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SURGICAL JOURNAL..

VOL. III. UU5

A TRULY VIRTUOUS WILL IS ALMOST O M X I P O T K N T .

EI3ITEi3 KT

MILTON ANTONY, M. D.

Professor of Obstetrics, ^c. in the Medical CoUpge of Gcors:ii'

AUGUST i. GA.

Printed by Gitirv. A- Tkomj'ii'y'%,

iiclniosh-strpft.

1839.

To THE Subscribers of the Southern Medical axd Surgi-
cal Journal.

Since the notice on the cover of the Journal was printed,
which announced that the undersigned had undertaken its Edi-
torial management, unfor^^een circumstances have occurred
which render it necessary for them to decline the undertaking
should other arrangements be made for the continuance of the
work, due notice will be given to its subscribers.

JOSEPH A. EVE, M. D.
I. P. GARVIN, M. D.
Augusta, Oct. 16th, IS3i).

7^

J . I

SOUTHERN MEDICAL

AND

SURGICAL JOURNAL

Vol. III.] OCTOBER, 1838. [No. 1.

Part L ORIGINAL COMMUNICATIONS.

ARTICLE I,

Address to the Class, on opening the Course of Lectures in the
Medical College of Georgia, the ilth of October, 1837. By
Paul F Eve, M. D., Professor of Surgery and Dean of
the Faculty,

Gentlemen :

It has been thought proper, under the present organization
of our School of Medicine, to deliver but one public lecture, in-
stead of occupying, as heretofore, the first week by an Intro-
ductory on each day ; and through the kindness of my colleagues,
I have been made the humble instrument of w^elcoming you, at
this time, to the Medical College of Georgia. In the name
of the Faculty, whom you have honored by your presence on
this interesting occasion, I bid you welcome, thrice Welcome,
within these walls, dedicated to the science of Medicine. We
would hail you, as youthful but zealous votaries, aspiring after
the honors of a profession, whose exercise is the preservation of
life and health ; whose office is the doing of good : and as this
hour may be supposed to have been set apart to initiate you to
the advantages held out to students by our College, nothing
A 1

Address. [Oct.

seems more appropriate than to devote it to llie brief consid-
eration of this object. This too will enable you to decide, if we
have voluntarily assumed solemn responsibilities without due
deliberation, or have assumed important duties without the
requisite preparations for their faithful performance.

The early history of the Medical College of Gcori^ia, like
that of many individual enterprises, the success of which has so'
greatly distinguished our country among the nations of the
earth, presents a striking example of wdiat may be accompfish-
ed by industry and perseverance. On this day five years ago,
the first Introductory lecture was delivered in the Masonic Hall
of this city. We were then without a suitable Building and
almost alike destitute of Anatomical Museum, Chemical Appara-
tus, Library, and nearly all other conveniences for carrying on'
our College operations. As early, however, as 1827, the idea
was suggested by a member* of the present Faculty, of es tab-
lishing a Medical Academy in this place. In the winter of
1830, a charter was granted by the Legislature of this State to'
the Medical College of Georgia, empowering its Trustees to con-
fer the degree of Doctor of Medicine upon those, who had com-
plied with the requisitions demanded by the most respectable
Medical Schools of the United States. In the summer of 1832,
the Faculty was organized by the election of six Professors,
five of whom still hold office in the College ; and during the
winter of 1832, '33, the first regular course of lectures was de-
livered in two rooms, temporarily fitted up in the city Hospital,
to a class of twenty-seven students, four of whom were gradua-
ted at the first commencement.

From the Legislature of 1833, we received a donation of ten
thousand dollars, and from the City Council of Augusta, five
thousand more, by guaranteeing medicines and medical services
to the Hospital for ten years. With the fifteen thousand dollars
thus obtained, this edifice was erected on this lot, generously
ceded to us by the Trustees of Richmond Academy. During
the winter of 1833, '31, the class in attendance amounted to
thirty, and at the second commencement, the degree of M. D.
was conferred upon fifteen approved Candidates.

^Or. Antony

1838.] Address.

Early in the Spring of 1831, the Faculty raised, upon their
own responsibility the sum of ten thousand dollars, and dis-
patched to Europe one of the Professors,* to purchase an Ana-
tomical Museum, Chemical Apparatus, Surgical Cabinet, &c. for
the use of the College. -At the unanimous request of the Facul-
ty, the Trustees appointed this year the present Professorf of
Physiology and Pathological Anatomy, Adjunct to the Profes-
sorship then existing of Anatomy and Physiology. The class of
'34, '35, numbered thirty-seven, audits Graduates fifteen.

Aware of the defects, and the want, especially of system, in
the course of instruction pursued in the Medical Schools of the
United States, and feeling the necessity of some uniform stand-
ard of qualifications for Candidates for the honors of the pro-
fession, in May, 1835, our Faculty respectfully addressed a
Circular to every Medical College of our country, calling
their attention to these subjects, and recommending a Convention,
to be hejd at Washington City to correct these evils, and to
adopt such other measures as might be calculated to promote the
general welfare of the medical Profession. The number of dele-
gates to be sent from each School, and their time of meeting, were
left, in compliment, to the University of Pennsylvania, the oldest
medical Institution in the United States. Her Faculty, howev-
er, declined taking any interest in these objects, and our proposi-
tion, which had been favorably considered by some of the other
Medical Colleges, consequently failed in effecting any good end.
Posterity will judge of the liberality and wisdom of that act,
which has deliberately rejected medical reformation at the pre-
sent day, and in a country too, where from the grossest abuses in
medicine, its practice has almost ceased to be honorable among
men. Spirits of Shippen, Rush and Wistar, and thou time-hon-
ored Father of American Surgery, J upon whom have your
mantles fallen !

But we rejoice to know that the spirit of reformation is
aroused in our land. A voice has just been heard in a distant
section of our country, loudly proclaiming the necessity for a

*Dr. Dugas.

fDr. Novvton, now Professor of Anatomy, (1838.)

|Dr Physick died the 15tli Dec. 1837.

Address, [Ocf,

National Medical Society,* and but recently, the abuses in the
present system of Medical Education, have been forcibly present-
ed to the Legislature of our sister state, by one of the distinguish-
ed Professors of her Medical Coilegcf In fact, so urgent is the
demand for amelioration in the course of instruction, now gener-
ally adopted in the medical Schools of the United States, that a
prolongation of the ordinary term of lecturing, is already pro-
posed in more than one of them. And may it not be expected,
that when the time for action arrives on this all-important sub-
ject, as, come it must, and will be prayed for most devoutly by
every friend of the Profession and of well regulated Society, this
College, which breathed the spirit of reformation in her very
infancy, will not then be found wanting ?

A second successful application for pecuniary aid, was made
by our Trustees to the Legislature of 1835, and most gratifying
to every friend of science, their most sanguine hopes were fully
realized. The state generously gave to our College, all her in-
terest in the premium resulting from the sale of the increased
stock of the Bank of Augusta, valued at twenty-five thousand
dollars. This has at once relieved the Faculty, liquidated every
debt, and provided a fund for contingent expenses.

Owing to the disappointment experienced, from the College
Building not having been completed agreeably to contract, and
to our being deprived of the valuable services of the present
Professor of Physiology and Pathological Anatomy by his de-
parture for Europe,J the class of '35, '36, amounted only to
thirty-two and its Graduates to eight. This we arc happy to
say is the only exception to the annual increase of the number
of Students in our Institution, the only check to her gradual pros-
perity she has received; and this evidently arose from the causes
just assigned. At the last session, with but six Professors, there
was a flattering increase to forty-six, being a much larger class
than has ever yet been in attendance here. The number who
received the Degree last April was fifteen.

*See Boston Med. & Surg. Journal, also Southern Med. & Surg. Journal.

fDr. Moultrie.

^Dr. Newton, now Professor of Anatomy, (1838.)

18^8.] Address. 5

Since the past winter, the Trustees of our College have been
actively engaged in advancing the interest, and enhancing tlic
value of the course of Instruction, hy important additions to tie
regular lectures. They have, as you are all aware, created two
new Professorships, and \ye honestly believe have been truly
fortunate in the election of gentlemen of first rate abilities, who
we feel fully persuaded, will give entire satisfaction to the re-
spectable and numerous Class now assembling here. There are
eight Professorships in this College, on as many distinct
branches of medicine, a number surpassed by none, and found
existing in only one other of the medical Institutions of our fa-
vored country ; and we challenge a better division of the de-
partments of the science in any one of them.

By a very recent ordinance of the City Council of Augusta,
the Hospital has been placed in a very respectable condition, and
upon a much better system; offering now inducements not only
to the sick poor of our city, but to all, who may require medical
or surgical aid, for a very trifling consideration. This charita-
ble Institution is entirely under the professional care of the Facul-
ty, and I need scarcely add, your attention will be directed to all
the interesting cases, which may be introduced into it during
the course of lectures.

Besides completing a neat fire-proof house for the purposes of
practical Anatomy, entirely apart from the main Building, the
Library has been arranged for the reception of books, and many
valuable additions have been made to it and the Chemical Labor-
atory. We have also commenced fitting up an extensive room
for a general Museum, and in another one, is placed a grand solar
and a superior compound Microscope. An order is now on its
way to Europe, and wd:iich would have been sent in the spring,
but for the difficulty of effecting exchange between the two
Countries, for a large accession to our already increasing Library.

In January, 1836, the prospectus of a Southern Medical and
Surgical Journal was announced by the Faculty of our College,
and in June followins: the first number was issued from the
press. The failure of all similar experiments in this section of
our Country, and even that so recently of the Southern Re-
view, in Charleston, have not prevented us from employing orr
feeble efforts, to be useful in this way, to our day and generation.
We would not bury even the one talent, which may have been

Address. [Oct,

Go.nmitted to our caro. The Southern Medieal and Snr2:iral
Joirnal has aheady entered upon its seeond volume, \vith an
j.icreasing patronage, not only eneouiaging to its undertakers,
hut at onee sceuring its coni[)lete success.

From, this hasty collection of facts connected with the origin
j^nd progress of the Medical College of Georgia, you are capa-
ble of forming some idea of her actual condition. In the brief
space of live years, what has she not eflccted ? What lacks she
now for the medical Education of the youth of our Country ?
We point you to this Edifice, with its classic exterior and ample
accommodation within, alike an, ornament to our City and State,
and a monument to their munificence, acknowledged by all who
have examined it, to be the most appropriate and convenient for
Medical purposes in the United States -to that Anatomical Mu-
seum, surpassed perhaps by none in our country, for the beauty
and usefulness of its preparations to that Chemical Laboratory,
rich in its apparatus for the performance of experiments, to il-
lustrate the various subjects connected with this science to
hat Library, containing already many rare and valuable publicq.-
tions, both in the ancient and modern languages see too that
'Journal, monthly teeming with original communications of an in-
teresting character, and comprising the latest important intelli-
gence connected with the profession behold her Professors,
already increased to eight, and now prepared to enter upon
their respective duties but above all, see her sixty Graduates,
binding up. the wounded and healing the diseased in our Southern
and Western States , and when you reflect that all these are the
fruit of but five year's labor, what, we ask, may not be promised
in the future career of this School of Medicine ? What has been
left undone to render her a blessing to our people ?

But this is not all. Connected with the history of the Medical
College of Georgia, there is one circumstance which has distin-
guished her from all similar Institutions of our Country, and
upon which perhaps her success thus far has mainly depended.
In her very infancy, she has dared to difl^er from all other Schools
in the United States, in thelenc^th of the course of instruction.
This may be considered her peculiar and characteristic feature.
While the term of lectures in other Colleoresis of about four
months continuance, the session here is nearly six. Instead of
occupying the whole day in delivering lectures for a term of

i^as.] Address.

1 tree and a hulfto four inomlis, there are but four hours daily,
appropriated here to public iustructiou, and the course is con-
tinued from tlie third Monday in' October to t!ie fu'st of Aj)ril.
All the lectures are presented to the Students in the morning,
and the after part of the day niay be exclusively devoted to
demonstrations in- Anatomy, and the evening to study. The de-
c'djd advantages of this plan of instruction in Medicine, must be
admitted by all. No one who will reflect on the subject can for
a moment hesitate. To a beginner in our science, (and what
else are Students,) four lectures daily are as much as his mind can
possibly digest ; and the regular division of the time, to public
instruction, to improvement in practical an'atomy and to reading,
is infinitely superior to the old system of six successive discourses,
and these too, delivered as they are, on diflerent branches of the
Profession. The prolonged course, alone, it must be admitted,
allows time for minute investigations and manual operations,
or study and reflection, for the many various and important
preparations for the successful practice of Medicine. It is cer-
tainly not alone by hearing lectures on a given subject, that we
can derive the most profitable and intimate knowledge of it, but
we must thoroughly examine and attentively consider it for our-
selves. This which is true of all arts and sciences, is especially
so of Medicine. It must be patiently studied for years by all
who wish to comprehend the length and breadth, the height
and depth of its usefulness to suflering humanity. If the science
of Medicine is not secured by the purchase of a patent right,
neither is it to be acquired by even the faithful attendance on
two short courses of lectures. And it is gratifying for us to
know that the protracted system adopted here, is recommending
itself in spite of self-interest and prejudice toother Schools, while
it has received the uniform and unqualified approbation of our
Alumni.*

Notwithstanding the Trustees of the Medical College of Georgia have
been compelled, from the want of co-operation on the part of other Schools
of Medicine, to forego the advantages of the prolonged Course of Lectures,
they are still advocates for it. They believe it offers the best system of in-
struction to Students. Necessity has alone forced them to the change, (at
least for a time,) from sLv to four months, the period adopted in other hi-
stit unions of our country. The Faculty will, however, make all the amends
they can for the shortening ol the course, by rendering their Lectures as
demonstrative ds possi[)le, addn-.s-mn' rho ovc as well ;is the car.

[Oct.

Among llie advantages liclJ out to Studonls of medicine in
this place, not the least important is that otlered by the present
organization of llie Medical Society of Augusta. This Body
holds its meetings every two weeks in the library room, to which
all connected with the Profession are admitted, and the regular
business is the reading of an llssay and its discussion, in which
onch member successively engages. An opportunity is thus
ntlbrded of either confirming the truth ])resented, or of correcting
an error wdiich may have been committed in the lecture-room ;
while ib'c attention of all present is necessarily directed to the
elucidation of one particular subject.

J5esides the advantages presented here, by the prolongation
of the ordinary term of lecturing, which, if it be not superior, at
least obviates one serious objection not only experienced, but
even complained of by other medical Schools, and those already
enumerated, there are other circumstances which should induce
you to obtain your medical Education at the South. Apart
from that Slate pride which every true patriot must ever feel
glowing in his bosom, and of that duty wdiich every good citizen
owes to the encouragement of home Institutions, where under
heaven can you so properly investigate the diseases peculiar to
ourselves ? In no other place do they occur with precisely the
same type, and hence the utter impossibility of examining them
elsewhere to the same advantage. A great deal, it will be con-
fessed, has been written on diseases peculiar to each climate,
but without exaggerating the importance of investigating them
where they prevail endemically, there is one view of this sub-
ject which exemplifies not only the propriety, but even the very
necessity of studying them at home. Granting that Medicine
as a science is based upon certain general and well established
principles, the correct and intimate knowledge of which is as
essential to the safe and skilful Physician under the Equator, as
at the Poles ; and admitting too, that these general principles
can be equally acquired at any medical College, be its situation
where it may, still would you not expect a marked difference
between the information given here at the South and that at the
north, on the diseases to which the negro is most subject. Where
would you go to study w ith most profit, his peculiar habits, the
causes, progress, and more especially the proper treatment of
Yi\^ particular affections I Would it be among the Abolitionists

1838.1 Address. 0

of the North, the Colonizationists of the West ; or would it not
rather be here, in this his native place, the sunny South, where
in despite of abuses and insults heaped upon us, he is better
clothed, fed and provided for ? Now the blacks comprise about
one half of our entire population; in some of our adjoining Stales
they even out number the whites, and they are precisely that
class of our community first committed to the professional care
of the young physician. Self-interest then, and the pure dic-
tates of humanity, conspire to urge upon you the importance of
this subject, the acquisition of that knowledge at home which
you can never obtain abroad to the same advantage.

Let me not however be misapprehended. I would not be
understood as undervaluing the medical Schools of other sections
of our country, or as even drawing invidious comparisons. I
hope I would not be so recreant to every sense of justice, nor
so destitute of every feeling of gratitude. All that is intended
by the remarks on this subject, is to impress upon you not only
the propriety in the very nature of things, but the importance,
even the necessity of acquiring as far as practicable, your med-
ical Education at the South. The knowledge of Medicine which
you can obtain here or in Charleston, will but the better pre-
pare you to profit by what may be presented you abroad. But
in your visit to the North, permit me to make one suggestion,
abundantly confirmed both by reason and experience. It is
this, more benefit can be derived there by southern Students,
from attending a summer course of lectures, than from those
delivered during the winter. Besides the rooms being less crowd-
ed and the greater length of the days, the Hospitals can then be
visited with much greater advantage. There is far more time
in the summer for observation and research, and the diseases of
that season will approach much nearer the type and character of
our own.

So far, however, from rendering myself obnoxious to the
charge of illiberality by what has been said, or of referiiig to
subjects calculated to excite prejudice against medical Institu-
tions situated in other sections of our country, I have even pur-
posely avoided alluding to the out-breaking of feeling last win-
ter, in opposition to the whole southern medical Students in the
City oi brotherly love, or to the recent unhappy disclosures about
the oldest school of the West. So far too, from discouraging

B 2

10 Address. [Oct.

you from visiting other Colleges and Universities where our sci-
ence is taught, I can but wish that each and every one of you,
may not only enjoy all the advantages and privileges possessed
by our country, but those also which exist in foreign Lands. But
when you do go forth into the world, I would have you fully
prepared to profit by all you may observe in the profession
while absent, and convert every fact you may receive abroad
to usefulness in your practice at home carrying with you not
only Southern feelings and repubhcan principles, but American,
Southern theories of Medicine.

Some consideration too with a southern Student of medicine
is the congeniaHty of our climate compared with the rigors of a
northern winter. There are here not only fewer temptations
to dissipation and less to attract attention from study, but there is
also a better security for the continuance of health. We are
actually capable of effecting more at home, in the way of prepa-
tion for the important duties of life, than we can any where else.

Another reason why a Southern Institution of medicine should
be patronised by her own citizens, is the improvement it will ne-
cessarily induce in the science, for the cultivation of which it has
been established. Its immediate privileges, though confined to a
few, will be of essential benefit to the whole community. It of-
fers advantages to all connected w^ith the profession, more espe-
cially to Students ; gives an impulse to its cultivators ; elevates
its character ; and sends out an influence which will be felt in
the remotest regions. No one can calculate the value of the
impression already made in the science tiiroughout our Southern
States, by the Schools of Charleston and Augusta ; nor predict
the inestimable blessings they are destined to confer upon our
people, sustained as they now are in the good work, by the ex-
tensive circulation of the Southern Medical and Surgical Jour-
nal. Were now, I w^ould ask, the necessity for either patients
going North to derive the full benefits of the healing art, or of
Students to obtain a complete medical Education ?

And where. Gentlemen, else than here, does there exist a
greater necessity for the creation and endowment of just such
an Institution, as this is designed to be, for the good of the Med-
ical profession, and the safety and welfare of Society ?

Here, where Medicine was degraded by the last Legislature
of Georgia, to the abject condition of the vilest, murderous and

1838.] Address. 11

most nefarious trade, by an association with mercenary venders
of patent-rights and other nostrums, of the most specious but
grossest miposition upon a too confiding and too credulous
public here, where Medicine which had engaged some of the
best and most talented in every age and country, and been re-
spectedj honored and cherished by the laws of every civilized
nation under the sun, was publicly declared by a solemn and
deliberate act of the Legislature, to be no longer deserving its
fostering care and protection here, where Medicine is not
acknowledged by the laws of the land to be a science, and where
there are no restraints to its abuse in practice, where it is de-
nied being worthy of study, and its profession daily ceasing to
be honorable ; its accumulated facts and learning pronounced to
be useless, and the whole science taught to be comprehended in
a patented pill, a vegetable powder, or boiling water and
all this by a State which had just appropriated thirty-five thou-
sand dollars to endow a College, for the cultivation of this very
rejected science of Medicine. Nothing it seems can equal the
folly of this act of the last Legislature, but the height of its own
inconsistency. Another such, and the moralist might have ap-
propriated to Georgia, the interrogatories of an ancient Prophet
r)f Israel, who when mourning over the desolations of his coun-
try, exclaimed, is there no balm in Giiead, is there no Physician
there ?

As Georgians, Southern men, real Students of Medicine, you
are called upon to sustain this much abused, but little compre-
hended, this neglect-ed and now degraded, this noble, this God-
like Profession. And is it not essential to study man, before
being qualified to practice Medicine ? The Author of the Uni-
verse, when he bowed the heavens and came down upon the
earth, as the Saviour of mankind, delighted while he taberna-
cled in the flesh, to heal the sick, restore the blind and relieve the
lame. As the Creator of man. He had of course the most inti-
mate and perfect knowledge of his very wonderful and compli-
cated structure. We read indeed in holy writ, that supernatu-
ral power to cure diseases, was given to the immediate followers
and disciples of our Lord and Master ; but we have also been
taught to believe, that the day of miracles has long since closed.
Men, however, have arisen in the nineteenth century, who, if
they have not discovered the royal, at least have invented an

13 Medical Electricity. [Oct.

easy and gilded road to the hill of Medical science, on which too,
its travellers are rapidly, if not recklessly, propelled by the pre-
sent popular locomotive agent. This system of medicine acts
in unison with that spirit of the day, now threatening our country
with the destruction of all order in society ; the spirit of agrarian
mobocracy. It denies the necessity for study or application to
the arts and sciences ; it declares all knowledge to be intuitive ;
it would destroy all distinctions among men, and place the ignor-
ant and the wise, the dolt and the talented, the sluggard and the
industrious upon the same footing. It is at variance with reason,
common sense and the natural order of things ; it sets at defiance
all philosophy ; it makes even the creature arrogate superior powd-
er and attributes to the Creator, for we know God made man ere
He cured his diseases. No, Gentlemen, w-hatever others rnay
think and practice on this subject, we act hei^e upon the princi-
ple and axiom, that it is impossible for him wdiohas no knowledge
of man, to know medicine. And relying upon your support,
and the good sense and intelligence of our people, we will pro-
ceed to instruct you to the utmost of our preparations and abili-
ties, in this much persecuted and slandered, but most benevolent
and useful science ; teaching you that Profession, which our Sa-
viour honored with its exercise when^oiw^ about doing good.

ARTICLE n.

Medical Electricity. By M. Axto^y, M. D., <tc.

Electricity is a subject from w^hich the mind of the pathologist
and the therapeutist has been repelled by the idea o^ great jiower.
The medical philosopher has been accustomed to contemplate
this agent in view of its severe, or its destructive influence. He
contemplates the convulsive action arising in obedience to its
impulse on the animal nerve the riven oak after the thunder

1838.] Medical Electricity. 13

storm the mighty ruin of cities after earthquakes and the
blazing ebulhtions of the volcano ; and in the immortality of his
mind, extending the thought to other worlds, he contemplates it
operating through inconceivable distance and with incalculable
power on bodies of immeasurable magnitude, not only sustaining,
but propelling them in the immense orbits around their common
focus ; and aofain, stretchin<? the imairination bevond the limits of
human senses and the power of the lens, he theorises, and this
whole system, from its centre to its yet undiscovered circumfer-
ence, is found, by an immense duplication of this agent, whirling
around another centre, until the mind is lost in its abstraction
from every thing which his senses can reahze to him as truth
thus forgetting to contemplate and adore the infinite intelligence
and power which created and preserves the universe, he drops
back into the mean conclusion that it is a power intactible and
unavailable for the minor philosophy of life, disease, &c. Here
the subject is dismissed from the mind's presence, without once
turning to the other extremity of this infinite physical agent. It
is seen in the wild and destructive tornado, but not in the gentle
zephyr it is seen in the vivid lightning and in the immense velo-
city of Jupiter or Herschellium Sidus in its orbit, but not in the
gentle growth of a plant or flower it is seen in the Aurora Bo-
reahs, but not in the human eye it is felt in the discharge of
the electric battery, but not comprehended in the action of a
muscle it is contemplated in the motions caused by its transi-
tions for restoration of equilibrium, but not in the repose of na-
ture which that equilibrium alone can secure. Let the mind
extend its grasp and comprehend the vastness of power, and the
ubiquity of this agent, and rapt by the sublimity he contemplates,
bow in humble reverence and adoration before Him who created !
Here is the end of the contemplation of the infinite greatness
and power. But not less adorable is that same Creator when
he is contemplated in the minuteness and delicacy with which
he has endowed this agent. Turning the attention in this di-
rection, we find here, as well as in the great fields of grandeur
and sublimity we have contemplated, a wise and kind adaptation
of power to purpose an agent capable, not only of being the
physical cause of the smallest events ; but even of the primeval
stillness and repose in which nature rested before the worlds
were.

H

Medical Klcctricitv.

[Oct,

In this contemplation are to be found materials for all minute
philosophy, and amongst the rest, for that of physiology, pathol-
ogy and therapeutics.

We have, as before intimated, long entertained physiological
and pathological views materially different from the received
doctrines in these important departments of medical science -
views fairly deduced from the elementary truths of nature,
and which make up a philosophy of life and of disease, not only
essentially different from doctrines received as orthodox in the
present age, but in many particulars actually adverse thereto;
We have for many years regretted the want of opportunity for
placing them before the medical public. We have not hesitated,
(as we believe others have ever done \\\\\\ regard to some of
the plainest facts of observation) to bring those doctrines before
the public, from the fear of ridicule a penalty too often suffered
by innovators on received doctrines, however false, and even
absurd and ridiculous these may l)e ; for we feel that our con-
clusions are enabled, by their inherent powder of demonstrable
truth, to w^ithstand alone, the combined opposition of all other
doctrines, and the uncharitable illiberalities of differing doctrina-
rians. But we have thought it indispensable to their ready
comprehension and adoption, that the w^hole elements should be
at once fully laid before the public, and their truth demonstrated.

In consequence of the w^ant of time and other means necessary
for such a preparation for the press, this has not been, nor can it
at present be done. Meanwhile, we need not withhold from
the readers of our journal, the purpose of which is mainly,77rac-
tical utility, i\\erdi\)eui\(id\f acts in connexion therewith, which,
whilst they tend to draw the mind to the contemplation of the
more minute operations of the great physical agent, are availa-
ble for convenience, as well as the most important purposes in
practice.

Eclectic medicine adopts well substantiated f.^cts, without
awaiting their suggestion by such imperfect and fanciful theories
as may be entertained ; and uses these facts both for practical
utility and for the development of sound philosophy. These well
substantiated facts may be used, and cannot fail to be found ben-
eficial in the treating of disease, as w^ell as in reasoning back to
first principles in life, health and disease.

1838.] Medical Electricity, 15

Although we have long been impressed with a sense of the
duty of calhng the attention of the profession to the appHcatiou
of electricity and galvanism to therapeutic purposes, we have
been impelled to the discharge of that duty at this time, by the
presentation of the following translation by the fair hand of a
young female friend, who had observed the pleasure which we
enjoyed on witnessing the salutary effects of " the BoxT as it is
called, in the resolution of some inflammatory affections to w^hich
it had been applied. The translation is from an old French
manuscript, the authorship of which is not certainly known.
The author appears not to have well understood the science of
electricity ; but to have arrived at his practical facts by close
observation of the truths presented to him. Thus it appeal's he
has arrived at a practi(;e with " the box" which we shall call the
electrical box, on principles in strict conformity with the laws of
electricity, without understanding them.

The manuscript is a very old one, and must have been written
at a day long anterior to the present most improved pathologi-
cal views; but if we may judge by the directions of the author
with regard to the application of the electrical box to many cases
we should say that his experiments and observations have
brought him to apply his remedy in a manner much more con-
sistent with true pathology, than the generally received doctrines
of the present day would have taught him ; and that too, without
seeming to have any particular pathology in the cases, in the
abstract. This arrival at therapeutic accuracy without the
guidance of theory, and perhaps in opposition to any theory ex-
tant in his day, stands forth in good proof of the correctness of a
more humoral doctrine than that which has pervaded the world
for the last fifteen years.

In speaking of electricity as a therapeutic agent, it is to be un-
derstood however, that it is one, calculated peculiarly to act on
the excitements of the body. Whatever of humoral doctrine*
may belong to true pathology, these (excitements) cannot be
denied an important place in the constitution of disease ; and
their correction, one of the most important of therapeutic purpo-
ses. So far then as the fulfilment of this purpose may conduce

*We do not mean antient humoralism, precisely, but a due regard to the
tateof the fluids.

16

Medical Electricity,

[Oct.

to the correction of secretions by the return of healthy action,
and no further, we may reasonably look for good from the appli-
cation of electricity. Nor would we pretend to ask, for elec-
tricity as a therapeutic agent, a confidence in a uniformity of
good effect beyond that of many other remedies in doing good
by producing their own peculiar effects on the system.

Morphine will not always procure sleep, or ease from pain ;
nor is it always salutary in its effects when it does. Calomel
cannot always cure disease, notwithstanding' it may operate
finely on the hepatic secretion when this seems to be the most
needed. Nor will it always saUvate when intended to do so,
nor cure the disease for which it is prescribed, if it do salivate.
Nor may electricity be expected to be so guided by sound pa-
thology in every application as to effect a cure, even in cases
which are not beyond the reach of all remedies ; many of which
are presented for the consideration of the practitioner. But
there are benefits derivable from the agency of electricity and of
galvanism which are less injurious, less unpleasant, and in very
many instances far more beneficial than can be drawn from the
materia medica.

Preparation of the Box, and the manner of using it on diferent

occasions.

Preparation On opening the box, rub the cake of sulphur
on a piece of white fiannel, which should be doubled several
times and fixed on a piece of board. Observe in rubbing the
cake, to turn it always in the same direction 150 or 200 times,
which will be found sufficient to animate it. In order to
ascertain if the cake is sufficiently animated, before closing
the box, bring it to one finger's length from the thread ap-
pended to the board. If it should attract the thread with
great force, you may then know that the cake is sufficiently ani-
mated. You may then close the box. Place the silk bag* with
care fully over the box, leaving the top of the box uncovered,
where the cake adheres. f It is this extremity of the cake that

*It should be remarked here, that the box is covered with two bags of
silk made to fit it ; one of which is kept between the fingers and the body
of the box for insulation, and the other in like manner for handling the cover
on re-applying it. Ed.

fit will be perceived that the box itself is here called the tap, for it is the
box itself in which the cake is fixed. It is also observable that in the above
directions, it is the bottom of the box to wiiich the electric is attached that
is directed to be applied; but such is not the usage witJi those who apply

1833.] ^ Medical Electricity. 17

must be placed on the most painful part, taking care tihat your
fingers do not touch the cake that is uncoveied ; ibr if, by acci-
denr, you do, it wilJ materiaijy afTjct the fluid.

Diuatioii of the apphcaliun. The appheation may be contin-
ued from twenty to thirty minutes^ and you should, belbre m.a-
king use of the box, see that tlie patient have taken nothing into
the stomach for an hour before ; but if so, wait about an hour
before you app'y it.

Jiemedics and JJing^ opposed to the effect. All remedies are
opposed to the good cfiec-t of the box,* es;jeciaily plasters. You
must ohicrve never to apply the box on any pajt which has been
greased; but if any grease or salve shall have been applied to
the part, be very particular to wash it otf ; as whilhout so ding,
no good can be derived from the treatment, and it would only
be apt to break the box.j You must also be very paiticular
not to a}ply any water to the place for sonie time alter ihe afi-
plication of the box. Tlie cake and the flannel sliouid be kept
very clean and dry. In datnp weather you may perceive that
the cake is very dilficult to animaie. ^ ou may then warm the
cake by holding it near llie fire, to facilitate the preparation.

Treatment of Pleurisy. Two boxes aie necessary for this
treatment, one on the pit of the stomach, and the other on the
side. At the snnie time, if you have but one box, apply it lo the
pit of the stomach fifteen minuics animate the cake about two
minutes after lor fifty seconds. You may tlien leave it for
twenty- five minutes.

Treatment (/fsic/: headache occurring in Pleurisy. If the pa-
tient have sick headache and you have two boxes, apply one to
the head above the pain, and the other on the side. J It you
have but one box, after having app ied it on the side, you may
place it on the head. At lirst, two applications will be neces-
sary in twenty-ibur hours ; but after the fiist two or three days,
one will suiiice. In all cases, the sooner the application is made,
the better it will be.

it here : it is the top. The author is not sufncicn'^ly clear liere on the sub-
ject of insuhation. Each part, both the cap and cover, must be insulated
by the silk one bag over each when put together ; after which, that is re-
moved which covers the top, and leaves it bare for application. Ed.

*We suppose the author means, topical remedies. Ed.

f V7e suppose the author only means to guard against a useless applica-
tion. Ed.

^Of course, the diseased side is meant by the author. Eo.

Jit appears Irom this direction and that for sick headache in malignant
fever, that, in case of there being but one box, it is a rule to apply it first to
the leading or original disease. Ed.

c 3

IB Medical Electricity/. [Oct,

Treatment of Malignant Fever. Apply the box to the pit of
(he stomach. After having held it there for ten nninutes, yoti
may slide it in the direction of the ribs until you come to the
side, where you may leave it fifteen minuies.* You must first
be very sure that the box is sufficiently heated. f If it were not,
after the first fifteen minutes, you may turn it thirty or fifty
times.

If the patient have a sick headache also, and you have two
boxes, you may place one at the same time on the mos^t painful
parts. If you have but one, after having made the application
on the stomach and on the liver, you may place it on the pain in
the head. In the commencement of the sickness, you may apply
the box twice in twenty-four hours. The fever generally changes
in three or four days; you may then npply the box ance a day,
as the fever declines. You should continue this treatment for
eight or ten days^ after the fever has left.

Intermittent Fever. This fever is treated by applying the
box on the pit of the stomach, where you arc to leave it ten or
fifteen minutes. Y'ou may then slide it the length of the false
ribs until you reach the liver, where you may leave it fifteen
minutes. It is much better to make use of this application on
the days of intermission ; how^ever, in case of necessity, you
may apply it on the day of the fever : but it should be used as
near as possible, before or after the fever, as otherwise it some-
times increases it.

Bilious Colic. Leave the box on the pit of the stomach for
ten minutes; you then let it slide slowly until you reach the
navel, where you leave it for five minutes. You may then
place it on the pit of the stomach again. You then slide it the
length of the side, until you reach the liver, where you Jeave it
ten minutes.

You must observe never to slide the box upwards, nor cross-
wise, but always downward, or place it immediately on the part
that is affected.

An effusion of troublesome Bile. The patient must lose no
time, when he feels a trouble of this kind, but apply the box on
the stomach and then on the liver Two or three applications
are sometimes sufficient for a cure.

In severe cold in the head. Place the box on the front of the
head until you reach the roots of the hair let it slide slowly
down to the nostril on both sides of the nose, alternately leaving
h for a minute on each side of the nose. Afier having applied
it ten or fifteen minutes in this manner, you may then slide it
from the length of the forehead until you reach the ear, leaving
it there for a minute or two.

*We presume that hypochondrium is meant, where the liver 13. Ed.
iThie evidently means, the electric is sufficiently excited. Ed.

163S.] Medical Electricity. !

iS'ephritic Colic. Place the box on the pit of the stomacfif
then s.'ide it to the navel, where leave it several minutes on the
most painful part.

Disorder of the stomach. Place the box on the most painful
part. When changing the box from place to place, observe
never to slide it upwards; it should always be passed downward.

Rlteumatic Fain. Place the box directly on the part affected.
If the pain is fixed you may slide the box downward, but if it is
not fixed, and the patient has sufTered for a great while with the
aforesaid pain, it will be necessary to make use of the box for
thirty to fifty minutes every day. For a cold, three or four
applications are generally sutiiciei:t.

Wet Nurses. Wet nurses who are subject to pain in the
breast, have found themselves entirely cured by means of this
application. In this case, this instrument should be used as early
as possible, in the manner above mentioned in other cases**

Sorti Throat. Application of the box, local.

Sore Eyes. For sore eyes, the box should be held lightly on
the eyelid, and often removed.

Blows. Bruises, <^c. Place the box on the bruise, or part
most painful, leaving it there for some time. Bleeding is not ne-
cessary in these cases ; but the application should be made as
soon as possible. 'I he danger of the disease stops after the
first application. Two applications are necessary during the
day. if there is danger of extravasation of blood, continue ttte
application for several days.

Treatment of Children. There is no danger in making use of
the box in the diseases of Children. So contrary is the fact, that
it affords them more sure relief.f There is however this difference
to be observed in the use of the box w^ith them, that it should not
be so much animated as for adults ; audit should be held lightly
on the part that is to be trented, about ten minutes.

General observations. The use of the box is admissible in all
the diseases to which the human body is subject ; the only pre-
requisite being to discover the part affected, in order to make
the application. The great merit of this remedy is in establish-
ing the regular course^of the humours ; and it is often the case

*This is a case in which, more than any other, we have had the pleasure
oi witnessing the salutary influence of the electrical box. For the last
twenty years we have been depended on for services by most of the French
families in this place ; amongst whom, and some of their immediate friends*
the electrical box has been in us?, and have known of its frequent applica-
tion ; but we do not recollect to have ever witnessed amongst them, a breast
which suppurated. Ed.

If have found this eminently the case in the use of galvanism. Ed.

20

Medical Electriaty.

[OcU

that these erronsoas directions of tiie humours are caused by too
much or too little perspiration, the patient must observe care in
shehering himself from cold or dampness, at least during the
treatment.

We have gieancd from the manuscript the following additional
particulars relative to the application to other cases.*

Tootiiaclie and Ivjlaminations. In these cases the electric
was rubbed about 200 times. The box was tlien shut and in-
sulated by the silk, except the top, and ^iven to the patient w^ho
held it on the painful part for tifteen minutes. The greatest
part of the cases of to.thache treated in this manner, were cured
in the quarter of an hour. In some cases, temporary relief only
was obtained the pain having afterwards returned, requiring
several re-applications.

J. I iter r up Lion, of the Courses. Women who suffer an interrup-
tion of the natural courses, have found great relief by passing
the box below the stomach. Jf their courses are still irregular
the treatment should be used in the most critical period,! and
should be continued at least three or four days. J

It is evident, from thfs manuscript, that the author w\is not a
physician ; bat that he was a man ofscicnce, for his day, and an
honest observer. It would be supposed further, that he was a
landlord with many tenants, and that these and his owm imme-
diate famil}^ were the ffrst and main subjects of his care ; and
that in consequence of his success with th.ese, others were after-
Wards induced to visit him from a distance.

]\ow, even with this view, .we should scarcely be inclined to
notice statements coming as these have, from an individual not
known in the profession, but for some knowledge of their truth
from observation, and their analogy to galvanic operations, of
which we have liad decided experience ; and in both of which
the great therapeutic fact is established, that the positive pole,
or inducting point, produces sedation, or what has in old surgery
heen called discntient effects, and the negative pole, or point of

*We find al?o on recing tlie French manuscript, the followinj: caption of
a diapter : "The Friend of Nature. Chap. vii. of Physic." And in pencil,
" By Sousselier, Lord of many manors." Ed.

f By this, we understand the author to mean, the time the menses should
flow. Ed.

|In giving tlie case of his son, aged sixteen, who labored under fever
and what he calls putrid looseness, the author dates the case Apr!!, 1783 "
This gives us some idea of the period of these experiences. Ed.

1638.] Medical Elcvir icily, 21

eduction, on the contrary, exalts Che excitement. But so valua-
ble is medical truth, especially such gs tends to the immediate
amelioration of the sufferings of humanity and disarming the
dangers of life, that we should not be afraid nor ashamed to
take it wherever we may find it. Every physician is aware
of the truth, that most of our valuable practical facts are from
the bold and reckless experiments of the unscientific whose ig-
norance has made tliem free to experiment where science would,
in humanity, have restrained the hand.

The intehigent reader will at once perceive tliat the apparatus,
the use of which is described in the extract we have given, is a
kind of economical electrophorus. The specimen before us
whilst we write, is a round, \\i\ box, precisely three and a half
inches long, including the cover, and two and a half wide. The
cover is so made as to fit well on the box, and is itself two and
seven-tenth inches- long. Tlie box is one and a half inch deep,
and is filled wnth a cake of sulphur which projects half an inch
above the upper part and terminates in a plane, polished surface.
We have seen some specimens in which there appeared to be
seme metallic oxyde combined with the sulphur, or the lattef
had been so burned in prepaiing it, that its color was materially
altered.

This cake of sulphur is an electric, and when the cover is at-
tached to the box, tlie electric stands in the cavity of the boXi
intactible.

In the preparation of the box, the two silk bags are used as
insulators; one for the box and the other for the cover ; but on
its application, the insulator is removed from the cover, whilst
the box which contains the electric, is held in msulation by hav^
ing the silk bag over the whole of the tin to where the cover comes.
Tlius, whatever charge may have been created by the friction^
is preserved from every conductor except the atmosphere within
the cover. The boai'd which is covered with flannel is about
nine inches wide, arid is of circular shape ; having appended to
its edge a light cotton thread about eight inches long.* This
thread is the electrometer, and the board covered witli flannel is
the exciter or rubber.

*Which should have a cork or pith-ball attached to Its extremity.

22 Medical Eiectricihj. [Oct

The instrument, or electrical box, might Le greatly improved
by substituting shellac, or amber; or perhaps iiard resin or
sealing wax, for sulphur.

Jt is a point on which there is some doubt, whether this appa-
ratus operates by communicating gradually to the part, a possi-
tive charge communicated to the box by the excited electric,
through the medium of the atmospheric air the box contains ; or
whether the box remains negative, and by its near approximation
to the positively charged electric, acts with power on the possitive
electricity of the diseased part, by attracting it into itself? To
the latter of these opinions, we are most inclined. This opinion
is favored by the duration of the power in the box when well
excited, or, in the language of the author, " animated." It is
also favored by the fact, that in none of the boxes is the electric
designed to be so large as to allow its excited edge to touch the
sides of the cover when placed on the box. It appears to us that
the polished surface of the end of the electric is the only point
charged, primarily at least, and that this surface is itselfproperly
insulated from the box by that part of the electric intervening
between its excited surface and the edge of the box in which it is
incased. But it may be otherwise. It may be the case that the
atmosphere within the cover conducts the sensible electricity
slowly to the cover: dry, atmospheric air, being a bad conduc-
tor. This idea is favored by the fact, that positive electricity
and positive galvanism inducted to a part, produce sedation in
that part.

Mode of action of the Electric Box, Of the physical power of
electricity, galvanism and magnetism on diseases of the human
body, there remains now no doubt whatever. No one can dis-
pute this fact who is satisfied with any fiict on human testimony;
and credence is not asked as an act of abstract faith, nor as the
mere suggestion of theory. And if not willing to receive other
human testimony than his own, it is his own fault if he do not
test the point, which when fairly done will afford him the testi-
mony of his own senses. We should have said there is a class
of men whom we may except. There are those, (and there are
many of them,) who are always ready to declare against even
demonstrated truth, merely because they do not understand
the rationale of that truth, or the laws whereby that truth is de-
veloped ; and such are surely the greatest impediments in the

*

1638.] Medical Electricity. 23

rurriculum of science. We do not intend by this to be under-
stood to mean that men of science should be so credulous as to
believe every thing that is told them, on partial or snperticial
observation. On the contrary, every man v/ho professes fealty
to science, should consider that on him rests the responsibility of
the guardianship of her treasury of pure and holy truth. He
should scrutinize well the facts alleged, ant! the authorit}', and
investigate well the train of antecedent phenomena which may
have existed in the line of causation. But every man of pro
found science has learned to know that in the immensity of the
wisdom with which nature has been wrought, there is often to
be found, when least expected by him. the displays of that infinite
wisdom to which he is a stranger. Every such man has also
learned, whilst he guards well the portals of science against the
ruthless entrance of error, to ply well those unalterable laws of
philosophising, which are stern enough to turn him against his
own vain and pre-conceived notions of the way to truth, and
place him in another, and to him a new one, adverse to all his
interests of pride, ambition and profit. When a fact is alleged
on good authority, such as would be received in other matters,
his philosophical investigation of the subject is at least demanded
before he can in honesty deny the allegation ; because he knows
there is no effect without competent and appropriate causation ;
and that fact therefore declares the existence of this. And he
knows that when an effect has been once produced by given
causation, that the whole of the same causation must invariably
be succeeded by the same results. It is therefore incumbent on
him (not to deny the fact, but) to demonstrate the error in the
premises, or the cause of it in the conclusion, before he has a
right to deny. The denial of a fact alleged on such testimony
as we have not reason otherwise to doubt, is a ground which no
man has a right to occupy, because no man has a right to sup-
pose there are not still in the arcanae of nature, truths many
truths which he has not in all his wisdom, yet understood. But
to return.

IS'eed we allege facts in support of the assertion just made,
relative to the truth of the physical agency of electricity, gal-
vanism and magnetism, on the human body, in health and
in disease ? The reader may prove for himself the power
of electricity by the translation of excitement from one sits

24 Medical Electricity. [Oct.

to another, by the proper application of the current of posi-
tive electricity from a point of increased action, whilst the
subject is insulated, and receiving it trorn another point. This
we have done in several forming abscesses, and even in a vene-
rial bubo wliilst there was the cause of the morbid excitement
still remaining uncorrected. In this case, the bubo, into wh!cli
the current from the prinie conductor was received, was resolv-
ed, and the point on the leg from which it was eductcd, (the
subject being on an insulating stool.) was vesicated, and the pa-
tient fainted. Ii may be exhibited stili more simply by the educ-
tion of electricity by acupuncture, from a large joint, fur inst ince>
suffering from acute rheumatism, as in the case related a few
years ago by Baron Dupuytren, Vv'ho, after introducing some
fifteen or sixteen needles into a rheumatic knee, and connecting
their outward extremities by a wire, obtained sensible sparks.
It is but fair, however, on giving this flict from Dupuytren, to
state that he took special care to say that the relief afibrded by
this operation was not attributable to the eduction of electricity.
But the Baron appears to have been one of those men who are
unwilling to admit the existence of the relation of cause and
effect between successive phenomena, however uniform the se-
quence, for no better reason than that they do not themselves
see how, or in what manner, this relationship is exercised. Doubt-
less Dupuytren had not the idea of accumulated electricity in
an inflamed joint, and that too, from the internal resources of the
system, in all his pathology of inflammation or of inflammatory
rheumatism ; consequently he could not risk so exalted an opin-
ion as his own on the point in question, a fact, abstracted from
known theory.

In the apphcation of the box, as above directed, there is but
one point at which the agent acts, and still resolution is gener-
ally the consequence of faithful and timely application. These
three cases illustrate the physical the therapeutical agency of
electricity, by induction, and by eductive, jointly and severally.

The same may be said of passing a steady current of electricity
into the body at the point of morbid action, without insulation.
In the former of these instances, it is clear that if the box receive a
charge from the charged or excited electric, it nnust receive it
gradually, and as gradually introduce it in the seat of excessive
action to which it is applied, producing there, its resolvent effects.

!8'^S.j Medical Electricity. 45

whilst the electricity is passed off again diffusively from all other
parts of the uninsulated surface: but if the near approximation
only tend to increase the negative power of the box, (as such
arrangements are wont to do,) this box becomes thereby a
more powerful attracter of the positive electricity superabound*-
ing in the diseased part, the eduction of which relieves the pairi ;
in which case, it must, according to a well-known law, lessen
the accumulated electricity in the part diseased, by attracting it
for that equalization to which all electricities tend ; and without
which tendency, primeval stillness must pervade all the kingdoms
of nature.

Of Galvanism the same may be said ; for its effects are hot
less, but even more conspicuous, because it is susceptible of
tnore steady application for a length of time. So signally is
the discutient power of galvanism displayed at the positive pole>
when the body is not insulated, and the charge is consequently
^ducted by the conductors in contact, or when the eductioit
is made purposely by insulation and application of an educting
conductor to a suitable point at some other place ; that whilst
the positive pole is in application to one denuded surface and the
negative to another, the former point will remain stationary Or
cicatrize, whilst the latter (the negative,) doubles the intensity
of the inflammation which the denuding blister left ; and in some
instances will sphacelate. This experiment may be made at
pleasure by any one not satisfied of the fact.

For nearly twenty years past, we have used this appllcatiortv
in cases of perpetual convulsions and epilepsy in chiildren, with
the best effects, as frequently witnessed by physicians and pu-
pils in this place. And so evident has been the power of gal-
vanism that, sometimes, when the plates were removed for
cleansing the sores, the convulsions which had been suspended
for many hours, or a day or two, have returned in the short
space of time occupied in this service ; and have again yielded
as promptly, to their re-application.

On the physical agency of magnetism in therapeutics, we need
only refer our readers to the prompt efficiency of the nrtagnet in
removing and restoring pain, as in tic douloureux, in some of
the London hospitals.

Whilst these facts of experiment and observation are found to
identify the natures of the (so called) three powers, with n<^
D 4

25 Medical Electricu'y. \OcU

other difference than that of habitude, they tend to the unequivo
cal estabhshment of this great therapeutic fact, that whatever
may he the true philosophy of ivf. animation, both the vitrious and
metallic electricities, {electricity and galvanism,) if we may plu-
ralise them, are available as amongst the most certain and pow'
erful revellants of excitement the therapeutist has at command.
These differ from other revellants, revulsives or translators ot
action in that the positive pole, exerts a positive diseutient or
resolvent effect on the morbid action of the part to which it is
applied, by a discutient power of that pole ; whilst the negative
when located or stationary, acts on the part by the same princi-
ple as other revulsives, as vescatories, rubefacients, (fee. in
drawing action to the point, (and fluxion succeeds irritation or
increased action,) to the detriment of the excess at the seat of
disease.

One box then may be said to act, in effect, as a discutient.
How the second box operates, we know not, unless it be con-
jointly, or simultaneously, or successively in the same manner
on another point of morbid action, having the negative pole un-
located, as to apparatus, but every point of conducting contact
becoming the negative pole ; for we cannot conceive that, when
both are similarly charged, (which is the direction) that they
can make efficient opposites. Moreover, when there are not
two boxes at hand, the same one is directed to be applied to dif-
ferent places, alternately.

Whether, however, the electric box acts by having its nega-
tive power increased by the charged electric, and thereby with-
draws with the greater attracting force the excess of electricity
from the seat of disease; or whether the induction of a current
of positive electricity simply repels the positive in the part, it is
unimportant in a therapeutical point of view. Let this be refer-
red to the domain of abstract science, when it may be easily
determined. Our business is at present with therapeutics. It is
well directed, and observed experiments alone which afford us
the truth in regard to therapeutic powers. It is from observa-
tion chiefly that our knowledge of materia medica is derivedy
and we are satisfied w^ith ihcfact of the power of any article or
means which we see uniformly and immediately succeeded by
another phenomenon, being the cause ofthat phenomenon. The
deduction of the true theory of causation is not more difficult,

iS38.] Medical EleciriciUj. ^^

because here too the facts as regularly succeed the previous
phenomena, in imnriediatc and regular succession.

Healthy and disordered function and condition make up the
sum of the phenomena of life, health and disease. Causes precede
snorbid action, whether of excess or default this morbid action
becomes again the cause of new phenomena, wliich again are
cause of others and so forth, to make up a chain of phenomena
consisting of successive cause and effect. Morbid action, whe-
ttier of excess or default, cannot be without cause, either active
or passive, or both. Tlie causes in such cases are morbid ac-
tion, or excess or defect of material physical power or powers,
of a nature disproportioned to the effect of physiological condi-
tion and function. So flir as action is concerned itself as cause,
electricity with its sedative and exciting powers seems to be
suitable to the end of changing that action, if it can be properly
manipulated : and so faa' as .material physical powers present in
tbe system may be concerned, action is the mean whereby alone
they are removable. "This removal is demanded absolutely
demanded by that law of philosophy and of nature, whereby
effects are perpetuated, so long as all their causes continue.
Here again, electricity, with the double r.nd opposite powers of
its two poles, seems adapted to good use in either excess or de-
fault of action, if it can be duly manipulated as a therapeutic
agent. And when we contemplate the fact, that the lightning of
heaven, with its wild and tremendous power, has been arrested
by man and made a plaything for babes, it does not seem a
hopeless purpose to look for the construction of apparatus where-
by electricity may be rendered extensively applicable to thera-
peutic purposes. Knowing well the fact of the differing powers
of the two poles, the positive and negative of electricity and of
galvanism, and the north and south of the magnet, we feel it a
duty to call the attention of the profession, whose great end is
tbe best service of humanity, to any approximation toward suc-
x;ess in obtaining the means of application.

We hope to embrace an early opportunity of again calling the
iO-ttention of the profession to this subject.

iS Leclures on Stramonium and Digitalis. [Oc*.

Part II. REVIEWS AXD EXTRACTS.

J^otice of Dr. G. G. Sigmoid's Lectures on Stiamoniujji and'
Digitalis ; as published in the London Lancet, and subse-
quently in the American Journal of the Medical Sciences.

We meet with few things in foreign or domestic journal&,
which possess an equal proportion of practical value with the
lectures of Dr. Sigmond on materia medica, which are in a course
of publication in the London Lancet. We notice the present
subjects from the last (August) number of the American Journal,
as they are of great and peculiar therapeutic interest.

On the use of' Stramonium in Neuralgia. Dr. Sigmond found.
;that in some of those neuralgic affections which occasionally
t>affled every expectation, and by which he was driven frora>
one remedy to another, stramonium sometimes answered the
desired end. He states that Dr. Begbie considered the narcotic
properties of this plant as decidedly superior, in some cases, to.
that of other medicines of that class, and he details instances in
illustration of its sedative effects. Dr. B. had perceived in no.
instance, any bad effect, except once an unpleasant nervoiis sen-
sation in the throat. Dr. Eiliotson, of St. Thomas Hospital,
had treated a neuralgic affection of very severe character, by
giving a grain of extract of stramonium an hour before the ac-
cession of the paroxism, which was intermittent. On the third
day the pain was mitigated and the dose increased one half.
The case was w^ell in ten or twelve days. In another case, it
was used in combination with mercury, and on the production of
ptyalism, the cure was effected. Dr. Sigmond speaks of the
consciousness, of not having yet precisely ascertained all the
points connected with neuralgia. We do not recollect to have
seen Dr. S.'s patiiology of neuralgia any where detailed ; bu^
from the expression just mentioned, we are inclined to the opin-
ion that the difficulties to which he alludes are in his pathology.
He is probably with the great current on this subject, in consid-
.^ring neuralgic affections, or rather, the spinal irritations frona
which they arise, primajy diseases ; than which there has pro-
bably not been a more troublesome error in pathology since the
day of Broussais' glory, w^hercofwe speak, although much of his
.error yet floats on the superfices of the profession, ns of a thing
which was. And, we would ask, must this error too, like his,
have its vain and injurious course around the world, and be
taught, and used, and be fashionable; inundatin;^ the medical
mind by its universality, and obscuring truth by its frothy ebul-
Jitions for ten or fifteen years, before physician? can subject

1858.] Lecturer on Strcwionuim and Digilalis. 20

themselves to the government of tlie wholesome htlle law of
nature which allows no efiect without competent causation ?
We do trust that men will consider will reason. \V^e do look
to those who had minds incapable of bowing to the injurious
dogmas and sophistries of Broussais, here too, to preserve their
intellectual dignity, and refuse to worship at the sh.rine of t/iis
error : for v/e are much inclined to think that Broussaisism is its
legitimate parent. And under this impression, we would wil-
lingly, il" we can do no better, make parlies, that some at least
may be saved from superficial reasoning, and its common con-
sequence injurious error -then we shall hope that a redeem-
ing spirit will soon again pervade the world and wrcsi human-
ity from so afflicting a thraldom.

We would not be so exclusive as to assert that jn^imaj^j/ irri-
tation of the spinal column cannot possibly occur ; no more than
we did that pnmaTy gastritis and interitis could not. These we
w^ell knew could and did occur : but when they did, we knew
them well by their characters as such, and not by the consequen-
ces in the progress of a fever toward, and its termination in
disorganization and death. But of the occurrence of that (pri-
nnary spinal irritation) we are not so sure ; for we have not yet
found the first case, except from pecuii'ar mechanical causes.
And when spinal irritation is in question, we must know its ex-
istence by its own symptoms, and not attribute to its supposed
existence, effects, or morbid phenomena, which may arise from
other causes, and in its stead. We cannot malie effects neural-
gic, unless they are so. \o error can be more fatal to correct
therapeutics, than to suppose, and be guided by that supposition,
that a cause of disease is of a kind, or in a place where it is
not. From the moment this is done, error begins ; and to say
the least of that error, time is lost, and the self-preserving resour-
ces of the system become at once the only rational hope; for the
practitioner is undertaking to guide his barque over the (would
we could say pathless) deep, without the helm of true reason.
In this case, it is true that, many times, the spinal irritation it-
self may be corrected to a greater or less extent, or even, in
some cases, permanently removed, with all its oicn consequen-
ces. But it is not unlike sweeping a house whilst the trash
continues to be supplied : or, in the latter case, stopping it fronv
passing into one room, whilst it flows freely and injuriously into
another. Here metastasis is effected, or the powers of nature
alone, eradicate the evil causation. We would not pretend io
say that cases of neuralgic affections do not occur ' which oc-
casionally baffle every expectation, and by which we are driven
from one remedy to another." But we are confident of our
justification in saying that much more rarlicalism is needed ir^
the profession especially in pathological investigations, and
^BfXore particularly still, in the ctiologiral department of this part

30 Lcclitres on Stramonium, and Digitalis. [Oct

of medical science. No diagnosis no prescription can be a
truly scientific one, which is not founded on thorough research
into the real origin of the morbid phenomena presented : for
even if it be the case, that the first causes have been fugitive
only leaving their efiects behind them, or have been removed by
nature or art, it is necessary that we should hnow it that we
should know that we have only to attend to the correction of
the remaining effects ; and not be induced to direct indications
to causes which no longer exist and operate. Had Dr. S.
taken a thorough view of the origin of his neuralgic affections.,
doubtless he would, in most of ihem, have found adequate cause
of the obstinacy ; and very possibly have discovered that, with-
out resorting^ to so danc^erous a drusr for internal administration

Cor*

as the ext. stramon., he might have relieved or cured most of
those cases by means comparatively trivial.

Ot" smoking stramonium, as a' remedy for asthma, Dr. Sig-
mond spates that the first legitimate introduction of datura stra-
monium, as a remedy for asthma and other pulmonary affections,
was by Dr. Sims, who strongly recommended smoking the
herb. And that in 1802, Gen. Gent, on his return from Jndia,
gave to that learned physician and accomplished botanist, a re-
medy w^hich was used in the east as a specific for relieving
paroxysms of asthma ; the preparation of which was as follows;
The roots of the wild parplc-tlow^ered thorivap]>Ie (the datura
ferox,) were cut into slips as soon as they w^ere gathered, and
exposed to the dry air, in the shade, until all moisture had com-
pletely evaporated. They were then beaten into fibres, very
much resembling in appearance dry hemp. This substance
was, when used, placed in the bulb of a pipe, either with or with^
out tobacco, according to the previous custom of the patient;
and then inhaled, after being kindled. This plan had received
the sanction of the highest medical authorities in India ; and Dr.
Anderson, then physician general at Madras, not only recom-
mended it, but is said to have had recourse to it himself Dr.
8ims administered it to the daughter of an eminent physician
who labored under phthisis pulmonalis, combined with asthma.,
as it appeared to him, from the frequency of the paroxysms of
difficult breathing not usual, at least in so early a stage of pure
phthisis. With the view of alleviating these distressing parox-
ysms, he recommended atrial of the datura, as given to him by
Gen. Gent. The relief obtained far exceeded his expectation,
and although the lady gradually sank under the incurable phthis-
is, yet she continued to experience, througrhout its progress,
even to the last, the greatest comfort from its use. He then
recommended it to Dr. Toulmin of Hackney, who had for several
years suffered frequent paroxysms of asthma. He was much
{benefitted by its use, and having exhausted all the stock given
him by Dr. Sims, he determined to supply it? place with the

1838. J Leclures on Stra/nuniuni and iJigUalis. SI

datura stramonium, which he found equally serviceable. Du-
ring the three tirst months, to April, 181 J, Dr. Bree saw eighty-
two patients who had smoked stramonium. Those of them
who had derived no permanent good effect, amouuted to fifty-
eight out of that number the remaining twenty-four had been
all of them more or less injured, and some of them destroyed by
the practice. Of fifty-eight, eleven certainly were not in a state
to try the remedy. Whether the others derived even temporary
benefit or not, we are not informed. Dr. Bree's observations
went to shew many ill consequences from its use, such as, epi-
lepsy, a rapid supervention of a variety of distressing symptoms,
6lc. But these results occurred in highly debilitated constitu-
tions, and in cases of organic changes in important viscera, and
where disease would under any circumstances, have rapidly
developed itself Gen. Gent, who introduced the remedy from
India, subsequently fell a victim to its deleterious powers. He
was found by Sir George Gibbs, a physician of high character
and talent, who was called to him at Bath, comatose, appeared
stunned, his recollection impaired, his head reclining on a sofa,
pulse scarcely perceptible even the carotid arteries had little
or no pulsation. On inquiry, it appeared that the gentleman had
smoked stramonium the previous evening, in consequence of his
having been afflicted with sliortness of breath. After various
treatment, under which he seemed to mend a little in several
respects, he expired suddenly on the fourth day, whilst sleeping,
or immediately after waking. He was of full habit, and had,
without any consultation with his medical adviser, smoked large-
ly of stramonium thi'ec or four times.

Dr. S. concludes the practice Avilh this article thus: In pure
spasmodic asthma, during the paroxysm, stramonium may be
smoked, when there is not the slightest tendency to apoplexy,
epilepsy or paralysis. When dyspnoea is present, or constant
difficulty of breathing, it is not to be recommended, nor when
the embarrassment is to be attributed to hydrothorax or to dis-
eased abdominal viscera. It is only to be pursued for a very
short time, and the intervals between inspiration should be long.
When the slightest giddiness comes on, it must be immediately
given up. The saliva should be swallowed. The patient should
if possible, avoid sleeping immediately after its use, and in pre-
ference, should take moderate exercise.

Treatment lohen poisonous effects supe? vene during the use of
Strainonium. Dr. Sigmond recommends the discontinuance of
its use wdien, during the smokmg of stramonium, incoherent
talking, flushed face, and alternation of vision supervene; nor
should it be persevered in, if relief be not very speedily obtain-
ed. The fumes of the more decided narcotic, opium, inspired
only once or twice, has as much influence as a ^rain of that drug.
Should stupor, delirium tremor, convulsions and coma occur, it

Lectures 07i Stramonium and Digitalis. [Oct;

will be found that afllislon of cold water on the head, or sprinkling
it well with water, slightly acidulated, will be the best step to be
taken for instantaneous relief; and then, the internal adnninis-
tration of different stimuli. One of the most striking means of
restoring the patient under such circumstances, if the apparatus
be at hand, is the injection of a lavement containing camphor ;
for no sooner is it introduced than it is found in the pulnrionary
transpiration, which you will immediately recognise by the
odour of the expired air. The quantity used must be very small,
for the stimulis to the system is very great. Ten grains of
camphor is as mucli as should be administered in this way lafgS
quantities being intoxicating and injurious.

iMode of action of Digitalis. Dr. Sigmond is of the opinion
that this article decreases the irritability of the constitution, di-
minishes the frequency of the action of the heart ; and that, hence
the circulation through the system becomes so slow as to allow
the kidneys much more time to take from the blood the watefy
portion which they secrete: for, says he, we have no reason to
believe that these organs are stimulated to any increased action
by the herb. Instead of diminishing action in one instance and
increasing it in another, Dr. S. attributes the apparently newly-
acquired energy of the kidneys, not to any new energy imparted
to them, but to their having a longer period allowed them to act
on the fluid which is detained in the renal vessels. Dr. S. thus
accounts for the apparently powerful stimu'ant eflect of this me-
dicine on the system in some instances. When, says he, from a
diseased state of the kidneys, the due separation of the fluid froiti
the blood does not occur, or when, from pulmonary disease, the
due transpiration does not take place, for the circulation is slow-
ly carried on at first ; but if no elimination fi'om the blood take
place, the whole frame is thrown into disorder and a febrile
state produced. Dr. S. finds that in the form of powder, it is
liable to produce considerable irritation of the stomach, and in-
fluences the brain so as to bring on a state resembling the ap-
proach of intoxication. Upon the generative system its power
is strongly marked, bringing on seminal secretion in the male*
and in the female, symptoms simi'ar to those experienced by fe-
males, premonitory of the approach of particular periods; All
these phenomena however, he attributes to the retardation of
the blood in the capillary system. Dr. Mossman in the yeat
1800, w^as the first who drew the conclusion, from its influence
on the minute arteries, and the diminution of vascular actiorl,
that it was strictly a sedative ; and he went so far as to state
that he could obviate pneumonic inflammation with as much cer-
tainty by it, as he could arrest an intermittent fever by means
of the bark of cinchona.

Of the use of Digitalis in Drops?/. Dr. Sigmond asserts that
there is no remedy to which, from its efTects upon the urinary

18SS.] Lectures dn Strdmonium and Digitalis. WS

excretion, the name of diuretic is given, which mora certainly,
speedily and effectu:Hy evacuates the hydropic fluid than this
herb. He proceeds: When it is tjiought riuht to employ it,
he on the guard. IMever continue it too long; and always be
wary in attempting to increase the dose. Jt is not a remedy to
be trifled with. It produces the most appalling effects where it
has been injudiciously prescribed, and has been the fertile source
of fatal sorrow to those who have indiscriminately recommended
it, and to those who have followed bad advice. With regard to its
use in dropsical efl'asions there is considered by him, as well as
by Dr. Lombard, a state of election which is necessary for its
safety and success. Where, says Dr. S., there is great general
strength and vigour, which has been unimpaired by the ravages
of disease, wh^n the muscular fibre is tense, the sk'n hard and
dry, if the individual be inclined to corpuienc!e, if the counten-
ance be at all indicative of determination to the lieud, rr veinous
relaxation, or if the habit of the bowels be slov/, and difficult to
be called into action, it will generally be found i o only useless,
but occasionally injurii>us. Dr. VVithering first drew the dis-
tinction of the cases of hydrt^pc effus'on in which digitalis would
be found unsuccessful, nnJ Dr. S. believes the truth of this dis
tinction is confirmed by the great majority of medical men who
have been in the habit of employing it.

On the other hand, the experience of the most acute and in-
telligent practitioners has satisfactorily demonstrated that there
are states in which it is pre-eminently efficacious. These are,
weak, delicate, irritable constitutions, where there may be pre-
sent much laxity of fibre, a thin, soft, smoothe pale skin, which,
in the anasarcous limb seems to be transparent ; where, upon
pressure on the skin, there appears to be no elasticity whatever,
but the impression sinks deeply, and there is no evident power of
resistance, where the emaciation of the other parts of the body
is very striking, when the countenance is very pale, when there
is feeble or intermitting pulse, when the constitution lias been
much broken dow^n, more particularly if itwereorig'nally strong,
sound and DOust, where anv indulgence in spirituous liquors,
bad habits of life, the action of mercury, or any debilitating cause
has produced the mischif^f; in such cases digitalis will be indica-
ted in preference to most diuretics.* It should be remembered,
however, that it is merely the evacuation of the hydropic fluid
which is effect3d, and that this is not more than one step in the
cure of the disease, more particularly if that disease be connected
with a disordered slate ot the vist era. or if it be attended with
paralysis. It will, however, do that, which is sometimes of as
much importance as any object we can have in view ; it will

This is corroborated by Dr. Hooker's use of this article in delirium
rmen.

K S

34 Lectures on Stramonium and Diiiilalis. [Oct,

alleviate the distressing symptoms, and gain time, dr.ring which
the system may be enabled to rally and ihen sustain the impres-
sion of well directed, en( rgeiic remedies.

Tlie di.^re'^irj of tli3 distinciiun ol'the ditTerent s'ates in which
it is delete; i>us or bcnefi^:"a!, his (r]ven lise to many co.itradic-
tory stalements of" \\s dinielic efli-fts. By atri-niirn to these,
which an.' of Vital imp )itanc(?. i s ihen jndiciou.s uso cannot in
the opin-on iS Dr. ISiginond, fu.l to i^lljid rcWci' when it is ju-
diciously emplf)yed.

CasRn in which. Digitalis may, nr may not he employ er^. In
hydrothorax from any obstacle lo circ^l itirn, as liVperilir. phy
of the heart, when it is ihe termination of jonir protracted disi-ase
of the thorax, if it ho not ac^cnmpnnied by disordered condition
of the valves of the heart. Digiiaiis may be empioyc^d.

In ascites and in anasarca, c'cpendent on disordered states of
the exhalent vessels, which throw out a lager quantity of fluid
than can be absorbed, good rffrct is produced by diminishing
the impulse with which the blood is directed to the rapillaries;
and that fluid is presented to the kidneys for a greater length nf
time, whereby the kidneys are enabled to secrete much m< re
than they could otherwise. It may be the case, that Dr Sig-
mond has settled the digitalis practice thus, more fi'om his theo-
ry of its modus nperawli, than from actual ob.-e:vation in parti-
cular cases. Jn the use of an article of so much power
d*anirerous power, as digitalis the practitioner should look to
this with great cai*e.

Jn ovarian di'opsy, digitalis is seldom found to succeed.

In hydrocephalus in infancy, it is highly noxious. Many
practitioners prefer lowering the acrtion of the system, when ne-
Cf^ssary, before the use of digitalis, by ample depletion. Dr. S.
i\\\uks other diuretics will be more serviceable ; and urgps it as
a matter of deep imporiance, to avoid, if possible, the junction
of these two means of cure. It is true, he says, that after vene-
section, digitalis is more diuretic ; but he adds, that the most fatal
effects have occurred fi'om giving the ht^b after blood-letting
had been pi'actised. This pmnt is strongly urged, if our memo-
ry serve us, by Dr. Lombard, of Geneva, for whose observa-
tions on this subject, see a former number of this Journal. In
the following injunction, Di's. Sigmond. l^aylden and Lombard
agree : During the action of digitalis for the cure of dropsy, the
recumbent position is preferable, for it is observed, on experi-
ment, that it decreases the action of the heart most, when the
individual is lying down. Dr. Biilden, who repeated the expe-
riment several times on himself, found that after digitalis had
taken its efl^ect, as long as he s'ood erect, his pulse, which was
more than one hundred, was not diminished in frequency ; when
he sat down, it was reduced to seventy-five ; but when he lay
upon his back, it became as low even as forty. He observed
the same effects in all to whom he saw cause to administer it^

183S,] Lectures on Stramonium and Digitalis. 9d

. f .

Nausea, languor, uneasiness, or general irritability, commonly
arises under ihe use of diif talis, and seem to so accompany or
CDMtribute to its good etil-cts, that it is deeined improper, and
impiiring to its diureiic properties, to cunntcract these by the
combiiiation of aromatics, &c.

Dalelerioas effects of Digilaha. These, Dr. Sigmond in-
forms us are, first, primary; and are evidences of disturbance of
the aliinentaiy cara!, tl cy are niusea, vomiiing, purging, exces-
sive depression of spijits, fainting. When the poisonous ef-
fects are produced alter the symptoms of disturbance of the ali-
mentary canal, these cause a vertigo, drowsiness, and frequent
faintings the skin becomes bedewed with a cold sweat, tongue
and lips swell, profuse salivation occurs sometimes the action
of the kidneys is totally suspended, at others, it is increased, with
frequent desire to exp .'1 the urine ; or at others, inability to re-
tain It is felt. The pul>e intermits and is slow, and delirium,
hiccough, cold sweats, confused vision ; sometimes convulsions,
and frequent faint inus follow, till death closes the scene.

There is a point, says Dr. S., at which we can no longer ad-
minister digitalis. This h's been ascribed to its accumulation
in the stomach ; but Dr. S. thinks it is rather dependent upon
the very low tone to which the vascular and muscular systems
have been lowered ; for neither by vomiting, nor purging has
digitalis been thrown off. The same results occur after the en-
dermic use of this aiticle. It is generally at about the eighth
do5e, says Dr. S., that the baneful influence of this herb is visi-
ble; and this often happens, whether the dose has been large or
small whether diminishf'd or increased ; whether it has been
given twice or thrice; in the course of the day. This fact seems
to uige the great necessity of caution in its use. Dr?. Sigmond,
Hallor m, Hamilton and others, consider digitalis as a narcotic ;
first stimulating, and afterwards, as a sedative.

Use of Digitalis is Phthisis. Dr. Sigmond ranks digitalis as
a curative agent in this disease, only in the early stages; but
says it may, in its latter moments be important as a palliative.
The high character in the treatment of phthisis, which this article
has obtained, has arisen out of its use in the early stages, before
the breaking down of tubercles in the lungs ; for, says Dr. S.. ac-
cording to observation of a 1 the cases found in our periodical
literature, the opinions of the most enlightened men of our pro-
fession, and the quantity of experience his own practice has af-
forded, he is convinced of this fact a fact whicli every honest
maa is ready to end use, thai irhen. actufl (fiso/iranizf/fion h<is
occurred^ no remp.di/ that v^e have as yet discovered,, will lead to
the eradication of the dis'ase. This I'act attaches peculiar im-
portance to a familiarity with the premonitory symptoms of tu-
bercular phthisis, as then, we may ward off the threatening dan-
ger. The golden ma.xim, " venienti occurrite morbo" Dr. S.

tfi Lectures on Stramonium and Digitalis. [Oct,

considers is no where so rigidly to be enforced, as when suspi-
cion is excited that the system is predisposed to this melancholy
disease; not only because it is the only lime for the hope of vic-
tory over it, but because it selects tie most interesting subjects
for its victims ; and at a period when our sympathy is most ex-
cited in their f tvor. ^-There ar.> some," says Dr. JS. who "lay the
flattering unction to tfieir souls," that they liave cured the tiuc
peM^7^e pulmonic phih's's. where tub r-:l( s hive been fufly deve-
Toped, their structure broken down, and they have poured forth
purulent discharge/' He assures us, such have been deceived.
To the truth of this we can testify, and have only been brought
to a correct diagnosis by the recoven/ of our patients under the
use of prussic acid and of digitalis ; for the fact of recovery
is sufficient to correct the error of diagnosis with any prac-
titioner who will contemplate the functions of the* lungs, in
health, and their real condition in /?'we, genuine tubtrcular
phthisis. Here, Dr. Sigmond, lays down the proper grounds
for diagnosis, between those cases so calculated to deceive
the practitioner, and genuine pluhis's in its early stage: There
are instances, says he, nor are they very uncommon, v/here
even fever, attended with copious expectoration of viscid mu-
cus, (and we will add genuine pus,*) bias worn the fatal ap-
pearance, and when it lias been stated that the individual is in a
rapid cons u?r}pt ion one of those false terms which mislead.
Hectic fever has been present, attended with morning and even-
ing exacerbations, night sweats and wheezing cough. Clilorisls
has likewise borne a somewhat similar appearance ; there may be
a harrassing cough, pain in the side or chest, rigors, succeeded
by great heat, and not unfrequently, night sweats. These
states have yielded to appropriate treatment, whilst the medical
man has believed they were consumptive cases.

But in the coming on of consumption. Dr. S. says, there is
one great, and never-to-be mistJiken sympt( m. the state of the
pulse, which too often escapes observation ; but reveals more
than does the cough, the loss of strength, the emaciation of the
body. This he looks on as the pathognomic symptom which is
peculiar to pulmonnry affections. He is surprised that it is so
often unheeded, and that many of the bet writers merely men-
tion its quickness ; and that writers who may in future be rank-
ed among the clussic medicnl authorities, devote so little atten-
tion to a diajrnostic of so much value. One, thnt to his mind is
of not less importance than the signs afforded by auscultation or
by percussion. That there are many shades of distinction in
pulsation which can be perceived by but few, Dr. S. readily ad-
mits, but he thinks that the principal obstacle we have to en-

* But this has been from a common plUegmon, terminating in abscess
ind Bot from tubercles.

16SS.] Lectures on StrammiiiLiT^ and Di^italit. 37

connler is the conveying to oihers the sensations excited in our
owu minds.

The indication of consumptive tendency, by the poise, is much
more easiiiy re< og'^is^^d l!an it is cxj.ldintd lo unutijer ; a i'emark
which hti has occasionally hc;ird Ijom other experienced physi-
cians. He thinks that the peculiar rapidity, of the circulation
exlubited in the pulse, indicates an extraordinary state of irrita-
bility of the living tib^e not that vviiicii is attendant upon lever,
having neitiie*' the strength, nor the hardness of the indammato-
ry ; nor the weakness nur smallness Wiiicli belongs to low fever;
in i>oth of which cases, there may be increased celerity of the
pulse. There is tension, but it is not the whijjcordfe- /of inflam-
mation there is a vibration, but it is essentially distinct from
that which betokens, disease of the heart ; it is extraordinarily
dependant upon mental emotion, and its rapidity is excited by
moral causes in a most surprising and unaccountable manner.

Here is plainly set forth Dr. fSigmond's early diagnosis by the
pulse; experiencj of tact must make up the deficiencies of his
verbal description. There is no slate of incipient consumption,
says Dr. S., in wliich digitalis, properly administered, is of such
infinite importance as when this disease first arrests our suspi-
cion, as being likely to occur in the young female, in whom, at
the age of puberty, nntuie exerts hsrseH'with unerring precision,
for the developerneiit of that Svstem upon which the increase of
our species depends. These efforts of nature are almost invari-
ably successful, and the greater number of females are, after a
short interva , prepared to lulhl the destiny for whi"h, as a sex,
they were ordained. It is at this moment, however fair m^ay be
the external form, that that form is most fragile. jAothino^ can
be more exquisite in nature's uorks, than that which she has
taught us niost to adtnire and esteem a w^omnn, in the full
possession of her bodily attraction and her mental charms.*

Thus indeed is the young female presented to us in the plen-
itude of her peculiar chirms, marked by the cessation of deve-
lopments in some pans of their continuance in others ; but these
again, in turn, having accomphshed the wise and beautiful out-
line enstamped on the seK by creative wisdom, must cease. But
Q. surplnssage. w\se\y su])p\\er\ for the development and susten-
ance of the offspring, still arises, and woman must menstruate
for about thirty yeais of her life, wlien this is not vicariously
answered ; or change, as Cuvier says, from that perfection
which renders her at once, a being the most enchanting, to a

*Here Dr. S. refprs to his revered prece[)tor Dr. Gregory, who in his
" Conspectus Medicin:c Theoreiicr,'' he say^ has given, in classic language,
which Cicero or Tacitus would have -idraired, probably one of the most
enchautinsr dehneations that ever was drawn, ot thie charm of female perfec-
lions. We think it fully equalled by one of pretty sim'lar import by Cuvier.

3^ l.<.tutS on Stramonium and Digitalis, [Oct

loalhsoine, putrid mass, and undergoing chemical changes, be-
come assimilated wiiii the diist of the earth. It is indeed a law
of hernature, tiiat she must menslruatc iVum pul)erfy to forty-
five or lifiy, unless breeding oi lac(aii;ig ; nr suffer the rava!T:es
of most dislress.ng or dcs'ractive d sj:isj : and the reason oflicr
peculiar liability to certain d'sea^cs, is that this surplnssage,
wisely provided in the proportions of her economy for ihj per-
petuation of the Fpecies becomes, wlien disposed of otherwise in
the system, an extraneous, exciting and injurious non-natural a
proper cause of moi bid changes and phenomena. >he is, thus
in her perfections, in the full exhubei-ance of susceptibilities
ready for the strong excitements of suitable means. J^very
thing, as Dr. 8. states, proves that her circulation is in a state
of easy accelleration. In an instant ihr. heart quickens wiih an
unnatural throb, the cheek is suffused with the crimson blush of
modesty, the whole iace flushed, the mind, like the body, in an
electric state, every chord is tremblingly alive to the touch its
tension irresistibly strong ; every vibr.ition is conveyed along
tlie whole frame, the pulse quickly shews the mental emotion ;
the eyes radiate the light of love, or sparkle with the illumination
of genius, or beam with the fondest and truest afiection*

*l)r. S. has indsod adopted ths ideas, and almost the identical words of
Cuvier, in this description.

The following are Cuvirr's words :

"Examinons, par example, lo corps d'une frmme dans I'etat de jeuncFse
et de sante : ces formes arroiulies et voluptiieuses, cette souplesse gracieuse
de mouvemenp, cette douce clialeur, ces jou''s teintes desro^es de lavohipte,
ces yeux bn.l ens de I'^tincelh' de I'amour on de feu du gin e; cet (^,j1 ysion-
omie tgnyte par ics saillies de .'c'^prit, ou aniniee par le feu des passions ;
tout semble se rcunir pour en taire un etre enchanteur. Un instant suffit
yiour detruire ces prestige : souvent sans ancune cause apparente le mouve-
ment et le sentiment \i niient a. cesser; le corps perd sa chaleur ; les mus-
cles s'affaissent ellaissent paraitre les saillies angileuses des o> ; les yeux
deviennent terneF, les joues et les levres livides. Ce no sont la que les pre-
ludes de changeniens plus horribles : les chairs passent au bleu, an verd, au
noir ; elles attirent rhnmidite ; et pendant qu'une portion s'tvapore en t ma-
nations infectes, une autre s'ecou e en une sanii putride, qui ne tarc'e pas k
se dissiper aussi : en un mo% au bout d'un petit nombre de jours, il ne reste
plus que quelques priiirip?s terreux ou salins ; les autres cUmens se sont
disperls dans les airs et dans les oaux pour en'rer dans de nouvelles com-
bina: i >ns." Le(;ons (T Anatomie Com^avce, de G. Cuvirr. Turn. 1. re. p. 2.

The following is a liberal trinslation of the above paragraph :

" Let us examinf', for example, the person of a female in the state ofyouth
and htJalth, that form round an;1 dehij^^tful. that graceful supplenes> ofmove.
ment, that genial warm'h, those cheekslinted with the roses of } Jeasure,
those brdliant eyes sparkling with love or the fire of geniup, that expression
enlivened by sallies of wit, ur animated by the tire of the passions ; all seem
to unite to render her an enchanting being. An instant suffices to destroy
the fond illus on: often, without apparent cause, motion and feeling cease ;
thebody loses its genial warmth, the muscles shrink, leaving the bones to
appear in angular projections ; the eyes lose their lustre, the cheeks and

1838.] Lectures mi Slrarnontum and Digilahs, fit

\heve is gcnt'c warmth, nnJ ail that can bclokcn the highest
hcahh, gives h>p3 and expectation of j'y and lile. There is
nnvv a great determination to tlie thorax, but mere pai'ticulai-ly,
exicrnully. to the glands which are d-. siined ior the future secre-
tion of nutrition i'ov the Hsjirin^S tfiey are fully cliarged with
blood fr.)!n wliich the milky (lud is to be secreted.* Expo-
sure to col. I is at once, says Dr. S. suificient to determine ihc
blofd to the internal membranes I. encu are young women pe-
culiarly sul)j( ct, from dress and other exposure, to inf animation
of the thoraiic contents; but ihesj inflammations yield to exter-
nal couiiter-ii-ritanis, such as blisters, more easily than they do
in men. 'J'heso frequent light colds, call into action any predis-
position to disease ol tl'.e lungs which may exist; and where, at
Jir^il, the membranes only were diseased, the lungs becom.e solid,
ulcerated, or clianjed in their structure.

There is so much go:">d sense, and so close and legitimate a

connexion of cause and cffjct, and all so true, in the following

^ observativ.ns of Dr. Siirmond, leadin:.^ to the use of digitalis in

these cases, that we feel bound lo extract his own words, which

perhaps, we had better commenced ear'icr.

Kvei'y thing tend?, at this eventful inninen'^ of life, to increase the circu-
latio.i ; yd tjiere feerns a wor.derliil adapta'ion of" means to rarry it, on
without e idmgpring the funcMons of tije vaino;is organs; congestions do
not occur, but the tendency is to fill everv rninu'e capillary vessse', which
again q-iickly unloac's itself. It is not only the ar'enal system that is thus
replete, but the venous system partakes of the fulness : you observe the
white coat of the eye sometimes exiiibit a most beautiful hue, there is an ex-
q lisite tint of blue which gives to the peary memhrare a sliade that has
somethmg of heaven in it, snm3ihing so snpernatura], that Byron's ]me,
" that eye was in itself a soul," appears not only poetic but descriptive;
this deoends upon the m'nutest venous chnnnels of this coat being charged
with the blue-color^'d blood which circulates in the venous system. At no
Cher period of life is this visible. Sometmaes the heart labors with the
fluid that is transmitted through it, the slightest exertion produces palpita-
tion, and you will find young females constanMy liable to this state, which
has been mistaken for organx disease. Indeed, I myself have known in-
stances wh^re the adroit stethescopist has pronounced an affection of the
heart wliere there was only this state peculiar lo the age and sex. You

lips become livid. These are but the prelude to changes more horrible.
The fljsh passes to blue, gre-^^n, black It attracts humidity ; and whilst
one portion exhales in infectious emanation.^-, another runs into putrid sanies
which soon also is dissipated. Finally, after a few days, there remains no-
thing but a few earthy and saline principles ; the other elements are dissi=
pared in the air and water, to enter into new combinations."

* In this state of things, who is so blind as not to see at first glance, the
dinger of that compression of these organs, which modern fashionable dres=
sing is calculated to afford who does not see that blood determined to
these parts for their proper developement must, if repelled by compression,
work injurious effects in other parts already developed to the fullness of
their purposes ; and peculiarly the lungs.

40 Lectures on Stramonium and Digitalis, [Oct.

will hear it often remarked, that females hive lived for years after it has
been formal]}' announcd that there is organic alteration of tliis great cen-
tre of life, {n such ca^es small quantities of the tincture of digitalis only
occasionally exhibited, heginning with five dr(pF, will act most beneficially,
and, if combined with an equal quantity of tincture of opium, wil), in those
higii states of nervous excitement to which young ladies are sometimes
subject, prove much more useful than the arom;it:c spirits of ammonia, tl e
f aiiplicr, the hartshorn, which momentarily stimulate. This is a ufceltl
combination on very particular and urgent occjisions, but it is by no means
to be frequently had recourse to; it is only when necessity demands it that
digitalis is to be used. In consequence of the acce.'l ration through the
lungs, the minutest vessel becomes full of blood ; ench capillary is surcharg-
ed ; not only the pulmonary vessels are in this state, but tlie invesMrg pleu-
ra is absolutely injected with fluid ; still there is not inflammati >n unless
some exciting cause occurs ; if cold constricts the extreme ends of the ves-
sels, this takes place, and the thoughtless imprudence of youth too often ex-
poses the delicate system to the dangers that are consequent upon it. A
cold, variable climate should at this time be avoided, and the diet must not
be too stimulating; every thing that can Cirry off the accumulated irr'tabi.
lily of the system must be adramistered. It is to be remembered, that in the
majority of cases phthisis does not occur, as many writers (very judicious
on other points,) have stated, when puberty arrives, and the system is to be
placed in its new state, hut it is after that time, for nature is generally suc-
cessful in the accomplishment of the change, however much it may be retar-
ded, and if she be no% the disease that is proluced is not wasting of the
lungs, but of the body generally. In the state to which I have drawn your
attention, there has been demanded another channel to carry off the nutri-
tion in which some precocious individuals is prepared at a very early period,
and all their functions are carried on with a vigor which is too great for
their feeble habits. Should the proper circumstunces not arise, and con-
sumption not occur, various other morbid conditions quickly present them-
selves.

The uterine system first betrays the constitutional disturbance, by head-
ache, pain in the loins and back, heat of skin, quick hnrd pulse, sometimes
great tenderness of the abdomen, vvhich would almost indicate thenecessi'y
of abstraction of blood, but for which the tincture ofdigitalis, combined with
opium or with tincture of iron, according to circumstances, will be most effi-
cacious. Medical interference, in all these cases, must be most carefully
limited, for upon judgment must depend the future hippiness of some (f ihe
most interesting subjects of our skill. How often do we see disorders of
that period yield spontaneously. In some cases you will find young females
at this eventful period of their existence, complain of the mosi sevf r3 Fufl>^r-
ingin the very lower region of the back ; this is mistaken, probably, for d's-
ease of the spine; the unforiunate victim is sometimes cimdemned for months
to a reclining posture ; is tortured in every way that honest but m s'akrn
zeal and ingenuity can suggest ; and, to use the favorite expression, "every
thing has been tried," when probably', to the astonishment of the uninitiated,
some emotion of the mind kindles a new tram of thought ; she awakfF, as
from a slumber and from a dream of harrassmenf, and in the figurative but
descriptive language of the east, "She takes up her bed and walks." As
the young lady has probably had the advice of " all the first men in London,"
who, knowing the real state and cause, have not been able to effect a cure,
but, most probably, have told, in as delicate a manner as possible, the truth,
she has had, as her last doctor, some shrewd, bold man, well acquainted
with the world, who has, whilst his pockets have been lined with feer, led
on her friends, by exciting their hopes, and making their creduhty subservi-
ent to his views. The case is related as a wonder, and the natural resuU
proclaimed to be a great cure performed by a marvellous learned man. It

1838.] Leclures on Stramonium and Digitalis. 41

is the frequent result of our present state of society, that many females must
be disappointed, and incapable of fulfilling the general destiny, and that to
some it must be pregnant with mischief ; it is for you, as philosophers and
consolers of the human race, to obviate, as far as you can, the unavoidable
sorrow that may grow out of it to individuals. We cannot, from any un-
fortunate examples, conclude that our moral system is bad ; I believe it to
be the best for our social condition ; for "when the women are chaste the
men will be brave."

I would have you, whenever the care of families is committed to you, re-
gard each member of it as your personal friend, and though you may be lia-
ble to the caprices of individuals, you will eventually gain esteem and regard.
I think you should look with parental- solicitude to your youthful patients at
the time of which I have spoken ; remember there is a general susceptibility
to extraordinary vascular action, but not to inflammation ; there is an un-
wonted but not altogether unnatural condition of the blood-vessels, which
is necessary for the performance of peculiar functions. You may arrest un-
due action "by digitalis, administered occasionally in the form of tincture, but
it is not to be persevered in, and long intervals are to be allowed to pass be-
tween each period of prescribing it. When the duration of what was sup-
posed to be a slight cold is longer than ordinary, when the cough appears to
oe aggravated on going to bed, when the pulse is at different times in the
day more than usual quick, when a sliglit difficulty of breathing is percepti-
ble in a horizontal position, when the heart beats violently on going up or
down stairs, and we observe the individual to be of a delicate habit, and un-
der twenty years of age, we must watch with great tenderness and anxiety,
lest symytoms of a more aggravated character supervene, nor is it then too
early to give from ten to fifteen drops of the tincture of digitalis, three times
a day for three successive days, and then to wait, or gradually to diminish
the dose ; if there be chlororic symptoms in the female, for they not unfre-
quently are developed at the same time, the tincture of the muriate of iron,
now called tinctura ferri sesqui chloridi, may be administered, or the mistura
ferri composita ; these preparations will have their efficacy much improved
by the digitalis, and their doses should be smaller in proportion. Indeed,
the tincture of iron is more serviceable in small doses largely diluted in water,
than in large doses in a small quantity of fluid; this rule holds good in many
of the salts, which have their powers very much increased by their being
held in solution in much larger quantities of fluid than in this country we
are in the habit of prescribing.

Digitalis should often be discontinued, sometimes at once, at others by
degrees, and then again had recourse to ; but even the very gradual increase
of the dose is most cautiously to be watched : if giddiness, pain in the head,
throbbing at the forehead, or in the orbits ; if there be unwonted vision,
such as ocular spectra, a cloud interposing between objects usually clear ;
if small spots appear to be waving in the air, if nausea be present, it must
immediately be abandoned, and . may again be tried ; but if your patient
complains " of a faintness or sickness at the stomach as if their hfe was go-
ing from them," an expression which, even at the time of Dr. Maclean, was
observed to be the most striking effect, when an individual is under its full
influence, and almost all complain of it nearly in the same way, you must
give up the remedy. On some individuals it acts as a soporific ; it disturbs
the intellectual faculties, and scarcely any person whilst under its influence,
is capable of going through the ordinary routine of occupation. Some sto-
machs are very much ahve to it, and twenty drops will produce nausea, a
larger quantity will cause an inclination to syncope, and this is sometimes
one of its most distressing effects, the swooning continuing long, and being
often repeated, the languor too is very overpowering, whilst cold clammy
sweats burst forth.

p 6

4li On Ophthalmia in Genera/. [Oc^

The urinary secretion often exhibits some very striking changes under
the administration of digitalis. V/hen it has been very high colored, has
had a thick deposit, and has been scanty in quantity, it has obtained a more
natural colour and consistency, and has been increased in quantity. Some
men, bolder than others, have continued its use, even when vomiting has
taken place, and they think that the viscid mucus that has been thrown up,
has reheved the chest, but surely under such an impression the milder emet-
ics should be preferred. The effect upon the appetite in the intervals of nau-
sea is sometimes very remarkable ; the desire and, craving for food, when
thei'e was previously distaste, are very striking.

The circumstance to which your attention is more particularly to be di-
rected, is the agency of the remedy upon the pulse. You will most generally
find two results, either a marked reduction in its frequency, or, on the other
hand, an extreme irregularity. Instead of a quick, irritable pulse, betoken-
ing the state of excitement of the Vascular system, there will speedily be
produced a slow, steady, uniform pulsation, occasionally it will seem to be
fuller than before, but the slightest bodily movement will counteract its infiu-
ence, and, in most instances, very little exercise will accelerate it. If it fall
below the standard of fifty beats in the minute, you will most generally find
that the head and the stomach exhibit some signs of distress, but this is much
more observable in phthisis than in drops}'-, in which latter disease the exci-
tability of the whole system is very much less. If irregularity of pulse be
the sequela, it is marked by a few pulsations being performed with exceeding
rapidity, and then a return to the previous condition and rhythm ; but, occa-
sionally, a complete stroke is intermitted. In asthmatic affections, in dysp-
noea, it is very serviceable, whether they be dependant upon chronic or
active affections of the lungs ; but it will not control or cure the disease effec
tually, and, in most states of disease in those organs, it will alleviate the most
formidable symptoms, and aid in prolonging life, and in rendering the last
hours of Hfe more endurable.

Use of Digitalis in the affectiorts of tlie Ulerlne System, ioMcli iislier in and
accompany Phthisis. Dr. Sigmond considers digitalis highly useful in these
affections, and, indeed, its influence upon the periodical evacuation, renders
it a most valuable emmenagogue when properly employed, namely, in those
states which are marked by acceleration of the pulse, and a morbid tension
of the vascular system. It is observed, that most of the young females who
go out to India, although they have been remarkably healthy with respect to
the periodic evacuation, rarely, if ever, perform that function more than
once during the whole of the voyage, however long it may be protracted ;
and ci their arrival they generally have to encounter a train of morbid sen-
sations consequent upon the effort of nature to resume her wonted condition.
Most of the symptoms would be considered inflammatory; but it is merely
constitutional excitement, the result of the disturbance the system has un-
dergone, and the energies which the vis medicatrix naturae is exerting to re-
cover her lost balance. In such a state, digitalis is to be employed. If
undue bleeding take place, it only protracts, to a very late period, the re-
establishment ot the menstruation, and there is a severe struggle, marked
by a morbid condition of the membrane lining the uterus ; and'there is some-
times formed a false, or adventitious membrane, which is with great difficulty
detached and dislodged, occasioning very considerable pain ; besides which,
so long as it remains within the womb, it forms a mechanical obstruction,-
irritating its vessels and its mouth. This membrane is large enough to cover
the top of the finger, and corresponds in shape with the fundus uteri.

On the Treatment of Ophthalmia ingenernl We shall at present endea-
vor to establish some therapeutic laws which may find their application in-
the greater pnrt of thc^e disease.?.

IS'SS.] On Ophihahnla in General. 4S

The treatment of ophthalmia is that of inflammation in general ; being
subject to variations according to the seat, the degree, the character of the
inflammation, its tendency tu a certain termination, and the causes which
may give rise to it.

Among the causes there are some Vv hich it is necessary to remove before
directly attacking the inflammation, and there are others which may be at-
tacked u'irh success only at the decline and sometimes during the convales-
cence from the ophthalmia.

Among the tirst, are foreign bodies wliichhave fallen between the eyelids,
whether moveable between these and the anterior surface of the globe, or
tixed in the external membranes ;; which should be immediately removed.
It may happen that the eyelashes are turned towards the gJobe of the eye,
and then it is indispensable that they should be either rectihed or extracted.
When there is only an accidental inversion, as sometimes takes place from
rubbing the lids, they shoud be replaced. But it is necessary that they
should be extracted if their deviation is the result of a disease of the border
of the eyelids, as is the case in trichiasis.

We may refer to the first of these classes of cr;uses, the too strong or
long-:o.Uinued action of the solar or artificial hght ; this it is necessary to
modify, for one cannot with impunity withdraw the patient entirely from its
influence. Also the excessive fatigue of the eyes, to which we may oppose
an absolute rest to this organ. Among the sQcond class, we may rank all
the internal causes, such as lymphatic^constitution, scrofulous affections, an-
cient rheumatisms, syphilitic diseases or others, which should be opposed
by specific therapeutic agents, Vv-hich cannot always be used without incon-
venience during the inflammatory period.

Without entering too minutely info detail concerning the symptoms, we
shall consider the two most important and prominent anatomical characters
characters which ot themselves fix the antiphlogistic treatment, and thus
become the source of the division of the inflammations into two principal
classes, and farnisii the two indications to which we should attach the
greatest importance in the treatment of inflammatory afiections. These
two anatomical characters are

1st. Local congestion, that is to say, the permanent and two abundant
flow of blood into the diseased organ.

2nd. The increase of plasticity of the blood and its tendency to decora-
pose itself during life into its constituent parts, and to produce fibro-albumi-
nous exudations, which become organized into false membranes.

According as the one or the other of these characters predominates in
the inflammations, we msy divide them in a therapeutic point of view in
two classes, characterised by particular forms, and requuring different treat-
ment.

1st. Inflammation with predominance of congestion.

2nd. Inflammation with predominance of the increased plasticity of the
blood.

Another group might be formed of those inflammations which exhibit an
almost uniform developement cf these two phenomena.

If we take into consideration these two principal characters, the anti-
phlogistic may be divided into two groups :

1. Means directed against congestion.

2. Means directed against the increased plasticity of the blood.

Anil- Congestive Means.

Sangnineous congestion consists not only in local plethora, but also in the
morbid direction of the blood towards the diseased organ, where it is inces-
santly attracted by the inflammatory irritation. Hence the necessity of
taking from the diseased organ or the general system the superfluous blood,
in order to diminish the too violent action of the arterial system caused by

w

44 On Ojj/ithalmia in GeneraL [Oct.

local irritation (depletion,) or of driving back from the organ affected the
morbid current (repulsion,) or of direciing it more or less actively towards
the healthy parts and towards the surface (derivation.)

Repulsion is suited to the least considerable degree of inflammation ; to
that which resembles rather the simple congestion ; but only when it is si-
tuated in the external parts of the organ. In most cases of conjunctivitis,
repulsion employed in good season puts an end tb the disease. Cold water,
a means which one can procure so easily, is the best, the most energetic,
and the most sure of repulsive?, when used in .a contmuous manner. But
there are many intiammations whose nature is averse to cold such is the
catarrhal ophthalmia, for example. In these cases, the astringents of every
naturf , but principally the astruigent mineral solutions, which we may em.
ploy lukewarm, or at the ordinary temperature of the atmosphere, fulfil the
indications. The less the intiammation is, the more it approaches to the
nature of a simple congestion, and the more also is it allowable to increase
the strength of the coUyrium, In the more considerable degrees of inflam-
mation, we may make use of a simple solution of the acetate of lead, an as-
tringent, the anti-phlogistic powers of which are well known.

Depletion may be immediate or derivative, that is to say, it may be prac-
tised near to the diseased organ or at a distance from it. If the former has
the advantage of relieving more quickly the inflamed part, by causing the
irritation, the pain and the compression to cease rapidly, a relief to which
the patients are sufficiently sensible, the second also fulfils the very import-
ant indication of giving another direction to the morbid flow of blood.

In order to obtain the united effect of these two depletive methods, it is
well to employ them, in severe ophthalmias, either simultaneously or alter-
nately being made to succeed each other at very short intervals. In chil-
dren, general bleedings are rarely indicated ; it is nevertheless possible that
we may be forced to have recourse to them. In adults \ve may often
shorten considerably the duration of the ophthalmia, and may decidedly di-
minish the danger in cases of a great degree of intensity, by causing the
local bleeding to be preceded by a general bleeding of from W to 16 ounces,
to be repeated in 24 hours if the symptoms do not lose their intensity. In
some cases it is necessary that the bleeding should be carried to syncope.
Arteriotomy, bleeding from the jugular vein, and that from the nasal vein,
do not appear to possess any peculiar advantages, and they often require
the considerable inconvenience of compression in the neighborhood of the
diseased organ, which restrains the venous circulation and increases the
inflammation. Bleeding from the arm as simply depletive, and that from
the foot as revulsive, have in our practice always proved sufficient. They
may be used alternately in order to unite their advantages. The best local
bleeding consists in the application of leeches over the mastoid process, to
the temple, or in front of the ear. If placed too near the eyelids they often
produce, in consequence of the looseness of the cellular tissue of the part,
an erysipelatous oedema with great swelling of the lids ; and sometimes
ecchymoses, which frighten without relieving the patient, and prevent the
physician, for a certain time, from examining the state of the eye. The
same inconvenience results from applying the leeches upon the internal
surface of the eyelids. Here, the limited space permits only a small num-
ber to be applied, so that the depletion is less considerable than the inflam-
mation caused by the bites. This last reason, founded upon a long experience,
has led us to employ always a larger number of leeches in the case of direct
local depletion than when they are used as derivative ; indeed, in the latter
case, Ave draw advantage even from the irritation of the skin caused by the
leeches, while in the former case this irritation is an entire loss, and adds
often, at least temporarily, to the intensity of the inflammation.

Derivative bleedings may be found useful either after the local bleedings,
or when a suppression of any habitual evacuation, as of the menses, or an

1833.] On Ophthahiiia in Gi^neral 45

hemorrhoidal flux or of an epistaxis, furnishes a special indication. It is in
this case that the application of ten or fifteen leeches to the anus or tlie ge-
nitals, cupping upon the bach, the ioins or the lower extremities, may hnd
their applicati(in.

The derivative effect produced by bleeding is powerfully aided by certain
means of irritation, which attract the blood towards the circumference and
thus turn it from tlie diseased organ. Of this character are the foot-bath,
with mustard sinapisms to the extremities, and tlie application of the eni-
plast. resinos. cantharid. to the back or between the shoulders, for the pur-
pose of producing a temporary rubefaction of the skin. In proportion as
these derivative means ol a transitory action are useful, and serve to aid the
direct effects of depletion and repulsion, by so much, the more energetic
agents which give rise to a vesication of the skin, or which keep up for a
long time a puriform secretion in the neighborhood of the inflamed organ,
appear to us injurious, and rather adapted to add a new irritation than to re-
lieve the primitive inflammation. In the course of our experience we have
rarely witnessed any salutary effects result from these violent remedies m
the active periods of ocular inflanunations. We believe that they possess
a marked advantage only in the inflammations of the mucous textures ac-
companied by an abundant puriform secretion ; for example, in the blenorr-
Iiagic ophthalmia. It is still necessary, even in these cases, that the seve-
rity of the inflammation should have been modified by the previous employ-
ment of bleeding and repellents. Bufwe are far trom wishing to depreci-
ate the value or these agents, used when the severity of the disease begins
to diminish, or when it is desired to prevent a relapse in a rebellious inflam-
mation. In most cases the application of a blister, or frictions with tartar
emetic ointment composed of a drachm of tartarized antimony and two
drachms of lard, is suflicient, towards the decline of the inflammation, to
produce rapid amelioration and give to the disease a more decided progress
towards a happy termination. It is only in a very few cases which are very
complicated, chronic and obstinate, that there is any necessity for having
recourse to moxas, to issues and setons. Blisters and the tartar emetic oint-
ment have the advantage of exciting an irritation which we can readily ar-
rest without danger, and afterwards reproduce with renewed activity, whilst
the more profound irritants, as setons, etc. are with difficulty removed and
soon become an habitual, useless and injurious secretion useless, because,
accompanied witii a very feeble irritation, it has not the power of displacing
an irritation of a morbid and secretive character injurious, because it con-
stitutes an artificial and additional morbid condition, of which the patient
may not be able to rid himself without great precaution, and sometimes not
without serious consequences.

Purgatives act in various ways, as depletive, derivative or antiplastic
agents. We speak of them in this place because they form a kind of intro-
duction to the means which belong to the second class of therapeutic indica-
tions relative to inflammatory affections.

Purgatives, by inducing an abundant secretion from tlie intestinal canal,
give rise to the evacuation of a large quantity of serous and fibro-alburainous
matter. This kind of evacuation is not less important than sanguine emis-
sions, especially when the ocular inflammation attacks very young subjects
in whom the serous and fibre albuminous parts predominate. Purgatives
are stifl very important when a peculiar morbid disoosition, as scrofula, in
the cause of the predominatice oflymph in the constitution of the organic
liquids.

If the advantages of depletion by the aid of purgatives are evident, it is
not the less true that they do not offer the inconveniences Vv-hich some have
wished to attribute to them. The fear of their causing intestinal irritation
is not founded upon experience. Unless some pathological condition of the
intestinal surface pre-exist which forbids their use, they are .well supported

46 Bltjod-letting. [Oct.

by individuals of all ages. The increased secretion which they excite is

itself the crisis of their first irritating impression upon the mucous membrane,
and the surest security that this congestion is not transforming itself into a
permanent or infiaramatory irritation ; thus the irritation is opposed and
subdued by its own effects. The second effect of purgatives consists in the
transferring the irritation of the mucous membrane of the eye to another
very extensive portion of the mucous system. This powerful and favorable
revulsion is equally useful in the inflammations of all the tissues of the eye.

By removing from the mass of the blood a large quantity of fibro-albumin-
ous matter, purgatives contribute td diminish the plasticity of this fluid, and
thus already fulfil in part the second indication.

Finally, they are also useful in these cases, by no means rare, in which
the local inflammation is accompanied and often kept up by a gastric irrita-
tion. It is especially in practice among the poor that their employment is
of great value and of extensive application, for the double reason of the bad
quality of theii- food, which produces in every disease frequent complica-
tions of gastric embarrassment; and of the high price of leeches, for which,
evacuants from the intestinal canal may often be substituted, chiefly in lym-
phatic constitutions. There are cases of conjunctivitis of a mild character
in which a simple purgative alone fulfils the indication of depletion, and dis-
sipates at once all the morbid phenomena.

The purgatives which v^e are in the habit of employing are, for adults, the
neutral salts, as the sulphates of soda and magnesia. These, beside their
purgative effect, appear to have a modifying influence upon the blood.
With children we use manna in a dose of one or two ounces, dissolved in
water, or an infusion of senna with coffee, or an electuary of senna with
prunes and cream of tartar or the syrup oif rhubarb. If we desire a more
drastic effect, we add scammony or jalap, in a dose of a scruple for adults
and of half a scruple for children. Calomel may be given with jalap in a dose
of from 4 to 12 jjrains.

Experience has taught us that we may obtain sufficient purgative effects
with the tincture of the seeds of colchicum, given to children in a dose of
from 4 to 12 drops, and to adults in that of from 15 to 20 drops four times a
day. This remedy is doubly useful in practice among the poor, as its cost
is trifling, and because its taste may be so easily disguised in some mucila-
ginous drink that children may be made to take it without difficulty.

Emetics, the action of which is similar to that of purgatives, are seldom
required in inflammations of the eye. The depletion produced is less com-
plete than that produced by purgatives. The efforts which precede and
accompany the act of vomiting, have the disadvantage of causing a determi-
nation of blood towards the head, and of consequence towards the eyes.
Tartarized antimony in large doses, not as an emetic, but as a counter-
stimulant, may be used in violent ophthalmia according to the same rules
which have been fixed for its use in inflammations of the other organs.

There are certain cases of chronic ophtlialmia, complicated with abdomi-
nal plethora or rheumatism, \yhich are rapidly benefitted by the use of tarta-
rized antimony or ipecac in nauseating doses. Boston Med. d^ Sur. Jour.

Blood-letting.

On a former occasion,* we gave some of Ur. Hall's observa-
tions on this very important subject, with his table o^ tolerance^
&c. But we consider Dr. Hall's investigations on this subject

* See Southern Medical and Surgical Journal, Vol. ii. p. 668.

k

1838.] Blood-htthig. 47

as so important as having brought this recourse of the physi-
cian from a course of haphazard use to a subserviency for true
science ; an improvement, more important than the introduc-
tions of weights and measures into pharmacy ; that we feel that
We cannot do our readers a greater service than to recall their
attention to the subject, by the following extract from his lec-
tures, through the Boston Medical and Surgical Journal.

Blood-letting is so important, so powerful a remedy, so replete with conse-
quences, both good and evi], according as it is well or ill applied, and I have
made, as I believe, such improvement in its mode of exhibition, that I propose
to enter at great length upon this subject. Part of wl^at I have to say, must
be said now in connection with the subject of inflammation : but part must
be reserved for another entire lecture on blood-letting.

The great difficulty is to ascertain, when we have determined upon the
institution of blood-letting, lioio muck or hoic little hhod shall be withdrawn.
Where, where can you learn this ? In what book in Vv'hat lectures ? Shall
we take ten, or fifteen, or twenty, or twenty-five, or thirty ounces of blood
Of more T It may be said that, if the patient be young and robust, and if the
disease be violent, we take mucii blood ; but if the patient be feeble, and the
disease slight, we take little. But how much ? and how little 1 are still the
questions to which I know of no answer in medical writings or lectures.

Now it is precisely to determine these questions, which are questions of
life and death, that I have a proposition to lay before you, of the utmost value
in many, many points of view. The proposition applies to every case in
which it is required to bleed the patient fully ; that is, to the extent the sys.
tem may bear and the disease require. It is full of safety, guiding us in the
use of the lancet, and guarding us, at once, against excessive and inefficient
blood-letting.

The plan I propose is this :

Place the patient perfectly upright, in the sitting posture, and desire him to
look towards the ceiling of the room; having previously prepared the arm, lei
the blood flow to the most incipient syncope.

If the patient be strong, and the inflammation be seated in the serous
membranes, or parenchymatous substance of organs, and severe, much blood
will flow ; if the patient be feeble, and the inflammation be seated in the
mucous membranes, and be moderate in extent and degree, little blood will
flow ; and not only this, but precisely as much and as little as the case re-
quires, and the patient can safely bear to lose.

This is the plan, then, which I recommend you to adopt. Determine the
first question that the case requires the full detraction of blood, by the his-
tory, the symptoms, by the diagnosis ; then adopt the mode of blood-letting
which I have described, and all will be safe. You will often take more, and
often Zess, than you would have done under the former system of guessing,
but you will always take the proper quantity ; you will not allow the disease
to proceed, unchecked for want of the due use of the remedy ; and you will
, not sink your patient by carrying it to excess.

But this is not all; for by the very quantity of blood which has been drawn,
you wiU learn much relatively to the actual powers of the patient, and the
degree and nature of the disease much of a practical kind of diagnosis.

Nay, you will be much guided, in connection with the subsequent state
of the patient, and by the previous duration of the actual symptoms of the
disease, as to the repetition of the remedy another most important point.

If mux:h blood has flowed before incipient syncope has been induced, re-
visit your patient soon ; you will probably have to repeat the blood-letting in
consequence of the severity of the disease, especially if you were not called
in early in the first instance. U\ on the contrary, little blood has flowed,

48 On Midwifery. [Oct.

neither does the disease require, nor would the patient bear, further general
depletion. Is not this an interesting and important piece of information 1
And is it to be found in medical writings or Irctures 1 No ; for even now,
many years since the rule was first suggested in my work on blood-letting, it
remains, either from inattention or jealousy, neglected, and unapplied in
practice except by a few. Bat you will appreciate it duly, you will adopt it
in your future career of practice, and Vv-ill, in many a case of an anxious na-
ture, think of me with satisfaction, and, I trust, with some warmer feeling.
1 consider the rule for the administration of blood-letting, which I have laid
before you, as the most important for conducting with safety the use of a
powerful remedy in the whole range of the practice of medicine ; and I
deem myself happy in being its discoverer and promulgator. Would we had a
similar rule and guide, in the use of all our plans of treatment, fraught, as
they often are, with good or ill, according as they are applied Vi-ith or with-
out judgment and skill.

An Elementary Treatise on Midwifery y'cr Principles of Toko-
logy and Ernhryology. By Alf. a. L. M. Velpeau, m. d*
&c. Translated from the French, with notes. ]iy Chas. D.
Meigs, m. d., Member of the American Philosophical Socie-
ty, Lecturer on Midwifery and the Diseases of Women and
Children, &c. &c. Second American edition. Philadelphia.
Grigg & Elliott, 9 A^orth Fourth-street, 1838. pp. 592.

We have seen nothino^ from the author of the work now be-
fore us, but what declares its author to be a man of uncommon
natural endowments and unusual zeai and industry in the litera-
ry as well as practical departments of his profession. Whene-
ver there w^as room for progression in his subject he has gone
foward. Never content to see error or ignorance in a science
so important to humanity as his, when he has given a case or a
report of facts of any kind, it has been to develope some new
truth, remove the doubts which before obscured its beauty, or
to drive from their lurking places soma of those hideous errors
which infest his professional curriculum. In the more fixed
branches of the science of medicine, those which are made up
of facts, as anatomy for example, where for much novelty, he
would have to transcend the boiindaries of nature's truth, he
has of course not been able to do much more than set forth these
truths in a fair light.

His Human Ovology is indeed a master-workof his day, con-
taining every thing of merit which previous ages had produced
in human and comparative anatomy and physiology, so far as
it tended in the least to elucidate the truth ; and also his own
and other investigations of the present day, all abundantly and
beautifully illustrated with costly engravings ; and all combining
to render the science of human ovology plain and abundantly
interesting. We regret that this work has not been translated
into English : an event which we fear we shall never be called

K

1838.] Velpeau's Midwifenj. 411

on to announce, on account of the unavoidable high cost of such
a work with the necessary illustrations, and the limited demand
for even a splendid work and one highly interesting to the natu-
ralist; but of little practical utility.

But no man has made to the medical profession in America,
a richer offering than Dr. Meigs has in the translation of Vel-
peau's midwifery. He has given us a work fraught with deep
science a work which systematizes in the most accurate and
lucid manner, the truths "known to the profession, and with a
mind competent to the end, looks into many of the hitherto ob-
scure and dark places, grapples with truth, and, victorious by
the mighty agency of genius and science, reveals it to the naked
eye. We will not* say that it contains every thing necessary
for that department ; far from it. Volumes, and perhaps ages
will yet be employed in its farther developement, but nothing
extant can be considered as containing as great a sum of use-
fulness for the accoucheur ; and this too most happily arranged
for the easy acquisition of the reader.

The first American edition of this work has been long before
the public. It was a large edition we understand ; and the re-
sistless demand for the work since the first American edition was
exhausted, which has compelled a second edition, declares at
once the value which is put on it by the profession here. We
are pleased with the magnanimity of the proprietor of the Ame-
rican edition, which is displayed in the republication of this
work which had before received his very full commendation, at
the very moment when he had just placed hiniself before the public
in the capacity of author of a treatise intended, no doubt, to oc-
cupy the same place. We have not had the pleasure of seeing
the work of Dr. Meigs, but have noticed its announcement in
the northern journals. If it be a work of merit, (and it can
scarcely be otherwise, from an author so conversant with the
writings of Velpeau, and so well stored with practical facts of
his own as Dr. M.) we trust it will not suffer a w^ant of patron-
age by the profession, in consequence of the disinterested conduct
of the American translator of Velpeau's Midwifery. There is
a great error common amongst medical men, which consists in
their satisfying themselves with only one good treatise on an
important subject, or with one medical periodical, &c. A man
would be about as wise to content himself with one idea when
he might have two, or a dozen to proportionate advantage.
Each medical practitioner or teacher should take every respec-
table medical journal or publication ; at least so far as his means
will allow ; and it were better to economise in some other way
than in preventing the streams of knowledge, when this is his
only vehicle to fame and usefulness in a profession, over whose
short-comings humanity ever weeps. The same principles ap-
ply toevcry one who dares to approach the bed of accouchement.

G 7

bo Velpeau's Midwifejy, [Oct

Nothing but absolute inability should induce him to deny himself
any means of fullest knowledge. He should remeniber that he
is laboring in a department wherein there is a double responsi-
bility, and this too, for the safety of the most interesting part of
our species lovely woman, and her more lovely and innocent
offspring.

The present edition is a decided improvement on the first,
both in paper and typography. Dr. Meigs, the American edi-
tor, has, though " with the utmost deference for the author," ad-
ded a few foot notes, to which he has affixed his initial. On
page 35 we find the first of these notes. The author in treating
on deformity of the pelvis from excess of amplitude, says :

" During gestation, the womb being less completely supported, may be
wpset, either backwards or forwards, as long as its dimensions do not exceed
the abdominal strait, and it may incline in any direction after the fourth
month."

To this Dr. M. adds

" I have seen a retroversion in a ycung virgin."

On page 54, Dr. M. in his note, considers the " hymen to be a
fold, or duplicotion of the mucous lining of the orificium vagincB.
It is, he says, m all respects analagous to the valvulse conni-
ventes of the bowxls. In many individuals it is ruptured by the
sexual congress ; in others, it escapes uninjured, and is not un-
frequently met with in the examinations made during the con-
duct of labors." He considers it so " tractile and distensible,
that it is even possible for a child to be born without destroying
it, as I have (he has) ascertained in my (his) attendance on per-
sons confined with a second parturition. I make (he makes)
this statement with confidence, as I am (he is) sure it will be
confirmed by persons much engaged in obstetric practice, W'ho
will take the trouble to make the enquiry."

On page 71, M. Velpeau, in speaking of the ligaments of the
uterus, and particularly of the round ligaments or sur-pubic
cords, says,

" Being put on the stretch by the ascent of the womb, it is possible that
they may, when the woman is on foot, and particularly when on her knees,
occasion pretty smart pains in the groins and thighs." Dr. Meigs adds

* It is very common for women laboring under prolapsus uteri to complain
of pain and soreness in the regions traversed by these cords. I am accus-
tomed to the prescription of leeches for these regions, in many cases of ute-
rine disease as I consider that blood taken from capillaries here, actually
effects depletion of the vessels of the uterine circulation."

* Vicious conformations of the vagina are not less frequent than those of
the womb. Its total absence is pretty common. M. M. Boyer, Caillot,
Willaume, and an infinity of others have seen it terminate in a cul de sac
above the vulva, and not open externally at all ; in some cases its vulvar
opening exists, but is obliterated above, and does not extend to the uterus.*

* Such a case as this we had under our care a few years since. The
vulvar opening existed to the extent of one inch and a half, when it termina-
ted in a cul de sac. The subject of it was a married lady about thirty years

1838. J Velpeau's Midwifery. 51

All the students of the school of Paris may have seen a woman of this con-
formation a few months since in the wards of the Hotel Dieu. I have ob-
served a similar disposition in a woman about thirty years of age, who had
been delivered of a child five years previously, and had not had her menses
since that period- Yelpeau, p. 79.

Here Dr. Meigs relates the following interesting and afflict-
ing case.

I have now a patient under care, who is about nineteen years of age.
The external organs are well formed. The pudendem being well covered
with hair, as in a healthy individual. Upon separating the labia, it is found
that there is no vagina. A shallow cul de sac is all that exists at the bottom
of the vulva. A style in the urethra and a finger in the rectum, enables
me to know that no vagina is interposed between the rectum and the ureth-
ra. The uterus, or what is supposed to be the uterus, is so large as to oc-
cupy the whole excavation, and to be felt two inches above the brim of the
pelvis by a hand externally applied. The patient has suffered for several
years, from monthly attacks of the most violent pain, which is only to be
mitigated by large anodyne doses. Hoping to find a portion of vagina at-
tached to the cervix. Dr. Randolph, by means of horizontal strokes, efTected
an opening which was large enough to receive the thumb, and at least three
and a half inches in depth yet no vagina was discovered, nor could we
learn where the cervix uteri was placed. This artificial vagina was kept
dilated with a golden bougie, which at last was abandoned on account of
the irritation it caused. The distress of the patient increased pari passu
with the monthly growth of the pelvic tumour, which we supposed to be
the womb filled with the menstrual blood and hermetically enclosed. As a
last resort, it was determined to tap the womb, and accordingly Dr. Ran-
dolph, with great precautions, pushed the point of a curved trocar at least
two and a half inches in a direction perpendicular to the surface of the tu-
mor. No fluid followed the puncture. The patient had a slight fever after-
wards, from which she recovered in a few days. Such is the lamentable
situation of this young and estimable girl. The agonies she endures at
each menstrual period are pitiable.

of age. She had never menstruated, but asserted that she had considerable
monthly distress as in rctension. On examination and pressing firmly in the
depth of this vulvar canal, we thought we perceived a firm substance, the
size of the os tincae, which easily receded from the pressure. Hoping that
the termination of the cul de sac was caused by an imperforate and unusual-
ly dense hymen, we applied a short speculum, and made a crucial incision
through a very dense white substance, about one-eighth of an inch thick-
sufficiently large to admit the end of the index finger. Beyond this was a
body of very loose cellular structure, which yielded very easily to the knife,
and indeed to the finger which was passed about an inch beyond, at which
distance, the hard body was still perceptible, about as plainly as before the
incision ; and still receded with like ease, from the touch. At this state of
the investigation of the case, the patient became unable to bear its longer
continuance and it was dressed with a plug of lint covered w^ith simple cerate
and fitting the new opening. Before the removal of this, we were confined
to the sickbed, and the patient was left to herself; whereon she declined a
renewal of the effort in her case and left the city. We have not since seen
her, but understand she is alive. There was no tumour perceptible in the
hypogastrjum . Editor .

52 Velpeau's Midwifery. [Oct.

For a case of atresia vaginaB in which the womb was tapped, a remarka-
bly successful operation by Dr. Randolph, see the Phil. Prac. of Midwifery,
by C. D. Meigs, p. 860. [Meigs.]

The next note by Dr. M. (p. 84) is one in which he declines
translating the French terms given by M. Velpcau, by which
the common people designate the menstrual flux, as "regies,
lunes, mois, fleurs or flueurs, purgation, affaires and epoques.*'
Here the editor gives the common English terms, as " menses,
flowers, monthly discharge, show, regular discharge, monthlys,
time," and the common allusion to it with a nod.

On page lOG, M. Velpeau states that the weight of the whole .
ovum does not in general excede seven to ten pounds. Dr. M.
states that a patient under his care gave birth to twins, one of
which weighed in the scales eight and a half, and the other eight
pounds ; the placenta was at least one pound, the water ten
ounces= eighteen pounds.

It should have been remarl^ed that the average dimensions
and weight of the child in Europe will not do to be taught in
this country. Our average is decidedly greater.

M. Velpeau in speaking (p. 117) of sympathetic phenomena,
and rational signs of pregnancy, says

" The neck swells, become's softer, and is the seat of a conjestion, which,
according to Diogenes, was formerly indicated by Democritus, and which
Catullus has mentioned- in the following lines :

Non, illam nutrix, criente lace, revisens,
Hesterno collum, poterit circumdare file ;
a congestion which Dumas says he has positively observed. But Dr. M.
thinks there is more poetry than truth in the lines of Catullus. The feet,
(he says,) become less swelled, and the neck and face more swelled by a
night spent in the horizontal position, and the lines ai-e as applicable to men
as they are to women."

On page 142, two notes are added by the editor: the first is
intended to define and adopt into English use the word ''viable''
in the original, without translation. This is a convenient word
and has no equal in our language for the same purpose. It has
been adopted by the force of its convenience and appropriate-
ness long since. It expresses well, as Dr. M. remarks, " that
state of developement in which the child may live, independent
of its connexion with the mother."

The other note on the same page, is of important practical
bearing ; therefore we shall give it entire. It' is appended to
Velpeau's treatment of extra-uterine pregnancy.

"In as much as the diagnosis of extra-uterine pregnancy can in no case
be absolutely clear and undeniable, the question of gastrotomy i^ one of the
most difficult that can be presented to the surgeon. While the woman con-
tinues to enjoy even a moderate degree of'health, I think few surgeons
could be found, bold enough to recommend or effect the incisions requisite
for the extraction of the foetus; the more particularlv, smce the patient may,
as in many exam})les has been shewn, continue to live, for ten, twenty, and
even fifty years, without great suffering or distomfort, and as she enjoys the

1838.] Velpeau's Midwifery. 53

further prospect of getting rid of the difficulty by suppuration, and the other
modes pointed out by ^ elpeau. A cKsarian operation would be far less
dangerous than a gastrotom'y for extra uterine pregnancy, because the con-
traction ol the womb after delivery by the ca?Farian section, obliterates the
great danger of internal hemorrhage, a circumstance v.hich cannot be predi-
cated of the incisions into an accidental sac containing the extra uterine
foetus. For a very excellent paper on uterine pregnane}-, see Dr. James'
article in the North-American Medical and Surgical Journal, volume iv.
page 275." {Meigs.']

" In nierine Tinnpaniiis the wopr.b may acquire a considerable size, but
it always remains very hght, there is no ballGtiemehl, and percussion of the
belly occasions such a resonance as at once dissipates all uncertainty."
[Velpeau, p. 144.]

Here Professor Yclpeau is very positive a maRner which
he is not wont to adopt, but on personal know]ed,re. Such a
resonance is afforded by percussion " as at once dissipates all
uncertainty.^' Yet Dr. M. seizes this occasion to say that he
" cannot admit the existence of uterine tympanitis as a disease
proper' asserting that it is not possible to retain air within the
womb without the aid of a tampon of some sort. " There is no
ground," says he, " to believe in the existence of such a malady."
We have indeed never met with a case of uterine tympanitis,
nor hydrops uteri, properly so called ; but cases of the latter
malady have been too often well attested, and demonstrated by
the actual discharge of their contents, to admit a reasonable doubt
of its possibility to exist. Now, with regard to the tympanitis
alluded to, we perceive no natural impossibility of its existence,
and the air making the tumefaction, promptly retained; more
than the existence and retention of the fluid in the case of drop-
sy. As to the origin of the air, that is another matter ; so is the
origin of the fluid in dropsy. But v/e are not to disbelieve a fact
wdiich stands before us on authority which w^e have no right to
impeach, merely because ice do not understand by what philoso-
phy its occurrence is brought about. If a crystal stream should
gush forth in our presence from a rock in the mountain's top,
we see it, allay our parching thirst with it, we cannot hesitate
to acknowledge tlie certainty of the fact because we do not know
a fountainhead to raise tlie water to the great height, accor-
ding to hydraulic principles : or the force, and the manner of
its application, whereby the rock was rent: or even if, contrary
to the known law^s of hydraulics, the w-ater should rise to a
height far above its level, we still cannot deny the fact, because
we do not know by wd:at strange influence the hitherto supposed
laws of nature could be thus modified. Truths are insuperable
things not to be laid aside because we may not understand
why they arq. so, but to be received on competent evidence of
. the fact and used in the practical or rational department. When
^^mtm- therefore, such a man as Yel peau asserts, as he does, the actual
facts of tympany of the uterus, w^e have as much reason to be-
lieve the fact, as w^e have the statements about dropsy, which all
admit.

jL

54 Velpeau^s Mldwiferij. [Oct.

But we are induced to suppose, that Dr. M. has mistaken the
matter, and concluded that the tympany of the uterus has been
supposed to exist, from the occasional discharge of air from the
vagina; a phenomenon almost universal with ev^ery woman la-
boring under prolapsus, after the proper replacement has been
eftected ; for the uterus is never easily and effectually corrected
after descensus uteri, without tlie admission of air into the vagi-
na to occupy its place. Thus air is always found to regurgitate
on the re-descent of the uterus, making an audible and most dis-
agreeable sound.

M. Yelpeau in treating on (p. 185) the vascular connexion of
the uterus and placenta, acknowledges that he has " vainly
sought for these utero-placental vessels in a great number of
subjects," and is convinced, by the condition of the parts that, if
they sometimes exist, they are far more frequently wanting.
He says, that whenever he has exammed the ovum in the ute-
rus after the third month, its surface, as well as that of the womb
was smooth throughout its whole extent, and that not a single ves-
sels served to maintain the connexion between those two parts.
He concludes, however, that it is yet fairly a subject for investiga-
tion, and consequently of uncertainty, as evinced by the follow-
ing questions ; " might not the learned authors whom I have
mentioned, (Dubois, Biancini, Reuss and Albinus.) have been
deceived by some anomaly, some pathological state, or some
false appearances 1 Could I have been mistaken myself? Time
and additional facts alone can resolve the question," &c. Dr.
M. here gives his testimony to the same point. He has care-
fully examined the separation of the ovum from the womb at
full term and could never see the smallest vessel passing from
one to the other ; and does not believe there is any utero-pla-
cental connexion appreciable by the senses.

On this subject, one fact is clear ; it is that the maternal blood
does pass into the foetus in the latter months of gestation. The
facts of pregnancy, gestation, character and circumstances of the
fcEtus settle this point. Nor may'ornithologicalovology be brought
to operate against this truth ; for the analogy only holds tolerably
good before the umbilical cord is perforate throughout, and whilst
the alantoide and umbilical vesicles continue to aflbrd nourishment.
For whilst the young fowl breaks its enclosure and comes forth to
independent liie, after its vesicular nutrition is exhausted, the
human foetus continues to grow from a few ounces to many
pounds weight, the very ratio of wdiich increase proves that a
new source of nourishment pours forth its contributions. If
then, the maternal blood actually passes into the offspring, the
enquiry is forced on the mind, through what medium does it
come ? For it must not come by irregular sluices, but most gra-
dually at first, and with great regularity and in an increasing ra-
tio subsequently. This can only be eflected through the medi-

1838.] Velpcaus Midwifery. 55

um of vessels ; and even these must not be so arranged as to al-
low the direct impulse of the maternal lieart en the now tender
organization of the foetus ; for this would be a competent cause of
death in the latter. In order then that the strong maternal pul-
sation may not destroy the offspring, veinous imbibition is insti-
tuted, whereby the blood is most gradually and softly poured
into the foetal circulation just before it enters the foetal heart,
where it is to become diffused in the general mass and equally
distributed to every part. Such are the suggestions of reason-
ing from known enects to appropriate and proportionate causes.
Now what have the anatomical investigations for the elucida-
tion of this subject proved ? That there is a vein placed exact-
ly where, and of just such construction and arrangement as is
demanded for use. This vein is perforate through its whole
length from the time the vesicular nourishment is exhausted.
But where does it originate ? In the cells of that organ (the
placenta.) which is attached to the womb, and the ofhce of
which vein is, in part, to return this umbilical arterial blood in-
to the circulation of the foetus. But were this all, no farther de-
velopement would be effected after about the fourth month, as
there is no effect without cause, present and competent to the
effect. It follows that, if the foetus continue to grow, it must
acquire additional nourishment. But no other source of in-
crement remains to the foetus, but through the umbilical vein.
J^s this arises in the placenta, it must imbibe its additional nou-
rishment for increase, there. The final question then arises,
how does this nourishment get there and from whence does it
come ? Many have not been able, notwithstanding their best
use of injections, to detect the slightest vascularity between the
uterus and placenta. Amongst them are included some of the
best practitioners ; but others, as Dubois and Biancini have, on
the other hand declared that they have injected them; and Reuss
given drawing of them, and Albinus and others observed them.
The communication is however still demanded by the necessi-
ties of the case.

This brings us to a survey of the circumstances of the parts
and the organization concerned, for ascertaining why investiga-
tors have arrived at such opposite results. Here we find in
the gravid uterus many substances most wisely arranged, and
so tender they are deciduous. The attachment of the fiptus
to the placenta is tender and intended to be deciduous so is the
placenta itself with the membranes. And this appears to be
the order of creative wisdom, in relation to reproduction; that
all parts which are only temporarily necessary, should exist no
longer than the necessity ; and at the same time, so tender as to
pass away without much resistance. Now, whatever commu-
nication does exist between the uterus and placenta, is of this
kind. If, therefore, injections be thrown into this attachment, it

66 Vel/jeau^s Midwifery. [Oct*

must be by a very delicate and experienced hand, so to fill them as
to demonstrate, without rupturing them. This, however, has not
generally been the consequence of attempting injections, and the
injection has been found in an irregular mass between the two
parts. But others have, with better success so tilled them as to
display them. Js it not then altogether probable that the utero-
placental vessels do exist ; but are of such soft and delicate
structure as to be easily lacerated, and then shrink away and
become unobservable ? Whence comes the blood in cases of
concealed hemorrhage, and indeed in all uterine hemorrhages?
If it were from the foetus, the mother could not feel the effects of
its loss. But it not only comes from the part where the placen-
ta adheres, but it sinks and exhausts the mother. It follows,
therefore that the vessels of the mother do pour out blood fronn
the womb, where the placenta is attached, in a manner in which
they do not in other parts of the uterus. Now wiiy do these
vessels become so enlarged immediately at the placental attach-
ment only ? And what becomes of the unusually great quantity
of blood thus transmitted to the inside of the uterus? Can any
one suppose that these vessels come to the inner surface of the
uterus and cease ? Every thing proves the existence of vascular
communication between' these parts the necessity from the
beginning, the effects produced, the visible structure in connec-
tion, &c.

Effect declares cause, although that cause may not be detect-
able by the senses or the ingenuity of man. We have no right
to conclude there is no atmospheric air, because it is not sensible
to the eye or touch. But so far as the evidence of man is to be
received, these vessels have been demonstrated by injection,
illustrated by drawings and seen by many. One ascertained,
positive fact, is of more value in the ascertainment of truth, than
a thousand negative ones.

Of "four thousand children born at the Maternite at Paris in
a given time, Madame Lachapelle never met with one weighing
twelve pounds. Baudelocque, who had a case where the child
weighed twelve pounds and three quarters, maintained that it is
incredible that a larger one was ever seen. According to Chaus-
sier, the weight of the child is frequently only five, four, and
sometimes three, or only two and a half pounds." (Velpeau, p.
201.) The incredible weights given by people out of the pro-
fession, and even many authors of the eighteenth century, M.
Velpeau attributes (and, without doubt, very correctly,) to an
undue estimate of the weights, without taking the trouble to
weigh the child ; and says, " in fact, a new-born child of eight
or nine pounds is enormous."

"Nevertheless," says Dr. M. " I beg leave to affirm that new
born children weighing ten pounds, are by no means rare in the
United States. I have ^veighed many at eleven and a half, and

k\

183 8. J Veljyeau^s Midwifery. 57

several at twelve pounds." And finally, he states that he weigh-
ed one child of thirteen and a half, the mother of which died,
however, a few days after delivery.

We are able to confirm Dr. M.'s assertion, that " children of
ten pounds are not uncommon in the United States"? although
the usual weight is between seven and a half and ten, still
we have met with many from eleven to thirteen, by actual
weight on the day of birth. Several we have seen, oVer thir-
teen ; and one of seventeen, but this was removed by embryo-
tomy, after labor, w^hich had commenced five days previous, but
which had worn oft', leaving the woman languid and exhaustedj
and insusceptible of a renewal of labor. This case was twelve
miles from town, and amongst unenlightened people in the coun-
try hence its neglect for so long a timCi The child was
delivered by the perforator, crotchet and blunt hook. Consider-
able brain and some blood was lost. The weight of all that was
preserved was seventeen pounds. This weight was not owing
to unusual cellular repletion, but its increased length was pro-
portionate to its weight ; and the measure was preserved a
length of time ; but keeping no case book at the time, it was not
recorded and is forgotten* Contrary to expectation, the woman
had a good getting^up. The opinion of the patient and her
friends was that she had by several months transcended the
usual period of nine months.

In a note to p. 208, Dr. M". corrects Velpeau's expression*
that the foetus is '* s uspended'^ hy means of the umbilical cord. Dr.
M. very properly considers the child is not suspended^ because
the cord almost always exceeds in length, the diameter of the
Uterine cavity at term, by many inches, and often by several
feet. It is therefore only connected with its parent by the cord.
"We can assert, however, that there are cases of suspension by
the cord ; and indeed we have been once obliged to divide the
cord before delivery could be eflfected: but the suspension is
owing to the winding of the cord around some part of the child.

Our notice of this new edition of Velpeau's Midwifery, has
been protracted greatly beyond our intention when we took it
up. We regret that it is not consistent with our limits to con-
tinue to notice the substance of Dr. Meigs' notes throughout.
These are interesting, and often of much practical utifity. But
we must conclude with the following note (on p. 244), referring
our readers to the work itself for the balance, and believing that
no practitioner who can form a due estimate of it, will think of
contenting himself with any thing short of possessing a copy.

Appended to Velpeau's treatment of Abortion, is the following
note by Dr. M.

" Dr. Physick told me that he was accustomed to order an anodyne ene-
ma every night at bed-time, for such of his patients as were prone to abor-
lion. Fifty drops of laudanum and a wine-glass of flax-seed tea was thrown
H 8

5?i Southern Medical and Surgical Journal. [Ocf.

into the rectum regularly at night, with a view to any too great tendency tc
uterine contraction. 1 have, in several instances, happily succeeded in con-
ducting the woman to full term by this method of treatment I have alec
sometimes found it to fail."

We now bring our notice of tliis work to a close, leaving its
interesting pages with reluctance ; but not without again renew-
ing the high gratification we feel on the appearance of a new
edition, with the annotations of the American editor. We hope
the edition is a copious one.

The su^bject of abortion, at which we stop, is one of great in-
terest, and one of which we feel impelled to say something more
than barely to notice it briefly in passing over Velpeau's work ;
and more especially, when we find it left as it is by this justly
celebrated accoucheur, whose acquirements may be considered
as the sum of what is valuable in the profession. We will
prepare a few remarks on the subject in a future number of this
journal.

Part 111. MONTHLY PERISCOPE.

Southern Medical and Surgical Journal. We congratulate
the medical profession of the south on the sustentation of this
journal, so fir that it has been enabled to enter on the third vo-
lume, of which this is the first monthly number. We are duly
conscious of the many faults of the work. These have been
unavoidable, from the want of editorial experience, and of leisure
from other, and indispensable duties. But we trust that, no^
withstanding it has not been brought up to that degree of merit
it should possess, still we feel free to declai'e ihat it has been the
means of disseminating amongst the profession much useful
matter, which, without this medium, would never have been laid
before southern physicians. We have ventured forth as pioneers,
opened the way, to level the road, and threw up works for fufuie
passengers ; and ieeX that it were better to have pressed through
the undertaking in the best way we could, be that as it miirht,
than to have retreated or stopped short. The way is now open
the brambles and sinks made passable, and the oppoi'tunity of
increasing usefulness is before us.

We trust in the kindness of a liberal profession, to be excused
by all parties in medicine for not havin^- given our labors to the
support of either party, or of any opinion, which may have been-

1888.] Operation for the Restoration of the Lower Lip. h^

the fashionable one of the day, which had not reason tonnaintain
and establish its correctness. Our future course designed is tho
same as heretofore, so far as true philosophy in medicine is con-
cerned. We are still disposed to give to facts their proper su-
premacy, and to deduce from the true nature of things as ascer-
tained, inductive truth. We have endeavored to bring into
-operation, a perfect freedom of mind, unfettered by any partiality^
or prejudice, and ready to receive and pursue the indications of
the facts of nature. We wish not to depend on our own re-
sources for the entertainment and instruction of our readers ;
this could not long prove satisfactory or eminently useful,
if at all, unsupported by that variety of materials which
can only be obtained from the thoughts and experience of many.
We hope, therefore, that in future, the abundant talent in the
profession at the south, m the praise of which, our acquaintance
justifies our speakinrr freely, will be brought into more active
operation in the literary bearing of the profession, and that each
will feel it both a privilege and a duty, to bring up to the sacri-
fice some time, and some labor, that others may be benefitted,
the dignity and usefulness of the profession enhanced, and our
common country honored.

^ We occupy an older country than our w^estern and northwes-
tern brethren, but our eflorts iu the cause of our favorite sci-
ence does not htilf equal theirs. We ask then of the friends of
medical science every where, but we urge those of the south
particularly, because we are in their midst, and because of their
shortcoming heretofore, to come forward with their contribu-
tions to the general weal. We wish not such communications
as we shall be obliged to manufacture anew. We have not
time, talent, nor disposition for this; but all facts of substantial
utility, either in the practice or the philosophy of medicine, we
and our .readv.rs will recei^-e most gratefully ; and by these alone
can the honor and usefulness of the profession at the south be
advanced.

Judicious, well written, brief reviews of new publications will
be gratefully received from our readers and friends, as they
would save us time, and assist us in doing more justice to this
department than we can alone do: for we owe an apology to
many friends at a distance for not having noticed their pamphlets,
lectures, books, &c. which have been forwarded to us. We
hope to do better in future, in this respect. Editor.

Operation for the Restoration of the Lower Lip. A. young man belonging
to Warren, R.I. while on a whaling voyage, in tlie month of December last,
being in an open boat, was struck by a whale in such a manner as to force
an oar against his face with sufficient violence to carry away a portion of
the anterior surface of the superior maxillary bone, and, worse still, the lar-
gest part of the under lip. In this unsightly and truly melancholy condition

60 Bandage for the Cure of Prolapsus Uteri. [Oct.

he returned from the voyage. On presenting himself for advice to Dr. Lew-
is, of this city, he exhibited the following spectacle. Although the wound,
in a measure, had healed, no liquid could Le retained in the mouth without
covering the void, formerly controlled by the under lip, with one hand, close-
ly pressed against the uneven and exposed dental wall. Besides these for-
midable difficulties, in consequence of the rent made in the bones of the roof of
the mouth, his articulation w^as imperfect. The sahva, unless it was con-
trolled by a handerchief, was constantly drivelling over the chin. Under
these circumstances Dr. Lewis operated on Monday, the 21st June, with a
view, primarily, of remedying the deformity. The process was essentially
similar to the common operation for hare hp the wound being dressed after
the admirable method of Dr. Walker, of Charlestown, whose success in such
cases is well known in this community. Fortunately, the wound healed by
the first intention, and the patient, to his great gratification, is reheved from
the manifold inconveniences to which he was subjected for the want of a lip.
An artificial palate is to be made for him by Dr. Harwood, next week, which
will undoubtedly enable him to converse again in his accustomed tone of
voice. Boston Med. and Surg. Jour.

Bandage for the Cure of Prolapsus Uteri. Dr. Robert Thompson, of Co-
lumbus, Ohio, has invented an apparatus for the cure or pclliation of jprolap-
sus uteriy which we have not had an opportunity of testing, but which seems
well in appearance ; and, in his own practice, we are told, has answered
every desirable end. It makes firm pressure around the pelvis, holds up the
abdominal viscera, and supports the perineum and vulva. Boston Journal
from Western Med. Jour.

We see in the above, nothing more nor less than the very
claims preferred which attach to Hull's Utero-abdominal Sup-
porter ; unless indeed, Dr. Thompson's invention may be affor-
ded for the use of patients on more moderate terms than Hull's ;
an article which, like his patent truss, has only been accessible
by the patient at two, if not three times the worth of the work
and materials employed in their manufacture. Practitioners
should condemn, in the most unqualified terms, the custom of
taking advantage of a protected right, to secure to themselves
many times the value of their labor.

Such has been the enormous price of this article, which should
not be worth more than two or three dollars at most, that at first
the consumer could not obtain them at the second sale from the
factory under fifteen dollars, a price entirely too high ior ena-
bling the practitioner or patient to experiment with an article of
such doubtful efficacy ; and consequently, practitioners have
been obliged in many instances to receive back a second-hand
supporter, because he could not extort from his patient such a
price for an article which did not effect any useful end ; and
druggists, have already been obliged to dispose of them at cost
and charges. But we have more serious objections to the sup-
porter than even its price, which we shall embrace the earliest
opportunity of laying before the public. We wish success to
Dr. Thompson's bandage ; but from the nature of things, we
have no confidence whatever in its curative powers, and very

1888.] Superfatation. 61

little indeed in its utility in preventing the onward progress of
that disease, for which it is desired to be considered a remedy.
Only a proper knowledge of the causes of the production and
perpetuation of prolapsus uteri, and the real condition and pow-
ers of the parts concerned is necessary to assure the practitioner
that it is no easy nnatter to produce a remedy by any application
which may supersede the necessity for the frequent assistance
of the practitioner or competent nurse. And when we hear
practitioners speak about curing it generally by such means, we
leel that we are only assured of their ignorance of the disease,
or their superficial observations on the cases subjected to their
treatment.

Superfxtation. The fact of superfoetation, so long mooted by
physiologists, may now be considered as no longer a matter of
doubt. The facts reported within the last two or three years
are, alone, sufficient to settle in the mind of every physiologist
the truth of the possibility and even the occurrence of this phe-
nomenon. It is not a Httle curious and amusing to contemplate
the course of the mind of man relative to truths which are con-
sidered rare. The adoption of an opinion or a fact, which does
not strike the mind forcibly at first with the impression of its
truth, is sometimes as difficult, as finding the correct explanation
of a conumdrum which is often allow^ed so to puzzle the mind as
to render it entirely incapable of using the very answer, when
given in so many words. It seems to search the world of ideas
over to find something other than the truth ; and this seems to
be barred out from the mind by a thousand possible or imagi-
nable difficulties in the way of its reception ; whilst at the same
time the same truth, as to its unreasonableness or improbability
is found demonstrated on every hand. It is the case with re-
gard to many subjects in the different departments of medical
science. Such has been the case with regard to the subject at
the head of this paragraph. Cases after cases as well attested
as we should desire for any truth, and on as good authority,
have been in all ages detailed to the public, in which this has oc-
curred in the human subject ; and comparative anatomy,
which we cultivate, and to which we resort for illustration and
confirmation of human anatomy and physiology, abounds with
this truth, as in many quadrupeds and fowls ; and still the point
thus established, instead of being received as truth, is turned
aside by every ffimsy possibility which the mind of man can ar-
ray in opposition. Indeed it is not yet a well-established fact,
that this is not a very frequent occurrence with our own species.
Cases of twins, triplets, &;c. may in many, if not in all instances
consist of superfoetation ; for it is not in the least, more conveni-
ent to conceive of two ova being impregnated simultaneous-

62 Superfa'tatlon. '[-Oct.

ily, than successively. Be this as it may, the truih of its occur-
rence in animal physiology is spread over a large portion of the
face of nature. It is even found in the physiology of plants.
All reproductive nature illustrates this truth. 1 he two follow-
ing cases, one in the human species, and the other in a quadru-
ped are given in the last American Journal, {August l8cS,)from
the Revue MedicaIe,for March, 1838.

Siiperfcetatlon in the human species. Madame C , the mother of seve-
ral children, became pregnant in the month of June, 1837, and nothing re-
markable occurred until the 20tli of September, when, without any ascer-
tainable cause, a slight discharge took place from the vagina, and continued
for eight days, when it hicreased, and pains came on: Dr. P. was sent for,
and on examining the clots of blood, found in them, first a foetus of three
months, without its annexes, and next, one entire ovum, on opening of
which last, he found a foetus of not more than five weeks. The secondaries
of the first foetus were discharged the following day.

This ease was communicated by Dr. Pertus.

Superfoetation in the Goat. This case was communicated to Dr, Pertits
hj Dr. Berjaud. A goat received the caresses of a ram the beginning of
December, 1^36, and was supposed to have been fecundated. However,
she continued to manifest desire for the male, and she was gratified in this
desire fifteen days after the first connexion. From this moment the animal
appeared satisfied, she began to increase in size, and about the beginning of
May she brought forth two young ones, perfectly formed, but which soon
perished, for the mother would not suckle them. Her abdomen continued
large, and fifteen days subsequently, to tlie surprise of her keeper, she gave
birth to three perfectly formed young, to which she shewed great eagerness
,to give her milk. These young lived three days. It may be well to remind
the reader that the tej-ra of gestation in the goat is five months, and the
jiurober of their young generally two never .more than three.

On the use of Chloride of Lime in Wonvds attended with much pain, h.y
Dr. Chopin. In wounds produced by contusion, laceration, or by the ex-
plosion of gunpowder, where there is much pain, speedy and certain relief,
says Dr. C, is produced by chloride of lime. That this relief is not the ef-
fect of cold or any other cause than the chloride in solution, the author is
convinced by many experiments. Charpie, moistened with the same so-
lution, has been also found a useful application in reUeving crescences in the
vagina. That such is frequently the case. Dr. C is convinced from repeated
examination. Excoriated breasts are most efficiently treated by the use of
the same external application. Brit, and For. Med. Rev.

Typhus Fever in London. It seems that a fever, unusually severe in the
city of London, has become rather alarming on account of the number of
medical gentlemen who have fallen victims to it. This had led some of the
principal citizens to an opinion that they are harboring an infectious disease
of unusual malignancy. Typhus fevers, in England, are never so managea-
ble in their cities, as in the cities of this country: Bast. Med. Jour.

1838. J ^Medical Intelligence. 6^

MEDICAL INTELLIGENCE.

Medical College of Georgia.

Tii3 naxt course of lectures will commence in this institution, on the Se-
cond JMonday in November. This institutioit which has laboured so mucf/
to render the course of instruction more useful than it can possibly be other-
wise, by affording more time and opportunity for improvement, has been"
obliged to conform to the usual custom of a short course. However desira-
ble and important the object in view may have been, and cit. par.,' nothing
less could have answered the same valuable purpose, it has been found im-?
possible for one school, and especially one as new as this, to enforce such a
regulation without the co-operation of the others. It has therefore reduced
the period of its course to that of the other institutions.

The following is the organization of this College at present.
G. M. Newton, M. D. Professor of Anatomy.
Charles Davis, M. D. Professor of Chemistry and Pharmacy.
Joseph A. Eve, ^\. D. Professor of Therapeutics and Materia Medica.
L. A. DuGAS, M. D. Professor of Physiology and Pathological Anatomy.
M. Antony, M. D. Professor of Obstetrics <t Diseases of Women & Infants.-
L. D. Ford, M. D. Professor of Institutes and Practice of Medicine.
Paul F. Eve, M. D. Professor of Principles and Practice of Surgery.

Professor Newton will discharge the duties of Demonstrator of Anatomy ;
by which the class will have free admission to all the demonstrations.

The employment of such talent as Dr. Newton in the demonstratorship
is a rare feature in any College.

Another most interesting and important feature of this College is, that
the distinguished Professor Dr. Charles Davis, and Professor Newton, de-
vote their whole time to their professorships.

Introductory Lecture by Dr. Joseph A. Eve.

Medirdl College of the State of South- Carolina.

The following extract from the annual circular of this Southern Institu-
tion, gives a statement of it present organization :

The Faculty of the Medical College of the State of South Carolina an-
nounce, that the annual session of the College will commence on the second
Monday of November as usual. An Introductory Lecture will be given on
that day at noon, and the regular course will be resumed on the following
morning.

On Anatomy, by J. E. Holbrook, M. D.; On Surgery, by John Wagner,
M. D,; On the Institutes and Practice of Physic, by S. Henry Dickson, M.
D ; On Physiolog-y, by James Moultrie, M. D.; On Obstetrics, by Thomas
G. Prioleau, M. D'; On Chemistry, by C. U. Shepard, M. D.; On Materia
Medica, by Henry R. Frost, M. D.; On Pathological Anatomy and Medical
Jurisprudence, by E. Geddings, M. D.; Demonstrations of Anatomy, by F*
Wurdeman, M. D.

64 Medical Intellisencd,

Jeffeison Medical School.

The professors of this school announce some changes in its organization
and arrangements, which they consider essential. These are an indepen-
dent character, under the title of Jefferson Medical College of Philadelphia*
with an increase of its number of Trustees from ten to fifteen. The char-
ter confers the same powers and restrictions as the University of Pennsyl-
vania.

The regular course of lectures in this institution will begin on the first
Monday in November. The following is its organization :-

Professors ^Surgery,- George McClellan, M. D.; Chemistry, Jacob Green,
M. D.; Materia Medica and Pharmacy, Samuel Colhoun, M. D.; Midwifery
and Diseases of Women and Children, Samuel McClellan, M. D.; Anatomy^
Granville Sharp Pattison, M. D.; Principles and Practice of Physic, John
Revere, M. D.; Institutes of Medicine and Medical Jurisprudence, RobJey
Dunglison, M. D.; Samuel Colhoun, M. D.Deanof thfi Medical Faculty.

Medical College of South- Carolina.

With the annual announcement of the professors of this institution, we
have been presented with an extensive catalogue of the contents of its Valu-
able museum.

The annual course of lectures in this institution will commence on the se*
cond Monday in November next. The following is its organization :

Faculty B. B. Strobel, M. D. Professor of Anatomy ; Elias Horry Dea?,-
M. D. Professor of Surgery ; Thomas Y. Simons, M. I). Professor of The-
ory and Practice of Medicine ; Henry Alexander, M. D. Professor of Inst,
of Medicine and Materia Medica ; Wm. Hume, M. D, Professor of Chemis-
try and Pharmacy ; Francis Y. Porcher, M. D. Professor of Obstetrics and
Diseases of Women and Children ; A. G. Mackey* M. D. Demonstrator of
Anatomy.

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

Clinical Lecturers At Alms House, A. G. Mackey, M.- D At. Mariiie
Hospital, B. B. Strobel, M. D.

We regret that we have not yet received the annual circular of the other
medical colleges for the ensuing season. It is with great pleasure that wer
witness the rising prosperity of the southern country in the increase of med-
ical institutions. Every movement of the kind, if properly organized and
regulated, cannot fail to enhance the character of the profession as well as
its usefulness at the south, and generally.

One circumstance is pecuharly gratifying in this contemplation : it is that
amongst these institutions there appears to be no disposition to lower the
standard of professional merit.

Medical Prize Question.

The sum of one hundred dollars is offered by the Medical Society of the
State of New York, for the best dissertation on " 7'he Diseases oj the Spinal
Column their diagnosis, history and mode cf treatment."

Communications are to be made to the Secretary of the Medical Society
of the State of New York, on or before the first of January, 1839.

We regret that the notice of this which we have seen, has not given the
address of the Secretary ;

SOUTHERN xMEDICAL

A\D

SURGICAL JOURNAL

Vol. III.] NOVEMBER, 1838. [No. 2.

Part 1. ORIGINAL COxMMUNICATIONS,

ARTICLE I.

An Essay on the subject of maternal injiuence on the Fastus in
Utero. Read before the Medical Society of Augusta, by
appointment. January, 1838. By M. Antony, M. D., Pro-
fessor of Obstetrics, &c. in the Medical College of Georgia.

Question assigned by the Society,

" Can the mental or physical state of the female exercise any
important influence over the foetus in utero ?"

When we attempt to look into the unsolved problems with
which nature every where surrounds us, and when called on to
determine the truths of nature in regard to matters, the premises
or elements of which have not been fully arrayed before the
mind by the facts of history or the researches of science, we
know not whither to turn for imploring aid.

If we look to the thousand volumes which industry and learn-
ing have heaped around us, we find little more than a few soli-
tary facts of observation, and the isolated, or abstract opinions
of men some truly in the course of honest research, but which,
from partial data, must also be partial or imperfect. Others,
which are themselves fair and legitimate deductions from the

A I

66 An Essay on Maternal Injluence. [Nov.

premises reasoned from, but which (premises) are themselves
not fair and true. But still, these opinions, coming from men of
influence, pass in the crowd of truths by which they are accom-
panied, as legitimate deductions. Others again, and by far -the
most numerous, the sheer imaginings of men, which cannot bear
the scrutiny of the first step of a rational investigation. And
again, we find homogeneous conclusions drawn from heteroge-
neous facts which should have been assorted and arranged separ-
ately, in order that in the reasoning process, they might fairly
have yielded, each its individual, or each class their own peculiar
results.

Such is the situation of the enquiry presented to your essayist.
The question as presented is duplex. It includes two proposi-
tions essentially different, and connected by a disjunctive, and
this is their declaratory reading : Can the m^ental state of the
female exercise any important influence on the foetus in utero ;
or can the physical state of the female exercise any important
influence on the foetus in utero ? These, as cannot fail at first
view to be perceived, involve physiological enquiries of extreme-
ly different natures. The last is one which, although it has
been from time to time contested amongst medical philosophers,
and even as late as the present century, may now be considered
as settled beyond the reach of controversy.

Many are the facts in point, whereby this truth is rendered
indisputable. Setting aside the most rational view of the healthy,
uninterrupted operations of nature ijj the formation and perfect
development of the offspring, a whole class of foetal peculiarities
or anomalies, are the indispensable results of the constitutional
physical imperfections of the mother. Amongst these we may
name very few out of many ; such as the descent of small-pox,
measles, syphilis, &:c. &c. from the mother to the foetus in utero.
This truth is palpable ; as the offspring is, prematurely, as well
as at term, brought forth under the fully developed symptoms
which characterize these morbid aflections ; whilst in other
instances, children are born of mothers who have, during ges-
tation, labored under those diseases which, prevailing once^
destroy the susceptibility of them ever after ; are found to be as
exempt from them as those who have suffered them after birth
with all possible regularity. These facts are received as une-
quivocal proof that the offspring had suffered and recovered

II

1838.] An Essay on Maternal Influence. 67

from those diseases, in utero ; and consequently, by the " import-
ant (physical) influence" exercised by the mother on the foetus
in ulero.

These are morbid phenomena. But there are others not less
demonstrative of the truth of the proposition which these so sub-
stantially reveal ; and which are found in the perfectly physio-
logical condition of both parties. Amongst these we will name
the peculiar conform.ation of the offspring to that of the mother
in many instances the colour of the skin, as of the white, with
the East or West Indian, the Spaniard, or the African, &,c. The
unavoidable tendency of these facts is to establish the truth of
the influence of the physiological, as well as the others did that
of the pathological physical state of the mother.

But there is another class of influences ; or Vv^e should rather
say, in the present state of the argument, phenomena, included
under the general term of ti'anscendeutal anatomy, which we
may describe under three orders :

1. Monsters by excess ; or transcendental anatomy, properly
so called.

2. Monsters by default.

3. Monsters without excess or default, but with peculiarity
of structure or function.

Under the first of these orders are included supernumerary
parts, as fingers, toes, limbs, heads, testeSjUteri, hermaphroditism*
(so called), imperforate parts, disproportionate viscera, &e.

Under the 2d order, or monsters by default, we may name
hare-lip, fissured palate, defect of fingers, toes, hands, feet, nose,
eyes, legs, arms, head, abdominal parieties, brain, spinal marrow,
uterus, &c.

Under the 3d of these orders, we may include corporeal and
mental anomalies, which are neither transcendental nor in de-
fault as to quantity ; as spots in the skin, albino skin, hair and
eyes, &c., transposition of viscera, peculiarities of mind, dispo-
sition, temperament, &c. &c.

Before going farther into this argument, let us spread before
us the different orders of causes and facts, as we do definitions,

*It is understood that there is no case of hermaphroditism recorded on
competent authority, by an anatomist, in which the individual is capable
both of impregnating and being impregnated, &c.

68 An Essay on Maternal Injlmnce. [Nov.

axioms, postulates and propositions in philosophy, which may
necessarily be looked to, in order to fair reasoning. Causes
may be considered, in the language of logicians, final, active,
passive, remote, proximate, efficient. The several, or joint, or
successive efficacy of these is to be duly considered. Again :
They may be mental or physical. It is the mental only with
w^hich we have to do on the present occasion. Our facts will
be applied to the argument in the progress, as occasion may
require.

In regard to the causes of these human anomalies, (and ani-
mals too, for they are found in almost all orders of animated
nature, as the frog, fish, fowls, quadrupeds of all kinds as well
as bipeds,) we find in reviewing the labors of philosophers in the
premises, that error which has, in but too many departments of
science, ever retarded its progress a disposition, arising out of
the pride of human nature, which leads to a dogmatical denial,
not only of opinion formed from observation, because they see
not themselves the rationale ; but facts on the best authority,
because they know not how to make deductions therefrom.

Now in going down, in a scientific investigation, to elementary
principles, we have to say that we know nothing previous, in
the nature and relationship of cause and effect, to the fact of the
immediate antecedence or succession of phenomena which bear,
in their nature, that just proportion, one to the other, which must
exist, in order to afford competence of causation to the product
resulting, when all the varieties of causation, both in the active,
passive, proximate and remote relations are considered ; and
especially, when these causes are, according to the rule of in-
duction, ascertained and competent.

In this investigation it is admitted that there are many causes
which are occult not ascertainable in whole, or in part ; in
others again they are partly ascertainable and partly not : whilst
in others again they are all sufficiently obvious. Still however
we are not, because we know not any or all of the causation in
the case ; or because, knowing this, we may not understand
how to reason from that which we do know, at liberty to deny
the fact of an etiological nature to the case.

In the first place, it is an axiom in logic, as it is in mathemat-
ics, that there is no effect without a competent cause. But we
are able in this matter to investigate a little more specially, and

18S8.] An Essay on Maternal Injiuence. 69

determine that there are causes of peculiar nature which do op-
erate through existing media, between mother and foetus, from
which we may reason with tolerable analogy. For example,
syphilis is found affecting the tegumental y or the ossious tissue
of the new-born child the mother having suffered this disease
during gestation. So of small-pox, &c. Your essayist once
knew a woman who herself had congenital cataracts, and who
gave birth to seven children, of which we now possess one,
all of whom had congenital cataracts. These are all doubtless
material physical influences of the mother on the foetus in utero.

But your essayist is not unaware that there are many grounds
of plausible objection to the common opinion which many pro-
fessional men, with the vulgar, entertain, that maternal influences
are extended to the foetus in utero. Your essayist would, how-
ever, analyze some of the most plausible and see if there is not
an error in their application to the subject before us remarking
at the same time that those sayings called vulgar, because com-
mon, and because their rationale is not understood, are often
sayings founded on the observations of nature's truths for suc-
cessive ages : nor has man the liberty of denying their truth,
except on rational demonstration.

It has been said* that a knowledge of the different kinds of
the anatomical structure of monsters, affords a very strong, and
indeed incontrovertible proof of the absurdity of the common
notions that the most zealous advocates of these notions will
hardly contend that the imaginations of the mother can annihil-
ate one-third, or one-fourth of the head, and adapt it to an exactly
corresponding piece of another head resembling it in size, form
and features make a double vertebral column, &c. It is tri-
umphantly asked, " how the longings, or fright of the mother
can dispose of the brain, membranes, scull, scalp, &c. as in ace-
phili ?" " How can it stop up the anus, destroy the fore-arm
and place the fingers on the end of the stump, annihilate the nose
and bring together and confound in one the two eyes, as in a
cy clops ?" Again, we are asked, ' how do hogs, horses, hares,
&c. long ?" " How does the explanation apply to trees and
other vegetables in which monsters are found ?"

*Rees' Cyclo^edi" word Monsters.

70 An Essay on Maternal Injluence. [Nov.

It appears to us that results are not liable to be identical from
different remote causes, as from the same, even if the proximate
and immediate cause influencing be the same ; and we would
look fully to the etiological department of this question ; because
in so doing we may perceive reasons to account for results,
similar or dissimilar, by similarity of the proximate ; or dissimi-
larity from difference in some of the causes considered of minor
influence, as the passive, or the remote ; and in passing, we must
remark that, here is a field for great error in practice ; nor has
it remained uncultivated. Predisposing and remote influences
are generally more or less obscure ; they are farther off*, appar-
ently, from the phenomena we arc called on to correct, and, ob-
scured by the glare of the exciting causes, they are lost sight of
as contributors to or modifiers of the morbid phenomena. As
these are indeed the great specified modifiers, no course of treat-
ment founded on a reasoning process in which these have been
omitted, or not allowed their due influence, can possibly be cor-
rect, provided this predisposition be abiding, which is generally
the case. And hence it seems to us has arisen the great ^rror of
the ultra solidists in medicine, and hence, the inglorious evan-
escent bubble which arose from Val de Grace, and meteor-like,
glittered in the firmament, and shed a false glare over the world,
obscuring for a time all rational views, until like a sweeping
pestilence, it left death and destruction in its train.

We find, as we have before intimated, that writers have jum-
bled together facts essentially different in their nature and their
indications of causation, and applied a similar causation to this
heterogeneous assemblage, to try its proportionate appearance as
cause ; as in the triumphant description of their position just
above referred to ; and that, even here, they have made the ap-
plication to false premises for making the test, thus : " How
can longing, or fright dispose of the brain, membranes, scull,
scalp ; or how destroy the fore-arm, &c. ?"

These, it will be observed, are our second order of monstrosi-
ties, or monsters by default. Now, |^it is altogether assumed
on their part, that the brain, scull, membranes, &e. of the bead,
or that the fore-arm was ever there to be ^^ disposed of " or " de-
stroyed." This assumption cannot be allowed ; for nothing po-
sitive has a right to be assumed, without some evidence of the
fact. It may, there fore, instead of endeavoring to shew how the

1838.] An Essay on Maternal InJlucJice. 71

mother's longings, fright, &c. shall be made appear competent
to the effect of removing these parts in default, be denied that
those parts were ever there in the case which ultimated in such
a deformity. But men have gone a great way to find cause,
more strange than any we need find, to account for ''the remov-
al" of a part, without any evidence that the part ever did exist
to be removed by such a cause. It were enough, to find cause
for the present phenomena, without reaching beyond this to in-
volve our already difficult problem in mist and confusion, be-
fore it is called forth by X\\e facts of the case.

Although the condition of the body is known to reflect certain
influences on the mind, still the great superiority of this to the
mere organism, has not remained unclaimed and unestablished
to this day, and to this argument. Its power of effecting physi-
cal ends throuo^h the medium of the oro^anization over which it
presides, is a proposition which none may controvert. It is
therefore a remote, mental cause, of many physical effects, acting
through the medium of the organism. But it is not the only
cause which may bring the organism into a certain state of exu-
herant or of deficient functional action, no more than that traction
is the only manner of applying force to move a body. Propul-
sion may do it as well. It may no more be considered the only
cause, than that the force in moving this body must only consist
of animal force, when steam may as well effect the same.

In generation, and in gestation, the foetus is developed by vas-
cular action in effecting secretion and nutrition, and appropria-
tion to the accomplishment of the purpose in view. This is all
amply provided for in the previous developments and limitations
of growth in the female, and she is physically prepared for the
sustenance of the foetus in and extra utero for a certain period
of her life. Thus arranged according to the regular order of
nature, and the imperfect performance of the functions, the
whole foetal formation and development is effected. This is all
just as plain and simple as that the stomach, in a perfectly healthy
state and condition, receives good diet, and digests it perfectly,
and the nutriment is then regularly and rightly appropriated
to the renewal or the proper development of parts. But here,
the impression of profound grief, or transporting joy, or exces-
sive anger, will impair the appetite, and the depressing passions
more or less completely impair or destroy the digestive power

72 An Essay on ^uu^^t ilUl x/ijiuence, [Nov.

of the stomach, as well as excessive watching, abuses of wine
or diets ; causes essentially different in their natures. When
animation is concerned, the law of causation appears to differ ;
but it is only appearance, because we do not always know how
to estimate the difference of this accessory or modifying cause.

Generation and uterine development of the foetus is but a
function, as other processes in the economy, as digestion and
nutrition ; nor is it more entirely exempt from the power of dis-
turbing causes than other functions. This is obvious in many
ways. Let us bring to our view the facts of nature. Your
essayist once had the care of a lady who had three children
successively, who were born with imperfect feet. In each of
these pregnancies she was seized with a flooding about the pe-
riod of foetal growth at which the feet are perfected in their de-
velopement. The deformities were very similar in all the cases.
At the subsequent pregnancies, hemorrhage was prevented, and
no more deformities occurred in the only two succeeding births.
Again : It is a fact of common observation, that in the advance
of the child-bearing period of woman's life, when the surplussage
to which she is subject for about thirty years of her life, is less
abundantly kept up, her last lactations become insufficient for
the sustenance of her offspring after birth. It is in like manner
often manifest that her last pregnancies are less perfectly sustain-
ed, and sometimes, from this cause alone^ abortion or premature
birth takes place. Here is a physical cause of that foetal imper-
fection which does sometimes arise in this period of life. In the
other case, where there was actual loss of blood at the time for
certain developements, these parts being then developing, were
retarded in their progress, and deformity or monstrosity of the
second order, or monsters by default, were the results. Here
was again a physical proximate cause alone, so far as could be
determined, or reasonably supposed ; for when this cause was
prevented, the resulting phenomenon was likewise.

But your essayist takes this as a postulate, the proof of which
is however observable in many physiological phenomena, that
mental causes are often antecedent to the physical phenomena,
and indeed exert decided influence on the physical organization to
the end of producing physical effects. An example is found in
the condition of the pulse, and of the capillaries under the different
exciting and depressing passions ; as tranquil joy, highly exhil-

1838,] An Essay on Maternal lujltiQitc^ *i%

crating joy, anger, fear, grief, &c. Another is found in the im-
paired appetite and digestive pov/ers under the influence of pro-
foun i grief, &c. To these we might add many more, but theso
are decidedly in point.

If then, those sensorial motions which we call passions, have
power to lessen, and to increase the appetite and the digesting
and appropriating powers by'their influence on the organization,
so that excess or defect of nutriment may be created ; and if at
the same time they may so influence the circulatory system, the
very machinery of appropriation, as to increase or decrease its
actions or appropriating functions, v/hy may not this, as a re-
mote cause producing a decided influence on the organism, thus,
fee considered as a cause of monstrosity by excess or by default
transcending the ordinary boundaries of nature's limits, or
coming short thereof. Wrio that has been in the habit of at-
tending nursing women, has not observed the injurious effects of
that milk on the child which was elaborated during fits of violent
anger? And who does not therefore regard the temper in this
view in selecting a wet nurse ? Again :

The feelings of the nervous system, (of which system, surely
we know but little,) vary in health, yielding different physiologi-
cal phenomena as decidedly in the different temperaments, as
the skin does the inter-communion of sexes of difFarent colour.
Contemplate the prominent characters of the leading tempera-
ments the sanguine, the nervous and the phlegmatic, or the
melancholic. Are they not as widely different as the sombre-
looking, short-legged, clumsy Dutchman, and the sprightly,
shrugging, jumping, dancing Frenchman ? They are not unlike
Dr. Goldsmith's Genius and Industry ; the former of whom was
remarkable for beingj seen with brilliant eye and light step,
starting behind Industry in the ascent of the hill of science. At
the next view, he is far above presently at the summit, and
anon, at the base ; whilst Industry is laboriously trudging along
with heavy, but sure and firm step, never losing ground ; and
who, by the time his competitor has passed and repassed in his
giddy whirl to the base, is found seated on the sublime summit,
firm as the rock of De Kalb. What can be more different?
So it is with temperaments. Their plans, views, feelings, tastes,
are all different not calculated to harmonize in running along
the stream of life, unless the peculiarity of one or both should be
B 2

?4 An Essay on Maternal Injiueiice, (Xoi".

wholly over-ruled by good sense and great prudence. So much
is this the fact, that they are perfectly unfit to be joined in matrr-
mony. Whilst a sujiposed neglect, or abstraction of mind,
would be by one (the sanguine) received as fire in powder^
arousing the most frantic and ruinous passion, and impelling to
deeds of direst vengeance, even towards the best of friends.
Another (the nervous) would receive the same with mortifica-
tion of feeling, sorrow and tears ; whilst the other (the phlegmat-
ic) would pass it by as the idle w^ind, w^ithout feeling or regard.
Whilst one, indulging the dictates of its own taste, will attire
itself in scarlet, buff and gold, or its shining substitute, brass, a
second seeks the more delicate and modest apparel of uncon^
spicuous or various hues ; and a third the most plain, uniforn^
and grave apparel, regardless of, or disgusted with, those peculi
arities of dress which w'ould be calculated to render him con-
spicuous : so of many other peculiarities of these different
healthy varieti^rs oi nervous natures. But these are physiologi-
cal phenomena. Considering the human mind as an abstract
entity, possessing power, but needing a channel for the commu-
nication of that power, we find an anatomical arrangement
finely adapted to intermediation of this powder as a remote cause;
and the phenomena of the physical operations of the organism^
and the physiological chain of phenomena is found to extend
from a seJisorial 7noiion to the nervous system, (the same through
which sensorial motions come from physical causes, or in some
part of v.'hich it is generated by the operations of the mental
faculties.) which nervous system is a bond of union between the
mind and the organic functionaries, and through which these are
influenced in their actions or conditions perhaps action per-
haps the want of it.

We see, therefore, thus fir, a train of communication of pow-
er and of susceptibility sufficient to be considered as affording
the means of causation antecedent to the physical cause proxi-
mate to the effect on the foetus ; for none will now deny that
the foetus in utero is nourished by maternal nutrition for the
chief part of its developement, as there is no other source, un-
less we resort to the old hobi.y, sympathy, and say this nour-
ishes it : and we trust the day for that has passed, never to
letura.

1838.] An Essay on Maternal Injluefice. 7S

Now it is not denied that the foetus is often influenced by phy-
sical causes alone, \vithout the least influence of mental : but if
in any way, the proximate causation may come to be the same
in physical kind and power, and consequently in effect, as it well
may, by physical agents impairing digestion and nutrition, &c.
and by the influence of the passions as we have seen, why, your
essayist would ask, may we not, when we w^itness the same
proximate phenomena in the relation of cause to the ultimate
physical effect, for which we were attempting to account, con-
clude that these are related as remote cause and effect ; as to
exclude that which did operate in the line of direction, so to
speak, of the phenomena? As well might we refuse to acknow-
ledge that a grandfather belongs to the chain of causation of the
existence of the grand-son, and say that his father was the only
cause.

We trust we have shown a way for the operation of mental
cause of the ultimate physical eflfects on the foetal developement;
and that competent causation is at hand in certain cases. Now,
considering the sequence of phenomena as it really transpires in
many cases, (remembering at the same time that physical cau-
ses may alone produce the same final results) we feel compelled
to consider the relation to be that of cause and eflf^jct, where
there is a proportionate relationship between their different phe-
nomena in the sequence.

Here are some examples in point. I once am-putated a man's
arm immediately above the wrist. A lady residing in the im-
mediate neighborhood, and who was at this time in the early
months of gestation received the intelligence with very strong
impressions as to the kind of misfortune. When l.er child was
born, the arm was deficient from the same part at which that of
my patient had been amputated.

Your essayist is aw^are that in the annals of science, those
who are bold enough to advocate the opinion that festal peculi-
arities of the skin, &c. may be the effect of mental impressions
of the mother, are called, byway of reproach, ^'soi-disant phi-
losophers ;" but in philosophical investigations, he places himself
out of the reach of that kind of management for getting around
or over a connected train of phenomena which cannot be broken
in upon by a mere rational philosophy, not founded on facts, and
hold? those as in ignorance unimprovable, and on ground un-

7& A?c I'Jssaij on MiUtrnal InJJiten&e. [Nor,

worthy of refutation, or even serious consideration, who will
dogmatically condemn and attempt to break up the evidence
which a chain of facts affords, because they cannot understand
the rationale. It is enough if the sequence, of phenomena be es-
tablished. Kor is it repugnant to sound reasoning to find that
with a train o^ conspicuous phenoniena, the result is not always
precisely the same, because, if A. B. and 1). be a train of phe-
nomena which alone would produce a given efieet, as E., then C,
another cause may interpose somewhere in the chain, and if it
do, must of necessity manifest its effect in the resulting phenom-
ena, and another resulting phenomenon F. be produced. But
if C. be not known or noticed, it would be argued that A. B. and
D. were in this reasoning process all the antecedent phenome-
na and consequently all the causation, and that it is contended
that they produced different results under Hke circumstances,
which is impossible. But this is nothing more nor less than evi-
dence of the ignorance of the intervening cause C. and does not
impair otherwise, the correctness of the reasoning when all the
phenomena are known and observed.

Facts are too common and too well characterized to leave a
doubt not that maternal impressions always produce anoma-
lous appearances, but, that they do in many instances that is
to say, in the terms of the question before us, they can produce
effects on the foetal developements. Women of the best intel-
ligence and observation, who feel the power of longings, or the
other strong mental impressions in a manner, of v/hich, doubt-
less, man cannot conceive, wjth one consent, and in all ages
have, on observation confirmed the fact of the sequence of the
phenomena, where they have existed at all ; and the physical
representation of the phenomena in the organization has, in thou-
sands of instances, been so exact a representation of the mental
configuration, that its legitimacy was no more to be disputed
than the fact is that different colours must have been concerned
in the causation of a human offspring of a colour intermediate
between white and black, because that communication was not
known in the abstract.

It would be as rational to deny that when the artist executes
a design on his canvass or marble, that his mind, or his mental
conceptions of that design had influence in the production, or
that the archetype in his mind w-as a cause of the result. The

1,638.] A7i Essay on Maternal jiifucncr. 77

chief difference is that, in one, we see, and in the other we do
not, the modus operandi ; and this convinces our understanding.
The fitch and palette, or the hammer and chisel with the physi-
cal force of the Hving hand, guided by the mind of the artist, as
seen in his close attention to his purpose, assure us at once of the
real nature of the whole process. But we should be consistent
with ourselves; for we do not know^ precisely the whole opera-
tion of nature in the grow^th and full deveh^pement of a rose ;
but this does not make us doubt its having been produced by the
natural process of growth, effected by certain causes, and so in-
fluencing its parent stock as to cause its sure and beautiful de-
velopement.

Many instances are familiar to the mind of your essayist, in
which the design originally draw^n on the tablet of the mother^s
mind has been represented in the skin of the offspring. He has
seen the cherry, the mulberry, the strawberry, honey-comb, the
skin of different animals represented as accurately after the
avowed peculiar impression on the mother's mind from longing,
fright, &c. as the painter can detail on the canvass his mental
conceptions. He has knowm those representations of such cha-
racter as the mother had never conceived of, until the moment
of receiving the strong impression during pregnancy ; and so
perfect in character that the peculiar representation on the skin
was not distinguishable from the original prototype which had
created the maternal impression.

Your essayist once delivered a finely developed child, in all
parts except the head, which was, in shape, ears, eyes, colour of
hair, (fee. &c. the precise representation, (according to the testi-
mony of the mother of the patient,) of a dog which had, to her
very great alarm, in early pregnancy, seized the mother by her
dress on her entering a yard m the country. The mother of
this child never saw it, nor does she now know of the deformity.
Its knowledge was limited to your essayist, the mother of the
patient, and an attending female friend. The grandmother of the
child who accompanied the pregnant mother at the moment of
this alarm, described the dog the shaggy and red hair of the
head, &c. before seeing the child.

Your essayist knew a lady, who he thinks is yet hving, when
she was a child practised in her father's family, and saw her
frequently ; whose mother wa*. during gestation with her, and

79 An ICit:itif/ ail Maternal Irijlue^act. [Nov.

in the early stage of it, suddenly alarmed, nearly or quite to
fainting, by the unexpected appearance of a tropical dog, as
they called it, which came from behind her as she was walking
the street of the village in wiiich she lived. When the fruit of
this pregnancy came forth, it was a daughter, beautiful in face
and general form, but u'hose skin wore the identical peculiar ap-
pearance of the dog by vvhich the mother had been alarmed,
even to the colour, grain of skin, the peculiar scattering bristly
hair, and every other character. This peculiar skin covered by
far the greater part of the body, extending over the breast and
neck almost to the base of the cranium.

Your essayist has knov.n a case of mental mark, or impres-
sion, communicated to the offspring without corporeal change,
and not less conspicuous and plain, (and it could not be more
clear and positive) than those above given of corporeal deformi-
ty, which comes under our third order of monstrosity, or those
in which there is neither excess nor default ; but having protract-
ed this essay to a very unexpected extent, he foi'bears to state
fan her facts, many of v.hich he lias observed personally. In con-
clusion, your essayist will remark, that although evidently the
truth that the foetus receives physical from maternal mental im-
pressions, still notliing appears to him more difficult than to de-
termine how many of these impressions are made ; because of the
manner of nutrition of the fcx'tus in utero during the first two or
three months.

Were the umbilical circulation or communication existing
during this time, it would not, in his estimation, present the great
difficulty which it now does. But the facts of human ovology
prove to us that until about the middle of the third month, the
embryo derives its nurtriture from the umbilical and alantoid
vesicles with Vv^hich it is provided ; for the umbilical communi-
cation with the mother is not yet perforated or completed ; nor
have we any reason, to know that direct nervous communica-
tion exists between the mother and the embryo through the um-
bilical cord even when perfected.

Closer observation, however, may prove that only those im-
pressions which happen to be made for a very short time after
the umbilical channel becomes perforated, are those which take
effect, as we know of many very strong ones made at other pe-
riods in pregnancy which are not followed by noevi maturni.

isns.j Rupture of (he Rcclu/h^ ij^c. '"^

Were your essayist to advance an hypothesis on this subject, he
would say that, to have cfiect, the maternal impression must be
a strong and vivid one, and must be made during that period of
gestation at which the particular part of the foetus impressed is
being perfected or developed.

AUTICI.E II.

Exlraordlnary case of Rupture of the Rectum and protrusion of
the Intestines through it, and their expulsion extermdhj, pcf
annum. Read before the Georcria Medical Society, at Sa-
vannah, Feb. 4th, 1S3S, by Riciivrd D. Arnold, M. D., of
Savannah, Geo.

The following strange case ocdurred in the practice of Dr. J.
C. Habersham. As I wished to bring it to the notice of the so-
ciety, I recfuested of Dr. H. a history of the case so far as it had
been under his observation. The following letter from Dr. H. to
myself, will afford the necessary information :

" Feb. 2, 1S38.

" Bear Sir- I was called to visit the w^oman Flora, owned by
Mr. Blake, on the 19th November last. She had been sent from
the country under the impression that she was crazy. She com-
plained of pain about the occipital region, had furred tongue,
and on pressing the epigastrium, she said she experienced a dull
sensation of pain. 1 applied a blister to the neck, and gave blue
mass and c. oil. The next visit she was missing, and was ab-
sent from the mill two days, and when she returned, said she had
been to see her friends. She continued to convalesce until about
the 16th December last, when I was requested to bleed her, as
she said she was again troubled w^ith pain about the epigastrium.
She got better and was assisting in the cooking department at
the mill, and continued there until the 24th January last, when I
was requested to see her early on that day. A woman who
professed to be a widwife, had been with her all night, and told

B9 Rupture of the Rectum, <J-<:. [Nov.

inc sh'j was in labour. As I hud not suspected pregnancy du-
ring my attendance, and as my attention had never been directed
to that condition by her, I doubted her statement, and uncover-
ing the patient, I found, to my great astonishment, a vast quantity
of intestine tied and susp3nded on the floor in a handkerchief.
The woman said that Flora had complained of being in labour
when she was called to her, and they were both under that im-
pression when I commenced the examination. As you saw her
with me about a half hour after my first visit, I leave the subse-
quent circumstances to your own recollection.
" Yours, very trulv,

-J. C. HABERSHAM.

" To. Dr. Arnold."

By request of Dr. H. I accompanied him and Dr. Richard-
sone to visit her while still alive. We found her lying on the
floor, cold and pulseless ; and protruding from the anus and lying
on the floor, was an immense portion of the intestines, which
upon inspection we pronounced to be small intestine and a por-
tion of the colon. The mesentery was attached lo that portion
of the small intestine protruded, in an almost entire state, except
where it had been torn from its attachmant to the posterior pa-
rietes of the abdomen. The intestines protruded w^re cold and
vitality had evidently fled from them. It was found that there
was no rupture of the vaginal canal, and that the protrusion was
posterior to it. The opening by vi^hich they protruded seemed
very large. An unsuccessful attempt was then made to return
the bowels after which nothing further was attempted. She
died in about half an hour afterwards.

The dissection was conducted by Dr. J. Blakely Tufts and
myself, four to five hours after death, in presence of Drs. Haber-
sham, Earle and Richardsone, and Mr. Guernsey, student of
medicine. The body was that of a robust female, the muscular
system very well developed. The abdominal muscles presented
no peculiarity to attract attention. On cutting through them,
the stomach was perceived very much distended with wind.
The greater portion of the colon also appeared in the abdomen.
The peritoneum appeared highly injected.

In order to ascertain what portion of intestine had passed out,
an examination was carefully commenced from the duodenum
downwards, the mesenteric attachments being carefully cut and

1^8.] Rupture of the Rccium, <^c. hi

tiie bowel, (as it were) unravelled. , It wassaon perceived that
the portion of bowel protruded, involved all the snriall intestines,
beginning from the upper third of thejejunum, and the whole of
the ccecum which had been. torn away frotn its attachments in
tlie right iliac fossa. I now passed my finger freely from the
cavity of the abdomen.throagh the opening by whicn the bowels
had passed externally. It' was the impression, I believe, of
every one present, tha^t there' had been a rupture of the peri-
neum. What was our astonishment, w^hen, after further dissec-
tion, we discovered that there was a impture of the rectum upon
its anterior portion, five inches above the anus ; and that the in-
testines had passed, th' ough the aperture made hy the 7'upture,
into the rectum and thence externally per anum.

The intestines that had protruded _were then cut off, and the
rectum with the sphincter ani carefully removed. Further ex-
amination proved that there v/as no rupture of a single fibre of
the sphincter ani, but a simple (jflatation ; and thus revealed the
extraordinary fact of a person's having actually passed per
anum the greater portion of the bowels in /he body. A case similar
to which no medical gentleman present had ever seen or read ofT

The rectum presented a slate-coloured appearance over near-
ly its whole internal surface, and around the edge of the rupture
tlie mucous membrane was quite^ black. In short, it abounded
with marks of chronic inflammation.

The mucous membrane of the stomach was not at all unhealthy.
The womb was examined, but presented nothing abnormal.

How then did this extraor^inary.protrusion happen ? I think
the explanation may be given as follows:

The fact of the rupture oi the rectum is of itself a sufficient
proof that there was disease of long standing in that bowel. A
portion of the small intestines lay in contact with the diseased
portion of the rectum, and when the coats, of the rectum .burst,
slipped into it, and then, portion by portion was involved and
then expelled ; on precisely the same principles that defecation
is carried on. A foreign body w^as felt on the mucous membrane
of the rectum, and^every action proper for that purpose was
called into service to, expel it. Hence those continued and
bearing down pains which were mistaken by the sapient mid-
wife for parturient ones.
c 3

B9 IfoUet ef Patent Laws^ <^c. f Not,

No examination of any other cavity than that of the abdo-
men was made.

When the woman was first taken with pain, she tied a hand-
kerchief very lightly around her waist.

I have not been able to find any written record of a case m
any way similar to this, and hence I thought it would nat be ua-
interesting to the society to present it to their notice.

I

KiRT II. REVIEWS AND EXTRACTS.

Notice of Patent Laws and Letters Patent, particularly in re^
gardto their influence on Medical Discoveries, Inventions and
Improvements,

LBTTBR8 Patent Hull's Truss Ftero Abimikal Scr-

PORTSJR.

It is said of the science of law, that if is founded on reasbu'
and justice. That this is the intention of law-givers, we feel no-
disposition to controvert on the present occasion. If this be
the fact, governments should hare a definite purpose ofjusticey
regulated by reason, in authorising grants of exclusive privileges^
or the protection which letters |>atent afl^ord for a time. If the
laws of a state be intended to effect the reasonable adminis-
tration of justice, it is clear that legislators have failed of
therr purpose in the enactment of what are called patent laws,.
or that there is no law more infracted and abused than those
which authorize the issuing of letters patent for the protection of
inventions, discoveries and so forth. To the rational considera-
tion of this subject we would call the attention, not only of phy-
sicians, and the community at large, but of legislators, presidents
and sovereigns ; and we apprehend that in the investigation it
will be found that the error is rather in the departure of legisla-
tors from the true line of reason and justice in the framing of the
law, than in the infractions of patentees ; for men rarely refuse
grants of benefits or even sinecures, when these are freely oflfered
to them.

Letters patent, or overt, are grants by a sovereign, or in the
United States, by the president, under seal with his own proper
signature, securing to inventors, discoverers, &c. the exclusive

1898,] N<}ticc of Patent Laws, ^. #1

benefits of such inventions, discoveries, &c., provided always,
that the privilege or protection secured do not be construed to
interfere vi^ith the rights of others previously enjoyed. They
are so called because they are open, with the seal and signature,
as testimony of the right therein secured, and in contradistinction
to close rolls, or writs, charts, &:c. directed to particular persons,
and under seaL Patent letters secure to the patentee the sole
right of profit, with the pricilege of fixing the price of his inven-
tion, discovery or improvement, without any other restriction
except that which the purchaser himself may impose by his re-
fusing to purchase. Letters patent royal are then, nothing lesi
than a relic of the ancient British statute of monopolies ; and the
patent laws of the Untted States are nothihg more nor less than
a perpetuation of the same on this side of the water. Let us
examine briefly, how far reason and justice are regarded in
these patent monopolies.

What is the reason which induces governments to grant
letters patent? It is mainly the encouragement of useful
enterprise, ingenuity and industry, by securing to those who la-
bour in inventions, discoveries or improvements, all the benefits
arising from such improvements. But is this a good reason,
and is it all which should operate on the minds of legisla-
tors who, in enacting laws, are in a good sense, acting as arbi-
ters of justice between two parties, the interest of, and juijtioe
to both of whom should be alike consulted, as well in this case
as in the common law operating between debtors and credi-
tors? To secure the inv^entor in all he can possibly exact from
the necessitous user, is as partial as it would be to secure all the
claims of a creditor, immodified, unrestricted by the just offsets
of the debtor. Justice therefore is alike necessary to each party,
and should be so esteemed by every legislator. How is this
regarded by the patent laws ? Not only in securing to the pat-
entee a just and proper reward for the time, labor and money
necessarily expended in the business of experiment and con-
struction, and the security of due reward and remuneration for
the same subsequently in the promises ; but, a grasping monop-
oly, sufficient to overwhelm the moral principle of almost any
man and induce him to search as deeply as possible, not only
into the full pockets of the wealthy, but the scanty ones of the
poor and afliiicted who may chance to need the benefits of hi^
labor.

On examination, however, we shall find that the first bearing
of this reasoning has not that force, which, at the first glance, it
may seem to have. Men of genius for discoveries, invention^
and improvements are, we think, always men of active minds
which will operate. These operations are effected, without be-
ing led on by the promises of pecuniary reward. They are gen-
erally minda which are not sordid, not regardful of vaovmi but

4 Notice of Patent Laws, ^c, [Nor.

active, searching and ever observing. If such individuals have
money, they expend it in supporting the operations of their
genius more freely than money is expended for other things, if
we except intoxicating drinks and other gratifications of the
" lusts of the flesh." Moreover, it is incompatible with true in-
ventive genius, to turn even their 6\m valuable inventions to
good money purpose. We have known siicb a man die in ad-
vanced age with some dozen and a lia If patents, many of them
expire, without having turned any one of them to the purpose
of his own pecuniary benefit: one of which, from its intrinsic,
indispensable utility, and the extensiveness of the demand, could
not, with proper attention, have failed to yield several hundred
thousand dollars. He was ever most ardent and active in the
accomplishment of his discovery or invention ; but no sooner
was it realized, than its interest appe^ared to be lost, and the mind
engaged in the zealous pursuit of another invention. A parsi-
monious disposition and a very active and in^^enious mind, are
naturally incompatible, and there is scarcely a more difficult task
than for the active minded man of genius to exercise ev^en prudent
economy. His prodigality in the use of money is proverb^ial. -
It is indeed one of the infirmities of genius to undervalue money
in all respects, and more especially in regard to its expenditure
for the development of the designs of genius. Hence it is, that
such persons are generally burthened with debt, and die bank-
rupts, or at best, men of small fortunes. The love of money
must predominate over the other feelings and mental operations,
in order to amass a fortune, and those fortunes accumulated by
patents are generally indicative of the unworthiness of the in-
vention or discovery ; because they are not the produrtions of
such mind as will turn it to money account. The designs of
men of genius are peculiarly rich in their own view. No one
else sees in them the same beauty and interest as the projector
himself. They have his partiality as bis own children do, in
whom other people see no uncommon interest ; but in whom
he sees and feels peculiar value.

True genius has a force, in this way, which impels it onward
to the accomplishment of its designs. ^ The whole of the fine
arts, as they are only cultivated successfully by persons of ge-
nius, generall}' end in abject poverty and ruin, or a bare subsist-
ence ; or at most, a moderate competence. Old age com^s on
after a life of great toil and efl()rt, with but moderate supplies for
this winter of life. The genius of the poet operates for the per-
fection of its designed verse, which cannot, in any way, remu-
nerate him for the time, labor and money expended. The same
may be said of the painter, the composer of music, &c.

The effects which result from the operations of their genius
are intoxicating. Designs are pictured to them in more vivid
colours than they are. to others, and this created a value for them

1838.] Notice of Patent Laics, <^-c. 85

which prepares the way for sacrificebf labor, time every thing-
that is valuable, to the eficcting of that design, and which, when
effected, is contemplated with indifference by some, a p^sssing
interest more or less deep by others perhaps the.majority ; but
to him, it is ever rich and glowing with interest not the interest
of the money it is worth, but the interest it possesses to tht fe cl-
ings of genius. He sees in his "effect,'' a clear and bea; tif.i
reflection of his own mind, and isenamorn^ed of it, as the beauti-
ful Narcissus, who saw his likeness reflected by the fountain,
and, believing it was the nymph of the place, was said by some
to have gazed at it until he starved. But others say that Nar-
cissus destroyed his life in Consequence of the provocation of his
fruitless attempts to acquire the object which fascinated him.
So it is with true genius. Its designs are presented to the mind
as the reflected image of Narcissus, and fortune, time, life every
thing is sacrificed t(^ its fulfilment. This is the true course of
nature. . It is the same in inventive genius in other departments.
Labor may be bought, may be promoted by money ; whilst ge^
nius is like the resistless power^.of steam it must operate in. the
noblest effects, or direful explosions ; and unfortunately, the lat-
ter issue is but too common.

But notwithstanding this natural course of genius, the commu-
nity receives a substantial good from its operations, and a quid
pro quo in return ma\ be always right certainly not less so for
mental pr<>ductions than those of labor or cash cost. The man
of genius who has expended his, valuables, (and amongst them
his mental labor may perhaps be estimated asof most value
indeed it is the sine qua nan of invention,) in the production of a
valuable discoveiy or invention which it is the interest of the
community to use. is entitled to a lair reward and remuneration
at their han Is, f )r his la-i3or and expenditure. A bridge or a
ferry charter is but a species of patent right ; but its price is de-
termined and fixed by the legislature ; and on what basis? That
of a reasonable, or if you please, a liberal reward for all the ex-
penditures, in making and perpetuating this good to the commu-
nity. Were it not so, what would be the tendency, and where the

rend of human avarice which, instead of being fed and cherished,
should in all cases, for the best public, as well as social interest,
be restrained ? It would tend to, and end in this, (and we say it
from a knowledge of human nature,) that extortion would be ex-
ercised to the utmost cent when the necessities of life demanded

^ the good of a passage. The same may be said of physicians in
whom great confidence is placed, when danger comes, w^ere it
not for the restraining influence of competitors which makes them
willing to Hinder their services at a fair valuation. Indeed the
whole social compact is regulated more by the suppression of
monopolies than the force of the moral principle. The monopo-
ly which is granted in letters patent, is therefore calculated, as

80 Notice of Patent Laus, cjv. [Nor.

far as the subject of it will allow, to subvert good order, equality
of right and all the best interests of the social con)pact ; is obso-
lete in the policy of government and should be allowed no foot-
ing as sucli. in a republican community intended to be civilized.
It were better, if, in all cases of this kind, the government were
made one pariy, and the inventor the other, and a price deter-
mined on a proper basis the real value of the commodity or
the invention, and paid by the government for the common weal.
But if this be objected to on the ground that taxation is equal,
but all who pay tax do not wish the use of the invention, which
by the way is not a valid objection, the government should still
be the party on one side, to determine the value of those labors,
&.C. to which a monopoly is to be granted, by way of reward-
ing or remunerating the inventor or discoverer. Instances of
this are abundanrly afturded in all civilized governments. There
is the same propriety in it as there is in regulating the common
interest in a state, by law; or the interest which a bank shall re-
ceive for the use of iis money. Why is it that six, seven, or
eight per cent, is fixed by law as the worth of the use of money ?
It is that men who have surplus capital can well afford it at this
price, and the tendencies of a higher price would be but to fix
and increase monopolies lor the wealthy, to the ruin of others;
notwithstanding these would olten, from necessity of the moment,
find it of more value to them. As to fortune, the happiness of a
community depends much on its equal distribution ; but monop-
olies tend now, as they did in the days of Queen Elizabeth, to
that inequality w^iich ends in one direction in oppression, want,
misery and ruin ; and in the other, in monied aristocracies with
power and disposition to oppress and enslave the poor ; and
cultivate for themselves every ruinous vice and luxury. They
are Uke electricity, which, when its equilibrium is destroyed,
according to its degree, commotion is the consequence ; as the
gentle breeze, or the wild tornado, the rending lightning, or the
engulphing, destroying earthquake. But when in equilibrium,
all nature presents a scene of universal repose.

Now it IS quite as easy a matter to determine the value of a
(discovery or an invention, or improvement of any kind, and to
regulate the price for it, as it is that of money ; and the govern-
ing principle is the same a liberal remuneration for all the costs
incurred: the exclusive right of manufacture and first sale
being sufficient protection for the perpetuation of this benefit.
When the American government found it necessary to encour-
age domestic manufactures and industry by a protective tariff,
the sovereign people and their intelligent representatives found
it sufficient to protest so far as to secure the preference of the
purchaser for domestic manufactures at a fair price. This was
done by a small duty imposed on certain foreign importations.
The intelligent American citizens threw at once their capital

1888.] Notice of Patent Laws, <^c. 87

under this proteclif)n. It was ail tliey warned ; for it secured
them the sale of iht; products of their own I bor and capital;
without dangerous t:on)peti!ion iV Mn ahr >ad t u!y, but with
abundant competition at home. They obtained a go )d mt( rest
on the capital and a safisi'actory reward f(r their labor; '.{ni\
hence mainly, came the swelling tide of wealth, which extin-
guished the national debt, nearly freed the people from taxation,
andburthened the treasury with overflowing millions for restor-
ation back to the people. Why then may not the protection of
exclusive right of manufacture and first sale at a fair valu-
ation of the money and labor concerned, effect all the good and
prevent all the evils of a monopoly which is without restraint
and as insatiable as death. On the present plan of patent rights,
the community, so far as its necessities for the discovery exists^
are as badly situated as it would be under monied aristocracies
unlimited in their usury ; the only difference being in the less de-
mand for patented inventions than for money.

But these observations are applicable generally, to the unjust
and improper grants of letters patent according to the patent
laws, for all inventions, discoveries and improvements. Justice
requires that there should be some proportion between the ex-
pensf^s of the discovery, invention, &c. and the price at which
ti is afforded to the community. But when we consider the
proper claims of humanity, these are to be weighed in the op-
posite scale, as much more precious than the benefits of pecuni-
ary interest. We see no harm, no injustice, in the protection of
the right of exclusive manufacture and first sale of a medicine,
or an instrument, or any thing calculated to serve the good pur-
poses of humanity in tinges of distress or danger; provided the
article were still afforded and at a fair price : although we should
feserve our right of the iy'Ge exercise of our opinion of such an^
individual in a community as would not yield so much individu-
al pecuniary interest as would be afforded by a barrier of this
kind, placed between the benefits he might bestow on humanity,
and the exemption from pain and the prevention of danger or
death ; for we hold it to be the duty of members of a social com-
pact, as of the members of civilized society, to contribute as^
their talent may enable them, to the general weal the general
good of the community. The social compact justly demands
such a sacrifice by its constituents. The most favorable sen*
t-ence therefore, which we could put on such, is the same we
should on a physician who would smile at the continuance, or
wish for a cause of pestilence in his community which should
afflict both this, and his professional brethren, in view of the in*
crease of his own profits, or the opportunity thus afforded him
ft)r extortion. He is destitute of humanity, and consequently
unworthy of a place in the profession of medicine, who will thus
liniit the good which the operations of his own mind might eflect.

88 Notice of Patent Laws, ^c [NoVi

He is indeed, no more called on for '^)ecunlary sacrifices than
other men; but p!)ssessing his knowledge of the caus( s of dis-
ease and the preventive arid curative means, he is peculiarly
called on as a good citizen, to give the free operations of his
own understanding, for the ge.ncral irood. IIis doing this con-
stitutes his peculiar worth* a a citizen in commuijity ; and his
refusal should take from him all tliose superior claims; and
more, because he alone has judgment \w such matters.

But wlien an invention or improvement is made, the end of
which h benefit to hvmanity, ^s in .the discovery of valuable n^m-
edies, the claim of the fcommanity for protection against extortion,
is as far stronger than that against pecuni".ry losses, as the de-
sirjB of life is superior to that oF pecuniary pr(>^t.

It is not a little strange that, although monojiolie^s of this kind
were found to be erroneous, oppressive and unjust, as long ago
as the date of the great chart<T of the liberties of Enirland,* and
the same decision confirmed by Henry III. and Edward I., a
monopoly of any description capable of (^xercising oppression
should still be authorized by law, both in England and America ;
and more especiaily when calculated to operate against the pre-
servation of human life. Legislators, therefore, who profess to
have one spark of humanity, should look to this inconsistency,
this prostitution of sacred rights, of justice and of reason, by
which monopolies are created with power to drag from suffering
humanity the last shilling of povert\' itself unjustly, because out
of all proportion to the sacrifices made on the part of the pro-
prietor. A fair investigation of this subject will bring every
unbiassed man to ihis conclusion : that it is just and r a>onable
that even in discoveries and inve^itions which are for affording
facilities to the accumulation of profit, or f>r labor-savinL^ &c.
should be granted it being no less than the actual exchision of
all competition in business a benefit, without which the great
mass of the (!ommunity are content to go on through life, and if
prudent, prospf'r to their heart's content. And surely, not move
but less protection, should be extended to those thin^zs which
have for their purpose the prevention ofd'S'-ase and of death.

Judging from what we know of the effects of patent riiihts in
our own- day, we are compelled to suppf)se that during the four-
teen years of the Letters JPatent Royal, the essence of pepper-
mint, Hateman's pectoral drops and pare<joric elixir, sold at pri-
ces which must have been w^orthy the serious consideration of
the purchaser; butit w^ould be an unreasonable man who would
not Idc content with the means of a fortune which would be given
him in the exclusive right for fourteen years, of making and
vending either ofthese articles at the trifling price of fifty cents
per dozen, as a reward for the expenditure and labor in the man-
ufacture.

*June 19, A. D. 1315.

1838.] Notice of Patent Laws, <^c. 89

Under these considerations, it would become the profession,
when they find a man not satisfied with the protection of his
right to manufacture and sell at a price determined by the ex-
pense and labor incurred and bestowed in affording the commo-
dity, but taking advantage of the prohibition extended to others,
to refuse to the community the benefits of his labours without
sponging from the pockets of the necessitous many times the
real value of his productions, to contemn him as an extortioner,
as dis.ionest, and as perfectly unworthy of their patronage.

We well remember when Hull's patent truss came to the con-
sumer at the enormous price of fourteen dollars, which is now,
with the same work and materials employed in the manufacture,
afforded to the purchaser at three to three and a half dollars ;
and still the profit is such, that, doubtless the proprietor is pre-
pared to manufacture any quantity that may be needed by the
nation or the world, on such terms as will enable the retailer to
vend them any where at three dollars, w^ith satisfactory profit.
Every dollar, therefore, which the proprietor has received over
the rates at which they are now afforded at wholesale, may, to
say the least of it, be justly considered as filched from the pockets
of the afllicted.

We know another truss of recent invention, the cost of labor
and materials in the manufacture of which does not exceed one
dollar and thirty or forty cents, the retail price of which by the
proprietor or his agents is fourteen dollars.

The utero-abdominal supporter appears to be running the
same course. Such has been the enormous price of this article,
which should not be worth more at the factory than two or three
dollars, that, at their first introduction, the purchaser at retail
could not obtain them at less than fifteen or sixteen dollars a
price entirely too high for enabling the practitioner or patient
to experiment wiih an article of such doubtful utility ; and drug-
gists are therefore driven to the necessity of aflfording them at
cost and charges.

But we have other objections to this article, besides the price
which renders it unavailable in general practice. The disease,
for the treatment of which it has been thrown before the com-
munity, as capable of effecting a radical cure, is one of great
importance on account of its extensive prevalence, the afflicting
and fatal consequences to which it tends, and the quantity of
disagreeable and expensive treatment demanded for its best
management. These considerations compelled us, although in-
credulous of its just claims to confidence, from our knowledge
of the true nature of the disease and the difficulties attending its
cure, to pay the enormous price demanded for them, in the
wish, (we cannot say hope,) that they might be effective of some
good ; but our prescription of them has but confirmed our first
opinion, which was that they could not cure the disease for which

D 4

90 Notice of Patent Laws, <^. [Nov*

they were offered ; and that their only real utility would be
found in their staying, in some small degree, in very few cases,
the progressive or rapid increase of the disease, by partially
sustaining the weight of the superincumbent viscera. This is
no more in effect, and little more in convenience than the old
practice we have long and often adopted, of preventing the pres-
sure of the viscera in some degree by a bandage and compress
well applied on the hypogastrium. The article then may be
looked on as one for which an enormous price is demanded, be-
cause it promises a cure without the disagreeable exposure to
the ordinary treatment ; but v/hich experience proves to be in-
effectual and unworthy of the confidence endeavored to be cre-
ated in it. We observe occasional notices of its utility by prac-
titioners ; but we are compelled to say, by an experience with.
it, as well as from a knowledge of the nature of the disease and
the treatment, without which recovery is impossible, and which
at the same time, this supporter cannot effect, that thc^se practi-
tioners have been deceived. They have not remarked the con-
sequences, after the effect of novelty passed away from the
patent ; or they have considered the temporary palliation of
distress they sometimes afford, and of which every -woman will
avail herself in order to avoid those other services which are ge-
nerally necessary, as evidence of curative power. Women
conceal this complaint as long as possible at first ; and even after,
on the least palliation of their urgent distresses, are disposed to
consider themselves well and refuse treatment. Let not the"
community be deceived in this article its price is too high to
be bought without more great claims than it has to utility ; nor
should it even be depended on as possessing curative powers
adequate to the necessities of any case which would not recover
by a few days rest only.

There is one more point in patent laws which merits particu-
lar attention, and without advertins^ to which we feel unwilling
to close this notice. Early medical letters patent were rare.
At that day the art of robbing the community out of a fortune
was not so familiar to the acquaintance of the people as the lat-
ter experience of the /w^orld has made it. Applications were
few, and they were doubtless well examined, and the articles
were of solid merit. But now the world is inundated by thou-
sands of secret preparations which are brought to the communi-
ty under the pressure of captivating names and numerous certi-
cates, quite sutlicient for securing the confidence of the people
until a purchaser and a trial are made. It is true that the same
articles do not generally last longer than a steamer does in one
settlement, which is a year or two ; and has like him, to seek
another market which has not yet learned its usefulness or inju-
rious tendencies ; but by the t'ime it is gone, others, with new
dress and pretence, arc in its place. Eighteen months ago, every

188S.] Notice of Patent Laics, ^c. 91

chamber mantle v/as burthened with Jewett's Liniments, and
such was the high estimate of tliem that some of the people
were disposed to eat them. Now, scarcely a bottle of them can
be procured ; nor is tlie price advanced in consequence of the
scarcity.

This proves the inutility of tlie article as to the real powers
they possessed ; for they probably consisted of little if any thing
more than a little cayenne in lard. But this was sufficient. A
twelve-month's run through the country, one sale to every indi-
vidual who will purchase such things, and an agent for every
section of the country is paid his salary of thousands for the
years service, and an overwhelming fortune is accumulated for
the proprietor no matter how worthless, as to cost or merit,
the article may have been.

Thus is the community, which is ignorant of every principle
of medicine and all the means of judging of any thing out of the
way of every day experience, imposed on, and thus made tribu-
tary to immense fortunes for the undeserving the impostors.
A safeguard should be thrown around the good people, whose
innocence and simplicity lay them open to the impositions of the
designing. They do not once think that a man would impose
something on them which was not fully equal to the praises he
bestows on it 4 or that he would write certificates of remarkable
cures, in the name of persons who were not to be found on earth,
or even in the name of the respectable, living in some distant
part where the publication was never expected to reach. But
these impositions and frauds are the very machinery of quack
impositions. They are the sole dependance, instead of the sub-
stantial merit of the article. This is a matter of secondary
consideration, or none at all. Every patentee should be com-
pelled to make the secret of his discovery public; and if by the
judicious and scientific analysis of the chemist, or otherwise, he
should be detected in fraud' in this, he should forfeit his letters
patent and be punished additionally. Then might the common
people judge for themselves of the merits of the discovery from
their own knowledge of them previously; or the scientific might
judge for them. Both the necessities of humanity and the prcr
vention of fraud not one fraud, but perpetual and increasing
succession of them, demand that the rights of the community
should be protected in this, as well as in such other matters as
ihev are not able to protect themselves in.

2 Gerhard's Clinical Lecture. [Nor.

Clinical Lecture on Laryngitis and Bronchitis. By W. Ger-
hard, M. 1)., Physician to the Philadelphia Hospital. (Pub-
lished originally in the Medical Examiner.)

Laryngitis. Continuing the subject of diseases of mucous membranes,
I shall, to day, consider some of the affections of an organ, the healthy action
of which is most important to life, 1 mean the larynx. Laryngitis may oc-
cur as an acute disease, the symptoms of which are exceedingly simple, and
I shall make but few remarks upon it. It occurs both in adults and children,
and is rarely fatal ; its pathological characters consist in inflammation c^
the mucous membrane, which is injected, and thickened, to a sufficient ex-
tent, to impede respiration. The act of respiration is, in consequence, ac-
companied by a peculiar stridulous sound, and the tones of the voice altered,
in a decided manner. Another symptom of the affection is pain, which, you
know, is always present in severe mucous inflammations, ahhoughless acute
and less limited than m those of the serous membranes. The membrane of
the larynx is irritated by the passage of the air over it, which occasions a
dull pain, of more or less severity, but not lancinating. This pain is increased
by deglutition, from the action of the muscles of the pharynx.

The condition of the voice is an important point in the diagnosis ; it is
stridulous, which is never the case in simple inflammation of the lungs ;
shrillness is peculiarly characteristic of laryngeal inflammation ; as the dis-
ease goes on, the voice is either lost, or resumes its tones by the recovery of
the patient.

Laryngitis may be confounded with simple inflammation of the tonsils,
from which it may be distinguished by the absence of the nasal sound of the
voice, which, in tonsiJitis, is caused by the air being cut off^at the posterior
part of the pharynx, in its passage through the nose. The diagnosis of laryn-
gitis is a very easy affair, and I shall not detain you with it any longer.

The treatment proper for acute laryngitis, is laid down by every author
who has treated of the subject, and I shall not take up your time, by detail-
ing the various antiphlogistic remedies which may be resorted to ; laryngo-
toniy, I may remark, is rarely necessary.

The croupal variety of laryngitis, or that in which a false membrane is
thrown out, may be subdivided into two kinds. In the first, the formation of
the false membrane commences in the pharynx, and this variety is to be
recognized by examination of the throat, before the larynx becomes implica-
ted ; if it extend down into the latter, unchecked by art, the affection is
mortal. In this type of laryngitis, the voice is more shrill than in ordinary
cases, or the patient is aphonous. In the treatm.ent of this variety, antiphlo-
gistics are to be resorted to, though they are not alone to be depended on.
Local applications are to be made to the pharynx, such as a strong solution
of nitrate of silver, or of alum, or the muriatic acid ; a sponge may be dipped
in these- liquids, and applied to the part, which is to be afterwards gargled
with flax-seed tea. It behooves us entirely to destroy the false membrane
and prevent its extending down into the windpipe, where a slight obstruc-
tion is fatal.

The last variety of acute laryngitis is the croupal, in which the secretion
of the false membrane commences below, and not above, as in diphtheritis.
It is rarely confined to the trachea, but extends much further into the bron-
chial tubes of both lungs ; in this variety, the voice is stridulous and shrill,
and, in young children, there is a peculiar cry ; there is also cough. The
respiratory sound in the chest is feeble, from the difficulty offered to the free
entrance of air into the Jungs ; there are other signs of the affection, such
as a flushed, swollen face, and dyspnoea, with incessant restlessness and jac-
titation. In this variety of laryngitis, so much dreaded m children, the rules

1838.] Gerhard's Clinical Lecture. 93

of treatment are are so wel] laid down, and variety of opinion is so limited,
that I shall not detain you by pointing them out at length. It is not to be
treated as diphiheritis, or spasmodic croup. Bleedings, general and local,
nauseating remedies, as tobacco externalJy applied, are beneficial in both
varieties ; but the croupal is an exceedingly difficult one to cure.

Subacute laryngitis has lately occupied much of my attent.on. It usually
occurs in subjects afflicted with previous disease of the lungs ; and, when it
assumes this secondary shape, it is very apt to be mortal, if suffered to ad-
vance, for no patient can resist so extended an interruption of respiration.
In these cases, it is the duty of the physician to interfere with promptness.
An active depletory treatment is, however, scarcely called for ; but we rely
upon external irritants over the larynx. Emollient fumigations are useful ;
and when the disease arises in the pharynx, and passes downwards towards
the larynx, as in diphtheritis, it is always proper to apply a stimulant wash to
the pharynx. Tracheotomy may be resorted to, after the caustic has been
ineffectually applied. Tracheotomy is a remedy of doubtful propriety ; the
use of it has been abandoned in genuine croup ; but it is resorted to in diph-
theritis, where the inflammation has not yet extended from above downwards
to the bronchi, and there are indications of a sound condition of the lower
part of the windpipe.

Chronic laryngitis is the most common form of the affection, and I propose
to dwell upon it at greater length than upon the other varieties. This dis-
ease has been sometimes termed laryngeal phthisis ; but I shall be disposed
to doubt the propriety of universally applying this term, since the laryingitis
often occurs before the developement of phthisis pulmonalis, as was the case
in a patient who has just left the hospital. Indeed, it may sometimes cc-n-in-
ue for a long period, without any signs of pulmonary disease. Now, in these
cases, the original point of disease is in the larynx, although the lungs rarely
escape, especia ly if the affection be much protracted, or if the patient be of
an original tuberculous constitution.

The patient, whose history I shall make the subject of this lecture, has
been very dissipated in his habits, having twice had syphilis, and been sali-
vated severely for it each time.

_ The patient entered the hospital June 4th, 1838. He is an Irishman, a
single man, originally a sailor, but broke his leg, and, for the last three years,
has been a shoemaker. Has drunk freely from boyhood, particularly for the
last two years, but has never had delirium tremens. Has had the venereal
four times ; has been twice salivated, the last time about the middle of last
November recovered entirely, and never before had sore throat or secon-
dary symptoms. Never had a cold before, nor ever sick ; has always been a
stout, healthy fellow, excepting during a temporary illness, in a tropical cli-
mate. Began to cough in September, 1837, having been previously quite
well, but after drinking hard, slept out in the grass, for several nights. Had
no pain ; but, nearly at the same time, had cough and hoarseness. The
cough has been, on the whole, increasing, so has the hoarseness ; and, since
Christmas, the voice, which is naturally clear, and, during the whole Jftitumn,
has been rough, has been almost entirely lost. Soreness of the throat began
about four days after the cough, opposite the depression beneath the hyoid
bone. No pain at the sternum, nor any in the chest, except six weeks ago,
when it was slight at the anterior part of the right axilla, and was speedily
removed by a blister.

The patient went to the Camden races in October, drank very freely, and
contracted gonorrhoe and chancres ; was slightly salivated ; became' more
hoarse, and coughed more. Went to work at his trade, until the 22d of
March ; did nothing for his cough until he recovered from the venerea], a
month after the infection, when he took simple remedies, as honey, &.c.
On the 22d of March, he entered the Pennsylvania Hospital, where he re-
mained until two days before he came to our hospital ; during that time, ho

04 Gerhard's Clinical Lecture. [Nov.

had less soreness of the throat, and less tumefaction of the glands. The
cough continued, with greater severity.

Expectoration beg m, before he went to the races ; he spit about half a
teaspoonful of blood", clotted, appearing to come from the throat. Appetite
good, until about the first of March, and he drank less spirits. Bowels never
Loose; regular. No pain in the belly, nor uneasiness, after eating. No
night sweats. Emaciation began immediately after the venereal. No sore
legs. Never had epistaxis, except twice, in last winter.

At the Pennsylvania Hospi< al, he was leeched tvv'ice to the throat, blistered
constantly for two weeks, and took some opiate mLxture. Swallowed with
diiSculty at first, but now more readily.

At the time of his admission, his condition was as follows. Em.aciation.
Light chestnut complexion. Height five feet seven inches. No swelling
of the lim.bs. Strength feeble ; can readily walk up stairs, and thinks he
can walk half a mile. Much dyspnoea. Pulse 100, feeble, regular ; hands
cool. Tongue mjist; slightly coated. Appetite good. Abdomen retracted ;
bowels regular ; one or two stools daily. Aphonia nearly complete. No
pain in the throat, but some tenderness. Uvula thickened, enlarged ; slight
redness of the fauces only. Cough stridulous ; frequent. Expectorates
eight or ten ounces of puriform and nearly numular matter. He was order-
ed lime water and milk, the infusion of the prunus virginiana, and inhalations
of laudanum and v/ater.

The physical signs, afforded by an examination, the day after the patient's
admission, were the following : Posteriorly, there was flatness on percus-
sion at the summit of the left side ; dulness at the middle, but below it was
tolerably clear. On the ri^ht side, it was clear, in the lower half, but became
flat towards the summit. The respiration on the left side was cavernous at
summit, bronchial at the root of the lung, for the extent of two inches ; feeble,
but vesicular, inferiorly. Pectoriloquy at the summit, notwithstanding the
alteration oi the voice. On the right side, cavcru^us respiration at the sum-
mit, rude at the root, vesicular at the lower hall of the lung. Anteriorly,
there was flatness at the summit, on both sides ; contraction between the
clavicles. On the left side, some vesicular sounds were still heard at the
clavicle, with distinct cavernous respiration ; a little crackhng. On the
right side, the respiration at the clavicle v.as cavernous, without vesicular
sound, and without crackling.

I shall not occupy your attention with the details of the progress of this
case, but will merely mention the symptoms at the time of the man's dis-
charge, the 27th of June. The intermediate treatment, in addition to that
mentioned, consisted in occasional doses of blue pill, with some acetate of
lead and ooium, for a diarrlicea which came on, and which was arrested.
At the time the man left the hospital, his aphonia was rather less ; he was
feeble, and had irregular sweats. Bowels regular. Cavernous respiration
very pure, under tlie right clavicle ; at the left, crackling, with rude respira-
tion ; loud and puerile, at the lower portion ol the left lung ; feeble with mu-
cous rhonchus, at the lower part of the right. Discharged, at his own
request.

I shall not particularly dvrell upon the case, the history of which 1 have
just given you, but, instancing it merely as an example of the afiection under
notice, I shall enter into some general remarks on the subject.

Chronic laryngitis is associated v\'ith pulmonary phthisis in several wayig.
The affection of the larynx may be strictly secondary, and result from the
direct irritation of the sputa passing over the bronchial tubes and the mu-
cous membranes of the larynx ; this form of the disease occurs in the more
advanced stages of phthisis when the sputa are more irritating than at the
commencement, before softening of the tuberculous substance has occurred.
In other cases, the tuberculous disease appears in the larynx nearly, if not
quite as early, as in the lungs, and arises from a deposit of tuberculous mat-

I8J58.]

Gcrhards CUnical Lecture, 95

ter in the follicles of the larynx. This variety is strictly analogous to ths
tuberculous affections of the serous or mucous membranes v.'inch so often
accompany phthisis ; that is, the tuberculous disease of these various organs
is in reality but a part of one and the same affection, which merely shows
itself in many points nearly at the same time. The third variety is the most
interesting, and is the one olTered by the case which I have just detailed to
you. The affection of the larynx does not here seem to be originally of a
tuberculous character, but may be either a simple chronic inflammation or
one dependent upon a syphilitic taint. The pulmonary affection is of later
date, and only appears as a consequence of the irritation which is developed
in a continuous mucous membrane. Not that all cases of chronic laryngitis
necessarily terminate in this way ; it is only those wiiich occur in individuals
vrho are disposed to phthisis, either from original constitution or acquired
habits.

Phthisis may not follow this variety of chronic laryngitis for a very long
period after its developement. In the case vrhich forms the illustration of
this lecture, although there can be no doubt as to the order of time in which
the affection of the larynx and lungs appeared, there is a less distinct inter-
val than in many patients. I have seen a number of cases in vrhich the
lungs w^ere undoubtedly free from any appreciable signs of disease for months
after the laryngeal atT^^ction had taken place. In all probability, the lungs
were as free from actual as they were from all appreciable lesions, for the
general symptoms of phthisis did not appear until about the period when the
local signs were discoverable.

I know of no certain rule by which you can distinguish those cases of
chronic laryngitis which are to pass into phthisis, from the more simple
forms of the disease, in which the ulceration of the raucous membrane and
the caries of the cartilages are the only lesions. You should therefore re-
collect, when you meet with a case in which a careful exploration of the
dhest convinces you that the patient has no pulmonary affection, how very
cipt true phthisis is to follow chronic diseases of the larynx, and you should
riot give the patient to understand that his lungs are entirely out of danger.
In fact, such cases are often but the prelude cr the first stage of a variety of
phthisi?, the symptoms of which persist Lntil the death of the patient. From
a neglect of this necessary caution, or rather, from not.being fully impressed
with the connexion which exists between the early and the more decided
stages of the irregular varieties of pulmonary phthesis, I have known physi-
cians of high standing commit grave errors, which proved injurious to the
health of their patients, as well as to their ovrn reputation. These errors
are sometimes committed by physicians who are familiar v/ith the physical
means of exploration, and who have acquired that power of diagnosis which
is possessed only by those who are thoroughly conversant with the pathology
of pulmonary disease ; you may readily imagine how much mere frequent
they must be with practitioners v>-ho diagnosticate disease merely from a
tew of the most obvious symptoms.

There is no difficulty in the diagnosis of chronic laryngitis ; but there is
much difficulty in distinguishing its different varieties. For instance, if you
meet with a case in which there has been pain and difficulty of deglutition
felt at the region of the larynx, and an alteraiionof the voice vrhich may be
limited to a mere huskiness scarcely observable by any one not previously
acquainted with the natural voice ot the patient, you should regard the case
as one of chronic laryngitis, if it persists longer than a week or tw'o. The
absence of any obvious alteration of the .pharynx does not prove that the
larynx is in a normal state : although, when the pharynx is diseased, the
larynx rarely escapes for a long period without participating in the evil, at
least to some extent. The anatomical changes, occurring in this early stage,
are lirnited to a mere thickening of the mucous membrane, especially that
covering the vocal chords ; it is sometimes so shght as to disappear entirely

96 GerlianVs Clinical Lecture, [Nov.

after death* This stage of the disease is that which is most frequently fol-
lowed by phthisis, or, to be more strictly logical, we should perhaps say, that
at this stage, phthisis generally supervenes.

You will find the diagnosis of the following stages still more easy than at
the period of ulceration. The ulcers are most common near the vocal chords,
in the variety which attends phthisis ; but in syphilitic laryngitis, the epi-
glottis is commonly attacked and very often the cartilages of the larynx be-
come necrosed. By depressing the base of the tongue very firmly, you can
often obtain a view of the tip of the epiglottis, and thus ascertain if it present
the white or greyish ulcer of syphilis. Still in the laryngitis accompanying
phthisis^ the epiglottis is not unfrequently ulcerated, so that this sign is not
infallible. The peculiar grayish colour of the ulcerations of syphilis, and the
simultaneous occurrence of ulcers on the pharynx and tonsils of a similar as-
pectj are better guides. But we are, after all these precautions, obliged to
trust largely to the commensurative circumstances, especially to the signs of
syphilitic or tuberculous disease in other organs. There will then remain a
few cases of doubt ; for instance, the patient whose case is mentioned to-
day^ has, undoubtedly, had syphilis more than once, and is, evidently, now
laboring under a confined phthisis. In his case, I regard the laryngitis as
genera'ly of a syphihtic character, but the phthisis very speedily added a
new Fource of irritation to the larynx.

Besides these cases of chronic laryngitis, there are others in which it is
very difficult to distinguish how much of the symptoms is owing to the afl^ec-
tion of the larynx, and how much to that of the pharynx and trachea which
may accompany it. These cases constitute the annoying disease which has
been sometimes called clergymen's sore throat. This designation it has re-
ceived from its frequent occurrence in the members of the clerical profession.
It is now rather less frequent than formerly, and is passing from out of the
iist of fashionable complaint?:, so that in a few years v/e shall probably scarce-
ly hear of its appearance. In speaking of it as a fashionable disorder, I do
not mean to jest about a very anno^-in^ complaint, one that is quite inexpli-
cable, and which indirectly leads to serious consequences.

This variety of sore throat which occurs so often in clerofymen, is by no
means very rare in other professional men who are engaged in pursuits little
calculated to promote vigorous health, and are at the same time obliged to
exert their voice in addressing large audiences. There is no doubt that a
feeble constitution, especially if inclined to scrophulous disorders, favors in a
remarkable degree the sore throat, but, notwithstanding, I have often seen
men of a vigorous, and apparently altogether firm constitution, suffer ex-
tremely from this affection. The liability of clergymen to this kind of sore
throat depends upon several causes ; in the first place, the duties of a clergy-
man in this country are sometimes unreasonably arduous. In many cases
his parishioners expect that, in addition to the ordinary duties of his calling,
he should take an active part in many religious societies and meetings,
which make large demands upon the time that should be devoted to active
exercise and cheerful recreation. The origin of the feeble constitution of
clergymen in many cases depends upon still more remote causes, and arises
from an absurd neglect of the ordinary rules of hygiene while pursuing their
preparatory studies. When you reflect upon the influence of these sources
t)f disease, and add to them the feeble constitution that not a few clergymen
possess from original habit of body, you may understand the reason why the
clergymen in our cities enjoy less perfect health than any other class of pro-
fessional men. In Europe it is well known that the reverse is universally
true.

The affection of which I am now speaking rarely offers laryngitis in its
acute form. Indeed it generally commences in the pharynx, and extends
in a secondary manner to the windpipe. Its exciting cause may be either
an attack of acute fever, especially scarlatina, or it may occur as an ordinary

1838]

Gerhard^ s Clinical Lecture. 97

angina which is prolonged beyond the usual duration of these affections.
Wnen \va examine the pharynx we lind it to be red, smooth, and irregularly
elevated; the redness of the membrane extends also into the larynx, and
may be detected at the tip of the epiglottis. When these cases are either
acute or have lasted for a long period, the trachea and larynx will be found
painful on pressure^ and the voiCe becomes feeble and hoarse.

The Jung" often becoine tubt?rcu!ous alter the irritation of the pharynx has
laste.l for some weeksi but vou must not suppose that there is any necessary
connection between phthisis and this affection ; it is a more exciting cause,
but not a frequent precursor of ^he disease, as is the case with true chronic
laryngitis. It is quite surprising how long these cases wdl last without the
lungs materially suffering, and unless the general and local signs of phthisis
are both evident, you must not conclude that your patient is in the early stage
of consumption.

Chronic' Laryngitis treatment. The treatment of chronic laryngi-
tis is always a matter of great ditficulty ; indeed, when the case has become
complicated with tuberculous disease of the lungs, you will find no plan of
treatment of much avail. Taese cases ofconsu'nption are the most intract-
able, and most painful to the patient. It is of little moment whether the dis-
ease of the throat his occurred ve\y early, or whether it is mere'y one ofthe
sequelae of phthisis ; hi neither can you hope to succeed in arresting -the
disease of the throat, if ulceration has once confmenced.. You have seen
enough of these complaints, to understand that a cure is siarcely possible,
when the interior of the larynx is constantly irritated ty the passage of dis-
eased secretions from tlie lungs, and by the motion caused by ei'hjr speaking
or deglutition. Still a cure does sometimes take place tp3ntaneously, and
may be aided by a judicious treatment.

1 once saw a case of most complete cicatrizatiqn ofthe larynx^ where the
vocal chords had been completely desf-oyed, and the epiglottis was contracted
much within its usual dimensions. The voice, of course, was not restored,
but the patient was quite healthy, and died of a disease in no wise connected
with the larynx. If the destruction has been complete, you mnstnot there-
fore look for entire restoration of the functions of the larynx, but for the ces-
satioa ofthe local pain felt in coughing and swallowing, as the test of the
disease having quite abandoned its acute character. With the cessation of
the pain, there is an end oi" the acute form of the disease which is attended
with active inflammatio i ; but there is^a form of chronic laryngitis in which
the uneasiness is so slight as not to be felt by patients of obtu&e sensations*
In these cases, the proof of entire cicatrization is very difficult of attainment.
You can only judge in an approximative manner, by the dimnution of the
hoarseness of the voice, and by the cessation of the harsh, stridulous, laryn-
geal cough, as well as the disappearance of the clotted, opaque sputa, which
are formed in the larynx.

The cases that you have just seen of phth'sis^ accompanied with chronic
laryngitis, were not of the most favorable kind for treatment. Stiil, in both
cases, there were results of a very pos^itive and gratifying character. One
patient left the hospital with the symptoms of phthis much mitigated, and the
laryngeal affection decidedly improved. He will not recover, but the relief
which he obtained is in itself a most desirable object. The other patient
was still more decidedly benefitted ; he has no soreness ofthe throat, and
can speak almost in his natural key. These cases exemplify the only treat-
ment for affections ot the larynx which I conceive to be called for ; I had
almost said, which was justifiable in an advanced stage of phthisis. I di-
rected for both of them merely inhalations of laudanum and water, to be re-
peated several times a day. About a drachm of laudanum was poured OD

E 5

C^ Gerhard's Clinical Lecture. [Nor.

Bome boiling water in an open vessel, and the patient was directed to brca'be
over the cup twice daily. This mode has some advanta.L'"es m such cases
over any inhaler ; it is preferable to usinir any vcF>'eJ with a ppoir, as it
avoids all straining- or forcing- oftiie musc.'es of respiration, and at the same
time the patient receives a sufiicient portion of the aqueous raiour charged
with alcohol and the narcotic properties of tiic opium. Von may readily re-
new the heat by pLic'ng a spirit lamp occnslonaily bene;;th the vessel con-
taining the liquid. Tlie vapour of tnr, which has I eon ?o much lauded in
the ireatment of ph'hisi?, is ofien of grca* service in these cas( s, bi t is most
useful in those varieties in which the infiarnmat-cn c.Nterids over the pharynx^
and thence into the larynx and trachea.- I am not di.'^posed to exrggcrate
the value of inhalation?, they liave been greatly abused, or at least have
been extolled much beyond their valye ; but tliey certainly furnish the most
direct mode of acting upon the hnirPg membrane of the air passages, and nuy
be managed so as to avo d all risk to the patient.

In these c^ses, leeches- are often advisable-; but they should be applied
rarely and in small quantities, for a large abstraction of blocd by leeches
applied over the trachea, debihtates extremely, and should be avoided a.t.an
advanced stage of phlh'sis. Now the very reverse of this obtains in the
commencement of the very same d'sease ; but two or three days since I pre-
scribed leeches above the summit of tlie sternum for a young lady who labors
under the commencement of phthis s ; the, relief from a most distressing seir-
sation of tickling and ircljing throughout the windpipe, ^was immediate. I
have seen similar results very renerally f(<l:ow in such cases, and regard the
application of leeches as much more certainly useful in laryngitis rnd nflam--
mation of the trachea, than in most cases of disease ; but you must always
carefully select the proper time and mode of application, or you will find it
positively hurtful. J would give you the followirg pri:ctical rule: when
there is sorrness of the larynx and trachec\ and pain on pressure, without
the permanent altei-aticn of ihe voice and appearance of the sputa indicative
ef ulceration, you may take from two to six ounces of blcod, wilh almost cer-
tain advantage. The soreness of the larynx vrhich accompanies the clergy-
man's sore throat, is nearly as certainly relieved as that which is confined to
the peculiar afffctions of this organ. This leeching may be repeated, if yon
find that the patient is not rapidly losing his colour, or showing other signs
of excessive loss of blood. You must not, however, expect that when ex-
tensive ulceration of the mucous membrane of the larynx has taken placer
and still less when the cartilages are necrosed, that the abstraction of the
blood from the neighboring parts, will cure the disease ; it <ran no more
change this state of things, than arrest The progress of white swelling when
the cartilages of the knee-joint are partially eroded. There is nothing to be
done, but to check as far as possihle the irritation of the part by appropriate
inhalations, and then trust to the gradual operation. of nature in throv.-ing off
the diseased portion. In the syphilitic variet}-, a mercurial course m.ay be
most useful ; indeed,- you may sometime? succeed in curing cases of the mos5
unproniising appearanco, provided they depend upon a vrnereal cause.

in the late work of Trousseau and Belloc, on chronic laryngitis, which
obtains d a prize from the Acarlemy of Medicine, much stress is laid upon the
cauterization of the larynx. This may seem ahold procedure, and doubtless
requires much skill to avoid mischievous effects ; but if the operation be
practised with care, these authors state that it is not very difficu't, and is of
great service. They sometimes touch the mucous memlDrane of the larynx,
at its entrance, with the nitrate of silver, but more frequently sprinkle the
interior of this organ with a solution of thecaus'ic, bymeaiis of a syringe
constructed for the purpose. Of course, the great difnculty in the operation
consists in introducing the injection behind the epiglottis, and in preventing
the caustic from d'sorganizirg the membrane of the larynx, or irritating the
adjacent bronchial tubes. I have never attempted to perform this operation.

isns.]

Gerhard's Clinical Lecture, ^

and cannot thprefcre speak to you from persona] knowledge of its powers;
but il 1 were to form ar.y '])in;on upon the subject, I thouid conc]ude fi om ihe
remarkabiy benefici'ai edects of inLalat or s, that it was a useful mode of treat-
ment ui the l]an<is> of those wjjo are skilful enough to enipjoy it. It has one
great advantage ; it irrigates but Jittle the bronchiaJ tubes.

External irritants are recommended, perhaps in part frcm a kind of habit
which makes them always enter into the list of remedies advised for all chro-
nic indammations. That they are often grossly abused, no one can doubt ;
and we may regret that we have no means of distinguishing with certainty
those cases v^hicli arc really benefitted! by external applications, from those
in which they are either useless or injurious. The subject, hov.ever, is per-
fectly open for observation^^and may he readily settled on a rightly determin-
ed basis by a careful observation. My own experience enables me to give
you the loUcwing rules as tolerably well fixed. Blisters are rarely useful ; 1
usually avoid them, and would restrict their use to the sub-acute forms of
laryngitis ; 1 have seen little benefit, and often much injury, result from their
use in the very acute and in the chronic cases. Caustic issues and setons
are both troublesome and painful, and rarely of benefit Frictions over the
larynx and trachea, v.ith a stimuiating liniment, particularly one so mild as
to allow of genileand long-continued application, are much more useful ; in-
deed, you will ofien find them of signal advantage in cases of sub-acute laryn-
g'itis, and sometimes of service in the more intractable chronic varieties.
Weak sinapisms, frequently applied, are also useful, and less inconvenient
than linimepits.

There are many less important medicinal agents which I am in the habit
of using : some of them you have seen me prescribe. These are chiefly the
opiates and demulcents ; although these medicines are regarded as mere pal-
liatives, they are nevertheless highly important, and prevent the increase of
the laryngeal affection. INothing acts more injuriously upon the larynx, or
is of more immediate injury to it, than frequent coughing, and any simple
remedy wliicb can check the constant disposition to cough, is sometimes
more than a palliative it prevents that constant motion of the larynx which
hastens the progress of incurable cases of laryngitis, and is a serious obsta-
cle to the recovery of those which are less advanced. The opiates are ad-
vantageously combined uitli ipecacuanha. I greatly prefer the form of
lozenge; a medicine which dissolves very slowly, acts more certainly and
more completely relieves the distressing sensation of tickling about the en-
trance of the larynx. You may give a lozenge four or five times daily,
contaming from the twentieth to the twenty-fifth of a grain of sulphate of
morphine, with gr. 1 4 to gr. ss. of ipecacuanha,- to this I sometimes add a
minute portion of antimony.

Whatever treatment you adopt in chronic laryngitis, 5'ou will soon find
that in no disease is it more necessary to attend rigidly to those hygienic
rules, which are here often so much overlooked. The larynx, from its struc-
ture and position, is extremely exposed to the causes of disease ; and when
its mucous coat is ulcerated, or its cartilages denuded, no cure can reasona-
bly be anticipated, unless you protect the org^ from the deleterious action
of external causes, and keep it as nearly as p^sible in a state of rest. It is
therefore a matter of absolute necessity to l-.eep the patient as silent as pos-
sible, and to guard him from sudden changes of temperature. A damp,
moist air, is often soothing to the larynx, and rather diminishes the tendency
to cough ; but if the air be damp, and at the same time chilly, as is the case
when easterly winds prevail in this climate, patients with laryngitis nearly
always suffer, and cough much more frequentKy than at milder seasons. A
very dry, cold air, produces very variable effects ; if the patient be extremely
feeble, it is usually injurious, and proves directly debilitating; but if his
strength be still retained, the influence of cold, dry air, is no otherwise inju-
rious than as a direct irritant to the larynx. Extremes of heat are injuriom

tO# Gerhard's Clinical Lecture, [Nor,

on other groundt:, a patient debilitated by the intense heat of summer aU
ways sulKrs trum an inciease ol' laryngeal symptom? he is besides liable
to profuse perspiration, which is suddenly checked by draughts of air. Now,
from all these causes of disease, it will be your duty to protect the patient,
more carefully, perhaps, when sufieriiig^ from laryngitis, than any other dis-
ease ; the extraordinary susceptibiljty of the larynx renders it difficult to
restore it to the normal condition when seriously affected.

Silence should be enforced in all acute inflammations of the larynx ; but
in its chronic diseases, absolute silence is impracticable. All that we can
do, is to direct the patient to speak as little as practicab e, and to avoid all
loud or prolonged exertion of tlie voice. When recovery takes place, you
must permit your patient to return but slowly to his usual tone of voice and
habits of speaking, otherwise he will be exposed to a continual recurrence
of this most troublesome disorder. - .

Bronchitis. Bronchitis is an affection, which is rare during the summer
months of the year. Most of the cdses which oecur in our wards are met
with in the winter season ; and they are generally engrafted on some other
affection, for we have few^instances of pure acute brorichiiisin hospital prac-
tice. In its simple ordinary form, it is too slight a disease to require much
attention, and m the large majority of cases is left to the unaided eflorts of
nature. Patients affected withphthisis will tell you, that they labored first
under a bronchitis, which may Ijave been ordinary or secondary. They
usually suffer it to run on until it reaches a stage which compels them to
seek for medical relief, and they thtn enter the hospital. Hence in hospital
practice, we see only severe and grave cases, which, in many points ol view,
is advantageous in the study of disease.

We have a case now in the hospital, which is rather unusual: it is not
perfectly pure bronchitis, for, as I have said^ that is comparatively rare, but it
is compl.cated only with slight pleurisy. The patient is ^tremely stupid,
and we were therefore not able to gather from him much of his anterior his-
tory. He is a stout and strong man, a labourer, born in Ireland, entered the
hospital the 24th of June. He had been in the out-wards of the house trora
the 15th of April till the 13rh of June, wlien he went out of the house, and
went to work at Havre de Grace. He had no cough of severity until he
wag hurt on the 21?t of June by a bank of sand falTmg on his breast, and
principally on the leftside, which became immediately painful, and soon after
he became oppressed; he was not bled. Two days after he came to Phila-
delphia on the rail road cars, without suffering much pain, and entered the
hospital on the 23ii ; he has been subject to colds, but never had one of any
severity. On the 24th, the day after his admission, his condition was the
following :

Intellect extremely dull, and memory bad ; fare slightly csdematous under
the eye-lids ; feet not swollen, voice hoarse, cough loose and hoarse, appetite
lost, slight pain in the left side of the brens', chiefly under the axilla ; none
in the right side ; this pain t^S^creased by breathing; dyspnoea caused by
breathing and speaking; skin moist and cool ; pnlse eighty-four, quick and
thrilling ; respiration twenty ; chest anteriorly full ; percussion clear through,
out anteriorly and posteriori}', but less marked on the left than on the right,
and the left side not so full as the right ; sonorous and mucous rhonchi on
bolh sides, anteriorly respiration vesicular and slightly feeble ; ordered
JNlist. pectoral f3v.
Syrup scillar. foi.
M. S. ^^s. q. h. secunda.

June '2oth. Man much oppressed ; face flushed ; dorsal decubitus ; loose
mucous cough, i aia extending over the sternum, especially towards left

1838.] Gerhard's Cluneal Lecture, 101

side ; ] u'se ninety. six, rather lull and ret-isting ; tongue moist, a little whit-
ish ; cepiialalgia in ihe niuni:n^, and at night very severe, preventing sleep.
Sonorous rhonclius extending ihroughout liie whole of the chest ; mucous
rhonchus in the lower th:rd of tiie Jell side; percussion at the base of the
right side a JittJe less clear than at ihe left; the pain was \i\ the right side,
but the mucous rhonchus at the I'jft. Venesection tartanzed antimony,
two grains dissolved in a quart of flaxseed tea, to be taken during the day
and night.

From the 25lh to the 29lh, the oppression and pain in the right side ceas.
ed completely ; the flush of the face disappeared. The patient was cupped
upon the chest alter the bleeding.

Jmie 29th. More oppressed ; sweating profuse on the 28th. No pain
in the right side, which has not returned since the bleeding ; cough very
loose ; soreness at the upper part of the sternum severe in coughing. Tongue
moist; appetite bad. Chiiliast evening. No palpitation. Pulse eighty-
four, rather feeble, regular. Respiration twelve. Impulse of the heart
clear ; both sounds clear, distinct, but distant. Anteriorly mucous rhonchus
over the whole left side of the chest ; vesicular on the right where there
was no rhonchus ; percussion posteriorly clear on both sides, nearly equal,
a little in favour of the right ; abundant mucous rhonchus at the lower por-
tion of the left side, w itli sibilant le^s marked ; no stools ; no nausea for the
last twenty.four hours.

July 2d. {Sweating abundant ; pulse eighty-eight ; still loose mucous
cough ; expectoration almost ceased ; tongue a little dry at the edges only ;
one stool yesterday ; perspiration decidedly acid, but less so than that of a
healthy individual. Abundant mucous rhonchus in the posterior part of the
whole chest, particularly on the right side extending throughout, anteriorly
respiration feeble throughout. On the 3d, still cough, but more loose ; less
dyspnoea. Sweating abundant ; a little hoarseness ; pain only at the thorax ;
urinates with difficulty and pain ; costive ; perspiration now alkaline ; sputa
decidedly alkaline ; urine extremely acid ; appetite lost ; tongue moist ; pulse
sixty-iour, full and soft ; mucous rhonchus throughout posteriorly ; the tar-
tarized antimony continued.

July 6th. Expectoration mueo-purulent, not numular ; skin cool ; pulse
regular, moderately frequent ; on the left side anteriorly, the respiration is
vesicular and pure ; sibilant rhonchus at the summit of the right side, with a
little rudeness of repiration ; percussion clear. Balsam of copaiba gtt. v.
four times a day.

Juiy 7th. Bad taste in the mouth ; strength feeble ; expectoration thick,
yellow, and muco-purulent ; twenty drops of elixir vitriol four times a day.

July 9th. Respiration vesicular throughout the left" side; traces of si-
bilant rhonchus only throughout the right side anteriorly ; moist and dry
rhonchi abundant ; percussion sonorous ; sleep interrupted by the cough ;
sweating profuse ; anorexia ; thirst ; two stools in twenty- four hours ; tongue
a deep purple, but rather dry ; strength feeble ; pulse ninety-two ; saliva
slightly acid, although patient has not taken the elixir of vitriol for four hours;
perspiration also slightly acid ; treatment continued.

July lOih. Peispiration and saliva slightly acid; urine extremely acid;
took last night by mistake about twenty drops ofcopail a ; elixir vitriol con-
tinued. The oppression continues ; anteriorly on the lelt side respiration
clearer; mucou^:, with some sibilant rhonchus on the right side.

