on any subject, if we would
have that ignorance corrected, it is best that it should be well
defined and treated. It is reasonable to conclude that in erysipe-
las, as in most other diseases, there are at least' two sources of
causation, a remote which is predisposing, and an exciting cause.
The latter is very plainly taught in the above observation in
private practice. It is cold, and more especially, this with mois-
ture, which is always calculated to enhance the deleterious in-
fluences of the temperature. But it is evident that this only in-
troduces disease of some kind, the peculiar character of which
is determined by the peculiarity of the predisposition produced
by the remote cause ; and this peculiarity of predisposition is the
radical point of ignorance ; knowledge of which would, without
doubt, add greatly to the means of determining an effectual treat-
ment. Of a number of cases of erysipelas which fell into our
hands during the last year, during an epidemical prevalence of
this disease, two died ; and both of these were persons recently
from a residence in a much more bilious location than that of
Augusta. These cases were perfectly unyielding to any mode
of treatment which could be adopted ; whilst others yielded
more or less readily to an alterative treatment calculated to act
on the various secretions, with or without topical means as
dressings for wounds when they existed, &c. Here it was evi-
dent that the difference of predisposing climate was followed by
a corresponding effect, as manifested in the additional violence
and inveteracy of the disease. Such views as this enable us to
approach somewhat more nearly to the nature of the predisposing
cause, and prehaps as near to a precise knowledge of it as we
possess of the predisposing cause of a bilious fever. But still
reasoning from effect, under the law, that peculiarity of cause
must produce peculiarity of effect, we are still obliged to conclude
that there must be some modifying influence differing from
that which the general conclusion might declare, which deter-
mines the case to be one of Erysipelas and not of bilious fever

598 Universality of Fever. Quinine in Fever . [June.

<

But these difficulties exist alike in all the various forms and
species of eruptive diseases. ^

Universality of Fever.

In his Principles of Pathology and Practice of Physic, Dr. Jnov
Mackintosh, of Edinburg gives the following six propositions
as embodying his own opinions, and as containing general
views which are admitted by all writers whose opinions are of
any value ; although some facts, have been called by different
names.

" 1st. That the functions of almost all organs are embarrassed
in fever from the very beginning, and often fot days before the
sense of coldness is felt by the affected person.

2d. That the blood leaves the surface of the body, and accu-
mulates in internal organs, and that, unless they are overwhelm-
ed, the system makes an effort to relieve herself, and certain
combined phenomena take place, which are designated by the
terms : reaction, fever.5

3d. That inflammation of all parts of the body will give rise
to fever.

4th. The inflammation may supervene during-, fevor, without
being the primary cause of the febrile commotion.

5th. That the nervous system is involved as well as the vas-
cular ; and,

6th It follows as a consequence, if all these things be true,
that the blood itself must be in a diseased condition."'

Quinine in Fever.

Perhaps there is no article in the materia medica of equally
uniform powers, and of whose physical operation on the human
system there is as little room for variety of opinion, that has been
as variously used as quinine. Except those differences which
good reason and fair experience enforce, as from peculiarity of
climate, or location ; or the various nature of different cases, we
consider this great difference as indicating the texture of mind
of the different practitioners. We know of those practitioners
who. in like cases, are in the habit of giving but half a grain

1838.1 Quinine in Fever. 699

doses ; and of others, who give ten to twenty as an ordinary
portion. We think much is yet to be understood by practition-
ers relative to the use of this article; and that as more strict rea-
soning is exercised on the subject of its use its physical powers
and: the pathological 'and therapeutical principles which make
up the elements of the rigid reasoning, less of the article will be
found in use. We would" not be understood to object to quinine
as one of the finest tonics we have at command, and more espe-
cially for the control of the paroxysmal nature of diseases; but we
do believe that great carelessness and mental laziness have been
indulged in the prescription of this tonic, whereby it has become a
kind of routine prescription. A fair patient of ours, who, when 45
drops of laudanum were prescribed, concluded very arithmeti-
cally that if 45 drops would render a given benefit, 90 would
afford a double product. We believe that many practitioners
have acted on this arithmetical kind of proportion in the admin-
istration of quinine. In the days of mathematical medicine we
should not have been surprised at such views ; but when in
these bright days of physiology, of pathology and of therapeutics,
we confess that such things lead to a depreciation in the estimate
value of mind concerned. We think practitioners should settle
in their minds the knowledge of first principles which form the
basis of correct reasoning, before they prescribe even quinine?;
for however much it may be thought a simple, innocent thing,
which will do no harm if it does no good ; the fact is, it is often
injurious by its own operation, and still oftcner so, by being used
to the exclusion of agents which would be dictated by sounder
reasoning.

Something of this wandering we think is observable with men
of the first rank. For example, Dr. Mackintosh, lecturer on
%the practice of Physic in J3dinburg, has his rule of giving three
doses of five grains each, with half an hour interval, immedi-
ately before the expected paroxysm, or three grains every half
hour, beginning about three hours before the expected parox-
ysm. Dr. Morton, the American Editor of Dr. Mackintosh's
work, would not be understood as "according with the practice
of administering quinine in the large and frequently repeated
doses advocated by his author, (Dr.' Mackintosh." He (Dr.
Morton,.) considers it seldom requisite to adrninistei more than

'00 Bleeding in the cold stage of Fever. [June,

twelve grains during the first interval, and half that quantity
during the following interval', for the cure of nearly all the cases
which occur. Instances however, he considers, frequently pre-
sent themselves in which a larger quantity than is necessary to
obtain the end, would be positively injurious; so that practi-
tioners have adopted the safer plan of giving a grain each hour,
and limiting the amount to the number of grains specified, (that
is, twelve in the first interval, and six in the second.) And Drs.
Forbks and Conolly of England, the experienced and talented
editors of the Cyclopedia of Practical Medicine, and of the Brit-
ish and Foreign Medical Review, say that their own experience
leads them to recommend the practice of American Editors, rath-
er than that of Dr. Mackintosh ; a practice which they have
scarcely ever found fail, even with patients contiuning to reside
in the malarial locality which produced the disease ; and that
they find that half the quantity above- stated, is quite sufficient in
the majority of cases, to cure the endemic agues of England.

Some allowance may perhaps, be made for their differences, on
account of the differences of climate and locality.

Bleeding in the cold . stage of Fever.

i;The peculiar practice of bleeding in the cold stage of inter-
mittent fever, introduced by Dr. Mackintosh agocd many years
since, is well known to most of our readers. This practice na-
turally takes a prominent place in the chapter treating of ague,
and is illustrated and supported by many new cases. Without
admitting that such treatment is necessary in the great majority
of cures of ague, as we know from considerable experience that
the disease is perfectly and snfcly and speedily curable without
it, we cannot deny that the practice is in particular cases indis-
pensable, and indeed affords the only means of saving life. We
must therefore always consider medical science as under great
obligation to Dr. Mackintosh for having introduced this prac-
tice, and for having advocated it with such praise-worthy zeal.
Wo are far from wishing our younger brethren to have recourse
to it in br'duiary cases, much less habitually, in the treatment of
anno; as we are of opinion that this would be not merely use-
less but highly injurious \ but it is incumbent on everyone to
make himself acquainted with the mode of its application, the
principles on which it is founded, and the safety of its adminis-

1838.1 Bleeding in the cold Stage of Fever. T<>1

tration. For our own parts, we do not hesitate to say that, had
we been acquainted with this practice twenty years agp', we think
we could have saved some Jives which we allowed to he hope-
lessly lost beneath the overwhelming stupor of inter tropical
ague.

The following brief extracts exhibit the pathological grounds
on which Dr. Mackintosh was ldd to employ this remedy, and
the general mode and limits of its application ; but we earnestly
recommend to the notice of our readers the whole chapter on
this subject, and the numerous cases by which the practice is
illustrated and confirmed.'

* Cold Stage. The first circumstance which we distinctly
perceive, is diminished circulation of blood in the extremities,
then a sense of coldness, and with it a feeling of weakness. These
are evidences of an irregular determination of blood, by what-
ever cause produced ; and in proportion as blood accumulates in
the vessels of internal organs, their functions become impeded.
The lungs shew their gorged state, by the short, difficult, and *
anxious breathing; by the impossibility of inflating them be-
yond the least degree ; and by the violent dry cough which
occasionally takes place. The- livid appearance of the cheeks,
lips, and mucous membrane of the mouth, is an additional proof .
of the embarrassed state of the lungs, shewing that the blood is
not properly decarbonized. The disordered functions of the
brain in this stage, depend, I imagine,, principally upon the
gorged state of the lun^s, and also upon the overloaded state-
of the right side of the heart, preventing the free return of blood
from the head. The disordered functions of the brain may also
be produced by a change in balance of the circulation of the ves- ,
sels of the head, independently of the state of the lungs and heart.
The tremors may probably be attributed fo an accumulation of
blood in the vessels of the brain and spinal marrow. The sense
of cold seems to be owing partly to the state of the nervous sys-
tem, and partly to the state of the lungs.' The pain in the head
and loins, and oppression at the praecor Jia, may be fairly attri-
buted to the same causes. The muscular prostration, and feel-
ing of sinking, are not owing to actual debility, but to obstructed
action, in consequence of the above-mentioned condition of or-
gans. The proof of all which circumstances is to be found in .
the fact, now well known, that abstracting blood in the cold
stage; will immediately remove not only the difficulty of breath-
ing, the pain in the head and loins, the disordered functions of
the brain, (when these exist,) the oppression at the praecordiaj
&c. but will also stop the rigors, restore the strength of the pulse,
increase the heat of the whole body, and cause the sensation of
cold to vanish in an instant.'

'Bleeding, in the cold stage, will, in a great majority of in-

02 Medical Publications in France. [June,

stances, cut it short; in fact, it will rarely fail in stopping the
existing paroxysm, and, on many occasions, it has prevented a
return of the disease to which the patients had been long sub-
ject, and by which they were nearly worn out. It is dilficult
to determine what. quantity of blood it will be necessary to draw
in any given case; sometimes it requires twenty -four ounces;
I have known three ounces suffice, and, in one case, an ounce
and a half produced the full effect. The larger the orifice in the
vein, the greater is the chance of arresting the disease at a small
expense of blood; but, in many cases, the operation is attended
with considerable difficulty, from the convulsive tremors which
affect the whole body. I was once successful in arresting the
disease by bleeding, in a cold stage which had continued twenty-
six hours ; but 1 regard this as an extreme case. The blood
sometimes only trickle down the arm, and, as the system is re-
lieved, the stream becomes larger and stronger, till at last it
springs from 'the orifice, and frequently before six ounces are
taken,, the patient will express relief from violent pain in the
head and loin?, and it will soon be observed that he breathes
more freely. The tremors become slighter and slighter, and,
by the time a few .more ounces' are abstracted, they will cease
altogether, an8 with them vanish the painful sensation of cold.
The pulse will be found stronger, and a gentle moisture will be
observed on the body. If the patient be properly managed with
respect to bed-clothes, neither the hot nor sweating stage will in
general follow. Most of the patients who have been treated by
myself, or by my pupils under my immediate inspection, have
fallen asleep immediately after the operation ; but some have
even -got up and dressed themselves.'" Brdt. <$% For. Review.

*.
Medical Publications in France.

There were in 1836 more than three hundred volumes pub-
li&hed on the various branches of medical science in France
alone. These three hundred vols, if added to the pamphlets,
memoirs, and other small publications, would make a total ot
upwards of one hundred and fifteen thousand pages : and if to
li ese be further added the periodicals and those published du-
ring the year, the number of pages would amount to oik1 hun-
dred and eiirhty thousand, thus requiring of the student wishing
to review the whole, if one could be found so courageous, to read
a( least 16000 pages per month, or 500 per day. La Prcsse
deeale, v. 1. p. 24.

1838.] Medical Intelligence. 703

MEDICAL INTELLIGENCE

Wo have received the circular of the Medical College of Richmond, Virginia,
The following is khearrangement of the Faculty.

IT. Johnson, M. D. Professor of Anatomy and Physiology.

John Oi/u.i-.v, M. D. Professor of Theory and Practice.

S W. Chamberlayne, M. D. Professor of Mat. Med. and Therapeutics.

R. L. Bohannon, M. D. Professor of Obstetrics and Diseases of. women and
children.

Aug, L. Warner, M. D. Professor of Surgery.

Socrates Maupin, M. D. Professor of Chemistry and Pharmacy.

This new Medical School is opened under the auspices of the Hampden Sidney
College, whose Trustees hjive organized and located it in the city of Richmond.
Its annual session is to commence on the 1st Monday in November, and continue
until the last week in March, a period of five calender months ; and candidates for
the Doctorate are required to have deposited ,with the Dean, a suitable essay by the
1st day of January.

Although of sound political bearing, pointing the citizens of its own state to
what it considers both their duty, and present and prospective interest, the circular,
considering the usages of the day in such cases, enjoys an honourable exemption
alike from the boasting, and the invidious comparisons and electioneering manoeu-
vres which have too often disgraced the annual announcements of some of the Ame-
rican Medical Seminaries.

It is observed that the session of lectures is extended to five, instead of the usual
term of four months. This is, of itself, correct. And it is very justly observed, that

the addition of another month to the ordinary session of medical lectures, (which
is admitted by every physician to be entirely too short,) will enable the professors to
complete the course which would otherwise be imperfect." But from experience
in point, we are led to apprehend that the advantages thus offered, will not be duly
appreciated by the medical student so long as there are other similar institutions
which offer a shorter term ; but on the contrary, could the majority of medical
students be allowed to sway the colleges in this particular, the term would soon be
reduced to two or three months. Students expect in the inconsideration of their
youth, to " combine pleasure with business, and gain the rewards of industry with,
out suffering its fatigues," and rca;> to themselves the profits of a costly profession
without paying the tribute money necessarily due to its procurement.

LOUISVILLE MEDICAL INSTITUTE.

This new institution has accomplished its first 'course of lectures. Twenty-four
young gentlemen were admitted to the Doctorate. The session is from the last
Monday in October, to the last of February, a term of about four months.

The following are the present incumbents of the different chairs :
Anatomy, Jkdf.diaii Cobb, M. D.

Institutes and Clinical Medicine, and Medical

Jurisprudence, CHARLES Caldwell, M. D.

7<il Medical Intelligence. [June^

Theory and Practice of Medicine, Jno. E. Cook, M. D.

Surgery, Joshua B. Flint, M. D.

Obstetrics and Diseases of Women and Chil-
dren. Henry Miller, M. D.
Materia Medica, Charles W. Short, M. D.
Chemistry, Lunspord P. Yandell, M. D.
The price of the Tickets is SI 10.

The endowment made by the city of Louisville alone, for the buildings, appara-
tus, Library, &c. affords an example of high-minded munificence and of a proper
regard of her. citizens for the medical institution, worthy of the imitation of others.
And when we come to recollect that Kentucky is comparitively a new state, and
Louisville a new city, 890,000, the amount appropriated, is well calculated to put to
shame the citizens of older states and cities, who have but too grudgingly appropri-
ated a few thousand only, and left a struggling, enterprising and patriotic faculty to
work out their days for future generations, or allow their institutions to lapse into
ruins.

The building under contract is to be 130 feet by GG, which will afford the most
ample accommodations.

Professor Flint has started for Europe with ample means for the purchase of all
tilings necessary from abioad, for the successful operations of the medical institute.
We know of no institution, commencing with fairer prospects of success.

MEDICAL COLLEGE OF LOUISIANA.

We have received the annual circular of this new Institution, containing a pros-
pectus for the session of l838-!39'. It is under the government of a President and
twelve Trustees. The President is the Governor of the State, and the Trustees
are all ex-professional gentlemen, many of whom we know to be of the greatest
respectability.

The Faculty consists of six individuals, filling seven professorships as follows :
Warren Stone, M. D. Professor of Anatomy.

Edward H. Barton, M. D. Professor of the Theory and Practice of Medicine.
John Harrison, M. D. Professor of Physiology and Pathology.
James Jones, M. D. Professor of Obstetrics and Diseases of Women and Chil-
dren.
J. Monro Mackie, M. D. Professor of Materia Medica and Therapeutics.
John L. Riddell, M. D. Professor of Chemistry and Pharmacy.
Warren Stone, M. D. Professor of Surgery.

This " was founded,'' (like all other Southern Institutions of the kind,) " with
the expjfess view of educating Southern Physicians." The session for 1838-'39
will openat the Charity Hospital, on the 1st Monday in December, and close on
the 4th Saturday in March. The commencement for conferring the. Degrees will
Ik; held on the Wednesday following the close of the Lectures.
The following are its requisites for graduation :
The candidate must have attained the age of twenty-one years.
I Ic must have beefl a student of medicine at least three years
He must have attended two full courses of medical lectures, the last of which
inn i have been in the Medical College of Louisiana.

1838.1 Medical Intelligence, ~()~'

Hf must present to the Dean a respectable thesis, on a subject connected with
medicine, or some collateral science, by the first day of March, an<l exhibit satisfac-
tory testimonials of moral character and preliminary education.

TRANSYLVANIA JOURNAL

According to a note addressed to subscribers, this quarterly journal is to be en-
larged fifty pages, without increase of subscription price, which still stands
in advance. The ability of the Editors and Publishers to do this without a corres-
ponding increase of subscription, stands as evidence ot the fact, that thd good
citizens west of the Alleghany arc much more liberal in the support of medical
science than they are in the Southern Atlantic states.

When enlarged, as it will be forthwith, by a supplement to the first No. of the
present year, the annual volume will amount to 1000 pages.

TRANSYLVANIA UNIVERSITY.

Medical Department. The Trustees of this institution have lately elected
Dr. N. R. Smith of Baltimore, to the chair of the Theory and Practice.

The Faculty for the next season is as follows :
Anatomy and Surgery, by B. W. Dudley, M. D. Professor, and James M. Blsh,

M. D. Adjunct Professor.
Institutes of Medicine and Medical Jurisprudence, by James C. Cross, M. D.
Theory and Practice of Medicine, by Natiia.v R. Smith, M. D.
Obstetrics and Diseases of Women and Children, by Wm. H. Richardson, M. D.
Materia Medica, and Therapeutics, by Thomas D. Mitchell, M. D.
Chemistry and Pharmacy, by Robert Peter M. D.

The lectures will commence on the 1st Monday in November next, and each
teacher will lecture daily Sabbath excepted.

Fees of the course, including matriculation and access to the Library, will be
.$110. Graduation fee S20.

It will be observed by the above, that there is scarcely a relict of the old faculty
in this Institution. : Tcmpora viutantcr."

Death by Steam. In a letter to the Editor of the Boston Medical and Surgical
Journal from one of his correspondents, we have an account of a most palpable death
by steam and Thomsonian Practice.

The victim in this case was a female who had been confined to childbed about
three weeks previous to the operation which caused her death; but had so nearly
recovered, that she went from room to roorif and dined with the family. The only
difficulty was, that she had rather a poor appetite, and was, at times, tioubled with
costiveness. To the advice of some of her friends whose opinions she had always
regarded, to adopt the Thomsonian method of treatment, and take a ' patent sweat/
she consented ; and accordingly began by the use of internal and external stimu-
lants, gradually increasing the heat till she was in the most severe distress. And
notwithstanding her groans, which could be heard in the road, the coursr

706 Medical Intelligence. [Jimc7

blindly persisted in, until she breathed her last. A few moments before she died,
the regularly attending physician called at (lie house, Expecting to find her comfor-
table and doing well, as when he saw her last. But when he entered the room,
(which he was not allowed to do till her attendants saw that she had gone.) there
he beheld her a lifeless corpse. He did every thing in his power to restore life, but
it was too late. The body was so heated that the hand could scarcely be borne
upon it a few moments after death.

The woman was one of the highest respectability, and strongly indeared to her
friends who now have to lament and mourn over her sudden and most deplorable,
death. Not the least shadow of doubt is entertained as to the cause of her death.
It is acknowdedged by the friends as well as foes of this method of treatment, that
she died in consequence of the operation, in fact she died before they had comple-
ted the process.

This unfortunate affair reminds us of the case of Rhodes, which was mentioned
in this Journal some time ago. The circumstances are very similar, as they are
also to many others which arc almost daily reported verbally. But we cannot afford
room for them all. Let a word to the wise suffice ; the foolish have to learn at the
end of severe experience.

In conclusion the reporter of this case writes as follows :,

" And now, in reflecting on this melancholy accident, which from the fact that
it took place within my own knowledge, has particularly awakened my feelings, I
cannot but be filled with astonishment that in this enlightened age, any one can
be so deluded. But such is the case, and many there are, who suffer themselves to
be blinded and duped by the boasting and absurd pretensions of modern quackery.
But such ignorance and absurdity cannot long conceal itself; and we may hope and
believe the day is not far distant when this system, which originated in ignorance,
and which is disseminated generally among the ignorant, will be buried deep and
forever, and the true principles, those that have been the result of labor, investiga-
tion and research, will be adopted and maintained by every individual."

This affair needs no comments.

S ( J U T H E R JN

MEBI(OAIL Ml STOMDAJL
JOURNAL.

Vol. II. JULY, 1838. No. XII.

PART I.
ORIGINAL COMMUNICATIONS.

ARTICLE I.

On the influence of Pain in the 'production of Death. By
Dr. Samuel D. Gamble, Zebulon, Pike Co. Geo.

[It will be recollected that at .the instance of one of the readers

of the Southern Medical <fc Surgical Journal, we lately requested

the contribution to our pages, of an essay on the following subject :

" Is any degree oipaint sufficient of itself, to produce death?'5

In compliance with that request, the following essay has been

forwarded to us.t-Ed.]

