Digitized by the Internet Archive in 2012 with funding from LYRASIS Members and Sloan Foundation http://archive.org/details/southmed1838medi 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 sSW\ 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, 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 . 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, 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," 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