July 11th. Cough frequent ; sweating at night ; drowsiness throughout
the day ; expectoration puriform, thick, running together ; twenty drops of
laudanum at night.

July 18th. Cough at night, less during the day ; skin cool ; pulse eighty-
eight, feeble ; tongue red, smooth, and clear ; appetite bad ; sweating last
night ; one stool in twenty-four hours ; pain under the right clavicle ; vesi*
cular respiration ; imperfect sonorous rhonchus at the internal margin ; vesi*

105 Gtrhard^s Clinical Lecture. [Nor,

cular simply inferiorly ; on I he left side fuller, and more vehicular; no con-
stant e:\pira'ioii ; impu'se of tlie heart increased ; ^oiindt? clear, ihe second a
little dul! ; pcrciission clear on both sidyp, less "so on the right; posteriorly
on the r.ght side abundance of sonoro.is and sibilant rhonclii, rather feeble
on the left. Dry cups' no. viii. between tlie shoukU-rs.

Julij 'ZOAi. Tlje (oHowing prescripiion was ordered :
ly.. Copaiba 3j.
Tr. Opii 5 ss.
Syr. Tolu 5J. '
Mucil. Acac, q. s., ut fiant 1 iv., S. f ss. q. h. sec. nocte.

This case, which afTords us a very good, altfwugh not an uncomplicated
example of bronchitis, will enable you to learn the signs ot the disease, and
the dilxiculties which soinetinjes arise from its coaiplications with more
grave, though less apparent disorders. The patient was quite well until he
v/as injured by a fail of earth ; from that time he began to cough, and at his
entrance the bronchitis was fully developed. Now, this is by no means the
usual mode of commencement for bronchitis ; and if the patient had given a
less connected account of his case, I shouid certainly regard his statement
as very doubtful. As it is, you may well hesitate before you admit entirely
the account which he has given you ; for his perceptions are dull, and ho is
therefore not capable of appreciating the slight degree of uneasiness which
would arise from a previous chronic bronchitis Of one thing, however, we
are certain ; that is, that the bronchitis assumed a character of much se.
verity only after the occurrence of the accident, which the patient met with
while at his work ; the same external violence therefore gave rise to an in-
flammation of a serous and a mucous tissue.

The diagnostic characters of bronchitis are well illustrated by the present
case ; the rhonchi which are so well marked in the present case, and which
vary from one moment to another, are, on the whole, the best signs of the
disease. But you must not lay too much stress on these signs ; you must
remember the anatomical condition of the bronchial membrane, and keep in
view the causes of the rhonchi. Now, in bronchitis, espi^cially if the case be
of moderate intensity, such as is offered by this patient, the membrane is
throughout its whole extent more or less th.ckened and coated, with mucus
of considerable tenacity. The thickening arises from congestion of the
blood vessels of the membrane, and will be found to vary very much at dif-
ferent times of the day and in different portions of the membrane ; hence
the sounds will cease entirely, and be rephiced by a respiration which is
nearly natural, but more feeble than usual, for tjje mucous membrane is al-
ways sufficiently altered to prevent the respiration from returning to its full
strength as long as any inflammation whatever remams. Hence 1 am dispo-
sed to lay more stress upon the feebleness of the respiration, particularly the
irregular and varying feebleness, than upon t'-e rho chi. The feebleness of
the respiration is of course most evident.u'hen complicated with emphysema;
in the emphysematous portions of the lung there is a permanent cause for
the feeble vesicular murmur; and they yield scarcely any sound, when the
patient has an attack of acute bronchitis added to the chronic disease. You
will find that persons afTected with emphysemn, are especially subject to
bronchitis. Besides the feebleness of respiration, those of you v.^ho are good
auscultators, and I am ghid to say that several of my pupils deserve to be so
called, must have perceived that the respiration has more or less of the cha-
racter which 1 denominate rustling; that is, the inspiratory sound has lost,
in a measure, its softness, and a rustling sound is heard during the passage
of the air into the smaller tubes and vesicles This is a very frequent ound
in chronic bronchitis ; it is also heard in the acute variety, if it happen to be
accompanied with but li'.tle mucous secretion. By the rustling sound 1 do
not mean the dry crepitant rhoncims, which is rarely heard in these cases,
and is therefore an unimportant sign, but I allude to a mere alteration in
tjiie tons of the respiration, no adventitious Eoiuid bein^f produced.

1838.]

Gerhard's Clinical Lecture. 103

You are we!] aware of the channres wiiicli occi;r i t the rhnrchi , thepe
are inproj)ortion to the qiiantii}^ of the s-cretioii into i-h,? bronchial tube?, and
to the (ipgree of the thickening of the membrane. ' Thu? you obi^ervcd in the
present instance that the mucous rlio^ichus was well marked when th.e sputa
became abundant ; nowj in cases of acute bronchiris, it is important to at-
tend to this rhonchus^ for when gecrciion has fairly taken placp, yon may re-
gard your patient as dscidely improved; but in chronic bronchitis, it is of
less importance, except in cases wiiere a cluHinic ciry catarrh is replaced by
an acute iuflimmation the mucous rhonchus then becomes a very good mea-
sure of the degree of severity of the acute disease, and from its gradual sub-
sidence we ran ascertain the" precise progress made by the lungs in return-
ing to their habitual state.

You may have remarked^ that tlie oppression in tins patient was much
greater than the physical signs would seem to indicate. Now, when you
find this state of things in bronchitis^ you may look for its cause in one of tvvo
complicat'ons ; that is, eiuphysema, or disease of the heart. Of course I
exclude comolicatjons of an acute kind, such as pneumonia, or severe pleuri-
sy* for sligl.t'pleurisy, not more severe than that offered by this patient, doe.s
not constitute a very distressing com.plication. The signs of emphysenip, I
shall detail to you at another pprio 1 ; they are in part obscured by those of
the bronchitis, bat still a sufiicient number of signs will remain for the diag.
nosis. The evidence ofcardiac disease is rather more obscure ; that is, of a
moderate degree of onlargement of the heart, vvithout-either extensive val-
vular disease, or inflammation of the membranes. The means of diagnosis
are in a great degree within your reach, but it requires much tact and some
experience. In the present instance you will scarcely find demonstrable
signs of heart disease ; at least these are limited to a slight degree of dulness
at the bronchial region, and a little confusion of the sounds of tiie heart : by
this expression I mean that the sounds of the heart have not their usual
clearness and fulness, although they are not posiHvely so different from the
ordinary standard as to be called morbid. The impulse is besides too difia-
6ed< and not sufficiently sharp ; not limited to the point of the heart ; it is,
however, at least as forcible as in the natural state. Now, these signs,
which I merely allude to, at present, without expecting you fully to appreci-
ate their value, indicate a distension of the heart with blood, causing a la-
boured and slow contraction, and sometimes terminating by the fonnation
of fibrinous coagula in the rigiit ventricle and auricle. In more favorable
cases, this distension of the heart is of little immediate danger, but may lay
the loundation for future hypertrophy and dilatation.

Having now pointed out the signs which are important for the diagnosis
of this case, I have but a few vvord:^ to say as to its prognosis ; it is almost
nece.ssarily favourable* for the complications do not threaten any immediate
danger ; and the patient, from his ag-p and constitution, is nearly exempt from
pulmonary pht^hisis, which is apt to follow chronic catarrh, in the patients
who have any predisposition to the formation of tubercles from hereditary or
other causes. I shall insist upon the relations between phthisis and bron-
chitis, and point out their distinctive characters in another i art of the course^

The treatment consisted, as you knovr, chiefly in venesection, cupping,
and tartarized antimony, follou^ed by the balsam of ccpaiba. The bleeding
was particularly requisite in this case, from the full, plethoric condition of
the patient, and his evident ten lency to congestion of the heart and lungs.
When the necessity for a remedy is as strong as in the present instance,
you may expect to find that immediate relief will follow its emplovment.
Accordingly, the patient was'immediately relieved of his most troublesome
symptoms and esoecially of his extreme dyspnoea. I am np^, however, an
advocate for bleeding in ordinary cases of bronchitis ; indeed, it often retards
the cure; for in all inflammatory diseases, but more especially those of a se-
creting mucous membrane, a certain degree of energy in the circulation i^

104 GerhartTs Clinical Lecture. [N"oT

necessary to brinor about the natural termination of the disease. This ter.
mination always takes place by secretion from the inflamed surface, unless
the mrtamination be arrested so easily as to leave no thickening' or conges-
tion of the mucous coat* The disadvantage of bleeding is, that it does
somewh"-.; retard the process of secretion, it the bronci itis be not severe, or
if the strength of the patient be not very robust; on the other hand, when
the congestion is so considerable as to impede the circulation, we find it high-
ly expedient to take blood from the arm. It removes the over large quantity
of blood from the heart and lungs, allows these organs to perform their func
tions with comparative facility, and materiaHy assists secretion. You have
seen how materially this was promoted in the present instance, and that the
patient was immediately relieved alter bleeding. Cupping is less useful in
bronchitis, tlian it is in either pneumonia or pleurisy ; the relief is not propor-
tionate to the quantity of blood taken. I use cups but rarely in acute bronchi-
tis ; I almost limit their use to those cases in which it is complicated with so
considerabla a degree of dyspnoea, that bleeding has failed to remove it.--
They are, however, more useful in the chronic variety ; they should then
always be applied between the shoulders, a point where y^^u may abstract
more blood, and at the same time approach m.uch more nearly to the bron-
chial tubes.

The tartarized antimony was also directed for this natient j it certainly
tsduced the force of the pulsej and was probably useful. You need not be
startled when you hear me use the words probably useful ; I am most anx*
ious to point out to you the best modes of treatment^ and to insist most
strongly upon the positive results obtained from treatment, either in the man-
agement or cure of disease ; but when I do no: perceive uneciuivocal, benefit
lollow trom a prescription^ 1 feel myself bound not only not to conceal, but
to call your attention to it. In the present instance, we can merely say that
our patient improved a little while taking the antimony, uncombined with
other remedies ; buttne medicine was not followed by the same quick reso-
lution of the disease, as often occurs in cases of pneumonia, treated by this
remedy. Nevertheless, antimony is, in general, one of our best and most
certain remedies in the management of acute bronchitis.

Vegetable emetics arc largely used in the treatment of bronchitis ; they
are most useful in the chronic varieties, or in the bronchitis of children*
Squill, ipecacuaha, and nauseants of a more stimulating character^ are all
used. I shall speak of them in their appropriate place. _

The patient is now using the balsam of copaiba, a most excellent article
in sub-acute bronchitis. Of the various terebinthinate articles, none is so
much used as this balsam : and where it is not resisted by the stomach, its
action is more certain than that of any remedy of this cJass. It probably
&cts upon the same principle which renders stimulants effectual in the de-
clining stage of most inflammations. It certainly is one of the most certain
remedies we possess in the treatment of chronic bronchitis, especially those
varieties in which the secretion from the bronchial tubes is much diminished.
In the chronic mucous catarrh, its action is less certain, but often highly ben-
eficial. Our patient will, in all probability, require no other treatment, as
he is already fast approaching towards convalescence. Other modes wiii
be appropriately mentioned, when I speak to you of the chronic forms of the
disease*

1839.] Ajiimal Magnetism. 105

Animal Magnetism* '

This is a subject on which our own facts are few indeed, but
as well wishers to truth, we purpose caHing the attention of our
readers to it. It were, in our opinion, better, had it been called
Animal Electricity; and Galvanism, Galvanic electricity. Cer-
tain it is, however, that it is a subject much more worthy of sci-
entific investigation tiian some otiiers to which much of the
attention of the ablest investigators has been zealously directed.
The powerful shafts of ridicule, abuse and evil report, have in-
deed been sped at it in as deadly and inveterate a manner as if
it had been a nonpareil in sin and unclsanness. But ^vere these
to be received in the place, and with the credit cf demonstrable
truth, what would be the lot of any man, when he frowns on the
vices of the multitude; as that of intemperance, for example ?
or what that of the aspirant after fame, fortune and usefulness,
when his successes begin to obscure the bright prospects of his
competitors?* or what that of him who comes cut fi'om the
world of sin, and walks in the commandments and ordinances
of his Creator ? It would, in many ca^es, at least, be i-hat of
banishment from the society, and the ccuntenance of the wise
and good, and of ruin irremediable. What ridicirle and abuse
have not been extended to the best of men, and even to the son
of God himself? It follows therefore that ridicule and abuse
are no arguments against any fact ; nor is the mere unbelief of
the wisest. We are not prepared to come forward r/ith a de-
claration of belief in all the things which have been said of
animal magnetism, for, like medicine arid all other things, some
of its friends have, in the fulness of their partial'ty and under tiie
excitement of party zeal, and of the inflictions of ridicule and
slander, caressed it almost to death. But in our researches af-
ter truth, and in our adoption of facts, as true, we have found
it a prudent rule of action to receive facts when given on such
authority as we cannot, oh a fair and impartial estimate, refuse
to receive on any or every ether subject. A man may dream,
or imagine, or he may play the somnambule ; but hovrever un-
yielding his reverence for truth en other occasions, v/e are not
called on for credence on these.

But when men who have been long before the world, and all
their lives have but connrmed more and more, every confidence
in their n|^ntal and moral sanity ; and when, in opposition to

*Was it not said of t^e Father of American Medicine, our own Rush,
that

< Times are ominous indeed

When quack to quack cries, purge and bleed I*

F G

106 Animal Magnetism, [Nov*

their own party opinions, and declaring themselves unbelievers,
they come forward from their sense of common honesty to na-
ture's truth, and declare facts calculated to favour their oppon-
ents, and make against their own party interests when, we saj
such men come before their own party-men, as members of the
Royal Academy have done, and state that they are unbelievers
in animal magnetism, but feehng bound to give the clear truth,
whatever may be its bearing, state that they have with their
own hands extirpated molar teeth, amputated female mam-
ma?, &c. &c. without the least painful perception of the opera-
tion by the patient, we are obliged to believe the fact alleged.
The truth is, that our difficulty in this matter is misplaced. Our
minds have been misled by the idea of magnetism being attached
to the human nature, and w^e have allowed ourselves to doubt,
and dispute facts, which, as* fair reasoners and philosophers, we
had no right to do ; when the difficulty was indeed only with
regard to the manner of the production of these facts. "We have,
very unwisely, (because the principle cannot, must not, be car-
ried oul, in other m.atters,) allowed ourselves to deny truths,
merely because we did not understand the laws by which they
were revealed. They have appeared to be contrary to our
ideas of the known laws of nature. Having set ourselves up as
the very priests of nature, and concludiug there were no other
rules by which she performed her offices, but those we know, we
have taken on ourselves the right of deciding that the fact could
not exist, because contrary to the laws of nature ! Who knows
the laws of nature ? Do you, reader ? Do I? No. We may
have learned by observation or otherwise some of them, as we
may some few spots on the surface of the earth, or a few of
the other world's v^^hich we behold delightfully, as brilliants in
the firmament ; but docs it follow that there are no lands nor
seas but those which we know ? or that there are not worlds
beyond the utmost limits of our ocular sense, assisted by all
the means of improving it, by taking advantage of the refrac-
tions and reflections of light ? The truth is, that men dislike to
own flatly that there are things in the world which they do not
understand ! It has been said, and surely v/ith general correct-
ness, at least, that all men desire to be thought better of in some
respect than they really deserve ; and that no man would be
content with all his sins written on his forehead. Whilst this
may be true may be admitted as barely so, this fact will not be
denied that there are those, and they are generally the least
gifted in intellect, v^ho would have the world believe tftre was
nothing left in nature which their intellect had not scanned and
encompassed and mastered. Such are ashamed to acknowledge
even a truth which is on evidence sufficient to make it as clear
as the noon-day's sun in fair weather, because by so doing they
would be forced to acknowled^rc their own isfnoranco of the

1838.] Animal Magnetism, l(fl

laws of nature concerned in its prodaction. It has been well
said that " the undevout astronomer is mad." We may say
the same of the proud philosopher. If not mad, he who is puff-
ed with this kind of leaven is as much out of place in the study
of nature as dandyism would be in the Christian's closet.

The fact is, that true wisdom, like true piety, tends to teach
one how small a portion of the Creator's wisdom he has in the
one case as the other does how little of the purity of His Master
he possesses both leading directly to the spirit of teachableness
of a little child.

Soi-disant philosophers thank their stars, or rather their schools
or teachers, that they are not, as some other men, ready to be-
lieve a fact, without knowing whence or how it came ; just
as the proud pharisee did his God, for not being as the publican
who felt and acknowledged himself a sinner before God. This
phariseeism is as inadmissible, and as much opposed to truth
and reason in philosophy in one case, as it is to genuine piety in
the other : in both cases tending only to prove that pride, instead
of teachableness and humility, possesses the mind and heart.

If somnambulism and clairvoyance are possible to human na-
ture, and it is beyond dispute that they have occurred in the
human system under certain morbid influences, they are but
phenomena, and the successors of certain antecedents or causes ;
and the production of the same phenomena by the agency of
men is nothing more than the simple fact, that man has learned
to imitate by art, those effects Vv^hich nature, by the operation
of her own laws, without man's assistance, developes. Compe-
tent causes produce them, and what the difference, whether these
causes are brought into operation by, or without the agency of
man, except that man has learned so much of nature's ways as
to design, and then execute, w^ith like effect. Nor is all this
more strange than that he should have reasoned out the fact that
a western continent existed, that he should learn how to produce
water by effecting a combination of its original elements, or that
he should make the canvass or the bleak marble declare and
perpetuate the history of men, or that he should reveal to the in-
tellectual eye the abstruse principles of physiology and pathol-
ogy, and operate on these principles, though ever hidden and
intactible, with his remedial agents as with implements, and
thus for a time, disarm sovereign death of his powerful and de-
structive weapons. Before the days of Franklin and of Rich-
man, who thought of arresting the vivid lightning in its destruc-
tive flight and subjecting it to the use of children as a playthmg ?
When phenomena so strange as the truths which are before the
world on the subject of what has received the name of animal
magnetism are presented, it becomes the solid student of nature
to look well to them ; and rather to investigate their rationale^
than deny the assertions of the most credible witnesses.

103 Animal Magnetism. [Nov.

We have said that, in producing at v.ill the phenomena of
somnambuHsm and clairvoyance, man has only learned to apply
by art, causes, and by them, opejate effects, \vhich unassisted
nature does. For some of nature's doings in this way we refer
the reader to the authentic accounts of a goodly number of our
northern professional brethren, for the facts of somnambulism
and of clairvoyance arising in cases of disease under their own
care facts which he has no more right to dispute than he would
the statement of a respectable physician of Charleston that black
vomit had occuiTed in some case of fever during the present
season. We have also learned from an unprofessional source,
but not less to be depended on for that, the fact, that somnambu-
lism and decided clairvoyance have been recently displayed, as
the operation of disease on a female in a neighboring state, and
that these phenomena were often repeated and with considera-
ble regularity, for a length of time. We are satisfied that the
facts of this case can be given on testimony which no southern-
er, at least, will pretend to deny, and we trust that this case
will be reported, as it should be, at an^ early day. The lady
has, v.-e understand, entirely recovered her health, and is not
conscious of any thing which passed on the occasions of her
somnambulism ; but having been tcld that the peculiar pheno-
mena of her case excited much curiosity, is most absolute in not
allowing her most intimate friends to say any thing to her on
the subject

In ca::es of this kind in philosophy, one of three courses has
to be adopted : we must make a flat denial of the facts alleged,
or pass them by in silence, or give loose to our investigating
powers, in order, if possible, to develope the true philosophy of
the case. The first cf these courses is that generally adopted
by these who are denominated " the unbelieving" on the subject
of animal magnetism, so called. The second it is not a little
amusing toobserve how silent philosophers generall}^ and phy-
siologists particularly,* are on the subject of a lady in a northern
state, who exhibited in her own person very strange and rare
electrical phenomena for several months in succession following
the aurora borealis which appeared in the early part of the last
year a case, which, for its strange nature, is a very good par-
allel with claix'voyance. The tiiird and only other cause is that
which but few adopt ; for it is- considered hazardous, and is
known to be troublesome to exert one's" self for the support or
explanation of phenomena so at variance with the common
course of events and the hiowii operations of moral or physical
causes, as the phenomena of animal magnetism, and the electri-
cal phenomena of the lady to whom we just alluded.

We have ever been of the opinion that the solution of the
strange problem of animal magnetism would be found in the

*Except Professors Silliman and Mussey and Dr. Hosford.

1838.] Animal Magnetism. 109

laws of electricity, and in this opinion we have recently received
support from some of the facts of M. SousseHer which we have
noticed in the French manuscript to w'hich we had occasion to
refer in our last ]\o. when writing on the subject of medical
electricity. The following are^ome of his observations on this
subject. ' After treating on the manner of applying electricity in
tiie treatment of many diseases, M. iSousselier commences his
ix. chapter, " on the manner of treating by touching," thus :

Abbe Nollet, and several physicians and druggists, tried, about the year
1742, to treat patients and particularly paralytic^-, by electricity ; but they
only thought of the use of sparks and shocks. These wise men would soon
have been undeceived, had they reflected that nature, which is continually
working for our good, does not affect the body by sparks and shocks. They
would then have studied the means of obtaining, dividing and distributing
the electric matter at their will. When thunder strikes a person, it is a
spark coming out of a cloud, and entering the earth, whilst the man inter-
vening between the two is stunned. When a person draws a spark from
the conductor, or is submitted to the electric bath, the volume of matter is
not great enough to wound ; but when he is exposed to the shock, it is the
Bame matter accumulated in the leyden bottle in a large quantity, which
passes from one arm to the other in its return to the earth. When this
same force is applied to a quire of paper all the leaves will be pierced through.
If you give the shock to the branch of some delicate plant, the branch will
die a iew days after.

Stihlam aware that this abominable plan of treating epilepsy and other
complaints, is continued in use. Numbers of unfortunate persons who are
afflicted, seduced by recommendations, expose themselves to a miserable
death in thus satisfying the cupidity of a man who ought not to be ignorant
of the fact, that the matter which pierces a number of leaves of paper, also
pierces through the breast. Let such a man keep a list of the persons he
attends let him look over it two years after, and if then he find one lialf
alive, it will be a great deal, and he 'will be able to see in what condition the
others will be. 1 know that the answer is that some persons are cured by
thunder ; a thing that is not impossible. It might have happened that the co-
lumn of matter having passed through the body of the patient, had relieved,
or even cured him ; but I know a person of good constitution, having never
had a pain in the breast, who every time he receives the shock, spits blood
immediately after. Frequent shocks are calculated to destroy the best con-
stitution.

As to M. Mesmer, having no relation in the capital by whom I could
acquire any other knowledge of his operations, but by his views and purpos-
es w^hich were spread before the public, which often appeared opposed and
contradictory to the principles I knew, I had no \,'ay of imitating his method
but by knowing its effects. If they told me he gave a fever or a looseness,
they added, he could cure the one or the other at his own desire. At length,
however, a person of my acquaintance, on her return from Paris, came to
visit me, and told me, tliat having suffered fever and pain, with spitting of
blood, she w^as advised to take, for her physician, a scholar of M. Mesmer.
This physician assuring her that her Ulness w^ould not be of long duration,
placed his hand upon her liver, where he held it about ten minutes ; after
which, he passed his thumb along her bod}^ from the top of her head down
to her feet ; which operation he repeated about fifteen times ; always turn-
ing his hand in another position each time.*

*We understand the writer to mean, that in returning the hand to the
head after each pass, as it is called, the ends of the fingers and the thumb
are turned off from the bod v. Ed.

no

Animal Magnetism.

[Nov.

This physician told her tliat she would perspire eo much that she would
wet three or four linens ; after which, she could eat a pottage. He advised
her to dissolve some cream of tartar in boiling water, and drink to her thirst.

This person certified to me that, after that operation she felt no more the
pain m her side that she had sweat a great deal had eaten the pottage,
and the next day was clear of the fever. She kept her room, however, and
continued drinking the solution of the cream of tartar.

M. Sousselier, pleased with tliis effect of P.Iesmer's medica-
tion, adopted the following plan to discover its nature and the
manner of using it :

M. Mesmsr announced that the agent which he made use of could be re-
flected by looking-glasses. I knew that some persons had experienced
some peculiar sensations (m having an iron red, a stick, or a sword, placed
near the body, whether touclied by it or not, and that others again had felt
nothing. I rightly imagined that the svarMing electric matter was not
suited for these trials ; I therefore made a small resinous cake of electro-
phore upon a piece of wood, four inches in diameter, and a little more than
an inch in thickness. I prepared a small pointed iron rod, and had made a
pair of silk socks. Some days after, I put on my socks and silk stockings
over them put my little rod in my pocket and charged my resin cake, which
I wrapped five or six times with silk stuff. In this situation I put it in my
bosom, with the bottom turned towards my bodj'-, so that I could remove
the stuff on the side next the skin, that I might receive the matter and be
able to communicate it. Thus prepared, I went into the parlour, where
there was a young man about twenty years of age, m good health, and ap-
parently, a strong constitution. I begged him to stand up before a glass,
with his face at the distance of about fifteen inches. I requested him to fix
his eye on the glass, as I wished to direct a rod opposite his right eye in the
glass. I then took the small rod, and directed it exactly towards the right
eye in the glass. I then asked him if he felt any thing in his right eye : he
answered that he felt a coldness which he did not in the other. After four
or five minutes, seeing the coldness did not increase nor diminish, I caused
him to stand off some pace?, and standing up, I presented the point of the
rod near his body. On moving it in various directions, it was not long before
he told me that it seemed to him that he had dust in his mouth, which filled
up more and more. I kept him in that situation six minutes ; and fearing
that I should make him suffer, I told him to set down ; which he had no
sooner done than he told me, with an air of impatience, to " take away the
harm I had given him" that " he could neither spit or blow his nose." I
told him he had nothing to fear, for in a quarter of an hour he would not
suffer, which was the case. A few days after, I proposed another experi-
ment, but he refused to undergo it.

The little cool wind he felt in his right eye, was the same matter with
which I was impregnated, and which escaped to him by the point of the rod.
This goes through the glass but slowly, and is thrown back by the mercury
upon which it has no known effect.*

A young girl whom I had attended and cured of a convulsive hiccough,
had suffered a return of that troublesome disease a year after. She returned
to my treatment which did not appear to produce tlie desired effect. I caus-
ed her, with her mother, who came with her, to spend a day in my wife's
apartment, with a physician who was near me. I prepared myself in the
manner before mentioned, and then rejoined the company ; when 1 caused
her to stand up in the middle of the floor. I removed the silk without bemg

This passage seems to shew the writer's ignorance of electrics and non-
electrics.

1838.] Animal Magnetism. 1 1 1

perceived, in order to place myself in communication with the bottom of the
resinous cake. In that situation, I put my hand upon her stomach without
questioning her. It was not long before she tv^ld mo that I made her suffer
a great deal in the stomach. I asked her if the pain was so acute that she
could not bear it still for some time ? Siie replied that, if it increased any
more, she could not stand up. I then withdrew my hand and made use of
my rod, by passing the point at the distance of an inch, from the forehead
down to the lower part of her legs, and repeated the same process, taking
care to turn the point of the rod in another direction as I brought it back to
the head. I had not repeated t4iis operation the tJiird time before she told
me she could name to me, with her eyes shut, every part where I presented
my rod that sjie felt it every where, but more particularly at the stom.ach,
where the pain was more acute. I took this patient in preference for this
experiment, because I knew her nerves were very sensitive.

M. SoLissclier next gives the case of his own son, laboring
under what he called "fever and putrid looseness ;" which was
as follows :

My son, sixteen years of age, was taken sick in the month of April, 1783'
The fever was violent, and attended with great weariness and entire weak-
ness. As the measles were then prevailing in the part of the country where
I lived, I thought it best to advise no remedy. The physician who attended
was of the same opinion. Bat a putrid looseness came on, which increased
daily. On the seventh day of his disease, his pulse was so bad and his sense
of fatigue so great, that I judged that danger was near. The physician pro-
posed to me to purge the patient, which I refused to do telling him at the
same time, that I would attend him in m^y own way : but that, in order to
a better judgment on the effect of the treatment upon a disease of this kind,
I would not commence until the next morning.

Early on the morning of the next day, on entering his room, I found that
he had passed a very bad night, without any change of his pulse. Prepared
as before mentioned, I p"ut my hand upon his hver for ten mmutes, and
passed my rod about a dozen times from his head to his feet, in the course
of the day, but perceived no change whatever, in the disease. The next
day I repeated the same thing ; and in the evening found his pulse better,
and a moisture on his skin, which never was the case before. From this
moment, I received the greatest hope. The tliird day I continued my own
method ; and by night, the perspiration was restored and the looseness con-
siderably dimidished. On the fourth day, it ceased almost entirely and the
fever w^as nearly subdued. On the fifth, his appetite returned and he be-
came convalescent, wlien I discontinued my services. But being taken,
three days after, wnth an indigestion and violent fever, f repeated my pro-
ceeding three or tour days after which, the child was cured.

The next, and last case of this practice of M. Sousselier,
which we shall give, is one of rheumatism :

I went to the house of one of my relations, (says M. S.) who was attacked
with rheumatism, which was so severe as to confine him to his bed, without
sleep or rest. This relation did not at all believe in magnetism, but consent-
ed to my offer of my owm powers. After having touched him ten minutes,
he was somewhat reUeved. The next day the patient told me that he had
slept well and suffered less. I repeated the course. On the third day he
arose, suffering very little. I touched liim again ; and on the fourth day he
walked out, in good health.

It was from these experiments that M. Sousselier, believing
the effects wrought were by the power of electricity, invented
** the box," a description of wliich was given in our last number.

113

Animal Magnetism,

[Nov.

It is evident, we think, if reliance may be placed on the state-
ments of M. Sousselicr, (or the manuscript, which we believe to
be the minutes of a gentleman of that name,) that electricity is
imparted in the common process of magnetising, as it is called.
Considering, however, the many circumstances attending the
operations of animal electricity, many things are to be consider-
ed in explaining all the real phenomena of animal niagnetism to
which M. S. appears to have been an entire stranger. For ex-
ample, he appears to be entirely ignorant of the fact of the gen-
eration, or rather the de-latentizing of electricity in the animal
system ; a fact which the writer of the present article feels,
stands on an immovable basis, and is constantly and easily de-
monstrable. This ignorance caOsed him, in addition to insulat-
ing his body with silk stockings and thick silk socks, to charge or
rather excite an electric, and place it in communication with his
body, under the belief that this would, and did, impart to him the
extraordinary charge with which he operated. Had he under-
stood the fact of human or animal origin of sensible electricity,
he would have been led to observe that the insulation alone, in
suitable weather and circumstances, would have sufficed to im-
part to him all the powers he really had under the application of
the electric ; for we well knov/ that this electric, placed in con-
tact with his skin, could not continue to generate new and succes-
sive supplies, but imparted its whole charge at the first moment
of contact; and this again, was equalized with other things on
the first touch of the insulated body. But we may conceive the
fact very different, Vv'hen vre consider that, as really as in the
Silurus Electricus, the hunian body has within itself all the ap-
paratus necessary' for the developement of sensible electricity
necessary for all the common, and even extraordinary electrical
powers or phenomena which the system presents, whether phy-
siological or pathological ; it is easy to conceive that successive
powers may as well be offered as successive sparks from a prime
conductor : and this is evidently the case in those rapidly suc-
cessive contractile efforts which make up the common sensible
action of a muscle, or common muscular movements. Looking'
into this doctrine, and contemplating the various structures and
temperaments of different human beings, and their various con-
ditions in life, v/e find that the electric power of these differing
individuals, must differ essentially ; hence the greater magnet-
izing powers of some, than others. Nor would it be straining
the known laws of electricity too far to suppose that, as this
fluid ever tends to equilibrium, and as the electricity in one body
often influences that of another, and as the influence of the
mind on the organism is sufficient to influence the electrical phe-
nomena presented in the sam.e, so different phenomena may be
induced in different individuals by the same extraneous influence :
or by the same internal extraordinary impulse, as in the oper^i-

1838.] Animal Magnetism. 118

tion of the mairnetizer in the production ofclairvoyance, &:c. in
some and not in others ; and the same phenomena resuhin^^ |Vom
morbid action or condition. We should be pleased to see M.
Sousselier's experiments repeated on his own phin, and also
with the appHcation of the electric cake or plate to the body.

If there be truth to any extent, in tiie phenomena said to
occur ur.der eiiher the operations of Mesmer and his followers,
or Sousselier, wiiich may influence disease in a salutary manner,
or even mitigate the severity of capital operations of any kind,
medical philosophers are culpably negligent of duty in failing
to know the fact, and to avail themselves of its benefits. We
shall be pleased to receive any well authenticated facts affirma-
tive of the truth of such powder. Negative facts could not al-
ways be so satisfactory, not because of any partiality on the
subject which we would favor, but because, judginur from our
opinion of the diflering peculiarities of the human sulje-^t, exper-
iments failing to produce the results searched for, could not be
conclusive, as different individuals differ immenselv in their nat-
ural electrical powers. This is evident in the different opposinsf
temperaments, as the sanguine and melancholic. 6lc And still
more one well authenticated fact establishes more truth than
ten thousand attempts which fail to produce the same can coun-
tervail.

In conclusion, we insert from the Lancet and, subsequently,
the American Journal, the following facts from the pen of Dr.
Sigmond, a gentleman whose observations and instrucii )n in
medical science are received by all ; whose judgment seems to
be of the best cast, and whose statements of facts, no one will
venture to question.

Animal Magnetism. It would appear from our Journals that animal
magnetism is makinor decided progress in London, and that some %-ery dis-
t'miruished men of that capital have become converts to a greater or less
extent, to its verily.

It IS to be hoped that now so many able men have their attention directed
to the subject, that whatever modicum of truth there may ba in this supposed
power, will be estabhshed, and that the great amount of fallacy which is
mixed with it will bs fully and irrefragab'y exposed.

In the meantime the following extract, from a communication to the Edi-
tor of the Lanc?t on th3 subiec% by Dr. S gmond, will be read with interest :

"I entered the fiel 1 ofin-j-jiry as a skeptic, and as sue j, after my inquiries.
I remain, as to the belief thi*. any individual is in possession of a power, save
that which the strong mnJ exer.s over the weak one, by which he can ex-
ercise a preternatural effect over the human frame. I totally disbelieve the
existence of any fluid which can, at the will of an operator, be made to pass
from his body into that of another, and thus, at his command, produce un-
wcn'ed sensation.

" In the course, however, of my imitations of the operations 1 have seen
performed by other?, I have observed certain most singular phenomena to
arise, with which I was previously unacquainted, and which, I think, are of
some value; and which, by the cautious investigation of the hghlyintellectu-
al men who are constantly seeking to add to the means of prolonging life,
and rendering it happier, may yet be found to lead to some physiological and
G 7

Animal Magnelism, [Nov.

psychological facts. I merely wish to state what I have observed, and to offer
to show that certain consequences result from a pecuhar kind of manipula-
tion, which may easily be acquired, and which, if practised with dexterity,
in some instances, might be productive of considerable influence in different
conditions of the body.

" Some weeks since the Baron Du Potct de Sennevoy, did me the honor
to invite me to be present at a trial of his magnetic power at the University
College Hospital. I there saw him perform a series of actions upon different
individuals, and he, in two instances, produced what may be termed artifi-
cial sleep upon two females, and this was the full extent of his success ; his
other attempts were failures. The successful cases, however, arrested my
attention ; they seemed to be the result of simple means, nor could there, at
least I thought, be a doubt that the same power existed in any individual
who chose to exert it. This species of magnetism, I must observe, differed
very materially from what I had seen practised many years since by a pupil
of Dr. Maineduc, at Bath; it had less pretension, and was much more prac-
ticable. From the Httle opportunity I had of judging of the Baron Du Potet,
I drew the conclusion in my own mind, that he felt an honest conviction
that he was possessed of a peculiar faculty, and most distinctly do I acquit
him of any intention of playing upon the credulity of those by whom he was
surrounded ; but I ieel that I have a right, with the same candour, to say,
that 1 do not think that he is aware how he produces the extraordinary effects
that followed his manipulations.

" I immediately determined to investigate the subject, and for that purpose
tried a great number of experiments ; but 1 was most unwilling, for a great
length of time, to make my observations at all public, because 1 thought that
I might be accused of seeking notoriety by investigating a subject which
rather belonged to the community th^jn to the profession, and one which
seemed to be addressed to the popular feeling so easily excited, rather than
to the calm and dispassionate consideration of the followers of science.
Finding, however, that two distinguished members of the profession. Dr.
Elliotson, and 3Ir. Mayo, thought the subject worthy their attention, 1 per-
severed in my observations ; and, added to this, I was invited by an illustri-
ous individual, whose regard for the medical profession, and for every thing
connected with it, I have, from my official position, had opportunities of wit-
nessing and admiring, Fiarl Stanhope not only attended the Baron in his
visits to the hospital, but devoted the energies of f.is highly cultivated mind
to an examination of the merits of the system, and he did me the honor to
express his wish that I should prosecute the labours I had commenced. As
a lecturer, too, I thought this a subject intimately connected with therapeu-
tic powers, and as, by the publicity of your Journal, I am standing before the
profession, I have felt tiiat I am not intruding myself by giving the result of
my experiments. These have been performed, of course, with the full cer-
tainty that I possessed no peculiar power which could be productive of any
effect that might not attend upon the exertions of any other individual. The
extent of my examination has been such as to satisfy me that I can produce
a sleep of a very unusual character, by certain manipulations which do not
require me to be in actual contact with the person upon whom the operation
is intended to be performed ; that I have acquired a certain degree of expe-
rience, by which 1 know how to accommodate the manipulations for the
purpose required ; and that I can communicate to another individual, in a
short space of time, all the information necessary for the production of this
sleep.

"I commenced my series of experiments by imitating the actions of the
Baron Du Potet. My first subjects were of the uneducated class ; but I
found them so prone to believe in the marvellous so anxious for extraordin-
ary results, that they deceived both themselves and me. I have since tried
the same manipulations upon the higher classes, and though I find them

1838.] Animal Magnetism. 115

much more sensitive to every impression, and their nervous system n^ore
easily acted upon, and although occasionally, the imagination has led some
of them away, yet I have succeeded in giving a very peculiar sleep, amount-
ing almost to stupor, to a vast number of mdividuals. I have constantly
found females much more susceptible of the influence than men ; nor does
it produce upon them all precisely the same state of sleep. For while in
some it is a sort of trance, during which, as often occurs in that unnatural
state, pain is scarcely felt, in others it produces hysteria, convulsions, and I
have hkewise known fainting occur. The most remarkable case that has
fallen under my observation, and which, while it excited in me great anxiety
and the deepest interest, has taught me to prosecute my researches with
extreme caution, has occurred to me within the last two days. I was enjoy-
ing the hospitality of a most amiable family in Fitzroy-square, when animal
magnetism became the topic of conversation, and I related the trials I had
aheady made. One of the young ladies proposed to become the subject of
experiment, to which I very willingly assented ; for, having on former occa-
sions attended her during momentary sickness, I was fully aware of the
natural strength of her constitution, and the absence of that nervous temper-
ament which renders this system totally inapplicable. I began what are
technically called " the passes." They, as is not unusual, excited laughter
and increduhty. I proceeded, for about five minutes, and then stopped and
inquired if any sensation was produced, and the answer was, " a slight
sleepiness ;" and ridicule was again thrown upon the subject. 1 recom-
menced the manipulations ; I observed tJie eyelids falling, and at last they
closed ; but, as the same incredulous smile remained, I persevered for three
or four minutes, when I, almost doubting Vv'hether any influence had been
produced, inquired what the feelings were ; to this no answer was returned.
I found my young friend was in the most complete trance I had ever yet
witnessed as the result of my magnetism. The stupor was most profound ;
and I then tried the usual means to arouse her, but they were vainly exer-
cised. After a few" minutes I found the hands become icy-cold, the face lost
its natural hue, and became perfectly pallid; the extremities became quite
cold; the respiration was imperceptib e ; the stimulus of light did not affect
the eye ; on speaking to her a faint smile was excited, and a quivering of
the lower jaw, which seemed to indicate a wish but an incapability of an-
swering ; the pulse became gradually feebler, whilst the external appear-
ance altogether bore such a decidedly deathly cast that naturally some ap-
prehension was excited amongst her family, by whom she was surrounded.
Of course I could not but feel a certain degree of anxiety and regret that I
had produced such a state, and much uneasiness at the thought that I had
inflicted a moment's alarm to my kind friends. These feelings were howev-
er, less acute, from the full knowledge I entertained that the family had long
reposed the most perfect confidence in me, and that no member of it had that
nervous susceptibihty, which would have embarrassed me had any untoward
accident presented itself.

" 1 placed the perfectly unconscious subject of this distressing scene in a
horizontal position, and directed the application of warmth and of friction to
the extremities. Circulation and animal heat were gradually excited, but
she presented a most singular appearance of suspended animation. In tins
condition she remained more than four hours, for I had commenced a little
after ten in the evening, and it was about half-past two, that, on some slight
effort being made to rouse her, she uttered some of the most piercing shrieks
I have ever heard; there were convulsive efforts to raise the limbs ; the
face, too, became convulsed ; she opened her eyes and stared wildlv around ;
she was placed in the upright posture, and seemed sensible. Advantage
was taken of this circumstance to carry her to her apartment ; before, how-
ever, she could reach it, she fell into a profound slumber, but its character
was more natural. She was placed in her bed, appearing perfectly compo-

116 Animal Magnetism. [Nov

sed; the countenance had acquired its natural hue; the respiration was
perfecly easy, and tJie pu]?e natural. In this state she remained during ;he
whole of the day, until 9 o'clock in the evenin^f, once only openirg lier eyes,
and addressing a few words to an anxious and alieclionaie sister who never
left her side. In the evening the young lady joined her family perfectly rt?-
tored to her wonted cheerfulness. She expressed no complamt whatever.
She stated that the feelings that first rameover her were those of extreme
quiet tnd repcs?, a species of ecstacy a gradual languor seemed to steal
over her; that she heard something passing around her ; felt an inclination,
but an utter impossibility, to reply. The first waking up she, however, de-
scribed as almost terrific. It was as if she was bursting fiom a narrow and
confined space, and as if she arose from interminable darkness. The lesson
that I have thus learnt will not be lost upon me.

'It is upon the respiration that my efforts are directed, and the pr'nciple
is percisely that which is called "stealing the breath away," besides which
bythe undulations of the air caused by the movements of the hands an unu-
sual cold is produced which very much assists the effect. The art seems to
me to consist in obliging thy individual again to inspire, by the nostrils, the
carbon he has already expired, whdst the currents of air caused by the ex-
tended fingers produce some effect upon the facial nerves, thus inducing the
eyelids to fall down. Association ot ideas is very strikingly evidenced by those
who have been once magnetised, for then the slightest quantity of manipula-
tion is necessary ; the patient evidently having acquired a habit < t inhalation
by the nostrils. It is from the centre of the nose downwards that the efiect
is most speedily induced, and that the drawing of the hand downwards from
the brow, so as to effect the eyes, I find to be quite unnecessary towards pro-
ducing the effect. I do not consider the process I have employed by any
means perfect; and I have little doubt, when the attention of the profession
is drawn to the subject, that considerable improvement may result ; at the
same time I am persuaded that the manipulations may be the cause of very
great alarm. I have now exercised this art upon nearly a hundred persons,
and with very general success in the fairer part of creation ; I have quieted
dehrium and given sleep where it has been for many nights vainly solicited.
1 have magnetised in the presence of many medical men who have been in
attendance on the Baron Du Potet's lectures, and they have declared that
the sleep appears identical with that he produces, and that it is proved by the
fact that animals may be sent to sleep by the same movements. I am very
anxious that the members of the profession should try the same process."

1838.] Operation of the Thigh Spontaneous Rupture, ^-c. 117

1'art III. MONTHLY PERISCOPE.

Sticcessful opL'.ratinn for permanent adduction of the Thigh.
On page 671, vol. II. of this Journal, in giving tiie account of
M, Lutcns' operation for retraction of the leg, we inentioned
thai a case of similar nature had been recently presented to the
Professor of Surgery in the Medical College ofiieorgia that
he had determined on making a section of the disorganized
flexor longus fenioris, which was the cause of the functional
impairment ; and that the patient was then in preparation for
the operation. This patient recently returned, to the city, pre-
pared for the operation, which was performed by Dr. Eve on
the forenoon of Tuesday the 9th (Oct.) inst. To-day, (15th
Oct.) availing ourself of the politeness of Dr. Eve, we saw the
case at the first entire dressing, full six days after the operation,
and had the pleasure of witnessing a complete adhesion, except
some part of the superficial integuments; with restoration of
free abduction of the thigh restoration of the proper length of
the limb, which, by the fixed inflexion of the thigh on the lower
part of the pelvis, as we had before witnessed, was more than
an inch shorter than the healthy side, when extended together;
and a partial, but improving restoration of the rotary motion of
the limb. Animal lig.itures were used in this operation on two
small vessels, but have not in the least interrupted the adhesive
process. Nothing now remains of the wound but the cicati'iza-
tion of a part of the superficial integuments, which will be com-
pleted within a day or two. Thus has the operation proved not
only perfectly safe, but successful. Nothing short of new dis-
ease, or extreme imprudence of the patient, can cause ultimate
ill success. We found the patient to-day, out of bed, and occu-
pying a chair with perfect ease.

We hope soon to favor the profession with the details of this
very interesting case, from the pen of the operator.

The following facts w'ere communicated to the Editor by
Paul F. Eve, M. D., &c.

Spontaneous Rupture of the Uterus during delivery On the
27th of last July, I was requested by my friend Dr. Burt of Edge-
field district, S. C, to meet him in consultation at Mr. D.'s, 18
miles from Augusta. On arriving there at 1 o'clock, P. M., I
learnt that a stout well made negro woman, asred about twenty-
one years, had been sev-eral hours in labor. The doctor having
been called to another patient, had left her at day-light. The

118 Necrology. [Nov.

old woman in attendance, stated that an arm of the child had
been down, with the hand out, for some hours that the labour
pains had been very strong until about sun-rise, since which
lime they had ceased, and the patient was easier. I found her
with sick stomach and occasional vomiting of bile, pulse very
frequent and feeble, and the abdomen tender to the slightest
touch.

Upon touching, I felt a hand of the child with the cord in the
vagina, which receding upon the slightest eflort at introduction,
was followed by my hand into a very relaxed cavity. Feeling
the edge of the ruptured womb, I took it at first for the placenta,
but on following the child with my hand, I was soon undeceived.
There was no pulsation in the umbilical cord. I brouojht down
the feet and by turning completed the delivery the only impe-
diment to it being the re-passage of the child's head through the
rupture, into the vagina. The placenta was found in the fundus
of the womb and easily removed. I again introduced my hand
to be assured of the exact nature of the case before me, and dis-
tinctly traced the rupture, which was transverse and just above
the OS lincae. Dr. Burt having arrived during the delivery of
the child, I was anxious he should examine the patient, but from
her exhausted state and unwillingness to submit, he in kindness
desisted.

There were no marks of violence upon the arm or hand of
the child, and nothing had been given to increase labor pains.
There were no disproportions between the head of the child and
the pelvis of the muther. The patient had had three living child-
ren, and the child now delivered was of the ordinary size, or
perhaps a little larger, weighing about eight pounds. 'The only
difficulty in the case was the presentation of an arm and an um-
bilical cord, from this cause then, the uterus was ruptured.
Our unfortunate patient died in 24 hours after delivery.

We hasten to correct the errors of carelessness, or of trans-
lation, contained in the following notice of Dr. Physick, especially
as we have some reason to apprehend that the notice taken by
the Editor of the Gaz. Med. de Paris was from the obituary con-
tained in the 5th No. of the II. vol. of this Journal, to wliich we
refer the reader.

" Necrology. The Dean of American Surgeons, Dr. Phy-
sick, Professor in the College of Georgia, has just died at a very
advanced age. Dr. Physick merited the title of the Father of
American Surgery, of Dupuytren of America. The Medical
Societies of the United States have resolved that all their mem-
bers wear mourning for thirty days."

1838.] Anomaly of the ManwKE, il9

We have translated the above notice from the 25th No. Tom.
vi. (June 23d, 183S,) of Gazette Medicale de Paris. This forci-
bly recalls to recollection the first time our French brethren had
occasion to refer to the name of the late illustrious American
surgeon, Dr. Plnlip Syng Physick it was then published Dr.
Philip Syng, Physician of Philadelphia.

We must inform our French brother, the Editor of the r>Iedi-
cal Gazette of Paris, that Dr. Physick was never in Georgia, that
we know of, and our Medical College was certainly never hon-
ored by his name among its professors.

A singular anomaly of the mammcc of a woman, presented to the
MedicO'Cliirurgical Society of London. By Dr. Lee, Prof,
of Obstetrics in St. George Hospital.

A woman, aged 33 years, had just been delivered, before the
full term of her first child. Her mammae having become ex-
cessively painful and enlarged, she C(.>nsulted Dr. I.ee. Upon ex-
amining them, this practitioner found foz^r manimce. instead of
two, with as many nipples, two on each side. The inferior or
pectoral mammas are very well developed and normally situated
their nipples, their areolae and their glands offer nothing pe-
culiar. Aear the anterior edge of the axilla of each side, and
above those just described, is another mammae of one-sixth of
their volume. The nipples of these two latter are small and
flat, but give an abundance of milk upon the slightest pressure
of the fingers this fluid escaping by several small holes as in
the common breast. In pressing the milk from the inferior
mammae, there tiovvs at the same time a small quantity from
the superior nipples, and when this fluid escapes from the first,
the others constantly swell and harden. The woman suckles
her child alone by the inferior mammae ; the superior are not
servicable, because of the smaliness and flat state of their
nipples.

After this fact, Mr. Stanley reported another analagous to it.
A female entered St. Bartholomew Hospital to be disembarrass-
ed of two inconvenient tumours which she had on each side of
the axilla. Upon an examination, it was discovered that these
two tumours were nothinor else but two supernumerary mammae
without nipples ; in the place of nipples there were orifices from
which flowed an abundant quantity of milk. The woman nursed
at this lime ; the child's mouth was applied to these mammae,
but it ccuM not take them on account of their smaliness. The
patient left the hospital without being subjected to any operation.

[Gazette Mtdicale de Paris.

$

120 TreatDieM of Aneurism. [Nov,

Aneurisms in both popliteal regions ; ligntiires to the two femor'
al arteiies ; cured. By G\vy?;^e Uird, {Surgeon to the JSvvan-
sea Infirrnars'.

David Philips, a porter, nged 3S years, very robust and a
great drinker, was admitted the 3d Jan. 1S37, to be treated for
two aneurisins which he had, one in each ham. This disease
declared itself two years ago in the right, and since only some
weeks in the inferior extremity ; at least, the attention of the
patient was only directed to it at these periods. That in the
right had rapidly increased lately.

Mr. Bird found in the right hain, a considerable tumour com-
pletely lilling the popliteal space and even extending beyond it
laterally. In the left ham, tl-e tumour was less considerable
and less firm, its volume beiu^: about the size of an orange,
'i hey both exhibited the oniinary cliMracteristics of aneurisms.

Shortly after the patient entered the infirmary, the tumour of
the right side made progress, threatening to become diffused
and to bur^t. Mr. Bird requested a consultation, and an oper-
ation was decided upon by Messrs. Rowland and (.'ohen.

Operation.-^ThQ 7th Jan. the femoral artery was tied after
the manner of Hunter. Every thing went on well ; the ligature
came away on the 1 3th day , the wound cicatrized ; and the
tumour w^as effaced.

The 7th of March ^^Iv. Bird tied the femoral artery of the op-
posite limb, and the pulsations in the tumour were completely
arrested ; but two or three days afterwards they re-appeared,
although a little less strong than at first. The ligature of this
artery came aw^ay near the seventh week, preserving its ring
made by the knot and proving that the vessel had been tied and
obliterated at the place of the wound. The return of pulsation
in the tumour could only consequently be exjilained by the in-
tervention of some anastomosing branch communicating with
the aneurismal sac. The wound cicatrized, but the tumour be-
came as large as before the operation.

It was determined to wait before attempting another opera-
tion; the patient rose from his bed, walked pretty well, and
finally left the hospital the 4th of May, with the promise to re-
turn from time to time, in order that his case might be watched.
He gradually resumed his former occupation ; the first tumour
had entirely d'sappeared, and the other, instead of augmenting,
remained at first stationary, then its volume and pulsations gra-
dually diminished, and at last it has completely vanished.

On the 14th Jan. 1838, this individual after a careful examin-
ation, was declared radically cured.

From the above, the Editor of the Medical Gazette of Paris,
remarks, that it can be said with truth, that the treatment of

1838.] Intussusception Tomato. 191

aneurisms after the manner of Hunter, is one of the greatest
triumphs of modern surgery. The two femoral arteries had
already been tied with successinthe same individual (V. Scarpa);
so also the two carotids ; but the case just reported claims our
attention from another circumstance not less important the
return of pulsation in the tumour. Hardross, we believe, was
the first to properly appreciate the return of blood in a ligated
artery. Whatever may be the size of the anastomosing branch
which communicates with the aneurismal sac, if the ligature to the
arterial trunk retard the movements of the blood, it will suffice to
effect a cure in the end. This retardation, in fact, provokes the
successive deposition of layers of plastic lymph in the sac, and
the tumours are gradually obliterated. This took place in the
patient whose history we have just read. Gaz, Med. de Paris.

A new means of curing Intussusception in Infants. Dr. Mit-
chell, who has had occasion to meet several times w^th cases of
intussusception; in one of this nature, having tried all the usual
remedies without success, had recourse to the followmg expedi-
ent : He introduced into the rectum, as 'high as possible, a gum
elastic catheter, then adapting \he nose of a comm.on bellows, he
distended the intestine by a large quantity of air, which loosened
the strictured portion of the digestive tube. The symptoms of
strangulation disappeared as by enchantment, the bowels were
freely opened and the child was cured. This, however, is the
only case in which this means has been tried.

It must not be dissembled that great difficulties exist in the
employment of this remedy in infants, on account of tlie equivo-
cal state of the diagnosis. If it is true, however, that the vom-
iting of stercoracious matter, as Dupuytren has established, is a
certain sign of intussusception, then v.'e would be sufficiently
authorised to employ the means proposed by Dr. Mitchell. It
is but right besides, to recollect that the same mode has been
recommended by O'Beirne (and before him, by HaufF, Busch
and Kohler) against. strangulated hernias.

Tomato. The editor of the Boston Medical and Surgical
Journal has been gravely asked for his opinion upon the medici-
nal virtues of this plant, by a correspondent, who says "there
seems to be a prevalent opinion that the tomato is the matchless
sanative^ &c. We hope this enquiry was not gravely made
by any physician ; for we think it quite bad enough for the com-
mon people, who are not willing to trust in the opinion and
advice of men of medical science, to be gulled and hoaxed out oi
n 8

182 Tomato. [Nor.

their money and their lives, by gulping down every imposition
which the thousands of impostors are daily pressing on their
attention. " If I must tell you," said a travelling agent, when
pressed by us, not long since, to know why he was so anxious to
see certain druggists for whom he was in search, " if I must
tell you,** said he, " I have eighty or an hundred of Jewett's
physicks to put off on the people here, and I must do it, as I get
a fat salary for my services, and I must be faithful to my em-
ployer." And accordingly, ten days had scarcely elapsed before
almost every mantle-piece was burthened with bottles of Jew-
ett's Liniments, for different purposes ; and the rude composition
of hog's lard, cayenne, &c. sold to the people, at something like
seventy-five cents per ounce a speculation nearly or quite equal
to the sale of Thompson's Book of 37 1-2 cts. for $20. No great
harm has been done by this, because it was an external applica-
tion. We found a few persons, intelligent on other subjects, at-
tempt its internal administration ; but without much success in
promoting its consumption in that way. It is now done, and we
apprehend no agent will be seen travelling through these parts
again for " putting off" that article.

We know not whether to consider it amusing or provoking
perhaps both, by turns, to see the cheat put upon the people on the
subject of ihQ tomato. For the character of the country, it is a
great pity that there is no more common sense amongst the com-
mon people, on such a subject. A year or two ago, some of the
** Reformers," as they call themselves half brothers of Thom-
sonians, published in their little periodical, that the tomato was
found to possess all the virtues the medicinal virtues of calomel,
without its ill tendencies. The editors of newspapers were stu-
pid enough to catch this genteel touch of the reformers, and
make a little more of it than was originally intended. The re-
formers knew it had no medicinal virtues, and asserted that calo-
mel had none, and upon the very plain axiom that things which
are equal to the same are equal to one another, made their asser-
tion that the former possessed all the medicinal virtues of the
latter. The unsoundness of their assertion relative to calomel
not being examined, the tomato comes to be asserted to have the
virtues which calomel is known to have. Seeing the turn this
matter took with the people, some guessing spright, or some
western reformer, essays to put forth the " tomato pill" to sup-
ply the place of calomel, without its ills, and medical men per-
haps are induced to enquire, or rather request, that observations
me made on the article " tomato," as a medicinal agent, and
report the results. Now, w^e will venture to say, that this pill
will take the round of these united States, before one tenth part
of the people will remember that they themselves have all their
lives lived on raw tomatos, tomato sauce, pickles and catsup, &c.
m all quantities, without any other effects than those of a light,

1638.J Rheumatism, ^c. Antimonial Suppositories, <^c, 123

trifling vegetable. Let citizens look and blush at their credulity
and let physicians who ask for observations and reports on
its medicinal powders, draw themselves into a nut-shell, and
finally disappear from the professional walks, as a " vanishing
scene."

Rheumatism cured by Vapour Bath of Camphor Fumes. A laboring mar*
22 years of age, had long suffered from attacks of flying rheumatism, but, aa
the pains were not severe, he neglected to use any remedial means.

Exposure to wet and cold brought on a smart attack of the disease in its
acute form ; and for this he had to undergo a vigorous antiphlogistic treat-
ment by general and local bleedings, blisterings, &c. The active symptoms
were speedily subdued ; but the pctient continued to experience dull gnaw-
ing pains, increased by motion, sometimes in the loins, and at other times in
the thighs and legs. Various means were used without much effect ; and
the physician was therefore induced to give a trial to the ingenious proposal
of employing a vapour bath of camphor fumes, as recommended by M. Du-
pasquier in the Revue Medicate for 1826. The patient was made to sit on
an open-seated stool, under which was placed a chafing-dish. A plate of
iron was then put on this dish, and, the patient being enveloped in a blanket,
a small spoonful of powdered camphor was thrown every five minutes, on the
heated plate, until about half an ounce had been used. The vapour speedily
induced a copious perspiration, and this was promoted by putting the pa-
tient into a warm bed, and giving him copious diluent drinks. The first,
and even the second, fumigation did not produce any very decided relief; but
by the fourth day (for the treatment was repeated daily) the pains were
greatly abated, and the freedom of motion much increased. Considerable
debility followed the employment of this medication ; but by appropriate
means the strength of the patient was speedily restored, and he remained
free from his rheumatic pains. Jour. des. Con. Med. Chiruig.

On Antimonial Suppositories as a means of restoring the Hemorrhoidal
Flux. By Dr. A. Trousseau. The physicians of past ages, have, perhaps,
too much exaggerated the importance of hemorrhoids in the scale of patho-
logical phenomena, while those of our own time are fallen into the contrary
extreme.

It cannot be denied that the suppression of the hemorrhoidal flux, when
habitual, may be pi^oductive of general disorders among men, almost as se-
rious as the suppression of the menses in women. Moreover, it is as gen-
erally admitted, that with certain persons who have, not only regularly, but
at indeterminate periods, a draining or hemorrhoidal flux, the existence of
this pathological condition is attended with a state of general good health ;
although it may remain for a long time uncertain and variable, provided the
hemorrhoids do not manifest themselves as soon as usual. Observation
shows, also, that persons who have had hemorrhoids for a long time, suffer
generally, if this flux entirely ceases. And it often happens that there is a
call for its restoration.

Many means have been advised to effect this indication. The warm local
baths, mustard foot baths, leeches to the part, suction applied to the lower
part of the large intestines, purgatives and cupping glasses to the part. Of
all the means which we have made use of, only one has succeeded in any
satisfactory manner. This is the application of cupping-glasses. Thi

i24 Aniimonial Supposuories, [^Nov.

means was entirely forgotten, when a student of the Medical Faculty of Pa-
ris restored it to honor, and I am able to bear witness to its effects on him.

He had. had hemorrhoids till the age of twenty 3-ears, and always enjoyed
good health. This flux now ceased, when he became subject to violent
pains in the stomaah, and continual disorders of the digestive organs. He
consulted M. Andral, wliile attending the Hospital de la Pitie, and this phy-
sician made use of every means advised by authors for restoring this flux*
Nothing succeeded, and the disease remained stationary. The young pa-
tient then conceived the idea of applying a cupping glass to the part. Du-
ring this application the circumference of the anus enveloped the hemorrhoi-
dal tumours, wliich for eight days were swollen and painful. From this
time his health was re-established. A month after this he experienced a
slight return of gastric disorder ; and one day, while attendmg my visit t&
the hospital, he spoke to me of the relief which he had obtained the previ-
ous month from the sufferings which he now began to feel again, and offered
to let me witness the prompt appearance of the hemorrhoids under the ope-
ration of the cupping glass. I accepted the invitation with alacrity, and at
the same time I placed him upon the bed of one of the patients, and in the
presence of more than forty physicians and students i applied a cupping
glass to the fundament. A mmute did not elapse when the tumours made
their appearance, and becoming united, they acquired the size of a small
pigeon's egg ten minutes after the application of the instrument. The
same means were made use of the following day, and the hemorrhoidal flux
continued for a week, and was followed by a cessation of the disorders of
the stomach. M. Andral also saw this young physician, and can testify with
me to the great rapidity with which the tumours became swollen.

After this I had only one opportunity of locally applying cupping-glasses
for recalling hemorrhoidal flux. This v/as with a female* afflicted with erratic
rheumatism, which to me appeared to be caused by the suppression of habitu-
al hemorrhoidal flux. I succeeded in pufHng up the hemorrhoidal vessels by-
means of the cupping-glass ; but the tumours disappeared soon after the ap-
plication of the instrument. What prevents m.y using this remedy more
frequently is this : in the first place, patients, especially women, have a great
aversion to it ; secondly, I have conceived that a much more simple remedy,
and the employment of* which can never be the subject of serious objection,
will answer the sameend, I allude to antimoniai suppositories.

As I had never succeeded with aloetic suppositories, I thought by substi-
tuting in the place of aloes one of the most energetic irritants 1 might attain
the desired end. Now, tartrate of antimony, applied locally to the skin or
mucous membrane, creates an inflammatory action very powerful and per-
sisting, I therefore preferred this article. I mix with a drachm of butter or
lard, from two to six grains of tartrate of antimony. The suppository, be-
ing introduced within the sphincter of the anus, melts quickly, and the tar-
trate of antimony remaining in contact with the mucous membrane, excites
a lively local irritation, a species of tenesmus, as a necessary consequence.
When the suppository contains only a grain, or halt a grain of the tartar, it
can be retained for tvrelve hours without the necessity of going to stool ; but
when a greater quantity of it is made use of, the patient experiences a heat,
at first slight, but afterwards scorching, and attended with painful pulse tions
at the part ; there is a necessity of frequently going to stool. The arterial
pulsations increase at tlie same time that the circumference of the anus pro-
trudes, and pustules, similar to those excited by tartar emetic on the skin,
now appear; bluish tumours arise, hard and painful, permitting occasionally
a large quantity of blood to transude. These are the true hemorrhoidal tu-
mours, perfectly evident with those who have had them ah-eady, and only
apparent with those who have not had them. Journal des Connaissances
Medico- CUrurgicaleSy Sept. 1836,

1838.] Method of treating Intermittent Fevers, 125

Method of treating Intermittent Fever s, in the Infirmary of Clinical Medi-
cine of the Surgical School of Lisbon. By Prof. Limx Leitao. Ague is of
very frequent occurrence among the laborers in the flooded or marshy
grounds bordering on the Tagus. The following divisions comprise the va-
rieties observed : 1st. intermittents proceeding from gastro duodenal phlogo-
sis ; 2nd. those arising from inflammation of the liver, of tiie spleen, or both
conjointly; 3d. such as proceed from phlogosis embracing simultaneously,
wholly or in part, the gastro-duodenal mucous lining, the liver, and the spleen;
4th. intermittents not arising from inflammation.

1. The symptoms of the cases referred to the first division are thus de-
scribed. It^ during the intermission, the following phenomena are observed
redness of the margin of the tongue, with a white or slightly yellow coat-
ing on its surface ; more or less thirst ; an obscure feeling of pam or weight
in the epigastrium, even when pressure is not iipphed ; a sense of heat in
the urethra and rectum in passing urine and faeces ; nausea, or vomiting of
mucous or bilious matter ; a pulse v^ithout being decidedly iebrile, yet not
that of health ; then, according to the author, there exists inflammatif n of
the mucous membrane of the stomach, duodenum, or bcth. This form of the
di ea?e Dr. L. has observed exclusively in persons of the sanguineous, or bil-
io-sanguineous temperament ; of youthful and adult age ; of a constitution
not yet broken down, and in first att^acks of ague. He does not remember
to have observed it in the quartans of Portugal ; but only in quotidians, and
double and single tertians. For its cure he recommends, repose in bed; a
diet of light broth ; beverage lightly acid and edulcorated (agridoce) or mu-
cilaginous, according to the taste of the patient, taken tepid ; and emollient
cnemata. After the second paroxysm, or after twenty-four hours' repose in
the hospital, whatsoever number of paroxysms besides the second may have
occurred prior to the patient's admission there, leeches are applied to the
epigastrium, followed by poultices. The number of leeches is proportioned
to the age of the patient, twenty-four being the mean number. Dr. L.
thinks the paroxysm the most suitable period for their application. Should
the symptoms above described have disappeared in the apyrexia next ensu-
ing, but should the paroxysm follow with the same or nearly the same inten-
sity, a grain of the sulphate of quinine is given every three hours, every two
hours or every hour (according to the type of the disease) during the inter-
mission. After each dose of the medicine Dr. L. gives some mild mucilagi-
nous or sugared beverage, and very little other sustenance is taken. It is
important that the apyrexia be perfect, and that the indications of local affec-
tion have ceased before administering the sulphate of quinine, otherwise
there is risk of converting the disease into the remittent or continued form.

Should the inflammation resist the first application of leeches, they must
be repeated a second or even a third time, till it is removed. If the parox-
ysm does not recur after the application of the leeches, or if it be much di-
minished in intensity and later in coming on, no sulphate of quinine is
administered ; and, in the latter case, it is observed, that after one or two fits
more and more slight, the disease ceases. The author thinks that conva-
lescence is more speedy and relapse less hable to take place in these, as it
were, spontaneous recoveries, than where the sulphate is employed.

2. In the second division, comprising cases in which the liver, the spleen,
or both conjointly are affected, the author recognises the phlogosis of the
liver (should there not be enlargement) by obtuse pain, heat, and tension,
increased bv pressure ; yeh'ow tinge of the face and eye ; yellowish furred
tongue ; bi'ijus vomitings and dejections, &c. When the liver is enlarged,
the local symptoms are referred to the left lobe. If the spleen sufl^ers, it
presents analogous local symptoms ; both organs are often simultaneously
affected. The remedies of this form of the disease are the same as those
of the preceding, with this difference, that general blood letting is found

126 New method of curing Stammering, [Nor.

more serviceable than leeches, or, at least, should precede their employment.
Two bleedings of eight ounces each are generally sufficient. Dr. L. has
seen intermittents of this division and of all types, yield to depletion alone
by genera], followed by local blood-letting ; and this successful result from
depletion solely has been more manifest in the diseases of this than the pre-
ceding division.

3. The third division, comprising intermittents connected with inflamma-
tion of the gastro-duodenal lining, end of the liver and spleen conjointly, is
marked by a combination of the symptoms of each of the preceding diseases.
The malignant intermittents, observed by the author in eastern Africa, be-
longed to this class. The treatment ccnnsts of the methods employed for
the other two divisions combined, that is bke ling, general and local, except-
ing in nervous temperaments, when he has recourse only to the latter. He
thinks this kind of case very suitable for the endermic method of employing
sulphate of quimne. In the malignant intermittents of eastern Africa, he
derived much advantage from frictions of tincture of bark, and from sprink-
ling blistered surfaces with powdered bark and camphor.

4. The fourth division, consisting of cases unattended with local inflam-
mation, he treats as he does those of the preceding, except that bleeding is
omitted.

The author subsequently gives a practical conmientary on the 59th apho-
rism of the 4th section of Hippocrates, " tertiana exacta m septem circui-
tibus ad summum judicatur," Having tried its truth, he found the patientf
solely from the influence of low diet and repose, escape the seventh paroxysm
in some cases and the eighth in others. The examples in which this fortunate
result took place, belonged principally to his fourth division ; but a proportion
of them to his first, or that comprising the complications with gastro-duode-
nal inflammation. These spontaneous recoveries, wheresoever they occur,
Dr. Leitao regards as the most favorable, the general health being the least
disturbed, convalescence most prompt, and relapse very rare. B. and F.
Med. Rev. from Journal da Sockdads das tSciendas de Lisbon^ Feb., April,
1836.

NeiD metlwd of ciiring Stammering. Dr. Voisin was afHicted with art
impediment in his speech, for the cure of which he tried every plan, but
without success. Finally, chance led him to the discovery of a method
which he has adopted with advantage. He was reading a paper before a
society, and wishing to do so with some energy, he happened to look into a
mirror which was opposite him, and he perceived that he rested the border
of his right hand upon his chin, in a manner so as to depress the inferior
maxilla and hold the mouth half open. The idea immediately suggested
itself that this instinctive and mechanical movement might contribute to
his reading more promptly and easily. In fact, v;pon ceasing the pressure,
the difficulty of expression was quickly reproduced ; but upon replacing his
hand the freeness of articulation immediately returned. Endeavoring to
give an account of this, he observed : 1st. That the mouth was kept half
open, the distant^e between the teeth being a line or a line and a half. 2nd.
That the tongue, abandoned to itself, in the state of repose placed itself
against the inferior dental border, whilst during pronunciation it is project-
ed forwards and upwards, but is withdrawn almost immediately behind the
alveolar arch. 3d. That a medium pressure is necessary upon the chin ;
this should be sufficiently strong to resist the muscles which move the infe-
rior maxilla, without impeding its movement of elevation, so strong as to
prevent perfect approximation. To produce this pressure, and, at the same
time, make it excusable, it is necessary to use a certain delicate art, so that
the manoeuvre may not appear forced, but oa the contrary almost natural.

1888.] Stammering Treatment of Erysipelas. 127

This pressure should be made with the external border of the right or left
hand indiscriminately, the thumb applied upon the chin and the fingers free.
Since he has made the discovery he finds he frequently takes the position
without thinking of it, and has observed the same in other individual afflicted
with impediment of speech. This habit does not appear to be peculiar to
stammerers, since it is frequently assumed by timid persons when speaking
in public. Dr. V. has only had an opportunity of trying it in two individu-
als, but the effect surpassed his expectations. B. and F. Med. Rev. from
Bull de r Acad. Roy. de Med , Sept., 1837.

Treatment of Erysipelas by Raw Cotton. The efficacy of cotton in the
treatment of burns, and the analogy between the inflammation of the skin
produced by heat, and of erysipelas, has led M. Reynaud to employ the cot-
ton in the latter disease ; and he has found the application equally beneficial.
In erysipelas, as in burns, M , R. says, the cotton calms pain, as it were by
a charm; a mild and moist warmth takes the place of the itching, the formi-
cation, the sharp and biting heat which so much increase the pain ; the
swelling gradually diminishes, the redness disappears, the skin becomes flac-
cid and wrinkled, and without becoming covered with those furfuraceous
scales, which characterizes the termination of erysipelas, and which some-
times continue during a long period. All that separates are a few slight
layers of epidermis, and this is speedily effected. The general excitement
ceases with the local phenomena, the fever diminishes, and in simple cases
the organic functions return to their normal state, without the necessity of
any other treatment. A circumstance of great advantage in the use of cot-
ton is, that it is equally fitted for, and produces analogous effects, in all forms
of erysipelas, whether idiopathic or traumatic, whatever may be its situation,
on the face, body, or limbs ; whatever may be the depth of the tissues which
are affected ; for in the cases which are collected, are some of phlegmonous
erysipelas greatly amended and others entirely arrested by the simple appli-
cation of cotton. The result, M. Reynaud vrould thus explain, that the
cotton acts by exciting in the diseased part a moderate warmth, a sort of va-
pour bath which keeps up a constantly equable temperature, a proper degree
of humidity, by keeping the diseased part from contact with air and light,
two powerful excitants of the cutaneous system. Cotton does not suffice in
all cases ; no more than other remedies does it enable the surgeon to dis-
pense with general means, but it lends to these a great assistance ; it hastens
the resolution, and when the termination cannot take place, it still serves to
limit the inflammation, and to arrest its progress.

The method of applying the cotton is very simple. Raw cotton which is
well carded must be selected, in order that it may be free from all foreign
substances which it sometimes contains. A layer sufUciently thick to protect
the diseased part from the light and air must then be applied, taking care
always that the cotton extends some inches beyond the limits of the mflam-
mation. A compress and a few turns of a bandage will keep the cotton ap-
plied. A linen mask is well fitted for the face. The cotton should be
removed every twenty-four hours to judge of its eff Tts, or, if there is no
contra-indication, it may be allowed to remain during the whole course of the
treatment. If the cotton should adhere too strongly to the skin, in a case
where there is slight exudation, it may be removed by applying over it an
emollient poultice. The author has added to the previous remarks, several
cases of various forms of erysipelas treated with cotton ; to which it is unne-
cessary to call the attention, otherwise than to state that seven are cases of
simple erysipelas of the face and extremeties ; that one is of traumatic ery-
sipelas ; the ninth of erysipelas complicated with a miliary eruption ; four of
phlegmonous and one of gangrenous erysipelas. Jour, des Connaiss. Med.
Chirurg., Feb., 1837.

128 Consolidation of Fractures,

Causes which retard the consolidation of Fractures. The Archives Gent-
rales for August, contains an interesting article on this subject, by M. Louis
Fleuky. Two indications must be fulfilled, observes M. F., to insure the
perfect consolidation of fractures : 1st Placing the broken ends in contact.
2nd. The maintaining them in this position. The former is done with facil-
ity, but there are some difficulties in accomplishing the latter. At the pre-
sent day, most surgeons are of opinion that complete immobility of a fractured
limb, joined to strong pressure on the soft parts, are the best means of main-
taining the fragments in position, and of obtaining a quick and regular con-
soHdation. Unfortunately, these means are frequently unsuccessful ; and,
notwithstanding the care used in their application, the callus is frequently
thrown out in an irregular manner, or perhaps never formed at all. What,
then, are the causes which prevent or retard the consolidation of a fracture 1
Authors have enumerated a great number, but seemed to have overlooked a
very important one. Scrofulous and venereal affections, old age, rents
in the periosteum, formations of pus, cold apphcations, all, undoubtedly,
exercise a prejudicial influence. But, by far the most frequent of all the
causes, is the apparatus used with the view of favoring the consolidation,
which it prevents by the compression it exercises upon the vessels of the
limb ; whether this compression is inevitable, as in the moveable apparatus,
or produced voluntarily by the surgeon.

If a fractured thigh be placed in a thick layer of soft materials, the effects
of the compression cannot be very appreciable ; for, in this case, although
the capillary circulation and the small arterial branches are more or less re-
stricted, still the large vessel's continue free. The same does not occur in
the forearm or leg, where compression, ever so slight, interrupts the course of
the blood, not only in the superficial vessels, but also in those which supply
the fractured bone and periosteum. In order to obtain a rapid and regular
consolidation, we must be careful not to apply more splits than are absolutely
necessary, and not to bind these too tight by means of bandages. In follow-
ing an opposite method, we wait, sometimes three, four, or six months, for a
union which has not yet commenced. It is then that the surgeon, eager at
each dressing to reapply the apparatus, with more care, that is to say, to
augment the number of splints, surrounds the limb more exactly, &c., finds
himself deceived; and the more he renews his efforts, by the same meanr,
the greater is the distance separating him ft-om his object.

The following case, one of four reported, exemplifies the beneficial results
of this practice.

Ca.se. C. D., aged 41 years, had a fall on the loth of February, 1836,
broke his right leg, and entered the same day the Hospital of St. Louis.
The fracture was complete, situated immediately above the internal malleo-
lus, and complicated with a deep excoriation and extensive echymosis. The
wound Vv'as dressed with cerate, the rest of the leg covered with charpie
dipped in the white of egg, and the ordinary apparatus for fractures of the
leg immediately applied. The member was maintained in absolute repose
during six weeks. On the 10th of April, the apparatus was removed, the
w^ound was found cicatrized; the ecchymosis had disappeared, but the con-
soUdation had not commenced. The apparatus was reapplied, and a more
generous diet ordered. , On the 30th of April, the consolidation was a little
more advanced. The splints and anterior cushions were then removed, and
the limb sprinkled with spirits of camphor. From' this period the callus rap-
idly solidified ; by the end of the month of May, it was very resistant, al-
most inappreciable to the touch, and the patient quitted the hospital.

SOUTHERN MEDICAL

A^'D

SURGICAL JOURNAL.

Vol. III.] DECEMBER, 1838. [No. 3

Part l.ORIGINAL COMMUNICATIONS.

ARTICLE I.

Buccessful Division of the Adductor Longus Femoris Muscli,
for Deformity and consequent loss of motion in the Inferior
JSxtremitij. By Paul F. Eve, M. D., Professor of Surgery
in the Medical College of Georgia.

In the XI. No. of vol. II. page 671 of this Journal, the editor
has been pleased to make the following remarks, concerning an
operation, the result of which 1 now design presenting the pro-
fession " We are happy in having it in our power to remark,
that a few days previous to that on which the Gazette Medicale
came to hand, which contained the following case and operation
of M. Lutens, a case of similar nature was presented for the in-
spection of the Professor of Surgery in the Medical College of
Georgia, Dr. P. F. Eve, who at once decided on an operation
for extirpating the diseased and disorganized muscle, and his pa-
tient is now under preparation for the operation. The muscle
affected in this case is the adductor lonr^us femoris, causins: an
inconvenient and distressing adduction of the left lower extrem-
ity. The particulars of this case we hope to afford our readers
in a future No. of this Journal. Dr. Eve has not yet seen the
March No. of the Gazette Medicale." The operation is them
I

ISO Division of the Adductor Longus Femoris Muscle. [Dec,

described as performed by i\j. Luiens, ^iirLTcon 1o ib.e lie spital
at Anlwerp, npi n i\ sailor, for retraction of the leg. the jioiice of
which in the French Journal eoncIud(!S, by staling thnt a similar
operation has subsequently been executed with success by M.
Duval, of Paris.

It was in the latter part of last May (1S38), that the patient
upon whom I have just operated, called upon me. Tlie I'^ditor
of the Southern Medical and Surgical Journal has correctly
stated, that I had not then seen a notice of the operation of M.
Lutens. This case was published in one of the March Nus. of
the Gazette Medicale de Paris, w4iich did r.ot reach here until
June, a few days after it had been decided in consultation with
Professors Antony and Newton, to operate on my patient. Dr.
Newton, after our meeting, addressed me a note calling my
attention to the No. of the French Journal just mentioned
This w^as the first intimation 1 had of the case of M. I.utcns.

The two cases, however, differ materially. In that of M.
Lutens as well in the one of M. Duval, the Stromeyrean princi-
ple, (the division of a tendon to cure deformity and consequent
loss of motion,) was simply acted upon ; while in tfie case Jin
which I operated, a muscle was divided Again, they operated
to remedy a defect of the leg ; I for that of the thigh. Their
operation was near the femero-tibial articulation ; mine near the
cox o-fe moral.

The history of my patient previous to his application to me, is
presented in the following letter *' From infancy to fourte(?n
years of age, I was strong, active and remarkably healthy, and
of good constitution. When fourteen, or about that period of
hfe, I practised night-hunting to a great extent, and occasionally
fishing; would sometimes lay on the wet ground, or remain oa
the bank of muddy creeks all night. In the month of February
1829, I felt one evening, an aching in the left side of my shin-
bone, and a sharp ketch on the inside of my thigh, with acute
pain whenever I moved off a high step. At night the contrac-
tion in my thigh became very violent, and the pain extended
from the groin to the knee. The first two or three weeks of
the attack, the suflering w^as so excrutiating that it rendered me
almost senseless. At the expiration of this time, th.e pain grad-
ually moderated. 1 lay on my back with my legs drawn half
up for four months, without my position being altered { after

1838.] Division of the Adductor Longus Femoris Muscle. 151

which I was able to be turned on my right side with a pillow
between my knees. At the end of six months the pains entirely
subsided, but left me drawn up as before described. I was now
lifted out of bed, and gradually improving, I ventured to use
crutches. The c<)ntraction was such that for a long time I
could apply only one-half of my left foot to the ground it was
about eighteen months before 1 walked at all without a stick.

* During the first year I was up, there came a small ulcer or
sore, dischartring bloody matter, just below the left buttock. I
attributed it to my sitting so much.

" Jn the commencement of the attack, Dr. Alexander Jones,
then of Lexington, Geo. was my physician. I have also appli-
ed a multiplicity of remedies to my thigh, but all to no purpose.
I at length resolved to let nature take her course, and for the first
five years I made considerable improvement, though it was
always with great inconvenience, stiffness, soreness and pain,
that I took exercise. For the last three years, I have been
pretty much upon a stand; if any thing, getting worse.

** It has now been more than eight years, since this disease has
been seated in my left hip or thigh, and have not been able for
the time mentioned, to ride a horse half a day without great
soreness and contraction of the limb affected, apparently short-
ened at times two or three inches. I have also not been able
to walk hidfa mile without debility, and the least exercise would
produce great suffering. 1 walk with my foot turned in, which
increases more and more as \ exercise.

Signed, ALLEN A. BEALL."

Oct. 21st, 1838.

On the 30th of iVIay last, having procured a suitable place for
my patient, I made a minute examination of his case. He had
a considerable limp in walking, more especially when he com-
menced to walk, and invariably used a slick. He is a very
muscular and robust man, aged 22. His left extremity was
full one inch shorter than the other, nor when placed in the hori-
zontal position, would traction reduce it much. Both the thigh
and leg, are much smaller than the right. The foot was turned
inwards, and the whole limb inclined in this direction. The foot
could not be carried rut farther, than about twelve inches from
the median line of the body. There was a small depression and
a round cicatrix near to the left ischium. h\ the internal and

1811 Divisionof the Adductor Longus Femoris Muscle, [Deo,

upper tliird of the thigh there was a hard substance^ feeling like
a hempen rope situated just under the skin. It was about four
inches long by one and a half broad. However relaxed the
thigh nnight be made, this diseased mass still presented the same
resisting, insensible, cartilagenous hardness. It could be isolated
from the surrounding tissues, all of which appeared to be nor-
mal. Ii was taken for a fibrous degeneration of the adductor
longus femoris muscle. The shortening of the limb was attri-
buted to the permanent disorganization of this muscle, with the
inclination of the pelvis from long habit. There w^as no symp-
tom of disease in the hip-joint.

Before resorting to an operation, it was deemed prudent to
place Mr. Beall upon a treatment, with the view of effecting some
change, or of ascertaining somethingof the nature of his disease.
This consisted chiefly in the use of warm bathing, heated va-
pour, and the most stimulating liniment, which were continued
for about twenty days, without producing any appreciable ben-
efit. Mr. B. then left for his home in the interior of Georgia, to
make his arrangements for the operation which had at first been
proposed to him.

He again called upon me early in October, and submitted to
the operation the 9th of this month. Assisted by Professors
Dugas and Newton, an incision was made, commencing at the
pubis and cutting upon the internal edge of the affected mucle,
and extending it about five inches, in a semi-lunar direction.
The surface of the adductor longus was then exposed, and cau-
tiously divided with the knife and a pair of scissors, about three
inches below its origin from the pubis. The upper portion was
found to be converted into a fibrous tissue, which slightly grated
under the knife, but the portion below the section contracted, so
as to separate the cut edges of the muscle about an inch. Its
degeneration therefore, did not extend throughout its whole
length, but the muscular tissue appeared to be healthy an inch
below where it was divided in its course to be inserted into the
OS femoris. We removed from the upper portion a small sec-
tion for a pathological specimen. Two small arteries required
a ligature. The wound in the skin was closed by adhesive
pla-^ter, and a compress and roller completed the dressing. The
patient was put to bed, and a two pound weight attached the
uexl morning to the left foot, and allowed to hang out of the bed-

1888.] Division of the Adductor Longus Ferncns Muscle, 1S3

clothes over the back of a chair, so as to make traction in a ho-,
rizontal direction.

There was no material alteration in the length of the limb
until the next day, when it commenced gradually elongating, so
that when dressed on the fourth day after the operation, the difi'er-
ence between the two lower extremities did not exceed a quarter
of an inch. At the end of a week, even this difference had dis-
appeared, and Mr. Beall commenced using ihe hmb. His friends
Dr. Wm. Butts of Warrenton, and Dr. Joel Branham of Eaton-
ton, visiting him during the second week of his confinement, and
did not remark any difference in the length of the two extremi-
ties. On the 15th day after the operation, my patient was out
in the streets walking about, with scarcely any impediment ;
and on the 28th of Oct. the 19th day since the division of the
muscle, he returned home on the Georgia rail road.

The left inferior extremity has not only been restored to its
original length, but all its motions have been so far regained
that the patient, before his departure from the city, could turn
the foot and carry the leg and thigh outward to nearly the same
extent and with almost as much freedom, as on the sound side ;
he was daily improving in these respects, and is in a fair way of
realizing from the operation all the benefits that had been pro-
posed.

Supposing the disease for which the operation was performed
in this case, to have been the result of acute rheumatism, may
not similar cases be relieved by surgical, in addition to medicin-
al treatment.

134

-4 71 Essay.

[Dec.

ARTICLE II.

An Essaj/ on t/:e reJtJlfoi f.pUreen the Fiespiraiory and (^ircula-

tinnr Functions, [>y Charles Hooker, M. D. Read at the

Annual iVcw Haven County Meeting of the Connecticut

'Medical Society, April 12, 1638. Republished from the

*^'' Boston Medical and SurGfical Journal.

The above is th.e lit'e of a pamphlet of forty-seven pages,
which we have had the satisfaction of receiving from the author.
We had observed the same in course of publication in the week-
ly numbers of the Boston Journal, but notwithstanding the great
interest we felt in this hitherto too much neglected subject,
we lost the value of the essay by the lapse^of a week between
every few pages. On reading the whole pamphlet through, at
once, however, we find the subject so amply treated, and ren-
dered so practically important, that v/e feel unwHling to give a
viere notice, or analysis of it; we therefore present it entire to
our readers, believing that our pages could not be more usefully
employed. We urge on them the importance of reading the
whoh essay at one sitting, as we are confident no one will have
occasion to regret the hour thus appropriated.

The genera] relation between the respiratory and circulating
functions has long been known. It is unquestioned that the
main office of the lungs is to effect that change in the blood
which constitutes the difference between venous and arterial
blood ; and that the sole office of the right side of the heart is to
transmit the blood to the lungs for the .purpose of this change.
This process has been called oxygenation, dccarhonization, &c.
according to different theories by which it is explained; also
arterialization, a term implying no theory, but simply the fact
that the blood is thus prepared for circulation through the arte-
ries ; an aeration, which simply implies that this change is
effected by an exposure of the blood to air in the lungs.

RELATIVE FREQUEXCY OP THE RESPIRATIO>' AND THE PULSE.

From what is known of the philosophy of the process of aera-
tion, it is reasonably inferred that a proper balance is required
between the two functions of respiration and circulation, or, in
other words, between the quantity of air respired, and that of

1S3S.] An Essay, 1S5

the blood circulntins: through the lung's. It might further be in-
ferred that, in a hcahhy condition of the organs, a definite ratio
is observable between the frequency of the respiration and of the
pulse. As a general rule, this ratio maybe stated as 07ie to four
and a half that is, in a healthy, well-formed adult, when the
pulse is 70 in a minute, the number of respirations is about 15
or 16 ; while, if the pulse is naturally more or less than 70, there
is a proportionate frequency of the respiration. So, in case of
general febrilt; excitement, if the pulse is increased in frequency,
a proportionate increase of the respiration is required to pre-
serve a due balance between the two functions. In disease,
however, it is very common that this balance between the func-
tions is not preserved, and there are many variations in the ratio
between the respiration and the pulse.

The object of this essay is to trace the diagnostic, pathological
and therapeutic indications of these variations.

That this subject has heretofore received little attention, is evi-
dent from the fact, that the few authors who have adverted to
it, are not agreed even in regard to the natural ratio between
the respiration and the pulse.

This ratio is stated by Haller to be as 1 to 3 or 4 ; by Dr.
Graves, as 1 to 4. The number of respirations in a minute, in a
healthy adult, is estimated by Magendie as 15; by Ur. Dun-
glisoa. about IS ; by Sir Humphry Davy, ^u or 27 ; while Dr.
Good, Dr. (y. J. B. Williams,' and most other writers, give 20
as the ordinary number. Supposing; the latter to be the true
number, and the pulsations, as commonly estimated, to be 70 in
a minute,^ the nitio 'will be 1 to 3 1-2 ; while, according to the
estimate of Sir Humphry Dav\% the ratio is about I to 2 1-2.

The discrepancy of statements plainlv shows, that the obser-
vations of authors on this point have been very limited. The
only method which will lead to correct conclusions, a method
which I have frequently practised since my attention was turned
to this subject, is to count the respiration of persons who arc
not aware of such observation ; for, as the respiration is much
under the control of the will, its frequency wnll be varied by the
operation of the mind. Hence, a conclusion drawn from ob-
serving one's own respiration would be liable to error. Perhaps
diversity of climate, and national peculiarities of constitution,
may occasion some variation from the ratio wdiich I have stated ;
but so constant has been this ratio, of 1 to 4 1-2, according to my
observation, that I have refjarded any considerable variation
from it as a pretty sure indication of malformation or disease.
In a diagnostic and pathological point of view, therefore, I re-
gard the coinparati, e frequency of the respiration and the pulse
as highly important.

In early infancy there is less regularity in this ratio. Owing
to imperfect development of the lungs, or some other cause, it is

136 An Essay. [UcCi

not uncommon that an infant, with a pulse of 120 or 130, will
have 40, 50, or even 60 respirations in a minute. Generally,,
however, the healthy ratio becomes established in the course of
the first or second year. So in adults, the respiration is ren*
dcred frequent by many circumstances which can hardly be con-
sidered as disease. Obesity, by preventing a free and large
expansion of the chest, gives occasion to increased frequency of
the respiration. The same efiect is produced by a distension of
the stomach or intestines, by pregnancy in females, and by any
circumstance which prevents a free descent of the diaphragm.
Any circumstance, indeed, that prevents a full quantity of air
from being received into the lungs with each inspiration, neces-
sarily calls for more frequent respiration. As a general rule, if
the respiration is deficient in fullness, the deficiency is compen*
sated for by increased frequency.

DIAGNOSTIC INDICATIONS OF A DISPROPORTIONATE FREQUENCY OF
THE RESPIRATION AND THE PULSE.

The general diagnostic indications afforded by variations of
the ratio between the respiration and the pulse, may be reduced
to two heads.

1st. A disproportionate increased frequency of the respiration
mdicates,

A. Disorder of the lungs or air passages.

B. Some mechanical impediment to the motions of respira*
tion : or,

C. imperfect function of the organic nerves of the lungs.
2nd. A disproportionate diminished frequency of the respira^

tion indicates a want of energy m the nerves which control the
respiratory motions.

1st. A. Frequent Respiration from Disorder of the Lung^
or Air Passages.

It is obvious why disease of the lungs should occasion a dis-*
proportionate increased frequency of the respiration. If by en-
gorgement, hepatization, tubercular deposition, or other disease,
a portion of lung is rendered unfit for respiration, the remaining
healthy portion, having the whole office of aeration to perform,
must act with increased frequency in order duly to arterialize
the blood. If, for instance, only one half of the lungs is fit for
respiration, the frequency must be doubled. Thus, in acute dis-
eases of the lungs, the ratio between the respiration and the
pulse may be considered as some criterion of the amount of
pulmonary obstruction. In cases, however, attended with either
depression or exhaustion of nervous energy, as we shall hereaf-
ter notice, this criterion must be received with some allowance.

I

1838.] An Essay on Respiration and Pulsation, 137

Frequent Respiration in pneumonitis. The relative frequen-
cy of the respiration in pneumonitis is one of the most constant
symptoms of the disease. As in other febrile diseases, the pulse
is commonl}^ frequent, but the increased frequency of the respira-
tion is altogether disproportionate to that of the pulse. In cases
of extensive engorgement, it is not uncommon that the respira-
tion is 45 in a minute, when the pulse does not exceed 90; the
ratio becoming as 1 to 2. In extreme cases, the respiration be-
comes even GO or 70 ; and in children I have occasionally noticed
it 140 or 150. In less degrees of engorgement, the ratio is as 1
to 3, 3 1-2 or 4.

Commonly the pain in the chest, cough, and other symptoms,
sufficiently indicate the general character of the disease. In
some latent cases, however, these general symptoms are want-
ing ; and there is scarcely a single symptom indicating pulmo-
nary disease, except the comparative frequency of the respiration.

A single case may be adduced, as an example of the import-
ance of lh3 ratio between the respiration and the pulse, as a
diagnostic indication in such cases.

In March, 1S32, I was one morning called to visit a young
man, who had been attacked, the night previous, with chills,
succeeded by considerable heat and febrile excitement. The
skin was now cool, the tongue slightly furred no pain or sore-
ness in any part of the system, no disturbance of the stomach or
bowels, no cough or expectoration, nor was the patient sensible
of any difficulty of resf)iration. The pulse was 78, the respira-
tion 30. This disparity between the pulse and the respiration
was the only apparent general symptom of local disease a
symptom which probably would not have been noticed, but for
my constant habit of attention to this point. The patient had
not been subject to habitual shortness of breathing, and strict
inquiry gained no clue to the existins: disease. But the abnor-
mal ratio between the respiration and the pulse (about 1 to 2 1-2)
warranted a suspicion of disease within the chest ; and, on ap-
plying auscultation and percussion, it directly appeared that the
lateral and posterior portions of the right lung were extensively
engorged in short, there was a latent pneu??ionitiSi occupying a
greater part of the right lung. A large blister was applied to
the affected side, and calomel, elaterium, sanguinaria, and other
remedies which had proved serviceable in the pneumonitis of
that season, were perseverins^ly administered. The disease
continued day after dav to run a perfectly latent course ; and
the nurse, a judicious elderly lady conversant with disease, was
very distrustful of my diagnosis, saying that she had *' always
seen lung fever attended with pain in the chest, couQfh, difficulty
of breathing and expectoration." At the commencement of the
6th day of the disease, I was called to my patient in the night.
The nurse met me at the door, exclaiming, " now, doctor, I be-
B 2

138 An Essay on Respiration and Pulsation. Deds

lieve you the man has lung fever." The sj^mptoms at this
time were a severe pain in the afFected side, a laborious, rattling
respiration, and a copious bloody expectoration. The disease
was now making a crisis, and the patient gradually convalesced.
Whether this favorable result would have occurred is very
doubtful, had not the treatment been directed by an early correct
diagnosis.

We often hear of similar irregular cases of disease, which are
described as " typhoid fever," or " general debility," which con-
tinue for 6 or 7 days, when a " pneumonia sets in" and carries
off the patient. In such cases, attention to the comparative
frequency of the respiration and the pulse would always lead to
investigation for disease of the respiratory organs.

Frequent respiration in Phthisis. In the early stage of
phthisis, this disparity between the respiration and the pulse
may be regarded as one of the most valuable signs. It is not
uncommon, in this disease, that considerable tubercular deposi-
tion in the lungs takes place, before the occurrisnce of cough, ex-
pectoration, and many other of the ordinary symptoms of the
disease. Frequently, indeed, there are no prominent general
symptoms, except, perhaps, a progressive debility and emacia-
tion. With these symptoms, a disproportionate mcreased fre-
quency of respiration affords a strong presumption of tubercular
deposition. A simple general debility increases the frequency
of respiration,' but it occasions a proportionate increased fre-
quency of the pulse the ratio of 1 to 4 1-2 is still preserved.
Whereas, if the lungs are obstructed by tubercles^ the respiration
is out of proportion to the pulse.

In this disease the abnormal ratio between the respiration and
the pulse is a more uncertain criterion of the amount of pulmo-
nary obstruction than in acute diseases ; for the scrofulous affec-
tion which produces the tubercular deposition in the lungs, at
the same time impairs the processes of digestion and sanguifica-
tion hence, the quantity of blood in the system is much less
than in health, the pulse is weak, and each contraction of the
heart sends a small quantity of blood to the lungs ; the quantity
of blood to be aerated in the lungs is, therefore less than natural,
and a smaller quantity of air is required in respiration. In ad-
vanced stages of phthisis, there is so little blood in the system,
that a very small proportion of healthy lung is sufficient for its
arterialization, with only a moderate acceleration of the breath-
ing. 1 have examined subjects who had died of this disease, in
whom scarcely a tenth part of the lungs appeared to have been
fit for respiration ; when, a few days before death, with a pulse
of 130 or 150, the respiration had not exceeded 35 or 40. Were
the lungs obstructed to this degree in acute diseases, with a full
quantity of blood in the system, an immeasurably increased fre-
quency of respiration would be required to sustain life. But in

!

1838.] An Essay on Res^nj-ation and Pulsation, 130

the progress of a lingering case of phthisis, the quantity of blood
in the system ; the size of the aorta and other arteries, which are
sometimes diminished in calibre nearly one half; and the feeble
imperfect contractions of the heart, all become accommodated
to the small remaining portion of healthy lungs.

I should here notice some incidental remarks in the clinical
lectures of Dr. Graves, of the Meath Hospital, Dubhn, which
seem to be the result of imperfect observation. He remarks,
" I have seen many cases of phthisis, in w^hich there was accel-
erated breathing, v/ith slow pulse, but these were always cases
of a chronic kind. I have never observed the same phenomenon
existing wiien the disease was acute ; it is a state of things
which is compatible only with chronicity of disease." In acute
pulmonary disease, he says, when the respiration is considerably
accelerated, there is " a corresponding increase in the frequency
of the pulse," The very reverse of this is true. Certainly no^
thing is more common, in the early stage of acute pneumonitis,
than to have the respiration HO, 40, or even GO in a minute, when
the pulse does not exceed 90. In acute oedematous inflamma-
tion of the lungs, I have often, within a few hours from the first
attack, observed the respiration 70 or SO in a minute a mere
panting when the pulse scarcely exceededits natural frequency.
And in the early stage of phthisis, with a comparatively moder-
ate tubercular obstruction of the lungs, I have commonly observ-
ed the disparity batween the frequency of the respiration and
the pulse greater than in the more advanced stages.

The observations and judgment of Dr. Graves are justly con^
sidered as high authority ; but he has evidently given little atten-
tion to this subject; and he properly remarks, " I do not know
any point on which accurate observations are more wanting
than on the proportion between the pulse and respiration in va-
rious states of the system., and in various diseases. Facts upon
this subject might be easily collected, and would probably lead to
curious and instructive results.

Frequent respiration in cedema of the lungs. This disease is
a very common cause of frequent respiration. Though the dis-
ease was noticed by Hippocrates, and has been more particular-
ly described by Van Swieten, Darwin, Maclean, and others,
most recent writers appear not to be aware of its common oc-
currence. Dr. Good barely notices it, as if doubting its occur-
rence. In treating of other dropsical affections within the chest,
he says, "Mater \s, perhaps, sometimes effused into the cellular
texture of the lungs." Laennec says it is "rarely a primary
and idiopathic disease. It comes on most commonly, with other
dropsical affections in cachectic subjects, towards the fatal ter-
mination of long continued fevers, or organic affections, especially
those of the heart."

140 An Essay on Respiration and Pulsation. [Dec.

It appears to me that the question, in regard to this affection,
is to be resolved into the general one, whether any dropsy is a
primary and idiopathic disease. I am certain that no part of the
system is so commonly the seat of dropsy as the lungs ; and, in
general anasarca, it is commonly in the lungs that the disease is
first manifested. Even those authors who appear to doubt the
existence of such an affection as idiopathic oedema of the lungs,
generally mention disordered respiration as a symptom of general
anasarca.

There are many cases which appear to be intermediate be-
tween a proper inflammation and an acute dropsy of the lungs
cases which might be termed oedematous inflammation, ^uch
cases certainly have claim to the character of a primary and
idiopathic disease. Of this character was the prevailing affec-
tion of the lungs in the epidemic influenza in ]\ew Haven, in
the winter of 1831-32. In many cases of that disease, extreme
frequency of the respiration, as compared with the pulse, con-
stituted almost the only symptom of thoracic affection.

In cases of chlorosis, in most of the chronic disorders of men-
struation, in general debility, and in cachectic diseases generally,
swelling of the ankles and other symptoms of general anasarca
commonly occur. In almost all such cases I have found oedema
in the lungs, before its manifestation in other parts of the sys-
tem ; and frequently the lungs are the only part 'in which it is to
be observed. The affection can hardly fail to be injurious, by
obstructing the lungs and interfering with a due aeration of the
blood, and it is therefore very important to detect it in its early
stages. Attention to the relative frequency of the respiration
will afford suspicion of the disease ; and a slight dullness observ-
ed on percussing the posterior portions of the chest after the
patient has been lying on the back, or the same observed about
the inferior lobes of the lungs after sitting or standing, with a
dull respiratory sound corresponding to the dullness of percus-
sion, will render the diagnosis almost certain. If the serum
infiltrates into the air cells and the minute bronchia, as frequently
occurs, especially when the aflection has any thing of an inflam-
matory character, the stethoscope detects a sound like that pro-
duced by squeezing a wet sponge, by wringing wet clothes, or
by the effervescence of fermenting liquors a feebler and finer
sound than the crepitation characteristic of proper inflammation.
Frequent respiration in various disorders of the lungs and air
passages. Besides the diseases already mentioned, any affection
of the lungs, which prevents a portion of them from being freely
permeated with air, necessarily occasions frequent respiration.
Atrophy or emphysema of the lungs, congenital imperfection of
the organs, solidification or any other lesion consequent to former
disease, or pulmonary apoplexy, may produce this efl^ect. A
like effect is produced by disorders of the bronchia or bronchial

1838.] An Essay on Respiration and Pulsation, 141

membrane, as mucous or other obstructions within the bronchia
impeding the passage of air, or any affection of the bronchial
membrane preventing a communication between the air and the
blood within the lun<T3.

o

B. Frequent Respiration from some Mechanical Impediment
to the Motions of Respiration.

Any disorder within the chest, exterior to the lungs, which
affords a mechanical impediment to the expansion of the lungs,
necessarily causes frequent respiration, as hydrothorax, pleuritic
effusion, effusion into the pericardium, enlargement of the heart,
aneurism of the aorta, or any tumour within the chest. The
same effect is produced by ascites, flatulent distension of the
stomach or intestines, or fullness of the abdomen from any other
cause, operating to prevent a free descent of the diaphragm ;
hence a full meal occasions some acceleration of the breathing.
Frequent respiration is caused also by any circumstance which
renders a full inspiration painful, as rheumatism, or any inflam-
mation of the intercostal or other muscles of respiration ; or a
like aftection of the pleura, pericardium, heart, or any of the
abdominal viscera. Jn p::;ritoneal inflammation, the soreness
and tumefaction of the abdomen render the respiration extremely
short and frequent. Sometimes a debility of the respiratory
muscles occasions the motions of respiration to be feeble, short,
and frequent.

C. Frequent Respiration from Imperfect Function of the Or-
ganic Nerves of the Lungs.

In the function of respiration two important classes of nerves
are chiefly concerned.

The jnotions of respiration are effected by that class which
Sir Charles Bell terms ^/ie respiratory 5?/5^em of nerves. These
nerves arise from tne lateral portions of the medulla oblongata
and upper part of the spinal cord. The functions of these nerves
and, of course, the motions of respiration, are performed without
the aid of the will ; but, by means of voluntary nerves distributed
to the respiratory muscles, the will acquires some control over
these motions.

The branches distributed to the lungs from the great sympa-
thetic nerve, termed also the ganglionic^ or organic system of
nerves, are more immediately concerned in effecting the aeration
of blood. A full quantity of air in the lungs is inadequate to
effect this change, without the influence of these branches of
nerves. The motions of respiration therefore, may be continu-
ed, through the influence of the former class of nerves, but if
the organic or arterializing nerves cease to perform their oflice,
Je venous blood is returned unchanged, to the left side of the
^^rt, and thence transmitted to the system through the arteries.

1 12 An Essay on Respiration and Fulsation, [Dec.

So if tlic function of these nerves is imperfect, the blood is in the
same degree imperfectly arterialized.

These considerations explain reasonably how imperfect func-
tion of the organic nerves of the lungs occasions a relative fre-
quency of respiration. Like organic disorder of the lungs, and
the mechanical impediments to respiration, which have been ad-
verted to, this nervous lesion operates to diminish the arterializ-.
ing etficacy of each inspiration ; and, consequently, a greater
number of respirations is required.

The lesion of function of the organic respiratory nerves is
considered, in this place, only as one of the causes of frequent
respiration: the pathological etTects of this lesion, in preventing
a due arterialization of the blood, will be considered under our
second general head, in connection wiih the subject of imperfect
function of the motor respiratory nerves.

General diagnostic indication of increased frequency ofrespira->

tion.

From the preceding considerations it may be inferred, that a
disproportionate increased frequency of respiration does not in-
dicate the particular disease which impedes the respiratory func-
tion. The impediment may be some disorder of the lungs or air
passages, or some mechanical impediment to the motions of res-
piration, or an imperfect function of the orsjanic nerves of the
lungs. The frequency of breathing only affords the general in-
dication, that there is some impediment to the respiration, the
particular cause of which i to be investigated by attention to the
symptoms, and by auscultation, percussion, and other means of
exploration. Attention to this general indication will, in many
cases, enable the practitioner to adapt his remedies successfully
to local diseases, which otherwise might altogether elude obser-
vation, and lead to serious and even fatal results.

2d. A disproportionate diminished frequency of the respiration
indicates a want of energy in the nerves which control the respi-
ratory 7notions.

A lesion of function in either of the two classes of nerves
principally concerned in respiration, occasions a disparity be-
tween the respiratory and circulating functions, and causes im-
perfect aeration of the blood. Imperfect function of the motor
respiratory nerves produces this effect, by causing a dispropor-
tion between the quantity of air respired, and that of the blood
circulating through the lungs. Imperfect function of the organic
or arterializing nerves produces the same general result, by im-
pairing the influence of the respired air on the blood. In the
former case the quantity, in the latter the effect, of the respire*
air is diminished. As the pathological effects are in general *^

1838.] An Essay on Respiration and Pulsation, 143

same, it is proper to consider in connection, A. Imperfect aera-
tion of the blood from disordered function of tlie motor respira-
tory nerves ; and, B. Imperfect aeration of the blood from dis-
ordered function of the organic respiratory nerves.

GENERAL PATHOLOGICAL EFFECTS OF IMPERFECT AERATION OF

THE BLOOD,

The celebrated French physiologist, Bichat, was the first who
drew the attention of physicians to any satisfactory knowledge
of the pathological effects of imperfect arterialization of the
blood. He found, by experiments, that if a current of venous
blood is turned into the carotid arteries, it produces torpor of
the brain. A moderate quantity ofblack blood thus transmitted
to the brain, produces a degree of stupor and drowsiness. A
large quantity produces loss of sensation and voluntary motion,
and occasions coma and death. By turning, in the same man-
ner, a current of venous blood into the main artery supplying
one of the limbs, he found it to occasion a numbness and para-
lysis of the limb. In short, if venous blood is made to circulate
through any artery of the system, it occasions a torpor of the
part supplied by such artery. If the function of the lungs ceases,
while the heart continues to act, the blood not arterialized circu-
lates through the whole system, occasioning a general torpor,
paralysis and death.

The effects caused by a cessation of the respiratory function,
are termed asphyxia. The general phenomena of asphyxia
produced by a sudden cessation of the respiratory flection, as in
hanging, drowning, &c., are well known the heart continues
to act, sending the black blood into the arteries which naturally
circulate red blood; the skin and all parts of the system assume
a livid color ; consciousness, sensation and voluntary motion are
suspended; and, with the cessation of the heart's action, death
ensues. Similar phenomena occur m most diseases at the close
of life ; and, in the opinion of Bichat, asphyxia is by far the
most common immediate cause of death. " Whatever may be
the seat of the principal disease," he says, " whether it be an
organic defect, or a general injury of the functions, as fever, &c.
almost always, in the last moments of existence, the lungs are
embarrassed; the respiration becomes painful; the air is taken
in and exeplled with difficulty ; the coloration of the blood is
hardly carried on ; it passes nearly black into the arteries. The
organs, already debilitated by disease, receive much more easily
in tnat state the fatal influence of the contact of this blood, than
in asphyxia where they are unaffected. The loss of sensations
and of intellectual functions, and very soon that of voluntary
motions, succeed the embarrassed state of the lungs. The man
has no longer any connection with surrounding objects ; his

l4t An Essay on Respiration and Pulsation, [Dec*

whole animal life is interrupted, because the brain, which, as it
is known, governs this hfe, penetrated with black blood, ceases
its functions. By degrees the heart, and all the organs of inter-
nal life, innbibing this blood, cease their motions also. In this
Case it is the black blood which altogether stops the vital mo-
tions already enfeebled by the disease. It is in general very
rare tliat debility produced by disease brings on death in an im-
mediate manner ; it paves the w-ay to it, and renders the organs
susceptible of being influenced by the smallest change in the red
blood. But it is almost always this change which puts an end
to life. The cause of the disease is therefore only an indirect
cause of general death; it occasions that of the lungs, which
latter brings on that of all the organs." {Treatise on life and
Death.)

These views of Bichat, in regard to the deadening influence
of the black blood on those parts of the system which are natur-
ally supplied with red blood, are now commonly received by
pathologists. Perhaps this influence is not so generally the im-
mediate cause of death, as this author supposed ; but it is proba-
bly true, that death is most commonly produced in this way.
Since the publication of Bichat, the subject of this influence has
received considerable attention, particularly as an immediate
precursor and cause of death ; while but little attention has been
given to a less degree of the same influence observable in the
progress of many diseases. Throughout the progress of some
diseases, particularly fevers of a typhous character, this relation
between the respiration and circulation appears to have a most
important influence, a correct understanding of which, it is be-
lieved, win lead to many important therapeutic indications.

A. Imperfect Aeration of the Blood from Disordered Function
of the Motor Respirator]/ Nerves.

A lesion of function of the respiratory system of nerves im-
pairs the motions of respiration, causing the respiration to be
infrequent and small; and in consequence, less than a natural
quantity of air is respired. In this condition of the respiration, if
the circulation continues strong, a disparity between these two
functions occurs ; the air respired is insufficient duly to aerate
the blood in the lungs ; and consequently the blood passes into
the system imperfectly arterialized.

The deleterious efl^ects of such impaired function of the respi-
ratory nerves may be estimated from a consideration of the well
known deadening influence of the black blood in extreme cases
of asphyxia. The imperfectly arterialized blood, though still
retaining enough of its arterial character to sustain life, occa-
sions a degree of torpor in the brain and all parts of the system
supplied by the arteries. Sensation, consciousness, voluntary
motion all the cerebral functions become impaired. The

1838.] An Essay on Respiration and Pulsation. M6

capillary vessels, partially paralyzed, become distended and
engorged with dark colored blood ; the lips and finger nails
have a livid tinge, a livid paleness pervades the whole surface,
and the florid hue of health is nowhere seen. Secretion and
absorption become affected ; passive engorgements take place
in various parts ; indeed, a torpor produced by the deadening
influence of the imperfectly arteriallzed blood pervades the whole
system. The respiratory nerves, in common with other parts
of the system, become affected w4th this torpor, which, by ren-
dering the respiratory motions more languid, tends still further
to impair the arterialization of the blood, which again reacts on
the respiratory nerves. As the degree of this influence increases,
the cerebral functions become more oppressed, and symptoms
of approaching dissolution appear, such as subsultus tendinum,
coma, coUiquative discharges, and frequently tympanitic disten-
sion of the abdomen.

Typhous fever. Something of the train of symptoms above
described ordinarily occurs in typhous fever, and in other dis-
eases of a typhoid character. The lesion of nervous function
in the brain, which is a prominent characteristic of typhoid dis-
eases, almost always extends to the respiratory system of nerves,
occasioning a disparity between the respiration and the circula-
tion. While the healthy ratio between the respiration and the
pulse is 1 to 4 1-2, in typhous fever it is commonly 1 to 5 or 6,
and in many cases 1 to 7 or 8. The respiration, though often
more frequent than in health, is not proportionate to the increased
frequency of the pulse ; and if the pulse is less frequent than
natural, as sometimes occurs, there is more than a proportionate
infrequency of the respiration. In most cases this relative in-
frequency of the respiration continues through the whole course
of the disease, and during the last seven years 1 have never seen
a case of simple typhus in which it was not remarkable in some
stage of the fever.

It is true, that in this disease the heart partakes of the attend-
ing general debility, and in consequence, its action being feeble,
less blood is thrown to the lungs by each contraction ; from
which it might seem that, notwithstanding the relative infre-
quency of respiration, the blood may be sutffciently arterialized.
On the contrary, however, it may be observed, that the repira-
tory muscles also partake of this general debility, and in conse-
quence the respiration is feeble and small. In general, I think
the smallness of the rcspirarion is more than proportionate to
that of the pulse, so that the deficiency of arterialization is even
greater than is indicated simply by the infrequency of respira-
tion.

That the blood is imperfectly arterialized in typhus, is suffi-
ciently evident from the symptoms of the disease. Dr. Arm-
strong, in giving the distinguishing signs ol common continued

146 An Essay on Respiration and Puhalion. [Dec,

fever and typhus, says, " that " In the common continued fever,
the patient commonly has not much inaptitude of mind, often
answers questions readily, and in a pretty firm voice, without
much increased agitation of the breathing; whereas in typhus
the answers are mostly given with languid slowness and reluc-
tance, and much speaking obviously disturbs the respiration. In
the common continued fever the skin is generally of a brighter
red than natural, especially on the cheeks ; on the contrary, the
skin is always more or less of a dusky color in typhus, and an
admixture of it may be best observed in the flush of the face.
This duskiness of the skin is one of the proper symptoms of
typhus, and seems to arise from some change in the constitution
of the blood, which I have almost invariably seen darker on
dissection than in ordinary fevers. In the worst cases, this
duskiness increases in the progress of the disease, and lessens in
those that assume a mild aspect. So very characteristic is this
cutaneous duskiness, that I think I could distinguish typhus by it
at any time, if two patients were presented to me, the one la-
boring under that disease and the other under the common con-
tinued fever." {Gn Fevei^p. 235.)

In another part of his treatise, (p. 410), Dr. Armstrong
observes, " The blood is always blacker in typhus than natural.
In severe cases it is remarkably so where the excitement is fully
emerged, and at last the solids are most decidedly affected, as
any one may perceive who marks the dark hue of the muscles
on dissection. This state of the blood in typhus, if I mistake
not, is connected with that peculiar depression of strength, and
with the peculiar condition of the sensorium, which attend the

rise and progress of this disease But," continues Dr.

Armstrong, " the nature of this change in tlie blood, I do not
pretend to determine, and only meant to point to it as an object
worthy of far maore attention than it has yet received."

Dr. Southwood Smith says, " The skin is always of a darker
color than in synochus ; the whole surface is of a dull and dusky
tinge." (0?z Fever, p. 166 )

The dark color of the blood in typhus is noticed by other au-
thors, as of common occurrence. That it ^' is always hhcker
than natural," as asserted by Dr. Armstrong, is questionable.
Though I have ahvays observed, in some stages of the fever, a
relative infrcquency of respiration, with the dark colored blood,
and other symptoms necessarily attending this imperfect respira-
tion; yet I have noticed, in the commencement or progress of
some cases, an occasional acceleration of the breathing, contin-
uing for several hours or even days, during which the cheeks
assumed a florid color, and there was every indication of perfect
aeration of the blood. Sometimes there is even a morbid fre-
quency of respiration apparently depending upon irritation of
the respiratory nerves, during which the skin is uncommonly

1838.] An Essay on Respiration and Pulsation. 147

florid, and there is morbid wakefulness and sometimes a phren-
zied delirium. Such a state, however, is ordinarily of short
continuance, and is succeeded by infrequent respiration, lividity
of skin, a low delirium, subsultus tendinum, and coma the irri-
tative excitement being succeeded by a morbid depression of
nervous energy.

No inconsiderable part of the symptoms occurring in typhus,
it is believed, may be attributed to the imperfect respiration
which we are considering. The " sensorial debility and disturb-
ance of the mental powers," which are prominent characteristics
of typhus, may be produced by any impediment to the respira-
tion, preventing a proper aeration of the blood. But it is not to
be supposed that this imperfect respiration is ordinarily the first
link in the chain of disease in typhus. It is preceded and caused,
in most cases, by a torpor of the respiratory system of nerves,
which appears obviously connected with a general depression of
nervous energy throughout the system. In such cases, however,
the imperfect respiration cannot fail to add to the general nerv-
ous torpor, through the paralyzing influence of the black blood ;
and in cases of disease commencing in the lungs, a similar torpor
of the nervous system is a consequent result.

I have adverted particularly to typhous fever, as a disease in
which this deficient arterialization of the blood is ordinarily
prominent throughout its progress. In this disease there is
hardly a point requiring more careful observation for prognostic
and therapeutic indications. A remarkable relative infrequency
of respiration, in the early stage of the disease, indicates an
alarming prognosis. If in this stage the respiration and pulse
are as 1 to 7 or 8, it is almost certain that its course \\\\\ be of a
low typhoid character. Vertigo, tinnitus aurium, subsultus, a
muttering delirium, and coma, are almost sure to succeed. If
such infrequency of respiration occurs in any stage of the disease,
it may be considered as the precursor of a similar train of symp-
toms. Those symptoms which are commonly attributed to
" determination to the brain" or " congestion in the brain," are
associated with, and in a great measure depending upon, this
imperfect respiration.

Congestive typhus. In that form of disease w^iich is treated
of by Armstrong and others as congestive typhus, this deficiency
of respiration appears to be a prominent cause of the peculiari-
ties characterizing this form of fever.

This variety of typhus is commonly ushered in with chills,
vertigo, drowsiness, and extreme general prostration ; the
breathing is infrequent, irregular and sighing, or in some cases
frequent, but short, feeble and inefficient ; the skin pale and
-somewhat livid; the heat of surface unequally difilised; the
pulse rather frequent and irregular, or in some cases very infre-
quent and oppressed; sensation and voluntary motion are sud-

148 An Essay on Respiration and Pulsation. [Dec.

denly impaired ; and subsultus, muttering delirium, and coma
soon supervene. In rapid cases the disease has a near resem-
blance to apoplexy. On dissection, the blood is found accumu-
lated in the veins and the right side of the heart ; the arteries,
brain, muscles, and all parts of the system, are dark colored
from the black blood contained in them ; and the blood either
remains liquid, or coagulates very imperfectly.

Dr. Southwood Smith, in describing this form of typhus, says,
the patient " lies insensible, with a cold and dusky skin ; with a
sw^ollen and livid countenance; with a heavy and oppressed
respiration ; Vv^ith a pulse perhaps not to be felt, or, if distinguish-
able, either so rapid that it cannot be counted, so small that it is
like a thread beneath the finger, and so weak that it is lost by the
slightest pressure, or else slow, irregular, and intermittent. In
this state the patient is almost as completely paralyzed as in
apoplexy, and the attack is almost as rapidly fatal as apoplexy."

{Treatise on Fever, p. 175.)

The symptoms and post-obit appearances certainly are the
same as those attending asphyxia produced by inhaling certain
noxious gases, by mechanical obstruction of the lungs, and by
a division of the respiratory nerves ; and a careful consideration
of the phenomena, I think, must lead to the conclusion that im-
perfect respiration is a most prominent feature of the disease.
These circumstances surely demand a most careful attention to
the disparity between the respiration and the pulse, which at-
tends this form of disease.

Not only in typhus, but in all diseases, when the relative fre-
quency of the respiration is less than in the proportion of 1 to
41-2, it is a sure indication of deficient aeration of the blood,
unless, as in some rare cases, there is some disproportionate de-
bility of the heart, occasioning frequent, feeble, and ineffectual
contractions of that organ.

But there is, in many cases, deficient aeration, when the ratio
between the frequency of the respiration and pulse is normal ;
and e\ en when there is a comparalive increased frequency of
respiration. Typhous fever may be complicated with some
affection of the bronchial membrane, preventing a free commu-
nication between the respired air and the blood within the lungs ;
or with some affection of the lungs or pleura, preventing a full
expansion of the lungs : or with tympanitic distension of the
abdomen (a common symptom in typhous and typhoid fevers),
preventing a free descent of the diaphragm ; or with other cir-
cumstances before adverted to as occasioning a mechanical
impediment to the respiratory motions. Sometimes, also, in
connection with the general debility attending typhoid diseases,
there is a disproportionate debility of the respiratory muscles,
causing the motions of respiration to be small, feeble, and ineffi-
cient. In all such cases the blood will be imperfectly aerated.

1838.] An Essay on Respiration and Pulsation. 149

unless the relative frequency of respiration is more than natural ;
as the deficient fullness of respiration ought to be compensated
for by increased Irequency. If the cause of this impeded respi-
ration is manifest, it will of course be considered in counting
the respiration and pulse ; but if the impediment is latent, the
relative frequency alone might lead to an erroneous conclusion.
The degree of fullness of respiration is to be considered in con-
nection with the frequency. Commonly, however, the imperfect
aeration is sufficiently evident from the livid tinge of skin, the
drowsiness, listlessness, and other symptoms which it produces.

Pneumonitis. In this disease, especially when of a typhoid
character, the symptoms of imperfect aeration of the blood are
always evident. In almost all cases the frequency of respira-
tion is considerably increased. In a moderately severe case,
with a pulse at 90, the respiration will be as frequent as 30 in a
minute that is, in a ratio of 1 to 3 ; and when the lungs are ex-
tensively engorged, the ratio is often as 1 to 2. In one sense a
very frequent respiration in this disease is a bad symptom, as it
indicates extensive engorgement; but while the engorgement
continues, this frequent respiration is favorable, and indeed ab-
solutely necessary to sustain life. It is desirable that the increased
frequency should compensate for the pulmonary obstruction ;
but it is rarely fully sufficient for this purpose. The " tumid,
purple face or lips," constituting a part of the definition of pneu-
monitis in Good and other authors, indicate that, notwithstand-
ing the increased frequency of respiration, still the blood is
imperfectly arterialized. A further increased frequency is de-
sirable, provided there is not a corresponding increase of the
pulmonary obstruction ; if this obstruction is diminished, a pro-
portionate diminished frequency of respiration is not unfavora-
ble ; but if the respiration suddenly becomes less frequent, while
auscultation and percussion detect no abatement of the obstruc-
tion within the lungs, the symptom is alarming. It indicates
that the nerves of respiration are losing their energy, and that
imperfect aeration of the blood, with its consequences, muttering
delirium, coma in short, a fatal asphyxia will ensue. The
more typhoid is the character of the pneumonia, the greater is
the danger of this failure of respiration. Indeed, in all typhous
and typhoid diseases, a torpor of the respiratory nerves is to
be apprehended as a common source of danger.

Typhous fever, complicated with pneumonitis, is a disease in
which the effects of imperfect aeration of the blood are remark-
ably prominent. Dr. Southwood Smith, in treating of "typhus
mitior with thoracic affection," very well describes the ordinary
phenomena of this disease. " Prominent thoracic affection, as we
have seen," he remarks, " is not infrequent in synochus ; in ty-
phus it is more constant ; and the signs which denote its exist-
ence are more obvious, but they are not precisely the same.

150 An Essay on Respiration and Pulsation, [Dec,

The pain in the chest is less severe ; it is more often absent al-
togetlier ; while the sense of stricture and the dyspnoe are more
urgent. The cough is more constantly attended with mucous
rattle ; the respiration is shorter and more hurried. The skin
in general is cooler, and it is always more dusky. The dark
color of the skin, in severe cases becoming quite livid, is one of
the most characteristic marks of intense thoracic affection. The
color of the cheek is at first of a deep and vivid red ; as the dis-
ease advances it becomes of a purple tinge, and at length it is
quite livid. In these cases it is not uncommon for the respiration
to be from forty to fifty in a minute. The pulse is invariably
rapid and weak.* The cerebral affection is equally peculiar
and characteristic ; it never consists of intense excitement ; it is
never accompanied with violent delirium ; it is indicated by
confusion and stupor passing rapidly iuto coma ; and it is at-
tended with low muttering incoherence or disjointed rambling,
the trains of ideas that pass through the mind being extremely
faint, and linked together by no distinguishable affinity. We
know that one of the most essential conditions to the due exer-
cise of the sensorial faculties is the due supply of the brain with
arterial blood ; but in this state of the system arterial blood
does not and cannot circulate through the brain, because it is not
formed in the lungs: the patient is in a state approaching to
asphyxia, and m very severe cases lie remains for several days
in as perfect a state of asphyxia as seems to be compatible with
life. Why debility should, in these cases, be carried to the ut-
most possible extent ; why such cases should form the most
exquisite specimens of the adynamic state, need not be pointed
out : the disease is concentrated in the very organ which elabor-
ates the pabulum of life, and that stream which should convey
its vivifying and animating influence to every nook and point of
the system, is corrupted at its source." {Treatise on FeveVj p,
169.)

With this clue to the prostrating influence of the black blood
on the system, it is remarkable that Dr. Smith appears to have
drawn no practical inference from it, even in the thoracic cases
under consideration ; and it is scarcely less remarkable that he
should not have traced the effects of this influence in the other
forms of typhus, and in other fevers. These effects of imperfect
aeration of the blood are almost equally observable in the " ty-
phus mitior with cerebral affection," and other forms of ever
described by this author, and especially in typhus gravior.

The author also omits to m.ention the important fact that
pneumonia, when occurring with typhus, is ordinarily of a latent
character. Sometimes it manifests the thoracic symptoms

*The oppressed ^xAse^ which is common in this disease, is not "invaria-
Wy rapid and weak," but sometimes infrequent, irregular and intermitting.

1838.] An Essay on Rcspirution and Pulsation, 151

which he has described ; but more commonly not only the pain
in the chest is " absent altogether," but no " sense of stricture"
is complained of, there is no cough or expectoration, and, unless
in the advanced stages, there is no *' mucous rattle."

Another important omission in the detail of symptoms might
seem remarkable, were it not common to most authors ; in the
description of one hundred and fifteen cases of fever, the num-
ber of respirations in a minute is stated in only two or three
cases. That almost all authors neglect this point, while varia-
tions in the frequency of the pulse- are carefully and minutely
detailed, is sufficient evidence that the importance of the relative
frequency of the respiration and the pulse has been most unac-
countably overlooked.

Delirium tremens. In this disease, according to my observa-
tions, there is always this imperfect respiration. Ordinarily
there is a remarkable relative infrcquency of respiration, even
when the disease is complicated with affection of the lungs.
Authors generally appear not to be aware how commonly this
disease is thus com.pJicated. In May, 1S32, I lost a patient
with delirium tremens, who had manifested few symptoms of
pulmonary affection ; but after death the lungs were found very
extensively engorged. The case induced me to examine par-
t'calarly for latent affection of the kind in all cases of this disease.
Since that time, now six years, I have attended more than 60
cases, and have been surprised to find in every case decided in-
dications of pulmonary engorgement. In most cases there is,
in the early stage, a distinct crepitation, sucTi as ordinarily at-
tends pneumonitis ; in other cases the sound is such as indicates
edematous engorgement, resembling the sound produced by
squeezing a wet sponge, by wringing wet clothes, or by the
effervescence of fermenting liquors. The engorgement appears
to be of a passive kind, being manifested in the most depending
portions of the lungs about the posterior portions, if the patient
has been lying on the back ; or in the inferior lobes, if he has
been long in an erect posture. I am inclined to believe that
this engorgement, which prevails through the whole course of
the disease, has commonly been mistaken, in post-obit examina-
tions, for that passive accumulation in the back of the lungs
which takes place in most diseases in the last moments of life, or
after death. Since turning my attention to this point, my expe-
rience has co-incided with that of the late Dr. David Hosack, of
New York, who stated in his lectures, that he had always found
delirium tremens complicated with pulmonary disease.

As before remarked, the respiration is ordinarily infrequent.
The ratio between the respiration and the pulse is sometimes 1
to 6 or 7, even when there is considerable pulmonary engorge-
ment. This condition of the respiration accounts for the livid
skin, and may be a principal cause of the cerebral perturbation
and the trembling which characterize this disease.

152 An Essay on Respiration and Pulsation, Dec.

Night-mare (Ephialtes nocturnus, Good) is unquestionably
owing to imperfect respiration. This disease is described by
Dr. Good, as "produced during sleep, and interrupting it with
violent struggle and tremor : the pressure on the chest seeming
to be that of some hideous monster or phantom." The respira-
tion is remarkably infrequent, irregular, and interrupted ; and
commonly attended with a noise indicative of anxiety and dis-
tress. The mental hallucination is sometimes an apprehension
of being crushed by some heavy weight, or of being violently
grasped by some hideous animal, or of being smothered under a
bed, or of being tightly bound or closely confined. In general,
the hallucination is such as appears to have its origin in some
interruption of the respiratory motions ; and it is quickly dis-
pelled by awaking, or by an external impression which excites
the motions of respiration. It occurs during sleep, when res-
piration is deprived of the aid of the will ; and is in many cases
produced by a full meal taken at bed-time, which operates, in
part at least, to impede the motions of the diaphragm. It most
commonly occurs when a person is lying on the back, probably
because in this position the weight of the lungs presses on the
ganglia and trunks of the organic nerves, and the abdominal
viscera crowd against the diaphragm, more than in other pos-
tures of the body.

B. Imperfect Aeration of the Blood froyn Disordered Function
of the Organic Respirator!/ Nerves,

The aeration of the blood is immediately dependent upon
the nerves distributed to the lungs from the sympathetic, gangli-
onic or organic system. The lungs may be sound and duly filled
with air, but still the function of aeration is not performed with-
out the aid of these nerves. A lesion of their function suspends
the process of arterialization, notwithstanding the motions of
respiration are continued, through the influence of the respiratory
nerves.

Some degree of the imperfect action of these nerves is very
common in typhous and typhoid fevers, and other diseases, and
especially in erysipelas, scarlet fever, malignant cholera, and
some forms of dyspnoea and asthjna. It causes the respiration
to be frequent, irregular, sighing, and anxious. The patient,
while possessed of consciousness, feels the unsatisfying efl^ect of
respiration, and often says that his breathing seems to do little
good. All the voluntary muscles accessory to respiration are
instinctively called into occasional vigorous action ; but even
after several successive full inspirations, a conscious want of
further respiration remains. If this kind of breathing continues,
in any aggravated degree, for a considerable length of time, it
ordinarily becomes complicated with a torpor of the brain and
respiratory nerves, and the patient sinks into a state of asphyxia.

1838.] An Essay on Respiration and Pulsation, 153

This appears to be the most common fatal termination of scarlet
fever, erysipelas and other similar diseases.

It is a fortunate provision of nature, that there is an intimate
connection between this set of nerves, and the nerves governing
the action of the heart : in consequence of which there is ordi-
narily a relative proportion between the function of arterialization
and the motions of the heart. If torpor affects the arterializing
nerv^es of the lungs, it ordinarily affects, at the same time, the
nerves of the heart. Hence, while the arterializing function is '
impaired, the heart sends a moderate quantity of blood to the
lungs to be arterialized, the pulse becoming slow and infrequent,
or frequent, small and feeble. In the course of typhus, and
other fevers, the pulse sometimes becomes extremely infrequent
50, 40, and even 30 in the minute : in some cases this state
of the pulse occurs at the onset of the fever.

This infrequent pulse may attend a torpor either of the motor
respiratory nerves, or of the organic nerves of the lungs. In
the former case, the breathing is infrequent, slow and small ; the
skin livid ; and there is listlessness or tendency to coma. When
the arterializing nerves are i n fault, the skin is livid ; but the
breathing is full, hurried, irregular, sigliing and anxious; and
there is wakefulness, extreme mental anxiety, and sometimes
delirium, succeeded by coma.

Cholera. These circumstances are strikingly manifest in
malignant cholera. In that disease the morbific cause seems to
determine especially to the organic system of nerves. In some
cases the process of arterialization seems at once almost wholly
suspended the peculiar sighing moan, and other symptoms of
disordered respiration are observed, and the whole system as-
sumes a livid hue. At the same time the pulse, at first feeble,
soon ceases to beat. So far as the influence of the organic
nerves extends, life is suspended ; while the energy of the brain
and medulla oblongata, at least in some degree, remains. Con-
sciousness, volition and respiratory motion continue ; but the
arterializing function of the luno-s and the motion of the heart
have ceased. In this state I have seen a patient lie, perfectly
pulseless, for more than eight hours, when the functions of or-
ganic life gradually revived, and the patient recovered.

Most physicians, like myself, from mistaken views of the pa-
thology of this disease, treated their first cases by attempting
to arouse the action of the heart with opium, alcohol and other
stimulants. This attempt, in some cases, w^as too effectual.
The heart being excited to action, the blood is throw^n to the
lungs, from which it returns not arterialized to the heart ; the
left ventricle now contracts, and sends the black bluod, with its
usaal deadening influence, to the brain and whole system sup-
plied by the arteries ; insensibility and coma ensue, and the
patient dies asphyxied. Life may continue some time with a
D 4

154 A7i Essay on Respiration and Pulsation. Dec

total stoppage of the circulation ; but it is soon extinguished by
a circulation of black blood in the arteries.

The asthma with jniejnle respiration described by Laennec,
affords an example of this imperfect arterialization from disor-
dered function of the organic nerves. " In cases of this kind,"
says Laennec, *' the respiratory sound has resumed all the in-
tensity which it possessed in early infancy : we perceive distinct-
ly the pulmonary expansion taking place w^ith uniformity, com-
pleteness, and puerile promptitude, in all the air cells : and yet
the patient is oppressed in his breathing, or, in other words, he
constantly feels the want of a still more extensive respiration
than he enjoys. The lungs, dilated as they are in an extraordi-
nary manner for an adult, nevertheless have not capacity enough
to satisfy the wants of the system. This affection is sufficiently
common in persons affected with chronic mucous catarrhs, at-
tended by a copious and easy expectoration. In such cases, the
dyspnoea is frequently very intense, and is sometimes so aggra-
vated by the slightest motion, that the patient, though otherwise
in pretty good health, is condemned to a life of inactivity, or
even to an almost complete state of immobility. Attacks of
asthma, however, properly so called, are less frequent in such
subjects, than in those affected with the dry catarrh. In these
latter cases, the imperfection and small extent of the respiration
easily account for the oppressed breathing. But in the others,
even during the severest attacks, the completeness with which
the respiration is performed is quite astonishing; the sound of it
is quite puerile ; and, as in the case of a strong and healthy child^
we are sensible of the dilatation of the pulmonary cells to their
full capacity, and over the whole extent of the chest. Never-
theless, the patient is oppressed, and, as I have already stated,
would require a more extensive respiration than his organization
allows ; in other words, the respiration is very perfect, but the
wants of the system in relation to it are increased beyond the
standard of health. In such cases it is not in the lungs that we
must look for the cause of the disease, but in the innervation or
nervous influence itself; and this will hold equally good, even
if we adopt the chemical theory of respiration, and refer the
dyspnoea to an extraordinary want of oxygen in the blood. If
a temporary obstruction of the bronchia by a little mucus im-
pedes the transmission of the air to even a small portion of the
lungs, the patient experiences an extreme oppression." {Forhe^
LaenneCj p. 512.)

SYMPATHY BETWEEN THE DIFFERENT NERVES CONCERNED IN

RESPIRATION.

Such is the sympathy between the different nerves concerned
in respiration, that there is rarely disordered function in one class

1838.] An Essay on Respiration and Pulsation. 155

of nerves, without some degree of similar disorder in the other
class. In the disease, which have been adverted to, as examples
of the disordered function of each class of nerves, commonly all
of the nerves concerned in respiration arc, in some degree, sim-
ilarly affected. In typhous fever, for instance, the torpor of the
motor respiratory nerves is commonly the most prominent, but
there is ordinarily also some degree of torpor in the organic
nerves ; and in many cases it is not easy to decide whether one
or the other class is the more affected. If disease commences
with torpor of the organic nerves, the consequent imperfect
aeration of the blood ordinarily soon occasions torpor of the
motor nerves, by the paralyzing influence of the black blood.

Many diseases, besides those already adverted to, are com-
monly attended with deficient aeration of the blood." Dr. Stevens,
for many years a distinguished practitioner in the West Indies,
has particularly noticed the dark color of the blood in yellow
fever, and some other diseases of tropical climates. Dr. Daniell
has made similar observations in the autumnal fevers of Savan-
nah. In dyspepsia, hypochondria, and some forms of mania, it
may ordinarily be observed. From obvious causes it occurs in
croup, and other diseases in which there is obstruction of the
air passages. All fevers of a typhoid character are commonly
attended with this condition of the blood ; and indeed there are
few diseases in which it may not occasionally occur.

From the preceding considerations it may be observed, that
imperfect aeration of the blood is occasioned by various causes.
Attentive observation of the symptoms in particular cases is
requisite to ascertain whether there is any mechanical impedi-
ment to the expansions of the chest, or whether the fault is in
the air passages, the lungs, the motor respiratory nerves, the
respiratory muscles, or the organic nerves of respiration. A
correct diagnosis in regard to these circumstances is highly
important in a therapeutic point of view.

THERAPEUTIC INDICATIONS.

It is doubtful whether, in any disease, an excessively aerated
condition of the hlood is a prominent morbid feature. I suspect
that such a condition sometimes occurs, dependent upon irrita-
tive excitement of the organic nerves, in erysipelas, scarlet fever,
and some other diseases ; but, if so, this state ordinarily is soon
followed by collapse, with imperfect arterialization. On the
contrary, there are few diseases in which deficient arterialization
does not sometimes occur. Bichat considered it as by far the
most common immediate precursor and cause of death, and I
think it has been rendered evident, in the preceding part of this
essay, that such a condition of the blood has some degree of
injurious influence, in various stages, and sometimes throughout
the progress, of many diseases.

156 An Essay on Respiration and Pulsation, [Dee.

The general therapeutic indication, therefore, connected with
the relation between the respiratory and circulating functions,
is to promote the arterialization of the blood, or, in other words,
to remedy deficient respiration.

Contra-indications in cases of deficient respiration.

Stimulants, which ordinarily operate to increase the action of
the heart, without a corresponding increase of the respiration,
should be withheld, or given with extreme caution, when the
blood is imperfectly arterialized. From erroneous pathological
views, much injury is done, in such cases, with this class of rem-
edies. The deleterious effects of such medication in cholera
have been already adverted to ; and the same remarks are ap-
plicable to cases generally in which the respiration is in a dimin-
ished proportion to the pulse. The paralyzing mfluence of the
imperfectly aerated blood occasions a torpor of the whole sys-
tem. The heart becomes affected with this torpor, and the feeble,
small, and sometimes slow, infrequent pulse, seems to indicate
debility of this organ. It is, however, commonly a torpor or
oppression, rather than the debility of exhaustion ; the respira-
tion is inadequate to produce that change in the blood which
renders it fit fully to support the vitality of the organs to which
it circulates ; there is already more blood circulating through
the lungs than they can arterialize. Under these circumstances,
alcohol and fermented liquors, opium, quinine, serpentaria, and
all articles which operate to increase the action of the heart,
more than that of the lungs, may have a most injurious effect.
By transmitting^n additional quantity of blood to the already
over-burdened lungs, they cause the whole mass of blood in the
system to become more deteriorated, and thus add to the torpor
which occasions the apparent debility. Such effects are too
frequently produced in the progress of typhous fever, typhoid
pnemonitis, and other diseases, especially in the last moments of
life.

We will suppose a case of pneumonitis, in which during the
progress of the disease, one half of the lungs has been obstructed
by engorgement. The pulse has been about 90, the respiration
35 or 40. The respiration has been thus frequent, because one
half of the lungs has had to perform the whole office of arterial-
ization ; yet the tumid, purple lips, the general lividity of skin,
and some cerebral oppression, have shown that, with this forced
effort, the respiration still has been deficient. At length com-
monly on the sixth day there is an effort towards a crisis.
There is as yet little if any resolution of the engorgement within
the lungs ; but there is increased secretion ii'om the bronchial
membrane, while the secretions of the system generally are
beginning to be unlocked. The lungs, almost suffocated by the
bloody mucus poured out into the bronchia, are struggling with

1838.] An Essay on Respiration and Puhalion. 157

increased effort to perform their office. AH the accessory, as
well as ordinary muscles of respiration, are engaged in agonizing
labor to aerate the blood. But the hvidily ol'skin has increased,
and the brain, rendered torpid by the black blood circulating in
its arteries, scarcely allows the aid of the will to sustain the
respiratory efforts. Under these circumstances active stimu-
lants are administered for the purpose of supporting the sinking
powers of life. The action of the heart is exciied, and th
blood is hurried through the lungs, at once overwhelming the
exhausted respiratory powers. For a few moments the sys'em
appears to make a renewed struggle to relieve itself of the suffo-
cating oppression ; but coma comes on ; the respiration, becom-
ing feebler and shorter, soon stops ; and the heart, " the ultimum
moriens," after a few more feeble, irres^ular pulsations, yields
under the deadening influence of the black blood.

Cases of the above description are not uncommon; and a
less degree of the injurious effects of such stimulants, given in
the progress of fevers attended with deficient respiration, it is
believed, is one of the most common errors of medical practice.

Yet there are cases of deficient respiration cases attended
with absolute debility or atony which are benefitted by these
remedies. Coma even sometimes is relieved by full doses of
opium ; and in small doses opium and other stimulants often
may be serviceable in absolutely atonic cases. Their operation
hov^ever, should be carefully watched ; and if they increase the
action of the- heart, without a corresponding increase of the
respiratory function, the operation v/ill be injurious.

A nutritious diet^ by invigorating the circulation, and in-
creasing the quantity of blood ; ad muscular exercise, by hur-
rying the circulatien, commonly have an injurious effect, in cases
of this comparative infrequency of respiration.

The disparity between the respiration and pulse is aggravated
also by remedies which opprate directly to diminish the frequency
of respiration. Most of the narcotics, given in full doses, so
as to affect the brain, producing vertigo, drowsiness, or coma,
have this effect by inducing torpor of the brain and respiratory
nerves ; and some of them in moderate doses have a similar
operation.

Strychnine in large doses occasions the respiration to be re-
markably slow% irregular and infrequent ; while in moderate
doses it sometimes improves the respiratory function. I am
now treating a general paralysis of the portio dura with this
remedy, in whom one sixth of a grain four times a day produ-
ces fornication, slight pricking pains, and frequent spasmodic
twitching of the muscles. While under this operation, the ratio
between the respiration and pulse is about 1 to 7 or 8 ; though
the patient has the ordinary healthy ratio, 1 to 4 1-2, when not
under the influence of medicine. In this case, 'however, the

15S An Essay on Respiration and Pulsation. [Dec.

strychnine does not appear to occasion a deterioration of the
blood proportionate to the- diminished frequency of respiration ;
and in less doses it is a uscfid remedy for deticient arteriahza-
tion depending on a torpor of the organic nerves. In such cases
it appears to have an exciting operation on the arteriahzing
nerves, as mi^ht be inferred from its efficacy in some forms of
asthma and dyspnoea, in which a torpor of these nerves is mani-
fested.

By a similar operation, as before remarked, alcohol, opium,
and the exciting narcotics generally, in small doses, sometimes
have a favorable effect. Their general exciting operation may
be determined especially to the organic nerves of the lungs, or
to the brain and motor respiratory nerves, occasioning the breath-
ing to be more full and easy, and the blood to be more perfectly
aerated. In some epidemics these effects are so uniform that
the physician learns to prescribe such remedies in particular
cases, with almost perfect confidence. Aside from the observa-
tion of epidemic peculiarities, however, and a consideration of
the attending general debility, I know not what general rules
can be given to enable a practitioner to calculate on a favorable
operation of such remedies, in cases of imperfect arterialization
of the blood. As before observed, when used in such cases their
operation should be carefully watched; and if they are found to
excite the circulatory, more than the respiratory function, their
operation will be injurious.

Rf^medies icli'ich i^i^oniote the arterialization of the blood.

These are,

1st. Remedies which diminish the action of the heart and
arteries.

2d. Remedies which excite and invigorate the motor respira-
tory nerves.

3d. Remedies wdiich excite and invigorate the arterializing
nerves of the lungs.

4th. Ventilation.

5th. Remedies which obviate mechanical impediment to the
respiration.

6th. Remedies which excite secretions vicarious of respiration.

1st. Remedies ichich diminish the action of the heart and
arteries.

These remedies obviate a disparity between the two functions
by reducing the circulation to a proportion with the respiration.
The antiphlogistic medicines generally belong to this class.

Venesection is one of the most important of this class of rem-
edies. If the pulse is frequent, full and strong, with a compar-
ative infrequency of the respiration ; or, as occurs in pneumon-
itis, pleuritis, bronchitis, and some other diseases, if, with this

1838.] A.n Essay oil Respiration and Pulsation. 159

condition of the pulse, the respiration is frequent, but still inad-
equate to a due aeration of the blood, there ran be no question
as to the propriety of bleeding to reduce the circulation. There
are other cases, equally requiring bleeding, in which the indica-
tions are less obvious. Imperfect respiration, by producing
torpor of the heart and arteries, through the ordinary influence
of the black blood, may render the pulse infrequent, slow and
feeble. This constitutes what is called the oppressed, depressed,
or obstructed pulse.

This oppressed pulse is common in the congestive variety of
typhous lever, in some forms of pneumonitis, and in otiier dis-
eases. When a vein is opened, the blood runs slowly, and has
almost a tarry consistence and color: but as the circulation
becomes relieved, and the process of aeration is better performed,
the blood assumes a florid appearance, and runs freely. This
change in the blood takes place more suddenly when some degree
of lainting occurs during bleeding, to check or suspend the
heart's action ; hence when the principal object of bleeding is
to restore the balance between the respiration and the pulse,
and promote the aeration of the blood, it is well to encourage
fainting by bleeding in an erect posture.

The oppressed pulse may occur in a highly inflammatory, or
a low typhous or typhoid condition of the system. In both
these conditions, bleeding tends to restore the balance between
the respiration and the pulse. In the former, bleeding is required
not only to reduce the pulse to a proportion with the respiration,
but also to subdue inflammation the pulse rises in fullness and
strength, as the oppressing eftects of the black blood are re-
moved; and the bleeding may be continued freely. In a low
typhoid case, only one of these objects is to be accomplished by
bleeding, which should be stopped as soon as faintness is indu-
ced, or the blood assumes a florid, arterialized appearance; or,
if possible, the disparity between the respiration and the pulse
should be oviated by other means without bleeding.

Antimony has a striking effect in diminishing the action of the
heart, without producing a corresponding diminution of the res-
piration. In cases of inflammatory excitement it is useful in
reducing arterial action, but it is particularly useful when such
excitement is connected with deficient respiration.

This affords one reason for its efficacy in pneumonitis, in
which this remedy has been employed successfully in frequent
large doses, by Rasori, Laennec, and other modern waiters. In
this disease, the refrigerant and alterative powers of the remedy
have a favorable operation, in reducing and resolving inflam-
mation ; but I have found it especially adapted to those cases
in which the symptoms of deficient arterialization are promi-
nent when the respiration is infrequent and small, the skin
livid, and the cerebral powers oppressed. Laennec observed

160 An Essay on Respiration and Pulsaiion. [Dec.

patients, in this disease, to rocover their consciousness under
the use of this remedy ; and he advises a persevering employ-
ment of it when " the oppression is great, or the head affected.''

Dr. Thomas Marryatt, of Bristol, England, who published a
treatise on therapeutics, in 1788, gave tartar emetic successfully
in fever and in pleurisy. " I have seen many instances," he ob-
served, "wherein a paper has been given' every three hours
[gr. X. in six papers], without the least sensible operation, either
by sickness, stool, sweat, or urine; and, though the patients had
been unremittingly delirious for more than a week, wnth subsul-
tus tendinum, and all the appearances of hastening death, they
have perfectly recovered without any other medical aid a
clyster every other day excepted."

Laennec found tartar emetic successful in "hydrocephalus*'
[cerebral congestion ?] supervening " in the course of continued
fever," and " general debility" also " in nervous affections
connected with a congested state of the brain or spinal marrow."

Dr. Graves employs this remedy in delirium tremens, and
* with very remarkable success at various periods of fever, but
principally towards its termination." In the low stages of spot-
ted fever, when the symptoms denoted " a combination of
primary general nervous excitement with a secondary cerebral
congestion," he found a combination of tartar emetic with lau-
danum very successful. " This method," he observes, " has
manifestly saved many, many lives, under a combination of cir-
cumstances apparently hopeless " (Graves's C.inical Lectures^

In the low stages of many febrile diseases, opium may be
given advantageously in combination with antimony, when it
could not be given alone, without danger of producing cerebral
congestion. The opium allays nervous irritation, exercises its
general stimulant operation, and thus sustains the powers of
life ; while the antimony, by preserving the balance between
the respiratory and circulating functions, and thus promoting
the arterialization of the blood, prevents the congesting effects
of the opium.

Ipecac, like antimony, operates to diminish the force and fre-
quency of the heart's action, and thus obviates a disparity be-
tween the respiratory and circulating functions. It is less pow-
erful than antimony ; but is appropriate to some cases, in which
the more debilitating effects of antimony might be injurious.

The refrigerant salts, nitrate ofpotassa, bitartrate of potassa,
sulphate of magnesia, sulphate of soda, (fee, reduce the circula-
tion, and in appropriate cases thus have a favorable effect in
equalizing the respiratory functions.

In the use of antiphlogistic remedies, for the purpose under
consideration, the general tone of the system is to be observed ;
and in low atonic cases caution is required, lest their general
debilitating effects shall more than counterbalance the advantage

IS38.] An Essay on Respiration and Pulsation, 161

of equalizing the respiratory and circulating functions. In low
stages of typhous ieYer, for instance, these remedies sometinies
may be required for this purpose ; but as it is important, in such
cases, to avoid the occasion of debility and exhaustion, it is de-
sirable to equalize the functions by other means ; and when
debilitating antiphlogistics are employed, their operation should
be continued no longer than necessity requires.

Digitalis is well known to possess the property of diminish-
ing the frequency and force of the pulse in a remarkable degree*
It sometimes has a similar effect on the respiration, especially
in large doses, but not in proportion to its effect on the pulse*
By virtue of this operation, it is often useful in typhus, pneumo^
nitis, erysipelas, scarlet fever, and other diseases, and particularly
in congestive fevers. It relieves morbid wakefulness, subsultus
tendinum, muttering delirium and coma ; and sleep induced by
it is commonly more refreshing than w^hen induced by opium
and most other narcotics, because tlie respiration is less op-
pressed.

In a former part of this essay, the remarkable deficiency of
respiration which occurs in delirium tremens has been noticed ;
and the success with which I have treated this disease, princi-
pally witli digitalis, induces me briefly to describe my general
plan of treatment. In 1820, Dr. A. L. Peirson, of Salem, Mass.
(New Eng. Jour, of Med. and Surg., Vol. IX.), recommended
digitalis in the treatment of this disease. After bleeding, he
gave the tincture, in doses of seventy-five drops, every two
hours.

Several years since, owing to epidemic constitutional changes,
or some other reason, I observed that opium was less successful
in this disease, than it had formerly been in my practice ; and
I was induced to make trial of the digitalis. I commence the
treatment of a case with a full cathartic dose of calomel, which
is followed with the exhibition of nitrate of silver,* in doses of
gr. 1-8, every hour, .or gr. 1-4 every two hours. If called in
the early part of the day> I adopt no direct means for inducing
sleep until night the natural time for sleep. In the evening 1
direct one ounce of tincture of digitalis, of which a third part
is to be given every two hours until sleep is induced. If this
fails, the nitrate of silver is resumed and continued through the
following day ; and on the following night an ounce and a half
of the digitalis is directed, one third to be given every two hours.
In a great proportion of cases sleep is induced, and the disease
suspended, the first night ; and it is very rare that the wakeful-
ness continues through two nights. In most cases no other
remedies are used ; though sometimes, in connection with them,

*For a notice of the medicinal properties of this remedy, see subsequent
part of this essay.

E 5

162 An Essay on Respiration and Pulsation. [Dee^

I direct castor, artificial musk, camphor, or some bitter infusion,
with a blister to the back of the neck, or a wash of tincture of
cantharis and aqua ammonia3 to the scalp. In a few cases the
digitalis has been rejected from the stomach, when I have di-
rected smaller doses at shorter intervals. Of more than fifty
cases, treated on this general plan, only four have been fatal.
One had been tampered with by a quack, before I was called ;
the second was complicated with a S3vere pneumonitis affecting
both lungs ; the third cam.e on in the course of a severe dysen-
tery sleep was induced, but the patient sank, after two weeks,,
with the dysenteric symptoms ; the fourth was complicated with
erysipelas affecting the face and head, and terminated fatally on
the ninth day. In the latter three cases, death appeared to be
owing less to the delirium tremens, than to the diseases with
which it was complicated.

Ergot has even greater efficacy than digitalis in depressing^
the circulation. In doses not sufficient to produce any violent
effects, it will reduce the healthy pulse from 70 to 50 or even 40
in a minute. But at the same tim.e it depresses the respiration.
While digitalis affects the motor nerves of the heart more thaa
it does the respiratory nerves, ergot affects both, and in most
cases the respiratory nerves chiefly. When the object is sim-
ply to diminish the action of the heart, as in active and irritative
hemorrhages, I have found this remedy incomparably more
valuable than any other ; but on account of its depressing the
respiratory motions, it is decidedly injurious in cases of deficient
arterialization ; and it is noticed, in this place, only to contrast
its powers with those of digitalis.

Sanguinaria Canadensis in its medicinal effects is considera-
bly allied to digitalis. It is narcotic and alterative. By its narcotic-
operation it diminishes the frequency and force of the heart's
action ; and by virtue of this operation, when the circulation is
proportionately more active than the respiration, it restores an
equilibrium of action. It is particularly useful in diseases of
the lungs and bronchial membrane. In pneumonitis, catarrh,,
croup, and other diseases of the respiratory organs, its alterative
operation promotes healthy secretion, produces resolution, and
thus aids the respiratory function, by improving the condition of
the lungs, while its narcotic operation tends still further to equal-
ize the respiratory and circulating functions by depressing the
action of the heart. In such cases, when the skin is livid, the
cerebral powers are oppressed, and other symptoms of imper-
fect arterialization are manifest, its favorable operation relieves
the cerebral symptoms, and gives a florid hue to the skin. As
an operation consequent to these effects, the oppressed pulse,
which is common in such cases, often becomes more frequent,
fbll and strong an elfect which probably has occasioned the
common, but erroneous impression, that sanguinaria operates
directly to stimulate the action of the heart.

1838.] An Essay on Respiration and Pulsation. 163

In very large doses, sanguinaria, like most other narcotics,
produces torpor of the brain and respiratory nerves, with infre-
quent, slow, and stertorous breathing, and its consequences the
ordinary symptoms of asphyxia.

Colchicum, Vej-atrum, Nicotiana tahacum. and Lobelia injlata,
with general narcotic and alterative powers like sanguinaria,
have also a similar operation in diminishing the action of the
heart.

Poly gala Senega though destitute of narcotic powers, is sim-
ilar to sanguinaria in its alterative effects, and in its operation on
the heart. The latter operation, probably, is dependent on the
nauseating property of the remedy a property which, in several
of the articles before enumerated, contributes to diminish the
action of the heart.

2d. Remedies which excite and invigorate the motor respira-
tory nerves.

Articles generally which produce sudden cerebral excitement
with mental exhileration have this effect. Ether, camphor, am-
monia, musk, castor, assafxtida, oil of amber, cajuput oil, and
the volatile terebinthinates, such as oil of turpentine and that of
the Abies Canadensis, belong to this class. These remedies are
commonly termed diffusible stimulants ; but, with the exception
of the volatile terebinthinates, they have little, if any, direct
stimulant operation on the heart. Their main operation is on
the nervous system. They produce cerebral excitement, reliev-
ing drowsiness, coma, and low delirium, and in virtue of this
operation they call the aid of the will to assist in respiratory
action ; and at the same time they appear to have a direct exci-
ting operation on the respiratory nerves. In the low stages of
typhous and typhoid fevers, when the respiration and the cere-
bral functions are oppressed, they quicken the respiration, and
thus tend to relieve coma, delerium subsultus tendinum, and
other symptoms of nervous oppression. They are especially
useful about the time of the crisis of fevers, particularly the
crisis of pneumonitis and other diseases of the respiratory or-
gans. Their operation is ordinarily transient ; but the frequent
use of these various articles, in succession, is highly important
in sustaining the nervous energy and the respiratory action,
through the critical period of such diseases. Whenever in the
progress of typhous or typhoid fevers, the' respiration is observ-
ed suddenly to become " infrequent, these remedies should be
promptly and perseveringly employed to quiclien the respiration
and prevent the deadening influence of the black blood through
the system. . * *

Dr. Graves highly recommends this class of remedies, in
cases " when there is great prostration of the powers of life,
oppression of the nervous functions, and low, muttering deliri-

104 An Essay on Respiration and Pulsation. U)ec,

um ;** and a remark of his in regard to musk, that "it exercises
a stimulant effect on the nervous system, without having any
tendency to produce cerebral congestion or coma," is applicable,
in general, to other remedies of this class. Indeed, the practice
of giving these remedies, for the relief of such symptoms, is
common ; but the rationale of the practice, and the leading prin-
ciple, that coma and other symptoms of cerebral oppression are
commonly owing to imperfect respiration, have not been gener-
ally understood.

Enemata of some of the articles above enumerated partic-
ularly of camphor and oil of turpentine semetimes operate
very promptly to relieve oppression of the respiratory and cere-
bral functions.

Coffee and green tea are mild but valuable remedies of this
class. I think that injury is often done to persons who habitu-
ally use these articles in health, by withholding them during
sickness. In typhous fever, typhoid pneumonitis, and many
other diseases, their remedial efficacy, in producing cerebral
excitement, and in quickening the respiration, is important. The
use of strong tea, in cases of stupor occasioned by excessive
doses of opium or alcohol, is common.

External vesieatories and irritants, such as cantharis, nitrate
of silver, corrosive sublimate, mustard, oil of turpentine, oil of
cinnamon, and the like, are valuable adjuvants in such cases.
A blister applied to the back of the neck is one of the most
common remedies for coma and other symptoms of cerebral
oppression ; and probably irritants applied to this region, from
its proximity to the origin of the respiratory nerves, are more
effectual than io other parts of the system. Dr. Graves pre-
scribes blisters with this view ; and in some cases of typhus, I
think I have seen good effects from continuous irritation in this
region, excited by a pitch plaster, with a small quantity of pul-
verized nitrate of silver sprinkled on its surface.

Callmg the attention of a patient to his respiration, and
prompting him to take frequent full inspirations, tend to keep up
the process of aeration, and to prevent the patient from sinking
into a comatose condition. I am always careful, about the sixth
day of pneumonitis, to watch the symptoms of an approaching
crisis. If the symptoms of deficient arterialization are increas-
ing, as always occurs when the crisis is likely to prove serious,
I perseveringly employ the diffusible excitants above mentioned,
apply a blister or other irritant to the back of the neck, and
"whenever the respiration flags, I arouse the patient to the ne-
cessity of full and frequent inspirations. I remain by the patient
until a nurse or other attendant has learned this mode of man-
agement, which in some cases is required to be continued for
several hours. By this management I have seen patients sus-
tained through the critical period of this disease, who otherwise
would almost certainly have sunk into a fatal asphyxia.

1838.] An Essay on Respiration and Pulsation. 165

It is well known, that in a low typhous or typhoid state, it
is necessary that a patient, who inclines to sleep, should be fre-
quently aroused. In natural healthy sleep the respiration is
ordinarily slower and less frequent than during wakefulness.
The ratio between the respiration and the pulse ordinarily be-
comes 1 to 5 or 5 1-2. The aid of the will is withdrawn, and
the breathing is performed wholly by the involuntary respiratory
nerves. In low typhus fevers the disparity during sleep becomes
still greater. While awake a patient feels those distressing sen-
sations, which attend imperfect aeration of the blood, and which
instinctively demand the aid of the will to assist the torpid and
enfeebled respiratory nerves and muscles ; but during sleep, the
aid of the will being withdrawn, the breathing becomes irregu-
lar, intermitting, short and infrequent a breathing which in this
diseased condition would soon overwhelm the system with as-
phyxia.

But in spite of all our efforts, the respiration sometimes flags,
and patients sink into a comatose sleep, from which, for a time,
they cannot be fully awaked. Our efforts should be still contin-
ued ; if the patient is able to swallow, the most diffusible excitants,
ammonia, ether, camphor, &c., should be administered little dilu-
ted, so as to make a strong impression on the mouth and fauces ;
or the same substances should be applied to the nostrils, or
sprinkled on the face. These means, with perhaps the aid of
frictions over the chest, if they do not awake the patient, will
generally arouse the system enough to occasion several succes-
sive full inspirations. I recently saw a liltle patient recover
from a coma succeeding scarlet fever, during which, for about
three days, the breathing absolutely stopped, whenever these
means were discontinued even for a few minutes.

In a similar way cases *of profound coma consequent to large
doses of opium and other narcotics, taken by accident or with
suicidal purpose, have been treated successfully by flagellation
and other violent external irritation. That such means prove
efficacious by exciting and sustaining the respiration, may be
inferred from experiments, made by Brodie and others, of sup-
porting life, under the influence of enormous doses of certain
narcotics, by artificial respiration. These experiments prove
that such narcotics occasion death by suspending the respiratory
motions and inducing asphyxia, rather than by a'' direct operation
on the brain.

This general mode of treatment has been applied to extreme
cases of intoxication with remarkable efficacy.

3d. Remedies ichich excite and invigorate the arterializing
nerves of the lungs,

^ Most of the remedies above enumerated, which operate to ex-
cite and invigorate the motor respiratory nerves, have in some

166 An Essay on Respiration and Pulsation. [Dec.

degree a similar operation on the organic nerves of the lungs.
Such is the sympathy between these two classes of nerves, that
when one of them is affected with torpor, the other is in some
degree similarly affected ; and the remedies which affect one
class, also ordinarily affect the other. But the effects of artificial
respiration in cases of coma caused by alcohol, opium, and other
Btupifying narcotics, show that in those cases the torpor is prin-
cipally in the brain and motor respiratory nerves. On the other
hand nervous asthma, malignant cholera,, and some other dis-
eases, are instances in which the torpor is chiefly in the organic
nerves, while the brain and respiratory nerves are compara-
tively little affected.

These circumstances afford grounds for a distinction of two
classes of remedies. The class above treated of operates prin-
cipally on the motor respiratory nerves. The remedies next to
be considered appear to operate principally on the organic
nerves, though some of them have also an evident operation on
the motor nerves. In general this class produces a gradual and
permanent increase of nervous energy, while the former class
effects a sudden and more transient excitation.

Nitrate of silver, arsenical solution, chlorine, cantharis and
capsicum, are the principal remedies of this class. Tetrakini-
trate of bismuth, sulphate of zinc, and bisulphate of copper,
have a less degree of the same operation. Mustard and other
pungent tetradynamous plants, also belong to this class.

Nitrate of silver, I consider this article as one of the most
valuable remedies for restoring and sustaining the balance be-
tween the respiratory and circulating functions. It commonly
increases the frequency of the respiration ; but it appears to
operate more on the organic nerves.

My common dose is gr. 1-8, in pill, repeated every hour, or
once in two or three hours, according to the urgency of symp-
toms. Frequently I give a solution of the following form: ^,
Nitrat. argent, gr. ij.; aqua^ distillate 3J. dissolve and add syr.
simp. 3vii. M. The dose of the solution may be such as to
contain from 1-8 to 1-4 of a grain. The solution is the prefer-
able form when an effect of the remedy on the fauces is desira-
ble, as in scarlet fever, and some other diseases ; and it is ordi-
narily more easily administered to children than the pill.

In typhous and typhoid fevers, in w^hich a failure of the
respiration is 'a source of no iiiconsiderable part of the danger
to be apprehended, 1 place much reliance on thi^ remedy. In-
frequent respiration, ahdominal tympanites,'^ aphtha, subsultus
tendinum, and coma symptoms which are commonly associa-

*For my fjrst hint in reg'ard to the efficacy erf. nitrate of silver in ob\aa-
ating tympanites, I am* indebted to Dr. Lester l^eep, of Fair Haven, in this
county. .

1858.] An Essay on Respiration and Pulsation. 167

ted in typhus are some of the most prominent particular
indications for its exhibition. Commonly, however, I commence
its use as soon as any degree of deficient respiration is observed,
and continue it through the whole course of the disease. When
there is a great degree of deficient respiration, and the disease
has decidedly the congestive form, with urgent symptoms of
oppression of the respiratory and cerebral functions, bleeding,
antimony, the diffusible excitants, or other remedies, which
more promptly relieve such symptoms, are required ; but to
prevent these symptoms, to relieve them when moderate in
degree, and to sustain the respiratory function when restored
from a state of depression, I have found no remedy more effi-
cacious than nitrate of silver. The intestinal hemorrhage,
which often occurs in the course of typhus, I have almost in-
variably observed associated with tympanites ; and with the
subsidence of the tympanites, which this remedy is almost sure
to effect, the hemorrhage has always ceased.*

In delirium tremens this remedy contributes to obviate the
imperfect respiration, which has been noticed in this essay, pages
21 and 31, as a prominent symptom of the disease. It relieves
also the tremor, false vision, and other symptoms of nervous dis-
order. These effects are sometimes so obvious to attendants,
when the remedy is alternately administered and withheld, that
I have been often asked whether its design was to obviate the
trembling.

In the treatment of typhoid pneumonitis I consider this reme-
dy a valuable adjuvant, and in many cases I employ it through
the whole course of the disease.

In phthisis the nitrate of silver has been highly recommended ;
but physicians generally appear to have been disappointed in the
use of it. As a curative remedy, in this disease, little can be
expected from it ; though it is useful in relieving occasional
symptoms, as paroxysms of dyspnoea, and the drowsiness, livid
skin, and other symptoms denoting imperfect arterialization of
the blood, which frequently occur.

*In the use of nitrate of silver, the greatest caution is requisite in regard
io chemically incompatible remedies. Most authors complain of the uncer-
tain operation of this remedy ; and I am confident that inattention to this
circumstance is a common cause of the failure of its efficacy. It is ordina-
rily inert, if given in connection with any alkali or alkaline salt. Ammonia
or prepared chalk, for instance, wholly neutralizes its power ; and the alka-
line salt contained in Dover's powder frequently has this effect. A practi-
tioner, who was formerly a student of mine, several years since complained
to me that he had been often disappointed with nitrate of silver in treating
typhus. On inquiry it appeared that, in connection with this remedy, he
frequently prescribed a mixture containing carbonate of ammonia. Since
that time he informs me that he prescribes tlie remedy with the greatest
confidence, and that he could hardly dispense with it in the treatment of
typhus.

168 An Essay on Respiration and Pulsation. Dec.

Dyspnoea, asthma, dyspepsia, hypochondrias and cholera in-
fantum, are diseases to which this remedy is often adapted; and
in most diseases attended with general nervous torpor or irrita-
bility, or with flatulent distension of the intestinal canal, or with
any of the symptoms above mentioned, as constituting particu-
lar indications for its exhibition in typhous fever, the nitrate of
silver may be advantageously employed.

The following case of erythema anatomicum a case of the
writer's personal experience may serve to show the general
indications for which I prescribe the nitrate ol silver in erysipe-
las, scarlet fever, and other allied diseases, as well as to illustrate
some other points connected with the general subject of this
essay.

One afternoon in March, 1834, I examined the body of a
man who died the day previous with a malignant erysipelas
affecting the face, scalp and brain. I had at the time on my
left thumb two slight scratches made with a common pin a few
hours previous ; and while examining the body I slightly scratch-
ed the same thumb with the point of a scalpel. They were
slight abrasions of the cuticle, not sufficient to occasion the least
oozing of blood. On the following morning these scratches
were a little red and inflamed, attended with a slight itching and
smarting sensation. I touched the thumb with a piece of nitrate
of silver ; and, without apprehension of danger, proceeded to
visit my patients during the forenoon. At 1 1 o'clock, A. M.
about twenty hours subsequent to the post-obit examination, I
was seized with chills, w4iich continued violent about an hour,
when heat of skin, thirst, a quick, frequent, jerking pulse, and
other symptoms of irritation and febrile excitement supervened,
with nausea and vomiting. There was now no irritation about
the thumb, nor any inflammation extending up the arm ; and
the slight injury of the thumb did not even occur to my mind as
the cause of the present symptoms. An emetic of ipecac, with
a small proportion of tartar emetic, produced no relief. At
evening a swelling and soreness of a gland in the axilla was no-
ticed ; and in the course of the night a vivid erythematic inflam-
mation covered the whole left side of the chest. From this time
symptoms continued severe, and with Httle variation until the
eighth day of the disease. The pulse was ordinarily from 120
to 130, quick and jerking, but weak ; skin rather hot and dry ;
the affected side painful, and so sore that friction of the bed-
clothes or any slight touch seemed intolerable. But the promi-
nent symptom, indicated by my feelings, w^as a difficulty of
respiration, evidently connected with affection of the organic
nerves. I frequently observed to my attending physicians, that
my respiration seemed to be scarcely of any service ; and that
the sensation was as though the breath was drawn into an inan-
imate ba;?. Durincr occasional mental aberration I fancied that

1838.] A7i Essay on Respiration and Pulsation, led

I was using a pair of borrowed lungs. The acute pain and
soreness attending the disease seemed trifling as compared with
this distressing sutfocating sensation. For eight days and nights
I was not conscious of a moment's sleep ; and when J shut my
eyes they were filled with as many imaginary objects, as ever
haunt the mind of a patient with delirium tremens. The gener-
al nervous irritation, the sensation of impending suffocation,
and the want of sleep, were truly agonizing. The disordered
function affected the motor, as well as the organic respiratory
nerves ; and a constant effort of the will was required to sustain
the motions of respiration. With such continued effort I ordi-
narily made from 25 to 35 inspirations in a minute ; but still the
respiration was unsatisfying. During this period the nitrate of
silver, in doses of one eighth or one fourth of a grain, every two
or three hours, and sometimes every hour, was almost constantly
employed. It rendered the respiration easier, and mitigated the
general constitutional irritation ; and w^henever its administra-
tion was suspended for a few hours, the distress and anxiety of
breathing became extreme. No other internal remedy showed
decided beneficial efiects. All exciting remedies appeared to
fall in with the diseased irritation and aggravate it. A few
drops of laudanum, or a teaspoonful of brandy, produced a dis-
tressing nervous excitement through the whole S3^stem. Two
draps of the oil of valerian seemed to pervade the system with
a thrilling sensation, almost like electricity, increasing threefold
the nervous irritation. After the disease had progressed several
days, the local aflection was treated with a wash of the nitrate
of silver, 48 grain to sij. of water, so as to vesicate almost the
whole left side of the chest, with a most happy effect on the iocal
and constitutional symptoms.

I expected this state of irritation to be followed by a general
nervous torpor, and apprehended danger from failure of the res-
piration. I directed the attention of the nurse to this subject ;
and told her what symptoms would require notice, and what
remedies would be needed, should my consciousness and respi-
ration begin to fail. On the eighth day the nurse observed me
suddenly fallen into a state of drowsiness, with shortness and
extreme infrequency of respiration. On being aroused I found
a torpor pervading the system ; the whole lower extremities
were entirely devoid of feeling : and though the sun was shi-
ning bright against my windows, a sense of darkness rendered
surrounding objects scarcely visible. My attentive and judi-
cious nurse prompted me to vigorous respiratory efforts; but
such was the mental and physical torpor that respiration could
hardly be continued. The skin at this time, as I was subse-
quently informed, assumed a deep livid hue ; and, notwithstand-
ing the assiduous exertions of attendants, my respiration occa-
sionally sunk to ten and even eight in a minute, while the pulse
F a

170 An Essay on Respiration and Pulsation. Dec.

was beating irregularly about 130. Ether, ammonia and cam-
phor were freely administered and applied to the nostrils ; and
frictions with volatile liniment and oil of cinnamon were perse-
veringly employed. I soon revived in some degree ; but fox'
several hours the sense of darkness induced me to suppose it
real night ; and respiration was sustained only by constant and
laborious efforts. The involuntary respiratory nerves seemed
almost powerless; and for more than twenty-four hours I could
not be suffered to sleep longer than two or three minutes, with-
out a nearly total cessation of breathing. The sensations at
this time were very different from those of the preceding days,
when the difhculty of respiration seemed chiefly depending on
the organic nerves. Then the breathing was anxious the con-
scious feeling of imperfect respiration, with the exercise of rea-
son, called for vigorous and hurried respiratory action. Now,
consciousness, sensation, reason and muscular energy were at
the lowest ebb ; the little life which remained was a burden 5
and the exertions of friends to arouse me seemed an annoyance*
A person who has never experienced the feelings attending such
a state can have no adequate idea of them. As consciousness
and reason revived, I felt like one who is laboring to escape
from drowning ; who has been swimming for the shore, until
his strength is almost exhausted ; occasionally his head is suffer-
ed to sink in despair, and again the agonizing sense of suffocation
calls for another desperate struggle ; while every wave threatens
to overwhelm the last effort of exhausted nature.

After this critical period, wine, brandy, quinine, and a moder-
ate use of opium, operated favorably. Two abscesses formed
en the posterior part of the side, each of which discharged five
or six ounces of healthy pus.* I was confined to the room in
all fiv^e weeks. Much of the time there was considerable ten-
dency to tympanitic distension of the abdomen, which was
promptly relieved by more full and frequent doses of the nitrate
of silver. The disordered function of the nerves concerned in
respiration, which was so remarkable through the whole disease,
continued in some degree even after I was able to resume the
active duties of my profession. Frequently I was aroused
from sleep by a sudden deep spasmodic sighing inspiration,
which sometimes also affected me when awake. f

*Dr. Higginbottora speaks highly of the external use of nitrate of silver
in promoting healthy suppuration. I have observed many proofs of the
correctness of his views ; and I am fully satisfied that the internal use of
the remedy has a no less salutary effect in promoting this object.

tA remarkable symptom, attending the early stage of my disease, was a
Hiorbid excitation of the faculty of memory. Articles that I had read cnr-
Borily, years before, were fresh in memory, so that I could recollect not only
general ideas, but almost the precise language, pages, &c. points on which
aay memory ordinarily is very deficient. After the critical stage of collapse,

1838.] An Essay on Respiration and Pulsation. 171

Arsenical solution. It has been a matter of dispute whether
this article is a stimulant to the circulating system. I am unde-
cided whether it is directly so, or only secondarily through the
influence of the arterializing function. The latter operation is
certainly the most prominent ; and it is therefore a valuable rem-
edy in the congestive form of typhous and typhoid fevers. Drs.
Miner and Tully recommend this article as a valuable remedy
in the low stages of typhous and other fevers, when the general
debility is attended either with irritability or torpor. {Essays
on Fevers.)

Cantharis, as an internal remedy, is of much value in the
low torpid stages of typhous and typhoid fevers, particularly
those of a congestive form, in which the respiratory function is
deficient. It operates upon the nervous system generally, re-
lieving subsultus tendinum, coma, and other symptoms of nervous
exhaustion ; and its eftect on the nerves concerned in respira-
tion, I think, constitutes no inconsiderable part of its favorable
operation.

Capsicum is particularly adapted to scarlet fever and erysip-
elatous diseases generally ; but is useful in the low stages of
most diseases attended with nervous torpor.

Chlorine. The change which this remedy effects in the blood
has been noticed by several writers, and different views have
been entertained in regard to its modus operandi. It is useful in
typhus ; but more especially, I think, in scarlet fever and ery-
sipelatous diseases. The chlorides of soda and lime are conve-
nient forms for its administration.

Creosote appears to have an operation on the respiratory
function, similar to that of chlorine ; but, from limited experience
with this remedy, I cannot speak confidently of its powers.

4th. Ventilation.

Free ventilation is very important in cases of difficult or im-
perfect respiration. Its advantages are very obvious in dyspnoea
and asthma, and in many cases of phthisis, pneumonitis, and
other diseases.

A most injurious custom prevails in many places that of
crowding the room of the dangerously sick and dying with
iriends and acquaintances of the patient. I would not, for slight
reasons, object to a custom which to many minds appears sanc-
tified by common association with the solemnities of death;
but a custom so injurious so murderous as this, ought not to
be tolerated. To persons in health the impure air of a crowded

there was a proportionate failure of this faculty, the effects oi which re-
mained some time after my general health was restored. The first time I
rode out, it was with difficulty and uncertainty that I could remember streets
and houses with which I had been most familiar ; and on several occasions
I even found myself laboring to call to recollection my own same.

172 An Essay on Respiration and Pulsation. LDec,

room is often unpleasant ; and in the diseases just mentioned it
commonly occasions distressing sensations to patients. But its
most injurious effects are to patients who from unconsc'ojsness
or extreme exhaustion cannot express the injury thus occasioned
them the dying, and those in imminent danger of death. Many,
very many lives, I have no doubt, are sacrificed to this perni-
cious custom ; and, in a great proportion of cases, it renders
the last moments of life more distressing, and hastens death.
When the system is struggling in agony to sustain the respira-
tion, and nature is almost exhausted, the deteriorated air occa-
sioned by surrounding, anxious, sympathizing friends, may turn
the scales in which life and death are so equally balanced.

In severe paroxysms of dyspnoea and asthma, patients com-
monly feel the necessity of free ventilation ; and in phthisis I
have had many patients insist on having the windows and doors
of their rooms kept open, even in the coldest w^eather of win-
ter. Such cases show the importance of attending to this sub-
ject, in the low critical stages of other diseases ; and as a general
rule, in such cases, 1 would advise that a room should be freely
opened, while, if the weather is cold, the body is protected with
warm but light clothing ; and no person should be in the room,
excepting such as are required to attend the patient.

5th. Remedies which obviate mechanical iinpediments to the
respiration.

This indication is sometimes very important in the treatment
of diseases attended with deficient respiration. The various
mechanical impediments to the respiratory motions, adverted to
in a former part of this essay (page 10), should receive careful
attention and be obviated if practicable. If, for instance, the
respiratory motions are obstructed by water collected within
the pleura or peritoneum, calomel, elaterium, digitalis, and
other remedies of this class will be appropriate.

One of the most common mechanical impediments to the
respiration, in the low stages of typhous and typhoid diseases, is
tympanitic distension of the intestinal canal. For this affection
various remedies are used, as ether, camphor, capsicum, the
pungent aromatics, and the introduction of a flexible tube per
anum ; but there is no remedy which I have found so commonly
efficacious as the nitrate of silver, exhibited in doses of gr. 1-8
or gr. 1-4, every hour or every two hours..

In dyspepsia, hypochondrias, phthisis, delerium tremens, and
other diseases attended with deficient respiration, injury is often
occasioned by tight dress, which confines the motions of the
chest.

In dyspnoea, asthma, phthisis, and other diseases, patients
frequently complain of inconvenience from the weight of bed-
clothes. In the low stages of pneumonitis, typhus, and in gen-

1838.] An Essay on Respiration and Pulsation, 173

eral when there is extreme exhaastion, with laborious imperfect
respiration as in the dying the bed clothing should be of the
lightest fabric ; and in many cases it is desirable that the cloth-
ing should be supported by the hand of an attendant, so as to
prevent its pressure on the body of the patient. Under such
circumstances, a slight impediment, which in health would occa-
sion no uiconvenience, may prove a fatally oppressive load to
the system exhausted by disease.

6th. Remedies which excite secretions vicarious of respiration.

The bronchial membrane, the liver, skin, kidneys, salivary
glands, and the uterus and mammary glands in females all the
secernent organs are to some extent vicarious in their func-
tions.

The menstrual secretion has an important relation to the res-
piratory function. In cases of oppressed and deficient respiration
it is not uncommon that this secretion occasions immediate and
decided relief.

In some cases of general exhaustion, as in advanced stages
of phthisis, it is generally considered as desirable that this secre-
tion should be suspended. The utility of this suspension ap-
pears, however, to depend upon other circumstances than simple
exhaustion. If with much exhaustion there-is a frequent, quick
and irritative pulse, a florid skin, natural wakefulness, and other
indications of perfect arterialization of the blood, a continuance
of the menstrual secretion is injurious. On the contrary, if the
pulse, whether frequent or nifrequent, is oppressed ; if the lips,
the finger nails, and the surface generally, have a livid tinge ; if
there is a disposition to drowsiness with occasional vertigo and
tinnitus aurium ; if the exhaustion is complicated with torpor
a torpor occasioned by imperfect respiration if such are the
permanent prevailing symptoms, the menstrual secretion com-
monly has a favorable efiect, and rarely fails to aftbrd at least
temporary relief.

I apprehend that the injurious effects of morbidly excessive
menstruation have rendered many practitioners over-cautious in
regard to the debility which this natural drain of the system is
supposed to occasion.

A similar remark appears applicable in reference to the func-
tion oHactation. Excessive lactation is exhausting; and should
be cautiously avoided in the low stages of fever, in phthisis, and
other diseases attended with much debility. Yet a sudden sup-
pression of the milk is almost sure to occasion unpleasant nervous
symptoms, with oppressed respiration ; and in typhous and
typhoid fevers, and in some cases of phthisis notwithstanding
a considerable degree of exhaustion if there are prominent
symptoms of oppression of the respiratory and cerebral functions,
the secretion should commonly be encouraged.

174

An Essay on Respiration and Pulsation, [Dec.

The shin is well known tcyjcrform an office in some degree
vicarious of respiration. I^^^ cutaneous secretion is checked,
the respiration becomes hurriea and laborious ; and in cases of
oppressed respiration a free perspiration often produces decided
relief. These circumstances clearly indicate the importance of
attending to the skin, in disorders of the respiratory function.
Caution is required, however, in case of disparity betw^een the
respiratory and circulating functions, that the remedies exhibited
to act on the skin, do not excite arterial action, and thus increase
this disparity. Through neglect of this caution, much injury
is done by the hot drinks, the external heat, and the general
stimulating regimen, commonly employed in domestic and em-
pirical practice, to "sweat" or *' steam" a patient, in the com-
mencement of any febrile disease.

The liver also performs a similar important vicarious office.
The green discharges, produced by increased action of the hver,
which attend a favorable crisis in cholera, are an example of the
agency of this organ in depurating the blood. So in congestive
fevers free bilious evacuations are almost. invariably accompan-
ied with a relief of the subsultus, stupor, coma, livid skin, and
other symptoms of imperfect respiration.

Of the remedies which act upon this organ, and thus obviate
the effiicts of imperfect arterialization of the blood, calomel is
the most important. This remedy, a notice of which has been
deferred for this place, on account of this peculiar operation, is
one of the most important of the class of remedies, before ad*
verted to, which operate to excite and invigorate the arterializ-
ing nerves. It appears, indeed, to have an exciting operation
on all the organs supplied by the great sympathetic nerve ; and
hence it produces a general effect on the secretions of the system.
Its operations on the liver, the mucous membranes, the skin and
the salivary glands, are well known ; and most practitioners
must have noticed the relief afforded by calomel in cases of cer-
ebral and general nervous oppression subsultus, stupor, coma,
muttering delirium, &c. symptoms which, as I have endeavored
to show, are commonly connected with imperfect respiration.

CONCLUDING SUMMARY.

The preceding essay, it is believed, establishes several im-
portant pathological principles, affording valuable diagnostic and
therapeutic indications, which hitherto" have been but slightly
noticed, or wholly unknown. The indications of the pulse have
received much attention ; but the variations of the respiration
have been little attended to, and the relations between the respi-
ratory and circulating functions have been almost wholly
neglected.

1838.] An Essay on Respiration and Pulsation, 175

The comparative frequency of the respiration and the pulse
in health, which from constant observation during a period of
several years, I have ascertained to be 1 to 4 1-2 (p. 3), has not
been commonly observed ; and most of the indications afforded
by variations of this ratio (p. 5) have been altogether overlooked.

A disproporiionate increased frequency of the respiration has
been shown to afford the general indication (p. 11) that there is
some impediment to the respiration ; which may be owing to,
A. Dissorder of the lungs or air passages (p. 5), as pneumonitis,
phthisis (p. 7), oedema, of the lungs (p. 8), or (p. 9) any affection
of the lungs which prevents a portion of them from being freely
permeated with air, or any disorder of the bronchia or bronchial
membrane which impedes the communication between the air
and the blood within the lungs : or, B. Some inechanical im-
pediment to the motions of respiration (p. 10): or, C. Imperfect
function of the organic nerves of the lungs (p. 10).

A disproportionate diminished frequency of the respiration,
which indicates a want of energy in the nerves which control the
respiratory motions (p. 11), has been shown to be common ia
typhous fever, and in many other diseases.

The pathological effects of imperfect aeration of the blood,
which had been treated of by Bichat and some subsequent w^ri-
ters (p. 12), but which they scarcely noticed except as immedi-
ate precursors and causes of death, I have observed to be mani-
fest through the progress of typhous fever (p, 14), and many
other disesses. What is commonly termed congestion in the
brain, I have endeavored to show (p. 17), is simply a deteriora-
tion of the blood caused by this imperfect aeration, a prominent
example of which occurs in the disease termed congestive ty-
phus (p. 17). The effects of this imperfect aeration, depending
upon disordered function of the different nerves concerned in
respiration, have been traced in various diseases (p. 14 to p. 25).

The common occurrence, and the injurious effects, of this
imperfect aeration of the blood suggest the important general
therapeutic indication (p. 26) to remedy deficient respiration.
The medicinal agents are detailed (g. 26 to p. 28) which aggra-
vate deficient respiration, by increSng the circulation, or by
diminishing the respiratory function.

The use of remedies, with a view to promote the arterialization
of the blood (p. 28), it is believed, has never been distinctly treated
of by any author, as a prominent object of medication. Though
my 1st class of these remedies those which diminish the action
of the heart and arteries (p. 29) have been commonly known
to possess this power over the circulation, still they have not
been commonly employed with the view a view which I con-
sider as highly important in many cases to obviate a disparity
between the respiratory and circulating functions. The 2d and
3d classes of remedies (p. 64 and p. 36) those which excite

176 American Phrenological Journal, [Dec.

and invigorate the motor respiratory nerves, and the arteriah*-
zing nerves of the lungs have rarely, ifever, been recommended
for those particular purposes ; though I think it will be obvious
to my readers, that many of the known valuable effects of these
remedies are owing to such operations. The other three class-
es 4th. Ventilation (p. 42) ; 5th. Remedies which obviate
mechanical impediments to the respiration (p. 4 J) ; and, 6th.
Remedies which excite secretions vicarious of respiration (p. 44)
though their general effects on the respiratory function have
been known, have not been commonly employed for the distinct
purpose of obviating deficient aeration of the blood.

In short, the general subject of the pathological relations be-
tween the respiratory and circulating functions has received
little, very little attention. The writer hopes that he has at
least shown the subject to be deserving of investigation.

Part II. REVIEWS AND EXTRACTS.

The American Phrenological Journal and Miscellany. Phila-
delphia : Published (for the proprietors) by A. Waldie, No.
40 Carpenter-street.

We have just received the first (or October) No. of this new
Work, with a prospectus of the same, which we take pleasure in
giving a place under our head of Medical Intelligence. Although
we still occupy the same ground formerly avowed relative to
the science of phrenology that is to say, we consider its claims
as a practical science, at least in the present state of its advance-
ment, unworthy of the confidence of the community ; and its
claims to truth, as a science, incompatible with the facts of anato-
my ; still we are pleased with the avowed objects of the work
before us, and shall be pleased to see truth on this subject, as
well as on others, placed beyond the reach of controversy. We
have no prejudice against phrenology, or its enlightened and
prudent advocates, or partiality for its opposers, which we wish
to sustain. If, therefore, there be truth in its compatibility with
anatomical facts, in its harmony with " the truths of revelation"
&c. we shall be pleased to see these facts demonstrated. We
would not be considered in thus requiring its consistency with
revelation, as wishing to proscribe truth merely because it did
not comport with revelation ; but that, as Spurzheim says of

I

1838.] American Phrenological Journal, 177

religion, we hold that Revelation " is central truth" /MTi^amcn-
tal truth truth with which truth a/owe, and with which all
truth will harmonize. It is so much the very criterion of truth,
that all claims to this which do not harmonise with it, may be
considered either fiilse, or not well understood : and so insidious
is error, and often so plausible too, from the omission of some
of the premises which lay the foundation of the reasoning pro*
cess by which conclusions are arrived at, that we feel it the duty
of every friend of truth, whether religious or philosophical, to
challenge error at the threshhold, yes, even at the very outposts
and refuse its entrance, without the true sign and password,
which prove on good and sufficient trial a fraternal harmony
with the great fundamental truths which constitute what are
called the revelation of God to men.

The avowed object of this new periodical, as will be seen irt
the prospectus, is " to preserve from oblivion the most interest-
ing of the very numerous facts confirmatory and illustrative of
the truth of phrenology ; to show the true bearing of this sci-
ence on Education, (physical, intellectual and moral ;) on the
Medical treatment uf the insane ; on Jurisprudence ; oN
Theology, and on Mental and Moral Philosophy." (Page
2, Prospectus.) Again : "One prominent object in giving it (the
Journal) existence is, to wrest Phrenology out of the hands of
those, who, in ignorance of its true nature and tendencies, sup-
pose that they find in it an instrument by which to subvert the
truths of revealed religion, and lessen the bonds of human ac-
countability, and moral obligation."

The religious character of the work is declared to " be deci-
dedly evangelical ;" and respectful enquiries and honest objections
on the subject of its religious bearings are solicited ; as well as
"the communication of facts which are supposed to militate
agaitist phrenology, which last, when well authenticated, and all
the facts furnished, will be published in the Journal.

This cause may, for ought that we know, be a good one it
may be the cause of truth ; but if so of itself, it has been made to
appear false, and the instrument of imposition by the itinerant
hordes who have been peddling it around the country. We are
therefore pleased with the purpose of wresting it from the hands
of ignorant im posters, and sitting it on the fair basis of its own
merits.

The first article in the number before us, occupying nearly
twelve pages, is an introductory statement of its object and de-
sign ; these are freely, boldly and handsomely set forth. The
course marked out is a good one ; and in addition to what we
have said from the prospectus, promises " to show ils bearings
on human welfare, corporeal and mental, for time and for eter-
nity." " This large field, therefore," says the editor, " is open
before us ; and we enter on the cultivation of it, with the assur-
o7

Its American PhreTioIogical Journal, [DeCk

ance that it will not be fully traversed and rendered fruitful till
long after we shall cease to be numbered among its labourers."

We regret that our space will not allow us to draw more
largely on this ably written introductory statement. According
to its views and the purposes it holds forth, the subject which it
advocates should be fairly investigated ; and we really trust
that, as the pages of the only American phrenological journal
are fairly open to all respectful objections and enquiries, and to
the publication of facts which militate against the truth of the
science of phrenology, its pages may become the means of re-
moving all the obscuring rubbish and revealing the truths of
nature in this departuient of science, whether they be for or
against phrenology.

The next article is a notice of Dr. Sewall's " examination of
Phrenology" and Dr. Caldwell's Phrenology vindicated, and anti-
phrenology unmasked." Looking to this work for every thing
ingenuous, we regret to observe, as we think we do, a decided
faroritism for the vindicator of phrenology, and a spirit of direct
proscription of its examiner. For whilst the production of the
former is spoken of but in measured terms, relative to we
had almost said its severity, v/hen we should have said, its ful-
some abuse, at once disgraceful and calculated to contaminate
whatever portion of truth it may have been intended as the vin-
dication of;* Dr. Sewall is hurled into ridicule, and into the con-
tempt of "fourthrate phrenologists," &c. without fully and fairly
meeting and disproving the facts from which the examiner
deduces his conclusions. He (Dr. S.) is criminated of plagiar-
ism, disingenuousness, intellectual obtuseness, &c. w^ithout shew-
ing him to be a plagiarist, only by the dictum contained in the
violent ebullitions of the vindicator, and in the face of a personal
character for ingenuousness, long observation, intellectual acu-
men, and piety, at least fair, amongst those of fair claims.

For the sake of truth, we hope sincerely that the editor will
not suffer its beauty and richness to be obscured by untempered
seal ; for this is only necessary, to help a had cause by leading
the attention off from the contemplation of the error ; and when
brought into operation in favor of a cause, stands as prima facia
evidence of its want of truth. Truth has an intrinsic worth and
power too great for it not to prevail, and against which, though
beaten on and overwhelmed by successive tides of error, will
withstand every assault ; and which, though consumed like a
phcenix, will like this prototype, rise renowned from the ruins of
the conflagration and ultimately maintain its glorious majesty.

*We have only seen those points of Dr. Caldwell's vindication which
have been given by reviewers ; but in these, we have seen enough to know
that Dr. C. has greatlv compromitted his merited literary character by the
Whallowed mixture of the gall of disgraceful passion.

4838.] New Infirmary. It^

If then, phrenology be indeed founded on the rock of truth, it
needs no unhallowed aid of this kind for its support. It does
not need that its competitors be dragged down from their first
elevation ; but will rise to more glory by its greater exaltation
above them.

The number of the Phrenological Journal now under notice
contains, in addition to those we have noticed, an article entitled,
*^A Phrenological Analysis of ConversiorC^ ; another, entitled,
^^ Pathological fact, confirmatory of Phrenology" ; an article on
" Phrenology in Germany," and one on George Combe, Esq."
We regret that we cannot give time to the investigation of theii"
merits.

Part III. MONTHLY PERISCOPE.

New Infirmary, Dr. Chase has organized and will open,
"with this month, an infirmary for the relief of poor persons
laboring under hernia or rupture, at No. 98 Locust street, above
ninth, Philadelphia. Dr. C, has, as is well known, had his atten-
tion drawn peculiarly to the department of surgery here alluded
to, and has made many improvements in various apparatus for
the treatment of hernia. This institution is a novel one in this
country, in all its plan and purpose, except that oi treating her-
nia for the cure, instead of selling the apparatus. The plan of
treating for the cure, was adopted by Stagner and his agents,
who itinerated for this purpose, and not professedly for the sale
of trusses. We hope and expect better success from Dr. C.'s
operations than was found in the wake of Stagner, within the
sphere of our acquaintance.

Two very important purposes lie in the course of this enter-
prise: 1st. It is purely a charitable institution, designed and
calculated to effect an extensive charity to a class of sufferers
hitherto illy provided for by various imperfect retentive means,
or none at all ; whilst they are, more than other people, under
the necessity of bodily ability for active and laborious life. The
public may not be aware of the large proportion of individuals
in this country who suffer more or less privation from some form
of hernia, and those diseases which are sometimes mistaken for
hernia. Various estimates have been made of the proportion of
cases of hernia, in different countries. Its frequency in England

180 New Infirmary, (Dec*

has been estimated as great as one in seven ; and in the United
States, the proportion has been estimated as great as one in
five ; which we think probably about correct, relative to the
male population, amongst whom hernia is more common than
amongs females. Dr. C. thinks it, however, perfectly safe to
estimate the proportion at one in ten of the human family in
the United States. This may be a very fair estimate for the city
of Philadelphia, but the general proportion is increased when
extended to those engaged in country occupations, and especially
in new countries, where the hard-laboring class is greater and
the labor more calculated to produce this disease in those who
otherwise would pass their whole life free from the affliction.
The more relaxing climates of the south are also calculated to
influence in some degree the proportionate frequency of hernia.
But at I )r. C's estimate of one in ten, the population of Phila-
delphia, which is about two hundred and twenty thousand per-
sons, will jifford no less than twenty-two thousand patients of
this description. Of these, by far the greater proportion are
amongst the poor, to whom this charity, most creditable to the
heart of its author, is addressed. If Dr. Chase's apparatus are
such as to exercise curative powers, and that they are, has been
settled by a body as competent as any other, so far as time and
opportunity have allowed, the good to be afforded by the faithful
administration of this charity by Dr. Chase, as surgeon, cannot
fail to afford him abundantly, the delightful complaicency arising
from helpmg those who cannot help themselves; to make the
poor bless him as he passes, and cause his memory to be em-
balmed in the rich tears of gratitude.

2d. But other valuable purposes cannot fail to be effected by
the operation of this institution. The collocation together at
one establishment, of the great number of cases of these diseases,
and their treatment under close observation, and with regular
records of all facts, which we doubt not, is no small consideration
in the establishing this institution, will soon afford the most am-
ple tests of the extent of the value of the improvements to be
put into use in the institution be it great or small ; and at the
same time, by the opportunity offered pupils and practitioners,
for gratuitous instruction, will disseminate a far greater famili-
arity with, and more accurate knowledge of those afflictions
than has hitherto been enjoyed by the medical community. Dr.
C. has our hearty wishes for the greatest possible success in all
the benefits designed by this institution, both to himself and to
the public.

This institution will be under the government of a board of
superintendance, consisting of seven gentlemen, having not less
than one-third, nor more than one half, at any time, medical
men.

1838.] C cesarean Section, 181

Dr. Chase is surgeon, and Dr. R. Coates' services are enlisted
as consulting surgeon and ex-officio naember of the board.
The rules, regulations, and general laws, are all such as they
should be, and are not to be altered or amended, nor new ones
enacted, without the consent of the committee of superinten-
dance. The first general law is as follows : " No officer of the
institution shall ever be permitted to receive any pecuniary
emolument for instruments or surgical advice given in the infir-
mary, nor shall any be required of the graduates or students
who may attend the practice thereof."

Cesarean Section. The propriety of an early resort to this operation in
cases where it is necessary, has been very properly insisted upon ; but the
circumstances which render it necessary, are not always readily determined.
M. Castel stated, at a recent meeting of the Academy of Medicine, (Feb.
17th, 1836,) that some years since, a woman was in labour at the hospice de
perfectumnement, the professors were all assembled, and the caesarean sec-
tion resolved on. The crowd of students was so great that some delay
took place whilst arrangements were making for their accommodation, and
during this time the woman's delivery took place naturally.

M. Gimelle also stated that he saw, at the hospice of M. Dubois, a small
woman who had five times submitted to the caesarean section, and who
was delivered naturally the sixth time. Gaz. Mid. de Paris, March 3, 1838.

The occurrences above related, afford a very salutary lesson
to the obstetrician, and at the same time evince great weakness,
or what is worse, carelessness, in high places. In the first in-
stance, the consultation of the hospice de perfectionnement had
settled the matter, that the child could not hf horn per via natu-
rules, but it was thus born, too soon to allow the time necessary
for accommodating the company and proceeding to the opera-
tion. In the second instance, a sma'l woman w as delivered in
the natural way, at the hospice of Dubois, who had, at the five
last preceding accouchements been compelled to suffer the Caesa-
rian section. We feel disposed to venture the belief that M. Du-
bois was not the operator in the five previous cases, or any of
them ; we have too much confidence in his good judgment and
discrimination.

Under the best circumstances, this operation requires the
greatest care to prevent its being one of the most formidable in
all surgery. Much of the success of those who have a great
fondness for the knife, depends on their early accession to the
operation, and on the other hand much of the ill success of sur-
gery arises from too much procrastination, either from the in-
subordination of the patient or want of timely decision on the
part of the sur2:eon. With the former cause of delay, the sur-
geon has little to do ; his course is plain when his patient rebels
against his prescription. But no one point in the practice of
surgery is of more importance to humanity and to the science,

18^ C cesarean Section. [Dec.

than that rare, but valuable attribute, called decision. We do
not mean b}' decision, that tiippant quickness of pronunciation by
which words are made to announce that an operation must be
performed. This may be imprudent or criminal precipitancy,
the effects of which are doubtless seen in many communities,
where the loss of limbs abounds on every hand. This speaks
badly for the surgery of such place ; for the beauty and the
perfection of surgery lies \ci its ability to cure, to save, or to
renew deficiencies instead of mutilating. That is commenda-
ble decision the only kind with which the surgeon or physician
should feel self-complaicency, or which should be tolerated by
a community, which is promptly deduced from the whole bear-
ings of the case duly ascertained and properly estimated ; and
every decision short of this manner of coming to it, is but a
guess. The nobleness the greatness of surgery is not in the
mere manipulations or the dexterity and accuracy with which
the knife, the saw and the tenaculem are used. It is true that
good surgery cannot be practised without good and accurate
manipulation; but the main, radical value of the science lies in
the judgment exercised in its administration.

We have often thought that there was in many instances bet-
ter practice found in exercise by many thinking men in our
own country, and in private practice, than was found amongst
those m high places. We have often observed announcements
of wonderful improvements in general practice, and in surgery
and obstetrics abroad, which were old things and long proved
by our judicious practitioners ; and we have often seen successes
boasted of abroad, of which many of our private practitioners
would feel perfectly ashamed. But we confess ourselves utterly
astonished at the facts of the tw^o cases at the head of this arti-
cle ; and we trust that there are no such blunders any where in
American surgery.

Case of C cesarean Section, performed icith success for the
fourth time, on the same individual. Although we believe this
to be the same case reported some time ago, by M. E. Charlton,
President of the Medical Society of Edinburg, and noticed on
page 178, vol II. of this Journal, (q. v.) we give it here as re-
ported by Dr. Michaelis. and taken by the Eclectic Journal irom.
PfafTs Mittheilungen, on account of some additional facts of
interest which the present version contains.

Case of Cccsarean Section, performed with success for the fowih time on ths
same individual. By Dr. Michaelis, of Kiel. An account of the three pre-
ceding operations, and of the case generally, is given in our second volume,
p. 270. The first operation was performed'in June, 1826, the woman being
then in her twenty-ninth year ; the second in January, 1830 ; the third in
March, 1832. This woman became once more pregnant, and, the operation
being equally necessary as before, it was performed by Dr. Michaelis, on
the 27th June, 1836, after the patient had been in labour three days. The

1838.3 Opium. l83

new incision intersected tl;e second and third cicatrices, and the uterus haa
become so completely adherent to the abdominal pcrietes that the j)eritoneal
cavity was not laid open. On the third day after the operation, the patient
was threatened with alarming symptoms of peritonitis, accompanied by-
tympanitis, which speedily yielded to the internal exhibition of ice and a
few doses of calomel. The external wound could not heal, on account of
the gaping of the uterine opening, which kept apart tlie adherent margins
of the divided skin, and thus converted the wound of both integument and
uterus into a single symmetrical aperture. On the 1st of August, (the period
at which the last report is dated,) the uterine aperture was rather more
than half an inch in extent ; and this diminution appeared to be solely de-
pendent on the gradual contraction of the uterus, inasmuch as the healing
process itself was not then contemplated. Nevertheless, the patient lett
her bed daily, and her general health was good. She herself suckled hef
child, which w^as thriving well.

[An interesting point connected with this case is the occurrence of peri-
tonitis after the fourth operation, in which instance alone, it will be remark*
ed> the serous sac was not opened, and was therefore unexposed to the
influence of external agents, as the atmospheric air, &c.

A medical friend suggests the expediency, in cases of hopeless deformity
of the pelvis, that the iallopian tubes should be divided during the Caesarean
operation ; in the event of a successful result to the operation, this proceed*
ing would, of course, do away with aE risk of a second.]

PfaJ's Mitikeilungen^

Opium in large doses to prevent inJlamm<ition. M. Malgaigne has commu-
nicated to the Academy of Medicine his first results from a new method of
preventing traumatic inflammation. After wounds from accident or in
operations, the principal enemy to be feared is inflammation. This traumatic
inflammation, according to Mr. M., consists of but two elements, the nervous
element or the pain, and the inflammatory engorgement. It occurred to
Mr. M., that by paralyzing the former the latter might be prevented. With
this view he has given the gummy extract of opium in the dose of from six
to ten grains a day, continuing as long as inflammation is to be feared. The
results so far have exceeded his hopes ; he has prevented in the four cases in
which he has administered the remedy, fever, local inflammation, and even
pain. Bull. General de TMrapeutique^ 15 Nov. 1837.

We are pleased with observation in medicine, and with ex-
periments tending to improvement in practice every thing
which tends to increase the certainty, the facility, expeditious,
ease and economy of anieliorating or removing the ills to w^hich
humanity is subject : but we are often led to regret the unguard-
ed direction which the minds of some men take for effectlno*
these good purposes. It should be the first purpose of the
practitioner, to guard against doing harm. When this precept
IS neglected, it is true that we may still profit by their experi-
ence, but in order to it, we w^ill often have to take the back
track, and profit by the effects of their errors, w^hich we find in
the trail they have marked out. Here we may find what to
avoid, and here receive stronger lessons than we had before
received. But it is most stupid, to design those changes in
practice which, instead of actual improvements, are, when
eflfected, retrogressions. We had occasion to remark somewhat

184 Carbonic Acid Gas in Dysmenorrhosa, [Dec.

in this manner on a former occasion, when noticing the use of
opium in large doses, for the cure of rheumatism. We have
similar objections to the experiments of M. Malgaigne in the
present instance the injuries done by the remedy adopted.
JSix to ten grains of the gummy extract of opium a day, is ra-
ther worse, in our estimation, than a quart of good West India,
or Cognac, for it has other injurious effects besides high stimula-
ting powers. But in addition to this, we may well object to the
very purpose of this prescription ; at least in its general appli-
caiion. It is the prevention of traumatic inflammation ; whether
from accidental wounds or operations. It is true that in some
wounds, and some operations, the height and extent to which
inflammation may tend is to be looked to with much anxiety ;
but it is equally true that the present highly improved antiphlo-
gistic plans of treatment are found competent to every end
which may be hoped in the case, as possible under the circum-
stances. Look at the success attending lithototomy and the
Caesarian operation at the present day. Who now dreads fatal
inflammation from the former, with the opportunity of prepara-
tion, and with proper enforcement of regimen aftex-wards. And
are we not now constantly informed of the successful termina-
tion of the causes of delivery by the caesarian section, without
preparation, even to the fourth and the fifth time, in the same
individual ? These are surely amongst our most formidable
operations for the dangers of inflammation.

But we would ask, who will say he can cure a wound, whe-
ther accidental or designed, without inflammation ? To whom
is this natural agency of the system not the handmaid on which
he most relies ? and who has not in practice the chief purpose
of contenting himself with merely favouring, by a removal of
those circumstances which are calculated to prevent its natural
salutary tendencies of the increased action nature institutes ?
We apprehend that no surgeon is to be found on this side of the
atlantic who does not operate on, and adjust parts, &:c. wiih the
view of simply enabling the natural efforts of the system or of
the part, to effect the cure.

We think the Royal Academy, all medical societies and jour-
nals, should watch well these kinds o^ improvement in medicine;
and if exporimentors fail to see more than one thing at one view,
academies, societies, &c. should not fail to do so.

Carbonic Acid Gas in Dysmenor? hasa. The following arti-
cles, the first from the MedicoChirurgical Review and the Bull.
Gen. de Therapeutique, and the second from the American Jour-
nal of Pharmacy and the American Medical Library and Intel-
ligencer, we think proper to present together, to our readers.
Nothing can be more desirable than useful information on the

183S.] Carbonic Acid Gas in Dysmenon-hcBa. 185

subject of dysmcnorrhoea, not only on account of the immediate
distress attending the periodical returns of this disease, but the
dithcuky which the profession has ever found in its permanent
cure, and the extreme importance of that cure to the hfe of those
who are chronically afflicted with it. We hope to be informed
of the successes of the remedy related tj, aminigst American
practitioners. We have mu( h blame to attach to most of Amer-
ican practitioners in relation to their management of those com-
plaints of females which are peculiarly disagreeable, distressing
and dangerous. We know not why it is that this blame is so
much merited whether irom wilful neglect of attention to those
distresses, or from the great sin of torpid ignorance from ob-
tuseness of intellect, or a wilful neglect of the sludy of them.
Nor are we less at a loss to determine which of these sources
merits the greatest reprobation. Certain it is that the profes-
sion is far behind its progress in other particulars, in the under-
standing and the treatment of most of the uterine affections
to which females are subject. It is passing strange that afflictions
so severe and dangerous at least, as are ail those which interfere
in the least with the natural functions of the uterus, should be
passed ligiitly from the care uf the profession; and especially
when vislied alone on the linesi sensibilities and deepest interests
of humanity.

Dysmenorrhaa relieved by Carbonic Acid Gas. Every physician is award
that some females suiier most severe pains in the uterine region, for one or
more days before each appearance, and not unfrequently also during the
conlinuince of the catamenialfiow. Young girls residing in large towns
are perhaps more subject to this distress than any other females ; their
Bystems being often unusually irritable, and this excess of irritability being
Very generally associated with constitutional weakness. It is a common
remark that such girls menstruate earlier in lif^ than such as are robust,
and those who reside in the country. Under these circumstances, marriage
Will often aggravate the dysmenorrhoea ; the generative organs being apt
to be so higaly excited by coition, that the accu-tomed monthly discharge,
intended, no doubt by Nature as a means of local relief, is either stopped
altogether, or IS only very sparing and uncertain. The treatment of such
cases is often extreinely difficult. The employment of the ordinary emmen-
agogues is very generally pernicious, and even the application of leeches to
the feet, or to the vulva, will sometimes only aggravate the sufferings. Pro-
fessor Mojon, of Geneva, assures us that he has used injections of carbonic
acid gas per vaginam, with the most soothing effects. Like Rasori and
Borda, he considers this gas as a powerfully depressing or contra-stimulant
agent ; and it was by reasoning from its known effects, as such, that he was
led to try its effects a^^ a local application to the womb in painful dysmenor-
rhoea. The gas is easily obtained by pouring diluted sulphuric acid on some
pieces of chalk into a flask, (which ought to be provided with a double orifice)
like an inhaling apparatus ; a curved flexible tube is fitted on to one of these,
and when the gas is freely disengaged, the extremity of the tube is to be
introduced into the vagina, and the fumigation is to be continued for five or
six minutes. This remedy may be used two or three times in the course of
the day.

M. Mojon assures us that be has employed this mode of treatment in a
g^reat number of cases, and very generally with decided advantage. Not
H 8

186 Carhonic Acid Gas as a Tlierapeuiic Agent. [Dec.

only was the pain almost always relieved for the time, but also the menstrual
flow, in future, became more regular in its retuni, and more copious in its
quantity. Am. Jour. Med. Chii'urg. Rev. from Bull. Gende Tiierapeutique*

Observations on the Employmenl of^ Carbonic Acid Gas as a Therapeutic
Agent, by VVm. R. Fisher, -M. D., Professor of Chemistry and Pharmacy in
the University of Maryland. In the twenty-third number of the first vol.
of the "American Medical Intelligencer," (pp. 415 to 417,) occurs an ab-
stract from the memoir of Dr. Furnari, relative to the etnployment of car-
bonic acid gas in medicine. In this abstract the use of fumigations of this
gas to various diseased tissues is spoken of, and the intravaginal employ-
ment of it in amenorrhoea and other uterine diseases warmly recommended.
It is not my purpose to comment either upon the pathological considerations
which have induced this practice, or to offer any views as to its efficacy ;
but an apprehension lest some injury may result from the ap[:lication of the
gas to tissues of such delicacy and sensibihty, unless the administration be
attended with proper precautions, induces me to ask the attention of the
profession of this country to the following considerations. The danger,
which I apprehend, may arise from the following paragraph : " These fumi-
gations are prepared, in^cases of uterine pains, by receiving into the vagira
the free extremity of a gum elastic canula, surmounted with a nipple-like
end, through which is passed carbonic acid gas, which is disengaged from
carbonate of lime by means of dilute s.ulphuric or. hydrochl6ric acid."

" Nothing is more simple, less expensive, and more

easy to practice than this operation."

It is true enough that there is no simpler operation in chemistry than the
disengagement of carbonic acid gas, and the subi^equent distribution of it in
any direction by means of an elastic tube ; but did the author bear in mind
that nascent gases, especially those resulting from the action of an acid,
always carry over with them iarge quantities of the acid in the form of vapor,
intimately associated with every bubble that rises ] Is there riot room for
apprehension, that the gas fresh from the materials, to the reaction of which
its escape is due, will carry over a sufficient quantity of the mineral acid to
act, if not as an escharotic, at least as a powerful rubefacient or stimulant to
the delicate tissues for whose advantage it is directed to be employed ?

So great have been my apprehensions upon this subject that I have felt it
my duty to caution the profession against this effect immediately upon the
perusal of the paragraph quoted ; and I am induced at the same time to
suggest a means by which the efficacy may be tested, without exposing the
patient to the risk of injury from the direct action of the strong mineral
acids.

It is essential that the gas employed for this purpose should be perfectly
free from the sulphuric or hydrochloric acids, by means of which it is liber-
ated from its solid compound; and this degree of purity can only be accom-
plished by washing the gas in water. The employment of an apparatus for
this purpose may be somewhat inconvenient in the country ; but it would be
far better to abstain from the use of the gas altogether than to incur the r si
of irritation, or even inflammation, which might ensue from its employment
m an unwashed state, I shall endeavor to arrange some simple apparatus
for this purpose, in which, if I should be successful, I will forward you a draw-
ing and description of it. At present, the only means which suggests itself,
is to employ for the purpose Woulfe's bottles, connected with each other by
a bent tube. In the one, the carbonate of lime is to be placed ; in the other,
water enough to cover the end of the bent tube which connects the bottles.
The elastic tube should then be connected with the open mouth of the second
bottle, in which the water is contained ; and the whole apparatus being pre-
pared, the dilute acid may bo poured into the first bottle containing the car-

163?,] Varicose-and Hernia cui'ed by Acupuncturatioiu 1 87

bonate of lime ; the mouth of the bottle being immediately closed. Efferves-
cence wil^immediateiy take place, and the gas proceeding through the bent
tube will be compelled to pass through the water in the second bottle, be de-
prived of all contamination, and forced out of the elastic tube by the pres-
sure from behind, arismg from the constantly accumulating pressure in the
bottle wherein it is disengaged.

The chief difficulty attending the use of this would be obtaining the
Woulfe's bottles ; in all other respects no improvement or simplification
would be required. The patient could readily perform all the manipulations
herself, after having been once instructed in the proper proportions of the
materials to be employed.

A word or two as regards the acid to be used. Hydrochloric acid is de-
cidedly preferable to sulphuric acid, on account of its yielding a soluble salt
with lime, which may be removed from the generator with far greater ease
than the heavy, adhesive, insoluble sulphate ; and on this account it should
always be employed. Tfie quantit}'' of carbonic acid yielded by limestone or
chalK, if of tolerable purity, is always the same, whatever be the acid em-
ployed ; and I annex the quantity by v-eight which is required to produce a
gallon of carbonic acid gas at the average temperature of 60qF.; should
the temperature range above 60^ F., the volume of gas will be somewhat
increased. The paper from which I quote the above paragraphs, gives no
idea of the quantity of gas required ; but it is decidedly an advantage to
the correct observer to be acquainted with the exact amount employed, as
he may thereby be enabled not only to form a much more correct estimate
of its influence, but to increase or diminish the quantity in definite propor-
tions as the indication may require.

In large cities, where carbonated waters are manufactured on a large
scale, the most easy plan of all to obtain the use of this new therapeutic
agent, and in a perfectly pure condition, is to affix the elastic tube to a bottle
of soda water, as it is called, and having introduced the canula into the va-
gina, to compel the gas to pass over by immersing the bottle in a basin of
boiling water, by which means a quantity of gas would be obtained equal to
about five times the volume of the soda water employed.

The exact quantity of pure carbonate of lime required to furnish a gallon
of carbonic acid, is 242.86 grains, near enough to half an ounce to allow that
weight to be substituted for it. To decompose this quantity, a liuid ounce
of common muriatic acid will be sufficient. By adopting these proportions
the gas may be administered in definite doses, as it were, and its effects be
much more satisfactorily observed and determined. Am. Jour. Pharm. Am,
Med. Lib, and InielUgencer^ Baltimore, 1338.

Radical cure of Varicose Veins and of Hernice by Acupunc-
iuration. We have before noticed with great pleasure the suc-
cessful application of acupuncture and the small ligature to the
cure of varices, hydrocele of the tunica vaginalis, neck, &c.
We have now the pleasure of calling the attention of the pro-
fession to the successful apphcation of a similar practice, agun
to varicose veins, and to the herniary sac.

The common operation for hernias with the knife is itself so
formidable that it has not been prudent to adopt it merely with
curative views ; but it has, as a matter of prudence, been held
in successful use in cases rendered irreducible by strangulation,
incarceration, &c. Whilst, therefore, it has been a valuable
acquisition to surgery, it has not been available for the treat-

IS8 Krcosote in Gonorrhoea and Gleet. [Dec.

ment of ordinary cases the great frequency of which we have
had occasion to notice in another place. We coni^ratulate the
profession, therefore, on the demonstration of success offered by
M. Bonnet, of a simple and safe plan, of operation, which none
may dread or find difficulty in adopting, it seems to be calcu-
lated to afford, with little pain and danger, in a short time, and
with a good share of certainty, all the success, and upon the
same principle too, which has been desired by the truss-makers
"who have so generally failed to effect their desired end a rad-
ical cure. We commend the practice of the surgeon of the
Hotel-Dieu at Lyons to the favorable notice of American
surgeons.

M. Bonnet, chief surgeon of the Hotel-Dieu at Lyons, informs us that he
has treated eleven cases of varicose veins by introducing pins through their
cavities, and allowing them to remain there for some time. Nine of these
cases were cured. He has applied the same treatment to herniary sacs ;
and the following is a short account of his method, and of the success which
he has obtained from it. He passes three or four pins through the herniary
covering close to the inguinal ring, and in order that they may exert a certain
degree of compression, as well as of irritation, on the sac, he twists upwards
their points and heads, so as to give them a circular direction.

Caution is necessary not to injure the spermatic cord. The inflaramation
and pain commenced usually on the third or fourth day after the operation,
and the pins were removed a few days afterwards. M. Bonnet has treated
four cases of inguinal herniEB by acupiincturation. In two of these, the
hernifie were small, and three weeks sufficed for the cure. The third was
more troublesome. It occurred in an old man 67 years of age ; and in him
the hernia descended to the bottom of the scrotum, and was with difficulty
kept up by a truss. Six needles were used. After a months treatment,
this patient could walk about, w^ithout any tendency of the viscera to de-
scend. In the fourth case, the hernia was of thirty years standing ; no
truss could keep it up ; the inguinal aperture was large enough to admit
^' I'introduction de cinq doigts reunis." and the tumour descended a consid-
erable way down the thigh. Five weel- s were necessary for the cure. We
are assured that all these patients could cough and walk about freely with-
out any escape of the bowels, and that the inguinal ring was so plrgged up,
that it could no longer be distinctly recognized. Eci. Jour. Bulletin dz
Therapeutique, from Med. Chir. Rev.

Kreosote in Gonorrhoea and Gleet. Dr. Dick of Glasgow, has employed
Krcosote in the chronic stages of gonorrhraa and in gleet ; and thinks its
beneficial effects are more obvious than those of copaiba. He administers
it in doses of 2 drops a day, with loaf sugar, beaten into syrup, with water.

[Am. Jour, from Ed. Med. and Surg.

This is an important fact to the practitioner, and we hope it
will be soon confirmed by the observation of other practitioners ;
for however loathsome to the feelings of the practitioner, the
treatment of this class of diseases may be, still it has to be
done ; and in order to this, he now^ has to pay enormously
for copaiba, the use of which the kreosote is designed to sup-
plant.

1 838. ] Remarkable Calculus Nitrate of Si leer Injection . 1 S9

Very large Calculus passed by a yowij Woman wUJiout operation. A
womm, 18 years of a^-e, who h:id for seven years suffered from great pain in
the pudendum, &.c. whilst sitting- upon a pot-de-chamhre, endeavoring, by
very forcible etforts, to discharge her urine, and which exertion she continu-
ed for tea minutes, passed into the vessel a calculus of an oval form, 2 5-8
inches \(^vig, 1 8-8 inches broad, and weighing 651 grains. Am, Jour.
Guy's Hospital Reports, April, 1839.

Injection ofr.ilrate of silver in the trcntmcnt of chronic vesical Catarrh.
There is recorded in the Bulletin Gen. de Thtrapeut. (Jan., 1838,) by M.
Alquie, a case of chronic cystitis, which resisted, for three years, various
means, and which was cured in a few days by an injection of a solu-
tion of nitrate of silver, in the proportion of one grain to four ounces of dis-
tilled water. The urine was first evacuated by a silver sound, and the
solution then injected into the bladder through this instrument, and allowed
to remain for five minutes. The sound was then withdrawn and the injection
was evacuated by the patient without any pain. This operation was re-
peated for four days in succession, after which period the patient was com-
pletely relieved.

The remedy is worthy of further trial. Am. Jour.

Vspful application to Bed- Sores. A correspondent of the Bulletin Gener-
r*l3 de Therapeutique recalls to the attention of medical men a very excel-
ie-it, and easily prepared, local application for those troublesome and distress-
ing 6-)res which are so apt to occur in bed-ridden patients.

It is unnecessary to allude to the frequency of this annoyance in certain
cases of protracted disease, more especially of obstinate fevers, of phthisis,
&., and to tlie extrem'" difficnhy of counteracting them. The late M.
A'.tenrei'h, ot Viennr), was much in ihe habit of using the thick sedementary
d posit obtained by adding the liquor plumbi, drop by drop, to a strong de-
coction of oak baric, (in short, a tannate of lead,) as a topical remedy to bed-
sores, with great success. The super-natant liquor being decanted off, the
sediment is easdy procured ; it is then to be snread on linen, as we do with
an o'ntment, Thr- application to the abraded surface should be repeated
everv night and morning.

Dr. Tott, a countryman of M, Autenreith, has, of late years, used this
rems^dy with very satisfactory effects. In some cases, where it did not seem
to aofree, he mixed a certain portion of the tannate previously dried, with
pimple ointment, (two draclims to oie ounce,) and he found that the sores
often healed readily under the use of this cerate.

We can bear our testimony in favour of the good effects of this applica-
tion to bed-sores. In our own practice we have prepared it by mixing to-
gether the liquor plumbi and tha common tincture of kino, Lond. Med.
Chirurg. Rev., July, 1838.

190 Medical Intelligence. [Dec.

MEDICAL INTELLIGENCE,

Z^SBICAI* PRIZE.

The Medical Society of Augusta, Ga. offer a Prize of Fifty Dollars, or
its equivalent, to be designated by the successful competitor, for the best
approved, original Essay,

On tlie use and abuse of Calomel, as a therapeutic agent.

The following are the arrangements adopted by the society :

1. The Essay shall not exceed 40 octavo pages. -

2. Essays, intended for the corapetition, are to be directed, /ree of expense^
" To the Secretary of the Medical Society of Augusta, Ga." and must be in
his possession by the 1st day of May, 1639. Each essay must be endorsed
with a motto, which must be also on an accompanying sealed letter, contain-
ing the name and address of the writer.

3. The Medical Society will, as a body, proceed to the readmg and
inspection of all the essays received by the Secretary, as soon as practi-
cable after the 1st day of May, 1839, and will determine by the vote of
the majority, on the successful essay. After such decision, the letter bearing
the corresponding motto, will be opened, and the essay published under
the name of the author, in the Southern Medical and Surgical Journal.

4. Should none of the Essays be judged worthy of the prize proposed,
they will remain in the hands of the Secretary, subject to the order of their
authors, for three months, the names remaining under sea] ; after which, if
not otherwise directed, will be considered the property of the Society.

inr The Medical journals of the United States, and also the Literary peri-
odicals, are respectfully requested to give notice of the same by publishing
the above. [^Extract from the Minutes.

Prospectus of the American Phrenological Journal and Miscellany . It is
a remarkable fact, that while the converts to the belief that Phrenology is
true, have, within a few years, most astonishingly multiplied, there does not
exist on the American content a single periodical whose object is to advocate
its truths, repel the attacks made upon it, or answer the enquiries which
even candid persons are disposed to make concerning it. And this is the
more surprising since the materials already existing and daily augmenting,
with which to enrich such a publication, are almost uiexhaustible.

1838.] Medical InteUigencc, 191

The science of medicine has its appi-opriate media through which to
present to the profession and to students all the new facts which occur, and
all the new theories which are advocated in the various institutions of medi-
cal science throughout the world ; and it is proper that it should be so.
The same is true of the other leading professions of law, and of divinity.
But, notwithstanding the important bearings which phrenologists know tlieir
science to have on medicine, and divinity, and law, there is no publication
through which, as the appropriate channel, those bearings may be pointed
out. It is true that some newspapers, and also one or two works of a less
ephemeral character, do occasionally admit articles in favor of phrenology :
but these do not meet the present necessity. A periodical which is avow-
edly p^renoZoo-^ca/ one, whose pages shall constitute a permanent depository
of facts, and which shall be open for the expression of opinions and the re-
cord of principles connected with those facts^ is noiv needed : and a strong
feeling of this necessity* together with a belief that such a work is exten-
sively demanded, and will meet with encouragement and support, has indu-
ced the publisher to present the prospectus of " The American Phrenologi-
cal Journal and Miscellany."

The object of this work will be to preserve from oblivion the most inter-
esting of the very numerous facts, confirmatory and illustrative of the truth
of phrenology ; to show the true bearings of this science on Education^
(physical, intellectual and moral ;) on the Medical Treatment of the Insane;
on Jurisprudence ; an Theology, and on Menial and Moral Philosophy. On
all these subjects there is encouragement to hope for contributions from
several able pens : while the resources of the editor himself w^ill not, it is
hoped, be found inconsiderable.

The religious character of the work will be decidedly evangelical : for one
prominent object in giving it existence is, to wrest Phrenology out of the
hands of those, who, in ignorance of its true nature and tendencies, suppose
that they find in it an instrument by which to subvert the truths of revealed
religion, and loosen the bonds of human accountability, and moral obligation.
A frequent subject of discussion in our pages will therefore be, Tne Har-
mony between the truths of Revelation and those of Phrenology. And on the
subject of the religious bearings of our science we respectfully solicit the
enquiries and objections, not of cavillers, but of the truly candid, and the
conscientiously fearful. SucJt correspondents we shall always welcome to
our pages, and they will always be treated with kindness ; as, also, will ho-
nest and respectful objectors to Phrenology. But the captious and cavillers
will ensure to themselves our silent contempt ; and the ignorant pretender,
who seeks to overthrow a science which he w^illnot be at the pains to inves-
tigate, may expect a merited rebuke.

As our object is the establishment of Truth, we solicit the communication
of facts which are supposed to militate against Phrenology ; and we pledge
ourselves to publish them, in all cases in which we have satisfactory vouch-
ers for their genuineness ; and m which all the facts in the several cases are
furnished to us. But as we must form our own judgment of the cerebral
development in all cases on which we express our opinions, it is obvious that
we cannot receive, in these instances, the opinions of non-phrenological or
anti-phrenological writers, as to the degree in which the several organs are
developed : wq must, in every such case, see the head or skull, or a castoj it,
properly certified to be true to nature.

Original Essays on Phrenological subjects v.'ill form part of the Journal ;
as also, Reviews of Phrenologi(*al and Anti-Phrenolrgical Works : nor shall
we fail to present to our readers such matters of interest and importance as
may be found in foreign Phrenological w^orks of standard excellence, and
which are not generally accessible to the American public. Our facts we
pledge ourselves shall be bmm fide such ; and, as often as practicable, we

192 Medical InteUiiience.

shall accompany our descriptions with illustraiivc cuts ; indeed, we intend
and expect that scarcely a number will be isjsued without two or more such
cuts.

To encourage Phrenologists of talent (and especially professional men
who are Phrenologists,) lo eiiricli the work with their contributions, we of.
fer for accepled matter^ as liberal a compensation per prinled ](i^e, as is usu-
ally atforded by the very first periodicals in our country : bu the editor does
not promise to endorse all which his correspondents may communicate ; nor
all which he may admit into the work. ' 'J'o error, if serious, and especially
if it affect the interests of morality and reh'gion, he claims the right of cor-
rection, in the form of reply, or of the suppression of objectionable matter :
and communications for which compensation is expected, must be so pre-
pared as to be fit for the public eye.

In conclusion, we may be allowed to say, that the pecuniary value of each
number will depend much on the extent to which the work is patronised.
It is not with the desire or expectation of gain that it is offered to the com-
munity, but from moral considerations : from a desire to know and to pro-
mulgave truth. Hence should a large subscription list be obtained, a consid-
erable proportion of the profits will be devoted to the enlargement and
improvement of the work, without an increase of expense to the suuscribers.
More frequent illustrations and embellishments wiU, in that case, be inserted,
and the attractions of the work be thus multiplied.

Terms. 1. The American Phrenological Journal and Miscellany will be
issued monthly, commencing on the 2d of October next.

2. Each number vviil contain at least 32 octavo pages, making a volume of
not less than 384 pages ; corresponding in point of raechaiiicai execution
with the best periodicals of the day

3. The work will be furnished to subscribers at $2 per annum for a single
copy ; Bo (current in Philadelphia or New York) tor tkr-e copies, or $10
(current as above) for sereri copies sent to one address. To Clergymen and
Theological Students, single copies w^ll be furnished at $1.50 per annum ;
and to companies of eight or more of such, it will be reduced to 61.25 per
copy, if sent to one address, and the subscription forwarded to the publisher
free of expense.

N. B. As funds are already deposited for sustaining the work one year^
subscribers will incur no risk of loss by paying in advance ; and for the same
reason, subscriptions will be invariably requ red in advance.

Money sent by mail, if enclosed in the pres?nce of the poi-tmaster, will be
at the risk of the publisJier ; but jjostage must, in every case be raid.

To editors w^ho wiil give this Prospectus one or two insertions, and for.
ward a paper containing it to the publisher, the work will be sent for one
year.

Subscriptions, and letters of business, may be addressed to thp publisher,
Adam Waldie, 40 (>arpenter-street, Philadelphia, and commm.ications for
the work to the Editor of the Am. Phren. Jour., care of A. Waldie.

(Cr Postmasters throughout the country, will please to act as agents for
this Journal.

SOUTHERN MEDICAL

AND

SURGICAL JOURNAL.

Vol. m.] JANUARY, 1839. [No. 4.

Part 1. ORIGINAL COMMUNICATIONS.

ARTICLE I,

[We have requested, of Dr. Joseph A. E\'e, the clear-minded
and talented author of the following introductory address, a
copy for publication, both on account of its intrinsic worth, and
the great need on the part of the profession, for just that kind of
philosophy it inculcates. We commend it most cordially, not
only to the perusal, but to the diligent study, even of those more
advanced in the profession of medicine, as well as the young
practitioner and the pupil. We are pleased to learn that the
present Class in the Medical College of Georgia, to whom it
was addressed, perceiving its high worth, have requested a copy
of the same for publication in a pamphlet form, which is forth-
coming from another press. JEd.']

INTRODUCTORY ADDRESS,

Permit me, gentlemen, in the name of the Faculty of this
College, whom I have the honor to represent on this occasion,
to bid you a hearty welcome !

To me has been assigned the task of giving you an introduc-
tion to the present course of lectures ; and happy will I be,

A 1

1&4 Introductory Address. [Jan.

should the manner in which I fulfil this duty equal the pleasure
I feel in the attempt should I improve this opportunity, by
exhibiting views of the profession of medicine, and setting forth
principles which shall be of service to you, not merely through
the period of your pupilage, but during the whole term of your
professional life.

You have embarked in the study of a profession which, while
it affords much to excite pleasure, and call forth admiration and
wonder, while it lays open before you a most extensive and
fertile field for virtuous ambition and laudable enterprise, is still
replete with difficulties a profession holding forth the richest
rewards, yet demanding the greatest amount of labor and sacri-
fice, the most patient investigation, perpetual study and untiring
application.

In contemplating the present state of medicine, it is difficult
to say which strikes us with the greater astonishment, the
vast improvements which have been made in the science during
the present century, or its extreme distance still from ultimate
perfection: But happily, whether we contemplate its highly
improved state, or its susceptibility of improvement, equal grati-
fication is afforded : Had medicine already attained its highest
state of perfection, it would have been left to us only to admire
and imitate those who had gone before us ; had it remained sta-
tionary for many years, we should have been discouraged from
laboring for its advancement, and regarded it as a barren field
in which no laurels were to be won : but whilst the achievements
of our predecessors stand as imperishable monuments to their
well earned fame, and musi ever excite admiration, they should
not fail to awaken within us a noble spirit of emulation ! Yes,
the youthful aspirant after fame may be encouraged by the re-
flection, that although much has been achieved, much more
remains to be accomplished : that although many laurels have
been won, more still remain to adorn his brow and reward
his toil 1

Generation will follow generation age after age will pass
away, before medicine shall attain the summit of perfection,
before its cultivators shall behold their work complete.

Like those mathematical lines that may approach each other
forever without meeting, medicine will continue for ages to ap-
proximate without reaching perfection the art of healing

1S39.] Introductory Address, 19St

become more and more improved ; but it never can, in the na-
ture of things, attain that state of perfection and certainty, pre-
dicted by our venerated, but enthusiastic Rush, when "old age
and accidents, will be the only outlets to human life." Before
medicine could become so perfected, that the practitioner should
be invariably triumphant in his conflicts with disease before
he could with unerring certainty repel the shafts of death, man
must become perfect, not only in his physical organization, but
in the exercise of his reasoning faculties ; for although the sci-
ence of medicine were so perfect, that it were possible to esti-
mate with precision the nature and intensity of the disease
and to determine, with mathematical accuracy, the kind and
power of remedial agency demanded for its cure, yet unless the
human mind were perfect, unless the physician were infallible
in perception and judgment, failures would still be common
from errors in these faculties : And besides the frequent frus-
tration of his best laid remediate plans, by the stupidity or per-
fidity of those to whom their execution has been entrusted, how
often are the most exalted exercise of skill defeated, the most
sagacious and scientific labors of the practitioner rendered un-
availing, by defect of constitntionaJ energy in the patient, from
want of power to live after the disease has been subdued*
Such a consummation of skill, contrary to the order of nature
and economy of Providence, is neither to be expected nor desired.
It is far better for mankind as a species, that Death should con-
tinue to number his victims from the earliest to the latest period
of existence, than that Earth should become crowded with a
multitude of time-worn and decrepit beings, to whom life had
become a burden, in whose bosoms the frost of age had chilled
every kindly emotion and frozen up every avenue to pleasure,
and whose only hope and wish could be to die ! But the im-
provers of medicine need never apprehend this deplorable result
from their labors : the all-wise Creator of man, to whom alone
appertanieth perfection, and who has ordained the science of
medicine to relieve the sufferings of his creatures, has mercifully
assigned it metes and bounds far short of this imaginary per-
fection, which it can never pass to their injury. Medicine has
always conferred a blessing on the human family individually
and collectively, and the more it is improved, the more nearly it
approaches a perfect state, the greater and more diffusive will

196 Introductory Address, [Jan.

be the blessing. In direct ratio with the improvement of med-
icine, will the number of incurable maladies, the opprobria
medicorum, be lessened, pain and suffering diminished, happiness
promoted, and the average duration of life extended!

In a retrospective glance at the history of medicine, we behold
doctrine following doctrine in endless succession, as wave succeed
wave upon the ocean, or as the foliage of Autumn falls to be
succeeded by the leaves of Spring : one theory appears upon
the stage, culminates for awhile in meridian splendour and then
sinks down into obscurity and night with all that have passed
before : but happily for the cause of humanity, for the advance-
ment of science, exploded doctrines falling fertilize the field of
science and render the future harvest more luxuriant. A med-
ical theory may be refuted, the name of its author may be en-
tombed in oblivion,whilst some principle, established or illustrated
by him, may outlive the ruin, and prove to be of lasting value and
benefit to suffering humanity. Who now does homage to the name
of Brown, the unfortunate child of genius, the victim of error ?
where are his disciples ? where his once dazzling doctrine ?
Behold it, a shattered wreck, floating down the stream of time,
no longer extant above the waves ; yet it must be acknowledged
by all, that to Brown the honor belongs of having announced
to the profession a principle that lays at the foundation of all
correct theory in medicine, that constitutes the basis of all sound
reasoning in physiology, pathology and therapeutics, that vital
phenomena are excited and maintained by stimuli or excitants.

From true principles not having been applied to the study and
cultivation of medicine, the greatest confusion and uncertainty
long prevailed : there was little or no improvement for many
centuries, until the light which the Baconian philosophy had shed
over the other sciences, began to extend its salutary rays over
medicine and dispel the clouds of ignorance and error, that had
so long enshrouded it. Before this time, the most extravagant
notions and wildest hypothesis were prevalent. Instead of
building theories on the impregnable basis of established facts,
the most absurd doctrines were advanced, and facts then sought
and distorted for their support. The only true source of know-
ledge, nature herself, was seldom consulted : Most of the ridicu-
lous opinions that were admitted into medicine and dignified
with the appellation of doctrines, were founded in analogies de-

1839.] Introductory Address, 197

rived from the principles of other sciences, or in total ignorance
of all science, and were nothing more than the reveries of dis-
tempered imaginations. But as soon as the true principles of
philosophy were applied to the cultivation of medicine, as soon
as physicians began to seek truth by the only correct and legiti-
mate methods that is, by observation, experiment and inductive
reasoning, a new era commenced in our science ; demonstration
took the place of hypothesis, experience of speculation, and the
systems that had only served with ignis fatuus' light to bewilder
and mislead, soon vanished like the illusive phantoms of a dream.
It is to the principles of the inductive philosophy that we are
indebted for all that is valuable in medicine, it is to the application
of these principles to the investigation of medical subjects that
we owe the great improvements made in the present century
the elevated state to which medicine has already attained ;
and it is these principles that will advance it to the highest state
of perfection of which it is susceptible.

Lord Bacon was the author of this Philosophy ; in his great
work entitled "Novum Organon Scientiarum," he taught the
only correct method of conducting scientific enquiry he laid
down those rational principles of philosophizing which have led
the way to all those discoveries and valuable improvements, in
the arts and sciences, which have so eminently distinguished the
last two centuries from all that have preceded. This great phi-
losopher rose like a sun upon the dark days of mental thraldom
and delusion, and with superior light scattered the dense shades
that had for ages obscured the human mind ; this master-spirit,
this oracle of nature, exposed the absurdities of the scholastic
philosophy, with the irresistible power of truth, wrested the scep-
tre from the hand of Aristotle, who had two thousand years,
held the minds of men in abject bondage proclaimed inde-
pendence of thought intellectual liberty emancipation from
the tyranny of false philosophy ; he taught mankind to assert
the high prerogative of reason the noble privilege to think for
themselves the natural and inalienable right to employ their
own senses and mental faculties in the pursuit of truth.

" Lord Bacon, (says an elegant writer,) was the first who
taught the proper method of studying the sciences, that is, he
pointed out the way in which we should begin, and carry on
our pursuit of knowledge in order to arrive at truth. He gave

1&8 InirodiLctory Address. [Jan..

a set of rules by which mankind might deliver themselves from
slavery to names, and from wandering among fanciful systems,
and return once more as little children to the school of Nature.
The task he chose was far more useful to the world, and honor-
able to himself, than that of being, like Plato or Aristotle, the
author of a new sect : he undertook to expose the errors of
those who had gone before him, and to sliew the best "s^ay of
avoiding tkem for the future : he had the principal share in pul-
ling down the old building of a false philosophy, and with the
sidll of a superior architect, he laid the foundation, and sketched
the plan of another fabric, and gave masterly directions to those
who should come after him -how, upon the ruins of the first,
the temple of science must be erected anew. As in a great
army, there are those whose office it is to construct bridges, to
cut paths along mountains, and to remove various impediments,
80 Lord Bacox may be said to have cleared the way to know-
ledge ; to have marked out the road to truth ; and to have left
future travellers little else to do than to follow his instructions ;
he was the miner and sapper of philosophy, the pioneer of na-
ture ; and he eminently promoted the dominion of man over the
materianvorld. He was the priest of Nature's mysteries; ho
taught men in what manner they might discover her profoundest
secrets, and interpret those laws w4iich Nature has received
from the great Author of all."

This philosophy teaches mankind that the only certain method
to arrive at truth in the sciences is to relinquish all pride, to re-
nounce all preconceived opinions and theories, and to study Na-
ture herself as the only source, from which correct information
can be obtained. It sets out with this fundamental principle
** Man, the servant and interpreter of nature, understands and
reduces to practice just so much as he has actually experienced
of Nature's laws ; more he can neither know nor achieve." It
teaches us, that it is only by patiently observing natural pheno-
mena, and by careful experiment which Lord Bacon styles
" interrogating, or asking questions of nature," that we can pro-
ceed safely and surely in our enquiries after truth ; that it is
from facts, thus laboriously obtained and brought together, we
must reason, and not from baseless conjectures and vague hy-
potheses relative to the laws and operations of nature. It is by
bringing together all the facts bearing on any subject that can

1839.] hUroduclory Address. ISO

be obtained by observation and experiment, by examining them
in every point of view and carefully comparing them, that we
can arrive at some general conclusion, or delermine some fact or
principle, applicable to them all, which general facts or principles,
when satisfactorily established, become so important and valua-
ble in science, that the celebrated Locke styles them, " the
gems of knowledge ; "but it is obvious that unless the individual
facts be true, and include every thing that can affect the result,
the general fact or principle must also be false or at least uncer-
tain. This method of conducting the pursuit of knowledge, by
forming conclusions from the particular to the general, is termed
induction a logical process which leads the enquirer from par-
ticular facts or propositions, collected by experiment, when the
subject admits of it, as Chemistry, &c. or otherwise by atten-
tive observation, as in Astronomy, into some general proposition
which may constitute an axiom or principle in that science.
This is the only certain m.ethod of investigating and arriving at
truth in the medical sciences : the moment we leave it we are
bewildered in the mazes of error.

But this philosophy, while it inculcates freedom and indepen-
dence of thought, at the same time requires the most profound
humility and modesty the docility, the teachableness of little
children that with all their artlessness and simplicity, we ask
questions of nature, as of a mother, and receive instruction at
her feet : it admonishes us, as expressed in the beautifully figur-
ative language of its author, that " the kingdom of man which
is founded in the sciences, cannot be entered otherwise than the
kingdom of God, that is, in the condition ofa little child." There
are too many who would enter upon this kingdom proudly, and
by violence, as lords or princes, but to such its gates are barred.
There are too many, who, like Euclid's royal pupil, would
geek a kingly road to knowledge, but in vain : the only avenues
to the temple of science, are observation, experiment and careful
induction.

It was by the effectual aid of the inductive philosophy, that
the immortal Newton made his splendid discoveries in natural
philosophy, which have been the glory of his own, and the ad-
miration of all succeeding ages ; but to recount all the good
results that have flow^ed from the same source, would be to de-
tail the history of the arts and sciences for the last two hundred
years.

200 Introductory Address. [Jan.

It was not until comparatively late, that physicians have be-
come properly impressed with the importance of the inductive
philosophy ; hence, whilst the other sciences flourished, medi-
cine languished : and it is only since its cultivators have adopted
the principles of this philosophy, and sought truth by induction,
that medicine has witnessed such rapid improvements and justi-
fied its claims to rank, among the certain sciences : and may it
not be said with truth, that more has been accomplished, that
medicine has made greater advances towards perfection in the
nineteenth century, than previously, in the long lapse of ages,
since the days of Hippocrates ?

It would be an interesting task to trace the beneficial effects
of this philosophy upon the medical sciences, but time will per-
mit us only to refer, very generally, to some of them.

Chemistry, which, before the days of Bacon, appeared " to
have an electrive attraction for all that was absurd and extrav-
agant in the other parts of knowledge," first felt the amehorating
influence of the principles he taught, principles which have di-
vested it of all its wildness, extravagance and romance, and
elevated it to the slate of a certain science a science which has
not only reflected the most important benefits on medicine, but
one of more extensive and varied usefulness to mankind : these
principles have indeed rendered chemistry one of the most ac-
curate and exalted of the sciences, and thus contributed most to
enlarge the sphere of human knowledge, and extend man*s ena-
pire over the physical world.