"Is any degree of pain sufficient, of itself, to produce death?"
If we may credit the writings of many eminent practitioners,
pain, when amounting to a certain degree of intensity and
duration, is of itself destructive. Difficult and protracted partu-
rition is occasionally fatal from this cause; and even incases in
which neither extraordinary difficulty nor protraction was expe-
rienced, a fatal prostration has sometimes supervened, which has
admitted of no other explanation. The delivery has been com-
plete without any degree of physical injui'y, and not more than
an ordinary quantity of blood has escaped from the vessels of the
uterus, Yet the woman, in despite of the encouragement derived
from the consciousness of safety to herself and infant, and o*
\ 1

*08 influence of Pain ih the production' of Death. [July

comfort from the conclusion that her sufferings were at an end,
has never rallied, either in strength or spirit ; but after an inter-
val, not exceeding a few hours, spent ih a low and sinking state,
has unexpectedly and with little perceptible alteration, expired.

It is lair to say, that these cases are by some persons differently
explained. It has been argued that in a state of exhaustion a
very moderate loss of blood is sufficient to induce a*fatal syncope,
which is very true; an exhaustion so great that even the natural
and ordinary circumstances of delivery annihilated the power
of recovery. But. to what was the previous exhaustion to be
attributed, especially where the labour, as above stated, has
been neither unusually lingering nor difficult ? Others have at-
tributed the catastrophe to presentiment or mental impression, and
cases have undoubtedly occurred demonstrative of the fatal effect
of this depressing cause. But even where the evidence of this
state has been most conclusive, I have been disposed to question
its single and unmixed operation to the extent supposed ;
but coupled with bodily suffering and exhaustion from that
cause, its fatal influence, is beyond all doubt.

There is a case in which, with an unconfined state of bowels,
abdominal after-pain, aggravated by pressure, augments, at no
distant period from delivery, to a degree sufficient to induce the
belief that puerperal inflammation exists ; the pulse is accelerated,
and notwithstanding its want of power, and a general expression
of feebleness, the practitioner, suspicious of the pain, takes away a
full quantity of blood. No satisfactory result is obtained; the
pulse and the patient, sink together, and a fatal coma succeeds.
This is a pain not of inflammation but of irritation, and would
have a better chance of relief from laudanum than the lancet.

The following case is extracted, as well illustrating the effect
of acute and enduring pain from Dr. Meriu.ai.ak's "Synopsis of
the various kinds of difficult Parturition. ": It is communicated
to the esteemed author of that work in a letter from Dr. Goo< n.

" Dear Sir, The followin icurred more than twenty

years ago, June 1?(.>(.>. to .Mr. i> \kim;tt, of Yarmouth, with whom
i was then residing as apprentice. I do not relate it from my
own observation, but from a manuscript account which he drew
up at the. time, and winch, as too "voluminous, for your purp
il try to abridge.

L83S.I Influence oj Pqiii in tin production of Death.

The patienl wasalady 31 years ofage, in labour with her
sixth child. On his first examination, Mr. B. found a large fleshy
substance, almost filling the vagina; passing up his finger be?
tween the front of tin; tumour and the symphysis pubis, he felt
the orifice of the uterus, the anterior segment completely dilated,
but the posterior could not be feit because of the tumour. Whilst
he was examining, a pain came on, and the distended mem-
branes descended but- tumour and the pubis, and aimost
protruded externally; another pain ruptured the mcml/ranes,
when he discovered the head of the child resting on the sym-
physis pubis. As the head did not advance, he introduced his
hand, brought down the feet, and with some difficulty extracted
the child ; it was born lifeless, but he persevered in inflating the
lungs, and in half an hour it cried lustily. Whilst he was occu-
pied about the child, the placenta was expelled, and afttr wait-
ing for some time, the patient appearing easy and well he left her ;
this was at seven in the morning. At three in the afternoon lie
was sent for again; she had had such violent pains that she
thought there was another child ; but as the abdomen was flat,
and the contracted litems could ^e easily felt, he assured her to
the contrary, and gave her an opiate.- When he saw her at
eight at night, he learnt that the pains had continued violently:
she felt as if there was something to come away, and on exami-
nation there was discovered a- soft tumour pressing against the
os-externum. What could it be? He would have thought it
was the uterus inverted, but it was the same tumour which he
had felt in the morning before the child was born ; there was no
hemorrhage, the placenta had been expelled spontaneously, and
the uterus could be distinctly felt in the hypogastric region. He
consulted his medical-friends in the town, and sent off to Norwich
for Mr. Rigby. She took an anodyne mixture;, but the pains
continued with violent expulsive efforts all night, and the next
morning he found her with a languid pulse, and a pallid coun-
tenance ; a large fleshy, livid tumour had been 'forced out of the
vagina, and every pain brought it more and more into sight;
she continued to suffer and to sink through the rest of the day :
in the evening: Mr. Rigby arrived, but she had expired about half
an hour before. The body was opened the next day ; the irterus
was contracted, but its mouth was dragged down as low as the
external orifice, by a tumour which grew from it by a broad
base; it was attached to the posterior part of the mouth of the
womb, and some way up the neck, was of a livid colour, and
weighed three pounds and fifteen ounces. The patient had borne
her last child two years before, easily and naturally : but some
time before her present pregnancy she looked, as large as if she
was seven months with child.

This case is curious, not only as a specimen of the rare coin-

710 Influence of Pain in the prodticttm of Death. [July*

cidence of polypus and pregnancy, but as a striking proof- that
mere pain can destroy life. The labour-pains continued after
the uterus was empty, and she may be literally said to have died
of a protracted labour which took place after the child and pla-
centa were born. I am, dear Sir,

Yours Truly,

R03ERT GOOCH."
Berners Street, March 26th, 1820.

Certain forms of mortal injury are productive of sudden excru-
ciating and unremitting pain, such as ruptures of the stomach,
gall and urinary bladders. Death ensues in these cases many
hours sooner than when the pain is less intense, and before the
morbid changes, which take place in consequence of the injury
are so far established as to make it credible that the result is to
be ascribed to their influence. Mr. Travers gives an account
of a case to which he had been called to a gentleman writhing
with pain in the abdomen, which he had endured for the space
of two hours previous to. his seeing him, and described as unlike
any he had ever experienced. He accosted the Doctor in these
words: " Doctor if you cannot put an end to this pain, it will
soon put an end to me." So true was his prediction, that in
twelve hours, from a state of comparitive health, (he had been at
the theatre the preceding evening,) he was no more. iThis
disease was an ulcer in the pyloric portion of the stomach, which
had perforated its coats, and allowed of the escape of its contents
into the general cavity.

Oxalic acid, arsenic, and some other poisons, taken into the
stomach, seem to destroy life by their action on the nervous
system; the characteristic expression of this action is overwhel-
ming pain, and no organic change presenting itself competent to
explain the phenomenon of almost immediate death, it is highly
probable that pain has the principal share in determining this
result. I shall not be understood to question the otherwise fatal
effects of such injuries and noxious agents as the above, in con-
sidering the acceleration of their issue to be owing to excessive
pain.

In what degree pain contributes to the speedily fatal result of
the various forms of complicated injury befalling parts not essen-
tial to life, and therefore not in their nature mortal, we are only
enabled to judge by the expression of suffering. But not to

838.1 Influence of Pain in ihA production of Deaih{ 71 1

speak of the difference of temperament indifferent individuals,'
it is. probable that the expression of suffering, whether more or
less, is often a fallacious criterion of the measure of pain actual-
ly endured ; and that the operation of pain upon the system varies
both with the character of the pain, and the state of the system.
In all cases pain has its seat in the brain, being only armodc of
sensation. It is evidently subject to varieties both in kind and
degree, by the texture injured, by the nature of the injury or exci- *
ting cause, and by the state of the circulation. Every texture
has its characteristic sensation under irritation. The different
forms of injury and of inflammation have also theirs. Thereis
a pain of the nerves, and of; the muscles, and of serous mem-
branes a pain of laceration, of division, and of distention a
pain of suppuration, of ulceration, and of scirrhus and the
figurative terms, burning, pricking, shooting or lancinating,
throbbing, gnawing, twinging, aching, and many others, arc in
constant use to express these varieties: We should, a priori,
conclude that the pain excited by the mechanical operations of
cutting, burning, and bruising of sound parts is essentially differ-
ent from that produced by any action of inflammation ; and that
the nervous system excited by fever, or enfeebled by sickness of
any kind, would receive impressions of pain widely different from
those transmitted to it when overtaken by injury in a robust and
healthy state. It is probable that in these contrasted states of the
system, very opposite effects are produced by pain ; as for exam-
ple, in one case stupor, and in another delirium ; and this is ren-
dered more probable by the fact that anodyne medicines are, more
than any others variable and uncertain in their effects, and that
pain in different individuals, or at different times in the same, is
relieved by remedies possessing qualities diametrically opposite.
Such is the effect of the transient bodily .pain experienced in the
extraction of a tooth, or the extirpation of a wart or corn, as in
some persons to produce syncope, retchings or convulsions.

The influence of pain on the stomach to excite nausea and
vomiting, and on the kidneys to suspend the secretion of urine
is well known. Surgeons have frequent opportunities of wit-
nessing the first *of these effects succeeding injuries and opera-
tions. The following case came under the observation of Mr.
Travkrs the senior Surgeon to St. Thamas's Hospital, &c. &c.

Case. A young fellow of unbroken and vigorous constitu-

p

712 ' Influence of Pain itt the, production of Death. [July,

tion was thrown into a dungeon al Hayti. Thumb-srews were
})iil upon him. and a, jug of water placed by his side, to which
however lie could not apply his mouth, owing- to the confine-,
merit and acute pains in his hands. The gaoler, who came to
him occasionally, lifted the pitcher toMiis mouth, at which times
he drank freely ; in the intervals his mouth was parched ; he
was restless but dozed a little. In this state he remained up-
wards of forty eight hours, during which period he never felt the
least inclination to void either'urine or stool. Some hours after
the screws had been removed, he passed a moderate quantity of
very high coloured urine, after which the secretion gradually
returned to its ordidary state, and he suffered ho subsequent in-
convenience.

, In most instances of feath from violent disorganization of tex-
ture, little, if any pain te apparently endured. The shock sus,
pends the sensibility of the system without deranging the mental
faculties, although their vigour may be considerably" abated. But
when the symptom of excrutiating-and enduring pain is present
unaccompanied by the shock of violent injury, it excites and ab-
sorbs the faculties of the mind ; renders the sufferer wholly in-
different to external objects, and insusceptible of domestic sym-
pathy and the tender emotions m'ajces death an object not of
terror, but of earnest and unceasing solicitude ; and terminates
life by exhaustion in a very few hours.

Pain in excess,' as I have already observed, exhausts the prin-
ciple of life, so that either its continuance without intermission,
or the super-addition of the slightest shock subsequent to its
endurance for a certain period, is fatal. Sir Astley Cooperj
in his lectures, relates the case of a brewer's servant, a man of
middle age, and robust frame, who had suffered much agony for
several days, from a thecal obscess, occasioned by a splinter of
wood penetrating beneath the, nail of the thumb, and who, a few
seconds after the matter was discharged by a deep incision, raised
himself by a convulsive effort from his bed, and instantly expired.

In operations protracted by unforseen difficulties, as in case of
lithotomy in which the stone is of such magnitude as to' require
crushing, the patient has begun to die upon the table. The
same happens in parturition protracted by mechanical impedi-
ments, a's in the rase of a hydrscephalic foetus, where the nature

Influence of P%tin m J,h> procuzctioii of Depth. / L!

of the impediment has been unknown and therefore unrelieved
Pam, even of the most harrassing kind, when periodical, or

relieved by intervals of ease, as in lie douloureux, can be endured
For a longtime; but this gradually undermines and wears out
the preserving principle, as 'was proved in the melancholy in-
stance of a late eminent physician, whose* remarkably athletic
and robust frame became emaciated to a shadow by mere corpo-
real suffering. "'Pains," he was wont to say, " is the greatest
sedative in nature."'

The first effect of intense and unremitting pain is precipitation
of the action of the vascular system, with corresponding senso-
rial excitement : but neither of these sign* is of lbn^ duration-
The pulse, which has at first' a strong bound or jerk, soon be-
comes small, tremulous and irregular or fluttering; .the counte-
nance, the features of which in t%e first instance are braced and
compressed by a strong convulsive expression, quickly becomes
relaxed, hollow and ghastly. The extreme preternatural mobility
of the muscular system, indicated by great restlessness, disap-
pears, and a state of stupifaction and indifference to surrounding-
objects, announces the state of exhaustion. If pain he the result
of inflammation, its gradual increase prolongs the stage of excite-
ment. If oil the other 'hand its accession in an extreme degree
is instantaneous, as from breach of texture, or the operation of
any destructive agent upon the system, the stage of excitement
is comparatively shortlived. And when the description and ex-
tent of mischief inflected arc such and so aggravated as to pro-
duce a sensorial paralysis, evinced by partial stupefaction with-*
out absolute loss of consciousness, it so far neutralizes or renders
void the effect, of painful impressions, as to admit of a direct pros-
tration of the system without reaction. A large loss of blood at
the moment of injury tends invariably to this result ; that is, it
cuts off the staire of excitement.

II Enlargement top the Ovarid. IJulv

ARTICLE II.

Remarkable case of FibroScltlrro Cartilaginous Enlarge-
me?it of the Ovaria. By G. K. Holloway, M. D.} of

Warren tun, Georgia.

The subject of Tumours attracting of late the attention ol a
considerable portion of the medical world, induces us to present
the following case as one of extraordinary occurrence ; and
which, so far as our confined observation and more limited ex-
perience and reading extends, is without a parallel in medical
science.* We will endeavour to give a brief description of the
case so as to enable our readers to come at once to its merits
under the following

History. Mrs.. Bush, of swarthy complexion, blue eyes and
black hair, about five feet eight inches. high, of nervous tempera-
ment but good constitution, was what might be termed a labouring
woman, in as much as she had to perform all tfye domestic drudge-
ry of a large poor family, the mother of seven children, was in the
month of February, 1836, in the 37th year of her age, attacked
with chynanche parotidies (or mumps;) it being washing week

* Some years ago wc removed from the abdomen of a coloured woman who died
in this city, the property of the late Hon. Nicholas Ware, a scirrhous tumour, in
which the uterus and ovaria were so involved, as not to be distinguishable no
traces resembling cither of them being discoverable, a tumour, the parietes of which,
when the purulent matter which occupied its central parts was removed, filled a
common washing tub and weighed fifty three pounds. We took various measure-
ments of the body of this woman before her death, but have mislaid them. AVe
need not say that her size was enormous. The tumour had been growing more
I ban fifteen years. Her abdomen extended beyond her knees when Sitting and w.as
enormously distended laterally. Tho patient bad been in the habit for many years
Oif placing her dinner and other meals thereon and eating from it, as she could not
reach a table. For sonqjc weeks previous to her dissolution, her abdomen was
obliged to be suspended to the joists by strong coi\\^ and sacking to sustain its
weight and favour her breathing, and she remained in a standing position. Thus
she remained night and day until her hither' became hydropic, and

so enormously swollen that they burst and discharged copiously of hydropie fluid.
Apprehending sphacelus of the legs, ii was then determined to tap the tumour at a
point in the side of the lined alb i uy distended, at which a deep and ob-

scure fluctuation could be felt. This was done and half a bushel of thick Sangui-
nco-purulent matter removed b\ inula. The tumour was too thick and

firm to collapse air filled the place of the matter fever supervened, and she died
three days after paruc< ' i removing the tumour, upward;- of a peck moi

mattet

1838.] Enlargement of the Ov aria. 715

she omitted that part of her business, but the next week laboured
hard at the wash-tub and got pretty wet. In the evening of that
day she was somewhat feverish, and at night discovered that the
mumps had returned, and in the night experienced an acute pain
immediately in the region of the dvaria, or as she said, high up
in each groin; which (acute pain) continued with more or less
violence for a long time, with* a gradual enlargement of appa-
rently two hard bodies as he thought, which gradually increas-
ed in size for a very long time; attended in- the first instance
with apparent ascites, and in the latter'part of her illness which
was long, prptracted, excruciating, severe and very painful, with
hydrothorax. #

During the major part of the time she had no treatment, or
perhaps, more properly speaking, she was allowed to have no
treatment, not even that of decent humanity.

On the 15th of December, 1836, we. saw her for the first time,
and was not a little surprised to find a human being alive, in her
then situation she was swelled beyond and thing of which we
had any idea had evidently a large collection of water in the
abdomen and apparently two hard oblong round bodies extend-
ing nearly across and meeting in the centre of the umbilical-
.region. We immediately advised paracentesis abdominis, which
was declined from the fears of our patient, as she appeared at that
time very reluctant to quit this vain world. We honestly set
before her all the chances for and against recovery, which were
received with perfect sang froid indifference. Our advice being
declined, we left her the compound powder of super tartrate
of potass and jalap, with orders to use it so as to keep her
-bowels freely open; and recommended sleep to be procured by
the judicious use of laudanum, for sleep, she could not. With
these directions we made a gratuitous tender of our professional
services which were declined both by herself and husband.
In the spring of 1837, we believe it was in the month of April,
we were again requested to visit Mrs. Bush, and if on our first
visit we were surprised at her situation, we were now more. than
astonished at her enormously increased and unwieldy size. On
examination we found the (apparent) two tumours had met or
rather (more properly speaking) passed each other, and so very
-completely filled up the abdominal cavity, that upon using the
b 2

716 Enlargement of the Ovaria. \}^i

usual and common test in [hose and similar cases, we could dis-
cover,no collection of water, I began to think that we had mis-
taken the disease or its nature, if we had not been very positively
confident that at the first examination we could and did discover
a fluctuating fluid within the abdomen. We again recommend-
ed tapping as the surest means of affording relief, as the breathing
was sturtorous and laborious ; pulse very quick and the coun-
tenance haggard in the extreme with great anxiety, but implicitly
and positively gave it as our opinion that no. cure could be
effected or expected at this time. At present the whole system
wore evident marks of general dropsy, and the inferior extremi-
ties were enormously distended and a fluid could be heard
upon turning herself in different positions: Our advice was
again rejected, but whether from choice or tutorage is to be
inferred from the fact, that the common necessary comforts of
life were withholden by a most loving and affectionate hds-
band. Death ivas not U1211 so near at hand in his humble
opinion as to render it certain that life would become extinct
on the performance of an operation. His victim must yet suf-
fer a long time, although death would then have been a welcome
friend. We departed and report says things/continued to as-
sume an aggravated aspect with increased violence, till the
month of February, 1838, when we were again requested to
visit the wretched sufferer, who was swollen beyond description.
Again tapping was recommended' as the only means of affording
any possible chance of relief, but with this assurancetm our
opinion, (for the pulse was rapid, quick, threaded and very
feeble) that the operation would now be productive of instant
dissolution ; but at the same time that we gave such as our opin-
ion, we said that it was possible that such might not be the fact.
To this Mrs. Bush did not object, neither did her truly affec-
tionate husband, but some superstitious old women coming in,
said that they had "heard a Banshe crying all night," and they
were certain that if Mrs. Bush was tapped it would kill her.

The wishes of Mr. & Mrs. Bush were overruled by witchery
and superstition, and Mrs. Bush was left to suffer all the direful
and distressing affections of tumours and hydropie diseases and
the morosed imagination of a most affectionate husband, whose
only regret was, that the Father of mercies had not sooner re-

1838. J Enlargement of the Ov'aria. 717

lieved him of his constant trouble, a most truly honest and affec-
tionate wife. On this occasion Mrs. Bush fully opened herself
to us, complained of the bad, harsh and hard treatment of her
husband, but like a christian she forgave her persecutor, and
requested that at her death we would make an examination of
her body and report her case, if it was worm reporting, to the
world. This we promised, and so far as comports with our
humble ability we now perform and redeem that solemn promise.
She departed this life, as we have been informed, at 4 o'clock,
P. M.on^Friday, the- 1st of June, 1838 ; and at 11 P. M., precisely
seven hours after death, fn the presence of Drs. Wm. P. Butt,
Jas. S. Jones, E. M. Pendleton and Students, Jas. W. Wi-
laer and A. Paris, we commenced the autopsis. The general
appearance of the subject presented nothing worthy of remark,
if we except the appearance of the tumour, the emaciation of the
chest, face, superior and inferior extremities, which were literally
nothing but skin and bone : countenance haggard, hippocratic
and greatly dejected. Calculating to find a large quantity of
water in the cavity of the abdomen, we made an incision with the
trocar and canula in the most prominent part which was about
two or three inches below the umbilicus, after which, upon draw-
ing the trocar from the canula, not a drop of fluid .escaped for a
second or two and then we were somewhat surprised to a see
a dirty, thick,' curdy, tenacious, brownish fluid or pus come
dropping out. Finding that the case was different from what
might be, or was expected, a crucial incision was made in
the usual manner. Upon cutting through the parietes of the
abdomen we came to the tumour closely adhering to the perito-
nium and extending longitudinally from a considerable way
below the pubis to above the cartilago enseformis, and laterally
from the anterior superior spinous process of the ilium on
one side, to that of the other, and very nearly filling up
the entire cavity of the abdomen. At first, view there ap-
peared to be two tumours, but upon cutting and examining,
it was discovered that there was out one tumour > but that
one was somewhat inclined to be double. The external ap-
pearance of the tumour might be said to be convoluled and glo-
bular. "Where the tumour was cut into it was .evidently some-
what cellular, and some of those cells contained an albume

Feet.

lnche

4

10*

5

t

4

3|

8

7|

718 Enlargement of the Ovaria. [July-

nous matter, some a gelatinous matter, and some contained
a semi-fluid very much resembling both in colour and consisten-
cy, semen or sperm. In dissecting out the tumour we came at
last, in. the posterior part of the abdomen, to a large quantity of
dirty looking coffee-ground coloured thick water, which was
collected in tubs, and from appearance we would say twelve
gallons at least. The tumour when dissected from the body
weighed twenty-one pounds. The following is the size of the
tumour as measured in the presence of the attending gentlemen :

Circumference of the Tumour around the Abdomen,
From Symphysis pubis to Euseforme Cartelage,
From Vertebra to Narel,
Or around the body,

The contents of the thorax abdomen and pelvis, were in turn
respectively and seperably examined. In the thorax there wag
a large quantity of bloody water, at least two. gallons. Lungs
natural and heart considerably smaller than natural. In the
abdomen the intestines were generally inflamed but not exten-
sively : the spleen, pancreas and liver somewhat enlarged : kid-
neys normal. In the pelvis, the contents generally not diseased,
the right ovaria enlarged so as to weigh twenty-one pounds :
the right fallopian tube as large as a large sperm candle, the left
ovaria and tube of natural size, the uterus somewhat enlarged
but healthy in appearance with a patulous mouth. The corpora
lutea apparently injected with venous blood, but otherwise
healthy.

