NATiOHAD 
UBRARniHOERKO 

'          ATUA?!TA  ' 


SOUTHERN 


^^M 


MEDICAL  AND  SURGICAL 


JOURNAL. 


EDITED    BY 

PAUL  F.  EVE,  M.  D.,  and  I.  P.  GARVIN,  M.  D. 


Medical  College  of  Georgia. 


Jc  prends  U  hien  oujele  trouve. 


VOL.  I.-1845.-NEW  SERIES, 


p.  C.  GUIEU,  PUBLISHER. 

AUGUSTA,  GEO. 

PRINTED  BY  JAMES  McCAFFERTY 

1845. 


SOUTHERN 

MEDICAL  AND  SURGICAL 
JOURNAL. 

Vol.  I.]  NEW  SERIES JANCiRT,  IS45.  [No.  1. 

r    .  t 

INTRODUCTION. 

The  -vvant  of  some  convenient  repo.sitory  for  the  results  of  the  observation  and 
experience  of  Southern  Physicians  some  medium  through  which  they  can 
communicate  with  each  other,  and  with  the  profession  at  large,  has  long  been 
felt  and  deplored.  In  all  the  broad  region  occupied  by  the  Southern  and  South- 
western states,  there  exists  but  one  periodical  devoted  to  the  Medical  Sciences, 
and  that  of  recent  origin,  though  in  this  section  are  to  be  found  hundreds  of 
intelligent  and  experienced  practitioners,  who  are  thoroughly  conversant  with 
the  diseases  peculiar  to  it,  and  with  all  those  modifications  which  climate, 
physical  constitution,  and  other  causes  produce  in  those  maladies  which  are 
common  to  our  v.'hole  country.  It  is  true  that  there  are  already  established  in 
the  Northern  cities  .several  Medical  Journals  which  are  conducted  with  distin- 
guished ability.  But  these  cannot  supply  our  peculiar  wants  Of  necessity,  a 
large  portion  of  the  correspondents  of  these  periodicals  reside  where  many  of 
our  most  common  and  serious  disea.ses  are  but  little  knowai Moreover  the  field 
of  labor  of  the  Southern  physician  is  so  di.stant,  that  he  does  not  feel  that  incite- 
ment to  prepare  the  results  of  his  observation  for  the  public  eye,  which  he  would 
experience  if  there  were  published  in  his  vicinity,  a  Journal  in  which  his  com- 
petitors and  his  friends  were  earning  distinction  for  themselves  and  extending  the 
boundaries  of  the  Science,  From  the  want  of  such  facilities  for  communication, 
a  vast  amount  of  valuable  knowledge  is  lost  to  the  profession,  and  its  Iwnor  and 
usefulness  seriously  impaired. 

In  view  of  these,  and  other  cogent  reasons,  the  Faculty  of  the  Medical  College 
of  Georgia  began  the  publication  of  the  Southern  Medical  and  Surgical  Journal 
in  the  year  1836,  under  the  editorial  management  of  the  late  Prof.  Antony. 
The  work  was  continued  with  constantly  increasing  usefulness  and  success 
until  the  lamented  death  of  the  Editor  led  to  its  suspension  at  the  close  of  the 
third  volume.  Since  that  time,  they  have  received  from  various  quarters  urgent 
appeals  to  revive  the  Journal,  and  in  accordance  with  these  requests  several 
attempts  have  been  made  to  re-establish  it,  heretofore  however,  without  success. 


SI 


o 


INTRODUCTION. 

But  arrangements  have  now  been  made  which  justify  the  revival  of  the  work, 
and  render  certain  its  future  continuance. 

The  Journal  has  been  jjlaced  under  the  editorial  management  of  two  mem- 
bers of  the  Faculty.  They  would  distrust  their  o^ti  ability  to  carry  on  so 
laborious,  and  responsible  an  undertaking,  but  they  are  led  to  make  the  effort  by 
the  promise  of  the  valuable  aid  of  their  colleagues,  and  of  other  distinguished 
members  of  the  profession  in  this  and  the  adjoining  States.  They  have  entire 
confidence  in  the  ability  of  Southern  physicians,  to  furnish  matter  which  will  do 
honor  to  themselves,  and  prove  highly  useful  to  the  profession.  We  therefore 
cordially  solicit  them  to  furnish  us  with  their  communications,  not  only  upon 
medical  subjects,  but  also  upon  any  of  the  collateral  sciences,  ,.^---; 

It  is  proposed  to  devote  a  portion  of  the  Journal  to  Reviews  of  new  works,  and 
to  such  Extracts  from  these,  and  from  other  periodicals,  as  may  be  useful  and 
interesting.  Another  part  of  the  Journal  will  be  appropriated  to  a  general  Sum- 
mary of  the  improvements  and  discoveries  in  medicine,  which  are  being  made 
throughout  the  world.  The  facilities  of  the  Editors  for  this  part  of  their  task  are 
ample,  as  they  are  now  regularly  receiving  all  of  the  most  valuable  European 
and  American  Medical  Journals, 

The  first  number  of  the  new  series  of  the  Southern  Medical  and  Surgical 
Journal  will  be  sent  to  the  former  subscribers  to  the  work,  and  also  to  many 
other  professional  gentlemen,  in  the  confident  expectation  that  they  will  aid  the 
undertaking  with  their  patronage.  No  selfish  feeling  prompts  this  solicitation  
for  no  pecuniary  benefit  is  expected  to  accrue,  unless  it  should  be  to  the  pub- 
lisher. An  anxious  desire  to  do  something  to  advance  the  usefulness  and 
respectability  of  Southern  medicine,  prompts  the  efibrt.  The  harvest  is  great, 
the  laborers  are  few,  and  the  Editors  enter  upon  it,  trusting  that  with  the  blessing 
of  God,  and  the  aid  of  other  professional  brethren,  they  may  be  in  some  degree 
instrumental  in  the  improvement  of  a  Science  whose  sole,  unselfish  aim,  is  to 
benefit  the  human  race. 

The  Journal  will  be  issued  puncUially  on  the  first  of  every  month and  will 
be  forM-arded  to  subscribers  by  mail,  unless  some  other  mode  of  delivery  is 
specified. 

Letters  containining  remittances  should  be  directed  (free  of  postage)  to  the 
publisher,  P.  C,  Guieu. 

Communications  intended  for  publication,  must  be  accompanied  by  the  name 
of  the  writer,  and  should  be  addressed  to  the  Editors. 

Augusta,  January,  1845. 


Part  I. ORIGINAL  COMMUNICATIONS. 

ARTICLE   I. 

Pathology  of  Intermittent  Fever  By  Lewis  D.  Ford,  M.  D.,  Pro- 
fessor of  the  Institutes  and  Practice  of  Medicine,  in  the   Medical 
College  of  Georgia. 

The  writer  offers  no  apology  for  an  article  on  the  common  and 
trite  subject  of  Intermittent  Fever ;  for  after  all  that  has  been  written 
upon  it  and  all  that  is  known  of  it,  it  still  remains  a  subject  of  the 
deepest  interest,  and  one  worthy  the  most  thorough  study.  The 
philosophy  of  that  physician  is  not  to  be  envied,  who  rests  satisfied 
with  his  knowledge  of  Intermittent  fever,  when  he  has  learned  to  dis- 
tinguish it  from  all  other  diseases,  and  to  treat  it  after  the  commonly 
received  rules.  That  its  pathology  is  still  unknown,  continues  to 
stimulate  the  inquiries  of  those,  whose  ultimate  object  of  research,  in 
every  disease,  is  to  ascertain  its  primary  location  and  the  very  nature 
of  the  physical  changes  in  which  it  consists.  The  very  act  of  tracing 
out  the  relations  of  its  open  phenomena  with  the  hidden  parts  of  the 
organization  is  interesting,  if  only  for  the  gratification  of  a  scientific 
curiosity  "  Felix,  qui  potuit  rerum  cognoscere  causas.^^ 

But  the  study  of  the  intimate  nature  of  a  disease,  which  is  well 
marked  by  external  symptoms,  and  which  has  a  specific  and  well 
known  treatment,  has  a  higher  aim  than  this  ;  for  however  well 
known  the  physiognomy  of  Intermittent  fever  in  its  simple  forms,  and 
however  certain  its  cure,  yet,  in  its  complicated  forms  it  becomes 
most  formidable  and  fatal ;  and  he  who  understands  best  the  patholo- 
gy of  the  simpler  form,  will  be  best  prepared  to  trace  it  in  all  its  com- 
plications, and  to  vary  his  treatment  according  to  its  ever-changing 
accidents.  Again,  if  the  opinion  entertained  by  Dr.  Cullen  be  true, 
that  this  is  the  fundamental  or  model  type  of  all  fevers that  even 
the  most  continued  fever  consists  of  a  repetition  of  paroxysms,  then 
the  true  mode  of  studying  all  fevers  must  be  to  begin  with  the  simple 
form  ;  and  he  who  passes  by  this  form,  without  getting  a  definite 
knowledge  of  its  intimate  nature,  will  scareely  be  able  to  comprehend 
fever  in  its  more  complex  forms.  We  have  no  intention  now,  to 
examine  the  question  whether  there  really  does  exist  any  form  of 


4  Pathology  of  Intermittent  Fever,  [January, 

fever,  which  is  truly  continued,  but  only  assert  the  fact,  the  result  of 
our  own  observation  of  many  years,  that  the  fevers  of  this  climate,  do 
almost  invariably,  in  their  commencement  and  through  the  greater 
part  of  their  course,  present  a  decided  paroxysmal  character ;  and 
that  it  is  not  until  after  the  occurrence  of  those  fixed,  structural  chan- 
ges, which  inflammation  produces,  that  they  loose  this  character. 
To  the  physician  of  the  Southern  States  then,  whose  great  business 
is  the  treatment  of  periodical  fever  of  various  forms,  an  effort  to 
illustrate  the  nature  of  simple  Intermittent  fever,  may  not  be  unac- 
ceptable. 

It  is  unnecessary  to  enter  into  a  detail  of  the  symptoms  of  Inter- 
mittent fever,  these  being  so  familiar  to  all.  The  problem  with  which 
the  writer  proposes  to  occupy  himself  is  this :  the  symptoms  of 
Intermittent  fever  being  given,  to  determine  the  organic  alterations 
upon  which  these  depend  in  other  words,  the  diseased  acts  being 
given,  to  ascertain  the  diseased  state;  for,  as  already  intimated,  he 
fully  recognizes  that  sound  principle  of  medical  philosophy,  that  the 
ultimate  object  in  the  study  of  disease  is  the  knowledge  of  the  dis- 
eased state  the  physical  state  of  the  organ  or  organs  suffering. 

If  organic  medicine  had  done  nothing  more  than  establish  this 
cardinal  principle,  it  had  rendered  an  inestimable  benefit  to  our 
Science;  f()r  although  it  must  be  candidly  declared,  that  this  high 
degree  of  knowledge,  even  in  the  most  palpable  diseases,  is  very 
imperfect,  yet  its  pursuit  is  not  chimerical ;  in  proposing  to  gain  it, 
we  are  not  in  search  of  the  unattainable.  This  great  principle  of 
organic  medicine  teaches  the  physician  to  study  his  Science  with  i\iQ 
Bame  inductive  method,  that  has  so  beautifully  illustrated  the  physical 
Sciences,  in  the  assured  hope,  that  new  modes  of  investigation  shall 
make  definite,  that  knowledge  which  is  now  so  imperfect.  It  is  a 
great  polar  star,  v/hich  will  keep  him  in  the  right  way,  and  that 
which  he  does  not  reach  himself,  after-generations,  beginning  where 
he  left  off,  shall  not  fail  to  discover.  Even  at  the  present  day,  this 
principle  steadily  kept  in  view  will  lead  to  the  coarser,  but  by  no 
means  unimportant  knowledge  of  the  organ  affected,  in  any  given 
disease. 

The  physical  changes  in  the  organization,  upon  which  simple 
intermittent  fever  depends,  have  not  as  yet  been  satisfactorily  deter, 
mined  ;  because,  in  the  few  cases,  in  which  after  a  prolonged  course, 
it  proves  fatal,  it  can  scarcely  admit  a  doubt,  that  the  appearances  of 
inflammation  in  the  stomach  and   bowels,  and  enlargement  of  the 


1845.]  Patliology  of  Intermittent  Fever, 


liver  and  spleen,  are  the  consequences  rather  than  the  causes  of  the 
disease.  These  morbid  states  are  by  no  means,  uniformly  discovered 
after  death  or  manifested  during  the  disease ;  these  enlargements, 
often  do  not  exist  nor  any  evidence  of  these  inflammations ;  and 
moreover,  nothing  is  more  common  than  their  continuance  long 
after  the  fever  has  disappeared.  Besides  this  uncertainty,  we  believe 
another  reason  why  these  physical  changes  have  not  been  discovered 
is,  that  they  have  not  been  generally  sought  for  in  the  right  direction 
nor  with  sufficient  patience  and  minuteness.  And  although  autopsic 
examinations  of  cases  of  complicated  malignant  Intermittents  shew 
physical  changes  to  have  taken  place  in  the  central  organs  of  the 
nervous  system,  very  uniformly,  yet  the  inference  is  not  allowable, 
that  it  is  upon  this  kind  of  organic  disease,  that  s^mpZe  Intermittent 
fever  depends.  So  that  simple  Intermittent  never  proving  fatal, 
pathological  anatomy  can  furnish  us  no  aid  in  determining  its  organic 
lesions ;  and  we  are  left  to  reason  out  its  pathology,  under  the 
guidance  of  general  principles. 

In  considering  the  various  functions  of  the  body,  during  a  paroxysm 
of  fever,  we  find  almost  every  one  of  them  disordered  functional 
disease  is  absolutely  omnipresent ;  and  as  we  can  conceive  of  no 
functional  derangement  independent  of  organic  changes,  we  infer 
that  organic  disease  is  as  universally  present.  Upon  this  state  of 
universal  disease  of  the  organs,  we  are  obliged  to  conclude,  that  they 
did  not  contain  within  themselves  an  independent  cause  of  irritation, 
acting  simultaneously  to  produce  their  disordered  action  this  were 
an  absurdity.  We  are  compelled  to  regard  this  universal  disorder 
as  consequent  upon  disturbance  in  the  action  of  those  systems  uni- 
versally distributed  throughout  the  body,  and  therefore  universal  in 
their  influence  upon  its  organs  namely,  the  circulating  and  nervous 
systems.  Each  of  these  has  its  great  central  organ,  whose  varying 
degrees  and  kinds  of  action  are  quickly  manifested  by  corresponding 
changes  throughout  the  entire  economy-  And  again,  when,  in  a 
paroxysm,  we  observe  the  whole  circulating  system  disordered  in  its 
action,  this  becoming  either  increased  or  diminished  or  irregular,  we 
are  equally  compelled  to  attribute  this  disturbance,  not  to  irrritation 
or  disease  developed  simultaneously,  in  the  various  parts  of  this  sys- 
tem, but  to  the  increased,  diminished  or  irregular  action  of  its  central 
impelling  muscle  the  heart.  This  is  true  of  ever\'  part  of  the  arte- 
rial system  depending  directly  for  its  action,  upon  that  of  the  heart  
and  to  a  considerable   degree  of  the   capillary   system   also;   for 


Pathology  of  Inter  milt  eni  Fever.  [January, 


although  it  possesses  an  independent  action  of  its  own,  still  that  is 
undoubtedly  modified  to  some  extent  by  that  of  the  heart,  as  illustra- 
ted by  the  opposite  states  of  the  capillary  system  in  the  extremes  of 
high  and  low  general  action.  Seeing  then,  that  a  vast  number  of  the 
phenomena  of  a  paroxysm  may  be  dependent  upon  disordered  action 
of  the  heart,  it  becomes  an  important  enquiry  how,  in  fever,  is  the 
disordered  action  of  the  heart  produced  ?  To  aid  in  the  solution  of  this 
question,  let  us  first  determine  the  various  modes  in  which  an  organ 
may  be  disordered  in  its  functions.  Inflammation  present  in  an 
organ  does  most  signally  disorder  its  actions;  and  this  is  a  state, 
discoverable  by  palpable  characteristic  changes  structural  changes 
in  its  organization.  Besides  this  state  of  inflammation,  the  functions 
of  an  organ  may  be  deranged  by  the  state  and  quality  of  the  blood 
circulating  within  it;  thus  too  much  blood  or  too  little,  or  blood  of  a 
depraved  quality  produces  deranged  action.  Again,  besides  these 
two,  there  is  a  third  cause  of  disordered  function  of  an  organ  viz  : 
the  influence  of  other  diseased  organs  upon  it,  through  the  medium  of 
the  nervous  system  sympathetically  disordered. 

Does  this  disordered  action  of  the  heart,  manifested  during  the 
paroxysm  of  fever,  depend  upon  inflammation?  Is  the  primary  seat 
of  fever  in  the  heart  itself  ?  This  question  may  safely  be  decided 
upon  the  testimony  of  morbid  anatomy  alone  :  which  does  not  dis- 
cover the  evidences  of  inflammation  of  the  heart,  or  any  of  its  tissues, 
even  in  cases  of  fatal  malignant  Intermittents.  Further,  its  inflam- 
mation is  characterized  by  well  marked  symj)toms,  not  present  during 
the  paroxysm;  and,  again,  this  disordered  action  of  the  heart  is 
secondary  to  other  afftjctions  previously  developed.  As  to  the  second 
source  of  disorder  too  much  or  too  little  or  depraved  blood  ;  ahhough 
this  class  of  causes  must  necessarily  exert  a  powerful  influence  over 
its  action,  at  various  stages  of  the  paroxysm,  yet  the  diminution  of 
the  natural  quantity,  or  its  increase,  belongs  to  a  secondary  series  of 
phenonvena  the  eflect  of  pathological  states  previously  existing; 
and  this  varying  quantity  of  blood  in  the  heart  is  probably  dependent 
upon  the  peculiar  action  of  the  heart  itself.  We  are  led  therefore  to 
conclude  that  the  action  of  the  heart  is  disturbed  by  the  influence  of 
other  organs  antecedently  diseased. 

In  determining  which  of  the  organs  exerts  this  influence  over  the 
heart's  action,  we  remark,  that  the  inflammatory  state  of  each  and 
every  tissue  in  the  body  and  of  each  organ,  has  this  power  of  disturb- 
ing the  action  of  the  heart,  and  thus  of  inducing  fever.     We  have 


1845.]  Pathology  of  Intermittent  Fever. 


ample  proof  of  this  in  the  great  number  of  the  Phlegmasiae  such  as, 
Gastritis,  Enteritis,  Pleuritis,  Pneumonia,  Phrenitis,  d:c.  But  this 
pathological  principle  will  not  enable  us  to  illustrate  the  nature  of 
Intermittent  fever  it  cannot  be  called  a  phlegmasia  of  any  of  the 
organs ;  because  these  local  inflammations  consist  in  radical  altera- 
tions of  the  tissues,  which  cannot  be  promptly  changed,  and  which 
therefore  manifest  themselves  by  continuous  symptoms  ;  accordingly, 
these  fevers  of  the  phlegmasiae  are  not  marked  by  intermission  
they  are  nearly  continuous.  So  that  the  pathology,  which  would 
regard  Intermittent  fever  as  a  phlegmasia  simply,  of  some  of  the 
organs,  leaves  unexplained  its  most  characteristic  feature  its  peri- 
odicity. Indeed,  so  far  is  this  opinion  from  being  correct,  that  on 
the  contrary,  the  occurrence  of  positive  inflammation  in  any  one  of 
the  organs  is  sure  to  destroy  the  periodicity  of  Intermittent  fever.  
Moreover,  after  a  paroxysm,  the  organs  all  return  to  their  healthy 
functions,  so  that  the  symptom?  of  the  paroxysm  must  have  depended 
upon  some  pathological  state  of  the  organs  less  permanent  than  that 
of  inflammation  a  state  capable  of  being  cured  by  the  very  com- 
motions of  the  paroxysm. 

This,  however,  only  settles  the  opinion,  that  Intermittent  fever  is 
not  a  phlegmasia ;  and  the  question  returns,  what  are  the  organs 
primitively  affected  ?  The  recollection  of  the  symptoms  and  the  order 
of  their  occurrence  will  suggest,  that  it  must  be  some  part  or  the 
whole  of  the  central  organs  of  the  nervous  system ;  for  among  the 
very  first,  or  premonitory  symptoms,  are  those  indicating  disorder  of 
their  functions;  for  they  are  symptoms  of  disjordered  sensation,  of 
disorders  in  the  muscular  system,  and  of  disorders  of  the  intellect. 
Before  interpreting  these  symptoms,  however,  it  is  proposed  to  estab- 
lish  the  general  principle,  that  a  diseased  state  of  the  brain  and 
spinal  marrow  may  produce  a  vast  variety  of  functional  deranf^e- 
ments  in  distinct  organs ;  and  to  specify  the  various  kinds  of  derange- 
ment known  to  bo  thus  produced.  To  commence  with  those  affections 
of  the  spinal  marrow,  about  which  there  can  be  no  doubt  affections 
that  are  accompanied  with  and  leave  behind  them,  structural  disor- 
ganization, we  take  Myelills  or  inflammation  of  the  spinal  marrow. 
It  is  sometimes  general  at  others,  confined  to  particular  portions  of 
the  spinal  chord.  When  it  exists  in  the  cervical  region,  there  is  local 
pain;  wliich,  however,  is  so  obscure  as  not  to  command,  forcibly,  the 
attention  of  the  patient,  until  after  pressure  upon  the  spinous  pro- 
cesses; which  is  generally  follov/cd  by  continuous  ^nin    *^^ 


Pathology  of  Intermittent  Fever,  [January, 


urgent  symptoms,  to  which  the  patient  himself  refers,  are  pain  in 
the  upper  extremities,  with  spasms  of  the  muscles,  numbness  of  these 
limbs,  permanent  rigidity  of  some  of  the  muscles,  followed  by  para- 
lysis ;  the  respiration  is  notably  injured,  becoming  laborious  and 
asthmatic  ;  and  it  is  remarkable  that  death  comes  by  asphyxia,  from 
embarrassment  of  the  respiratory  function.  When  in  the  dorsal 
region,  besides  the  local  symptoms  already  mentioned,  the  most  obvi- 
ous symptoms  are  those  of  disordered  respiration  and  especially  of 
disordered  functions  of  the  abdominal  viscera,  cramps  of  the  stomach, 
cholic,  constipation,  contraction  of  the  abdominal  muscles.  When 
seated  in  the  lumbar  region,  its  characteristic  symptoms  are  mani- 
fested in  the  lower  abdominal  and  pelvic  viscera  and  in  the  lower  ex- 
tremities obstinate  retention  of  fasces  and  urine,  or  incontinence  of 
both,  convulsions,  rigidity  and  paralysis  of  the  muscles  of  the  lower 
extremities.  Allusion  is  here  made  to  acute  Myeletis,  with  fever 
finishing  its  course  in  a  few  days,  leaving  marks  of'  unequivocal 
inflammation,  which  it  is  needless  here  to  specify.  Nor  is  it  necessa- 
ry to  do  more  than  merely  refer  to  the  acute  diseases  of  the  brain, 
as  exemplifying  the  principle,  that  primary  disease  of  the  brain  or 
spinal  marrow  is  manifested  by  symptoms  in  distinct  organs.  Physi- 
ological experiments  upon  living  animals  establish  it  equally.  If  a 
nerve  be  irritated  at  its  origin  in  the  spinal  marrow,  this  irritation 
will  be  manifested  by  pain  and  muscular  contractions  in  the  parts  to 
which  that  nerve  is  distributed;  and  if  this  connection  between  the 
irritated  portion  of  the  marrow  and  the  distant  parts  be  broken,  by 
dividing  the  trunk  of  the  nerve,  these  effects  do  not  appear. 

But  let  us  look  at  this  principle,  more  closely,  in  reference  to  the 
common  symptom  of  pain.  If  the  finger  be  pricked  by  a  pin,  we 
feel  pain.  We  are  apt,  without  reflection,  and  even  in  the  face  of 
our  positive  knowledge,  to  conclude  that  this  pain  is  produced  by 
injury  done  to  the  nerves  of  the  part,  and  to  rest  in  this  explanation  ; 
but  surely  the  sensation  of  pain  depends  essentially  upon  the  action 
of  a  particular  part  of  the  nervous  centre,  with  which  the  tissue 
injured  is  in  connection  ;  for,  do  but  cut  off  the  part  injured  from 
communication  with  the  nervous  centre,  by  dividing  its  nerve,  and 
no  pain  will  be  felt,  from  the  severest  violence.  The  action^  then, 
of  some  particular  portion  of  the  central  nervous  organ,  is  indispensa- 
bly necessary  to  the  production  of  this  pain  ;  and  this  action  is  the 
result  of  a  peculiar  modification  of  this  nervous  substance.  Now  it 
is  fair  to  infer,  that  if  from  any  idiopathic  affection  of  this  portion  of 


1845.]  Pathology  of  Intermittent  Fever. 


the  nervous  centre,  the  same  modification  should  be  produced,  the 
same  kind  and  degree  of  pain  would  be  felt  in  the  finger,  as  was  pro- 
duced by  the  pin.  We  may  safely  adopt  the  same  explanation  of 
pain  from  disease ;  and  yet  there  is  the  same  stopping  short  at  the 
part  itself,  instead  of  looking  to  the  more  far-off  source. 

In  pleurisy,  for  example,  no  doubt  that  if  the  communication  with 
the  nervous  centres  were  cut  off,  no  pain  would  be  felt ;  and  on  the 
other  hand,  if  from  any  cause,  the  portion  of  the  nervous  centres  bo 
similarly  modified,  the  same  kind  of  pain  would  be  felt  in  the  pleura, 
as  is  felt  when  it  is  inflamed.  Now,  we  are  not  left  to  conjecture 
on  this  point,  for  this  state  of  things  actually  occurs,  in  that  disease, 
closely  resembling  pleurisy,  in  its  violent  and  pungent  pain,  though 
unaccompanied  by  its  inflammation,  its  characteristic  effusion  or  its 
fever  pleuralgia ;  dependent  on  spinal  irritation,  as  we  believe, 
both  from  the  fact  that  it  is  accompanied  with  tenderness  on  pressin*' 

  r  o 

some  of  the  spinous  processes  of  the  dorsal  vertebrcs,  and  that  it  is 
promptly  relieved  by  revulsive  applications  to  the  spine  relieved  as 
by  a  charm.  We  have  proof  of  the  dependence  of  pain  in  an  organ 
upon  the  diseased  state  of  the  spinal  marrow,  in  tlie  almost  instanta- 
neous relief  o^  false  pains  in  the  uterus,  by  revulsive  applications  to 
the  loins  ;  indeed,  so  certain  is  this  mode  of  relief,  that  the  writer 
has  long  been  in  the  habit  of  using  a  sinapism  to  the  sacrum  and 
loins,  as  a  test  of  the  nature  of  these  pains,  instead  of  a  manual 
examination  of  the  os  tineas. 

But  irritation  in  some  portion  of  the  spinal  marrow  not  only  deter- 
mines pain  in  distant  parts,  but  we  think  it  may  be  shewn  to  deter- 
mine those  physical  alterations  in  the  tissues,  in  which  inflammation 
itself  consists.  These  physical  derangements  in  inflammation,  take 
place  in  the  capillary  system  its  beginning  is  there;  suppuration  in 
which  it  often  terminates,  is  evidently  a  secretory  process  carried  on 
by  its  vessels.  If  we  enquire  into  the  mode  in  which  these  vessels 
perform  their  action  in  heahh  the  mechanism  of  their  action  it 
will  aid  in  determining  this  question.  There  are  two  circumstances 
indispensably  necessary  to  the  production  of  the  actions  of  these 
vessels,  as  of  every  other  vital  action  1st.  the  living  organized 
surface,  endowed  with  the  capability  of  feeling  the  impression  of 
excitants,  and  2nd.  the  agents  to  make  this  impression.  Now, 
without  going  into  the  question  in  physiology,  whether  the  actions 
of  the  organs  are  independent  of  nervous  influence,  we  remark  that 
this  susceptibility  of  the  tissues  to  impressions  is  dependent  on  their 


10  Pathology  of  Intermittent  Fever,  [January, 


organization,  and  the  nerves  are  indispensable  to  this  organization  
and  it  is  according  to  our  knowledge  at  the  present  day,  to  say  that 
the  power  of  feehng  impressions  is  dependent  upon  the  nervous  sys- 
tein.  In  determining  what  are  the  agents  and  stimulants,  which 
making  their  impressions  upon  the  susceptible  capillaries,  excite 
them  to  action,  tlie  remembrance  that  their  functions  nutrition, 
absorption,  secretion,  &;c.  are  incessant,  never  interrupted,  not  even 
in  sleep,  suggests  that  these  stimulants  must  be  always  in  contact 
with  them  that  this  agent  is  the  blood  within  them:  in  this  we 
recognize  a  beautiful  provision,  inasmuch  as  the  fluid,  which  is  to 
furnish  the  materials  for  the  nutrition  and  secretion  of  the  organs,  is 
itself  the  stimulus  to  the  actions,  which  separate  these  materials.  If 
this  be  a  correct  account  of  the  mechanism  of  the  capillary  action, 
then  a  change  in  the  quality  of  the  stimulus,  the  sensibility  remaining 
in  the  natural  state,  will  derange  their  action  ;  but,  a  change  in  their 
sensibility  an  increase  of  this  sensiljility,  the  blood  remaining  of  its 
natural  quantity  and  quality,  will  also  derange  their  action.  Lotus 
apply  these  principles  to  explain  how  inflammation  may  be  induced 
by  idiopathic  disease  of  some  portion  of  the  nervous  centre.  Let  us 
take  the  pleura :  in  its  sound  state,  it  is  exercising  all  its  capillary 
functions  with  regularity;  these  capillaries,  constantly  supplied  with 
tlieir  stimulus,  the  blood,  by  the  action  of  the  heart;  their  suscepti- 
i)iiity  to  this  stimulus  as  constantly  kept  up,  by  the  incessant  action 
of  that  portion  of  the  central  nervous  system,  with  which  it  is  in 
commtinication,  by  intercurrent  nerves.  But  suppose  that  this  por- 
tion of  the  nervous  centre  becomes  diseased,  its  healrhy  action  disor- 
dered, then  this  susceptibility  of  the  caj)illarics  must  become  changed 
also;  and  if  increased,  their  ordinary  stimulus  will  excite  its  capillaries 
to  higher  action  the  first  step  in  every  simple  inflammation.  The 
writer  would  not  be  understood  as  aflirming,  that  pleurisy  and  other 
inflammations  have  their  beginning  in  the  central  nervous  system  ; 
he  is  only  explaining  how  a  particu.ar  moditicalion  of  some  portion 
of  this  system  may  determine  the  first  beginnings  of  inflammation. 

It  must  be  acknowledged,  that  a  j)hysiological  argument  to  prove  the 
possibility  of  the  dependence  of  inflammation  upon  a  diseased  state  of 
the  nervous  centres  would  be  notliing  worth,  if  observation  did  not 
discover  the  fact.  Acute  Rheumatism,  with  its  local  heat,  swelling, 
redness,  and  excessive  pain  in  the  joints  may  be  considered,  at  the 
present  day,  as  proved  to  ])e  dependent  on  a  diseased  condition  of 
some  portion   of  the   spinal    marrow  proved   by  the    evidence   of 


1845.]  Pathology  of  Intermittent  Fever.  11 


uniformly  co-existing  and  antecedent  disease  ihcre,  and  by  the  fact 
of  the  great  success  of  revulsive  applications  to  the  spine.  We  assert 
the  fact,  that  absolute  mucous  gastritis  is  uniformly  attended  with 
spinal  tenderness,  in  some  portion  of  the  upper  dorsal  vertebrae,  and 
that  of  all  the  means  for  relieving  this  most  distressing  affection, 
none  can  compare,  in  promptness  and  efficiency,  with  leeches,  cups, 
sinapisms,  and  blisters  to  the  spinal  column.  Again,  we  have  for 
many  years,  recognized  the  same  connection,  in  acute  peritonitis  
it  exists  with  great  uniformity,  even  in  puerperal  peritonitis,  and 
these  topical  applications  to  the  lower  dorsal  and  lumbar  region  of 
the  spinal  column,  we  have  been  accustomed  to  use  as  most  important 
auxiliaries,  in  that  affection,  which  so  often  taxes  all  the  resources  of 
the  physician.  The  writer  regrets  that  he  cannot,  here,  illustrate 
these  pathological  facts,  by  carefully  observed  and  recorded  cases,  of 
wiiich  he  has  an  abundance  at  his  command. 

There  is  another  pathological  state,  strictly  dependent  on  original 
disease  in  some  portion  of  the  spinal  marrow  ^pasm  or  convuL-^ions 
of  the  muscles  of  organic  life,  such  as  the  heart,  the  muscles  of  res- 
piration, the  muscles  of  the  stomach  and  intestines,  &c.;  and  if  those, 
we  are  authorized  to  conclude  the  muscular  tissue  of  the  capillaries 
also:  thus,  upon  some  diseased  state  of  the  spinal  marrow  are  de- 
pendent nervous  palpitations  of  the  heart,  some  of  the  varieties  of 
asthma,  hysteria,  colic,  and  cramp  of  the  stomach.  Tlie  writer 
could  adduce  many  instances  of  predisposition  to  this  last  mentioned 
disease  entirely  destroyed  by  a  seton  between  the  shoulders.  The 
recent  records  of  medicine  abound  with  facts,  shewing  the  de- 
pendence of  ahnost  every  variety  of  disordered  sensation,  as  also 
of  disordered  secretion,  upon  original  disease  in  the  spinal  marrow. 
Thus  has  it  been  shewn  that  acute  pain  and  almost  every  variety  of 
disordered  sensation,  throughout  the  body,  spasms  of  the  muscular 
tissue,  and  those  disordered  actions  in  the  capillaries  which  are  man- 
ifested  in  inflammation,  and  disordered  secretions  maij  depend  on  a 
diseased  condition  of  some  j)artsof  the  brain  or  spinal  marrow  that 
is  every  variety  of  functional  disorder  which  is  observed  during  a 
paroxysm  of  Intermittent  fever. 

We  now  proceed  to  an  interpretation  of  the  symptoms,  with  the 
aid  of  these  principles  to  show  that  thoy  depend  on  lesions  of  the 
central  nervous  organs.  Consider  the  premonitory  symptoms  of  a 
chill;  which  certainly  forma  very  important  part  of  the  disease. 
These  are  pain  in  the  back,  in  the  knees  and  other  joints,  together 


12  PaiJiology  of  Intermittent  Fever,  [January, 


with  a  feeling  of  general  weariness  in  the  muscular  system,  prompt- 
ing the  patient  to  move  his  muscles,  and  an  unwonted  degree  of 
faliguo,  upon  slight  exertion  ;  so  that  the  patient  is  tormented  between 
two  opposite  states,  the  desire  to  move  the  muscles  and  to  keep  them 
at  rest.  For  days,  there  is  a  loss  of  appetite  and  disordered  digestion, 
with  nausea  and  even  vomiting.  Pain  in  the  back  On  remarking 
pain  in  the  region  of  any  important  organ,  we  hesitate  not  to  attri- 
bute some  disease  to  that  organ  ;  why  not  in  this  instance,  especially 
as  this  symptom  is  so  invariable  ]  These  pains  in  the  joints  are 
without  the  usual  signs  of  local  inflammation  ;  and  those  accustom- 
ed to  treat  chronic  rheumatism  of  the  joints,  by  applications  to  the 
spinal  column,  will  confidently  refer  them  to  the  state  of  the 
spine. 

The  healthy  sensations  of  the  muscles  are  well  known  to  depend 
upon  a  good  condition  of  those  portions  of  the  nervous  centres  from 
which  they  derive  their  nerves,  and  of  course  disease  in  those  portions 
must  disorder  them.  And  when  we  remember  that  the  muscular 
tissue  is  not  readily  diseased,  wo  have  another  argument  that  the 
disorders  already  mentioned  in  their  sensations  and  motions  originate 
in  the  spinal  marrow. 

As  for  the  heaviness  of  the  epigastrium,  and  the  uneasiness  there, 
with  loss  of  appetite  they  are  symptoms  clearly  referable  to  spinal 
irritation,   in  other  cases  where  they  are  not  attended  with  fever  in- 
dyspepsia,  for  example  where  repeated  blisters  to   the   spine  often 
prove  an  effectual  relief     So  much  for  the  precursory  symptoms. 

The  chill  itself  is  marked  by  irregular  action  of  the  whole  mus- 
cular system  ;  producing  rigors  of  the  limbs,  chattering  of  the  teeth  ; 
universal  pallidness  and  constriction  of  the  skin,  and  suspension  of 
the  secretions,  that  is  disordered  actions  of  the  capillary  system.  We 
do  not  hesitate  to  account  for  these  symptoms,  with  Dr.  Cullen, 
by  saying  that  they  proceed  from  spasmodic  constriction  of  the 
capillaries.  If  now,  we  consider  how  closely  the  muscular  and 
capillary  systems  depend  on  the  central  organs  of  the  nervous  system, 
we  shall  find  in  a  diseased  condition  of  the  latter,  a  sufiicient  expla- 
nation of  all  these  symptoms  ;  but  as  these  are  manifested  in  all  parts 
of  the  body,  we  must  suppose  the  whole  extent  of  the  central  organs 
to  be  in  a  pathological  state.  These  general  disorders  of  the  capil- 
laries become  in  their  turn,  causes  which  modify  the  action  and  con- 
dition of  all  the  other  organs,  particularly  of  the  circulating  system,  by 
accumulating  the  blood  unduly  in  the  large  vessels,  as  explained  by 


1845.]  Pathology  of  Intermittent  Fecer.  13 


Dr.  CuLLEX,  and  thus,  by  exciting  strongly,  the  action  of  the  heart 
becomes  the  procuring  cause,  of  the  succeeding  hot  stage. 

But  there  are  more  positive  reasons  lor  assigning  the  proximate 
cause  of  Intermittent  fever  to  some  lesion  of  the  nervous  centres. 
The  first  we  shall  mention  is,  the  uniformity  of  the  evidence  of  a 
diseased  state  of  some  portion  of  the  spinal  marrow.  This  evidence 
we  find  in  the  fact,  that  pressure  upon  some  of  the  spinous  processes 
of  the  vertebrae  is  accompanied  with  pain.  Upon  this  point  the 
writer  begs  leave  to  refer  to  an  article  on  this  subject  in  the  1st  vol. 
Southern  Medical  &  Surgical  Jourual,  in  which  this  symptom  is 
shewn  to  have  existed,  in  nearly  every  case  of  Intermittent  and  Re- 
mittent fever,  occurring  under  his  notice,  for  one  reason.  His  own 
subsequent  observations,  as  well  as  those  of  others,  have  satisfied  him, 
that  this  is  one  of  the  most  constant  of  its  symptoms.  And,  again, 
that  this  diseased  point  of  the  spinal  marrow  exerts  a  decided  influ- 
ence in  producing  the  phenomena  of  fever,  we  may  infer  from  the 
prompt  relief  afforded  to  many  distressing  symptoms  of  the  paroxysm, 
through  revulsive  applications  to  the  spinal  column  ;  in  proof  of  which 
many  of  the  same  cases  may  be  cited.  Another  good  reason  is  the 
fact,  that  Intermittent  fever  may  be  cured,  by  repeatedly  cupping 
over  the  tender  points  of  the  spinal  column,  without  medicine,  and 
even  without  dieting  a  fact  which  the  writer  has  repeatedly  verified. 
-  We  may  infer  the  nature  of  a  malady,  from  the  medical  treat- 
ment, by  which  it  is  best  combatted.  That  ordinary  treatment, 
which  experience  has  sanctioned  as  the  best  for  Intermittent  fever, 
harmonizes  with  this  pathology.  This  theory  enables  as  to  account 
satisfactorily  for  the  success  of  Emetics,  Cathartics,  Narcotics,  Stim- 
ulants, such  as  alcoholic  tinctures  of  aromatics.  and  tiie  great  specific 
quinine.  Emetics  are  revulsives  applied  to  the  surface  of  the  stom- 
ach, and  operate  by  relieving  the  nervous  centres  Cathartics,  in  like 
manner.  Alcoholic  Stimulants  heighten  the  normal  functions  of  the 
nervous  centres  and  thus  prevent  the  recurrence  of  those  physical  states 
which  constitute  the  basis  of  the  disease.  With  regard  to  the  groat 
remedy,  quinine,  there  are  good  reasons  for  thinking  that  its  action 
upon  the  nervous  system  is  a  specific  one  such  at  least  is  the  fair 
inference,  when  we  see  decided  doses  of  it  producing  blindness,  deaf, 
nessand  roaring  in  the  cars;  that  is,  phenomena  of  disordered  sensa- 
tion ;  and  if  so,  its  power  as  a  febrifuge  is  best  explained  by  supposing 
that  tlie  causes  of  fever  are  lodged  in  that  svistem  where  its  effects 
are  most  strongly  produced. 


14  Pathology  of  Intermittent  Fever.  [January, 


The  opinion  of  many  distinguished  pathologists,  that  the  mucous 
membrane  of  the  stomach  is  the  true  seat  of  the  disease,  and  that  this 
aiTection  is  inflammation  of  that  membrane,  is  disproved  by  the  very 
difTerent  effects  of  the  same  remedies  in  Gastritis  and  Intermittent 
fever.  What  physician  would  administer  emetics,  or  narcotics,  or 
alcoholic  tinctures  in  the  former?  all  which, yet,  have  their  measure 
of  success  in  the  latter.  Quinine,  the  grand  remedy  in  Intermittent 
fever,  is  perfectly  inadmissible  in  simple  inflammation  of  the  stomach. 
It  is  no  answer  to  these  objections  to  say,  that  gastritis  is  modified  by 
being  intermittent ;  for  this  is  not  a  modification,  but  an  essential  and 
distinctive  difference. 

This  opinion  of  the  primitive  location  of  intermittent  in  the  mucous 
membrane  of  the  stomach,  seems,  at  first  sight,  countenanced  by  the 
general  acknowledgment  of  the  profession,  that  marsh  miasma  is  the 
exciting  cause  of  the  disease.  For  if  this  be  the  cause,  it  must  be  a 
physical  cause  borne  to  the  body,  by  the  air,  and  therefore  makes  its 
first  impression  upon  the  skin  and  mucous  membranes  of  the  lungs  and 
stomach.  And,  indeed,  this  objection  has  been  made  to  the  pathology 
proposed  in  this  article.  But,  passing  by  the  very  obvious  remark, 
that  if  this  exciting  cause  must  produce  disease  in  the  first  tissues,  to 
which  it  is  applied,  we  would  find  the  mucous  membrane  of  the  lungs 
to  be  the  seat  of  the  disease,  seeing  that  this  is  the  most  accessible ; 
let  us  look  at  some  analogies.  Strychnine  and  Cantharides  taken 
into  the  stomach,  tell,  the  one  upon  the  spinal  marrow,  the  other  on 
the  organs  of  generations;  the  latter  will  exert  its  specific  efl^ects, 
even  when  applied  to  the  skin.  Alcohol  in  the  stomach  affects  the 
brain  Ipecac  injected  into  the  veins  tells  upon  the  stomach.  So, 
miasma,  though  applied  first  to  the  skin  or  lungs  or  stomach,  may 
very  well  give  rise  to  effects  in  a  remote  part  of  the  system  and  the 
specific  action  of  morbific  causes  strongly  persuades  us  that  it  does 
so.  That  miasma  involves  the  nervous  centres,  is  further  shewn  by 
the  fact,  that  where  it  abounds,  we  find  a  great  variety  of  neuralgic 
affections,  all  having  the  intermittent  character,  prevailing  simulta- 
neously with  Intermittent  and  Remittent  fevers. 

The  writer  remembers  with  great  pleasure,  that  the  observation  of 
this  fact,  first  led  him  to  a  critical  study  of  the  pathology  of  Inter- 
mittent fever.  It  was  a  case  of  neuralgia  of  the  knee,  of  the  regu- 
lar tertian  form,  occurring  in  a  boy,  whom  he  had  cured  of  a  simple 
tertian  intermittent  fever.  The  patient  had  suffered  three  paroxysms 
of  neuralgia ;  on  the  day  following  the  last,  he  was  cupped,  twice  on 


1845.]  Treatment  of  Gonorrhcea.  15 


the  sacrum  and  loins,  and  twice  on  the  day  of  the  expected  acces. 
sion,  and  local  applications  to  the  knee  as  well  as  medicine,  were  most 
studiously  avoided  ;  the  paroxysm  was  arrested  and  returned  do 
more. 

In  conclusion  if  we  find  gastritis,  determining  such  a  number  of 
sympathetic  effects  that,  in  the  opinion  of  the  physiological  school,  it 
is  sufficient  to  account  for  all  the  phenomena  of  fever,  how  much 
more  may  we  attribute  them  to  idropathic  affections  of  the  spinal 
marrow,  seeing  its  connection  with  the  organs  and  tissues  is  vastly 
more  extensive  than  that  of  the  stomach,  and  that  the  diseased 
stomach  itself  can  operate  only  through  its  medium. 

It  was  the  intention  of  the  writer  to  have  noticed  some  of  the  most 
dangerous  complications  of  Intermittent  fever,  and  to  have  shewn 
how  the  pathology  herein  proposed  points  to  their  most  successful 
treatment ;  but  this  article  has  been  already  extended  beyond  its 
proper  limits,  and  he  reserves  this  subject  for  a  future  number  of  this 
journal.  He  will  feel  that  he  has  not  multiplied  words  in  vain,  if 
he  fixes  in  the  mind,  more  especially  of  the  young  practitioner,  a 
principle,  which  will  guide  him  to  success,  in  that  class  of  cases, 
which  make  up  so  large  a  part  of  his  practice. 


ARTICLE  II. 

The  Abortive  and  Curative  Treatment  of  Gonorrhcea  by  the  Nitrate 
of  Silver,  with  cases  By  H.  F.  Campbell,  M.  D.,  Demonstrator 
in  the  Medical  College  of  Georgia, 

In  the  October  number  of  the  Medico-Chirurgical  Review,  for 
1843,  and  also  in  a  late  number  of  the  American  Journal  of  the 
Medical  Sciences,  is  an  article  on  the  abortive  treatment  of 
Gonorrhcea,  by  Lunar  Caustic.  In  the  two  communications,  tho 
reporters  have  applied  it  differently  Mr.  Cuilds  recommending  its 
application  in  substance,  while  M.  Debeney  prefers  it  injected  in  a 
solution  of  strength,   from  viii,   to  xv.  grs.  to  the  ounce  of  water. 


1^  Treatment  of  Gonorrhaca.  [January, 


Having  in  the  treatment  of  Gonorrhoea,  used  Nitrate  of  Silver  after 
hoth  these  modes  of  application,  my  experience  goes  to  corroborate 
their  testimony  as  to  its  efficacy  under  either  form,  though  of  the  two, 
I  prefer  its  application  by  injection. 

I  have  found  that  the  strength  of  the  injection  prescribed  by  M. 
Dere^'ey,  is  not,  generally,  sufficient  to  relieve  by  the  first  or  second 
apphcaiion,  and  that  it  was  necessary,  in  most  cases,  to  increase  it 
to  from  XX.  to  xxx.  grs.  to  the  ounce  of  water,  and  I  have  applied  it 
in  even  a  more  concentrated  solution.  This  I  find  to  be  a  good 
modification  of  the  two  plans,  inasmuch  as  that,  while  we  secure  its 
application  minutely  to  the  whole  extent  of  the  diseased  surface,  we, 
by  this  increase  in  the  strength  of  the  injection,  provide  a  sufficiency 
of  the  agent  to  produce  more  effectual  cauterization.  I  have  had  but 
one  case,  as  will  be  hereafter  seen,  wherein  the  application  has  been 
followed  by  a  high  degree  of  inflammation,  and  in  that  one,  I  have 
reason  to  suppose  it  to  have  commenced,  before  this  means  of  treat- 
ment had  been  resorted  to.  Generally,  I  have  found  the  patient 
recovering  speedily  from  both  the  disease  and  the  effects  of  the 
cautery. 

Case!,  A  carpenter,  aged  80  years,  general  health,  good;  was 
exposed  to  the  disease,  and  on  third  day  experienced  pain  in  urinating, 
and  a  continued  burning  for  some  time  afier.  He  was  relieved  by 
one  injection  of  Lunar  Caustic,  xxx.  grs.  to  the  ounce  of  water. 

Case  2.  A  young  man  aged  17.  The  discharge  in  this  case  had 
began  to  show  itself.  Treated  by  one  injection  of  Lunar  Caustic,  xl. 
grs.  to  the  ounce  of  water :  there  was  a  discharge  of  blood  afterwards 
in  small  quantity,  but  in  a  iew  days  he  was  entirely  well. 

Case  3.  A  recent  case  wherein  the  patient  complained  of  tender- 
ness of  the  chord  before  treatment.  One  injection  was  made  of 
nearly  xxx.  grs.  to  the  ounce  of  water.  The  application  was 
followed  by  pain  in  the  testicle  and  orchitis.  The  patient  was 
from  that  time  treated  by  another  physician  ;  of  the  result  I  have  not 
as  yet  been  advised.  This  is  the  only  case  wherein  the  Nitrate  of 
Silver,  applied  by  myself  in  this  disease,  was  followed  by  unpleasant 
symptoms. 

Case  4.  A  negro  man,  a  taylor,  aged  26.  A  recent  attack,  relieved 
by  two  injections  of  Lunar  Caustic,  xv.  grs.  to  the  ounce  of  water. 

Case  5.  A  mulatto  boy  aged  20  years;  of  a  Strumous  Diathesis: 
first  treated  by  another  physician,  and  afterwards  by  myself,  unsuc- 
cessfully, with  various  balsamic  mixtures  and  astringent  injections, 


1845.]  Treatment  of  Gonorrhoea,  17 


was  cured  by  one  injection  of  the  Nitrate  of  Silver,  xxv.  grs.  to  the 
ounce  of  water.  In  this  case  a  whitish  membranous  eschar  was 
voided  while  urinating  a  few  days  after  the  application. 

Case  6.  A  negro  man  aged  about  23  years  :  a  boat  hand,  had  had 
the  disease  about  ten  days.  One  injection  was  applied  of  from  xx.  to 
XXX.  grs.  to  the  ounce  of  water.  The  balsamic  treatment,  before 
used  without  making  any  impression  on  the  disease,  was  continued ; 
the  patient  was  well  in  less  than  a  week's  time. 

Case  7.  A  white  man  aged  30,  a  team  driver,  a  recent  case,  cured 
by  one  injection,  xx.  grs.  to  the  ounce  of  water. 

Case  8.  A  male  aged  33  years,  a  recent  attack  :  discharge,  abund- 
ant, commenced  the  day  before  no  pain.  I  applied  one  injection 
of  Lunar  Caustic,  xl.  grs.  to  the  ounce  of  water.  That  day  there 
was  an  increase  in  the  discharge  and  much  pain  in  urinating,  with 
some  blood  at  that  time.  On  the  second  day,  the  discharge  ceased 
altogether,  though  the  pain  and  bloody  urine  continued  for  some 
days.  In  this  case  I  Combined,  during  their  treatment,  a  ^qw  dosea 
of  balsamic  emulsion  each  day. 

Case  9.  A  male  aged  20  years,  treated  on  the  third  day  after  the 
discharge  had  commenced  with  one  injection  of  Lunar  Caustic,  xxx. 
grs.  to  the  ounce  of  water,  together  with  balsamic  emulsion.  On  the 
fourth  day  the  patient  was  entirely  cured. 

Case  10.  Prof.  P.  F.  Eve  here  kindly  furnishes  me  with  a  case 
wherein  the  balsamic  and  astringent  treatment  had  proved  entirely 
inert,  though  persevered  in  for  some  weeks,  till  combined  with 
injections  of  the  Nitrate  of  Silver  of  from  viii.  to  xv.  grs.  to  the  ounce 
of  water. 

Of  the  application  of  the  Nitrate  of  Silver  in  substance,  I  can  adduce 
but  three  cases  ;  one  of  which  occurred  in  the  practice  of  Dr.  Edward 
A.  Eve,  near  this  city  the  other  two  came  under  my  own  observation. 

Case  11.  A  young  man  aged  26  years:  sanguine  temperament  
treated  unsuccessfully  with  balsamic  emulsion  and  injections  of  sul- 
phate of  zinc,  and  sulph.  of  morphine.  Dr.  E.  applied  the  Nitrate 
of  Silver  in  substance,  by  paring  the  end  of  a  cylinder,  and  intro- 
ducing it  for  about  a  half  inch  or  more,  within  the  orifice  of  the 
urethra.  This  was  done  repeatedly,  and  the  patient  was  relieved  in 
a  short  time  after  this  plan  of  treatment  was  adopted. 

Case  12.  A  male  aged  30  years,  a  mechanic :  bilious  tempera- 
ment general  health  good.  In  this  case  the  Gonorrhcca  was 
complicated  by  a  stricture,  the  result  of  previous  disease,  at  the  dis- 

2 


18  Treatment  of  Gonorrhcea,  [January, 


tance  of  about  an  inch  from  the  orifice  of  the  urethra ;  it  was  at  a 
point  somewhat  beyond  this,  that  the  urethritis  appeared  to  obtain, 
the  patient  experiencing  pain  at  that  place,  during  manipulation,  and 
the  matter  confined  behind  the  stricture,  on  pressure  would  appear 
at  the  orifice.  After  dilating  the  stricture  by  bougies,  I  freely  applied 
the  Nitrate  of  Silver  in  substance,  by  means  of  a  style  and  canula 
somewhat  similar  to  those  of  Mr.  Childs.  The  pain  was  not  felt 
after  the  burning  of  the  caustic  had  subsided,  the  discharge  ceased, 
and  in  a  few  days  the  patient  was  well. 

In  the  female,  I  have  found  the  application  of  the  Nitrate  of  Silver 
in  substance,  preferable  to  the  form  of  injection  :  it  is  more  practica- 
ble, the  locality  of  the  inflammation  not  being  invariable.  Of  this 
class  is  the  following  :  

Case  13.  A  white  woman  aged  26  years:  general  health  good, 
habits  regular.  Treated  for  some  weeks  with  the  usual  balsamic 
remedies,  using  at  the  same  time  very  strong  astringent  injections  of 
sulph.  cup.  and  sulph.  zmc.  a  a  viii.  grs.  and  sulph.  morphine  1  gr. 
to  the  ounce  of  water,  applied  once  a  day.  Finding  this  treatment 
unsuccessful,  I  applied  with  a  speculum  uteri,  the  Nitrate  of  Silver, 
by  means  of  a  port-caustic,  freely  to  the  orifice  of  the  urethra, 
mouth  of  the  womb,  and  interruptedly  to  the  sides  of  the  vagina. 
The  application  was  made  but  once ;  it  caused  much  pain  and  there 
started  a  few  drops  of  blood  from  the  posterior  lip  of  the  os  trncae, 
which  seemed  very  much  congested.  In  this  case  I  continued  the 
balsamic  mixture  together  with  the  above  injection,  diluted.  The 
discharge,  though  undiminished  before  the  cauterization,  soon  entire- 
ly ceased,  and  she  was  well  on  the  fourth  day. 

From  the  consideration  of  the  thirteen  cases  given  above,  together 
with  the  well  attested  experience  of  Mr.  Childs  and  M.  Debeney,  I 
think  we  may  safely  conclude  with  regard  to  this  mode  of  treatment : 
Firstly,  that  the  treatment  of  Gonorrhoea  with  Lunar  Caustic,  as 
proposed  by  them,  is  preferable  to  any  other  mode  of  treatment ; 
Secondly,  that  the  form  of  injection  is  preferable,  to  its  application  in 
substance ;  Thirdly,  that  in  cases  not  relieved  by  the  injection  as 
prescribed  by  M.  Debenet,  of  strength  from  viii.  to  xv.  grs.  to  the 
ounce  of  water,  it  being  perfectly  safe,  it  is  advisable  to  increase  it, 
even  far  beyond  that  strength.  And  further,  that  in  those  cases, 
wherein  of  itself  it  does  not  wholly  relieve,  we  should  by  no 
means  reject  it,  but  continue  its  use  as  a  very  valuable  adjunct  to  any 
other  plan  of  treatment  we  can  adopt. 


1845.]  Bilateral  Operation  of  Lithotomy.  19 


ARTICLE  III. 

The  Bilateral  Operation  of  Lithotomy  another  successful  case  :  By 
Paul  F.  Eve,  M.  D.,  Professor  of  Surgery  in  the  Medical  College 
of  Georgia. 

Since  the  publication  in  the  April  number,  of  the  American 
Journal  of  the  Medical  Sciences,  of  four  cases  of  the  bilateral  opera- 
tion, I  have  had  another  opportunity  of  removing  a  stone  from  tbo 
bladder,  by  the  use  of  the  double  Lithotome  cache. 

The  first  and  leading  article  in  the  last  No.  of  the  Journal  referred 
to  (Oct.  1844)  is,  ''On  the  Bilateral  Operation  of  Lithotomy;  and 
on  Lithotrity  in  the  Female  :  By  John  C.  Wakken,  M.  D.,  Professor 
of  Anatomy  and  Operative  Surgery,  in  Harvard  University,  Boston." 
In  presenting  to  the  profession  the  four  cases  successfully  operated 
upon  by  my  friend.  Dr.  Ogieb,  of  Charleston,  and  myself,  I  stated 
my  belief  that  they  were  the  first,  at  least  in  this  section  of  the 
country,  wherein  the  double  Lithotome  of  Dupuytren,  had  been 
employed  ;  and  i  also  ventured  to  recommend  this  mode  of  operating 
as  superior  to  the  one  in  general  practice.  It  is  no  small  gratifica- 
tion to  find  this  opinion  defended  by  so  distinguished  a  Surgeon  as 
Professor  Warren,  of  Boston  the  very  head  of  the  profession  in 
New-England. 

Dr.  W.  states  that  in  the  course  of  40  years  practice,  he  has  been 
called  upon  to  perform  all  the  operations  of  Lithotomy  in  Boston. 
These  amount  only  to  25  cases,  3  of  which  alone  were  natives  of 
that  city  or  its  vicinity  of  this  number  2  died,  one  from  suppuration 
in  the  pelvis.  This  was  a  patient  of  bad  constitution,  with  stone 
adherent  to  the  bladder;  in  the  other  case,  death  occurred  the  fifth 
day  from  general  peritonitis,  after  the  patient  had  indulged  in  eating 
heartily.  This  brief  report  furnishes  two  interesting  facts  the 
success  of  the  operation,  especially  as  no  selection  was  made  of 
cases ;  and  secondly,  the  exemption  from  urinary  calculi  in  the  city 
of  Boston. 

In  explaining  the  immunity  thus  enjoyed  by  the  inhabitants  in 
and  about  the  capital  of  New-England,  Professor  Warren  is  inclined 
to  attribute  it  to  the  circumstance,  that  there  exists  no  calcareous  rocks 


^0  Bilateral  Operation  of  Lithotomy.  January, 


or  soils  near  that  city  an  explanation,  which,  although  it  will  not 
be  admitted  as  satisfactory  on  the  other  side  of  the  Atlantic,  is  correct 
so  far  as  my  observation  extends  in  the  Southern  States  of  our  Union. 
In  a  biographical  sketch  of  the  professional  career  of  Joseph  Glover, 
M.  D.,  of  Charleston,  prepared  by  Drs.  Bellinger,  Whitridge,  and 
PoRCHER,  for  the  Medical  Society  of  South  Carolina,  and  published 
in  the  American  Journal  of  Medical  Sciences,  we  find  the  following 
sentences :  "  Calculous  diseases  are  so  rare  in  this  locality,  that  to 
have  cut  for  stone  in  the  bladder  constitutes  an  era  in  the  professional 
career  of  our  Surgeons.  As  late  as  1808,  only  three  operations  of 
the  kind  could  be  '  distinctly  and  certainly  recollected  as  having  been 
performed' in  Charleston.  *****  Up  to  the  present  time, 
(Dec.  1840,)  continues  the  Committee,  only  seven  operations  for 
stone  in  the  bladder  have  been  performed  upon  persons  who  were 
natives,  or  who  had  been  for  many  years  residents  of  Charleston." 

The  following  extract  from  a  letter  of  my  friend.  Dr.  Kollock, 
an  estimable  physician  of  several  years  practice,  gives  a  report  on 
this  subject  from  Savannah  : 

"  In  compliance  with  your  request,  I  have  endeavored  to  obtain 
for  you  all  the  information  which  we  possess  on  the  subject  of  urinary 
calculi,  and  the  operation  of  Lithotomy,  in  Savannah  and  its  vicinity. 
I  have  enquired  of  our  oldest  practitioners,  in  regard  to  their  obser- 
vations on  this  point,  and  all,  without  an  exception,  state  that  they 
have  never  met  v/ith  a  single  case  in  their  own  practice,  nor  ever 
heard  of  one  in  the  practice  of  any  other  physician  or  surgeon  who 
has  lived  here. 

"  The  advocates  of  the  theory  of  the  influence  of  miasmata  in  its 
production,  will  find  it  difficult  to  maintain  their  position  in  this 
region,  and  will  probably  be  under  the  necessity  of  acknowledging 
that,  if  a  residence  in  a  calcareous  district  is  not  absolutely  necessa- 
ry, and  the  sine  qua  non  to  the  production  of  stone  in  the  bladder,  it 
is  a  very  important  link  in  the  chain  of  morbid  causes." 

From  Norfolk,  in  Virginia,  to  New-Orleans,  along  the  whole  sea 
coast,  so  far  as  I  have  been  able  to  obtain  information,  the  occurrence 
of  urinary  calculus  is  quite  rare  ;  and  it  is  only  as  we  approach  the 
mountainous  regions  that  we  find  the  number  increasing.  But  two 
cases,  so  far  as  ascertained,  have  originated  in  Augusta  one  was 
operated  upon  in  New-York,  some  years  ago ;  and  the  other  is  the  one 
now  about  to  be  submitted  to  the  reader's  attention.  My  other  cases 
already  reported,  were  from  abroad  that  is  from  the  upper  calcare- 


1845.]  Bilateral  Operation  of  Lithotomy.  21 


ous  parts  of  the  country.  So  far,  they  corroborate  the  opinion  of  Dr. 
W.  in  relation  to  the  origin  of  stones  in  the  bladder  that  they 
are  rather  the  product  of  calcareous  waters  than  of  atmospheric  vicis- 
situdes. 

Professor  Warren  says  "  The  particular  object  which  I  have  in 
view,  in  this  communication,  is  to  direct  the  attention  of  the  profession 
to  the  best  mode  of  doing  the  operation  of  Lithotomy.  I  have  till 
recently  performed  the  lateral  operation,  formerly  with  the  gorget, 
and  latterly  with  the  knife.  In  the  two  cases  alluded  to  above,  which 
terminated  unfavorably,  the  gorget  was  employed.  Accident  led 
me,  a  year  or  two  since,  to  examine  the  merits  of  the  bilateral  opera- 
tion more  exactly  than  I  had  ever  done  before.  In  this  investigation, 
I  many  times  dissected  the  organs  concerned  in  this  operation,  both 
before  and  after  having  been  done  on  the  dead  body.  The  result  was 
so  satisfactory,  that,  in  a  case  particularly  adapted  for  this  mode  of 
operating,  I  ventured  to  do  it  on  the  living  body,  and  found  it  to  be 
comparatively  so  easy  in  the  performance,  and  so  successful  in  the 
result,  that,  in  the  next  case  which  presented  itself,  I  was  induced  to 
repeat  it.  These  cases  I  ask  leave  to  bring  before  the  profession  in 
this  country,  in  order  to  invite  their  examination  into  the  merits  of 
this  mode  of  extracting  stone  from  the  bladder." 

It  is  right  to  state  that  this  distinguished  Surgeon  objects  to  the 
Lithotome,  and  makes  the  incisions  in  the  Prostate  gland,  with  a 
straight,  short,  narrow,  probe  pointed  knife.  He  also  states  that  the 
bilateral  operation,  called  Dupuytren's,  was  originally  proposed  by 
Ihe  late  Professor  Ribes,  of  the  School  of  Medicine  in  Paris ;  the 
former  giving  it  character  and  stability  by  his  descriptions  and  en- 
gravings. Dr.  Warren  concludes  by  remarking,  that,  although  he 
should  not  feel  justified  in  recommending  the  bilateral  operation  for 
general  use,  from  his  limited  experience  with  it,  yet,  from  the  lights 
before  him  and  his  views  on  the  subject,  he  feels  disposed  to  employ 
it  in  most  cases  where  Lithotomy  is  required,  in  preference  to  the 
lateral  operation. 

In  the  October  No.  (1842)  of  the  American  Journal  of  Medical 
Sciences,  will  be  found  an  article  by  Dr.  Josiaii  C.  Nott,  of  Mobile, 
Ala.,  on  the  subject  of  Lithotomy  ;  in  which  the  following  paragraph 
occurs:  "It  should  be  remembered  that  Dupuytren  saved,  by  the 
bilateral  operation  in  the  foul  air  of  tbo  Hotel  Dieu,  (the  larircst 
Hospital  in  Paris,)  twenty-six  patients  in  succession  ;  a  success  per- 
haps, even  more  astonishing  than  that  of  Prod-ssor  DunLr.v,  when  all 


22  Bilateral  Operation  of  Lithotomy.  January, 

the  circumstances  ar^  considered."  Doubtless  my  medical  friend  in 
Mobile  believed,  when  he  published  this  article,  that  his  data  for  the 
above  successful  report  was  reliable  ;  but  since  then  facts  have  been 
revealed,  by  which  it  is  now  ascertained,  that  the  late  celebrated 
Surgeon  in  chief  of  the  Hotel  Dieu,  lost,  at  least,  one  in  every  six 
cases  he  operated  upon  for  stone.     This  much  is  due  to  truth. 

Case.  Lewis,  a  mulatto  boy,  3  years  old,  had  been  laboring  under 
the  symptoms  of  stone  for  several  months.  Having  satisfied  myself 
of  its  presence,  by  sounding,  and  with  the  finger  in  the  rectum,  and 
having  prepared  the  patient  for  the  operation,  it  was  performed  on  the 
8th  of  June  last.  The  patient  being  secured  in  the  usual  way,  the 
semi-lunar  incision  was  made  between  the  bulb  of  the  urethra  and 
anus,  with  its  convexity  to  the  scrotum,  and  down  to  the  staff*  in  the 
membranous  portion  of  the  urinary  canal,  through  which  it  had  been 
previously  introduced  into  the  bladder.  To  the  groove  of  the  staff 
thus  exposed,  was  adapted  the  beak  of  a  double  Lithotome,  of  a  small 
size,  which  had  just  been  received  from  Charriere,  of  Paris.  This 
instrument  was  introduced  into  the  bladder,  the  one  in  the  urethra 
withdrawn,  the  Lithotome  turned  upon  its  own  axis,  so  that  its  con- 
cavity was  towards  the  rectum,  and  its  blades  being  expanded  it  was 
drawn  out  in  lowering  the  handle.  A  gush  of  urine  indicated  the 
opening  made  in  the  bladder,  through  which  the  finger  introduced 
felt  the  stone,  which  was  extracted  by  a  small  pair  of  forceps. 
From  some  little  delay  in  the  seizing  the  calculus,  and  the  alarm  of 
the  patient,  the  operation  lasted  twelve  minutes. 

This  little  patient,  like  the  others  upon  whom  I  had  operated 
for  stone  by  this  mode,  had  a  remarkably  rapid  recovery-  The 
urine  in  a  few  hours  passed  per  ureihram^  and  all  the  dressing  applied 
was  a  small  strip  of  plaster  over  the  wound  in  the  perineum.  No 
catheter  was  introduced  during  the  treatment.  He  had  a  little  fever 
for  the  first  forty-eight  hours  after  the  operation.  He  sat  up  in  bed 
on  the  fourth  day,  and  on  the  eighth  was  considered  well.  He  did 
not,  however,  recover  the  full  tone  and  control  of  the  bladder  for 
some  days  afterward.  The  calculus  weighed  about  3  iss.,  and  was 
of  the  mulberry  variety. 


1845.]  American  Journal  of  the  Medical  Sciences,  23 


Part  II. REVIEWS  AND  EXTRACTS. 

ARTICLE    IV. 

The  American  Journal  of  the  Medical  Sciences  Edited  by  Isaac 
Hays,  M.  D.,  October,  1844. 

The  present  number  of  this  quarterly,  although  not  heavily  freight- 
ed with  such  original  matter  as  should  be  expected  in  a  work  of  its 
pretensions,  brings  us  the  details  of  several  cases  of  interest.  Its 
first  article  is  from  the  pen  of  the  venerable  Professor  Warren,  of 
Boston,  who  has  recently  become  satisfied  of  the  superiority  of  the 
Bi-Iateral  over  the  lateral  operations  of  Lithotomy.  We  are  happy 
to  find  such  high  authority  corroborating  an  opinion  we  have  long 
since  entertained,  and  feel  surprised  that  this  able  surgeon  should 
have  been  so  tardy  in  testing  a  method  long  since  adopted  by  manyi 
and  possessing  such  obvious  advantages.  We  cannot  agree  with  him 
in  the  preference  he  gives  to  the  knife  over  Dupuytren's  Lithotome 
cache,  nor  can  we  perceive  any  force  whatever  in  his  objections  to 
this  instrument.  It  must  certainly  be  by  far  the  safest  instrument 
with  which  the  bladder  can  be  opened,  independently  of  the  facihty 
and  simplicity  it  imparts  to  the  operation. 

The  article  contributed  by  John  Watson,  M.  D.,  of  New- York, 
on  organic  obstruction  of  the  (Esophagus,  contains  the  particulars  of 
his  case  of  (Esophagotomy,  and  fhe  history  of  the  operation,  which 
has  been  very  rarely  performed.  Dr.  W.'s  case  in  itself  (independ- 
ently of  the  skill  and  ingenuity  displayed  in  prolonging  the  life  of  the 
patient,)  is  calculated  to  throw  but  little  light  on  the  subject,  and  its 
result  is  not  such  as  to  encourage  others  to  penetrate  the  QEsophagus, 
except  as  a  dernier  resort  in  cases  ofimpending  death.  The  Doctor 
suggests  the  propriety  of  making  an  opening  into  the  stomach  itself, 
in  cases  of  insurmountable  stricture  of  the  (Esophagus  with  progress- 
ing inanition,  and  cites  the  repeated  instances  in  which  peiforations 
of  that  viscus  have  terminated  favorably.  It  may  be  apprehended, 
however,  that  the  operation  performed  under  the  only  circumstances 
that  could  justify  it,  namely,  impending  death  from  inunition,  wonld 
not  be  so  apt  to  terminate  favorably  as  when  it  harf  been  the  result  of 


24  American  Journal  of  the  Medical  Sciences.       [January, 


accident,  and  in  a  system  not  previously  enfeebled  by  long  suffering 
and  insufficient  nutrition. 

The  article  on  Isopathia  or  the  Paralleli-m  of  Diseases,  by  Dr. 
John  M.  B.  Harden,  of  Liberty  county,  Georgia,  is  highly  credita- 
ble, and  evinces  much  research  and  correct  views  on  one  of  the  most 
important  classes  of  maladies.  The  more  we  study  the  effects  of  the 
cause  of  Intermittent  fever,  the  more  convinced  will  we  become  of  its 
power  to  give  rise  to  phenomena  the  most  discordant  in  appearance, 
yet  all  traceable  by  the  enlightened  physician  to  the  same  deleterious 
agency,  and  controled  by  the  same  class  of  remedial  means.  The 
ptamp  of  intermittency,  either  complete  or  partial,  is  the  grand  char- 
acteristic of  all  the  morbid  phenomena,  however  varied  in  other 
respects  they  may  be,  that  owe  their  development  to  this  unknown 
and  widely  pervading  cause. 

Dr.  Tabb's  Statistics  of  Deaths  in  the  Philadelphia  Hospital  during 
a  period  of  twelve  years,  possess  much  interest,  as  must  do  all  such 
papers  when  judiciously  and  accurately  drawn  up.  As  illustrative  of 
the  value  of  such  documents,  we  will  cite  a  few  of  the  results  obtained 
by  Dr.  Tabb.  The  treatment  of  Mania  a  potu  has,  it  is  well  known, 
been  generally  by  opiates,  and  during  the  first  six  years,  included  in 
these  tables,  when  this  plan  was  used,  the  deaths  averaged  1  in  10, 
whereas  during  the  latter  six  years,  when  alcoholic  drinks  were  sub- 
stituted for  opiates,  there  occurred  but  one  death  out  of  223  cases. 
Again,  in  the  Women's  Asylum,  in  which  neither  opiates  nor  alco- 
holic drinks  were  resorted  to  in  the  treatment  of  this  disease,  there 
was  also  but  one  death  in  128  cases.  Such  facts  need  no  comment. 
We  have  long  since  entertained  strong  doubts  of  the  advantage  of 
opiates,  and  relied  principally  on  the  cold  shower  bath  as  the  most 
powerful  and  prompt  means  of  allaying  the  ravings  of  delirium 
tremens.  The  table  of  diseases  of  the  Respiratory  organs,  shews  that 
one  fourth  of  the  fatal  cases  of  Pneumonia  occurred  in  children  under 
the  fifth  year  of  age,  and  of  Bronchitis  more  than  one  third.  Al- 
though these  proportions  are  undoubtedly  much  greater  in  the  latitude 
of  Philadelphia  than  in  Georgia,  they  are  certainly  much  greater  here 
than  is  usually  believed,  a  fact  of  which  the  profession  will  become 
more  aware  as  the  use  of  the  stethoscope  becomes  more  general  with 
pur  practitioners.  On  the  subject  of  the  Exantliemata,  it  is  found 
that  the  number  of  deaths  from  Measles  is  much  greater  than  from 
Scarlatina.  It  is  to  bo  regretted  that  the  proportion  of  deaths  to  cases 
admitted  of  the  same  disease,  is  not  included  in  these  tables,  with  the 
exceptions  given  in  relation  to  Mania  a  potu.  D. 


1845.]  The  New-  York  Journal  of  Medicine^  iSfc.  25 


ARTICLE    V. 

The  New-  York  Journal  of  Medicine  and  the  Collateral  Sciences  
Edited  by  Samuel  Foeey,  M.  D.     Nov.  1844. 

The  periodical,  the  title  of  which  is  given  above,  is  published  every 
two  months,  and  has  now  reached  its  ninth  number,  havincr  fully 
realized  and  sustained  the  anticipations  of  all  acquainted  with  the 
merits  of  its  very  able  Editor.  We  are  not  of  those  who  regard  a 
multiplicity  of  medical  journals  or  of  medical  schools  as  having  an 
injurious  effect  on  either  medical  literature  or  medical  instruction. 
Indeed  there  is  no  proposition,  the  fallacy  of  which  has  been  more 
fuliy  established  by  experience.  It  is  notorious  that  the  number  of 
contributors  has  uniformly  increased  in  a  direct  ratio  with  that  of 
periodicals ;  and  able  observers  who  had  never  before  lent  their  aid 
to  the  advancement  of  science,  by  publishing  the  results  of  their 
labors,  have  been  incited  to  do  so  by  the  establishment  in  their  vicin- 
age of  a  medium  of  easy  access.  Nor  is  the  case  dissimilar  with 
regard  to  new  medical  schools.  The  ver\'  appointment  of  individ- 
uals to  Professorial  Chairs  acts  as  the  most  powerful  incentive  to 
exertion,  not  only  on  the  part  of  those  who  must  prepare  themselves 
to  teach,  but  also  on  the  part  of  all  who  come  under  the  reach  of  their 
influence  and  who  possess  sufficient  professional  pride  not  to  permit 
themselves  to  be  distanced  in  the  race  for  scientific  distinction.  We 
therefore  bail  every  new  journal  and  new  school  as  the  sure  precursor 
of  a  better  state  of  things  within  the  whole  range  of  their  respective 
influence. 

The  profession  in  New-York  are  justly  entitled  to  an  organ  of 
communication  with  our  extensive  country,  and  we  sincerely  wish 
the  fullest  success  to  the  work  now  before  us.  Among  the  contribu- 
tors to  the  9lh  number,  we  remark  the  name  of  a  distinguished 
physician  of  a  sister  city,  all  of  whose  articles  that  have  come  under 
our  observation,  evince  a  mind  well  stored  with  professional  as  well 
as  literary  lore,  and  a  ready  pen"  to  communicate  the  deductions  of 
sound  judgment.  The  article  of  J.  Le  C\>nte.  M.  D.,  of  Savannah, 
is  entitled,  "Extraordinary  Elfects  of  a  Stroke  of  Li'^htnin*' ;"  but, 
not  confining  himself  to  the  mere   narration  of  the  circumstances 


26  The  New-  York  Journal  of  Medicine^  iSfC,       [January, 


attending  the  case,  the  writer  takes  occasion  to  touch  upon  various 
subjects  of  much  interest.  The  function  of  menstruation  having 
heen  singularly  affected  in  two  of  the  individuals  who  received  the 
electric  stroke,  the  writer  reviews  the  present  state  of  our  knowledge 
of  this  interesting  peculiarity  of  the  human  female  the  age  of  its 
occurrence  and  final  cessation  its  connection  with  the  state  of  the 
ovaries  and  impregnation,  &;c.  He  then  passes  to  the  consideration 
of  the  general  and  local  effects  of  electricity  on  the  human  body,  and 
its  use  as  a  remedial  agent ;  and  concludes  with  many  valuable 
remarks  on  meteorology.  The  whole  article  is  highly  creditable  to 
the  writer. 

Article  II.  is  from  the  pen  of  the  Editor,  Dr.  Forry,  and  is  on  the 
"Nature  and  History  of  Vital  Statistics,"  than  which  no  subject 
possesses  more  intrinsic  value  to  society.  Dr.  F.'s  attention  has 
been  for  some  time  strongly  directed  to  this  kind  of  research  his 
contributions  are  therefore  always  interesting.  With  the  following 
remark,  the  writer  furnishes  a  few  tables,  which  we  cannot  refrain 
from  transferring  to  our  pages. 

"All  the  phenomena  of  the  human  frame,  but  more  especially  the 
physiological  acts  connected  with  reproduction,  the  development  of 
man's  faculties,  and  mortality,  when  examined  and  measured  in  a 
great  number  of  individuals,  it  has  been  proved  by  observation, 
furnish  a  mean  result  equally  correct  with  that  of  any  other  physical 
phenomena." 

"  As  regards  diseases,  it  will  suffice  to  give  a  few  instances  from 
the  Fifth  Registration  of  Births,  Deaths,  and  Marriages  in  England, 
as  presented  in  the  following  table  : 

1838.  1839.  1840.  1841. 


Pneumonia  :  

Total  deaths. 

17,999 

18,151 

18,582 

17,997 

Deaths  to  a  million  living, 

1,219 

1,200 

1,209 

1,154 

Phthisis  ; 

Total  deaths. 

59,025 

59,559 

59,923 

59,592 

Deaths  to  a  million  living, 

3,996 

3,939 

3,897 

3,822 

Child-birth  ; 

Total  deaths,       . 

2,811 

2,915 

2,989 

3,007 

Deaths  to  a  million  living. 

190 

193 

193 

193 

Violent  Deaths:  

Total  Deaths,     . 

11,727 

11,632 

11,594 

11,100 

Deaths  to  a  million  living, 

791 

769 

754 

712 

1845.] 


The  New-  York  Journal  of  Medicine^  (S^'C. 


27 


But  even  the  conditions  which  ^eem  to  depend  wholly  on  accidental 
causes,  have  the  same  constant  recurrence,  as  is  shown  in  the  follow- 
ing table  in  reference  to  the  recruitment  of  the  French  army. 

NUMBER  OF  YOUNG  MEN  IN  FRANCE  WHO  HAVE  BEEN  EXCUSED  MILITARY  SERVICE  ON 
ACCOUNT  OF  BODILY  INFIRMITIES.* 


Causes  of  Unfitness. 


Wanting  fingers, 

"       teeth,  

Deafness  and  dumbness, 

Loss  of  other  limbs  or  organs, 

Goitres, 

Lameness, 

Other  deformities, 

Diseases  of  bones, 

Short-sighted,  

Other  allections  of  the  eyes, 

Itch,^) 

Scald  head, 

Leprosy, 

Other  cutaneous  diseases, 

Scrofulous  affections, 

Affections  of  chest, 

Hernia, 

Epilepsy,  (falling  sickness,) 

Different  other  diseases, 

Weakness  of  constitution, 

Insufficient  size  of  body, 

Amount  of  whole  class  of  certain  age, . . 


1831. 

1832. 

1833. 

75-2 

047 

743 

1,304 

1.243 

1.392 

830 

730 

725 

1,605 

1,530 

1,580 

1,125 

1,231 

1,293 

949 

912 

1,049 

8,007 

7,030 

,494 

782 

G17 

GG7 

948 

891 

920 

1,72G 

1,714 

1,839 

11 

10 

10 

749 

800 

794 

57 

19 

29 

037 

983 

895 

1,730 

1,539 

1,273 

5G1 

423 

359 

4,044 

3,579 

4,222 

4G3 

307 

ai2 

9,108 

9,058 

10,28G 

11,783 

9,979 

11,259 

15,935 

14,902 

15,078 

295,91 


277,477 


285,805 


The  reports  of  criminal  justice  in  France  show  the  same  remarka- 
ble con.stancy  as  regards  the  annual  perpetration  of  crimes,  and  their 
punishments,  as  appears  from  the  subjoined  tablef :  


182G 

1827 

1828 

227 
GO 
8 
34 
31 
21 
42 

G 

21 

2 

1829 

1830 

1831 

Murders  in  general, 

241 
5G 
15 
39 
23 
20 
35 
2 
G 
28 

17 

234 
G4 

40 

28 

20 

40 

5 

IG 

12 

1 

1 

231 
61 

7 
4G 
24 
21 
45 

2 

1 
23 

1 

205 
57 
12 
44 
12 
11 
4G 
2 
4 
17 

*2 

2GG 

Gun  and  pistol, 

88 

Sabre,  sword,  stiletto,  poniard,  dagger,  &c 

Knife, 

30 
34 

Cudgels,  cane,  &c 

21 

Stones, 

J) 

Cutting,  stabbing,  and  bruising  instruments, 

Strangulations,     

49 
4 

By  })rccipilating  and  drowning, 

3 

Kicks  and  blows  with  the  fist, 

2G 

Fire, 

Unknown, 

2 

These  results  assuredly  merit  the  attention  of  the  philosopher;  for 
it  is  here  seen  that  even  moral  phenomena,  apparently  the  most  acci- 


*  Q,uetelet's  Treatise  on  Man. 
tlbid.,  p.  G. 


E'.linburg  Edition,  p.  109. 


28  The  New-  York  Journal  of  Medicine,  Sfc.       [January, 


dental  or  fortuitous,  are  produced  annually  in  the  same  numbers. 
Aye,  even  murders,  wJiich  are  generally  committed  at  the  close  of 
quarrels,  without  any  premeditation,  do  not  only  present  very  nearly 
the  same  annual  numbers,  but  experience  further  shows  that  the 
instruments  used  to  accomplish  the  object  bear  like  proportions  in 
each  year." 

These  extracts  are  sufficient  to  show  the  importance  of  vital  sta- 
tistics to  science  and  to  society  at  large.  Facts  are  always  valuable, 
but  especially  so  when  their  bearing  is  on  the  social  system  of  the 
human  family.  We  would  earnestly  entreat  all  who  have  it  in  their 
power  to  contribute  to  this  fund,  to  neglect  no  opportunity  to  do  so. 
Europe  is  far  in  advance  of  us  on  this  subject,  and  it  is  much  to  be 
regretted  that  the  only  attempt  of  our  National  Legislature  to  assist 
in  the  matter,  has  proven  so  complete  a  failure  in  many  respects. 

Article  III.  is  "  On  the  Pathological  Effects  of  Alcohol,  by  John 
C.  Peteks,  M.  D."  It  contains  a  summary  of  post-mortem  appear- 
ances of  the  bodies  of  seventy  persons  vvhodied  trom  intemperance. 
The  most  interesting  facts  are  the  following  :  The  substance  of  the 
Brain  was  unusually  white  and  firm. 

