'emm Digitized by the Internet Archive in 2012 with funding from LYRASIS IVIembers and Sloan Foundation http://archive.org/details/southnned1839nnedi TOE gyT&^lffSM !M1[E[Q)0^[L \ 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., 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 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 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 chartonable 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-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( 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 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 inJlammarpenter-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;