The abdominal contents lay entirely behind the tumour. We
were promised a drawing by an artist, but causes not within our
control have delayed and prevented its reception, although we
used every exertion in our power to procure the same.
Such was the general necropsy which brings us to our neces-
sarily imperfect remarks on the case.

Remarks. From the tjfne Mrs. Busn was first attacked with
a relapse of the mumps, there appeared to. have been a violent
pain in each ovaria, and an enlargement of both ovaria. when in
fact but one was affected, which famishes very strong grounds
to those who adopt the doctrine of sympathy. She continued to
menstruate regularly until a short period before her dissolution.

38.] Enlargement of the Ocu 719

say since February last, and with the exception of the rapidly
increasing size and pain of the tumours and accumulation of
water, experienced no particular inconvenience. There was one
thing very remarkable to every person who made an examina-
tion of the case, that all looked upon arid regarded the enlarge-
ment as two tumours which could be very distinctly felt. This
deception might have been caused by convoluted and globular
feel and form of the tumour. When Mrs. Bush would lie
in any position in the latter 'part of her illness, the usual test
could discover no water, but if she attempted to turn you
might then very distinctly hear, plainly feel, and evidently see,
that there was a large collection of fluid, and as upon using the
customary test we could not hear nor discover any fluid, we were
somewhat at a loss how to account for the difference. One thing
is very evident, that if at any time from the first time we saw
Mrs. Bush, had an attempt been made at paracentesis abdominis,
that the attempt would have been futile. Tapping could not
have been perfected in the usual way or method, for if an attempt
had been made to have drawn off the water, (and all persons
looked upon, and considered- her case as dropsy, we looked upon
it as dropsy of the ovaria,) the trocar or any other instrument
which might have been selected for use, would instantly after
passing through the walls of the abdomen, have come in imme-
diate contact with a tumour of twenty one pounds weight, large
in proportion, and some eight or nine inches in diameter, and at
least two feet in length after excision. From what we observed
we are now inclined to the opinion that tapping might have
been perfected in the inferior posterior part of the illiac region.
But the most remarkable part of the history of the case is
that Mrs. Bush had a? single sister, who, when about the
age of 37, (but who had no children,) was taken in a very
similar manner to what Mrs. Bush was, with the exception that
the single sister did not have mlimps. It is nothing uncommon
for there to be a metastasis from the parotid gland to the mammae,
and sometimes to the uterus, but for the metastasis to be to the
ovario, is what we never knew or heard of before.

From the. foregoing, it "may be very plainly inferred, if not pro-
ven, that the assertion of John Hunter was correct, when he
.said that there was no such thing as horeditory disease, but that

720 Amputation of nearly one half of the Jaw-Bone. [July,

1 : '_

in individuals of the same family, there is a strong tendency or
disposition to take one disease of a similar nature.

In the case of Mrs. Bush's sister, no autopsis or necropsy was
had. The tumour was evidently of a fibro-schirrc-cartilagi-
nous nature.

We have perhaps extended our remarks beyond the usual
length of such communications, and should have repressed them
if we could have expressed ourselves in more concise and laco-
nic language.

Warrenton, July I lth, 1838.

article nr.

Successful Amputation of nearly one half of the Lower Jaw
Bone, (4 3-4 inches, including' one of its angles,) for Osteo-
sarcoma. By Paul F.' Eve, M. D.5 Professor of Surgery
in the Medical College of Georgia.

My attention was first called to the following' case about the
middle of last May, by my friend Dr. Philip S. Lemle, a highly
intelligent practitioner of medicine, of Louisville, in this State.
The patient is a negro woman, about 25 years of age, the
mother of one child ; she had experienced pain in the left side
of the lower jaw-bone for ten years. Some of her friends think
that she had suffered even from childhood, what was supposed
the tooth-ache. The molar and bicuspid teeth of the side
affected had all been successively removed, the last by Dr.
Lemle, about four months before the operation. A very large
tumour had gradually developed itself around the left half of
the lower jaw-bone, and as it was at one time somewhat elastic
at one point, had been punctured", from which however, there
flowed only a few drops of blood.

Dinah, the patient, was brought to Augusta on the 26th of
last May, and placed under the care of Dr. Antony and myself.
In a letter addressed to us, it was stated, ': that she had been

1838.] Amputation of nearly one half of the Jaio.Bone. 721

complaining for years of the jaw-ache, which had entirely
resisted the usual remedies for the tooth-ache. The presumption,
therefore, is, that the disease has been gradually working its
ravages for a great length of time." We were particularly
instructed under no circumstances to operate, without there
existed a reasonable hope of saving her life. It was first
determined by us in consultation, to prepare the patient for an
operation, which had been decided upon, not only from the
existing circumstances of the case, but also from the knowledge
of the judicious treatment of the disease by Dr. Lemle, aided
by Dr. Jenkins, an old and very respectable physician, also of
Louisville. 'But during the night of the 29th, three days after
her arrival, Dinah was nearly suffocated by the pressure of the
tumour upon the larynx, and was only able to swallow after
the application of ice to it. This at once hastened our prepa-
rations for the operation, which was performed on the 31st of
May, and certainly not under very favorable circumstances.

Assisted by the faculty, but more especially by Drs. Antony
and Newton, the operation was commenced by making an
incision from the left angle of the mouth, and extending it in a
perpendicular line to the thyroid gland, from which an illiptical
one was made to the lobe of the left ear, including the most
prominent part of the tumour in the illipsis. Upon cutting
through the lip and denuding the lower jaw-bone, we found an
effort of nature at separation near its symphysis. Extracting
the canine or stomach tooth, the bone was divided by a small
saw, half an inch beyond the line marked by the absorbents.
The next object was the removal of the inferior maxillary on
the affected side from its connection with the temporal bone, or
of its division, provided the disease was arrested in it short of
this articulation. By careful dissection, aline was perceived
and defined by the absorbents in the lower part of its neck.
The saw was again employed, leaving only the condyle with a
small portion of the neck, and the operation was completed by
detaching* the insertion of the temporal muscle into the coronoid
process of this bone, which was removed with the diseased mass.
The section of the lower jaw-bone measured at its base 4 3-4
inches.

The outer surface of the portion of bone removed, was very

722 Amputation of nearly one half of the Jaw- Bone. [July,

rough and denuded of its periosteum, to which latter was at-
tached a large irregular fungous growth, varying in consistency
from cartilage to fibrous structure, and extending into the skin
and surrounding tissues there being nothing in this direction
like a cyst or even decided limit to the disease. The periosteum
of the inner surface of the bone was not completely detached
from it, arid to it were also adherent large masses of fungus,
which had filled the mouth, pushing the tongue to the right
side, and projecting down the throat. These had an investing
membrane of a delicate structure, and resembled large irregular
tubercles. The artery of the lower jaw-bone was entirely
obliterated,, and its canal was greatly enlarged and made very
rough by the action of the absorbents. At both the divisions,,
however, made by the saw, this bone bled freely, thereby pro-
ving that at these places it was sound and unaffected by the
disease which had destroyed a portion of its body.

As the patient had fainted several times during the operation,
though sustained by stimuli, and as the tumour was not
encysted, it was found impracticable to remove every part which
had become affected by the diseased actiom We had moreover,
proceeded in this case upon the principle, that the disease origi-
nated in the bone, and that if the root and body of the tumour
were extracted, its projections into the surrounding tissues
would necessarily be absorbed. A small tul^rcle was therefore,
left under the zygomatic arch, together with some enlargement
in the skin over the left carotid artery, and also over the thyroid
cartilage.

The application of three' ligatures to as many arteries, some
eight or ten sutures irr the skin, with adhesive strips and patent .
lint to fill up the cavity made by the removal of the jaw-bone
and tumour, with a bandage, completed the dressing ; and the
patient was placed in bed, after having been on the operating
table three hours. Much of this time, however, was consumed
in restoring her from syncope.

At 8 1-2 o'clock, seven hours after the operation,* found the

system of the patient re-acting. Took at 4 1-2,. a tea spoonful

of common solution of morphine, which afforded much relief,

and was swallowed with ease.

June l.s'/., 5 A. M. Had a pretty good night drank freely

1836. J Amputation of nearly one half of the Jaw- Bone. 723

of cold water nothing else. Prescribed chlorine tooth-wash
for month. 8, A. M. Pulse 124. Took a table spoonful of
gruel, not relished; sick at stomach. Quiet the remaining part of
this day.

June 2d, 3 1-2 A. M. Cannot swallow fever. Prescribed
ice water, warm pediluvium ; head to be elevated, 8. A. M.
Pulse 124, deglutition easy. 12 M. -Has t.slept quietly, and
desires nourishment. Prescribed gruel. 4 P. M. Pulse 140.

June 3d, 2, A. M. Called to patient on account of sick
stomach. Prescribed enema of salt and water, morphine and
free use of chloride of soda to mouth. 8, A. M. Pulse 120
patient comfortable. 2, P. M. Dressed the wound, took off all
the plasters looks weil patient sitting up. 7, P. M. Pulse
120 took a cup of tea. #

June Ath, 7, A. M. Pulse 118 patient assists herself in bed
and sits up. 5, P. M. Has appetite ; pulse the same. (It has
now rained almost incessantly for the last 50 hours.)

June oth, 7, A. M. Pulse 104. Dressed the wound, and
continued to do so every other day. Removed to-day all the
sutures. Union by the first intention took place at the lip and
near the lobe of the ear. The skin in the angle of the wound
near the thyroid gland sloughed, and at one or two other points
where the stitches had been applied. The patient gradually
improved, granulations commenced on the 9th day after the
operation, and on the 10th* Dinah walked out of her room.

1 have nothing particular to relate concerning the patient up
to the 17th, except the difficulty, common with all negroes, of
making her comprehend the importance of diet. She would
insist upon solid food, particles of which were frequently found
in the lips of the wound. She had also two attacks of colic,
the result of eating improperly. It was about this time I per-
ceived the skin taking on disease in the region of the pomurn
adami, and'soon two tubercles projected from it into the wound,
all of which had cicatrized except this place, where an opening
was still kept up, and through which a portion of her ingesta,
particularly fluids, would flow out.

On the 21st. of June, I had to leave Augusta for Charleston,

to bring home a near relative, saved from the awful shipwreck

of the Pulaski, and on my return, saw with regret that diseased

action, apparently of the most malignant nature, had not only

c 3

721 Diseases oj the Spinal Marrow. [July,

commenced in the skin, but had also invaded the sound cicatrix.
Kreosote, iodine, &c. were now freely employed, but seemingly
to little purpose, and Dinah left on the 9th of July for the
country.

I had the pleasure to hear on the 3rd of August, (more than
two months since the operation.) from my patient, who is unex-
pectedly much improved. She has still continued the internal
use of iodine, 9 drops of the tincture three times daily, and
dresses the ulcer with chloride of soda. I learn the diseased
skin has sloughed off, and the only tumefaction now existing is
in the right sub-maxillary gland. There is no enlargement
under the zygomatic arch, nor in the course of the left carotid.
Her appetite is good, and she takes exercise daily.
9 Augusta, August 7th, 1838.

PART II.
REVIEWS AND EXTRACTS.

Dr. Gerhard's Clinical Lecture on Certain Diseases of the
JSpinal Marrow.

Friday, June 15th. I shall, to day, make a few remarks on
the subject of diseases of the spine, which are suggested by the
case of a man, who furnishes a very striking illustration of this
class of affections. He was admitted this morning, but was in
the hospital, three years since, under my care, for an affection
of the spinal marrow, the symptoms of which were pain down
the spine, extending thence, along the course of the sciatic
nerves, more on the left side than the right, accompanied by a
slight, sense of weakness, across the back. and in the. limbs, not,
however, amounting to paralysis. This complaint had begun
two years before the man entered the hospital, so that the affec-
tion dates its origin to a period live, years antecedent to the
present time. When the tnai ; in the hospital, he was

treated on. a systematic plan kept up with much perseverai

183S.1 Diseases oj tin Spinal Marron : 725

lie was cupped down the ipine, and along the course of the
sciatic nerve, from which considerable advantage was derived.
Long strips of blister were applied also in the same direction ;
and counter-irritation was afterwards made by the moxa, an
excellent and not very painful remedy for this purpose. A
single moxa was applied, every day, in such a manner as to
produce a superficial ulcer, so that there were always three or
four of these points of counter-irritation. The man went out
relieved, and was directed to continue the use of the moxa ; this
he did not, however, do, and of course the remedy had not a
fair chance of success, although the man was, certainly, vastly
relieved by its partial application. The patient is obliged to
return to the hospital, from the failure of his strength. He
now, however, no longer presents symptoms of an affection of
the medulla spinalis alone, but of the bones as well as the
medulla ; the disease having probably originated in the former
texture, but, as it was unaccompanied by any distortion, it was
impossible to ascertain whether the spinal chord was the original
seat of the affection, or not. There is now a tumor in the
region of the sacrum, and an obvious prominence of the lumbar
vertebrae ; and the man now walks like a paraplegic patient,
supporting the upper part of his body by leaning forwards, and
resting his hands upon his knees. Having lately lectured upon
the subject of apoplexy, we may now find it interesting to trace
paraplegia in contrast with hemiplegia, or the paralysis depend-
ing on the spinal marrow, in contrast with that depending on
the brain. Hemiplegia may be the result of simple neuralgia,
and is therefore not an intallible indication of cerebral disease ;
but. there are, in such cases, numerous other signs of the
nervous character of the disorder, which will prevent you from
confounding it with the cerebral paralysis to which 1 am now
alluding.

To study paraplegia to most advantage, it will be best for us
to examine the symptoms of injury to the spinal marrow,
resulting from fracture of the vertebra, in which there is com-
plete loss of motion, and of the powers of the bladder and the
rectum. The effects of the excessive paraplegia, resulting from
an injury of the spinal marrow, are most strongly manifested
on the organs contained within the pelvis ; and, in consequence
of the abstraction of nervous sensibility from the parts, the;
patient dies from over-distention of the bladder with urine or
pus, or else gives way under the irritation attending the slough-
ing caused by pressure in the region of the sacrum and trochan-
ters. The case under notice has not advanced, by any means,
to the condition I have just described. The patient has still
some control over the powers of locomotion ; but, you saw, this
morning, when I directed him to walk, that he did not hobble

726 Diseases of the Spinal Marrow. c [July;

as in hemiplegia, but bent his body forwards, to fortify the mus-
cles of his back, the muscles most difficult to sustain in the act
of walking, and to alter his centre of gravity.

The next point to be considered is the loss of nutrition, which
has taken place in the lower extremities, particularly in the left
leg, which is thinner than the right. This is, of course, owing
to the wasting away of the muscles, from long disuse. The
change in the sensation of the limbs, is also worthy of notice ;
in the legs there is a feeling of pricking, or of formication, or
of numbness, or the sensation which is caused when the limb
is said to be asleep. This arises from the pressure on the nerves
of the limb. Spasms may occur in diseases of the spinal
marrow, but are not usual when they are chronic.

Let us consider the diagnosis, prognosis, and treatment of
this case. First, the diagnosis. When the man came into the
hospital three years ago, we knew that he had an affection of
the spine, but we could not ascertain whether the vertebra?
were in a carious condition, or not. The diagnosis of disease
of the vertebrae cannot be made out, with certainty, at an early
period of the affection. But there are usually, as in the present
instance, some circumstances, that assists very much in forming
a diagnosis, although it can be only an approximate one. When
the lymphatic glands of the neck and other parts are in a
swollen condition, or if there be other indications of scrofulous
diathesis, such as tubercles in the lungs, or that peculiar physi-
ognomy which is so often observed in such patients, we may
infer that the disease of the spine is of a secondary character,
and dependent on a constitutional taint, developing itself in the
bodies of the vertebras.

The organic diseases of the spinal marrow are numerous,
and some of them are with difficulty distinguished from the
secondary alterations, just alluded to. Apoplexy of the sub-
stance of the medulla is a rare disease so rare, that I have
never seen a dissection of it ; but membranous apoplexy, in
which the blood is poured into the sheath of the medulla, I
have several times witnessed ; in both these varieties, the disease
is sudden in its onset, and is attended with paraplegia. Where
the effusion of blood occurs into the membranes, the paralysis
is more extensive, and gradually tends to ascend from the lower
extremities, the nerves of which are supplied from the lower
part of the spine, towards the upper parts of the body ; death
follows as soon as the muscles of respiration arc palsied. In
the apoplexy of the nervous substance, the paralysis is more
fixed, and, if not complete, the patient may recover. Neither
of these varieties can well be confounded with cerebral
haemorrhage, in which there is nearly, if not quite always, palsy
of the side of the body only. In the case of the patient just

183S.1 Diseases of the Spinal Marrow, 727

admitted, as well as in most others who are affected with spinal
paralysis, the intelligence is remarkably clear, and more bright
than usual, which is another point of distinction between the
affections' of the spinal marrow and those of the brain. I have
already stated, that we can distinguish, with great difficulty,
chronic inflammation of the medulla, from the effects of scrofu-
lous disease of its bony covering.

The prognosis, in this case, is not difficult. From the fact of
its dating its orio-in to live years since from its having1 been
partially arrested, and now returning with aggravated symp-
toms, there is, we fear, but one termination for it it will proba-
bly end in death. But before the disease of the vertebrae is
established, if the early symptoms are combated, there is a tole-
rable chance of success ; now that evident distortion has taken
place, indicating- extensive bony disorganization, the affection is
almost necessarily fatal.

The treatment, proper in this case, applies to all chronic
inflammations of the spinal marrow. They are to be managed
on the same principles as those of the brain ; the treatment is,
however, more local in its character. Purging should be em-
ployed with a view to act upon the local disease, as a revulsive ;
instead of diminishing, it rather keeps up the general health.
Rest is essential : hence, as in cerebral apoplexy, I would avoid
stimulating the organ with strychnine, or remedies of the sort,
unless in the very chronic stages; keep it perfectly quiet, by
placing the patient on his back, and retaining him there, rigo-
rously. If the symptoms are tolerably active, cupping must be
freely employed ; but only in a moderate way, if the affection be
altogether chronic. After local depletion by cups and leeches,
remedies of a more permanent character must be used. There
are several which may bo tried, and a preference given to that
which is found to answer best, in the particular case. From
blisters I have derived but very slight advantage. Moxas I
have found decidedly the most useful, though 1 cannot say that
they are always permanently serviceable. They have several
advantages ; they produce the same good effects as the caustic
potash, or setohs, and are much more moderate in their action,
and less irksome to the patient ; they likewise, from the pain
they produce, stimulate the nerves in the least injurious way,
being thus of double service as a counter-irritant and an
excitant. They are to be applied frequently, say one every day,
and on half-a-dozen different places, which may thus be kept
sore ; their application being continued, until they produce
vesication, but not deep ulceration. In this case moxas were
used for two or three weeks ; and, in other cases, I have used
them for months. If they give intense pain, they may be given
up, and other remedies tried, as the caustic, setons. and blisters.

Diseases of the Spinal Marrow. |_July,

Acute inflammation of the spinal marrow is an affection of
rare occurrence. The most unequivocal case I ever saw which
terminated fatally, took place at the Children's Hospital at Paris,
in a child six or seven years of age. The little girl was very
intelligent, and could give a very good account of herself. She
had received no injury, and there was no obvious cause of the
disease, but the constitutional tendency to it, which was evident
from another sister soon after entering' with nearly similar
symptoms. She entered the hospital, after having been ill for '
three days. At this time there was stiffness and flexion of the
limbs of the upper and lower extremities, which could not be
extended without great pain, and this was the only uneasiness
felt ; when the limbs were touched she did not complain. This
contraction continued to increase till death, and was always
greatest in the upper extremities, the arms being bent to an acute
angle, at the elbow. Upon examination after death, the upper
portion of the spinal marrow was found in a softened condition,
particularly, just below the crossing of the corpora-pyramidalia.
The softening involved both the anterior and posterior portions
of the spinal column, thus accounting for the affection of the
nerves of motion and sensation according to the theory, at pre-
sent generally received, which, however, some recent experiments
appear to call in question.