"  The  Lungs  were  generally  healthy,  except  that  congestion  of 
them  was  frequently  met  with.  Where  large  quantities  of  spirits 
had  been  taken  shortly  before  death,  the  lungs  were  often  found  in  a 
state  of  extensive  splenization  ;  they  appeared  perfectly  saturated 
with  dark  blood,  which  soon  changed  to  a  florid  red  on  exposure  to 
the  air,  except  that  which  flowed  from  the  large,  severed  blood- 
vessels, for  this  remained  thick,  dark,  and  tar-like.  The  parenchyma' 
was  heavy  and  semi-solid  to  the  feel,  but  softened;  for  the  finger 
could  be  easily  forced  through  it.  We  must  make  particular  men- 
tion of  the  infreqnency  of  phthisis  in  drunkards;  never  have  we  met 
a  tubercular  abscess  in  them,  even  of  the  smallest  size,  while  a  small 
number  of  chalky  tubercles  was  frequently  noticed ;  and  cicatrices 
also  were  often  met  with,  and  were  marked  by  presence  of  puckering 
of  the  surface  of  the  lungs,  of  solid  bodies  which  were  readily  felt 
before  the  lungs  was  cut  into,  and  when  this  was  done,  they  were 
found  to  consist  of  lumps  or  stripes  of  callous  fibrous  tissue,  arourd 
which  we  rarely  discovered  a  few  discrete,  grey,  crude,  small,  tuber- 
cular granulations  ;  in  every  instance  these  appearances  were  strictly 
confined  to  thp  upper  third  of  the  superior  lobes,  and  the  rest  of  the 
lungs  was  entirely  free  from  either  old  or  recent  tubercular  disease. 
The  hronciii  were  almost  always  found  reddened,  somewhat  <lilated, 
and  more  or  less  filled  with  catarrhal  secretions.  'J'he  readers  ot  the 
London  Lancet  will  remomber  that  T'jlarshall  Hall  has  lately  recom- 
mended  the  constant  application  to  the  chest  of  folds  of  linen  or 


1845.]  The  New-  York  Journal  of  Medicine,  c^-c.  29 


flannel  soaked  in  alcohol,  as  a  cure  for  incipient  plithisis  ;  we  should 

judge  that  this  mif^ht  prove  serviceable. 

********* 

"  The  Liver,  in  moderate  drinkers,  was  found  a  little  larger  than 
natural,  somewhat  softened,  and  its  external  surface  spotted  with 
patches  of  fatty  infiltration,  which  extended  but  two  or  three  lines 
into  the  parenchyma ;  the  color  of  the  rest  of  the'organ  was  nearly 
natural,  and  the  edges  retained  their  normal  sharpness.  In  higher 
degrees  it  was  considerably  larger,  the  edges  more  obtuse,  and  the 
patches  of  fat  larger  and  more  numerous.  In  old  drunkards  tho 
liver  was  very  large,  weighing  at  least  six  to  eight  pounds,  often  ten 
to  twelve  ;  the  edges  were  very  thick  and  much  rounded  ;  the  paren- 
chyma almost  white  with  fat,  soft,  fragile,  and  the  peritoneal  corering 
could  be  torn  off  in  very  large  pieces  with  ease.  Granular  liver  was 
found  in  four  or  five  cases  only.  The  gall  bladder  was  always  large 
and  filled  with  bile;  gall-stones  were  found  in  two  cases  only,  and 
singularly  enough,   both  on  the  same  day ;  cone  were  found  either 

before  or  after. 

*********f 

"The  appearance  of  the  omentum  is  very  peculiar;  it  is  loaded 
with  an  ashey-grey  slushy  fat.  Our  attention  was  called  to  this 
sign  in  Vienna ;  it  is  there  regarded  as  so  characteristic,  that  a  man 
is  often  judged  to  have  been  a  drunkard,  from  a  glance  at  the  omen- 
tum, when  the  abdomen  is  first  laid  open. 
********* 

"According  to  Rokitansky,  Andral  and  Engel,  the  blood  in  tuber- 
cular cachexia  is  arterial  and  rich  in  fibrin  ;  while  in  the  cancerous 
cachexia  and  typhus  fever,  it  is  more  venous,  it  abounds  in  albumen, 
and  is  deficient  in  fibrin;  hence  alcohol  would  seem  to  produce  a 
state  of  the  blood  opposite  to  that  which  occurs  in  tubercular  disease, 
and  is  somewhat  similar  to  that  which  obtains  in  cancer ;  therefore, 
it  may  prevent  the  development  of  the  former,  and  hasten  that  of  the 
latter." 

Article  VII.  is  from  the  pen  of  Dr.  James  Stewaht,  who  furnishes 
valuable  hints  on  the  diet  of  infants  in  aflTections  of  the  bowels  and 
specially  insists  on  the  advantages  of  animal  food  in  such  cases. 
Dr.  S.  recommends  the  substitution  of  calfs-foot  jelly,  or  isinglass 
jelly,  in  lieu  of  the  preparations  of  arrow-root,  sago,  flour,  &c.  in 
common  use.  Dr.  S.'s  experience  in  the  treatment  of  infantile  dis- 
eases entitles  his  views  to  much  weight.  They  coincide  very  tlilly 
with  those  of  the  writer  of  this  notice.  D. 


oO  Dcbroync  on  Chronic  Diseases,  [January, 


AKTICLE  VI, 

We  extract  lb6  following  article  from  the  Medico-Chirurgical 
Review.  We  regret  that  its  length  renders  its  division  necessary. 
The  remainder  will  be  published  in  our  next  number. 

Thcrapeiiiique  Appliquee,  on  Traitemenls  speciaux  de  la  pluparl  des 
Maladies  Chroniques.  Par  P.  J.  C  Debkeyne.  2me,  Edition, 
jfp,  332.     Bailliere,  1844. 

This  is  really  a  very  useful  and  instructive  v^^ork.  It  contains  the 
results  of  our  author's  experience,  over  a  period  of  nearly  thirty  years, 
in  a  variety  of  those  chronic  diseases  which  are  of  most  frequent  oc- 
currence. Dr.  Debreyne  is  evidently  a  shrewd  and  practical  obser- 
ver ;  he  has  learned  to  think  and  reason  for  himself;  and  seems  to 
have  had,  throughout  his  professional  life,  a  marked  aversion  for  all 
the  nosological  theories  which  have  occupied  so  largely  the  atten- 
tion of  most  of  his  countrymen  during  the  present  century.  See, 
how  he  treats  the  chiefs  of  philosophical  (!)  medicine. 

"  The  Pinel-ists,  the  organicians,  the  anatoxno-pathologists,  the  Broussais-ians, 
the  statisticians,  the  numerists,  have  all,  by  the  exclusiveness  of  their  particular 
doctrines  and  views,  stood  in  the  way  of,  and  materially  retarded  the  advance 
of  sound  therapeutic  knowledge.  Now,  however,  that  the  system  of  universal 
irritation  and  of  a  materialist  physiologism  has  fallen  to  pieces,  a  new  era  has 
happily  opened  up  to  our  view,  and  Kijipocratic  vitalism  has  reappeared  amongst 

us  in  all  its  primitive  splendour The  reign  of -anatomism,  that  is 

to  sa}',  of  necropsies  and  facts  and  figures,  has  nearly  come  to  an  end ;  and 
medical  men  now  long  for  something  more  tangible  and  more  applicable  to  the 
every-day  duties  of  a  professional  life ;  in  other  words,  they  wish  to  have  point- 
ed out  to  them  useful  rules  of  treatment  and  rational  means  of  cure,  instead  of 
endless  catalogues  of  statistic  tables  and  of  post-mortem  examinations." 

Dr.  D.  is  professor  of  practical  medicine  to  the  establishment  of 
Grande-Trappe  (Orne),  and  seems  to  have  reared  a  number  of  pu- 
pils, who  have  contributed,  for  some  years  past,  not  a  little  to  dissem- 
inate his  peculiar  doctrines  and  modes  of  treatment  in  different  dis- 
tricts of  France.  He  is,  moreover,  the  author  of  several  treatises  
on  Physiology,  Hygiene,  Moral  Theology  in  its  relations  with  Medi- 
cine, of  which  we  gave  a  short  notice  in  the  last  number  of  this 
Review.  However  much  we  may  feel  inclined  to  dissent  from  him 
on  several  points  of  practice,  we  have  been  decidedly  pleased  with 
the  general  tone  of  the  present  v/ork,  which  appears  to  be  a  faithful 
record  of  discriminating  observation  of  disease  at  the  bedside  of  his 
patients.  There  is  nownere  any  parade  of  learned  phrases  ;  no  dark- 
ening of  knowledge  with  a  multitude  of  words  ;  no  wearisome  and 


18  i5.]  Dehrcyne  on  Chronic  Diseases.  ?51 


most  profitless  description  of  very  common  cases  ;  no  heaping  toge- 
ther of  other  men's  opinions  and  doings,  with  a  hesitating  announce- 
ment of  his  own.  Instead  of  this,  we  have  a  plain  unvarnished  talo 
afwhat  the  author  has  seen  and  found  in  practice;  and  all  this 
explained  in  as  few  Vv'ords  as  possible.  In  fine,  this  book  is  tho- 
roughly and  essentially  a  practical  one  a  somewhat  uncommon 
feature,  by  the  by,  of  a  French  medical  work  in  the  present  day.  Its 
motto  is  experire :  our  readers  cannot  do  better  than  accept  the 
challenge  and  judge  for  themselves. 

The  diseases  which  pass  under  review,  are  arranged  in  three 
[livisions  Neuroses  or  Neuropathies  ;  Chronic  Phlegraasiee ;  and 
AsthenisB.     We  begin  v.'ith  a  short  notice  of 

Epilepsy.  The  remedy,  which  Dr.  D.  has  found  by  far  the  most 
successful  in  the  treatment  of  this  disease  when  it  is  idiopathic,  and 
there  are  no  symptoms  of  existing  cerebral  congestion,  is  the  extract 
of  Belladonna.  He  gives  it  in  the  form  of  pill;  beginning  with 
about  one  or  two  grains  per  diem  at  first,  and  gradually  raising  the 
dose  to  four  or  five  grains,  provided  no  affection  of  the  sight  or  any 
other  intoxicating  symptom  is  induced.  In  some  cases,  he  conjoins 
with  advantage  the  use  of  a  decoction  or  infusion  of  Valerian.  But 
neither  this  latter  remedy,  nor  yet  the  oxyde  of  Zinc,  nor  the  nitrate 
of  Silver  although  all  of  them  have  been  found  occasionally  use- 
ful  can  be  trusted  to  alone.  In  general,  the  more  frequent  the 
paroxysms  are,  the  more  hopeful  we  may  be  of  making  an  impres- 
sion on  the  disease  :  it  is  when  two  or  more  months  intervene  between 
each  attack,  that  this  Neurosis  is  usually  most  obstinate  and  intract- 
able. In  such  cases,  the  Belladonna  should  be  administered  for  a 
week  or  two  before  the  expected  invasion.  When  (his  is  preceded 
by  a  distinct  aura  Epilepiica,  a  strong  dose  of  Ammonia  will  some- 
times serve  to  ward  off  the  attack  :  the  patient  therefore  will  do  well 
to  carry  a  small  phial  of  the  volatile  alkali  in  his  pocket.  In  some 
cases,  the  paroxysms  of  Epilepsy  may  be  arrested  for  several  months 
by  the  use  of  the  Belladonna;  but  nevertheless  they  ultimately  re- 
turn almost  as  frequently  as  ever,  in  spile  of  the  prolonged  continu- 
ance of  the  remedy.  It  is  under  such  circumstances  as  these  that 
the  decoction  of  Valerian  root,  or  of  Orange  leaves,  should  be  exhi- 
bited at  the  same  time. 

Dr.  Derreyxe  does  not  conceal  the  fact  that  several  writers  havo 
recorded  their  opinion  that  his  favourite  remedy  has  utterly  failed  in 
their  practice.  He  mentions  particularly  a  report  by  M.  Picard  of 
22  cases  that  were  treated  with  it  by  M.  Fesrus,  in  the  Bicetre 
Hospital,  in  1837.  He  attributes  its  lailure  in  these  cases  in  part 
at  least  to  the  injudicious  manner  in  which  the  extract  was  given  ; 
the  doses  being  far  too  large,  and  carried  to  such  an  extent  as  to  prove 
rather  poisonous  than  sanative.  This  is  certainly  not  the  way  to 
give  a  fair  trial  to  the  remedy. 

Our  author  remarks  that,  "  if  in  symptomatic   Epilepsy,  after  the 


33  Dehreyne  on  Chronic  Diseases,  [January, 


removal  of  the  exciting  cause,  the  paroxysms  continue  from  a  sort  of 
nervous  habitude,  they  will  be  best  obviated  by  the  Belladonna  ;  and, 
in  the  event  of  this  failing,  by  the  use  of  Quinine  and  Valerian." 

Ilijsteria.  The  following  formula  is  very  highly  lauded  by  Dr.  D. 

in  the  treatment  of  this  too  common  disorder. 

I^  P.  CamphoroB        ...        ss. 

P.  As.saiixtidae       ...       ss. 

Extr.  Belladonnce       .     .     3  iv. 

Extr.  aquos.'  Opii       .     .     9j. 

Mix  and  divide  into  120  pills  ;  commence  with  two  at  first  per  diem, 
and  gradually  increase  the  dose  to  six  in  the  24  hours ;  they  should 
always  be  taken  before  food.  Occasionally  a  wine  glassful  of  the 
infusion  of  Valerian  or  Orange  leaves  may  be  given  with  much  ad- 
vantage along  with  each  dose  of  the  pills. 

Dr.  D.  is  in  the  habit  of  administering  them  also  for  the  cure  of 
general  or  partial  nervous  Trembling,  and  of  Chorea.  SomtJtimes  ho 
exhibits  in  the  latter  disease,  the  Belladonna  by  itself;  and,  he  says, 
very  generally  with  success.  When  it  fails,  he  has  recourse  to  cold 
bathing.  No  allusion  is  made  to  the  use  of  Steel  in  the  treatment  of 
this  complainft  by  our  author ;  an  omission  that  seems  the  more 
strange,  as  we  shall  afterwards  find  that  he  is  so  partial  to  ferrugi- 
nous medicines  in  the  treatment  of  many  diseases  of  debility.  Ac- 
cording to  our  opinion,  the  remedy  for  Chorea  is  the  carbonate  or 
sesqui-oxyde  of  Iron,  especially  when  administered  in  any  bitter 
infusion. 

Neuralgia. ^^''  For  the  last  fifteen  year^,  we  have  been  in  the  habit 
of  using  with  the  greatest  success,  in  all  the  forms  of  neuralgia,  
Sciatica  excepted  the  Belladonna  as  an  external  application.  Our 
favorite  formula  is  this  : 

'fy .  Extr.  Bell'adonnoe        .    .     1  ss. 

Opii  pulveriz 9ij. 

Adipis  suis   ss.  * 

Olei  thy  mi Tt[vj.     M." 

A  portion  of  this  ointment,  as  big  as  a  hazel-nut,  is  to  be  well 
rubbed  upon  the  affected  part  two  or  three  times  a  day,  or  whenever 
the  paroxysms  of  pain  are  severe.  The  rubbing  should  be  continued 
for  eight  or  ten  minutes  at  a  time,  until  the  ointment  is  quite  absorb- 
ed by  the  skin  :  a  little  saliva  may  be  added  every  now  and  then  to 
promote  the  absorption.  Let  it  be  remembered  that  the  use  of  this 
ointment  should  be  at  once  suspended,  if  the  sight  becomes  very  sen- 
sibly affected,  or  any  unpleasant  cephalic  symptoms  supervene.  In 
very  obstinate  cases.  Dr.  D.  conjoins  the  internal  administration  of 
the  extract  of  Belladonna  or  Opium  with  the  use  of  the  above  pom- 
made  ;  but  in  the  majority  of  instances,  this  is  unnecessary,  as  the 
pain  will  very  generally  yield  to  the  outward  application.  We  em- 
ploy it,  he  says,  specially  against  facial  neuralgias  and  other  local 
painful  affections  of  a  nervous  character,  the  Megrim  &;c.     In  one 


1845.]  Debrei/ne  on  Chronic  Diseases.  83 


very  severe  case  of  Neuralgia,  which  had  lasted  for  nearly  twenty 
years,  and  which  had  resisted  our  author's  quasi-specific  pommade, 
as  well  as  a  score  or  two  of  other  approved  remedies,  the  pain  which 
was  seated  in  the  skin,  over  the  lower  left  ribs,  at  length  yielded  to 
the  a])plication  of  the  Vienna  Caustic  paste,  so  as  to  produce  a  pretty 
large  eschar  upon  the  affected  part.*  With  respect  to  the  treatnient 
of  Sciatica  which,  as  we  have  seen,  Dr.  D.  separates,  in  a  thera- 
peutic point  of  view,  from  the  other  forms  of  Neuralgia  his  usual 
plan  is  first  of  all  to  order  the  application  of  several  volanle  blisters 
along  the  course  of  the  affected  nerve;  and  if  these  do  not  quickly 
succeed  in  relieving  the  pain,  to  have  recourse  to  his  terebinthinate 
mixture,  which  is  only  a  modification  of  that  recommended  first  by 
Professor  Recamier,  and  subsequently  by  Dr.  Martiivet.  The 
formula  is  this : 

;^ ,  Aquoe  lactucas    ....      viij, 
Olei  volat.  terebinth.    .     .      ^j. 
Gummi  Arabic  ....      3  v, 
Syrupi  simpl ?  iiss.    M. 

The  dose,  a  large  table-spoonful  in  a  glassful  of  rice-water,  three 
times  a  day,  upon  an  empty  stomach.  Dr.  Debreyne  recommends 
at  the  same  time  the  external  application  of  an  embrocation  com- 
posed of  Spirits  of  Turpentine,  Ammonia,  Camphorated  Spirits  of 
Wine,  and  melted  lard,  with  which  the  affected  parts  are  to  be 
vigorously  rubbed  night  and  morning.  In  still  more  intractable 
cases,  he  has  recourse  to  the  use  of  moxas,  applied  over  the  seat  of 
the  chief  pain  ;  the  best  point  generally  for  their  application  is  imme- 
diately behind  the  great  trochanter.  In  conclusion,  he  frankly  admits 
that  the  use  of  his  favorite  Belladonna  ointment  is  seldom  efficacious 
for  the  relief  of  Sciatica. 

Paraplegia  and  Local  Palsy.  "Before  we  were  acquainted," 
says  Dr.  Debreyne,  "  with  the  special  action  of  Nux  Vomica  on  the 
spinal-marrow,  we  were  in  the  habit  of  trusting  almost  entirely  to  the 
use  of  moxas,  applied  over  the  lumbar  or  sacral  vertebra},  for  the  cure 
of  Paraplegia.  But,  for  the  last  twenty  years,  we  have  invariably 
commenced  our  treatment  of  this  disease  with  the  alcoholic  extract  of 
the  Nux  Vomica,  exhibited  in  the  form  of  pills,  each  containing  one 
grain  of  the  extract."  He  begins  with  one,  and  gradually  increases 
the  dose  until  six  two  at  three  different  times  be  taken  in  the 
course  of  the  tv/enty-four  hours.  Whenever  the  patient  ex|)eriences 
cramps  and  spasmodic  twitches  or  tetaniform  rigidity  in  the  limbs, 
the  action  of  the  medicine  must  be  narrowly  watched  ;  and  it  will  be 
prudent  either  to  diminish  the  dose,  or  even  to  suspend  its  use  alto- 
gether, if  these  symptoms  become  excessive.  The  object  should  be 
to  keep  up  the  nervous  excitement  in  a  moderate  and  safe  degree, 


Vienna  Caustic.  Equal  parts  of  vegetable  caustic  and  quick  lime,  moi^stcncd 


with  alcohol.    Edts 


34  Debreyne  on  Chronic  Diseases.  [January, 


for  a  considerable  space  of  time.  If  after  a  month  or  two's  use  of 
the  Vomica,  no  decided  benefit  is  obtained.  Dr.  D.  advises  the  appli- 
cation of  one  or  more  moxas  over  the  lumbar  region- 
He  very  properly  cautions  his  readers  not  to  expect  the  same 
benefit  from  the  use  of  the  Nux  Vomica  in  the  Hemiplcgic,  as  in  the 
Paraplegic,  forms  of  Palsy.  It  may,  indeed,  prove  serviceable  in 
some  cases  of  the  latter,  where  there  is  every  reason  to  suppose  that 
the  sanguineous  coaguUim  within  the  cerebral  substance  has  been 
nearly  or  altogether  absorbed  ;  but  in  no  case  of  this  description 
should  we  be  sanguine  of  doing  mucli  good. 

For  the  cure  of  Amaurosis,  our  author  relies  chiefly  on  the  repeat- 
ed application  of  small  blisters  in  the  neighborhood  of  the  affected 
eye,  first  on  the  temple  and  then  over  the  eyebrow.  In  obstinate 
cases,  the  blistered  surface  should  be  sprinkled  with  a  powder  com- 
posed of  starch  and  strychnine  about  a  fifth  of  a  grain  may  be  used 
at  first,  to  be  gradually  increased.  When  this  treatment  fails,  a 
seton  should  be  tried.  Dr.  D.  has  used  with  very  decided  success  a 
collyrium,  containing  some  extract  of  Belladonna,  in  a  good  many 
cases  of  day  blindness  or  Nyctalopia.  % 

He  also  mentions  a  simple  remedy  for  nervous  Deafness^  which 
may  deserve  notice.  Let  the  patient  fill  his  mouth  with  the  smoke 
of  Tobacco,  or  of  any  other  dry  aromatic  plant  Sage,  for  example  
and  then  make  a  forced  expiration,  while  the  mouth  and  nostrils  are 
closed :  this  should  be  done  several  times  in  the  course  of  the  day. 
The  smoke  enters  the  Eustachian  tube,  and  thus  produces  a  slight 
stimulant  effect  upon  the  internal  ear.  The  remedy  can  do  no  harm  ; 
and  this  is  saying  a  good  deal  in  its  favor,  considering  the  nature  of 
many  of  the  means  of  acoustic  medication.  It  is  best  suited  to  those 
cases  where  the  deafness  has  supervened  on  some  catarrhal  com- 
plaint, and  whenever  we  have  reason  to  believe  that  the  pharyngeal 
end  of  the  Eustachian  tube  has  become  thickened  or  obstructed. 

Asthma.  "For  the  last  twenty-five  years  we  have  seldom  pre- 

scribed  any  other  formula  but  the  following:  

^ .  P.  Inulae  Elecam.     ...     ^  ss. 

Flor.  Sulphuris        .     .     .      |  ss. 

P.  rad.  Belladonnaj      .    .     9iv. 

P.  rad.  Scillse      ....      3j. 

Kermes  min 3j.     M. 

To  be  divided  into  90  powders,  of  which  one  is  to  be  taken  three  times  a  day. 
Our  author  assures  us  that  he  has  witnessed  excellent  effects  from 
this  remedy,  not  only  in  asthma,  but  also  in  a  variety  of  chronic  pec- 
toral affections,  when  they  are  unaccompanied  with  fever  or  inflam- 
matory irritation  ;  as,  for  example,  in  what  has  been  called  Catarrhal 
Phthisis,  and  so  forth.  To  allay  the  cough  in  such  complaints,  he 
combines  the  use  of  the  Iceland  moss  jelly  with  the  anti-asthmatic 
powders.  When  these  fail  which,  according  to  his  report,  is  not 
often  the  case  he  advises  a  trial  of  the  Stramonium  inhalation,  and 
also  of  a  strong  infusion  of  the  Camphree  of  Montpelier  (Camphor- 


1845.]  Dthreync  on  Chronic  Diseases.  85 


asina  Monspeliaca)  with  the  medicinal  virtues  of  which  our  author 
was  first  made  acquainted  by  a  writer  in  the  Revue  Medicale  for 
March,  1821.  Daring  the  paroxysms  of  asthmatic  dyspnoea,  he 
recommends  a  mixture  containinij  the  extract  of  Belladonna,  Oxymel 
of  Squills,  Kcrmes  Mineral  and  Orange-flower  Water. 

In  Hooping. cough  also  he  again  mainly  trusts  to  the  internal  use 
of  the  Belladonna,  in  the  form  of  its  powdered  root.  This  remedy 
was  employed  with  very  marked  success  by  Wetzler  during  a  severe 
epidemic  of  this  disease  that  prevailed  at  Augsburg  in  1810;  and  it 
was  about  seven  years  afierwards  that  our  author  first  gave  an  exten- 
sive trial  to  it.  The  dose  of  the  powder  must,  as  a  matter  of  course, 
depend  upon  the  age  of  the  child,  its  constitution,  the  character  of 
the  existing  symptotns,  and  so  forth ;  but,  if  we  state  that  a  third  of 
a  grain  should  be  given  to  a  child  twelve  months  old,  twice  or  thrice 
a  day,  it  will  not  be  difficult  to  apportion  the  doses  to  other  ages. 
When  the  fits  of  coughing  are  usually  followed  by  vomiting,  the 
powder  should  be  given  very  soon  after  this  has  ceased.  W^e  need 
scarcely  say  that,  if  symptoms  of  inflammatory  irritation  be  present, 
these  must  be  subdued  by  the  appropriate  remedies,  before  recourse  is 
had  to  the  use  of  the  Belladonna  powder. 

In  accounting  for  the  failure  of  his  favourite  remedy  in  the  hands 
of  several  medical  men,  who  have  recently  published  the  results  of 
their  experience  with  it.  Dr.  D.  alludes  with  much  judgment,  to 
some  of  those  causes  or  influences  which  should  always  be  attended 
to,  in  estimating  the  virtues  of  a  medicine  in  any  epidemic  disease; 
and  the  neglect  of  which,  in  the  present  day,  has  induced  such  stri- 
king discrepancy  of  opinion  on  various  practical  points  among  differ- 
ent writers,  as  is  any  thing  but  creditable  to  the  sagacity  of  profes- 
sional men. 

"  Before,"  says  he,  "any  one  can  fairly  and  satisfactorily  determine  the  med- 
icative virtues  ofBelladoima,  or  indeed  of  any  other  remedy,  inHoopin2;-cough, 
by  tlie  efiects  which  it  may  produce  ia  any  particular  epidemic,  it  i.s  ab^^olutely 
necessary  that  he  should  imitate  the  example  of  such  observers  as  Sydenham 
and  SroLL,  and  have  fust  carefully  noted  the  type  and  genus  of  the  epidemic 
itself,  in  order  that  he  may  know  vi  Umhic  whether  it  be  inflammatory,  or  ca- 
tarrhal, or  bilious,  &c.  in  its  nature.  He  should  moreover  have  attentively 
ascertained  the  character  not  only  of  the  medical  constitution  of  the  season,  but 
also  of  the  prevailing  diseases  of  the  preceding  as  well  as  of  tlie  current  year, 
so  that  he  may  be  able  to  determine,  if  possible,  their  cor-relations  and  mutual 
dependencies.  If  the  existing  epidemic  proves  to  have  an  inllammatory  char- 
acter, it  is  scarcely  necessary  to  say  that  the  use  of  antiphlogistic  measure.^  is  an 
indispensable  preliminary  in  the  treatment:  whereas,  if  it  has  a  bilious  type,  we 
must  trust  more  to  the  use  of  emetics  and  purgatives,  betbre  having  recourse  to 
the  exhibition  of  the  Belladonna." 

Before  dismissing  the  subject  of  Coughs,  we  may  state  that  Dr. 
Debrey.xe  very  strongly  recommends  the  internal  use  of  the  extra(  t 
of  Belladonna,  in  the  form  of  mixture,  in  most  coughs  of  a  nervors 
nature  occurring  in  adults.  He  mentions  the  case  of  a  woman,  who 
had  been  afflicted  with  a  violent  convidsive  cough  for  upwards  cf 
twelve  years,  that  was  speedily   relieved  by  this  remedy  d^se,  one 


^^  Debreyne  on  Chronic  Diseases.  [January 


grain  two  or  three  times  a  day.  It  is  equally  serviceable  in  the  cure 
of  obstinate  Hiccup,  and  of  any  spasmodic  constriction  of  the  throat 
and  larynx. 

An  ointment,  composed  of  four  parts  of  the  extract  and  twelve  or 
fifteen  of  spermaceti  ointment,  may  be  most  advantageously  used 
with  much  benefit  in  many  cases  of  contraction  of  the  anus,  and 
painful  afFcctions  of  the  cervix  uteri :  also  in  various  neuralgic  com- 
plaints of  the  bladder  and  urethra. 

We  now  proceed  to  notice  some  of  the  most  common  gastric  and 
intestinal  afTections,  for  the  purpose  of  explaining  our  author's  ther- 
apeutic views ;  and  first  of  all  we  take  the  subject  of 

Vomiting.  In  the  vomiting  that  may  be  considered  to  be  nervous 
or  spasmodic  in  its  nature  i.  e.  when  it  is  not  connected  either  with 
inflammation  or  any  bilious  disturbance  of  the  stomach  he  recom- 
mends very  highly  the  use  of  Columba  powder  :  it  possesses,  he  says, 
a  sort  of  specific  virtue  in  such  cases  nearly  as  great  as  Bark  does  in 
Agues.  He  gives  it  in  doses  of  from  15  to  20  grains  in  two  or  three 
spoonfuls  of  red  (French)  wine,  before  meals.  The  addition  of  a  few 
grains  of  magnesia,  or  of  a  minute  dose  of  opium,  may  be  necessary, 
if  much  acidity  or  gastralgia  be  present;  and,  should  the  patient  be 
feeble,  and  anaemic,  the  subcarbonate  of  iron  may  be  very  advan- 
tageously combined  with  it.  Opium  is  freely  used  by  Dr.  D.  in  va- 
rious abdominal  affections,  afler  the  state  of  the  intestinal  secretions 
has  been  ascertained  to  be  tolerably  healthy.  The  following  quota- 
tion will  show  how  highly  he  rates  its  value. 

"We  treat  all  internal  pains  whatsoever,  and  more  especially  those  of  the 
abdomen,  with  some  preparation  of  opium  provided  always  they  are  not  con- 
nected either  with  acute  fever,  or  with  inflammation,  or  gout.  We  may,  indeed, 
make  a  still  more  general  assertion,  and  say  that  it  is  to  the  use  of  opium  
which  is  the  antidote  of  pain  that  we  mainly  trust  for  the  relief  of  all  painful 
chronic  diseases.  If  along  with  the  element  "of  pain,  there  should  happen  to  be 
co-existing  a  rheumatic  principle  whether  this  show  itself  externally  or  in  some 
internal  organ  we  associate  the  use  of  rubefacients  and  other  appropriate  med- 
icines along  with  that  of  opium.  Without  this  most  valuable  drug,  there  could 
be  no  possible  medication  for  a  multitude  of  chronic  diseases.  If  we  were  de- 
prived of  it,  we  should  ourselves  instantly  abandon  the  practice  of  the  healing 
art.  Sydenham  thanked  God  for  His  gift'of  opium  to  mankind  for  the  cure  of  so 
many  of  the  ills  to  which  we  are  liable;  and  we  can  safely  affirm,  as  far  as  re- 
lates to  our  own  practice,  that  never  a  day  passes  over  that  we  have  not  occasion 
to  exhibit  opium  in  some  form  or  another.  How  admirably  it  acts,  almost  as  a 
specific,  in  most  cases  of  Dysentery,  not  to  enumerate  a  host  of  other  maladies." 


1845.]      Process  of  Secretion  Malformation  of  the  Heart,  87 


PART  III. MONTHLY  PERISCOPE. 

Process]  of  Secretion.  The  greater  number  of  the  fluids,  which 
constitute  the  basis  of  the  different  secretions  such  as  the  gastric 
and  intestinal  juices,  the  saliva,  tears,  milk,  mucus,  wax  of  the  ears, 
fat,  &;c.  proceed  from  a  gradual  dissolution  of  the  substance  of  the 
very  glands  which  are  generally  supposed  to  eliminate  them.  The 
blood,  no  doubt,  furnishes  certain  elements  for  each  secreted  fluid; 
but  that  which  constitutes  the  characteristic  constituent  of  each  se- 
cretion, is  the  fluid  contained  in  the  microscopic  cells,  which  enter 
into  the  formation  of  every  gland  :  this  fluid  is  poured  out  in  con- 
sequence of  either  the  bursting,  or  the  dissolution,  of  the  cellular 
envelopes.  The  cells,  which  along  with  the  blastema  constitute  the 
parenchymatous  substance  of  glands,  are  developed  within  the  minute 
secreting  canaliculi.  When  they  have  attained  to  a  certain  degree 
of  maturity,  they  detach  themselves  from  the  interior,  and  are  car- 
ried along  in  the  secreted  fluid.  MandVs  Manual  of  Gen,  Anat, 
applied  to  Physiology  and  Pathology  fi-om  Am.  Jour. 

Case  of  Malformation  of  the  Heart  of  a  Child,  who  expired  on 
the  fifth  day  after  Birth  The  child  was  well  developed,  and  appear- 
ed to  be  in  perfect  health.  On  the  third  day  it  became  soporose, 
sighed  and  had  hurried  respiration.  The  skin  became  dusky,  breath- 
ing increased  in  rapidity,  no  fever,  respiratory  murmur  puerile,  with 
moist  crepitus  behind  ;  the  child  died  on  the  fifth  day. 

Autopsy.  Tlire  was  only  one  large  artery  given  off  from  the 
heart,  and  from  this  the  pulmonary  artery  sprang.  The  thus  united 
aorta  and  pulmonary  artery  was  considerably  larger  than  the  aorta 
of  so  young  a  child.  It  proceeded  from  a  large  ventricle,  which 
appeared  at  first  sight  to  constitute  the  whole  of  the  ventricular  por- 
tion of  the  heart.  The  systemo-pulmonic  artery  was  separated  from 
the  ventricle  by  semilunar  valve,  and  from  a  very  large  auricle  by 
tricupsid  valve.  Into  this  auricle  entered  by  three  openings,  three 
pulmonary  veins.  The  large  auricle  communicated  by  a  small  open- 
ing with  another  auricle,  about  the  size  of  a  small  horse-bean,  into 
which  entered  the  two  venm  cavce,  each  not  above  two  lines  in  diam- 
eter. This  small  auricle  communicated  with  a  cavity  of  the  size  of 
a  swan-shot,  in  a  fatty  muscular  mass  upon  the  side  of  the  large  ven- 
tricle, constituting  with  it  the  whole  ventricular  mass,  and  evidently 
being  the  representative  of  the  right  ventricle.  The  right  ventricle 
and  the  right  auricle  were  separated  from  each  other  by  small  cob- 
web-like membranes,  representing  the  ventricular  valve. 

The  circulation  of,  in  all  other  respects,  an  apparently  well  devel- 
oped child,  was  thus  reduced  to  that  of  a  reptile  of  the  lowest  order, 


38  Ope/  Foramen  Oca^e^  ^-c.  [January, 


very  nearly  resembling  that  of  a  frofr.  The  very  small  size  of  the 
venm  cavce  would  lead  to  the  supposition,  that  tiie  circulation  of  the 
b^ood,  enabling  a  child  to  live  in  the  air,  for  five  days  \vilh  so  slight 
derangement  for  two  days  at  least,  could  not  be  carried  on  with  the 
adequate  return  of  blood  from  tlie  system  which  such  veins  would 
indicate,  and  that  one  of  the  three  orifices  by  which  the  blood  return- 
ed into  the  large  auricle  was  that  of  a  systemic  vein.  The  auricle 
is  of  much  greater  capacity  than  that  of  the  united  auricles  of  a 
child  of  that  age  ought  to  be.  It  cannot  even  be  conceived  that  extra- 
uterine life  could  continue  with  such  an  inadequate  return  of  venous 
blood,  as  is  indicated  by  the  small  proportion  of  the  two  ven(2  cavcD 
to  the  pulmonic  systemic  artery.  Dr.  Carson  in  the  Report  of  the 
Liverpool  Pathological  Society.  Dublin  Journ.,  for  Sept.  1844. 


Period  at  which  iJic  foramen  ovale,  the  ductus  arteriosus  and  ductus 
vcnosus  become  obliterated.  It  results  from  the  investigations  of  M. 
Elsyesser,  made  on  144  children,  that  the  oI)literation  of  these  tem- 
porary circulatory  channels,  does  not  (ake  place  until  a  month  or  six 
weeks  after  h\x\\\.-^V Experience^  Aug.  24:th,  1843,  from  Heke's 
Zeitschreft,  t.  42  from  Am.  Jour. 


Open  Foramen  Ovale  no  cyanosis  Dr.  Woodiiouse  exhibited  to 
the  Reading  Pathological  Society,  a  heart  taken  from  a  woman  aged 
71,  who  died  of  apoplexy.  The  foramen  ovale  was  patulous  to  a 
considerable  extent  about  half  an  inch  ;  the  valvular  portion  of  the 
septum  auriculorum  unusually  lari^e.  There  were  no  symptoms 
during  life,  as  lividity  of  countenance,  deficient  nutrition,  <Sz;c  to  in- 
dicate such  a  condition.  Prov.  Med.  Sf  Surg,  Journ.,July24, 1844, 


It  was  but  recently  that  the  doctrine  was  taught  in  the  Schools, 
that  impregnation  generally  took  place  just  after  menstruation.  It 
will  be  seen  that  a  different  theory  is  now  advocated,  and  said  to  be 
sustained  by  facts,  in  the  following  Report,  copied  from  the  British 
and  Foreign  Medical  Review  : 

Escape  of  ova  independent  of  fecundation,  and  the  connection  of 
this  with  menstruation.  Each  act  of  menstruation  is  connected  with 
the  maturation  and  discharge  of  an  ovum.  Numerous  cases  in  proof 
of  this  are  related  (in  addition  to  those  formerly  recorded  by  him, 
and  by  M  M.  Ge>dki>%  Negkier,  and  others.)  by  Dr.  Robert  Lee  ; 
others  by  Mr.  Girdwood.  M.  Raciborski  has  four  times  found 
that  ova  have  been  recently  discharged  from  the  ovaries  of  virgins  who 
died  at  or  near  the  period  of  menstruation  ;  arui  I'isckoff  has  also 
four  times  foun^l  Graafian  vesicles,  containing  etnised  blood,  in  gijls 
who  have  recently  menstruated- 

This  menstrual  discharge  of  anovurn  i~  "=^rii<!  '>v  R AfinmisiKi  and 
BiscHOlF  to  bo  followr-d  by  thp  funn tin.)  of  a  corpus  iutf urn.  siniihir 
to  that  which  is  formed  when  the  o\uin  ia  iniprt  gnaled  and  developed 


1845.]  Escape  of  Oca,  independent  of  Fecundation.  b9 


[But  in  this  i  have  no  doubt  they  are  mistaken.  If  it  were  so,  one 
or  more  corpora  lutea  should  be  found  in  the  ovaries  of  all  who  die 
while  the  habit  of  menstruation  continues;  for  the  corpus  luteum 
which  forms  when  impregnation  has  taken  place,  is  distinct  not  only 
through  the  pregnancy,  but  for  more  often  much  more  than  a 
month  after  delivery.  Neither  are  the  cavities  which  are  left  after 
the  menstrual  discharge  of  ova.  or  the  processes  by  which  they  are 
closed,  at  all  similar  to  those  found  when  impregnation  has  taken 
place.  In  many  examinations  of  ovaries  I  have  not  yet  seen  a  case 
in  which,  without  impregnation,  any  thing  has  been  found  which 
could  be  mistaken  for  a  corpus  luteum  formed  afier  an  ovum  has 
been  discharged  and  impregnated.]  Mr.  Girdwood  believes  that 
the  cicatrices  left  after  the  discharge  of  menstrual  ova  may  be  count- 
ed, so  as  to  indicate  the  number  of  ova  discharged  and  the  number 
of  times  of  menstruation.  [But  recently  I  have  examined  a  case 
in  which  a  girl  of  seventeen  had  not  menstruated  for  four  months 
before  her  death,  but  previously  had  menstruated  regularly :  the 
ovaries  showed  no  cases  of  cicatrices.  Probably,  therefore,  the  cica- 
trices remain  for  a  time  distinct,  but  are  gradually  obliterated,  as 
thev  are  in  the  nearly  analogous  case  of  the  dischar<TC  of  the  Fever's 
and  solitary  glands  of  the  intestines.] 

3.  The  menstruation  of  women,  in  so  far  as  the  periodical  matura- 
tion and  discharge  of  ova  is  concerned,  is  analogous  to  the  heat  or  rut 
of  animals.  The  phenomena,  according  to  Raciboeski  may  be  most 
distinctly  seen  in  the  sow  ;  but  in  all  the  domestic  mammalia  at  their 
period  of  heat  one  or  more  follicles  attain  their  highest  degree  of  de- 
velopment, project  upon  the  surface  of  the  ovary,  and  at  length  burst 
with  hemorrhage  into  their  containing  cavities,  and  this  whether 
copulation  have  taken  place  or  not.  Bischoff  also  has  repeatedly 
found  the  same  things  occur  in  bitches  and  rabbits  whose  uterus  and 
tubes  have  been  extirpated  :  they  have  heat,  the  ova  mature  and  de- 
tach themselves  and  pass  into  the  remaining  portion  of  the  tube,  but 
of  course  cannot  be  impregnated. 

4.  The  discharge  of  the  ova  and  their  passage  along  the  tubes  are 
independent  of  impregnation  and  the  passage  of  the  seminal  corpus- 
cles. This  is  evident  from  the  facts  already  mentioned  ;  and  others 
are  furnished  by  Bischoff.  In  one  experiment  he  kept  a  bitch  care- 
fully  secluded  till  the  period  of  heat  ensued.  She  then  copulated 
once,  and  immediately  after  he  extirpated  the  left  uterine  horn,  ovary 
and  oviduct.  The  copulation  had  lasted  a  quarter  of  an  hour  ;  and 
he  found  that  the  semen  had  penetrated  to  the  upper  angle  of  the 
uterine  horn,  but  not  into  the  tube.  He  found  also  five  ova  in  the 
oviduct  more  than  two  inches  from  its  abdominal  orifice;  a  distance 
sufiiciently  great  to  prove  that  they  had  not  been  detached  in  the 
copulation.  Next  day  he  killed  the  bitch,  and  found  (hat  spermato- 
zoa had  reached  about  a  quarter  of  an  incli  in  the  right  lube;  he 
found  also  five  ova  in  the  same  tube,  and  as  many  corpora  luica  in 
the  right  ovarv,  but  none   of  the   spcrmatd-na  had  come  h\  contact 


40  Escape  of  Ova,  independent  of  Fecundation,     [January, 


with  the  ova.  These  cases  proved  the  detachment  of  ova  before  copu- 
lation. In  some  others  Bisciioff  found  that  they  were  not  detected 
till  long  after  the  act.  In  some  he  found  that  they  were  undetached 
twenty-tour  hours  after  copulation,  and  that  the  seminal  corpuscles 
had  passed  on  towards  them.  In  others  also  he  found  the  independ- 
ence of  the  passages  of  the  ova  and  the  semen  still  more  marked  ;  for 
example,  several  days  after  copulation,  ova  were  found  fecundated  in 
one  tube,  but  in  the  other  spermatozoa  alone,  none  of  the  Graafian 
vesicles  in  the  corresponding  ovary  being  either  enlarged  or  fully 
developed.* 

5.  Thus,  according  to  the  period  of  heat  at  which  copulation  takes 
place,  will  be  the  place  at  which  the  semen  meets  the  ovum.  If  it 
be  early,  the  ovum  may  not  escape  before  the  semen  reaches  the 
ovary;  if  late,  the  ovum  may  have  arrived  at  the  uterus;  and  proba- 
bly if  it  have  arrived  at  the  lower  or  uterine  third  of  the  tube  before 
it  comes  in  contact  with  the  semen,  impregnation  is  impossible  on 
account  of  the  chano;es  which  the  vitellus  has  alreadv  undergone.  In 
women  it  is  in  like  manner  near  the  period  of  menstruation  that  im- 
pregnation is  most  likely  to  occur.  It  may  take  place  just  before 
menstruation  if  the  ovum  be  just  mature  when  the  semen  reaches  the 
ovary ;  or  some  days,  the  ovum  after  its  discharge  remaining  impreg- 
nable till  the  semen  reaches  it.  Or,  again,  as  many  analogous  cir- 
cumstances in  lower  animals  prove,  an  ovum  may  by  the  sexual  ex- 
citement be  hurried  on  to  its  maturity  and  discharged  ;  and  so,  in 
unusual  cases,  impregnation  may  take  place  at  a  greater  than  usual 
distance  from  the  menstrual  period.  Still  the  most  common  time 
must  be,  as  common  ol>servation  shows  it  is,  either  during  or  very 
near  the  menstrual  perio<l.  M.  Raciborski  has  found  that  in  one 
hundred  women  there  are  not  more  than  six  or  seven  in  whom  this  is 
not  the  constant  rule. 

6.  All  these  circumstances  prove  a  closer  analogy  than  was  sup- 
posed to  exist  between  the  discharge  of  the  ova  of  mammalia  and 
those  of  the  fish,  batrachia,  and  others  in  which  the  ova  are  discharged 
from  the  body  and  impregnated  external  to  it.  In  all  alike  the  dis- 
charge of  the  ova  is  an  independent  act  ;  the  differences  are  in  the 
distances  from  the  ovaries  at  which  the  semen  is  usually  brought  into 
contact  with  it. 


*  These  facts  bear  on  the  question  of  the  possibility  of  a  woman  conceiving  by 
two  diflerent  men;  and  I  fmd  a  recent  notice  of  a  case,  often  referred  to,  of  a 
negress  who  having,  as  it  was  believed  by  herself  and  others,  conceived  twice  in 
the' same  night,  first  by  a  negro  and  afterwards  by  a  European,  bore  twins,  of 
which  one  was  a  pure  negress,  the  other  a  mulatto.  Dr.  Hillk,  a  Dutch  military 
surgeon  in  Surinam,  where  the  delivery  occurred,  adds  that  the  children  were 
living  in  1841,  that  they  were  eight  years  old,  that  the  black  child,  which  was  at 
first  the  strongest  of  the  two,  retnained  so,  and  that  the  mother  had  died  .some 
time  previously,  and  on  examination  was  found  tc>  have  normal)  v  formed  genital 
or'^ans.     {Camper's  IVackcnsthriJr,  Jan.  23,  181^2.) 


1845.]  Age  of  Puberty  in  Girls,  41 


Age  of  Puberty  in  Girls.  Mr.  Robekton,*  of  Manchester,  in 
continuation  of  some  former  papers,  the  object  ofwliich  was  to  prove 
that  the  age  of  puberty  is  as  early  in  the  cold  as  in  the  tropical  re- 
gions of  the  earth,  and  that  the  early  fecundity  in  Hindostan  and 
other  warm  countries  is  only  the  consequence  of  early  marriages, 
proceeds  now  to  show,  that  in  ail  countries  alike,  early  marriages 
(and  earls'-  fecundity)  are  always  connected  with  moral  and  political 
degradation,  as  exhibited  in  bad  laws  and  customs,  the  enslavement 
more  or  less  of  the  women,  ignorance  oi  letters,  impure  and  debasing 
systems  of  religion  ;  and  that  they  bear  no  relation  to  the  climate  of 
the  country. 

His  evidence  is  extensive  and  very  interesting;  and  the  conclu- 
sions he  arrives  at  are,  1.  That  in  England,  Germany,  and  Protestant 
Europe  in  general,  early  marriage,  i.  e.  marriage  about  the  age  of 
puberty,  is  comparatively  rare.  2.  That  early  marriage  prevails 
among  the  uncivilized  tribes  within  the  arctic  circle,  as  it  likewise 
does  in  all  cold  countries,  the  inhabitants  of  which  are  in  a  state  of 
iirnorance  and  moral  degradation.  3.  That  throughout  European 
Russia,  which  is  confessedly  low  in  civilization,  extremely  premature 
marriage  was  the  universal  custom  at  no  distant  date.  4.  That  at 
the  present  day,  in  the  most  southerly  countries  of  Europe,  where 
the  people  are  immersed  in  superstition  and  ignorance,  marriage  is 
early.  5.  That  in  Ireland,  which  as  to  its  moral  condition  somewhat 
resembles  the  last  mentioned  countries,  the  marriage  union  takes 
place  among  the  Roman  Catholic  po})U)ation  almost  as  early.  6. 
That  in  England,  about  two  centuries  ago,  when  debasing  political 
and  social  circumstances  combined  to  favor  tlie  practice,  early  mar- 
riages were  general,  at  all  events  in  the  upper  ranks.  7.  That  in 
all  the  countries  to  which  reference  has  been  made,  juvenile  mar- 
riage is  invariabl}'^  seen  as  an  attendant  upon  ignorance  and  moral 
debasement,  and  this  without  reference  to  climate.  8.  That  conse- 
quently it  is  allowable  to  infer  that  early  marriage  in  oriental  coun- 
tries (which  has  generally,  but  without  any  proof,  been  ascribed  to 
precocious  {)uberty.)  depends  solely  on  the  same  moral  and  political 
causes  as  produce  it  elsewhere  ;  more  especially  as  those  very  causes 
are  well  known  to  exist  at  present  in  an  aggravated  degree  in  all 
oriental  and  intcrtroj)ical  countries. 

These  conclusions  are  probably  in  a  great  measure  true;  yet 
that  the  commencement  of  menstruation  and  of  fecundity  does  bear 
some  relation  to  the  latitude  and  average  temperature,  appears  to  be 
proved  by  the  following  table,  in  which  M.  Raciborski  gives  his 
results  as  to  the  average  age  at  which  menstruation  commences  in 
different  countries  and  towns  : 


  Edinburgh  Medical    and    Surrrical    Journrd,   October,    1832,    and    Julv, 
1812. 


42 


-*^^  'i/  Puherly  in  Girls. 


[January, 


Name  of  Town. 

Lati- 

Aee  at  first 

Mid.  Temp. 

No  of  Ob- 

Observer. 

tude. 

menstruation. 

of  the  year. 

servations. 

Toulon 

.  43^ 

.     .  14-081  . 

.  15^    . 

.    43    . 

.  Marc  d'Espcne 

tMarseillcs 

.  43 

.     .  14015  . 

.  15-     . 

.    25    . 

Ditto. 

tLvons 

.  46 

.     .  14-492  . 

.  110   . 

.  100    . 

.  Bonchacourt. 

Paris 

.  49    , 

.     .  14-405  . 

.  18-0   . 

.  200    . 

.  Raciborski. 

Gotdngen     , 

.  53 

.     .  10038  . 

.    8-     . 

.  137    . 

.  Osiander. 

Warsaw 

.  52 

.     .  15-083  . 

.    9-2 

.  100    . 

.  Lebrim. 

J  Manchester  . 

.  53 

.     .  15-191  . 

.    90   . 

.  450    . 

.  Roberton. 

Skeen 

.  59     , 

.     .  15-450  . 

.    0-      . 

.  100    . 

.  Fave. 

Stockholm    . 

.  59 

.'    .  15-598  . 

.     5-7   . 

.  102    . 

.  Wistrand. 

Sv\-edish  Lapland 

.  05    . 

,     .  18- 

Wretholm. 

In  general,  therefore,  the  period  of  puberty  is  later  in  nearly  the 
same  ratio  as  the  latitude  is  higher;  for  each  degree  of  the  one  the 
other  is  retarded  about  a  month  and  a  few  days.  And  the  lower  the 
latitude^,  the  more  frequent  are  the  examples  of  precocious  appearance 
of  menstruation. 

A  still  more  exact  relation  is  bet\vcen  the  date  offirst  menstruation 
and  the  mean  year's  temperature;  as  may  be  seen  by  comparing 
Warsaw  and  Gottingen,  Gottingen  and  Manchester,  &c.  M.  Raci- 
borski adds  that  race  often  determines  the  period  offirst  menstrua- 
tion. The  children  of  negroes  born  in  England  menstruate  as  early 
as  their  parents  ;  those  of  Europeans  born  in  India  as  late  as  their 
parents.  To  determine  how  far  circumstances  of  climate  could  coun- 
tervail the  influence  of  race,  M.  Raciborski  obtained  information 
respecting  the  period  of  menstruation  in  Jewesses  in  Poland,  from  M. 
Lebunr,  medecin-en-chef  of  a  hospital  in  Warsaw,  and  found  the 
mean  period  in  Catholics  15'83,  in  Jewesses  15*89  ;  (100  observa- 
tions of  each  race  ;)  showing  that  the  influence  of  race  remained  after 
ten  or  more  centuries.  And  in  like  manner  the  menstruation  ceases 
sooner  in  Polish  Jewesses  tiian  in  Sclavonian  women,  lasting  in  the 
former  on  an  average  '29  23-83  years,  and  in  the  latter,  31  6-33 
years. 

There  is  a  difiererice  also,  dependent,  probably,  on  numerous 
causes,  between  the  women  of  Paris  and  those  of  vilhiges  a  league  and 
a  half  or  two  leagues  t>om  Paris,  tiiough  both  have  a  similar  soil, 
lemperature,  ^c.  In  the  villages  the  average  age  at  first  menstru- 
^jtinij  is  15*020  years,  in  Paris  14-4G5,|| 

M.  RaciborskiIF  has  also  published  an  account  of  the  age  at  which 
menstruation  ceases.  At  Lvons  the  average  ajie  is  between  45  and 
iiO ;  at  the  Salpetriere,  in  100  women,  the  average  was  46*03:  at 
Warsaw,  47'G5  :  at  Christiana,  48*07.     As  a  general  rule,  the  grcat- 


  Archiv.  Gen.  de  Med.  1835.    t  Diet,  des  Sc.  Med.  2mc  edit.  "Menstruation." 

:  Edinb.  Med.  and  Sur^.  Journ.  Oct.  1832. 

  Eighteen  years  is  only  a  general  statement,  it  should  prob?bly  be  less. 

II  A.  Raciborski,  "Dc  I'Epoque  de  la  Puberte,"  &c.,  L'Expericnce,  Juillet  20, 
1843,  and  many  subsequent  numbers.  Numerous  facts  bearing  on  this  and 
similar  questions  rnav  be  found  in  Brierre  ucRoismont,  "Dcla  Menstruation," 
&c.,  Paris,  1S42.       \  Medical  Gazelle,  Dec.  9, 18-12. 


1845.]         Epidemic  Inlermillancc  of  InUrmitlcnt  Fever.  43 


er  the  number  of  children  born,  the  longer  is  the  continuation  of 
menstruation;  the  earlier  the  commenceinent  of  mcnslrua(ion,  the 
greater  the  number  of  children  and  the  later  the  cessation. 

On  the  Epidemic  InfcrmiUance  of  Intermittent  Fever.  The  de- 
velopment of  Agues  in  marshy  countries  is  by  no  means  uniform  or 
constant:  it  is  itself  suSject  to  intcrmittanccs.  'i'hus,  at  Antwerp 
and  its  environs,  in  1S22  and  1823,  these  fevers  be^an  to  become 
more  common  and  severe  than  they  had  been  observed  to  be  for  some 
years  before.     Their  intensity  increased  during  the  following  seasons. 

"The  periodical  genius  or  type,"  says  M.  Gouzee,  "arrived  at  its 
acme  in  1826,  the  period  of  the  memorable  epidenne  of  Gronin'^en. 
During  the  three  summer  months  of  that  3^ear,  which  were  remarka- 
l)Ie  for  an  almost  constant  dry  heat  of  from  20^  to  28*^  Reaumur, 
the  number  of  insidious  and  malignnnt  remittent  fevers  was  consid- 
erable at  Antwerp,  among  all  classes  of  the  population.  During  the 
month  o(  July,  twenty-five,  thirty,  and  even  forty  i'avov  cases  entered 
the  military  hospital  daily.  In  1927,  this  epidemic  constitution, 
although  very  decided,  was  nevertheless  not  of  so  great  violence  ; 
after  having  suffered  a  little  remission  in  the  foliowiui^  years,  it  re- 
appeared, and  prevailed  again  with  considerable  intensity  in  1834, 
1835,  and  1838. 

"  During  this  long  succession  of  years,  more  particularly  in  the 
first  eight  or  ten,  nothing  was  so  common  as  marsh  cachexias,  leuco- 
phlegmatic  inflammations  and  engorgements  of  the  spleen.  It  wa.s 
notuncommon  to  meet  with  invalids  in  whoin  the  hypertrophied  spleen 
occupied  the  entire  left  side  down  to  the  pubis.  The  frequency  of 
malignant  fevers  at  that  time  obliged  the  medical  men  to  be  constantly 
on  the  watch.  In  1837,  a  rapid  change  took  place  all  at  once:  the 
intermittent  fevers  ceased,  and  their  sudcien  disappearance  coincided 
with  the  appearance  of  a  severe  epidemic  of  Influenza,  v/hich  pre- 
vailed from  the  middle  of  January  to  the  end  of  tlie  followinn-  month. 
Diiring  the  entire  pr(ivaler)C(5  of  this  new  epidemic,  we  did  not  meet 
with  a  single  case  of  intermittent  fcver^  a  circumstance  well  worthy 
of  notice. 

"From  1837  to  1841,  that  is  to  say,  during  an  interval  of  five 
years,  the  paroxysmal  fevers  were  so  rare,  and  so  slight,  that  the 
sulphate  of  Quinine,  formerly  tlie  anchor  of  safety  in  the  majority  of 
cases,  had  then  in  a  manner  fallen  into  neglect.  The  niaii'niant 
remittent  feverrf,  the  obstructions  of  the  spleen  and  the  marsh  cach- 
exias had  also  almost  entirely  disappeared.  At  last  the  periodic  fevers 
re-appeared  in  1812  ;  and,  during  tlie  following  y(>nr,  in  our  localities, 
thi'v  returned  to  sucli  an  extent  and  ol"ien  with  such  gravity  as  could 
not  fail  to  arrest  the  attetition  of  all  our  practitioners.  During  the 
months  of  August  and  Septemb^.r  of  this  year,  the  appearance  of  a 
good  many  cases  of  pernicious  fevers  was  noted  at  Antwerp;  a  cir- 
cumstance which,  for  more  than  six  yearb  before,  had  not  been  met 
with  in  practice.." 


44  Treatment  of  the  Itch  in  Belgium.  January, 


These  variations  proceeded,  according  to  our  author,  from  dry  pro- 
longed lieats,  without  great  agitations  of  the  air,  and  cold  nights. 

'*In  our  low  and  marshy  countries,"  he  observes,  "it  is  not,  as 
many  physicians  believe,  the  humidity  of  the  atmosphere  that  occa- 
sions the  development  of  intermittent  fevers.  There  is  no  situation 
in  vvliich  fewer  paroxysmal  fevers  arc  met  with  when  the  seasons,  in 
which  they  generally  show  themselves,  are  rainy  and  damp.  If  the 
humidity  of  the  air  is  necessary  to  their  development,  it  is  in  districts 
not  so  low  as  ours,  in  order  to  prepare  the  work  of  miasmatic  decom- 
position, which  it  requires  other  conditions  of  the  atmosphere  to  com- 
plete." Jour,  Beige, 

Remark.  From  the  tone  of  the  preceding  observations,  our  read- 
ers will  perceive  that  medical  men  on  the  Continent  are  beginning  to 
pay  attention  to  a  subject,  connected  v/ith  the  history  pf  diseases, 
which  has  been  far  too  much  neglected  in  the  present  century  we 
mean  the  nosological  influences  of  seasons,  atmospheric  changes  and 
so  forth.  We  need  not  say  that  the  writings  of  Hippocrates,  Sy- 
denham, Baglivi,  &c.  are  pregnant  with  allusions  to  this  matter.  
Med.  Chlr.  Review,  1844. 

Treatment  of  the  Itch  in  Belgium.  The  following  circular  has  been 
addressed  to  military  surgeons  by  the  Inspector  General  of  the  Bel- 
gian army. 

"Each  patient  is  supplied  with  an  ounce  or  an  ounce  and  a  half  of  liquid 
sulphuret  of  lime  in  a  small  pot ;  this  quantity  he  is  to  rub  carefully  and  slowly 
v.'ith  his  hands  on  every  part  that  is  covered  vv  ith  papulse.  If  there  be  any  papu- 
loe  on  the  back,  another  patient  is  to  rub  the  liquid  upon  that  part.  The  opera- 
tion is  to  be  repeated  three  times  in  the  twenty-four  hours,  so  that  each  patient 
consumes  three  or  four  ounces  of  the  sulphuret  daily.  A  bath  is  to  be  taken 
every  alternate  day;  the  frictions  are  to  be  suspended  on  that  day.  Fifteen  fric- 
tions (or  ten  daj's  use)  are  usually  sufiicient  for  the  cure  of  the  disease,  if  the 
medical  officer  in  charge  sees  that  the  remedy  is  properly  used." 

The  su'phuret  is  prepared  thus:  take  of  sublimed  sulphur  16 
pounds,  and  of  quick  lime  32  pounds ;  boil  in  80  pounds  of  water 
for  three-quarters  of  an  hour.  Let  the  mixture  rest  for  some  time 
until  it  settle,  and  then  let  the  clear  fluid  be  decanted  off.  Boil  the 
residue  afresh  in  about  the  same  quantity  of  water,  treat  it  in  a  sim- 
ilar manner,  and  add  this  decoction  to  the  first.  Usually  140  pounds 
of  the  sulphuret,  at  12  by  the  areometer,  are  thus  obtained.  If  the 
liquid  be  more  dense,  it  should  be  lowered  to  this  standard  by  the  ad- 
dition of  rain  water.  Ann.  de  la  Soc.  de  Med.  d'Anvers.  Med* 
Chir,  Review. 

We  give  also  Dr.  Gibeet's,  (one  of  the  Physicians  to  the  St.  Louis 
Hospital,  Paris,)  prescription  for  the  Itch  :  Two  parts  of  sulphur  to 
eight  of  lard,  to  which  is  added  twelve  grains  of  the  carbonate  of 
potassa  for  each  ounce.  Edits. 


1845.]  Malaria.  43 


Malaria.  A  Reviewer  of  Dr.  M*Willia:vi's  "  Medical  History  of 
the  Niger  Expedition,"  in  the  xVthenasum,  having  doii'ottd  the  exist- 
ence of  Malaria,  attributing  what  are  called  malarious  diseases  to 
other  causes,  as  the  "ordinary  accidents  of  climate,  heat,  and  hu- 
midity," Dr.  M'W.  combats  the  Reviewer's  scepticism  by  a  paper  in 
the  same  journal,  for  21st  Septemlier,  1844. 

We  suspect  that  the  reviewer  had  never  practised  in  a  tropical  or 
in  any  malarious  climate,  else  he  would  not  have  considered  mias- 
mata, malaria,  marsh  effluvia,  or  whatever  name  we  may  give  the 
poison,  as  a  creature  of  the  imagination.  The  following  quotation 
from  Dr.  M'Williax's  "reclamation,"  must  be  satisfactory  to  most 
of  our  readers,  though  ten  thousand  other  instances  and  facts  equal- 
ly stringent  might  be  adduced  in  proof  of  a  morbific  emanation  from 
certain  soils,  exclusive  of  heat  and  moisture.  Medico -Chirurg,  Rev. 

"  Heat  and  moisture  are  conditions  of  the  atmosphere  which  readily  admit  of 
minute  quantitative  determination,  by  metliods  in  common  u:.e :  and  if  fever 
were  caused  by  them  alone,  in  Europeans  within  the  tropics,  it  should  prevail 
wherever  their  amount  is  the  same.  Now,  by  reference  to  the  meteorological 
tables  in  my  work,  the  temperature  and  dew  point  outside  the  Niger,  where  no 
fever  occurred,  and  while  in  the  rivers,  were  as  follows: 

Temp.        Dew  point. 

3,  P.M.  3,  P.M. 

Pa.ssage  from  Sierra  Leone  to  Accra        .        .        .81 .13  74-03^ 

Outside  Niger  from  9th  to  12th  August    .        .        .    7J.00  73.70 

In  the  Nun  and  descending  to  Aboh        .        .        .    80.G0  74.00 

At  Aboh,  Iddiih,  and  the  confluence  of  the  Niger  and 

Tehadda  to  Sept.  21 8-1.00  73.50 

Confluence  ofNiger  and  Tehadda  to  Egga     .        .    86.00  72J0O 

"  Thus,  though  the  expedition  was  exposed  from  the  1st  of  July  to  the  begin- 
ning of  August,  to  air  containing  more  moisture,  and  but  little  inferior  in  tem- 
perature at  the  hottest  part  of  the  day,  to  any  experienced  within  the  river,  not  a 
case  of  fever  made  its  appearance  until  the"  4th  of  September,  three  weeks  after 
it  had  entered  the  river,  and  had  been  exposed  to  the  emanations  from  the  ordi- 
narily recognised  sources  of  malaria.  Similar  results  have  been  observed  else- 
where ;  in  Barbadoes,  for  instance,  no  fever  occurred  among  the  troops  in  the 
garrison,  during  August,  September,  or  October,  18-11,  and  although  in  Novem- 
ber a  very  violent  description  of  yellow  fever  broke  out.  the  temperature  of  the 
air  was  lower  than  in  August,  and  the  dev/  point  lower  than  in  September;  their 
means  were  as  follows :  

Temp.  3,  p,  m.      Dew  point,  3,  p.  m. 
August        .        .        .  83.77  70.61 

September  .        .        .  82.13  73.78 

October        .        .        .  82.31  72.67 

November   .        .        .  82.83  71.67 

"  Hence  the  connection  between  '  heat  and  humidity '  of  the  atmosphere  and 
severe  remittent,  or  yellow  fever,  is  by  no  means  so  clear  as  the  reviewer  v.-ould 
have  us  suppose.  It  is,  in  fact,  one  of  those  hasty  conclusions  which  will  not 
stand  the  test  of  comparison  with  observed  facts,  and  could  only  have  been  made 
with  a  limited  view  of  the  history  of  disease  in  warm  climates. 

*'  At  Barbadoes  the  fever  was  almost  completely  confined  to  one  of  the  regi- 
ments composing  the  garrison,  while  the  other,  the  men  of  which  were  equally 
exposed  to  'heat and  humidity,'  and  performed  the  same  duties  with  their  neigh- 
bors, was  almost  wholly  e.xempt.  The  cau.se  of  the  disease  in  this  instance, 
was  very  obviously  tiie  effluvia  arisini^  from  a  pool  of  water,  immediately  to 
windward  of  the  building  occupied  by  the  regiment  that  sutfercd. 

"  But  to  return  to  the  west  coast  of  Africa.  In  1836,  H.  M.  S.  Sc&id,  under  the 
command  of  Capt.  Robkrt  Craigie,  proceeded  to  the  we.*t  coast;  and  by  a  care- 


Malaria.  [January, 


ful  obs'^rvance  of  the  stringent  'General  Orders'  of  the  senior  officer  on  the  sta- 
tion, '  that  no  sliip  was  ever  to  remain  in  port  more  than  forty-eight  hours  at  any 
one  time,'  and  that  Oilicers  were  so  far  as  was  practicable  to  avoid  entering  any 
of  tlie  rivers  on  the  coast,'  only  two  cases  of  fever  occurred  in  her  during  the 
lirst  )'ear,  and  these  were  traced  to  two  days'  stay  2t  Sierra  Leone.  In  the  month 
of  April,  1837,  Capt.  Cragjr  was  obliged  to  ascend  the  Bonny  river,  in  the  Scout, 
as  far  as  King  Peppel's  tov\m,  for  the  protection  of  the  British  mercantile  inter- 
ests there.  On  this  occasion  he  also  took  the  Dolphin,  a  brigantine,  with  him, 
and  left  the  Liinx,  another  brigantine,  anchored  at  the  river's  mouth.  The  Sroiit 
and  Dolpkln  were  detained  nearly  a  week  at  Bonny  town,  and  on  leaving  the 
river,  fever  broke  out  in  both  vessels,  and  their  united  loss  by  death  amounted  to 
live  officers  and  seventeen  men  and  bo3-s,  while  on  board  the  Lynx  not  one  was 
even  attacked.  Bonny  town  is  only  about  six  miles  from  where  the  Lynx  was 
lying,  consequently  there  could  have  been  very  little,  if  any,  difference  as  to  the 
.  'heat  and  humidity'  of  the  atmosphere  in  the  positions  of  the  vessels  that  suffer- 
ed and  that  which  escaped. 

"Capt.  BRUNswrcK  Popiiam  commanded  the  PcZimw,  with  a  complement  of 
101  M'hite  men,  for  four  years  and  a  half,  on  the  east  and  west  coasts  of  Africa. 
During  this  time,  his  loss  by  death  amounted  to  three  Europeans.  He  made  it 
a  rule  to  avoid  rivers,  his  boats  having  on  one  occasion  only  been  in  the  Bonny, 
and  that  for  a.  very  short  time.  Capt.  Popua.m  was  on  the  station  during  1835- 
6-7-8,  and  part  of"39,  during  which  the  mortality  on  the  coast  is  but  too  well 
known.  In  short,  it  seems  to  me  perfectly  clear,  from  the  evidence  of  many  old 
African  cruisers,  non-professional  as  well  as  professional,  and  from  my  own 
experience,  that,  as  a  general  rule,  a  ship  will  continue  healthy  on  the  west  coast 
of  Africa,  if  she  is  clean  internally,  and  keeps  at  sea,  and  that  disease  will  ap- 
pear if  she  remains  much  nearer  the  shore,  or  has  intercourse  with  the  rivers.  If 
we  admit  the  immunity  in  the  one  case,  and  the  occurrence  ofdisease  and  death 
in  the  other,  surely  the  destructive  agency  must  have  been  owing  to  something 
connected  with  the  land,  vrhich  is  acted  upon  by  the  same  meteoric  agencies  as 
the  sea,  with  this  difference,  that  the  land  and  sea  breezes  become  more  feeble 
as  we  advance  into  the  interior.  The  sun  is  mainly  effective /ra7/A  bcJon-  in  heat- 
ing the  atmosphere  on  land  and  v.-ater,  both  of  which  absorb"  its  rays  and  com- 
municate them  to  the  air  above.  Theoretically,  we  would  expect  nothing  per- 
nicious to  be  evolved  from  the  sea.  the  surface  of  which  is  always  in  a  state  of 
greater  or  lesser  agitation  ;  and  practically  we  find  the  conclusion  to  be  just. 
On  shore,  on  the  contrary,  we  have  all  varieties  of  soil,  in  many  conditions  of 
which  we  have  a  right  to  inler,  that  gaseous  evolutions  will  take  place  by  the 
action  of  heat;  and  experience  but  too  plainly  tells  us,  that  wherever  certain  con- 
ditions are  present  within  the  tropics,  there,  in  general,  disease  is  mo^t  rife.  It 
will  no  doubt  be  said  that  we  have,  as  yet,  no  chemical  evidence  of  the  existence 
of  malaria.  But  because  its  precise  nature  is  unknown  to  us,  are  we,  in  the 
face  of  such  destructive  results,  to  deny  its  being'?  We  may  just  as  well  say, 
small-pox  and  other  exanthemata  cannot  be  propagated  through  the  medium  of 
the  atmosphere,  although  the  constitution  of  their  poisons  has  not  as  yet  been 
recognised  by  any  '  chemist  or  physiologist.' 

"  Provided  that  men  have  not  been  for  a  considerable  time  exposed  to  the  nox- 
ious exhalations  within  rivers,  it  seems  abundantly  evident  that  their  effects  are 
in  a  great  measure  counteracted  by  the  air  of  the  open  sea. 

"In  November,  1838,  H.  M.  S.Piladcs,  (a  ship  remarkable  for  her  general 
salubrity,)  under  the  command  of  Captain  William  L.  Castle,  had  occasion  to 
be  in  the  Bonny  about  forty-eight  hours ;  several  of  her  crew  were  attacked  with 
fever,  soon  after  leaving  tlie  river,  but  they  speedily  recovered  on  the  passage  to 
Saint  Helena,  to  which  island  the  ship  was  ordered.  Capt.  Castle  has  observed 
similar  results  in  other  ships  during  along  period  of  service  on  the  west  coast. 
*********  ** 

"From  these  and  numerous  other  instances,  it  would  appear  that  the  action  of 
miasma  is  quite  analogous  to  that  of  other  poisons,  inasmuch  as  its  injurious  ef- 
fects is  in  proportion  to  the  amount  taken  into  the  system.  By  remaining  long  in 
rivers,  the  quantity  imbibed  will  be  very  commonl}'  sufficient  to  destroy  life,  while 
a  short  stay  in  such  localities  will  only  produce  a  temporary  disorder  of  the  func- 
tions." 


ld-15.J  Medical  InicUigence.  47 


MEDICAL  INTELLIGENCE. 

Death  of  Dr.  Forry,  Editor  of  the  Nev:-York  Journal  of  MjJicinc.  It  is  with 
deep  regret,  that  we  are  thus  early  in  the  discharge  of  our  Editorial  dulics,  called 
upon  to  record  the  death  of  one,  who  had  promised  so  much  to  our  Profession. 
Dr.  Samuel  Forry,  the  editor  of  one  of  the  Journals  reviewed  in  another  part 
of  this  No.,  was  no  ordinary  man.  His  position  in  our  Army,  and  particularly 
his  station  at  Washington  City,  though  but  for  a  brief  period,  gave  him  oppor- 
tunities, which  he  industriously  improved,  and  subsequently  enabled  him  to 
publish  in  quick  succession,  a  work  on  the  Climate  of  the  United  States,  Statis- 
tical Reports,  and  many  other  articles.  His  last  labors  with  the  pen,  were 
crowned  by  the  Prize  of  the  Eoylston  Medical  Committee  of  Plarvard  Univer- 
sity, on  the  subject  of  vaccination  and  re-vaccination.  At  the  early  age  of 
thirty-three,  he  has  been  called  awa)^  from  the  busy  scenes  of  life  and  usefulness. 

A  meeting  of  the  Profession,  we  see  by  the  papers,  was  held  in  the  city  of 
New- York,  and  after  the  passage  of  Resolutions  appropriate  to  the  melancholy 
occasion,  a  committee  was  appointed  to  superintend  the  erection  of  a  monument 
to  his  memory,  and  a  gentleman  of  the  profession  selected  to  deliver  a  public 
Eulogy  on  the  deceased. 


We  offer  no  apolog}'  to  our  readers,  for  inserting  the  following  interesting 
letter,  from  our  young  and  talented  friend.  Dr.  Cumming,  now  of  Amoy,  (China.) 
This  is  an  answer  to  a  request  to  contribute  to  the  pages  of  the  Medical  Journals 
of  our  country ;  and  we  hope  in  a  few  months,  to  be  in  the  regular  receipt  of 
valuable  articles  and  information  directly  from  abroad. 

"In  your  letter,  5'ou  request  me  to  send  home  accounts  of  our  medical  opera- 
tions. Up  to  this  time  there  has  been  so  little  of  order  and  method  in  my  practice, 
that  I  have  had  few  op^wrtunities  of  observing  cases  long  enough  and  well  enough 
for  description.  Of  the  history  of  the  cases,  there  is  often  little  or  nothing  known 
by  the  patients.  They  seem  to  forget  the  dates  and  peculiarities  of  their  disor- 
ders with  the  greatest  facility.  But  as  we  learn  more  of  the  language,  this  diffi- 
culty will  be  diminished,  as  we  may  do  much  towards  refreshing  their  memories 
by  pertinent  questions.  As  yet,  all  description  must  be  most  general.  The  most 
common  of  all  the  disorders  is  Gastralgia  (generally  complicated  M-ith  PjTosis) 
 of  388  new  cases  received  during  February  and  March,  there  were  G8  of  this 
disease,  13  of  simple  Indigestion,  9  of  simple  Pyrosis,  making  90  affections  of 
the  stomach.  Of  Coughs  (principally  Bronchitis)  50,  Asthma  15,  Rheumatism 
17,  Pains  (from  falls,  &c.)  18,  of  affections  of  the  skin  20,  and  miscellaneous 
medical  cases  23.  Of  Keratitis  32,  Conjunclivitis  25,  Blepharitis  18,  Opacity 
of  Cornea,  14,  Trichiasis  G,  Iritis  3,  Staphyloma  of  Iris  3,  miscellaneous  affec- 
tions of  the  Eye  7,  (of  whicfi  one  of  melanosis)  Eye  cases  108;  Syphilis  17,  other 
affections  of  the  genital  organs  5,  Otitis  3,  Ulcers  8,  miscellaneous  medical  ca- 
ses 8.  Of  all  these  diseases,  the  acute  inflammations  of  the  eye  and  tlie  affec- 
tions of  the  stomach  are  most  frequently  cured.  For  the  former  we  cup,  purge, 
blister  and  anoint.  I  have  recently  been  much  pleased  with  an  ointment  of  Sul- 
phate of  copper  I  use  from  8  gr.  to  16  gr.  per  ounce  of  lard.  For  Gastralgias, 
&c.  we  have  almost  a  specific  in  a  preparation  of  pepper  5  parts,  and  rhubarb  6 
parts:  we  make  133  pills  of  an  ounce  of  this  mixture,  and  give  six  pills  daily, 
2  an  hour  before  each  meal;  it  has  done  admirablv  thus  far,  (nearly  two  years.) 
For  the  Cough,  we  use  Ipecac  or  Tartar  oiii!^ti<'  pill"^,  with  some  success  (12  gr. 


4S  Medical  In!clligcnce,  [January, 


of  the  former  or  3  of  the  latter,  in  twelve  doses  daily.)  Many  cases  of  Asthma 
are  much  relieved  by  Belladonna  and  Ipecac  pills.  For  Rheumatisms  we  blister 
and  give  Dover's  powders.  For  Syphilis,  corrosive  sublimate  pills  1-6  gr.  each, 
l)eginning  with  two  a  day  and  going  on  to  ten.  In  cases  of  Opacity  of  Cornea, 
w^e  blow  into  the  eye  a  mixture  of  sugar  candy  and  red  precipitate,  finely  pow- 
dered this  is  done" from  two  to  six  times  daily.  In  these  we  are  quite  successful. 
Of  Hydroceles,  vre  see  a  great  many  I  punctured  two  to-day,  bat  our  patients  are 
generallj'  satisijcd  with  having  it  emptied,  go  away  ver}^  much  rejoiced  and  never 
comeback,  AVe  have  quite  a  number  of  misceiraneous  surgical  cases,  such  as 
whitlows,  abscesses,  wounds  (especially  among  the  sailors)  bruises,  &c.  &c, 

"1  suppo.->3  that  yon  have  heard  that  Dr.  HKPBURN,of  the  Presb}lerian  Board, 
came  here  in  November.  He  is  fast  picking  up  the  language,  and  is  a  good  deal 
interested  in  medical  matters.  We  rented  two  houses  in  x4mo)^  about  the  end 
of  the  year,  and  I  came  over  the  1  Dth  January.  Since  the  opening  of  our  Dis- 
pensary here,  we  have  many  more  patients  than  before.  Since  tlw  beginning  of 
February,  Dr.  H.  and  I  have  liad  more  than  5G0  new  cases,  averaging  10  dailj'  
they  are  also  of  a  more  interesting  kind  than  formerly,  there  being  a  far  larger 
proportion  of  acute  cases.  Our  Dispensary  consists  of  a  front  room  42  by  21, 
in  which  the  patients  arc  seated,  and  a  back  room  18  by  21,  in  which  are  our 
medicines  and  in  which  we  carry  on  our  operations.  We  have  two  Assistants 
{Chinese  servants)  who  can  cupj  spread  blisters,  &c.,  make  pills  and  help  us  in 
many  ways,  I  am  desirous  of  getting  three  or  four  youths  trained  as  regular 
Assistants;  with  these,  Ave  could  accomplish  far  more  than  at  present.  My 
teacher  thinks  of  learning  the  business.  Of  medicines  we  have  had  a  pretty 
good  supply,  and  we  expect  that  Mr.  Boone  will  make  permanent  arrangements 
on  this  point.  We  are  even  now  looking  out  for  a  stock  just  arrived  from  the 
United  States.  We  have  opened  a  Hospital  also,  principally  for^ases  of  Cata- 
ract. We  have  room  for  50  patients,  but  have  now  only  eight.  If  we  succeed 
in  our  first  operations  for  cataract,  I  think  that  we  shall  have  multitudes  of  cases. 
What  v.^e  need  is  skill,  and  if  we  acquire  that,  vv'c  may  do  a  great  deal  of  good. 
In  time,  I  have  no  doubt  that  we  shall  be  able  to  send  home  some  interesting  ar- 
ticles, but  it  will  take  considerable  additions  to  my  knowledge  both  of  medicine 
and  Chinese,  before  such  memoirs  can  have  much  value. 

"  Our  Missionary  Medical  body  in  China  is  increasing  in  number  A  Dr. 
McCauter,  of  New- York,  has  recently  arrived,  sent  out  by  the  Presbyterian 
Board,  with  a  Printer.  We  learn  from  home,  tjiat  Mr.  Boone  hopes  to  bring 
out  a  number  of  new  Missionaries  they  will  be  welcome,  for  they  are  much 
needed.  Dr.  MgGowan,  of  the  Baptist  Board,  expects  to  settle  at  IN'ingpo  he 
was  there  during  the  winter,  and  had  many  patients.  As  soon  as  vve  can  have 
access  to  the  neighboring  cities,  we  shall  have  an  immense  field  for  medical 
practice;  andl  thinkit  likely  that  we  should  be  tolerated  where  no  one  else  would. 
Within  forty  miles  from  Amoy,  there  are  probably  more  than  three  millions 
of  people  How  fine  a  field  for  medical  enterprise  '/  Amoy  might  be  made  the 
central  station,  from  which  medicines,  &c.  could  be  forwarded  from  other  places. 
In  a  few  years  there  will  be  ample  employment  for  scores  of  physicians.  And 
if  we  hope  to  raise  up  men  among  the  Chinese  to  practice  the  healing  art,  we 
cannot  expect  that  three  or  four  teachers,  having  their  hands  full  of  work,  v.ill  be 
able  to  do  much.  If  those  Christians  who  complain  that  they  can  find  nothing 
to  do  as  physicians  at  home,  would  come  hither,  their  complaints  would  soon 
cease.  And  for  men  anxious  to  learn,  here  is  a  fme  opportunity.  If  we  had  the 
funds  for  a  large  hospital,  we  could  easily  keep  it  full.  By  feeding  the  patients, 
we  could  keep  them  as  long  as  v/e  desired,  and  by  judicious  selection  we  could 
soon  beat  any  hospital  in  Europe,  for  we  have  a  population  around  us,  and  an 
absence  of  competition  which  would  draw  hither  all,  of  medical  importance  for 
many  leagues  in  the  interior,  so  that  La  Charite  and  L'Hotel  Dieu  of  Paris, 
would  be  completely  eclipsed.     May  that  day  come." 

^;^  Subscribers  to  the  Sonthcni  Mcdicol  and  Sur^rical  Journal,  will  recognise 
in  this,  (with  the  old  scries)  the  commencement  of  the  4th  Vol.  and  of  the  whole 
Nos.  the  37th, 


SOUTHERN 

MEDICAL  AND  SURGICAL 

JOURNAL. 


Vol.  I.]  NEW  SERIES. FEBRUARY,  1845.  [No.  2. 

PART  I. ORIGINAL  COMMUNICATIONS. 

ARTICLE    I. 

Remarks  on  the  Pathology  and  Treatment  of  Convulsions,  By 
L.  A.  DroAs,  M.  D.,  Professor  of  Physiology  and  Pathological 
Anatomy,  in  the  Medical  College  of  Georgia, 

The  announcement  by  M.  Trousseau  of  a  new  method  of  arrest- 
ing  Convulsions,*  furnished  me  with  an  opportunity  of  making  a  few 
remarks  on  the  Pathology  of  those  affections,  in  the  second  volume 
of  the  Southern  Medical  and  Surgical  Journal,  p.  546,  published  in 
1838.  The  following  article  is  designed  as  an  extension  of  the  views 
then  presented. 

The  term  Convulsion,  in  its  most  extended  sense,  has  been  applied 
to  all  morbid  contractions  of  the  muscular  fibre.  Thus  considered,  it 
comprehends  all  the  degrees  of  disordered  action  to  be  found  between 
the  two  extremes  of  mere  tremor  and  permanent  contraction.  And, 
Avere  the  etymology  of  the  term  not  adverse  to  this  acceptation,  there 
would  be  a  manifest  convenience  in  its  adoption,  for,  as  will  be  seen 
in  the  sequel,  all  these  degrees  of  disordered  action,  may  be  regarded 
as  mere  manifestations  of  as  many  degrees  of  the  same  condition  of 
the  nervous  system,  or  rather  of  innervation.  Being,  however,  in 
possession   of  no  term  adequate  to  the  expression  of  all   these  phe- 


*  JoTirnal  de?  Connaissanccs  M^dico-Chinirgicalr^,  1837. 

4 


50 


Pathology  and  Treatment  of  Convulsions,      [February, 


nomcna,  and,  looking  to  the  true  import  of  the  word  Convulsion,  it 
should  be  restricted  to  designate  all  abnormal  series  of  alter Ji ate  con- 
tractions  arid  relaxations  of  the  muscular  fibre.  It  is  in  this  sense 
we  shall  use  it. 