This philosophy has been no less successful in its application
to anatomy than chemistry : among its most happy results, is
the grand system of general anatomy, a noble and enduring
monument to the genius and industry of its author.

It was said of Sir Isaac Newton

** When Nature and her laws lay hid in night,'*
" God said, 'let Newton be,' and all was light.'*

The same high eulogy is appropriate to Bichat in anatomical
science, as to Newton in natural philosophy.

Bichat cultivated anatomy according to the most rigorous
principles of induction : the means he employed were " experi-
ments on living animals, trials with different reagents, on organ-
ized tissues, dissection, examinations after death, observations
ttpon man in health and disease." He performed a great number

1839.] Introductory Address, 201

and variety of experiments with the simple tissues, which he
" subjected successively to desiccation, putrefaction, nuiceratlon,
ebullition, stewing and to the action of the acids and alkalis,'*
the object of v'> hich was to determine the distinctive characters
of these simple tissues, and to prove tliai the organization of
each is different and peculiar. It was thus, by the most patient
observation, by an infinitude of the most minute and laborious
experiments, and by careful induction from them, that he was
enabled to substitute demonstration for conjecture, fact for sup-
position, principle for hypothesis, light for darkness, truth for
error, to illustrate many phenomena in physiology and pathol-
ogy previously deemed inexplicable, to solve many mysteries
unfathomed before, and to become the originator of a new sci-
ence, whose publication to the world constitutes the most brilliant
epoch, in the annals of medicine !

Metaphysical speculation had hitherto entered too much into
physical investigation, but this philosophic author "Shewed that
the only legitimate aim of the physiologist's enquiries, is to study
the properties or functions of living bodies, in health and in dis-
ease, and to endeavor to find out tl.eir mutual dependencies, the
phenomena which they exhibit, the action of external agents
up )n them, and the uniformity or irregularity of iheiroperations.'*

The principles and precepts of Bichat have in a great mea-
sure banished ontology from medicine and impressed, upon the
minds of physicians, the importance of the localization of diseases
and of investigating, minutely, and determining with precision,
the organic changes in which they consist, which investigations
have subsequently resulted in the beautiful and philosophic sys-
tem of Organic Medicine.

The introduction of the inductive philosophy, into the study of
medicine, has by degrees led medical philnsophers to consider
the subjects of their investigation in the light of physical sciences,
capable of being studied as such : and the application of the
principles of physical science to ihese subjects has proven, most
satisfactorily, that this is the only correct and successful mode of
studying them. It has, by sugtresting the value of the employ-
ment of the senses in physicnl rcse;<rch, led to their application
to the investigation of disease ; and the consequence has been
most iiappy. It has clearly demonstrated that a vast amount
of the most exact and valuable knowledge, in pathology, lay con-
B 2

202 Introductory Address. [Jan.

cealed from physicians, until brought to lio^ht by this method of
investigation. The employment of the sense of hearing, until
very recently, was restricted almost entirely to the patient's
own account of his sufferings, or the still more fallacious narra-
tions of friends and attendants : but since the days of Laennec,
this sense, by means of auscultation, mediate and immediate, and
percussion, is employed in exploring the physical condition of
organs, in the hidden cavities, farthest removed from observation,
and reveals information which enables us to decide the diagno-
sis of many diseases, with an accuracy unattained and unhoped
for before the certainty already arrived at, by the employment
of the physical means of diagnosis, in thoracic diseases, cannot
be regarded otherwise than one of the most splendid triumphs
and valuable attainments of this inductive philosophy, teaching
physicians to seize with avidity every thing connected with the
subjects of their investigation, to improve every opportunity
and try every method, in their power, of acquiring all the discov-
erable circumstances in every subject.

The sense of touch, formerly employed for scarcely any
other purpose than to ascertain the pulse and the temperature
of the surface, is now much more extensively used, in the ex-
ploration of disease and examination of patients.

Means have been invented, such as the speculum, &c to
extend the useful application of vision, and the other senses have
all been brought, into the same strict and beneficial requisition.

The inductive philosophy is emphatically the philosophy of
facts; but whilst it teaches their primary and paramount im-
portance and declares that observation and experiment, alone,
can furnish them, it instructs us that to render facts, when thus
obtained, valuable and available to science, they must be brought
together, compared and classified for the deduction o^ principles;
which method of deriving general principles from particular
fajts, generalization, is one of the highest and noblest exercises
of the human intellect, and the talent for it most characteristic
of genius. BicHAT possessed this faculty in an eminent degree,
hence his conclusions are so exact, so beautifully true to nature,
that they must ever stand as irrefutable axioms in medical sci-
ence, and his doctrine of the tissues, deduced from his observa-
lions and experiments, is justly regarded as a revelation in
medicine. But great caution is necessary in the exercise of this

1839.] Introductory Address. 203

. . . . : II i

talent for equal evil has resulted from the error of generalizing,
as of particularizing too much errors into which our profes-
sion have too frequently fallen.

Whilst in accordance with the dictates of this philosophy, I
would endeavor to impress upon your minds the futility of the-
ories not based upon facts, and the necessity of regarding the
truths of nature as the foundation of knowledge, I would, with
equal solicitude and earnestness, warn you against the danger
of false facts, and the fallacy of experience, as lamentable in the
present day, as when first declared by the venerable sage of Cos.

Medicine has always abounded in false facts, which Cullen
has correctly said are more numerous than false theories. False
facts, or errors in experience, result from superficial, careless*
or partial observation and unfair experiment: men are wont too
often to see every thing through the distorting medium of pre-
judice, and to admit nothing that contradicts their preconceived
notions, or proudly cherished opinions : many err from want of
opportunity, or disposition, to compare their own experience
with that of others : many errors have arisen from mistaking
the relation of cause and effect: there is no more frequent mis-
take than that of taking simple antecedence for cause : when
one event follows another, a careless observer is almost sure to
rei^ard them in the relation of effect and cause, although there
may not have been the slightest connection between them ;
hence the necessity of the most attentive and candid observa-
tion, and the greatest care and caution in our experiments.
From the want of due attention, cause is often mistaken for
effect, and the latter for the former from the same defect, par-
tial and erroneous conclusions are adopted all the causes that
co-operate in the production of a result are not carefully scanned
the succession or concatenated series of causes that conduce
to the same end is seldom traced, with sufficient attention and
labor : What more cogent and conclusive evidence can be re-
quired to prove the fallaciousness of experience, than the con-
stant reference that is made to it as an infallible proof of the
success of the most opposite and incongruous modes of prac-
tii'.e ? To prevent error and obviate danger, the most rigid
principles of a sound and discriminating philosophy are coatin*
ually required.

204 Introductory Address. [Jan.

Every attempt to exaggerate the importance of principles
over fiicts, or oflacts over principles, is alike unphilosophical and
absurd it is equal to the folly of contending for the superior
importance of the base or superstructure, in architecture, as
though both were not equally essential to the construction of the
edifice.

Principles or theories without facts for their foundation, like
air built castles, exist only in the minds of visionary dreamers,
anil facts without principles, are as materials ready for the build-
er's use, but require his skill and labor to collocate and build them
together, in the erection of a fabric, symmetrically beautiful and
harmonious in all its parts.

" Should we bui^d facts upon facts," (says Rush,) " until our
pile reached the heavens, they would tumble to pieces, unless
they were cemented by principles. Medicine without principles
is an humble art, and a degrading occupation. It reduces a phy-
sician to a level with the cook and the nurse, who administer
to the appetites and weakness of the people, but directed by
principles, it imparts the highest elevation to the intellectual and
moral character of man."

, Jn medicine, all knowledge is either demonstrative or inferen-
tial that is, it is either demonstrable to the senses, or it must
be inferred or deduced by the mind, from facts which are objects
of sense. Let your attention be engaged now in laying a good
foundation in positive f .cts, that you may have substantial pre-
mises from which to reason: Let yciur study be principally
directed to those departments of medical knowledge, which are
demonstrative ; however difficult, however uninteresting or dis-
agreeable they may be to you, they must be mastered before
you can understand those that are based upon them otherwise
there will be no stability in your opinions, no consistency in your
practice, you will be fluctuating as the waves of the sea
your system of medicine, like the house of the foolish man
built on the sand.

As medical philosophers, you must contemplate and study-
man as an assemblage of organs, performing distinct offices ;
you must acquaint yourselves intimately with the constitution
and composition of these organs and their offices in health, with
the changes in structure and modifications in action, resulting
from disease, and the constituent properties and quahties of the

1839.] Introductory Address. 20S

remedial agents that may be brought to act beneficially upon
them the knowledge of these sulgects constitutes the sciences
of anatomy healthy and pathological, physiology, chemistry
and materia medica, these, beins: elementary and fundamental,
demand primary attention ; I would however by no means have
you undervalue the importance of the practical branches which
are, indeed, the end and object of medical science.

If it be important in every undertaking to commence aright
in every journey to take the path that leads, most safely and
directly, to the point proposed ; it is certainly not the less desir-
able and necessary, that in commencing the study of medicine,
you should set out with correct principles and be assured, Gen-
tlemen, it is only the right conception and appreciation of the
principles of the inductive philosophy, that can conduct you to
a thorough knowledge of your profession these alone that csn
make you scientific physicians and rational and successfiil prac-
titioners, therefore, have I chosen the subject of this philosophy
as most appnipriate for your induction into a profession, in
which Its principles are required at every step. The study cf
physic in which you are engaged, is literally and truly the study
of nature the very term physician, signifies a natural philos-
opher, a naturalist, one whose business and study are with
nature this is the volume whose pages you must read the
inductive philosophy, the only teacher that can unfold to you its
knowledge.

Our plan of instruction his b^en already made known* to you,
our arrangements and facilities, for demonstration and imparting
knowledge in the various departments of medicine, are open to
your inspection : without pompously boasting of superior claims
to your patronage, I will only promise, for myself and my col-
leagues, the utmost endeavors to impart to you the largest
amount of useful iuformation and to teach you important facts
and correct principles in medicine. But whilst this will demand
our most arduous efforts, it will require a corresponding degree
of attention and study on your part to render our labours profit-
able to you. Were we to devote our whole time to instruction
and labor incessantly day and night fi^r your improvement ; had
we all human knowledge; were we masters of every science

*In the annual announcement of lectures.

206 Introductory Address, [Jan.

and every art ; had we the eloquence of Demosthenes, could
we lecture to you in language more mellifluous, in strains more
sweet and enchanting, than angels use ; all would avail nothing,
without your most diligent attention liere and studious applica-
iion to books at home : We might entertain you for the time ;
but no lasting impression would be made on your minds ; you
would return unimproved,unprofitted, by your sojourn among us.
The strong desire I feel for your improvement prompts me to
urge upon you, with all possible emphasis, the indispensable im-
portance of employing all yourtime, with the greatest assiduity
and industry, to acquire and retain knowledge. Every minute
lost not/; is lost/or^i'er / Were you to live a thousand years,
you could not redeem one moment of misspent time. Every
hour has its own occupation and you can not crowd into it the
concerns of another. Your respectability and success in the
profession will depend, in a great measure, upon the improve-
ment you make of your present opportunities if they are not
improved, the loss is irreparable, no future industry, no subse-
quent efforts can make atonement for it ; but if properly im-
proved, the benefit will be experienced through your whole
life; and the full amount of good resulting not to be estimated,
until you shall have terminated your professional labours. Far
more valuable than gold, knowledge is not lost in using, but
improves, grows brighter the more it is employed. Know-
ledge has been very appropriately styled, by the author of induc-
tive philosophy, " Power :" knowledge in medicine is indeed
power of the highet i and most noble order power approaching
nearest to Divine it is truly God-like in its nature it is power
to heal the diseases and relieve the sufferings of our fellow crea-
tures : in no business or occupation in life, does man exercise
an office more heavenly, in none is he enabled to follow more
closely the footsteps of his Divine Master who went about do-
ing good, healing the sick, relieving the distressed, and comfort-
ing the poor. How glorious a vocation ! how supremely
calculated to ennoble and exalt human nature ! how eminently
productive of the highest happiness and most refined plea-
sure to him who practises it, with proper motives and under
tlie influence of correct principles and feelings ! how impor-
tant then that, in qualifying yourselves for such a profession,
no time be lost in trifling amusements and frivolous put-

1889.] Introductory Address. 207

suits ! Shourd you find, hereafter, when the duties of this pro-
fession devolve upon you, that time misspent and'opportunities,
unimproved, have left you unprepared to discharge them aright,
how condemned would you feel before the tribunal of your own
conscience! how guilty in the sight of heaven 1 The present is
the time to prevent the future upbraidings of your conscience,
to deliver yourselves from the lacerating thoughts that must
ever torture those who have, in proper season, neglected to lay
up stores of knowledge against the days of need. When called
on as the sick man's only hope, when wife and children, w^ith
streaming eyes and groans of anguish, look to you to rescue the
husband and the father from the grasp of death ; and when con-
vulsively struggling with the grim monster, in his agony, he
cries to you for help, how bitter would be your remorse, should
your inability to affoid relief be chargeable to your indolence or
neglect should it be the consequence of your having failed to
qualify yourselves for the high and solemn responsibilities you
have assumed. In such an awful hour, so fraught with grief, how
terrible then to be constrained to mourn over murdered time and
opportunities forever lost ! Happy would I be, could I persuade
you not to sow the seed that yields such bitter fruit ! Could I
do justice to my feelings and in force of expression equal the
intensity of my interest for you, I would so forcibly impress
up"n your minds the importance of improving every moment of
time, that your collegiate life, the period of your pupilage, would
always afford you pleasure in retrospection; You should ever
be enabled to look back with delight on time well spent and op-
p irtunities improved ; in the discharge of your responsible
duties in every trial and difficulty, you would be sustained and
cheered by the invigorating confidence that you are prepared to
do all that man can do.

Whilst I would most heartily congratulate you, upon entering
the profession at such an auspicious period when medicine has
been so far elevated above its former position when medical
education has been rendered more complete when higher hon-
ours and rewards are promised those who will seek them with
adequate zeal and industry; I should not fail to remind you that
much more will be required of physicians henceforth than here-
tofore, that moderate attainments and limited qualifications
will no longer suffice : correspondingly greater labors and

208 Introductory Address. [Jan.

sacrifices will be demanded : medical science must be cultivated
with more ardour and assiduity : there must be more time de-
voted to study ; more untiring perseverance and industry in the
charnel house, the museum, the laboratory and the infirmary.
The field before you is wide and fruitful ; but without proper
culture it will yield no harvest, self-indulgent ease and indolence
will reap no reward but contempt and shame! If you would
rise to eminence and dislinction in your profession, you must
pay the price, " laborious watching, toil and care." ^ ou must
turn away from the blandishments of pleasure, the delightful
converse of friends, the fascinations of the social circle, to trim
your lonely midnight lamp: You must leave the gay and fes-
tive scene, and familiarize yourselves with the sick, the dying
and the dead. It will not be yours to contemplate human na-
ture, in its strength and majesty, its beauty and loveliness ;
your study will be of humanity in its weakness, its most distress-
ing and appalling forms, in decay and ruins : But are not the
inducements sufficient the recompense most ample to compen-
sate you for all the sacrifices you shall make, for all the priva-
tions you shall suflfer, for alt the labors you shall undergo ? The
profession of your adoption will aflTord you field for the employ-
ment of the noblest faculties and exercise for the most exalted
benevolence and heavenly charity : the gratitude of the widow
and the orphan, the blessings of the poor, the respect and regard
of the wise and virtuous, the approbation of your own consciences
and the approving smile of heaven, shall be your rich reward a
reward far more glorious and worthy of aspiration, than heart-
less fame or sordid wealth !

1839.] Amputation of the Penis. 200

ARTICLE II.

Amputation of the Penis, for a fibrous induration of the prepuce
and body of the Penis. By W. H. Robert, M. D., of Co-
lumbia County, Ga.

The treatment of gonorrhoea is too much neglected by physi-
cians generally, which is one of the reasons why patients labor-
ing under this disease very rarely place themselves immediately
under the care of an intelligent practitioner, and continue to
drench themselves with patent nostrums, or to yield to the
treatment of quacks, old negroes, &c. until they become M
much affected that it is impossible to conceal the disease. The
effects then become worse than the disease itself, and are man-
ifested by strictures of the urethra, fistulous openings, fibrous
enlargements of the prepuce, indurated fibrous tumours in the
perineum, and sometimes rupture of the bladder, infiltration of
urine and gangrene. - Are not the consequences of gonorrhoea
then to be dreaded as much, if not more, than those of syphihs?
Yet there are many physicians who do not take the trouble
carefully to study gonorrhoea, and who consequently very often
fail to treat it with success ; we very often see them prescribe one
remedy, and would continue it for months, if the patient would
submit to it. Such a course might be tolerated, if there were a
certain specific against this disease, but the contrary is but too
well estabhshed. I recollect a case in which a patient laboring
under inflammation of the testicles, (the consequence of gonor-
rhoea) applied to a respectable practitioner, who ordered him to
poultice the inflamed part, and continue it for two months.
The patient being all this time scarcely able to walk fifteen steps,
finally refused to submit to the treatment any longer, and appli-
ed to another physician, who ordered twenty leeches to be ap-
plied daily ; the second application was sufficient to dissipate
all trace of inflammation, and the patient speedily recovered. I
have lately had occasion to see a few cases of neglected or badly-
treated gonorrhoea, one of which I will here relate :
c 3

210 Amputation of the Penis, [Jan.

The subject of this narrative being a stupid African, and having
concealed his disease from his master, rendered it impossible to
obtain a circumstantial account of the origin and progress of
his case. It has been ascertained, however, that he contracted
gonorrhoea about five years since, that he was subjected to no
treatment, that his penis soon began to swell, the passage of
urine to become obstructed, until finally it ceased to pass through
the ordinary channel and made its way by fistulous apertures
through the penis in various directions. He states that the en-
largement commenced with phimosis, but the appearances of
the tumour do not permit the belief that this state of the pre-
puce continued.

The patient, about 45 years of age, the property of Mr. A.
M., was sent to me in the beginning of September, when i
found his situation as follows : The penis presented the appear-
ance of a tumour, measuring 12 inches in circumference, nearly
globular, with the skin studded with warty excrescenses, and
containing a number of deep fissures through which the urine
made its escape. The orifice of the urethra had partaken of
the morbid growth and v>^as nearly an inch in length, but the
smallest probe could not be passed up the canal for more than
an inch. The glans v/as uncovered by the prepuce and very
much enlarged though by no means so much so as the body
of the penis. It was somewhat indurated, and its surface was
covered with innumerable small tumours, apparently tubercular,
and which gave it the aspect peculiar to the straw^berry or mul-
berry. The prepuce was lost in the general transformation of
the skin and subjacent cellular tissue of the penis. The en
largement extended to within an inch and a half of the pubes,
the remainder of the penis being in a normal state. There was
no enlargement of the inguinal glands.

From the long standing of the case, from the impossibility oT
introducing a bougie, and from the extent as well as the cause
and nature of the tumour, amputation was deemed the only ex-
pedient that promised relief. I therefore performed it in the-
usual way, in the presence of Dr. J. Butt, on the 14th September
last, at 12 o'clock, M. With one stroke of the knife I amputated
the penis at an inch from the pubes. Having previously appli-
ed a small bandage around the root of the penis, which prevented
the retraction of the cavernous bodies, we were enabled to apply

1839.] Amputation of the Penis. %\\

without difficulty the ligature to three arteries which required
it. A silver catheter was then introduced into the bladder with
ease, and adhesive strips, a compress, and a T bandage com-
pleted the dressing.

4 o'clock, P. M. Discovering that there was considerable
oozing of blood from the stump, I applied a large piece of sponge
as a compress. Complained of considerable pain in the stump ;
ordered 50 drops of laudanum to be given at bed time ; pulse
evinced some little excitement.

15th. Patient passed a bad night, on account of the pain;
pulse 100, and slightly intermittent ; has passed his urine during
the night ; no more oozing ; bowels regular ; ordered a drachm
of Peruvian bark to be given three times a day.

16th. Passed a pretty good night ; still complained of some
pain ; pulse 90, full and strong ; passed his urine without any
difficulty ; appetite good.

17th. Passed a good night ; pain diminishing ; complains of
the bandage being hard ; removed the bandages, which were
rery stiff and hard ; the wound looked very well, had not united
by the first intention, but appeared to close in a circular manner ;
pulse 80 and regular ; re-applied the dressing, still leaving the
catheter in the bladder.

I8th. Patient continued to improve, without any unfavora-
ble symptoms ; appetite good ; all the functions appear to be
performed in a healthy manner.

22d. The dressing has been renewed daily since my last
report; the wound has a very healthy appearance, and has
gradually closed in a circular manner ; removed the catheter ;
the ligatures have come away ; urinated freely.

30th. Patient improves rapidly ; the wound has closed very
regularly, but in order to keep open the urethral orifice, I intro-
duced a gum elastic bougie, during every night ; has complained
for a few nights past of pain in the stump, produced by erections.

Oct. 15th. Wound has closed until it is now about the natu-
ral size of the urethra, patient urinates in a full and bold stream
and is entirely well. The stump is about an inch in length.

On examining the tumour after the operation, the urethra
could be distinctly traced from the point of section, to within
about two inches from the urethral oriiice. In this course it
gradually diminished in size until its caliber became completely

/ '/

212 Remarkable Biliary Calculus. [Jan.

obliterated. The occlusion continued about an inch, or up to
the glans, in which the canal was open. In the narrowed por-
tion of the canal were found a number of small apertures, lead-
ing into and through the tumour in various directions, thus ena-
bling the urine to escape as stated above. The corpora caver-
nosa were easily isolated from the general mass, the intervening
cellular tissue not having been so much indurated as that more
externally situated. These bodies were however, considerably
condensed. The remainder of the mass was firm, fibrous, and
evidently the result of hypertrophy and induration of the integu-
ments and subcutaneous cellular tissue, induced by the irritating
qualities of the urine, which continually oozed through it.
There w^as no earthy deposit in it.

The specimen has been presented to the Museum of the
Medical College of Georgia.

ARTICLE III.

Case of the Passage of a Biliary Calculus of remarkable size.
Read before the Medical Society of Augusta, on the 6th De-
cember, 1838. By F. M. Robertson, M. D. of Augusta, Ga.

Mr. J. P. S. aged 40 ; born in Ireland ; came to the United
States in 1823. He was the subject of autumnal fever the first
season after his arrival in this country. The fever was extreme-
ly severe, and his recovery protracted. He afterwards sufl^ered,
repeatedly, from the same disease, and, for several years past,
has been subject to attacks of, what was termed, bilious colic ;
they were frequently followed by 'a jaundiced state of the skin,
which was very difficult to remove, though all the remedies, re-
puted to be useful in such cases, were used.

I was requested to visit Mr. S., on the 12th of April, 1838,
who, the messenger stated, was laboring ujider a severe bilious
colic. When I arrived, I found him drawn completely double
with pain ; pulse quick, but small and feeble ;* nausea and vom-

* 1 should here state, that in health Mr. S. has a small and feeble pulse,
and rather quicker than natural.

1839. J Uemarkable Biliary Calculus, 213

iting ; constant desire for cold drinks, which were thrown from
the stomach as soon as taken ; no bile with the fluids thrown
from the stomach. The tongue was moist, expanded and light-
ly coated with white fur. The pain was paroxysmal ; that is,
though he was, at no time, free from pain, yet the exacerbations
were so violent as to cramp his whole muscular system. When
the paroxysm, in which I found him, had passed off, I had an op-
portunity of making a more minute examination of the different
regions of the abdomen.

Pressure upon any part of the abdomen produced considera-
ble pain; the right hypochondrium, however, was extremely
painful ; it was also, decidedly enlarged, and percussion gave a
dull sound belov/ and in advance of the margin of the false ribs.
Immediately over the gall-bladder, and track of the ductus com-
munis, the pain was intense and circumscribed ; the patient sta-
ted that it could be covered with a silver half dollar. In apply-
ing cups to this region one was placed immediately over the
seat of the circumscribed acute pain, and the suffering produc-
ed by the exhaustion of the cup was so intense that it became
necessary to remove it entirely. The patient stated that each
stroke of the piston, in exhausting the cup, caused a sensation as
though a dagger had penetrated this particular spot. His skin
and eyes were jaundiced.

Each paroxysm of pain produced vomiting ; but, through the
whole course of the attack, no bile could be detected in the mat-
ter vomited. The bowels were easily moved by cathartics, and
without increasing the pain. Opium and the warm bath were
used freely ; and, as the diagnosis was not clear, and inflamma-
tion was feared, blisters were applied to the abdomen and region
of the spinal column. On the fifth day his strength evidently
failed, and, though the paroxysms of pain were not so frequent,
yet, symptoms of a fatal termination exhibited themselves; such
as extremely small, feeble and quick pulse ; cold clammy sweat ;
coldness of the extremities and forehead, and singultus. Under
these circumstances, and from the fact of his having been accus-
tomed to take two or three drinks of brandy and water during
t'le day, this form of stimulus was administered pro re nata.
He continued in ihis state until the sixth day, when he
informed me, at one of my visits, that something had given
way, at the point at which the pain had been most severe,

214 Remarkable Biliary Calculus. [Jan.

and he feit to use his own language as though it had fallen
down to the lower part of the abdonnen. From this moment he
felt no more acute pain over the region of the gall-bladder and
ducts, but referred to an uneasy sensation felt lower down the
abdomen. He gradually recovered, though it was some time
before his skin cleared oft', or his bowels were brought into a re-
gular state.

He continued in this state until the 9th of August of the same
year, when I was summoned to visit him in haste. On my ar-
rival, I found him in extreme anguish. The pain was confined
to the region of the ileu-cecal valve ; pulse feeble and quick ;
cold, clammy sweat ; constant nausea : vomiting accompanied
every paroxysm of pain. Unlike the previous attack, there
was no pain o< er the region of the liver, and the matter vomited
was high'y colored with bile. It was impossible to get a pas-
sage ihr-ugh the bowels. Opium and the warm bath relieved
the pain ; but it was impossible to get any thing to remain on
the stomach sufficiently long to act upon the bowels, and ene-
mata were repeatedly returned uncoloured.

On the evening of the second day it became necessary to ad-
minister stimulants, as in the previous attack, and a large blister
was applied to the whole abdominal region. The stimulants
remained on the stomach, but whenever any thing was taken
with a view of relieving the confined state of the bowels, it im-
mediately brought on vomiting, accompanied by extreme pain
in the lower part of the alimentary canal. At one time he
threw up nearly half a pint of dark brown fluid, of an odor
similar to that of foecal matter. On the evening of the third day,
1 determined to try the efficacy of the croton oil, applied ender-
mically. For this purpose I tore up a small portion of the sep-
arated cuticle from the blistered surface, on each side of the
abdomen, and rubbed in three drops of the oil immediately over
the ileo-cecal valve, and tw^o drops on the opposite side. In
about eight hours after the application the bowels were slightly
moved, and the sufferings of the patient were greatly relieved.*

On the afternoon of the next day. the 12th, while on the close
stool, he stated to his wife that the cause of his disease was

*I had tried this oil before, and knew it to be good. It had operated
promptly, in several cases, administered by the mouth.

1S39.] Remarkable Biliary Calculus, 215

coming away, but he feared his strength would not enable him
to pass it. He bore down with considerable effort, when a solid
substance escaped from the rectum, and struck the bottom of
the vessel with so much force as to be heard all over the room.
The substance was carefully washed and handed to me at my
next visit. I found it to be a gall-stone of unusual size. It was
nearly the shape of a large plum ; its long diameter measured
one inch and a tenth ; the shortest diameter one inch ; its great-
est circumference three inches and three-eights ; the smaller cir-
cumferance three inches and one-eiorhth. It weif]rhed, after hav-
ing been twenty-four hours out of the intestines, two drachms
and ten grains. It was composed of concentric laminoe, of a
dark brown color, interspersed, at a few points, with spots of
dull vvhitj. NoArly the whole of the outer lamina was rubbed
off in washing it. The particles, that crumbled from it, could
easily be marked, and imparted a deep yellow tinge to the wa-
ter, though on becommg dry they were hard, and failed to im-
part the yellow color to water in which they were crumbled.
It was tasteless. The effect of heat was not tried, as 1 was
anxious to preserve the specimen with as little mutilation as
possible.

The passage of a calculus of such dimensions is very unusual ;
much larger have been discharged, though some think that the
passage was effected by ulceration betwesn the duct and duode-
num. Pemberton, in his work on diseases of the abdominal vis-
cera, states that '* the size of gall-stones, which have passed
without destroying the patient, almost exceeds belief. I have,
in my possession, the model of one whose long diameter i? two
inches and a quarter. The patient, from whom this passed, suf-
fered for five months, the most acute pain. From the magnitude
of the stone, I should believe that ulceration in consequence of
inflammation had taken place between the duct and the duode-
num, and that thus an aperture was made for the stone to pass
into the intestines, as it is unlikely that the duct could admit of
such dilatation."

Dr. Baillie, in speaking of the extent to which the biliary ducts
are capable of being dilated, states that he has seen " the ductus
hepaticus and ductus choledochus so much dilated as to be near-
ly an inch in their transverse diameter." He further states " this
dilatation of the biliary ducts takes place in consequence of the

216 Remarkable Biliary Calculus, [Jan.

passage of gall-stones ; and it is astonishing how large gall-stones
pass into the duodenum." He also states, that he knew an in-
stance of one which was " full as large as a hen's egg"*

Marcet mentions a biliary calculus two inches and five-eights
in length, and two and a quarter in width, but does not state
whether it passed from the living subject, or was found in the
gall-bladder after death. f Good, in speaking of the passage of
gall-stones, states that ' the calculus, when v^oided, has some-
times been found to measure two inches in its long diameter, and
upwards of three inches and a quarter in its widest circumfer-
ence." He does not give the particulars of any case, but refers
to the Medico-Chir. Transactions, vol. 12, article 21st.

Blagdeu, in the Medical Transactions, relates a case in which
the gall-stone excited inflammation, which resulted in the for-
mation of an abscess in the liver, adhesions, and, finally, a dis-
charge, externally, of the contents of the abscess, with the
calculus, which weighed nearly an ounce and a quarter. The
patient, who was a lady of sixty-six years of age, gradually re-
covered J

Many cases are on record in which biliary calculi, of an enor-
mous size, were found m the gall-bladder after death; also
instances in which no inconvenience was produced by their pre-
sence during life, post-mortem examination alone revealing
the fact.

Hebberden mentions the case of Lo^d Bute, after whose death
a calculus was found in the gall-bladder, weighing two drachms,
though he had never complained of jaundice, or any disorder
which could be attributed to this cause.

Good mentions that, " in Dr. Baillie's plates, there is an exam-
ple of a concretion, of the size of a pullet's egg, which filled up
the whole of the fundus of the gall-bladder. Yet so perfect was
the adaptation of nature to the case, that the bladder not only
because sufficiently enlarged at its base to hold the concretion,
but was also sufficiently enlarged immediately above it to form a
new reservoir, and contain very nearly, the usual quantity which
the gall-bladder is capable of holding in its healthy state.'*

* Works of Dr. Baillie, by Wardorp.

f Dictionnaire de Medicine, art. Calculs, par P. Jolly.

^Good's Study, vol. 1st, p. 229.

^Good's Study, vol. 1, p. 300.

1839.] RemarJiobh Biliary Calculus. 217

It would appear, from the history of this case, that the calcu-
lus must have es<!aped into the duodenum durins: the first attack
in April, and remained in the small intestine until the second at-
tack, in August, wliich resulted in itsexp ilsion from the bowels.
No douht this second attack was brouglit about by the calculus
gradually working down to the ileo-coecal valve and thus becom-
ing entangled, produced a complete obstruction of the alimen-
tary canal. In the first attack no bile was found among the
matter thrown from the stomach, and cathartics acted readily
on the bowels, but without afl^ordinof any relief In the second,
bile was copiously ejected from the stomach, cathartics would
not ai.'t for some time, and whi?n they did, relief was ob-
tained, and in a short time, the calculus was discharged.
The skin became jaundiced in April ; not so in August.
In the first attack, the pain was more acute, and continued in
the region of the ductus communis, and was only relieved after
the sudden giving way which the patient experienced. In the
second, the pain was confined to the region of the ileo-ciucal
valve, and cathartics increased it, until the calculus was dislodg-
ed from its situation.

The concretion has been deposited in the Museum of the
Medical College of Georgia.

The gentleman gradually recovered, and is now residing in
the city of Savannah.

t)4

IS18 Action of Diuretic Medicines. [Jan.

Part II. REVIEWS AND EXTRACTS.

On the action of Diuretic Medicines. By Dr. C. G. Mitcherlich.

There is a rich jewel of pathological truth in the following
observations of Dr. Mitcherlich, :which we are happy to see
so fully sanctioned by Dr. Johnson. Dr. Johnson has never
been a Broussaist, nev.er a solidist, never a humorahst, in-
deed, never a party man ; but a man, early and well prepared
for observation, abundant opportunities for which have been
afforded liim the world over, and well embraced, from India
to America. He now sits crowned with the honor of all the
science which nine septenniads most profitably spent could
heap upon him. We will not say there is no other man now
on earth possessing equal medical literature ; but we certainly
know of no other in whom are combined so much of the gen-
eral diad medical scholar, the sound logician, the man of com-
mon sense, and the practical man, as Dr. James Johnson,
of London. These pre-eminent qualifications prepare him
for just what he is the most able reviewer of the medical
world. With powers of discrimination, as if intuitive, he has
always been found, independent of partiality or prejudice,
early and immovably fixed in the ways of that truth which is
fortified by the invulnerable bulwark of sound inrluction. With
all that confidence which the soundest reasoning from the fullest
stores of truth could afford, he has always been the first to fos-
ter and cherish truth, to clip the pinions of the fanciful in their
giddy flight, and to mark the errors of ultraism of every descrip-
tion and from whatever source. He never was troubled with
that limidation of mind so common in the profession, which
leads men, when they get a glimpse of one cause, so to maojnify
it, as to be able to see and contemplate, and reason from no
other. In short, he is a sound philosopher, who lends all the
energies of his mighty intellect to b(Mir on medical science in
all its departtrients He js a cause-and-effect man examines
to its very elements, everv cause, whether active or passivf ;
\ook\ng \ve]\ to lis pj'oportio7u/fe ajtitude to the effect. Thus
has he found that neither a purely nervous, nor a purely humoral
pathology, was the true and sout)d philosophy of medicine, but
that truth consisted in, and is dedu^;ible only from a due estimate
of active ^nd passive causes ; and that whilst the principles of
action which are taught bv somd physiology are true, and that
all deviations from fhat p'lysioloj^ical state indicate disorder or
diseasf^ ; that it is not less true that the fl lids of the system have
also their physiological and their pathological state, and that

TS39.] Action of Diuretic Medicines, 219

these are to be as duly considered in the reasoning process, as
the physiological and the pathological conditions of the action.

We know of no calamity which could befall the profession,
which would be a parallel with the death of this truly great
man. We only regret that he has not, according to the nature
of the * stream of human life," nine more " septenniads" to
live. But we recall us from the wanderings, if such they may
be considered, into which our admiration of such a man as Dr.
J. leads us, and in which w^e ever delight, and turn to the con-
sideration of the interesting pathological point to wdiich we at
first adverted. It is the idea of " the healthy composition of the
blood." This is a subject which, if not of paramount, is of equal
importance with a healthy state of action. And why? The
reason will be found in the fact that, whenever the blood is found
to deviate from its healthy composition, disease must as cer-
tainly follow, as from a like deviation of action. Indeed that is
generally the cause of this.

These are doctrines which the mode of the world has, for the
last twenty years, by clamor and dogmatism, kept in the back
ground. But truth, smothered by the mists and clouds of false
reasoning, and trampled down by magisterial feet for a season,
is like the unquenchable fire of the volcano. In its proper time
it will burst forth with resistless power and brilliance, illumin-
ating and fertilizing the fields of science by the refreshing influ-
ence of its light in exposing to view and banishing every error.

We will give the world the credit of having been able, in all
ages, to perceive the fict, that certain parts of the ingesta which
are left in the first passages, after the functions of digestion and
chylification have been exercised on them, are at least superflu-
ous, or " no longer of use in the animal economy ;" and not
only so, but that disease must be the consequence of the contin-
ued' want of their excretion. This has how^ever, been a plain
matter for comprehension. But an age has not half passed
away, since the dominant philosophy of the medical world
would not allow that medicines passed from the primae viae into
the circulation ; and physiologists were almost made to believe
they were first generated, and then nourished and sustained by
sympatliy. Thus forestalled, they have not been able to realize
the truth that excretion is as necessary from other parts, as from
the first passages. But whilst their anatomy has stared theni
in the face with the fact that, as perfect and ample arrangements
had been made for eliminaiion from the blood, of its refuse mat-
ter, as those arranged for the bowels ; and whilst their physiolo-
gy taught them that these secretions and excretions were actu-
ally effected, still they have strangely lapsed into that weakness
which allowed them to conclude that although, ordinarily in
health, these depurating functions went on with great regularity,
and that large eliminations were effected by them, especially

t20 Action of Diuretic Medicines. [Jan,

those of greatest imporiance, that is to say, the skin, the liver
and the kidneys ; yet their interruption for a longer or shorter
time exercised no morbific tendencies. They were not able to
conceive the fact that the retention of those excretions which
consisted of effete, superfluous, acrid, or other materials vhich
were no longer useful or proper in the economy whose sepa-
ration was necei^saiy to keep the blood in its natural, physiologi-
cal state, or preserve "the healthy composition of the blood,"
must, by tl^ great change in its composition, necessarily effected
by such retention, unavoidably alter ihe physiological state of the
blood to Si pathological one. " Action," " the state of action,"
was the everlasting cry this the beginning and the end t)f the
pathology. " Increase," " decrease," or " translate action or
excitement" by direct appliances, as cold, abstinence, stimulants,
&LC. the sum total of the therapeutics.

Every one has known the ills inseparable from too long sus-
pension of alvine excretion. Our author. Dr. Milcherlich, has
laid before us as plainly the ills consequent to the undue suspen-
sion or entire cessation of one of the other excretions which are
more hidden, and destined for the still further purification of the
nutriment after it has passed into the circulation we mean the
kidney secretion. See in the second paragraph in the extract
we are about to make, the whole facts in such a case facts, not
of supposition, but of experiment and observation of such men
as Prevost and Dumas. Here ocular inspection, with the
assistance of animal chemistry, prove the fact that all things
which should be eliminated by urinary secretion, are found m
the blood, and in immediate connexion with this disease, as the
next and immediate sequent or phenomenon proving its relation
of effect, co-extensive with the circulation itself, which now b-
comes the universal distributor of an incorrigible cause of dis-
ease. Surely no one will hereafter find difficulty in applying
this doctrine to the derangements of other secretions, and espe
cially those of great and frequent import, as the liver and the
skin.

We are of the opinion that the plainest farmer would under-
stand this whole philosophy, were we to tell him, by an analogy
familiar to him, that the first passages are comparable to his
barn in which he stores his sheaves of grain that chylification
is as the winnowing process the absorption by the lacteals as
the grinding process ; but that the bran is not separated and the
pure flour obtained until it passes the seive or boulting-case.
These secretories are the internal boulting-cases which separate
from the pure, and finally useful part of the aliment those in-
gredients which are unfit for use in the economy.

Now let us apply the doctrine to the more or less complete
obstruction of cutaneous or hepatic excretion; and see what
must as truly follow from these, as the phenomena which we

1839. J Action of Diuretic Medicinen, S91

know to result fr< m sup};n ssed urinary secretion. In few
words we nnay say tliat, trctn the former, all those phenomena
arise which belong to what we call infl;immatory fever in all its
usual forms, not traumatic ; as well as ail those phenomena
which we recognize ;js effects of cold. From the latter, all
those which are recognized as hepatic symptoms ; both of which
parcels of phenomena have been too little studied in view of
their etiology ; and should be more attentively examined in the
same relation to their relative secretories. as those which attend
renal deranp^ements. Animal chemistry has indeed done much ;
but in relation to the two function to which we now allude, it has
doiiTe little, except to investigate the physiological state of the
secretions. The blood should be analyzed under these several
and combined suppressions, and the ce-nstiiuents of those secre-
tions in health, shewn to exist in the blood in disease, as compe-
tent cause of morbid phenomena, and as serving as such, as really
as do free uric acid, Iree lactic acid, (fee. &c. in the blood conse-
quent on suppression of urine.

When the whole etiology of disease is thus made plain, and
not until then, will the therapeutics applicable to particular dis-
eases be worthy of men who aim at truth and sound philosophy
m medicine.

On the Action of Diuretic Medicines. By Dr. C. G. Mitcheilich.

(From the Archiv. Fiir Anatomie, Physiologic, von Dr. J. Miiller, Jahrgang
18:^7. Heft. 3.)

We trust the following cx^pions analysis of an essay coming from so dis-
tinguished an authority as Dr. Mitcheriich, on so interesting and important
a subject, will not be considered out of place in a journal devoted, as ourg
ever has been, to the advancement and improvement of practical mkdi-
ciNB. If there be any one class of therapeutic agents more abused than
another, in the hands of the mere routine practitioner, it is the class of diu^.
retics. In treating the disease for which diuretic medicines are principally
employed, namely dropsy, it has been and still is too much the practice to
prescribe for a mere name, the pathological condition on which dropsy may
depend, and the primary disease of which the dropsi.-al effusion is but a
symptom, being entirely left out of consideration. Did the physician, when
prescribing diuretics, recollect that most of those articles of the materia
medica which are specifically and Kar' s|op^T]v classed under this head,
are powerful local stimulants, and that it is by^heir revellent effects combi-
ned with the diuresis whicti they occasion, that they produce beneficial
results, we should not so often see ^hem prescribed in cases wherein the
primary affection is seated in the Kidneys, this affection being accompanied
with inflammation or at least irritation'of those organs, and consequent di-
minution of the urinary secretion ; m which from an exclusive attention to
the latter circumstance their use appears to the superficial observer to be
indicated. In such cases their employment cannot fail to add to the mischief,
the best diuretics obviously being the lancet and the antiphlogistic plan of

S2J5 Action of Diuretic Medicines. [Jan.

irealmen!, \vh)cb, by rennovirg tlie cpu^e cf ihe d minishcci sfcretior, would
tend indirecvjy tocstiblieh i-t; | ( iiett rts-tDiaiJon. Icr a l-.r.t v\]c('^e of the
fact lliai droy.^ic;)] (.fttMoii is ijt qi i i.t v c( ) < i c:t i t rn d f i f.re <! li.e kidncyp,
and that the mark of iIup cep* r;d;.nce i? plain'y r.flirTt ed 1 y the albuminous
state of the LTiue, we ;re iiidt bttd to lie \ JjilKjo^jral rrt-eHrciirs of Drs.
Brioh% Chrisiif-ci), GMg( ry ai d Cf-t(rnp. VVef-halJ viiiioLt further pre-
amble pn Feni ihe cesjy io our r fideip. The Lr.r.ary eecretion removes
superfluous water ;.id otht rn, alt laJ^', which are lo loigcr of i ee in the
animal economy, from the maf-s ot biood, and, rrmc ction with those organs
destined to t-imiJar functions, keeps up ij.e healthy com[;osition of the blood.

^5hould the uriuciry secjelidi) be stopped, serious diseases are occasioned.
The extirpation of both kidneys, according- to the experiments of Prevost
and Dumas, pn^duces death before the tenth day, and the blood is then
four.d to be thin, more fluid thrai natural, abounding in urea ; serum also is
effused into tlie cerebrajcavitie!--, the mucous membrane of the lungs is cov-
ered \\\X\\ mucus, ;:nd a quanti'y of thin fceces with a considerable quantity
of bile is found in the iu'esiinal canal. {Should the suppression of the urina-
ry secretion not take p'h ce t^uddenly, as in the experiments on animals just
mentioned, the disease (i^fhur a renahs) in such case proceeds as follows :
a urinous taste is p. rod' ced in liie mouth, the cutaneous, salivary and intes-
tinal secretions are increased, and emit a urinous smell ; violent fever, and
dyspnoea ensue, severe head-ache with dizziness, somnolency, dehrium,
convulsions, and apopkxy or siffocaticr. termmate life. On instituting a
post-mortem exauiinatiou, there is then f(,uid a copious collection of water
in the different cavities, and the cdour of urine is also distinctly perceived.
The non-secretion of the urine from the blood makes this latter fluid thin,
produces increased secretion from the other secreting organs, is followed by
effusion of serum into the cavities, and gives rise moreover to peculiar
symptoms, which in all probability depend on the action of the constituents
of the urine. Should the urinary secretion be gradually diminish( d, with-
out becoming entirely suppressed, t ho results are of a different kind, and
dropsy becomes estabJislitd ; this for instance takes place in degenerescence
of the kidneys. Cases are on record in which no discharge of urine took
place for months or even for years. Richardson mentions a case in which
no urine was ever passed, and that without any inconvenience. Such obser-
vations jiowever are to be considered extraordinary phenomena, and stand
in need of confirmaiion.

The urine in a heal hv indiv'dual has an acid reaction, a specific gravity
of 1,(K)5 1,03, at mostof 1,()'J5 (Pmut), and should contain from 4 to 8 of
solid constituents. Great var.eties are jound here, according as the urine of
the morning or the evening be made the subject of examination, according^
as the condition be after copious drmking, or a long thirst, &c. The quanti-
ty of the urine evacuated daily by a healthy man varies considerably, and
depends on the quantify of the fluids secreted by the skin, miestinal canal,
&c. and on the quantity of the fluid and solid food consumed by the individual.

The ordinary constituents of the urine are: free uric rcid, free lactic
acid, lactate of ammonia, sulphate of potass and of soda, phosphate of soda,
biphosphate of ammonia, chloride of sodium, muriate of ammonia, fluoride of
calcium, phosphate of lime and inagnesia, silica and u.rea, as also an inde-
terminate quantity of animal matter. Besides thi^, the urine also contains
some mucus from the bladder.

These cons'ituen's are f onsfantly found in the urine of an individual in
the 9tate of health, but not always in the same quantity, nor in the fame
relative proportions. The urine of children is poorer in urea and uric acid
than that of aduhs. The cutaneous transpiration exercises very considera-
ble influence on Ihe urinary secre'ion, and the greater the quantity of fluid
produced from the body by that means is, the more concentrated is the
urine, and in the less quantity is it secreted. Accordingly we find a great

1830.] Action of Diujetic Medicines, 223

difference in warm seasons and in wiijter with respect to the secretion of
urine, as also in a moist and dry atmosphere. When the intestinal dischar.
ges are copious, a smaller quantity of urine is secreted. Nor can we, under
such circumstances, raise the urinary secretion by moans of medicine, as
in the opposite case. Drink exercises still greater influence, as the urine
flows so much tiie more abundantly, and becomes poorer in sohd constituents
the more w^e drink. Water is carried away by the skin, &:c. but in consid.
erable quantities also by the kidneys. On this account the urine is more
concentrated in the morni?gtJian in the evening, because less is drunk at
night. Should the drink contain other materials hi solution, these alto fre-
quently change the composition of the urine, as they are partly excreted
through the kidneys, whilst some of them influence the formation of olher
materials. The food produces an import nnt change in the urine, as m:my
substances which are absorbed after digestion, are not converted intc mate-
rials of nutrition, and are ehminated with the urine ; they m.iy have suffered
a change during their circulation or not. 'I'hus after digestion the urine is
rich in urea, unc acid and salts.

The urine undergoes very important ch'^nges in disease both wi^h respect
to its quantity, and also with respect to i;s composiiion. These differences
we have here noticed, but very briefly. Tiie quantity of the urine is very
much increased in diabete?, at the same time that a greater quantity of wa-
ter is drunk. The urine diminishes very much and contains m ch olid c(m.
etituents, if violent sweating ordiarrhoei carry o.T a considerable quantity
of fluids from the 1 ody. and ifj as in dropsy, a great quantity of fiuid be
deposited into the cellular tissue or info the cavities of the body. The
composition of the urine also varies very considf rably in diseases, on which
subject, however, but few investio-ations hive been mnde. Thus, for in-
stance, in paralysis proceeding fnim the br dn or spinal con', we frequently
find urine with an alkahne reaction ; in diabetes mellitus it is found to con-
tain sugar ; in dropsy it often contains albumen; in gout and rheumatism
uric acid and urate of a^nmonia in great qunntity.

Most articles of the materia medica also ch mge the urinary secretion in
a very high degree, as well, with respect to quantity, as to its composition.
They produce these changes partly by acting on other organs as it were an-
tagonistically, as purgatives for example, partly by a direct action on the
kidneys, as saline me.licines, and partly by producing a change in the blood.
Some diminish the urinary secretion, as purgatives, opium, &c., others in-
crease it, and thence are called diuretics. Ti e changes in the composiiion
have been scarcely at all investigated, and we only know that many medici-
nal substances are again found in the urine, (salts, colouring matter, &,c.)
and that others change its odour (turpentine, asnaragus, &,c.)

Those medicinal substances which increase the quantity of the urine,
yield thereby a urine wh'ch is deficient in solid constituents, and which ac-
cordingly has a less specific gravity than before. This is frequently antici-
pated, in as much as sach urine generally con inues clear on cooling, though
this opinion is not confirmed by experiment. In diabetes the urine is often
very clear, and yet not unfrequently it has a very great specific gravity.
Accordingly the conclusion is by no means correct in every instance, that a
clear urine is less concentrated, th m a urine which, on cooling, yields a pre-
cipitate The uric acid, for instance, which is very scantily soluble in water,
falls to the bottom on the cooling of the urin^ as soon as it is secreted from
the blood in greater quantity, without the urine still being of a great specific
gravity.

For the investigation of these facts I have collected some observations
made on dropsical patients, and though several salts were present, I con.
itantly found Ihat the specific gravity of the urine is diminished, if its qiuintity
be increased. ^ In one case the urine was of the specific gravity, 1,02"2, and
on the following day, after 15 grains of carbonate of potass in solution were

224 Action of Diuretic Medicines. [Jan.

taken every threo hours, its specific gravity fell to l,(U. The quantity of
the urine secreted Wdsat this lime increased to about double. In the other
cases, this difference, though less palpable, was still evident. We possess
similar results with respect to other secretions : thus in the case of salivation
by mercury, the specific gravity of the saliva is diminished to 1,0021 1,0038
(instead oi 1,0032 l,008d). It is probable that every secretion, which be-
comes more copiously secreted than beibre, in consequence of the employ-
ment of a medicinal substance, also becomes poorer in solid constituents than
before. The seer tions of the intestinal mucous membrane are always ren-
dered very watery after large doses of purgatives. The differences which
the individual articles present, have not as yet been investigated. This
increased secretion of urine with a small proportion of solid constituents by
means of diuretics, and consequently of less specific gravity than the blood,
is a fact, which, as I shall presently shew, is of considerable importance,
investigations on the changes in the relative quantity ot th^ constituents of
the urine by diuretics we do not possess. In salivation after the use of
mercury the relative quantity of the constituents of the saliva is essentially
changed ; the quantity of the salts has increased, while that of the salivary
material has become less. On the appearance of new substances in the
urine after the use of diuretics we possess no facts, only some few conjec-
tures ; thus, during the use of turp 'ntine, we find the urine of a peculiar
odour. Those medicinal subs'^ances, which are easily found in small quan-
tity in solution with organic substances, are also found again in the urine, as
the salts for instance. Tne other substances are not detected in the urine.
Diuretic medicines are very various. We haue medicines, which in a
healthy individual produce an increased urinary secretion by increasing the
action of the kidneys, (diuretic properly so called). Other medicinal sub-
stances, on the contrary, produce their diuretic effect by removing the cause
of the diminished urinary secretion, (diuretics in a therapeutical sense); the
increased secretion in this case is only an adventitious result. Water itself
increases the secretion of urine, as it must be constantly removed again
through the skin, lungs, intestinal canal, and kidneys.

1. Diuretics whose Physiological Action is to produce

AN INCREASED SECRETION OF UrINE.

These occasion a more copious secretion of urine than existed previously,
it there be a sufficient quantity of fluid in the body. If the kidneys be the
Beat of irritation or inflammation, these increase it, and inflammation is even
occasioned by violent diuretics.

To these belong :

1. Acrid Diuretics which act directly on the kidneys. Inflammation of
the kidneys is increased by them. We observe, in many instances, stran-
gury and the secretion of bloody urine produced, in some cases, inflammation
of the bladder and of the kidneys, if these medicines be persevered in and
given in large doses. Those substances produce inflammation externally
only in those parts to which they are directly applied, but no where else.
To these belong cantharides, squill root, colchicum seeds and root, mustard
seeds, Mezereon bark, &c.

3. Stimulaiing Diuietics. These excite all the functions more or less.
The accelleration of the circulation is here of great influence, because in a
given time a greater quantity of blood is sent to the kidneys than before.
But stimulating medicines act directly also on the kidneys, because small
doses of them, which are followed by an almost imperceptible acceleration
of the circulation, manifestly increase an inflammation of the kidneys.
This excitement is the more violent, the more ck)sely the exciting Bubetan*

1839.] Action of Diuretic Medicines. 225

ces approximate to acrid substances, as for instance, turpentine. To this
class belong alcohol, ether, the stimulating ethereal oils and resins, balsams,
&c. and consequently all medicinal substances which contain these ingre-
dients as active principles.

3. Saline and Alkaline Diuretics. These substances act at one time by
changing the mass of blood, as I shall shew presently, and secondly also by
directly exciting the kidneys. No inflammation is excited by these, but
one already existing is exasperated by them. They act here in the same
way as they act on the first place of contact (the stomach, wounds, &c.)
where they increase the secretion, without producing similar phenomena in
the course of the circulation, whilst at the same time they produce even an
antiphlogistic effect. To these belong potass and soda, and their combina-
tions with strong and weak acids, &c.

These diuretic substances act directly on the kidneys, after being absorb-
ed and taken into the mass of blood. The proofs are as tollows :

A. The neutral salts and alkaline substances we can find again in the
urine. The acid is frequently changed, but the base continues. After the
use of alkaline substances the urine very soon becomes alkaHne. We find
that a given quantity of urine contains much more of these salts than an
equal quantity of blood. The acrid and stimulating substances have not
yet been detected in the urine by chemical examination, for the peculiar
odour of the urine occasioned by the use of oil of turpentine is no proof of
the presence of the latter, but merely points out a change in the urine.

B. The degree of local actions bears no proportion to the increase of the
diuresis. After large doses of acrid medicmes vomiting and purging take
place, and even inflammation may follow : the local action is accordingly
very considerable, but the medicinal substance is soon evacuated again, and
therefore cannot be absorbed ; consequently either no increased diuresis
follows, or at least a diuresis very slightly increased. If, on the contrary,
the substance be administered in doses so regulated, that its local action is
not too violent, and that it continues for a sufficient length of time in con-
tact with the intestinal mucous membrane, so as to become absorbed, it then
acts most violently on the kidneys. The same may be said of stimulating,
saline, and alkaline diuretics, which act most powerfully, when the local ac-
tion is not too great. Accordingly we cannot explain the diuretic action
sympathetically through local irritation of the intestinal canal.

c. The time after which the increased diuresis commences corresponds
with the time in which absorption can follow. All sympathetic phenomena
are observed instantaneously ; and hence, if these substances acted in this
way, the increased diuresis should also take place immediately. But this
does not follow till a later period ; often not till after the lapse of several
hours, in which time absorption may take place.

D. The same series of changes which these substances produce in the
intestinal canal on wounds, &-c., we all find produced in the kidneys, if they
be given in a sufficient, but not in too large a quantity. Cantharides pro-
duce inflammation on the epidermis m wounds, in the stomach, &c., and by
the continued administration of large doses of this substance, inflammation
of the bladder and kidneys also takes place. The stimulating diuretic sub-
stances increase inflammation in the stomach, &c., and exasperate inflamma-
tion in the kidneys. The salts which can be detected in the urine by chem-
ical examination, act in a manner so as to increase the inflammation in
the first place of contact, and after absorption in the kidneys, so as to di-
minish, on the contrary, the inflammation* which makes its appearance in
other organs.

The principle on which these substances increase the urinary secretion,
and the manner in which the effect is brought about we know not. We
only know that the salts are secreted with the urine in a more concentrated
E 5

226 Action of Diuretic Medicines. [Jan.

form than they exist in the blood, and that the direct action of the other sub-
stances on the kidneys can be shown with the greatest probabiUty. This
is what is called a specific action.

In morbid deposition of serum in the meshes of the cellular tissue, or in
the different cavities of the body, as in dropsy, absorption of the serum, and
the cure of the disease, frequently take place simultaneously with increased
diuresis after the employment of these diuretic substances. The diseases
which depend upon an acrimony of the blood, are often relieved and cured by
these substances ; to this class of diseases may be referred cutaneous erup-
tions, &c.

The cure of dropsy, by these substances, has been generally accounted for
in such a way, as that a speciiic action on the lymphatic vessels has been
assigned to them, and this at.tion was derived from a power inherent in them
of promoting absorption. No substance has been proved to possess such
specific action on these vessels ; but the increase of absorption is probably
owing to a change effected in the blood.

According to our present knowledge of absorption, and considering all
the phenomena presented by the increased diuresis through the medium of
the substances now mentioned, the absorption of the serum in dropsies, and
the cure of these diseases may be explained in the follow'ing manner. The
first momentum is the stimulation of the kidneys, and the secretion of a urine
deficient in solid constituents. If w^e now compare the composition and
specific gravity of this urine with those of the blood, the blood must neces-
sarily become richer in solid constituents, inasmuch as it possesses much
more of these ingredients than the urine secreted. But in consequence f
this, the blood has a greater affinity for fluids than before, just as we see
that violent thirst is occasioned, if much water be abstracted from the body
by excessive cutaneous perspiration., in the same manner absorption is
caused here by the mcreased attraction of the blood for serum. A similar
physical phenomenon is observed, if a glass tube, open at both ends, be closed
at one end with a membrane, and be half filled with a concentrated solution
of a salt, and be immersed to this depth in pure water, the concentrated so-
lution attracts the water through the membrane, and rises in the glass tube.

For the cure of those diseases by means of diuretics, which are said to
depend on acrimony, some have endeavored to account by ascribing to these
medicines a power of producing a change in the blood. But this is not pro-
ved in such a way as to enable us to explain any thing with certainty. It is
much more probable that these acrimonious admixtures with the blood, if
they really are the occasion of these diseases, are removed along with the
urine, in consequence of the action of the kidneys being called forth.

Analogy is also in favor of this explanation, as these same diseases ape
cured by cathartics, which produce an irritation of the intestinal canal, and
thereby an increased secretion of its mucous membrane. In the same man-
ner as diuretics increase the secretion of the kidneys, discharges of fluid take
place in the latter case. Purgatives act neither sympathetically, nor direct-
ly on the lymphatic vessels, but by exciting the secretion of the intestinal
canal, and separating a watery fluid from the blood.

II. Diuretics whose THERAPErTic Action occasiotjs an Increased

Secretion of Urine.

^ The diuretic means which call forth an increased secretion of urine in
disease are very various. Every means which can remove the cause of a
diminished urinary secretion belongs to this heed.

The abstraction of blood by venesection, leeches, &.c., bring about a more
copious secretion of urine, if an inflammation of the kidneys be present, if
inflammation of other parts, or an inflammatory fever be followed by a scan-

1839.] Action of Diuretic Medicines, t27

ty secretion of urine. By this means the inflammation, which was the cause
of the diminished secretion of urine, is put a stop to.

Neutral salts, and alkalies also, produce a more copious secretion of urine.
In the case of inflammation, the cause of the diminished diuresis is checked
by these means, if the inflammation has not its seat in the intestinal canal
and kidneys. In impeded circulation, occasioned by intumescence, or other
morbid states of the liver, spleen, and other organs, dropsy and a diminished
secretion of the urine occur. Many of these causes of impeded circulation
are curable by the means just mentioned, and with the removal of the cause
the serum is again taken up by the vessels. They here act as resolvents.

Temperant remedies (acida vegetabilia) act aiuretically in inflam.mations,
by their mitigating the symptoms of inflammation.

Emollients obviously occasion an increased diuresis in inflammation of
the kidneys. They mitigate the inflammation, and thereby increase the
secretion of urine.

Tonics also increase diuresis. Inconsequence of an atony of the solidi,
which atony coincides more or less with a blood poor in sohd constituents,
dropsy takes place. This dropsy is removed by the digestive functions being
strengthened so as to form more blood, and blood of a good quality (by bit-
ters, bark, iron, &c.), and so as to increase the tone of the tissues (by iron,
bark, and other astringents.) By these means the cause of the dropsy, viz.
the defective formation of blood and the atony of the tissues is removed.

Digitalis possesses the pecuhar property of lessening the heart's action,
of bringing down the pulse from 80 to 60 or 50, &c., and of diminishing the
strength of the pul?e, whereby it sets the kidneys to work simultaneously
as an active remedy. Accordingly, if the dropsy is a consequence of an
enlargement or hyperthropy of the left ventricle, digitalis mitigates the vio-
lent action of the heart thereby produced, and the dropsy disappears for some
time ; but this does not cure the heart disease, and the dropsy accordingly
returns. By lessening the heart's action, retarding the circulation, and by
directly increasing the urinary secretion, digitalis is also useful in inflamma-
tory dropsy, more especially if exsudation impends or has already occurred,
and the inflammation be first broken down by venesection, &c.

The acrid (scharfen) medicines are diuretic, if the diminished urinary se-
cretion is a consequence of torpor of the kidneys. Whether it results from
paralysis depending on the brain and spinal cord, can only be conjectured,
but not known with certainty.

Stimulating remedies increase the diminished urinary secretion in the
same case, and rspecially in deficient activity of the circulation. The drop-
sy is seldom cured by these means alone, as in torpor of the kidneys acrid
remedies are to be preferred ; and dropsy very seldom occurs in consequence
of the heart's inaction, without organic disease. But these remedies are of
the utmost importance when the morbid matter exists m the blood, keeps up
the disease, and is not eliminated. They accelerate the circulation, direct
more blood to the kidneys in a given time, to the skin also, &c., and call into
action at the same time the functions of those organs. Accordingly, copious
secretions often follow the employment of these means, crises take place, and
stimulants may, therefore, in such cases, become tonic remedies, &c., by re.
moving the cause which interferes with the action of the kidneys.

Antispasmodics are just as various as the causes of spasm. Almost all
medicines may act as antispasmodics under cirtain circumstances, but some
pre-eminently so, in primary spasmodic diseases of an entirely different kind,
as narcotics, for instance, and those with which we are able to produce a
powerful counter-irritation. If the diminished urinary secretion be a con-
sequence of spasm, the antispasmodic medicine is, in a therapeutical point
of view, a diuretic. Thus we often see an increased diuresis occur in con-
sequence of an emetic, and that either in consequence of the general counter-
irritation, or of the general shock and excitement given to the system by

228 Action of Diuretic Medicines, [Jan.

this means. In this way opium, which in healthy persons diminishes the
urinary secretion, may, by removing spasm, call forth a more copious secre-
tion of urine.

If from this point of view, we consider the action of those remedies which
are followed by an increased urinary secretion in dropsy, we must next turn
our attention to the primary affection, which is followed by dropsy as a
symptom in the progress of the disease. If we connect both these series of
facts, with our present experience at the sick bed, we may then consider the
following pointi as established.

The dropsy, which is a consequence of a so-called inactivity of the kidneys,
or of a diminished secretion from the skin, Si<j., is diminished or cured by
those remedies which directly excite the action of the kidneys. In the first
case, the cause of the disease is removed ; in the latter, the increased inacti-
vity in the kidneys takes on the function of the skin, &c., and there then re-
mains for us the problem of regulating the function of the skin, which is more
easily accomplished, if the accumulation of water is first stopped.

The dropsy, which is a consequence of a structural change in the kidneys,
is but seldom cured. The diagnosis is frequently uncertain, and, above all,
the kind of structural change for the most part continues unknown to us till
death. Medullary sarcoma, and similar organic diseases of the kidneys are
at present still mcurable. The structural change, which Bright, and sub-
sequently Gregory, Christison and Osborne, have detected in the kidneys,
appears to be increased by acrid, stimulating and saline diuretics, and to re-
quire partly the abstraction of blood, partly purgatives, as well as careful at-
tention to the cutaneous transpiration.

The dropsy, which is a consequence of an impeded circulation, is cured by
removing the cause of the latter. A tumor (Balggeschwulst), &c., may
create oedema by pressure on the veins, and in such a case the oedema dis-
appears with the removal of the tumor. Tumors of the liver, spleen, &c.,
depositions in these organs, and degeneration of them, impede the return
of the blood, and in this way may occasion dropsy. If these depositions and
swellings be still resolvable, the dropsy may be removed by neutral salts and
alkaline remedies, which act on these organs by changing the mass of blood.
What are called obstructions in the liver, spleen, in the portal system, and
in the lymphatie vessels, are often removed by these resolvents, often cured
by promoting the secretions of the Hver and capillary vessels of the intestinal
mucous membrane (cathartics in small and large doses). But incurable de-
generations often occasion the dropsy, by impeding the return of the blood,
and in such a case no remedy cures thfi dropsy.

The dropsy, which is the consequence of inflammation, as hydrothorax
after pleuritis, is removed by those means which mitigate or remove inflam-
mation, whether by a change in the composition of the blood, or by retard-
ing the circulation, and which have a solvent action on the effusion, if it is
no longer fluid, and at the same time effect an increased diuresis. To these
belong bloodletting, the neutral salts, and alkahne remedies, which diminish
inflanmiation by changing the blood, and at the same time act on the exsu-
dation. Mascagni showed that carbonate ofpotas dissolves the solid exsu-
dation in pleuritis, and accordingly this remedy is employed with the best
results when auscultation and percussion have detected an effusion into the
thoracic cavity. To this class also belongs digitalis, in as far as it retards
the circulation and excites the action of the kidneys.

The dropsy, which is a consequence of atony, depends on a deficient for-
mation of blood, and insufficient contractility of the tissues, which are not
properly nourished. In such a case the digestive powers are to be strength-
ehed by bitters, quinine, iron, &c. and from mere bitters the change may
be made to astringent remedies. Herewith the removal of the cause, the
dropsy, which is but a symptom, disappears.
The dropsy, which is a consequence of dilatation and hyperthropy of the

1839.] Consolidation ofFiactures, 229

left ventricle, is often removed for a considerable time, but again returns.
By bloodletting, should plethora exist at the same time, a temporary im-
provement is effected, and by the use of digitalis, which diminishes the ab-
normal energy of the heart's action, the dropsy, if it have not gone too far,
is often removed for some time, but returns, if the effect of the remedy has
ceased for any length of time. The cause of the dropsy is in this case sus-
pended for a long time by diminishing the heart's action, but the hypertrophy
is not cured thereby.

If the cause of the dropsy, or rather the primary disease, is not to be de-
tected, several modes of treatment are employed, according to the view
which the physician adopts in determining the casual relation.

If the case be one of hydrops saccatus, these remedies are seldom of use,
and a rational line of treatment, verified by experience, has not been yet es-
tabhshed.

If the effusion (as, for instance, into the pleura) be no longer fluid, and the
serous membrane be at the same time very much affected, these means are
sometimes of use after paracentesis, but seldom effect a perfect cure. Sa-
line and alkaline remedies hitherto proved most serviceable in these cases,
and that in the two-fold relation, as diuretics in the more limited sense of the
word, and as resolvents.

Causes icTiich retard the consolidation of fractures. The Archives Gencrales
for August, contains an interesting article on this subject, by IN J. Louis
Fleuy. Two indications must be lulfilled, observes M. F., to insure the
perfect consolidation of fractures : 1st. Placing the broken ends in con-
tact. 2nd. The maintaining them in this position. The former is done
with facility, but there are some difficulties in accomplishing the latter. At
the present day, most surgeons are of opinion, that complete immobility of a
fractured limb, joined to strong pressure on the soft parts, are the best means
of maintaining the fragments in position, and of obtaining a quick and regular
consohdation. Unfortunately, these means are frequently unsuccessful ; and
notwithstanding the care used in their application, the callus is frequently
thrown out in an irregular manner, or perhaps never formed at all. What,
then, are the causes which prevent or retard the consolidation of a fracture?
Authors have enumerated a great number, but seem to have overlooked a
very important one. Scrofulous and venereal affections old age rents in
the periosteum formation of pus cold appHcations all, undoubtedly, exer-
cise a prejudicial influence. But, by far the most frequent of all the causes,
is the apparatus used with the view of favoring the consolidation, which it
prevents by the compression it exercises upon the vessels of the limb ; wheth-
er this compression is inevitable, as in the moveable apparatus, or produced
voluntarily by the surgeon.

If a fractured thigh be placed in a thick layer of soft materials, the effects
of the compression cannot be very appreciable ; for, in this case, although
the capillary circulation and the small arterial branches are more or less re-
stricted, still the large vessels continue free. The same does not occur in
the forearm or leg, where compression, ever so slight, interrupts the course
of the blood, not only in the superficial vessels, but also in those which supply
the fractured bone and periosteum. In order to obtain a rapid and regular
consohdation, we must be careful not to apply more splints than are abso-
lutely necessary, and not to bind these too tight by bandages. In following
an opposite method, we wait, sometimes, three, four, or six months, for a
union which has not yet commenced. It is then that the surgeon, eager at
each dressing to re-apply the apparatus, with more care, thai; is to say, to
augment the number of splints, surrounds the limb more exactly, &c. finds
himself deceived ; and the more he renews his efforts, by the same means,
the greater is the distance separating him from his object.

ii^O Consolidation of Fractures^ fJant

The following case, one of four reported, exemplifies the beneficial results-
of this practice.

Case. C. D. ag-ed 41 years, had a fall on the 15th February, 1636, broke
his rinrjit leor, and entered the same day the Hospital of St. Louis. The frac-
ture \yas complete, situated immediately above the internal malleolus, and
complicated with a deep excoria'ion and extensive ecchymosis. The wound
was dressed with cerate, the rest of the leg- covered with charpie dipped in
the white of eg'^, and the ordinar\' apparatus for fractures of the leg immedi-
ately applied. The member was maintained in absolute repose during six
weeks. On the 10th of April, the apparatus was removed, the wound was
found cicatrized ; the ecchynjcsis had disappeared, but the consolidation had
not commenced. The apparatus was re-applied, hut a more generous diet
ordered. On the SOlh April, the consolidation was a little more advanced.
The splints and anterior cushions were then removed, and the hmb sprinkled
with spirits of camphor. From this period the callus rapidly solidified; by
the end of the month oTMay, it was very resistant, almost inappreciable to
the touch, and the patient quilted the hospital.

Every reflecting and reasoning man will acknowledge the
importance of the point urged by M. Fleury, in the above obser-
vations on the consolidation of iVacturcs. It is a lesson taught
early in the physiology of growth and development of parts, and
of the perpetuaiion of tlie same. It is taught in all surgery, and
also especially in the anatomy of those parts of the osseous sys-
tem which have been the seat of fracture, in which the bones are
more or less enlarged, &c. All these are effected by vascular
action the plastic agency of the arteries in depositing suitable
nutrition, and the conservative efficacy of venous and other ab-
sorption. Few and simple indeed are the indications in the case
of a fracture of bone They are adjustment of the fraginents,
and the retention of that adjustment. But these alone, could no
more effect re-union than the juxtaposition of two pieces of tin^
without the intervention of solder and heat. This can only be
done by vascular action appropriating materials by which
growth is to be effected. But inasmuch as the circulating cur-
rent always contains parts unsuited to new and healthy growth,
this purpose cannot be accomplished by the plastic power of the
arteries alone, as absorption must go on at the point, or increas-
ing disease will result as an unavoidable consequence. It is,
therefore, that it is indisjiensable to the well-dtiingof a fractured
bone, that the dressing and treatment of fracture should be in-
fluenced and regulated by the several purposes, of 1st. pi event-
ing further wounding and consequent irritation of the soft parts
by the fragments of bone. This is done by a proper adjustment
of the fragments, and the prompt preservation of that adjust-
ment. This at the same time effectually secures 2nd, the capa-
bility of being united by the powers calculated to effect it in
the part ; that is, the fragments are kept in reach, so to speak, of
the uniting process. 3rd. That freedom and that action of the
vessels of the part which is necessary for effecting healthy
growth and union. This should of course be done by some ar-

JB3&.] Spermatocele, or Varicocele of the Spermatic toriL 231

rangement for preserving acijustiiient, whereby the vascular or-
ganization shall not have its funciions impeded. This is the
subject oi'enquiry presented by M. Fleury in the foregoing in-
vestigations. His observations are v aluable. But we are not a
little surprised at the fact, that a practice advanced on a former
occasion, in this Journal,* should have been so perfectly disre-
garded by the profession. We allude to the treatment of frac-
tures of the OS femoris by weight and fulcrum ; a practice amply
tested by our own experience in anunjber of such cases as were
best calculated to test its peculiar etlicacy and desirableness.
If the reader will take the trouble to turn to our account of this
plan of treatment, as referred to above, he will find that in addi-
tion to its other most unavoidable claims on our preference, it is
peculiarly adopted to the purpose of preserving the freedom of
vascular intercourse. To this it is, doubtless, largely, if not
mainly indebted for its peculiarly complete and prompt effica-
cy. It is applicable to some other fractures as well as those of
the OS femoris. The point next in importance, after the fulfil-
ment of the above indications, is the comfort of the patient during
the tedious process of union. By the management just alluded
to this is more effectually secured, than by any other which has
been adopted by surgeons, as there is, in no case, a pressure
equal to more than one and a half or two pounds weight neces-
sary. We are well assured no surgeon will, after once fairly-
testing it, refuse to give it the preference to any other plan of
treatment, in all those fractures to which it can be applied.

Spermatocele , or Varicocele of the Spermatic Cord. The fol-
lowing interesting remarks, by Sin Astley Cooper, have been
extracted from Guys Hospital Reports, for April, 1838, and re-
published in the American Journal of the Medical Sciences.
They will be found interesting in relation to a disease, which,
though not of very frequent occurrence, has offered much per-
plexity to the practitioner.

In general this affection produces only inconvenience to the patient, and
the plan of treatment then consists in supporting the part ; and Sir Ashley
recommends that this bo " effected by applying a suspensory sling, with two
tapes sufficiently long to encircle the abdomen. The sling receives the
scrotum and testis ; and the tapes passed around the abdomen, and tied in
front, secure the parts in an elevated position. No straps should be placed
beneath, to pass between the thighs ; as they draw back, rather than elevate
the scrotum and swelling.

"As the parts should be kept as cool as possible, the materia] of the sling
should be an open silk net, which allows the escape of heat, and prevents a
relaxing perspiration. From this support the patient derives great relief;
and the application of an evaporating lotion of spirits-of-wine and water re-

* Southern Medical and Surgical Journal, Vol. I. page 281.

232 Spermatocele, or Varicocele of the Spermatic Cord, [Jan.

lieves him still more. A very good lotion for this purpose consists of alum-
inis 3 i. aqua I xi, spiritus vini I i.; but the lotion should be as much as pos-
sible devoid of smell, as it leads to the suspicion of some infirmity.

" Washing two or three times a day with cold water, with salt dissolved
in it, is useful ; and the employment of the shower bath, or common cold
bath, by constringing the scrotum, prevents the increase of the complaint.

" The dress should be as light as possible, to prevent the production of su-
perfluous heat, and to permit its escape ; and all tight dress around the ab-
domen is to be avoided, to allow of the free return of the venous blood from
the testis. Still, however, these means leave the patient with the badge of
his infirmity, from his continuing to wear his bandage ; and attempts have
been made to relieve him, by exciting inflammation and thickening of the
scrotum, and thus to render it a better support to the testes. I have applied
the pyroligneous acid for this purpose ; but the pain which it excited was
severe, and the good effect only temporary. I have also employed blisters
with the same view, and with the same effect.

** It has been advised to draw the scrotum through a ring, and fix it there,
the person continuing to wear it ; but, as it may be reaoily believed, this has
no advantage over the use of the sling-support ; and is a much greater an-
noyance to the patient's feelings, either than the disease itself, or the ban-
dage which he is usually called upon to wear."

There are cases, however, in which this complaint produces so much pain
and distress, as to render it absolutely necessary to do something more than
is generally advised. Sir Astley has seen, in the course of his practice,
many persons suffer so severely in mind and body from it, that they would
readily submit to any operation which was not attended with danger to life,
to obtain relief. As to tying the veins of the spermatic cord from what
he has seen of the dangerous and destructive effect of exciting inflammation
in veins he should never propose it ; nor does he thmk, if it were not dan-
gerous that it is founded on proper principles. But in his W.grk on the
Testis, published in the year 1830, he has advised the removal of d^portion of
the scrotum in the following words :

*' The removal of a foHion of the scrotum will lead to a diminution of the
veins of the spermatic cord,- and it is an operation, in an extreme enlargement
accompanied with pain, which might be tried with perfect sajeiy, and is very
likely to succeed.'*

He had, at that time, never performed the operation ; and he therefore
spoke of the probability of success only : but, aware of its being free from
dj^nger, and seeing that it would render the remaining portion of the scro-
tum a natural bandage, and that a great degree of relaxation of the scrotum
also attended this complaint, and that such relaxed portion might be safely
and eflfectually removed, he determined to take some opportunity of per-
forming the operation.

" Beside the advantage of making the scrotum, in its lessened state, a
means of support, he observes, it must naturally occur, that the adhesion, ex-
cited by the operation of the fascia which covers the cremaster, to the sur-
rounding parts would produce a permanent support, and render a suspensory
bandage unnecessary, ft might be thought a painful operation, but it is not
so, nor does it excite constitutional irritation.

' The mode of performing it is as follows : The patient being placed in
the recumbent posture, the relaxed scrotum is drawn between the fingers ;
the testis is to be raised to the external ring by an assistant ; and then the
portion of the scrotum is removed by the knife or knife-scissors but 1 prefer
the former. Any artery of the scrotum which bleeds is to be tied ; and a
suture is then made, to bring the edges of the diminished scrotum together.
The patient should be kept for a few hours in the recufnbent posture, to pre-
vent any tendency to bleeding ; and then a suspensory bag is to be applied,
to press the testis upwards, and to glue the scrotqin to the surface.

1889.] Spermatocele, or Varicocele of the Spermatic Cord, 233

*' The only difficulty, in the operation of removing the scrotum by exci-
sion, is in ascertaining the proper quantity to be removed ; but it adds but
little to the pain if a second portion be taken away, if the first does not make
sufficient pressure on the spermatic cord. It is of no use to remove a small
portion of the scrotum, for from doing this 1 have failed. When the wound
has healed, the varicocele is lessened, but not always entirely removed ; but
the pain and distressing sensations cease, if sufficient of the scrotum be re-
moved.

" In making the suture in the scrotum, its lower part is to be brought up
towards the abdommal ring, to raise and support the testis ; as does the sus-
pensory sling when it is worn."

The following cases are given in which the operation was performed.

" Case I. Mr. Rees, surgeon, of Blackfriars Road, sent me a patient of
his, who had a large varicocele on the left side, with a very relaxed scrotum.
He suffered severely from uneasiness in the spermatic cord and in the loins,
a sense of weight and oppression m the region of the stomach, and exces-
sive mental depression. On the 18th of February, 1831, 1 removed a large
portion of the scrotum ; and opposed the fascia covering the cremaster, and
the testis in its envelopes. By three sutures, the edges of the scrotum were
approximated, and the wound quickly healed ; and he, on the 3d of March
afterwards, quitted London."

This gentleman was 82 years of age. The portion of the scrotum remo-
ved, when extended, measured four inches in length ; and in breadth, in the
middle, two mches and a half. He left London quite well, and some time
afterwards, Sir Astley learned from Mr. Webster that the patient was able
to ride fifty miles a day without inconvenience.

" Case IL Mr. S , aged 30, has had a spermatocele three years and

a half, attended with a great sense of uneasiness in the part, and a dull
heavy pain in the spermatic cord and loin on that side. My assistant, Mr.
Balderson, held the scrotum between his fingers, and I removed all that could
be easily elevated from the testis and its coverings, which are necessarily
exposed in the operation. I then brought the integuments together by su-
tures, so as to close the wound completely ; but I previously secured some
small bleeding arteries. He was ordered to keep himself cool, and to remain
in the recumbent posture ; and the part was placed in a suspensory sling ;
however, the next morning he went down to breakfast ; but this imprudence
did not prevent his quick recovery from the operation, with the result of
which he was highly pleased. The varicose veins are greatly reduced : the
coverings of the testis adhere to the upper part of the scrotum. He soon
gave up the use of the shng-support ; and lost the pain in the spermatic cord
and loins, which he had previously sustained.

Case IIL H. B., aged 18 years, had a spermatocele upon the left side,
from the age of fourteen. At fifteen he fell across an iron bar, which greatly
hurt him ; and he thought the complaint had quickly increased after that
time. He suffered much from pain in the testis, more especially in walking,
and from uneasiness in the groin, spermatic cord, and the spineous process of
the ilium and loins. He consulted several medical men, who told him his
complaint was a hernia. But he was then recommended to Mr. Taunton,
in Hatton Garden, who informed him it was a varicocele : and the scrotum
was directed to be supported, and an evaporating lotion to be used.

" On July 20, 1837, 1 removed a large portion of the relaxed scrotum which
covered the swelHng, in the presence of Mr. James Babington ; secured some
small arteries ; and then used four sutures to approximate the edges of the
scrotum. He was sent from my house, in a coach, to Chelsea, after the
operation, and the scrotum very soon healed, and the uneasy sensation in the
part vanished.

" Case IV. Mr. John K , aged 25, four months ago found the scro-
tum enlarged on the left side, with occasional pain in the part, which darted
F 6

234 On the Resection of the Facial Bones. [Jan.

upwards to the external abdominal ring. It gradually increased, until it was
three times larger than the right side of the scrotum, became more painful,
and occasioned much depression of spirits. On the 15th October, 1837, I
removed a portion of the scrotum, by passing a needle and thread through it
in three different places, and cutting away the scrotum beyond them. This
plan did not facilitate the operation, and made the tying of the arteries more
difficult ; but it succeeded in relieving the disease."

A case is also given, communicated by Mr. Key.

In one case Sir Astley raised the scrotum, and placed a ligature around
the part which he designed to remove, drawing the thread quite tight : but
it produced a great deal of pain ; the part sloughed with considerable consti-
tutional irritation, and after a great length of time, and with more suffering
than the complaint justifies.

It must be distinctly understood that the removal of a portion of the scro-
tum is recommended in those cases only of spermatocele, in which the pa-
tient suffers great local pain ; in eases in which he is most urgent to have
the swelling and deformity of the p^art removed ; and more especially in
those instances in which the function of digestion suffers, and there is a
great degree of nervousness and of mental depression. For slighter cases,;
a suspensory bandage must be still recommended.

On {he Resection of the Facial Bones. By Professor Dieffenbach, of
Berlin. The resection of degenerated bones of the face, or the excision of
tumours situated between them, belongs to the class of the most formidable
operations. It is only in modern times that these operations have been per-
formed to any great extent, and to Professor Saeger,. at Erlangen, belongs
especially the great merit, not only of having zealously collected all that had
been done in this respect, but of having recommended the resection of dis-
eased bones in a great many cases, and having executed himself a variety of
the most important and ingenious operations of this kind. I add to his rich,
experience some cases from my own observation, the number of which, how-
ever, is not great, as 1 began to attempt the extirpation of diseased parts of
the upper jaw, and other facial bones, only a few years since, though I had
performed, long before, the rese ction of other bones. Some minor resections
of the alveolar process met with success, and gave me confidence for great-
er operations, in which the success I met with was no less satisfactory.

Case I. The first patient from whom 1 removed an osteosarcomatous de-
generation of part of the alveolar process, was a man 38 years of age. There
was a fungous softening,, of the size of a small hazel-nut, on the alveolar
process of the left side, which surrounded the small incisor. The tooth was
loose in the fungous mass, and blood oozed at its sides. I excised with a
small saw the diseased part of the bone, in the form of a wedge, and touched
the remainmg bones with the incandescent iron. Some splinters of the
bones having afterwards exfoliatedy the wound furnished healthy granula-
tions. In six weeks the depression having greatly diminished in its size,
was covered with a smooth scar, and the man was cured without relapse.

Case II. I resected from a woman 38 years of age, who likewise suffer-
ed with an osteosarcoma of the alveolar process, which had attained the size
of a walnut in the space of a year, the alveolar process, with one molar, one
eye tooth, and one incisor. In this case, also, I made use of the incandes-
cent iron after the operation, for the purpose both of stopping bleeding and
procuring exfoliation. After two months the cure was complete, and no re-
lapse followed.

Case 111. I excised, from a woman 46 years of age, on account of an os-
teosarcoma, of the size of a walnut, a part of the upper jaw, containing two
incisors, and the left eye-tooth. The incandescent iron having been used^

1889.] On the Resection of the Facial Bones, 285

afterwards some fragments of bone were exfoliated, and the cure followed
with a smooth cicatrice.

Ca.sb IV. A lady, 46 years of age, was afflicted with a hard dark-blue
sarcoma, which originated by degrees, and surrounded the roots of two in-
cisors. I excised the morbid part of the bone, and touched the wound with
the iron. The operation was successhil, and no relapse followed.

Case V. A delicate young woman, 24 years old, had been suffering for
three or four months under an osteosarcoma of the size of a large walnut. It
occupied ^the place of three teeth. I resected it in the form of a wedge as
high as the antrum highmorianum, and along the hard palate, on account of
the bones there being found softened. The incandescent iron was applied
to the wound, and the cure was complete in six weeks. The case is a re-
cent one, and no relapse has yet followed.

Ca^se VI. A young, delicate, fair girl, 24 years of age, suffered under a
softening of the alveolar process of the upper jaw, which was developed in
the space of a year. She had used, in vain, many external and internal
remedies ; a loose molar tooth had been extracted, the surrounding parts of
the fungous substance excised ; the surface of the wound was burned, but
without success. The progress of the disease was only the more rapid, and
was about to affect the zygomatic bone. The teeth projected only by the
upper part of the crown from the fungous mass, which was especially devel-
oped towards the roof ol the mouth. In seizing them with the fingers they
felt loose, and the blood oozed out at their sides. Without dividing the ex-
ternal parts of the face, I resected in this case the whole left alveolar process
to the incisors, passing with a small saw through the healthy bone, and
stopped the strong bleeding by the incandescent iron. Some frEigments of
bone were afterwards thrown off by exloliation, and the granulation was
healthy in every part, and in five weeks the young girl was perfectly cured,
and without any external disfiguration. In consequence of the operation
she became flourishing and healthy, and still continues so, though a year has
elapsed since the operation.

Case VII. Mad. B., a lady 55 years of age, suffered for a year under a
fungods softening of the greater part of the alveolar process of the upper jaw,
especially affecting the anterior part of its margin. She had been treated
by several physicians, by internal and external remedies, and the loose teeth
had been extracted one after the other. After some time, the whole alveolar
process was transformed into a thick steatomatous mass, which the upper
lip could scarcely cover. After separating the latter from the tumor, and
turning it upwards, I removed with the saw the whole alveolar process, as
far as it was affected, and touched it then with the incandescent iron. The
patient seemed cured after some months, and she recovered gradually from
her indisposition. But the cicatrix became again softened and covered with
new fungous granulations. They were limited by astringent gargles, the
penciling with extr. satumi, and cauterization with nitrate of silver ; but the
bone softened again, and the patient withdrew herself from my care.

Case VIII. A lady, 32 years of age, was affected for several years with
a thickening of the left upper jaw, between the wing of the nose and zygo-
matic bone, produced by an encysted tumour of the bone. I separated, at
first, the cheek from the bone, beginning from the mouth, and removed the
anterior part of the sac and of the osseous margin. The posterior surface,
situated in the bone, was touched with the red hot iron. The cure followed
without any other accident-

Case IX. A man 30 years of age, suffered under an apparent intumes-
cence of the hard palate, which existed for several years, and had increased
gradually. The tumour was convex, and not unlike a divided egg. I cir-
cumcised it with a knife, and removed it. The bones of the palate, which
were much pressed upwards, showed on their middle a small hole. I touch-
zed the cavity with the incandescent iron. It became filled with granula-

236 On the Resection of the Facial Bones, [Jan.

tions; the palate regained its natural appearance, and the articulation, which
before was very inaietjnct, was restored to its former distinctness.

Case X. The lower jaw of a man 60 years of age, was at several places,
and for a long period, enormously enlarged, in consequence of hydatid tu-
mours between the external and internal laminse of the lower jaw. At dif-
ferent times these were inflamed, and went into suppuration. I treated them
as single abscesses by incisions, by which means the suppuration ceased,
and the man became well again. The advanced age of this patient would
not allow of a radical excision.

Case Xi. A man S3 years of age, who, for several years, had become an
object of curiosity, in consequence of an enormous thickening of the left
cheek, required my assistance. The cheek projected from the face to the
size of two fists. The upper part was hard, the lower elastic, and had been
ten or twelve years in attaining this enormous developement. 1 considered
it to be an intumescence of the bones of the face, produced by hydatid tu-
mour. I therefore removed from the mouth the part of the tumour which
projected into it, and extirpated through this opening a great part of the sac,
together with the sharp edges of the bones. A strong suppuration was
produced, and, with the beginning of the cicatrization, the cheek, before
withered and attenuated, was so much lightened and contracted, that the
patient was cured without the least disfiguration.

Case Xtl. In a man of about 60 years of age, an osteosarcoma of the
left zygomatic bone, attended with much pain, had been formed. At last
the integuments were perforated, and the osseous fungous became plainly
visible. Neither internal medicines nor strong cauterization and burning
had met with any success. 1 circumcised the diseased part with the knife,
and removed, by means of the saw, the greater part of the zygomatic bone.
I happened, by separating the neighbouring healthy integument of the face,
to be able to cover a great part of the wound. In three months the patient
was cured, with only a slight disfiguration. I did not see him again, and
heard, accidentally, that he died of dropsy a year afterwards.

Case XIII. In a woman 60 years of age, a long time after the gradual
falling out of the molar teeth of the right side of the lower jaw, a tumour
had been formed, reaching, by degrees, the size of a fist. It greatly impe-
ded swallowing, respiration, and speaking, and threatened to destroy life in
a short time, as it filled the greater part of the cavity of the mouth and
throat. The tumour was free above, and below it was situated between the
external and internal lamina of the lower jaw, which were separated by it
from each other. It was not required to slit the mouth for the operation, on
account of the great laxity of the soft parts. During the extirpation, the
tumour was drawn forwards by a hooked forceps, and excised with a knife.
I removed then, by the saw, the highly projecting edges of the lower jaw,
which had been absorbed in the middle portion. The cure followed in a
few weeks. A long time after, a fragment of the bone exfoliated.

The tumour was of a fibrous nature, and there was formed on its anterior
and superior surface, a hydatid sac, which was filled with a clear albumin-
ous matter.

Case XIV. In the month of August of the year 1832, I was called to see
a Hebrew merchant. I found the second molar teeth of the upper jaw sur-
rounded by an osteosarcomatous tumour. I removed the teeth, with part of
the alveola, with a saw. Before complete cure, the man departed for his
country ; the* wound cicatrized very soon afterwards. After the lapse of
three months, a new fungus grew from the cavity. A clever surgeon extir-
pated it, and the wound cicatrized again.

In the year 1833, in the month of May, a new fungous growth was extir-
pated, and the wound was cauterized with the hot iron. It healed, but, in
the autumn of that year, another relapse occurred) and a new extirpation

1839.] On the Resection of the Facial Bones. :I37

and cauterization were required. For a fortnight aftt rwr.rt'.s the rtd-liot
iron was repeatedly applied to the fungus.

In spite of these repeated extirpations and applications of The actual cau-
tery, the softening and loosening of the alveoiar ni-iroin spread over the
moiety of the right palatine bone, the nasal procei:s vi the nj per j;nv, and
the body of the latter. In order to attack the diseased bone, it was neces-
sary previously to divide the soft part. I slit up ihe iialf of the face, from
the right inferior margin of the orbit, descending on the side of the nose, and
drawing the knife through the upper lip ; the lip and check were then rais( d
and drawn to one side, and the cartilaginous part of the no?e to the other.
The diseased bones were then removed by the saw to a considerable depth,
and the steatomatous degenerated masses on that side were extirpated with
scissors. Upon the margins of the bones I produced a strong effect with
the incandescent iron, and concluded the operation by applying many twist-
ed sutures, by means of which I united the divided integuments of the face
and the upper lip. The pins were extracted in a few days, when the wound
was closely united.

In a month the cure proceeded so quickly, that a great part of the wound
was filled up by luxurious granulations, to which a solid cicatrization follow-
ed. The patient seemed to be cured in the third month, but the upper jaw,
near the side of the nose, and part of the rcof of the mouth, began again to
soften and exhibit the re-appearance of the tumour. I extirpated again the
diseased parts, and burned the edges of the bone with the red-hot iron. The
whole exfoliated, and the cure was complete. The defect of the bones was
supplied by an instrument ingeniously contrived by Wallross, ivith a series
of teeth, and a plate for the palate. By this means the patient was enabled
to speak with a natural voice. With the exception of a cicatrized line,
there was no external disfiguration of the face.

The patient departed to his country, and, after two years, he wrote
to me, saying that he was quite well. However, six months later, he ap-
prised me of his disease having returned. He came immediately to Ber-
lin, to subject himself to a new operation, with his wonted fortitude. I found
both the old cicatrices of the bones, and the neighboring bones, very volu-
minous and softened : this was also the case with the left side of the lower
jaw ; I therefore repeated the lastdescribed operation. I made an incision
from the orbit to the angle of the mouth, turned the flap, containing the Hp
and the cheek, to the one side, ordered the assistant to press the nose to the
left side, and removed the diseased bones again by means of the saw. I
then burned the wound with the red-hot iron. The wound of the face I
united by twisted sutures, and this time also, a good and quick union follow-
ed. In a few weeks all was cured in the mouth. No external disfiguration
was to be observed. The patient departed home, and has continued to en-
joy the best health up to the present moment.

Case XV. Mr. G., a strong young man, 22 years of age, was disfigured
in such a manner as to prevent his going into society. The left side of the
face projected in the size and shape of a large cocoa-nut, and by tliis tumour
the right side was so much displaced, that the nose was thrown far to the
left side. The right eye protruded from its socket, on account of a tumour
of the size of a hen's egg, on the point of which the eye was situated. The
slit of the everted eyelids had the width, and presented the appearance, of
the female labia, when drawn from each other. There was, at the same
time, a complete entropium of both eyehds. The integuments of the cheek
were much strained and attenuated by strong extension, and covered above
with numerous varicose veins. The upper and lower tumours w^ere separa-
ted from each other by a deep furrow. The young man, notwithstanding,
enjoyed the best health ; none of his senses were affected, he could even see
with the protruded eye.
It may easily be imagined, that, in this case, many physicians had been

20*^ Ofi the Resection of the Facial Bones. [Jan.

corjsultetl, many medicines used, without stopping the disease. The best
^uroeojis HI Germany and France had seen the patient, and treated him with
not iioiriuBopathic doses, as he had taken, besides other things, 200 bottles
of the decoction of Zittniann,* and had been subjected twice to treatment
by iiunger and inunctions in all their severity , but as none of these meth-
ods had succeeded in checking the degeneration, he had discontinued for
two years all furcher treatment. The degeneration, however, had continu-
tid its progress, and had gradually increased in size.

Convuiced that internal treatment was of no use, that the tumour was of
a fibrous nature, I resolved to perform the operation. I first made an incis-
ion, beginning from the external corner of the eye, and descending over the
apex of the tumour to the margin of the lower jaw ; I then separated the
fc^oft parts from the tumours under them, and turned the flaps to both sides.
These flaps contained, together with the nose and cheek, the whole lower
eyelid, and the deeply contracted fold of the skin, which separated both tu-
mours from each other. I now began to work down below the boundaries
of the tumour ; I followed it below the extremely protruded zygomatic arch,
from thence tracing it over the body of the right upper jaw, I arrived at the
base of the cranium, where I found the principal root of the growth, which
I separated from the surrounding parts. I separated other roots from out
the nasal cavity, to which important ramifications extended. They had di-
lated the nasal cavity, and pressed down the roof of the mouth, which pro-
truded in a convex shape. I then began the extirpation of the tumour of
the orbit. Prolongations passing through the osseous plates of the orbital
parietes, comjected this tumour with the lower one. It was a difficult under-
taking to preserve the eye ; but I succeeded in freeing the bulb from all sur-
rounding parts, and in laying bare the optic nerve from the tumour. The
tumour was still firmly attached to the orbital parietes ; several osseous pro-
longations, or roots, proceeded from it through the perforated bones ; but I
succeeded, at last, in beco.ming master of the whole tumour. The bulb of
the eye, with its optic nerve extending like a string at the bottom of the
wound was now, as bare as an anatomical preparation, between my fingers.
My friend, Dr. Romberg, so highly esteemed for his researches on nervous
diseases, and myself, now tried some experiments on the faculty of vision ;
we closed the other eye, and wherever we directed the eye, the patient dis-
eerned all objects very distinctly. As the bulb was too small for the orbit,
theje not being any adipose or celkilar tissue, I made several coils of the op-
tic nerve upon itself, and brought it into the posterior part of the orbital cav-
ky. I then modelled from the lower eyelid, although enormously enlarged,
attenuated, and covered with varicose veins, another one on a smaller scale,
aaited it by fine knotted sutures, and after concluding the operation, I adjust-
ed and secured the large wound of the face by a considerable number of
twisted sutures, using, according to the thickness of the edges of the soft
parts, thicker or thinner Carlsbed insect pins.

The eyelids were closed to prevent the prolapse of the eye-ball,, and press-
ed into the ocular cavity with a large soft ball of hnt, and by this means they
were brought into a gentle connection with the eye.

The patient was subjected to a very strict antiphlogistic treatment ; saline
laxatives were recommended ; he was bled ; leaches were often apphed in
great number to the face, and day and night fomentations with ice-water
were made. By this treatment life was at no time in danger; the wounds
healed quickly. On the second, third, and fourth day, the sutures were re-
moved, as the margins were united by the first intention. In a few weeks
every where in the depth of the wound cicatrization followed. The bulb
and the eye-lids projected naturally by new formed cellular tissue, and, at a

A decoction of sarsapariUjt contaioing corrosive sublimate.

1839.] On the Resection of the Facial Bones, 239

later period, nothing extraordinary could be observed in the young man, ex-
cept an oblique position of the eye-ball with respect to the slit of the eye-lids,
and an obliquity of the cheek, and harg-ing down of the angles of the mouthy
a necessary consequence of the division of the facial nerve.

Two years after the operation, Mr. G. paid me a visit. The paralysis of
the cheek was strikingly ameliorated, and the corner of the month was much
more moveable. The sight of that eye is complete, and even the eye-ball i^
somewhat moveable, as it follows the motions of the eye-lids.

From this case the idea first suggested itself to me, in all my following op-
erations, where a complete division of the one side of the face might be re-
quired, and consequently of the facial nerve, to avoid this by not cutting
through the cheek, but perpendicularly through the middle of the face, and<
even then, if the operation should be necessary, on the posterior part of the
cheek. I therefore resolved, in the next case, to follow exactly the median!
Ime of the face, and, after dividing the nose and lips, to turn to one side the?
soft parts, like a half mask, and then to perform the operation.
This new method proved successful in the three following cases'.
Case XVI. Madame H., 54 years of age, often sickly, observed for ?eve
eral years an impediment in the left nasal cavity, and, at last, she could nt*
longer respire through it. It became completely obstructed, and a dark blue
tumour was observed in the depth. External and internal remedies had beer?
of no avail.

The patient now applied to me. I found a melanotic fungus firiing' \.h^
left nasal cavity, by which the external parts were much protruded^ and upoi?
them several melanotic tumours were observed.

The patient having taken, for some time, the decoction of Zittmann, I ex*
tracted all of the fungus that I could reach with the forceps, and" removed
then a great deal of the steatomatous degenerated mucous memhrane of th^
nose. The turbinated bones of the nose were effected with cafie?. Whe
the whole of the diseased parts were removed, the cavity was burned with a
hot iron, which had the shape of the little finger. The patient underwent a
slight antiphlogistic treatment, and she again took, for six weeks, the deeoctr
Zittmann.

Several months afterthe operation, all seemed to do well, an^ the cavity
to heal; but the fungus returned ; it affected the inner surface of the nasal
bone and the upper jaw, especially the nasal process of it ; the soft parts
swelled, and the protrusion of the fungus was only prevented in some places
by the external integuments.

Three months and a half alter the first operation, I performed the second.
The soft parts were divided below the forehead, the knife drawing along the
back of the nose, and, at last, the upper lip was divided. Tlie parts were
separated from their connections ; the flaps containing nose, cheek,- and lip^
were retracted, and the various parts of the ossa nasi, with a portion of the
degenerated upper jaw, was removed witli a saw. I then removed the cari-
ous and fungous portions of diseased bone which presented themselves m the
bottom of the wound ; some of the latter were prolonged even as far as the
frontal sinuses. And, finally, after having cut off a melaiiotic part of the ex-
ternal integuni6ntff of the nose, I united the wound by means of a multitude
of twisted msect pins, beginning at the forehead and terminating at the up-
per lip.

The patient was treated on the" antiphlogistic plan, and the preparation I
delivered to my celebrated friend Johannes M^iiller. This gentleman saw
the patient on the third day almost cured, and on the fourth the whole wound
of the face was united by a linear median cicatrix. Up to the present time,
a year after the operation, no relapse has followed.

The following case, however, of the resection of the facial bones, on ac-
count of a fibrous tumour, is, undoubtedly, of much greater importance.
Case XVII. One day a lady, closely veiled, came to me, desiring to speak

40 On the Resection of the Facial Bones. [Jan.

with mo aJone. She raised the veil, and I imagined I saw before me a
pumpkin ; I could discern notliing but a large round body, on the one side of
wijicii there was a disfigured, disiorted face, with a nose pushed to one side;
theleit ala was enormously extended, and, together with the mteguments of
the cheek, covered the tumour. The eyelids were hkewise greatly extend-
ed, and their orifices were obh(iue ; the whole skin was covered with thickly
studded varicose veins. The disease had reached this extent by degrees
between the 18th and 48th year of her age. I began the operation in this
case by dividing the face in the median line, commencing between the eye-
browt=, which were placed laterally, having been thrown from their natural
situation to the position in vv-hich otherwise a check only is to be found.
Having extended the incision to the nose and upper hp, I made over the root
ot the nose a transverse incision, parallel with the aperture of the eyelid. I
then separated the soft parts, i. e. the moiety of the nose, the lower eyelid,
the upper lip, and the cheek from the tumour, near to the ear, and directed
this immense flap to be resected.

The extent of the tumour, which projected on all sides, and which was un-
even, and of an osseous structure, did not allow me to commence resection
from within outwards, and I was forced previously to remove with an ampu-
tation saw, a projecting portion of the size of a fist. I was thus enabled to
penetrate with a small saw on the side of the nose to the frontal cavity. I
then sawed out the greater part of the inferior orbital margm, together with
the inferior wall of the orbit. 1 then resected the zygomatic arch, and saw-
ed in a transverse direction through the upper jaw, so that the alveolar pro-
cess only remained. After dividing with a knife-saw the deeper situated
hard connections, and separating the softer ones with incisors and knife, 1
was able to elevate the whole mass with strong levers, and I now beheld a
large wide cavity. If the appearance of the tumour before the operation was
not dissimilar to a pumpkin, it might be easily imagined now, after the ope-
ration, that the cavity had the appearance of an excavated one. On the left
and right side, v/ith the exception of the parts where the bones were sawed
through, the parietes were felt smooth. The lateral wall of the cavity was
formed by the inner surface of one-half of the nasal fossae. The posterior
limits of it were formed by the perpendicular posterior wall of the pharynx.
At last I removed a great portion of the tumour from the frontal sinuses,
which were enormou.^ly dilated. This was followed by the discharge of a
quantity of fetid matter.

After restoring the fainting patient, I united the external incisions by a
great number of twisted sutures. The eyelids and their corners were uni-
ted by fine knotted sutures.

The patient at first received an analeptic medicine ; the face was slightly
covered ; internally some wine was given, until the weakness had somewhat
ceased, and on the following day a slight antiphlogistic treatment, corres-
ponding with the constitution, was commenced by giving a solution of pot-
ass. The thin deeply withered soft parts became slightly raised, and tur-
gescent on the following day, and on the third day the union was so complete
that all the sutures could be removed. In one place only, between the low-
er eyelid and the nose, did the united flaps open again to about the size of a
shilling. But I hoped by a future operation to remedy the accident.

The case did not present any complication, or any thing worthy of notice
during its treatment. After a few weeks the patient was able to get up and
move about. No paralysis of the face occurred.

Besides several younger physicians, Drs. Jiingken, Berendt, Romberg and
Holthoff were present at this operation.

After complete restoration of the patient to health, two things were still
to be done with regard to the face, which had become quite straight, viz : to
close the opening above mentioned, and to raise up the eyelid, which was
somewhat drawn down by the formation of the cicatrix. Through the great

1SS9.] On the Resection of the Facial Bones. 241

thinness of the skin and ahsenco of the subcutaneous cci'uiar tissue, I com-
pletely succeeded iu the first object, on^y aficr some unsuccessful experi-
ments, by refresiiinijthe edges, and by applying sutures, Jiaving rendered the
approxiaiation of its edges more easy by means of lateral inc.i.^ions. In the
latter, however, I have not yet fully succeeded. The lady, for the last year,
enjoys the best health, enters into society, from which she has been exclud -d
for more than thirty years. Hitherto there is no appearance of relapse : ths
cavity left by the enormous wound is much diminished. The face is natu-
ral, and the muscles, on both sides, are capable of being put into action.
The resected and extirpated tumour was of a fibrous nature. The bones
appeared partly absorbed, while in part they remained attafched to the tu-
mour, as attenuated though healthy plates.

Case XVIII. Mr. R. a judge, 50 years old, had observed, for many years,
a gradually-increasing sv/elling of the bones of the left half of his face.
There was no great pain, but always a dull sensation of pressure. The nose
was pressed to the right, and the lett wing was higher than the r ght, which
latter covered part of the globular tumour. The skin of the cheek was blu-
ish red in colour, and was perforated by several fistulous openings. Tlie left
nasal bone, the orbital margin, and the zygomatic bone felt softened, la
the cavity of the mouth, the alveolar process oi the upper jaw, and the
whole roof of the mouth were found to be transformed into asteatomatous
mass.

The patient had been under the care of able physicians, and had used
many of the remedies recommended against diseases of tlie bones, and last-
ly, the decoction of Zittmann. The disease, however, had developed itself
in spite of treatment, and was about to perforate the whole integuments of
the cheek. The patient now determined to come to Berlin.

I commenced the operation by d.viding the face from above downvyards,
the incision passing through the nose and upper lip into the mouth. An up-
per transverse incision was made into the ang e of the eyelids, and the m?e-
rior eyelid, the half of the nose, with the cheeK and the whole of the upper
lip were separated from the softened bones undr^rneath, until the masseter
muscle was freely laid bare. I then commenced the reoectior, by sawing,
at first, through the upper jaw in the direction from below upwards; pas.<ing
with the saw through the nose, I turned the instrument transversely into
the orbital cavity, and removed the greater partofthe inferior orbital mar-
gin, and of the inferior surface of the orbit. I then sawed through the zygo-
matic bone, and penetrating into the deep-seated mass, changing somjtimes
the saw for the knife and scissors,^ I resected the deeper situated parts of
the upper jaw, the vrhole osseous part of the roof of the mouth to the velnm,
and the whole alveolar process. Several large car:!lagmous portions of :he
bones, which were not fully softened, were gradually removed, and the pari-
etes of this large cavity vvere burned with the red-hot iron.- The bieednig
soon ceased, and I was now able to unite the wound of tlie face. Twenty
sutures were required for this purpose.

The patient was still able to stand after the operation. He was carried
to bed, however, and received for refreshment a glass of wine and water.
The tre'itraent was slightly antiphlogistic, and as the vital powers appeared
to be sinking on the next day, he took an infusion of valerian ; howeviM- we
were soon compelled to return to the use of carbonated waiers, S hz r wa.
ter, and Saidschiitz water, to open the bowels. On the fifth diy th t w.iole
wound of the face was united, and all the sutures r.:'n)oved, exc-'p' \\\d
inner corner of the eye on arconnt of the extreme thinness of the skin, where
an opening remained ; but the cure of this will soon be o'.itained. With a
slightly nutrient and strengthening trea-ment the p^it.ent has m ule siich pro-
gress, that to-day, twenty eight days after the operation, he walks about in
his room : he was able to leave the bed already a fortnight ago.

In most of the cases of osteosarcoma here related, I had already tried aa
0.7

J4t On the Resection of the Facial Bones, [Jan.

internal and external treatment, but it never was of any use ; the dieeaee
proceeded in its developement equally during the treatment, often continued
for months. Mercury, iodine, gold, and the decoction of Zittmann, were es-
pecially the remedies by means of which I hoped to produce a favorable ef-
fect ; externally I applied the pure extract of lead, and this latter appeared to
stop for some time the progress of the degeneration.

In most patient* the fungus began from an alveolar process, and extended
either to the lelt or to the right, by affecting the neighbouring alveolae one
after the other. The disease seldom spread over both sides from the first af-
fected alveolar process. Extraction of the teeth produced a much quicker
developement of the disease. 1 never extracted teeth but the patients came
always to me complaining, that immediately after extraction of the teeth the
fungous mass grew very quickly.

After the alveolar process had become degenerated in its greater extent,
the zygomatic bone generally became affected before the palatine bones.
The whole cheek formed an oval hemisphere ; the nose was drawn to one
side, and the nostril corresponding with the diseased cheek, formed a contin-
uous level with it. Not only in La Charitey but also in my private prac-
tice I have already seen a great number of such patients die, notwithstand-
ing they were submitted to judicious treatment up to the moment of death.
In some cases the fungous mass penetrated the skin, which previously be-
came brov.nish-red, and attenuated, and then the red fungous tissue were
seen quite denuded. In others a collection of matter was formed in the
cheek, which burst and gave issue to a decomposed and stinking fluid. In
these cases the fungous sometimes shot out from the parietes of the cavity ;
the nasal cavity was obstructed with fungoid masses, and the patients res-
-pired only through the mouth.

Having had many of these unhappy examples before my eyes I was in-
duced to perform the resection of the bones of the face to a greater extent,
more particularly as smaller operations of this kind had always met with
success. I generally found a relapse after resection of the bones, of a much
rarer occurrence, than after the operation for sarcoma, or fungus in other
parts of the body ; at least, the disease, in respect to its curability, is much
more favourable than carcinoma of the glands. Amongst the remedies cal-
culated to prevent a relapse, I prefer the decoction of Zittmann to all others.

Some of the operations which I have described, are, on account of their
great extent, and the success which attended them, not devoid of surgical
interest ; but their greatest value, in a scientific point of view, is to be found,
perhaps, in the fact demonstrated, that hy dividing the Jace along the median
line, I have suggested a new method of operating, the effects of which is to
prevent the paralysis of one moiety of the face, the infallible consequence
of commencing our incisions in the posterior part of the cheek. Lancet^
February 10, 1838.

1889.] Medical Society of Augusta. 348

Part III. MOxNTHLY PERISCOPE.

Medical Society of Augusta Session, M Dec. 1888.

The question for discussion this evening was,

Are there any positive evidences known of the presence of
gall-stones ?

Dr. Robinson read a detailed history of the case of the sponta-
neous presence of a loose gall-stone, with a minute detail of the
symptoms. The case will be found in the tirst part of this
number, and is one of interest.

On a general discussion of the question by the members
present, and a detail of all the symptoms observable in those
cases wherein gall-stones have been known to pass, or have
been found present after death, the general opinion was that there
was no unequivocal diagnostic symptoms of the presence of
gall-stones in the gall bladder that the symptoms attending
their passage, though more definite, were still not unequivocal ;
that o( these, the violent distress felt at the hepatic or vesicular
and the intestinal extremity of the duct, the pulse remaining
perfectly unaltered, as directed by Dr. Heberden, is the most
decisive ; but that this may fail to indicate the fact, by error in
the precise location of the distress, and by mistaking neuralgic
pain for that which attends the passage of a biliary concretion
through the duct.

Other Medical intelligence was then called for, whereon Dr.
Bowen stated to the Society, that in an adjoining County his at-
tention had recently been called to a woman about 25 years
of age, who had been confined to her bed for two years, on ac-
count of a chronic inflammation of the uterus. This alone, how-
ever, was not such as to disable her from rising from her bed ;
but the particular cause of her steady confinement, was the im-
mediate occurrence of violent palpitation of the heart on rising.
She had been, a year before, under the care of a regular practi-
tioner, without any benefit. Her color was good, and her com-
plexion fair. Dr. B. desired the opinion of any of the members
of the Society, as to the cause of this distressing and confining
palpitation. Dr. P. F. Eve asked if he had examined the artery;
whereon Dr. B. stated that he had not, having expected soon to
see the patient again.

Dr. Antony stated that in females, this palpitation was often
distressing, and was very frequently attributable to irritation
in the dorsal spine, in consequence of menstrual irregularity, and
requested that on his next visit. Dr. B. would explore the whole
spine, and particularly the dorsal portion, and report at a future
meeting, which he promised to do.

t44 Medical Society of Augusta. [Jan.

Dr. Bowcn stated anothc^r case, in which the woman harl suf-
fered three abortions very soon after qnickenirig. and was then
pregnant at an advanced stage oT about five months that the
Wf.man had bc^fure suffered from fiiior albus, and bearing-down
distress and uneasy sensations in the groins. He had become
of the opinion that the farmer miscarriages had arisen from the
difficuhy attending the rise of the uterus at that period, from the
excavation of the pelvis ; and had ordered a recumbent position
as steadily as possible, and that she was now nearer the term of
nine months than sh.e had been in the former pregnancies, and
had prospect o(" doing weil. Jh'. B. desired the opinions of gen-
tlemen on this case. Dr. Antony stated that abortions at that
period, and a little earlier, were generally attributed to bearing*
down, or descensus uttri when not from other palpable causes,
and might in almost every case, be prevented by the timely
correction of this species of a^doptosis, and the prudent manage-
ment of the patient subsequently. He further stated, that he
had sometimes met with the tnost serious and distressing symp-
toms, arising from the failure of the pregnant uterus to arise from
the excavation of the pelvis, at the proper time for this move-
ment ; but which he had always found relievable by replace^
ment with the hand.

Dr. Kennon then obtained leave to read the following report
of a case.

' At the meeting before the last, I stated to the Society, that a
case of what has been called *' Chigre" had lately come under
my observation, and requested the experience of those pre-
sent in such cases. Dr. Antony stated that he had seen the
affeftion, and had used the mercurial ointment successfully.

The gentleman who was the subject of this affliction, had
spent a part of the last summer in Florida, and exhibited seve-
ral scabs on the upper part of the foot, on the leg, and in the
nei^dibourhood of the anterior spinous process of the ilium.
These scabs were about a quarter of an inch thick, irregularly
rounded, and varying in size from that of a ten cent piece to
that of a quarter of a dollar. They were somewhat inflamed
fnr about half an inch from the edge, and attended with an into-
lerable itching. He said it began first with itching, then red-
ness, followed by a discharge of matter which dried into a scab.
I advised him to dress the parts with a simple poultice, to
dissolve ilie scabs then to apply mercurial ointment, and cover
with a ()!ast(M of basili(M)n. A few days since 1 met the gentle-
man, and had ilse pleasure of being informed by him, that he
was coniplrtely relieve d.

I am informed that tliis disease is of frequent occurrence in
the lower country, and Florida particularly,* and is often very

* It is common ia soma parts of the West Indies* Ed,

183t.] Medical Society of Augusta. t43

severe, sometimes rendering amputation indispensable. It is
said that the first treatment of the physicians, in those parts
where it prevails, is to apply m(3rcui-ial frictions. On their fail-
ure, salivation is resorted to. But Wijen these prove ineffectual,
as is sometimes the case from too late application, or subsequent
negligence, amputation is resorted to. As intercourse with Flo-
rida has become considerable, and is increasing, facts on the
subject become more important.

In Johnson's treatise on tropical climates,* we have an ac-
count of what is called " Dracunculus'' or guinea-worm, which
causes an affection somewhat similar to the foregoing ; but it is
produced by a Kmg worm, instead of an insect similar to the flea.f

On motion of I r. P. F. Eve, the subject for the prize e*say,
determined by the previous meeting of the Society, was altered
to that of Congestive Fever, The prize wiil therefore be award-
ed to the writer of the approved essay ' On the pathology and
treatment of Congestive FeverT The cliief reason for this alte-
ration was, that congestive fever has prevailed extensively, and
is still prevailing in some of the adjacent Districts and Counties,
and information has been often and anxiously called for from
those quarters.

Session, lOth December, 1838.

At the last meeting a committee consisting of Drs. Dugas,
P. F. Eve, and Douglass, was appointed to investigate, for the
Society, the subject of the " Ligamentum Dentis,'' which has
been recently announced as a new discovery. In the order of
business, the report of this committee was called for, whereon
the chairman. Dr. Dugas, read a partial report, exhibiting in con-
nexion with the same, two preparations, one of the inferior max-
illary of the human, and the other of that of the ox both of
which, exhibited, not " a ligament" but ligamentous fibres, in
every direction, connecting the teeth with the circumjacent
bone. At the request of the committee, and in order that this
subject should be more ful!y and conclusively investigated, the
time for their final report, w^as extended to the next meeting:
which will be the second Wednesday in January, 1839. We
hope to give the report of this committee, in full, in our Febru-
ary number. In the mean time, we would here express our sur-
prise at the fact, that although a definitely named ligament has not
been before pointed out by anatomists, the necessity of cutting
the ligamentous fibres, which secure firmly the teeth in their
places, has been so generally overlooked.

It was one of the lessons taught us in minor surgery, in the

Vol.1, page 381.

\ See Thomas' Practice, for soma history of those affections. Ei

S4G Singular Case of Extt a-Uierine Pregnancy. [Jan.

days of our pupilage, as far back as 1805, never to attempt the
extraction of a tooth, before dividing, carefully, not only the
gum, but the ligamentous fibres attacthing them. On this lesson
we have ever practised in the extraction of teeth ; and we have
been often surprised at the facility with which we have extract-
ed teeth, after other operators, both dentists and regular practi-
tioners of medicine, had failed. We presume now, since the
announcement of this discovery, and the improvement in the art
of extracting teeth, by some dentists in Philadelphia, that the
fact has been, that they were in the habit of extracting, without
dividing these adhesions with a cutting instrument thus sub-
stituting the severest laceration, for cutting.

After the action of the Society on the business of the commit-
tee, the essay for the evening was called for, whereon Dr. Ed-
win LeRoy Antony read a lengthy and interesting essay, on the
subject set apart for that purpose, which was "'the pathology
and treatment of Billious Fever. ^^ After a few desultory obser-
vations on the subject, by several members, the Society adjourn-
ed until the second Wednesday in January, 1839.

Singular cast of extra-uterine pregnancy. The following cu-
rious and interesting case of extra-uterine pregnancy, is report-
ed to us in a letter of 10th December, 183?*^, from Wm. F. Bald-
win, M. D. of Union Springs, iVTacon County, Alabama, near
which place it occurred. Dr. Baldwin was unable to obtain
any history of the case previous to death.

" Patient, a negro woman, aged about twenty five years.
Post mortem examination disclosed the follov/ing facts. Com-
menced the incision about two inches above the umbilicus ; in
cutting through the abdominal parietes, I first came in contact
with the placenta, adhering to the parietes of the abdomen for
about two inches around the umbilicus. On opening the abdo-
men I found the child in the following position : it was lying pa-
rallel with the abdomen of its mother, with its head occupying
the epigastric region, being in contact with the stomach its
right side opposite the umbilicus, and the left to the intestines.
It was as large a child as I have ever seen at birth, and perfect-
ly formed, except the head, which was enormously distended
with gas all the bones of the head were broken into several
pieces, which must have been occasioned by the inordinate con-
tractions of the abdominal muscles, at the period at which labor
should have taken place. The umbilical cord was of the usual
size and length, inserted into the placenta opposite the umbilicus.

The uterus was about the size of a goose-egg : its cavity con-
taining a small quantity of thin glairy matter. Saw no particu-

1839.] British Provincial Med. and Su7\ Asiocialion, 247

lar derangement of the abdominal viscera. The child was sup-
posed to have been dead some ten or twelve days.

The above examination was witnessed by several respectable

gentlemen.

British Provincial Medical and Surgical Association.

No one who has noticed in the medical periodicals for the last
few years, the proceedings of the Association above named, can
fail to perceive its immense importance to medicine, and its col-
lateral sciences. In a former volume of this Journal, we called
the attention of the profession to the importance of a similar as-
sociation for the United States of Atnerica ; and we are happy to
observe that, before and since, the subject has not been entirely
neglected in other quarters. Could a nucleus once be formed, we
feel assured it w^ould not suffer a loss of interest subsequently.
It may be observed, in the following extract, that the British Pro-
vincial Medical and Surgical Association had its bcgining in
1832, with but '-about 150 members, derived from a limited
district," but that at its recent meeting in 1835, it ''embraced
the whole kingdom, with upwards of 1200 members enrolled."
There can be no such College for usefulness to the medical prac-
titioner, and the scientific physician. We hope the day is not
far distant, wdien a spirit of philanthropy and a love of science
will be found moving amongst the profession in America, and
arousing her thousands to assemble, annually, at least, for re-
ceiving and imparting knowledge in that profession which is
dearest to humanity. l\o one can, without the experience, fully
appreciate the benefits which must result from such an Associ-
ation, in exalting the profession on the best of grounds its great-
er usefulness. Indeed, such is the importance of an institution
of this kind, not only to the profession and the literary character
of the country, but also to the community at large, that its insti-
tution and sustenance are subjects not unworthy of Congressional
action.

We give below, an extract, as taken from the Boston Medical
and Surgical Journal, from a letter written by Dr. E. Barlow,
who presided at the last anniversary, to Dr. Warren, of Boston.
It will be read with much interest.

We learn from Dr. Barlow's letter, that the Provincial Medi-
cal Faculty are about to enhance, still further, the interest of their
annual re-unions, by forming subordmate District Branches,
suited to the localities and personal convenience of the members
the plan which we suggested in our remarks on the subject.
This will afford opportunity for more frequent meetings, the im-
portant details of which will be concentrated at the annual gene-
ral sessions. We may, henceforth, look to our British neigh-

94S British Provincial Med. and Sur. Association [Jan.

bors with increasiiii;- interest, for all valuable thought and obser-
vation.

! lament that you could not have been present at the late anniversary
meeting of our 'Piovincial Medical and Suri,ncal Association,' which took
place in Bath last week under my presidency. Nothinfj can be conceived
more highly interesting than this annual reunion of the Provincial Medical
Faculty of this kingdom, nor more likely to lead to important results. After
a few mouths of deliberation this association was insiituted at Worcester in
183'j, and it has since held six anniversary meetings successively in Bristol,
Birmingham, Oxford, Manchester, Cheltenham and Bath. We began with
about 150 member^-, derived from a limited district : we now embrace the
whole kingdom, with upwards of 1200 members enrolled. For more effective
co-operation than one annual migratory meeting would admit, we are form-
ing subordinate District Branches, members reuniting themselves in branch-
es according as their localities and personal convenience direct, and holding
whatever local meetings their zeal and diligence may respectively r'^quire.
We assemble next year at Liverpool : our regular anniversary day is the 19lh
of July ; but in order to ensure the convenience of holding our meetings on
fixed days of the week, our rule is to assemble on the l&th and 19th of July,
when the latter day falls on a Thursday, as it did this year, or on the first
Wednesday and Thur.^^day after the lOlh, as will be the case next year.
This rule enables all concerned to foreknow the exact time at which meet-
ings will be held.

" Is it too much to hope that in this age of rapid navigation and steamboat
flight, some of our United States brethren may be tempted to cross the At-
lantic for the purpose of honoring us with their presence at these our nation-
al medical conventions, and personally receiving from us assurance of the
high esteem in which we hold them ? May I indulge the expectation that
at our next reunion at Liverpool, some representatives of the U. S. Medi-
cal Faculty may find their way to us, and allow us to evince towards them the
cordial respect and regard which we unfeignediy ieel 1 If you could hold
out any such hope, it would be an incentive to our energies of the most in-
spiriting and exhilerating kind. Pray think favorably of this suggestion,
and diffuse it as widely as you can.

[For the purpose ot exhibiting still further the objects of this association,
as well as some arguments which are equally in favor of a similar one in
this country, we present part of the address of the same gentleman on taking
the chair, as President elect for the year, at the late anniversary at Bath.
Extracts from the doings of the association may hereafter be copied.]

Gentlemen, In entering on the office which your kindness has assigned
to me, my first agreeable duty is to bid you all heartily welcome to this our
ancient city, which was never more signally honored than it is on the pres-
ent occasion. Cultivated talent and moral worth, especially when combin-
ed, must erer receive the respect and regard of all who are capable of ap-
preciating them. For both, our revered profession has always been emi-
nent ; and when they who, even amongst its members, distinguish themselves
by pressing forward in the career of humane and enlightened endeavor, as-
semble in such numbers as I rejoice to see now around me, for the purpose
ef cultivating still further their divine art, and promoting the best interests
of humanity, their presence must confer lienor on any place which is graced
by such an assemblage. It is not my design, gentlemen, to trespass long on
your time or attention, in the address from the chair, with which the cus-
toms of our association require me to open the present session. To do so
would be an abuse of the privilege which my present situation confers, and
prove only an irksome delay of the far more interesting matter which will be
peedily submitted to your consideration. In each ssuccessive year some
change takes place in the circumstances under which your President ad-

1339.] British Provincial 3Ted. and Sur. Association, 249

dresses ynu, IJfrt'toN'iv^ unA j:nt'] fijc ('rpigiie loj- u h c!' tiie Msvociation
was insiitu'ed iia;! becaim; gon'-rai'v iinders'CM^r, it was the duty of your
Presiden's--, in tiie:r i>tJ;;Fcli\e (lJc-t)L:r>es, lofiweli on tiiose desi^i.s and ijie
eviilcMices o^" their f'lrlfihneir, so a.- to nuke The;r iiaturr, sropr, tendeJiry and
proirr^'ssive realizitio;! lainiliar 1o ail cone? rned. Hnj.piiy tjrs is no longfr
needed for t!ie years that have elipspd sJMce wt^ first ussf ir.hlod to found
this assoc.i-ition, and the wide diffusion of our Rerf-r^s ar:d Tr'ns:<c!innF,
have made these d^sio'ns fujiy kiiown ; while extension of tLe association,
Avnich in respect boih of ninnbf;rs and space, haS advanced wjh a rap'di'y
which I may say is unexampied fijrtnshes asstirance the most uneq-iivocal
of {hd\r being Jiistly apprecia;6d. Were further proof of this needed, the
assemblage which 1 now see before me, congreg'ated (rom^lfnost every part
of tiie kingdom, must sufnce to c-irry co'ivic.ioa tottienisist skeptical. And
her', r-eiitlemen, I wi'l renin rk, that so long as we display such evidence of
zealous and harmonious co-op<^ra*ion, we mxy be content to pnrsne tjie direct
and even tenor of our way, whatever the oj)po>i?ion we may chance to en-
crtutiter; and, rlieered by the^co'iscionsness tha% so far as our abilities ix-
tend, we are pursuing laudable objects from pure nio'ivts, wm^ may saftdy d s-
gard o!)jec'ions such as only ignorance or mist o:icpp'ions of our designs
could urge Against us. Practical details and statistical elucidations you will
have abundantly in the ulterior procr-edings of the present meeting : on ail
such it wrtulJ be vain and idle for me to dwell. I pief t, th< refore, during the
few moments to which my presen' tr. spass shall be lihii'ed, to direct your at-
tention to tljose considera't (ns whii'h adini' not of statistical ex[ osiiioti, yet
whiehare not tiie less vnlu'ible from requiring to be ad;iressed nthcr to the
mind's cya than to our actual percep'ions. The main objects for winch we
are associated, a? stated in our fun-lamLmt-^l consti'ur o ', are, tijo advatice-
raentof m-Vdical science -a'ld the nrantenance of the honor and rrspecta-
aiilily of th^^profr^ssion. Th 'se oSjects ;}re inMni -tely connec-ed : for un-
less scif^nce be di i'rr>ntly andelfectively cnliivated, the honor and respecta--
b.litynf 'he Dr.)tession would rest on a very sligl;t foiuidation ; and unless
the iionor and ra-^pectabihty v/er.* o'ht'rwise main*ained.r on the high grourd
of moral in'egri y and liberal sen^imen\ I'o advance in sci'mce could vindi-
cate i*s claim to that hi^rh es'im ition jn which it has ibro'-gh ag; s been held,
an I which, [ 'rust, t"^ w-il ever, even wrfth sensilivejea'ousy, preserv-'. 'I'he
feelings of the sensitive Roman, who \\ov\ \ notrhat his wit'^ shou'd be even
suspec ed of c'ror, are to he commend d ; and with simil ir feelings it should
be our rare scrto cond.ict 'h-^ proreedings of our ssoci itiin, that not even
ll>e suspicion of selfish or sinister ilesigns sliouid a'tach to u=. To the culti.
vatioQ of medical scence ourendeavors have been hither' o directed, with an
earnpstnetJt* and steadiness of which it b'^romes me not here to speak. How-
ever h-'tle 'hese en.'!'avors miv h'X" hi leTto' produced, thf\v h >ve at least
b->en exe-ted v.ith a z^:?l wiir !iv of 'lie c?u e wh^ch c-slled them forth. My
pr^sent purpose, however, -s no^ 'o dili'eon these erVor's, or Mieir fruits, but
to impress on von a1', thit th-^v who woiidjnd.r nfth^^ val ?e of our associa-
tion, even by tlie effl^r s a"re :dv \\r'<\f^^ or the prod:?cts which Inve resulted
f.roni them, would forrn bU' a verv im'H^r ect estimat^e o' the b- nefi's which
our association is conferr nir, and w';ich it cannot fol eventually to realize,
fr^lias been a-'ked, and in a .-lenreciating tone and njifrir ndlv spiri', what have
we done ? The verv qiestion conv-v- to me ih" convir'ion that the par y
pr-)po<inT i* fias no ad^Tnnte concepion of 'he subject on which lie affects
to s Mk inform ition. No one r^al'y imbued wi-h 'he love of science or the
spirit of truth wo Id --ven form the concep'ion of iud,ri?Vg n'< by so crude and
mad -qua-e a test U is no don'>% trie that fruits sfiouUl be the proof by
v.h'ch mod >s of cul'ivnion.shou':! be j idijed ; hut surely no*^ tdltime be giv-
en for se<'ds to orprmmate an 1 prints to frnctifv. In our cultivation of med-
ical science, it siirelv cannot h^ barren of frm*s w' en upwards of one thou,
sand encrg.-tic members of a liber.-J aisJ ehlightensd profession are incited
II 8

251 British Provincial 3fed. and Sur. Association, [Jan.

by the iiipfiiritincr stimulup. which this association supplies, to exert their best
lacuities and most earne.-t eilbits lor investigating^ tliose truths of nature
wjjich it lias evtr been the object and ainn of our profesgion to explain. In
the activity thus aroused, ti^erc is an an)ple assurance that tiie energies eo
called forti) will not be unnrolitable that to the seed thu sown may we
look with full coniidenre for a rich and abundant harvest. I care not, gen-
tlemen, how slt)wly this h' rvest advances; it being enough to satisfy me
that It 1? advancmg. J am iOt impatient Jor brdliant discoveries, such as the
history o.'science has shown 1>) occur only at intervals, fev\' and far between.
Science is ever of slow advance, if this is to be judged by the sudden bounds
by which consummate genius starts a-headof contemporary talent, marking
epochs in tii^^ h;s'ory of sc ence. But it is ever steadily progressive, if we
no*c the slow, but sure the humb!e, unpretendmg, but diligent and unwea-
ri'd labor with which it? ordi lary V('aiies endeavor to extend it. Among
these humble labiir rs do we class ourselves; with the merit attaching to
Buc'i lal o'j- we w^'l be ron'ent, and on 'hi result of such labor are we sat-
uti d to rely. Should it Ja!l within the inscrutable designs of I*rov derce
th&t some master mind shouM sj r.ng up anio!igst us, some heaven born gen-
ius destined to achieve the performances and equal the eminence of a New-
ton or a Harvey, we shall grate uUy hail the distinction, assumirg only the
humble merit of havingr used our best endeavor to incite and cherish such
transcendent talent. Bj% geniemen, in the ordinary pursuit of our objtcta
we look not for such results, and oii the diligent exercise of ordinary talents
are we content to r^'st our clai.-iis lor commendatiop, encouragement anJ sup.
port. I am led to submit these views t > yon, gf^ntlemef), believing them to
be those of truth and sober reason ; ftr while f would deprecate all extrav-
agmt anticipations and vam boasting^, T conceive it essential to the steady
progress oi our combined exertions that we neither undervalue what we have
dorje, nor form an incorrect estimate of what our conjoined labors are capa-
ble of elffcting. On the second head of my ad.lress, tha% namely, which
relates to the mninlenance of the honor and respectability of the profession,
T shall be very brief for this honor and respectability must ever flom', not
from self-ela'inor pretensions or arrogant claim to consideration, but from the
jrofessional s-ill and moral worth of the individual members. Astheag-
gregate )f parts constitutes the whole, so must the maintenance of honor
and respectabiii'y by each indivi.iual member of onr association ensure, be-
yond the possibility of failure, the continuance of these long-enjoyed attri-
butes to the collective body ; and when I consider the high moral qualities
which the members of our body on all occasions display, the talents they
evince, and the zeal they manifest, to all of which even the brief records of
our association already bear amt^ie testimony, I can entertain no fears of our
ever, as a profession, descending from that high moral eminence, on which
th^; opinions of the world, and the express declaration of several of the sa-
gest and most acute observers of human nature, have for ages placed us.
On the conduct of our individual members I contidently rely for preserving,
unsullied, that reputation which the profession has hitherto maintained.

'So far as my judgment and fselinrrs are capable of guiding me, I would
say in cultivating medical science disdain not, through vain aspirations for
profound theories or dazz'ing generalizifions, that patient observation of
nature and diligent collections of accurate facts, from which all true theory
must be derived, all sound generalization deduced ; .nnd, in upholding the
honor and respectability of the profession, let the measures we collectively
sanction ever bear the impress of that high-toned moral feeling which has so
long distinguished our profession, and by which its true interests require u
ever to abide.

1890. J Ununited Fracture succesafuVy treated, 2>l

Ununited Frccture succfssfiilJi/ treated. Tlio following vory
interesting case olMw/^/z/Ve^/ iVMCiurc. successfully tn'Jitcd with
the use of mercury, In' Mr llr.inshy Coopor, is t.iken Worn Guy^s
Hospital Report', N.'. 5. (Xttobcr.* IS35 : edited ()y (I. II. Bar-
low, M i).,and J. I*. Banngton. iM. A. by ilu? Medical ( hirur-
gical Review. It is reporte<i as being c7/7-e<^ bij TJu? use of mer-
cury. Such may be ihe i'act ; for we have known even the
wound caused by the am[)Utation of a leg, to refuse adhesion and
cicafrization uniil the general system was re leemed from con-
stitutional disease by this invaluable alterative povv<r. .^ti^ll,
however, the fact of the cure havincr heen effvicfed l)v the njercu-
ry used, may, from all the circumstances of ib.is case, admit of
some doubt. The two circumstances most calculated to (xcite
this doubt, are the following: It will b.e o!)scrvod that in all the
previous part of the treatment, the fracture was very strictly
bound and compressed, by the diffcicnt kinrls of apparatus com-
monly used in su(!h cases precisely such as M. Flenry found
to prevent the consolidation of fractures, by the interruption of
vascular action which they caused, and the removal of which,
with other proper retentive means, secured ultimately the best
results.

it will be observed, further, that some time after this cure was
effected, the same patient suffered a frartnie of the same bon ,
near the seat of the former fracture. This fracture united by
the same local treatment, viz: ' a well-padded l(^athern girth.'
&.C. withotit the exhibition, of mercury. I5nt the reader will
form his own opinion on reading the case, which is as follows:

Ununited Fracture Influevc of Mercury A hGalthy-lookin^ youngf wo-
man aged 28, was admitted, MircliO, l-;3fi, with an ununited fracture of
the left humerus, just below the deltoid muscle.

Six months previously, wiien in good health, she was tlirown from a car*,
and received the fracti re. Splints were fippl'ed, but at the tndofeiiiht
weeks there was no union. The splmt^ were replaced, and the arm bound
to the s de for a month. There was still no union. The apparatus was
replaced with the addition of an iron splint, extending from the outer side
of the humerus to the wrist, being bent at an acute angle : and the arm was
as befo'-e, bound to the side.

This plan was also persisted in for a month, but with no better effect.
The surgeon, still unwdling to give up the case in despair, mide one other
attempt, by applyinsr a band ige tightly round the arm ; and, pi icing wooden
snlints over it, compressed them to the utmost the patient could bear, to
which she submitted patiently for two months ; at the e.vniration of which
period, the fractured extremities of the boae were found as moveable as
ever.

On admission, the two portions of bon-* moved readi'y upon each o'^her,
but with- ut producing anv thingr approaching to the s.^nsation of crepitus:
on the contrary, the mobility of the pirt conveyed tjie impression of the for-
mation of a supernumerary ioin% and ih? muscles were can;ible of producing
pome voluntary motion. Mr. C^ooier proposed the in*rodiction of a seto i
bf-tween the ends of bone. This was done on the 2-id of March. On the
25th, th-^re was som3 ip\'(;r, and lo:'al irr'tation. Bjt the se'on fii'e 1, after
a trial of ten weeks. Then a bandage dipped in a composition of egg aud

252 Sin^nJm' Jm^v^ Natures, [Jan.

tl >ur .v:is worn !ie ihe HmT) was OMVcIupeJ i;i plaister ()f Pari?. Neillier

p an f 111 Ct'eU. il.

'.vt)al i!u.-> ijrrit)*!, Mr. ('o'I>, Won D.i:)liM, paid a vij-it.to Guy's Hospi-
tal; .ui ;, 111 f^oiii^- r.) lii 1 ih- \v iris, Mr. Co'.;yer dr.-w his aUenion to the
la^e 111 queslioii. ii saiil lie li ;(1 st^rji :he admi!iis:r;ition of intrcury, con-
tiuu 'tl Uii il i. pro.iJccd p*ya!isin, le.id to tlie consolidi ion el' ununited trac-
tur. ., artt.r ali oLlier means Iia(i fuled ; and qiotc d two rnscs in illustrat'oa
of' tiij as.-^erjoa. 'I'lij piMttn'' w^is ;ircordini>"'y iiniuadialcly ordered four
g- iins of liyJ. c. Cr.-t. thri'e tim -s a-d-'y ; wA a w^ll p.iddcd leailiern girth,
turn irlifd wi.h Mr;ij ? and uiu k!< .% u a. tirmly aj |'!i< d inmpdiate!y over t!)e
sea' ol'tracturj. I.i fojr dav?, p'yaljpni was iToducef', and l!ie quantity of
mercury was iliniui;shed. Om '\w sivth day tlie powdi rs wr-re suspended,
as s,.e ^u.iereil SfV.rL'ly fnun fhcii etf c's. 'i'he !eat}ifrn pir'.h was worn a
nion:h ; and upon ils roinova\ prHect union of the bonf hid taken pl;ice ;
atf<>rJ iig saflsfach'iy pn)ofth!t thf !n.>r('i;iy hul produced an altered action
on .hj c .pi.Jaries of tiie alficte 1 P'rir', an i <v\<-in: lifyino- iho powert'ul altera-
tive inrtur'nce >rthal metal. She r. tn lined in the Ilor-pnal six weeks after
tJiis ha ijy r suK, to re;;^ain her sirenoth : when she was diifcharged as cured,
and Willi a perlcci use ol h rami.

T.iree moi h- after her d-'partur'-^, slie wpr Pfrain admitted into Guy's
Hos it i', f^ir a fr.ictur^ of il^c same arm, produced by a violent blow, inflict-
ed by a mm running with oreat velocity apiinst her, and knockingf her
down. Uj on e.vanijnati 'n, i" was fomd that the hinn'^rus was fractured ra-
th r be) 'vv the seat of the former injury: ail the usual conconiitant symp-
tu'us of simple fractir* wi re pn sen", as crepi'us, &:c.; and hy the npplica-
liv>ii of t!ie same o- r'li which h id bcf-n employed on the former occasio . the
bone uniieii at the u>ual perio ', wi hout hj exhibition of inercurv,"

Sini^iihir I ysus Nafifi(. Tlu* foHowinGT Interestinor and sin-
TT. ,!. CMS*.' f !u<us iititiitse. is ^xMM(:*pd from ;i letttM* dated 17th
I >: (! m!)cr. I.>: 8, 'r. >m oi.r \:i'icn .uid Sf.-iciitific coi respondent,
VVi liani Marklcy Loc, M. I >. of Gec.rgctovvn, S. C.

Wiiilsi nn a vis t t(j a sick v.r^r >. on fho plantation of J,
Hirlesio.i 11- ad. Ksc]., on W'inyavv Bay, on tlu; I7tli August
last, mv alt-nti )n u.ms calied t ;i fcjnnlo nefrro cliiid, horn the
night previ(M;s. 'V\\c head, iiody. i\\h\ upper cxTrciniTirs. were
Well lonnt^d ; hut the lower, exhiinted a his^ts r.iUuroR, sijch as I
had riever seen or read o'; the leirs wer apparenily transposed,
caeh f inur heiag inserted int<' the aer'tahiilnni of the opriosite
side; t!ie knees and Tofs turned haekward ; th(^ child .seemed
much etnaeiated and attemuited, l)y an indolent nicer, or rather
open ahscess. perhaps one and a htilf inc-h.es in diaincic r. seated
over ti'.e Innihar vertehios I preserdx-il a loeaj applittatiori, an!
now re/rrei that 1 did not nquest to he informed, in the ev(M)t of
fts !ealh. in order to make a post inoHem examination. The
case of tny piticnt he'nir of a clironic nature, 1 did not repeat
toy visit until a eek had eln; scd, when I was informed that
t'le infint h.ad died, -aw^S he-n f^tiried several days previous. As
a'readx- (!!)S<Tved, this is th.e only (-ase of the kind I had ever
seen : w'ill any medie.il irentlcMnan favor the readers of this Jour-
nal, with a statement of any similar case?"

1839.] J)/7^?io.9/.v hdiccen Amaurosis arid Cataract. 258

On a new 7/ieans rj Dict.^ri'i^if! Idiceen A.ir.av.r< >'.s nrul Cnlnrnct. Cy ^^
Sanson. Ifa lijrlit Lie j;rcscriie(lbt-l<>re jmij ni;n ni-ic ( y( li ej i:f ilniw hjch
is either iialuraiiy or ar'tilkially dilu'ed '.lirci- <!i^1ii.ct ini;ip>>- <t \hv tl^une
may be invariably observed. Of tin s^o ll,n e itiia<:(s, avo urc rpri^li', jmd
one is r^rersed; ihoy are si'ua^c!, Uie owe lei.iiul Uie oilier in Ihe lollowii'g
or<ler. Tlie anterior one, wliii h is a!.-^) most diPlnict, is one of tlic f<>rtn( r (r
upright imajres. The p<islerior r drepct^t, whicii is ifie ler.st distiiu", is alto
one of the upriiiht ininp;es. The intero'iediate inaageis ihe rererseil t^Dc.

Thislasf, or reversed imnge, is paler t!ian the firs% but brigliter than th.e
seconcl upright one; and it alsoditters in liiis cirr!:!u:'taiice, iiiat, when the
light is moved to either side or nrind the eye, il is separ tod from ilie other
two imagt'S so as always to occupy iiie opj osi!e side, while they (ti.e upriglit
ones) are seen to follow iJie position of the ligli*, inovin<r t. tlie right or
]ef% upwards or downwards, according as the caudle is moved in any of these
directions.

If the candle be held opposite to the axis of the cyr^, ;i]I the three images
are situated one behind Iheotler ihe t\\o f osttricr ones bi irg, as a n)atier
of course, masked and obscured by the anterior one. But if it l)e he'd to a
say the right- side, tlien the reversed image will be seen in the opp(^sile or
left angle of the eye, while the upright ones arc seen at its riglit angle.

If it be moved around the eye, tlie upnghr. images follow it i(>geihej-, whiie
the reversed image, although describing the circle in the same direction, is
always at the opposite end of the eye's diameter^

The unpractised observer may exp- rieixe some difaculty in observing
these phcnomerja.

Tlie patient, should be placed in a dai-Ic chamber; and let us suppose that
the candle is held at the external angle of the eye : the anterior upright im-
age, which is large and brillian', will he observed at the outer and upper part
of the pupil. If we now look very attentively in'o the bottom of the eye, the
reversed image will be seen at about one line's breadth from !he preceding
unright imajje, and at the meetmg of the lower with tji middle th rd of the
diam^'ter of the pupil- the r:ght (\N'rem!ty of which (ihe diameter) is occu.
pied with the anterior upright image.

If the surgeo 1 does not d<='tect these ])lienornena nt firs*^, he has only to
move the light upwards and downwardr, orci'. or twice, fi\-ir:g his look stea-
dily on the pupil, and he cannot fail to observe that one image rises and tho
other descends.

As !o the posterior or deep-seated upright im^gr-, it is always very diiTicult
to perceive i% in consequence oi' its p;iljitss, and of tlie inttrvcniion of the
other upright one of wiiiri] it looks like the sljadow.

Mr. Stmson assures the snrireon tha% when once tiiey h"ive detected tjie
very images tliey will a'ways readily perceive thecn afterwards, frovided,
iher? he no ubacurity nr oparJt;/ (f the tens.

Whenever the cataract e.\is;s, no matter what m-iy be the st^'ge or pro-
gress of disease, none of 'he images, described abov;, are ever perceptible.
Some time ago (says M. Sans(n%) a patient was sent to rnp frojii a great
distpnce lobe relieved by operation from a cataract: the three iiuagps were
perceived; the vatipnt was nffi'ct"d I nj glaucoma.

A few days ago I was desired to visit a patien% who h-^d been pronounced
by several metlical men in the rnnropohs to be afFecled with cataract : I per-
ceived the three images and docjared the case to be one of amaurosis.

A woman^ whose siglit v;p.s entirely In?-, was lately sent to my care as an
amaurotic patient. There was'no opacity visible in the field of the pupil ;
but two of the images were absent. I gve it as my opinion that she liad
two cataracts; and the accuracy of this ditgnosis has been subsequently
confirmed.

The preceding remarks were made by .M Sanson, one of the surgeons of
the Hotel Dieu in Paris, in his course of lectures on opthalmology during

2M Sf^ction of a Tendov, <^c. <!^'C. [Jan.

last year. lie had first noticed the phenomenn, described above, about
twelve tnontiis previously; and he had avaiU^d himseh of liis ample opjortu-
nilies in the hospital dunnj^ this period, to tept the accuracy of his opinion.
He assures us that his experience has (piite satisfied him of its truth. Med.
Chirurg. Rev., from I' Ex^;eritnce ; Journal de Med. tt Chirurg.

Section nf a tendon ligature cure. ProfrsFor Sf.rre of Montpelicr, has
communicated to the BalMin General de Thtra^mtiqiie, (15th Nov. 1637,)
the case of a surg'^-on's instrument maker, w ho a( c dt-ntaily divi<led with the
point of a knife the extensor tendon of the middle finger, d the left hand,
near the metarcarpo.phalangean articulation. Not being able to bring" the
ends of the divided tendon logeth(,'r Ity extei d-ng the limb, he exposed th m
by an incision, passed a suture throi gh them and thus maintained them in
apposition. On the eleventh day tlie 1 gature came away, and a short time
afterwards the patu nt recovered the perfect use of his liirger, without any
untoward accident having manifested i'self.

The treatment of divitied tendon wish the suture, is a most ancient one,
and it seems surprising (hat so distinguished a surgeon as the reporter of
this case, should adduce it as possessing any novelty. American Journal c,f
tJie Medical Sciences.

Division of the Tendo AchiUis Is it a !Seic Operation ? The next patient
brought in was a little boy of six years of agf% whose feet had been deform-
ed from birth; the foot being in bo'Ji cases turned in, and rotated upwards
and inwards, while the toes were at the same time kept po'n ed by contrac-
tion of the tendo Achilles. Mr. Kea'e inserted a narnw knife, with the flat
surface between the skin and the tendon; then turning the edjie towards the
tendon, it was cut across by the knife, the heel being at the same time drawn
downwards, so as to separate the divided ends from one another. An instru-
ment was then fastened upon the foo% so as to inrlose it in a strap and kind
of shoe, while an iron went up the leg on each side, and was buckled round
the leg just below the knee. Th? shoe part was so contrived a to stretch
the bt.ck of the leg, and allow of its being still more extended, if necessary,
afterwards. The little fellow bore bo: h operations without a single exclama-
tion, and hardly even moved during l he time. Mr. Keate afterwards explain-
ed tiie case to the students, and remarked th:it he had lately seen or heard
of this operation having been revived as a new discovery, but that he had
ofttn seen it done, and as long a.s five.artd.thirfjj vears utro ; and that he be-
lieved it generally succeeded very well Sir Bsnj. Brodie's Clinical Lec
tures in Med. Gaz.

The report is imperfect. It wouLl lead the reader to suppose that the
operation now so frequently perfor^ned was formerly very common and suc-
ceeded well. Then why, the reader ask?, had it fallen in'o disuse? Mr.
Kcate, w^e believe, said he saw it performed nvny years ago. He did not
say that he saw it often performed ; indeed we have reason to think that he
did not. Bat the operation that Mr. Keate saw v.-as not the operatioti now
in use for, in the former, the skin wns divi led as well as the tendon,
and in the present operation it is not divid -d. This makes a vast difference.
Medico- Chirurgical Revis w.

On Extra-uterine Pregnancy. By J. E. Dezeimeris, M. D. Respecting
the seat of this abnormal conception, ten varieties are enumerated ; 1st.
Ovarian pregmncy. 2d. Siib-peritoneo-pelvic. 3d. Tuho-ovp-r'an. 4th
Tubar. 5th. Tabo-abdominai. 6?.h. Tubo-utero interstitial. 7?h. Utero-
interstitial. 8th. Utero-tubar. 9ii. Utero-tubo-abdominal. lOfh. Abdo-
minal ; primitive secondary. M. Dezeimeris raises, in limiiie, the question

1839.] On Extra-TJicrine Pregnancy, 255

of the possibility or impossibility of ovarian pregnancy. MM. Prevost and
Damas have proveJ the iiiiportant office of the spertnatic animalculsp in the
act of fecundilion, but not tiiat th^ir actual introduction into the ovule i. ne-
cessary to vivitication ; nor y 't that these animalcuhe, imprisoned in the ca-
vity of the womb, wait there for 'h; descent of an ovule. C)u the cf)ntrary,
tubal pregnancies are inrontestabJe and uncontested ; and, as it is not to be
supposed that the fostus developed in the tube had been U'cundated in the
womb, and had thence re-ascended tf> its narrow alode, so must its vivifi-
catioii in the fallopian tube, be admitted by all. This tirst he\u\* gained, the
succ^elinr w.II hi inib With co ajj ir.itive ficility. E/en tho.-'e who deny
the possibility ot impresination takinr place while tiie ovule is yet enveloped
by the investment of the ovaries, must yet admit some vivifying influence
t!jat induces the ovule to burst its boundary walls arid descend through the
lube. Of the second varietv are cited two ca.^ies where a fcetus was found
between the layers of thr broad ligiment?-, one of them dissected by Profes-
sor Ijobstein. Among all thf c-is s u-^on recoil o^u'>To-inters'i ial pregnan-
cy, the most valuab'e tor the au hentic -y of its details is that communicat-
ed by Dance to M. Brr'schef. I is evident in tliis case that the pregnancy
wa^ really an! purely in er^titia', that is. withouithe participation of the fal-
lo:>iari lube in the wall of the cyst c >ntoimng the foeMjs ; the tube, in tra-
versing the uterus vv-is co.mected with the wall of the cyst, and presented
in one po nt an open ng, which was ind -^ed taken for a rupture made in de-
tacliin? ^h"^ pi icenta, bu*; wh )'e exi^^tence more probably preceded the pas-
sige of the fjBtus into th3 substance of the uterus. This circumstance of the
case conducts us by insensible gndations from the tubo-utero-interstitial
pregnan.-'y to the simple intt rstirial, whose locf lity is more distant from the
t-.ibe, and very much diminishes the mystery with w-Lich some have invested
this state of parts.

Primitive abdominal pregnancy is interesting only as shewing upon what
parts the foe us is ingrafted, and hou' it supplies itself with the necessary
q lantity of blood. S 'con.lary abdominal pregnancy involves the discussion,
whether, as M. Gruillemot states, some cases of normal gestation may not
thus terminate, in consequ"^nce of rupture of the waJls of the uterus: in ei-
ther case, if the immediate danger be surmounted, the mother may sustain
her unborn offspring for an unlimited period in this new condition.

Pathological Analomy of the Extra-Uterine Fcetation. In these cases the
embryo generally retains i's proper membranes, viz: the chorion and amios,
and also the placenta, if if has survived the first days of its existence ; the pla-
centa is larger than natural, thin, furnished Vv'ith very small vessels; circum-
stances induced by the difficulty of obtaining an adequate supply of blood
from the neighboring organs. In the primitive abdominal pregnancy, there
is rarely an enveloping cyst that can be considered analogous to the cadu-
cus ; owing, no doubt, to the trifling inflammation produced in the fir^^t in-
stance by the presence, in the cavity, of the periioneum, of so small a body.
In the secondary form this cyt is always found, being indeed as necessary
a consequence in this case as its absence was to be anticipated in the last ;
for, whether trie t'cEtus be disengaged into the abdominal cavity, by rupture
of its envelope, as a tubal, ovarian, or other gestation, or by rupture of the
uterine walls, the presence of so large a foreign body could not but excite in-
flammation, the glueing together of the neighboring organs, and thus at last
a perfect cyst. As to the foe*us itself, I, a remarkable developement of the
osseous system has been observed in some instances, as well as the presence
of several teeth ; 2, a putrid state of the fcetus, the bones of which made
their exit from the body by different routes , 3, a dessicated or mummified
condition ; and, 4, its transformation into a chalky mass, into amazone, or
into bone. Examples of monsters in these situations are rare.

Of the mo^/j^r. The normal change in the size and vascularity of the ute-
rus, its gradual diminution and return to the condition of vacuity, as well ai

256 Medical InfeUi^nncf*,

the forrin^ion of ihe in m')rnnn (]oc*i]uH, r^re aitfR'fd by cnsep. Tiio ^p^^e
tionofmiik ;uul ihoiujMsriMTioM o")cy Hie tl?ual ln\s of natural j:es:atini1 ;
most uneasiness ?) th* n > li r ;s nee s o-u-ci by 'uhal an! i!-eri-iiitest;nal fcB-
tatinn : th's con lition o;T rs no in tt rial obsrar'<^ to n^^nrsl jrtstjitittn and de-
Jiverv. A* the I'vpjr ilion oftju- (ir bn irv perio!. rbib! bf (I pains Fupervrnp,
an! bist som? <lu>', an^l are oP*m rPMf\vpl n* i^re'v refzubtr iTjferval? i^Iong
as t',e nr<',' jinrv CM-rin'N's. B. and F. M>'d. Uec. from Juunml des Con.
nains. Mtd. Chir.^ Jan. ld'37. Am. J(.iir.

iMSDICAL l.\T[i:L!.lC:E>:CE.

In tbe last number o' tiiis Journa', for D.'comber, we announced the ofTer
of a medical (.remium of fif'^y d^ilbir?, or its f qnivalenf, 'o b<. designaled by
the successful conij e'itor, for ibe best apprt-xed essay *^on the use and abuse
of calomel, as a thf rapeudc a/jent."

On a reco! sideration of lbs subjec*, at tbe next meeting-, which was on
the oh December, it was de'crm:ne<l by tbe Society, for various good rea-
sons, to substitute i('r the subj;^ct first anrounced, the fol'owing: :

* On tli<' Pdthnht^rtj and Trcdtmenl of Congeslice Fecer"

Th!> fo!!owhi^u' J. re 'lie ;:riaj!L'"( men!? adopted by tbe rociety :

1. Tiio i'l.-siy shall iioi exceed 40 octfivo pages.

2. Essays, Milenil. d fnr '.he con ph*io: , are ; be dirr ctrd,//rp ofpxjP7tse,
"To the Secr^'thry of the Medical So:-ie!y of Au2f!istfs Ga." and must le in
hii possession by the 1st day of Mny, IS]9. Kach essay must be endorsed
with a jnoffo, which must be ;ilso otj ;i!i acco npanyinjj sealed letter, contain-
ing tlie name and address of tiie writer.

3. The Mr-d^cal Society wiH, as a bod}-, proceed to tbe readmg" and
inspection of all tiie essays received ty the S.'crefr>ry, as soon as practi-
cable after the 1st day of May, 1^:^,9, and wdl deterinine by the vote of
the majonty, on the successful essay. A f er siuh decision, *he letter bearinjr
the corresponding ^wo/^, will be oppne<', and lh^ essay published under
the name ofthe author, in the So'.Uhern Met^cal and Surgical Journal.

4. Siiould none of tl)e Essays be judied wor:hy of the prize proposed,
they will renriin in ih " hands of the Secretary, subjrct Ui the ord<T of their
authors, for three monihs, the nam 's rem ining und< r seal ; after whicli, if
not otherwi-^e directed, will be considered the property of the Society.

O' The Medical journals of^he United States, and also the Literary peri-
odicals, are respect folly reqi^ested to give notice of the same by publishing
the ahovo.- '[Ext! act Jrani the Minutes.

SOUTHERN MEDICAL

AND

SURGICAL JOURNAL.

Vol. III.] FEBRUARY, 1839. [No. 5.

Part 1. ORIGINAL COMMUNICATIONS.

ARTICLE I.

A Treatise on Malignant Pustule, By Wm. M. Carpenter,
A. M. M. D. Professor of Chemistry and Natural History, in
the College of Louisiana, at Jackson.

Beautiful as is the structure of man, and perfectly adapted as
it may be, to the place which it fills in creation, many of the most
serious diseases to which he may be subject, arise, as a necessa-
ry consequence of this refinement of organization ; for, it is with
the animal system, as with machinery, the more complicated it
is, the more liable it becomes to derangements, and these aberra-
tions are called disease ; and it is a general law of nature, that
when an organized being has filled its station a certain time, per-
formed certain functions, and perhaps become unfit for their fur-
ther performance, it shall give place to others. Man, whom we
consider as the chef d'ouvre of organization, soon passes through
his bright and ephemeral career, and becomes a denizen of the
past; while some of the lower order of animals, as the toad and
tortoise, seem to be almost " impervious to the shocks and muta-
tions of time ; generations flourish and decay, age after age pas-
ses by, and they still drag on their languid and unsympathising
existence, denied all the pleasures of life, save life's passive and
dream-like perception. They seem to bear a charmed life ; the
common causes of dissolution cannot quench in them, life's slug-

A 1

S38 A Treatise on Malignant Pustule, [Feb.

gish spark ! the inexorable death that spares not pomp and beau-
ty, passes by things to which death could bring so insignificant a
change."

There are, however, diseases which have no perceptible con-
nexion with those laws of organic life, or with the wear and tear
of organism ; they shorten the period of man's natural existence,
but do not seem to have emanated wdth the rest of his ills from
the box oi Pandora, nor naturally to form a part of his rich her-
itage of misery. Among these, we find those diseases called
epizootic ; they belong properly to the brute creation, and often
make great havoc among the domestic tribes of animals. But
this destruction of property is not the circumstance which calls
for our attention ; the fact of their occasionally making man their
victim, gives them a claim upon us, and renders them worthy the
attention of the medical profession.

Standing in this list, is the disease termed " Charbon," the one
in which we are at present principally interested. It frequently
occurs as an epidemic among domestic animals, and is some-
times communicated to man, by inoculation or otherwise, and it
then receives, by consent of surgeons who have written upon the
subject, the appellation of" Malignant Pustule."

History. It is said to have been observed in this country
(Louisiana,) at an early period after its settlement by the French
and seems to have made its appearance among the deer feedin;
among the salt-marshes, near the sea, west of the mouth of th
Mississippi river. It afterwards attacked the cattle of the plan
ters on Bayou Lafourche, returning annually, and gradually ex-
tending its ravages over those districts, in which the benefits of
grazing had been appreciated, and turned to account by the in-
telligent and enterprising farmer.

This disease, though it appears to have been of comparatively
early occurrence in this region, and is now seen in nearly every
part of this state, seems not to have been even noticed in the
medical annals of America.* Some of the British surgeons

* This treatise was presented to the Faculty of the Medical College of
Louisiana, as a thesis, in April, 1836. Since that time, I have had the plea-
sure of perusing a most excellent article on this subject, in the American
Journal of the Medical Sciences, by Dr. C. W. Pennock, who has described
this disease in a most lucid and beautiful manner, and has given us many va.

1839.] A Treatise on Malignant Pustule, 259

mention it as endemical to some of the southern provinces of
France ; but they all coincide in saying that it is never seen in
England. It is, how^ever, very common in some of the provin-
ces of France, and occurs very frequently as an epidemic in Lor-
raine, Franche-Comte and Burgundy. In these countries, we
learn from writers on the subject, it is very common in low and
marshy regions, becoming epidemic after the great heats of sum-
mer, and when from inundation of the meadows, the grass be-
comes injured, is loaded with dead insects in a putrifying state,
and is thus rendered unwholesome, and produces in the animals
that feed upon it, diseases of a low and typhoid or charbonic
type ; the virus of which, when inoculated on man, produces the
disease called Malignant Pustule.* The epidemics of Charbon
among cattle, are recognised by planters, by the animals being at-
tacked, when in full health, by a swelling, often seated about the
throat, and dying in a few hours, if some efficient remedy is not
immediately applied. The common remedy, and the one which
seems to be nearly always used with success on animals thus at-
tacked, is, to burn the part with spirits of turpentine.

If an animal which has died in this way be skinned, as is
sometimes the case in neighbourhoods where this disease is not
common, and the people not familiar with it, fatal consequences
are the frequent results, to those who do it. Dogs, buzzards,
and all animals which feed upon the flesh, often die of the same
disease.

Causes. Though the causes of this disease are sometimes
hidden, and the origin in many cases equivocal, there are some
circumstances which are almost invariably connected with the
commencement of the epidemic in animals, and have been as-
signed by French authors as causes ; they are, low and marshy
districts, and very wet and hot seasons. That these may be pre-
disposing causes, is, perhaps, probable ; but some other cause,
efficient to the production of the disease is still wanting, as will
be hereafter shown.

I do not believe that the malignant pustule ever occurs, spon-
taneously, in the human subject, although M. Bayle addressed a
dissertation to the Medical School at Paris, in 1810, in which he
gave a series of observations, which he thought went to prove,

* Boyer, Maladies Ctiirurgicales.

2(50 A Treatise on Malignant Pustule, [Feb.

that the disease might develope itselfindependently of contagion.
But if we consider, 1st, that he says, that it was epidenjic among
the cattle of a village in the immediate neighborhood of the place
at which his observations were made, at the same time with the
pustular epidemic that he was observing ; 2nd, that the disease
always presented itself on some part habitually uncovered, and
generally on the face ; 3rd, that those persons who were confin-
ed within doors were never attacked by the disease we will
readily perceive, that his observations could not have warranted
his deductions.

The malignant pustule, is, generally, a purely local disease,
appearing, in the majority of cases, to have a local and external
cause, as the contact of substances that have been impregnated
with the virus arising from carbunculous diseases, or from touch-
ing a part that is the seat of malignant pustule. The chief agents,
however, of communication, are, probably, flies, which have fed
upon the carcasses of animals dead of charbon. There are many
well attested cases of the disease having occurred after the bite
of these carnivorous flies; which have led many to suppose that it
was a peculiar insect whose sting, or bite, produced the disease,
whereas they only inoculated it from other animals.

Dr. Samuel Cooper, speaking of it, says,* " The malignant
pustule, if the accounts of its origin be correct, is a singular and
peculiar disease ; for, instead of proceeding from internal cau-
ses, like all other carbuncles, it arises from contagion, derived
from animals affected with malignant pustule, or carbuncular dis-
eases. The infection is represented as being communicated to
the human subject by contact, respiration, deglutition, or the
bites of insects. * * Notwithstanding the multiplicity of au-
thorities in support of this account, some doubts may be ration-
ally entertained, respecting its accuracy, when it is remembered,
that the alleged causes exist in England, yet we have no disease
which corresponds exactly to the malignant pustule. The
French writers specify want, poverty, unclealiness, marshy sit-
uations, and the autumnal season, as predisposing causes. Were
all these circumstances, however, adequate, of themselves, to the
production of the disease, it would certainly be seen in some
parts of this kingdom. There must, therefore, be other things

Surgery, vol. 1, page 32.

1880.] A Treatise on Malignant Pustule. 261:

which contribute to its production, and render it endemical in the
southern provinces of France."

In the disease under consideration, there is no predisposition,
nor is the supposition of the existence of predisposing causes
warranted ; for whenever inoculation is effected in man, the dis-
ease will occur, independently of idiosyncracy or predisposing
causes.

It may be asked, whether the introduction of the virus of char-
bon into the intestinal canal, would produce the same deleterious
effects on the animal economy, as when applied to the external
surface ? This is a problem very difficult of solution. It has
been maintained by many, that the virus has no deleterious ef-
fect when applied to the internal surface ; and there are many
cases on record, which have been brought up to prove the truth
of this assertion. Morand, in his Opuscules de Chirurgie, speaks
of two butchers of the Hotel Royal des Invalides, who were at-
tacked with this disease, after having killed two beeves, which
had been brought from a distance, but which were fat and ap-
peared healthy : the flesh was well tasted, and produced no ill
effects on those who ate of it. Duhamel reported a parrallel
case to the Academy of Sciences : and the case from Boyer, ap-
pended at the end of this treatise, is still further illustrative of this
supposition.

On the other hand, Eneaux and Chaussier, in their "Precis sur
la pustule maligne," give facts which conflict with those above-
mentioned, and tend to show, that the charbonic virus taken into
the stomach, has caused gangrenous inflammations of that vis-
cus, and prompt death : that it is less active when taken into the
lungs by respiration, but still producing a malignant fever which
terminated by fetid evacuations, or other disagreeable effects of
this kind of fever. Orfila, also, relates many cases: he says that
" a boy undertook to skin an ox that had been killed at a tavern
in Gatinois, because it was sick, and inadvertently carried the
knife to his mouth. The tongue soon swelled ; he experienced
a tightness about the chest ; the body was covered with pustu-
lae, and on the fourth day he died, affected with general gan-
grene. In the 34th number of the American Journal of Medi-
cal Sciences, page 481, we find, under the head of " Observa-
tions on Malignant Pustule," an extract from Hufeland's Jour-
nal, a communication made by Dr. Wagner, on an epidemic

^^^ A Trectiss on Malignant Pustule, [Feb.

which prevailed at Striesa, in Prussian Saxony, in 1834, which
killed the animals attacked by it in a very short time. He says
that the animals all burst, and exhibited the follovv^ing appearan-
ces : the abdomen inflamed, the spleen gangrenous and putres-
cent, consisting but of a m.embrans in tiie form of a sack, con-
taining a thick black liquid ; i^ several places about the neck,
were oidematous tumours. M. Wagner gives it the name of
" gangrenous spleen," (Milzbrand,) from the state of that organ,
as found in all the infected individuals examined ; and to the
septic principle which appears to generate the malady, " virus
of gangrenous spleen, (Milzbrand gift)."

He says, that the disease was communicated to man, not only
by inoculation, but in many cases also by ingestion : that in
some cases, the flesh when eaten produced only serioijs indispo-
sition, without any external eruption.

The disease described in this article, is frequently epidemic in
some parts of the continent of Europe, and is described by
French writers, under the name of " sang de rate" ; it is very
diflferent from the epizootic, w^hich gives origin to the disease
commonly called by surgeons malignant pustule. Dr. Wagner
seems to confound the malignant pustule, with some of the other
carbunculous affections, which differ from it very widely, but
which resemble, in many of the main points, the disease describ-
ed by him. When we take these facts into consideration, and
many cases of equivocal origin, which have occurred in this
country, it is rendered highly probable, that it may be communi-
cated in this way, or, at least, that this principle, whatever it
may be, that produces the disease under consideration by inoc-
ulation, may, when applied to the internal surface, produce
carbuncular diseases of a serious character. Let this be as it
may, the inhabitants of districts in which this disease is epidem-
ic, cannot be too careful on this point, and sbould always reject
flesh or milk to which the least suspicion is attached.

Symptoms, In order to be more exact in their descriptions,
the French writers have divided the disease-into four periods :
but the symptoms run into each other very much ; and in this
country there are but few cases in which the disease passes re-
gularly through all the stages. The following is an abridged
translation from Baron Boyer's Maladies Chirurgicales, with

lSCf>.] A Treatise on Malignant Pustule. S68

such modifications as I have found necessary, in order to adapt
them to the disease as occurring under my own observation.

First period, " The septic virus having been apphed to the
surface, penetrates the integuments ; but its action is at first so
feeble that it rarely attracts any attention ; in fact, there is, as
yet, neither redness, heat, nor tension, in the part which is the
seat of inoculation ; the subject experiencing only a slight itchi-
ness or pricking, which is but occasional : soon the epidermis be-
comes elevated in the form of a serous vesicle, at first of the size
of a millet seed ; it augments gradually, becoming brownish;
opens spontaneously, or is torn by the patient in scratching ; a
few drops of a reddish serosity escapes, and the itching ceases
for some time, or gives place to smarting and pain.

Second period. " The poison passes the proper skin, the irri-
tation ceases, and there may now be felt a little, hard, and cir-
cumscribed, moveable and flattened tubercle, about the size and
shape of a lentil. The colour of the skin is not yet altered, ex-
cept in the centre, and under the vesicle it is yellowish, or a little
livid, as is seen in some of the psoric or venereal pustules ; the
patient now experiences sensations of heat, smarting, and gnaw-
ing ; the engorgement spreads ; the parts become turgid, and a
more or less extended circle is formed around the spot, the pe-
riphery of which is sinused and sahent, and always covered with
little phlyctense; filled with an acrid serosity. The disease now
assumes a dangerous character. It is at this time that the at-
tention of the person and his friends is called to it, as something
serious, and the assistance of art becomes necessary. The cen-
tral tubercle becomes brown or blackish, and the gangrene,
which has already taken place, rapidly spreads.

Third peidod, " The gangrenous point quickly extends in a
sudden and most alarming manner ; the vesicular areola enlar-
ges, and forms around the gangrenous part an elevated ring,
which makes it appear sunken in the centre ; the engorgement
has its seat principally in the cellular tissue; it is neither cedema-
tous nor inflammatory ; it has more the character of emphyse-
ma, which it similates, sometimes, still more closely by the cre-
pitation, which no doubt depends upon the gangrene, as it is only
perceived after this has made considerable progress ; and it has
been said (by Boyer) never to accompany this disease. The
tumour is hard and elastic, and the skin is red, erysipelatous and

264 A Treatise on Malignant Pustule. [Feb.

shining. The heat and pain give place to a numbness and sen-
sation of weight, and the mortification extends insidiously in the
subcutaneous cellular tissue.

Fourth period, " This period varies much, according as the
termination of the disease is fatal or favorable ; if the former, the
disease extends to the neighbouring parts, the engorgement be-
comes enormous, and the mortification penetrates deeply."
Soon symptoms of internal disease are developed, and the ap-
pearance of ataxic or adynamic fever of the worst character,
shows that the circulatory and nervous systems are implicated,
and it is this participation that leads the patient to the grave.
The pulse is now small and concentrated ; the patient is ex-
tremely anxious and restless, with a feeling of faintness and of
approaching dissolution ; the tongue becomes dry and brown ;
an obscure delirium sometimes supervenes, but this is, by no
means, a constant nor even a common symptom in the disease
as it occurs in this country ; the patient often retains the pow-
ers of his mind, unaltered, to the last moment of his existence.

When to the contrary, the issue of the disease is favorable,
an inflammatory circle, of a lively red, appears around the es-
char ; the engorgement diminishes ; the patient experiences a
sensation of heat in the part, accompanied by throbbing ; the
pulse becomes regular and healthy, and instead of the small,
tense or varying pulse, we have it full and soft ; the patient re-
gains his strength ; suppuration is established between the in-
flammatory circle and the eschar, which separates from the living
parts, leaving an excavation which is gradually filled up by gra-
nulations.

Diagnosis. The only diseases with which the malignant pus-
tule can be confounded, are the carbunculous affections ,* from
these it may be distinguished by many circumstances. Carbun-
cles may attack an individual in several points simultaneously ;
the malignant pustule is, perhaps, almost invariably single;
though there is no doubt, if inoculation were effected in more than
one place, there would be as many pustules as places of inocula-
tion. The former is always accompanied or preceded by fever,
or some other indisposition ; but the malignant pustule is at first
a local disease, and febrile symptoms only supervene after the
disease has made considerable progress. They also diflfer as to
their cause ; the carbuncles always originate in, or are connect-

1839.] A Treatise on Malignant Pustule. 26ft

ed with, some idiosyncracy or peculiar state of the general health.
Whereas, the malignant pustule has, as has been already stated,
a local cause, and is not essentially connected with a constitu-
tional affection. The peculiar, elevated, and phlyctenous bor-
der, is, however, the most marked characteristic.

Prognosis, This varies from many circumstances ; the seat
of the disease, its progress, the constitution and age of the pa-
tient, and the peculiarities of the epidemic ; but under whatever
circumstances it may occur, it is a dangerous and highly disa-
greeable disease. Very hot or very cold weather, is said by
the French surgeons, to aggravate the nature of the affection.
It is said to produce abortion in women who are enceintes, and
afterwards to prove fatal, in consequence of the debility which
results from hemorrhage, and the fatigue of labor. There are
many cases in which the most powerful agents are brought into
requisition in vain ; the disease runs on in defiance of our efforts
to produce a change of action in the affected tissues ; the swel-
ling extends over the neighbouring parts, no inflammatory circle
separates the dead from the living tissues ; the low typhoid pulse
soon points out the peril of the patient, and confirms the physi-
cian in an unfavourable prognosis. Fortunately, however, such
is not the most frequent termination of the disease ; and hope
may be entertained after it has made considerable progress, that
a change in the condition of ihe part may be produced, and that
a corresponding change in the constitutional symptoms will
follow.

Treatment. This must of course vary, according to the stage
in which the patient is seen. In the earlier periods, before symp-
toms of ataxic or adynamic fever have shown themselves, and
the disease is entirely local, the first indications to be fulfilled,
are, to protect the surrounding parts from the action of the vi-
rus, and to concentrate this action to the point originally occu-
pied by the disease. The means best calculated to fulfil these
indications are, incisions, and the application of caustics ; these
then should form the basis of our treatment.

When the disease is first discovered, under the form, perhaps,
of a vesicle filled with serum, it should be immediately opened by
a free incision, in order to evacuate its contents ; the surface
should then be cleaned, and completely dried, by wiping with a
soft cloth; and a pledget of lint soaked in the chloride of anti
B 2

866 A Treatise on Malignant Pustule. [Feb.

mony or liquid caustic potash, or a piece of solid caustic potash
should be applied to its central part, covered with a piece of dry
lint, a strip of adhesive plaster, and a bandage.

Baron Boyer rennarks, that ' caustics are curative agents of
the greatest efficacy in this disease : they combine the advanta-
ges of concentrating the septic virus in an eschar, of hmiting its
activity, and preventing in a great measure its effects. They
have another important effect : it is to restore the vital actions in
the neighbouring parts, excite their sensibility, and thus bring on
a true inflammation, which will mark the limits of the gangrene.
The disease then loses in a great measure its malignity ; or,
more strictly speaking, nature is restored to her prerogatives,
and has sufficient power to resist the destructive effects of the
virus."

Tavernier says, that the apparatus above recommended
should be removed in about five or six hours ; but two or three
hours is long enough : the eschar should then be dressed with
pledgets of lint smeared over with some stimulating ointment or
lotion. The next morning the parts should again be examined,
and if the engorgement has not increased, and there be no new
phlyctense, but only a moderate degree oftension and heat, there
will be every reason to beheve that the remedies have had the
desired effect, and the disease is entirely destroyed. We should
then promote, by every means in our power, the separation of
the slough.

If, on the contrary, the parts are covered with new vesicles,
or a hard and compact tumour has formed about the eschar, or
much swelling, it will be necessary to return again to the caus-
tics, with the precaution of removing the eschar, so as to be able
to apply them to the parts not affected by the other applica-
tions. The best escharotics in these cases, are, caustic potash,
the nitrates of silver or mercury, nitric or muriatic acids, chlo-
ride of antimony, or what has been preferred by many surgeons
of distinction in France, the actual cautery ; tliis possesses many
advantages, and when in skilful hands, is perhaps always to be
preferred. In using the actual cautery, the iron should be mas-
sive, so as to ensure a deep burn, at least through the eschar al-
ready formed, otherwise its salutary effects will be almost en-
tirely lost.

Incisions are of advantage, by procuring the discharge of the

1

1830.] A Treatise on Malignant Pustule, 267

extravasated fluids contained in the cellular tissue ; and by per-
mitting the remedies to act on the parts threatened by gangrene;
but to obtain these advantages, they ought not to be too deep
nor too superficial ; when too deep they produce injuries on the
living parts, thus increasing the liability to extension of the mor-
tification, they favor the propagation of the disease to these parts;
and cause a profuse hemorrhage, which might prove very incon-
venient in the application of other remedies. When not suffi-
ciently deep they do not divide the eschar down to the parts to
which we wish to apply our remedies. When the actual cau-
tery is used, incisions are nearly useless.

Such is the treatment that is adapted to the first stages of the
disease, while the general health has not suffered ; but later ia
the disease new and violent symptoms make their appearance,
and unless they are successfully combatted, and a change can
be produced in the condition of the part, the patient is almost
inevitably lost.

When the disease has run on to the fourth stage, escharotics
are much less efficacious than in the preceding stages ; it is,
however, still necessary to have recourse to them. We must
make use of such topical applications as are fitted to restore a
healthy action in the part to develope a well conditioned in-
flammation to induce an active suppuration to take place spee-
dily and kindly, which may relieve the engorged vessels, and
enable nature to cast off the disorganized tissues. The parts
should be washed with camphorated alcohol, or what is per-
haps better than almost any other application at this stage, La-
barraque's chloride of the oxide of sodium ; Dr. Pennock recom-
mends an alkaline poultice, very highly, made of flour and lie ;
but the chloride of soda is perhaps preferable. A poultice of
powdered cinchona would prove a good application, at this peri-
od of the disease its efficiency in other kinds of gangrene is un-
doubted diluted pyroligneous acid, or the highly lauded kreo-
sot would, no doubt, prove valuable adjuvants at this stage.

In this stage the disease is generally complicated, as has be-
fore been stated, and we have to direct our treatment to combat
constitutional affections of the most serious character. If the
slough is extensive, or the suppuration very profuse, the indica-
tions will be the same as in typhus fevers from other causes
all the functions of life are languid ; it is necessary to have re-

2G8 A Treatise on Malignant Pustule. [Feb.

course to energetic measures to restore these functions to a pro-
per condition, and to support the strength of the patient. The
preparations of bark are the best adapted to the fulfilment of
these indications ; and whenever they have been made use of,
they have produced the most satisfactory results.

It would be superfluous after what has been said, to say any-
thing against the abuse of relaxing agents, purgatives, emetics*
or general depletion ; they are generally contraindicated ; will
seldom fail to aggravate the constitutional symptoms, and are
always dangerous on account of the prostration they produce.

The condition of the bowels, should, however, particularly
engage the attention of the physician, as a diarrhoea would be
highly dangerous at this time ; tending, as it necessarily would,
to increase the debility, which even in the regular course of the
disease, is often a formidable part of the affection.

Tonics cannot be too much insisted on in every stage of the
disease, but more particularly when the part implicated is
extensive, or the suppuration is profuse. Of the prepara-
tions of bark, we have already spoken : these should be ap-
plied in as many ways as possible, both to the affected part and
taken internally. If the patient suffer from nausea, as is some-
times the case, the administration of quinine, in solution, by way
of enemata, will of course suggest itself to the practitioner. In
fact, this mode of administration is the best for quinine in the ma-
jority of diseases. The bark of the fringe tree (Chioranthus Vir-
ginica), the Chene bleu of the French Creoles, has been used by
the inhabitants of the western portion of this state, with great
success in the treatment of this disease. It is, hence, called by
them charbonwood, "Bois de charbon"; a poultice is made of the
bark, finely pounded, which is applied to the diseased part, while
a strong and most intensely bitter decoction is given internally.
It is considered by them as a specific, and no doubt has an admi-
rable effect, and may be used with great advantage as a substi-
tute for ci^hona ; for there can be no doubt that it depends for
its efficacy upon its powerful tonic properties.

Diet. The diet in the commencement of this disease should
be absolute ; permitting only rice or barley water ; but in the
latter stages, when the gangrene is considerable, or the suppu-
ration great, acidulated drinks, or any of the good wines diluted
with equal parts of water, may perhaps be allowed : a vegetable

183a] A Treatise on Malignant Pustule. SG9

diet is always to be preferred in the commencement of the dis-
ease, to an animal food. By administering wine and animal
food, in the early stages of the disease, when there is a tendency
to gangrene, the febrile heat and frequency of the pulse are in-
creased, always tending to increase the suppuration of later sta-
ges of the disease ; the stomach is loaded, the patient becomes
restless, sometimes delirious, and his situation is rendered dan-
gerous, and too often hopeless. A less stimulating regimen gives
the organs time for the performance of their functions, and af-
fords an opportunity for the administration of as much of a bland
and nourishing aliment, as patient's appetite requires, or his sit"
uation will warrant.

After gangrene has taken place extensively, and during the
separation of the mortified parts, the patient may be allowed
such food as may be deemed best to support his strength ; mode-
rately rich broths, or light meats, as mutton or chicken, may be
allowed in very moderate quantities. The drinks of which we
have already spoken, as proper for this stage, may also be taken
in moderate quantities. The regulation of the diet, in affections
of this kind, is of the highest importance ; and it is probable, that
if this were properly directed, with reference to the condition of
the patient, and the stage of the disease, no other internal treat-
ment, except the administration of tonics, would be necessary.

Cases, The first cases that will be given, are translated from
Boyer^s Maladies Chirurgicales, and show the mode of occur-
rence of the disease in Europe, and illustrate the practice of two
of the most distinguished surgeons, of that time, in Europe.

"In 1791, four persons, of whom three were butchers, and the
other the wife of one of them, bought at Mont-Rouge, near Pa-
ris, an ox which had died of charbon ; they divided into small
pieces, which they conveyed, clandestinely, into the capital. It
was sold, and no one who ate of it experienced the least incon-
venience from it ; but two of the butchers were attacked with
malignant pustule. The disease manifested itself, in both, be-
tween the angle of the jaw and chin, by a small lump surmount-
ed by a vesicle. A physician and a surgeon were called in, but
they mistook the disease for erysipelas ; bled both of them from
the arm and foot ; they died on the third day.

" The woman was attacked about the same time. The pus-
tule showed itself at the anterior part of the neck, under the base

370 A Treatise on Malignant Pustule. [Feb.

of the lower jaw, and made rapid progress. The engorgement
became considerable, and soon began to interfere with respira-
tion and deglutition. M. Larrey having been called in, recog-
nised the nature of the disease ; but as he considered the case as
very serious, had me called in consultation. The patient was
scarcely able to breathe ; the pulse was extremely weak, and
the prostration extreme ; an eschar of considerable extent occu-
pied the parts which had been under the vesicle. We scarified
the gangrenous part, and touched the bottom of the scarifications
with the nitrate of silver, and administered tonics and cordials
internally. This practice being followed up, the patient was
much relieved the next day ; the respiration became much more
easy ; the use of cinchona, in large doses, raised the pulse ; the
mortification was limited by a line of inflammation ; the eschar
became detached, and the cure was complete. The loss of sub-
stance, however, was great; the cicatrix formed a kind of fre-
num which extended from the chin to the clavicle, which inclined
the head to one side.

" In the third of the butchers, who was the woman's husband,
the pustule appeared upon the lower part of the right cheek :
we applied the caustic, which arrested the progress of the dis-
ease at its commencement. We administered, at the same
time, Bordeaux wine and cinchona, and our patient was quickly
restored to health."

The following cases occurred in this immediate vicinity, and
under my own observation.

Case 1st. A negro boy, aged 18 years, of good constitution,
vras attacked with malignant pustule on the 20th August, 1835,
The charbon was, at this time, epidemic among the cattle in the
neighborhood ; but this boy had not been about animals thus af-
fected cause of the disease, in this case, unknown. The pus-
tule appeared about the middle of the right cheek ; the swelling
increased rapidly, and a physician was called, who applied cups
to the part, w^hich was afterwards blistered, and a poultice of
poke root (Phytolacca decandra) was applied. Though not
practising at that time, I had an opportunity of watching the dis-
ease in its progress and termination. The remedies applied did
not seem to check or alter in any way the course of the disease.
The swelling increased rapidly, difficult respiration and degluti-
tion ensued on the fourth day, accompanied by delirious and in-

1830.] A Treatise on Malignant rustule. 271

terrupted sleep, and slight fever. On the fifth morning he died ;
the tumor at this time, extending from the clavicle over the neck,
throat, and entire face, rendering this latter an almost shapeless
mass, and entirely closing the eyes. The gangrene had extend-
ed, in a circle, to several inches from the centre.

Case 2nd. Negro man, aged 21 years, good constitution, was
attacked a few days after the last case the vesicle appeared in
the same region ; the same treatment was pursued as in the last
case ; but at my suggestion the actual cautery was applied, and
large doses of quinine were given internally, and a rapid conval-
escence commenced on the fourth day. Slough considerable.
Charbon still epidemic.

Case 3rd. Negro man, aged 22 years, was attacked on tlie
16th of October, the same year. The pustule appeared on the
upper and back part of the cheek ; it commenced to swell rapid-
ly ; the actual cautery was applied ; a poultice of powdered cin-
chona was applied after it, and amelioration of the symptoms was
almost immediately perceived. Quinine was given in conside-
rable doses, and on the fourth day the swelling had subsided con-
siderably, the pulse was good, and the convalescence progressed
rapidly ; slough small ; the resulting cavity filling, as usual, by
granulations ; charbon. still epidemic among the cattle ; but this
man, as the others, was not aware of having been near any ani-
mal affected by it ; he said that a fly bit him on the part before
the appearance of the pustule.

Case 4th. A negro man, aged 19 years, good constitution,
was attacked by the disease on the 27th October the pustule
and lump came about the middle of the left che^k. In this case,
as no iron was at hand, a small piece of caustic potash w^asused;
the place was afterwards dressed wnth cinchona, as in the pre-
ceding case ; quinine was also administered internally ; conval-
escence commenced immediately ; healthy inflammation was
produced, with suppuration, and on the third day afterwards, he
was able to do light work. Charbon still epidemic.

Case 5th. Negro man, aged about 22 years, had always
been healthy ; attacked on February 20, 1836 the pustule ap-
peared about the middle of the right cheek the actual cautery
was applied on the second day, and followed by the application
of the bark poultice, and internal administration of quinine. On
the next day, there was a decided amelioration of symptoms,

372 A Treatise on Malignant Pustule. [Feb.

and his convalescence progressed rapidly during two days,
when he was seized with inflanrimation of the lungs, and died on
the fifth day after the relapse. Charbon not epidemic at that
time.

Case Gth. A negro man, aged about twenty years, of strong
constitution, was attacked on the 23rd of March, 1836 the pus-
tule came on the back part of the right cheek on the 24th,
cups were applied by the physician attending, and blisters over
the part ; he became much worse ; and on the 25th, I was caHed,
and found the engorgement very great and spreading rapidly ;
the gangrenous part was about an inch and a half in diameter.
Caustic potash was applied ; and as I had no powdered cinchona
with me, I ordered a poultice of the boiled and pounded red oak
bark ; and gave quinine, hourly, in doses of one grain. The
next day I found him much improved, and his convalescence was
uninterrupted ; but the cavity left by the slough filled out very
slowly by granulations. Charbon not epidemic.

Case 7th. A mulatto child, aged five years, has always been
remarkably healthy until the present the pustule appeared on
the 27th of April, 1836, on the upper and back part of the right
cheek, near the under edge of the zygomatic arch it was pick-
ed by the child's mother with a needle, and found to contain a
drop of reddish serum, or very thin blood. After this time no
attention was given to it, as the charbon was not epidemic, and
the pustule excited no alarm. On the 29th, however, there was
a considerable tumor observed at the same place, with it's apex
or centre depressed ; but the child did not complain of pain, but
only of itching, and it was with difficulty that he was prevented
from scratching the part. On the 30th, the actual cautery was
applied, but the iron used was very thin, and the person who ap-
plied it very timid ; and the cauterization was rendered ineffi-
cient by not having been sufficiently deep to reach the parts sit-
uated beneath the gangrene. It was also scarified, and a blis-
ter was applied.

May 1st. I was this morning called in, and found the boy in
the following condition pulse 120 a minute, quick and thread-
like, subsultus, and irregularity in all his motions, showing that
the nervous system is implicated ; tongue covered with a dark
coat ; the swelling is very great, extending from below the clavi-
cle over the whole face, so as entirely to close the right eye, and

lS3d.] A Treatise on Malignant Pustule, 273

nearly to close the left ; the gangrenous eschar is about two in-
ches in diameter, and not circumscribed. Incisions were made
through the eschar, and liquid caustic potash applied ; a poultice
of poke root was afterwards applied, and quinine given inter-
nally. Prognosis unfavorable.

May 2nd. Swelling much increased ; pulse 125, weak ; mor-
tification rapidly spreading ; great ardor-urinas, perhaps from
the blistering of yesterday. May 2nd, evening very restless,
considerable difficulty in breathing, on account of the great
swelling.

May 3rd. Died this morning, at seven o'clock, without suf*
fering any mental derangement to the last.

Autopsy, three hours after death. Stomach pale, containing
watery fluid mixed with mucus ; large intestines having patches
of deep red, produced perhaps by woYms, of which it contained
a large number, and of great size. Liver and spleen healthy.
Mesentery also healthy. Lungs healthy, v/ithout any appear-
ance of inflammation. Heart having the appearance of intense
inflammation ; ventricles filled with uncoagulated blood ; the in-
flammation seems to have travelled along the veins from the seat
of the disease to this organ ; the columnae and parietes of the
right ventricle very much softened, so much so, that the dissect-
ing hook tore out, with the weight of the heart, though stuck in
to its full depth, in a direction transverse to the fibres ; all the
appearances of this organ, and the veins between it and the seat
of the disease, were those of phlebetes. As there was no men-
tal aberration, the encephalon was hot examined.

Case 8th. A young man, a white man, was attacked by the
pustule on the 6th March, 1837. He said that a fly had bitten
the part, about a day and a half before the disease first appeared,
and that he had felt from that time a kind of itching sensation.
Saw him on the 7th, the pustule was situated on the back and
lower part of the cheek, near the angle of the jaw ; I applied a
small piece of solid caustic potash, and made use of. the bark
poultice, with quinine internally, and on the next day found him
doing well. His convalescence was uninterrupted ; the part
gradually filled out, and left but little disfiguration. Charbon
has occurred in the neighbourhood lately, and several animals
have died on the farm of the father of the young man.

I have chosen these cases from among a great many, as being
c 3

274 Report on the Ligamenium Deniis, [Feb.

illustrative of the mode of occurrence of the disease ; and though
I could increase very greatly the number of cases, I refrain from
doing so, as the treatment has but little varied, and pathology
adding no new light, it would but serve to render this treatise
more prolix than is desirable.

From a careful observation of the cases I have seen, I am led
to believe, that the disease is essentially gangrenous from the
commencement ; that is, that there is gangrene before the phlyc-
tense make their appearance ; and that these vesicles are the
result instead of the forerunners of the gangrene the conse-
quence of this is, that any attempt to bring about resolution must
fail, as there will necessarily be a slough of this gangrenous
part, which will be smaller, the earlier a line of demarcation is
estabhshed between this and the sound parts. These points,
however, as some others that I have advanced, may, and pioba-
bly will be disputed by some; of course they are open to discus-
sion, and court investigation. I have not written to convince,
but merely to excite this investigation. And if this treatise can
direct the attention of our profession, to a disease that has of late
years brought dismay into some of our finest districts if it can
induce the experienced to bring forward their observations, and
excite the enquiry of the scientific, its objects will be attained^
and its author more than compensated.

ARTICLE II.

Report on the Ligamentum Dentis,

At a recent meeting of the Medical Society of Augusta, Drs.
L. A. Dugas, P. F. Eve, and B. Douglass, were appointed a
committee, to verify the correctness of the alleged discovery of a
certain ligament connecting the tooth and alveolar process in the
human subject. The following is the report of that committee,
read before the Society, by Dr. Dugas.

The Committee, to whom was referred the task of*-' verifying
the correctness of the alleged discovery of a certain ligament

1839.] Report on the LigamentumDentis. 275

connecting the tooth and alveolar process in the human subject,"
beg leave respectfully to present the following report :

Your committee have endeavored, in the 1st place, to determine,
whether or not, the existence of such ligamentous connextions have
been recorded by systematic writers on the anatomy of the teeth ;
in the 2nd place, to ascertain to whom should be attributed the
alleged recent discovery ; and, lastly, to examine, whether a li-
gament does exist, and, if so, to define its character. In the pro-
secution of the first inquiry, the works of Thos. Bell, of Charles
Bell, of Cruveilhier, of Lauth, of H. Cloquet, of Meckel, of Hor-
ner, of Blandin, of Wistar, of Sneii, of Delabarre, of Baume, of
Bourdet, of Fauchard, of Fitch, &c., have been examined ; in
neither of which can any allusion be found to the ligament under
consideration. They all concur in affirming, that the teeth are
held in situ by means of the gums and membranes interposed be-
tween the gums and alveoljE ; their extraction being, in some in-
stances, impeded by an irregular curvature or separation of the
roots.

With regard to the second inquiry, the means have necessari-
ly been limited to the few notices contained in the newspapers of
the day. From these, it would appear, that the discovery of a
method of extracting teeth, with, comparatively, little pain, is
claimed by three Dentists of Philadelphia, viz : Mr. Ebert, Mr.
Humphreys, and Dr. Caldwell ; all of whom, however, with the
characteristic reserve of charlatans, have, hitherto, endeavored
to conceal the principle on w^hich their simplified operation is
based. Mr. Ebert is, on the authority of Dr. George F. Klen-
gel,* said to have extracted teeth, on the new principle, as far
back as twelve months since. It has not been ascertained to
what date the other individuals refer the origin of their practice;
but, it would appear, that their claims are more recent. It will
be observed, that neither of the above Dentists claimed the dis-
covery of a ligament connecting the tooth and alveola, but mere-
ly of a peculiar method of extracting teeth.

The discovery of the ligament, is claimed by Dr. P. B. God-
dard, in an article published in the November number of the
American Journal of the Medical Sciences. In this article, the
doctor stales, that having been informed " that the new method

* Philadelphia Saturday Courier, December 1, 1838.

27fl Report on the Ligamenium Dentis. [Feb.

[of extracting teethj consisted in cutting with a pen-knife sonne-
thing which held the tooth in its place, I resolved to scrutinize
the matter closely. * * I then procured a jaw, and
making a very careful dissection, satisfied myself of the exis-
tence of a ligament. This consists of short. Strong ligamentous
fibres, existing on one side of the human tooth only, and unites
the neck of the tooth to the alveolar process. The fibres arise
from the edge of the alveolus between the teeth, and proceeding
forwards in the case of the molars, and inwards in the case of
the incisors, is inserted into the neck of the tooth, not quite the
sixteenth of an inch from the enamel. Its size (and of course its
strength) varies with the class of teeth to which it belongs. In
the incisors, it is a narrow tape-hke band in the cuspidati and bi-
cuspidati, it is wider and in the molars, it is as wide as the neck
of the tooth and very strong. A few of its fibres are blended
with the gum in its neighborhood ; and thus we may account for
its occasional laceration when a tooth is extracted. Its adhe-
sion to the tooth is stronger than to the jaw, and, if not cut, it is
commonly dragged out with the tooth. Its ligamentous cha^
racter is very distinct, the fibres being- white and shining, Hke
tendon."

We now come to the third division of our labor, and, at the
same time that we are enabled to confirm the fact of the exis-
tence of a ligamentous connexion between the teeth and alveo-
lar processes, we cannot concur with Dr. Goddard in his des-
cription. Our researches have presented to us not " a liga^
ment" but a set of ligaments ; and, not only connecting one por-
tion of the tooth to one portion of the alveolar process, but the
whole circumference of the tooth to the whole circumference of
the alveolar process, and, moreover, the teeth to each other.
By dissecting a jaw, previously subjected to maceration, these
bonds may be very readily detected. The ligamentous fibres
are seen to pass from the edge of the whole alveolar process to
the tooth, about a line from the enamel, thus closing entirely the
cavity in which, the root is contained. But, in addition to this
kind of capsular ligament, there are other fibrous massed, much
more developed, and which extend from the alveolar process, be-
yond its edge, to the neck of the tooth, and from one tooth to that
next to it. The fibres, extending from one tooth to the other, are
necessarily situated between the teeth, but project considerably

1839.] Report on the Ligamentrim Dentis. 277

on the internal or lingual face of the teeth, though not at all on
the external they are much stronger than those which extend
from the alveolar circumference to the tooth, and constitute a
very distinct ligament, whose fibres, extending from one tooth to
that next to it, rest, as it w^re, on the osseous partition separating
one alveolar cavity from the other.

Your committee, therefore, have ascertained, that the state-
.ment made by Dr. Goddard is correct in one particular only ;
that is to say, in ihe assertion thot a ligament does exist. Dr. G.
states, that the fibres exist on one nde only of the tooth, and that
they unite the neck of the tooth to the edge of the alveolar pro-
cess. From the description we have given, you will perceive
that the fibres which extend from the neck of the tooth to the
edge of the alveolar process, are not confined to one side only,
but extend from the entire circumference or edge of the process,
to the entire circumference of the neck of the tooth. Again, the
Doctor affirms, that the fibres proceed forwards in the case of
the molars, and inwards in the case of the incisors. We have
seen that this is an error, and that the tendinous fibres extend in
a horizontal direction, from the neck of one tooth to that of the
root next to it, and that in their course they rest on, or rather,
are attached to the upper edge of the partition separating the al-
veolae from each other. These strong ligaments are not, how-
ever, as advanced by Dr. G., limited to the space between the
teeth, but really project, or extend considerably, in the case of
the molar teeth, over those angles of the neck which look to-
wards the cavity of the mouth, thus constituting for the molar
teeth a very distinct set of ligaments, not to be found belonging
to either the incisors or cuspidati. All the teeth, are, therefore,
bound to the edges of the alveolar processes by the same kind of
capsular ligament, but the molars are provided with additional
and much stronger ligaments, covering the capsular ligament
and extending from below the edge of the process to the neck,
and from one neck to the other. Your committee can perceive
in Dr. G.'s description, no allusion to these additional fibres,
which must constitute a very great additional impediment totjie
extraction of the molars.

From these premises, it is evident that your committee re-
gard the alveolar cavity as entirely closed, and having no com-
munication with either the m'ncous membrane of the gum, or the

27S Report on the Ligamentum Dentis. [Feb.

general periosteum of the jaw-bone ; that the roots of the teeth
are enclosed within said cavity, in the same manner that the
head of the os femoris is enclosed within its articular cavity, by
a surrounding capsular ligament ; that the ligamentous fibres
extend from the edge of the alveolar process to the neck of the
tooth, in the same manner that similar fibres extend from the
edge of the acetabulum to the neck of the os femoTis. Now
these views are altogether at variance, with the opinions advan-
ced by every writer whom w^e have had an opportunity of con-
sulting. These authofs differ from each other only in one res-
pect one class believing that the mucous membrane of the gum
dips down into the alveolar cavity to furnish its lining mem-
brane, whereas the other class believe, that the lining membrane
is furnished by a continuation of the periosteum of the maxillary
bones. The French* generally advocate the former, and the
Englishf the latter disposition. These opinions have doubtless
originated, on the one hand, in the theory of the continuity of
substance in membranous expansions, and on the other hand, in
the more recent theory of integumentary excrescences. Those
who regard membranes in general, as neither commencing at
any given point, nor terminating at any other, were led to trace
the periosteum from the surface of the maxilla into the alveolae,
by which the continuity of substance might be understood ;
whilst those who, in their endeavors to generalize, refer the

* La portion reflechie de ]a gencive repond, sans y adhtrer, a la racine
de la dent dans toute la portion de cette racine qui deborde I'alveole, puis
s'enfonce dans la cavite de cette alveole pour constituer le perioste alveolo-
dentaire, perioste que nous avons vu etre un puissant moyen d'union entre
la racine etralveole. Cruveilhier, Anat. Desc. T. 2. P. 388.

The mucous membrane which enters into their constitution, (the gums,)
is prolonged into the alveoli, and from the bottom of these cavities, sends into
the cavity of each of the teeth, a bulbous prolongation which exactly fills it.
English translation of H. CloqueVs Anat. p. 597.

f The periosteum of the maxillary bones, after covering the alveolar pro-
cesses, dips down into each alveolar cavity, the parietes of which it lines.
From the bottom of the cavity, where the vessels and nerve of the internal
membrane enter, it appears to be reflected over the root of the tooth, which
it entirely covers as far as the neck, at which part it becomes intimately
connected with the gum. Hunter, and others, believed that there is only a
single layer of periosteum common to tbe alveolus and the root. Thomas
Bell on the Teeth, p. 42.

1839.] Report on the Liga?nentum Detiiix. 2711

hair, nails, and teeth, to a secretory process of the integumenta-
ry surface, find it convenient to describe the secerning appara-
tus of the tooth, as contained in a duplication of the mucous
membrane of the gum, dipping down into the alveolae, and an-
swering the double office of periosteum to this cavity, and of in-
vesting membrane to the tooth. It is certain that neither of
these views could have ever been sustained by anatomical in-
spection ; and now that this inspection has been made, and the
influence of high testimony set at naught, it may be interesting
to explain the origin of the membranes, which unquestionably
exist between the tooth and socket ; and also to determine the
disposition of the gum and general periosteum.

In order to do this, it must be observed, that the first rudi-
ments of the tooth are lodged in the alveolar cavity, and consist
of a small sac contained within another, between both of which
is contained a limpid fluid. Within the inner sac the tooth is
formed. The disposition of these sacs is such, that whilst the
inner adheres to the tooth, and the external to the alveolar cavi-
ty, both unite in their adhesion to the neck of the tooth when
more fully formed. As the formation of the tooth progresses,
the space between the two membranes diminishes, until they are
brought into contact. Whether or no the cavity existing be-
tween them is ever obliterated, and the fluid it manifestly con-
tains in the early stages of the development of the tooth ceases
to be secreted, does not seem to have been determined.

Prior to the perforation of the gum by the tooth, the gum co-
vers the alveolar cavity and can certainly have no open commu-
nication with it;* and unless we admit that the membrane ex-
tends down into it afier the exit of the tooth from beneath, it is
difficult to imagine the possibility of the disposition described by
Cruveilhier, &c. The same objections apply to the continuation
of the periosteum into the alveolae. The mucous membrane and
periosteum of the roof of the mouth, for example, closely con-
nected by cellular tissue, pass on to the alveolar processes, ex-
tend over them, and continue their investment of the external
face of the maxilla. This is perfectly evident, on examination

* The gvhemaculum dentis, or neck of the dental follicle, which extends
to the covering of the alveolar orifices, though believed by some to be an open
tube terminating at the mucous surface of the gum, is asserted by others to be
always found closed. Vide Systeme Dentaire par Blandin^p. 87, etseq.

^SO Report on the Ligamentum Dentis. [Feb*

of the parts previously to the evolution of the teeth in children,
and after their entire removal in extreme age. The beautiful
series of fcetal skeletons in the Museum of our College, includ-
ing specimens of the growth of each month, from the second to
the ninth, shows clearly and distinctly, the closure of the alveo-
lar cavities by the periosteum which has been allowed to remain.
We have already seen that the alveolar cavity is lined by the
membranes belonging to the tooth ; it can, therefore, need no
other. When, however, the toolh begins to make its way out, it
presses the periosteum above it, against the mucous membrane,
until they are brought in immediate contact ; then they yield a
passage to the perforating tooth. By this mechanism, the mu-
cous membrane, the periosteum, and the membranes proper to
the tooth, are necessarily brought in contact, or nearly so, and all
adhere to the neck of the tooth on nearly the same line. These
facts may explain the error of those who consider the lining
membrane of the socket, to be continuous with the mucous mem-
brane, or with the periosteum ; but they do not account for the
formation of the bonds we would call the capsular liga//tent, and
of those extending from one tooth to the other. These must be
subsequent developments, as our dissections establish them to be
entirely distinct, and unconnected with either the gum or sur-
rounding periosteum: In making these dissections, we have al-
ternately torn oft'these coverings by seizing either the gum or the
periosteum ; and, in either case, both are removed, and leave the
ligaments full}' exposed. This process is materially facilitated
by previous maceration, as we have already had occasion to
state. At Vi^hat period these ligaments are developed, we have
not had the opportunity to determine.

1839] Abdomino-intealtnal Wound. 281

ARTICLE III.

Case of Ahdomino-intestinal Wound, and Recovery^
By A. R. KiRKPATRicK, M. D. of Cheney ville, La.
On the 23rd day of August, 1838, I was called on to attend a
hegro man belonging to Mr. L. Burges. He had been engaged
with a fellow servant in falling a cypress tree in the swamp,
both cutting facing each other, on the same side of the tree, when
the other negro's axe flew off, in the downward stroke, and cut
Alfred entirely through the abdominal parietes, dividing the recti
abdominal muscles transversely, at the line dividing the left iliac
from the left lumbar region, six inches in extent, and making a
small opening of about eight lines into the ileum also transverse-
ly. Immediately the axe dropped from the wound, and the in-
testines followed, as they were very much loaded with food and
melons, v/hich he had eaten early in the day. The accident oc-
curred about half past four o'clock, P. M. It was an hour and
a half before I saw him, at which time he was nearly exhausted
with loss of blood and the great pain he suffered. I found near-
ly a hat crown full of the descending colon and the ileum pro-
truded and lying in the hands of the patient, and two negroes,
who were in attendance. There was some discharge of sterco-
raceous matter, and watermelon seeds, and the shreds of me-
lons, through the aperture in the ileum. No omentum was ex-
posed. The coats of the intestines, and the mesentery, were
swollen, and highly injected with arterial blood, and indicating
an active inflammation in its incipient stage. The mesocolon
and mesentery had several points where they were discolored
and darkened, and there was an areola around the incision in the
ileum of a dark color, which was made worse by the escape of
the faeces and seeds. Owing to the gorged condition of the en-
tire alimentary canal, I found considerable difficulty in returning
the protruded portion ; and had not large quantities been dis-
charged, as above mentioned, I should have been compelled to
enlarge the abdominal wound. I retained the wound of the in*
testine at the external opening, whilst returning the intestines,
and finally secured it in that position, by introducing a single su-
ture through it, untied, and leaving the ends outside of the wound
d4

282 Ahdomino-intestinal Wound. [Feb.

this was to prevent extravasation of fsecal matter, and allow
the egress of any deleterious substances. I then closed the ex-
ternal orifice with interrupted sutures and adhesive strips. His
pulse had nearly ceased at one time, but it recovered, and was
at 65 when the dressings were applied. He complained of a
sense of colicy pain, and much soreness of course, and some
head-ache and nausea. Having sustained the injury in the
swamp, and in order to convey him with ease and safety to the
house, he was laid on a sheet, the corners at each end tied sepa-
rately and carried on a pole. At ten o'clock a dose of oleum ri-
cini was administered to him, which caused him to vomit, and a
large quantity of half digested food was thrown up of a disagree-
able acid odor and every thing, except cold water, caused the
same. There was no appetite, nor any disposition to go to stool.

August 24th. Rested well during the night. Slightly fever-
ish now ; pulse quick and somewhat accelerated ; no alvine dis-
charge yet ; passed his urine with difficulty and straining ; no
appetite ; wound very painful, and feels as though there was a
heavy weight across his abdomen the wound is in good condi-
tion, and secreting healthy pus. At eight o'clock, A. M. bled
him to the amount of eight ounces, and administered a dose of
sulph. magnes. which produced nausea and retching. A large
sinapism was applied to the abdomen above the wound this
was in order to subdue, or rather prevent, any inflammation of
the wound in the peritoneum and intestines. Ordered that an
enema of salts and oil be administered, if he had no passage by
ten o'clock, A. M.

Evening visit. The glyster was given, and tvv'o small evacu-
ations procured : pulse quick and accelerated : venesection to
the amount of four ounces ; no appetite ; little pain ; abdomen
swollen and tympanitic. Prepared a solution of sulph. magne-
sia, sweetened, and administered a swallow of it every twenty
minutes; directed an enema at midnight if there was no discharge
before that time ; and directed blood to be drawn if the pulse de-
manded it.

25th. Morning Visit. Rested well last night ; two evacu-
ations ; pulse natural ; abdomen still tympanitic, though not so
much so as yesterday ; wound in good condition, granulating
finely, and adhesion throughout its entire line ; the intestine was
in its proper situation, as the ends of the suture were secured by

1839.] MdominQ-intestinal Wound. 283

the adhesive strips ; nausea on taking any thing ; no appetite ; a
large vesicatory was apphed to the abdomen, for the purpose of
keeping up the counter-irritation and making it more permanent.

Evening Visit. Three evacuations ; much flatus escaped,
and indeed his intestines are constantly in motion and borborig-
my; pulse 108, full, though compressed ; considerable heat of the
surface.

Thinking that the intestine had been confined long enough, I
removed the suture, and from the ease with which it was with-
drawn, I am induced to think that the part through which it pas-
sed had entirely sloughed off; as the reader will remember, I
stated the lips of this incision to be in a state of advanced inflam-
mation, and approaching to disorganization and mortification, at
the time the suture was introduced.* Scraped lint was applied
to the wound. Dressed the blister. Still no appetite ; and nau-
seates at any thing but cold water. The weather being oppres-
sively warm, he was very thirsty, and demanded the coldest
water that could be procured. The tympanitis is less. The
heat of the surface is owing as much to the heated atmosphere
as any thing else. Fahrenheit's thermometer, from ten to three
o'clock, is from 87 to 92.

UQth. Rested very well last night ; pulse this morning at SO,
though full and difficult to compress ; one alvine evacuation du-
ring the night ; did not examine the wound ; he took a small
portion of corn meal gruel, which is the only diet allowed ; yet
he has no desire for any food, though his nausea is less than for-
merly. The coldest water is allowed to him freely. Directed
him to be bled in the afternoon, if he had an excitation of pulse ;
and an enema at one o'clock, if necessary. He now passes his
urine, regularly, unattended with pain.

Though I am always averse to passing any prognostic on a
case where there is danger, yet, from the length of time this
man had survived, and, added to that, his good constitution, and
the good attendance he had, I was led to pass a favorable opin-
ion on the result of his case, and assured him and his owner, that
proper care would ultimately restore him to a share of his for-
mer health and usefulness.

%lth. Morning Visit. Rested well during the last twenty
four hours ; several copious alvine discharges , many melon

* Was not this too early for incipient mortification ? Ed,

JIJ84 Ahdomino-intestinal Wound. [Feb.

seed discharged, which were eaten on the day he sustained the
injury; thereby showing that the ahmentary canal was attempt-
ing to perform its proper functions. During this time, nothing
has escaped from the intestines, through ihe external orifice, un-
less it were purulent matter or blood. Appetite improved and
returning. Pulse G8. The wound was found in a healthy state,
and granulating finely and rapidly. One of the sutures was re-
moved, on which the skin and integuments slowly separated,
and the wound somewhat opened this was secured by adhe-
sive strips \ dry scraped lint was applied ; tympanitic state much
lessened ; lips of the wound not swollen as much as heretofore ;
perspiration regular ; ordered glysters, if necessary, to prevent
constipation.

28th. Evening Visit. Continues to rest well ; tongue some-
what furred ; pulse 68 ; borborigmy ; appetite restored and not
easily satiated ; he is allowed thin chicken soup. There was
some thunder and lightning to-day, which, he said, made his
wound and his intestines pain him more than usual. Adhesion
of the muscles appears to have taken place, but the skin is still
open ; this is owing to the lint being pressed down between the
sutures, and thereby preventing it, and causing a constant dis-
charge of pus. I discontinued the lint and applied a strip of soft
linen, saturated with olive oil.

30/^. Being engaged on the 29th, I was not able to visit him.
During this time he has rested well, except that he is much fa-
tigued from remaining constantly in the recumbent posture, and
most of that time on his back. Much redish-brown liquid was
discharged yesterday morning, preceded by considerable pain,
after which, the discharge became easy. This, I had no doubt,
was bilious secretion, mixed with blood and pus ; and I was
confirmed in this when, removing the dressings, my pocket case
of instruments accidentally fell on his abdomen, which caused a
sudden movement and contraction of his abdomen, and immedi-
ately there was a vast quantity of bile, fecal matter, bloody sa-
nies and pus, discharged in a large stream. I was much alarm-
ed, though I concealed it as much as possible I made pressure
on the whole abdomen, and caused all to be discharged, that I
could ; air also escaped in bubbles. The abdomen now seemed
flaccid, and the lips of the wound were drawn in close apposition
ind retained by adhesive strips. No alvine discharge on the

183d.] Ahdomino-intestinal Wound. 285

29th ; appetite good ; pulse GO ; bread and butter allowed him.
I thought the sutures kept up irritation in the skin, and they were
all removed.

Slst. Great deal of pain in the sore ; constant discharge of
the above mentioned matter from the time I left him yesterday
morning. When I removed the dressings, thick fecal matter
was seen lying on the wound. He remarks, that when he eats
any thin matter, it escapes, in a short time, at the wound ; but
if he eats any thing like bread, hominy, or rice, it is not thus, but
continues down, and he has his natural fecal discharge.

Heretofore the w^ound has had on it a thick coat of white pu-
rulent matter, strongly attached to the parts, which could not
be removed by soap and water, and when taken off by the for-
ceps caused the place to bleed ; but this morning this had all
disappeared, and the wound presented a clean, red, granulating
surface ; this I attributed to the action of the bile which was
thrown out. The orifice through which the discharge takes
place is about three lines. The wound was secured tightly with
numerous strips in difl^erent directions, and the roller drawn as
tight as could be borne. He is allowed to eat a small portion
of food four times a day.

September \sL Purulent matter on the wound ; some watery
discharge ; no bilious tinge or mark of any fecal matter. Bub-
bles of air w^ere seen at the opening, which is smaller than be-
fore. An adhesive strip was placed immediately over it, and a
small compress on this again, and all confined by strips, and a
larger compress and bandages. Repeated alvine evacuations
per anum. Pulse GO.

2nd. Wound easy and no discharge perceptible. The dres-
sings were not removed, as I thought the v.'ound had been inter-
rupted too much, (once every day.) and al! the granulations de-
stroyed as fast as they were formed. Appetite and digestion
good ; bowels loose.

^rd. All going on smoothly. On removing the dressings 1
was happy to find that I was correct in my suspicion, for the
cuticular adhesion had progressed rapidly. The passage from
the intestine, through the w^ound, \vas, however, still open, and
some gas escaped. Dressed as before. Determining to dress
it less frequently, I did not visit him till the

5f//. Found him much better, and the wound had closed, ex-

2SQ Ahdomino-intestinal Wound, [Feb,

cept a small place where the gas and feces had escaped. He felt
the feces discharging through this opening, and notified the nurse
of it, who immediately made gentle pressure over the part with
her fingers, and afterwards tightened the roller.

1th. He now walks about without any pain, and sits up se^
veral hours in the day. The small opening is still perceptible,
though lessened, and nothing escapes but sulphuretted hydrogen
gas, as is known by the dark color of the strips.

From this time till 17th September, I visited him two or
three times a week, to see that nothing untoward should be al-
lowed to happen ; and he continued improving ; and by the 15th
was able to hoe in the garden, and attend to little matters about
the yard and kitchen. Whenever any flatus begins to move in
the intestines, it gets to the wound and then stops, causing con-
siderable pain, but is immediately relieved by pressing his hand
over the part and dispersing it.

On the 12th, there was a ridge under the cicatrix, which I at-
tributed to the divided muscles having retracted down to that
place. But he continued to complain of pain and uneasiness in
the part, and it seemed to enlarge. It became evident that a fu-
runculus was forming, and I ordered meal poultices to be kept
to the part. On the 20th, it opened spontaneously, and discharg-.
ed a quantity of pus. The cicatrix is small, and finely healed in
every part at this date. He is going about performing his regu-
lar and ordinary duties, complaining of no pain or weakness
whatever.

It is evident that the intestine has grown to the abdominal pa-
rietes, as w^as intended and desired. When flatus moves in the
bowels, the cicatrix is puckered and drawn, as a person's lips
drawn forcibly together and inward.

This is not given as a strange phenomenon or anomalous case,
as I am well aware of many similar cases by surgical authors,
and in the Medical Journals of the day ; but as shewing what na-
ture may suffer, and yet, when properly assisted by surgical at-
tendance and a good system, may surmount. The patient, aged
47 years, remained, on a hot summer's afternoon, after active
exercise, more than one hour and a half, with a considerable
length of his intestinal canal exposed to the atmosphere, and the
rough handling of negro men, who had much injured the protru-
ded parts, by their eflforts made to return them. He then had

183&.] Surgical cases by Professor Dugd^, SSt

to be transported more than half a mile, partly through a I'ough
wood, in which he was much jolted and disturbed. Active in*
flammation had taken place in the intestines and peritoneum be-
fore they were returned ; and then there was the additional irri-
tation of a thread passing through the coats of the intestine*
"When all these are taken into consideration, the case presents a
wonderful example of the power of nature to overcome disease
and injury* At first, I despaired of doing any permanent c^ood ;
but was determined to act while there was breath and pulse, so
far as my judgment directed any effort to be made ; and all may
judge of the joy I feel, in seeing my efforts attended with such
marked success.

Many minor points of surgery I have intentionally omitted,
as being unnecessary to the report of the case. No rule can be
laid down for the management of such cases every physician
must be guided by the attendant circumstances, and his own
judgment.

ARTICLE iV.

Surgical cases occurring in the practice of L. A, Dugas, M. D,
Professor in the Medical College of Georgia. Reported hy
W. H. Robert, M. D. of Columbia County, Ga*

Having had occasion, during the prosecution of my studie!l
with Professor Dugas, to witness many of his surgical opera-
tions, and believing the report of cases, however trivial at first
sight, to be useful as contributions to our fund of facts, I will of-
fer no further apology for relating the following.

Case 1. Amputation of Scirrhus ma?n7na.

Rachael, a negro woman, aged 35, the property of Miss H.
of Columbia county, of apparently good constitution, and in good
health, had a small tumor in the left mamma, occasioned by a
blow. This tumor had, during two years, increased but little^
when the patient received another blow on the breast, which
caused the tumor to grow rapidly during the six succeeding

288 Surgical cases hij Professor Dugas. [Feb.

months, niid to become very painful. The pains were sharp
and hxncinating, the tumor lobulated, uneven, hard, and occupy-
ing the anterior portion of the mamma; no enlarged axillary
glands ; lancinating pains occasionally felt in the upper part of
the left hypochondriac region, near the epigastric, but no tumor
to be felt ; mammary tumor about the size of a turkey's egg.

At this stage of the case, the patient was sent to Dr. Dugas.
The usual discutient means had been ineffectually used for the
reduction of the tumor. Dr. D. therefore, without further delay,
removed the whole of the mammary gland in the ordinary
manner, on the 1 0th January, l83o. The wound healed by the
first intention, and in a few days the patient returned home.

April 1. No pain nor uneasiness about the cicatrix, but the
pain has continued increasing, near the epigastrium, where a
tumor can be distinctly felt, which increases rapidly, is deep-
seated, and of uncertain attachment. Says she feels the same
kind of pain as she formerly experienced in her breast. Her ap-
petite, though formerly good, is now bad ; she frequently rejects
her food when coarse ; is very low spirited, and wishes to go to
a " cancer doctor."

July 22. Was sent to the quack, with whom she remained a
fortnight, and returned entirely relieved of her epigastric pain
and tumor. Now feels in excellent health and spirits ; no symp-
tom of a return of the disease in the breast ; says, however, that
she still occasionally feels some of the pains about the axilla, al-
though none of its glands are enlarged, or tender on pressure.

Having occasionally heard from the patient since the above
date, we have been informed that she still continues well. On
examining the tumour after the operation, it was found to present
all the peculiarities ofascirrhus.

Case 3. Amputation of a Scirrhus mamma.

Mrs. H. of Edgefield district, South Carolina, aged forty, of
a good constitution, and leading an active life, placed herself un-
der the care of Dr. Dugas, in May, 1S3G. She had, about eigh-
teen months previously, received a blow on her right mamma,
which gave rise to a considerable degree of inflammation and
sweUing. This was treated by discutients ; the acute symptoms
subsided and left a hard tumor, which was subsequently expos-
ed, accidentally, to repeated bruises, and which was subjected to

1339.] Surgical cases by Dr. Dugas. 289

a variety of topical applications, vesicatories, Iodine ointment,
(kCi. without advantage.

The tumor was now adherent to the skin, about three inches
in diameter, and occupied the right side of the mamma towards
the axilla. Two of the axillary glands were considerably enlar-
ged. The tumors were rapidly increasing in size, and the seat
of lancinating pams. Both mammae were, naturally, very vo-
luminous.

On tho 201 h May, Dr. Dugas removed the whole of the mam-
ma, and by extending the incision, exposed the affected glands
which were also removed. The wound was closed in the usual
way, with adhesive strips, &c.

24th. Removed the dressing, and found that adhesion by the
first intention had taken place, throughout the whole line of in*
cision. Not a drop of pus was formed, and the lint was soiled
by only a little bloody oozing. The case was left in the charge
of Dr. Spann, a neighbouring physician.

June 8th. Dr. S. being absent, Dr. Dugas was sent for, and
found that the case had been neglected ; that the ligatures had
not been removed, and that suppuration had taken place along
their course, ripping up the adhesion of the integuments to the
muscles, but not effecting a separation of the lips of the wound.
A slight incision made in the cicatrix, at the place of exit of the
ligatures, gave issue to about a gill of healthy pus. The liga-
tures were now removed, a compressing bandage applied, and
the whole wound healed in a few days.

December, 1838. Mrs. H. has experienced no inconvenience
from the operation, nor has there been any manifestation of a
disposition to a return of the disease.

The tumor removed from the mamma, as well as those from
the axilla were eminently schirrous. That i)i the mamma pre-
sented, in addition to the usual features of schirrous tumors, the
peculiar indications of approaching suppuration. Its tissue con-
tained softened particles, and its surface adhered closely to the
skin.

RemarJiS. The two above cases, are interesting in several

respects. In the first place, they establish the propriety of such

operations, even after the axillary glands have become implicated,

a point on which there is still much hesitation among surgeons.

That schirrous affections do frequently return after the use of the
E 5

290 Surgical cases hy Dr. Dugas. [Feb*

knife, and other means, is but too true ; yet if it can be estab-
lished that in many cases such a return does not occur, the sur-
geon should certainly never be reluctant to offer the patient the
only known chance of escape from a most horrid death. The
uncertainty of the diagnosis between tumors termed fibrous, and
those designated by the appellation of schirrous, is such, that no
practitioner would be warranted in resorting to the knife, before
fully testing the efficacy of the various topical applications known
occasionally to remove tumors of such ambiguous nature. Yet,
when in despite of such medication, the tumor steadily continues
to progress, the knife should no longer be withheld, -

The success of the cases above recited, may, with much pro-
priety, be attributed to the fact, that the entire mammary glands
were removed. The examination of the parts, after their remo-
val, evinced such an intimate union of the morbid with the heal-
thy tissue of the gland, that it was extremely difficult to assign
the true limits of either. This difficulty would have been much
greater, had the attempt been made during the operation, and
under the influence of a desire to hasten, and to spare the patient
as much pain as possible. The objections to the sacrifice of the
entire gland, can v/eigh but little, in comparison with the danger
of leaving a portion of the diseased structure, by endeavoring to
save appearances.

The progress of the -second case, after the operation, exempli-
fied the necessity of attending particularly to the removal of li-
gatures, however strongly union may have taken place between
the integuments and stump. The formation of pus, in such ca-
ses, should be carefully v/atched, and an Issue given it, as early
as possible, in order to prevent such an accumulation as occurred
in this instance.

Case S. White Swelling of the Knee Amputation.

Henry, a mulatto boy, about 15 years of age, belonging to
Mr. A. Gumming, had sufiered several years with an affection
of the knee joint, of spontaneous origin, during which time he was
subjected by several practitioners of distinction, to all the me-
thods of local and general treatment usual in such cases. He
was, in 1836, placed under the care of Dr. Dugas, who found the
knee considerably swollen, though presenting no fluctuation : the
leg permanently semi-flexed, the patella resting on the inner side

1839.] Surgical cases hy Dr, Dugas. 291

' J '

of the joint, and immovable, and a fistulous opening four inches
above the articulation, which admitted the probe to the lower
extremity of the os femoris. Wishing to attempt the production
of perfect anchylosis. Dr. D. placed the patient under the inter-
nal use of the lodated solution and compound decoction of sarsa-
parilla, for several months, during which time the limb was kept
perfectly still, and the fistula injected at first with a solution of
chloride of soda, and subsequently with a diluted solution of Io-
dine. This treatment proving ineffectual, amputation was per-
formed, above the knee, on the 7th of October, 1836. Two ves-
sels were secured with -animal ligatures, (the deer-smew,) and
the wound dressed in the usual way. Adhesion was effected
completely by first intention, and the. ligatures, on the 18th Oct.
separated even with the cicatrix, leaving the knots within, which
must have been absorbed subsequently.

On examining the joint, the patella was found completely dislo-
cated to the inner side of the knee, its internal face ulcerated, and
its ligaments much enlarged ; the head of the tibia was appjied
to the posterior surface of the condyles, which had sustained a
loss of substance equal to half an inch 'in depth ; the inter-articu-
lar cartilages were partly destroyed ; all the soft parts red and
edematous ; and the joint filled with pus.

Case 4. Affection of the Knee and Foot Amputation.

The subject of this case was Ned, a negro boy about 15 years
of age, the property of Mr. I. S. Tuttle. He had for several
years been afflicted with a swelling of the left knee, which re-
sisted all the usual remedies. From the knee, the swelling ex-
tended down the leg and occupied the whole of the foot, which
finally became the seat of ill-conditioned ulcers, and of great
pain, depriving the boy of rest, and seriously impairing his ap-
petite. It was observed that his growth had been very much re-
tarded, and that his general health, though not seriously injured,
was beginning to suffer.

Several physicians having decided on the propriety of ampu-
tation, this was performed, above the knee, on the 11th March,
1837, by Dr. Dugas. The vessels v/ere secured with ligatures
derived from the deer's tendon, as in the above case, and the
same dressing applied; yet on removing the dressing on the
fourth day, union was found to have taken place in but one half

J^2 Surgical cases hy Dr. Dugas. [Feb.

of the wound. The stump being daily washed with diluted
chloride of soda, and the flaps kept together with adhesive strips,
healed in a fortnight, without further trouble.

The joint, on being laid open, evinced a very red and infiltrat-
ed state of the synovial memhranes and circumjacent tissues, and
slight erosion of the cartilages.

Remarks. In both of the above cases the circular method of
amputation was adopted, and in both similar ligatures and dres-
sing were employed. Yet how different the result ! In the
first, adhesion was complete on the fourth day ; whereas in the
latter, it was but half eflfected in the same time. Whence the
cause of this difference ? Shall it be referred to some unper-
ceived peculiarity or disturbance of the dressing, or shall it be
looked for in the condition of the patient's general system 1 Such
enquiries merit the serious attention of the profession, and should
be specially attended to by Hospital Surgeons,whose opportuni-
ties are extensive. In the case referred to, no derangement nor
defect could be detected in the dressing ; the want of total adhe-
sion must, therefore, have depended on a deficiency of curative
energy in the system.

On the first removal of the dressing, in case fourth, although
but one half of the stump adhered to the flaps, these adhered to
each other in the whole extent of their lips. Now, the pus in-
terposed between the remainder of the stump and flaps, must
have been originally yielded, either by the whole, or by a part
only of the surface with which it was in contact. I agree with
Dr. Dugas, in the belief that it was probably first produced by
the presence of the ligatures, and that having no exit, it accumu-
lated and tore up adhesions already formed between the flaps
and stump, and that had the removal of the dressing been delayed
a day or two longer, the whole of the stump would have been
similarly denuded. If such be the fac!, we should deduce from
it a strong objection to the prevailing custom of delaying the first
removal of the dressing to the fourth day. Would it not be pru-
dent, at least, to remove as early as the second day, so much of
the dressing as would permit any formation of pus about the li-
gatures to be detected ?

Another consideration presents itself with regard to cases
third and fourth. The loss of so important a limb as the leg,
should be very differently estimated in the different classes of

1839.] Surgical cases by Dr. Dugas, 295

society. Whilst to the gentleman of fortune it would be a horrid
deformity, and the destruction of most of his enjoyments ; and to
the free laborer, it would, in many instances, constitute the loss
of the means of subsistence for himself and family ; it is to th3
slave a matter of comparatively little importance. Idleness being
his greatest enjoyment, and having but few wants, and the cer-
tainty that these will always be met by his master, the negro
dreads nothing from the operation but the pain it may occasion.
This once over, he rejoices that the source of his discomfort has
been removed, and no desponding hallucinations supervene, to
disturb or to impede the efforts of nature to heal the wound.
Hence it is, that such operations are much less fatal to the negro
than to the white man ; and hence it is, also, that we should he-
sitate much less to remove a limb, whose affection endangers the
life of the patient, if he be a slave, than if he be a free man, and
especially a white man. Such considerations doubtless influen-
ced the decision in case fourth, which some might think ought
to have been subjected to still further efforts to save the limb.
Further delay, however, w^ould have materially diminished the
chances of success, by permitting the general health to become
seriously impaired. As it is, the lad's life has been saved, none
of his comforts sacrificed, and he is in the full enjoyment of fine
health; nor has his master sustained any loss, for he has made
him a cobler. A poor Irishman, whose leg I amputated
for a dreadful injury sustained by a rail road car, now w^an-
ders about a miserable beggar !

Case 5. Aneurism Ligature of the Brachial Artery.

Billy, a negro man about thirty years of age, belonging to
James F, Hamilton, Esq. was bled in the left arm during the first
week of April, 1S36, by a fellow servant, who wounded the bra-
chial artery. Not aware of the accident, he corded up the arm,
and the incision healed kindly. About a week after, perceiving
a swelling at the bend of the arm, and experiencing pain from it,
Billy consulted a physician of the neighborhood, who applied
over the tumor a bit of sheet-lead and a tight compress, without
at all impeding its development. On the first of June following,
the patient was sent to Augusta, and placed under the care of
Dr. Dugas. The arm w^as then found to present, at its bend, a
tumor the size of a turkey's egg, though not regularly globular,

294 Surgical cases hy Dr. Dugas. [Feb.

pulsating strongl3\ The pulsations produced under the finger
a very strong thrilling sensation, which also extended several
inches above and below the tumor. Pulse at the wrist normal
Basilic vein very much enlarged, and pulsating slightly The
bruit-de-soufllet (bellows-sound) strongly marked in the tumor
Health otherwise good.

4th June. Dr, Dugas placed a h'n^ature of cat-gut on the bra-
chial artery, midway between the elbow and axilla, and dressed
the wound with adhesive strips, leaving one end of the ligature
out. The pulsations in the tumor and wrist were immediately
arrested.

5th. Considerable febrile excitement ; passed a restless night
from pain about the shoulder ; arm and hand became very cold
and benumbed last evening, but warmth was restored by hot
bricks, &c. Pulsations distinct, though feeble, in the radial ar-
tery at the wrist ; none in the tumor. Prescription, gruel diet.

6th. No febrile excitement ; no pulsation in radial artery nor
tumor. No pain ; feels quite comfortable ; temperature normal.

7th and 8th. No pulse in radial artery temperature normal.

9th. Pulse distinct in radial artery, and behind the elbow
none in the tumor feels well.

12th. Ligature came ofFeven with the cicatrix, adhesion hav^
ing taken place.

14th. The tumor has not diminished, but has become quite
hard. In order to excite its absorption, a tight bandage was
now applied from the fingers to a little above the tumor. The
patient walks about the streets.

20th. Small fragments of the ligature came away by ulce-
ration.

25th. Aneurismal tumor very much softened and as large as
ever signs of fluctuation, but no pulsation. It was laid open
freely, and found filled with fibrin, so firmly attached, as not to
come away, with the small quantity of pus diflfused through it
a tent placed in the wound.

27th, Tumor much diminished suj5purates slowly no pain.

14th July. Tumor has almost entirely disappeared the open-
ing into it is nearly closed. The use of the arm is perfect. The
man sent home.

Information received, since the last date, that the wound

1839.] Surgical cases hy Professor Dugas. 293

healed in a few days after the patient's return home, and that he
has since feh no inconvenience from the operation.

Remarks. In the above case it is evident that the artery wag
punctured by the lancet after having transfixed the super-impos-
ed vein. Yet the tumor was formed neither at the expense of
the artery nor of the vein, but in the surrounding cellular tissue.
At the same time, however, that the eftlised blood was thus con-
tained in the celiular tissue, it communicated freely both with tlio
artery and vein, as was evidenced by the pulsations transmitted
by the arterial circulation to the tumor and to the basilic vein.
The vein thus receiving an increased quantity of blood became
considerably enlarged.

The bellows-sound, the cause of which when occurring at the
heart is yet involved in some mystery, was, in this, remark*
ably audible, and can only be attributed to the forcible propul-
sion of a column of blood through a narrow aperture leading into
a large sac. The aperture existed, moreover, in a tube whose
coats present a considerable degree of density and of resistance ;
and to this fact may, perhaps, be referred, much of the sound as
well as the peculiar thrilling sensation transmitted along the ves-
sels. These circumstances, though not novel, are worthy of
attention, inasmuch as they may assist in determining the cause
of similar sounds and vibrations, when occurring in situations
more remote and of more difficult observation.

A singular circumstance will be observed in the progress o^
this case ; I mean the fact that the pulsations at the wrist which
had been arrested by the ligature, returned on the day after the
operation, and then ceased again completely for several days.
The only explanation we can offer for this is, that on the day
after the operation, there existed a considerable degree of febrile
action, by which the blood was propelled with more force through
the new channels of circulation than subsequently when the ex-
citement subsided, and that the heart's ordinary impulse was
again felt only when the anastomosing vessels had acquired an
increased caliber. The pulse w^as then felt not only at the
wrist, but also in the enlarged vessels behind the elbow.

Finally, it should be noted, that fragments of the ligature,
which was made of cat-gut, were not absorbed after remaining
imbedded in the living tissues sixteen days, but at the end of this
time were thrown off by ulcerative process.

29t) Surgical cases hy Professor Dugas. [Feb.

Case G. Removal of a large Adipose Tumor.

Mrs. W. of good constitution, and about forty five years of
age, had a large tumor, the origin of which she attributed to a
fall sustained in early life, situated over the spine between the
scapulcC. It had been gradually increasing for upwards of 20
years, but never occasioned serious inconvenience until its size
and weiglit became such as to produce, at its attachment, a
sense of dragging, and finally considerable pain. The skin over
tlie tumor was healthy, and the diagnosis offered no difficulty.
Dr. Uugas, therefore, resolved to remove it, and operated on the
J 5th October, 1835, The tumor was removed with a portion
of skin included between two eliptical incisions, about fifteen in-'
ches in length. Two vessels being secured by Amussat's pro-
cess of twisting, and a number of others by ligatures, the flaps
were brought together by three stitches and adhesive strips.
Adhesion was completely effected by first intention. The cica-
trix-was, in a short time, reduced to ten inches in length.

The tumor presented a lobulated appearance, and consisted
of apparently healthy fatty matter, contained in hypertrophied
cellular tissue. It measured thirty inches in circumference, aU
though its weight was only fifty four and a half ounces.

Remarks. This offers nothing new, but illustrates the facility
with which such immense tumors may be removed, and the rea-
diness with which adhesion takes place, under certain conditions
of the system.

Case 7. Foreign body in the Esophagus six weeks its ex-
traction.

A boy about five years of age, the sou of Mr. J. L. of Augus-
ta, was playing with a large ivory button in his mouth, when he
accidentally swallowed it. Presuming it had passed into the
stomach, no notice was taken of the event until meal time, when
the boy complained that he could swallow nothing but liquids,
and that even these occasioned pain in the esophagus, opposite
the upper extremity of the sternum. It was now presumed that
the button had lodged in this part of the passage, and a physician
was called, who introduced without difficulty an elastic tube into
the stomach, without detecting any thing indicative of the pre-
sence of the foreign body. The presumption was that the pain-
ful deglutition was to be attributed to abrasion of the mucous sur-

1 ^39.] Division of Tendons. 297

face, and the boy was ordered to use liquid and unirritatingfood.
This state of tilings continued several weeks, during which time
the tube was again passed without obstacle into the stonnacli
emetics, I believe, were administered, &c.

At the end of six weeks Dr. Dugas was called, and on exam-
ination detected the presence of the button at the seat of pain,
and withdrew it with a common probang. It was of ordinary
thickness, and measured one inch in diameter. No unpleasant
effect followed its removal, and the soreness soon subsided.

Remarks. This case presents the remarkable fact, of the pre-
sence, during six week.-^, of a foreign body in so delicate a tex-
ture as that of the oesophagus, wiihout occasioning any serious
inflammation, and without disturbing the general health. It was
so low down as not to be felt by external pressure, and the but-
ton having no eye, j eimitted the free passage of the small tube.

Part II. REVIEWS AND EXTRACTS.
DIVISION OF THE TENDO-ACHII-LIS AND OTHER TENDONS.

-A.BSTRACT OK K CLINICAL LICTURE BY MR. I.ISTON.

(Delivered at the University College Hospital.)

Division of the Sterno.masloid, for Torticollis ; of the Tendo AchiUisfor Club
- foot; of Flexor Tendons f.r Contracted Knee Joint; of the Tendons of the
Toes, fnr Inflamed Corns, <^c.

In the commencemerit of his iecturr, Mr. Listen saii, the division of ten-
dons for the cure of deformity, was by no means a new proceeding ; it was
frequently resorted to by tnany of the older surgeons, among whom were
John Meicran, and Mr. Sharpe, a surgeon of < 'uy's Hospital, nearly a centu-
ry since, which latter was in the habit of dividing the origin or attachments
of the Bterno-mastoid muscle, for the cure of torticollis'. Tlii? operation had
been re|)eated of late years by Sir B Brodie, by the late Baron Dupuytren,
and he, Mr. List' n, had seen cases in which its performance was attended by
good results. It was a proceeding, however, which was not frequently call-
ed for, inasmuch as the twisted stale of the neck v.as generally produced by
disease of the vertebrae, or from a painful swelling or ulcer on the side of the
neck, producing such an alteration in the structure of the part, as to render
operative proceedings useless. I )elpech in'ght justly be considered as the
founder of the operation of dividing the tendo-Achiilis for the cure of club-
foot. He had related in his " Chi'-urgie Chnique" several cases of varus, as
they were called, and described the plans of his apparatus for carrying out his
toode of curing them. One or more cases were related in which the tendon
was divided. His plan was to make a longitudinal incision on each side of
F 6

29S Division of Tendons. [Feb.

the tendon, through whiclihe slipped his knife, and div:Jed the tendon from
before backwards. Within t!ie last year or two a great number of cases in
which the tendo-Achiilis had been divided, had occurred, and were related
by the operators, Stronieyer, DiefTenbach, Guerin, and Dr. Little, who him-
self was the subject of varus, and had pui^lished a thesis on the deformity.
This gentleman had also latttrly published a number of cases in which the
tendo-Achillis was divided for the cure of deformity, to which he had given
odd and long-sounding names, such as talipes equinus verus, &c. &.c. The
deformity of the foot presented itself in a variety of forms. When the under
part of the foot was turned inwards, the deformity was termed varus. In
other c^ses the foot was turned outwards. The first, however, was the most
common deformity, and in this case the toes were turned inwards, the pati-
ent rested on the cuboid bone, and the root of the metatarsal bone of the little
toe. The bones of the foot in this kind of deformity were little altered in
form or appearance. They had atto'ned their ordinary size, and were little
distorted regarding their position one with another. After a time, however,
if the deformity was not remedied, the bones on the inner side of the foot di-
minished in size by interstitial absorption ; the internal cuneiform, the os cal-
cis, and the soft parts covering them became altered. The patient rested
on this part, the integuments of which became thickened, and a bursa formed
in this situation. The limb on the affected side, to the knee-joint at least,
lost its size and strength, the muscles becoming soft and flabby, and losing
their red appearance. In many cases whicli were met with, the heel was
much elevated, owing to the natural shortness of the gastrocnemius and so-
leus, and their combined tendon ; other tendons were also necessarily short-
ened, while, on the other hand, some tendons, as ttiose of the peionei, were
of course elongated. Sometimes, in the deiormity called "horse-foot," the
patient rested on the distal' extremities of the matatarsal bones ; this defor-
mity was congenital, sometimes affecting both, sometimes one of the feet.
A variety of apparatus had been invented for the purpose of curing these de-
formities, almost every inslrument-maker having ii plan of his own. The
celebrated Scarpa had recomnaended one kind ot instrument, Delpech anoth-
er, and Mr. CoUes, of Dublin, another. Sometimes the use of an iron, which
passed up on each side of the leg, if continued for years, might affect a cure^
but there was always much opposition from the contracted state of the ten-
dons, particularly of the tendo-Achillis, the division of which mu-ch accelerat-
ed the cure, leaving the instrument-mat- er much less to do,, or at all events
diminishing his difficulties.' Wlien the tendo-Achillis was divided by acci-
dent, it united after a time in a favorable mannei, a substance being deposit-
ed between the ends of the divided tendon ; this substance became dense and
fibrous, and could not be distinguished from the tendon itself. Horses were
subject to an acquired deformity, in which they walked on the point of the
hoof of one of their feet. Most oft he pupils had seen horses going about with
this deformity. Veterinarians had long been in the habit of cutting across
the flexor tendons for the relief of this state ; ihey were not at all particular as
to the mode in which they performed the operation ; they just drew the knife
across the Jeg, and brought the foot into its proper position ; the tendons soon
united, even though, in some cases, there was a space of three or four inch-
es between the ends of the divided portions, new matter, resembling the ori-
ginal tissue, soon filled up this space, and the cure was completed. It was
from reasoning on these tacts that Delpech was induced, in 1816, to resort
to the proceeding of dividing the tendo-Achillis, but he cut through the in-
teguments awkwardly. (Air. Listen here exhibited several casts, also spe-
cimens of the deformity, at various ages, dissected, and a horse's-tendon,
which had been cut and united.) Tiiere, said he, was a specimen of varus;
and there two cases in which the foot was permanently extended, the patient,
in one case, having walked on his toes with one foot ; in the other, both feet
were affected from birth. In all these cases the foot was brought into the

ISSa] Division of Tendons. 293

natural position by division of the tendo-Achillis, which proceedng materially
assisted the apparatus nidker. He alluded shorily to a case of acquired ex-
tension of both feet which iiad occurred some years ago during a severe at-
tack of rheumatic gout, or rather of gonorrhoeal rheumatism. The heels
could not be brought within several inches of the ground; the patient had
been to watering places, and had been most judiciously and anxiously treat-
ed, but without relief. The tendons, in a most rigid state, were divided with
great benefit. The operation was easily performed ; there was no necessity
of dividing the integuments ; a small punctured wound with a very narrow
history, or what was better, with a needle somewhat resembhng a cataract
needle, being sufficient. He had dividr-d many with that needle (showing
it) with scarcely a perceptible external wound ; the tendon was first to be
felt for, and being found, the instrument was to be passed close to it, be-
tween it and the bone ; there were Jio blood vessels or nerves likely to be
wounded ; the point of the instrument was then to be turned towards th3
tendon, which was to be tickled through and divided gradurilly ; the division
was indicated by an audible snap. Thers was a slight effusion of blood in-
ternally about the ends of the divided tendon, but there was no mark or ex-
ternal injurv, no sweUing, infiammation, or its consequences. The extremi-
ties of the tendon soon poured out plastic matter, and this uniting medium, at
the expiration of about ten days, might be extended by means of the appara-
tus employed for this purpose, and in six weeks the foot wouJd be brought
into its natural position. In this case' (showing a cast) the patient'a foot was
not only extended but turned inwards. A cure was effected by a rod which
passed up the inner side of the foot. Li this case (showing another cast)
the patient had distortion of the spine accompanying the deformity of the
foot. In two months after the division of the tendon he was able to walk
about, the foot being of the natural shape, and altogether of a better form ;
there was only a little bulging to be perceived in the situation of the divided
tendon. There (showing the bones of a toot) was a case in which all the
bones were altered in form ; the os calcis was smaller than usual. The pa-
tient walked all his life on the out-side of the foot ; a iaroe bursa had formed
underneath the thickened cuticle.