The general symptoms, then, of acute inflammation of the
spinal marrow, are numbness, pain, stiffness, and rigidity of the
muscles, supplied from nerves coming off below the part affect-
ed, and if the inflammation is towards the upper portion of the
spinal marrow, the contraction is more obvious, in the upper
than the lower extremities. If in the case to which I have
alluded, the pain had been unaccompanied with contraction, I
should not have deemed it a necessary symptom. The func-
tions of the alimentary canal were not altered in a remarkable
manner. The appetite was good, and the powers of urining not
impaired, although this cannot be generally the case. The
integrity of the cerebral functions, in this patient, sufficiently
showed the spinal marrow to be the origin of the symptoms.

The treatment must depend upon the activity of the affection,
and the period at which you are called to it.' The rase of the
little girl was not so actively managed in the French hospital, as
it would have been by our practitioners. There (he treatment
was confined to some remedies of a local character ; but with
us, it would have been looked upon as an affection of a most
irere grade, (for the patient inevitably dies, as soon as the dis-
ease extends to the neck and the functions of respiration become
affected,) and we should have treated it accordingly. A patient
of a strong constitution, 1 should bleed freely, and follow the
bleeding up by cupping over the part affected, to an almost

1838.1 Diseases of the Spinal Marron 7 20

indefinite extent. Ii' the patient I depletory tr

ment must he somewhat modified, and confined to leeching.
After this plan has been pursued for several days, it is proper to
attempt to moderate the local symptoms, by blisters, moxas and
purging, the latter of which, however, is to be looked on as a
mere adjuvant. This affection is not a rare one in children ;
like most diseases, however, it assumes something of an epidemic
character, and you will have, at certain periods, a number of
cases together, and may afterwards not meet with one for several
years.

There are a number of affections of the spinal marrow, into
which I shall not enter in this course some of a very tangible
character, and others, protean in form and nature. Within a
few years past, it has been the fashion to ascribe to affections of
the spinal marrow, an almost endless variety of symptoms
some with propriety, but others on very inadequate grounds.
This subject was investigated, some years since, by Tate and
Teale, of Yorkshire ; and the results of their researches attract-
ed to it considerable attention. Three or four years ago, these
complaints were more common, certainly, than at present, and,
hence, some of the interest with which they were regarded, has
subsided.

Under the term, spinal irritation, which has also been given
to the more indefinite class of affections, I am disposed to include
two undoubted varieties of disease ; first, all cases of neuralgia,
originating in the spinal column, and extending along the course
of one or more nerves, and in which there is pain on pressure
over the corresponding vertebra?. If the pain be greater over
the vertebra?, than in the' muscles affected ; if you have, for
instance, pain over the scapula, and upon pressing the spine, you
find it more tender than in the muscles of the scapular region,
you may at once conclude that you have neuralgic rheumatism.
Secondly, I use the term, also, in those cases of more obscurity,
in which you have pain in a circumscribed spot, at the anterior
part of the chest, near the heart, or sometimes, although rarely,
at the same point of the right side. In these cases, if you find a
tender spot in the vertebra?, corresponding with this cardiac
pain, it is fair to infer the existence of spinal irritation. The
diagnosis becomes more clear, if you have also pain on pressure,
along the course of the intercostal nerves ; although such an
extension is by no means necessary. Many are disposed to
account for other functional disorders, by tracing them to spinal
irritation, cases of palpitation of the heart, in which there is no
anemia, and where there is pain on pressure over the vertebra?,
may be referred to this cause. If the latter symptom be wanting.
yon can decide only by the results of treatment.
Affections of the alimentary cq dto the

1 30 Diseases vf the Spinal Marrow, [July.

cause. .You may recollect the prevalence of dyspepsia all over
the country, some years ago, when lawyers, clergymen, and all
who pursued sedentary occupations, as well as some who led a
more active life, were uttering universal complaint on this sub-
ject. Much of this undoubtedly depended upon spinal irritation :
how far the spinal marrow was connected with the symptoms,
was to be known from the evidence of pain on pressure, or by
the success of the after treatment. Disorders of the lower
bowels are never ascribed to spinal irritation. '

Some are disposed to deride the very name of spinal irritation,
as applied to the last mentioned disorders; but I think it may
still, with propriety, be given to certain groups of symptoms, for
want of a better term by which to designate them. Although
they are not now met with, so often as they occurred a few years
ago, they still present themselves in sufficient numbers to claim
a fair share of your attention.

There is one other affection, in which the spinal marrow some-
times plays an important part. This -is acute articular rheu-
matism, in which we find another element in addition to mere
neuralgia. In articular local inflammations, if you can detect
pain on pressure along the spine, and if the local pain is at the
same time increased, cups along the spine, as recommended and
successfully used by Dr. Mitchell, of this city, will often prove
of signal service.

The diagnosis of the various disorders, dependent on irrita-
tion of the spinal marrow, is not a little difficult; and, from the
kind of enthusiasm with which the researches of Teale and
Griffin were received, ludicrous mistakes are sometimes made,
in attributing to this cause, important functional disturbances, in
which the spinal marrow is not at all affected, or only in a slight
and secondary manner. I shall point out some of the modes of
discrimination, in these cases. In affections of the chest, of
the lungs or heart, physical examination may be resorted to,
to determine all points of doubt. In disorders of the stomach,
the best test of the presence of gastritis is afforded by the effects
of food, which proves irritant as soon as taken, in chronic gas-
tritis; whereas, in neuralgia, although the ordinary aliment
may occasion some inconvenience, slight stimulants, as wine,
are both salutary and proper.

The pathology of the class of affections which we are ex-
amining, is unknown. The probability is immense, that there
is no pathological alteration in the organ, but that the distur-
bance is altogether functional. Besides, the disorder generally
disappears so long before death, as not to allow us to detect any
morbid alteration, that may have previously existed. If to. this
we add the great difficulty attending the pathological examina-
tions of the spinal marrow, we can readily accouni for our

1838.] Diseases of the Spinal Marrow. 731

ignorance on the subject. Physicians, however, generally
treat these affections, as if they were known to be inflammatory,
by local depletion, and, afterwards, counter-irritation by blisters,
tartar emetic, and croton oil. The tartar emetic is a good
remedy for this purpose, but a painful one ; the croton oil is
less painful ; and blisters cease to give much annoyance, after
one or two applications. This mode of practice is found by
experience, to be the most successful, and in our ignorance of
the precise nature of the lesions, we cannot do better than
pursue it.

1 had lately a marked case of obvious functional disorder of
the heart, the symptoms of which disappeared, after one or two
blisterings to the back. Another similar case, was that of a
woman in the hospital of the almshouse, who had been for a
long time unavailingly treated for gastritis, and severe pain in
the region of the stomach, which were relieved at once by one
or two cuppings to the spine. About the same time, a friend,
of mine, a young lawyer, of high promise, offered a well-marked
example of a similar affection. He had been treated for it,
with little success, by a country physician of skill and experi-
ence, when he applied to Professor Jackson, who, just at this
time, had become acquainted with the then novel subject of
spiritual irritation, and, a few leeches and counter-irritation to
the spine, directed by him, effectually relieved the symptoms,
which did not return. This simple treatment will often suc-
ceed, without resorting to tartar emetic or other irritating
remedies.

In cases of organic diseases of the heart, complicated with
spinal irritation, Dr. Marshall, who has written an interesting
treatise on this subject, recommends the direction of our thera-
peutics to the cure of the latter. I have seen many such cases,
and have often succeeded with great facility, in so far modifying
the symptoms, that they have ceased to annoy the patient ; for
if, in these cases, you remove the functional disorder, the organic
lesion often proves of little injury to the comfort of the patient.
A gentleman now residing in Washington, consulted me a few
months ago, in an analogous case, in which there was conside-
rable valvular disease, with extreme functional disorder of the
heart. I succeeded in removing the latter symptoms, which
were in this instance, treated without irritants to the spine, and
the patient is scarcely conscious of the heart disease. Now, in
such cases, the local remedies addressed to the spine, often prove
of extraordinary advantage. In diseases of the lungs, less
success is to be anticipated, than in those of the heart or stomach.
Whenever you find irritation distinctly extending from the spine
to the viscus affected, the success of the spinal treatment may
d 4

Eclectic Journal of Medicine. [July.

be looked upon as almost certain, and relief will often be almost
instantaneous. Last summer we had several cases, illustrative
of the good eifects of this treatment, and, although none offer
themselves at this time, we may look for their not very distant
return.

These brief remarks will prove sufficient for the purpose for
which they are intended to call your attention to an important
and very troublesome affection. For fuller details on the sub-
ject, which are not now demanded, I refer you to several capital
treatises, perhaps a little ultra, in some o the points which they
urge. They are those of Tate ; of Teale, on Hysteria ; of the
Messrs. Griffin, of Ireland, a more complete and distinct work,
in which the protean forms and transient, character of these
affections, are amply discussed and illustrated by cases; that of
Marshall, of Scotland, and, afterwards, of the North of England,
(not Marshall Hall,) a valuable work, which has been repub-
lished in this country, and from which you can extract much
that is excellent, allowing for some exaggeration of views and
facts. I say exaggerations, for others have certainly not been
so successful, in the management of neuralgic affections, as this
author seems to have been.

Should many other nervous affections present themselves
during the course of the summer, I shall take them up : but it
is probable that our attention will be occupied with more acute
and violent affections. Besides, the excellent series of lectures
which were given by Dr. Jackson, upon this subject, during
the past winter, (which you will find in the earlier numbers of
the Medical Examiner,) renders it less necessary for me to
enlarge upon the subject of these diseases. Medical Examiner.

Eclectic Journal of Medicine for May, 1838.

This valuable periodical continues its monthly appearance
with great regularity : and its pages shew hy their judious selec-
tions and observations the good ability with which it is edited.
This work promised well in the beginning, nor has it failed to
maintain amply its first promise. We hope it is liberally pat-
ronized, not only on account of its able editor, but because it is a
work which every medical man should receiveno matter how
many other journals may receive his patronage. The number
before us begins with an extracted review from the Medico Chi-
rugical Review, of the works of Colles, 1 [unter and Devegie,

Eclectic Journal of M dicine. 733

on the venereal disease. This review contains a very fair com-
parison of the English and French views of the disease and of
pathological principles generally; with the judicious observa-
tions of Dr. Jonx.sox, the Nestor of the professional present.
We noticed this subject briefly on a former occasion. The next
article is an extract from the Edinburg Medical and Surgi-
cal Journal for January, 1S3S, and is an article from Dr.
Wardrop's work on Diseases of the heart. It contains an ac-
count of a new mode of increasing the heart's action ; which for
its practical value we extract at length.

A new mode of increasing the the Heart's action For re-
storing the powers of lije in persons apparently dead from
drowning, or in *S{/ncope.

Some years ago I had occasion to bleed a lady, and abstracted
upwards of thirty ounces of blood, whilst she was in bed. About
three hours afterwards, on attempting to rise, she fainted. The
family being in great alarm, I was sent for, and when I got to the
bedside, I found that another practitioner was in attendance.
He said to me " your patient is dead." The basin of blood re-
mained still on the table, and I was in great uneasiness on
account of the lady's condition, and I confess I also dreaded the
effect of the largeness of the bleeding. Spirits of ammonia had
been sent for, but deglutition was suspended ; a flexible tube
was sent for, and I became very much alarmed.

In this state of anxiety of mind, and without having any pre-
cise purpose in view at the time, 1 desired her husband, who was
almost frantic, to assist me in raising up her head and shoulders
from this supine position. She gradually resuscitated, and in
three or four minutes she became quite revived. I again visited
her late at night, when she said she had great pain in her arms,
and she thought that her husband and I had grasped her arms
too tightly. On returning home and reflecting on the circum-
stances of this case, I concluded that pressure (quite uninten-
tional, however,) on the brachial arteries by impeding the circu-
lation and causing congestion, must have excited the action of
the heart.

On making the experiment, I found, that by pressing the bra-
chial artery, the pulse, though it gradually beat laster and faster,
continued still small and thready, and when the pressure was
removed, it became very full, and continued so for some time.

lean at any time raise the pulse in this way. On repeated
trials, I find that the pulse being first felt so as to ascertain the
progress, it runs nearly thus :

734 Eclectic Journal of Medicine. [July;

In 3 1-2 minutes it rises from 6S to 74
5 - - 68 to 78

7 - - 68 to 80

So that in seven minutes, twelve beats in the minute can be
gained. Is there any medicine known which can do this in so
short a time ? How valuable, then, is this fact !

It was only yesterday that an eminent anatomist called on me.
He doubted the fact. I convinced him by stopping the circula-
tion in his right arm, when in nine minutes his pulse rose to
fourteen beats in the minute. I measured his pulse, it was,

75, and in 3 1-2 minutes it rose to 83
in 5 - 85

in 8 1-2 or 9 - - 90

As the laws in the animal system sometimes call in the act of
pressure, I conclude that to imitate nature in that respect, and in
other instances of disease, especially in such as proceed from
great exhaustion, they may be (after the knowledge of this fact)
successfully treated.

Before I conclude, I have only to say, that if the tourniquet
was known formerly to be of use in disease, I can surely affirm
it is not used at the present day, nor for the thirty- six years that
I have been in practice in London, either at public hospitals or
in private practice.

If the patient is thin and delicate, the force of the operator's
thumb will be sufficient to produce the necessary pressure. But
if the patient be more muscular, a tourniquet must be applied.
It may be objected by saying, " but where is a tourniquet to be
had?" A simple and effectual one can be made of a neck-cloth
or pocket-handkerchief, and a bit of stick, a pencil-case, or the
handle of a pocket-knife.

I have, on this occasion, pointed out the good effects to be de-
rived from this practice, as regards a sudden stimulus to the
heart when in case of suspended animation ; in cases of persons
apparently dead from drowning and in syncope. But much is
left to be said of its use in various other instances, where the san-
guiferous system requires quick attention, and a remedy fortu-
nately always at hand. Edin. Med. and Surg. Journ., Jan-
uary 1838.

The next article, from the pen of Dr. Robert Lee, of the
British Lying-in Hospital, and taken from the London Medical
Gazette, is a brief history of the rare anomaly of a female who
had four mammae and nipples, all of which afforded milk. Two
of them are about the natural site, and the others are a little above
them.

1838.] Eclectic Journal of Medicine. 7 36

The author considers the above case as furnishing one of
tlie best examples on record of quadruple mamma? in the human
subject, and cites from several foreign authors some of the most
striking instances he has met with of the same malformation :
the cases present no material deviation from the one under con-
sideration. The author remarks, that in some women only one
breast has been developed ; others have had two nipples placed
on one mamma ; and a few individuals have had three breasts,
two in the natural situation, and a third between them. Only
one case has been recorded of five mammae in the human sub-
ject." London Med. Gaz., Jan. 1838.

The next article consists of a report of cases occurring in the
Clinque of M. Louis, by Henry Curling, Esq. This report
is from the London Medical Gazette for January 1S3S, and is of
practical value ; especially as it contains the practice of M. Lou-
is who is now one of the best pathologists of France. fl he fol-
lowing cases are given :

" Enteritis Recovery. A female, aged 30, of a weak con-
stitution, was admitted into La Pitie, under M. Louis, April 12th.
She had been attacked on the 2d instant, about noon, with a
rigor, which lasted two hours, followed by increased heat. She
had likewise vomited, but had neither headache nor giddiness.
These symptoms were soon succeeded by pain in the abdomen
and diarrhoea, which, with the fever, have continued to the pres
ent time. The pain has been confined to no particular spot.
On the second day of her illness she had considerable nausea
and vomiting, attended with slight pain in the epigastrium, to
which she had never been subject. On the third or fourth day,
cough was added to these symptoms. For the six or seven days
preceding her illness she had a little tinnitus aurium, but it has
since ceased, except when she coughs. She has one child ; and
menstruated about three days ago.

April 12th. Pulse 94, full ; yesterday evening 100 ; skin
hot ; eyes hollow ; the inferior lip covered with a white crust ;
countenance expressive of weakness, but there is no appearance
of stupor; memory exact; the circumference of the tongue red,
white and villous in the centre ; nausea increased by drinking ;
complete anorexia; four stools yesterday ; no pain in the abdo-
men. A little below, and to the left of the umbilicus, there is a
swelling about two inches in width. It is hard, fixed, gives no
sound, and is not at all painful ; respiration quite natural.

Diet. Ptisan, Oiij. Extract. Opii, gr. i.

15th. Feels better, and is in good spirits ; has eaten some
bouillon without being followed by nausea ; pulse 100, regular ;

Eclectic Journal of Medicine. [July,

heat natural ; no pain in the epigastrium ; the tumour is more
moveable, and is very close to the neck of the uterus, which is
not, however displaced; tongue white and villous ; has had one
stool.

All these symptoms gradually subsided, with the exception of
the diarrhoea, which persisted to the 22d inst. A few days after,
she left the hospital convalescent.

Enteritis Recovery. A man, aged 53, of a moderately
strong constitution, was admitted under M. Louis, March 22d,
having been ill seven days. His illness commenced with pain
in the abdomen and diarrhoea, which have continued to the
present time. He lias" had as many as thirty stools in one day,
but no .tenesmus. The matter voided was often compared by the
patient to white of eggs, and was frequently mixed with blood.
He lias had considerable fever, attended with perspiration and
headache. He ceased working from the commencement, but
has not kept his bed. He has never had a similar complaint.

March 23d. Countenance natural ; tongue moist ; thirst
moderate ; has vomited twice ; six stools yesterday ; abdomen
well formed, sensible to pressure; the pain does not follow a
transverse direction. Pulse 52; no fever ; subcrepitation poste-
riorly and inferiorly on both sides, but especially on the right.

TV. Opii} 37. m inject lone admlnist.

The diarrhoea ceased the second day after the administration
of the injection, and in three or four days he was quite well.

Typhoid Fever with Eruption Recovery. A young
man, aged 23, of a strong constitution, with black hair and eye-
brows, well developed, came to the hospital March 9th. For six
or seven days previous to his illness he had had diarrhoea, but had
paid no attention to it. He has been obliged to keep his bed
the last fortnight. His illness commenced with shivering,
cough, and headache, followed by excessive heat and great pros-
tration of strength. The diarrhoea has continued except during
the last two days ; the fever has not ceased, but he has no return
of the rigors. Anorexia and tinnitus aurium are to be added
to the symptoms. The sight has been troubled, and lie has felt
giddy; but he has had neither pain in the abdomen, nor epi-
staxis.

March 10th. Lies on his back ; face covered with red spots,
and has an expression of anxiety ; answers questions rapidly and
sensibly; sight troubled ; eyes injected ; nostrils dry ; feels gid-
dy ; tongue dry in the centre, moist and natural in its circum-

ence; no ineteorism; no gargouillemcnt in the right iliac
fossa. The chest, axilla, and abdomen, covered with numerous
vesicles, half a line in diameter ; perspired a little in the nigh? :

>3S.] Eclectic Journal of Medicine.

several rose-coloured spots arc seen on the chest and abdomen ;
pulse 96 yesterday evening; 100 this morning. A bitter ti
in the mouth; no nausea; respiration vesicular ; much thirst.

Antim. Tartariz. gr. I in nd.

11th. Countenance less injected; has not vomited; pulse
92 yesterday evening, SS this morning; tongue dry in the cen-
tre, but trembles less : tinnitus; fresh vesicles on the chest and
neck ; desquamation of the skin ; four stools; spleen cannot be
distinguished.

Eau de Seidlitz, half a bottle to be taken during the day.

On the Mth the sudamina were still more numerous, and con-
fluent, particularly about the axilla. The tongue began to clean,
and to become moist.

On the 17th he felt a little appetite, and from this period he
became rapidly convalescent.

Remarks. These three cases afford examples of two diseas-
es, enteritis and typhoid fever, which by inattentive observers
are often confounded. Though several symptoms of typhoid
fever were absent in the last case, those that were present were
sufficient to announce its nature. The diarrhoea and excessive
prostration of strength at the commencement, the headache, the
giddiness, and tinnitus, the presence of sudamina and rose-lenti-
cular spots, could, when combined, be attributed to no other
disease.

In like manner, in the second case, the nature of the disease
was denoted by the very numerous stools, the little fever, the
pulse being only 50; the little prostration of strength (for al-
though the patient ceased working the second day, he never kept
his bed) ; the advanced age of the patient (53) ; the absence of
giddiness, tinnitus, and spots. These symptoms are only ob-
served in enteritis. Pain in the abdomen and diarrhoea, though
ufliciently frequent in typhoid fever, are 'still more constant in
enteritis. Headache occurs in forty-nine cases out of fifty of
fever, but in not more than two of the same number of cases oi
enteritis. Among a great number of cases of enteritis observed
by M. Louis, only one quitted his work the day of the attack,
while the contrary happens in typhoid fever. The rose-lenticu-
lar spots, the sodamina, epistaxis, metorism, are rare in enteritis ;
not more than one in twenty-three had epistaxis. Vomiting is
also rare in enteritis ; but it does not often occur in fever be!
the eighth or ninth day. the period when most of the complica-
tions of fever are developed. Enteritis may occur from infancy,
may be repeated several times, and triplicate other dis>

es. Typhoid fever rarely attack's very young or very old indi

73S Eclectic Journal of Medicine. [July,

viduals. When M. Louis wrote his work on Fever, 25 was the
mean age of the cases he had observed. From a more recent
analysis of a still greater number of cases, he finds 23 to be near-
er the truth. He has never seen it after 60 years, and very
rarely after 50. M. Louis has only seen five fatal cases of ente-
ritis ; and, considering its frequency, he does not view it as a
dangerous disease.