Distinctive  appellatives  have  been  assigned  to  convulsions,  accord- 
ing to  the  various  circumstances  under  which  they  may  occur  ;  hence 
we  have  convulsions  termed  infantile,  puerperal,  hysterical,  epileptic, 
hydrophobic,  d:c.  It  is  evident,  however,  from  our  definition,  that  we 
comprehend  under  the  denomination  of  convulsions,  all  abnormal 
series  of  alternate  contractions  and  relaxations^  without  regard  to  the 
number  of  muscular  fibres  implicated,  nor  to  the  degree  oi  violence 
with  which  they  are  afTected.  We  therefore  recognize  as  convul- 
sions, local  as  well  as  general  contractions,  and  tremors  as  well  as 
epilepsy.  Indeed,  when  examined  with  the  lights  furnished  by 
modern  physiology,  they  arc,  as  already  remarked,  really  but  difTer- 
ent  degrees  of  the  same  modification  of  innervation. 

Of  the  classifications  of  the  afTeciions  of  the  motor  system  proposed 
by  the  several  Nosologists,  that  of  Sauvages  appears  the  least  objcc- 
tionable.  I  will  therefore  insert  it  here  for  the  purpose  of  subsequent 
reference,  and  offer  one  of  my  own,  in  which  it  is  simply  attempted  to 
supply  the  deficiencies  of  that  of  this  distinguished  Nosologist. 


Classificatio^^ 

BY  Sau^ 

"AGES 

m  Class- 

-Spasms. 

\st  Order- 

Partial  tonic  spasms. 
Strabismus. 
Trismus. 
Wry-neck. 
Muscular  stiff-joint. 

Pandiculation. 

Apomyttosis. 

Trembling. 

Palpitations. 

Claudication. 

Cramp. 

ith  Or^er General  Clonic  spasms. 

Priapism. 

Rigor. 

ed  Order- 

-General  tonic  spasms. 
Tetanus. 
Catalepsy. 

Eclampsia. 

Epilepsy. 

Hysteria. 

Zd   Order- 

-Partial  Clonic  spasms. 
Nystagmus. 
Carpholog}'. 

Chorea. 
Beribery. 

Classification  i 

3yL. 

A. 

DUGAS. 

Affections  of  the 

Motor 

Si/s 

'evi. 

lit  Order- 

-Partial  Tonic  spasms. 
Strabismus. 
Trismus. 
Wrv-neck. 
Muscular  stiff-joint. 
Priapism. 

of  small  intestines. 

"  large  intestines. 

"  rectum. 

"  urinary  bladder. 

"  uterus. 

"  gall  bladder. 

'  heart. 

Cramp, 

of  voluntary  muRcle*. 

"  diaphragm. 

"  tomach.' 

1845.] 


Pathology  and  Treatment  of  Convulsions, 


51 


2d  Order  General  Tonic  spasms. 
Tetanus. 
Catalepsy. 
3i  Order  Partial  Clonic  spasms. 

N)'stagmus. 

Carphology. 

Gaping. 

Palpitations. 

Claudication. 

Sub-sultus  tendinum. 

Twitching  of  facial 
muscles. 

Stammering. 

Hiccough. 

Sneezing. 

Pertussis. 

Vomiting. 

Spasmodic  croup. 

Spasmodic  asthma. 

Laughing. 


Sobbing. 

Sighing. 

Coughing. 

Abortion. 

Grinding  the  teeth. 
Uh  Order  General  Clonic  spasms. 
Shudder. 
Rigor. 
Trembling. 
Jactitation. 
Chorea. 
Shaking  Palsy. 
Raphania. 
Beribery. 
Eclampsia. 

infantile, 
hysterical, 


puerperal, 

hydrophobic, 

epileptic. 


The  causes  of  convulsions  may  with  great  propriety  ])e  divided  into 
the  predisposing  and  exciting.  The  former  are  eitlier  congenital  or 
acquired.  That  the  congenital  predisposition  to  convulsions  may  be 
hereditary  does  not  admit  of  a  doubt,  as  the  observation  of  all  practi- 
tioners will  attest.  No  children  are  so  subject  to  these  affections  as 
those  born  of  parents  similarly  predisposed ;  hence  the  offsprings  of 
hysterical  mothers  are  singularly  prone  to  convulsions.  There  are 
many  instances  of  this  peculiarity  being  transmitted  to  several  succes- 
sive generations,  and  of  mothers,  all  of  whose  children  have  fallen  vic- 
tims to  it.  The  congenital  predisposition  is,  however,  not  always  the 
effect  of  hereditary  transmission,  for  it  is  not  uncommon  to  find  chil- 
dren extremely  susceptible  to  convulsions,  when  no  such  susceptibility 
could  be  recognized  in  their  parents.  The  undue. preponderance  of 
the  nervous  system,  and  a  general  deficiency  of  tonicity  or  stamina 
may  usually  be  observed  in  such  individuals.  According  to  Jolly,* 
*  all  the  physiological  and  pathological  conditions  that  increase  the 
susceptibility  of  the  brain  to  respond  to  external  irritations,  are  cffi- 
cient  causes  of  convulsions."  Baumes,  who  has  certainly  written 
the  best  practical  work  en  infantile  convulsions,  holds  the  followin"" 
language:!  "'Jhe  mobility  of  the  system  is  in  a  direct  ratio  with 
the  feebleness,  laxily  and  delicacy  of  the  various  parts  of  the  living 
body.     Upon  these  evident  peculiarities  depend  the  extreme  reaction 


  Diet,  de  Med.  et  dc  chir.  Pratiques,  art.  convulsion.*!. 

+  Translated  from  p.  21  of  the  "Traits  dcs  convulsions  dans  I'cnfar.rr,  par  M. 

FisnnT'*!.     Omp.  r  Htton      Pan'?,  lf^O.'>. 


62  Pathology  and  Treatment  of  Convulsions,      [Februnry, 


of  the  sensorium,  (lie  great  susceptibility  of  the  nerves,  and  the  undue 
mobility  of  the  muscles."  It  is  to  this  mobility  of  the  system,  conse- 
quent on  the  deficient  powers  of  resistance  peculiar  to  all  newly 
formed  tissues,  that^vc  may  refer  the  greater  susceptibility  of  children 
than  adults  to  convulsions,  and,  in  proportion  to  the  difference  be- 
tween  the  full  development  of  energy  and  stamina  in  the  male  and 
female  adult,  will  be  found  the  disposition  to  such  disorders.  Femalea 
are,  in  general,  therefore,  more  subject  to  them  than  males ;  and 
those  reared  under  the  enervating  influence  of  city  life,  of  sedentary 
habits,  &;c.  still  more  so. 

It  has  been  remarked,  that  it  is  during  the  period  of  the 
evolution  of  the  body,  when  new  tissues  are  being  formed,  that  the 
system  presents  the  greatest  degree  ofsusceptibility,  and  is  therefore 
most  liable  to  convulsions.  This  is  no  doubt  correct ;  but  it  is  also 
urged  by  some  that  in  females  tliis  period  may  be  said  to  continue 
much  longer  than  in  males,  inasmuch  as  even  after  the  full  develop- 
ment of  her  own  system,  the  form-ation  of  new  tissues  is  continued  in 
the  production  of  new  beings  in  the  evolution  of  the  fcetus  in  utero. 
This,  however,  can  scarcely  be  adduced  as  a  reason  of  their  greater 
aptitude  to  convulsions,  (or  it  isto  the  imperfect  solidification  or  tonicity 
of  newly  formed  tissues,  especially  the  nervous,  that  this  aptitude 
should  be  attributed,  and  not  to  the  act  of  formation.  At  the  same 
time  that  the  mother  contributes  the  elements  of  new  tissues  to  her 
oflspring,  her  own  tissues  cannot  be  said  to  undergo  any  special 
modification,  save  in  the  uterus.  Unless,  therefore,  the  mere  devel- 
opment of  the  uterus  under  impregnation  be  regarded  as  a  process  of 
evolution,  similar  to  that  of  growth,  the  argument  cannot  be  valid. 
Yet  it  is  true,  that  females  are  more  subject  to  convulsions  during 
pregnancy  than  during  any  other  portion  of  their  adult  life,  and  that 
they  cease  to  be  so  after  the  cessation  of  child-bearing.  It  is  a  re- 
markable fiict  that  the  disposition  to  convulsive  afi^ections  decreases 
rapidly  after  this  period,  and  that  the  aged  of  both  sexes  scarcely  ever 
suffer  from  them  Baumes  says  ihey  never  do.* 

The  predisposition  to  convulsions  may  be  acquired  by  any  train  of 
circumstances  calculated  to  retard  or  to  impair  the  solidification  and 
perfection  of  the  tissues,  and,  consequently,  the  acquisition  of  strength 
and  stamina.  Acute  and  chronic  diseases,  atmospheric  vicissitudes, 
insufScient  or  unwholesome  food  and  raiment,  deficient  ventilatioD, 


*  Op.  cit.  p.  19. 


1845.]  Pathology  and  Treatment  of  Convulsions.  59 


want  of  exercise,  &c.  are  among  the  most  common  causes  of  this  ac- 
quired habit. 

The  exciting  causes  are  as  numerous  as  the  agents  capable  of 
disturbing  the  function  of  innervation.  These  might,  according  to 
Hippocrates,  be  summed  up  under  the  head  of  repletion  and  deple- 
tion. Thus:  "  Convulsio  fit,  aut  a  repletione,  aut  ab  dcpletione.'"* 
To  which  Galex,  in  commenting  on  this  aphorism,  very  properly 
adds  irritation.  Convulsions,  however,  occur  under  circumstances 
that  cannot  be  referred  to  either  of  these  heads.  They  may  be  occa- 
sioned, for  example,  by  peculiar  odors,  musical  or  harsh  sounds, 
affecting  sights,  &c.;  nay,  even  by  the  workings  of  imagination,  as 
was  strikingly  exemplified  by  the  fanatical  sect  of  Convulsionisls  of 
St.  Mcdard,  who,  in  their  meetings,  frequently  went  into  violent  con- 
vulsions. Indeed  the  same  may  be  occasionally  seen  in  our  own 
time  and  country  under  a  somewhat  similar  state  of  the  mind. 

But  direct  or  indirect  irritation  of  the  nervous  system  is  by  far  the 
most  common  exciting  cause  of  convulsions.  In  using  the  term 
irritation,  it  may  be  well  to  state  that  we  do  not  thereby  wish  to 
designate  one  of  the  stages  of  inflammation,  but  merely  an  impression 
which,  when  perceived,  is  followed  by  a  perturbation  of  some  of  ths 
acts  of  the  economy.  Now,  whilst  sensations  are  usually  but  tlio 
perception  of  impressions  made  on  the  tissues  by  some  mechanical 
or  physical  agent,  there  are  sensations  developed  within  the  system 
independently  of  any  antecedent  impression  that  we  can  detect.  
Hence,  the  latter  are  denominated  internal  sensations,  and  their 
cause  is  said  to  be  physiological  or  functional.  Let  the  nostrils  be 
titilated  by  a  feather,  the  mechanical  irritation  is  immediately  per- 
ceived, or  a  sensation  is  produced,  and  this  is  followed  by  a  sudden, 
convulsive  action  of  certain  muscles,  constituting  sneezing.  The 
convulsions  will  then  intermit  and  return  again,  until  the  cause  of 
irritation  be  removed.  Yet  sneezing  will  as  cff.ctually  be  produced 
by  the  irritation  of  the  lining  membrane  of  the  nostrils  consequent 
on  a  modification  of  its  capillary  circulation,  as  occurs  in  commen- 
cing coryza.  Here  we  have  an  instance  of  internal  or  functional 
sensation,  the  irritation  being  independent  of  any  mechanical  or 
physical  impression.  In  like  manner,  vomiting  may  be  excited  by 
irritating  the  fauces,  and  by  functional  disorder  of  the  btomich  ; 
laughing   may  be  the  effL*ct  of  tickling  or  of  a  physiological  condi- 


  Aphor.  30  sec.  vi. 


54  Pathology  and  Treatment  of  Convulsions.      [February, 


tion  of  the  brain,  or  of  the  morbid  state  of  the  system  termed  hyste- 
ria. What  is  true  in  those  cases,  is  equally  so  with  regard  to  more 
violent  convulsions.  These  may  likewise  be  occasioned  by  mechan- 
ical and  by  functional  irritations,  by  thn  pressure  of  a  tooth  making 
its  way  through  the  gums,  by  the  presence  of  indigestible  food  in 
the  stomach,  by  worms  in  the  intestines,  as  well  as  by  spontaneous 
gastric  or  intestinal  irritation.  'J'raumatic  causes  as  well  as  occult 
ones,  will  induce  epileptic  convulsions  ;  and  intermittent  fever,  in 
which  there  is  always  more  or  less  spinal  irritation,  may  be  attended 
by  all  the  grades  of  convulsion,  from  the  tremors  of  the  cold  stage 
to  the  most  violent  eclampsia.  It  is  a  singular  fact  that  the  violence 
of  convulsions  is  by  no  means  in  a  direct  ratio  to  the  violence 
of  the  apparent  irritation,  the  slightest  wounds  occasionally  giving 
rise  to  violent  tetanus,  and  lesions  so  mild  as  to  escape  detection, 
causing  epilepsy  and  eclampsia. 

'J'he  tendency  of  the  age  is  to  the  localization  of  maladies,  and  whilst 
we  would  be  among  the  furemost  in  acknowledging  the  immense  ben- 
efits which  have  accrued  to  the  science  of  medicine  by  this  course,  we 
must  confess  that  in  the  study  of  convulsions  it  has  rather  misled 
certain  a  ithorities,  otherwise  entiiled  to  much  respect.  The  chief 
purpose  of  Buaciiet,  in  the  preparation  of  his  valuable  monograph 
on  infantile  convulsions,*  appears  to  have  been  the  demonstration  of 
the  existence  of  lesions  in  the  brain,  and  especially  of  its  meninges 
in  the  great  majority  of  convulsive  alToclions.  Among  the  various 
authorities  he  invokes  in  support  of  his  views,  we  find  Portal,  who, 
in  summing  up  the  lesions  of  the  encephalon,  detected  in  cases  in 
which  convulsions  had  occurred,f  enumerates  1st,  the  collection  of 
air,  water  and  gelatinous  matter;  2J,  congestion  of  the  blood-vessels 
or  sanguineous  cflusions  ;  3d,  engorgements  composed  of  various  sub- 
stances; 4lh,  inflammation;  5ih,  induration;  6th,  abscesses;  7th, 
ulcers;  8th,  wounds;  9th,  foreign  bodies;  10th,  increased  or  dimin- 
ished volume;  ilth,  change  of  color,  &c.  But  Postal  takes  care 
to  remark  that  those  lesions  are  not  peculiar  to  convulsions.  Bka- 
ciiET  also  cites  a  niunber  of  cases  from  Morgagni,:j:  LALLEJIA^DJ| 
Abercrombie,  Andral,^  &c.,  in  many  of  which  it  is  by  no  means 
demonstrated  that  the  lesions   were   not  ratlier   the  effect  than  tho 


*  Traite  Prat,  des  Convuls.  dans  I'enfance,  par  J.  L.  Brachet,  2me.  6cl.  Psrip, 
1837.        t  Anatomie  Medicale.     T.  iv.  p.  69  et  seq. 
X  De  sedibus  et  causis  rnorb.  Tome  1,  epi^t.  x.        II  Lcttrcss'.:r  Tcncr-jhrJe. 
SDi.sGcises  of  the  Brain,  &c.        U  Clinique  Medicale. 


1845.]  Pathology  and  Treatment  of  Convulsions.  66 


cause  of  the  convulsions.  The  congestions  and  effusions,  for  in- 
stance, so  frequently  found  in  post-mortem  examinations,  may 
assuredly  be  the  fffect  of  the  convulsions,  inasmuch  as  these,  when 
violent,  always  produce  intense  congestion  of  the  organs  contained 
in  the  cranium  and  spinal  column.  So  far  then  from  considering 
these  lesions  as  the  cause  of  the  convulsions,  we  should  expect  to 
find  them  as  a  necessary  consequence  of  such  disorders.  That  the 
inference  drawn  from  these  cases  is  not  always  legitimate,  will 
appear  from  the  first  of  the  series  he  adduces.     It  is  taken  from 

MoRGAGM,  and  is  as  follows  ; 

* 

"Obs.  xlvii.  A  girl  five  months  old  was  taken  with  fever  and 
looseness  of  the  bowels.  The  following  day  the  fever  alone  persisted. 
The  third  day  she  was  seized  with  strong  chronic  convulsions  of  the 
upper  extremities,  extending  with  less  intensity  to  the  muscles  pos- 
terior to  the  chest,  and  still  less  to  the  glutei  muscles.  Towards  the 
end  of  the  fifth  day,  the  convulsions  diminished,  were  manifested 
only  at  intervals,  and  were  entirely  suspended  when  the  child  slept. 
Universal  jaundice  now  supervened. 

"After  death,  the  entire  surface,  but  especially  that  of  the  hack, 
presented  dark  red  blotches.  In  the  abdomen,  nothing  remarkable 
was  discovered,  save  that  the  rectum  was  of  a  biaolc  color.  The 
pericardium  was  filled  with  yellow  fluid  ;  the  rigiit  ventricle  of  the 
heart  contained  polypous  concretions  which  extended  into  the  pul- 
monary  artery,  and  which  resembled  concrete  mucus.  The  blood 
every  where  else  was  liquid,  but  slowly  coagulated  when  exposed  to 
the  air.  Within  the  cranium  all  was  natural,  with  the  exception  of 
a  seroili  humour  found  between  the  dura  mater  and  pia  mater,  and 
which  had  formed  concretions  around  the  blood  vessels,  in  the  form 
of  gelatine." 

In  this  case,  Braciiet  thinks  the  convulsions  were  manifestly 
caused  by  meningitis.  Was  there  not  also  in  this  case  intense  dis- 
order of  the  rectum  and  of  the  biliary  apparatus?  Was  there  not 
an  effusion  in  the  pericardium  as  well  as  in  the  cranium?  And  if 
effusions,  (as  our  author  seems  to  think,  but  to  which  we  cannot  ac 
cede.)  be  indicative  of  irritation,  why  not  admit  it  also  to  have  existed 
in  the  pericardium  as  well  as  in  the  meninges? 

If  it  be  borne  in  mind  that  Braciiet  derives  almost  all  his  cases 
from  special  works  on  diseases  of  the  brain,  the  following  passage 
will  no  longer  excite  surprise:*  "I  will  not  quote  a  greater  number 


  Translated  from  op.  cit.  p.  345. 


66  Pathology  and  Treatment  of  Convulsions,      [February  


of  autopsic  examinations.  Had  I  added  even  many  more,  tlic  result 
would  have  been  the  same.  They  would  all  have  presented  the  same 
lesions:  congestions,  inflammations,  abscesses,  membranous  or  gela. 
tinous  productions,  tubercles,  hydatids,  osseous  deposits,  &;c."  Yet 
he  unwittingly  exposes  the  bias  under  which  Morgagni's  cases  were 
drawn  up  in  the  following  paragraph:*  "This  celebrated  author 
(Morgagni)  is  so  well  convinced  that  convulsions  depend  on  menin- 
geal irritation,  that,  wherever  he  does  not  discover  traces  of  inflam- 
mation, he  considers  as  a  sufficient  cause  of  irritation  the  small 
quantity  of  serous  matter  found  in  the  ventricles,  and  announces  that 
we  are  not  to  judge  ofirritating  causes  by  their  quantity,  but  by  their 
power,  and  finally  admits  that  this  serous  matter  possesses  an  acrid 
irritating  property." 

Believing  convulsions  to  be  symptoms  and  not  special  diseases,  the 
only  advantage  we  can  perceive  in  these  attempts  to  localize  it,  ia 
the  collection  of  facts  that  may  be  used  to  establish  the  relative  pro- 
portions of  the  various  exciting  causes  of  those  phenomena.  The 
predisposition  to  convulsions  might  we  think  be  regarded  with  much 
iftore  propriety  as  a  special  disease  than  the  exciting  causes,  for  with- 
out that  condition  of  the  system,  the  same  irritation  will  not  excite 
convulsions. 

Let  us  now  analyze  the  phenomena  presented  during  a  paroxysm 
of  convulsions,  and  in  order  to  do  so  the  more  eflfectually,  let  us  select 
hysterical  eclampsia,  or  epilepsy.  The  individual  is,  to  all  appear- 
ances, in  the  enjoyment  of  perfect  health,  when  more  or  less  sudden- 
ly, he  falls  to  the  ground  with  violent,  though  intermittent,  contrac- 
tions of  all  the  muscles  of  animal  life,  and  with  loss  of  consciousness. 
I  say  with  loss  of  consciousness,  rather  because  such  appears  to  be 
the  case,  than  from  a  settled  conviction  that  consciousness  is  abolished 
at  the  onset  of  the  attack.  The  mere  facts  that  the  patient  cannot 
then  manifest  consciousness,  nor  remember  after  the  paroxysm,  v.'hat 
has  occurred,  should  not  satisfy  us  on  this  point,  inasmuch  as,  in  tho 
first  place,  he  has  lost  the  control  of  the  organs  (the  muscles)  by 
which  he  could  express  consciousness,  and  in  the  second  we  have 
continually  instances  in  which  circumstances  taking  place  without 
any  apparent  deterioration  of  this  faculty,  are  not  remembered  a 
short  lime  afterwards.  Be  this  as  it  may  at  the  onset  of  a  par- 
oxysm of  epilepsy,  the  patient  soon  passes  into  a  state  of  stupor,  with 

  Op.  cit.  p.  329. 


18-15.]  Pathology  and  Treatment  of  Co niuhions,  57 


stertorous  breathing,  full,  strong  and  slo.v  pulso,  congestion  of  the 
superficial  veins  and  complete  relaxation  cf  the  muscles.  He  is  then 
unquestionably  unconscious,  and  will  remain  so  until  the  equilibrium 
of  the  circulation  be  restored.  Frothing  at  the  mouth,  symptoms  of 
asphyxia,  priapism,  defecation,  <5cc.  may  occur  or  notduring  the  con- 
vulsion, according  to  the  intensity  of  action  in  special  muscles.  If, 
at  the  moment  the  contractions  cease,  the  case  were  seen  by  one 
unapprised  of  the  antecedents,  it  would  certainly  be  regarded  as  pre- 
senting all  the  characteristics  of  apoplexy,  viz.  loss  of  consciousness, 
stertorous  breathing,  perfect  relaxation  of  m.uscles,  and  full,  strong 
and  slow  pulse.  The  stupor  gradually  subsides,  the  patient  breathes 
better,  begins  to  swallow  his  saliva,  groans,  turns  over  or  changes  his 
position,  and  finally  opens  his  eyes  and  asks  the  by-standers,  what  is 
the  matter?  lie  is  again  a  well  man,  with  the  exception  of  the  las- 
situde consequent  on  the  violent  exertions,  but  which  soon  wears  off. 
Such  is,  however,  not  the  termination  of  all  cases  of  convulsions.  It 
not  unfrequently  occurs  that  as  the  stupor  diminishes  and  conscious, 
ness  returns,  the  patient  v.iil  open  his  eyes,  look  about  as  though 
intending  to  speak,  and  immediately  be  again  seized  v  ith  convulsions 
as  before  ;  or  the  return  of  the  convulsions  may  take  place  after  the 
complete  restoration  of  intellect  and  voluntary  motions,  even  after 
b\\  traces  of  the  former  attack  had  disappeared;  or  they  may  termi- 
nate  Hitally. 

We  have  then,  manifestly,  in  violent  general  convulsions,  regard- 
less  of  their  cause,  two  distinct  stages  or  conditions  of  the  system 
the  one  a  state  of  violent  muscular  action,  and  the  other  of  tolal 
muscular  relaxation  the  one  a  state  of  high  excitement,  and  tho 
other  of  torpor.  Now,  whence  this  change?  Is  the  nervous 
system,  or  innervation  in  the  same  condition  during  these  two 
stages?  Certainly  not.  Can  the  same  cause  produce,  directly, 
effects  so  opposite?  I  apprehend  not.  The  explanation  is  found  in 
the  old  maxim,  that  irritation  causes  convulsions,  and  compression 
paralysis.  Whatever  be  the  immediate  cause  of  the  first  stage  of 
the  paroxysm,  the  phenomena  are  those  that  pertain  exclusively  to 
disordered  innervation,  to  a  modification  of  the  functions  of  tho 
nervous  system  that  may  be  induced  by  various  agents,  mechanical, 
chemical,  or  physiological,  acting  in  almost  any  portion  of 
the  system.  That  it  is  only  through  the  intervention  of  certain 
portions  of  nervous  system  that  such  phenomena  can  be  developed, 
will  be  subsequently  shown.     Tho  violent  contractions  then  may  bo 


59  Pathology  and  Treatment  of  Convulsions,      [February, 


assigned  to  a  modificalion  in  the  supply  of  nervous  influence  to  tlio 
muscles  affected.  But  we  have  seen  that  violent  and  general  con- 
vulsions  are  invariably  attended  by  a  stage  of  stupor,  stertorous 
breathing,  relaxed  muscles,  &;c.  This,  the  second,  or  the  apoplectic 
stage,  comes  on  more  or  less  early  in  the  attack,  according  to  its  in- 
tensity, usually  in  from  2  to  5  minutes.  The  more  violent  and  gen- 
eral the  convulsions,  the  sooner  will  the  second  stage  ensue,  and 
consequently  the  sooner  will  the  paroxysm  be  terminated  ;  whereas, 
if  the  convulsions  be  slight,  less  intense  or  partial,  the  apoplectic 
stage  of  stupor  may  be  much  longer  in  coming  on,  or  may  not  follow 
at  all.  In  such  cases  the  continuance  of  the  convulsions  varies 
from  a  few  minutes  to  hours,  and  even  days.  Partial  convulsions  or 
such  as  affect  only  a  portion  of  the  body,  are  those  which  usually 
continue  the  greatest  length  of  time,  and  are  very  rarely  attended 
with  unconsciousness  never  with  the  apoplectic  state.  Let  me  not 
be  misunderstood  :  I  am  aware  that  in  certain  cases  of  Eclampsia 
and  even  of  Epilepsy,  followed  by  the  stage  of  stupor,  or  apoplectic 
stage,  it  would  appear  that  there  is  hut  one  side  of  the  body  affected. 
Such  however  is  not  strictly  true  in  such  cases,  for,  although  the 
muscles  of  one  side  arc  more  violently  agitated  than  those  of  the 
other,  these  are  by  no  means  in  a  state  of  relaxation,  but  will  gen- 
erally be  found  quite  rigid.  I  repeat,  if  one  side  only  is  affected,  the 
other  being  in  a  normal  state,  there  will  be  no  apoplectic  stage  and 
the  convulsions  will  continue  for  an  indefinite  time.  These  remarks 
recall  to  my  memory  a  case  I  witnessed  about  two  years  since,  in 
which  the  lady's  entire  right  side,  including  the  right  side  of  tho 
face,  was  affected  with  strong  convulsions  for  several  hours,  without 
being  followed  by  stupor  nor  attended  with  impaired  intellect.  In- 
deed  she  retained  the  power  of  speech  and  deglutition  during  the  whole 
time,  crying  out  for  relief  and  swallowing  readily  the  remedies  pre- 
sented her.  Cases  more  or  less  similar  to  this  are  by  no  means  un- 
frequent  among  hysterical  females. 

If  it  be  now  asked  why  the  apoplectic  stage  occurs  in  general  a,nd 
not  in  partial  convulsions,  the  solution  is  quite  easy.  Examine  for 
a  moment  how  the  circulation  is  affected  under  these  circumstances. 
It  will  be  seen  at  once  tliat  whenever  the  muscles  are  violently  con- 
vulsed, the  blood  contained  in  the  muscular  as  well  as  intermuscular 
veins  must  be  forcibly  driven  out  and  accumulated  in  those  veins  so 
situated  as  to  be  exempted  from  the  compression.  These  are  found 
in  tho  surface  cf  the  body  and  wiihin  the  cavities  of  the  chest,  spine 


1815.]  Pathology  and  Treatment  of  ConiuWior.s.  50 


and  head,  and  observation  demonstrates  that  the  organs  of  the  chest, 
spine  and  liead  are  precisely  those  that  suffer  the  greatest  degree  of 
congcstiojj  under  such  circumstances.  Again,  the  act  of  respiration 
is  materially  impeded  by  the  fact  alone  of  its  muscles  and  those  of 
the  laiynx  being  affected.  This  impediment  then,  taken  in  connec- 
tion with  the  congestion  determined  as  remaiked  above,  will  accouut 
sufficiently  for  the  deficient  aeration  of  the  blood,  and  for  the  symptoms 
of  asphyxia  presented  during  violent  general  convulsions.  It  is  well 
known  that  asphyxia  is  always  attended  with  congestion  of  the  ner- 
vous centres  ;  so  that  we  have  \\cvq  two  conditions  of  the  system,  each 
tending  slrongly  to  accumulate  blood  in  organs  contained  within  un- 
yielding walls,  and  consequently  where  no  such  accumulation  can  take 
p'ace  without  compression  of  the  soft  pulpj  material  of  said  organs. 
The  nervous  centres  are  really  and  truly  compressed  in  this  manner, 
until  their  faculty  of  perception  as  well  as  that  of  dispensing  nervous 
influence  be  materially  diminished  or  even  irretrievably  destroyed. 
If  these  faculties  are  merely  diminished,  so  that  neither  the  cause  of 
the  convulsion  can  be  perceived  or  give  offence,  nor  the  muscles  be 
supplied  with  nervous  power  to  contract,  the  convulsions  will  cease, 
and  consciousness  wdl  gradually  return  as  the  congestion  subsides. 
If  the  cause  of  the  convulsion  still  continue,  however,  the  return  of 
consciousness  will  be  attended  with  a  return  ot  convulsions  thus 
constituting  the  alternations  of  convulsive  action,  apoplectic  stupor, 
recovery  and  relapse  already  described.  But  if  those  faculties  be 
entirely  abolished,  death  will  be  the  necessary  consequence. 

In  cases  of  slight  or  partial  convulsions  the  phenomena  of  conges- 
tion above  recited  must  necessarily  be  corresj)ondingly  slight  or 
partial.  Hence  the  nervous  centres  retain  the  perceptive  and  dispens- 
ing faculties  the  cause  of  convulsion  continuing  to  act,  continues  to 
give  offence  to  the  nervous  sensibilities,  and  innervation  continues  de- 
ranged. There  are  certainly  many  instances  in  which  the  cause  of 
the  convulsion  not  being  apparent,  we  cannot  perceive  that  it  has 
been  removed,  and  yet  the  convulsion  ceases.  May  we  not  admit 
that  the  perturbation  of  the  circulation  consequent  on  convulsions 
may,  of  itself,  so  modify  irritation  or  its  cause  as  to  lessen  its  inten- 
sity or  bad  effects?  Many  of  our  most  efficient  remedial  agents  act 
ill  this  way.  The  warm  bath,  cold  afiTusion,  diffusible  stimuli,  &c. 
may  be  regarded  as  modifying  the  capillary  and  general  circulation. 
Emotics  even  in  hysteria,  and  oth"r  osas  in  which  the  stomach 
cannot  be  considered   tho  seat   of  irritation,  constitute  one  of  our 


60  Pathology  and  Treatment  of  Convulsions,      [February, 


most  efleclive  means  of  arresting  convulsjicns,  and,  doubtless,  afford 
relief  by  the  great  perturbation  of  the  circulation  occasioned  by  the 
act  of  vomiting. 

The  study  of  the  pathology  of  convulsive  affections  demands  an 
acquaintance  with  the  physiology  of  the  organs  implicated.  These 
organs  are  the  muscles  and  those  portions  of  the  nervous  system  by 
which  they  are  supplied  with  nervous  iniluence.  The  muscles  them- 
selves, being  inert  when  cut  off  from  the  influence  of  the  nervous 
eystem,  it  becomes  highly  important  to  deteimine  the  laws  and  cir- 
cumstances under  which  such  influence  is  manifested.  These  have 
of  late  years  been  studied  with  great  success  by  Magendie,  Flour- 
ENS,  Sir  Chaeles  Bp:ll  and  JMarshall  Hall,  and  the  conclusions 
to  be  deduced  from  their  researches  will  be  very  briefly  slated.  The 
nervous  system  is  now  divided  into  three  very  distinct  and  well 
defined  portions ;  the  brain,  the  spinal  marrow,  and  the  ganglionic 
system;  and  to  each  of  these  portions,  ycry  distinct  functions  are 
assigned.  Tiie  brain  is  the  seat  of  perception  or  sensation,  of  voli- 
tion, and  of  trie  mental  faculties  ;  the  spinal  marrow  is  both  a  medium 
of  communication  with  the  brain,  and  an  independent  excito-motory 
apparatus;  the  ganglionic  system  presides  over  the  functions  of 
organic  life,  as  nutrition,  formation,  secretion,  &;c.  To  the  brain 
then  must  be  referred  all  the  abnormal  conditions  of  sensation,  of 
volition,  and  of  mind  pain  as  v/ell  as  paralysis,  perversions  as  well 
as  loss  of  the  will,  mental  aberrations  as  well  as  idiocy.  Lesions  of 
the  senses,  acts  of  violence,  insanity,  all  have  their  origin  distinctly 
in  the  brain.  Vivisections  clearly  demonstrate  that  injuries  inflicted 
on  the  brain,  induce  neither  pain  nor  muscular  contractions,  and, 
consequently  that  this  organ  is  endowed  with  neither  sensibility  nor 
the  vis  nervosa  of  Ilaller.  But  when  the  brain  is  irritated,  delirium 
ensues,  when  it  is  compressed  coma  follows,  and  when  destroyed 
paralysis  or  loss  of  voluntary  motion  is  the  consequence.  According 
to  Dr.  M.  Hall,  if  other  phenomena  accompany  diseases  of  the 
encephalon,  they  arise  ficm  the  extension  of  (he  influence  of  these  to 
the  true  spinal  and  ganglionic  systems,  through  irritation  or  pressure^ 
counter-irritation  or  count er-fres sure.  Let  us  here  be  permitted  to 
quote  the  learned  Doctor's  own  words  on  this  interesting  portion  of 
our  subject  :* 


  Mem.  on  some  Principles  of  Patiology  of  the  Nervous  system. 


1845,]  Pathology  and  Treatment  of  Convulsions,  61 


"  M.  Andral  speaks  of  irritation  of  the  cerebrum  ns  <hc  cause  of 
abnormal  muscular  contractions.  Now,  in  our  investifjaiions  into 
the  nature  ofcerebral  diseases,  we  must  remember  one  circumstance  ; 
it  is  impossible  to  induce  muscular  action  by  any  irritation  of  the 
substance  of  the  ccM-ehrum  itself.  Vr'henever,  therefore,  there  are 
s[)asmodic  affections  in  diseases  of  the  nervous  system,  we  must 
conclude  that  the  spinal  system  is  involved,  either  primarily  or 
secondarily,  in  the  disease.  Irritation  of  the  cerebrum  may  induce 
delirium  and  other  disorders  of  the  cerebral  functions;  congestion  of 
the  cerebrum  may  iudijce  co!na,  paralysis,  d:c.  Bat  if  these  morbid 
conditions  of  the  brain  be  attended  by  spasmodic  or  other  deranged 
actions,  it  is  because  the  true-spinal  system  is  involved  in  the  dis- 
ease, or  alTected  by  it  \n  the  way  of  irritation,  counter-irritation,  or 
of  pressure,  or  counter-pressure.  Hence  we  observe  the  symptoms 
of  spasm  in  various  diseases  of  the  encrphalcn,  the  condilion  being 
not  the  nature  of  the  disease,  but  that  they  produce  these  interme- 
diate effvicts.  Time,  as  is  well  known,  is  a  very  important  element 
in  this  problem  ;  and  why  is  it  so?  The  fact  is  to  be  explained  on 
the  same  principles.  The  very  same  lesion  occurring  quickly,  will 
produce  efiects  which  will  be  tofally  absent  if  It  creep  on  slowly.  In 
the  former  case,  we  b.ave  the  effects  of  irritation  and  pressure,  or  of 
counter-irritation  and  counter-pres-ure  ;  in  the  latter,  the  cerebrum 
has  so  accommodated  itself  to  the  new  state  of  things,  probably  by 
the  altered  condilion  of  its  vessels,  as  to  avoid  these  eiiects,  except 
towards  the  close  of  the  disease. 

"  We  need  not,  therefore,  now  view  with  surprise  the  fact  tbat  the 
same  lesions  as  found  po^f-Z/'zor/PT??,  had  been  attended  by  a  totally 
different  series  of  symptoms  during  life,  any  more  than  the  other  fact 
that,  in  the  diflercntperiofZ^  of  that  lesion,  the  symptoms  have  been 
dillerent. 

'*The  symptomsTrequcntly  subside  too  and  re-npprar.  If  the  dis- 
ease  be  not  regularly  progicssive,  the  encephalon  accommodates  itself 
as  I  have  stated,  and  the  synjptoms  disappear;  if  now  the  disease 
proceeds,  the  symptoms  also  return.     At  least  all  this  may  bo. 

"A  rapid  efiusion  of  serum  may  resemble  haemorrhage  or  ramolis- 
sement  in  its  effects;  or  slow  effusion  may  merely  obscure  the  intel- 
lectual faculties."     105. 

  **  ***  *:j<+  :ici|(4i 

"  It  is  well  known  from  the  experiments  of  M.  Flourens  especially, 
that  irritation  of  the  cerebrum  has  no  influence  in  inducing  spasmodic 
action.  Whenever,  therefore,  spasmodic  symptoms  occur  in  diseases 
of  the  cerebrum,  it  must,  as  I  have  already  stated,  be  on  a  principle 
different  from  that  of  irritation  of  tiie  cerebrum  itself;  it  must  be 
from  an  impression  made  upon  j)arts  of  the  nervous  system  in  which 
the  property  of  exciting  spasmodic  .action  on  being  subjected  to 
irritation  resides;  thcso  parts  arc  the  tubercula  quadrigemina,  the 
medulla  oblongata,  the  intra-cianial  nerves.  d:c. 

**That  ///i<Z//f  counter-pressure  on  the  medulla  oblongata  may,  and 


C3  ratho^ogy  and  TieaUnent  of  Convulsions,      [February, 


nctually  does,  excite  convulsions,  is  proved  by  tlic  following  facts  :  
In  the  interesting  case,  most  anxiously  watched  and  accurately  de- 
tailed to  me  by  my  friend  Mr.  Toogood,  of  Bridgcwater,  of  his  own 
little  girl,  aged  tliirtecn  months,  the  croup-like  convulsions  occurred 
repeatedly,  until  one  day,  when  the  bones  of  the  cranium  separated, 
and  the  convulsion  ceased.  In  a  case  of  spina-bifida,  related  to  me 
by  Mr.  Herbert  Evans,  of  Hampstead,  there  was  a  croup-like  convul- 
sion vvhencver  the  little  patient  turned  so  as  to  press  upon  the  tumour. 
In  the  case  of  an  anencephalous  foetus,  described  by  Mr.  Lawrence, 
convulsion  was  produced  on  pressing  on  the  medulla  oblongata.  In  a 
case  of  meninfTJtis,  civen  bv  Dr.  Abercrombie,  the  anterior  fontanel'e 
became  very  prominent.  Pressure  upon  it  induced  convulsion.  Hy- 
pertrophy of  the  brain  affords  an  argument  of  the  same  kind;  it 
induces  convulsion,  except  in  the  case  in  which  the  cranium  grows 
with  the  encephalon.  These  and  other  facts  lead  me  to  think  that 
convulsion  arising  from  cerebral  disease  is  thus  to  be  explained."  107. 

We  have  stated  that  the  spinal  marrow  is  a  medium  of  communi- 
cation  vith  {\\(i  brain,  and  an  independent  excito-motory  apparatus. 
That  it  is  a  medium  of  communication  with  the  brain,  is  easily  shown 
by  sections  of  this  cord,  v.hich  deprive  all  the  parts  receiving  ncri-cs 
from  below  the  section,  of  the  influence  of  sensation  and  volition, 
and  consequently  of  voluniary  contraction.  Yet  contractility  is  not 
annihilated  by  such  sections,  in  these  parts  contractions  may  still 
be  excited  by  irritatinfi  causes  applied  to  the  nerves,  or  directly  to 
the  spinal  marrow.  Hence  Vae  theory  of  the  excito-motory  process 
so  happily  developed  by  Marshall  Hall.  His  views  may  be  glean, 
ed  from  the  following  paragraph  : 

*' A  peculiar  set  of  nerves  consti'ute,  with  the  true-spinal  marrow 
as  their  axis,  the  second  subdivision  of  the  nervous  system.  As 
those  of  the  former  subdivision  (the  brain)  were  distinguished  into 
sentient  and  voluntary,  these  may  be  distinguished  into  the  excifor 
and  motory.  The  first,  or  the  cxcitor  nerves,  pursue  their  course 
principally  from  internal  surfaces,  characterized  by  peculiar  cxcita- 
bilities,  to  the  true  medulla  oblongata  and  spinalis  ;*  the  second,  or 
the  motor  nerves,  pursue  a  reflex  conv sc  from  that  medulla  to  muscles 
having  peculiar  actions  concerned  principally  in  ingestion  and  eges- 
tion.     The  motions  connected  with  the  former,  or  cerebral  subdivi- 


*  Dr.  Hall  includes  the  tubercula  quadrigemina  in  the  true-spinal  system. 
He  regards  as  excitor  nerves  of  this  system,  the  fifth,  the  pneumogastric,  and 
the  posterior  spinal  nerves;  and  as  reflex  or  motor  nerves,  the  fourth,  sixth,  por- 
tio  dura  of  the  seventh,  the  pneumogastric,  tiie  spinal  accessory,  the  phrenic, 
the  inferior  external  respiratory,  and  the  spinal  ner\*es.     (Op.  cit.) 


1845,]  Pathology  and  Treatment  of  ConvuUions.  C3 


sion,  are  sometimes,  nay,  frequently,  ^pon^aneoz/y ;  those  connected 
with  the  true-spinal  are,  I  believe,  always  excited.^''*' 

The  muscles  of  voluntary  motion  then  contract  under  the  man- 
dates of  volition  emanating  from  the  hiain,  and  also  under  the  influ- 
ence of  irritation  director  indirect  of  the  sj)inal  marrow,  and  this 
whether  the  communication  of  their  nerves  with  the  brain  be  cut  ofT 
or  not,  whether  sensation  be  developed  or  not.  Nothing  is  more 
common  than  to  find  a  limb  so  j)aralyzGd  as  not  to  move  in  the  least 
under  the  strongest  efforts  of  will,  and  yet  be  affected  with  more  or 
less  violent  contractions  when  a  feather  is  passed  over  its  surface,  or 
it  is  otherwise  irritated.  In  such  cases,  as  has  been  justly  remarked 
by  Marshall  Hall,  the  seat  of  the  lesion  must  be  that  of  volition 
 the  brain  ;  for  the  persistence  of  the  reflex  actions  indicate  an 
unimpaired  condition  of  the  seat  of  involuntary  motions  the  spinal 
system.  If  on  the  contrary  it  be  found  impossible  to  excite  motions 
in  the  paralyzed  limb,  the  lesion  should  be  referred  to  the  spinal  sys- 
tem.    This  is  an  important  means  of  diagnosis. 

Seeing  that  voluntary  movements  emanate  alone  from  the  brain, 
independently  of  excitement  or  irritation  properly  so  called,  and  that 
all  involuntary  movements  are  manifestly  produced  by  mechanical, 
physical,  or  functional  excitement  or  irritation,  the  true  pathology  of 
convulsions  is  perfectly  plain.  Convulsive  contractions  are  involun- 
tary  therefore  not  produced  by  tlie  organ  presiding  over  the  func- 
tions of  volition,  but  by  that  organ  which  presides  over  motions 
susceptible  of  being  excited  by  stimuli  other  than  that  of  volition. 
Excite  the  nostrils,  or  the  fauces,  or  the  anus,  and,  despite  of  the 
efforts  of  the  will,  sneezing,  vomiting,  or  contraction  of  the  sphincter 
ani  will  ensue,  and  these  sequences  vviil  obtain  whether  the  irritation 
have  been  perceived  by  the  brain  or  not,  as  may  be  demonstrated  in 
vivisections  in  lower  animals  and  in  cases  of  paraplegia  and  hemi- 
plegia in  man.  If  such  things  take  jilace  in  localities  exposed  to  our 
view,  there  is  no  reason  why  they  should  not  in  those  more  deep  seated 
or  hidden. 

In  the  physiological  or  healthy  state  of  the  system,  these  phenome- 
na of  reflex  action  are  essential  to  the  normal  performance  of  the  acts 
of  the  economy.  It  is  only  when  they  occur  under  the  influence  of  a 
pathological  state  of  the  system  that  they  constitute  convulsions.     In 


  Lcclnrc^  on  the  Nervou><  System  and  its  Discafcs,  by  M.  Hall.  London,  1K)6. 


CI  Pathology  and  Treatment  of  Convulsions,      [Fcbruarr, 


idiopathic  convulsions  tiie  lesion  is  in  (he  centre  of  the  true  spinal 
system  and  in  sympathetic  convulsions  at  its  periphery.  In  tho 
former,  the  movements  take  place  without  the  intervention  of  tho 
cxcitor  nerves;  in  the  latter  they  result  from  irritation  transmitted 
hy  these  cxcitors  io  the  centre.  To  the  former  class  may  be  referred 
the  trembling  of  the  cold  stage  of  intermittent  fever,  chorea,  car- 
phology,  claudication,  &c.  and  sometimes  hysteria,  epilepsy,  &:c. ; 
whilst  to  the  latter  class  belong  traumatic  tetanus,  and  the  great 
majority  of  the  convulsions  thrown  under  the  head  of  eclampsia  in 
the  classification  we  have  proposed,  as  the  infantile,  puerperal,  hy- 
drophobic, d:c. 

"Tetanus,"  says  Dr.  Hall,*  "is,  in  every  respect,  the  most  une- 
quivocal example  of  an  aficction  of  the  true-spinal  marrow,  through 
an  incident  and  the  motor  nerves.  All  the  functions  of  this  sub. 
division  of  the  nervous  system  are  affected  in  the  most  violent  form, 
whilst  the  cerebral  functions  are  unaiTected  :  the  dyspnoea,  the  dys- 
phagia,  the  constipation,  the  trismus,  the  emproslhotonos,  the  opis- 
thotonos, the  extreme  susceptibility  to  causes  of  physical  impression 
and  ngitation,  and  of  mental  emotion,  all  mark  an  affection  of  the 
true-spinal  system;  vv'hilst  the  freedom  from  all  afTections  of  the 
senses  and  of  tho  intellect,  the  absence  at  once  of  delirium  and  of 
coma,  denote  the  normal  condition  of  the  cerebral  system.  Hydro- 
phobia is  in  the  same  cntegory." 

Again,  according  to  Dr.  Hall,  "in  Epilepsy  the  very  first  symp. 
tom  is  generally,  if  not  always,  one  of  the  true-spinal  kind.  The 
first  symptom  is  constriction  about  the  throat,  and  closure  of  the 
larynx,  more  or  less  complete  ;  then  follow  violent  expiratory  efforts 
and  convulsive  movements  of  the  trunk  and  limbs.  Intermediately, 
and  even  without  the  convulsive  movements,  the  cerebrum  is  affected 
with  congestion,  and  a  multitude  of  cerebral  symptoms  occur  :  flashes 
of  light,  tinnitus  aurium,  the  aura  epileptica  ;  a  momentary  oblivion  ; 
a  state  of  terror,  of  delirium,  or  of  unconsciousness,  &;c;  as  parts 
of  the  general  convulsion,  the  tongue  is  protruded  and  bitten,  the 
fcEces,  the  urine,  or  the  semen  expelled  ;  as  consequences  of  that 
convulsion,  the  cerebrum  is  congested,  and  there  is  coma.  If  this 
state  continues,  another  order  of  symptoms  takes  place  ;  the  respira- 
tion becomes  stertorous,  and,  at  length,  aiTected  with  mucous  rattle, 
the  true  spinal  and  ganglionic  systems  becoming  fatally  involved  in 
the  disease. 

"It  is  the  constriction  about  the  throat  which  assimilates  epilepsy 
to  the  state  of  things  which  exists  in  strangulation,  and  which  distin- 


*  Memoirs  on  some  principles  of  Pathology-  in  the  Nervous  System,  hy  M. 
Hall,  noticed  in  the  Meilico-Chirur^ical  Review  Januarv,  1843. 


1845.]  Pathology  and  Treatment  of  Convulsions.  65 


guishes  it  from  hysteria.  It  is  this  circumstance  which  associates 
epilepsy  with  the  crowing  inspiration  of  the  convulsions  of  children  ; 
all  are  laryngismal.  In  epilepsy,  there  is  sometimes  a  crowing  in- 
spiration and  convulsion  of  infants  are  sometimes  followed  by  epi- 
lepsy in  subsequent  years." 

Shall  we  be  told  now  that  convulsive  affections  are  for  the  most 
part  to  be  referred  to  lesions  of  the  brain  or  of  its  meninges?  that 
congestion  of  the  brain  and  effusion  are  among  the  most  efficient 
causes  of  convulsions?  that  involuntary  movements  emanate  from 
the  organ  of  volition?  It  is  evident  that  those  who  entertain  such 
views  have  mistaken  the  effect  for  the  cause,  in  not  duly  attending 
to  the  order  in  which  are  developed  tlie  several  phenomena  presented 
before,  during,  and  after  a  convulsive  paroxysm. 

The  main  object  of  this  com.munication  has  been  to  elucidate  the 
true  character  of  such  affections,  in  order  that  correct  views  of  treat- 
ment might  be  attained.  If  in  certain  cases  the  origin  of  the  per- 
verted movements  must  be  traced  to  the  centre  of  the  true-spinal 
system,  whilst  in  certain  others  it  must  be  found  at  the  periphery  of 
this  system,  all  that  is  necessary  will  be  to  distinguish  these  cases 
from  each  other,  and  to  localize  the  peripheral  portion  affected*  If 
the  excitation  proceed  from  the  gums,  the  indication  is  plain ;  if 
from  the  stomach,  the  intestines,  the  cutaneous  surflice,  or  even  the 
encephalon,  it  is  equally  so.  There  can  be  no  difficulty  in  the  mat- 
ter, once  that  the  tiue  nature  of  the  case  is  ascertained.  Each  case 
should  be  treated  on  its  own  merits-  due  regard  being  paid  to  the 
consequences  as  well  as  to  the  cause  of  the  convulsions.  But  there 
can  be  no  question  that  the  same  degree  of  local  irritation  that  will 
occasion  convulsions  in  one  individual,  or  at  one  time,  will  not  have 
the  same  effect  in  another  individual,  or  at  another  time.  Hence, 
as  has  been  already  stated,  there  is  a  convulsive  predisposition  some- 
times existing  in  the  system,  that  must  be  combatted  as  well  as  the 
paroxysm  itself  and  its  effects.  The  treatment  of  convulsive  diseases 
should  therefore  be  directed  against  this  predisposition,  against  the 
immediate  cause  of  the  paroxysm,  and  against  the  effects  of  the  con- 
vulsive struggles. 

To  the  predisposition  must  be  opposed  all  the  means  calculated  to 
increase  the  solidification  of  the  tissues  and  the  stamina  of  the  system. 
Tonics,  especially  the  anti-spasmodic  tonics,  wholesome  diet,  exer- 
cise, change  of  scene,  diversion,  regular  habits,  6lc  will  accomplish 
these  purposes.     The  predisposition  being  known  to  exist,  dueattcn- 

5 


66  Faihology  and  Treatment  of  Convulsions.      [February, 


tion  must  be  paid  to  the  condition  of  tbe  localities  from  which  excita- 
tion most  frequently  proceeds ;  and  these  will  vary  according  to  tho 
age  and  sex  of  the  individual.  In  children,  they  are  the  gums,  the 
stomach,  the  bowels,  the  encephalon  ;  in  adult  females,  the  uterus. 
These  localities  should  therefore  be  maintained,  as  far  as  practicable, 
in  a  state  of  integrity. 

Should  an  attack  nevertheless  supervene,  it  must  be  treated  accord- 
ing to  the  seat  and  nature  of  the  exciting  cause.  Lancing  the  gums, 
emetics,  cathartics,  enemata,  anthelmintics,  emmenagogues,  warm 
bath,  revulsives,  &c.  will  furnish  us  the  means  most  generally  needed. 
During  the  paroxysm  of  violent  general  convulsions  very  little  can 
be  done  to  moderate  its  intensity;  the  supervention  of  cerebro-spinal 
congestion  will  of  itself  arrest  it.  But  the  paroxysm  of  partial  or  of 
mild  convulsions,  may  be  mitigated,  and  the  threatened  return  of 
violent  ones  prevented,  by  the  use  of  the  above  means,  and  also,  ac- 
cording to  the  suggestion  of  Dr.  Hall,  by  titillating  the  fauces  and 
the  nostrils,  and  by  dashing  cold  water  in  the  face,  so  as  to  modify 
the  condition  of  the  respiratory  muscles  ;  inspiration,  &c.  being  pro- 
voked by  such  impressions. 

The  effects  of  the  convulsive  struggles  should  not  be  overlooked. 
The  most  formidable  are  cerebro-spinal  compression  from  congestion 
or  effusion,  and  asphyxia  from  accumulated  mucus  in  the  bronchi,  or 
from  constriction  of  the  rima  glottidis.  The  means  instituted  to  ar- 
rest the  bad  effects  of  the  former  must  be  proportioned  to  its  intensity. 
Knowing  that  congestion  is  the  necessary  consequence  of  violent 
convulsions,  and  that  it  usually  subsides,  more  or  less  early  after  the 
cessation  of  the  struggles,  without  leaving  any  bad  effects,  we  should 
not  too  hastily  resort  to  depletion.  The  abstraction  of  a  portion  of 
the  circulating  mass  should  be  reserved  for  those  cases  in  which  it 
may  be  deemed  requisite  for  the  removal  of  the  exciting  cause,  or  for 
the  moderation  of  the  determination  to  the  cerebro-spinal  centres. 
Now  it  is  exceedingly  rare  that  the  exciting  cause  is  such  as  to  re- 
quire aciite  depletion,  if  any;  and  I  believe  it  perhaps  equally  rare 
that  the  congestion  is  such  as  to  excuse  the  profuse  waste  of  blood 
advised  by  most  practitioners.  The  expediency  of  blood-letting,  and 
the  quantity  to  be  taken,  should  be  determined  by  the  antecedent,  as 
well  as  the  actual  condition  of  the  circulation.  If  the  exciting  cause 
of  the  paroxysm,  and  the  general  state  of  the  system,  would  not  have 
warranted  the  abstraction  of  blood  5p/orc  the  paroxysm,  such  abstrac- 
tion can  certainly  be  tolerated  during  or  after  the  paroxysm,  only  in 


1845.]  Pathology  and  Treatment  of  Convulsions.  67 


so  far  as  it  may  be  imperatively  called  for  by  the  violence  of  the  con- 
gestion  of  the  nervous  centres.     How  often  have  not  children,  (at 
which  afre  the  loss  of  blood  is  always  a  serious  matter,)  and  women 
in  child-bed,    when  the  process  of  parturition  must  of  itself  tax  the 
system  with  loss  of  blood,  how  often,  I  say,  have  not  patients  of  these 
classes  been  hastened  to  the  grave  by  injudicious  depletion  ?     Do  we 
not  continually  hear  of  copious  blood-letting  having  been  practised  in 
convulsions  occurring  after  parturition,  and  consequently  after  the 
blood-vessels  have  already  been  more  or  less  unloaded?  and  all  this 
in  the  very   class  of  individuals  whose   constitutional  peculiarities 
evince  that  general  want  of  tonicity  and  stamina  which  predisposes  to 
convulsions  !     If  the  irritability  of  the  nervous  system  be  in  a  direct 
ratio  with  the  feebleness,  laxity  and  deficient  tonicity  of  the  tissues, 
should  we  not  pause,  should  we  not  carefully  weigh  the  case  in  all  its 
bearings,  before  we  resort,  in  convulsive  affections,  to  the  most  direct 
method  of  impairing  the  strength  and  stamina  of  the  body?     lam 
persuaded  that  the  indiscriminate  and  lavish  abstraction   of  blood, 
recommended  in  convulsive  affections  by  some  authors,  and  instituted 
by  too  many  practitioners,  is  most  pernicious,  and  probably  one  of 
the  most  frequent  causes  of  the  fatal  result.     Opiates  and  narcotics 
in  general  have  been  too  sparingly  resorted  to,  owing  to  the  erroneous 
apprehension  of  cerebral  congestion.     This  class  of  remedies,  by 
subduing  the  irritability  of  the  nervous  centres,  accomplishes  precise- 
ly what  is  most  desirable  when  the  patient  is  threatened  with  convul- 
sions.    There  can  be  no  doubt  that  by  their  judicious  administration 
on  the  first  appearance  of  the  symptoms  denoting  a  convulsive  ten- 
dency, a  large  number  of  cases  of  puerperal   convulsions  would  be 
averted,  and  that  if  given  after  the  paroxysm  they  would  prevent  their 
recurrence.     Although  these  remarks  are  applicable  to  almost  every 
convulsive  affection,  they  are  peculiarly  so  in   those  cases   in  which 
the  spasms  are  induced  both  by  pain  and  by  irritation,  as  in  those  of 
the   puerperal  and  traumatic  state.      Brachet  recommends  very 
highly  in  infantile  convulsions  a  combination  of  Ext.  Hyosciam.  nicrer 
and  ox.  zinc. 

With  regard  to  the  tendency  to  asphyxia  manifested  in  certain 
convulsive  affections,  as  epilepsy,  spasmodic  croup  and  asthma,  puer- 
peral eclampsia,  hydrophobia,  &;c.  it  demands  our  special  attention, 
as  it  is  in  many  cases  the  immediate  cause  of  death.  The  riraa 
glottidis,  being  in  such  affections  more  or  less  closed,  respiration  is 
correspondingly  impeded.     It  is  particularly  under  such  cir-cumstan- 


68  Pathology  and  Trealmenl  of  Convulsions,      [February, 


ces  that  Marshall  Hall  recommends  dashing  cold  water  in  the 
face,  and  tickling  the  fauces  and  nostrils,  so  as  to  induce  inspiration. 
They  have  been  proposed  also  in  the  asphyxia  of  new-born  infants. 
The  operation  of  tracheotomy  under  impending  asphyxia  in  hydro- 
phobia was,  I  believe,  proposed  by  Dr.  Physick,  since  when  its 
necessity  in  all  similar  spasmodic  conditions  has  been  strongly  urged 
by  Dr.  M.  Hall  and  others.  Some  years  ago  a  patient,  apparently 
dying  from  asphyxia,  consequent  on  deep  intoxication,  was  saved  by 
the  timely  performance  of  this  operation,  by  Mr.  Sampson,  of  Salis- 
bury in  England. 


article  II. 
An  Essay  on  Auscultation  By  Wm.  H.  CumMing,  M.  D.* 

Since  the  great  discovery  which  has  so  illustrated  the  name  of 
Laennec,  the  subject  of  Auscultation  has  received  more  attention 
than  any  other  in  the  whole  range  of  medical  science.  The  accuracy 
of  its  results,  the  important  information  which  it  gives  concerning  the 
nature  and  progress  of  a  numerous  and  important  class  of  diseases, 
often  existing  in  an  isolated  state,  and  perhaps  more  frequently  still 
intercurrent  with  other  disorders,  sufficiently  account  for  the  enthusi- 
asm manifested  in  the  cultivation  of  this  most  important  mode  of 
observation.  We  shall  attempt  in  this  essay  to  show  the  falsity  of 
the  generally  received  theory  of  the  production  of  the  sounds  per- 
ceived in  the  respiratory  organs.  Without  devoting  any  time  to  the 
useless  and  therefore  irksome  task  of  stating  preliminaries  now  com- 
mon in  the  science,  we  proceed  at  once  to  the  consideration  of  our 
subject. 

In  its  examination,  we  shall  pursue  the  following  order :- 1st.  We 
shall  state  in  all  their  simplicity  the  facts  which  present  themselves 


*  It  is  but  justice  to  Dr.  Gumming  to  state  that  this  essay  was  drawn  up  before 
he  left  for  China,  two  years  ago.  Edts, 


1845.]  An  Essay  on  Auscultation*  69 


to  the  observer.  2nd.  We  will  give  the  explanation  proposed  by 
Laexxec.  3rd.  We  shall  offer  various  objections  to  this  explana- 
tion. 4th.  We  shall  conclude  with  an  exposition  of  the  theory  of 
Mr.  Beau. 

In  ausculting  the  various  portions  of  the  respiratory  apparatus  of  an 
individual  in  good  health,  different  impressions  are  received  by  the 
organs  of  the  observer.  These  sounds  are  generally  admitted  to  be 
three  in  number.  The  first,  which  may  be  heard  in  the  larynx  and 
superior  portion  of  the  trachea  has  been  called  the  tracheal  soiijle. 
This  division  was  not  admitted  by  Laexxec  who  confounded  this 
sound  with  the  second  it  is  supposed  to  be  produced  by  the  friction 
of  the  air  against  the  different  surfaces  of  the  pharynx  and  larynx. 
The  second,  which  differs  from  it  in  some  respects,  though  preserving 
the  same  general  character,  may  be  most  readily  perceived  by  apply- 
ing the  ear  to  the  back,  between  the  scapulae  opposite  to  the  root  of 
the  lungs.  This  sound  is  too  well  known  to  need  any  description. 
It  was  styled  by  Laenxec  the  bronchial  respiration.  The  third 
sound  is  more  generally  diffused,  and  may  be  heard  on  applying  the 
car  to  any  portion  of  the  chest  whose  internal  surface  is  applied  to  the 
lungs.  It  was  said  by  Laexxec  to  resemble  the  deep  inspirations 
which  occasionally  take  place  in  quiet  sleep. 

To  the  explanation  of  the  causes  of  the  bronchial  respiration, 
Laexxec  does  not  seem  to  have  given  much  attention.  It  is  evident, 
however,  from  one  or  two  incidental  remarks,  that  he  considered  it 
to  be  produced  by  the  friction  of  the  air  against  the  internal  surface 
of  the  bronchia.  His  attention  was  much  more  excited  by  the  third 
sound,  styled  by  him  the  vesicular  murmur.  He  asserts  that  it  may 
be  readily  perceived,  and  that  it  indicates  the  penetration  of  air  into 
the  pulmonary  tissue  and  its  subsequent  expulsion.  He  says  that  the 
impression  conveyed  to  the  mind  of  the  observer,  is  that  of  a  fluid 
passing  from  a  narrow  canal  into  a  more  ample  space.  We  will  not 
here  state  the  many  peculiarities  of  this  sound,  and  of  the  conditions 
under  which  it  is  produced.  These  we  shall  reserve  for  our  chapter 
of  objections,  as  we  shall  find  in  each  one  a  stubborn  fact  refusing  to 
pass  under  the  yoke  of  this  explanation.  And  as  a  theory  is  only 
valuable  as  a  general  expression  of  individual  facts,  we  shall  go  fiu 
toward  the  destruction  of  the  explanation  of  Laexxec,  if  we  can  show 
that  most  of  the  facts  so  well  observed  by  himself  and  others  remain 
still  isolated  and  refusing  to  bo  admitted  into  this  unnatural  gener- 
alization. 


70  An  Essay  on  Auscultation.  [February 


Before  entering  upon  an  exposition  of  the  many  direct  and  (as  we 
think)  unanswerable  objections,  we  must  present  a  few  reflections  on 
the  indispensable  prerequisite  to  the  exactness  of  this  theory,  viz. 
the  existence  of  the  cellular  structure  of  the  lungs.  This  cellular 
structure  once  generally  admitted,  is  now  not  only  doubted  but  even 
denied  by  many  anatomists.  The  latest  researches  on  this  subject 
seem  to  show  that  the  lungs  are  nothing  more  than  an  agglomeration 
of  brenchial  tubes  ever  decreasing  to  their  termination  lined  by  a 
mucous  membrane  in  which  ramify  the  terminations  of  the  pulmona- 
ry arteries.  These  tubes  are  united  by  a  tissue  resem.bling  the  gen- 
eral cellular  tissue  of  the  body,  forming  however  a  smaller  portion  of 
the  pulmonary  mass  than  is  generally  supposed.  Besides  this  con- 
clusion derived  from  actual  inspection,  there  is  a  consideration  drawn 
from  the  philosophy  of  anatomy  which  has  presented  itself  to  my 
mind  with  great  force,  probably  because  it  has  originated  there.  It 
is  evident  that  the  lungs  were  intended  to  expose  an  immense  surface 
to  the  action  of  the  atmosphere.  Their  structure  must  however  oc- 
cupy but  a  small  space  that  it  might  not  interfere  with  the  functions 
of  the  adjacent  organs.  A  moment's  consideration  will  show  that 
the  existence  of  vesicles  at  the  extremity  of  the  bronchia  is  not  com- 
patible with  the  exposition  of  the  greatest  possible  surface  to  the 
atmospheric  air.  Though  this  consideration  may  not  be  conclusive, 
it  must  have  great  weight  with  those  who  have  carefully  studied  the 
structure  of  the  body,  and  observed  the  wonderful  wisdom  every 
where  displayed  in  our  physical  frame.  These  two  considerations 
render  the  vesicular  or  cellular  structure  of  the  lungs  highly  improba- 
ble, and  theretore  tend  to  invalidate  a  theory  based  on  that  supposi- 
tion. But  we  go  farther,  and  assert  that  we  doubt  not  only  the  mode 
of  formation  generally  assigned,  but  even  the  locality.  We  are 
disposed  to  deny  that  this  respiratory  murmur  is  formed  at  or  near 
the  termination  of  the  bronchia  in  the  lungs.  Let  us  notice  some  of 
the  peculiarities  of  this  sound.  One  of  those  most  worthy  of  remark 
is  the  superior  intensity  during  inspiration.  It  is  indeed  heard  at 
expiration,  but  is  feeble  and  seems  distant.  This  fact  did  not  escape 
Laennec.  It  has  been  supposed  that  the  explanation  of  this  fact 
might  be  found  in  the  introduction  of  a  larger  quantity  of  air  than  that 
expelled  by  expiration.  But  this  difference  is  found  to  be  very  small 
if  it  really  exist.  It  is  also  fully  compensated  by  the  increased 
quantity  of  watery  vapour  and  carbonic  acid,  while  at  the  same  time 
the  elevation  of  temperature  which   the  air  necessarily  undergoes  in 


1845.]  An  Essay  on  Auscultation.  71 


the  lungs,  must  render  the  volume  of  gaseous  matter  expelled  fully 
equal  to  that  inhaled.  It  has  been  also  urged  in  reply  to  this  objec- 
tion, that  the  air  enters  the  lungs  with  greater  velocity  than  that 
with  which  it  is  driven  off*.  This  is,  however,  a  pure  hypothesis, 
based  on  nothing  but  the  determination  to  find  a  reason  for  an  un- 
reasonable notion.  The  time  employed  in  expiration  is  equal  to  that 
in  which  the  air  is  introduced,  and  as  we  have  shown  the  quantities 
to  be  equal,  there  is  no  reason  for  an  increase  of  velocity.  It  has 
also  been  observed  that  this  respiratory  murmur  is  much  more  intense 
in  women  and  children  than  in  men.  So  uniformly  does  this  exist 
in  children,  that  an  unusual  degree  of  intensity  in  the  murmur  of 
adults  has  been  styled  puerile  respiration.  This  fact  had  evidently 
puzzled  Laexnec.  He  explained  it  by  supposing  that  children 
breathe  more  largely  than  men,  forgetting,  as  it  would  seem,  that  the 
same  could  not  be  true  of  women.  But  we  know  that  there  are  found 
men  in  good  health,  of  active  habits,  indeed  differing  in  none  of  these 
respects  from  others,  who  yet  exhibit  this  puerile  respiration.  In 
certain  diseases,  when  a  large  portion  of  the  lungs  is  affected,  we 
frequently  find  this  puerile  sound.  This  was  most  readily  explained 
by  Laennec,  who  asserted  that  when  a  large  number  of  cells  were 
closed  those  which  were  pervious  were  more  forcibly  distended  than 
>mder  ordinary  circumstances.  But  this  triumph  was  short-lived, 
for  it  was  found  that  in  certain  cases  of  violent  pneumonia  or  pleurisy, 
when  large  portions  of  the  lungs  were  unable  to  perform  their  func- 
tions, and  when  therefore  the  pervious  cells  must  be  much  distended, 
no  puerile  sound  was  observed.  To  comprehend  in  its  embrace  tlieso 
tiiree  apparently  conflicting  facts  is  above  the  power  of  the  theory  of 
Laennkc.  It  is  also  found  that  in  certain  animals,  e.g.  the  horse, 
the  ass,  the  ox,  the  camel,  the  camel-leopard,  &,c.  who  breathe  freely, 
whose  lungs  fully  expand,  the  respiratory  murmur  is  not  heard  in 
ordinary  circumstances.  If  the  force  and  frequency  of  respiration 
be  augmented  in  these  animals  by  rapid  and  violent  exertions,  wo 
shall  succeed  in  hearing  this  murmur  as  distinctly  as  in  the  human 
subject.  We  have  thus  cited  many  facts  observed  and  stated  by 
IjAENNec  which  he  was  unable  to  explain.  They  are  inexplicable 
by  his  theory.  The  last  and  strongest  objection  we  shall  reserve  until 
wo  shall  have  presented  the  theory  of  our  adoption,  for  it  acts  at 
once  on  the  offensive  and  defensive,  overthrowing  the  old  and  estab- 
lishing the  new  <loctrine  on  a  firm  and  immovable  basis.  We  think 
that  enough  has  been  said  to  show  that  the  theory  generally  received 


72  An  Essay  on  Auscultation.  [Fcbruarj, 


is  opposed  by  many  well-observed  facts,  which  it  cannot  explain,  with 
which  it  is  inconsistent,  and  with  which  therefore  it  cannot  be  con- 
sistent. Shall  the  facts  or  the  theory  yield?  We  prefer  the  latter 
alternative,  and  as  the  former  are  universally  admitted,  we  shall 
adhere  to  them.  And  before  proceeding  farther,  we  will  present  a 
few  thoughts  which  seem  to  be  peculiarly  appropriate  here.  After 
considering  the  structure  of  the  bronchia,  lined  as  they  are  by  a  smooth 
membrane  lubrified  by  a  thin  mucus,  remembering  at  the  same  time 
the  small  velocity  with  which  the  air  traverses  them,  we  are  surpris- 
ed that  any  appreciable  sound  should  be  produced.  When  we 
auscult  an  artery  in  the  healthy  state  of  the  system,  diflering  as  it 
does  from  the  transient  bronchia,  by  its  superior  size,  by  the  density 
and  velocity,  and  consequently  by  the  momentum  of  the  fluid  passing 
through  it,  we  find  a  sound  far  inferior  in  intensity  to  that  perceived 
on  ausculting  the  chest. 

Proofs. 
Is  the  sound  more  intense  at  inspiration  than  at  expiration? 
What  more  natural  or  consistent  Vv'ith  every  day's  experience,  than 
that  a  sound  conveyed  to  us  by  a  current  of  air  should  be  louder  than 
the  same  sound  compelled  to  force  its  way  to  us  against  the  direction 
of  that  stream?  Is  it  stronger  in  women  and  children  than  in  men? 
A  knowledge  of  the  comparative  anatomy  of  the  larynx  in  different 
sexes,  and  at  the  various  periods  of  life,  offers  a  ready  solution.  Do 
we  not  know  that  the  cavity  of  the  larynx  undergoes  great  changes 
in  males  at  the  age  of  puberty  that  the  ventricles  are  dilated,  the 
thyroid  cartilage  enlarged,  the  opening  of  the  glottis  increased  ?  Do 
we  not  know  that  in  females  this  change  is  slight?  What  then  more 
reasonable  than  that  the  intensity  of  the  sound  should  increase  when- 
ever the  conditions  favorable  to  this  modification  exist?  And  if  the 
original  sound  be  mere  forcible,  it  will  be  more  intense  at  each  point 
where  it  is  examined.  But  actual  observation  excludes  all  necessity 
for  a  resort  to  reasoning.  If  we  auscult  individuals  of  the  different 
sexes  and  children,  we  shall  find  that  the  laryngeal  sound  of  men  is 
feebler  than  that  of  women  and  children.  Do  we  find  some  men  who 
present  this  puerile  respiration  ?  On  ausculting  such  we  shall  find 
an  unusual  intensity  of  the  laryngeal  sound.  We  shall  find  that  their 
thyroid  cartilage  is  not  much  developed,  that  their  voice  is  high,  and 
that  this  change  which  occurs  in  all  men  has  been  slight  in  these 
cases.     Do  we  observe   this  puerile  respiration  existing  in  certain 


1845.]  An  Essay  on  AusciiUaiion.  IIS 


diseases  of  the  lungs?     On  examination  we  shall  find  the  laryngeal 
sound  proportionahly  increased.     Do  wo  fail  to  observe  it  in  certain 
cases  where  the  violence  of  the  disease  is  the  same  or  even  greater? 
We  shall  find  that  these  individuals  present   no  sensible  augmenta- 
tion of  the  laryngeal  sound.     In    no   disease  can  this   fact  be  more 
readily  observed  than  in  pneumonia.     We  frequently  see  patients  of 
this  kind  who  produced  great  sound  in  ihe  larynx.     This  should   not 
be  confounded  with  that  formed  in  the  nasal  fossae.     We  find  others, 
who,  while  breathing  as  rapidly,  and  with  as  great  difficulty,  present 
no  increase  of  the  natural  sound.     The  position  of  the  patient,  the 
state  of  his  nervous  system  will  introduce  remarkable  modifications  in 
his  respiration,  and  by  placing  in  supination  an  individual  occupying 
the  sitting  posture,  we  may  frequently  augment  the  laryngeal  sound 
and  the  consequent  respiratory  murmur.     An  objection  must  be  met 
here.     V/e  have  said  that  en  ausculting  the  chests  of  certain  animals 
we  could  not  perceive  the  respiratory  murmur.     It  will  be  asked,  did 
not  the  laryngeal  sound  exist?     We  answer  that  it  does,  but  is  pre- 
vented from  reaching  the  cliest  by  a  peculiar  circumstance.     We 
have  cited  the  horse,  the  ox,  the  girafie,  the  camel,  as  instances  of 
this  kind.     Though  differing  widely  in  their  organization,  they  have 
one  thing  at  least  in  common,  a  long  neck.     In  many  of  them,  the 
laryngeal  sound  is  feeble,  and  is  lost  before  arriving  at  the  terminal 
bronchia,  or  is  rendered  so  soft  tliat  it  is  not  perceptible.     It  will  bo 
noticed  that  these  animals  have  low  voices,  proving  thereby  that  tho 
aperture  of  the  glottis  is  large.     But  if  the  laryngeal  sound  be  much 
augmented  by  rapid  and  violent  exercise,  we  are  then  able  to  per- 
ceive the  respiratory  murmur.     So  that  this  objection,  apparently  so 
formidable,  readily  enters  with  the  others  and  acknowledges  the 
justice  of  our  generalization.     In  the  third  portion  of  this  essay  we 
mentioned  the  reservation  of  a  powerful  objection   to  the  vesicular 
theory.     We  did  so  in  order  to  bring  it  with  more  eficct  to  the  estab- 
lishment of  our  adopted  doctrine.     It  contains  within  itself  the  root 
of  the  matter,  and  is  amply  suflicient  to  answer  all  our  ends  of  demo- 
lition and  edification.     It  is  the  fact,  that  we  all  possess  the  power  of 
diminishing  at  will  the  intensity  of  the  respiratory  murmur  without 
aflTecting  the  plenitude  or  rapidity  of  respiration.     The  only  condi- 
tion is  an  enlargement  of  the  aperture  of  the  glottis.     So  far  from  a 
necessity  of  diminishing  cither  the  fullness  or  frequency  of  respira- 
tion in  order  to  produce  this  effect,   we   may  increase  both  almost 
indefinitely    without  endangering  the   success   of  tho  experiment. 


-471  Essay  on  Auscultation.  February, 


With  a  little  practice  any  one  will  soon  be  able  to  respire  largely  and 
rapidly  without  producing  an  appreciable  sound  in  the  larynx  or  chest. 
To  such  a  fact  commentary  is  injurious.  All  possible  inductions  will 
readily  be  made  by  the  feeblest  intellect.  For  the  information  of 
those  who  desire  to  repeat  the  experiment,  we  shall  give  a  few  direc- 
tions. Three  persons  are  necessary  to  its  proper  performance :  one 
to  auscult  the  trachea,  another  the  lungs  of  the  third.  The  diminu- 
tion of  the  laryngeal  sound,  as  observed  by  the  first,  will  be  found  by 
the  second  to  coincide  with  the  diminution  of  the  respiratory  mur- 
mur ;  and  when  the  former  ceases  to  perceive  the  sound  in  the 
trachea,  the  murmur  will  he  imperceptible  to  the  latter. 

The  arteries  are  frequently  more  favorably  situated  for  the  trans- 
mission of  any  internal  sound  to  the  ear  of  the  observer,  as  they  are 
far  more  superficial.  We  indulge  therefore  in  a  legitimate  astonish- 
ment when  we  are  told  that  so  rare  a  fluid  passing  with  so  small  a 
velocity,  through  so  small  a  vessel  and  at  so  great  a  depth,  should 
produce  a  sound  so  superior  in  energy.  And  under  such  circum- 
stances we  are  justified  in  demanding  an  explanation  which  shall 
solve  all  the  phenomena.  On  finding  that  the  generally  received 
theory  is  thus  at  variance  Vv'ith  so  many  well  known  facts,  we  are  led 
to  inquire  on  what  lias  been  founded  the  favorable  reception  which 
has  been  given  to  it  by  the  members  of  the  medical  profession.  It  is 
the  appearance  of  simplicity  which  it  presents  that  has  secured  for  it 
Kuch  general  support.  Indeed,  the  first  impression  is  that  the  sound 
perceived  is  formed  immediately  under  the  ear  of  the  observer.  But 
this  is  at  best  but  a  small  probability.  Nothing  is  more  fallacious 
than  the  decisions  of  our  minds  in  regard  to  the  direction  of  sounds. 
Were  we  guided  by  them,  we  should  suppose  that  the  clifT  addressed 
us,  because  the  sound  is  reflected  from  it  to  our  ears.  We  shall  here 
conclude  our  objections  to  the  former  theory,  and  proceed  to  expose 
and  dcvelope  that  whose  defence  we  have  assumed. 

In  a  preceding  part  of  this  essay  we  have  examined  the  sounds 
according  to  the  scholastic  mode.  We  have  gone  to  their  study  in 
the  manner  counselled  by  t!ie  dogmatists  of  our  science  we  have 
studied  them  *^  sccundcm  Grfrm  :^'  let  us  reverse  the  method,  and 
trusting  to  the  guidance  of  another  leader,  let  us  examine  the  same 
phenomena  secunclcm  naivrnm.  And  let  us  set  out  on  this  course 
assured  that  we  are  under  the  direction  of  a  safer,  if  a  less  brilliant 
guide.  Let  us  then  follow  the  air  as  it  penetrates  the  respiratory 
passages  The   first   point  open  to  our   investigation  is  the  larynx. 


1845  ]  An  Essay  on  Auscultation. 


Here  we  find  a  sound  of  peculiar  character  and  of  considerable  ener- 
gy. The  cause  is  readily  discovered.  The  slightest  knowledge  of 
the  anatomy  of  the  larynx  convinces  us  that  all  the  conditions  neces- 
sary for  the  production  of  such  a  sound  are  present  in  that  organ. 
The  column  of  air,  increased  in  diameter  by  the  existence  of  the 
ventricles,  is  compelled  to  traverse  the  narrow  passage  offered  by  the 
glottis.  If  we  examine  it  at  inspiration  and  at  expiration,  we  find 
that  it  does  not  vary  much  in  intensity  at  these  different  times.  This 
might  have  been  admitted  a  priori,  for  the  glottis  is  inferior  in  diame- 
ter to  the  trachea.  The  induction  which  we  have  made  as  to  the 
cause  of  the  sound  is  then  entirely  conformable  to  the  physical  laws 
of  sound.  Admitting  that  we  have  discovered  the  cause  of  the  sound 
in  the  larynx,  we  follow  the  trachea  down,  ausculting  it  at  short  inter- 
vals. We  observe  a  modification  of  the  sound  which  has  become 
very  apparent  before  wo  have  reached  the  sternum.  We  are  here 
compelled  to  leave  the  trachea  in  front:  but,  nothing  daunted,  we 
recommence  our  examination  in  the  rear.  On  applying  the  ear 
above  the  spinal  column,  near  the  level  of  the  superior  extremity  of 
the  sternum,  we  perceive  a  sound  very  similar  to  that  of  the  trachea, 
and  yet  differing  in  some  respects.  We  now  proceed  either  to  the 
right  or  left  from  this  point,  and  we  find  a  decided  but  gradual  change, 
until  we  arrive  at  the  axilla,  where  we  receive  the  respiratory  mur- 
mur in  all  its  purity.  By  this  mode  of  observation,  instea<l  of  three 
sounds,  we  have  an  indefinite  number,  which  pass  from  the  laryngeal 
to  the  tracheal,  to  the  bronchial,  and  finally  to  the  vesicular,  by 
insensible  gradations.  What  cause  has  effected  these  changes  ?  The 
changes  are  gradual,  i.e.  comi)osed  of  a  large  number  of  slight  modi- 
fications, requiring  for  their  production  an  equally  large  number  of 
efficient  causes.  We  may  examine  the  trachea,  the  lar^re  and  smaller 
bronchia,  but  we  find  no  anatomical  condition  capable  of  explaining 
these  phenomena.  We  have  found  that  each  sound  in  the  trachea 
is  merely  a  modification  of  that  heard  in  the  larynx.  We  have  traced 
the  same  relation  between  the  tracheal  and  bronchial  sounds.  The 
idea  then  irresistibly  suggests  itself,  that  there  is  an  original  sound, 
and  that  it  is  the  laryngeal.  Where  then  arc  the  modifying  agents  ? 
for  v,-c  have  admitted  that  they  must  exist  in  indefinite  numi)ers. 
They  are  the  diflerent  distances  of  each  successive  point  from  the 
glottis.  The  sound  is  borne  by  the  current  of  air,  and  is  thus  carried 
to  the  terminal  ramifications  of  the  bronchia,  where,  from  the  dis- 
tancc,  and  the  small  size  of  the  tubes,  it  assumes  the  peculiar  charac- 


70  An  Essay  on  Auscultation,  ^  [February, 


ter  of  the  vesicular  murmur.  The  increase  of  the  aggregate  diame- 
ters of  the  bronchia  may  also  exert  some  influence  upon  the  quality 
of  the  sound.  Here  is  the  conclusion  of  the  whole  matter.  Are  our 
proofs  demanded  ?  We  take  the  facts  which  we  have  before  urged 
against  the  former  theory.  The  reverse  experiment  will  be  still 
more  readily  performed.  By  increasing  the  sound  of  the  larynx,  the 
respiratory  murmur  may  be  made  to  surpass  in  intensity  the  loudest 
puerile  sound.  To  our  mind  this  experiment  is  satisfactory  It  fixes 
every  point  which  was  before  doubted,  and  bestows  the  fullest  assur- 
ance of  the  truth  of  the  theory  which  we  here  advocate.  Before 
concluding,  we  beg  leave  to  introduce  an  argument  from  analogy 
which  must  please,  if  it  do  not  instruct.  If  we  apply  an  ear  to  the 
chest  of  a  person  speaking,  we  observe  a  confused  sound  somewhat 
resembling  the  noises  of  a  distant  crowd.  If  on  the  contrary  we 
examine  the  trachea,  or  bronchia,  of  an  individual  engaged  in  speak- 
ing, the  sound  is  louder  and  more  defined.  We  seem  to  have  the 
tube  under  our  car.  We  observe  here  the  similarity  of  the  modifica- 
tions impressed  upon  these  different  sounds.  The  seat  of  the  voice 
is,  without  doubt,  the  glottis.  But  this  similarity  is  still  greater  in 
morbid  states  of  the  pulmonary  organs.  In  those  cases  where  the 
minute  bronchia  are  rendered  impervious  to  the  air,  either  by  the 
extravasation  of  the  blood  or  by  external  pressure,  we  find  certain 
modifications  of  the  respirator)^  and  vocal  sounds.  And  it  is  remark- 
able that  the  writer,  to  whom  we  have  so  frequently  referred,  has 
used  almost  the  same  language  in  speaking  of  these  modifications. 
In  these  cases  he  says  that  the  bronchial  souffle  is  heard  so  distinctly 
that  it  seems  as  though  some  one  was  blowing  softly  into  the  stetho- 
scope. In  speaking  of  bronchophony,  he  remarks  that  the  voice  ap- 
pears to  be  produced  within  the  same  instrument.  In  describing  the 
higher  degree  of  these  two  phenomena  which  exist  in  cases  of  exten- 
sive excavations,  he  observes  that  the  respiration  produces  an  im- 
pression similar  to  that  resulting  from  the  breathing  forcibly  in  the 
stethoscope,  the  sound  seems  to  reach  the  ear.  This  very  remark  is 
applied  to  pectoriloquy.  The  voice  seems  to  rise  into  the  tube,  and 
in  some  cases  appears  even  to  reach  the  ear,  and  in  a  few  instances 
resembles  the  sound  produced  by  the  act  of  speaking  aloud  in  the  ear 
of  an  individual.  How  striking  is  this  unintentional  tribute  to  our 
theory !  It  could  scarcely  have  been  rendered  more  flattering. 
An  important  induction  from  these  facts  must  here  be  noticed. 
In    examining   patients    affected    with    diseases   of  the    chest    we 


1845.]  '       Dehreyne  on  Chronic  Diseases.  11 


are  often  uable  to  auscult  the  voice,  either  from  its  weakness  or  from 
the  unwillingness  of  the  patient  to  speak.  We  need  never  be  uneasy 
on  this  account.  Do  we  hear  a  souffle  1  There  is  bronchophony. 
Do  we  hear  the  cavernous  respiration  ?  There  is  pectoriloquy. 
Have  we  a  patient  who  is  constantly  talking?  Allow  him  this  privi- 
lege It  does  not  interfere  with  the  auscultation  of  the  rales,  nor  do 
you  need  any  other  information  as  to  the  state  of  the  respiration.  Is 
the  voice  indistinct  and  murmuring?  Rest  assured  that  the  respira- 
tion is  good.  Have  you  bronchophony  or  pectoriloquy  ?  If  the 
patient  were  silent,  you  would  hear  the  bronchial  or  cavernous  souffle. 
Does  the  voice  assume  an  amphoric  sound  ?  Believe  that  the  ampho- 
ric souffle  is  not  absent.  Do  you  expect  the  existence  of  some  com- 
pression on  the  trachea  or  large  bronchial  trunks  ?  Examine  the 
voice.  Formed,  as  it  invariably  is,  during  expiration,  it  is  so  much 
louder  than  the  murmur  of  expiration  that  it  will  advantageously 
replace  the  latter  as  an  object  of  examination.  We  are  aware  that 
other  inductions  may  be  made  from  these  facts,  but  we  are  disposed 
to  leave  them  to  the  ingenuity  and  reflections  of  the  reader. 