'"i'he division of tendons answered the purpose of curing deformities in oth-
er situations. A case had been in the hospital in which the knee-joint was
contracted. Tne tendons of the tfemi-memi ranosus and seml-tendinosus
were divided. The contraction in this case, resulted from an attack of rheu-
matism some time since. After the tendons were divided, a screw-joint ap-
paratus was applied similar to that used in fractures of the bones of the leg,
by which means the leg could be gradually extended from day to day, by
turning the screw. The knee-jotnt of this patient originally formed a right
angle, but she was now enabled to put her toes to the ground, though she
was still obliged to use crutches. He, Mr. Listen, would get the knee ex-
tende*d an inch or two more, if possible, not quite str ight, however, as the
patient would not walk so well as though it were slightly bent. He hoped,
by dividing the tendon of the biceps to produce this extension.

He, Mr. L'ston, had also latterly divided the tendons of the toes an opera-
tion, he beheved, entirely new for a common deformity. We often find the
toes bent permanently ; the middle toe, generally, sometimes the little toe,
which stood up above tl>e others. This deformity was either congenital, or
arose from the use of tight shoes. The integument on the convexity of the
joint became thickened, and a corn formed. The pain in these cases was
sometimes so severe that the patient begged that amputation might be per-
formed. Acorn, as the students were aware, not only consisted in a thick-
ened state of cuticle, but there was often a small adventitious bursa under-
neath it ; this bursa sometimes inflames and suppurates ; here was a speci-
men in which this was seen, (showing a preparation) and in this case the toe
was amputated. In this specimen the papiUae of the cutis were also much

8d0 Clinical Lecture on Dropsy , SfC. [Feb.

enlarged ; th"s occurrerl from the greater demand for the secretion of cuticle,
as was also observed in, the paw of the dog. Some chiropodists, as his
friend, Mr. Durlacher, were very dextrous in cutting out a corn, and with
scarcely any pain, by wiiich means a cure was effected , but in cases in which
the toe was, from its awkward position, constantly subject nd to pressure, the
suffering was much increased, and interference with the corn was of little
use. It was in such cases that patients, applied for the performance of am-
putation. He, Mr. Listen, had some time ago, been ren'ieSTed by a gentle-
man to amputate both his littie toes, which had became affected in the w^ay
described. In this case he did not wish to remove the toes, but the suffering
was so great that the patient insisted on its being carried into effect. At
length it was agreed that one toe should be removed, on condition that the
otht r toe should be treated as he, Mr. Listen, wished, by the division of the
extensor tendon. This proceedmg was accordingly adopted. The toe, the
tendon of which was divided, was brought into its proper position, and the
footioon became healthy and' well. The patient was laid up with the foot
from which the toe had been removed, for five or six weeks, an abscess hav-
ing formed on the dorsum ; and he did not go sound for a longtime after with
this foot, while with the other he need net have been confined a single day.
He (Mr. L.; hrd operated on cases of a similar nature successfully, and had
others under his care, in which he meant to pursue the practice. It did not
deserve the natne of an operation, oein^ unattended with pain, or the losis of
more than one drop ot blood. Eciec. Jour.

Lecture on Clinical Medlcin-c, " Dropsy as a conseq'uence of the disease of
the heart,'' ielirer^d at the Philadelphia Medical Institute, by W. W. Ger-
hard, M, D. Physician to the Pniladelphia Hospital, <^-c.

In concluding the subject of the diseases of the heart, 1 have only to speak
of their complications and of their terminations. You have witnessed most
of these complications, and have had numerous opportunities of observing
those which occur most frequently, namelv, dropsical effusions. Jn watching
the course of a heart disease, we expect'that the patient v.-ill, sooner or la-
ter, become dropsical. We know that the various forms of dropsy may be
called the natural termination of disease of the heart, and that when the ef-
fusion of serum is not sufficiently abundant, and does not occur in such a
situation as to cause death, it is still a cause of serious inconvenience to the
patient. Hence you '.re, as it were, obliged to be upon the alert, and must
endeavor to detect this comphcation at its earliest appearance, and to recog-
nise the signs by which it is preceded. That is, you must not only render
yourselves familiar with the more evident phenomena of dropsy, but with
those more obscure symptoms which precede the effusion of serum. Al-
most every important lesion is preceded by more or les.-" constitutional dis-
turbance before it actually manifests itself; this is the case with dropsy oc-
curring in disease of the heart.

Besides dropsy, which may be termed the natural termination of heart
diseases, these aifjctions sometimes end prematurely, from some unforeseen
accident ; such, for example, as the occurrence of pneumonia, which is much
more dangerous in persons laboring under a disease of the heart, than in
those who were previously in good health, or what is still more sudden,
death may instantly ensue from an arrest of the heart's action. This latter
kind of termination is by no means rare in this class of patients ; it sometimes
occurs without the slightest premonitory sign ; the patient may be nearly in
hia usual degree of health, when, from some accidental cause, the heart for a
moment ceases to bear, and death immediately follows.

These accidental termination", you have also seen : you may recollect the
cage of endocarditis complicated with pneumonia, which proved fatal, and

1 83S. Clinical Lecture on Dropsy^ ^c. tO 1

you may rffmember liou suddenly one or two patients were carried off, with-
out having previously otfered more than J he usual symptoms of shgh'' disease
of the vaJves My present object is no-, however, 1o insist upon a chss of
sudden deaths which can rareiy be foreseen, and w'lich can almost never be
prevented ; nor do I {.impose just now to speak of the complication of heart
diseases with acute intiammation of the lungs ; but 1 will merely recapitulate
the symptoms w'hich you have recently observed in some p?.tients who have
suffered from the common, and, as it were, the regular complicatM)n of val-
vular disease of the heart, that is, fri)m drofisy. 1 shall select for this pur-
pose three cases, and although I have the complete observations before me.
It may be more useful just now to confine ourselves to giving a condensed
statement of two of them, instead of entering into details which are of great
utility, but may somewhat impede our examination of the subject under the
single point of view in which we are now examining it. The third case I
shall give more in detail, as it occurred more recentFv, and is very interest-
ing from some therapeutic difficulties which it of!f?rpd.

William Elfrey, aged seventy eight, l^orn at Philadelphia, entered the hos-
pital October 9, 18^38. He had been a cooper for the last six years in the
house, and in the habit of moderate drinking. Before admission, he wag
sensible of short breath omy for three weeks ; never had dyspnoea on ascend-
ing, until about that time. Cough began at the same time, with expectora-
tion of whitish mucus. Great oppression at the epigastrium ; was not con-
scious of palpitation, except on ascending ;'\vas unable to work for last six
months, on account of the failure of his eyesight; cedema of the legs since
last week ; swelling of the abdomen moderate ; unable to lay at night for two
weeks, and obliged to sit up, inclining forwards ; cough worse at night, in
spells, one every hour or two ; no pain, only a sensation of suffocation ; has
had no piles ; no epistaxis or heemorrhage from the lungs ; never ill but icith
ague, seven years since, when he had had it ior five years ; never had rheu-
matismoccasionally a little pain in the feet. His condition at tiie time of
his entrance was the following :

Dark complexion ; large frame, but rather emaciated ; hair and teeth still
preserved ; y- llowish, jaundiced complexion ; cedenvi of lower extremities ;
position, seated ; nostrils dilated ; very little lividity efface ; respiration forty
five, very high ; pulse one hundred and eight, tolerably resisting, very irregu-
lar ; the artery ossified ; coldness of extremities ; cough in parovysms has
had three this morning ; thin, waterv, mucous expectoration ; conscious of
no palpitation ; complained of uneasiness in epigastrium and hyporhondri-
um, where there were evident prominence and flatness as far as the umbi-
licus ; .cund6 of the heart confused the second almost lost : impulse very
moderate ; first sound loud and rough ; flatness below fourth rib in the prse.
cordia complete, passing from thence to the nipplp, where it became continu-
ous with th>' flatness of the side ; on the right side flatness complete below
third rib : res[iration on left side natural and expansive above fourth rib ; res-
piration absent below upper third ; posteriorly, respiration vesicular through-
out left side f.-eble towards the base, where percussion was dull ; on right
side posteriorly, very feeble in lower two-thirds ; percussion very obscure.
A pediluvium w s ordered, with the infusion of the meUssa officinalis, and
three grains of Dover' powders, and a quarter of a grain of digitalis, every
three hours.

Octnbrr iOth. Last evening was cupped eiglit ounces to the praecordia ;
fits of dyspnaea ceased ; poultice applied immediately after cupping ; skin
was warm after balm tea ; miw lies with head a little elevated, much less than
yesterday ; less oppression ; respiration twenty three, less elevated, by an
alternate movement of the r,bs and diaphragm : pulse ninety two, fuller,' less
irregular ; skin rool at extremi'ies, bub less so than before : face a little livid,
with permanei;t dilatation of the nostrils ; tongue a little blue, moist, clean ;
Btill dizziness ; intellect less dull ; urine evidently increasedtwo or three

393 Clinical LxcVire on Dropsy, ^c, [S*b.

discharges this morning ; respiration, left si dr, anteriorly, louder and fuller ;
on the right side, mucli louder feebleness of i' ex'^ending scafceiy above
the nipple ; dulness on percussion to I he same extent ; impulse of heart very
moderate; boih sound-* heard, something lik.* the double tick of a watch;
creaking of parchment doubtful yesterday, clear to-d;jy ; percussion fltt to
fourth rib ; posteriorly, respiration, right s.di, inferiorly, rud.? ; ptTcussion
much clearer, a httle dull at base. Bilm tea, Dover's powders^ and digitalis,
continued ; poultice. .

Oclohcr I2lk. Pulse one hundred, less irregular ; five paroxysms from 12
o'clock yesterdiy, until tlie evening ;!skin more natural ; no sweating ; can
lie with hiS head at an angle of forty degrees ; cedema of the l(>gs much less;
no swelling of the abdomen-; cougii less severe ; no soreness at epigastrium,
less tension ; lips less injected ; bronzed colour of the skin less marked ;
tongue moist, still somewhat purplish ; respiration on right side anteriorly,
vesicular and feeb'e, at lower fourth, almost absent throughout, a little
harsh ; leftside Jouder than on right, vesicular absent over praecordial re-
gion ; creaking now very loud at the level of the valves, evidently not valvu-
lar sounds ; can be felt as well as heard ; extends to the sternum, a space one
and a half inches sqnire ; sounds of the heart louder ; second almost lost, ac-
companied by bruit de cire ; rhythm altered ; impulse stronger than average;
to the rignt of the sternum both sounds heard a little altered ; percussion
dull over the fourth rit), to an inch beyond the nipple, where it is lost in the
axill?., perfect near the sternum, extending to the right margin ; respiration
posteriorly left side, at the inferior one third absent ; upper two thirds vesi-
cular, nearly natural; right side, absence, v-)f respiration almost complete in
lower one half, slightly bronchial ; oegophonj on both sides corresponding to
the level of the liq lid; higher on right than left ; continue treatment.

I'Stli. Slept much better than before ; had two or three paroxysms last
night, none this morning. Lies with his head much lower; pulse eighty
iour, very irregular ; thinks a paroxysm is coming on ; asks for powder, thinks
they shorten the paroxysm ; dyspnoea much less. Some rasping in the first
sound of the heart ; absence of second almost complete at the semilunar
valves ; creaking occasionally heard, most loud over the middle of the heart,
both in the systole ^nd diastole. During auscultation, a paroxysm coming
on ; action of heart becomes quicker, spasmodic ; the bruit de cire more con-
stant, louder ; impulse increased ; same sound heard in both sounds, but
less loud in second ; powders continued every four hours.

l^th. Sleep has been very good since last' date ; can lie on either side,
with his head very low ; oppression almost gone ; pulse sixty eigh% less irre-
gular ; no cephalalgia ; no pain any where ; cough very slight ; tongue
moist, scarcely coated ; urine abundant, about three quarts daily ; no sweat-
ing ; abdomen flaccid ; tension at hypochondrium almost gone ; no swelling
of the feet , tongue moist, but still of a purple tin% as well as the lips ; top of
skin generally less bronzed ; two stools ; respiration easy, fourteen ; respira-
tion on left side anteriorly vesicular, alm)st natural, except at the base of
the axilla, heard distinctly over the heart; i.npulse of the heart much strong-
er; strong rasping sound in the first ; second almost lost ; a little creaking
heard at times. Percussion sonorous below four;h rib ; flatness from thence
continues with the region of the pleura, not connected with the pericardi-
um ; posteriorly, respiration vesicular throughout ; powders continued morn-
ing and night ; infusion of juniper berries ; full diet.

I7th. Decubitus low, nearly horizontal ; pulse sixty, irregular ; respira-
tion twenty ; tongue less livid ; lips less so ; urine continues copious be-
tween three and four quarts no swelling ; cephalalgia better ; two stools
daily ; powder once daily ; continue infusions.

22nd. Convalescence has continued ; the patient is walking about; full
diet given after the first four days ; walks up stairs without difficulty ; very
little shortness of breath ; no cough ; no pain.

1839.1 Clinical LecCure on Dropsy ^ cj-c. 303

Auacullaliim <)f the heart s'rongly ra?pinf, Ptnrre in the first soundovrr*
verge ol tlie s^fmiluiinr valves; a nitie grating heard lew arcs :lie aptx; :uid
diifereiit Iroiii the action ot tlie valves ; on r gljt s.de of sternurn, v\ ijcrc ihe
Becoiid sound -s most developed, the rasping continues ; impulse at the top
of the sternum strong : which is syriciuonous with that heard at valves ; and
second transmitted along aorta ; nnpuJse evidently distinct ; respiration dull
at upperlhitd otsternum ; flat at lower two thirds ext. nd.ng to n'pple-, but
not to axilla ; not to right of sternum.

Dischargeel, cured of the ai'ute attect'on. There remains chronic disease
of the valve's of the aor;a with hypertrophy and dilatation, with pr.tches of
lymph m the petiqardium

This patient was employed, asyeni perceive, in the out-w^ards of the insti-
tution, and suffere'd 50 little inconvenience from his disease of the heart, as to
be quite unconsc ous of its existence'; there were neither dyspnoea nor palpita-
tions sufficiently severe to prerv'ent hini from follovvijig his ordinary occupa-
tion. He IS, liowe.ver, afterwards, attacked with a new c(nnplication : that
is, acute inflammation of the pericardium, and in aslicht degree of the en-
docardium. This complication at once increases the dysproea offers an ad-
ditional impedhnent to the circulation of the blood through the lungs and
heart, and is quickly followed by dropsical efi'usions.

When the patient rntered the he)spita', there was oedema oft he limbs, and
effusion into both the pleuras and the pericardium, that is, hydrolhorax ; we
were able to trace the quantity qi liquid then contained in the cavities, and
we could also estimate the rapidity of its absorption, by the gradual subsi-
dence of the line ofdullness. By physical examination we could go still fur-
ther in our diagnosis, and ascertain that the heart was at first separated to
some distance from the wails of the thorax, by the lie^uid effused into the pe-
ricardium, and that in proportion as the effusion diminished, we heard a gra-
tmg sound at the proecordial. region. This creaking sound was a proof that
the effusion into the pericardium was not simply dropsical, but that it de-
pended in part, at least, upon an inflammatory action in this cavity.

Ye)u have observed how intense the dyspnoea appeared at the entrarce of
the patient; he was obliged to sit up and lean forward, breathing with ex-
treme effort, and obviously laboring under an almost complete stasrnation of
the circulation. The heart pertorm.ed its functions with great difficulty, its
cavities were surcliarged, and the lungs were, therefore, over loaded. The
same impediment totiie circulation, gave rise to coldness, lividity, and oede-
ma of the extremities. Ttie patientwas obviously in danger ; the circula-
tion required to be relieved, and at the same time, in the effort to diminish
the quantity of blood in the heart, we are bound to av. id increasing the fee-
bleness of the patien*, for in these cases a very slight abstraction of blood
may do harm. T therefore directed sinapisms to be placed upon the extrem-
ities, with a warm infusion of the common balm, as a drink. Dover's pow-
ders, combined with digitahs, were to be given internally, but these reme-
dies could not, of course, produce any immediate effect. I directed cups to
be applied, if the circulation should again become more vigorous ; the sina-
pisms and warm drinks were followed by some rehef ; but the patient was
not cupped until complete reaction had occurred ; he was immediately re-
lieved by the cupping, and continued to improve, untd the effusion had com-
pletely eiisappeared.

When you meet with cases of this kind, you may generally relieve them,
provided they have occurred suddenly ; if, however, the dropsy has corne on
more slowly, and is connected with an enfeebled state of the system, and a
diminution of the quantity of red globules in the blood, you will meet with
much more difficulty. When the patient has not completely lost the vigour
of his constitution, he may readily react from the temporary depression
caused by the impediment to the circulation, but it is always expedient first
to resort to measures designed to excite the circulation in the exterior of the

304 Clinical Lecture on Dropsy, 6fC. fFeb,

Itdy, sucli as fomentation?, sinapisms, stimulating^ petliluvia, and warm
driiiks. You may, at.erwards, as soon as ihe circuJation lias become more
equalized, unload ihe heart and larj^e vessels, by lakin^' blood Irom the arm,
by Iree cupp:ng over tlie praecordial region, oi between the shoulders. When
you have succeeded ni yuur treatment, and have diminished the dysprcea,
you may place the patient upon the use of dij^ntaiis. As you may have re-
n.arked, I frequently combine this remedy \\\\\\ Dover's powders, and m this
way irauquihize the action of tlie heart iiiore effectually than could be done
by the dsfjitalis alone.

One of the otjjer cases to which I have alluded, is now in tlie wards. It
IS VVise,^ patient who labors under the unfortunate complication ot phthisis,
and dilatation and hypertrophy of the heart, with its antecedant disease, ge-
neral dropsy. The tuberculous disease is chiefly confined to the right lung,
wnich is adherent throughout a considerable part of its extent. Now, the
effused serum cannot accumulate in the right pleura, in consequence of these
adhesions, and it is ilierefore collected in such quantities on the left side as
to give rise to the most distressing dyspncea. It is also secreted in conside-
rable quantities in the pericardium. Of cor.rse, the disease of the right lung
diminishes the quantity of pulmonary tissue still permeable to the air ; the
patient, therefore, suffers doubly from the hydrothorax.

The dropsy extends to the extremities, as well as the parts of generati'n,
and annoys the patient very much from the pain which he suffers in the
scrotum and penis. The anasarca commenced suddenly after making a vi-
olent effort in lifting a heavy beam. From the symptoms offered by the pa-
tient after his admission, there was reason to beheve that m this case, as
well as in that just relatt d, the dropsy coincided with an acute inflammation
of the heart, occurring during the course of chronic hypertrophy. The pa-
tient is still in great danger, and the treatment is necessarily difiicult from the
numerous complications of the disease, which require to proceed with ex-
treme caution. 1 am now carefully puncturing the thighs and scrotum, ap-
plying bandages to the legs, and giving the patient a pill three times daily,
composed of tnree fourths of a grain of digitalis, a sixteenth of a grain of ca-
lomel, and a third of a grain of opium, lie lakes also an infusion of juniper
berries, as a ptisan.

The third patient is a mulatto, named Henry, who was twice under treat-
ment. On the first occasion, anasarca came on sjmultaneously with peri-
carditis. He was entirely cured of the dropsy, and the disease of the heart
was reduced to simple hypertrophy and dilatation. The man left the hospi-
tal, commenced a laborious employment of the most unsuitable kind drawing
a hand-cart, and was exposed to a shovver of rain. The next day after this
wetting, he was attacked with dyspnoea and palpitation, and in a day or two
aiterwards was obliged to enter the ward for a second time : the patient was
again treated for anasarca with httle success ; ascites afterwards superven-
ed, lie was tapped, suffered little inconvenience from the operation, and, after
a partial improvement, was carried off suddenly, without any previous in-
crease in the alarming symptoms. Upon f xamination, the heart was found
to be enlarged, it was thickened, and its cavities were dilated to nearly twice
their natural size ; the valves were nearly in the natural state. Organized
patches of lymph and partial adhesions, were found in the pericardium- I
mention this case, that you may again remark, how frequently acute inflam-
mation of the membranes of the heart comphcates a chronic disease, and
proves the exciting cause of dropsical effusions. 3feJ. Examijier.

l&Qd.] Stone in the Bladder. 303

Part III. MONTHLY PERISCOPE.

Stone in the Bladder. It is not a little to be regretted, that
chemistry and other means have not been more extensively and
successfully applied, to the investigation of the causes and pre-
vention of urinary calculi. When we contemplate the extreme
and protracted distress of most cases of this disease, the ill suc-
cess of merely medicinal powers, the severe and hazardous
treatment of surgery, and the very frequent occurrence of this
disease in many sections of the country, we perceive at once,
that there is scarcely a topic presented for the investigation of
medical men, of deeper interest to humanity, than the prevention
of this malady.

Whilst we accord to surgery the full measure of its just claims
its indispensable value to humanity that it is not only able
to lessen and shorten affliction, but is life-saving still, looking
to the interests of humanity, we most earnestly deprecate the
necessity for its use. It is, at least, a kind of dulcamara, for
whilst it relieves pain and prolongs life, it is through the medi-
um of the most severe inflictions. And we heartily rejoice that,
though ever prepared (as all practitioners should be,) to encoun-
ter this dreadful disease with the gorget in hand, v/e have been
allowed to grow grey, and our lithotomy apparatus to lie in case,
unmolested having never earned the cutler's bill. We greatly
prefer our lot, in this case, to the glory of having performed a
thousand operations for the stone without one unfavorable re-
sult. We only regret that we cannot say the same relative to
the rest of surgery, and from the same cause ; that is to say, the
absolute want of demand for it, within our cable- tow. We
know of no cases of distress, from urinary calculi, having occur-
red in this section of country, so serious as ever to call for sur-
gical aid ; at least, for extraction from the bladder and of but
oneinstance, in the whole population of our city ar^d surrounding
country, of a person for whom that operation has been demand-
ed ; and that case occurred many years ago. The only cases,
and these are few, are those in which gravel, or small calculi
pass, more or less easily, with the urinary discharges ; and a few
instances wherein, from the smallness oFthe urethra, these have
lodged in the passage, so as to require a simple incision into the
urethra for their removal.

Whilst such is our happy exemption from this disease. Dr.
Dudley, of Kentucky, performed, on the l3th of October last, his
157th operation of lithotomy, on a boy often years of age, and
which was the thirteenth case from the same county. And wc
should remark too, that it is not in evei^y case presented to Dr.
o 7

305 Stone in the Bladder. [Feb.

Dudley, that he operates ; but, simply those in which he may
calculate with much certainty on a favorable result.

Would not an extensive and minute investigation into the cha-
racter of the waters, diets, habits of life, &:c. of those.sections of
country where this disease is most common, and these results
compared w^th those of similar investigations where the disease
does not occur, be calculated to contribute to prophylactic ends ?
Perhaps a more minute and critical examination of the history of
the whole course of hfe, in those who are subject to calculus,
might develope views of deep interest relative to the causes of
\\\\s ultima tlmle of medicine.

We, neveriheless, rejoice, that we have in the s.cience of sur-
gery, a co?ys de reserve, for the good services of humanity in
extremis ; and that, in looking around, we have great reason to
be happy in its. achievements ; particulyirly in the United States
of America, where, more than elsewhere, it is, in general, practi-
sed with judicious and prudent boldness ; and with a success, in
this particular disease, unequalled in any land.

We hope to present to the public, in a future number of this
Journal, some interesting results, in the practice of lithotomy,, by
Dr. Richard Banks, of Gainesville, Ga. Meanwhile, we give the
following extracts from the late foreign journals as interesting,
and calculated to inspire prudent confidence. The first is inter-
esting on account of the early age of the subject, and all, on ac-
count of the magnitude of the calculi.

Lilhnirity in a Child. M. Segalas lately presented to the Royal Acade-
my of Medicine, a boy nearly five years of age, whom he had operated on
with success, for vesical calculus. This child was weakly and affected with
rickets, and did not appear to be more than two and a half, or three years of
age. He was the oldest child amongst ten, upon whom M. Segalas had, as
yet, operated. The calculus, in this case, was a large one, being an inch
and a quarter in diameter. Twelve sittmgs were required to break it up,
and on three different occasions fragments of the stone became arrested in
the bladder. Notwithstanding these unfavorable circumstances, the boy
was completely cured, and in the interval of the sittings was able to run
about and play with his companions. On the whole,"IM. Segalas declares, as
tho result of his experience, that whenever the instrument can penetrate the
foreign body, the operation of lithotrity, like that of lithotomy, presents the
more chance ofsuccess in proportion to the youth of the patient. Ga-. Med.
de Paris, Bost. Jour.

Litliniorhy. Dr. Knight, Professor of Surgery in the Medical School at
New Haven, recently performed the operation of lithotomy in Middletown,
Conn. Tlie calculus was fie inches in diameter, and iceighed six hundred
andninefi/.one grams. The patient is represented to be doing well. Bost.
Med. Jour.

':.-, Operation of the Stone. In the Medical Gazette for August, Surgeon Hugh
Ffkser, of the Kmg's Royal Rifle Corps, at Corfu, gives the details of the
Successful Extraction of an Imjnense Calculus, by the Bilateral Opera-
tion. The bladder was exposed by a transverse semi-circular incision, at
tii distance of eight or nine lines in front of the anus, and of a sweep of about

1839.] Inflammation and the Restorative Proceis. 307

eleren or twelve on each side of the raphe towards the tuberosities of the is-
chium. The membranous portion of the urethra beinc reachec', was sht
open, and the beak of the Lithotome (set at nineteen hues and a fraction)
planted in the grove of the staff, which had been held by an assistant. The
operator taking hold of the staff, and depressing it, the lithotomo was steadi-
Jy insinuated through the prostrate, which made a little resistance ; its en-
trance into the bladder was marked by a stream of urme. ~

" The lithotome was then deliberately turned from having its convexity
looking sacral, to the pudic aspect, and withdrawn, having the beak directed
to a point an inch below the umbilicus, the handle much depressed upon the
rectum and anus. By this mode the prostrate gland is cut into about two
equal portions, the one pudic, the other sacra] ; so that the floor of the inci-
sion is the rectum, the traject from the prostrate to the external wound al-
most perpendicula.'* an incision obviously much guardmg against cellular
infiltration."

After no little trouble by efforts to extract the stone with the forceps, and
an abortive attempt by an assistant to break it down with a powerful lithotri-
potor, it was most luckily caught very firmly in the only diameter that" it
co.uld possibly have been dr.awn through the perineum, and brought awaj
without the farther assistance of the knife.

The calculus in shape and size, greatly resembles the e^g of a turkey ; and
it is somewhat flattened.

"It has a bloody, rough growing coat, and would probably, in no long
while, have become adherent to the bladder. Its weight is five and a quar-
ter ounces add a quarter splintered off its small end in the attempts at ex-
tra^ction, and you have a stone weighing five and a half ounces, apothecaries*
weight. Measuring the long circumference, it is exactly seven inches, and
the circular or short diameter, is six inches and three-tenths."
By a rapid transition from the Island of Corfu, in the Mediterranean Sea,
to the town of Maysville, on the Ohio, we next notice the operation of litho-
'tomy successfully performed on three subjects during the last summer, by
Doctor John Shackleford, of the last named place. The patients were all
youths. Eclectic Journal.

Injiammation, and the restorative process. Dr. Macartney,
Lecturer on Surgery in the University of Dublin, gives, in a lata
treatise on inflammation, the following theory and praetrce. "His
views with regard to the connexion between inflammation and
the restorative process, are original. According to his theory,
this process, (the restorative,) does not depend upon inflamma-
tion, but is rather incompatible with it. Reunion and reorgan-
ization, he supposes to be effected in four different ways." (Ed--
Med. Examiner.)

" First, by immediate union, without any intervening substance, such as
blood or lymph.

"Second, the union by the medium of coagulable lymph, or a clot of blood.

"Third, re-organization without any medium of lymph or granulation?,
the cavity of the wound becoming obliterated by a natural process of growth.
- " Fourth, the reparation by means of a new, vascular, and organized sub-
stance, called granulations.

" To the first of these modes of cure, I should wish to give the name of
immediate. The second may be called the mediate hij lymph or blood. Tho
third, being compounded of different actions, I find a difficulty in distin^iah.

tv8 Ivjiammation and the Restorative Process. [Feb.

ing it by a single name. It might be denominated the approximating or the
modelling process of reparation, or that by a natural growth. The fourth
mode of union should bo termed mediate by granulation.

" The three first mentioned modes of restoration, are quite incompatible '
with the presence of inflammation ; a slight degree of which may, however
exist with the fourth. Not that I admit the growth of granulations to be an
inflammatory process in itself. It ought rather to be viewed as the mode of
reparation, 3 dopted under the unfavorable circumstances of irritation, or a
degree of inflammation being still contmued, and proves that parts previous-
ly m a healthy state, are disposed to heal in despite of many impediments
thrown in their way.

" The circumstances under which immediate union is effected, are the ca-
ses of incised wounds, that admit of being, with safety and propriety, closely
and immediately bound up. The blood, if any be shed on the surfaces of
the wound, is thus pressed out, and the divided blood-vessels and nerves are
brought into perfect contact, and union may take place in a few hours ; and
as no intermediate substance exists in a wound so healed, no mark or cica-
trix is left behind." (p.T53-4.)

^' The union of parts w^ith the medium of lymph or blood takes place in
wounds, which either cannot, from the extent or shape of their surfaces, be
brought into perfectly close contact, or where the parts will not sustain much
pressure, without the danger of inducing inflammation. The lymph which
issues from the adjacent surfaces, in the first instance, glues them together,
and in a few days is found to have acquired some vascularit)'^, and an imper-
fect degree of organization ; after which, an external restraint for keeping
the divided surfaces in contact becomes unnecessary." (p. 155.)

" When healthy parts are injured, although it may be to the greatest ex-
tent, if placed under the most favorable circumstances for carrying on their
natural actions, the process of reparation is nearly the same, even in the hu-
man subject, as that which I have described as belonging to the animals of a
simple structure. The pain arising from the injury soon ceases. JNo tume-
faction ensues separating the edges of the wound, and its surfaces are not
only disposed to lie in contact, but even to approach each other so much thct
they cannot be kept asunder by mechanical restraint ; there is, therefore, no
necessity for the effusion of lymph ; and as there is no cavity to be filled up,
granulations are not formed. The surfaces of the wound, although they
come into contact, do not unite by vessels shooting across ; they are smooth,
red, and moistened with a fluid, w'hich is probably serum^ and present the
appearance of one of the natural niucous surfaces of the body. It the parts
have been killed by the injury, they are separated by simply as much inter-
stitial absorption as is sufficient to set them free. The wound is finally
healed by the same means which determine the shape of the natural parts of
the body. It gradually diminishes in extent until it is obhterated, or it may
be cicatrized before the surfaces are abohshed ; after which the same process
of natural grovvthgoes on, until no part of the original wound is left. The
cicatrix which succeeds the cure of the injury by the modelling process, is
small, pliant, free from those callous adhesions to the parts underneath, and
the morbid sensations that so often belong to those cicatrices which have
for their bases the deposits of lymph or the formed structures called granu-
lations. When the modelling process or cure by natural growth goes on
perfectly, there is no inflammation in the part, and the patients are so en-
tirely free from all uneasy sensations, that I have know-n instances of their
being ignorant of the real site and extent of the injury, untd they had exam-
ined the part with their hand, or saw it in a looking-glass." (p.*53-4.)
Medical Examiner, from Macartney on Injlammation.

We are compelled, of late, by their intrinsic worth, to look to
the more prominent Dublin Physicians, with great interest, for

1839.] Tartar Emetic in InfMmmatinn. 301)

every thing of practical value in their several departments; whilst
we recognize in their practical value, the best assurance of sound
theory.

But, apart from this direction of our confidence, we arc pre-
pared to go further than the editors of the Examiner, and yay,
that the doctrine held forth is not only " originnl," but that it is
strictly true, and may well be set down as the perfection of me-
dical philosophy relative to the restorative process in effecting
reunion, reorganization, and final separation.

Tartar Emetic in Inflammation. On a former occasion, we
gave a valuable extract from one of the Dublin Physicians, en-
joining the steady application of cold, and the injurious conse-
quences of disregarding this precept. The following extract
from Dr. JMacartney, on inflammation, through the Medical E;c-
aminer, is to the same therapeutic point, and is of like import-
ance, so far as relates to securing the qood effects of Tartar
Emetic ; but, on the other hand, we think there is not the same
danger of actual injury from re-action, which is a natural ten-
dency under alternations of heat and cold. Much injury has, of
late years, been done by the unsteady application of this valuable
sedative power (cold).

The same doctrine as is here held forth, relative to the import-
ance of moderate but frequent doses, for maintaining a continu-
ous and steady effect, is^ applicable to almost all medicines, as
means of influencing the actions, secretions, or sensations of the
system, such as expectorants, diuretics, diaphoretics, sedatives,
anodynes, cholagogues, &c. (kc; especially in all cases wherein
more than a single impulse is needed. This practice is sound in
theory, and wholesome in effect ; and is directly at variance with
w^hat are called /^rom/?^ emetics, the 20 to 100 grains, or what
are called heroic doses of calomel, (a medicine which should
rarely be given merely as a cathartic,) hydro-cyanic acid, the
use of poultices, &c. &c. But we hasten to give Dr. M's. sug-
gestions on this important subject.

' Tartar Emetic he uses in smaller th3n the usual doses : 'the good ef-
fects of nausea depend on the feeling being steadily kept up for some time,
and this can best be accomplished by very divided and frequently repeated
doses of the medicine.' Externally, the remedial operation of a. moderate
degree of cold, is, he thinks, in most cases to be preferred. The application
of intense cold is reserved for very severe injurii^s, compound luxations, for
example, where the inflammation cannot be restrained by other means. The
operation of cold and moisture must be uninterrupted to be of use. Irriga-
tion, by means of the syphon, effects this purpose. The alternations of heat
and cold to an inflamed part, which result from the imperfect renewal of
cloths, dipped in refrigerant lotions, are necessarily hurtful ; and the plan of
irrigation, which we owe to the French, is a valuable improvement in sur-
gery." Med. Examiner^

310 Lead Lotion in Tinea Capitis, [Feb.

Lead Lotion in Tinea Capitis. Dr. Macartney illustrates
the importance of the s^ea//?/ enn ploy mcnt of external applica-
tions, by his success with lead water in Tinea Capitis.

"The lead lotion never fails to cure tinea capitis, however lon^ and obsti-
nately the complaint may have resisted other remedies, provided the appli.
cation of the lotion be properly conducted. The hair should be first shaved
off; water dressing, or a poultice of any kind, is then to be applied, merely
for the purpose of cleansing the skin of the crust, and all other impurities.
There will then be seen, under each crust, a red spot of the skin, denuded of
its cuticlr, and the villous surface exposed. The lotion should now be ap-
plied by means of lint, thoroughly wetted with the fluid, and covered with a
plate of India rubber, or a piece of oiled silk to prevent evaporation. Every
time this dressing is changed, which should be very frequently at first, the
head should be washed with some of the lotion, and the lint should be re-
placed by some that is clean, which is to be completely wetted with the lo-
tion, and covered as before. The efncacy of this mode of treatment de-
pends entirely on the head being continually subjected to the operation of an
astringent fluid ; for, if the application be suspended for one night, or even
for a few hours, the peculiar viscid secretion w-hich forms the crusts will re-
appear, and the whole treatment will have to commence again." (p. 182-3.)
Macartney on Injlammaiion.

We do not feel at liberty to allow this slrons: recommendation
for the cure of Tinea Capitis, to go to the public from us, with-
out a wholesome caution against such a plan of cure. Close
observers have too often been brought to witness the ill effects
of repelled eruptions,_by the use of astringents and other repel-
lants, in the production of other more serious and more fatal
diseases, for prudent practitioners to venture upon such a plan
alone. Many have been the cases in which the most serious
consequences have followed the repellino^ of the slightest cutane-
ous eruptions even of ring- worms. The same may be said of
the suppression of in<;rdinate perspiration of the feet ; and, doubt-
less, it is because of the peculiarity of the perspiration of these
parts ordinarily, that the influence of cold taken by the feet is ge-
nerally so much more serious than the same Exposure of other
parts. We feel it a duty to state, in this place, that we earnest-
ly believe that we were instrumental in laying the foundation of
a fatal pulmonary affection, by one solitary prescription of the
yellow wash, (mere. mur. fort, and aquacalcis.) for a salt rheum
on the instep, not larger than the palm of a hand, but which had
been occasionally very troublesome for years. The case was
this On passing the store door of a merchant in Broad street,
with whom we were not before acquainted, he called our atten-
tion to an eruption on his instep, which was then considerably
irritated, and discharged a sanious fluid, and was attended with
itching and burning ; all of which rendered it inconvenient for
him to wear a stocking. On his request of advice for destroying
the eruption, we gave him a formula for the yellow lotion. A
few days after, we met him, fully dressed, and was informed that

1839.] Waj-m Vajyour, or Sisam in InJlammaiio7ts^ 3il

the wash had completely cured ihe Salt Rheutn. He continued
apparently well tor a few months, when a cough gradually ac-
ceded, attended with occasional pains in the breast. Not being
his physician, we lost sight of iiim ; and only learned from him,
subsequently, wdien on his way southwardly, for a southern
winter, that his eruption had never returned, but that the pul-
monary affection, which was then at a very advanced stage, had
progressively increased, without any particular exposure or
other known cause. His case was then beyond all hope, and he
died at the southern location which he sou2:ht, the follovvinij
winter.

The almost total banishment of every thing like a rational
humoral doctrine from medicine, for the last twenty or thirty
years, has tended to conceal from the view of physician?;, the
important pathology which such facts declare. But facts should
make theories, and these facts declare to us not action mereh/f
which being repelled will occur in another part, bui some ?7iorbi-
fic humor, (let theory say what it may,) w^hieb imperiously de-
mands the rigid adoption of such an alterative plan as will exter-
minate it from the system, before repellants are applied to these
eruptions ; however simple they may seem. This plan is made
up of Regimen, Stillingia Sylvatica. Sarsaparilla, Guaiacum,
Mercurial Alteratives, Antimonials, Plummer's Pills, vapor or
warm water baths, &c. &c. But this is considered to be too
serious a course to be adopted for such trifles. Let practition-
ers look at the great and serious results arising out of its neglect 1

Warm Vapour, or Steam in Inflammations . Dr. Macartney
observes, that those remedies which affect in an agreeable yuan-
ner the sensations of inflamed parts, exert a powerful tendency
to subdue the inflammation. Dr. Rush taught the same doc-
trine, but not to the same unlimited extent, livery practitioner
knows the truth of this observation, to a greater or less extent ;
but, we presume, few are prepared to receive it as universally
true. And, furthermore, the diiferent terminations of inflamma-
tion should be kept in view, with their relative desirableness.
For example, prompt and perfect resolution, is decidedly the
most desirable. It follows, therefore, that ^ remedy ''affecting
in an agreeable manner'" \.\\e sensations of an inflamed part, and
lending to terminate it by promoting suppuration, when resolu-
tion is practicable, would not be a desirable remedy : but such as
would have a prompt " tendency to subdue'* it by resolution
would be preferred. Now, both cold and heat would, in many
cases, "affect in an agreeable manner" the sensations of the in-
flamed part. It follows, therefore, that in such a case, the un-
remitted application of cold, as " tending to subdue the inflana-

3 1 3 Warm Vapour ^ or Steam in Injlammations. [Feb.

niation" by resolution, would be correct ; whilst a warm, simple
poultice, ti^.e tendency of which would be to terminate it in sup-
puration would be incorrect practice. The same doctrine is
also applicable to a more advanced stage or degree of inflamma-
tion, in which suppuration is a desirable alternative from gan-
grene, &c. The same logick, may, therefore, be liable, when
some modifying influences and circumstances are brought into
the reasofiing process", compel us to arrive at conclusions which
are materially difierent in a practical point of view. But Dr.
M. "has found the application to the skin, of steam at a suitable
temperature, the best means we possess, of producing a grateful
state of sensation." Therefore, it has " a most powerful tenden-
cy to subdue inflammation." Q. E. D: Now we are not dispos-
ed to controvert this conclusion in the general ; for we know that
it often " affects in an agreeable manner, the sensations of an in-
flamed part." \Ve know further, that resolution does sometimes
follow tiie application of warmth. But our observation goes,
further, to inform us that its tendency is more to promote the
suppurative sta^e and termination, than cold and some other
discutient remedies, so called ; as well as the fact that there are
some cases of inflammation, in which heat, any way applied,
does not " affect in an agreeable manner the sensations" in the
part. Other circumstances, speciMcally characterising the pre-
sent case, must, therefore, be taken into the calculation in arriv-
ing at a correct prescription. Doubtless, however, these views
would be often most happily applied to practice; for we have
witnessed this fact in many instances. Therefore, we take plea-
sure in giving tl>e folloAing description of the apparaUis invent-
ed by Dr. M. " for the correct employment of steam, from the
hottest degree at which it can be borne, down to below the stan-
dard temperature of the human body."

" It consists of a small tin boiler, supported on a platform, on which a .spi-
rit lamp is placed. The pecujiarity of the vessel is, that the superior open-
ing is an expanded funnel, in consequence of which the steam ascends from
the boiler with a vertical motion, being- attracted to the smooth and infundi-
bular aperture. The effect of the steam escaping in this manner is to dif-
fuse and cool it so much, that if the vessel be uncovered, the hand may be
placed within an inch of the surface of the boiling water, without experien-
cing any unpleasant feeling of heat, although, if the steam be made to spread
in a straight line, by diminishing the opening of the funnel, it will scald the
hand held two or three feet above the water. The steam is conducted to
any part of the body, by means of a tube of woollen cloth, about twelve inches
wide and three feet long. Its cylindric form is maintained by circular pieces
of whale-bone. One end of the woollen tube is tied round the contracted
neck of the boiler, and the other end admits of being adapted to the shape of
any part that is mtended to be fomented, from holding within its opening a
piece of flexible wire.

"By this apparatus, steam at any temperature may be applied for any
length of time, with only the momentary interruption of renewing the boil-
ing water, and the spirit in the lamp. The great advantage of making a
continued, instead of a temporary application, at a determined temperature,

1839.] Treatment of Varix, <^c. 313

and without the intervention of the woollen cloths used in common fomen-
tation, which irritate many wounds and ulcers, gives to the mode I have de-
scribed for administering steam, the character of a new remedy, which it ex-
hibits also in the more extended and more beneficial efiects than those of
common fomentation."

"The effects of steam, at a high but comfortable temperature, are gently
stimulant, and extremely soothing to the feelings of the patient. When
used immediately after the receipt of lacerated gunshot and punctured
wounds, contusions of bones, fractures near joints, recent luxations, bruises,
and strains of joints, and in all wounds accompanied with a peculiar over-
coming pain, and a shock to the nervous system, it removes all pain, and con-
sciousness of injury in a short time. After the pain and sense of injury have
passed away, the steam may be continued at a lov.er temperature. Hot
steam is remarkably successful in improving the condition of the indolent ul-
cer ; and for inflammation of a more active character, no local application can
compete with steam at a low temperature." (p. 176-7-8-9.)

The water dressing consists of two or three layers of lint, floated in the
water before being folded, and covered with French oiled silk or India rub-
ber, which should project beyond the margin of the lint^ to prevent evapora-
tion. It is to be changed two or three times a day, and is recommended as
having not only better, but very different effects from poultices. It
prevents or diminishes the secretion of pus, and under its use, granulation?,
w^hich are rendered exhuberant by poultice, are either never formed, or exist
in a slight degree. Very ancient authority is cited for the employment of
water as a remedy for wounds and inflammation, but Dr. Macartney claims
the credit of having introduced it to the attention of the profession in modern
times. For this and other valuable practical suggestions, he is entitled to
our thanks ; and, as far as we know, the novelty of his views, as to the pos-
sibility of open wounds healing without inflammation, and without the medi-
um of either coagulable lymph or granulation, cannot be disputed. Medical
Examiner.

Treatment of Varix. E. H., aged 25, a lady's maid, was admitted into
iJniversity College Hospital, June 21, under the care of Mr. Listen. About
six years ago, during the time she was travelling, her left leg became frozen,
and was afterwards suddenly exposed to considerable heat, by the limb being
immersed in a mash-tub. In consequence of this treatment the veins of the
leg became varicose, and the hmb flexed at the knee-joint. This state of
flexion continued for some time, when it was overcome by main force, and
the hmb was moved w-ith freedom. She has had recourse to a variety of
treatment under various surgeons without experiencing any relief. On her
admission the veins of the leg were much enlarged, and there was a small
ulcer on the inner ancle.

July 25, Mr. Liston passed eight needles under the principal varices, and
applied twisted sutures. The ulcer soon healed, and the veins ceased to
appear enlarged.

30th. Three of the needles were removed to-day ; the other five on the
31st. Water-dressing applied.

August 4. The leg bandaged to-day. Went on well till the 16th, when
she was discharged cured. London Lancet. Bost. Jour.

Modification of the Appareil Immobile, for the treatment of Fractures. In
No. 21, we gave a description by M. Velpeau, of the appareil immchil?^ ofM.
Seutin, for the treatment of fractures. From the London Medical Gazette
II 8

314 Treatment of Varicose Veins, <^c. [Feb.

for August 11th, we take the following suggestions for the improvement of
this apparatus, by Drs. Christophers and King. The objection to M. Seu-
tin's apparatus is, that it docs not expand and contract as the limb may
swell or diminish with the development or subsidence ol inflammation. Dr.
King's first idea was to slit the apparatus, so that it miglit yield and return
upon itself, according to the variation in the volume of the limb. It answer-
ed the purpose tolerably well, but was not sufficiently elastic to follow the
iimb in its changes of volume. At the suggestion of Dr. Christophers, a fur-
ther improvement was now adopted, which consists of a simple and ingeni-
ous contrivance. "He proposed applying around the apparatus slit open, a
certain number of elastic straps, made' of India rubber, with buckles which
admit of their being drawn to the requisite tightness. They are rather more
than an inch wide, and rather longer than is necessary to encompass the
limb. Four of these were applied, and converted the apparatus into a case
sufficiently elastic to follow the changes in the volume of the limb, and yet of
sufficient strength to afford the requisite support. Seutin's apparatus, thus
modified, fulfils, as nearly as possible, and much better than any other, all the
indications required ; and it must be evident that it will be even a great-
er boon to the patient affected with a compound fracture than to one whose
fracture is simple.

In case the limb undergoes a considerable diminution of volume, it will
only be necessary to remove a longitudinal strip of the apparatus, instead of
opening it by a longitudinal incision ; and the strip should, of coursr, be re-
moved, or the slit made along that side of the limb on which the nerves and
vessels exist, and which can least bear pressure. We deem it notimproba-
ble, that the apparatus, thus modified, will be found useful in the treatment of
many diseases, where it is essential to keep tlie^ parts motionless, without
exercismg an unyielding resistance, or a pressure in the least degree une-
qual. Dr. Christophers proposes to employ it for that troublesome disease
a varicose state of the veins." Examiner.

Treatment of Varicose Veins. A writer in the London Medical Gazette,
recommends the introduction of needles vj'Uh a cutting edge, and a small,
round silk ligature under the vessels. Commenting on the report of the
Pennsylvania hospital operations for the cure of varicose veins, copied into
the British Journals from the Examiner, he remarks that " the passing of a
needle tlirougli, as well as under the vessels, before applying the ligature,
does not seem to have any advantage over the latter mode, if the needle has
a cutting edge, and the thread is round, small, and firmly applied." Ibid,

Nitrate of Stryclinine for Paralysis. A child, three and a half years of
age, born of healthy parents, remained apparently well until the end of April,
1834, when, without any apparent cause, it was seized with paralysis and
convulsive movements of the upper and lower extremities, and paralysis of
the tongue ; the expression of the face was wild, and the child had been in
this state fourteen days when the author was called in ; he found no symp-
toms of fever or congestion about .the head ; the appetite was good ; tongue
clean ; bowels natural. As the child had formerly passed some worms, an-
thelmintics were administered, and a few lumbrici expelled, but without any
relief; on the contrary, the child became thinner every day. The following
medicine was now^ given :

Nitrate of Strychnine, gr. i.; dissolve in

Alcohol, one drachm ; add

Ci'mamon water, two drachms. Three drops thrice a day.

1830.] Case of Worms. 315

The dose was gradually increased until the child took SG drops, or 1-lOtk
grain of strychnine in the course of the day.

After the lapse of a few days the patient's condition was much improved,
the convulsive movements declined, and tiic j)ower over the extremities was
gradually recovered, and at the end of six weeks the child was completely
cured. Lancetjrom Sieb. Journal, Vol. 17, No. 3. Ibid.

Case of Worms. Tlie following rare and interesting case,
recorded by Dr. Phineas Spalding, we extract from the Boston
Journal, for January, 1S39.

Mrs. S. after having been treated three years for dyspepsia, liver com-
plaint, hysteria, spinal irritation and leucorrha3a, came under my care No-
vember 3rd, 1826, with the following symptoms. Great debility, barely
able to walk about ; emaciation ; skin dry, with frequently a red spot upon
one or both cheeks ; countenance generally pale ; upper lip considerably
swollen ; tongue slightly coated, edges red ; gums soft and spongy ; breath
offensive ; a slight cough, but no expectoration ; appetite irregular, at times
quite craving ; bowels tumefied, generally costive ; dejections bilious, at
times clay colored, and the fceces occasionally we-re improperly digested.

There was painful menstruation, with a constant leucorrhoea, mostly of
the milky character. Urine was high coloured, dark and scanty, at times
large quantities and perfectly colorless. Pain in the head, back and limbs,
alternately ; spine tender its whole length, but very much so over the lower
dorsal vertebra. Pulse feeble, very easily compressed, and not accelerated ;
nervous system very excitable, and a fixed appreheosion that no remedies
could be adapted to her case. She had been bled, cupped, blistered, phy-
sicked, had caustic issues to the spine, used female injections, and, in short,
almost exhausted the materia medica for remedies, to no purpose.

After taking into consideration the whole history of the case, I came to
the conclusion that worms might be the exciting cause of all her difficulties.
Gave her one and a half ounces of the spirits of turpentine, followed the next
day wdth a large dose of calomel and jalap, which brought away more than
one hundred lumbrici, after which she took large doses of Carolina pink, fol-
lowed by an infusion of senna and sulphate of magnesia, with occasionally
the extract of butternut. In the course of three weeks about as many more
were discharged, some of which were enormously large for this variety of
worms. Her unpleasant symptoms immediately abated, and in a few weeks
she resumed her ordinary labors, considering herself quite well, until March
last, when she took a violent cold and had a severe cough, with some fever
and much stricture upon the lungs, but no pain or soreness about the chest.
She had had a leucorrhoea for some weeks, and the spine had become some-
what tender on pressure.

After being bled a few times, applying a blister to the chest, and other re-
medies commonly used in diseases of the lungs, her fever abated, and breath-
ing became eas}^ but the cough contmued unabated, and was but very little
affected by what had been done. Presuming that worms might have a con-
trolling influence, she resorted to her former course, took spirits of turpen-
tine, calomel, Carohna pink and senna, as before, and in a few weeks dis-
charged over one hundred very large lumbrici, after which her cough imme-
diately abated, bowels became regular, leucorrhoea ceased, and she has since
remained perfectly well.

There appears to be, in her constitution, a peculiar disposition for the ge-
neration of worms, and it is highly probable that they will collect again. In
children this is a common occurrence ; but in adults, worms in the alimenta-

BIG Extensive Desquamation^ <^c. [Fb.

ry canal are rare, and when once removed, the patient is generally ever af-
ter free from them.

This case throws some light upon what is commonly denominated spinal
irritation. It has been considered, by some writers, and many good physi-
cians, that this disease arises from irritation at the origin of the nerves of the
spine, transmitted to the several organs to which they are distributed, exci-
ting in them all the symptoms of idiopathic disease. However this may be,
in certain instances, it is more than probable that in the great majority of
cases the irritation is in the mucous membrane, transmitted by direct sym-
pathy to the spinal marrow and origin of the nerves. The little success in
the treatment of so many cases of neuralgia is probably owing to inattention
to the digestive organs, and not discriminating between those cases which
depend upon derangement of the nervous trunks and spinal marrow, and
those which result from continuous sympathy, kept up in a great measure
by irritating causes operating upon the delicate and susceptible tissue of the
alimentary canal. We also see illustrated very clearly the intimate relation
one portion of the mucous membrane has with the others. The cough, leu-
corrhoea, stranguary, irregular urine in quantity and quality, without doubt,
arose from the irritation produced by the worms.

Irritation in the bowels not only manifests itself by deranging the organs
directly affected, but frequently excites in parts far remote a sympathetic ac-
tion, which is often mistaken for the primary disease. This is peculiarly
the case in many cutaneous affections.

Boston, November 29, 1838.

Extensive Desquamation. A patient for some time subject to attacks of
fever, had, besides the common febrile symptoms upon the invasion of the
disease, universal itching of the skin, and more especially at the joints ; and
the itching was succeeded by a number of httle red spots, with a slight de-
gree of swelling. Soon after that, his fingers became very stiff, hard and
painful at their ends, and at the roots of his nails. In twenty-four hours, or
thereabouts, the cuticle began to separate from the cutis, and in ten or 12
days this separation was general from head to foot, when he has many times
turned the cuticle off from the wrists to the fingers' ends completely, like
gloves ; and in the same manner also to the ends of the toes ; after which
his nails shoot gradually from their rootSj at first attended with exquisite
pam, which abates as the separation of the cuticle advances, and the nails
are generally thrown off by new ones in about six months. The cuticle rose
in the palms of his hands and the soles of his feet like blisters, but contained
no fluid under them ; and when it came off, left the subjacent skin very sen-
sible for a iev7 days.

Sometimes upon catching cold before he has been quite free from fever-
ish symptoms, he has had a second separation of the cuticle, but then so thin
as to appear only like scurf ; thus demonstrating the quick renewal of this
part. London Med. Jour. ' Medical Examiner.

Adulteration of Quinine. M. Pelletier, of Paris,- states that if twenty
drops of the pure and concentrated sulphuric acid be poured upon twenty
grains of suspected quinine, the solution will present a most beautiful crim-
son colour, more or less intense, according to the quantity of saJicine pre-
sent. The adulteration of one part of salicine wuth ninety nine of quinine is,
by these means, easily discovered. Lancet. Ibi4.

1839.] Medical Intelligence, ^n

MEDICAL INTELLIGENCE.

Medical Prize Questions.

The questions for the Fisk Fund prize, for 1839, are :
First. The Medical Botany of Rhode Island.
Second. Erysipelas, its varieties and best mode of treatment.
Dissertations to be sent, free of expense, before the 1st day of May, to M.
Parsons, M. D. Providence ; or E. Fowler, M. D., Smithfield, Rhode Island,

The Boylston prize questions, for 1839, are :

First. The Pathology and Treatment of Rheumatism.

Second. What is Scrofula 1 And what its best mode of treatment ? For
1840

First. The Pathology and Treatment of Typhus and Typhoid Fever.

Second. The Pathology and Treatment of Medullary Sarcoma.

The prize of the Boylston Essays is a Gold Medal, or Fifty Dollars. Dis-
sertations, for each year, are to be transmitted before the first Wednesday
in April, to John C. Warren, M. D., Boston, Massachusetts.

The Medical Society of Augusta, Ga., offer a premium of Fifty Dollars, or
its equivalent, for the best approved Essay on the Pathology and Treatment
of Congestive Fever. The Essay is not to exceed forty octavo pages, when
printed. Essays are to be sent, free of expense, to the Secretary of the Me-
dical Society of Augusta, Ga., by the first day of May, 1839, with a motto,
which must also be endorsed on a sealed letter, containing the name and ad-
dress of the writer.

Wistar*s Anatomy. The Boston Medical and Surgical Journal, of De-
cember 5th, 1838, says : " A new edition of this standard treatise is announ-
ced by Dr. Pancoast," of Philadelphia. The industry and perseverance of
the profession of that city, are worthy of all praise. The old editions of
Wistar's Anatomy are still valuable and their accuracy and conciseness
of detail are recommendations. Such revisions and additions as the present
editor is qualified, by long experience, to give it, almost ensure an extensive
sale. It is surprising that some one does not remodel that excellent old
system of Anatomy by Andrew Fype, which in point of accuracy and mi-
nuteness, has never been surpassed by any demonstrator in any age. It is
so nearly out of print, that few copies, if any, can be had at the book-stores.
The Edinburgh edition, of 1815, in three volumrs, octavo, is the last that has
pome to our notice."

318 Death of Broussais. [F^.

The ce-ebrated Broussais is no more ! lie expired on the morning of
the IStii November last, at Vitry, his country scat, near Paris, at the age
of sixty six years. The French paper from which this intelhgence is de-
rived, does not mention the maJady to which he fell a victim ; but we learn
from other sources, that it was a disease of the rectum.

By tlie death of this celebrated man, the French Institute has lost one of
its distinguished members literature, one of its brilliant votaries and the
medical profession, an able teacher, and the founder of the " physiological
doctrine of medicine."

From the Medical Examiner.

Death of Broussais. Professor Broussais died at one o'clock on Sunday
morning, the 18th November, at his country seat of Vitry, a few miles from
Paris.

His immediate decease was rather sudden, but he had long laboured under
cancer of the rectum.

Broussais was born at St. Male, in December, 1772, and was, therefore,
sixty six years of age when he died. In 179:3 he entered the army as a pri-
vate soldier, but soon afterwards became an officier de sante. He subse-
quently served in a trading vessel during a period of six years, after which he
went to Paris, and graduated as Doctor in Medicine. His thesis was on
Hectic Fever, and was dedicated to Pinel.

Subsequently to this, he followed the campaigns in Holland, Germany,
and Spain ; audit is said to have been amid the fatigues of military service,
that he conceived the plan of the work to which he owes his celebrity the
History of Chronic Phlegmasiee. Of this, the fifth edition was published in
Paris during the current year.

Broussais was Physician-in Chief to the Val-de-Grace ; Professor of Gen-
eral Pathology in the Ecole de Medecine ; and a Commander of the Legion
of Honour. His appointments brought him 10,000 fr. per annum.

He was attended in his last illness by M. Amussat, and when arrested by
death, was actively engaged in a reply to the Memoir of M. Jouffroy against
Phrenology, and in preparing anew edition of his work on Irritation and In-
sanity. There was a rumor, arising probably from the abruptness of his
death, that he had been poisoned ; but there seems to have been no ground
for such a suspicion, and it appears to have speedily subsided.

M. Broussais was buried on the 21st of November, on which occasion all
the usual display and parade which mark such scenes in Paris, were exhibit-
ed. A crowd of practitioners andpupiJs were assembled in the Rue d'En-
fer ; military medical officers, and the members of the Ecole, in their official
dresses ; deputations from the Academies of Sciences and of Medicine, were
in attendance, to say nothing of a detachment of troops. This imposing
cortfge proceeded to the Val-de-Grace, MM. Larrey, Orfila, Boissy d'Anglas,
and Droz, being the pall-bearers. Divine service having been performed in
the chapel, the procession proceeded, the students having taken out the hor-
ses, and dragging the hearse all the way to Pcre-la-Chaise.

Discourses were pronounced over the grave by MM. Droz and Arago, in
the name of the Institute ; M. Larrey (J/7s) on the part of the military medi-
cal officers ; andM. Bouillend on that of the Ecole de Medicine.

The officers at the Val-de-Grace propose to go into mourning for a month,
as a testimony of their affectionate respect for the deceased.

A subscription has been opened in Paris, for the purpose of erecting a mo-
nument to the deceased, hon. Med. Gaz. Dec. 1, 1833.

1839.] Bealh of Broussais. 81tt

The following interesting- and correct sketch of the life, character, fortune
and death of M. Broussais, Ave extract from the cdilorial department of the
Medical Examiner

Dr. BicoussAis, the founder of the Physiological Doctrine of JMedicine,
died at Paris on the 17th of November, of a cancerous disease of {he rectum.
The labours of Broussais have left so deep an impression upon the science
of medicine, that we cannot pass over this death in silence. Like all other
founders of exclusive systems, he could scarcely be appreciated during his
life. On the one hand his zealous admirers, and on the other his opponents,
were disposed to exalt or to depreciate his medical reputation, according to
the partial standard by which they were governed. The pliysiolc-gical doc-
trine of disease had already passed through its complete revolution before the
death of Broussais. At iirst earnestly opposed, it soon became the system,
which, in France, attracted the most zealous, if not the most numerous fol-
lowers, and, for a while, it seemed destined to become the predominant sys-
tem of medicine. The physiological doctrine, during its most brilliant p.eri-
od, was not limited to France, nor, indeed, to Europe ; it seemed to possess
a power of universal application, and was received with enthusiasm in many-
countries of the American continent, especially those in which the violent
febrile diseases of tropical climates are most destructive.

During the rapid progress of the physiological doctrine, its author was ear-
nestly and constantly engaged in an incessant polemical warfare with its op-
ponents. For him, there \\"as no medium ; the physiological doctrine of me-
dicine solved all difficulties, simplified therapeutics, and, with a few formulae,
enabled the young and inexperienced physician to combat disease with more
success than the veteran practioner, who had toiled through a long life of
patient observation. The high talents, and energetic, impetuous character
of Broussais, sustained him in this endless controversy, and placed him and
his school in an attitude of hostility to established opinions, which soon gain-
ed him numerous disciples. Of these, some adhered to his doctrine from
love of its apparent simplicity, others joined the physiological school, from
that fondness for distinction w^hich is most easily gratified by becoming a pro-
selyte to the opinions which are most novel, and therefore attractive.

The onward progress of the physiological school continued as long as its
followers were freely examining one after another the medical opinions w-hich
had been based upon the accumulated experience of centuries, and in substi-
tuting for them the new combinations of irritation or inflammation. But a
single leading idea is soon exhausted and, however much the nomenclature
of diseases might be varied by referring constantly to the organ which is
chiefly affected, it became very evident that in all cases there w-as some mo-
dification of inflammatory action, which was to be removed by the same sys-
tem of therapeutics. The medical profession soon began to tire of these
continual repetitions, and very soon discovered that, with some trivial excep.
tions, all works on the physiological doctrine consisted only of an incessant
reiteration of the same theme, with a few unimportant variations.

An epoch in the history of the physiological school occurred, when Brous-
sais became Professor of the Faculty of Medicine of Paris. A new chair
was founded for him at the revolution of July, that of General Pathology
and Therapeutics. This appointment was a sort of acknowledgment of the
standing of the physiological school, and as it were, a pubHc recognition of his
system. There were never more than two or three professors of the School
of Medicine of Paris who entirely adopted the opinions of Broussais ; but
his admission into the faculty, was, in itself, a signal triumph.

Much to the surprise of every one, the physiological system declined with
increased rapidity from that moment; tlie endless repetitions of the new
])rofessor wearied, while his fondness for sarcasm, and, at times, for gross
personahties, disgusted his audience ; his class became less and less numer-

BW Death of Broussais.

ous, and, for some years, was one of the smallest at the School of Medicine.
About the same time that Broussais was appointed professor, the reaction
against his system became more decided ; a number of observing men had
been studying disease with the aid of pathological anatomy and the new
nieans of investigation which Laennec had discovered ; the results of their
inquiries were published, and proved that Broussais had been carried vastly
beyond the deductions which could fairly be drawn from observation. It
Boon became clear to those who were most attached to the physiological doc-
trine, that the nature of a disease was not always explamed by calling it an
irritation or inflammation, and that leeches and demulcents could not replace
the whole materia medica. As a system, the physiological doctrine can
Bcarely be said to exist; very few of these ultra adherents can now be found,
except amongst the French army surgeons, and in some parts of the tropical
regions of America. That its existence as a system should cease, was natu^
ral enough; a similar fate has befallen others, which, for a time, have had
equal notoriety with the doctrines of Broussais.

VVe must not, however, examine the opinions of Broussais as a system;
however defective they may be as a whole, in many respects they have pro-
duced a most salutary reform in medicine. Had Broussais contented him-
self with the publication of his works on "Chronic Inflammation," and the
^Examination of Medical Doctrines," the good which he has done, would
have been unmixed with evil, and it is to these earlier works that we must
look for the best evidence of the genius of the author. His later productions
are much more feeble and less interesting.

We have already alluded to the indirect good which resulted from the
Works of Broussais. Many experienced and observing physicians could not
adopt the opinions of Broussais, while they were unable to oppose them, ex-
cept by pursuing a new course of observation on the diseases which he had
treated of most largely. VVe are, therefore, in some measure indebted to
Broussais, for the admirable works of Louis, Chomel, and Andral, which fur-
nish the only satisfactory reply to his exaggerated notions. It would, how-
ever, be doing great injustice to his memory, to pass over the positive and
direct good which has resulted from his writings. He has enforced the ex-
amination of suffering organs in febrile diseases; has explained many of their
sympathies; has shown that by perseverance in a mild antiphlogistic treatment
many chronic affections will disappear and, above all, has prevented the ab*
use of irritating remedies in inflammatory diseases. The results are most im-
portant, and will be finally received amongst the admitted maxims of medi-
cine, but they are not the only good which Broussais has done; a vast num-
ber of diseases have become better known through his labours, and the novel
points of view from which he has examined them. He has rarely studied
them with an unbiassed mind, but while we make the necessary allowance
for his peculiar views, we can in every case gather a vast amount of practi-
cal knowledge, which is rendered the more impressive from the earnest, en-
ergetic language in which it is clothed.

SOUTHERN MEDICAL

AXD

SURGICAL JOURNAL.

Vol. Ill,] MARCH, 1839. [No. G.

Part 1. ORIGINAL COMMUNICATIONS.

ARTICLE I.

An Essay read before the Medical Society of Augusta, January
loth, 1839 ; on the subject Are there any signs or symptoms
by which Worms can be inferred certainly to exist in the ali-
mentary canal; and if there be, what are they ? With cases.
By Paul F. Eve, M. D. Professor in the Medical College of
Georgia.

In examining this question, selected at the last meeting of the
Society, it is proposed to examine first, what is meant by signs
and symptoms ; and, secondly, to consider all those produced by
worms in the alimentary canal, in order to decide if there are
any pathognomonic or characteristic of their presence.

First, then, what are signs and symptoms of disease?

Until recently, these two terms were considered synonymous

in pathology. But, omnc symptoma signum est, sed omne sig-

num non est symptoma every symptom is a sign, but every

sign is not a symptom, is now an axiom of the profession. By

the symptoms of disease are meant the phenomena or effects

produced by it, and which strike the senses either of patients or

physicians. They are the expressions of the suffering organs

the lights by which diseases are revealed. They are not the

n-')rbid action itself; neither can we, bv the symptoms alone, de-
A 1

S22 An Essay on Sig7is and Symploins of Wonns. f Alarelu

termine the true nature and character of a disease. But,, by a
knowledge of anatomy, physiology, and pathology, the physician
converts the symptoms to signs of diseases. A pain in the side
for instance, is a symptom of pleurisy, equally manifested to pa-
tient and physician ; but the latter alone from his acquaintance
with the structure of the parts affected, &c., can deduce from it
a sign of this affection.

Symptoms of diseases, have very properly, been divided into
the essential, accidental, and common. The essential symptoms
are those which are constantly present, and determine the clia-
racters of a certain affection. The accidental, on the contrary,
are those symptoms which are adventitious,* and may depend
upon some pathological complication or some modification of
the vital forces. Lastly, the common symptoms are those be-
longing to a number of diseases, and are, therefore, of little value
in diagnosis. %'

The signs of disease are, the conclusions which the physician
deduces from the symptoms,, respecting the past, present, and fu-
ture condition of a patient. They are the legitimate results of
the operations of a mind enlightened on the subject of m.edicine,
when the symptoms of a disease have been presented to it.

The division of signs is into commemorative, diagnostic and
prognostic. The commemorative signs include all tlie circum-
stances anterior to a disease, its causes, its developem^ent, &c.,
and is important indeed sometimes essential to its diagnosis and
prognosis. The diagnostic are those signs which ascertain the
actual state of the disease and condition of the patient. These
signs have, moreover, been sub-divided into the pathognomonic,
the accidental, and common. The pathognomonic signs have
such an intimate relationship to the disease itself, that they can-
not be separated from it, and without their presence the disease
is not known to exist. They are the essential and characteris-
tic signs of disease. The accidental and common sub-divisions
of the diagnostic signs, are already explained by the use of these
terms in defining the symptoms of disease they are, in fact, ex-
pressive of themselves. The last division of the signs in patho-
logy, are those called prognostic, which enable us to predict tl>e
issue of the disease, as well as all future changes in its progress.

Having now defined what are tlie symptoms and signs of dis-
ease, we are prepared to consider the second division of our sub-

1889.] An Essay on Signs and Si/?}iploj?]s of JVoj'ms. 323

ject ; which is, what are the signs and symptonns of worms in
the alimentary canal, and are any of them pathognomonic of
their existence ?

The symptoms and signs of worms, produced by their pre-
sence in the alimentary canal, may be properly grouped into
two classes ; first, those which depend upon a derangement of
the digestive organs ; and, secondly, those of other organs sym-
pathetically affected. It will be conceded by every reflecting
mind, that if it be shown that none of the primary symptoms or
signs of worms are pathognomonic; a fortiori, neither can any of
the secondary be characteristic of their existence. With this
understanding then, we hope to avoid an enumeration of the se-
cond class or sympathetic affections of worms.

In enumerating the principal derangements produced by
worms in the alimentary canal, dependant upon irritation of the
gastro- intestinal organs, we shall proceed from the superficial
symptoms, to those that arise from the condition of deep seated
parts, and are consequently more obscure. The countenance is
pale, or of a leaden color ; there are occasional flushes ; the pu-
pils are dilated, and there is a blueish color under the lower eye
lids. There exists great itching of the nostrils, but more especi-
ally is this intolerable in the anus, in cases of ascarides. The
upper lip is tumid ; the saliva is increased ; the breath is offen-
sive ; the tongue is foul ; and there is grinding or gritting of the
teeth during sleep. The appetite is exceedingly variable, some-
times there is a diso^ust for all food ; but more commonlv the
hunger is excessive, particularly when the lumbricoides or taenia?
exist ; and though the patient may eat heartily, still he becomes
thinner. The abdomen is swelled, there is nausea, sometimes
vomiting, pains in the bowels, a sensation of something alive in
t-he insides, borborigmy, colic, tenesmus, diarrhoea alternating
with constipation, and the stools are slimy, ropy, broken up into
fragments, eftensive in odor, with a want of bilious admixture.
But the most certain of all the signs of worms is, the passage
from the intestines of a portion of one, or of one or more. And
this is the only symptom which authors unanimously agree, can
at all be considered pathognomonic of the existence of worms in
the alimentary canal.

It is well known, that worms may remain for years in the in-
testines, without producing unpleasant symptoms. Dr. Heber-

824 An Essay on Signs and Symptoms of Worms. [March,

den, and Dr. Good, mention cases, wherein the lumbricoidesand
ascarides have thus existed for thirty years. Dr. Parr even be-
lieved they formed a part of a healthy constitution, producing
only occasionally, as he termed it, an inconvenience. And Dr.
Rush absolutely taught that worms acted in the intestines the
part of scavengers, and that they were necessary to preserve
the health of children.

Although few, at the present day, will subscribe to the opin-
ions of Drs. Parr or Rush, yet none will deny the facts, that
worms not unfrequently remain perfectly inoxious for a length
of time in the intestines, and that they are occasionally passed
from the healthiest children.

If we now analyse in succession each and every symptom
enumerated by authors, produced by worms in the alimentary
canal, we shall soon be satisfied that no one can be converted to
a pathognomonic sign of their presence. Without consuming
time by noticing others, let us even take up that one so general-
ly admitted as the most certain of all, and which, in fact, is of
more importance in the diagnosis of worms, than all others put
together, vv^hether local or sympathetic, their occasional passage
from the alimentary canal ; and what does even this symptom
amount to ? Why, certainly, nothing more than that worms
did exist, and not that they are actually existing in the intestines.
Assuredly, if the very same symptoms continue that obtained
before their expulsion, then undoubtedly the probability of more
being in the alimentary canal, is greatly increased. But who
will pretend to admit, that this probability, great as it may be,
is ever converted or amounts to a certainty ? Who can deter-
mine but that the last worm discharfred, is not in realitv all that
were in the bowels ? We do contend, that all that can positive-
ly be indicated by a rigid and precise signification of this prom-
inent symptom of worms, " tlieir occasional expulsion either by
the mouth or per anum," is, that they once existed in the intes-
tines. And who will not admit that all the symptoms of lumbri-
coides, ascarides, &c. may be present in a given case, excepting
the one we are now considering, and yet in reality none exist 1
Certainly there is a period in every case of worms successfully
treated, when their passage from the bowels, even this very
symptom, is not a certain sign that there are more ; and this is
the discharg.e of the last one, which, could we ascertain, would

1839.] An Essay on Signs and Syviptom^ of Vr'orms.

he proof positive, that there were no more in the intestines. So
much then for this supposed most certain sign of worms in the
nhmentary canal.

As for the other symptoms, who need be told, that itching of
the nostrils and anus, gritting of the teeth, foul tongue and foetid
breath, variable appetite, pains and uneasiness in the bowels,
colic, slimy stool, &c. &c. are produced by other causes, than
by the presence of worms in the intestines ? Or, what would
be thouMit of him, who would seriously entertain the belief, that
the sympathetic symptoms occasionally observed in verminous
diseases, such as troubled urine, dry cough, cold surface, head-
ache, and a v/hole host of nervous affections, were the true cha-
racteristic signs of these little animals ?

Have we tiien no essential symptom or symptoms of worms,
when they exist in the alimentary canal ? Certainly not. There
is not one tliat is constant and invariably present. Worms we
have seen often exist without exciting one unnatural phenome-
non without producing one symptom, be it essential, commion,
or accidental. Neither are the symptoms uniform or constant
when they do occur. Even the one considered the most cer-
tain, is by no means essential to their existence Many patients
die with worms without ever havinc^ evacuated even a sinojle one.

Seeing then that we have no symptoms by v/liich worms can
be inferred certainly to exist in the alimentary canal, are there
any signs from which we can deduce this fact? We have already
examined that sign, and determined its true import, which has
the most pretensions to be regarded the pathognomonic of the di-
agnostic signsof these parasites. Of the commemorative, diag-
nostic, and prognostic signs of worms, this is the only one which
has any claims to be considered characteristic of their existence.

Dr. Wm. Stokes, the great pathologist of Dublin, says, it is a
singular fact, that we have not one single pathognomonic sign
of the existence of intestinal worms, except the circumstance of
their being occasionally passed by stool or vomiting ; almost all
their symptoms are referable to irritation of the gastro-intestinal
surface, and its sympathetic relations.

After th^ enumeration of the symptoms of worms by Profes-
sor Chapman, he remarks, taken alone, no one of the preceding
circumstances will be conclusive of their existence. And in a
note, quoting an intelligent writer in his Therapeutics, it is said,

320 An Essay on Signs and Symptoms of Worms. [March,

the ambiguity of every symptom ascribed to worms, except that
of voiding tlicm, is v/ell known.

The lamented Ebcrle observed, that none of the symptoms
are certain indications of the existence of worms in the bowels^
the only certain indication being the appearance of them in the
evacuations frijm the bowels or stomach.

Brera, wlio has written one of the best works on verminous
diseases, says, the most sure sign in the local or sympathetic af-
fections arising from worms, is their expulsion from the mouth,
or per anum.

In the article Vers, of the Dictionaire dcs Sciences Medicales,
by Merat, 57th volume, it is said that the only indubitable phe-
nomenon which indicates worms, is the discharge of a portion,
or of some of these animals from the body.

In the seventh volume of the Dictionaire de Medicine et de
Chirurgie, the celebrated anatomist, Cruveilhier, writes, among
the symptoms of worms, some are located in the alimentary ca*
nal, others are sympathetica! ; all are vague taken separately,
they declare nothing ; grouped together, they form an assem-
blage of probabilities, which never conduct to certainty. This
can only be demonstrated by the fact of their spontaneous or
provoked expulsion either aliveor half putrefied.

If we are rii^ht in our estimate of the real value of the indica-

o

tion which the passage of one or more worms affords, viz : that
they did exist, and not that they actually do, and that it never
offers a certain and positive sign of their existence; and if this
be the only one, as we have seen by the language quoted of some
of the most celebrated helminthologists, that has any claims to
be considered a pathognomonic sign, then are we safe in the
conchision, that there is none such.

Nor is it a small matter to decide the question under conside-
ration, U there be no sign or symptom by which worms can be
inferred certainly to exist in the alimentary canal, it ought to be
admitted and publicly confessed, that greater caution might be
exercised in the diagnosis, but more especially in the treatment
of diseases reputed verminous. What serious errors have not
been committed in practice, on account of the obscurity in de-
termining positively the existence of intestinal worms ? What
practitioner has not the candor to acknowledge having been de-
ceived on this subject ? Who has not acted upon the suspicion

1839.] An Essay on Signs and Symptoms of Worms. 827

of worms producing a certain group ofsymptoms, wiien in real-
ity it was afterwards made evident that none ever existed; and
on the contrary, who has not occasionally been baffled in the
treatment of some sympatlietical or nervous affection, the cause
of which has accidentally been revealed by the evacuation of a
lumbricoides, a portion of ta3nia, &c. How many diseases have
been aggravated how many inflammations excited and how
much distress been produced, by the habitual, indiscriminate, and
semi-annual drugging ofchildren with anthelmintics, where w^orms
never have existed ? Or, who is not prepared even to admit,
that where every symptom of worms have obtained, still this
class of remedial agents has been most grossly abused ? Hence,
the importance of a correct answer to the question, are there
any signs or symptoms by which worms can be inferred certain-
ly to exist in the alimentary canal, and if there be, what are they ?

Worms are said to occur in persons of feeble constitution, or
in those of ill health. It is known, too, that the lumbricoides, or
common round worm, and the ascarides, or thread worm, are
found existing almost exclusively in children, while the ta3nia or
tape worm, inhabits the small intestines of the adult.

With respect to the diagnosis of particular worms, it may be
remarked, that there are a few special symptoms, by which we
Riay be assisted in distinguishing one species from another.
The general symptoms already described, together with vom-
itings, when they exist in the stomach, are those belonging to the
lumbricoides. In fact, there is rather a want of peculiarity in
the phenomena produced by these worms. They occasionally
pass from the intestines, per anum, and are those most easy to
be removed. They are most common in children from two
to seven years of age, and occasionally are found in adults.

The ascarides are the easiest recognized. They inhabit the
lower part of the rectum, often producing the most violent itch-
ing in the anus, and are sometimes seen by inspecting those parts.
Were the speculum ani, as applicable to infants as to the adult,
we might have in it the means of arriving at a pathognomonic
sign of their existence. Their discovery, by stretching open the
sphincter ani, is, undoubtedly, the nearest approach to a certain
and positive symptom of their presence.

The taenia, we may say, is alone recognized by the passage
of a portion of it, and by its existence in the adult almost exclu-

328 An Essay on Signs and Symptoms of Worms. [March^

sively. In the last species of worms found in the human body,
the tricocephalus, we have nothing peculiar in their symptoms
they are decidedly the least frequent of all.

Our conclusion then, from a careful review of all the symp-
toms and signs of worms, and from a rigid scrutiny into the
value of each in diagnosis, is, that there is not one which can he
considered putfiognomonic of their existence in the alimentary
canaL

Case first, occurred in the practice of Dr. Edward A. Eve,
of this County, and is interesting, from the fact, that worms (lum-
bricoides,) produced death in an adult, in a few hours, probably
by exciting peritonitis.

" Agreeably to your request, I undertake to give you the his-
tory of a case, which has very recently come under my observa-
tion, in which death was caused by worms, in an adult.

On the 18th December, 1S3S, I was called to see a negro wo-
man, about forty five years of age, servant of Mr. Robert Green-
wood, of this Count;/. On visiting this patient, I found her af-
fected with great jactitation, and apparently in great agony,
complaining of severe and sharp pain about the umbilical re-
gion. Upon examination, I found her pulse small and feeble,
though not unusually frequent, tongue deeply coated, tempera-
ture of the extremities low, and such other symptoms present, as
indicate concentrated irritation about the stomach and bowels
flatulence, and many of the symptoms which characterise colic,
being present. I found it extremely difficult to localize the
disease ; and upon pushing my inquiries further, into the previ-
ous history of the patient, I was informed, that she had been in
the habit of eating dirt, and that, not very long since, she had
passed several worms.

Ti'eatment, To answer the two-fold indication of removing
the worms, which I supposed existed from the concurrence of
the symptoms and previous history of the case, and of allaying
intestinal irritation, I prescribed calomel, with an occasional
dose of morphine, to be followed with oil and turpentine. The
following day, having seen the patient first at midnight, a wine-
glass full of the decoction of Spigelia was taken every second
hour during tlie day ; from this combined course, about two hun-
dred well grown lumbricoides were expelled. On my visit in
the evening, the pain and symptoms of severe irritation having

1839.] An Essay on Signs and Sijmplojus of Worms, 329

subsided, together with the expulsion of so great a quantity of
worms, which were supposed to be the origin of the disease, I
left the patient, directing^ a mild course of treatment, with gentle
nourishment, calculated to expel the remaining worms, and re-
store the tone of the alimentary canal.

On visiting my patient, to whom I was summoned in great
haste the next morning, I found her decidedly in a moribund
condition extremities cold, pulseless, intellect clear, articulation
not materially impaired, muscular strength sufficient to raise or
turn in bed ; she complained of severe pain, evacuated about six
or eight worms, was drawn into the posture of a patient affected
with opisthotonos, and died in about ten minutes from the time
I entered the room.

Pott mortem examination. About fifty six hours after death,
the time of inspection in this ca'se, the appearance of the cadaver
was such, as is generally designated, very natural ; the features
placid, and but little altered in their expression ; emaciation in-
considerable, as would be supposed from the short duration of
the attack. My time being limited, the body having been
brought, but a short time before night, to the grave, where I was
to attend for the purpose of making the examination, I com-
menced by an incision sufficient to allow me to detach the sto-
mach from the oesophagus and duodenum. After which, I re-
moved it to a convenient place for examination, and emptying
it of its contents, I discovered, not only intense inflammation,
but effused blood adhering to its internal surface; and upon more
particular inspection, after carefully washing out the organ, I
found, in several places, severe lesions, its parietes being nearly
perforated. Rapidly approaching darkness compelled me to
abandon any further investigation ;. which I regret, more espe-
cially, since you have desired a report of the case. And I
fear now, from the imperfect register of symptoms I am forced
to give, from the late period at which I was called to this case,
it will be very little available, in determining the certainty or
uncertainty of diagnosis in verminous affections ; for had it not
been for the light thrown upon the subject, by the previous his-
tory of the patient, I would have been left in great incertitude as
to the true nature of the case. It will, however, go to prove,
that worms can exist in great abundance in the adult, and that

B 2

830 An Eisai/ on the Causes of Abortions. [March,

they are not harmless inmates of the alimentary canal, as somo
have absurdly supposed them to be."

Case second. This also was treated by another physician ;
and I regret much the impossibility to procure further particu-
lars relative to it.

In this case, a negro girl, about thirteen years old, it was
remarked, both by physician and attendants, that the worms
"were distinctly felt through the abdominal parietes, forming dis-
tinct tumours, and their motion was distinguished from that of
the intestines. l\ear nine hundred lumbricoides were discharged,
and the patient entirely recovered.

This case is interesting, as it offers a new symptom and sign
in the diagnosis of worms, and this circumstance alone has in-
duced me to present it to the professional public.

ARTICLE ir.

An Essay on the following question, propounded hy the Medical
Society of Augusta, " What is the most common cause of ahor-
tions ?" Read before the Society, at the Session of the IGth
January, 1639. By M. Antony, M. D. Professor of Ob-
stetrics and Diseases of Women and Infants, in the Mhdical
College of Georgia.

Under the head of his treatment, M. Velpeau very correctly
remarks, that

" The practitioner should turn his attention to the prevention
of miscarriages ; for when it has once commenced, all he has to
do is, to hasten its termination." This is, however, evidently in
allusion to the term abortion, being considered to mean only the
actual passing of the foetus from the uterus. With this defini-
tion in view, this precept of Velpeau is perfectly correct ; for
hardly can a greater outrage on common sense to say nothing
about reason be committed, than to attempt to stop a miscar-
riage after the ovum has commenced its passage outward. But
we consider, and we presume all will concede the point, that,

1839.] An Essay on the Causes of Abortions. 381

according to the good etymology of the term, the abortion is, in
effect, as complete, the moment the foetus is deprived of that life
which is necessary for its ultimate vital existence, as it is after
its actual expulsion through the vulvo-uterine passage; for its ex-
pulsion is a mere consequence of that action which first separat-
ted il.* But there is a key to usefulness in these cases, on which,
the profession seem not to have taken hold ; but which opens
the way to more usefulness than all anodynes, depletions, ex-

* This suggests an important practical inquiry, in order to the correct
management of a case, in which the treatment must alter to extreme oppo-
sites, by the differing stages of the disease. When the abortion has com-
menced, that is to say, when the foitus has commenced passing away from
the uterus, wc should hasten its termination. In view of this alone being
abortion, w^e would feel bound to reply to the inquiry of the Society by say-
ing, what perhaps few, if any, would deny, that the most common per-
haps universal immediate or proximate cause of abortion is, the expul-
sive action of the uterus. But to prevent confusion from the endless quib-
ble about W'Ords, we have chosen to consider the uterine contractions, as
well as all evidences of excitement or action concerned in, or tending to this
result, as belonging to it ; as, for example, irritation or inflammation of the
uterus ; because these are the. first changes of animal actions, in the chain
of phenomena which constitute abortion. They, therefore, as properly con-
stitute a part of the business of miscarriage, as do the early phenomena of
labor at term, of which uterine action is the chief, constitute the first stage
of labor. For practical purposes, it appears to us therefore, that whilst it is
consistent with the etymology of the term, abortion should be divided into
two stages. That to which Velpeau seems to allude, .should constitute the
second. This stage is irremediable, and therefore should be made the best
of, by completing it. The first stage should include all the phenomena pre-
vious to the actual separation of the ovum from the uterus, and its begining
passage off. These are, principally, irritation or mflammation, which are
the results of physical causes on the excitability of the parts concerned.
These are remediable, and therefore demand treatment extremely opposed
to that of the second. How important, therefore, is it, to determine in which
of these two stages the present case is, before adopting the first item of
treatment. The duty is therefore imperious, and the neglect of it criminal,
to determine the stage. The touch alone can determine this generally, and
with certainty, from the time the ovum enters the os uteri. Previous to
this, we have no absolute means of determining, although the placenta may be
detached; and we must therefore, include every thing previous to this entrance
into the os uteri, in the first stage, and treat it accordingly, .until the evi-
dence of the second is manifest. We have, on a former occasion, alluded
to the indispensable duty of touching early in abortions, when their progress
is not otherwise plainly evinced.

332 An Essay on the Causes of Abortions. [March,

pectations, &c. &c. which have been brought into use and most
relied on. This key is found in the due and proper consid-
eration of the etiological department of this subject. In en-
quiring for the most common cause of abortions, we presume
those animal actions which themselves constitute abortion, are
not alluded to ; but such physical causes as tend to excite those
animal actions concerned in accomplishing the loss of the off-
spring. It is presumed that the object of the inquiry is, as it
should be, practical interest. It cannot therefore be considered
as searching for things as causes, which are beyond the possible
power of remedial means. Whilst therefore, it is true that,
when abortion commences, in the sense in which Velpeau seems
to mean, that is to say, when the ovum is actually separated
from the uterine walls, and on its passage outward, no means can
possibly ever secure the vitality and prosperity of the offspring,
still the next step of retrogression, or that stage in which the
placental portion of the ovum, that part through which the foetus
derives its principal support, has not entirely separated, and no
advance of the ovum made, outward ; there is a begining hope
in the possible power of those means which tend to remove cau-
ses and correct their effects. This hope, having more reason
for its sustentation, the further back we find the case in the first
stage, increases according to the less advancement of those cir-
cumstances w^hich tend to destroy hope. For, notwithstanding
when the ovum is being actually separated to a considerable ex-
tent from its attachment to the uterus even at that part of it
through which the foetus derives its chief support, we mean the
placenta, still, in some of these cases we have succeeded in ar-
resting this event, by enforcing a practice, at once calculated to
prevent the combined operation of causes, and to correct the ef-
fects already produced by their action. The only real adhesions
of the placenta to the uterus (in the proper sense of that term,)
we have had good reason to believe were indebted for their exis-
tence, to a partial separation of the placenta from the uterus being
followed, in the recovery, by a cicatrix of more strength and
firmness than the ordinary attachment a strength which it were
beyond the powers of uterine contraction to lacerate. These
adhesions we consider eyidence of the partial separation of the
placenta. The less this detachment of the placenta, (and the
hcemorrhage is our best index to its extent,) the better is the

1889.] An Essay on the Causes of Abortions, 833

prospect of preventing the completion of abortion, or the final
failure of the offspring. In the previous phenomena of the first
stage of abortion, however, that is to say, tliose of uterine irrita-
tion, &c. the chance of success is still better, better yet is our
chance of prevention, before the begining of those actions which
tend to effect abortion, and which are the effects of physical cau-
ses, when we know those causes which are most common, and
the means of preventing their physical action on the uterus.
Thus we have thought proper to give this view of abortions, be-
fore entering on the consideration of its" most common cause."
We will now return to the consideration of the causes of abor-
tion.

Much has been said by authors and teachers, on the subject
of the causes of abortion, and many notions have been adopted
and systematized, from the previous opinions of men, without
due consideration of their natures and modes of operation. En-
forced by such high names as Desormeaux, Lachapelle, Duges,
Boivin, &c., they have been received., and divided into efficient
and determining causes. The efficient causes are said to be,
contractions of the womb ; the determining causes have been
divided into

l5^ Predisposing, under which are mentioned certain gener-
al states of the system, as plethora, abundant and regular men-
struation, great irritability, nervousness, lymphatic, of fair com-
plexion,* weakly, sickly, who have large eyes and bluish schle-
rotica, persons affected with syphilis, scurvy, rickets, badly
formed pelvis, organic lesions, any chronic disease, anthritic,
dropsical, cancerous, badly nourished, compression of belly by
lacing or other tight cloathes ; marshy, unhealthy countries ;
certain atmospheric constitutions, and many others of similar
import.

2nd. Other causes are considered occasional^ &c. Any of
these may be found grouped up Wi\h.X\\G phenomena of abortion,
as indeed are some which are classed with predisposing, and all
considered causes.

We will not pretend to say there are not predisposing, as well
as exciting causes ; but instead of going the whole round of the
particulars of each, let us ask not what are these causes ? and

* Velpeau.

SS4 An Essay on the Causes of Abortions. [March^

content ourselves here, but what are they, and how do they act
as successful ones, contributing to tliis fearful result ? Very
rarely, these operate primarily and mainly on the fcutus, causing
its death. They may, and do operate on the mother in predis-
posing her with greater susceptibility of the action of exciting
causes. But it is still mo're frequently the case, that abortion is
caused by an occasional cause, which acts through the medium
of the uterine irritation, inflammation, or topical congestion which
it causes, and which proves efficient, in the end," and sufficient,
under any circumstances, through this medium, to accomplish
abortion by its physical action on the natural and ordinary sus-
ceptibilities of the system.

It is not our purpose, in this enquiry, to determine every
thing which may possibly, under some circumstances, contribute
to abortion ; but with views to greater practical utility, as we
have found in our intercourse with such cases, to enquire into
the immediate, or efficient cause of abortions, and those causes,
whereof the efficient cause is the effect ; for we can contemplate
no cause, without beholding it somewdiere in the concatenation
of cause and effect each link in this chain of concatenation be-
ing, in turn, cause, and in turn again, effect. The efficient cause
of abortion, according to Yelpcau's definition of the term, which,
we consider implied in the precept quoted at thebegining of this
essay ; or the proximate, or that which im.mediately effects the
expulsion of the ovum, is uterine expulsive action. But consid-
ering this action a part of the dii^ease, which, according to our
definition we consider abortion, we look for the efficient cause, to
the previous link in the chain of phenomena, or the physical phe-
nomenon proximate to the first phenomenon in the act, so to speak,
of abortion. Here, by a general division of the chain of pheno-
mena, we would separate noxious cause from morbid effects.
That cause, which is the next link in the chain of events previous
to that of the action of the uterus, which commences and com-
pletes the separation, expulsion, and destruction of the ovum, is,
indeed, the proximate. Its first morbid effect we observe in that
excitement and uterine action, by which the ovum is separated
and expelled from the uterine cavity ; for it's expulsion is a mere
consequence of that action which first separated it ; and all must
agree that the abortion is, in effect, as complete, according to the
good etymology of the term, the moment the child is deprived

1839.] An Essay on the Causes of Abortions. 835

of that life, which, as a parasite, it derives from its mother, and
which is necessary for its ultimate vital existence, as it is after
its actual expulsion through the vulvo-utcrine passage. But in
this expulsory action we behold the effect of irritation, created
in the uterine fibres in some way, and by some particular cause
or causes. Starting, at this point, let us reason from effect to
cause, and trace back the chain of phenomena from the final ef-
fect, throughout its extent ; and, in doing so, notice, as we pass,
for a competent and present cause, or one which has been suffi-
ciently present for effectual action in the production of its appro-
priate result. It is an axiom that effect declares causation.
When we trace back the chain of phenomena from the ultimate
result, abortion, through the expulsory efforts of the uterus, to
the uterine irritation, or that condition of it which next preceded
the expulsory action; if we enquire, as we must do, what has oc-
curred whereby the present irritation has been effected? we may
be told, nothing that no accident has happened to which it may
be attributed. But, as this is inconsistent, in fact, with sound
philosophy, we must not receive it as truth, and drop the further
enquiry. We know, by the above axiom, that every event must
have its due and appropriate causation ; therefore, the want of
recognition of it does not establish the fact that it does not, or did
not exist ; but that our investigation has been too imperfect for
its detection that it is still thefiict that it does or did exist, and
that it is our duty to ascertain that particular truth.

Now the key to which we alluded in the begining of this in-
quiry is, that in all such cases as these, which are generally met
with in practice, (for others, though their occurrence is within
the bounds of possibility, are so rare, that, for practical purposes,
they need scarcely to be attended to,) there is an internal, hid-
den cause, the very investigation of which is of so delicate a na-
ture, as generally to elude the detection of the accoucheur and of
the patient ; because she can only know its existence by the phe-
nomena it produces ; and on these she looks, as symptoms of
miscarriage, instead of eu/r/ettcss of the action of this cause. But
the unprejudiced, candid,and faithful accoucheur,who understands
well the anatomy and physiology of the parts concerned, will
find, on observing these phenomena or symptoms, abundant rea-
son to know the cause of these, its effects. Soreness, pain, or
bearing-down distress in the hypogastrium, pain or tenderness

330 An Essay on the Causes of Abortions. [March,

in one or both groins or iliac fossae ; more or less strangury or
other forms of vesical disturbance ; or perhaps some ill besetting
the rectum will be discovered. He then remarks that it is not
until towards the fourth month, that the uterus ascends above
the excavation of the pelvis, and that, after its ascent, and that
increase of growth which is sufficient to prevent its easy des-
cent again into the cavity of the pelvis, it may still, with its in-
creased weight, press with unwonted force on the brain or supe-
rior strait.

Excluding then, all other competent causes by the deficiency
of evidence of their existence, and contemplating the physical
tendency of this, on the anatomy and physiology of the parts
concerned, he finds some, or all of the ordinary phenomena
which, from the very nature of its operation, he can now per-
ceive, arise from a descensus uteri, a circumstance which he
knows to exist, to some extent, with all females in the early
months of utero-gestation. It is true that this is often harmless,
and if withstood for a time, will pass oflP, without leaving any
ill consequences in its train ; and thus it occurs, that most fe-
males pass on, through the whole period of utero-gestation^
without misfortune. But with others it is different. When its
greatest transverse diameter happens to be below the superior
strait, which is not very unfrequently the case, especially when
symptoms of descensus have existed previous to the pregnancy^
the uterus continues to enlarge with the grow^th of the ovum, un-
til it impacts itself more or less tightly within that strait. Hence
arises irritation in the surrounding parts the neck of the blad-
der, the rectum, the round ligaments, the ala3 uteri or lateral
folds of the peritoneum, the short ligaments, &c. &c.; and not
unfrequently, symptoms of compression of the nerves which tra-
verse the excavation of the pelvis, &c.

But this is rather too promiscuous an assemblage of these phe-
nomena : it includes those of different bearings, as to their rela-
tion to a?)or^zo7i ; for example, strangury, tenesmus, or dyseur
teric feelings in the lower bowels, nervous and vascular troubles
in the lower extremities these may and often do exist for a
length of time, without other misfortune than the distress they
afford, and are, therefore, to be regarded accordingly, so far as
we are concerned for the immediate relief of the present distres-

1830.] An Essay on the Causes nf Abortions. 837

ses.* But at the same time we are to consider tiiem as plainly
telling us what manner of violence is being done ; and that a
cause is in operation which repeated observation, as well as rea-
son assures us is liable, and constantly tends to produce an undue
excitement in the uterine substance ; for action and re-action are
equal and contrary, and therefore is the uterus equally compres-
sed with the same violence as it compresses the adjacent parts
But when the broad, the round and the short ligaments evince
irritation, which they early do, it is to be remembered that it is
no difficult matter for the irritation of these to extend, by conti-
nuity of vessels and other tissues, to the substance of the uterus.
Again, the lateral parts of the uterus may, and generally will
suffer irritation by the re-action on them afforded by the sharp
brim of the pelvis at the abdominal strait, which is known by the
n3.me o( '^ linea ilio-pectinea." In short, various influences are
in operation, whereby the contractile organization of the uterus
is liable to become irritated into expulsory effort.

The uterus is an organ possessing no small share of irritabili-
ty. This should be closely scrutinized, and its excitement pre-
vented. There is no harm, in view of abortion, so long as the
expulsory effort remains unproduced ; but the instant it makes
its beginning, its immediate counteraction is necessary ; and this
is now easily done by removing the cause and correcting its ef-
fects. Here, it should be observed, that evidence of the truth of
causation is derived from effects, or reasoning from effect to cause;
for cause is that, which, being removed, the next phenomena
which we call effects, cease ; and experience constantly certifies
us of the truth in this way. But we may be told that the wo-
man had a fall, or that she underwent sudden and violent effort,
&c. What, we enquire, are the physical agencies or powers
we are to attribute to these violences ? Mere concussion, un-
less it be extremely violent, is not, by any means calculated to
separate the membranes, or the placental part of the ovum from
its attachment within the uterus "no more" says Yelpeau, "than
such things w^ould tend to separate one bladder full of water
from another which closely invested it." We have seen a young

* It is to be remembered however that, very rarely, vesico-vaginal fistu-
las follow strangury, from this cause ; and that, not unfrequently, recto-ute-
rlne abscesses, or recto-vaginal openings are consequent to tenesmus, and
dysenteric distresses from this cause,
c 3

33S An Essay on the Causes of Abortions. [March,

female who, on our pronouncing the existence of pregnancy, and
refusing her the use of abortive means, for which she offered the
most hberal reward, stepped into the yard, and, grasping a post
with both hands, suddenly forced her enlarged abdomen against
it with, apparently, all the powers of lier arms this violence
was repeated many times before we could get to her and loose
her grasp ; but she remained uninjured. It is then, not immedi-
ately ^ by the mere violence of percussion, that accidents, as falls,
excessive exertions, &c. tend, as is generally supposed, to effect
miscarriage ; but by these causes so operating as to produce a
descent of the uterus, or strong tendency thereto. It is but jus-
tice however, to the cause of truth, to remark here, that it is
sometimes the ease that the violence of percussion and such like
powers may, and do operate otherwise, as by severing the ten-
der and delicate connexion existing between the uterus and the
placental portion of the ovum ; but these cases are extremely
rare, and the distinction of this immediate mode of action from
that, through the mediation of descensus uteri, is easily ascer-
tained, by the immediate occurrence of hasmorrhage. It may be
still further observed that, even in those few cases in which the
miscarriage is actually effected by the separation of the ovum
by external violence immediately, and not through the inter-
rnediation of descensus, there is often a descensus produced si-
multaneously by the same accident, which, if disregarded, very
often tends either to prevent conception subsequently, or to cause
miscarriage in subsequent pregnancies, when such pregnancies
do occur. Again : concussion and other such causes mechan-
ical violence of different kinds, may, and do sometimes operate
also, by rupturing the membranes and causing a discharge of the
waters ; and this is liable to be followed by abortion of the whole
.ovum ; but here another cause arises, which is either the undue
pressure of the foetus on the uterus, exciting it to expulsory ef-
fort, or the death of the fcetus, operating ultimately the same ef-
fect. In this case, however, it does not necessarily follow in
all cases that abortion must be completed ; but a preventive in-
.4ication arises, which is, to prevent by suitable means that exci-
tation of the uterus which results in expulsory action. This is
often adopted with success, and a re-accumulation of waters
takes place. And, lastly^ such violences may, and do operate
in such a manner on the uterus, otherwise than by causing its

1S39.] An Essay on the Causes of Abortions. SSft

depression, so as to excite inflammation, whereby abortion is
sometimes effected. In the first and second of these modes of
action, such causes may be considered proximate ; but in the
third, wherein inflammation is set up, this becomes a proximate
effect in the chain of abortive phenomena, and a cause of the next
phenomenon, or expulsory action; and the violence, becomes the
remote cause. But the mode of action of such forces, to which
we have before alluded, that is to say, by effecting some degree
of descensus ide? i, is abundantly more common than all others
collectively ; and in this case such causes* are also to be consid-
ered remote, and the descensus the proximate cause. In all
these several modes of operation, whether as remote or proxim-
ate, there are often causes of an instant; not abiding, but leaving
their effects, which are abortion only, or a proximate and compe-
tent cause of it ; and do not, therefore, generally demand further
regard in the treatment, than just to know that they are gone*
There are, however, exceptions to this, the most common and
mischievous of which is, the compression of the abdomen, by la*
cing and other tight dressing, w^hich does not fail in those who
are possibly susceptible of it, to produce descensus uteri.

Tight dressing, as lacing, as it is called, is a specimen of re-
mote cause which is not always momentary ; for, on account of
the foolish not to say criminal sway of fashion over the in-
tellects of some women, reason is reduced below instinct, which
certainly would not tolerate the use of such an injurious a pow-
er ; this cause does not pass away. Such a cause as this, would
therefore demand the efficient attention of the practitioner in his
attempts to secure his patient against the dangers of abortion, at
least, when threatened. The same may be said of habitual la-
borious efforts of any kind which tend to call into violent action
the abdominal muscles, and of violent coughs, &c. When,
therefore, in the investigation, abiding causes of any kind are
found, it would be more than unreasonable to treat the morbid
effects alone, whilst the causes of these effects remain in opera-
tion. Such abiding or continuous causes demand the first atten-
tion.

But whether momentary only, or abiding, what is the effect
of those remote causes ? It is simply a descent of the uterus to
some degree below its natural site. This effect once produced,

* Mechanical violence.

MO ^ An Essay on the Causes of Abortions. [March,

is not only too apt to abide, but is liable to constant increase in
degree, as well as in irritating effects on the neighboring parts,
and by re-action, on itself.

With this view of the case, the indication is perfectly plain
remove this effect, which has now become a cause^o. proximate
causeof irritation, the first pathological phenomenon belonging
to the act of abortion. This indication may sometimes be ful-
filled by horizontal rest on the side, with a moderate elevation of
the pelvis,, with or without regimen and other antiphlogistic mea-
sures, according to the degree of irritation already manifested.
But as dangers sometimes indeed often, speedily arise under
such circumstances that is to say, on account of irritation na-
turally belonging to the uterus, in consequence of pregnancy,
this simple measure should not be long entrusted with the cure,
without early and decided evidence of amendment. Under the
necessity thus suggested, the more thorough practice of com-
plete restoration of the uterus, per taxis, should be effected, and
that, as often as an understanding and rational view of the case
jnay demand. This proper adjustment should be combined with
position and other means, according to the necessities of the case.

Observation of the uniform efficacy of this treatment a treat-
ment adopted in view of this cause, a phenomenon generally
found on examination, to exist, assures us of the truth of the pro*
position we have advanced.

We would not be understood to say that this is the only cause
of abortions, or that they are never effected by other causes ;
but we do mean to say that it will be found, by far the most
usual, if not the only cause of all those which are not obviously
attributable to other causes, (and these are a large proportion;)
as well as of many which are apparently attributable to other
causes. We mean to say, further, that although violent accU
dents, &c. may have instituted the troubles, and stand promi-
nent as causes ; and although they are indeed, remote causes ;
still the part in the chain of cause and effect which connects them
with the final event that part which explains their operation
by effecting a descent of the uterus to a greater or less degree,
which, in turn, becomes a source of irritation, is overlooked in
common practice the cause, (violence, for example,) has pass-
ed away ; and therefore needs generally, no prescription ; and,
as the next phenomenon is believed to be ijritation, as the im-

183J^.] An Essay on iJie Causes of Ahorlion^. 341

mediate effect of that cause ; tJiis, and this alone, generally be-
comes the sole object of attention and treatment. Here, it will
be perceived) the effect of another interesting phenomenon, which
has, in turn, become cause, is subjected to treatment, whilst ils
proximate or immediate cause, not bein^ detected, continued in
operation. This is one of the grossest absurdities in pathology
or therapeutics.

With one more remark, we will close this enquiry.

Periodical abortions, as those are sometimes called which oc-
cur about the same period of pregnancy, are those which, as
Vclpeau says, occur in the same woman at nearly the same pe-
riod after conception, have been, too often, the opprobrium of
the accoucheur. Whenever causation is not duly and properly
considered, error, either of omission or of commission, becomes
unavoidable ; either of which, may be alike injurious and inex-
cusable.

Our observation of these cases, compels us to differ essential-
ly with our highly valued Velpeau on this subject. He says it
" appears evidently connected with a menstrual, or spontaneous
molimen." We will not deny the possibility of this, but its great
infrequency is, with us, beyond dispute, and for these very good
reasons, as we consider them that in those cases in which
abortion occurs about the same period of pregnancy, the descen-
sus uteri is generally found to exist in some degree, sufficient to
cause the symptoms, and its constant correction generally pre-
vents an unfavorable result with as much uniformity as any oth-
er purpose is effected in practice. This proves the great fre-
quency of the cause to which we attribute periodical abortions,
and the great infrequency, at least, of spontaneous molimen.
He allows it possible for it to arise from that special state of the
uterus, congenital or acquired, which prevents its distension be-
yond a certain partial extent, corresponding with the period of
pregnancy at which the abortion inclines to occur. Tothejoos-
sihility of this, we will again not object. As to such an acquir-
ed state, it has been again and again demonstrated by the scal-
pel of Madame Boivin,* and that too, as the result of descensus
or prolapsus uteri ; but with long and extensive observation in
these cases, we have no reason to believe we have ever met with

'^ Recherches sur une dcs causes, les plus frequentes, et la^noins conune,
de L'Avortemcnt.

843 Medical Electricity. f March,

this " special state," congenital, or acquired, in such a manner as
to be necessarily perpetual, except in those disorganizations^
(as extensive adhesions, &c ) resulting from disease of some kind,
and generally from descensus or prolapsus uteri.

M. Yelpeau next looks to the influence oi habit. These hav*
ing been looked to, as common causes, have done little better, if
not indeed worse than an entire omission of all etiological inves-
tigation ; for they have only served to divert attention from true
causation.

In conclusion, we state that the truth of the proposition here*
in maintained, that the most frequent cause of abortions is some
undue degree of descent of the uterus from its natural site, is not
only clear from an impartial view of the facts, and their relative
position in the chain of cause and effect ; but a practice founded
on this view, reveals the truth, that the timely correction of this
phenomenon rarely, ifev^er, fails to prevent the dreaded disas-
ter ; and at the same time, reasoning from effect, determine, the
true causation.

ARTICLE III.

Medical Electricity. By M. Antony, M. D. Professor of Oh-
stetrics and Diseases of Women and Infdnts, in the Medical
College of Georgia.

In the former part of this volume,! we advanced the impor-
tant therapeutic fact, that the positive electric or galvanic pole,
which is the inducting point, produces, when a current is estab-
lished through the system, sedative, or what was, in old surge-
ry, called discutient effect ; and that the negative pole, which is
the point of eduction, on the contrary, exalts the excitement.
These facts have been established by very many experiments
and observations of our own. They are, so far as we are
aware, original, and were first suggested to us by our peculiar

t See " Medical Electricity," page 12, et seq.

1839.] Medical Electricity, 313

theory of animal life, and proved by the experience founded on
that theory, and instituted with a view to tlicsc facts.

Many years since, (we think about eighteen,) we observed in
some Medical Journal, perhaps the Boston, a brief notice of some
experiments made at Bath, in England, for the cure of epilepsy,
by the application of galvanic plates ; but which experiments,
proving unsatisfactory, were, after several attempts, abandoned.
There happened at the time to be, within our knowledge, an in-
tractable case ofepilepsy, in a coloured girl, about nine years of
age ; a case on which we had, two years before, exhausted our
therapeutic resources, and had been followed by several other
practitioners, and finally by the various empirical means of
neighborhood prescriptions, patent medicines, &c. with no bet-
ter results. Meanwhile the epileptic-fits, v'hich had been origin-
ally a month apart, had now become, in frequency, from eleven
to twelve daily, with very considerable impairment of intellect.

On the suggestion made by the Bath experiments for testing
the utility of galvanism, and believing we could avoid the cause
of their failure, we instituted its use in this case. To our very
agreeable surprise, the fits failed lo return again. So soon as
they were found to be arrested, having always attributed the case
to worms, the infusion of Spigelia, which, as well as all other
vermifuges, had been before repeatedly used, was now adminis-
tered, and was promptly followed by the discharge of nine of the
largest lumbricaks we have ever seen. The patient commenced
to improve forthwith. The plates were applied to surfaces de-
prived of the epidermis, by. the previous application ofvesicato-
ries : one for the silver'plate, on the back of the neck, and the
other for the zinc plate on the inner and upper part of the leg.
The plates used were nearly one inch square, and were connect-
ed together by two or three annealed wires ; and a thin layer
of fine wet sponge under the silver plate, and a similar layer of
fresh flesh under the zinc plate.

Fearing the return of the fits, we were unwilling, notwithstand-
ing the discharge of worms we had procured, to abandon the
galvanic current, for twelve or fourteen days. During this time
however, it was several times observed, that the sore surface on
the neck, on which the silver plate was applied, had dried, and
needed to be again and again vesicated ; whilst that under the
zinc plate had continued to increase in inflammation, until it be-

8i4 Medical Electricity. [March,

came so serious a sore as to compel the abandonment of the
current.

Since this experiment, many have been made with similar re-
sults ; some of wliich being on younger children, produced gan-
grene at the zinc point within three or four days ; whilst the sore
under the silver plate dried and became well, or nearly so.
These experiments may be used, and the same facts demon-
strated by any one at any time. Experiments were subse-
quently made by connecting the insulated body with the prime
conductor of an electrical machine, making the inducting point
on some seat of inflammation, and i\\e educting one, a distinct,
healthy portion of the skin, to which the knob of the discharging
rod was applied by an uninsulated person, for the purpose of
eduction. In these experiments, the inflammation at the posi-
tive pole was reduced, whilst vesications were raised at the point
of eduction. Thus was it demonstrated, that the electrical cur-
rent, however produced, acted on this principle a principle
which seemed calculated to guide to the most important thera-
peutic results.

In view of these operations of this physical agent, we have
planned a variety of instruments, and adopted several others in-
vented by other persons, for the application of this principle to
therapeutic purposes, and named them according to their parti-
cular applications and objects. It is not now a matter of inqui-
ry, whether the electric current acts on this principle ? the only
question is whether or not, the instruments are well adapted to
its application to the several purposes contemplated. Several
of them which we had constructed, we have repeatedly applied,
with satisfactory results.

We have just received from our cutler, the following instru-
ments, constructed more perfectly than those with which we
have experimented ; and feel assured, by the principle we have
demonstrated that, so far as the applicahiUty of the instru-
ments, and the immediate influence of action, by sedation in
one part, or excitation in another, or revulsion, is concerned in
curative indications, they will be found efficacious, convenient
and easy of application and most of them capable of being ap-
plied by the patients themselves, or their friends or nurses.

The following are the Galvanic instruments

The Galvanic Purgative. This was originally constructed

1839.] Medical Electricity.

by some of the northern cutlers, and especially used as a remedy
for dyspepsia, and habitual constipation ; and so far as we have
learned, without the knowledge of, or regard to any guiding
principle of action. It consists of a zinc cylinder and a silver
plate, connected by a silver wire. We have adopted two sizes.

No, 1. Cylinder of zinc 3 6-10 inches long, and 3^-10 of an
inch in diameter ; with an oval silver plate 2 7-10 inches long,
and 1 4-10 inches from its greatest width.

No. 2. Cylinder of zinc three inches long, and 3-10 of an inch
in diameter ; with an oval silver plate 2 2-10 inches long, and 1
l-lO inch from its greatest width !

Remarks. This article has been considerably in use in the
United States as a remedy for dyspepsia. We have not had
occasion to use it in this chronic disease, which w^e generally
treat on another plan. But we have repeatedly used it as a pur-
gative power, and with satisfactory results. Its most important
use, under our prescription has been, in those cases of tympani-
tes which occur in gastric and intestinal fever, with red and
swpllen tongue, insensibility of the bowels to purgatives gener-
ally, soreness and tumefaction of the abdomen, with hiccough.
In these cases we have repeatedly succeeded in promptly redu-
cing the abdominal tumor from flatus, the abdominal tenderness,
hiccough, preternatural redness, &c. of tongue, and indeed all the
symptoms of the gastro enteritic state ; evidently begining with
the reduction of symptoms at the upper part of the canal, and
finishing at the lower, in the manner in which this change is ob-
served in recovery from this state, when effected by other means;
but in a much shorter space of time.

Application. The cylinder is wetted and introduced into the
rectum, and the plate is laid on the upper surface of the tongue.
The application is continued from thirty to sixty minutes, and
even longer if the bowels will bear it without excessive purga-
tion, when it is desired to apply the principle to the inflamed
fitate of the alimentary canal.

The Galvanic Intestinal Revellant. This instrument we have
constructed on the principle on which this power acts, that is to
say, the positive pole is repellant, and excitement and fluxion are
produced at the negative. No case has yet offered for its
use. But according to the principle of Galvanic action, it is well
calculated for the correction of troublesome tenesmus, or other
D 4

846 Medical Electricity. [March,

irritations of the rectum, and probably in painful internal hae-
morrhoidal distresses. We have adopted two sizes, Nos. 1 and
2, The cylinders and plates of these are the same size as those
of the Galvanic purgative, but the elements are reversed, the cy-
linder of this instrument being silver, and the plate, zinc.

Application. This instrument is applied in the same manner
as the Galvanic purgative.

Remarks. The large size, No. 1, of both the Galvanic purga-
tive, and the Galvanic intestinal revellant, is adapted to the use
of adults, and the smaller, to that of children. As this revellant
does not lead to purgative operation as the Galvanic purgative
does, it may be worn at will, according to the necessity of the
case. Should there be fear of unduly exciting the stomach or
tongue by thus reversing the direction of the Galvanic current,
the zinc plate may be applied on the neck or some other part,
with a thin layer of fresh flesh interposed between it and the de-
nuded surface to which it is applied.

Galvanic Cutaneous Revellant. This instrument or appara-
tus consists of two plates of equal area one of silver and the
other of zinc, connected together by silver wire. We have
adopted three sizes, oval, the proportions of which are as follows:

No. 1. Plates each three inches long and two wide, oval.

No. 2. Plates 2 2-10 inches long and 1 7-10 wide.

No. 3. Plates 1 7-16 inches long and 1 2-10 wide.

Remarks. The plates of this apparatus may be of any shape
which is best calculated to suit the places to which they are
to be applied. The proportion of the area of the different num-
bers should be about the same as those of oval shape, the dimen-
sions of which we have just given.

This is the same instrument to which we before referred, as
used in the Bath experiments in epilepsy, and as successfully ap-
plied by us in epilepsy, and in convulsions of children generally.
We have, by its application, repeatedly arrested, with great
promptness, perpetual convulsions, from various causes, and
prevented their returns, when not perpetual. In illustration of
this, we will refer to one case. A girl, eleven years old, labor-
ing under scarlatina, had several convulsions, returning after
two or three hours intervals ; and there being no change in the
circumstances of the case, it was believed they would continue
to return. The apparatus was applied as soon as vesications

183.] Medical Electricity. 347

were produced. No convulsions returned for the next twenty
six hours. By this time, the negative pole having become some-
what offensive, the zinc plate was removed for dressing the sore
with a fresh layer of flesh ; and in the short space of time neces-
sary for washing the sore and applying the new dressing, anoth-
er convulsion as violent as the former had been, came on. The
dressing was completed, and kept several days without cleansing
again, during which time a thorough course of anthelmintic me-
dicines succeeded in causing the discharge of many lumbricales.
By this time however, the negative pole had caused a very of-
fensive ulcer, covered with a gangrenous slough. The appara-
tus was then removed, and the sore dressed with an alkaline
poultice, which speedily corrected its ill disposition, and no fur-
ther convulsions returned.

Application, The surfaces to which the plates are intended
to be applied, should be first denuded of the epidermis, to the
size of the plates intended to be used. This may be done by
any of the vesicatories even by hot water, when the necessity
is very immediate. The cuticle is removed. The blister to
which the positive pole is to be applied, is covered with a piece
of fine wet sponge, on which the silver plate is placed, and secur-
ed by adhesive strips crossing it in different directions. The
negative pole is applied in like manner to the other denuded sur-
face, interposing between it and the surface a thin layer of flesh
instead of sponge. We have adopted these interposing substan-
ces, from their having been thus used in the Bath experiments.
We are not conscious of any good reason why both of these
should not be of the same material their uses being to shield
the sore from the wounding of the plates, and at the same tirtie
to preserve a moist, conducting medium at those points of con-
tact. We continued the use of sponge and flesh as above, be-
cause we found them answer our purpose.

For the action of this current on the general nervous system,
and producing a revulsion from the great nervous centres, the
positive pole should be applied as high as possible on the spinal
column, or rather, as near as possible over the medulla oblonga-
ta; and the negative, on some convenient place on one of the
lower extremities, as the inner and upper part of the leg, a Httle
below the knee joint. In its application for other purposes, the
positive pole is to be applied on the point at which it is desired

348 Medical Electricity. [March,

to reduce the excitement, or produce a resolvent or discutient ef-
fect, and the negative on some distant part which may be most
convenient.

Galvanic uterine exciter or emmenagogue. This apparatus
consists of a concave zinc plate, mounted on the large concave
end of a trumpet-shaped horn rod, somewhat resembling a stem
pessary, having a rod of the same material proceeding from the
under side of the plate, through the horn longitudinally, and ter-
minating beyond the small end, in a button, to receive a bandage,
and a loop or small hole to receive a wire ; thus making this part
of the Galvanic current complete, whilst, by the insulation ef-
fected by the horn, the current is the more completely directed
through the os tinae, which is intended to rest in the concavity
of the zinc plate. The other part of this apparatus is a plain sil-
ver plate, corresponding in area with the concave zinc plate
above described ; and connected with it by a silver wire.

Of this apparatus, there are three sizes

No. 1. The vaginal piece, exclusive of the button and loop,
five inches long ; and the zinc plate on the large or uterine end,
one and three quarter inches in diameter.

No. 2. Vaginal piece four inches long, and its plate one and a
half inches in diameter.

No. 3. Vaginal piece four inches long, and the plate one and
a quarter inches in diameter.

Remarks. This instrument is constructed, as will be at once
perceived, for the application of the negative or exciting pole to
the OS uteri itself, and is, according to the principle on which it is
constructed, calculated to effect all the good possibly afforded by
any means calculated to increase the action in the uterus, or de-
termine fluxion to it. The irritation and increased fluxion to the
OS uteri by the application of leeches, has of late years been
much depended on for restoring menstruation. This apparatus
certainly has not the power of depleting by wounds as the leech-
es do, but has all the desirable power of excitation ; and, whilst
the leeches are necessarily of short application, and extremely
inconvenient necessarily requiring the assistance of another
person, and sometimes that of the practitioner ; this apparatus
may be as well applied by the patient, as by another person, and
its exciting powers continued to any desirable extent.

It is proper however to remark, that its use must be carefully

1830.] Medical Electriciiy. 349

avoided in those cases in "wliicli there is engorgement of the os
and cervix uteri, or any considerable irritation of thenn ; and
should never be so long continued as to exalt the action to in
flammation. This could not be, we apprehend, in the space of
twelve or twenty four hours, as the part to which it is applied is-
not divested of its natural covering. It is therefore only appli-
cable to those cases of menstrual deficiency, in which stimulat-
ing emmenagogues are properly indicated.

There is however, another very important office which this
apparatus is calculated to subserve. A very large proportion of
cases ol menstrual irregularity are dependent, partly or entirely
on the existence of descensus or prolapsus uteri ; the correction
of which, if timely effected, will be often found to remove the dif-
ficulty ; whether it be retarded, accelerated, excessive, deficient
or merely painful menstruation. This benefit is efTected through
the liberation of the arteries, veins, lymphatics, nerves, by removing
that pressure of the uterus which tended to the impairment of
their functions ; and peculiarly those of the absorbent vessels
through which alone refluxion from the part can be effected.
The use of the vaginal piece of this apparatus is admirably cal-
culated to relieve this pressure, when bound to its place for a
length of time, as twelve or twenty four hours, by the bandage
which embraces the button or vulvar or small end. At the same
time this liberation is effected, a wholesome excitation must be
imparted to the circulatory organization of the part, and the
more complete performance of function ensured. We suggested
this apparatus, on the principle only, as this application of it has
not been made. Electricity has often been successfully applied
from the machine ; and this fact seems to declare its utility.

Application. The uterine or large end of the vaginal piece, is
introduced and carried on to the upper part of the vulvo-uterine
canal ; which, when it arrives there, can scarcely fail to receive
the OS uteri into its concave extremity. A T bandage is then to
be so applied, as to receive the button of the vulvar, or small
end, into a hole made in the bandage for that purpose. The
bandage should receive the button before the wire is fastened to
the loop. The silver plate of corresponding area, belonging to
the same No. is then connected with the vaginal piece by silver
"wire, and may be applied on the tongue, or on a denuded place
on the back of the neck. The latter will be preferable when it

350 Medical Electricity. [iMarch,

is desired to continue the application nnore than two or three
hours at a time, which we apprehend would generally be the
case.

The Galvanic Uterine Revdlant. This apparatus is con-
structed precisely as the uterine exciter just described ; the ele-
ments been received only. Like the former, three sizes of
this have been adopted, Nos. 1, 2 and 3.

Remaiks. This apparatus is also suggested by the principle
of galvanic action; by which it is peculiarly adapted to cases
of irritable os uteri, engorgements of the same, &c., at the same
time that, like the other, it seems for the time, as a stem pessary.

Application, This revellant is applied in the same manner as
the exciter.

The Mediate Ocular Revellant. This apparatus consists of a
concavo-convex silver plate, of suitable dimensions, to cover the
front of the eye-ball by being placed with its concave surface on
the upper palpebra when closed. From the middle of the con-
vex or external surface, which is covered by tortoise shell or
horn, or other electric, proceeds a metallic projection through
the electric, and forming a button and loop, used for re-
ceiving a bandage and a wire. By means of, a silver wire, the
loop of this silver plate is connected with a plain zinc plate of
equal area. ^

Remarks. This apparatus is yet untried, and is only con-
structed on the suggestion of the principle on which galvanism
operates. It is applicable to the treatment of inflamed eyes, in
which a discutient effect on ihe organ is desired.

Application. Apply the concavo-convex plate of silver im-
mediately on the closed upper lid secure it with a bandage em-
bracing the button, and passing a silver wire through the loop
or hole beyond the button, connect it w^ith the zinc plate, which
is to be placed on a denuded surface on the back of the neck. A
thin layer of fine, wet sponge is to be interposed between the
silver plate and the eyelid, and a piece of flesh between the zinc
plate and the denuded surface to which it is to be applied.

The Mediate Ocular Exciter. This apparatus is construct-
ed precisely as the mediate ocular revellant, except that the
galvanic elements are reversed; the zinc being made concave
to fit on the eye-lid, and the silver plate plain for the neck.

Remarks. This is intended for fulfilling the indication of in-

1830.] Medical Electricity. 851

creasing the excitement of the eye ; an indication, perhaps, rarely
arising in practice. It was particularly on view of experi-
ments with this indication, in amaurosis, a disease, hitherto, so
unmanageable, that this arrangement of the galvanic elements
was prepared for application to the eye ; and is it not worthy of
trial in such a disease ? It will not be denied that a remedy in
such cases is a great desideratum. Other cases may occur in
which this action may be desirable ; and we here ask the atten-
tion of surgeons who attend eye infirmaries, to the several gal-
vanic arrangements we have constructed for application to the
eyes, and should esteem it a great favor to receive reports of
their results.

Application. This is the same as that of the last named, or
ocular revellant, except that the concave zinc plate is placed on
the eye, and the plain silver plate on the neck ; the thin layer of
flesh, of course, under the zinc, and that of sponge tinder the
silver plate.

The Immediate Ocular Revellant. This consists of a very
delicate,. oval shaped, concavo-convex silver p!ate, finely polished
and fitted to the forepart of the eye-ball, within the lids. It has
a thin loop proceeding from the centre of the convex surface, to
pass between the eye-lids, and receive the silver wire which is
to connect it with the negative, or zinc plate of like area.

Remarks. This is intended for exercising, in a greater de-
gree, the same repellant efforts designed by the immediate ocu-
lar revellant ; particularly in severe conjunctivitis, and other
inflammations affecting the globe of the eye. It is so con-
structed as to be worn with nearly the same ease with which a
false eye is worn.

Application. The concave silver plate is interposed between
the palpebral and the anterior part of the ball concave to the
ball, and the greatest diameter of the oval, transverse ; the loop
passing between the tarsi to receive the wire. The plain zinc
plate is connected to the loop by a silver wire, and is applied to
the neck as in the application of this plate in the use of the me-
diate ocular revellant. A thin layer of flesh is interposed be-
tween the zinc plate and the denuded surface. A bandage and
light compress over the eye-lids, will secure the silver plate ;
and strips of adhesive plaster are to be crossed over the zinc
plate.

332 M-edical Electricitg. [March,

The Immediate Ocular Excite?: This instrument is construct-
ed ill the same manner as the immediate ocular revellant; the
.galvanic elements being reversed, so that the concave eye plate
is of zinc.

Remarks. It is intended to operate in the same manner, and
for the same purposes, as the mediate ocular exciter, but with
more power, by being in i-mmediate contact with the moist con-
junctiva, as the silver plate is, in the immediate ocular revellant,

Appllcatian. This is applied in the same manner as the im-
mediate ocular revellant, except that the layer of sponge is used,
in this case, under the plate on the neck, which, with this ar.
rangement, is silver.

The following are the ele-ctrical instruments, or those intended
for infusing electricity into the part, or operating on that whic^
is in it, and so modifying it as to exercise a salutary influence on
such morbid affections as they are applicable to ; or such as may
be benefitted by modifications of the electricity of the part.

The Anodyne^ or Electric Brush. This instrument is con-
structed of very fine steel wires, firmly inclosed at one end, in a
metallic handle, having the other ends pointed and left free, to be
used in the manner of a brush, which, indeed, it is. The whole
instrument is about five and a half inches long the brush part,
below the handle and slider, being three inches. The brush is
flat, and at the handle, where the wires are closely confined by
the handle and slider, is 6-10 of an inch wide, and 1 1-2 10 thick,
and contains ninety or one hundred wires. Immediately below
the handle, and on the upper part of the wires, is a slider, which
fits so strictly as to keep the wires in close contact. The use of
this is to bring the wires into close contact, by sliding it down to
the extremity, for introducing them conveniently into the case.
A metallic cover then passes over the brush, and sliding on the
lower part of the handle, completes the whole as a convenient
pocket instrument.

Remarks. This is an improvement on the anodyne brush of
Professor Hildebraiadt. Instead of a round bundle of wires,
illy applicable to any surface of the body, we have constructed
it flat, and completed it as a neat, portable instrument, incased
in silver or block tin.

Hildebrandt obtained by the use of his, in various painful
affections, such results as caused him to indulge freely in its use,

1S39.J Medical Electricity. 363

and give it the name of" Anodyne Brush," from its power of re-
lieving pain. With a rude one of our own construction, we
have had experience, with very satisfactory results. One case
in particular occurs to our recollection, which was the first in
which we applied it. It was a case of painful stiff-neck from
the effects of cold, in which the head was confined to only one
precise position the most exquisite torture arising from the
least change of position. After the use of the brush over the
painful muscle for ten minutes, the part to which the brush had
been applied, became flushed with red color, and covered with
perspiration. The lady was then requested to turn her head,
which she first attempted, with great fear of extreme pain ; but
on making the attempt, she found, to her great surprise and grat-
ification, that she could move it in any way, with perfect ease.
She then covered the part with her cape. On making some
movements of her head, in conversation a few minutes after-
wards, however, she perceived some little sensation in the part,
for which I again applied the brush for two or three minutes,
when on trial, it was found to have disappeared, and she remained
perfectly well.

Use, Heldebrandt's brush was made of copper or iron wire,
and wetted with diluted acid, or a saline solution. As these im-
prove the conducting .power, they may possibly tend to heighten
the effect of the brush ; but on account of their corroding power,
we applied the brush without their use. The manner of using
it, is to place the points of the wires at the brush extremity, on
the skin, in such a manner as to bring as many points as possible
into contact with the surface. The brush is then gently drawn
over the surface with its own weight, or perhaps a little more
pressure ; but not such as to give pain by scratching, or abrad-
ing the skin. This is done repeatedly in the direction from
the central extremity of the nerves ''of the part, towards
their peripheral extremity. Its use may be continued as long
as may be convenient, or until the effect is completed. As the
part may then be moistened, or unusually excited, it will be
well, if the part be one ordinarily covered, to cover it with
flannels ; at least in winter.

The Electrical Box. An ample description of this box is
given in the first paragraph on the twenty first page of this vol.
ume ; and the appendages to this apparatus, in the two succeed-
E 5

354 Medical Electricity, [March,

ing paragraphs. It is therefore unnecessary to report it in this
place. On the next page, we suggested the improvement of
this box by substituting for the sulphur, an electric of shellac,
amber, or hard sealing-wax. We have succeeded in procuring
one constructed of sealing-wax, which appears at least as excita-
ble as that of sulphur.

Remarks, This is "the box," originally invented, as we
suppose, "by M. Sousselier, Lord of many manors." It is a kind
of economical electrophorus, and has been found highly useful
in many painful, inflammatory and nervous affections, lis
mode of action will be found on the 22 and following pages of
this volume.

Use. The use of the electrical box will be found at large on
the sixteenth and following pages of this volume, together with
its application to many particular cases, on the sixteenth and
following pages, to which we again refer the reader.

Here we conclude our description of galvanic and electrical
apparatus, the use of which w'e suggest to the profession, in the
hope that they will be found of service to humanity, or w^ill un-
dergo such improvements, either in their construction or appli-
cation as to become so.

One more new instrument we offer to the notice of the profes-
sors, w^hich is

A Guarded Scarificator. This is a small instrument, not oc-
cupying in the pocket, more room than the handle of a common
pen-knife ; which, indeed, it greatly resembles. The handle of
this instrument may be made of wood, bone, horn, ivory, pearl,
(fee, on the end of which is fixed a smooth convex guard, through
the centre of which a fleam projects, which is regulated and fixed
by a screw in the side of the handle, so as to cut to any depth
less than three quarters of an inch. This instrument is as con-
veniently portable as a pen-knife, is easily cleansed and kept in
order, and the fleam retracted into the handle for portage. It is
so w^ell guarded as to enable the operator to make as many inci-
sions, and these in as quick succession as he may please. The
price is considerably cheaper than the spring scarificator
which, for economy or the comfort of the patient, is often substi-
tuted by the common scalpel. It has the additional advantages
of being easily cleansed and kept in good order, and of changing
the old for a new fleam, by the turn of one screw.

1839.] Professor Dickson*s Lecture. 355

By increasing the length of the handle, this scarificator would
be found very convenient for scarifying the tonsils and assuag-
ing palatine abscesses ; and as it is, it is v^rell adapted to the
purpose of scarifying deeply in those cases in which this becomes
necessary.

- Part II. REVIEWS AND EXTRACTS.

Introductory Lecture, delivered at the opening of the Medical
College of the State of South Carolina, November l2th, 1838.
By Professor S. H. Dickson, M. D. Published by the Class.

The appropriateness, to its purpose, of Professor Dickson's
composition his accuracy as a writer, and the beautiful simpli-
city of his style, are too well known to need our commendation.
Of all these, the Lecture before us affords a pleasing example.
One thing which is common in productions of this kind, and which
is peculiarly disgusting, is the mongrel language in which the
ideas are often couched a language concocted of incompatibles
and obscurities, from the admixture of as many different lan-
guages, as the memory and pedantic taste of the writer enable
and dispose him to jumble into wards, lines and pages. Some
of our books which should have been standard works, have been
blighted in the very onset by being thus written in obscure, pu-
erile language. These errors are great follies in writers, which
have, of late, received wholesome rebukes by the northern re-
viewers, and by the failure of such productions. The good taste,
sense of propriety, and sound judgment of the author now before
us have borne him above these things. He ever writes with that
elegance and simplicity which render his productions at once
pleasing and instructive. There is also manifested in Professor
D's. composition, a fulness of thought, and depth of idea, which
imparts to it a peculiar value. The whole ground on which he
stands is fully occupied, and the strength of his views, although
sometimes, at first, appalling, are still found, on examination, to
be correct. We take great pleasure in laying before our read-
ers the following excellent and beautiful extract, not only on ac-
count of its classical beauty, but for the highly wrought and cor-
rect views which he inculcates, of the labors, the acquirements,

^56 Professor DichsorCs Lecture. [March,

the obligations and the responsibilities of those who devote them-
selves to the science of medicine.

From the earliest times, our order have set themselves with unabated zeal
and untiring patience, to mitigate the sufferings of their fellow men. We
have watched by the gray dawn, through the noontide heats, and all the
livelong night, at the bedside of the sick, to catch the first ray of hope, to
seize upon the first favorable moment in which to offer our kindly aid.
While others have fled before the approach of pestilence, we have remained
by the noisome couch, we have breathed the foul breath, and inoculated our-
selves with the deadly secretions of disease, to wrest even from the grasp of
the poison some salutary instruction. Nay ! to protect and preserve the li-
ving, w^e dare the very vapours of the charnel-house, and inhale the revolt-
ing effluvia from the dead. Like the Prometheus of the Greek Poet, it has
been our pride to struggle against Fate herself, a4id to traverse with unbend-
ing resolution the evil current of destiny, it is ours to stand in the breach
to arrest the contagion that infects whole nations ; to check the course of
the destroyer, and to put limits to the sway of the dread king of terrors. We
are called upon to sustain the fainting spirit, and feed the flame of almost
exhausted vitality ; to restore impaired vigour and lost powers of action and
enjoyment. We are expected to minister to the mind diseased ;" to re-
lieve the tortured imagination from the horrors of a gloomy delirium ; to tem-
per the violence of passion ; to regulate the wildness of the will ; and to seat
the vacillating intellect upon a steady throne.

These scenes such entire and unreserved immolation of self- -such de-
votion to the call of duty ; demand a firmness and courage of more inflexible
grade and of finer texture, than all the other avocations of life. No tran-
sient excitement can sustain us in this protracted self-sacrifice, no love of ap-
plause, no intoxicating impulse or exhilaration of sympathetic and multiplied
feeling. We labor, we suffer, we die alone. No crowd surrounds us to in-
crease by its huzzas the animation of victory, or cheer the gloom of the
grave. Yet of the thousands of our brethren who have thus like Curtius
leaped into the gulph, and thrown away their lives for their fellows, not one,
as we fondly believe, not one has failed to find his obscure virtue, its own
rich reward ; its quiet daring, its patient endurance sustained and illuminat-
ed by the delightful consciousness of doing good by the divine luxury of
benevolence. If there be one among you who does not find himself warmed
and spurred forward by such examples, who does not anticipate with glow-
ing enthusiasm the day when he may join these shining ranks as a volun-
teer, and if need be, a martyr, I tell him plainly, that he has mistaken his vo-
cation that he is not one of us that he is not worthy to unloose the shoe-
latchet of those glorious Philanthropists, to whom I have alluded, and who to
the honor ol our profession and of humanity, are in every age and nation so
numerous, that their biography would fill another library of Alexandria.
He may be gifted and useful^ but it must be in another sphere. He may
found a city, or improve the processes of Agriculture, or the machinery of
manufactures ; he may win a naval battle, or ride red-hoofed over the
mournful field of conquest ; but unless he can possess his soul in tranquillity
amidst the busy solitude of a lazar-house, and perform without repugnance
the most menial offices of kindness to ajj unknown pauper, he is not, he never
will be a Physician.

Let it not be supposed, that I am ignorant or forgetful of the infirmities of
our nature, or unaware of the alloy and imperfection of the best human in-
centives to action. In the phrase with which the Persians conclude all trea-
tises on every subject, 1 too would humbly acknowledge, " Ther is nothing
perfect but God !" but you will readily understand, that I speak of the rul'
ing passion, the impelling motive^ the mailer propensity. In the true PhysL

1839.] Professor Dickson's Lecture, 357

cian this must be benevolence, and can be nothing lower. Its energy may
be increased perhaps, its efforts certainly may be doubled, by the stirring in-
citements to ambition, by the hope of wealth, by the wish to attain import-
ance and influence in society ; all these are allowable, it may be, praisewor-
thy, if the hand be pure and the heart be right, and every other feeling be
kept subservient to the engrossing purpose, the absorbing desire of doing
good. Do I require too much of the aspinmt after medical honors ] Sure-
ly not. Without the support of such principles as I have indicated, and of
such enthusiasm as I have pronounced necessary, he will fail in the hour of
trial. His weapons, if of less than this celestial temper, will shiver in his
hands when he has entered upon the strife which awaits him, and finds him-
self jostled in fierce collision with all the difficulties which are to surround
and press upon him. Nothing else can preserve him from the arrogance of
dogmatism, the bitterness of rivalship, the stings of jealousy and envy, the
mean subservience to popular prejudice and vulgar clamor, in which he will
make shipwreck of the proverbial honor, the prisca fides of the profession, and
in his anxiety to promote his own objects, and aggrandize himself forget his
patients, his conscience, and his God.

It is easy to shew that I have exaggerated neither the extent of the sacri-
fices, the exhausting and wearisome weight of duties, nor the wide and lofty
efTorta demanded of the profession.

With the best statistics we have, in hand, relativ^e to the aver-
age duration of life of men of various classes in Germany, Pro-
fessor D. next reminds the pupil of the greater brevity of the
life of the physician than that of any other class of men " not
exceeding ten years of actual practice;" and that " the chance of
attaining the age of 70 is for the physician, compared with the
theologian, as 24 to 33 with the agriculturist, as 34 to 40, and,
even including all the contingencies of a military life, with the
soldier, as 24 to 32. These conclusions are drawn from a suffi-
cient compass of time to give them great claim to fairness. In
the conclusion of the lecturers observations on this subject how-
ever, we find the following remarks, which we confess we are
unable to receive as conclusive, relative to the average duration
of life amongst the graduates of the Medical College of the State
of South Carolina, for the years 1834, '35, and '36 ; and much
less, relative to that of physicians generally,

" Of the 120 Graduates who received their education here within the
three years preceding the last course of lectures, we had heard of the death
of eight. This gives an average duration of life after entrance on practice,
of considerably less than 15 years ; a melancholy result indeed, when we re-
flect that the^subjects of this calculation were all in the very prime of youth-
ful vigour."

In the first place, the number of deaths and the ages at which
the graduates died, appear to be determined doubtfully be-
cause, more may have died than have been heard from. And
in the next place, if we suppose this uncertainty removed by po-
sitive assurance of the continuance of life with the rest, all not
tiaving died, it appears to us impossible to determine the aver-

35S Professor DicksorCs Lecture, [March,

age duration of life amongst the 120, until its termination witli
all of them, is taken into the statistical view.

The next subject embraced by the Professor, is a brief but
proper view of the immense number and extent of resources
from which the practitioner should be prepared to draw, before
he can be considered duly qualified for the discharge of his pro-
fessional obligations, with justice to his friends and to himself.
This view embraces all philosophy all sciences and all arts
a field which, although it be desirable, and should be cultivated
in all parts to the greatest possible extent, is rather Utopian
than practicable, when we consider the " vita brevis" alluded to
by the Coan sage.

We cannot but admire the eclectic spirit, the merited tribute to
Dr. Cullen, and the rational views of medicine contained in the
following extracts.

We may spend a few moments not unprofitably, in taking a rapid survey
of the actual state of Therapeutics, or the Practice of medicine; properly so
called, in the several countries of the globe, and in endeavoring to ascertain
the true position of our science, the ground upon which is based the art of
healing, as at present understood, practised and taught. Let us inquire whe-
ther any principles are established any doctrines received as elementary.
What is the complexion of modern Medicine ] Is it embodied in the shifting
Kaleidoscope of theory, or shall we look for it in the vagaries of a contradic-
tory Therapeutic'? Whichof all the vehement and angry disputants who
fill'the arena and stun us with their noise and dogmatism, shall we pro-
nounce to be in the right, or shall we venture to declare them all equally in
the wrong? What clue shall we seek to guide us through this labyrinth]
These questions seem at first difficult and embarrassing, but if investigated
with the proper spirit of philosophic reasoning, admit of ready solution. No
one will doubt or deny that facts ascertained by experiments sufficiently
clear, and repeated sufficiently often, and observed by a sufficient number of
competent witnesses, must be taken as tlie bases of all the sciences, and of
ours among the rest. The ready reception of bold assertions, the prompt
credulity which entertains without proper inquiry statements and explana-
tions confidently oflfered, these constitute Empiricism. The very phrase is
odious to the professional ear, but we cannot escape from the alleged neces-
sity. We must still search for, accumulate and collate facts^ in order to
make any advances. It is obviously incumbent on us, however, to lay down
for our safeguard and direction, some rule of evidence, and establish some
definite test by which we shall separate truth from falsehood, and avail
ourselves of the former, while we endeavor to shut out all error and decep-
tion. And here we may pause to pay a tribute to the memory of the illus-
trious Cullen, to whom more than any other of our revered predecessors, the
Practitioner of the present day is indebted for whatever is most clearly es-
tablished in the prevailing system of Therapeutics. To Cullen we owe the
"rational Empiricism," as it is styled by one of his recent eulogists, which
guides the practice and instructions of the British and American Schools of
Medicine, constituting indeed the peculiar stability of that Therapeutic
which has so long withstood all the stormy changes of theory, and which,
admitting to be interwoven with it all the improvements of every tributa-
ry science, grows with their growth and expands as the boundaries of human
knowledge are enlarged. Against this rock have beaten in vain the turbu-
lent wave of Brownism, and Broussaisism and Hahneinanisra. In contrast

1830.] Professor Dickson's Lecture, 359

with it, all the antagonist heresies are shifting and transient ; nay they can-
not fail ultimately to contribute to its support and confirmation. Each the-
orist appeals at last to facts there is no alternative; each consents, and
must consent to be judged by the observed results of the apphcation of prin-
ciples or hypotheses suggested. If, says Broussais, the most ingenious and
obstinate of dogmatists, m his lafe forcible strictures upon the numerical plan
ofLouis** if it can be proved upon experience that Tartar Emetic will re-
lieve a Gastro Enterile, 1 will administer it ; if'Arsenic v.ill do good, I will
prescribe that."

This then, we may recognize, as the primary rule, tlie elementary princi-
ple of our science. We may regard the Culienian Philosophy of Rational
and Eclectic Empiricism, as established beyond the reach or prospect of fur-
ther contjoversy. All that remains is to define exactly what is meant by
the qualifying adjective 'rational,' and to lay down suchsules of evidence as
shall commend themselves to all men upon the universal grounds of reason,
justice and truth. But we cannot set up anv new methods for the examin-
ation of testimony in reference to alledged facts we must employ the same
tests which are resorted to in Logic, Law, Natural Science, Natural and Mo-
ral Philosophy. Our Empiricism will indeed be rational, enlightened and
Eclectic, when it is thus guarded ; storing up recorded observations, cau.
tiously considered, duly weighed, carefully collated, and from these, by the
Baconian method of deliberate induction, proceeding to infer principles and
weave a tissue of doctries. It may be, nay it must happen, that we shall be
occasionally hasty in this deduction, and regard principle and doctrines as
settled, which time shall overthrow by adducing new, clearer, and more pre-
cise facts in opposition or illustration. But this is obviously no fault in the
system ; it is merely the result of the admitted imperfection of all hu-
man attainments. We know v-e are in the right path ; we must not expect
to find it free from intricacy and impediments ; we must exert ourselves w-ith
energy to overcome difficulties found to lie in our way. All extremes are
proverbially dangerous ; they are almost universally erroneous in themselves,
as well as in this, that they necessarily imply error, from excess. But the
golden mean in which truth and safty are only to be found, is of course dis-
tasteful to all formers of sects and their zealous followers, who unite to at-
tack and disparage it. Thus the rational Empiricism, in which lies the
Avhole philosophy of Medicine, is assailed with equal violence on one hand
by the Dogmatists, or ultra-scientific Physicians, and on the other by the
mere Empirics, properly so called, the nostrum mongers, the men of exclu-
sive experience and observation ; and in this crusade are allied the Physio-
logical School, with the Brunonians, the Perturbers with the Pinelians or
Expectants, and the Homoiopathists with their natural enemies, the ex-
treme Allopathists or Contrastimulators. But we defy them all! Nay
more as Eclectics, we select from the armory of each his best weapons,
and make them useful in the interminable contest. From the champion of
every school, we are willing to learn what he is eager and able to teach, and
as in the phrase of Bacon "all error is founded upon some truth," we find in-
struction every where.

********
We have inherited top much of the practical propensities and habits of our
British ancestry, to run great risk of being led far into the misty fields of Hy-
pothesis. Permanent reputation and eminence are to be attained among us,
only by direct usefulness, and an immediate application of scientific acquire-
ments, to the purposes of philanthropy. All our successful medical works
are therefore of a strikingly practical character, and so thoroughly Eclectic
are we, (I had almost said by instinct) that every efiort to put forward the
exclusive claims of any school whatever, has not only failed altogether, but
has recoiled promptly upon the head of the rash advocate who consulted so

3G0 Professor Dickson's Lecture. [March,

little the genius of his compatriots. We have determined, as well in sci-
ence, as in government, to call no man master.'^ Our Chalmers, Rush, Ir-
vine, Hosackj Eberle, and Physick, were all Eclecto-Empirics, and their sue*
cessors, whether in the cold and calculating East, the ardent South, or the
fertile valleys of the West, pursue the same course, and with every prospect
of fulfilling the same happy destiny, of enlarging the bounds of useful knowl-
edge, and subtracting something, each in his turn, from the vast mass ofhu*
man misery.

The space alteady occupied admonishes us to draw this anal}'"
sis to a close, which we do with regret, because our readers will
thereby be deprived of many pages of this interesting and able
lecture, the reading of which could not fail greatly to contribute
to their pleasure. We jcannot, however, take our leave of it,
without extracting the following sensible and jast allusion to the
great mammoth quackery which now infests our country, taking
advantage of the credulity of an unsuspecting populace, ignorant
of medical philosophy, and of the collateral sciences, by affecting
an unholy and impious alliance with sacred orders, to borrow
therefrom a weight of influence for its support, which its own
merits cannot afford^

While we are thus ascribing honor to whom honor is due^' let us extend
our acknowledgments to the Patent School of Ametican Physic, which
surely must deserve this notice at our hands, patronized as it is even by ed-
ucated men among us, who have purchased the 'rights' which shall entitle
them to experiment upon the lives and happiness of their helpless families
and slaves, (whom heaven protect from the disastrous results !) and sanc-
tioned as it has been by certain Legislatures in the South and West, who
have thus granted a premium to indolence and presumption. Since the ear-
liest records of Quackery, nothing has been heard of, to be compared in au-
dacity with this Mormonism in mrdicine ; this system, which not only treats
all diseases by rule and measure, but actually claiming to be derived from
heaven by the express gift of God !" sneers at all science and learnings and
in the broad light of day denounces their votaries. It is well that ignorance
has been thus avowedly made its basis, as constituting the most available
attempt at an apology for the tools of the shrewd old Patriarch the only
gainer by the invention. " Father forgive them, for they know not what
they do ]" From these Thomsonians or Botanicrtl Practitioners, we have
learned that the credulity of the mass of mankind, in afTairs which concern
their physical health, is absolutely unbounded, and without a horizon ; that
the vanity of the rudest and most untaught disciple is flattered at being al-
lowed to handle the instruments, instead of passively submittmg to the skil-
ful workman, while his conscience is quieted by the ease with which all res-
ponsibility for consequences is shifted to the shoulders of the distant paten-
tee ; that the vapor bath, with certain emetics and stimulants are empirical-
ly applicable to a greater number of cases by disease, than would have been
subjected to the trial of any one less reckless than themselves ; and that the
most fiery cordials and alex'ipharmics given to a patient in fever, will not ne-
cessarily kill him, however indefinitely they may injure his constitution.

1830.] Efficacy of Aconite in the cure of Rheumatism, 301

The following interesting extracts from Dr. SIgmond's Lec-
tures on Materia Medica and Therapeutics, are taken from the
American Journal of Medical Sciences, for November, 1838.

Efficacy of Aconite in the cure of Rheumatism. From ail that has been
wricien by a vast number of men of great practice, of watchful mind, and of
the most unquestionable integrity, aconite is one of the most important the-
rapeutic agents in certain states of rheumatism. I have had occasion to
tell you that, in the very early stage of acute rheumatism, when the patient
has just been seized, and where the muscular system only suffers, Dover's
powder is an invaluable agent, if blood-letting has not been tlie first remedy,
which it very often is, and that it may be considered a specific ; but when
the joints are tumefied, wiien they are painful, and the suffering is agravated
by the slightest touch when- the swelling is diffused and elastic, and the
skin is intensely hot, aconite is the most serviceable remedy with which we
are acquainted. Tt is sometimes extraordinary, when not only the sub-cuta-
neous and deejoly cellular tissue are affected, but even the cartilages of the
knee-joint, the periosteum, and the articulating capsules are evidently the
seat of rheumatic inflammation, how speedily pain is relieved, and health re-
stored, by the administration of this agent, which Dr. Lombard has reason to
consider acts specifically, and great praise is due to him for the revival of a
practice which had obtained, in former days, the sanction of the greatest
authorities of the continental schools. In gout its efficacy does not seem
less decided.

In all the various seats of rheumatic inflammation, whether the disease
have been of long or short duration, however great the agony which has
been expressed, however incapable the limbs have been of bearing the- slight-
est motion, aconite has been acknowledged to have proved of *he most de-
cided service ; the testimonies in its favor are so numerous, that I have felt
surprised that, in this country, it has not been a favorite ; a^d I can only at-
tribute it to the want of a good supply for the use of the practitioner, and
certainly, the carelessness with which the herbalist has treated this remedy,
has been sufliciont to prevent its more frequent employment. It was not
Stoerck alone who praised aconite ; we flnd not only the German physicians,
but the Swedish medical men, loud in extolling its merits, and they are ge-
nerally slow, but right, in the conclusions to which they come.'": Rosenstein
gave an interesting narrative of a young female who suffered almost mar-
tyrdom from rheumatism in the hip joint, for no less a period than eight
months, but who v/ithin two weeks from the trial of this remedy, was restor-
ed to health. Blom and Odhelius, in few words, express their satisfaction
on employing it at the liospital in Stockholm. Ribe has narrated an inter-
esting case of a female v.'ho, besides suffering the most intense agony, and
perfect incapability of moving her arms, had her muscles contracted and har-
dened, 0 tiiat they almost wore the appearance of ivory.

There are many foreign writers v.'ho have added testimonials in favor of
aconite, but the one, probably, that outweighs all others, is the benefit which
liappened to the veteran professor of Materia Medica, at Gottingen, Andreas
Murrav, who, in his invaluable " Apparatus Aledicaminum," says, '' Posse m
pi opus esset plura rheumatismi exempla curati etiam ex propria ex|)erien.
tia addere et nominatim, ischiadis nervosse cujus ante paucos annos tormenta
atrocissimi ipse sensi sed vesicatorio et Napello brevi discussa." When the
limbs have begun to be rigid, to loose all power of motion, and even where
the muscles have begun to waste away, and however apparently hopeless,
from the contractions'that have taken place, the case may seem, the number
and variety of successful cases give us reason to anticipate a successful re-
sult from this powerful remedy.

Notwithstanding all that has, at different periods, been urged as to the va-
F 6

S63 On Tonics. [March,

lue of aeon! turn in rheumatism, it would, probably, have been consigned to
oblivion, and colchicum would have remained the favorite remedy, had uot
Dr. Lombard, of Geneva, instituted his experiments, which deserve, at our
hands, the warmest eulogiums.

The failures that were so often experienced from the employment of the
common extract, eitherfrom the presence of too much vegetable matter di-
luting the active principle, or from some fault in the preparation, induced Dr.
Lombard to try an extract obtained from tb.e expressed juice of the plant,
subjected to slight boiling, in order to coagulate the vegetable albumen ; this
was evaporated in a sand bath, treated with alcohol filtered, and then again
evaporated at a moderate temperature. He obtained by these means an ex-
tract, upon whose efficacy he had, from repeated trials, every reason to de-
pend ; the volatile principles were not dissipated, as in the ordinary extracts,
and the active principles underwent no modification by the application of
heat. This alcoholic extract of monkshood. Dr. Lombard agrees with oth-
ers, possesses a specific virtue in dispelling rheumatic fluxions which have
been determined to the articulations ; he believes its power not to be confin-
ed to the immediate vicinity of the articulations, but to extend to the synovi-
al membranes, and to essentially contribute to excite the absorption of fluid
effused within them ; its action is speedily evinced, and patients have stated
to Dr. Lombard, that they have felt great alleviation of their sufftrings in the
course of an hour ; this, however, is not a general lav%' ; from twelve to 24
hours form the usual period of improvement. A certain degree of excite-
ment of the brain attended upon its administration, marked by a degree of
gaiety, great vivacity, and nocturnal visions ; in no one case did lie perceive
any disagreeable effects nrise, although he has administered as much as a
drachm and a half in twenty four hours. In only one case did it act as a su-
dorific ; he does not attempt to explain its mode of action, but contents him-
self with the 'dea, that it is a specific against rheumatic congestions. It acts
upon the excretions neither by altering their appearance nor their quality.
He found it not requisite to combine the aronitum with any other drug, and
therefore, prescribed it alone ; he began with one-fourth, or half, of a grain,
which he gave two or three times a day.

This power of producing absorption at the joints has, from an early period,
been attributed to aconite, and in gout it had met with the commendation of
Stoerck, but it was ascribed to its sudorific agency ; and its efiects upon the
transpiration by the skin, were promoted by confining the patient to bed. and
giving him large quantities of ptisan ; for this purpose, Rosenstein ordered an
infusion of the flowers of the elder; s-metimes perspiration was thus pro-
moted over the whole of the body, at other times it was confined to the af-
fected part. Gesner observed, that considerable tingling of the skin, pus-
tules full of fluid, and desquamation, followed. The same remark that Dr.
Lombard makes, as to the rapidity of its action in rheumatism, is made by
many of those who, at an earlier period ot its introduction, employed it.
Those who had suff*ered for years, and, indeed, were deemed incurable, are
stated to have been free from pain in an incredible short time, and to have
had the swelHngs of the joints completely dissipated. Lancet, August 5th,

On Tonics. I shall point out to your notice those substances, which pro-
duce gradual, yet permanent, changes upon the system, without attempting
to enter upon any consideration of the theory of their action ; for I believe it
is not yet sufficiently matured ; they seem, uniformly, to act primarily upon
the stomach, and hence to be conveyed to the various tissues and organs.
How they influence the living principle, I am not prepared to say ; but they
seem quickly to produce an increased action in the circulation, marked by a
firmer state of the pulse, which is occasionally rendered more frequent. The
muscular system, then, seems to derive fresh power ; the excretions bccocae

1S39.] On Tonics. S6i

more uniformly natural, and there is firmness given to the nervous system.
From their action upon the digestive organs, it would appear that the more
nearly tonic medicines approximate to the aliment which would he most ea-
sily digested, and be more decidedly nutricious, the greater the influence they
possess. They should never be of a nature to produce any inordinate ex-
citement, for the reaction, or exhaustion, that would follow upon the stimu-
lus, would be more hurtful than any beneficial influence they could exert. It
is a slow, steady, and uniform operation that is required ; and the greater
the delicacy of constitution for which you are called on to prescribe, the more
careful must you be in the quality, quantity, and mode of preparation, of your
tonic. The stage of the disease, the state of the functions, and even the
eason of the year, must be considered before you select your remedy. Iron,
cf such value in some cases, is productive of mischief if the pulse be full, if
any tendency to inflammatory action is present ; cinchona, or its alkali, qui-
nine, will prove a dangerous remedy if the vessels of the brain are more than
usually full, and particularly if venous retardation be present ; arsenic, to
which we look with such confidence in the intermittent fevers of the autumn,
and in periodic affections during the winter months, is inferior in value to
cinchona, or to carbonate of iron, in the spring of the year. As Fodere has
justly observed, arsenic is an autumnal medicine ; but it may prove deleteri-
ous in the spring. That the barks of trees should have more efficacy in the
autumn, when the changes have taken place in vegetable circulation and se-
cretion, is not, to us, a matter of much surprise ; but that these substances
should, in the spring, act upon the system in so marked a manner, is some-
what unaccountable ; but that such is the case has been very generally ob-
served. Some of these remedies enter into the circulation, and are capable
of being detected by their usual tests ; others, again, have not been discov-
ed. Iron is soon received into the blood; and may easily be recognised ; but
the Peruvian bark, though it has been continued for some length of time,
has not been found. Sometimes diminished susceptibility of the excretory
organs follows quickly upon the use of tonics. At others, again, there is
found an increased action, almost amounting to violent diarrhoea; and this is
oftentimes evi-dent upon the administration of cinchona, and seems to con-
traindicate its use ; but this more generally occurs where proper steps have
not been previously taken to remove, by gentle laxatives, any sordes that
may have accumulated during the disordered action in the alimentary canal;
and sometimes it is a salutary effort of nature, which, if checked, may after-
wards prove an abundant source of distress and harrassment to the patient,
and of difficulty and doubt to the practitioner.

One of the striking characteristics of this class of medicines is the power
that some of them possess of preventing the recurrence, at fixed intervals, of
particular states of the body; and from which circumstance they have ac-
quired the quaint, but expressive, n'^me of antiperiodics. Amongst the un-
explained phenomena attendant upon thr- morbid conditions of the living be-
ing, is that peculiar tendency to the return of certain marked symptoms, for
several days at the same hour in the day at which they at first developed
themselves ; thus, an anguish fever coming on daily, will almost always com-
mence its attack very early in the morning ; whilst the tertian, which recurs
at an interval of about forty-eight hours, for the most part, begins at noon ;
and the quartan, which exhibits itself after an interval of about seventy-two
hours, is generally present much later in the day.

Several of the affections of the nervous system have a strong tendency to
become periodic. The painful disorders called neuralgia, epilepsy, St. Vi-
tus' dance, or chorea, and lunacy, have their precise intermissions and their
paroxysms so evident, as to have engaged, at a very early period, the atten-
tion of medical observers ; but the causes that produce this singular habit of
the constitution have been very uselessly sought for. That in many of the
functions of the organs periodicity may be acquired, daily experience teach-

864 Suh' Carbonate of Iron in Cancer ^ <!^c. [March,

es us. There is no difficulty in so regulating the excretions, both of the in-
testines and of the bladder, that the action siiail only recur at expected mo-
ments ; but that the whole system should be called into morbid states, as in
intermittent fever, must remain a subject for inquiry and mvestigation. But
over this striking habit, the tonics, both metaUic and vegetable, exercise a
peculiar mfluence, restraining, if taken during the intervals, the worst symp-
toms of the paroxysms, and gradually preventing their recurrence. It is
probable that all the febrile diseases have their stated moments of aggrava-
tion ; and there are few of them that do not, towards evening, exhibit a de*
gree of exacerbation, during which tonics do mischief, even if, in the remis-
sion, they have been found serviceable ; the proper time, tjierefore, of em-
ploying them, is of greater consequence to us than the mquiry into the cau-
ses of the periodic return. Ibid. October 26th, 1837.

Suh- Carbonate of Iron in Cancer^ It is chiefly in ulcerated cancer that
the carbonate of iron is found serviceable, and cures of cancerous ulcers of
the face, hp, nose, uterus, and other parts of the body are detailed in several
of the periodical publications of the day ; but the claims of the carbonate, or
any preparation of iron, to the character of a specific, were after very fair
examination disallowed. That in various states of ulceration wearing a very
malignant and formidable aspect, this remedy is most advantageous, daily
practice fully confirms ; that in carcinomatous ulcerations the diseased parts
very frequently acquire an aspect infinitely more liealthy is also generally
allowed ; that we may very often, in the most unpromising cases of open
cancer, obtain respite from the progress of disease, is all that we can expect
from this remedy ; which deserves, therefore, our attention and our knowl-
edge of the cii-cumstances that have yet been made known with regard to
its exhibition. Ibid. November 4th, 1837.

Sub. Carbonate of Iron in Tic Douloureux. In the year 1820, Mr.
Hutchinson gave to the world the result of his observations on the cure of
tic douloureux, for which he had administered, with very great success, the
carbonate of iron. To the employment of this remedy he had been led from
a reflection upon the curative powers of arsenic, which, if this deleterious
agency w^as not such that it cannot be pushed beyond a certain quantity,
would be more frequently administered, and with every probability of uni-
form success. He was led to inquire whether some mineral, possessing
nearly the same action upon the system, without producing its noxious influ-
ence, might not be found in carbonate of iron ; and his expectations of good
results were increased by its utility in many diseases arising ircm debility
and a want of a proper action in the digestive organs. He enters, in the
work he published, upon the history of this agonizing malady, and discusses
the measures that had been fruitlessly taken for its cure. ' He then brings
before his readers six cases in which the iron had been found efficacious.
The preparation w'hich he has found serviceable, under different states of
the constitution, and various periods of its duration, is this medicine, in do-
ses of two scruples, or even a drachm, repeated two or three times a day j
and he adds, that used to this extent, it removes several other afTections over
which it had been supposed to exert no power. Since the period at which
Mr. Hutchinson gave his useful observations to the public, the carbonate of
iron has been very largely tried by the profession, and occasionally with the
happiest results.

You will read, in the Lancet for 1832, a letter from Dr. Hutchinson, phy-
sician to the General Hospital near Nottingham, which ho thought it neces-
sary to write in consequence of a clinical lecture delivered by Dr. EHiotson,
on the subject of neuralgia, in which he imagined the learned professor dis-
courages the employment of the medicine. In this letter he says "Ninety
eight unquestionable cases of tic douloureux, the fuJl reports of which I bav

1839.] Properties ofi^^'^^^ ^""' ^''^ ""f Calomel. 367

now before me, many occurring in the V'-^?" ""^ ^^^f^^ ^i'{^r<^ of irr^^-y.
selt, and olhcrs reported to us by medical jjracf'^p'^/^'^^^lrthe liigtrc.Crespec-
tability and attainments, ail of which were cured by the use oi the carbonate
of iron, most after the persevering employment of other remedies, distinctly
prove the fact that the disease is generally not only susceptible of alleviation,
but that it may usually be cured." Tlie cases to which he alludes are the
result of the successful application of this remedy.

Dr. Elliotson's observations are practical, and will, I think, be assented to
by all those who have tried the carbonate of iron. It is "one of the Lest re-
medies in this disease, but by no means a specific, and by no means so suc-
cessful, 1 think, as in some other nervous complaints." The case which
called for the observations of Dr. Elliotson, is one of peculiar interest. You
will find it in the Lancet, of December &ih, la32. lOid.

On the Therapeutic Properties of the Tinctura Ferri Sesquichloridi. This
medicine is found in our earliest pharmacopoeias under the name of tinctura
martis in spiritu salis marini, and was a great favorite amongst the physi-
cians of former days, and was ranked in the dispensatories " as preferable to
the calces and croci of iron, being both more certain and more sp^.edy in its
effects." As a tonic, where the digestive organs, have become impaired,
either from disordered function of the stomach, in assimilation, or from di-
minished power of excretion from the intestinal canal, it is much to be com-
mended. Where much debility,, arising from loss of appetite dependent
upon such causes occurs, a few droi.s of the liquid taken in a glass of soda
water for a few successive days, invigorates the system, raises the spirits,
and improves the general health in c very striking manner. In females the
effect of this preparation of iron is much more remarkable than in man, it
seems to be particularly adapted to them in many of those states in which a
deficiency of menstrual excretion, or irregularity of appearance occurs.
Whilst it promotes this function, it is also serviceable in restraining haemorr-
hage from the womb, although it has been supposed to be contraindicated,
from its possessing the power of acting as an emmenagogue ; whenever, in
such cases, it produces flushed cheek; dry lips, white tongue, and tendency
to cephalalgia, it must for a time be discontinued, and again had recourse to
after aperients, as castor oil and the neutral salts. Twelve or fifteen drops
taken daily, three times a day, largely diffused in water, will be quite suffi-
cient ; soda water, notwithstanding a decomposition occurs, is by far the
most agreeable mode of administering it, if given not more than once in
in the day. It is not generally to be prescribed in combination with the al-
kalies, nor with their carbonates, nor with the carbonate of lime, or of mag-
nesia, nor should it be added to any infusion of the vegetable tonics which
possess an astringent principle, as it renders it of a black color. It is decom-
posed by a solution ofgum arable. Mr. Cline first recommended it, in the
course of his lectures, in retention of urine arising from spasm at the neck of
the bladder, and since that time it has been very generally administered in
the dose often minims every ten minutes, until some relief is afforded, and
generally this is preceded by a slight nausea. In states of irritation of the
bladder during gonorrhoea, when the excretion of water is attended with
great pain and suffering, a similar dose,more particularly if a few drops of lau-
danum, or of tincture of hyoscyamus be premised, will be found most materi-
ally to allay the excitement.

It has not been detected in the urine after being thus taken, but, as is the
case with the other preparations of iron, it tinges the faeces black. In pain-
ful micturition it is best given in warm water, and a warm bath likewise fa-
cilitates its operation. ^In a case related by Dr. Collins, of Swan.'?ea, where
opium, conium, and the warm bath had failed to give relief, five minims
were given every six minutes ; after the third or fourth dose a cessation of
<the suffering occurred, and in less than half an hour water passed without

808 On the Effects of Blue Pill. [iVlarcIi,

intestines some power, as the gaseous exhalation materially differ when it
has been employed, and this is 'pririicularly strikintr in children, the odour of
the dejections being very materially influenced in them, and much more offen-
sive iaetor being the re&;ulr,and thip, in general, is a proof of the due action
of the medicine, for the system, previously disordered, appears thus to rid it-
self of a deleterious agent.

Where the chloride of mercury is too irritating alone, it may very proper-
ly be combined with other remedies, and there is a pill which has long been
iinowntothe profession under the name of Plummer's pill, which has been
found a useful medicine. Lancet, Decembep 2, 137.

On the effects of Blue Pill. The blue pill has been long much celebrated
and is one of the most popular remedies of the day in tiie dose of four or five
grains. Its high estimation, it chiefly owes to the work of the late Mr.
Abernethy, entitled '-Surgical observations on the Constitutional Treatment
of Local Diseases," and likewise to the practice he pursued, and the precepts
he inculcated amongst a large portion of the students of medicine, who are
now in the full zenith of their honourable career.

Mr. Abernethy 's mode of pursuing his mercurial course was cautious and
regular. He prescribed only small dosep,taking care that the error so often fal-
len into, of increasing the quantity, when any benefit was perceptible, should
be avoided. Nothing can be more injudicious than the augmentation of the
quantity of this medicine without sufiicient reason. In small doses the bih-
ary secretion is corrected, and the digestive organs are placed in a healthier
condition; larger quantities exert an influence on the whole constitution,
and alter the state of the nervous system ; thus controlling diseases depen-
dent on an irritable and disturbed state of the nervous function ; but, in still
larger quantities, it never fails to irritate and weaken the system, and thus
to derange the digestive organs. Five grains of blue pill, taken at nfght,
will not irritate the bowels, but, generally the mouth becomes affected, with
a very few night's repetition of the dose, but this often depends upon the bad-
ness of the blue pill, for a very small quantity of sulphuric acid, in the con-
serve of roses, will materially affect the preparation, and produce very bad
consequences. It happens that whilst the secretions I'rom the liver are ma-
terially improved, as the excretions testify, that dyspeptic symtoms super-
vene ; in such cases the blue pill is to be discontinued, and again had re-
course to at a future time. Calomel, in a very small quantity will often be
the source of high irritation, where blue pili is indicated, but, as I shall have
occasion to state to you, the powers of calomel, when properly administered,
are essentially necessary to be trusted to.

The functions of the skin are often impaired in consequence of a disor-
dered state of the digestive system, and these are restored to their wonted
state by this remedy ; the operations of the mind are enfeebled from similar
causes ; hence hypochondriasis, disorders of the absorbent glands, malignant
tumours, and ulcerated sores, are relieved and cured, when they are connec-
ted with such disorders of the digestive organs as are remedied by the the-
rapeutic agent which I have considered. Every system of practice is not
only likely to be too much extolled, but it is also liable to be followed with
too sanguine expectations, and to be pushed to a greater extent than the
original founder intended, and doubtless this has been the case with the blue
pill. It is capable (f producing much mischief; its abuse is as formidable a
cause of disease as its proper employment is certain of being a source of
health. It is not any one plan, or any one particular remedy, that can be
relied on, in all the complicated maladies of our nature, but there are uner-
ring principles which are to guide us in our practice; there are certain effects
produced upon the human economy by certain agents, and a knowledge of
the influence of each must teach us not to circumscribe our hst of remedies,
nor to place undue reliance upon any drug however powerful it may prove.

1839.] Injluence of Weather vn the action of Mercury^ 369

From want of such a reflection, the blue pill has been too often indiscrimin-
ately employed, and has become the source of mischief, as I shall have oc-
casion to state to you. Ibid. Nov. 11,

Influence of the Weather on the action of Mercury. It is always of very
considrable importance to pay attention to the state of the weather, both as
to the prevalence of disease, and as to the proper period at which remedies
are to be administered, * * * During fine clear weather the prepara-
tions of mercury seldom affect the bowels, nor do they produce that depres-
sion of spirits, which is 0 often observed to accompany their use during
damp moist weather. * * ^ During moist states of the weather mer-
curial preparations should be sparingly prescribed ^ and when, from the dis-
eased state of the system, they cannot be dispensed with, great attention is
to be paid to the clothing* To every one in damp, moist conditions of the
atmosphere, flannel is a great comfort, but silk is the most useful covering'
to the body. =f' * * Patients, therefore, during the mercurial influence
are much better wrapped in silk than even when confined to bed ; but this
latter precaution can more generally be taken, and hence the different pre-
parations are always best administered on the invalid retiring to bed, and he
should be kept there until the effects have been produced ; this- is more es-
pecially the rase with calomel-. As much mischief has arisen from the want
of proper precaution, as from large doses ; and the habit of the individual is
always to be duly weighed and considered. Females of a delicate, nervous,
irritable frame, are rendered languid, peevish, incapable of fulfilling their
usual duties ; they feel chilly, they easily shed tears, are sometimes almost
hysterical ; and though they have no actual suffering to endure, are almost
as miserable as if they had'it to encounter. On the other hand, the stout,
robust, plethoric individual, who probably has to bear very great pain, from
the nature of the disease, seems quite insensible to any unwonted effect;
it, however, more generally acts upon such a constitution with greater en-
ergy, and leaves behind it a more decided state of debility, if it be persever-
ed in for any length of time, or if it be often repeated. The inhabitants of
this country are very little influenced by it, comparatively speaking,
froni their being so much habituated to the changes of climate ; but the
foreigner is not so fortunate, nor can he bear a dose which in his native air,
he could take with impunity. Indeed, they have a horror of blue pill and of
calomel ; and I certainly have witnessed their greater incapability of bear-
ing it here than in their own climate. I have had opportunities of comparing
these points I have seen the practice on the Continent, and 1 held the sta-
tion of physician to the King's Theatre, under the administration of Mr.
Ebers, for three or four years, and I was uniformly struck with the singular
change that climate and habits of life produced upon the effects and opera-
tion of medicine. Those who could bear well full doses under ordmary cir-
cumstances, could not submit to much smaller ones here, nor could they bear
in any shape or form, the administration of mercury.

The annals of practice in India, likewise show that doses of mercurial pre-
parations are very much influenced by a dry climate. Some very highly in-
telligent men there have prescribed quantities, and their repetitions which,
in our moist and uncertain atmosphere, would very quickly injure the consti-
tution, and leave it in a state to be acted upon by every morbid exciting
cause that might present itself. Whether all this is to be attributed to elec-
tric states of individuals, or of the atmosphere, remains to be explained.
Some of the phenomena which are observed demand further inquiry ; nor do
I know that they have undergone much investigation. Ibid. Nov. 25.

a /

370 Treatment cf an important Injury of the Wrist, [Marcn,

Injuries of the Wrist.

The followinor observations of Dr. Barton are of much inter-
est, as they relate to a kind of case, of which h'ttle has been said;
l)tit which is af frequent occurrenee, and for which too little has
"been done. We have observed this most frequently in elderly
ladies, and resulting from falls by which the wrist is most easily
injured. Either the inactivity, or the greater delicacy, or both,
which is common with that portion of the community, may con-
tribute to the greater frequency of its occurrence with them. It
is not very uncommon to find both wrists of elderly ladies of in-
dustrious, active habits, afflicted in the manner alluded to ; and
he who contributes any thing to the relief af this injury, renders
a very important service to humanity.

Views and treatment of an i7nportani Injury of the Wrht. By J. Rhea
Barton, M. D. Any further observations on a class of accidents, so com-
mon, and which have been so often the subject of inquiry, as that of injii-
rfes of the forearm and wrist-joints, may be deemed superfluous by those
who read, but have no personal experience in surgery. But to those enga-
ged in the active pursuits of our profession, it is we]l known that, notwilh-
Btandin^ the volumes that have been written on this subject^ there yet are
certain injuries mvolving these parts which are not fully understood, and
consequently not successfully treated.

My attention was early fixed upon such cases, and through a series of
years they have been particulariy'intercsting to me ; and it is my firm con-
viction that, up to this time, error prevails, both as to the nature and the
treatment of them, that I am induced to pubhsh my views and practice therein.

I do not know any subject on which I have been more frequently consul-
ted than on deformities, rigid joints, inflexible finger, loss of the pronating
and supinating motions, and on neuralgic complaints resulting from injuries
of the wrist, and of the carpal extremity of the forearm one or more of
these evils having been left, not merely as a temporary inconvenience, but
as a permanent consequence.

The accidents which are to bo the principal subject of my remarks, usu-
ally pass either for sprains or dislocations of the wrist. Under one of these
denominations, are these cases to be detected, which, though partaking"
somewhat of the character of sprains or dislocations, are distinguishable
from either of them respectively. They may be recognized by their being
accompanied by more distortion of the hand and arm than any which can
arise from simple sprains of the ivrist, and yet less than that which must ne-
cessarily take place when there exists a complete luxation of the carpus.
The profile of the limb under this injury is a peculiar one, distinguishing it on
the one hand from the sprained wrist, and on the other from luxation.

A nice discriminatiouvbetween these and tlie other varieties of accidents,
is not a mere matter of ijseless refinement in diagnosis ; but it is one of great
practical importance, as is confirmed by the number of persons who have
never fully recovered from the efliects of accidents of this nature, treated
without such discrimination.

In simple sprains of the wrist, though accompanied by extreme swelling,
the limb will still be found to retain a characteristic outline of its natural
contour. It is not marked by any abrupt and solid eminences, the swelling
is rather uniform, diffuse and pufi^y, the hand continues on the same line
with that of the forearm, &c. In complete dit;locations, the nature of the
injury must always be very palpable from the great bulging of the over-

1S30.] Treatment of an imporlanl Ivjurij of the Wrist. 371

Japped bones, and from the shortening of the Ihnb, &c. Between these two
injuries there is too great a dissimilarity to admit of an excuse for the sur-
geon who mistaken the one for the other ; but lie may confound with these,
and it is a common fault to do so, a sub-luxation of the urWy consequent to a
fracture throi/gh the articular surface of the curpal extremity of the radius; al-
though to this accident belong appearances exclusively its own.

It is to this peculiar injury that I wish to draw attention.

It is one of the most common injuries to which the upper extremities ar
subjected ; and every practitioner of moderate experience will, I am sure, be
able to call to his recollection the appearance which the Hmb presents under
such circumstances, as well as the embarrassment which he has experien-
ced in his attempts to obviate eventual deformity, to preserve the functions
of the fingers, and to restore the motions of the wrist and forearm.

The similarity of manner in which this accident generally occurs, is strik-
ing. It is almost always found to have taken place in consequence of the
individual having thrown out his hand to rescue himself from falhng, or to
ward off injuries threatening a more important part of the body. In the act
of falhng, for example, the hand is thus instinctively thrown out, and the
force of the fall is first met by the palm of the hand, which is violently bent
backward until the bones of the wrist are driven against the dorsal edge of
the articulating surface of the radius, which, being unable to resisti it gives
way. A fragment is thus broken off from the margin of the articular sur-
face of this bone, and is carried up, before the carpal bones, and rested upon
the dcrsal side of the radius ; they having been forced from their position, ei-
ther by the violence, or by the contraction of the muscles alone. We have
then an imperfect luxation of the wrist, depending on a fracture through the
extremity of the radius. The deformity will be found to correspond with
this state of the case. There is a tumor on the dorsal side of the arm form-
ed by the bulging of the carpal bones and fragments ; whilst below it, on the
palmer side, the extremity of 'the radius projects. The degree of promin-
ence of these parts, depends upon the size of the fragment and the violence
of the injuring force. The ulna not being very intimately involved in the in-
jury, retains its position, and serves as an abutment, against which the hand
seems to rest ; v.'hilst the radius, as it has its edge broken off, allows the
hand on that side to be drawn upward, and hence to render, on the under
side, the styloid process of the ulna more conspicuous than natural. Crepi-
tus cannot always be felt, sometimes in consequence of the smallness or
crushed condition of the fragment; at other times, owing to the great swell-
ing and tension ; but in every such case, the distortions of the limb are to
be seen, and may be removed by making firm extension and counter- exten-
sion from the hand and elbow, at the same time gently depressing the tu-
mors already spoken of. By the employment of these means, all deformity,
except that which evidently depends upon the more general swelling, may
be satisfactorily removed ; but the moment the extension and counter-exten-
sion are relaxed, the combined action of the flexors and extensors of the fin-
gers, as well as those of the wrist, force the deformity to re-appear as conspi-
cuously as before : and as often as the effort is renewed and discontinued,
will the deformity appear and disappear. In this respect does this species
of injury in an especial manner differ from a complete simple luxation of the
wrist ; which, when once reduced, must continue so after the reducing
force has been withdrawn. There is no spontaneous reluxation after the
simple complete dislocation has been removed ; whereas, in this case it im-
mediately succeeds the withdrawal of the force. This accident must not
be confounded with those which are also of frequent occurrence, namely,
fracture of the radius, or of the radius and ulna just above, and not involving
the joint. It will be tound on referring to the writings of Boyer, Desault,
Sir Astley Cooper, Dupuytren, and many others, that this frequently hap-
pens, and that the fracture often reaches to within a few lines of the extrem-

372 Treatment of an important In jui-y of the Wrist. [March,

ity of the bone ; and that these cases are very frequently mistaken for dislo-
cations, though they are in reahty fractures exterior to and disconnected
with the joini ; the deceptive deformity being occasioned by the displace-
ment of the broken ends of the bone caused by the action of the muscles and
the weight of the hand. A very good illustration of such cases may be
found in plate 12, figure 1, in Mr. Hind's folio work on fractures of the ex-
iremities. It may there be seen how powerfully the flexors and extensors
act in retracting the inferior portions of the bones, and how closely the radi-
us and ulna are drawn together through the instrumentality of the pronator
quadratus muscle below, whilst towards the brachius the pronator teres is
exerting its power to keep the limb in a state of pronation. Now these are
consequences which do not result from the species of injury to whieh 1 re-
fer. The fragment may be and usually is, quite small, and is broken from
the end of the radius on the dorsal side, and through the cartilaginous face
of it, and necessarily into the jomt. The pronator quadratus is not involved
in the fracture. The radius and ulna are not materially disturbed in their
relations to each other. The only important change, which takes place in
consequence of this fracture is, that the concave surface at the extremity of
the radius, which receives and articulates with the three first carpal bones,
is converted, as it were, into an oblique surface by the loss of a portion of its
marginal ridge ; commonly by the separation of an entire piece ; sometimes
by the crushing of its substance. The moment the cartilaginous extremity
of the radius is deprived of its concave form, the united force of the carpal
and digital flexors and extensors is exerted to create a complete luxation ;
but as the ligaments are only stretched, or but partially torn, this cannot
take place. The carpal bones, therefore, only emerge collectively from their
natural position, and carrying before them the broken piece,, rest on the dor-
sal side of the radius, forming a tumor there ; whilst the end of the radius
itself occasions on the palmer side a prominence which is round and smooth,
and difTering in this from similar projections formed by the fractured ends of
bones, the abruptness and harshness of which may sometimes be distinctly
felt through the soft parts, and which are themselves, when pressed upon,
.acutely painful.

It follows, in injuries of this kind, that unless some method of dressing
be adopted whereby the retraction of the liand may be permanently countei-
acted, and prominences repressed, the patient will recover with a crooked
arm, and under a sacrifice of some of the functions of the hand. The custo-
mary modes of treating either sprains or dislocations of the wrist, or fracture
of the foream, are totally inadequate to the purpose, and should not be relied
on as a treatmentfor these particular cases by any practitioner who hcs re-
gard for the welfare of his patient, and for his own reputation. There is no
professional point upon which I can more confidently express myself, than
.upon the errors committed in the treatment of these cases,- -passing, as they
commonly do, for sprains of the wrist and hence treated as such. After an
unvarying success in the management of this accident for many years in the
Pennsylvania Hospital, m the Blockley Hospital, and in private practice, I
can strongly recommend the following plan of treatment: Two thin, but firm
splints of wood, are to be prepared, of sufficient length to extend from just be-
low the condyles of the os humeri to the ends of the fingers, and of
.width enough to embrace the sides of the hmb. These are to be lined
on one of the sides w;ith carded cotton, or something equally soft, and wrap-
ped with a bandage. Two compresses, each about two inches square, and
composed of strips of bandage, about one yard and a half long, evenly folded
up, are also to be in readiness. The arm is then to be flexed at the elbow, and
one assistant is to hold it firiply above the condyles, whilst another makes
, extension from the fingers. The surgeon now presses the prominent end of
the radius on the inner side, and the bulging carpus and fragment on the out-
,^r side, into tjieir respective places. The.roller is then to be lightly pressed

1839.] Treatment of an imp or ta at Injury of Uie Wrist. 37J

around the hand and arm, securing in its course up the limb one of the com-
presses precisely over the carpus and back of the hand the other with equal
precision over the palmar side of the radius just above its carpal extremity.
These compresses, when properly arranged, will be found not opposite to each
other, hut ttie inner one commencing on a line opposite to that on which the
outer one has terminated. These being applied, the inner splint is next placed
against the limb, the assistant shifting his hand to admit of this being done
without his relaxing in the least degree the extension until the limb is band-
aged to this splint, when it will be found that the extension is well
maintained. The outer spHnt is now to be applied and secured to
the arm by the return of the roller. The prmcipal use of the latter
splint is to act upon the outer compress, and by its general presBure to
weaken for the time the force of the resisting muscles. By the employment
of these simple means, the indications in the treatment of this accident
will be found to be fully met. The arm may be carried in a sling, and the
patient permitted to walk about, &.c. In three or four days the limb should
be undressed and inspected ; and whilst held so that relaxation cannot take
place, the wrist and fingers are to be bent enough to preserve the fllexibili-
ty of the joints. The dressings are then to be re-applied. These operations
are thenceforward, for four or five weeks, to be repeated every day, adding
to them the motions of pronation and supination.

The practice of keeping, a limb in splints, with the joints in an immovea-
ble state for weeks, even when the fracture is remote from the articulation,
cannot be too earnestly ; deprecated; and in cases where the injury to be
repaired has involved a joint, such treatment is censurable to a high degree,
as it is almost certain to destroy the mobility of it by promoting the ad-
hesion of ligaments, the union of tendons with their thecae, and by oblitera-
ting burssB evds never to be fully repaired.

So prevalent is the error on this point, and so serious are the results
of such practice, that I have settled my mind to the belief, that in very
many cases of fractures the imperfect recovery of the patient is owing to
the injudicious use of splints and bandages, rather than to the complication
or original difficulty of the case. For the interruption of adhesions of
the ligaments, for insuring a continuance of the muscular power and offices
of the tendons, and for the entire preservation of the motions of joins, it is
indispensably necessary that these parts should be put into action frequently
during the treatment of a fracture, in which they are interested, either from
the adjacency ot the fracture, or from their confinement by the splints neces-
sarily used on the occasion. The movement of those parts by the surgeon
at stated periods, is not at all incompatible with the quietude and the pro-
gressive re-union of the bone itself. Tiie omission of this duty arises, 1 am
persuaded, out of our knowledge of the necessity of securing rest to a broken
bone, without at the same time considering that by the means we employ,
and the course we pursue to accomplish it, we may entail upon our patient a
calamity quite as deplorable as that of an ununited fracture or a crooked bone
namely, a stiff and useless limb. The surgeon, then, is to recollect, that
in the cases made herein the special subject of notice, he has not only the
duty to perform of obviating deformity of the limb, but of preserving the free
motions of all the other parts, and that this can be accomplished only by daily
trials of their freedom and functions.

By an adherence to the plan of treatment just recommended, and by an at-
tentive pursuance of the means spoken of to preserve the functions of the
limb, I have uniformly succeeded in restoring perfectly the arm to its natu-
ral shape and offices. I can, consequently, on just grounds, advise others to
adopt the same practice.

It sometimes happens, also, though rarely, that fracture of a similiar
character to the one just described, occurs on the palmer side of the radius,
from the application of force against the back of the hand whilst it is bent

374 Medical Society of Augusta. [March,

forward to its ultimate degree. This usually happens in awkward attempts
to parry tlie blow of a fist, from pressure in dense crowds, and from falling
on the back of the hand whilst it is bent forward. Whenever the fracture
takes place in front, the end of the radms projects over the wrist on the dor-
sal side, and the carpal bones and fragment rise out of their proper situa-
tions, and form the tumour on tiio palmar side, thus reversmg the deformity
of the arm. The principle in the treatment of this variety of the injury, is
the same as in the foregoing.

Dupuytren used to trace an analogy between the ordinary fracture of the
lower end of the radius, and fracture of th.e lower end of the fibula; and as he
had founded a very successful method of treating the latter injury from the
view he took of such cases, he extended his analogy to the treatment of the
former by means and apparatus designed to accomplish the same ends. How
tar the practice may be successful when applied to the cases for which the
practice was specially intended, I cannot say. Having myself found simpler
means attended with success, I never adopted his practice; but for the treat-
ment of fracture through the joint,&c, the practice would be unavailing. Nei-
ther is there any resemblance of this injury to the fracture of the fibula. It
may be, however, not inaptly compared to the partial luxation of the foot,
depending on fracture of the internal malleolar process of the tibia, includ-
ing a portion of the articular face of the bone an accident well known to
surgeons. Medical Examiner^

Taut III. MOxNTHLY PERISCOPE.

Medical Society of Augusta Session, lOth February, 1S39,

Question for discussion,

*' Are there any signs or symptoms by which worms can be
inferred certainly to exist in the alimentary canal ; and if there
be, what are they ?" -

Dr. P. F. Eve was the essayist, and read the essay on that
subject, which is found in part first of the present number.

Tlie discussion then ensued, in substance, as follows :

Dr. Dugas said he proposed the question now before the So-
ciety, because almost every case of infantile disease is referred
to worms, to which prejudice, he conceived, a large number of
deaths were attributable mothers being led thereby to trust to
their treatment for worms or for teething, according to age, &c.
In consequence, the gums are cut, and the little sufferer is dosed
liberally with spirits of turpentine, and other vermifuges. He
had, therefore, called the Society's attention to the subject, with
the hope of putting down the prejudice. He considered the
case recorded by Dr. E. A. Eve, and read by the essayist, as
highly interesting, but its value was necessarily much curtailed by
the want of further pathological anatomy. Dr. D. concluded by

1S39.] Medical Society of Augusta. 375

observing, that the essay was so full and complete a description
of the subject, that there was no room for further remark.

Dr. Bowen said he was with Dr. Dui^as. He approved of the
essay, as well supporting the truth. There may, he said, be ir-
ritation, with, or without worms ; and no man can distinguish
from which source the irritation arises. He gave a case in
point it was of a man laboring under symptoms of dyspepsia.
Dr. B. then gave the following case A negro girl, six years old,
was treated by a respectable physician o^ Columbia County,
with fifteen drops of wormseed oil, three times a day, followed
by large doses of calomel. The attending physician being one
day absent, Dr. B. was called, and found tympany to great ex-
tent. He gave castor oil, which operated copiously, and reduc-
ed somewhat the distension ; but no worms passed, and death
ensued ; after which, upwards of sixty were found in the ali-
nnentary canal, and three had passed into the abdominal cavity.
No spasms occurred in this case.

Dr. Robertson rose, he said, merely to concur in the general
sentiment, that there was no certain diagnostic, more than that
of their actual passage. He was not only certain that there is
no sure diagnostic, but that, if there were, there is no certain
treatment in the event of a good diagnosis. He, therefore,
treats the symptoms which occur in these cases on general
principles, and with general success. Afterwards, sometimes,
a few worms pass. He has observed large numbers come away
without either previous symptoms of their presence, or treat-
ment ; whilst it is often the case that, with the strongest symp-
toms, none can be obtained. He thinks they depend on an un-
healthy state of the digestive apparatus, and consequently, the
best treatment is to restore the general health ; which plan, he
thinks, will succeed nine times out of ten. He stated a case
wherein he used syrup of Stillingia Sylvatica for Porrigo Scut-
ellaria ; and a large number of lumbricales were produced. Dr.
R. then referred to the case given by Dr. Bowen, in which three
worms- were found in the peritoneal cavity. He considered,
that in this case, disease had run its course, and the worms had
gone through the openings formed by other disease.

Dr. Dugas differed from Dr. Robertson, in thinking that worms
arS to be traced to a morbid condition of the canal, or of the di-
gestion ; and thinks that opinion conflicts with facts ; because
large numbers of persons presenting no symptoms of disease, pass
great quantities of worm.s ; whilst others, habitually diseased,
never pass them. Again, he said, worms are most commonly
generated at a certain early age, and not usually in adults ; and
with them, not under appearance of disease, but under the best
aspects of health and good digestion, and vice versa. He con-
cluded, therefore, that thev are not the result of disease.

370 Medical Society of Augusta. [March,

Dr. Bovven accorded with Dr. D., for worms are as common-
ly met with in healthy, as in unhealthy rco^ions children in the
most healthy places, passing large quantities, without sickness.
He considered them the cause instead of the consequence of in-
testinal irritation.

Dr. Robertson declined the explicit belief that worms origin-
ate from disease, but merely gave the opinion of some authors on
this subject. But he was not disposed to retract any thing he
had said, and referred to the investigations of some writers
which served to prove the fact that they originate from disease
of the intestines or the collateral viscera; and urged the point
that functions and secretions may become disordered, as
well as other effects from secretions thus disordered ; and on
this ground the opinion of those writers cannot be condemned.
He denied that the majority of cases are in children, in propor-
tion to their I'elative number ; but if it be the case, it is because
adults enjoy a greater immunity from disease. Some seasons,
he remarked, worms are more common, and many children are
often complaining, but are not noticed. He then referred to Dr.
E. A. Eve's case, in which the woman ate dirt ; and to the great-
er frequency of worms in cases of dirt eaters.

(Quere Is this, effect, or cause ?)

Dr. E. LeRoy Antony believed that there is no certain diai^-
nostic ; but looks on the cases as intestinal irritation, and
considered worms as a very common cause of that irritation,
especially in children. He did not believe they arose from irri-
tation or disordered secretions, but that they were more proba-
bly the products of a kind of fermentative process, because this
is known to produce verminous insects of different kinds out of
the body. He thought proper to refer to Dr. Bo wen's observa-
tion, of spasms produced by Spigelia. He could not conceive
how Spigelia produced spasms in the case, with dilated pupils.

Dr. Bowen tated that children were often treated for the in-
testinal symptoms and recovered, and passed the worms some-
time after.

Dr. P. F. Eve thought that worms were introduced by ani-
malculae or ova and then multiplied rapidly. When generated,
they produce irritation in the alimentary canal. Disease is,
therefore, p^ec^, and not cause. He was of opinion, that Dr. E.
A. Eve's case died from peritonitis.

Dr. Dugas declared his firm belief, that animals do not gener-
ate spontaneously ; but that they are produced by eggs, as in
botts, which in spring, and in summer and autumn are passed off
in chrysalis form. He therefore concluded, that at certain times,
children carry into the alimentary canal, ova or animalculac,
which multiply hence their greater frequency in some seasons.

IS39.] Medical Soclehj of Augusta, 377

Dr. E. LeRoy Antony did not believe that peritonitis is al-
ways the cause of death in these cases ; because this (peritoni-
tis) must have a certain time more than is often allowed in tho
case, lie considered that death in these cases is often, perhaps
generally owing to injuries suffered by the nervous tissue
hence the opisthotonos in Dr. E. A. Eve's case. He thought the
botts had been well accounted for, but inquired how gentlemen
would account for worms in the middle of a nut, as a chesnut
for example?

Dr. Dugas replied that the punctures were made when the
nut was in Its early stage, but growth obliterated the aperture.

Dr. M. Antony's opinion accorded with that of the gentleman
who had gone before him, that there was no absolute diagnostic
of worms in the first passages, generally available for practical
purposes, which, he apprehended, was the object of the enquiry
before the Society, lie differed, however, wiih some senti-
ments which had been offered in the course of the evening
particularly that of worms being the effect instead of the cause of
disease, and of their inocuou& tendencies in the intestinal canal ;
for although he had oftQu found them remain inocuous for a
length of time, and notwithstanding the difficulty, and often the
impossibility of distinguishing the symptoms from those of other
mechanical and chemical irritants, still he considered them so
frequently the cause of intestinal, vascular, or nervous irritation,
and so suddenly destructive was their tendencies in other cases,
that he conceived that good was done by the empirical practice
used by the common people, of treating all suspected cases for
worms ; and he knew no better plan for the use of those who had
no medical judgment. He knew them to be so ample a cause
of some of the most dangerous diseases, that he thought it the
less of the two evils, to treat suspected cases for worms, at the
risk of its inefficacy, rather than delay for the development
of other causes. At any rate, he considered it far more
prudent to treat cases, the symptoms of which render it
probable that they arc worm cases, with vermifuges, than
to omit their use ; not only on account of the real proba-
bility of worms in such cases, but likewise on account of
the often immediate dangers of neglecting those offending causes,
as he knows them to be. The idea of their being effects of dis-
ease, is calculated to, and often does, lead to a passive course of
treatment relative to them ; but he considered it limited reason-
ing on the case to allow that idea, this influence, even were it
correct : for, whether effects or causes of some morbid phenome-
na, they arc not the less calculated to be causes of others, and of
some which are so severe and rapid in their course, as to pre-
clude the hope of remedy. Such, particularly, were those cases
where perpetual convulsions w<?rG produced, which often ter-
II 8

878 Medical Society of Augusta. [March,

minate only in deaths [Such, also, were those cases of violent con-
vulsions which terminate in a profound apoplexy, followed by
death ; and which are not unfrequent with children of such con-
formation and habit as to favor apoplexy. It would, he consid-
ered, be easily seen, that, under such circumstances, besides the
doubt of their sufficiency for correcting these conditions, the very
administration of most remedial means is precluded. Such, also,
were those cases in which mechanical injuries of the intestines
are effected by worms, and such injuries thus arising are now
beyond controversy ; pathological anatomy establishes abun-
(dantly this fact. He would give a case: A girl, sixteen years
old, was left by a travelHng party under his care. She had
been sick for many days, but no accurate history of her case
could be obtained. He found her very torpid and lethargic
comatose, pulse small and quick, and not very much increased
in frequency skin dry, with diarrhoea, and very considerable
emaciation tongue clean and red abdomen tympanitic. He
administered vermifuges only, by which, during the first day,
two large lumbricales were evacuated. Next day the girl died.
On examination of the abdominal viscera, no mark of disease was
observable, except two perforations through the whole of the
coats of the intestines, about the size of, and much resembling,
buck-shot holes. Much engorgement was found about the
wounds, and extended from each, six or eight inches, up and
down the intestinal tube, affording a grumous and bloody aspect,
beyond which, it vanished into a moderately increased vascula*
rity of the canal, diminishing in degree in proportion to the dis-
tance from the wounds. Here it would be preposterous to con-
clude, as had been supposed, and may, for aught we know, have
been the case with Dr. E. A. Eve's case, that other primary
disease had run its course and caused ulcerations. These open-
ings were not of the character of ulcerations produced in the
progress of typhoid fevers, but were evidently recent wounds, as
proved by their appearance in every respect. There were also,
but two, corresponding with the number of worms ; for none
"were found in the canal on dissection ; nor was there any other
wound, and the ecchymosis or engorgement evidently extended
from these wounds as primary foci of irritation, just as it would
have done from any other mechanical injury which might not
have sooner produced death. He had observed similar effects
in kind, in a number of other cases, and had often observed them
in the intestines of swine. When such results of the action of
worms occur, it is obvious that all remedial means will prove
fruitless ; and even from slighter wounds from this cause, in
which only the villous lining is wounded, recovery is often ex-
tremely tedious, and the patient seems to become dwarfed by
the permanent impairment of the functions of digestion and nutri-
tion, for many years, and even for life. Under these views then.

1S89.] Medical Society of Augusta. 879

he considered that, in the want of unequivocal evidence of the
presence of worms, the symptoms which render them probable
should be treated with the best vermifuges ; not omitting, how-
ever, regimen and other treatment demanded by the other cha-
racters of the case. He further remarked, that we have no certain
vermifuge power ; and consequently, cases were often considered
as not occasioned by worms, because these were not brought
away by our best vermifuges. He had found cases which re-
sisted all vermifuges, repeatedly and freely administered, at va-
rious times ^even one in which epileptic fits had first occurred
monthly, and which had continued, under the use of vermifuges,
and all other plans of anti-epileptic treatment, until the fits had
come to recur eleven or twelve times a day, and in which worms
were never obtained until a galvanic current was established
through the system : on which, nine of the largest iumbricales he
had ever seen, were at once brought away by the use of Spige-
ha the fits ceasing immediately on establishing the galvanic
current. He considered, therefore, that practitioners too often
overlooked worms as a cause of disease.

Here the regular discussion of the evening closed. #

Dr. Dugas then read the following interesting case.

Premature pariurition The infant weighing hut seventeen
ounces lived twenty-four hours. Phillis, a young negro wo-
man, had a severe attack of remittent fever, during which, she
was repeatedly threatened with abortion, having violent uterine
contractions, which were usually quieted by opiates. She was
discharged well on the 18th September, and continued so until
the 2nd October, when, about an hour before day, she was taken
with nausea, vomiting, and violent labor pains, soon followed by
a discharge per vaginum. I gave her an opiate, but in an hour
after, she was safely delivered of a girl weighing seventeen oun-
ces, and which lived four and twenty hours ! The little infant
opened her eyes, cried, sucked a " sugar teat," would gape, and
indeed seemed disposed to live on. She, however, gradually
became less vivacious, and finally died.

When called to see the mother, I found the fundus of the
uterus nearly or about as high as the umbilicus, which had led
me to estimate the pregnancy as one of six months ; but, from
the calculations of the mother and grandmother, as well as from
the child's development, it could not have exceeded five and a
half months.

The Society then adjourned.

3S0 Voluntary Power of the Iris. [March,

Voluntary Power of the Iris.

The following very curious and interesting case, manifesting
the extension of volition to the Iris, is extracted from a letter
from our excellent and talented friend Dr. Henry Hull, dated
Athens, January 23d, 18 39

" Mr. H. a highly respectable and worthy gentleman of S

possesses the very unusual, if not unprecedented power, o^ con-
tracting and dilating the pupils of the eyes at will, m a strong
light. Although it may not be so to others, this is to me, new ;
as I have ever regarded the contraction of the Iris as purely sym-
pathetic, resulting from irritation of the retina ; and its dilata-
tion, as the result of the absence of this irritation. In this case,
the power to dilate, as well as contract, was indubitably volun-
tary : this I witnessed. Hov/ do you account for it V*

The idea of the voluntary control of -the Iris, especially under
the presence of its appropriate stimulus, light, we admit is a no-
vel one. There are many instances in v.hich some persons have
a free voluntary control over certain muscles which others have
not ; such instances are common with regard to the platysma
myoides, the attollens aurem, the occipito-frontalis, &c. And
we have believed that much of the difference in the physical
powers of individuals their peculiar activity in the perform-
ance of movements which, to others, are impossible, was attri-
butable to an original or acquired command of some muscles
not at all subject to the will in others, or an unusual increase of
the powers of volition over those ordinarily subject, in a limited
degree, to the control of the will. The management of the
voice, as in singing, ventrllloquism, &c. faculties so peculiar to
some, may perhaps, be accounted for on this ground. The lan-
guage of the face, so to speak its great difference of expression
in different individuals, as being fixed as in death, in some cases,
whilst in others, it moves and speaks in every part, may be ac-
counted for in like manner. But the peculiar structure of the
Iris, the purpose designed to be effected by it, which is- chiefly
the regulation of the admission of light to the retina, &c. are
such that we are barely able to consider it in the l!f!:ht of a mus-
cle ; and when considered so, vre have, with Dr. Hull, consider-
ed it as necessarily sympathising with the retina, and conse-
quently, supplied with nerves from those which are peculiarly
subject to excitation by light. We sliould be pleased to see the
opinions of physiologists on this subject.

1839.] Hohert 11. Copelandthe Snake Man, S81

Jiohert IL Copeland.

We have recently received from Dr. Bean, the following mi-
nute description of this curious example of nionstrosity. We
have delayed noticing it for s )me time, in the hope of seeing for
ourselves, this singular phenomenon ; but he has not, according
to appointment, visited Augusta; and as the persons whose
names are attached to the following statement, afford assurance
of its truth in every particular, so far as ample inspection could
enable them to describe, we feel unwilling to detain it longer
from the medical public. We consider it confirmatory of the
y)roposition which we recently advocated in this Journal, on the
subject of maternal influence.

A Physiological Phenomenon^ or the Snake man ; Roleri H. Copeland.
This most singular being, perhaps, has not a parallel in medical history.
He is now about 29 years old of ordinary stature and intellect. His defor-
mities and physical peculiarities are owing to a fright his mother received
from a large Rattle-Snake attempting to bite her, about the sixth month of
her pregnancy. For sev,eral minutes after the snake struck at her she be-
Jieved herself bitten just above the ankle ; and so powerfully was lier mind
affected, that, when she was delivered, the child's will was found to have no
control over his right arm andrightleg; which are smaller than his left extre-
mities. He can use his right leg now, sufhciently to walk in a hobbling
manner, but cannot retain it stationary, without the aid of the weight of his
body. His right hand has the usual number of fingers, but they are smal-
ler than those of his left hand. The wrist joint is looser than usual, and his
hand stands at an angle with his arm. His front teeth are somewhat point-
ed, and incline backward, like the fangs of a snake. The right side of his
iace is sensibly afTected ; his mouth is drawn considerably farther on the
left side ; his right eye squints, has several deep grooves radiated from it,
and has a very singular appearance, much resembling a snake. But perhaps
the most extraordinr.ry circumstance on record, is, that his right arm, when
not restrained will draw the lower part to about a right angle with the up-
per and sometimes two or three, but most commonly, only the fore finger
will project, curved at the first joint, much resembling a snake's head and
neck, when in the attitude of striking ; and the whole arm will strike at
an object with all the venom of a snake, and precisely in the same
manner, for two or three, and some times for four or five strokes,
and then the arm assumes a vibratory motion, will coil up and ap-
ply itself close against his body. During this period, his right foot and leg
become excited, and if not restrained, will strike also. His face is also exci-
ted ; the angle of his mouth is drawn backward, and his eye snaps more or
less, in unisoii vrith the strokes of his hand, whilst his lips are always separ-
ated, exposing his teeth, which, being somewhat pointed like the fanks of a
snake, causes his whole visage to assume a peculiar and snaky aspect.
During infancy and childhood, the Vv-hole shape of the snake, even to its fangs,
was printed on the anterior of his leg ; but as he grew up, it became gradu.
ally obliterated, tih now there is only a small depression where the snake's
head was imprinted. The sight of a snake fills him wnth horror, and an in-
stinctive feeling of revenge ; and he is more excitable during the season of
snakes ; and even conversation concerning them excites him, and his arm
appears more anxious to strike than when no such conversation is going on.

All the above phenomena are perfectly independent of his will, as hun-
dreds can testify who were acqaintod Vvith him long before he had any idea

3S2 New Treatment for Pterygium. [March

of exhibiting himself publicly. This singular beintr was born in Carolina,
and moved to Georgia in the year 1S29 ; where he has since remained, per-
forming such labor as he could with one hand, and by unremitting exertions
has maintamied his wife and an increasing family. Plis physical peculiari-
ties being considered only in the light of a common deformity, lie never
thought of exhibiting himself publicly, till it was suggested to him by a me-
dical friend in 1837.

We the undersigned, Physicians and others, after carefully examining
Mr. Robert H. Copeland, do certify, that the above description of him is
substantially true.

JACOB STOKES. M. D.

ADDISON BEAxN, M. D.

F. E. MANSON, M. D.

A. V. MANN, M. D.

SAMUEL G. ELLIOTT, M. D.

Of McDonougli, Henry county.

Hon. WM. SEGAR, M. D. of Henry co.

J AS. LOVE, Sheriff of Henry county.

JACOB MARTIN, Attorney at Law, Zcbulon, Pike county.

New Treatmxnt for Pterygium. Dr. Brand, of Jonzac, (Charente Infe-
rieure,) has successfully treated a case of pterygium, in which this morbid
growth extended a hne and a half on the cornea, by passing over its surface
from its apex to its base, a pencil of solid nitrate of silver. After this appli-
cation the eye was immediately bathed in cold water and then a compress wet
with this liquid placed upon the organ. Li three days the slight inflammation
caused by the cauterisation disappeared ; the caustic was then again ap.
plied, and the cauterisation repeated every three or four days ; the ptery-
gium under this treatment gradually diminished ; the cornea recovered its
transparency without the slightest cicatrix, and in a month the affection was
entirely removed. Journal de Medicint et de Chirurgie Pracliques^ Oct. 1837.

Impropriefij of operating for Fistula of the Anus in phthisical subjects.
Last year a tuberculous patient, affected with fistula of the anus was admit-
ted into M. Lisfranc's wards. Two years previously, this patient had been
operated on for fistula by a surgeon of Paris, but this disease returned. M.
Lisfranc refused to repeat the operation, saying that the patient was most for-
tunate in his complaints returning, for his death from phthisis would in all
probability have succeeded his cure. This surgeon added that he had often
seen natural emunctories prolong the hfe of phthisical patients for a greater
length of time than those established by art. Jowrn. d^ Qonnaiss. Med. Chi'
rurg., August, 1837.

1839.] Medical Intelligence. 383

MEDICAL INTELLIGENCE.

We have just received the prospectuses of two new publications, which,
from the references to their contents, we should expect to meet with exten.
sive patronage. The first is a translation from the third edition of a trea-
tise on the Diseases of Infants, by C. M. Billard, Docteur en Medecine de la
Faculte de Paris, &,c. &c.

A good work on this subject, founded on long and minute observation, we
consider still a desideratum, notwithstanding several late publications of in-
terest by some of our most talented practitioners. It appears that Dr. Bil-
lard founded his treatise on recent Clinical observations and investigations in
Pathological Anatomy, made at the Foundling Hospital at Paris, under the
superintendance of M. Baron. It is translated from the French, by James
Stewart, M. D. late Physician to the New York Orphan Asylum, and one of
the Consulting Physicians of the ]>sorthern Dispensary of the City of
New York. The situation of the author in the Hospice des Enfans
Trouves, enabled him to examine the condition of many thousands, and to
extend his anatomical researches to many hundreds of children m the course
of a year opportunities abundantly calculated to give to the work the deep-
est interest. The author professes to exhibit the peculiar character of the
symptoms of infantile diseases, and to consider them in relation to the alte-
rations which the organs have undergone to have passed each apparatus
under review, and to have studied the varieties of form and appearance of
each, with reference to their healthy and their pathological conditions ; and
to have drawn no conclusions until the symptoms and the nature of the le-
sions have been duly considered.

The translation has been submitted to the inspection, and received the un-
qualified approbation of, Isaac Hays, M. D., Editor of the American Journal
of the Medical Sciences, Philadelphia; of John W. Frances, M. D. late Pro-
fessor of Obstetrics, Diseases of Women and Children^ and of Forensic Medi-
cine, in the College of Physicians and Surgeons, New York ; Richard K.
Hoffman, M. D. one of the Surgeons of the New York Hospital, and others.

The work is to contain 600 pages, neatly bound in sheep. Price to sub-
scribers will be three dollars. The work was to have been published in the
course of the past winter. Subscribers names are requested to be forwarded
to the publisher, George Adlard, 46, Broadway, New York.

The other new work is published by the same publisher, and is entitled
Medical and Physiolooical Commentaries. The work will be comprised
in two volumes, each consisting of at least 600 pages, and the price to sub-
scribers, six dollars, for the two volumes. By Martin Payne, A. M. M. D.
Professorofthe Theory and Practice of Medicine in the University of New-
York, and author of Letters on the Cholera Asphyxia of New York.

38 4 Medical Intelligence.

The following, amongst others, are the topics to whicli tlie author profess-
es to have given his attention.

Examination of subjects rt-Iatirg to obscare and controverted questions in
Pathology and Mouicine.

The Pathology of Venous Congestion.

The Philosophy of the Operation of Blood- Letting its practical applica-
tion, and the philosophical and practical distinctions between General Blood-
Letting, Cupping, and Leeching.

General Views of the Treatment of Inflammations and Venous Congestion.

The existing Theories of Inflammation, and how far Inflammation is con-
cerned ia structural changes.

The Humoral Pathology, and an examination of opinions thereon.

Examination of Views in relation to the Laws of Vitality.

Inquiry into the comparative merits of the Hifpocratic and the Anatomi-
cal Schools.

Examination of M. Louis' Works on Typhoid Fever, Blood. Letting, and of
his Numerical System of Inductions.

Examination of Marshall Hall, on Blood-Letting, and Irritation from the
Loss of Blood.

The Philosophy of Animal Heat, especially in reference to the Induction
of Dr. Edwards, with some new experiments.

The Laws which govern Venous circulation.

The application of Chemistry to the Philosophy of the Vital Function?,
and their results.

The theory of Digestion, &:c. &c.

The topics of each of these works, are of the greatest interest to the pro-
fession, good treatises on which, written under the guidance of rigid induc-
tion, should be in the hands of every member. Induction is, fortunately, be-
coming so much the order of the day, that we presume these treatises would
Fcarcely be offered to the public at the present tim?, without this as a shield
to defend them through the reviewing ordeals of the present day. We have
not had the good fortune to see either of the works ; but so far as we can
judge from the prospectus' of each, which is now before the public, we feel
disposed to commend them to t!ie attention of practitioners and students.

SOUTHERN MEDICAL

AND

SURGICAL JOURNAL.

Vol. III.] APRIL, 1839. [No. 7.

Part 1. ORIGINAL COMMUNICATIONS^.

ARTICLE I.

An Essay on Congestive Fever. Presented to the Faculty
of the. Medical College of Georgia, at the Annual Com-
mencement in March, 1839. By Wm. M. Burt, o/Jg-e-
ji^ld, S, C, a candidate for the Doctorate.

[The frequency of occurrence, extensive progress and dan-
gerous character of the fevers, which have, of late, been known
by the name " congestive," impart great interest to every thing
calculated to diffuse a knowledge of the disease. Essays and
observations on the subject, from those of the south under whose
notice it has been most abundant, have been repeatedly, but in
vain called for some have been promised, but none have come to
hand; and now, a premium is offered by the Medical Society of
Augusta, for the purpose of drawing forth the best information
on the subject for the benefit of the public. Meanwhile, we
seize on the present opportunity of laying before the public a
very faithful and accurate, though brief view of this disease, as
it has appeared in an adjoining district. We regret that it has
not been in the power of the promising author, to give the autop-
sic appearances which follow congestive fever. This, however
is not to be expected to any extent, of those whose observation
is limited to country practice.] Editor.

386 Congestive Fever. [April,

As there are few diseases which I conceive to be of more im-
portance, or which afford more room for original speculation
than Congestive F^uer,! have ventured to select it as the subject
of my thesis. But it is with hesitation I undertake its exposi-
tion, as 1 am pei'fectly aware of my incapacity to do justice to
a subject of siich vast importance. I shall, however, endeavor,
in a cursory manner, to present my views with regard to the
character and causes of the disease which has prevailed in Edge-
field District, S. C, for the last two or three years under the
above name, and then relate the mode by which I have known it
most successfully treated. With regard to the nature of this,
as of many other diseases of malignant character, physicians
appear to entertain a variety of conflicting opinions ; some be-
lieving it to be a modification of one, and some of another dis-
ease ; no two, so far as my inquiry has extended, appearing to be
alike in their belief. This we may, however, expect will con-
tinue to be the case, until a series of post-mortem examinations
shall have revealed to the world its true pathology.

As to my own part, I am convinced, at least, so far as the ex-
ternal phenomena enables me to judge, that it is a species of
fever, differing in some respects from any other which had ex-
isted among us previous to its invasion; and that it depends pri-
marily on congestion of the capillary vessels of some portion of
the mucous membrane of the alimentary canal, most generally
that of the ilium or small intestines.

On account of this local congestion, the equilibrium of the
circulation becomes destroyed, and the sanguiferous system
brought into a state of febrile re-action. The blood is then
forced upon this morbid membrane by the increased action of the
heart and arteries, and a new set of phenomena are produced,
indicating more conspicuously the presence of intestinal irrita-
tion ; which, in attacks of extreme violence, spreads by contin-
uity of surface or otherwise, until it has even reached the oeso-
phagus.

The mucous membrane of the lungs also appears to be often
involved in the disease, which renders it much more perplexing
to the practitioner, and by far more liable to be attended with
fatal consequences.

Symptoms. The symptoms characterising congestive fever,
vary according to the extent and location of the affection ; and

IS39.] Congestive Fever. 387

therefore cannot be satisfactorily delineated without considering
it under two varieties, the mild and the malignant ; the former
of which, I believe, depends in all cases, upon functional de-
rangement of the capillary vessels of the mucous Coat of the
ilium; which opinion, I trust, will be rendered somewhat justifi-
able, by pointing out the characteristic symptoms of this variety
of the disease.

An individual, previo.us to an attack of congestive fever in its
mild form, will sometimes for days and even weeks, experience
a loss of appetite, and even the small quantity of food which he
takes will be imperfectly digested ; his bowels become irregular
in their action, being sometimes constipated, and at other times
preternaturally relaxed. There is extreme languor, especially
in the after part of the day, most generally attended with sensa-
tions of chillness, which are succeeded by a slight increase of
pulse and drowsiness. After these premonitory symptoms have
continued for an indefinite length of time, the individual is taken
with a decided chill, which also varies in duration, and from
which the system gradually passes into a state of re-action,
which, in some cases, is so very slight, that one unacquainted
with the nature of the disease, might be induced to believe fofa
short time, that the patient did not require medical attention.
But by close observation, he will soon become convinced of his
error with regard to the transientness of the symptoms. The
patient's pulse, though not increased in fulness, remains frequent
and rather tense, the surface of his body becomes dry and rather
shrunken, except about his neck and forehead, where a slight
moisture is found almost invariably to exist throughout the
whole course of the disease. He does not complain of any pain
under ordinary circumstances, but if pressure be made upon the
abdomen just below the umbilicus, he will experience obtuse pain
or soreness in the bowels. His tongue invariably assumes a
red color along its edges and tip ; having in almost all cases a
streak of dirty white fur in its middle. His appetite is most
generally wanting, or very much impaired, though in some rare
cases it is exceedingly voracious, an instance of which I have
seen, and in this ca'se the patient's tongue, instead of being of
the usual color along its middle, presented an aspect approach-
ing very nearly that of indigo. There is generally considera-
ble thirst present, but the patient appears to be indiflferent with

389 Congestiue Fever. [April,

regard to the temperature of the fluids given him, taking them
warm or cold without complaint. His urine is diminished in
quantity and rather more highly colored than natural. His
bowels are apt to remain irregular in their action diarrhoea
being easily excited ; his strength is quickly exhausted, and his
extremeties liable to become cold, especially in the morning.
Sometimes towards the third or fourth day, the abdomen be-
comes slightly tympanitic, more especially if drastic purgatives
have been freely used at the commencement of the attack.

Without proceeding farther with the history of this form of
the disease, I would remark that it seldom, if ever, proves fatal,
provided a judicious plan of treatment be pursued from the com-
mencement ; although it frequently runs on without much alter-
ation for the better or w^orse, until the fortieth day. But the
usual period at which it terminates is about the twentieth day.

Having thus briefly considered what I have ventured to de-
nominate the mild form of congestive fever, I will now pass to
the history of the disease in its mah'gnant form ; which, although
not so abrupt in its attack or altogether so rapid in its progress,
is, I presume, little less to be dreaded than Asiatic cholera or
yellow fever. Still I am inclined to think that future investiga-
tion will divest it of many of its terrors, by proving that one
grand cause of practitioners having heretofore been so uni-
formly unsuccessful in its treatment is this : diseases previous to
its invasion had for a long time observed an uniform character ;
hence arose an uniform and unalterable plan of treatment, which
could not prove otherwise than pernicious in a disease like the
one under consideration. I do not wish it inferred that I en-
tirely condemn the use of purgatives in this disease, but only
their injudicious employment. And thus I apprehend many in-
dividuals have been precipitated into an untimely grave b}' erro-
neous treatment, rather than by a disease necessarily uncontrol-
able in its nature.

Symptoms. The symptoms characterising the malignant
form of congestive fever, are much more conspicuous than those
already described. The febrile heat is much more intense, the
pulse more voluminous, and incompressible ; there is considera-
ble nausea with vomiting, most generally attending at the com-
mencement, with other signs of gastric irritation, such as a sense
of burning and oppression in the epigastric region ; the breath-

1839.] Congestive Fever. 3S9

ing is short and very much hurried ; the pvilient complaining of
considerable uneasiness in the chest, and having a dry cough, his
thirst is most insatiable, with a desire for the coldest drinks ; his
tongue is o^ a fiery red color, presenting a smooth or polished
surface ; indeed so uniformly does this redness of the tongue
accompany the disease, that it received, and still retains among
the common people the name of the red tongue fever, which is
very characteristic of it. The individual is extremely restless,
tossing himself from one side of the bed to the other ; his bowels
are generally constipated at the commencement of the a Hack
and sometimes very obstinately so, resisting the action of ca-
thartics surprisingly ; and in such cases when they once yield,
their whole contents appear to be passed off at one discharge.
His urine is scanty and very high colored, being passed some-
times with more or less pain. As early sometimes as the second
day, the patient will complain of great intolerance of light, and
a sense of fulness in the head; his abdomen is apt to become
turned, and v/hen the disease is going on to a fatal termination
deglutition becomes difficult, a low delirium supervenes, and the
discharges both by urine and stool are passed involuntarily. A
copious secretion of v/hite, frothy, and extremely tenacions mu-
cous is thrown off by the bronchial tubes, a most profuse pers-
piration breaks out over the whole surface of the body, the ex-
tremities rapidly grov/ cold, the countenance assumes a cadaver-
ous aspect, the pulse general!}' intermits, or ceases to be felt at
the wrist, and at this extreme period, the mucous secreted by
the bronchial tubes becomes so abundant as to produce suffoca-
tion, and thus put an end to the patient's indescribable suffer-
ings.

The period at which the crisis generally takes place, is on the
fourteenth or fifteenth day, and when it occurs short of the ninth,
death, I believe, invariably follows.

Cmtses. The causes which conspire to raise congestive
fever, appear to be quite numerous and diversified. Among
them may be enumerated, sudden suppression of cutaneous
transpiration, thereby producing a determination of blood from
the surface to the internal organs. Taking a draught of cold
water while excessively warm, will sometimes produce the dis-
ease in its most terrific form. In this case, I presume, the
morbid impression produced on the nerves of the stomach by

393 Congestive Ftver. [April,

the cold water, is transmitted through the medium of the senso-
rium commune, to the cutaneous exhalents and capillaries; which
occasions not only the retention of a large quantity of perspira-
ble matter, but a constriction of the extreme vessels, thereby
causing the blood to accumulate in the internal organs. The
disease may also be produced by exposure to a cold and humid
atmosphere, especially at night. Standing long upon wet ground,
sleeping in wet clothes, eating of indigestible food, such as un-
ripe fruit. Miasmata also appears to be one of the most fruitful
sources of congestive fever, of which I think I could adduce
ample evidence were it necessary. But how this aerial morbific
agent operates in producing its deleterious effects upon the sys-
tem, I shall not pretend to say. In short all agents may predis-
pose the system to congestive fever, which are calculated to de-
range the functions of tlie body, by producing hyperoemia of
the mucous surfaces.

Treatment. In the treatment of congestive fever, our grand
object is to equalize the circulation, restore the natural functions
of the excretory organs, and obviate inflammation. For the ac-
complishment of this, our agents must be adapted to the
degree of violence the disease assumes : for instance, general
bloodletting is seldom required in the mild form of the disease,
and when employed, it should be at or soon after the commence-
ment of the febrile symptoms, and when the bowels are in a
state of constipation, and the pulse resisting. Under these cir-
cumstances, it may be productive of good by diminishing the
force and frequency of the pulse, and rendering it more volumi-
nous, and also by assisting the action of such remedies as may
be administered for the purpose of evacuating the alimentary
canal, and promoting diaphoresis. As the powers of re-action
in the system are generally feeble from the commencement of an
attack, I would here remark, that venesection should always be
resorted to with a great deal of circumspection, lest permanent
debility be the result. With regard to the beneficial efi^eets of
purgatives in this as well as in the malignant form of the dis-
ease, a great deal depends on the nature of the articles employed ;
for example, drastic purgatives are always liable to be attended
with the most dangerous consequences, producing great irrita-
tion in the bowels, and excessive purging. Hence the mildest
articles belonging to this class should always be selected.

1839.] Congestive Ferer. 391

When at the commencement of the febrile symptoms the
bowels are constipated, purgatives are indispensable, and those
too, which are calculated to produce thorough evacuations ; f r
it is quite evident that the retention offojcal matter, or any viti-
ated secretion in the bowels, would constitute a prolific source
of irritation. For this purpose, I know of no remedy in the
materia medica, which is preferable to calomel and Dover's
powder combined, and followed by castor oil in the course of a
few hours. After the bowels have been evacuated by this
means, they should be kept open by the occasional use of some
mild aperient, or injections of warm water.

Should signs of intestinal inflammation or colliquative diarr-
hoea ensue, small and repeated doses of the pulvis ipecacuanha
compositus should be given. Leeches or cups should be ap-
plied to the abdomen, and followed by emollient poultices, for
the purpose of promoting the discharge of blood, and also assist-
ing in producing a more decided revulsive effect.

The patient's diet should be strictly antiphlogistic at the com-
mencement, consisting of mucilaginous drinks altogether. But
as the disease is one of long duration, the diet should be rendered
more nourishing as soon as practicable. As often as the ex-
tremeties sink below the natural standard of temperature, epis-
pastics or sinapisms should be applied. The malignant being
much more formidable in its nature than the mild form of con-
gestive fever, necessarily requires a more energetic plan of
treatment, and as there are often at the very commencement of
the attack, marked signs of gaslro-intestinal irritation, together
with a disposition to cerebral congestion, we at once conclude,
that general bloodletting is a most important means for arrest-
ing the progress towards inflammation. The blood, in such
cases, should be drawn from a large orifice, and the operation
repeated until a decided impression be produced upon the pulse,
or until we have reason to doubt the propriety of its use. In
the meantime a blister should be applied to the epigastrium, and
the head kept cool by means of a bladder containing ice, or
clothes rung out of cold water. When by these means the vom-
iting has been arrested, and the action of the heart and arteries
moderated, small doses of calomel combined largely with opium
or the sulphate of morphia should be given at proper intervals,
and followed by oil or some of the saHne preparations. Pro-

392 Congestive Fever. f April,

vided the means prove too energetic in their operation, produc-
ing copious watery discharges, and the patient's strength fail
rapidly, blisters should be applied to the extremeties with a
view of keeping up excitement, and the black drop administered
for the purpose of arresting the discharges from the bowels.
The patient should be allowed the free use of cold mucilaginous
infusions at all times ; all irritating or soHd articles of food be-
ing avoided : for I am confident there is no disease in our south-
ern country, in which more can be effected by a proper regula-
tion of diet, than in the one under consideration.

In all cases where tympanites occurs, cups ; or leeches, which
I consider preferable, should be applied to the abdomen, and
their application succeeded by warm poultices. In the latter
stage of congestive fever, our treatment should consist of means
the most simple in their nature, such as mild aperients, for the
purpose of keeping up regular and moderate discharges from
the bowels, with the occasional use of some innocent diaphore-
tic. Frictions should be frequently applied to the surface of the
body, in order to equalize the circulation, and the natural tem-
perature of the extremeties sustained by stimulating cataplasms.

During convalesence from this disease, the strictest regard
should be paid to the patient's diet. Mild farinaceous hquids
are generally quite sufficient for several days after the subsi-
dence of the fever.

1839.] Pathology and Treatment of Cholera Asphyxia. 393

ARTICLE II.

An Essay in answer to the question^ " What is the pathology
and treatment of Cholera Asphyxia^^ read before the Medical
Society of Augusta. By Edward A. Eve, M, D., of Rich-
mond County^ Geo.

The importance of the subject for our consideration is so well
established, and generally acknowledged, that it is altogether
unnecessary to endeavor to impress it on the present occasion ;
therefore we will proceed at once to examine the question or
questions before us " The Pathology and Treatment of Chol-
era Asphyxia." Although the generic name cholera is inap-
propriate and calculated to convey imperfect and erroneous
ideas of the true pathology, the symptoms of " cholera asphyx-
ia," Asiatic, or spasmodic cholera, (the species designed for dis-
cussion this evening,) so readily occur to the mind of every
physician, that a regular detail of them in this place would be
superfluous, and such only as may be required to substantiate
or elucidate principles shall be adverted to in the course of the
following remarks. The object of the present discussion being
to elicit truth, it has been my aim in examining the different the-
ories promulgated by different authors, to adopt and support
such as seems the most rational, and best sustained by facts in
possession of the profession, rather than coin a new one, whose
only recommendation might be its novelty : still, as the same
evidence makes a different impression on different minds, in the
spirit of the familiar motto, "addictus jurare in verba magistri
nullius." I will take the liberty of only adopting such parts of
a theory as are consistent with my views, physiologically and
pathologically considered, and of rejecting the rest, however
respectable the authority from which they emanate. In the
rapid review of the doctrines of the pathology of cholera, that
I have taken, 1 cannot account for the very diflferent views that
authors of equal celebrity and equal opportunities of observa-
tion, have advanced, unless it is that they have founded their
doctrines on the phenomena existing in different stages of the

disease. It can be from this cause alone, that we have it styled
b2

394 Pathology and Treatment of Cholera Asphyxia. [April,

on one hand a disease of high excitement, requiring active de-
pletion, and on the other, one of most perfect prostration, de-
manding powerful stimulants. Now avoiding either extreme,
hoping to steer a safe and correct course between them in the
humble attitude of an eclectic, I have endeavored, after a survey
of the different theories that have been erected on this subject,
to gain from each some fact that may be valuable in the forma-
tion of one that can derive its support from its accordance with
the symptoms, the only external and visible signs of the inter-
nal, and invisible ravages of disease before death, and the struc-
tural lesions apparent upon post mortem inspection, which bear
witness of the truth of those external signs which before were
only uncertain indications of the internal condition. We admit
that neither the symptoms, nor post mortem appearances, taken
separately, can develope the true nature of disease; but when a
due correspondence can be established between these indices,
that is, when we can predict by the symptoms what structural
lesions will appear post mortem, and vice versa when we can
tell by inspecting the structural lesions, what the symptoms
were during life; thus reasoning from cause to effect, and from
effect back to cause, our circle of ratiocination becomes com-
plete, and our conclusion attains to the certainty of demonstra-
tion. It is after severe perquisition by these laws, that 1 adopt
the following views concerning the pathology of cholera
which are, that it is threefold in its nature, according to the dif-
ferent stages of the disease. The first, or initiatory stage, I
conceive, consists in congestive irritation of the gastro-intestinal
mucous membrane, accompanied by excessive secretion of the
aqueous elements of the blood ; this condition of the mucous
membrane has not been inappropriately termed by different au-
thors, secretory irritation, and serous hemorrhage, conjoined
with this state of the alimentary canal, there is great loss of
equilibrium in the circulation, with a centripetal tendency of the
fluids, in obedience to the often quoted axiom, " ubi irritatio ibi
humorum affluxus." This stage continues for a longer or
shorter period, as the powers of resistance inherent in the sub-
ject attacked, stand in relation to the violence of the attack.
This gradually glides into the second stage, which is character-
ized by the accession of a new phenomenon, the deterioration of
the blood. Very respectable authority, notwithstanding, could

1839.] Pathology and Treatment of Cholera Asphyxia. 893

be adduced, who maintain a depravation of the blood to be the
proximate cause of this disease ; chemical analysis, however,
could be brought to disprove the allegation if necessary; but we
do not think it " nodus vindice dignus," as the deterioration of
the blood that we allude to, can be accounted for satisfactorily
by the deperdition of its saline and aqueous elements, from tha
excessive drainage through the mucous membrane, which con-
stitutes the leading characteristic of this disease, leaving it dark,
and of a syrupy consistence. This inspissation of the vital fluid,
rendering it unfit to permeate the delicate ramifications of the
vascular system, is a mountain-like difficulty in the way of the
recovery of a cholera patient advanced to this stage; it is a diffi-
culty whose tendency is to increase, as with a self-generative
power. The blood deprived of its aqueous elements, penetrates
with difficulty the capillaries of the lungs, and in a state unfit to
be oxygenized, it being through the medium of the serum that
the blood receives its oxygen from the atmosphere. Now this
deoxygenated blood stimulates less actively the organs of cir-
culation, and the organs of circulation in turn still nnore imper-
fectly bring it in the sphere of oxygenation ; thus acting in a
perpetual circle of cause and effect, each effect acting in turn as
the cause of the next effect. And when in addition to this increas-
ing devitelization of the blood, we recollect that the follicles of
the alimentary canal are acting as so many wastegates of vital-
ity, can we wonder that death should be an early result ? What,
according to our arbitrary division of this disease we designated
the third stage, or that of collapse, or approaching collapse, is
distinguished by the system of ganglionic nerves being brought
within the sphere of morbid association. By this complication,
the relation that one organ bears to another being destroyed, the
difficulty of recuperation is very much increased hence the
great difficulty we have in this stage of irradiating excitement
by any remedial means he can institute ; and hence, also, that
icy coldness, that so obstinately i*esists external heat, that would
be sufficient to elevate the temperature of the cadaver consider-
ably above the standard of healthy vitality.

Having now given a cursory and very imperfect sketch of
our pathological views of cholera, we will in the next place con-
sider the treatment with reference to those views.

Venesection. This remedy has been variously estimated, ac-

39G Pathology and Treatment of Cholera Asphyxia. [April,

cording to the opposite views entertained by different writers
on the subject. Of course, those believing in the phlogistic and
inflammatory nature of the disease, would esteem it of the first
importance. Those, on the contrary, who consider this disease
a state of debilitation or sedation, would, in consonance with
those views, deprecate it as an agency fraught with danger, and
whose direct tendency would be to increase the difficulty under
which the patient was already laboring. According to the pa-
thological views that we entertain, venesection, if employed pre-
cisely at the proper period, would often exercise a favorable in-
fluence. Its chief value is derivable from its power in equaliz-
ing the circulation in the onset of the disease, and of moderating
the violence of re-action, when too high, in convalesence. Not-
withstanding these beneficial effects may sometimes be derived
from this remedy, still, the science we have to treat, glides with
such rapidity from one stage to another, as to make the general
employment of this agent, a doubtful, if not a hazardous prac-
tice ; topical depletion being a safer, if not a better remedy.

Emetics. Emetics, if administered in the early stage of this
disease, and with judgment, will sometimes be productive of
good. Warm salt and water, with the addition of mustard, are
preferable to any other.

Counter-excitement. When we consider the congestive char-
acter of this disease, and the centripetal tendency of the fluids, re-
vulsive applications will be esteemed of the highest importance.
They should be used in the early stages,for then only we can hope
to achieve much ; but they should be used also in collapse, as
then little else can be done. But notwithstanding counter-iri-
lants, and internal stimulants appear to be our sheet anchor in
this moribund state, still, on that account, we must not, as is
very often done, apportion the power of the stimulants to the
apparent necessities of the patient, any more than we would
apply an intense degree of heat to a frozen member. It is from
the supposed analogy that this algid condition of the cholera
subject bears to a frozen member, that the practice of adminis-
tering cold water in this affection has arisen ; and however ab-
horrent, at first view, appears the idea of applying cold exter-
nally and internally to a patient already affected with the death
like coldness attending collapse, still, according to the analogy
just alluded to, it is not altogether unreasonable ; and no doubt.

1839.] Pathology and Treatment of Cholera Asphyxia. 397

it adniinistered with discrimination, in suitable subjects, and in
proper stages of the disease, it might be found beneficial. Where
thirst, and the sensation of internal heat are very great, iced
water taken, internally, and bladders of ice applied to the epi-
gastrium at the same time that the extremeties are surrounded
with warm applications, would tend powerfullv^ to divert the
centripetal tendency of the fluids, and to restore the lost balance
of the circulation. Although we believe that this advantage
might accrue from the judicious use of cold in cholera, we ap-
prehend, that, from the ultraism that pervades our profession,
far other has been the result ; for we find that when the success-
ful employment of cold as a remedy in cholera was announced
to the public, not only was it grasped at with avidity, as a hith-
erto much neglected remedial agent, in this terrible disease, but
numerous writers contended for the credit of having previously
advocated its employment in this affection; and as a result of
this re-action in the mind of the profession, all medicine was
withheld, and the poor shivering subjects of collapse were
drenched internally with several gallons of cold water in a few
hours, and subjected to the affusion of as many bucketfuls in
quick succession.

Calomel and Opium. Although revulsives appear to be in-
dispensable in the treatment of this disease, still, it is to calomel
and opium that we look for our chief curative means; what-
ever other adjurants we may call in, still they are only auxilia-
ries, and this valuable alterative, calomel, combined with the
sedative power of opium, must form the basis of our treatment.
The liver is affected with almost indomitable torpor the secre-
tions generally are thoroughly deranged, and nothing less than
this powerful cholegogue and alterative can be relied upon to
change their disordered action, and restore them to a normal
state. Besides its suitableness to the pathology of the disease,
the success with this remedy when resorted to early, has been
such as to justify the confidence that has been reposed in it.
When opium, from the irritability of the stomach, cannot be
retained, opiate enemata, frequently repeated, offer an invalua-
ble resource ; it might be well in almost all cases, to put the
patient under the influence of an opiate enema.

Astringents, The next class of remedies which claim our
attention, is that of astringents. These agents from the patho-

If

SDS Pathologi/ and Treatment of Cholera Asphyxia. [April,

logical views we have taken of this afTection, are certainly im-
periously demanded, although the eflect produced, unfortunately,
falls far short of the demand and of the promise their therapeu-
tic applicability would sanction. Acetate of lead, from its well
known antihemorrhagic power, seems peculiarly applicable to
this state of the alimentary canal, so closely resembling that of
hemorrhage.

Saline Mixtures. These remedies administered by the
mouth, or as enemata, to supply the aqueous and saline ele-
ments of which the blood has been deprived, in this active state
of the exhalents, and inactive condition of the absorbents, I can-
not conceive would have any useful effect.

Nostrums, catholicons, and antidotes, &:c., have been multi-
plied without number; but each "has strut its hour upon the
stage," and sunk into oblivion, unfortunatel3% only to give place
to another ; and the more malignant the epidemic has been, with
the greater audacity have their certain cures been heralded
forth. As it would be an endless task to notice them in succes-
sion, we will pass them over with the silence they deserve.
Not predicting whether there ever will be, or not, a specific
found for this truly terrible and intractable malady, we cannot
but come to the mournful conclusion, that it has not yet been
discovered ; and though we may be able, by the remedial re-
sources we possess, to treat cholera patients to whom we are
timely called, and in the less malignant attacks, with considera-
ble success, still, when the attack is malignant, or t^ patient
has reached the stage of collapse before we are called, it matters
little what course we pursue, the result being nearly the same
in each.

Though about to conclude, there is still one remedy, which,
from the interest it excited in its day, I think ought not to be
passed over in silence I allude now to saline injections into the
veins ; when we take into view the great deperdition the blood
sustains of its important elements in this disease, the alteration
it undergoes, both in its chemical and physical properties, the
former rendering it unfit to perform the vital functions for which
it is designed, and the latter by its inspissation incapable of per-
meating the delicate capillary system, thereby erecting an al-
most inseparable barrier to recuperation ; it is not wonderful
that such a deplorable crisis should have suggested the idea of

1839.] Pathology and Treatment of Cholera Asphyxia. SD9

supplying the loss of these elements, by injecting into the veins
fluids as nearly as possible resembling the nature of those lost.
This, however, as well as the whole catalogue of other reme-
dies, in most instances has failed ; but not, as it were, without
winning a smile of approbation for its ingenuity ; death has re-
laxed his grasp, and re animation has flushed features, a few
moments before cold, pale, shrunken, and wearing the signet of
death, with the rosy promise of life ; but it has been like the
last flickering flash of an expiring light, in a moment they
were shrouded in the night of death ! The general result
of this treatment, as we gather from a history of the cases in
which it has been employed, has been of this character, a flat-
tering amendment has been produced ; but for the most part,
the disease has returned with violence, and the patient has in a
short time succumbed. We do, however, find a solitary in-
stance or two recorded, where the recovery has been said to be
permanent. A better understanding of this treatment, and an
improvement, in manual adroitness, acquired by its frequent em-
ployment, might, in some measure, enlarge the number of recov-
eries ; but there are practical difficulties, in the way of the ope-
ration, sufficient to prevent it from ever becoming generally
available as a remedial agent. The introduction of air into the
veins alone, would often render the operation abortive. To
prove the destructiveness of this accident, which does not seem
to be recognised generally, even by physicians, we have but to
advert to several well authenticated accounts of surgical opera-
tions recently performed, some of which have been very much
embarrassed, and others rendered fatal, by this complication.
In corroboration, also, of the destructive energy of this agent,
when intromitted into the veins, I can adduce an instance, from
the little veterinary surgery that has accidentally fallen under
my immediate observation. A horse, affected with tetanic spasm
was bled, the puncture being small, the blade of a penknife was
introduced to dilate the orifice ; by this manoeuvre, owing to the
dullness of the instrument, the vein was raised out of its natural
bed, a peculiar gurgling noise was heard ; instantly the animal
was aflfected with a convulsive trembling, and fell dead at my
feet ; being myself the operator on this occasion, I had the
best opportunity of hearing the peculiar noise, and witnessing
tb^eflfects of the accident. I have brought forward this case,

400 Pathology and Treatment of Cholera Asphyxia. [April,

merely to show one difficulty in the way of the operation ; oth-
ers will occur to the mind of every one who reflects on the sub-
ect. Might not the transfusion of the blood of a healthy
human subject into the veins of a choleric patient, be attended
with a happy eflTect ? We are awax-e, that for the reasons
above stated, this could not be at all times practicable ; but, if
at all possible, and the effect conservative of life, it would be
well, nay, ineffably desirable to have it amon^ our resources.

When we take into consideration the deoxygenated state of
the blood as evidenced by the livid plumbaginous hue of the
skin, as well as the appearance of this fluid itself, when brought
to view, does it not seem reasonable, that, together with using
every means to preserve, or if lost, to restore the aqueous ele-
ments of the blood, if we were to cause the patient to inhale an
atmosphere charged with a greater than usual proportion of
oxygen, it might have a happy effect in giving vitality to the
languid circulation, and thereby conduce to the recovery of the
patient?

With the above suggestions we will bring these remarks to a
conclusion ; this essay being intended to be decidedly ele-
mentary, precludes that entrance into the minutia of the treat-
ment, that would be allowable and necessary in one of a more
practical character.

1839.] Balsam of Copaiba. 401

Part ii. REVIEWS AND EXTRACTS.

Obset'vations on the use of Balsam of Copaiba in Diseases of
the Mucous Membrane of the Intestinal CanaL By R. La
Roche, M. D., of Philadelphia.

We extract from the pages of the eleventh and twelfth num-
bers of the 2d volume of the Eclectic Journal, the entire essay of
Dr. La Roche, on the use of balsam copaiba in diseases of the
mucous membrane of trie intestines, because it is calculated to
bring before the practitioner a much neglected, but valuable
remedy for some of our most troublesome and unmanageable
diseases. The practical utility of this balsam in these cases, is
by no means of recent date, but its adoption in practice has
been strangely limited to a few sections of country, and to the
practice of but few practitioners.^ Dr. La Roche has, in this
essay, given us a history of its use, both interesting and substan-
tially useful setting forth, as it does, the very best authority of
different ages, for its efficacy. Editor.

In the fifth number of the North American Medical and Surgical Jour-
nal, I laid before the profession the details of several cases exemplifying
the beneficial effects derived from the balsam of copaiba in the treatment
of chronic bronchitis. At a more recent period* I published the results of
my experience with the same remedy in catarrh and morbid irritabihty of
the bladder, as well as in leucorrhceal discharges. The object of the present
communication is to show, by facts which have come under my personal ob-
servation, and also by a reference to high medical authorities, that when
employed under appropriate circumstances, and with suitable precautions,
the copaiba has been found decidedly useful in some diseases of the intesti-
nal lining membrane.

The first of these to which I shall call the attention of the reader is dy-
sentery. The introduction of the copaiba in the treatment of this disease is
not, so far at least as I have been able to ascertain, of very ancient date.
Dr. Armstrong, it is true, states that it was recommended by some of the
older writers in that " and similar diseases of the belly." But, conformably
with his almost constant custom, he cites no names, so that his less learned
reader is left in the dark relatively to the standmg of those writers, and the
period at which they flourished. Etmuller, and several of his contempora-
ries and immediate successors, speak of the use of balsamics in the second-
ary stages of the complaints in question. But as their remarks have refer-
ence to the Peruvian balsam, and never, it would appear, to the copaiba, and
as neither James, Motherby, Lewis, Lieutaud, Cartheusen, nor other writers
of their times to whom I have access, make any mention of it, it is not un-
reasonable to conclude that the practice of resorting to the copaiba was
not, to say the least, as ancient or common as Dr. Armstrong would lead
us to believe.