Though it is impossible to confound well-marked cases of en-
teritis and typhoid fever, yet as a disease is more denoted by the
combination of certain symptoms than by the presence of any
one particular sign, so, when some of these symptoms are absent
when they occur in a different order, the diagnosis is often
rendered difficult. This occurs in enteritis and typhus fever,
slight cases of which are often confounded. And the distinction
between them is more important than is generally thought, par-
ticularly as regards the prognosis. All the cases of perforation
of the intestines which have fallen under M. Louis's notice were
at the commencement very mild, and comparatively trifling.

In the first case the diagnosis was doubtful : the disease com-
menced by a shivering fit, fever, diarrhoea, pain in the abdomen,
succeeded on the second day by epigastric pain and vomiting,
and on the fourth by a little catarrh.

The diarrhoea, the depression of strength, and the vomiting,
would seem to indicate fever, whilst the slight headache, the
absence of giddiness, of spots, and of pain confined to the right
iliac region, would rather indicate enteritis.

A white exudation on the mucous membrane' of the mouth
was considered by the ancients as a very fatal sign ; but that it
is not always so the first case proves. It certainly is only devel-
oped when the patient is very weak, whether from the effects of
an acute or chronic disease, and depends upon an inflammation
of the mucous membrane. In like manner sudamina are often
looked upon as a very dangerous symptom, whereas only one-
half of the patients in whom this symptom is present die.

Typhoid Fever Erysipelas of the face Acute Pe-
ritonitis FROM SUPPOSED PERFORATION OF THE ILEUM

Recovery. A cook, aged 33, had resided in Paris three weeks,
when on attempting one morning (March 22) to get up, she was
attacked with vertigo, pain in the head, buzzing in the ears, and
dullness, which obliged her to keep her bed. She arrived in
Paris in perfect health, and had not been exposed to privations.
These symptoms continued til the 25th, when, being obliged to
go out, she fell down from weakness. The next day she vomi-
tep for the first time, and had diarrhoea, with pain in the abdo-
men. On the 31st she entered the hospital, having walked there
widith cfrhilty, supported by (wo persons.

1S3S.I Eclectic Journal of Medicine. 739

April 1st. Memory exact; lies on her back; eyes sunk;
cheeks of a livid red colour; vision troubled ; tinnitus auriuin ;
great prostration of strength, but not complete ; tongue dry and
red, not pointed; pulse 1 'JO, small and feeble; great thirst ; ab-
domen soft; the spleen cannot be distinguished; pain in both
iliac fossae increased by pressure ; no pain in the epigastrium;
twenty stools yesterday ; respiration healthy.

Diet: ptisan. Antimon. Tart. gr. j. in die sumend.

2d. Has had three stools, and vomited four times. Yesterday
afternoon the nose became red and swollen ; the left cheek soon
became in a similar state, and during the night the right cheek.
The erysipelas extends as far as the chin ; the occipuf is painful
when pressed, but is not ceu'ematous ; pulse 112; other symp-
toms continue the same.

Eau de Seidlitz, half a bottle.

6th. The erysipelas has subsided considerably, and there is
abundant desquamation of skin ; her menses returned yesterday ;
no headache ; pulse 104 ; no thirst ; ieels very weak.

7th. At half past six yesterday evening she was attacked with
an acute pain in the right iliac fossa, accompanied by nausea
and vomiting and rigors. At midnight the abdomen was uni-
versally painful, the pulse 116, weak and feeble. The pulse is
now 140, and very small. Some laudanum was immediately
given her. The tongue is projected with difficulty ; the cheeks
are of a deep violet tint; 40 respirations in a minute ; she cannot
bear the least pressure on the abdomen ; pulsations of the heart
imperceptible; two stools after a lavement: only took three
spoonsful of soup and a biscuit yesterday.

Three oranges. Acet. Morph. gr. j. in Mist. Mucilagin
sum. Strict diet.

Sth. Pulse 152 yesterday afternoon: now 116. Counte-
nance improved ; no nausea; circumvolutions of the intestines
can be distinguished ; abdomen soft, and without pain, except
when pressed; no stool. Tongue slightly moist; red in its
circumference) white in the centre.

Three lemons, and a little ice. Rep. Mist.

10th. Cheeks red ; abundant desquamation ; no pain in the
abdomen, except in the right iliac fossa; tongue red, not very
moist; small white spots on the mucous membrane lining the
lips, and a while exudation at the roots of the teeth.

Hep. Mist. Fomentations to the abdomen.

For several days she continued in a very precarious state, the
pulse beimr very quick and small: but by persevering in the
e 5

74Q Eclectic Journal of Medicine. [July,

administration of opium, and in complete abstinence from all
food, she was, towards the end of the month, enabled to get up,
although very weak. In the course of another month she left
the hospital.

Remarks. The symptoms at the commencement bore some
resemblance to those of ramollisscment of the brain. Indeed, it
has twice happened to M. Louis to confound typhoid fever with
that disease, which he has seen at the commencement attended
with no other symptom than excessive prostration of strength.
On the fifth day the nature of the disease was announced by the
diarrhoea, abdominal pain, vomiting, &c, although many other
important symptoms of fever were absent. It is by no means
rare to see erysipelas of the face developed during the course of
a typhoid fever, whereas it is very rare to see erysipelas preceded
by cerebral and abdominal symptoms for twelve days ; so that
this complication would rather tend to confirm the diagnosis.
On the 7th instant evident symptoms of acute peritonitis were
present, which M. Louis believed to be caused by a perforation
of the small intestine caused by ulceration, and situated about
the junction of the ileum with the caecum. Peritonitis so rarely
complicates acute diseases, that it may almost be laid down as a
law, that if in the course of an acute disease there suddenly
comes on a pain, if this pain is increased by pressure, and
accompanied by a rapid alteration of the features, or more or
less promptly by nausea and vomiting, a perforation of the
intestine exists. The probability becomes still greater if the
disease is typhoid fever, as it is always accompanied by some
degree of ulceration of the intestines. This is the first case of
perforation of the intestine, occurring in the course of a typhoid
fever, which M. Louis has seen recover. Would not the perito-
nitis be considered by many physicians, and perhaps justly so,
as a metastasis of the erysipelas of the face ?

SciRRHirs of the Py'lorus- Death A sempstress, aged
69, previous to the month of November, ]8o(>, enjoyed excellent
health ; her digestion had always been good; she had never ex-
perienced pain in the epigastrium; had always been in easy cir-
cumstances, and enjoyed the necessaries of life without having
committed ahy.pxcess in drinking, &c. &c. In that month she
was troubled, for the first time, with a pain in the epigastrium,
and her appetite at the same lime diminished. In December she
was attacked with frequent vomitings, and often brought up her
food thirty six hours after eating it. On that account she took
hardly any nourishment, and became very thin. The pain in
the epigastrium increased during the months of January, Febru-
ary, &c, and came on generally two or three hours after a meal ;

1S38.J Eclectic Jmtriuil of Mjdicine

'41

the vomiting also became more frequent, the food which had
boon eaten three or four days before being often rejected unal-
tered. In the month of April she was admitted into La Pitie
under M. Louis, and presented the following appearance:

April 22. She is in the last stage of marasmus ; cheeks pur-
ple, and very hollow ; superior limbs of a purple hue ; pulse
very small ; pulsations of the heart well marked ; tongue villous
and white; no diarrhoea or cough; a depression in the epigas-
trium; pain upon pressure 1 1-2 inches to the right and a little
below the umbilicus ; aiso a little above and below the umbili-
cus a projection- having the form of ttie little curvature of the
stomach. Upon pressure being applied, a species ofgargouille-
rnentA is heard; has vomitej lour times since yesterday a clear
fluid; continual eructations of gas; respiration healthy. She
remained in the hospital about a fortnight ; at the expiration of
which period she died. Extensive scirrhus of the pylorus was
found to be the cause of the symptoms, but 1 unfortunately was
not present at the examination.

Pain in the epigastrium and anorexia are by no means
always the signs of an organic disease of the stomach. They
occur also in chronic gastritis, a disease which has not yet been
well described, and of which M. Louis has seen but few exam-
ples ; that is to say, in healthy persons, and occurring as a
primitive disease ; for nothing is more common than chronic
gastritis in the course of phthisis and other similar diseases.
But in the lai*er disease there is seldom vomiting of food taken
two or three days before, as in this case. The vomiting was,
however, by no means pathognomonic of organic disease ; it
was composed solely of the food, and was never mixed with
blood, so that there was no reason to suspect ulceration of the
mucous membrane. The depression at the epigastrium, the
projection! above and below the umbilicus, and the gargouille-
ment, indicated a distended stomach ; the projection being
chiefly caused by the lesser cul de sac The situation of the
pain seemed to indicate the pylorus as the part diseased, which
was the case. M. Louis does not consider scirrhus an inflam-
matory affection, or to be a sequel of inflammation. Cancer
seldom occurs before the age of fifty, whereas gastritis occurs at
all ages. Men are less liable. to cancer than women, though
they more frequently commit excesses. This, however, proves
nothing ; for, according to the same authority, women are more
subject to acute gastritis than men. Cancer has a predilection
for certain parts of the stomach. Thus out of 33 cases

In If) the cancer occupied the epilorus.
11 - - - - small carvatnre.
0 - - - - the large do.

~42 Eclectic Journal of Medicine. (July,.

The cicatrices of ulcerations of the stomach are never observ-
ed in the epilorus ; they more usually occupy the posterior
surface of the stomach. The parts of the body most subject to
cancer, are less liable to inflammation. Out of 65 cases

21 consisted of cancer of the stomach.

22 ..--_- uterus.
10 -..._- liver.

5 .---.. lung.

2 -_.-- rectum.
No account is here taken of the mamma or testicle. In the
lung, which perhaps is the viscus most subject to inflammation,
it only occurred in five cases, and in none of these primitively.

Cancer of the Uterus Death. A woman, aged 40, the
mother of six children, was attacked with hemorrhage from the
uterus fourteen months ago, which lasted seven days, and has
frequently recurred. She commenced menstruating at 16 ; her
menses were not very abundant, and were always preceded by
pains in the loins, which ceased on their appearance. She has
had leucorrhoea from the time she first commenced menstruating.
Her accouchments have all been natural, and she has generally
kept her room five weeks alter each. Since the first hemorrhage,
the leucorrhoea has been more abundant. She has continued
her work, except during the last two days. The hemorrhage
was preceded by pain in the loins, extending round the sacrum.
She has had a difficulty in making water since her first ac-
couchment, and passes it very slowly and frequently. The
pain in the loins and sacrum has augmented during the last
week, and the discharge has been red. She has scarcely any
rest during this time, on account of the great pain at the anus.
Her abdomen is well formed, but pressure in the left lumbar and
iliac regions causes pain ; pulse 84 ; chest healthy.

Pidv. Opi% gr. j. node sumend.
Inject. Calcis CI dor id. ziij ad Oj.

January 23d. Has suffered much from pain ; less discharge
passing her water with facility ; no sensation of weight at the
uterus ; pulse 83 ; no headache ; above the left clavicle are situ-
ated several small round spherical tumours which have existed
for months ; they have caused no pain, and had existed some
time before they were discovered : several of the glands in the
inguinal region are enlarged.

During the month of February she was examined with the
speculum ; the neck of the uterus w;is found indurated and en-
larged on the right side;, and of a livid tint, presenting a very
unequal appearance. She complained greatly of a pain at the
arms, which ceased after the application of leeches. Having

lS3bi- J Eclectic Journal of Medicine.

obtained admission into Salpe'triere she soon after left the hospital.
The symptoms were quite sufficient to denote the nature of

the disease. The hemorrhage occurred at the commencement,
was considerable, and was repeated lour limes. In inflamma-
tion of the uterus there is often hemorrhage, but it is very slight.
W lien fibrous tumours exist in the uterus, there is also hemor-
rhage, but by no means so abundant : and it occurs at a later
period. Out of twenty-one cases of cancer of the uterus, all of
whom died and were examined, in two only was hemorrhage
not present, and in one case there was a rose-coloured discharge.
Out of the nineteen, in winch hemorrhage formed one of the
principal symptoms, in 13 it was developed 3, 4, and 5 months
after the commencement oft4ie disease. In the remaining six
it was the first symptom that was observed, preceding or occur-
ring at the same time as the pain. Age had no influence upon
it, lor it occurred at the various ages of 23, GO, and 70, The
two in whom this symptom was absent, were between 30 and
40. Hemorrhage accompanies organic diseases of various
organs, and in none is it so frequently presented as in cancer of
the uterus. The mucous membrane is frequently found quite
healthy : the bleeding often precedes the pain. The sensation
of weight at the anus, which ^ad lasted s considerable time, and
was relieved by leeches, must probably depend upon a swelling
of the neighbouring parts. The mean duration of cancer of the
uterus is about two years or two years and a half. Cancer of
the stomach causes afcath in a much shorter period, in eight or
ten months ; the great importance of the functions of the organ
fully accounts for this. Lond. Med. Gaz. Jan. 183S.

The next article in the Journal is a letter to the Editor on
the subject of the "pernicious effects of enamel cards? The
^writer objewts to the suitableness of these cards for the purposes
for which they are used. But the object of the letter is to shew
their injurious effects on the manufacturers, and is a serious
appeal to the public to decline the use of the article on account
of the injuries caused in their manufacture.

The next article is one of more interest, and is the report by
M. Martin Solon on the inoculation of morphine as proposed
by Dr. Lafargue ; and is from the Bulletin de 1' Academie
Royal de Medecine. The effects of this mode of medecation by
morphine are considered by Dr. Lafargue as worthy of conside-
ration, both in their bearing on practical medicine and on me-
dico-legal questions. The following are the effects observed on
the introduction of the point of a lancet chained with a watry

7M Eclectic Journal of Medicine. [July,

solution of morphine, horizontally, one third in depth beneath
the epidermis and allowed to remain three or four seconds.

1. About a minute after the operation, a small pimple, with a
dilfuse rosy areola, and slight itching.

2. In about twenty minutes, the pimple becomes four lines in
diameter and one in thickness ; flattened. Its color more than
that of the skin, it is hard, its areola very red and about an inch
and a half in diameter; its heat has increased, and the sensa-
tion of itching remains about the same.

3. During the first hour, the pimple and its areola arc at their
highest degree of development.

4. After this time, the appearance diminished and at the end
of two or three hours, the red colour of the skin has entirely dis-
appeared the pimple becomes flat ; but it does not entirely dis-
appear until 12 to 24 hours after the operation.

5. If several punctures arc made near one another, in the
same manner, the appearance of the pimples are as above des-
cribed, but the areola? are confluent ; the heat and itching con-
siderably increased. The appearances however, disappear in
the same time as when a single puncture has been made.

G. The general effects which Dr. Lafargue experienced
from thirteen punctures thus made upon the front of his forearm
were, heaviness of the head, frequent yawnings, clamminess of
the mouth, and an invincible desire to sleep ; the quantity of
muriate of morphine not having exceeded a quarter of a grain.

The effects just noticed, Dr. L. considers as showing that the
inoculation of morphine may supersede the use ofljlistcrs anuV
ammoniacal applications, and that it merits employment more
particularly where the object of the physician is to produce the
local effects of morphine. Its effects as a rubefacient are also
very marked.

The local effects produced by the inoculation of belladonna,
of strychnine, of sulphate of quinine, were different from those
above mentioned. In employing other opiate preparations, such
as Sydenham's Laudanum, and solutions of opium in fat, milk
coffee, beer mucus, acetic acid, and gelatine, the proportion of
opium being extremely small, the same results were obtained,
and no such effects were produced when those substances were
introduced without opium.

1S3S.] Eclectic Journal of Medicine.

"M. Martin-Solon repeated the experiments of Dr. Lafar-
gue. From the inoculation of all the common preparations of
opium, he observed the same effects as those above mentioned ;
except that the papulae sometimes acquired a diameter of an inch
and a half, and that they became radiated and diffuse. To as-
certain whether any other substances were capable of producing
the same phenomena, belladonna, strychnine, the gastric juices,
chyme, &c, were employed, and the effects which were observed
destroyed the exclusiveness which Dr. L. wishes to attribute to
the action of preparations of opium.

The conclusion which may be derived from these experiments,
may be of some assistance in determining the absence of opium
from a fluid which is suspected to contain it ; seeing that in all
the cases in which fluids containing opium were inoculated (in
one instance, the proportion of opium to the solvent was as 1 to
2000), the phenomena described above were observed by both
Dr. Lafargue and M. Solon. The development of the papula
can, however, be only regarded as presumptive evidence of the
presence of opium; seeing that other substances are capable of
producing effects so nearly identical as not to admit of any defi-
nite distinction.

Dr. Lafargue has also innoculatcd a concentrated solution of
emetic tartar and the croton oil. The former has always pro-
duced a pustule similar to that of acne simplex, containing pus,
twenty-four hours after the operation ; and the effect of croton
oil has constantly been the production of a furuncle thirty-six
hours after the introduction of the medicine. Neither of these
substances has, however, been sufficiently employed to allow of
any inference to ,the advantage which this mode of applica-
tion possesses over that in general use. Its simplicity, neverthe-
less, renders such an experiment very easy.*' Bulletin tie V
Academic Roy ale de Medecinc.

We next come to some observations by Dr. Robert Dick of
Glasgow, on the employment of gunpowder as a medicine in
various states of the gastro-cntcric mucous membrane from
Ediriburg Med. & Surg. Journal. Dr. Dick was induced, from
theoretical considerations to prescribe. this article, and had reason
to be satisfied with its effects. The derangements for which it
appeared to him to be peculiarly adapted were morbid secretions
of the gastro-mucous membrane, depending on sz/fc-inilammatory
action, or accompanied by it. In such cases, gunpowder, given
in various doses, and with the occasional interposition of ordina-
ry mild laxatives has proved, in his hands, eminently servicable.
Dr. Dick would not be suprised if, given in large doses, and for

746 Eclectic Journal of Medicine, [July,

a greater length of time than he lias prescribed it, it should be
found useful as a constitutional alterative, or as a cutaneous
drug. He administered from ten grains, indefinitely upwards,
several times a day. He found spirituous liquors, pungent con-
diments, &c. contra-indicated dining the use of gunpowder.
The gastralgic effects which Dr. D. found these produce, when
used simultaneously with gunpowder, he ascribed to what he
designates the detergent effects of that substance on the mucous
membrane, which, owing perhaps to its charcoal and mixture, it
denudes of its attaching albumino-mucous secretion, clearing,
and seemingly attenuating that membrane in some measure. It
is found in common, ready for use. The best form of adminis-
tering it is in the dry state, as Dr. D. thinks the liquid form docs
not suit. No apprehension need be entertained of the charcoal
producing any unpleasant consequences. Ih pica, and in the
chlorotic state, large quantities of this substance are eaten with
impunity ; and further, J. P. Frank* recommends it as an effec-
tual remedy in flatulence.

The above notices are very general, as the remarks of an indi-
vidual, who suggests a new remedy ought always to be.

We have long known the extensive use of the article in the
country for the promotion of labour pains, and as we have always
understood, with very fine effect. We have never prescribed it,
in consequence of always having efficient articles for this pur-
pose, die operation of which was well known.

Dr. Dick follows the above with some observations on the
use of charcoal, which seem to banish fears of its use; as well as
set forth its beneficial effects, with references to cert Ai late au-
thors by whom its use is justified and advocated, yfe give these
observations, with the extract from Dr. Graigle, below, after
stating that charcoal lias been long and abundantly used in tliis
country as a valuable medicine perhaps longer than any period
referred to by Dr. Oraigie m speaking of its history. It had
been in considerable use as a domestic remedy, and by sonic
physicians, in New Orleans, and other southern locations in
liver irregularities and bilious fevers, previous to publications
on the subject by Dr. Daniel of Savannah, in which his exten-
sive experience in its use was set forth, and its medicinal vir-

* De Curandis Honunum Morbis

1638.] Eclectic Journal of Medicine. 7M

tues strongly advocated. Now, it is a very common article in
this country in domestic practice, as well as in that of many of our
best physicians, some of whom we know use twenty or thirty
pounds a year in their practice. The preparation which comes
now for use, is a beautiful powder under the name of Calcined
Charcoal.

"In speaking of the therapeutic effects of gunpowder in va-
rious morbid states of the gastroenteric mucous membrane and
its secretions, it may be not unseasonable to add to the observa-
tions now made by Dr. Dick, the remark, that charcoal in its
separate and pure state has been long used by many practitioners
with similar intentions, and to fulfil similar indications in the
treatment of ague with gastric, enteric, or dysenteric complica-
tions. As a short notice of the use of this substance is given in
the Elements of the Practice of Physic by Dr. Craigie,~without
entering into all the dttails of the history of the introduction of
this substance into the practice of medicine, the easiest way per-
haps is to quote the account given in that work.

<:The exhibition of charcoal for the cure of ague, as a substi-
tute for bark, appears to have been practised in 1S13 by Calcag-
no at Palermo, and afterwards by Dr. Calvert, Mr. Mackesy,
Mr. Tully, and other English practitioners, in Sicily;* and it
was used with that intention by Dr. Jackson in the West Indies.
In simple ague it seems to produce little or no benefit. But in
ague with affection of the gastric, or the hepatic, or gastroenteric
circulation, in ague with anguish at stomach, squeamishness,
flatulence, or hiccup, and in dysenteric ague, its, sanative influ-
ence is unequivocal and powerful. It may be given in doses of
from ten to twenty grains, in rice-water or arrow-root, either
alone or with six or eight grains of rhubarb, and two or three
grains of Jfnvder of ipecacuan. It appears to operate chiefly by
rectifying disordered secretions of the stomach and bowels. It is
probably by its charcoal, that the snuff of a candle, which has
been alledired to be beneficial in curing a^ue, as mentioned by
Lind, operates." ' Edin. Med. $ Surg. Jour.