Part  II. REVIEWS  AND  EXTRACTS. 

Therapeuiique  Appliquce,  ou  Traitements  speciatix  de  la  plupdrt  deg 
Maladies  Chroniques.  Par  P.  J.  C.  Debreyxe.  2me  Edition^ 
pp,  332.     Baillicre,  1844. 

(C0^XLUDED.) 

Phthisis.  Although  Dr.  D.  classes  this  too-frequent  scourge  of 
France  among  the  chronic  Phlegmasicc,  he  expressly  says  that  he 
does  not  regard  it  as  at  all  of  an  inflammatory  character  in  its  early 
stages.  During  the  course  of  the  disease,  there  is  a  strong  tendency, 
as  every  one  knows,  to  the  frequent  occurrence  of  a  pneumonic  and 
pleuritic  attack  ;  but  this  is  to  be  regarded  only  as  an  epi-phenojncnon^ 
and  not  as  a  necessary  symptom.  With  respect  to  treatment,  wo 
find  that  our  author  has  almost  entirely  renounced  after  the  expe- 
rience  of  their  utter  ineflicacy  the  employjnent  of  nearly  all  reme- 
dies,  save  and  except  the  insertion  of  a  scton    in  some  part  of  the 


78  Dchreyne  on  Chronic  Diseases,  [February, 


chest,  and  the  persevering  use  of  Iceland-moss  jelly  in  large  quan- 
tities, not  forgetting  the  Opium  or  Belladonna  once  or  twice  in  the 
course  of  the  24  hours.  He  recommends  the  same  line  of  treatment 
in  those  cases  of  chronic  purulent  Catarrh,  the  symptoms  of  which 
so  closely  resemble  those  of  gemiine  tubercular  Phthisis;  and,  in 
not  a  few  instances,  has  a  cure  taken  place  under  their  use,  when  the 
case  had  seemed  to  be  utterly  hopeless. 

From  the  Chest  we  pass  on  to  the  Stomach.  After  delivering  some 
excellent  remarks  on  the  mode  of  distinguishing  gastraJgic  from  gas- 
triiic  pain,  our  author  exposes,  with  no  less  truth  than  severity,  the 
melancholy  mistakes  that  have  been  committed  of  late  years  by  so 
many  of  his  countrymen,  since  the  prevalence  of  the  Eroussaian 
doctrine.  He  shows  that  the  existence  of  an  inflammatory  state  of 
the  stomach  may  generally  be  diagnosticated  by  observing  the  effects 
which  different  kinds  of  food  have  upon  the  gastric  pain.  If,  for  ex- 
ample, farinaceous  and  milky  substance  can  be  taken  well,  while 
those  of  an  animal  nature  give  rise  to  a  sense  of  uneasiness,  we  may 
very  generally  presume  that  there  is  a  greater  or  less  degree  of  actual 
gastritis.  If  the  reverse  be  the  case,  and  if  light  animal  food,  such  as 
chicken-tea  or  mutton-broth,  be  borne  best,  we  may  feel  assured  that 
there  is  no  inflammation,  however  troublesome  the  gastric  uneasiness 
may  be.  The  diet  may  therefore  be  regarded  as  a  most  useful  explo- 
ratory means  of  diagnosis. 

"It  often  happens  that  the  epigastric  pain  does  not  yield  to  leechings  and  low 
diet;  and  wo  be  to  the  physician  who  pertinaciously  seeks  to  combat  it  b}^  con- 
tinuing the  use  of  the  same  means,  and  who  has  not  learned  to  modify  his  treat- 
ment according  to  the  varying  condition  of  each  case.  For  the  relief  of  the 
gastric  pain,  which  resists  the  application  of  leeches,  &e.,  opium  is  often  an 
excellent  remedy;  a  light  preparation  should  always  be  preferred,  and  it  will  be 
well  to  exhibit  it  in  some  mucilaginous  vehicle.*  If,  however,  this  does  not 
succeed  in  the  course  of  a  day  or  two,  we  should  then  have  recourse  to  a  volant 
blister.  Should  this  also  fail,  we  shall  have  good  reason  to  believe  that  the 
epigastric  uneasiness  is  more  or  less  dependent  upon  an  atonic  state  of  the 
stomach ;  and  this  we  can  generally  determine  by  having  recourse  to  the  explor- 
ative diet  of  which  we  have  spoken.  Should  such  be  found  to  be  the  case,  we 
must  allow  the  patient  more  nourishing  food,  and  we  should  try  the  effect  of  an 
infusion  of  Rhubarb  or  Columba-root,  to  which  may  be  added  a  weak  opiate,  if 
deemed  necessary." 

In  Chronic  Hepatitis,  our  author  strongly  recommends  the  use  of 
emollient  poultices  on  the  hypochondriac  region,  applied  every  night, 
and  also  during  the  day,  if  the  patient  keeps  his  bed.     They  produce 


*  A  favourite  formula  of  our  author  is  this:  

^.  AqucC  lactucae ^'iiij- 

Laudani  Sydenhami . .     . .  ^\[\. 

Gum.  arabic        .5vj. 

Syrupi  simpl ij. 

Bicarbonat.  sodaR        ..      ..  3ij.     M. 
A  labie-spoonlhl  or  two  to  be  taken  twice  or  thrice  a  day. 


1845.]  Debreyne  on  ChrGnic  Diseases. 


a  local  diaphoresis,  which  is  often  very  serviceable  in  relieving  the 
internal  congestion.  The  occasional  use  of  a  tepid  bath  at  the  samo 
time  will  much  promote  the  cure  ;  for  the  skin  is  orenerally  very  dry 
and  lichenous  in  chronic  liver  complaints.  Emollient  aperient  ene- 
niata  are  nlso  very  useful.  Saline  purgatives,  dissolved  in  a  large 
quantity  of  herb-tea,  to  be  followed  by  repeated  doses  of  rhul)arb  
which  has  long  had  the  reputation  of  directly  promoting  the  flow  of 
the  bile  are  always  more  or  less  necessary. 

In  various  chronic  hepatic  affections  and  visceral  obstructions,  the 
followinsr  formula  has  been  found  bv  Dr.  D.  to  answer  exceedingly 
well. 

5^.  Pul.  Aloes 5ij, 

Sapon  Hispanic. 
Pulv.  Rhei. 

Ferri  Subcarbonat.    .   aa  3iv. 
Potassii  loduretU      .     .     3ij.  In  pil.  120  divide. 
Dose  From  two  to  six  pills  in  the  course  of  the  day. 

If  these  pills  do  not  prove  to  be  sufficiently  purgative,  the  patient 
should  be  instructed  to  drink  some  aperient  mineral  water  to  aid  their 
action. 

Erysipflas.  "The  treatment  which  we  usually  adopt  in  recent  cases  of  this 
disease,  before  the  formation  of  pus  has  taken  place,  is  the  abortive  and  empiric 
plan  followed  by  Dupuytren,  and  which  he  derived  from  the  practice  of  M. 
Petit  of  Lyons.  This  method  consists  in  applying  a  volant  blister  to  the  very 
centre  of  the  inflamed  part.  The  object  which  we  have  in  vie\v  by  this  bold 
and  seemingly  not  very  rational  mode  of  treatment,  is  to  arrest  the  internal  in- 
flammatory action,  and  to  cause  it,  so  to  speak,  to  abort,  by  drawing  to  one  cir- 
cumscribed spot  of  the  skin  all  the  violence  and  raptus  of  the  existing  disease. 
It  is  quite  true  that  this  powerful  concentration  and  sudden  localization  of  the 
inflammatory  action  may,  in  consequence  of  being  excessive,  induce  gangrene 
of  the  blistered  part;  but  this  accident  is  of  very  rare  occurrence  indeed.  Out 
of  between  thirty  and  forty  cases  treated  by  us,  we  have  only  met  with  a  single 
instance  of  it;  and  this  occurred  in  a  cachectic  patient,  whose  constitution  was 
altogether  unhealthy.  The  application  of  a  blister  to  the  knee  was  in  this  case 
followed  by  the  formation  of  a  gangrenous  eschar  in  the  part,  and  the  eventual 
consequences  were  extensive  detachment  of  the  surrounding  skin,  and  consider- 
able suppuration.  Of  late  years,  however,  it  would  seem  that  this  unpleasant 
result  of  the  vesicatory  treatment  has  been  observed  .several  times  in  the  Hotel 
Dieu,  at  Paris,  and  that  antiphlogi.stic  measures  have  been  on  the  whole  very 
successful;  whereas  during  the  years  1813,  1814,  and  1815,  it  was  remarked,  bV 
all  who  followed  Dupu^nren's  practice,  that  bleeding,  &c.  produced  but  little 
benefit,  while  blisters  seemed  to  be  quite  a. specific  remedy." 

Chronic  Cutaneous  Diseases.  Our  author,  without  troubling  him- 
self with  the  divisions  and  subdivisions  of  these  diseases  adopted  by 
most  dermatological  writers,  groups  them  together  under  the  general 
appellation  of  dartres,  and  lays  down  some  general  therapeutic  direc- 
tion that  may  be  applicable  to  all.     A  mild  unirritating  diet,  more 

vegetable  and  milky  than  animal,  emollient  refreshing  drinks one 

of  the  best  of  which  is  whey  and  the  more  or  less  frequent  use  of 
warm-baths,  should  never  be  omitted.      Dr.  1).  throws  overboard,  as 


80  Dehreyne  on  Chronic  Diseases,  [February, 


being  utteil^y  useless,  the  farrago  of  what  liave  been  called  Jepwra/ire 
remedies,  such  as  the  infusion  of  Fumaria,  Dulcamara,  Bardanum, 
Saponaria,  Scabiosa,  *S;c.  &c.  and  he  supports  his  own  opinion  on  this 
point  by  quoting  that  of  Alibert.  The  only  internal  remedy  that 
he  uses  is  the  following  : 

"fy.  Flor  Sulphuris 5iv. 

Sulphureti  Antimon.  nibri.    .    3j. 
Calomclanos    ,.,"...    gr.xij.    M. 
To  be  divided  into  40  pov.'ders,  of  which  one  is  to  be  taken  twice  a  day. 

The  external  treatment  is,  according  to  his  experience,  of  much 
greater  importance  than  any  internal  remedy.  As  a  matter  of  course, 
as  long  as  there  is  any  irritation  present,  the  more  simple  the  baths 
and  other  external  applications  are,  the  better;  but  when  this  has 
been  subdued,  we  should  as  early  as  possible  have  recourse  to  such  as 
are  slightly  stimulant  and  exciting.  Of  these  a  sulphur  bath  pre- 
pared by  adding  five  or  six  ousices  of  sulphuret  of  potash  to  an  ordi- 
nary bath  will  be  found  very  convenient.  The  use  of  this  should 
be  continued  steadily  for  two  or  three  months  at  least.  If  the  darU 
rous  affection  is  limited  to  the  legs,  as  is  often  the  case,  it  may  be 
sufficient  to  use  a  partial  sulphur  bath  to  them  alone  :  from  one  to 
two  ounces  of  the  sulphuret  may  be  added  to  the  requisite  quantity 
of  water.  This  is  a  far  better  application  than  all  the  ointments  and 
lotions  that  are  so  generally  in  use.  "If  the  local  atonic  dartres 
prove  very  obstinate,  and  will  not  yield  to  sulphuretted  baths  and 
lotions,  we  are  in  the  habit  of  trying  an  ointment  composed  often 
drams  of  the  sulphuret  of  potash  to  six  or  eight  ounces  of  lard,  fla- 
voured with  oil  of  thyme  and  usually  with  good  eflect:  the  strength 
of  the  ointment  must  be  varied  according  to  the  degree  of  irritability 
in  the  affected  parts."  Dr.  Debreyxe  tells  us  that,  for  the  last  five 
and  twenty  years,  he  has  made  use  of  no  other  application  than  the 
sulphuretted  ointment  weaker  strong,  according  to  circumstances  
in  the  numerous  varieties  of  Tinea,  or  Scalled-head. 

Of  the  Asthenic  class  or  division  of  chronic  diseases,  none  is  of 
such  frequent  occurrence,  and  therefore  so  important  in  the  eyes  of 
the  practical  physician,  as  atonic  Dyspepsy,  or,  as  our  author  desig- 
nates it,  Gasiro-atouy.  The  following  remarks  are  picked  out  from 
the  description  which  he  gives  of  it. 

This  disease  is  of  very  frequent  occurrence,  especially  among 
women  who  are  subject  to  leucorrhoeal  and  chlorotic  afiections.  Its 
most  obvious  symptoms  are  loss  of  appetite,  uneasiness  and  sense  of 
distention  after  eating,  flatulence  and  often  nausea  and  sickness,  a 
feeling  of  sinking  weakness  and  craving,  more  rarely  of  dragging, 
pain  about  the  stomach  ;  constipation  ;  tongue  white  ;  taste  more  or 
less  depraved,  but  without  being  bitter  or  clammy,  as  in  bilious  de- 
rangements ;  loss  of  muscular  strength  ;  tendency  to  nervous  ail- 
ments, and  these  usually  accompanied  with  great  irritability  of  temper. 
Very  generally  (and  this  remark,  by  the  by,  it  is  especially  important 


1845.]  Dehreyne  on  Chronic  Diseases,  81 


to  attend  to,)  an  invigorating  animal  diet  agrees  better  than  a  farin- 
aceous and  vegetable  one  a  circumstance  that  is  very  significant, 
and  obviously  excludes  the  idea  of  any  phlogistic  or  irritative  element 
being  present.  The  mere  circumstance  of  there  being  some  degree 
of  pain  in  the  epigastrium,  even  although  this  be  increased  on  pres- 
sure, is  by  no  means  a  sufficient  reason  for  suspecting  the  existence 
of  any  inflammatory  action  ;  for  this  pain  may  be  truly  called  an 
atonic  pain,  and  can  be  relieved  neither  by  opiates  nor  antiphlogistics, 
but  only  by  appropriate  tonics. 

With  respect  to  the  treatment  of  Gastro-atony,  the  mere  regulation 
of  the  patient's  diet  will  often  suffice  to  relieve  the  milder  and  less 
chronic  forms  of  it.  He  should  avoid  the  use  of  much  vegetable  or 
farinaceous  food,  and  live  chiefiy  on  animal  meat  and  good  bread, 
with  or  without  an  allowance  of  a  light  sound  v/ine,  according  to  cir- 
cumstances. The  drinking  of  large  quantities  of  hot  drinks,  such 
as  tea,  coffee,  &c.  is  most  injurious,  Our  author  very  pithily  remarks, 
'  pour  les  maladies  chroniques  apyrctiques,  medicaments  sees  ;  et  pour 
les  affi3clions  aigues,  medicaments  liquides:'  the  remark  would  apply 
better  to  food  than  to  medicines.  Steel  and  vegetable  bitters  are  by 
far  the  best  remedies  that  we  can  administer,  more  especially  when 
there  is  any  leucorrhceal  or  chlorotic  ailment.  Rhubarb  is  the  pre- 
ferable aperient  medicine  in  such  cases.  If  the  patient  be  subject, 
as  occasionally  happens,  to  attacks  of  nervous  or  spasmodic  vomiting, 
Dr.  D.  always  has  recourse  to  the  Columbo  powder.  If  much  pain 
accompany  this  unpleasant  symptom,  a  small  portion  of  opium  should 
be  added  to  the  Colombo.  Ice  too  will  often  be  both  grateful  and 
useful,  not  only  in  allaying  the  irritability  of  the  stomach,  but  also  in 
giving  it  tone. 

When  LeucorrTi(Ba  accompanies  this  atonic  state  of  the  digestive 
organs,  Dr.  Df-breyne  recommends  the  use  of  the    following  pills  : 

IJ;.  Ferri  Subcarbonat 3iv, 

P.  Cassuvii  (Cashew)    .     .     ,  5iv. 

P.  Aloes        5j. 

Terebinth.  Veneti     .    .    .     .  q.  s.  ut  fiat  raassa  in  pil. 
cxx.  div. 
Dose:  one  or  two  to  be  taken,  along  with  some  bitter  tincture  or  infusion  twice 
or  thrice  a  day. 

A  somewhat  similar  formula  will  be  found  very  efficacious  in  most 
cases  of  Chlorosis. 

Dropsy.  The  following  extract  gives  a  good  summary  of  our 
author's  views  respecting  the  treatment  of  this  disease,  when  it  is  not 
dependent  upon  any  organic  visceral  lesion. 

"We  should  always  make  sure  of  one  of  the  outlets,  by  which  nature  usually 
seeks  to  evacuate  the  .<;erosities  elTused  within  the  .5planchnic  cavities.  Now, 
as  in  theciu-e  of  Dropsies,  the  serous  evacuations  most  frequently  take  place  by 
the  bowels  and  kidneys,  it  will  be  prudent  to  act  uix)n  both  of  these  emunctories, 
by  combininj^  the  use  of  diuretics  with  that  of  hydragof3;uc  purgatives.     At  the 

6 


82  Dehreyne  on  Chronic  Diseases,  [February, 


same  time,  we  should  prescribe  a  dry  and  tonic  diet,  consisting  chiefly  of  broiled 
or  roasted  meats,  bread,  and  a  certain  allowance  of  light  wine.  The  patient 
should  be  directed  to  take  as  little  fluid  food  or  medicine  as  possible,  and  he 
should  therefore  seek  to  quench  his  thirst  with  fruit,  ice,  and  such  like  things." 

The  favorite  medicine  of  Dr.  D.  in  dropsy  is  a  medicated  wine, 
composed  of 

Rad.  Jalapas  contus 3  iiss. 

ScilltE  contus 3  iiss. 

Pot.  Nitratis 3  v. 

Vini  Albi ibj. 

Dose :  from  one  to  three  tablespoonfuls  thrice  daily. 

The  number  of  alvine  evacuations  need  not  exceed  six  or  eight  in 
the  24  hours.  The  remedy  acts  in  some  cases  chiefly  on  the  bowels, 
in  otliers  chiefly  on  the  kidneys,  while  in  a  third  set  of  cases  both 
emuncfories  are  powerfully  affected  at  the  same  time.  When  patients 
object  to  the  use  of  this  wine,  or  when  it  appears  to  disagree  with  the 
stomach,  we  may  have  recourse  to  the  following  pills:  

'fy.  Pulv.  Digitalis  .  .  .  5jv. 
Pulv.  Scammonice  ,  .  5ij. 
Pulv.  Scillac     .     .     .    .     5ij. 

Extract.  Juniperi     .    .     q.  s.     Ut  fiat  massa  in  piL 
cxx.  dividenda. 
Dose:  from  one  to  two  pills  three  times  a  day,  washing  them  down  with  three 
or  four  spoonfuls  of  white  wine,  in  a  bottle  of  which  half  an  ounce  of  nitrate  of 
potash  has  been  dissolved. 

Dr.  D.  says  that  he  has  found  these  pills  especially  servicable  in 
cases  of  Hydrothorax  and  Hydropericardium.  He  is  too  experienced 
and  candid  a  practitioner  not  to  admit  that  we  can  seldom,  or  never, 
hope  to  effect  a  r)^rmanent  cure  in  such  cases  ;  still  it  is  an  important 
thing  to  relieve  our  patients  for  a  time,  and  prolong,  if  it  be  not  given 
us  to  save,  life. 

In  cases  of  Organic  Diseases  of  the  Heart,  our  author  mainly  re- 
lies  on  the  internal  administration  of  the  nitrate  in  combination  with 
tincture  of  Digitalis  given  in  much  larger  doses  than  are  usually 
recommended  and  on  the  api)lication  of  leeches  and  blisters  over 
the  cardiac  region.  He  seldom  varies  his  plan  of  treatment,  and 
assures  us  that,  with  these  simple  means,  followed  out  foi  a  due  length 
of  time,  he  has  succeeded  in  relieving  a  great  many  patients,  who 
had  derived  no  benefit  from  a  variety  of  other  remedies. 

In  the  closing  Chapter  of  his  Work,  Dr.  D.  lays  down  some  excel- 
lent  general  rules  for  the  treatment  of  disease  in  the  members,  male 
and  female,  of  those  austere  religious  orders,  who  insist  so  rigidly  on 
the  observance  of  numerous  and  prolonged  fasts,  in  addition  to  other 
modes  of  penance.  Of  these  orders  the  most  conspicuous  are  the 
Chartreux  and  the  Trappists,  "whose  establishments,"  we  are  told, 
"are  now  so  numerous,  and  whose  moral  and  religious  mfluence,  along 
with  the  benefits  of  agricultural  improvement  which  they  have  intro- 
duced, are  every  day  more  and  more  felt  and  appreciated  io  many  of 


1845.]  Observations  on  the  use  of  Blisters,  ^c,  83 


the  finest  districts  of  France."  A  vast  deal  of  harm  has  been  done 
for  nrianv  years  past  lullietoo  common  ado|)tion  of  Broiissaian  prin- 
ciples, by  themedicnl  praclitioners  of  the  Provinces;  but  now,  thank 
God,  the  errors  of  Physiologism  are  mosf  fully  acl<rio\vIedo[ed  and 
repudiated.  As  a  genera'  truth  it  may  he  asser.od,  that  the  diseases 
of  austere  religionisls  will  not  bear  well  mui'-h  depletion. 

Even  in  acute  disf)rders,  the  lancet  shotdd  be  sparingly  used  ;  and, 
instead  of  repeated  bleedings,  recourse  should  be  had  to  the  internal 
use  of  antimonials.  and  to  hhsters,  &;c.  In  fevers,  when  there  is  no 
distmct  inflammatory  localization,  general  bleeding  should  very  rare- 
ly, if  ever,  be  practised.  Of  chronic  diseases,  by  far  the  most  com- 
mon among  tlie  Monastic  Community  are  Gastro-atony  and  its 
usual  concomitants  of  Dyspepsia,  Colic,  Gastralgia,  general  weak- 
ness, and  so  forth. 

As  for  Gaslrilis,  the  term  might  be  erased  from  the  peculiar 
nosology  to  which  we  are  at  present  alluding.  Opium,  cither  alone 
or  in  conjunction  with  other  remedies,  according  to  circumstances, 
is  an  admirable  remedy  in  a  vast  number  of  the  gastric  and  enteric 
disorders  to  which  the  Trappist  brethren  are  liable.  It  would  seem, 
from  the  statements  of  our  author,  that  these  monks  are  singularly 
exempt  from  the  epidemics  which  prevail  in  the  neighborhood  of  their 
establishments.  Even  the  cholera  in  1832,  did  not  enter  one  of  them 
throughout  the  whole  of  France.  This  exemption  he  attributes  to 
the  temperance  of  their  diet,  and  the  calm  unruffled  tenour  of  their 
lives.  He  paints  in  glowing  terms  the  joys  of  the  peaceful  life  of 
the  pious  Cenobiles. 

"  How  greatly  mistaken,"  exclaims  our  worthy  author,  "  are  they  who  sup- 
pose that  religious  penitents  are  gloomy,  melancholy  and  hsrd-hesrted  men,  or 
that  they  become  the  early  prey  of  a  tedious  and  painful  death!  IS'o;  their  life 
is  one  long  and  blessed  repose;  or  rather,  as  the  Prophet  says,  it  is  a  river  of 
peace  which  calmly  bears  them  on  to  the  everlasting  rest  of  God.  They  seem 
to  the  eyes  of  the  worldly,  who  are  altogether  absorbed  with  the  frivolities  of  the 
passing  scene,  to  languish  and  die;  and  yet  they  are  full  of  health  and  life,  for 
they  taste  a  peace  and  happiness  of  mind  whichthe  world  cannot  know:  Visi 
sunt  oculis  insipicntium  viori ;  illi  aiUeni  sunt  in  pace." 


Observations  on  the  Use  of  Blisters  in  Acute  Infammatory  Diseases, 
and  on  the  Effects  of  Bleeding,  B'isters,  and  Mercury,  on  the 
Blood.  By  James  'Purnbull,  M.  D.,  Physician  to  the  Liverpool 
North  Disyensary. 

In  the  Lancet  of  the  31st  of  August,  1844,  my  attention  was  drawn 
to  the  treatment  of  acute  inflammation  by  large  blisters,  from  observ. 
ing  some  excellent  practical  remarks  on  the  subject  by  Dr.  Henry 
Bennet,  in  which  he  has  shewn  that  they  may  be  safely  and  benefi. 
cially  used  at  an  earlier  period  of  acute  inflammatory  diseases,  e^pe- 


88  Observations  on  the  use  of  Blisters,  <^c.       [February, 


Dr.  H.  Rennet  has  shown  that,  "both  in  non-inflammatory  and  in 
inflammatory  diseases,  hlistcrs  do  not  give  rise  to  as  nuieh  ^enernl 
excitement  as  is  gencraily  believed  ;"  nnd  in  this  I  coincide  wiih  him, 
thoiif2;h  I  am  dis[)osed  to  regard  their  exciting  effects,  and  (he  possi- 
hihty  of  their  doing  harm,  as  greater  tiian  he  has  estimated  them. 
We  must  hesitate,  too,  before  we  conclude  that  large  blisters  aie 
devoid  of  injurious  efl^ect  when  applied  in  the  early,  stnge  of  acute 
inflammations,  except  in  very  rare  cases,  when  we  find  that  such 
writers  as  Copeland,  Stokes,  and  Alison,  express  themselves  strongly 
against  the  use  of  blisters  before  vascular  depletion;  and  when,  too, 
we  find  that  Andral  has  expressed  a  doubtful  opinion  as  to  whether, 
by  their  influence  on  the  fibrin  of  the  bleed,  they  may  have  a  benefi- 
cial or  injurious  effect. 

Dr.  Stokes,  in  regard  to  the  treatment  of  acute  bronchitis,  observes, 
'*that  counter. irritation  may  be  considered  inapplicable  in  the  earlier 
periods  of  the  diseases  long  as  the  skin  is  hot,  the  pulse  strong,  the 
expectoration  scanty  and  difficult  ;  in  fact,  so  long  as  the  first  stage 
of  (he  affection  continues,  that  stage  in  which  bleeding  and  (ar{ar 
emetic  are  useful,  blisters  are  inefficacious  and  ofien  hurtfid.  It 
may  be  laid  down  as  a  general  rule,  that  the  longer  we  can  with  safe- 
ty postpone  the  application  of  a  blister,  the  greater  certainty  will 
there  be  of  its  favorable  action."  His  views  of  their  action  in  pneu- 
monia are  similar;  for  in  treating  of  that  disease,  he  refers  to  the 
observations  he  had  previously  made  as  to  the  treatment  of  bronchi- 
tis. We  have  here,  then,  the  experience  of  one  of  our  best  practical 
writers,  supported  by  the  opinion  of  others  of  equally  high  authority 
in  this  country,  opposed  to  the  treatment  of  M.  Gendrin. 

Let  us  see  what  light  is  thrown  upon  the  subject  by  investigating 
still  further  the  effects  which  are  produced  upon  the  blood  by  the  ac- 
tion of  blisters.  Andral  has  shewn  (hat  every  local  phlegmasia  has 
the  effect  of  raising  the  quantity  of  fibrin  in  the  blood  above  the  natu- 
ral standard  of  three  parts  in  a  thousand,  and  that  this  increase  is  in 
relation  to  the  extent  of  the  inflammation,  and  the  degree  of  febrile 
movement  excited  in  the  system,  averaging,  in  acute  inflammations, 
from  six  to  eight  parts,  but  in  inflammation  of  the  lungs,  rising  higher 
than  in  any  other  disease,  in  one  instance  having  been  found  as  high 
as  ten  and  a  half,  'i'his  ir:crease  of  the  fibrin  occurs,  not  only  in 
inflammation  of  internal  organs,  but  also  in  (hat  of  the  skin  as  well 
as  in  burns,  which  most  nearly  resemble  the  eflects  ofa  blister. 

We  have  no  experiments  to  shew  directly  how  far  blistei-s  may 
have  the  effect  of  increasing  the  fibrin  in  the  blood  ;  but  from  what 
has  been  observed  in  those  cases  of  pleuritis  in  which  a  portion  of  the 
serum  and  fibrin  have  been  separated  from  the  blood,  we  have  reason 
to  think  that  the  discharge  of  serum,  or  even  of  fibrin,  at  the  stirface 
of  the  wound  caused  by  a  blister,  tends  less  to  diminish  than  the  arti- 
ficial inflammation  does  to  increase  the  quantity  of  fibrin.  Andral 
has  shewn  that  in  two  cases  of  pleurisy  without  effusion,  the  quantity 
of  fibrin  was  5-8  and  5*9,  while  in  eight  recent  cases  with  effusion,  it 


1845.]  Observations  on  the  use  of  Blisters,  dfc.  87 


varied  between  four  and  six.  It  would  seem  from  this,  that  no  very 
decided  diminution  of  the  fibrin  of  the  Idond  follows  immediately  from 
the  effusion  in  pleuritic.  Direct  experiment  only  can,  however,  de- 
cide how  far  the  quantity  of  fibrin  in  the  blood  is  affected  by  blisters. 
In  treating  of  the  effects  of  revulsive  remedies  upon  (he  blood,  Andral 
expresses  his  opinion  on  this  point  as  follows:  "Thus,  a  large  blister 
takes  from  the  blood  a  certain  quantity  of  its  serum;  hut  besides,  some 
fibrin  is  doposited  at  the  same  time  at  the  surface  of  the  wound  pro- 
duced by  the  action  of  the  cantharides.  Where  there  exists  in  the 
blood  a  superabundant  proportion  of  fibrin,  would  this  be  the  means 
of  diminishing  the  excess  of  this  principle  in  the  blood  ?  Or,  on  the 
contrary,  if  the  action  of  the  cantharides  be  exercised  on  a  pretty 
large  surface,  if  the  inflammation  which  results  from  its  application 
have  a  great  intensity,  if  especially  it  augment  the  febrile  movement 
already  existing,  may  there  not  arise  from  this  a  new  cause  for  the 
superabundant  fornw\tion  of  fibrin,  and  may  not  this  cutaneous  phleg- 
inasia.  artificially  produced  to  diminish  tiie  intensity  of  another  by 
the  kind  of  influence  which  it  may  excercise  upon  the  blood,  have  the 
effect  of  increasing  the  morbid  condition,  which  represents  in  the 
blood  the  phlegmasius  state,  and  from  which  its  intensity  is  derived?" 
(Essai  d  ILMnatologie  Pathologique,  p.  12  4.) 

The  same  distinguished  pathologist  has  himself  furnished  us  with 
the  means  of  pursuing  this  inquiry  some  degree  further,  in  comparing 
the  action  of  blisters  with  the  effects  produced  upon  the  blood  by 
mercury,  when  given  so  as  to  act  upon  ihe  motith.  He  examined 
the  blood  in  four  cases  in  which  the  mouth  was  affected  with  different 
degrees  of  severity,  and  it  is  a  sin^jular  fact,  that,  instead  of  finding  a 
diminution  of  the  fibrin,  as  we  should  have  expected,  from  our  know- 
ledge of  the  influence  of  mercury  in  subduing  inflnmmation,  he  dis- 
covered  that  tliere  wasan  increase  in  the  quar)tity,w!)ich  corresponded 
with  the  severity  of  the  specific  mercurial  inflammation  of  the  mouth, 
and  the  degree  <f  febrile  action  excited  in  the  system. 

In  the  first  case,  in  which  the  pulse  was  60,  the  inflammation  of  the 
mouth  slight,  but  the  salivation  abundant,  the  quantity  of  fibrin  was 
4"5.  In  the  second,  there  was  more  inflammation,  and  more  febrile 
action;  the  pulse  was  100.  and  tlje  quantity  of  fibrin  5.  In  the  third, 
there  was  nxire  intense  inflammation;  the  febrile  action  was  nearly 
the  same  as  in  the  second  case;  the  pulse  was  9G,  and  the  quantity 
of  fibrin  0-4.  In  the  fourth  case,  the  face  was  greatly  swelieil,  and 
the  mouth  crusted  with  talse  membranes;  the  pulse  was  120,  and  the 
quantity  of  fibrin  G-G.  In  the  last  case,  the  blood  had  been  examined 
a  few  days  beture,  when  the  patient  had  been  bled,  on  account  of  a 
slight  attack  of  apoplexy,  and  only  3'o  of  fibrin  had  then  been  found. 
In  all  the  other  cases,  there  was  no  other  disease  present  that  could 
have  affected  its  quantity. 

We  see,  from  these  cases,  that  mercury,  by  its  specific  effect  upon 
the  mouth,  nets  not  from  any  power  of  causinu  a  state  of  dissolution 
of  the  blood,  but  as  a  counter-irritant  or  derivative,  and  that  its  power 


88  Paracentesis  Thoracis  in  Acute  Pleurisy,     [February, 


of  subduing  inflammation  arises  from  a  local  counter-action,  similar 
to  that  caused  by  a  blister.  Both  remedies  produce  more  or  less 
febrile  excitement,  both  seem  to  exercise  a  similar  effect  upon  the 
blood,  and  both  cause  more  or  less  secretion  of  fluid.  The  similarity 
in  their  mode  of  action  being  such,  we  must  inquire  how  far  they 
agree  as  to  the  circumstances  in  which  they  are  useful  in  the  treat- 
ment of  inflammation.  In  this,  too,  we  find  that  there  is  a  similarity ; 
for,  in  treating  acute  inflammatory  diseases,  we  do  not  give  mercury 
at  once  with  the  view  of  inducing  its  specific  action  on  the  mouth, 
but  first  make  use  of  depletion,  where  it  is  admissible,  with  the 
double  intention  of  reducing  the  inflammation,  and  of  rendering  the 
system  more  easily  affected  by  the  mercury.  Both  remedies,  too, 
possess  a  powerful  influence  in  causing  absorption  of  the  fluid  which 
has  been  effused  from  inflam.mation  of  a  serous  membrane. 

For  these  facts  in  regard  to  the  effects  of  bleeding,  blisters,  and 
mercury,  upon  the  blood,  we  are  chiefly  indebted  to  the  recent  re- 
searches of  Andral.  They  seem  to  confirm  the  common  opinion,  that 
abstraction  of  blood  should,  in  all  cases  in  which  it  is  admissible, 
precede  the  use  of  blisters  and  mercury  ;  but  while  they  throw  some 
light  upon  the  obscure  but  interesting  subject  of  the  eflects  of  reme- 
dies on  the  blood,  they  would  scarcely  justify  us  in  drawing  any 
other  positive  inference.  London  Lancet, 


PART  III. MONTHLY  PERISCOPE. 

Paracentesis  Thoracis  in  Acute  Pleurisy.  At  the  latter  end  of 
last  year  M.  Trousseau  communicated  to  the  Paris  Academy  a  case 
in  which  he  had  successfully  resorted  to  paracentesis  in  acute  pleuri- 
sy. He  has  just  published  two  other  cases  in  which  the  operation 
was  performed  under  similar  circumstances  ;  one  of  the  patients  re- 
covered, the  other  died. 

The  first  patient  was  a  young  woman,  twenly-three  years  of  age, 
who  was  attacked  with  acute  inflammation  of  the  left  pleura  on  the 
9th  of  June.  She  was  actively  treated,  but  without  any  ameliora- 
tion taking  place.  The  effusion  was  very  considerable,  the  entire 
thoracic  region  on  the  left  side  being  dull,  the  intercostal  spaces  dila- 
ted, and  the  heart  thrown  underneath  the  right  cartilage.  On  the 
21st  the  menstrua  appeared,  but  stopped  in  the  evening.  During  the 
night  the  oppression  increased  to  such  an  extent  that  M.  Trousseau, 
who  was  consulted,  decided  on  performing  the  operation  of  puracen- 


1845.]  Paracentesis  Thorasis  in  Acute  Pleurisy.  89 


tesisas  the  only  chance  of  saving  the  patient.  A  smiill  incision  was 
made  in  the  skin,  between  the  seventh  and  eighth  rib,  a  little  to  the 
outside  of  the  breast.  Tije  skin  was  then  raised  until  the  incision 
corresponded  to  the  intercostal  space  immediately  above,  and  the 
ordinary  abdominal  trocar  was  introduced  tiie  depth  of  about  two 
inches.  On  the  spear  being  withdrawn  the  fluid  rushed  forth  impetu- 
ously. In  order  to  prevent  the  air  from  penetrating  into  the  cavity 
of  the  chest,  M.  Trousseau  wrapped  round  ihe  pavilion  of  tlie  canula 
a  strip  of  very  thin  skin,  wliich  the  fluid  raised  easily  in  passing  out, 
but  wliich,  falling  on  the  orifice  during  deep  inspirations,  effectually 
closed  it.  An  assistant  compressed  the  abdomen,  so  as  to  push  up 
the  diaphragm,  as  also  the  parietes  of  the  chest.  Four  pints  of  sero- 
sity  were  thus  withdrawn.  The  canula  was  then  rapidly  withdrawn, 
the  skin  being  pressed  down  at  the  same  time.  Tiie  incision  regain- 
ed its  position,  below  the  puncture,  and  was  covered  with  a  small  piece 
of  court-plaster. 

The  heart  immediately  returned  to  its  natural  position,  and  all 
dyspnoea  disappeared.  The  patient  slept  seven  hours  the  following 
night,  and  rapidly  recovered.  A  fortnight  after  the  slight  operation 
she  was  able  to  walk  out ;  the  respiratory  murmur  had  returned,  her 
general  health  was  good,  and  the  only  abnormal  symptom  which  she 
presented  was  a  certain  degree  of  matity  in  the  inferior  part  of  the 
left  thoracic  region. 

The  second  patient  was  a  young  woman,  twenty-five  years  of  age, 
who,  a  couple  of  days  after  a  laborious  accouchement,  was  seized 
simultaneously  with  symptoms  of  pleurisy,  enteritis,  and  peritonitis. 
She  v/as  bled,  a  blister  was  applied  to  the  parietes  of  the  chest,  and 
calomel  was  given  internally.  The  abdominal  symptoms  became 
less  intense,  but  the  thoracic  increased  in  violence,  and  the  effusion 
became  so  considerable  on  the  twelfth  day  that  death  appeared  immi- 
nent. The  heart  was  displaced,  and  the  intercostal  spaces  thrown 
out.  The  operation  was  performed  as  in  the  former  case,  and  three 
pints  of  purulent  serosity  extracted.  The  patient  became  much  ea- 
sier, but  in  the  course  of  five  days  the  fluid  accumulated  to  such  an 
extent  as  to  render  the  operation  again  imperative.  Four  pints  of 
serosity,  containing  an  enormous  quantity  of  pus,  were  extracted,  to 
the  great  relief  of  the  woman,  but  the  skui  not  having  been  used,  a 
small  quantity  of  air  entered  the  thoracic  cavity.  The  following  day 
there  was  pneumothorax.  Four  days  later  the  puncture  again  be- 
came indicated,  and  about  four  [)ints  of  fetid  pus  were  withdrawn. 
The  patient  died  a  few  days  afterwards.  At  the  autopsy  the  lung 
was  found  firmly  bound  down  by  liaise  membranes.  The  pleural 
cavity  contained  about  three  pints  of  fetid  pus.  Slight  traces  of 
peritonitis  were  found  in  the  abdomen,  and  an  abscess  of  the  large 
ligaments. 

M.  Trousseau  remarks  that  the  second  case,  one  of  intense  puer- 
peral fever,  with  a  purulent  diathesis,  was  of  so  unfavorable  a  nature 
as  not  to  give  paracentesis  a  fair  trial.     In  the  first  case  the  opera- 


90  Anasarca  Cinchona  in  Rheumatism.         [February, 


tion  gave  immcdinte  relief,  and  was  followed  by  nearly  immedialo 
recovery.  He  thinks  it  of  great  importance  to  keep  the  air  out  of 
the  pleura  in  order  to  prevent  the  decomposition  of  the  pus,  and  con- 
siders that  the  slate  of  his  second  j;>atient  was  aggravated  by  the 
omission  of  this  precaution.  In  addition  to  the  instantaneous  relief 
produced  by  tlie  suhtraction  of  so  large  a  quantity  of  fluid,  M.  Trous- 
seau says  that  great  benefit  is  experi'juced  Irom  the  air,  which  imme- 
diately rushes  down  into  ihe  bronchi,  breaking  the  adhesions  which 
bind  the  luno:  down.  Journal  de  Medicine. 


M.  CASTEL>rAU  on  ihe  Causes  of  Anasarca  IVI.  Andral  profesjies, 
at  present,  that  anasarca  is  always  occasioned  either  by  disease  of  the 
liver,  of  the  heart,  by  some  other  obstruction  of  the  venous  system, 
or  by  Bright's  disease.  This  assertion  is  not  the  result  of  theory, 
but  the  expression  of  his  clinical  experience.  He  has,  he  says,  al- 
ways found  dropsies  which  do  not  depend  on  some  obstruction  to  the 
circulation  of  the  blood  to  coincide  with  albuminous  urine.  M.  Cas- 
telnau  questions  the  accuracy  of  this  opinii^n,  and  founds  his  doubts 
on  four  cases  of  anasarca  in  which  the  urine  was  not  albuminous, 
and  there  was  no  perceptible  obstruction  to  the  circulation  in  the 
heart,  liver,  or  any  other  organ.  In  these  cases  the  anasarca  appear- 
ed to  be  th(i  result  of  a  state  of  anemia  or  chlorosis,  demonstrated  by 
all  the  symptoms  which  indicate  the  existence  of  such  morbid  condi- 
lions.  Archives. 


Observations  on  ihe  Treatment  of  Acute  Ilheumalism  by  Cinchona 
Bark.  By  John  Popiiam,  M.  D.  The  cases  in  which  it  was  most 
successfully  employed  were  those  of  fibrous  rheumatism  or  rheumatic 
fever  properly  so  called.  When  it  appeared  at  all  probable  that 
either  the  pericardium  or  heart  was  affecfed,  the  bark  was  not  exhib- 
ited, at  least  until  the  inflammatory  symptoms  were  checked.  In 
capsular  rheumatism  the  bark  seemed  to  disagree  with  the  acute 
stages,  aggravating  the  symptoms,  but  in  very  chronic  cases  it  seemed 
of  service. 

The  conclusion  at  which  Dr.  Popliam  appears  inclined  to  arrive, 
with  regard  to  the  administratioii  of  this  medicine,  are  these  : 

"  That  it  is  iinportarit  to  procure  due  evacuations  previous  to  the  exhiliticn 
of  the  bariC,  except  the  patient  be  greatly  deteriorated  by  constitutional  debility, 
or  the  protraction  of  the  disease. 

"  That  it  is  more  qidcldy  successful  when  the  disease  is  cnrhj  combatted  by 
depleting  measures,  than  when  inefiiciently  managed  at  the  onset,  and  allowed 
to  take  root  in  the  system. 

"Hence  that  is  more  likely  to  extinguish  the  disease  and  prevent  chronic  in- 
firmity in  ihe  seqi-el  of  first  attacks  being  uncomplicated,  than  when  a  habit  has 
been  termed  by  reason  of  repeated  relapses. 

"That  the  periodicity  of  the  symptoms  either  peculiar  to  the  attack,  or  produ- 
ced by  treatment,  and  the  duration  and  apyrexia  of  the  intervals,  afford  strong 
presumptive  arguments  for  the  use  of  bark. 

"That  bark  is  especially  called  for  in  cases  where  there  is  complete  atony  of 
the  cutaneous  ve.^els,  so  that  the  .skin  is  unceasingly  pouring  out  acid  colliqu2- 


1645.]  Surgical  Operations  in  Cutaneous  Diseases.  91 


live  sweats,  giving  it  a  dull  end  pcrlwiled  sppearance.  at  tbesame  time  that  the 
pains  are  abated,  and  the  pulse  small  and  inaicaiing debility. 

'That  to  produce  its  eiTects,  quantity  is  not  by  tny  means  so  essential  as  in 
intermittent,  and  that  large  quantities,' especially  of  the  sulphate  of  quinine,  de- 
range the  stomach  in  many  cases,  and  bring  back  the  fever. 

'That  it  is  judicious.to  administer  it  at  the  periods  of  remission,  and  stop  it 
at  the  return  of  the  exacerbations. 

"That  it  is  injurioi^s  when  important  visceral  disease  co-exists,  and  is  espe- 
cially contra-inaicated  in  cerebral  or  the  acute  stage  of  cardiac  complications. 

"Lastly,  that  in  the  synovial  variety,  it  is  interior  to  other  modes  of  treatment ; 
but  in  persons  of  a  rheumatic  diathesis,  when,  from  the  long  continuance  of  the 
disease  the  strength  has  sulTered,  and  disfisruration  of  the  joints  has  occurred 
without  serious  de.<;truction.  a  course  of  baik.  combined  with  sulphur,  iScc.  of.en 
prevents  the  recurrence  of  subacute  attacks,  and  promotes  the  absorption  of  the 
effused  svnovia.  Dublin  M^d.  J^i.r. 


On  the  utility  of  Surgical  Opera'ions  in  Cancerous  Diseases.  
The  grand  points  of  tiiis  most  innportant  surgical  question  are  to  de- 
te  mine  1,  if  it  be  really  true  that  Cancerous  disease  i^  primarily  of 
a  local  nature,  and  subsequently  dcgencrat(S  into  a  constitutional 
malady;  and  2,  if  e.xtirpaiion,  performed  at  on  early  period,  pre- 
vents the  occurrence  of  this  deg^norafion.  With  the  view  of  elu- 
cidating these  matters,  .M.  Leroy  d'Etiolies  his  collected  the  followirg 
statistical  ohsorvntions.  Of  601  operations,  117  were  performed 
within  a  twelvf-month  after  the  first  m.tnifp^tation  of  the   disease. 

Of  these  117  cases,  there  were  61  in  which  tlie  disease  had  return- 
ed at  the  time  when  the  reports  reached  me.  It  is  more  than  proba- 
ble that  this  proportion  would  bo  foun<1  to  be  still  higher,  if  we  knew 
the  actually  present  state  of  these  cases. 

The  results  of  operations  for  Cancer  of  the  Lip  are  curious  ard 
worthy  of  notice,  in  consequence  of  the  diltVrence  in  this  respect 
observed  in  the  two  sexes.  Of  6.*33  cnses  of  Cancer  in  the  male  sub- 
ject, 165  were  examples  of  Cancer  of  the  Lip:  of  these  114  were 
treated  with  the  knife  12  with  caustics.  There  were  15  relapsesin 
all:  that  is,  about  an  eighth  of  the  whole.  On  the  other  hand,  cf 
2,143  cases  of  Cancer  in  the  female,  there  were  only  34  instances  of 
the  disease  in  the  lip;  of  these,  22  were  treated  by  excision;  and  in 
seven  nearly  a  third  there  was  a  return  of  the  disease. 

This  ditf(;rence  does  not  hold  good  of  Cancer  of  the  Tongtie  :  for 
then  the  disease  is  equally  fatal  in  both  sexes.  Of  nine  operations, 
in  which  a  cancerous  tumour  of  this  organ  was  extirpated,  thrco 
were  performed  within  one  twelve-month  after  the  earliest  appcArance 
of  the  disease.  In  the  other  si.x  cases,  the  patients  died,  the  disease 
having  previously  returned. 

As  respects  Cancerous  diseases  of  the  Mamma,  we  find  the  follow- 
ing data.  Of  277  operations,  73  were  performed  within  the  last  two 
years:  as  yet  we  cannot  say  positively  what  are  the  results.  Of  the 
remaining  204  cases,  22  of  them  proved  fatal  in  the  year  after  the 
operation,  and  in  S7  others  there  was  a  relapse  of  the  disease. 

M.  Lcroy  deduces  tite  followintr  conclusions  from  bis  researches: 

1.  Extirpation  does  not  arrest  tho  progress  of  Cancerous  disease. 


92  Treatmerd  of  Hydrocele  Ovariotomy.        [February, 


2.  This  operation  should  not  \m  resorted  to,  as  a  general  method 
of  treatment,  except  for  Cancer  of  the  skin  and  lips. 

3.  There  is  no  necessity  to  extirpate  Cancerous  disease  of  other 
organs,  except  when  an  alarming  hcCinorrhage  supervenes.  Compies 
rendus. 

The  Acadeni}^  appointed  ]\!M.  Roux,  Velpeau,  and  Serres,  to  report 
upon  this  communication  of  M.  Leroy.  Mcdico-Chirurgical  Review* 


Treatment  of  Hydrocele  with  lodiirettcd  Injections.  In  more  than 
300  cases  of  this  complaint  treated  with  an  ioduretted  injection, 
(composed  of  tincture  of  iodine  4  parts,  and  distilled  water  125  parts,) 
by  M.  Ve.peau,  not  a  single  accident  or  unpleasant  symptom  has  ever 
occurred.  One  of  the  patients  indeed  died  ;  but  the  fatal  result  in 
this  instance  proceeded  from  a  purulent  inflammation  of  the  cellular 
tissue  of  the  pelvis,  quite  unconnected  with  the  operation,  and  not 
having  any  communication  whatever  with  the  affection  of  the  scro- 
tum. The  average  period  for  effecting  the  cure  was  15  days.  In 
one  case  only  the  injection  found  its  way  into  the  tissue  of  the  scro- 
tum, in  place  of  the  tunica  vaginalis  :  not  withs-tanding  this  misadven- 
ture, no  appearance  of  gangrene  supervened,  and  the  patient  recovered 
without  any  unpleasant  accident.  L^Experience,  Medico- Ciiirur- 
gical  Review, 


Ovariotomy  Dr.  Ciiuhciiill.  Ovariotomy  is,  just  now,  a  formi- 
dable rival  for  fame,  with  Mesmerism  or  Hydropathy.  The  two 
former,  indeed,  ought  to  go  hand-in-hand  ;  for  as  ovarian  tumours 
seldom  grow  in  any  but  ihe  patrons  and  recipients  of  animal  mag- 
netism, it  would  be  a  great  advantage  to  those  who  come  under  the 
scalpel,  to  have  its  pains  and  penalties  annihilated  by  the  passes  of 
an  adroit  mesmerist.  Be  this  as  it  may,  the  ovarian  operation  can 
be  tested  only  by  time  and  statistics  the  advocates  and  opponents 
steering  such  opposite  courses,  and  using  such  ingenious  arguments, 
as  to  puzzle  tlie  practitioner.  Statistics  will  settle  the  question.  Dr. 
Montgomery  has  gone  into  considerable  detail  on  this  point,  and 
collected  from  various  points  of  the  compass  a  mass  of  materials 
that  may  greatly  assist  our  prognosis  perhaps  even  our  diagnosis, 
in  these  dangerous  cases. 

Dr.  M.  properly  remarks,  that,  under  the  head  of  ovarian  dropsy, 
are  comprehended  many  swellings  very  different  from  dropsy.  There 
may  be  a  single  or  many  cysts  and  the  contents  of  the  cysts  may 
and  do  vary  from  clear  serum  to  an  almost  wholly  solid  substance. 
The  ovaries  may  consist  of  malignant  deposits  and  last,  not  least, 
they  may  be  detached,  or  they  may  have  acquired  extensive  adhesions 
to  various  adjacent  parts,  rendering  a  successful  operation  all  but 
impos.sible. 

Mr.  Southam  has  published  the  result  of  20  cases  of  paracentesis 
 ten  from  Bright  five  from  Barlow  and  five  of  his  own.  Out 
of  these,  14  died  within  nine  months  after  the   first   operation.     Of 


1645.] 


Oi'ariotoiny, 


93 


the  remaining  six,  two  (.lied  in  IS  months  and  four  lived  for  several 
years,  from  four  to  nine. 

Of  eleven  cases  of  ovarian  dropsy  admitted  into  Guy's  Hospital, 
seven  were  tapped,  three  of  which  were  unsuccessful.  The  proposal 
of  injecting  siimulatin-T  fluid-  into  the  emptied  sacs,  has,  we  believe, 
eiiher  never  been  tried,  or  entirely  abandoned. 

The  following  throe  tables  will  exhibit  a  coup  d'ceil  of  the  results 
of  almost  all  the  cases  on  record.  It  has  been  constructed  with  great 
care  and  labor  by  the  able  and  indefatigable  author. 

Table  I.  Cases  of  Extirpation  of  the  Ovary. 


No.  and 
Date. 

Operator. 

Age 

Incision. 

Result. 

Character  of  Disease, 

Adhesions. 

1 

L'Aumonier. 

4  inches. 

Recovered. 

Abscess  of  ovary. 

21809 

Dr.  M-Dowal. 

9     tlo. 

do. 

Gelatinous  matter. 

3-1816 

do. 

Long. 

do. 

Scirrhous  ovary. 

4 

do. 

do. 

do. 

Dr.  N.  Smith. 

do. 

do, 

Died, 

Recovered. 

Cyst,  fluid. 

5 

6 



71821 

33 

3  inches. 

Adhesions, 

8 18-25 

-Mr.  Lizars. 

36 

Long, 

do. 

91325 

do. 
Dr.  A.  G.  Smith. 

35 
30 

do! 
do. 

D:e.'. 
Recovered. 

Adherent, 

10 

Cyst,  fluid. 

11 

Dr.  Qui.tenbaum. 

About  4  in. 

do. 

12-1829 

Mr.  D.  Ilo^MTS. 

About  3  in. 

do. 

Solid  and  fluid. 

Adhesions. 

13 

Dr.  Grariville. 



Died, 

14 

Dr.  Chrysmer. 

47 

Long. 

do. 

Cart,  and  lardaccous 
matter. 

Adherent. 

15 

do. 

38 

do. 

Recovered. 

Honey-like  and  green 
sanies. 

do. 

15 

do. 

do. 

Died. 

17 

Dr.  Ritter. 

si 

do. 

Recovered. 

Cyst,  fluid. 

18-1836 

Mr.  King. 

57 

Short. 

do. 

do. 

19 1SJ3 

Mr.  JeartVeson. 

do. 

do. 

do. 

20 

M.  Dolhoff 

23 

Long. 

Died. 

Cyst  and  fluid. 

Adhesions, 

211835 

Mr.  West. 

Short. 

Recovered. 

'         do. 

22 

do. 

do. 

do. 

do. 

23 

do. 

24 

do. 

Died. 

do. 

34 

do. 

do. 

Not  cured. 

do. 

25 

Mr.  Hargrave. 

40 

do. 

do. 

Multilnc,  cysts. 

Adhesions. 

26 

Dr.  Clay. 

16 

27  inches. 

Recovered. 

Cysts,  sol.  and  fluid. 

do. 

27 

67 

14    do. 

do. 

do. 

E  t.adh. 

2^^ 

39 

28    do. 

do. 

do. 

do. 

29 

40 

14    do. 

Died. 

do. 

do. 

30 



22 

14     do. 

Recovered. 

do. 

Adhesions. 

31 



40 

14    do. 

Died. 

do. 

None. 

32 

43 

14     do. 

Recovered 

do. 

Ext,  adh. 

33 

59 

16     do. 

DioJ, 

do. 

do. 

34 

46 

16     do. 

Recovered, 

do. 

do. 

.^51940 

MrB.'philifps.' 

2  inches. 

Died. 

3V-1S4I 

Dr.  Stilling, 

6    do. 

do. 

37184-2 

Mr.Walne. 

5M 

Long. 

Recovered. 

do. 

None. 

38-1843 

do. 

57 

do. 

do. 

do. 

do. 

39 

do. 

21 

do. 

D  ed. 

40-1543 

do. 

20 

do. 

Recovered. 

do. 

do. 

4I-IS13 

Mr.  Morris. 

do. 

do. 

421843 

Mr.  Sontham. 

do. 

do. 

Cystic  sarcoma. 

do. 

43184  5 

Dr.  F.  Bird. 

3  or  4  in. 

do. 

<:yst  and  fluid. 

do. 

441814 

do. 

do. 

do. 

Cysts  and  solid  mat- 
ter. 

do. 

45 

Mr.  Atlec. 
Mr.  Lane. 

3  inrhes. 
Long, 

do. 
do. 

Adhesions. 

46 

Cysts,  fluid. 

None. 

47 

Mr.  Key. 

19 

do. 

Died. 

do. 

do. 

48 

Mr.  Grecnhow. 
Mr.  B.  Cooprr. 

L9 
32 

do. 
do. 

do. 
do. 

do. 

40 

9i 


Ooariotomy, 


[February, 


Table  II.  Cases  of  Ovarian  Disease^  in  which  the  operation  could 

not  be  completed. 


Date. 

Operator. 

Cause  of  failure. 

Result. 

Incision. 

50 

Dr.  M'Dowal. 

Adhesions  to  ])lad- 
der  and  uterus. 

Recovered. 

Long. 

61 

Mr.  Lizars. 

Solid  and  very  vas- 
cular tumoiir. 

do. 

do. 

52 132G 

Dr.  Granville. 

Firm  Adhesions. 

do. 

6  inches. 

53 

Dr.  Dieffenbach. 

Vascularitv. 

do. 

Long. 

541826 

Dr.  Martini. 

Solid  and  fixed  tu- 
mour. 

Died. 

do. 

55 

Anonvmous. 

Fixed  tumour. 

do. 

56 

M.  Dolhoff. 

do. 

do. 

About  6  inch. 

57 

Dr.  Clay. 

Exten.  Adhesions. 

do. 

Long. 

58 

Mr.  Walne. 

do. 

Recovered. 

5  inches. 

Table  III.  Cases  in  which  ihe  Operation  failed  from  Error 


in  Diagnosis. 


Date. 

Opera' jr. 

Result. 

Disease. 

59-1823 

Mr.  Lizars. 

Recovered. 

No  tumour  found. 

CO 183-1 

Mr.  King. 

do. 

do. 

61 

M.  Dolhoff. 

do. 

do. 

G2 

Dr.  Clay. 

Died. 

Uterine  tumour. 

63 

do. 

Recovered. 

Hvdatid. 

64 

do. 

Died. 

Pelvic  tumour. 

65 

do. 

do. 

Uterine  tumour. 

66 

Mr.  Heath. 

do. 

do. 

Thus,  the  entire  numhor  amounts  to  66,  of  which  42  recovered  and 
24  died  or  ahoiit  1  in  2^.  Of  the  49  cases  in  which  the  ovary  was 
extirpated,  16  died,  or  1  in  3.  Of  the  nine  cases  in  which  the  opera- 
tion could  not  he  completed,  four  died  or  1  in  2:| ;  and  of  the  eight 
cases  where  the  operation  was  unnecessary,  4  died,  or  1  in  2. 

Age  does  not  appear  to  have  had  much  influence,  heneficial  or 
otherwise,  and  the  same  may  be  said  of  marriao;e.  Adhesions  render 
the  result  of  the  operation  much  more  dangerous  than  freedom  from 
the  same,  and  yet  not  so  much  so  as  one  would,  a  priori,  except. 
Where  other  organic  diseases  co-existed  with  ovarian,  the  termina- 
tion was  almost  always  fatal.  It  is  strange  that  the  operation  should 
have  been  ever  performed,  where  no  tumour  has  existed  ;  yet  the 
mistake  has  been  made  by  eminent  surgeons,  and  without  any  negli- 
gence on  their  parts. 

Dr.  Montgomery  mentions  a  case  where  he  felt  a  distinct  tumour 
in  a  female's  abdomen,  which  suddenly  vanished  in  the  very  act  of 


1845.]  Camphor  a  Preservative  of  Ergot  of  Rye.  05 


examin.ition !  The  abdominal  iniiscles,  in  fact,  often  act  in  such  a 
way  as  to  imitate  organic  enlargements  of  the  liver,  spleen,  ovaries, 
&c..  and  thus  deceive  even  the  most  careful  practitioners.  After 
many  jiiilicions  remarks,  cautions,  and  comparisons,  our  author  comes 
to  the  following  conclusions  : 

"Even  after  the  details  I  have  given,  it  is  very  difficult  to  come  to  a  definite 
and  perlecily  satisfactory  conclusion,  because  1,  Ave  have  not  sulliciently  accu- 
rate data  to'  estimate  the  progress  of  the  disease  unaided  by  surgery.  *2.  The 
tible  quoted  from  Mr.  Southam  is  clearly  too  limited  to  aiford  a  fair  average  of 
the  results  of  tapping,  and  it  is  not  easy  to  obtain  suiTicient  facts  to  enlarge  it. 
3.  The  cases  in  which  ovariotomy  has  been  performed  are  of  such  a  mixed  cha- 
racter, that  it  is  impossible  to  i^le'ct  with  fairness  those  cases  in  which  the  opera- 
tion was  demanded  for  the  relief  of  urgent  suffering,  and  suitable  to  the  nature 
of  the  disease,  v/ithout  the  appearance  of  partiality.  And  4,  from  the  obscurity 
of  the  diagnosis,  it  is  too  much,  perhaps,  to  expect  that  our  practice  in  future  will 
be  free  from  those  drawbacks  on  the  operation. 

"  But  bearing  in  mind  these  diiiiculties,  and  making  allowance  for  those  draw- 
backs, I  think  we  may  conclude  that  there  are  cases  in  v.hich  the  operation 
would  be  ju.stifiable;  and  on  these  grounds,  we  find  the  general  opinion  is 
against  the  curability  of  the  disease  by  medical  means:  that  after  a  time  the 
patient  will  die  from  local  disease  or  accident,  or  constitutional  disturbance,  and 
that  meantime  she  suffers  more  or  less  inconvenience:  that  tapping  in  almost 
all  cases  affords  but  temporary  relief;  and  that,  as  far  as  the  limited  statistics 
we  have  adduced  are  admissible  as  evidence,  it  is  attended  with  great  danger: 
i.  e.  1  in  5  died  of  the  first  operation,  and  of  twenty  patients,  fourteen  (more  than 
two  thirds)  died  within  nine  months  of  the  first  tapping;  whilst  of  the  entire 
number  ot  those  who  underwent  the  operation  ofovariotomy,  about  one  half  have 
absolutely  recovered  so  far." 

The  foregoing  paper  is  very  creditable  to  the  industry,  the  talents, 
and  the  judgment  of  its  author.  Dublin  Journal,  July,  1S44. 


FROM    THE  LONDON  LANCET. 

Camphor  a  Preservative  of  Er^of  of  Rye.  Sir  :  I  was  not  a  'itt'e 
surprised  to  read  some  remarks  hy  Mr.  Rawle,  stating  that  he  had 
discovered  camphor  to  be  a  preservative  of  ergot  of  rye.  lean  only 
say  that  I  have  been  in  the  habit  of  using  it  for  the  last  nine  or  ten 
years,  but  not  exactly  in  the  manner  prescribed  by  him.  I  order  the 
camphor  to  be  mixed  with  the  powdered  ergot,  in  tiie  proportmn  of  a 
grain  in  every  scruple.  By  this  tneans  I  think  the  camphor  is  more 
intimately  diffused  throughout  the  whole  than  can  possibly  take  place 
by  the  plan  proposed  by  Mr.  Rawle.  I  do  not  give  this  either  as  a 
new,  or,  indeed,  my  own  discovery  ;  for  I  adopted  the  method  by 
having  seen  it  in  the  practice  of  Mr.  Spurgin,  an  old  practitioner 
at  Saffron  Walden,  and  from  whom  I  have  every  reason  to  believe 
that  your  correspondent  also  obtained  the  same  information,  he  hav- 
ing been  engaged  in  the  same  gentleman's  practice. 

If  you  think  the  ahove  worthy  of  notice,  you  will  oblige,  Sir,  yours 
respectfully, 

John  N.  Si.MrsoN,  M.  R.  C.  S.  dcr. 

Staines,  August  28,  1844. 


00  Medical  Intcllis^ence, 


Simple  MetJtod  of  Preparing  the  Pihda  Ferri  lodidi.  Take  of 
iodine  127  grains,  iron  wire,  about  the  thickness  of  a  thin  quill,  half- 
nn-ounce,  distilled  water  75  minims.  Agitate  them  briskly  together 
in  a  strong  ounce-phial,  provided  with  a  well-fitted  glass  stopper,  until 
the  froih  which  Mirms  becomes  white,  which  will  happen  in  less  than 
ten  minutes.  Pour  the  liquid  upon  two  drams  of  finely-powdered  loaf- 
sugar  in  a  little  moriar,  and  triturate  immediately  and  briskly  for  a 
few  minutes  ;  add  gradually  a  mixture  of  the  following  powders,  viz  : 
liquorice  powder  half-an-ounce,  powder  of  gum  arabic  a  dram  and  a 
half,  and  fjour  one  drain.     Divide  the  mass  into  144  pills. 

Each  pill  contains  about  a  grain  of  iodide  of  iron. 

In  operations  on  the  large  f^cale,  the  bottle  ought  to  be  wrapped  in 
a  strong  towel,  in  case  of  an  explosion  being  caused  by  the  evolution 
of  steam  from  the  heat  produced;  and  even  on  the  small  scale,  the 
stopper  must  be  hold  firmly,  otherwise  it  will  probably  be  blown  out 
and  the  materials  lost.  Pliannaceulical  Journal,  Medico- Chirur- 
rical  Revieiv. 


RJiaiany  in  Chronic  Catarrhal  Oplitlialmia.  M.  Reveillee-Parise 
strongly  recommends  the  decoction,  or  a  strong  infusion,  of  Rhatany 
root,  as  a  lotion  with  which  the  affected  eyes  are  to  be  bathed.  Be- 
sides acting  as  an  astriii;rent,  this  remedy  seems  to  have  some  other 
mode  of  operation;  for  we  do  not  find  that  similar  preparations  of 
oak-bark  or  of  gall-nuts  ailhough  both  of  these  contain  a  large  por- 
tion of  tannin  are  equally  efficacious,  as  Collyria  in  the  Ophthalmia 
alluded  to.  The  application  should  be  used  lukewarm,  and  a  few  drops 
of  Goulard's  Extract  may  be  added  to  it,  if  deemed  proper.  Medico- 
Chirurgical  Rcvieiv, 


MEDICAL  INTELLIGENCE. 

The  January  No.  of  the  New-York  Journal  of  Medicine,  (just  received,)  con- 
tains a  short  biography  of  its  late  Editor,  Dr.  Samuel  Forry;  and  also  a  history 
of  his  last  illness,  prepared  by  Charles  A.  Lee,  M.  D.  Professor,  &c.,  and  enti- 
tled, "Epilepsy  terminating  fatally;  with  hypertrophy  and  induration  of  the 
cerebral  substance,  induced  hy  excessive  mental  application." 

"We  are  pleased  to  fmd  that  the  Journal  is  to  be  continued,  notwithstanding 
the  decease  of  its  late  able  Editor. 


FhJ:e  Fvvd  Prize  Qnestionr  The  Trustees  of  the  FiskeFund,  in  Rhode  Isl- 
and, propose  the  following  questions  for  1844-45:  1.  "The  best  mode  of  treating, 
and  the  best  apparatus  for  the  management  of,  fractures  of  the  thigh."  2.  "  The 
character,  causes  and  best  treatment  of  bronchitis."  For  the  best  dissertation  on 
each  of  these  questions,  the  sum  of  fifty  dollars  will  be  paid  the  dissertations  to 
be  sent,  previous  to  Mfjy  10.  1845,  to  "Dr.  L.  L.  Miller,  of  Providence,  Dr.  T.  C. 
Dunn,  of  Newport,  or  Dr.Jabcz  Holmes,  of  Bristol.  JN'.  Y.  Journal  of  Medicine. 


w 


SOUTHERN 

MEDICAL  AND  SURGICAL 

JOURNAL. 

    -* 

Vol.  I.]  NEW  SERIES MARCH,  ISIa.  [No.  3. 

        ^ 

PART  I. ORIGINAL  COMMUNICATIONS. 

ARTICLE    I. 

Calomel  its  Chemical  characteristics  and  Mineral  origin  considered^ 
in  view  of  its  Curative  claims.     By  Alexander  Mea>'s,  A.  M., 

Professor  of  Chemistry  and  Pharmacy  in  the  Medical  College  of 
Georgia, 

Few  substances  within  the  range  of  the  Pharmacopoeia,  whether 
we  regard  its  history,  the  extent  and  potency  of  its  therapeutic  action, 
or  the  deep  and  inveterate  prejudices  in  the  popular  mind  with  which 
it  has  often  had  to  contend,  can  be  considered  as  subjects  of  greater 
interest  than  that  placed  at  the  head  of  this  article. 

Its  claims  to  antiquity  cannot,  it  is  true,  be  compared  to  those  of 
Opium,  Antimony,  Sulphur,  and  a  few  other  remedies  whose  history 
may  be  traced  to  the  days  of  Diagoras,  Basil  Valentine  and  Par- 
acelsus, but  it  has  nevertheless  been  contemporaneous  with  each  of 
seven  successive  generations  past,  and  at  the  present  day  occupies  a 
conspicuous  and  elevated  rank  among  the  articles  of  the  Materia 
Medica.  Loudly  as  its  virtues  have  been  proclaimed,  and  its  employ, 
raent  recommended  by  its  friends,  and  vehemently  as  its  properties 
have  been  decried  and  its  use  reprobated  by  its  enemies  within  the 
known  period  of  its  history,  still  strange  as  it  may  seem,  this  profes- 
sional altercation  has  not  yet  led  to  the  circumstances  of  its  origin  or 
the  name  of  its  discoverer.  It  is  believed  to  have  been  long  known 
to  the    retired   and   idolatrous   inhabitanta  of  Thibet,    but  lay,  like 

7 


93  Calomel,  [March, 


themselves,  hidden  from  the  scrutiny  and  observation  of  the  world, 
amid  the  deep  seclusion  of  their  own  mountain  fastnesses.  Oswald 
Croll,  in  the  beginning  of  the  17th  century,  is  believed  to  have 
been  the  first  European  writer  who  mentions  our  medicine,  while 
the  first  directions  for  lis  preparaiion  were  given  by  Beguix  in  the 
*'Tyrocinium  Chemicum,"  published  in  1608.  The  energy  of  its 
action  in  the  removal  of  formidable  diseases,  was,  probably  at  that 
early  period,  well  understood,  as  Beguin  denominated  it  "Draco 
Mitigatus,"  or  the  Tamed  Dragon.  Other  fanciful  and  cumbrous, 
but  expressive  appellations,  which  it  afterwards  wore,  seem  strongly 
to  sustain  this  opinion:  e.g.  Aquilla  Alba,  (the  White  Eagle) 
Manna  Metallorum  (the  Manna,  or  Honey  of  the  Metals,)  Panchy- 
magogum  Minerale  (the  Mineral  Extractor  of  all  Humors,)  &c.  &;c. 

Mercurius  Dulcis  and  Hydrargyri  Submurias,  were  names  subse- 
quently given  to  the  same  preparation.  The  latter  appellation  (de- 
pending for  its  adoption  and  its  currency,  upon  the  theoretical  views 
of  the  celebrated  Bektkolet,  and  other  French  chemists,  who  de- 
nominated the  electro-negative  element  of  the  compound.  Oxygen- 
ated Muriatic  Acid,)  maintained  its  place  in  the  Pharmacopoeia 
until  the  researches  of  Sir  Hujipiirey  Davy  proved  it  to  be  a  simple 
substance,  which  from  its  yellowish  green  hue,  when  in  the  form  of 
gas,  he  called  "Chlorine,"  (from  XAw^oj  green.)  Since  that  time 
the  several  synonyms,  Protochloride,  Dichloride,  and  Subchloride 
of  Mercury,  have  been  applied  to  it  by  different  chemists.  The  pre- 
sent popular  and  familiar  term,  "  Calomel,"  was  first  used  in  1655  by 
Sir  TouRQUET  DE  Mayeuxe,  (from  xaUs,  good,  and  /^^as>  black,) 
prohahJy  because  it  was  regarded  a  good  remedy,  for  the  removal  of 
black  bile,  which  the  ancients  regarded  so  fruitful  a  source  of  disease. 

Adopting,  with  the  latest  writers  and  under  the  authority  of  Kane, 
Graham,  &c.  101'43  as  the  chemical  equivalent  of  Mercury,  Calo- 
mel must  be  regarded  as  a  Dichloride,  containing  2  atoms  of  the 
base  (Mercury)  and  1,  of  the  electro-ncgative  element,  (Chloride.) 
A  chemical  classification  will  rank  it  as  a  Bi-elementary  compound, 
among  the  Haloid  Salts  ofBerzelius.  Although  Calomel  is  found 
natural  in  Germany  and  Spain,  in  white  crusts  as  well  as  in  the  form 
of  quadrangular  prisms,  terminated  by  four-sided  pyramids,  yet  for 
pharmaceutical  purposes  it  is  prepared  artificially  either  hy precipita- 
tion or  sublimation.  The  intended  limits  of  the  present  article, 
however,  will  not  authorize  a  detailed  account  of  the  process  of 
manufacture  at  directed  by  the  several  colleges.     SuflTice  it  to  say 


1S45.]  Calomel.  99 


that  by  precipitation  it  is  obtained  from  the  Nitrate  of  the  Protoxide 
of  Mercury  in  contact  with  a  solution  of  the  Chloride  of  Sodium,  by 
which  an  interchange  of  i)ases  takes  phice,  and  the  Bichloride  of  Mer- 
cury and  the  Nitrate  of  Soda  are  the  result.  This  process,  carefully 
conducted,  gives  a  pure  salt.  It  is  also  procured  by  rubbing  inti- 
mately 4  parts  of  the  Chloride  of  Mercury  (less  recently  the  Bichlo- 
rifle)  with  3  parts  of  metallic  Mercury,  and  afterwards  subliming. 
The  first  sublimation  is  not,  however,  sufucient  to  free  the  mass  from 
the  dangerous  presence  of  adherent  Corrosive  Sublimate.  It  must 
be  repeated  and  carefully  levigated  and  washed  wilh  boiling  water, 
until  no  white  precipitate  is  observable  on  the  addition  of  a  few  drops 
of  Aqua  Ammonia.  All  the  British  colleges,  (varying,  however,  in 
the  details  of  the  process,)  direct  the  trituration  of  metallic  Mercury 
with  the  Bi-pcrsulphate  and  common  salt,  and  afterwards  sublima- 
tion and  elutriation.  The  Hydrated  Sublimate  of  Mercury  prepared 
by  Mr.  M.  O.  Hexry's  modification  of  Sn well's  apparatus,  by  which 
the  sublimed  Calomel  is  condensed  in  the  midst  of  steam,  is  in  the 
form  of  a  beautifully  white  and  impalpable  powder.  The  slight  buff 
color,  however,  which  frequently  characterizes  the  ofiicinal  prepara- 
tion, is  favorable  to  the  conclusion  that  it  is  uncontaminated  by  cor- 
rosive sublimate  although  much  of  the  pure  white  calomel,  prepared 
as  above,  is  also  free  from  it.  The  color  cannot  therefore  be  re- 
garded as  an  infallible  criterion  of  purity. 

It  is  extremely  desirable  that  a  medicinal  agent  to  which  is  justly 
assigned  so  wide  a  range  in  the  treatment  of  diseases,  shoul  I  not 
only  have  the  mode  of  its  action  upon  the  animal  tissues  thoroughly 
and  patiently  investigated,  but  that  it  should  be  readily  distinguishable 
by  appropriate  and  convenient  tests,  and  its  chemical  incompatibili- 
ties wilh  other  remedies  satisfactorily  understood.  The  cxperiencG 
of  centuries,  it  is  true,  has  not  secured  uniformity  of  opinion  as  to  its 
physiological  effects,  and  its  classification,  therefore,  as  an  article  of 
the  Materia  Medica,  has  depended  upon  the  peculiar  notions  of  indi- 
vidual writers,  or  the  prevailing  theories  of  the  day.  That  Calomel 
has  been  placed  upon  the  list  of  SiaJn/^orrvs^  by  Cullex,  Chapmax, 
Eberle,  and  others;  among  S/zmw/a/?/.^,  hy  Dr.  A.  T.  Tho.mpsox, 
Vavasseur,  6cc.  among  SecIatit)cSy  by  Urrtklr,  Horx,  d:c. ;  whi'o 
by  such  men  as  Mlhiray,  Begin  and  Giacomim,  it  has  been  severally 
arranged  with  Tonics^  Revulsives  and  Hyvosthetiics,  and  by  others 
still,  among  the  '^incertcn  sedis,'^  only  argues  the  valuable  and 
ficxile  powers  of  the  remedy,  which  iindcr  modifipd  cirrumstanrp;.  i^s 


100  Calomel,  [March, 


capable  of  exhibiting  such  a  great  variety  of  effects  upon  the  animal 
economy.  A  slight  acquaintance,  however,  with  Pharmacodynamics 
discovers  similar  characteristics  in  Opium,  Antimony  and  other  arti- 
cles,  equally  embarrassing  to  a  settled  classification.  The  mere 
question  of  its  technical  position  on  the  roll  of  remedies  is  to  us  a 
matter  of  minor  consideration,  and  may  he  safely  left  for  the  deter- 
mination of  future  pharmacologists,  but  its  intrinsic  energies  and  past 
achievements  have  certainly  distinguished  it  as  a  powerful  auxiliary 
to  the  ranks  of  restorative  agents.  Nur  have  its  virtues  fled,  nor  its 
claims  upon  a  benevolent  and  intelligent  profession  been  extinguish- 
ed, because  interested  ignorance,  or  popular  charlatanism  in  their 
temporary  ascendency,  and  within  limited  circles,  may  have  defamed 
its  character  and  withheld  its  rights.  No,  verily  the  spirit  of  vir- 
tuous  heroism  glowed  as  brightly  in  the  noble  soul  of  the  A  erican 
Frenchman,  when  in  the  dungeons  of  Olmutz,  and  the  sympathies  of 
the  generous  and  good  clustered  as  warmly  around  him,  as  when  he 
moved  side  by  side  with  his  great  compatriot  in  arms,  the  immortal 
Washi^^gton,  and  received  a  nation's  homage. 

We  design,  however,  to  indulge  in  no  acrimonious  invectives 
against  those  who  honestly  differ  from  the  views  here  designed  to  be 
expressed.  Far  from  it.  We  appeal  to  sober  Reason,  and  in  can- 
vassing the  following  questions,  only  ask  an  impartial  decision  at  her 
bar. 

1st,  then  :  Is  Calomel  to  be  ranked  in  the  category  of  poisons  7 
That  Mercury  in  this  form,  under  an  ill-timed  and  injudicious  ad- 
ministration by  unwarrantable  exposures  on  the  part  of  the  patient, 
or  unjustifiable  indulgences  on  the  part  of  the  nurse  and  still  more 
rarely,  by  an  unsuspected  idiosyncrasy  of  constitution,  may  once, 
perhaps,  in  500  cases,  overpass  the  boundaries  of  its  usual  and  healthy 
action,  and  leave  traces  of  its  violence  long  and  deeply  to  be  regret- 
ted, no  reasonable  advocate  of  its  use  will  deny.  But  what  other 
active  remedy,  vegetable  or  mineral,  may  not,  under  similar  circum- 
stances, lead  to  like  unfortunate  results.  Each,  it  is  true,  may  ac- 
cording to  its  peculiar  properties,  act  upon  different  organs,  or  tissues, 
but  the  morbid  impression,  or  over-action  generated,  being  equally 
injurious.  What  practitioner  has  not  known,  Gamboge,  Scammony, 
or  Podopyllum  peltatum,  in  certain  instances,  to  produce  exorbitant 
and  prostrating  catharsis,  from  the  effects  of  which  the  after  admin 
istration  of  opiates  or  stimulants  could  with  difficnlly  save  the  patient  ? 
How  often,  too,  has  the  specific  action  of  the  Tartrite  of  Antimony 


1845.]  Calomel.  101 


upon  the  coats  of  the  stomach,  resulted  in  excessive  emesis,  followed 
by  dangerous,  if  not  fatal  exhaustion  of  the  powers  of  life.  And 
yet  these  remedies  maintain  their  claims  upon  professional  regard,  and 
occupy  a  respectable  position  in  the  catalogue  of  medicines.  Indeed 
the  mere  fact  that  diseased  action,  under  given  cu'cumstances,  may 
follow  the  contact  of  solids,  Jiuids,  or  gases,  with  either  the  internal 
or  external  portions  of  the  human  organism,  is  no  proof  of  the  poi- 
sonous effects  of  such  agents.  If  this  position  be  admitted,  the  thou- 
sand luxuries  of  modern  tables  must  submit  to  the  ostracism  of  pro- 
fessional authority,  nor  will  even  roast  beef  and  pudding,  be  suffered 
to  retain  their  places  upon  the  landlord's  bill  of  .^are  ;  for  where  tem- 
perament and  diathesis  have  favored  cerebral  engorgement,  many 
an  apoplectic  has  met  his  fate  by  epicurean  indulgence. 