* American Journal of the Medical Sciences. Vol. xxvii., May ISS-J.
c3

402 Balsam of Copaiba. [April,

But, however it may be in regard to the antiquity of the introduction of
the remedy in the treatment of dysentery, a question which, after all, is
quite unimportant to most readers, we have evidence that, at a compara-
tively recent period, several British practitioners, whether guided by their
theoretical views of the mode of operation of the copaiba,^ or by the result
of their experience of its effects in other diseases of a kindred nature, or
following the example of their predecessors, it matters not, were induced
to resort to it in that complaint. What the effects of the practice were, or
what w^as the estimate formed of its utility, may be ascertained by a refer-
ence to the works of Pemberton, Cheyne, Good, Armstrong, Abercrombie,
andothers. The first of these writers employed it in both the acute and
chronic form of dysentery. He states, that when the griping pain, in the
acute form, has in some degree subsided, he has frequently observed the
greatest relief from the tenesmus, obtained by small doses of this remedy ;
and that injections of the same will often tend to remove the last mentioned
symptom. "If it should happen," he continues, "that the practitioner is
consulted after this disease has continued for some time, and has now put
on the form of chronic diarrhoea, with the excretion of mucus and blood, at-
tended with occasional griping pain and tenesmus ;, and if, moreover, the
discharge should be unusually offensive and curdled, there will be reason to
suspect that ulceration has taken place in the large intestines : here, too,
the same dose of balsam of copaiba may be recommended, and injections of
it as before mentioned."

Finally, when the disease arrived at this stage, and was attended with
great debility, Dr. P. prescribed the same remedy in conjunction with the
decoction and tincture of bark, and with tincture of opium when the tenes-
mus was distressing.

Dr. Cheyne, to ivhom the profession is indebted for a very excellent ac-
count of the dysentery which prevailed some years ago epidemically in
Dublin, makes some valuable remarks on the use of bleeding and mercury
m that formidable ilisease ; and adds, that as soon as the influence of the
latter was rendered apparent by the condition of the mouth, it was laid
aside, and a mixture with balsam of copaiba \^'as given every fourth or sixth
hour. From this the greatest relief was often obtained : the faeces, from
being of a bottle .green, and mixed with mucus (the effect of the calomel
and opium,) and passed, with tenesmus, became more natural in appear-
ance, and were voided less frequently ; the patient considered himself cured,,
and in many cases his recovery followed. It resulted from a considera-
tion of the cases in my possession," Dr. Cheyne remarks, "that venesec-
tion, calomel and opium, followed by the copaiba mixture, with farinaceous-
diet, proved more successful than any other method which was adopted in
the severest cases."

Dr. Armstrong states, that the copaiba might be beneficial in dysentery,
but especially in those protracted cases which usually baffle the ordinary
remedial means. He is of opinion, that it will hereafter be placed among
the most useful secondary remedies, and generally employed after the lan-
cet and calomel in the acute and subacute cases. In chronic dysentery he
thinks it peculiarly suited, and states that in three obstinate cases,, where
purulent matter was passed from the intestines, it appeared to be of consid-
erable service.

Dr. Abercrombie, than whom we know of no higher authority in relation
to the treatment of diseases of the alimentary canal, states that in the more
advanced stages of acute dysentery, when the morbid secretion continues
after the inflammatory symptoms have been subdued, various remedies of a
tonic and astringent nature appear to be useful. Among these he cites the
copaiba. Dr. Abercrombie likewise recommends it, among other remedies,
in chronic dysentery, and in the slighter and more obscure forms of affec-
tions of the intestinal macous membrane. In all these cases it is also meu-

839. ] Balsam of Copaiba. 403

tioned by Dr. Good as a valuable medicine. Mr. Hooper prescribed it m
the dysentery which prevailed among the troops that returned to England
after the discomfiture at Coruna ; though particularly when the complaint
was attended with suppression of urine. Sir James MacGregor, in his
*' Sketch of the Medical History of the British Armies in Spain," remarks,
that Mr. Woolrich found great benefit from a mixture of the balsam copaiba
in gum water with infusion of columbo, in the cases of dysentery treated
by him in the Hospitals of Celorico and Castello Branco. Dr. Bamfield,
after remarking that the copaiba has sometimes been used successfully in
chronic dysentery, adds :*< The friendly and kind Mr. Pearson, senior sur-
geon to the British factory in China, assured me he had cured the Hon.

Mr. E ne with it, after every remedy prescribed in India and Europe,

for two years, had failed. It preserved a lax state of the bowels, and an in-
creased flow of urine." ** It is a mild, safe medicine, and is entitled to its
turn, in the very obstinate chronic cases sometimes met with, among the
variety and changes of symptoms and of medicines prescribed." Finally,
Dr. O'Brien used the copaiba with much success in chronic dysentery, and
Dr. Joseph Brown recommends it combined with opiates in the same form of
the disease, as well as for the removal of the tenesmus in the acute form.

Favorable, however, as these testimonials of the effects of the copaiba
doubtless are, it would appear that, up to the present time, the practice of
resorting to it in d3-sentery has been almost exclusively limited to England.
On turnmg to the various publications that have appeared in France on the
subject of the treatment of that disease, or in which the therapeutic virtues
of the copaiba arc noticed, we shall find that, with the exception of Barbier
and a. very few others, the physicians of that country either discard it com-
pletely as inapplicable and injurious, or at best speak of it as of a remedy of
doubtful efficacy in the very cases in which the English have found it useful.
Dr. Eberle, it is true, remarks, in his work on the Practice of Medicine, one
of the best of the c5ass of which we can boast : that this remedy frequently
does excellent service, and that he has employed it with unequivocal benefit.
But judging from all I have seen, Dr. Eberle forms an honorable exception
in this matter ; the copaiba being seldom, if ever, alluded to by American
writers in reference to its effects in dysentery. The difference of opinion
respecting the efficacy of the balsam the high estimation in which it is
held by many eminent physicians in England, and the opposition or neglect
it has met with in France and this country will be accountedfor by those
who have had opportunities of noticing its effects in the above mentioned
disease, by the ditlerence of experience with it in the two countries. la
England, practitioners, waiving all preconceived notions, if any such exist-
ed, have not hesitated to make a fair trial of the remedy; whereas, the
French and the practitioners of this country, entertaining more respect for
their theoretical views than for the testimonials of the practical experience
of foreigners, or a few of their countrymen ; not aware perhaps of its
having been used advantageously by others; or feeling a reluctance to sub-
stitute a new agent for those which they are accustomed to employ, have
discarded it untried from their practice. Such at least, is the only explana-
tion of this difference which occurs to me. I have little doubt that had the
remedy been as fairly tried in France and this country as it has been in En-
gland, we should find it more generally spoken of in the former country, and
among us as a valuable agent in the management of the painful disease in
question. It is impossible to deny that, on a superficial examination of the
subject, and laying aside for a moment the testimony above recorded in rela-
tion to the usefulness of the copaiba in dysentery, great objections may be
urged against the propriety of the practice ; for the copaiba, it is well
known, is endowed with stimulating properties, and few physicians will, now
a days, venture to say that dysentery consists in any thing else than in an
inflammatory condition of the raucous membrane of some portion of the

404 Balsam of Copaiba, [April,

alimentary canal, with or without concomitant affection of annexed or dis-
tant organs. But, when we consider that the primary impression of the
remedy is made on the stomach, which is not the seat of the complaint
that by tlie time it reaches the inflamed surface it has probably already un-
dergone considerable modifications that these modifications must still more
evidently occur if it is absorbed, and only penetrates to the diseased part
through the medium of the circulation ; that if such be the route it takes,
the intlamed surface is placed in nearly the same relation to the lining mem-
brane of the stomach as other portions of the mucous tissue in those inflam-
matory complaints in which the balsam copaiba is known to be used advan-
tageously. If, I repeat, we bear the circumstances in view, and recollect, at
the same time, that remedies endowed with stimulating properties do not all
act in disease merely in virtue of those properties, and that other articles of
the same class are beneficially employed in inflammation of particular por.
lions of the animal tissues, it will not be difficult to discover that something
more is required to lead us to abstain from copaiba in dysenlery than the
simple fact of the former possessing stimulating properties, and the latter
being of an inflammatory character. Nothing, indeed, but a positive demon-
stration of its injurions effects should induce us to reject its use in dysente-
ry ; theoretical speculations should be of no avail, and experience should
be appealed to confirm or infirm the position. But so far from this demon-
stration having been given so far from experience having confirmed the
validity of the opposition made to the remedy by some, or justified its neg-
lect by others, the references above made to the writings of several eminent
English practitioners, will show that the efficacy of the copaiba in dysentery
is a fact placed beyond the possibihty of doubt ; while a consideration of its
known elTects in diseases of other portions of the mucous membranes, ought
to have appeared sufficient, by itself, to lead physicians to think well, a pri.
ori^ of the practice.

Influenced by these circumstances I was induced, some years ago, to
resort to the copaiba in a case of dysentery which had proved mtractable to
the ordinary means. The effects obtained were such as to encourage me to
make farther trials of the remedy ; and, after duly reflecting on the issue of
those cases, and on the phenomena presented, not only in obstinate, but in
ordinary cases also, I have no hesitation in expressing the opinion that, so
far as my own experience goes, the copaiba is entitled to the praise it has
received, and consequently deserves a trial in some forms of the disease in
question. It is hardly necessary to say, in the present state of our knowl-
edge respecting the uncertainty of the action of medicinal agents generally,
that the copaiba can not be expected to succeed in every case, and that it
should not be prescribed in all stages of the complaint. Like other reme-
dies, it will, in this disease, as in other forms of mucous inflammation, often
fail, even when used under the most appropriate circumstances ; so far as I
can decide, it would be improper to have recourse to it at the commence-
ment of the attack, before the violence of the inflammation has been re-
duced by general and local depletion, by diluent drinks, tepid baths, fomenta-
tions, mild purgatives, ipecacuanha, opiates, emollient injections, and blis-
ters. Some physicians may perhaps allege^ that these means being gener-
ally found sufficient by themselves to bring tlie disease to a favorable ter-
mination, there can be no necessity for administering, in addition, a remedy
not universally successful and highly offensive to the taste. I am far from
denying the sufficiency of the common remedies in ordinary cases of dysen-
tery ; like most practitioners I have myself, over and over again, seen them
prove entirely successful. But the point at issue is not, whether these
means will generally be sufficient, but whether it would be prudent or right
to trust to them alone in all cases ; and whether we should not do better,
even in ordinary cases, with, than without the copaiba. As every one must
be aware, dysentery sometimes proves intractable to the most favorite plans

1889.] Balsam of Copaiba. 405

of treatment and approved medicinal agents. Now, no one will deny tliat
it is necessary to have recourse, mider those circumstances, to additional
means, before we can shorten the disease and afford effectual relief to the
patient. If such be the case, there-can certainly be no necessity to dwell
on the propriety of making trial, when other remedies prove insufficient, of
one recommended by high professional authorities, and which, from a con-
fiideration of its known effects in other mucous inflammations, we are natur-
ally induced to conclude, may prove beneficial in the disease before us.
\\ hile the question of the greater advantage resulting from its use even in
ordinary instances, in those that may generally be cured by the usual
plans alone, resting on authorities which, to say the least, are as good as
any that can be brought in opposition, is not to be set at rest by the mere
<'xpression of doubt, or by an assurance of the sufficiency of such plans,
l)ut by a comparative survey of the results obtained with and without the
remedy.

But even in cases in wiiich depletion has been premised to reduce the
force of the inflammation, some discrimination is necessary as regards the
employment of the copaiba, because, although in general nothing contra-
indicates its use so soon as the above object is attained, instances occur
wherein the remedy would be likely to give, and has given, rise to effects
of a different character from those anticipated, and which may forbid its
continuance, or render additional means necessary. The generality of wri-
ters who have used this remedy in dysentery, are accustomed to speak in
a rather vague manner of its usefulness in certain forms or stages of the
Jatter; and though it is sometimes remarked that it disagrees with the pa-
tients, producing nausea, uneasiness, vomiting, and even aggravating the
fever and the symptoms for which it is prescribed, nothing is said of the
phenomena which may serve to indicate beforehand that it should be ab-
stained from, or the condition of the organs on which such phenomena
depend. And yet precise information on this subject is greatly desired,
inasmuch as cases may occur in which, although the copaiba had given rise
to those symptoms, it may nevertheless be persevered in, provided auxiliary
means are used ; while m others it would be proper to discontinue it at
once. A few words on this subject may not be inappropriate in this place.
In some cases the effects in question, nausea, vomiting, &c., depend on a
simple nervous irritability of the stomach ; itself the result of the existing
disease, or of a peculiar idiosyncrasy in the patient. That such is the case
cannot be doubted ; for these effects sometimes occur under circumstances
which forbid our referring them to any other cause. In cases of this kind,
the gastric irritability, if it be a simple accompaniment of the disease, man-
ifests itself whenever food, drinks, or medicines are introduced into the
stomach, and, if severe, will contra-indicate the use of the copaiba, for, if
excited by articles of a less offensive character, it is but fair to expect it will
be greatly increased by the one in question. In some instances, however,
where this irritability is great, and in many others where it is moderate, the
copaiba, if used with laudanum or aromatics, or bitters, will be made to sit
upon the stomach ; and may be prescribed with impunity, and even v'ith
beneficial effects.

But though the symptoms mentioned depend often upon the caiise as-
signed, cases occur in which they are evidently the consequence of a more
serious condition of the gastric organs infiamm.atory irritation. In dysen-
tery, the latter is more frequently encountered than is generally supposed ;
and in cases in which the stomach itself is not so diseased, it is not rare to
find the nausea, vomiting, fever, &c., produced or increased on the adminis-
tration of the copaiba or other remedies of similar character, are kept up
,by vascular irritation of the upper portion of the small intestines. It can-
not be necessary to enumerate here the signs which serve to distinguish
Ihis condition of the gastric organs (rom simple nervous irritability. Suffice

406 Balsam of Copaiba. [April

it to remark, that, in every instance in which they manifest themselves with-
out a possibility of being referred to copaiba, the latter should be abstained
from ; whereas, when they follow the use of this medicine it should be dis-
continued, and recou'-se had to the means calculated to check, as speedily
as possible, th;^ morbid state on which they depend.

Judguig from what I have had occasion to observe, I think I may safely
say, that the balsam of copaiba is as serviceable in the secondary stages of
acute dysentery as in the chronic form, and that it will be found particularly
useful when the stools are rather copious, and contain a large proportion of
mucus, or glairy matter mixed with blood. When the griping and tenes-
mus are still very severe, it wdl be necessary to combine the medicine with
a suitable portion of opium ; otherwise it may be used without, in an aro-
matic mixture, in cold water, or in an emulsion. The opium may also be
required if the copaiba disorders the stomach, and if this effect can justly
be attributed to the simple irritability of that organ. In general it is advisa-
ble to give the copaiba in moderate and repeated, rather than in large doses,
as it is thus less apt to produce griping pain, to purge, and to increase fever.
iiut whether the quantity be large or otherwise, no time must be lost in sus-
pending the remedy, and restoring to antiphlogistic^, emollients, and narco-
tics, whenever symptoms of increased gastro-intestinal irritation and febrile
excitement supervene.

The following cases, selected from several of which I have preserved
notes, will confirm what has besn said of the effects of the copaiba in dysen-
tery.

Case I. Mr. A , aged about forty years, of a sanguine, bilious tem-
perament, and generally enjoying good health, requested my attendance in
March, 1830. 1 found him laboring under the usual and well known symp-
toms of acute dysentery frequent stools, attended with severe griping
pains, and violent tenesmus. His skin was dry and hot, tongue pointed, red
on the edge and tip, and furred in the centre : pulse quick and active. Be-
sides these symptoms there was thirst and nausea. The matter voided was
small in quantity, and consisted, for the most part, of slimy mucus, combined
with a tolerably large portion of blood. The urine was scant ; but, owing
to its being passed with stools, could not be inspected. Finally, pain was
occasioned by pressure of the abdomen, and particularly of the epigastric
region, as well as by the movements required to get in and out of bed, or to
turn from one side to the other. These symptoms had cx>me on suddenly
during the precedin^^ night; were preceded by slight chill, and were appa-
rently the result ef exposure to cold.

It is not deemed necessary to present here a detailed account of the vari-
ations in the symptoms which occurred daily during the course of the dis-
ease, or of all the remedial means resorted to in succession or simultane-
ously. Let it suffice to remark that viewing the disease in the light of an
inflammation of the large, and of a portion of the small, intestines, consid-
ering likewise that the lining membrane of the stomach was, to a certain
extent, implicated, depletion, both by venesection and leeches around the
anus and at the epigastric region, was promptly and repeatedly used. To
this were added tepid hip baths, emollient cataplasms over the abdomen,
emollient and slightly anodyne injections, sweetened and acidulated gum,
barley, and fiax-seed water. Under this plan the irritation of the stomach
was soon so far allayed as to allow of the exhibition of small and repeated
doses of ipecacuanha and opium ; Dover's powder with calomel at night;
and mild purgatives in the morning.

By these means the violence of the dysenteric inflammation was in a
short time subdued, the fever abated, the tongue lost its redness and be-
came moist, the abdominal pain lessened, and the skin became softer. But
although from the.:e circumstances it was evident the patient had much im-
proved, and yet the disease was far from being effectually checked ; for tlie

1839."! Balsam of Copaiba. 407

griping, and particularly tho tenesmus, continued troublesome : the matter
discharged presented pretty much the same appearance as before, and the
pulse remained quicker and the skin warmer than natural.

Under these circumstances T determined to make trial of the balsam of
copaiba, the efficacy of which, in diseases of other portions of the same
tissue, I had had frequent occasions to observe, and the utility of which, in
the present complaint had been, as I knew, recorded by Dr. Pemberton,
Dr. Cheyne, and other writers of equal character. Twenty drops of this
remedy, combined with eight of laudanum, were directed to be taken every
four hours in two table-spoonfuls of mucilage. The fomentations on the
abdomen, emollient injections, tepid baths, were continued, and light farina-
ceous nourishment was allowed. With this plan the patient had every rea-
son to be pleased, for in a very little while the tenesmus began to give way,
and finaii}; disappeared entirely ; the stools, though still somewhat frequent,
lost their unheahhy appearance ; the urine was passed in nuich larger
quantity than before, ai.d was evidently impregnated with the copaiba ; in
short, the patient was relieved of all the most urgent symptoms under
which he had labored. His appetite gradually returned, his digestive func-
tions were restored, his strength increased, and in a few days he acknow-
ledged himself to be as well as he had been for years past. A flannel roller
was applied around the abdomen ; and although the weather was unsettled,
and the temperature rather low, he soon left the house, and resumed his ordi-
nary occupations.

It may be proper here to remark, that this gentleman experienced an at-
tack similar to the one just described some years before, and was treated on
the depletory and evacuating plan; According to his own statement, the
tenesmus and griping continued much longer, and the convalesence was
much more protracted on that occasion than on the present. In 1832, he
once more came under treatment for the same complaint, brought on by ex-
posure to cold and rain, aud inattention to regimen. Yielding to his impor-
tunities I administered the copaiba earlier than had been done in the pre.
ceding attack. But we had soon occasion to regret this precipitancy, for
the stomach being still in a state of irritation and the fever high, nausea,
vomiting, pain and weight in the abdomen, and other unpleasant symptoms
soon supervened, and compelled a discontinuance of the remedy. As soon,
however, as the mischief thus occasioned, and the morbid state on which it
depended had been properly corrected, the copaiba was once more resorted
to, and proved as successful as it had done before.

Case II. Casimir L., a colored man, aged about fifty years, and of a deli-
cate and sickly habit, applied to me for advice in September, 1830. He
labored under the ordinary symptoms of acute dysentery ; and informed me
that the disease had come on two days before, and had greatly increased
since the evening previous to my visit, and soon after his taking a large dose
of rhubarb. Without dwelling on the details pursued in this case, I shall
merely state that, the evacuations being frequent, the tenesmus violent, the
fever high, and the pulse tense and accelerated, the patient was as copi-
ously bled, both generally and locally, as his strength permitted. He was
freely purged with castor oil, magnesia, and epsom salts ; and immediately
after put under the use of ipecacuanha and opium to say nothing of inter-
nal and external emollients. On the third day, finding that the intestinal
disease continued with but slight mitigation, that the tenesmus did not yield
as rapidly as was desirable under the use of narcotics, and that the loss of
blood was no longer admissible, blisters were applied to the inside of the
thighs, and anodyne glysters pushed high up the rectum through the medi-
um of a gum elastic tube. As soon as by these means the inflammation and
fever had been sufiiciently subdued, the copaiba mixture, with the addition
of opium was prescribed, and was not long in producing the desired effect ;
for under its use the tenesmus, together with the rest of the symptoms enu-

408 Balsam of Copaiba, [April,

meratcd, gradually, but completely, disappeared, and the patient was restored
to his usual share of health. The convalesence in tiiis case was more te-
dious than in the preceding, owing probably to the dehcacy of the individual,
who continued for some time subject, from the least exposure, to intestinal
derangements. From these, however, he was invariably relieved by a dose
of magnesia or castor oil, followed up by a few drops of] copaiba and lauda-
num, and aided by abstinence from animal food.

Case III. The subject of this case was a lady, thirty. seven years of age,
of a week constitution and nervous temperament. She had labored, durmg
some years previous to the present attack, under the dysmenorrhoea and
other irregularities of the menstrual functions, for which the tincture of
guaiacum, and other remedies of a kindred nature were prescribed. But as
they invariably occasioned, even when given in small doses, irritation of the
bowels, attended with dysenteric symptoms, they were at first temporarily
suspended, and finally discontinued ; leeches, opiates, tepid baths, and other
palliatives being alone resorted to. These circumstances are mentioned to
show the unusual degree of irritability of the intestinal surface in this case,
and the caution it imposed as regards the administration of medicines of a
stimulating or irritating character, as well as to account for the obstinate
nature of the disease about to be described, and the disappointment experi-
enced in obtaining from the remedies used their customary effects.

In the month of July, 1831, this lady was seized with symptoms of acute
dysentery, accompanied with high febrile excitement. Antiplilogistics,
emollients, and narcotics ; bleeding, both general and local ; tepid baths,
cataplasms, and injections ; together with mild purgatives, and ipecacuanha
and opium, were resorted to. The former, however, were not carried as
far as was desirable, considering the frequency of the evacuations, the
severe nature of the griping and tenesmus, and the high arterial excite-
ment in consequence of the prejudices of the patient, and of her great
nervous irritability, which was aroused to an unusual degree, and appeared
to be aggravated by every fresh loss of blood. For these reasons, and
owing to purgatives seeming to do more harm than good, opium was more
freely administered than is commonly done, both internally, (by the mouth,
and in the form of injections,) and externally. Chief reliance, indeed, was
placed in this medicine, aided by emollients.

Under this plan of treatment, progress towards recovery "was, as may be
supposed, much less rapid than it would have been had it been possible to use
more active means. Nevertheless, though the tenesmus continued trouble-
some and the dejections frequent, slimy, and tinged with blood, amendment
in other respects was obtained. The febrile excitement, the abdominal
pain, and other inflammatory symptoms, being somewhat lessened, and the
stomach apparently free from irritation, the opportune moment seemed
arrived for resorting to means specially calculated to put a stop to the
dysenteric symptoms. With this view the copaiba was administered in
small doses combined with opium. But the expectations placed in its effects
were not realized ; for under its use the stomach became deranged, and the
intestinal complaint aggravated. It was consequently laid aside, and sugar
of lead and opium, as well as Hope's mixture of camphor water, nitric
acid, and opium, substituted ; but with no better effect the dysenteric
symptoms continuing with little or no abatement, and assuming the chronic
form.

As it appeared from these circumstances, that no advantage, but rather
positive injury, was to be expected from active remedies, or at any rate that
the gastro-intestinal organs were not as yet placed in a proper condition to
bear their impression, the treatment was once more limited to emollient in-
jections, tepid hip baths, demulcent drinks, opiates, and light farinaceous
diet ; to which were now added occasional doses of blue pill. After pur-
suing this plan for sonic time, it waa i)crceivcd that, though some amend-

1S39.] Balsam of Copaiha. 409

ment in the more urgent symptoms was obtained, it was not sufficiently
great to encourage the hope that a speedy stop would be thereby put to the
disease ; or, indeed, that the means employed could act otherwise than as
palliatives. Recourse was therefore had to other remedies ; but with the
same want of success which had attended previous trials, ^^t length the
copaiba was once more tried, and administered with laudanum in cold cina-
mon water. Finding that it no longer produced the baneful effects above
mentioned, and that the gastric derangement o.'.casioned by it was slight
and transient, it was continued for some time, the dose being increased
gradually from fifteen to twenty and twenty-five drops three times a day.
Under its use the disease gradually gave way, the patient was allowed more
substantial food, a flannel roller was^'applied around the abdomen, moderate
exercise was enjoined, and at the expiration of a few \veelvS she was com-
pletely restored to health.

It is scarcely possible, that in this and the preceding cases I should have
attributed to the copaiba a benefit referable to the powers of nature or to
the other means used, inasmuch as before it was prescribed, the change, in
neither instance, had been sufficiently great to lead to the expectation that
the disease would disappear without the further interposition of art.
Whereas the amendment obtained during its employment was much more
striking and lasting than that derived from the previous means ; and during
the time it was used, no other remedy, likely to contribute in a powerful and
prompt manner to a favorite result, was exhibited. Abstinence from solid
food, and a restriction to small portions of light farinaceous diet, Vv'ill, no
doubt, produce a very happy effect in dysentery and other abdominal dis-
eases, and there can be but iew physicians who have not seen cases in which
this simple plan has been sufficient to effect a cure without the aid of any
remedial agent, properly speaking. But it is, at the same time, very cer-
tain that, except perhaps in very mild cases, it would be unsafe to rely ex-
clusively on this plan in acute dysentery, even after the inflammation has
been subdued. It is only suitable in the really chronic form of the disease,
and in all instances the effects alluded to, when obtained, are slow in being
evinced. As regards opium, which, we have seen, was prescribed freely in
the above cases, and v/ithout the aid of which one has yet to learn how
dysentery can be treated, it is only necessary to remark that, however use-
ful it may prove as an auxiliary, we may doubt whether it can ever alone
cure the disease when the inflammation which remains, notwithstanding
the kee emplojnnent of depletory means, is somewhat severe. If, while wc
use it, the disease disappears, the effect must be attributed in great measure
to the powers of nature, which, as we know, are sometimes alone adequate
to the task, or to the other remedies simultaneously employed. At any rate,
in admitting that the powers of nature and opium are alone sufficient to
relieve the patient completely of the disease under which he labors, or that
the latter remedy can prove the efficient agent, it is presumable that the cure
will not be effected promptly ; and that time will be required before the dis-
ease gives way entirely. Nov/, in the above cases, although the irritation
was not violent, relief was soon procured, and the cure was completed in a
short time after the copaiba could be readily tolerated by the stomach and
small intestines. It may be remarked, in conclusion, that the cases above
described serve to confirm the opinion expressed in reference to the neces-
sity of the stomach being free from irritation, and of the febrile excitement
being moderated before the copaiba can be used advantageously. A neglect
of these circumstances during the second attack under which the subject of
the first case labored, led to injurious consequences ; while, on the contrary,
as goon as the gastric irritation was subdued, the copaiba was used success-
fully. In the second case, the subject of which was throughout remarkably
free from stomach affection, the copaiba was advantageously employed as
soon as the inflammation had been subdued. In the third, again, the gastric
pi

410 Balsam of Copaiba. [-A-pril,

and intestinal organs being inordinately sensitive, it was some time ere the
remedy could be employed ; yet, as soon as this morbid state was relieved,
the desired effect was obtained. It may be thought that 1 have not attri-
buted sufficient influence to ipecacuanha or to purgatives, and that had 1
used them more freely, the copaiba might have been dispensed with en-
tirely, or, at least that the patients might have been more quickly relieved.
On this subject I must be allowed to entertain a different sentiment, and
frankly to admit that I have not yet been made sensible of the advantages
resulting from active and repeated purging in dysentery, That the bowels
should be freely emptied of theip contents at an early period of the attack
depletion, general and local, being premised if the inflammation runs high,
is a fact T am not disposed to dispute. Nor does it appear less proper, that
they should be kept open throughout the course of the disease, with a view
of allaying the griping and the tenesmus. But in order to meet these indi-
cations there can be no necessity for repeated and active purging, as the
first can be met by a mercurial cathartic or two, followed by a few doses
of some mild aperient; while the frequent use of emollient injections will
in general suffice to keep up a soluble state of the bowels. Indeed, while
this plan is equally efficient in clearing the intestines of all irritating mat-
ters, it is superior to the other in occasioning less distress to the patient,
and in being less likely to aggravate the disease or retard recovery. In
order to produce the evacuant effects expected from them, purgatives must
pass along the whole tract of the alimentary canal over the diseased as
well as the healthy portions and there occasions en impression of greater
or less force according to the degree of their activity ; or they are absorbed
into the circulation, and operate on particular portions of the tube for which
they have an affinity. In either case the effect must be of a stimulating
character, for the secretory process is greatly promoted, and the peristaltic
action of the intestines excited. If such be the case, it can scarcely fail
to follow, that active purgatives will often, particularly if frequently repeat-
ed, occasion more distress and anr.0}ance to the patient, as well as more irri-
tation of the inflamed surface, tlian is safe, or is compensated for by the
evacuation of fluid. They may thereby tend to aggravate, or at least to
keep up the disease, and should the.'-efore give way to the employment of
the other means above mentioned, which either act mildly, or, as in the case
of injections, operate on the diseased parts, and, while emptying them pf
iheir irritating contents, tend to assuage pain and hasten recovery.

in respect to ipecacuanha, though I think highly of its effects, either
when used alone or in combination with calomel or opium or both-^particu-
larly in acute dysentery, I am not prepared to rely exclusively upon it in all
stages at that disease, or in the chronic form ; and whenever the yijolenco
of the disease is moderated, I have for many years been in the habit of sub-
stituting other means, under the impression that they proved more success-
ful. These opinions will doubtless excite the censure of many of tlie read-
ers of this Journal : for I am av/are that a large portion of the members of
the profession in this country have formed a different estimate of the virtues
of purgatives and of ipecacuanha in dysentery. But so fully persuaded am
I that the plan of treatment advocated in these pages, and which could be
shown to have the sanction of high professional authorities, is, to say the
least, as successful as the other, and indubitably less distressing to the pa-
tient, that I have little doubt, much of the opposition it may encounter will
cease the moment it is put to the test of actual experience.

Diarrhaa. The next subject to which I shall call the attention of the
reader, is the effects of the copaiba in the treatment of diarrhoea.

VV hen and by whom the practice of resorting to this remedy originated
I shall not attempt here to determine. It will be sufficient for my present
purpose to show, by a brief reference to a few writers withm my reach, that
for more than a century it has been countenanced by practitioners of de-
ferved reputation, and by-^wme of them warmly recommended.

1839.] BaUam of Copaiba, 411

In his work on copaiba, which was published as early as the year 1710,
Hoppe speaks of its use in diarrhoea, in a way to indicate that the practice
was common at the time he wrote. Nor was it neglected at a later
period. It has been already stated, that Dr. Pemberton recommends it ia
those cases of dysentery in which the disease, having continued for some
time, has assumed the form of chronic diarriicea and is attended with exuda-
tion of mucus and b]o(xl, occasional griping pain and tenesmus. The same
writer also used it, both by the mouth and m the form of injection, in cases
m which he was lexJ, by the offensive srteil and curdled appearance of the
discharges, to stiSpect that there existed ulcerations in the large intestines.
Halle in his notes on Tissot, and also Nysten, speak in favorable terms of
the copaiba in atonic diarrhcfea. Ribhard regards it as an advantageous
agent in the chronic form of the disease when the mucous membrane is the
seat of slight inflammation ; and Barbier of Amiens ako speaks favorably
of its effects in some varieties of the same disease. Dr. Good recom-
mends it, in a particular manner, in that form of diarrhcsa in which the dis-
charges consist more or less of membrane-like tubes, wlritish, viscous and
inodorous. He remarks, that the copaiba has proved stiR more serviceable
in such cases than the milder preparations of mercury, which he thinks are
very useful. " When in this disease I have not been able to induce the pa-
tient to take it by the mouth, I have recommended it in the form of injec-
tions. In one case, in which I prescribed it in this form, three drachms
intermixed with three ounces of mucilage of linseed being thrown up three
fim^ a day, it proved eminently useful." Br. Copeiand also advocates its
use in the chronic form of simple mucous diarrhoea, and in cases complicated
with, or depending On, the ulceration of the intestines.

Among the physicians of our own country we find, so far as my memory
extends, but a few by whom the copaiba is spoken of as an useful agent in
the disease in question. Indeed, I believe, that of the writers of note, Dr.
Eberle, again, forms an exception on the subject. In his work already
quoted (ii. 305,) he remarks that in obstinate cases the internal use of that
remedy will sometimes do much. Differing, however, from some of the
writers already mentioned, he does not think it probable that it can procure
any permanent relief in cases attended with ulceration of the intestinal mu-
cous tissue. Yet, incases of this kind, he has know'n considerable tempo-
rary benefit derived from this article. In a case of chronic diarrhoea, of
Upwards of si^ months's continuance, and depending, as Dr. E. thinks, on
Simple chronic inflzimmation without ulceration bi the mucous tissue, he
succeeded in effecting a perfect cure by means of copaiba, given to the ex-
tent of from thirty to forty ^rops thtee times daily, and fifteen drops of lau-
danum with^ach dose.

Such being the views entertained by high pfoTeSsrOnal authorities abroad,
relative to the remedial agercy of copaiba in diarrhoea, and such the neglect
It has met with at home, I shall offer no apology for devoting a few pages to
the consideration of the subject, by laying before the reader the details of
several cases, and a few remarks suggested by the phenomena presented.

'Case I.^A case Answering to the description given by Dr. Goor', of the
tubulated form of diarrhoea, and bearing some resemblance to those, of
which an account was published by Dr. Powell in the sixth volume of the
Transactions of the London College of Physicians, came under my imme-
diate notice a few years ago. The patient, a female, aged about forty years,
hid been subject, occasionally, for isometime back to a slight derangement of
the bowels. The attack in question had come on suddenly, and had rapidly
assumed a serious character. When I first saw the patient she had not left
the house for several weeks ; during which time she had taken a great vari-
ety of family medicines. She complained of pain along the arch of the
colon, and about the umbilicus. The pain was occasionally very severe and
griping, but was not excited or increased by pressure. The etomach was

412 Balsam of Copaiba, [April,

irritable ; there was some fever, and the tongue was pasty. The alvine
evacuations were not very frequent, but consisted, in great measure, of thin
unhealthy feculent matter, mixed up with a large portion of a substance
which was at first supposed by the friends, and attendants to be worms, and
subsequently by some persons the internal lining of the intestines ; but
which evidently consisted of flakes of coagulable Jymph. Leeches were
applied around the anus rnd over the epigastric region the diet was
restricted to small quantities of farinaceous articles ; and tepid baths, opi-
ates, alterative doses of blue mass, with rhubarb and ipecacuanha, were cus-
cessively prescribed. But, although by these means, the pain and irritation
were allayed, yet little impression was made on the diarrhoBtic symptoms
the discharges continuing as frequent as before, and containing the same
albuminous flakes. It was in consequence thought advisable, with a view if
possible of expediting the cure, to resort to additional means ; and selection
was made, at my suggestion, of the copaiba. It was administered both by
the mouth and in the form of injections, as recommended by Dr. Good.
Under the use of this medicine the disease gradually gave way, and in a few
weeks the patient was restored to health.

I am disposed to attribute the largest share, if not the whole, of the benefit
obtained in this case to the copaiba, because during the time it was used, no
other article hkely to exercise an agency in the cure was resorted to, and
before it was prescribed the amendment obtained was not such as to justify
a belief that the disease, if left to itself, would terminate favorably in so
short a time.

When on this subject it may be proper to remark, that Dr. Powell is of
opinion, there was no evidence, in the cases of which he has given an ac-
count, of an infl immatory process going on, as the pain was rather of a
spasmodic nature, and the skin and pulse were natural. With due defer-
ence, however, to the pathological knowledge of Dr. Powell, others may be
allowed to suspect that in the present instance he has not adopted a correct
view of the subject. To this opinion we are led by the circumstance, that
when exudations of coagulable lymph occur in other portions of the mucous
tissue, they are found to be the product of inflammation. Tliey occur in
dysentery, in croup, &c., which are undoubtedly mflammatory diseases ;
'and experience has fully shown that inflammation, ev-en of vital organs, is
not necessarily accompanied with fever and hot skin. But, however, it may
be in regard to the cases which fell under the notice of Dr. Powell, there
can scarcely be any doubt that in the instance just described the complaint
depended on inflammation. The state of the skin, the febrile excitement,
the abdominal pain, the furred and pasty tongue, and the effect of the treat-
ment to say nothing of the character of the matter discharged indicate
that such was the nature of tlie disease. Nor can this view be invalidated
by our knowledge of the stimulating property of the copaiba : the facts al-
ready detailed in this communication, as well as others to which I shall ads'ert
presently to say nothing of its use in gonorrhosa and other diseases de-
monstrate that the same remedy is used with unequivocal success in cases
depending on inflammation. Dr. Povvell relies principally on purgatives
senna tea, combined with infusien of gention and liquor of potasse. From
such remedies, however, it is not probable we can obtain any other effect
than the evacuation of the coagulable matter; supposing, indeed, that pur-
gatives will not be sometimes apt to aggravate the disease. By those who
entertain views different from those of Dr. P. relative to the pathology of
the disease, and who are sensible of the mode of operation of purgatives, it
will be readily admitted Ihat it would be more rational to resort to such
means as are calculated to remove the cause of the exudation, by changing
the action of the secerning vessels, than to trust to those that act' principally
as evacuants of the bowels.
Case II. Mucous Diarrhcca. A gentleman applied to me a few years

1S39.] Balsam of Cojmiha. 4 13

ago for advice. He liad recently returned from India, and liad labored,
during- nearly the whole passage, under bowel derangement. At first the
disease was attended with pain, and, as far as I could ascertain, with consid-
erable fever. But whatever might have been the case at first, these symp-
toms had in greet measure subsided at the time the patient came under my
observation ; for the skin, though dry and harsh to the feel, vras rarely pre-
ternaturally hot, the pulse was but moderately excited, and the pain was
seldom if ever troublesome. Thy stools were very frequent, and consisted
of a mucous-like substance, Vv'ith very little bile, and a small portion of fecu-
lent matter, and occasionally contained a fluid having the appearance of pus
tinged with blood.- The patient was emaciated, and labored under depressed
spirits the abdomen was tense and hot, the stomach ivas not much impli-
cated, and the urine was passed in small quantity, and of a red color. The
disease had come on after exposure to wet and cold, and was probably ag-
gravated and kept up by improper treatment and diet.

Believing from a review of the symptoms enumerated that the disease
depended on chronic inflammation of the lining membrane of the intestines,
and fearing the existence of ulceration, I had recourse to antiphlogistic
means, leeches around the anus, and cups over the abdomen ; followed by
ipecacuanha and opium, alterative doses of blue mass, tepid bath?, diluent
drinks, and emollient injections. Under this plan, the evacuations gradually
lessened in frequency, and the skin lost, in a great measure, its harshness
and dryness. But though some amendment was thus obtained, the disease
was not arrested ; the evacuations continuing to present the same unhealthy
appearance both as regards the color and the consistence of the matter
voided. U\ider these circumstances, and expecting little further benefit
from the remedies already used, it was thought advisable to make trial of
others of a different character. Yv^ith this vJew the balsam of copaiba was
prescribed in doses of tv/enty-five drops three times a day, with from five to
ten of laudanum in each dose according to circumstances, in a wine glassful
of cold camomile tea. Finding that the remedy did not disagree with the
stomach, and that the effects on the bowels appeared from the first, benefi-
cial, it was persevered in the dose being gradually increased, and light
nourishment at the same time enjoined. At the end of about a month the
patient was restored to health.

Whether in this case the diseased membrane was the seat of ulceration
is a point upon which I am not prepared to express a decided opinion; al-
though the appearance of the dejections, as also the long duration of the
disease, may probably be thought to justify an opinion that such vras the
case. This leads me to remark, that I am not disposed to join Dr. Eberle
in the opinion that the copaiba though capable of relieving, cannot cure
diarrhoea attendant upon ulceration of the bowels. It is well known that
these ulcerations are curable, and cases in which they are thought to occur
are cured, by the same means which succeed in those in which they do not
exist ; hence it is very difficult, if not impossible, to decide positively durino-
the continuance of the disease, whetlier or not they are present. When we
bear these circumstances in view, and remember besides, that it is admitted
the copaiba may afford relief in such cases, it is dilticultto discover what arc
the grounds for believing that in none of the cases that had got well under
the use. of that remedy the membrane was the seat of ulceration. Nor is
this all. Dr. Eberle admits that the copaiba is excellent in chronic enteritis,
and in describing the post morlem appearances in that disease, he states that
ulceration is the ordinary condition of the mucous tissue of the intestines.
By this he seems to involve himself in contradiction, for it is not probable
that ulcers exist only in cases that terminate fatally. As they are not ne-
cessarily fatal they may be presumed to have existed also in individuals who
recovered ; and if the copaiba had contributed to their cure, there can be
no reason to deny that it is adequate to the same task in chronic diarrhcea

414 Balaam of Copaiba, [Ap

rili

which dissection shows is generally accompanied by ulceration, and between
which and chronic enteritis there appears to be a distinction without a dif-
ference.

But be this as it may, it is not my wish to ascribe to the copaiba the whole
credit of the cure in the case last described. The remedies previously em-
ployed, aided by proper regimen, had evidently produced much good ; they
might perhaps have sufficed, in time, to effect the desired object, and had in
^11 probability placed the patient in a situation to get well more readily than
he would otherwise have done. But from what we know of the effects of
the copaiba in mucous inflammations generally, and particularly the disease
before us from the known protracted nature of such cases when treated
by other means or when left to the powers of nature, we may reasonably
presume that it was instrumental in shortening the duration of the disease
or even effecting the cure.

Case III. A young female, about twenty-two years of age, applied 16
me for advice, in November 1834, for the ture of diarrhoea. The disease
was of four months standing. The patient was somewhat emaciated her
complexion was sallow, skin dry and husky, pulse \yeak and frequent. Her
appetite was capricious, and thirst troublesome. The abdomen was a little
tender to the touch, and the evacuations were very frequent, particularly
towards morning and evening, and were attended with severe griping pain^
and often with tenesmus. The matter discharged consisted of a stiiall
quantity of thin, unhealthy feculent matter, mixed with pieces of undigested
food, and a large portion of mucus ; the whole generally tinged with blood.

The patient had been, on different occasions, under regular medical trea'-
ment, and had besides made use of a number of family and popular medi-
cines ; but without more than temporary relief.

Cups were ordered to be applied along the arch of the colon, and over the
right iliac region, and blue pill, followed by rhubarb and magnesia, prescribed.
To these succeeded small doses of ipecacuanha and opium, lime water and
milk ; while boiled milk and water crackers were allowed for nourishment.
From the local depletion some advantage was obtained ; the tenderness
and tenseness of the abdomen being a little mitigated. But so far from any
benefit being produced by the other remedies, the disease in a few days ap*
peared rather aggravated than otherwise- -the stools being more frequent,
and attended with more griping, and considerable nausea. The ipecacuanha
was discontinued; and, as soon as the gastric distress had subsided, re-
course was had to the copaiba, which was administered three times a day
in doses of fifteen drops, with five of laudanum, in a glassful ot CaWomile
tea ; the patient being at the same time allowed at her oWh repeated solici-
tation, water crackers, and boiled flour mixed with milk and water lor nour-
ishment, and cold toast and water for drink. The evacuations being still
attended with pain, and the abdomen tender and tense, the local depletion
was directed to be repeated ; but this being objected to by the patient, a
flannel roller and emollient injections were substituted.

From this plan a sensible amendment was obtained before the end of a
week. The stools were reduced from ten or twelve, to four or five in the
twenty-four hours, and the griping, though still troublesome, was lessened in
degree. The copaiba was increased to twenty. five drops three times a day;
and at the end of another week the patient reported that the evacuations
were reduced to two or three in the twenty-four hours, and were attended
with less pain ; that the matter discharged was of a firmer consistence and
healthier appearance ; and that her appetite was good and her thirst less
troublesome. The remedies were directed to be continued ; but in dimin-
islied doses.

The disease continued with but little further abatement until about the
1st of December, when the intestinal derangement appeared to yield; the
appetite became better, the stools were re,duGed to two, at most, in the

1839.] Balsam of Copaiba. 415

twenty -four hours; the matter evacuated assumed a very natural appear-
ance. The copaiba and laudanum were gtili farther reduced in quantity,
and more nourishing food prescribed. On the seventh of the month, in
consequence of exposure to cold and humidity, the disease was of a sudden
considerably aggravated, and was attended with pain and fever ; but after a
few days it gave way to proper remedies. The copaiba was resumed ; ani-
mal jelly was allowed ; and this was followed, on the twenty-second, by solid
food. The medicine was in a day or two discontinued, and on the 2d Janu-
ary, the patient reported that she was now perfectly well.

The agent in the cure of this case is, I think, easily recognized. The
quantity of laudanum added to each dose was very small, too much so to
exert a decisive effect on the disease, and only sufficient to place the sto-
mach in a condition to support the other medicine. Besides, previous to
the time the copaiba was prescribed, opium was administered, in substance
And in various of its preparations, by those who preceded me in the manage-
ment of the case ; and the patient had, of her own accord, taken, for several
days, repeated doses of laudanum, and never with more than temporary
rehef. It is not probable, that if of no service as a curative means, if
only beneficial as a palliative, when thus prescribed freely, it can have had
the principal agency in the removal of the disease when admmistered in
minute doses conjointly with another medicine. As regards the articles of
nourishment that were allowed, it may fairly be doul?ted whether they could
be sufficient to effect a cure in a case of this kind. In mild attacks of
diarrhoea, unattended with signs of severe irritation, there is little doubt
that a proper regimen will often be sufficient to enable us tp attain the ob-
ject. But when the, disease assumes a severe character rwljen it proves
obstinate, it is in general found that other and more active means a^e
required. Considering, indeed, the presence of griping, of tenderness of
the abdomen, and other symptoms of the kind, it is probable that more phy-
sicians will be disposed to censure the use of such articles as were allowed
in the case before us, than to approve of them ; and that, therefore, few
ivill refus.e to coincide with me in denying to them the principal agency jn
the cure.

From this it follows that, if the favorable termination of the case cannot
be ascribed to the opiates, or to the articles of nourishment employed, we
must necessarily refer it to the remedial agency of the copaiba ; particu-
larly as its beneficial effects in other instances of a similar or kindred kind
have been well ascertained. While the local depletion produced relief but
of one symptom only ; the purgatives and other remedies employed, if they
did not aggravate, at any rate did not arrest the disease ; and the flannel
roller and emollient injections, though excellent adjuvants or palliatives, are
not by themselves adequate to the task of eradicating the cause upon which
such diseases depend.

In conclusion, it may be proper to remark, that other remedies, often era-
ployed successfully in the treatment of severe and protracted diarrhoea, were
not resorted to, partly because the patient objected to them, but principally
because it was desired to make a fair trial of the copaiba, the efficacy of
which was already well known. Whether this plan was judicious or justi-
fiable ; and whether a cure might have been more speedily obtained by
other means, can only be decided by those who have made trial of the rem-
edy in questions, and compared the results with those obtained from other
modes of treatment.

Case IV. In a case of feculent diarrhoea which came under my notice
in the Autumn of 1833, the balsam of copaiba', though it did not effec ta cure,
was sufficiently serviceable to justify an account of its effects. The pa-
tient, Mr. J. B , about sixty five years of age, had been for a long while
subject to attacks of hemorrhages from the bowels. These came on at
irregular periods, and generally continued with longer or shorter remissions

41G Balsam of Copaiba. LApril,

(lurlno^ a day or two. They were considered in the light of a salutary effort
of nature to unload the vessels of a superabundant quantity of blood ; par-
ticularly those of the brain, which had a tendency to fulness, and they were
unconnected with intestinal disease. In August lei33, this gentleman was
attacked with hemiplegia, and palsy of the tongue ; both of which, how-
ever, together with the cerebral inflammation winch supervened, were re-
moved by active antiphlogistic and revulsive mean?, and mercurial ptyalism.
A short time after this .Mr. JJ. was seized with febrile symptoms attended
with considerable determination of blood to the iiead, which gave way m a
few days to depletion and mild purgatives. From this period, however, he
remained subject to frequent attacks of bowel complaint, preceded by con-
fusion in the head, and occasionally severe vertigo. The diarrhoea generally
continued three or four or even more days, and had the efiect of relieving
the cerebral derangement. In this respect it may have been salutary ; but
as the discharges, which consisted of thin feculent matter, mixed occasion-
ally with a large portion of blood, were at times frequent and copious, they
finally produced considerable emaciation and debility. In consequence of
this It became necessary to restrain these attacks within safe limits, with-
out, however, putting a stop to their return, and thereby losing the advantage
of the derivative action they occasioned. For this purpose the balsam of
copaiba was prescribed, after an inettectual trial of other means, and was
used alone during the intervals of the attacks, and in combination with
laudanum when the discharges were carried too far. From this plan, aided
by restrictive and appropriate diet, the desired effect was obtained. The
bowels v.'ere kept in a soluble state ; and though i\lr. B. continued subject
to attacks of diarrhoea, these gradually lost much of their former seventy,
and came on at longer intervals ; whUe, the cerebral-derangement was les-
sened in foic9, and the patient improved in flesh and strength.'*'

As the relief in this case (in which, for the reasons assigned, a complete
cure was not attempted) followed immediately after the copaiba was resort-
ed to, and as other means had failed, it cannot be improper to ascribe it to
that remedy. But whatever may be the opinion of others on this subject,
there cannot be any doubt as to the eflicacy of the copaiba in the following
case.

Case V. Miss Isabel D , aged thirteen years, was attacked, while

travelling during the summer of lb32, with looseness of the bowels. The
discharges were at times frequent and copious, and attended with some
griping pain. But, as the friends of Miss D.were of opinion that the dis-
ease arose from, and was kept up by change of water and inattention to
regimen, and that it v/ould give way as soon as the subsidence of the chol-
era, (which then provailed in this city,) would allow them to return home,
nothing of importance was done to check it. In this expectation, howev*er,
they were disappointed ; for although the patient was placed under medical
treatment soon after her arrival, the disease continued with short intervals
of respite until the commencement of the following year. Various reme.
dial means local depletion, revulsives, opiates, alteratives, astringents,
chalybeates, tonic?, aided by proper regimen, were successively resorted to;
but to httle purpose. The disease was, it is true, occasionally mitigated for
two or three days, or even for a week or more at a time ; but it invariably

* Mr. B. adhered with good eflTect to this plan for some months. Gradu-
ally, however, he relaxed in his attention to his health. He indulged in the
luxuries of the table ; ate copiously, and finally abandoned the use of the
copaiba. He refused to resort' to the active means required to relieve his
attacks of cerebral irritation ; whicli increased in frequency and violence,
and produced considerable emaciation. His bowel complaint became very
troublesome, and he died in March 1835.

1839.] Balsam of Copaiba. 417

returned with renea-ed violence sometimes from imprudence in diet, at
others, witliout any assignable cause. Tlie longest interval of relief was of
five weeks continuance ; and was apparently obtahied through the agency
of col umbo powder. But as, during the whole of that period the patient
was strictly kept on small quantities of cold roasted fowl and stale bread
a regimen which experience had shown to agree with her better than any
other ; and as her other symptoms were little amended, and as she relapsed
whenever a change of diet was allowed, or the medicine was omitted, it
may be doubted whether any substantial amendment was obtained of the
morbid state of the intestinal tissue, upon which the diarrhoea depended.
But, however this may be, after the recurrence of the jdisease, the remedy
above mentioned no longer produced any beneficial effect.

The number of stools was seldom less than six or seven daily ; and they
consisted generally of dark, thin, offensive, and frothy feculent matter, mixed
often with portions of undigested food. In the progress of the disease, the
skin became dry and harsh to tne feel, and of a waxy appearance ; emacia-
tion and debility gradually supervened, attended with thirst, and a feeble and
accelerated pulse. The appetite continued notwithstanding nearly as before
the attack, and although the patient was usually disturbed once, and some-
times twice in the night unless she took opiates the evening before, her
sleep was quiet and refreshing.

Such was the condition of Miss D. when my attention was more particu-
larly called to her case. Finding that none of the remedies heretofore
employed had produced permanent relief, and recollecting the salutary
oflects obtained from the balsam of copaiba in similar complaints, it was
prescribed in doses of twenty drops, with three of laudanum, three times a
<lay. The benefit derived from it exceeding my warmest expectation ;
the discharges soon diminishing in frequency and improving in appearance.
The medicine was increased in quantity, and the laudanum gradually omit-
ted. The patient, who had been kept on the diet already mentioned, was
allowed to resume gradually her ordinary food, and experienced no ill effects
from the change, fehe gained strength and flesh ; her skin resumed its
natural appearance, and in the course of some weeks she was enabled to
discontinue the use of the medicine.

When we bear in mind the longstanding and obstinacy of the disease in
the foregoing case ; the failure of all the remedies employed ; the relief
obtained soon after recourse was had to the copaiba, and the permanency of
that relief; when, besides, we compare this result with that obtained from
the same remedy in the cases already described in the present communica-
tion, and in affections of other portions of the mucous membrane, it appears
evident that the credit of the cure is ascribable to that agent and to no
other. The conclusion is the more natural, as no other remedy likely to
produce the effect was employed in conjunction with the copaiba, except
laudanum. But as this had failed before being used with the former, though
administered in large doses ; and as it was laid aside before a cure was ob-
tained, it is impossible to lay much stress on its operation. As regards the
regimen, it will be sufficient toremark, that it was similar to that which had
been allowed from the time Miss D. was first placed under treatment; and
that as it did not succeed in curing the disease before recourse was had to
the copaiba, it is not probable it was\more effectual at a subsequent period
of the attack.

Case VI. Chronic Enteritis. In speaking in another place* of the
efficacy of the balsam of copaiba in disease of the urinary organs, I stated
that that remedy could be employed usefully, not only in cases characterised
by an increased mucous, or by suppurative secretion ; but also in certain
varieties of irritation of the lining membrane of tlie bladder, unattended by

* American Journal of the xMedical Sciences.
e5

418 Balsam of Copaiba. [April,

either of these changes. The following case will serve to show, that in
complaints of the aumentary canal dependent upon clironic inflammation,
but unconnected with symptoins of dysentery, or of diarrhoea properly
speaking, the copaiba will be found, at least sometimes, highly useful.

Miss ;VL, aged about twenty-five years, of a bilious and uervous tempera,
ment, had been subject for along period, to attacks of gastro-intestinal irri-
tation. Late in the autumn of 1825, she exposed herself during her cata-
menial period, to a current of air, immediately after coming out of a warm
bath. The consequences of tins imprudent act were soon manifest : she
was attacked with chill, followed by hot fever and acute pum in the left iliac
region ; and the menstrual discharge was suppressed. The pain was aggra-
vated by pressure and the least change of position, and was accompanied by
a sensation of weight in the uterine region, frequent desire to urinate, con-
stipation of the bowels, thirst, &c.

Presuming, from this assemblage of phenomena, that the patient labored
under peritoneal inflammation ; and that the left ovary and the neck of the
bladder were probably impUcated in the morbid state, recourse was had to
active depletion, general and local, emollient application?, diluent drinks,
enemata, mild purgatives, and finally to a blister over the parts affbcted.
By these means Miss M. was so cflTectually relieved, that in the course of a
few days she was allowed light nourisjiment ; and soon after was enabled
to leave her bed. She did not remain long, however, in this favorable situ-
ation ; for in a few days she experienced, in consequence of inattention to
diet, a return of the disease. This attack was more alarming than the
preceding one, inasmuch as, independently of the morbid state already
described, she now suffered from an inflammation of the lining membrane
of the digestive tube and of the vagina ; and, owing to her present debihty,
it was found impracticable to carry energetic measures to the extent usually
required in complaints of this kind.

By means of local depletion, however, proportioned to the strength of the
patient and the state of the pulse, as well as of emollient applications, and
external revulsives, the most urgent symptoms soon gave way. But the
irritation of the intestinal mucous membrane assumed a chronic character,
and continued after that of the serous tissue had entirely subsided. The
patient now complained of pain between the umbilical and epigastric re-
gions, particularly a few hours after taking food. The tongue was red at
the edges, and there was thirst ; the appetite though not lost was feeble
and irregular. The stomachic digestion was not much impaired ; but the
intestines performed their functions in a very imperfect manner, being usu-
ally costive, at times preternaturally relaxed, and the passage of food through
them being attended with pain and considerable flatulence. The skin was
pallid, and of a slightly yellow tinge, and became warm and dry towards
evening. At other times its temperature was a little above the natural
standard, with the exception of the feet and hands which were cold. The
pulse was accelerated and small, and there was slight oedema of the face
and ankles. The nauscular strength was much reduced, and the menses
suppressed.

To combat this morbid state of the intestines, moderate antiphlogistic?,
emoUients, alteratives, and a mild regimen were employed, and persevered
in for some time ; but they failed in making a strong impression on the dis-
ease. At this period a medical friend of the family was consulted, who
came to the conclusion that the combination of phenomena presented was
ascribable to the suppression of the menses ; and that this suppression was
probably occasioned by a rheumatic affection of the uterus. In conformity
with this opinion, and regardless of the condition of the lining membrane
of the alimentary tube, which he regarded as of secondary moment, and
likely to subside as soon as the uterine disease had been eradicated, the
vol. tinct. guaiacura was recommended, in teaepoonfui doses three times

1639*] Dahcm of Copaiba. 419

daily. This remedy was selected on account of its emenagogue and anti-
rheumatic virtues, as well as from its having, as was stated, succeeded in
the hands of the adviser in several cases of the same kind. Opposition waa
made both to these pathological views and to the use of the guaiacum ; from
a fear, that it would aggravate the intestinal irritation, which whether pri-
mary or secondary demanded serious attention. However, seeing that the
remedies heretofore employed had failed, consent was reluctantly given to
the adoption of a mode of practice, which, irrational as it might appear to
him and to some of his friends, was enforced with a promise of success by
one in whose experience and skill great confidence was reposed. But the
hopes thus raised were not destined to be realized, and the guaiacum, so far
from displaymg advantageously its anti-rheumatic and emenagogue virtues,
produced an aggravation of all the prior symptoms, and, in addition, brought
on an infjamraatory irritation of the rectum, attended with pain and dysen-
teric discharges.

The medicine was in consequence discotitinued, and was replaced by an-
tiphlogistics and emollients, by means of which the patient in a few days,
gained the state in which she had been before the recent aggravation of her
malady. But though the effects of the guaiacum were tlius obviated, no
advantage was gained over the original disease, which continued its course
with little or no change for some time, when Miss M. was placed under the
use of the balsam of copaiba. This reniedy was recommended on the
ground, that it had been found useful in irritation of the bladder, unattended
by a secretion of mucus or puriform matter ; that in the case under treat-
ment the inflammation was in all probability situated in the lov/er portion
of the small intestines, and not in the stomach or jejunum. In its passage
down, the remedy would probably be absorbed before reaching the diseased^
spot in which case the latter would be placed in the same relation as re-
gards the copaiba, as other and more distant portions of the mucous mem-
branes in the diseases of which it is found useful. Experience had proved
it to be often of great service in dysentery and diarrhoea ; and if so, there
was reason to think that even supposing it not to be absorbed before
reaching the diseased surface it might be equally efficacious in the present
complaint ; in as much as it was highly probable it did not act in the former
cases in virtue of its astringent properties, but by altering the morbid action
upon which the discharges depended.

The copaiba was directed to be taken in cold water, in doses of twenty-
five drops twice a day, and to our great satisfaction was found, in the course
of eight or ten days, to have produced a marked amendment in the disease.
Encouraged by these results, and finding that though the medicine was
swallowed with repugnance it did not disagree with the stomach, it was
ordered to be repeated three times a day, with the addition of a few droj:s
of laudanum, to guard against its acting upon the bowels. This course
was pursued during three weeks ; at the termination of wiiich period, the
disease having nearly subsided, and the digestive functions being almost
restored to their normal condition, the patient was allowed to discontinue
the copaiba, and to partake of better fare. A short time after this she was
sent to the country, whence she returned much improved in appearance and
strength ; her catamenia re-appeared, and she was at length res'.ored to the
enjoyment of health.

At the date of the occurrence of the above case, I vi^as not aware that
the copaiba had been employed successfully in the peculiar form of chronic
enteritis, under which Miss M. labored. Since then, however, and indeed
since drawing up the preceding account, 1 have found that the practice, like
every other thing under the sun, is not new. In his Practice of Medicine,
Dr. Eberle enumerates the remedy among the most useful in such affectionF,
But of Dr. E.'s experience with the copaiba in the management of chronic
nteritie I could know nothing in 1825 ; as he is silent on the subject in hi

420 BaTsam of Copaiba. ' [April,

Materia Medica, published a year or two before, and his other work, above
alluded to, only made its appearance in 1830, or 1831. At what period Dr.
E. discovered the efficacy of the balsam iu such cases does not appear.
But, however this may be, the testimony of this distinguished writer is of
great value, as it will doubtless serve to settle the question respecting the
propriety of the practice.

The balsam of copaiba has been used as a vermifuge medicine ; and is
regarded by Dr. Ribes and others as highly efficacious for the destruction
and expulsion of the different varieties of intestinal worms. It forms a
component part of several preparations employed in cases of taenia and
lumbrici. Alerat and Delens {Die. de Mat. Mul. vol. ii.) state that the co-
paiba has been efficaciously used by a medical practitioner of Lyons in a case
of taenia. But the fullest and most satisfactory account we have on the
subject, is recorded by Chauffardof Avignon, in one of the volumes of the
Transactions MkUcales of Paris (13 p. 29 July, 1833.) A soldier of the
garrison was admitted into the liospital of Avignon, under the care of Dr.
C, for gastric fever. He recovered from this disease in due time. But
being affected with gonorrhcea he was retained in the establishment, and
put under the use of Chopart's mixture, wjiich contains a large proportion
of copaiba. Soon after taking the medicine, he was troubled with borbo-
rygmi, accompanied with noise in the abdomen and salivation. These con-
tinued during several days; but as the pulse was not disturbed, and the
skin was cool, the tongue moist, and the appetite good, those phenomena
were attributed solely to the ingestion of the copaiba. Finding that the
medicine did not produce any serious derangement, and that the gonorrhoea
was getting weW under its use, it was canlinued ; and on the eleventh day
the patient voided, both to his own surprise and that of the physician, a very
long taenia, which appeared to be entire and alive. It is worthy of notice,
that the patient had, for a Jong time prior to the attack of fever fur which
he was admitted into the hospital, enjoyed good health, and had experienced
none of the phenomena usually indicative of tlie presence of such a worm
in the alimentary canal.

Dr. Armstrong suggests the propriety of using the copaiba in what has
been denominated the schirro-contracted rectum, on the supposition that it
will keep the fasces in a liquid state an effect very much to be desired as
the patients are always more easily cured when it occurs. It may he thinks
from its specific operation on the lining membrane of the intestines, con- .
tribute to induce a favorable change of action on the morbid part itself.
How far Dr. A.'s supposition on this subject will be verified by experience
I am unable to decide, as I have not had occasion to employ the copaiba in
cases such as he alludes to. Nor can I say any thing positive of its use in
what has been denominated anal leucorrhoea, or white discharge from the
anus (Hcemorrhoides albce mucosa:, of some writers.) Moutegre, in his ex-
cellent treatise on Hemorrhoidal Affections, recognises the existence of sev-
eral varieties of the anal leucorrhoea, according as the disease is true or
inflammatory ; false or ulcerous ; symptomatic or venereal ; acute or chronic.
In the first variety the inflammatory ; he recommends antiphlogistics ; and
when the urgent symptoms have been removed, and the disease has assumed
the chronic form, he prescribed eccoprotic purgatives, tonics, and finally bal-
samic medicines, at the head of which he places copaiba.

Montegre, however, prescribes the medicine with no otlier view than to
arrester lessen the discharge in these cases. But there is every reason to
believe that, if it be beneficial at all iu hemorrhoids, and of this there can
be no doubt, it does not operate solely by virtue of its astringent properties,
but by modifying the diseased condition of the tissue on which the dis-
charges depend, and thereby restorino- it to the healthy state. The only
case of disease approximating to. the description given of anal leucorrhoea
in which I saw the copaiba employed, occurred a few years ago. The pa-

1839.] Balsam of Covaiha. 421

tient had long* suiTered under the complaint, and had been under the cnrc
of a great number of physicians, both in Europe and this country. The
discharge had come on soon after recovery from a scorbutic afTection, and
was suspected by some to depend on a venereal taint. A variety of gt;n-
eral and local means was resorted to in vain. The balsam of copaiba
was allowed a fair trial ; but although it seemed at first to dhuinsh the dis.
charge, and to modify its nature, it soon lost its efiects, and was in conse-
quence laid aside.

1 can speak with more confidence of the efficacy of the copaiba in piles.
On this subject, neither Montegre, Larroque, nor Lalvert say a word. Tije
last writer, however, remarks that in some forms of the disease, cubebs and
oilier remedies of the sort are useful, and among these we may perhaps sup-
pose that copaiba is meant to be included. But if the writers vvc have
named are sdent on this head, others speak in decided terms of the good
effects of the remedy in the disease in question. The late Dr. Cullen was
in the habit of prescribing it with, as he informs us (Mat. Med. ii. 13.5 Am.
ed.) great advantage. He derived the practice from an empirical practi-
tioner. Motherby states that the copaiba gives relief; Parr that it is occa-
sionally trusted to ; Mr. Brande that it has been found effective ; Dr. James
Johnson that it is a valuable remedy in the disease in question. With the
late Dr. Kuhn of this city it was a favorite remedy, and among our present
practitioners there are, to my certain knowledge, several who will wilhngly
join in the opinion that it sometimes proves highly serviceable. To specify
the kind of cases in which it is more particularly applicable, and to point
out the manner in which it operates, are undoubtedly objects of considera-
ble interest to every physician. But on these subjects T cannot at present
say more than a few words. Judging from what I have had occasion to
observe myself, or from all I have heard, I am disposed to say, that when
there is much vascular irritation in the parts, the copaiba will not be as use-
ful as when this morbid state has been reduced bj; antiphlogistics, and tlie
discharge consists in part of mucus. Dr. Good entertains the same opin-
ion, and remarks that he has often tried the remedy in the disease proba-
bly in the other varieties without benefit. Dr. Cullen, though he does not
express himself very positively on the subject, seems inchned to ascribe the
benefit he obtained from the copaiba to the laxative operation of this medi-
cine. While Dr. Good, from numerous trials, is induced to ascribe its salu-
tary effect rather to the common principle on which it acts on the mucous
membranes generally, than to the above mentioned power. On this point
I have no hesitation in coinciding with the last mentioned learned physician ;
both on account of the effects obtained from the copaiba without its oper-
ating as a laxative in diseases of the mucous membranes of the lungs,
bladder, and intestines ; and in consequence of finding that in hemorrhoidal
cases, in which it has proved eminently serviceable, laxative medicines had
been used unavailingly; and that it has afforded relief without increasing
the alvine evacuations.

432 Contagion and Quarantine. [April,

Contagion and Quarantine.

It is not a little surprising to see how slow the world is in
receiving some of the most palpnple truths; whilst a mere spec-
ulation, a hoax, or any thing which has about it the charm of
novelty, will, like a swift epidemic, flash over the world, even
if it mark its way by famine, pestilence, and death. We
acknowledge with regret, the fact, not only in politics, in reli*
gion, and in commerce, but also in medicine and all sciences of
capital importance VVc know not how to account for it, con-
sistently with our hopes and desires relative to the character of
the liuman intellect. But there has always been evinced a
strange willingness to receive opinions or assertions from ances-
try as we would fortunes, without examination or care relative
to the manner in which they were obtained. Perhaps these
opinions are early imbibed from those authors or teachers whom
we respect, and in whom we confide, before our own judgment
is sufficiently developed for their rigid scrutiny ; and having
once adopted them, pride comes in the way of a just and fair
criticism, and party spirit is finally aroused to their support.
Or perhaps we are too lazy to undertake the exarcise of our
own reasoning from the evident or established facts in the pre-
mises.

In this way the w^orld has always been, relative to the conta-
giousness of many diseases. And such has been the weight of
numbers and character in the maintenance of the doctrine of
contagion, relative to many diseases which were not so, that few
have ventured to come forward with noble independence, and
proscribing former mere assertions, appeal to simple facts and
draw^ from them proper conclusions. Yet in almost every age
and country, there has been a small minority who have been
honest and hardy enough to go in advance of popular opinion,
and occupy the firm ground of demonstrated truth, but they
have been as the distant islands of the sea, or the oases of the
desert, isolated and lonely. Still, such is the power of truth,
though opposed for a time though contemned, abused, and ridi-
culed, and every inch it claimed contested to the last extrenf>ity
of power, with the help of time, great labor and new generations,
and the continued pressure of misfortunes, it has been able to
prevail to a good extent in particular cases. But great and sys-
tematic men seldom live to witness their own glory in the exten-
sive prevalence of those truths which they have descried far
ahead of the common mind ; yet when the nobler faculties are
early developed, and life protracted through many septenniads,
it is sometimes the case, to a considerable extent ; whilst on the
other hand, the author of a false, but fanciful and captivating
doctrine, will often live to reap and enjoy for a time hisilJ earned

183D.] Contagion and Quarantine. 423

honors, and, witnessing their latter end, sink into oblivion. In-
stances of the former are found in our own Rush, the choice
home spirit of the past age ; and in Dr. James Johnson, the great
head of foreign medical mind of t!ie present. The former deter-
mined for iiimself the fact of the non-C(;ntagiousncss of yellow
fever, and lived to see the mighty inroad which he had made into
the policy of quarantine, against yellow fever ; and, seconded and
sustained by converts to the truth of his doctrine in Europe and
America, who were willing to test the great truth, by even
swallowing the black vomit from this disease ; this truth, we
had hoped, pervaded the civilized world until we witnessed,
during the past year, the trammelling of coinmerce again by
quarantine against Charleston on account of the prevalence of
yellow fever in that afflicted city during the past season.

A somewhat similar ground has been occupied by Dr. John-
son, relative to Asiatic cholera, who has lived to witness the
prevalence of the truth of his position. But several circum-
stances have tended to assist him in an easy and early arrival
at this consummation. Hush had pinionered with much suc-
cess in the almost untravelled region of non-contagion the way
was open in regard to one disease, and the public mind some-
what relaxed from its tensive grasp on the error of contagion.
Besides this, the opposition in India, when his sentiments were
first adopted, was inconsiderable ; whilst his character at home,
for accurate judgment, was fair, and without the opposition of
claims on alleged facts of experience, as the cholera had not
yet pervaded England. Still, however, when it did appear, a
storm of contention from benighted Russia, with its more pesti-
lential breath reached Sunderland, and for a short time, spread
dismay over the great metropolis. But, as after the first shots
in battle, the dismay soon passed over, and the public mind
received the dignity of truth for which it had been so well pre-
pared. We are pleased to witness these conquests of truth over
error, not only for the honor of the human mind, but for the bene-
fits of commerce; and above all, for the good of humanity. It
would be behind the advance now occupied by the enlightened
and liberal minds of the present day to enumerate the injuries to
humanity which necessarily attach to, or rather result from, the
fact, or the mere idea of contagion. Let it suffice, to say, that
there is no promise of success in preventing or curing a disease,
the cause of which is not understood to some good extent; and
that, whilst the attention is captivated and absorbed by the cry
of contagion, all other sources of causation are neglected. There
are yet many other diseases for which, from the foul charge of
contagion, humanity cries aloud to the mental energies of the
land. And we trust that those who are within the call will not
be backward in coming up to the rescue. Meanwhile we ex-
tract from the proceedings of the British Association for the ad-

421 C .nUigion and Quaianlhie. [April,

vancv^meiU of science, as containcil in the Eclectic Journal from
the Alhen^f uni, the observations ot Dr. Boki?;g on Plague and
Quarantine, as iuliows :

Dr. Boring apologised for coming before the Section, he not being a medi-
cal man, bul iia\ ing travclJed in the East lor the purpose of observation in
reference to our cuinrnercial relations, his attention had been naturally di-
rected to the subjects of plague and quarantine subjects the importance of
which could hardly be overrated, many millions being annually lost to this
country from quarantine regulations. The results of his observation had
produced a strong conviction of the non-contagion of plague ; and he
ihougiit it right therefore, to lay before this Section a few remarks on the
subject. He alluded to the very secondary charcxter of the facts, on which
the prevalent opinions were founded. Some were so absurd as not to be
worthy of the slightest attention : such as plague being introduced at Leg-
horn, by the unrolling of a mummy that had Leen buried for 2000 years,
at Constantinople by the wing of a bird having touched a kite which a boy
was tiying from a house top, from a cat having been seen to jump into a
basket in which were some clothes, from which the disease was subse-
quently caught. Dr. Bowring said, that physicians residing in the East
were rapidly changing their opinions on the subject, but they were pre-
vented in many instances from freely expressing them, by the interested
Boards of Health, who neither hked to part with their extensive power,
(even of life and death,) or with their salaries. Clot Bey was a decided
anti-contagionist, and that after an experience of 8,^000 or 10,000 cases.
Dr. Bowring mentioned many cases where facts were distorted, or invented
to account for cases of plague from contagion ; and in one remark.ible in-
stance, where the misrepresentations were exposed, it was denied that the
case was plague at all, because they could not maintain their assertion of
contact having taken place. The Mussulmans are by their religion non-
contagionists, and Dr. Bowring hoped they might never become otherwise,
as the aggravation of the calamity would be tenfold if they did. The opin-
ion as to the contagious nature of the disease prevailed principally amongst
the Levantines and Franks ; but every other superstition was as readily
believed by them. He had collected the most solemnly attested evidence
of the appearance of Peris and Genii, and of the intermarriages of the
former with mortals : he had collected more strongIy.attested/<zc^s on these
subjects, than on the contagious nature of plague. Dr. Bowring asserted
that, from innumerable instances, quarantine appeared to give no security,
and was of opinion that these establishments were mere political engines,
of great power and convenience in a despotic country. In the lazarettos
the whole correspondence of the East was read. The Russians had a
most perfect system of quarantine, yet the plague got into Odessa. In
1831 quarantine and lazaretto establishments were introduced into Egypt,
under the superintendence of the Consuls, yet the plague got into Egypt.
In Jaffa it broke out in the house of the Russian Consul spontaneously, and
in Jerusalem in a convent, with which there could have been no communi-
cation. In the lazarettos, a little disease was miade a great deal of; in one
instance a greater number died from dysentery than from plague. Lazar-
ettN?, he continued, rather increased than diminished the evil. If a strict
separC>i9n could ensure safety, the Pacha's harem would escape ; yet in
1835, sev?ndied there of plague. It appeared at one time in Old Cairo,
and not in New, and vice versa, altliough there was constant communication;
the same was true as to Cairo and Alexandria. The disease never pene-
trated Nubia, though constantly on the borders^, and frequent intercourse
taking place. In Cairo on one occasion 400 or 500 houses, whose inhabi-
tants had all perished, were subsequently opened, the Imen and clothes in

1839.] Contagion and Quarantine. 485

them sold in tlie market-place, witliout any cases of plap^ue resulting. Clot
Bey had again and again inoculated liimself without producing the disease.
Dr. Boulard wore the clothes of a patient, who died of the disease, for
twenty-four hours, without catching it. The following information was
communicated to Dr. Bo wring, by a physician of long experience, in an-
swer to a series of direct queries, viz : that it is indigenous in Egypt, never
entirely absent, never imported, that \t frequently occurs spontaneously, that
cordons afford no security, tiiat contacts very fre<iuently did not produce it,
and that the most cautious frequently suffered from it ; that free ventilation
was effective in checking the disease, that it was not produced by linen
which had been exposed to the infection, and that when a number of per-
sons exposed to its influence removed from the spot, the mortality became
much diminished. Dr. Bowring concluded by expressing his own strong
conviction on the subject ; but he had no object but to promote the discovery
of truth, which could only be done by patient and serious inquiry, and by
evidence of a primary character.

Dr. Lynch begged leave to propose a resolution, to the effect, that Dr.
Bowring's paper should be published. Mr. Green how could not but remark
on the strong analogy, which existed between the statements of the learned
gentleman on plague and lazarettos, and the events which occurred in this
district relative to cholera and cholera hospitals. He also requested Dr.
Bowring to furnish a copy of his observations to the Secretaries. Dr.
Granville opposed the motion of Dr. Lynch. The communication he con-
tended was not strictly medical ; it was political, not pathological : he must
oppose too the deductions of Dr. Bowring ; he was not indeed present at the
commencement of his address, but that was the less necessity as he had
heard the whole subject in detail, on board the Ocean steam-packet. It
was not by declaiming on the superstition of the Levantines, or by the elo-
quent introduction of Peris, Genii, and Vampires, that a strictly pathological
question could be decided, nor by false inferences from bad Boards of
Health. The chairman interrupted Dr. Granville, by protesting against
this line of personal attack, and allusion to what had taken place elsewhere.
After some desultory observations, Dr. Lynch's motion, somewhat modified,
was passed. Dr. GranviUc thon begged leave to propose that the Com-
mittee should make application to Her Majesty's Government for a grant to
be applied to the purposes of inquiry into the important subject of the con-
tagious or non-contagious nature of plague. This motion was passed unan-
imously, as also one of thanks to Dr. Bowring.

42G Periscope. [April,

Part III. MONTHLY PERISCOPE.

Prolapsus Uteri.

We give place to the following correspondence on the sub-
ject of prolapsus uteri for several reasons ; a few of which are
considered sufficient.

1st. Because the letter requesting advice contains a very ac-
curate description of the mos^t common cases of this disease,
and an independent, rational, and accurate diagnosis by its
author, who is professedly, not experimentally acquainted with
the disease ; and by which, cause and effect phenomena too
commonly transposed are placed in their proper relationships
in the concatenation of phenomena attending this disease.

2d. The symptoms or secondary moxhid phenomena produced
by this disease, are generally treated as primary^ whilst their
cause, without the removal of which, no permanent good may
be expected to result, is generally neglected, or most inefficiently
treated by practitioners.

3d. The reply to that letter is about such as the author is so
often compelled to write to his professional brethren, that he
hopes, by its publication to supply at once, to many, those reme-
dial suggestions, for writing which promptly for individual cases,
his engagements do not allow him leisure. He hopes therefore
by this measure to prevent injurious delay in such cases, and to-
save to himself many hours.

Through motives of delicacy, the names and location of the
patients are omitted.

" W S , Feb. 20th, 1S39.

Dr. Antony :

Though not personally acquainted with you, yet your high
professional character, and the confiding esteem with which I
look up to your practitional skill, induces me to address you
this letter, and to ask of you the benefit of counsel and advice.

The case in which I wish your direction and advice, is that of

Mrs. , aged about 20, and lately married. Mrs. is

of sanguine temperament, and strumous diathesis, with light
hair, fair skin and blue eyes, an intellect highly cultivated, and
a lively imagination that delights in the wild and fanciful. For

some years past, she resided in , and only very recently,

has removed to this state : and still more recently, placed herself
under my professional care.

In asldng of Mrs. the history of her case, and the char-

1839.] Prolapsus Uteri. 427

acter of her disease, I was informed by her that her disease was
a pain in her right side that it had existed for five years, gra-
dually increasing ; and that her medical advisers had treated
her case as a chronic hepatitis, with a variety of medicines with
perfect ill-success.

Though my acquaintance with Mrs. was very slight,

still I could not believe that the cause of her ruined health was an
affection of the liver. Her lively disposition, her gay repartee,
and her animating sociability were the very opposite of the
mental and social character of one suffering from chronic hepa-
titis. Her face was pale, but not jaundiced her eyes swollen
and surrounded with a yellow circle great excitability, and
great lassitude on the slightest exertion, accompanied with an
increase of the pain in her side. From such symptoms, I
thought it probable that her physicians might be in error in diag-
nosis in her case ; and that, instead of ascribing her ill health to ,
primary hepatic derangement, it might be more truly referred to
the powerful influence exerted on the whole system by derange-
ments of, or diseases in, the genitalia. With this impression, I
examined my patient as minutely and accurately as my compe-
tency enabled me ; and from the examination learned that she
had pain in the right hypogastric region, extending from the in-
ferior margin of the ribs, downwards into the groin, frequently
into the thighs, and often even to the leg and foot of that side
a dull pain or sense of uneasiness in the sacral region, with a
sense of dragging weight when she was long in the standing
position, and after taking exercise by walking, or riding on horse-
back or in a carriage. She was frequently annoyed with tenes-
mus and strangury, with flatulency and pain in the bowels.
Her catamenial returns were irregular and painful, and she was
affected with leucorrhoea, not in its first stage or mildest form.

With this knowledge of the symptoms I informed my patient
that I looked on her disease not as hepatic, but as uterine i. e.
prdapsus uttri as the original disease, and dysmenorrhcea, &e.,
as consequences of the primary displacement. To verify my
diagnosis, I requested and was permitted to make a vaginal ex-
amination, and thus found the os uteri resting on the perineum ;
its lips anterior and posterior, and its neck enlarged, indurated,
and painful, ifec.

Such is a very hasty and imperfect history of the case in
which I wish your counsel I might add many other symp-
toms ; but your thorough knowledge of this class of diseases,
and perfect familiarity with all its symptoms render it unne-
cessary.

I may add that, in treating the case I inserted an oval glass
pessary, (2 1-8 inches,) but found, as I anticipated, that it in-
ci*eased, very much, the irritation of the os tineas, and after a
i^w day's trial, its use was necessarily discontinued from the

428 Periscope, [Aprils

present. I then ordered rest, recumbency, low diet, semicupi-
m, cups to the hypogastric and uterine regions, and a laxative
pill, night and morning, composed of aloes, sulph. ferri and the
sulphuret of antimony and gum myrrh.

Such is the present condition of the patient. I hope you will
do me the favor to write me, and all suggestions in the treatment
of the case will be thankfully received by your friend, &c.,

J. W. H.

Augusta, 10th Marchj 1831).
Dear Sir :

You could not have described more accurately than you have

done in giving me a history of Mrs. 's case, a common

case of prolapsus uteri. Indeed the case is one, if I may so
speak, remarkable only for the fullnessof symptoms which most
fully characterize its nature. Judging from your history, I must
say then, that your diagnosis, which is that * prolapsus in the
'primary affection, and dysmenorrha^a, leucorrhoea, dysury, con-
stipation, all hepatic symptoms, &c. &c., are but its symptoms
and consequents or effects, is perfectly correct. Some of these
may, however, demand treatment, as well as the primary affec-
tion ; for, although we may not expect effects to cease whilst
their causes continue, still it is often the case that the removal
of causation does not remove all the effects it may have pro-
duced ; and these require the intervention of art. But in such a
case as this, it is often delightful to the practitioner to observe
how abundantly the powers of nature suffice to correct the ill
effects of this cause when it is removed. I have often the sat-
isfaction of finding all such symptoms or effects speedily to
vanish on the correction of their cause, without one dose of

medicine ; and especially in such temperaments as Mrs. 's,

which is, more than others, calculated to surmount hepatic inju-
ries. I would therefore advise

ist. The correction of the cause, according to the diagnosis
you have so accurately made observing, as the case pro-
gresses, the condition of the effects, and giving such assistance
as nature evidently demand, and no other; because medical
treatment tends to produce debility, whilst the reverse you will
need to assist you in the cure, as well a^ to perpetuate it ; and
tonics, except occasionally the shower bath, are most commonly
contra-indicated -by different local excitements, visceral derange-
ments, &c.

The uterus must be considerably engorged, at least about the
cervix. This endangers ulcerations or other consequences, not
only difficult of cure themselves, but also calculated to interfere
with your convenience and success in treating the ])rimary dis-
ease. Let the uterus therefore be restored to its projier site as
promptly as })ossible, and ke]>t so. This is the great indication.

1839.] Prolapsus Uteri. 429

Mere position, the good itself, and necessary, will not, alone,
suffice. The patient must be first placed in such a [)ositioii as
to secure the full power of gravitation in drawing the uterus in
the direction of the upper extremity of the axis of the superior
strait of the pelvis, which is in the direction of the umbilicus.
Whilst in this position, the abdominal muscles must be relaxed
to prevent them from counteracting the gravitation ; whilst the
vulva is to be dilated to admit the influence of atmospheric pres-
sure into the vagina. Thus attracted by gravitation of the
uterus, and forced by atmospheric pressure, the uterus is brought
more or less completely to its proper site ; any deficiencies of
which may then be corrected by placing the ball of one fmger
or more, carefully on ihe os uteri, and co-operating with the
forces already in use, in the same direction, as far as can be
done, without much pain. Whatever deficiency may yet remain
in consequence of surrounding engorgement or inflammation,
will be easily corrected at subsequent attempts ; for it is often
the case that the restoration cannot, by prudent force, be fully
efTected at the first attempt. The patient remaining thus, a
wash should be thrown into the vagina by means of a good
womb syringe, and the vulva closed and compressed by a nap-
kin and the hand, until the hips are carefully placed on a pillow,
without the muscular efforts of the patient.

If there be much irritation, the wash should first consist of 4
or 5 grains of sub. acid, plumb, to the ounce of water. But if
otherwise, should consist of about 3 vj. sulph. alum, to the pint
of water, or a strong decoction of red oak bark, or a decoction
of I i. of powdered galls, well boiled in 1 pint of water. The
two last arc preferable, because more permanent in their tonic
cfTects on the parts.

This treatment or dressing should be repeated twice or thrice
a day. After some days, if the improvement be such as to
induce the hope that she may be able to sit up for an hour or
two without injury just before the dressing, she should do so,
because it is too enervating to be long confined to bed ; and
especially in the position above pointed out. If, on this trial,
she be found to remain uninjured, she may rise earlier subse-
quently, accordmg to her improving ability, until, at last, she
may be up all day after an hour or two from the time the wash
is used in the morning ; and finally, omit the morning use of the
wash, retaining only the use of it at night, until the cure is com-
pleted. The washes must be carefully avoided from two or
three days before the time for the menstrual return, until it is
over continuing the replacement, with great care, if necessary,
during the whole menstrual flux.

Should such means be found insufficient, a pessary, or uterine
prop should be introduced, so as to prop the uterus up to its
proper height. This should be applied and worn through the

430 Periscope. [April,

menstrual period, if she should not bo able to menstruate well
without it. It should be made of carded wool, built up into the
shape of an hour-glass when wrapped around the middle with a
thread, which is necessary, to keep it well together. It should,
when done, be 2 1-2 to 3 inches long, and should have a strong
string passed longitudinally Irom the lower to the upper end,
through the centre, and returned. This is for the double pur-
pose of drawing the upper end into a funnel shape for receiving
the OS uteri, and for the convenience of extracting it, when ne-
cessary. If it be introduced [through the vulva, and placed
in the lower part of the axis of the superior strait, when in
this place, the upper end will receive the os uteri, and the lower
end will rest in the fossa over the perineum and behind the
vulva, so as to keep it from easily protruding through the vulva,
or compressing and irritating the urethra. With this in use,
the patient may be up the most, or all of the day. But when
it is removed, she must be very rigidly treated with position^
and strengthening washes until retention is effected. This pes-
sary, you will observe, is not to be used unless proved necessary
by the circumstances above detailed. The patient should not
be annoyed by any of the other pessai'ies, as they neither tend
to assist in the cure, nor serve to retain the uterus up to its
proper site. The best they can do, is to prevent procidentia, or
the actual falling out of the uterus, when cure becomes hope-
less. Connubial intercourse should be absolutely interdicted, as
it can scarcely fail to irritate the uterus and relax the vagina
tioo efforts incompatible with curative purposes.

With these views, I hope you will be able to extend to your
patient that assistance which is so much needed, and than
which, none is more impoitanttoher comfort and safety.

M. ANTONY.

J , B Co., Sih March, 1839.

Dear Sir:

I am anxious to obtain your opinion and advice in regard to a
most singular and obstinate case now under my care, and which
I will proceed to relate.

Mrs. , now in her 54th year, enjoyed general good

health until five or six years ago ; when, on attempting to raise
a heavy burthen, she perceived, (to use her own expression,)
" something give way, or pass down, internally." On investi-
gation by herself, it was found that the uterus had prolapsed to
near the vulva. In this situation it continued for several weeks;
at the end of which she attempted the correction of the dis-
placement herself, and continued better thereafter, for a few
days ; when, on taking considerable exercise in walking, the
prolapse returned, but not to so great an extent as at first. The

1839.] Prulapsua Uteri. 431

womb remained however, within about one inch of the vulva,
when she was erect, for the two following years ; but when in a
horizontal position it returned to its proper site. During the
third and fourth years, copious Icucorrhoca existed, which added
greatly to her alarm and uneasiness ; but she could not be pre-
vailed upon to employ a physician. The prolapse and leucorr-
hoeal discharge rendered her exceedingly unhappy and distressed
in mind. Thus she continued in this dreadful situation until the
middle of the fifth year. She now discovered considerable
tumefaction of the neck of the uterus, attended with frequent
and copious hemorrhage. She was now induced to call on me
for advice in regard to the hemorrhage. I found her weak and
reduced, and prescribed astringents and tonics; with the desired
effect of suppressing the hemorrhage and the leucorrhcea to some
extent ; but a gradual hemorrhage still continued. Some three
or four weeks since, she desired me again to visit her. At this
visit, I found her situation indeed alarming. The hemorrhage
excessive, general fever, pulse quick and 120 to the minute,
tongue unexpectedly in a natural state ; bowels much consti-
pated, having had no operation for the last seven days ; vomit-
ing every hour or two ; and for the last three days, every thing
taken into the stomach has been immediately rejected. 1 now
resorted to such cathartics, diaphoretics, astringents, revulsives,
&c., as I found necessary. The use of these ended in the re-
moval of the fever, constipation, hemorrhage due, and the dis-
charge of much bilious secretion from the bowels, to her very
great relief.

My preceptor, Dr. John Sanders, was present at the time
with me, and we attempted to make an examination per vagi-
nam, on which the uterus was found, as above stated, within an
inch or inch and a half of the vulva ; the os and cervix uteri
enlarged and much indurated, conical, and presenting to the
touch a horn-like feel. The os uteri was not occluded, and
on pressure the uterus was almost perfectly immovable in every
direction. Free hemorrhage was produced by the attempts to
move the uterus; it was however promptly counteracted by styp-
tics. The fact was strange to me, that on the cessation of
hemorrhage, leucorrhasa supervened, and vice versa. There
was some pain in the lumbar region, but it is remarkable that in
the neck and mouth of the womb which appeared to be the chief
seat of disease, the patient had not suffered the least pain ; but
she declared it had not pained her the first time. * * * *

In our treatment of this horn-like induration of the uterus, we
resorted to revulsives, blistering, &:c.,to no good effect in reduc-
ing either the tumefaction or cornuous hardness of the enlarged
and elongated cervix. From fear of the insuliiciency of the
belladonna ointment to so relax and soften the tumor as to ena-
ble it to yield to pressure, I have not yet given it a thorough

432 Periscope. [April,

trial. The hemorrhage and Icucorrhcoa, neither of which is, at
the present time, very reducing to licr system, can be suppressed
ibr a while.

Your opinion, in regard to this afllicting case is earnestly so-
licited. What would be your treatment? To an operation,
though it might promise the greatest success, she would not sub-
mit. Can you refer me to just such a case ? How can it be,
that she has been clear of pain about the cervix which is so ex-
tensively affected? Please give me an immediate answer to all
that I have requested, and accept my best wishes for your
health, prosperitv, and future happiness.

Yours, &c., SIMON H. SANDERS.

M. Antony, M. D.

Augusta, llth March, 1839.
In reply, my dear sir, to your request of my " opinion in
reirard to the alTlictino: case" you have described in vour letter of
the 8th, I say you have given me a minute detail of a progres-
sive case of prolapse of the womb, with several of the impor-
tant results arising out of that species of genital prolapse.
These succedania, which are, by an error too common in the
profession, usually looked on as primary diseases, and treated
accordingly, are very numerous. In the present case, however,
they are limited, so far as you have noticed them, to engorgement
and consequent indication of the os and cervix uteri, menorrha-
gia and leucorrhoea ; and perhaps some nervous derangement
and disorder of the digestive and hepatic functions. The three
iirst narned are however the subjects of your chief reference. I
am pleased to observe that you have not committed the very
common error of considering them primary, self-existent dis-
eases, or related to the prolapse as cause. They are evidently
effects, and not causes of this displacement. This is proved by
reasoning both ways. They are all, effects precisely in the line
of direction, so to speak, of the prolapse as a cause, and are pro-
portionate as ellccts to this, as a cause ; and phenomena most
uniformly following this. This, it appears to me, must be evi-
dent to every good anatomist or observer whose mind is unbi-
assed by the partial views of writers and teachers on this sub-
ject. They are just such effects as we see, almost consequently
follow this cause varymg however in degree, proportion, &c.,
with the age, temperament, and various conditions and circum-
stances of tlie patient. And they are proved to be effects, by
their constant correction by the timely removal of their cause,
for those phenomena which disappear on the removal of certain
antecedent phenomena must, in fair reasoning, be considered the
effects of those previous phenomena. This is clear and indis-
putable, in pathology, notwithstanding the fact that sometimes
the causing or antecedent phenomena may be removed without

1839.] Prolapsus Uteri. 433

the removal of its consequents. The cause of this difference of
reasoning in pathology and pbysicks is, that the animal structure
is subject to new ami consecutive causation to which physicks,
abstractly, are not that is, morbid lesion or injury of parts to
such an extent as to constitute a self-existent disease, or one
which can continue by virtue of its own peculiar circumstances.
Such is the case with a wound inflicted by any violence. The
contusion, laceration, or division of parts continues, although the
cause is but momentarily in action. The same of diseases pro-
duced by cold, as a pleurisy, a catarrh, a rheumatism, or an in-
ilammatory lever. These continue self-existent that is to say,
they are, when once produced, perpetuated by their own inhe-
rent circumstances, notwithstanding the cold which was a cause,
without which they could not have occurred, is no longer in ope-
ration, and so forth. Anotlier reason is the peculiarities of ani-
mal nature. This is one of the most important points in d'agnosis,
and one in which the most frequent and fatal errors in practice
arise I mean properly distinguishing between causes and effects.
The error arises, without doubt, in many cases, from the too
strict application of the rules of reasoning in physicks, Xo 2')atho'
logy, in which the principles of life are concerned, and must
necessarily introduce new and consecutive causation calculated
to modify the results ; but which is overlooked in the reasoning.
And what must be the unavoidable result in such a case as that
before us, for example, but the neglect of the causes and tiieir
continuation in operation, and the consequent perpetuation of
their various effects? Hence the great, general indications,
remove causes and correct their effects.

But the case before us is too palpable to be misapprehended.
An evident and competent cause existed ; its legitimate efiects
were soon so plainly manifested that the patient herself, without
medical mind with which to investigate, detected the effect of
this cause, and cause of subsequent phenomena, which was pro-
lapse. She attempted to correct this effect, (all that was to be
done, as its cause was no longer in operation.) Relief followed
in just proportion to her success in fulfilling the indication. But
when, (the parts being weakened, the same efiects were more
easily induced than at first, Y/hich is a proper predisposing
cause, calculated to modify the results from other causes.) a
new cause, as a fatiguing walk, &c., was applied, the effects
were, as they must necessarily have been, renewed ; but more
gradually, and hence the progress and continuance of the pro-
lapse, and consequently, some of its effects, without suddenly
arousing the sensibilities of the patient. The parts thus becom-
ing gradually injured, disease has been allowed finally to pro-
gress to great extent, without sensible distress in the chief seat
of engorgement, to which the sensibilities of the part have be-
come gradually habituated. I have often produced more actual

434 Periscope. [April,

pain, for a short time, by adjustment of theutcras, than had been
experienced in the part by the patient previously. To this, I
may add that engorgement, hypertrophy, and even scirrhus, may
exist to a very considerable extent, without much pain in the
part of the uterus affected. Indeed, we are otlen surprised to
tind, on examination, either of these ; when, from the external
symptoms we had no reason to expect it.

Having replied to two of your inquiries, I shall now proceed
to speak of the treatment.

In regard to this, I must say that much depends on the par-
ticular impressions received from the manual examination by one's
self. Certain it is that the general indications of removing the
cause and obviating its eflects, exist prominently in the case,
and their fulfilment will be very apt to control the troublesome
menorrhagia and leucorrhoea by which you have been so much
perplexed. Your experience in this case is enough to prove to
you the inefficacy of prescriptions directed immediately to
these, regardless of the cause the prolapse ; your success, after
extensive trials being but partial in degree, and temporar}^ff
duration.

The first of these indications is to be fulfilled by restoring the
uterus to its proper site in the upper part of the pelvis, with
its axis in relation with that of the abdominal strait. This is most
easilly and effectually done by placing the patient in a position
in which gravitation, acting on the uterus in conjunction with
atmospheric pressure, will tend to draw this organ towards the
umbilicus. Whilst in this position care must be taken that
these forces be not counteracted by the pressure of the abdom-
inal muscles. These being perfectly relaxed and continued so,
the vulva is to be carefully opened lor tne free admission of air.
Then will the two forces above named be in full action. Should
it be the case, as it sometimes is, that from surrounding engorge-
ments, tumefactions or adhesions, the uterus fail to pass to its
proper place, the soft ball of the index finger is to be carefully
placed on the os uteri, and pressure made in the direction of
the axis of the superior or abdominal strait, so far as it may be
without giving much distress, until the uterus is forced away to
the upper extremity of the vagina. Be not discouraged, if this
effort produce no very perceptible change in the position of
parts ; for this is often the case, when the engorgement is consid-
erable. But when all is done which can be prudently at one
time, the patient is to be carefully placed on her side, with her
hips on a pillow. This should be daily tried, on which it will gen-
erallyjbe tound that the mobility of the uterus gradually increases,
until it is totally restored to its proper site. This accomplished,
the second indication is to be iulfilled by applying to the vag-
ina by means of a good womb syringe, such discutient and
astringent washes as are calculated to remove any inflammatory

1839.] Prolapsus Uteri. 435

condition which may still remain, and renew the contractile
energies of the vagina, in which the enlarged uterus has been so
long nestled. These may consist of a strong solution of about
.5 grains of sub-acetate of lead to the ounc: of water a strong
solution of something hke .5, 6, or 7 drachms of sulph. alum, to
a pint of water a strong decoction of oak bark, or of 8 or 10
drachms of aleppo galls to 20 ounces of water, boiled down to
16. Some one of these, according to the circumstances of the
case, should be applied once or twice a day, immediately after
rectifying the uterus, and in the same position in wiiich this is
done ; after which, a napkin being firmly pressed against the
vulva, the patient is to be carefully placed on the pillow as be-
fore. But previous and subsequent indications may exist. It
may be found that there is entirely too much engorgement for
the rectification of the womb. In this case the previous indi-
cation will be to reduce the engorgement preparatory to the
replacement. For this purpose, leeches applied to the os and
cervix uteri, wnth a proper regulation of the diet to prevent
repletion, with occasional warm hip baths will be best suited to
the purpose. Cuppins: low^ on the hypogastric and iliac regions
may be considered advisable, on the impossibility of applying
leeches to the os uteri; but cupping or leeching on parts other than
the actual seat of engorgement, or parts having immediate vascu-
lar connexion therewith,amounts to nothing more than a poor gen-
eral bleeding. It is a great error in practice, to exercise topical de-
pletion otherwise, although greatly indulged in since the days
of Broussais, to the great annoyance of the patient, and impru-
dent profit of the practitioner. It may be found also that vis-
ceral obstructions exist elsewhere, as effects of the primary
disease, or irritations set up in other parts, as the liver, spinal
marrow% &c. These aftbrd subsequent indcations, which should
be fulfilled by the means usally suited to such cases. And I
will here remark, that the treatment of the fiver, by occasional
slow mercurial purgatives, is one of the most important means
at command for promoting the disgorgement of the uterus. If
this uterine engorgement is decidedly chronic in all its character,
an alterative course consisting chiefly of Plummer's pills will be
found serviceable.

As to the operation of amputating the cervix uteri, the pa-
tient is wise in opposing it ; it has been greatly abused, and its
chief promoter has already outlived its glory.

You ask to be referred to such a case. '* I refer you therefore
to the whole work of Duparque on the uterus, a recent work of
more value on the subject than any other extant, and replete
w^ith cases of morbid affections of this kind. His cases are
finely descriptive, and the only considerable fault I find in the
work, is the want of sufficiently strong views of the influence
of uterine prolapse as a cause. This deficiency must of course

43G Periscope, [Aprils

extend its influence in a considerable degree to the treatment.
Still, in justice I must say that in this particular, Duparque has
decidedly improved the previous state of knowledge on this
subject. I could also refer you to many cases of the same pa-
thology, in my own practice, successfully treated according to
the views here detailed. Yours, &c.,

M. ANTONY.
Dr. S. M. Sanders.

Injury of the Urethra fro?n Prolapsus Uteri.

In addition to the above cases, and to show one amongst
many of the curious varieties of afHictions which so often arise
from prolapsus, w^e record in this place, with the patient's con-
sent, a case which is now on hand.

Mrs. Mc , of the state of New York, placed herself

under our care on Wednesday, the 18th of the present month,
(March.) She is 28 years of age, well proportioned, but rather
taller than the medium stature, sanguineo-bilious temperament
the former predominating; eyes dark grey, and hair black.
Her bowels tend to constipation, with a sense of obstruction at
the rectum. She has been many years married, but has never
conceived. Her menstruation has been accelerated to less than
three weeks from the beginning of one flux to that of the next ;
attended wnth pain about the loins and hypogastrium, and numb-
ness and pain in the thighs. She has suffered now for several
years, great and increasing distress in menstruation, exquisite
tenderness and considerable swelling of the urethra, and partic-
ularly at the punctum, from which, a preternatural growth
fungous, from her description, arose to a considerable magni-
tude, and about half the length of her thumb. This was
exquisitely sensitive, affording blood on the slightest violence,
exquisite distress on unnatloD, and a small quantity of yellow
purulent discharge from wnthin. She has never suffered from
any infectious disease. In this state of the case, when under the
care of Dr. S********, of the state of New York, she suffered
the removal by the knife, of the extraordinary growth at the out-
ward extremity of the urethra ; but the part from which the
excision was made ^'emained denuded, exquisitely tender and
painful, and with the wdiole urethra, svrollen to double its natural
size, until she came under my care on last Thursday. Dr. S.
had attempted to pass a small female catheter, but it was so
much resisted by the swelling of the urethra, and afforded so
much pain, that it was abandoned as impracticable. She had
been habituated, through her whole life to tight lacing, during

1839.] Prolapsus Uteri. 437

which, the increase of distress produced by li;is cruel i)ractice,
has eflectunlly prevented its continuance.

On investigating this case on Thursday last, the os uteri was
found tightly impacted in the angle between the perineum and
rectum, whilst the fundus was (irmly pressed against the urethra
near its vesical extremity, and the whole volume of the utei-us
unusually hard and somewhat enlarged. The careful examina-
tion of the uterus gave great pain, chiefly in consequence of the
extreme soreness of the urethra from t'le uterus outward.

In all these phenomena of the case, I saw no more than the
situation of the uterus seemed to me competent to produce.
The correction of this organ appeared then to be the only im-
portant indication in the case ; and 1 therefore attempted, hut
with only partial success, to carry the uterus higher in the pelvis
and briniT^its axis into relation with that of the abdominal strait.
With this attempt, the patient was left, on her side, with a pillow
under her hips, until the next morning.

Thursday j)[or7iing, 14th. I found the patient still complain-
ing of much pain on urination, but on examination it was obvi-
ous to her that the tenderness Vvas less exquisite ; and I found
that the uterus had more mobility. It was then replaced to its
proper site with considerable ease, and she was again placed in
position, on the pillow. Thursday evening I found the sensi-
bihty and swelling at the point decidedly lessened, and applied a
lotion to the vagina by the means of a womb syringe, vvith a
small curved pipe, consisting of 3iv. sub.acet. plumb, and 1 pint
of water.

Friday Morninrr, 15th. Found her perfectly comfortable,
having urinated twice since last evening, with freedom and ease.
It was yet perceptible to her that the outward extremity of the
urethra v/as not healed, but its naorbid sensibility/ as well as the
general swelling of the whole urethra vvas greatly reduced.
The saturnine lotion was again applied in the same manner.

Friday Evening. Having passed the day very comfortably
she had ventured to spend an hour or two out of bed previous
to this visit, and complained of pain again in the urethra. On
examination it was found that the uterine , displacement had
to some extent returned. It was now promptly corrected,
the lotion applied, and position strictly enjoined. The distress
vanished immediately, nor was there any remaining swelling
or increased sensibility.

Saturday Evening. 16th. Replacement had been well pre-
served and all the morbid enlargement and sensibility of the
urethra seem to have disappeared. The lotion and position
continued. The inflammation being subdued, an astringent
lotion consisting of 5 i. of bruised aleppo galls, put into 3 xx. of
water, and boiled down to sxvi., ordered for to-morrow, should
there be no return of inflammation in the part.

438 Periscope. [Apfil,

Sunday, 17th. Tlio patient is doing well to-day. No unita-
tnral tenderness nor swelling remain^. She is now advised id
ase the va2:inal injection of decoction of galls.

Take bruised Aleppo galls, j j.

Water, ! xx.

Boil down to "E xvi.

inject, morning and at bed-time.

It now only remains to secure that energy of the vagina
which is necessary to close the delatation which the uterus has
made by being Ions: nestled in it, and which is indispensable for
preventing the easy prolapse. It should be remarked of this
case, that it is not sufficient, in the re|T!acement, to secure the
due elevation of the uterus to its site in the hypogastrium ; but
that anteversion which caused the injurious pressure of the
fundus on the urethra, still causes the fundus to incline forward
of the axis. This needs correction at every application of the
lotion, by drawing the os and cervix uteri anteriorly until the
axis of the uterus is in relation with that of the superior, or ab-
dominal strait of the pelvis; for unless this is done, the due
contraction of that portion of the vas^ina against which the os
uteri presses, which is the upper and posterior part, cannot be
secured.

It is useless to give further details of this case, which is ycf,
and will be for a few days more, under our care ; after which, the
patient will leave for the north- The strengthening lotion will still
be necessary for some time, in order permanently to overcome
the relaxation of the vagina which the long continuance of this
genital prolapse has produced. Her menstrual period is within
a week ; she will therefore omit the lotions a day or two previ-
ous to that period, and carefully preserve the replacement during
the term, and return to the use of the lotion after the menses
cease.

Wednesday, 20fh. We have pleasure in stating that she is
discharged, apparently well ; yet we apprehend that her travel
to the north will re-produce some of her distresses, which will
require farther treatment of the same kind when she arrives at
home.

Friday, 22d. Our periscope being open until this time, gives
us the opportunity of stating that we called on the patient to-
day, and find that her menstrual flux commenced yesterday with
ease and regularity in all respects, and continues in like manner
to-day. To-morrow, according to her course in health, it will
decline. Editor.

Hydrophchia. It is to be regretted that cases of disease of
the deepest interest, as well as anatomical and physiological

18.39,"] Hydi ophohia. 439

facts occur within, and even under the knowledge and supervi^
sion of medical men, which are left to the common people to he
reported ; and to be, coni^equcntly, subjected to all dieir whims,
caprices, lears, prejudices, inuigujalions, t!cc. This is more
especially to be deplored, when the cases are of such a charac-
ter as the profession needs light upon; and this is abundantly tlie
case with regard to hydrophobia,a disease so differently and often,
without doubt, so erroneously defined or described. Jt is a dis-
ease, at least, in regard to its appearance in the human species,
of such rare occurrence, that it falls to the lot of but lew physi-
cians to observe even one genuine case. JStill sucli are the hor-
rible descriptions of it, and such the just terror of the commu-
nity on any occasion of alarm, that the faithful practitioner leels
extremely unhappy with the idea of meeting a case of it without
even the means of diagnosis. In the case beibre us, we are
informed of the attendance of several physicians, and still the
case appears not from either of them ; but comes to us in the
JNew York Star, rather as a puff to the Eai>t India Medicine,
(orspiritus vitce, than as a medical report.

We are aware that very many cases occur and wear the
name of hydrophobia which are really not that disease. We have
often been called to treat such cases, but f>ave never yet met
with any thing we could consider hydrophobia. One case in
particular, the recollection of which is fiesh in our mind, attract-
ed our attention whilst travelling through Alabama in the early
settlement of that country. It was so strongly characterized,
that we were induced to go considerably from our way to see it.
The girl who was the subject of it was about 11 years old, and
had been bitten by a small dog which came unexpectedly into
,the house some three weeks before, bit her heel, and left the
house immediately. Without naming all the symptoms, we
\yill only state that several persons were engaged in holding her
in such a manner as to keep her from biting, whilst water was
occasionally poured within her hearing or sight, or ofiered to her
for drink, in order to produce a display of those spasms, which
are said to occur under such circumstances. We remained
-vvith this case about an hour, taking the whole management of
the patient. We first liberated the hands, head and leet, from
those who were holding them, searched for the wound on the
heel, the scar of which could not be found indeed, the family had
forgotten on which heel it had been inflicted. We conversed
with her, and before we left, she was quite tranquil, as to actions,
andeven drank water twice, without any appearance of spasms
being excited thereby.

We could not remain to make further investigations of ihe
case, but believed that her nervous excitement was probably the
.effect of worms, and alarm relative to the dog-bite.

We give Dr. Good's characters of this disease ; and extract

440 .Periscope. [April,

ihc case to wiiicli wo allude, as it now appears in the Eclectic
Journal of :\lod;cine ironi the Now York JStar.

* liable::. spasmodic constriction of the chest; supervening
U) the bite of a rabid aninird ; preceded by a return of the pani
and inliaiiiniation in llio bitten p^irt ; grcai: restlessness, horror,
and hurry of nund."

Hudroplwhla. There has been lately published, in the New York Star, a
wonderful accoLint oi;' a case ot" an alls^^ed cure ol violent hydrophobia by
the outward application of what is called the Jj^aaC India jMedLcina or Spin-
las Vilix:. The subject ot' the attack was a youn^ female of the Society of
iVieiids, nanied Ann Dickers, residaig in the middle road, m the neighbor-
liuoJ of the Deaf aud Dumb Asylum, New York. This person, twenty
years of age, wa?, it is said, bitten, in the month of Apnl last, " by a dog
which had oeen given to the family by a neighbor, named Chrues; but which
circumstance &[i^ did not at the time make known to any one, in conse-
{juence of her father having freqiientiy warned her against playing with
uugs she being fond of sporting and teazing them. Soon after receiving
this bite the dog which had previously exlubited symptoms of being rabid
disappeared, and nothing has since been heard of it." So far the prelimi.
nary history which, it must be admitted, is not very clear.

Un a Sandfly evening, in the latter part'of October, or beginning of No-
vember, up to which time Miss Ann had enjoyed full health, she lirst began
to manifest strange feelings, among v/hich v.'as distress at tiie sight of a pail
of water, which her sisiers had taKen up to their room ; afterwards, though,
she poured oat tea, but didnot drinii any, "she appeared to look wild, and
started oti' on seeing the gravy vv^ith some meat which her sister took from
the stove. Going to bed, siig felt a paroxysm coming on, and told her sis-
ters to fly, intimating slm v/as mad ; they got out of iicr way, fearing that
she would injure them. " We all," '^-ys one of her sisters, *- ran up in a
fright, seeing she was m dreadful spasnit', the foam coming in thick masses
from her mouth, her eyes glaring, and her u-hole appearance being altered.''
After this (her father had arrived m the room,) Ai:,n voluntarily held her
arms back to be tied, and one of the men who were let into the room did go
up and tie her. " Sue then threw herself wildly on the bed, her face down-
w^rd, and began to bite and tear the pillows and bed-clothes. Alter the
first spasm she repeatedly exclaimed, ' Oh ! it's Chrues's dog ! it's Chrues's
dog! it's all over with me I know it is ! 'twas Chrues's dog!'" This
was the lirst time, says the deponent, her sister, that we had known about
her being injured by that dog. " She had iiQe.n bitten in the nose three or
four days before her illness, by a little pet dug, but we thought that had got
well." "Her barking, howling, and grownng were hideous, and exactly
like a dog."

Drs. Rawson, Baldwin, and Lindsey are mentioned as having visited and
prescribed for the patient. The last named gentleman " came and tested
the disease by calling for water ; water was procured, but she did not see
it she only lieard it being poured into the glass, and the spasms produced
by it were dreadlul in the extreme, continuous, and truly frightful. All the
spasms were not attended with barking, but the most were. The barking
continued untd next day." Dr. iM'lNiven and son visited her on Monday
jiight. Nothing prescribed was of any service ; indeed it is said she did
not swallow any thing. About a pint of blood had been taken from her,
the first night of her attack.

Mr. Jennison's Eas^; India Medicine or Spiritus Vita3 was first applied on
Tuesday morning, with the consent ot Doctors Baldwhi and Lindsay. "Her
throat was bathed v/ilh it ; then a tobacxo poultice was ordered to be apphed
by the physicians to her throat and bov/els. 'Mr. Jennison then came, re-

1839,] Attached Twins Certain Signs of Worms. 441

moved the poultices, and applied the East India Medicine freely to her
hands, throat, head, feet, and the joints of her limbs, by the permission of
Doctor M'Nevin, to whom the operation and properties had been explained."
It was repeated every half hour until about twelve o'clock, when she ap-
peared to recover, and soon called for drink, and not only slept a little, but
conversed some." " We had applied the East India Medicine twice before
Mr. Jennison came ; it had not been used more than two or three hours and
a half, after the fii-st thorough application was made, before she called for a
drink, which she had not done for several days, and seemed considerably
reheved. She asked for buttermilk ; it was given her at first a spoonful
at a time. She said she could drmk a pail full I gave her the pitcher she
drank the contents, holding nearly a quart. It was about two o'clock when
Mr. Jennison left she was then asleep. About day-hght she had a slight
return of the spasms, with delirium, which was immediately subdued on the
first application of the East India Medicine."

The preceding are the chief facts as detailed by the sister of Ann, in a
deposition before a magistrate. What was the disease of this young wo-
man 1 What was the nature and composition of the remedy used ] How
did it, provided it did, operate, by absorption or by sympathy 1 We pro-
fess ourselves unable to answer these questions, or to pretend to guide the
faith of our readers in this matter. Perhaps we may be favored with fuller
details of the case from one of the medical gentlemen in attendance.*

Attached Twins, The following case is related in one of the French
pohtical papers, the Journal des Debats^ in a letter from Rambouillet :

" On the 7th of October, a woman of the commune of Prunay-sous-
Ablis was brought to bed of twin daughters, but so united as to have the
appearance of one body with two heads, four legs, and four arms. Two
vertebral columns are perfectly distinguishable, and there are two chests
and throats, with the organs of deglutition. There are also disthict organs
of evacuation for each, and consequently it is inferred that the whole ot the
internal economy is double ; but there was only one umbilical cord. This
phenomenon is yet too young for any extensive or accurate observations to
be made, but it is clear that the faculties^ the two united beings are dis-
tinct, as one is frequently engaged in taking nourishment whOe the other is
asleep. The heads are reversed, so that should one be placed on its teet,
the head of the other would be hanging downwards with the feet in the air.
The length of the two children is twenty inches. The arterial pulsations
are isochronic in general, but those of one are a little more frequent than
in the other. They have been baptized separately by the name of Marie
Louise and Hortense Honoree. Their mother is a healthy woman, and was
brought to bed last year of a cliild perfectly formed." Eclectic Journal.

Certain signs of Worms, In a letter from Dr. G. K, Hollo-
way, dated 6th March, 1839, he declares himself unable to come
to the conclusion that there is no positive symptom of the pre-
sence of worms in the alimentary canal ; because, in a pretty
extensive practice for nearly twenty years, he has " found one
sign certain and possitively time, as found in every case in which
he has pretended to give positive opinion.

The sign is " a spotted or indentated appearance of the tongue
resembling the top of a pepper castor, with a peculiar color,

* We have learned, since, that Mr. Jennison's remedy caused vesication
of the parts rubbed.

h8

442 Feriscope, [April,

neither white, as that which is ohscrvcd in common remittent
fever of the country ; but to a nice observer, it exhibits an in^
flammatory blush, in color more nearly approaching the pink
than the rose." When Dr. H. sees such a state of the tongue
concentrated with the other general symptoms and signs of
worms, he has no hesitation in coming at once to the conclusion
that the case is one of worms ; and is happy to state that his
conclusion, thus arrived at, is generally correct.

Dr. H. do6s not wish, however, to be understood that this is
the only sign by which worms may be certainly known to exist
in the prima3 viae. As another very certain sign of worms, he
gives "the smooth, glossy, brownish state of the tongue in
leuco-phlegmatic children who have a foDtid breath, and who
are generally gluttons ; and who generally call the attention of
.the parents to the actual state of their situation by having what
are vulgarly called worm fits."

In support of the two evidences of worms above named. Dr.
H. calls our attention to the three following cases, which made
a lasting impression on his mind.

Case I. This was a negro boy, 6 years oldj much addicted
to dirt-eating, with a pale, leucophlegmatic, (?), ashy, harsh skin,
haggard countenance, emaciated, interior extremeties somewhat
enlarged, abdomen considerably swollen, upper lip tumid, and
pupils dilated. When called, we found him in strong convul-
sions , and on examining the abdomen, hard round tumors were
distinctly perceptible in the intestines. Ordered the warm
bath, and gave an enema of oil and compound tinct. of castor,
which brought aw^ay a considerable quantity of hard, clay-col-
ored scibilistic matter. So soon as we could get to see his
tongue, we positively pronounced it a case of worms, although
laughed at for our opinion by a professional brother. Ordered
20 grains of calomel, and 2 of gambouge, and the continuance
of the warm bath. So soon as'this medicine operated, we gave
the China root tea and castor oil ; and before sunset, he passed
upwards of 337 large lumbrici. The tongue in this case was as
a pepper castor top, fully indulated.

Case II. This was a boy about 11 years old, who labored
under, apparently, intermittent fever of the common grade.
The tongue, in this case, was somewhat of a pale, brownish,
shmy appearance. No particular symptoms or signs of worms,
except sudden jerking of the extremities and spasmodic affec^
lions of the intestines resembhng colic. He was obstinately
costive. We proceeded to treat this case with calomel and
opium, which, contrary to our expectation, caused the whole
alveola process of the lower jaw to slough off.* But, eventu-

* It is a great virtue in the profession of medicine freely to acknowledge
the unfortunate results of prescriptions, either from their injurious operations.

1839.] Certain Signs of Worms. 443

ally, about 48 or 50 large worms were discharged, one of which
was a tricoccphalus after which the child had a speedy reco-
very.

Case Ilf. This was a young lady, of a cold phlegmatic
temperament, who consulted us on account of dyspeptic symp-
toms ; and the symptoms were certainly strongly indicative of
such a disease. They were, disinclination to food, some eructa-
tions,' pain in the region of the stomach, palpitation and flutter-
ing of the heart, nervous irritability, interruption of the catamenia,
and cold extremities with occasional exacerbation of fever.

Ftom the general history of her previous life and the present
symptoms, for she was a girl of excellent senS'e, we were led to
look on the case as one of worms. The tongue was of a veri/
pale pink, and the spots on it resembling the top of a pepper
castor. We were now, in our mind, most positively confident
that the great difficulty in the case, was worms ; but not wishing
to incur the displeasure of a beautiful young lady by saying
that she was wormy, we pursued a very effeminate course for
a few days, at the end of which we were called on most per-
emptorily, by the aforesaid beautiful young lady, for an opinion,
as to the true nature of her case. We endeavored to parry the
question, as one of no moment ; but this, apparently, only in-
creased the desire of the fair one to know the true character of
her disease. But after a while, and under the most solemn and
honorable assurance that no exceptions would be taken to our
opinion, we delicate!]/ hinted tliat it might possibly be a case of
worms, although perfectly positive in our opinion. But no

oY theif inefficiency, as othefs are thereby timely jjuarded against the same
misfortunes. But we venture the decided opinion that in this case Dr. H. has
exceeded the fact. Both books and general opinion, as well as prejudice
against calomel have taught us to believe that such affections of the mouth,
as is here alluded to, are the effects of mercury its fata], ruinous effects.
They have been called "dry salivation" But facts of observation in this
climate have taught us very differently. The truth is, that there is no one
evidence of mercurial action in such cases. They occur without the use of
mercury in any form, and are very uniformly curable by a judicious and
timely use of calomel. Our practice for the last 18 years fully justifies these
conclusions. Such cases have, more than all others together, been used to
injure the character of calomel, and to deprive a suffering community of its
benefits. These accidents are a gangrenoptic state, produced by other cause
chiefly a highly impure state of the blood from faulty hepatic action, and
intestinal irritation from worms or other causes. The same state of the
blood often produces, in this climate, a tendency to gangrene in other parts,
as blisters, bad sores, &c. The fever in which there is this tendency is
pecuUar, and the disposition should be marked, and attended to before there
is fata] destruction of parts. The motto ^^ omnia ex sanguine" should not
be lost sight of. Ultra-solidism passing away a long and earnestly desired
event, we may now hope for a salutary direction of attention to the state of
the fluids which have for the last 30 or 40 years, been so much neglected.
We reter the reader to an essay of Dr. E. A. Eve, in a former volume of
this journal for Bome good observations on this disease. Epitoe.

444 Periscope. [April,

sooner had we let the cat out of the bag, than we had a volley
of abuse, like iEtna, Vesuvius, and Slrombolo, thrown at us for
saying that the pretty Miss was wormy. Now, however, the
issue was fairly joined, and she had, nolens volens, to submit to
our judgment and treatment, or depart as she had come. Pre-
ferring the former, after a few days sulking, she agreed to take
such medicines as I might prescribe ; on doing which, there
came away upwards of 3(T0 counted ascarides, besides some
which were apparently wound up into a ball."

Smce the discussion of this subject in the Medical Society of
Augusta, we have been informed by an experienced and intelli-
gent mother, that she has been always able to detect the presence
of worms in children by inspecting their nostrils. She states
that in this disease, they exhibit, within, an unusual redness, or
somewhat irritated appearance. Our own observation has not
been extended to this fact ; but it may be well for it to be no-
ticed by practitioners ; and if possible to distinguish, the differ-
ence between the appearance of this part under irritation from
worms in particular : for we have often remarked that itching
of the nose may arise from different kinds of irritation in the
first passages, and that this itching leads to the picking of the
nose a symptom so often referred to as evincing the presence
of worms.

Strumous Ophthalmia. We have been not a little perplexed
with this form of scrofulous affection, as indeed with all other
forms of it. But in this, more than others, we have recently
arrived at satisfactory results, after the ineffectual use of the
whole routine of other remedies for ophthalmia without any
success, (except in a partial degree under the use of issues,) by
placing our reliance on the external use of iodine. The form
in which we have used it was as follows :

Dissolve Iodine gr.j.

Hydriodate of Potass grs. ij. in

Water ij.

This has been increased in strength, in the progress of some
of the cases, one hundred per cent.

This iodine eye-lotion was used by dropping it into the eye ;
and in severe and obstinate cases, applying pledgets of lint satu-
rated with it, at bed-time.

Lugol's iodine eye-lotion, the formula for which we have
since seen,* is more conveniently prepared, and perhaps capa-
ble of longer preservation, and would, without doubt, prove
equally beneficial.

* See " A new supplement to the pharmacopeias of London, Edin-
burgh, DubUn, and Paris, including the New Frencli Medicines, &-c., 3d
London Edition, p. 199.

1839.] Strumous Ophthalmia Injection of Galls. 445

\

Take 30 drops of Tincture of Iodine,
36 drops of Laudanunn, and
! iv. of distilled water. Mix.
It should be borne in mind that starch and vegetable prepara-
tions containing it, are incompatibles therefore the external
application is effected by the medium of lint, and not of poul-
tices of any farinaceons substance.

Injection of Galls. It has been a matter of much difficulty
to find a convenient and effectual lotion or injection for use in
cases of prolapsus uteri, prolapsus ani, piles, and leucorrhoea.
The solution of alum in water in common use has proved too
ephemeral in its effect, the Port wine recommended by Dr.
Good has too much abounded in stimulating, and proved defi-
cient of styptic powers, whilst the decoction of oak bark has
been extremely inconvenient on account of its staining qual-
ity. We have adopted, for use, in cases of prolapsus uteri, a
decoction of galls made by boiling ij. of bruised galls in 5 xx
of water, down to 16. Dr. Copeland recommends the decoc-
tion of galls, made by taking ^ ss of bruised galls, Oiiss. of
water, boiling down to Ojj. strain and add 5j. tincture of
galls for prolapsus ani, piles, and leucorrhcea.

The tincture of galls (tinctura gallarum of the Edinburc^h,
Dublin, and Paris, pharmacopoeias) is made by adding o ij.
powdered galls to f xvj. of proof spirit, and making a tincture.

An injection of galls for gleet and gonorrhoea is also made by
mixing ! ij. each of decoction of galls and distilled water.

Doses. Much of the uncertainty attending the use of medi-
cines is owing, not so much to the imperfect nature of the medi-
cine, as the want of attention to, and due discrimination of, the
various particulars of the case in which it is prescribed. To
some of these points the attention of the practitioner is called on
the XXIII page of the introduction of the new supplement to the
pharmacopoeias of London, Edinburg, Dublin, and Paris ; from
which we take the following judicious precepts :

" In prescribing a medicine, the following circumstances
should always be kept in view : Age, Sex, Temperament, Ha-
bit, Climate, State of the Stomach, and Idiosyncracy,"
to which we would add, the period of the disease.

Age. For an adult, suppose the dose to be one, or 1 drachm.
Under 1 year old, will require 1-12 or 5 grains.

2 "

ti

a

1-8

or 8

3 *

it

n

1-6

or 10 "

4 *

u

(i

1-4

or 15 "

7 "

<

((

1-3

or 1 scruple.

14 "

a

n

1-2

or half a drachm,

20 "

u

2-3

or 2 scruples.

21 the full dose.

one

or 1 drachm.

65 the inverse gradation of the above."

446 Periscope. [April,

We have found no necessity for varying the dose above the
close of the second septenniad, or 14 years, until wc arrive at
the inverse .irradation demanded by old'ao^e.

" fc>Ex. Women i-equire smaller doses than men, and the
state of the uterine system must never be overlooked." This is
a very important precept.

Temperament. Stimulants and purgatives more readily
affect the sanguine than the phlegmatic, and consequently, the
former require smaller doses.

Habits. The knowledge of these is essential; for those in
the habitual use of stimulants and narcotics require large dose^
to affect them, when laboring under disease ; whilst those who
have habituated themselves to the use of saline purgatives are
more easily affected by these remedies.

Climate. Medicines act differently on the same individual,
in summer and in winter ; and in different climates." This is^^
particularly observable in the use of calomel.

" State of Sto.mach, and Idiosyncracy. The least active
medicines operate very violently on some individuals, owing to
a peculiarity of stomach, or rather, disposition of body, uncon-
nected with temperament. This state can be discovered only
by accident or time ; but when it is known, it should always be
attended to by the practitioner.

In prescribing, the practitioner should always so regulate the
intervals between the doses, that the next dose may be taken be-
fore the effect of the former is altogether effaced; for by not
attending to this circumstance, the cure is always commencing,
but never proceeding. It should, however, also be kept in mind
that medicines, such as mercurial salts, arsenic, are apt to accu-
mulate in the system, and danger may thence arise if the doses
too rapidly succeed to each other. The action also of some
remedies, elaterium and digitalis, for example, continues long
after the remedy is left off; and therefore much caution is requi-
site in avoiding too powerful an effect, by a repetition of these
even in diminished doses. Dr. A. T. Thomas.

1839.] Medical Intelligence. 447

MEDICAL INTELLIGENCE.

Medical College of Georgia. The exercises in this institution closed^
for the present season, on Saturday, the 2d March last ; and the annual
commencement was held on the Saturday following, when the dep^ree of
Doctor of Medicine was conferred by the Vice President on the follow-
ing gentlemen, each of whom was, upon examination, unanimously present-
ed to the Board as worthy of this honor.

Ransom Linch, Thesis on Pleuritis,

.George F. Taylor, " " Indigestion,

Wm. M. Burt, " " Congestive Fever,*

Augustus A. Cullens, " " Acute Gastritis,

Jxo. T. Sims, " " Delirium Tremens,

Thos. K. Dunham, " Phthisis Pulmonalis,

Henry H. Meals, " " Bilious Colic,

Thos. E. Bowdre, " " The Organs of Digestion,

Edward W. Alfriend, " " Menstruation,

Henry P. Turner, " " The Physiology of the Liver, -^j^

George E. Smyth, " " Physiology of the Mind, *^ ^^

JoHANNON McLester, " " The Liver and Bile.

After the degrees were conferred, an address was delivered to the gradu-
ates by Dr. A Cunningham, a member of the Board of Trustees, in which
the graduates were counselled to regard themselves as having but entered
upon the study of their profession. In illustration of the correctness ot
this sentiment he sketched the many and extensive studies which have a
claim on him who is honored with the appellation of a learned man ; and
concluded with just and appropriate remarks on the duties of physicians to
each other^ and to soc'ety.

A very complimentary communication from the students to the faculty at
the close of the session, testifies that the course of lectures just ended, was,
in every respect, highly satisfactory to the class ; also that the anatomical
accommodations were abundant each dissecting class having had no less
than three subjects. Indeed, such are the ample and effectual arrangements
made by this institution, that the opportunities it affords for practical anato.
my are no longer to be doubted. The class, for the last season, amounted
to 60 ; an increase of about fifty present on that of the previous season ;
which affords to the friends of the institution the most cheering prospect of
its good success.

* This thesis, being on a subject of deep interest at the present time, ia
inserted in the I Part of this No. of the Southern IMcdical and Surgical
Journal,

418 Medical Intelligence. [April,

Wo arc pleased to state that, during the last winter the College received
a large accession to its library, consisting of an importation of the most
valuable ticw^ and rare old works from Europe. Its chemical department was
also greatly enriched by the accession of many rare and valuable apparatus,
constructed in Philadelphia during the last summer, under the immediate
supervision of Professor Davis, the present very able incumbent of that
department.

It is but justice, both to the graduates and to the faculty to state, that the
approvals as well as the disapprovals, at the late examination were, in every
instance, unanimous. Twelve candidates for graduation were successful.
We are pleased to see the high standard of talent exacted in this institution
to entitle the candidate to its honors. It promises well for the good of
hnmanity, for that of the profession at the south, and for the sure and per-
manent prosperity of the College.

It is but justice to the whole class to state that their good order and gen-
teel deportment has probably never been surpassed by the same number of
young gentlemen of any class assembled together in such close relation,
and fur so long a space of time. We hope the excellent example will be
imitated by others ; and that young gentlemen will begin with their colle-
giate course, when they have not done so before, to estabUsh that character
which properly belongs to the profession they adopt, and which is so indis-
pensable to their successful career.

Correction. For Scutillaria, in the 15th line from the bottom of the
375 page, contained in the last No., read Scutulata.

SOUTHERN MEDICAL

AND

SURGICAL JOURNAL.

Vol. III.] MAY, 1839. [No. 8.

Part 1. ORIGINAL C0MMUNICATI0N5r.

ARTICLE I.

Tke Use nf the Double Inclined Plane in Fractures of tha
Lower Extremilies* By J. C. Nott, M. D., Mobile,

" Teach me what you know, and not what you believe^* is a
maxim full of wisdom, and should always be borne in mind by
medical writers. I do not pretend to be infallible, and may be
as easily blinded as others, but in the present instance I feel a
deep conviction, that I am writing what I know to be true, and
shall bring forward credible and competent witnesses to vouch
for the facts stated.

I am not so wedded to my own opinions or inventions, as to
believe that the apparatus I propose is perfect, (for my object
has been to contrive the simplest one possible which would ful-
fil the indications,) but I assert boldly that all Hie fractures of

* I sent an article on this subject to Philadelphia to be published in the
American Journal of Medical Sciences it appeared in the Nov. No. 1838,
but in a mutilated form, probably from want of space. The present paper
is m substance a part of what should have appeared in the one alluded to,
and should be read with it, neither being complete by itself. A part of
what I say here will probably not be fully understood without reference to
the plates in the Philadelphia Journal.

450 On the Use of the Douhle Inclined Plane. [May^

the thigh and leg can he treated with more comfort to the patientt
and less risk of defarmity hy some apparatus acting on the same
principles. Mine has answered perfectly so far, and I therefore
recommend it._

I have perused attentively every thing I can find in French or
English on the subject, whether in favor of or against it, and
my conviction of the utility of the double inclined plane has
become stronger at every step of the investigation.

I lay very little claim to originality, for almost every idea I
utter, (some of which I once thought peculiar to myself,) I find
scattered here and there through difierent authors, but have
taken some pains to collect and embody them into a more tangi-
ble form. My only desire is to direct the attention of the pro-
fession to a mode of treating fractures, which much reflection
and experience have taught me is vastly superior to those usU"
ally adopted.

Sir Astley Cooper, Dupuytren, Travers, Charles Bell, Ames-
bury, Key, White of Manchester, Mclntyre, Lislon, and other
surgeons of high repute in Europe, have recommended differ-
ent modifications of the double inclined plane in certain cases of
fracture. In the United States it is barely alluded to as a mat-
ter of history, is never exhibited in our medical schools, and
scarcely a trace of it is to be found in our writings.*

Why this discrepancy ? It is because the different double
inchned planes recommended, are on the one hand very defec-
tive, or on the other (like that of Amesbury,) too complicated
and difficult to make, or too expensive and because long es-
tablished usage and authority have wedded our surgeons to
other modes of treatment.

The apparatus generally employed in this country for fractures
of the femur, are nnodifications of those of Desault, Boyer, Prof.

* I have not until recently seen the apparatus of Dr. Smith, of Balti-
more J but I take great pleasure in saying that it is one of the most perfect
I have seen, and admirably calculated to meet the indications. Though not
very complicated, I fear it will be considered too much so to be extensively
adopted, for surgeons dislike trouble as much as any other class of men I
have not had an opportunity of trying it, but have no doubt of its great
comfort and utility in all fractures between the middle of the thigh and the
ankle. I think it permits too much motion for fractures near the tro-
chanter.

iS39.] On the Use of the Double Inclined Plane. 451

Gibsoirs modification of Hagedorn, and the single iadined
plane.

All these I have seen applied either in this country or in Eu-
rope, under the direction of distinguished surgeons, and the
same objections have struck me every where viz : excoria-
tion of the foot and perineum fatigue both of body and limb,
produced by the extended position pain and stiffness in the
knee inapplicability in fractures near the neck of the bone or
siear the cond^des constant tendency of the limb to shorten
from stretching of the extending and counterextending bands
inconvenience of stooling permanent shortening, which often
occurs, <fcc.*

IVovv if all these objections occur, amongst surgeons of high
repute and extended experience, how much more forcible are
they, when these apparatus are in the hands of young surgeons
or country practitioners, whose surgical cases are " few and
far between.'' I should much prefer Prof Gibson's modification
of Hagedorn to any of those named ; it is not so liable to ex-
coriation and shortening, but all the inconveniences of the ex-
tended position and other objections hold good against it.

Every surgeon will recollect the embarrassment he felt,
during the first years of his practice, in making and fitting the
different apparatus recommended for the different fractures of
the thigh and hg. A double inclined plane properly constructed
would save ail this complication, and if any surgeon would
practise its application on a sound limb for a very short time, he
would avoid a great deal of trouble for the remainder of his
life. An apparatus of the dimensions I have given can be made
to fit the limb of almost any adult, and with the addition of a
few junks and short splints or binders boards, a dressino- would

*Prof. Gibson says "So far as; ray own experi?nce goes, (which
:amounts to up-wards of 12 years, during the greater part of which time I
iiad the chief control of the surgical cases of a large hospital and almshouse,
together with an extensive private practice,) I am ready to declare, that I
have never met with a single instance of oblique fracture of the thigh bone,
in which I used the apparatus of Desault, (and until the last six months I
have never used any other,) that more or less ulceration of the perineum or
foot, and shortening of the limb were not the consequence.*" Phil. Jmjjr,
of Med. and P]njs. Scienca^^ Vol S.

452 On the Use of the Double Inclined Plcme. [May^

always be ready for any fracture of the thigh or leg* I have
been using one for ti years, and have never had a shortened or
deformed limb, or seen the excoriation, or inconveniences of
other apparatus in a single instance. ISeveral of my medical
friends have also used it, and invariably with the same success*

Objections made against the Double Inclined Plane,
I have searched for objections with all the impartiality I pos-
sess, and expected to find them more numerous and strong than
I have. I give all I can meet with, and as truth is my object, I
should be much obliged to any gentleman who will point out
others. I hold myself open to conviction, and will cheerfully
abandon every position 1 have taken if they can be proven la
he false.

It has been objected, that when the double inclined plane is
used, there is a difficulty in fixing the pelvis, and that its motions
are communicated to the point of fracture. This is the strong-
est and almost only objection that can be urged, and is true to
a certain extent when the fracture is high up in the thigh, but I
think 1 have answered this satisfactorily in another place. Ad-
mitting this objection, however, (which I am not disposed to do,)
it does not hold good in the slightest degree, where the fracture
is below the middle of the thigh or in the leg ; and it must at
the same time be recollected, that a fracture in or near the neck
of the femur, cannot be treated in the extended position^ without
shortening.

It is objected, that when the knee joint is implicated, and
there is danger of anchylosis, the straight position is better than
the flexed, a straight limb being better than a bent one. This I

* If the surgeon should have to treat a patient very much over or \indet
the size of an ordinary adult, a coarse double inclined plane can very soon
be constructed ; and as one unaccustomed to it might be at a loss for pro-
portions, 1 will give the following very simple rule. Take a piece of board of
proper width, and long enough to extend from the tuberosity of the ischium 4
inches below the heel ; saw it in two exactly opposite the knee joints and you
have two pieces of proper length for the thigh and leg the horizontal piece
which rests on the bed, should be of the same width and about as long as the
other two together.

The construction may take a little more lime than the apparatus of De-
sault or Hagedorns apparatus, but much time will be saved in the treat-
ment, as it requires very little ra- adjustment when the limb is once dressed.

1839.] On the Use of the Double Inclined Plane. 453

deny, because a limb a little bent, gives much less fatigue ii)
walking than a perfectly straight one.

Mr. Listen says, that fractures just below the tuberosity of
the tibia, are to^be treated in the straight position, for when the
knee is bent, the upper fragment is made to project, by the ex-
tensor muscles of the thigh, acting on it through the ligamentun^i
patellar. I have not treated a fracture of this kind with the dou-
ble inclined plane, and this objection may have more weight
than I suppose. It will be seen by examining the apparatus I
propose, that one of the straps is made to buckle across the up-
per part of the tibia, which 1 should think, with the assistance of
a compress, would counteract this tendency Mr. Amesbury's
experience confirms my opinion.

I now come to the objections of Prof. Gibson, published in the
third volume of the Philadelphia Journal of Med. and Phys.
Sciences. They are the fullest I have met with, and in order
that the subject may be as fairly stated as possible, I extract
what he has said on this point.

" The patient laid on his back, has the limb placed over the
inchned boards, at an angle corresponding with an easy and re-
laxed flexion. Cushions are placed beneath to obviate undue
pressure, and splints secured to the limb to afford lateral pres-
sure. The weight of the body hanging by and operating upon
the superior fragment, naturally draws this from the inferior
fragment, and thereby effects counter extension, while the infe-
rior fragment, supported and fixed by the angle of union of the
inclined boards which operate upon the ham of the patient, main-
tains permanent extension. There can be no doubt that many
of the objections to the semi-flexed position, as practised by
Pott, and followed by the majority of the English practitioners,
are obviated by this simple and ingenious contrivance ; and were
1 disposed to select that position as more favorable than the ex-
tended one, I should certainly, to this form of apparatus, give a
very decided preference ; but there are objections even to this
I apprehend, ingenious as it is, which will prevent it from ever
coming into general use."

'* Let any one for the sake of experiment, place beneath his
own sound thigh and leg the machine of James or Bell, so as to
have the leg secured on one side, the thigh on the other, and the
body suspended and supported by the thigh he will then find, be

454 On the L^vc of Ihe Douhle IrLcUn'^d Plane. [May,

the cushions ever so sofr, tlmt the po'^Ilion is by no means so
comfortable, as one might be led to imagine ; that the calf of the
leg m.ust be firmly and painfully pressed against the flat sur-
face of the boards, ttiat ike ham sustain.^ not only the whole
weif!;htof the (higJi, hut ill at port) on of the bodf/ elevated above the
plane on which it would naturally rest, and under circumstan-
ces too, most disadvantageous bein^ fixed upon a sharp angle^
formed by the union of the inclined boards, and leaving a surface
too inconsiderable to foim any other than the most painful sup-
port."

" That extension and counter-extension can be produced by
this apparatus, there cannot be tlie slightest doubt. But it is
extremely doubtful, whether the patient can sustain the torture
necessary to carry the operation into full effect. Cannot a mo-
derate degree of extension and counter-extension, it may be ask-
ed, be kept up '? To this it may be answered, take off from the
ham the degree of pressure necessary to relieve the patient, the
body sinks and is supported by the bed, counter-extension is
therefore removed, extension destroyed, and how then does
your method differ from that of Mr. Pott, except in the patient
being placed on his back, and a partial support being given to
his limb ? But granting these objections to be unfounded, would
the weight of the body he always sufficient to effect counter -exten-
sion, and prevent the bones from over-lapping ? On the other
hand, would it not sometimes happen in large and heavy men,
that from too much force being exerted on the superior frag-
ment by the weight of the body, inordinate irritation would en-
sue ? Again, how are we to prevent the rotation of the pelvis,
when one limb is suspended on a frame, and the other extended
and left at liberty ? But in answer to all this it may perhaps be
said, that the twenty years experience of Mr. Cooper, and the
authority of Mr. Bell, are sufficient to justify the practice." &c.

It so happens that I have never seen the apparatus of James
or Bell, alluded to, but if they create one half the ills which
Prof. Gibson attributes to them, they should be ranked amoncfst
instruments of torture, and not surgical apparatus. The one I
propose certainly acts upon very different principles. He says
*' the extension is made by the angle of the inclined boards acting
on the ham, and that the body is suspended by this point in or-
der to effc'Ct counter-extension, bv its weicrht on the superior

iSiiO.] Oil the Use of the Double Inclined Plane. 4b j

Iragment." If the two boards were put together at a ri^ht or more
acute angle, the ham certainly would suffer ; but it wiil be seen by
examining the drawing given of my apparatus, that it is placed at
a very obtuse angle, and the ham scarcely touches at all the
only pressure being (as in the use of any other apparatus) on
the calf of the leg, well protected by a hair or chafFbag.

Prof. Gibson too would lead us to suppose, that even the .
weight of the body, when suspended by the thigh, was not suffi-
cient to keep up counter-extension ! J must contess that I was
very much surprised to see such a position advanced by one of
his deservedly high reputation. Certainly neither the appara-
tus of Desault or Boyer, exert a force any thing like equivalent
to that of the weight of the body ! no tissue of the human frame
could sustain it, and it is a well established principle, that a small
lorce constantly acting, will overcome any muscular resistance
we are called upon to counteract.

In the double inclined plane I propose, the extension is effect-
ed (in fractures of the thigh bone,) principally by the weight of
the leg, resting on the calf and whole under surface down to the
heel the leg acts as a lever on the lower fragment of the thigh
bone, and when the straps are buckled across, and the foot bound
to the foot board, this lever cannot fail to perform its office per-
fecdy. The lower fragment is thus held firm, while the pelvis is
resting comfortably on the bed, and it will be seen at once, that if
the proper extension be made, and the limb be placed over a
double inclined plane, which has the thigh piece as long as the
sound thigh, shortening cannot possibly occur the weight of
the body makes a passive counter-extension, (without being hung
up) whilst the extension is effected as before stated.

Several of my medical friends have not only seen me do it,
but have treated cases in this way themselves, and are satisfied
that the double inclined plane I use is free from the objections
urged.

I have thus fully stated and replied to the objections of Prof
Gibson, because I have the highest respect for his opinions be-
cause I am satisfied he is in search of truth, and open to convic-
tion because he has had no experience icith a double inclined
plane properly constructed, and because he occupies a station
which enables him to do much towards suppressing or propagat-

45G On the Uss of the Double Inclined Plane. [May,

ing whatever is prejudicial or useful to ihose whom misfortune
may place under the surgeon's care.

For plates, proportions, construction, application of double in-
clined plane, advantages over other apparatus, &c., the reader
is referred to the November No. 18j8, of the American Journal
of Medical Sciences, published in Philadelphia.

It w^ilJ be seen that the second plate in that Journal is very in-
accurately done, the knee not being opposite the angle of the
planes.

By a misprint, too, I am made to say that the cases reported
did not occur in my own practice. They did occur in my
practice, but were selected because they had been witnessed by
other surgeons.

Since those cases were reported, my friend, Dn Fearn, and
myself, hav'e treated others in the same way, and with the same
satisfactory results. One of these cases was a very interesting
one* The patient was a boy oi four years old, who had his thigh
bone crushed near the trochanter, by the wheels of a carriage
passing over it the limb was placed over a double inclined
plane, and at the end of thirty five days perfect union had taken
place, without the slightest shortening or deformity. The little
fellow was cheerful all the time, and never complained of the ap-
paratus.

The apparatus was constructed in the simplest manner. We
procured two pieces of white pine board, five inches wide, and
long enough when placed under the limb, to reach from the tu-
berosity of the ischium three inches below the sole of the foot.
One of the boards was then sawed in two, exactly opposite the
knee joint. We thus had at once, a thigh piece, a leg piece, and
a horizontal piece to rest on the bed and support the other two
the thigh and leg pieces were then hinged together with leath-
er and tacks and the thigh piece was fixed to the horizontal
board in the same way a foot piece was next fixed on the
limb was then secured to it with pads and splints, and pieces of
bandage, instead of leather straps and buckles, &c. (For mode
of construction, see Philad. Med. Journal.)

Dr. Fearn, who has very uncommon mechanical ingenuity,
made an improvement in this case which is very important he
nailed to the outer edge of the horizontal board, at its upper end,
a narrow splint which extended along the body of the arm pit

1839.] Fracture of the Lower Extremity. 451

irfto this he fixed, at intervals of three or four inches on the out-
side, pegs about an inch long to prevent a bandage from slipping
a bandage was then passed several times around the thigh,
carried around the pelvis, andcontinued up the body high enough
to fix the pelvis and body firmly to the lateral splint in this
way the httle patient was prevented from twisting about and
<deranging the fragments by motions of the pelvis. This con-
trivance answered admirably in this case and I see no reason
why it should not in all others.

Fracture of the Lower Extremity. By H.V. M. Miller, M. D.

Having, myself, been a sufl^erer from the above injury, I have
looked with no small degree of interest, to the various methods
which have been proposed for its treatment.

The apparatus of Desault, I can say from personal experience,
is inconvenient beyond measure. The species of pulley or sus-
pended weight proposed by Dr. Antony, has not answered the
expectations I was induced to form of it from his recommenda-
tion. The double inclined plane I have never used, but it is liable
to the same objection as the others, namely, that it confines the
patient for weeks to his back, a position which becomes insup-
portably irksome long before the period of his release has ar-
rived.

It was with pleasure, therefore, and anxiety for the result^
that I witnessed the treatment of the first fracture of the \eg at
La Charite, by M. Yelpeau, upon a totally different principle
from any which I had seen practised. I allude of course, to the
immoveable apparatus, first proposed, I believe, by a surgeon
of Brussels, and possibly familiar to most of the readers of the
Journal.

But as all of them may not have seen or employed it, I will
detail three cases which I have treated by means of it, with man-
ifest advantage.

458 Fracture of the Lower Extremity. [MaVf

The first was a little boy, a servant, five or six years old,
belonging to Maj. Dawson, of Cassville. He fractured both
bones of his left leg, by a fall from his feet while skating on the
ice, the last week of November, 1838. I saw him almost im-
mediately, and without difficulty effected the reduction. The
apparatus was applied in the usual way, that is to say, a com-
mon roller bandage is passed from the toe to a prudent distance
above the seat of the fracture, over some light compresses with
which the limb has been previously enveloped these are then-
well moistened with paste or starch, and another bandage ap-
plied, passing in a reversed direction from the first, which is also
wet with the paste. Four pieces of stout paste-board, cut of a
proper shape, are then wet with the paste, moulded to the limb
and confined firmly to it by two other bandages, passing the first
upwards, the last downwards, which finishes the dressing. Af-
ter a few days, three or four, the whole apparatus becomes per-
fectly dry and affords so strong and firm a support to the limb,
that the patient may get at once upon his crutches and move
about at his pleasure. In consideration of the youth of my
patient, and the probability that he would attempt some move-
ment which would displace the dressing before it became har-
dened, I confined a splint or small piece of white pine board to
each side of the hmb, by an additional roller, which was removed
on the fourth day after the fracture.

My patient had no bad symptom beyond the restlessness
common to his period of life. During the week, I thought it
safest to confine him to his couch. The seventh day after the
injury, he was permitted to get up, and although too small to
walk surely with crutches, he contrived to locomote by means of
the sound limb and his hands, much to his own comfort and
greatly to the relief of his attendants.

On the first of January the apparatus was removed, and the
limb found to be perfectly straight, of equal length with the
other, and firmly united.

The second is a case in which speculative opinion would have
deterred me from the application of the Immovable Apparatus,
if I had not previously have seen similar ones successfully trea-
ted with it, and every theoretical objection triumphantly refuted
by a practical fact. It was a compound comminuted fracture,
produced by the falling in of stones and earth in one of the deep

1-SS9.] Fracture of the Lower Extremity. 459

excavations on the Western and Atlantic Rail Road. Some de-
lay ensued before the sufferer was extricated from the rubbish
amongst which he was we^lged. and much more before I could
visit him at the shanty of his employer, Mr. Y., a distance of
fifteen miles.

The patient was an athletic young man, and had suffered
miserably from spasmodic muscular contraction before I reached
him. The superior fractured extremity of the tibia was pro-
jecting slightly from the external wound, but was easily made
to resume its proper position. Three small fragments of bone
w^ere found wholly detached and removed, and the fractured
portion as properly adjusted as the very considerable tumefac-
tion which had ensued would permit, and the bandages or ap-
paratus applied as in the above case, omitting the pine splints
and dressing the wound of the integuments with a little cerate
and plaster. The bandage relieved the spasmodic contraction
of the muscles almost as soon as applied, and a strictly antiphlo-
gistic regimen quite reduced the swelling in four days, when
another roller had to be strondy drawn over the whole dressing
to make it adapt itself to the diminished size of the limb. This
intention it answered completely; the better for the envelope
having been again remoistened with the paste before its appli-
cation.

When it had acquired sufficient firmness, on the sixth day af-
ter the injury, the patient mounted his crutches and continued to
move about as he pleased until the fortieth, when the apparatus
was removed, and the external wound discovered to be entirely
healed. No deformity of the limb could be perceived, nor is
there any halt in the gait of the individual subsequently. The
pus discharged from the wound, which had occupied the inter-
stices between the limb and bandage, had become indurated and
produced no inconvenience during the cure.

The tumefaction, and especially the supposed necessity for
dressing the external wound, would in this case, at the first blush,
appear decidedly to contra-indicate a contrivance like to that
described above, but experience in this as in many other instan-
ces, shows that the employment of the additional roller obviates
the first of these difficulties; and the exclusion of the atmos-
phere from the discharged pus, so deprives it of its virulent pro-
perties, that the necessity to remove it no longer exists.

460 Expulsion of Fcstus six hours after death of mother. [May

The third case is of quite recent occurrence. On tlie morning
of the 25th of February, the patient, a negro boy IG years old,
belonging to Mrs. O'Neal, of Monroe county, Ga., was engaged
in felling trees, and one of them fell upon' his left leg and frac-
tured, or rather mashed, both bones of it without any injury to
the integuments.

I saw the patient, and arranged the bandage very soon after
the accident, before it had produced much pain or swelling. On
the 28th, the dressing had become sufficiently hard and strong
to allow of his leaving his bed and walking upon crutches with-
out injury. He still uses them, (14th March,) but has had no
accident or unfavorable circumstance, and doubtless will be en-
tirely v/ell when a sufficiency of time has elapsed to justify his
liberation.

These cases bear no sort of proportion to the large volume of
evidence in support of this method of treating those injuries
which has been hitherto furnished by other individuals, but if they
induce a few Physicians to practise it, and rescue their patients
from a horrible four or six weeks confinement, the utmost extent
of my hopes will be realized.

Cassville, 14th March, 1839.

Case of Expulsion of a Foetus, after the death of the Mother,
By J. C. NoTT, M. D. of Mobile.

This patient was a negro woman, aged about 35, belonging
to Robert Purvis, merchant of Mobile. She had menstruated
irregularly for twelve months before conception, and during this
time, her health was not good. I was called first to see her
about the middle period of pregnancy she was then complaining
of pains in the uterus, which became more troublesome as ges-
tation advanced. During the last month, the pains were almost
incessant, and often so violent that I thought her actually in la-
bor. She had a good deal of fever, and her strength failed so
as to alarm me, and I determined, if possible, to hasten the deli-

1 S3d. ]Expidsion of Fastus six hours after death of mother. 40 1

very. On examination per vaginam, during a strong pain I
found the os tincoe dilated to the size of a dollar, but when the
finger was placed against the membranes, no contraction of the
longitudinal fibres could be felt the action appeared to be con-
fined entirely to the circular fibres. When the pain went 08*1110
mouth of the uterus was fully relaxed. Repeated examinations
gave the same result.

I ruptured the membranes with the hope of inducing a differ-
ent action, but was disappointed. I gave ergot, but without ef-
fect. The case finally became so urgent that I determined to
open the head, which, with the assistance of Dr. Fearn, I did.
All of the bones of the head were removed, and the child still did
not advance. The uterus was in a very unfavorable condition
for an operation of this kind, and the patient sufl^ered so much,
and was so much exhausted, that we thought it most prudent
to desist Tor the present; and after removing the head, we left
her at midnic^ht about dav licrht she died and when I went to
^ee her about seven o'clock in the morning, I found her laid out
i-i (-^i" burial clothes. About mid-day I received a message that
r D r^'ld was born, and a request to visit her immediately. I
did so, and found that u, full grown foetus had been expelled about
six hours after death. She had become distended to fully twice
her natural size with gas not only the abdomen and thorax, but
the head, neck, and extremities. I have no doubt that the child
w^as forced out by this extrication of gas.

462 Dr. Nott on the Double Inclined Plane. [May^

Part ii. REVIEWS AND EXTRACTS.

Description of a Modification of the Double Inclined Plane, with
an exposition of its advantages over other apparatus for frac-
tures of the lower extremity. By Josiah C. Nott, M, D^ of
Mobile, Am. Jou.for Nov. \Sis.

This " description of a modification of the Double Inclined
Plane," is from the pen and the experience of one of our most
valuable southern practitioners, but has been so curtailed in pub-
lication in the November number of the American Journal, as
to cause the author to iee\ himself under the necessity of farther
exposition of the subject. We insert, in the first part of the pre-
sent number of this Journal, Dr. Nott's last remarks on this in-
teresting subject, in which reference is made to the article at pre-
sent under consideration. In order, therefore, to bring Dr. N's.
views and experience as fairly as possible before the readers of
this Journal, we have thought proper to notice, in this place, the
former publication in such a manner, that its contents may be
brought near to that which it is its purpose to elucidate. Mean-
while, we enter our protest against the plan of Journalists cur-
tailing the statements of writers, in such a manner as to alter oi'
render unperspicuous. their meaning. This is often done, with-
out intention of that effect, because it is not always the case that
the authors views are as clearly and impressively received by
the editor as they are entertained by himself; and if they were;
there is something of idiom in the expression of most writers, as
there is in different languages, which must suffer by elimination,
or new verbiage, with almost the same certainty as the ideas
written in one language do by being translated into another. No
part of an essay or communication calculated to bear, in the
least, on the subject treated, can generally be omitted with pro*
priety. We recollect to have had the cause of truth suffer in^
one instance, and of truth and humanity in another, by such mu*-
tilations of our remarks. In the former instance, which was a
description of a case wherein about one half of the right lung
was disorganized, and sections of the fifth and sixth ribs takeni
from the same side;in which we were made to give the understan-
ding, that the patient finally recovered ; whereas he finally died.
In the other, we attempted to illustrate the utility of that invalu-
able chemical medicine, known by the name of Hydrocyanic, or
Prussic Acid, by the minutes of some twenty of the first cases
in which we prescribed it, taken in the order of our experience,
from our notes kept of the cases, in many of which its sedative
powers W:Sre eminently valuable ; whilst in a few others, they

1839.] Dr, NoU on the Double IncUnsd Plane, 463

were less conspicuously so. At the same time, on account
of the great power of this article, and, consequently, the
absolute necessity of its uniformity of strength, we annexed the
process by which the acid used in the cases detailed, was made.
The reader will be able to realize our surprise when he learns,
that in the publication only a lew of the most discouraging and
unfavorable cures, such as confirmed tubercular phthisis ni the
iast stage, &c. were inserted, whilst the weight of evidence of
the important virtues, and the safety in the admuiistration of
Prussic Acid, were omitted, in company with the process by
which the specimens used were made.

There has been much complaint of the exercise of this kind of
curtailment by Journalists ; the eftects of which have not only
been to suppress and to distort the truth on subjects of the great-
est importance, but it has so operated on the feelings of practi'
tioners as to prevent, in very many instances, the communication
to the public, of opinions and facts of great value.

The apparatus of which Dr. Nott speaks, * consists of four,
pieces; a thigh piece, a leg piece, a moveable foot board, and a
horizontal board resting fl:it on the bed. The thigh piece is fif-
teen inches long, eight wide at the upper, and seven at the lower
end, and one inch and a quarter thick. The upper piece is hol-
lowed out a little, and brought to a thin edge above, to fit it well
under the nates ; and the corners are rounded off, as otherwise,
they would be in the way in passing fa3ces." This thigh piece
has three openings on each side, two inches from the edge, for
the passage of leathern straps the lower being as near the knee
as possible, the upper one near the groin, and the third, interme-
diate. The leather straps, with buckles attached, are long
enough to pass around the limb after the pads and splints are
applied, and buckle firmly across ; in order to which two and a
half feet are required. The leg p"ece is two feet long, seven
inches wide at the upper, and six at the lower end. it has a
slit at the lower end, seven inches long and one and a half wide,
for the purpose of receiving the tongue or tenon of the foot-board,
allowing it to be moved up or down, according to the length of
the limb. There are four openings near each side of this board
for receiving leather straps, as in the thigh piece. One of them
is as near the knee as possible, one near the ancle, and the other
two at intermediate points. Small holes are bored horizontal-
ly through that part of the leg piece through which the mortice
is made, for the purpose of fixmg the foot board at any desired
point.

'The foot board, is twelve inches lon^, and four wide, with a tongue one
and a half inch wide, so as to fit closely in the Ion*,"- sht, where it is firmly
held by the wire. In order to hold it more steady, it has a small block nail-
ed on the lower back part on a level with the commencement of the tongue;
this block prevents the foot from pu&hiug it forwards.

464 Dr, Nott on the Double Inclined Plane. [May ,

The horizontal board which rests on the bed, is notched at its lower ex-
tremity; in these notches the leg piece is supported, and by means of them
tjie angle may be varied when necessary it is three feet long and eight
inches wide at each end it is fastened to the thigh piece two inches from
the upper extremity of the latter by two hinges the thigh piece fits better
under the nates for projecting over in this way these hinges may be of iron
or leather.

The joint between the thigh and leg piece, is formed like a carpenter's
rule the two pieces being fastened together by a piece of strong wire
iron or leather hinges would answer here also the angle formed here should
Oti rounded (>Jf'\xi prevent injury of the ham.

In the thigh and leg piece, half an inch Irom the edges on each side there
is a row of holes, half an inch in diameter, to receive wooden pegs six inches
long which stand perpendicularly on each side of the hmb, these may be
inserted at any points the surgeon thinks advisable, to give additional firm-
ness to the fixtures thus giving all the advantages of a fracture box with-
out its inconveniences.

Extension, in fractures of the thigh, is effected, in this apparatus, principal-
ly by the weight of the leg resting on the calf and whole under surface down
to the heel, by the straps buckled across to keep it stationary and where
necessary by an extending band or gaiter (on which there is very little
stress) which fixes the foot to the foot board. The lower fragment is thus
held firm while the body is resting comfortably on the bed. It will be seen
at orice that if thefragmentsare properly adjusted and thehmb placed over the
inclined boards (the thigh board being of the proper length) shortening can.
not possibly occur ; the weight of the body makes a passive counter-exten-
sion, without being hung up by the ham, while extension is effected as be.
fore stated.

Manner of applying the Double Inclined Plane. The surgeon may bf
guided by his own judgment with regard to the propriety of applying a roller
or many tailed bandage to the limb ; in the great majority of cases it may
be dispensed with.

1. In Fractures below the Knee. In the first place a narrow bag of the
width and length of the two inclined planes, about half filled with bran, chaff,
or what is much better curhd hair, must be spread over the appartus for
the limb to repose on ; it should then be placed under the sound hmb so as
to get every part of it properly adjusted, foot board &.c.; then raise the fractu-
red Urab, adjust the fragments, place the apparatus under it and lay it gently
down on the cushion, taking care to arrange the latter so that it will press
equally from knee to heel. It is frequently necessary to stuff cotton or tow-
under the part of the pad between the calf and heel. Next apply two nar-
row junks or pads prepared in the same way as the one under the limb, on
the outside and inside of the leg and long enough to extend from the knee
to the sole of the foot ; over these two splints, of the same length and three
inches wide, if necessary, a pad and spht may be placed on the anterior sur-
face of the leg also and the four straps should then be buckled firmly
across. Before all this is done, however, the foot should be bound by a ban-
dage to the foot board ; if the fracture is oblique it may require a gaiter.

If preferred,wet binder's boards may be placed next to the leg and the junks
on the outside. One or two straps should also be buckled across the thigh
to keep it still. A few pegs ^should also be inserted along each side to
keep the whole more steady.

This dressing answers for all the fractures of the leg, oblique or transverse,
simple or compound, and displacement is imposssibie.

2. In Fractures in the middle or Loicer third of Femur. The application
is equally simple here and should be commenced in the same way, by
spreading over the apparatus a stuffed bag for the hmb to repose upon, and
adjusting it properH- on the sound limb first so as to be sure that every thing

183y.] Dr. Nvtl on the Double Inclined Plane. 465

will fir snugly. Three junks and the same number of splints long enough to
extend from the pelvis to the knee on the outside, inside, and anterior sur-
face ; these are properly placed and the thigh straps buckled across. The
foot must be bound to the foot board and the leg straps buckled to keep the
leg quiet.

A very important point in fractures of the thigh is to have the thigh piece
of the proper lejigh^ diud this may he determined by applying it first to the
8ound limb. If the thigh piece of the apparatus is too long for the patient,
place a folded blanket under the pelvis, which will be equivalent to the short-
tening the thigh piece as it brings the pelvis nearer the angle of the inclin-
ed planes. If the thigh piece is too short for the patient, place a board un-
der the horizontal board of the appparatus and this will be equivalent to
lengthening the thigh piece.

3. In Fractures of the Femur in or near the Neck. In these cases the
apparatus of Desault, Boyer, or Hagedorn, and in short all other than the
doubled inclined plane, are confessedly inadequate to a cure, without defor-
mity.

There are difficulties to be surmounted even with the double inclined
plane, but I do not think them very great, and it must be recollected that we
have no choice. The indications in those cases are :

1st. To keep the limb of its natural length.

2d. To flex the thigh upon the body and the leg upon the thigh so as to
relax all the muscles which have a tendency to produce displacement.

3i. To raise the body by placing under the back an inclined board or bed
chair, in order still further to relax the iliacus internus and psoas muscles.

4th. To keep the foot firmly fixed in the upright position.

5th. To keep the trochanter a little raised by putting under it a wedge
shaped pad, where the fracture is in the neck thus preventing one end of
the bone from falling below the level of the other.

6th. To keep the fractured surfaces in close apposition.

7lh. To prevent the motions of fragments.

Sth. To fix the pelvis.

Now I repeat, that the indications, all ot which are important, cannot be
met, by any other apparatus than the double inclined plane.

The manner of dressing these fractures is precisely the same as that de-
scribed for fractures in the middle and low third, except that the sphnt on the
outside ot the hmb should be long enough to reach beyond the hip joint and
in addition to the straps be secured at the upper end by a bandage passed
around the pelvis. This assists much in controlling the motions of the
pelvis.

In these it is all important that the pelvis should be fixed, as motion from
side to side would necessarily produce derangement. W hen the patient is
restless the only effectual plan which has occurred to me is that (which I
adopted in Case 1st) of placing a double incUned plane under the sounds as
weel as the broken limb the two being pressed up, on the same level, under
the nates, will of course prevent any twistmg motion and keep the pelvis in
its position. In order to keep the relative positions of the two double inclin-
ed planes the same, lay a narrow board across the foot of the bed in contact
with the bed posts let the lower ends of the horizontal boards of the two
apparatus rest on the cross board, and fasten them together by boring a
hole through each and inserting moveable pegs. The apparatus for the
sound limb may be of the simplest kind no junks, splints or straps are re-
quired there is nothing wanting but to let the hmb rest on the inclined
planes it can be taken away when faeces are evacuated and replaced with-
out the least trouble. See Case I for a practical illustration.

These cases are comparatively rare, fractures of the femur generally oc-
c'rring near or below the ml '"^.

466 Dr. Nott on the Double Inclined Plane. [May,

The advantages of the double inclined plane over other apparatus for frac-
tures of the lower extremmity, are the following :

Is/. The double inclined plane costs but little, is so simple in its con-
struction that it can he made by any one ; is easy of application, and when
applied difficult to derange ; the argle, too, in most cases can be varied oc-
casionally, which gives great relief to the patient.

2c?. Extension and counter-extension are steadily preserved, the frag-
ments are brtter guarded agaist motion, while, at the same time, the patient
can be moved with much less risk, moved from one part of the bed to ano>.
ther.

Zd. It is constructed in such a manner, that it can be adjusted so as to
fit hmbs of different lengths Is equally applicable To all the fractures of ike
ihif^h and Z?g, whether simple or compound ; and therefore, with a few shin-
gles for splints, and junks, a dresssing will always be in readines for a frac-
ture of the lower limb ; one apparatus of this kind will last a surgeon for
life.

4ih. The foot is so well secured that no retraction or lateral motion can
occur to derange the fragments.

5th. If there should be a wound in the soft parts, swelling or inflamma-
tion, the limb may be simply laid over the inclined planes, the foot bound
to the foot board and two or three straps buckled across to keep it steady
extension and counter-extension are thus kept up (which is all that is ne-
cessary until callns begins to form) and there is no impediment to any local
treatment which may be deemed requisite or even after the limb is fully
dressed you may, at any time during the cure, open the dressings to exam,
ine the limb without the possibility of harm.

6th. The flexed position relaxes the muscles, (thereby counteracting the
cause of shortening) is much more comfortable than the straight position,
and obviates in a great degree that painful stiffness which often follows the
latter.

7ih. The flexed position is greatly preferable to the extended, where the
fracture is near the trochanters, or near the condyles. In the former case,
the iliacusinternus and psoas muscles, draw up the fragment, and in the
latter, the gastroc-nemii and popliteus draw the lower fragment down, so
that the proper line and apposition of the bones is not presen-ed. and short-
ening or angular derangement or both are the consequences. This must be
admitted by everv one.

&fh. The weight of the leg on one of the inclined planes, keeps up exten-
sion on the lower fragment (in fractures of the thigh), the extension being
made principally on the calf; while counter-extension is effected by the
weight of the pelvis, which holds the upper fragment in its place there are
no bands to produce excoriation an extending band in some cases of oblique
fracture may be necessary to keep the foot in its place, but the stress upon
this is triflmg generally speaking, the foot only requires to be lightly bound
to the foot board to keep it upright the heel, instep and periueum, are thus
saved from excoriation.

9th. The facility of passing faeces, too, is another great advantage the
patient has only to raise the sound limb, and a bed pan can be slipped under
him without inconvenience.

10/?i. When the fracture is in the uoperpart of the femur, the patient must
be kept always in a half sitting posture, but when in the middle or lower
third, he can assume at pleasure any posture from the recumbent to the sit-
tiDSi and may thus amuse himself with reading, writing, chess, cards, &c.

iltk. The apparatus of Desault, Boyer, and Hagedorn, do not permit of
access to injuries of the soft parts, when situated under the lateral splints.

The apparatus above described, is illustrated in the American

1^39.] Dr. Nott on the Double Inclined Plane, 40'

Journal by two good cuts ; one exhibiting plainly the apparatus,
and the other, its application. The four following cases are
given by Dr. Nott, at the end of the description of his niodifica-
lion of the double inclined plane, in further illustration of its ap-
plication and utility.

The four following cases illustrate the eS^cticy of the double inclined plane
J employ. I have selected these, because they occurred not in my own prac-
tice, but in that of other surgeons.

Case I. Fracture of the Thigk. The subject of this case, G. R., about
nineteen years of age, from Charleston, while a student in the South -Caroli-
na College, became mvoJved in a difficulty which resulted in a duel on the
29th May, 1833. 1 was at this time living in Columbia and tlie case came
under my charge. His antagonist was shot through the abdooien and sur-
vived but twenty eight hours, and R. was shot through the thigh
fracturing the femur the ball entered the right thigh -on the outside, four
inches below the trochanter and passing through the bone came out at the
opposite point two inches below the groin so exactly over the track of the
femoral artery that it must have been struck, though not with sufficient force
to cut it, the bone having protected it. The ball passed through a large plex-
us of blood vessels of and nerves, and the hemorrhage was considerable
though not ahrming the thigh swelled immediately to double size from ex-
travasation of blood. I had him carried to town that night, fifteen miles.

This case according to all authority was one which demanded immediaie
amputation, and was exceedingly interesting in many particulars, but I shall
omit every thing but what relates to the supject before me.

I did not attempt to set the limb before the 11th of June (13th day) be-
cause I was afraid of sloughing in the track of the ball and that the motion
required in setting it might produce a rupture of the artery and fatal hemor-
rhage. There being wounds on the outside and inside of the thigh which
required constant attention, the ordinary apparatus was inapplicable, and
this fact as well as the situation of the fracture (being very high up) deter-
mined me to select the double inclined plane which 1 had never seen apphed.
The limb was accordingly dressed in the manner already described, on the
llthof June, thirteen days after the accident. From my notebook I take
the following extract which I think important.

"June i6ih. Patient has a great deal of pain in the wound, is very rest,
less and cannot be confined in any position which will prevent him from
twisting the pelvis to the opposite side and thus distorting the limb. The
bones form a salient angle externally and the lower fragment rides the upper
the limb is shortened and the patient so restless thot 1 fear an artificial
joint. I have therefore ordered another double inclined plane for the sound
Umh, with the view of confining it and Keeping the pelvis square, hi
hopes by this means, of preventing the motion which produces the derange-
ment of the fragments."

2Sd. On the 18th the other double inchned plane was placed under the
sound limb exactly on a line with the other, and the two acting like wedges
under the nates, of course kept tlie two sides of the pelvis on the same level
they were fixed by pegs (as before stated) to a transverse board to guard
them agninst motion. No bandages, splints or any dressing was applied to
the sound limb except a pad for it to repose on. The foot of the broken
limb was well securd to the foot board, a compress laid over the pro-
projecting extremity of the lower fragment and a strap buckled over it so as
to draw this fragment inwards and counteract the angular derangement
(the other dressings as already described.) This arrangement succeeded

468 Dr, Nott on the Double Inclined Plane. [May,

even beyond my expectations the limb is now straight and erf its natural
length."

In the early part of July the patient had a severe attack of intermittent
fever for about a week, for which he took quinine and the usual reme-
dies. On the 31st he was up walking about on crutches, and on the 18th
of August he left town m a stage coaci], perfectly well and without deformity.

During its progress this case was seen repeatedly by Dr. Wells and Dr.
Gibbes who will vouch for the principal facts stated.

This young gentleman was one of high respectability, but misfortune
seemed to have marked him for her own. He afterwards had the same thigh
again fractured by a fall, three or four inches below the original fracture,
and after recovering from this went on to Philadelphia (as a medical student)
where he died with an attack of fever.

Case IT. Fracture ofihe Thigh. In the month of October last (1837) a
young negro man belonging to Air. Alexander Pope of Mobile, fell through
a trap door in the second tioor of a warehouse, drawing along with him a
large box of goods, which fell upon bis thigh and fractured it in two places^
about four inches above the knee and also about four inches below the groin
the middle fragment too, felt as if it was crushed into several pieces.

Dr. R. Lee Fearn and myself attended the patient together. We placed
the limb over the doubled inclined plane (as described) bound the foot to
the foot board, and without any bandagiug, placed pads, and on the top of
these splints, on the outside, inside and anterior surface of the thigh the thigh
straps were then buckled firmly across, and also the straps across the
]eg. He was the most unmanageable patient I ever saw and appeared to
be perfectly regardless of consequences. He would unbuckle the straps
and take off all the dressing but the limb still remained on the inclined
planes and the foot, bound to the foot board in the upright position
he was unabled to move the Jimb, and extension and counter-exten-
sion were thus maintained in spite of liim. At the end of five or six
days, finding him so unmanageable, Dr. Fearn thought he could be confin-
ed better by Desault's apparatus ; and accordingly the limb was taken oft*
the inclined planes and Dr. Physick's modification of Desault apphed. The
next day we found every, bandage untied and the limb shortened it was
again applied and again every thing was torn loose. We once more ap-
plied the double inclined plane which kept up extension and counter exten-
sion, although he would unbuckle the transverse straps when he pleased.
Under these circumstances, unfavorable as they were, the cage did well
the bones united and on the forty-second day the man was np walking on
crutches about the termination of the third month he walked to our office
without crutches, and when stripped and standing before us, the eye could not
distinguish the fractured limb from the other there was no shortening and
no deformity.

But one double inclined plane was used in this case : the second is very
rarely required.

Case 111. Fracture of the Leg. Mr. 1. C. D., a connection of mine, was
thrown from his horse during the last summer and fractured both bones of
the leg about two inches above the ankle the malleolus internus was frac-
tured also. I applied the straight splints and other dresssings ordinarily em-
ployed, which were continued for a week. He complained so much of pain
in the knee and the point of fracture that I determined to put the limb on the
double inclined pbne, thinking that the more perfect support to the limb, and
the relaxation of the muscles might afford him relief. 1 first laid down on
the leg piece (the apparatus being first protected by a hair pad) the bandage
of Scultetus and then placed the limb upon it. I next applied wet binder's
boards on the outer and inner part of the leg from the knee to the sole of the

1839.] Jr. Nott.onthe Dvuuie ^Hcini cune, 4GJi

foot the strips were then drawn across junks on each side and the leather
straps buckled firmly over the whole the foot also was secured in an upright
position by being bound to the foot board. The relief from pain was imme-
diate and I heard no complaint afterwards the cure marched steadily and
rapidly on.

In this case, junks next the skin and wooden splints or binder's boards
on the outside would have answered all the purposes oi binder's boards
and bandage of JScultetus.

Case IV. Fracture of (he Leg. This was a patient in the Mobile Hos-
pital under the charge of Dr. Kenwood, through whose politenee-s I was al.
lowed to apply the double inclined plane. All the circumstances connected
with this case (with the exception of the fracture being a few inches higher
up) resemble so closely case third, that I deem it unecessary to give a detailed
account of it. He was rendered much more comfortable by the iiiclined
plane and was speedily cured.

We shall be pleased to find Dr. Nott's modification of the
double inclined plane, prove adequate to ihe libeiation of the pa-
tient from the bed in cases of fracture of the lower extremities.
If it will effect this, and at the same time preserve good adjust-
ment, it must meet the desire of every practitioner of surgery ;
for the bed has become the chief source ol distress in these ca-
ses ; all other troubles, being met by the various modern im-
provements in surgery. We do not, however, see why it may
be expected to prove more serviceable than Amesbury's appa-
ratus, to which )t is, in its principles, very analagous.

We are of the opinion that the high price at which Amesbu-
ry's apparatus has been held, rather than its falling short of the
purposes for which it was designed, has been the cause of its
want of more general adoption. The apparatus of Dr. Nott can
be speedily constructed by any practitioner of tolerable mechan-
ical ingenuity, or may be procured of the mechanic, we presume,
for five or ten dollars. We treated, during the last summer, a
compound fracture of both bones of the leg, of an old man, with
double inclined planes of temporary construction, preserving ex-
tension with a moderate weight hung at the foot, whh very sa-
tisfactory results ; but we confined the patient to the lying posi-
tion for several weeks, before we allowed him to be up at all.
In the use of Amesbury's apparatus in recent, and indeed in all
cases, we have found such a tension of the dressing demanded,
in order to the prompt preservation of adjustment, which was
incompatible with the comfort of the patient, and which we have
thought more distressing than the irksomeness of lying, without
that tightness of the dressing. One case occurs to our recollec-
tion, wherein the muscular powers of the lower extremity were
destroyed for many months by the tension of the dressing which
the surgeon thought necessary to use. In this case, the whole
limb remained shrunk considerably below its natural size ; and
we doubt whether its powers and development have yet return-
ed, although the accident occurred some seven or eight years

'i'/O Siorlatlna, [May,

ago. We do not know what pressure was used, as the case
was not nncJcr our craie until alter the ap[)aratus was dispensed
witli. The practitioner who had the management of the case,
was, howevci', not witliout experience and judgment.

The following observations are from the pen of
Joseph Reynolds, of Gloucester, iVlass. VVe extract them from
the Boston JMedical and ISurgical Journal, of 27th March last:

I have been pleased to observe that you have several times, of late, called
the attention ot the faculty to the subject of scarlet lever. I hope you will
continue your cabs, until their attention shall be thoroughly aroused. I ad-
dress you at this time to make two or three inquiries ; and 1 do this for the
purpose of directing- attention to a point which 1 fear has not received suffi-
cient attention in this country. Several European writers have noticed
the combination to which my inquiries refer, but 1 am not aware that
lauch observation has been directed to it in this country.

Before propounding my inquiries, I wih remark that 1 have never observ-
ed those inconveniences resulting from the use of tartarized antimony, in
this disease, which have induced Professor Cross to condemn it in such de.
eided terms. On the other hand I have used it freely, and should my suc-
cess continue as groat as it has hitherto done, I shall certainly continue its
use. Seven yearsi ago 1 attended, in one autumn and wihter, seventy. six
cases, and only one of them terminated fatally. My treatment consisted
chiefly in the iree use of calomel, small doses ot ant. tart., with occasionally
emetics of the same, and opiates as they were required. Such small doses
of opium as are useful in allaying the irritation of the system, will be sufficient,
in most cases, to counteract the tendency of the antimony to run off by the
bowels. This fact seems to have been overlooked by the professor.

The inquiries which 1 wish to propose, are the following. Does-cynanche
maligna run into c. trachealis ? In other words, does the inflammation ex-
tend from the tonsils and fauces to the larynx, trachea, and even to the bron-
ehail tubes ? If it does, in what proportion of the fatal cases does the inflam-
mation thus extend ? Does c. maligna often prove fatal, in the acute stage,
without exhibiting decided symptoms of c. trachealis ] Does the tendency
of this extension of the inflammation depend upon any appreciable cir-
cumstance, as the state of the atmosphere, season of the year, local cau-
ses, &c. ! Jf it should be decided by observation that the inflammation
does frequently extend to the trachea and its branches, and especially that
this is true in a large proportion of the fatal cases, will this lead to my modi-
fication of the treatment of cynanche maligna J

Should these inquiries turn the attention of observers to this point, and
epecially should they lead those who have made observations relative to it,
to communicate them, my purpose will be answered.

In addition to the standing wants of the profession, on the sub-
jects of its cause, true pathology, and best treatment, Scarlatina
has again, in consequence of its epidemic prevalence and severi-
ty in several places, and the appearance of fatal sporadic cases
in others, become a subject of great interest. Much has been
recently published on the i^ubject, from the pens of Professors
Chapman and Cross ; from neither of whom, however, do we re-
ceive any thing of practical value in addition to the old stock of

1830.] Scailatlnn. 471

knowledoro. The cause, whether ri speeifie ronfnfrion, opornt-
ing according to the regular laws ofcontatxion. or accordinfif to
special laws of its own peculiar kind, or peculiarity of atmos-
pherical, or sol-lunar influence, or derived from some straneo
and rare peculiarity in the constitution of diet, is not vet fully
determined. Nor has the disease been satisfactorily described
bv writers whose observations have been circumscribed bv a
small geographical extent : consequently, owing to ihcse cir-
cumstances, little improvement has been made in the prophylac-
tic and therapeutic departments, calculated to aflxDrd uniformity
of success. The disease, therefore, remains a very formidable
scourge of humanity, and one, concerning which, much has yet
to be drawn from the secret recesses of nature. The truth is,
the disease differs materially with season, location, individual
constitution, intensity of cause, the mere general differences of
its character, in its epidemical appearances, at various times of
its prevalence as an epidemic, &:c. And with regard to preven-
tion and treatment, there never can be more than sheer empiri-
cism until its true causation and true pathology are better un-
derstood. We look with great hope and anxiety, to the revo-
lution now progressing in the profession for the banishment of
ultra " so7idis7n" for directing the enquiries of the medical mind,
more than heretofore of late years, to the condition of the JIuids,
and thereby diffusing more light on the subject.

Whatever may be the fact, relative to its contagious nature
elsewhere, we hesitate not, one instant, to assert the non-conta-
giousness of Scarlatina, in the circle of our observation. We
have all the evidence we can consider necessary, to place this
fact beyond even plausible controversy. Such as, its occur*
ence in a very large proportion of cases, without the least possi-
ble communication with previous cases its non-appearance in
a like proportion under the circumstance of the most free com-
munication^its appearance in individual cases, at all periods,
from a few hours only, to weeks or months after communica-
tion, &c. And to these, we add that we verily believe that our
own case of this disease appeared but partially, at different, re-
mote periods, before the disease was completed ; for in iSll, we
suffered with many others in whom the disease appeared at that
time, the eruption only, and in its latter prevalence, a few years
ago, in the United States, we suffered the peculiar typhoid, con-
stitutional, and the quinzy distresses, which, taken together,
make up the general and complete characteristics of Scarlatina.
Excluding then as we do, explicitly, at least for our region, spe-
cific contagion as a cause, we have now only to look to atmos-
pherical and dietetic influences. Continuing our excluding plan
of etiological research, we find much reason to put dietetic infiu-
ence also koi's de combat : leaving atmospherical influence the

472 Scarlatina. j^May,

only field for research. Whether this epidemical constitution of
ihc atmosphere be derived from some peculiarity of tempera-
ture, locality, uranic influence, &c., as pre-remote causes, we
do not pretend to determine on the present occasion ; but in
passing, we will remark, that a uniform sequence of events or
phenomena, amounts to a declaration of cause-and-effect rela-
tion : and we think that few unbiassed persons can look over the
facts which Noah Webster collected many years ago, relative
to the appearance of great and remarkable physical phenomena
of the universe, and the appc^arance of epidemics in different
parts of the earth ;* and brini^ to^iether like events which have
transpired since the time of his publication on this subject, with-
out observing!, at least, a remarkable uniformity in the sequences
of their phenomena.

But it is of little importance, in a practical point of view,
whence this pre-remote influence is derived, or what its nature
and name in the catalogue of things. The great questions are,
how does it primarily afl^ect the human system ? Whether
the solids or fluids, or both ? And is it of a nature susceptible of
neutralization in or out of the system, or of elimination after be-
ing introduced ?

We must look upon the morbid actions, which make up the
sum of the phenomena of Scarlatina, as the eflects of its cause,
receivedinto and retained within the system, in sufficient power
to develope such phenomena. It is no gratuity, but an axio-
matic truth, that, otherwise^ the cause, whatever it be, or from
whatever source, could not act at all. But peculiar morbid ac-
tion is produced : it is therefore, unavoidable to conclude, thai
the cause is introduced into, and retained within the system, in
sufficient power for the production of the morbid phenomena.
Now is it reasonable to expect, under such circumstances, tha
the best efforts for the correction of these actions, directly, and
these alone, without due regard to the abiding presence of the
cause, can be looked to for the final extermination of the disease?
or shall we expect, as we should in all other matters for the final
prevention or destruction of subsequent phenomena, to be oblig-
ed to remove, or render inert in its place, the cause ?

Abundant attention to the action produced, alone, has been the
rage during the reign of solidism, and banishment of humoral-
ism, which has strangely existed for the last twenty or thirty
years. This then has been fully brought to the touch-stone of
experience, and has, on fair observation, been found wanting ;
and consequently the cry for a remedy has never been louder
than at present. The success which has attended this practice,
appears to us to be about this : that the morbid kind andinequal-

*See Webster on P'^stilenr/-

1839.] Scarlatina. 473

ities of action have been, in some instances, so Equalized and re-
gulated, as to prevent local destruction of* parts and functions,
until the constitutional energies of the system have restored the
secretions which have finally effected the elimination of the
cause, and the patients have recovered. So al^o, very light
cases have occurred, which, not having power to destroy or-
gans, or derange functions to any considerable extent, have re-
covered without remedy. As to this practice, then, we say, it
is insufficient, and therefore unsatisfactory. This excludes all
the inquiries, except those rel'ative to the elimination, or intra-
correction of the cause. We are then, on finding that the cause
is introduced into and retained in the system, brought to the ne-
cessity of determining its location, and its chemical nature.

Just in proportion as the false glare of an exclusive nervous
pathology passes from our eyes, will be the ratio of increase of
oui: perception of the physical cause of the morbid phenomena
being in the circulating fluids. If here abiding, we have all the
knowledge and control of it, which we have of fever, and we are
brought to look to the secreting and excreting functions for its
eradication. So far then as the emunctories can be brought to
act on this cause, by medicinal powers, &c. which are at our
command, will the disease be found under our control ; whilst
insuperable organic lesion or destruction of parts or powers,
must be looked to, in many instances, as having transcended the
extent of our remedial means ; and this is the end of professional
purpose in the case.

But in this view, we would not exclude the attention from the
due consideration and employment of those means which are ra-
tionally calculated to act on the solids. The state of general
excitement or local mischief, need at the same time, when these
effects are set up in such a degree as to exist independently,
their peculiar and appropriate corrections. The only remain-
ing enquiries are What is the chemical nature of this cause,
if indeed it have a chemical nature? And what would be its
incompatibles, whereby we might expect to neutralize its ener-
gies ? This, if ever, will be determined by careful observation
of the phenomena resulting, and a posteriori reasoning.

We consider the great error in the treatment of this disease,
has been in the exclusive and immediate treatment of the morbid
actions of the system, to the neglect of the causes of those ac-
tions. But we have greatly transcended the limits we assigned
ourself, when we took up the pen, and shall here leave the sub-
ject for the consideration of other and 'more able minds.

Id

474 Prophylactic and Curative Powers of Tobacco. [May^

Prophylactic and Curative Pov)ers of Tobacco. On this sub-
ject, wc extract entire, in the lirst place, the following article
from the editorial head of the Boston Medical and Surgicaf
Journal, for March last :

Impaired voice, in Clergymen. Within less than twenty years a new
thsease has been developed in thjs country, which is almost exclusively con-
fined to parish ministers. It is a loss of tone in the vocal organs, attend-
ed by a sense of fatigue in the muscular apparatus of the throat, and accom-
panied by a peculiar dryness and rigidity, apparantly, of the lining mem-
brane of the larynx. All these finally incapaciate very many excellent men
from discharging their pastoral duties. A multitude of divines are actually
more or less affected with this malady of the throat, at this moment, and
very many have been absolutelyly obliged to ask dimission from their peo-
ple, in consequence of a total inability to read their discourses in public, or
conduct the ordinary services at the desk. Many have placed themselves un-
der medical care, with an ex])ectatiorr that rest, together with the admin-
istration of a gentle course of tonic remedies, would eventually overcome the
difficulty, and enable the vocal cords to vibrate with their original energy.
In other words, the sufferer has generally supposed that the original sono-
rous intensity and power of articulation, which by some unexplained com-
bination of causes has been partially destroyed, might be restored by the op-
eration of external or internal applications. But the success in treatment
has by no means answered the expectations of those who prescribe, or those
who take the intended remedies. The disease, instead of diminishing,
though neither infectious or contagious, increases in a ratio corresponding
with the multiphcation of the clergy. What can be the cause 1 Let it be
premised that the clergy of olden times, both in and out of New England,
performed quite as much clerical service as those of modern times and
yet their vocal organs were the last to fail.

A few evenings since, in the course of conversation with Dr. Mauran, a
distinguished physician of Providence, R. I., this topic was under discussion,
and he remarked that he could not ascertain, either in his own circle of
acquaintance, or by inquiry among professional gentlemen residing in dif-
ferent sections of the country," that those clergymen who use tobacco, had
ever suffered from the ??iims^er'5 rr/i, with one single exception. The in-
ference, , therefore, was,that smoking or chewing kept up a secretion in
the neighborhood of the glottis, favorable to the good condition and heal-
thy action of the vocal box.

Since the great temperance reformation commenced, tobacco has beeii
anathematized, and it is now extremely rare to find any of the new comers
into the ministry, who would tolerate tobacco ; and all who are distinguish-
ed for their devotion to the great moral revolution which is going on, aban-
doned tobacco, if they had ever been addicted to its use. Now it is almost
susceptible of positive demonstration that the clergy of olden times smoked
and chewed very universally. The la"wyers speak hours together, and when
leisure permits, many of then smoke ; and, as a general rule, the leading ad-
vocates are very great smokers and yet, who ever lieard of a lawyer who
Jbad lost his voice ?

It may appear behind the present age of reformation to ad-
vocate, at this time, the ue of an article, so contrary to good'
manners one supposed to be so foreign from the catalogue of
our necessaries for life and one on which the prevailing spirit
of reformation has seized with the hand of extermination. But
wc use opium in the service of humanity an article which, for

1830.] Prophylactic and Curative Powers of Tobacco. 475

the correction of its abuses, calls into requisition a nation's pow-
er. And we would use alcohol itself, in any of its formulae,
from the distilled to the merely fermented than which there is
no article on which we look with more perfect hatred nay, des-
pise with a vengeance which would make us, if possible, thrust
into Lethe's dark, sinking, hellish torrent, the last formula) for
its preparation, and know that the world would be greatly im-
proved by suffering its privation for the prevention of its injuries
this article, we say, we would use for the saving of life, when
other things would not do it. In like manner, we feel it a duty
to advocate the use of tobacco, both as prophylactic and cura-
tive in certain cases. We are pleased to see the intimations
given by the editor of the Boston Journal, Jiot only on account
of the fact that they may lead to truQ etiology, without the
knowledge of which, neither prophylasis nor cure may be ex-
pected with any degree of uniformity.

We acknowledge that the suggestions relative to the prophy-
lactic virtues of tobacco, in regard to the cases alluded to, are
new to us ; for we have been in the habit of looking to the chill-
ing walls at the back of pulpits, against which clergymen often
rest the upper part of the back, immediately after the exercise
of preaching, as a cause of this disease. But as the ' minister's
ail,'' as it is called, is but of very limited extent in the South, we
have had but little observation in such cases. We have, how-
ever, had some observation on the effects of the abandonment of
the habitual use of tobacco, in causing a cessation of an habitual
secretion from the mouth, and thereby greatly impairing the per-
fection of guttural articulation, and in the production of coughs
incurable by ordinary means : as well as the curative powers it
exercises on resuming its use.

We had once the care of a case, in which the free chewing
of tobacco was, with a view to the reformation of a bad habit,
abandoned. In a short time the voice of the patient was sen-
sibly impaired, both of its ease in exercise, and its fine perfec-
tion of sound. As the case progressed, a cough, increasingly
troublesome and obstinate, made its appearance, which soon
became most violent and convulsive. Many ordinary remedies
were used, for the first six months, without the least beneficial
result. At the end of this period, our attention was directed to
the case, and no ground was left unoccupied which had been
hitherto found beneficial in the treatment of coughs in such a
state of the general system. A consultation was held, but all to
no good purpose, and the patient succombed before the expiration
of twelve montlis.

Not long after this observation, we became perfectly familiar
with another else of impairment of voice, and subsequent cough,
which progressed by the same gradations as that just described.

47G Prophylactic and Curative Powers of Tobacco. [May,

from the first of Jauuary, the time at which the chewing of to-
bacco was suddenly abandoned, until the first of July. Obser-
vations on this case, proved it to be very peculiarly like the fatal
case just given. We had observed closely the progress of this
ditliculty from the time the tobacco was discontinued. At the
cndot six months the cough was quite as far advanced as in the
former case ; not allowing the patient twenty minutes sleep at
any one time, and attended by a remarkable impairment of the
vocal powers, and those of deglutition. This patient resumed
the free use of tobacco, by chewing ; but in order to avoid as
far as possible, the injurious stimulating and narcotic effects, the
very weakest was selected, instead of that strong tobacco which
is sold at the highest prices. By the Christmas following, the
soreness of the thorax and the cough, were nieasurably but not
entirely subdued ; the voice and deglutition both improved, but
were not perfectly corrected. It is now some eight or nine
years since this case occurred, and there is still a tendency to
frequent but not severe cough, and there is still an evident defi-
ciency of the power of propelling downwards from the upper
part of the pharynx, so that all things pass on without further
effort for deglutition.

We could give numerous cases in which, with the strongest
marked predisposition to phthisis pulmonalis, persons have, un-
der the free use of tobacco, contrary to all reasonable expecta-
tion, grown old, in perfect exemption from its ravages.

We will only further remark at present, that the impairment
of voice amongst clergymen, is of very rare occurrence in this
section, whilst the practice of using tobacco, either in chewing
or smoking, and most commonly the former, is almost univer-
sal. We have at present. in mind, one clergyman, remarkable
for the length of time, and the quantity of his labor in the ministry
for the time, in addition to the labors of school teaching, through
a long life, who is never awake, we believe, without having a
remarkable quantity of tobacco in his mouth, except when eat-
ing ; nor is he less remarkable for the quantity of saliva which
he accumulates almost imm.ediately around him. This man has
out-lived the youth of his youngest children ; he came, early in
life, to the ministry, and the wife of his youth died at the age of
sixty, some ten or twelve years since. No man of his age re-
tains the voice of his early life, in greater perfection. He is yet
as pleasant in the pulpit as ever, and modulates his voice with
great pleasure to the softest melodies of his old recollection, in
which he m'catlv deli^^hts.

We hope observations will be made by practitioners on this
"subject, and promptly reported to the profession.

1839.] On the Immovable Fracture Bandage. 411

On the immoveable Fracture-bandage. By Dr. Fhioke. Dr. Fricko has
given reports of sixteen cases of fracture successfully treated by means of
JSeutin's starch-bandage. He applies it by first rolling the limb with a com-
mon broad bandage, over which a layer of starch is phi'ced^ On this, two
pasteboard splints, the length and shape of the fractured limb, and near-
ly cncirlingit, are appUod wet ; then a layer of starch, and over this a roller,
after each turn of whicii the starch is applied ; the whole being covered
with paper, to prevent its sticking. Fricke has usually found the applica-
tion of this bandage successful.

The following are some of the advantages attending the use of this ban-
dage : 1. The materials are readily procurable. 2. The apparatus lies
close to the inequalities of the extremity, o. Any part of it can be renevved
without disturbing the other parts. 4, It is light, and does not prevent the
use of the extremity. 5. The limb is so firmly supported, that in two days
the patient can leave his bed and walk about.

If the lower limb belractured, it should be supported by means of a sling
round the neck. In applying this bandage, Fricke recommends the sur-
geon to wait for the subsidence of swelling and inflammation. He does not
think, with Seutin and Velpeau, that the patient might even undertake a
journey immediately after the injury when the bandage is dry. lb. from
Hamburg Zeitschriji f. d. g. Med. April, 1838.

We feel unwilling to allow some of the late improvements in
surgery, for improvements we do consider them, to pass on with
their high and unlimited clamis, to the full, unsuspecting em-
brace of the profession, without throwing out a beacon to guard
hidden cliffs which lie in the course of this fair sailing. It is true
that " all is well, that ends well" ; but extremes are dangerous,
and in the moment of bright prosperity, when the delights of
success absorb all thought and feeling, there is, we conceive,
great propriety in calling out for circumspection a close look-
ing to all the apparatus and the circumstances the causes and
effects, in successive train, their physical powers, proportions,
&c. &c. We allude particularly to the improvements in the
treatment of fractures by immovable dressing, the double inclin-
ed plane, and Amesbury's apparatus. These are all thrown
before us with the charms of steam-power expedition. Every
pleasure has its alloy, and if it appear v/ithout it, w^e should do
well to inspect well the ground over which the march of intel-
lect is progressing. This is necessary to give safety to that
march. A thousand schemes in life are admirable they would
amount to the heart's perfect content, but for the ifs which arc
to be guarded against or sufiered m the way. These alloy the
charm of steam-travelling; and but for these, the balloon would
afford us more expedition, and combine more of the charm of
novelty, and the beauty of prospect, sublimity of li^ht, velocity,
&c. and all this, by the bare touch of the finger of science no
matter how hard the wind should blow, ?f it were not a tornado
7fit would drive to the desired goal, and land safely ?/no ex-
plosion, or combustion, or other disaster, should octuir in the
atrial voynge. Tliese, however, are amply met by the para-
rhufe. //'it will with certainty so operate as' to arrest the rapid-

478 On the Immovable. Fracture Bandage. [May,

Jy acc(;lora1m,^ pro_f]:ross downward, &lc. Wc should, there-
juro, look well to all tlic c]rcuin;.-tanccs and possibilities, an(i
take care lestVve risk out of proportion to the premium. In the
use of the apparatus to which we aliade, we are promised rath-
er more than most patients are wilhngto accept far more than
ihey should reasonably expect. The bone of the thigh, or those
of the leg, or all of them are broken perhaps comminuted or
complicated with external wound. The limb is dressed with
the immovable bandage, or the double inclined plane, or the
older apparatr.s of Amesbury, which is nothing more nor less
than a double inclined plane, fixed for travelling, and the patient
may go about his ordinary business on his crutches, or go on
a journey in the mail coach.

Now it is not our purpose to say one w^ord which should les-
sen the true value of these improvements, to suffering humani-
ty, or the convenience of the practitioner, or the honor of the
several inventors and improvers of them ; but rather to call at-
tention to some dangers which lie in the way to success, which
should be duly guarded against, in order tha,t safety, and the
best success consistent therewith may be had. The mere con-
venience, or even the comfort of the patient, does not justify
much, if any risk of fatal accident, rather than to suffer some
inconvenience and discomfort, for securing absolute safety.

There are two important accidents which we have had occa-
sion to observe, and which lie in the way of the use of the im-
movable bandage, and the double inclined plane, and Amesbu-
ry's dressing

1st. The dan<jer of a fixed de^rrce of tension of the dressins^,
which is to remain unaltered. No one can determine absolute-
ly the extent of swelling which may occur in the wound. It
depends on circumstances which cannot always be foreknown
or regulated, notwithstanding the prudent caution of Fricke.
" to wait for the subsidenqe or swelling and inflammation."
Nor is this caution, (though one of prudence relative to the use of
the immovable bandages,) founded on sound reasoning. What
we ask, is the cause of the swelling and inflammation, and of
their perpetuation, but the wound itself, with all the causes of
irritation which its nature and condition afford ; and amongst
the greatest, at least of the perpetuation of their effects, the irri-
tat,ion afforded by the unadjusted extremities of the fragments
ofbone, and their mavements against the irritable parts with
which they are in. contact ? Is it then reasonable to await the
subsidence of these capital, dangerous effects, before the dress-
ing, which is to remove and perpetually prevent the cause of
their perpetuation, and all this, in order to apply a dressing
wliich will afford the patient exemption from" the irksomeness of
the surgeon's bed? Certainly, the drcs^ns: is necessary as early

1839.] On the Immovahk F/achcre Bandui^e. 47I>

if-

as possible, for v/ithho!diiig the irritatiiii; causes, which. must per-
petuate swelling, pain and inflaniination, very .injuriously, it" al-
lowed to remain. It is true, that good apposition of bones for
several days, ditfering with the age of the patient, is suiTicient
lor all the purpose of the union of the fragments alone, but this
convenience, as it may be considered, and really is, should be
used properly^ not as a dispensation to leave the bony frag-
iments in situations calculated to exert one atom of injury on the:
iidjoining soft parts, which the good adjustment would prevent,
but only to allbrd us the consolation of knowing, that the little
accidents, calculated to displace for a moment the Iragments, in
the early days of confinement, do not amount. to a re-fracture of
the part, as union had not commenced : and the only injury in
such cases is the irritation which the momentary displacement
is calculated to afford. How important tlicn it is, that the bones
be adjusted as early as possible, and retained so ! That appa-
ratus then, which will best answer these purposes at first, is
best at first. The question then a arises, is it prudent, at a
subsequent time, when, under these proper circumstances, the
swelling and inflammation shall have been reduced, to re-
move the first dressing, which has proved its efficacy by its ef-
fects in preventing displacement, and irritation, for the purpose
of applying one calculated to afibrd the patient the comfort of
leaving his bed two or three weeks earlier than he otherwise'
w^ould ? a liberty, the propriety of which, we doubt under any
circumstances, on account of the accidents to which it subjects
him. The change itself, just at such a time, when the union-
is beginning, or begun, affords a material danger of retarding
the cure.

But w^ith the temptations this dressing throws before the com-
mon practitioner, however difierent the case mioht be in the
hands of Suitin, Fricke, and Velpeau, th^re is this danger to be
apprehended a danger which w^ould certainly sometimes oc-
cur ; that however prudently the immovable dressing is at first
adjusted, a little swelling, beyond what can be safely borne, will
aiford a new cause of obstruction, irritation, inflammation, and
sphacelus, unless the dressing is removed, and the absorbents
and other vessels of the part liberated. We have had the mor-
tification of being obliged to amputate the arm of an interesting
young girl, of eleven years of age, near the shoulder, in conse-
quence of a bandage, applied with moderate tension, for fracture
of both bones of the fore-arm, near the wrist. This dressing
was applied by a surgeon of excellent tact, and ordered to re-
main, as he left it, for a certain number of days. The girl was
of thin habit and phlegmatic tem})erament ; nor was there much
prospectof swelling in the i)art. The reigns of Bacchus, how-
ever, guided the surgeon in another direction, and the siren song

4S0 0)i the hnuioviahle. Fracture Bandage. [May^

of this, iiis God, led him to forget his patient, until, by the swell-
\n^ which occurred, the circulation became completely obstruct-
cd, and mortiilcation to the upper extremity of the bandage
ensued.

2nd. The donble inclined plane, with the modifications of
Amesbury and Nott, for the purpose of enabling the patient to
enjoy relief from tlic bed at an early period, are exempt from
the danger just referred to, as attending the immovable ban-
dage. The tension of this dressing can be altered at pleasure,
so as to be easily applied, and subsequently, to be safely regu-
lated according to the necessities of the part. The only dangers
of these different apparatus, are trivial and avoidable':

1st. These require, for ordinary preservation of adjustment
alone, more pressure on the limb than some others.

2nd. That tension of the dressing necessary to retain adjust-
ment under the various movements of the body, the liberty of
which it is their great purpose to secure to the patient, is calcu-
lated to injure, more or less permanently, the subsequent use of
the limb. Surely this would not be the case with surgeons of
habitual experience, and who are in the habit of observing closely,
and reasoning well on theirobservations. But how few, alas, do
these things! When we set forth an improvement of this kind,
it is for all who may need its use ;' and should be accompanied
by a knowledge of its dangers. Most surgeons, like most other
people, go, to the letter, according to the instructions given in
the book, neither adding to, nor " extenuating aught"; nor do
they think once of the inherent independence which intellect i^
calculated to confer on man. Such will blunder and do mis-
chief, if not guarded and dictated to at every step. We are,
therefore, of thc' opinion, that even under the use of these appa-
ratus, the tension should not be such as to enable the patient to
leave his bed, except perhaps, in those cases v/herein union has
been, by any means, prevented for a long time, and the chronic
case is so protracted as to have lost the irritability of a recent
wound. They are, doubtless, the best apparatus known for the
correction of an artificial joint.

Without any pride in the matter, as we honestly believe; for
as the original discovery was not our own, we are still decided-
ly inclined to the use of the treatment of fractures oftheosfemo-
ris, which we had the pleasure of recommending to the public on
a former occasion,*' by weight and fulcrum. The only distress
or hazard attending this apparatus, is the absolute confinement
to the bed for three or four weeks. There is no distress or dan-
ger whatever from the dressing.

We continue to be uniformly ]jloased with its efiects, and trusi
that, for the good of humanity, it will not be lost sight of by the
profession, witfiout fair trial. _^

' ''See SouthonrModical and {Surgical Jourual, vul. 1, page 261.

1839.] Treatment of Carcinoma of the Mamma. 481

Treatment of Carcinoma of the Mamma. We commend to the attention
of our readers the following remarks on the treatment of carcinoma of the
mamma, by John Macfarlane, M. D., the distinguished senior surgeon of
the Giascow Royal Infirmary. His estimate of the value of escharotics and
compression appears to us to be entirely just ; and, tliough many surgeons
of high authority repose great confidence in extirpation early resorted to, we
fear that a careful examination of the results of the operation will show
that there are too good grounds for the distrust in its iitillity expressed by
Dr. Macfarlane. It is certain that, in a large majority of cases in which
this measure has been restorted to, the cure has not been permanent ; and
also that, in a large majority of cases in which the disease did not recur
after the use of the knife, the tumour removed was not genuine cancer.
The facts adduced, therefore, by Dr. Macfarlane of the unsuccess of extirpa-
tion should be fairly weighed, and carefully compared with ihe resuhs ob-
tained by others, for it is only by a comparison of a large number of well
observed cases that the proper estimate of the value of extirpation for
the cure of cancer can be ascertained.

" In regard to the treatment of carcinoma of the mamma, I shall consider,"
says Dr. Macfarlane, "shortly, the three different surgical methods at pre-
sent in use, for the purpose of attempting to estimate their value, and of
ascertaining how far they have proved successful in eradicating or palliating
the disease.

"1. By Escharotics. This mode ol treatment has been long known, and
its history has been diversified by the employment of a great variety of caus-
stic remedies. Among the proesfsion it has in a great measure fallen into
disuse, having been found very painful and uncertain ; but it has been, and
continues to be, extensively employed by empirics. Within the last four
or five years, however, the attention of the profession, both in this country
and in France, has been again directed to this mode of treatment ; and at-
tempts have been made to convince us that it is less painful and more cer-
tain in eradicating the disease than extirpation.

Drs. Canquoin and Riofrey have published memoirs showing the great
advantage obtained from, and the numerous cures effected by, the use of the
chloride of zinc, when employed in the form of paste. In illustration of its
efficacy, they relate cases in which the whole mamma, and all the tissues be-
tween the breast and the arm-pit, with the diseased glands in the axilla,
were destroyed, exposing the muscles and laying bare the blood-vessels, not
only with impunity but with success. After a careful examination of the
histories and progress of several of these cases, I am not prepared to view
them as having been all decidedly cancerous ; and in some of the others,
where the mahgnant nature of the disease is less equivocal, I doubt much if
the apparent cures proved permanent. From what I have experienced,
and I shall afterwards mention, of the great want of success in removing the
disease by the knife, when the diseased parts are more immediately under
observation, and can be followed out and more certainly extirpated, I am sa-
tisfied that, in other hands, the sanguine anticipations of the advocates of tliis
new caustic treatment will not be realized.

" During my late attendance at the Infirmary, and since that time in pri-
vate practice, I have employed this paste in four cases of scirrhous mamma;
in two cases where the disease had returned after ablation, and in several
cases of cancer of the lip, and in cutaneous cancer of old people. In the lat-
ter affections, which are almost uniformly local, I have succeeded ; but not
in the former. On the contrary, although I have destroyed large portions
of the mamma, and obtained for a time firm and healthy looking granulations,
yet nf.-w tumors uniformly sprung up in the old site or its vicinity, and the
general progress of the disease was always accelerated. The application,
which had to be frequently repeated, produced great pain, and was not with-
out its injurious effects on the constitution. In two of the cases, in which
5e

482 Treatment of Carcinoma of the Mamma. [May

the mammary tumors were large, the febrile excitement was excessive, of
more than two week's duration, and complicated with a violent g-astro-entc-
rite, which 1 attributed to the action of the medicine ; and in patients of a can-
cerous diathesis this constitutional excitement unquestionably hastened the
progress of the internal disease.

'2 By Compression. This method of treatment has also had its periods
of popularity and neglect. Young, in this country, and Recamier in France,
have been its most powerful advocates. The former commenced this prac-
tice in 1809, and employed, for the attainment of his object, adhesive straps,
sheet lead, tin plates, compress, and bandages. He gives a few successful
cases where the mamma only was affected, and also in which there were
diseased glands in the axilla ; and he alludes to others in which the practice
was unsuccessful.*

" Recamier, as one of the physicians of the Hutel-Dieu, of Paris, has on-
joyed ample opportunities of witnessing this disease, and testing the efficacy
of continued, and methodical pressure, which he employes by means of com-
presses of agaric, bandages, fccf Of 100 patients treated by him, 30
were completely cured by compression alone (but he does not state in how-
many of these the disease was seated in the rnamma ;) 21 were benefit-
ted by it ; 15 submitted to ablation, after compression had failed ; 6 were
cured by compression and cauterization combined ; and the remaining 28
were either incurable, or not benefitted by any of the means employed. | On
the other hand, this practice has been fairly tried by others, but without suc-
cess. Jn the year 1816, Sir Charles Bell had recourse to it in 16 cases of occult
and open cancer, in the Middlesex Hospital, without any apparent benefit.^
My own experience of it has not been great. I have tried it, however, in
several cases, and seen it practised by others, but without any decided ad-
vantage. It appeared to render the tumour harder and more compact, cau-
sing absorption, not of the diseased structure, but of the instertitial fluids,
and surrounding adipose substance. It is, besides, a tedious and irksome
process, to which iew would vviUingly submit, if the slight chances of the
benefit were explained to them. Were it, however, to prove as succesful
in the hands of others as it appears to have done in those of Recamier, it
would certainly be a milder and more efficient plan than any of the others
we employ. The good effects of steady and well-regulated pressure in dis-
persing indolent swelling have been well known to the profession. When
these indurations are chronic, and not of a specific character, the advantages
of compression in promoting absorption and suppressing arterial action are
undoubted ; but I cannot bring myself to beheve that in genuine cancer of
trie mamma this practice will be entitled to the commendation it now re-
ceives. In an immense majorit}^ if not in every case, scirrhoma of the
breast is of constitutional origin, and therefore not capable of being perma-

* Cases of Cancer, &c., London, 1816.

f In estimating Recamier's success, it may be well to recollect, that the
French physicians and surgeons are accustomed to apply the term scir-
rhus to every hard and indolent tumour, whetJier malignant or not, many of
which would yield to proper local treatment. Were the disease to be en-
tirely and permanently removed by compression, I would feel satisfied that
it was not malignant, for I cannot believe that pressure, however carefully
and metho(iically applied, can possibly subdue the specific action of the dis-
ease.

X Rccherchcs sur Ic Traitement dc Cancer, torn. i. p. 550.

) Surgical Observationr^, vol. i.

1839.], Treatment of Carcinoma of tlie Mamma, 483

nently eradicated by local means. Besides, it is not possible, even should we
succeed in dispersuifr by compression a carcinomatous tumour of the breast,
that we' shall, instead of insuring the patient's recovery, accelerate iier fate.
The S})ecihc and mahgnant matter of cancer must be carried into the circu-
lation by the absorbents, so that we are only exchangin!j an external for an
internal disease.

"3. By Extirpation. This has long constituted our chief plan of treat-
ment, and continues to be employed both as a means of cure and as a pal-
liative.

" In a curative point of view, the operation of ablation of the mamma con.
tinues to be extensively practised ; and of all local means we possess, it
certamly holds out the best hopes of a permanent cure. If undertaken at
an early period, when the constitution is but httle impaired, and the counten-
ance is unchanged when the tumour is small, isolated, and indolent, and
the axillary glands are sound, we are told that it seldom fails in eradicating
the disease, provided all the morbid structure be removed. I admit, so far
as the external disease is concerned, that its return to the same locality is
often to be attributed to an imperfect operation, too much of the integuments
or surrounding soft parts being left behind ; but, at the same time, I have ne-
ver, seen a case, even bf the most favourable description, in which the dis-
ease did not return, although every precaution was adopted to render the
operation suc.essful. We generally find that the disease is more exten-
sive than we anticipated, and that, although we go far beyond its appa-
rent boundaries, we seldom, if ever, succeed in preventing its reproduction.
There may be points of disease in the absorbents, lymphatic glands, or sur-
rounding adipose substance, so minute as to elude detection, or, as happened
to Professor Camper and Sir A. Cooper, the absorbent vessels may carry the
disease from the mamma to the glands under the sternum, where it could
be neither discovered nor reached.

" The peculiar state of the system upon which the disease seems to de-
pend, presents another and still more serious obstacle to the success of our
operations. There are, unfortunately, too many cases on record, and of
daily occurence in practice, in which scirrhoma of the mamma is shown to
be, in its origin, not local. All the cases I have detailed point out the co-ex-
istence of mammary and internal scirrhus, or the rapid and fatal superven-
tion of the latter form of the disease, i have frequently seen cancer of both
breasts and of the uterus and breast, occur at the same time, and oftener
still, the external cancer is complicated with disease of the lungs, liver,
&c., in which organs its progress may be so obscure and insidious that we
cannot fix its locality, or assign to it precise limits. We are therefore not
authorised in promising success, even from the earliest ablation of the mam-
ma, since we cannot assure ourselves or our patients that the tumour we
extirpate is the only part that has undergone this morbid change.

" But the best of all tests for determining the efficacy of this operation is
its success. It has been adopted for so long a period, and so generally, that
were medical men to acknowledge candidly, and record faithfully, the results
of their observation, v/e could have no difficulty in estimating the chances
of u'timate success. Unfortunately, diversity of opinion prevails as to its
advantages ; and whilst a considerable number of the profession acknowledge
the liability of the disease to return, they are not less decided in reccmmend-
iug and performing the operation*

' Mr. Hill, of Dumfries, who published, in 1772, on the results of operations
in this disease, seems, at first sight, to have met with greater and more per-
manent success than has fallen to the lot of any surgeon before or since his
time. He operated upon 88 cases of all descriptions, and only one in seven
of these had a return of the disease. But, on examining the details more min-
utely, we find that in five of the cases only was the mamma extirpated ; that

484 Treatment of Carcinoma of the Mamma, [May,

in two of these the wound did not heal ; in another, the disease returned ;
and the remaininur two continued well at the date of publication. a

" Sir E. Home has asserted that this disease is of local origin, and that it
is capable of being safely and effectually extirpated. 6 Richerand, whde
he acknowledges tliat the disease returns in about four cases out of five,
either in the original situation or in some distant part, states at the same
time that the proportion of permanent cures is such as to justify the opera-
tion.*

" Sir A. Cooper states, 'that a large proportion of cases return ; but few-
er than formerly, if the patient, immediately after recovering from the oper-
ration, undergoes an alterative course of medicine'f This implies that there
is something wrong in the constitution, and that by rectifying this morbid
condition, the return of the local disease is often prevented. It is acknow-
ledging in fact, though not in direct terms, the constitutional origin of cancer
of the mamma, and at the same time assigning to constitutional treatment
more efficacy than I have ever seen result from it. I acknowledge the util-
ity, in such cases, of attending to the uterine and alimentary functions ; and
1 believe that if we shall ever succeed in controlling this formidable disease,
it will be by acting on the general system ; but as yet we certainly do not
possess any constitutional means of either warding it offer preventing its re-
currence. Mr. S. Cooper states, 'that modern experience has given ample
encouragement to the early performance of an operation, and even to ma-
king an attempt to cut away the disease, in every instance, both of the oc-
cult and ulcerated kind, when such a measure can be so executed as not to
leave a particle of the cancerous mischief behind. 'J

"Professor Syme has met with 'repeated instances in which, though other
circumstances were by no means favourable, the tuberculated kind of carci-
noma was extirpated with the happiest result.'}

"Mr. Travers states, that 'the poison of cancer does not act upon the sys-
tem during the integrity of the tubercles, since persons generally recover,
and finally, in whom the disease is freely removed m this early stage. On
the contrary, if the tubercle be softened, and undergoing ulceration or absorp-
tion, the disease recurs, however freely the parts be removed. '|| It does
not accord with my experience, as I have already stated, that free operations
in the early stage "of the disease are generally followed by absolute, recove-
ry ; nor can I subscribe to the opinion, that the system does not become con-
taminated until softening or ulceration of the tubercle occurs. I admit that
absorption goes on more rapidly during the soft or ulcerated stage, but at the
same time I have seen many cases in which the disease has been conveyed
to the axillary and the subclavicular glands, and into the system, while the
primary disease of the breast retained its original hardnesss and density.

"The utility of the operation has also been denied by many high authori-
ties, both of ancient and modern times. Hippocrates,^ Celsus,** Galen,
and others of the older writers, are decidedly opposed to it. Dr. Alexander
Monro had the candour to announce his great want of succeess, which seenjs

a Cases in Surgery.

h Observations on Cancer. London 1S05.

* Nosographie Chirurgicale, 3e. edit., tom. iv., p. 424.

t Lectures, by Tyrrell, vol. ii., p. 198.

\ Surgical Dictionar}', article "Cancer."

^ Principles of Surgery, p. J^92.

II Medico-Chirurgical Transactions, vol. xv., p. 22^y.

^ Aphor. xxxviii.. Sect vi.

**. De re Medica, Lib. V., cap. xxviii.

1839.] Treatment of Carcinoma of the Mamma, 48i

to have di^icouraofed, for a long- time, many surgeons from having recourse
to it. He only met with four cases out of sixty, in which the disease did not
return within two years after the operation. |f In ll'O cases operated upon by
Boyer,+| where the disease was seated in the hreast or other parts of t lie bo-
dy, not more than four or five were radically cured, in consequence of which
he declares, and tiie same opinion seems to have been entertained by sever-
al eminent French surgeons of his day, that an operation ought never to be
undertaken when the disease had been ascertained to be genuine cancer.
Delpech also acknowledges that the operation is rarely if ever successfu],(r)
and the same opinion is entertained by a number of other authorities whom
I need not mention. Believing tliat amid such discordant opinions we can
only arrive at a just and satisfactory conclusion by an appeal to facts, and an
accumulation of individual experience, I feel myself bound to contribute the
results of my limited observations towards the fulfilment of so desirable an
object. The momentous question must be finally settled by the combined
experience of the profession, and not by a reference to the records of our
hospitals and infirmaries, where we find the cases dismissed as cured as soon
as the operation wound has healed.

" Of thirty- tw^o cases operated upon by myself, in which the carcinoma-
tous nature of the disease was distinctly ascertained, the cure was not per-
manent in a single instance. The ages of these patients varied from 42 to
59 years ; 23 were married and had children, and nine were unmarried. In
eighteen cases the right breast was the seat of the disease ; and in four-
teen, the left. In twenty, the glands in the axilla were more or less affected,
but not extensively ; they were all removed, and in the remaining twelve
no disease in the axilla could be detected. In ten the disease was in the
form of tubercle; and in twenty-two the whole gland was affected. In
nine cases the disease returned in the integuments of the chest, or in the
axilla, within a period varying from six weeks to^three month after the oper-
ation ; in thirteen cases, from three to nine months ; in four, from nine to
twelve months; in three, within two years ; and in one, nearly three years
elapsed before its return was discovered. Two of the operations proved
fatal; one from pleurisy, and the other from erysipelas. In many of these
cases, symptoms of pulmonary and hepatic affections w-ere well marked, and
seemed to have occasioned death ; in others the symptoms were too obscure
to lead to accurate diagnosis. The lungs appeared to be most frequently
implicated, but the proportion cannot be accurately stated, as in several of
the cases no post-mortem examination could be obtained.

" Besides these cases which have occurred to myself, I have, on inquiry
of a few of my medical friends, who have had opportunities of witnessing
this disease, ascertained ihe results (if 86 additional cases, in which the mam-
ma was extirpated for well-marked carcinoma, and in not one of these was
the cure permanent. Without going into details, I may shortly state, that
in a majority the operations was performed at an early period, and under
the most favourable circumstances ; the affected parts were freely and exten-
sively removed, and in many there was no distinct indication of constitution-
al deterioration ; yet in all,'the disease returned, both externally, and inter-
nally, and proved fatal. It was also observed, that in robust women of a
sanguineous temperament, the reappearance of the disease after the opera-
tion, and its subsequent progress, were more rapid than in those of a ner-
vous or lymphatic temperament, and that the internal organs were sooner af-
fected.

tt- Edinburgh Medical Essays, 3d edition, vol. v., p. 346.
II Traite dcs Maladies Chirurgicales, tome vii., pp. 240, 241.
55 Sur los Maladies Chirurgicales, tome iii.

%

4SG Treatment of Carclnnrna of iJic. Mamma. '[May,

"It sometimoR happens, especially when the disease occurs in very old
person?, that it may iviiiain Jor inaiiy yciirs in a quiescent state, without
much pain or tendency to s^horten life. The anxiety of mind arising from a
knowledge of the nature ol'tlie disease, sometimts induces such patients to
f )re^-o the'comparative traiVquiIlily liiey enjoy, and attempt to Irce themselves
of the disease by au operation. 1 could adduce' several patients who ijad
laboured under the njalignant disease, for ten, fifteen, and twenty years, ai-d
who were cut oti'ni three or four months by an oper;ition.

"Ablation of the mamma is also recommended and practised as a pallia-
live, in cases where there is no prospect of a radical cure. It is had re-
course to chiefly in the ulcerated stage of the disease, to rid the patient of
pain and annoyance arising from the presence of an open ulcer, and the foe-
tid discharge proceeding Ironi it. Seeing that we have other and milder
means of soothing the (hstrcssing symptoins, and mitigating the patient's
suifering, 1 must confess'rthat this })ainful and dangerous procedure, and for
effects so partial andinefficacious, appears to me cruel and unjustifiable;
and I am satisfied from what 1 have seen, that by it the progress of the
dise:iseis ])ainfully accelerated, the knife appearing to rouse it into fatal
activity.

" Of late years it would appear that in the hands of some surgeons the
knife has frequently succeeded, and there seems to be rather an increasing
confidence in its efficacy, and a disposition to employ it, under the belief that
it will cure the disease. 'J'here are certainly on record a good many cases
in which no relapse took place ; and we find at the present moment women
alive upon whom the ojieration was performed years ago. But after the
unfortunate results I have detailed, the question naturally occurs. 'Were
these cases of genuine cancer?' We often meet with tumours in the fe-
male breast of a benign character, which so greatly resemble scirrhus even
in their structure, as to render it difficult for us to classify them. Indeed, in
the majority of mammary tumors which present themselves to our notice,
the disease is not malignant at all, but consists, of an indolent enlargement
of the gland, of an adipose tumour, a deep-seated chronic abscesss, of stru-
mous tubercle, or of a hydatid cyst. In some of these cases even the most
experienced may be deceived, and be led, from the disease not having return-
ed, to assign more value and importance to the operation, than it is justly
entitled to, and thus to take credit for cures which were never performed.
When these mistakes, which are by no means uncommon, originate in ig-
norance, they may be pardoned, as we are all liable to them ; but when the
real nature of the disease is designedly concealed, and they are held out as
cases of cancer cured by operation, we cannot but lament that there should
be found in the profession an individual or individuals so devoid of honesty and
candour as to attempt to mislead, in a matter of such serious importance.

" It may appear to some that I have taken too unfavourable and gloomy a
view of the results of operations for the cure of this formidable disease. If 1
have done so, it has not been done hurriedly or unadvisedly. The painfnl
truth has been slowly and reluctantly forced upon me, by an uninterrupted
series of unsuccessful cases, and I feel myself bound to state as my decided
and conscientious opinion, that in no stage or form of the disease is an oper-
ation to be depended upon, either as a means of permanent cure, or as a pal-
liative. On the contraiy, I believe that while it never arrests, it almost uni-
formly accelerates the progress of the disease. Why should we, therefore,
continue to recommend and practise it ] Why subject our patients to the
torture and risk of an operation v.'hich we believe to be not only useless but
injurious ? It would be better for our patients, and more creditable to sur.
gery, were the operation altogether abolished ; and the melancholy fact at
once acknowledged by the profession, and made known to the public, that
wecannoteradicate the disease by the knife ; but that still much may be

1839.] Connexion of Diseases uilh Seasons, Ages, <^c. 4S7

(lone, and by milder means, to alleviate the painful symptoms wliicii attcnJ
upon it.

" By refusing to operate upon what is usually considered a favorable ca?o,
it may be said that we are depriving tiie patient of the only chance she had
of recovery, and consigning her to a state of hopelessness and misery. It is
surely better, bya candid statement of facts, to dissuade from an operation
which we believe to be useless, than to hold out prospects of a euro which
will never be realized. The operation is submitted to only underthe belief that
it will eradicate the disease, and when it proves inetlectua!, the mental as
well as the bodily condition of the patient is worse than if it had never be per-
formed. It is doubtless a painful duty to be obliged to confess our inabdity
to afford the relief and assistance which is expected from us ; but would it
not be more discreditable to our professional character, were we, in the teeth
of accumulated observation and daily experience, cruelly to persist in oper-
ations which have been found not only useless but pernicious 1 By persist-
ing in such a practice, we are doing an act of gross injustice to our patients,
without having the candour to forewarn them of the results ; and by resting
contented with the operation as a means of cure, which every day's expe-
rience tells us that it is not, we are retarding the improvement of our profes-
sion, and preventing the talents and energies of its members from being di-
rected to other remedial sources, from which we may yet obtain means moro
effectual than those we now possess, for eradicating this forraidabe disease.'*
London Medical Gazette^ June 2, 1838. Am. Jou.

Connexion of Diseases irith the different seasons of the yeai\
with different ages, cj-c. Wc have received the Annual Report
of the Interments of the City and County of New York, for the
year 1838, from which, interesting remarks may be drawn, re-
lative to the proportionate frequency of certain diseases in dif-
ferent seasons, in persons of diflerent colors, the natives of dif-
ferent countries, the proportion of deaths to the population, age,
&c. &c. We shall not, however, on the present occasion, go
further than to throw before our readers, the proportionate fre-
quency of certain diseases, which may be reasonably consider-
ed as having some connexion with the particular seasons of the
year, age, sex, and color; and a few remarks in connexion
therewith. It will be remarked, that the termination of most
chronic diseases, do not seem particularly connected with any
one season ; whilst with acute diseases it is different.

The extensive and minute table, cocupying nineteen pages,
large duodecimo, commences with

DISEASES OF TIIE BRAIX AWD NERVOrS SYSTE3I.

' Of Inflammation and Congestion of the Brain, the total num-
ber of deaths was 1.55 ; of which 83 were white males, 62 white
females, 3 black males, and 7 black females. Of these the great-
est number was in Aufjust, which was 20 ; the other months va-
rying from 9 to 17. Within the Jst year 38; 2nd year 21; 3rd,
1th and 5th, together 2G, &c.

Of Dropsy of the Brain total 3CS. Greatest numbers, in
July 48, and Atigust 46. In other months, from 18 to S'J. All
of these except six were under ten years of age.

4S8 Connexion of Diseases with Seaso7is, Ages, ^'C. [May,

Of Apoplexy total 164. There were 70 in July. Janua-
ry, February, March, and November had, each, J.*i; the other
months varied from 3 to ll. All these, except 15, (and one un-
kiiovvn,) were between 20 and 70, and the greatest proportion
bjtween 40 and 50.

, Asphyxia. Of this there were 20. January and September
\^ ere exempt. In the other months they varied from 1 to 4.

Falsy total 48. Varied through the different months from
1| to 6.

I Convulsions total G3S. Of these, the males had the largest
proportion, both in white and black. White males 313 ; white
Je males 275 black males 30, black females 20. The chief dis-
proportion of these was not in relation to season, but to age.
i^ ugusthad 71, the greatest number, and October and Novem-
bar 39, each, being the smallest number of any of the months.
I>ut of these 501 occurred in the 1st year, 64 in lh6 2nd, and 37
i.i the next three years, &c.

Epilepsy total 14. No month exceeded two.

Hydrophobia total two both of which occurred in August.
[ Insanity total 24. Two months only, January and June,
Ihad four each ; all these, but five, occurred between 20 and 50 ;
jail but three, between 20 and 70.

I Lock Jaw total 13. All these occurred from April to Sep-
tember, inclusive the six warm weeks.

Neuralgia, or Nerve Ache. Only one death from this, which
was in June. This name is too indefinite.

DISEASES OF THE RESPIRATORY SYSTEM.

Croup total 182. White males 100 ; white females 70
black males and females, each six.

It is interesting to give the whole number in each month, and
remark the difference between the months of January, Februa-
ry, March, October, November, and December, and the interme-
diate six months, or the six cold and six warm months :

January, 22 ; February, 20 ; March, 20 ; October, 19 ; No-
vember, 22 ; December, 27.

April, 8 ; May, 9 ; June, 8 ; July, 10 ; August, 7 ; Septem-
ber, 9.

All of these, except 16, w-ere under five ; and of these 16, 13
were between five and ten.

Hooping Cough total 2l0. White males 90 ; white fe-
males 117 black males five; black lemales seven. It w'ould
appear by the smaller proportion of males, both white and black,
that the male constitution has better powers for surmounting
this obstinate disease. Of these, August, September, and Octo-
ber had far the greatest proportions : August, 47 ; September,
56 ; October, 32. The other months had three to sixteen ; of
which November had 15 ; December, 16 ; and June, 3. All of

1839.] Connexion of Diseases with Seasons, Ages, ^'C. 48t>

these, but eight, were within the first five ; and those eight, be-
tween five and ten years.

Ht'm'tpiysis total 29 ; of which nineteen were white males,
and five white females one black male, and four black females.
No month had less than one, and none over six ; and this was
November. Only two of them occurred under twenty years of
age.

Injiamniation or Congestion of Lunc;s or Membranes total
542. White males 274 ; white females 210 black males 32 ;
black females 26. Remark the greater proportion of males of
both colors. These are important diseases, both in practice and
insurance; we shall, therefore, give the whole ofthe months:

January, 53; February, 72 ; .March, 85; April, 65; May,
36; June', 31; July, 26; August, 18; September, 23 ; Octo-
ber. 20 ; November, 43 ; December, 50.

Here remark the difl^erence between the colder and the warm-
er months. Of these, 183 died within the first year; 78 in the
second year ; 62 within the next three, or between two and five;
18 between five and ten ; nnd eleven betw^een ten and twenty ;
40 between 20 and 30 ; 52 between 30 and 40 ; 39 between 40
and 50 ; 29 between 50 and 60 and so on, decreasing.

Gang' ene of Lungs. Of these only two cases occurred, which
we re i n A p ri 1 a n d A i ay.

Pulmonary Consumption total 1225. We remark that in
this disease, as well as hemoptysis, the white males and colored
females exceed the opposite sexes of each. White males 6?2 ;
white females 475 black males 61 ; black females 67. The
mortality of the eight coldest months greatlv predominated,
whilst the extremes of June, Julv, August, and September, were
71 (in September,) and 8y (in July). The order of mortality
was as follows, begining with the greatest : December, Novem-
ber, April, February, October, March, May, January, July,
June, August, September. It is worthy of remark, that 546,
besides ten unknown, were foreigrners; and of these 395 were
natives of Ireland ; 89 of Great Britain ; 34 of Germany ; and
13 of France.

Asthma total eight. AH these deaths occurred in the first
three months, and between the ages of forty and eighty.

Inflammation of the Chest^ total fifty five. They occurred
almost entirely in the first and last four months ; there being but
four cases in the middle four months. Nearly half occurred
within the first year ; and all but nine, within the first five years.

Dropsy ofthe Chest total fifty one. 3uly, August, Septem-

* This is an indefinite name. We know not what it is intended to mean;
but suppose it alludes to some acute inflammatory affection of seme of the
respiratorr i^pp^ra^n?,
6f

490 Confiexion of Diseases with Seasons^ AgeSy t^-c. [Mar,

ber and October, were decidedly more exempt than the othc7
months. The greatest number of these were between five and
ten, and between thirty and forty years.

Abscess of Chest total four. 'J'hese occurred in April, May,
and October ; and all but one between fifty and eighty.

Inflammation of the Throat ioVdl 28. These were most
abundant in the first half of the year. Eighteen w^ere under five
years.

DISEASES OF THE DIGESTIVE SYSTEM.

Inflammation of the Stomach total 62. The greatest num-
ber in any one month was sixteen, and these occurred in July.
The other cases were distributed through the other months ;
there being no more than five nor less tnan one in any other.
They occurred principally between twenty and fifty years.

Inflammation of the Bowels total 156. These occurred
chiefly in March, July, August, September, and October ; there
being but sixty three in all the other months.

Cholera Morbus total 25. These occurred chiefly in July,
August, and September ; there being but six in the other months;
and mostly about middle age.

Cholera Infantum iols] 437. Of these, January had two ^
March, four ; June, four; July, 102; August, 174; Septem-
ber, 114 ; October, thirty one ; November, five ; and Decem-
ber, one. All these occurred under five years : 264 within the
first year, and 14S in the second year.

Diarrhoea total 121. These were most numerous in Au-
gust, which had twenty one ; next in September and October,
which were equal ; then July, which had seventeen ; April had
two : the smallest number. They occurred at all ages ; but the
first year had forty two ; the second, twenty ; the three next
years, eighteen, &c.

Dysentery total 150. These w^ere most numerous in males
of all colors. They occurred almost exclusively in July, Au-
gust, September, and October ; only twentv two occurring in alt
the other months ; of which February and March were exempt.
September had forty three ; August thirty three : October, thir-
ty one ; July, sixteen. Thirty cases occurred in the first year ;
twenty four in the second ; twenty seven in the next three
years these decreased with the advance of life, to two between
eighty and ninety.

Marasmus, or Emaciation total 470. Under this head is
included a great amount of mortality to be characterized mere-
ly by the name of one of the symptoms, or eflxjcts of disease.
It is an indefinite name, as applied to point out the disease itself;
and is, therefore, a bad one. We shall, therefore, as the disease
is not definitely pointed out to us, consider it only as a symptom
or effect of disease, followed by death. It was followed by
death in 232 white males ; 200* white females; twenty blaxik

1839.] Connexion of Diseases icith SeasonSt AgeSf i^K. 401

Kiales ; and eighteen black females ; therefore, rather more fre-
quent with males, supposing the males and females about
equal ; but we believe the females are most numerous, if so,
the ratio of frequency in males is increased. It was pretty
equally distributed throughout the whole of the months;
twenty six being the smallest number of deaths in any month,
and these occurred in January. The next smallest were
May and Decen^iber, each of which had twenty eight. The
greatest mortality was in August, in which it amounted to sixty
nine ; the next greatest was September, which was sixty six ;
and the next, October, which was fifty one; then July, which
was forty five, &c. 209 occurred in the first year ; 110 in the
second ; forty five in the next three ; and so on to one between
eighty and nmety.

Teethi?ig total 146. Of these, nearly half (sixty nine) oc-
curred in August and September. The other months having
from two to seventeen. The first year had eighty ; the second,
sixty three ; and the next, three ; the balance, of only three.

Wor7ns total 2'S. We doubt the correctness of this item in
the report, and think many cases of worms are included under
other names. However, May and December were exempt;
the other months varied from one to five ; March and August
had five in each. Two occurred during the first year ; eleven
during the second ; seven in the next three ; and three between
five and ten.

Inflammation of Liver total 4S. The greatest number in
one month was in September : being eight. The other months
varied from one to five. They occurred chiefly between thirty
and fifty ; and just about the time that what is called "genteel
wine dnnking," works out this kind of death.

DISEASES CF TH3 CIRCULATORY SYSTEM.

Under this head we find

Fever (type not named). Total uhy six. These fevers oc-
curred pretty equally, from tv/o to six, in the month. The
greatest proportion of deaths occurred in the first year, and in
the latter half of life thirty to sixty years.

Intermittent Fever total only nine : a small number for such
an immense population ; however, it is a disease which should
scarcely ever kill. Six occurred in October ; two in Septem-
ber ; and one in January. One death the first year ; four the
second ; and tie other four between twenty and sixty.

Remittent Billiaits Fever total 103. White males forty
nine ; white females forty six black males five ; black females
three. These were most considerable in August and Septem-
ber ; but were from three to seven through the other months.
Eight died the first year ; eight the second year ; and fifteen du-

i^'2 Coimexioii of Diseases with Seasons, Ag^s, ^-c. [Mar^

ring the next three. The greatest number in ten years, after
this, was eighteen, between twenty and thirty.

Typhus Fever total 104. The mortahty was nearly in the
sanne proportion in the different sexes, both black and white.
White males forty five; white females forty four^ black males
seven ; black females eight. The disease appeared in every
month, varying from six to fourteen. The greatest mortality
was in I\ovember (fourteen), but was nearly equalled by De-
cember (twelve). The greatest mortality was between thirty
and forty.

Spotted Fever total two. One in a male, and one in a fe-
male. Both occurred in June.

ERUPTIVE FEVERS.

Under this head are included some of the most important dis-
eases ; as ,.

Scarlet Fever total 257. White males 136 ; white females
ll3 black males two ; black females six. The first seven
months had 205 deaths, leaving a balance of fifty one, to be pret-
ty equally distributed through the other months. All these, ex-
cept seventeen, and two unknown, were within the first ten
years: not one occurring after fifty.

Measles total 79. These cases were distributed through
the whole year no month having Jess than two, and none more
than eleven. . The mortality of this disease was confined to the
early years ; there being thirteen in the first year ; twenty one
in the second ; thirty seven in the r.ext three years ; six be-
tween five and ten ; and two between ten and twenty.

Small Fox total ninety one. The greatest mortality from
small pox was in the three first months of the year ; the pro-
portions of which were twenty three, thirteen, and thirteen. l\o
other month exceeded six; and July and August, only one, each.
In the first year, twenty two died ; in the second, seventeen.
Only two died after forty, and these were between sixty and
seventy. As to the occurrence of this and the iormer disease,
measles, they depend on specific contagions as their cause.
There is nothing, therefore, in season, favorable to its produc-
tion ; and this is only calculated to influence their mortality,
when produced.

Chicken Pox. There were only two of these cases which
proved fatal, and these occurred during the first year of age,
and in the months of January and May.

Erysipelas total thirty three. These cases spared no month
in the year. July and November had one each ; and January,
August, and September each, four. Seventeen of them occur-
red during the first year ; the others are scattered through the
range of life, from the first to the seventieth year ; and one be-
tween ninetv and a hundred vears.

lS.'il).] Connexion of Diseases with Seasons, Ages, cj-r. 41)3

Aphtha; or Sprne^\o\dA twexiy nine. They principally oc-
curred in July, August, ISeptember, and October. All died du-
ring tlie first year, except iour ; which were in tlie course of the
next four years.

Strophulus, or Red Gum. Only one case of death from this
disease, and that was in the first year.

Bleeding {\ydv\s uoi named) total thirteen. Nine of these
occurred in white and black males, and four in white females.
All these occurred in the first seven montlis in the year, but one
m October, and one in November. All except three occurred
between twenty and sixty.

Dropsy (seat not named) total i3l. Greatest mortality in
December, which was seventeen. March and >eptember had
each fouiteen ; August had only five: the smallest number.
Forty six occurred between the thirtieth and fiftieth years.

Purpura HcomGrrhaglca, or Purples. Only one case of death
occurred from this disease, or rather followed this symptom.
]t was in September, and between the ages often and twenty.

DISEASES PF THE URIxNAIlY ATVD GENITAL ORGANS.

Of this class w^e shall only notice a few diseases, merely for
assisting in diagnosis. *

Cancer and Scirrhus of Womb total seven. The earliest
case of death from this cause, was between thirty and forty.

Rupture of Womb. Only one case of this occurred, which
was between forty and fifty. We have never known a case of
this e.irlier.

Childbed.* total twenty. No month exceeded two, nor
was there any under one. except November.

Puerperal Fever or Peritonitis total seventeen. Distribu-
ted through all the months pretty equally, except July and Au-
gust, which had none All were between 20 and 40.

Puerperal Convulsions Only three ; and those occurred in
February, June, and December.

Cruritis,or Milk Leg only one ; and in October; and some-
where between twenty and thirty years of age.

Cancer of Breast total six. One between thirty and forty ;
one between forty and fifty ; two between fifty and sixty ; and
two between sixty and eighty. And possibly, that between 30
and 10 was not genuine cancer, as it seldom occurs so early.
Facts on this point are extremely important, as they may tend
to put down a custom too prevalent, of calling a breast cancer-
ous, and operating for it, before it is so.

Cancer total eighteen. Here we have cancer again, with-
out naming thelocation. Six were in males, and twelve in fe-
males. All except one was between thirty and one hundred

*VVe do not know what diseases, under this title, destroyed life ; as the
most formid?.b]e diseases of child-bed are mentioned in the report separately.

404 Connexion (if Di'senaex ivith Seasons, Ages, <.]-. [May,

years ; and this one is piU between twenty and thirty. There
were seven between hWy and sixty , three between sixty and
seventy, and two between tliirty and forty,

GouL Only two cases of death, which were in July, and be-
tween forty and fifty tiie most usual time for habitual wine
drinking to begin its fatal operations by this disease.

Rhtumatism total thirteen. One in January ; three in
March : one in April ; three in June ; one in July ; two in Au-
gust ; and one in December. All but three we-re betw^een thir-
ty and Jteventy.

Scrofida-^\oXdi\ thirty. Rather more with males. Deaths
chiefly fiom February to August ; and twenty four out of the
thirty, under tw^enty yeaas.

Scurvy total jbur. All these deaths were between thirty
and seventy.

Carbuncle only one. It was in July ; and between sixty
and seventy.

Dry Gangrene total four. All occurred betw'een sixty and
eighty.

Mortification total tw^enty eight. Six were in January ;
the rest distril^uted through the other months, except June,
which had none. The deaths occurred at all ages under 80.

DISEASES OP THte BONEY SYSTEM.

We shall notice butfew^ of these, as they have no connexion
with season, as to the time of death.

Moibus Coxarius total five ; 'of which, four occurred in Feb-
ruary, March, April and May : the other in August. Four
deaths between five and twenty ; and the other between fifty
and sixty.

White Swelling. One case, between twenty and thirty.

Lues Venera total fifteen. Four occurred in the first year.
All the rest between thirty and sixty except one, which was be-
tween seventy and eighty.

DISEASES OF INTEMPERANCE.

The nomenclature adopted in the report is by no means
clear; indeed Intemperance is not given as a class, but occupies
the place of the name of a disease. For the cause of truth and
humanity, as well as temperance, which it is the duty of all
physicians to sustain and promote, as far as facts enable them,
it would certainly have been more correct and advantageous to
have given intemperance a generic rank, and arranged under it
the deaths from all accidents and circumstances, wdiereof this
could have been fairly considered cause: such as delirium tre-
mens, some apoplexies, palsies, suicides, marasmus, dyspepsia.
&c. However, we shall notice them as contained in the re-
port:

Intemperance: total thirty three. Five was the f^reate^t

ISiJO.] Connexion of Di incases IV I th Seaitons, Ages, c^c. ii)^

number in any one month, but no month was exempt but Sep-
tember. They all occurred between twenty and sixty.