We are next presented with a very interesting case of apoplec-
tic disposition which appeared hereditary and which had been
often palliated by the usual means, as copious depletion, &c.
This case is also from the Edinburg Med. & Surg. Jour., and is
given by Mr. Law. The case is too interesting to be omitted.

"M. F., aged 37, has for seven or eisfht years been occasion-
ally subject to violent headache, continuing for some days, and

g. Joum. x. 15, 403
6 F

749 Eclectic Journal of Medicine. [J^y,

though not always, very generally proceeding to a hysterical
paroxysm, which, along with the headache, is only, dispelled by
free bleedings of from- sixteen to twenty ounces of blood, and
sometimes a larger quantity.'

She is rather above tiie middle stature, and of a full habit,
without much complexion, the bowels apt to be slow, but the
necessary aperients regularly employed. She is rather apt to be
sedentary, but partakes most, sparingly of sleep, or even the
recumbent posture, and takes food as well as liquid.^ in much less
quantity than the average of her own sex, avoiding vinous sti-
muli almost entirely. Catamenia regular.

Every practitioner summoned to her assistance, wherever she
may have been residing, has, from the urgency of the symptoms,
been led to the use of the lancet, which alone ever relieved her
effectual ly at. the time, the blood flowing with unusual force from
the arm when I have had occasion to open a vein in this | erson.
In a few hours alter one of these full bleedings, she will leave
the recumbent position, proceeding with her usual occupations
as if nothing had been the matter. These attacks became of
more frequent occurrence towards the end of last spring, when
it seemed to me, that as it was next to impossible to diminish
the ingesta here, and as the degree of exercise necessary to sub-
due so strong a disposition to plethora would be of very difficult
enforcement, independent of other collateral circumstances in
this case, arsenic administered in small doses at the commence-
ment of an attack, would, from its sedative (?) influence on the sys-
tem, lessen what we are contending against, and for a longer
time than the bleedings, which are so apt to demand repetition.
Accordingly she had a watery mixture prepared with five mi-
nims of the arsenical solution in each teaspoonful, directing her
to take a teaspoonful in a little more water, morning and evening,
just after a meal, when threatened with an attack, and to intermit
it entirely when the tendency disappeared. *

It is now six months since the trial was first made, the medi-
cine being, according to these directions, only occasionally em-
ployed ; nor has she ever since suffered, but in a very slight
degree, from what had begun to assume a more alarming aspect.
She has, on several different occasions, in this time, found it ne-
cessary to have recourse to the arsenic for three successive days,
but with the same marked benefit, and what may appear less
accountable, the disposition to such a disease has been thus con-
trolled under even some increase of appetite, using rather more
food than formerly.

I have been informed that one of her parents died of what has
been described to me as apoplexy; but if it was so, and there is
a hereditary tendency to cerebral disease, the influence of the
medicine in this case is not less worthy of attention.

I never for one instant intend to be understood as wishing to

1838.] Rape. Pregnancy. 719

see such treatment substituted for that of the lancet in most ordi-
nary occasions where its use is signal and direct, but there are
many others where the above may be successfully employed,
either by itself, or in conjunction with, or consequent to sorno
mode of depletion." Ibid.

Extirpation of the Parotid Glands.

The next and last case which we shall notice, is one in which
the Carotid Gland was extirpated on account ofdisease, in the
Toronto Hospital, Upper Canada, by C. Widmer, Esq. surgeon
to the forces.

"An elliptical incision having been made in the internments
of the most prominent point of the tumour, its removal was effec-
ted without much difficulty,, and with little loss of blood, the
facility bem^ attributed by the author to the adoption of the
method of separating the mass from the lower part upwards.
The external jugular vein and external carotid artery being
necessarily divided, were immediately secured by ligatures, the
latter being- tied at both ends. When the removal of the mass
had been entirely accomplished, the styloid process, and the
transverse process of the atlas, were exposed to view. 'I he
result of the operation was quite favourable, the wound being
entirely healed in six weeks/' Loud. Med. Gaz. Jan. 1838.

The present No. concludes with a notice of Dr. Kramer's
Air Condenser as a remedy in cases of deafness, with a cut, and
full description of the condenser Bibliographical notices of l)r-
Coate's Family Adviser Dr. Steven's Lectures on Lithoto-
my Dr. Caldwell's Protest. &c. &c.

Rape.-+-Pregnancy.

In speaking of external and internal explorations by the touch
for determining the fact of the commission of rape, M. Hohl,
Professor Extraordinary of the University of Halle, observes, that
"unless this examination be made soon after the commission of
the crime, it will be to little or no result; and the difliculty will
be much increased, if sexual intercourse had previously taken
place." This opinion is corroborated by Forbes and Conollyj
of the British and Foreign Review, who state, that "for ascer-
taining the existence of virginity and proving the commission of

750 Rape. Pregnancy. [July,

rape, we can prove little by mere manual exploration." "The
presence or abscence," say they, " of the hymen has Ion? been
ascertained to be no evidence whatever, for or against the exis-
tence of virginity. " A case occurred to them a few years ago,
of primipara, where the greater part of the hymen was still exist-
ing. "The different conditions of the labiae, nymphse and the
vaginal rugae," say they, very justly, "are much too uncertain
to ground any decisive opinion upon ; as a slight degree of dys-
pepsia, or other abdominal derangements, or of ieucorrhoea, will
produce nearly all the changes which professor Horn, considers
necessary to observe. The feeling whether the clitoris be still
covered^by its preputium, needs no observation, as few decided
changes take place in the female external organs from only one
occurrence of sexual intercourse; and little alteration is produced,
until the passages have undergone the extreme dilatation which
they suffer during labour."

This view of Forres and Conolly demands some qualifica-
tion, before it can be adopted for the diagnosis in question: viz.
the determining virginity.

In Descensus uteri, where the uterus descends to the upper
boundary of the vestibule, or the location of the hymen, it is in-
deed often the case that the whole vestibule is as well contracted
as in virginity, and notwithstanding the continuance of this state
of things for a considerable length of time, the hymen itself is
often so little interrupted as to afford no trifling obstacle to the
use of the touch for the correction of this species of jEdopsto-
sls ; and sometimes this difficulty is so considerable as*to render
replacement impossible, without a degree of violence so great as
to lacerate the hymen. A case of this kind we once witnessed,
attended with a violent fit of hysterra, which was characterised
by incessant and violent fits of laughter of many hours duration.
This occurred in an unmarried female about 19 years of age, and
having refused to yield in the least degree to the use of the ordi-
nary remedies in such cases, examination per taxis was institu-
ted , whereon it was found that the distended uterus was in con-
tact with the hymen, the opening through ^whicti was notjarge
enough to receive jhe end of the little finger. Believing that the
paroxysm depended on irritation of the uterus from its monthly
plethora, to which was added no inconsiderable obstruction from
uterine descent, advantage was taken oi a position to favour the

1838.] Ripe. Pregnancy. 751

action of gravitation, which, with the pressure of the finger
against the hymen and uterus, and the introduction of air, soon
enabled the uterus to fall back from its position in contact with
the hymen, to the } artial relief of the patient. On a repetition of
this process, the laughing effort entirely ceased and the menstrual
flux appeared. A lunar month elapsed, and another paroxysm,
lighter in degree, supervened. This was relieved in like man-
ner. After the conclusion of this menstrual period, a styptic
lotion was carefully introduced by means of a womb syringe,
above the hymen, which stiil remained entire, hut with some
slight dilatation of its foramen. The daily repetition of this for
ten or eleven days was iol lowed by no other bad symptoms du-
ring our acquaintance with t.iis patient, which was for several
years.*

But most commonly, when this disease has lasted for a con-
siderable length of time, the hymen has not only disappeared,
but the whole vertibule has become so much dilated by the pre-
sence of the os and cervix uteri, as to appear not dissimilar to
those who have borne children, and capable of suffering the
convenient application of the pessary. Thus then, in determin-
ing virginity, and much more, rape, the dilatation is not availa-
ble. These facts are of deep interest in forensic medicine.

Pregnancy. This state sometimes becomes a subject of
forensic investigation. We have known several instances wherein
pregnancy was claimed for the respite of execution, or mutation
of penalty, by females nnder sentence of death. But pregnancy
is a subject of deeper and more frequent interest, simply in a
medical point of view. It is therefore one, which of all others,
as Forbes and Conolly say, should be handled in a clear,
concise and practical manner. Professor Hohl divides this in-
quiry into nine questions of great importance :

1. Js she pregnant?

2. In what month ?

3. Is she pregnant for the first time ?

4. Is there more than one child?

5. Is a state of disease combined with pregnancy?

6. Is it extra-uterine ?

7. Is the foetus alive?

* It may be well to remark that the subject of this case was a coloured woman,
and the case was protracted, severe, unyielding, and apparently dangerous.

752 Rape. Pregnancy. [July*

S. What is its position ?

9. Will the labor be anormal from mechanical obstruction?

" In determining the first question, we will not detain cur
readers with the Jong and tedious enumeration of the various
points to which the practitioner must direct his attention, and
upon which the changes are rung with a degree of persevering
repetition that is almost exhausting. It is little short of non-
sense to suppose that the state of the os extern urn' and the carun-
culae myrti formes, the calibre of the vagina, the swelling of its
purietes, its temperature, secretion, the length and condition of
its rugae, are points on which we can fix the slightest data for
forming our opinion as to the presence of pregnancy. We can-
not aii'ree with hi. n that the temperature or secretion of these
parts are so much increased during pregnancy; with respect to
the former, we might say the contrary : for we have repeatedly
found the vagina of a pregnant woman impart a feeling of cool-
ness to the finger, and it must be a well-known fact to every
body who is frequently in the habit of examining per vaginam.
that the labia are frequently even cold : this is in some measure
produced by the moisture of the vaginal secretion, but we can-
not think that this is so increased in quantity during the earlier
months of pregnancy as in any degree to justify its guiding our
prognosis. This certainly applies to the relaxed females of a
great metropolis, or those living in the swampy parts of Holland,
&c, where it is a known fact that there is much greater disposi-
tion to copious vaginal secretion than elsewhere, but we appre-
hend that the insufficiency of this as a point of diagnosis applies
equally to the more robust natives of other districts. We have
examined many hundreds of the author's countrywomen during
the last months of pregnancy, as well as at other periods, and are
not inclined to make an exception in their favour.

In examining a woman to ascertain the existence of pregnancy,
it is desirable to place her in such a posture, that we may exam-
ine both externally and internally at the same moment, and also
ensure as far as possible, the complete relaxation of the abdominal
integuments. Some excellent directions have been left us for
this purpose by Rcederer, which have been also quoted by the
late W. J. Schmitt, of Vienna, in his short but valuable collection
of doubtful pregnancy cases. "After the third month, the ute-
rus projects above the pelvis, gradually increases and distends
the abdomen ; but a careful examination is necessary, in order
to distinguish the enlarged uterus from other prominences,
because an enlargement of the abdomen from disease may easily
be confounded with pregnancy: merely looking at the abdomen
will not assist, us much in our diagnosis; we must examine by
the touch. In order to prevent any chance of uncertainty, the
following points should be attended to ; we should place the

1838.] Rape. Pregnancy. 753

patient upon her back (before sbe has taken her meals, and hav-
ing previously emptied the bladder and rectum.) with the head
and (eet raised above the loins, the heels drawn up to the nates,
so as to relax the abdominal parietes; the practitioner should
place his hand across the abdomen, so thai the little finger is
turned towards the pubes, and thumb to the navel. Let the
patient breathe deeply, and the practitioner press gently with his
hand during expiration ; if he feels at this moment a hard globu-
lar resisting mass above the -pubes, he may be certain that this is
the enlarged uterus."

in ascertaining how far pregnancy has advanced, our atten-
tion must be chiefly directed mthe circular form of the cs uteri,
its being closed, the smoothness and softness of its edges, (now
no longer lips,) the alteration in the shape, size, and substance
of the portio vaginalis ; viz. that part of the cervix which pro-
jects into the vagina; a distinction which is very useful, and
which we have for some years adopted from the German ac-
coucheurs; the increased size, weight, and diminished mobility
of the lower portion. of the uterus; and lastly, if it be in the lat-
ter months, the contents of the uterine cavity and diagnosis of
the presenting part this must also be combined with the exter-
nal examination of the abdomen, in order to estimate the height
of the fundus abov ethe symphysis pubis, the size and form of the
uterus generally, and whether the movements are yet percepti-
ble: these are the chief practical points of investigation to which
the practitioner must turn his attention in such ca^es : but, as to
the old, oft-repeated dogma of its being necessary to examine the
pufliness or turgesceuce of the vaginal parietes, the diminution
in the size and number of its rugee, the prolapsus-like duplica-
tures of the anterior wail, its temperature, mucous secretion, &c.
&c., all this is useless, at least, in practice.

In deciding whether it be her first pregnancy, our chief atten-
tion must be directed to the form and condition of the os uteri.
An os uteri which has once undergone the dilatation which takes
place during labour, seldom entirely recovers its former shape :
it becomes unequal, so that, instead of forming a circular depress-
ion, with edges quite smooth, like a dimple, as it were, at the end
of the cervix, it forms an irregular-shaped margin, with uneven
edges, which are generally hard in places, from the little cica-
trices of former labours. These are important points of diagno-
sis, and have more than once enabled us to assert confidently
that the patient had already borne a child, in spite of previous
assurances to the contrary. The absence, however, of these
effects of parturition, we mean the perfectly round and smooth
depression of the os uteri, as felt in the primipara, is not always
a proof of first pregnancy : we have occasionally, though rarely,
met with a similar condition in a patient who had already borne
a child. Besides the examination of the os uteri, that of the

754 Rape. Pregnancy. [July

perineum, and especially its fraenulum, should not be neglected ;
for this latter rarely escapes being somewhat torn in the first
labour. As regards the external examination in detei mining
whether it be her first pregnancy or not, the flaccid abdomen and
rugae in the skin are certainly effects of previous labour which
are worth noticing; but it must be recollected, that their pres-
ence or absence are not distinct proofs for or against." British
4* Foreign Review.

We would however warn the practitioner against the danger
of a hasty decision on the fact of pregnancy. In medical juris-
prudence, even a doubt entertained relative to this fact, should
be considered sufficient to justify a respite of capital punishment,
until time elapse to dispel it. But the importance of a
decision in a medical point of- view, is not. a matter of such tri-
vial concern, nor so easily passed over. We are well aware of
the fact, that most practitioners think it a very easy matter to
decide on the existence of pregnancy at almost any- time, and
especially after the first month; and it is true that a decision
made on the light grounds usually depended on, is very often
correct. This, however, only proves the want of thorough at-
tention to the nature and effects of other causes than pregnancy
in the production of nearly all of what are commonly considered
evidences of this state. These are morning. sickness, coloured
areolae, swelling of the mammae and lactation, expression, absence
of menstruation, buffy blood, abdominal and even uterine tume-
faction, borborigmi, hysteric symptoms, fickleness of appetite,
melancholy, unusual irritability of temper, salivations, acid sto-
mach, depraved appetite. &c. etc., all of which may be, and often
are, produced by other causes than pregnancy. The faithful,
conscientious and scientific practitioner will find therefore, when
he comes to adopt a practice founded on a decision of the ques-
tion oipregnomcy or no pregnancy, a practice which for the
former of these states would amount to little less than a culpa-
ble neglect of the necessities of the latter; and for the latter,
would be highly dangerous to the former Ihe practitioner, we
say, when brought up to the decision of this point, must find
that he has, in view of absolute decision, especially in the first
four mouths, one of Ihe most difficult problems in all the prac-
tice of his profession. He must not decide in favour of pregnan-
cy by a numerical estimate of the symptoms or otherwise, when
it does not exist, because the instant he does this, he is lost to all

1838. j Hupc. Pregnancy. 753

other views both ofcausation, and pathological condition. These
are therefore allowed to go on in their ruinous, and for a time,
hidden operations, until the golden moment passes, beyond
which there is no hope. He must not decide against the exis-
tence of pregnancy when it does exist, because by such a decis-
ion he will, if he attempt any thing like thorough investigation,
determine on other views of the pathology, the therapeutic
means for which will be calculated, as far as medicinal means
may have power of abortives, to terminate in this dangerous and
criminal disaster. There is no case which requires more of the
diligent study and attention of the practitioner than the early
months of pregnancy. Women labouring under this doubt, may
not be depended on. They are often deceived by their own
supersentiousness or by their desires or aversions ; or they may
have strong motives uncontroled by moral principle, which in-
duce them to desire to deceive. We have witnessed the great-
est errors in experienced mothers in this regard. We recollect
the case of a woman, the mother of many children, to whom we
were called for the purpose of her accouchment upwards of 30 years
ago. Her abdominal tumour was equal to the 7th or 8th month,
and she believed her parturient pains had commenced. She is
still alive, but has never given birth to a child, or any other ute-
rine production calculated to make the symptoms. The abdomi-
nal tumour subsided spontaneously in the course of1 a year or
two, and her health, though not very good, has been such as to
sustain her very well to the present time, and to the age of about
70 years. We could name many other cases similar in their
nature, but less conspicuous.

By the well-founded doubts which hang about the first four or
five months of pregnancy, the practitioner is reluctantly driven,
with much mortification of feeling' and self-disapprobation, to
withhold his positive decision in many cases until the period of
quickening. This, in the present state of the science, is to be
relied on as the earliest unequivocal evidence of pregnancy. Nor
can this evidence be received on the word of the patient alone.
The practitioner must feel or see it for himself; and even here
he may be deceived. We recollect another case to which we
were called some twelve years ago for accouchment. The patient
was a monomaniac on this subject. Her husband had been
absent, and supposed I d for several years ; still she main

g 7

756 Rape. Pregnancy. [July,

tained most pertinaciously that she was pregnant and that her
time of travel had arrived. Her abdominal tumefaction was
fully equal to a nine months development. She was of corpu-
lent habit and appearance of very fine general health. From
her manner we were induced to believe she suffered under
labour pains ; but to the internal touch she exhibited nothing
like either labour or pregnancy, whilst to the external, she exhi-
bited a large tumor, much resembling that of pregnancy, and at
one place, just below the scrobiculus cordis, to which she called
our attention, there was uniformly, the appearance of a knee or
elbow which seemed to recede from the touch as soon as the
touch was sufficient to preceive it distinctly. We made no pre-
scription. Four or five years after we were again called to this
woman, whom we found much larger than before. She claimed
then, as confidently, the entertainment of no less than seven
children within her abdominal parietes, which she said had in-
creased at the rate of one for every nine months since we first
saw her. On being assured that such could not be the case, she
was pleased to demonstrate the fact, as she considered it, by exhi-
biting the whole abdomtnal tumour for inspection, in the hope of
procuring aid from gastrotomy. On this exhibition, seven dis-
tinct compartments, or distinct projections very much resembling
those made by the fundus of the pregnant uterus in obliquities.
These were carefully arranged so as to fill all the anterior and
lateral regions of the abdomen. She desired that we should see
and feel the movements exhibited by each of the children. On
inspecting for this purpose, three tumours, each of which she
ascribed to the presence of a foetus, exhibited, by turns, both to
the eye and touch, the appearance of a swelling anq^roling motion,
whilst she sat still upon the chair. Whilst thus situated, a
theme of conversation was offered which was thought most likely
to captivate her attention, and lead her mind off from the imme-
diate consideration of her affliction. During this, and whilst
her mind seemed fully engaged in this subject, foreign from the
examination, and whilst she still sat deeply engaged in a well-
connected narrative, relative to loss of fortune, &c,j the same
movements were exhibited in as plain a manner as when her
attention was directed to them ; and this without any other in-
terruption of her train of thought and conversation, than the
frowns which indicated the pain those movements inflicted. By

1S33.] Rape. Pregnancy. 757

her leave we took a friend, an intelligent clergyman,* on the
next day to witness the phenomena, all of which were exhibited
as palpably as before, whilst this gentleman monopolized her
attention by an interesting rel igious conversation. She remained
in onr neighborhood for several years, corpulent, and exhibiting
all the appearance of very fine general health, and was after-
wards often seen in the streets, apparently actively engaged in
business. We determined on an autopsy at all hazards after
her death, but latterly she has disappeared, and we know not
whither she has gone.

Another case of pretty similar import, so far as regards the
evidence of the patient herself, we feel disposed to state briefly,
because we think the subject of this diagnosis is one that cannot
be too abundantly illustrated. The room of a widow lady about
40 years of age, was entered one night whilst she was in bed
and asleep, by some ruffian, who, it was believed, was in search
of her beautiful daughter, who, as it appeared, was spending that
night from home, with a young female friend ; and it so hap-
pened that her mother occupied her bed. The lady awoke by
the feeling of a hand on her face and made an attempt to call for
help from across the street ; but her throat was immediately
seized by the hand of the villain with a distinct threat of death
on her making the least noise. He accomplished his purpose
and made his escape, with no more discovery of the offender than
by the feeling of his head, that he was a negro.

The woman called us the next morning to relate the circum-
stance and to ask our opinion as to the possibility of impregna-
tion under such circumstances. We gave a negative opinion,
but this did rrot seem to satisfy her mind on the subject. After
several months we were notified by her of the fact of pregnancy
according to every symptom which she could relate, not excep-
ting quickening. We examined fully and freely by the internal
and external touch, and could find nothing but her own .fears to
lead to the suspicion of pregnancy. Subsequently she engaged
me to attend her accouchment. During all the nine months
following her misfortune, she emaciated and wore a bad aspect.
At the end of nine months, I was called for her accouchment,
with assurance of quickening, <fcc, and could not satisfy her on

Rev. James Shannon, now President of the Louisiana College.