Fruits,  too,  must  be  classed  with  the  list  of  poisons.  The  grateful 
juice  of  the  luscious  plum,  and  the  delicious  nectar  of  the  blushing 
peach,  both  fall  under  the  ban  of  this  decision,  for  imprudent  gratifi- 
cation  here,  has  been  often  succeeded  by  Cholera  Morbus,  Diarrhoea, 
or  Fever.  But  the  very  water  we  drink  must  be  proscribed;  for 
large,  cold  draughts,  taken  into  a  heated  and  exhausted  system,  has 
often  produced  fatal  effects.  Nay,  this  is  not  all  the  use  of  the 
h\a.nd  atmosphere  we  breathe  must  be  interdicted,  for  Catarrhal  fevers, 
Croups  and  Pneumonia  have  often  resulted  from  sudden  and  untimely 
exposure  to  its  currents.  Nor  should  indiosyncratic  temperaments 
bo  allowed  to  decide  this  interesting  question.  The  writer  is  inti- 
mately acquainted  with  a  gentleman  who  cannot,  with  impunity,  par- 
take of  one  of  the  elements  of  the  Holy  Sacrament  the  mere 
morsel  of  wheat  bread,  presented  on  such  occasions,  acting  like 
poison  upon  his  stomach  ;  and  yet,  surely  the  toxicologist,  as  well  as 
the  epicurean,  would  scout  the  philosophy  which  should  atten)pt 
gravely  to  label  the  baker's  loaf,  with  the  alarming  epithet  ^^Poison.'" 
He  has  known  another  who  was  instantly  sickened  by  the  smallest 
quantity  of  the  albumen  of  an  egg.  even  when  tasted  in  the  coffee 
which  it  had  been  employed  to  clarify  :  still  this  isolated  caso  of 
injury  would  never  authorize  the  popular  voice  to  sanction  the  expul- 
sion of  so  innocent  and  nutritive  an  article  of  diet  from  the  list  of 
aliments.  These  remarks  are  designed  to  be  made  too,  in  full  view  of 
the  unfavorable  reports  made  in  former  years  by  such  writers  as 
HoFF3iAN,  Vagnitius,  Hellweg,  find  others,  where  in  a  very  few 
instances  even  small  doses  are  said  to  have  proved  fatal,  but  whether 
under  circumRtancos  of  neglect  or  aggravation,  or  by  the  administrn- 


102  Calomel.  [March 


lion  of  aa  improper  article,  cannot  now  be  ascertained.  It  is  at  least 
a  plausible  conjecture,  advanced,  peri^aps,  first  by  Dr.  Christison, 
that  where  such  cases  have  occurred  the  Calomel  may  have  contain- 
ed  Corrosive  Sublimate,  a  conjecture  warranted  by  the  fact  to  which 
the  reader  will  recur,  that  according  to  one  of  the  formulas  given 
above,  the  latter  article  has  been  long  and  largely  employed  in  the 
manufacture  of  the  former  and  can  only  be  removed  from  it  by 
careful  and  repeated  edulcorations.  Surely,  however,  the  congregated 
testimony  of  hosts  of  intelligent  physicians  in  later  years,  and  the 
reports  of  multiplied  thousands  of  cases,  more  than  sustain  our  indi- 
vidual opinion  long  since  formed,  i.  e.  that  "  Calomel  deserves  to  he 
classed  with  the  mild  preparations  of  Mercury. ^^  It  has  y)een  amply 
tested  that  in  small  doses,  either  alone,  or  in  combination  with  opium 
or  other  adjimct,  it  acts  as  a  safe  alterative,  checking  violent  pur- 
gatives correcting  hepatic  derangement  by  promoting  the  biliary 
secretion,  and  overcoming  obstinate  chronic  diseases  of  the  cutane- 
ous surface  ;  while  in  large  doses,  it  often  acts  the  part  of  a  sedative 
 quiets  gastric  irritation  stops  vomiting,  and  moderates  debilita- 
ting catharsis  in  some  of  the  most  alarming  and  fatal  forms  of  disease. 
At  the  Cholera  Hospital,  Bethnal  Green,  London,  Mr.  Charles 
Benxet  had  18  cases  of  Cholera  introduced  to  his  treatment.  The 
first  administration  was  160  grs.  of  Calomel,  immediately  given,  and 
60  grs.  at  the  interval  of  every  one  or  two  hours  afterwards,  until 
some  effect  was  produced.  The  result  was,  that  in  17  out  of  the  18 
cases,  "vomiting  and  purging  diminished,  and  the  patients  recover- 
ed." In  the  unsuccessful  case  just  alluded  to,  "  53  drachms  of  Calo- 
mel," says  Dr.  Pereira,  "  were  administered  within  42  hours  without 
the  least  sensible  effect."  To  one  patient  (a  female)  30-^-  drachms 
(1820  grs.)  were  administered  in  48  hours,  producing  only  a  moder- 
ate ptyalism  and  followed  by  recovery.  iMr.  Roberts,  of  London, 
reports  a  case  where  one  ounce  of  Calomel  was  taken  by  mistake, 
and  "  retained  on  the  stomach  two  hours  before  the  error  was  dis- 
covered." The  only  unpleasant  effects  which  supervened  were 
**  slight  nausea  and  faintness,  but  by  the  application  of  lime  water, 
emetics  and  purgatives,  the  mass  was  thrown  ofl*,  and  on  the  second 
day  afterwards  "the  patient  was  quite  well." 

Dr.  Griffin  asserts  that  in  1448  cases,  when  given  in  doses  of 
from  one  to  two  scruples,  every  30  or  60  minutes,  and  before  the  stage 
of  collapse,  "it  proved  a  most  successful  remedy,  controlling  or  arrest- 
ing the  progress  of  this  formidable  disease   in  the  ratio  of  84  cases 


1845.]  Calomtl  103 


out  of  100.*'  Dr.  David  M.  Reese,  one  of  the  most  successful  prac 
titioners  in  the  professional  field  during  the  ravages  of  this  epidemic 
in  the  city  of  New  York,  in  1832,  depended  mainly  upon  the  admin- 
istration of  large  doses  of  our  medicine  in  connection  with  ice-water, 
for  the  numerous  cures  affected  under  his  care.  Indeed  the  conjoint 
testimony  of  almost  all  writers  upon  the  spasmodic  Cholera,  as  it  has 
prevailed  in  India,  Europe,  or  America,  has  sustained  the  use  of 
Calomel  as  a  safe  and  effective  remedy,  while,  so  far  I  know,  no 
writer  of  any  distinction,  either  cis  or  trans-atlantic,  has  ventured  to 
charge  upon  it  injurious  consequences,  much  less  to  anathematize  it 
as  an  "irritant  poison."  But  its  safe  and  efiicacious  action  in  the 
disease  above  referred  to,  mny  have  been  made  unnecessarily  con. 
spicuous.  Its  claims  are  equally  strong  and  its  triumphs  equally  de- 
cided in  a  large  range  of  morbid  affections,  to  which  its  diversified 
characteristics  so  happily  adapt  it.  It  cannot,  must  not  be  confined 
to  the  exercise  of  mere  tetrarchical  functions  over  a  petty  province  in 
the  vast  dominion  of  medicine.  It  wears  and  wields  princely  preroga- 
tives, gives  ample  evidence  of  its  power  to  rule,  and  consociated  with 
a  few  other  leading  and  active  agents  of  the  Materia  Medica,  cons^ti- 
tutes  that  Oligarchy  of  medicinal  power,  in  which  alone  the  profes- 
sion can  confide  for  the  suppression  of  some  of  the  most  formidable 
rebellions  against  life  and  health,  which  Disease  has  ever  generated 
in  the  human  system.  Other  valuable  remedies  have  their  intrinsic 
merit,  and  occupy  important  positions  as  auxiliaries  in  this  grand 
allinement  for  constitutional  defence,  yet  few  are  capable  of  occupy- 
ing so  wide  a  field  of  action,  or  destined  to  accomplish  so  much. 
In  contemplating  the  noble  spirit  and  invincible  heroism  of  the  inde- 
fatigable Ney,  the  foremost  in  the  achievements  of  the  army  upon 
the  Rhine,  and  the  "  bravest  of  the  brave"  on  the  memorable  field 
of  riohcnlinden,  my  heart  recoils  with  an  honest  indignation  at  the 
cold-blooded  cruelty,  which  presents  that  manly  bosom  as  the  public 
target  for  the  muzzles  of  a  score  of  French  musketeers,  simply  be- 
cause the  Bourbons  are  inpower.  Now,  although  from  Ihe  nature  of 
the  subject,  similar  sympathies  cannot  be  involved,  yet  something  like 
a  kindred  aversion  is  excited  against  that  ruthless  policy  which  (from 
motives  best  known  to  those  who  advocate  it,)  would  strike  forever 
from  the  roll  of  medicinal  honor,  an  ng<Mit  signalized  so  long  for  its 
energy  and  its  success,  and  to  which,  under  Providence,  the  writer 
has  been,  at  least  once,  indebted  f<^r  h'\fi  life. 

But  again,  in  organic  bodies  fheUws  ofchcmicil  nfiinifv  are  held 


104  Calomel  [March, 


in  subordination  and  control  by  tho  vital  forces,  and  in  the  human 
body,  although  these  affinities  still  exist,  yet  all  combination  with 
foreign  elements,  hostile  to  the  health  of  the  several  organs  and  tho 
harmony  of  their  movements,  are  steadily  and  successfully  resisted, 
and  it  is  only  where  the  attraction  between  foreign  agents  and  tho 
tissues  of  the  living  organism,  is  stronger  than  the  resistance  of  the 
vital  principle,  that  the  equipoise  is  destroyed,  and  temporary  or  per- 
manent functional  or  organic  derangements  supervene. 

Medical  substances   therefore,    whether  organic  or  inorganic  ; 
whether  acting  topically  or  generally,  and  remotely  by  mechanical 
irritation  by  chemical  combination  with  some  of  the  constituents  of 
the  tissues,  or  in  the  production  of  what  has  been  denominated  "vital 
effects,"  apparently  unattended  by  either  "  mechanical  or  chemical 
lesions,"  must  always,  we  apprehend,  to  be  safe  and  efficacious,  be 
subordinate  in  their  action  to  the  existing  affinities  which  bind  toge- 
ther  the  elements  of  the  corporeal  organism,  under  the  superinten- 
dency  of  the  vital  principle.     While,  however,  on  the  one  hand  an 
increase  of  mass^  even  of  a  mild  agent,  may  compensate  for  the  want 
of  intensity^  and  overcome  the  resistance  of  the  vital  forces,  so  as  to 
terminate  fatally;  so,  on  the  other,  minuteness  oi  (\\\^n{'\iY  or  high 
dilution  is  an  equivalent  for  hlandness  of  quality  in  the  agent  employ- 
ed, and  reduces  its  action  below  the  force  of  the  vital  affinities,  so 
that  even  acrid  and  virulent  poisons,  by  only  feebly  disturbing  the 
organic  activity,  of  the  parts,  and   establishing  a  new  and   different 
action  for  the  morbidly  existing  one,  may,  under  judicious  adminis- 
tration, be  made  to  subserve  valuable  purposes  in  the  curative  art. 
While,  therefore,  under  the  scrutiny  of  an  enlightened  medical  phi- 
losophy, it  would  be  deemed  no  less  fruitless  than  futile  to  attempt  a 
defensible  line  of  contradistinction  between  those  substances  popular- 
ly denominated  "  poisons,"  and  others,  by  common  consent  denomi- 
nated "  medicines,"  yet,  it  is  proper  to  remark,  that  there  are  many 
chemical  compounds,  both  from  the  organic  and  inorganic  kingdoms, 
which  produce  violent  changes  in  the  living  organism,  and  which,  if 
continued  to  a  certain  intensity,  result  in  the  death  of  the  part  or  the 
whole.     The  action  of  inorganic  poisons,  as  the  salts  of  lead,  copper, 
and  several  other  metals,  are  only  to  be  [satisfactorily  accounted  for 
upon  the  adoption  of  the  views  of  Liebig,  viz :  that  the  powerful 
affinities  which   they   manifest  for  some  of  the  constituents  of  the 
animal  organism,  as  muscular  fibre,  albumen,  cellular  tissue,  &;c.  is 
Buch  as  to  break  down  the  vital  energies  of  the  part,  and  form  a  new 


18-15.]  Ccilomd.  lOo 


and  insoluble  compound  which  henceforth  refuses  to  '^suffer,  or  effect*' 
metamorphosis  or  transformation,  and  is  tlierefore  removed  i)eyond 
the  claims  of  animal  life  no  longer  subject  to  its  laws,  and  ihercfore 
no  longer  sustainable  among  the  living  tissues.  Such  are  Arsenious 
Acid,  the  Corrosive  Chloride  of  Mercury,  Nitrate  of  Silver,  A:c. 
either  in  solids,  or  in  blood-globules,  and  if  the  calculations  of  the 
same  celebrated  chemist  are  correct,  the  very  high  atomic  \vcight  of 
these  several  animal  products,  or,  in  other  words,  the  large  amount 
of  them  vi'hlch  it  takes  to  constitute  a  single  equivalent  for  a  sjnaJI 
amount  of  the  salts  in  question,  indicates  clearly  how  very  few  grains 
of  the  two  former  sa-lts  especially,  may  prove  fatal.  He  supposes  that 
5  grs.  of  Corrosive  Sublimate,  unites  as  the  lowest  equivalent  propor- 
tion, with  100  grs.  of  fibrine,  and  1^-  grs.  of  Arsenious  acid  with  100 
grs.  of  albumen.  Ordinarily,  however,  the  toxicologlcal  effects  of 
each  agent  is  limited  to  their  degree  of  solubility.  In  accordance 
with  this  physiological  law,  therefore,  the  timely  administration  of 
Sulphates  (as  Sulph.  Soda,  Su -ph.  Magnesia,  &c.)  constitutes  the  only 
safe  antidotal  policy  for  poisoning  by  the  soluble  Salts  of  Baryta,  (as 
the  Carbonate,  Muriate,  &;c.)  the  play  of  affinities  which  takes  place 
in  the  stomach,  resulting  in  the  formation  of  an  insoluble  Sulphate  of 
the  metal,  at  once  preventing  morbid  action,  and  averting  all  danger. 
Indeed,  the  Hydrated  Sesquioxide  of  Iron  itself,  the  gieat  modern 
antidote  for  Arsenious  Acid,  whose  invaluable  efficacy  has  been  tho- 
roughly tested  in  scores  of  cases,  depends  solely  for  its  success  upon 
the  formation  (in  the  stomach)  of  the  insoluble  Arseniate  of  the  Pro- 
toxide of  Iron,  which,  refusing  to  enter  the  circulation  or  combine 
with  the  tissues,  secures  the  system  against  a  fatal  result.  Another 
class  of  substances,  such,  for  example,  as  Sulphuric  Acid  and  the 
Caustic  Alkalis,  which  the  distinguished  Professor  of  Giessen  has 
forborn  to  denominate  "poisons,"  nevertheless,  by  a  sort  ofchemico- 
vital  process  act,  firsts  destructively  upon  the  organization  of  the 
parts  with  which  they  come  in  contact,  by  their  energetic  affinity 
for  wafer,  which,  according  to  Miller,  constitutes  "  four- fifths  of  the 
weight  of  the  animal  tissues,"  and  without  which  the  vital  phenomena 
dependent  upon  them,  cannot  be  continued.  And,  secondly,  by 
instituting  an  inflammatory  action  in  the  adjacent  surviving  parts. 
Now  under  these  authorized  views  of  the  action  of  inorganic  poisons, 
we  do  not  feel  warranted  lo  class  among  them,  the  article  under  con- 
sideration :  

Ist.  Because,  we  have  shown,  we  trtist,  by  referejice  to  sufficient 


lOe  CahfiitL  [March, 


written  authority  which  might  bo  quadrupled  at  pleasure,  and  to 
which  we  now  add  the  testimony  of  our  own  experience  for  the  last 
18  years,  sustained,  as  we  believe,  by  thnt  of  almost  the  entire  body 
of  the  intelligent  and  scientific  members  of  the  profession  in  the 
South,  (to  many  of  the  peculiar  and  violent  diseases  of  which  our 
medicine  has  proved  to  be  happily  adapted,  and  where  its  powers 
have  been  most  largely  tested)  that  the  Siibchloride  of  Mercury, 
under  the  direction  of  proper  professional  skill,  may  be  given  in  S7nall 
ov  large  i\oses,  singly  ov  repeated,  with  equal  impunity  J*" 

2nd.  Because,  instead  of  acting  as  an  irritant  upon  the  mucous 
roat  of  the  stomach,  it  is  known  to  act  like  a  charm,  in  allaying  that 
gastric  irritability  which  constitutes  one  of  the  most  troublesomo 
symptoms  in  many  of  our  autumnal  diseases. 

3rd.  It  does  not,  like  the  Corrosive  Chloride,  &c.  combine  with 
{\\e  organic  elements  of  the  tissues  overcome  the  vital  affinities  of 
the  parts  in  which  it  acts,  and  generate  inflammation  in  contiguous 
surviving  parts. 

4th.  Its  great  insolubility  resists  the  process  of  imbibition,  and 
consequently  transfusion  through  the  circulating  mass  the  ready 
medium  through  which  inorganic  poisons  ordinarily  act.  So  nearly 
insoluble  is  it,  that  according  to  Graham,  of  London,  "when  the 
Mercurous  Nitrate"  (Nitrate  of  Mercury)  "  is  added  to  Hydrochloric 
Acid,"  (by  which  Calomel  is  generated,)  "diluted  with  250,000  times 
its  weight  of  water,  a  sensible  precipitate  of  Subchloride  of  Mercury 
appears." 

But,  "Are  not  mineral  substances,  unsafe  and  improper  remedies^ 
and  therefore  to  he  prohibited  in  the  treatment  of  disease  ?^^  Perhaps 
with  the  enlightened  and  unprejudiced  mind  this  question  might  be 
regarded  as  scarcely  meriting  a  philosophical  examination,  and  were 
it  not  that  a  class  of  professional  teachers,  differing  from  ourselves 
toto  ccelo  in  the  etiology  and  methodus  medendi  of  disease,  have  re- 
peatedly prono-snced  ex  cathedra,  as  well  as  in  private  intercourse, 
their  burninfj  anathemas  upon  our  hapless  salt,  denouncing  its  pre- 
tensions  to  public  confidence  under  the  broad,  ungenerous  charge, 
that  it  could  not  boast  a  botanical  ancestry,  and  spurning  it,  with 
every  kindred  article,  of  mineral  origin,  as  an  illegitimate,  and  mur- 


  Idiosyncratic  CcTses  are  of  conrse  excepted,  and  from  Avhat  has  already  been 
said,  should  not  subtract  from  the  force  of  onr  remark. 


1845.]  Caltrmt!.  10" 


derous  intruder  into  the  taniily  circle  of  remecliil  n^ents  the  pnliiic 
eye  would  not  have  been  taxed  with  the  penisal  of  the  tollovvirjg  re- 
ply. To  the  thoughtful  and  dispassionate,  whether /Arore//r//z/ with, 
or  against  us,  the  views  which  it  presents  are  ingenuously  submitted. 
However  ph3'siologists  may  speculate  upon  the  modus  exislcndi  ot' 
the  vital  principle,  life  itself  must  be  regarded  as  a  constant  struggle 
against  the  operation  of  those  physical  laws  which  effe^rt  matter  in  its 
inanimate  and  passive  forms.  The  human  body  iiself,  presents  an 
instance  of  a  temporary,  but  triumphant  ascendenc}'  of  a  vitalized 
organism  over  a  thousand  active  and  wklely  pervading  agencies,  hos- 
tile to  its  perpetuity.  The  presiding  Spirit  of  the  living  machinery, 
within  the  circumscribed  range  of  its  dominion,  modifies  and  controls 
those  chemical  laws  which  give  form  and  character  to  inorganic  mat- 
ter, and  makes  them  suljservient  to  her  own  high  purposes,  while  the 
powerful  momentum  of  the  vital  forces  keeps  at  bay,  for  the  time 
being,  those  multitudes  of  external  assailants,  v.'hich  like  the  be- 
leaguering hosts  of  the  Roman  Titus,  around  the  venerable  walls  of 
doomed  Jerusalem,  never  raise  the  siege  until  the  last  energies  of  the 
physical  constitution  are  exhausted,  and  its  beauty  and  strength  both 
fall  victims  to  their  merciless  power. 

Our  corporeal  organization,  then,  i.i  liable  to  assault  from  every 
quarter.  The  Earth  itself,  by  tlie  great  law  of  the  attrnclion  of 
gravitation,  continually  tends  to  draw  our  bodies  towards  its  centre, 
and  our  erect  attitude  is  only  maintained  by  the  expenditure  of  a 
countervailing  vital  energy  acting  upon  nniscular  irritability.  The 
stagnant  lagoon  evolves  its  invisible  mephilic  gases,  and  the  ready 
winds,  commissioned  for  the  work  of  death,  transport  them  to  our 
lungs.  The  serpent,  tlie  tarantula,  and  the  rabid  mastiff,  each  injects 
its  destructive  virus  to  dislodge  the  vital  principle.  Botany  too,  often 
lends  the  agency  of  its  juices,  fruits,  and  foliage  to  disturb  the  ba- 
lance of  the  harmonious  functions,  and  speed  us  to  our  doom  ;  while 
MineraJo^jy  but  joins  the  general  crusade  against  the  human  exist- 
ence, and  furnishes  her  Acitls  and  Alkalis,  ?.Ietals  and  Salts,  which 
by  careless  or  malignant  administration,  may  break  down  the  resist- 
ance of  the  vital  forces,  and  destroy  life.  But  this  is  not  all :  The 
skies  drenc!)  us,  the  lightnings  blast  ns,  or  the  floods  drown  us. 
Shall  then  the  wonderful  and  complicated  structure  of  the  human 
body  the  organ  of  communication  between  an  imniortal  mind  and 
the  surrounding  universe,  and  on  whose  soundness  and  preservation 
that  mind   depends  for   every  eartlily    minilb^tation  of  its  powerful 


109  Calomel.  [March, 


emotions,  lofty  conceptions,  and  far  reaching  energies,  be  thus  sub- 
jected  to  injuries  from  earth,  and  air,  and  sea,  and  sky :  from  solids, 
fluids,  and  gases  animals,  vegetables,  and  minerals  ;  from  enemies 
visible,  and  invisible  living  and  dead,  and  yet  its  hygienic 
and  therapeutic  resources  be  restricted  to  the  narrow  limits  of  any 
kingdom,  or  any  condition  of  matter,  much  less  to  the  exclusive 
and  fanciful  formularies  of  a/ij/ pr'ofessional  dogmatist  ?  No,  verily. 
No.  The  voice  of  Reason  and  the  voice  of  Nature  both  unite  in 
this  response.  Let  aid  come  to  suffering  human  nature  then  from 
the  four  v.'inds  of  Heaven.  The  world  belongs  to  it,  by  merciful 
conferment.  Earth's  millionary  treasures  were  made  tributary  to  its 
use  and  comfort,  and  with  this  mundane  system  its  very  temporal 
being,  happiness,  and  history  are  inseparably  identified.  We  repeat 
it,  then,  let  remedies  come  no  matter  whence:  from  forest,  field, 
fen,  or  fountain ;  from  mountain  height,  or  ocean  cave ;  from 
earth  beneath  or  heaven  above.  Let  them  come  no  matter  how:  
solid,  liquid,  or  aeriform,  ponderable  or  imponderable,  until  they 
cease  to  present  any  appropriate  characteristics  for  the  rescue  of  hu- 
manity, and  then  and  not  till  then,  may  they  forbear.  But  to  be 
more  specific  in  the  expression  of  our  views  upon  the  propriety  and 
reasonableness  of  employing  mineral  agents  in  the  cure  of  disease  : 

1st.  The  same  elementary  substances,  as  (e.  g.)  Oxygen,  Hydro- 
gen, Nitrogen,  and  Carbon,  are  found  in  organic,  as  well  as  inorganic 
matter,  and  are  only  combined,  in  each  respectively,  under  different 
modifications.  Now,  inasmuch  as  no  remedy,  animal  or  vegetable, 
is  taken  in  a  living  state  into  the  human  stomach,  the  power  of  the 
vital  principle  is  no  longer  exerted  in  controling  the  chemical  ar- 
rangements of  its  particles,  and  it  then  becomes  subject  to  the  laws 
which  govern  inorganic  matter. 

2iid.  Some  minerals  are  known  to  be  innocuous,  when  taken  into 
the  human  stomach,  as  Magnesia,  Chalk,  Sulphur,  &c.  and  ojie,  at 
least,  has  become  an  article  of  such  popular  use  in  the  preparation  of 
human  aliment,  in  every  grade  of  society  which  is  removed  from 
downright  barbarism,  as  to  constitute  a  sort  of  national  test  by  which 
to  distinguish  civilized  from  savage  man.  And  yet  who  would  de- 
nounce the  Chloride  of  Sodium  (common  salt)  expel  it  from  our 
tables  return  to  the  rudeness  of  savage  taste,  and  eat  the  half-broiled 
flesh  from  the  reeking  coals,  unseasoned  by  this  grateful  condiment, 
simply  because  it  is  dug  from  the  mines  of  Cracow,  and  crystalizcsin 
the  form  of  cubes? 


1845.]  Calomel,  109 


3rd.  Calomel  itself  i^  an  analogous  compound  :  nay,  more,  for 
it  is  only  necessary  that  the  negative  element  ot^  the  Chloride  of  So- 
dium,  viz.  Chlorine,  should  exchange  its  metallic  ba^e  {Sodium)  tor 
another  metal,  (i.  e.  Mercury)  two  equivalents  of  the  latter  base, 
being  united  to  one  of  the  ibrmer,  and  we  have  the  important  salt 
which  has  elicited  this  dissertation. 

4th.  The  animal  fibre  is  powerfully  impressible,  and  the  various 
organs  promptly  and  signally  modified  in  their  action,  by  mineral 
remedies.  Now  whatever  agents  are  known  to  exert  an  efficient 
control  over  functional  movements,  may,  under  a  judicious  and  dis- 
criminative  administration,  be  made  valuable  auxiliaries  in  the  work 
of  cure. 

5th.  But  is  it  not  a  virtual  impeachment  of  the  Divine  wisdom,  to 
denounce  this  ichole  class  of  substances  as  injurious  to  the  animal  or- 
ganization, when  both  the  Jluids  Rnd  solids  of  that  structure,  furnish 
minerals  as  a  portion  of  their  elementary  constituents?  What  intel- 
ligent physician  has  yet  to  learn  that  Lime  (a  mineral)  in  combina- 
tion with  phosphoric  Acid,  is  found  in  the  cellular,  serous  and  muscu- 
lar tissues,  and  in  the  brain  itself?  that  from  the  most  careful 
ultimate  analysis  of  the  human  blood,  Magnesium,  Calcium,  Sodium^ 
and  Iron,  (all  minerals  the  last  in  the  form  of  a  peroxide  and 
Phosphato)  are  constituent  elements  of  that  fluid,  and  going  the  con- 
stant rounds  of  the  circulation  ?  that  the  whole  osseous  skeleton  of 
the  human  body  consists  of  little  else  than  inorganic  salts,  deposited 
for  the  time  being  in  a  cartilaginous  network  of  appropriate  confor- 
mation, and  all  of  which  may  be  removed  by  digesting  bones  in 
dilute  Muriatic  Acid,  while  the  cartilage  alone  remains  in  situ.  One 
of  these  circulating  salts  too  (Carbonate  of  Lime)  is  the  same  which 
constitutes  the  bulk  of  many  of  our  mountain  ranges,  and  in  the 
form  of  statuary  marble,  withstands  the  waste  of  ages  and  gives 
immortality  to  deeds  and  men.  The  renal  secretion,  also,  as  might 
have  been  anticipated,  contains  these  saline  impregnations,  and  some 
of  the  most  common  forms  of  urinary  calculi  consist  of  the  Oxalate 
or  Phosphate  of  Lime. 

6th.  Nature  seems  to  have  imposed  no  interdict,  preventive  of  a 
rigorous  reaction  and  chemical  union  between  the  several  elements 
of  animal,  vegetable  and  mineral  substances,  and  we  therefore  ra- 
tionally infer,  that  the  three  hlngdoms  were  designed  to  contribute  to 
the  resources  of  the  profession. 

The  Chloride  of  Mercury  (Corrosive  Sublimate)  combines  with 


lit)  Calomel.  [March, 


Albumen  {animal  maltor)  and  forms  an  inert  and  /iarm?e55  compound, 
arid  hence  tlie  while  of  an  egg  is  the  best  antidote  to  the  action  of 
this  virulent  salt. 

The  proximate  principle  of  vegetables  unite  Avitli  minerals,  as  the 
'J'jirtaric  Acid  with  Antimony  and  Potassa,  forming  the  Tnrtar  Emetic 
of  the  shops:  the  Citric  Acid  with  Iron,  making  t)ie  Citrate  of  Iron, 
and,  as  recently  discovered,  the  still  more  complicated,  but  beautiful 
and  valuable  coiDpound,  the  Citrate  of  Quinine  and  Iron,  in  which  a 
vege-ahie  and  mineral  base,  conjointly  submit  lo  the  action  of  an 
Acid  from  the  organic  kingdom.''^ 

7th.  Ajrain,  the  mere  fact  that  a  medicinal  agent  is  obtained  from 
\\\e  vegetable  kingdom,  is  no  guarantee  for  its  innocence  or  usefulness, 
while  the  converse  is  eqtially  true,  i.  e.  that  a  mineral  origin  is  no 
presumptive  evidence  of  deleterious  properties,  and  should  not,  there- 
fore, vitiate  its  claims  to  public  confidence.  For  whi'e  the  Vegeto- 
Alkalis,  Strychnine,  Brucine,  Veratrine,  Conicine,  Atropine,  and 
Daturine,  with  a  host  of  other  organic  agents,  among  which  may  be 
ranked  Hydrocyanic  Acid,  and  the  active  principles  of  Opium  and 
Tobacco,  furnish  some  of  the  most  active  and  virulent  poisons  on 
earth,  many  ?nincral  substances  employed  for  ages  in  medicine  are 
knoirn  to  be  exceedingly  mild  and  harmless,  as  well  as  appropriate 
and  useful  in  the  cure  of  diseases.  Such,  for  example,  are  Sulphur, 
Chalk,  and  Magnesia,  with  its  compounds,  i.  e.  the  Carbonate  and 
Sulphate  :  Soda,  in  the  forms  of  the  Sulphate  and  Phosphate;  and 
Iron,  as  a  Protoxide,  or  Carbonate,  &c.  &;c. 

8th.  But" lastly.  Nature  has  settled  this  great  question,  and  from 
her  own  granite  alembics  in  the  base  of  the  "everlasting  hills,"  has 
distilled  her  own  pure  waters,  and  richly  impregnated  them  with  the 
healing  properties  of  her  own  subterranean  resources.  Chalybeate, 
Sulphureous,  and  Saline  springs,  with  their  respective  minerals  in 
ready  solution,  gush  freely  from  a  thousand  localities  over  the  earth's 
surface,  to  heal  the  maladies  of  our  afflicted  race. 

In  conclusion  then,  with  these  facts  before  us,  and  the  powerful 
and  effective  energies  of  our  mal-treated  remedy  freely  acknowledg- 
ed, shall  we,  because  in  careless  and  injudicious  hands,  or  in  idiosyn- 
cratic temperaments  it  may  have  occasionally  overleaped  the  pre- 


  This  fine  pnrpli5:h  brown  salt,  in  tabular  crystals,  with  a  vitreous  lustre, 
maybe  found  in  the  Drug  store  of  Mr.  Marshall,  the  suoces.or  of  Dr.  Wray, 
At^jrusta,  Cra. 


1845.]  Calornd.  Ill 


scribed  bounds  of  its  therapeutic  action,  and  done  violence  to  th3 
human  constitution,  consent  to  cower  to  the  otit-cry  ofbliiid  preju- 
dice, or  ignorant  and  interested  empiricism,  a'ld,  before  the  e\('S  of 
the  living  myriads  wiiom  it  lias  rescued  from  the  jnw.s  of  the  grave, 
deliberately  pronounce  the  blistering  curse  of  Science  upon  iJs  lioHd, 
and  consign  it  to  the  reproach  and  malediclions  of  posterity?  Xo, 
never!  Sooner  let  the  fate  of  the  laceratf;d  and  entruli)lH'd  multi- 
tudes, who  have  fallen  under  the  explosive  power  of  unconlrciled 
Steam,  and  found  their  winding  sheet  in  the  ocean  wave,  authctrizo 
the  utter  expulsion  of  this  great  agent  from  the  civilized  world,  whe?i 
ten  thousand  burning  axles  arc  rolling  under  its  impulse  and  bearing 
with  the  speed  of  the  winds,  the  exchanges  of  intelligenee  and  com- 
merce to  rising  and  expectant  nations.  And  yet  who  is  prepared  lor 
such  a  national  sacrifice?  None.  The  voice  of  Civilization  is  the 
voice  of  Reason,  and  the  world  obeys  ;  hear  it :  

"Study  more  profoundly  your  science  strengthen  your  cylin- 
ders, modify  your  machinery,  and  increase  your  circumspection, 
but,  still  retain  THE  MASTIDON  IX  HARNESS,  to  do  iLe  work 
of  an  AGE  in  a  YEAR." 

NOTE.  Havine:  concludod  our   c^^neral   views  in   regard   to  this 

o  o  tn 

interesting  article  of  the  Materia  Medica,  it  has  been  thought  desira- 
ble to  append  a  few  practical  observations  which  may  be  made 
available  in  detecting  Us  presence  or  asserlinrr  ils  parity. 

Properlies.  Its  specific  gravify  is  about  7.2,  i.  e.  its  weight  com- 
pared with  an  equal  bulk  of  ira/er,  is  as  7.2  to  1. 

By  exposure  to  light,  even  in  closely  stopped  glass  bottles,  it 
hcquires  a  darkish  tint  the  chemical  constitution  of  the  change  thus 
produced,  not  being  well  understood.  We  cannot  believe,  however, 
with  Du3iAS,  that  it  depends  upon  the  formation  of  a  small  quantity 
of  the  Corrosive  Chloride  and  the  deposition  of  Metallic  Mercurv, 
but  should  rather  suggest  (were  our  own  opinions  to  be  consulted, 
that  from  the  chemical  activity  known  to  be  imparted  to  Chlorine  by 
the  action  of  light,  a  portion  of  that  negative  element  of  the  com- 
pound, was  dismissed  and  minute  j)articles  of  Metallic  Mercury  de- 
posited on  the  exterior  stratum  of  the  mass. 

Tests.  To  ascertain  first,  whether  an  article  supposed  to  be  Cal- 
omel, be  a  mercurial  preparation,  heat  it  with  one  of  the  vegetable 
alkalis,  or  their  carbonates,  and  if  mrrcury  be  present,  small  globules 
will  appear. 


llvJ  Cases  of  Episioraphy.  [March, 


f)r:  Digest  il  with  Nitric  Acid,  and  then  rub  it  with  a  woollen 
rioth,  or  buckskin,  upon  a  bit  o^  clean  copper  if  tiie  metal  be  there, 
a  silvery  stain  will  be  left  on  the  copper,  removable  by  a  red  heat. 

Next,  to  ascertain  whether  the  Mercnrous  salt  thus  detected  bo 
Cnlomel,  ascertain  first,  whether  it  is  insoluble  in  neater. 

Secondly,  wiiethcr  with  Aqua  Ammonia,  or  Caustic  Potassa,  it 
strikes  instantly  a  blackish,  or  with  Lime  water,  a  blackish  gray  pre- 
cipitate which  if  produced,  is  the  Profoxide  of  Mercury,  while  the 
supernatant  liquor  containing  the  dislodged  chlorine  in  alkaline  solu- 
tion,  with  Lunar  Caustic,  will  give  a  white  precipitate  (the  Chloride 
of  Silver.) 

Other  tests  might  be  added,  these  we  trust  will  suffice,  and,  to 
hhow  the  value  of  such  tests  in  determining  the  chemical  character, 
istics  of  the  article  under  examination,  I  close  by  remarking,  that  my 
esteemed  and  lamented  friend  and  former  partner,  Dr.  Wm.  P.  Gra- 
1IA3I,  of  Covington,  Ga.  once  purchased  from  a  store  in  the  village 
a  considerable  quantity,  perhaps  ^  lb.  of  an  article  labelled  'Calomel/ 
and  which  from  a  superficial  examination,  he  supposed  to  be  such.  
Before  attempting  to  use  it,  however,  after  returnmg  to  his  office,  he 
determined  to  subject  it  to  the  action  of  an  Alkali.  To  his  surprise, 
no  blackish  preripitate  appeared.  He  saw  me  some  days  afterwards 
and  requested  me  to  examine  it  in  my  laboratory.  I  did  so,  and  by 
the  most  decisive  tests,  found  the  white  mass  to  be  Arsenious  Acid, 


ARTICLE    II. 

Cases  of  Episioraphy.*     By   Jony   Lake,   M.   D.,  of  Edgefield 
District,  S.  C 

Having  received,  through  my  pupil,  Mr.  James  Hill,  now  in  at- 
tendance on  the  Lectures  in  the  Medical  College  of  Georgia,  a  request 
from  the  Professor  of  Midwifery,  Dr.   J.  A.  Eve,  to  communicate 


  Epibion,  external  labia  ;  and  raphe,  suture.  Edts. 


1845.]  Cases  of  Episioraphy.  113 


for  the  Southern  Medical  and  Surgical  Journal,  two  cases,  in  which 
I  had  performed  successfully  the  operation  of  Episioraphy,  I  will 
with  pleasure  place  them  at  the  disposal  of  the  Editors;  although  in 
presenting  Mr.  Hill,  fiom  my  journal,  a  rough  sketch  of  these  cases, 
to  assist  him  in  preparing  a  thesis  which,  as  a  candidate  for  gradua- 
tion, he  would  be  required  to  present  to  the  Faculty,  I  little  thought 
my  cases  would  be  regarded,  in  so  flattering  a  light,  as  to  call  forth 
a  desire  to  have  them  laid  before  the  public. 

When  about  to  enter  the  practice  of  medicine,  which  is  now  four- 
teen years  since,  as  is  common  with  all  young  men,  I  commenced 
with  sanguine  expectations,  thinking  the  profession  had  approxima- 
ted much  nearer  to  perfection  than  I  now  conceive  it  to  be  :  I  figured 
to  myself,  that  nothing  was  more  certain  than  that  success  must  follow 
the  theoretical  views  of  the  celebrated  authors  which  I  had  read, 
when  applied  to  practice :  but  as  much  as  I  respect  the  profession, 
and  as  high  as  I  think  medicine  deserves  to  stand  among  other  estab- 
lished sciences,  I  still  recollect  the  mortification  I  felt,  when  I  first 
became  practically  acquainted  with  the  many  cases  which  baffle  the 
best  directed  eflTorts  of  the  attentive  and  well  read  physician,  and  in 
this  catalogue,  to  my  astonishment,  the  case  of  prolapsus  uteri  as  of- 
ten presented  itself  as  any  other. 

Professor  Dewp:es,  to  whose  memory  the  ladies  of  Philadelphia 
justly  owe  the  monument,  which  they  proposed  to  erect  as  a  feeble 
tribute  of  respect  for  the  able  counsel  and  prompt  aid  which  he  was 
ever  ready  to  render  to  their  sex,  taught  in  his  lectures,  which  I 
always  attended  with  unusual  interest,  and  his  works,  which  I  have 
ever  since  continued  to  consult,  that  this  malady  is  certainly  control- 
lable by  the  common  metallic  concavo-convex  pessary. 

As  much  as  I  think  Dewees  merits  the  reputation  which  he  has 
acquired  as  an  author,  and  as  unsafe  as  I  conceive  it  to  be  to  differ 
from  him,  upon  topics  generally  connected  with  the  subject  of  mid- 
wifery and  the  diseases  of  women  and  children,  yet  I  must  enter  my 
humble  protest  against  this  proposition.  Admitting  what  is  true,  that 
his  views  on  its  pathology  are  correct,  I  must  yet  contend  that  his 
treatment  based  thereon  is  improper:  for  if  a  relaxed  or  weakened 
vagina  bo  the  proximate  cause  of  a  large  majority  of  displacements 
of  the  uterus,  the  reasonable  inference  is,  and  a  considerable  practice 
in  this  line  has  convinced  me  the  idea  is  correct,  that  any  hard  body 
placed  in  the  cavity  of  the  vagina,  with  a  view  to  support  the  uterus, 
muRt  be  sufficiently  large  to  distend,  very  considerably,  the  parietes 

R 


1 1 4  Cases  of  Epislorayhy.  [March, 


of  the  vagina,  which  distonsion,  if  persisted  in,  must  eventually  lessen 
the  tone  of  an  already  debilitated  organ,  so  as  to  render  the  probabili- 
ty of  a  radical  cure  at  least  doublfui,  without  an  operation. 

With  this  view  of  things,  my  treatment  for  a  length  of  time  has 
been  to  enforce  rigidly  tlie  horizontal  position,  if  necessary,  for  weeks 
or  months,  and  at  tlio  same  time  to  persist  in  cold  and  slightly  stimu- 
lating lotions  to  the  vagina, and  such  constitutional  measures  as  have 
a  tendency  to  impart  tone  to  the  system  generally.  With  this  treat- 
ment I  am  entirely  satisfied. 

As  for  those  extreme  cases  which  cannot  be  greatly  improved  or 
entirely  cured  by  the  above  treatment,  I  have  reason  to  believe  they 
Avill  not  be  made  better,  by  any  treatment  short  of  the  operation  which 
Dr.  Dewees  denounces  in  such  unmeasured  terms,  and  which  I  will 
give  as  performed  in  two  instances  in  my  own  practice. 

The  first  case  is  that  of  Mrs.  D.,  who,  when  the  operation  was 
performed,  was  about  forty-three  years  of  age.  She  had,  for  at  least 
twelve  years  previous  to  that  time,  been  the  su'DJect  of  prolapsus  uteri, 
the  latter  half  of  which  time  she  had  been  confined  to  bed.  The 
constitutional  derangement  growing  out  of  this  disorder,  frequently 
seemed  to  require  more  attention  tiian  the  prolapsus  itself;  for  her 
sufferings  from  nausea,  gastrodynia,  cardiaigia,  a  sense  of  weight  in 
the  stomach  and  very  evident  distension  of  the  bowels,  almost  unin- 
terrupted fetid  eructations,  jiyrosis,  a  sensation  of  sinking  or  flutter- 
ing at  theheart,  &;c.,  were  so  great  as  frequently  to  induce  the  belief, 
not  only  with  Mrs.  D.  and  her  friends,  but  with  her  physicians  also, 
that  under  this  state  of  things  she  could  not  long  survive,  and  sincerely 
do  we  believe  that  death  by  her  was  looked  to  as  her  best  friend. 
Mrs.  D.'s  case  was  successfully  and  no  doubt  correctly  managed,  by 
several  intelligent  physicians.  During  the  illness  of  the  last  physician 
in  attendance,  we  were  consulted  and  requested  to  prescribe  for  her : 
we  in  turn  recommended  the  usual  treatment,  such  as  the  application 
of  the  pessary,  accompanied  wiih  astringent  washes,  at  the  same 
time  combatting  the  constitutional  disturbance  which  had  supervened, 
Avith  no  better  success  than  our  predecessors  ;  we  became  chagrined, 
almost  ready  to  look  upon  procidenJia  uteri  as  belonging  to  the  op- 
probria  medicorum,  and  we  were  about  to  pronounce  it  a  hopeless 
case,  when  the  operation  termed  by  some  Episioraphy,  was  suggested 
to  us  by  a  friend,  as  a  last  alternative-  \Ye  proposed  it  (though  we 
confess,  with  little  hopes  of  success)  to  our  patient,  who  readily  sub- 
mitted to  the  operation;  which  was  performed,  by  denuding  the  ex- 


1 "? 45. ]  Cases  of  Ep isioraphi/.  Ho 


ternal  labia,  cornmenciRg  something  more  than  a  finger's  breadth 
below  the  superior  comsnissure  and  also  about  the  same  distance  from 
the  margin  of  the  labia,  extending  the  incisions  which  were  at  least 
half  inch  in  breadlh,  to  the  fourchette  which  \ras  included.  The 
raw  or  cut  surfaces  were  then  kept  in  apposition  by  the  quill  suture. 
For  the  first  few  days  after  the  operation,  the  urine  was  drawn  off  by 
the  catheter,  which  it  was  apprehended,  if  passed  in  the  natural  way, 
might  prevent  adhesion  of  the  parts.  In  a  few  days  after,  our  most 
sanguine  expectations  were  more  than  realized  ;  for  notwitlistanding 
from  want  of  action  in  the  system  generally,  adhesion  did  not  take 
place  to  the  extent  we  wished,  yet  there  was  a  degree  of  rigidity 
brought  about,  in  the  parts,  which  effected  a  radical  cure  in  a  short 
time.  Her  general  health  began  to  improve,  the  symptoms  of  dys- 
pepsia were  gradually  removed,  and  all  the  train  of  nervous  affections 
attendant  upon  an  aggravated  case  of  prolapsus,  was  soon  gone.  In 
a  few  months  she  was  so  far  recovered  as  to  visit  her  friends  in  Ala- 
bama. Since  when,  (which  was  in  the  latter  part  of  the  winter  of 
1S41,)  she  has  enjoyed  good  health,  and  not  suffered  with  a  trace  of 
her  former  complaint. 

The  second  case  was  a  negro  woman,  who  had  been  confined  to 
bed  for  the  space  at  least  five  years.  She  had  had  the  benefit  of 
the  judicious  application  of  the  different  pessaries  in  vogue,  none  of 
which  offered  her  sufiicicnt  relief  to  enable  her  to  follow  any  kind  of 
business :  in  fact  she  was  completely  bed-ridden,  and  had  been  for 
the  time  already  specified.  She  was  regarded  by  her  owner  as  a 
nuisance.  Encouraged  by  my  success  in  the  case  of  ]Mrs.  1).,  and 
wishing  to  give  the  operation  a  still  further  trial,  I  proposed  to  her 
owner  to  take  cliarge  of  her  case,  and  if  her  situation  was  not  greatly 
ameliorated,  my  attention  should  be  given  free  of  charge.  He  con- 
futed :  her  case  was  conducted  in  a  manner  similar  to  that  of  i\rrs. 
1).  and  the  like  happy  consequences  resulted;  for  in  a  few  months 
(which  is  now  near  two  years,)  she  was  returned  home  and  placed  in 
the  kitchen  as  a  cook  for  a  large  family,  which  post  she  has  occupied 
ever  since. 


116  Lithotomy.  [Marcli, 


ARTICLE   III. 


Fifteen  Cases  of  LUholomy,     By  P.  H.   Wildma>',  M.  D.,  Colum- 

bus,  Ga. 

Within  the  last  five  years,  it  has  fallen  to  my  lot  to  operate  in 
fifteen  cases  of  stone  in  the  bladder. 

One  of  these  cases  was  that  of  a  female  about  30  years  of  age, 
from  whom  a  calculus,  measuring,  in  its  longitudinal  circumference, 
four  inches,  and  in  its  shortest,  two  and  three  quarter  inches,  was 
extracted  through  the  urethra,  previously  dilated.  The  instrument 
used  for  dilating,  was  made  of  steel,  and  constructed  so  as  to  open  on 
the  principle  of  the  speculum  auris  the  blades  standing  at  a  right 
angle  with  the  handles,  and  about  three  inches  in  length.  It  was 
constructed  by  a  blacksmith  in  the  village  where  I  then  resided. 
This  instrument  was  passed  through  the  urethra,  and  its  blades  sepa- 
rated with  moderate  force,  for  the  space  of  ten  minutes,  every  other 
day,  during  ten  days,  previous  to  extraction.  On  the  tenth  day  the 
patient  was  placed  on  the  table,  a  middling  sized  lithotomy  forceps 
carried  into  the  bladder,  the  stone  seized  and  extracted  easily.  The 
patient  had  a  rapid  recovery  having  had  from  the  first  hour,  no 
incontinence  of  urine. 

By  means  of  the  dilator  above  described,  dilatation  of  the  female 
urethra  may  be  carried  to  a  much  greater  extent  than  sufficed  in  this 
case  ;  and  if  desirable,  effected  in  the  space  of  a  iesv  hours.  In  view 
of  these  facts,  and  when  I  reflect  that  incontinence  of  urine  is  a 
frightful,  and  almost  inevitable  consequence  of  laying  open  the  female 
urethra,  and  that  the  high  operation  is  both  difficult  and  dangerous, 
I  can  scarcely  conceive  of  a  case  of  calculus  in  the  female,  in  which 
I  would  not  recommend  the  operation  by  dilatation,  above  any  other 
which  has  been  devised. 

The  remaining  fourteen  cases  occurred  in  male  subjects,  and  the 
calculi  in  all  of  them,  were  extracted  through  bi-lateral  incisions  of 
the  perineum  and  prostate  gland.  The  following  is  the  method  in 
which  I  have  executed  the  operation  : 

The  patient  is  secured  as  for  the  lateral  operation.  The  bladder  is 
injected  with   tepid  water,  unless  the   urine  has  been  retained  for 


1845.]  Lithotomy.  117 


several  hours.  A  staff,  larger  than  that  in  general  use,  and  with  a 
deeper  and  broader  groove,  and  also  with  a  shorter  curvature,  is  car- 
ried into  the  bladder,  and  its  handle  consigned  to  the  right  hand  of  an 
assistant,  (standing  on  the  left  side  of  the  patient,)  who  is  directed  to 
elevate  the  scrotum  with  his  left  hand.  With  three  fingers  of  his  left 
hand  placed  over  the  anus,  and  their  extremities  resting  on  the  peri- 
neum just  below  the  inferior  border  of  the  triangular  ligament,  the 
operator  makes  the  first  incision,  through  the  skin  and  superficial 
facia,  with  a  scalpel  held  in  his  right  hand.  This  incision  is  made  of 
a  semilunar  shape,  its  centre  on  the  median  line,  its  convexity  looking 
towards  the  scrotum,  and  its  horns  resting  on  a  point  midway  between 
the  anus  and  tuberosity  of  the  ischium  on  either  side.  The  dissec- 
tion is  continued  in  the  line  of  the  first  incision,  till  tlie  membranou:* 
[)art  of  the  urethra  is  exposed,  just  below  the  bulb.  An  openintr,  half 
an  inch  in  length,  is  made  into  this  part  of  the  urethra,  with  a  scalpel 
or  bistoury,  and  the  beakofDoct.  Alexander  H.  Sfevexs's  ^^pros^a- 
tic  bi-sector'  inserted  through  it  into  the  groove  of  the  staff.  The 
handle  ff  this  latter  instrument  is  now  taken  tVom  the  assistant,  and 
the  bi-sector  gradually  carried  forward  through  the  prostate  into  the 
bladder. 

The  prostatic  bi-secfor  "  in  form  resembles  an  olive,  with  a  beak  at 
its  extremity,  with  cutting  edges  at  its  sides,  parallel  to  its  longest 
axis,  and  with  a  straight  handle."  I  have,  in  my  operations,  usod 
three  sizes  of  this  instrument.  The  blade  of  the  largest  is  one  inch 
in  its  longest  transverse  diameter  of  the  smallest  nearly  throe  quar- 
ters of  an  inch  the  other  is  intermediate.  Not  more  than  one-third 
of  the  blade  is  exp(sed  the  remainder  being  covered,  above  and 
below,  with  bulbs  of  polished  horn. 

It  is  not  my  intention  or  desire,  to  laud  this  method,  or  this  instru- 
ment, above  all  others  in  the  operation  of  Lithotomy  :  but  merely 
to  add  my  mite  to  the  general  experience,  upon  a  subject  so  deeply 
interesting  to  the  profession  and  to  mankind.  Still,  I  cannot  refrain 
from  expressing  the  belief,  that  the  bi-lateral  operation  is  safer  for 
the  patient,  and  easier  for  the  surgeon,  than  the  lateral.  This  opin- 
ion is  sustained,  no  less  by  the  anatomy  of  the  parts  concerned  in 
the  operation,  than  by  my  own  experience  and  the  testimony  of 
othors. 

Of  my  fotirteon  cases  in  the  male  subject,  two  were  cut  in  tho 
month  of  January,  two  in  April,  one  in  May,  one  in  July,  two  in 
Augu*t,  four  in  St^ptembcr,  one   in  Octol)cr  and  one  in  November. 


118  LUhotom?/.  [March, 


The  youngest  was  three  years  of  age  the  oldest,  seventy-one  ;  nino 
were  between  three,  and  twenty  three,  between  twenty  and  forty. 
Seldom  have  my  patients  been  subjected  to  any  preparatory  treat- 
ment. I  have  several  times  operated  in  the  midst  of  a  paroxysm  of 
greater  or  less  severity,  and  these  patients  have  recovered  as  rapidly 
and  as  perfectly  as  the  others.  I  have  operated  upon  all  who  have 
made  application  to  me,  except  one.  This  patient  was  confined  to 
his  bed  and  so  much  debilitated  as  to  become  pulseless  under  the 
operation  of  sounding.  Besides  this,  I  suspected  that  the  calculus 
was  encysted,  or  had  lodged  or  been  formed  in  the  vesical  extremity 
of  the  left  ureter  about  one-third  of  it  only  projecting  into  the  cav- 
ity of  the  bladder. 

Of  the  fourteen  patients,  all  have  permanently  recovered,  except 
one,  who  died  in  five  weeks  after  the  operation.  This  patient  was 
seventy-one  years  of  age,  corpulent,  and  had  enlargement  and  indu- 
ration of  the  prostate  gland.  Eight  friable  calculi  Vs'ere  removed  
two  or  three  having  been  previously  fractured  in  the  bladder.  The 
difliculty  of  removing  these  fragments  through  an  indurated  prostate, 
and  deep  perineum,  from  a  bladder  pushed  high  up  into  the  pelvis,  by 
an  enlarged  prostate,  may  be  easily  conceived.  I  left  the  patient  in 
three  or  four  days  after  the  operation,  and  am  not  in  possession  of  the 
subsequent  history  of  his  case,  but  am  informed  that  the  wound  had 
healed. 

About  a  week  since,  and  afler  this  paper  had  been  prepared  for 

publication,  I  extracted,  by  the  bi-lateral  operation,  a  small  mulberry 

calculus,  from  a  little  boy  about  seven  years  old.     He  is  doing  well. 

Supposing  the  following  case  not  devoid  of  interest,  I  transcribe  it 

it  in  the  words  of  Mr.  Craig,  one  of  my  pupils  : 

"J.  U.  W.,  aged  18,  was  wounded  by  an  axe,  Oct.  30th,  1844.  
The  blade,  having  first  wounded  the  thigh,  struck  the  scrotum,  passed 
between  the  testicle,  and  penetrated  the  urethra.  The  family  physi- 
cian introduced  a  catheter  which  was  suffered  to  remain  twenty. eight 
days.  Eight  or  ten  days  after  the  accident  the  scrotum  sloughed  and 
exposed  the  right  testicle.  He  was  brought  to  Dr.  Wildman  on  the  26th 
November.  At  this  time  he  discharged  his  urine  through  a  fistulous 
opening  in  the  scrotum,  and  the  urethra  was  nearly  closed  by  a  car- 
tilaginous stricture  anterior  to  the  fistula  it  being  impossible  to  pass 
the  smallest  bougie.  Under  these  circumstances,  it  was  resolved  to 
cut  down  and  lay  open  the  stricture.  The  patient  being  secured  in 
the   position  for  lithotomy,  and  a  large  silver  catheter  passed  down 


1845,]  Lithotomy.  ^  119 


to  it,  the  scrotum  was  laid  open  horn  fop  to  bottom,  on  the 
median  line.  Continuing  the  dissection  between  the  testicles,  that 
portion  of  the  urethra  covered  by  the  scrotum  was  completely  expo- 
sed. The  urethra  was  now  opened  upon  the  end  of  the  catheter; 
but  finding  it  impossible  to  pass  a  director  from  before  backward, 
the  urethra  was  opened  in  its  healthy  portion  behind  the  stricture,  a 
small  director  passed  from  behind  forward,  and  the  stricture  slit  open. 
The  catheter  was  now  carried  forward  into  the  bladder  and  confined, 
the  wound  closed,  by  sutures  and  adhesive  straps,  and  a  suspensory 
bandage  applied.  The  catheter  was  suffered  to  remain  only  four  days. 
When  it  was  first  withdrawn,  the  urine  gushed,  during  micturition, 
from  the  whole  length  of  the  incision.  The  quantity,  however, 
gradually  diminished,  finally  ceased  altogether,  and  the  patient  was 
discharged  cured  in  three  weeks." 

Remarks.  Wounds  of  the  urethra  should,  if  possible,  be  treated 
without  a  catheter.  The  urine  has,  if  I  may  so  express  it,  a  strong 
natural  ajfinify  for  the  lining  membrane  of  the  urethra.  This  is 
evinced  by  the  uniformity  with  which  the  urine  retuYnoi]  sponlaneoiisly 
to  its  natural  channel,  after  the  operation  of  lithotomy.  In  fact, 
judging  from  the  cases  of  urinary  fistula  which  I  have  seeD^  strict ure 
seems  to  be  an  essential  precursor  and  concomitant  of  the  disease; 
and  the  fistula  invariably  disappears  spontaneously  after  the  removal 
of  the  stricture.  Thus  it  would  seem  that  nothing  short  of  mechani- 
cal obstruction,  is  capable  of  permanently  forcing  the  urine  from 
its  natural  channel.  I  object  to  the  wearing  of  a  catheter  after 
wounds  of  the  urethra:  1st,  because,  that,  by  putting  the  urethra 
upon  the  stretch,  it  causes  the  wound  to  gape;  and  2ndly,  because, 
by  attracting  the  urine  along  its  outer  surface,  it  favors  the  escape  of 
this  fluid  by  the  wound.  A  catheter  is  thought  to  prevent  infiltration 
 I  think  it  favors  it.  This  accident  is  best  guarded  against  by 
dilating:  frcelv  the  external  wound. 


120  Monstroslti/.  [March, 


ARTICLE    IV. 

A  Case  of  Monstrosity.     By  S.  B.  Cunningham,  M.  D.^  of  Jones- 

horo\   Tennessee. 

On  the  second  day  of  July,  1843,  Mrs.  E*****s,  of  this  county, 
was  taken  in  labour  with  her  twelfth  child  a  country  midwife  was 
in  attendance,  and  the  labour  advanced  regularly  and  slowly  until 
the  head  was  born  ;  when  it  ceased  to  make  farther  progress.  After 
some  effort,  the  attendant  succeeded  in  bringing  down  the  arms,  but 
the  body  remained  obstinately  stationary.  Eight  or  ten  hours  had 
been  passed  in  fruitless  efforts  to  effect  delivery,  when  we  first  saw 
the  case.  The  pains  though  enfeebled  from  exhaustion,  were  yet 
tolerably  regular,  and  the  delay  under  such  circumstances  and  at 
such  a  stage  of  the  labour,  was  unaccountable  gentle  efforts  having 
proved  unavailing,  the  shoulders  were  grasped  firmly  with  both  hands, 
and  by  a  pretty  forcible  zigzag  traction,  made  during  each  pain,  the 
foetus  advanced  until  the  abdomen  passed,  and  the  patient  was  quickly 
delivered  of  a  still-born  child.  In  due  time  the  placenta  came  away, 
but  it  was  fully  three  times  the  ordinary  size. 

This  foetus  presented  a  very  remarkable  case  of /m?w5  wa/wrcp,  and 
congenital  deformity,  combined  The  abdomen  was  unusually  large, 
and  contained  two  large  tumors,  like  foetal  heads  The  circumfer- 
ence of  the  body,  measured  at  the  umbilicus,  was  twenty-three 
inches.  The  ribs  and  sternum  were  pushed  up  to  make  room  for  the 
abdominal  viscera  Each  hand  was  supplied  with  a  thumb  and  five 
well  tbrmed  fingers,  and  each  foot  with  six  toes.  The  spinous  process 
of  the  superior  dorsal  vertebra  was  wanting,  and  its  place  supplied 
by  a  spinal  bi-fidal  tumor,  about  the  size  of  a  small  walnut.  The 
internal  surface  of  the  tumor  was  covered  with  a  sero-purulent  fluid, 
the  adjoining  vertebrae  were  partially  eroded  The  occiput  was  per- 
foratcd  below  the  upper  crucial  ridge  by  a  hole  the  size  of  a  shilling, 
with  rounded  edges,  and  surrounded  by  the  lacerated  covering  of  a 
sac  which  was  ruptured  by  the  manipulations  oftlie  midwife  There 
was  hare-lip,  the  cleft  of  which  extended  completely  through  the 
palate  bones,  reducing  the  cavities  of  the  mouth  and  nose  into  a 
single  one. 

The  appearance  of  the  genital  organs  rendered  the  sex  doubtful. 


1945.]  Monstrosity,  121 


Superficially,  the  vulva  appeared  to  be  well  formed,  with  deep  com- 
missure superiorly  and  invaginated  clitoris,  alias  penis,  about  half  an 
inch  in  length,  soft  and  without  any  appearance  of  corpora  cavernosaae, 
gland  or  prepuce.     There  was  a  meatus,   through  which   a  knitting 
needle  was  passed  into  a  kind  of  cwZ  de  sac,  with  thick  and  solid  walls 
about  one  inch  in  length  and  of  the  diameter  of  a  large  straw.     The 
labia  when  separated  shewed  no  other  opening,  nor  was  there  any 
appearance  of  nymphae.     As  the  labia  approached  each  other  be- 
hind, the  fissure   rose  more  superficially  until  lost  in  ralher  loose  in- 
teguments posteriorlvf  suggesting  to  the  observer  the  idea  of  a  scro- 
tum, or  an  abortive  etfort  of  nature  to  make  one.     Internally  there 
were  some  slight  traces  of  spermatic  chords,  which  were  attached  to 
vascular  convolutions  in  the  lower  margin  of  the  kidneys  on  both 
sides,  which  were  easily  unravelled,  and  more  nearly  resembled  the 
plexus  ciioroidts  of  the  ventricles  of  ihe  brain,  than  any  llrirg  else  to 
which  I  can  compare  them.     Yet  I  hey  were  located  in  tlie  situ  jjro- 
pria  of  the  fcetal  testes,    and  one  was  much  larger  than  the  other.* 
The  kidneys  were  two  large  rolling  tumors  cf  a  rather  spongy  tex- 
ture, ii'ifi'.trated.  of  a  pale  color,  and  together  weighing  three  pounds 
and  three-quarters.     The  other  viscera  w  ere  natural  the  lower  ex- 
trerrfllies  were  unusually  small  tiie  foetus  weighed  between  eight 
and   nine   pounds,    the   kidneys  lurnisiiing    one-half   of  the    entire 
weight.     A  most  singular  circumstance  connected  with  this  case,  is 
the  fact,  that  of  twelve  children  born  of  the  same  woman,  five   had 
nn  abdominal  and  sexual  organization  similar  to  that  just  described, 
and  were  also  still-born  the  hydro-rachitic  symptoms,  however,  were 
absent  in  these  cases  The  alternate  children  were  well  formed  and 
healthy.     During  gestation  of  each    monstrosity,  the   woman  com- 
plained of  unusual  and  anomalous  symptoms,  which   enabled  her  in 
her  last  pregnancies   to   foretell   tlieir  issue.     The  families  of  hoth 
the  parents  were  as  healthy  as  others,  and  there  was  nothing  in  tho 
appearance  of  either,    which    could   account    for  such    a  deformed 
progeny. 

I  leave  to  others  the  province  ot"  comrneniing  on  such  cases  
Though  nothing  practical  may  be  dirived  from  that  just  deiscribed,  it 
furnishes  an  instance  of  a  remarkable  aberration  of  nature,  which 
mav  interest  the  curious. 


  Had  this  child  lived,  it  doubtless  would  have  been  classed  as  r.i\  horma- 
phnxlite,  as  the  parents  and  nfii:hl'ors  were  not  able  to  determine  tlie  fox. 


12:3  Extirpation  of  the  Mamma,  [March, 


ARTICLE  V. 

Extirpation  of  the  Mainma  of  a  female  in  the  Mesmeric  Sleep,  with- 
out  any  emdence  of  sensibiJiiy  during  the  operation.  By  L.  A. 
DuGAs,  M.  D.,  Professor  of  Physiology^  S^c.  in  the  Medical  Col- 
legs  of  Georgia, 

On  the  3rd  of  January,  1845,  Mis.  Clark  (wife  of  Mr.  Jessh 
Clark,  of  Columbia  Co.,  Georgia)  came  to  this  city,  for  the  purpose 
of  Kettino;  m.e  to  remo'  a  schirroiis  tumor  of  her  rio^ht  mamma, 
which  had  been  gradually  increasing  for  the  last  three  years,  and 
which  had  now  attaiii  i,  ihe  size  of  a  turkey's  egg.  The  tumor  had 
never  caused  any  pain  of  consequence,  was  not  adherent  to  the  skin, 
nor  did  it  implicate  any  of  the  axillary  glands.  Mrs.  C.  is  about  47 
years  of  age,  [las  never  borne  a  child,  and  her  health,  though  by  no 
means  robust,  was  pretty  good,  and  had  not  been  impaired  by  the 
evolution  of  the  tunior.  The  operation  having  been  determined 
upon  for  the  following  day,  Mrs.  C.  remarked  to  me  that  she  had 
been  advised  by  Mr.  Kenrick  to  be  mesmerized,  but  that  as  she 
knew  nothing  about  it,  slie  v/ould  like  to  have  my  advice,  and  would 
abide  by  it  to  which  I  replied  tiiat  there  were  several  well  authenti- 
cated cases  on  record,  in  which  surgical  operations  had  been  perform- 
ed,  under  mesmeric  influence,  without  the  consciousness  of  the 
patient ;  that  I  would  be  happy  to  test  the  subject  in  her  case,  and 
that  I  would  endeavor  to  mesmerize  her,  instead  of  operating  as  had 
been  proposed,  on  the  day  following. 

On  the  4th  January,  at  11  o'clock,  A.  M.,  I  called  on  Mrs.  C,  and 
was  informed  that  on  the  preceding  evening  she  had  been  put  to 
sleep  by  Mr.  B.  F.  Kenricx  (at  whose  house  she  resided.)  I  then 
mesmerized  her  myself,  and  induced  sleep  in  about  fifteen  minutes. 
Finding  my  patient  susceptible  to  the  mesmeric  influence,  and  re- 
flecting that  it  would  not  be  convenient  for  the  same  person  to  main- 
tain tliis  infliienceand  to  perform  a  surgical  operation  at  the  same  time, 
I  requested  Mr.  Kexuick  to  mesmerize  Mrs.  C.  morning  and  even- 
ing, at  stated  hours,  until  insensibility  could  be  induced.  This  way 
regularly  done,  with  gradually  increasing  efi'ect,  when,  on  the  evening 
of  the  6ih  January,  sleep  was  induced  in  five  minutes,  and  the  prick 


1 843.  ]  Extirpation  of  the  Ma?nma.  1  '^'3 


of  a  pin  was  attended  with  no  manifestation  of  pain.  The  sittings 
were  continued,  and  the  patient's  sensibility  daily  tested  by  myself 
and  others  in  various  ways.  On  the  9Lh  January,  I  invited  Professor 
Ford  to  be  present,  and,  after  pricking,  and  pinching  strongly  the 
patient  without  evidence  of  pain,  the  inesmerizer  was  requested  to 
leave  the  room,  when  we  exposed  the  breast,  handled  it  roughly  in 
examining  the  tumor,  and  readjusted  the  dress,  without  the  con- 
sciousness of  the  patient.  We  then  held  to  her  nostrils  a  vial  of 
strong  spts.  of  Hartshorn,  which  siie  breathed  freely  for  a  minute  or 
two,  without  the  least  indication  of  sensation,  unless  the  fact  tliatshe 
swallowed  once  be  regarded  as  such,  instead  of  a  mere  reflex  action. 
On  the  11th  of  January,  in  presence  of  Professors  Ford  and  Means, 
in  addition  to  the  usual  tests,  I  made,  wilh  my  pocket-knife,  an  incis- 
ion about  two  inches  in  length,  and  half  an  inch  in  depth  into  the 
patient's  leg,  without  indication  of  sensation. 

Fully  satisfied  now  of  our  pov.'er  to  induce  total  insensibility,  I 
determined  to  operate  on  her  tha  next  day  at  i\oon,  but  carefully  con- 
cealed any  such  design  from  the  patient  nnd  her  friends,  who  did  not 
expect  its  performance  until  several  days  later. 

On  the  12th  January,  at  29  minutes  past  11,  A.  -\I.,  Mrs.  C.  was 
put  to  sleep  in  forty-five  seconds,  without  touch  or  pass  of  any  kind, 
the  facility  with  which  the  mesmeric  inHuonce  was  j)roduced  having 
gradually  increased  at  each  sitting.  At  1*2  o'clock,  M.,  in  presence 
of  Professors  Ford,  Means,  Garvin  and  Xewton,  and  Dr.  IIalsee, 
the  patient  being  in  a  profound  sleep,  I  prej)ared  her  dress  for  the 
operatio!),  and  requested  my  professional  brethren  to  note  her  pulse, 
respiration,  complexion,  countenance,  cVc.  before,  during  and  after 
the  amputation,  in  order  to  detect  any  evidence  of  pain,  or  niodifica- 
lion  of  the  functions.  As  Mr.  Kenricic  had  never  witnessed  a 
surgical  operation,  he  feared  he  might  lose  his  self  possession,  and 
requested  to  be  blindfolded  ;  which  was  done.  He  now  seated  him- 
self on  the  couch  near  the  patient,  and  held  her  hands  in  his  during 
the  operation.  This  was  accomplished  by  two  elliptical  incisions 
about  eight  inches  in  length,  comprehending  between  them  the  nipple 
nnd  a  considerable  portion  of  skin,  after  which  the  integuments  were 
dissected  up  in  tha  usual  manner,  and  the  entire  mamma  removed. 
It  weighed  sixteen  ounce>\  The  wound  was  then  left  open  about 
three  quarters  of  an  hour,  in  order  to  secure  the  liloeding  vessels,  six 
of  which  were  ligatcd.  The  ordinary  dressing  was  applied,  and  nil 
appearances  of  blood  carefully    removed,   ro    ilmf   tIiP\-  niijjht  nr)t  bo 


124  Extirpallonof  the  Mamma.  [March, 


seen  by  the  patient  when  aroused.  The  amount  of  hemorrhage  was 
rather  more  than  is  usual  in  such  cases. 

During  the  operation  the  patient  gave  no  indication  whatever  of 
sensibility,  nor  was  any  of  the  functions  observed  by  those  present, 
modified  in  the  least  degree.  She  remained  in  the  same  sound  and 
quiet  sleep  as  before  the  use  of  the  knife.  Subsequently,  the  pectoral 
muscle,  which  had  been  laid  bare,  was  twice  oc  thrice  seen  to  con- 
tract when  touched  with  the  sponge  in  removing  the  blood.  About 
fifteen  minutes  after  the  operation,  a  tremulous  action  was  perceived 
in  her  lower  jaw,  which  was  instantaneously  arrested  by  the  applica- 
tion ofthe  mesmcrizer's  hand  to  the  patient's  head.  This  phenomenon 
rrcurrcd  in  about  ten  minutes  after,  and  was  again  in  the  same  man- 
ner quieted.  Professor  Ford,  who  counted  the  pulse  and  respiration, 
states  that  before  any  preparation  was  n)ade  for  the  operation,  the 
pulse  was  96,  and  the  respiration  16  per  minute  ;  that  after  moving 
the  patient  to  arrange  her  dress  ior  the  operation,  and  just  before 
this  was  commenced,  the  pulse  was  9S,and  the  respiration  17  ;  that 
immediately  a^ter  the  detachment  ofthe  breast  the  pulse  was  96,  
respiration  not  counted;  and  that  after  the  final  adjustment  ofthe 
bandages  and  dress,  which  required  the  patient  to  be  raised  and 
moved  about,  the  pulse  was  98,  and  the  respiration  16.  All  present 
concur  instating  that  neither  the  placid  countenance  ofthe  patient, 
nor  the  peculiar  natural  blush  of  the  cheeks,  experienced  any  change 
whatever  during  the  whole  process  that  she  continued  in  the  same 
|)rofound  and  quiet  sleep,  in  which  she  was  before  the  operation,  (with 
the  exceptions  above  noted.)  and  that  had  they  not  been  aware  of 
what  was  being  done,  they  would  not  have  suspected  it  from  any 
indications  furnished  by  the  patient's  condition. 

The  patient  having  been  permitted  to  sleep  on  about  half  an  hour 
after  the  final  arrangement  of  her  dress,  the  mesmerizer  made  passes 
over  the  seat  ofthe  operation,  in  order  to  lessen  its  sensibility,  and 
aroused  her  in  the  usual  manner,  when  she  engaged  in  cheerful  con- 
versation with  Mr.  Kexrick  and  myself,  as  though  she  had  no  suspi- 
cion of  what  had  taken  place.  I  then  introduced  to  her  the  gentlemen, 
who  had  placed  themselves  so  as  not  to  be  seen  by  her  on  awakening, 
nnd  observed  that  1  had  invited  them  to  come  in  during  her  sleep,  in 
order  that  we  might  fully  test  her  insensibility,  preparatory  to  the 
operation.  After  a  few  minutes  of  conversation,  I  asked  her  when 
she  would  like  to  have  the  operation  performed  ?  to  which  she  re- 
plied,  the   sooner   the  better,   as   she    was  anxious  to  get  home.      I 


lSi5.]  Eitirpallon  of  the  Mamma.  125 


added,  "  Do  you  really  think  tliat  I  could  remove  your  entire  breaist, 
when  asleep,  \^ithout  your  knowledge  ?"  Ans.  "  Why,  Doctor,  the 
fact  is,  that  from  the  various  experiments  I  am  told  you  have  madfe 
on  me,  I  really  do  not  know  what  to  think  of  it."  "Well,  Madam, 
suppose  I  were  to  perform  the  operation  one  of  these  days,  and  to 
inform  you  of  it  when  you  would  awako,  would  you  believe  me,  and 
could  you  control  your  feelings,  on  finding  that  it  had  been  done  ?" 
Ans.  "  I  could  not  suppose  that  you  would  deceive  me,  and  of  course 
I  would  be  very  glad,  but  would  try  not  to  give  way  to  my  feelings." 
*'  Have  you  perceived,  since  your  arrival  here,  or  do  you  now  perceive, 
any  change  in  the  ordinary  sensations  of  the  affected  breast  ?"  "  No, 
sir,  it  feels  about  as  it  has  done  for  some  time  back."  About^a 
quarter  of  an  hour  having  elapsed  since  she  awoke,  I  then  told  her 
that,  as  we  found  her  in  a  proper  state  for  the  operation,  I  had  per- 
formed it,  and  that  the  breast  was  now  removed.  She  expressed  her 
incredulity  said  I  was  certainly  jesting,  as  it  was  impossible  that  it 
could  have  been  done  without  her  knowing  it  at  the  time,  or  feeling 
anything  of  it  now.  She  became  convinced  only  on  carrying  her 
hand  to  the  part  and  finding  that  the  breast  was  no  longer  there. 
She  remained  apparently  unmoved  for  a  few  moments,  when  her 
friends,  approaching  to  congratulate  her,  her  face  became  flushed, 
and  she  wept  unaffectedly  for  some  time.  The  wound  healed  by  the 
first  intention. 

In  laying  the  above  narrative  before  the  Profession,  it  is  due  to  the 
cause  of  truth  to  state,  that  it  has  been  submitted  to  all  the  Physicians 
present  at  the  operation,  and  that  I  am  authorized  by  them  to  say 
that  it  accords  in  every  particular  with  their  own  observations  so  far 
as  they  were  present.  I  should  also  add  that,  having  no  other  object 
in  view  than  the  establishment  of  the  fact  that  a  surgical  operation 
may  be  performed  under  such  circumstances  without  the  conscious- 
ness of  the  patient,  I  have  designedly  avoided  any  mention  of  the 
various  and  interesting  mesmeric  phenomena  manifested  prior  and 
subsequently  to  the  operation.  These  have  been  carefully  and  judi- 
ciously recorded  by  Mr.  Kknrick,  whose  well  directed  zeal  has 
enabled  him  to  collect  a  body  of  highly  important  facts  from  a  field 
unfortunately  explored  too  exclusively  by  ignorance  and  charla- 
tanism. 

Augusta,  (Ja.,  1st  February,  1810. 


120  Cachexia  Africana.  [March, 


Pakt  II. reviews  and  EXTRACTS. 

Obsprvafions  on  the  Cachexia  Africana,  or  the  habit  and  effects  of 
Dirt-eaiing  in  the  Negro  race.  By  W.  M.  Carpenter,  M.  D., 
Prof.  Mat.  Med.  in  the  Louisiana  Med.  College.  (New  Orleans 
Medical  Journal,  No.  8.) 

The  nature  and  treatment  of  tlie  diseases  which  seem  to  he  pecu- 
liar to  the  Afrjcan  race,  present  questions  of  deep  interest  to  the 
the  Southern  physician.  Among  these  diseases  none  is  more  worthy 
of  the  attention  of  the  pathologist  than  that  upon  which  Professor 
Carpexter  has  written,  nor  has  any  subject  equally  interesting  re- 
ceived less  attention  from  the  physicians  of  our  section.  No  Amer- 
ican physician,  we  helicve,  has  noticed  it.  But  in  the  West  Indiet? 
where  the  habit  prevails  to  a  great  extent,  it  has  excited  considerable 
interest,  and  a  number  of  articles  have  been  written  upon  the  subject. 
We  are  much  pleased  that  Prof.  Caepekter  has  laid  before  the  pro- 
fession the  valuable  results  of  his  observations  of  this  singular  malady, 
and  we  very  much  regret  that  our  limits  prevent  us  from  extracting 
the  entire  article. 

In  the  Southern  Slates,  dirt-eating  is  of  frequent  occurrence,  par- 
ticularly on  large  plantations  which  occupy  unhealthy  localities.  It 
is  not  so  common  however  in  this  region  as  it  appears  to  be  in  some 
of  the  South-Western  States.  We  are  informed  by  Dr.  C.  that  in 
Louisiana,  large  planting  establishments  have  been  entirely  broken 
up  by  the  extensive  mortality  amopg  the  slaves,  resulting  from  this 
pernicious  habit. 

^^  Symptoms.  The  initial  and  essential  feature  of  (his  disease,  is  a 
depraved  appetite,  causing  an  invincible  craving  for  earthy  substances, 
and  so  strong  is  this  desire,  that  it  generally  triumphs  over  every  effort 
to  prevent  the  practice;  and  such  is  the  i;idomilable  force  of  the 
habit,  that  neither  holts,  nor  bars,  nor  punishment,  flor  the  certainty 
that  it  will  inevitably  end  in  death,  can  in  any  measure  prevent 
their  indulging  in  it  'The  only  appreciable  signs  of  mental  activity,' 
says  Dr.  Craigin,  'exhibited  during  tlie  course  of  this  disease,  are  the 
crafty  and  cunning  plans  which  the  patient  most  subtily  matures,  and 
as  stealthily  executes,  to  procure  his  desired  repast.'  They  usually 
fix  upon  one  article,  as  preferable  to  the  rest,  but  in  its  absence  wiil 
readily  indulge  in  those  at  hand.     The  iirticles  most  frequently  eaten 


1840.]  Cachexia  AJ vicuna,  12" 


are  clay,  mud,  dried  mortar,  plater,  lime,  d'.i>f,  ashes,  chalk,  tobacco 
I'ipes,  slate,  bricks,  sanri,  rotten  wood,  rags,  hair  and  some  other  un- 
ratural  substances.  iMr.  Hunter  states  that,  in  Jamaica  *  thoy  are 
Jondest  of  a  kind  of  white  clay,  like  tobacco-pipe  clny,  with  which 
ihey  till  their  mouths,  and  allow  it  to  dissolve  gradually,  and  express 
as  much  satisfaction  from  it  as  the  greatest  lover  of  tobacco  could  do.' 
lij  Surinam,  Dr.  Craigin  found  (hey  generally  preferred  to  eat  the 
fossil  shells,  of  which  a  bed  lay  near  the  surface  :  and  the  streets  of 
the  towns  were  made  and  repaired  with  the  same  material. 

"As  the  symptoms,  resulting  from  or  accompanying  dirt-eating, 
are  trivial  in  the  beginning,  and  very  slowly  progressive;  and  as 
they  only  come  under  the  observation  of  the  physician,  in  the  latter 
stages,  and  after  a  considerable  lapse  of  time,  when  they  have  assu- 
med a  serious  aspect,  it  becomes  difficult  to  determine  what  is  the 
order  in  which  they  apppar.  On  enquiry,  however,  it  will  generally 
be  ascertained,  that  the  first  symptoms  that  attracted  the  notice  of  the 
patient,  are  those  indicative  ofmoreor  less  serious  derangement  of  the 
digestive  functions.  The  bowels  are  irregular  in  their  action  ;  in  some 
cases  habitually  constipated,  in  others  the  constipation  alternates  with 
spells  of  diarrhoea.  Heart-burn  and  flatulency  are  common  symp- 
toms at  this  stage  ;  and  many  patients  complain  of  loss  of  appetite, 
or  of  vomiting  after  their  meals.  In  some  cases  there  is  slight  fever 
occasionally,  or  sensations  of  burning  in  the  palms  of  the  hands  and 
fiiQt,  The  patient,  at  this  earl}-  stage,  frequr^ntly  begins  to  exhibit  an 
inclination  to  avoid  efl<)rt  of  any  kind,  skulks  from  work,  and  some, 
times  pleads  indisposition  ;  but  as  he  conceals  the  true  nature  of  the 
case,  looks  as  well  as  usual,  and  can  oidy  designate  a  slight  derange- 
ment of  the  bowels,  or  some  other  disorder,  of  an  apparently  unlm- 
portant  nature,  his  plea  is  generally  heard  with  suspicion,  or  rejected. 

This  state  of  things  continues  for  some  time  ;  the  disease  pursues 
its  insidioiis  course  ;  the  patient  retains  a  degree  of  embonpoint  which 
might  easily  delude  the  observer,  in  regard  to  the  gravity  of  the  case. 
A  closer  examination,  howevei*,  will  reveal  the  extensive  lesions  that 
exist  in  the  structure  or  functions  of  the  vital  organs. 

"The  whole  body  has  a  full,  and  rather  edematous  appearance; 
and  the  skin  is  dry,  sometimes  smooth,  but  more  frequently  scurfy  or 
furfuraceous,  and  it  generally  has  a  turgid  or  shining  look.  The 
face  has  a  peculiar  tumid  but  flabby  fulness  ;  and  those  portions  of  the 
body  which  usually  abound  in  fat,  retain  their  full  appearance,  though 
they  are  wanting  in  their  ordinary  eias;tic  resistance.  The  muscular 
])aits  of  the  arms  and  legs  still  have  their  roundness,  but  feel  soft 
and  flabby.  The  feet,  ankles,  and  hands  are  almost  always  cedema- 
tous,  pit  under  pressure  of  the  flnger,  and  retain  the  impression  after 
the  removal  of  the  force.  Dr.  Craigin  observed,  in  some  cases,  and 
in  some  parts  of  the  body,  a  peculiar  state  which  he  compared  to  the 
condition  of  the  tissues  in  elephantiasis,  in  consequence  of  the  elasti- 
city of  the  integuments  and  of  the  sub-cutancous  tissues.  There  is, 
however,  one  trait  in  elephantiasis  that  I  have  not  seen  in  this  discaijc; 


128  Cachexia  Africana.  [March, 


nnd  that  is,  tlie  hypertrophy  of  the  skin  itself;  for  thoufrh  the  sub- 
cutaneous tissues  are  otien  hypertrophied  without  oedema,  vet  the 
skin  in  a  great  monsure  retains  its  thinness.  The  eye  is  prominent, 
being  rendered  so  by  the  abundance  of  the  adipose  tissue  of  the  orbit, 
and  tr.e  lids  are  often  pufTy  or  cedematous.  The  eye  has  generally  a 
languid,  unmeaning  look,  devoid  of  vivacity.  The  conjunctiva  has 
generally  a  snouy  v.hite  or  dirty  yellow  and  jaundiced  appearance. 
Dr.  Craigin  says,  that  in  all  the  cases  he  saw  in  Surinam,  it  was  'of a 
peculiar  snowy  whiteness,  untinged  by  a  particle  of  red  blood.'  This 
condition  however  is  by  no  means  universal  here,  and  the  jaundiced 
appearance  exists  in  a  large  number  of  the  cases.  The  palms  of  the 
hands,  and  soles  of  the  feet,  are  strikingly  white  and  pale ;  the  lips, 
gums,  and  the  whole  mucous  membrane  of  the  mouth,  are  remarkably 
pale  and  anaemic,  and  the  'tongue  which  in  health  performs  its  duty 
with  so  much  alacrity,  lies  bleached  and  bloodless,  scarcely  able  to 
represent  the  motives  of  its  owner.' 

'*  These  symptoms  are  referable  to  an  ana?tnic  condition,  or  rather 
to  a  condition  characterized  by  a  great  deficiency  of  the  red  globules 
of  the  blood.  In  several  cases,  blood  was  drawn,  and  it  always  pre- 
sented the  same  characters,  but  varying  in  degree.  In  general  it  has 
a  thin  but  turbid  appearance ;  the  globules  having  a  peculiar  pur- 
plish colour,  somewhat  like  that  of  pale  claret  lees  ;  and  floating  per- 
ceptibly apart,  separate,  or  in  little  groups,  in  the  large  mass  of  serum. 
The  proportion  of  clot  to  the  mass  of  blood  is  remarkably  small, 
though  the  organic  solid  matters  of  the  serum,  are,  in  quantity,  as 
great,  or  even  above,  the  ordinary  standard.  I  regret,  not  to  be  able 
to  give  exact  numerical  data  respecting  the  quantities  of  the  ele- 
ments of  the  blood  in  these  cases,  as  I  only  analyzed  the  blood  in  one 
case,  and  my  notes  on  this  analysis  have  been  mislaid.  In  this  case 
the  solid  matter  of  the  clot  was  less  in  weight  than  that  obtained  by 
Andral  and  Gavarret  from  the  blood  of  chlorotics  ;  the  solid  organic 
matters  of  the  serum,  to  the  contrary,  were  abundant,  and  the  serum 
coagulated  at  a  temperature  of  153*  of  Fht. 