Delirium Tremens total 64. Of these, twelve occurred in
August alone. No month was exempt from o'eaths from deliri-
um tremens; but March' and November had. but two in each.
Of these, tifty two occurred in white males, and eleven in whito
females I Only one amongst black males, and none in black fe-
males. Perhaps to the poverty of the colored, they were indebt-
ed for their happy exemption from tins horrible disease. Of
these deaths, iburleen occurred between twenty and thirty ;
twenty six betvv'een thirty and forty ; and seventeen between
forty and fifty. Only seven occurred after fifty : as few who
are disposed to that turn of intemperance, live in that indulgence
which causes it, to a later period. ^

Unknown Causes total 159. Many of these were, doubt-
less, results of intemperance. .July had twenty two, and Au-
gust eighteen. Eight, the smallest number in any one month,
and this month was November. Twenty nine of these occurred
in children during the first year. But the most fatal periods
were from twenty to thirty, 10 ; thirty to forty, 31 ; from forty
to fifty, 36 ; and from fifty to sixty, l5 ; making in the period
from twenty to sixty, a proportion to the whole number, of
ninety four. Of these we suspect many to have arisen from in-
temperance.

Suicide. Forty three cases of deatb occurred from this cause.
Of these, twenty (nearly half) occurred in July, August, and
September. Eighteen between twenty and thirty ; and eleven
between thirty and forty. All occurred between twenty and
seventy. Doubtless, intemperance was that, without which,
this number would have been considerably less.

Casualties total ninety one. These were distributed througb
all the months, and ail periods of life ; but thirty five of them
occurred between twenty and forty. Some of them were,
doubtless, the results of intemperance.

Burns or Scalds total 50. Of these, thirty three occurred
within the first five years.

Drowning total 93. Some occurred in every month, but the
iour warmest months alone had sixty eight: showing probably
the connexion of the proportion with bathmg. Seventeen were
white males ; five white females ; and thirteen black males.

Drinking Cold Water total 22. Tliese all occurred in
June, July, and August ; and all but five, between twenty and
forty.

Old Age total 114. All but eight occurred between nmety
and 105. No month was exempt, but August had the greatest
number, which was eighteen. -^

At the end of the table we are told that pleurisy, peripneumo- Wbl
Bia, bronchitis, colds, catarrh, influenza, and pneumonia typhoide?.

49G Connexion of Diseases with Seasons, Ages, <^'C. [May,

arc included aQioni^ ihe deaths from in(l;immation of the lungs
and membranes. Also, that deaths from de(;ay, debih'ty, tabes
mysenlerica, and atrophy, are inchided with deaths Irom ma-
rasmus.

The full total of deaths amo'jnted to 7,533

To whigh, if we add tlie still-born 520

We make the total of interments 8,053

The follovvinfT table will show the proportion of white and
black males and females, who died at the ditferent periods of life.

:_

i n

7;

r

M

ai

93

K 1 (X r.

(-

CQ

5

a

c:

a

c:

c3 K Sr

^

0

Qj

C

0

0

0

0 c c

V

u

>.

>.

>

>.

>>

>>

>. > >

c

'~'

o

>.

0

0

0

0

.00 0

is

O

-3

!-^

0

0
0

3

0

xyl

0

0

!o

t-

2J

0

y~ *-*

*-".

0

0

0

0

0

0

0 a =

D

407

332

165

132

SAO

CO

472

322

197

0 '^ t- 1 cc i 0

White Miiles,

1052

136

59, 42

6

28

White Females,

811

465

370

140

141'

33S

290

182

lOJ

93

79

36

12

10

mnr.k Males,

84

28

20

10

12

34

51

32

16

13

4

6

1

1

Black Females,

74

2:3

30

10

15

49

47

27

11

14

f)

4

2

2

The following table shows the rate per cent, of deaths of each
class, betvveen certain ages :

White males umler 5 y'rs. 125.22
While females " " 22.24

Black males " " 1.75

Black females " " 1.68

Per cent, total,

2.19

1.85

.13

.13

175I451I 6 56 4.2r;2.6n.8 [ .781

1.85 4.48
..15 .45
.19 .651

3.84 2.41
.671 .42
.62i .35

1.3811.3 '
.21. .171
.U\ .18

1.3

.05
.07

.63 .37

11.46

.13

54

50.91i 4 311 3.9610.1 '11.41 7.47'4.353.46 1.83

We subjoin a few ofthe most important remarks made by the
City Inspector, at the close of the tables

By this report it will be seen that the deaths in 1838 were 679 less than
in 1^.'37. Precisely the increase of 1S37 over 1S86.

It may be wei], for the gratification of those who have not the time or
taste to enter into the investiga'tion, to subjoin a running commentary upon
some of the details herein presented.

There are several interesting results to be gleaned from the precise and
peculiar mode of arranging these tables, and which could not be shown by
any other method.

Leaving others to account for the causes, while the facts are simply pla-
ced before them, I wfil premise that, while the total of deaths has been 679
less, the variation in prevalency of ditrerent diseases has been immense ;
from a decreased mortality of 1654 upon some, to an increase of others of
1209.

The decrease has been chieflly upon the following diseases, viz : of Scar-
lot Fever, 322, TvDhus,234, Consumption, 233 ; Measles 159 ; Small Pox,
79; Fever, 74; Teething, 93; Inflammation of the Chest, 40; Diarrhea,
30 ; Drunkenness and Delirium Tremens 31 ; Child bed, and Puerperal
Fever, 24 ; Dropsv, 19 ; Bleeding, 12 ; Mortification, 10 ; Old Age, 8 ; and
Epilepsy, 5 ; and 28 less were drov/ned

Ofthe Diseases that have increased, the followmg stand most conspicu-
ous : of Cholera Infantum, 184. More deaths of this disease occurred this
year than ever before, with the single exception ofthe cholera year, 1834,
when it was only 38 greater. In the vear 183'2, it was 103 less than in this.
The increase of Marnsmu.s is 178 ; 'H<)oping^on^h, 15'5} Unknown 102 ;

1^39.] Tartar Emetic in Pntnrmoma, 4SPi

J^poplexy, 53 ; Croup, 31 ; Remittent Fever, 28 ; drinking cold water, 20;
Malibrraation, 31 ; Qrg-anic disease of Hearty 18 ; Bleeding from Lungs, 13;
Dropsy of Chest, 13 ; Scrofula, 12 ; while of casualties, 12 more occurred,
and 8 naore were killed or murdered.

The increase of apoplexy. Unknown, and drinking cold water, oocuired
chiefly during the extremely warm part of last summer.

The number of Still I^orn and Premature is precisely the same as last
year. There is a curious circunastance connected with this casualty that
ideserves a remark : that is, the great disproportion of white females, and
which does not take place between the sexes of the blacks.

The greater fatality cf male life in the white race commences before birth,
continues throughout the first year of existence. This year almost 51 out
<f every 100 died before reaching 5 years of existence, of whom over 25
were white males, and 22 females, ^the rest blacks. This inequality does
not continue so great after passing the year ; there being no trifling varia-
tion (although the males exceed,) between 1 and 2 2 and 5 5 and 10, un-
til between 10 and 20, females predominate ; between 20 and 30 they arc
nearly the same ; but, between 30 and 50, even to 60, the males are al-
ffnost doufele in number to females. Between 60 and 70, they vary a trifle ;
(between 70 and 80, the females outnumber the males, but from 60 upwards,
they are equal.

Throughout the whole series there is a total excess of male <ieaths, of
eiearly 10 per cent., and this cannot arise from exposure or casualty alone.
There is not a disease of childhood, except Whooping Cough and Measles,
in which the male deaths do not preponderate. The same thing occurs,
with few exceptions, at the other periods of life, ex-cluding the peculiar dis-
eases of females, and old age. Qf casualties of all kinds, the males exceed
females only 148.

According to the last census, the female population was not 5 per cent,
greater than the male. This constant loss of male population (which, tak-
ing the whole series embraced in my last year's report, of 32 years
past, has been still greater, having been nearly 12 per cent.,) is in some way
or another supplied, or, inevitably, the male race would eventually become
-extinct. 5t is for the purpose of ascertaining the facts, that a register of
births is desirable.

It is singular, in regard to the deaths of the colored population, that the
males and femdes differ so little ; the colored females exceed the males only
one. '

Of those diseases so fatal under the year some of them are fatal within a
few daysof birtfe. Of Convulsions 638 died 501 of them under the year;
but 159 of them were not 7 days old ^ between that and 21 days, 177 died ;
between that and 2 months, 79 ; and 28 between that and 3 months, leaving
but 118 to divide between the remaining three fourths of the year. Of Mal-
formation and Premature, 77 died under 20 days.

Tartar Emetic in Pneumonia. We look with great pleasure
on the beginning practical improvements of the present age.
Ridiculous and nonsensical, not to say mischievous ultraisms
have, to a great extent, beset the profession for the last twenty
or thirty years in a practical as well as theoretical ^omi of view.
Whilst expectant practitioners, on the one hand, have urged
upon the profession abstinence from the use of almost every
medicinal agent of valuable powers, and Hahnemann has per-
fected these views, by urging the propriety, or rather the almost

49 TaHar Emetic in Pnenmonm. [Msjp

infallible the inconceivable powers andefficacyofiiifinitessimal
doses, which are fully equivalent to no doses at all, other practi-
tioners have vibrated in the other direction to an extent almost as
ridiculous perhaps much more actively injurious in the admin-
istration of Herculean doses. This has been eminently the cas
in the southern and western parts of the United States, so far
as regards the use of calomel, and in Italy and France in the use
of tartar emetic. Perhaps these errors were founded on Hahne-
mann's cpinion, that the smaller the dose, the greater its pow-
er, &c. for it has been contended and declared by these ultra he-
roic practitioners, that the greater the dose the less energeticat-
ly it operates. The only difference then between these practi-
tioners and Hahnemann is, that they take different ends of the
same doctrine, if it may be so called ; and whilst the latter used
infinitessimal doses for the most powerful y the former used
Herculean ones for lighter effects.

But the redeeming spirit of the age, is daily approximating
the entire extermination of this doctrine, by bringing us back to
the primary truths of observation observation, not alone of the
fatal depredations of the disease, but of the truths which they
afford during their progress ; and with rigid reasoning is exter-
minating one error after another. The vibrating pendulum of
truth which has left its line of direction to vibrate to extremes on
either side, is now being settled in its proper position, and the
wild errors of fancy are becoming things that were.

As the tide of popular theoretical error rolls away, we observe
that antimonials are assuming their proper rank in the poso-
gical table, and will, doubtless, be soon permanently located as
a nauseant and an emetic, and an aperient or cathartic in cer-
tain circumstances, and secondarily, a diaphoretic. This will
fix the doses at that which will just produce their several effects
in the desired degree, and through these, exercise their valuable
powers of correcting morbid action. Modern bumoralism has
not yet progressed so far as to give a proper weight to its dia-
phoretic virtues, for action alone still dazzles the professional
eye too much for the clear perception of the importance of the
purity of the great circulating fluid the blood, in the production
and maintenance of health in the animal economy. Blood is, in
health, a perfect and uniform composition, consisting of various
elements or constituents, in well adjusted proportions, and even
organization, to some extent, and is sui generis. So long as this
condition of it is preserved, perfect health, as to general action,
prevails. This perfection, in all respects, is generally preserved
by the perfect regularity and due operation of, the eliminating
or depurating functions the various secretions. It is true that
extraneous and deleterious influences are often derived from in-
gesta, in unusual quantities and qualities ; but these again are, in
an otherwise healthy condition of the functions, generally provi-

I

IS^^.] Tartar Emetic in Fnenimnki. 4'99

ded for by the eliminators, and speedily expelled. But the in-
stant these depurators are m the least disordered in their func-
tions, the wanderings from perfect health begin, howev-er small
the degree. It may be barely in a rational, but not sensible de-
gree, or it may be insensible, but not incommoding degree, or a
certain dxsgree of variation from perfect health which has been
called disorder. But when these functions are disordered for a
Jong time, or in a great degree, whether by excess or deficiency,
but most comn^only the latter, the regular constitution of the
blood is changed, and, consequently, its influcKce in the economy
proportionately altered, if such be the case, and that it is, is
constantly declared by the construction and arrangement of the
various fuzactionaries, the diierent composition of the blood in
the vadous morbid and healiJiy conditions, the manner <?f opera-
tion of noxious causes, the regular succession of proportionate
effects to them, the constant observation x)f the efficacy of the
operations of nature or of art, in the restoration and the preser-
vation of health, (fee. if, we say, it be the case that all degrees
of change of the depurating functions are calculated to disorder
the economy, how important it is to hygiene to preserve the most
perfect integrity of their functions -, and to the restoration of
health or the removal of disease when produced, to restore those
actions which have been thus disordered ! We would not, how-
ever, hold forth the idea that this is, in every case, all that is to
be done ; but this, distinctly, that without these purposes being
effected by nature or art, the other efforts, however indispensa-
ble tbemselves, must prove .unavailing. We are pleased to see,
as we thluk we do, in the observations of M, Chomel, of the
Hotel Dieu, an approximation to truth and soundness in this res-
pect. We give tiie remarks of La Lancette Francaise, through
the Med. Chi. Rev. and Eclect. Jour, on M. Chomel's use of tar-
^.ar emetic, and his opinions of its medicinal powers, founded oa
(lis expensive, accurate, and independent observations.

M. Chamd on Tartar Emetic in P-ne'dinonia^ This eminently practical
physician of the Hotel-Dieu has not, it seems, so high an opinion of the tar-
tar emetic practice in contralling thoracic inflairraiat^ion, as many of his pro*
fessional brethern in Paris, tHe frequently uses it ; but only as a subsidia-
ry remedy, after a -decided impression has been made on the disease by
blood-letting. With respect to its having any directly antiphlogistic or con-
tra-stiraulant properties, independently of the depressien induced by nau-
sea and by evacuation, M. Chomel professes himseif to be very sceptical;
and hence, of late years, he has discontin'asd the common usage of combin-
ing opium with it, for the purpose of inducing a tolerance of the antimonial.
According to his views, its action is to be referred to an eiiergetic revulsion
pon the alimentary tube, and to the powerful compression of the lungs, dur-
ing the efforts of vomiting, aided by the nausea which precedes and ioWovrs
these eflfbrts.

The antimonial will always be found of most efficacy, when the first
violence of the inflammatory attack is arrested, and when the disease indi-
cates a tendencv to remission or abatement.

SOO Remarks cm, with case of , Pnemno-Tfiorax, [MaiTr

Alluding to the excellent effects of intestinal derivation upon all thoracic
HiflammationSyM. Chomel takes the opportunity of strongly recommending:
castor oil as the safest and one of the most eflectual purgativesj^ whith ca
be used for this puypose.

Remarks on^ with Case of^ Pneumo-ihorax, Tlie following ease kktely"
occurred in the practice of M. Chomel, at the Hotel l>ieu.

A nian^ affected witii pu.lmonary tubercles in a state of softeningy was sud-
denly seized with a violent pleuritic pain or stitch, whish caused extreme diffi-*
culty in- breathing, and considerable febrile action in the whole system.

On examining the chest, it was observed to be altogether fuller and more
capacious than it had been, and at the same time, to be much more
lesonant em percussion, while the respiratory murmur had become much
more indistinct*

When lecturing upon this case, M. Chomel took occasion to state that,,
in his opinion^ the disease o pneumo-ihorax is never idiopathic, or, in other
words, that air is never secreted from the pleural surfaces but is always-
the result of a communication between the air cells of the lungs and the bag
of the pleura, Buch a communication may take place in one of two ways ;
either by the ulceration of a vomica outwards, as in the present ease, or in
consequence of a purulent effusion in the pleural cavity being followed by
an ulceration at some point of the lungs.

He stated, at the same time, that he took the game view of tympanites
abdominalis the effusion of air being, according to him, always the re-
sult of an intestinal perforation.

Such a perforation may have taken place either from within outwards, as
is occasionally the case in some cases of typhus fever, or from without in-
wards, as now and then happens in consequence of a purulent collection in
the abdominal cavity. An instance of this sort occurred very recently in M.
Chomel's clinique,in a worn an ^ who died from an immense abscess in the
pelvis : ulceration had taken place at one pcint of the large intestine, and
had penetrated through all its coats, except the mucous one.

It is necessary to distinguish the peritoneal tympanites, which we not
unfrequently meet with in dissection^ when there is certainly no perforation
of the intestines, from that alleged or presumed jorm of the disease, which
has been attributed to the secretion of air during life : it is entirely owing
to the incipient cadaveric decomposition. M, Chomel mentioned a very
remarkable instance of this cadaveric tympanites, which he recently met
with. A restaurateur in Paris, who was immensely fat, but seemed to be
in very good health, was most unexpectedly found dead in his bed. The
body was examined thirty hours after death. The season w^as summer.
No sooner were the abdominal parietes divided, than a loud explosion,
which M. Chomel compares to that produced by the discharge of an air-
gun, was heard ; so violent was the rush of the confined air from the aper-
ture which had been made into the cavity of the abdomen.

But now to return to our case of pneumo-thorax.

On the following day, after the presumed rupture of the vomica, and the
communication between the air cells of the lungs and the pleural cavity had
taken place, the expansion and also the resonance of the thoracic parietes
were found to have considerably increased.

In proportion, as the pneumo-thorax was more decided, the ausculta-
tory signs became more and more distinct and decisive. At the lower part
of the chest, a sound, analogous to the amphoric bruit, was perceptible ; and
more externally, a distinct metallic tinckling was to be heard. Over the
scapular region, a bruit de secousse, such as is caused by striking a drum
with the finger, was audible when the patient spoke.

Along with these symptoms, there was extreme anxiety and difficulty of

1S39.] Professionat Charges^ ^c. 501

breathing", amounting to orthopnoea, &c., and, as we have mentioned above,
the chest was remarkably resonant on percussion.

The treatment which M. Chomel adopts in almost all cases of interna] per-
foration, whether of the thoracic or of the abdominal viscera, consists in the
exhibition of opiates, until they produce a decided narcotism of the system.
The object is not only to quiet the pain which is almost always present, but,
also to bring on a state of inertia of the whole system, so as to permit nature
to exercise her own medicative and reparatory efforts.

From the results of several cases of presumed intestinal perforation, this
treatment certainly seems to be by far the most advisable. Med. Chirur.
Rev. for Januanjy from Lanrelte Franc aise.

Part IIL MONTHLY PERISCOPE.

Professional Charges. Aulopsij for Legal Purposes, Let-
ters of Consultation.

At its last session, tlie Medical Society of Augusta passed,
with unanimous vote, a resolution, that autopsic examinations,
for legal purposes, are proper subjects of charge, and that the
price for each and every such examination should be from twen-
ty five to one hundred dollars.

The principal arguments on which this resolution was based
were, 1st. That the County is always able to pay, as well for
professional labor and service for its own purposes, as for any
other commodity. 2nd. That a man's professional qualifica-
tions, whereby he is rendered competent to the discharge of this
service, are his capital, or his stock in trade, in a pecuniary
point of view, and neither the public, nor any individual, has a
right to their use, without a satisfactory return for the same,
any more than the pubHc, or any individual, has to take, with-
out due remuneration, the labor or property of any other man ;
and 3rd. That these anatomical investigations demand for them-
selves an ability, which is found only in ample scientific attain-
ments that they require much lime for their proper perform-
ance, and much more in attendance on the legal investigations
to which they lead, and to which they are all-important. To
these we may add, a peculiar weight of responsibility ; because
on medical, more than any other testimony in such cases, a cor-
rect decision depends, in which human life is concerned. By the
slightest error, or delinquency in the discharcre of this duty, the
guilty may be allowed to escape the just inflictions of the law.

502 Perhcojje. [May,

or the innocent caused to suffer the punishment due only to the

guilty.

It may be an enquiry in the mind of some, ^vhether such a re-
solution as that alluded to in the beo^inning of this lecture is, or
ever would be, called for whether any counter-sentiment on
the subject exists, to call forth this action of the medical com-
munity / To this enquiry we reply, that a case is now pend-
ing in the Superior Court of this County, in consequence of the
relbsal, on the part of the County, to afford to the anatomist in
such a case, a satisfactory remuneration for his services. In
this movement the members of the Society feel themselves sus-
tained by the laws of the land, as fairly as they would be under
an attempt, on the part of the general government to force them
to the gratuitous discharge of the duties of an army surgeon.

The task is, as we have said, a most disagreeable one ; and
one which it is the desire of most practitioners to avoid. In
case of refusal to discharge those duties according to the demands
of justice, the law may and should exercise compulsory pow-
ers ; but not without ample remuneration.

Another subject of charge for professional services, than which
there is none more proper, but which has been overlooked alike
by the profession and the community in this section, is consulta-
tion by letter. Jt is a frequent occurrence for a physician to
receive a letter from some other practitioner, or a patient at a
distance, making a large demand on his time, attention and la-
bor no fee inclosed, nor even the postage paid. It would seem
from such communications, that the writer of such letter pre-
sumed on the sufhciency of the compliment \\\us paid to a physi-
cian, for paying: the debts of the latter, or bearing the current ex-
penses of his family, and paying the postage to boot. Truly,
honor is pleasant enough to most men, but he who has learned
that, to live honestly and honorably, the necessary expenses of
life and of the profession must be met with promptness^ will say
" honor to the dogs," in such a case.

It is worse than useless to open accounts with persons at a.
distance of 100 or more miles ; as the collection would cost more
than it would profit. It is, therefore, indispensable, that a fee
fully sufficient to reward the physician for his labor in the pre-
mises should accompany the letter, or application otherwise
made, or a certificate of the disability of the patient to reward
the adviser; for, otherwise, a prompt return (if return at all)
cannot be reasonably expected. Physicians who are most fre-
quently consulted in this way, have generally enjoyed i\\e honor
of high confidence before, and for a length of time therefore, a
mere expression of confidence is no reward. Such persons are,
moreover, not " gentlemen of leisure," but are busy men, replete
with important engagements ; such as are not, are rarely wor-
thy of such consultations ; for it is by their habitual professional

1839.] Professional Charges, cj-r. 503

enn^agement and studious habits, that they obtain that worth in
the profession which causes their advice to be thus souiiht. To
men thus engaged, time is more precious than gold. 'J'inie, and
mental and corporeal labor are their capital, and it is not more
just and reasonable, to expect such men to take these, their capi-
tal, from a profitable emplo3'ment, and bestow them gratuitous-
ly, than it would be to expect or ask a monied institution, to draw
its capital from those employments by which ilrelurtis, with in-
terest, and give it to an individual whom it is never expected
will be heard of again. No. If advice sought in this way be
necessary and proper at all, it is only on i\\Q present state of the
case described. The advice must, therefore, in order to be pro-
ductive of good, be prompt. Nothing, therefore, can generally
secure this promptness, but a competent fee in liancL or a clear
and fair claim on the charity of the physician ; which latter, to
the honor of the profession, is seldom slighted.

It is not a \cyv uncommon thing for some persons to think
more about the business of others than they should do ; but we
are of the opinion, that this is an instance in wdiich there is a de-
ficiency of thought of the business and interest of others. Would
it not be well that the community at large, as well as physicians,
should be reminded of the fact, that consulting physicians, as
well as other people, are obliged to secure a competent income
by their means, and that they are even as much entitled to the ac-
cumulation of a fortune by their time and well-directed acquire-
ments ? And, therefore, when a benefit is asked, that a quidpi'o
quo is necessary to secure it ? We remember an old anecdote
which frequently occurs to our mind on these occasions. A
gentleman being about to sail to a foreign country, received or-
ders for the purchase of many articles for A. B. C. D. E. and F.
On his return, A. B. and C. received promptly all the articles
for which they had sent, perfectly to their satisfaction ; but D.
E. and F. not receiving any of those, the procuring of which
they had requested, inquired anxiously into the cause : whereon,
the gentleman informed them that, one day during his voyage,
he had spread before him the whole of the orders he had receiv-
ed, to see what articles he had to procure, placing the money,
accompanying some of the orders, on them. Whilst engaged in
looking over them, a sudden breeze came and carried overboard
all the bills which were not weighed down by the money ; and
as he could not recover them from the sea, he was unable to as-
certain the articles named in these orders, which happened to be
theirs ; but all the orders which were thus saved by the pressure
of the money, he had been able promptly to fulfil. So it is with
letters of consultation. Were they made subjects of pecuniary
interest to the consulting physician, they would be kept careful-
ly in hand until duly attended to, and not be allowed to accu-
mulate around his desk, or in his pocket, by the necessity which

504 Periscope. L^^^X*

otherwise exists, for their awaiting an hour of disengagement
from other business of value.

Allusion is not here made to those applications on behalf of
patients who are proper subjects of charity : the character of our
profession should be ample protection against a charge of un-
willingness to aftbrd to the poor our assistance, as far as consistent
with other obligations ; for it is a well known truth, that (consi-
dering the time, talents, labor, &c. of physicians, their capital.)
they bestow on the indigent and afflicted, a greater amount of
charity than all other classes of the community together. But
there is no more justice in claiming a physician's servicesfor the
sick, without reward, than in claiming the undertaker's for his
coffin ; and who thinks of finding a mechanic who may be called
from his other business to make a coffin, or a merchant to afford
the habiliments of death gratuitously ? Each may give\^ he
please, and we are happy to know that the physician always
gives in such cases, as far as he can, injustice to his other busi-
ness, which, in point of humanity, is not less obligatory than the
afflictions of the indigent.

New Diuretic. Some time since, we noticed that Dr. Hollo-
way, of Warrenton, had found the pith of old corn stalks a po-
pular remedy for some of the most troublesome disorders of the
urinary organs, with some experiments of his own with the arti-
cle. In his last letter Dr. H. writes thus on the subject:

" Since I last had the pleasure to hear from you, I have had
another opportunity of trying the pith of old corn stalks in dys-
uria and hematuria, in which it was found promptly efficient.
What are its virtues, and why does it act so very promptly ?"

New Theory and Treatment of Erysipelas. By M. Blandin, Surgeon to the
Hotel Dieu, Paris. Erysipelas maybe divided into two varieties, according
to the causes which give rise to it. These may be either external or inter-
nal ; as a wound or injury, or a disordered state of the constitution general-
ly ; and the disease will vary considerably in its characters as the one or the
other cause may occasion it. According to M. Blandin's theory, that varie-
ty which is excited by external injury is at first a local affection, and after-
wards tends to dilFuse itself generally ; the fluids, which are altered by the
diseased actions, going on in the part, having a concentric course, and thus
spread themselves through the whole system and excite violent reaction.
Erysipelas, on the contrary, arising from an internal cause, is at first gener-
ally diffused, and has a tendency to become localized ; nature making an
effort to determine the disturbing influence towards a single point.

With regard to the anatomical nature or proximate cause of erysipelas,
M, B. considers that it consists in acute inflammation of the minute lympha-
tic vessels of the skin, which are first affected, and inflammation of the sub-
stance of the skin itself afterwards follows. [This idea of the absorbents
being inflamed in erysipelas is not new, though M. B. is the first who has
extensively applied it, in numerous cases, both to pathology and thera-
peutics ; this same tlieory has been entertained by several authors ; among

1 839 J Vaccination as a Preservaiive against Small Pox. 505

others, M. M. Ribes, Dance and Chomel.] The decjree of mflammation be-
tween the lymphatic capillaries and the substance of the skin is not ahVays
in equal proportion. In erysipelas from internal causes, it is the latter which
predominates ; in the traumatic variety, the absorbents are principally af-
fected : and this causes the difference m the seriousness of the affections ;
for according to M. B., physicians generally find erysipelas a trifling disor-
der, while surgeons regard it as a most serious disease.

M. Blandin's treatment is founded on the principle that the pre-existing
and predominant affection is inflammation of the lymphatics, and that, when
this is checked, there only remains simple inflammation of the integuments.
As the disease is propagated towards those lymphatic ganglions which
are situated most centrically, or nearest to the trunk, it is here that we
should commence the treatment, which consists in successive applications
of leeches over the absorbent glands, and not on the erysipelatous surface
of the skill itself; as in the latter case they only weaken the patient. This
plan is principally applicable to the traumatic variety, when situated in the
extremities ; but he considers that it may be also employed Vv'ith advantage
when the skin of the trunk is affected, and when the disease arises from in-
ternal causes.

M. B. has applied his plan of treatment to a great number of cases, and
informs us that, during two years that he has employed it he has scarcely
lost a single patient; but he ought to publish the exact number of instances
in which he has tried it, with the particulars of the different cases; this would
render -Jiis statements much more valuable, Brit, and For. Med. Rev. for
January^ from Journal des Connaissances Medico-chirurgicales. July, 1837.

Vaccination as a Preservative against Small Pox. The fol-
lowing conclusions, close a long communication from Doctor
Schaeffer, in Rusfs Magazin fur die ges : Heilkunde, on the
contagion of the Variola, during 1836, in Haischberg, in Ger-
many. So far as these conclusions go to impair confidence in
the preservative efficacy of vaccination, we are compelled to
attach the blame, not to the vaccine disease, but to the i?npe?fec-
tion of that disease, either from fault of the virus used, or the
condition of the system when that which is genuine is used, or
some other cause of a want of its wonted and proper action.
We are rather surprised when we consider the various circum-
stances calculated to modify morbid actions of any kind, that un-
der the circumstances which have attended the use of vaccination,
it has not every w4icre so degenerated as to have lost its charac-
ter as a preventive povv^er. Under all the circumstances, how-
ever, and particularly with vaccination in the hands of the com-
mon people throughout the country, who are neither judges of
the characters of genuine vaccine disease, nor of the good con-
ditions of the system for its best effects, it is found every where
in this country, so far as we have been able to ascertain, as pre-
servative as variola itself

We find that small pox cannot progress in those communities
in which care has been taken to keep up genuine vaccina-
tion. We know of many individual instances wherein per-
sons have had the vaccine in the lightest manner, having had no

506 Periscope: [May,

eruption but the pustule made by vaccination, in whom the pro-
tective power has been amply and repeatedly tested by expo-
sure to small pox contagion and even contact. Indeed it will
be found, at least in the circle of our observation, that not one
case in fifty is attended with pustules elsewhere than the point
punctured in vaccination ; and it is a rare circumstance for re-
vaccination to afford a perfect pustule at this point, and when it
does, it appears to be a good evidence that the former vaccina-
tion was, in some way, imperfect. The conclusions of Doctor
Schaeffer, on this subject, are calculated to impress us with the
importance of such regulations or management, as shall secure
good judgment and faithful attention to the use of this invaluable
preservative. A medical staff should be organised, on salaries
sufficient to secure the best attention and judgment, and every
case duly prepared, and observed in its progress ; in addition to
which, re-vaccination should be practised at least once in every
individual, with different virus, not for the purpose of renewing
former impressions, which the revolution of a few years have
effaced a mere notion which some people have, but for supply-
ing any imperfections which may have attended the former
course of the disease.

1. Vaccination, as a preservative against the sma]l-pox, has appeared to
be in a direct relation with the number of scars visible on the arms of the in-
dividuals. Thus in 43 vaccinated persons, who have caught the small-pox,
there were, in all, only 126 scars ; whereas in other 38 persons, who have
escaped, although they had been repeatedly exposed to infection, there were
211 scars counted.

2. Vaccination is far from having the same preservative influence on all
persons. In some a single cicatrix seems to prove a sufficient security
against the small- pox ; while othes, whose arms have exhibited half-a-dozen
of genuine scars, have been seized with the disease.

3. Jt is very difficult, if not q^jite impossible, to pronounce any character-
istic ngns of true genuine cicatrices.

Of43 vaccinated persons, ivho have taken the small-pox, 14 exhibited ci-r
catrices perfectly normal ; in 25 they were more or less abnormal, or irregu-
lar ; in 4 none at all could be discovered.

On the other hand out of 38 vaccinated persons, who had resisted tho
infection, 34 presented normal cicatrices ; in 3 they were more or less in-
distinct, and in the remaining one no traces were visible.

4. The majority of vaccinated persons, who have been attacked with
small-pox, have been from 20 to 30 years of age. The severity of the dis-
ease has been almost always in a direct ratio with the length of the interval
elapsed since vaccination had been performed. In general the disease was
more severe in the more aged than in the youthful. In one case the small-
pox declared itself in an adult immediately after a normal vaccination; and
in another case it showed itself, in a slight degree, on the eighth day after
vaccination the progress of which however was not interrupted.

5. A great number of persons have been submitted to re-vaccination ; and
of these not one has been attacked with small-pox. Moreover all those algo,
in whom re-vaccination has not produced any effect, have escaped, although

1 839.J Researches on Menstrualion, 50ir

tnany of them have leen much exposed to the contagion a strong* argument
in favour of the opinion, that when re-vaccination does wot take^ the Jiability
to catch the small-pox is extinguished. Med. Chi. Rev.

Researches on Menstruation. IM. Petrequin, one of the most intelligent
contributors to Builetm Medical Beige, published lately a small work in
which he has recorded the result of his enquiries on the above subject.

The first question he proposes for consideration is, at what age does the
menstrual flux usually appear in our climate (France) ] Tvvo hundred and
seventy-two cases have served him to draw up the followiug table, from
which it appears that the earliest age is about ten years, and the latest about
twenty-two years : -1 at 10 years of age ; 10 at 1 1 ; 15 at 12 ; '3*3 at 13 ;
33 at 14 ; 45 at 15 ; 48 at 16 ; 32 at 17 ; 27 at 18 ; 12 at 19 ; 7 a1 20 ; 5
at 21 ; 1 at 22.

M. Petrequin, therefore, fixes upon the period between 13 and 15 years
of age, as that at which puberty generally occurs in France.

From his researches it appears, that the first appearance of menstruation
is the more apt to be irregular and disordered afterv'ards.

The next question, which our author endeavors to solve, i?, at what pe-
riod of life does the cessation of the catamenia usually take place 1 He fix-
es it at between the 35th and 55th years. It is well known that, in some fe-
males, it is prolonged considerably beyond the latter period, Thus Desor-
meaux has known it to continue to the 65tii, Richerand to the 70th, and Gar-
tlien to the 75th year of life.* Occasionally the now returns, after it has ceE-
eed for several years.

From the comparison of 60 cases, M. Petrequin states, that menstruation
ceases between 35 and 40 years of age, in about one-eighth ; between 40
and 45 years in one-quarter ; between 45 and 50 in one-half ; and between
oO and 55 in one-eigh'h of the whole.

We shall now briefly consider, whether the common notion that the epoch
of life, at which the function of menstruation usually ceases, is really a very
critical one to womer, in reference to mortality.

M. Petrequin has not been able to satisfy himself on this topic from
personal researches ; he appeals, therefore, to the statements of preceding
authors.

According to Muret, the period from the 40th to the 50th year of life is not
more critical to women than the period from the 10th to the 20th year. M.
Lupecq found that of 1,478 deaths in persons between 20 and 50 years of age
there were 718 females and 760 males ; and M. Benoiston states that, from
the result of his enquiries, it appears that the period of life between 40 and
50 years of age is m truth more critical for men than for women.

M. Lachaise has come to the same conclusion in his Medical Topography
of Paris.

M. Finlayson states as the result of his numerous researches that, after
the period of infancy, the life of women is, on the average, considerably more
lengthened than that of men.

It is not to be denied that at the period of life, when the catamenia cease,
there is a tendency in some women to the developement of certain diseased
actions ; but then be it remembered at the same time that in others--as in
those who have long suffered from excessive or irregular menstruation
there is a very marked improvement of the general health; the one set of
cases may therefore be said to be counterbalanced by the other set;

A few hygienic precautions, such as the use of cooling aperient raedicinee,-

* The Belgian Journali?, a short time ago, mentioned the case of a woman
giving birth to a child in her 70th year.

50S Periscope, [May,

tho use-of light food, the abstinence from venereal pleasures (which are apt,
according to Desormeaux, to induce cancerous disease,) and the occasional
loss of a little blood, will lead most women safely through this often-dreaded
periou of life.

We may notice, en passant, that blindness from amaurosis is of frequent
occurrence, when the catamenia cease to return.

With respect to the quantity of the catamenial secretion, we may proba-
bly state it at about from tJiree to live ounces. It is usually more copious in
Spring than in other seasons of the year; and there is reason to believe
that the sexual passions, and also the aptitude to conceive, are greatest in this
former season. AI. Villerme has deduced, from the comparison ot 13,903 ca-
ses of labour, that most conceptions take place in the months of April, May,
and June.

The quantity of the catamenial discharge is very generally greater in wo-
men of a voluptuous than in those of a cold and less susceptibfe constitution.

It is an idle waste of time to endeavor to find out the cause of the monthly
return of the catamenia. All that we can say is that it is a law of the system
in the human female ; just as the period of nine months is that of utero-gesta-
tion, or as certain plants flower in certani months and not in others.

The 2r/i?/ of these phenomena is beyond our research; and he, who at-
tempts to discover it, will only subject himself to the satire of another Moli-
ere : Opium facil dormire^ quia est in illo virtus dorimtiva.^-BulLetin Medi^
cale Bel(re. Ibid.

Musk and Gum Ammoniac in Tympanitis. Dr. Tradfni recommends
highly a combination of moschus et gum. ammoniac, in tympanitis in the
following proportion :

Mosch. gr. iij.
Gum. ammon. gr. xii.
M. FiantpilulsB tres. D. P. Take one pill morning, noon, and evening.
The remedy is most proper where there is much weakness and debihty,
which generally accompany the above disease. (II filiatre sebazio)

MoxcB and caustics applied on the head in hydrocephalus acutus in children.
Against the above disease, Dr. Constant, in Paris, {Bullet, de Therapeu-
iique, Med. et. Chir.,) recommends, particularl}^ moxae applied on the head,
on each side of the Eutura sagittalis, and assures us, that he has by this
treatment been able to save several children. Dr. Durr, in Hall, in Wur-
temburg, who has lately written on this disease, has derived great benefit
from the use of caustics in this disease. (Frorieps Notiz., ]\o. 1021, Feb.,
1836.) He shaves the head, where the sutura sagittalis and lambdoidea
come together, and put on a small emplastrum, about a^ large as an Amer-
ican dollar, (silver dollar,) spread thinly with the following unguent :
Ungu. acris Autenriethi oj.
Tartar, emetic.
Ungu. canthar. "ilT 3 ss.
After four or six hours the skin is raised without there having been any
considerable pain. The plaster is spread again, and when, after six or
twelve hours, he observes water, he makes an incision, lets the water run
out, and applies, every twelve hours, au ointment made up from
Ungu. basilic.
Emplast. de minio 77.
After twenty-four hours, you will hav produced an artificial, good looking
ulcer. Jn cases where the suppuration is not great, or seems to cease. Dr.
Durr applies a combination of both the above ointments. Bibliothec. for
Lcpger, Copenhagen. Med. Examiner.

1^39.]Co?npression of the Large Blood Vessels in Neuralgia.b^O

Therapeutic Injluence of Compression of the Large Bloodvessels in Neural-
gia, cj-c. M. J)ezeimens, the author of the memoir from which the follow,
ing observations are drawn, appears to be much more deeply read in Brit-
ish medicalliterature tiian any of this countiymen, with the exception of
two or tln'ee, such as MM. Rayer, Velpeau. &c.

He points to the late Dr. Parry of Bath, as being the first who ascertain,
cd and announced the curative effects of compression of the carotid arteries
in various cephalic diseases, as severe headache, epilepsy, convulsions,
(fcc.

M. Dezeimeris's observations apply chiefly to the efficacy of such com-
pression in neuralgic afFectionsof the face and head. The following two ca-
ses appear to us to be very interesting. ,,

Ca.se 1. Madame C, *<34 years of age, and of a rather feeble constitution,
determined, after the loss of her parents in ldl4, to retire to a convent. There
she spent five years in fasting and various penances ; the effect of which was
to impair her health very greatly.

It is now about six yeass ago since she experienced thefirst attack of neu-
ralgia, which came on after deep and protracted chagrin. The paroxysm of
pain was quotidian, returning almost regularly between three and five o'clock
in the morning. The use ot the sulphate of quinine effectually cured it.

Three years subsequently, and again after severe mental distress, Ma-
dame C. was seized with gastralgia, accompanied with bulimia. These
symptoms yielded to the use of pills composed of opium, magnesia and subni-
trate of bismuth.

In the Spring of 183G she had a return of facial neuralgia, which was con-
fined to one spot, being sometimes supra-orbita^, and at other times infra-
orbital or maxillary, or seated in the ear. It very rarely exhibited any re-
gularly intermittent type ; and hence resisted the quinine. Various narco-
tic remedies, employed endermically as well as internally, were tried,
but WMth only temporary and partial success; and the disease did not fairly
cease, untill a suppurative eruption made its appearance on the ear.

, The last attack of the disease was in the Autumn of the same year
This time it occupied almost the whole right side of the face, and although
not so severe as on the former occasions, it resisted every means that where
employed.

The physician in attendance having a.'.cidentally spoken to M. Dezeimeris
respecting this case, he, (the latter) suggested to him to try the effects of
compression of the carotids. At this time the pains were so excruciating as
to force the patient to scream out, and the integuments of the affected part
were red, swollen, and shining. Upon firm pressure being made over
the right carotid artery for two or three minutes, the facial congestion rapid-
ly subsided, the pain became almost entirely assuaged, and the patient felt
a soothing drowsiness creep over her.

When the compression was removed, the pain returnned, but in a less ag-
gravated degree ; and again it was checked by re, applying the finger. For
the following three or four days the sufferings of the patient were much less
than they had been for a length of time, recurring at intervals only and
with diminished severity. At length an eruption broke out in the right side
of the face ; and since then there has been no renewal of the pain.
Case '2nd was communicated to the author by M. Rayer.
A young female, of a highly nervous temperament, had been subject, for
several years, to attack of excruciating neuralgic pain in the right side of the
face.

During the paroxysms, the suffering was so intense that she was scarcely
conscious what she was about. All classes of medicines had been tried, biit
without any decided benefit.

M. Rayer, at the suggestion of M. Dezeimeris, tried compression of the
corresponding carotid artery. After being continued for about twenty min-

510 Vtility of Ergot if Rye in Paralytic Affections. [May,

utes, the pain was very greatly relieved. On the threatened approach of
the next attack for the paroxysm was usually preceded by a feeling ofstiff-
ness in the left temple compression with the fingers over the left carotid,
until the circulation through the corresponding temporal artery was sensi-
bly diminished, was at once resorted to; and with the efftct of preventing the
accession of the fit- Since that period the return of the fits lias not indeed
been delayed or prevented; but, adds iM. [layer, the pain, which was former-
ly excruciating, has become sa iupportallj that I may say that the paroxysm
miscarries each time.

M. Dezeimeris then alludes to the curative effects of compression of the
carotid arteries in some cases of convulsions and epilepsy ; and narrates,
without however approving of the practice, tlie three cases in which Mr.
Preston tied the common carotid artery to relieve certain cephalic affections.
(Trans, of Med. and Fhys, Society of Calcutta.)

He mentions also some of the observations of Dr. Cooke (History and
Treatment of Epileps}', London, 1&'23), to prove the benefit of compression
of the carotids in many cases of this disease. We shall close these remarks
with the short notice of a case of Coma Vigil, in which M. Rayer employed
compression with advantage.

This case occurred in a young woman who, for many years, had suffered
from various forms of hysterical disease. Latterly sne had become affected
with a species of coma, which returned every day, and which usually lasted
for several hours.

If she was aroused from this state, she became vehemently excited and
convulsed. At the suggestion ofM. Dezeimeris, M. Rayer tried the effect
of compressing the carotid during the attack of coma. It was not contin-
ued for more than two or three minutes, before all symptoms of stupor ceas-
ed. The same practice was adopted several times afterwards, and always
with the same effects. L' Experience.- J\Jed. Chi. Rev,

Vtility of Ergot of Rye in Paralytic Affections. It is reasonable to pre-
sume that the modus operandi of this remedy in tardy parturition, Amenor-
rhcea, &c., is its stimulant influence on the lower extremity of the spinal-
marrow. Hence some physicians have been led to try the use of it in some
case oi paraplegia ; and, according to their report, decided benefit has been
thus obtained. It seems to have no influence in hemiplegia ; the seat of
that more unfavorable species of palsy being either in the brain itself, or in
the cervical portion of the medulla.

The Ergot has been employed with marked benefit in that form of para,
plegia, to which infants during dentition and young children are subject.

Adults too have derived equal benefit from its use. Thus M. Ducros
of Marseilles mentions the case of a sailor who, by falling Irom the rigging
of his ship, lost the use of his lower limbs completely. Moxas, and other
means, had been unsuccessfully tried by Professor Delpech ; and nothing
seemed to do any good but the Ergot of Rye, under the administration of
which he quite recovered.

The usual dose, it is proper to commence with, is six or seven grains :
this should be raised gradually to thirty or forty grains, or until the patient
begins to feel prickings, and a sense of formication in the limbs, somewhat si-
milar to what are produced by the use of the Nux Vomica.

An excellent adjuvant of its remedial virtues is the occasioned exhibition
ofa turpentine enema.

Whenever we administer the Ergot of Rye for a length of time, it is ne-
cessary to guard against the septic influence of the agent on the system, by
recommending the use ofa generous animal diet, &c. &c. M. Ducros men-
tions a case in which sloughing of the heel supervened: by proper means,
however, both the gangrene and the paralvsis vrere cured. La Lancette
Franraise. ' Med. Chi. Rev.

2639.] Medical Intelligence. ' 511

MEDICAL INTELLIGENCE.

Under this head we take the liberty of asking of the editors of Medical
Journals in the United States, and of respectable physicians generally, their
views of propriety relative to tho use of secret preparations for effecting cer-
tain medicinal operations on the system, which operations are clearly indi-
cated for the cure of disease, when all articles known to the profession fail to
have the desired operation. We will illustrate our views in this interroga-
tion by stating a case.

Let us suppose a case of dropsy, far advanced, in a patient 60 or 80 years
of age general, long continued, and increasing, anasarca, ascites, hydro-
thorax, to a degree which prevents recumbence, &.c. &c. This is a case
in which, it will be admitted, a cure may scarcely be expected from the or-
dinary, or any treatment the regular practitioner may suggest ; or the best
plans of treatment known to the profession have been tried, but the disease
.continues to increase after all desirable trials. Now shall the regular prac-
iitioner resort to any secret preparation for effecting his curative purposes,
jfthe efficacy of which, in other similar cases, he is well assured; and the
modus operandi of the preparation as plain and simple as that of any simple
article or composition in the Materia Medica whose operation is known to
be safe, and the state of the case with its complications plainly marked out,
and only that state treated with which the composition is found to best agree?
And, suppose the use of such composition be adopted and found speedily
successful in reducing the hydropic effusion, and in connexion with the oth.
er part of the plan of treatment, which makes up a part of the course, finally
prove, with peculiar uniformity in such cases, its curative efficacy. Should
physicians purchase for themselves, under obligations of secrecy 1 Should
they recommend the state to reward the proprietor of such a discovery, and
lay it freely before the world for the general good 1 And should practition-
ers, on finding such medicines more efficacious than any other, withhold the
truths of their own observations on their use, merely because the secret of
their preparation is not divulged ]

We do not ask the sentiments of others, without fully committing our-
selves in such cases, by stating that, however disagreeable, ungenerous, and
uncharitable the concealment of the secret of preparation may be thought,
we should, under such circumstances, adopt the use of such preparation, and
report on it according to its merits or demerits, as we should on any newly
discovered article in the Materia Medica, in favor of the virtues of which,
ample testimony was afforded : and rather than allow a patient to suffer from
the want of such remedy, and the impossibility of getting it under other cir-
cumstances, we should think it a duty to buy it under the obligation of se-
crecy. On ample experience of its efficacy, wc should feel it a duty to re-
ceive information from any source, relatire to any medicine which can better

12 Medical Intelli

[Tcnce.

meet tlie demands of humanity, than any we have at command. There was
a time when Peruvian Bark, contained a secret, relative to its constituents
which was not known, and the same may be said of many other articles ;
but physicians did not, on this account, reject that article. Black Drop has
been a secret preparation, and is so to the present day ; but the most res-
pectable members of the profession, however desirous of knowing the prepa
ration, and of divesting the suffering community of the burthen of patent right
extortion, did not hesitate to use it in preference to the othei preparations
ot. opium then known ; and even at the present day, when its base has been
analysed, and its constituent elements are found with every practitioner,
the Black Drop is used.

Whatever of error or disgrace which attaches to such a case, we are bound
to conceive is to be fairly attributed to him, and to him only, who is wilUng
to withhold from the service of humanity a secret, the withholding of which
is equal to the bartering of human life for the purpose of exhorbitant indivi-
dual emolument. Such a course is justly condemned, for the physician
is answerable for the character of the profession to which he belongs ; that
character is eminent for charity, for the doing of the most possible good to
suffering mortaUty ; not only within the little circle of his own personal ope-
rations, but every where. How, consistently with this obligation to expan-
sive benevolence, can he be possessed of knowledge so calculated for the
relief of human misery and danger, and refuse its universal diffusion ] The
question then returns,^ shall he receive this knowledge under the circum-
stances ] We are inclined to think, that he should not refuse to do a par-
tial good because he cannot do all he desires ; and, therefore, if he cannot
avail himself of the benefits of such a piece of knowledge, with liberty to
use it for effecting all possible good, he should, for effecting all within his
own personal operations : and that when the secret, which is, indeed, the
property of another, is communicated to him as a friend, or purchased by
him, under the limitation to his own use in practice, he is bound by his obh-
gation to truth, not to trespass on the rights of the discoverer, by disclosing
it beyond the liberty given or purchased. Accident sometimes throws in
the jvay of individuals out of the profession, facts of much value in practice.
We cannot expect such to feel themselves under the same obligations to
professional conduct and character as physicians do : besides, they are often
indigent sometimes, laboring under bodily disabilities. Here we feel the
odium attached to secrecy in a professional man, entirely unmerited, and that
the proprietor has even a fair claim of remuneration for his observations, &c.

All these conclusions of our own are, of course, only on the supposition
that this medicine is worthy of the character given it. We should be pleas-
ed to have the. opinions of others on this subject. We have thus thrown
it before the professional public, in the hope of removing any unreasonable
obstacle which may prevent the service of humanity in the least degree.

In the present attitude of the profession, it feels compelled to refuse even
a demonstration of the successful operation of a medicine, until the compo-
sition be made known, with the privilege of freely communicating it to the
world.

SOUTHERN MEDICAL

AND

SURGICAL JOURNAL.

Vol. III.] JUNE, 183D. [No. 9.

Part 1. ORIGINAL COMMUNICATIONS^.

ARTICLE I.

Outlines of the Anatomy and Physiology of ihe Liver, By
L. A. DuGAS, M. D. Professor of Phyhiology^ ^c. in the
Medical College of Georgia.

The Liver, by far the largest organ of glandular structure in
the human body, is situated in the upper part of the abdominal
cavity, and in contact with the inferior surfiice of the diaphragm.
It usually occupies the whole of the right hypochondriac, the
upper part of the epigastric, and a portion of the left hypochon-
driac regions. It is said by Meckel* to occupy a larger por-
tion of the left hypochondrium in the female than in the male
subject, and by Rouxf to be more prominent anteriorly in the
former than in the latter sex. This difference in the position of
the liver in the two sexes, though not accounted for by other
writers, is attributed by CruveilhierJ and Saunders, to the use
of corsets, which, by compressing the ribs, must diminish theca-

*Meckel, Man. of Anat. vol. 3, p. 298,
f Bichat, Anat. Descript. t. 5. p. 72.
tCruveilhier, Anat. Decc. t. 2. p. 552:
jSaunders, on the Liver, p. 21.
1a

514 Anatomy and Physiology of the Liver. [June^

pacity of the region allotted to the liver by nature. According
to Cruveilhier, the liver is the principal organ affected by tight
lacing. Thus exposed to circular compression, its transverse
and antero-posterior diameters are diminished, and its vertical
diameter increased. It then projects below the margin of the
ribs, sometimes into the right iliac region, and even to the supe-
rior pelvic straight, without sustaining any organic lesion.

The diameters of the liver vary materially, not only in differ-
ent individuals, but also according to age. In the adult Meckel
fixes its transverse diameter at from ten to twelve inches, its
antero-posterior diameter at from six to seven inches, its great-
est thickness at two inches, its weight at four pounds, and its pro-
portional weight to that of the whole body at 1-36he also
states its specific gravity to be 15.10. Its colour is of a peculi-
ar reddish brown.

The liver is in contact superiorly with the diaphragm, inferi*
orly with the stomach, colon, and right kidney*, on the left with
the spleen, posteriorly with the spinal column, and great blood
vessels, audits anterior edge hangs slightly in front of the sto-
mach. Its form is irregular, presenting a smooth convex sur-
face superiorly and an uneven concavity inferiorly. The falci-
form duplication of the peritoneum, extending from the median
line of the diaphragm to the superior surface of the liver, divides
it into two unequal portions termed the right and left lobes, and
its inferior surface presents a peculiar elevation designated as
the lobulus spigelii ; also an antero-posterior fissure giving pas-
sage to the umbilical vein, and another perpendicular to this, in
which is lodged the portal sinus, the hepatic artery, and the bil-
iary duct.

The liver is almost entirely invested by the peritoneum,
whose duplications constitute the various bonds by which it is
held in situ. But, independently of this envelope, it has a pro-
per fibrous coat, covering its whole surface and sending prolon-
gations throughout its substance, so as to isolate its granulations
and to furnish sheaths to the vena portse, the hepatic artery, and
the biliary ducts. The internal surface of these sheaths is con-
nected to the vessels by very loose cellular tissue, whereas their
external surface adheres intimately to the proper texture of the

CniveUheir, t. 2. p. 566.

1^39.] Anatomy and Physiology of the Liver. 5l5

liver and is continuous with the septa already stated to exist be-
tween tlie granulations.

The liver differs from all other glandular bodies in receiving
both venous and arterial blood. Its venous blood is derived from
the portal system. With the exception of that returning from the
kidneys, bladder and uterus, the blood coming from all the oth-
er contents of the abdomen is carried into the liver by means of
this system of vessels. The origins of the vena portse are there-
fore found in the spleen, the pancreas, the stomach, the intesti-
nal tube, and the peritoneal duplications, constituting what has
been called the abdominal portion of the portal system, to dis-
tinguish it from that which ramifies in the liver, and is conse-
quently termed the hepatic portion, The trunk resulting from
the union of the various branches of the abdominal portion of
the portal system, plunges into the inferior surface of the liver
and immediately bifurcates, sending one division to the right and
the other to the left. These subdivide ad infinitum in their
course, which is always in a transverse direction, until they pe-
netrate every part of the organ.

The hepatic artery is one of the branches of the coeliac artery,
and follows the vena portse in its subdivisions. It is exceeding-
ly small when compared with the dimensions of the liver and
with the arteries supplying the kidneys, the muscles, and indeed
any other organ.

The veins leaving the liver, unlike those of other organs, have
a caliber corresponding to that of the vena portae, instead of that
of the hepatic artery. They converge from all points towards
the vena cava, in which they empty. Proceeding thus from the
anterior to the posterior edge of the liver, they cross the divi-
sions of the vena portae, whose course is from the centre to the
lateral extremities of the organ. This circumstance, when
viewed in connexion with the fact that they are not separated as
are the other vessels, by loose cellular tissue, from the glandular
structure, but adhere closely to it, and, consequently, remain
open when a section of the liver is made, will serve to distin-
guish them from the portal veins.

The lymphatics of the liver are divided into superficial and
deep seated, and are so numerous that they were first discover-
ed in this organ, which was long considered the great origin of
this class of vessels. They pass into the ganglions about the in-

516 Anatomy and Physiology of the Liver, [June,

ferior surface of the liver, and in the lumbar region, and many of
them communicate freely with the thoracic duct.

The nerves of the liver are derived from the sympathetic and
from the pneumo-gastric, and it is thought by 'some that it re-
ceives filaments from the phrenic nerve.

The pori biliari are first seen in the capsule of Glisson, ac-
companying the subdivisions of the vena portae and hepatic ar-
tery, and subsequently unite after the manner of veins, until they
result in a large trunk, the hepatic duct, which makes its exit at
the inferior surface of the liver, where it meets the cystic duct,
the united ducts then assuming the name of ductus communis
choledochus, and opening into the duodenum.

The cystic duct, as its name implies, leads from a reservoir
the gall bladder which is situated beneath the great lobe of the
liver, and imniediately to the right of the antcro- posterior fissure.
This receptacle is of an oblong shape, may contain from one to
two fluid ounces, and consists of a mucous membrane, a fibrous
coat, and a peritoneal investment. Amussat believes it to con-
tain certain muscular fibres calculated to expel its contents.

The texture of the liver differs in appearance from thatofall oth-
er secerning organs. The whole organ consist? of granulations,
identical in all its parts, and whose intimate structure it is interest-
ing to determine. Ferrein, who lived in the earlier half of the
eighteenth century, regarded these granulations as of two kinds,
distinguished by their color, the one being yellow, and the other
of a brownish red ; hence the division of the hepatic texture into
a yellow and brown portion, which is still retained by anato-
mists, who have also designated the latter as the medullary, and
the former as the cortical substance of the liver. According to
Cruveilhier, however, these distinctions are founded in error, for,
in the first place, the two colors are not always perceptible, and
in the second, whenever they are visible they both exist in the
same granulation, which is then yellow in the centre where the
bile exists, and red at the circumference in which the blood re-
sides.

This distinguishedanatomist having studied the liver of swine, in
which the granulations are remarkably well developed, observes
that these granulations are small ovoid or rather polyhedral bo-
dies, with five or six faces applied to each other, in such a man-

1839.] Anatomy and Physiology of the Liver. 5l7

ner as to leave no space between ihetn ; that it is perfectly man-
ifest, that there is but one kind of granulations, that they are not,
as believed by Malpighi, disposed in snnall lobes, but are in jux-
ta-position, and that each is contained in a distinct cell, fornned
by projections of the fibrous membrane of the liver. The gra-
nulations being thus isolated, one or more of them may be dis-
eased to the highest degree without necessarily implicating the
remainder. They are, however, found to be of different sizes in
different individuals, without regard to the general dimensions
of the organ. Cruveiihier further observes, that in those cases
in which the liver is softened by disease, as soon as the envelope
is torn, a portion of the substance runs out in the form of a soft
yellowish-brown pulpy matter, and that if this pulpy matter be
thrown in water, myriads of small though distinct yellowish
granulations may be seen, similar to small grains of dried rai-
sins, which are appended to the ramifications of the various or-
ders of vessels by vascular pedicles.

A granulation, when examined with a simple microscope, is
distinctly seen to be porous, and to resemble the pith of the el-
der ; and this porous or spongy tissue may be easily filled by in-
jecting the vena portse. The granulations may, however, be
penetrated by injections whether thrown into the vena portse,
the hepatic veins, the hepatic artery, or the biliary ducts, and the
fluid thus injected passes with more or less readiness from one
of these systems of vessels into all the others, with the exception
of the lymphatics.

Each granulation consists, therefore, of one or more ramifica-
tions of the vena portse, of the hepatic veins, of the hepatic arte-
ry, of the biliary ducts, and probably of the lymphatics and
nerves, all of which vessels communicate more or less freely.
The respective disposition of these integrant parts in the granu-
lation, was determined by Cruveiihier, by successively injecting
1st, the vena cava, and consequently the hepatic veins, with
blue wax ; 2nd, the vena portas with red ; 3rd, the hepatic arte-
ry with red also ; and 4th, the hepatic duct with yellow. The
liver was that of a pig, and was placed in tepid water, whilst
the injection was pushed with gradually increasing force. Du-
ring the injection of the cava and portse, the wrinkles of the li-
ver were seen to disappear, and the central depressions of the

i18 Anatomy and Physiology of the Liver. [June,

superficial granulations to swell out. It was evident that the
granulations were filled by the injected matter.

Having been thus injected, the liver was subjected to the ac-
tion of chemical agents, and presented the following appear-
ance. 1st. The blue matter, contained in the cava, had pene-
trated into the central portion of the granulations, that portion
usually called the yellow substance of the liver. 2nd. In the
middle of this central portion was seen the yellow matter, or
that thrown into the hepatic duct. 3rd. At the circumference
of the blue injection, was found the red or that contained in the
vena portae and hepatic artery, filling the portion usually called
the red substance of ^he liver. Each glandular grain then pre-
sents a vascular apparatus so disposed that a biliary duct occu-
pies the centre, and is surrounded by ramifications of the hepat-
ic veins, which last are in their turn encircled by the vena portae
and hepatic artery. The disposition of the artery and vena
portae with regard to each other, is such, that on tracing them
through the liver, it is lound that the former always accompa-
nies the vena portae and biliary ducts -in the common sheath, and
that the arterial ramifications penetrate and are lost in the coats
of the vein and duct in the same manner that the bronchial ar-
teries are lost in the parietes of the bronchial tubes. Cruveil-
heir, therefore, considers the hepatic artery as constituting the
vasa vasorum of the vena portas and biliary ducts.

These injections explain the cause of the yellow and red sub-
stances seen in each granulation, prove that there is a portion
of each grain not susceptible of being injected, and establish their
porous or spongy character, which is perfectly visible to the
naked eye, when a section of the liver thus prepared is held up
to the sun.

In short then, the liver is an agglomeration of grains of an
ovoid or rather polyhedral shape, and exactly adapted to each
other, though independent. Each granulation is contained in a
proper fibrous capsule, all of which are connected by prolonga-
tions of the general envelope of the liver and of the capsule of
Glisson.*

The liver has, by common consent, been always classed
amongst the glands, and its texture is generally considered a

Cruveilhier, t. 2. p. 575.

1839. J Anatomy and Physiology of the Liver, 519

perfect type of what has been denominated by Bichat the glan-
dular tissue. The truly philosophic researches of Beclard and
others, have, however, long since demonstrated the error of Bi-
chal's views on this subject, and rejected this from the number
of elementary tissues, properly so called. However convenient
and expedient it may be to throw together under a common
head the various organs termed glandular, it should always be
borne in mind, that the intimate structure of these bodies is far
from identical. Indeed, the most superficial observation will de-
tect striking differences between the salivary, the hepatic, and
the renal glands: the salivary are made up of small and appa-
rently homogeneous bodies, held together by loose cellular tis-
sue, from which circumstance they are styled conglomerate ;
the renal present two portions intimately .connected, though
very distinct, viz : the cortical, and the medullary or tubular ;
and the hepatic differs from the two foregoing, not only with
regard to aspect, but also with regard to the elements which en-
ter into its composition, viz : the portal veins and blood, and the
spongy erectile cellular tissue by which its dimensions may be
increased or diminished without affecting its integrity. The
psesence of this erectile tissue, so admirably demonstrated by
Cruveilhier, is highly important both as a distinctive anatomical
feature, and as illustrative of one of the functions of this great
viscus. I say one of its fuiictions, for I hope to establish the fact
that the liver differs from all other glands in not being exclusive-
ly a secretory organ.

Let us now turn our attention to the development of the liver,
one of the most interesting points of its history. This is not only
one of the first organs formed* in the early product of concep-
tion, but its relative volume, to that of the foetus, is greatest the
earlier it is examined. f It may be distinctly recognised as ear-
ly as the first week of gestation,J in the midst of the gelatinous
foetal mass. Walter represents its weight in the foetus of three

Cruveilhier considers the liver the first organ formed, whereas AndrsiJ
(Anat. Pathol, t. 1. p. 109,) and others regard the heart as preceding the
liver.

fMeckel, Man. of Anat. v. 3. p. 308.

^Cruveilhier, Anat.'Desc t. 2. p. 588.

\Y. A, Walter, De Structura Hepatis, &c. p. 45.

^P

Anatomy and Physiology of the Liver. [June

J, which enter largely into the composition of bile.. This
sre supposition ; but, admiting its correctness, why is it
. adipose matter, marrow, &c. all of which also contain the
iements alluded to in great quantity, should be formed from ar-
terial instead of venous blood ? There is certainly no more an-
alogy between venous blood and bile, than there is between ar-
terial blood and fat ; and the act of secretion knows no re-
gard to chemical affinity, so far as it has been studied, the new
combination being formed under the influence of laws essential-
ly vital and unknown. If we were in this manner to determine
the source from whence any other secretion is derived, it would
certainly very seldom if ever be traced to the arterial blood.
Moreover, if the liver were to rid the portal blood of its carbon,
the blood returning from th liver ought to be decarbonized, or in
other words arterialized ; yet no one, we believe, has ever been
able to detect any difference between the blood taken from the
portal vein and that found emerging from the liver. This cannot
be said of the arterial blood sent to this organ : it enters with
certain characters which it loses before it leaves the liver.
Does it lose them all by furnishing nutritious particles alone ?
A conclusive reply must be found in the analogy of other glands^
4th. It is insisted that the hepatic artery is too small to supply
the demand both of nutrition and secretion, and that the por-
tal vein is more proportioned to the size of the liver. But it
should be remembered that the hepatic artery is not the only
source by which the liver is supplied with arterial blood. This
cwrgan receives branches from the internal mammary, the epigas-
tric, the diaphragmatic, the gastric coronary, the emulgent, and
the right spermatic arteries, all of which, though small and irre-
gular, must furnish a quantum nearly, if not quite, equal to that
sent by the hepatic artery. We should also, estimate the quan-
tity of blood needed by the liver for nutrition, and the quantity
required to meet the demands of the secretory process.

It has already been stated that in estimating the quantity of
arterial blood sent to the liver, the error is very commonly com-.
mitted of looking at the caliber of the hepatic artery alone,
whereas it should be viewed in connexion with the united cali-
ber of all the smaller arteries which indirectly reach this organ,
and by so doing it will be perceived that the liver is by no mean5
so scantily supplied with this kind of blood as is generally im-

il85d.J Anatomy and Physiology of the Liver.

gined. It certainly receives a much larger supply the
lungs can possibly derive from the bronchial arteries, which c
now admitted to be destined to the nutrition of these organs, anc
which I think probably furnish a large portion of the bronchial
secretions. Again, if from the quantity of arterial blood sent to
the kidneys, or even to the salivary glands, we deduct the por-
tion consumed for the copious secretion of these glands,* it will
be found that what is left for nutrition cannot be much.

If it be argued that the supply is sufficient for nutrition, but
not for secretion also, it may be replied that this depends on the
estimate made of the quantity of bile secreted. If this be, as has
been advanced by some,f equal to several pounds per day, the
argument will then be strong ; but if, as is almost certain, it
does not exceed a few ounces, the case must be very different.
Dr. Johnsonf estimates the quantity per day at from six to eight
ounces ; Faithorn at six ounces ; Magendie, Adelon, &c. be-
'iieve it very small, and justly refer to the size of its receptacle,
the gall-bladder, in confirmation of their views.

Having endeavored to show that the quantity of arterial
blood sent to the liver is adequate to the demands of this organ
for nutrition, as well as for the elimination of bile, our position
with regard to the fluid which yields bile, will still be strength-
ened by comparing the great quantity of portal blood with the
paucity of the biliary secretion, for, if we are to infer the quanti-
ty of product from the quantity of circulation, as has been done
by those who deny that there is arterial blood enough in the li-
ver, we would be led to the conclusion, that the biliary exceeds
in quantity all other secretions. Such, however, is not the case,
and we must admit that the venous blood sent to the liver is thus
disposed of for other uses than for merely furnishing the ele-
ments of bile.

Pathological anatomy also furnishes additional, and per-
haps the strongest grounds for the belief we advocate.
Abernethy met with an instance in which the trunk of the ve-

*The secretion of saliva is very great even under ordinary circumstances,
but is astonishing in the case of tobacco chewers, who not unfrequent-
ly throw off a half pmt in the course of an hour.

t Diet, des Sciences Med. t. 3. p. 128. Haller, Element. Physiol, t. 6.
,p. 604. Schultz, De Aliment. Concoct, p. 107.

\ Op. Cit. p. 55.

\ Faithorn, on the Liver, p. 8.

^ Anatomy and Physiology of the Liver. [June,

^/jB terminated in the vena cava ; yet bile was found in the
/y ducts, which could have been derived only from the he-
itic artery.* Another case, somewhat similar, is recorded by
Lawrence;! and a third by P.Ionro in his Elements of Anatomy
still other instances, though less entitled to credit, are related
by Lieutaud and Huber. All these cases prove conclusively
that bile may be formed from arterial blood alone, and we know
that little or no bile is secreted during the very period at which
the liver receives the largest quantity of venous blood, that is to
say, prior to birth.

Why then is the portal blood sent to the liver, instead of being
poured at once into the vena cava? We believe the collection
of venous blood in the liver necessary to insure a stead/and uni-
form supply of blood to the right side of the heart, J and also to
prevent the too sudden admixture of foreign matters absorbed
by the alimentary surface with the general mass of the circula-
tion. Let us examine the arguments in favor of this belief.

One of the functions most indispensable to the continuance of
life, is the action of the heart, by which the blood may be sent to
the lungs for renovation, and then thrown to ail parts of the bo-
dy ; and any deviation from the normal performance of this
function is immediately attended with a corresponding impair-
ment of health. It is therefore highly desirable, that the supply
of the fluid thus acted on should be exempted, as far as possible,
from contingencies, and especially from those more or less de-
pendent on the exercise of other functions. The afflux of blood
to the heart may be increased or retarded by a variety of cir-
cumstances increased by febrile diseases, by lesions of inner-
vation, by violent muscular contractions expelling a large quan-
tity of blood from the muscular veins, by sudden exposure to
cold, or by chills driving the cutaneous circulation to more deep
seated organs ; by the ingestion of food, especially fluids, which
add more or less largely to the mass of blood, &:c diminished
by diseases of debility, by obstruction of the veins from compres-
sion, by insufficient nutrition, hemorrhage, excessive secre-
tions, &:c,
, i

* Philos. Trans. 1793, v. 1. p. 59. et seq.

t Med. Chir. Trans, v. 5. p. 174.

X Broussais, Tr. on Physiol, p. 389.

\ Magendie, Precis de Physiol, t.2. p. 260.

1S39.] Anatomy and Physiology of the Liver.

ISfow it is evident that unless there were provided a res
to receive the blood when thus thrown from the surface and
tremities towards the centre of circuhition, and also to insure a
sufficient supply to the heart under an opposite state of the sys-
tem, the action of the heart would be exposed, not only to con-
tinual vicissitudes, but also frequently to fatal repletion, or want
of circulating medium. The liver is this reservoir, and is con-
structed accordingly. The vessels bringing blood to this or-
gan being surrounded by a peculiar cellular sheath, are well
adapted to the alternate increase and diminution of their caliber
consequent on the fluctuations of the circulation. The veins
leaving the liver are not supplied with this sheath, because they
do not participate in the repletion of the hepatic artery and vena
portse, and are probably filled principally by the suction power
of the heart and thorax. The case is different with regard to
the spleen, an organ confessedly subject to great fluctuations of
capacity. Here we find both arteries and veins surrounded by
a cellular sheath, because the splenic veins, being a portion of
the portal system, must become distended whenever the hepatic
portion is in a state of repletion. The office of the spleen ap-
pears to be supplementary to that of the liver in regulating the
circulation. The construction of the vascular system of these
two organs is such, that the circulation of the one must ever in-
fluence that of the other. But besides this, the spleen undoubt-
edly performs the office of a diverticulum from the stomach, and
perhaps the liver. The great secerning action of the stomach,
and probably of the liver, being intermittent, that is to say, being
suspended during the intervals of digestion, these viscera must
require a larger supply of arterial blood when the gastric juice
and bile are freely poured forth than at other times. The ne-
cessary consequence of this state of things must be a diminution
of the quantity of arterial blood allotted to the spleen during di-
gestion, and an increase of this quantity during the intermission
of this proeess, for these three organs derive their arteries from
a common trunc, the coeliai.

The study of these diverticula has not attracted sufficient at-
tention. Their necessity, wherever there exists an intermittent
secerning action, will be made apparent by examining this sub-
ject in other parts of the body. The salivary secretion, for ex-
ample, is much more abundant during the mastication of food

Anatomy and Physiology of the Liver^ [Jan^<

^^ jr*, other times, and we accordingly find in the vicinity of the
,<iary glands the thyroid body capable of diverting the blood
^ i*^vhen not needed by them ; and we find this body proportion-*
/ ately much larger before birth, when no saliva is needed, than
'j subsequently, when a portion of the blood is consumed in the
production of this fluid. If we now look to organs whose secre-
tion is uninterrupted after birth, but was not effected previously,
we find them provided with a diverticulum only during foetal ex-
istence. Such is the case with regard to the kidneys, whose di-
verticula, the supra-renal capsules, though large prior to birth,
gradually disappear as their blood is abstracted for the secretion
of urine. The thymus, so largely developed in the fcetus, is
probably the diverticulum of the pulmonary mucous membranes,
and accordingly dwindles away on the supervention of the per-
manent secretion of these surfaces. But it does not disappear
after birth in those animals whose habits subject them to a sus-
pension of respiration more or less lengthy. The able research-
es of Meckel have shown that it continues in the hibernating
mammiferoD, and in those which seek refuge under water, or in
the earth, thereby requiring a temporary cessation of respira-
tion. It is deficient in fish whose respiratory apparatus is devoid
of bronchial tubes, and consequently of the secerning mucous
membrane so extensively developed in other animals.* All the
organs performing the office of diverticula, are proportionably
larger before than after birth, and all gradually perish after b:rth,
excepting those appended to organs whose action is intermittent,
and which, consequently, still stand in need of them during the
intervals of secretion.

The spongy and elastic texture of the liver readily permits it
to adapt itself, by expansion or contraction, to the quantity of
blood sent to it, as may be seen by alternately filling and empty-
ing the vena portae.f From its volume and its vascularity, it
contains at all times a large quantity of blood, which has free ac-
cess to the heart. Under ordinary circumstances of health, it
furnishes a quantity of blood proportioned to that derived from
other sources ; but let the equilibrium be deranged by abnormal
action in some other organ or tissue, and it is at once called on to

* Carus, Anat. Comp. t.2. p. 294, et. seq.
t Cruveilhier, Op. Cit. t. 2. p. 650.

18S9.] Anatomy and Physiology of the Liver.

regulate it, as already suggested. The circulation of the
must be closely connected with that of the lungs, for if theca^
city of these for blood be diminished, the supply to the right sid*.
of the heart must be correspondingly lessened, the consequence
of which will be an accumulation in the venous system. But
the general venous system, deriving its supply from the lungs,
through the left ventricle and arteries, would not participate so
much in this accumulation as the portal system of the liver,
which is supplied, in part at least, by absorption from the ali-
mentary mucous surfaces. It is in this manner we may explain
the morbid condition of the liver found in almost every case of
chronic pulmonary disease, and in many of the acute.

The intimate relation of the liver and lungs is strongly mani-
fested by the relative development of these organs prior to birth,
the volume of the liver diminishing as the capacity of the lungs
increases.* Indeed this relation is remarkable, not only in the
human species, but also in the lower animals, whose liver is al-
ways developed in an inverse ratio to the lungs.

The almost simultaneous appearance of the liver and heart in
the early product of conception, and, as has already been re-
marked, long before the secretion of bile can be necessary, would
of itself favor the idea of some connection of functions. In some
of the inferior animals, in reptiles and certain birds, the liver ac-
tually surrounds the heart like a vast sponge, and has been sup-
posed! to supply the place of the thymus and thyroid bodies
when these were missing. That the liver may supply the defi-
ciency of these diverticula is highly probable, since it is the di-
verticulum of the whole body, and before birth, specially of the
lungs. The facts that the liver is found in all animals possessing
a heart, and that it is wanting in all the cases of malformation in
which the heart is deficient,} tend strongly to corroborate the
belief that the liver is an essential part of the circulatory appara-
tus, independently of its secerning function.

We have stated that besides insuring a steady supply of blood
to the heart, the portal circulation by its slow passage through
the liver, would prevent the too sudden admixture of foreign

* Carus, Op. Cit. t. 2. p. 260-

t Ibid, t. 2. p. 293.

X Andral, Anat. Pathol. 1. 1. p. 109,

Anatomy and Physiology of the Liver. [June,

.4. fiS brought from the alimentary canal with the general cir-
wE-.tion. We presume it will hardly be denied at present, that

J vh' very large portion of the matters absorbed at the mucous sur-

' at faces of the digestive apparatus, is taken up, either direcily or
indirectly, by the veins. The experiments of Magendie and
others, would seem sufficient to set this subject at rest. A very
large portion of the blood sent to the organs from which the
portal system takes its origin, must be consumed in nourishing
these organs, and in furnishing the secretions which so abundant-
ly flow from them. The blood of the vena portae is, therefore,
derived partly from the arterial supply, and partly from the
substances thrown into the digestive apparatus, especinlly flu-
ids. The caliber of the thoracic duct, as well as the slow pro-

gress of its contents, should of themselves lead us to look for
some other channel for the admission into the circulation of the
immense quantities of fluid ingesta taken and passed off* under
certain circumstances in a comparatively short time. The wri-
ter has been informed, by a person of undoubted veracity, that
he saw a man take in the course of a day, thirty eight glasses of
beer, and six of mint juleps, at the same drinking establishment,
without injury. Now as these glasses measure half a pint, the
individual must have taken eleven quarts, or nearly three gal-
lons ; and perhaps, as our informant further remarks, he may
have patronized, in the mean time, some other establishment, so
as to make the quantity still greater. Besides all this, he took
his meals as usual. Did all this fluid pass through the thoracic
duct? We think not. Indeed it is not necessary to invoke in
this matter any other testimony than that of the justly celebrated
Magendie.

But, to return to our subject, foreign matters are taken up

. into the venous circulation and carried to the liver, in which they
are diluted, and from whence they flow gradually to the heart,
and into the general circulation. In order to prove the advan-
tage of this channel lor the ingress of deleterious matters into
the circulation, Magendie made the following experiments. He
injected /(^rc/6Z?/ into the crural vein of an animal, a certain quan-
tity of atmospheric air, and death immediately ensued, whilst
the same substance thrown also forcibly into the vena portsB
produced no bad efl^ect. The injection, however, when made
slowly into the crural vein, was harmless. The same experi-

1839.] Anatomy and Physiology of the Liver.

ments made with a small quantity of bile, were' attendee
milar results ; so that it seems that noxious substances n.
introduced gradually without the bad consequences which
tend their sudden admission into the circulation ; and moreovt
that by passing through the liver, this gradual introduction is se-
cured, and consequently the bad effects prevented.

These facts explain why it is that substances of decided dele-
terious properties may, with impunity, be carried into the circu-
lation, through the digestive tube, in large quantities, when they
would prove fatal if introduced otherwise. We have a daily
illustration of this in the free use made of alcoholic beverages in
our country, and likewise in the difference of effect produced by
the free use of concentrated spirits and of mild wines. They
will also account for the serious injury sustained by the liver of
those who indulge in the use of ardent spirits ; for, if the alcohol
be carried directly to the liver, and sojourn there, until it be gra-
dually carried off into the general circulation, it must necessari-
ly exert a stimulation of the liver, which, when kept up for a
length of time, occasions an excessive nutrition or hypertrophy
of the cellular tissue of the organ, condensation of'tissue, and
finally an impairment of the Wonted elasticity so necessary to
the general equilibrium of the circulation.

In recapitulating then the functions of the liver, we must dis-
tinguish those which precede from those which follow birth.
Prior to birth the liver is the great reservoir of new blood brought
from the placenta ; it has an increased volume in order to retain
the blood subsequently to be lodged in the pulmonary tissue, arid
it secures a ready and uniform supply to the heart. After birth
it still continues the reservoir of new blood, no longer brought
from the placenta, but from the alimentary canal ; it still sup-
plies the demands of the heart, equalizes the circulation, dilutes
foreign particles brought into the blood, perhaps assimilates
them, and finally allows them to be gradually introduced into
the general circulation. But, besides all this, the liver performs
now a new office it secretes bile a fluid neither exclusively
excrementitious nor recrementitious, but partaking of the na-
ture of both, and the real use of which is still unknown.

c3

bservations on Membraneous Sore Tliroat [June^

,ervations on an Affection of the Throat, in which a False
Membrane is formed, terminating in Croup. By Thomas Y.
Simons, M. D. formerly President of the Medical Society of
South Carolina, and late Professor of the Theory and Prac-
tice of Medicine in the Medical College of South Carolina,

The object of this communication, is to describe a peculiar
form of affection of the throat, which I would term membrane-
ous, and which terminates in croup. I have been a practitioner
of medicine in Charleston for eighteen years, yet I have not, until
this year, understood its character, nor had I seen a case in the
incipient stage, but I had seen a few cases in the last stage, and
I confounded them with Cynanche Maligna or Putrid Sore
Throat, as have most of the systematic and elementary writers.
From Hossack's Lectures, recently published, I extract the fol-
lowing : " In other instances again, the same peculiar inflamma-
tion and ulcer travel down the trachea, producing symptomatic
croup or cynanche trachealis. (See Dr. Barde's excellent dis-
sertation on this disease, as it prevailed in this city many years
since. Am. Phi. Trans.) Dr. Cullen refers to this dissertation
in his Nosology, under the head of Cynanche Maligna, which is
its proper place, the symptoms of croup being not primary but
symptomatic." And, again, in describing the treatment of the
same disease, we find the following : *' But, as I said before,
my chief dependance is upon the yeast, borax and honey, as my
local application, with a solution of the sulphate of copper or lu-
nar caustic occasionally to touch the parts before using the
yeast gargle. In children, cleanse the throat by a piece of
sponge, attached to a small piece of stick or whalebone, or the
common swabs of linen. This is necessary, as the children swal-
low this acrid matter; and it renders the disease more danger-
ous the greater fatality of this disease in children is partly as-
cribed to this circumstance." M. Bretonneau is the only one
who has given a partial description of the disease, as I know of.
I quote from Good : " More commonly, as has been shewn by
Bretonneau, the inflammation commences on the tonsils or the
pharynx, and from thence spreads at the same time downwards
to the larynx, and upwards to the nostrils. The affection usu*

i839.] Observations on Membraneous Sore Throat, 531

ally stops at the oesophagus, but occasionally the false mem*
brane extends to the stomach. In children the disease almost
always begins in the bronchise or larynx, and very rarely ex-
tends beyond the glotiis ; while in adults it more frequently ori-
ginates on the tonsils or pharynx, M. Bretonneau has also
shown, that what may be called plastic angina has been frequent-
\y mistaken for malignant sore throat." But here I diifer with
him, for in children it likewise and prmcipally occurs, and the
larynx, trachea, and bronchi, and not the oesophagus, are affected,
I will now give a brief description of the symptoms and patholo-
gy of the disease, and the treatment and here I may remark,
with success, when I have had the patients in the earliest stage,
and could get them to submit to the remedies. The disease gen-
erally commences with a chill, succeeded by fever, and an ap-
pearance of slight catarrh. The paroxysm of fever is about for-
ty eight hours, of greater or less intensity, when it generally
subsides, which is often a deceptive symptom, and may lead to
the impression that the patient is getting better. There is gen-
erally an enlargement of the glands of the throat in some in-
stances this is not apparent but upon examining the internal
portion of the throat, around the tonsils will be found a white
surface or coating, of a jagged appearance, which has led to the
notion that it is an ulceration, which is not the case. This will
extend to the posterior portion of the uvula. When this takes
place the breathing through the nostrils is much impeded, and a
vitiated mucus issues from the nose. There will be found no
difficulty of swallowing, or any pain, even when pungent and ir-
ritating substances are taken, for reasons which will presently
be given. If the disease is not arrested, the respiration becomes
affected, and partially interrupted a huskiness of voice is ob-
served, which gradually increases, with an increased difficulty
of breathing. Next follows a barking cough, which usually
commences the fourth, fifth, or sixth days, shewing that the dis-
ease has extended to the trachea ; then comes a heaving of the
chest, and occasionally sensations of sufibcation, when it is
thought the patient is dying. This is an evidence of an imper-
fect performance of the function of respiration. The skin now
becomes cool, and the capillary circulation languid and conges-
tive. The brain becomes partially affected ; a heavy drowsiness
occasionally occurring, which is interrupted by difficult respira-

532 Observations on Membraneous Soi^e Throat. [June,

tion ; but the mind when the patient is aroused is unimpaired.
This gradually progresses ; the aperture of the larynx, trachea
and bronchi diminishing, and the functions o\ respiration becom-
ing more and more impaired, until death ensues.

From investigation into the pathology of this disease, I found
the following results. The white appearance of the throat is, I
believe, an exudation of coagulable lymph forminga false mem-
brane, which becomes extremely dense, commencing at the ton-
sils and bronchi, extending, if not arrested, to the trachea and
bronchi, and terminating in death. Beneath the false membrane
the mucus membrane has the appearance of congestion, in place
of inflammation, having very little of sensibility, and not much
excited by stimulating applications. It will thus be seen why
no pain is felt in swallowing. An important diagnostic symp-
tom, and the general appearance of the patient, independent of
the laborious breathing, would mislead the ordinary observer.
I will now succinctly give the practice I have found successful.
In the first instance I have used emetics, either of the sulphate of
zinc and hippo, or the tartar emetic and hippo, in doses suitable
to the age of the patient ; and have then used injections of a mild
character, and if not sufficient, mild aperients. The next point
is to attend to the local affection. I apply leeches to each side
of the throat, so as to produce a large bleeding, to obviate the
congestion, and the tendency to the formation of the false mem-
brane. The next and important point, is the local application to
the internal part of the throat. To depend upon gargles of any
kind, I regard as useless, unless the cases are mild. A mop
should be used, composed of fine and well prepared sponge, or
linen, and a solution of nitrate of silver, say four grains to the
ounce, or diluted muriatic acid, in which the mop should be in-
troduced, and then rolled round the tonsils and neck of the uvU"
la, so as to detach as much as possible of the false membrane
and gargles may be used, as diluted pyroligneous acid, say one
drachm to an ounce of water, after the mopping. The mop
should be used at least three times a day, and persevered in until
the white appearance ceases, and healthy action ensues, for it is
amazing how quick the membrane will be reproduced. Mush-
room like, after having thoroughly cleansed the throat, I have
seen it reproduced in five hours. I regard the mopping as in-
dispensable in the accomplishment of a cure, as I will presently

1839.] Obser cations on Membraneous Sore Throat, 583

show by some cases. This plan is far from being new. The
mop has been frequently used, and the lunar caustic, muriatic
acid, and corrosive sublimate, with success by other physicians.
But what I mean to say is, that it has not been sufficiently used,
and the disease has been considered a cynanche maligna, and the
white appearance round the throat, as ulcerations ; and appre-
hensions were felt that the patient would swallow it, and produce
irritation in the stomach and bowels, while, on the contrary, the
whole danger is in the accumulation of this false membrane, and
its extension to the trachea and bronchi, (one of which I traced
to that point,) and by impeded respiration producing death.

I will now state a few cases which 1 have had.

The first case which I had, in the incipient stage, was that of

the daughter of Mr. . He had been in the country with

his family, and returned with a daughter having the membrane-
ous sore throat, of four days duration. The disease had extend-
ed to the larynx and trachea. Croupy symptoms commenced,
and in a few days the case proved fatal. While this case was
in progress, his eldest son was attacked immediately I gave
an emetic of hippo and sulphate of zinc, which operated well.
The glands being much enlarged, I applied six leeches to each
side of the throat, and allowed them to bleed freely. The for-
mation of the false membrane having commenced on the tonsils,
I next made a solution of nitrate of silver iv grs. rain water 3J,
and with a mop of fine sponge, rubbed every portion of the throat
freely, touching every surface. This was repeated three times
a day regularly ; and every day two leeches to each side of the
throat were applied, until the swelling subsided. I found the
leeches diminished the swelling and congestion of the vessels,
and the solution of the nitrate of silver arrested the progress of
the disease, preventing its extension beyond the pharynx, and
produced a healthy action of the vessels. His other daughter
was seized, and treated in the same manner, and with the same
happy result. My distinguished relative and friend, Dr. B. B.
Simons, was in consultation with me in this case. Independent
of these, I had several cases which proved successful. Indeed
every case which I have seen in the incipient stage, where the
mop could be used freely, the patients recovered ; and when it
could not be used, proved fatal, although all the other remedial
agents had been administered. In one family this was strikinor.

f)34 Prof. ChapinafCs Lecture on Menorrhagia^ d(-c. [June,

ly proved. Four of the family, the mother and three children,
were successively taken with this disease. The mother and one
child allowed the mop to be used freely, and they recovered
the others from constitutional timidity resisted, and all efforts to
apply the mop proved unavailing, and they died. It is true,
however, there was great difficulty in getting them to take me-
dicine. I should here remark, that although I prefer the nitrate
of silver solution, diluted muriatic acid, or pyroligineous acid,
or a weak solution of corrosive sublimate might accomplish the
same ends.

Before concluding I will condense my views.

1st. I use emetics, and as often as I find a disposition to accu-
mulation of phlegm.

2nd. I use leeches largely the first time, and one or two every
day to keep down the congestive state.

3rd. I use the solution of nitrate of silver, to remove the false
membrane, and produce a healthy action.

The bowels are kept open with injections, and occasionally
with castor oil and if required, some calomel is used, and purg-
ed off with oil.

Part ii. REVIEWS AND EXTRACTS.

A Lecture on Menorrhagia, vel Hasmorrhagia Uteria, or Ute-
rine Haemorrhage. By N. Chapman, M. D. Professor of the
Theory and Practice of Physic in the University of Pennsyl-
vania,

This lecture of Professor Chapman was reported for the Me-
dical Examiner, and is contained in the thirteenth and fourteenth
numbers of the second volume of that valuable periodical, in
which a series of lectures are in the course of publication, from
the same respectable author. These lectures of Professor C.
seem to contain the substance of his general course in the Uni-
versity to which he is attached ; and as they are from one so
long and extensively conversant with professional matters, theo-
retical and practical, they cannot fail to contain much of con-
stant interest to the profession. Such have, however, been the

1839.J Prof. Chapman s Lecture on Menorrhagia, ^-c. 535^

changes in the various departments of the profession, and more
especially in physiology, minute anatomy, pathology, chemistry
and surgery, that, things written thirty years ago, seem to the
medical reader of the present day, a century old. Such is, in
some respects, the character of the lecture before us. In some
respects, however, the state of medical science was better in the
seventeenth than in the eighteenth century : but we will consider
the lecture somewhat in detail.

As might be presupposed, on reading the caption, Professor
C. commences his lecture by an examination of the nomen-
clature by which the disease under consideration is distin-
guished.

The following paragraphs contain the Professor's criticism on
the term menorrhagia^ and his reasons for substituting in its
stead, hcBinorrhagia uteri.

An opinion having been formerly entertained that the whole of the extra-
vasations of a sanguineous aspect from the womb were of a menstrual na-
ture, the former term, which means an undue flow of the menses, was appli-
ed pretty much in the sense in which we now employ haemorrhagia uteri, or
uterine hsemorrhage. Elsewhere,* I trust I have shown, that the catame-
nia, instead of blood, are a peculiar fluid, the product of a secretory action of
the uterus. Nor is it true, as many suppose, that all of the periodical dis-
charges from this source are menstrual. On the contrary, I have found, in
every instance in which such were copious, pure coagulable blood to be
emitted. Even where, in the commencement, the fluid seemed to be parti-
ally menstrual, it lost that character, and became blood.

Granting, then, the correctness of this view, and which I think very few
can now be found to deny, the impropriety of the term menorrhagia is obvi-
ous. Convinced of this, some have proposed the substitution of metrorrha-
gia. But as it means only a discharge from the womb, it is vague and un-
satisfactory. Nothing can more precisely express the affection than hcB-
morrhagia uteri, and hence it should be adopted to the exclusion of all other
titles, p. 197.

It is obvious that the objections to the term menorrhagia, are
founded on the physiological doctrine that the " catamenia, in-
stead of blood, are a peculiar fluid, the product of a secretory ac-
tion of the uterus." Were this proposition granted, which he
takes to be the case in the second paragraph above quoted, the
reasoning founded on it must lead to the conclusion, that the
term menorrhagia is ill appropriated to the designation of a pre-
ternaturally copious flux of blood from the uterus, and that hae-
morrhagia uteri w^ould be a most appropriate name for the de-
signation of this disease. Now we do not so much object to the
conclusions arrived at, as we do to the unwholesome founda-
tions from which the conclusions arise : for let the catamenial
discharge be what it may, certainly a preternatural flux of blood
from the uterus is uterine haemorrhage. But instead of suppos-
ing, with the Professor, that " very few can now be found to

* Elements of Therapeutics and Materia Medica.

^3tJ Prof, Chapman's Lecture on Menorrhagia f ^c. [June,

deny" that the " catamenia, instead of blood, are a peculiar fluid,
the product of a secretory action of the uterus/* we should rath-
er expect to find but few at the present day, notwithstanding the
very respectable authority of Professor Chapman, added to that
of many others of different ages, who would have the hardihood
entirely to decline the converse of the proposition, or assent with
the Professor, to the complete exclusion of the possibility that
the menstrual discharge is sanguineous. Literally, maenorrha-
gia signifies nothing more nor less than a monthly discharge or
breaking out ; and would be applicable, as well to monthly dis-
charges from any other part, or of any other kind, as it would
that of a monthly discharge of a sanguineous fluid from the ute-
rus of human females, from the age of puberty to that of forty
five or fifty. And certain it is, that the term " menorrhagia'*
has nothing in it which refers either to the quality or the loca-
tion of the discharge nothing that intimates a discharge of any
kind from the uterus more than from any other part. It is there-
fore, as appropriately used to designate a monthly recurrence of
bleeding, or any other discharge from the nose, a purulent or
sanguineous, or any other eruption from the rectum, or any oth-
er part, or a leucorrhoeal or purulent one from the uterus, &c.
as the red monthly discharge from the uterus of the human fe-
male. But custom, which is and always has been but too much
the arbiter of language, has, for no better reason, in our cogni-
tion, than that w^hat we call menstrual discharge, is the only one
"which is generally, and with uniformity, monthly in its recur-
rence, established its meaning for centuries. Still, however, even
this, we conceive, is no good reason why a correct nomenclature
should not be adopted ; for surely it were better to be correct
late than never: or to use an old maxim, " it is never too late to
do good." Let it therefore be understood, that our objection is
not so much to the proposed nomenclature of Professor Chap-
man, as to the ground on which it appears to us to be made ;
or the purpose which, unobserved, it is calculated to effect in
regard to the truth of an important point in physiology a point
which is of no little importance, not only in its relation to an ab-
stract truth in human physiology, but also in its bearing on pa-
thology I mean the doctrine of the very able Professor, that the
catamenial discharge is not a discharge of blood, but is a peculi-
ar secretion. On this subject the Professor seems to have adopt-
ed the physiological opinions which were prevalent many years
ago, and settled down in ease and contentment, without apply-
ing the energies of his own intellect to the examination of its
physiological truth. We feel assured that were Professor C. to
apply his reasoning powers to the investigation of the subject,
with freedom from all partiality for opinions previously adopted
and long cherished, he could not fail to arrive at very different
results. We have no hesitation in affirming the proposition, in

IS39.J Prof. Chapmaits Lextare on Menorrhagia^ ^c. 637

the most unequivocal terms, without the least fear of the results
of rational investic^ation, that the menstrual discharge is truly a
discharge of blood; and is not, properly, a peculiar secretion ;
but is, when in the usual and health}^ quantity, only modified by
the secretions with which it comes in contact. The present oc-
casion does not afford us an opportunity of engaging in a ration-
al demonstration of the proof of the bold proposition, as it may
seem to some, which we have just stated ; but in passing, after
the statement of it, which we thought necessary for arresting the
progress of error, it may be allowable to notice a few observa-
tions from the best authorities of the past and present ages for
the same opinion.

H1PP0CRA.TES, the most respectable authority in ancient medi-
cine, whose close observation has been constantly before the
world in all ages, the most worthy example for imitation, and
which has estabh'shed so many truths which have withstood
<jhanging infiuences of time, and the revolutions of centuries,
says, " Procedit autum sanguis velut a victimd, et cito coagula-
tur^ si Sana fue?^ii muUer." The most healthy animals were
chosen fur the ancient sacrifices ; hence this comparison. He
died 361 years before Christ.

Mauriceau, w^hen IVevost of the Company of Master Sur-
geon Jurors of the City of Paris, in 1672, had and embraced the
opportunity of examining the body of a woman who was hung
for a crime, durmg the menstrual epoch. All that portion of the
cavity of the uterus about the fundus, was plastered over with co-
agulated blood; and these vessels were much larger than those of
the neck. He saw those coagula connected with those vessels
about the fundus, which disgorged themselves of the blood.*

Madame Boivix, whose excellent and peculiar opportunities
for investigating the truth on such subjects, we have before no-
ticed, Jtays, she has had occasion to see the uterus of many young
females who died during the menstrual epoch, in whom the inter-

* "C'estce qua j'ai remarque plusieurs fois, et fait observer devant
plusieurs de mes Confreres, ie 12 Janvier, 1672, ay ant I'honneur pour lors
d'estre Prevost de la Celebre Compagnie des Maistres Chirurgiens Jurez
de cette ville de Paris. Ce fut en la dissection d'unc femme qui avait aussi
este pendue pour pareil crime, dans le temps qu'elle avoit actuellement sag
menslrues, sur Ie cadavre de laquelle M. Deveaux le fiis faisoit son chef-d'-
vEuvre anatomique. On voyoit manifestement en cette femme, le contraire
de ce que disent Primrose au I. livre des maladies des femmes, et Colum.
bus au 6. liv. de son anal., car toute la cavite du fond de sa Matrice estoit en-
duite de petits gremeaux de sang cailie ; el ses vaisseaux estoient beau-
coup plus gros que ceux du col, et mesme, tout pleins de sang cailie, vers
las orifices qui se degorgent dans le fond de la Matrice." CEuvrede Mfftu
'rittaxi. Train des Maladies des Femmes Grosses, <f*c. P. 47.
d4

^39 Prof, Chapman^ s Lecture on Menorrhagia^ <^c. [ June^

nal face of the uterus was *' couverte cfune couche de sang (Fun
rouge vif" and this fluid she caused to pass out of the vessels
which afforded it in small drops, by simple compression, or by
plunging it into warm water.

With these facts and authorities then, Vv'ithout calling to our
aid the fact, that tbe phenomena of the menstrual fluid are per-
fectly explicable without the idea of a peculiar monthly secretion
we must be so far at issue with the learned Professor, as to set
it down as a physiological truth, established, beyond the reach
of fair controversy, that the menstrual discharge as it emanates
from the vessels of the uterus, into iis cavity, is verily, as pure-
blood as that which circulates in the general sanguiferous sys-
tem that immediately on being poured into the great tricorn
cavity of the uterus, it comes in contact and is incorporated
with the mucous s^ecretion which lines and lubricates the mucous
membrane of this cavity ; aiid that, as it escapes through
the fusiform canal or cavity of the cervix, into the vagina, it
partakes still further of the other secretions wiih which it meets
in its passage outward, which mucous and odorous secretions
have the power of changing a certain proportion. of such pure
blood, in such a manner as to give it all the qualities fairly claim-
ed for menstrual discharcje. This blood is coagulable when it
enters into the uterine cavity, and does coagulate in death, but
not ordinary in life, at this part; nor does it, when in natural
proportion to the mucus, any where in its passage, or after-
wards ; but whenever, from any cause, the sanguine flux ex-
ceeds the natural proportion to the mucus which the parts af-
ford, whether by an increase of the flux of blood, or decrease of
mucous secretion of the parts through which it passes, the dis-
charge becomes more or less coagulable, in just ratio with the
disproportion which exists. The diff^erenco then between the
menstrual discharge and uterine hasmorrhage, is not that one
is a peculiar secretion, and the other a discharge of pure blood ;
but that

1st. The former is pure blood mixed with a great proportion
of mucus, whilst the latter is pure blood inixed with a small
proportion of mucus.

2nd. The law of nature durin^^ health is, that the parts through
which this monthly discharge of blood takes phice, are supplied
with a copious mucous secretion, and that, monthly, from some
cause, a discharge of blood is gradually emitted from a certain
order of vessels of the uterus, in a quantity not exceeding that
which is capable of being rendered non-coagulable by the pro-
portion of mucous discharge ; whilst the latter, or what we call
uterine haemorrhage consists in a greater proportion of blood
than the natural mucous secretion of the parts can render non-co-
agulable. The former, therefore, is a normal discharge of blood
from the uterus, in obedience to a physiological law^ of the hu-

1839,] Prof. ChapmarCs Lecture on Menorrhagia J ^c. 6^

man female economy, and the latter an abnormal or morbid phe*
,nomon,in which this physiological law is transcended.

After this explanation of the physiology and pathology con-
cerned in this nomenclature, we are perfectly willing, as we in-
timated at the onset, that the latter or abnormal phenomenon
should be distinguished from the formiCr, or healthy one, by a
name, differing more essentially from that of the former, than
^menorrhagia does frorm menstruation that uterine haemorrhage
he adopted as a cognomen for those discharges of blood from the
uterus which are too great to be altered in quantities by the mu-
cus of the parts through which they pass, in contradistinction to
menses and catamenia, which are in universal use to mean those
monthly discharges of blood which are thus altered in their pas-
sage outward.

Here we gladly leave this part of the lecture before us, on
^vhich we have expended much more time than we intended, and
'Corns to the consideration of the next topic for discussion.

This haemorrliage may take pLice in the unimpregnated or impregnated
state of the organ, and precede or succeed dehvery. The latter is occa-
sioned in a mode, namely, by a rupfure of vessels, which removes it from my
-consideration, and v,'i]I be resigned to the department of midwifery. To
ma it belongs to treat only of the former, as properly vital, or spontaneous
-.haemorrhage. This may recur monthly, with considerable exactness, or
more irregularity, at shorter or longer intervals, or continue almost uninter-
ruptedly. But the lavv' of periodicity is observed by it with greater uniform-
ity than by any of its kindred affections, p. 197.

In this paragraph v/end a very proper distinction made be-
tween those uterine hemorrhages v/hich take place in the vacant,
4ind those which occur in the pregnant state of the ulerus. The
Matter, the I'rofessor very correctly observes, are occasioned by
the rupture of vessels, and assigns them to the obstetric depart-
ment. The f)rmer, by way of distinction, he calls "vz7a/, or
spontaneous haemorrhages," by which, we presume, he means
that they occur in a manner consistent with the integrity of the
vessels of the uterus. This is as it should be, and brings fairly
wnder consideration a pathological inquiry of the greatest inter-
est and of very frequent occurrence. It is highly interesting in
its philosophy abstractly considered ; but its intei'est is greatly
enhanced by the fact, that its true philosophy alone can dictate
correct and radical curative indications.

An attack of an active uterine haemorrhage may be ushered in without
any, or a very slight premonition, though generally by a train of precursory
symptoms, lassitude and weariness of the limbs especially sometimes chilli-
ness, followed by fever, or, at least, by increased force or acceleration of
pulse, headache, flushed face, embarrassed respiration, a sense of fulness in
the uterus, pain, acute or dull, in the lumbar region, or groins, with sensa-
tions of dragging or bearing down, attended by a frequent desire to urinate,
and occasionally by tenesmus. These phenomena are often connected with

m

540 Prof. Chapman's Lecture on 3Icnorrhagia, <^c. [Jane,

much of that sort of feeling, expressed by the vague term nervousness. The
discharge appearing, not a little relief is afforded, unless it be very profuse,
when the antecedent suffering is exchanged for the wretchedness of ex-
haustion, sometimes with nausea and vomiting, coldness and shivering, dis-
position to syncope, &c. &c. p. 197.

In the paragraph just extracted, we have a very good account
of the phenomena which accompany those uterine haemorrhages
which are not the result of rupture of vessels, as well as many
of those which are ; but these are given as symptoms of uterine
hsemorrhage, as a primary disease. Here lies the great pa-
thological error, to guard against which was our purpose in
giving the time we have to the first paragraphs of this lecture.
Radically wrong and injurious as it is to transpose cause and ef-
fect, when wc come to the deiails of the practice founded on the
reasoning process concerned in the pathology, but little is requir-
ed to change the aspect of the present view to that which is right
and salutary. We only need to add hcBmorrha^e to the list of
symptoms or phenomena above adduced, as a mere phenomenon
with thiC others, all combining to prove the existence oi'some
derangement of the uterus and its vessels and nerves, and consi-
der them as evincingthe existence of such derangement as the pri-
mary disease w[>ereof they are only the symptoms, and we shall
be not only correct in truth, but will, with this truth established,
be, on fair ground for arriving at radical curative indications,
Sijmptnms. and the morbid condition of the system, or of a part,
which they indicate, are very different things. The crying er-
ror of the present age has been, to treat symplnyns alone, instead
of using them to determine the true pathology of the case, which
should always include the whole previous part of the chain of
cause and effect, on which alone, or rather without which, radi-
cal indications and radical treatment cannot be adopted; and if,
under the neglect of this previous part of the train of phenome-
na, a cure is ariived at, which certainly is sometimes the case,,
this happy result is rather attributable to accident, or the un-
known resources of nature, than to sound pathology which i3
founded only on good and true reasoning.

i\ow vv^e are well aware of the fact, that those symptoms
themselves do in many instances require treatment, and are re-
movable, for a time, at least, by it ; as the hfemorrhage under
consideration, for example, without radical reasoning on the
cause. The haemorrhage, for instance, may be staunched for a
time, and it should be, when necessary, by cold applications, by
acetate of lead, by ergot, &c. &:c. which have nothing to do with
the cause of these symptoms, except to fulfil the latter part of the
great, general indication : which is to obviate the efl;ects of the
cause. The same may be said of the pain attending many cases,
&c. But the most important part of investigation is, to deter-
mine definitely what the causes are, and whether they are abid-

1839.] Prof. Chap man\s Lecture 071 Menorr /tag i a, i^c. 511

ing or have passed away. If the latter be the case, then they
need no indication ; the effects only requiring our curative ef-
forts. But if the former, the great precept, remove the cause,
lays ihe strongest claims to our consideration and efficient ef-
forts. Here are we called on for those operations which alone
may be depended on. not only for facilitating the relief of di.^tress-
ing symptoms or effects of the primary disease, but for giving
permanence to the cure, and even for correcting those effects
Avithoui other means and efforts directed to them individually ;
for unless there be disorganization, the morbid effects of noxious
causes will generally cease when these causes are obviated.
Proper research into the nature of their causes, w-ill satisfy the
close and unbiassed observer, that the symptoms above detailed
are the effects of uterine displacement in a very large majority
of cases. Certainly they may exist from other causes ; but at
least eighty or ninety per cent, of chronic uterine derangements,
and a still greater proportion of uterine haemorrhages, are the
results or effects of uterine displacements in some way. This
truth is not only consistent w^ith the anatomy and physiology of
the parts concerned, but is determined also by the fact that this
(uterine displacement) will generally be found present in such
cases, and its causalvmis fairly established by the cessation of
the effects, in very exact proportion to the correction of this as a
cause.

We rarely fijjd a better description of the external symptoms
of uterine displacement, than is detailed by Proiessor Chapman
in his description of the phenomena attending uterine haemorr-
hage ; and should we take their pointings to satisfy us of the ex-
istence of this cause, ;ind act on this view, we shall be favored
with a degree of prompt, as well as permanent success to which
we will otherwise renain strangers ; and we shall find uterine
hagmorrhage, instead of being that cause of alarm which it
proves to many, a mere trifle, never calculated to alarm us as to
its final consequences, provided its cause be promptly attended to.

In the next paragraph Professor C. gives us, as the most con-
spicuous remote cause of haemorrhage from the vacant uterus,
the period oflife. If by this, he means what is commonly called
the critical period of woman's life, the idea is very obscurely ex-
pressed, as will be seen by the following :

AmonfTthe remote causes of uterine hemorrhage, the most conspicuous is
the period of Jife. It is seldom met with previously to the season of puberty
is very apt to occur slightly, in anticipation of the complete estabhshmen't
of the menses again, when they are about to cease, and, sometimes, very
copiously. No period, however, between these extreme points, is exempt
from attacks, p. 197.

It is no novelty that we learn when w^o are told that " it is
seldom met with previously to the season of puberty," nor has
our observation taught us that it " is very apt to occur slightly

54t^ Prof. Chapman s Lecture on Menorrnagiaj i^c, [June,

ia anlicipatioQ of the complete establishment of the menses."
The remark is, however, true, that when the menses are about
to cease, these uterine ha3morrhages are more common and se-
vere ; but its more irequent occurrence at this time is not so
much attributable to " the period oflife," abstractly, as a cause,
as it is to that species ofgenital prolapse or displacement in the
female, which is so much favored by the relaxation of the female
genitals and their attachments, common in this period oflife.
The proof of this position is found in the treatment of those ca-
ses, in which relief is most certainly effected by the proper treat-
ment of this prolapse, which, on examination, is found to exist;
and from the existence and the neglect of which, and not from
other causes, this period of life has obtained the character of be-
ing peculiarly critical. The seventh septenniad is, therefore,
rather to be considered an age of pecuVvdv predisposition to ute-
rine hsemorrhage, by being a predisposing stale to that prolapse
which is its cause.

Predisposition to active uterine hsemorrhage is, according to
Professor C. also found in the " sanguineous, florid, and robust;
and to passive, in the enervated, relaxed, and phlegmatic."

The following particulars are next named as peculiarly de-
termining blood to the uterus, and therefore promoting uterine
hJ3emorrhage: Habits of sitting, or luxurious indulgence, such
employments and amusements as spinning, dancing, equitation,
walking rapidly, excess of venery, or abstinence from it, when
the desire is urgent, numerous labours, repeated abortions, leu-
corrhoea, constipation, frequent purging with articles operating
mainly on the rectum and through it, on the uterus ; certain em-
menagogues, as undue use of warm bath, of foot-stoves, &c. In
this enumeration w^e have an extensive assemblage of direct and
indirect causes of haemorrhage that is, of some w^hich operate
directly in the production ol haemorrhage by determining blood
to the uterus, and others which operate indirectly, by producing
obstructions to the free circulation of blood in the various ute-
rine vessels, through the intervention of prolapsu<? ; amongst
which latter, we will particularize dancing, especially under
the use of corsets, riding on horseback, walking rapidly, excess
of venery, all hard labors, and abortions. But we may add that,
some of these things enumerated ascausesof haemorrhage, should
foe considered merely as concomitants of hsemorrhage as ef-
fects of prolapse. Of these we particularize, most of the abor-
tions, whether repeated or not. These, occurring from any
cause^ are very liable to produce uterine prolapse ; whilst this is
by far the most common cause of abortions.

We pass over the next paragraph, as referring to haemorrhage
from the uterus in consequence of cancer, fungi, &c. (fee, which
belong to another department. We next come, however, to a
very correct observation of the lecturer, by the knowledge of

1839.] Prof, Chapman^ s Lecture on Menorrhagia, <^'C. 54^

which we are surprised that the confidence of the Professor in
his physiology was not impaired.

" No difficulty can exist in distinguishing the uterine from the
other hcemorrhnges. Menorrhagia is most apt to be confound-
ed with it." Here we find things, inade the same in tlie nomen-
clature, put in opposition. '* An inspection of the disc-barge
will, however, at once remove all doubts ; it being in the one,
pure coagulated blood, and in the other, a thin dark fluid of a pe-
culiar odour. Between the blood, in some of the less active he-
morrhages, and the menses, there is a close resemblance, and
greater attention will be required in the discrimination."

We confess we are at a loss to know what is meant by the
first clause of this quotation, unless it be to hint to us, what every
man's common sense would teach him, or rather, the self-evi-
dent proposition, that hemorrhages from the uterus may be ea-
sily ascertained not to be from some other part, and that he-
morrhages from some other part are rot from the uterus. But
in the latter part of this paragraph, we are told that between
some of the less active hemorrhages, and the menses, the discri-
mination is not so easy. It is strange, we say, that on making
this observation, the Professor did not perceive that instead of
the non-coagulability of the discharge from the uterus being at-
tributable to its being a peculiar secretion, that it was owing to
its proportionate admixture with mucus; and more especially
when he observed that, what he called uterine hemorrhnge ap-
proached nearer to the character of menses, the less the propor-
tion of blood to the mucus of the parts ; as in those hemorrhages
which are less active.

With the next paragraph, we fully accord, as our observation
long since led us to the same conclusion : that is to say, little im-
mediate danger is to be apprehended from active spontaneous
hemorrhage death, at least, rarely, or perhaps never suddenly
ensuing from it ; whilst much is to be apprehended in the ulteri-
or consequences, &c.; but it is otherwise in the less active or
passive states of the disease ; the loss of blood being here some-
times most copious, and the effects truly alarming. The conclu-
ding sentence in this paragraph is, we suppose, the observation
of every experienced and judicious physician: " Yet it would
seem, that from no part of the body is excessive hemorrhage
better borne than in the uterus, or the preservation of life more
frequent, under, apparently, desperate circumstances."

" The rareness of a fatal termination in either state of this af-
fection, has prevented the acquisition of any precise knowled^i^e
of its anatomical characters. No doubt, however, they are the
same as in hemorrhages of other mucous surfaces."

Certainly, this is the case with regard to those hemorrhages
from the uterus, which are without organic lesion or structural
disorder : the only cases properly under consideration in this

514 Prof. Chapman^ s Lexture on Menorrhagia^ ^c. [June,

place. Bat wiion the mind is set on investigation in one way,
it is too apt to neglect all the other means of arriving at truth.
Such appears to have been tfio case, to no small extant, with re-
gard to ihe hemorrhages under consideration. A little more at-
lentioii on the part of pathologists would have enabled them to
arrive at clear views, by reasoning from effect to cause ; a pro-
cess which would have developed a truth of the first order, be-
cause it would have pointed directly to curative ends by the re-
moval of cause. We do not, therefore, "confess the peculiar
obscurity in which the pathology of the uterine hemorrhages
(under consideration) are said to be involved." To us, as to
Professor C. " it is as plain as any of its affiliated affections," but
the simplicity of the pathology of these cases is so indeed, when
divested of the miserable error of " secretion,'" which we find
constantly brought up to the great confusion of the pathologist
and obscuration of the simple truth of nature. This we find
abundantly the case in the following:

*'Lined, as the uterus is, with a mucous membrane, why (says
Professor C.) should it not be subject to hemorrhage?" Now
we acknowledge ourselves of too obtuse intellect to see, in this
fact of anatomical structure, the slighest shadow of reason, or
means of accounting for the fact in question. If this were any
reason why uterine hemorrhage should occur, we ask, why does
not every man's nose bleed, and that excessively, and frequent"
ly, without the help of visceral obstructions : for this organ too,
is lined with a mucous membrane, and blood, when discharged
from it in a quantity, proportioned to the mucus secretion of the
part, as the blood discharged in menstruation is to the mucus of
the parts through which it has to pass, it is alike uncoagulable,
and really needs nothing more than the set of glanduloe odorifo-
rce of the genital organs, to endow it with the peculiar odor of
the discharge of females, called menses.

''But the chief difficulty complained of," says the Professor,
"seems to relate to those cases where pure blood periodically
escapes, instead of menses, or in which the two fluids are mix-
ed." Here is, we acknowledge, tfie perplexity ; and it arises, as
we stated in the beginning of this notice, in the error of physio-
logy, which has ever, like a will o' the wisp, haunted some of the
profession, and decoyed them into quagmires and amongst
brambles. We believe we have before explained the difference
between blood and menses, in a way which removes all this per-
plexity, and which is, at the same time, so perfectly consistent
with truth, that we defy any anatomist or physiologist to ac-
count for the phenomena of menstruation otherwise, except by
a departure from anatomical truth, for the adoption of sheer hy-
pothesis, which is never admissible in philosophy, when there is
no reasonable impeachment of what appears to be a plain and
rational demonstration of truth. But we will say again that the

1839.J Prof, ChapmarCs Lecture on Menorrhagia, <^c, 545

menstrual discharge is blood and mucus^ and uterine hemorr-
hage is blood and mucus ; but in the former, the mucus bears
such a proportion to the blood as to impair its coagulability;
whilst in hemorrhage it is in too small a proportion to eflect this
end ; and coagulability of the discharge exists. Again, there is a
reason why, in regular menstruation, it is generally the case that
the proportions of blood and mucus are such as to give the pecu-
liarity of the discharge in this respect ; and it is to be found far
back in the original design of female construction, in view of the
peculiar purpose of being the mother of mankind, for which she
was designed. Here will be found, as definitely as the differ-
ence of her corpopal construction, a peculiarity in the rate of
her repletion, for a certain period of her life, whereby a surplus-
age is provided. This is at the rate calculated to afford growth
to the foetus in utero, and to the new born infant until its organs
are sufficiently developed to derive support from other means.
This surplusage is, therefore, definite always, in perfect health
and nutrition, about the same, in the same individual ; although
not exactly so in different ones ; but in none, in perfect health,
in too great a proportion for the mucus with which it is to be in-
corporated in its passage outwardly. Now in this state of
things, purely physiological, we have nothing to do, in order to
have a hemorrhage, but so to increase the sanguineous discharge
as to overrule the non-coagulating powers of the mucus of the
part ; nor is it important, except in relation to therapeutics,
whether it is with or without disorganization. To talk then
about a secretory office, periodically exercised, is perfectly
Utopian. Would the learned Professor say, when the nose, the
lungs, the rectum, or an ulcer performs the menstrual function,
occasionally by a discharge of blood, or the tonsils, by a month-
ly enlargement, that these are secreting? If so, where is the
structure ? Where also is the cause of periodicity ? It is al-
ways bad reasoning, when causes and facts are claimed, of the
existence of which there is no evidence. Causes must be known
to be present, and they must bear a proportionate relation to the
effect produced, as the weights in different scales to produce or
to destroy the balance. One error begets many, and these af-
terwards multiply and increase, in the progress of the reasoning
process, as an error in the beginning of an arithmetical process.
In addition, therefore, to the want of nature's truth in physiology,
and the bearing of this on pathology and therapeutics, we find
the distinction made by the Professor, and others of the same
physiology, between hemorrhage and menstruation, leading to
another hypothesis relative to anatomical structure, which would
be as hard to demonstrate, as the vessels which were once sup-
posed to transmit semen from the vagina to the ovaria, without
its passing the route of the uterus ; or the sympathy whereby the
ova were believed to be impregnated, or the fallopian . tubes

e5

546 Prof. Chapmari's Lecture on Menorrhagia^ <^c. [June,

?

brought into action without the agency of the semen, nearer
than the vagina, wliich, we think, would do as well to remain in
the vesiculae seminales. Jt is seriously asked, and the question
referred to by Professor C. whether dilferent sets of vessels are
not engaged in these operations, (i.e.) hemorrhage and menstru-
ation ? Ahhough the question was obliged to be answered cor-
rectly as to the anatomical fact, the doctrine of secretion, being
lugged along with this truth, so cloggs it as to make it almost a
falsehood, because the modus operandi of these vessels is neces-
sarily erroneous. And this is the explanation of the fact, that
the same vessels do both agencies " The secretory vessels of a
part may be so differently influenced at the time, that while one
portion ofthem is adequately performing its duty, another shall
allow blood to pass through them, little or not at all affected."

The next topic discussed, is the local pathological condition
of the uterus, which is found to be more or 'less engorged, and
needing depletion. But surely the Professor will not contend
that this IS the case with general repletion. If not, from what is
it we ask, but local derangement ot circulation from some cause?
And under this circumstance, how can the almost universal rule
of general depletion in these cases, be a good on/e ; and that to
the exclusion of the correction of the cause? Certain it is, that
topical congestion or engorgt^ment, and sometimes actual in-
flammation does exist ; and when this is the case, the indication
is to correct this unwholesome effect of the cause of this disease.
And various are the medicinal means brought under review for
this purpose in the sequel of this lecture, without once refering,
at least, intelligibly, to the correction of the true cause the vas-
cular obstructions occasioned by uterine displacements. Yet, it
is said, " all is well that ends well," and this is applicable to some
of the remedial means recommended for the correction or pre-
vention of uterine hemorrhage : these are chiefly the superior
efficacy of the tampon in correcting hemorrhage; and of long
confinement to a horizontal position, fo* curing or preventing
its recurrence. But so cfearly is the source of true causa-
tion overlooked, or hidden by the glare of false physiology,
that after fairly advancing the real fact, that such things are val-
uable, their modus operandi is referred to another direction, in-
stead of that in which it is in truth found ; and the tampon is de-
clared to operate by causing coa'gula to form, and thus mechan-
ically staunch the hemorrhage.

Various astiingents and other medicinal powers are next ar-
rayed in review, which are calculated to act on the disordered
condition of the part concerned, by closing ihe patutous mouths
of vessels, and correctin": the enCTorfi:ed state of the uterus, under
the pressure of its cause, which is left operating: and many ot
these are sometimes, though rarely, necessary; for it is not always
the case that the effects of a cause cease to exist on its suspen-

1839.] Prof. ChapmarCs Lecture on Menorrhagia, SfC. 647

sion. But if. in the onset, the real cause be corrected, then the
most of these articles will be found left on our shelves. Yet as
these are sometimes found necessary, and as the preference
amongst them should be always at the command of the practi-
tioner, we may take time briefly to refer to them.

In the first place the Professor holds it more or less desirable,
that the hemorrhage should continue, for the purpose of correct-
ing the topical engorgement which he finds existing, instead of
venesection, which appears to be almost universally necessary.
Digitalis, as recommended by Currie, Farriar and Drake, as a
substitute for depletion. But Professor C. cautions against its
use, except when the pulse is " without force or volume," and
the hemorrhage not copious. The article of lead stands promi-
nent in the rank of astringents; although the Professor's experi-
ence does not enable him to place the same impHcit reliance on
it as Heberden, Barton, and others ; he even charges the ac-
counts of these respectable gentlemen with exaggeration, rela-
tive to its eflicacy. We regret to be compelled to difl^er with the
Professor on this point m practice, but we have rarely, if ever,
used this astringent, in cases in which the action of any astrin-
gent could be expected, without benefit more or less prompt and
complete our only motive for avoiding its use being, to avoid
the internal use of a preparation of lead. This motive has in-
clined us to the use? of alum, pulvis stypticus made of alum
and kino, or alum or catechu, the ergot, &c.; all of which we
have found as uniform in their efficacy as we could expect to
iind any medicines in their operation.

The topical applications usually resorted to, are given
and approbated ; but, says the Professor, " more, however, to be
trusted than any of the means I have suggested, is plugging up
the vagina, so as to allow a coagulum of blood to form ; and the
best substance foi- this purpose is sponge; though tow, flax, cotton,
or even soft rag, may be substitu-ted." We would not assert that
coagulation of blood does not in some instances, alone, arrest ute-
rine hemorrhage ; but we have not found it alone to be general-
ly depended on for arresting hemorrhage from the uterus, wheth-
er pregnant or not ; and we have long since found it far more
serviceable, and to be trusted to for certainty', to disregard those
coagula, so far as it may be necessary for determining the posi-
tion of the uterus, in view of, and effecting its adjustment, than to
neglect this, and depend on coagula. These eheck hemorrhage
momentarily ; but as the cause is generally continuous, the he-
morrhage is very apt to recur : and if it do not, the horrible af-
fliction ofdisplacementcontinues, and becomes a constant trou-
ble to the patient, instead of being, as it should be, timely cor-
rected. Now, the observation of Professor C. on the efficacy of
the tampon is correct ; and the reason of this efficacy is simply,
that the tampon is nothing more nor less than a pessary of soft

548 Prof. Chapman^ s Lecture on Menorrhagia^ ^c. [June,

material, by which the uterus is replaced and retained at its pro-
per Site, and its regular circulation established, to the prevention
of those obstructions and engorgements which demand topical
depletion for their relief, or terminate in some other of the horri-
ble catalogue of uterine diseases, as permanent engorgement, ul-
ceration, (fee. &c. The sponge, we are aware, is a favorite
tampon, or, as we should call it, prop, or pessary, because it is
of easy introduction, easily cleansed, and efiectual in retaining
the uterus in its proper site, and may be generally applied by the
patient herself ; a consideration of no trivial importance; nor
have we ever been able to find but one objection to its use, and
that only obtains in those cases of uterine prolapse, in which the
treatment is, not palliative, but intended for permanent cure ; and
this objection is its tendency to swell and distend on imbibing
moisture. When it is remembered that the lateral dimensions
of the vagina are, of the utmost importance in the treatment of
prolapse of the uterus, and that this organ cannot be expected to
be retained in situ, without securing and preserving a certain
narrowness of the vulvo-uterine canal, it cannot fail to be per-
ceived, that any thing which tends constantly to swell laterally,
and thereby widen the canal, must tend in the same degree to
prevent the support which the uterus needs. Observation on
this point, for more than twenty years, has led us to the use of
some soft article not possessing the spring or elasticity of the
sponge, but which, when wetted, is more easily compressible ;
and even in the use of such substance, we have twined it around
with small pack thread, in such a manner as to prevent its la-
teral distension in the least ; and at the same time preserve the
permanence of their length, as a support to the uterus at its pro-
perheight. Thisgivesand retains to these props an hour-glass or
bilboquet shape, just suited to effect the pressure needed, and
prevent all other. The sponge is, itself, a good material, if very
fine, and sufficiently secured, by wrapping or stitching around,
to prevent its lateral distension. It is only in this way that it
should be used : for the very good reason, thatotherw^iseit tends
to dilate the vagina laterally.

After what we have said, there will be little use in repeatedly
calling up instances of the erroneous application of improper
physiology, and the doctrines of excitement to the therapeutic de-
partment of this disease. After starting wrong, these things
must be. The physiological error at the begining, must extend
its ramifications through the subsequent process, to a greater or
less extent. It must make effects causes, and vice versa, and
must make the symptoms of one thing, the symptoms of anoth-
er, as well as effects of one cause the effects of another. We
pass over, therefore, a train of phenomena arrayed in order as
symptoms of uterine hemorrhage, which, instead of being a gen-
eration of events arising mainly out of this one, (hemorrhage,)

1"839.] Prof. ChapmarCs Lecture on Menorrhagia, <^'C. 549

are collateral effects with it, and arise out of the same causation.
We allude to various symptoms of impaired health, or " feeble,
quick pulse, respiration hurried on the slightest exertion, skin
damp and cold, pallid and sallow" with oedema and other
symptoms evinced in the lower extremities, pain in the lumbar
region, sense of weariness in the back, &c. Now we do not
mean to say that most if not all of these symptoms may he pro-
duced by hemorrhage; but that they are generally, only its ac-
companiments, and produced by the cause of the hemorrhage
very often, without being accompanied therewith, and curable
without any of the remedies properly directed to idiopathic he-
morrhage. It is strange to us, that any man should be engag-
ed, even for a few years, in the care of female health, without
being familiar with the facts just stated. -

The next class of remedies, in tlie treatment of what Professor
C. calls inactive hemorrhage of the uterus is, that of emetics ;
because, as he says, " the practice is not without claims to ori-
ginality." Of the emetics, ipecacuanha is his favorite. These
remedies are given "^ to reinvest the uterus with the faculty of
secretion, when suspended or perverted." This secretion must
be a very curious thing : when it comes on, hemorrhage must
cease, so must amenorrhoea of course, and fluor albus too. ' It
struck" the learned Professor, with great force, " that, by the re-
vulsion of vomiting, distinct from the secondary effects of the
process, the fluv/ of blood might be checked, and that, in the in-
terval of its recurrence, by occasional repetitions of the remedy,
the uterus reinstated in its secretory functions."

Now, this done, who will say that the flooding can possibly
continue ] But " emetics", he was "aware, are among the most
active and certain of the emmenagogues, by which I (he) mean,
an immediate power to arouse the energies, or otherwise to re-
invest the uterus with the faculty of secretion," &:c. On this
ground then, " having seen their salutary agency in this respect,
dz-c. I (he) indulged the hope that, if in these cases they can re-
vive a natural action, or rectify a depraved one, so they might be
serviceable in the same way in hemorrhage ;" Q. E. D. !

Certainly, emetic medicines in under doses, are not without
their beneficial effects, occasionally in checking active hemorr-
hage, and removing the phlogosis of the part, when the cause is
not abiding ; but we have too often seen the very disease, the re-
medy for which the Professor finds in emetics, produced by these
very powers, not to look for far more injury from their propul-
sive, than benefit from their revulsive power ; whatever may
have been the experience of the Paris and Dublin practitioners.
{Coffin and Osborne.) But we will leave it for the present, to
others, to determine the merits of the doctrine of similia simili-
bus curantur.

5.T0 Prof. Chapman i> Lecture on Menorrnagiay <^'C. [June

We intended here to have closed this notice ; but Professor C's.
originality has gone a little further in the use of enaetics ; and
that is, to continue them as preventive of recurrence, " or in oth-
er words, to effect a thorough cure," and " as to the applicability
of the practice, he (Dr. Osborne), perceived no difference, wheth-
er the hemorrhage was decidedly active or the reverse, it being
alike successful. Thus ' the emetic (ipecac.) repeated once or
twice, never failed to complete the cure." This is charming in-
deed !

Of the utility of cathartics in perfecting the permanence of the
cure, we are next informed.

" Cathartics which act on the lower portion of the bowels, and
indirectly on the uterus, have also been employed. The aloetic
preparations are of this description, and among the very best of
them are hiera picra and elixir proprietatis. These articles are
designed to operate, not so'much as evacuants, as by an impres-
sion on the vessels of the uterus, supposed to be promotive of the
menstrual function" (secretion). " Governed" continues the
Professor, " by the same principle, emmenagogues of a more de-
cisive character have been directed," but of the merit of them he
is ' exceedmgly distrustful/'

It is well to contemplate in these suggestions the use of hie-
picra, elixer proprietatis, &c., some of the most powerful and
successful emmenagogues v/e have at command, the contradic-
tory extremes to which one may be led by the glare offalse doc-
trine. Sea^etion, instead of vascular action without secretory
process, forces to indications calculated precisely for the pro-
duction of the very event, for the correction of which its use is
suggested.

By reverting to a former part of this lecture, now under ob-
servation, the reader's memory will be refreshed with the singu-
lar fact, that, then, the lecturer introduced just such purgatives
and emmenagogues, as aloes is believed to be, (that is, frequent
purging with articles operating mainly on the rectum, and
through it, on the uterus; certain emmenagogues, &c.) as cau-
ses of uterine hemorrhage. Now we find them introduced to
the reader as curative means now they \\\\\ produce secretion
not hemorrhage ; no\Y they will determine secretory action and
not hlood to the uterus.

If mercury cures salivation, or if belladonna produces, pre-
vents, and cures scarlatina, then we admit that hiera picra, (fee.
are appropriate remedies for uterine hemorrhage, and that too,
on the principle that similia simihbus curantur.

18 39.] Remarks on Cynanche Tonsillaris, 551

Remarks on Cynanche Tonsillaris^ and on its Treatment By R. Gerar-
din, D. M. Cynanche Tonsillaris is at present treated of in works on sur-
gery, as well as in those of medicine. It ought, therefore, to liave been suf-
ficiently studied to leave nothing new to say on the subject. In endeavor-
ing to trace its double relation to medicine and surgery, I have been led to
conclude that its imperfect treatment, during the stage in which it properly
belongs to the other department, most frequently permits it to pass into the
domam of the latter, by the formation ot abscesses and indurations, requir-
ing surgical aid. Some of the modern authors, and especially M. Andial,
have made known the changes produced by inflammation, whether in the
interfollicular cellular tissue, or in the parietes of the follicles themselves.
But I know of none but M. Velpean, who, in his Surgical Anatomy, distin-
guishes two kinds of inflammation of the tonsils ; the one seated in the mu-
cous membrane ; the other in the intertollicular and sub-mucous cellular
tissue.

The distinction of these two seats of tonsillary inflammation, is very im-
portant in a practical pomtof view, and should, therefore, lead us to regard
them as distinct affections. I would call this one mucous or superficial ton-
sillitis,* and the other parenchymatous or deep seated tonsillitis.f The
mere inspection of the throat will suffice to distinguish them. I need not,
therefore, dwell on their diagnosis ; it is sufficient that I have pointed out
their difference, and proposed the necessity of designations founded on pa-
thological anatomy. This distinction is indispensable in practice, for those
means which may^be successful in the treatment of the superficial form, in-
crease the intensity of the deep seated. Is it not to the con.^usion of these
forms that may be attributed the failure, in the hands of some, of remedies
lauded by other practitioners ] The local appli.'.ation of powdered alum, for
example, so highly recommended, may be resorted to with advantage in mu-
cous tonsillitis, especially when the inflammation is not disposed to extend,
and when the tonsils are covered with white exudations ; but in parenchy-
matous tonsillitis, attended with much inflammation and swelling of the ton-
sils, the use of alum has always, in my hands, increased the inflammation,
and, consequently, the pain. Should we not criticise the various remedies
proposed for tonsillitis ] Is it not strange that an inflammatory affection,
that may be seen and touched, should still be treated by indirect means ]
The cncients, at least, attacked the ranine and subhngual veins, doubtless in-
ferring that relief, might be most effectually obtained by approaching the
seat of disease.

My attention having, for the last ten years, been directed to this point of
pathology, and continually called to it in seminaries of both sexes, I feel it a
duty to make known the prompt and immediate effects of scarifications made
at the seat of inflammation. In every case, whether superficial or deep
seated, I examine the pulse. If the patient's constitution, his age, or the
immediate cause of the phlegmasia, impart to the general circulation much
power, I abstract blood from the arm, and, a few moments afterwards, I sca-
rify the inflamed parts ; and it is rare that this has to be done more than
twice. In the most intense parenchymatous forms, the disease has yielded
to scarifications twice performed at intervals of twelve or twenty four hours.
The congestion is instantly relieved, and the patient very soon acknowledges
that he feels more comfortable. 1 regard poultices to the neck, fumiga-
tions, and pediluvia, as of doubtful benefit, and only allow their use when re-
quested to do so.

The scarifications should be more or less deep, according to the nature of
the case. If the inflammation be m the mucous membrane, I scarify slight-
ly all the reddened region, even though it extend from the tonsils to the soft

* Esquinancie muqueuse ou superficielle.

t Esquinancie parenchyitiateuse ou profonde. *

552 llemarhs on Cynanche Tonsillaris. [June,

palate and uvula. If, on the contrary, the inflammation be parenchymatous,
I penetrate more deeply into the tonsils, and scarify them freely. I continue
the scarifications until the surface be masked by the blood, and complete
them after this has been thrown off, as the operation is not painful, and the
patient has then become reconciled to it. The number of scarifications, of
course, cannot be specified, and must be proportioned to the extent of the
disease, and to the flow of blood. In the deep seated tonsillitis, twelve or
fifteen expectorations well chargfed with blood, indicate a sufficient local de-
pletion. Under the influence of scarifications, resolution is prompt and in-
variable, and is usually obtained on the day following- the operation. Some
time afterwards, small white lines may be seen, produced by cicatrization.

With me, the scarifications constitute a general remedy, and the only ex-
ception to them is the difficulty of reaching the seat of the disease, when
called in late, or when the intensity of the disease prevents the opening of
the mouth. An author whom every practitioner hkes to consult, Boyer,
speaks of scarifications in this disease, but insists on them only in certain
cases. It is surprising that he does not extend its use, after saying that
by scarifications the alarming symptoms are arrested, and the anxiety of
the patient promptly relieved."

I scarify at whatever period of the disease I am called to see it. If sup-
puration has commenced, the lancet will give issue to the pus. If there be
a tendency to gangrene, scarifications will prevent it, by diminishing the in-
tensity of the inflammation, and by lessening the tension of the tissues : for
scarifications produce two effects, they relieve constriction, and give issue
to blood. By scarifications, hypertrophy of the tonsils is rendered impossi-
ble, and, when their use will become more general, the necessity to excise
these glands will cease.

I also resort to scarifications in guttural and pharyngeal inflammations, and
always with the most signal success. They are certainly preferable to cups
applied to the neck. Aloreover, by scarifications, we avoid the cicatrices
left by leeches applied to the neck, a matter of some importance to females.
It is to the refusal of a young lady to submit to the application of leeches to
her neck, that M. Monge was compelled to resort to scarifications. This
fine case, though long since published, does not appear to have led practi-
tioners to follow his example. The application of leeches to the sub-maxil-
lary regions is also injurious, by occasioning a sub-cutaneous congestion in
the neighborhood of the diseased tonsil, and which increases as the leeching
is repeated, without any benefit to the patient. Messrs. de la Berge and
Monneret, authors of the Compendium^ have named, in the article on Amyg^
dalite, the distinguished practitioners who have, hke myself, remarked the
injurious effects of leeches to the neck in cases of tonsillitis. It is to be re-
gretted that this practice should have become so common that the physi.
cian is rarely called in until the friends have made one or more applications
of leeches.

According to M. Bouillaud, (Gazette des Hopitaux, Avril^ 1838,) the in-
flammation of the tonsils may extend to the veins, and reach the heart,
producing coagula and death. But although this disease is not always so
serious, it is frequently allowed to pass from the acute to the chronic state ;
articulation is then impeded, the delicacy of hearing sometimes impaired,
and the consequences are occasionally such as to incapacitate the patient
for the bar or the pulpit, to suspend the musical studies of youthful talent,
and to compel artists to retire, prematurely, from the lyric stage.

Besides, there is no region better adapted to scarifications than the interi-
or of the mouth. By the rapid removal of congestion, effected by scarifica-
tions, the cure is promptly obtained in cases of tonsillitis, of guttural and
pharyngeal inflammations, in phlegmonous affections of the palate, gums,
&c. These regions are pen'aded by no vessel, the puncture of which should

1839.] Effects of Tobacco on the Voice of Public Speakers. 553

be apprehended, for it would require much violence, if not awkwardness, to
endanger, as is feared by Professor B:>c!ar(!, the internal carotid artery.

Willi regard to the instrumentp, I have but liMld to sny. A lancot, whose
blade may be partly wrapped with linen, is always at hand. Yet when the
operation has to be performed on timid persons, on young fcma!e?, or on
children, the preparation of tiie lancet will, not unfrequently, occasion alarm
difficult to overcome. Jn order to avoid this inconvenience, I requested M.
Charriere to make a scarificator, concealed in the manner of a pencil in its
case, and which could, therefore, be projected after its introduction into the
mouth, without the knowledge of the patient. Journal des Connaissances
Midico- ChirurgicaleSy Nu. 5, 1838.

Effects of Tobacco on the Voice of Public Speakers. In the
last nuinber of this Journal we gave an extract from the Bos-
ton Medical and Surgical Journal, with some additional remarks
and lacts, on the same s'uhject with the following communica-
tions. The subject is an important one, and highly worthy of
the consideration of the profession. We are happy to find that
it is now under discussion. As our object is useful truth in me
dicine, we give the following articles jrom the sime source, in
order that the reader may have materials, as far as they are fur-
nished, for his own judgment on the sui')J8c.t. Meanwhile, we
will state that, a few days past, we accidentally met with an in-
telligent medicalgentleman of considerableexperience in the pro-
fession, from the low country, who, on the suggestion of the sub-
ject, stated that a gentleman of the city in which he resided, had
been a free indulger in the use oftobacco that after becoming a
pious man he abandoned it, perhaps from moral impressions re-
lative to its use, and became, what is termed ' an exhotter," to
some extent. In the course of four or five years he found him-
self seriously injured in his vocal organs. The use of tobacco
was resumed not, that wc understand, as a remedy. Subse-
quently to the re-ajoption of its use, however, the symptoms of
the throat complaint disappeared, and he has remained to the
present time, now several years, exempt from all the distresses,
privations, and threatcnings of this hitherto intractable disease.

The claims of humanity arc high ; and in no instance more so
than when preferred by the suffering clergy ; but in all cases
they are sufficient, to overrule, if necessary, the formalitic^s of
fashionable etiquette, or the unpleasantness of a rrm.^dy. These
cannot, therefore, we conceive, be advantted in argument on the
subject, which is indeetl of vital imprirtance. and one which
should rest on statistical facts alone. We hope, therefore, that
intelligent citizens generally, as well as physicians, will feci them-
selves duly impressed with the duty of reporting any fact which
may be calculated to determine the true influence of tobacco in
regard to the cases alluded to: and we hope further, that both
physicians and patients will examine well the authentic facts

554 Effects of Tobacco on the Voice of Public Speakers. [June, <j|

which have been, and may be, offered, and yield to the cause of
truth as developed by facts alone.

To the Edilor of the Boston Medical and Surgical Journal.

Sir I find I am not alone in being surprised at the opinion expressed by
Dr. Mauran, and apparently endorsed by yourself, of the necessity of tobac-
co for public speakers, to prevent the occurrence of the disease that has rft-
cently affected clergymen so extensively. I apprehend, my dear sir, that
these opinions have been given upon few data, and without the reflection
which is desirable for those whose views on this subject may have an ex-
tensive influence upon the habits of mankind.

If it is indeed true, that one qualification for preaching the gospel should
be the practice of a most disgusting and vicious habit the use of a narcotic
which is second only to alcohol in its deleterious effects upon health and
morals then, indeed, a new era of knowledge has commenced. The facts
that have been presented to me in a practice of more than thirty years lead
xne to very diflferent conclusions. The first clergyman that consulted me,
many years ago, for this difficulty, had arrived at the age of filty when the
disease commenced. He had used tobacco from his youth upwards ; he
used it then, and afterwards, and I believe continues to use it till this time.
He left the desk long ago, in consequence of loss of voice.

Another clergyman, with talents of the first order, was obliged, at the age
of thirty, to leave a people greatly devoted to him, in consequence of this
affection of the voice. He was an inveterate chewer of tobacco, and I be-
lieve smoked the cigar also.

I am not confident what were the habits, in this particular, of the numer-
ous patients who have applied to me for advice, or whose cases have come
to my knowledge ; but the impression is strong upon my mind that quite a
large proportion used tobacco in some form. The effect of snuff" upon the
voice is proverbial, so much so that many are able to detect the habit by
the voice alone.-

The influence of tobacco upon health is certainly deleterious. There is
no mistake in this matter. It deranges the nervous system, and diminishes
the tone of the stomach, in innumerable instances. A narcotic of such pow-
er as tobacco, which cannot be used in the minutest quantity, by the unini-
tiated, without the most disagreeable and often dangerous effects, the habit
of using which cannot be established without difficulty and great caution, and
when established, cannot be abandoned without severe suffering, great pros-
tration, loss of appetite, gastric sinking and distress, which shows how near-
ly allied are its effects to those of alcohol, should never be prescribed with-
out great caution. Indeed, I have supposed that it was the most ready and
common stepping stone to that use of spirituous liquor which leads to intem-
perance. Those who chew or smoke tobacco are rarely satisfied with wa-
ter, or other insipid or tasteless drinks, else why should the bar-room and
the grog-shop be the resort of the smoker 1 I would not insinuate that all
who use tobacco are lovers of strong drink, nor proscribe alcohol or tobac-
co as remedies in some forms of disease ; but I would be very cautious how
I recommend either as preventives of disease. How many thousands have
found an untimely grave by the use of brandy, wine, and other narcotics,
used to guard against sickness, or as remedies for chronic diseases !

Fully beheving that the tendency of the use of tobacco is to promote, rath-
er than prevent, the disease in question, I could not forbear to state my
views on this one point, and may, at a time of more leisure, give you more
*t large the results of my observation on this active and dangerous narcotic.

One word with respect to the disease. I have been led to suppose that
the modern practice of preaching in vestries, and thickly crowded, close and
warm rooms, and afterwards inhaling cold air while heated, had much to do

3L8"39.] Effects of Tobacco on the Voice of Public Speakers, 555

in producing the new disease. Vestries are of modern origin, as places of
religious worship ; the rooms are small and low, and when filled with people,
the air becomes exceedingly bad. 'I'lie speaker, elevated above the audi-
ence, and often near the wall above, inhales none but contaminated air, un-
fit for the lungs, and highly stimulatmg to the organs of speech. In such an
atmosphere, tending to paralyze his eftbrts, he is obliged to redouble his ex-
ertions. How often do candles burn dim in such rooms ; and how often, ia
spite of all effort, do both speaker and hearer become dull and languid !
This effect is doubtless the consequence of the inhalation of an atmosphere
rendered deleterious by the exhaustion of the principle which supports life.
1 believe the disease in question often arises from the frequent repetition of
this cause, by a preacher whose health is not firm, and whose constitution if
not vigorous. Yours, truly, S.B.WOODWARD,

April idlh,lSS9.

To the Editor of the Boston Medical and Surgical Journal.

SiiR, I received this day, your valuable Journal, and noticed the com-
munication upon the subject which forms the caption to this article ; and
not aspiring to be, as has been elsewhere said, the "apologist for the fil-
thiest of all fashionable vices," must be permitted to enter a partial disclai-
mer to some of the sentiments advanced.

My "opinions" may "have been given upon few data, and without the re-
flection which is desirable for those whose views on this subject may have
an extensive influence upon the habits of mankind ;" but should the sugges-
tions offered lead to just and profitable results, however their tendency, the
nds of the writer will have been happily accomplished.

Little did I dream, my dear sir, when conversing with you incidentally at
my office, on the subject of the throat affection of clergymen, and the use of
the " noxious weed," that I was to be arraigned at the bar of public opinion
for my remarks ; but as the object was then, and is now, simply to ehcit
truth, I do not hesitate to " take the responsibility," and entrench myself
behind such facts as are at hand, however imperfect may seem the cata-
logue, hoping that others will present theirs of an opposite character, that the
, legitimate inferences and deductions therefrom may be secured. For mere
theory and cant I care not a gtraw ; and therefore offer no reply to sugges-
tions drawn from such sources ; and I am happy that a gentleman has noti-
ced your article so truly competent to discuss its merits or demerits upon
facts alone.

As to what would, or would not, have been, had circumstances been
thus, or so whether we should have lived to the good old age of Methuselah
upon a diet exclusively vegetable, or died, as we now do, at the very limited
period of three or four score and ten, upon the mixed yankee diet of vegeta-
ble and animal food ; or, what would be the probable consequences of rigid
abstinence in all things from the commencement of time, or of habits such
as our community now presents, I will not pretend to discuss, but shall be
satisfied to examine things as they at present really exist, and discuss them
solely upon their intrinsic merits, or, if you' please, demerits. That errors
prevailed, and do still prevail, it is not doubted, both in our eating and drink-
ing, and the " wherewithal that we are clothed ;" but thatour health statis-
tics and bills of mortahty exhibit so marked and favourable a character, as
might have been anticipated from the 1 had almost said diarrhoea of mat-
ter which has been dispersed broadcast, as it were, over the community by
cur modern book-making and lecturing hygienists, et idomne genus^ I doubt
exceedingly. There is evidently a fault somewhere, which can only be de-
tected and developed by attending rigidly to tacts as they present, eschew-
ing altogether speculative theory, unless based upon something more sub.
fitantial and tangible than moonshine, mere moonshine.

556 Effects of Tobacco on the Voice of Public Speakers. [June,

What, then, are the prominent circumstances upon which the original
conversation with you was predicated ] 1st, I'hat tlie disease in question
is comparaliveJy ot recent origin. 2d, That it occur?, or has been develop-
ed onJy, or ratlier mostfrequeiiily, among those who either in fact or by com-
mon ctjurte sy the most sirictly temperate in all things. 'M, That its patho-
logy is but liale known or appreciated, and therefore demands a moie rigid and
severe investigation, albeit the effort niay cause tube suspected for jack of
consistency a valuable public journal devoted io "the scientific preservation
of health and cure of disease, or seevn to conflict with the principles, or with
our ultraists' I'rociustean dogmas, of the prevailing reformation from indul-
gences hurtful or apparently unnecessary. Not that I would say or do
aught to arrest the onward progress of a temperate temperance reform be-
lieving, as I most sincerely do, ihat much, and it is jjoped substantial good
has been, and is being actoniph'shed through its potent agenc y ; but only
en eavor to check t/ie wholesale denunciation, under all circumatancf-s^ of
peculiar articles, because, fors-ooth, they happen to belong to the same class,
conveniionaljy, with oiher known noxious agents. A fourth reason offered
for my remarks, wa.--, that the aftiection in question is not the result of occu-
pation merely, or much, or loud, or long speaking, nor is it attributable to
Ihenoxious jjitiueiices of a confined and vitiated atmosphere alone, judging
from the well known fact that ;he lawyer, quo ad hoc proverbially heajihy,
outtalks the divine immeasi rabiy ; frequently addressing a Jury e-r/ laui xoix^
Eome three, six, and even eioht hours consecutively (the clngyman rarely
more than an iiour at one time, and that at intervals, and with a low and
meausLred nitonation), and in the vitiated, rum-and-tobacco atmosphere of
alow, ill ventilab. d, crowded court rcom, and this not mertly once, twice or
thiice a week, but daily, for weeks, aye months together, as not infrequently
occurs with many of our popular advocates at the bar during protracted sit-
tings of county aud general courts.

B-t to recur to our first position, that the disease is of recent origin, and
was therefore wholly unknown to, or unappreciated by the clergymen of
olden time. True, the labors of the closet (clerical), then, were not infre-
quently, and 1 doubt not advantaoeousl}', connected, more or less, with that
of the plough and the wood axe, and it cannot be denied were less severe
than ai present. But what, in other respects, were the then habits of the
clergy ] !So far as tobacco is concerned that is the present question they
almost to a man indulged in the use of "the weed," ah libitum; nor am I
aware of the fact, noiwithstanding their incessant professional exertions
(their style of preaching being mostly ofa hortatory character, very earnest
and enthusiastic, andoiien accompanied for hours with a stentorian utter-
ance), that their average early mortaiity, as a class, was greater than that in
our own day and j,cnerat:on.

But to the facts, in th s city, wherein I have been in constant profession-
al practice for nearly a q'!ar:er of a century, and where, from the incessant
changes of pastors (a habit, by the way, much to be deplored), the aggregate
number he s been not few, I liave never known per snna/.ly, or through my pro-
fessional brethren, of a single case of ///e throat affection, so cailed, among
those ot "the order" who u^ed tobacco habitually either 1 y chewing or
smoking! but, on the other hand, of several cases among those unaccustom-
ed to it use, or, if you please, abuse. JN'ovv w'hether this is the happy result
of the tobaccoc^, or its "tap-room concomitants and tendencies," as sugges-
ted by your correspondent. Dr. Woodward, I confess myself wholly unable
to say. I will in justice add, however, that in the cases to which we have
alluded, so far as our observation e.xtends, the habit has not formed the
"stepping-stone to that use of spirituous liquor which leads to intemperance,'*
nor have the individuals been found lingering about the " bar room and the
grog shop ;" all having even "been satisfied," as a beverage, with "drinks
as insipid and tasteless as water, and also considered by the community in

1839.] Effects of Tobacco on the Voice of Public Speakers. 557

which they live as respectable, and in all respects excellent, nay, worthy mem-
bers of society !

Of Snuff, and its effects, alluded toby Dr. W., I conceive the altered voice
lo be purely mechanical, the reverberatory passages being actually blocked
up by this vile specits of vegetable plaster.

But permit me to recapitulat.-^ very briefly, for my remarks have already
occupied more space than I had intended, a few of the circumstances which
Jed to the suggestions hinted to you. Being in conversation, a year or two
since,wiih two most eminent divines oft he Harvard school, upon the subject in
<juestion, they (both semi- martyrs to the disease) were in turn suggesting
the probable causes of the malady, such as close application, long and loud
speaking with the head in the uplifted posture, confined, vitiated air, &c. &.C.,
when 1 mterrupted by sying, that there was evidently something wrong, or
far from healthfulness, iii the habits of the clergy of the present day ; that
the circumstances by them cited (lid not obtain as the exclusive causes of
the disease, being amply refuted by the undeniable facts above alluded to
in relation to the gentlemen of the bar and clergy of olden time ; that the
frequent recent occurrence of the disease among them could only be account-
ted for by the difference in the habits of living between the two professions,
and those of their own order who were even exempted from its influences
further, that I had ever known an individual clergyman thus affected, who
was in the habitual use of tobacco. I then inquired what had been their
experience and observation in this respect, among their immediate friends ;
although their professional acquaintance was extensive, neither could recol-
lect a single case of the affection where the individual w^as addicted to the,
if you will, "vile practice."

About a year smce, being most happily present at a very interesting
** Wednesday-evenining Club meeting," in your city, with the celebrated
Dr. Mussey, of tobacco lecturing memory, this subject was again under dis-
cussion (and very naturally so, for, from the delicious fumes of the Vuelta
Abajo which ever and anon greeted the olfactories, Ijudged that every mem-
ber must, or ought to have been, to be eligible, a smoker), my remarks, as
above, were there repeated, but were most promply, though very courteous-
ly, met by Professor M with the statement that the most inveterate case
of the disease ever prescribed for by him, was in a gentleman, I think of
Brunswick, largely addicted to the use of tobacco. The inquiry then was,
what other cases of a similar character do you recollect! And my impres-
sion now is that he did, or.could, not name one in particular, but thought,
as does your correspondent, that there were many such. Dr. Mussey, to
whom, as a ready writer, the medical public is much indebted, was very ur-
gently requested, as he had already posted up the subject largely, and, as I
c.")nceive, very happily and justly thus far, to give the hint expressed a second
thought, and say somethings about it to the public ear. Having never heard
from him, either directly or indirectly which is exceedingly to be regretted,
the subject being.vital in itsconsequences,he will pardon me for supposing him
to have yielded a tacit assent to the statement expressed, viz., that "the throat
affection," strictly so called, and understood by the faculty, does not, as a gen-
eral remark, develope itself in the habitually tobacco-using subject that is,
by chewing and smoking. To the use of snuffmy observations have never
been extended, the practice of 'snufEing" being too apparently injurious from
its general stupefying effects upon the system, and mechanical effects upon
the voice, ever to be tolerated in a public speaker.

But granting that tobacco is a preventive, will it also act as a curative?
Of this, I must confess 1 have doubts, and such, (knowing the vile and cap-
tivating nature of the habit) as have ever precluded its prescription there-
for in my practice. Indeed, I am fully convinced, (as is, or ought to be,
every medical man of experience) of its noxious tendencies in certain habits,
and have many a time most advantageously proscribed its use, as I do inva-

558 Occasional existence f>f Animalcules in the Blood. [June,

riably to tlie healthy man, that of every species of narcotics and stimulants
in general vogue.

Now, my dear sir, as I rejoice in having all mooted questions of impor.
tance rigidly tested, I am truly happy that this has been bruited ; and if my
notions are wrong, which, being a decided, though not ultra, temperance
man in all things, 1 truly hope may so prove to be, no one will sooner yield
than myself a hearty assent to the conviction ; but if, through rigid investi-
gation, it shall be found that the investing membranes of the vocal organs
call for some peculiar stimulus to exalt their secretions, and give a more
healthy tone to the function, and that tobacco is that agent, let us know the
fact, maugre all expressions of " disgusting and vicious habit," " narcotic in-
dulgencies," "new era of knowledge," tendency to swell the number of in.
mates of the " tap room," &-c. &c.

Your correspondent, after reading a homily in which I, nay all, fully coin-
cide, " that thousands have found an untimely grave through the use of
brandy, wine, and other narcotics, used to guard against sickness, &c." at-
taches a universally Hke agency to the cigar, finding fault with a recommen.
dation of tobacco as a preventive, notwithstanding the old adage, that an
ounce is worth a pound of cure, but admits that he " does not hesitate to
prescribe it as a remedy in some forms of disease." Now I would as soon
prevent as cure disease, especially such an one as this, an opprobrium medico-
rum, which annually numbers its scores of victims, thus depriving the com-
muniiy of their highest and most enobling teachings, could it be efiected by
eo morally harmless a remedy as tobacco.

Although, peradventure, I do, with the ultraist or the honestly sensitive,
subject myself, through these remarks and confessions, to the imputation of

" Compounding for sins one is inclined to.
By damning those we have no mind to,"

still I am constrained to offer this "testimony" of my individual observations
and experience, submitting with pleasure to whatever judgment their inves-
ligation in the premises may declare, respectfully subscribing myself.

Your servant, &c. J. MAURAN.

Providence, April 26, 1839.

Occasional existence of Animalculco, in the Human Blood. The occasion-
al existence of animalculae in the human blood has been admitted, for a long
time, by some of the best authorities in physiology.

Brera and Treutler were the first to discover and announce the presence
of the polistoma (one species of these entozoa) in venous blood. M. delle
Chiaje, who has long devoted himself to microscopic researches on this sub-
ject, has confirmed the accuracy of these gentlemen's statements, and he
has also minutely prosecuted his enquiries respecting the physical charac-
ters of the animalculae, and the mode of their generation.

He is inclined to regard the polistoma as a result or product of a patholo-
grical condition, and, therefore, of a spontaneous developement or generation
as well indeed as all other entozoa. The morbid products, he sajs, may
become organized and live at first at the expense of the tissue, in which they
arise ; they may then detach themselves from these, and in this state enjoy
an independent existence as for example the Alcephalocysts or Hydatids.
The most simple Acephalocysts, (those of which the animal character was
so long called in question,) are now admitted to be genuine animalcute, pro-
vided with a head, and also with special suckers, according to the research-
es of M. della Chiaje.

1839.] Remarks on, and Treatment of, Con. Hcsmorrhages. 559

With respect to the Polistoma, M. Chiaje informs us that he has discov-
ered worms of this genus in two classes only hitherto. Both patients were
laboring under phthisical disease.

In one, the blood rejected during the fir'^t attack of haBmoptysis, exhibited
half an hour afterwards, several small fiat worms, somewhat similar to mi-
nute leeches, and either floating in the serum, or adhering to the sides of the
vessel which had been perfectly clean, before the blood was received into it.

The two physicians in attendance showed them to M. delle Chiaje, who
at once recognized them to be the PoListoma Sanguinea. He examined
them minutely with the aid of a microscope, and quite satisfied himself of
their real character. The same phenomena were observable in the subse-
quent haenioptoic attacks of this patient.

The second case was very similar to the one now mentioned. A young
man was laboring under hcsmoptysis ; the rejected blood, on several occa-
sions, presented a considerable number of these worms to sight.

M. Chiaje alludes to the case detailed by Mr. Bushman, of Dumfries, and
recorded in the number of the " Medico Chirurgical Review," for January,
lb34. It may be interesting to reproduce a brief acccfunt of this case here.

The patient, a young boy, was laboring under influenza, for which he was
bled. In the blood, after it had remained at rest for an hour, Mr. B. discov-
ered numerous worms, some floating in the serum, and others imbedded in
the crassamentum.

Mr. Rhine, of Edinburg, an able naturalists, drew up an accurate report of
these animalculae. They were from one half to two thirds cf an inch long ;
they consisted of an articulated body, a head with rudiments of antennae and
palpi, and a tail terminating in two tubular bodies or stigmata, 'i'he colour
of the animals was bright red. In structure, color, and size they correspond,
says xMr. Rhine, exactly to the larvae of the Tijpula olaracea fly, which in
summer is so abundantly found in ditch and river water.

Various other causes are also mentioned. Thus Notorianni has informed
us that he discovered thirteen worms of the genus PoliUoma in one of the si-
nuses of the aorta ; and Borelli, Redi, Vallisneri, and Lucarelli have recorded
similar instances.

M. Chiaje has extended his enquiries to the blood of the lower animals ;
and he has discovered that anima'culae are often present in the circulating
fluids, not only in the higher Vertebrata, but also of many of the Inverte-
brata. Thus, in the blood of several Sepiae and also of the Sea-mouse, he
has succeeded in detecting occasionally a species of round or ovular ani-
malcule. The mesenteric vessels of the Rana pipa, and the cranial veins
of the porpoise have been found to contain worms similar to the Polistoma.
We also know that the aneurismal sacs of the meseraic blood vessels in tho
horse frequently contain the Stmngylus Armatus; and that M. Andral has
met with Acphalocysts in the pulmonary veins of man. (Clinique Medic, t.
iii.) Annali Universali di Medicine. Med. Chi. Rev.

Remarks on Constitutional Hxmorrhages with cases. Use of the Sulphate
of Soda as an Internal Remedy. Case 1. A man, twenty. four years of age,
was admitted into the Hotel Dieu, in consequence of a false aneurismatic
swelling in the palm of the right-hand, which, having been mistaken for an
abscess, had been opened. This man had been subject, since his boyhood,
to frequent recurrence of Epistaxis, and to very profuse bleedings from any
accidental wounds.

His life had once been seriously endangered by the haemorrhage from some
leech bites on one of his knees. The swelling of the hand had come from
a. violent strain, which, he (the patient) said had dislocated his thumb-joint
at the time. The surgeon, who first saw it mistook it for an abscess, in

560 Remarks on^ and Treatment of, Con, Haemorrhages. [June,

consequence of the absence of all pulsation and from the distinct sense of
fluctuation, which was perceptible in it. The haemorrhage had been very
abundant, and could not be restrained by pressure on the radial and ulnar
arteries, but only by firm press^ure on the wound itsell. Whenever the com-
presses were removed, it returned ; and M. Roux, therefore, determieed at
once to tie the arteries of the fore-arm. The radial one was first secured ;
and, as the bleeding still continued, the ulnar also was tied. The haemor-
rhage seemed to be arrested for the time ; but, in less than an hour, all the
bandages were found soaked with blood, which had oozed not only from the
palm of the hand, but also from the two incisions in the fore-arm, which
had been made during the operations. Suspecting that the blood might
continue to flow through the interrosseous arteries, the dresser applied a
tourniquet above the elbow-joint ; but even this failed, and the patient
died in the course of the evening.

The dissection was performed with great care. Almost all the viscera of
the three great cavities were pale and exsanguine ; some fluid blood was
found in the right, but none in the left, cavities of the heart. The blood ves-
sels of the affected limb were minutely injected ; but irregularity, either
as to distribution or visible formation of their branches, wore anywhere dis-
coverable. The radial and ulnar arteries had been fairly tied ; there were,
however, no traces of any coagulum either above or below the seats of the
ligatures. The deep palmer arterial arch was intact (in other words, was
not involved in the aneurismatic tumor). The anastomosing branch, which
passes between the superficial and deep arches, appeared to be the only one
which was lost in the aneurismatic sac. The soft parts surrounding and
forming this sac were reduced to a state of a blackish bouillie^'m which no
distinction of tissues could be discovered.

The reporter of the preceding case is inclined to attribute the diseased ac-
tion, which, we may suppose, gave rise to the very remarkable disposition
to haemorrhage, rather to an extreme fluidity of the blood itself, than to any
change of structure in the blood-vessels, or in any other of the solid parts. --
That the blood was, indeed, remarkably fluid, and uncoagulable, cannot be
disputed ; but as to the cause of this change we are quite in the dark.

Case. 2, A man, forty-one years of age, who had frequently suffered from
profuse epistaxis and hcematuria, and also from rheumatic pains, acciden-
tally struck his side against the edge of a door : the consequences of this
was an enormous ecchymosed swelling, accompanied with extreme gener-
al languor and tendency to syncope.

On a former occasion, the mere pressure of another person's arm on the
patient's elbow had caused a most extensive extravasation of blood from
that part up to the shoulder.

It is worthy of notice that two uncles of this man had died, when young,
from accidental haemorrhages ; one of them from the bleeding after the ex-
traction of a tooth.

His only sister too died in her infancy from a haemorrhage from the vul-
va ; and his two brothers, after having been subject for many years to vio-
lent epistaxis, perished ; the one in consequence of a blow on the head,
which had caused an enormous sanguineous infiltration of the scalp, and the
other from secondary haemorrhage alter ligature of the crural artery, rendered
necessary by the profuse bleeding from an accidental wound in the calf of th
h^. {Revue Medicale^ October, 1835)

The Hemorrhagic. Diathesis, or ConstUiUion seems to have been very ra-
markable in this family.

Case. 3. In the number of the Archives Genernles for October 1833, there
is the detailed history of a c;ise ofhaemorrhagic diathesis, in which, as in the
precceding one, the patient, a youny boy, was afflicted at the same tijppe
with rheumatic pains. Dr. Hugues had made diligent enquiry as to the
health of the other members of his family, and had learned the foDowing par

18 39.] Remarks on, and Treatment nf, Con, Hcemorrhages. 5G1

ticjlar?. A'l ilir" TO.7Z.'?.<; were subjrct tn nVrnFionnl Rpittinnf and vomiting of
b!i):J ; also lo ti3P !i itiin:), f.\ )isr;i.\-s, Ji'ul to M-.cihlL'soiu lice iiorrliij^e ii'in
any par . vvliich ciiMiicrd to t)L^ v.ouiitl. d. All (tltlietii suff rrd iVorn trouble-
so n.; r.ieiiin I'.ic (>iiiis,"vlie!Jever ili;-'y vvf rc'afKjcteil uirh any torin ol hfEiin r.'-
Iijire, Several lia i died in iheir voutli ; and in those who survived to more
nrifurc ye;irsthe lisinorrhiio-ic. disposition seeniod to l)8C0!nf> less d^'ided.
It had been freqienly remarked ilia% if any of iheni chanced to be blisler-
eil, the dif-cluir^'-e fiyin ijie ve.-ic: led sm-f ce was ij^nornjly bloody.

Several of ; he /e??7a/.-.v of tiiis family, rililioujrh tliey have exhibited the
liemorrha^ic diatjjesii in iheirovvn case, had transiiiil'led it, sans exceilion!
to their o.T^pr.ng-.

If the i.Tf'cedintr observa'io'is are quite accnratn and to bs d^'perd^d up-
on, they present a v-'ry reiir;<abL:' ni-^'ance ofa peculiarity of constitution
i I the mz'e ofa fimily, while the lemales were exempt from it. Th^* ro-exist-
ence of tlu h^ni )rri) iijic aitack> an I of rh 'jm iric pams, :hG former always
preceJintr tjie latter leserves also to be tjoticed.

I '1 the Archives for Jnly IWio, we find some particulars of a family, Uie
Tn-zL'.s of which e^hihi ed ;i snniiar disposition to iroublefome lipn.orrli igev.
<.).>, a boy nine years of aire, p-rished from excessive biet^iin^ af rr the
application of cuppir'g.gjjisscs to the knee; ano'hrr, 'lireo years younptr,
died from a wound on one of his tem;)les from which thrre jiad b< en a most
profuse hemorrlu'tje ; a thin', thirteen years of r-^r, near y lost i. is life fiom
tJie obstinate bleeding- from leech h\'e< n|)on Irs shnu'der.

T.voof the childmi h i 1 l<m<r suTered fnmj rhpumat'c pams.

CrtS^ 4. A man forty years of rgr, ;:rd ofa roft lym|liaiic constitution,
w IS subject lo most troubh-soaie liemorrliiire from very si rjht wounds. Oil
two <K-casions the lileedirfT jifer the extru-lion of a too h iind requiret', for
its arres*, con'iniied compression (or several days. At luuilifr time it was
iiecessiiry to use the actu;il cautery to stop ihe bleedmjr Irom leech bitrs;
an I til'' same means Wcjr,', on o le o "casior, voquisi'e to s:op the bleeding
ii'vu a situ )'e woukI ofa tinker. Several tiin.'s large ecchymoses had form-
ed -ifier very slight braises.

li was for a swelling of this sort on the inner si le of the thijih, tlia* he bad
Con"*ulte I i\I .M ir^olin. 'I'lrs eminent snr^'-eon was inclined to attribu'e the
sing liar ten 1 .'ncy to Ir^rn irr! ig^', wh'ch existed in sue i a case ns the pre.
sen*, r ither to an atony of tht? c.tpillnry vessels, than to Kny marked fluidity
ofth^ bloo ! itsel'", although he w;.s i;o'. disposed to deny some influence to
th's U^ter cause.

It deserves to be no" ice 1, ii refr^'e ten to this su')] .^c', tint wou'^d^ of the
larger bio )lvessel-, such a< th it m 1 1.^ in venssec ion, are usu illy found 'o
h'^il as readily in /ij'/i>''-,i-jij individuals -s'nany o'li-r set of pitienrs.
This, ho vever, is n )r alw -y-s 'h ' cis:^. I).- O'fo of Pliibu'e'phi?, has rec<rd-

0 1 'h ' hisfoi-y of a worn IP, a('o///*.'w.s" s/*r/..s had a remarkable tendency to
tr.) ihles(n ' h *m >rr.'i iges fi->) n h slig'res!: wornds. On \ if not twr, of
tli'i)!<'M; ii .' 1 i 1 e. I J ' I I M i of r'l > I HJ 'i.' b'o 1 tVo n oiM-nary ven'sec-
tioi A cirio i^circu iisr.nnc' is m Mrio!ied of th? ex' r 'ordinary power of i be
9i'.)'i'i'-of>iilx\ 1 ir.-iJ-i I r IT) n >,r'i\i fron soiie of tl.o-e rer-ons I* was
f n I th I', f this s ilr w tj t.ik >, fo.* sever il d lys suce ssively. in doses
larro eno ijfii to p ir,rn the bo.veN-, the bleeding c, ised, md the wound speed-
i'y b'sjin to cic I'ris . (S.>.e no'e at th o.\ I <f this article )

K'*ini >r also allu les to th" effi/ncy of this reme<ly in such casrr. He al.

1 I I 's pirticnlarl/ to the hi-! orv of o.i?> faunlv, of ivliicb all the malz dec<*ru
din's for /.'jur gdn,?rali)rL'^, hid bjcn in;jst strikingly subjact lo hcmorrhag.c
aCiii lents. ,

.M. SiMnn in hi Conr.oirs tjpsis for l*^.^'', nmntims the rase of a tnan
w!i3 lie I fr),n a urc'hral liasii jrrhagc ; d.\ cf his children had perished frtCl
the bleeding from casual wouiidis.
la

Z^2 Vicarious MenstTuatiort, [Junc^

Blagdcn has given us the particulars of a man, wh" ncnrly perihpd irom-
haemorrha^e after the extraciion of utoo'Ji : it wiis not completely iliecked
for nearly ihree ucek;^.

This patient Fubs^cq'iea'Iyliad an alnrmin.nr ]iT:nnrrli"gp from a Ir'fl'nfT
wound of the scalp ; and en a future orca>ion, the Ideeihng which follow( d
the exlractioii of H tooiii proved so obstinate as to r-'qu'.rj the ligatiire ot
tho carotid artery, Iwfore it was arrested I The p?vr'iculurs of this case are
reported in iSainueJ Cooper's "Dictionary of Scr.jvry.".

Inchuimjr mese remarks on ('onsiitutionai hapmorrhrg'^, we may once
raore siate that the cause of this most serior.s conditioi may he either an
atony oi contractility in the tninutp Lloud VFFsels of the part, or a dissolved
and unusually thin state ..f the blood i'selt; wh'ch is thus hut little disposed to
coagulation. IVobably both of these agencies are present in most cases.
(See the following note.)

Finally, in the treatment of such cases, the use of internal astringents ha?,
perhaps, been hitherto too much neglected. The use of the preparations of
lead and of some other mineral astringents may probably contribute very
materially to promote the utility of he il styptic applica'ions. We have foinid
it stated m the report of one of the preceding c;i-es i halt he administration of
large doses of sulphate of soda had a iitr.rked eflTect in f.rrcsiii'g the liEemor-
rhage. Was this owing at all to the rapid discharge of serum by copious
watery stools ]

When we have reason to suspect any scorbutic tenrency in the patient's
constitution, the useof lemon-ju:ceand of other vegetable and mineral ac;ds,
should, as a matter of course, be adopted. Archiies Geneialts.

NoTT The cfRcacy of sii!;>h. of todn, in ilirsc rases, as proved by Dr. Otto, is
very iinjiortant fact in a patliold^ical point ofvitw. It scrms to iis calculated
to confirm tic trull) of ;\vo propfsitio':s. wliich, by the habit of exclusive and
practical views, {jrcatlv to be com^ijaincd of in ibe present a;jc, appear to be ar-
ranged in opposilion to cadi other tiiat is to say, when we consider the pby>i.
logical action of saliocs, this fact confirins the Irnlhs that, no/ to a marked flu.
idity of the blooJ, nor an atony of ih^ capillari-s alone, may these hemorrhages
be attributed ; but, to both of these causes. Thus is the trutli of Dr. Steven's sa.
line doctrine proved, so far as ibis one fact will ^n ; and the opinion of M. Mar.
j'oZin'* opinion of atony of the capillaries. I\l. Maijidin is, however, " not dis.
posed to deny some influence to the humoral doctrine in these cases." There is
no greater or more general error in medical reasming, than tiie omissicn of some
of the causes of the phenomena. This has been the great error, at the starlings
point, of both humoralists and soliJisis. Ed,

Vicarious Menstrvniion. A vrry intriTsling cnse of this
kind occurred ircoittly in Sir P. Dunn's llospital, Huhlin. un-
der the observMiions oI'Dr Lnw. The lollowinir noiicx' of it is
given in the E(lt/thur<s Medical and Suroical JnurnaL This
case, with the cnsr-s of constitutional hcinon liaoc nhove ^ivrn,
demonstrate pLiinly. we think, the ^ircat impuriancc nf nttrnd-
ing with much care, to the state of the great circulating fluid,
and of regarding it as a proper subject of consideration in palho-

1839.] On the Cure of Hernia by Acupuncturation, 563

logy, which has, duiinrij the present a^c, been too much neglected.

" Miry Miirpiiy, ngcil '21, liacl boon in bad li-'.-iltli nnd subject to dis-
trjssjiii<r iie.iil.iciK-.-3 previtiii.s H) I tT aciinit'S.oii iii;n liof^pital. Di;riiij' her
stty ^lJe misled \i lujiisirual iktIuJ, iiiid was ^lnirjy alicr attacked uiilj he-
iiioiTii iie irotn boJi e.ur, uli.rli w.is i:L'|ealeii at iiilerval.s ol't'-OiH three to
'five riigirp, each lasiiiig- t^oiiie Imjrs. Very olt( ii Iruiii liliec ii iDiwenty
oJijceb ot l)l( oJ \v>;ro co.LhUm', wbxli d.d i.ul conuulaie. lu j lit r did biood
taken Irom the iirm. ]i\' siiiiab!e Jreaiiiu.'iit tlie system was ^lr.rlt^Iheue(l,
and the intervals letween the b.eedmgs increased, but the(,ischar;,fe, though
thus niodilied, still peroiisled, and she Jett the hospual. After jier departure
she was attacked wiih vnmitniy; ol bleod, to a cerlain extent, superseding"
the nvacuatio;i trmn the ears, wh. eh only occurred onco or" twice a niontJi.
She retitrned to ih;-r hospital ni coiisequence of tiiis new symptom, and con-
lin.jed in the sam- state tor sdme tnn..% with some etfort at menstruation ;
but at last the saiiguin-ious drscharge was supplanted by severe diarrhcEJ,
whicln having relitned the other cuniplaints, wms itseir cured by opium.
'J'ne quantity of b!ood lost must have Leen enorin )US, and it is not a little
retnirkabie, iha'. none of the s.'jueZ-i; of scverj heuiurrhiige occurreJ."
Aled. lAb.unl EJ.x. Jour.

On the Ralical Cure nf Hjrnia bj Arnpunciiirn/ ion. M. Bonne% one of
the suriTt on>^ of the Horel D.eu at Lyon.--, has coMtr.bnted a very valuable pa-
per to ihe (iazetie M'^'d cale on the above st.b;ici. He has been prosecuting
iiis enquiries lor several y'ais pas', and in that lime he has met with so ma-
ny cases, which lully warrant hini in recomniend.ng the practice alluded tc^
t.iit he is now anxiouo to cuiM.nu.iicare 1> s experience* to the profession at
larjre.

Th' m.'^tho:^ which heciriploys, is to insert several needless near to the
inguinal ipertiire an.i fairly throegli the hrriiiary envelopes, and then, after
T-n'^ngmg lh^'m ^o that the opposite par.e'es ottlie sac are brought and kept
in co!i:.acr,*o leave them in this situat.o;i until r.dhesive inflammation has betn
established.

Bnore djtaling particular cisf?s to illustrate the effects of this practice,
M. Bonnet allude-: to several applications of this form of acupuncturation m
surgery. MM. Velpean and (>aron d;i Villards have, for example, used it
for The purpose of inducing obliteration of arteries; M, Duvat in the treat-
ment of varicose veins, and seveial other surgeons in cases of hydrocele, of
encysted watery tumors, and navi, or aneurisms by anastomosis.

IJ'Jt it IS unnecessary to do more than simply to call the attention of our
readers to these particulars, without entering upon any of their details. The
'object in all these cases is to excite the effusion of lymph, and thus to induce
an agglutination of parts previously apnrr.

The method, which .M. Bonnet, adopts in the treatment of herniae, is as
follows.

Hiving reduced the pro'rurled bowo', he lays hold of the sac close up to
the ring, keening the spermaric cord f^iirly and firmly to the outside of the
fore-finger and thumb oNiisleft hand: lielh^n passes a long needle quite
Ihro'.ijifh tilt entirj thii',kn'?ss of the par', g.iarding tlie head and point of the
instrument, when ir IS fairly throt'gh, with pieces of cork, so as to prevent
its displacement. Sometimes he iwists or curves the two ends of the needle
as a further security against, its slipping out.

H ; iltjr.v irjs p issjj several o'har needles, with S'milar precautions, on
the insidi of this one ; and som3tim3s also one or two on the outside of the
spermatic cord The number of needles that he employs is from six to
eight. It is well to pass a thread through one of the pieces of cork affixed

664 On the Cure of Hernia by Acupuncturation, [June,

to each needle, for the piirposc of a:diiig i's \v;;h:^r2\va!, in case ;L be imbed-
dtd in theswoj.en |)art.

The needies are to be withdrawn nn fnu-ii the s'x'h lo the twelfth day ;
and then a }.ou!t;ce or a coiiii.ctt-.s wcl.cd wiih toiUi- 5|.iriiuous was h, sluuld
be appjied. As soon as the lendenicTg ol the part abate?, a coiupreFsive
bandage is lobe used.

The following is the catalogue of cases treated in this manner by M.
Bonnet.

Casel. A man OR years of age, had been fiffllctcd with an inguinal her-
nia on tlie r ght side Inr seven years. 'J! e i.{.uij.al ( ; i.al w::? to wide that
two fingers might readily be pascjed alor.g it; and htr.ce the | rot ruded mats
was as large and bulky, as iwi* fists when <:!n:cd trreiht r.

Six needies were ir.Lroduced in two ii)wr,o;ie ab we or nearer to ths in-
guinal apperiure than the other.

The mtlammaioryaction m oid pv=ople being tardy, the first needle was rot
removed till the eighth day afier jiistriioi: ; a t^j cond on the ihirttenth. and
the rest on tlie ioli^wmg two days. Tlie patient kept his bed lor ten days :
after this time he rose ; and it was th'^n fonnd that tlie cough, which always
caused the rupture to detccjid quickly befire tlie optraiK.n, had no cfictt
Ujtm It.

A U r;n"gh* Inter he wrs dinnirpf d. arrrrrnlly cr.rrd, l,ut wearing a trus-'S.

Ji seem.-, Iidu evtr, th^t th..i)id im.iii'.< tniigh coMrmued aMirwards to be
as tnfu;iies():ne as c\ ir, and ihar, in coMsetjU. nee of tiiO c>nlinu;il <uccl;fs! n
thys kept up, the rujlurc^ cani'.M. I. un again tl.icc uiun'.hs alUr he lelt ihe
hospiial

Kf It arks. I' "s r"o bo no:ci'd Ihrit every! Iiinr was nr.f ivcrable to a cure
in this case -Ju agj I'fihv.' j)iiuMr, the size ot ilu hcr.s.a, and the constant
coiijih.

O/.s.^ 'J An idio', 45ypar?. ofagr, iiad bron ri:p'in'e;l for twelve years in
I' o jefi groii', when M. BoLnM saw hnn. lie wouhl i o: wrnr a in>>: fo
that eviry !io\v and ttien the iifitni brcime 'xretding^y ;arg'\ (!escpr d
ingas ii)W as thu m dd!e of thi? shii:h, very psinfL', and aiinosi iire. ucbh' ;
the inguinal apuriure was so w:de Ui it iLr-e cio.-ed fingert m glit Le pasted
through i'.

i\in.; ne3 ilos w.:r,-! in'ro lucPv!, f fir in mo rn-.v, in 1 fivj in th,^ o'licir.

P'or the firsis.x day^, th.-TK WIS but ht.:h* pain or irritation. At^f^r this
period, however, ihe sac brg::n ioswel', and a Llush ol" redness surrounded
the seat of 'he purc'invs.

By t!ie twelfth day, the [ur.ct'jrrs wrrc- fourd !n h? ulrcrated ; the nee-
dles, therefore, were withdrawn on this and on ihe jollowing day.

On the 17 Ji day.Mhe h(\nii iry sac was felt to be empty ; but the inguinal
aperruro wasstih perc^ipiib'e, a|'h!>' g'l it was mnch less open than hetorp.

Unfortunately, at thio? period, an aiiaik of erysipelas came or, arcnn pa.
nied with a tronbltsonit' cough. Ther.s;i!L of ihis was thy renewal of the
hi rniary pro'rusion.

3. Tiie following cafe wa? more si:rcc.;sfi:l.

A locksmith, lib years of ag'-, h id b^en jffl c'ed wiih an inguinal rupture
for 13 years: it. was as iar^e as t/ie closed ti^^i. M. Bonnet passed lour
needlf^s thro ighthe sac, as near totharnig as (.o sible. For the first four
days, the patient eypprienced but little iiiccmvenience ; but then tlie seat
ofihe punctures became red and pamfn! ; and by the sixth day the punc-
tures were more or less deeply ulcerated. Tl;e needles were ren:o\eJ on tle
following d ly.

W/ien the tender -.esf-, &" Ind snbs\hf', !he patient renrwed the use of a
tru5S; but nvery uow and :hen In liid i-t aside : yet it was f(.'und that even
when a fit of cough. ng came on, thera was do return of herniary swelling.
AI. Bonnet saw hiin at various intervals during the ne.xt twelve monthf, and

1S39.J On the Cure of Hernia hij Acvpuncturation, 563

Batisfied himself repf?atcdly that the inguinal aperture had become nearly,
if not quitt', impervious.

The fourik case occurred in a ycung map, 24 years of aje : the hernia
was not largerth in a hen's egjf, and ii did net pr():rjde, excep: after exertion
or coiigliiii^-. Hu had betii riicominended to vvearatnis?-, but finding the
UFe oJ It lo be very inconvenient while engajied at work, he h:id laid it aside.
This then;. ore was a favourable c;iS( ; and the result of the acupuncturation
corresponded with the hopes of .M.Bonnei.'i'hree needles only were iniroduc-
ed : on ihee-ghih day ihey were wi'.hdrawn. He remained in the hospital
for another lortnjgjji, ard wrstlun d ecliaiged.

M. Bonnet saw hmi repeatedly during the next fifteen months, and satis.
fied hims-'lf of the permanence of the cure.

In \\\e fifth case, the hernia was of seven year's standing: the patient was
2'A years of age, and the tumor was as large as the fist. Five needles were
passed : they were removed on the seventh and eighth days.

ll is only necessary To add, thatthere was never any threatenirg of the pro-
trusion afterwards. The pa.ient however continued the use of a truss, esQ-
ry now and then, with the view of consolidating the cure.

M. Bonnet alludes to two or three ot^ er cases, and also to an instance of
umbilical rupture in a dog cured hy his meil.od; but oi:r space prevents
us from giving their details. It is important honever to add, that he lias had
two opportunities of ex immiiig ;he state of ihe pir s after the operation in
one case 21 days after the witiirjrawii ofthe needks ; and, in the other, a
year an;J a half af'er the d ite o\ the oi)eiarH)-i.

In tiietirsi of tliase ( x imples, the pa'ient died from an apparently aggra-
vated fi:rni ol sup| rrative or ihiin;i!i('. le\(r. A I; ij^e ; 1 1< ( ts ill lie pto: s
muscle was foui d on tic dissccjon, andscvtral ol ti.e LLccininal vis ctia ex-
hibited marks ot the disease,

'I'ho s!ibcur.aiieoiis cellular subs'ance at the seat of the r.cnpuncturation
was thickened and iidiitfated. The fibrous nienbrar,e enveloping the her-
niary sac, ard,contmioi s \vi h 'he aj oneujosis ol \\\e (.J.lkvva ' aiemvs mus-
cle, did no', exh bit any appearance ofcliaiii^e. One only t>f the five nee-
dles had pa.-sed fairly thro: gli this envelope ; the o her \onr aiaitni ].asst en
dthors df> sa cacit\

On slitting open the peritoneal sac, i's anterior and posterior surfaces did
not aflhere, e^cf pt at i ne pojri oi;!y, whfrc a filiois(oumr, two Imcs in
length and as thii-k Hs a until gr,Lill (or.iuct(d tlifse surfaces together;
thus dividing rhe peritoneal sac in'o an inner ;m(l an outer canal.

Remark. The unsuccessful is^ue ofthe pr.T-pding case was unquestion-
ably attr.butable to the visceral ar.d o'her disc asc, w hich \\!:s cxistirg at
the date of the operation; It cannot therefore be fairly deemed as urging
agHinst the propriety ofthe practice.

The oilier case, in which M. Bonnet had an opportunity of examining
the state ofthe herniary luinor after ijie operation by dissection, occurn^d
in an idio* 43 years of age. He had been affcctefl wnh rupture from his in-
fancy. The tumor was so large that it hung down to the middle of the
th'gh. and the; "nguinal canal was wide enough to allow the passage of four
clased fingers.

M. Bonnet passed eight needles ; but there was great difficulty expe-
rienced in retaining them in their situation. Considerable swelling and
tenderness of tho sac sii')3rvene;l, and a con<id.M*ab!e efF^ision of fluid into
i*.s cavity toek place. Tliis howev^er subsided by rest and the use of discu.
tient applications By the end of the fourth week, the patient was permit-
ted to rise from bed ; and it was lound that even on rough'ng the herniary
tumour did not protrude. It seems however that, two or three months af-
ter his discharge from the hospita', the rupture re-appeared. He return-
edto the hospital about a twelvemonth afterwards, in consequence of a tho-
?acic affection, which ultimately proved iatal.

d60 Amaurosis, [June,

On the dissection of the liorniary tumor, IM. Bonnet found three small fib>.
l-ous i*-ordt', each ofaboulthe size of a wr.nng.qijil', which bound closeJy to-
gether the peritoneal sac and itsj outer fiji-uuiTcnvolope.

M. Bonnet, supposes that iliero wer.^ similar conneclinn; cord?, connecting
t'le anterior, and posterior surfaces ufihe sac i;sfl*', and i hat these were pro-
fa ibly ruptured, when tiie buu els ijrulruded iwoor three munihs after iIjc
on^raion.

it IS worthy of notice tha', b-'foro dispcctinjr the parts, M. Bonnet passed
eight needles throutjh the neck of 1 he herniary s;ic, in ordr r to ascertain
what immediate effects were prodtjced by 1 he iipcraiion. It was foimd on
examination, that three nvly had traversed the >ac. There is therefore, it would
seem, considerable uncertain'y ntlei.ding the use of ucupuncturalion, as des-
cribed 2i\)0\'c.-- Gazelle Medicate.

Amaurosis. A late number of tlic (j'zette Mfu'iicale do Pans, contains
some interesting cases and obse-rvationson this d.s;rr.ssiny alfiction, by .\f.
Petrequin, of the Ho el Pieu of Lyons, who bus cs!abli^hed an opihalmic
cLinique in that institution. Did our hiiiits permit we would gladly lay be-
fore the profession, the cases iind remarks o! M I'etrcquin t ntire, as they
furnish rational views ;ind successful treatnient of a disease, which has long
been one of the o/)/;ro/;nri 7/?ec?ic-y'ifm. We must content ourselves, for the
present, with a brief synopsis.

M. Petrequin objects to a rniform treatment of amnurosis, as all cases
a'e not identical, and the disease is mo^^t jrequently lound coinplicattd wi'h
anemia, sanguine coigesti(:is, chronic sub inihimmaiion of the retina, or oth-
ermorbid condiiions, whicli rende;- any uniform mode of treatment necessa-
rily unsuccessful. His plan is, in ihe hrst place, to treat these morbid slates
with appropriate remedies, and when thiy have been subdued, to resort to
the preparations of ntix vomic;). The tirrit case wii:ch is presented, is that
of a worker of silk, P years of age. and ol sanguine temperamen*, who la-
bored under amaurosis of the rght eye, preceded ny conges ive amblyopip^
The catamenia were regular, and she had never suffered with any affection
of the eyes, except once, tiie prece-ding year, from bathing her feet in the(o!d
waters of the Khine. For some tnj previous she lu-d perceived a weak-
ness in the sight of the ri^h' eye, mists floating before her eyes, orbital
pains, and an unusual sensibility lo Ighl her eye was clear, the ground of
the pupil very black, pupil d.Iated, bui little mobile, and of an irregular form;
from an old wound ot the cornea fo'lowed by adhesions of the iris she had
pains in the orbi', the temple, and forehead, but no other traces of inflamma-
tion or fever. The sight was h s% and th'- patient could neither walk alone*
nor see the hand or fingers of her attendant. She was bled Irom the arm to
the extent of x. and a co.lyrium of rose water and extract of opium appli-
ed ti the eyes. 'J'hese were tbilowed by a saline jurgative, ten leeches to
the right temple, and light diet. On the third day there was some ameliora-
tion ten new leeches were applied, and a laxative ptisan administered.
Under this treatment the pains were r^'moved, and the obscurity of vision so
far relieved, that the patient could distinguish M. I'.'s hand, in proportion
as the sight improved, a little jihotophobia returned. T-mi more new leech-
es were re-applied to the temple. On the seventh day a blister was applied
to the nape of the neck, 'i'liere was no pain, but the dilatation of the pupil
remained, and the pupil was quite black. Hersiglr, however, continued to
improve, and she can distinguish characters of half an inch in length. Be-
yond th'S point, however, no im[)rovement could be effected, and in this state
she remained some days, during which time the treatment was suspended.
M. Petrequin now used frictions with the tincture ofnux vomica on the tem-
ples, forehead and eyebrows. In two days the sight had .became more clear
and extended, and she improved rapidly. This treatment was continued for

isso.j

Atnawosis. 5G7

five day?, at the pxpiration of which time her eye was perfectly restored,
and she left the hospital..

In this I'.a.^e. so noon as the congestion with wiiich tlie asthenia of the re-
tina was coniphcattd was reninvet', by appropriate mean^, the progress of
the case was aslonishinoly rapid.

The next case prescnied by M Pe;requni, was co:np!ic;iTed with anemia,
and ascites, and anasarca, coasec] loit upon intermittent ffver, and conse.
qiently required an ontirt-jy d.tt'orent tre itment. Tne patient was a sadier,
aged 27 years, of a lyniphat:c hut not sTofulous trmperam.nt. He had ter-
tian fever in .August, Iti'M. The disease lasted three weeks, during which
time lie was bled, and look pill.-- cedHiia soon manifested itself in liis feet
and legs, and gradually extended itseli to his thighs and trunk, and wiiTi it a
voluminous asci'es was developed. This state of thmg:! was partially re-
moved by purgatives, but as soon as the abdominal swelling began to sub^
side, the sight became feeble and obscured, and the patient was affected
with an amblyopia which augmented in intensity as the ascites and anasar-
ca disappeared. He was bled trom the arm, and vesica' ones and a seton
applied to his neck ; but the ama-jrosis continued to increase, and he left the
hospital. On the first of January lie re-entered the lio-piial in a miserable
state. His skin was pale, his lunbs ce lematous, and his abdomen swollen,
but without pain, his digestion fee >le, and appetite but small. He cannot
walk, andean scarcely rise from his b(-d. There was no appreciable alten--
ti' n in the eyes. The pupil was cleir, and moder itely dilated the iris of a
brown color and mobile 'he paralysis of the retina is general, and he sees
ro better on one side than the other bat there was neitlier pnn nor photo-
phobia. He could see his hinrls indistinct ly, but could not rlistinguish his
ti;gers, and he hid the characteristic, physiognomy of the blind M Petre-
qum belore he begin the tre itment <'f the am lurosis, placed the patient
upon a suitable resrora'ive course under why-h his general health improved,
but his eyes remained in the same state vesication on the forehead over
the right eye was pro lured, an I a q rirter o'a grain of strychnine and three
grains of nux vomica were applied to the abraded surface. This was repea'-
edin a few days. In a few hours af'er tite firsr, application, there was an
evident improvement in the visioi of the rigiit eye but the left remained un-
altered. A similar treatment was now ad >ptPd for the left eye, and two
pills of calomel given daily The visir)n of the left eye now began to im-
prove. .As an auxiliary the tincture of nux vomica whs applied o the fore-
Jiead. Soon alter the sixth vesication, which had been rept-ated every five
days, his vision became clear and expended he read small characters nculo
curen^g, and saw equally well with either eye. The whole treatment only
occupied twenty six days, and when it is considered that the disease had
lasted four months, that the ordinary moms had failed, and that it was com-
plicated with a radically depraved state of the general health, we must ad-
mit that theendermic method of applyingrlie strychnine is one of great pow-
er, and that M. Petrequin is entitled to high credit fur his successful treat-
ment. In his remarks upon this case, M. P. give his oiinion that in anala-
gous cases the seton in the neck has the effect of increasing the visual as-
thenia. He also condemns the use of bandages in similar cases, as he be-
lieves the light is then a very useful excitant.

We have n t rortm for a more extended svnopsis of M, Petrequ-n's inter-
esting paper, and will only add some of M. P 's co'u hiding observations.

" Without method we shall arrive at no'hing. P is with this view that I
have endeavored to point out the nncessi'y of preparing the patient proper-
ly, and of thorouglily anaiy:,innp the di(fv.'re:it elements of the disease, as the
only course which will enabie us to combat it with appropriate meanp.
Without that, this metjiod though so efficacous, may prove dangerous, if,
for example, there exist ramollissement of the brain, a varicose state of thff

56S On the Catcptric Exnminalion of the Eye, fJune,

vessels of tliPretinn. ;i lunit nriilnr plilpcrmisip, nn infljimtmtorv, connrpstive
or iipnpl(?ctic. KiiosyiuT.icy, &o. Mt^rcun'^ils e\erf. a powcriul iiifluenrr,
1h()in-li ni-.n-eneril hsit li.ile mi(lerst<i<-l. Cnlitinpl, wlrcli produces such re-
m)rkib!e anripljlo^isiic rffl'cJs in p'ri!oriitis, i-i n';nple or plilecrmon'c erysi.
pehis, and wliicli proljces smpIi an iniporrfint. antiplastic ac.iion in iriijs and
in iny ncular att'-crjon--, constitutes an efficacious r. mody, wliicli has not been
suffi.iiently lestf'd in anala;i"oJs cases Ii protno'es llse ahsorprion (f ob-
structions of the retina, and a rettjoval of the irritatioi s which are dev( hipetl
ther<% and. contributes to a favorabh' issue of the disease, bul every iJiing de-
pends upon t'jfir being aduiinisterfd uj.ro^os.

On t'lP- CatnjArir Exam\nal.lm.nJ' t'le Eyz. Hy the Editor Tn our num.
ber for Aujjusf, H38, we give an account of a n<^w means of diagnosis be-
tween amaurosis andcafarac*, discovered by M Saiif-on. The snrgpon ob.
Ferved th it, when a hgh'eJ candle was held before an eye, the pupd of w hich
was dil ited, and i:i which thf're was no obscurity of the transparent tissues,
three distinct im iges of the fl ime were visible ; 'two upright and one invert-
ed. Experiments mule to dc?termine ihe causes of these reflected images,
and the changes which oi-t ur in ih,;ir nnm')ei*, position, .&,c. have shown, that
if a light be placed before the convex face of a single watch glass, or ot sever-
al arranged one behind the other, one or morj u[)r!g!it imag 's of the flame
will bi seen, accordmj: to the number of glasses used.* Now, in the eye
there are two superiinposcd convex surfaces, viz : I. the cornea, 2. the an-
terior capsule of the chrysraline lens. Thus the formation of two upright
imag's IS explained.

Again, if a ligit be placed he "ore the concave surface of a vvatch jrrl-'ss an
inverted imige is seen. Such a surf ice exists in the ey, in the j osterior
capsule of the lens ; and thus the third imiL'^e is accounted for.

We have been led, by tjje statoment. of iM. S inson, to examine the eye ra-
toptrically in a irmr)er of cases with n the last ten months, and the results of
our investigations are eU'irely corihrmitory of the representations of that
distinguished surgeon. I5ut it is nor merely as a means of diagnosis between
cataract and am iurnsi'=', that this jn^ihod ofeximining the eye is useful.
The color, size, dis'inctness, &-'". of the reflected images, enables iis to dis-
tinguish many conditions of the transparent tissues of the eyes, vv])-ch could
no% by any other means, be diagnosticated. f)r. Macken/ie, ot Glasgow,
iias recently employed it to deferiiiine the seat of the different varieties cf
glaucoma, and it is capable of fur; her application. In fact, we are persuaded
that the c:itopM-ic examin ition of the eye will prove as useful a means of di.
agnosis m various alterations of that organ, as auscultation and percussion
are for those of tlie c!iest.

ft should be borne in mind thit very mrefal examination is usually r 'quir-
ed before those who ar.j un i^'.cnst.nni m1 to observe them are able to defect
the refljcted images once noticed, however, they are afcrwards readily
seen.

Dr. John Neil', the in'ellio-ent re.<?ident surgeon at VVilk Hospital, hns
constructed soru' udIjN w'lich serve lodlus'rre thf^se catoptric ohenome-
na, an 1 to assist, the stn l.^nt in d'tecting the r.'fl M'.ted m tg.-^p. These mo-
de!s are form ul of three w itc'i glasses, 'i'wo of rh^'m are of the same size
and sm iller than the th'ri. The former are attached lo(rethpr with their
concave surfaces oppose^', so as to represent the capsule of the len.sandare
I I -111 iiiii. - . I . , , , . > , . . , . ^,y_

* At lea<5t so it is sta'n 1. B it in (r Jt!i, eic'.^ im i^e is double one beings
reflected' from eacif surface of the glass ;. aud liicse images are the^ more
distinct the thicker the glass is.

I939.J Recamier on the Efficacy of ExlensioTit (^c. fiC9

inserted in a hole made in a circular piece of pasteboard. Tiiis diaphragm
thus constructed, is placed in a pasteboard cylinder or circular box near one
end, and this end is covered uiih a J;irger glass, to represent the cornea.
Tue other end ol the box is closed, and ilie pans described are kept togeth-
er by strips of paper and paste. We have thus a gouu representation of a
natural eye. 'lo represent the opacity or the capsule, other models are
made with paper pasted on one or the other of the reflecting surfaces.
With a little ingenuity niod^-ls m ly thus be ni;uh lo exh'bit sufficiently
well most of the diderent conJitions of loss oi transparency of the t.ssues of
the eye.

Our investigations are not sufii-ient'y matured to authorise us to lay them
at present beiora the public, but we hope in due lime lo communicate the
results. Am. Jour. Mea. tSci.

On the EJicacy of Extension, Shampooing, and Percussion^ in Muscular
Contract ions, iiy Dr. Kecamiee, ot the liotel D;eu. The j.eculiar func-
tions of all the organs of the body may be disturbed, either directly or indirec-
tly the deviations from health being in many cases deptnuent upon the
state of an organ at a distance from ilie one, which exhibits the moibid phe-
nomena.

The contractile functions of the miiscles, involuntary as well as voluntary^
not unfrequenlly exhibit the truth of this remark. My object m adducing the
following cases is to point out the great etfioacy of sunple nijchamcal means
in rectiiymg many muscular ailments.

1. About eighteen years ago, 1 was consulted by a middle-aged gentle-
man, who had for upwards otiour years been regularly nailed to his bed by a
pain in the right side of his neck, shou.'d^r, and arm, which was so agoniz.iig
on the slightest movement that often he cojiJ noi rjirain from screaming
out.

All sort of anodynes and emollients had been ineffectually tried- I advis-
ed the use of regulated and, us it weri, elastic ptTcussjoj vvnh the hand
on the affected part. At the first it was to be adm.nislered in gentle taps,
and gradually wi'h morj and more k)rcible b-.-ats. By ili j aid of this simple
means alone, the patient was speec i y r 1 jved from all his suifering, and
was soon enabled to resume his duties as a judge of the peace.
2. A young girl, 13 years of age, was acm:ued, in ISV\ intJ the H3tel Dieu
under the care of M. Racamier, lor pleurisy. At the beginning of the follow-
ing year, the catamenia, which tor some tim? bii:k had been scanty, were
sudd.mly arrested by exposure to wet and cold. Dyspnoea and general ma.
laiie were the consequence. fcJhe was re. admitted into the liotel Dieu,
Leec'ies were applied repeated by to tip vulva ; but then the left arm, fore-
arm, thigh and leg, becanu affected with extre nj ng d.ry, and theje symp-
toms were accoaipanied with reteniioa of uri.u, and vvitii a most painf j1 dil-
ficuity in evacuating the lo.vels.

B eedng, anodynes, in eneina'o, as well a' given !y th^mou'ii, &.C.,
&c., were freely eini)loyed, but wiih no avail : and this poor creature remain,
ed fur two entire mDiitns n the most disir rsi g situa'ion of stitfjess of tae
left limbs and retention oi (or rather, we pi\;. u.ne, > i dju ty in pas: n ;) the
urine and the fseces.

On examining the rectum i'. was found to 1 o q lite cm;)ty ; but the Tjphinc*
ter ani was exceedingly contracted.

1 dilated the stricture ; the pain, although severe at the time, ceased al-
most immediately, and the evacuation of tne bovvels became at or.c^ much
more easy.

The rusult of this first txial induced me to treat the urinary affection in

570 Recamier on the Efficacy of Extension t ^c. [June,

a similar manner ; and with this view I b^an to work Or knead {was^er^ the
neck of the bladder against the pubes, by means of a finger introduced into
the rectum ; the strangury ceased as quickly i.s the constipation had done.

1 then resolved to appiy a similar mode of treatment to the contracted
muscles of the limbs, acting as in cases of ordinary cramp.

1 commenced with the arm ; and it was not without great difficulty that I
overcame, little by little, sometimes by continued efTorts and at other times
by efforts en ca(/e/ice, the resistance of the extensor muscles of the fore-arm,
the fiexor of the hand, and, also of the deltoid and other muscles of the shoul-
der-joint.

By dint of patience, however, the arm was bent, the hand opened, and the
arm was gently removed from the side ; then laying hold of the hand, 1 kept
swinging it about.

After this rather violent, and moreover painful, manipulation had been
continued for some time, it was found that the patient was able to move her
arm about herself.

My attention was then directed to the affected lower extremity ; but here
it required the strength of three people to bend first the knee and then the
thigh on the pelvis. We may readily suppose that these efforts were attend-
ded with great suffering to the patient. When the pliabihty was once res-
tored, the hmb w as swung about from side to side lor some time. This did
rot require to be continued long, till the girl was able to use the limb herself,
BO as to walk about the ward.

Gradually she recovered the use of all the contracted parts, so that she
Boon left the hospital nearly quite well.

The third and fourth cases were of wry neck ; in both, the disease was
cured by the gradual but forcible extension of the contracted muscles.

The eleventh case which M. Recamier relates, was one of permanent
and painful rigidity of the muscles on the back of the neck, in an
elderly lady, who was, in consequence of the affection, confined constantly
to her sola. A variety of means had been ineffectually tried for a length of
time, when, on the suggestion of our author, shampooing and compression
speedily effected a cure.

5. Five and twenty years ago, I was consulted by a lady, who had long
severely suffered from ti fissure of the rectum, for which the late Baron Boyer
had divided the sphincter.

The operation, however, did not prevent a relapse of the disease, and the
patient continued to suffer dreadful pain in the rectum, especially on going to
stool.

Dilatation of the sphincter and of the lower end of the rectum, by means of
bougies, gradually increased in size, ultimately succeeded in effecting a per-
fect cure.

It is to be remarked in this, and ii? many other similar cases, the dilata-
tion was attended with excruciating pain.

Dr. Recamier mentions several other instances of painful constriction of
the anus, either simple or complicated with hsemorrhoids, fissures of the rec-
tum, &-C. in which the use of gradual but forcible distension of the gut was
speedily followed by great rehef, and ultimately by complete recovery.

He adds that the surgical operation of dividing the sphincter may be dis-
pensed with in the majority of cases.

6. Several years ago I was sent for to a middle aged lady, who was suf-
fering dreadful torture from une colique nerveuse et apyretique.

Without delay I placed my extended palms on her belly, and commenced
a gradual and firm compression this had not been continued long before
the severity of the suffering quite ceased.

In a future paroxysm 1 made her waiting maid asseoir sur le venire de sa
mairesse ; and this mode of compression was speedily effectual. (!)

1839.J Recamier on the Efficacy of Extension, <^. 571

In another case of a like nature, T have used with success a binder drawn
very tightly round the abdomen ; adding, if necessary, a pad or cushion
over the seat of the pain at the same time.

When in severe colic the intestines are felt through the abdominal parie-
tes, like hard cords or serpents, I have repeatedly relieved the patient's suf.
ferings by kneading them, as it were, with my hands, so as to overcome their
unnatural state of constriction.

7. A lady, thirty two years of age, long suffered from excruciating pains
in the hypogastrium, unattended, however, with fever. On examining per
vaginam, the uVerus was felt to be quite healthy ; but, on examination by
the rectum, the posterior surface of the uterus was found to present several
inequalities to the finger. This c ise I regarded to be one of a purely nervous,
or muscular, character, and likely therefore to be benefitted by compression.

Grasping the uterus in the hypogastrium with my hand, I pressed upon,
with two fingers of my right hand in the rectum, the inequalities just now
mentioned ; I was surprised to find them gradually disappear ; while at the
same time the patient, who at the beginning of the experiment suffered
most severe pain, declared that she was now comparatively quite easy.

These bosselures having been in this manner dissipated, on three or four
occasions, the pains ceased to return.

The cure was rendered per.nanent by the use of a bandage, tightly lac-
ed round the pelvis and hypogastrium.

What relation is th^re, ad Is \I. Recamier, between the cause of these
uterine pains and the partial spasms of the womb an organ which we
know to be muscular and eminently contractile 1

The next two cases, which our author records, are instances of violent
intestinal spasms, which were speedily relieved by the employment of forci-
ble compression, and of enemeta of warm water administered at the same
time.

10. A lady, thirty years of age, had for several months been affected with
a permanent and apyretic hiccup, the secowss^s of which were so violent, as
quite to lift up and shake every part of the body. Various remedies of an
anodvne, antispasmodic, &c:, nature had been employed but without decided
benefit. I suggested the use of a firm belt, provided with a pad or cushion
placed over the pit of the stomach. By this simple means alone, the patient
got entirely rid of lier annoyinsr ailment.

12. A young lady wa?, in 1884,affected with various chlorotic symptoms,
for which si^eel, active oxercise in thp open air, &c., &c., were recommend-
ed by Dr. Colson of Beavais, In 1835, after exposure to wet and cold, she
began to be affected with an incurvation of the spine to the left side, so that
the trunk formed at length an angle of 45 degrees with the vertical 'axis of
the pelvis ; and at the same time, the right fore-arm was immoveably con-
tracted upon the arm. Such was the condition of this poor invalid, when she
was sent to Paris to be seen by MM. Andral and Marjolin and by myself.

Leeches, cupping over the spine, baths, &c., had been repeatedly tried ;
but without any effect. The result of the metropolitan consolation was to
recommend the use of gymnastic treatment, of fumigations, of leeching and
cupping, of embrocations, &c, but these means were used with no better
results than heretofore.

She was then put under the care of M. Guerin, and subsequently <jf
M. Humbert at Morlaix ; and, although nearly two years were spent in try-
ing various remedies the condition of the patient was little, if at all, improv-
ed.

Upon her return from Morlaix, she once more consulted M. Recamier,
who, remembering the striking results obtained in the second case, sugges-
ted to M. Colson to try a similar mode of treatment.

Severe pain was caused by the forcible extension of the forearm, combin-

672 Recamier on the Efficacy of Extension, ^, [June

ed with the shampooing of the biceps muscle. This might have been ex-
pected, seeing that tlieinuscle had beeen permanently contracted for up-
wards of three years.

Tlie gradual extension and kneading of the muscles of the affected shoul-
der and of the Irunk were attends. 1 with m icli less pain ; indeed the mani-
pulation, although verv irI<so:ne, \v;is ulrnnst im:)iedi;itely followed by a feel-
ing of ffreat relief. The iinprovetneni of the state (jfih'e shoulder and of
the affected side of the neck was speedily m->st remarkable; the condition
of the arm and fore-arm was not so promising.

By continuing, however, steadily the same plan of treatment, this young
lady gradually recovered the use of the contracted limbs, and was enabled
to resume S3S ancknnes habitudes ; whereas, during the preceeding three
years, she had been quite shut out from society, and an object of great
helplessness.

13. Last December 1 was sent for to meet MM. Lisfranc and Chevreux
in consultation upon the case of a middle-aged lady, who had been affected
pome months previously with hysterical ailments ; on the ces>sation of which
there supervened a violent pam, first in the coccygeal and then in the cer-
vical and occipital regions, recurring in fits of the most excruciating agony.
Durinor ihe continuance of these most sevrre sufferings, there were also,
now an I then, symptoms of subacute inflammations of the uterus and its ap-
pend^g-es present.

The patien' hnd bpen visited by M.^^. Andral and Chomel. A host of
mf?<licines, antiphlogistic, anodvne, epispastic, derivative, &c., had been tried;
but without any decided benefit. The quantity of opium, which she had
taken w-ithout producino- even narcotism, was immense. What had procur-
ed perhaps more relief than anything else was the application of four grains
of the extract of stramonium to a blistered spot on the scalp; but the symp-
toms of pnsoning from it wero so alarming that the pliysician was unwil-
ling to repeat thi^ remedy.

M. Recamier, havin'jr attenrivelv studied all the phenomena of this very
aggrnvated case, sufro-ested the following means to be tried: a firm belt
round the hypoo-istraim, provided with a strap and cushion to compress the
OS coccyx and the fundament ; cnemata of assofoetida, camphor, castor,
opium, an-l sometimes ofquinin?, when th? return of the paroxysm appeared
to be at all prnodic ; the internal use of pills of musk, camphor, and assafce-
tida ; electro pnncturation ; and lastly the^ extension and shampooing of all
the muscles, which were at any time affected v.ith cramp.

Before leavinsT the house of the patient, M. Recamier had an opportunity
of wi^nessinor one of her dreadful paroxysms of pain, which had, hitherto,
usually lasted for three or fo ir hours ; the head was thrown backwards, and
lier features were distorted hy convulsions. Having satisfied himself that
the muscles ^i 'he h^ck of ilie npck and shoulder were violently contracted,
he rpi]ue=*ed M NT. Lisfnnc and (^hevreux to fix the two shoulders, while with
one hand lie C NT. Recauiier) forcihlv drew the head forward, and with the
othf^r he Iwaiel and rommeUr'd\\\9 affected muscles.

The p-tient all tin's time was screaming out with pain ; but no sooner was
th" hpad fairly bent ferwardthan she becran to smile, and confessed that she
was quite easy. AT. Recamier advised that the head should be removed
n''M|t from side to side for some time, in order to prevent the speedy return
of tho cramn.

Th-^ f ?tur'^ ppi-'n^ps of rh'' dispaso were always treated in the same simple
manner, and with equally gratifying success.

(The report stops here.)
^ M.Recam-er closes his interesting and instructive paper by the enuncia*
tionofthe following conclusions :
. It is necessary to discriminate those spasms or contractions, which tt

1S39.] Urea in the Blood in Cholera, ^c. 873

not dependent upon or proceed from, an affection of the nervous system, but
which constitute a direct loss of the contractile functions of the affected
muscles themselves.

h. In idiopathic muscular contractions, in VvTV-neck, in spasmodic colic, in
permanent spasms of the sphincters, &c., the use of extension, compression,
and shampooinr^, and the application of the cupping-glasses, seem to be by
far the most efficacious means of treatment.

c. Hence it is rarely necessary to have recourse to section of the contract-
ed muscles in such cases. Where we know, or have reason to suspect,
that there is an actual degeneration or morbid change of structure in the
part, such an operation will probably be necessary. Revue Medicate.

Remarks. We quite agree with the Editor of the French Journal, in
which M. Recamier's paper appears, that it is one of the most practically
valuable which has been communicated to the profession for a great length
of time.

The character of M. Recamier stands very high among the ablest phy-
sicians of the French metropolis : from our own experience of the French
medicale literature, we should be inclined to award the palm of pre-eminence
to him and to M. Andral, as the two men of the largest and most compre-
hensive minds, and the best imbued with the genuine spirit of true philoso-
phy.

Their views on medical questions are always clear and sagacious, and
their practice seem? to be invariably simple and natural.

They are the very antipodes of such men, (able though these are) as MM.
Bouillaud, Velpeau, &r., who too often allow themselves to adopt certain no-
tions of disease, and strive to confine nature within definite and arithemeti-
cal calculations. Ed. Med. Cldr. Rev.

Ur^a in /he Blond in Cholera. In a recent Number of Poggendor/*s Aiu
nals, it IS stated that Marchand detected slight indication of the presence of
Ur^a in th^ blt)')d of a patient who was affecFed with cholera, and who had
no', pisse,] urin3 for thrje diys. Sill m)r3 racently Dr. Harry Rainey, of
Glasgow, his distinciy detected urea in the bloodof a patient who had died
with all th? svm'oms of Asiatic cholera. The patient, a female, was ill
eleven lavs d irioof which only 'V^ ounces of urine was secreted, including a
small q-nn'ity f JunJ in the blad Jer after death. The blood analyzed was ta-
ken from the'laruer vessels and heart. There was detected rather more
thmonegrainof urea in each ounce measure of blood. Lo/icfon Medical
Gazelle, 1839.

Annalysis oftheliquor Amnii. Dr. G. O. Rees has made a chemicale ex-
amination of the liquor amnii in four cases obtained, at the 7 1-2 month of
uterogestation. 'J'he results shovv that this fluid varies greatly in propor-
tionafconstitution in different, individuals, at the same period of utero-ges-
tation, so that, Hke all the secretions of the body, it is agected by the temper-
ament r.nd diathesis of the mother. The specific gravity of the secretions,
however, varied but little in the specimens examined by Dr. Rees, (1007. to
lOOS f)) a precaution, he thinks, on the part of natifre, to preserve a medium
of fived power to oppose the motions of the foetus in utero.

The experiments ofDr. Vogt, of Berne, (see this Journal for Nov. 1837,
p. 219,) would lead us to suppose that there is a great variation in the densi-
ty of the fluid at different periods. Dr Rees does not regard those experi-
ments as conclusive, as there is a want of proper relation between the solid
contents and specific gravity of the fluids, as given by the Swiss chemist.
Guy's Hospital Reports, Oct. 1838.

574 Periscope. [June,

Part III. MONTHLY PERISCOPE.

Hooping Cough treated with Carbonate of Iron, We are in-
formed by the Med. Chi. Rev. from die Medicinishes Corresp,
hlait, that " Dr. Steyaiann, a correspondent of one of the Ger-
man Journals, very strongly recommends the use of chalybeate
medicines, in the cold or chronic stage of hooping cough.

He gives it, at first, in minute doses, frequently repeated,
alone, or in combination with sugar. He always premises the
use of an emetic.

The following cases illustrate his practice :
" Case 1. Henry Schraeder, 11 years of age, had been suffer-
ing from severe hooping cough for upwards of two months,
when Dr. S. visited him. He prescribed.

Carbonate of iron, twenty five grains.
White sugar, twenty grains,
divided into ten powders, and one given every three or four
hours.

In the course of a very few days there was a marked mitiga-
tion of the cough. The quantity of the carbonate in tiie pow-
ders was gradually increased ; the hooping ceased, and the pa-
tient quickly recovered his strength and plumpness.

Case 2. Jules Etier. five years of age, had just recovered from
the small pox. when he was seized with hooping cough. He
had been suffering from most violent paroxysms of it for up-
wards of three weeks, when Dr. S. ordered him the use of the
carbonate of iron. At the expiry of four days, the child was
completely relieved from the cough.

N. B, The suggestions in the preceding communication ap-
pear to us to merit the attention of medical men."

Closure and Obliteration of the os uteri, during pregnancy.
We give the followmg extract from the American Journal, as
it is curious and novel. But since we have found accoucheurs
disposed to cut the presenting part of the uterus, in cases of this
anteversion of the uterus which carries the os uteri too high
up on the sacrum, we feel unwilling that it should go the public
without a caution for ensuring a correct diagnosis between such
cases and real obliteration.

Dr. Samuel Webber, of Charleston, N. H. says Early one morning I

was called upon to attend Mrs. O , aged '28, in labor with her first child.

The pains were said to have been regular and of moderate strength at night.
Upon examination I found a large rounded tumor pressing well down into

1839.] Neuralgia of the Testicle, S^^c, 575

the vagina, but could at first discover no os uteri. After a prolonged and
careful examination, I found a little back of the centre of the tumor a slight
inequahty ; consisting of a very shallow depression or dimple, just admitting
the tip of my finger with a little inequality in the edges surrounding it, a
very slight protuberance being perceptible before and behind it. The ca-
vity of the dimple was smooth and firm. It immediately occurred to me,
that from some inflammatory action, union had taken place between the lips
of the OS tincff, thus obUterating it, while the cervix had been completely di-
lated, either by the growth of the child, or by the parturieni action. As the
pains were not excessive, 1 determined to wait, with the hope that their pro-
gressive action would either overcome the adhesion of the opposing surfaces,
or so dilate and enfeeble the point of union, that but little assistance would
be necessary ; at three P. M. the pains began to be severe, but on again ex-
amining, I found but little change, though the whole accessible parietes of the
uterus seemed thinner and softer than in the morning. After noticing the
effect of a pain or two, as another was coming on, I pressed the end of my fin-
ger firmly into the shallow depression, so as to present the edge of the nail
to its bottom, aiding its effect with a slight scratching and boring motion.
In a few seconds the finger passed through to the membranes, and the os
uteri rapidly dilated to the size of half a dollar. The labor terminated fa-
vorably about seven o'clock P. M. and the mother's getting up was speedy
and favorable.

Neuralgia of the Testicle. This, wiih the two following arti-
cles, have been extracted from the Doublin Journal, by the
American Journal of xMedical Sciences.

This is fortunately a rare disease, for it is one of the most painful ones to
which man is subject, and often a very intractable one. Dr. Graves, in the
Doublin Journal for January last, mentions two cases. The first occurred
in a young gentleman of highly irritable nerves, who had studied hard and
dissipated much. The paroxysms of pain did not observe any marked peri-
od, but returned daily at uncertain intervals, which grew shorter and short-
er, until at last he had scarcely any respite day or night. There was no fe-
ver, and not the slightest appearance of local congestion or inflammation.
This case yielded to large doses of carbonate of iron freshly prepared, and
frequent inunction of the testicle and cord with belladonna ointment.

The second case occurred in a gentleman who labored under neuralgic
pains decidedly of a gouty nature. h\ him the pain of ihe cord and testicles
used to come on every afternoon about four o'clock, and continued for sev-
eral hours. The pain was at times very severe. The neuralgia of the tes-
tia disappeared after a few days, and was replaced by a violent gouty pain in
the loins and right hypochondrium. The latter yielded to the usual local
treatment and the use of colchicura internally.

Method of preparing Sinapisms for the purpose of withdrawing Gout from
the vital organs to the extremities. Dr. Graves says that the sinapisms usu-
ally employed for inviting gout from vital organs to the extremities, act too
quickly to be long borne ; and of course only give rise to very superficial in-
flammation, and that of very brief duration. To fi.x gout in a part, e.g., the
foot, he adds, our application must act much more gradually, and must excite
the deeper seated tissues. These objects may be obtained, he states, by
mixing one part of strong and fresh ground mustard powder with three of
flour, and adding as much treacle as will convert them into a viscid paste,

070 Periscope.

which may be spread like a plaster on linen, and applied to the part. This
will be borne i'or lour or six hour?, and will cause a redne.^s w liich will last a
whole day. The proportiua of fiour may vary according to circumstances.

Treatment of Permanent Hypertrophy of the Tonsils. Dr. Graves consi-
ders the best remedy tor this atfection, to be the nitrate of silver, and he pre-
fers Mr. Cusack's method of applying it which is as follows : "The solid
stick of lunar caustic, or some of the latter in powder, and placed in a proper
instrument, must be kept steadily pressed against a particular spot ot Ihe
enlarged gland ; two, three or five seconds will suffice to secure the forma-
tion of a small eschar, which falling out, will leave in the part, when healed,
a slight depression like the largest pit formed by a small pox pustule. When
this has been effected, which is usually in about five days, a similar proceed-
ing must take place with the other amygdalae ; and so on in each, turn about,
until the desired reduction of size has been accomphshed." Dr. Graves
prefers this method, to the use of the ligature or to excision. When the
glands arc l:irge, he says, this process usually requires about six months ; it is
slow but sure , and must be intermitted when any accident gives rise to
temporary sore throat or catarrh.

Division of ihe Prostrate in Lithotomy. H M. Phillips, Esq. Assistant,
surgeon to the Royal Cornwall Infirmary, strenuously recommends the fol-
lowing modification of the above operation, as diminishing the risk of hfe
usually attending the lateral operation of lithotomy ; viz. hemorrhage,
puncture of the rectum, peritoneal inflammation, with parulent deposit about
the neck of the bladder ; and infiltration with its consequences.

Having introduced a straight grooved staff into the bladder, and having
reached the membraneous portion of the uretha by the usual incisions on the
left side of the perineum, I cut into the groove of the staff. The staff being
still firmly held by an assistant, 1 introduce the nail of the fore finger of the
left hand into the groove, then insert the point of the knife, also into the
groove in advance of the finger, i;s flat surface resting on and parallel to the
plaine of the nail ; both are then carried steadily onward until the knife en-
ters the bladder: indicated by the gush of water ; it is then withdrawn, and
the finger used in pushing firmly and fairly into the bladder. The forceps is
then introduced upon the linger (the best director in all opcrii >as}, and the
stone is embraced.

"It will be seen that the princ'p'o actel upon here is tlie sa Tie as that
which proved successful in ihe hands of Cheseldon, and was so warmly com-
mended by iSirAstley Cooper ; namely, the partial separation of the lower
portion ofthe prostrate gland with the knife completing the separation to
the necessary extent without a cutting instrument. ("heselJen used for this
purposed the blunt curved gorgot, I use the fin<j,er. And I do declare, hav-
ing tried this method on the adult, 1 have found no difficulty v h u ve in en-
larging the opening sufficiently, by simply protruding the ling r nlo the bk d.
der, which is accompanied with the sensation of a slight tearing.

" The advantages of this mode of operating are the certainly of avo'('i ^g
hffimorrhage, or of puncturing the rectum, and the equal certainty ot being
able to make the opening into the bladder 'arge enough, to extract the stone,
and no larger. I may add, that 1 never yet found any perineum too deep to
prevent my enlarging the section of the prostrate with the finger; and I am

auite satisfied that any iithotomist who may adopt this method will^^not rea-
ily abandon it. London Med. Gaz. 15. Dec- 1838.

-#l^^%

SOUTHERN MEDICAL

AND

SURGICAL JOURNAL.

Vol. III.] JULY, 1S39. [No. 10.

Part 1. ORIGINAL COMMUNICATIONS.

ARTICLK I.

A case of Aneurism^ successfully treated hy the Needle, Read
befne the Medical Sf ciety of Georgia, JJy C. P. Richard-
SONE, M. D. of Savannah^ Geo,

In submitting the following case, as illustrative of ihc treat-
ment of aneurisai, to the consideration of the Medical Socit-ty. I
do so as miali from its n )velty, as a h ipa that its successful ter-
mination may induce others, when th(j opportunity occurs, tore-
sort to a similar practice. On one or two occasions I had
met in the periodicals of the day, with cases of aneurisms treat-
ed successfully with the needle, and as the reasons advanced in
support of the plan appeared to me fair and specious, I determin-
ed, sliould a case of the kind come under my care, that I should
give il a trial. When the following case came under my obser-
vation, I put my resolve in practice, and feel gratified in saying,
that its issue was as hnppy as I could have wished.

An3urism is a disease of so peculiar and dangerous a r'larrc-
ter, that its treatment in modern limes has nccessari'y engaged
much of the attention of surgeons; consequently, we find, that va-
rious methods have been devised and promulged for their allevi-r

lA

578 Aneurism successfully treated hy the Needle. [July*

ntion but all approved modern authority appears to liave set-
tled down into the belief that the ivnife is the only remedy on
which they can rely. That aneurism can be sucxossfully treat-
ed wi;h the needle, I have every confidence, and if so, certainly
the taciliiy of the modus medendi the small amount of suffer-
ing the rapidity with which tlie cure is effected the absence
of all danger all taken together and this superseding a pain-
ful, and to say the least, not always successful operation, is an
achievement in the cause of suffering humanity, and certainly
worthy of the consideration of the accomplished surgeon. Jn
all lesions of parts, nature establishes a process of reparation of
her own. The successful surgeon is he, who narrowly watches
her indications, and acts as an auxiliiary to her. We all know
that the knife is the opprobrium of our art ; if then, by sedulously
consulting the hints that nature throws out, we can substitute
means by which the knife may be set aside, humanity and sci-
ence alike call on us to do it. It is particularly worthy of atten-
tion, that in aneurism, as in other diseases, nature is known^
sometimes, to perfect a natural or spontaneous cure, and that
this cure is achieved Ly no less than five w^ays though in all,
the principle which nature employs for the cure is identical.
The first of these is accomplished by the aneurismal sac being
so strengthened and filled with coagulable lymph, that no fluid
can pass into it, and of course all danger of rupture is prevented^
whilst at the same time the original canal of the vessel remains
pervious, and transmits the blood. 2nd. An aneurism may un-
dergo a spontaneous cure, by not only the sac being filled with
coagulable lymph, but by the arterial canal being obliterated.
3rd. An aneurism may be closed by the tumor acquiring such a
size and position that by pressing on the trunk of the artery above
or below, the sides of the aneurism are thus brought into con-
tact and adhere. 4th. A spontaneous cure of aneurism has
also been known to take place, where the whole periphery of the
vessel has been dilated, the sac being filled up with coagulum,
bm leaving a canal in the midst of the tumor, through which
Llocd continued to pass. And fifth, an aneurism may be cured
by a process ofsuppuration taking place in the sac, after both it
and ihej^rtery above and below the tumor have been filled with
coagulum. In such a case, of course, the integument ulcerates,
and a portion of coagulum is discharged through the external

1839.] Aneurism successfully treated by the Needle, 679

opening, which cannot be removed by the process of absorption.
It will be at once perceived, that in all these modes by which
nature cflects a natural or spontaneous cure, that the coagulum is
the sine qua nun. Now, any method by which this natural or
spontaneous process can be imitated, and brought about, name-
ly, the formation of the coagulum is the great end we ought to
have in view. I believe that the needle will accomplish this
and if my opinion is correct, together with the opinions of others
who have successfully treated aneurism according to this plan,
one branch of surgery will, at least, have become much simplifi-
ed, and the sufferings of humanity much ameliorated. The mode
by which I believe the needle acts, is at once simple and plain
a coagulum is formed around the needle, so soon as it is intro-
duced, by its low temperature, depriving a portion of the blood
contained in the sac of its vitality this forms a nucleus, which
goes on rapidly augmenting, until the sac is filled with coagulum
and terminates in the obliteration of the tumor by one of the
modes above indicated.

With these views I enter into the detail of the case.

A. B. an Irish laborer, called at my office on the 27th of Jan-
uary last, with a tumor, the size of a pigoon's egg, two inches
above the wrist ; the arm was much swollen and tense ; its tem-
perature greatly elevated, and as may be supposed, he was la-
boring under great constitutional disturbance. The tumor was
aneurismal : produced by a wound of the radial artery, an inch
below the aneurism. The history which he gave me of the case
was, that in some fight, three weeks before, he had been stabbed.
At the time, the wound bled considerably, but was stopped with-
out surgical aid, and as the wound readily healed, no more was
thought about it. In about a week afterwards, his arm became
swollen from the elbow to the wrist, and very painful. The
tumor then became obvious at the place 1 have mentioned. Its
gradual increase, with the pain and tumefaction of his arm, in-
duced him, two weeks afterwards, to seek advice. When I first
saw him, his arm was much swollen, with the blood that had in-
filtered throughout its whole cellular tissue ; the heat and red-
ness intense ; liis whole system participating in the irritation ;
and the aneurism tense and pulsating. It was at this time that I
passed the needle horizontally through the tumor using the

5S0 Aneurism succesafally treated by ths Needle, [July,

precaution to arm the extremities of the needle with pieces of
cnrk, that it might not escape or be cauLrht by the roller with
wh'ch I encircled the arm. Directions werj then given to keep
th3 arm constantly flexed the bandaije to be saturated with
cold water to l die a large dose of salts, and to refrain from
food. Previous to the passing of the needle, the pulsation of the
tumor and the radial artery below the tumor, was distinctly felt.
l>ut shortly afterwards (ten minutes) tl e diastole of the artery
was barely perceptible, whilst the pulsating of the tumor had al-
together ceased. On the 33th. three days after the first dress-
ing, the tumor was hard, and no impression could be made by
pressure the pulsation of the artery below the tumor was very
plain the pain, heat, and tumefaction of the arm had subsided,
with no appearance of suppuration at the point at which the nee-
dle was introduced.

2nd of March. The tumor was still hard, and there was no
pulsation of the radial artery ; round the place of entrance and
exit of the needle were appearances of suppuration. In one
week fio.n the time I passed the needle, the coagula had slough-
ed out, and the artery above the tumor, as far as could be ascer-
tained, obliterated. Two weeks perfected tlie cure, and the
man was able to go to work. Had the needle been withdrawn
three days after its introduction, or before any signs of suppura-
tion had made their appearance, 1 believe that the coagula would
not have sloughed, but would have been absorbed, and the parie-
ties of the sac gradually coalesced. I further believe that when-
ever coagulation of the blood in an aneurismal tumor does take
place, that the cure of the aneurism may be considered as ac-
compli>hed, for, as I before said, the sac will contract, the coag-
ulum will be absorbed, some portions in continuity with the sac
will become cngjrged, and consolidate, others will escape
by the process of ulceration through the integuments, and ul i-
mately a progressive coalescence of the tumor will thus take
place.

There were circumstances in the case just detailed, that were
far from being ftvorable to a fair trial of the plan of cure by the
needle. The arm was very much swollen, and inflamed, and
the constitutional disturbance greatly in excess, all of which ad*
monished me, that any additional irritation would probably end
la ulceration of the parts. If then, a cure can be effected of an

1839.] Extirpation of an Aneurismal Sac. 59!

aneurism, under such untoward circumstancf s, whnt might wc
not expect, vvlicrc the aneurism was slowly progressive where
the system was not much imphcated and where the contigu-
ous parts did not participate in the abnormal action?

ARTICLE ir.

Extirpation of an Aneurismal Tumor on the Os Humeri cuir,
Bi/C. 13. Barrett, M. D. of Monticello^ Jefferson County ^
Middle Florida.

Mrs. Elizabeth Phillips, setat thirty two, of nervous tempera-
ment, and the mother of nine children, in the year lvS28, whilst
engaged in her domestic duties, received a severe kick from a
cow, on ihe right arm, almost immediately on the summit of the
OS humeri. The blow at the time gave her excessive pain, so
much so, as to prevent for three days afterwards, her using i'.
Ten or twelve days after receiving the mjury, "a small lump,"
to use her own words, "as big as a nutmeg, and as hard, made its
appearance."

Her friends tried the medicinal virtues of herbs, &.c. &c., but
finding it gradually increasing, s!i3 applied, whilst in Savannah,
in the summer of ''^O, to a physician, who recommended its re-
moval, whilst in its incipient stage. She did not like the idea of
the knife, but said " she would let it take its chance." Year af-
ter year passed on, and the tumor gradually increased in size,
until it totally inca;*/acitated her from the performance of her
domestic duties. On the 10th December, lS.38, 1 was requested
by my friend and colleague. Dr. Pettiss, to visit my patient the
Doctor requesting me to give my opinion relative to the possibil-
ity and safety of the operation; as two physicians had said that
if a knife was ever put on her arm it would kill her.

On visiting my patient for the first time, I found her in posses^
sion of a large aneurismal tumour, (I distinctly felt the pulsation
of the brachial artery) extending from the base to the anterior

5S2 Extirpation of an Aneurismal Sac. [July*

superior part of the os humeri, and covering the whole of the
dcltoides, biceps flexor cubiti and triceps extensor muscles.

I made a sfnall incision with my lancet, at its extreme lower
point, from its feelini^ very soft, and readily giving place to the
slightest pressure, as well as with a view of ascertaining its con-
tents. The incision was one inch in length, and from it exuded
a clear fatty substance, extremely vascular, and of a peculiar
odour. The incision gave no pain my patient was not sensi-
ble of its having been done. She informed me that she always
experienced the most exquisite suffering, whenever muscular
force was required. She observed to me that the tumour had,
on the different phases of the moon, and also on changes of the
weather, '' made her feel as though her shoulder was going to
jump out of its place."

From a careful and attentive examination, as well as from the
satisfactory replies of my patient to my enquiries, I declared
the possibility of extirpating the tumour assuring her of
safety by adopting a judicious course of regimen, and other
sequent dietetic measures. I could not foresee any possible
danger. Ten days after this, her husband called upon me and
said that "his wife had concluded to have the operation per-
formed." #

I appointed Thursday the 21st day of February last, for the
operation. It may probably seem strange, that I should defer
the operation for so long a period as two months, but my rea-
sons for so doinnr arose from the following^ circumstances ;

1st. In my first interview with my patient she was suckling a
iine hearty robust girl eighteen months of age. I therefore,
deemed its; removal necessary for the mother's future safety.

2nd. My patient was of a very full plethoric habit, weighing
about 17ft pounds ; the subject also of much constitutional irri-
tation and believing, from personal observation, that many
causes off ailure, with American surgeons, aflei' the performance
of surgicSil operations, to be in consequence of their not having
sufficiently pir^pared the system, by putting their patients under a
a proper dietetic treatment before operating I was anxious^
and indeed determined, if possible, not to fall into a similar
error.

I performed the operation in the presence of my valued and
csteemeai friend, Dr. J. G. Pettiss, and several other friends.

1839.] Extirpation of an Aneurismal Sac, 583

I commenced by making two eliptical incisions of nine inches
in length, including also a portion of the skin. On prece-
ding with the operation, I found the tumor intimately con-
nected with the supra-capsular, musculo-cutaneous, radial and
ulnar nerves, and attached to the biceps flexor cubiti, and part of
the triceps extensor muscles. I removed the tumor, after care-
fully and cautiously dissecting it from its numerous attachments,
and from its original formation, to the deltoid process of the os
humeri. Its weight, on dissection, was seven pound'', or 112
ounces its circumference at its extreme breadth 32| inches
height from base to apex 18| inches. Two vessels were secur-
ed, and the flops brought together by six stitches and adhesive
strips. Adhesion was perfected by first intention. The cica-
trix was reduced on the lOth day to four and one third inches ;
and on the 15lh day from the operation, my patient was dis-
charged. The arm has now, np to this date, the appearance of
a cicatrised wound but no inconvenience from fever, swellinnr,
or lancinating pains has been felt from the moment ofits extirpa-
tion ; neither has it diminished in size, or altered its appearance
with the other. The only complaint my patient has ever made
to me, and I give it in her own words, is," that her arm seems
mighty long." The tumour has a conical appearance, and is
composed of a fatty, stringy, or ropy substance, enveloped m
an hypertrophied cellular tissue. 1 had nearly forgotten to say
that the tumor had been elt^ven ijears on her arm. I cannot
conclude without a slight comment on the intrepidity and brave-
ry of my patient she even refused the necessary preliminary
of securing the arm, bidding rne "t/o my duty and she would do
hers" It is a source of much grateful feeling to the friends of
my patient, that she is once more restored to the bosom of her
family, from attention to the duties or the performance of the
offices of which she has been withheld for four years past.

April 28th, 1839.

384 Ruw Cotton in Erysipelas^ with cases, [July,

ARTICLE ni.
Successful treatment of Erysipelas, by Raw Cotton. ThefoU
lowing is ejdlracted from a letter to the Editor, by F. M. Ro-
bertson, M. D. Augusta, Ga.

Having noticed in the first volume of the Medical Examiner,
that the external application of raw cotton had been successfully
employed in erysipelas, by M. Raynaud, I resolved to try the
efficacy of the remedy in the first cases that should come under
my notice. About two months since, I was called to a case in
which the disease had invaded the forehead, face, and a part of
the back. The patient was suflfering extreme distress from the
tension and burning heat of the parts, and the system labored
under a state of general excitement. 1 had the inflamed parts of
the surface entirely covered with finely carded bats of raw cot-
ton, which were suffered to extend over on the sound skin. At
the same time an ordinary dose of calomel was administered,
and followed in two hours by a moderate saline cathartic. On
visiting my patient in the afternoon, I found the local symptoms
entirely relieved ; she stated (hat the pungent heat and pricking
had ceased soon after the application of the cotton. The medi-
cine had operated well, and the general excitement was conside-
rably moderated. The bats of cotton were renewed for the
night. On visiting her the next morning, I found that the dis-
ease had not spread ; the local symptoms were entirely relieved,
and the inflammation h,ul nearly sul)sided. The cotton was
continued through the day and the following nigfit, after which
it was thrown aside, and the patient recovered, with no desqua-
mation whatever of the cuticle.

A few days afterwards, I was called to a little girl who had, a
week previous, accidentally received a small wound, which pen-
etrated through the scalp to the cranium. The wound had sup-
purated, and, on close examination, I found that it had taken on
erysipelatousinflammation, which had extended to the right ear,
and, on the forehead, as far as the nose and appeared to be pro-
gressing over the entire scalp and face. It was in the afternoon
'when I saw her : during the morning, the febrile excitement was

1839.J Raw Cotton in Erysipelas, with cases. 585

high, and she had been, occasionally, delirious. I immediately
had the hair cut as close as it could be, with a pair of scissors,
and a cold bread and milk poultice applied to the wound, and the
entire scalp and forehead covered with the bats of cotton, as in
the former case ; at the same time, a dgse of calomel, to be fol-
lowed by epsom salts, was administered. The relief from the
cotton was immediate ; all the bad symptoms were relieved,
and, after the operation of the medicine, the general excitement
was moderated and the delirium did not return again. In this
case the inflammation progressed as far as the cheeks, and to the
left ear. The cotton could not be applied over the eyes and nose,
as the patient was too young to understand the importance of
submitting to such a cumbersome application ; it, however, ar-
rested its further progress from the cheeks and scalp. All the
local symptoms were relieved as soon as the cotton was appli-
ed ; no blisters formed on the forehead or cheeks, and the des-
quamation of the cuticle was very slight : much less than I have
ever seen it in the mildest case of this disease, when treated with-
out cotton. During the progress of this case, which lasted for
seven days, the only internal medicine administered, except the
first cathartic, was an occasional saline aperient and cold lemon-
ade or soda water, made by dissolving the common soda pow-
ders of the shops.

I have simply presented these cases for the purpose of draw-
ing the attention of practitioners to this very simple application,
without attempting to account for the modus operandi of the re-
medy. Its use appears to have been suggested to M. Raynaud,
by the analogy between the disease and burns, and the well
known efficacy of cotton as a local application in the latter.
Those who had to contend with the disease, when it prevailed in
our city in 1837, as ah epidemic, will feel the importance of any
remedy which promises to arrest the frightful progress of this,
apparently, incontrollable affection, which, in many instances,
during the prevalence of that epidemic, from the slightest scratch,
spread with terrific rapidity to the whole surface, and carried
off its victim amid the most excruciating tortures.

May, 1839.
2b

585 Mortality of Hooping Cough in Charleston. [July,.

{

ARTICLE IV.

Mortality of Hooping Cough, in the City of Charleston, Read
before the Medical Society of the State of South Carolina,,
By H. W. DeSaussure, Jr. M. D. 1839.

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Being unable to ascertain the number of children affected with
Hooping Cough, during any one period of the ten years allotted
to me as my portion of duty, I cannot offer any table of the pro-
portional mortality of this disease. Nor, have I been able to ob-
tain any account of the varying characters of the affection in
different years, if it varied at all. AH that I have been able to

1839.] Mortality of Hooping Cough in Charleston. 587

ascertain is, the absolute mortality, the age of the patients, and
the monihs in which they died. This may be found in the ta-
ble on the opposite page, which comprises a period of twelve
years, viz: from January, 1826, to January, 1838. The hori-
zontal line marked total, shows the number of deaths for the
whole period, according to sex, color, age, and the season of the
year in which they died. The perpendicular line marked total,
shows the mortality for each year.

By referring to the above table it will be seen, that the mor-
tality varies much in different years. In 1S27, there being but
one death, while in the next year (1828,) the number rises to 61;
and in 1832, there are no deaths reported. Upon what circum-
stances this great variation depends, I am unable to ascertain*
It may, perhaps, be attributed to the difference in the numbers
vaffected in these years.

It will be seen that the whole mortality for the twelve y^ars,
was 166, giving an average of 13 5-6 for each year. Sex appa-
rently exercised very little influence on the fatality pf the dis-
ease: a few more females than males dying. Color appears to
exercise far more influence, nearly 4-5ths of the whole mortality
being among the colored population ; this may in some measure
be attributed to their habitual carelessness and greater exposure,
in some measure perhaps to the prevalence of a scrofulous dia-
thesis pertusses, when neglected in such constitutions, tending
to the developement of tubercles. Age also exercises conside-
rable influence on the fatality of the disease : more than one third
of all the fatal cases occurring in children under one year near-
ly one fourth in those under two years and one fifth in those
under three years while, after this period the mortality rapidly
decreases. Between the ages of ten and thirteen only one death
is reported, and none of children over thirteen. In children un-
der one month, the mortality is also very small, depending, I
think, on the small number affected at that age. Season exer-
cises considerable influence on the disease. July, August, Sep*
tember, and October, shewing nearly two thirds of all the fatal
cases, while December, January, and February, present the least
mortality, indicating that the heats of summer and alternations
of autumn are less favorable to the disease than the steady cold
of winter and this remark is constant for each year of twelve.

In conclusion, I can only regret that I have been unable from

58S Report on a specimen of Milky Urine. [July,

want of documents, to hand in any details of more value ; and
that my want of familiarity with statisiical details, should have
rendered what I have obtained of less value than it would have
been made by abler hands.

With respect it is submitted to the Chairman.

ARTICLE v.

Report on a specimen of Milky Urine. By Charles Upham
Shepherd. Read before the Medical Society of the State of
South Carolina^ Jannary 11, 1839.

The specimen was submitted for examination by Dr. Bennet.
In color and general appearance it resembles milk scarcely
differing from that fluid in sensible properties, except in possess-
inof a faint tino^e of red and a weak unnous odor.

Its specific gravity is 1.0086, in which respect it differs essen-
tially from healthy urine, which on an average is as high as 1.02.
(The ratio between the two is as 10.C86 to 10.200.)

Its red colour is owing to the presence oniematosine, or the
coloring matter of the blood, as appears from the effect of hydro-
chloric acid in first deepening its tint, and subsequently in pre-
cipitating it from the solution ; no less than from its disappear-
ance on simply boiling the urine, in consequence of which it is
coagulated along with the albumen. The fluid thus cleared of
this matter resembles milk more closely than before.

A few ounces of the urine were exposed to the air in an eva-
porating basin for a couple of weeks. A thick, creamy ring
surrounded the edges of the dish, the fluid being reduced to less
than half its original bulk by evaporation, but without having re-
markably altered in its appearance, or having acquired a parti-
cularly disgusting odor or any decided acid or alkaline proper-
ties. The fluid was poured out, and the cream-like ring allowed
to desicate. In the course of a few days, it turned yellow,
shrunk up, and finally resembled gum.

1839.] Report on a Specimen of Milky Urine. 589

A portion of the fresh urine was boiled. As the fluid ap-
proached the point of ebullition, a thin film spread over its sur-
face, which was so tenacious as to prevent the steam from break-
ing freely through it ; consequently it became inflated like a
thick solution of soap in water, when blown into with a tube :
and although the basin was at first less than one third filled, the
liquid rose into a frothy mop, projecting far above the top of the
dish, and required to be removed from the fire to prevent its
overflowing. The appearance it presented under the circum-
stances described was obviously similar to milk. After having
been reduced by slow evaporation to about one half its original
bulk, it Was permitted to cool. The froth subsided into a tough,
wrinkled, but thin pellicle, which overspread the surface of the
fluid, and also lined its bottom. The contained liquid on being
poured oflfhad lost its redish tinge, and had assumed a shade of
yellow in its place. It now readily passed the filter, (which it
would not do prior to boiling,) but without relinquishing in the
smallest degree its milkiness or opacity. The film was regard-
ed as albumen, mingled no doubt with hematosinc and mucus,
particularly in the heavier portion, which subsided to the bottom
of the fluid, inasmuch as it is a property of both mucus and he-
matosinc to become inspissated by heat, and to exhibit a higher
specific gravity than coagulated albumen.

Concentrated, pure acetic acid was added to a portion of the
boiled urine, and heat applied until the fluid entered into ebulli-
tion. The urine hereby became much clearer, and nearly lost
its milky aspect, while numerous globules of yellow oil swam
upon its surface, which, on the cooling of the fluid assumed the
consistence and color of pale butter. From this experiment I
am led to conclude that an animal principle analogous to fibrin is
present in the urine, similar perhaps to what has been called in-
cipient fibrin in chyle, which principle is dissolved, when treated
with acetic acid, and hence the fatty matter with which it was
previously combined (after the manner of an emulsion,) became
isolated and rose to the surface.