753 Rape. Pregnancy. [July

the subject, although her emaciation and abdominal relaxation
were such, that by pressure on the hypogastrian region with a
force under that which would give pain, the anterior parietes
could be easily brought into contact with the umbar spine.

After the nine months had elapsed, this woman daily increased
in health and yet lives, a robust and active woman of high
sanguine temperament.

After all then, it must appear that we have no evidence for
the absolute diagnosis of pregnancy previous to the time of
quickening, and this, not merely declared by the woman, but
actually seen or felt by the accoucheur is the best evidence which
can be alforded. This, when distinguished from other move-
ments, is of course, absolute and unequivocal ; but care is some-
times necessary when it is least thought of in such cases.

We pass over the brief and unsatisfactory notice by these
gentlemen of the diagnosis of pregnancy, in connexion with a
state of disease, of extra-uterine pregnancy, of the dead or liv-
ing state of the fetus, and the question of the position of the
child; and come to "the investigation of various points of in-
terest during labour, which M. Hohl divides into the following
questions, viz : 1st. Whether labour has commenced and will
go on ? 2nd. How far it has advanced? 3d. What are the
obstructions to labour ? 4. Is there a second child in the ute-
rus? 5. Is the child alive or dead?

On the 2nd of these questions, that is to say how far has la-
bour advanced, M. Hohl makes the following observations :

"Attention to this question," says he "is of especial impor-
tance, where abortion threatens to take place ; because our prac-
tice will be considerably influenced byi't ; our ho^es, or despair
of averting the expulsion will depend upon it. When the ap-
pearance of haemorrhage, with periodical hardness of the uterus,
relaxed mammae, and fallen abdomen, afford reason to dread ex-
pulsion of the embryo, the internal examination must be insti-
tuted with the greatest caution aud gentleness : it will be chiefly
directed to the vaginal entrance, the vagina, and uterus ; espe-
cially the os uteri. With respect to the former, this, as abortion
proceeds, will be felt somewhat wider, from participating in the
cushiony and soft condition of the vagina^ in which we shall
find an increase of mucous secretion, (in all probability, more or
less mixed with blood,) the temperature increased, and coagula
lodging in it. Not unfrequently the anterior wall of the vagina.
will be felj pecu #ollen ; and. if there be any difficulty

1838.1 Rape, pregnancy.

in passing water, we shall feel a I like mass, which

is the swollen urethra. The,, uteri hat lower in

the vagina; we feel the exl and some-

times the os uteri internum also open. Where the opening is
large enough to admit of the tip of the finger, it feels as if sur-
rounded by an elastic ring of cartilage; where this is the case,
the os uteri seldom closes again : in other cases it is more dilat-
ed, and we can feel the ovum presenting] When the abortion
is in the second or third month, the practitioner must bear in
mind that it may have been retention of the menses, and that
therefore what he feels in the os uteri may either be an ovum or
a coagnlum of blood. To decide this point, he must keep his
finger in contact with the substance lying in the os uteri, and
wait for the accession of a pain, (lor where ciots come away,
pains like those of labour are present.) and ascertain whether
the presenting mass becomes tense, advances lower, and increases
somewhat in size; this will be the case where it is the ovum
pressing through the os uteri. On the other hand, if it be a co-
agulum of blood, which it is well known assumes a fibrous
structure, it will neither become tense nor descend lower, but be
rather compressed. Generally speaking, the ovum feels like a
soft bladder, and at its lowei end is rather round than pointed ;
whereas a plug of coagulum feels harder, more solid, and less
compressible, and is more or less pointed at its lower end, be-
coming broader higher up, so that we generally find that the
coagulum has taken a complete cast of the uterine cavity. If
we try to move the uterus by pressing against this part, it will
instantly yield to the pressure of the finger if it be the ovum;
whereas the extremity of a coagulum, under these circumstan-
ces, is so firmly fixed, that, when pressed against by the finger,
the uterus will move also. When abortion happens at a later
period of pregnancy we shall be able to feel the different parts
of the child as the os uteri gradually dilates, viz. the feet, or
perhaps the sh^rp edges of bones, although we cannot distin-
guish the form of the head, from the cranial bones being so
compressed and strongly overlapping each other.'1

760 Theory of Organic beings. [July,

Theorie des etres organises renferment les generalites de
la vie organique; par Andre Sniadecki, traduitenfran-
cais du Polonais, par Ballard & Dessaix, p. p. 283.

Theory of Organic beings, including the generalities of
Organic life. By Andre Sniadecki, translated into
French from the Polish, by Ballard & Dessaix. p. p.

283.

This work of Dr. Sniadecki so advantageously known in

France since the translation of M. M. Ballard & Dessaix, we

believe, has never been reviewed or noticed this side the Atlantic.

For ages, France, England, Spain, Italy and Germany, stood

erected into literary principalities, and their selfishness contented

them, for the most part, with believing there was little new to

be learned beyond the limits of their respective empires. Mind

has been franchised, the ideas of nations have lost their local

habitations ; they are rapidly becoming the common property of

the enlightened species; gathering together in a common centre

from the wide circumference of thinking men, new comparisons

are made, new thoughts evolved, fresh light breaks forth ; the

sciences rush forth ; and truth triumphant assumes a colossal

and glorious form. In other ages the love of rule and power,

the clangor and glory of war, governed ; in ours, it is the glory

of truth. For her praises the triumph of fame is engaged in the

two hemispheres ; the triumph of fame, which once delighted to

ring its loudest peals on the path of warriors and conquerors, the

oppressors of the species. It was this spirit which brought the

work of our author from Poland to France, where it now reflects

redeeming honor and lustre on the literature of the author's

native country, which like our own America, has long stood in

degradation in the eyes of all literary Europe, t

It is our intention to make such original observations and des-
cantations on the subject of our author, and translate such parts
of his work as will enable our readers to understand its general
scope and tenor, and the substance of his ideas.

Zoogeny, the subject he treats, is of prodigious magnitude, and
lays under contribution almost the whole empire of existing
knowledge. On the one side it lays hold of the arm of chemis-
try, invokes the aid of aryctology, physics, zoology, medicine,
stcitics, mineralogy ; on the other, it stretches along the domains
of theology. At first, the existence of the animated universe
was predicated upon the forms and properties of matter, and
depends upon them still for sustentation. This matter, by vir-
tue of which there is life, is not a misshapen, fragmental mass,
resting in space, or flying at random, but enjoys forms of most

1S3S.] Theory of Organic Being. 761

perfect beauty, and orders of constitution and adoption, evincing
they were not made for themselves ; that their being is not soli-
tary, but that they are only individual parts, materials for a
greater design, a more comprehensive organization. AYe do not
see them piled up in the chambers of the sky, but disposed of at
vast and different distances irom one another, accordingly as we
may judge, to their make and powers of action. The places they
occupy are the besc fitted for the displays of their movements
and influences, each part acting on the whole, and the whole,
upon all its parts ; each laboring for itself and for the whole, the
integrity and continuation of its being depending upon this
double action. Thus in the great uranic whole, the solar system
is but one unit.

In animal life we can distinguish a great number of individual
parts or actors, digestive organs to appropriate aliment ; a heart
to distribute it ; lungs to rob the air of its animating fire for it-
a brain to elaborate and irradiate the power and excite move-
ments in every part ; thus by its own elaborations forming an
atmosphere about every living atom, and subjecting the entire
economy to its own empire. In the great system of material
life, for so we may call it, we cannot distinguish the same num-
ber of parts or actors: we know of none but suns, planets and
comets, as constituting the bone and sinew of uranic animation.

There are, however, statical considerations to induce the
belief of the existence of other orders of forms, which play in
and enjoy this life, which we have never seen. For, if so many
multifarious forms as we know, enter as constituents in our life,
since the same mind designed both from analogy, why may not
the great material life, from which ours is derived, and upon
which it is engrafted, be made up too of an equal or greater
number of elementary constituents? We know but very little
of the uses of the few different parts with which we are ac-
quainted, in the stupendous economy of this uranic vitality.
Something like the heart in our telluric life, the sun is placed in
the focus, where the radii meet of all the planitary orbits, which
is nearly in the centre of the system they form, which places the
focus of all the system's action some distance from the centre of
his own body, causing eliptical motion in him and them. Thus
as in our life, every part or organism of the uranic economy,
labors continually labors for itself and for the conservation of
the whole. Stop his motion in either of his foci : on that side
his planets would press toward him, their orbicular movements
becoming more furious : on the other side, langor and sluggish-
ness would ensue. On the one side, the fury and excess of
action would be in proportion to the defect and torpidity of the
other. There would be partial stagnation or congestion of one-
part of the system, and raging fury in the other. This state con-
tinuing, the planets could never regain their orbits, the proper
places of their conservative action in their economy.

762 Theory of Organic Being. [Julys

Again : As in our living economy, all the motions of uranic
life are circular ; so that Empedocles was right, when he said,
'nature delights in circular motion.1 Thus, there is an action or
function proper to each world above us, which tends the equilibri-
um and good of the whole, whose use or function is necessary and
essential to the conservation of the economy, to which it belongs.
No part or member is useless or idle ; all in their make possess
adaptations to participate and respond in the whole's great effort,
common fountain of their individual good and being. So in our
life; if the absorbents relax their efforts, there is dropsy; the
heart, there is capillary stasis ; the lungs, there is a crushing
of excitement; the brain, radiatory organ, there is def alliance
of all the economy. All are essential to each individual part or
member, and each to all. Jt must be so in all circular move-
ment, where the motion passes through, and is carried on by
different actors. And* this is the great type of movement im-
pressed upon the whole universe. All beings then obey its im-
pulses, all are formed upon the same great model, all enjoy the
same life, performing their parts alike in their respective econo-
mies, bearing this conspicuous and specific mark of a solitary
origin and creator.

In the opinion of Tasso* and others, this same type of move-
ment holds in the elder orders of creation.

" Now round his throne, which stood in awful heightj
Roll the fair Cherubim, bright wheels of living light."

Thus life irradiates throughout all being ; its streams flow
through every sun and planet, and meander through all the
limits of space. Thus the earth, which nourishes us, is naught
but our fellow creature and our kind sister; the butterfly which
disports in the breeze but our pretty neighbor, and the sun-
which warms us, our elder brother ; all born of the same line-
age, all our cotemporaries, enjoying and playing in the same
fountain of uncreated life.

To proceed : In our vital telluric economy, among the higher
orders, life everywhere has its tripple focus. The number of *
these foci mark the perfection of life and organization. 'Under
them is placed in dependence respectively the bal lance of the
organisms composing the animal. In man, these foci, or the
lungs, heart and brain, are the most happily and advantageously
bal lanced, which places him, with considerable interval at the'
head of the scale. Descending this scale, we behold sensibility
and the phenomena of intelligence disappear as these foci dimin-
ish in number. In the molusca, they have all disappeared, except
some slight rudiments of a medullary or cerebral one. This
focus, the most preeminent, which Dot rochet has proclaimed

Jcrusaiemedc. Ivvmg, Ihinldn \ expressible in

the sftine line of < tion.

1838.] Theory of Organic Beings, 763

for the whole vegetable world,* seems to he essential to and insepa-
rahle from all life, and accordingly is coextensive with its empire.
The actors or organs composing the individual economy of
animals, are all placed in contact, and action plays only through
"continuity of tissue. In the u runic economy, the actors or
organs, so to speak, are placed at vast and exquisitely geometri-
cal distances from one- another, and action plays not through
continuity of structure, hut through empty space to connect all
the parts into one operative whole. About each organic part or
planet, all motion tends to the centre ; .so that each enjoys a
focus of its own to regulate its individual economy. All these
foci are ballanced upon the ctauble central one of the sun, which
unites all the parts into a great community the community of
worlds, exciting, coaidinatmg the movements of the whole. We
see bone, tendon, muscle, &c. in our -life : here we behold our
array of regular parts of different orders, qualities and proper-
ties suns, planets, subplanets and planetoides; and space, the cel-
lular tissue which unites them. Here they display their unborn
strength, pressing onward without ages. Here, then, is action,
subordinate consentaneous action ! And if the amount and in-
tensity of life is measured by the amount of movements, how
full, how abundant and perfect must be the uranic ! ! This is
the life of Nature proclaimed by Pythagjrus and Diodorus,
not the life of Kepler, who held the stars to be "beautiful, re-
fulgent, living animals ;" but the life, the great and beautiful life
of Nature ! ! the parent life of all that lives and walks and
breathes among us ! These forms so symmetrical, so polished
and beautiful are not as some thinkers are wont to believe, self-
formed or at leasi self-finished. Rolling or rather wallowing in
space asemiliguid mass at first, their poles become flattened, and
their equatorial portions elongated by the joint action of the cen-
tripetal and ceiitrefuiral forces Idea unworthy of their bearing
and philosophy ! Like the beautiful foims of animals, they
soar beyond the empire of their own system, claim a Creator,
and, in their being's make, call our souls and bodies, brother.

No being in nature enjoys a solitary existence ; the essence of
what it is, is not in itself; its make necessitaies for it the enjoy-
ment of a double life, the one individual, the other, the life of
community or of the whole. Thus life impels life, being, being,
all clothed with the fulness of uncreated vitality.

Guided by these developments in the study of nature, Truth
will come leaping forward to meet us ; no other rout will lead
us to her sacred repose.

Let us study life in the individual, in its community ; then,
the older life in material individuality ; in the great and higher
community of the stars. But alas ! ars longa^ vita brevis."

An energy darts from the brain, and voluntary movements

* Recul., j irncntales. &c.

8 H

764 Theory of Organic Beings. [July,

are excited. This energy is the nervous or sensorial power, in
its nature material, and transmitted by material media, the
nerves, to the muscles, where the movements begin. This is
mind moving matter. The light from the mountain falls on the
retina, the shock penetrates the brain, and the eye sees its blue,
craggy top. The light, like the sensorial power, has no trans-
mitting media, but its shock undulates throughout the brain,
and there is vision., This is matter moving mind. Emotions
of beauty, grandeur and sublimity, awake at the sight. This is
matter let through the eye undulating through the soul, pro-
claiming the law of the individual and universal life of nature.

Again : From all the sun's substance emanates a prodigious
energy ; the same sort of energy in upwards of forty mighty
globes respond, and all/whirling oil their axes, wheel around the
common centre. The interplanitary spaces are vast, and must
be materially vacuous to admit of the motions they do. Wve see
going from the sun no nerves or transmitting media to convey
this energy, and yet the everlasting fountain of motion flows on
in plenary exhaustlessness. How subtle, how immaterial, nay
spiritual and omnipresent is this corporeal energy which darts
the planetary bands round their burning focus. And if the old
statical problem be true, " that nothing can (acl where it is not"
are we to conclude the interplanetary spaces are an astronomical
delusion, and the sun and his train are in actual contact? or with
our astonishment confess our utter ignorance ? If, therefore, we
are entirely ignorant of the manner and instrumentation by
which matter moves matter, we can behold a few' links in the
chain of causes by which matter impels movements in mind, and
mind, in matter, and motions are propagated in organic living
bodies through the continuity of tissues. ,

Amid all our ignorance, however, of one thing we may be
certain, of which all our meditations confirm us : all our organi-
zation and life here below are sustained by the intercourse they
enjoy with the mineral globes that roll over our heads, with
the great uranic body and life. We are able to behold many of
these uranic relations and instrumentations ; celestial channels,
down which life flows to us ! which bind our life to the univer-
sal material life of nature; and as a subspecies, merge it in it.

Cold appears to be the natural state or quality of the earth's
superflce, the home of all our living. The polar coldness evin-
ces it to be inconceivably cold. The fire to warm us nowhere
blazes on it. We warm at the fire of another world. This fire
evolved from its surface undulates throughout space, the common
fire, which vivifies all planetary animation.

It comes to us mixed with another substance not less impor-
tant to our good, light, with Milton, "nature's eldest born,"
which we know possesses most powerful control over the mole-
cular affinity of chemical bodies often determining their forms.
Over the vital organic forms it exerts not less power ; plants

1S3S.1 Theory of Organic Beings. 765

and animals etiolate in its absence, and their vital forces lan-
guish. It is upon the encephalic tissue its power is mainly ex-
erted. The value and precipusness of this substance, light, to
all nature may be infered from the beautiful apparatuses she has
flung round the distant planets where it is scarce, to econo-
mise and gather it up for their use. To enjoy it, they turn
on their axes, and, quailing it in eternal festival, dance round
the centre whence it Hows. Without the riches of the sun,
the earth of herself would not be able to afford a cup of cold
water for her children, a useless pauper tenanting useful
space. Her chemical fire aud volcanic flashes, would only be
fit to melt ice or make a noise ; not to shape the green grass, to
open the flower, to warm the blood, to form and unlock the mystic
chambers, and malic thought and spirit, and immortality start
from breathing matter. All the earth could do, would be noth-
ing without the uranic life, of the instrumentations of which,
we will mention a few more. Not only the star of our centre
but innumerable others, in regular alternations, dart their influ-
ences upon us. Observe the great diameter of our planet's orbit,
and how many stars appear and disappear in its different points,
all of which in her great annual flight, she visits, and passes by
out of sight, taking in fresh food, refreshing her children she
carries with her, at every world she passes. Out of how many
glittering, burning cups, does our life drink its being! How
boundless the intercourse, and the reciprocal influences worlds
exert upon one another ! ! They were not formed, we repeat it,
for themselves.

Again : It is the establishment of .the gravitating foci of all
the planets, which causes bodies within a certain distance of
their surface to tend to their respective centres; the placing of
these foci at various distances from one another, and the centre ;
and the combining all these foci, fountains of stupendous power
and movements into one great active focus or centre near the
sun's surface,that fixes and regulates the relative weight of worlds
the different velocities and densities of their masses, or the length
of days, nights and years ; and the weight of bodies about their
surfaces. In this divine code of laws thus framed to govern?
and combine the isolated actions of each planet or of the uni-
verse, whose type of movement we have said is circular, all life
has a radical interest ; and a species peculiar to eacli part of the
heliogarchy is necessitated. Do we not sec if these general
laws decide the state and condition of chemical bodies, of which,
it is highly probable, but not determinable in our present. ad-
vancement of knowledge, molicular and aggregative affinity,
electrical and galvanic attraction, and the polar forces, are only
modifications or the local results? do we not see. I say, it is up-
on these bodies, whose characters and qualities are thus deter-
mined, life exerts all its influences, and, in which it manifest
itself by organization?

766 Theory of Organic Beings. [July

The law of distancing or collocating the planetary foci in
space, so that each might sustain within certain limits an equil-
ibrium of action fom the central focus, is one of the great pri-
mary laws of the universe, which is every thing to life ; because,
as 1 have shown, this law regulates the Weights of the planets,
and bodies about their surfaces. The direct mechanism of this
influence upon life, is the alteration of the weight of living bo-
dies, and of those, by which they are surrounded. The influ-
ence of these foci, all antiquity have recognised; and to many
of the morbid as well as the healthy phenomena, they accord-
ingly gave significant names, as lunacy, menstruation, *&c. Nor
should we be astonished, when we behold what prodigious influ-
ence the combination of these, as the sol-lunar", exerts upon our
globe, in the atmosphere and the seas, raising mighty tides, and
tending to lift up the solid continents themselves. The princi-
ples of our existence, however, to a given extent, are accommo-
dated to the -variations of the universal laws; for, in winter we
know our globe is much heavier than in summer; and that its
weight, as well as the bodies of its surface, sustains often tempo-
rary variations from the accidental conjunction of other planetary
foci with its own. Besides these temporary variations of the
regular weight of bodies on our planets surface and thai of its
own, which, at the maximum allowing X to represent the
whole amount, will be nearly XV3; the difference in the
lengths of her polar and equatorial diameters, causes again the
same bodies on different parts of her surface, to have different
weights. Thus, "clocks which beat seconds in London and
Paris, require the pendula to be shortened to do the same thing
in the West Indies, because their weights are not so heavy there
as in the former places. And thus another disturbing force is
offered to the dynamical system of the life she nourishes. It
must be the same with all planetary life. There are local causes
which alter weight, and powerfully affect life. The atmosphere
being expansile and contractile by heat, varies its weight in its
meteoric states, as is manifested by the barometer. We see it
energetically affected in summer and winter by the ever-varying
intensity of the uranic stimuli, the oceans of heat and light
flowing from the sun ebbing over the face of every planet.

In the flood-tides of these {lowing streams, life wakes, toils and
advances forward ; in the ebb, enjoys the brumal sleep. How
obedient, how accurately does life play up. and beat time harmo-
nious to the great horologic movements of the universe ! Like
its planet, it has its summer and, winter, its days and nights !

Now if our life be not one with the life of all material globes,
with the uranic life, how came impressed upon k the same form
of motions, the great horoldgie, which is the circular form, of
which we have spoken ? Why, as we have seen, are the ac-
tions of life but the continuation of actions begun in, and radia-
ted from, the solar focus? And if, one day, it shall be proved

1838.] Theory of Organic Beivgs. 767

that molicular affinity, the galvanic and electric attraction and
the polar forces, are only modifications or the local and special
effects of that great energy, which combines into one great
movement all material worlds, the vital forces, then, will claim
the same rank, and account wherefore all the beings of nature
are clothed with the salne sort of action and movement and life ;
and confirm to the fullest extent, the great truth now well estab-
lished, that the Divine Creator, from causes the most simple and
unique, produces eiiecls the most multiform and variant. In
favor of this view, observe the order and dependence of nature.
It was not until after the formation of the dry land and the seas
and of the effulgent solar globe, that there was life, and, after life,
that there was thought, intelligence. This order still holds:
mind placed in dependence puts forth its efforts only in concert
with the vital forces; and, life again in dependence, acts in con-
cert with the chemical and statical forces of matter. Active,
organized, material existence rose first; then life, for we came
from the dust, and. lastly, mind. Then forces, then, which ani-
mate matter are simple, while the forces of life are double: 1st.
those of matter impelling, 2d. its own ; and those of mind, trip-
pie, for, besides its own, the two forces of matter and life impel
it. In its dynamia, nature's tripple focus terminated all her move-
ments, and all her productive energy. Mind, then, is the highest
elaborated of all physical existence, all the energies of the solar
system are engaged and active in its production a flower which
blooms here below for another world's immortality.