"The  patient  is  excessively  dull;  sometimes  stupid  almost  to 
idiocy;  is  very  susceptible  to  the  influence  of  cold,  and  'delights  to 
bask  in  the  sun's  rays,'  or  to  hang  over  a  fire,  even  in  the  hottest  days 
of  summer. 

"As  the  disease  progresses,  function  after  function  becomes  deran- 
ged, and  soon  the  physiological  balance  is  completely  destroyed. 
Cutaneous  transpiration  is  almost  completely  suspended,  the  urine  is 
sometimes  diminished,  but  in  other  cases  greatly  augmented  in  quan- 
tity, and  there  is  often  an  irritable  state  of  the  bladder,  which  is  ex- 
ceedingly troublesome,  in  consequence  of  its  giving  rise  "to  repeated 
calls -to  urinate,  which  are  so  urgent  and  painful  in  some  cases,  that 
the  patient  has  not  time  to  walk  a  few  steps,  or  even  to  get  out  of 
bed,  before  the  urine  is  discharge.  In  two  or  three  cases,  that  have 
come  under  my  observation,  this  condition  existed  to  such  a  degree 
as  to  amount  to  absolute  incontinence,  but  apparently,  without  any 


1845.]  Cachexia  Africa na,  129 


paralysis  about  (he  neck  of  the  bladder,  and  depending  solely  on  the 
intolerance  of  the  bladder  to  the  presence  of  urine.  Some  of  these 
patients  have  assured  me,  that  they  were  oblifjed  to  micturate  twenty 
and  thirty  times  in  the  course  of  the  night  ;  others  that  they  had  calls 
of  the  same  kind  every  few  minutes,  and  being  worn  down  by  the 
disturbance,  thev  no  longer  got  up,  but  had  made  provisions  which 
prevented  the  necessity-  of  rising.  In  women  there  is  generally  sup- 
pression of  the  cafamenia,  which,  in  some  cases,  however,  are  gener- 
ally re-established  whenever  there  is  for  a  short  time  an  improvement 
of  the  general  condition. 

"  Instead  of  the  constipation,  which  is  the  most  common  condition 
of  the  bowels  in  the  earlier  periods  of  the  disease,  we  have  in  this  ad- 
vanced stage,  almost  incessant  diarrhoea.  The  stools  are  of  variable 
consistance,  and  pale  or  yellowish,  sometimes  mixed  with  mucus  or 
pus,  or  streaked  v\ith  blood.  The  abdomen  is  not  generally  tender 
when  pressed,  but  is  generally  flaccid  or  tympanitic ;  and  the  mesen- 
teric glands  can  rarel}^  be  felt. 

"The  disinclination  to  exercise  now  amounts  to  actual  lethargy; 
and  the  slightest  exertion,  such  as  walking  a  short  distance,  or  even 
rising  up,  produces  an  overpowering  sense  of  fatigue  and  lassitude, 
attended  by  an  oppression  of  respiration,  painful  palpitations  of  the 
heart,  which  are  often  audible  to  the  bystander  ;  the  carotid  and  tem- 
poral arteries  beat  strongly,  and  a  distressing  throbbing  is  felt  in  the 
head. 

"The  patient  is  completely  overcome  by  any  attempt  to  walk  up 
an  acclivity,  and  when  obliged  to  perform  any  labour  that  requires  ac- 
tive exertion,  or  to  walk  briskly,  particularly  when  it  is  hot,  will  some- 
times sink  suddenly  to  the  ground  overpowered  and  exhausted,  and 
sometimes  in  a  state  of  sufibcation  or  of  syncope. 

"When  the  patient  is  quiet,  these  painful  feelings  are  relieved  or 
diminished  though  the  dyspnoea  still  continues  to  some  extent,  the 
heart's  action  remains  laborious,  and  in  some  cases  the  painful  throb- 
bing in  the  head,  disturbs  and  almost  prevents  sleep  at  night.  I  havo 
seen  cases  in  which  this  symj)tom  causes  more  distress  and  complaint 
than  in  all  others;  and  some,  if  not  all,  thus  affected  died  suddenly, 
nt  night,  I  suspect,  from  effusion  upon  the  serous  surfaces  or  in  the 
ventricles  of  the  brain. 

"Notwithstanding,  however,  that  the  visible  signs  of  disorder,  are 
diminished  by  rest;  careful  auscultation  easily  detects  the  important 
ftmctional  or  structural  lesions  which,  according  to  my  observation, 
invariably  attend  upon  the  advanced  stages  of  this  disease.  The 
pulse  is,  in  general,  rather  small,  but  tense,  and  varies  in  frequency 
from  90  to  120  a  minute.  In  two  or  three  cases,  I  observed  pulsationa 
of  the  jugular  veins  which  were  synchronous  with  the  pulse,  and,' in 
these  cases,  thought  that  the  signs  afforded  by  auscultation,  indicated 
hypertrophy  of  the  ventricles  and  dilatation  of  the  auricles  :  in  one 
case,  my  diagnosis  was  confirmed  by  post-mortem  examination  :  one 

9 


130  Cachexia  Africana,  [March, 


of  the  others  is  still  living,  and  I  hope  to  know  the. condition  in  case 
of  her  death,  which  can  scarcely  fail  to  take  place  soon. 

"The  derangements  of  the  heart's  action  seem,  in  the  early  stages 
of  the  disease,  to  be  sympathetic,  or  perhaps  dependant  on  an  irrita- 
ble condition  of  that  organ ;  but  as  the  disease  progresses,  changes 
soon  take  place  in  the  structure  of  that  organ,  and  in  the  latter  stages 
auscultation  almost  invariably  indicates  the  existence  of  structural 
lasions  of  the  heart  or  its  appendages.  Tn  no  one  instance,  have  the 
post-mortem  examinations  failed  to  confirm  the  indications,  afibrded 
by  auscultation,  of  the  existence  of  these  lesions. 

"The  examination  of  the  respiration  generally  aflbrds  no  very 
decided  results.  The  dyspnoea  which  in  some  cases  amounts  almost 
to  an  asthmatic  state,  is  generally  aggravated  by  a  horizontal  posi- 
tion, especially  when  laying  on  the  back,  and  is  sometimes  so  urgent 
as  to  require  that  the  patient  should  be  propped  up  in  bed  continually. 
This  dyspna3a  however  seems  to  depend  upon  the  cardiac  lesion,  and  no 
correspojiding  sign  can  generally  be  detected  in  the  function  of  the 
lungs.  The  respiratory  murmur  is  sometime^  wanting  over  small 
portions  of  the  chest ;  the  mucous  rale  is  frequently  heard,  but  there 
seems  to  be  nothing  constant  or  definite  in  the  condition  of  the  lungs. 

"With  the  heart  it  is  different.  Its  irnpulse'is  generally  very 
strong,  and  can  be  distinctly  perceived  in  some  cases,  over  the  en- 
tire chest;  and  though  its  sounds  and  impulse  are  increased  by  exer- 
cise, they  retain,  when  the  patient  has  ]>een  long  at  rest,  a  degree  of 
energy  much  greater  than  in  the  normal  state.  The  bruit  de  soujjlet 
is  a  common  symptom,  and  indeed  may  be  said  to  be  rarely  absent. 

"In  liot  weather,  the  symptoms  are  generally  aggravated;  the 
bowels  are  more  deranged,  the  heart  more  irritable,  and  the  disturb- 
ance of  the  circulation  greater,  the  dyspnoea  more  urgent,  the  extrem- 
ities become  cxjdematous,  and  menstruation  in  the  woman  ceases. 
It  is  consequently  in  summer,  that  the  disease,  when  left  to  pursue  its 
course,  naturally  tends  to  a  fatal  termination.  This  however  is  not 
the  case,  in,  perhaps,  a  majority  of  the  cases;  for  as  far  as  my  ob- 
servation extends,  the  greater  number  go  offin  winter;  not  from  the 
immediate  effects  of  the  disease,  hut  from  attacks  of  acute  diseases, 
particularly  acute  pleurisy  and  pericarditis. 

"Cool  weather  is  highly  favorable  in  its  effects  on  the  general 
course  of  this  disease,  and  I  have  seen  several  cases  in  which  there 
appeared  to  be  a  complete  restoration  of  the  health  in  winter;  the 
patient  would  seem  well,  be  able  to  perform  active  work,  and  in  wo- 
men the  catamenia  become  restored.  I  have  known  several  women 
thus  adected,  who  became  pregnant,  and  bore  children  during  the 
existence  of  this  improved  condition.  It  is  probable  that,  in  cases 
in  which  the  habit  had  not  been  continued  so  long  as  to  produce  im- 
portant lesions  of  the  heart,  and  other  organs,  the  amelioration  of 
the  symptoms,  resulting  from  favourable  weather,  might  become  per- 
manent, if  the  habit  could  be  broken.  The  respite,  however,  gener- 
al I  v  terminates  soon  alter  hot  weather  sets  in,  the  next  summer ;  the 


1845.]  Cachexia  Africana.  131 


symptoms  soon  assume  a  more  formidable  character  than  before  the 
respite,  and  a  brief  period  brings  the  fatal  end." 

The  diagnosis  is  oftentimes  very  difficult,  as  the  cardiac  derange- 
ments, and  chlorotic  symptoms  which  result  from  dirt-eating,  may 
depend  upon  other  causes.  In  these  cases  we  have  no  aid  in  the  in- 
vestigation from  the  patients,  for  in  almost  every  instance  they  will 
most  pertinaciously  deny  the  existence  of  any  such  habit,  and  they 
often  evince  a  degree  of  cunning  in  their  attempts  to  evade  detection, 
in  remarkable  contrast  with  the  stupidity  which  usually  characterises 
the  subjects  of  this  unnatural  appetite.  Dr.  Craigin,  and  Dr.  Car- 
PEXTER  also,  regards  as  pathognomic,  the  white  and  pallid  appearance 
of  the  palms  of  the  hand,  and  soles  of  the  feet,  but  more  especially 
the  bloodless  and  blanched  appearance  of  the  inside  of  the  lips,  gums, 
tongue  and  lining  membrane  of  the  wiouth. 

"The  tongue  and  gums  often  have  the  peculiar  translucent  and 
pallid  hue  of  white  wax.  These  appearances  have  never  been  absent 
in  any  case  of  confirmed  and  habitual  dirt-eating,  that  has  come 
under  my  observation ;  and  from  these  symptoms,  if  existing  in  the 
marked  degree  which  is  common  in  this  disease,  and  accompanied 
by  the  general  aspect  of  these  patients,  I  feel  safe  in  pronouncing 
unhesitatingly  upon  the  existence  of  this  habit.  In  numerous  in- 
stances the  patient,  as  well  as  the  master,  will  positively  deny  the 
existence  of  any  such  habit,  but  if  those  signs  are  present  it  is  a 
strong  indication,  and  in  such  cases  1  have  always  been  able,  in  a 
short  time,  to  establish  the  fact  to  my  own  satisfaction,  and  generally 
to  that  of  all  parties. 

"As  there  are  cases  of  chlorosis  in  which  the  apparent  conditions 
of  this  disease  are  represented,  it  sometimes  becomes  difficult  to  dis- 
tinguish between  them.  Indeed,  the  condition  arising  from  dirt-' 
eating,"  constitutes  a  peculiar  variety  of  chlorosis,  produced  by  a 
special  cause,  and  characterized  by  highly  aggravated  symptoms. 
The  extraordinary  whiteness  of  the  tissues  of  the  mouth,  may  serve 
in  some  measure  to  direct  us,  tor  thougii  the  general  complexion,  in 
chlori.sis,  is  callow,  I  have  never  seen  a  case  of  it  in  which  the  mu- 
cous lining  of  the  mouth  had  the  bleaciied  aspect  observable  in  the 
least  marked  of  these  cases." 

The  prognosis  is  generally  unfavorahu'  Without  the  habit  is  bro- 
ken up  at  an  early  period,  which  can  rarely  beeUccted,  the  treatment 
will  consist  in  but  little  more  than  a  palliation  of  some  of  the  more 
distressing  symptoms  In  the  West  Indies  it  is  looked  upon  as  equally 
fatal  with  phthisis. 

"  Notwithstanding  the  possibilily  of  curing  this  affection,  when 


133  Cachexia  Africana.  [March, 


treated  under  favourable  circumstances,  it  must  be  admitted,  that 
cases  of  cure  are  remarkably  rare  ;  owing  to  the  inveterate  obstina- 
cy with  which  the  habit  is  persevered  in.  But  few  cases  have  come 
under  iny  observation,  in  which  the  habit  could  be  considered  as 
eradicated,  .and  the  patient  permanently  cured.  Mr.  John  Hunter, 
states  that,  in  Jamaica,  'a  negro  labouring  under  this  malady,  is 
considered  as  lost.  On  many  estates,  half  the  number  of  deaths,  on 
a  moderate  computation,  is  owing  to  this  cau^e.'  All  other  writers 
confirm  his  statements  respecting  the  difiiculties  encountered  in  treat- 
ing this  affection  in  the  West  Indies,  and  it  is  to  be  regretted,  that 
in  this  countiy,  the  results  of  various  expedients,  and  modes  of 
treatment,  have  afforded  but  little  better  results." 

"Tfie  length  of  time  required  by  this  affection  to  run  through  its 
course  to  a  fatal  termination,  depends  upon  so  many  circumstances, 
that  no  general  rule  can  be  applicable  to  all  cases.  I  have  seen 
negroes,  who  had  been  in  the  habit  of  eating  dirt,  occasionally,  for 
four  or  five  years,  and  who  had  only  indulged  so  far  as  to  induce  the 
dyspeptic  state  which  constitutes  the  premonitory  stage  of  more  ag- 
gravated cases.  One  case  of  this  kind  terminated  in  general  anasarca 
of  which  the  patient  died  ;  others  are  still  living.  This,  however,  is 
by  no  means  the  usual  course  of  the  affection,  lor  it  is  rare  that  these 
patients  exercise  the  slightest  control  over  their  inclinations  :  the 
habit  becomes  a  passion  with  them,  and  the  derangements  resulting 
from  it  generally  end  fatally  in  a  few  years.  M.  Hunter  says,  that 
in  Jamaica,  when  carried  to  excess,  perhaps  with  a  view  of  commit- 
ting suicide,  it  is  sometimes  very  quickly  fatal,  and  '  there  are  in- 
stances of  their  killing  themselves  in  ten  days.'  " 

Considerable  difference  of  opinion  prevails  as  to  the  causes  which 
produce  this  affection  Unwholesome  food,  prolonged  abstinence, 
and  irregularity  in  eating,  have  been  mentioned  as  causes,  but  every 
^  one  conversant  with  the  disease  must  be  satisfied  that  such  opinions 
are  erroneous,  for  in  many  instances  it  prevails  among  those  who 
have  an  abundant  supply  of  wholesome  food,  and  at  regular  hours. 
JoHiv  Hu^'TER  considered  the  affection  as  being  in  its  origin  "more 
a  mental  than  a  corporeal  affection."  However  true  this  may  be  of 
some  rare  cases,  it  cannot  be  so  generally,  for  the  disease  is  of  frequent 
occurrence  even  among  young  children.  The  influence  of  example 
often  causes  an  extension  of  the  habit  when  once  it  has  been  estab- 
lished on  a  plantation.  We  are  fully  convinced  that  most  cases 
depend  upon  a  depraved  state  of  the  digestive  organs,  brought  on  by 
long  exposure  to  a  malarious  atmosphere,  for  cases  in  adult  negroes  are 
rare  in  healthy  localities.  Prof.  Carpenter  considers  an  unwhole- 
some atmosphere  as  a  predisposing  cause. 


1845.]  Cachexia  Africana.  133 


"Flat  swampy  and  insalubrious  regions  seem  to  predispose  io  this 
disease ;  for  tlioiigh  we  meet  with  occasional  isolated  cases  on  plan- 
tations of  the  higher  and  rolling  lands  of  this  State,  the  disease,  in 
these  districts,  is  rarely  seen  aflecting  a  large  number  of  negroes  on 
the  same  plantation,  as  is  sometimes  the  case  in  low  and  unhealthy 
sections  of  the  country.  There  are  many  plantations  situated  on  the 
banks  of  the  rivers  and  bayous  of  this  State,  on  which  so  many  ca- 
ses have  occurred,  as  sometimes  to  create  alarm,  and,  in  one  or  two 
instances,  to  cause  the  desertion  of  the  places.  Instances  of  its  ex- 
tensive prevalence  on  plantations  are  common  on  Bayou  Lafourche, 
though  they  are  said  to  have  been  much  more  so,  some  years  ago.  On 
the  Bayou  Boeuf,  particularly  in  the  parish  of  Rapides,  it  seems  now  to 
be  causing  great  mortality,  and  on  the  banks  of  the  Mississippi  River, 
and  the  Teche,  instances  have  likewise  come  to  my  knowledge." 
******** 

^^  Paihologrj.  In  describing  the  appearances,  1  would  be  under- 
stood, not  as  desiring  to  establish  upon  these  {qw  observations, 
any  general  conclusions  respecting  its  pathology  ;  but  only  as  indica- 
ting the  lesions  which,  in  these  particular  cfises,  appeared  to  me  toariso 
from,  or  to  have  some  relation  to,  the  disease  under  consideration. 

*'The  first  thing  that  attracts  notice  in  mnkinir  post-mortem  ex- 
aminations of  these  cases,  is  a  peculiarly  pale  and  anoematous  appear- 
ance of  the  muscular  tissues.  The  adipose  tissues,  so  far  from  being 
much  reduced  in  quantity  below  the  usual  standard,  are  generally 
abundant,  filling  up  the  spaces  usually  occupied  by  it,  between  the 
muscles  and  other  organs,  and  giving  to  the  body  and  limbs  a  rounded 
and  plump  appearance. 

'*The  contents  of  the  abdomen  present  the  same  pale  appearance 
as  the  muscles,  but  even  in  a  more  remarkable  degree  ;  the  stomach 
being  white  and  flaccid,  the  lining  membrane  appearing  soft,  but 
possessing  in  fiict  its  ordinary  consistency,  and  is  poorly  supplied  with 
blood  vessels,  excepting  sometimes,  a  few  sinal'  distant  patches,  which 
are  vascular  and  reddened,  and  sometimes  slightly  ecchymosed.  The 
intestinal  canal  partakes  throughout,  of  a  similar  gruoral  aspect; 
is  pale  and  thin,  and  sometimes  prest^nts  a  rejiiarkahly  diaphanous 
or  almost  transparent  appearance.  This  cliaracter  appears  more 
striking  in  the  small  intestines,  though  it  is  sometimes  equally  so  in 
the  colon.  Scattered  at  considerable  distances  apart,  along  the  in- 
testines, the  reddish  patches  are  discernablc  and  in  one  or  two  cases 
I  have  detected  ulcerated  patches,  which  were  more  common  in, 
though  not  confined  to,  the  large  intrstines.  These  ulcerated  patches 
by  no  means  correspond  to  the  glands  of  Peyer  and  .Bninner,  but 
appeared  to  be  merely  spaces  fronj  whic-h  the  epithelium  was  remov- 
ed.  The  glands  above  nn'ntioned,  exhihited  signs  of  irritation  and 
engorgement  in  several  cases,  and  it  is  probable  that  they  may  bo 
ulcerated  in  some.  The  mesenteric  glands  were  enlarged  in  some 
cases,  and  in  one  case,  several  of  them  contained  tuberculous  deposits; 
in  this  case  however,  tubercles  also  e\i^tpd  in  thi^  lunrr??.     The  liver 


134  Cacliexia  Afrkana,  [March, 


and  spleen  were  each  enlarged  in  some  cases,  but  in  others  appeared 
nearly  natural ;  and  the  gull  bladder  vaiies  as  usual  in  chronic  cases, 
in  its  dimensions,  the  quantity  and  colour  of  its  contents,  but  presented 
nothing  special  or  worthy  of  remark.  The  kidneys,  which  1  expect- 
ed, from  the  symptoms  of  some  of  the  cases,  to  find  altered,  were 
apparently  of  a  normal  size  and  consistence.  The  bladder,  I  have 
several  times,  found  to  exhibit  traces  of  inflammation,  about  tho 
neck,  and  extending  along  the  urethra.  The  womb,  in  the  case  of  a 
woman  who  had  only  been  delivered  about  a  month  before,  was  about 
three  and  a  half  inches  long,  and  remarkably  white  and  granular  in 
its  structure,  and  very  friable  (1.) 

"The  earthy  matters  cannot  invariably  or  perhaps  generally  be 
detected  in  the  alimentary  canal,  which  may  be  accounted  for,  by 
the  circumstance  that  in  many  cases,  severe  diarrhoeas  precede  their 
fatal  termination,  and  remove  all  of  these  matters  which  are  not  im- 
pacted in  the  intestinal  pouches,  or  concretions  which  cannot  readily 
pass  through  the  narrow  portions.  In  those  cases  however  which 
terminate  suddenly,  in  consequence  of  acute  attacks  or  other  acci- 
dents, without  having  been  subject  to  severe  diarrhoeas,  the  earthy 
matters  are  generally  detected  with  ease.  In  some  cases  it  is  found 
in  grains  or  fragments  dispersed  through  the  ftecal  matters,  but  in 
others  they  are  more  or  less  agglomerated  by  mucus  in  different  por- 
tions of  the  canal ;  and  in  one  case  I  found  the  earthy  matter  (alum- 
inous clay),  occupying  three  or  four  of  the  sinuses  of  the  colon,  in 
the  form  of  hard  concretions,  which  fitted  the  shape  of  the  pouches 
so  nicely  as  not  to  be  easily  removed.  The  surfaces  of  these  con- 
cretions, w  hich  presented  towards  the  canal,  w'ere  smooth  and  cover- 
ed by  an  envelope  of  tenacious  mucus,  probably  left  by  the  faeces 
when  traversing  it,  and  this  mucus  seemed  to  be  continuous  into  the 
substance  of  the  concretions,  which  indeed  appeared  to  have  increas- 
ed in  size  by  particles  of  earth  lodging  in,  and  being  cemented  to  the 
masses  by  mucus.  The  abdominal  serous  tissues  do  not  seem  to  bo 
generally  the  seat  of  any  remarkable  changes,  though  that  cavity  fre- 
quently contains  more  than  the  ordinary  quantity  of  serum. 

"The  contents  of  tlie  thorax  exhibit  the  most  important pathologi- 
cal  changes.  The  lungs  themselves  are  not  generally  diseased,  and 
we  only  find  in  them  lesions,  arising  from  influences  in  a  great  mea- 
sure independent  of  this  disease,  and  such  as  are  frequently  found 
accidently  co-existing  with  other  diseases,  such  as  engorgements, 
hepatization,  tubercles,  &;c.  The  pleura,  however,  very  frequently 
shows  marks  of  old  or  recent  inflammation,  and  itscavity  contains  an 
unusually  large,  sometimes  immense  quantity  of  fluid,  of  a  disagree- 
able odour,  and  with  or  without  flocculi.  The  heart  or  its  appendages, 
I  have  never  failed  to  find  diseased.     One  or  both  ventricles  are  gen- 

(1.)  In  this  case  the  child  was  born  at  full  term,  it  nursed  well  and  was,  be- 
Fides,  fed  with  appropriate  articles  of  food,  but  notwithstanding  its  gradual 
growth,  it  weighed  at  the  age  of  four  weeks,  only  three  pounds.  It  died  a  fpw 
days  after  the  mother. 


145.J  Cachexia  Africana.  135 


erally  found  hypertrophled,  sometimes  enormously  so;  and  the  auricles 
are  sometimes  dilated.  There  seems  to  be  no  constancy  in  the  rela- 
tions between  the  hypertrophied  condition  of  the  ventricles,  and  the 
dilatation  of  the  auricles.  The  muscular  tissue  of  the  ventricles  is 
always  paler  than  natural,  and  even  when  hypertrophied  has  a  fiabby 
look  and  feel,  and  there  is  an  evident  want  of  that  firmness  of  struc- 
ture which  naturally  characterizes  this  muscle.  Another  singular 
condition,  which  existed  in  a  remarkable  degree  in  two  cases  examin- 
ed by  me,  in  a  somewhat  less  degree  in  one  other  case,  and  which 
may  in  fact  be  observed  to  some  extent  inmost  of  these  cases,  was  the 
accumulation  of  fat  about  the  heart,  and  in  the  tissues  of  the  thoracic 
septum.  In  several  cases,  the  fat  has  been  abundant  about  the  baso 
of  the  heart,  occupying  the  tissues  about  the  auricles  and  base  of  the 
ventricles,  though  not  appearing,  in  any  extent,  to  penetrate  the  mus- 
cular tissues,  but  lying  over  the  surface  or  occupying  depressions,  and 
forming  large  bunches,  which  are  sometimes  connected  round  in  such 
a  manner  as  to  constitute  a  prominent  collar-like  mass,  surrounding 
the  base  of  the  heart,  and  partly  enveloping  the  auricles.  As  this 
condition  coexisted  in  each  of  the  cases  in  which  the  developements 
of  the  fatty  masses  was  greatest,  with  dilatation  of  one  or  other  of  the 
auricles  it  might  be  supposed  to  have  caused  this  dilatation,  by  ob- 
structing the  free  passage  of  the  blood  from  the  auricles  to  the  ventri- 
cles ;  this  however  can  only  be  established  by  a  greater  number  of 
observations.  It  would  perhaps  be  supposed  too,  tiiat  this  lesion 
should  occasion  some  marked  modifications  in  the  cardiac  sounds,  but 
though  careful  auscultation  was  practised  in  each  case,  I  was  not  led 
in  either  of  them,  to  sus{>ect  any  thing  more  than  a  degree  of  hyper- 
trophy of  the  ventricles  with  more  or  less  dilatation  of  the  auricles. 
Of  the  eight  well  marked  cases  that  I  have  examined  after  death, 
three  exhibited  hypertrophy  of  both  ventricles ;  two  hypertrophy  of 
both  ventricles,  dilatation  of  the  right  auricle,  with  a  considerable 
hypertrophy  of  the  adipose  tissues  at  the  base  of  the  heart ;  one,  hyper- 
trophy of  the  right,  and  slight  hypertroj)hy  of  the  left  ventricle,  dila- 
tation of  the  right  auricle,  h\  |)ertropI)y  of  the  tat  at  the  base. 

1  have  had  no  opj)ortunity  of  making  examination  of  cases  dying 
during  the  earlier  |)eriods  of  tlie  disease,  but  wotjld  inf  >r,  from  the 
indications  obtained  by  auscultation,  that  the  lesions  of  the  heart  are 
primarily,  only  functional,  and  that  the  structural  changes  arise  at  a 
later  period.  For  in  the  earlier  stages,  though  the  heart's  action  is 
tumultuous,  after  exertion,  it  soon  becomes  composed  by  rest;  where- 
as at  a  later  period  the  heart  labours  incessantly,  but  issjlil!  augmented 
by  motion." 

As  we  have  already  rcjiiarkcd,  the  disease  is  most  generally 
fatal.  AH  treatment  must  be  unavailing  unless  the  habit  of  dirt- 
eating  is  broken  up,  and  this  cannot  often  ho  effected.  Some 
persons  resort  to  severe  punishments  in  order  to  deter  the  patient 


13Q  Cachexia  Africana.  [March, 


from  his  unnatural  indiilgcncies.  We  entirely  agree  with  Frof.  C. 
in  condemning  this  comse  as  cruel,  because  it  is  almost  uniformly 
inefficacious.  Others  confine  the  patient  in  tight  rooms;  but  as  this 
course  deprives  him  of  proper  exercise,  and  pure  air,  it  is  of  course 
injudicious.  The  plan  employed  in  the  West  Indies,  and  recom- 
mended by  Dr.  Cakpentj:ii,  is  to  cause  the  patient  to  wear  a  close 
wire  mask,  secured  by  a  lock,  which  prevents  him  from  eating  im- 
proper articles,  and  allows  him  at  the  same  time  to  take  free  exercise, 

"One  of  the  most  important  measures,  not  only  in  reclaiming  the 
subject  from  the  habit,  but  in  relieving  them  of  the  cachectic  state,  is 
the  establishment  of  an  appropriate  system  of  diet. 

"The  nature  of  the  diet  should  of  course  correspond  to  the  stage 
of  the  disease  in  which  each  individual  is  seen.  When  the  case  is 
only  so  far  advanced  as  to  prevent  the  chlorotic  condition,  with  a  de- 
gree of  functional  disturbance  of  the  heart's  action,  we  may  expect 
the  most  decided  advantage  from  the  use  of  fresh  and  easily  digested 
animal  food,  well  seasoned  with  capsicum  ;  and  we  may  sometimes 
permit  the  occasional  use  of  other  stimulants,  as  a  little  wine,  or  even 
brandy,  in  fact  a  generous  diet.  When,  however,  we  find  the  pa- 
tient laboring  under  the  symptoms  of  organic  lesions  of  the  heart,  or 
under  diarrhoea  or  other  symptoms  of  irritation  or  ulceration  of  the 
bowels,  it  will  of  course  require  a  corresponding  modification  of  the 
diet;  and  we  may  in  these  cases  obtain  good  results  from  the  em- 
ployment of  bland,  very  easily  digested,  but  at  the  snme  lime  very 
nutritious  substances,  such  as  animal  jellies,  or  amylacious  prepara- 
tions  seasoned  with  cinnamon,  or  other  appropriate  spice.  A  fish 
diet  has  been  insisted  on  most  strenuously  by  some  w  ho  have  studied 
this  affection  and  seen  the  various  methods  of  treatment,  in  practice  ; 
and  it  is  easy  to  imagine,  that  when  the  bowels  are  in  a  condition  to 
tolerate  such  food,  it  might  answer  a  good  purpose ;  indeed,  1  have 
seen  cases  that  have  improved  rapidly  on  this  diet,  though,  as  they 
were  sent  to  the  sea-shore,  it  would  perhaps  be  nearer  the  truth  to 
attribute  the  amelioration  to  change  of  air. 

"Next  in  importance  to  a  proper  diet,  in  these  cases,  certainly 
stands  a  change  of  air,  to  a  higher  region  or  at  least  to  a  healthy  one  ; 
and  if  a  change  to  the  sea-shore  is  practicable,  if  is  to  be  preferred. 
In  cases  in  which  this  has  been  practised,  tjiey  have  almost  invariably 
improved,  and  the  improvement,  in  son^.e  cases,  seems  to  have  been 
permanent. 

"Upon  these  means  of  improving  the  general  health,  our  principal 
chance  of  cure  depends;  and  in  some  favorable  cases  nothing  more 
is  required.  Edwards,  in  his  history  of  the  West-Indies,  says,  'the 
best  and  only  remedy  is  kind  usage  and  wholesome  animal  food  ;  and 
perhaps  a  steel  drink  may  be  of  some  service.' 

"  In  regard  to  the  medical  treatment,  we  must  be  directed  by  gen- 
eral principles,  in  the  application  of  remedies  directed  against  the 


1 845.]     Extraction  of  Foreign  Bodies  from  the  (Esophagus.  1 37 


conditions  which  give  rise  to  the  groups  of  symptoms.  Thus,  with  a 
view  of  removing  the  chh^rcsed  state,  tonics  ^Yiil  be  proper,  particu- 
lariy  the  preparations  of  iron  ;  and  the  aromatic  stimuhints,  especially 
cinnamon,  canella  alba,  or  winter's  bark.  The  bitter  tonics  may  be 
beneficial  in  some  cases  ;  among  these,  the  best  will  probably  be 
quassia,  simarouba,  cusparia  or  gentian.  If  cathartics  should  be  re- 
quired,  rhubarb  seems  to  fulfil  the  indications  in  this  particular  case, 
and  has  been  most  generally  recommended. 

"  The  acute  infianimalions  which  frequently  attack  the  pericardium 
and  pleura,  generally  yield  promptly  to  local  depletion,  and  the  dis- 
tress arising  from  the  tumultuous  action  of  the  heart  is  generally 
much  diminished  by  the  same  means:  indeed,  notwithstanding  the 
thin  state  of  the  blood,  I  have  never  seen  small  local  depletions  act 
more  favorably  than  in  these  inflammations  ;  blisters  may  perhaps  be 
applied  in  some  cases  with  advantage,  but  it  has  appeared  to  me,  in 
the  one  or  two  cases  in  which  I  used  them,  that  they  rather  increased 
the  effusions  into  those  serous  cavities,  particularly  into  the  pericardi- 
um. Hydrocyanic  acid,  and  digitalis,  hy  allaying  the  inordinate 
action  of  the  heart,  greatly  promote  the  comfort,  and  perhaps  improve 
the  general  condition  of  the  patient. 

"Both  Dazille  and  Mason,  laud  the  operation  of  emetics  in  this 
affection,  and  recommend  that  they  should  be  followed  up  with  brisk 
purgatives.  Mr.  Mason  recommends,  as  atonic  laxative,  an  inlusion 
of  quassia,  rhubarb,  and  ginger,  and  it  is  unquestionably  well  adapted 
to  many  cases  requiring  the  action  of  purgatives.  I  cannot,  however, 
see  what  advantage  is  to  be  gained  by  the  use  of  emetics  in  any  case, 
and  should  regard  them  as  decidedly  dangerous  in  many  instances." 

We  cannot  conclude  this  article  without  an  expression  of  our 
gratification,  that  the  public  attention  has  been  called  to  this  curious 
malady,  and  we  trust  that  others  will  follow  the  example  and  lay  be- 
fore the  profession  their  observations  of  the  modifications  of  morbid 
action  which  result  from  the  peculiar  physical  constitution  of  the  negro 
race. 


Extraction  of  Foreign   Bodies  from  the  (Esophagus.     From  Mr. 
List  on  s  recent  Lectures  on  the  Operations  of  Surgery. 

How  arc  foreign  bodies  in  the  gullet  to  be  got  out  ?  ^  It  will  depend 
very  mu^h  on  their  sort  and  size  and  situation.  You  will  not  set 
about  taking  out  needles  or  pins  in  the  same  way  that  you  would 
large  lumps  of  gristly  meat,  bone,  coins,  or  any  other  hard  body  that 
may  have  lodged  in  the  passage. 

Foreign  bodies  in  the  oesophagus  and  pharynx  cause  a  great  deal 


138         Exlraction  of  Foreign  Bodies  from  the  CEsovhagus.  [March, 


of  pain  when  the  part  is  put  in  motion.  If  it  be  a  hard  and  sharp 
body,  there  is  a  pricking  sensation;  if  the  body  be  of  large  size,  the 
passage  may  be  obstructed,  the  breathing  may  even  be  affected,  as  I 
have  said  ;  at  all  events,  the  patient  will  be  unable  to  swallow  any- 
thing. A  very  small  solid  substance  will  obstruct  the  passage  com- 
pletely when  the  patient  is  naturally  very  nervous,  or  the  part  is  at  all 
diseased.  Patients  who  have  a  difficulty  of  swallowing  become  ner- 
vous :  hysterical  women  are  choked  with  very  small  substances,  and 
patients  who  are  laboring  under  stricture  or  organic  disease  of  the 
oesophagus  may  have  the  passage  closed  from  the  lodgment  of  a  very 
small  portion  of  food.  I  have  repeatedly  seen  cases  of  this  kind.  I 
recollect  a  woman,  who  came  to  me  three  or  four  times  within  two 
years,  complaining  that  the  passage  to  the  stomach  was  completely 
closed.  By  introducing  a  small  probang,  the  obstruction  was  disco- 
vered in  the  usual  place ;  a  piece  of  meat  vvas  pushed  through  the 
contracted  portion  of  the  canal,  and  she  was  relieved.  She  would  not 
suffer  the  introduction  of  instruments  for  any  other  purpose. 

Suppose  that  a  large  piece  of  gristly  meat,  or  a  large  piece  of 
tripe  oh  !  indeed,  you  need  not  smile  at  this,  for  you  will  find  in 
surgical  books  many  accounts  of  persons  who  have  been  choked  with 
tripe  gets  entangled  in  the  narrow  part  of  the  canal,  immediately 
behind  the  cricoid  cartilage,  you  must  consider  how  \'ou  are  to  re- 
move it.  By  introducing  a  probang  you  may,  it  is  true,  push  it  down 
to  the  stomach.  A  piece  of  whalebone,  with  a  sponge  at  the  end  of 
it,  will  do  very  well.  In  introducing  an  instrument  for  any  purpose 
into  the  pharynx  or  oesophagus,  you  must  look  to  the  position  of  the 
head,  and  bring  all  the  tube,  fauces,  pharynx  and  oesophagus,  as  far  as 
possible  into  a  line  with  the  month.  For  this  purpose  you  throw  the 
head  very  well  back,  depress  the  tongue  with  the  finger  of  the  right 
hand,  and  push  the  instrument  back  to  the  forepart  of  the  vertebrae, 
where  you  guide  and  bend  it  suitably  with  the  finger.  Just  as  you 
get  it  behind  the  velum,  and  into  the  top  of  the  pharynx,  you  desire 
the  patient  to  swallow  his  saliva.  By  this  action  the  instrument  is 
drawn  back  into  the  throat,  the  rima  glottidis  is  closed,  and  you  then, 
with  the  greatest  security,  push  the  instrument  downwards,  certain 
that  it  will  go  in  the  right  passage.  You  continue  to  push  it  onwards 
till  you  meet  with  some  obstruction.  But  there  are  foreign  bodies 
whir.h  it  would  be  very  unsafe  to  push  down,  such  as  a  piece  of  rough 
bone  or  cartilage,  or  hard  gristly  meat.  You  might  tear  the  passago, 
or  cause  a  rupture  of  it,  and  this  would  be  attended  with  xary  serious 
consequences.  Infiltration  in  the  loose  cellular  membrane,  putrid 
abscess,  and  death,  have  not  unfrcquently  followed  rash  operations 
of  this  kind.  If  the  foreign  body  is  of  such  a  nature  that  you  cannot 
push  it  down  safely,  you  must  bring  it  up  if  you  can.  For'this  pur- 
pose you  must  be  provided  with  instruments  of  various  forms.  Here 
is  a  pair  of  forceps  well  suited  for  removing  hard  meat.  You  feel  that 
there  is  something  obstructing  the  canal  ;  you  open  the  instrument- 
on   the  foreign  body,  seize,  and  extract  it.     I  have  taken  out  many 


1  b45.  J     Extraction  of  Foreign  Bodies  from  the  (Esophagus.         1 39 


lumps  of  meat  in  that  way.  If  the  foreip;:i  body  is  hard  a  piece  of 
l)one  or  a  piece  of  metal  you  seize  it  with  such  forceps  as  these. 
The  blades  are  made  to  open  in  diti'erent  ways,  according  to  the  posi- 
tion in  which  the  body  lies.  If  a  piece  of  metal  generally  a  coin  
is  fixed  in  the  oesophagus,  you  may  ascertain  its  position  correctly, 
though  you  may  well  guess  whereabouts  it  is  to  be  found,  by  passing 
down  a  steel  probe.  This  is  the  way  to  deal  with  large  foreign 
bodies ;  but  you  very  often  find  small  sharp  bodies  lodged  in  the 
pharynx  sticking  deeply  in  the  tissues  composing  it  pins,  pieces 
offish-bone,  and  portions  of  the  beards  of  barley.  I  have  seen  a 
great  deal  of  irritation  produced  by  a  small  husk  of  oatmeal  stuck  in 
the  fauces  or  pharynx.  These  things  will  sometimes  stick  in  the 
membrane  for  a  Imig  time  ;  but  you  must  recollect  also  that  these 
patients  will  often  complain  of  a  foreign  body  lodging  in  some  por- 
tion of  the  passages  long  after  it  has  got  into  the  alimentary  canal. 
The  feeling  of  pain  and  uneasiness  often  remains  a  considerable  time 
after  the  foreign  body  has  gone  away.  The  same  takes  place  in  the 
eye.  A  small  fly  gets  betwixt  the  lid,  for  instance  no  uncommon 
occurrence  in  riding  or  walking  out  into  the  country  in  summer  it 
causes  intense  pain  ;  you  get  a  friend  to  raise  the  eyelid  and  pick 
the  ^y  out,  but  the  feeling  still  continues, and  does  not  goctf,  perhaps 
for  many  hours.  You  must  be  quite  sure  that  the  foreign  body  is 
really  lodged  in  the  throat  before  you  attempt  to  take  it  out.  You 
bring  the  patient  opposite  a  strong  light,  hold  the  tongue  down,  and 
then,  perhaps,  you  see  the  substance  :  and  by  taking  hold  of  it  with 
small  forceps,  pull  it  out.  Or,  if  it  be  low  down,  you  hold  the  pa- 
tient's head  back,  and  with  your  finger  feel  down  by  the  epiglottis,  by 
the  root  of  the  tongue  on  each  side,  and  if  your  nail  is  a  little  long, 
you  may  entangle  and  bring  up  the  foreign  body  between  the  finger 
and  the  nail.  I  have  even  taken  pins  and  needles  out  in  this  way. 
But  you  may  not  be  able  to  reach  the  foreign  body  in  this  manner, 
and  you  must  then  use  the  forceps.  You  will  find  a  difiiculty  in  dis- 
entangling needles ;  you  are  obliged  to  humor  them,  moving  tiiem  first 
m  one  way  and  then  in  another,arjd  atlast  you  will  succeed  in  extract. 
jf)g  them.  Pieces  of  wire,  nails,  ti^c,  are  sometimes  lodged  here,  and 
great  caution  is  required  on  the  part  of  the  surgeon  in  handling  them. 

I  should  have  stated  that  coins  are  sometimes  extracted  by  means 
of  forceps,  and  sometimes  they  are  removed  by  a  blunt  bent  hook. 

Occasionally  you  find  very  curious  foreign  bodies  lodged  in  the 
throat.  The  following  case  came  under  my  Jiotice  years  ago,  though 
the  patient  was  not  under  my  care.  A  boy,  engaged  in  herding  cat- 
tle, was  prc])aring  his  fishing  tackle,  lie  had  a  hook  for  catching 
jack,  which  he  |)nt  in  his  mouth  in  order  to  repair  it  in  some  way. 
The  cattle,  meanwhile,  wandering  amongst  the  corn;  he  shouted  out 
on  observing  them,  and  in  recovering  his  breath,  tilling  his  lungs 
again,  the  hook  slipped  back  into  the  gullet,  anil  there  it  stuck.  You 
are  aware  that  in  fishing  for  jack,  there  arc  used  three  large  hooks, 
tied  back  to  b;uk,   like  a  grappling  iron,  by  means  of  brass  wire. 


140         Extraction  nf  Foreign  Bodies  from  tlie  (Esophagus.  [March, 


There  was  much  fuss  made  about  this  case ;  the  boy  was  brought 
from  a  great  distance  to  the  Hospital,  and  he  was  kept  as  a  show  for 
some  time.  Every  one  suggested  some  plan  or  other  for  getting  out 
the  foreign  body.  It  was  a  case  in  which,  had  it  been  in  the  hands  of 
a  very  energetic  surgeon,  cesophagotomy  ought  to  have  been  at  once 
performed.  There  appeared  but  little  chance  of  the  three  hooks 
coming  out  again,  and  the  only  apparent  way  of  getting  the  boy  out 
of  the  scrape  would  have  been  to  make  an  opening  below,  and  extri- 
cate them  by  pulling  them  downwards.  The  lad  had  a  long  chain 
hanging  out  of  his  mouth  for  weeks  together,  and  at  last  it  was  pro- 
posed to  use  a  bone  proba ng,  a  large  ivory  ball  with  a  hole  in  it ;  and 
this  was  to  be  pushed  down  to  disentangle  the  barbs.  By  this  time, 
however,  extensive  ulceration  of  the  pharynx  had  taken  place,  and 
the  foreign  body  was  gulped  up,  to  the  relief  both  of  the  patient  and 
of  the  medical"  men.  In  cases  of  this  kind,  you  frequently  find  that 
practitioners  are  as  much  indebted  to  chance  as  to  good  management. 
Sometimes  foreign  bodies  can  neither  be  got  down  nor  drawn  out, 
and  in  those  cases,'  as  in  the  one  I  have  just  related,  the  oesophagus 
ought  to  be  cut  into.  The  incision  should  be  made,  not  in  the  medi- 
an line,  but  by  the  side  of  the  windpipe.  An  incision  ought  to  be 
made  in  the  superior  triangular  space  of  the  neck,  of  sufficient 
Jength  to  enable  you  to  get  cleverly  to  the  obstruction.  The  larynx 
must  be  turned  aside,  and  you  will  take  care  not  to  come  in  contact 
with  the  recurrent  nerve,  or  to  interfere  with  any  of  the  other  import- 
ant organs  in  the  neighborhood.  Guided  by  the  foreign  body,  you 
cut  through  the  parietes  of  the  oesophagus,  lay  hold  of  it,  and  extract 
it  with  forceps,  vulsellum,  or  hook,  as  may  be.  I  think  that  Mr.  Arnott 
had  occasion  to  perform  this  operation  in  the  i'liddlesex  Hospital  somo 
5'ears  ago,  but  it  is  not  had  recourse  to  once  in  a  quarter  of  a  century. 

Where  there  is  simple  contraction  of  the  gullet,  you  endeavor  to 
restore  the  passage  to  its  natural  size.  For  that  purpose  you  intro- 
duce instruments,  day  after  day,  till  the  parts  recover  themselves, 
and  you  can  pass  an  instrument  of  full  size  without  difficulty.  You 
must  be  sure  that  there  is  really  contraction,  and  from  thickening  of 
the  walls  of  the  tube,  that  it  is  not  merely  an  hysterical  affection  ; 
and  you  endeavor  to  ascertain  if  there  is  organic  disease,  that  it  la 
not  of  a  malignant  character,  before  you  propose  a  proceeding  of  this 
kind.  You  would  not  think  of  destroying  the  stricture  by  caustic,  as 
proposed  by  Sir  Everard  Home;  it  is  only  by  very  gentle  manage- 
ment that  you  can  expect  to  succeed,  or  to  benefit  your  patient. 

You  require  to  introduce  an  instrument  where  persons  have  receiv- 
ed injuries  of  the  neck,  but  you  would  not  put  in  a  tube  and  retain  it 
there.  In  bad  cases,  where  the  pharynx  or  oesophagus  has  been 
wounded,  this  may  be  done  ;  but  in  the  majority  of  cases  all  you  have 
to  do  is,  from  time  to  time,  perhaps  two  or  three  times  a  day,  to  intro- 
duce a  common  elastic  catheter,  such  as  is  employed  for  the  urethra. 
You  pass  it  beyond  the  wound,  and  through  it  inject  broths  and  jel. 
lies.     Of  all  this  I  have  already  fully  informed  you.  London  Lacet, 


1845.]  Contributions  to  Therapeutics.  141 


Contributions  to  Therapeutics.  By  J.  T^rooRE  NELTGA^^  M.  D., 
Physician  to  Jervis-slreet  Hospital  Lecturer  on  Materia  Medica 
and  Therapeutics  in  the  Dublin  School  of  Medicine,  (^-c. 

On  the  employment  of  Conium  in  painful  diseases.  In  the  follow- 
ing  communication  it  is  my  intention  to  offer  a  few  practical  observ- 
ations on  the  anodyne  -and  sedative  powers  of  the  common  hemlock, 
and  to  illustrate  ifs  niedicinaf  properties  by  relating  a  few  cases  in 
which  its  employment  has  been  attended  with  much  benefit.  Although 
much  employed  and  highly  extolled  by  the  ancients,  hemlock  had 
fallen  into  complete  disuse  in  modern  medicine,  until  the  latter  end 
of  last  century,  when  it  was  again  introduced,  and  very  generally 
used,  owing  to  the  bigh  terms  in  which  it  was  spoken  of  by  Baron 
Storck,  who,  in  1762,  published  an  account  of  the  physiological  and 
therapeutical  properties  of  this  drug.  Stt')rck  ascribed  two  distinct 
therapeutical  properties  to  the  preparations  of  hemlock  ;  first,  that  of 
a  powerful  anodyne  and  sedative,  and  second,  that  of  a  deobstruent 
and  alterative,  especially  in  the  treatment  of  glandular  or  visceral 
enlargements,  of  scrofulous  affections,  or  of  secondary  syphilis,  and 
of  chronic  cutaneous  diseases.  In  the  present  day  but  little  faith  is 
placed  in  the  deobstruent  virtues  of  the  drug,  and  much  diff;renceof 
opinion  exists  even  as  to  its  anodyne  properties,  consequently  it  has 
again  lost  much  of  its  reputation  as  a  medicine,  and  is  not  nearly  so 
much  employed  as  it  deserves  to  be. 

Since  the  discovery  of  the  active  principle  of  ihe  plant,  this  almost 
universal  discredit  of  its  medicinal  powers  has  been  very  satisfactorily^ 
accounted  for,  as  it  has  been  distinctly  proved,  that  the  application  of 
even  a  moderate  degree  of  heat,  when  continued  for  any  time,  causes 
it  to  undergo  decomposition,  and  therefore  that  the  extract  (the  pre- 
paration  most  generally  cmi)loyed)  when  prepared  in  accordance 
with  the  directions  of  the  Dublin  and  London  Pharmacopceias,  is,  for 
the  most  part,  inert,  or  nearly  so  ;  that  this  is  the  easel  have  repeat- 
edly satisfied  myself,  by  a|)plyinjr  the  potash  test  to  various  samples 
of  the  extract  of  our  Pharmacocpia,  obtained  at  the  best  shops.  This 
potash  test  is  of  so  simple  a  character,  so  easy  in  its  application,  and 
so  certain  in  its  results,  that  we  should  never  omit  its  employment  be- 
fore commencing  the  use  of  any  of  the  preparations  of  hemlock.  It 
consists  merely  in  triturating  in  a  mortar  the  preparation  we  wish  to 
lest  with  a  small  quantity  of  strong  cau^^tic  potash,  when  the  peculiar 
odour  of  the  active  principle,  conia,  is  in  a  few  moments  emitted  : 
care,  however,  must  be  taken  not  to  confound  this  odour  with  that  of 
the  plant  itself,  from  which  it  dillers  most  remarkably,  the  latter 
bearing  a  singular  resemblance  to  the  smell  of  mice,  while  that  of 
conia  is  a  peculiar,  penetrating,  very  disagreeable,  somewhat  alkaline 
odour,  an  acquaintance  with  which  may  be  easily  acquired  by  applying 
the  test  to  the  fresh  green  leaves,  or  to  the  recently  gathered  ripe,friit. 


142  Contributions  to  Therapeutics.  [March, 


In  commencinp;,  then,  any  new  investigation  into  the  medicinal 
action  and  uses  of  hemlock,  it  becomes  of  much  importance  to  take 
especial  care  that  the  preparations  of  the  drug  which  we  administer 
should  have  their  energy  unimpaired,  and  the  peculiar  properties 
which  exist  in  the  recent  plant  as  little  changed  as  possible.  The 
preparation  whicli  I  employed  in  tiie  following  cases,  and  which  I 
have  been  in  the  habit  of  prescribing  for  the  last  two  years,  under 
the  name  of  Succus  Conii,  is  simply  prepared  as  follows :  Take 
of  fresh  hemlock  leaves  any  quantity,  express  the  juice  in  a  tincture 
press,  set  it  aside  for  forly-eight  hours,  pour  off  the  clear,  supernatant 
liquor  from  the  fecula^and  chlorophylle  wliich  it  has  deposited,  and 
lastly,  add  to  it  a  fifth  part,  by  measure,  of  rectified  spirit.  This  pre- 
paration I  have  found  to  keep  well  for  two  years,  and  its  uniform 
strength,  as  well  as  t!ie  facility  with  which  we  can  increase  or  dimin- 
ish the  dose  we  are  administering,  gives  it  a  decided  advantage  over 
cither  the  extract  or  powder  of  the  fruit  or  leaves.  The  best  time 
for  gathering  the  leaves  is  when  the  plant  is  in  full  flower,  and  previous 
to  submitting  them  to  expression  the  stalks  should  be  carefully  picked 
out  and  rejected,  the  leafy  part  alone  being  used.  As  in  many  in- 
stances it  is  often  of  great  advantage  to  possess  an  active  preparation 
of  u  remedy  in  a  solid  state,  I  have  tried  many  ways  of  preparing  an 
extract  of  hemlock  which  would  retain  unimpaired  the  medicinal 
powers  of  the  plant,  and  the  best  I  find  is  to  be  obtained  by  submitting 
the  expressed  juice,  prepared  as  above,  to  spontaneous  evaporation  ; 
but  even  this  extract,  no  matter  how  well  and  carefully  preserved,  soon 
loses  all  traces  of  conia. 

Hemlock,  when  administered  in  medicinal  doses  to  an  individual 
labouring  under  disease,  appears  to  me  to  produce  its  beneficial 
effects  by  allaying  nervous  excitability,  and  diminishing  muscular 
pain  ;  under  its  use  also,  both  the  force  and  frequency  oi  the  heart's 
action  are  lowered,  but  in  no  instance  have  I  seen  it  produce  the 
least  tendency  to  drowsiness  or  sleep.  This  is  quite  consonant  with 
the  account  given  by  Christison  of  the  action  of  hemlock  when  its 
poisonous  effects  are  produced  ;  "  that  it  does  not  excite  convulsive 
spasm,  or  bring  on  insensibility,  but  that  it  exhausts  the  nervous 
energy  of  the  spinal  chord  and  voluntary  muscles,  occasioning  mere* 
ly  convulsive  tremors,  and  slight  twitches,  and  eventually  general 
paralysis  of  the  muscles,  and  consequent  stoppage  of  the  breathing." 
The  active  principle,  conia,  according  to  the  same  able  authority, 
produces  a  similar  remarkable  action  on  the  spinal  chord,  "a  iew 
drops  killing  a  small  animal,  such  as  a  rabbit,  cat,  or  puppy,  in  a  few 
minutes,  causing  a  gelieral  paralysis,  sliglit  convulsive  tremors,  and 
death  from  the  suspension  of  the  breathing,  without  any  alteration  in 
the  appearance  of  the  blood."  Such  being  the  effects  of  hemlock,  and 
its  alkaloid,  when  given  in  poisonous  doses,  it  can  be  readily  under- 
stood that  when  administered  as  a  medicine  it  will  produce  no  very 
apparent  physiological  action,  and  that  in  producing  beneficial  results, 
it  appears  to  act  insensibly  on  the  system.     The  only  manifest  effect 


1845.1  Contributions  to  Therapeutics.  143 


which  I  have  seen  it  produce  is  where  its  use  has  been  persevered  in 
for  some  time,  or  the  doses  rapidly  increased,  when  the  patient  gen- 
erally complains  of  a  disagreeable  sensation  of  dryness  of  the  throat, 
with  a  feeling  of  constriction  and  difficulty  of  swallowing,  amount- 
ing to  actual  pain,  and  which  always  compels  us  either  to  suspend 
the  use  of  the  medicine  altogether  for  a  few  days,  or  greatly  to  di- 
minish the  dose  in  w  hich  it  has  been  given. 

The  diseases  in  whicli  I  have  administered  hemlock  with  decided 
advantage  are  rheumatic  affections,  both  subacute  and  chronic,  par- 
ticularly when  attended  with  severe  pain,  neuralgia,  and  senile  gan- 
grene. And  although  I  have  employed  it  very  extensively,  both  in 
hospital  and  private  practice  in  those  diseases,  I  have  met  with  but 
very  few  instances  indeed  in  which  this  remedy  failed  to  afford  relief: 
nevertheless,  some  cases  occasionally  occur,  in  which,  as  is  the  case 
with  most  other  medicines,  it  does  not  appear  to  produce  the  least  ben- 
efit. I  shall  now  proceed  to  give  a  short  abstract  of  a  \ew  cases  in  illus- 
tration of  the  therapeutical  virtues  of  this  drug,  a  perusal  of  which  will 
show  the  precise  character  of  the  disease  in  which  it  proves  most  bene- 
ficial. 

Case  T.  Obstinate  rheumatic  Pains  from  Exposure  to  Cold  and 
Wet,  Reported  by  Mr.  ]ME^-I^0LD.  Lackey  iM'Cormick,  a  labourer 
on  the  Dublin  and  Drogheda  Railway,  aged  32  years,  of  a  strong, 
robust  appearance,  witli  a  sallow  complexion,  and  sanguineous 
temperament,  was  admitted  into  Jervis-street  Hospital,  April  14th, 
1843.  He  complains  of  a  dull,  aching  pain  in  tnc  inferior  dorsal  and 
lumbar  regions,  stiffness  in  the  shoulders  and  knee-joints,  and  occa- 
sionally at  the  fingers  at  the  metacarpo-phnlangeal  articulations,  in 
short,  he  states  that  the  only  joints  in  his  body  which  have  been 
wholly  exempt  from  pain  and  stili'Mcss  (not  even  excepting  the  tempore- 
maxillary  articulations)  are  the  elbow-joints.  Some  puffiness  is  appa- 
rent in  tiie  shoulder  and  knee-joints,  but  there  is  no  redness,  nor  is 
pain  increased  on  pressure.  'J'he  pains  appear  to  be  erratic,  as  they 
frequently  disappear  from  one  joint,  and  as  suddenly  seize  another; 
they  are  more  distressing  in  the  afternoon,  but  are  not  aggravated  by 
the  heat  of  the  bed,  or  by  any  increase  of  temperature.  His  pulse  is 
at  present  slow  and  weak  ;  skin  cool,  not  perspirable  ;  tongue  clean  ; 
bowels  constipated;  appetite  good ;  urine  healthy,  both  in  appear- 
ance and  quantity. 

He  has  been  cngngod  as  a  labourer  on  the  railroad  for  the  last  two 
years,  previous  to  which  time  he  had  been  at  work  in  Scotland,  but 
always  enjoyed  good  h(Jth  until  he  came  to  Dublin.  His  occupa- 
tion has  obliged  him  of  late  to  be  up  fre(jucntly  at  night  in  the  most 
severe  weather,  and  to  be  exposed  to  the  greatest  vicissitudes  of  tem- 
perature. After  a  severe  wetting  on  one  of  those  occasions,  about 
five  months  since,  he  was  attacked  w  ith  severe  pains  in  nearly  every 
joint  in  his  body,  but  he  continued  to  work  without  intermission, 
although  sutfering  severely,  until  the  last  few  weeks,  when,  in  conse- 
quencc  of  the  pains  and  stilfnc^-^  o{'^^'<  Ininis  Inrrcusinfr  so  much,  he 


144  Contributions  to  Therapeutics.  [March, 


was  compelled  to  give  up  work  and  apply  for  admission  into  the  hos- 
pital. 

On  the  5th  of  April,  the  day  after  his  admission,  he  was  ordered 
house  medicine,  so  as  to  act  on  the  howels  freely,  and  on  the  follow- 
ing day  he  was  directed  to  take  30  minims  of  the  Succus  Coniiihree 
times  a  day  in  a  glassful  of  water. 

April  11th.  Since  last  report  M'Cormink  has  gradually  improved, 
and  is  much  freer  from  pain,  which  seems  now  to  he  principally  con- 
fined to  the  shoulder-joints  and  to  the  small  of  his  hack.  The  dose 
of  the  hemlock-juice  v^as  increased  to  4(1  minims  three  times  a-day. 
The  bowels  being  confined,  he  was  also  ordered  house  medicine  to- 
day. 

April  14th.  Much  freer  from  pain  to-day,  but  complains  of  a  dis- 
agreeable sensation  of  dr)'nessof  ihe  throat,  accompanied  with  a  feel- 
ing of  constriction,  and  some  difficulty  of  swallowing.  The  drops 
were  omitted,  and  he  was  ordered  saline  cathartic  mixture. 

April  16th.  Since  the  omission  of  the  drops  the  pains  have  again 
become  more  severe,  but  the  unpleasant  sensation  about  the  throat 
has  cjuite  disappeared.  To  take  a  grain  of  the  extract  of  hemlock 
(prepared  b}-  the  spontaneous  evaporation  of  the  expressed  juice) 
every  night  at  bed-time. 

April  18th.  Twenty  minims  of  the  Sitcciis  Conii  to  be  taken  three 
times  a-oay  :  the  pill  to  be  continued. 

April  24th.  Much  improved  to-day,  the  pains  l)eing  now  confined 
to  the  shoulder-joints,  and  not  occurring  until  towards  nightfall. 
The  dryness  of  the  throat  and  difficulty  of  swallowing  have,  however, 
again  returned.  House  medicine,  so  as  to  eflect  the  bov/els :  the 
drops  to  be  omitted.  To  take  one  grain  of  tiie  extract  of  hemlock 
three  times  daily. 

May  1st.  Quite  free  from  pain  to-day.  Ordered,  at  his  own  re- 
quest, a  warm  bath  to-night. 

May  3d.     McCormick  was  discharged  to-day  perfectly  cured. 

I  have  given  the  details  of  this  case  pretty  fully  from  the  hospital 
case-book,  as  it  illustrates  well  the  form  of  the  disease  in  which  I 
found  hemlock  prove  most  useful,  and  also  as  it  was  one  in  which  I 
found  the  peculiar  constitutional  eficcts,  which  I  before  referred 
to,  were  m.ost  manifestly  induced.  The  following  cases  are  more 
condensed. 

Case  II.  Severe  chronic  Arthritis  irilh  Sicelling  and  Deformity 
of  the  Joints.  Reported  by  Mr.  ]\IA^"DEVILLE.  John  Nowlan,aged 
56,  a  cow-driver,  was  admitted  into  Jervis  street  Hospital  March  8th, 
1843.  He  complains  of  agonizing  pains  in  all  the  joints  of  his  fingers 
and  toes,  as  also  in  the  shoulders  and  knees,  which  almost  completely 
deprive  him  of  rest  day  or  night,  and  render  him  altogether  incapable 
of  following  his  usual  occupation.  All  these  joints  are  considerably 
swollen  and  deformed,  the  legs  being  semi-flexed,  on  the  thighs,  and 
the  fingers  forming  an  angle  with  the  metacarpal  bones,  slanting  out- 
wards  towards  the  ulna.     The  swollen  parts  are  slightly  reddened, 


1945.]  Contributions  to  Therapeutics,  145 


and  the  pains  are  aggravated  by  pressure  or  motion,  but  scarcely,  if 
at  all,  by  external  warmth.  The  pulse  is  small  :  skin  bathed  in  a 
clammy  perspiration  ;  tongue  loaded  with  a  white  fur  ;  appetite  bad; 
bowels  constipated  ;  urine  high  coloured;  countenance  indicative  of 
much  suffering. 

He  states  that  his  present  illness  commenced  about  twelve  months 
ago,  and  that  it  was  caused  by  his  being  compelled  to  sleep  constantly 
in  the  open  air  at  night,  and  t>equently  on  the  wet  grass.  Since  that 
time  it  has  gradually  increased  in  severity,  attacking  joint  after 
joint,  and  for  the  last  two  months  he  has  been  so  crippled  that  he  has 
been  scarcely  able  to  move. 

On  the  day  of  his  admission  into  the  hospital  he  was  ordered  a  saline 
cathartic  draught,  and  on  the  9th  of  March,  the  next  day,  he  was 
directed  to  take  30  minims  of  the  Succus  Conii  four  times  daily. 

March  13th.  Pains  remarkably  relieved;  swelling  also,  particu- 
larly of  the  knee-joints,  considerably  diminished.  He  got  out  of  bed 
to-day  for  a  short  time,  and  states  that  he  was  able  to  move  about  with 
much  more  case  to  himself  than  he  could  for  the  last  three  months. 
To  take  40  minims  of  the  hemlock-juice  three  times  a  day,  and  to 
have  house  medicine  to  free  the  bowels. 

March  23d.  The  drops  have  been  continued  steadily  since  last  re- 
port without  producing  the  least  apparent  constitutional  effect.  He 
appears  considerably  improved,  expressing  himself  tolerably  free  from 
])ain,  and  as  possessing  much  njorc  power  of  motion  in  all  his  joints. 
The  articulations  of  the  fingers  and  toes  are  now  but  s+tghtly  swollen, 
and  have,  at  the  same  time,  regained  much  of  their  natural  appear- 
ance ;  the  knees  are,  however,  much  enlarged  and  painful,  particularly 
at  night.  The  dose  of  the  Succus  Conii  to  be  increased  to  60  minims 
three  times  daily. 

March  31st.  As  Nowlan  complained  ofsomedrynessof  the  throat 
to-day,  with  slight  diflTiculty  of  swallowing,  he  was  ordered  to  take 
two  cathartic  pMls  immediately,  to  omit  the  drops  for  this  day,  and  to 
have  a  warm  bath  at  bed-time. 

April  5th.  The  hemlock-juice  was  repeated  on  the  1st  instant,  and 
continued  until  this  day,  when  the  same  symptoms  having  occurred 
as  on  the  31stofMarch,  a  repetition  of  the  treatment  as  on  that  day 
was  directed. 

A|)ril  15th.  The  same  dose  of  the  Succus  Conii  was  continued  up 
to  this  date,  when  Xowlan,  was  discharged  from  hospital,  expressing 
himself  quite  free  from  pain,  and,  to  use  his  own  w'ords,  able  to  walk 
almost  as  well  as  ever  he  was  in  his  life.  The  swelling  and  stiffness 
of  the  knees  are  quite  gone,  and  it  is  really  astonishing  how  little  de- 
formity remains  in  the  joints  of  the  fingei-s.  Nowlan's  wife  came  to 
the  dispensary,  about  a  month  after  his  discharge,  to  say  that  ho  re- 
mained quite  well. 

Case  III.  Suh-acufe  Rheumatism  confined  to  the  muscular  part  of 
the  Calves  of  both  Legs,  Jieported  by  .Mr.  Bray.  James  Barrett, 
aged  57,  a  gardener,  was  admitted  mto  Jervis-street  hospital,  .Tun 

10 


146  Contributions  to  Therapeutics.  [March, 


29th,  1844,  complaining  of  a  dull,  heavy  pain  in  the  muscular  part 
of  his  legs,  extending  from  the  inferior  termination  of  the  po|)liteal 
space  to  within  ahout  an  inch  of  tlio  malleoli.  The  pain  is  rendered 
most  excruciating  by  his  standing,  or  placing  his  limbs  in  any  other 
than  a  horizontal  position:  he  was  carried  into  the  dispensary,  and 
while  there  lay  on  the  ground,  being  totally  unable  to  stand.  With 
the  exception  of  his  present  attack,  he  states  his  health  to  be  excel- 
lent ;  the  pulse  is  regular,  tongue  clean,  bowels  free  ;  he  passes  about 
three  OjUarts  of  very  pale  urine  in  the  twenty-four  hours,  which  does 
not  contain  any  albumen  ;  the  whole  surface  of  the  body  is  constantly 
bathed  in  a  clamm}^  perspiration.  The  countenance  is  indicative 
of  much  suffering. 

He  states  that  about  a  fortnight  since  he  was  attacked  with  head- 
ache and  obstinate  constipation,  accompanied  with  profuse  perspira- 
tions, during  the  continuance  of  which  he  went  to  mow  in  wet  grass. 
He  remained  at  this  employment  for  four  or  five  days,  when  he  was 
suddenly  seized  with  an  acute  pain  in  the  calves  of  both  legs,  which  has 
continued  since  without  intermission.  For  the  last  week  he  has  been 
rubbing  the  parts  with  soap  liniment,  and  has  also  taken  some  medi- 
cine, but  from  neither  did  he  receive  the  least  benefit. 

On  admission  he  was  ordered  a  dose  of  cathartic  medicine  and  a 
warm  bath,  and  the  following  day,  June  30lh,  he  was  directed  to  take 
15  minims  of  the  Succus  Conii  tlirce  times  daily.  On  the  2nd  of 
July  the  dose  was  increased  to  15  minims  every  sixth  hour.  The 
report  of  the  9th  of  July  states  that  he  only  finds  a  slight  pain,  when 
he  stands,  in  the  calf  of  the  right  leg,  but  that  the  left  is  quite  well. 
July  13lh  he  was  entirely  free  from  pain,  and  could  walk  with  ease  ; 
and  on  the  14th  he  was  discharged  from  the  hospital  cured. 

Case  IV.  Acute  Rheumatism.  Reported  by  Mr.  Bray.  John 
Egar,  aged  36,  musical  instrument-maker,  was  admitted  into  Jervis 
street  hospital,  July  27th,  1844.  He  gives  the  following  history  of 
his  illness.  In  working  at  his  trade  he  is  much  suhjected  to  extremes 
of  temperature,  but,  notwithstanding  his  having  been  a  hard  drinker 
all  his  life,  was  in  the  enjoyment  of  excellent  health  until  lately. 
About  six  months  ago  he  felt  a  shooting  pain  in  his  right  breast, 
which  used  to  shift  to  the  same  situation  on  the  other  side,  and  con- 
tinued thus  alternating,  hcing  sometimes  ahsent.  Twelve  days  since, 
on  getting  up  in  the  morning,  he  felt  an  acute  pain  in  the  left  instcj), 
which,  on  examination,  he  found  to  be  red,  swollen,  and  excessively 
tender  to  the  touch.  This  was  treated  by  the  application  of  eight 
leeches,  which  gave  him  some  temporary  relief,  but  on  the  same  night 
the  left  knee  was  similarly  attacked  ;  and  in  two  days  afterwards  the 
ball  of  the  left  thumb,  and,  consecutively,  the  fingers,  arm,  and 
shoulder  of  that  side.  A  pain  in  the  small  of  the  back,  which  was 
also  present  from  the  first,  became  much  v\^orse,  and  after  four  days 
the  disease  spread  to  the  hand,  arm,  shoulder,  and  breast  of  the  left 
side.  During  this  time  he  was  attended  by  a  physician,  who  treated 
him  by  the  application  of  sinapisms  to  the  affected  parts,  and  put  him 


1845.]  Contributions  to  Therapeutics,  147 


under  a  course  of  mercury,  which  salivated  him  so  severely  that  he 
has  expectorated  nearly  a  pint  of  saliva  within  the  last  twenty-four 
hours. 

As  he  now  lies  in  hed  he  is  free  from  pain,  except  in  his  right  arm 
and  shoulder,  where  there  is  a  settled  sensation  of  soreness  ;  but  on 
the  least  movement  in  the  noi^hboring  muscles,  his  legs  and  back, 
together  with  his  left  arm  and  breast,  are  seized  with  the  most  acute 
pain,  while  the  soreness  on  the  right  side  is  likewise  much  increased. 
He  is  thus  unable  to  use  the  least  motion,  and  he  cannot  even  stand, 
much  less  walk.  The  tongue  is  loaded  with  a  thick  white  fur,  yellow 
in  the  centre ;  pulse  65,  hard  and  incompressible  ;  bowels  constipated  ; 
whole  body,  particularly  the  head,  covered  with  profuse  perspiration. 

On  the  28th  of  July  he  was  ordered  an  active  saline  cathartic,  and 
a  gargle  containing  solution  of  chlorinated  soda. 

July  29th,  the  following  mixture  was  ordered ; 

IJi.     Succi  Conii,  f.  |ss. 

Mistuiac  Camphorce,  f,  fvii.  ss. 
M.    Cochleare  ampliim  sextis  horis. 

July  31st.  Much  improved.  To  take  a  table-spoonful  of  the  mix- 
ture every  fourth  hour. 

August  5tl).  The  pains  are  all  gone  to-day,  except  in  the  ball  of 
the  thumb,  and  the  wrist  and  ankle  of  the  left  side,  which  are  somewhat 
swollen  and  red.  Two  table-spoonfuls  of  the  mixture  to  be  taken 
every  fifth  hour. 

On  the  Gth  of  August  the  dose  was  again  diminished  to  a  table- 
spoonful  every  fourth  hour,  as  he  complained  of  dryness  of  the  throat, 
and  some  pain  in  the  head.  On  the  8th  he  only  complained  of  a  little 
stiffness  in  the  left  ankle-joint,  and  of  a  tired  feel  in  his  arms.  On 
the  9th  the  medicine  was  stopped,  and  he  was  ordered  a  warm  bath; 
and  on  the  11th  he  w;is  discharged  from  the  hospital  perfectly  cured. 

I  have  now  detailed  four  cases  of  rheumatism,  none  of  which  are 
precisely  similar  in  character;  and  the  hospital  reports  fur  the  last 
two  years  contain  many  others  which  were  rapidly  and  effectually 
cured  by  the  use  of  an  efficient  preparation  of  hemlock  ;  and  that  the 
recovery  was  solely  due  to  the  use  of  this  remedy  is  sufficiently  evi- 
dent  from  the  fact,  that  it  was  the  only  medicine  used  in  any  of  the 
cases.  I  do  not,  however,  pretend  to  say  that  hemlock  will  cure  every 
case  of  chronic  rheumatism,  a  disease  so  intractable  in  its  nature,  that, 
to  use  the  words  of  that  eminent  clinical  physician.  Dr.  Graves, 
'there  is  scarcely  any  affection  which  tasks  the  ingenuity  and  tries 
the  patience  of  a  medical  man  more."  The  following  case  was  one 
of  those  in  which  the  remedy,  at  first,  appeared  to  afford  some  relief, 
but  afterwards  liiiled  to  produce  any  benefit. 

Case  V.  Chronic  Rhcinndfisni  caused  by  constant  exposure  to 
damp.  Reported  by  I\Ir.  Bkay.  John  Diifly,  aged  25,  a  labourer 
on  the  Dublin  and  Drogheda  railway,  was  admitted  into  Jervis-strect 
hospital,  June  21st,  1844,  complaining  of  pains  in  both  his  Kgs-frora 
the  thighs  downwards,  in   both  shoulders,  in   the   back  of  his  neck, 


148  Conlributions  to  Therapetttlct.  [March, 


and  in  the  right  arm.  The  pains  am  intense,  arc  never  ahsent,  and 
are  much  increased  hy  the  least  muscular  eff)rt.  The  right  side  is 
more  afTectcd  than  the  left,  particularly  the  shoulder,  and  the  left  arm 
is,  as  yet,  free  from  jinin.  He  states  thnt  for  the  last  fourteen  years, 
he  h.as  been  constnntly  cngngcd  as  a  labourer  in  the  construction  of 
various  pu])lic  works,  where,  from  the  nature  of  his  employment,  he 
Avas  much  exposed  to  damp,  having  been  frequently  for  hovirs  together 
up  to  his  breast  in  water;  and  also  that  from  haliits  of  intemj)erance 
he  has  often  l-iin  out  at  night  exposed  to  the  inclemency  of  the  wea- 
ther. He  has,  however,  enjoyed  good  health  until  about  five  montljs 
ago,  when  the  pains  first  commenced  in  his  right  knee  and  shoulder, 
since  which  time  they  have  gradually  increased  in  severit}',  attacking 
in  succession  nearly  every  joint  in  his  body. 

On  his  admission,  the  bowels  being  regular,  the  tongue  clean,  and 
the  appetite  good,  he  was  immediately  put  under  the  use  of  the  Succus 
Conii.  being  ordered  to  take  20  minims  of  it  four  times  a  day.  On 
the  25th  the  dose  was  increased  to  20  minims  every  fourth  hour. 
On  the  28th  he  expressed  himself  as  being  much  relieved ;  the  dose 
was  now  incrcnsed  to  25  minims  every  fourth  hour.  July  2nd,  he 
complained  of  dryness  of  the  throat,  with  some  pain  in  the  head, 
when  the  dose  of  the  medicine  was  again  reduced  to  20  minims  every 
fourth  hour.  On  the  9th  of  July  the  following  report  appears  in  the 
case  book  :  slight  effusion  is  nov/  evident  in  the  synovial  membranes 
surrouiiding  the  right  knee  and  both  shoulder-joints,  and  on  the  whole 
the  pains  arc  much  worse  than  on  his  admission  intt)  the  hospital ;  the 
use  of  the  hemlock  was  therefore  suspended.  This  patient  was  af- 
terwards discharged  from  the  hospital,  July  30th,  considerably  relieved, 
but  not  cured  ;  the  subsequent  treatment  adopted  having  been  Col- 
chicum.  Aconite,  Dover's  powder,  and  warm  baths. 

I  have  also  stated  that  I  have  employed  hemlock,  with  benefit,  in 
the  treatment  of  neuralgin,  and  of  senile  grangrene.  In  the  former 
of  those  diseases  it  will,  like  all  other  remedies,  be  found  frequently 
to  fail  in  affording  relief ;  and,  on  the  other  hand,  it  will  often  prove 
successful  in  cases  which  have  resisted  the  use  of  numerous  other 
medicines.  The  following  short  case  will,  I  think,  sufficiently  illus- 
trate its  beneficial  influence  in  this  disease  : 

Case  VI.  Facial  Neuralgia.  Reported  by  M.  Fitzgekald.  
Mary  Fulton,  aged  21,  a  servant,  was  admitted  into  Jcrvis-street 
hospital.  May  13th,  1844.  complaining  of  intense  shooting  pain  in  the 
left  side  of  the  face.  The  pain  is  not  constant,  but  comes  on  in  acute 
paroxysms,  the  intermission  between  whichj  however,  is  of  very  short 
duration;  it  is  most  severe  towards  evening,  and  during  the  night, 
BO  as  almost  completely  to  deprive  her  of  sleep.  She  describes  it  as 
commencing  in  the  cavity  of  the  ear,  and  darting  forwards  towards 
the  supra  and  infra-orbital  foramina;  sometimes  it  extends  up  to  the 
forehead  and  head,  and  to  the  side  of  the  nose,  but  it  never  passes 
the  mesial  line.  During  the  paroxysm  the  surface  of  the  face  is  pain- 
ful to  the  touch,  and  the  least  motion  of  the  muscles  of  the  jaw, 


1845.]  Contributions  to  Therapeutics,  149 


even  talking,  produces  intolerable  anguish.  Ker  general  health  is 
good,  and  all  the  functions  normal;  the  face  is  indicative  of  much 
suffering. 

She  states  that  the  disease  occurred  nbout  eighteen  months  ago, 
since  which  time  it  has  been  gradually  increasing  in  severity;  ;it  lir.st, 
intervals  of  six  weeks,  or  two  months  occurring,  duririg  which  she 
would  be  completely  free  i^rom  pain,  butof  late  tlie  intervals  have  not 
been  longer  than  IVom  two  to  three  weeks.  The  attack  is  always 
much  more  severe  when  the  bowels  are  constipated  ;  prolonged  con- 
stipation having  been,  she  thinks,  the  original  cause  of  the  disease; 
at  present  the  bowels  are  quite  regular.  Since  the  commencement 
of  the  disease  she  has  been  submitted  to  a  gn?at  variety  of  treatment, 
such  as  cupping,  leeching,  blistering,  large  doses  of  iron,  mercury, 
bark,  and  turpentine;  the  latter  of  which,  alone,  appeared  to  afiford 
Iier  the  least  relief.  On  the  day  of  her  admission.  May  13th,  she  was 
ordered  to  take  20  minims  of  the  Succus  Conii,  three  times  a  day,  in 
a  glassfull  of  water. 

May  15th.  Much  improved;  she  says  that  she  is  completely  free 
from  pain  for  nearly  an  hour  after  she  takes  each  dose  of  her  drops. 
She  was  ordered  to  take  15  minims  every  four  hours. 

16th.  Bowels  constipated,  nevertheless  the  pains  are  less.  To 
have  two  cathartic  pills  immediately;  the  drops  to  be  continued. 

23rd.  Expresses  herself  as  being  quite  free  from  pain  for  the  last 
two  days,  and  feeling  perfectly  well.  The  hemlock-juice  was  con- 
tinued in  the  same  doses  since  last  report;  it  did  not  produce  any 
dryness  of  the  throat  or  difiiculty  of  swallowing.     Discharged. 

July  30th.  Fulton  sent  to  the  hospital  to-day  from  the  country, 
stating  that  she  had  remained  perfectly  (Vce  from  the  least  return  of 
pain  since  she  left  the  hospital,  a  period  of  more  than  two  months, 
until  within  the  last  few  days,  when  she  had  a  slight  attack  ;  and  to 
ask  for  a  small  bottle  of  the  drops. 

In  two  cases  only  of  senile  grangrene  have  I  had  an  opportunity  of 
trying  the  effects  of  hendock,  and  in  both  I  have  found  it  an  cicel. 
lent  adjunct  to  opiates.  In  one  of  those  cases,  which  occurred  in 
private  practice,  and  in  which  the  disease  lasted  from  the  9th  of  !^]ay 
to  the  29ih  of  June,  1843,  the  mortification  having  reached  nearly  as 
high  as  the  knee  before  the  disease  t(;rminated  fatally,  the  most  dis- 
tressing symptom  was  a  constant  twitching  of  the  tendons  of  the 
aflected  limb.  This  unceasing  cause  of  suliering  was  not  in  the  least 
alleviated  by  the  use  of  the  opiates  which  were  administered,  but  was 
at  once  removed  by  the  use  of  the  hcnilock-juice,  and  bv  a  per.^ever- 
ance  in  its  employment  was  kept  completely  in  check  throu'diout  the 
whole  of  the  illness.  Dublin  Journal. 


150  Epilepsy  cured  by  Blisters,  [March, 


PART  III. MONTHLY  PERISCOPE. 

EpVepsy  cured  by  Blisters.  TIio  sn])JGct  of  this  case  was  treated 
at  the  Hotel-Dieii,  by  Dr.  Recamier,  a  bold  and  ingenious  physician, 
who  has  made  more  than  one  discovery  in  the  science  of  therapeutics. 
It  is  well  known  that  a  paroxysm  of  epilepsy  is  usually  announced  in 
some  cases  by  a  peculiar  sensation  in  certain  parts  of  the  body,  most 
frequently  in  one  of  the  limbs  ;  a  sensation  to  which  we  have  applied 
the  term  aura  epileplica.  It  has  been  thought  that  by  preventing 
the  aura  we  should  arrest  the  epilepsy,  and  occasionally  it  has  suc- 
ceeded. A  tight  ligature  has  been  placed  above  the  spot  at  which 
this  awra starts;  escharotics,setons,  and  even  the  actual  cautery  have 
been  resorted  to  for  the  same  purpose.  M.  Recamier  sought  to  op- 
pose an  effectual  harrier  to  the  passage  of  the  aura,  and  thus  prevent 
its  reaching  the  head,  by  means  of  circular  blisters;  with  this  view 
he  pursued  it  and  attacked  it  with  flying  blisters  at  every  point  where 
it  declared  itself,  and  in  one  month,  by  means  of  eight  blisters 
judiciously  applied,  he  effected  a  radical  cure  of  this  intractable  dis- 
case.  It  has  nov/  been  three  years  since  this  case  was  thus  treated, 
and  yet  there  has  been  no  relapse.  As  this  case  is  curious,  and  will 
suggest  the  proper  method  to  be  pursued,  we  will  relate  it. 

A  tailor,  aged  32,  was  seized  on  the  9th  Nov.,  1839,  without  any 
assignable  cause,  with  an  attack  of  epilepsy,  and  loss  of  conscious- 
ness. During  the  attack  he  fell  into  the  fire  and  burned  his  right 
thigh,  without  being  conscious  of  it.  From  this  period  to  the  7th 
Dec,  when  he  entered  the  Kottl-Dieu,  (about  a  month,)  he  had  eight 
such  seizures,  but  less  violent ;  three  of  which  were  accompanied  with 
loss  of  consciousness.  The  attack  was  ushered  in  by  a  trembling 
and  a  vibration  which  was  felt  only  in  one  half  of  the  body,  and  at 
the  same  moment  the  patient  experienced  a  cramp  in  the  let^t  ankle; 
these  premonitory  symptoms  continued  for  a  few  teconds,  at  the  end 
of  which  t.me  the  attack  was  ushered  in.  After  the  first  attack,  the 
left  leg,  from  the  fjot  to  the  middle  of  the  thigh,  remained  benumbed 
and  half  paralyzed.  Ij-^  to  the  2 ith  Dec.  he  had  experienced  two 
paroxysms  one  strong,  the  other  feeble.  The  seizure  came  on  with 
cramps  in  the  left  ankle,  then  swelling  and  livid  redness  of  the  face, 
contraction  of  the  muscles  of  the  f^ice,  which"  becams  hideous;  froth- 
ing at  the  mouth,  a  hoarse  voice,  throwing  the  head  tbrward  and  back- 
ward, tetanic  rigidity  of  the  trunk,  convulsive  respiration,  coiitor- 
tions  of  the  arms,  &;c.  The  paroxysm  lasted  more  than  ten  minutes, 
and  the  patient  returned  to  himself  ignorant  of  what  had  transpired. 
M.  R.  placed  a  circular  blister  about  three  fingers  wide  around  the 
calf  of  the  leg,  above  the  spot  where  the  cramp  was  felt. 