A portion of the unboiled urine was treated with one third its
volume of purified sulphuric ether, and the two fluids thorough-
ly agitated together, and corked up in a phial for twenty-four
hours, at the expiration of which time, the ether had assumed a
deep yellow color, and the urine had nearly lost its milkiness.

590 Report on a Specimen of Milky Urine. [July,

The ether was withdrawn from the phial by a sucker, and slow-
ly evaporated on the sand bath. An abundant oily residuum re-
mained, whose consistency was intermediate between olive oil
and butter. Its color is yellow and its odour peculiar both
which properties are no doubt owing to the presence of some
odorant, resinous body. Farther to show the presence of oily
matter in the urine, it may be remarked that in treating it with
potassa, we obtain an abundant soap, which collects in a soft cake
at the top of the fluid.

The urine becomes clear and transparent on being boiled with
potassa, with the exception of a few floes of phosphate of lime ;
an effect we should naturally anticipate, inasmuch as fibrin and
albumen are both dissolved by potassa, while the fatty matter
present becomes converted into a soluble soap. On adding a
few drops of acid, however, to the clear fluid, it instantly be-
comes clouded, but does not recover its milky aspect ; the acid
operating to precipitate the albumen and the fibrin, the latter of
which, however, it immediately re-dissolves. The acid added,
also throws down the animal acids into wnich the oil had been
converted during the process of saponification. Whether these
acids are identical with the stearic, the margaric and oleic, or
whether a nice research would prove them to be new, it is difli-
cult to conjecture ; though the latter idea will not be regarded as
impossible, when it is recollected that the source of the oily mat-
ter which is concerned in the formation of a soap, effects the na-
ture of the acid or acids, produced. Hence butter gives rise un-
der these circumstances, to butyric, caproic and capric acids
the oil of the porpoise to the phocenic acid ; and that of the goat
and the sheep to the hircic acid.

The urine was next tested for urea, by treating a portion of
the concentrated fluid with pure nitric acid.

No precipitate of nitrate of urea appeared, although the mixed
fluids were allowed to stand for several days. This experi-
ment would not be conclusive in proving the deficiency of urea,
inasmuch as the milky consistence of the fluid might operate to
prevent the crystallization of the nitrate ; but when considered
along with the want of urinous odor in the fluid, and the slight
tendency to putrefaction it possesses, the non-production of car-
bonate of ammonia, and the diminished specific gravity of the

I

1839.] Report on a Specimen of Milky Urine. 591

urine, leaves no doubt of the almost entire absence of this nnost
conspicuous ingredient of normal urine.

Uric acid, the parent substance of urea (as Libbib, from late
researches proves, inasmuch as he converts uric acid by the ac-
tion of per oxide of lead into urea, oxalic acid, and allantoin*)
is equally wanting in the fluid under consideration. This v^^e
prove also by the action of nitric acid, which fails to develope
that rich rose-red hue in the fluid which would occur if uric acid
or even urate of ammonia were present it being an infallible
trait of uric acid to suffer such a modification from the action of
nitric acid as to give rise to the rosacic acid of Proust, the pur-
purate of ammonia of Prout, or in the opinion of Berzelius,
simply to an union of extractiform matter with uric acid.

The fresh urine, instead of exerting an acid, produces only a
feeble alkaline reaction. This I am inclined to attribute to the
presence of uncombined (or free) soda, as potassa when heated
with the fluid emits no traces of ammonia. The absence of
carbonic acid is obvious on the addition of nitric acid to the
fresh fluid which causes no sensible effervescence. A second
specimen of urine, however, furnished me within a few days^
has on being exposed to the recent warm weather, become car-
bonated to such a degree as to effervesce very freely, but the al-
kaline carbonate generated is chiefly that of soda, and not am.
moniacal.

The urine is very nearly rendered clear by being allowed to
stand for some time after being mingled with either of the fol-
lowing re-agents : viz. corrosive sublimate, alum, infusion of nut
galls, ferro-cyanide of potassium, as well as the mineral acids.

A portion of the urine was evaporated to dryness, and the
carbon burnt off*in an open platinum-capsule. One part of the
residium was fused with anhydrous carbonate of soda, and af-
terwards supersaturated with acetic acid, and tested with acetate
of lead for phosphoric acid, which ingredient was detected.

Another portion of the above residium was tested for chlorine,
and still another for sulphuric acid, both of which were ascertain-
ed to be present.

It was, however, extremely obvious, that a marked deficiency

* See Report seventh Meeting Brit. Association for the Advancement of
Science,

502 Report on a Specimen of Milky Urine. [July,

of saline ingredients existed in the urine ; and the sulphates and
phosphates in particular were much below the usual proportion,
while the chlorides approached more nearly to their standard
ratio in healthy urine.

It will be seen, therefore, as a result from the following, that
the urine under examination differs in the first place from heal-
thy u'ine in the deficiency of uric acid and urea, and in the low
proportion it contains of saline matters generally; and secondly y
in the presence of an unusual amount of fatty or oleaginous mat-
ter, mingled witti albumen, incipient fibrin and mucus, to which
we must add traces of the coloring matter of blood,

It.may be interesting merely to add, from one or two authors,
a few allusions to certain diseased urines, which in many res-
pects would appear to resemble that which we have examined.

Berzelius says, that in the species of dropsy called anasarca^
and which results from a general debility of the animal economy,
serosity prevails throughout the urinary passages, and conse-
quently the urine becomes albummous. It may then be precipi-
tated by the bichloride of mercury, although it still possesses an
acid re-action. When the disease has proceeded still farther,
the kidneys secrete an albuminous liquid. .'\ his liquid i-s preci-
pitated by alum, and in a still more advanced period of the case
by nitric acid: and finally, it coagulates by ebullition. The
more the proportion of albumen augments, the more the urea di-
minishes ; and at last, it disappears altogether.* The presence
of albumen in urine is observed in cases of dyspepsia, as well as
towards the end of hectic fevers.

Berzelius likewise speaks of milky urine, which he says de-
posites a cream and coagulates on ebullition the clot having
the properties of caseum and ether, withdrawing from it fatty
matter. I suspect that here, allusion is had to a fluid nearly
identical with that under consideration, though I venture to ex-
press my dissent from Berzelius in considering the clot as pos-

* The liver, according to Thenard, sometimes affords a bile, highly al-
buminous and charged with fatty matter. In a particular instance, this or-
gan was converted into a fatty mass, which yielded l-16th part its weight of
oil. Signor Bizio analyzed bile of a patient who died in the Hospital at
Venice of a diseased liver, which contained fibrin, a peculiar insoluble fatty
matter, albumen, yellowish oil, a green resin, gummy extract, sugar, chlo.
ride of sodium, phosphate of soda, phosphate of magnesia and oxide of iron-

1839.J Treatment of Scarlet Fever. 693

sessed of a caseous nature, inasmuch as it does not suffer the ace-
tous fermentation on being exposed to the air, and a mild tempe-
rature even for a long time. I rather prefer to regard h as con-
sisting of albumen, and what has been called incipient tibrin.

Berzelius goes on to say that this sort of urine has been ob-
served equally among males and females ; and that it originates
in causes not understood, and is unattended by any serious de-
rangement of the general health.

Dr. Elliotson (in the Lancet for 1830,) believes that if iho
kidney be organically affected, if it have a congestion of blood in
it, or be in an inflammatory state, the urine will generally be al-
buminous. But on the other hand, he does not think, that the
circumstance of the urine being albuminous is a proof that the
kidney is in this state at least in a state of organic disease; be-
cause he has seen many persons cured of dropsy and restored to
perfect health, who had labored under albuminous urine ; and if
the kidneys had been originally diseased, he thinks it hardly pos-
sible that a recovery would have ensued, lie is, therefore, of
opinion, that although it is possible that in diseases of the kidney
and in congestion of that organ, the urine may generally be al-
buminous, the converse cannot be asserted, viz. that ifihe urine
be albuminous we must necessarily conclude that the kidney is in
these diseased conditions.

ARTICLE VI.

Treatment of Scarlet Fever contained in a letter to the Editor.
By Edward C. Keckeley, M. D. Chaileslon^ S, C.

Believing it to be the duty of every physician to add all he
can to the stock of medical facts, 1 send the plan of practice
which has been pursued by me in Scarlet Fever. When first
called to prescribe for a case, I candidly confess, that I obeyed
the call with reluctance. I had been induced to consider the
disease as almost an opprobium medicorum. I determined to at-
tempt a track which was not altogether beaten smooth. I found

c3

504 Treatment of Scarlet Fever, [July

it so pleasant, that I now travel it without the slightest fear of
not arriving at the full consummation of my fondest hopes the
speedy relief of my patient.

The division of Scarlet Fever which has been made by Dr.
Pcwees, answers all practical purposes. The ** scarlatina sim-
plex, or simple constitutional disease, without any morbid affec-
tion of the throat," requires very little medical treatment. It
will run its course, and the patient get well without any thing
being done. I have seen several cases terminate in this way,
without the least attention being paid to them. This was the
case in my own family. When medicine is necessary the bow-
els should be gently operated on with srn-all doses of calomel,
and epsom salts, and magnesia. The diet should be antiphlogis-
tic. In the anginosc slate of the disease, the treatment must be
commenced with the full emetic operation of ipecac. The eme-
tic m:iy be repeated daily, or even twice in a day. This is the
anchor of ojr hopjs. I have seen the disease put a stop to after
one fill emetic operation. The bowels should be operated on
daily by s nail doses of calomel : two grains to be given every
hour until the object is accomplished. So much for the consti-
tutional treatment. Not the least important part of the treat-
ment is the faithful use of suitable gargles. When ulceration
has not taken place, I have derived the greatest advantage from
the ('.ip^i''u ri It may be made into a tea with hot water. It,
I think, effects more when digested for a time in vinegar. After
ulcoratinn has l.ikeii place, no mixture as a gargle is superior to
the Inllowing: 8 oz. solution Gum Arab. 3j Spts. Turpentine, m.
1 have used ihis. instead of the ('apsicum, with the happiest ef-
fects. The mr^di'- nil virluj^s of the Tur()entine are not known,
and will pro'.)ably long remain so, in consequence of its being an
article of home proJuction. Medical men too generally under-
value our vegetable productions. Jn addition to the preceding,
external stimulant applications to the throat should not be for-
gotten. For this purpose, the throat should be rubbed frequent-
ly ihrouiih the day with the following liniment: to !j Olive Oil,
add 3j Tinct. Capsicum, m. At night a light woollen bag filled
with warm ashes should be applied around the neck; and through
the day, a piece of flannel. 1 have seen much benefit derived
from the use of the foot bath at bed time. In the malignant form,
the same treatment is to be pursued as in the preceding variety..

1839.] An Essay on Congestive Fetdr, 595

Should any untoward symptom arise, the physician must apply
the proper remedy. For the dropsical affection which some-
times supervenes, I generally use small doses of Capsicum, com-
bined with the Sup. Carb. Soda. No peculiarity of treatment is
necessary. In the management of Scfarlet Fever, the greatest
attention must be paid by the physician and nurse. From the
trouble attendant upon every case, the nurse requires to be
closely watched. A good rule to be strictly observed is, what-
ever is done, let it be done quickhj Siud fait hfuUi/. I have not
the least doubt that nearly all of the cases which terminate fa-
tally, are the result either of improper practice, too long delay,
or gross neglect on the part of the nurse. I hold Scarlet Fever
to be one among the most easily managed diseases, with which
the physician has to contend ; but neither of the above three
faults must be present. For the above plan, 1 claim unlimited
success out of about twenty cases one died, and this one was
the result of nedect by the nurse, until it became to) late for any
thing to be done. I forgot to mention that cold drinks are to be
strictly forbidden. Avoid the external application of water, as
you would the sting of the pj^isonous serpent.

ARTICLE VII.

An Essay on Congestive Fever, B(/ G. K. Hollow ay, M. D*

WaiTentonj Ga.

Of all the diseases which, of late, have claimed the attention of
the profession, we know of nnne that has done so in a more emi-
nent degree, than that species of fever usually denominated
*' contrestive" In proceeding to a treatise on this subject, let us
first inquire whether this is a disease of recent origin, or only an
-aggravated form of some disease ? From all we have been able
to ascertain, we are inclined to the latter opinion that it is an
aggravated form of bilious fever. Although we have every
symptom of congestive fever, in its most malignant form, present
irom the very begining of the disease, still we are inclined to

590 An Essay on Congestive Fever. [July

view tills disease, as it is considered, as an aggravated fornn of
bilinus faver. This term then seems to quality ihc fever; and
as far back as 1814, we recollect to have heard physicians speak
of" Congestive Fever" then prevaihng, and having prevailed in
]New Hampshire, as far back as 1811; in Massachusetts in
1812 ; in New York and Connecticut in 1813 : in JXew Jersey,*
Pennsylvania, Maryland, and Virginia, in 1814. What pro-
gress it made south we know not ; but from the foregoing ac-
count it would appear that it was not very rapid. f

In some sections of Virginia it appeared to rage with much
more violence than in others ; and its most frequent appear-
ance was in its most aggravated form, where there is a conges-
tion of the internaly with a constriction of the external capillary
vessels, accompanied with sudorific exhalation. At that time
scarcely any two of the faculty agreed as to the proper course
of treatment. There seemed, however, to be three different
plans of treatment adopted one, essentially Brunonian ; anoth-
er, antiphlogistic ; and a third, a medium course, carefully avoid-
ing either extreme. The last named, or medium course, seem-
ed to be the most correct and successful. At the lime of that
observation, we were not connected with the profession ; but
i'rom the prescription we tkeu. saw, we now know that some of
the laculty took similur views ol the disease to those now taken
by the most eminent of the profession : nor were they those who
depended solely on a siimuiatingor depleting plan of treatment.

Tais type of fever continued lo prevail in Virginia with more
or less irequency of occurrence, until the time we left the " Old
Dominion,' which was in l8^t>; and as we came southwardly,
we louud the same disease, wearing ail its frightful forms, ra-
vaging whole neighbourhoods, and laying waste whole families.

Having located in Sumter district, tSoulh Carolina, in April,
182(5, we observed it prevailing with great severity in the lower
part of that district. From that time, we have given much of
our attention to it ; for, being engaged in country practice,^ we

* Dr. Benjamin Rush is said to have died of this disease in April, 1813.

f We have observed this disease in Georgia for thirty years. The rta.
son why the writer thinks it has made sJow progress, southwardly, is, that
the culpable negligence of southern practitioners has prevented the publica-
tion of its history. Editor.

1839.] An Essay on Congestive Fever. 597

were thrown on our own resources, and although young in the
profession, we were consequently compelled to use no small de-
cree of discretion, as we were aware that we were compelled to
differ materially from some other members of the profession, as
to the nature of the disease, as well as the plans to be pursued
in the treatment. The correctness of the opinions then formed,
and the remedial means used has been confirmed by upwards of
ten years experience, in a practice, for the most part, not very
limited.

We then adopted the opinion that it was a disease of a highly
malignant character, caused by a congestion of the internal ca-
pillary vessels of some of the mucous tissues of the alimentary
canal, and that these tissues were disordered in proportion to the
length and severity of the disease. We came to the conclusion
that the stomach and small intestines were the principal seats of
the disease, thereby making a case of "^as/ro entei'ite" if we
may be allowed the term. This local congestion tends, as do
all local congestions, to destroy the equilibrium of the circula-
tion, and the sanguineous system comes into, or rather, has a
tendency to take on disease ; but its action is centripetal^ and the
blood is consequently propelled to the disordered mucous coat of
the intestines by the impetus given to it ; especially in all
forms of an inflammatory nature ; and we would, in some in-
stances, but not in all, look upon and treat this disease according-
ly. The consequence of this centripetal action is, the produc-
tion of a iiew set of phenomena clearly and satisfactorily indica-
ting the existence of internal irritation, which continues to in-
crease until a centrifugal action is established. Nor can we
limit our remarks to saying, that the morbosity is confined to the
mucous membrane of the intestines ; for we know that all the
mucous membranes soon partake, more or less, of the conges-
tion and irritation ; but that of the lungs more frequently than
others. And when this is the case, we generally consider the
prognosis more unfavorable.

tSymptoms. These are very various in different individuals,
and in the time and length of the attack, and its intensity ; but in
general, the patient feels some ennui, loathsomeness to food, dis-
inclination to action ; food, if taken, digested imperfectly ; bow-
els irregular, sometimes even obstinate constipation, and at oth-
ers, serous or bilious diarrhcea will manifest itself. There is also

598 An Essay on Congestive Fever. [JulVt

cephalalgia and drowsiness in the after part of the day, with
some chilliness, followed by febrile excitement ; but the chilli-
ness is not an invariable attendant. After the continuance of
these symptoms for an indefinite period, the person is alta^cked,
most generally, with a distinct chill or ague, which is of indefin-
ite duration, but generally abates gradually and fever supervenes.
We have, however, known this chill continue for eight or nine
hours in many instances, and in a few, we have known
the patient die in it. Again, we have known the attack so very
mild, as to pass unnoticed ; so that the patient considered him-
self only a little indisposed. These various forms and grades of
attack will be seen, when we come to state our cases as they
occurred.

On the next paroxysm, however, the symptoms are generally
more pointed, or the characters of tie disease more fully devel-
oped, and the suflferer is then given fairly to understand that he
is suffering a regular attack of this fever ; but of its danger, he is,
both happily and unfortunately, not aware happily in not
knowing the danger to which he is exposed, and unfortunate in
not calling medical aid in due time. The pulse is, sometimes,
though not always, increased in fullness, and rather so in fre-
quency say 85 to 90 in the minute, and somewhat chorded.
The surface of the body is cool, dry, and somewhat shrunk or
hipoeratic, except about the upper part of the chest, neck, fore-
head, and back of the hands, which, so far as our observation has
extended, are always and universally in a state of moisture,
which continues throughout the disease. We have seen a most
profuse sudorific exudation cover the whole surface, in which it
was next to impossible to dry the skin by the most powerful as-
tringent and corrugating remedies. The patient considers him-
self free from pain, but if pressure be made below the umbilicus,
he experiences an obtuse pain, or rather, soreness in the intes-
tines at that part. We have known the pain, however, in some
cases, so very acute, as to occasion the patient to cry out with
distress from it.

In the first stage, the tongue is generally, though not invaria-
hly^ of a slight or pale red, on Vie tip and edges^ and sometimes,
it cannot be very easily protruded out of the mouth, but has a
kind of tremulous motion, and is usually covered in the middle,
with a dirty white, or pale brownish fur. No appetite at all, or

1839.] An Kssay on Congestive Fever. 599

if any, very dainty, except in a very small proportion of cases.
We have known it to be excessive, in which cases the middle of
the tongue is very black.

There is, almost always, a very great thirst, and nothing is
craved so much as cold water; yet when he is promised to be in-
dulged, he is often indifferent to it ; neither is he then very choice
as to the temperature of his drink. His urine is generally of a
rosy tint ; yet we have seen it perfectly limpid ; and then again,
we have seen it as high colored as cogniac brandy. We have
also known it passed easily, and then again, with all the distress
of severe strangury, and passing only in stillicidium, as if these
symptoms had been produced by the exhibition of cantharides,
or the application of blisters, or some other article calculated to
produce extreme irritation of the urinary passages. When this
is the case, the patient has a constant desire to be stripping the
preputium penis through his fingers and thumb.

His bowels are irregular, diarrhoea easily induced, either by
drastic, or saline, or hydragogue cathartics. The vis vitse is
readily exhausted, the extremities having an unusual tendency
to become cold, particularly in the latter part of the night. The
abdomen, after a few days, is filled with flatus, or becomes tym-
panitic, especially when purgation has been freely resorted to
which should now he done.

In the mild form of the disease, when judicious treatment has
been employed, a favorable prognosis may be entertained, and
recovery expedited by the end of 3, 4, or 5 weeks ; still, howev-
er, the disease is sometimes arrested as early as the fifteenth
day from the attack. So much for the disease. In the more
intense or malignant form, the attack is much more insidious, and
is truly to be dreaded as a most inveterate and formidable dis-
ease. In this form, all the symptoms are greatly aggravated
the pulse more full and incompressible nausea most constant
and distressing, with vomiting of a thift, glairy fluid, burning and
sometimes sour, with an occasional emesis of thick, yellowish
brown, bilious matter. In fact, most of the signs of gastric irri-
tation are present the breathing short, hurried, stentorous and
laborious the eyes of a fiery red, easily suffused with tears^
and of quick movement chest uneasy and oppressed dry
tickling cough, especially when the lungs are involved in ihe dis-
ease mcreased thirst, desire of cold drinks tono^ue red and of

tJOO An Essay on Congestive Fever. [July,

a glassy smootheness. Extreme restlessness, and d'sposition ta
change beds, almost constant. The bowels are, sometimes, ob-
stinately costive, resisting, wonderfully, the power of cathartic
medicines ; whilst, in other cases, the very reverse obtains. In
the former case, when cathartics does take place, it seems as if
all the feculent contents of the first passages are passed at once,
and the dejection is generally full of dark grey, foetid sciballistic
matter ; after which, a serous diarrhoea, which is always to be
dreaded, occurs. The urine is more scant and high colored,
and always passes with pain, accompanied with a burning intol-
erance of light, pain in the eyes, fullness of the head, throbbing
of the temporal and carotid arteries the tympanitic symptoms
are increased, the abdomen somewhat sore under pressure, deg-
lutition difficult, low muttering delirium, tinnitus aurium, singul-
tus, picking the bed clothes, the sphincters give way, and the
secretions are discharged sua sponlce. The sputa secreted, is
white, frothy, and extremely tenacious ; the extremities soon
become alarmingly cold ; the countenance becomes deadly pale
and cadaverous ; the entire body is covered with a cold clammy
sweat, the pulse begins to intermit, and cease to be perceptible,
and the tragick scene is closed by the suffocation of the patient,
from the bronchial secretion. Such are the general characteris-
tics which mark this form of the disease, although they are some-
what modified in a few instances. And although it may appear
paradoxical, it is nevertheless a fact, that the malignant form of
the disease runs its course in a shorter period of time than when
the attack is of a more mild type. The continuance, or rather
the crisis, may be anticipated at from fifteen to twenty one days.
When death occurs it generally takes place before the tenth day;
not that it has any apparent cause for so doing ; but owing en-
tirely to this almost unmanageable form of fever.

Causes, The causes which are most calculated to produce
this fever are, as in all other fevers, numerous. To look for a
proximate cause, we cannot : for, as yet, the proximate cause of
no disease is known, unless we adopt the opinions of Gaubius
and Rush, and consider the proximate cause, the " ipse morbus**
But as to the remote causes, they are of easy enumeration ;
such as the sudden suppression of perspiration, or of any cu-
taneous eruption, or of the catamenia, and thereby producing a
centripetal circulation. Copious draughts of cold drinks when

1839.J An Essay on Congestive Fever. 601

much excited and heated, produce the same effects by causing a
morbid state of the gastric nerves which is transmitted to the ex-
halents of the skin, and the small blood vessels and capillaries,
thereby causing a constriction of these vessels, and consequent-
ly, a retention ol perspirable matter, and the accumulation of
large quantities of blood in the capillaries of the internal organs.
It may not be improper to state here, that as there are three
distinct sets of circulation, each performed in a different manner*
and dependent on their own peculiar laws, that, as the one is af-
fected, no matter from what cause, there must be more or less
impairment of the others ; or, as Mr. Abernethy said, " if there
is a disturbance in the garret, there will he one in the kitchen.**
To the above, as causes, may be added, exposure to intense heat
of the sun, and to night air, especially if damp standing in the
wet sleeping in damp sheets wearing wet clothes setting
up late debauches of all kinds free indulgence in butcher*s
meats in hot wether fiee use of alcoholic liquors and all un-
wholesome and indigestible food.

As the doctrine of malaria is not perfectly established, or very
well understood, as to the manner of its producing its deleterious
effects on the constitution, we shall pass it over by classing it as
one of the most fruitful causes of fever; and to all we have set
down as causes of fever, may be added, all agents whose tenden-
cy is to obstruct the natural passages, and derange the natural
functions of the bodv, bv inducing^ an abnormal state of the inter-
nal system, but more especially the mucous membranes.

Treatment. The first object in the treatment of this disease
is, to equalize the circulation, and reduce the inordinate action ;
which accomplished, we turn our attention to the cleansing of
the first passages, so as to remove all impediments to the return
of the natural functions of the secerning and excreting organs ;
and if there be prospect of inflammation, to arrest it by suitable
antiphlogistic remedies. But if, on the other hand, typhoid
symptoms or debility be threatened, to be prepared to meet the
emergency. We cannot adopt the views of many, so as to con-
sider this disease as one of entirely an inflammatory diathesis;
for we are positively confident that in cases which have not ex-
ceeded three weeks in duration, and sometimes of a much less
period, we have seen symptoms of a thoroughly typhoid charac-
ter, which required a practice corresponding with this nature.

4

602 An Essay on Congestive Fever. [ JuJy^

Nor is it less our duty to see that the skin and temperature of
the body are both alike natural.

In treating this disease, the remedial agents which we employ
must be in accordance with the violence of the attack. So far
as we are capable of judging, venesection should in most, if not
in all cases, be resorted to in the very first stage of the disease.
When the pulse is moderately full, somewhat tense, and if the ef-
fect produced should indicate debility, we should loose no time
in counteracting the injurious tendencies of the disease. Indeed
we have heard from very high authority, that we should be jus-
tifiable in using the la;ncet and brandy at one and the same time ;
but a more proper procedure would be always to bleed by the
pulse, and so soon as we discover the least flagging of the pulse^
to stop the blood. As to the changes of color the blood may un-
dergo, it is a most fallacious sign, and not to be, in the least, de-
pended on ; for there is no one of the profession who has had even
an ordinary share of experience, but who must have noticed its
fallacy. A question may now present itself at what time is it
most prudent to institute depletion and the use of a cathartic?
As to the first, we unhesitatingly say, at the onset of the attach,
and on the exacerhation of fever, because the patient will, in that
event, be stimulated by the increase of excitement attending the
exacerbation ; which will, hpwever, be of shorter duration.
Now as to the proper time to exhibit a purgative to produce the
most salutary effect, we would certainly not give it on the rise of
fever, because it might, possibly, increase the violence of the ex-
acerbation, which is always too great. Nor would we give it
when the fever is at its height ; for we well know that then we
should only tend to increase the engorgement of the hepatic sys-
tem to which the congestion tends. The most that we can do
in the paroxysm will be, to endeavor to moderate its violence ;
for it will, despite of our efforts, run its course ; but we should
neglect no means calculated to prevent recurrence. We are
then left to select the decline of the fever as the most suitable pe-
riod to exhibit our purgative; and this is the more preferable,
as it then appears that nature seems disposed to relieve herself
of the blood with which she was but just now oppressed. The
surface of the body begins to loose its intense heat, the skin be-
comes r^ore moist, the arteries cease to throb, the head ache re-
n>i-ts, and the patient begins to be somewhat refreshed, the

li

1839.] An Essay on Congestiiie PeU7\ 603

emurtctories take on their wonted but heretofore depressed en-
erofy-^the liver disburthens itself of the redundant bile collected
in it, and all the secretions and excretions are performed more
in accordance with nature. In this disease, the vis vita3 is soon
exhausted, and the efforts at restoration are often in a great mea-
sure ineffectual-^at any rate, they are feeble ; therefore, we
must again caution those who wish to employ the lancet, to de-
liberate well on the effect which may be induced by its use, and
not be unnecessarily led into error, from the fact, that venesection
renders the pulse more voluminous, whilst at the same time itdi-,
minishes its force and frequency. Having bled the patient ac-
cording to the exigency o^ the case, we proceed to open the bow-
els by some mild purgative, assisted by warm bath, sinapisms,
and en'emata, which, having been accomplished, we proceed
with small doses of calomel and ipecacuanha ; and if the sto-
mach be irritable, we may add a small portion of Acet. Morph*
<fec. as by the following :

l^ Calomel, gr. xij.

Pulv. Ipecac, gr. iij.

Acet. Morph. gr. ij.

Refined Sugar. 3j.
Make into twelve powders, and give one every three hours.
As drinks, we allow soda water, rice water, Irish moss, slip-
pery elm, gum water, either plain or as lemonade, andevery oth-
er simple drink that may be desired by the patient, such as toast
or apple water, good buttermilk, and such like. And we must
here say, that much depends on what we may select as our re-
medies ; for in no case should drastic, saline, or hydragogue ca-
thartics be used, except with great caution, as from their exhibi-
tion the most serious consequences are to be apprehended they
invariably produce irritability of the stomach and bowels, and
excessive catharsis, to which, rapidly follow all their evil conse-
quences. To the powders above, we add at night,' about ten
grains of calomel and one of ipecac, or if we dare, ten grains
of Dover's powder. In all cases, purgatives of the most bland
kind should be selected. If the calomel prove inefficient by the
morning, we employ an enema, and give castor oil, or the fol-
lowing

^ Pulv. Rheub.gr. xij.

Calc. Magnesia, (best) ^ij.

604 An Essay on Congestive Fever, [July,

Oil Anise, gt. ij.

Spanish Soap, gr. viij.
Mix and divide into two papers, one of which is to be given
every three hours, until the bowels are open. We again begin
on the calomel and ipecac powders, to procure and keep up, if
possible, a moisture on the skin. To assist in this purpose some
of the herb teas, or a weak infusion of Serpentaria or Seneka,
may often be advantageously brought into use. If, from open-
ing the bowels, there should be any gastric irritation, calomel
combined with morphine in doses of one or two grains, or the
blue bill in two or three grain doses every three hours, with the
occasional use of an effervescing draught. Should this efferves-
cing draught tend to pass off by the bowels, it may generally be
prevented by the use of lime water or new milk.

From the foregomg remarks it must not be inferred, that vre
are opposed to purgatives ; on the contrary, we deem them of
essential importance because, if the alimentary canal be not
free from obstructions,, we would not be able to treat this case
judiciously. All fcecal matter must be kept cleansed away, to
prevent the irritation it is calculated to produce. But if, in the
pursuit of this purpose diarrhoea be induced, it must be correct-
ed by the use of appropriate means ; as the following

I^ Powder of I{)ecac. and Opium gr. xij.

Acet. of Alorphiagr. iij.
Made into twelve powders, and one given every hour. Or if
the diarrhoea be excessive, and accompanied with great sudorific
exudation

'^ Acet. of Lead, 3j.

Sub. Mur. Mercury, gr. viij.

Tart. Antim.

Sulph. Morph. aa gr. j.
Make eight powders dose, one every two hours.
Should typhus symptoms appear, we may then add to the
above, 3ss. Sulphate of Quinine. In the former stage, howev-
er, revulsion, or suppuration may be advantageously promoted
by leeches, cups, stupes, poultices, blisters, to the surface.

Diet. This should, by no means, be neglected. It should be
bland Jight, simple, easy of digestion, nourishing, and as antiphlo.
gistic as may be, consistently. Mucilaginous and farinaceous
articles, as slippery elm, arrow root, Irish moss jelly ; or when

ZS39.] An Essay on Congestive Fever. 605

needed, calf's foot, isinglass or hartshorn jeily, &c. These
may, when prudent, be rendered more nourishing.

Very frequently it will be found that the extremities suddenly
become alarmingly cold, and the patient is found in collapse.
Here rubefacients, sinapisms, blisters, &c. must be liberally re-
sorted to in order to restore the equilibrium. The colliquative
sweats which attend this state should be arrested, if possible, by
-rubbing the skin with red pepper, brandy and alum ; and if ne-
cessary, with spirits of turpentme, red pepper, and Spanish flies ;
or indeed any thing which may be thought useful in arresting
this fatal condition. We would suggest in this state, the trial
of Jenning's patent steam bath ; but our experience does not sup-
ply us with any facts relative to its use.

Emetics. We look on these, in congestive fever, as certainly
fatal.

We will now illustrate the doctrine and treatment we have
advanced, by stating a {q\v cases, with their treatment and re-
sults.

Case. 1. J. M. K. 28 years of age, good constitution, robust
and healthy, when heated by exercise, drank freely of very cold
water, which gave slight uneasiness in the stomach and head.
During the afternoon was somewhat feverish, and rested badly
that night. The next day he rode 20 miles under a very hot
sun. We were then called to him, and found his face greatly
flushed, pain in the head, eyes wild and injected with blood, bow-
els had been for several days constipated ; pulse full, tense, la-
borious ; breathing laborious ; tongue pale red on tip and edges,
and a dirty whitish brown colour in the middle.

He was bled to the extent of I xvj. on which the pulse be-
came more soft and voluminous. Ordered warm bath and in-
jections of tepid water also, 20 grs. of calomel and 2 grs. Ipe-
cac, to be assisted, if necessary, after three hours, by ^j. of cas-
tor oil. After six hours had elapsed without dejection, the calo-
mel and ipecac, were repeated, and a table spoon full of oil di-
rected every two hours, to be assisted by injections until the
bowels were opened. Under these directions the patient took
nearly a pint of oil, in addition to 3ij. of calomel, without mov-
ing the bowels. We next ordered a very large sinapism to the
whole of the abdomen, to be kept on until the skin was perma-
nently red. This had not been in application more than five

606 An Essay on Congestive Fever. [July,

{minutes, before the patient became very uneasy on continuing
it a little longer, however, he manifested a desire to get up, oa
doing which, he had one of the most copious dejections we have
ever seen. This dejection was full of scyballistic matter, was of
dark bilious color, and very fa3tid. This afforded very great
relief. Having no other passage that day, the calomel, ipecac,
and injections were repeated, and followed by other purgatives,
as rheubarb, soap, magnesia, &c. In the afternoon of the third
day from the attack, a sinapism was again applied to the abdo-
men, with the same happy result as before. The state of the
system now became tolerable, and under a simple treatment he
appeared to be so convalescent, that we were induced to say that
we should discontinue our visits after the tenth day : but urged
the necessity of great prudence and caution, as to drinks, diets,
jand the regularity of the bowels ; recommending oil for this last
purpose, should a purgative be needed.

On the twelfth day we were again summoned to this patient,
who was supposed to be dying. We found him in a colloqua-
itive sweat, and diarrhoea, apparently in articulo mortis pulse
.barely perceptible; tongue cov^ered with a dirty, slimy mucus,
;and pointed. On enquiry, we found, that after leaving him on
;,lhe tenth, he partook largely of water melon, which brought on
..a cholera morbus. After using a variety of domestic remedies
for the correction of this unfortunate state of things, he, next
morning, took a large dose of salts, which was soon followed by
the collapse in which we found him. A consultation was call-
ed on the case, but he died on the fifteenth day from that on
which he indulged in the too liberal use of cold water when ov.ej'-
Jieated.

It may not be amiss to state in this place, that whenever the
iongue is flat and pointed, or round and pointed, be it moist or
dry, hut more especially if dry, or if dry in any shape, with a
.dark crust on it, it is a most certain sign that the patient will
^ear depletion no fa 'ther^ especially by purging.

Case 2. This was in the person of the son of a minister of
'the gospel, who, presuming much on his own superior medical
rskill, bled him, during the chill, and administered a portion of
.salts and tartar as an emetic ; and on the following morning, re-
;_peated the dose. The consequence of this was death, on the se-
.cond day, before one o'clock, P. M. We arrived only in time

1

fS39.] An Essay on Congestive Fever. 60T

^o witness the last moments of life. Soon after death the body
of this most interesting youth was found covered with gan-
grenous spots, and vesicles filled with dark fluid, evidently the ef-
fect of rapid putrescency. The body soon swelled to six times
'its usual size. Another case occurred in the family of the next
neighbour, who also used emetics and the lancet, with the same
results. These two cases sufficed to stop these errors of domes-
tie ^practice, and no other death occurred in the neighborhood
(during the season afterwards.

'Case 3. J. B. about 26 years of age, of melancholic tempera-
iment, and good, but not robust constitution, was suddenly taken
very ill of this disease, and sent for a practitioner who bled him
copiously, and put him on the use of salts and tartar, in small
and frequently repeated doses, so as to keep up a constant nau-
ea. The consequence of this course was, an aggravation of all
the symptoms, such as an increased burning at the stomach, op-
pression at the preeordia, laborious breathing, haggard counte-
iaace, pulse quick, intermitting, and threaded, jactitation, with
violent desire for cold water. The patient said he was on fire
within. A Consultation was called, and it was agreed to give
salts both by the mouth and anus, whereon they injected into the
patient a pound and a quarter of salts, which of course only
tended to increase the heat, whilst the patient continued to sink
rapidly. On the seventh day of this case, we were called to it.
in the afternoon, when we found him laboring under all the dis-
tressing symptoms above enumerated, with collequative diarr--
hoea and sweat, passing large, serous, coffee ground-coloured
stools. We at once said that recovery was not to be expected.
Our first purpose, however, was to arrest the diarrhoea, in which
we succeeded by giving at once, a full dose of laudanum, as the
best and only hope. We used stimulants, rubefacients, blisters,
&c. washed him in brandy, pepper, and alum, and left nothing
undone to arrest the onward course of the fatal symiptoms : not-
withstanding all, however, he succumbed on the second day after
our first seeing him.

Case 4. This was a young girl of about sixteen, who, as we
were informed, was attended in the usual manner, and whose
case had evidently been neglected and maltreated. She had been
very ill for about sixteen days before we saw her. Her pulse
was soft and voluminous, bowels soluble, skin dry and hot, ex,-

^OS An Kssay on Congestive Fever. [July,

cept about the upper prirt of the chest, back of the hands and
forehead, all of which were moist. Her tongue was inclined to
be dry, and of a dark brown colour, with sordes about the teeth
and gums ; respiration natural, but great anxiety about the
countenance, with occasional subsultus tendinum ; abdomen free
from pain on pressure, but there was a decided tendency to ty-
phoid symptoms. We began the treatment of this case by the
prescription of small doses of calomel and Dover's powder, and
keeping the bowels open when necessary, by injections, support-
ing the system with stimulants and tonics, such as weak sanga-
ree, mint julep, red pepper lea, d:c. It was a very trouble-
some, obstinate, and difficult case to manage ; for it assumed dif-
ferent grades of violence, and so soon as we had overcome one
evil, another of more aggravated character supervened. Fronn
the first of our seeing her on the fifteenth day, there was a con-
stant tendency of the extremities to become cold about 2 o'clock
in the morning ; but as the coldness was not sufficient in the first
part of our observation to demand particular attention, we omit-
ted the use of revulsives until the patient had arrived at what
we thought the blistering point ; and when that crisis presented
itself, we used the remedies with the happiest effect, and the dis-
ease terminated according to our wishes. On the forty second
day after the attack, the fever 5^eemed to leave the suflferer sud-
denly, and the patient acknowledged that she was perfectly un-
conscious of any thing that transpired during the last four weeks.
This fact seemed strange to us, for we had asked no question
without obtaining from her a rational and correct answer. Her
recovery was very slow. About a fortnight after w had taken
leave of the patient, we were again called to examine a tumor
immediately over the parotid gland, which, on inspection, we
found to be an abscess, which we, at once, opened, when a large
quantity of perfectly pure, healthy, straw coloured matter was
discharged,andwithit,^Aee7i^ire parotid gland, (?) in a state of par-
tial decomposition. This gland we examined with great care.
Besides the evidence arising from the inspection of this gland it-
self, we examined the fauces of the same side, and found it al-
ways devoid of the usual moisture. Thus have we one in-
stance, at least, of the parotid gland sloughing out ; nor are we
conscious of the like having occurred either before or since. So

1889. J An Essay on Congestive Fever, C09

far as we are aware, no untoward circumstance has occurred,
and the girl is still in the enjoyment of good health.

In case of resorting to venesection, we shou'd keep it up until
we make a deciiJed impression on the pulse, or until we are con-
vinced of t.'ie impropriety of the practice. But one good bleed-
ing from n large orifice will be produciivo of more good than
two or three small bleedings from small orifices; and when
there is much pain in the head, cold cloths, or what is preferable,
bladders of cold water, will be found very refreshing to the pa-
tient. By such means we hope to arrest the malignity of the
symptoms, and prepare ihe patient for the exhibition of proper
remedies, such as we have already inentioned. In no case, how-
ever, can we admit of the us3 of saline or any hydragogue pur-
gatives; as they invariably tend to the production of colliqua-
tive sweats and diarrhoea. When we have reason to believe
there is mucojs inflxmmation, we have fojinl the following pe-
culiarly beneficial :

^01 llicin.Opt. j.

Jlals. Copaiba, ^ss.

01. Tart, per delig gtt. ilj,

Pulv. Gum Arabic, 3J.

Sacc. Alb. 3J.

Aqua Ment, pip 5 vj.

M. et f. emulsion.
Of this, a table spoon full may bo taken every hour or two, as
occasion may require-.

This preparation of oil almost invar'ably S2ts well on the sto-
nmch. and is very pleas int to the tasfe. In its use we run no
risk of producing hypsrcatharsis, or thin watery passages;
but if they should ever com3 o"i, they are at once to be arrest-
ed, by the timely exhibition of full doses of the tincture of denar-
cotizr^d opium, or the black drop. Nor should we lose sight of
the fact, that a great deal depends on a careful attention to
drinks and diets.

lathe course of the disease, it is not unfrequent, in extreme
cases for hiccough to supervene. In such an event, we expect
more benefit from the u^Je of tincture of castor in doses of about
forty drops every hour, than from all othjr antispasmodics. On
observing the approach of prostration, we order volatile orcam

5

610 An Essay on Congestive Fever, [July,

phorated julap, or both combined ; but in milder cases we pre-
scribe the spiritus mindereri.

The following cases are intended to illustrate this latter course
of practice.

Case 5. Several cases occurred on the border of a mill, pondy
which proved quickly fatal. One however, a young lady, whom
we saw, evidently labored under congestion of the lungs, with
great oppression of the chest, and difficulty of breathing ; pulse
very soft and compressible, and not voluminous, and so strong a
tendency to prostration, that we deemed venesection impracti-
cable ; edges and tip of tongue pale red, and the middle covered
with a dirty white fur. In this case we opened the bowels with
an enema and a simple dose of castor oil. Slight pains in the
bowels, on pressure, below the umbilicus. We then treated the
case with small doses of turpentine, calomel, and Dover's pow-
der ; with expectorants, such as calomel and squills, brown mix-
ture and infusion of seneka. Under this treatment, all things
seemed to progress according to our wish, and as convalescence
advanced, we gave tincture of Iodine in a little ginger tea*
The following was our formula.

:^ Iodine, g. x.

Hydriodate Potass, gr. xx.

Aq. Font. 3j.

Spt. Gall. Vini. ovj. m.
Dose, ten drops every three hours, in a wineglass of Seneka
tea. Under the use of this the pulse moderately improved, and
the patient said she felt better ; the tongue began to cleanse, the
skin to become moist, and every thing progressed favorably.
On the next morning we found our patient quite cheerful, and
free from fever. On her manifesting a desire to eat, we gave
our consent to the use of some simple" articles of diet, as panada,
&;c. Instead of this, however, the preparation given her wasa
mixture of molasses, vinegar and water, very sour, and in ity
some tough, half baked buiscuit. Of this she partook very free-
ly ; the consequence of which was, a sudden suppression of the
.perspiration and of the catamenia, which happened to be present
at the time, and the production of violent pain in the bowels, col-
liquative diarrhoea and sweat. Late in the afternoon we were
called, and arrived only to witness the fatal result of this error
in diet ; for although warm bath, laudanum, epispastics and sina-

1839.] An Essay on Congestive Fever. 6ll

pisms were liberally used, the catharsis continued, and the pa-
tient sank into her final sleep at sunrise the following morning,
which was on the eleventh day. This was a case which ought
to have had a flivorable termination, and doubtless, would, but
for the impropriety above alluded to. It is astonishing in these=
cases to see how quickly the tongue will change its aspect, shapel
and color.

Case 6. This was the case of another young lady who was at-
tacked a few hours after the death of the last named. She was
seventeen years of age great depression of spirits ; hysteria;
quick and moderately full pulse, and so easily compressible, that
we omitted the use of the lancet ; bowels constipated for several
days ; tongue pale red, &c. as in the above case. The bowels
were opened by calomel and ipecac, assisted by castor oil, injec-
tions, and warm bath. On the operation of these means, a very
large discharge of sciballistic matter was evacuated, to the relief
of the tenderness, pain, and burning sensation in the bowels and
stomach. Pain in the chest and head, dyspnoea and considera-
ble restlessness, with strong inclination to run into a typhus
tate even now manifested. We then applied large blisters to
the chest and epigastrium, cupped the spine, used hip bath every
night, applied bottles of warm water to her feet, and ordered si-
napisms in the event of their becoming cold, which was the case.
Not being pleased with the progress of the case, we advised a
consultation, which was had on the seventh day, and by which
it was determined to persevere in the use of calomel and Do-
ver's powder, to be assisted with small doses of castor oil. The
mucous coat of the bronchia evinced inflammation, small streaks
of blood were occasionally observable in the sputa, but this was
most commonly a frothy, white, tenacious substance. By acci-
-dent, the young lady, in attempting to spit, did spit directly into
our eye ; and if we had had as much soap, salt, or spirit in our
eye, it could not have smarted worse. The consequence of this
was, a violent ophthalmia, of several weeks duration.

We gave also emulsions, expectorants, and warm teas, and
paid particular attention to the secretions and excretions. The
sweat had a peculiar kind of sour, disagreeable scent, and the
skm was generally cool and clammy, bowels irregular, some-
times confused and sometimes the reverse. From the whole as-
pect of the case, the prognosis was now unfavorable, and it was

Cl2 An Essay on Congestive Fever. [July,

considered that the case must terminate fatally. Tinct. of Io-
dine, and infusion of Scneka, nnd stimulanls and tonics, were
tried in vain. On the eleventh day tlie case t<)f)k a most unfa-
vorable turn ; violent diarrhcca, wiih cokl, clammy sweat super-
vened. These could not be controlled, and s!ie sunk into col-
lapse, and expired on the fificenih day at sunset.

'J'his case made the fourih death which had occurred in this
family, on the border of the mill pond, in le^s than one month.

Case 7. This was the case of an interesting little boy, who
was attacked with the usual symptoms of congestive fever had
been treated uith antimonials, p:jges, (kc. : diarrhoea superven-
ed. The first physician failing to attend, we were called, and
found the little suttLrer in a slate of collapse, with clammy sweat,
coldness of surface, and literally covered with petechia and vi-
bices, which filled v;ith a semi-transparent fluid. So extensive
was this state of the surface, that there was scarcely a place
where the skin would not slip. Ordered sinapisms, and milk
punch: but death occurred three hours after our arrival. We
were astonished, when we came to slirowd the child, (for this
melancholy duly devolved on us, in consequence of the illness of
the rest of the lamily) at the extent of ihe desquamation effect-
ed in so short a time, in this case. We consider lite fatal lermi'
naiion nftliis case aroaefro/n the error of Ireatlug it with cooU
ing poipdei s" as theij are called Hush's Anti/zionial Powders,
instead if calomel and Docer's Fowdeis.

Case 8. This case was somewhat anomalous in its charac-
ter. 'J" he subject was a mulatto boy eleven years of age. Wc
had, in the same family, a neyro man under treatment, accord-
ing to our usual practice in such cases. He had been sinapised,
blistered, &;c. and was, to all appearance, doing w^ll, when he
was suddenly seized With a proluse diarrhoea, which could not
be arrested, and he died on the eleventh day. His owner be-
came violent, and accused us of neglect, and of kdling the ne-
gro, although we had carefully avoided all purgatives which
could have occasioned a diarrhoea. But the diarrhoea was, and
came on as a natural consequence, in the case ; or, more proper-
ly speaking, such cases hace a strmig tei.dency to run int suck
a diarrhoea. But to the case of the boy. He was very un-
governable, and it was with difficulty that he could be made to
take the most simple and tasteless medicines. In his case there

It

1839.] An Essay on Congestive Fever. 613

was this peculiarity : he had very frequent spasms of the lower
and upper extremities, and occasionally great tormina of the in-
tesiiijcs. The tongue was as usual, and there was tenderness
of the abdomen, evinced on pressure, with burning in the sto-
mach. With the violence of the disease, and the obstinacy of
the patient, it was found no easy matter to please both him and
his master ; consequently, another physician was unceremoni-
ously called, and as unceremoniously took charge of the case.
From all we could learn, he adopted the same views of treat-
ment which we had : differing only in the manner of carrying
out. The patient recovered.

Case y. We were called to see a negro boy about sixteen
years old, and found him perfectly comatose ; skin dry and cold,
and his pulse barely perceptible ; and bowels constipated. We
put him into a warm bath, and gave him an injection of strong
turpentine soapsuds, with a table spoon full of spirits of turpen-
tine, and two of castor oil. We then sinapised and blistered ex-
tensively, and ordered that, so soon as he could be aroused, to
give calomel and ipecac, powders. During the night he had a
good and copious passage, which was said to have a/fordcd con-
siderable relief. In the morning we found him much warmer,
and with less stupor. We continued the powders, and ordered
Haifa table spoon full of castor oil at night. The tongue was,
as usual, red on the edges and tip, and covered in the middle
with a dirty whitish fur ; great burning at the stomach ; some
pain in the bowels and chest ; some congestion of the liver. The
oil purged freely, and next day, the tongue was very pointed
and dry, and the skin yet dry and somewhat cool. We gave in-
fusion of seneka, and calomel and Dover's powder in small do-
ses. From the pointed state of the tongue, we were convinced
that purging should be most carefully avoided. By pursuing the
above practice, and giving a small opiate at night, in the course
of a fortnight he recovered, without any untoward symptom; but
his convalescence was tardy.

Case 10. We were called in consultation to Mrs. W. E. and
found her in a cold clammy sweat, hurried respiration, anxiety
and restlessness ^reat, soreness of the bowels on pressure, burn-
ing in stomach, and sense of oppression in the chest. The bow-
els were moderately open that day, though she had been freely
purged the day before. We advised extensive blistering, and

614 An Essay on Congestive Fever. [July,

small closes of calomel and the com p. powder of ipecac, and opi-
um, with instructions that, if the bowels were not open by ten
o'clock, A. M. next day, to give a tea spoon full of castor oil ;
but unfortunately a colliquative diarrhoea came on during the
night, and the next morning we found her passed all hope of re-
covery. She died that day. We have very little hesitation in
attributing her death mainly to the use of antimonials and Seid-
litz powders, early in the spell ; for she was young, strong, heal-
thy, robust, and of excellent constitution.

Case 1 1. Mrs. B. had been several days confined to bed with
morbilli, but treated herself by domestic remedies. We were
called to her in the month of August, during the warmest weath-
er we have ever experienced. We found her in a small close
room, with all the doors shut, and covered in bed with no less
thun six large blankets and two or three bed covers. So dense
and confined was the atmosphere in the room, that we were al-
most suffocated when we entered it. Her pulse was very much
hurried, breathing laborious, and bowels constipated,* not hav-
ing been open for the last three days. There was some cough,
great pain in the head, chest, liver, side, and bowels, with great
tenderness on pressure, just below the umbilicus. The tongue
was red at the tip and edges, and covered in the middle with a
dirty white fur, and attended with great restlessness.

From the history of the case, we were induced to conclude
that the whole of the mucous tissues and surfaces were in a high
-State of inflammation and congestion. We commenced our
treatment by gradually ridding our patient of the many bed
clothes with which she was covered, and admitting fresh air by
.opening one window and a door at a time, and recommending
the patient to a more comfortable apartment. So soon as the
.excitement produced by the circumstances above mentioned, and
the hot teas taken for the eruptive disease, had somewhat subsi-
^ed, and the patient become relieved by these means, we pro-
ceeded to bleed her, as she had enjoyed excellent health, and a
fine constitution. We took about 5 xvj. of blood, which exhibit-
ed appearances of very high inflammation. This bleeding gave
very great relief. We then ordered fifteen grains of calomel,
and six of ipecac, which, during the night, produced ow/y one

* The patient had used two bottles of Bateman's drops.

1839.] An Essay on Congestive Fever, 615

evacuation, and that one, by no means large. The next morn-
ing we found our patient a good deal better, and all the symp-
toms improved. As the bowels had not been sufficiently open-
ed, and were somewhat painful, we ventured to give a dose of
Seidfitz powders. Being detained by other professional engage-
ments, we did not arrive until about four o'clock the next after-
noon. During this absence a colliquative diarrhoea had super-
vened, and another practitioner was called, who was said to
have given a volatile julap. When we arrived we found our pa-
tient in a state of most perfect collapse, covered with a cold
clammy sweat, and so profuse that it was impossible to wipe
the skin dry. Every five or ten minutes large serous dark bil-
ifjus stools were passed. Nothing had been done to arrest the
diarrhcea. The pulse was then almost imperceptible. The
tongue was pointed and dry. We stopped the purging by a
large dose of laudanum ; but neither blisters nor sinapisms could
effect revulsion to the surface, and the patient died that night.*

This case affords us another instance of the injurious and ru-
inous effects of using, in congestive fever, saline purgatives,
without giving very strict attention to the effect produced. The
tongue at four P. M. was very pointed and dry a certain sign
of excessive purgation.

We cannot blame ourself for giving the Seidlitz powder in
this case, because this was not, strictly speaking, a case of what
may be termed congestive fever ; and yet, very many of the
symptoms were the same. It was, as will be recollected, a case
of morbilli, and in all cases of this disease, so far as we have
known, saline purgatives are considered admissible.

Case 12. O. W. A. aged twenty three, of fine lively disposi-
tion and excellent constitution, and who enjoyed an uncommon
share of good health, was attacked in the night with violent pain
in the head, back, side, chest, and bowels ; pain on pressure be-
low the umbilicus, and also in the hepatic region ; pulse mode-
rately full, and somewhat tense ; skin hot and dry ; oppression
in chest, and breathing somewhat laborious : a little moisture on
the upper part of the chest, about the neck, on the back of the
hands and on the forehead ; great burning at stomach, sour eruc-

* The morbillous eruption was completely suppressed during our attend.
atoce ; but when this suppression took place we know not.

6l0 An Essay on Congestive Fever. [July*

tations, and excessive thirst. This attack was ushered in with a
distinct chill.

We ordered vencseclion to Sxvj. and gave calomel and ipc
cac and oil, and injections of warm water to open the bowels
which were constipated. These pnr^^ative means produced a
very large stool, which gave great relief. Having now a very
fair way opened, we began our treatment by ^'iving small doses
of calomel and Dover's powders, alternated with calomel and
ipecac, in small and frequent doses. The urine being passed
with great pain, and also being very hi.uh coloured, we used a
suppository of opium and camphor in the rectum, to allay the
irritation or strangury, sooner than rould be effected by means
taken by the mouth. In order, at the same time, to purge the
kidneys, we gave Spt. Nitri Dulc. in an infusionof Seneka, with
very happy effjct the urine soon assuming its natural color
and being voided without pain. Under this treatment the skin
also became moist, and pleasant to the feel : all the symptoms
readily gave way, and on the thirteenth day we left the patient,
irQQ from fever, and from all disease, except a slight uneasiness
in the liver, for the relief of which we left blue pills, to be taken
every night and morning, until the gums manifested slight mer-
curial action. Knowing him to be very volatile and thoughtless,
we were very particular in urging prudence in the use of diets,
drinks, and exposure. But no sooner was he out of our immedi-
ate care, than he began to exercise a perfect contempt for our
parting advice. In short, after all imprudencies in diet, exer-
cise, &c. he sat on the cold damp ground, and drank copiously
of cold water, when extremely heated by a long fatiguing walk,
by which his perspiration was suddenly suppressed, and a chill
consequently produced, with great pain in the bowels, and great
swelling and hardness and pain of the liver. A dose of salts,
which he was induced to take, produced a profuse diarrhoea, at-
tended with all its evil consequences, and he died on the second
day.

Case 13. This is the last case we shall give. The subject of
it was a little girl of about six years, and was the patient of an-
other physician who, in consequence of illness at the time was
compelled to omit his visits. We found the child laboring un-
der congestive fever, with the usual symptoms. When about to
make our prescription, the former physician arrived ; and not

1839. J An Essay on Congestive Fever, G17

desiring a conference on the cure, we retired, leaving it in his
hands, and remained silent spectator. Antimonial powers
were, as we anticipated, administered pjiving at the same time
the opinion, that the child wouid soon he well. We then left,
not without the opinion that the antimnnial powders should he
avoided, and catamous revulsives, with calomel and Dover's
powder used in their stead. Our worst fears were fully verified
by the death of the little sufferer the next day. We are decided-
ly of the opinion that this child should, and would hnvc recover-
ed, had it been treated on the plan whicli wesuirgested above.

From the above observations and cases, it is apparent, that
congestive fever, as it is called, is a disease of a most obstinate
character, and dangerous nature, and difficult to manage that
it is, in its first stage, evidenthj inflammatory^ and therefore, re-
quires great skill, prudence, judgment and caution, to treat it
successfully and that medicines of the most simple nature r>7z///
are required to eflidct that purpose. It appears also in these ob-
servations of cases, evident, that the mucous membrane of the
intestines is the chief seat of this disease ; but that other mucous
membranes, as well as other internal organs are also sometimes
involved. We could have given many other cases, but their
great similarity renders it unnecessary. Bein;j: engaged in coun-
try practice, we have had no opportunity for making autopslc
examinations ; we hope, however, that those who have such
opportunities, will thoroughly investigate the suhject, and favor
the public with their views, thence derived, of this formidable
disease.

We do not presume that we have, in this communication,
presented any novelties, or shed new light on the subject of con-
gestive fever. Our only motive has been to give a view of the
practical facts as they have occurred under our observation,
and those views of treatment which we have found beneficial, or
injurious. Should this prove serviceable to humanity, ev(?n in
a very limited degree, we wdl feel amply rewarded for our
trouble. .

We would not be understood to inculcate the idea, that all sa-
line purgatives are to be uniformly proscribed as ruinous ; for
WG could adduce cases in which they were useful, and some in
which these alone afford any relief. Why it is that in conges-
tive fever, emetics should be so signally prejudicial, wiiilst in
6f

CT8 Memoir of Dr. Physich P^ryv

other congestions they are so beneficial, we are not prepared to
say. We wish to remark, relative to a very common practice,
that of giving a large dose of calomel, followed by a drastic or a
saline purgative, that in no case of congestive fever can we jus-
tify it as we have, to the extent of our experience, observed
the very uniform inefficacy, or immediately injurious tendencies
of such a course in cotigestive fever.

Part ir. REVIEWS AND EXTRACTS.

A Memoir on the Life and Character of Philip Syng Phy-
sick, M, D, By J. Randolph. M. D. Am. Jour, Med, Sci,

We trust that no apology will be deemed necessary for occu-
pying so large a portion of our pages, with the following extracts
from Hr. Randolph's biographical sketch of the Father of Ame-
rican Surgery. He was an honor to his couatry, and a bene-
factor of his kind and the history of the life of such a man can
never fail to afford rich materials for profitable reflection. It
never fails to teach those who are entering upon a scientific or
professional career, that talent, even of a high order, always
ffids it necessary to call to its aid untiring industry, and unwa-
vering perseverance, to enable it to secure lasting and deserved
fame. We regret, with Dr. R., that the extreme modesty of
feeling which Dr. Physick possessed, prevented him from fur-
nishing many facts which would have rendered his biograyjhy^
as complete as the world would desire. Notwithstanding these
difficulties, the biographer from his long intercourse and intima-
cy with Dr. P. has been enabled to furnish a most interesting
sketch extracts from which, we proceed to lay before our
readers.

Philip Syng Physick was born in Philadelphia on the 7th of July, 176S,.
His father, Mr. Edmund Physick was an Englishman,, and was character-
ised for possessing strong mental powers, with which were united strict
integrity and considerable knowledge of the world. Previously to the separ-
ation of the United States from Great Britain, he held the office of Keeper
of the Great Seal of the Colony of Pennsylvania ; and subsequently to the
Revolution he took charge of the estates belonging to the Penn family,
and served as their confidential agent. Doctor Physick's mother was a
rooet estimable, pious woman, who was blessed with a strong intellect, and

I

4839.] Memoii- cfDr. Physick, 15

evinced throughout her life, great judgment and decision of character.
The Doctor never ceased to feel and express, the greatest filial love and re-
verence for these honoured parents. He frequently declared, that he was
convinced that whatever was most useful and excellent in his character, was
attributed to the early lessons and impressions which he imbided from them.

By such parents as these the greatest care and attention would naturally
be bestowed upon the education of their children. Fortunately his father
had succeeded by great industry and attention to business, in accumulating a
property which, in tlwse days, was looked upon as considerable ; and being
thus in possession of ample means, he was enabled to carry out fully the plan
of education which he designed for his son.

In doing so Dr. Physick informed me that his father was influenced by a
degree of hberahty very unusual in that, or indeed in any age. Double fees
which he uniformly transmitted to the teacher testified the great importance
which he attached to a liberal education, and the value which he thought
should be set upon the sources from which it emanated. This was not only
intended for an encouragement to the instructor to use his best endeavours
on behalf of his pupil, but because the donor believed the charges for tuition
at that day were not a fair equivalent for the services rendered.

Mr. Physick placed his son, when eleven years of a^e, in the academy be-
longing to the Society of Friends, in south Fourth street, under the tuition
of Robert Proud. At this period Mr. Physick resided in the country, on the
banks of the Schuylkill, several miles from the city, at an estate belonging to
the Penn family. To faciliate the education of his son, he boarded him in
the city, in the family of the late Mr, John Todd, the father-in-law of the pre-
sent venerable Mrs. Madison. Even at that early age the subject of our
memoir exhibited strong indication of those well regulated habits, order and
method which adhered to him so closely throughout his life. Every Sa-
turday after school broke up, he was allowed to go to his father's residr^nce
in the country, where he remained until the following Monday morning.
He then not unfrequently was obliged to walk into town, and sometimes
through most inclement weather. Notwithstanding this, he always presen-
ted himself at school exactly at the opening. His teacher was so much gra-
tified with this extraordinary punctuality, that he took pleasure in holding
him up as an example to other boys, who though living in the vicinity of the
school, were too apt to be remiss in makmg their appearance at the proper
hour.

Young Mr. Physick remained at this academy until he entered the collegi-
ate department of the University of Pennsylvania. He then passed through
the usual course of studies prescribed in that institution, and took the degree
ol Bachelor of arts in May, 1785. I am not aware that any thing remarkable
occurred during the period of his collegiate studies. That he was a diligent
and exemplary student cannot for a moment be questioned. It is well known
that he was particularly succesful in acquiring a thorough and intimate
knowledge of the classics, of which he retained sufficient, amid all his en-
gagements, to be able to translate them with facility, to the time of his death.

In June, 1785, he commenced the study of Medicine, under the superin-
tendance of the late Dr. Adam Kuhn, well known as the pupil of Linnseus,
and a most distinguished and successful practitioner, and then Profes-
sor of the Theory and Practice of Medicine in the university of Pennsylvania.
Of the particular motives which influenced young Mr. Physick in the
choice of this profession I am unable to speak. It does not appear that he
at that period evinced any strong predilection for this department of science.
Prnbably he was in a great degree governed by the wishes of his father ;
and so strong were his feelings of filial obedience that I am very certain that
he would at any time readily iiave yielded his own wishes to those of his pa-
rents. The following anecdote is traditionary in the family. His father,
whilst handling a knife, had the misfortune to cut one of his fingers ; and the

G20 Memoir of Dr. Physich [July,

wound proved to be so severe that he was obliged to engage the services of
a in j.lical friend. Qpoji one occasion his son begged of him lo be permitted
to apply tli3 necessary dresssiiigs and b indnge to ihs Hnger : his father con-
Sc-n'-ed, and was so much surprised at tlie great skill and dexterity which his
Fon (iisphiyed m making the applications, that he determined to make him a
Burgeon.

*:;*** % * * *

Dr. Physick was remarkable through life for feelings of the most acute
rnd susceptible nature. It may be truly said of iiim that he possesed a soul
feelingly alive to the miseries and sufferings of others. He could not him-
self support pain with ;iii ordinary degree of fortitude, and it is undeniable,
that htj was extremely unwilling to inflict it upon others. This tenderness
of feeling, which existed strongly in the days of his youth, continued in full
foiCJ as Jongcishe lived, as I shall have occasion to show dunnjr the prcgress
o[ tins mitnoir. Hi used frequently to declare at this period of liis hfe, that
he never could be a surgeon. Little was he awarp, that he was destined to
afford ^a complete illustration of the position, that the practice of medicine and
F'.irjff rj^ so fdr from hnrdeningand rendering callous the feelings, has a direct
c n'riry tendency, and serves pre-eminently to solien and r.- tine them. His ex-
am jle, as well as the result of our wliole experience upon this subject, de.
m; ns ra'es tha'for a man to become a grt-at and good surgeon, it is absolutely
necessary for him to possess to the .ullest extent, the btst and kindest feei-
ing:5 of our nature.

'J'.ie following inc:den% which occurred to Dr. Physick, and which was in
fact characteristic, may not be deemed uninteresting. Soon after he com-
m nrjcd the study of niedxine, it was announced that an amputation would be
performed upon a certain day at the Pennsylvania Hospital. His preceptor.
Professor Kuhn, wished him to witness this'operation, but understanding per.
fectly well the peculiar temperament of h;s pupil, he advised his father lo ac-
coimany him ; and fortunately too, inasmuch as i)\\ l^hysick b( came so sick
diiring the operation that It was necessary that he should be led from the
ampliitlieatre ' eforeit was concluded.

Dr. Physick continuerl his medical studies under the superintendence of
Pr>fe>sorKiilin. for three years, in those days it was customary for the stu-
dent of medicine, prev.ously to obtaining the honours of the doctorate, to go
through a much mure extensive course of reading than is now deemed ne-
cessary. By the direction of his preceptor. Dr. Physick readtiirough most
diligently and faithfully, many voluminous works of the older medical writers,
som^ of which, if not absoljt-Iy obsolete at the present day, are only used as
wor\'s of reference. We linve abundance of evidence, that even at thateaily
p-^ri ):lof his life, Hr. Physick evinced the most resolute deiermmation to qual-
ify hin.sjfby every possible means, for assuming a most useful and honourable
standinc^ in his profession: and there cannot be a question but that he
must hive gleaned from amidst this great mass of laborious reading, much
valuable inform ition, which he subsequently applied to an excellent purpose.

J)r. Physiclv's whole deporrment during his pupilage was so perfectly cor-
rect and satisfacfory, as to merit the entire approbation of Professor Kuhn :
and it is well known, that Dr. I^hysick always cherished feelings of the
warmest affection and regard for his venerable preceptor.
^In addition to the instruction which Dr. I^hysick received from Professor
Kuhn, he attended at this period the medical lectures delivered in the Uni-
versity of Pennsylvannia. He did not, however, graduate in medicine
in that institution. The opportunities for the acquisition of medical know-
ledge offered by the schools and hospitals of this country, then in its infancy,
were too limited to satisfy either his conscience or his ambition. He could
not convince his mind that his knowledge of medicine was sufficiently en-
larged to vv'arrant him in assuming ttie deep and important respon-
fiibiUties attendant upon the practice of a profession which involved

1839.] Memoir of Dr. Physick. 631

the lives and liappines of his fellow creatures. For the completion of hi? ed-
ucation, he enteriained an ardent desire to visit Great Brilam, and to avail
hiniseU ottlie advaniag-es which vvt're afforded by ihe great scliools and hos-
pitals ol London and hdinburgh. His lather happily coincided wiih these
views, and determined upon accompanying^ his son to Europe. Accordmo^ly
they embarked in iXovember, 178b, and arrived in London in January, ITttU.

Dr. Physick's sole object in going abroad was to acquire medical mlbrma-
tion. He had no desire to partake of the gaieties and amusements of an
European capital. I repeat, witli him the grand consideration was the ac-
quisition of knowledge: to this he applied himself with the most ardent devo-
tion, and never permitted amusements ol any kind to turn him aside from its
pur^uit.

|-t)rtunately for Dr. Physick, his father's connections in London were such,
that he was enabled to introduce his son to some ol the most learned and po-
lished society, of that great metropolis. An intercourse of this kind crea-
ted for him an influence and gave him opportunities by means of which his
cherished views were considerably promoted. All who ever saw Dr. Phy-
sick must have been struck with the exceeding dignity and courteousness of
this manner. For this no doubt he was principally indebted to nature, though
it must have been improved and confirmed by his association with the eleva.
ted society which he enjoyed whilst abroad. By means of this same influence
Mr. I'hysick succeeded in securing the consent of Mr. John Hunter, then
one of the most celebrated anatomists ftnd surgeons of the age, to receive
the subject of our memoir under his immediate care and tuition.

Dr. Physick considered this as the most important era in his professional
life. He early became convinced of the extraordinary advantantap;es which
ho might derive Irom this connection with Mr. Hunter, and proceeded
accordingly to devote himself with the most ardent zeal to the study
of practical anatomy and surgery. By dint of constant and unwearied ap-
plication to his studies, aided also by a course of unceasing and uniliring dis-
sections, he soon made rapid advancement in the attainment of his objects,
and what was also of much consequence, secured to himself the approbation
and esteem of his great master. Mr. Hunter, in fact, was so well pleased
with the zeal, industry, and correct deportment, of Dr. Physick, that the took
pleasure in acknowledging him as a favourite pupiJ, and bestowed upon him,
with the most unreserved confidence, the full benefit of his advice and expe-
rience. During this period Dr Physick attended regularly the lectures deli-
vered by Mr. John Clark and Dr. Wm. Osborne on Midwifery.

<c * * * * * ^ ' ^ 4:

Dr. Physick continued to prosecute his studies with the most exemplary
perseverance and idustry, under the immediate superintendance of Mr. Hun-
ter, throughout the year 1789. On the first of January, 1790, he was ap-
pointed House Surgeon to St. George's Hospital for one year, the usual
period of that service in the institution. This appointment he owed exclu-
sively to the patronage and influence of Mr. Hunter. The advantages of
such a situation to the student of medicine, in facilitating his acq^jisition of
practical knowledge and skill, were of the most important character; and
were so well known as to cause the place to be sought after by numerous
applicants, most of whom, from the circumstance of their English birth alone,
it might be supposed, could have had an influence vvhich would have render-
ed them successful co'mpetitors against a foreigner for the place. Here were
exemplified in the most happy manner, the important advantages which Dr.
Physick derived from the favorable impressions which Mr. Hunter had imbi-
bed respecting his general worth, his talents, and his acquirements. These
considerations induced Mr. Hunter unhesitatingly to exert the whole of his
iufluence in behalf of Dr. Physick, with what effect has been stated.

A few months after this period. Dr. Physick had so severe an indisposi-
tion, that Mr. Hunter became alarmed about him, and was on the eve of
insisting upon his return to America. This attack, no doubt, was prmcipal-

fi'Sa jfcniolr of T)r. Flujsich. [July.

'\^ ovf'mg to the laborious ]ife which he led, and the close confinement to
which lie subjected himself. Providence, however, for its own wise and be-
nelicent purposes, thought proper to restore him to health, to the great de-
light and gratitude of his parents and friends.

It was during the period of his remaining at St. George's Hospital, that
Dr. Physick acquired a vast deal of that surgical skill and dexterity which
laid the foundation of his subsequent greatness. Having his whole time oc-
cupied in administering to the wants of such unhappy objects as were suf-
fering from the effects of accidents or disease ; being constantly engaged in
applying the necessary bandages and dressings to Iractured bones, didoca-
tions, wounds, and injuries of every description, and seizing hold, as was
his invariable custom, of every such opportunity of making himself minutely
acquainted with the most perfect manner of performing these services, he
soon became remarkably expert iu all his manipulations, and acquired a de-
gree of experience which increased greatly his stock of practical knowledge.
He indeed exhibited a degree of neatness and dexterity in the application of
bandages and dressings never excelled probably by any other surgeon.

During the period of his services in this institution, he learned also the
manner of constructing and contriving several kinds of instruments and ap.
paratus, which he, subsequently, was the first to introduce into this country,
to the great benefit of our art.

An anecdote frequently related to me by Dr. Physick, connected with his
early appointment to JSt. George's Hospital, I may be pardoned for mention,
ing here, notwithstanding it has already been promulgated from another
source. His success m obtaining this situation caused some slight degree
of dissatisfaction on the part of some of the disappointed applicants, who con-
ceived that their claims for this situation were stronger than his. In conse-
quence of this, Dr. Physick perceived thatthoy evinced uncommon curiosi-
ty respecting his manner of discharging his duties, and were disposed to
scrutinise his actions with the greatest strictness. A siiort period after
commencing his services, a patient was admitted into the hospital with dis-
location of his shou'der ; the head of the humerus being lodged in the axilla.
Fortunately the accident was quite recent. It so happened that at the time
the man was admitted, the whole class were in attendance at the house.
They, of course, were exceedingly anxious to witness the manner in which
the reduction would be effected, and Dr. Physick was well aware that his
method of restoring the bone to its natural position would be severely criti-
cised. He directed the patient to be seated upon a high chair, and then
proceeded to examine the injured shoulder, questioning the man as to the
manner in which the accident had happened. Whilst making these enqui-
ries, he placed his left hand in the axilla, and taking hold of the lower end
of the humerus with his right hand, he made all the extension in his power,
then suddenly depressing the elbow of the patient, he dislodged the head of
the bone, which glided instantaneously into the glenoid cavity.

In relating this incident, Dr. Physick never assumed to himself much me-
rit for his success, but rather ascribed it, in a great degree at least, to the fa.
vorable nature of the case. His characteristic modesty, however, induced
him to underrate his services ; his success was doubtless principally owing
to that unrivalled address and dexterity of which he subsequently proved
himself to be so complete a master. The treatment of this case produced
the most happy influence in promoting the interest and comfort of the doc-
tor during the remainder of his stay in the hospital. He stated that from
that time forward he always enjoyed the uninterrupted regard and respect
of the medical class.

In January, 1791, the period for which he had been elected to St.
George's Hospital having expired, he quitted the institution, carrying with
him the warmest testimonials, from its proper authorities, of his medical
qoalifications, and also of his general good conduct. They went so far as

1839.1 Memoir of Dr. Fhtjsick C23

to declare, that instead of considering him to lie under any oblig-ations to
the institution, they considered the institution indebted to him tor the many
benefits he had conferred upon its unhappy inmates, and for tlie Uj^eful re-
sults which had been produced by his singular zeal and abilities. He now
received his diploma from the Royal College of Surgeons in London.

Soon after leaving St. George's Hospital, Dr. Physick received from Mr,
Hunter a mark of respect and esteem, which was in the highest degree gra-
tifying to him, and more particularly so as it furnished conclusive evidence of
Air. Hunter's entire confidence in his professional skill and attainments. Mr.
Hunter invited him to take up his residence with him, to become an inmate
of his house, and to assist him in his professional business ; he also held out
inducements to him to establish himself permanently in London.

Notwithstanding the tempting nature of these offers, and the great advair.
tages which Dr. Physick might have derived from accepting them, it did not
comport with either his own designs, or those of his father, that he should
exile himself from his native country. In accordance with the plan previ-
ouslylaid down for the completion of his medical education, he was to visit
Edinburgh, in order to graduate in medicine in the University of that city.
He, however, gratefully accepted Mr. Hunter's invitation to reside with hinr
until this period should arrive ; and accordingly he remained with Mr. Hun-
ter, and assisted him, not only in his professional business, but also in the
prosecution ofhis physiological experiments, and the making of anatomicaP
preparations, until May, 1791, when he took his final leave of London. I
may notice that his father hady previoysly to this period, returned to America,

* A* -^ :c * * :(c ;^

Immediately after his arrival in Edinburg, Dr. Physick entered with hif
usual ardour upon the prosecution of his studies. He attended very dili-
gently the medical lectures delivered in the University, visited constantly
the Royal Infirmary, was a careful observer of the practice pursued in that
institution, and witnessed all the operations there performed. In May,
1792, having complied \\\Xh all the requisitions demanded by the University,
he obtained the degree of M. D. The subject of his thesis was apoplexy,"
and in compliance with the established regulations, it was written in the
Latin language. The original manuscript of this essay, which he first wrote
in English, is now in my possession, and bears the most satisfactory evidence
of having been prepared with a vast deal of careful attention.

To show the familiar knowledge of the Latin language which Dr. Phy-
sick possessed, I may relate the following anecdote. It is well known that
the examinations for a medical degree in Edinburgh are conducted in Latin,"
and that there are many applicants for the honor, who, from not possessing
a sufficient knowledge of that language, are compelled to have recourse to-
the aid of a class of men termed grinders, whose occupation consisted in pre-
paring students, by a system of drilling, which should render them compe-
tent to reply to such questions as were likely to be put to them. It so hapv
pened that, a short time previous to the examinations, Dr. Physick was in
company with a fellow student from this city, and in reply to some allusion
made bv his companion to these grinders, the Doctor stated that he should
not seek their aid, but that he was determined to rely upon his own knowl-
edge of the language to carry him safely through. His companion express-
ed much surprise at this statement, seeming to consider it as a vain boast
on the part of Dr. Physick ; and he intimated his doubts of the Doctor's ca-
pabilities, inquiring whether he meant to say that he possessed a sufficient
knowledge of the Latin to enable him to carry on a conversation in that lan-
guage. Dr. Physick satisfied him completely, by instantly addressmg him in
Latin, and continuing for some time to converse with him in that tongue.
*********

Dr. Physick returned to his native country in September, 1792; and com-
menced the practice of his profession in Philadelphia. Hi office was situ-

C24 Memoir of Dr. Phi/sick. [July,

ated in Mulberry street near Third. That Dr. Physick entered upon his
pracriciil career under the most favorable circumstancoF, wil', I tijink, be
rd:i:lily adniitted. I have already shown tha% jn addirion to Irs own extra-
o.;d n iry qualificjition-', he had enjoyed the most ample opportunities of ac-
qainn^r knowiedo^e from sources distin<:uit--hed alike for their exalted ( ha-
racter and superior excellence. Nature also rendered her best aid for fit-
ling him pre-eminently, by all external advantagres, for the successful ac-
complishment, of his objects. His personal appearance was commanding in
the extrema. H) was of a medium height ; his countenance was noble and
expressive ; he had a largo liomannose; a mouth beautifully formed, the
lips somawhat thin ; a high forehead, and a fine penetrating hazel eye. The
e.vpra>sion of his countenance was grave and dignified, yet often inclined to
nialancholy, more especially when Jie was engaged in deep thought, or in
performing an important and critical operation. Dr. Physick rarely indulg.
ed in excessive mirth ; he was, however, far from being insensible to playful
humor, and on such occasions his countenance would be lighted up by a be-
nign smile, which altered entirely the whole expre.-sion of Ins features. His
manners and address were exceedingly dignified, yet polished and affable in
the extreme ; and when he was engaged in attendance upon a critical case,
or in a surgical operation, there was a degree of tenderness, and at the same
lime a confidence, in his manner, which could not fail to soothe the fcelmgs
and allay the fears of the most timid and sensitive.

Tiie introduction of a young practitioner of medicine to the notice of the
community, is proverbially slow ; and, not unfrequently, before he can in-
spire a sufficient degree of confidence to lead to his employment, a length of
time is requisite which, in some instances, produces bitter disappointment,
and o-^casionally, even utter hopelessness and despair. As might have been
anticipated, there \^ere but few professional calls made upon Dr. Physick du-
ring the period of the first year after he had established himself in this city ;
and it is highly probable that, notwithstanding all the advantages of which
lie could boast, he would have been obliged to exercise an enduring degree
of patience for a considerably longer period, were it not that in the summer
of 1793, Philadelphia had the misfortune to be visited by that awful calamity,
the yellow fever. It is not necessary in this place to give an account of the
dastructive ravages caused by this epidemic. The most ample and detad.
ed description of its origin and progress, with all its concomitant circumstan-
ces, has been furnished by one of the brightest luminaries of the age ; one
who was a most prominent and efficient actor in the tragical scene ; whose
dismterested patriotism, brilliant imagination, and splendid acquirements,
endeared him to the hearts of his countrymen, and who invariably evinced
himself to be the warm friend of Dr. Physick. Need I add the name of Dr.
Benjamin Rush ]

The occurrence of the yellow fever afforded to Dr. Physick his first op.
portunity of proving to his fellow citizens, his entire devotion to his profes-
si( nal pursuits, his utter disregard of all personal considerations which
might interfere with the discharge of his duties, and the fearless intrepidity
with which he exposed himself to danger, in order to contribute to the safety
of others. As a means of preventing an extension of the disorder by remov-
ing, as far as possible, from overcrowded situations those who were attack-
ed by it, and also to afford an asylum and the most efficient treatment to
such as were destitute, the Board of Health, in August, 1793, established the
yellow fever hospital at Bush Hill, and Dr. Physick, having offered his ser-
vices, was elected by them physician to the institution. He immediately
proceeded to the performance of his duties with singular ardor and ability ;
and during the time he remained in the hospital, rendered services which
were acknowledged to be of the most important character, and which serv-
ed to secure to him the approbation and esteem of the community at large.
Dr. Physick himself did not escape an attack of the fever. It however yield-

1839. J Memoir of Dn Physkh 025

ed to treatment, although I heard him declare, but a short time previous to
his death, that he did not think his constitution had ever completely recover,
ed from the shock which it then received.

After leaving the hospital he removed to the city, and jr^ivehis undivided
attention to hiy professional engigennnts. In the year 1791, D.'. Pnysick
was elected, by the managers o! ti)e Pennsylvania llospitaK one of the sur.
geoiis to that institution. T.iis perlo:! was the diwn of his great surgical
fame and usefulness. The reputation sustained by the Pennsylvania Hospi-
tal for a long series of years, not only for the amount of benefits which it has
conferred, but also on account of its excellent adm'nistration, are so well
known as to render superfluous any encomiastic notice of it on my part.
Til t Dr. Physick contributed largely to the support of its character and re-
putation, can be readily shown by a record of his services. It must be ad-
mitted, however, that his ap^ntment to th" hospital had a considerable in.
fluence in promotmg his succ^s, and ieadit)g to an extension ol his business.
The situation enabled him to add greatly to his stock of experience, and af.
forded him ample opportunities of perfecting himself in the operative depart,
nient of his profession. I have already stated that in his manual procedures
lie exhibited the utmost degree of neatness and dexterity. Mr. Physick pos.
sessed, pre-eminently, all the qnalifications requisite for a bold and success,
fdl operator. His sight was remarkably goo.i ; his nerves, when braced for
an operation, were firm and immovable; his judgment was clear and com.
prehensive, and his resolutions once formed, were rarely swerved from, la
addition to these he owed much to his thoughtful and contemplative cast of
character, which induced him to deliberate and reflect intensely upon all the
circumstances of his case, and to make elaborately, beforehand, every prepa-
ration which might become needful in the performance of his task.

In order to appreciate fully and correctly the amount of contribution made
by i).\ Physick to the department of Surgery, it is important to call to mind
the imperfe'ct condition of the art in this country, at the period of his com-
mencing his professional career. It is well known that the principles of sci.
ence which sh')u:d govern the treatment of m\ny disorders were at that day
very imperfectly understood. It is true that there were some members of
the profession, possessed of great merits Mnd learning, who devoted them-
selves especially to the cultivation of surgery. These grentlemen were quite
competent to the performance of what were then considerpd the c.-.pital one-
rations in surgery ; still it must be confessed that nooneof them ever arqri-ed
the necessary d'gree of skill and pre-eminence to create an unlimited confi-
dence in his abilities. In consequence of this there was no head, no rallying
point in surgfry, an appeal to which, when once m ide, would be regarded as
decisive. We cannot feel surprised at the comparatively insignificant posi-
tion which the science of surgery then held, when we reflect thit, prior to
th3 appointment of Dr. Physick, surgery was not taught in this city as a se-
parate and distinct department. The professorships of anatomy and surge.
ry were conbined in the Uaiversity of Pennsylvani^i, and the duty of teach-
ing both branches devolved upon one individual. Under these circumstan-
ces, it would have been extremely unreasonable to expect an efficient course
of instruction when it is well k'lo.vn that the usual period allotted to a course
of lectures upon cither department, as now separated, is confessedly too
limited.

In, the year 1791, Dr. Physick wis elected one of the phvsicians to the
Philadelphia Dispensary; and during the p>eriod he held this appointment,
1)9 performed his duties with the strictest filelity. IJg subsequently was
appointed one of the consulting surgeons to this institution, and retained the
i tuation till the time of his death.

From a reference to Dr. Physlck's papers, it appearf, that his profession-
7a

626 Memoir of Dr. Physich [July,

al engagements increased very considerably in the year 1795. About this
perio I, his prospects of establishing himself in practice became exceedingly
riutering. Dunng the year 1795, he commenced keeping a journal ofihe
most remarkable and interesting cases which occurred in his practice, more
especially of a surgical character. This journal is continued up to the year
1810, although in consequence of the multiplicity of his engagements about
this period, we have to regret, the number of cases inserted is very conside-
rably lessened. The first case recorded in the note book, is that of a lady af-
fected with blindness fnm cataract. In this case, he performed the opera-
tion of extraction of the opaque crystalline lens, with complete success, and
restored his patient to sight.

^ The year 1800, formed a most eventful one in the life of Dr Physick. Du-
ring this year he formed a matrimonial allianJD with Miss Elizabeth Emlen,
a high'y gifted and talented lady, and daugljer of one of the most distin-
guished mmisters of the St)ciety of Friends. By this marriage he had four
children, two sons and two daughters, all of whom are now living.

Jn the year 1800, a request was made to Dr. Physick in writing, by a num-
ber of gentlemen engaged in attending the medical lectures delivered in the
University of Pennsylvania, that he would lecture to them on Surgpry,
Among these gentlemen, who so fully appreciated his extraordinary qualifi-
cations, was included our present pre-eminently distinguished Professor of
the Theory and Practice of Medicine, Dr. Chapman.

No man could feel more deeply the solemn responsibilities attendant upon
such an enterprise than Dr. Physick. After mature deliberation, liowever,
he determined to accede to their request, and this may he considered as the
commencement of his labors as a lecturer.

The tollowing anecdote, related to me by the doctor himself, will exempli-
fy the ardor and zeal with which he entered upon the performance of his
duties, and it illustrates also most happily the great advantages which may
be derived from a word of encouragement and approbation, ccnjing from a
source in which entire confidence is reposed.

After preparing the lecture introductory to its course, he committed it to
msmory. Among the persons invited to be present at its delivery, \^as liis
valued friend. Dr. Rush. The scene was a trying one to Dr. Physick. It
was the first time he had ever publicly addressed an audience. 1 have been
informed, however, that he acquitted himself extremely well. At the close
of the lecture. Dr. Rush stepped up to him, gave liim his hand, and congrat-
ulated him upon his success, saying to him very emphatically, " Doctor, that
will do that will do you need not be apprehensive of the result of your
l;cturing--l am sure you will succeed " Dr. Physick never forgot Dr.
Rush's kind manner to him on this occasion. He assured me that it exerted
a considerable influence in strengthening and confirming his resolutions to
persevere. It is needless for me to say that Dr. Rush's predictions respect-
iigDr. Physick's ultimate success in lecturing were fulfilled to the utmost.
Five years subsequently to that period, the Professorship of Surgery was
created in the University of Pennsylvania, and Dr. Physick was elected to
the chair.

In the year 1801, Dr. Physick was appointed " Surgeon Extraordinary^''*

and also one of the physicians to the Philadelphia Alms-house Infirmary, f

am not aware that any appointment similar to the former has been since

made in that institution.

fc * ** * * * * *

About this period, it may be said that the talents and acquirements of Dr.
Physick began to be extensively known and appreciated, not only by the
members of his own profession, but also by others. I may mention, that in
this same year, (1802,) he was elected a member of the American Philosophi-
cal Society: a well merited tribute due to his rising greatness.

I 839.] Memoir of Dr. Physick. (J27

This year Dr. Physick devised and executed an operation which forms
one of the most beneficial results to suffering humanity. On the 18th of
Dscemher, he performed, in the Pennsylvania Hospital, his celebrated oper-
ation of passing a seton between the ends of an ununited fractured humer-
us, for the purpose of causing a deposition of callus, and thereby producing
the consolidation of the broken hone. The patient was a seaman, who had
the misfortune to fracture his left arm, eighteen months previously, whilst at
sea ; and in consequence of the bones not having united, the limb was ren-
dered nearly useless. At the expiration of five months after the performance
of the operation he was discharged from the Hospital perfectly cured. Dr.
Physick published an account of this case in the Medical Repository of New
York, vol i. ly04 ; and it was republished entire m the Medico- Chirurgxal
Transactions of London, vol. v. 1819.

It so happened, that, in the year l!:J30, I was requested to visit a patient
who was lying dangerously ill with remitting fever. A few days after my
first visit, in riding past his door in company with Dr. Physick, feeling very
uneasy about the condition of my patient, I requested the Doctor to step in-
to the house and give me the benefit of his advice. He complied, and upon
entering the sick man's chamber he immediately recognised him as the in-
dividual upon whom he had performed the operation which I have just de-
scribed, twenty-eight years previously. Upon questionmg the patient he
informed us that the arm which had been broken was quite as strong as his
other arm, and that he had never sustained any inconvenience from the oper-
ation. The man died ; and having obtained permission to make a post mor-
tem examination, I procured his humerus, which 1 still have in my posses.
sion, and regard it as one of the most interesting and valuable pathological
specimens extant. At the place of fracture, the two ends of the bone
are perfectly consolidated by a mass of osseous matter, in the centre of which
there is a hole, through which the set on had passed.

Since the performance of Dr. Physick's first operation, this method has
been resorted to with entire success in numerous instances by himself and
other surgeons, for the cure of ununited fractures, not only of the humerus, but
alsoof some other bones. That this operation, like all others, occasionally
fails, must be admitted : it is, however, generally conceded that it possesses
many advantages over the method not unfrequently resorted to, of cutting
down to the ends of the bone and sawing them off, recommended by Mr.
Charles White, of Manchester.

In describing that process M. Boyer declares it to be "painful, terryfying,
and of dubious event." He once performed it on account of a preternatural
joint, situated in the middle of the humerus ; the limb mortified, and the pa-
tient died on the sixth day. Independently of the greater hazard attending
this method of operating, it is unquestionably much more painful
than Dr. Physick's; and although occasionally it succeeds perfectly, in many
instances it has entirely failed.

It is a matter of much surprise and regret, that Mr. Wm. Lawrence, of Lon-
don, a gentleman^distinguished for brilliant talents and extensive learning, in
speaking, in his 'surgical lectures, of the different methods of operatmg
for the cure of ununited fractures, should greatly undervalue the importance
of Dr. Physick's operation, and limit exceedingly its successful results. Td
correct the false impressions which this statement might create, and as an
act of justice due to the distinguished inventor of the operation, my friend
Dr. Hays gave in his valuable periodical, the American Journal of the Medi-
cal Sciences, vol. vii, p 267, a brief summarry of numerous cases of ununited
fracture successfully treated by means of the seton, collected from various
sources. D:. Physick was extremely gratified at the able manner in which
Dr. Hays vindicated the merits of his operation, for the care of artificial joint
by means of the seton.

Dr. Physick's private journal, and also a book of cases, kept by his ne-

C28 Memoir of Dr. Physieh. [July.

phew, Dr. Dorsey, clearly evince that at this period Dr. Physick was occu-
pied in attending to amoi-t extensive and laborious practice. In J)r. Dor-
sey's note book are recorded the rr.ost interest inj^ cases and operations oc-
curring in the practice of Dr. P/iysick, to which he was a witness. It is ex.
ccedingly probable, that during t'hnt period there were but few operations per-
formed by Dr. Physick, at which Dr. Horsey wasr.ot present ; for in seme
places he gives an account of important and capital operations performed al-
rnost daily hy his uncle.

It has always been a subject of deep regret with the profession, that Dr.
Physick should have evinced thronghout liis whole life such an extreme re-
luctance to tiie publication of the re^uIts of valuable observations and expe-
rience. Wliat a fund oT knowledge has in 1 liis manner been permitted to
pass away, which might have been happily applied to ameliorating the mis-
eries of humanity \ ^)trange asit may appear, I unhesitatingly assert, that
posthumous fame was not sought after by Dr. Physick. I am well convin-
ced, however, that in the latter years of'his life, 'he regretted very much
himself that he had not published more for the benefit of his fellow beings ;
but at this period his disinclination and habits had become so confirmed that
it was impossible for him to change them.

_ 1 have already staled, that at the period when Dr. Physick commerced
his professional career, the organization of the medical department in the
University of Pennsylvania was so imperfect, that the chairs of Anatomy and
Surgery were combined. To remedy this acknowledged dpficiency, in the
year 1805, the chair of Surgery was made distinct frrm that of Anatomy,
and Dr. Physick was elected, 1 believe unanimously, Professor of Surgery.

It should be borne in mmd, that he iiad previously, in the year I6C0, com-
plied with a request, made to him by a number of gentlemen engaged in
the study of medicine, to deliver lectures on surgery. These lectures were
in the Pennsylvania HospLal ; and lie exhibited such positive and satisfac-
tory evidence of his entire competency to the task which he had assumed,
that he very soon became exceedingly popular as a teacher, and added great-
ly to his fame.

It is more thin probable that the position which lie now held as a lectu-
rer on surgery, exerted no little influence m producing the charge which
was madeintiie medical faculty.

I presume it v/ill not be denied tha*, however grent the advantages may
have been which accrued to Dr. Physick in consequtnce of his being appoint-
td Professor of Surgery in the [Jnivcrsity of Pennsylvania, the institution
itself derived equil advantages from his connection with its medxal faculty.

It is cer'ain that soon after h s appoiitmen*, the number of students who
resorted to this city ?o attend the medical lectures, greatly increased; and
although I freely admit that there were many co-oppr^tin2f circumstance?,
his efforts in behalf of the school being seconded by collepgnes who posses-
sed ta'ents nf so refulgent a character that the I'ght shed from them fias not
yet passed away, still it is worthy of r^cord, that the zenith of Dr Physick's
fame and usefulness was the period at which the University of Pennsylva-
nia attained the acme of its reputation.

Having shown that Dr. Physick's eff )rts as a private lecturer were atten-
ded with the most entire succesp, we can readily believe that he was quite
prepared to enter upon the duties of his new appointment. Jnarmuch,
however, as this situation opened to him a more extensive field of acti..n
than he had previously cultivated, he felt himself called upon to make renew-
ed exertions.

It is almost impossible to conceive nf the great amount of labour which he
was in the habit of performmg daily, during this period of his life. He has
frequently told me that it was his custom, throughout the winter months, to
jrise at four o'clock in the r;jornin^. This hour being too early to disturb a

139.] Memoir of Dr. Physick. 029

servant, he was obliged to arrang^e Iiis own fire. He would then sit down
to his desk and prepare his lecture for the day ; after which he would dress
himself, and then take Jiis breakfast, and leave jiis house between eight and
nine o'clock, to attend to an extensive and laborious practice. In addition to
all this, he discharged his duties as surgeon to the Pennsylvania Hospital, and
to the Alms House Infirmary. He used often to remark, that in order toob-
tam entire success as a practitioner of medicine,it was necessary to work hard.
He told me that in London tins idea was conveyed by the emphatic expres-

s. on "Doctor or i\Jr. is icpr/iin^ his way into business." It will be

conceded that no portion of his success ever came to him gratuitously; on
the contrary, he made laborious exertions lo obtain it.

Dr. Pnysick's manner as a public lecturer was extremely grave, dignified
and impressive. His style was clear, simple and chaste. He was uniformly
careful never to say too much. His choice of language was remarkably good,
and he possessed the liappy faculty of communicating knowledge agreeably
and clearly to a degree which I have never known surpassed. Perhaps one
great reason for this was, that he never undertook to instruct others upon
subjects which he did not clearly comprehend himself. He attempted no dis-
play of oratory ; neither did he permit his reason and imagination to run
wild in the regions of theory and fancy. He found much better employment
for his mind in constantly studying the realities of life, and in reflecting upon
the best methods of promoting the welfare of his fellow creatures. His lec-
tures were carefully prepared and written out. He did not at all approve of
extemporaneous lecturing; as he thought that in lecturing upcm scientific sub-
jects, and more especially such as involved the lives and happiness of our fel-
low beings, no man had a rigiit to place so much confidence in the strength
of his memory as is implied in that practice.

Or. Physick's cours oMectures on surgery was eminently valuable, from be-
ing founded principally upon his own practical knowledge and experience,
and also from his discarding all mere hypotheses ; besides which his lectures
derived an additional attraction and importance from the circumstance that
his reputation for stern integrity and strict veracity was so well known and
established, that whenever he asserted Aids to be true, they were implicity
believed.

As a letter writer he was exceedingly exemplary and p'-'cujiar. I regret
very much not havmg the privilege of inserting a few of his letters in this
memoir. In general they were remarkably brief and pithy. He was ex-
cessively annoyed at receiving, and being obliged 'o read letters of an un-
meaning and unnecessary length. It was the same with respect to books,
1 have often heard him complain of the hardship of being obliged to read
through a volume of two or three hundred pages, to get at ideas which might
have been embodied in ten or twenty.

In the winter of 1813-14, Dr. Physick suffered from a severe attack of ty-
phus fever. On this occas.on his illness was so extreme, that his medical
friends despaired of his life for some time. He gradually convalesced, but
his constitution did not entirely reco\er from the shock which it then re.
ceived. From this period he never tnjoyed what might be called uninter-
rupted health. His powers of digestion became exceedingly impaired,
wnence ensued a train of most unpleasant dyspeptic symptoms. He became
subject also to frequent attack>= of catarrh, and hi-^ susceptibility to this con-
dition increased to such an extent that he was obl'ged to observe the most
rigid precautions in order to guard against ic. His method of treatment
when laboring under a severe cold, required confinement to a warm room ;
and in fact he accustomed himself to a degree of heat in his apartments
which to many others was almost insupportable. In addition to this he al-
ways employed the strictest antiphlogistic treatment, as regarded his diet
and remedial agents. 1 think that he injured himself, and in a measure pro-

C30 Memoir of Dr. Phy sick, [July

duced the very enfeebled and prostrated condition of his system which at-
tended him during ihe latter years of his life, by the excessively reducing
system of trealment to which he had recourse.

Tiie small amount of food of which he would sometimes permit himself
to partake, is almost inconceivable ; and this for many days together. I
frequently expressed to him my regrets respecting the meagre diet he was
using; and upon one occasion I dissented soundly from the propriety of
such a course of dieting. He replied that he regretted it very much himself,
and that he wished he could indu!ge in a more generous living, but that
he had accustomed his stomach for so long a time to abstinence from ricli
food, that It was impossible now to make any change.

About the period to which we are alluding, he began to experience cer-
tain unpleasant symptoms, indicative of a diseased condition of the heart,
and which, eventually, terminated in organic affection of that organ, and
doubtless laid the foundation for the hydropic complaint of which he died.

Among the complicated forms of disease to which he was subjected, must
also be enumerated a nephritic disorder, with calculous concretions in the
kidneys. Jt is impossible for language to describe the pain and agony
which he frequently endured from the passing of the small calculi through
the ureters into his bladder. Upon one occasion, about ten years previous to
his death, 1 knew him to be for near two hours without any pulse perceptible
at the wrist, in consequence of intense suffering, caused by the lodgment of
a small calculus in the ureter. It remained fixed in this situation for some
days, and grew to the size of a small pea ; it finally passed into the bladder,
and was discharged a few minutes subsequently through the ureter.

The practical knowledge and experience which Dr. Physick derived from
the careful and minute attention which he bestowed not only upon every de-
partment of his profession, but also, I may say, upon each separate and indi-
vidual case of disease which came under his notice, enabled him to suggest
numerous modifications and improvements which have exerted the happiest
influence in elevating the condition of our science. Jt would be impossible,
in a communication of this nature, which has already exceeded the limits
originally proposed, to give even a brief outline of the many invaluable in-
ventions for which we are indebted to him. In order to do this, it appears
to me, that it would be necessary to review almost every professional act of
liis life ; because there was no form of disease of which he undertook the
management, in which he did not exercise a tact and treatment peculiarly
liis own. I do not mean to say that in every case he prescribed a new reme-
dy, and one original with himself my meaning is, that he invariably modifi-
ed either the dose, or the preparation, or the time of its administration, or
the method of its application, according to his own proper and pecuhar views.
*********

I have already shown that his health was considerably impaired ; and it
is probable, that about this period he must have been deeply sensible of his
increasing infirmities, inasmuch as he thought proper, in li6, to resign his
situation as Surgeon to the Pennsylvania Hospital. He had received his ap-
pointment in 1794 ; consequently, he served the institution twenty two
years. Some time previous to. this he had resigned his situations in the
Philadelphia Dispensary, and in the Alms-house Infirmary.

In the year 1319, Dr. Physick resigned his chair of Surgery in the Univer-
sity of Pennsylvania, and was transferred to that of Anatomy, which had
become vacant the preceding session by the death of his nephew, Dr. John
Syng Dorsey.

*The premature death of the lamented Dorsey, plunged Dr. Physick into
the deepest affliction, and had the effect of creating a melancholy gloom,
which overshadowed the remainder of his existence. Dorsey, of all others,
was fitted to cheer and solace the declining years of his uncle. He had
been regularly educated under the immediate inspection and superintendence

1S39.] Memoir of Dr. Phi/sick. 631

of Dr. Pliysick had imbibed from him his early lessons of wisdom and
knowledge, and at a more matured period of his life, fully adopted the prin-
ciples and doctrines of his preceptor. Advantages like these, aided by ta-
lents of a brilliant and comprehensive order, enabled Dorsey at an unusually
early period of his life, to assume a most elevated and distinguished rank in
his profession. Relentless death, however, seized upon his prey, whilst in
the midst of his honors and his usefulness.

Jt was always a source of deep regret with Dr. Physick's immediate fa-
m'ly and friends, that his comforts in the evening of his days, and whilst la-
bouring under physjcal infirmities, should be so greatly interrupted by trans-
lating him from the chair of Surgery to that of Anatomy. We had positive
assurances from himself, that the change was contrary to his own wishes
and inclination : how far the interests of the institution to which he belong-
ed m^y have been promoted by it, I do not niean to inquire. My own im-
pression is, however, and 1 believe I am not singular in the opinion, that if
he had continued in the chair of Surgery up to the period when he retired
from the University, it would have numbered in its catalogue of students
many more than it has ever shown.

**********

In the year 1821, Dr. Physick was appointed Consulting Surgeon to the
Institution for the Blind.

In 1822, the Phrenological Society of Philadelphia elected him its Presi.
dent.

In 1824, he was chosen President of the Philadelphia Medical Society.
He held this situation until the time of his death.

In 1825, January 6, he was appointed a Member of the Royal Academy
of Medicine of France ; so far as 1 know, the first American who ever re-
ceived that honour.

In 1831, in consequence of his declining health, he felt it incumbent on
him to retire from the active duties of the University ; and accordingly he
resigned his situation as Professor of Anatomy. In acknowledgment of the
extraordinary services which he had rendered, in elevating the character of
the school, and in promoting the advancement of medical science, the insti-
tution, upon accepting his resignation, conferred upon him the higliest honor
in its power, by electing him unanimously " Emeritus Professor of Surgery

and Anatomy."

*********

In October, 1831, Dr. Physick performed the operation of lithotomy on
Chief Justice Marshall. This case was attended with singular interest, in
consequence of the exalted position of the patient, his advanced age, and the
circumstance of there being upwards of one thousand calculi taken from his
bladder. It is well known that for several years previous to this period,
Dr. Physick had declined performing e.\tensive surgical operations. He felt
somewhat reluctant to operate upon Chief Justice Marshall, and offered to
place the case in my hands. Taking all the circumstances into considera-
tion, and knowing well that this would be the last time he would ever per-
form a similar operation, I felt desirous that he should finish with so distin-
guished an individual ; and accordingly urged him to do it himself. Upon
the day appointed, the Doctor performed the operation with his usual skill
and dexterity. I do not think I ever saw him display greater neatness than
on that occasion. The result of the operation was complete success.

It will be readily admitted that, in consequence of Judge Marshall's very
advanced age, the hazard attending the operation, however skillfully per-
formed, was considerably increased. I consider it but an act of justice due
to the memory of that great and good man to state, that in my opinion, his
recovery was in a great degree owing to his extraordinary self-possession,
and to the calm and philosophical views which he took of his case, and the
various circumstances attending it.

632 Memoir of Br, Physick. [Jul^r

It fell to my lot to make the necessary preparations. In the dischargre of
this duty, I visited him on the morning of the day fixed on for the operation,
two hours previously to that at which it was to hs performed. Upon enter-
mg his room I found him eating his breakfast. 11^ received me with a plea-
sant smile upon his countenance, and said, " Wei), do( tor. you find me tak-
ing breakfast, and I assure you 1 have had a good one. \ thougbt it very
probable tbat this might be my last chanc'\ and therefore I was determined
to enjoy it and eat heartily." I expressed the great pleasure which I felt at
peeing him so cheerful, and said that I hoped all would soon be happily over.
He replied to this, that he did not feel the least anxiety or uneasiness res.
pectingthe operation or its result. He said that he had not the slightest
desire to live, labouring under the sufferings to which he was then subject,
ed ; that he was perfectly ready to take all the chances of an operation, ani
he knew there were (niny against him ; and that if he could be relieved by it
lie was willing to live out his appointed time, but if no', would rather die
than hold existence accompanied with the pain and misery which he then en-
dured.

After he had finished his breakfast, I administered to him some medicine :
he then enquired at what hour the operation would be performed. I nen.
tioned the hour of eleven. He said, "Very well ; do you wish me now for
any other purpose, or may I lay down and go fo sleep ]" I was a good deal
surprised at this question, but told him that if he could sleep it won'd be very
desirable. He immediately placed himself upon ihe bed and fell into a pro.
found sleep, and continued so until 1 was obliged to rouse him for the ope-
riJion.

He exhibited the snme fortitude, scarcely uttering a murmur throughout
the whole procedure, which, from the peculiar nature of his complaint, was
necessarily tedious.

Chief Justice Marshall survived this operation some years, and finally
died of a disease of an entirely diiTerent character.

**** *****

In November, 1833, he was elected an honorary fellow of the Royal Med-
ical and ('hirurgical Society of London. The conferring of this honour was
a full acknowledgment of his exalted merits, and justly acquired reputation,
and he did not affect to conceal th'5 high gratificaiioti ho derived from it.

I hive mentioned in the f'^rmer pnrt of this memoir that the first rase re-
corded in his private journal is one in which he performed the extrnction of
the crystalline lens. By a singular coincidence, it happened that the last
operation everperformed by Dr. Physick was for cataract, and took place
but a few months previously to his death. He, however, never, saw
h s patient after completing the pn cess ; the attack which terminated his ex-
istence occurring on the afternoon of the same day.

I ought to mention, by way of apology for his engaging in any surgical ope-
Tation whilst labouring under such feeble health, that the circumstances at-
tending this case were exceedingly peculiar. The applicant was a foreigner,
Dr. Physick had operated upon his eye a year previously, and the gentleman
had remained in this city during a whole year for the purpose of having it re-
peated by him. He consequejitly felt it incumbent upon him not to disap-
point his patient ; and he was not the man to shrink from the performance
of what he believed to be his dutj, notwithstanding, as he informed me, he
was well aware that death was impatiently waiting for his victim.

This operation was performed on the 13th of August, 1837. 1 was pre-
sent and watched hiiu with the most intense anxiety. lie was quite collec.
ted and firm, and his hand was steady, though he was labouring under great
mental and physical suffering. Whi'st witnef ting this effort in t/ie cause
of affliet.ed humanity, I felt a melaneholy conviction that it would be the final
*ct of his professional life.

1839.] Memoir of Dr. Physick. 633

From this period his complaint went on increasing in intensity and vio-
lence. The symptoms of hydrotorax became developed to a most painful
extent, and he suffered extreme agony from oppression at his chest and dif-
ficulty of breathing; so much so, that sometimes he became unable to lie
down in his bed for whole nights together, but was obliged to stand upon the
floor, supported by assistants. In consequence of his increasing illness, his
old and well tried friend and associate, Professor Chapman, was requested to
visit him in consultation with myself. His malady, however, had become
uncontrollable, and it resisted the most strenuous efforts that professional
skill and affectionate attention could exert.

Some time previously to his death, anasarca took place ; and in conse-
tjuence of his remaining so much in the erect position, his lower extremities
became enormously swollen and distended with serum. The integuments at
length gave way, and openings formed, which finally ulcerated and became
gangrenous.

The Father of American Surgery expired without a struggle, on the
morning of the 15th of December, 1837, at twenty minutes past 8 o'clock.

" He gave his honours to the world again.

His blessed part to heaven, and slept in peace."

It must be admitted that, by the community at large, Dr. Physick's pri-
vate character was but imperfectly understood. This was owing to the ha-
bits of perfect seclusion which he contracted, and to the slight intercourse,
other than professional, which he permitted himself to enjoy with his fellow
citizens. It must not be supposed, however, that this isolation arose from
morosenessof character or want of inclination to mingle with society. A
satisfactory explanation may be afforded by the entire self-abandonment with
which he devoted himself to his professional engagements. This formed one
of the most striking and remarkable points in Dr. Physick's character. His-
tory probably cannot show an example of a more pure and absolute devotion
to professional pursuits than he exhibited.

For the reasons just mentioned, he was supposed by some to be stern and
unfeeling, and wanting in the kinder sympathies of our nature. There
could not be a greater misapprehension. His feelings were tender and sus-
ceptible in the extreme ; and could those persons who entertained an oppo-
site opmion have been admitted to closer and more intimate relations with
him, they would have acknowledged the great injustice they had done him in
such a surmise. Many instances might be cited, were it expedient to occu-
py the necessary time, to illustrate Dr. Physick's extreme tenderness of
feeUng. At an early stage of his professional career, he performed a few
experiments upon living animals, with the view of determining some physio-
logical points. This formed a subject of regret to him as long as he lived ;
and he could not divest his mind of the idea that he had been guilty of use-
less as well as wicked acts of cruelty.

Previously to his performing important surgical operations, his feelings
were so harrowed up, and he experienced so much anxiety, that it was the
custom of his family to endeavor to prevail upon him to execute such opera-
tions as speedily as possible, in order to relieve his mind.

To those who only saw Dr. Physick as the bold and unflinching operator in
surgery, his character might have appeared cold and unfeeling, and they
might have thought him,

" Unlike to other men,

A snow-crown'd peak of science, towering high ;"'
but to the few who knew him in his private circle the veil was withdrawn.
It was in the gentle charities of domestic life, as the tender and affectionate
parent, or the sympathising friend, that his true character became revealed,
8h

634 Memoir of Dr, Physick, [July,

and his heart was felt to be keenly alive to the kindest and softest emotions
of which human nature is susceptible. He never appeared so happy as
when surrounded by his children and his family ; and indeed I feel assured
that this formed one of the greatest consolations to him in the midst of his
protracted sufferings.

In his intercourse with his professional brethren Dr. Physick 's conduct
was regulated by the strictest principles of honour and integrity. Whenever
he was called in consultation with other physicians, without inquiring how ex-
alted or humble their positions might be, he was scrupulously careful to avoid
saying or doing any thing which could wound their feelings, or prejudice
them in the least in the estimation of their patients. He invariably stated
his own opinions in a frank and manly manner, and was ever willing to pay
due deference to tbe opinions of others. Upon all occasions he was happy
and ready to confer upon his fellow practitioners the benefit of his advice
and experience, whether the information desired had special relation to them-
selves, or to those under their charge. He was far removed above the mean-
ness of interfering with the patients of others ; and whenever he had in his
power to render a service to a younger member of the profession, by a word
of encouragement or commendation, it was cheerfully bestowed.

It was impossible that a man possessed of a mind of so reflective and con-
templative a character as his, should not turn with anxious solicitude to the
doctrines of religion, and the contemplation of a future state. Religion consti-
tuted, in fact,the most engrossing subject of attention during the latter years
of his life. How far he derived comfort and consolation from his religious stu-
dies, it is not for me to say. I am very certain, however, that a more pure
and ardent seeker after divine truth I never knew. As an observer of the
principles of strict integrity and morality, I believe it will be conceded that he
was exemplary to a remarkable degree. He, however, arrogated nothing
to himself from this source. He expressed to mo but a short period previous
to his death, that he possessed no merits of his own to give him a claim to
salvation. His humility and self abasement upon the subject of religion
were extreme ; and he was always willing and ready to apply to any source,
however humble it might be, provided he thought he could be enlightened
and instructed by it.

His course of reading upon theology was very extensive ; and unfortunate-
ly for him he read many works of a conflicting and contradictory nature. The
effect of this upon one who had, during all his life, been in search of indispu-
table evidences, was to create at times gloomy and desponding views. Yet
for very many years of his life he was in the uniform habit of perusing, every
morning, a portion of the New Testament ; and when, in consequence of
his illness and increasing infirmities, he was incapable of so doing, his chil-
dren were constantly employed in reading this and other works of devotion
to him. During his last illness he derived great pleasure and satisfaction
from the visits of his friend and pastor, Dr. Delancy ; whose kind attentions
towards him were unremitting. I feel assured that the hopes and promises
of the Christian religion were the greatest sources of consolation to him in
the closing hours of his life, and smoothed his passage to the tomb.

1839.] Irritable Uterus. 63-5

Part III. MONTHLY PERISCOPE.

The following case of irritable uterus, we extract from the
Eclectic Journal. It is full of interest. It affords demonstra-
tion of the very general error in practice, of neglecting the tho-
rough investigation of the true cause and nature of the affliction.
In such cases, we venture the belief, that in the present state of
the profession, where one practitioner would thoroughly investi-
gate and determine the true etiology and pathology of such a
case, and treat it accordingly, as John Brown, CM. of Her Ma-
jesty's Victualing Yard at Deptford has done, one hundred
would be content to theorise and speculate on a superficial ob-
servation of symptoms, and determine on the existence of some
local inflammation or irritation, and medicate the patient for
months and years, should she live so long. Cases of the same
general character have not unfrequently occurred under our ob-
servation ; and we have at present under care, a case, of which,
the following would be a very accurate description. Such in-
deed we have almost always found those cases, which are de-
nominated " irritable uterus.'^ We have rarely, if ever, found it
the case that the irritability of the uterus was not correctible by
treatment on the same views as those taken in this case,

IRRITABLE UTERUS.

To the Editor of the Medical Gazette.

Sir. 1 forward for publication in your valuable journal the following case*
which appears to me to be an important one, inasmuch as it shows that in
the female sex the uterus is sometimes the source of those painful, local, ner-
vous affections that simulate structural diseases in different parts of the bo-
dy ; or at least that remedies which had the effect of restoring that organ
to a healthy state, were, in one severe case of the above description, the
means by which a cure was accomplished, after every other plan of treat-
ment had been tried in vain. I am, sir. Your most obedient servant,

JOHN BROVVJNJ, C. M.
Her Majesty's Victualhng Yard, Deptford, Dec. 24, 1838.

A young lady, who had suffered for a great length of time from pain in her
back and partial paralysis of the lower extremities, was brought to London, in
the summer of 1837, for the benefit of medical advice. While she was in the
country, various plans of treatment were tried for her relief, but without the
least benefit ; and at the time I first saw her, which was immediately on her
arrival here, and about two years and a half after the commencemest of her
illness she said that her complaint began with a throbbing in her left foot,
which gradually extended up the leg as far as the back, and was followed by
severe pain in her stomach and right side, which continued for several hours,
and then went off, leaving her in a very languid state ; that paroxysms of
this kind succeeded each other, at short and irregular intervals, for the

<J36 Irritable Uterus. [July,

space of eighteen months ; that she had often, during the above period, hys.
terical fits of the usual descriptions ; that she often suffered much from pain
in Iho abdomen, pirticthrly around the umbilicus, that a great many reme-
dies had been tried lor her relief, but without any good effect ; on the con-
trary, that the pain in her back at lengh became so constant and severe as
to lead her medical attendants to conclude that she was labouring under a
d.sease of the spine, and that she was accordingly cupped, blistered, and kept
in the horizontal position for a great many months, but without any benefit
whatever.

At the time this patient came to town she could not walk, nor even stand,
in consequence of the pain in her back and weakness of her limbs. 1 therefore
carefully examined the spine, but could perceive no mark of structural dis-
ease there ; indeed the poor girl complained just as much when the
skin was merely touched as when very forcible preessure was made
upon the vertebrae. Hysterical fits at that time, she said, came on
twice or thrice every day. She also stated that when she attempted to sit
up, she felt an unpleasant weight in the lower part of her belly, with a sensa-
tion of bearing down, and that she had always pain and difficulty in passing the
faeces and urine. On examination jper vaginam, which I considered to be
necesssary, in order to enable me to ascertain the real nature of the case, 1
found that the uterus was very low down ; and upon mentioning this circum-
stance to the patient, she admitted that organ had several time partially pro-
truded beyond the external parts. It was also in a highly irritable state ; in-
deed the mere touch of the finger gave great uneasiness, and brought on one
of the most violent paroxysms of hysteria 1 ever witnessed. There were oc-
casionally, too, a profuse leucorrhoeal discharge; but as the displacement
appeared to me to be the point which required to be first attended to, in or-
der to remedy that, I put a piece of sponge into the vagina, but so great was
the irritability of the parts that its presence there could not be borne, and I
was consequently obliged instantly to remove it. Under these circumstan-
ces, conceiving that the affection of the back and paralysis of the limbs were,
in some way or other, connected with the irritable state of the womb a
state which the patient said bad existed from the commencement of her ill-
ness I directed strong anodyne injections to be frequently thrown into the
vagina, which, in time, produced an excellent effect. Astringent injections
were next employed with advantange ; and, at last, a solution of the nitrate
of silver was in this way used, which, by degrees, diminished both the leucor-
rhceal discharge and the irritability of the uterus, and in the end entirely re-
moved them. As soon as this change in the state of the parts was effected,
the usual treatment for the prolapsus was had recourse to, and the girl then
began rapidly to improve.

But during the time that this local treatment was being followed, the con-
stitution was not neglected. The physical powers of the system in this case
were very low. The patient had a weak pulse ; her appetite was small ;
her muscles soft, flabby, and relaxed. She suffered much from coldness of
her hands and feet ; and, as hysterical paroxysms at the commencement of
the local treatment were very frequent, anti-spasmodic medicines were pre-
scribed, particularly the tincture of assafoetida, to which, however, she at
first strongly objected, on account of the nauseousnessof its foetor, but, after
having taken it for a short time she either acquired a taste for it or expe-
rienced so much relief from it use, that always, upon the least symptom of the
approach of a paroxysm, she flew to the loathsome draught with avidity,
and drank it off without any apparent reluctance. Tonics, too, were from
the first prescribed. The compound infusion of gentian, the disulphate of
quinine, the sulphate of copper, and the tincture of muriate of iron, were all
"by turns, taken in proper doses, with benefit. The cold shower-bath was al-
so had recourse to ; and, although the patient's constitution was certainly
\very weak, the shock was followed by no unpleasant effects ; on the contra-

1839.] Medical Intelligence. 637

ry, she always experienced, after using the bath, a comfortable glow of heat
over her whole body, with a considerable increase both of bodily and mental
energy.

Under the above treatment the patient gradually recovered ; indeed as
Boon as the irritable state of the womb was removed, she began to walk
about, and in the course of a few months she could accomplish a distance of
three or four miles with but very little fatigue. She, however, remained about
a year under my care, and in July last returned to her parents, who reside at
Plymouth ; from whence she now writes to me, and informs me that her
health is good, and that, notwithstanding the season of the year, she frequent-
ly takes a cold salt-water bath with decided benefit.

MEDICAL INTELLIGENCE.

We give the following interesting extracts from a letter to the editor, from
Dr. P. F. Eve, Professor of Surgery in the Medical College of Georgia, who
is now in Europe, revisiting some of the most celebrated hospitals. We are
happy to learn that he has made a safe and remarkably short passage. Prof.
Eve is expected to return in time for his professorial duties, at the ensuing
session.

PARIS, 13th May, 1839.

Dear Doctor Providence has again thrown me in the midst of another
French revolution. I arrived on Friday last ; just four weeks from our Med-p
ical College ; and on yesterday most serious disturbances commenced in the
city between the populace and the civil and military authorities. About six-
ty of the wounded have already arrived at the Hotel Dieu. I have had the
pleasure of meeting several of the graduates of the Medical College of
Georgia. * * *

I visited La Charite, went around the wards, and attended the lecture of
M. Velpeau, who, afterwards, operated on a cataract. M. Velpeau is now
about forty years of age ; of ordinary French stature ; has a fine head, and
great command of words with good enunciation. It is told of him that he
was originally a blacksmith, and at the age of twenty one could neither read
nor write ; he is now a striking example of what may be effected by industry
and perseverance. At present, no one stands higher in these head quarters
of medical science, for surgery, for general medical lore, and for his brilliant
concourse, than M. Velpeau.

The most interesting case in the Clinique this morning was, that of a wcp
man who, in lifting a mattrass on a beadstead, fractured the ulna. M. Vel-
peau said he could not positively assert this was a genuine case of fracture

638 Medical Intelligence. U^^Yt

produced by muscular action alone ; for the woman may have been diseas-
ed. He then entered into the cases of fracture produced by muscular con-
traction, which he properly arranged under two orders. 1st. Those in
which the bones or the patients were diseased ; and 2nd. Those whose os-
seous system was not only unaltered by disease, but whose constitutions
were robust and healthy at the time.

Notwithstanding several surgeons had denied the possibility of fractures
under such circumstances, M. Velpeau stated that he had, himself, seen se-
vera', besides the many previously recorded. If the case under considera-
tion be one of fracture of the ulna from muscular effort, it will be the first
one recorded.

I am informed that M. Yelpeau is very successful in the application of his
apparatus, (a needle or pin under the diseased vein, and a twisted ligature
upon its two extremities, so as forcibly to compress the vessel between the
two,) for varicosed veins : a case of which I had the pleasure of witnessing
this morning.

There is nothing very novel in surgery at present in Paris ; and still less
in medicine. More are, I understand, now engaged m illustrating old facts^
and establishing those already advanced, than in searching for new ones.
The club foot is still the fashionable topic of the day, in the way of opera-
tions. M. Brechet is, 1 believe, the only one that has any thmg new, and
which, by the bye, is sufficiently novel to merit attention. He is engaged in
marking the results of a uniform temperature upon the healing of wounds ,
as amputations, &.c. His apparatus is a spirit lamp, enclosed with the limb,
and a thermometer indicates the degree of heat, &c. to which the part is
subjected.

14th May. 1 have just returned from visiting La Pitie and Hotel Dicu
this morning. At the former Lisfranc did not appear. It is said he is so
much of a republican, that whenever he can aid his fellow citizens, he neg-
lects his wards in the Hospital. I saw here M. Serre only.

At the Hotel Dieu, there was a great crowd. Thirty of the wounded
have already died, and there are about sixty who are now dressed in this
Hospital, upon v\-hom amputations and other operations have been performed.

I had the pleasure of seeing in operation one of M. Brechet's apparatus al-
|-eady described. Instead of a spirit lamp to keep up an uniform tempera-
ture, around the amputated stump, a syphon and tepid water were employed,
instead of cold, which, as you are aware, has been for some years recom-
mended.

I had the pleasure of meeting here Dr. Harlan, of Philadelphia, and also
of seeing Louis, Roux, &:c.

1839.] Medical Intelligence. 039

MEDICAL INSTITUTION OF YAfiE COLLEGE.

We have received the annual Circular of the Medical Institution of Yale
College, for the term of 1839 40.

At its last commencement, this Institution conferred the Doctorate on
seventeen young gentlemen, and the Licentiate on two.

The whole number of graduates since 1813 is 439' : that of licentiates 293,

According to the statutes of the state, candidates for license to practise
physic and surgery, are required to have the same qualifications as those for
the doctorate. The licenses are granted by the President of the Connecti-
cut Medical Society, on the recommendation of the Board of Examiners,
who is, ex officio. President of the Board. The only difference in eligibility
to the doctorate and the licentiate is, that the latter may be granted after
one course of lectures only, whilst the former requires two. This arrange-
ment, whereby time, and not talent is made to constitute the only difference
between these benefits, is a wholesome one ; for it is only suited to young
men of merit, without pecuniary means ; but prevents effectually that delica-
cy of feeHng which must shrink from conferring all the rights of a practi-
tioner on the inciv'idual in granting a license, whilst he is unworthy of the
doctorate ; and for the refusal of which he may be called on at a future day
to exercise the prosxriptive power of the black ball. Here, in the first place,
the faculty constitute but one half of the Board of Examiners ; and even if
they alone constituted the Board, their work before them is perfectly plain;
they have to determine the same qualifications in the candidate for license,
as they have in that for the doctorate ; and to be fully prepared to approve
of the capacities of the candidate ; the difference of the time engaged in the
study of medicine alone, being the sole ground on which the doctorate is
withheld.

The course in this Institution commences with October, and terminates
n the 22nd of January.

The faculty consists of the following gentlemen. "''

Rev. Jeremiah Day, D. D. L. L. D. President.

Benjamin SiUiman, M. D. L. L. D. Professor of Chemistry, Pharmacy,
Mineralogy, and Geology.

Eli Ives, M, D. Professor of the Theory and Practice of Physic.

Wm. Tully, M. D. Professor of Materia Medica and Therapeutics.

Jonathan Wright, M. D. Professor of Principles and Practice of Surgery.

Timothy P. Beers, M. D. Professor of Obstetrics.

Charles Hooker, M. D. Professor of Anatomy and Physiology.

VV^e recognize a good proportion of fine talent in this faculty, particularly,
m the names of Silhman, TulLy, and Hooker, with whose characters alone
we have acquaintance.

640 Medical Intelligence.

MEDICAL DEPARTMENT OF TRANSYLVANIA UNIVERSITY.

The Annual Circular for this Institution.

The following is the organization for the present year.

B. W. Dudley, M. D. Professor of Anatomy and Surgery.

J. C. Cross, M. D. Professor of the Institutes of Medicine and Medical Ju-
risprudence.

N. R. Smith, M. D. Professor of the Theory and Practice of Medicine.

W. H. Richardson, M. D. Professor ot Obstetrics and Diseases of Wo-
men and Children.

T. D. Mitchell, M. D. Professor Materia Medicaand Therapeutics.

R. Peter, M. D. Professor of Chemistry and Pharmacy.

J. M. Bush, M. D. Adj. Prof. Anatomy and Surgery, and Dean.

A highly commendable liberality on the part of the City Council of Lex-
ington, in bestowing on this Institution the sum of forty five thousand dol-
lars, enables it to promise a splendid medical hall for the future accommoda-
tion of the Class. The total number of the Class, during the last course
was 211 : of whom 106 were from Kentucky, 25 from Tennessee, 19 from
Alabama, 10 from Mississippi, 8 from Virginia, and 7 from Georgia. The
numbers from several other States were from one to five.

At its last commencement, this institution conferred the degree of Doc-
tor of Medicine on fifty one candidates, and honorary degrees on three other
practitioners of Kentucky.

It is pleasing to see a state and a city in which a medical institution is lo-
cated, take the interest in its success which has been manifested by Ken-
tucky and Lexington. Such institutions are generally left too much to
struggle on their slow route to success, under every difficulty, which the px-
traordinary effiDrts and sacrifices of the individuals who project them cannot
obviate, or lapse into insignificance.

SOUTHERN MEDICAL

AND

SURGICAL JOURNAL.

Vol. III.] AUGUST, 1839. [No. 11.

Part 1. ORIGINAL COMMUNICATIONS.

ARTICLE I.

An Essay on the questions Are there any direct sedatives ?
And if there are^ what is their mode of operation ? Read be-
fore the Medical Society of Augusta^ by Josbtu A. Eve,
M. D.

Before attempting to answer this question, it will be neces-
sary to determine the proper signification of the term sedative.
Most medical writers apply this word to depressant agents, to
all means that diminish action or reduce excitement, whether
the principle on which their effects are produced be negative or
positive ; that is, whether they act by withdrawing stimulants, as
by the abstraction of blood, of caloric, &c., or by directly di-
minishing the excitability of the system, and rendering it less
susceptible of the impression of excitants, without any depletion
or the withdrawal of any stimulus. But we conceive it highly
important that a distinction be made between negative and posi-
tive depressants, inasmuch as they operate on very different
A 1

642 An Essay on Sedatives. [Augostr

principles, and are applicable lo the remediate management of
very different states of the system and forms of disease.

We will consider the term sedative applicable only to those
agents that depress excitement, restrain action, and allay pain,
by an immediate effect upon the excitability ; and will, in the en-
suing remarks, restrict the signification of the term to those
means, which, leaving in full force and operation all those exci-
tants upon which excitement depends, whether normal or mor-
bid, reduce it by lessening, neutralizing, subtracting, or in some
way depriving the system, or some part of it, of its excitability
or capability of being excited.

The state induced by the action of these agents is, properly,
designated by the term sedation, which is directly opposite to
irritability ; the latter signifies too great susceptibility to the im-
pression of irritants and excitants ; the former, on the contrary,
expresses an iftaptitude to be affected by them.

Having now stated fulfy what we understand by the term se-
dative, we will proceed to examine and to answer the first ques-
tion, " Are there any direct sedatives ?'^ This is indeed a diffi-
cult question, ujx)n a most recondite and obscure subject a
subject that has given us more embarrassment and perplexity
than any other in the science of therapeutics. No author whose
writings we have seen, appears to entertain clear and correct
views of it, or to have treated it in a satisfactory manner : we
have returned from alt our researches unsatisfied : if some clouds
have been removed^ their removal has only afforded light for the
discovery of difficulties still unanswered or unanswerable light
has been evolved to render the darkness more visible. It is ne-
cessary that our knowledge of the mysterious laws and hidden
springs of life should be much more profound-, before the nature
of sedative action can be fully and perfectly comprehended, and
the whole truth be revealed in its simple and unmantled love-
liness.

Two of the best essays, we have seen, bearing on the subject
of sedatives, appeared some years since in the American Jour-
nal of Medical Sciences, one by Dr. Hodge, of Philadelphia, on
Sedation, and the other by Dr. Geddings, of Charleston, on De-
bility. These authors do not attempt to explain the modus ope-
randi of sedative agents, but by their arguments, and by facts

1839,] An Essay on Sedatives. 643

and observations adduced, they prove very conclusively that
there are such agents, and describe very satisfactorily the effects
produced by their action.

Dr. Geddings, after speaking of negative depressants, makes
the following remarks, " Perhaps a more important variety of
asthenia or debility, is that which is produced by the operation
of contrastimulant agents, or those causes which tend by their
peculiar properties to produce a direct depression of the pow-
ers of life, independently of any negative property or quality."
" Brown (he continues) laid it down as an axiom, that all agents
that are capable -of affecting the organization, produced their re-
sults by a process of stimulation. In this opinion, however, he
was not sustained by subsequent observations. Indeed experi-
ments have satisfactorily demonstrated, that there are an im-
mense number of agents that produce an impression directly op-
posed to that of stimulation, or that enfeeble or depress the vital
forces, by an operation that is direct and unpreceded by any
excitement."

Many medical writers, besides Brown and his disciples, deny
the existence of direct sedatives, and contend most strenuously
that their supposed operation involves a co^itradiction or a logi-
cal absurdity. It is difficult to conceive how any thing can act,
without being active and producing action : whereas the effect-
of a sedative is not action, but the reverse, the suppression or
reduction of action. They assert that the agents, termed seda-
tives, are primarily stimulant, and that the sedative effect is only
the consequence of the previous action of stimulants which ex-
haust the excitability and thus leave the general system, or the
organ or part acted on, in a state of depression : tiiat is, they lose
sight of sedation altogether, confounding or identifying it witli
exhaustion or indirect debility. But we contend that this is a
gratuitous assumption without foundation or support; it is mere-
ly a subterfuge for our ignorance a resort to compass a diffi-
culty which we cannot explain. Innumerable observations and
experiments have most satisfactorily established the doctrine
that many substances exercise a directly depressing effect withr
out any previous excitement.

There are some substances which are complex in their opera^-
tioH^ possessing both stimulant and sedative properties which are

644 An Essay on Sedatives. [August,

manifested either simultaneously, in succession, or upon different
organs or parts. But there are some that are wholly sedative
in every dose, under every circumstance, and in all modes of ad-
ministration this is certainly and most unequivocally the case
with hydrocyanic acid, whose depressing influence over the vital
power is so decided, that were there no other example in na-
ture, this would be sufficient to afford an affirmative answer to
the question proposed.

The subject before us is one in which we are compelled to
reason from effect to cause the nature of the cause can only
be inferred from the effect produced. When depression follows
the administration of a mean that neither stimulates nor abstracts
stimulus, the unavoidable conclusion is, that it must act by di-
minishing excitability, that is, by a directly sedative effect ; for
there are only three modes in which depression can be produc-
ed, debility from abstraction of stimulus, exhaustion, and sedation.

Every candid physician must admit that there is an almost
endless variety of substances, which, taken internally, or applied
to the surface, depress the vital powers, and whose effects can-
not be explained on any other principle than that of direct seda-
tion ; we therefore unhesitatingly reply in the affirmative to the
first question proposed, and proceed to examine the second
"What is their mode of operation ?"

This is indeed a difficult and perplexing subject a subject
that admits much more of speculation than demonstration.

"Of the several causes that act thus on the animal organism,
(Dr. Gedding*s remarks,) some produce their effects, as it were,
instantaneously, and in a moment extinguish the powers beyond
recovery ; others act more tardily, and merely produce a gra-
duil diminution of the vital energies. Even a single drop of
prussic acid, merely applied to the surface of the eye of a dog,
or to the tongue, produces death in three or four secwids, and
injected into the veins of an animal, it extinguishes life in an in-
stant, as by a stroke of lightning, leaving the muscles almost en-
tirely devoid of all traces of irritability. All substances pos*
sensed of narcotic properties, enfeeble the powers of life, and
produce a degree of asthenia which is sometimes alarming, and
even fatal. The nervous susceptibility is annihilated ; sensation
is enfeebled or obliterated ; the pupil is widely dilated ; the eye

{

1839.] An Essay on Sedatives. 045

is insensible to light ; the mind becomes incoherent, or is over-
whelmed with a general stupor or coma ; the pulse flutters, or
is scarcely perceptible ; the respiration is slow and heavy ; a ge-
neral coldness diffuses itself over the body ; and death is gradu-
ally induced by the overwhelming debility which pervades the
organization." The effects of sedatives thus admirably describ-
ed, almost invariably, in some degree, follow the use of a large
dose of opium, tobacco, digitalis, hydrocyanic acid, cicuta, bella-
donna, &c.; but how these substances operate in the production
of such effects is an inexplicable mystery, upon which neither
chemistry nor physiology can throw the least light. It does not
at all depend on the elementary composition of the substances
employed. Some suppose the produce of azote and absence of
oxygen essential to the constitution of a sedative; but, with the
exception of hydrocyanic acid, all sedatives contain oxygen
and further, and most conclusively against this fanciful theory,
one of the most powerful stimulants in nature, ammonia, is de-
void entirely of oxygen, being composed of hydrogen and azote,
while one of the most decidedly sedative, carbonic acid gas, con-
tains a very large proportion of oxygen and no azote.

With respect to electricity, we believe it to be one of the most
important and universal agents in the production of natural and
vital phenomena ; but a knowledge of chemistry does not de-
clare to us any mode in which sedative substances can affect
this subtle fluid so as to depress the powers of life we have no
data on which to reason the moment we attempt to explain
sedative action on electrical principles, our reasoning is nothing
but hypothesis, speculation, and groundless conjecture.

As sedatives diminish sensibility and action, and these depend
chiefly on the brain, it has been suggested that they act primari-
ly and principally on that organ ; but it is asserted, in objection
to this opinion, that they act locally on parts to which they are
applied, in many instances without affecting the brain at all
and, farther, that some substances produce directly opposite ef-
fects on different organs or systems, exciting one and depressing
another emetic tartar inflames the skin and prostrates the ac-
tion of the heart and arteries digitalis, tobacco, and many oth-
er articles act differently on different organs and systems.
Cullen supposes, " that their operation is upon a matter in

f54(> An Essay on Sedatives. [August,

common to the whole nervoJis system" " that there is a subtle
elastic fluid in the medullary substance of the brain and nerves,
upon the motions of which all sense and vital motions depend ;
and by which, therefore, motions are communicated from every
one part to every other of the nervous system." His conclu-
sion is, that sedatives or narcotics diminish the sensibility and
action of the system, by lessening the mobility of this fluid. This
theory is ingenious, but it is based upon a hypothesis. Who
has proven the existence of this subtle fluid pervading the whole
nervous system ? And it is by no means proven that the ope-
ration of sedatives is confined to the nervous system.

Inasmuch as the most prominent efliects of these medicines
are remarked in the functions of the animal economy, which are
dependent on the nervous system, it is inferred by some, and
tliere is much plausibility in the inference, that their action falls
principally on the brain and its appendages. It must be admit-
ted that these parts are most conspicuously affected by seda-
tives ; it does not, however, follow as a necessary consequence,
that their action falls more directly or forcibly upon them ; but
it is simply, because they enjoy the highest degree or largest
quantum of excitability, and from the functions they exercise,
those of animal life, the influence of sedatives, as well as all oth-
er medicines, is more obviously and conspicuously manifested,
on those, than on organs whose functions are less important.

The result of our experiments, observations, and researches is,
that sedatives produce their effects by acting directly on the ex-
citability, or irritability as it is styled by some physiologists,
which is a property or principle essential to, and inherent in, all
living tissues, though possessed by them in different degrees ; as
for example, it is greater in the nervous than in the muscular,
in the muscular than the cellular, &c. The excitability is also
modified in the different tissues and organs, in consequence of
which modifications, they receive different impressions from the
same agents, whether stimulant or sedative.

We believe that sedatives make a local impression on the part
or organ to which they are first applied, which impression is by
sympathy or nervous communication extending to other parts of
the system, just as stimulation is communicated from the part
first impressed to others more remote : many sedatives are also

1839. J An Essay on Sedatives. 617

absorbed into the circulation and through that medium convey-
ed to the nervous centres, and thence reflected throughout the
organism.

As regards the proximate mode of operation of sedatives, or
the rationale of the intimate changes produced, we know nothing
certain but do we know any thing more definite with respect
to stimulants?

Inasmuch as excitability is not equally difllased throughout the
organism, but exists in greater degree in some tissues than oth-
ers, and in the same at difl^erent times, is exhausted by stimuli
and re-accumulated after their action is over, there must ne-
cessarily be some provision in the animal economy for its re-
accumulation and restoration when expended ; it is presuma-
ble sedatives prevent or suspend this accumulation, prepara-
tion, or secretion of excitability, and thus render the system or
the organ acted on less excitable, and consequently diminish ac-
tion ; but as to the mode in which this effect is produced, we
know nothing.

Sedatives are so valuable and extensively employed in prac-
tice to allay pain, reduce inordinate action, and restrain exces-
sive secretions, that every circumstance connected with their
operation is, in the highest degree, interesting ; but there are
difficulties which it is perhaps impossible to explain in the pre-
sent imperfect state of our knowledge. Gladly would I use my
utmost exertions to remove the obscurity that involves the mo-
dus operandi of sedatives and of medicines in general, and ex-
plain their hidden and mysterious principles and modes of ac-
tion but how hopeless the attempt, when the wisdom and learn-
ing of ages have availed nothing ; and in defiance of the labours
of the most gifted of the sons of science, the mystery ^the deep,
the dark, the inexplicable mystery, still remains ! And this
mystery will perhaps ever remain shrouded in impenetrable
darkness, beyond the discovery of man. But when we reflect
how much has been achieved by untiring industry, patient inves-
tigation, and laborious application how many of her profound-
est secrets Nature has revealed to the prying eye and importu-
nate pleadings of enterprising genius, may we not anticipate the
auspicious day, when some God-like genius shall lift the curtain
that veils Nature's deepest mysteries, and reveal to the wonder-

618 MorlalUy in Augusta during 1837 and 1888. [August,

ing world licr untold secrets, and explain the essence, forms,
modes, hidden springs and principles proximate of action, sense
and life !

In conclusion, we have endeavored to examine attentively and
candidly the two questions proposed by the Society. The first
we have answered in the affirmative. With respect to the se-
cond, we have given some of the opinions of others, and advan-
ced our own, but we would be gratified to see a more satisfacto-
ry solution.

ARTICLE II.

Mortality in Augusta, during ike years 1837 and 18J8. Taken
from the Sexton's Book^ by L. A. Dugas, M. D.

The writer has on a former occasion* expressed his regret
at the very imperfect manner in which the records of the City
Sexton are kept ; yet for the last two years they have been more
imperfect than ever. We are happy to learn that measures are
about to be taken to have the subject better attended to in fu-
ture. It is impossible at present to derive any accurate infor-
mation with regard to the diseases which prevailed during the
period included in our researches. We can, therefore, do but
little more than merely to furnish the tables below.

The number of still-births, in 1827, was, whites 12, blacks 10,.
total 22 ; and in 1833, whites 9, blacks 12, total 21. These are,
of course, excluded from the tables, as never having existed.^
Of the whites who died in 1837, thirty three were foreigners^,
(mostly Irish,) and of those who died in 1838, sixteen were fo-
reigners. The proportion of deaths to the population, estimat-
ing this at eight thousand, is, for 1837, one in thirty four ; and for
1838, one in forty five.

* Southern Med. and Surg. Journal, toI. l.p.650.

1839.] Mortality in Augusta during 1837 and 1838. 649

Summary of the Tables below.

1837-7-White males,

80

" females,

50

130

Black males,

46

" females,

58

-104

Total 234.

1838 White males,

74

" females.

13

87

Black males.

57

* females,

34

91

Total 178.

TABLE NO. 1. DEATHS IN EACH MONTH ; WITH THE AGES.

WHITES

di^^l

?

^

!?

^

!?!

"^

t?

^

!?

>

H -.

ry

s_

d

o

d

c

o

o

d

o

o

o

2

3

3

3

3

5

3

3

3

5

<

1837.

tjr

o

o

g

o

-I

o

00

o

o
o

^

O

o

o

o

o

o

o

o

o

o

-^

n

ct>

ps

1 >

to

00

4^

c^

(TS

^1

OD

iX>

o

V

S

p

o

o

P,?

p

p

p

p

p

n

January,

1

~2

4

6 2

1

1

February,

3

2

2 1

1

1

March,

2

1 1

April,

5

3

2

1

1

May,

3

1

5

4

2

June,

1

2

1. 1

1

July.

6

2

6

1

2

August,

5

1

6

1

1

September,

1

3

1

October,

3

2

2

4

1

November,

2

1

3

3

1

1

December,

3

I

1

2

33

3

7

38

26

13

3

3

3

1

0

0

1838.

17
10

4
12
15

6
17
14

5
12
11

7

January,

1

1

2

February,

1

4

4

March,

2

1

2

April,

1

May,

1

1

1

2

June,

7

3

1

July,

4

1

1

3

4

1

August

2

1

1

2

1

2

September,

3

1

3

2

1

October,

1

2

1

November,

3'

1

2

De cember,

'\

3

1

3

1

26

1-^

2

21

22

4

6

2

0

0

0

11

4

9

5

1

5

11

14

9

10

4

6

9

B 2

650 Mortality in Augusta during 1837 and 1838. [August,

TABLE NO. II. DEATHS IN EACH MONTH ; WITH THE AGES

BL A CKS.

d

^

^

!?

^

^

*^

^

^

^

^

>

-^

3

o

i

o

o

d

S

5

5

O

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1839. J An Essay on Exercise: 65l

ARTICLE III.

Essays on Exercise. No. I. By P. H. Wildman, M. D. of
Laurencemlle^ Geo.

Definition. Exercise signifies, literally, to employ, and as
there are innumerable substances in nature, each of which may
be employed in a variety of ways, it is obvious that there must
be various kinds of exercise. In the present case, I wish to re-
strict the term to its signification in human physiology and pa-
thology. Exercise then, when thus restricted, signifies to em-
ploy the body, and is resolvable into natural exercise and unna-
tural exercise.

NATURAL EXERCISE,

Every organ of the human body has a definite and distinct
function to perform, in order to give rise and continuance to that
state of the system denominated />e7/ec/ health. The act of per-
forming these definite and distinct functions, in a harmonious
manner, constitutes the natural exercise of the various organs ;
thus the natural exercise of the brain, is mentation ; of the sto-
mach, digestion ; of the muscles, contraction and relaxation ; of
the lungs, respiration ; and so on. But we know that mental
manifestation is subject to derangement ; that digestion may be
impaired ; muscular contraction and relaxation, spasmodic; and
respiration, morbid. These axe examples o^ unnatural exercise.

Natural exercise^ however, may vary in degree, d^nd still be
natural in hind ; thus we have deficient exercise, adequate exer-
cise diudi excessive exercise. "But" it may be said, "deficient
and excessive exercise, frequently gives rise to unnatural, the
characteristic of deficiency or excess still continuing, so that here
we have a mixture of natural and unnatural exercise, not inclu-
ded in your classification. My answer is, that at the point
where the alteration in quality occurs, deficient or excessive ex-
ercise, properly so called, terminates, and at that point also, un-
naturaLexercise begins the latter being indeed somewhat mo-
dified in its characteristics, by the casual operation of the former.

All vital activity, or in other words, all exercise is the result
of an adaptation of sensibility to stimulus; consequently, there

652 An Essay on JEjxercise. [August,

must be operative in the healthy human system, as many speci-
fic kinds of sensibility and of stimulus, as there are developed,
specific modes of vital activity or exercise. In order more fully
to understand this matter, let us go into detail. Sensibility,
then, is a vital property which has the sole power of taking cog-
nizance of, and responding to stimuli ; it belongs exclusively to
nervated matter ; and in the living animal one does not exist
without the other.*

It has long been known and acknowledged, that the olfactory,

* It will be observed, that a more extended signification is here given to the
term sensibility, than it has usually received ; but a desire to avoid confounding
peculiarities which, owing to the general anatomical arrangements and connec-
tions of portions of the nervous system, occur in phenomena, with peculiariiies of
the original and inhinslc properties of the nervous system, I trust will be consi-
dered sufficient grounds to justify the innovation.

The presence or absence of sensibility, is usually judged of, by our being con.
scious or not, ofthe conditions or movements of a part. Now our consciousness
of the conditions of an organ, evidently depends upon the anatomical distribu-
tion and connections ofthe nervous fibres which control its operations. If these
fibres extend to the cerebrum, and are connected with the organs of perception
in the brain, we shall be conscious ofthe impression of their stimuli, whereas, if
they do not extend to, and are not connected with, the brain, we shall necessa-
rily be unconscious of it ; that, we are conscious ofthe impression of light upon
the optic nerve, of sound upon the acoustic, and of odors upon the olfactory : we
are unconscious ofthe healthy operations of the stomach, the intestines, the li-
ver and the kidneys. The causes of this difference are readily found, in the an-
atomical connections ofthe nervous S3'stem.

Sensation is said to consist in impression, transmission, and perception. I
believe it to consist in impression, transmission, and their result. ..the result al-
ways occurring at the opposite extremity ofthe nervous fibre, to that where the
impression has been made. If this extremit.y be in connection with those ner-
vous fibres which constitute the organs of perception, the latter will be stimulat-
ed by the sensation, and the phenomenon of consciousness by this means be de-
veloped if this extremity be not thus in connection, what we call consciousness
will not be developed, but gome specific phenomenon ofthe system, the nature of
which, so far as this question is involved, will depend upon the connection of the
resultent extremities ofthe nervous fibres, the sentient extremities of which hava
been stimulated.

Bichat has already introduced the terms " animal and organic," to express
the diflTerent sets of phenomena now under consideration, and although objected
to by Gall, I think they embody our meaning more perfectly than " sensibility"
and " irritability," and are, therefore, as contrasted terms, to be prefened to
them. Perhaps conscious and unconscious sensibility, would be more correct
than either. Descartes, Stahl, Cabanis, Cuvier, Blumenbach and Ricl, there-
there, are right, in stating that sensibility exists without consciousness, though
none of them have explained tohy it docs so.

1839.] Ak Essay on Exercise, 653

the optic, the auditory, the gustatory, the tactile, motory and res-
piratory, are separate and distinct nerves and sets of nerves,
responding to definite and distinct stimuH, and each performing
an independent function. The sanae I beh'eve is acknowledged
to be true of all, or nearly all the nerves, of what has been call-
ed animal life ; but it has yet to be generally understood, that
for each definite and distinct function of the body, there is a sepa-
rate and distinct nerve or set of nerves, each possessing a defin-
ite and distinct sensibility and responding to a definite and dis-
tinct stimulus.

In the daily and momentary phenomena which recur within
the immediate range of our observation, nature has furnished us
with keys to many of her surest operations. To observe ana-
lytically the most ordinary appearances and phenomena, is the
surest method of arriving at important natural truths. Thus
Newton discovered that a modification of the same force which
impels an apple to the earth, retains the earth in its orbit from
the attention of Galileo, being arrested, by the regular vibrations
of a lamp, swinging from the roof of the Cathedral at Pisa, sprang
the first instrument which was ever constructed, for the accu-
rate measurement oftime. So, by the careful analysis of the
functions of a single nerve, we may arrive at a just conception,
of the method in which all nerves perform their functions.

I have before stated that all exercise or activity is the result of
an adaptation of sensibility to stimulus. The sensibility of the
nerve of smell, is adapted to the stimulus of certain odorous par-
ticles of matter, and the result of this adaptation is smelling.
The sensibility of the nerve of vision, is adapted to the stimulus
of light, and the result is seeing. Now, the sensibility of the
nerves of osseous deposition is adapted to the stimulus of certain
earthly particles of matter contained in the blood, and the result
is, the formation of bone. The sensibility of the nerves of bili-
ary secretion, is adapted to the stimulus of certain other parti-
cles contained in the blood, and the result is the formation of
bile. This law. holds good of the whole system, each function
having its pecuhar sensibility and each its peculiar stimulus.

Let it not be inferred from what has now been said, that I
maintain the nerves to be the only active material agents in the
body. All that I shall attempt to prove in this respect is, that
nervous matter possesses such power, and is so distributed in all

r)54 An Essay on E.vcrcise. [August,

the organs, as to enable it to direct and control their movements;
other parts of the body being merely the protectors and execu-
tive agents of the nervous system.

It now becomes necessary to bestow a few remarks upon the
different degrees of natural exercise, and as I have before ob-
served, these are three in number deficient, adequate, and ex-
cessive.

Deficient exercise consists m privation ; adequate exercise con-
stitutes temperance ; and excessive exercise, intemperance the
first occasions craving ; the second gives rise to sensations of
comfort ; and the third to those of fatigue.

Craving then is one of the consequences of deficient natural
exercise. Natural sensibility, at first, remonstrates against be-
ing deprived of an adequate supply of natural stimulus, and if
remonstrance prove unavailing, becomes clamorous in demand-
ing it. But if reiterated appeal and demand pass unheeded, na-
tural sensibility thus baffled, gives up the contest, and changes to
unnatural, or sinks into a state of inanity.

The principal inlet of a class of natural stimuli, which is abso-
lutely essential to the very existence of the body, leads through
the stomach I now refer to nutritious particles of matter.
Without an adequate supply of these, no part of the body can
long retain its natural and adequate sensibility, and no part can
be naturally and adequately exercised. Without this supply,
the brain cannot think, the muscles cannot contract and relax,
the eye cannot see and the ear cannot hear in a natural and ade-
quate manner. Hence the faithful advocates, and deluded fol-
lowers, in this country, of the false philosophy of a deficient and
exclusively vegetable diet, who during the enjoyment of vigor-
ous health, set unnatural limits to digestion, must keenly feel
the craving clamorous demands already spoken of the lustre-
less eye, the pallid surface, and attenuated muscles of such of
them as have been fortunate enough to escape the mad house,
and have not reached the grave, are so many examples of dege-
nerate sensibihty and inanity, produced by deficient natural ex-
ercise. The records of criminal jurisprudence, in innumerable
instances, present a complete history of the cravings, remon-
strances, and clamorous demands of the natural sensibility of the
organ of consciousness in the human brain. On referring to
these records, it will be found that criminal career generally

1839.] An Essay on Exercise. G55

commences in a disregard of some of the less important social or
moral relations of man. The natural sensibility of the organ of
consciousness, then begins to crave for its natural stimulus as
the individual progresses in his career of crime, it alternately re-
monstrates, demands, and clamors, until finally it gives up the
contest in the language of Scripture, becomes "seared as with
an hot iron," and quietly permits the perpetration of deeds the
most inhuman.

Though augmentation of natural sensibility is the immediate
result of excessive natural exercise, its secondary effects are suf-
ficiently manifest m the fatigue and debility which succeed
sensibility is diminished by each repetition of excess, until finally
it becomes incapable of a natural response to an adequate quan-
tity of natural stimulus. This constitutes one process of confir-
mation in bad habits.

It may, at first sight, appear anomalous, that both deficient and
excessive natural exercise should produce the same result di-
minished natural sensibility. It will be remembered, however,
that throughout nature, a given object may generally be accom-
plished in a variety of ways. The same solution of the same
mathematical problem, may be the accurate result of different
methods of calculation ; it frequently happens in chemistry, that
the same compound or elementary principle may be obtained by
practising different modes of sinthesis or analysis ; on the sur-
face of the earth, different routes lead to the same locality. So
likewise in the human system ; both deficient and excessive ex-
ercise, each in a different manner, and by a different route, lead
to diminished sensibility excessive exercise being the most di-
rect, fashionable and thronged pathway. It will, therefore, I
hope, be recollected, that excessive exercise of any part of the
body, constitutes intemperance.

The successive advent of new faculties and functions during
infancy and childhood; the progressive developement of all the fa-
culties and functions during youth, their maturity and perma-
nency in manhood ; their gradual decline in age, and final ex-
tinction at the portals of eternity, are all, the legitimate conse-
quences of adequate natural exercise.' It gives placidity to in-
fancy, frolic and joyousness to childhood, buoyancy to youth ^
vigor and might to manhood, and then commences to destroy.
But eveniits works of desolation are not painful. Obtuse hear-

656 An Essay on Exercise. [August,

ing or indistinct vision, may be the first obvious token to the
aged, of diminished natural sensibility; if however, the diminu-
tion have not been prematurely induced by deficient, excessive
or unnatural exercise, it will not be painful, masmuch as the sen-
sibility of those organs which enable man to observe external
objects, and of those which attach him to them, fail proportion-
ately and simultaneously. External sensation becomes less and
less vigilant and keen, the intellect becomes less and less active,
the affections less and less strong, digestion less and less rapid,
until finally when the last spark of sensibility is about to be ex-
tinguished, its possessor yields it wiUingly, and sinks gently
to his parent earth. This constitutes the natural termination of
human life.

Adequate natural exercise then, can never produce disease,
nor be accompanied by pain. It is the standard of health and
comfort.

We are necessarily conscious of the exercise of some organs
of our body, on account of the anatomical connection existing
between them and the organs of perception in the brain ; conti-
nuous nervous fibres being known to pass directly from one to
the other : but as there are other organs of the body, not thus
directly connected with the organs of perception; there are also
some, concerning the exercise of which u e know nothing, ex-
cept by observation. But do we not possess organs for obser-
vation ? Have we not the power, and is it not our duty to ex-
ercise them ? And how can we exercise them more agreeably
or usefully, than by observing the effects of external agencies
upon our own system ? And yet many people pay as little at-
tention to this matter, as though they were convinced, that the
only essential objects to be accomplished, by exercising the di-
gestive organs, the lungs, and the muscles, were, to appease hun-
ger, to expand and contract the chest, and " to make one leg
run races with its brother." Such persons seem never to have
perceived that the digestive function was instituted for the pur-
pose of furnishing fresh material to supply the natural waste of
the body ; that the object of breathing was to expose to the ac-
tion of the atmosphere in the lungs, the mass of circulating flu-
ids, thus fitting them for nourishing all parts of the system ; and
that the power of contracting and relaxing the muscles, was con-
ferred upon man for useful and salutary purposes. Ignorance

iS 39.] Ati Essay on Exercise. 657

of the laws and objects of exercise, among a large majority of
mankind, affords the most ready and rational solution to the in-
consistency of their habits. One man experiences an unusual
disinclination to mental and muscular exercise, a sense of wea-
riness and lassitude of his whole frame ; but instead of attribut-
ing these disagreeable feelings to their true cause to the brea-
thing of the contaminated atmosphere of some crowded and ill
ventilated assembly room, theatre or church, he foolishly consi-
ders them the result of an inexplicably perverse tendency of his
constitution, for which he is neither to be blamed, nor held ac-
countable. Another after indulging to excess, for a length of
time at table, in high-seasoned food, and fermented or alcoholic
drinks, has an attack of paralysis, rheumatism, or inflammatory
fever ; but because these effects do not instantaneously follow
the voluntary transgression of natural law, the afflicted individu-
al and his friends recognize in them neither salutary warning
nor merited punishment, but impiously call or think them unrea-
sonable dispensations of Divine Providence. The inhabitants
of a large town or city, after allowing the daily offal of their
persons and dwellings to accumulate in the private yards and
alleys, the public streets and sewers, until the whole atmosphere
becomes saturated with the deadly effluvia from putrifying and
fermenting masses of animal and vegetable matter, are visited by
the scouring pestilence ; but instead of considering this calamity
the inevitable consequence of their own voluntary violation of
natural laws, written in legible characters on the every day face
of things, they look upon it as a mysterious manifestation of Di-
vine wrath ; and instead of applying themselves vigorously to
remove its causes, they flock to the churches, and vainly and
wickedly implore the Almighty to suspend the operation of his
own laws to intercept the progress of the pestilence, by a di-
rect and miraculous interposition of omnipotent power !

At the time of its creation, every animal was undoubtedly
provided with a mechanism, and endowed with properties which
adapted it to the medium in which it lived, and fitted it for the
salutary operation of the external influences to which it was ex-
posed ; nay, further, I believe that the nervous system was ori-
ginally so constructed, and so connected with its executive
agents, and that its sensibilities were graduated in such a man-
ner, as to enable it when exposed to the full influence of appro-
C 3

658 An Essay on Exercise; [Augus*,

priate external stimuli, spontaneously to manifest all the pheno>
mena, and develo-pe all the functions proper to the animal. Now
whereas the nervous systems of all animals of the highest and
lowest, as well as of the intermediate gradations possess some
properties and some anatomical arrangements in common ; and
whereas there are also points of difference observable, in the
properties and anatomical arrangements of the i>ervous systems
of animals the most nearly related to each other, there are of ne-
cessity some external stimuli, to the salutary influence of whicb
all animals are adapted ; as the stimulus of oxygen, and aome^
which are calculated to impress favorably only a certain cfess or
species ; as the stimulus of a particular kind of food. The more
numerous the points of difference in nervous structure and- ner-
vous sensibility, which exist between one animal and another^
the fewer will necessarily be, the number af stimuli whreb they
can enjoy io common. Hence what is nourishing food iby ne-
animal, becomes deadly poison to another.

The above facts should be borne constantly in mind', m per>
forming those experiments upon inferior animals, whicfe consist!,
in the administration of substances for the purpose of ascertain^
ing their effects upon the human system. For such experiments,,
animals should always be selected, which, in their structure and
habits, are nearest assimilated to man ; and even then, the infer-
ences deducible from experimental results, cannot be extended
with much certainty, to the human species they should, there-
fore, be acted upon in practice with great caution.

Vegetables, it is known, are in a great degree, stationary be-
ings ; still, by the structure or tenacious vitality of theiy seeds^
nature has in many instances, provided for their extensive distri-
bution ; and by the universal diffusion of the stimuli to which the
simple structure and limited properties of nearly all vegetables
are adopted, she has furnished the same plant with the natural
means of subsistence, in regions very different from the place oF
its nativity : variation of temperature, being almost the only cir-
cumstance, which appears to set limits to the distribution o{
plants. The same remarks apply to the geographical distribu-
tion of those animals, which, in simplicity of structure and en-
dowments, nearest approach the vegetable kingdom.

The wants of animals increase however, in proportion as their
litructurc becomes more coniplcx, and the sensibilities of their.

'1 039.3 An Essay on Exercise, 65J>

nervous system more numerous ; and inasmuch as these wants
<jannot all be gratified, except by subjecting each specific sensi-
foifity to the impression of its appropriate stimulus, it will be
found that mountains and rivers do not form, the natural boun-
daries of the region which any animal may inhabit, but that the
presence and absence of particular stimuli, fix and circumscribe
the local abode of every species of animal ; each having, what
may be termed, its natural sphere of adaptation, beyond which,
it will not voluntarily penetrate. It may be truly said, that the
several organs of any one of the superior s.nimals, typify in their
sympathies and dependencies, the whole animated world. This
may in fact be regarded as one stupendous animal : i\\Q primary
stimuU of which, are the unalterable phenomena of universal na-
tu^re the secondary, modifications of the first, produced by the
exercise of individual organs, and giving rise to mutual relation-
ships and mutual dependencies.

By bestowing upon man, organs, the most numerous and di-
versified, and properties th most refined and elevated, nature
has evidently designed him for the highest destiny we accord-
diQgly find him at the summit of the scale of animated existence.
Man has a sphere of adaptation extending beyond that of other
animals, and this constitutes the superiority of human destiny.
Owing to difference of organization also, the sphere of adapta-
tion of one portion, or of one individual, differs, in some particu-
lars, from that of other individuals and other nations ; and from
itkis di5erence result national and individual destiny.

6600n the Remedial Powers of Persesquinitraie of Iron. [August

Part II. REVIEWS AND EXTRACTS.

On the Remedial Powers of the Persesqidnitrate of Iron. By T. C. Adam,
M. D., of Lenawee county, Michigan. For upwards of five years we have
been in the habit of prescribing, almost daily, the liquor ferri persesquinilra-
tist a remedial agent first discovered and introduced to notice, we believe,
by Wm. Kerr, Esq.; though Dr. Graves, in a clinical lecture, quoted in No.
XXXV. of this Journal, ascribe this merit to Dr. Christison, of Edinburgh.
We have derived from its use very remarkable assistance in the treatment
of several diseases, especially diarrhoea, and other aflfections of mucous mem-
branes accompanied by discharges ; and as its virtues seem not to be so
generally known in this country, as they deserve to be, we have been in-
duced to lay before our brethren a few observations illustrative of its value
as a therapeutic agent.

The formula for the preparation of this remedy, as given by Mr. Kerr, will
be found in the No. of this Journal for May, 1832, p. 235.

Our first trials of this remedy were in cases of diarrhoeaj and from its em-
ployment we have derived highly beneficial results. We must not be misun-
derstood to mean that this astringent is applicable to every case of diarrhoea,
or that it has been found indiscriminately useful. We have not thought proper
to administer it in every variety of this complaint; but of its beneficial effects
in such cases as the followmg, we can speak with much confidence.

In January, 1832, a child of six months of age became our patient, on ac-
count of a diarrhflea, nearly habitual, but aggravated by dentition. Immediate
relief was obtained by means of a free incision through the gums, down to
the tooth or teeth. The fretfulness ceased, and the diarrhoea subsibed to its
nsual degree. Two drops of the nitrate were then ordered three times a
day, and to be continued for at least ten days after cessation oi the diarrhoea.
The effects of this treatment were a cessation of the habitual diarrhoea
for at least eighteen months, and an improvement in ruddiness of complexion
and in temper or feelings of comfort.

In April, 1832, a lady applied for advice, probably in consequence of the
threatened invasion of cholera. Her bowels were very readily moved, gen-
eraly tender or uneasy ; she was languid and weak; pale and ema-
ciated, and was much troubled with cold feet and profuse perspi-
rations. She had been subject to diarrhoea from the shghtest causes for
several years. Intelligence of an unpleasant nature would almost invaria-
bly produce it. For her I ordered frictions with salt, water to the surface,
and the nitrate, in doses of 15 to 25 drops, four times a day. After using
tiie remedy a few days, this lady commonly improved ; but from giving up
its use too soon, the relief was not of long continuance.

We have generally ordered the medicine to be continued for at least ten
'days after the disease disappears ; and have continued its use as long as
four months after every threatening of diarrhoea was gone. The diarrhoea
never returned for several months, if the medicine was faithfully taken for
'ten days or more ; but, as in the cases of this lady, we have had relapses
dn those who neglected the usual order so soon as amendment took place.
This lady's case closely resembles that alluded to by Dr. Graves in No.
XXXV. of this Journal. We may remark in passing, that Dr. Graves pre-
scribes the nitrate in much smaller doses than we have been accustomed to
do. We prescribe ten drops at a dose, two, three, or four times a day, fre-
quently twenty.five; whereas Dr. Graves gives seven, gradually increased

1839.] On the Remedial Powers of Persesqulnhrale of Iron. 661

to fifteen drops in the course of the day ; and we think we have obtained a
more rapid amendment, from the hirger dose.

A lady, about 30 years of age, had liaddiarrhooa for ton moths previously to
applying to me. It commenced as soon as she got up in the morning, and
continued all forenoon ; in the afternoon it subsided almost entirely. It was
accompanied with but little pain ; but there was considerable thirst. Dur-
ing the ten months she had tried a variety of proposed remedies in vain.
She has never been Iree from her complaint except for about two weeks,
after having taken some purgative pills, which operated very powerfully. In
constitution and symptoms, this case was exactly parallel with those refer-
red to by Dr. Graves, in the XXXVth No. of this Journal. She took ten
drops of the liq. persequmitr. ferri, gradually increased to twenty drops, three
times a day. in four days she was nearly quite free from the diarrhoea ; and
in two weeks felt stronger and in better health than for ten months previous-
ly. For about a year, as long as we knew her history, she had no return of
diarrhoea, or bad health.

A gentlemen, about 30 years of age, had recently moved to Michigan, when
he applied to me on account of diarrhoea, accompanied with considerable
uneasiness and griping pains. He attributed these complaints to the chan-
ges he had been obliged to make in his diet, especially to eating more pork
than usual with him, and partly to the water he had to drink. I could as-
certain no other causes in operation, and thought his own etiological theory
probably the true one. To lesseri the irritability of the mucous membrane
and at the same time restrain the discharges, I could think of no medicine
more likely to be effectual, than the nitrate of iron. Fifteen drops were
taken three times a day in water, and on the third day he reported him-
self much relieved from the griping pains and uneasines in abdomen. By
continuing the use of this remedy tor not more than ten days, this gentle-
men obtained complete relief from his "new country" complaints, which had
existed upwards of six weeks before the nitrate was prescribed. From the
effects of the remedy in this case, and from some similar observations in
other cases, we were inclined to believe that this nitrate, like some other
metallic nitrates, had the property of subdumg morbid sensibility of the or-
ganic nerves. In the paper of Dr. Kerr, will be found a case remarkably
confirmatory of this theory.

Since we commenced the use of the nitrate of iron, there has seldom been
any long interval between our cases of children who were habitually subject
to oft recurring attacks of diarrhoea, who occasinally had attacks of what mo-
thers call worm fever infantile remittent. In such cases diarrhoea not
unfrequently alternates with constipation. It is seldom such cases are put
under medical treatment, except when the remittent fever or the diarrhoea
is more than usually severe. We have generally had children of this des-
cription put under our charge when they were labouring under fever. With
doses of calomel and rhubarb, followed by oil in the morning, repeated every
second night, and conjoined with a bland,'easily-digested diet, and with at-
tention to ablution, quietude, and warm clotliiiig, we have usually succeeded
in alleviating or curing the fever. We have, t1ien, in a majority of cases,
recommended that the child should, for some weeks, have a bland nutritious
diet, consisting chiefly of well-boiled farinaceous articles, and make use of
the nitrate of iron regularly. In several instances we have failed to procure
a steady employment of this medicine for a sufficient length of time ; in some,,
again, the parents have continued it, of their own accord, for upwards ot
two months ; and in all the cases in which it was regularly administered for
a period of three weeks or more, we do not know that such chddren were
again attacked with fits of diarrhoea, or suffered from infantile fever. Of
several we can affirm confidently, that they were altered subjects ; formerly
pale, exsanguine, peevish, delicate, and requiring much anxious attention.

662 On the Remedial Poicers of Persesquinilr ate q/'/ron.[ August,

they have become hale and fresh-coJoured, strong, playful, and easily taken
care of.

Such are the varieties of diarrhoea for which we most frequently prescrib-
ed the liq. persesquinitr. ferri. They are all of a chronic nature, and the
temperament of both the younger and the adult patients has had a large ad-
mixture of the nervous. This we incline to attribute to the irritable condi-
tion of the mucous membrane of the intestinal tube, and to the debilitating
effects of frequent diarrhoea. Numerous cases, similar to those given, might
be produced trom our case-book ; but our purpose is solely to indicate clearly
the kind of cases in which we have employed this medicine most frequent-
ly, and in which we have found it without a rival. For this purpose we have
jgiven, we hope, sufficient naiTation, and avoided *'vain repetitions," We
will now add a few explanatory observations.

The dose which we employ in adult cases is, as we have already inciden- .
tally remark, much larger than that which Dr. Graves is reported to employ-.
We seldorn order less than fifteen drops at the commencement ; after a few
<lays of employment of the remedy we increase the quantity to twenty.five,
and thirty drops at a dose. For children we proportion the dose according
to the age. We have only in one case that we recollect o^ that of a Mrs. J.
Dunlop, had occasion to reduce the quantity. In this case, which, by the
5)ye, was one of recent, not habitual diarrhoea, the usual dose did not pro-
duce any alleviation of the symptoms, but seemed rather to increase the gri-
ping pains ; we, therefore, reduced the quantity to sevein drops, and in less
than twenty.four hours, the amendment was very marked, VVe have ad-
ministered, and we have taken as much as a hundred drops ; but, lately,
where the usual quantity does not produce relief in two or three days, we pre-
fer adding a little laudanum, or employing some other auxiliary, to the em-
ployment of more than thirty-five drops. At the same time, we had never
-experienced any bad effects from so large a dose as even a small teaspoon-
ful, which we have frequently known to be taken three and four times a day.

The time during which the nitrate will keep good, that is, clear and trans-
parent, varies considerably. Dr. Graves says about a week some of my
acquaintances aad correspondents say three and four weeks, while I myself
have never had any become turbid in less than five or six weeks, and gene-
rally I have it quite traiosparent for two months or upwards. 1 have also used
it turbid without any sensible diminution of its astringent effects. Mr. Kerr,
iiowever, thinks that when it has become turbid, it is not so powerful. It is
only in a few instaxKces that we have employed it after this change.

In cases such as we have above described cases of habitual diarrhoea,
from birth perJaaps, in children, and in cases in which there seems to exist an
-excess of irritability in the digestive tube we knew of no medicine which
produces a more beneficial, immediate effect; and certainly, in its power of
preventing similar attacks in future, this remedy is without any rival, so far
as our experience extends. In cases of children, we have found its long-
continued employment produce the most satisfactory results.

We have endeavoured to guanl agamst any miscon-ception of our ideas as to
the cages of morbid condition to which our remedy is particularly applicable.
We meet with chronic diarrhoea in two forms persistent and what may be
called intercurrent. The former is generally the consequence of a severe
acute attack ^ by the latter, we mean to designate such cases of this dis-
*ease as consist in a tendency or predisposition, or in the frequent occurence
of slight attacks of an acute kind, the usual state being more or less normal,
or rather inclination to constipation. In the majority of cases of both kinds,
the proximate cause, as the pathological condition has been called, undoubt-
edly consists, not so much in the application of foreign irritating matter, or
on fsecal accumulations or morbid secretions, or on an undefined debihty or
relaxation of the mucous membrane, or on congestion or inflammation, so

1839. J Oti the Remedial Powers of Persesquinitrate of Iron, 663

much as on an excess in the sensibility of the organic nerves which sup-
ply the digestive tube. It is not ior cfironic diarrJuca a name for a symp-
tom not a specific condition, tliat we prescribe this chalybeate astringent
and sedative ; but when, by investigation, we have satisfied ourselves that
the diarrhoea is dependent on the above named condition, we then employ
this remedy in preference to opiates, or any other anti-diarrhccal medica-
ments.

Having thus laboured to indicate, with precision, those forms of disease
in which we liave derived from the use of the liq. perse squiniir. Jerri the
most satisfactory and beneficial results, we will now briefly notice a iew ad-
ditional forms of disease, in which we can speak favorably of its remedial ef-
fects, though not with the confidence we feel as to our previous observations .

In Leucorrhcea, we have employed the nitrate of iron with excellent suc-
cess. But to procure benefit, we are careful in the selection of proper cases.
These we think are such as seem chiefly dependent on a laxity of fibre, or on
an over-secretion without inflammatory action. The persons in whom we
meet with this kind of leucorrhcea, are generally pale, exsanguine, feeble,
languid. We would not administer the nitrate where there was reason
to suspect any disease ol the uterus. But in the former kind of cases,,
we have employed It very successfully, using it internally, generally, and
always topically, in injection. We add to four ounces of water such a quan-
tity of the nitrate of iron as will produce in the vagina a gentle efegree of
heat or smarting. The internal use is prescribed where it is probable that
the system by this means may be so roborated as to aid in the cure of the-
local disease. Almost all the preparations o iron are useful in such cases^
and we think this not inferior to any in this respect.

In several cases of Menorrhagia, we have found this astringent and tonic
of much service. We think it may be preferred,.in cases accompanied with,
anemia, debility, and relaxed fibre, to any astringent in common use. We
know of none equal, save a mixture, in equal proportions, of the sulphates.
of alumina and iron.

We have made trial of the remedial power of this medicine in such cases,
of almost all the diseases in which astringents are usually prescribed as we
thought the most appropriate. We donot know of any case in which the
nitrate enjoys a marked superiority to the common astringents ; but judging
from our experience, we presume it will be found a convenient and useful
addition to the list of such remedies.

Dr. M. A. Patterson, of Tecumseh, informs me that he has found the ni-
trate of much use in the treatment of aphthous sores, or what is vulgarly cal-
led "canker." Our experience, though small,, confirms the utility ofthieK
application of the medicine.

A gentleman, in whose house a bottle of this remedy was at a time when ,
he had the toothache, applied a few drops sua sponie, and obtained relief. ..
May the nitrate of iron not possess a sedative or anodyne effect like the ni
trates of silver, bismuth, &c. 1

In fine, it may be mentioned as no small recommendation of the prepa-
ration, that it is cheap and easily procurable, and as each practitioner can,
prepare his own, it may be depended upon as uniform and unadulterated in.,
any important emergency. Those who have felt the deficiency, in purity
and uniformity, of many of our remedial agents, will account this as not the,
smallest of its recommendatory qualities.

e04 A T/eatLse on Ivjlammation. [August,

A Treatise on Inflammation. By James Macartney, M. D. F. R. S. &c.

&c. &e. Quarto, pp. 214. Two Plates. Longman's, 1838.

It will probably appear a hazardous experiment to publish a work upon
inflammation at present. The subject is so hackneyed as to excite little
curiosity or attention, and few persons would conceive it possible that
any man could advance new views of its nature, or new plans of any value in
its^ management.

But Dr. Macartney's reputation will secure that notice which might other-
wise be denied, and command a full audience and respectful attention when-
ever he addresses the profession. We may be satisfied that we shall meet with
ingenuity and originality, and whether we are convinced or not, we are cer-
tain of pleasure and instruction.

Dr. Macartney tells us in a brief advertisement, that:

"The present Treatise contains the theory and practice, respecting the
subject of inflammation, which 1 have taugfit durmg many years in my lec-
tures on surgery. Its publication did not become necessary, until I had re-
signed my professorship in the University of Dublin, asl had annually the best
means, perhaps, of promulgating and explaining my views in the form of
lectures. The delay has been attended with the great advantage of ena-
bling me to verify and improve my early opinions, by a longer experience,
and by the successful practice of my pupils, who are now settled in every
part of the United Kingdom and throughout our Colonies. Whatever the
})rofession may think of the doctrines 1 have advanced on the subject of in-
flammation, the practice founded on them is at present established too ex-
tensively, and confirmed by the experience of too many individuals, to ad-
mit of controversy.

We shall run through these lectures, or this Essay, as rapidly as is con-
sistent with justice both to the author and our readers. We shall content
ourselves with noticing those parts that are either novel, or give some new
turn or some striking confirmation to what has been familiar.

The work is divided into fourteen parts, or sections, in which Dr. Ma-
cartney discusses in succession The History of Inflammation Phenome-
na of Inflammation The Real Consequences of Inflammation The Reput-
ed Consequences of Inflammation The Different Modes of Reparation
Cicatrization The Reparation of the Different Tissues The Constitution-
al Causes of Inflammation The Local Causes of Inflammation The Prox-
imate Cause of Inflammation Species of Inflammation Congestion as con-
tradistinguished from Inflammation The Remedies for Inflammation.

1. History of Injlammation. Dr. Macartney presents a brief sketch of
the different classes of animals, in reference to their liability to Inflamma-
tion.

In those zoophytes which present no visible Serves and a very simple ner-
vous system, none of the phenomena of inflammation are exhibited.

Dr. Macartney alludes to the phenomena of reproduction in the articu-
lata. The instances are numerous, the phenomena rather varied, and we do
not perceive conclusive proof of the non-existence of inflammation in the
class.

The class mollusca, says our author, do not seem to be capable of genuine
inflammation.

Ascending to the vertebrata. Dr. Macartney does not believe it possible to
produce the genuine effects of inflammation in either amphibia, or reptiles,
or fishes.

"In conducting some experiments on the swimming-bag of fishes^ .1 was
surprised to find that the wounds made into the belly of animals did not in-
inflame. I was therefore curious to know what injuries fishes would bear with-
out producing inflammation. Having taken some living fishes from the water,
I introduced pieces of wire beneath the skin and amongst the muscles of the

I839.] A Treatise on Ivjlammalion. 665

body ; the fishes were then returned to the water, and on examining them
several days afterwards, I found that no suppuration had taken place. The
tracts of the wounds were pale and smooth, and only moistened with a se-
rous fluid, and none of the usual appearances of inflammation were visible.
A very common occurrence in fishes, is the existence of worms, which
perforate the tunics of the alimentary canal, without producing any change
of structure, except an increased vascularity around the perforations. The
reproductive power o{ fishes is confined to their fins, which are sometimes re-

fenerated after being lost by accident, or by a species of death which is quite
ifferent from that whicii is the consequence of inflammation in the higher
classes of animals.

I have never seen any appearance of inflammation in reptiles after wounda
or injuries. Serpents often lose a portion of their tail; and although there is no
attempt made for its reproduction, it is very speedily cicatrized without in-
flammation. Some lizards are able to reproduce parts that are lost, though
not so perfectly as in the lower classes of animals. When lizards get a new
tail, it wants the vertebrae. The salamander has more power of reproduction
than any other of the class, being capable, according to the statement of
many physiologists, of regenerating the tail, the limbs, and the lower jaw.
I have seen imperfect attempts at the reproduction of the fingers and toes in
the toad a.nd frog. In all this class of animals, there is great tenacity of life,
and power of repairing the effect of injury, though not always the ability of
regenerating limbs. Having had occasion to make the experiment of remov-
ing a part of the brain of a toad, it became necessary to take away a consi-
derable portion of the skull. The wound never seemed to inflame. In a
very short time it was healed, and the vacancy in the skull was made up by
a substance half cartilage and half bone, leaving, however, a depression, cor-
responding to the quantity of brain removed."

In birds external mechanical injury produces indubitable inflammation ;
but the instances in which internal disorders become a cause of inflamma-
tion, are very limited and are nearly confined to febrile states and particular
epidemics.

Quadrupeds are subject to inflammation both from external injury and in-
ternal disorders ; they usually shew but little constitutional sympathy with
local disease.

Man is especially prone to inflammation as well as to constitutional and
sympathetic disturbance.

' Upon these data and premises. Dr. Macartney founds a much bolder
hypothesis than will probably be suspected by our readers. This hypothesis
contain the spirit of the book, and embodies the main fact, which its author
endeavors to establish. Let him speak for himself.

" The history I have given of the effects of injury in the different classes
of animals, proves that the powers of reparation and of reproduction are in
proportion to the indisposition or incapacity for inflammation, and leads
necessarily to the induction, that inflammation is so far from being necessa-
ry to the reparation of parts, that in proportion as it exists, the latter is im-
peded, retarded, or prevented, and that when inflammation does not exist,
the reparative power is equivalent to the original tendency to produce and
maintain organic form and structure ; that it then becomes a natural func-
tion, like the growth of the individual or the reproduction of the species. I
am aware that this opinion is opposed to universally received doctrines.
The subject, I think, has never been fairly examined. The necessity of
some degree of inflammation to the process of reparation has been suppoe-
ed by the early surgeons, and has been received by the moderns without in-
quiry. The opinion arose in those rude ages of the art when nothing was
trusted to nature, and the treatment of every wound was such as to mduoe
and maintain for a certain time the most severe inflammation. The igno-
D 4

666 A Treatise on Inflammation. [August,

ranee of the ancients of the use of the ligature for suppressing htBmorrhage,
led them to employ, instead of it, strong compression, and the actual caute-
ry in cases of wounds and after amputation ; and being accustomed to see
wounds ultimately heal after surh barbarous treatment, they naturally sup-
posed that inflammation and all its evil consequences were necessary ;
which they took care to ensure in all cases, by boiling oils, hot and irritating
ointments, tents, setons, and strict and cumbrous bandages." 7

After proceeding to notice and partly to criticise the views of Mr. Hunter,.
and to point out inconsistencies between his doctrines and bis facts, Dr.
Macartney seizes on a passage in ISir Astley Cooper's lectures, as a fair point
on which to try the issue inflammation or no inflammation in the repara-
tion of injuries.

"The doctrine," he observes, (that inflammation is necessary) **has been
avowed by Sir Astley Cooper in the strongest language, in his Lectures on
Surgery, published by Mr. Tyrrell. The passage may be taken as expres-
ing the general opinion cf the profession in this country on the question.
He says : 'Inflammation is a restorative process; no wound can be repaired
without it ; even the little pu7u:ture made by the lancet in bleeding, would inevi-
tably destroy life, if this salutary process did not prevent it.'

I am well pleased, that the doctrine has thus been so clearly and une-
quivocally asserted, that no doubt can exist respecting the meaning of the
author. It is also fortunate, that Sir Astley has selected the wound made
in venesection as his example ; as I shall afterwards have occasion to quote
the heahng of this wound, as one of the strongest and most familiar instan-
ces of union being effected, without the slightest inflammation." 9

We would make a few observations before we proceed any farther.

1. We perceive that confusion is already approaching from the vague sense
in which the terra inflammation is used by the respective parties. Dr.
Macartney does not define what he means by inflammation whether cer-
tain phenomena, as swelling, redness, &.c. ; or certain effects, as adhesion,
suppuration, or so on. Mr. Hunter, whose w^ant of education was so unfor.
tunate, sometimes employs "inflammation" in one sense, sometimes in ano-
ther. Yet this makes all the difference, especially in a dispute.

2. We may, nay we must conceive, that though the pathological state of
inflammation be excitable in all animals, its mode will vary in the utmost
possible degree. In an animal with a distinct circulating nutritive fluid, in-
flammation consists essentially in an abnormal afiiux of that fluid to a part.
How different must the phenomena be, in a creature v/ith red blood or white,
with warm blood or cold. If this be so, and reason informs us that it must,
how essentially must the nature of inflammation be changed when we ar.
rive at animals, as the polype, in which we can detect no circulating fluid at
all. If there be no such fluid, it follows of course that there cannot be any
partial or abnormal collections of it. Yet the purposes served by inflamma-
tion elsewhere, may be served in such animals by a different process differ-
ent in mode, but similar in object. Animals in this category cannot legiti-
mately be compared with those which possess a true circulation, undoubt-
edly not with the highest of that class endowed with warm red blood.

To determine the precise points of analogy or difference, a series of ex-
periments would be required. But Dr. Macartney communicates none.
The actual effects of mechanical and chemical stimuli the results of va-
rious lesions the changes, if there be such, of disease, are not stated by
our author, and do not appear to have been determined. Yet, in the absence
of direct experiment and of positive information, we do not feel ourselves
warranted in assenting to the position, that nothing analogous to inflamma-
tion occurs in the lowest animals.

1839.] A Treatise on Injlammation. 667

3. The statement that reproduction is greatest where inflammation is least
or is absent, requires something more than that naked announcement. In the
simplest annnal the whole body is comparatively homogeneous, and there is
no centralization of fluids or of organs. All the molecules, then, must have,
loosely speaking, the same powers, and the addition of fresh molecules, is
comparatively simple. Bat as animals rise in the scale, centrahzation ob-
tains, the parts are no longer homogeneous, their life consists in a finely ad-
justed balance and dependence, and the reproduction of lost parts becomes
too great an effort. It is unphilosophical to imply that reproduction is less
active in these creatures because inflammation is more so. The cause of
both phenomena is to be sought in the centrahzation of the vital powers
and organs. The polype may, for aught that appears to the contrary, have
inflammation in its own way, though it cannot have the "dolor, rubor, calor,
tumor" of man. In the polype, increased vital energy in the molecules of the
part, may constitute the essence, and give rise to undoubted effects of in-
flammation in man, such augmented local action would be useless, unless
combimed with correlative augmented energy in the vital organs.

4. When surgeons of the present day assert and believe that inflammation
heals the simplest wound, the best informed imply or understand nothing
more than this: lliat, after the simplest wound, an effusion of plastic mate-
rial take place, which forms first a l3ond of union between the divided surfa-
ces, and afterwards is more or less identified with them in structure ; that,
these changes are attended with a certain afflux of blood to the part ; that,
this appears the simplest mode of what an increased ratio constitutes the
pathological state, and gives rise to the effects of inflammation: and that, the
steps from this restorative adhesion to the more aggravated phenomena of
inflammation are so gradual, that it is impossible to fix any positive limit
between the reparative and inflammatory process.

The second Chapter is on the Phenomena of Inflammation. Dr. Ma-
cartney commences by digressing to the hypothesis of the cause of animal
heat. If we have observed some indications of a tendency to confident
generalization in the previous chapter, those indications are rather augment-
ed in the present one. The opinions of physiologists are daily leaning more
and more on the connexion between animal heat and respiration; a connexion
supported by a broad survey of the animal kingdom. But Dr. Macartney de-
cides in the negati'ce. It would be foreign to our purpose to enter on so im-
portant and extensive a question. We must content ourselves with stating
that we do not and cannot go along with our author in several of his opinion*
and conclusions. We may observe that Dr. Macartney is disposed to as-
cribe the increased heat of inflamed parts, more to their state of local organ-
ic sensibility, than to the condition of their arteries, as regards circulatioon
or secretion an opinion which is certainly less intelligible than the com-
monly received one.

Dr. Macartney treats seriatim of the signs of symptoms of inflammation
heat, pain, redness, swelling, and altered or suspended natural secretions.
On each, his remarks are ingenious. We pass to the next Chapter, on the

I Consequences op Lxflammation.

' Dr. M. very preperly observes that, what are denominated the phenome-
na of inflammation are the immediate ejj'ecls of the augmented sensibility and
circulation in the parts engaged. To these succeed, or rather, there arise
out of them as a matter of necessity, if the inflammation persist for any time,
a number of consequences. These he enumerates as chemosis, cedema, vest,
cation, suppuration, and the total disorganization and death of the part.

1. Chemosis. "When c^iemosfs, or the extravasation of the blood, takee*
place without a rupture of the vessels by mechanic injury, it is not designed
to become organized, and therefore it remains in a fluid state. The absorp.

668 A Treatise on Inf animation. [August^

tion of the blood, when shed under these circumstanceB, is tedious. I have
kaown chemosis arising from erysipelas of the face, remain for months before
it was removed. When blood is found extravasated in an inflamed part*
there are always, I think, ruptured vessels. Such effusions take place under
circumstances favourable to the laceration of the small arteries ; as when in-
flammation is very violent, or occurs in lax cellular tissue ; or where parts
are not yet supported by the. deposition of coagulable lymph. Thus, the
mucous membrane and the surtace of ulcers, when highly mflamed, yield
blood. The loose cellular membrane joining the conjunctiva to the globe of
the eye, becomes charged with blood m severe opthalmia, and the submu-
cous tissue of the great intestines is similarly affected in acute dysentery.
In the first steps towards the formation of an abscess, betore the parts are
made solid by coagulable lyumph, blood is commonly extravasated.

In some abscesses, as those of the hver, spleen, and brain, we sometimes
see with the naked eye the lacerated vessels ; and in the first, I
have observed the biliary vessels also to be broken, and the bile
mixed with blood and pus contained ni the cavity of the abscess. The
best evidence is to be obtained by injecting any part, in wich blood has beea
extravasated, when the fluid injection will escape through the broken ves-
sels and imitate the previous effusion." 24.

It will be observed that Dr. Macartney employs the term Chemosis, to sig-
nify extravasation of blood. Ecchymosis is the designation usually giveu to
that pathological condition, and chemosis is commonly understood to mean
effusion of serum into the submucous cellular tissue itself. We mention
this, to prevent misconception on the part of our readers. An observation
ofDr. Macartney's would imply that he considers chemosis in the eye aa
purely extravasation of blood. There is some confusion in this.

2. CEdema. This, says the Doctor, is the diffused extravasation of serum.
It is usually found in relaxed and dependmg parts. It may occur with a
very low degree of inflammation, as in some species of erysipelas. Persona
are most prone to cedema in inflammation, who have the small veins full, or
who have a tendency to anasarca ; and the parts of the body where oedema
is most remarkable, are those in which the cellular membrane is most lax
as the eye. lids, the prepuce, the scrotum, and the external labia of females.
CEdema is always unfavourable to reparation, and parts once affected with it
are apt to retain some serum in the cellular membrane afterwards, giving
them a bloated or tumid appearance. Where the disposition to oedema is
general in the body, it is a proof of weaknes, and often leads to a fatal result
after severe accidents or surgical operations.

3. Vesication is familiar. It may result from simply increased irritation
in the vessels of the cutis or form inflammmation in constitutions or parts
which are incompetent to effect reparation ; so it accompanies mortification.

4. Suppuration. Dr. Macartney considers this as always arising from
more or less of inflammatory action. His remarks upon the process need
not detain us.

Speaking of acute abscess^ our author offers the following rationale of tl>e
observable phenomena. In the first inscance always, he says, some of the
small vessels give way, and some blood and serum are poured out into the
surrounding tissue. In order to separate the disorganized from the healthy
structure, lymph is shed, by which the extravasation of the blood and serum>
is restricted within certain Umits. This lymph next acquires vascularity and
organization, and then, and not before, the secretion of pus commences.
In the first stage of abscess, if the fluid be evacuated, it is well known to
consists of blood and serum streaked with pus. As the lymph which is de-
signed to compose the walls of the abscess advances in organiza-

A Treatise on Injlamrnahon. OGU

tion, pus of a better quality is secreted ; and as the contents ofan abscesa
are proved to be, like the other parts of the body, transitory in their exis-
tence, while fresh pus is being added, the rig-mal contents are removed by ab-
sorption ; hence, an abscess of some duration is found only to hold genuine
pus. During the time that this change is taking place in the fluid contents^
a similar one is proceeding on the solid walls of the abscess. On the side,
the process of absorption is reducing the thickness of the parietes, while the
other sides are increasing in the same proportion by the addition of new sub-
stance. There is also another remarkable circumstance attending the
progression of an abscess, which was first accurately described by Mr.
Hunter. On the side of the abscess that is becoming thinner, there is al-
so a disposition to yield, or to be extended ; and on the side that is growing,
there is a tendency to contract. The pus of an abscess is, therefore, brought
to those surfaces on which it is to be evacuated, by four processes absorp-
tion, new growth, extension, and contraction ; and as the object to be at-
tained in this case, is the removal of fluid, the same means are emplo} e\
for conducting extraneous substances out of the body.

It is not generally supposed that the effusion of lymph and its vasculari-
zation are necessary for the secretion of pus. The observation of Dr. Ma-
cartney, if well founded, is interesting. Yet, as we see pus formed by mu-
cous membranes, it is not impossible that other tissues when inflamed may
do so by their own vessels independently of effused lymph.

Chronic Abscess. When the attempt, continues our author, is made to
form an abscess by weak or scrofulous constitutions, and in situations where
the cellular substance is lax, the progress of the disease is very different from
that above described The first extravasation is serum, which passes easi-
ly into the large cells of the cellular membrane, with httle or no injury to
their structure ; the parietes of the chronic abscess are not composed in the
beginning of organized and vascular lymph; no genuine pus therefore is
found in such cavities in the first instance ; the fluid they contain is serous,
mixed with coagulable lymph, parts of which are found as flakes float-
ing in the serum. As the cavities of chronic abscesses are not provok-
ed, either by severe tension, or the quality of the contained fluid, there is no
preparation made for some time to remove their contents. The collections
therefore often traverse a considerable distance along muscles or under
plates offasci a, before they arrive at the skin, which ulcerates very slowly ;
aft^r which the cavities may inflame, their interior surface become more
highly organized, and secrete genuine pus.

He proceeds to remark that sometimes these abstiesses, even when of con-
siderable size, are absorbed.

I have known this occur several times in psoas abscess, where there
was no disease of the vertebrsB. In one instance a young lady had one of
these languid abscesses formed suddenly above the clavicle; it descended
behind the clavicle, and proceeded underneath the mammary g)and nnlil it
came to the waist, where it was finally removed by absorption ; the patient'*
constitution was strengthened during this time, which I have found in se-
veral instances effectual in causing the absorption of such collections.'* 34,

Dr. Macartney offers nothing now on the termination of inflammation in
mortification, or disorganization of a part.

On the Reputed Consequences of Inflammation.

Dr. Macartney apologizes for including under the head of reputed conse-
quences of inflammation, the effusion of coagulable lymph, and ulceration.
These, be says, are processes which, from being sometimes associated with
inflammation, are ascribed to an inflammatory action, although in their own
mature they are perfectly diflferent. This is a startling assertion, particularly

670 A Treatise on I/tjLimmof.ion. [Auga>;t

when cominof from a innnlikp Dr. Macartney, Our renders will be natu-
rally inquisiLive tolfarn his proofs.

"It is well known," he argue?, "that congulable lymph may be thrown out
by a natural and healthy action, as in the formation of the decidua uteri :
that it IS eminently conservative, m arrtsring- hemorrhaire trorn opened ves-
sels ; in the union of all the soft parts when divided ; in foimingthe medium
of conjunction of fractured bones, and in constructmg the walls of an ab-
scess, and of an aneurismal sac. Immediately on the receipt of an injury,
also, lymph is shed before there is time for inliammaiion to set in. The sur-
face of a uound that does not bleed is covered by a layer of lymph, in the
very moment that the; injury is inflicted. The inflammation which would
ensue Irom the opening of a serous cavity is sometime altogether averted,
and almost aiwaj's restrained Vv-ithin certain bounds by the effusion of lymph,
ununiting the opposed surfaces with each other." 38.

After noticing the case of hydrocele, cured by an operation and disposing
of it as an objection to his views, Dr. Macartney goes on to remark :

"It is true, there are some cases of adhesion, which are highly detrimental
to the parts concerned. Wherever freedom of motion is necessary to the
functions of parts, adhesion may be inconvenient, or fatal. Thus, the iris
has its office destroyed by being bound to the adjoining parts : the actions
ot the heart are embarrassed, by extensive adhesion between it and the pe-
ricardium; and I have known the general union of the peritoneal surfaces
of the intestines cause strangulation of the whole ahmentary canal, and death.
It is also the agglutination by lymph, which is the most frequent cause of
hernia becoming irreducible, and occasionally of the protruded parts being
strangulated. The effusion of lymph in the trachea during croup, causes as
much danger as the inflammation : so likewise, when the bladder and uiethra
are blocked up with lymph." 39.

But, he continues, the circumstance of evil occasionally resulting from
adhesion is no proof that adhesion is the consequence of inflammation; and
he cites the case of closure of the glottis against irrespirable gases, as analo-
gous a closure salutary in its intention, though actually endangering hfe.

Such are the grounds on which Dr. Macartney rests, in excluding the ef-
fusion of coagulable lymph from among the products of inflammation. They
do not appear to us to be satisfactory.

1. Inflammation is a positive pathological state, marked by certain signs
and symptoms. If, affer those signs and symptoms, we find pus, or serum,
or mortification, we conclude those states to be consequences of inflamma-
tion. It signifies nothing what may be the tendency of those consequences,
whether salutary or pernicious to the individual. Whichever they may be,
they are sequences of the state which we call inflammation.

2. So far as we can see, there are just the same grounds for considering
coagulable lymph such a sequence, as for believing serum or pus to be so.
A man has a sword run through his belly or his thorax. The familiar signs
of inflammation follow, and we find, after death, serum, and lymph, and pus
in the peritoneum. Why should we say that the first and the last are the
consequences of inflammation while the second is not ] Take rheumatic
pericarditis, or acute pleurisy, or even inflammation of the cellular mem-
brane. During life and after death there is every possible evidence of the
existence of inflammation, and we find lymph in abundance. These are
positive facts, which it appears to us impossible to disprove, and almost
equally impossible to explain on any other supposition than the one general-
ly entertained.

3. It is no answer to say that lymph is usually salutary in its operation.
That may or may not be the case. ^Vhen lymph is effused on a mucous

1839.J > A Tieailae on InfLainmation. . 671

membrane, or even around it, or in the cranial cavity, it may be pernicious.
And pus rnay be proved, by tlie same line of argument, to be no consequence
of inflammation ; for the formation of pus by an inflamed mucous membrane
IS infinitely more salutary than that of lymph. Were the latter the usual se-
quence of inflammation in the urethra, the consequences of a common clap
would be formidable.

4. The argument employed by Dr. Macartney, based upon the occasional
eff'usion of lymph as a natural action, is more serious than conclusive. Jjith-
er, in those instances, the usual phenomena of inflammation precede the ef-
fusion of lymph, or they do not. Jf they do. tlien the case is one of inflam-
mation if tliey do not, then the case is obviously different from tjiat in which
Ihey do. Neither in loo-ic nor in reason can it be allowed, that, because in
one case inflrimmation does not precede the eff'usion of lymph, while in the
other it does, therefore in the latter inflammation does not produce the effu-
sion. To make this argument available, it should be shown that, in both ca-
ses, the effusion is similar in degree and kind, and that in the latter the same
circumstances exist, to operate as causes, which exist in the former.

5. The truth is, that from the simple cut, producing an effusion of the li-
quor sanguuiis, up to the extensive and violent inflammation of peritonitis, is
not a sudden jump, but a series of gradual transitions. The mere interrup-
tion of continuity of a few small vessels, and the slight stimulus of a trivial
injury, give rise to the effusion of no more lymph than is sufficient to glue
the edges of the wound. A more extensive lesion, particularly of certain
tissues, leads to positive inflammatory action, and to the effusion of lymph in
such an injurious quantity. But, as inflammation, in the first instance, is
only an augmented capacity and action of the hlood vessels, it is obvious that
there may be any degree of it between their normal standard, and the max-
imum of which they are capable. We think it would be just as iinphiloso-
phical to deny that the effusion of lymph is a common consequence of inflam-
mation, as to assert that inflammation to any amount must precede it. It
is impossible to maintain the latter position, until we determine with preci-
sion the limit between non-inflammatory and inflammatory augmented ac-
tion. That has not yet been done.

U/ceraiion or ulcerative absorption is equally denied by Dr. Macartney, the
right of being a result of inflammation.

The same spirit of argument is employed by our author in this as in the
former case, and mutatis mutandis the same mode of reply may be resorted
to. The dispute is, perhaps, more verbal than substantial ; yet as we think
that Dr. Macartney's views are calculated, in many respects, to breed per-
plexity, we cannot avoid objecting to them. It would be uncandid not to
admit that Dr. Macartney reasons with great ingenuity, that many sound
and excellent reflections are mixed up with his hypothetical opinions. All
we think it necessary to quote from the remarks on ulceration is the follow-
ing passage

The term ^dcer is not a correct one. It expresses only a part of the his-
tory of the object, to which the name is given ; or applies to that state in
which the ulcerative process only is going on ; perhaps, we might say, that
in all instances, where either inflammation or morbid structure does not
prevent it, the phenomena that belong to an ulcer, are more reparative than
destructive ; since in many cases of ulcers tending to cure, there is only that
degree of interstitial absorption of the granulations which serves to approxi-
mate the edg'es of the sore, thereby diminishing the magnitude of the cica-
trix. An ulcer, therefore, as it is usually presented to our observation, is the
result of a compound, or rather opposed action, as the granulative, succeed*
the ulcerative processes.

<57'2 , A Treatise on Injlcunmatian. [August,

Of the differexNT Modes of Reparation.

Discarding the classification generally received of union by the first and
by the second intention, Dr. Macartney proposes his own.

Reunion, he says, and re-organization are effected in four different ways,
which may be designated in the following manner :

First, immediate union, without any intervening substance such as blood
or lymph.

Necom/, the union by the medium of coagulable lymph, or a clot of blood.

Third, re-organization without any medium of lymph or granulations, the
cavity of the wound being obliterated by a natural process of growth.

Fourth, the reparation by means of a new, vascular, and organized sub-
stance, called granulations.

Speaking of the organization of effused lymph. Dr. Macartney makes the
following observations, with which we are disposed to agree, in spite of the
opinions of Muller to the contrary.

' Mr. Hunter assumed, that the vessels arose in the lymph, and subse-
(juently established their connexion with the vessels of the part, because, he
observed, that vessels began to form in the membrane of the incubated egg,
before they existed in the fa3tal chick. There is a great difference, howev-
er, between the original formation of vessels, and the acquisition of vascula-
rity by lymph, deposited m cqntact with surfaces that are already organized;
and it is more difficult to imagine, that vessels should commence in a clot of
lymph or blood, than that they should be extended into it from the adjoining
surfaces. It is also impossible to conceive that the thin layers of lymph
which unite serous membrane, or the effusion which consolidates cellular
structure, do not obtain their vascularity from the adjoining parts. Further,
I have seen vessels passing for a short way into a clot of blood, covering the
surface of an ulcer, when the coagulum possessed no vascularity ot its own.
I have also succeeded in forcing injection into the coaguia formed in the ca.
vitiesof the heart after death, which injection presented the appearance of
red elongated lines." 51.

Reparation by the modelling process, has never, says our author, been
described. However, when healthy parts are injured, although it may be to
the greatest extent, if placed under the most favorable circumstances for
carrying on their natural actions, the process of reparation is nearly the same
as in animals of a simple structure.

" The pain arising from the injury soon ceases. No tumefaction ensue?,
separating the edges of the wound, and its surfaces are not only disposed to
lie in contact, but even to approach each other so much, that they cannot be
kept asunder by mechanical restraint ; there is, therefore, no necessity foF
the effusion of lymph ; and as there is no cavity to be filled up, granulations
are not formed. The surfaces of the wound, although they come into con-
tact, do not unite by vessels shooting across; they are smooth, red, and moist-
ened with a fluid, which is probably serum, and present the appearance of
one of the natural mucous surfaces of the body. If any parts have been
killed by the injury, they are separated, by simply as much interstitial ab-
sorption as is sufficient to set them free. The wound is finally healed by
the same means which determine the shape of the natural parts of the body.
It gradually diminishes in extent until it is obliterated ; or it may be cicatriz-
ed before the surfaces are abolished, after which the same process of natu-
ral growth goes on, until no part of the original w^ound is left. The cicatrix
which succeeds the cure of injury by the modelling or growing process, is
small, pliant, free from those callous adhesions to the parts underneath, and
the morbid sensations that so often belong to those cicatrices, which have for
their bases the deposits of lymph, or the new formed structures called gran-
Illations. When the modelling process or cure by natural growth goes on

1839.] A Treatise on Injlaminalion. 673

perfectly, there is no inflammation in the part, and the patients are sO en-
tirely free from all imeasy sensations, that I have known instances of their
being ignorant of the real site and extent of the injury, until they had exana^
ined the part with their hand, or saw it in a looking-glass." 54.

We confess that we are not familiar with the mode of reparation, and we^
cannot therefore offer an opinion on the fidelity, or otherwise, of Dr. Ma-
cartney's description of it.

Dr. Macartney's observations on granulation are ingenious, but do not re-
quire particular notice from us. ^

Passing over the chapter on Cicatrization, we pause at that on
Reparation in Diffjerent Tissues.

Different tissues possess different powers of reparation. It is difficult to
refer those differences to a general law, or to express the facts by any sim-
ple formula. But the simpler the tissue the more perfect is its reparation.

It is both curious and instructive to examine the reparative process in
each tissue.

A. Nervous Tissue Vacancies in the brain are not filled up by any
substance, bearing a resemblance to the cerebral tissue. The spinalmarrow
also is never regenerated.

All wounds of nerves heal by the formation of a hard bulb or nodule ; this
exceedingly firm and condensed structure is found uniting the two ends of
a divided nerve, and also surrounding the part of which it had been cut in
amputation ; therefore, this is the natural mode of heahng of a nerve, whe-
ther by the medium of the lymph or granulations. Though visible nervous
filaments have been fruitlessly sought for in the nodule, sensation and volun-
tary motion are restored, sooner or later, beyond it. In some parts, the
nerves naturally present a very condensed structure the posterior tibial
nerve, for example below the inner ankle.

"When the nerves are divided some way from the end of the stump, I
have been able to trace the appearance of filaments radiating from the bulbs
and proceeding to the skin. A preparation of this kind in the stump of a
finger, was preserved in my anatomical collection, which is now in possess-
ion of the University of Cambridge. Professor Muller states, that hisassistant.
Dr. Schann, was able to dissect filaments passing from one end of a divided
nerve to the other in the frog. Also, it cannot be doubted that the sensibil-
ity of granulations is caused by the extension of nervous filament into them.

I once had the digital nerve of my thumb divided by a wound. The sen-
sation was not perfectly recovered for some years, but is now as complete
as before the accident. I observed a curious fact on this occasion. I was
aware, from the depth of the wound, that the nerve must have been divided,
and I was surprized that the sensation was not instantly lost ; but, while ex-
amining the part, the sense of feeling vanished, giving me the impression of
a blast of air having passed from the thumb up my arm. This occurred in
about two minutes after receiving the wound." 68.

B. Muscular Tissue. Probably this is never perfectly restored in the
higher classes of animals The deficiency is commonly seen to be partial-
ly filled up by a pale substance, which appears to be coagulable lymph im-
perfectly organized.

c. Fibrous Tissue When tendon is divided, and afterwards united, it is
by means of a newly-formed condensed substance, not possessing the true
structure nor the brilliant metallic lustre of tendon, yet eufficiently strong to
perform its offices. If tendinous structure do not unite, as in the laceration
which occurs m a dislocation, the tends of the fibrous tissue form a number
of tags or little bulbs, by the effusion of coagulable lymph ; these become
E 5

674 A Treatise on Injl animation. [August,

very hard, and finally smooth on the surface. It is said that the dura mater
is not reproduced. A dense membrane, however, is formed, which answers
a similar purpose. The only fibrous structure which is perfectly regenera-
ted, is the 'periosteum.

c. Cartilaginous Tissue. The cartilages covering the ends of bones,
when destroyed, never appear to form agam. In old persons, especially, the
place of the cartilages of the joints is often supphed by the conversion of
the osseous tissue into a substance possessing the density, hardness, and po-
lished surface of china or white glass. Y elm false joints^ the ends of the
bones that rub on each other become covered with a sort of spurious cartil-
age.

A vacancy in the cartilages of the larynx is filled up by a tough dense cellu-
lar substance. The cartilaginous portions of the ribs are not reproduced by
genuine cartilage, and the union of these parts is often confirmed by being
eorrounded with a shell of bone.

Dr. Macartney doubts whether the place of the fibro-cartilages is ever
supplied, except by a tough cellular structure, not unlike common ligament,
but wanting its brilliancy.

E. Serous Tissue. This seems as perfectly restored as any tissue, saving,
perhaps, the cellular.

F. Cutaneous Tissue Neither the skin nor mucous membrane appears
to be perfectly restored. The villous surface is not regenerated.

G. Arterial Tissue. The middle coat has not been observed to be rege-
nerated. The puncture of an artery is closed by condensed cellular mem-
brane.

H. Venous Tissue. "The proper tissue of the veins never grows again.
I have always observed that veins on which venesection had been perform-
ed, presented on the inner surface a depressed line corresponding to the in-
cision made with the lancet. The vacancy in veins being always closed by
the cellular membrane somewhat condensed, accounts for those little pou-
ches that are occasionally perceived over the vein, when the edges of the
puncture have not been brought together after the operation of bleeding.
These pouches are oiten seen, and sometimes of a large size, on the veins of
horses, in consequence of the mode employed by farriers of pinning the edges
of the wound, made in bleeding these animals, and the horse being allowed
to stoop the head after the operation. There is no true venous tissue found
in these pouches. 71.

I. Osseous Tissue is repaired by bone, in a manner that we need not spe-
cify. We regret that we have not space for Dr. Macartney's observations
on necrosis. At a future opportunity we shall advert to them.

K. Epidermoid Tissues. The reproduction of these, subjected to attri-
tion, &c. as they are, is usually a process similar to that of their growth.
But when the secreting apparatus is destroyed, the product cannot well be
reproduced. Thus, when the capsules which contain the roots of the hairs
are destroyed, the part continues bald.

"If the vascular surface which furnishes the horny substance of the nail, be
completely destroyed, no new nail is usually formed ; nevertheles, there ap-
pears to be sometimes a great disposition to the revival of the proper struc-
ture for secreting the nail. It reappears, in some cases, after caustic has
been repeatedly applied to it, to prevent the reproduction of a nail which pen-
etrates the skin. Two instances are recorded of a nail growing on the
stump of an amputated finger ; and I had a preparation of a finger, which
hadthe last and apart of the second joint removed by amputation. The
vascular structure had been produced on the stump, and a true horny nail
generated ; which, however, had a deformed appearance, and was very

1839.] A Treatise on Injlammaiion, 675

much hooked. This preparation is now with my coUectioa placed in the

University of Cambridge." 77

As nail is only a modification of the horny or epidermoid tissue, we can-
not be astonished at the occasional production of a modification of it. We
say modification of it, for it is unlikely that perfect nail could be formed
without a matrix. Dr. Macartney admits, that, in his case, the nail had a
deformed appearance, and was very much hooked.

We arrive at the Chapter on the

CORSTITUTIONAL OR RemOTE CaSES OF InFLAMMATIoN.

This contains some ingenious hints mixed with much that must necessa*
rily be familiar. We shall only pick out one or two insulated passages for
notice.

a. Speaking of sympathetic morbid sensations, Dr. Macartney remarks:
"I remember a very curious instance, in which I discovered a stricture in

the oesophagus, by the person feeling an acute pain in the little finger of the
left hand every time he swallowed." 84.

b. It is well known that the suppression of natural secretion or of habitu-
al discharges, may prove a cause of Inflammation. The explanation gener-
ally consists in supposing that the blood or the system becomes charged with
the peccant matter previously evacuated. But Dr. Macartney observes, that,
generally speaking, the mischief occurs before there is time for the circula-
ting fluid to become redundant, in consequence of even extensive secretions
being interrupted ; and in many cases, the discharge which is stopped, is
so insignificant, as to quantity, as to be incapable of producing any influence
on the mass of blood.

We must, therefore, he continues, adopt some other explanation for the
suppression of secretion becoming the cause of inflammation, than the dis-
turbance of the balance between the quantity of the circulating fluid, and
that of the discharge which has been suspended. It is probable, that the
interruption of the secreting function, in any one part of the arterial system,
and especially on sentient surfaces, may, from the law of sympathy, which is
so remarkable between the vascular system and these surfaces, become a
direct motive to the arteries to assume, in certain places, an inflammatory
state. This mode of explanation is rendered more probable, from the fact,
that the removmg very slight external irritation, or inflammations, which
furnish very little or no pus, sometimes causes the most severe constitutional
disturbance, which is removed, by the recurrence of the local irritation.

We think there can be little doubt of the correctness of this explanation. It
is not the mere suppression of discharge, but the alteration or repulsion of
a mode of action that affects the system. Suppose some habitual vascu-
lar excitement or congestion in a given point. If that is suddenly repressed,
some other part in the vascular circle, by the operation of the perplexing
law of sympathy, becomes the seat of congestion or excitement. That vas-
cular plethora is mixed up with this, seems, however, to be proved, by the
security which, under such circumstances, evacuant medicines offer.

1 have seen," says Dr. Macartney, "the most serious diseases endanger-
ing life, induced by the cure of that slight cutaneous aff*ection of the cheek,
which sometimes is a mere effloresence, periodically throwing off'a little fur-
fur, or forming a crust. Dr. Jenner once shewed me a red spot on his wrist,
that could be covered with a sixpence ; he said, whenever it faded, liis sto-
mach and general feeling of health were affected." 87.

But in cases like Dr. Jenner's, it is more likely that the general distur-
bance was due to some modification of the state of the internal organs, than
to the influence of so trival a cutaneous eruption. The latter was in all pro-

C76 A Treatise on Injlammation. [August,

bability a symptom. When present, it shewed a condition of internal organs
compatible with health. When a contrary condition of those organs ensued
ii subsided.

c. Dr. Macartney is eloquent on the subject of " taking cold.*' Of all
parts of the body, he says, the back is the most susceptible of cold, thus in-
sidiously applied, and the chilliness is sometimes even felt first along the
back, although it may not have been the part immediately exposed. Per-
haps this circumstance depends on the nerves of the skin of the back having
0 direct a communication with the spinal marrow.

Dr. Macartney follows this up.

" In the same manner, when a person is placed in the situation favoura-
ble to giving cold, the danger may be avoided, by turning the face instead of
the back to the direction of the stream of cold and damp air, observing the
sensation caused by the impression, and voluntarily rousmg himself to a feel-
ing of resistance. In protecting the body by clothing, the back is the part
chiefly to be regarded, and hence winter waistcoats should have the back
made of at least as thick materials as the front. People commonly fall into
the error of clothing the front of the body warmly, and expect to escape cold
by muffling the throat. The Irish peasantry more wisely, expose the throat
and breast, and defend the back by a warm great coat, which they seldom
close in front." 89.

So that the idea of Pat's having " his coat buttoned behind to keep his
belly warm" is a libel on him. He keeps " his belly warm" by not button-
ing his coat at all.

The Local Causes of Inflammation,
Form the subject of the next Chapter.

Dr. Macartney's observations are both numerous and judicious, But they
are scarcely suited for our pages, containing, necessarily, much familiar
matter. We may quote the following passage, with the expression of a
hope, rather than a confident expectation, that Dr. Macartney's ideas may
not be of too sanguine a complexion. Speaking of the eflfects of dead ani-
mal matter introduced into the body or merely applied to the skin, he ob-
serves

" Every anatomical class has annually furnished examples of the effects of
this species of infection, except the dissecting class of the Dublin Universi-
ty, during the time it was placed under my direction. Very simple means of
prevention were employed, with so much success, that no severe disease
from wounds received m dissection occurred, (when the proper means of
prevention had been employed,) during the last fifteen years that I held the
Professorship of Anatomy in that University. The means resorted to, con-
sisted in immediately washing the wounded part, and afterwards keeping it
wet for a few hours, with a solution of alum in water. Most probably, any
other fluid, such as the liquor plumbi, solution of sulphate of zinc, Sz.c., which
would have the effect of coagulating the animal substance, would answer
quite as well ; but the solution of alum was always at hand, and, I beHeve, if
immediately apphed, would never fail in preventing infection." 104.

Dr. Macartney remarks very justly, that the two stages of decomposition
in the dead body, which render the animal substance most dangerous, are
that which takes place immediately after death, and the extreme degree of
putrefaction. The latter is most apprehended, but it usually occasions only
a diffused inflammation in the part wounded, without any serious sympathy
of the constitution.

Some dead animal substances, he goes on to say, are more likely to com-
municate this dangerous disease, than others. The brain, in the recently

1839.J A Treatise on Injlammation. 677

dead body, is extremely apt to produce it, even when no wound is received.
The sero purulent fluid, found in the large cavities after death, (if no means
of prevention be employed,) seldom fails to inftrct persons ; and the most
dangerous animal fluid js that contained in the cavity of the abdomen, after
puerperal peritonitis, or the serum found in parts which have suffered diffused
or gangrenous inflammation. The white cancer of the liver, and the sub-
stance of medullary tumors, are found to be very irritating, when merely
applied to the hands, without a breach of surface. Dr. Macartney has sev-
eral times had his hands inflamed from handling this morbid structure, even
after it had for some time been preserved in spirit.

"Some persons are more susceptible of the infection from dead animal
matter than others. I have heard of a student who never escaped it, after
receiving a wound in di>5section, I have, myself, so strong a tendency to be
affected by the irritation of animal matter, that 1 formerly suffered more or
less every year from this cause. Since, however, I adopted the means of
prevention already mentioned, I never have experienced either local inflam-
mation or constitutional illness, after wounds received in dissection. That
there is no diminution of my susceptibility, is proved, by my still having red
patches on my hands, which itch and smart, if I dissect a brain, without con-
tinually wetting my hands with the alum water." 107.

We have only twice suffered severely from handling dead bodies. It is
singular that each time it was after examining a person who had died from
scarlet fever, and in neither instance was there the shghtest evidence of our
having received a wound. On the second occasion, the local symptoms
were succeeded by a sort of erythematous affection of the throat, a true se-
condary symptom.

Dr. Macartney remark?, that the secretions of the human body, when they
are accumulated in foul clothes, occasionally produce a dangerous and ob-
stinate inflammation of the hands of washerwomen. He has never seen
this followed by more than common sympathetic fever. But ill-conditioned
abscesses may orcur, and the Hmb may even be lost. We have twice seen^
in washerwomen, and after washing suspected linen, inflammation of the
deep cellular membrane of the hand, diffusing itself along the fore-arm,
beneath the annular ligament, and between the muscles. Each case proved
fatal.

Dr. Macartney goes on to observe that The dead substance of other ani-
mals, besides that of the human subject, although less dangerous, is capable
of infecting somewhat in the same way. Persons who clean tripes are lia-
ble to a peculiar erysipelatous inflammation, which passes up one finger and
down another. The same has occurred from paunching a hare, and horse-
killers occasionally suffer severe diffused inflammation. The fluids of the
recently killed animal are, however, much less irritating, than the same in
an advanced state of putrefaction, and hence butchers seldom are known to
suffer from wounds received in the practice of their business ; although, as
already observed, the greatest power of infecting, belongs to animal substan-
ces immediately after death with respect to the human subject.

Dr. Macartney does not mention, at least in this place, any special treat-
ment for this affection. Sir B. Brodie recommends the oxymuriate of mer-
cury. We have, on several occasions, seen small doses of blue pill with sa-
line aperients, and the application of a strong goulard poultice, remove the
affection in a day or two.

We proceed to the

Proxdiate Cause of Inflammation.

We must pass over the Chapter on this subject. There is much in it,
which, if we discussed, we must dispute ; and there is also much that is cer-
tainly ingenious and probably true. We must pass, too, over tljc succeeding-

678 A Treatise on Injiammalion. [Augustr

Chapter on the Species of Inflammation, which contains nothing of con-
sequence.

0>' Congestion as contra-distinguished ffwOm Inflammation.

It is obviously of great importance to distinguish, during life or after death,
the two pathological states of congestion and inflammation. Dr. Macart-
ney devotes a short Chapter to the subject, and points out some criteria
which he deems decisive.

Congestion, he rightly observes, belongs to the venoucJ system. It is
caused by any meciianical impediment to the free motion of the blood in the
veins; such as obstruction to the circulation of the blood in the liver, the
lungs, or other important organs, or by pressure on the trunk of any vein.
It is also brought on by the suppression or diminution of natural secretions,
and by supplying the body with more nutriment than is expended in growth
or secretion. It is sometimes induced, and always favored by dejection of
rnind and sedentary habits, which serve to accumulate the blood in the ve-
nous system, and to embarrass the circulation.

Every impediment to the passage of blood through the small veins, neces-
sarily renders its passage slow. But the blood also appears to be very fluid,
at least it transudes in many cases through the coats of the veins into the
neighbouring cellular membrane. The blood, in congestion, is either purple
or still darker ; in melsena, the blood poured out is black.

" The most remarkable circumstance, with respect to congestion, and the
one which has not hitherto been described is, that arteries found in a con-
gested part are smaller than their natural size." 140.

After a few other observations. Dr. Macartney goes on to remark

" In order to ascertain the direct effect of venous congestion, on the arte-
ries of the part concerned, I made the following experiment : I put ligatures
on both the jugular veins of the rabbit; the ajiimal died apoplectic, and upon
examining the state of the vessels of the ears, I found the veins which he
towards the outer edge of the ear, greatly enlarged, and gorged with dark
blood ; but the artery, which runs in the centre of the ear was reduced very
much below its natural size, so that it appeared as a mere line. The result
of this experiment made me wish to see what would be the instantaneous ef-
fect of arresting the venous circulation. I accordingly exposed the mesen-
tery in a young rabbit and having tied the trunks of several mesenteric veins,
their corresponding arteries contracted immediately, in the most palpable
manner, and to a very small size ; as if taught by their organic instinct, that
blood should not be permitted to go where it must immediately return.

From the description just given, congestion never should be confounded
with inflammation. They are essentially different in all respects : the uni-
form and dark red colour of a part in a state of congestion, as constrasted
with the brighter red colour, and distinctly ramified arteries in inflammation
ought at once to be sufficient to point out the difference between these two
affections." 141.

Dr. Macartney concludes by laying down the distinction between conges^
tion and determination of blood.

When blood, he says, is sent in too great a quantity to any part, it is be-
cause the arteries of that part dilate beyond their natural state, in conse-
quence of some excitement of particular organs ; and therefore, the sensibi-
lity, temperature, and bright red colour of the parts are increased : whereas,
in congestion neither the sensibility nor temperature is augmented.- Deter-
mination of blood may itself be easOy distinguished from inflammation, by
the general appearance, by the causes, by the absence of any of the conse-
quences of real inflammation, and especially by the want of the peculiar

1839.] A Treatise on Injiammation. 610

pain, which would belong to the tissue concerned, if its turgescence or ful-
ness of blood had arisen Irom inflammatory action.

It appears to us, that determination of blood to an organ, is a state by no
means accurately defined, or definable. If Dr. Macartney's account be cor-
rect, it is difficult to say in what determination of blood differs from the ear-
her stage of inflammation. Probably determination of blood is a state which
may end either in inflammation or congestion, as concurrent circumstances
may determine. The phenomena of several cerebral affections appear to
point out a much closer connexion between the determination of blood and
congestion, than Dr. Macartney is wilKng to allow, We proceed to the last
Chapter ot the work, which treats

Of the Remedies for Inflammation.

Dr. Macartney classifies these remedies under the following heads

1st. Remedies which diminish the force of the heart, and give the disposi-
tion generally, to the small arceries to go into the contracted state.

2nd. Means that effect a diminished size of the arteries, or reduce the
sensibility in the inflamed part.

3rd. Aledicines that augment or reproduce the natural secretions, and
thereby abate the circulation, or lessen the effusions made into inflamed
parts.

4th. Counter.irritations, secretions, or impressions made in different parts
from those which are inflamed.

5th. Lotions or fluids which exert sedative and astringent power.

6th. Means for affecting in an agreeable manner, the sensation of inflam-
ed parts.

7th. Causes which produce an easy or satisfied state of feeling, on the
eentient surfaces, or in the individual.

Speaking of tartar emetic. Dr. Macartney professes himself unable to un-
derstand on what grounds, the very large doses of the medicine, now so
fashionable, are prescribed. Small and frequent doses, he contends, are
sufficient to produce all the effects that are desirable. If one grain of tartar
emetic be dissolved in a pint of water, and a table spoonful of this solution
be administered every half hour or hour, an extreme degree of nausea will
certainly be excited, with a reduction in the strength and frequency of the
pulse, and usually some perspiration. The good effects of nausea depend on
its being kept steadily up for some time. But as Dr. Macartney observes,
preparations of antimony act on some peculiar constitutions as a mineral poi-
son, producing an alarming degree of prostration and distress. He has
known these medicines also, when long continued, sometimes induce ten-
derness of the gums, an increased flow of sahva, and a cadaverous fsetor of
the breath.

Coldajyplications. Dr. Macartney makes some good remarks upon these.
The sudden application of cold induces a re-action. But it must be remem-
bered that It IS the sudden application of cold, speedily withdrau-n, which
does so. If the cold be maintained, there is no re-action. Dr. Macartney
advises that the cold should never be suddenly applied, nor suddenly with-
drawn. The inflamed part should be, as it were, seduced to surrender its
temperature wiUingly, until the power ot resistence or of re-action be past,
and in carrying it back to the natural state, the same principle should be
followed.

" The best example of the power of low temperature to cause contraction
of the arteries, is seen in what is called a dead finger, in which, there is nei-
ther circulation nor feeling, a fact I had the opportunity of proving lately by
a direct experiment on a person whose thumb was benumbed in this manner.
On making a cut into it with a pair of scissors, no pain was felt, nor did any

680 A Treatise on Infiammalion. [August,

blood issue from the wound, until the sensibility and circulation returned :
now, this extreme case never occurs in the mot-t intense frost, but always
when the atmosphere is damp, and not severely cold." 157.

We were not aware of the last mentioned fact, nor does it seem consis-
tent with what we hear of the effects of very low temperature. Our au-
thor believes that the remedial operation of a modern degree of cold is in
the majority of cases preferable. It is usually imperfectly attained by the
evaporating lotions in common use. Dr. Macartney describes his ingeni-
ous method of obtaining, for the part, the uninterrupted operation^of cold and
moisture.

The most easy and manageable way of employing irrigation, is to place
the limb of the patient in a trough, and having laid some lint on the inflamed
part, to let the water be conducted by means of a stripe of woollen cloth,
from a vessel holding the water or other tliud, which may be placed on a
chair or table standing beside the bed. One end of the stripe is to be in-
serted into this vessel : the other, which should be cut into a pointed shape,
laid on the lint. The water will then proceed in the manner of a syphon
continually from the vessel, not by drops falling from a height, the sensation
of which is disagreeable. The water is carried off by a tube proceeding
from the end of the trough, into a vessel, placed at the end of the bed. 1
have found that a stripe of cloth of some breadth, where it is inserted into
the water, and ending in a point, where it touches the lint, answers the pur-
pose of a syphon much better than the filaments of candle-wick, which
some surgeons have employed. The patient with this apparatus is able to
vary his position, which is a great comfort to him. It is obvious, that irri-
gation can only be used with convenience to the extremities. The water
may have any degree of temperature that is desired, and if it should be wish-
ed to employ iced water, the vessel holding it may be placed at a distance
from the patient's bed, or even outside the room, and conveyed by an elastic
tube, on which there is a cock to regulate its admission into a smaller ves-
sel, situate near to the bed." 159.

Our author goes on to state, that the mode of maintaining a continual ac-
cession or renewal of a fluid application, may be converted to many useful
purposes. Professor Wiedleck has availed himself of it in the construction
of his chair: in the back of which is placed a reservoir of lluid, from whence
a tube passes underneath the seat, to the front of the chair, where it is con-
nected by a stop-cock with a catheter, which has been previously introduced
into the bladder. This catheter is double internally, or has two passages,
each with an opening into the bladder, and the handle of the instrument ex-
hibits the two distinct tubes, into one of which, the end of the elastic tube
which is furnished with a cork is introduced. The fluid from the reservoir
is thus conveyed by one side of the catheter, and is returned by the other,
and consequently, there is a sort of stream carried through the bladder. He
has used the apparatus for chronic inflammation and catarrh of the bladder.
And Dr. Macartney has contrived a tube on the same plan, for transmitting
a continual stream of fluid through the vagina or the rectum. Dr. M. has
likewise invented a glass vessel, something like a cupping glass, but larger,
with two tubes entering it, one vvhich admits the fluid near the top, and an-
other near the bottom that allows it to escape. This vessel was designed
for cleansing foul ulcers or cancers; but might be used for the purpose of ab-
stracting the heat, by a stream of cold water, or for administering medicated
fluids to external surfaces, if flat, m the same manner as the double canuja
conveys them to the internal cavities. And he has further proposed, that
the principle of the double passage should be extended to the tube of the
stomach-pump ; by which, he thinks, the effects of the instrument would be
rendered more certain and speedy.

Dr. Macartney particularly insists on not applying cold too suddenly, when

1839.] A Treatise on Injiammailon. 68l

we wish to g-et tlie lowering- effects of cold. To obviate re-action, the tem- ^

perature of the part should be gradually reduced. In all cases where he- M

morrhage is to be apprehended, the use of ice or iced water is most valuablej 1

and may save the patient from the application of ligatures to small arteries.
Dv M. has treated cynanche tonsillaris by the frequent use of a gargle of
iced water*, with remarkable success. The disease has been by this means
arrested in a few hours. He has also found ice effectual in stopping obsti-
nate hiccup, when all other remedies had failed.

**Ice or iced water is better for the purpose of generating a great degree
of cold, than any of the frigorific mixtures. Some of the latter would con-
geal the part, none ofthem would be proper witli a raw surface, and it is rare-
ly necessary to reduce temperature in an extreme degree, without the ex-
isteRce of a wound. When they are proper it may be useful to know, that
the mixture of five parts of muriate of ammonia, five parts of nitre, and sixteen
parts of water, sinks the thermometer from 50 degrees to 10 degrees ; equal
parts of nitrate of ammonia and water reduce the temperature from 50 de-
grees to 4 degrees, and five parts of sulphate of soda, with four parts of dilut-
ed sulphuric acid, bring down the instrument from 50 degrees to three de-
grees." 161.

Moderate cold is generally suitable when the inflammation is not very vi^
ol^nt, and is accompanied with heat. Irrigation with cold water, especially
in the Summer months or in warm cHmates, is the most convenient mode of
applying iL As a general rule, the feehngs of the patient are a valuable test
of the propriety of warm or cold applications.

Waiving the discussion of the efl^ects of mercury, saline purgatives, and
baths, we may pause and examine the operation of counter-irritants. We
do so, because we are not quite certain tliat remedies of this description are
always employed in a really scientific manner.

Counter-irritants are divisible into mere rubefacients vesicants, or such
as give rise to secretion of serum orlympli, and sero-purulent fluid appli-
cations wfeich induce suppuration and ulceration, as tartar emetic^
and applications which first destroy the skin and cellular membrane and
give rise to suppuration afterwards, as the caustic potass, &c.

Dr. Macartney observes, that the milder counter-irritations are suited to
tliseases near to the surface, or which are situated opposite to the skin
to which the apphcation is made. The cautery or severe caustics are
only justifiable, where the disease to be counteracted has a deep situation,
and has a variety of interjacent structures, as in the hip disease and caries of
the vertehTiB.

He remarks that all -counter-inflamraations -should be of a kind that natu-
rally tend to subside. This is quite obvious. If an artificial inflammation,
he adds, be carried so far, as to join or communicate with the original
disease, it becomes mischievous ; for, it is essential to the operation of any
counter-irritation, that the parts placed between it and the internal disease,
should be entirely free from inflammation, although they maybe very thin,
and consequently the two inflammations very near each other.

" If the inflammation from the previous disease, and that induced by the
surgeon, be kept perfectly separate, although near each other, the influence of
the latter is very considerable in diminishing the former : nevertheless, the
original disease does not appear to possess any power over the counter-inflam-
mation, either in diminishing or increasing it. This fact is difficult to ex-
plain; indeed, the mode of operation of any counter-irritation is very ob
scure ; perhaps it is because the artificial disease being always disposed to
cease or recover, creates the same lendencv in the original mflainmation.''
166.

F 6

682 A Treatise on Injiammaiion. [August,

It does not appear to us that the tlifPiculty is, theoretically, so great as
Dr. Macartney represents it. Counter irritation is principally used and
useful for diseases characterised by increased vascular action and determi-
nation of blood. If we can set up an action and determination in contigu-
ous vessels, it is easy to suppose that we may diminish the quantity of blood
in those concerned in the disease, and consequently the diseased action it-
self. We see these variations in the balance of the circulation continually.
A woman who is menstruating has generally a pallid face and a mottled
complexion from the diminution of the vascular supply to the surface. The
feet are cold when the cerebrum is oppressed with blood. The same state
of the cerebrum is reheved by active purgatives, which determine the blood
to the lower bowels. We might multiply instances of this sort, and follow
out the argument more in detail ; but we think we have said enough to ren-
der it probable that the action of counter-irritants is tolerably explicable on
.admitted principles.

" Sinapisms are counter-irritants of more value I believe than is gener-
ally supposed ; the rapidity of their action is of importance, and the redness
which remains on the skin for a considerable time, is an advantage, that
does not belong to any of the milder kinds of counter-inflammations. From
observing the good effects of blisters in gonorrhcea, gleet, and irritable blad-
der, I am disposed to think that sinapisms might be more useful in those dis-
eases. I have found sinapisms very effectual in removing the inflammation
ofthe tonsils in seme cases." 167.

Of blisters, Dr. Macartney says that, in general, they are suffered to re-
mam too long before they are cut, unless it be in persons with strong skin.
It is usually sufficient that the skin be inflamed, the serum will continue to
flow at the first and second dressings. When it is designed to heal a blis-
ter soon, the water dressing should be used in place of any ointment. With
some persons, he continues, blisters continue to form serum, and there is no
tendency in them to heal. In one instance the blister remained open for
weeks, in such cases the discharge is speedily stopped, and the blister
healed, by sprinkling over its surface, a powder composed of equal parts of
lapis calaminaris and cinchona, and using the water dressing over the part,
to prevent the powder encrusting on it.

Dr. Macartney states that there is a plaster made by only one person in
Paris, for maintaining a purulent discharge on a blistered surface, which is
much preferable to savine cerate. It is paper on which there is a soft plaster
very thinly spread ; there are two kinds, one milder in its operation than the
other, but they both keep up a secretion of pus, from a raw surface, appa-
rently for any length of time, without inducing as much irritation as the
savme cerate occasions in a few days. It is made and sold by M. Alhespej/-
res, Rue du Faubourg St. Dennis, No. 84, Paris. The composition of the
plaster is a secret.

Such are the principal remarks which Dr. Macartney offers upon counter-
irritants. We would observe, that a priori it appears reasonable, and ex-
perience, we think, bears out the presumption, that the mode of counter-irri-
tation should have a sort of physiological relation to the primitive morbid
action. Thus, in diseases characterized by a tendency to effusion of se-
rum and lymph, blisters are advantageous ; inflammations ofthe serous and
synovial membranes are examples ofthe fact. In chronic diseases, especi-
ally in such as are disposed to end in the formation of pus, those counter-
irritants which produce a secretion of pus from the surface generally answer
best ; thus in ulceration of the cartilages ofthe joints and in caries of the
vertebrae, setons or issues are preferable to blisters. In the slighter morbid ac-
tions which consist of determination of blood, rubefacients are often suffi-
cient. In the more sudden or severe determinations, which amount to in-
flammation, the positive abstraction of blood from the neighbourhood of

18^9.] ^1 Treatise on Injiammation^ 6S3

the large vascular trunks is indispensably requisite. Without pushing thi^
view of the subject too far, vv^e are justified in recommending it as a general
principle of action, and in considering it far from useless.

Dr. Macartney proceeds to the Different Medlcaled Lotions.

He speaks very highly, and we cordially agree with him, of the dilute li-
quor plumhisubacetatis. The following, however, is a greater amount of suc-
.cess than we should have expected from it.

"The lead lotion never fails to cure tinea capitis, however long and obstin-
ately the com])laint migiit have resisted other remedies, provided the appli-
cation of the lolion be properly conducted. The hair should first be cut close
to the head, but need not be shaved oil'; water dressing or a poultice of any
kind is then to be applied, merely for the purpose.of cleansing the skin of the
crusts, and all other impurities. There will then be seen under each crust,
a red spot of tiie skm, denuded of its cuticle, and the villous surface exposed.
The lotion should now be applied by means of lint thoroughly wetted with
the fluid, and covered with a plate of Indian rubber, or a piece of oiled silk
to prevent evaporation. Every time this dressing is changed^ which should
be very frequently at first, the head should be washed with some of the lo-
tion, and the lint should be replaced by some that is clean, which is to be com-
pletely wetted with the lotion, and covered as before." 173.

But the application must not be suspended for one night, nor even for a
iew hours ; the crust will re-appear if it is so. We have often used the lead
poultice for ezema of the scalp, but we cannot ourselves speak positively to
its utihty in genuine porrigo.

The next set of local remedies to which Dr. Macartney proceeds, is that
which gives rise to an agreeable slate of Jeeling in a part or in the the whole
of the body. The most powerful of these means is steam ; Dr. Macartney
describes a simple mode of applying it, for which we must refer to the work
itself. The use of z/;c;:er at all temperatures is strongly advocated by our
author, and the ivater dressing, already often alluded to, is his favourite me*
thod of employing it.

'"The substance that I have generally made, the immediate object of ap..
plication, is the finest and softest lint : and for the covering material either
oiled silk or a plate of Indian rubber. Simple as this m^ode of dressing may
appear, it requires to be managed with care, and attention to many circum-
stances, whicii would appear trivial, to persons unacquaintanted with the na-
ture of the remedy. Two, ihree, or four layers of the lint should be first
folded together, according to the size of the part to be covered, taking care
also that the soft side of the lint is the outer one. hi wetting the lint the
first time it is necessary to either float it in the v/ater before folding it, or if
it be first folded, it should be pressed between the fingers, to urge the fluid in-
to the interstics of the lint, which receive fluid with difficulty, until all the air
they contain be expelled. Tiie lint, v/hen applied, should just contain as
much water as not to drop. The oUed silk, or India rubber should project so
much beyond the margin of the lint, as may prevent evaporation, which will
vary according to the shape of the part on which the dressing is laid, and the
thickness of the folded lint." 161.

The lint should be wetted, without any bandage, as that might rise to a
feeling of constraint. It is, therefore, sometimes necessary to stitch the silk
into a particular shape. As a general rule the lint should be changed three
times during the day and twice during the night. In cases, where the in-
flammation is moderate, and the skin unbroken, the dressmg will only re-
<iuire to be changed every twelve hours. At each time the dressing is re-
newed, the lint and oiled silk should be carefully washed, and when it is ap-
plied to ulcers, fresh lint should replace that taken off, the utmost cJeanIi-

684 A TrcaLise on hijiamraaiion. [August,

ness being of the first importance. French oiled silk is mucli superior to
English, as it does not adhere to the skin. When it is desirable to combine
cdm with the water dressing, a bladder holding iced water may be laid over
the oiled silk, or where tlie comfort of warmth may be required, the dres-
sing may be covered with flannel.

Dr. Macartney denounces poulitices. It seems to us that he does them an
injustice, when he declares that a poultice is made of materials, which, in a
term far short of its renewal, become sour, and thereby render the poultice^
after the first few hours, an irritating application. The greasy substances
which is adhering to the skin, do not always answer the end,, and soon be^
come rancid. A poultice favours the formation of pus, and causes a throbs
bing or pulsating pa.in, and feeling of tenderness in the part, which are the
natural attendants on the process of suppuration. It imbibes the pus it serves
to create, and thereby becomes more irritating. A poultice, before it is many
hours on, is a mixture of farinaceous substance, rancid oil, and pus, oppressing
the part by its weight, and beginning to adhere round its edges to the skin*
creating a sense of constriction. In proportion to his dislike of poultices is his
regard for water dressing. He speaks in the most laudatory terms of it.
That he is well disposed to believe every thing in favour of it must be evi-
dent when he states that it puts boils completely under our control ; that he
has received numerous 2.czo\mioi gonorrhaca being cured in one or two weeks
by the external application of water to the penis ; that it never fails to
eradicate corns, rf used long enough ; that ganglia are removed, and
loose cartillages, he thinks, may be so too, by it ; //(a/ tetanus can hard-
ly come on when it is employed. All these are confident opiniojis, and
evince a very strong predilection for water dressing.

Dr. Macartney offers some very good observations on, the effect of repose,
proper position, change of air, exhileration of mind, confident anticipations,
and so jorth. The following extract is curious.

"Anew, and at first sight, a very singular mode of treating wounds and
ulcers has been proposed by Dr. Jules Guyot. He published his views m
the Archives Generales de Medicine, and afterwards he printed an extract
from the Archives in the form of a pamphlet in 18^5. The object of Dr.
Guyot is simply to expose recent wounds of all descriptions, and ulcers, to
hot and dry air, with the view of forcing a scab to form, by drying the clofi
and serum of a wound, or the pus of an ulcer. He made Ins first experiments
on rabbits, on whom he inflicted several wounds, and al'terwards placed the
animals in a box having apertures, through which their heads projected.
The air contained in these chambers was heated by a spirit lamp, generally
to 25 degrees of Farenheit, and sometimes higher. The animals were se-
cured so that they could not move. Their wounds wept at first serum, but
as they dried, their edges approached each other. In some cases no tume-
faction, nor appearance of inflammation was observed ; in others suppura-
tion took place after some days, underneath the crust ; but by a longer ex-
posure to the heated air, the pus thus formed, also dried ultimately into a
thin scab. After it was removed, the wound was found to have been per-
fectly cicatrized underneath. ,

Dr. Guyot was not so successful in getting ulcers in the human subject to
heal in this manner. After two or three weeks' trail, he was obliged in some
cases to relinquish it, the patients not being able to bear the fatigue of hav-
ing the limb so long confined to a box, without any change of position ; ne-
vertheless he did succed in curing by the process of scabbing some ulcers
of long standing and of an obstinate character, although pus formed again
and again under the dried films which covered the ulcers. Dr. Guyot im-
putes great virtue to the heat, but it would seem to be merely instrumental!
to the drying of the serum, lymph, or pus which may happen to lie on th*
Y<'ounds or ulcers." 206."

1839.] Strychnia in Retention of Urine, (f^c. 085

We do not anticipate much from this. But we must quit Dr. Macartney.
We think our readers will agree with us that much instruction and more
pleasure may be derived from a perusal of Dr. Macartney's volume. That
g^entleman has the good wishes of all on his retirement from the lecturer's
chair.

Part III. MONTHLY TERISCOPE.

Strychma in Retention of Urine. In the Eclectic Journal
we find extracted from the Medical Gazetie, a case of retention
of urine successfully treated with strychnia, by Edward A.
Cory, M. D. The patient had been delivered a few hours pre-
viously, of a first child, after a tedious and severe labor, since
which time she has passed no urine. She was in great pain,
which was considerably relieved by the introduction of the ca-
theter. The atony of the bladder however, still continued, and
it became necessary to resort to catheterism twice a day ior
three weeks, during which period, there was not the slightest
abihty to void the urine. Soon after delivery, symptoms of pe-
ritonitis were evident, but were removed by an antiphlogistic
treatment. Finding that the inability to pass urine continued,
Dr. Corry resorted to the use of strychnia, of whicfi he gave
one sixteenth of a grain three times a day. To his sui prise, af-
ter taking the second dose, the patient was able to pass her urine
sua sponte, and with ease and comfort to herself The medicine
was continued until one grain had been taken. There was no
return of the retention. We think the strychnia worthy of a
full trial in such cases, though we must confess, that were it not
for the known effects of the article in paralytic states, the sud-
denness of the relief, after so small a portion of the medicine,
would have led us to consider it rather a coincidence than a cure.

Pathology of Porrigo. The observations of Basse and Audouin on the na-
ture of Muscardine, a disease to which silk worms are subject, had proved
that it was owing to the growth of minute fungi on the animal. Professor
Schoenlein, of Zurich, has been led to examine under the microscope, some
cutaneous eruptions. On the first examination of a pustule of porrigo lupi~
Twsa, he satisfied himself of the vegetable and fungous nature of the pustule.
Prof. Schoenlein is busily employed in prosecuting this subject, and means
oon to publish the results of his investigations. Miller's Arch, from Lon-
don Med. (Jaz.

GSG Quinine in the Urine Ejjcct of position, (^c. [August,

Quinine in the Urine of individuals to idiom it has been administered in
large doses. By M, Queveiuie. The researches of M. Tiorry, on the pre-
sence of quinine in tlie urine, led the author of this communication to pub-
lish some analogous researches, which he has niade on the urine of an indi-
vidual to whom jM. Leroy adnunistered GO ^-rains of the sulphate of quinine
during the first day of a malignant fever, GO grains on the second, and 110
grains on the third. Two and a iiah' ounces onJy of this urine bemg remit-
ted to him, he was not able to subject it to all the expermients v*'hich he de-
sired to make. After having treated this urine with various re-agents, and
having submitted it to many operations which we cannot detail, IVJ. Que-
venne obtained a limpid solution which possessed in a high degree the bitter
taste of quinine, and exhibited, when examined in a reflected light, that blue-
ish aspect peculiar to the salts of quinine. This solution exposed to an air
bath deposited slender bands which, upon microscopic examination, were
composed of beautiful prismatic needles, entangled in each other. Some of
these prismatic needles were about 15-100 millemetre and 1-400 in breadth.
They were obliquely truncated at their summit. Evaporated to dryness the
solution furnished a crystalline residuum very bitter and soluble in alcohol.