What we first asserted, then, is true all life firmly rests, and
is predicated upon the forms and properties of matter; and all
the varied forms of nature constitute but one great statical unit
or whole one movement undulates the universe, and all beings
partake of it and live live their life varied in all live and play
in the fountain of uncreated vitality. And do we not see, as
before urged, that if life consists in the reaction^of its own powers
upon matter, to which it gives its own peculiar forms, and in
which it displays all its phenomena, must not any change in the
properties or influences of this matter, be felt and effect changes
in it? Hence in nature's order, the perfection of the material
preceded that of the vital economy, which fixed the fate and
perpetuity of life upon the stability of the material properties.

And again : We have seen that these properties are deter-
mined by the different distances of the planets irom one another
and the centre, and modified by the different lengths of the plane-
tary semidiametcrs : that the accidental combinations of their
foci, and their elipsoidal motions, which carry them nearer and
sometimes farther from the'rentre modifying1 their properties,
must act as disturbing causes upon dynamical life. Hence, we
see every law which influences the material or nranic economy,
likewise influences life, which causes it to play off as above, its
actions in imitation of the great celestial horologne.

76S Theory of Organic Beings. [July,

The forces which urge life, are every where unequal, and in
perpetual variation. Not only those of statical matter occasioned
by its elipsoidal movements, &c. but likewise those of the solar
effusion, suffer perpetual variations of intensity from the dip of
the planetary axes below the plain of the ecliptic. How momen-
tous to life this dip, this southern dip of our world i how prodi-
gious the consequences of it ! compelling its poles alternately to
wheel in the cold shadow of perpetual night, and clothing its
surface with climates; momentous, because solar heat and
light are essential and primary, present forces ; and the conse-
quences prodigious, because it modifies and impresses characters
upon living nature to accomodate these climates. This dip,
which of itself divides the earth into so many empires, and peo-
ples each with a peculiar life, evinces, most incontestably, as
before, the great superiority of the sun over the other forces.
Has this axis changed? The elder fathers of the lyre, who
sung the golden age, portray the beauties of perpetual verdure,
and ever-ripening fruits, where winter now holds his reign.
Where are the gigantic pachy derma, the rodentia, the last living
races of Cuvier? Has this dip varied and entombed them in
the fossil beds, where they are now found ? And have its vari-
ations in the night of year's been continually pouring new streams
of life along the path of time, and blotting out the families, the
earth once nourished? All shows that the sun empires su-
premely over all the other powers of nature in the causation of
living existence. And, if all the functions or actions of what
lives be but the actions continued of the material universe ex-
pressed and epitomised by living organs or organisms, over
which we have now thrown a few thoughts, does our physiology,
by isolating as it does the vital economy, hold up the faithful and
perfect truth ? Nature is simple, is one ; and, if understood, one
science would cover all her ground. Is it owing to the crooked
way through the senses, we have to look at her? 1 will ex-
press a great truth : Man looks at his Creator's work with inver-
ted vision, sees not the interior make, decomposes every where
into many what is one, and hews out to himself broken cis-
terns." An idea is credited by him for a thousand years, another
comes and. dashes it to pieces. His mind's chronicle shows that
his thoughts are entombed, I may say, in a fossil state, in the
thick black crust of years as his generations are in that of the
earth. The old ideas, Nature's \abhorrence of a vacuum" the
Pythogarean numbers" once so popular and familiar, meet us
now with the "pale altered visage of another world," "as the
awful faces of other times looking down from the clouds of
Crawla." Why? Because of oit# proncness to decompose, to
misinterpret, to scatter and isolate, which fetter the growth of
our sciences ; and none has suffered more from this abuse than
the one we discuss.

1838.] Theory of Organic lien 7G9

Facts should govern opinions, and not. opinions, facts. If
changes in the general condition of matter arc followed by cor-
responding changes in the world of life, the laws which govern
both are. then, universal, and the fundamental ies of our

author are proven. But let us hear him in his own words :

" All the beings of Nature," says h<3, " which are offered to our
contemplation, belong to the great whole which compose the
universe, and are connected to the earth as an integral part of
her system. Animal bodies, beside the laws which govern their
own economy, are subjected to the influences of all the other
bodies of nature. So close and powerful is this connection
which binds all physical existence, that living bodies only can
live in the presence of those foreign to them, and perish in a
moment if isolated from them. Two phenomena characterize
the whole living world, organization and life ; and all material
bodies present but two great relations, vitafiable (viable,) and
now vitafiable. Viability or a tendency to organization is the
inherent and inseparable property of a part of the matter of our
g-lobe. This viability tends to the production of no particular
living form, but equally and indiscriminately to the forms of all
life."

Like Newton's gravity which could not move the new worlds
until after the Creator's hand had first impelled them, this viability
could not have evolved the living forms at!? first to impel them
through the torrent of ages. The Creative force was necessary
to develope the genera and the species to excite, superintend
and give direction to its action, which was to become the proxi-
mate cause of all life, through all time.

" Life, in its most general acceptation, is the result of certain
operations equally physical, which take place between dead mat-
ter and matter animated is a mode of existence peculiar to
matter, and can only exist in it. More strictly, it is the result of
the reciprocal action of the viable matter deprived of life or
disorganized, upon living organic matter.

Throughout its entire empire, life has its peculiar forms, its
modal existences, which have continued unaltered and unaltera-
ble throughout time. The forms of a blade of grass, of the
bones and integuments of an insect or animal, have been, and
will continue the forms of all future generations.

This is the work of the organizing force, the spiritual link,
which connects all life with? its Divine Creator." We make no
comment.

Of psychological physiology, he scarcely touches the arcana.
The mind's acts pyrceiving, comparing, abstracting, Cyc,
are the proper 'phenomena fjjp investigation. Of the nature of
that which perceives, we never can really know any thing. The
properties and actions the phenomena of things, are above the
proper objects of our research. The human mind will never

770 Theory of Organic Beings. [Ju?

make a revelation beyond the facts. He evinces himself to bt
a sound philosopher of, the school of Bacon.

But to proceed with his history of the life of our globe.

"In the operation of ages, causes take place, whose tendencies
are to diminish the amount of life. Since perpetual organiza-
tion is essential, and one of the great actions of all life, and the
atmosphere being the reservoir, the earth's crust or surface be-
comes emphatically the" spacious theatre of the living world.*
The action of the winds, the washing and attrition of rivers, the
motion oi the tides, the underwashing of the sea waters, causing
earthquakes, all tend to the entombing (enfouissement) of vhfe
viable matter, and putting it beyond the reach of organization
and life." Here there is a portion of the viable or orga/iijiable
matter incarcerated in the bowels of the earth, no longer peo-
pling its surface with living forms, and is an abridgement of the
aggregate amount of what lives. '-' Nature in her wisdom and
infinite resources, provides means for the resurrection again of
this matter to organization and actual vitality."

This viable matter, the debris or ruins of what has lived, con-
tains in itself the means of spontaneous combustion. Buried by
winds, by earthquakes, &c; deep in tiie bowels of the earth, in
the course of ages its icrnific decomposition begins, and gives ori-
gin to volcanoes, by which it is again vomited forth, and thrown
upon the surface to run through the endiessforms oi' organiza-
tion and vitality. t

In nature's stupendous economy, volcanoes, which destroy so
much life, are useful and indispensable to that'very life. They
are her great instruments, by which she counteracts the causes
of vital destruction, sustains the organizable matter on the
earth's surface, and keeps the cup of life forever full aad flow-
ing.

Those who take pleasure in transcendental physiology, and
in the laborious manner in which the Germans study, for whom
this work was written, cannot fail to be pleased with the perusal
of this volume, and are cordially recommended it.

J. B. G.

June 9th, 1833, Talbotton.

* ' Tout l'ensemble, All living bodies, says Cuvicr, arc oxydised or burnt bo-
dies. Organization, therefore, is their de combustion in its lirst process. Rappart
des Sciences, iyc.

INDEX.

NO TE. In consequence of a mistake of the printer, in work-
ing off the 2nd No. of the present volume without altering
the pages of the first, we are under the necessity of giving
a separate Index to the first No., and then a general Index
to the other eleven numbers.

INDEX TO NO. I, VOL. II

A.

American Medical Association, - - 51

Anencephalous Monstrosity, case of, by Drs. Nicoll & Arnold, 10

Asthma, Thymic, of infants, .-- 40

Azalea, diuretic virtues of by Dr. E. H. Macon, 20

C.

Cataract, operations for, by M. Serres, 44

D.

Dysentery, pathology and treatment of by J. G. Davey, 49

Extra-Uterine Fcetation in the Sow, by Dr. A. Bean, - I

Intussusception, case of, 18

Itinerants, Mercury, remarks on, 46

J.

Jefferson Medical. College, announcement of Lectures in, 64

Lower Jaw, new mode of reducing dislocations of, - 44

M.

Macon, Dr. E. H. on the diuretic virtues of azalea, 20

Medical College of Georgia, ------- 62

" of the State of South Carolina, 62

" Transylvania, -------- 63

Meek, Dr. S. M., on Female Diseases and use of pessary, 25

Metorrhoea, by M. Chassinat, report on by M. Moreau, ... 45

Nicoll, Dr. A. Y., Anencephalous Monstrosity, case of, by, -"'-.-- 10

P.

Pessary, use of, by Dr. S. M. Meek, 25

T.

Thomsonian Surgery, editorial remarks on, 55

letter on, from Dr. H. V. Miller, - 59

V.

Verminous Irritation, by Dr. Wm. Markley Lee, 7

Y.

Young Mother's Guide, by Dr. R. S, Kissam, notice of, - 3*

IV.

INDEX.

INDEX TO THE LAST ELEVEN NUMBERS.

Abscesses, opening of, by M. Lisfranc, 244

Academy of Medicine, French, proceedings of the - - - - 40-351
" Extraction of Tooth during the Magnetic Sleep, - 40

" Amputation of Breast " " " " - - 40

" Animal Magnetism, 41

" Influenza, ---.----41

Spontaneous Perforation of the Heart, - - 43

f* Ingress of Air into the Veins, - - - - 351

Acetate of Morphia, mode of detecting its presence, - 373

use of in Cancer of the Uterus, 510

" " " Rheumatism, 511

Address delivered by Dr. John P. Barratt, 585

Amaurosis, spontaneous cure of by Dr. L. L. Cohen, - 515

Amenorrhea, use of secale cornutum in, ------ - 690

Amputation, editorial remarks on, 361-572

of Penis, 347

" of nearly one half of Lower Jaw Bone, by Dr. P. Eve, - 720

Amussat's case of Ingress of Air into the Veins, 351

Anatomy of Lymphatic System, 484

; " of the Skin, - 493

Anchylosis, new treatment of by Dr. J. R. Barton, - - - - 471

Andral's Report on treatment of Typhoid Fever, - - - - - 287

Aneurism of Iliac Arteries cured by application of Ice, - - - - 550

Animal Magnetism, - - -'- - 45

Antony, Dr. M. un Nepeta Cataria, ------- 8

" " " Menstruation, 135

" " Contributions to Obstetrics, 331

" " on Sulphate of Gtuinine, 401

,' " c< case of Fistula cured by coffee, 398

Apoplectic Disposition, arsenic in, - 747

Arm, re union of, after almost complete division, 178

Arsenic, in apoplectic disposition, 747

Arteries, compression of; - 428,-549-684

" Editorial Remarks on, ------ 447

" Vital Properties of, -------- 521 <

Asthma, case of Thymic, ",".'"" 690

B.
Baldwin, Dr. A. C, on Treatment and Pathology of Enlarged Spleen, . 131

Barton's new mode of treating Anchylosis, ..... 471

Belladonna in Ileus, ....... 249

Berge, Dr. Louis de La, on Tubercular Affections of the Lungs, . 355,675
Biliary Calculi, remarkable case of, ..... 195

Blandin's new Doctrine of Erysipelas, ..... 305

Blennorrhagia, injection for, ...... 448

Blood, Electrical Phenomena of, ...... 551

Blood-Letting, remarks on by Df. Hall, ..... 668

in cold Stage of Fever, ..... 700

Brain, Ciliary Motions of, . . . . 374

Bronchitis, observations on, by Dr. Cooper, ..... 315

Bronchotomy, . . . . . . 168

C.
Caesarian Operations performed successfully, ..... 172

Calculi, Auscultation for detection of Urinary, .... 449

" Urinary covered by a kind of gelding, .... 320

" Biliary, remarkable case of, ..... 195

INDEX.

Calomel obtained by precipitation,

Cancer, Essay on by Dr. P F. Eve,
" of Uterus,
" of Lungs, - .

'"' ol' Pe

Cantharidin Plaster,

Capillary System . physical action of. .

Carotid Artery, compression of, in Gonvulsio

Chase, Dr. Hebor, on ! istaken for Hernia

Cholegoguc Pill, composition of,

" of Dr. Holloway,
" of Dr. Hull, " .

Ciliary motions of the Brain, .
" in man, .

Cirsocele, new mode of operating for, .

Clinique of M. Louis,

" " " Enteritis,

': " " Typhoid Fever,

" " . " Scirrhus of Pylorus,

Cohen's case of spontaneous cure of Amaurosis',

Compression of Arteries,

Convulsions, compression of Carotids in, .

remarks on by Dr. L A. Dugas,

Cooper, Dr. on Chronic Bronchitis,

Copaiva, capsules of

Croton Oil in Ptosis,

D.

Death, Signs of .....

' by Thompsonian Practice, ....

Debilitants and Sedatives, remarks on by Dr. J. A. Eve,
Diet of Infants, ......

Diervilla Canadensis, remedial virtues of, .

Digitalis in Diopsv, ......

Discharges from Urino-Genital Organs, -

Double on Medical Statistics, .....

Draper. Dr. J. W., on physical action of the Capillary System,
Dropsy. Digitalis in. ......

Drunkenness, cure for, .....

Dugas, Dr. L. A ., on Pathology & Treatment of Bilious Fever

" <: <: on Convulsions.

" " " Operations on the Eye,

E.
Eclectic Journal of Medicine, notice of, .
Ectopia of Aorta, ca^e of, by M. t ...

Elder, root of in Scrofula & Lcuchorrhcea,
Electricity, human, editorial remarks on,
Electric Excitement, remarkable case of.

Child. . . .

cc Phenomena of the Blood, .
Enteritis, case of Clinique of M. Louis,
Epilepsy, lecture on, by Dr. Jackson,
Epilectic Fits, cured by the Trephine, .
Epistaxis, quinine in Intermittent,
Ergot, in anticipation of Uterine Hemorrhage,
Erysipelas, remarks on,

new doctrine of. by M. Blandin,
Eve, Dr. Joseph A., on Debilitants and Sedatives
" " !: Expectation in Medicine.

Eve, Dr. Paul F., remarks by, on the cases of Dr. E. il. i
Surgical Cases, by,
on Cancer.
Amputation of nearly one half of Lower Jaw

. 3;3

462
510-712

. 341

318
. 609

428
. 259

194
. 258

258
. 374

375
. 674

735

. 735

. 736-738

. 740

515
428-549-684

428
. 526

315
. 319

374
. 381

509

63-189-705

15-212

. 693

185
. 294

379
. 219

609
. 294

248
. 387

526

. 647

732
. 433

378
. 421

422
. 678

551
. 73 ">

595

. 254

, 696
. 305
15-212
. 321
11

Expectation, essay cm, by Dr. J. A.Eve uo

bye, operations on, by Dr. L. A. Dug.- . %

1

Fever, Universality of, . . fQfl

" Q.uinirfein, . ' ' '

Bleeding in cold stage of, . 7/m

|| Bilious, Pathology & Treatment .of. bv Dr. L. A Du^as ' 387

* dlow, remarks on by J. B. Whitridtre, A. M. M D & 451

J ante. mnltent treated by the endermic method, ' 510

ti Typhoid, chloride of soda in, . . 57JJ

r Von on purgative treatment of, . . '" <287

r Climque of M. Louis, . . . , 73G-738

( Iyphus, .tartar emetic anif opium in- . . . 539

. " Purgatives, Bleeding in, . q-n

Fistula. .case of, cured by co.fee, . ' ' ' SOS

Flora G^orgiensis, by L. Lataste, notice of," " :it

Fractures, treatment of, . . . . ' ' \\%

' G.

' Gamble Dr. S. D on theinfluenccof Pain in producing death, . 707

Geddmg s case ol Enlarged and Ossified Ovaiia, . = ' 579

Gerhard's lecture on Rheumatism, ... . ' ' 553

" Diseases of Spinal Marrow, . ' ' 704

C*orman,+Dr. J. B., on the actual state of our Medical Epoch, . ' 268

r. , ... _, " <> employment of Mercurial Preparations '201

gonorrhoea with Malformation of Urethra, * ' fiQ

fcrraves on use of tartar emetic and opium in Fever, . ' 540

~ ' on " I i's treatment, .' * a9e%

Gunpowder, therapeutic effects of, ..."." 745

H.

Hemorrha, ^s. cases of by Hon. C. E. Haynes, M. D. - - I

rgot in anticipation ol, - " - '. _ . 254
reosote in

Operation ol

tt , vyiru:>u:e in, - - ... . - . _ . _ 07^

Hahnemann,* & Thomsonianism, ed. remarks on, 57

Hall, Dr. remarks on Blood-Letting by, - - . cao

Haynes Dr. CE. eases of Hemorrhage, by, - . . ". " ' ,

Headache, nervous, Innoeulation of Morphia, in. 514

Heart, case of "Spontaneous Perforation of, - '- A

t Action of Certain Medicines on, - - 512

h Influence of Certain Medicines on Functions of. - - '-"'-369

-1 ,/. 'V n'1^ increasing action of, --... 7^

Heidelfers case of Cancer of the Luncr? - . . oo'c

Henna Remarks on Diseases mistaken for, by Dr. Chase, - 059

JNotice of report on Radical Cure of, - - . . Un

golloways case of Enlargement of the Ovaria, - 714

Hydrocele, ^.vv Treatment of, by Professor Velpeau, - - - "'. 530

Mel '^ting for, bv B. Travers. Esq ky

Acupuncture. ----- 587

tt , , ' " injection for - - . aqo

" . %g

Ileus, Bdladona in. Q q

Inflah " - Kg

bb~
31<>

., 1
trfhe

f, "

INDEX.

Vll.

Iris, Congenital Division of,
" Laceration of.

Jackson's Lecture on Epilepsy,

L
Lefargue's proposal of Innoculation of Morphine,
Lelut's Phrenological Investigations,
Leucorrhcea, Inula Helonium in,

11 And Menorrhagia, editors remarks on,

Iodine in .

Injection for, ....
" Root of the Elder in,

Lewis D., Acupuncturation in Hydrocele, by,
Lime, Sulphuret of, in Diseases of the skin,
Liquor Opii, Sedativus of Battlcy, .
Lisfranc on the opening of Abscesses, .
Lithotomy remarks on, ....

Lithotrity, circumstances favorable and unfavorable. to,
Louisville Medical Institute,
Lungs, Tubercular Affections of,

" Case of Cancer of , ;
Lunatic Asylums of Salpetriere & and Bicetre, report on
Lymphatic System, Anatomy of, .

M.
Magnetism, Medical, remarks on,
Medical Examiner, notice of,

" Statistics, by M. Double,
" Publications in France,
" College of Louisiana, .

" Richmond Virginia, .

" South Carolina, .

Georgia,
Menstruation Remarks on, by Dr. M. Antony,
Case of supplementary,
Case of retained, .
Mercurial preparations in Acute Fevers, .
Mattaner, Dr., on Amputation of the Penis, .
Morphine, Innoculation of,
Muscular Fibres, structure of,

N.
Nepeta Cataria, observations on, by Dr. M. Antony,
Nitrate of Silver, remarks on, .

O.
Obituary of Dr. Philip Syng Physic,
Obstetrics, contributions to, by Dr. M. Antony,
Osseous System, development of by M. Serres,
Ovaria, Enlargement and Ossific Transformation of, .
" Fibro-Schirro-Cactilaginous Enlargement of,

Pain, Influence of, in the Production of Death,

Parotid Gland, Extirpation of, .

Penis, Cancer of, Amputation, ....

" Amputation of, by Dr. Mettaner,
Phagedenic Paste, formulae for,

" Method of using,
Phrenology, notice of by Dr. Sewall, .

Editors remarks on Investigations of Lelut
Physic, Dr. Philip Syng, Obituary of. .

Poiseuille on Electric Phenomena of the blood,
Polypus within Uterus removed hv Ligature, .
Premium offered by Medical Society of New York,
Ptosis cured by Croton Oil, ....
Pus in the Blood, manner of detecting its presence,

691
659

595

odine in,

and allay vomiting

Theory of Q'rga
Marrow, lecture on dis<

570

Jojirn

368

. 428
318

510
379

G78