In  three  d  lys  the  cramp  was  f^lt  in  the  lower  part  of  (he  thigh, 
and  was  fjliowed   by  an   attack  of  epilepjy;  a  second   blister  was 


1845.]        C hronic  Rheumatism  and  Neuralgia  Asthma,  151 


made  to  surround  the  thigh  entirely.  After  the  application  of  these 
two  blisters,  the  paralysis  of  the  leg  was  in  a  great  measure  removed, 
and  the  patient  was  enabled  to  walk  with  greater  facility.  On  tho 
2nd  of  Jan.  the  left  foot  was  numb  ;  a  blister  was  ordered  to  the 
foot,  and  the  numbness  disappeared.  On  the  6th,  had  pains  in  the 
leg;  circular  blister  above  the  painful  spot ;  the  pain  disappeared. 
On  the  10th,  patient  felt,  for  two  days,  sliocks  i\nd  formica,  extend- 
ing from  the  left  hip  to  the  mamma  of  the  same  side,  with  a  tenden- 
cy to  another  epileptic  attack :  a  blister  was  placed  so  as  to  engirdle 
t!ie  lower  part  of  the  chest.  On  the  ISlh  the  patient  complained  of 
a  painful  sensation  of  pricking,  above  the  right  mamma,  and  a  painful 
numbness  above  the  instep  of  the  right  tuot:  a  blister  around  the 
neck,  and  another  belov/  the  calf  of  the  right  leg.  On  the  22nd  Jan. 
some  shooting  pains  from  the  elbow  to  the  left  shoulder;  blister  in 
the  form  of  a  bracelet  above  the  elbow  ;  besides,  the  patient  was  or- 
dered to  take,  morning  and  evening,  the  following  pill : 

'fy    Oxyd.  Zinci.    .    .    .    1  gr.  1 

Caniph i  gr.  >  M. 

Ext.  Belladon.      .    .    i  ?r.  S 


On  the  25th  tlie  patient  thought  the  pricking  sensation  mounted 
from  the  foot  to  the  left  knee,  and  from  thence  to  the  groin  ;  the  pills 
alone  were  continued.  2Gth,  numbness  in  the  back,  and  constipation 
for  four  days  ;  ordered  a  purgative  lavement,  which  procured  a  free 
operation,  and  with  it  disappeared  the  numbness.  Jan.  27th,  the 
sensation  of  formication  remains  constantly  in  the  left  leg;  the  last 
blister  was  made  to  surround  the  thifrh,  and  all  unpleasant  symptoms 
disappeared.  From  this  day  up  to  March,  at  which  time  the  patient 
quitted  the  hospital,  no  symptoms  of  the  former  disease  were  experi- 
enced ;  the  pills  were  however  continued  for  about  three  weeks.  The 
disease  did  not  return.  Bulletin  dc  Therapcut.  and  JV.  Orleans  Jour, 


Useful  hint  on  the  Treahnent  of  Chronic  Rheumatism  and  Xeu- 
ralgia:  By  Dr.  James  Johnsox.  A  tea-spoonful  of  brimstone  in 
a  small  cupful  of  milk,  taken  everv  night  at  bed-ti:ne  for  a  week  or 
two  together,  is  one  of  the  best  of  all  remedies  that  we  know  of, 
against  old  obstinate  riieumatic  aches,  cratnp  of  the  legs,  the  pains 
that  aie  connected  with  a  varicose  state  of  the  veins,  chronic  sciati- 
ca,  vScc.  The  well  known  nostrum  the  '*  Chelsea  Pensioner"  thnt 
has  so  long  had  high  repute  in  chronic  rheumatism,  is  mainlv  indebt- 
ed to  sulphur  for  its  virtues.  It  may  be  worth  while  to  mention  its 
composition-  It  is  made  thus  :  ft.  Flor.  Sulphuris  5jj.  Pot.  Super- 
tartrat.  gj.  P.  Guiaci  5j.  P.  Rhei  5jj.  Spir.  Nucis  Myristic.  5ij. 
IMellis  q.  s.  ut  fiat  clectuarium. 

The  dose,  one  or  two  drachms  every  morninj*  and  cvenincr, 

[Med.  Chir.  Review, 

Iodide  of  Potn.rxium  in  Asthma,  By  W.  H.  Ca!ey,  M.  D.  I  havo 
now  made  use  of  the  medicine  in  some  twenly-fivo  or  thirty  cases 


152  Pains  of  the  Loins.  [March, 


of  Asthma,  some  of  them  very  severe  and  afj^ravated  ;  and  so  far, 
in  no  one  instance,  \\  hen  a  fair  trial  has  been  made,  has  it  failed  to 
afford  unequivocal  and  decided  relief.  As  a  general  rule  the  patient 
is  benefitted  after  a  few  days  employment  of  tli  article,  but  some 
cases  will  require  more  time,  perhaps  weeks,  before  they  impiove  ;  in 
one  of  mine,  a  very  severe  case  of  over  twenty  years  duration,  I 
persevered  for  nearly  three  months,  before  there  was  any  decided 
amendment.  In  almost  one-fourth  of  my  cases,  relapses  have  oc- 
curred after  discontinuing  the  remedy;  this  occurrence  however  was 
in  most  cases  owing  to  severe  attacks  ofcatarrh,  or  to  errors  in  diet  and 
consequent  derangement  of  the  digestive  organs,  which  by  the  way 
should  never  be  overlooked  in  the  treatment  of  Asthma.  From  two 
to  five  grains  of  the  Iodide  of  Potassium,  given  three  times  a  day, 
dissolved  in  water  or  some  syrup,  as  for  mstance  that  of  Sarsaparilla 
or  Tolu,  will  generally  be  found  sufficient  for  ordinary  cases  of  the 
disease.  Its  continuance  must  be  regulated  by  the  circumstances  of 
each  case.  N.    Y.  Jour,  of  Med. 

Pains  of  the  Loins.  By  Dr.  Ore,  Sovihampion.  Perhaps  there 
is  no  symptom  more  commonly  met  with  in  practice  than  pain  in  the 
loins,  which  is  usually  and  at  once  attributed  to  bile,  gravel,  or  rheu- 
matism ;  but  as  it  may  be  also  derived  from  other  causes  left  out  in 
a  hasty  decision,  I  shall  enumerate  them,  and  endeavor  to  point  out 
the  symptoms  by  which  each  may  be  distinguished.  Pain  of  the 
loins  may  be  derived  from  the  muscles,  from  the  liver,  from  the  duode- 
num, from  the  kidneys,  from  the  colon,  from  the  uterus,  from  the 
aorta,  from  the  spine,  or  from  matter  collected  on  the  psoas  muscle 
independent  of  spinal  disease.  In  order  to  arrive  at  its  true  cause, 
we  must  endeavor  to  ascertain  what  function  is  principally  involved, 
which  will  at  once  lead  us  to  it. 

If  the  pain  be  rheumatic,  it  will  be  increased  by  pressure,  and  by 
the  slightest  action  of  the  muscles  affected.  There  will  probably  be 
also  rheumatism  in  other  parts  of  the  body,  the  system  will  not 
evince  much  disorder,  the  urine  will  be  high  colored,  and  deposit  a 
lateritious  sediment. 

If  derived  from  the  he/patic  function,  the  pain  will  shoot  upwards 
along  the  splanchnic  nerves  to  the  scapulae;  the  alvine  evacuations 
will  be  either  deficient  in,  or  exuberant  with,  bile  ;  or  show  a  morbid 
quality  of  that  secretion;  the  urine  will  have  a  bilious  tinge  ;  there 
may  be  congestion  of  the  haemorrhoidal  veins;  and  the  spirits  will 
be  depressed. 

If  from  the  duodenal  function,  three  or  four  hours  after  a  meal  the 
pain  will  be  aggravated,  shoot  through  towards  the  right  side  of  the 
abdomen,  and  remaining  till  the  tood  has  passed  into  the  jejunum. 
Dyspeptic  symptoms  will  prevail,  and  there  will  tVequently  be  painiul 
pustules  breaking  out  about  the  face.  1  have  lately  met  with  a  case 
in  which  the  boils  were  extremely  annoying. 

If  from  the  kidneys^  the  pain  will  shoot  down  the  course  of  the 


1845.]  Pains  of  the  Loins.  153 


spermatic  nerves  towards  the  round  ligament  in  the  female,  and  to- 
wards the  testis  in  the  male,  which  will  often  be  retracted  by  the 
action  of  the  spermatic  nerves  upon  the  cremaster  muscle.  There 
will  be  more  or  less  irritation  communicated  to  thatoiucous  membrane 
of  the  bladder.  The  urine  also  will  be  di;ignoslrc  in  this  instance  ; 
it  may  deposit  mucus,  calculus  matter,  blood,  pus,  or  albumen,  ac- 
cording to  the  nature  of  the  case ;  or  it  may  be  otherwise  morbid  in 
its  constitution. 

If  from  the  uterus,  the  pain  of  the  back  will  arise  cither  from  dis- 
ordered function  or  disease  of  that  organ.  In  the  former  case  the 
pain  will  be  of  a  neuralgic  character,  will  return  in  forcing  paroxysms, 
extending  around  the  hips  and  hypogastric  region,  will  be  attended 
with  hysteria,  and  often  with  increased  quantity  of  the  menstrual 
discharge.  In  the  latter  case  the  pain  will  be  constant  and  severe,   
extending  along  the  anterior  crural  nerve  halfway  down  the  thighs. 
There  will  be  a  thin,  ofiensive  discharge  from  the  vagina.  The  coun- 
tenance will  be  wan  and  sallow,  exhibiting  ttie  wear  and  tear  of 
organic  lesions. 

If  from  the  colon,  there  will  be  constipation,  and  inflation  in  the 
course  of  the  bowel,  or  the  foecal  discharges  will  be  of  small  diameter, 
or  there  will  be  soreness  of  the  intestine  under  pressure,  especially 
at  its  ascending  or  descending  portions,  accompanied  by  mucus, 
or  shreds  of  lymph  in  the  form  of  boiled  vermicelli,  amongst  the  ex- 
cretions. 

If  from  arterial  dilatation,  an  abnormal  pulsation  of  the  vessel 
involved  the  aorta,  for  instance  may  possibly  be  detected  by  aus- 
cultation, in  the  incipient  stage  of  the  disease,  if  such  were  suspected  ; 
but  in  a  large  majority  of  cases,  such  a  cause  may  reasonably  escape 
the  attention  of  the  ablest  surgeon,  from  there  being  no  tangible 
BVmptom  that  might  lead  him  to  suspect  it;  and  even  after  the  dila- 
tation has  considerably  advanced,  it  may  be  sufficiently  large  to  press 
upon  and  disturb  the  sj)ermatic  nerves,  but  not  large  enougli  to  pro- 
ject and  pulsate  externally,  and  this  may,  at  this  stage,  be  confounded 
with  diseases  of  the  renal  function.  A  few  years  ago  I  met  with  a 
case  of  this  kind  in  a  man  of  middle  age.  The  pain  had  been  con- 
stant and  wearing,  shooting  from  the  loins  down  the  course  of  the 
spermatic  nerves,  and  for  a  considerable  time  was  reasonably  attribu- 
ted  to  the  renal  function,  especially  as  there  had  been  constant  dis- 
turbance of  the  function.  At  length  the  aneurismal  sac  began  to 
approach  the  surface,  and  then,  of  course,  the  cause  became  apparent. 
If  from  disease  (f  the  sjnnal  column,  the  pain  will  be  aggravated 
by  percussing  the  spinous  processes  at  this  part  of  the  spine,  or  by 
suddenly  striking  the  toes  against  an  uneven  surface.  There  will  bo 
involuntary  action  of  the  muscles,  especially  of  the  llexors  of  the  legs, 
diminished  temperature,  abnormal  feelings,  and  more  or  less  loss  of 
power  of  the  lower  limbs.  Should  there  be  at  the  same  time  any 
unnaiural  projection  of  the  spinous  processes,  the  disease  will  bo 
confirmed. 


154       AiUiJoles  of  Coirosive  Sublimate,  Copper,  Lead,  dfc.  [March, 


If  from  a  colJeclion  of  matter  upon  the  psoas  muscle,  vnconnected 
V'ith  spinal  disease,  the  pain  will  be  continued,  dull,  and  deep-seated, 
extending  iVorn  the  loins  down  the  psoce,  or  in  whatever  direction  (ho 
nuitlcr  may  have  lakcn  its  course.  The  pain  will  be  aggravated  by 
flexing  the  thigh  t<nvards  the  a!)donien,  and  there  will  be  difficulty  in 
walking  ;  moreover,  tnere  will  be  marks  of  a  strumous  habit,  and 
more  or  less  symptoms  of  hectic  fever.  Should  any  (iiictuating  tu- 
mour present  at  the  groin,  or  at  any  other  point  where  the  matter 
may  t\m\  its  way  out  of  the  body,  it  will  be  concluaive  as  to  the  na- 
ture of  the  case.  Prov.  Med.  Jour. 


Anfidofes  of  Corrosive  Sublimate,  Copper,  Lead,  and  Arsenic, 
By  MM.  BouciiAKDAT  and  Saxdeas.  By  means  of  numerous^  ex- 
periments, first  made  in  the  laboratory  and  then  repeated  on  dogs, 
MM.  Bouchardat  and  Sandras  have  arrived  at  many  interesting 
results  relative  to  the  antidotes  of  corrosive  sublimate,  copper,  lead, 
and  arsenic.  All  these  are,  detailed  at  length  in  theirlong  papers  on 
the  subject.  Their  conclusions  were,  that  the  following  substances 
may  be  regarded  as  antidotes,  and  employed  as  such  in  medicine: 

As  anlido!es  for  corrosive  suhlimaie.  A  mixture  of  zinc  and  iron 
filings;  or  powder  of  iron  reduced  by  hydrogen;  or  the  moist  per- 
sulphurct  of  the  hydrated  peroxide  of  iron. 

As  antidotes  for  copper.  A  mixture  of  zinc  and  iron  filings;  iron 
reduced  by  hydrogen  :  porphyrized  iron  ;  zinc  filings  ;  or  the  pcrsul- 
phuretofthe  hydrated  peroxide  of  iron. 

As  an  antidote  for  lead.  The  moist  pcrsulphuret  of  the  hydrated 
peroxide  of  iron. 

As  antidotes  for  arsenic.  The  moist  hydrated  peroxide  of  iron  ; 
the  dry  hydrated  peroxide  of  iron  ;  and  the  moist  pcrsulphuret  of  the 
hydrated  peroxide  of  iron. 

These  experienced  chemists  add  the  following  reflections :  This 
last  preparation,  the  pcrsulphuret  of  the  hydrated  peroxide  of  iron, 
possesses  this  superior  advantage  over  all  the  rest,  that  it  changes  the 
nature  of  all  the  four  poisons  above  noticed,  and  is  especially  applica- 
ble in  those  cases  where  we  have  not  had  time  to  find  which  of  the 
poisons  has  been  taken.  As  to  the  manner  of  administering  these 
antidotes,  and  the  doses  which  it  is  necessary  to  administer,  the  sim- 
plest means  appear  the  best.  The  powders  of  zinc  and  iron  may  be 
suspended  in  any  electuary,  or  they  may  be  swallowed  in  wafer  pa- 
per. The  magma  of  the  hydrated  preparations  of  iron  may  be  swal- 
lowed in  the  form  of  jelly,  in  which  they  are  procured  from  the 
druggists.  Sever.il  draughts  of  lukewarm  water  ought  to  follow  the 
antidote,  and  the  fauces  be  tickled  with  a  feather,  to  excite  vomiting 
Rnd  the  expulsion  of  the  poison.  The  efforts  at  vomiting  scatter  more 
effectually  over  the  stomach  the  antidote  which  is  administered.  As 
to  dose,  the  experiments  proved  that  100  grains  of  the  powder  of  iron 
or  of  zinc  sufficed  to  prevent  any  bad  effects  from  15  grains  of  the 
acetate  of  copper.     Fifteen  drachms  of  the  moist  magma  of  the  per- 


1845.]        Albumen  as  an  Antidote Diseases  of  the  Skin. 


155 


sulphuret  were  required  to  produce  the  same  effect  with  the  samo 
dose  (15  rrrains)  of.the  acetate  of  copper.  To  act  as  an  antidote  to 
U  grains  of  arsenious  acid,  15  drachn.s  of  the  moist  magma  of  the 
persulphuret,  or  30  drachms  of  the  moist  hydrate^  peroxide  of  iron 
or  20  drachms  of  the  dry  hydratcd  peroxide  of  iron,  were  required. 
With  regard  to  the  time  when  these  antidotes  can  be  administered 
with  advantage,  in  so  far  as  the  acetate  of  copper  is  concerned  the 
lap^e  of  40  minutes  from  the  time  of  swallowing  the  poison  ougnt  not 
to  be  re'rarded  as  a  sufficient  reason  for  not  administering  the  anti- 
dote ;  but  arsenic  is  more  quickly  absorbed.  Nevertheless,  the  anti- 
dote  should  always  be  administered,  because,  though  it  will  not 
neutralize  what  is  absorbed,  it  will  prevent  its  further  absorption,  by 
decomposing  what  remains  in  the  sioinach. Edinburgh  Med.  df 
Surg,  Journal. 

Caution  in  giving  Albumen  as  an  ^yi/mVe. Practitioners,  in  em- 
ployincr  albumen  as  an  antidote  to  corrosive  sublimate,  should  be 
aware'that  it  may  be  given  in  too  great  quantity,  as  the  compound 
formed  is  soluble'in  an  excess  of  albumen,  and  in  the  deleterious 
combination  which  enters  the  blood,  producing  the  remote  influence 
of  the  poison.  So  long  as  the  vomited  matters  contain  a  white 
opaque  material  admixed,  the  antidote  should  not  be  withheld  ;  when 
the  ejecta,  on  the  contrary,  become  transparent,  the  further  employ- 
ment  of  the  remedy  is  generally  useless,  and  may  be  injurious. Atti. 
Jour.  Med.  Sciences,  from  Dublin  Medical  Journal. 

Selection  from  the  Formulary  of  Biett  on  Diseases  of  the  Skin. 
(From  the  work  of  M.  Cazenave,  translated  by  Dr.  Burgess:) 
Infernal  Remedies. SuhcvuUomxic  of  soda,  half,  to  one  drachm  ; 
barley.water,  one  pint.  Dose. rour  glasses  daily.  Use. Lichen  ; 
prurigo;  chronic  diseases  with  itching. 

Decoction  of  t//camara. Dulcamara,  lialf  an  ounce;  water,  a 
pint  and  a  half.  Boil  down  to  two  thirds.  The  quantity  of  the 
remedy  may  be  increased  to  one  ounce,  or  an  ounce  and  a  halt. 
Dose. Half  a  glass  at  fust  ;  then  a  glass,  morning  and  evening. 
Use.  Lepra  vulgaris;  chronic  diseases. 

Decoction  of  orma.Ovm;\  pyramidalis,  four  ounces  ;  water,  tour 
pints;  boil  down  to  a  half.    Dose. Two  to  four  glasses  a  day.    Use. 

Scaly  diseases.  ^     .  ,              i  r 

Syrup  of  fumaria,  twelve  ounces ;  syrup  of  viola  tricolour,  four 

ounces;  bisulphate  of  soda,   two  drachms.      Mix.     [M.  B.ett  oltea 

ompU^yed  this  mixture  in  cases  of  eczema,  lichen,  and  several  chronic 

disea.=:es  of  the  skin.]     Dose. Two  spoonfuls  a  day. 

Syrup  of  fumaria,  a  pint;  bicarbonate   of  .soda,  three  drachms. 

Dose. Two  tea-spoonfuls;  one   before  breakfast ;  the  other  at  bod- 

timo.     Use. Eczema  ;  lichen;  prurigo. 

Pgarsons  .^o/t/Zio;;. Arsenite  of  Foda,  four  grains;  water,  four 

ounces.     Dose. From  twelve  drops  to  a  drachm  or  more.     U.se. 


153  Diseases  of  the  Skin.  [March, 


Most  chronic  diseases  of  the  skin  ;  eczema,  impetigo,  lichen  ;  but 
chiefly  in  squamous  diseases,  lepra,  psoriasis,  (Sec. 

Fowlej-'s  solution.  Arsenious  acid,  and  carbonate  of  pofass,  of 
each  seventy-Gin;h,t  grains ;  distilled  water,  a  pint ;  alcohol,  half  an 
ounce.  Use.  The  same  as  Pearson's  solution.  Dose.  Three  or 
four  drops,  gradually  increased  to  twelve  or  fifteen. 

31.  BieAt's  sohition.  Arsenite  of  amonia,  four  fjrains  ;  water,  four 
ounces.    Use.  Same  as  above.    Dose.  Same  as  Pearson's  solution. 

Larrey's  Syrup.  Sudorific  syrup,  one  pint ;  bichloride  of  mercury, 
hvdro-chlorate  of  ammonia,  and  extract  of  opium,  of  each  five  grains  ; 
Hoffman's  liquor,  half  a  drachm,  Dose.  Half  an  ounce  to  two 
ounces.  \jse..  Syphilitic  eruptions.  Syrup  of  mezercon,  two  oun- 
ces ;  balsam  oftoiu,  four  ounces;  subcarbonate  of  ammonia,  half  an 
ounce.  Dose.  A  spoonful,  morning  and  evening.  Use.  Consti- 
tutional  syphilis. 

Van  Swieten's  liquor.  Bichloride  of  mercury,  eighteen  grains; 
water,  twenty. nine  ounces;  alcohol,  three  ounces.  Dose.  A  tea- 
spoonful,  daily,  in  a  glass  of  decoction  of  sarsaparilla.  Each  ounce 
contains  a  little  more  than  half  a  grain.     Use.  Secondary  syphilis. 

Powders.  Pills.  Sul)limed  sulphur,  magnesia,  of  each  half  an 
ounce.  Make  eighteen  packets.  Dose.  One,  daily.  Use.  Chro- 
nic eczema;  scaly  diseases. 

Proto-ioduret  of  mercury,  twelve  grains;  extract  of  lettuce,  two 
scruples.  Make  lorty-eight  pills.  Dose.  One  to  four.  Use.  Sy- 
philis.    Or, 

Proto-iodurct  of  mercury,  half  a  drachm  ;  extract  of  guaiacnm,  one 
drachm  ;  extract  of  lettuce,  two  scruples  ;  syrup  of  sarsaparilla,  q.  s. 
Divide  into  seventy-two  pills.  Dose.  One,  and  then  two,/ daily. 
Use.  Syphilis. 

Bichloride  of  Mercury.  Extract  of  aconite,  six  grains  ;  bichloride 
of  mercury,  two  grains  ;  marshmallows  |)owder,  eight  grains.  Make 
eight  pills.     Dose.  One  to  four.     Use.  Syphilis. 

Deuto-iod.uret  of  Mercury.  Deuto-iodurct  of  mercury,  six  grains  ; 
marshmallows  powder,  half  a  drachm.  Make  thirty-six  pills.  Use.  
The  same.     Dose.  Two  or  three  a  day. 

M.  Sedillol's  pills.  Strong  mercurial  ointment,  one  drachm  ; 
soap,  two  scruples  ;  mallows  powder,  one  scruple.  Make  thirty-six 
pills.     Dose.  Two  or  three,  daily.     Use.  The  same. 

M.  Bietl's  pills.  Mercurial  ointment,  powdered  sarsaparilla,  of 
each  a  drachm.  Make  forty-eight  pills.  Use.  The  same.  Dose. 
One  to  four,  daily.     Or, 

Phosphate  of  mercury,  half  a  drachm  :  extract  of  fumaria,  one 
drachm.  Make  forty-eight  pills.  Dose.  One  to  two  a  day.  Use.  
As  before. 

Aconite  pills.  Extract  of  aconite,  half  a  drachm;  mallows  pow- 
der, two  scruples.  Make  forty-eight  pills.  Dose  One  or  two, 
morning  and  evening.     Use.  Syphilitic  eruptions  ;  nocturnal  pains. 

Asiatic  pills.  Arsenious  acid,  one  grain  ;  black  pepper  powdered, 


1845.]  Ulceration  of  the  Cornea.  137 


twelve  strains ;  gum  arable,  two  grains;  water,  q.  s.  Make  twelve 
pills.     Dose.  One  or  two  a  day. 

Ar senile  of  iron.  M.  Bieti.  Arsenite  of  iron,  three  grains  ;  ex- 
tract of  hop,  one  drachm  ;  mallows  powder,  half  a  drachm  ;  orange 
flower  syrup,  q.  s.  Make  torty-eight  pills:  each  contains  the  one- 
sixteetith  of  a  grain.  Dose.  One,  daily.  Use.  The  two  preceding 
formulae  are  ciiiefly  used  in  cases  of  chronic  eczema  and  lichen;  in 
the  scaly  diseases,  lepra,  lupus,  and  psoriasis. 

Arsenite  of  soda.  M.  Bieit.  Extract  of  aconite,  one  scruple ; 
arsenite  of  soda,  two  grains.  Make  twenty-four  pills.  Dose.  One 
or  two,  daily.     Vs^.  As  above. 

Hydrochloraie  of  iron.  Hydrochlorate  of  iron,  twelve  grains; 
gentian,  in  powder,  twenty-four  grains.  Make  twelve  pills.  Dose.  
One  to  four,  daily.  Use.  Employed  with  success  by  M.  Biett  in 
scrofulous  eruptions. 

Sulphate  of  iron.  M.  Biett.  Sulphate  of  iron,  one  scruple  ;  pow- 
dered mallows,  twelve  grains:  syrup,  q.  s.  Make  twelve  pills.  \jsq 
and  dose,  the  same.  Lond.  and  Ed.  3/.  J.  of  M.  S. 


UJceraiion  of  the  Cornea.   The  danf^er  of  employing  certain  col' 
lyria  in  diseases  of  the  Eye.  M.  Florient  Cunier  has  recently  called 
the  attcnlion  of  practitioners  to  the  evil  effects  of  combining  opium 
and  its  preparations  with  solutions  of  tiie  meta'lic  salts,  such  as  zinc, 
copper,  silver,  &:c.,  in  the  treatment  of  opthalmia,  and  ulcerations  of 
the  cornea.  When  such  mixtures  are  made,  we  have,  says  he,  on 
the  one  hand,  a  sulphate,  a  carbonate,  a  nitrate,  <Scc.  of  morphine  ; 
on  the  other,  an  insoluble  meconate  of  zinc,  of  copper,  of  lead,  of 
silver,  and  so  on,  which  is  precipitated  to  the  bottom  of  the  phial. 
Before  the  mixture  is  instilled  into  the  affected  eye,  the  vessel  is  usu- 
ally shaken  ;  the  meconate  is  thus  suspended,  and,  in  this  form, 
brought  in  contact  with  the  eye,  and  should  there  be  any  ulcers  upon 
the  cornea,  the  mixture  will  bo  sure  to  lodge  in  such  ulcers.  In  this 
way,  we  create  a  great  number  of  specks  of  supposed  allougos, 
against  which  we  may  bring  the  materia-medica  to  bear,  but  in  vain. 

These  tacts  M.  C.  corroborates  by  adducing  a  very  striking  in- 
stance, the  principal  circumstances  of  which  we  shall  present  to  our 
readers.  An  English  gentleman,  in  attempting  to  open  n  bottle  of 
ammonia,  received  a  few  drops  of  the  fluid  into  his  eye.  A  physician 
being  immediately  called,  prescribed  cold  fomentations,  and  the  pain 
assuming  more  intensity  in  the  evening,  an  opiate  saturnine  collyriuni 
was  ordered.  This  treatment,  aided  by  leeches  and  calomel,  pushed 
to  ptyalism,  produced  no  relief.  The  patient  consulted  in  succession  - 
many  London  surgeons,  who  diagnosed  an  albougo.  the  result  of  a 
burn,  and  subjected  the  patient  to  every  variety  of  treatment  without 
any  success.  Three  yeas  afterwards,  tliis  man  came  to  consult  M. 
Cunier,  who  found  him  in  the  following  condition  :  The  lids  of  the 
eye  were  spasmodically  closed;  when  >f.  C.  attempted  to  separate 
them,  a  fiood  of  tears  deluged  his  cheek  :   thf  pHttont  suddenlv  threw 


ICS  Cure  for  Nccmhtj  Croion  Oil,  [March, 


his  head  back,  rose  from  his  seat,  linstened  to  his  room  and  seemed 
to  be  agitated,  alternately  opening  and  shutting  his  lids,  violently 
contracting  the  muscles  of  his  face  on  the  painful  side,  as  persons  are 
wont  to  do  when  any  loreign  body  is  admitted  into  the  eye.  After  a 
few  minutes  the  patient  reseated  himself,  and  M.  Cunicr  resumed  his. 
examination. 

'J'he  conjunctiva  was  highly  injected  ;  the  cornea, over  three-fourths 
of  its  extent,  presented  a  shining  yellowish  white  appearance  ;  around 
its  border  were  eight  or  ten  large  vessels,  which  terminated  abruptly. 
The  internal  (ace  of  the  lower  lid,  presented  two  or  three  small  points 
of  the  same  color,  as  the  spot  on  the  cornea.  I\I.  Cunicr,  after  ah 
attentive  examination,  and  being  well  assured  as  to  the  nature  and 
composition  of  the  first  collyrium,  diagnosed  an  incrustation  of  lead 
upon  the  cornea,  and  at  once  proposed  to  remove  it. 

After  some  hesitation  and  delay,  the  patient  consented,  and  M. 
CuF)ier  proceeded  in  the  following  manner  to  perform  it. 

The  patient  was  seated  in  an  arm  chair,  the  head  resting  against  a 
pillow.  Standing  behind  hirn  the  operator  adjusted  a  blepharostat. 
The  conjunctiva  being  seized  below,  and  about  two  lines  from  the 
cornea,  with  a  small  pair  of  serrated  pinchers,  held  in  the  left  hand, 
he  was  thus  enabled  to  carry  the  globe  of  the  eye  downwards,  and 
thereby  contract  its  movements.  Then  taking  a  proper  instrument, 
(siich  as  Dentists  use  in  cleansing  teeth.)  in  his  right  hand,  he  placed 
itf^at  on  the  lower  and  external  border  of  the  incrustation,  thus  act- 
ing from  below  upwards.  The  false  membrane  which  covered  the 
cornea  offered  no  resistance,  and  the  central  plaque  was  readily  de- 
tached in  one  entire  piece.  'J'his  operation,  executed  with  great 
care,  had  the  most  happy  success.  The  patient,  who  for  three  years 
bad  lost  the  use  of  that  eye,  who  believed  vision  completely  destroy- 
ed, and  had  suffered  beyond  measure,  saw  now  as  well  with  this,  as 
with  the  sound  eye.  M.  Cunier  received  several  communications 
from  his  patient  at"ter  his  return  to  England,  and  was  assured  that  the 
cure  remained  complete.  Since  that  time,  (3Iarch  1842,)  31.  Cunier 
has  had  frequent  opportunities  of  removing  incrustations  from  the 
rorpea.  In  nineteen  cases,  the  collyria  used  by  the  patients,  were 
composed  of  a  salt  of  lead,  or  of  zinc,  or  of  copper,  either  with  or 
without  the  addition  of  opium. 

M.  Cunier  has  then  rendered  a  real  service  to  opthalmic  surgery, 
by  pointing  out  the  dangers  and  inconvenience  of  using  these  kinds 
r.f  collyria,  in  the  treatment  of  ulcerations  of  the  cornea.  It  is  there- 
fore apparent  that  the  preparations  of  opium,  combined  with  these 
metallic  solutions  may  produce  those  incrustations,  of  which  M.  Cu- 
nier is  the  first  to  speak,  and  to  which  he  has  directed  the  attention 
of  the  occulist.  Annales  cV  Occidist,  as  quoted  in  Bull,  Gen.  de 
Therap.;  1844. 


Cure  for  Ncrin  hy  Croion  Oil.  M.  Lafarque  states  his  method  of 
curing  Naevi,  by  inoculating  with  croton  oil,  as  follows:     Five  or  six 


1845.]  The  Liquor  PotasscB  Fistula  Lachryrnalis.  loO 


punctures  should  be  made  on   and  around  the  tumour,  with  a  lancet 
dipped  in  the  oil,  just  as  in  vaccination. 

Each  of  the  punctures  causes  immediately  a  pimple,  which  in 
thirty-six  hours  is  developed  into  a  little  boil.  These  boils  unite  and 
form  a  rod,  hot,  painful  tumour,  covered  with  white  crusts,  and  re- 
semblinrj  a  smnll  carbuncle.  Two  days  afterwards  the  scabs  separatf, 
and  in  lieu  of  the  neevus  is  seen  an  ulcer,  which  is  to  be  treated  on 
jreneral  principles.  It  would  be  dangerous  to  make  more  than  six 
punctures  on  a  very  young  infant,  as  the  irritation  and  fever  are  con- 
siderable. Prov.  Med.  Jour. 


The  Liquor  Potasscc  Given  in  doses  of  from  15  to  30  drops,  three 
times  a  day,  is  an  admirable  remedy  in  many  cases  of  inveterate  skin 
disease.  Accordinf^  to  our  observations,  it  is  far  more  effiracious, 
and  perhaps,  too,  less  injurious,  than  the  potash  in  combination  with 
iodine.  The  liquor  potassoe  may  be  given  in  milk,  beer,  decoction 
of  sarsaparilla,  &c.  With  respect  to  the  sulphate  of  iron  as  an  exter- 
nal application,  in  sycosis,  menlagra,  &c.,  we  cannot  believe  that  it 
possesses  any  curative  virtues  above  those  of  the  sulphate  of  zinc,  or 
of  the  sulphate  of  copper,  that  are  in  daily  use.  The  white  vitriol  is 
our  favorite;  and  the  best  way  of  applying  it  is  by  dipping  rags  of 
soft  lin^n  in  a  tepid  solution  of  the  salt,  and  covering  these  with  a 
piece  of  oil-skin.  If  used  thus,  the  lotion  will  not  require  renewal 
oftener  tiian  night  and  morning.  In  some  cases,  a  little  hydrocyanic 
acid  may  be  conveniently  added  to  the  solution  with  advantage.  
Med.  Chir.  Review. 


Extirpation  of  the  Lachrymal  Gland  for  the  cure  of  Fistida  Lach. 
rymaJis.  By  *M.  Paul  Beknakd.  '(Revue  MedicaIc.)8omo 
time  ago  M.  Bernard  communicated  to  the  Academy  of  Scien- 
ces a  case  of  cure  of /f^/w/rt  Zflf/<77/?;?rz//5  by  means  of  the  extirpation 
of  the  lachrymal  gland.  Thisgland  had  only  been  previously  extir- 
j)ated  on  account  of  cancer  ;  and  the  simplicity  of  the  operation,  as 
well  as  the  rapidity  of  tiie  cure,  induced  him  to  remove  it  for  fistula. 
A  man,  30  years  of  age,  subject  to  a  considerable  discharge  of  tears 
from  the  left  eye,  but  without  fistula,  had  been  subjected  to  most  of 
the  usual  remedies  for  the  cure  of  that  oisease.  The  ranula,  colly  ria, 
and  ointments  of  various  kinds,  had  been  employed  for  a  period  of 
ten  years,  but  the  watering  of  the  eye  still  continued,  and  rendered 
the  vision  very  confused.  M.  Bernard  then  determined  to  remove 
at  least  that  part  of  the  gland  which  appeared  to  be  hypertrophied. 
V  vertical  fold  of  the  skin  on  the  outer  edge  of  the  eye  was  raised, 
and  a  bistoury  pushed  through  it.  This  exposed  the  palpebral  cdgo 
of  the  gland.  Tiiis  portion  was  found  to  be  hypertrophied  ;  it  was 
drawn  out  by  the  forceps,  and  removed.  The  orbital  portion  of  the 
gland  also.  No  bad  results  followed  :  the  wound  healrd  rapidly;  the 
watering  of  the  eye  disappeared;  in  fact,  a  perfect  cure  followed.  
{From  EdinhurghMcd.  and  Sur".  JonmnL  Jan.  l^lf).) 


IGO 


Cases  of  Fremalure  Delivery^  <S^g 


Cases  of  Premature  Del ivery-  By  M.  SENLE^^  (L^ Experience, 
30th  May,  1844  )  M.  Senlen  has  excited  labour  prematurely  13 
times  in  7  women,  in  consequence  of  deformed  pelvis.  In  three  of 
these  the  deformity  was  produced  by  rickets;  in  4  by  malacosteon. 
Of  the  13  labours  in  these  7  women,  only  7  children  were  horn  alive, 
and  4  of  these  died  very  shortly  after  birth.  The  antero-posterior  di- 
ameter of  the  pelvis  in  these  women  was  2  inches  in  one,  2^-  in  another, 
2i}  in  another,  and  in  the  rest  less  than  3  inches.  Labour  was  induced 
by  puncturing  the  membranes,  and,  according  to  the  contraction  of 
the  pelvis,  wasljrought  on  from  the  29th  to  the  38th  week  of  pregnan- 
cy. The  average  period,  however,  was  on  the  completion  of  the  30th 
week,  or  7  calendar  months. 


METEOROLOGICAL  0BSERVAT10^'S,  for  January,  1H45,  al  Augusta,  Gj 
Latitude  33  27' north Longitude  4  32' west.    W. 


S.R. 

Ther. 
3,  p.  M. 

Bar. 

Wind.     1 

S.R. 

Ther. 
3,  p.  M. 

Bar. 

Wind. 

1 

'18 

72 

30  inches 

X.  w.  fair.  '17 

56 

68 

296-10  in. 

s.    rain. 

21  41 

63 

29  9-10 

s.  E.   fair.    18 

58 

57 

29  7-10 

K.  w.  fair. 

3 

40 

64 

" 

s.w.  crdv.'19 

35 

37 

29  9-10 

N.E.   rain. 

4 

43 

70 

(C 

''     fair.  i!20 

36 

42 

" 

N.  E.  misty. 

5 

43 

71 

" 

"     iiSJl 

38 

55 

 

w.     fair. 

6i  57 

64 

29  3-10 

s.  E.  rain,  22 

29 

58 

39 

X.  w.       " 

/ 

56 

56 

29  5-10 

w.     fair.  ;23 

42 

50 

29  9-10 

E.    rain. 

8 

38 

60 

29  8-10 

"     i;24 

49 

56 

29  6-10 

w.    cl'dy. 

9 

32 

62 

29  9-10 

"     ,25 

32 

54 

29  7-10 

N.w.   fair. 

10 

33 

68 

s.w.     "     ii26 

31 

58 

29  8-10 

vv.        " 

111   12 

58 

29  7-10 

V.-.       "     :27 

31 

67 

29  7-10 

s. 

12 

39 

55 

29  8-10 

x.  w.      "     l'28 

31 

68 

29  8-10 

S.  E.         " 

13 

30 

61 

29  6-10 

s.w.      ''      29 

37 

58 

30 

X.  w.       " 

14 

38 

60 

29  9-10 

w.        "      iSO 

32 

52 

30  9-10 

u 

15 

36 

59 

30 

variable.  31 

26 

59 

30 

IS              (( 

16 

39 

70 

29  9-10 

S.  E.  cl%. 

22  Fair  days. 


inches. 


At  the  annual  examination  of  .he  Medical  In^'titntion  of  Yale  College^  held 
on  the  15th  January,  eleven  candidates  were  admitted  to  the  degree  of  Doctor 
of  Medicine. 


ERRATA.  In  Dr.  Meaxs's  communication  on  the  subject  of  Calomel,  on 
page  98,  line  9th  from  boUom,  for  "(Chlorir/e)"  read  Chlori7ze, 

"    102,     "  14th  from  top,  for '-'purgatives"  read  purgation. 

"    103,    "    8th    "      "     for  "so  far  1  know"  read  so  far  ^5  I  know. 

"    105,  a  whole  line  after  the  .5th  from  top  omitted insert  as  follows:  "which 
unite  vigorously  in  the  librin  Albumen,  &C."  then  follows  next  line,  "either  in 
solids,"  &c. 
page  105,  line  8th  from  bottom,  for  "Miller"  read  Miiller. 

"     1 12,    "  23d  from  top,  for  "t^Affe"  read  ithok. 


SOUTHERN 

MEDICAL  AND  SURGICAL 

JOURNAL. 

Vol.  I.]  KEW  SERIES. APRIL,  lSi5.  [No.  4. 


PART  L ORIGIXAL  COMMUNICATIONS. 

ARTICLE    I. 

Nolice  of  the  Memoirs  of  21.  de  Haldat  vpon  the  Mechanism  of 
Vision,  By  Joiix  'M.  B.  Harden,  M.  D.,  of  Liberty  County, 
Georgia. 

The  object  of  the  present  communication  is  to  bring  before  the 
readers  of  this  journal  the  recent  researches  ofM.  De  Haldat  upon 
the  Mechanism  of  Vision,  with  reference  more  particularly  to  tho 
adaptive  power  of  the  eye.  These  researches,  it  appears,  were  ori- 
ginally embraced  in  three  separate  memoirs  read  at  different  times 
before  the  Academy  of  Nancy,  and  published  among  its  transactions; 
but  a  complete  analysis  of  them  has  been  furnished  by  the  author 
for  the  September  number  of  the  Annales  de  Chimie  et  de  Physique, 
from  which  we  have  condensed  the  following  account :  

It  is  well  known  that,  for  the  purposes  of  distinct  vision,  several 
nice  adjustments  in  the  structure  of  the  eye  are  necessary  in  order 
to  correct  those  aberrations  which  are  dependent  upon  the  laws  of 
refraction  and  the  properties  of  light.  The  modes  of  correction  for 
spherical  and  chromatic  aberrations,  we  believe,  are  universally 
agreed  upon  by  philosophers  :  the  former  arising  from  tho  structure 
of  the  crystaline  lens  by  which  its  density  increases  from  the  circum- 
ference to  the  centre  the  latter  from  the  "adjustment  of  the  powers 
of  the  different  refracting  media  of  which  the  globe  fif  the  eye  is 
composed,  so  as  to  give  rise  to  wlat  is  c;illed  an  achromatic  comhina- 
Unn  "     Th   correction   for   parallactic   aberration,  however,  or  the 

n 


163  Mechanism  of  Vision,  L-^P^'^* 


adaptive  power  of  the  eye  by  wliich  it  maintains  tlic  srime  focal 
distance  for  rays  from  ditferejit  directions,  lias  given  rise  to  much 
controversy  and  has  Ijecn  made  the  subject  of  long  and  laborious 
investigation  by  Olbers,  PoRTEitriELD,  Hunter,  Home,  You^g,  (1) 
and  others. 

The  theory  which  seems  to  have  received  most  support  is  that 
which  refers  it  to  muscidar  action ;  but  there  has  been,  and  still  con- 
tinucs  to  be,  great  want  of  unanimity  in  regard  to  the  modem  which 
i\\\s  action  efTccls  its  object.  Some  have  supposed  that  the  contrac- 
tion of  the  muscles  compressed  the  whole  globe,  and  thus  increased 
the  convexity  of  the  cornea ;  while  at  the  same  time  the  axis  was 
eloH'^ated  and  the  retina  removed  farther  from  the  lens:  others  have 

o 

referred  it  to  a  change  in  the  convexity  of  the  lens  itself,  or  a  motion 
effected  in  it  by  the  action  of  the  ciliary  body,  or  ligamenta  ciliaria, 
by  which  its  distance  from  the  retina  was  either  increased  or  dimin- 
ished.    This  last  seems  to  have  been  the  opinion  of  Dr.  Youxg. 

The  chief  arguments  in  support  of  these  views  have  been  first,  the 
vague  and  unsatisfcictory  one  derived  ex  necessitate  rei,  and  believed 
to  be  good  and  true,  because  sufficient  to  exjilain  the  iihcnomenon  
the  second,  from  the  sensation  of  effort  and  fatigue  of  which  we  are 
conscious  when  we  attempt  to  adapt  the  eye  to  the  vision  of  near  ob- 
jects.  To  this  last  our  author  replies,  that  "it  is  by  no  means  certain 
that  this  sensation  of  fatigue  has  its  seat  in  the  muscles,  but  should 
rather  be  ascribed  to  the  state  of  the  retina,  fatigued  by  an  abnormal 
impression  1"  To  the  idea  of  any  change  in  the  form  of  the  cornea, 
he  opposes  first,  "  the  almost  absolute  incompressibility  of  the  humors 
of  the  eye,  and  the  extreme  tenacity  of  the  membranes  which  contain 
them  secondly,  the  difference  of  opinion  among  authors,  some  of 
whom  attribute  this  power  to  the  recti,  others  to  the  oblique,  while  a 
third  class  refers  it  to  the  combined  action  of  all  thirdly,  whether 
we  admit  the  combined  action  of  all  these  muscles,  or  the  separate 
action  of  each  set,  it  is  necessary  to  prove  that  they  can,  by  their 
contraction,  change  the  form  of  the  cornea;  a  power  which  cannot 
be  admitted  because  of  their  unfavorable  disposition,  and  particularly 
when  we  consider  that  the  recti  muscles,  which  are  most  powerful 
on  account  of  their  mode  of  insertion,  cannot  effect  this  change  with- 
out exerting  upon  the  posterior  hemisphere  njn'essvre  which  requires 
a  point  of  support,  (point  d'appui,)  or  resistance  which  we  cannot 

(1)  Although  denied  by  Dr.  Young,  our  author  follows  Euber  in  believing  the 
eye  to  be  perfectly  achrumaiic. 


1345.]  Mechanism  of  Vision.  163 


find  either  in  the  flexibility  of  the  optic  nerve,  or  in  the  extreme 
softness  of  the  fat  which  occupies  the  pyramidal  interval  which  sepa- 
rates the  recti  muscles  or  which  fills  the  base  of  the  socket.  As  to 
the  oblique  muscles,  which  can  only  act  in  producing  the  rotation  of 
the  globe  around  the  antero-posterior  axis,  we  cannot  see  how  they 
can  efiect  the  compression  necessary  to  produce  the  result  supposed." 

But  even  supposing  the  muscular  arrangement  ever  so  favorable 
for  the  purpose,  our  author  finds  in  the  size  of  the  muscles  an  insuper- 
able objection  to  the  admission  of  a  power  in  them  sufficient  to  change 
the  convexity  of  the  cornea.  By  an  experiment  made  upon  the  eye 
of  a  sheep,  he  found  that  a  power  sufficient  to  produce  the  least  change 
in  this  membrane  must  be  equal  in  pressure  to  three  kilogrammes,* 
v.hereas,  judging  of  the  strength  of  a  muscle  by  its  mass,  a  rule 
adopted  by  all  physiologists,  the  power  of  the  muscles  of  the  eye 
cannot  exceed  500  grammes. 

Another  strong  argument  against  any  change  in  the  form  of  the 
cornea,  is  found  in  a  fact  accidentally  observed  by  the  author,  viz : 
that  when  the  globe  of  the  eye  is  subjected  to  a  pressure  sufficient  to 
effect  a  chanrre  in  its  form,  the  cornea  becomes  fransJiicid,  assuming 
a  bluish  gray  tint,  entirely  incompafiblewith  dislinctncss  of  vision.  
"Hence,"  says  ho,  "  it  is  evident  that  the  hypothesis  of  compensation 
by  a  change  in  this  membrane  cannot  be  sustained." 

Not  satisfied,  however,  by  these  indirect  arguments,  the  author 
next  proceeds  to  direct  experiment  upon  the  poin!,  and,  in  the  manner 
ofDr.  YouxG,  measures  with  great  accuracy  the  curvature  of  the 
cornea,  while  the  eye  receives  rays  from  difierent  directions.  For 
this  purpose  he  uses  a  small  micrometer  telescope  having  a  mao-ni- 
fying  power  of  thirty  diameters.  The  experiment  may  be  conducted 
in  two  ways:  In  the  first,  the  eye  is  examined  in  profile,  and  the 
visible  part  of  the  cornea  is  brought  to  the  focus  of  the  object  so 
as  to  obtain  a  distinct  image.  The  wires  of  the  micrometer  are  then 
so  applied  as  that  one  will  be  a  tangent  to  its  convexity,  and  the 
other  will  pass  through  the  two  extremities  of  the  visible  crescent, 
and  thus  its  form  can  be  satisfactorily  determined  while  the  person 
fixes  his  eye  upon  objects  at  different  distances.  In  the  second,  the 
glass  is  directed  obliquely  towards  the  cornea,  and  receives  the  imaTe 
of  any  external  object  reflected  by  it.  This  image  being  broutrht  be- 
tween the  wires  of  the  micrometer  is  accurately  measured,  while  the 

  Kilogramme,  a  1000  ^raniine-*.    A  grammft,  20  sjains. 


IW  Mechanism  of  Vision,  [April, 


person  is  directed  to  fix  his  eye  intently  upon  an  object  by  exerting 
all  the  force  of  the  muscles.  The  constancy  in  form  of  the  cornea 
was  conclusively  shown  by  the  fact,  that  the  rejlected  image  always 
preserved  the  same  dimensions,  and  thus  the  experiment,  according  to 
our  author,  ''  completely  deprives  the  cornea  of  the  claim  to  the  func- 
tion of  a  compensating  instrument  which  has,  for  so  long  a  time,  been 
gratuitously  ascribed  to  il.^^ 

Having  satisfied  himself  upon  this  point,  our  author  next  seeks  in 
the  other  structures  of  the  eye  the  instrument  of  this  compensation. 
The  aqueous  humor  being  as  unalterable  in  its  form  as  the  cornea 
itself,  cannot  be  supposed  to  have  any  agency  in  it.  The  iris,  whose 
chief  use  seems  to  be  to  apportion  the  quantity  of  light  to  the  wants 
of  the  organ,  cannot  be  any  better  adapted  to  perform  a  part  so  im- 
portant. The  vitreous  humor,  when  separated  from  the  crystaline, 
forms  no  distinct  image  upon  the  retina,  and  therefore  we  are  forced 
to  ascribe  it  to  this  latter,  which  unites  all  the  properties  of  artificial 
lenses  by  which  images  are  formed  in  onx  instruments.  But  having 
determined  this  fact,  the  question  recurs  what  is  the  mechanism  by 
which  the  eye  adapts  itself  to  objects  at  different  distances?  In  de- 
termining this,  the  author  again  has  recourse  to  the  experimental 
method.  The  crystaline  of  an  ox,  fresh  and  sound  in  every  part,  was 
fixed  by  a  suitable  instrument  in  a  camera  obscura,  and  exposed  to 
the  rays  of  the  sun,  which  were  kept  in  a  horizontal  position  by  a 
heliostat- the  image  of  the  sun,  formed  at  the  focus,  was  received 
upon  rough  glass,  and  was  of  course  produced  by  parallel  rays  the 
direction  of  the  rays  was  then  changed  by  the  interposition  of  convex 
and  concave  glasses,  and  yet  the  image  constantly  retained  its  integ. 
rity,  although  altered  somewhat  in  extent  and  Zi7v7/ia7?ry,  proving  that 
the  crystaline  lens  has  the  property  in  itself,  within  certain  limits,  of 
forming  at  the  same  focus  constant  images  for  rays  from  different 
directions. 

The  author  has  performed  this  experiment  a  great  many  times, 
both  by  iiimself  and  in  the  presence  of  those  well  acquainted  with 
optics,  and  always  icith  the  same  result.  lie  has  also  varied  the  ex- 
periment by  using  the  entire  eye,  with  the  exception  of  a  small  portion 
of  the  posterior  hemisphere  of  a  circular  form,  which  he  removes  for 
the  purpose  of  receiving  the  image  which  would  have  been  formed 
upon  the  retina.  This  portion  is  replaced  by  a  watch-glass,  which  is 
fitted  into  an  instrument  composed  of  a  double  hemispherical  capsule, 
large  enough,  when  united,  to  contain  the  globe  of  the  eye  of  a  sheep 


1845.]  Mechanism  of  Vision,  165 


or  ox.  Each  capsule  is  perforated  \vith  a  hole  in  the  centre,  one  of 
which  contains  the  watch-glass  above  menlioneti,  and  is  to  be  applied 
to  the  posterior  part  of  the  eye  the  other  to  the  cornea.  They  are 
brought  together  by  means  of  a  hinge,  which  unites  the  branches  to 
which  they  are  attached,  and  may  be  opened  or  shut  at  pleasure ; 
vvhen  closed  they  leave  an  open  belt  or  zone,  surrounding  the  middle 
of  the  eye,  where  the  globe  may  be  compressed  by  the  ends  of  the 
fingers. 

From  all  the  experiments  performed  by  the  author,  he  thinks  him- 
self warranted  in  drawing  the  following  conclusions  :  "1st.  That 
all  the  possible  changes  in  form  which  the  cornea  may  undergo,  do 
not  give  it  that  influence  in  the  formation  of  the  image  which  has 
been  ascribed  to  it  since  we  may,  by  means  of  pressure  upon  the 
globe,  swell  it  out,  or  diminish  its  natural  tension,  by  removing  a 
portion  of  the  aqueous  humor,  or,  what  is  still  more  remarkable, 
remove  the  whole  cornea  without  destroying  or  even  modifying  the 
image.  2ndly.  Tiiat  we  may  replace  the  aqueous  humor  with  at- 
mosplieric  air,  by  means  of  a  narrow  oblique  puncture  ;  showing  that 
the  use  of  the  fluid  is  simply  to  give  to  the  cornea  that  peculiar  form 
which  is  natural  to  it.  3rdly.  That  the  crystaline  is  the  instrument 
essential  to  the  formation  of  the  image  since  its  removal,  all  the 
other  parts  being  sound,  renders  it  impossible,  and,  on  the  contrary, 
it  takes  place  vvhen,  the  crystaline  remaining,  we  remove  the  cornea 
and  the  aqueous  humor,  and  even  when  isolated,  the  focus  remaining 
constant  for  rays  from  diflerent  directions.  4thly.  That  the  crys- 
talinc,  nevertheless,  cannot  alone  form  the  image  upon  the  retina, 
without  the  aid  of  the  vitreous  humor,  because  the  focal  distance  of 
the  crystaline  is  too  short,  as  is  proven  by  a  comparison  of  its  focal 
distance  with  that  of  the  focal  distance  of  the  two  fluids  combined." 

The  property  of  uniting  into  one  focus  rays  from  diflerent  direc- 
tions, then,  recognized  in  the  cr?/.9/a/i'/Jc,  the  only  remaining  question 
to  be  solved,  is  in  regard  to  the  cause  of  a  phenomenon  so  remarkable 
and  apparently  so  much  at  variance  with  the  laws  of  optics.  The 
author  acknowledges  the  difliculty  ;  but  observes  that,  even  supposing 
we  cannot  explain  it,  we  must  still  admit  the  fact,  as  wo  are  obliged 
to  do  in  a  great  number  of  cases  where  phenomena  arc  equally  well 
knov.-n,  whose  causes  are  entirely  hidden  from  our  view.  The  con- 
clusion at  which  our  author  arrives,  liowevcr,  I.s  that  it  must  result 
from  the  form  and  intimate  structure  of  the  lens,  and  is  probably 
connected  with  that  urrargement  by  which  wo  know  the  aberration 


168  Mechanism  of  Vision.  [April, 


of  sphericity  is  corrected.  Tliere  is  one  fact  in  relation  to  this 
structure  brought  to  view  by  the  author,  which  he  seems  to  think 
may  have  an  important  bearing  upon  the  point,  which  is,  that  the 
elementary  lamina,  of  which  the  lens  is  composed,  gradually  change 
their  lenticular  or  ellipsoidal  form  as  they  approach  the  centre,  until 
at  last  they  assume  the  globular  form  completel}',  so  that  the  nucleus 
is  a  perfect  sphere. 

The  theory  of  our  author  recommends  itself,  not  only  on  account 
of  the  stable  basis  on  v/hich  it  seems  to  be  founded,  but  because  of  its 
agreement  with  that  simplicity  in  the  operations  of  nature  by  which 
she  accomplishes  many  objects  by  the  action  of  one  of  her  laws. 
Thus,  as  an  illustration,  by  a  modified  motion  of  the  earth,  no  less 
than  four  important  phenomena  are  produced,  all  of  which,  at  last, 
may  be  referred  to  the  one  law  of  vnicersal  gravitation  and  other 
instances  of  the  same  kind  might  be  adduced.  Another  argument, 
not  noticed  by  the  author,  whicii  appears  to  us  strongly  in  favor  of 
his  view,  is  found  in  the  structure  of  the  eyes  of  some  of  the  lower 
orders  of  animals,  as  for  instance,  the  insect  tribe,  where  the  eye  is 
so  immovably  fixed  in  the  socket  that  the  adaptive  power  which  they 
possess  must  depend  upon  the  physical  structure  of  the  refractory 
media  alone,  and  not  on  any  muscular  power  which  they  can  have 
in  modifying  their  forms. 

Like  every  other  theory,  however,  which  may  be  advanced,  it  is 
by  no  means  free  from  objections,  two  of  which  readily  occur  to  our 
mind.  The  first  is,  that  although  the  nearest  distance,  Ht  which 
distinct  vision  is  possible  to  the  eye  in  a  normal  state,  is  about  six 
inches,  yet  by  looking  through  a  pinhole  made  in  paper,  we  may 
distinctly  see  an  object  at  less  than  half  that  distance.  Now,  as  the 
pinhole  can  act  in  no  other  way  than  by  excluding  light  like  the 
iris,  it  seems  to  indicate  that  the  iris  may  have  something  to  do  with 
this  property  of  the  eye,  as  has  been  maintained  by  some  writers. 
Again,  it  does  not  appear  that  the  removal  of  the  lens  entirely  des- 
troys the  adaptive  power  of  the  cyo,  although  it  ccv tii[n]y  diminishes 
it  to  a  very  great  extent.  It  was  a  practice  pursued  and  recommend- 
ed by  Sir  William  Adams,  for  what  he  calls  "  Conical  Cornea,^^  to 
extract  the  lens  entirely,  and  in  the  cases  in  which  he  performed  the 
experiment,  the  result  was,  as  he  himself  declares,  "  that  although 
the  patients  were  unable  to  see  cither  near  or  distant  objects,  imme- 
diately after  the  operation,  without  glasses,  yet  after  a  time  they 
acquire  a  power  to  a  considerable  degree  of  perfection,  if  they  have 


1845.]  Mesmerism.  107 


the  patience  to  do  without  tliem ;"  and  he  gives  us  several  cases 
illustrative  of  the  fact,  so  that  after  all  this  faculty  maybe  connected 
with  more  than  one  structure  of  the  eye. 

Our  author  has,  it  is  true,  adopted  the  inductive  method  in  his  re- 
searches  upon  this  subject,  but  the  truth  or  falsity  of  his  deductions 
must  rest  upon  the  correctness  of  his  premises.  The  inductive  me- 
thod is  good  for  nothing,  without  good  observers  and  good  observations. 
Lord  Verulam  himself,  in  his  Essay  upon  the  Nature  of  Caloric,  for 
the  purpose  of  illustrating  his  own  doctrine,  associated  together,  as 
concordant  examples, //ze  solnr  rays  and  aromatic  herbs;  (1)  and 
many  a  fine  spun  theory  and  logical  argument  have  been  based  upon 
admissions  equally  groundless  and  untenable. 

January  31st,  1315. 


(1)  No  wonder  he  came  to  the  conclu5lon  that,  '-Calor  est  moms  expansionis, 
cohibetus,  et  nitens  per  partes  minores"  although  really  it  is  about  as  good  a 
definition  as  our  modern  philosophers  can  give.  Nov.  Organ.  Lib.  2,  p.  164. 


ARTICLE    ir. 

Mesmerism  A  Lecture  delivered  in  the  Medical  College  of  Geor- 
gia, {by  request  of  the  Students,)  Feb.  18th,  1845.  By  Paul  F. 
Eve,  ^L  D.,  Prof,  of  Surgery. 

The  subject.  Gentlemen,  proposed  for  me  to  examine  at  this  meet- 
ing, is  Mesmerism,  or  Animal  ^Magnetism.  In  the  course  of  lectures 
on  Surgery,  which  it  has  been  my  duty  to  deliver  before  you  \\\\% 
winter,  and  which  is  now  drawing  near  to  a  close,  I  took  occasion 
to  allude  to  it,  incidently,  once  or  twice.  When  recommending'  the 
means  employed  to  prevent  or  relieve  pain  during  the  performance 
of  surgical  operations,  you  will  recollect  this  supposed  agent  mms  not 
included  among  them.  An  operation  having  been  performed  by  one 
of  t!ie  professors  of  this  college,  upon  a  patient  in  the  "mesmeric 
state,"  without  evincing  consciour,ncs3  or  pain,  it  was  natural  for 


168  Mesmerism.  [April, 


you  to  desire  to  know  why  I  had  excluded  it  from  the  therapeutical 
applications  in  Surgery. 

In  yielding  to  your  solicitation,  to  give  the  reason  of  the  faith  tiiat 
is  in  me,  and  to  present  the  evidence  upon  which  I  rely  for  an  opin- 
ion on  this  subject,  1  do  it  with  some  reluctance.  It  is  known, 
that  as  a  faculty,  the  professors  do  not  agree,  and  probably  it  is 
well  we  should  not,  upon  a  topic  such  as  this.  As  an  associate,  like 
them,  I  am  an  humble  searcher  after  truth,  and  this  generally  is 
best  discovered  by  mutual  and  amicable  discussion.  And  though 
we  may  differ,  still  there  is  no  apprehension  of  the  well  known  har- 
mony and  good  feelings  which  exist  among  us,  being  in  the  least 
disturbed  by  this  investigation  of  an  intricate  and  mysterious  agency. 
In  examining  the  subject,  I  hope  to  do  so  as  a  medical  philosopher, 
to  oflend  none  who  may  not  share  my  own  opinions,  to  violate  in  no 
instance  propriety  or  courtesy ;  and  all  I  ask,  is  a  fair  hearing  and 
an  impartial  judgment. 

No  one  at  the  present  day  can  enter  upon  the  terra  incognita  of 
animal  magnetism,  without  some  hesitation.  The  man  who  would 
give  a  decided  opinion  upon  this  subject,  must  expect  to  encounter 
opposition,  and  should  bo  prepared  to  fortify  his  position  not  only 
with  good  reasons  and  sound  arguments,  l)ut  by  indisputable  facts  
a  point  however  much  desired,  not  yet  attained.  The  vantage  ground 
is  evidently  that  of  silence  or  non-commitment,  but  however  ditTicuit 
and  arduous  the  duty,  and  whatever  of  reputation  or  character  it 
may  involve,  I  cannot  now  shrink  from  attempting  to  discharge  it. 

In  discussing  the  subject,  I  propose  to  endeavor  to  establish  the 
three  following  propositions,  viz  : 

1st,  That  Mesmerism,  or  animal  magnetism,  was  unanimously  con- 
demned by  the  commission  appointed  in  1784,  by  the  king  of  France, 
to  examine  and  report  upon  it;  and  that  it  has  never  received  any 
favor  or  approbation  from  any  scientific  or  learned  society  whatever. 

2d,  That  Mesmerism  is  not  a  reality ;  hut  that  the  phenomena 
ascribed  to  it,  are  justly  due  to  the  imagination  and  excited  feelings. 

3d,  That  the  non-expression  of  pain,  is  no  proof  of  its  non-exist- 
ence, and  that  there  are  conditions  of  the  body  and  mind,  in  which 
no  suffering  is  evinced,  and  moreover  that  this  state  of  the  system  is 
independent  of  Mesmerism. 

First,  then,  I  am  to  prove  that  the  cf)mmission  appointed  in  France 
in  1734,  unanimously  condemned  Mesmerism  ;  and  that  it  has  re- 
ceived no  favor  since  from  any  scientific  society.     Tho  first  part  of 


1S45.]  Mesmerism,  1G9 


this  proposition,  one  would  suppose,  would  require  no  exposition  ;  but 
I  have  recently  heard  it  denied,  and  this  too  by  men  of  influence, 
that  the  French  commissioners  who  examined  Mesinerisn^  near  the 
close  of  the  last  century,  did  report  unfavorably  to  it. 

My  second  proposition,  tiiat  Mesmerism  is  not  a  reality,  and  that 
the  phenomena  ascribed  to  it,  are  justly  due  to  the  imagination,  is 
so  intimately  connected  with  the  first,  that  Ihcy  will  be  considered 
together  and  not  under  separate  divisions. 

It  is  said  to  be  as  difficult  to  define  Mesmerism,  or  animal  ma'jnet- 
ism,  as  it  is  to  believe  the  phenomena  ascribed  to  it ;  and  it  has  been 
observed  by  the  same  authority,  that  it  ditTers  from  common  magnetism 
as  much  as  natural  phenomena  do  from  supernatural.  It  is  not  even 
decided  whether  it  be  a  psychological  or  physiological  subject,  whe- 
ther it  belongs  to  the  clerical  or  medical  profession.  And  if  doctors 
have  differed  respecting  it,  so  have  divines  ;  for  while,  one*  has 
published  a  sermon  "  on  the  Satanic  agency  of  ^xlesmerism,"  another 
has  recently,  in  England,  issued  a  pamphlet  entitled,  "  Mesmerism 
the  Gift  of  God." 

Some  believers  have  pretended  to  trace  the  history  of  Mesmerism 
to  tlie  remotest  antiquity.  Indeed,  the  miracles  of  Moses  and  those 
performed  by  our  Saviour,  have  all  been  explained  by  reference  to 
this  agent,  by  some  of  the  followers  of  jMesmer,  in  France.  The 
holding  up  of  the  hands  of  the  patriarch,  when  Joshua  contended 
against  the  Amalekites,  and  the  imposition  of  the  hands  of  Christ 
upon  the  sick  on  some  occasions,  say  they,  were  acts  of  V^'smcrism. 
Cut  it  is  generally  admitted,  that  animal  magnetism  took  its  origin 
about  the  middle  of  the  last  century,  and  somewhat  after  the  follow- 
ing  manner:  Paracelsus,  Vax  IIelmont,  and  others,  having  in- 
vestigated the  singular  properties  of  the  magnet,  it  soon  became 
famous  as  a  curative  means.  A  certain  Jesuit,  named  Hell,  after 
curing  himself  of  rheumatism,  as  he  supposed,  by  this  agent,  excited 
the  ardent  imagination  of  .Mesmek,  then  residing  in  Vienna.  Mesmeii 
took  his  degree  in  that  city  in  177G,  and  wrote  a  thesis  on  the  influ- 
ence of  the  planets  on  the  human  body.  According  to  his  theory, 
all  the  phenomena  of  life  depend  upon  the  movements  of  a  mag- 
netic fluid  ;  and  by  |>ul)licly  maintaining  this  opinion  he  incurred  tho 
contempt  and  ridicule  of  his  own  coutitrymcn,  which  iiiduccd  him, 


  The  celebrate  J  Rev.  Mr.  T^eilf,  of  Liverpool. 


1"^  Mesmerism,  [April, 


with  other  considLTationJ^,  to  quit  Vienna  and  come  to  Paris.  Hav- 
ing created  a  gvawi  sensation  in  this  latter  capital  and  acquired  an 
immense  fortune,  the  king,  Louis  XVI.  ordered  in  1784,  a  commis- 
sion  from  the  Academy  of  Sciences,  from  the  Faculty  of  Medicine, 
and  the  Royal  Society  of  I\[edicinc,  to  examine  and  report  upon  this 
new  agent  employed  by  Mesmek  in  curing  diseases.  From  these 
three  scientific  bodies,  fourteen  persons  were  appointed,  and  among 
the  number  from  the  Academy,  were  Franklin,  Bailly  and  Lavoi- 
sier, names  inseparable  from  the  annals  of  science.  Mesmer  refused 
to  submit  to  this  commission,  and  declined  all  propositions  to  have 
the  subject  investigated.  They  then  had  recourse  to  his  acknow- 
ledged disciple,  lAI.  D'Eslon,  who  was  a  member  of  the  Medical 
'  Faculty  of  Paris,  and  was  one  of  the  first  converts  to  the  new  doc- 
trine. 

Every  week,  for  two  or  three  hours,  these  commissioners  experi- 
mented with  EsLON,  or  Deslon,  as  his  name  is  anglicised,  and  by 
themselves.  M.  Virey,  a  believer  in  Mesmerism,  as  any  one  may 
see  in  the  29th  vol.  of  the  Dlctionnaire  des  Sciences  Medicales, 
states,  tljat  they  felt  nothing  of  this  secret  agent  they  could  not 
recognize  the  slightest  sensation.  Children  did  not  experience  any 
thing  singular  when  experimented  upon.  When  they  bandaged  the 
eyes  of  a  patient,  and  then  persuaded  him  he  had  been  magnetized, 
but  without  doing  it,  he  exhibited  the  same  impressions  as  those  who 
had  been  subjected  to  it.  As  trees  were  also  magnetized  according 
to  Mesmer  and  Deslon,  they  bandaged  the  eyea  of  a  young  man, 
and  conducted  him  towards  one  non-magnetized  ;  upon  telling  him 
it  was  magnetized,  he  was  agitated  by  magnetic  convulsions.  All 
these  etTcctsthen,  ascribed  to  a  secret  pretended  agent,  they  concluded 
were  the  result  of  the  imagmation  :  and  the  commission  from  these 
learned  bodies  reported  that  animal  magnetism  was  a  chimera,  and 
that  the  magnetic  cures  were  the  effects  of  the  imagination.  This 
report  was  confirmed  by  every  member  of  the  commission,  except 
one,  M.  JussiEU,  who  did  admit  that  there  were  some  facts  which  in- 
duccd  him  to  believe  in  the  existence  of  a  particular  fluid,  which  ho 
compared  to  electricity  rather  than  to  magnetism.  lie  was  however, 
but  one,  out  of  fourteen. 

J.  BouiLLiAUD,  a  skeptic  on  the  subject,  and  at  present  one  of 
the  Professors  of  Medicine  in  Paris,  writes  concerning  this  same  re- 
port, that  the  ccmnissioners  acknowledged  that  those  who  pretended 
to  Mesmerize  patients  had  great  control  over  them.     But  this  com- 


1845.]  Mesmerism.  ITl 


mission,  of  which  the  celebrated  and  i:i  fortunate  Bailly  "vvas  the 
reporter,  concluded,  from  the  experiments  which  they  \vitnes.=^d  and 
from  those  they  made  themselves  1st,  that  there  existed  no  particu- 
lar fluid  which  deserved  the  name  of  magnetic  fluid  2d,  that  the 
facts  obtained  were  the  result  of  a  bewildered  (frappee)  imagination  ; 
since  from  their  experiments,  they  obtained  these  magnetic  effects 
without  magnetizing,  provided  the  patients  believed  they  had  been 
magnetized,  and  that  on  the  other  hand,  these  effects  did  not  occur 
when  the  patients  were  magnetized  without  their  guspcctirg  it  and 
Sd,  that  the  crisis  produced  in  the  magnetic  treatment  might  be  dan- 
gerous and  never  useful. 

In  the  article,  somnambulism  and  animal  magnetism,  written  by 
Dr.  J.  C.  Peicuard,  of  Edinburgh,  in  the  20th  part  of  the  Cyclopae-* 
dia  of  Practical  Medicine,  just  published,  will  be  found  the  following 
observations  respecting  this  celebrated  report  of  the  learned  societies 
of  Paris:     "The  commissioners  were  men  of  the  highest  authority 
in  science.     '''  *  *     They  saw  trees,  bottles,  glasses  and  cups  mag- 
netized.    *  We  cannot  prevent  ourselves,'  say  they  *  from  recognising 
in  these  constant  effects  a  powerful  agent,  which  acts  upon  patients, 
subdues  them,  and  of  which  the  person  who  magnetizes  them  seems 
to  be  the  depositary.'     The  commissioners  soon  discovered  that  it 
was  very  difficult  to  ascertain  to  what  point  the  results  produced 
were  the  cjj'ects  of  the  imagination,  to  the  excitement  of  which  so 
many  circumstances  were  adapted,  and  how  far  to  any  peculiar  agen- 
cy.    They    resorted    to  private  trials  of  the   same  manipulations. 
Some  of  the  most  interesting  of  these  experiments  were  performed  at 
Passy,  at  the  residence  of  Dr.  Franklin,  who  couM  not  be  present 
at  Paris  at  the  public  exhibition.     Here   Deslon    tried   his  art  in 
vain  upon  the  obdurate  American,  as  well  as  upon  the  members  of  his 
family,  who,  notwithstanding  that  some  of  them  were  ladies  in  del- 
icatc  health,  were  found  quite  insensible  to  the  whole  ceremonial  of 
magnetism.     Neither  cf  the  other  commissioners  could  perceive  anv 
effect  in  his  own  person."     Dr.  P.  then  relates  the  experiment  upon 
trees  said  to  be  magnetized,  with  a  boy  having  his  eyes  bandaged. 
This  youth   was   purposedly   selected  by    Dlslon,  as  an  individual 
susceptible  of  the  magnetic  influence.     This  gentleman  stood  in  the 
garden,  with  his  cane  pointed  to  the  magnetized  tree  to  keep  it  so, 
while  the  boy  approached  four  trees  successively.     Under  the  first, 
he  perspired  great  drops,  coughed,  expectorated,  and  felt  pain  in  his 
head  being  then  27  feet  from  the  magnetized  tree.     Under  the  se- 


17\J  Mesmerism,  [April, 


coiid  he  felt  stupor,  dec;  under  the  third,  these  symptoms  greatly  in- 
creased ;  the  youth  believing  he  was  a|)proacl)ing  the  magnetized 
tree,  though  in  reality  distant  83  feet  from  it.  Under  the  (ourth,  not 
magnetized,  but  24  feet  from  the  tree  pointed  at,  he  fell  into  a  crisis. 
"  He  lost  all  consciousness,  was  carried  to  a  neighbouring  grass-plot, 
where  Deslox  scon  reanimated  him.  The  operator  accounted 
for  this  untoward  phenomenon  by  saying  that  the  trees  had  probably 
become  spontaneously  magnetic.  'But,  rejoined  the  commissioners, 
if  trees  are  in  the  dangerous  habit  of  assuming  this  state  of  their 
own  accord,  a  susceptible  person  walking  in  a  garden  must  incur 
the  continual  risk  of  falling  into  a  crisis.' 

"  The  commissioners,"  continues  Dr.  Prichard,  "  having  repeated 
and  varied  the  experiments  in  every  way  that  seemed  to  afford  an 
opportunity  ot  arriving  at  the  truth,  at  length  came  to  the  conclusion 
that  the  whole  proceedings  of  the  magnetizers  were  calculated  in 
several  ways  to  do  injury;  that  they  were  devoid  of  any  salutary  or 
useful  influence,  and  that  the  results  were  wholly  to  be  attribu- 
ted  to  the  imagination  and  other  feelings^  which  were  excited  by  the 
performances.  ]\I.  Jussieu,  however,  refused  to  coincide  in  the  re- 
port, and  returned  one  of  his  own,  which,  though  by  no  means  favor- 
able to  Mesnier,  and  explaining  most  of  the  results  in  the  same  man- 
ner as  M.  Bailly  had  done,  yet  admitted  that  in  four  particular  ex- 
periments, he  could  not  account  for  the  results  by  attributing  them 
to  the  imagination.  He  proposed  an  hypothesis  of  his  own,  viz.  that 
animal  heat,  or,  as  he  termed  it,  '  the  electric  fluid  animalized,'  direct- 
ed and  accumulated  on  certain  parts,  may  be  the  cause  of  the  effects 
produced." 

It  is  proper  to  state,  that  in  addition  to  this  report,  a  private  one 
was  sent  by  these  commissioners  to  the  king,  referring  to  the  liability 
of  abuse  on  the  subject  of  Mesmerism.  And  indeed  one  would  sup- 
pose something  of  the  kind  was  necessary  even  thus  early,  as  the 
following  anecdote,  known  to  all  Paris  at  the  time,  will  explain  :  *'Un 
satyriasis  survint  subitement  a  un  monsieur,  a  la  vue  d'une  jeuno 
demoiselle  qui  etait  avec  sa  mere;  les  choses  allaient  si  loin,  que  la 
merese  leva  pour  y  mettre  ordre;  mais  M.  d'Eslon  s'ecria  ;  Laissez 
les  faire  ou  ils  mourront."  To  say  nothing  of  this  gross  violation  of 
decency  and  morality,  we  have  here  certainly  a  striking  instance  of 
sympathy  on  the  part  of  the  mesmeriser  for  the  sensual  acts  of  the 
mesmerised. 

You  have  now,  gentlemen,  the  conclusions  of  this  famous  report  of 


1845.J  Mesmerism.  173 


the  Royal  commission  of  France,  made  in  1784,  and  in  the  very- 
words  of  three  dififerent  persons  under  different  circumstances,  viz: 
by  ViREY,  a  believer  in  Mesmerism;  Bouilliaud,  a  skeptic;  and 
Prichard,  who  may  be  considered  neither  the  one  nor  the  other. 
If  what  has  been  stated  respecting  the  decisions  made  by  the  scientific 
Societies  of  Paris  be  true  and  that  it  is  correct  no  one  will  pretend 
to  deny  we  find,  in  the  first  place,  that  Mesmer  acted  the  part  of 
all  quacks  and  impostors,  by  refusing  to  have  his  pretended  magnetic 
fluid  examined  by  those  most  competent  to  judge  of  its  virtues,  and 
therefore,  if  true,  to  give  it  character;  and,  secondly,  that  after  a 
patient  investigation  of  the  subject  of  Mesmerism,  varying  and  re- 
peating experiments  in  every  possible  way  which  promised  to  arrive 
at  truth,  by  fourteen  individuals  selected  for  the  purpose  from  three 
of  as  learned  bodies  as  then  existed  in  the  world,  they  pronounced 
animal  magnetism  a  chimera.  Not  one  made  a  report  favorable  to 
Mesmer,  and  only  one,  M.  Jussieu,  refused  to  admit  that  the  opera- 
tions of  the  imagination  could  explain  all  they  had  seen.  He  classed 
all  the  phenomena  which  he  had  observed  under  the  foir  heads:  
1st.  those  general  facts  of  which  physiology  could  indicate  the  true 
cause  with  precision  ;  2nd.  negative  or  facts  contrary  to  animal  mag- 
netism; 3rd.  those  attributed  to  the  imagination;  and,  4th.  facts 
which  induced  him  to  admit  the  existence  of  a  particular  fluid.  He 
then  states  the  case  of  a  blind  v/oman  who  was  agitated  when  a  rod, 
leading  from  a  tub,  which  could  neither  generate  nor  retain  magnet- 
ism  or  electricity,  was  pointed  at  her  stomach,  and  which  ceased  when 
said  rod  was  turned  aside.  Virey  remarks,  that  Jussieu  did  not  say 
whether  the  blind  person  was  prejudiced  in  favor  of  animal  magnet- 
ism or  not,  for  this  idea  is  often  every  thing  in  these  delicafe  obser- 
vations. Several  other  facts,  continues  he,  analogous  to  this  one, 
(viz.  the  agitation  of  a  blind  woman  when  her  stomach  was  pointed 
at  with  an  iron  rod,)  induced  Jussieu  to  presume  that  there  really 
did  escape  from  the  human  body,  under  certain  circumstances,  a 
fluid,  which  he  compared  to  that  of  electricity,  rather  than  to  a  mag- 
netic fluid,  tint  yet  demonsiraled. 

From  this  slender  pretext,  the  impression  is  made  that  one  of  the 
members  of  the  French  commission  was  in  favor  of  Mesmerism  ;  and, 
moreover,  that  ho  was  one  of  some  (bur  or  five  commissioners 
appointed  by  the  King  of  France;  whereas,  the  truth  is,  not  ono 
believed  that  animal  magnetism  had  been  demonstrated,  and  there 
were  not  less  than  fourteen  individuals  who  were  associated  in  tlir 


174  Mesmerism,  [April, 


invcstlrration  of  the  subject,  and  not  from  one,  but  from  three  difTcrent 
Societies.  Notwithstanding  these  facts,  strange  as  it  may  appear, 
some  believers  in  Mesmerism  are  in  the  habit  of  referring  to  this  very 
report,  as  authority  fur  their  fliith  ;  because,  say  they,  the  commis- 
sioners acknowledged  constant  and  powerful  cfTects  upon  patients, 
the  agency  of  which  seemed  to  be  deposited  with  those  who  liad 
magnetized  them.  I  have  cetected,  however,  that  tl.e  word  seem, 
was  very  apt  to  be  omitted;  and  the  quotation  itself  not  comi)leted. 
The  commissioners  expressly  state,  that  this  agent  acting  upon  these 
patients  was  none  other  than  the  imagination.  They  never  thought 
of  attributing  these  effects  to  Mesmerism.  They  declared,  unani- 
mously,  they  had  never  felt  it  that  it  had  net  been  demonstrated  to 
them  :  they  condemned  Prliis^iER  in  fofo. 

Now  Vr'hat  were  these  efTects  which  this  commission  witnessed,  and 
wliieh  they,  with  so  much  unanimity,  attributed  to  the  imagination 
and  other  feelings  excited  by  the  performance  of  the  mugnetizers  ? 
Precisely  those  that  are  credited  at  the  present  day.  Besides  cough- 
ing,  pains,  tremors,  convulsions,  involuntary  movements,  &c.  &c.  
they  say  that  every  thing  depended  upon  the  will  of  the  magnetizer  ; 
were  the  patients  in  an  apparently  deep  sleep,  his  voice,  a  look,  a  sign, 
(\ve\v  them  out  of  it.  They  also  saw  a  young  man,  very  impressible 
by  the  magnetic  iniluence,  who  not  only  coughed,  e::pcctorated,  per- 
spired great  drops  cfsweat,  felt  pain  in  his  head,  had  stupor,  fell  into 
a  crisis,  and  lost  all  consciousness,  and  simply  because  he  believed  he 
was  approaching  a  tree  said  to  be  magnetized.  Having  lost  all  con- 
sciousness, of  course  this  youth  was  insensible  to  pain.  A  similar 
state,  unconsciousness  and  insensibility  to  pain,  is  now  produced  by 
a  look,  or  a  few  passes  with  the  hands,  for  some  seconds,  or  at  most,  a 
few  minutes.  In  the  former  case,  a  Fr.AMiLiN,  a  I5ailly,  a  Lavois- 
ier, a  GuiLLCTirf.  a  Jussief,  and  others  of  the  highest  authority  in 
Science,  attributed  it  wholly  to  the  imagination  and  other  feelings 
excited  ;  and  as  to  the  latter  instance,  Gentlemen,  while  others  may 
difier,  I  really  do  not  think  we  can  do  better,  than  follow  their  illus- 
trious example  two  effects,  so  similar,  cannot  be  very  remote  in  the 
cause  producing  them. 

We  now  leave  this  report,  of  which  so  much  of  late  has  been  said, 
and  allow  believers  in  Mesmerism  to  draw  v.hat  consolation  or  en- 
couragement they  can  from  these  undeniable  and  indisputable  Hicts, 
for  so  far  as  its  conclusions  are  concerned,  I  have,  in  all  honesty  and 
candor;  given  you  the  truth,  the  whole  truth,  and  nothing  but  the  truth. 


1845.]  Mesmerism,  1T5 

In  1831,  the  subject  of  Mesmerism  was  agitated  in  the  Royal  Acad- 
emy of  Medicine  in  Paris,  and  M.  Hussox  made  a  very  favorable 
report  respecting  it  even  admitting  its  extensive  influence ;  but 
wiiich  was  ably  criticised  by  31.  Dubois,  (D'Amiens).  This,  liowe- 
ver,  had  nothing  to  do  witli  the  Academy  of  Sciences,  or  Faculty  of 
Medicine,  in  that  city  :  and  even  the  report  of  M.  llussox  was  not 
adopted  by  the  Royal  Academy  of  Bledicine,  but  simply  read  to  that 
body. 

In  1841,  appeared  a  work  entitled  the  Academic  History  of  Ani- 
mal Magnetism,  and  wriiten  i)y  Drs.  Burbix  and  Dubois,  members 
of  the  Royal  Academy  of  Medicine  of  Paris.  "  These  authors," 
says  Dr.  Ja^ies  JoII^-sox,  the  celebrated  Reviewer,  "endeavor 
to  establish  a  connection  between  all  the  leading  juggleries  which 
from  one  age  to  another  have  made  their  appearance  in  the 
world.  They  carry  the  reader,  without  any  forced  transition, 
from  the  oracles  of  antiquity  to  the  witchcraft  of  the  middle  ages, 
from  the  devotees  of  London  to  the  tremblers  of  Cevennes,  from  the 
convulsionists  of  St.  Medard  to  the  exorcisms  of  Gassner,  and  lastly 
to3Iesmerism,  which  the  true  believers  point  to  us  as  the  era  of  the 
doctrine  of  animal  magnetism."  They  moreover  declare  that  the 
report  of  M.  Husson,  already  referred  to,  was  neither  discussed  nor 
approved  of  by  their  learned  Society. 