The author draws from his analysis the iOllo.wing conclusions

1st. Quinine or its sulphate may pass into the urme of persons who make
use of it.

2nd. Tannin is a most excellent re-agent to isolate vegetable alkalies,
since in this instance it was able to recover a very small quantity of quinine
which was dissolved in a liquid of a very complex nature. Gazette Medicale.

On the Effect produced upon the Pulse hy change of Posture. By William
Augustus Guy, M. B. Cantab. There is a paper on this subject compiled
with great care from many and well conducted experiments. The paper is
of too elaborate a description to permit us to enter into its details, and all that
we do is to present the summary given by our author, Dr. Guy, of the facts
which he seems to have made out. The summary in question is short, but
sufficiently explicit. Those who are anxious to become acquainted with the
data upon which it has been founded, will do well to consult the original pa-
per. That is essentially of a numerical character.

1. In healthy males of the mean age of 27 years, in a state of rest, the
number of the pulse is, standing 79, sitting, 70, and lying 67 ; the ditference
between standing and sitting being 9 beats ; between sitting and lying, 3
beats ; and between standing and lying, 12 beats. When all exceptions to
the general rule are excluded, the numbers are, standing 81, sitting 71, and
lying 66 ; the difference between standing and sitting being ten beats ; be-
tween sitting and lying 5 beats ; and between standing and lying 15 beats.
The same differences expressed fractionally, are as follow, inclusive of ex-
ceptions ; l-9th, 1.20th, 1.6th ; exclusive of exceptions, l-8th, l-13th, l-5th.

2. The extremes are very remote from the mean results. Thus, the
greatest diffe-rence between standing and sitting is 1.4th, the least 1.19th,
of the frequency standing; the greatest difference between sitting and lying
is l-4th ; the least 1.16th tf the frequency sitting ; whilst between standing
and lying, the difference may be somewhat less than one-half, and as little
as l-14th, of the frequency standing. The greatest difference observed
amounts to somewhat less than one half of the frequency standing.

3. The exceptions are as follow To the general law, that the pulse is
less frequent sitting than standing, there is one exception in 12 experiments:
to the general law, that the pulse is less frequent lying than sitting, there are
3 exceptions in ten experiments : to the general law, that the pulse is less
frequent lying than standing, there is 1 exception to 14 experiments. The

1839.] Signs of Undue Devclopmenl nf Bj'ain, <^'c. GS7

total number of instances in wliich 1 or more exccpUons to general rules oc-
curs, is 34, or somewhat more than 1 in every 3.

4. The effect produced by change of posture increases as the frequency o^
the pulse increases.

5. The exceptions to the genera] rule are more numerous as the pulse is
less frequent.

6. The effect produced upon the pulse by change of position is due to
muscular contraction.

7. Muscular contraction, wlietlier employed to cjmngo tlie position of the
body, to maintain it in the same position, nccpleratcs the pulse ; and the
effects produced by change of posture form but a particular case of this more
Sfeneral law. ?,Ied. Chi . Rev

Signs of Undue Derelopvient nf Drain, concomitant icith ilie changes in the
Form of the Head. The integuments of the skin of tlie head in these chil-
dren have a smooth stretched appearance, and a deep flush follows every
slight excitement. The veins are larger and more distinct than usual about
the forehead and temples, and easily become full and turgid as in crying;
the head is apt to become hotter than the general surface, and is often bath-
ed in perspiration, especially at night ; the hair is frequently redundant and
strong, but sometimes it is very deficient.

The fontanelle or open part of the head is large, its edges thin and stretch-
ed, and it varies its state of elevation or depression upon slight causes.

The mind of these children is generally premature, their affections lively,
and temper quick and excitable ; these qualities render them more than or-
dinarily interesting. They are more than commonly wakeful, or sleep
hghtly and are easily disturbed.

Their muscular s3'Stem is sometimes vrell developed, as shown ly fine
limbs, and an early ability to walk but this is when the brain does not devi-
ate very seriously from a sound state more frequently and in severe cases,
the power of walking is protracted, the balancing power of the will being
deficient.

A general irritability and excitability of frame (often deemed characteris-
tic of all children but much more marked in some than in others, as all
persons acquainted with children must have observed) is almost always as-
sociated with the condition of head above described. And looking at the
offices the brain sustains in the system, there can be no doubt of its depend-
ing upon and flowing from it-

At the same time, it will be obvious to every physiologist, how an oppo-
site set of symptoms may flow from a morbid brain, dulness, heaviness, stu.
por, and a preternatural immobility ; but such consequences are compara-
tively rare." 17.

The consequences of these abnormal states are head diseases especially
hydrocephalus, inflammation of brain or membranes, paralysis, croup, &.c.
The causes of kephalosis, he thinks, are hereditary predisposition, and over-
working of the brain itself. The author makes no allusion to the means of
counteracting or curing this kephalosis, but as the pamphlet is only the fore-
runner of a volume on the diseases of children, we shall look to that for more
minute details. The brochure is extremely well written, but we cannot
help suspecting that the " j^-act," after all, is somewhat tinged by fancy.
Med. Chi. Rev.

Ulcers on tJie Xippks, i^c. Dr. Boehni of Berlin has lound great benefit
from the employment of dodiccativc powder composed of one partofoxyde

68S Periscope. [August,

of zinc and one or two parts of powdered g-um arable sprinkled upon these
troublesome little sores. J t forms a crust or thin cake over the ulcerated
surface, which, being thus protected from all irritation, speedily heals. Med.
Chi. Rev.

Facility with wldch the Natives of India recover from Serious Accidents.-^
In the India Journal, for April 1, 1838, we find a communication from Mr.
Splisburry surgeon of Jubbulpore, irom which we extract the following pas-
sage.

" Some time ago I had occasion to bring to the notice of the Medical and
Physical Society two remarkable cases of wounds, showing with what facil-
ity serious accidents are gotten over by the Natives. The first was that of
a grass-cutter gored by a Spotted Deer with protrusion of intestines ; the
second that of a woman in the very last stage of pregnacy pitched on the
horn of a buUuck, which perforated the cavity of ih? uterus ; to these serious
ones of the abdomen and pelvis I have to add another.

A young woman about 18 was brought to me with a very extensive wound
of the occiput and posterior portion of the parietal bones inflicted with a tul-
war, a piece of the skull and margin was completely detached, laying bare
the brain to that extent; she had likewise a severe wound of the left
hand cutting through the metacarpal bone of the fourth finger, also a very
shght cut on the top of the same shoulder.

When brought to me she had lost a very considerable quantity of blood,
her clothes bemg saturated, and was in a very exhausted state from the time
of dressing her wounds, up to their healing, which they all did speedily,
with exception of the apparently very trifling one on the shoulder; not the
smallest symptoms of affection of the head took place, she never complained
of headache, nor was there the slightest tendency to heat of skin, except in
the injured hand for a day or two. P. nat. app. good, sleep unimpaired, ad-
ding another instance of the little constitutional irritation that takes place in
natives after very dangerous wounds." Med. Chi. Rev.

Nitrale of Silver in Gastralgia. Dr. Stoinitz has found this metallic salt
successful in some severe and obstinate cases of this disease, which had re-
sisted all the ordinary remedies, such as musk, castor, morphia, hydrocyan-
ic acid, the preparations of zinc, bismuth, &c.

It may be stated, as a remark of very general truth, that metallic salts have
a very marked effet^t upon all nervous affections, attended with high sensi-
bility.

The excellent affects of the oxyde and sulphate of zinc in chorea, of steel
in many cases of neuralgia, cupreous salts in spasmodic croup, &c. all tend
to prove the correctness of this observation.* Med. Chi. Rev.

* Our German friends seem to be not aware that the internal use of the
nitrate of silver in certain cases of gastric suffering was first recommended
by Dr. Johnson the senior Editor of this Review,

It is an admirable remedy in allaying the morbid sensibility of the stomach
in sorne forms of Dyspepsia. Ed. Rev.

1639.] Medical Intelligence. 689

MEDICAL INTELLIGENCK

FOREIGN CORRESPONDENCE.

itters from Paul F. ve, M. D. Professor of Surgrery iu tlie
Fledical College of Georgia.

PARIS, MAY 15th, 1839.

To the Editor of the Southern Medical and Surgical Journal :

Dear Sir This morning 1 went to La Charite, visited the patients,
and heard the Lecture of M. Velpeau. A man who received on Monday
last a ball through the abdomen died here last night of peritonitis. Another
who had a ball to pass through the middle of his left arm, without breaking"
the bone, was treated by bandaging from the fingers, and simple dressing to
the two wounds, is doing remarkably well. I have seldom seen a wound of
the kind in so good a state in so short a time. 1 learn there is a singular fact
connected with wounds, in general, in Paris it is this, that though erysi-
pelatous inflammation has been a very common result lately, yet no case of
the kind has been followed by tetanus. I understand that lock-jaw is not
now known in the hospitals of the city.

In the case last referred to, the track of the ball was not examined, and
not even was a probe used. M, Velpeau stated that it was of no avail, as the
subsequent suppuration would reveal whether the bone was fractured, or
whether the wound contained foreign substances ; and moreover, that prob-
ing, &c. would aggravate the irritation and inflammation attendant upon
gun shot wounds. Notwithstanding this high authority, I cannot but be-
lieve, that it is good surgery to examine and remove all foreign substances,
be these the ball itself, (though in the case under consideration, this was out
of the question, smce the ball hsd passed through the arm,) pieces of cloth-
ing, or spiculae of bone. Certainly, by a careful examination immediately af-
ter the receipt of a wound of this class, no great aggravation of it would be
produced ; and when foreign bodies exist in it, is it not essential that they be
at once removed ] In fact, would not their removal be the very best means
to prevent irritation and inflammation ? And as a class of wounds, gun-shot
are peculiar in almost always containing foreign substances.

After the lecture, M. Velpeau operated twice for obstruction in the la-
chrymal sac. He overcame the resistance in the usual way, with a straight
bistoury and probe, and then introduced a softened ivory bougie. He said
the mode of preparing the ivory was a secret, until a German student re-
vealed it in Paris.* They are now making urethral bougies, rectum, &.c. &c.

* The Ivory bougies are made by first removing the earthy salts by an
acid, and then subjecting it to tannin to acquire elasticity, firmness, &c.
G 7

690 Medical Intelkgence. [August,

of this material ; the peculiar excellence of which, M. Velpeair stated to be,
that it would increase one-third or one-fourth in thickness by absorbing the
moisture of the canal in which it may be pfaced, which renders it peculiarly
well adapted for the dilatation of the soft passages.

At eleven o'clock, I had the pleasure of hearing M. Magendie, who lec-
tures every Wednesday and Saturday on 'Experimental Physiology. He
was engaged with the fifth pair of nerves to day. After stating that this
was a double nerve, one part being motor and the other of sensation, and ex-
hibiting its minute ramifications ; proving that the nasal branch of this was-
the olfactory or true nerve of the organ of smell, and not the first pair or the
olfactory, commonly so called, he cut open the head of a rabbit, turned out a
portion of the brain, and predicted that on touching with a probe a portion
of the fifth nerve, the animal would cry. This was completely verified. He
then cut the branch in two, and estabhshed a perfect loss of sensation in the
parts to which it was distributed. He also stated that by touching the la-
clu-ymal branch of this nerve, tha tears would fiow as if one had opened th&
eock of a hydrant.

I regret to state that the climate of Paris has proven very fatal to Ameri-
can Medical Students. . Six died during the (\-inter of 1837-'38 ; and yes-
terday the third one died since the first of last January. This I think attri-
butable to the long continued cold of the winters, and the severe exercise the
students take in the morning before breakfast : some of them not unfrequeut-
ly walking two or three miles to reach the Hospitals, or to pass from one to
the other. The gentleman who died yesterday was a graduate of the
Charleston College, and a native of South Carolina. They have all died o^
pneumonia, and have generally been attended by Louis.

17th. WenttoZ/a Pitii. to see Llsfranc, but was again disappointed, and
learned he was not in good health. Returned immediately to La Charitit
and heard M. Velpeau's lecture, and saw him extirpate an eye. He first
presented the ball which had caused the death of the individual already men-
tioned in this letter. It entered theljuttock of the right side, and was found
in the left thigh. It passed through the bones of the pelvis, the rectum and
a loop of the small intestines and what was surprising the ball was not the
least flattened, but retained its natural shape.

The case of his clinic, upon which he dwelt the most, was that of a man
who had received a blow of the fist upon his nose and left eye, attended with
emphysematous swelling. After establlsliing the fact that it \yas air diffused
in the subcutaneous cellular tissue, M. Velpeau entered into the enquiry,
how it was generated there, since the skin was entire, and there was no
appreciable fracture, and certainly no decomposition. His conclusion was,
that some of the small bones of the nose must be fractured, producing also
a rupture of the Schneiderian membrane. In support of this opinion, he
mentioned a case of M. Blandin, who after operating for fistula lachrymalis,
or rather epiphora^ was much sm-prised to find the face of his patient quite
emphysematous on the operated side. Upon examination, however, he dis-
covered that when this patient held his nose in blowing it, or in sneezing.

1839.] Medical Intelligence. 691

the air entered the lachrymal duct, and became diffused into the subcutane-
ous cellular tissue, by means of the little wound made in the operation to
which he had been subjected : And another case yet more in point was ci-
ted ; that "of a man who fell from an eminence, and rolled down a conside-
rable distance. Dupuytren could find no wound in the skin, nor fracture,
still his face, neck, &c. were very emphysematous. A post mortem exam-
ination revealed a comminuted fracture of the internal bones of the nose.

In extirpating the eye, which he said was affected with cancer or fungus
hsematodes, M. Velpeau stated, that as there had been recently a good deal
said about the propriety of not removing the lachrymal gland with the eye>
lie mtended trying the experiment, and therefore left in this case that gland
in the orbit. The result of this I hope to communicate hereafter.

18th. M. Velpeau performed a very serious operation this morning. It is
said he was never so reluctant to operate before and that he had done
every thing to avoid it, for he apprehended the patient would die on the
table. She was a very intelligent young girl of 12 years of age, who had had
for six years a tumour in the axilla of the left side.- This had rapidly in-
creased during the last six months, and now threatened the loss of life. M.
Velpeau made a semi-lunar incision'over the tumour, and then carefully dis-
sected it from the bottom of the axilla. The operation was well performed,
and the little patient behaved with much courage. But the dressing spoiled
all the wound teas crammed full of lint. The French do not believe in union
by the first intention.

PARIS, MAY 28tb, 1839.
To the Editor of the Southern Medical and Surgical Journal :

Dear Sir : Since the date of my last communication, I have procured the
following medical intelligence which may be worthy your notice.

And first of Pied-Boi or Tendonotomy. I have seen several cases of this.
One where five tendons were cut or divided by M. Velpeau. The opera-
tion had been performed five weeks, and the patient, a man of 35 or 40 years
of age, could walk very well with the foot flat upon the ground. The se-
cond case was a female quite aged, having the great toe of the right foot
pointed upwards, or, in other Words, permanently extended. M. Velpeau
divided by mistake the common tendon of the toes, which not relieving the
patient entirely, he proposes to cut in a few days the proper tendon, or that
of the extensor longus pollicis pe.dis. A third case, the same surgeon ope-
rated on, Saturday, the 25th. This also was a female aged 30, who had
^ad for some time a permanent flexion of the right leg. The tendons of
the ham on either side were divided, but without as yet straightening the
limb. Indeed, it is even surmised, that the operation in this case will be
worse than useless, for the knee joint seems to be involved in disease ; but
which of course could not be positively ascertained before the operation.
There is now a girl entered yesterday to be operated upon next Saturday.
Her case is the common regular club-foot.

C99 Medical Intelligence. [August,

In performing the operation, a very small knife, somewhat resembling a
couching needle, is here employed. A simple puncture is made, and then
the tendon or tendons are divided. I shall not neglect, before my return in
the fall, to provide myself with these instruments, called Bouvier's.

The next most interesting operations I have witnessed, are the very sim-
p"'e ones for variaose veins. This is almost daily performed in La Charite,
and with one exception, with entire success. The case that proved fatal
was that of a man who had had several pins deposited under the internal sa-
phena, and in whom, after these were removed, phlebitis supervened. It is
Baid his blood would not coagulate. But this certainly cannot be offered
against the operation itself. We need only reflect how many have died af-
ter common bleeding from phlebitis, especially in Paris. The operation con-
sists in depositing a common pin under the vein that is varicosed, and then
twisting around its two extremities a silk ligature. M. Velpeau says he pre-
fers a circular twist to the common twisted suture, because the vein is thus
compressed at three points. Sometimes but one pin is used, but most fre-
quently there are several. For instance, in the two last cases operated upon
in one en last Saturday, two were placed under the vein (internal saphe-
na) in the leg, and two in the thigh ; and in the second, the one operated
upon, last Monday, four were deposited in the region of the ham or poplite.
al. In performing the operation, the patient either stands up or re.lines in
he'\. When the pins are placed, the ligatures are drawn very tight, and no
dressing whatever, not even a bandage is used. Only the points of the pins
are removed with the bone-nippers, and they themselves are generally with-
drawn at the end of a w-eek or ten days. It is an operation, as may well be
imagined, that produces but little pain ; and is indeed far superior in simpli-
city, safety, comfort, and celerity of cure, to any mode yet devised for vari-
cosed veins the patient, in fact, walks to his bed in the ward from the ope-
rating table.

On Saturday, the 25th, I went to Necker Hospital to see M. Civiale. In
waiting for him we entered the wards, and met young Bevard, a very pro-
mising son of the former Professor of Anatomy in the School of Medicine of
Paris. He exhibited a case where a large abscess in the parotid region had
produced, from lesion of the seventh pair of nerves, ectropium of the lower
eye-lid. Motion of the nr:us2les of that side of the face had been lost, but
not sensation. And he mentioned another case similarly afflicted, caused
by a ball entering the ear and coming out very near the eye being one of
the gun-shot wounds of the recent emeute in this city. M. Civiale, after vi-
siting his ward of eight or a dozen patients, entered his operating room and
lectured a few moments on every case, and then operated successfully by
crushing up a stone in the bladder the patient voiding the fragments be-
fore us.

M. Civiale is a very fine looking man of about forty years old. He has
outlived all the opposition of his rivals, Le Roy and D'Etoile, Amussat, &c.
and silenced the murmurings of calumny. I am happy to inform you that he
has already reaped a handsome reward for his ingenuity and perseverance,
and now lives in the first style. He is altogether one of the most polite

1839.] Medical Intelligence. 693

French medical men I liave met with, and uncommonly Hberal and generous
to strangers.

M. Civiale has now almost entirely all the cases of stone liiat occur in and
about Paris, and is frequently engaged with those from a considerable dis-
tance. In lecturing he is a very plain speaker, and deals exclusively in facts.
In his clinic he dwelt upon the propriety of so placing the patient as to have
the fundus of the bladder the lowest point, and thus avoid the neck of this
organ in the manipulation, fec. with instruments, because tliiswas the most
delicate and sensible part of it. fn operating he used an instrument modified
by himself, but which much resembles Jacobson's. In the introduction of the
bougie, catheter, lithotrity instrument, &c. he is par excellence, the best I
have ever seen. He never uses force, but the largest sizes seem as it were
to be drawn into the bladder when he operates.

On Monday the 27th I saw Velpeau perform five operations : One for va-
ricosed veins, two amputations of fingers ; and two cases of hydrocele, of
course with the tincture of Iodine, his favorite injection.

On Tuesday, the next day, he removed a carcinomatous breast the ope-
ration lasted two and a half minutes.

On the 29Lh, 1 again went to La Pilie, and fortunately met Lisfranc, who
I find has failed much since 1830. I regret to say his moral character is not
good among his countrymen, though he has quite a reputation as a surgeon.
He is the chief of the Hospital where he has labored so long. This morning
he examined the wombs, per speculum, of more than a dozen ca?es. Since
the expose of his inlern, he does not operate so frequently as he once did on
the neck of the uterus. He now mostly cauterizes the ulcers or carcinoma-
tous affections of this organ. He employs exclusively, as a caustic, the ni-
trate of mercury ; and applies it by means of a mop. In his cUnic, made
after the visit to the wards, he said he had in the last ten years cauterized
from two to three thousand cases in this manner. It is an operation that
seldom, if ever, produces any pain. He exhibited this morning a case in
which he amputated the neck of the womb fourteen years ago the cicatrix
he sa'd was firm, and the cure complete. She visited the Hospital now for
some tumefaction of the uterus. Lisfranc's principal intern, and the only
one it is said whom he makes his confidant, has nearly the half of his lower
jaw amputated by his master. I saw several very interesting cases in his
wards. One for instance, upon which he had operated for osteo sarcoma ot
the inferior maxillary repeatedly, until now, he has apparently, left only the
two articulating pieces of this bone. But I hasten to call your attention to
his peculiar dressing for recent wounds and amputations. He presented
us a case and insisted upon the superiority of removing the dressings every
day, beginning with the next after the operation. He first applies a Hnen
compress well imbued with simple cerate, but made with yelhnc zrax, be-
cause he says it contains more honey than the white, and then succeed the
lint, and a handkerchief so folded as to cover the stump. This he presents
to the profession as the ultimatum of after treatment in operations. Of all
Bubjects in the world, the French are the most obstinate in yielding to union
by the first intention. They will not believe the English or Americans and

<^0 1 Medical I ritelligence. [August,

their practice is to prevent by all means the direct union of wound?, or of
opposite surfaces after amputation, and to promote suppuration.

June 1. Li.sfranc is exceeding!}^ unpopular among his professional breth-
ren, and no wonder he never mentions a name with much respect, but ge-
nerally alludes to other surgeons as the parrots, or such an one has as much
to do with surgery as the grenouilles (frogs) have with feathers. His man-
ners are very brusque ; he is exceedingly petulant, and says whatever he
pleases, even in his lectures. He has a very loud and harsh voice, and often
elevates it to a very high pitch. Still Lisfranc is a great surgeon probably
the best now in Paris certainly in his after treatment and medical depart-
ment, he is the most successful.

Yesterday I visited M. Louis, and was most cordially received by him ;
and last night I spent with our distinguished countryman, Dr. Alott, late of
New York. I find he has just returned from an extensive journey in the
East and Egypt. The Doctor, as you know, left home on account of his
health an affection of the heart. He has all his family with him wife
and nine children. He informs me that his health is quite re-established ;
and were it not for the education of his children, he would return at once, to
New York, and resume the practice of his profession, to which he says he is
too much attached ever to relinquish. He expects now to return in a year
or two. He is at present engaged m committing to paper his views on the
practice of Surgery, and with some practice among the Americans and
English. He says he will be in no haste to publish ; and when he returns to
America, he wishes to confine himself to surgery, in its practice and teaching.

This morning M. Velpeau operated for club-foot in the case already men-
tioned. He made an incision in the skin, or rather a puncture with a lancet
along the side of the tendo-Achilles, then introduced Bouvier's knife, a long
narrow cutting needle, and divided the tendon by directing the edge towards
the bones of the logs or forwards. The divided edges separated under the
skin more than an inch at once, and the foot was extended. M. Velpeau also
removed the tonsils of a young man one with a hook and bistoury, and the
other with a new instrument of his own, called hy him a kind of guillotine
this operated remarkably well.

Monday 3rd. Visited this morning the wards of M. Roux, at the Hotel
Dieu. Saw him remove a very large ball, by a counter opening, in a man
wounded on the lath of last May. After making his visit he entered the
lecture room formerly so crowded by the great Dupuytren, whose successor
he is. But what a change did 1 behold in that room, which I had so fre-
quently entered in 18'30 and '31. Then it was frequently impossible to be
seated, and often contained from 400 to GOO students, collected from all parts
of the civilized world now, will you believe, the first bench is not filled ?
M. Roux is undoubtedly a very respectable man, and an eminent surgeon,
but more especially is he celebrated for dexterity as an operator. But as a
lecturer or even as a surgeon, he is far, very far inferior to the late Dupuy-
tren. He is from Gascony, and even his own countrymen cannot under-
stand his speaking in public. He is very rapid m his enunciation, hesitates
very much for words, and labours much with his hands, frequently pointing

1839.] 31 edical Intelligence. 01)5

or bending his monstrous nose with the riglit index, lie is the only man I
cannot comprehend, that I have met with since my arrival. After lecturmg
near an hour, he operated on three patients. The first was a case of poly-
pus of the ordinary kind. This he succeeded very well in removing with
forceps, and the breaking it up from its attachments, by pushing it baok with
his little finger. The other two operations were only tolerably performed.
The one for fistula in ano required near twenty minutes, and as many cuts
with the bistoury; and the other was an amputation of the leg. This too was
performed directly above the ankle, for a ball which had passed through this
joint. He was three and a half minutes cutting off the limb made two in-
cisions to complete the section of the skin, turned up the skin which was
dissected with a small knife, and after sawing the bones, had recourse to the
knife to divide some portion of a muscle which had not before been detach-
ed. Altogether it was an operation that would not be even creditable to a
tyro. So true is it that some of the best surgeons not unfrequently perform
very badly. Dupuytren once took half an hour to tie the brachial artery.

I ought not to forget that in the track made by the ball, and the counter
opening for its extraction, a long strip of linen was deposited by M. Roux.
The wound had been opened for more than three weeks, yet to prevent its
closing too soon a seton is employed. This was French surgery in 1790,
and is French surgery in 1839 ; and will, I fear, be the same for years yet to
come.

I find the immovable bandages or apparatus exclusively employed in Pa-
ris for fractures. M. Velpeau has the starch in which the bandages are
placed, or covered with, made so as to dry very quick, by subjecting it to an
acid. Patients generally walk about in three or four days with crutches.

M. Velpeau, in preparing the second edition of his Medicine Operatoire,
wrote to Dr. Mott requesting him to give some idea of the success of Ame-
rican surgeons. This Dr. Mott soon furnished, but M. Velpeau, I learn
from his chief intern, M. Perischaud, does not give credit to it. He says
this is contradicted by the Statistics of Dr. Norris, one of the Surgeons of
the Pennsylvania Hospital. I recollect being impressed with the greater-
ror which Dr. Norris' statement was calculated to produce, by those who-
take it as the basis of success of amputations in the United States. It no
more conveys a correct history of American Surgery on this, than it does of
any other subject. No surgeon of our country will consent to its being a
correct foundation of statistics in surgical practice. All it can pretend to,,
and all that Dr. Norris undoubtedly intended by it, v.-as the practice of the
Pennsylvania Hospital, and nothing more. I respect the surgeons of this
charitable Institution, but I am sure they even will acknowledge that they
erred, and that greatly, though on the side of mercy, in delaying amputations
during the period referred to by Dr. Norris. Who in reading these statis-
tics will admit them as correct, as applied to the United States 1 And these-
being the only ones yet published in our country, it is not astonishing that a
man of M. Velpeau's industry and penetration, should have noticed the con-
tradiction to it in Dr. Mott's letter to him.

June 4th. At seven o'clock A. M. I went to the wards of La CharitS^ and

C96 Medical Intelligence. [August,

after making the visit witnessed two operations. Tiie Surgeons here cut
very free in cases of fistula in ano like old Boyer, they are not satisfied
with a simple opening of it, but remove the whole tract of the fistula. This
I saw yesterday done by Roux, and to day by Velpeau. The second ope-
ration was also performed by M. Velpeau, who remarked that he believed it
was the first ever performed in Paris. The case was that of a female from
the country, aged near 50, who had carried for some years a stone in the
bladder. This, from all the symptoms and signs of a calculous affection, was
supposed to be very large, and after considering all the various operations
proposed for w-omen, M, Velpeau decided upon the vesico-vaginal section.
He staled that this operation had been performed about 20 or 30 times out of
Paris, in France, durmg the past few years, but never, as he believed, in the
city. It was without danger te the life of the patient, but was almost al-
ways followed by a vesico-vaginal fistula. Nevertheless, taking all things
into consideration, he thought this a case requiring the operation, which was
accordingly performed, and an immense calculus removed, thus completely
verifying his diagnosis. It measures two and three fourth inches by two,
and weighs three ounces.

The little girl who had the eye extirpated and the lachrymal gland left in
the orbit is doing very well. From the suppuration which still flows, I can
not tell if there be no secretion of tears. The other little girl from whom
M. Velpeau removed the large tumour under the axilla, is also nearly well
the last week the edges of the wound have been approximated, and it has
healed very kindly.

At 12 M. went to the School of Medicine, and heard M. Berard, aine,
lecture on Physiology. He is considered one of the best speakers in the pre-
sent Faculty: He was to day on Respiration. I observed that he insisted
upon a fibrous tissue or muscular fibres covering the lungs by which these
organs contract. He says the reason, why an opening into both sides of the
chest produces death, is because the air entering into the pleura, permits the
lungs to contract, and not that the atmosphere through the two wounds in the
sides causes it for the pressure of the air on the inside and outside upon
the substance of the lungs, can do nothing but balance each other.

At two to four o'clock, attended the ocular clinic of Dr. Sichel, and saw
him perform three operations for cataract.

There is an interesting concours now^ going on for the chair of Therapeu-
tics, formerly occupied by M. Ahbert. M. Trousseau, I learn, is the most
promising candidate.

Some Italian quacks are now in Paris making a considerable stir about a
water which cures all diseases, and more especially stops all haemorrhages.
It is said they have a certificate from Lisfranc, but they failed in procuring
one from Dr. Mott, although they pressed him very hard. The truth is their
water does promote the coagulation of the blood, some think chemically; but
all its properties are not known. There is also an Enghshman here who
professes to dissolve the stone in the bladder. M. Velpeau has just offered
him a case now in his wards-

1&S9.1 Medicallntelligence. 697

MEDICAL CONVENTION.

We are truly happy to perceive, by the subjoined notices, that the atten-
tion of the medical profession is again called to the importance of a Conven-
tion of its members. And although the Faculty to which we are attached
had the mortification, in 1835, to fail in an effort to bring about so desirable
a meeting, (see the Southern Med. and Sur. Journal, September, 1836,) we
still most heartily wish success to those who now urge the call. That a
concentration of the talent and views of the profession, from the numerous
institutions of our extended country, on the subject of medical education,
would be fraught not only with benefit to those destined hereafter to enter
the portals of our schools, but also with advantage to the country at large,
cannot for a moment be doubted. The fact that the usages of our govern-
ments forbid their interference in matters of special education, renders it ab-
solutely necessary that some body should be organized by the profession it-
self, for the purpose of regulating the mode of instruction, the requisitions
for the Degrees conferred by its Schools, and for taking such other steps to
elevate its dignity, as may be advisable from time to time.

It will be observed that, according to the notices given below, two Con-
ventions are called the one to meet at Washington City, in January, 1840,
and the other at Philadelphia, in May of the same year. We hope that
both will meet at the same time and place, and would suggest that prefer-
ence be given to the month of May, inasmuch as the professorial duties of
those attached to Schools would preclude their attendance in January.

[^From the ISational Intelligencer. '\
MEDICAL CONVENTION.

In obedience to a resolution of the Medical Convention of the United
States, assembled in Washington City, in January, 18S0, public notice is
hereby given, that a similar Convention will meet at the National Hotel, in
the said City, on the first Wednesday in January, 1840, for the purpose of
revising thePharmacopoBia of the United States.

Each State Medical Society, incorporated Medical College, and incorpora-
ted College of Physicians and Surgeons, is requested to elect a number of
delegates, not exxeeding three, to attend the said Convention.

The several incorporated bodies mentioned, are also requested to submit
the Pharmacopoeia to a careful revision, and to transmit the result of their
labours through their delegates, or through any other channel, to the next
Convention.

They are further requested to transmit to the undersigned the names
and residence of their respective delegates, so soon as they shall be appomt-
ed, so that a list of them mav be published, for the information of the medi-
cal pubic, in the month of October next.

By order of the Medical Convention, assembled at Washington, in Jan-
uarv, 1830. LHWIS COxNDICT, M. D. President.

Morristown, New Jersey, April 6, 1839.

xMEDICAL SOCIETY OF THE STATE OF NEW YORK.

At a meeting of the Medical Society of the State of New York, held Feb-
ruary 7, 1839, the following resolution was adopted :
H 8

69S Medical Intelligence. [August,

" Whereas a National Medical Convention would advance, in the appre-
hension of this society, the cause of the medical profession throughout our
land, in thus affording an interchange of views and sentiments on the most in-
teresting of all subjects, that involving men's health and the means of se-
curing or recovering the same : Therefore Resolved^ that in our opinion such
Convention is deemed advisable and important; and we would hence recom-
mend that it be held in the year 1840, on the first Tuesday in May of that
year, in the city of Philadelphia and that it consist of three delegates from
each State Medical Society, and one from each regularly constituted medi-
cal school in the United States ; and that the President and Secretary of this
Society be, and they are hereby instructed and required to transmit as soon
as may be, a Circular to that effect to each State Medical Society and Medi-
cal School in the United States." By order,

LAURENS HULL, M. D. President.

B. Van O 'Linda, Secretary.

From the Medical Examiner.
LETTER FROM DR. HARLAN. NO. Hi.

Seances of the Royal Academy M, Daguerre^ s Photogenic Discovery Mor-
tality among the Prostitutes of Paris Epidemic among the Cows Disea-
ses of the Silk- Worms French Surgeons Mortality after Operations M.
Roux Dr. Blandin's mode of treating Stumps after A mputalion Profes-
sor Breschefs Operation for Varicose Veins Treatment of fractures by the
Immoveable Apparatus M. Velpeau.

Paris, April 30th, 1839.

To the Editors of the Medical Examiner.

Gentlemen, Numerous pressing occupations, up to the present timp,
have effectually prevented the continuance of my correspondence. For the
same reason, I have taken no notes of my daily observations, but hope, ne-
vertheless, that some account of the general results may not prove altoge-
ther uninteresting to your readers. The weekly meetings of the national
Institute the daily exercises of the hospitals the tri-weekly open days at
the Jardin des Plantes, together with the urgent demands of Parisian socie-
ty, leave me but little time for other occupations.

The Academy of Sciences, the only section of the Institute open to the
public, holds its seances every Monday, at 3, P. M. The seats in the area out-
side those of the members, are always filled with visiters before half past 2,-
and those who arrrive later are not admitted. This would have proved a
great barrier to my attendance, had not the urbanity of my friend, Professor
Blainville, of the Jardin des Plantes, secured me one of the eight chairs im-
mediately before the President's chair, and devoted to foreign professors.
The meetings are alw'ays well attended by the members ; and more me-
moirs are usually presented than the Academy can receive, or by the perpe-
tual secretaries, M. Arago and M. Flourens, would be able to despatch.
The crowds of savans, both foreign and native, who always claim admittance,
shows the general interest that these seances excite.

Among the numerous interesting memoirs to the reading of which I have
listened, none has so much riveted my attention as the acccount of the Pho-
togenic discovery ofM. Daguerre the first annunciation of which was con-
sidered as fabulous. M. Daguerre's office, adjoining his splendid diorama
near the Boulevard, was daily beset with the curious, demanding to know the
truth of this new power of fixing an image, the inventor was obliged, in self-
defence, to close his doors, this was just before my arrival in Paris, and
previously to the reading of the memoir before the Academy of Sciences,
where this highly important and interesting d scovery occasioned much dis-

1839,] Medical Intelligence. 699

cussion and debate. J, however, enjoyed the rare opportunity of inspecting^
the portfolio of M. Daguerre, through the kind attentions of Mr. Walsh, by
whom I was introduced. Whilst examining the unique productions of M.
D.'s portfolio, and listening to his explanations, 1 felt as in the presence of
a superior power. Among the principal productions of this new process pre-
sented to our admiration, 1 must mention 1st, a view of the great gallery join-
ing the Louvre to the Tuilleries; 2d a view, of I'Isle de la Cite, and the Tow-
ers of Notre Dame ; 3d, views of the Seine, and several of its bridges; 4th,
views of some of the Barrieres of the Capital ; 5th, views on the Boulevards;
6th, interior of the Chambers, with statuary, furniture, &c. These designs
were of different epochs, from four years to four weeks, and were done at
different seasons, and at various hours of the day, some by the light of the
sun, some during a shower of rain, and some within door with a moderate
light ; nothing could equal the beauty, accuracy, and perfection of these de-
signs, which were equally magnificent when viewed by a magnyfying glass,
especially all immoveable objects. The process will not succeed with objects
in constant motion ; as an example, we observed a pair of carriage horses,
in which one of the animals was headless, that part having, been in contin-
ual motion. In answwer to my question, what time was required for the
entire process, M. D. stated that he could prepare his sensitive paper in two
hours, and complete the design in from five to ten minuter, or, continued
he, "I only prepare the paper, and hold it up to nature, and she executes the
drawing."

The time necessary for the execution of a view, when a great power of
tone is expected, varies with the intensity of hght, consequently the process
is affected by the seasons, and even by the time of day, and by climate ;
in Egypt, for expample, a view could be executed in one-third less time.

The process of M. Daguerre not only exacted the discovery of a substance
more sensible to the action of light than any hitherto known to philosophers
and chemists, it was also necessary to possess the means of depriving this
substance of this new property at v.-ill, and M. D. has the merit of accom-
plishing this also. When his designs are once completed, they may be ex-
posed to the direct rays of the sun, without undergoing any alteration. The
extreme sensibility of M. D's, preparation is not the only character which
distinguishes his discovery from those imperfect attempts formerly made to
draw profiles on a layer of muriate of silver, which salt being white, is black-
ened by exposure to' light, the white portions of the images becoming black,
whilst the black portions on the contrary, remain white. Upon the prepared
screens of M. D the drawing and the object are both similar the white
corresponding towhite, the demi-tints to the demi-tints, the black to the
black.

To demonstrate the extreme sensibility of M. D.'s preparation, he has
succeeded in producing an evident white impression from the image of the
moon, thrown through the focus of a moderate lens upon one of his prepared
screens. A similarexperiment was once made with the muriate of silver,
without any effect, by MM. Laplace, Arago, and Mains.

The modus operandi in producing these designs, when the paper is once
prepared, will be readily understood by all who are familiar with the came-
ra obscura originally invented by Porta ; every one has admired the neat-
ness, truth of colour, form, and tone, with which exterior objects are repro-
duced upon the screen placed in the focus of the large lens which constitutes
the essential part of this instrument, and have admired only to regret that
these beatiful impressions could not be preserved. These regrets, together
with the poetical expression "fleeting as a shadow" are henceforward
without an object M. D. having invented an artificial retina upon which
the optical image leaves a perfect and lasting impression ; or, in the lan-
guage of M. Arago, "in the chambre noire of M Daguerre, light itself reprodu-
ces the forms and proportions of exterior objec ts with a precision almost ma-

706 Medical Intelligence. [August,

thematical, the 'photometric al relations of the various white, black, and
gray parts, are exactly preserved, but the red, yellow, green, &c., repre.
Bent the demi-tints, for the new method creates designs?, and not coloured
pictures."

But, such designs ! There is nothing in the arts that bears any analo-
gous approach to them ; the watOi- is real water, the sky and clouds repre-
sent realities, the perspective and shading are the perfection of nature.
The invention of M. Daguerre is the result of the assiduous application and
labour of many years, during which he had as collaborator, M. Niepee, of
Chalons-sur-Saoge, recently dead. Some reclamations as to priority have
been published by Mr. Talbot, of London, but he has failed in establishing
his pnority, and results of his process are not similar lo those of M. D.; in
Mr. T.'s impression the white portions of the image are black, and the black
are white.

I regret to add that this inimitable porlfolio of M. Daguerre, together with
the splendid painting constituting his diorama, was reduced to a mass of
smoking ruins in three days after our visit; the premises took fire at 2. P. M.,
whilst M. Daguerre was onja visit to^Professor JMoss's, exammmg his Electro-
Magnetic Telegraph, and as M. D.'s property was not insured, his prospects,
at present, are ruinous.

My object in the present letter being to communicate results, rather than
details, 1 must noi enlarge further on other numerous and interesting me-
moirs presented to the Academy of Sciences; there is no subject, more or
less related to science, that does not, some time or other, come under dis-
cussion at its seances. A curious fact was stated recently in a statistical
memoir, viz ; only one case of disease out of thirty occurs among the pros-
titutes of Paris one of the happy results of the sanitary laws, which
exact a weekly surveillance of medical inspectors; but even this three
and a half per centage is enough, in such a town as Paris, to fill two
large hospitals, and the disease in question is indubitably a prevalent one
among the "gentlemen" of Paris. These, probr\bly, obtain this proof of
"attachment" from a class of society "above suspicion."

An "epizootic" or epidemical disease prevailed among the cows last winter
in the neighbourhood of Paris ; it was characterized by a contagious, vesi-
cular eruption on the udder ; it formed the basis of several memoirs of the
professors of the Veterinary School at Alfort. The disease was never fa-
tal, nor did it communicate any deleterious qualities to the milk, and it ia
only referred to now to show how much attention is paid to this interesting
department of science by the savans of Paris. It is also recorded that the
cows at Passy have recently been affected with the "cow-pock." The op-
portunity of fresh revaccination was improved with happy effect, he vaccine
thus obtain being much more active. The question was started also whether
or not the cow was originally affected with this disease by inoculation from the
human subject. I presume the experiment will sooner or later be made to
inoculate the cow with the natural small-pox matter, and the modifying
results noticed. We often listen to instructive memoirs on comparative
anatomy, (especially fossil osteology,) geology, geography, rural economy,
&.C. &.C,, which, together wiih a very important memoir on the diseases
of the silk worm, which destroys millions of worms in this country and
which consists in the growth or developementof a species of cryptogamous
vegetable of the genus Muscardine the subcuticular adipose matter of
the worm we must refer to another opportunity.*

* Inasmuch as silk culture appears to have taken root at last in our country,
and will soon, no doubt, add greatly to its agricultural resources, I may here re-
mark, that excellent memoirs on the Mvscardine, by Professor Audouin, have
l>eea communicated to the Academy of Sciences, and which were subsequently

if^sn.]

Medical IntelUgencc. 701

Parisian hospitals and French surger}' might be presumed, a prion\ to be
the first objects of attraction to a practical surgeon ; but I connot but con -
less that a longer acquaintance with them, a more extended course of in-
vestigation, and a more familiar intercourse with their most eminent teach-
ers of surgery, have in no small degree lessened the admiration with which
I once viewed the eclat generally attributed both_ to the men and the in-

pnblishcd in the "Annales des Sciences Naturelles" for October and November,
1837, January, 183S, and in the "Compless Rcndus" for llie 22J April, 1839.
M Bassi, of Lodi, was the first to announce, in IS35, the cause of this pestil-
ence, so long the dread of the silk cultures of Italy and the Sonth of Fiance.
When a colony of this useful insect is attacked, its ravages are instantaneous
and general; none of those attacked have any chance of es<ape.

After numerous experiments, M. Audouin lias arrived at the follo'^^ing con-
clusions, viz.:

" 1st. That the Muscardine may be spontaneously developed, and in all pla-
ces, when certain combined circumstances favour this development.

'2d. That it is not a disease confined to the silkworm, but that it is general,
and may be exclusively peculiar to the class of injects,

"3d. That the disease, or Muscardine, may be propagated not only from silk-
worms to insects of very different species, but that, havingf spontaneously ari-
pen among one ofthese species, it may, when transmitted to the silkworm, pro.
duce in them the same disease which shows ilselt in silk establishments, (mag-
naneries,) and which is designated under the name o^ 'Muscardine.''

"4th. That during this transport, which may be indefinitels varied by opera-
ting upon insects of orders, families, genera, and species, different or alike, the
cryptogamous plant, and tlie disease which it produces, experience no change.

" 5th. That if the dissemination of the sporules in the air, be the means which
nature employs for the reproduction of the plant, its artificial devlopement may,
nevertheless, be produced by inoculaiion of certain of its parts its ' ihallus,' for
example in the adipose tissue of the insect ; that is to tay, in the same soil in
which the sporules have already vegetated.

* 6ih. In fine, by this artificial mode of infection, the cryptogame invades the
adipose tissue much more rapidly, which occasions more promptly the death of
the animal."

^Subsequently, the following letter from a well-known agriculturalist, M. Poi.
debard, of the department of the Rhone, was communicated to the Academy
of Sciences: "There has resulted from the repealed experiments and obrerva-
tions which I have made in my magnanerie, (silk establishment,) a very impor.
tant remark, viz.: ^ magnanerie, ^v,nu2A\y infested by the Muscardine, may,
nevertheless, be made lo yield a goood harvest, by anticipating the period of
the invasion and development of the disease by accelerating the education
of the worms, which will allow them time to finish their cocoons before the germ
of contagion has made progress enough to occasion a general mortalitv.

" The following are the experiments on which my opinion is founded :

"1st. The silkworms of the white race, named iSina, whose term of existence
docs not exceed thirty days, reckoning from birth to the completion of the co-
coon, have been constantly less injured than those of the jpZiOip race, whose term
of existence extends ten days longer.

"2. The most precocious of the worms of the white race, were in no way afTec
ted by the disease.

"3J. Those a little tardy were affected, in small numbers.

"4lh. The more backward perished in much greater proportions.

5lh. "f^inally, the yellow silkworms, much more tardv, W3re nearly all destroy-
ed."

It has been incontestably proved, that contagion is one of the most constant
characters of the Muscardine.

I am convinced, Messrs. Editor?, that you will not consider the above extracts
foreign to the purposes of a medical journal ; you know too well the extent to
which the investigation of the diseases of the inferior animals has tended to the
elucidation of the philosophy of life and disease in our own species.

702 ^. Medical Intelligence. [August,

stitutions. It is true, wo cannot two much admire the long-continued and
laborious aj)plication by which they have attained perfection, as anatomists,
and the consequent manual dexterity in operationi?', so universally admitted
as a distinguisiiing characteristic of French surgeons, and here their dex-
terity or superiority ends. Not only so : this dexterity itself has been ob-
tained at the expense of principle, and at the expence of li e ; thousands are
annually consigned to a premature grave by operations not always necessa-
ry to be performed at all, or improperly timed, or performed in cases that
must terminate fatally, with or without operations. The mortality oc-
curring at the Hotel Dieu, perhaps one of the best, is absolutely frightful
in amputations alone ; the surgeons admit a loss of ninety-five per cent.;
and one of the internes admitted, that during his residence for one year at
the Hotel Dieu, not one case of recovery occurred after amputation ! I es-
teem M. Roux, the surgeon-in-chief of this extensive institution, as a per-
sonal acquaintance, and would not heedlessly detract from his hard-earned
reputation ; and in thus alluding to the results of my own personal observa-
tions, I have the interest of science only in view.

M. Roux possesses a grave, earnest, and decided character; but, like
most others of his profession here, he is over-fond of displaymg his manual
dexterity. I have heard him beseech a patient to submit to an operation, as
if it was the greatest favour conferred upon the operator; the operation
once performed, the patient is prettry much consigned to his fate, for the
after treatment of French surgeons 1 consider little better than no treatment
at all. The constitutional demands, the habit, diathesis, or idiosyncrasies of
the patient, are almost universally and entirely overlooked, and hence, to-
gether with the foul air of the hospitals, the dreadful mortality of these pest-
houses. On the very first coup d'cBil of the wards of these hopitals, no-
thing but disastrous consequences could be anticipated from one hundred
to one hundred and fifty human sufferers, crowded together, side by side, and
exhaling each the noxious effluvia peculiar to the gorgon form of diseases
which afflict the inhabitants of rooms constructed on the worst possible prin-
ciples for the purposes intended, and in which ventilation was not thought of,
and where classification of disease has never been attempted. The unhappy ef-
fects of afoul atmosphere, in cases of wounds, are familiar to every profession-
al reader, as a remarkable instance of which, we may refer to the Dutch army
at Batavia when attacked by the British nav}-, when every case of solution of
continuity, however slight, resulted in grangrene. As a lecturer, M. Rouxis
animated, though by no means eloquent. During a privated interview I
held with him at his house the other day, he complained seriously, and la-
mented the state of French surgery of the present day in comparison with
its former state ; no one surgeon now he said, could obtain half so many
operations as formerly, there w'ere so many hospitals, and then each institu-
tion was "si partage," "si isole,," there being eight or ten surgeons to each,
and then almost every department of surgery being pursued in particular by
some surgeon of eminence, that but few opportunities, comparatively, were
left now-a-days for the surgeon of a general hospital to show his skill. Only
seven cases of lithotomy occurred in his own wards last year. Thus the dis-
eases of the eye, the ear, hernia, club-foot, afTections of the bladder and uri-
nary organs, venereal disease, &c. &c., have each a hospital devoted exclu-
sively to themselves. M. R. is on the most familiar terms with his patients.
In going his daily rounds from 7 to 9 A. M. he has always something funny,
encouraging, or coaxing, to say to them all ; for one he has a poke in the
ribs with his finger, for another a box on the ear, fec. I have seen him
make a convalescent reel with a blow on the side of his cheek, for asking
him for something good to eat all in the best possible humor. He some-
times becomes very affectionate, and kisses a patient on whom he has just
inflicted a severe operation ; and this salute, the students sa}', always prog-
nosticates the death of the sufferer.

Medical Intelligence. 703

M. Roux mentioned to me Physick, Warren, and Mott, as the only Ame-
rican surgeons with whom he was acquainted ; and judging from them, said
he wondered at the large and rapid fortunes tliat were accumulated by Ame-
rican surgeons a consummation which he feared would never attend the
efforts of Parisian surgeons.

In person, Al. Roux is rather beneath the ordinary stature, of a sanguino-
phlegmatic temperament features blunt and ill-favored one eye projects
from Its socket, and has a cast in it. When earnest in discourse, his coun-
tenance is especially contorted.

Dr. Blandin is also attached to the Hotel Dieu. He has lately been coax-
ing his stumps to heal, by the application of warm air after amputations,
the stump being enclosed in a glass caisse, and air heated to the natural
temperature of the body caused to pass constantly through it, is left without
further dressing. Healing by adhesive inflammation, until within the last
few years, was unknown in Parisian hospitals ; from time to time some of the
surgeons have attempted the adhesive process, but they are by no means
fully aware of its importance. These stumps appeared to be granulating
well, which may probably be accounted for by the simple circulation of air
thus artificially produced. He has not yet published his results. It appear-
ed to me rather an empirical practice.
Previously to leaving the Hotel Dieu for the present, I must allude to Pro-
fessor Breschet's method of operating for the radical cure of varicose veins.
Your professional readers are already familiar with the construction of his in-
strument, consisting, briefly, in two parallel pieces of steel, brought togeth-
er by screws, so as to press upon the included veins ; the pressure is contin-
ued for several days, the patient keeping his bed ; the integuments included
above and below the veins slough ; the veins are involved in the inflamma-
tion, and their sides adhere, obliterating their calibres. I have seen but one
case involving the cord on both sides, in which the cure was apparently com-
pleted, the instrument being used on one side at a time.

On contrasting this operation with the method practised by M. Velpeau,
of La Charite, I gave the preference to the latter; it is less tedious, less
complicated, less dangerous, and, what is no inconceivable advantage, it is
applicable to enlarged veins in any part of the body. M. V.'s method con-
sists, simply, in passing a strong needle beneath the vein, and applying a li-
gature in circles, and not the figure of eight ligature. In a few days numer-
ous veins are thus obliterated.

I have not been so forcibly impressed with any surgical improvement,
since my arrival in Paris, as that of the treatment of fractures on the plan of
Suetin and Velpeau, by means of " Dextrine'^ bandages. In my opinion,
nothing but prejudice, superannuated or personal, can prevent the universal
application of this method by all who are acquainted with it. Some of the
Parisian surgeons have thus neglected it. At La Charite all other plans
have long since been banished ; and Velpeau and his assistants deserve
much credit for the very great dexterity with which they so successfully
treat all cases of fracture. There is, at present, a patient under treatment
for fracture of the tibia and fibula, who was permitted to walk the ward in
five or six days after its application. The same occurred since our arrival
here, in a case of fracture of theos femoris, where the patient w^alked in 15
days after the application of this bandage. These precocious efforts in si-
milar cases are not, however, advisable. Its application to the treatment of
fractured thigh is more effectual than any of the other methods, besides being
so much more agreeable to the patient, and so much more speedy in its re-
sults, and so little troublesome to the surgeon, one single application being
generally sufficient, especially if, before applying the bandages, sufficient
time is allowed to permit the subsidence of all tumefaction ; for this pur-
pose, the patient is permitted to rest in any easy position for three or four
days, when, if the bandage does not become loosened by the subsequent

704 Medical Intelligence.

atrophy of the Jirnb, a single application will suffice for the cure but even in
case of reiterated application, it is less troublesome than the usual method.

The followinof is Velpeau's method of application in fractures of the oa
femoris : the limb is in the first place enveloped in a common roller ; a piece
of bandage is then crossed over the ankle, for the purpose of extension, and
over these is placed another roller, throughly impregnated with the prepared
paste ; compresses of coarse paper, similarly soaked, are applied over the
Iracture, and other prepared rollers applied over these, coarse paste-
boad compresses, softened by similar soaking, are also applied, and kept in
position by other rollers. The extension is now made by tying the bandage
from the ankle to the foot of the bedstead, (which are all of iron in these
hospitals,) and counter-extension is made by a strap passed between the
thighs, and made fast to the bebstead above the head. The bandages har-
den m fevv hours, and the limb is incrased in a solid coat of mail.

Experiments have been made with numerous adhesive materials, such as
starch, glue, paste, gum, &c,, as substitutes for the, ''Dextrine" bandages
now used exclusively at La Charite, all the others having been proved less ef-
fectual ; gum arabic bears the nearest approach to it, but this is too expen-
sive. The "Dextrine" is made by boiling starch in dilute nitric acid, and
when separated from the liquor and dried, the powder costs about thirty
cents a pound. One great advantage which this powder possesses over
starch is, that it may be made into a paste v/ith cold water, the former re-
quiring boiling water. A very excellent and cheap substitute for linen or
muslin bandages has been found in coarse paper, cut into suitable length and
breadth, and soaked in this paste previously to their application ; there can
be nothing more effectual than a Scultet's bandage thus applied, a method
of economizing by no means beneath the notice of Parisian hospital sur-
geons, especially since a recent ordonance of government, which obliges
them to substitute paper for linen compresses the savings thus accruing to
be devoted to the gilding of that magnificent temple, the Madeleine church!
A more detailnd account of this "Dextrine" may be found by referring to
"Orfila's Chemistry."

M. Velpeau has been most unfortunate in the loss of patients in La Cha-
rite, in which hospital the mortality has been greater than in any other estab-
lishment. In addition to the usual causes which have gained for this hospi-
tal so mortifying a distinction, there has prevailed during the last winter
and present spring an erysipelatous diathesis, which has desolated its W'ards,
so that a puncture of a nail, the simple operation of extirpating a small
ganglion from the neck of a healthy subject, the operation for the radical
cure of varicocele, and amputations of all kinds, fractures, &c. I have seen
terminate fatally in numerous cases ; and yet M. Velpeau continued his
operations, and appeared astonished himself at their want of success, and is
far from taking advantage of the best means of averting the evil; his con-
stitutional treatment is worse than nothing. A patient was admitted with a
wound in the heel by a nail ; erysipelatous inflammation followed, and was
continued to the ankle-joint, producing suppuration, irritation, and death.
No measures were resorted to in order to rally the powers of a broken con-
stitution ; and in the autopsy and lecture on this subject, M. V. expressed
his inability to explain his want of success in the treatment of the case, and
viewed the death of a patient from the simple puncture of a nail as an oppro-
brium to surgery ! But human life, it is said, is of very little account with
French surgeons. M. V. operated five times successively for disarticulation
of the knee, and in every case his patients died.

SOUTHERN MEDICAL

AND

SURGICAL JOURNAL.

VoL.IIL] SEPTEMBER, 1839. [No. 12.

Part L ORIGINAL COMMUNICATIONS.

ARTICLE I.

A Treatise on Congestive Fe^ver, by A. B. Arnold, M. D.

of Lowndesmlle, Abbeville District, South Carolina.

In treating of Congestive Fever, I shall undertake to describe
the disease as it prevailed in Abbeville District since the sum-
Hier of 1832, and the mode of treatment which was found, from
experience, to be best adapted to it. In order that my views
may be better understood, I shall make a few physiological ob-
servations, as the basis of the Theory which I shall adopt in re-
lation to the disease. I shall assume the ground, that every
fibre of the body is endowed with a principle called irritability,
and that the application of appropriate stimulants to this prin-
ciple produces life and health to the degree that we enjoy it
and that these stimulants act upon what are called the surfaces of
relation, that is, the external and internal surfaces, and that these
are internal or secondary stimulants, namely, the different fluids
of the body, and that a very important stimulus of this class
is the electric fluid, which is transmittted from one point to ano-
ther through the medium of the nerves, and it is by the instru-
mentality of this fluid, that all the sympathetic relations are car-
ried on, and that it controls the circulation of the blood, and in
this way is of most importance both in health and disease. Bu^t

706 Treatise on Congestive Fever. [Sept

at the same time, as its production depends upon a free circula-
tion of blood, it may be increased or diminished according to
circumstances, and in complete congestion of any of the vital
organs, death is inevitable. Health then is the result
of the application of the appropiiate stimulants of life to
the irritable fibres of the body, and in the diseased econo-
my of the system many of its derangements denominated dis-
ease, are owing to an inordinate application of proper stimu-
lants to particular parts, deranging that proper balance of ex-
citement, w^hich is necessary to keep up healthy action. But in
most violent cases of actual disease, the system has been first
subjected to the action of some deleterious or noxious agents
which have created morbid action in parts most susceptible of
impressions from such stimulants and through the instrumental-
ity of the nerves these impressions are transmitted to other parts
of the body, to the brain first, and to those parts next which
sympathize most strongly with the parts originally affected, it
being a law of the animal economy that parts of similar struc-
ture sympathize most readily, and that the nerves transmit im-
pressions to different parts of the body precisely of the same
character of thoj^e which exist in the parts primarily affected.
Thus it is that the peculiar impressions made by the action of
the matter of contagious diseases, are transmitted to diflferent
parts of the body, and in further proof of this fact, we have it
from unquestionable authority that in cases of very high degree
of excitement of the kidneys, other parts have been brought un-
der sufficiently strong sympathetic action, to secrete a fluid pre-
cisely the same as that secreted by the kidneys. It follows then
that the system is governed by the same laws both in health and
in disease, and that the nerves are made to transmit healthy im-
pressions in the one case, and diseased impressions in the other.
It may here be necessary to observe, that there is a strong ten-
dency in the system to keep up healthy and peculiar action in
the diflferent structures, thereby continuing a proper distribution
of blood and excitement through the system. When any "part
of the body is subjected to inordinate or inappropriate stimu-
lants of sufficient strength to produce increased or irregular ac-
tion, other parts of similar structure will soon be involved in the
same sort of increased and diseased action, whilst other parts
will be left with deficiency of action. These principles in the

IS39.] Treatise on Congestive Fever. 707

economy of the system being settled, they will serve as land
marks in searchinp^ into the causes and effects of diseases and
conduct to both a rational theory and a rational practice.
Before I say any thing of Congestive Fever, particularly*
it may be proper to make a few remarks on the group
of symptoms denominated fever. Fever consists in an un-
equal distribution of blood attended, consequently, with in-
creased heat and action in some parts, and diminished heat and
action in other parts, creating irregular action in the heart and
arteries, and showing already that the whole derangement com-
menced in local irritation, and it is obvious from the principles
laid down above, that the local irritation will soon be followed
by more or less congestion at the point of irritation, and that
this determination of blood, if continued, will soon produce that
continued distension of the bloodvessels and painful state of the
nerves called inflammation, which in its turn becomes a great
airgravating cause. Thus it is easy to perceive that the action
and re-action of cause and effect has a tendency to keep up dis-
ease, which would take life in every instance, were it not for that
law of the animal economy, the tendency of which is to keep
up and maintain that balance of excitement between the parts
which is calculated to give health to the whole, there being a
tendency in every structure of the body to take on and continue
that action which is peculiar to its structure. It would appear
then, as Fever consists in increased and wrong action
in some parts of the system, that the plain indication of cure is
to equalize and alter the excitement by remedial agents so far
as to give the natural recuperative powers of the system
the advantage over the disease. The mode and manner of ef-
fecting these objects may depend upon circumstances. If the
disease is established, it is rational to commence by depletion
and other means of abating excitement, but if in a forming
stage, it may be done by remedies which have a revulsive effect,
sufficiently strong to overcome the centripetal tendency which is
given to the blood by internal irritation. These are the obvious
conclusions from the history of life as laid down above. To these
views of stimulants and irritability in the phenomena of life,
our minds are limited by that law of our nature which speaks
in the positive language, "Thus far shalt thou go and no farther."
We must view man as he is presented to us in the full posses

708 Treatise on Congestive Fever. [Sept

8ion of all his faculties, and confine our reasoning to the opera-
tions of causes and effects upon his material part, as far as
we can understand the laws by which they are governed. It
next becomes necessary to notice the peculiarities of Congestive
Fever. I regard Congestive Fever as nothing more than a pe-
culiar form of the Inflammatory and Typhoid Bilious Fevers of
our country, which peculiar form or character is entirely attri-
butable lothe operation of the predisposing cause upon the sys-
tem. I shall not pretend to say what this peculiarity in the pre-
disposing cause is, but shall content myself with referring mere-
ly to the fact, that during the prevalence of any epidemic, the
system is known to be under the influence of some pecuHar
cause which gives identity of character to every disease which
may happen to invade the system at that time. It is clear,
therefore, that the cause of diflference between this and other
fevers, must be the peculiarity of the predisposing cause of the
epidemic; for I deem it unnecessary to say that the exciting
cause cannot give character to any fever. It appears, then, that
the only peculiarity which I contend for in this variety of fever,
is the greater degree of congestion, admitting the seat of conges-
tion to be the same as in other Inflammatory and Typhoid Bil-
ious cases, that is, the internal capillaries and the important
glands, and that different points of the system are liable as in
other fevers, to become the principal seat of the disease owing
to the peculiarity of the predisposing cause, particular struc-
tures, showing their greater susceptibility for particular stim-
ulants.

Symptoms. This fever, like other bilious fevers, assumes at
one part of the season, the intermittent, and at another the re-
mittent, though during the whole season the one or the other
type will generally prevail. The only marked diflference that I
first discovered in the bilious fever of this neighborhood in
reference to the form of fever now treated of, w^as an increase
of the symptoms indicating congestion, and which rendered the
fevers much more difficult to treat than formerly. Having wit-
nessed variations in the character of bilious fever before in re-
gard to the organs most liable to suffer throughout whole sea-
sons and sometimes a change from an inflammatory to a typhoid
type, I at once ascribed the change, as I had done on former
ODcasions to a change in the character of the predisposing cause.

1839.] Treatise on Congestive Fever. 709

The fever was ushered in very much like other bilious fevers,
but during the hot stage, I discovered that the re-action was
much less perfect than in common bilious fever, the skin al-
ways remaining cold from the hips down, and hot and bathed
in perspiration from the hips up throughout every paroxysm, at-
tended, generally, with a dull heavy head-ache and with a ra-
ther more purple appearance of the skin in the upper part of
the system, showing it more perceptibly under the eyes than
any where else, great restlessness during every paroxysm, and
anxiety with short breathing, and sometimes complaining that
they could not breathe from the bottom of their lungs, redness
of the eyes, watchfulness, and a great tendency to delirium in
the inflammatory cases. The bowels were very costive, or
had a great tendency to watery stools. Every thing except
calomel, or a purge containing mostly calomel, or preceded by
a large doze of calomel which had been suffered to lie sometime
in the system, generally produced copious watery discharges,
amounting in some cases, to what may be called serous haemorr-
hage. It was always difficult to procure secretions from the
liver, but they were always attended with relief when they were
obtained. The pulse during the first paroxysm, with some ex-
ceptions, did not exceed in frequency 100 to 110 beats in the
iliinute, but, if the disease was not arrested, it increased in
frequency every day, always intermitting during the paroxysm,
and after a few days, at all times. After two or three days, un-
less a manifest impression was made upon the disease, the
pulse would increase to 120 or 130 during the paroxysm, and
sometimes to l50, or soquickihat the beats could not well be
counted. The tongue exhibited pretty much the same appear-
ances as in ordinary bilious fever varying in redness according
to the degree of gastritis which attended the case. This
inflammatory type of fever continued for three years, with
very little change, when it gradually assumed a typhoid type.
Symptoms, The colour of the skin was of a more leaden
hue than in the inflammatory cases, the pulse much quicker from
the beginning; this form of the disease was more apt to termi-
nate suddenly than the other. By far the most fatal form of
this fever, was the intermittent type, and was most apt to be
mistreated, the chill in some cases was so slight, that it passed
unobserved by the nurses, it only showing itself by an increase

710 Treatise on Conge stive Fever. [Sept'

of coldness in the extremities, which were cool before, and of
the nose. If the type of the disease was not changed, it gene-
rally terminated fatally in a few days, sometimes on the second
or third day, and when the brain was the principal seat of the
congestion, the patient would lie in an apoplectic state during
the paroxysm. It is the typhoid character of the disease, and
especially when the type was disguised, that has struck the
community with the most terror, on account of its most sudden,
and in many instances, unexpected termination in death.

The tongue, when the disease had run on for some time, was
coated with a darker fur than in the more inflammatory form of
the disease, though in some instances, it was slick and shining,
where there was more gastritis attending. It was generally
tremulous, the skin was not so hot as in the other description of
cases during the paroxysm, and after the heat subsided, a cold
perspiration would continue for some time. In some particu-
lar cases, the pulse was not much increased in quickness from
what was natural in health, the veins looked blue and distended,
which, however was more orless a symptom in all the cases,
and the circulation seemed languid. It was not attended with
that pungent heat which belongs to Typhus fever, nor were the
end and edges of the tongue generally so red, especially in the
onset of the disease. In the cases where death took place early
in the disease, the patient seemed to die entirely of congestion;
and I have often heard the remark, that they died, apparently,
without sufficient cause. In some cases there were no symptoms
of delirium until the patient was thought to be dying, and in-
deed, during the forenoon, one inexperienced in the disease
would suppose there could be no danger in the cases. But af-
ter a while the finger nails would assume a blue appearance,
and the nose, feet and hands, become a little colder. At this
time frequent sighing would commence, and after a while an at-
tempt in the system to re-act attended with great restlessness
and difficulty of breathing, and after a while a little wandering of
the mind, the pulse would become smaller and more thread-like
and in a few hours imperceptible, whilst in many cases the dy-
ing patient would converse rationally on the subject of his ap-
proaching death, occasionally using an idle word or two, the
bowels were sometimes disposed to secrete water and generally
made a gurgling noise. The liver was in some cases extreme-

1839.] T/ealise on Congestive Fever. 711

ly torpid, it being impossible to act upon it before the patient
would die, where the proper treatment was omitted in the onset
of the disease. In the fatal cases the first symptom of death
was indicated by the tongue becoming pale, and being very
much inclined to lie where it was pushed about with the fingers
suffice it to say, that the only difference which I could disco-
ver between congestive fever and the common inflammatory
bilious and bilious typhoid fevers of this part of the
country was in the degree of the congestion. 1 consi-
der congestive fever a variety of bilious fever because it disap-
peared at the appearance of frost, independent of the similarity
in symptoms between it and common bilious fever, the winter
diseases, however, showed the epidemic tendency to congestion,
but in a much less deG:ree than the summer fever.

Treatment. It appears obvious that as the causes of inflam-
mation are essentially stimulating to the parts which constitute
the seat of the disease, that the most appropriate remedies must
be depletion, abstinence, and counter irritation, together with
other remedies which act revulsively. It may be asked if stim-
ulants and tonics are not sometimes used to advantage
in the treatment of inflammatory diseases? In reply to
which I would say from the theory I have laid down I infer,
and I may add that experience bears me out in the assertion,
that when stimulants are introduced into the treatment of any
disease, their operation being to force the powers of life, they
have a direct tendency to increase the disease, and if in any case
a salutary effect is obtained from them, it is by making a strong
impression upon the whole nervous system, and thereby increa-
sing the natural powers of the system in gaining a due balance
of excitement and in this way local diseases of weak action may
be overcome. But not so with any considerable inflammation
of delicate structures. When the principal local affection is
seated in parts distant from those organs which are called vital,
or in organs which are not endowed with great sensibility, and
most especially where the brain is not much concerned in the
disease, something may be done with stimulants j as a case
in point, the eruption in scarlatina and measles, may be mzun>-
tained upon the surface, and the disease cured by the use of stf^
mulants and so may stimulants at all times be successfully ap^
plied in local inflammation of particular tissues especially of the

"^12 Treatise on Congestive Fever, [Sept.

skin. But who would think of using stimulants either locally
or internally, in cases of acute inflammation of the eyes, or brain,
or any of the delicate structures which are endowed with a
high degree of sensibility, until it has been so far reduced as to
depend upon debility in the vessels concerned. Now as Con-
gestive Fever is attended in most cases when fully formed, with
considerable inflammation of the mucous membrane of the sto-
mach and the bowels, it is clear that stimulants are inadmis-
sible unless it be such as promote the secretions from the parts
diseased and thereby do more good in the way both of depletion
and alteration than they do harm by their stimulating effect.
Such may be said to be the effect of all the medicines by which
we deplete the system, but when properly selected to suit the
case, the slight stimulating effect is sogreatly overbalanced by the
beneficial effects of depletion, alteration and counter irritation,
that it may be regarded as a matter of no consequence. But
at the same time great caution is necessary in selecting the re-
medies. Stimulants and tonics then are improper remedies for
inflammation unless under particular circumstances, and they
may be regarded equally so in congestion. For if it be true, as
it doubtless is, that congestion is produced by an increased flow
of blood to a particular set of vessels in greater quantity than
the vessels are able to circulate and in this way become choked
up, and that the cause of this is local irritation, or at least the
cause of its continuance in all cases when produced, it is cer-
tainly a fair inference from the principles laid down in the com-
mencement of this essay, that stimulants will aggravate the lo-
cal irritation as well as increase the general excitement, and if
they fail either to overcome the irritation or to enable the ves-
sels to unload themselves, they must aggravate the disease, and
I feel authorized in saying, from what I have seen and observed,
that the powers of life cannot be sufficiently forced, or in other
words the natural action of the system cannot be sufficiently
forced to do either, where either exists to a considerable degree.
As a case in proof, I appeal to every Physician of experience to
say if he has not often known congestions of the liver confirm-
ed by the imprudent use of quinine, and thereby a foundation
laid for other chronic derangements of the digestive organs,
and if this is doubted, let them look to the drunkard, and from
bim they will learn how certainly the free use of ardent spirits

i

1839.] Treatise on Congestive Fever. 713

will keep up when once produced, or even excite and continue a
congestion of the liver, and all its frightful train of consequen-
ces. I shall regard it as settled that stimulants, properly so
called, and tonics, are improper remedies in congestion as well
as in inflammation. It follows then, that the remedies most pro-
per in Congestive Fever, are of an opposite character, to wit:
depletion, abstinence, counter-irritation, and sudorifics.

Venesection. I regard blood-letting as a highly useful reme-
dy in all cases of acute inflammation, and equally so in conges-
tion, if resorted to early in the disease. Its best effects are to be
obtained in the forming stage of either, and more especially of
the latter. After congestion is fully established, its effects be-
come much more equivocal, and in some cases highly injurious.
The best time for drawing blood, is during the first paroxysm.
In many cases, the second, and in some the third uill answer
the purpose, but seldom afterwards. By the timely use of this
remedy the congestion is prevented either altogether, or so far
that it may be easily managed afterwards when followed imme-
diately by other proper remedies. The propriety of bleeding
during the cold stage is doubted by many. My experience is, that
whilst the system is not yet oppressed, it may be resorted to
with great propriety, but should be immediately followed by
warm sudorifi(!s. 1 have seen some of the best efl^ects when
used in this way, that I have ever witnessed from the remedy
under any circumstances in almost completely breaking up the
disease, but I must say that I have sometimes attempted it when
I have been obliged to stop the blood immediately, and resort to
warm drinks, and would therefore recommend when the system
is much oppressed, and there is reason to believe that the con-
gestion is pretty well established, to prefer the hot stage for the
bleeding, and if the congestion is fully established, and has been
so for a day or two, it would be well to om't the remedy altoge-
ther. The quantity to be taken, and the repetition of the bleed-
ing, are circumstances that must be left to the judgment of the
practitioner at the time. Bleeding freely is more necsssary in
some instances than in others. But there is one thing that I can
with propriety say from my experience in treating the inflam-
matory form of the disease, and that is, I could always cure my
patients, in less than half the time, that had been bled early in

#

714 Treatise on Congestive Fever, [Sept.

the disease, than it required to effect a cure where the remedy
had been altogether omitted. My experience also bears me out
in testifying, to the importance of cupping and leeching in relie-
ving local affections. I would earnestly recommend to all phy-
sicians when called to a case of Congestive Fever, to pay the
next visit in time to be with the patient at the commencement of
the next paroxysm, so that no time will be lost in preventing mis-
chief by letting off* a little blood in time. If the pulse yields ea-
sily to pressure and is very quick, it may be regarded as too late
to bleed. The next set of remedies are such as promote secre-
tions from the elementary canal.

Cathartics and Alteratives. It will be perceived that I
omit emetics altogether in the treatment of Congestive Fever.
My reasons for doing so are that there is often too much gastri-
tis to admit of the irritation from an emetic, and I further consi-
der them illy suited to relieve congestion when formed, as their
operation is both too hasty and too prostrating, though in the ab-
sence of much gastretis, and in the forming stage of congestion
they might be used to some advantage, but the circumstances
admitting their use so seldom occur, that I consider them unsafe
remedies to recommend, especially in the inflammatory form of
Congestive Fever. But to proceed to the consideration of the
remedies under this head at once. My experience has induced
me to reject Tartar Emetic, even in broken doses as an altera-
tive, finding in most cases, too much gaslro enteritis to admit of
a favorable operation from it, and for the same reasons I object
to the Pulvis Antimonials or James' Powder. There seems to^
be a suitable relation, or proper adjustment between the inflam-
mation and the remedies to be used to relieve it, that ought to be
considered in directing our choice of suitable remedies. For it
will doubtless be conceded that there is a certain degree of ac-
tion that is favorable to proper secretion, and that any excite-
ment beyond that, has a tendency to alter or suspend it. Dras-
tic cathartics are also objectionable as tending to excite too
much, and produce serous discharges. It would seem from
what has been said under this head, that the gastro enteritis
was regarded as the main hydra of the disease, but it will be
recollected, that congestion has been stated to exist to an extra-
ordinary degree, and from what I have seen of the disease, I am
sure that I can safely venture the opinion that whoever expects

%

1839.] Treatise on Congestive Fever. 715

to cure Congestive Fever of any form, by attending to the in-
flammation alone, will be disappointed and subjected to much
vexation and trouble. Cathartics of a suitable character are
absolutely indispensable, and Calomel is decidedly the best of all.
After the bleeding, if it is necessary, a dose of Calomel and Jalap
generally operates the most favourably. It should be propor-
tioned so as to operate promptly and freely. I found that it had
the best effect in arresting the inflammation and congestion by
operating freely, and producing but little irritation. Whenever
I could see the patient in time to bleed and purge freely with Ca-
lomel and Jalap, before the inflammation or congestion arrived
to a certain stage, I always found with due attention afterwards
the patient was sure to recover.

In some cases where the bowels were disposed to watery dis-
charges, the Jalap was too drastic, but on the other hand heat-
ing cathartics, although not so liable to produce watery dischar-
ges, were too apt to aggravate or produce an obstinate state of
inflammation, I allude particularly to aloes, I found it in the first
stage of the disease objectionable in the form of Cook's pills. In
all such cases, I found Calomel alone the best, and that it was
better not to interfere with it by giving other medicines to work
it off* until it had time to alter that condition of the bowels. I
have known even two tea spoonfulls of castor-oil to produce a
dozen or fifteen watery discharges, if given before the Calomel
had lime to effect the proper change, whilst the Calomel when
let alone, had the most favorable efl^ect. The liver was always
difficult to operate upon in proportion to the length of time that
the treatment had been postponed. If the treatment had
not been commenced before the stage proper for bleeding had
passed over, and the congestion fully formed, it sometimes re-
quired enormous quantities of Calomel to start a secretion from
the liver and bowels, but death was inevitable without it, as far
as my experience goes. I have given in some cases upwards
of a hundred grains a day for the first two or three days of the
treatment, and I believe saved my patients by it, and I have no
doubt but that 20 or 30 grains a day would have been sufficient
if the treatment had been commenced in time. In all cases
where very large doses of calomel have been given, it ought not
to be worked oflf under something like fifteen or eighteen hours,
and more calomel should be given as soon as the first dose is fair-

716 Treatise on Congestive Fever. [Sept

ly worked off. A great deal is gained by keeping up the im-
pression for a sufficient length of time. Castor oii, or some mild
cathartic, is best to work offlarge doses of calomel, and whene-
ver it is necessary to give large doses, if the bowels are not too
irritable, Ipecac should be combined with it. In fact, I have al-
ways discovered that whenever Ipecac was admissible, much
less Calomel might be made to answer the necessary
purpose. It will bo observed, that I have supposed some obsti-
nate cases of congestion. I would remark at the same time, that
the size of the dose of Calomel, or the quantity given in the day,
must be regulated by the degree of congestion, for I have no-
ticed where there is less congestion, the same sized doses would
prostrate, that are found necessary and safe in cases of great
congestion, because there is much greater torpor of the system
in one case than in the other. As soon as the secretion is started
from the liver and bowels, and of proper consistence, as little
calomel should be used as will have the effect of keeping up the
secretions. I have known patients prostrated by eight grains,
given every fourth hour, when the patient had been doing well
under half the quantity for a day or two, and when the eight
grains had not purged any more than, the four grains had done,
but the prostration was occasioned by over irritation, when the
bowels were in an excitable condition, so that much depends up-
on the judgment and experience of the Physician in the man-
agement of such cases. It is only in cases of great congestion,
and consequently great torpor, that very large doses are proper,
but they are absolutely necessary in such cases. There is. how-
ever, one remark which I will make as the result of experience,
and that is that half the quantity of calomel will answer the ne-
cessary purpose when not worked off under fifteen or eighteen
hours, that will be found necessary if worked off in eight or ten
hours. I think much good is derived from the alterative effect
of the calomel, while remaining in the system, for that reason, I
prefer giving calomel in broken doses when the secretions are
once properly started. It will be necessary to look into the
mouth and throat every day, to seeif Ptyalism or mercurial ul-
cers can be discovered, and for fear of producing such effects I
would advise the calomel to be laid aside and some other cathar-
tic substituted, whenever the secretions of proper consistence
and appearance can be kept up without the use of calomel.

18S9.] Treatise on Congestive Fever. 717

This can be ascertained by the trial occasionally of such cathar-
tics as will not irritate much. My experience is, that after the
system has been pretty well brought under mercurial action,
even before Ptyalism has been produced, the calomel may be
dispensed with, and there will be no impropriety in trying it af-
ter the symptoms of congestion have sufficiently given way.
The purging must be kept up as long as the symptoms of con-
gestion continue, and as long as the secretions are much vitia-
ted. After the disease is properly established, I have never seen
a case cured without the discharge of a considerable quantity
of black secretions. This kind of secretion seems necessary
to relieve congestion, and is secreted by the bowels as well as
by the liver. It may be ascertained from which it has mostly
come by pouring water on it, if from the liver, it will give the
water somewhat of a yellow tinge, which will show itself on
the sides of the vessel and mixes with the water, while that from
the bowels will not. I must appeal again to my experience when
I say that Congestive Fever requires more purging than any
other fever with which I have ever been acquainted, that is, if
the disease is fully formed before the treatment has been com-
menced, and that the purging must be continued until every ves-
tige of the congestion is removed, even if it should be necessa-
ry occasionally to give the patient sufficient rest for the energies
of his system to recruit between the doses; otherwise if he gets
up, he will be liable to chronic congestions of the liver and di-
gestive organs. The greatest obstacle that lies in the way of
treating inflammatory congestive fever, is the inflammation of
the alimentary canal. It requires great caution to keep from in-
creasing the gastro enteritis, or perhaps it would be more pro-
per to say, it requires great caution in the selection and reg ula-
tion of cathartics, to cure the gastro enteritis which attends the
inflammatory form of Congestive Fever, whilst relieving the
congested organs, and I contend that the surest and best mode
ofcurinsj congestion is by purging; but in obstinate cases, whilst
the cure is advancing, much aid may be derived from the next
course to be mentioned, and that is.

Abstinence^ Rest, Dieting and Opium So far as abstinence
and rest may he regarded as remedial in the cure of Congestive
Fever, I would say that no reliance should be placed upon such
means, except as merely auxiliary; but it is proper to rest a pa-

718 Treatise on Congestive Fever, [Sept*

tient sometimes for a day or two in the course of the treatment,
if he should be in danger of being exhausted. Abstinence is ne-
cessary to abate excitement but cannot be relied upon in violent
cases. Inflammation, and congestion especially, must be arres-
ted speedily by direct abstraction of the causes of irritation, or
else the disease would often run on to an incurable state before
any benefit could be derived from abstinence. As well might
we talk of curing a violent attack of cholic by abstinence as to
cure by it a violent case of fever, and above all others Conges-
tive Fever. It is impossible that very high excitement, and
more especially congestion can be relieved soon enough in this
way to prevent fatal consequences in many instances. It is on-
ly suited to particular states of disease as an auxiliary means.
So far as dieting may be noticed in addition to what has been
said of abstinence, and as a necessary means of sustaining life,
like purging, it may be said to be indispensable, but should be re-
gulated to suit the case. In most cases of congestive fever, it
should be light and mucilaginous, to soothe and allay irritation
of the stomach and bowels, and thereby abate improper excite-
ment of the parts diseased, whilst exhausted nature is sustained
by it. An anodyne to allay diseased irritation, is highly benefi-
cial as soon as the inflammation and congestion is sufficiently re-
lieved to admit of it ; thus it answers a valuable purpose in al-
laying the irritation of an active cathartic or any other irritating
medicine. But more is necessary to be said of opium than mere-
ly to allude to its effects in allaying the irritation from a dose of
medicine. Opium, in acute inflammation attended with high
excitement, is inadmissible, on account of its stimulating proper-
ties. In congestion, it is objectionable both on account of its
stimulating properties and its known effects in suspending secre-
tion : nevertheless, it is not so objectionable in congestion as in
high inflammation, because simple congestion bears stimulants
better than inflammation, and its properties in suspending secre-
tion may be counteracted in most cases by combining with it
other medicines. I have found opium in congestive fever, as
well as in other fevers attended with much irritation, as a valua-
ble remedy so soon as the inflammation is sufficiently abated to
admit of it; but I must say, that I regard it a very dangerous
stimulus in the early stage of the inflammatory form of conges-
tive fever, and indeed I found every thing dangerous which was

1839.] Treatise on Congestive Fever. 719

calculated to excite, and which did not act sufficiently, by way
of promoting secretions, to counteracting its stimulating cfTect.
I have seen many cases where inflammation was fixed upon the
brain by a teaspoonful of paregoric. I have always been able
to use opium much earlier in the disease when bleeding and free
purging had been early resorted to. Such was the obstina-
cy of the inflammation and congestion in some cases where blee-
ding had been omitted and purging had not been resorted to suf-
ficiently early, after purging my patients down to a state of
prostration, I would be driven to the necessity of restraining
them from the use of every thing but cold water and water gru-
el for days, until their system would rally its energies, and then
purge again before they would bear the least stimulus.

The next remedies to be noticed are such as are calculated to-
excite irritation in other parts of the system, and thereby to di-
vert the excitement from the parts diseased, and are denomina-
ted counter irritants. Of this class, blistering plasters are un-
questionably of first importance. The proper time for blistering
is after the excitement is considerably reduced. In inflammato-
ry cases, if early applied, they produce too much general ex-
citement ; the point to which the excitement must be reduced
must be left to the experience of the physician. Next to blis-
tering, rubefacients are most to be relied upon; hot appli-
cations to the parts, left without sufficient excitement, are
by no means to be overlooked ; and finally, whatever is cal-
culated to produce counter irritation, may be used to advantage
in the way of local applications. Internal remedies act in part
by producing counter irritation, but under this head, local appli-
cations to the external surface are particularly alluded to.

Sudorifics. Much benefit is likewise to be derived from me-
dicines calculated to excite perspiration, but like blistering, after
the disease is fully established, the excitement must be reduced
to a certain extent before they can be used to advantage. Ex-
ternal warmth and warm drinks may be first used, because they
excite least. When the inflammation and congestion is suflH-
ciently subdued to admit of the use of opium, the Dover's pow-
der is decidedly most to be relied upon, but it is better that it
should be assisted by warm drinks and warm applications. So
far the treatment detailed is in reference to the inflammatory
form of congestive fever the same principles will apply to the

720 Treatise on Congestive Fever. [Sept.

typhoid form of the disease, making due allowance for the dif-
ference in the intensity of the inflammation, and the strength and
tone of the nervous system. The typhoid type of the disease
being attended with a lower grade of inflammation, and a weak-
ened state of the nerves, will not admit of depletion to the same
extent that the other form of the disease requires. The lancet
should be sparingly used, and never at all unless it is in the
forming state of the disease : but at the same time, when the
disease is fully established, it requires a great deal of purging
also. The purging, however, must be carried on in a slow man-
ner, and the strength of the patient closely watched, and the pa-
tient rested whenever it seems necessar3\ _The inflammation
being of a lower grade, will admit of warm cordial drinks and a
more nourishing diet, whereby the patient's strength may be
greatly assisted. Opium may be used much earlier in this form
of the disease than in the other, and is a highly useful remedy in
combination with calomel, and sometimes ipecac.

External warmth and all the sudorific medicines, together with
blistering, may be more early applied, and constitute an impor-
tant part in the treatment of congestive typhoid fever, but it
must be distinctly understood that the patient is to be purged ac-
cording to his ability to bear it, and that the purging is not to
be dispensed with, until the congestion is broken up. In this
form of the disease, as I intimated before, alterative doses show
their finest effects. But after all that I have said or can say, I
would advise a strong effort to be made in every case to break
up the disease in the forming stage, for when fully formed it is
troublesome and highly dangerous. My own experience is that
when undertaken in time, it can often be arrested in this stage.
If it comes on with a chill, and an intermission or decided remis-
sion can be procured on the first or second day, it may be arrest-
ed at once by the liberal use of sulphate of quinine,opium, blisters,
and sudorifics. At the same time calomel should either be given
in combination with the opium and quinine or it should follow as
soon as it is discovered that the disease has been arrested in its
course, in order to break up what congestion may be left, and to
eflfect a radical cure. When the disease is fully established, the
most difficult part of the treatment consists in happily adjusting
the size of the alterative doses to suit the degree of irritation and
inflammation of the alimentary canal so as to prevent exhausting

I

1839.J Treatise on Congestive Fever. 721

the general strength of the patient too fast by over-irritation or
on the other hand by withholding the necessary quantity of the
remedy and allowing the disease to hold the advantage over the
powers of nature until it brings about that physiological death of
the stomach termed collapse. It will here be observed that I re-
cognize a specific effect in the calomel and other medicines, cal-
culated to promote secretions from diseased parts, but it is not in
that broad sense which is claimed by some for remedial agents*
For instance, I do not contend that calomel given in doses of any
size will produce that specific effect which is calculated to cure
a particular state of inflammation, but that the specific action of
the medicine best calculated to cure a particular state of inflam-
mation is to be brought about by properly adjusting the size of
the dose to the state of the inflammation, the cure being effected
by promoting secretions and producing suitable counter-irrita-
tion. The fact that, the same quantity of any stimulant applied
to parts possessing different degrees of excitability, will produce
difl^erent results, is a truth well founded in the physiology of the
system. When an increased quantity of blood to a certain
amount is propelled to a secreting surface, the quantity of secre-
tion from the part is increased, but a still higher action may be
created and the secretion is stopped. This fact may be testified
to by every one who has had a bad cold. Many other facts of
a similar kind might be referred to. And if allowed the liberty
of drawing illustrations from another science, abundant proof
might be obtained from observing the operations of the mind.
How diversified are the effects of grief and joy when excited in
different minds under precisely similar circumstances? Such,
doubtless, are the effects of all stimulants applied to the system.

722 Simple Ulceration of the Stomach, [Sept.

Part II. REVIEWS AND EXTRACTS.

On Simple Ulceration of the Stomach ; with Obser-vations on those Forms
of Gastric Irritation which more commonly precede and accompany it.
By Langston Parker, M. R. C. S.

The general pathological character of the disease 1 am about to describe
is that of a simple round, or oval ulcer, with edges generally thickened and
elevated, in which the mucous and muscular coats of the stomach are more
or less completely destroyed, and the bottom of the ulcer is formed by the
peritoneal coat of the stomach ; or, where the ulcers have healed by a
membrane, the result of the process of cicatrization.

The anatomical characters of the disease consist in a round, oval, or ir-
regular shaped ulcer, more or less deep, occupying various positions upon
the internal surface of the stomach, more frequently however situated in the
cardiac portion, the greater curvature, or, in the vicinity of the pylorus.
The edges of these ulcerations invariab'y present considerable thickening,
so that in many instances, they appear, as it were, dug out into the sub-
stance of the thickened adjacent coats.

In ulcers of moderate size, the mucous and muscular coats of the stom-
ach are commonly destroyed, and the bottom of the ulcer is formed by the
peritoneal coat, sometimes very much thickened, a membranous cicatrix,
or the base is rough, uneven, and fungous, and shows that the process of
ulceration is still going on. M. Cruveilhier has I think, committed an er-
ror, in stating that these simple ulcers of the stomach are generally single.
In a great number of instances they are not only double, but even multiple,
and the use of a moderate glass, or even the naked eye, will shew in many
instances where a large ulcer seemingly exists alone, that the mucous
membrane is covered with many small spots of ulceration which a superfi-
cial examination might pass over.

One great peculiarity of this species of ulcer is its tendency to cicatrize
under proper medical treatment. In some instances the cicatrices of these
ulcers precisely resemble those of a badly healed burn, and they have like-
wise the same tendency, if the ulcer be large and deep, and its edges very
much elevated, to pucker up, and draw together the surrounding parts, so
that the stomach is contracted and deformed, its peristaltic motion impeded
or destroyed, and the process of digestion in this manner rendered laborious
and painful.

All the cases of simple ulcer I have had an opportunity of examining af-
ter death have presented concomitant marks of inflammation in other parts
of the stomach ; these have consisted in general increased vascularity of its
mucous membrane a punctiform or arborescent redness, general or parti-
al a congested and distended state of the veins of the submucous cellular
coat, with general or partial thickening of the other tissues.

The terminations of ulceration of the stomach are four ; in three modes
fatally, in one favourably. It may terminate in erosion and perforation of
the stomach ; in one way by the continuance of the ulcerative process,
and in another by the weight of the food pressing continually upon a thin
cicatrix, or the centre of an ulcer occupying the greater curvature or cardi-
ac portion of the stomach. Simple ulceration of the stomach may termin-
ate secondly in a fatal hsematemesis, the process of ulceration, by its con-
tinuance, opening a large venous or arterial trunk. It may in a third way
become fatal, and wear out the patient by the constant and violent pain it
occasions, destroying his digestive powers, impeding nutrition, and produ-
cing gradual emaciation, and death. Fourthly, the ulcer m^y oicatrize, and

1839.] Simple Ulceration of the Stomach. 723

the patient become perfectly well, though even in this mode of termination
there are two evils to dread the recurrence of the disease from slight ex-
citing causes, and the rupture of the cicatrix from the pressure of tbod, or
from violent exertion.

CASE, illustrating the History, Symptoms, Pathology, and mode of Treat'
merit of simple Ulceration of the Stomach.

A remarkably stout man, a free liver, m the middle walks of life, began to
suffer from uneasiness after taking his food at the age of eight and twenty
years. He then suffered from weight, distention, and flatulence, with nau-
sea after eating ; he had also occasional vomiting. These attacks were
relieved by medicines prescribed for him by the physician, under whose care
he was at that time placed, but were prone to recur when the patient re-
turned to his customary habits of living. When I first became acquainted
with him, eight or ten years ago, he complained of fixed pain in the epigas-
tric region, which was much increased by pressure and taking food ; the
pain was not at that time constant, it was most distressing after eating, and
accompanied by much flatulence and distention. By restricting the patient
to a milk and farinaceous diet, sponging the epigastric region frequently du-
ring the day with hot water, and exhibiting some mild carminative aperients
daily for a short time, the symptoms subsided, and he again returned to his
occupation in apparently good health.

After a time the pain again returned in a more violent and obstinate man-
ner than before. It assumed the same character, was worse after eating,
and accompanied by some tenderness and heat in the epigastrium. It did
not now yield to the remedies which had before relieved him, but was much
mitigated, and for some time entirely disappeared after the application of
small relays of leeches, and continued counter-irritation over the epigastric
and left hypochondriac regions.

My patient again returned to his accustomed occupations and mode of
living, and after a lapse of eighteen months returned again with his pain as
bad, if not worse than before. He was again relieved, I may say cured of
his distressing uneasiness, by the administration of small doses o the mu-
riate of morphia, and a repetition and continuance of counter-irritation ;
observing, at the same time, a strict dietetic regimen.

In this manner, during the last ten years of his life, was this patient re-
lieved or cured six or seven times of the painful affection of his stomach,
which as constantly returned, when he resumed his customary habits of liv-
ing upon mixed and stimuUting food and drink."^

After having lost sight of him for some time, during which period his ail-
ments were so slight as not to lead him to seek medical assistance, I was
suddenly called to hirn during a violent attack of hjematemesis, in which he
vomited from two to three pounds of blood. I may here observe that, du-
ring the previous progress of disease, my patient had never vomited blood,
or those black discharges which are peculiar to ulceration of the stomach.
He had rarely nausea, and if he had an attack of vomiting, which did not
take place more than two or three times during the whole progress of his
disease, he vomited his food only. He was, however, occasionally subject
to discharges of blood by stool, and at other times when this was not the
C'a=e, his stools were black as pitch; these black disch.irges we shall after-
wards speak of, but when they occur with such gastric symptoms as the
present, and independent of any hsemorrhoidal or other disease of the rec-

*This part of the history of the case confirms a remark which 1 have made in
another part of this paper, and which I find confirmed by the experience of M. Cru-
veilhier, viz : ihat ulceration of the stomach, after having, by care and judicious
treatment, been brougivt 10 a state of cicatrization, is exceedingly prone to recur
from slight dietetic errors, or even from strong mental impressions. The physician
has seen a case similar to the one I have recorded, in which the disease jeturned
three times, at intervals of from two to four years.

724 Simple Ulceration of the Stomach, [Sept

turn or anus, they are symptoms indicating very strongly the existence of

ulceration of the stomach.

To the vomiting of blood succeeded great langour and depression, palpi-
tations, hurried breathing, with attacks of severe pain in the stomach and
bowels, which came on daily, sometimes twice or thrice in the twenty-four
hours. The pain seized him suddenly, and left him with a discharge of wind.
He had great tenderness and pain in the epigastrium and right hypochon-
drium ; the skin had a pale, sallow, blanched appearance, whilst the tongue
did not deviate in any appreciable manner from a perfectly natural condition ;
it had the same pale appearance as the skin ; no coating, no redness, no de-
velopement of the papillaB.

From this time to the period of his death, varied plans of treatment were
adopted, with a view of relieving the epigastric pain. The trisnitrate of bis-
muth with the ponderous carbonate of magnesia and the muriate of mor-
phia certainly afforded very marked relief; amongst many remedies that
were employed this was the most efficacious. Benefit was likewise deriv-
ed from the carbonate of iron with rhubarb, and a sedtitive. Small blisters
were also used, with a strong solution of the extract of belladonna applied
warm on a piece of flannel and laid over the epigastrium. Suddenly and
without any appreciable cause his breathing became embarrassed, cough
came on, and terminated in the expectoration of mucopurulent matter to
the extent of three half-pints daily.

Under the continued irritation of pain ; and bronchial disease, my pati-
ent sank, three weeks after the attack of hsematemesis, at the age of 52.
I believe the immediate cause of his death to have been bronchitis. I am
firmly convinced that from his stomach disease he would have recovered.

Inspection of the Body, 28 liours after Death. The coats of the stomach
were generally thickened, more particularly the peritoneal, and this more
marked in the pyloric half of the viscus. Great vascularity, and thicken-
ing of the mucous coat generally ; the veins of the submucous cellular tis-
sue gorged with black blood. The greater curvature contained a large,
deep ulcer, perfectly healed, with thickened and elevated edges ; the pro-
cess of cicatrization had puckered up, and contracted this portion of the
stomach to some extent, just as the skin is occasionally contracted by the
healing of a burn. The cicatri'x of another large ulcer existed in the im-
mediate vicinity of this ; here the healing process had been completed with-
out puckering or contraction of the surrounding mucous membrane. Se-
veral smaller ulcers were formed in different parts of the stomach, the one
immediately below and between the two large ulcers was rapidly healing;
in the two low' er ones, which I imagine gave rise to the gastric symptoms
during the latter weeks of disease, the process of ulceration is still going on.
The lowest, I have no doubt, gave issue to the blood vomited three months
before death.

The spleen was hypertrophied to some extent. The liver in the same
state. The pancreas much enlarged. The pericardium intimately adher-
ent to the heart ; the muscular structure of the heart very pale and soft.*
Several adhesions of the pleurae on both sides ; the bronchial mucous mem-
brane vividly injected ; general congestion of the substance of the lungs.

Remarks. This case is worthy of notice, in many points of view, and
exhibits in its history and morbid appearances most of the peculiarities of
that disease which has been termed by Cruveilhier simple ulceration of the
stomach ; a disease which has never been fully described in this country*
and but partially by the pathologists of France.

*Tbese two pathological phenomena, viz : adhesions of the pericardium, and pal-
lor with softness of the muscular substance of the heart, are commonly observed,
after death, from prolong^ed gastric, or gastro-hepatic diseases. Seethe cases; &c.,
<istailed in my work : **The Stomach in its Morbid states."

1839.] Simple Ulceration of the Stomach. 725

We will dwell for a moment on the history of this case. In the first place
we observe the symptoms of indigestion, as they are commonly termed, to
have commenced about the age of eight-and-tvventy, and to have harrass-
ed the patient more or less durmg the whole of his subsequent life. It will
be remarked that the attacks ot stomach disease were at first relieved by
medical treatment and strict attention to diet. As disease proceeded they
became more difficult of cure, and what was at first a mere active hypere-
mia of the stomach, terminated in confirmed chronic gastritis, and subse-
quently in ulcerative inflammation of the mucous membrane. 1 conceive
the facts of this case will admit of no other satisfactory explanation.

From examination of the accompanying preparation, it will appear,
that the ulcers of the stomach had been formed at different periods,
and certainly gave rise to those violent attacks of pain, which the patient
from time to time experienced at intervals, sometimes of two or three years.
I believe the process ol cicatrization was favoured by the local depletions,
and counter-irritation to which my patient was subjected, when his pain
became so violent, as to lead him to give up his occupation and seek for me-
dical relief. Under a perseverance in a strict regimen, small local bleed-
ings, counter-irritation, and minute doses of morphia, fec., he became per-
fectly well, and it was not till after a course of living upon a full and stimu-
lating diet, that the attacks of inflammation and pain again came on.

On examining the morbid appearances in this specimen, we find that it
^exhibits almost all the varieties of which the simple ulcer is capable. In
the first instance we notice the cicatrization of the large ulrer to be accom-
panied by that degree of contraction of the mucous membrane in its vicini-
ty which is commonly observed in the skin after the healing of burns. The
very healing of these ulcers may become a source of lasting inconvenience
and danger, for if they be situated near the openings of the stomach, in the
vicinity of the cardia or pylorus, the contraction of the cicatrix directly
shrinks the orifice, and the passage of food to or from the stomach is render-
fd more or less difficult. The pathological anatomy of Mr. Lruveilhier con-
tains the account of a patient in whom the cicatrization of simple ulcers had
contracted the pyloric orifice of the stomach so much that it would barely
admit a goose-quill. He had originally presented the symptoms of ulcera-
tion, which had been, by an appropriate treatment cured, but returning to
the pleasures of the table, and being a great eater, had suffered the most
agonising pain after meals, till he, at, length, sank from a succession of has-
morrhages, which M. Cruveilhier thinks arose from exhalation from the
surface of the congested mucous membrane of the stomach, since no ves-
sels of any magratude could be detected from whence the blood could have
issued.

It is thus that ulcers of the stomach, in their healing, sometimes lay the
foundation of diseases as formidable as those which characterise their open
condition.

The second ulcer has cicatrized without this contraction of mucous mem-
brane, at least with a very trifling degree of it.

Perforation of the stomach has been prevented, in this instance, by the ex-
treme thickness of the peritoneal coat of the stomach. This I imagine to
have been the result of that inflammation which was going on in the coats
of the stomacli, previous to ulceration of the mucous membrane, and to
which is owing that general thickening of the parietes of the viscus, which
ds very remarkable.

Ti.e thickening of the peritoneal coat appears a provision of nature for
preventing that perforation of the stomach, and discharge of its contents,
which must otherwise have taken place ; and hence it is that perforation of
the stomach, the consequence of ulceration, in males is less frequent than
an jemales ; the ulceration in the former, generally succeeding to a general
xhronic gastritis, accompanied by thickening ; whilst in the latter, the af-

726 Simple Ulceration 0/ the Sto7nach, [Sept.

fection is due to a localized inflammatory action, occupying a very small por-
tion of the mucous membrane, where the thickening is generally confined
to the edges of the mucous membrane surrounding the ulcer.

General Description of the Symptoms of Simple Ulceration of the Stom-
ach, The first of these is a fixed acute pain, occupying the epigastric or
left hypochondriac regions, the centre of the sternum, or some pomtonthe
dorsal portion of the spine, between the scapulae. This pain is the symp-
tom 'par excellence,". it is that, and generally that only which attracts the
patient's attention; from it he may be for some hours occasionally free;
but never is so entirely during the day. For many hours out of the twenty-
four this corroding uneasiness harrasses the sufferer, sometimes in the morn-
ing, at others in the evening, sometimes in the intervals of meals, but gener-
ally it succeeds to them, and commences with more violence after the din-
ner meal, continuing without abatement till late in the evening, when it
commonly subsides, and leaves the patient comparatively easy for the night,
till breakfast brings back a return of his sufferings. The seat of this pain
is, as I have just stated, variable. I attended a gentleman for some years
with simple ulceration of the stomach, who always suffered most severely
in the centre of the dorsal portion of the spine, and along the course of the
intercostal spaces ; in this patient the epigastric pain was not absent, but
in some measure masked by the greater suffering he experienced in the
back and sides. These parts were very sensible to pressure, and he inva-
riably experienced relief of the gastric uneasiness, from the application of
small relays of leeches over the tender spot on the spine ; this, during the
latter months of disease was the only remedy that afforded any marked re-
lief. This patient died ultimately from violent haematemesis.

In many other instances the pain is confined to the centre of the epigas-
trium, which is the chief, and indeed the only seat of sufiering.

Although the act of taking food occasions the patient so much uneasi-
ness, the appetite in many cases of ulceration of the stomach continues
good, and in some instances is morbidly increased. The remark of pati*
ents labouring under this disease is commonly "I could eat any thing but
dare not." In certain instances the appetite is defective. This I think a-
rises most commonly from extensive concomitant inflammatory action, and
where the ulceration is complicated with other lesions of the raucous mem-
brane.

The tongue is in a great majority of instances clean ; in some not the
slightest deviation from the healthy condition can be detected ; it is neither
redder, nor less moist than usual, and even when ulceration of the stomach
has been accompanied by profuse bloody vomiting, we observe the tongue
to present that blanched condition which is common to other organs in this
state, and not to offer that contrast to the external skin which is so remark-
able in the advanced stages of pure chronic gastritis, where the vivid red-
ness of the protruded tongue presents a striking contrast to the sallow, pal-
lid countenance.

I have, in my work on the stomach, adduced a variety of facts, noticed by
myself, and supported by the corroborative testimony of Louis and Andral,
of the uncertainty of the state of the tongue as indicating any particular
pathologic condition of the stomach. The tongue certainly bears no direct
relation to the kind, or degree of disease existing in the stomach. Doctor
Stokes has remarked that too much attention is, and has been paid to it,
with this view, by British practitioners ; whilst Louis says "we should ex-
amine the tongue for itself merely, not to ascertain by it what is the matter
with the stomach." I have rarely met with a case of simple ulceration of
the stomach, where constipation of the bowels has not been a prominent
and most distressing symptom ; and one which is a source of great anxiety
both to the patient and his attendants. The attacks of pain are more vio-
jent and frequent whilst constipation is present, and a^ain there is great

1839.] Simple Ulceration of the Stomach. 727

difficulty in framing an aperient that will relieve constipation, without pro-
ducing great pain during its operation.

Nausea is not a common attendant upon this disease, but sudden and
sometimes fatal vomiting of blood, or a black fluid, comes on at an earlier or
later period. M. Cruveilhier considers the black vomiting peculiar to, (and
almost pathogonomonic of,) ulcerations of the stomach, to result itself from
blood, slowly secreted from an ulcerated surface, and rendered black by its
sojourn tor a longer or shorter space of time in the cavity of the stomach,
and its mixture with the acids of the gastric juice.

Bloody vomiting, in ulceration of the stomach, is by far the most danger-
ous symptoms we have to contend with. I have certainly seen a patient re-
cover from ulceration of the stomach after several attacks of severe heema-
temesis ; these cases are, however, comparatively rare. Discharges of
blood rarely occur early in the disease, and when they come on to any ex-
tent, a patient is worn out and emaciated by constant pain ; they are very
commonly fatal. I have more than once seen persons, with ulceration of
the stomach, die in the very act of throwing up blood.

Before any vomiting of blood or black fluid takes place in ulceration of the
stomach, it will very often be found that these matters are passed by stool.
The blood is slowly exhaled, mixes with, and colours the food and faecal
matter, and passes off in stools as black as pitch. This symptom, consider-
ed with others, will leave no doubt on the mind that blood is slowly oozing
from an ucerated surface ; and it will lead to the adoption of measures to
prevent the sudden vomiting of blood, which commonly succeeds to the
black disc.harges by stool, of which these latter are, in many instances, pre-
monitory symptoms.

The manual examination of the epigastric region contributes little to con-
firm our diagnosis in this disease. It is sometimes highly sensible to pres-
sure, at others perfectly indolent. In the advanced stages of disease in the
male, where the coats of the stomach are commonly thickened, a tumor may
be detected, but, apart from the existence of other symptoms, we cannot say
whether this tumor result from mere thickening, the result of chronic gas-
tritis, or whether this thickening be accompanied by ulceration or cancer.

The general appearance of patients suffering from ulceration of the sto-
mach, is haggard and anxious in the extreme. Defective nutrition has pro-
duced a paleness in their tissues which is very remarkable ; the conjunctiva
his sometimes the appearance of the whitest marble, and the whole aspect
of the patient, in the advanced stages of disease, even when hsematemesis
has not taken place, is that of a person blanched by repeated haemorrhages.
We must here enquire into the nature of those symptoms of gastric irri-
tation which precede the actual state of ulceration, in other words, we must
look for the causes of this disease ; these, I believe, will be found in certain
states of gastric irritation, which are very much under the control of medi-
cal treatment.

M. Cruveilhier says, "The history of the causes of simple ulcer of the
stomach is involved in deep obscurity ; or, rather, this disease recognizes all
the causes of gastritis for which it has been mistaken. But why is only-
one single spot of the stomach affected, whilst all the other parts of the sto-
mach are in a healthy state !" It is singular so accurate a pathologist as M.
Cruveilhier should have made a statement disproved even by many of his
own cases, by the remarkable one detailed in this paper, and by the patholo-
gy of the stomach generally. The simple ulcer is met with as frequently
double, triple, or multiple, as it is single ; and I have never seen a case where
this organ has not presented the most unequivocal signs of long continued
inflammatory action, mAst frequently marked by general or partial thicken-
ing of its coats. Not only are the consequences of inflammation to be found
in the stomach after death from ulceration, but the whole class of symptome.,

I

728 Simple Ulceration of the Stomach, [Sept^

which precede and accompany ulceration during Jife, are clearly dependent
upon inflammation, as the results of inflammalion sufficiently prove.

Ulceration of the stomach succeeds more particularly to two conditions of
gastric irritation, which it is important here to notice ; these are inflamma-
tory indigestion, or certain forms of gastritis in males, and those affections
of ihe stomach which occur in females whose menstruation is irregular, who*
are the subjects of hysteria, or who are confirmedly chlorotic. These forms
of irritation are clearly of the inflammatory kind, though essentially modi-
fied by the state of the economy in which tiiey occur.

I shall endeavour to give a brief account of such of these forms of gastric
irritation which I have seen terminate in fatal ulceration of the stomach.
The case detailed in the earlier part of this paper, will illustrate in its histoi
ry, the origin and progress of that form of indigestion which is evidently of
an inflammatory character The fresh attacks of this disease are generally"
marked by fullness after meals, distention of the stomach, eructations, heart-
burn, nausea, pains in the back and sides, uneasiness in the epigastriumy
terminatmg in fixed and constant pain, aggravated by taking food ; strong
beatmg of the heart, throbbing of the carotids, head-ache or stupor suc-
ceeding a meal.

It is true that in a vast number of instances the inflammatory forms of
gastric irritation never terminate in ulceration of the mucous membrane of
the stomach, though I believe, from some experience in this class of diseases,
that ulceration is a more frequent termination of them than is generally
supposed. This opinion is likewise corroborated by the experience of M.
Cruveilhier, who, in his second paper on this subject, states this disease to be
much more frequent than he had ai first supposed.

I have seen the inflammatory form of indigestion, which is a true partial
gastritis, terminate in ulceration in five months, from its first commence-
ment, in a patient who had never, previous to this period, suffered in the
most remote degree from any afl^ection of his stomach.

M. Cruveilhier believes in the existence of acute ulceration of the stom-
ach, and adduces the case of a patient who died from the disease, twelve
months after a slight attack of cholera, prior to which he had been in perfect
health. He mentions a second case terminating fatally in ten days from
perforation, the subject of it never having been ill before this period, the an-
a-.omical characters of the disease shewing it to be a recent ulcer. A third
case is mentioned succeeding to indigestion of some months standing, fatal
by perforation.

The most insidious and alarming forms of irritation in the stomach, if we
regard their occasional termin-Uion, are those painful affection?, and disor-
dered conditions of the digestive powers which occur in young females, par-
ticularly where there is any disorder in the functions of the uterus. It will
be found on examination that most patients who are chlorotic suflTer more or
less from some form of irritation m the stomach or bowels.

Some complain of pain after food, nausea, daily vomiting, diarrhoea,' loss
of appetite, with heat and tenderness in the epigastrium. Accompanying
these symptoms there is commonly a dry, red tongue, and the patient suflTers
from a most distressing weakness.

Not unfrequently, in the midst of these symptoms, or after some partial
degree of amendment, the patient is seized With acute pain in the bowels,
and suddenly sinks and dies. On examination the stomach is found perfo-
rated in the centre from ulcer, with thickened and elevated edges, the im-
mediate vicinity of which exhibits marks of inflammation and thickening
of the coats of the stomach, whilst the remainder are generally very thin,
and the mucous membrane in all other points presents a remarkable pallor
or whiteness, and is almost exsanguined ; a totally aiflTerent condition from
that observed in the mucous membrane of patients dying from that ulcera-
tion of the stomach which is the result of general inflammatory indigestion

1839.] Simple Ulceration of the Stomach. 729

or pure chronic gastritis. In the former instance the disease is generally
confined to a very small portion of the mucous membrane ; it is a localized
inflammatory action occurring in a constitution in an extreme degree of
weakness or irritability, and seated m tissues so badly nourished that they
present but little resistance to the fatal termination of the disease in perfo-
ration of the coats of the stomach.

I conceive the difference of the circumstances, under which the disease
we are now considering occurs (in the male as the result of inflammatory
indigestion, on the one hand, and in the chlorotic, or hysteric, or debilitated
female already exhausted by uterine irr.tation on the other,) to be one most
powerful cause why the disease so much more frequently terminates in per-
foration in the latter than in the former.

I know of no instance where cicatrization of an ulcer of the stomach has
been shewn to have taken place in the female. In the male, the case of Pro-
fessor Beclard will suggest itself to the minds of all, whilst the case now de-
tailed is another and perhaps the most remarkable hitherto recorded. Cru-
veilhicr states that the simple chronic ulcer has a tendency to cicatrize, and
Dr. Abercrombie says that he is satisfied that he has seen the cicatrices of
such ulcers when the patient has died of another disease, after having been
for a considerable time free from uneasiness in the bowels. The latter au-
thority however records nothing definite upon the subject.

I believe ulceration of the stomach to be more frequent in the male than
in the female, whilst the fatal terminations of this disease by perforation are
much more frequent on the part of the female than the male. Mr. Pritch-
ard of Leamington, in a pamphlet on the organic character of hysteria, has
collected from various authorities eighteen cases of perforating ulcer in the
female, whilst he has only been able to meet with eight recorded ones of the
came disease in the male.

It is true that the disease is more frequently verified after death in the
female than in the male, but I think it will be found that the disease is more
prone to catrization in the male from the circumstances I have mentioned,
and again in the male its fatal terminations are more frequently by hssmate-
mesis, and gradual exhaustion, than by perforation, from the simple circum-
stance that the coats of the stomach generally, or those merely in the imme-
diate vicinity of the ulcer, are most commonly the seat of considerable thick-
ening, the consequence of long continued chronic inflammation. We do
not observe the same causes in the female.

Of the Treatment of Ulceration of the Stomach. ^The treatment of ulce.
ration of the stomach must be modified to suit the particular kind of affec-
tion we are called upon to manage, and hence it must be considerably differ-
ent in the male, where the disease is the result of gastritis or inflammatory
indigestion in any of its numerous forms, and in the female where it occurs
in the midst of disorder of the health generally, and upon which, in such in-
stances, 1 have no doubt it very materially depends.

I shall not here notice any plan of treatment adapted to the forms of in-
flammatory indigestion, having said enough on this subject in my previous
work.

The grand indication in the treatment of ulceration of the stomach is to
bring about cicatrization of the ulcer, and this I believe will be best accom-
plished in the following manner, at least it is the mode I have generally found
most successful.

The patient must be limited to the smallest possible quantity of food un-
der which he can be tolerably comfortable, but the wants of the stomach on
this head must be satisfied, for if any degree of craving, or irritability be
induced by the abstinence, it is carried too far. It must have been noticed
by all that have had the care of patients with ulceration, that they are tol-
erably easy except after a meal. They should never be suffered to take

D

730 Simple Ulceration of the Stomach, [Sept.

meals, properly so called ; we should first attempt to discover what kind of
food they are most easy niider, and small quantities of this should then be
taken every two hours, so as to prevent the appetite ever experiencing the
sense of hunger, or ever feeling a desire to satisfy it by eating a tolerably
hearty meal. It is almost impossible to lay down any rules as to the kind
of food under which a patient with ulceration will be most comfortable ; it
very commonly happens that light animal food agrees better than a farina-
ceous diet, and I have occasionally found cold weak brandy and water in
such instances the best sedative. The stomach must never be distended by
food, nor any kind of food administered which so far disturbs the digestive
powers as to give rise to the evolution of much gas during digestion, which in
itself, is nearly as great an evil as distending the stomach by food. The
next point is the condition of the epigastrium, if there be tenderness on pres-
sure, or heat in this situation, leeches must be applied in quantities suited to
the powers of the patient till it is removed. Even in the advanced stages of
disease, local bleeding from this is highly serviceable ; it diminishes conges-
tion, and renders the attacks of pain less frequent and violent. Employed
after attacks of pain it relieves that venous distention occasioned by them,
v/hich frequently terminates in hsematemesis. When the stools are black
or bloody, it is highly useful, frequently changing their character by dimin-
ishing the congestion or inflammation in the stomach, and checking the ex-
halation of blood from the ulcerated surface. Heematemesis frequently re-
lieves all the symptoms of ulceration, sometimes, for weeks ; but we must
recollect a patient may die, and commonly does die during the attack, these
efforts of nature th^refere should be imitated by the employment of means
likely to bring about the same result. If the epigastrium be indolent, and
the stools natural, or nearly so, the next remedy of importance is counter-
irritation by blisters, the antimonium tartarizatum, or other remedies ; this
should be persevered in constantly and unceasingly, as long as disease re-
mains. I do not think setons productive of much good. I have seen them
useless where repeated blistering has afforded great relief. Fomentations
laid on the epigastrium and kept on for several hours, sponging this region
night and morning with very hot water, reposing in a tepid bath for a consi-
derable time daily, are all remedies that maybe employed with advantage.
The patient is always worse during constipation ; the bowels are best regu-
lated by enemata. If aperients be given they should be of the very mildest
character; a few grains of rhubarb with a tenth or twelfth of the. muriate
of morphia, the ponderous carbonate of magnesia prepared by Henry or
Howard, administered in some infusion of orange-peel, or mint tea, are re-
medies sufficiently active ; the common magnesia is worse than useless.
After cicatrization has even taken place all active purgatives should be a-
voided. M. Cruvielhier records a case of rupture of a cicatrix from violent
aperients administered to relieve an apoplexy. The violent peristaltic ac-
tion of the stomach induced by the aperient had ruptured the cicatrix of an
ulcer. Internal remedies are exhibited in ulceration of the stomach with
several objects. To relieve pain, to facilitate cicatrization, to check the
oozing of blood from an ulcerated surface, or lastly to remedy some general
constitutional weakness or irritability which appears unfavorable to the heal-
ing of the ulcer.

To answer the two first indications minute doses of morphia may be ad-
ministered with the trisnitrate of bismuth. The nitrate of silver, first pro-
posed by Dr. James Johnson, will be found very serviceable with this view.
The sulphate of iron also may be employed ; there is sometimes a spongi-
ness of texture in the mucous membrane in long continued cases of ulcera-
tion when these latter remedies are highly beneficial. There is occasion-
ally also a great degree of debility, of langour, of laxity of tissue accompa-
nying ulcers of the stomach, in which the exhibition of tonics becomes ne-
cceeary, and in such forms of disease the carbonate of iron, or even the mis-

18 39.] Dysentery in South Alabama. 731

tura ferri com p. are employed with great benefit. Every thing that affects
the constitution generallj^ has an effect upon the lieahng of the ulcer, and
hence the condition of the health generally demands our strictest watchful-
ness ; the functions of the skm ; the state of the bowels ; the urine ; the
epigastric region, all demand unceasing attention. I would impress upon
the reader that ulcers of the stomach commonly cicatrize, as the state of
the general health under which they first made their appearance improves.
It is true that they more immediately depend upon the pathological condi-
tion of the stomach, but this is most commonly the result of general con-
stitutional causes.

The great difference which exists between the treatment of ulcer of the
stomach in the female and in the male, depends chiefly upon the general
condition of the economy in which the diseases separately occur, and the
pathologic character thus induced in the stomach 'in which the disease is
seated. Me^^ico- Chirurgical Review, October 1838.

From the Philadelphia Medical Examiner, July 1839.

An Account of a Recent Epidemic Dysentery, of South Alabama. By H,

V. Wooten, M. Z>., of Lowndesboro\ Alabarna.

It is not my purpose to offer any observations, having claim to novelty,
on either the nature or treatment of dysentery. But, having recently en-
joyed pretty extensive opportunities of witnessing its varying character, and
of reducing to practice several of the plans of treatment which have been
much spoken of of late, I have thought proper to mention the results, with
whatever remarks they may suggest.

Dysentery made its appearance in this place about the middle of April
last, and continued, with more or less violence, until the middle of June,
The town is situated upon a high ridge ot land, which separates the low
lands of the Alabama river from the large prairies. The soil is of a gravel-
ly, or sandy character, with abundant water springs, and of the clearest
freestone. This ridge is generally quite healthful, perhaps as exempt from
autumnal bilious fevers as any spot in South Alabama, and it is rarely trou-
bled with epidemics. This spring, however, dysentery has prevailed with
considerable violence here, while the flat lands and prairies have been near-
ly exempt ; nor has it prevailed any where in this part of the state, to my
knowledge, so generally and violently as here.*

Varying as it did, in its symptoms and intensity, to facilitate the history
of the treatment, I will divide it into two classes, or grades : The first
grade, characterized by violent griping and straining, with small muco-san-
guineous evacutaions, very frequent at the onset of the disease ; pain mostly
of the spasmodic character in the umbilicEl region, recurring at very short
intervals ; very little soreness on pressure, in the beginning ; pulse full,
strong, and frequent ; oppression in the epigastrium ; vomiting sometimes
troublesome ; febrile reaction high ; sometimes slight delirium ; counten-
ance flushed ; eyes yellowish ; tongue covered with a thick, dry, dark-
brown fur, with a deep furrow in the centre ; edges red and pointed ; in
many cases the urine was suppressed during the violence of the disease.
These cases, if not early met by thorough treatment, generally ran a tedi-
ous and painful course.

Second grade : Frequent evacuations, attended with pain, more or less
severe ; discharges larger and more watery than in the first grade, and

* Since writing the above, I have learned that it prevailed at the same time iD a
few other places, and in some with considerable fataUty.

732 Dysentery in South Alabama, [Sept.

pain only on evacuation ; pulse a little frequent, but otherwise natural ; fe-
br le reaction very slight ; tongue generally clear of fur, moist, edges red.
The symptoms, if neglected, generally increased in violence, and the case
became very nearly like one of the first grade, in the second stage. These
cases, like the others, if not treated in proper time, ran a tedious course, re-
covering very slowly. It will be observed that the most important differ-
ence in the two grades, was the great biliary disorder which existed at the
onset in cases of the first grade, and the comparative want of it in the sec-
ond grade, which appeared to be more particularly an inflammation of the
mucous coat of the intestines. I have only attempted a description of the
symptoms in the early stages ; they were subsequently modified by various
causes, which, however, should not be set down to the disease.

I had witnessed the disease in the marshy regions of Georgia, in the same
latitude ; and although the treatment was generally successful, it was not
altogether satisfactory, and when the disease was presented to me here, I
felt somewhat at a loss for the proper coun- e to pursue. My confidence was
first directed towards Hope's astringent mixture. The mineral acids have
long been recommended in this disease ; but my confidence in this particu-
lar preparation was greatly increased by the short article on the subject by
Dr. Meigs, published in the first volume of the Medical Examiner. Hav-
ing, during my pupilage in Philadelphia, formed a very high estimate of the
professional ability and moral integrity of Dr. M., I felt no hesitancy in re-
lying upon his recommendation of the mixture, and, accordingly, used it on
the first opportunity. At first 1 gave it as opportunity offered, not regard-
ing the character or stage of the case; but often, when "six doses" and
more, had been given, no perceptible benefit was produced. In some cases,
however, it appeared to have some influence in lessening pain, while all the
other symptoms continued unchanged ; 1 discovered, that when called to a
case, after purges of calomel or castor oil, or both, had been used, the mix-
ture was more likely to produce immediate benefit, and effect a cure. Hav-
ing given it a fair trial, and found it unavailing in many cases, it was discon-
tinued for a time, during which, combinations of calomel and opium, ipeca-
cuanha, castor oil, &c., were used ; and, on the resumption of the mixture,
it was found to produce the most happy effect. The cases of its application
to which I have alluded, were of the first, or biliary grade ; and I am con-
vinced that but little confidence can be placed in the acid mixture for their
cure, until the heavy congestion of the liver and the portal circulation is re-
moved ; and, for this purpose, 1 have found it necessary to excite the secre-
tory action of the liver by calomel or blue mass, pretty freely exhibited, and
purged off by castor oil. For exciting this action, I have always found the
alterative action of the acid mixture entirely too weak ; but, after this ac-
tion has been well established, I know of no medicine to perpetuate such ac-
tion, and, at the same time, address directly the irritation of the bowels, in
which I have greater confidence than in the mixture alluded to.

In the second class, or milder grade, the mixture was more generally ap-
plicable, requiring often only a simple purge, as of castor oil, to prepare the
way for its best effects ; yet, it was found in all cases, even of the lightest
grade, to act much better after such purge, than before ; and in many cases
of this class, which had been neglected until the glandular functions hadbe-
co'ne much disordered, the most thorough alterative action of calomel was
required, before the beneficial action of the mixture could be induced. In
these cases, however, I sometimes found the system ready prepared, the
patient having taken these medicines before calling my attention to the
case, and under such circumstances, I resorted to the acid mixture immedi-
ately, with satisfactory results. Witnessing these facts, and drawing their
deductions, I was forced to the conclusion, that a preparation was always
important, and frequently necessary, for the good effects of the acidulated
mixture, more particularly in the bilious form of the disease.

18J9.] Dysentery in South Alabama. 733

For this purpose, when pain was severe, and reaction high, I found great
benefit in free venesection ; this not being indicated, or already done, 1 gave
Hydrag. chlorid. mit. gr. x.
Pulv. ipecac, et opii. gr. xx.
To be administered every third hour until four doses had been taken, to be
followed, in three hours by castor oil, and laudanum, if required, to alleviate
pain. In some cases, where the pain was not so violent, and the stomach
not irritable, one grain of ipecacuanha was substituted for, or added to the
Dover's powder. The ipecacuanha seemed more particularly applicable
to the cases of children. In illustration of my plan of treatment, I will give
here a short sketch of a case : Mr. L., set. twenty-four, of bilionervous
temperament, good constitution and moral habits, was attacked seven days
ago with the mild, or second grade of the disease ; this being treated by ano-
dynes alone, gradually assumed a more formidable character, and at the
time of visit was marked by heavy glandular disorder, with violent mucous
inflammation of the intestines, presenting all the worst symptoms of the first
grade, with considerable exhaustion. He was purged, without permanent
benefit ; the acid mixture was then instituted, f 5 ii. being given every fourth
hour. At the administration of the seventh dose, no appreciable benefit
was produced. Tongue dry and thickly coated, with a deep furrow and red
edges, as above described ; febrile reaction high ; slight delirium ; oppres-
sion in the epigastrium ; anorexia, &c. The calomel and opium course was
then applied, on which copious evacuations of vitiated secretions, bile, &c.,
appeared. These ceased after the action of the medicine, and the evacua-
tions had the appearance of returning to their former condition, sero-san.
guineous, frequent and painful, when Hope's mixture was again brought
into service with immediate benefit, healthy secretions returning gradually,
and general condition improving. This case fairly represents the ordinary
results of my practice during the prevalence of the disease. It may be said
that the calomel made the cure, without the aid of the mixture ; this, how-
ever, would be an unjust conclusion, as the secretions were rapidly falhng
back to their former depravity when the mixture was resumed, which un-
doubtedly perpetuated the action excited by the calomel. It was sometimes
necessary to repeat ihe calomel and opium daily for two or three days. As
a simple purgative, I have found nothing so good as the castor oil ; I have
known several respectable practitioners, who used the Epsom salts altoge-
ther as a purgative in this disease, and from their recommendation I have
been induced to use it myself, but from the results that I have met, I great-
ly prefer the castor oil. When the irritation is primarily and chiefly in the
intestines, and the liver in a healthy state, the salts, acting as a depletant,
may do much good; I have myself seen much benefit arise from its use in
such cases. But in this climate, the long and excessive heat of summer,
keeping up an over-action of the liver, places that organ in an almost ex-
hausted condition, rendering it the weak point for the invasion of disease,
and whenever disorder, from any cause ensues, affecting ihe portal circula-
tion, the liver is generally found incompetent to the performance of its func-
tions, which is not unfrequently our greatest hindranee in the removal of the
disease ; this is particularly so in the epidemic dysenteries of our climate.
The salts, by producing a depletory eflTect, may, for a time, suspend the ne-
cessity for the liver's action, but wfU not restore to it that action which i
important to the recovery of health. Moreover, when we have given an al-
terative, destined particularly for the secretory function of the liver, it
seems to me absurd to set up a directly counteraction upon the intestinal
exhalents. Sometimes, it is said, the suspended action of the liver is owing
to an engorgement of its vessels, and that the salts, by their depletory ac-
tion, relieve this obstruction. Granting this fact, the salts should be admin-
istered in such cases before the calomel or other alterative, and not as is usu-
ally done, after it ; but where no other than depletory action is required, I

734 Dysentery in South Alabama. [Sept-

prefer the lancet. Castor oil, on the contrary, producing no unnatural dis-
charge from the bowels, but simply exciting the peristaltic motion of the in-
testines, thereby emptying them of their contents perhaps the products of
the alterative seems to mo an apt adjunct to the use of calomel, when pur-
gation is desired. These considerations, with the recollection of the fact
that mucous secretion, and not serous exhalation, is the natural product of
the intestinal mucous membrane, have led me to the constant preference of
the oil in this complaint, and all others where a promotion of hepatic action
is desirable.

When the tenesmus and griping were severe, great benefit was frequently
derived from a combination of rhubarb and Dover's powder, each gr. x, given
every second hour until the pain and discharges were moderated. It often
quieted the irritation, aad produced consistent evacuations, thus greatly re-
heving the worst symptoms of the disease. This was rarely permanent,
however, unless the secretions had been previously restored to a proper state;
consequently, I have confidence in this combination no further than its alle-
viation of irritation, for which it is an excellent remedy. The balsam copai-
va was also tried ; I did not resort to its use in the early part of the epide-
mic, nor until after I had become convinced of the propriety of first restor-
ing the secretions in ail serious cases, which I am satisfied, was the proper
time for its application. 1 observe in the essay of Dr. La Roche on the sub-
ject, that in all the cases which he instances of its best effects, it was given
after purgation ; and it seems that those cases in which the blue mass had
been previously used, were the most signally benefitted by the balsam copai.
va. The cases which he reports were prepared by other medicines for the
action of the copaiva, or such as had become chronic, the inflammation of
the bowels being the most important disease to be remedied. In either
case, its use corresponds with my experience given under these circumstan-
ces, its remedial powejs were strikingly happy. In one case, that of a
child, in which every other remedy had failed, and ulceration had apparent-
ly ensued, it acted promptly and efficiently, producing a speedy recovery. In
some cases I have no doubt, that from long neglect, and the violence of in-
flammation, it may become so permanent, and the discharge from the mu-
cous membrane so habitual, as greatly to counteract the action of alteratives
on the liver and other secretory organs, in which circumstances it becomes
necessary to address our remedies to the mucous membrane first. And,
further, 1 have no doubt that this state of things occurs in a greater propor-
tion of cases in the practice of Dr. La Roche and Dr. Meigs, than mine, or
the general practice m this climate, not owing particularly to the causes just
mentioned but to the great difference of climate, or rather its efiects on the
human system ; for in nearly all these disorders in this climate, the liver is
primarily involved, while such is not the case in Phi'adelphia, which may
well account for the different results from the use of the same remedies. In
cases where mucous inflammation was to be particularly addressed, I found
the balsam copaiva a very excellent remedy. I use it according to Eberle's
formula :

K. Balsam copaiv. ss.
Pulv. gum. arab. oii.
Sacch. albi. 3 iii.
Aquse. font. ^ viii.
Tinct. Opii 5 i.
A table spoonful every fourth hour.
In the chronic stages of mucous inflammation, where the existence or ap-
proach of ulceration is apprehended, I would rely more on the copavia than
any other medicine.

The acetate of lead was used in several cases, but its use was so barren
of good as to cause its early abandonment. Opiates alone, were used in
90ine cases, but they only had a temporary anodyne effect, the disease al-

1839.] Dysentery in South Alabama. 735

ways returning with its former violence on the witlidrawal of the medicine.
The use of anodyne and mucilaginous injections was resorted to in many
cases : but, unfortunately, those cases which most urgently demanded their
influence, coul.l not tolerate their presence, and they were immediately re-
jected, so that benefit from this source was rarely to be obtained.

In a very iew cases, which appeared rather tedious under the ordinary re-
medies, I tried the use of nux vomica, as recommended by Mr, Vaux,
through Dr. Armstrong. It seemed to exercise some anodyne influence ;
but, on increasing the dose to the amount advised, (seven grams,) its pecu-
liar constitutional eSects were such as to stop its use. I did not make a full
trial of this article.

In many cases where griping was frequent and severe, much benefit was
derived from the warm bath.

I have observed the disease closely, not only here, but in the same latitude
elsewhere, as above mentioned, and in the practice of an excellent physici-
an. Never being wholly satisfied with any particular remedy, or course of
treatment, and always viewing the disease as one distressing in its opera-
tion, and dangerous in its results, I have, while watching its varying charac-
ter, been equally watchful in applying various remedies, as I thought them
indicated. The comparative efficiency of these I have thought it unneces-
sary to mention, except, as applied during the same epidemic, frequently in
the same case, and altogether under the same circumstances, and this, the tri-
als being pretty extensive, I have thought interesting ; on which account I
have given the above sketch, from which the following conclusions may
be drawn :

1st. That, in all cases of dysentery, occurring in this climate, the liver is
either primarily or secondarily involved, producing a suspension of its secre-
tory action, which has a direct tendency to increase and perpetuate the phi-
logosis of the bowels, and that this organ must be restored to its due action
before a cure can be effected.

2d. That, to restore the secretory action of the liver, (depletion bein*
premised when indicated,) nothing can be fully relied on but mercurial pre-
parations, given in quantity and continuation sufficient to the purpose; and
that calomel is to be preferred, succeeded by castor oil, to produce gentle,
but free purgation.

3d. That to alleviate pain and stay the spasmodic action of the intestines,
opiates should be given with the calomel, in the quantity required, and the
stomach allowing, ipecacuanha should be added, with a view to its diaphore-
tic effect.

4th. That, when the secretory action of the organs involved has been re-
stored, and it is desirable to perpetuate that action, and at the same time al-
lay mucous irritation, nothing is more to be relied on than Hope's nitrous a-
ci'd mixture, freely given.

5th. That, where the advanced stage of mucous inflammation is to be
combated, as the main object in view, the balsam copavia is the best remedy.

6th. That, much suffermg may be saved by the proper use of the warm
bath and anodyne injections, when they can be retained.

7th. That, under all circumstances, a regular action of the liver and other
secretory organs, should never be loSt sight of.

8th. That proper dietetic treatment is all-important.

It may be proper, in conclusion, to remark, that I am indebted to my friend
and copartner, Dr. H. P. Perry, for much of the opportunity which I have
had of observing the disease, and the use of remedies ; and further, that du-
ring the entire prevalence of the disease, we had but two cases to terminate
fatally, both children under two years old, and one suddenly, evidently frona
intussusception.

Lowndesboro\ June 21st, 1839.

73G Diseases of the Chest and Heart, [Sept.

Brief Rules of Exploration of the Chest, in Diseases of the Lungs and Heart
By Jacob Bigelow, M. D., Physician and Lecturer on Clinical Medi-
cine at the Massachusetts General Hospital.

[Communicated for the Boston Medical and Surgical Journal ]
Since the discoveries of Laennec, which have constituted the most impor-
tant acquisition which medical science has received during the present
century, various treatises of a general or partial character have appeared,
on the subject of exploration of the chest. Although the experience of more
than twenty years has tended to confirm rather than invalidate almost all
the laws established by that distinguished man, yet a good deal of refine-
ment and o^ modification has been mtroduced into this branch of science by
some of the more voluminous writers on the subjects which it comprehends.
Many physicians and students, it is apprehended, are on this account de-
terred from making themselves familiar with the fundamental principles of
an art, without which no accurate knowledge can be obtained of the nature
or degree of thoracic diseases.

For this reason it has appeared to me that a brief and intelligible expo-
sition of the more essential laws of this art, as it is practised at the present
day, would not be unacceptable to a large part of the medical profession.
Such rules at least are more easy of remembrance and of application, than
the extended discussions of more diffuse writers.

In the physical exploration of the chest, a series of problems for solution
is presented to our attention by the external phenomena of that part of the
body. Each of these phenomena is a sign bearing a fixed and definite re-
lativin to some particular conditions of the internal organs. By a correct
interpretation and comparison of these signs, we arrive at a knowledge of
the state of the organs, whether in health or disease, which without them it
would be impossible to obtain.

Of the Examination of Shape. In perfect health the chest is for the most
part symmetrical and equally proportioned. In disease certain changes of
form are liable to take place, and to these it is necessary that the observer
shou d direct his attention. The patient to be examined should sit erect,
in a warm room, with his chest uncovered, and the arms down in similar
positions. He should be placed directly opposite to a front light, since
unequal or side lights produce deceptive impressions in the comparison of
prominent or depressed surfaces. The following circumstances should then
be observed, and the inferences resulting from them should be tested by the
other modes of exploration.

If one shoulder, including the scapula, is constantly raised, it may pro-
ceed from curvature of the spine, from pleuritic eflTusion, pneumothorax, or
more rarely from an internal tumor. If the spaces above and below the
clavicles, or those between the ribs, project on one side more than is natural,
we may suspect emphysema, pleurisy, or pneumothorax, on that side. If
the same spaces be preternaturally depressed, there are frequently adhe-
sions of the pleura underneath them, with sometimes cit'.atrized cavities, in
the lung; or the lung, after being compressed by the disease, may not have
recovered its due dilation. A prominence in the region of the heart is natu-
ral in some persons. When preternaturally great, if it be pear-shaped, with
its perpendicular diameter longest, it should lead us to suspect pericarditis.
If it be oval and transverse, there may be hypertrophy of the heart. But
these characters are by no means constant. Various irregularities in the
conformation of the chest, arise from softness or other change of the bones
in rickety constitutions, and they may also take place in some persons, espe-
ciaEy children, without any important disease.

The sides of the chest may be successively measured by carrying a string
or tape from the middle of the sternum of the spinous process of the vertebra^
below the nipple, or on the level of the greatest apparent projection. If one
side is found decidedly larger than the other, there is reason to apprehend

{

1839.] Brief rules for Exploration of the Chest. 737

the effusion of fluid, or less frequently of air into the cavity of the pleura ; or
the enlargement or morbid growth of some internal part.

Of Percussion. The art of percussion is founded on the familiar fact that
a hollo IV body resounds when struck, while a full body does not. Thus in
percussing: a cask, or the inner wall of a house, we can decide whether it is
empty or filled up, and in most instances can determine vi^here the vacant
space begins or ends. Percussion is employed in medical practice to indi-
cate the condition of that part of the body which is immediately within the
point percussed. Any portion submitted to this test, will sound more or
less hollow, in proportion as air, or a denser suhstance, predominates in the
spot upon which percussion is madn.

As it is sometimes painful to the patient to percuss directly upon the sur-
face of the body, it is now common to employ an intermediate substance,
called a pleximeter, to receive the impulse of the blow. Various pleximeters
have been employed, made of ivory, wood, and India rubber. But one of
the most convenient is the finger of the hand of the operator which is not in
use, laid firmly and flat on the surface which is to be percussed. It may be
variously turned, at the discretion of the operator, to fit the difl^erent curva-
tures of the chest. But in comparingr corresponding parts, care should be
taken that the finger used as a pleximeter should be placed at the same
angle, upon each part, as that it be held upon it with equal pressure. For
want of attention to this point, important mistakes are committed.

Percussion is commonly performed with the ends of all the fingers at once,
holding them so that the last phalanx shall be perpendicular to the surface
percussed. A single finger answers the purpose in many cases. The stroke,
or tap, should be short and quick, since in this way the clearest sound is
elicited. Percussion requires to be repeated with different degrees of
force, in estimating the seat of morbid changes. For superficial afi^ections,
slight percussion is sufficient; but to elicit the modifications of sound which
belong to deep-seated changes, more forcible percussion is needed. It is
desirable, however not to give pain to the patient in any case.

Some inconvenience is experienced from disadvantageous positions,
when we precuss surfaces of different obliquity, and especially on the side
next the operator. To obviate this difficulty, I have used, in the iVIassa-
chusetts General Hospital, for the the last three years, a percussor formed
of an elastic ball of woollen yarn, covered with velvet, about an inch and
three quarters in diameter, with a handle five inches long. This instrument
has the advantage of great freedom of motion, as evinced by the circum-
stance that the operator may percuss with it any part of his own chest. It
has also the mechanical advantage, that the centre of percussion falls with-
in the percussing part, which is not the case when the hand is used. Its
use is attended with much more despatch than that of the fingers, and the
sound of one may be employed to test that of the other. The tone varies
in proportion to the hardness or softness of the ball, in regard to which a
medium is best. It is carried inserted in a sethoscope, the ear-piece of
which, if thickened and used edgewise, makes a good pleximeter, more
convenient to hold than any other.

For the satisfactory performance of percussion, the patient, if able, should
sit up, either uncovered or with a single thickness of covering. It is essen-
tial, when opposite sides are to be percussed, that their position and cover-
ing should be similar, to enable us to form a just comparison. While the
anterior surface is percussed, the patient should sit erect, with the shoulders
back, and both arms in the same position. When the posterior surface is
percussed, he should fold the arms and stoop forward. To facilitate per-
cussion under the axillae, the arms should be raised over the head. When
the patient is too sick to sit up, the operation becomes more difficult. StilJ
we are able to percuss the anterior and lateral parts, and if the patient ca;i
turn upon his sides, the back also becomes Dccessible.

15

738 Brief rules for Exploration of the Chest. fSepf.

Id health the percussion is most resonant where there is most lung, and
the least integument, muscle or bone. It is therefore most sonorous in the
axillas, and in the inferior regions of the chest. It is somewhat less so be-
low the clavicles, and still less so upon and above them. It is dull upon the
epine and the scapulae, and somewhat to upon the mammae and pectoral
muscles. Yet these latter give a sufficient somid, if properly compressed
by the ple.ximeter.

The two sides of the chest should sound alike in healthy persons, with the
exception that the part of the left side occupied by the heart gives a duller
sound than the corresponding part on the right side. This portion, called
the prascordial region, extends from the middle of the sternum to the left
nipple, and from the base of the chest, obhquely to the junction of the ster-
num with the third or fourth rib. A source of inequality is found in the
lower part of the left chest, from its proximity to the stomach, in conse-
quence of which it becomes resonant when that organ is distended with gas.
But in this case the sound is peculiarly sharp and tense, having the tone which
Piorry has denominated stomachal resonance. The right side, also, at it
lower part emits a duller sound, from the proximity of the hver. With the
foregoing exceptions, the healthy chest should sound alike, or nearly eo, on
the corresponding parts of opposite sides. And if there be a constant and
evident difference in the sound elicited by percussion from the two side?, we
are justified in inferring that one side or the other is a seat of disease. In
estimating the results of percussion, we should not compare different indi.
viduals with each other, except in cases of great peculiarity, for perhaps no
two individuals veld precisely the same sound, owing to the size ot the chest,
the amount of integuments, &,c. But the same individual may always be
compared with himself.

Normal sounds are those which are naturally emitted by healthy persons
under exploration. In disease the sound of percussion is liable to become
pretemalurally resonant on the one hand, or dull -dnd Jiot on the other. The
sound is termed preternatural, when the part percussed is more resonant
than in health. If the resonance is excessive, it is called iymjjcnitic. It
exists in emphysema, in which disease the air vesicles are enlarged ; also in
pneumothorax, in which air exists in the cavity of the pleura.

The sound of percussion is termed c?uZ/, when the resonance of the chest is
less than natural ; and fat, when there is little or no resonance, the sound
in this case resembling that which would be yielded by the fleshy part of a
limb, if percussed. Dull and flat percussion are different degrees of the same
ihing, and take place when a portion of light vesicular lung is replaced by a
denser body. This may be a foreign or different substance, sucli as an en-
larged heart, a tumor, or an effusion of fluid ; or it may be a portion of the
iung itself consolidated by disease, as in hepatization, and tuberculous infil-
tration, the former occurring in pnuemonia, the latter in phthisis.

If the chest emit a dull or flat sound, which shifts its relative position
whenever the body is moved from one posture to another, always occupying
the lowest situation, we may conclude that there is effused fluid, which by
its own gravity seeks always the lowest level.

There is a peculiar sound sometimes heard in percussion, which is dull
and jarring like that of a cracked earthen vessel, and called by the Frenc^h
hruii depot JkU. It is best heard during expiration, and with the patients'
mouth open. It occurs in phthisis, ani indicates a cavity in the lung, im-
mediately within the percussed part. The diagnosis is rendered more cer-
tain if on light percussion that part gives a dull sound. i:\ rare cases the
cracked sound is met with when the lungs are healthy.

Auscultalu/Ti. .-Auscultation is the art of estimating by the ear the nature
of the difTerent eounda produced by natural process within the body, more
particularly v.'ithiu the chest ; and of explaining these sounds by reference to
tbcL- cdufies. These sounds may be heard most perfectly by the immediate

iS39.] Brief rules for Exploration of the Chest. 739

application of the ear to the surface of the body, and this method is called
immediale au?culation. It may also be heard by interposing^ between the
ear and the patient's body, a solid substance capable of conducting sound,
and this is called mediate ausculation. When a person breathes or speaks,
the walls of the chest are made to vibrate in a manner which corresponds to
the vibration of the parts immediately within them. This vibration is va-
riously modified by disease, so that to the cultivated ear, the vibration of
the walls of the chest expresses the pathological condition of the internal
organs.

For most purposes immediate ausculation is preferable to mediate, Pince
it is practised with greater ease and despatch, and in most cases gives more
satisfactory results. But Laennec, the discoverer of ausculation, intro-
duced an instrument, called a sethoscope, which is a hollow cyhnder made
of some light wood, having a broad surface for the ear at one end, and ;i
trumpet shaped cavity at the other. The trumpet-shaped extremity collects
the vibrations of sound from a considerable space, and these are conveyed
through the instrument to the ear. The original sethoscope of Laennec
was a large and clumsy instrument, and is now superseded by others of
more portable form and d mensions. Although the discoverer of auscula-
tion seems to have considered his instrument as indispensable, and styled
his great work a treatise on ' Mediate Ausculation," yet the best auscu-
lators of the present day make comparatively little use of instrumental
assistance.

The chief cases in which the sethoscope if? wanted in practice arc, 1.
To pxamme the depressed surface of the chest, into which the ear cannot be
inserted. 2. To explore very small spots or diseased portions of very lim*
ited extent. S. Toderermme the exact boundaries of a pathological affec-
tion. If this is attempted by immediate ausculation, the observer is liable to
be deceived in consequence of the conducting power of the bones of the
hand. 4. When circumstances unconnected with science arc opposed to
immediate ausculation, such as the modesty of females and the squahd con-
dition of the lower orders.

The patient to be ausculated should be placed in an even and easy posi-
tion, so that one side may not be more prominent than the other, and the
muscles may be equally relaxed. The erect position is to be preferred,
when the patient's strength admits it. The less covering is left on the chest
the better, and especially all substances, which may produce a fallacious
sound, as silk and woollen, should be removed. These precautions being
attended to, the ear should be applied to different parts of the chest in suc-
cession ; or if the sethescope is used, it should be placed even, so that every
part of its orifice may "be in contact with the surface of the body. The at-
tention should then be directed to the natural respiration, and to the respi-
ration when forced by more rapid eflf^.irts of the patient. Afterwards the
voice is to be attended to, and finally xhe sound of the cough. In all these a
careful comparison is to be made between the sound emitted from correspond-
ing parts of the two sides.

Jn immediate ausculation the ear is most easily directed to parts which
correspond on opposite sides, by placing a finger underneath it as guide,
and removing and replacing this by inspection. It is also useful in imme-
diate ausculation to vary the position of the ear, by sometimes turning off
the head so as to liberate the meatus, and still receiving the sound through
the bones of the cranium. This may correct our-first impressions. In this
way a double sound of the heart can often be heard, when only one is heard
by immediate application of the ear.

Two sounds are produced m natural respiration, and may be heard in
every healthy person. The first of these, called vesicular respiration, is a soft
breezy expansive murmur, which is audible when the ear is applied to most
parts of the chest, but particularly the lower part?. It is confined chiefly to

740 Brief rules for Exploration of the Chest. [Sept.

Ihe act of inspiration, and tlie expiratory sound is scarcely heard in health,
except in the upper and posterior parts, and in these places it is weaker
than the sound of inspiration. The second, called bronchial respiration, is
a more harsh and blowing sound, and may be heard in its greatest intensity
by placing a sethoscope on the trachea, Jrom which circumstance the highest
degree of bronchial, is called tracheal respiration. It is heard in a less de-
gree opposite the root of the lungs, between the scapulae and the spine. It
occurs both in inspiration and expiration.

Vesicular respiration is apparently produced by the entrance of air into
the pulmonary vesicles. Bronchial respiration seems to be caused in part
by the passage of air through the bronchi and their branches, but is chiefly
conducted, like broncophony (hereafter described,) from the fauces and
Jarynx. In health there is somewhat more bronchial sound on the upper
part of the right side than the left, owing to the right bronchi being largest.
The sounds in different individuals are found to vary greatly in intensity,
owing to natural differences in the structure of the integuments, and the
contents of the chest. But when in the same individual there is a difference
in opposite and corresponding parts of the chest, and the difference is not to
be accounted for by their mechanism of the chest, which has been already
explained, we infer the existence of disease. We suspect disease when the
vesicular sound of any part is comparatively diminished or increased ; also
when it is replaced by bronchial respiration in a part to which the latter does
not naturally belong.

When the respiratory sound is particularly feeble, or absent in any of the
anterior parts of the chest, we suspect the existence of emphysema, or dila-
tation of the pulmonary vesicles, especially if there is a degree of roughness
in whatever sound is heard ; and the diagnosis is confirmed if there is reso-
nant percussion. If feeble or absent respiration occurs at the posterior or
inferior parts of the chest, we suspect pleurisy, and proceed to test the cor-
rectness of our diagnosis, by examining for the other signs of that disease.
If feebleness be confined to the apex of the lungs, there may be tubercles ;
and if it varie?, by recurrring at periods of short duration, it is owing to the
mucous obstructions attendant on bronchitis.

When the respiratory sound of any part of the lung is preternaturally loud,
but otherwise healthy in its character, it constitutes puerile respiration, so
called by Laennec, from its resemblance to the loud respiration of children.
When this sound is universal, it merely indicates activity or functional ex-
citement. But when it is confined to any one part of the chest, we at once
suspect that some part is diseased, for when one part of the lungs is disabled
by disease from performing its proper function, the remaining parts take on
a supplementary action, attended with greater labor and more sound.

VVhen bronchial or harsh respiration is heard in parts where it ought to be
vesicular, and especially if the expiration is bronchial, we infer that there is
disease ia the part thus affected. This is very commonly an induration of a
part of the lung, by which the vesicles are filled up or consolidated, so that
the vesicular sound is destroyed, while the consolidated portion conducts the
sound from the bronchi directly to the ear. This happens in pnuemonia, m
which a part of the lung is hepatized ; an affection which may occur in any
part of the chest, but chiefly in the back ; or it may take place in phthisis
when a part of the lungs, usually near the summit, is indurated by tubercu-
lous infiltration. Bronchial respiration is often heard in pleurisy, apparently
when the effusion of fluid is such as to compress the air visicles without com-
pressing or obliteratmg the bronchi. It is also heard when a bronchus is
preternaturally dilated.

Rude or rough respiration is a mixture of bronchial and vesicular sounds.
It is heard in incipient phthisic, and in the lesFer degrees of pneumonia and
pleurisy.

1S89.] Brief rules for Exploration of the Chest. til

When bronchial respiration is intense, so as to resemble the sound of air
blown into the ear, it has been called tubal. The circumstance which is best
suited to produce ihis sound is a dense hepatization, extending from the
pleura to the trunk of a large bronchus.

Cavernous respiration is a modification of the bronchial. Its sound is so
modulated as to convey to the ear the impression of air being alternately
drawn into and expelled from a cavity. It is commonly of small extent, and
indicates an excavation of moderate size in the lungs. It is most clearly
pronounced in tuberculous cavities, the walls of which are indurated. It
may also exist, though more rarely, in abscess, in cavities from gangrene of
the lungs, and very large bronchial dilatations.

Amphoric respiration is well marked, and easy of recognition. It close-
ly resembles the sound produced by inflating a recent bladder to a great de-
gree of tension. It also is compared to the sound produced by blowing in-
to a glass bottle or tumbler held near the mouth. It indicates the exis-
tence of large cavities, with firm or tense walls, around which the air rever-
berates in breathing. It accordingly exists iu large tuberculous excava-
tions of the lung, and less perfectly m the cavities which follow gangrene.
In pneumo-thorax it is often highly distinct, especially if a free fistulous o-
pening exists between the cavities of the pleura and bronchi, permitting the
entrance and egress of air.

The sounds hitherto described are a sort of modification of the natural
respiratory noise. There remain to be considered certain adventitious
sounds, which are not present in healthy respiration, but occur in different
diseases. These are commonly designated by the French term rdles^ which
is the name originally given them by Lsennec. The Latin name rhonchu;<,
or rhonchi in the plural, is used to express the same thing. The English
term ratlle is sometimes used, but is liable to obvious objections.

The sonorous rale is a continuous sound, of a louder character than the
rest, and has been compared to the pipe of an organ, the bass string of a
viol, the creaking of a wagon wheel, or the cooing of a pigeon. It is heard
both in inspiration and expiration. It commonly attends bronchitis or pul-
monary catarrh, and is supposed to be caused by a thickening of the mu-
cous membrane in some of the larger bronchi.

The sibilant rale is continuous like the former, but is more acute in its
tone, resembling a low whistling sound. It is supposed to be produced in
the smaller bronchial ramifications. It occurs in catarrhal aflTections, in
which it is fugitive and olten changes its place ; also in emphysema, and in
typhoid fever after the first week.

The two foregoing have been called dry rS.les, to distinguish them from
those which follow, and which have been styled moist or humid rales. But
there seems to be no good foundation for this distinction, since the facihty
with which the sonorous and sibilant rales change their places, appears toi
indicate the presence of fluid in the bronchial passages.

The crepilous rale, sometimes called the fine crepitous, has been compar-
ed to the crackling of salt thrown upon the fire, or the rubbing of one's own
hair between the fingers close to the ear. It accurately resembles the
Bound of champaigne or soda water, held in the mouth in a state of eflfer-
vescence, or of the electric fluid drawn from a sharp point. It is sometimes
heard after cough, when otherwise inaudible. It is most distinctly heard
in common cases at the end of the inspiration. It belongs exclusively to
pneumonia, and is pathognomonic of the first stage of inflammation, or that
of pulmonary engouement. It is said to be sometimes heard in healthy per-
sons on a single forcible inspiration, after which it disappears.

The sub-crepitous or coarse crepitous rale, resembles the former, but dif-
fere in the size of its bubbles, which are larger and more unequal, forming-
altogether a coarser sound. It is heard in catarrh, in which case it is. usu-
ally audible on both sides at once. It exists in mdema of the lungs, &ud in

^45 BrUf rules, for Exploration of Ihe Chest, [Sepf,

pneumonia, wlien thnt dispase is passing into resolution. If it is heard
only on one side, and is confined to the top of the chest, we may suspect tu-
bercles.

The crddcUng Tii]o, craquemimt of the French, is a coarser sound than thft
lasti and resembles a short valvulas flapping, ll is heard best immediately
after cough, during the first inspiration, and affords the first sure indication
of the softening ot tubercles. It is usually met with at the top of the chest.

The mucoiLS rale is a rattling sound, more loose and coarse than any of
the preceding, and giving the impression of a fluid traversed by air in the
bronchial passages. It is heard in all diseases of the lungs which are attend-
ed with a copious secretion ot mucus or pus, such as catarrh, the advanced
stages of pneumonia, and phthisis. A lesser degree of this sound is called
muco-crepitous.

Gurgling rS-le, gargouillement of the French, is a bubbling sound, caus.
pd by the passage of air through a quantity of fluid contained in a cavi(y.
It may exist in cavities produced by pneumonia, gangrene, or a dilated bron-
chus ; also \n the trachea and its large branches. But by far the most com-
mon source of this rale, is a cavity formed m the lungs in phthisis. It often
alternates with cavernous and amphoric breathing, and apparently takes
place whenever the level of the fluid rises above the bronchial orifice which
supplies the cavity with air. It may often be produced by coughing, when
it is not audible in any other way.

The sign called metalhc tinkling resembles the snapping of a short musi-
cal wire, or it is like the sound of a glass or silver vessel when struck by a
pin. It requires for its production a cavity having tense or undurated wall?,
and containing both ajr and liquid. It mciicates the existence either of
pneumo-thorax, or of a large tuberculous cavity. The immediate cause of
metallic tinkling is the forcible or sudden disturbance of the liquid in a ca-
vity like those mentioned. The explosion of bubbles of air from beneath
the surface of the liquid, appears to be the most common cause of such a
disturbance ; but it may take place when a part of the liquid is thrown up-
ward m the act of coughing, and falls back upon the remainder. A minor,
or sub-metallic tinkling, having no musical resonance, may be produced by
slight impulses given to the air in the cavity, such as the breaking of bub-
bles of mucus at orifices above the surface of the liquid.

The sourul of friction^ bruit de frottement, has been compared to the rub-
bing together of two pieces of leather. It conveys the idea of difficult fric
tion, in which two opposing surfaces in close contact alternately move and
catch upon each other. It is sometimes not only audible, but palpable to
the hand. It exis*s in dry pleurisy, in which the opposite surfaces of the
pleura are covered with a false membrane, or coating of coagulable lymph,
without the interposition of serum sufficient to prevent contact. It is most
apt to occur after effused serum has been absorbed. It may take place in
interlobular emphysema.

Voice. The voice is produced in the larynx, and the vibrations belong-
ing to it are conducted through the trachea and its branches to all parts of
the lungs. If we apply the ear to the chest of a person who is speaking,
we perceive a contused, inarticulate noise. It is clearest and most resound-
ing at the upper parts of the chest, which are near the larynx, and in which
the bronchi are largest, especially at the inner edge of the scapula, ft is
feeblest in the lower parts, where there is a great deal of intervening, spon-
gy, vesicular texture. The degree of resonance varies in different sub.
jc'cts. If other things are equal, it is greater in thin persons than in those
who are fleshy, and in persons who have a strong deep voice, than it is in
those whose voice is high or feeble.

Aphonia, or loss of voice, may take place from catarrhal affections, de-
bihty, paralysis, ossification of the cartilages of the larynx, or ulceration of
the vocal chords in phthisis.

ldS9.] Brief rules for Exploration of the Chest. 748

The first deviation of the voice ftoni its natural state, perceived m auscu-
lation, is in its diminished resonance. When lliis takes place in a particu-
lar part, independently of affections of the integunients, :t most frequently
indicates eniphytieina. It may also occur in pleurisy, wjien the effusion in-
to the cavity of the chei-it is sufficient to compress the whole lung.

Increased resonance of voice takes' place when thepuinionary texture is
tjlightly increased in density. It occurs in incipient phthisi;:, and at th be-
ginning and decline of pneumonia and in dilatation of bronchi. This and
the foregoing variety of resonance, can be estimated only by comparing the
part of the lung in which they occur, with a correspondmg portion which
is in a healthy state.

Bronchophony is a peculiarly loud, clear, thrilling sound, which impresses
the listener as if the voice was close to his ear, or as if the patient spoke
through his ribs. In different degrees it accompanies bronchial and tubal
respiration, and depends upon the same causes, viz., induration of the pul-
monary substance by tubercles, hepatization, bronchial dilatation, &,c. Bron.
chophony, in some cases, is attended by a thrill whicii is not only audible,
but palpable to the hand.

Pectoriloquy is an exalted degree of bronchophony, resembling the sound
which is heard by placing a stethoscope on the trachea while a person speaks.
It is produced by a cavity in the lungs, of moderate size, having indurated
walls, and being empty, or nearly so, of fluid. It is liable to disappear and
return as the cavity becomes filled with fluid, or is emptied by coughing.
The value of pectoriloquy in diagnosis has probably been exaggerated, and
we seldom rely upon it without the concomitant signs of excavation.

Amphoric resonance of voice is a hollow, reverberating, semi-metallic
Bound, as if a person spoke in a brazen vessel. It accompanies amphoric
respiration in pneumothorax, and in tuberculous excavations of large size.

Mgophony is a sound which has been compared to the bleating of a goat,
from whence its name is taken. A good idea of it may be obtained from
the nasal voice of a person who closes his nostrils in speaking. It exists
at a somewhat early stage of pleuritic effusion, then disappears, and returiis
again after the fluid is partly absorbed. For its production it requires that
a certain amount of fluid should be interposed between the lung and the ear,
but not so much as to compress the lung wholly. It is usually heard near
the lower angle of the scapula. ^iJgophony occasionally runs into bron-
chophony, and an intermediate sound is sometimes produced in pleurisy, viz.,
broncho-eegophony. This sound is apt to exist in pneumonia, attended with
a slight degree of pleurisy. According to M. Reynaud, aegophony may oc-
cur in aneurism, when the trachea and bronchia are compressed.

SuccusaiON. A very ancient, though rough mode of exploring the chest,
consists in shaking the patient with ^ view to elicit the sound of free fluid,
if such exists in the cavities. This mode is applicable only to cases in
which air and liquid co exist, as in pncumo-thorax and large pulmonary ex-
cavations. In patients thus affected, if the body be agitated, the dashingof
the fluid ran be heard not only bv auscultation, but frequently by the ear at
some distance from the body. This mode should not be practised to the
annoyance of weak patients, but we have repeatedly met with patients who,
by their own efforts, could produce the sound ofsuccussion at pleasure.

Cough. S. short dry cough \s attendant on various irritations of the fau-
ces, elongated uvula, some febrile affections, and occasionally in persons in
whom no obvious cause can be detected. It attends on the incipient stages
of phthisis.

A hoarse cough is loud, dr}', hearty and forcible, without any peculiar
hatshness or stridulous sound. It exi^4ts in the early stages of pulmonary
catarrh, and eeems, like a hoarse voice, to depend on intumcEceiicc of the
vocal chords.

744 Brief rules for Exploration of the Che^t. [Sept.

An aplwnic cough, the tone of which is whispering and feeble, seems to
depend on the same causes which produce aphonia m the vocal functions.
It takes place in excessive catarrhal affections of the glottis, in great debili-
ty and in ulcerations of the larynx.

A striduhus cough, having a barking or brazen sound, occurs in croup,
laryngismus, and in some children at the commencement of catarrh or mea-
sles. In confirmed croup, under the production of false membrane, it is
apt to acquire a wheezing or whistling character.

A loose cough, as its name expresses, is characterized by the sound of a
loose fluid in the air passages. This fluid may be mucous, purulent mucus,
or pus. It occurs in the advanced stages of catarrh, in phthisis, in the third
stage of pneumonia, and in old age. In catarrh it is frequently a ground of
favorable prognosis. A cough may in some cases have a broken and some-
what loose sound, without evidence of much fluid.

A spasmodic cough consists usually of many short expirations, followed
by a single prolonged and often sonorous inspiration. It occurs in hooping
cough and sometimes in dentition and other affections of children. The
cough of asthma has generally more or less of a spasmodic character.

The amphoric cough has a hollow, reverberating sound, and constitutes a
striking symptom of the advanced stages of phthisis, with large cavities.

ExPECTORATi(N In a state of health the natural saliva and mucus arc
transparent and colorless, and they generally remain so in the incipient sta-
ges of pulmonary diseases.

When the sputa consist of mucus which is thick, whitish and opaque, du-
ring common pulmonary catarrh, they indicate a subsidence of the inflam-
mation. They are sometimes yellowish or greenish when the disease is
prolonged.

When the sputa are of a red color, viscid, heaped in small inasse, and
adherent to the vessel into which they ere discharged, the disease is pneu-
monia. They may also be sometimes brown or yellowish in this disease.

When liquid blood of a fresh, florid and frothy appearance is thrown oflT
by an expiratory effort, in any considerable quantity, the case is one of hse-
moptysis. It shows in most cases the existence of tubercles in the lungs,
but may take place under the influence of other causes, such as catamenial
irregularities, aneurism of aorta, and external accidents. Pulmonary he-
morrhage, when slight, probably proceeds from exhalation from the mucous
membrane ; when more serious, from the vesicular texture ; and in rare
cases, from the rupture or division of a blood vessel.

When pus is expectorated the disease may be bronchitis, pneumonia, or
phthisis. The characteristic sputum, often seem in advanced phthisis, has
received the Freneh name pelotonn'i, which has been rendered in English
by the word nummulated. It appears in roundish masses, with shred-like
edges, floating in a clear, transparent liquid. The taste is often sweetish,
and the smell nauseous. But it is in some cases extremely difficult to dis-
tinguish the pus of phthisis from that of chronic catarrh.

When chalky or calcareous concretions are coughed up,, they mostly in-
dicate tubercles or phthisis, usually in a more chronic form. Tuberculous
matter is sometimes coughed up in the same disease.

When the sputa are extremely fetid, and accompanied with a putrid odor
of the breath, the disease is gangrene of the lungs.

The expectoration of young children cannot be examined, from the cir-
cumstance that the substances raised are immediately swallowed by them.

The act of expectoration fails to take place when there is a want of suf-
ficient sensibility in the mucous membrane or the diseased part, to excite
coughing. This happens in the lethargic and the moribund, giving rise. to
the well-known rattling sound in the throat so often heard in these cases.
For the same reaFon expectoration is suspended during sleep, and takes
place in increased quantity on waking. Some patients voluntarily avoid

1839.] Brief rules for Exploration of the Chest. 745

expectoration as lon^ as possible, on account of pain or fatigue attending
the exertion of coughing.

Of the Heart and Arteries. The heart is situated in the left chest,
occupying the praecordial region already described. The apex of the heart
points forward, downward, and to the left, about the level of the fifth inter-
costal space. It is enclosed in the pericardium, and covered by the edges of
the lungs, with the exception of a small part of a rhomboidal shape, and
generally not two inches square. The portion which in most individuals is
thus uncovered, gives a dull sound on percussion, and beyond this part the
dulness diminishes, till it is lost in the surrounding pulmonary tissue.

The phenomena which are noticed when the ear is applied to the region of
the heart in health, are the impulse and the sounds. The impulse conveys
the impression that the ear is pushed or struck by the heart, and the sounds
which are heard are two in number. The first sound coincides, in point of
time, with the impulse, and occupies half the period of a whole pulsation.
7'he second sound is short and abrupt, occupying a quarter or less of the
pulsation, while a pause which follows, fills up the remainder of the period.
The causes of these sounds of the heart have been the subject of much re-
cent dispute and experimental inquiry. The latest results render it proba-
ble that the first sound is occasioned by the muscular contraction of the
ventricles, beginning with the closing of the auriculo-ventricular valves,
while the second sound is produced solely by the flapping of the semi-lunar
valves. In exploring the region of the heart for signs of disease, we attend
chiefly to the impulse, the sounds, the rhymth, or order and proportion of the
sounds, the extent of dull percussion, the extent of audible respiration, and
the prominence of the praecordial region.

VVhen the impulse of the heart is strong and lifting, we infer that there is
hypertrophy of the organ, or some of its parts. If perceived over a large
space, it is probably attended with dilatation. This diagnosis is confirmed
if there is OBdema of the lower extremities, dyspnoea, bloating and lividity of
the face, with violet-colored lips, and pulsation of the jugular veins.

When in acute disease the impulse is feeble, irregular, or wanting in an
erect posture, we should suspect pericarditis, and look out for its other signs.

When there is palpitation, or frequent and abrupt pulsation of the heart,
there may be structural or functional disease, or mere nervous irritability of
the system.

When the first sound of the heart is prolonged by a blowing or bellows
sound, there may be structural or functional disease, or inanition from loss
of blood, &-C.

When the second sound is prolonged or rough, w^e suspect disease of the
valves from vegetations, thickening, rigidity or contraction. When either
sound resembles th? noise of a file, rasp or saw, or the cry of a bird, there
is probability of still greater valvular disease. In these cases it is generally
found that the valves, by their increased thickness, obstruct the passage of
blood through the orifices which they command, or else, by their imperfect
closure, they permit a portion of the blood to regurgitate. By applying the
ear in succession to different quarters of the praecordial region, an opinion
may be formed as to the particular valves which are diseased. Neverthe-
less, our present knowledge of the import of valvular sounds is by no means
complete, and the certainty of their indications is doubted by some able
pathologists.

When the sound of percussion is dull or flat over a greater extent than
natural of the praecordial region, there is reason to suspect hypertrophy or
pericarditis, with serous effusion. A similar inference is to be made when
respiration is either absent or extremely feeble over the whole extent of this
region, and at the same time is distinct in other places.

F

746 Brief rules for Exploration of the Chest. [Sept.

When the heart is perceived in the right chest, pulsating as strongly as
in the left, or more so, there is either a preternaturaJly solidified portion of
lung, or tumor, by which the pulsation is transmitted ; or else the heart is
dislocated by effusion or tumor in the cavity of the left pleura. In some
very rare cases there has been a natural transposition of this and other
organs.

When prominence of the prsecordial region exists in connection with
other signs of diseased heart, there may be pericarditis or hypertrophy. If
the prominence be higher than this, we suspect aneurism of the aorta.

When there is a friction sound, like the creaking of new leather, which
is synchronous with the pulsations of the heart, there is pericarditis, with
effusion of lymph coating the surfaces in contact.

When there is dull percussion, with tumor, about the upper and anterior
parts of the chest, attended witli loud pulsation, either single or double, es-
pecially if there is a purring tremor above the clavicles, we may presume
there is aneurism of the thoracic aorta.

The abdominal aorta can be felt in thin persons pulsating along the spine.
If the pulsations be excessive and diffused over a preternaturally large
space, there is either aneurism of this part of the aorta, or some tumor trans-
mitting its pulsations. Strong pulsations, if not thus diffused, may indicate
merely functional disturbance.

_When a pulsating tumor is felt in the course of any artery, accompanied
with a thrill which is perceptible to the hand or ear, and the tumor subsides
on compressing the artery above it, and returns when the pressure is re-
moved, the case is aneurism.

When there is pulsation of the jugular veins, we are to apprehend an
imperfect closure of the right auriculo-ventricular valves, in consequence of
which, when the ventricle contracts, a part of the blood regurgitates to the
auricles and veins.

In certain patients, if a stethoscope be lightly pressed upon the side of
the neck, a continuous sound, without pulsation, is heard. It is sometimes
buzzing and musical, at others it resembles the blowing of wind against the
corner of a house. This sound is called by the French bruit de diable^ and
is now considered as having its seat in the jugular veins. It is chiefly found
in chlorotic and anemic subjects, and is supposed merely to indicate thinness
of the blood. Several varieties in this sound have been pointed out, which
seem of not much practical consequence.

The average frequency of the pulse in healthy persons is from 70 to 75
in a minute. In tall and stout persons it is slower, and in females and irrita-
ble subjects, quicker. In infants during the first month, it averages 120, in
the second year 90 to 100, and afterwards gradually diminishes. When the
pulse is habitually slower than these rates, it commonly arises from idiosyn-
crasy. But if the slowness is of recent occurrence, and is great in degree,
there may be pressure on the brain, or functional disturbance, as from nar^
cotics. On the other hand, the pulse in health may be preternaturally fre-
quent, from mere constitutional irritability, or from various exciting causes.
But in most grave diseases a pulse which at all hours exceeds 120, indicates
serious morbid affection, and a pulse of 140, if long continued and feeble, is
indicative of danger.

When the stroke of a pulse is hard, strong, and simultaneous with that
of the heart, it indicates a state which will bear depletion with benefit, or at
least with safety. But from this rule we must except the reaction of pulse
which sometimes follows excessive bloodletting or hemorrhage. On the oth-
er hand, when the pulse is feeble and easily compressed, and when it follows
the stroke of the heart by a perceptible interval, it indicates an atonic state,
in which depletion, for the most part, is contra-indicated. The radial pulse
may become imperceptible in syncope, in great prostration, and in the mori*
bund.

lS39.] Remarks on Hooping Cough. 747

The radial pulse, says Dr. Williams, in general represents truly the num-
ber of the heart's contractions ; it can never exceed them. But when the
heart acts very feebly its pulsations may not reach the wrist ; and when
they are irregular in force, some may be propagated to it and others not, in
which case the pulse will be intermittent. In some cases the heart, as well
as the pulse, omits to contract. This irregularity may be functional, or it
may be consequent on organic disease of the heart.

Syncope, or fainting, results from a failure of the heart in force, or fre*
quency, or both. It may be occasioned by a great variety of causes, such
as mental emotions, loss of blood, especially during an erect posture, violent
mechanical injuries, sedative poisons, &lc. Some persons faint readily, on
slight occasions, from idiosyncrasy. The pulse at the wrist is weak, and
often imperceptible during syncope. The sounds of the heart are also fee-
ble in most cases, very short, and without a second sound, and generally ir-
regular.

Hemorrhage takes place spontaneously in acute diseases, especially in
fever, and likewise in different morbid changes of structure. It occurs most
commonly from mucous membranes by exhalation, and less frequently by ul-
ceration or rupture.

Some remarks on the Hooping Cough^ communicated in a Letter to Dr. U.
J. Graves. By Dr. H. C. Lombard, of Geneva.

My Dear Dr. Graves^ I resume my long interrupted medical communi-
cation with you by some remarks on the hooping cough, which has been so
prevalent at Geneva during the last winter and spring. Seldom have I
seen so many children attacked at the same time with the convulsive cough;
and my field of observation on the sufferers under this painful complaint
has been proportionably great. My remarks have been made on the symp-
toms, the duration, and the various complications of the hooping cough, as
well as on the mortality, causes, and treatment of this disease. You will
see hereafter, that I have come to some practical results which I am glad
to communicate to you, who take so much interest in the means of lessen-
ing the sufferings of your fellow creatures.

The symptoms of the hooping cough have been the same in Geneva as
elsewhere ; it has generally begun in a slight catarrhal affection, with a
short, dry cough, which instead of becoming less and less, increased from
day to day, and after a period of two or three tveeks become quite convul-
sive. This first uncharacterized period has sometimes lasted six or eight
weeks, and sometimes has been totally wanting, so that the patients had in
the space of a few days the convulsive cough ; but the most general oc-
currence was a short, dry cough, for two or three weeks, and afterwards a
regular fit or paroxysm recurring from ten to fifty times a day. The fit or
paroxysm was most generally divided into two distinct parts, with an inter-
val, during which the patient could breathe easier, and have a few seconds
or minutes of rest. It was generally preceded by a great state of anxiety,
which lasted from five minutes to half an hour ; the little patients used
then to cry, and were very much agitated ; older patients used to announce
their fit a long time before its appearance, and they were troubled some-
times with a difficulty of breathing and sometimes with nausea. In a young
girl aged seven years, the nausea was so intense before the fit, and lasted
so long, that the only period of rest which she enjoyed, was that which fol-
lowed the fit, and even that was of short duration. Sometimes, however,
those precursory symptoms used to vanish, and were not constantly follow-
ed with a regular fit of hooping cough ; and I have chiefly remarked this

748 Remarks on Hooping Cough, [^Sepl.

favorable result when the patient's attention was directed to some interest,
ing object, or attracted by conversation. The mucus expectorated was ge-
nerally viscid, whitish and transparent ; sometimes, however, I have found
it in the latter period yellowish and even greenish. I have not met with
many cases of swelling of the iace in the most violent attacks, and I have
reason to think that this symptom, which has been considered as constant
in the hooping cough, is by no means a usual attendant of this disease ; and
the more so, as I have seen during the last winter two cases of simple
catarrhal affection in children, who had the swelled appearance of the face
which has been considered as characteristic of the hooping cough. I have
often met with profuse hemorrhages from the nose ; but they have never
been attended with any danger, on the contrary, they seemed to relieve ra-
ther than to increase the violence of the symptoms.

Nausea and vomiting, chiefly the last, were amongst the most constant
symptoms observed in my little patients ; some of tliem have seemed for
weeks to have thrown up all that they had swallowed, and yet they were
not much emaciated ; so that I am disposed to think that the very effort of
vomiting presses down the pylorus a certain part of the food, and gives an
ahment to the absorbents. This supposition appears to me corroborated by
what happens in pregnant women, w^ho during many months seem to vomit
all they have swallowed, and yet are not much emaciated, at least rot so
much as they should be were they to retain no food for the process of nutri-
tion. The tongue has generally been white and furred in most cases, and
yet the little patients have generally longed for food, and taken it with great
pleasure. The bowels have generally been as regular as they are in chil-
dren of the same age and constitution.

The progress and duration of the hooping cough has been quite different
in most of my little patients. The average duration has been from seven
to eight weeks ; in some cases it did not exceed three or four weeks, but in
other cases it has been protracted to as many months. 1 have heard of ca-
ses which had lasted a year or even eighteen months ; but none of those
cases have come within my personal observation, and I entertianm uch
doubt as to the correctness of this fact. I have not found weak or debili-
tated children more subject to violent fits of the hooping cough, than strong
and healthy boys or girls ; and the only cause of an increased cough has
been the presence of many patients in the same apartment ; and I think it
would be a prudent line of conduct to put the httle patients in different
rooms, otherwise when one has a relapse, all the other follow at a short in-
terval, and in this way the duration of the complaint is very much increased.

The progress of the hooping cough has been very irregular : the first pe-
riod has sometimes been entirely wanting, at other times it has been much
protracted ; the second period, during which the cough had attained its ac-
me, has been often very short, while the period of decrease has lasted a ve-
ry longtime. In most of my patients I have observed a temporary return
of the cough, which seemed to return with as much violence as before ; but
this relapse, though frequent, was never of much duration ; and after two
or three days the regular decrease continued its course. The fits of cough
were observed day and night ; and at first I had not perceived whether they
were more frequent during the day or during the night ; however, having
investigated the subject more closely, 1 have come to the following conclu-
-sion ; during the period of the increasing cough, the fits are more frequent
at night, and when the hooping cough is on the decrease, the fits are more
frequent during the day. The following table shows this fact as observed in
two patients, aged, one two years, and the other four years :

NUMBER OF FITS.

Day. NigU. Total.
Cask I. Is/, period, (from the 27th Jan. to the 13th
P^hruarj,) 134 143 27

123

291

266

548

288

519

126

278

1839.] Rerndrks on Hooping Cough. 749

2;rJ period, (from the 14th February to the 4th
March.) ... - - 148

282

Case II. 1st. period, (from the 27lh January to the
13ih February.) ' 331

2nd period, (from the 14th February to the 4ih
March.) 152

383 414 697
In both cases the greater number of fits is during the first period at night,
and in the second period during the day time. 1 have met with many in-
stances similar to this, and since I have communicated this singular result to
other f)ractitioners, they have had many opportunities of confirming its cor-
rectness ; and amongst other examples, I may name the two sons of one of
our most distinguished surgeon^^, who told me that he had made the same re-
mark in his family. The fact being well ascertained, what is the explana-
tion ] It is easily understood, that during the first period so violent is the
cough that it awakens the patient from the soundest sleep ; while when the
fits are weaker, the frequency of the cough is not so great as to awake the
patient. This supposition, however, explains only part of the fact, as it
leaves undecided why the greater number of fits takes place in the night
durnig the first period, when the agitation and cries of the little patients
seems to bring on constantly new fits. So we are led to suppose, that not-
witiistanding this last cause of increased cough, it is very likely that motion,
amusement, and the open air, contribute to lessen the cough ; while rest,
the horizontal posture, and the close air of the sleeping-rooms, increase the
tendency to the return of convulsive cough. The last conclusion is the more
striking, that in adults and m other cases the cough is rather diminished than
increased under the last mentioned circumstances.

1 have not met with a single well authenticated case of secondary hoop-
ing cough ; and what may have induced some authors to admit such cases
of relapse, is the peculiar prevalence of a convulsive cough amongst the a-
dults, while the hooping cough exists in the same town. During the last
winter we have seen many persons attacked with violent fits of cough, at-
tended with vomiting, tears in the eye, and bleeding from the nose. But
most of those cases were such as to preclude all idea of a true hooping cough,
and in most occurrences it happened in persons who had no communication
with children labouring under the convulsive cough.

The only cause which I can admit for the hooping cough, is its transmis.
sion by contagion ; the proofs of this assertion are the following : In most
families where one child was attacked, all the others fullowed at a short in-
terval. In the schools the transmission has been rapid and general; and
in the town of Geneva we have traced the first cases as having caught the
hooping cough in a neighboring town, where it had been introduced by a
sick child arrived from another county. The only exceptions to the trans,
mission of the hooping cough to members of the same family, has been ob-
served on infants who were suckled ; and it is a popular opinion in the Uni-
ted States, that infants at the breast will not catch the hooping cough. I
was attending, last winter, an American family consisting of five children,
who were all attacked with the convulsive cough except the youngest, who
was not weaned till the complaint had entirely subsided in the family.

The various complications of the hooping cough well deserve the atten-
tion of the practitioner, as many are serious enough to prove fatal, and oth-
ers lengthen the complaint, and make it last many weeks, even months. I
have never seen a single case of the hooping cough becoming a dangerous
complaint when no complication was to be met with, so that I may safely as-

750 Remar/in on Hooping Cough. [Sept.

sert, that the hooping cough never ends in deatli unless attended with some
other disease. Tiie various forms of complications which I have observed
are, bronchitis, pneumonia, anasarca, water in the brain, remittent fever,
and a disordered state of the stomach and bowels.

The inflammatory state of the bronchia is a frequent complication of the
hooping cough ; it is generally attended with a short cough between the fits,
and with much fever and agitation ; there is generally much uneasiness be-
fore and after the fits, and this uneasiness is caused by the difficulty of
breathing, and pam felt in the chest. The bronchial inflammation runs ea-
sily into pneumonia, and both are frequent complications of the hooping
cough. Most of those cases that terminate in death, are attended with in-
flamraation of the lungs ; however this is chiefly to be met with in children
who are not properly taken care of; and in the higher ranks of society I
have not seen one single instance of this cause of death ; indeed, so great
is the difference in the mortality of the various ranks of society in conse-
quence of the hooping cough, that I may fairly assert, that out of ten fatal
cases, nine belong to the poorer classes. I have seen this difference in my
own practice, which since the last four years has become more respectable,
and the consequence has been, that while in 1833 I had lost four patients, in
1838 1 have not lost one, though my little patients have been twice or three
times more numerous ; but they, almost without exception, belonged to the
higher classes. Anasarca is one of the frequent complications of the hoop-
ing cough. In most cases there is a slight degree'of cedema on the face and
arms, but in some more serious occurrences the serous effusion in the cellu-
lar tissue and in the cavities extends to such a degree as to cause death.
I have not met with such cases in my own practice, but another physician
of this town has described to me three cases which have proved fatal, with
symptoms exactly similar to those of the dropsy which follows scarlet fever,
and in none of the three patients had this complaint been observed, or like-
ly to have taken place.

Water in the brain is one of the most serious complications of hooping
cough, and it is not a rare one. The cause of hydrocephalus is easily found
in the constant trouble of the circulation during the spasmodic fits of cough ;
the face becomes then purple, the nose bleeds, and all the veins are swelled
to such a point that they seem likely to burst ; this intermittent stoppage in
the brain circulation is a frequent cause of hydrocephalus in children labor-
ing under the hooping cough. But besides the above mechanical cause,
there is also some great disposition to serous effusion of the ventricles which
may depend upon the nature of the convulsive cough ; this complaint has
undoubtedly its seat in the origin of the nerves, and consequently the brain
is originally affected ; so that it is not to be wondered at if it induces so of-
ten the formation of water m the brain. The only difference which 1 have
been able to trace between the spontaneous hydrocephalus and that which
,comes in the course of the hooping cough, is the different state of the bow-
.els, which are not so costive in the last as in the first. But a greater num-
,ber of facts is necessary to make it a general rule.

1 have often met, in patients laboring under the hooping cough, with a
continued or remittent fever ; it was sometimes attended with shivering,
hot skin, and night perspirations, so as to resemble consumption. Some-
times the fever is constant and lasts for days and weeks. I have seen such
cases where it was impossible to find the cause of the constitution of fever.
The chest, examined with the greatest care, did not show any inflammation
of the lungs or of the heart ; the stomach and bowels were in very good
order, and after the strictest search, I was obliged to consider the frequen-
cy of the pulse and heat of the skin, as caused by some obscure local in-
flammation. So serious was one of these cases that it terminated fatall}'',
and unfortunately I could not obtain permission to examine the body.

The stomach and bowels are generally in good order during the hooping

1839.] Remarks on Hooping Cough. 751

cough ; but in some rare cases I have met with a loaded tongue, nausea, and
loss of appetite, and in such occurrence, gentle aperients succeeded in doing
away with this complication. Often have I seen diarrhoea, but it has nev-
er been of much consequence, though sometimes attended with fever.

Of the two epidemics that we have had lately, the first has been the
most dangerous for children. From August 1833 to March 1834, twenty-
eight children have fallen victims to the complications of the hooping cough.
While, from August 1837, to March 1838, twelve only have died in conse-
quence of the same complaint. The forty cases of death have taken place
in the following months :

333 and 1834.

In 1837

and 1838.

Total No.

Auofust,

3

1

4

Sept.

9

1

10

October,

8

0

8

Nov.

3

1

4

Dec.

3

0

3

Jan.

1

.5

6

Feb.

0

3

3

March,

1

1

1

28 21 40

the first period, the greater number of fatal cases was in autumn, while in
the second, it was in winter ; but the cases have been too few to draw any
practical inference respecting the best or worst seasons in cases of hoop,
ing cough.

The age of the forty fatal cases was' the following :

Under 6 Months, 6) ,

From 6 to 12 Months, 7 ] ^'^

From 1 to 2 Years, - - 10

From 2 to 3, - . . 6

From 3 to 4, - - - 7

From 4 to 5, - - - 2

From 5 to 6, - - - 2

Above 6, - - - - 0

40

The above table leads us to a very important fact, viz : the danger of the
hooping cough in infants, and the decreasing mortality of this complaint aa
children grow older ; to those above six years not one case proved fatal.
We may draw the conclusions, that the danger of hooping cough is in in-
verse ratio with the age of the little patient. This result is at variance with
the general opinion amongst English practitioners, who think that in the
seventh year, and in children above seven years, this complaint is attended
with much danger. If other facts concur with the above, it will be an ad-
ditional proof to the usefulness of medical statistics, or rather of the sub-
stitution of direct observations to the vague experience of practitioners,
who have kept no record of their cases, and who, however, pretend to draw
inferences from vague recollections.

The treatment of hooping cough has, at all times, much occupied the at-
tention of the profession, but so various have been the results of experi-
ence, that each practitioner advises a remedy as far superior to the prac-
tice followed by others ; and so much has this path been followed, that we
have now a long list of unfailing specifics which have done wonders in the
hands of their inventors. And yet, after all, 1 corne to advise anew treat-
ment for this complaint. I have also my specific, and I give it to the public
with as much confidence as any of my predecessors. However, I am not
so exclusive as to have tried only one method, and I will give the result oi
my experience on those which I have followed with care and attentioa.

752 Remarks on Hooping Cough. [Sept,

Emetics are rather a matter of course than of choice in infants and chil-
dren, who, being unable to expectorate, swallow all the mucus formed in
the bronchia ; it is also necessary to fifive a certain activity to the ejsy^irato-
ry muscles, and in that also emetics are useful. I have given thesfe every
day, or every other day, and have always found it as good to unload the
chest as an aperient for the bowels. They are also useful as a preparatory
measure for some remedies which act better when preceded with emetics.
The syrup of ipecacuanha has been used nineteen times out of twenty ;
when some particular reason prevented its administration, I have given the
powder of ipecacuanha, or even tartar emetic, which, however, does not a-
gree so well with young children as with adults.

I have made a great use of assafcetida both internally and externally.
Rubbing the spine with the tincture has often been of great service, and a
plaster applied on the chest has helped the actions of internal remedies. 1
have sometimes given assafcetida in pills, but few have been the instances
of the children who could swallow th'S truly named stercus diaboli. The
flowers of zinc is a very good antispasmodic in hooping cough ; in 1884, I
have made great use of it, in the dose of four to twelve grains a day, and I
must say that 1 have often succeeded in making the fits less and less. I
have seen complete cures accomplished with that single remedy, in two
very young infants who had a convulsive cough, attended with symptoms
resembling epilepsy, the oxyd ot zinc has proved very beneficial, and has
stopped the cough and the spasmodic fits. I have never seen any bad con-
sequence from the use of this remedy.

Opium, in various shapes, has enjoyed at all times a great favor in the
treatment of hooping cough. The chief preparation which I have used is
the syrup of white popp)% in the dose of a tea-spoonful once, twice, or three
times a day. In some cases, it has taken away the most troublesome symp-
toms, but without shortening the duration of the disease. In those cases
in which it has proved beneficial it has diminished the number of night fits
by making the sleep sounder ; but even then it seemed to have little action
on those which came during the day.

1 have often given prussic acid, and in cases similar to those in which the
opiates were indicated, viz : when there w^as much irritation, and a great
variety of nervous symptoms. I have generally given half a grain, and
sometimes as much as one grain of the hydroiocyanuret of potash in the
twenty-four hours, but I have never dared to give a large dose of a poison
like prussic acid. Employed comparatively on a brother, whr.se sister was
taking the sub-carbonate of iron, this last remedy had a most^undoubted ad-
vantage.

Belladonna, in extract or powder of the root, has very often succeeded in
cases of hooping cough. I used to give from half a grain to two grains of
the root, and in many cases with advantage ; however, though the cough
was less troublesome and the fits less numerous, yet it seemed more to act
as a paliative than as a curative remedy, and in many cases it certainly fail-
ed and proved quite inefficacious.

I come now to my specific, or rather to the remedy advised by Dr. Stey-
raann, as the best anti-spasmodic in hooping cough. Dr. Steymann, had
advised to give from four to ten grains of sub-carbonate of iron in twenty-
four hours ; he gave as a rule to increase one grain for each year, so that a
child six years old was to take six grains in the day ; but from the beginning
1 found that dose quite inadequate, and I increased it to twenty-four, and e-
ven thirty-six grains in young children. I have given it either with water
and syrup or mixed with a cough mixture. It has never produced any in-
convenience, on the contrary, I have found that all the children treated after
this method were much less weakened, and recovered faster than with all
other remedies. The proofs of the advantageous effects of the sub-carbo.
nate of iron have been so numerous that I can scarcely enter into the de-

iS99.] Irritation of the Stomach. 753

tail ; however, I may give a few facts to corroborate my assertion. ^ In a
child, four years old, 1 gave the sub-carbonate of iron, and the fits which in
the preceding week had been 101 in number, were reduced to 66 in the fol-
lowing week. In a weak and debilitated boy, aged seven years, the pow-
ders of belladonna had proved quite useless, when I tried the powder of iron,
so prompt was Ihe effect, that in a few days the boy was quite cured ; the
sister of this boy was also cured with great rapidity. A young girl, aged
eight years, had eight fits in the day, and after a fortnight they were redu-
ced to two or three very mild fits of cough. A boy, aged six jears, having
thirty fits of convulsive cough during the day, when he began the sub-car-
bonate of iron, after one week the daily number was reduced to twenty-
one, and in a fortnight, to eleven or twelve fits much less violent than they
were before the treatment. One of our best apothecaries had tried vari-
ous remedies on his children, who were laboring under a violent attack of
hooping cough, when I advised him to try the sub-carbonate of iron ; the
result was far beyond his and my expectations, as after three days the night
fits ceased entirely, and those which occurred during the day were reduced
to three or four. The last case of hooping cough which I have treated
lately was of four months' duration, and every thing had proved useless,
when I gave the iron powders, which in the space of a few days succeed-
ed in making the cough less and less.

in fact, I think I may assert with security, that the sub-carbonate of iron
Enjoys a remarkable property to make the fits less violent, to diminish their
number, and after a certain number of days to cure entirely the hooping
cough. It enjoys, besides, the advantage of strengthening the httle patients,
and to give them the force to resist a complaint which sometimes lasts some
weeks and generally leaves the patients weak, low, and exhausted. In some
of those who have taken it, I have often seen during the first days a tempo-
rary increase of the cough, but it always subsided after two or three days,
and did not prevent the good effects of the medicament. The good effects
obtained by the use of the iron powders are easily explained by its anti-pe-
riodic and anti-neuralgic properties, and it shews a posteriori, how much the
hooping cough resembles a true neuralgic, or at all events a true nervous
disease.

Before concluding this long letter, I must not omit to mention the remark-
able effects of a change of air ; indeed, so striking is the fact, that it is now
a popular remedy, and many have been the instances which have proved to
me that this opinion is founded on a sound observation. In many cases
which had baffled all attempts to stop the cough, a change of air has accom-
plished the cure. I have found it equally indifferent to go out of town or to
come into town, provided there is a change ; and even at the short distance
of half a mile I have seen the good effects of this plan of treatment. In ma-
ny cases I have remarked that during the first three or four days the change
of air increased the cough, v>-hich became afterwards much less, a remark
similar to that made after the use of sub-carbonate of iron. Dub. Jour,
from Trans. Jour.

Treatment of Irritation of the Stomach. The following remarks on this
subject by Jonathan Osborne, M. D. of Dublin, are worthy cf attention :
" The treatment of both acute and chronic irritation of the stomach, is to be
directed, 1st, To the removal of its local caus^"--, by the substitution of an
appropriate diet, and 2ndly, To calmi.-!g the irritation already existing.
The latter is effected by, 1st, Dilution of the contents of the stomach ; 2ndly,
Diniinution of its sensibility, by the agency of cold or heat; 3rdly, The us

754 Irritation of the Stomach, [Sept,

of astringents in sedative doses, as acetate of lead, sulphate of lime, nitrate
of silver, lime-water ; 4thly, Stimulating the circulation of the skin by means
of external irritants, bathing, frictions, and exercise ; 5thly, Stimulating the
circulation of the pulmonary surfaces by changes of air ; 6thly, Stimulating-
the nervous system by mental exhilaration.

1. " The removal of the local causes, hy the substiluiion of an appropriate
Diet. When the mucous surface is irritated, it must be looked upon as in
the same condition as an irritated portion of the skin, with regard to topical
applications; and those substances which are most appeasing to the latter
in the form of poultices, are also to the former, as articles of diet. The food
then should be vegetable, and consist chiefly of amylaceous substances, as
rice well boiled, arrow-root, &c., stirabout taken in moderate quantity, with
milk diluted. It is, hov.-ever, to be observed, that stirabout lies under the
imputation of causing heat and itching of the skin, and justly so, those affec-
tions being peculiarly prevalent where oatmeal is much used. It is to be
ascribed to a resinous matter, in the covering ol* the grain, soluble in alco-
hol, which has been ascertained to produce this effect on the skin. When
meats are taken, they should be such as are most free from osmazome, as
chickens, rabbits, sheeps-trotters, &c., and should always be accompanied
by boiled rice or other vegetable matter, in order to diminish the stimulating
effect. Of all animal substances that which appears not only to have no
stimulating effect, but actually to appease the stomach, is the yolk of egg s.
I was informed some years ago, by Mr. Daniel Moore, of the case of a lady
laboring under pertinacious vomiting, which he completely cure(^ be fre-
quently repeated spoonfuls of raw yolk of egg, although it had been previous-
ly treated ineffectually, by a variety of the most approved remedies.
Amongst the cases attached to this communication, will be found an instance
of vomiting from a congested state of the stomach, in the last stage of dis-
eased mitral valve, in which a similar success attended its employment. I
could have added several others, and m.y failures with it have been princi-
pally in hysterical cases, in which, perhaps, it is too disagreeable and
disgusting, to be retained sufficiently long to exercise its soothing properties.
Eggs, in the form of light made custard-pudding, are commendable ; but
having mentioned puddiiig, it must be remembered, that all combinations of
flour and butter, in which the latter has to be subjected to heat, and then to
be rendered rancid, are not only indigestible, and thus apt to provoke a large
secretion of sour fluids from the gastric glands, but are also in a high degree
irritating to the mucous membrane. Such are various kinds of pastry, and
to these may be added, the rancid oily nuts.

" The articles to be avoided in these cases are, salt and sugar in their va-
rious combinations. Even tea should be taken without sugar. In short,
let the patient suppose at each meal, that he is going to apply a poultice to
the interior of his stomach, and he will go not far astray. Let him also not
overload, but eat slowly, and about four times in the day, because mere
weight acts as a mechanical irritant, and is felt as a 'load in the stomach.' A
habit of eating quickly, is productive of over-eating, hence slow mastication
must be strongly insisted on, and in case of defective teeth, the food must be
taken still more slowly, and in a comminuted form. These observations
appear trifling, but when we reflect, that the food has to come into actual
contact with the irritable surface, it cannot but be deemed of the highest
importance that it should be presented in the least irritating form. In the
whole series of stomach complaints, the physician must have the direction of
every thing which goes into the stomach, whether as food or medicine ; and
to be of real use to his patient, he must he no less skilled in cookery than
pharmacy.

2. ''Dilution of the Contents of the Stomach. The effect of water taken
into the stomach, is to diminish the irritation of its contents by diluting them.
Hence, it is the usual custom to drink towards the conclusion of a meal.

1839.] '. Irritation of the StoiAach. 755

Another use of dilution, end that which renders it a medicine, is to dissolve
the mucus, and thus to render the membrane accessible to astringent reme-
dies. This effect is best obtained by exercising after drinking largely of
warm water. The mucus is thus mixed up and dislodged. According to my
view, this mode of action explains the efficacy of mineral waters in irrita-
bility and chronic inflammation of the stomach. When an invalid, at one of
the German Spas drinks six or eight breakers of the water before breakfast,
and walks in the intervals, he washes out tlie mucus, (as I have proved can
be done in the dead stomach,) and thus the small proportion of salts held in
solution, acts on the membrane as sedative and astringent. This view has
to me been confirmed by experience ; as I find that by administering one or
more tumblers of warm water in the morning, then, aft(?r exercise, giving
the sedative astringents to be hereafter mentioned, the most striking results
can be obtained, and such as are usually only witnessed during a course of
mineral waters.

"Another kind of dilution;.is to mix mild along with stimulating articles of
diet. This is practised at our daily meals, when we use bread or vegetables
in alternate mouthfuls, with meats of seasoned dishes. An experienced
gourmand at a feast, will even venture to take things which he knows to dis-
agree with each other, if he has access to good stale bread, as by taking a
quantity of tliis, he is enabled to interpose such a substratum, as shall pre-
vent them from coming into immediate contact.

3. " The use of Astringents in sedaliae doses, as Acetate of Lead, Sulphate
of Zijic, Nitrate of Silver, Lime- Water. I merely state a fact, and am not
]}roposing a theory in- describing astringents as a sedative to the mucous
membrane when applied in small doses. Let this be judged of by the effects
produced, which are diminution of redness, of heat, and of sensibihty . Such
effbcts are vreli exhibited in the most approved applications to the conjunc-
tiva of the eye, and in gargles and lotions injected into the urethra. When
the same substances, however, are applied in an undiluted form, then chemi-
cal decomposiiion.and destruction of the membrane ensues. Seeing then
the importance of attending to doses in these cases, I shall state here, the
forms m which I am in the habit of prescribing these substances. They are
as follows: R super acetat. Plumbi. gr. xij; Aceti 3 ss; Aq. destil. 3 vij. M.
Sum, coch. ij. ampla mane et meridie.

" To the' above mixture, an addition may be made of half a grain of acetate
of morphine,, in case of general restlessness, or in case of the mucous irri-
tation being excited or aggravated by excessive secretion of sour fluid from
the gastric glands. In order to give the above and the two foliowing formulse
their full effect, the patient should drink a large tumbler of tepid water on an
empty stomach, and use a little gentle exercise before taking the medicine.
As for the danger to be apprehended from the preparation of lead taken in
this way, I can state, tliat although nov/ for years in the daily practice of
writing the above prescription, J have never seen one instance of either
cholic or paralysis resulting therefrom.

"The acetate of lead formulfe, I use in the earliest and more* acute cases.
Next in point of astringency, and more applicable to chronic eases, is the
following: R. sulphat. zinci gr. iv; aqua distillat. gij. M. Sumat
coch. ij. ampla post aqua calefactse amphorum vacuo ventriculo mane et
meridie.

"The last of these formuifs, and that most to be depended on in chronic
cases, which has also the advantage of being well suited to the cases of ul-
ceration of the stomach described in my former paper, is the following : R.
Nit. argenti gr. iv ; Sacchr. alb. gr. iv. M. Ft. pil. vij. Sumat j. mane et
meridie. With the same directions as tlf^ two former.

" The success obtained in hysterical and convulsive affections by nitrate of
silver, appears to me, to be derived from its astringent and sedative effects on
the mucous membrane of the stomach. It being decomposed very shortly

756 Mercury as an Antiphlogistic . fSept,

after its arrival there, by the free muriatic acid, and by the nitrate of soda,
causes it to change its properties before it descends into the bowels, where it
may eventually prove a laxative. Both in chronic irritation and inflammation
of the stomach, it is an heroic remedy, the effect of which, only requires to be
aided by a judicious attention to diet and the management of the bowels, in
order to inspire the patient with the highest degree of confidence in the re-
sources of the medical art. The discoloration of the skin, which causes
female patients to regard the internal use of nitrate of silver with great ap-
prehension, 1 have never yet witnessed in any of my patients. The above
mentioned dose, from being speedily decomposed, appears to act merely as a'
topical application to the stomach, and as 1 am not in the habit of continuing
the use of it longer than a week at a time, the absorption of it in an unde-
compcsed form, and consequent deposition of silver at the skin, appears next
to impossible.

" The last article mentioned, is lime-water. This is to be taken abun-
dantly as a drink, and mixed with milk or barley-water. I might also have
included the decoction of catechu and of log-wood,, the latter especially, as
being an agreeable drink ; but I have preferred to mention only those articles
which manifold experience has stamped with a peculiar value in my treat-
ment of this complaint, and leave to the judicious reader to supply the rest,
by always bearing in mind, that irritable or inflamed surfaces in the interior,
resemble those in the exterior with regard to those substances which come
in contact with them.

"The fourth, fifth, and sixth heads, embrace matters of the utmost impor-
tance, and without which, all others will prove ineffectual in this complaint.
Without exercise in the open air, I have rarely seen permanent benefit ob-
tained, and even at the risk of the cold and damp w^eather, the patient must
go out every day. Under stimulation of the skin, is to be placed an applica-
tion to which I attach a high value, namely, that of mustard to the region of
the stomach. The flour of mustard simply mixed up with water, applied on a
cloth over the stomach every evening, and suffered to remain on until smarts
ing is produced, is a powerful adjuvant, and interferes with no other remedy.
It also gives a temporary relief from the pain coming on after dinner, and is
generally most acceptable to the patient ; it requires no dressing except dry
lint or wadding. On the head of mental exhilaration much might be said.
Here the medidno mentis becomes a most powerful auxiliary. Many phy-
sicians know no other remedy of this kind but to send the patient to travel,
forgetting how^ often it proves true, that cczluin non animum mutant qui trans,
mare currunt, and that m the stores of the imagination, even when remain-
ing at home, there are many resources by which a healthy interest in life
may be excited, alternate employment and relaxation provided, and hopes
and expectations for the future enlivened. Of such importance is this, that
the patient vv^ill not only imagine, but will, at least for a time, actually derive
more benefit from a practitioner of high repute, whose words sound like ora-
cles, than from one of inferior eminence, although the prescriptions of both
may be the same." Dub. Jour. Med. ScL Jan. 1839,/raw Amer. Jour.

Efficacy of Mercury as an AntipJilogisiic Remedy.. M. Delhaye, the au-
thor of the following observations very justly remarks

" The wish to explain every thing in disease is one of the greatest errors
in every exclusive system of medioine, whether this be the humoral doctrine,
the physiological, or the doctrine of solidism."

There are certain occurrences or facts, which every practical man will
admit to be true, and which are yet as mysterious and inexplicable to us in the

1839.] Mercury as an Antiphlogistic, 757

present day, as they were two centuries ago thus shewing how little pro-
gress has been made in the physiologij (f disease.

In spite of the ingenuity and earnestness of a very able sect of physicians,
who have striven to reduce the various forms of morbid action to a few gene-
ral and primary elements, we suppose that few, if any, of their disciples will
be inclmed to deny the existence of certain specific diseases and of certain
specific remedies.

Take, for the example, syphilis and its (almost) unquestioned antidote,
mercury. Can we give any explanation, in the slightest degree satisfactory,
of the essential nature either of the disease itself or the modus operandi of
the drug] Certainly not.

Again ; is not ague an essential and specific form of febrile action? and is
not Peruvian bark its antidote, jyar excellence?

All attempts to explain the intrinsic and real nature of the diseases have
entirely failed. In shi>rf, we believe that there is nothing exclusive in medi-
cine ; and for this reason we do not hesitate at once to express our adoption
of a rational eclectism, in preference to all the much vaunted doctrines and
systems which have been proclaimed for the last 150 years. It seems to us
to be a great error, that of supposing that the science of medicine can ever
attain to that exactitude and precision, which appertains to those sciences,
which have to do with inanimate matter. A chemical result is invariable
and uniform provided the experiments are entirely alike at all times and
all places. The same is the case with the facts of mechanics and of the
other branches of natural philosophy. But this does not hold good in medi-
cine. Not two cases even of the same disease are entirely alike ; there is
always some trait or mark of difference in the vehemence, duration, or suc-
cession of symptoms ; and the art of the wise physician is to detect the
jphysiognoimjy so to speak, of each case, and to deal with it accordingly.
Then, too, the influence of the mind and of the feelings on the course of a
disease will never be overlooked by the practical man in directing his treat-
ment.

But to proceed to the immediate object of this paper, we shall first men-
tion a few cases, to illustrate the efficacy of mercury in certain forms of
ophthalmia.

Cass 1, Chronic Scrofulous {?) Opihalmia. A young girl of nervous ir-
ritable constitution, had for some months been suffering from sharp dart-
ing pains through both eyes, intolerance of light so great that she always
kept her head Bent upon her chest, and the tarsi were quite contracted in-
wards, &c. and these symptoms were attended by loss of appetite and gene-
ral feverishness. It was a matter of difRcalty to ascertain the state of the
eyes, in consequence of the spasmodically closed state of the lids. The
cornea of the left eye had partially lost its transparency, and presented a
deep ulcer on its lower half. The right eye seemed to be only sympatheti-
cally affected.

Dr. Delhaye says that, when this case was first submitted to him, he was
a most believing proselyte to the doctrines of the physiological school, and
that he therefore advised bleeding, leeches, blisters, low diet, &c. The dis-
ease however was not at all mitigated by this treatment.

M. Stievenart of Mons, a distinguished oculist, was called into consulta-
tion. Agreeing with Dr. Delhaye as to the nature of the disease, he sug-
gested the omission of all depletory and lowering measures, and the use of
small doses of calomel and belladonna a pill, consisting of a fourth of a
grain of calomel and a sixth of a grain of powdered belladonna leaves, to
be taken every four hours of an opiate collyrium, and of frictions upon the
eyelids with the extract of hyosciamus, thrice daily.

On the third day after the adoption of this treatment, the patient could
look at objects without much uneasiness, and by the end of the week bot|?
eyes were well, with the exception of the ulcer on the left eye.

758 Mercury as an Antiphlogistic. [Sept.

It is to be observed that a nourishing and somewliat generous diet was
administered at the same time, malgre les symptomes de gastrite, adds Dr.
Delhaye.

Case 2. A child, who from her infancy had been subject to repeated at-
tacks of opthalmia, was seized in her seventh year with scarlatina, which
was accompanied with severe thoracic symptoms. Purulent effusion into
the riglit cavity of the chest took place, and required the operation of para-
centesis thoracis. While recovering from this dangerous affection, the
eyes, more especially the right one, became the seat of a most distressing
opthalmia. There were frequently recurring sharp pains through the or-
bits, great intolerance of light, &c. Antiphlogistic measures were used for
some time, but without any advantage.

Dr. Delhaye, remembering the happy result of the former case, now a-
dopted a similar treatment, although he was in some degree afraid of a mer-
curial action in a system so debilitated. The calomel and belladonna were
given in small doses, the eyes were bathed with a mildly anodyne wash, and
a nutritious regimen allowed. The cure was complete by the twelfth day ;
and it is worthy of remark that the fistula in the side for this was still o-
pen had nearly cicatrized by the same time.

Case 3. A girl, 18 years old, and of a lymphatic habit, had been subject
from her childhood to attacks of ophthalmia, which had caused slight opaci-
ty of both cornege. The present attack w'as a very protracted one, and was
attended with much constitutional disturbance. Leeching, blistering, &lc.
had been tried without effect.

The treatment recommended by M. Stievenart was therefore adopted,
and, by the end of the second week, the ophthalmia had almost completely
disappeared.

. Mercurial Inunction in Periionists. Dr. Delhaye reports three cases to
illustrate the efficacy of this mode of treatment. According to him, two
were cases of entero-peritonitis occurring within a week after delivery ;
the third case was one of chronic entero-peritonitis in a woman 60 years
of age.

It seems to us unnecessary to give the details, as the reports are rather
prolix and vague.

Dr. Delhaye attributes the practice of mercurial inunction on the abdo-
men in puerperal perotinitis to M. Vandezande of Anvers, and seems to re-
gard it as one of the greatest discoveries of late years in practical medi-
cine. An ounce or more of the strongest mercurial ointment is rubbed in
every 24 hours, until a decided effect is induced.

He strongly recommends the same mode of treatment the inunction of
the mercurial ointment on the limbs, &c. so as to induce a decided ptyalism
quickly in cases of chronic inflammation of the meninges of the encepha-
lon and of the spinal marrow.

His memoir closes with the report of several cases of very troublesome
.onychm w-herein a nail had grown into the flesh of the finger, and had
caused severe irritation and sometimes ulceration also quickly relieved by
keeping the parts well covered with the strong mercurial ointment ; of chro-
nic scrofulous, abscesses and sores treated successfully in the same way ;
iand, lastly, of the phlegmasia alba in puerperal women. Bulletin Med. Beige.

1839. Physical Examination. 75(>

Part III. MONTHLY PERISCOPE.

On Physical Examinations.

Being called on by a distant subscriber for an opinion of the
practical value of what are called '-physical signs, or physical
examinations," we feel it a duty to say a few, and but a few
words on the subject. By "physical signs" are meant those evi-
dences of health or of disease which are manifold to the sense
of hearing ; whether by percussion, or mediate, or immediate
auscultation, as it is called.

In the first place we must object to the latter term, as speci-
fically used to mean the application of the ear, either to the
stethoscope, or to the surface of the part under examination.
Such we believe, is its common application. As however, per-
cussion addresses itself also to the ear, and the signs developed
by this mode of examination, can only be detected by this sense
attentively directed to the sounds produced thereby, it should,
in our humble opinion, be included under the term auscultationy
and generically, to include all those species of examination in
which the sense of hearing is concerned in the apprehension of
the evidences developed.

This point in nomenclature being disposed of, we next pro-
ceed not to define the possible merits of physical examinations
but to make a few observations on tliei?- present application to
practical purposes.

That healthy and morbid conditions are distinguishable in re-
spiration and pulsation as well as in some points of fatal circu-
lation, we have no doubt ; and that these distinctions should be
familiar to, and well understood by all practitioners is alike true.
Nor is it less so relative to percussion, particularly when appli-
ed to the two great cavities the thorax and the abdomen.
Nay more w^e are fully satisfied of the truth that many abso-
lute facts can be developed with greater or less precision by
both of these species of examination. But we are further of
the opinion, that all the facilities for demonstration of the truths
of the internal condition of parts, by auscultation before death,
which the immense Hospitals of Paris, and the very remarka-
ble mortality which attends their administration afford, have
not even to the present day instructed the most acute auscul-
tators to determine many parts with absolute precision. Pret-
ty clear inferences of a general nature as well as occasional-
ly, some which are very specific are deducible from these ex-
aminations by some few of the ablest and most experienced in
their uses. So also there are a few, whose minds may have
been peculiarly captivated by, and drawn to these modes of ex-
amination, and who have a peculiar tact for them even of less

^60 Physical Examination, [Sept.-

experience, may have arrived at the point of considerable ac-
curacy in detecting some internal parts by the physical sis^ns ;
but with such, as w^ith most persons of peculiar zeal especial-
ly those v^rhich is fired by novelties, or whose imagination is
inflated by things which look forth from a. distance, there is a
proportionate want of sound judgment in other respects, and
with them, the thing becomes a hobby, and is rode down, before?
it becomes a steed fitted for valuable service.

We are pleased to see young men aspire to great acquirements
and accomplishments, provided they do it in the right way.
This way is, mostly, great and untiring devotion to study
patient and steady inquiry into natures' ways by making a
sure ground-work of knowledge storing the mind with truth,
as a full garner; and when all this is done still, in the whole-
some exercise of that humility which is ever found in the mind
thus well stored, await the development of that proportion of
reasoning powers which shall not fail to draw legitimate con-
clusions from all the truths of the case. Now our observation
of more than seven septennials has taught us omitting all re-
marks on our own developments of the higher intellectual pow-
ers, except that they have been late in being developed, and are
yet extremely incomplete our observation, we say, has taught
us that the powers of accurate discrimination of adoption and
of exclusion ; that is, of proper examination and selection of
facts, and Xhe judgment, the great mental power by which alone
these parts can be safely, properly and profitably used, are of-
ten, very often late in being developed, and in some instances,
they even become items in the character of the individual. A
few there are however, who afibrd indubitable evidences of an
earlier development of the nobler mental powers. These few
will be found obeying, independently of all other influences, the
sound dictates of true reasoning from a wholesome selection of
facts chastely and impartially made ; whilst the fornier the
great herd, will be found contenting themselves, at least as
long as the community on whom they are dependent will al-
low it, with a routine course of procedure with' mimicking
some man, or set of men whom they believe for once, greater
than themselves. Nor have they any of the safe and whole-
some guidance of reason to determine their course, but are ful-
ly contented and justified in their own estimation in* doing so,
because some one else did so. This great herd seem to need to
be told that some men proceed in the business of life by the
small developments of mind such as the imitative powers, by
which children learn to talk and to assume the manners of oth-
ers. Whilst there are others, though few, who go forth on the
solid unimpracticable ground of a ju-'grnent, which seems con-
stantly omnipotent in controling their v*^ills and their purposes.
And these few are often verv honestly considered bv the former

1839] Physical Examination, 761

as obstinate, and this, forsooth, because their strong and conclu-
sive reasonini; is incomprehensible to, and will not bend about
in obedience to the mere assertion of some of those applepates.

With this view of mankind, what are we to expect from a
plan of examination which, in general, requires, at least at the
present day, the experience of a professional life, with constant
investigations, in connexion with prior examinatioiis dui ing
life, but repeated erroneous diagnosis, prescriptions, and prog-
nostics! Some of these errors have, when they terminated
innocently, been the subject of no little amusement to us; and
we hold in lively remembrance some very amusing facts aris-
ing out of some cf those errors in diagnosis from auscultation ;
such as a single dose of calomel so acting on the hf^pu^io func-
tion as to remove, within a few days in the form of a copious se-
cretion of black and green bile, all the difficulties which had
been dreaded to depend on tubercular phthisis ; but again,
when loss of fortune or of life have followed in their wake,
they have stood as monuments of the lamentable, and disgrace-
ful arrogance and conceit of those who committed them.

There is another objection to ready confidence in most of these
examinations, and this is found too, in the constitution of men's
minds. Some, yes many, are attracted by the glare of one
thought, especially if it be an unusual one. It exerts a sovereign
despotism on the whole palace of intellect, and banishes hence,
every thing which is not in strict servitude to itself. Thus
it happens that, when the pfiysical signs, as they are call-
ed, are trusted to for diagnosis, the former, or physiological, as
internal signs of the old class of symptoms may be called,
are entirely disregarded, whilst the more doubtful evidence
brought by the stethoscope and the pleximeter are exclusively
relied on.

But we have protracted this article far beyond our design
when we began it. We will, therefore, bring it to a close, by
giving our candid opinion, that the modes of examination by
auscultation and percussion, are yet in a very imperfect state ;
and that if ever perfected they will still require an extensive
and various experience thoroughly to decipher the case,
which a long professional hie only will afford; and that even
then, these signs are only to be taken, equally into the ground-
work for reasonintr in practice, with the well established signs
of disease, previously in use, to sustain their part only, in the
reasoning firocess without claiming any general supremacy.

It should not be supposed that we incline to insinuate that
auscultation (and we use here, the term, generically,) is of no
usp, or that it affords no valuable evidence in certain cases,
which could not be developed by other means. We are far,
from such an opinion. On the contrary, we would recommend

762 Abstraction of the Uterus, [Sept^

to every student and every practitioner, to study well, and prac-
tice dilifTcntly, the physical examinations, and study well the-
most valuable authors on the subject; and annongst such, for
the practical utility which they are calculated to afford, we will
take the liberty of recommending the reader to Lsennec and
Gherard, and to Dr. Bigelovv's communication on the rules of
Physical Kxamination, extracted into our present No. fronfi the
Boston Medical Journal. This last is so divided and so con-
densed that it may be easily and profitably read and remember-
ed by all. But we must not fail to conclude with this caution
to the partially experienced stethoscopist, and indeed to all^
that in all cases, other rational symptoms, must be allowed their
full force in determining the diagnosis.

If we are called on by our correspondent to contrast the two-
modes of examination -that is, auscultation in the sense in which
we use that term, and the other signs of disease by which phy-
sicians are governed without auscultation, we feel compelled
to state, that, at least in the present stale of the former, it bears
no proportion, in practical utility, to the latter. If therefore, one
is to be relied on to the exclusion of the other, we must at this
time prefer to place our dependence on the latter, for these rea-
sons chiefly; that it affords a greater variety of facts in point, and
consequently a fairer scope of investigation : and that it is more
applicable to that state and period ofdisease in which the con-
clusions arrived at may be valuable. They are also less tx-
posinn: and harrassingto the patient, whilst the former detects
tacts which avail but little for practical good, as they consist
chiefly of irremediable disorganizations, or those extremities of
disease in which all remedies are worse than useless.

Dr. J. H. Griscom, in the New York Medical Journal, has
furnished a report of a case of abstraction of the uterus after
delivery which we extract, not so much for any practical be-
nefit which may be derived from its perusal, as for the purpose
of disabusing the public mind of the belief most indusir>6usly
inculcated by many of the quasi doctors of the day, fh^t Sep-
timus Hunter, the perpetrator of this act of butchery, was a re-
gular bred physician. It appears from the report, that he was
an '"irregular," having no shadow of claim to the title or office
which he assumed. We subscribe fully to the justice of Hun-
ter's sentence, but at the same time we most sincerely believe
that those communities which legalize and patronize admitted
ignorance and quackery, are in a moral point of view equally
guilty with him who ignorantly and wickedly trifles with or de-
strovs the lives of his fellows.

1S39.] Abstraction of the Uterus. 763

Case of abstraction of the Uterus^ after delivery. On the 7th of April
1839, at the request of Ira B. Wheeler, Esq.', coroner, I examined the
body of Mrs. Cozins, Ihe wife of a respectable mechanic, No. 328 Madison-
street at the time absent from the city. I was assisted in the examination
by Dr. S. C. Ellis, in the presence of Drs. Nichols, Lobstein, and Walters.
JBefore the examination, we obtained the followinor history : Mrs. C. was
delivered of a hea.thy, living child, about one> A. M., without any other as-
sistance than her sister and a fem-ile frien<3, both married, and the former a
mother. The cord was tied and cut secundem artem ; but the placenta was
.retained beyond the usual time. Three hours having elapsed without its
disengagement, the sister went for a physician and obtained the services of
Septimus Hunter, who represented himself to be a physician, but was at the
time a clerk in a drug store. Upon his arrival, he immediately addressed
himself to the task of removmg the placenta, the successive stages of which
operation will be mentioned presently.

We were shown, prior to the dissection, a mass of fleshy substance in a
washbowl, which I at once recogniseil as a uterus ; also, in another vessel,
the placenta was shown us, which was entire, but without a vestige of the
umbilical cord attached to it. The latter was subsequently discovered in a
pail of dirty water.

On stripping the body, the abdomen was found very sunken. The usual
incisions were made, and the following uncommon appearances were pre-
sented : 1st. A total absence of the uterus. 2d. Tiie broad ligaments
much torn and raggeil, and partly deficient. One fallopian tube was absent,
but bothovana vemn'med in situ. 3d. The upper extremity of the vagina
was open and free, so that the hand introduced from without would pass di-
rectly into the cavity of the abdomen, and the intestines could hn touched.
The intestines were high up as left by the contracting uterus. 4lh. A con-
siderable quantity of extravasated blood was seen on each side near the ova-
ria, forming spots of ecchymosis beneath the membranes. No effused blood
was seen, however, within the abdomen. 5th. A laceration o; tlje
vagina, about an inch and a half in length, a short distance from its super:-
X)r extremity.

By revertinir to the uterus we find the deficient parts attached to it, viz :
one fallopian tube, entire; a portion of the broad ligaments, and about an
inch of the upper end of the vagina, which had been divided by an even cir-
,c!e, though manifestly v\i:hout the aid of any cutting instrument. The ex-
ternal surface of the uterus was about half denud'^d of its peritoneal coat,
leavmg the muscular fibres entirely bare. Its in'ernal surface was smooth,
and the part where the placenta had been attached very apparent, presenting
-a slight brown colour. The whole organ was about the size of a child's
head at birth. Large quantities of coagula were about the body ; the bed-
ding was thoroughly soaked with blood, and a large puddle of it, of a bright
Ted colour, covered the flogr beneath the bed.

The examination of an intelligent female witness before the coroner's ju-
ry, developed the fo'lowing facts : Immediately after the quasi doctor ar-
rived, he took hold of the cord, and making strong traction upon if, he com-
pletely inverted the uterus, the placenta still adhering ; pulling still harder ,
he severed the cord from its attachment and gave it to the witness. He
then took hold of the placenta, removed it, and laid it aside, saying there
was more to come away still. He then grasped the uterus of the unfortun-
ate patient, and by dint of ''excessive" pulling, after about three quarters
of an hour, (during which period he relaxed his pfforts occasionally to rest
and remove his coat, the miserable patient constantly uttering the most
piercing and heart rending cries, such as "you are tearing my heart out, &lc.)
he succeeded in dragging the uterus from its attachments, and separated
it from the body, holding it in his hands, and exhibiting it as a proof of his

704 Medical Electricity, [iSept.

prowess and skill, saying that "he never had met with such an extraordina-
ry case before." When asked what it was, he replied, "either a polypus or
a false conception." During this brutal operation, ihe groans of the suffer-
ing woman were at first strong and loud ; these, together with the force
which the man was seen to use, excited the alarm of the attendants, who
urg'^d him to desist and allow other medical advice to be called; but with
incrodible hardihood he persevf^red, insisting that all was risrht, that she
ma.-t endeavour to be patient, and that he would be responsible for her life.
Ti\vards the close of the performance, her cries became more and more
faint, and at length entirely ceased. He thought she was endeavouring to
support the pain with patience, and encouraged her in so doing by words.
When he turned to look after her, and to feel her pulse, he found that she
was dead.

It is due to the profession to say, that the performer of this horrible tra-
gedy is noK de jure, a member of the profession, though he asserts that he
has a recommendation from three surgeons of the British Navy, of his medi-
cal proficiency, and that ho has had a large amount (three hundred cases)
of obstretric practice. He appears to be about thirty-two or thirty-three
years of age, and has been in tliis country two years.

Meflical Electricity, It will be recollected by our readers,
that we gave, sometime since, in the pages of the Journal, a de-
scription and account of the manner of application and action of.
a variety of electrical and iialvanic apparatus for medical pur-
poses, with a limited view of our experience in the use of some of
theiTi. Jn compliance with our request to be informed of such
facts as might result from the use of any of them, we were a few
days since, favored with the following interesting letter, on the
application of the electrical box, from Dr. J. A. Hamilton, of
Waynesboro', in this State :

Waywesboro', August 7th, 1839.
"DraSir The day after my arrival at home, an opportunity
was afforded me for trying the effects of " 'I'lie Box,^** in a case
of Rheumatism. The subject was a young man of general bad
health; the part affected, the left knee. The leg of the same side
was flexed on the thigh at an angle of sixty-five degrees, and
could not bear the least extension without producing the most ex-
cruciating pain. I applied the box once, and let it remain fixed
to the knee for one hour ; at the end of which time, he was able
to extend his leg nearly to its greatest length. The following
day, it was not convenient for me to see tho' patient ; and there
was, consequently, no application made. The next day, how-
ever, I found him, when sitting, or in a recumbent posture, able
to extend the limb perfectly ; but when in an erect posture, he
was only able to bring the toes of the diseased limb to the floor.

*Ti(e Electrical Box, or Box of Sousselier, one of which Dr. H. had just
obtauied in this place and taken home with him immediately previous to the
f'ate of this letter.

1839.] Medical Electricity, TC5

The Box was now applied again, and in one hour, he was able
to stand firmly on his teet. Two days after this second applica-
tion, I saw him af^ain, and was l:appy to Icnrn that he had suf-
fered no return of pain, and was able to pronounce himself per-
fectly well."

The above facts with which Dr. Hamilton has had the kind-
ness to favor us, are extremely interesting ; not only because the
patient was promptly cured, but because they tend to confirm
our confidence in a remedy, not the least distressing in its ope-
ration, and very convenient in application.

We are happy in being able to add another case of similar im-
port, which recently occurred in the practice of Dr. Edwin Le
Koy Antony, of Hamburg, 8. C. He was called to a lady who
was sufl^ering the most extreme distress from a rheumatic pain
in one of her knees. The diseased joint was in such a condi-
tion as to afford the most exquisite torture on every attempt to
move the leg in any direction.

After many ineffectual attempts to relieve her distress by the
various means ordinarily used in such cases, the doctor resorted
to the use of the Electrical Box. After duly exciting the electric,
it was passed on the diseased joint for some minutes. Being
obliged to leave, for an hour or two, the Doctor, finding that evi-
dent relief was obtained, was unwilling to discontinue the appli-
cation, resorted to the expedient of binding the Box to the
lame knee, and left, with the advice that the application should
continue until his return. On his return, however, at the ap-
pointed time, he was surprised and gratified by meeting his pa-
tient walking about the room and enjoying a perfect exemption
from pain in the part. She continued U'ee from the affection.

During the past ten or twelve months, we have had opportu-
nity of instituting several experiments in the application of the
galvanic uterine exciter ; which, whilst they have not been alto-
gether so satisfactory and conclusive as those above stated, tend
to confirm the fact of the power of the galvanic current in
causing fluxion to the negative pole on establishing a cuyrent
through the system. Nor can we say of this instrument as of
the Electrical liox, that it is of very convenient application.
This objection is, however, measurably obviated by the fact, that
the application of the uterine exciter is made by the patient her-
self; and needs nothing more of the physician than intelligible
instructions relative to its use. We will give in this place, a
brief account of the several cases in which we have caused its
application.

Case 1. Miss , had for many years suffered much dis-
tress and great impairment of the digestive functions and gen-
eral health, in consequence of suppressed menses, from a
long continued uterine prolapse, consequent on the use of

768 Aledical Electricity. fSepU

corsets. The corset we proscribed, and the uterus was treated
for prolapse fur a few mjiiths, when her menstrual ditficulty
vanished and the menstrual fljx returned with great regularity
^nd continued for the proper time and quantity, without the least
perception efany of the distresses which had ordinarily attended
this period. Her general health was rapidly restored, and her
iiealihy aspect and feeling increased so as speedily to excel any
former period of her lite since puberty. JSlie retired to her
jiome in the country. In the course of a year or two however,
her prolapse being entirely neglected, her menstrual difficulties
began again to harrass her. This she suffered for a time, with-
out obtaining competent medical aid, and we were called on for
minute instructions in her case, as it was not then convenient
for her to remain in the city. These were given for her self-
management. This management she undertook and performed
as well as she could ; but it was so poorly done, that her diffi-
culties were but partially removed. Her menstrual pains wjere
not so excessively severe as they had formerly been, but the^
deficiency of the monthly discharge increased, until, finally, her
viscera became obstructed and enlarged and her digestion more
than ever impaired. Thus she continued for a long time, witb
increasing swelling and hardness of the liver and the spleen in
consequence of the almost eniire suppression of the monthly dis-
charge. In this condition she leturned tomy care. The uterus
was again treateil, with some, but not such decided benefit as
.on the former occasion. The secondary diseases received like-
wise their due share of attention, but with partial benefit; as
the cause, the more or less considerable menstrual deficiencies
tended monthly, to their greater confirmation. In this state, the
menstrual discharge was ushered on with some pain in the head,
i)ack, &c. and continued but twenty-four to thirty hours.

In this state, and at the decline of one of her monthly periods,
the uterine exciter was applied, but with little or no benefit. We
should have mentioned that all other means of restoration were
used, both before and since the galvanic current was in use.
"We have been thus minute in stating the facts of this case, be-
cause the apparatus failed of producing benefi:ial results. The
liver, spleen, kidneys and spiral marrow, have long been suffering
the determination of fluxion to them, which, in health, the uterus
should have eliminated from the system.

Case 2. This was also the case of a young lady, brought from
a distance and placed under our care in consequence of extreme
and alarming distress suffered at the menstrual terms. Her
dysnemorrhoea had been so long continued, without appropriate
treatment, that the returns were protracted to a period of seven,
instead of four weeks; and when the flux appeared, the distress
was such as to cause great apprehensions of death. The dif^-

1839."! Medical Electricity, 767

culty arose from a gradually increasincr prolapse. This was cor-
rected forthwith, with the effect of bringing on the next menstrual
flux, at four weeks and three days. The treatment bein^ con-
tinued, as far as necessary to secure the steady adjustment of
the womb, the next two periods were precisely at the end of
the lunar month, with ease, and in proper quantity. The patient
was now discharged.

{Some twelve months after, she was returned to me, after en-
joying her improved health in free exercise in dancing, the use
of corsets, &c. during her absence ; which, under the neglect
of treatment as the symptoms of returning disease began to ap-
pear, had the effect of producing an irregularity, consisting of
protracted periods, and a litnitation of the menstrual flux to one
day, followed by a complete cessation on the next, attended with
considerable distress. The returning prohipsus was duly at-
tended to, with relief to all the symptoms, except the deficien-
cy of monthly discharge. This continued as before, despite of
the ordinary medicinal means employed for its correction. After
ineffectual efforts by ordinary means ibr two periods, on the
usual decline on the second day of the third period, I caused
the galvanic uterine exciter to be applied the positive pole
to the neck and the negative to the os uteri. This applica-
tion was made on the evening of the day, when the cessa-
tion of dschnrge commenced as usual, and the apparatus
was worn through the night. On the following morniiig the
patient found as full a catamenial flux as necessary. The ap-
paratus was then removed. On the second day, the discharge
continued as free, and very similar to its ordinary appearance
on the first day. In the evening, however, it began to decline,
as on the previous day. The apparatus was again applied for
the night. On the morning following, which was the third day
the discharge was again found increased to about half the ordi-
nary rate of flowing. In the evening it began again to decline,
and no further application was made.

Case 3. This occurred in a married lady of Augusta, who
labored under sterility from uterine prolapse. Her menstrua-
tion was suppressed and painful. When the period arrived, I
directed the apparatus applied as usual; the negative pole to
the neck of the uterus, and the positive to a dc^nuded surface on
the nape of the neck. After some hours continuance of this
application, no effect was observable. The patient then, des-
pairing of effect, placed the silver plate on her tongue. Within
a very short time after this manner of application, not exceeding
twenty or thirty minutes, the menstrual flux commenced, and
continued for several hours after the removal of the apparatus,
which was done soon after the appearance of the menstrual dis-
charge. Finding the discharge decline after a few hours, she
reapplied the apparatus, and with like results ; and again, a third

768 Medical Electricity,

time : after which it was discontinued. We have given this
case entirely from memory, as we re(!eived it from the patient,
but we are satisfied that in all essential points it is substantially
correct. We could give some more particulars of interest in
this case, but for the absence of the patient from the city.

Case 4. This was a chronic case of dvsnemorrhcea, with
chronic visceral obstructions occurring therefrom, and accom-
panied with dyspeptic distresses. 'I he menstrual flux came on
every four or five weeks, but declined after the first, or (some-
times) the second day. The apparatus was left with the patient
for trial. It was applied by herself the silver plate to the neck
and the zinc one in the vagina ; but there was reason to doubt
the proper adjustment of the zinc concave to the os uteri. It
was applied once only, and on the decline of the dij^charge,
]Vo effect was observable. Havmg proved the inefficacy of all
ordinary prescriptions, she never reapplied it.

The medical ocular Hevellant. Tliis apparatus has been ap-
plied to only two eyes, both of the same patient. Iloth eyes
became highly inflamed, with great swelling of the palpebrcE and
conjunctiva exquisittiy irritable on the admission of light, &c.
The usual treatn)ent, including leeching, was adopted; still the
local inflammation rcmain(?d unabated. The left eye was first
inflamed. The ocular revellant was then kept in application
for two days; at the end of which time the inflammation was
greatly reduced ; so much so that the patient could open the
eye by the power of the muscles of the part, so as to shew the
conjunctiva and cornea. The swelling of the conjunctiva was
almost entirely reduced, but was still red. With weak astrin-
gent lotions kept applied with lint, the white of the albuginea
became distinctly visible in the twenty-four hours. The appar-
atus was applied to the right eye with like eflecl. During this
time, the patient, in attempting to kill a fly by a violent blow
with his hand, struck the left eye-ball witli the end of onefinger*
On opening the eye for the dressing afterwards, it was found
that the cornea was so injured as to allow the escape of the
aqueous and a portion of the vitreous humour. The dressing
was continued, and a considerable part of the fullness of the ball
preserved, and even the power of perceiving light by the left eye;
but no power of distinct vision is left in it. The right eye was
entirely preserved.

We have no additional facts of importance, to add to our for-
mer remarks on the use of the galvanic purgative.

I N D E X V 0 L. III.

A. PAGE.

Address, Introductory, in the Me-
dical College of Georgia, 1-193
Antony on Medical Electricity, 12-3i'4
Antony on Maternal Influence on

Foetus in Utero, 65

Arnold, case of Rupture of Rec-
tum, 79
Animal iMagnetism, 105
Aneurisms in both Papliteal re-
gions, cured, 120
Antimonial suppositories for re-
producing hemorrhoids, 120
Adductor longus femoris. success-
fully divided for deformity, 129
Attached Twins, 441
Abortions, most common cause of, 330
Antony on common cause of A-

bortion, 330

Aconite in cure of Rheumatism, 361
Arnold on Congestive Fever, 705
Autopsy for legal purposes, 501

Ammoniac Gum and Musk in

Tympanitis, 508

Amputation of Penis, 209

Abdomino-intestinal Wound, case

of, 281

Apparcil Immobile in Fractures, 313
Accidents, facility in recovery

from, 688

Aneurism, successfully treated

with the needle, 577

Aneurismal tumor, extirpation of 481
Animalculoe m human blood, 538
Amaurosis, 566

Analysis of liquor Amnii, 573

Abstraction of Uterus, 752

B.

Brain, signs of its undue develop-
ment, " 587
Barret, case of extirpation of tu-
mor, 581
Biliary Calculus, case of 212
British Provincial Medical & Sur-
gical Association, 247
Broussais, notice of his death, 318
Bloodletting, 46
Bed sores, useful application to, 189
Burt on Congestive Fever, 385
Balsam Copaiba, in diseases of in-
testinal AJucous Membrane, 401
Blue Fill, efTects of, 368

PAGS.

Conventions, Medical, in Phila-
delphia and Washington, 697
(Congestive Fever, Essay on, 595
Congestive Fever, Treatise on, 705
Congestive Fever, Essay on, 385
Cynanche Tonsillaris, remarks on, 551
Catoptric examination of the eye, 568
Carbonate of Iron in Hooping-
cough, 574
Carcinoma of the Mamma, treat-
ment of, 481
Consultation, letters of, 501
Compression of large blood-ves-
sels in Neuralgia, 509
Carpenter on Malignant Pustule, 257
Chloride of Lime in wounds, 62
Cesarean Section, Editorial re

marks on, 181

Cesarean Section, case of, 182

Carbonic Acid Gas in Dysmenor-

rhoea, 184

Carbonic Acid Gas, as a therapeu-
tic agent, 186
Calculus large, passed without an

operation, 189

Cholera Asphyxia, Essay on its

Pathology and treatment, 393

Contagion and Quarantine, 422

Commencement of the Medical

College of Georgia, 1839, 447

Cancer, Sub Carbonate of Iron in, 364
Calomel, its uses and properties, 366
Chestjbrief rules for exploration of, 736

Dessaussure on Mortality of Hoop-
ing-cough in Charleston, 586

Dugas on Anatomy and Physiolo-
gy of liver, 513

Double-inchned plane, modifica-
tion of, 462

Disease, connection of, with dif-
ferent seasons, 487

Diuretic new, 504

Diuretic .Medicines, action of, 218

Diagnosis between Amaurosis and
Cataract, 253

Dugas, Report on Ligamentum
Oentios, 274

Desquamation extensive, 316

Dujias,on Mortality of Augusta in
1837 and 1838. 648

INDEX.

II,

PAGE.

I.

PAGE.

Doses of Medicine,
Dysentery in South Alabama,

E.

445
731

Eve, P. F., Introductory Address,
Electricity, Medical, 12-

Erysipelas, treated with raw cot-
ton, 127-
Eve.P F., case of division of ad-
ductor iongus feraoris, 129
Evo, E. A., on Pathology and

Treatment of Cholera, 393

Eve, P. F , on symptoms ot worms, 321
Erysipelas, new theory and treat-
ment of, 204
Ergot, utility in Paralysis, 510
Eve, J. A., Address to Medical

Students, 193

Eve, J. A., on Sedatives, 641

Exercise, Essay on, 651

Extension, shampooing, &c. in

muscular contractions, 559

F.

Fractures, use of double-inclined

plane in, 449

Fracture of the lower extremity, 457
Fractures, causes which retard

consolidation, 128-229

Facial bones, re-section of, 234

Fractures un-united. Mercury in, 251
Foetus, expulsion of, after death
of mother, 460

Gastralgia, Nit/ate of Silver in, 688
H.

Hernia, new Infirmary for treat-
ment of, 179

Hernia, &,c. cured by Acupunctu-
ration, 187-

Hemorrhage Constitutional, re-
marks on, 559

Hooping-cough treated with Carb
Ferri, 574

Hooping-cough, mortality of, in
Charleston, 586

Hooi>ing-cough, remarks on, 747

Holloway on Congestive Fever, 595

Hydrophobia, 438

563

I.

Intussusception in Infants, new
means of curmg, 121

Intermittent Fever, method of
treating. 125

Immovable Fracture Bandage, 477

Inflammation, Review of Macar-

teny on, 664

Inflammation and the restorative

process, 307

Inflammation, Tartar Emetic in, 309
Injection of Galls, 445

Injury nf Wrist, treatment of, 379
Ins, voluntary power of, 380

Inflammation, warm vapor in, 311

K.

Kreosote in Gonorrhoea &Glett, 188
Keckely on treatment of Scarlet

Fever, 593

Kilpatrick, case of abdomino-in-

testinai wound, 2&1

L.

Lower Lip, operation for its res-

turaiion, 50

Laryngitis, Clinical Lectures on 92
Lusus Naturae, sin 'ular case of, 252
Ligamenturn Dentis, report on, 274
Liver, outlines ol its Anatomy and

Physiology, 513

Letters of Dr P. F. Eve, from

Paris, 637-689

Letters of Dr. Harlan to Editor

of Medical Examiner, 698

Lecture on Clinical Medicine, 300
Lead Lotion in Tinea Capitis, 310

M.

Maternal influence on foetus in

utero, 65

Mammce, singular anomaly of, 119
Menstruation, researches on, 507

Musk and Gum Ammoniac in

Tympanitis, 508

Medical Society of Augusta, ses-
sions of 243-245-374
Medical Prize offered by Medi-
cal Society of Augusta, 256
Malignant Pustule, a treatise on, 257
Menstruation Vicarious, 562
Miller on fracture of lower ex-
tremity, 457
Mortality in Augusta in 1837-38, 648
Medical Institution of Yale Col-
lege, 639
Medical Department of Transyl-
vania University, 640
>Iedical Prizf Questions, 317
Mercury, influence of weather

on action of, 369

.Mercury as an antiphlogistic, 756

Vledical Electricity, editorial, 764

N.

.Vecrology,
N'itrate of Silver injection in Ve-
sical Catarrh,

118

189

111.

nVDEX.

N.

PAGE.

Neuralgia of the Testicle, 575

Nott on the double-inchned plane

in fractures, 449

Nott, case of expulsion of foetus

after death of mother, 460

Nipples, ulcers on, 687

o.

Opthhalrnia strumous, 444

Opthhalmia, treatment of, 42

Opium in large doses to prevent
inflammation, 183

Observations on secret medical
preparations, 571

s Uteri, closure and obliteratiou
during pregnancy, 574

Operation fur Fistula in Ano im-
proper in Phthisical subjects, 382

Operation lor permanent abduc-
tion of thigh, 117

Prolapsus Uteri, bandage for cure

of, 60

Patent laws, and letters patent,

notice of 82

Prospectus American Phrenolo-
gical Journal, 190
Pneurao-thorax, remarks on and

case of, 500

Professional Charges, 501

Paralytic affections. Ergot in 510

Pregnancy extra-uterine, singular

case of, 246

Prostate, division of in Lithotomy, 576
Persesquinitrate ot Iron, reme-
dial powers of, 660
Porrigo, Pathology of, 635
Pulse, effects on by change of

posture, 686

Physick, life and character of, 618
Paralysi8,Nitrate of Strychnine in, 314
Posture, effects of on pulse, 686

Prolapsus Uteri, 4*26

Pterygium new treatment of, 382
Pregnancy, extra-uterine, 254

Physical Examinations, editorial, 759

Quinine in the Urine,

R.

Review of Velpeau's Midwifery, 48
Review of Dickson's Introducio

ry Lecture, 355

Review of Macarteny on Inflara-

maiion, 664

Rupture of Rectum, case of 79

R.

PAGE.

Rheumatism cured by vapor-bath
of Camphor fumes, 123

Respiratory and circulatory func-
tions, relations between, 134

Review of American Phrenologi-
cal Journal, 176

Robert, case of Amputation of
Penis, 209

Robertson, case of Biliary Calcu-
lus, 212

Review of Chapman's Lecture on
Menorrhogia, 434

Richardson, case of Aneurism, 577

Robertson on Raw Cotton in Ery-
sipelas, 534

Robert, Surgical cases, 287

Retention of Urine. Strychnia in, 685

Robert, remarks on Kreoslole in
Journal, 58

S.

Superfoetation, 61

Spontaneous Rupture of Uterus

during delivery, 117

Stammering, new method of cure, 126
Spermatocele or Variocele of the

chord, 231

Simons on an affection of the

Throat, 530

Sodae Sulphas, internal use of in

Hemorrhage, 559

Sinapisms, mode of preparation

for Retrocedent Gout, 575

Scarlatina, 470

Sedatives, an Essay on, 641

Strychnine in retention of Urine, 685
Shepard, report on a milky speci-
men of Urine, 588
Scarlet Fever, treatment of, 593
Surgical cases, 287
Stone in the Bladder, 305
Strychnine Nitrate of, in Paralysis 314
Silver Nitrase ot. in Gasiralgia, 688
Snake Man Robt H. Copeland, 381
Stomach, ulceration of, 720
Stomach, irritation of, 753

Typhus Fever ia- London, 62

Tomato, 121

Tendon section, of and cure, 254

Tendo-achilles section of, is it a

new operation? 254

Throat, observations on an affec-
tion of, 530
Tobacco, Its effects on voice of

public speakers, 553

Testicle, neuralgia of, 575

Tonsils. Iiyperirophy of, 576

Parrar Emetic in Pneiimonia, 497
ren.io-achilles and other tendons,
division of, 297

/A

INDEX.

IV.

PAGB.

Tartar Emetic in Inflammation, 309
Tinea Capitis, lead lotion in, 310

Tonics, 362

Tic Doloreaui, sub. carb. ferri,

for cnre of, 364

Tr Ferri Sesquichloridi, therapeu-
tic properties of, 366

u.

Urea in the blood in cholera, 473
Urine, report on its milky appear-
ance, 588
Uterus Irritable, 635
Ulcers on Nipples, 687
Ulceration of the stomach, 722

PAGE.

Varicose Veins, cure by a cupunc-
turation, 187

Vaccination as a cure for Small
Pox, 504

Varix, treatment of 313

Varicose Veins, treatment of, 314

w.

Worms, case of, 315

Wistar's Anatomy, 317

Wildmanon Exerrise, 651

Worms, certain signs of 441
Worms, Essay on their symptoms, 321

Wooten on Dysentery in South

Alabama, 731

iiii//>tt''iii