Tiie  only  other  instance  that  I  knov/  of  since  1784,  in  which  animal 
magnetism  was  alluded  to  in  the  Academy  of  Sciences,  the  most 
learned  body  in  the  world,  occurred  the  24th  of  June,  1841.  It  was 
contained  in  a  report  read  by  the  distinguished  physiologist,  M.  Ma- 
gendip:,  on  a  case  of  alleged  cure  of  a  deaf  and  dumb  woman,  made 
by  ?.r.  DupoTET.  As  the  exact  condition  of  this  patient,  a  female, 
was  not  ascertained  before  being  subjected  to  this  supposed  agent, 
the  commission  could  not  vouch  for  the  cure,  even  had  it  been  com- 
plete ''but  unfortunately  for  both  patient  and  doctor,  it  was  far 
from  being  so."  They  took  three  inmates  of  one  of  the  deaf  and 
dumb  institutions  of  Paris,  and  proposed  to  M.  Dupotet  to  test  the 
cflicacy  of  his  treatment ;  to  this  he  consented.  He  asked  for  only 
eight  days;  they  gave  him  fifteen.  At  the  end  of  the  eighth  day 
M.  D.  represented  them  as  cured,  but  the  regular  physician  of  the 
Institution  from  which  they  were  obtained,  told  the  commissioners 
that  the  amendment  was  in  no  respect  dilfcrent  from  what  mi'i^ht  at 
any  lime  be  atfocted,  by  proper  exercise,  v^c,  of  the  organs  of  hearing", 
but  which  continues   fur  a  sl.ort   time.     They  then  proposed  to  M. 


173  Mesmerism,  [A.pril, 


DupoTET  to  send  the  three  patients  three  times  a  week  to  his  own 
liouse,  to  complete  the  promised  cure,  hut  he  declined  giving  any  an- 
i^wer.  The  commission  therefore  concluded,  the  cure  alleged  to  have 
heen  efTected  by  animal  magnetism  on  a  deaf  and  dumb  patient,  is 
c  uite  without  foundation. 

Dr.  JoHXsox  says  that  at  a  subsequent  meeting  of  the  Academy 
of  Sciences,  they  resolved  by  a  largemcjorify  to  have  nothing  more 
to  do  with  the  subject  of  Mesmerism.  I\I.  CLoauET,  and  even  M. 
I>ouiLLiAUD,  objecting  to  this  summary  dismissal  of  it,  when  M. 
BinisciiET  stated  that  as  that  body  had  come  to  a  resolution  to  pro- 
ceed  to  the  order  of  the  diy,  whenever  the  question  of  the  quadra- 
ture of  the  circle  or  perpetual  motion  was  brought  forward,  tho 
Fui)ject  of  animal  magnetism  should  be  dealt  with  by  them  in  the 
same  way.  This  I  believe  was  the  final  action  of  that  most  distin- 
guished Society  on  the  subject  of  Mesmerism. 

On  Sunday,  tlie  1st  April,  1829,  M.  Jules  Cloquet,  one  of  the 
Professors  of  Surgery  in  Paris,  removed  a  cancerous  breast  from  a 
patient,  in  that  city,  while  in  what  is  called  the  mesmeric  state.  She 
was  a  pious  lady,  of  excellent  character.  She  evinced  no  pain 
during  the  operation  indeed  the  Ilermcs,  a  journal  of  animal  mag- 
netism, states  that  when  the  surgeon  was  washing  the  wound,  the 
patient  said  merrily,  "come,  leave  off  don't  tickle  me."  She  died 
a  fortnight  after  the  operation  ;  and  a  report  having  reached  England, 
that  while  dying  she  confessed  the  whole  had  been  a  cheat.  Dr.  El- 
LioTsor^',  who  was  ejected  from  a  professorship  in  the  London  Univer- 
sity, for  his  belief  in  animal  magnetism,  wrote  to  Cloquet  on  the 
subject,  and  who  replied,  (so  says  Dr.  ELLioTsorf's  student  in  Paris,) 
he  "is  quite  certain  she  never  made  the  confession  alluded  to." 

On  the  22d  November,  1843,  the  subject  of  P.Iesmerism  was  in- 
troduced  into  the  Royal  Medico-Chirurgical  Society  of  London,  by 
Counsellor  ToniAJi,  relating  the  case  of  an  amputation  of  the  thigh 
of  a  laboring  man,  who  was  in  the  mesmeric  condition.  Lawyer  T. 
was  backed  by  Dr.  Elliotson,  and  in  the  account  published  of  it 
by  the  latter  gentleman,  it  is  stated  that  *'soon  after  the  second  in- 
cision, a  moaning  was  heard  from  the  patient,  which  continued  at 
intervals  until  the  conclusion  ;  giving  to  all  present  the  iinpression 
of  a  disturbed  dream.  When  the  patient  awoke,  graduallj''  and 
calmly,  at  first,  he  uttered  no  exclamation  ;  and  for  some  moments 
seemed  lost  and  bewildered,  but  after  looking  around,  he  exclaimed, 
'  /  bless  the  Lord,  to  find  it  '5  all  over.''     When  questioned,  he  observ. 


1845.]  Mesmerism,  17' 


ed,  he  felt  no  pain,  but  once  '  felt  as  if  he  heard  a  kind  of  crunch- 
ing.^ ^^  As  all  in  the  mesmeric  state  are  poeti'-al,  this  last  expres- 
sion has  been  interpreted  to  mean,  he  heard  the  sawing  of  the  hone. 
But  the  proof  that  this  man  knew  what  was  fjoing  on  at  the  time, 
the  operator,  a  Mr.  Ward,  stated  he  designedly  [)inched  the  sciatic 
nerve  with  a  pair  of  forceps;  and  had  the  patient  been  even  decapi- 
tated, Dr.  Marshall  Hall  says  his  opposite  limb  would  have  been 
agitated  a  fact  which  you,  Gentlemen,  saw  illustrated  a  few  days 
ago,  in  the  partial  amputation  of  a  foot.*  Dr.  Hall  concludes  from 
this  circumstance,  that  the  quiescence  of  the  man  during  the  opera- 
tion was  the  effort  of  his  mind  to  control  his  suffering.  In  the  dis- 
cussion which  ensued  on  the  presentation  of  this  case  to  the  Royal 
Medico-Chirurgical  Society,  we  find  that  besides  Dr.  Elliotson, 
Drs.  Arxot,  Oliver  and  Sysies,  were  the  advocates  of  Mesmerism, 
and  those  who  opposed  it  were  Ja3Ies  Joit^soN,  Marshall  Hall, 
MooRE,  Blake,  George  Burrows,  Copland,  Grkgory,  Evans, 
Merriman,  Sir  Benvamix  Brodie,  Alcock,  Travers,  Listox, 
Wakley,  Editor  of  the  Lancet,  Cesar  Hawkins,  &;c.  It  need 
scarce  be  added,  that  animal  magnetism  was  peremptorily  dismiss- 
ed from  the  Society. 

In  the  two  patients  operated  upon  in  the  Mesmeric  state,  the  one 
recently  in  this  city,  and  the  other  in  Europe,  we  notice  this  differ- 
ence. The  one,  when  roused,  and  after  collecting  himself,  said,  "  I 
bless  the  Lord  to  find  that  it  is  all  over;"  but  the  other,  after  she 
awaked,  conversed  concerning  her  amputated  breast,  "  about  a  quar- 
ter of  an  hour,"  replied,  when  asked,  that  "it  feels  about  as  it  has 
done  for  some  time  l)ack,"  and  this,  too,  notwithstanding  the  Mes- 
meriser's  passes  over  the  scat  of  the  operation,  in  order  to  lessen  its 
sensibility,  and  yet  "slie  expressed  her  incredulity  said  the  operator 
was  jesting,  as  it  ^vas  impossible  that  it  could  have  been  done  without 
her  knowing  it  at  the  time,  or  feeling  any  thing  of  it  now.  She  be- 
came convinced  only  on  carrying  her  hand  to  the  part  and  findinrr 
that  the  breast  was  no  longer  there.'  'J'his  surely  is  the  most  as- 
tounding part  of  the  whole  operation.  That  she  was  insensible  to 
the  knife  is  certainly  nothing  compared  to  the  fact,  that  after  beinfr 
aroused  from  the   "Mesmeric   state,"   and   saying  distinctly   when 


  I  know  Dr.  E.  has  attempted  to  deny  this  reflexed  action  in  the  opposite  limb   
but  the  profession  need  only  be  reminded  of  the  fact,  that  the  uniform  practice^ 
until  a  lew  years  agjo,  was  to  tie  the  opposite  Urn!)  to  a  le;^  of  the  table,  to  iircvent 
this  very  movement  or  agitation,  during  amputation. 

12 


178  Mesmerism.  [April, 

questioned  too,  that  the  breast  felt  about  as  it  had  done  for  sometime 
back,  admitted  she  did  not  perceive  any  change  in  the  ordinary  sen- 
sation oithe  affected  breast,  conversoH  about  it  for  ^ifr.en  rpinutes, 
and  still  did  not  know  the  opera:ion  had  baen  periornied.  With  me 
this  is  the  greater  wonder  of  the  two,  and  is  proof  positive  of  the  ex- 
tent to  which  this  patient  was  deceived  by  her  own  sensations.  She 
declared  she  felt  no  Mesmeric  influence  in  the  breast,  notwithstand- 
ing the  passes  had  been  applied,  by  a  Mesmeriser;  and  then  again 
while  in  possession  of  her  natural  feeling  in  the  breast,  did  not  know 
for  about  fifteen  minutes  it  had  been  cut  off,  even  after  having  been 
aroused  from  the  Mesmeric  state.  If  this  be  not  proof  of  the  effects 
of  the  imagination,  or  of  the  operations  of  the  mind,  in  this  instance, 
controlling  the  ordinary  sensations,  then  I  know  not  where  we  can 
find  it.  This  lady  was  evidently  in  a  trance,  or  reverie,  brought  on 
by  the  workings  of  her  own  feelings  just  like  the  boy  who  lost  all 
consciousness,  from  believing  he  was  approaching  a  tree  said  to  be 
Mesmerised.  And  yet  this  one  case,  has  made  hundreds  of  believers 
to  Mesmerism. 

Who  does  not  recollect  the  incident  of  an  actor  on  the  stage  of 
Liverpool,  falling  dead  upon  uttering  the  words,  in  the  play  of  the 
Stranger,  "  There  is  another  and  a  better  world  ?"  To  what  was 
this  melancholy  and  unexpected  event  owing,  but  the  yielding  to  the 
impulse  and  energy  of  his  own  feelings?  How  often  have  hysterics, 
syncope,  &c.,  been  brought  on  by  patients  themselves  ? 

But  not  only  by  learned  societies  has  Mesmerism  been  invariably 
rejected,  it  has  almost  universally  met  the  same  fate  from  distin- 
guished men  in  every  country.  With  a  few  exceptions,  such  as 
CuviER,  RosTAiv,  Hussor^,  Bertrand,  &c.,  in  France;  Hufela^d, 
in  Prussia ;  Elliotson,  in  England,  &;c.,  animal  magnetism  has 
uniformly  received  but  little  favor  from  scientific  persons. 

Renauldix,  says,  "as  to  Mesmerism,  animal  magnetism,  som- 
nambulism, real  or  simulated,  or  Perkinism  and  other  modern  inven- 
tions of  charlatanry  and  of  bad  faith,  if  in  some  cases,  these  means, 
equally  disavowed  by  reason  and  experience,  have  appeared  to  give 
some  favorable  influence  to  pain,  it  is  evidently  in  individuals  who 
have  a  blind  confidence  or  a  credulity  without  limit,  and  disposed  by 
prejudice  to  receive  an  alleviation  desired  with  ardor." 

We  have  already  given  the  names  of  several  distinguished  men  of 
Great  Britain,  and  no  doubt  the  list  could  be  greatly  augmented.  To 
it  we  add  the  name  of  Sir  Astley  Cooper.     And  if  in  the  British 


1845.]  Mesmerism,  179 


realm  there  be  one  man  who  stands,  more  deservedly  higher  in  char- 
acter, us  a  physician  and  a  writer,  it  is  Dr.  James  Joiixsox,  of  the 
Medico-Chiriirgical  Review,  and  who  has  on  every  suitable  occasion 
been  the  uncompromising  and  unremitting  opponent  of  Mesmerism.* 
Brachet,  a  distinguished  author  in  Paris,  who  has  published 
largely  on  nervous  affections,  &c.  writes,  "  from  the  magnetism  of 
MssMERhas  arisen  that  other  jugglery,  denominated  animal  magnet- 
ism. Twenty  times  beaten  doum  by  science,  and  reason  and  facls^ 
every  now  and  then  it  has  again  lifted  up  its  head,  more  ridiculous 
and  amusing,  indeed,  than  dangerous.  We  do  not,  however,  mean 
to  deny  the  effects  which  may  be  induced  in  persons  of  highly  nerv- 
ous constitutions,  by  the  passes  and  other  grimaces  that  are  usually 
practiced,  in  the  magnetic  stupor  of  the  animal  energies  that  is 
sometimes  induced,  the  entire  nervous  system  is  compromised  ;  and 
this  influence  may  unquestionably  appease  pain  and  spasmodic  con- 
tractions for  a  time,  by  acting  pov/erfully  on  the  imagination."  He 
then  states  that  although  he  has  heard  of  such  cases,  he  has  not  him- 
self met  with  any  well-authenticated  examples.  "These  distant 
voyages,"  continues  M.  Beaciiet,  "without  moving  from  off  one's 
chair,  these  divinations,  these  transpositions  of  the  senses,  (kc  ,  are 
only  so  many  clever  tricks,  contrived  to  amuse  the  weak  and  entrap 
the  foolish.  It  may  happen  that  a  poor  silly  hypochondriac,  who  is 
strongly  prepossessed  in  favor  of  tliis  culpable  jugglery,  appears  for 


  Take  but  his  last  blow  at  this  subject,  and  which  is  the  last  article  in  the 
last  No.  (99)  of  the  London  Medico-Chirurgical  Review.  Ridicule  I  know  is 
not  argument,  and  neither  are  opinions,  facts.  I  grive  this  in  proof  of  great 
men,  in  the  medical  profession,  being  opposed  to  Mesmerism.  Let  it  pass  for 
what  it  is  worth. 

''  M  sMf  rism.  We  do  not  know  whether  to  congratulate,  or  condole  with,  the 
talented  Heroine  of  Political  Economv  on  the  strange  dream  that  has  come 
over  her  soul.  It  appears  that  Mi.ss  Martineau  recovered  her  health  and  we 
were  nearly  saying lost  her  senses!  But  tliis  is  not  the  case  she  hasacquired 
an  additional  sense  clairvovanck!  Her  maid,  Bktty,  placed  her  hand  on  her 
mistress's  ivory  forehead,  and,  presto,  a  Stkam-Tlu  that  was  passing,  became 
metamorphozei  into  a  ship  of  celestial  glory,  fringed  with  gola  and  silver,  and 
fit  to  be  *  a  God-head's  dwelling.' 

It's  all  in  my  eye,  Betty  Martin  eau. 
Betty,  however,  is  no  fool.  She  prescribed  ale  and  brandy  and  water  to  her  mis- 
tress, instead  of  opium  eating,  and  the  change  resulted  in  the  best  efi'ect.  Har- 
riet's Mesmeric  dreams  will  prove  a  god-send  to  the  animal  magnetizers,  and 
will  command  more  attention  among  the  old  women  of  both  sexes  than  her  Po- 
litical Economy  and  her  'Preventive  Checks.'     Bin  it  won't  do! 

"  It  will  be  the  wonder  of  the  day  perhaps  of  nine  dayh  and  then  sink  uito 
oblivion  with  the  exploits  of  Mi^s  Okcy." 


180  Mesmerism,  [April, 


a  timo  to  derive  some  benefit  to  his  lirnlth  ;  but  then  it  is  only  from 
his  becoming  the  (iupc  of  his  crediMous  fancy,  and  not  from  any  direct 
or  actual  sanative  influence  bestowed." 

In  concluding  the  above  transhilion  from  the  French,  Dr.  Jonis'- 
soN  says,  that  "  we  observe,  in  a  recent  number  of  the  Medical  Ga- 
zette, (a  Journal  of  Paris,)  a  quotation  to  the  same  efTect,  of  the 
opinions  of  the  celebrated  riiiller,  of  Berlin,  on  the  subject  of  animal 
mngnctism.  How  long  will  any  men  of  education  allow  themselves 
to  be  imposed  upon  by  the  juggling  tricks  of  clever  rogues,  and  paid- 
for  testimony  of  credulous  women  ?  Medical  men,  at  all  events, 
should  know  better :  for  they  must  have  studied  the  history  of  the 
nervous  system  and  its  functions  only  indifferently  well,  not  to  be 
aware  that  many  startling,  and  not  easily  explicable,  phenomena  arc 
apt  to  occur  during  the  progress  of  some  of  the  neuroses."* 

It  is  licquently  asked,  and  with  an  air  of  triumph,  by  believers  in 
Mesmerism,  will  yon  deny  facts?  No,  Gentlemen,  these  are  said  to 
be  stubborn  things,  and  we  do  not  wish  to  run  counter  to  them. 
But  what  we  do  deny  is,  that  all  are  not  facts  w hich  are  represented 
to  be  such,  and  this  Mesmerists  must  admit  themselves.  Ask  any 
one  why  he  believes  in  animal  magnetism,  and  he  will  tell  you,  be- 
cause I  have  seen  so  many  facts  I  cannot  doubt  its  existence.  Request 
of  this  same  person  an  explanation  of  the  phenomena  he  has  wit- 
nessed on  this  subject,  and  he  will  reply,  I  have  observed  so  few 
facts  1  can  give  none.     That  is,  he  has  facts  enough  for  his  senses 


  Benjamin  Franklin's  Estimate  of  Animal  Magnetism.  Franklin  Avrites 
thus,  to  M, De  la  Condamine: 

"You  desire  my  sentiments  concerning  the  cures  performed  by  Camus  and 
Mesmer.  I  think,  in  geneixl,  maladies  caui-cd  Ly  ol>tir.ciions,  may  le  Heeled 
by  electricity  with  advantage.  As  to  the  Animal  Magnetism,  so  much  talked 
of.  1  must  doubt  its  existence  till  I  can  sec  or  J'ecl  !-ome  cficct  ol  it.  ]None  ol  the 
cures  said  to  be  performed  by  it  have  fallen  under  my  observation,  and  there 
being  so  many  disorders  which  cure  themselves,  and  such  a  disj-osition  in  man- 
kind to  deceive  themselves  and  one  another,  on  these  occasions,  andlivinglong, 
has  given  me  so  frequent  opportunities  of  seeing  certain  remedies  cried  up  as 
curing  ever}''  thing,  and  yet  soon  alter  laid  aside  as  useless,  I  cannot  but  fear 
that  tlie  expectation  of  great  advantage  from  this  new  method  of  treating  dis- 
eases will  prove  a  delusion.  That  dehision  may,  however,  in  some  cases  be  of 
use  while  it  lasts.  There  are  in  every  great,  rich  city,  a  number  of  persons 
who  are  never  in  health,  because  they  are  fond  of  medicines,  and  always  taking 
them,  whereby  they  derange  the  natural  functions,  and  hurt  their  constitution. 
If  these  people  can  be  persuaded  to  forbear  these  doings,  in  expectation  ol  being 
cured  by  only  the  physician's  linger,  or  an  iron  rod  pointing  at  them,  they  may 
DDSsiblvfind  goodettects,  though  they  mistake  the  cause. 

"  I  have  the  honor  to  be,  &c.  B.  FRANKLIN." 

(nublin  Med.  Press,  July  2\st,  1841.) 


1845.]  Mesmerism.  1^1 


to  admit  a  thinff,  but  not  enough  for  him  to  exercise  his  reason. 
Now,  upon  what  sense  can  we  rely?  Is  it  not  true  that  courts  of 
justice  are  chiefly  sustained  by  errors  of  sight  and  hearing;,  and  that 
perver.ed  sensation  and  imaginary  diseases  feed  and  clothe  the  med- 
ical profession  ?  How  often  iias  even  lithotomy  been  performed 
where  no  stone  existed  ? 

Another  question  often  proposed  by  Mesmerists  is,  will  you  doubt 
your  senses?  If  I  receive  an  impression,  by  the  exercise  of  one 
sense  only,  and  this  act  be  contradicted  by  reason  and  judgment, 
then  I  should  not  credit  it,  Ijecause  I  know  how  liable  one  sense  is 
to  deceive  me.  But  if  by  the  question  so  often  asked,  is  meant  the 
senses,  then,  I  answer,  no,  I  do  not  (in  general)  doubt  them.  And 
upon  this  very  principle,  I  cannot  believe  in  Mesmerism  ;  for  it  has 
never  been  presented  to  my  mind  through  the  senses.  Like  the 
commissioners  appointed  by  the  King  of  France,  I  have  never  been 
able  to  perceive  any  ertbcts  in  my  own  person  or  in  that  of  another, 
which  could  not  be  otherwise  explained.  I  have  tried  until  satisfied 
that  nothing  unnatural  could  be  i)r()di:ced.  I  have  had  professed 
magnetizers  to  labor  by  the  hour  on  patients,  and  on  some  too  very 
anxious  to  be  put  into  the  Mesmeric  state,  and  still  no  relief  or  miti- 
gation of  pain  whatever  was  induced  before  the  knife  was  employed. 
Some  indeed  have  gone  to  sleep,  but  a  word  or  j)rick  of  a  pin  has 
sulliced  to  arouse  them.  And  I  know  and  have  heard  of  patient 
after  patient,  where  ah  the  ceremonials  of  animal  magnetism  have 
been  industriously  employed,  without  producing  the  expected  effects. 
Nor  have  the  promise  of  my  Mesmerising  friends  been  at  all  realized. 
True,  I  witnessed  on  one  occasion  what  produced  extacies  in  some 
of  them,  until  the  Mesmerised  boy  by  indication  exhibited  the  organ 
of  comhalii'cness^  from  touching  the  tips  of  his  shoulders.  I  have 
been  asked  several  times  since  if  I  would  like  to  witness  the  I\Iesmer- 
ic  phenomena,  and  I  have  replied  that  I  was  a  searcher  after  truth 
on  the  subject.  I  have  heard,  and  that  too  very  recently,  of  IMes- 
meric  soirees  or  parties,  at  which  I  am  told  some  of  you  were  actors, 
as  well  as  spectators,  but  as  I  was  not  invited,  it  is  presumed  the  experi- 
ments were  not  satisfactory.  Perhaps,  indeed,  my  skepticism  might 
have  made  me  an  unwelcome  visiter.     But  this  much  is  due  to  truth. 

But  slill  you  may  ask  me,  shall  I  not  believe  my  senses?  Cer- 
tainly, my  professional  brother,  you  are  the  best  judge  of  your 
own  perceptions.  And  pray,  let  me  ask,  whnt  have  you  experienced 
on  this  subject  ?     Ilav.-^  yr.ii  oven  recognized  it  by  any  four,  or  three, 


182  Mesmerism,  [April, 


aye,  even  two  of  the  senses?  If  so,  I  beseech  you  relieve  the  world 
of  the  anxiety  on  the  suhject  settle  the  question  at  once  of  its  ex- 
istence, by  telling  what  it  is.  But  can  animal  magnetism  abide  this 
test?  If  not,  and  there  are  still  difficulties  in  the  way,  mysteries  and 
contradictory  evidence,  yet  unexplained,  it  is  the  part  of  wisdom  to 
scrutinize  more  closely  and  delay  a  decision  favorable  to  its  existence. 
In  proportion  to  the  improbability  of  a  thing,  should  be  our  skepti- 
cism. The  more  extraordinary  the  phenomena,  the  more  irrecon- 
cilable the  fact,  the  greater  the  liability  to  error.  Voltaire  says, 
to  believe  a  miracle,  (and  what  is  the  conversion  of  water  into  wine 
compared  to  some  of  the  so-called  facts  of  Mesmerism,)  it  is  not  suf- 
ficient to  have  seen  it,  for  we  may  be  deceived.  To  be  well  established, 
it  ought  to  be  performed  in  the  Academy  of  Sciences  of  Paris,  or 
in  the  Royal  Society  of  London.  Now  it  has  so  happened  that  both 
these  learned  and  scientific  bodies,  as  we  have  already  observed,  did 
publicly  and  with  great  unanimity  condemn  Mesmerism. 

In  accounting  for  the  facts  ascribed  to  animal  magnetism,  and  in 
presenting  my  views  on  tliis  subject,  I  adopt  the  opinions  of  J.  Bou- 
ILLAUD,  and  reduce  all  phenomena  that  we  observed  to  two  classes 
or  orders  ;  1st,  disturbed  sleep,  gaping,  convulsive  movements,  deep 
sleep,  somnambulism  wilh  insensibility  more  or  less  marked,  shout- 
ings, laughters,  &;c.  These,  says  he,  do  not  depend  u'pon  Mesmerism, 
since  it  is  known  that  all  these  can  be  manifested  by  individuals  who 
have  not  been  subjected  to  that  influence,  and  are  the  effects  either  of 
certain  lesions  of  the  nervous  syslem,  or  simply  the  influence  of  cer- 
tain impressions  or  moral  feelings.  The  second  order  of  phenomena, 
continues  he,  cannot  be  classed  wilh  facts  admitted  at  the  present  day 
 they  are  entirely  contradictory  to  |)hysioIogifa!  truths  the  most 
evident  and  clearly  demonstrated  those  are  sight  without  the  eyes, 
at  the  epigastrium,  the  end  of  the  fingers,  tlie  occiput,  the  forehead  ; 
prophecy  ;  divination;  determining  the  seat  and  treatment  of  dis- 
eases by  those,  who  have  never  studied  medicine;  the  communica- 
tion of  thoughts  without  any  kind  of  sign  ;  the  immediate  communi- 
cation of  symptoms  of  |)atients  to  the  majjnetizcd  with  which  they 
are  in  relation  ;  &c.,  &c.  As  these  violate  and  are  at  variance  to 
known  and  long  established  principles  of  anatomy  and  physiology,  and 
are  ojiposod  by  reason  and  judgment,  and  since  it  is  not  agreed  what  ex- 
actly they  are  by  those  who  admit  them,  and  moreover  as  this  evidence 
is  so  conflicting  as  to  destroy  itself,  they  should  be  rc^jected  as  having 
no  scientific  value.     If  then  the  facts  of  the  first  class  are  explained 


1845.]  Mesmerism.  183 


independent  of  Mesmerism,  and  those  of  the  second  are  inexplicable 
by  it,  why,  I  ask,  employ  the  term  at  all  ?  Why  presume  the  exist- 
ence  of  a  thing  never  demonstrated  ?  Why  declare  the  presence  of 
a  new  agent,  when  those  known  to  the  profession  can  explain  all  the 
facts  that  are  well  established  ;  and  besides,  to  admit  it,  would  neces- 
sarily involve  the  performance  of  miracles  ? 

It  may  be  said  that  all  my  arguments  are  chiefly  directed  against 
the  name,  and  not  to  the  denial  of  the  existence  of  certain  phenomena 
attributed  to  animal  magnetism.  I  do  admit  that  sleep,  convulsive 
movements,  insensibility,  even  mania  itself,  yea,  death,  may  be  pro- 
duced, and  have  been  produced,  by  one  person  operating  on  the  feel- 
ings of  another  but  these,  in  my  humble  opinion,  are  not  the  effects 
of  an  occult  mysterious  agent,  called  Mesmerism,  but  the  legitimate 
results  of  the  imagination,  dec.  And  I  am  particularly  strengthened 
in  this  opinion,  by  M.  Bertrand,  one  of  the  most  zealous  advocates 
of  animal  magnetism  at  the  present  day,  in  Paris;  and  also  by  Dr. 
Prichard,  of  Edinburgh,  who  has  written  the  last  article  on  the  sub- 
ject now  before  the  profession  in  this  country  :  and  again,  by  Dr.  J. 
K.  Mitchell,  one  of  the  professors  in  the  JelTcrsen  Medical  College 
in  Pliiladelphia,  whose  views  in  its  favor  have  been  published,  and  so 
far  as  I  know,  he  is  the  first  and  only  one  who  has  ventured  in  this 
country  to  do  so. 

Dr.  Prichard  defines  a  somnambulator  to  be  a  dreamer  who  is 
able  to  act  his  dreams.  "  To  tliis  property,"  says  Dr.  Mitchell, 
"of  artificial  dreaming:,  ^^y  be  referred  the  alleged  miracles  ofclair- 
voyance,  intuition,  and  prevision.  The  subject  dreams  that  he  sees, 
and  the  questioner  is  deceived,  by  his  confidence,  his  plausibility,  and 
his  ordinary  character.  He  knows  liirn  to  be  honest,  and  he  does  not 
perceive  that  he  is  himself  led  astray  by  his  uncorrected  imagination. 
*  *  *  The  ra/7o;'/,  relation,  or  communication,  supposed  to  have 
an  absolute  existence,  dependent  on  the  Mesmeric  fluid,  seems  to  bo 
entirely  voluntary  on  the  part  of  the  patient,  and  rests  on  his  know- 
ledge of  its  supposed  necessity.  It  is,  therefore,  a  delusion,  but  ono 
of  the  greatest  convenience  to  the  public  exhihit)rs  of  Mesmeric 
wonders.  *  *  *  Many  of  the  feats  of  the  clairvoyants  are  the 
results  of  the  sharpened  hearinjr,  which  enables  them  to  detect  objects 
by  the  sounds  they  make.  'J'h(y  really  believe  they  see  them,  and 
so  does  the  exhibitor,  although  he  aids  them  by  handling  audibly  tho 
various  o))jects.  (C'rtninly  very  fltittcring.)  Tims  he  opens  and  shuts 
a  pencil,  a  |)en-knitV',or  a  s;!)r'cta<'!t'-rnso,  .ind  n;b-astick,  or  a  sheet  of 


184  Mesmerism,  [April, 


paste-boaid.     Ho  always  makes  as  much  noise  as  possible  with  every 
thinoj.  and  he  generally  asks  the  producer  of  a  marked  card  to  explain 
the  words  or  device  to  hitn.   As  we  cannot  believe  in  Mesmeric  rapport, 
so  we  are  not  able  to  credit  the  existence  of  any  peculiar  sympathy  be- 
tween the  operator  and  subject.     Untrained  or  ignorant  patients  never 
show  syaipatheiic  plienomcnn.     I  have  been  pinched,  and  hurt  other- 
wise, a  great  many  times,  without   ol)serving  any  suffering  on  the 
part  of  my  subjects,  until  they  were  taught  to  believe  thai  such  a 
relation  existed;  and  then  they  honestly  telt  hurt,  as  people  do  in 
dreams  a  kind  of  imaginary  suffering.     The  phrenological  phenom- 
ena of  Me-merism,  when  rigidly  examined,  are  found  to  consist,  as 
do   most   of  the  Mesmeric  wonders,   of  'such   stuff  as  dreams  are 
made  of.'     The  excitement  of  the  brain  is  general,  the  direction  of 
that  excitement  is  given  by  the  Mesmerised  person's  knowledge  of 
phrenology.     *     *     jMost  of  the  phenomena  of  Mesmerism  are  a 
strange    mixture    of   physical  impulse    and    menial  haUvcinafion." 
These  are  the  words  and  language  of  the  most  distinguished  believer 
of  Mesmerism  in  our  own  country. 

With  respect  to  the  rapport,  communication,  or  sympathy  claimed 
to  exist  between  the  Mesmeriser  and  the  Mesmerised,  there  is  one 
remarkable  circumstance,  that  has  been  overlooked.  The  person 
majznetized,  it  is  said,  experiences  all  the  sensations,  &;c.  with  the 
one  with  whom  he  may  be  placed  in  relation  ;  and  he  will  feel  pain, 
taste  the  same  articles,  imitate  the  act  of  swallowing,  &;c.  ;  indeed, 
be  in  subjection  even  to  the  will  of  the  Mesmeriser,  and  yet  they 
never  utter  the  same  words.  If  this  relationship  be  so  intimate,  this 
symj-.athy  so  close,  why  is  it  tiiat  they  do  not  speak  alike  if  one  does 
what  even  the  other  only  wills,  thus  having  in  reality  an  identity  of 
thouirht  and  actions,  why  don't  they  use  the  same  language. 

To  prove  too  what  can  bo  endured  by  practice,  the  Boston  Medical 
and  Surgical  Journal  states,  that  within  a  year  two  boys  voluntarily 
called  to  explain  the  tricks  and  impositions  of  Magnetizers  one  had 
been  several  months  the  wonder  and  admiration  of  hundreds  of  be- 
lievers.  "Yet  he  positively  declared  that  he  had  never  been  asleep 
in  any  instance,  before  an  audience,  nor  was  there  ever  a  period 
when  ho  was  not  thorougliiy  cojiscious  in  every  respect,  and  obedient 
to  command.  l>y  pradice,  ho  could  hear  to  be  pricked  under  the 
nails,  tolerate  tiie  blaze  of  a  candle  within  an  inch  of  the  eye  without 
recoiling,  allow  heavy  men  to  stand  on  his  toes  &c.,  and  in  short,  be- 
came bv  regular  processof  training,  the  best  subject  in  New-England." 


18^5.]  Mesmerism.  1S5 


But  further  in  proof  of  the  effects  ascribed  to  animal  magnetism, 
being  nothing  more  than  the  operations  ot  the  mind  upon  the  body, 
all  acknowledge  its  phenomena  resembling  very  closely  those  of 
somnambulism  now  it  is  certain,  that  the  somnambulist  sees  only 
those  objects  which  he  seeks, or  which  are  present  to  his  imagination. 
A  case  of  a  female  in  this  state  is  mentioned  by  Sauvages,  where  a 
lighted  candle  brought  so  near  to  the  organ  of  vision  as  even  to  burn 
the  hair  of  her  eye-brows,  a  person  unseen  uttering  suddenly  a  loud 
cry  into  her  ear,  brandy  and  a  solution  of  ammoniacal  salt  placed 
under  her  eyes  and  introduced  into  her  mouth,  the  feather  of  a  pen, 
and  afterwards  the  extremity  of  a  finger  applied  on  the  cornea,  Span- 
ish snuff  blown  into  the  nostrils,  pricking  by  pins,  twisting  her  ling- 
ers;  all  these  means  were  tried  without  producing  the  least  sign  of 
feeling  or  perception,  and  yet  she  perceived  objects  to  which  the 
current  of  her  thoughts  directed  her. 

We  have  the  authority  of  the  celebrated  commissioners  appointed 
in  France  in  1784,  to  report  on  the  subject  of  Mesmerism  they 
unanimously  agreed  that  almost  every  fact  they  witnessed,  was  the 
resulc  of  the  imagination  and  other  feelings,  to  the  excitement  of 
which  so  many  circumstances  were  adapted.  "  Dertkaxd  main- 
tains  that  the  effects,  as  well  as  all  the  results  of  magnetism,  are  to 
be  attributed  solely  to  the  excited  imagination  ;  and  he  declares  that 
the  effects  produced  within  his  experience  haveaiways  borne  the  most 
exact  proportion  to  the  conviction  of  the  patient."  He  also  supposes 
that  the  sense  of  weariness  or  numbness  of  the  limbs,  which  persons 
experience  when  experimented  upon,  is  occasioned  by  remaining 
long  in  one  position. 

The  theory  of  animal  magnetism  adopted  by  Rostax,  Hussoxand 
others,  and  practiced  upon  by  all  believers,  is  that  there  exists  a  pe- 
culiar fluid  in  the  human  system  which  can  be  set  in  operation  by 
certain  movements,  or  looks,  or  even  by  the  will  of  the  Mesmeriser. 
This,  says  Dr.  Pkiciiard,  soars  so  far  above  the  region  of  observa- 
tion and  experiment,  that  it  cannot  be  subjected  to  proof,  and  even 
were  it  conceded,  or  established,  would  not  account  for  the  phe- 
nomena of  which  the  explanation  is  sought.  "  A  much  more  proba- 
ble opinicni,"  says  ho,  "  is  that  of  M.  Hkktkand,  who,  after  surveying 
with  calmness  and  discrimination  the  whole  history  of  magnetism, 
and  witnessing  with  his  own  eyes  the  proceedings  of  (bo  operators 
in  this  art,  and  practicing  them  hijnstif  with  considerable  efloct, 
comes  at  lust  to  tlie  conclusion  that  all  the  results  of  these  operations 


186  Mesmerism,  [April, 


are  brought  about  through  the  influence  of  the  mind  ;  not  by  the  will 
of  the  magnetizer,  radiating  forth  his  own  vital  spirit,  and  operating 
through  this  material,  or  immaterial  instrument,  on  the  vital  spirits 
of  other  men,  who  are  the  passive  recipients,  but  by  the  energy  with 
which  the  feeling  and  imagination  of  t!ie  latter  act  upon  themselves. 

Abbe  Faria  boasted  that  he  had  j)ut  more  than  5000  persons  into 
the  Mesmeric  state,  simply  by  placing  them  in  an  arm-chair,  and 
after  telling  them  to  shut  their  eyes  and  collect  themselves,  suddenly 
pronounced,  in  a  strong  voice  and  imperative  tone,  the  word, 
"dormcZ;"'  sleep.  Bertrakd  says  that  though  this  may  be  an  ex- 
pggeration,  he  very  often  succeeded  by  this  method  even  upon  a 
considerable  number  of  persons,  remoced  from  all  suspicion  of  con- 
nivance.  Here  then  is  the  imagination  alone  producing  all  the  efliects 
ascribed  to  animal  mag".etism,  not  in  one  case  only,  but  in  5000  in- 
stances. What  more  can  be  required  to  prove  my  proposition  that 
Mesmerism  is  not  a  reality,  but  its  elTects  are  due  to  the  imagina- 
tion than  to  cite  ycu  5CC0  cases  of  the  Mesmeric  state,  induced  by 
placing  these  patients  in  an  easy  position,  and  crying  out,  sleep.  "We 
have  here  a  cause  proved  to  be  sufficient  for  the  phenomena  with 
which  it  is  more  philosophical  to  rest  satisf.e:l,  than  to  resort  to  the 
visionary  hypothesis  of  the  magnetic  fluid  radiated  forth  by  the  will 
of  the  operator  upon  surrounding  persons  and  objects,  or  to  confess 
the  strange  doctrine,  that  the  volition  of  a  human  body  is  capable  of 
exerting  an  immediate  influence  on  other  minds  and  bodies  than  his 
own."  The  co-operaticn  of  the  agency  of  the  will  on  the  part  of  the 
magnetizer  is  even  denied  by  Tertraxd,  "v'ho  declares  that  in 
trials  made  by  himself  precisely  the  same  results  followed,  whether 
he  willed  to  produce  them  or  not,  provided  that  the  patient  was  in- 
wardly persuaded  that  the  whole  ritual  was  duly  observed." 

If  animal  magnetism  be  true,  and  Mesmerism  a  reality,  where  are 
the  principles  deduced  from  the  facts  o!)served  even  to  the  present 
clay  ?  T!ie  whole  v.orld  has  been  engaged  for  60  or  70  years  col- 
lecting facts  from  any  and  every  source,  down  to  the  present  day, 
and  yet  not  one  established  law  not  one  uniform  rule  exists,  by 
which  we  may  examine  the  subject,  or  by  the  exercise  of  which  we 
can  with  any  dogree  of  certainty  produce  a  given  phenomenon.  We 
have  invariable  principles  for  electricity,  galvanism,  magnetism 
itself  yes,  f(r  all  other  sciences,  but  not  one  for  Mesmerism.  In 
the  selection  too,  of  subjects  upon  whom  to  display  its  powers,  animal 
magnetism  invariably  prefers  the  nervous  female  or  delicate  persons, 


1845.]  Mesmerism.  187 


those  especially  in  whom  the  imagination  is  most  lively  and  active; 
while  on  the  other  hand,  no  man  of  science  has  yet  been  able  to  feel 
its  influence.  What  the  commissioners  appointed  by  the  King  of 
France  said  more  than  60  years  ago,  in  reference  to  the  fact,  that 
not  one  of  them  could  be  made  to  experience  the  effects  of  Mesmer- 
ism, has  descended  to  all  other  men  of  learning  none  have  yet  been 
influenced  or  aflected  by  it. 

If  the  imagination  have  nothing  to  do  with  the  production  of  the 
results  ascribed  to  animal  niagnetism,  we  should  have  thouglit  ere 
this  to  have  witnessed  these  upon  the  inferior  animals.  Operations 
are  occasionally  performed  on  the  lior-?e,  cow,  dog,  d;c. ;  their  organi- 
zation is  similar  to  ours,  and  we  claim  for  them,  the  sympathizing 
benevolence  of  our  Mesmerising  friends.  Give  us  a  series  of  opera- 
tions upon  the  inferior  animals  in  the  Mesmeric  state,  and  our  opinion 
is  at  once  overthrown.  Or  if  this  be  asking  too  much,  then  pray  cite 
us  the  surgeon  who  has  performed  a  series  of  operations  even  upon 
the  human  species  while  in  this  condition.  But  what  is  the  fact  on 
this  point,  a  distinguished  Professor  of  Surgery  in  Paris  operates  in 
one  case,  (Cloquet,  1819,)  and  for  16  years  in  succession,  no  second 
one  is  presented  to  him.  Here  we  have  an  excellent,  benevolent  man, 
as  all  who  know  him  will  acknov/ledgn,  a  believer  in  IMesmerism,  or 
rather  who  was,  who  is  in  the  daily  habit  of  operating,  both  in  private 
and  in  the  hospital,  possesses,  as  is  supposed  by  some,  the  means  of 
relieving  pain,  and  yet  for  16  years  he  has  not  found  another  instance 
in  which  it  could  be  applied.  And  still  Mesmerism,  this  non  est  iw 
venttis  for  years  together,  is  dignified  with  the  name  of  Science. 
Can  any  one,  I  candidly  ask,  believe  that,  under  these  circumstances, 
animal  magnetism  even  has  an  existence,  v.'ithout  admitting,  it  only 
di.sj)layK  its  influence  by  exceptions  to  general  laws;  and  so  do  cata- 
lepsy, somnambulism,  mental  hallucination.  And  yet  in  this  very 
city,  I  have  known  an  operation  made  conditional  in  reference  to 
the  induction  of  the  Mesmeric  state,  and  tijat  too  upon  a  patient 
laboring  under  a  cancerous  mamma.  V/e  have  thus  a  new  science 
attempted  to  be  built  up,  upon  exceptions  to  generally  received  and 
well  established  princii)les  lor  instance,  that  the  knife  gives  pain  in 
surgical  operations.  l>at  with  all  the  zeal  and  industry  with  which 
it  is  now  cultivated  and  attempted  to  be  applicil  in  every  case,  with 
one  or  two  exceptions  only,  can  i)atients  be  thrown  into  the  insensible 
state  they  will  violate  the  Mesmeric  condition  by  flinching  when 
stuck  with  a  pin. 


18^  Mesmerism,  [April, 


Lastly  :  If  Mesmerism  be  true,  apply  to  it  the  test  by  which  we 
have  decided  the  existence  ofa  specific  virus  in  hydrophobia.  Give 
us  instances  of  its  effects  upon  inAmts  in  the  cradle.  Exhibit  the 
Mesmeric  state  in  the  child  before  it  exercises  its  imagination.  I 
insist  upon  this  test,  and  not  in  one,  but  in  a  series  of  cases. 

I  am  persuaded  that  Mesmerism  has  been  alone  continued  to  the 
present  day,  and  believed  to  iiave  an  existence,  from  the  circumstance 
of  its  supposed  connection  with  the  nervous  influence,  which  itself 
has  not  been  and  cannot  he  defined.  There  are  things  in  medicine, 
as  well  as  in  other  sciences,  which  have  not  been  demonstrated,  and 
yet  admitted  to  exist.  Miasm  or  malaria  is  assigned  as  the  cause  of 
a  large  class  of  diseases,  and  still  it  has  not  been  discovered.  The 
effjcts,  fever,  &;c.,  are  however,  uniform  and  almost  invariable,  so 
that  no  one  doubts  the  existence  of  a  cause,  although  undefined. 
But  this  cannot  be  said  of  animal  magnetism.  Its  phenomena  are 
far  from  being  certain,  but  on  the  contrary  are  exceedingly  irregular 
and  undetermined,  and  are  moreover  explained  even  hy  believers 
themselves,  as  well  as  by  men  of  the  highest  scientific  authority,  to 
be  dependent  upon  another  cause  viz.  the  imagination.  Perkins- 
ism,  e.  i.  the  cure  of  diseases  hy  metallic  tractors,  which  was  only  a 
branch  of  Mesmerism  and  founded  upon  its  supposed  existence,  w^as 
at  once  exploded  by  Dr.  Haygartii  employing  wooden  tractors 
painted  in  imitation  of  metal,  notwithstanding  the  wonders  it  was 
accomplishing  both  in  this  country  and  in  England.  Its  sole  effect 
was  thus  proven  to  be  wholly  attributable  to  the  imagination.  This, 
no  doubt,  will  be  the  result  of  any  treatment  or  system  based  upon 
the  supposed  existence  of  the  agency  under  consideration.  Mesmer- 
ism can  neither  be  demonstrated  nor  abide  the  test  of  experience. 

My  third  and  last  proposition  is,  that  the  non-expression  of  pain  is 
no  proof  of  its  non-exis;tence,  and  that  there  are  conditions  of  the 
body  and  mind,  in  which  no  sufTering  is  evinced,  and  moreover  that 
this  state  of  the  system  exists  independent  of  Mesmerism.  That 
many  capital  operations  have  been  performed  without  the  patient's 
complaining,  we  have  abundant  testimony  in  the  record  of  our  pro- 
fession. We  are  convinced  that  there  are  few  surgeons  who  have 
not  met  with  such  instances.     I  have  seen  several. 

Who  need  be  reminded  that  a  stoical  philosophy  once  taught  that 
it  was  beneath  the  dignity  of  man  to  complain  ;  that  pain  was  not 
an  evil ;  that  to  cry  was  a  shameful  pusillanimity  ?     Who  requires 


1845.]  Mesmerism,  189 


to  be  told  that  savages,  criminals  and  nnartyrs,  have  not  only  endured 
the  greatest  tortures  without  uttcrin";  a  groan,  but  welcomed  tlie  hor- 
rors of  death  itself?  Who  does  not  know  that  at  this  moment  there 
are  religious  fanatics  in  the  East,  whose  bodies  are  voluntarily  and 
cheerfully  sacrificed  to  false  gods  who  have  their  persons  suspend- 
ed in  the  air  by  great  hooks  stuck  in  their  backs,  d:c. 

Although  pain  is  designed  by  nature  to  protect  and  preserve  life, 
still,  a  contented  mind,  the  consolations  of  religion,  a  profound  medi- 
tation, delirium,  fanaticism,  mania,  d:c.,  can  suspend  the  action  of 
our  senses,  and  thus  prevent  the  perception  of  pain.  The  mind  at 
times  has  such  control  over  the  body,  as  even  to  extinguish  life.  At 
the  siege  of  Bude,  during  the  war  of  Ferdinand  I.  against  the  Turks, 
there  was  a  young  rnan  who  fought  with  such  heroic  valor,  that  he 
excited  the  admiration  of  both  sides.  At  last  he  fell  o\erpowered  by 
numbers.  He  was  sought  out  amonor  the  dead  that  be  mijrht  be  recog- 
nized ;  on  removing  his  mask  Raisciat  de  Souabe  observed  it  was  his 
son,  he  fixed  his  eyes  intently  upon  him,  and  fell  dead,  without  uttering 
a  word.  History  furnishes  us  several  such  instances.  The  influence 
of  the  mind  may  be  exerted  only  over  a  part  of  the  body.  Robert 
Boyle  relates  the  case  of  a  woman  who,  seated  near  a  canal,  saw  her 
infant  fall  into  the  water  and  drown  from  that  moment  she  was  attack- 
ed with  paralysis  of  one  of  her  arms,  which  attended  her  to  the  grave. 

The  savages  on  the  VVest  coast  of  North  America  had  long  pieces 
of  a  broken  bottle  stuck  deep  into  the  soles  of  their  feet,  without  pay- 
ing the  least  attention  to  the  circumstance;  and  when  spoken  to  on 
tbesuhjpct  by  the  European  sailors,  they  immediately  cut  their  bo- 
dies with  the  fragments  of  the  glass. 

Albucasis  relates  tliat  on  one  occasion,  he  refused  to  amputate  a 
hand  from  dread  of  hemorrhage,  when  the  patient  himself  performed 
the  operation.  Count  Mansfield  submitted  to  amputation  at  the 
sound  of  the  trum[)ets  playing  a  charge.  The  daughter  of  Henry  of 
Albert,  for  a  splendid  present  promised  by  her  father,  gave  birth  to 
Henry  the  IV.  of  France,  while  singing  a  song.  When  Marshal 
De  Muy  was  cut  for  stone,  he  uttered  not  a  word  or  a  groan. 

Baron  Percy  states  that  he  removed  a  cancerous  breast  from  a 
patient,  who  smiled  and  spoke  tranquilly  to  a  cross  she  held  in  her 
hand.  At  another  time  he  operated  upon  a  young  man  for  aneurism, 
which  was  complicated  and  very  painful,  who  remained  silent  with 
an  imperturbable  calmness,  as  if  the  surgeon  were  operating  u|)oa 
another  person.     He  assisted  also  in  a  c;ise  of  lithotomy  upon  a  pa- 


100  Mesmerisin*  [April, 


tient  of  sixty,  wherein  the  operation  was  long,  and  accompanied  with 
hemorrhntre,  and  alihoiigli  he  was  advised  by  his  surgeon  to  cry  out 
wh(3n  he  suffared,  he  replied  by  saying  the  thing  was  not  worth  the 
trouble  he  appeared  scarcely  to  suffer. 

Surgeon  Alcock  says,  "1  recollect  a  sailor  astonishing  Sir  A. 
Cooper  by  not  uttering  the  faintest  sound  while  his  leg  was  taken 
of!*,  *  *.  No  one  will  doubt  the  high  courage  of  the  Marquess 
of  Anglesey.  While  his  leg  was  amputated  (at  Waterloo)  he  uttered 
not  a  sound." 

Mr.  Travers  relates  the  case  of  a  man,  whose  mind  was  unimpair- 
ed, but  whose  hands  up  to  the  wrist,  and  feet  half  way  up  the  leg, 
were  perfectly  insensible  to  any  species  of  injury,  or  catting,  pinch- 
ing, scratching  or  burning.  He  passed  a  large  needle  into  the  ball  of 
the  thumb,  down  to  the  bone.  Not  the  least  degree  of  pain,  or  even 
of  sensation,  was  produced. 

Mr.  LisTON  describes  a  case  in  the  Edinburgh  Medical  and  Surgi- 
cal Journal  for  April,  18C0,  of  a  gentleman,  who  lost  his  sense  of 
touch  over  nearly  the  whole  surface  of  the  body,  and  when  Mr.  L. 
cut  away  one  of  the  bones  of  his  foot,  he  felt  no  pain  whatever,  and 
he  added,  "nor  would  I  now,  I  am  convinced,  were  you  to  dissect  the 
whole  foot." 

Mr.  Arnott  says  he  has  seen  operations  performed,  without 
the  knowledge  of  the  patient,  when  insensible  through  opium  or 
great  loss  of  blood. 

Dr.  Copland  states  that  he  had  taken  off,  or  seen  taken  off,  a 
leg  from  a  man  who  gave  no  sign  of  pain. 

Sir  R.  DoBsoiNT  relates,  that  when  the  late  Sir  Tho3ias  Thompson 
lost  his  leg  in  action,  it  is  well  known  that  he  was  singing  during  the 
time  the  operation  was  being  performed.  In  the  burial  ground  of 
Greenwich  Hospital,  continues  he,  is  a  monument  to  a  seaman  who 
was  wounded  at  Trafalgar ;  the  epitaph  relates  that,  "  while  the 
amputation  was  performing,  he  was  exultingly  singing  the  patriotic 
song  of  Rule  Britannia."  Another  seaman  in  this  hospital,  while 
loosing  his  leg,  said  to  the  surgeon,  "avast  a-bit  while  I  take  a  pinch 
of  snuff,"  coolly  took  the  box  cut  of  his  pocket,  and  after  having  of- 
fered a  pinch  to  the  assistant  surgeon,  took  one  himself,  and  the 
operation  was  finished  without  his  having  uttered  a  groan. 

Several  surgeons  had  attempted  to  remove  a  small  tumour  from 
the  eye-brow  of  a  lady  in  London,  but  the  moment  the  scalpel  touched 
the  tumour,  the  patient  would  scream  out  with  pain.     Wardrop  bled 


1845.]  Mesmerism,  191 


her  to  fainting,  and  extracted  the  tumour,  which  she  would  not  believe 
until  a  glass  was  presented  her  to  see  her  face.     She  too  was  deceived. 

The  cojebraicd,  but  uafortunato.  Gen.  ?.Ioeeau.  when  wounded 
near  Dresden,  hesitated  at  first  to  have  his  limbs  amputated  ;  but 
having  made  up  his  mind  to  submit,  called  for  a  segar,  and  while 
smoking,  had  both  thighs  cut  off. 

Mr.  Clever  cut  himself  for  stone,  a  few  years  ago  in  Paris. 

In  November,  1832,  Prof.  Gibsox,  aided  by  Drs.  Horner  and 
Bartox,  of  Philadelphia,  removed  a  large  tumour  from  the  neck  of  a 
bdy  17  years  old.  It  was  for  a  fungus  ha3matodes.  The  first  incis- 
ion was  seven  inches  long  one  nerve  had  to  be  divided,  the  internal 
jugular  tied;  and  another  nerve,  the  par  vagum  dissected  for  five 
inches.  "The  operation  lasted  34  minutes,  and  v/as  most  painful 
and  diflicult.  He  (the  patient)  remained  during  the  whole  operation 
motionless,  and  neither  complained,  sighed  nor  gj-oaned."  (See  6th 
Edition,  Gibson's  Surgery.) 

It  is  even  said  the  late  Sir  Thomas  Hardy  of  the  British  navy, 
was  altogether  insensible  to  pain. 

In  the  American  Journal  of  T-Iedical  Sciences  for  April,  1844,  I 
related  the  case  of  a  gentleman  Oj.erated  upon  in  Charleston  for  stone 
in  the  bladder,  by  my  friend  Dr.  Ogier  of  that  city.  It  is  there 
stated  that  "  he  refused  to  be  tied,  and  insisted  upon  it,  that  he  would 
be  able  to  remain  perfectly  quiet  during  the  operation.  He  was  told 
of  the  danger  to  which  the  least  motion  would  expose  him.  During 
the  whole  operation  he  remained  as  motionless  as  a  dead  subject.  Dr. 
O.  in  a  note  at  the  bottom  of  the  page  says,  he  was  not  Mesmerised. 

CuRLixG  gives  the  case  of  a  youth  who  performed  sclf-castration  
"he  said  he  was  not  conscious  of  any  pain  in  the  operation." 

Two  winters  ago  I  operated  upon  an  Irishman  in  our  hospital,  for 
a  bloody  tumour  in  the  scrotum.  At  the  first  and  only  incision  made, 
he  called  out,  "cut  away  doctor,  cut  away." 

In  June,  1842,  1  trepanned  a  man  for  a  spicula  of  bone  irritating 
the  brain.  The  operation  was  necessarily  tedious,  lasting  near  threo 
quarters  of  an  hour.  Towards  the  close  of  it,  I  had  to  insist  upon  the 
patient  checking  his  laughter,  and  to  cease  joking  about  the  silver 
})late  to  be  put  over  the  hole  made  in  the  cranium. 

But  why  multiply  examples  of  this  kind,  to  exhibit  the  effects  of 
the  mind  over  the  body,  so  as  to  induce  insensibility  to  surgical  oper- 
ations.    These  few,  hastily  collected,  will  sufiice. 

The  work  assigned  me,  Gentlemen,  is  now  before  you,  and  you  have 


192  Mesmerism.  [April, 


my  views  of  Mesmerism.  To  what  extent  they  are  correct,  is  for 
you  to  judge,  and  future  days  to  decide.  I  may  have  done  the  sub- 
ject injustice,  as  I  iinow  I  hnve  made  a  very  feeble  and  imperfect 
defence  of  the  opinions  of  those  whose  side  I  advocate;  but  I  have 
acted  conscientiously.  And  if  by  the  explanations  I  have  offered 
you,  conflicting  testimony  can  be  reconciled,  and  you  put  into  the 
right  path  to  investigate  this  mysterious,  all-absorbing  topic  of  the 
day,  your  Lecturer  has  his  reward.  It  will  be  perceived,  I  teach  no 
new  doctrine ;  but  those  do,  who  reject  the  opinion  of  the  imagina- 
tion being  tlie  source  of  the  phenomena  of  animal  magnetism. 

I  know  not  how  this  subject  is  viewed  by  you,  but  with  me,  the 
existence  or  non-existence  of  Mesmerism,  is  a  vital,  a  fundamental 
question.  If  true,  you  and  I  may  close  our  books  and  retire  forever 
from  these  walls,  for  by  it,  and  through  it,  omniscience  is  come. 
Would  you  be  wise  in  medicine  be  put  in  relation  wiih  JoH^'30N 
and  Velpeau,  and  your  object  is  accomplished.  Would  you  operate 
without  inflicting  pain  ;  would  you  know  what  remedies  are  now 
employed  in  London,  Paris,  or  China;  would  you  inspect  the  actual 
condition  of  the  internal  organs;  would  you  predict  the  retuin  of 
disease  ;  would  you  tell  vvheiher  that  lady  is  pregnant  with  a  boy  or 
a  girl ;  or  would  you  deliver  this  lady  v'ithout  pain  Mesmerism  be- 
ing true,  study  it.  But,  fsllow-laborer  in  the  science  of  medicine,/ y 
these  things  are  not  so ;  and  I  tell  you  whom  you  should  rather  con-// 
suit  the  Author  of  all  things.  To  the  law  and  the  testimony,  what 
say  they  intuition  !  in  the  sweat  of  thy  browshalt  thou  eat  bread  
divination!  thou  knowest  not  what  a  day  may  bring  forth  no  pain, 
no  suffering!  in  sorrow  shall  thou  bring  forth  children. 

That  which  was  unanimous!}^  condemned  by  men  of  the  highest 
scientific  authority  when  it  originated  that  which  is  now  classed 
with  the  quadrature  of  the  circle  and  perpetual  motion,  by  the 
Academy  of  Sciences  in  Paris  that  which  was  abruptly  dismissL^d 
from  the  Medico-Chirurgical  Society  of  London  that  which  is  ridi- 
culed by  every  Medical  Journal  of  the  day  that  which  has  never 
been  demonstrated,  but  which  is  opposed  by  reason  and  judgment  
that  which  has  never  received  favor  with  hut  few  exceptions  from 
scientific  men,  of  any  age  or  country  that  the  belief  of  which  cost 
Dr.  Elliotsox  his  professorship  in  the  University  of  London  that 
which  at  best  exists  but  in  a  dreamy  state  that  which  is  explained 
not  in  one,  but  in  thousands  of  cases,  to  be  due  to  the  imagination 
alone,  cannot  be,  is  not  true. 


1845.]  Dublin  Journal.  193 


Part  II. REVIEWS  AND  EXTRACTS. 

ARTICLE  III. 

Dublin  Journal  of  Medical  Science,  No.  lxvii. 

The  January  number  of  this  valuable  peiiodical  contains  its  usual 
variety  of  interesting  matter.  The  first  article  is  the  history  of  "  a 
case  of  loss  of  Speech,  &:c.  by  William  Edward  Steele,  A.  B.,  M. 
D.,  &;c."  The  patient  was  a  man  aged  about  25  years,  and  engaged 
in  a  laborious  situation  in  a  government  oiiice.  The  attack  was 
preceded  by  apoplectic  symptoms,  and  paralysis  of  the  right  limbs. 
Under  appropriate  treatment,  "  he  soon  improved  in  all  respects 
save  in  his  power  of  speech,  which,  v.ith  the  exception  of  an  occa- 
sional word  or  short  sentence,  Vv'as  obliterated."  Dr.  S.  relates  many 
of  the  observations  which  were  made  during  the  progress  of  the 
case,  for  the  purpose  of  determining  the  true  nature  of  the  mental 
disease.     His  conclusions  we  subjoin. 

'These  facts,  I  conceive,  warrant  us  in  making  the  following  de- 
ductions: 1st.  That  there  exists  a  faculty  of  the  mind  which  presides 
over  the  expression  of  thought,  by  speech,  writinir,  and  gesture. 
2ndly.  That  in  the  expression  of  our  tiioughts,  by  these  several 
means,  there  exists  a  considerable  di (Terence  in  their  perfcchon  and 
complexity,  as  communicating  media ;  this  difference  being  in  the 
order  enumerated  :  speech,  writing,  gesture.  3rdly.  That  admit- 
ting these  conclusions,  it  is  highly  probable  that  the  defects  exhibited 
in  these  actions,  as  a  result  of  disease,  arise  not  from  any  fault  of 
memory,  considered  in  itSL-lf,  especially  as  in  other  respects  (he  me- 
mory is  perfect;  but  that  this  may  appear  to  be  impaired  by  the 
destruction  of  one  of  the  means  it  possesses,  of  inanilesting  its  ex- 
istence, ill  common  with  it^  other  mental  attribu(es,  percep{i()n,  reten- 
tion, and  association  ;  these  being  thus  placed  in  the  same  position 
as  is  the  retina  in  cataract  or  opaque  cornea,  the  |)ower  of  sigiit 
remaining,  but  the  means,  by  whieh  its  exi&tence  is  manifested,  des- 
troyed. 

*'As  to  the  probable  situa(ion  of  (lie  cerebral  lesion,  in  cases  of 
this  description,  our  knowledge  is  imporfect.  Dr.  Osborne  believes 
it  to  be  the  upper  surface  of  the  cerebrum.  In  Abercroinbie,  cases 
of  brain  disease  are  related,  accompanied  by  los^  of  speech,  in  whieli 
the  central  parts  of  the  brain  were  those  cliielly  alfccted.  In  (his 
case,    however,  if  it   be  (rue,  us  laid  down  by  modern  cranioioyists, 

1.', 


194  Dublin  Journal,  [April, 


that  the  double  orgnn  of  language  be  seated  at  the  back  of  the  orbits, 
both  organs  niiist  have  been  involved  in  disease,  in  order  that  the 
almost  total  loss  of  the  power  of  expression  may  he  accounted  for. 
But  the  attendant  hemiplegia  would  indicate  the  lesion  (o  be  situated 
in  one  hemisj)herc  only,  leaving,  at  least,  one-half  of  the  double 
organ  of  language  untouched  ;  a  conclusion  which  is  manifestly  in- 
consistent with  the  total  absence  of  the  powers  of  speech,  which  this 
case  at  one  time  exhibited." 

Mr.  Donovan  furnishes  a  long  communication,  "on  the  physical 
and  medicinal  qualities  of  the  Cannabis  Indica,  or  Indian  Hemp; 
with  observations  on  the  best  mode  of  administration,  and  cases  illus- 
trative of  its  powers."  'J'he  remarkable  effects  produced  by  the 
Indian  Hemp,  and  its  value  in  the  treatment  of  certain  affections  of 
an  almost  hopeless  character,  were  first  brought  to  the  notice  of  the 
profession  in  an  essay  by  Prof.  O'Shaughnessy,  of  Calcutta.  Mr. 
Donovan,  who  appears  to  have  devoted  considerable  attention  to  the 
subject,  seems  quite  enthusiastic  in  his  Oj)inion  of  its  value  "I 
indulge,"  says  he,  "  in  the  expectation  that  this  powerful  agent,  when 
physicians  have  fully  developed  its  properties,  will  rank  in  import- 
ance  with  Opium,  Mercury,  Antimony,  and  Bark." 

It  has  been  a  question  whether  the  Cannabis  Indica  and  the  Can- 
nabis  Sativa,  or  the  common  hemp,  were  the  same  species.  The 
experiments  of  3Ir.  Donovan  shew  pretty  conclusively,  that  they  are 
distinct,  and  that  the  domestic  hemp  is  destitute  of  the  principle 
which  renders  the  Indian  plant  so  desirable  an  excitant  to  the  volup- 
tuous  people  of  the  East. 

The  symptoms  produced  by  the  action  of  this  agent,  differ  in  many 
respects  from  those  which  follow  the  use  of  other  narcotics.  Among 
the  remarkable  effects  noticed  by  Prof.  O'Shaughnessy  in  some  cases, 
was  a  well  marked  cataleptic  state.  In  almost  every  case  hunger 
seems  to  have  been  excited.  Mr.  Donovan  made  some  experiments 
with  this  article  upon  himself,  for  the  relief  of  a  neuralgic  affection. 
Vfc  extract  his  history  of  its  effects  : 

"Having  determined  to  try  Indian  h.cmp,  I  swallowed,  during  one 
of  these  attacks,  five  drachms  of  the  same  tincture  of  the  herb  which 
in  a  dose  of  three  drachms,  had  formerly  proved  powerless.  In 
twenty  minutes,  I  was  agrecahly  surprised  to  find  myself  without 
pain  ;  although  for  the  last  four  hours  I  had  suffered  severely.  There 
was  this  peculiarity  of  the  relief  obtained,  that  I  walked  without 
much  consciousness  of  the  motion  of  my  legs,  or  indeed  of  having 
legs  at  all :  I  felt  as  if  they  did  not  belong  to  me. 


1815.]  Duhlin  Journal,  195 


"In  some  months  after,  ^v;)l'o  suffering  under  a  severe  attack  of 
pain  in  the  foot,  I  took  nine  grains  of  iccaJc  resinous  extract  of  hemp, 
which  had  not  the  slightest  effect.  Next  night,  I  took  six  drachms 
of  the  weak  tincture  of  the  iierb,  without  ihc  least  hencfit.  The 
third  night,  bring  in  exceedingly  great  torture,  I  took  twelve  grains 
of  the  same  weak  resinous  extract:  in  twenty  minutes!  v:is  nearly 
free  from  pain,  went  to  bed,  and  slept  soundly  four  hours.  The  pain 
then  awoke  me,  but  it  was  much  less  severe.  In  the  morning,  there 
was  neither  headach,  nor  any  other  inconvenience. 

"  Considerable  pain  having  returned  the  fourth  night,  I  took  twelve 
grains  of  the  same  extract;  soon  fell  asleep;  and  awoke,  after  two 
hours,  free  from  pnin.  The  fifth  night,  the  pain  being  somewhat 
troublesome,  and  wishing,  more  tor  experiment  than  through  neces- 
sity, to  try  the  cfiect  of  a  larger  dose,  I  took  fourteen  grains  of  the 
same  resinous  extract.  About  five  o'clock  in  the  morning,  I  awoke 
to  encounter  a  most  extraordinary  scene,  one,  of  which  words  can 
give  but  a  faint  description.  I  felt  a  rush  of  strange  sensations 
through  my  head,  accompanied  with  a  crackling  and  singing  noise, 
and  a  vibratory  motion  through  my  whole  body.  These  gradually 
subsided  ;  and  while  dozing  off,  I  thought  an  ex[)losion  took  place  in 
my  head,  followed  by  the  same  rushing  noise  and  vibration  as  before, 
and  afterwards  by  a  strange  metallic  sound.  Various  other  noises 
succeeded.  My  sense  of  toucii  and  feeling  had  become  more  and 
more  obtuse,  until  at  length  I  lost  all  feeling,  unless  I  pinched  myself 
severely.  The  effects  were  now  at  their  height,  and  the  consequen- 
ces were  surprising.  I  absolutely  lost  the  consciousness  of  having  a 
body,  and  my  corporeal  existence  appeared  to  be  comprised  within 
my  head,  and  a  small  portion  of  my  chest,  near  the  throat;  in  these 
spots,  I  felt  as  much  alive  as  ever,  but  all  other  paits  were  without 
feeling,  and  to  my  perceptions  annihilated.  My  intellect  was  not  in 
the  least  disturbed;  memory  was  as  good  as  ever;  I  reasoned  well 
enough  ;  was  conscious  of  external  objects  as  in  perfect  health  :  but 
I  had  some  notion  that  if  I  gave  way  to  sleep,  I  should  never  awako 
in  this  worKl;  yet,  strange  to  say,  1  felt  perfectly  resigned  to  this 
sudden  termination  of  existence. 

"These  sinmdarafK'ctions  gradually  pa-^sed  off:  on  attempting  to 
get  out  of  bed,  I  could  scarcely  walk  for  giddiness  ;  my  stomach  be- 
came sicU,but  on  returning  to  bed  I  soon  recovered,  ate  an  immenso 
breakfast,  and  remained  perfectly  well,  without  having  experienced 
any  of  these   inconveniences  wiiicb  succeed   relief  obtained   from 

opium." 

******** 

"The  effect  on  the  sensorium,  prcduccd  by  the  medicine,  is  gcner- 
ally  alarming  to  the  patient  as  well  as  to  (he  by-slandcrs,  unless  they 
were  previously  made  aware  of  what  was  to  bo  expected-  Scsme  pa- 
tients evince  great  terror  of  death,  but  on  recovering  from  the  fit  of 
narcotism,  they  laugh  at  their  fears,  and  arc  generally  ready  for 
another  trial." 


193  Dublin  Journal,  [April, 


*'  Riim[)hins  says,  tliat  the  kind  of  montal  excitement  produced  by 
hemp  depends  on  the  temperament  of  the  consumer.  Professor 
0'Shau;^hnessy  represents  the  inebriation  to  be  of  the  most  cheerful 
kind,  causing  the  person  to  sin^^  and  dance  ;  and  adds,  that  in  persons 
of  a  quarrelsome  disposition  it  occasions  an  exasperation  of  their 
natural  tendency.  The  aphrodisiac  effects  of  hemp  have  been  in- 
sisted on  by  all  the  oriental  writers  :  Rumphius  douljts  that  the  herb 
possesses  any  such  power  ;  for  my  own  part  I  believe,  that  although 
it  may  powerailly  excite  Eastern  voluptuaries,  it  has  little  effect  on 
the  natives  of  our  own  country;  that  when  it  does  exert  this  influ- 
ence, it  is  only  on  the  young,  and  on  those  of  a  sanguine  tempera- 
men.  In  all  the  instances  of  its  exhibitions  to  male  patients,  record- 
ed in  the  foregoing  pages,  one  only  was  thus  affected,  and  I  made 
minute  inquiry.  In  no  case  that  fell  under  my  observation,  has  it 
produced  those  rapturous  ideas  and  ecstatic  dreams  described  by  the 
oriental  writers.  I  knew  but  two  or  three  whose  ideas,  while  under 
its  influence,  were  even  pleasing,  and  some  were  singularly  depress- 
ed, and  under  apprehension  of  immediate  death." 

The  Indian  hemp  has  been  employed  in  the  treatment  of  various 
diseases,  principally,  however,  of  such  as  are  of  a  painful  character. 
It  has  been  used  in  both  the  acute  and  chronic  forms  of  Rheumatism. 
Prof.  O'Shaugnessy,  as  quoted  by  Mr.  Donovan,  says,  "In  several 
cases  of  acute  and  chronic  rheumatism,  admitted  about  this  time, 
half-grain  doses  of  the  resin  were  given,  with  closely  analogous 
effects,  alleviation  of  pain  in  most,  remarkable  increase  of  appe- 
tite in  all,  unequivocal  aphrodisia,  and  great  mental  cheerfulness. 
In  no  one  case  did  these  effects  proceed  to  delirium,  nor  was  there 
any  tendency  to  quarrelling.  The  disposition  developed  was  uni- 
form in  all,  and  in  none  was  headach  or  sickness  of  stomach,  a  sequel 
of  the  excitement." 

The  powers  of  the  article  in  tetanus  are  truly  remarkable.  Mr. 
Donavan  refers  to  a  number  of  cases  of  this  fatal  malady  which  were 
treated  with  the  Indian  hemp,  and  in  almost  every  instance  with  suc- 
cess, lie  also  gives  several  cases  of  sciatica  and  other  neuralgic 
affections,  which  were  cured  by  this  remedy.  He  declares  that  he 
has  not  made  a  selection  of  the  successful  cases  out  of  many,  but  has 
faithfully  recorded  all  which  came  under  his  observation,  of  which 
the  termination  was  distinctly  known. 

The  resin  of  the  Indian  hemp  is  the  form  in  which  the  article 
has  been  most  frequently  employed.  The  tincture  of  the  resin,  of 
all  the  preparations  of  the  plant,  is  said  by  Mr.  Donovan  to  be  the 
only  one  on  which  reliance  can  be  placed. 


1845.]  Dublin  Journal  197 


"  I  say  the  tincture,  because  the  resin  itself,  being  totally  insoluble 
in  watery  liquids,  is  best  administered  in  the  state  of  solution  :  in 
the  pillular  form,  it  is  likely  to  pass  undissolved  through  the  intestinal 
tube.  Mr.  Richard  O'Shaughnessy  found  that  a  drachm  of  tincture 
which  was  only  cqunl  to  three  grains  of  the  resin,  had  a  much  more 
decided  effect  than  five  grains  of  the  latter.  The  strength  which  I 
employ,  and  of  which  I  have  made  a  large  quantity,  to  guard  against 
the  variability  of  new  samples,  is  two  grains  to  one  drachm  of  rec- 
tified spirit.  The  source  of  the  variation  of  strength  alluded  to, 
would  be  a  softer  or  harder  consistence  of  the  resin  employed,  giving 
rise  to  an  enormous  and  dangerous  difierence  of  power  :  other  sources 
are  the  collection  of  the  her!)  at  an  improper  season  :  the  decay  of 
the  herb  by  long  keeping;  bad  management  of  it  in  drying,  d:c. 

"As  to  the  modes  of  administration,  I  have  tried  many,  and  find 
the  following  to  be  the  best : 

R  Tinctura?  resinae  Cannabis  Indices  minim  quindecim. 
Spiritus  Rectificati  minima  quadraginta  et  quinque. 
Misce;  fiat  haustus. 

"The  patient  should  be  directed  either  to  swallow  the  whole  of 
this  directly  from  the  bottle  to  avoid  loss,  or  to  pour  it  into  a  little 
water,  and  ins  fa  ntly  swallow  it  off.  If  not  instantly,  the  resin  will 
be  precipitated,  will  adhere  to  the  vessel,  and  thus  escape  being 
swallowed." 

The  Indian  hemp  is  doubtless  a  most  potent  medicine,  and  is  des- 
tined to  prove  a  valuable  acquisition  to  the  Materia  Medica;  but  fur- 
ther  observations  are  necessary,  before  we  can  arrive  at  any  certainty 
touching  its  action  and  application  to  the  treatment  of  disease.  The 
interest  which  it  has  already  excited  will  soon  lead  to  ample  cxperi- 
ment.  In  our  Periscope,  we  publish  the  deductions  of  Dr.  Laurie, 
drawn  from  his  observations  of  its  efTects,  and  it  will  be  seen  that 
these  are  not  so  favorable  as  those  of  Mr.  Donovan. 

W.  F.  Montgomery,  A.  M.,  M.  D.,  Professor  of  Midwifery,  d:c. 
to  the  King  and  Queen's  College  of  Physicians,  in  Ireland,  reports 
"  a  case  of  a  large  Cauliflower  excrescence  successfijlly  removed, 
together  with  the  portion  of  the  Cervix  Uteri,  from  which  it  grew." 
This  case  presents  nothing  novel  in  its  features,  with  the  exception 
of  its  favorable  termination,  which  circumstance  we  presume  led 
to  its  publication.  Such  operations  have  heretofore  so  uniformly 
been  followed  by  a  reappearance  of  the  disease,  and  a  subsequent 
fatal  termination,  that  medical  men  generally  despair  of  atrordin"" 
any  pertnanent  relief,  and  therefore  attemj)t  lillle  more  than  a  pallia- 
tion of  the  more  distressing  symptonrMj.     Prof.  Montgomery's  cage 


198  Duhlui  Journal,  [April, 


may  serve  to  cncoun^gc  dToits  (o  cfTect  a  radical  cnie  in  such  cases. 

The  patient  was  a  woman  of  forty-fivc  years  of  age,  and  t!e  mo- 
ther of  nine  cliildren,  the  youngest  of  wliich  was  nearly  four  years 
of  age.  She  had  heen  complaining  of  her  present  symptoms  ever 
since  she  had  weaned  this  last  child.  On  examination,  a  firm,  rough, 
lobulated  tumor,  was  found,  nearly  filling  the  vagina  it  apj^carcd  to 
spring  from  the  os  uteri,  as  well  as  from  the  contiguous  parts  of  the 
vagina,  but  the  mouth  of  the  womb  could  not  be  felt. 

The  tumor  bled  readily  on  being  touched. 

"  By  the  speculum,  the  tumour  was  readily  brou;;ht  into  view,  and 
after  wiping  oliits  surface,  a  layer  tf  ccagnlatcd  blood  with  which  it 
was  covered,  it  appeared  of  a  dull,  dirty,  whitish,  or  light  drab  color; 
its  surface  uneven  and  studded  with  a  number  of  small  tubercles, 
like  the  head  of  a  cauliflower.  Tiiis  patient  had  been  previous. y 
operated  on  in  November,  1842.  vhen  the  tumour  then  existing  was 
removed  by  ligature,  in  doing  which,  portions  of  it  were  broken  off, 
which  afforded  Dr.  Anderson  the  opportunity  of  making  the  micro- 
scopical investigation  into  tiic  structure  of  this  fundus  growth,  already 
alluded  to:  but  it  scon  grew  again,  anil  in  the  intervening  four 
monihs  had  acquired  considorable  sizo. 

'Saturday,  .March  4.  I  included  the  whcde  of  the  tumour  in  a 
ligature,  which  I  placed  as  higli  up  as  possible;  its  application  gave 
no  pain,  and  very  little  discharge  occurred.  After  applying  the  lig- 
ature, I  drew  it  up  one  inch,  and  ordered  the  patient  an  opiate. 

"  The  ligature  was  tightened  every  day,  and  in  doing  so  was  follow- 
ed by  sharp  abdominal  pain,  without  any  accompanying  tenderness, 
or  acceleration  of  the  pulse;  indeed  pressure  over  the  juibes  gave 
her  so  much  relief,  that  she  constantly  kept  her  hand  firmly  pressed 
over  that  part.  Anodyne  fomentations  with  draughts  coiitainini; 
acetum  opii,  relieved  her  pain  ;  the  jiulsc  never  rose  above  80,  and 
she  was  (juile  free,  throughout,  from  any  constitutional  disturbance. 

"On  Sunday  the  12lh,  I  found  that  I  could  not  draw  the  ligature 
anv  further,  it  had  evidently  come  home  to  the  top  of  the  canula, 
and  yet,  neither  it  nor  remains  of  tumour  would  come  away;  and 
being  unwilling  to  allow  the  latter  to  remain  any  longer,  I  introduced 
a  curved  scissors,  and  removed  the  greater  part  of  it. 

"Thursday  IGlh.  1  exposed  the  u[5por  part  of  the  vagina  by  the 
speculum,  and  seized  the  remainiufj  portion  of  the  root  of  the  tumour 
with  a  dressing  ilu'ceps,  when  it  came  away  completely,  leaving  the 
Burfacc  behind  it  clean  and  healthy. lookin*: ;  it  sprimg  from  a  s|)ace 
ahoiit  tie  diameter  of  a  halfpenny,  engaging  the  margins  of  the  os 
uteri,  and  the  vaginal  mucous  membrane,  towards  the  left  side. 

"  On  examining  carefully  the  substance  r.ow  brought  away,  I  found 
thnt  I  had  removed,  not  only  the  morbid  growth,  which  was  now  re- 
duced to  a  mere  bundle  of  ragged  filaments,  but  also  the  parts  from 


1845.]  Dublin  Journal  199 


which  it  sprung,  namely,  the  os  uteri,  and  a  portion  of  the  vagina: 
 the  bloody  and  serous  discharges,  and  the  peculiar  abdominal  pain, 
now  ceased  altogether,  and  a  discharge  of  healthy  pus  took  place 
from  tlie  exposed  surface  ;  this,  after  a  few  days,  threw  up  exuberant 
granulations,  which  I  touched  with  nitrate  of  silver,  and  a  clean  and 
healthy  cicatrization  was  completed  in  three  weeks  from  the  time  of 
the  removal  of  the  parts.  On  the  7lh  April,  she  menstruated  natu- 
rally, and  on  tiie  17th  April  I  examined  her  with  the  finger  and  with 
the  speculum,  and  found  her  free  from  any  remains   of  the  disease. 

"1  have  since  seen  and  examined  this  woman  several  times,  the 
last  occasion  having  been  on  this  day  (Xovember  23lh).  She  has 
menstruated  regularly  and  fully  during  tlic  whole  interval  of  time, 
amounting  now  to  nearly  twenty. one  months. 

*-iIer  general  iiealth  is  pretty  good  ;  she  is  improved  in  aspect, 
and  increased  in  flesh:  she  complains  of  nothing  except  some  pain 
in  her  back,  especially  at  the  lime  of  menstruation,  which  still  con- 
tinues regular. 

"There  is  no  projection  of  the  cervix  uteri  into  the  vagina,  and 
the  OS  uteri  has  entirely  lost  the  defined  m;irgins  which  are  natural  to 
that  part  in  general ;  it  is  very  much  closed,  and  gives  to  the  finger 
the  feel  of  a  small  puckered  cicatrix ;  but  all  the  parts  are  quite 
healthy  and  sound." 

Dr.  IMontgomery  prefers  the  ligature  for  the  removal  of  such  tu- 
mors, and  he  states  that  the  operation  is  more  likely  to  be  successful 
when  the  tumor  has  acquired  a  considerable  volume,  than  when  it  is 
of  a  smaller  size,  because,  though  there  may  be  more  difiiculty  in 
passing  the  ligature,  it  can  be  placed  biirher  up,  and  will  more  cer- 
tainly  retain  its  position.  Moreover,  from  its  greater  volume,  it  is 
probable  that  the  portion  of  the  cervix  uteri  i\o\u  which  it  springs 
will  have  become  elongated,  and  will  thus  be  more  readily  and  com- 
j)letely  brought  under  the  action  of  the  ligature.  After  the  extirpa- 
tion of  the  tumour.  Dr.  ?.I.  recommends,  "that  the  surface  from 
which  it  has  been  removed  should  be  freely  touched  with  some  active 
caustic,  such  as  the  strong  nitric  acid,  fluid  nitrate  of  mercury,  ni- 
trate of  mercury,  nitrate  of  copper,  or  perhaps  with  the  actual  cau- 
tery,  which,  Dr.  Johnson  informs  me,  proved  eminently  useful  in  a 
case  lately  under  his  care." 

"Practical  Observations  on  Phageda^nic  Tlceralion,  in  connection 
witli  its  primary  and  secondary  forms,"  is  the  title  of  an  intcreslin;; 
article  by  John  C.  Egan,  I\I.  D.,  Licentiate  of  the  Royal  College  of 
Surgeons  in  Ireland,  and  one  of  the  Surgeons  of  the  Westmoreland 
Lock  Hospital.     The  term  Phagcdagna,  has  been  difTcrcntly  employed 


200  Dublin  Journal.  [April, 


by  authors.  Dr.  Egan  bestows  this  appellation  on  "  sores  caused 
either  by  the  process  ofulceration  or  slougliing."  As  this  species  of 
disease  is  acquired  by  impure  sexual  intercourse,  it  has  generally 
made  some  progress  before  medical  aid  is  sought. 

"It  rarely  happens  that  we  are  consulted  by  a  patient  having  re- 
cently contracted  such  a  sore,  and  on  this  account  are  not  always 
able  to  state  what  was  the  first  indication  of  the  disease.  If  we  in- 
quire he  will  tell  us  it  commenced  either  in  a  small  black  spot,  re- 
sembling a  grain  of  shot,  or  that  a  "  pimple"  was  the  first  intimation 
of  its  existence ;  that  it  rapidly  increased  in  sizo,  without  cuusing 
much  uneasiness  :*  and  that  his  fears  were  first  excited  by  a  bleeding 
which  took  place  from  its  substance.  When  we  come  to  examine 
it,  we  find  the  surface  of  a  dark-ashy  colour,  to  which  a  bloody  mat- 
ter tenaciously  adheres;  it  neither  exhibits  granulations  nor  sur- 
rounding induration  ;  the  edges  are  irregular  and  undermined  ;  the 
parts  bordering  on  the  ulceration  are  of  a  reddish  hue  ;  the  smell  ex- 
tremely foetid  ;  and  at  this  stage  it  is  generally  attended  with  con- 
siderable pain.  In  the  male,  the  part  principally  engaged  is  the 
glans  penis,  from  which  it  afterwards  extends  to  the  prepuce;  in  the 
female,  the  external  labia  pudcndi,  in  the  first  instance,  from  which  it 
spreads  with  extreme  rapidity  ;  and  if  not  quickly  checked,  involves 
in  its  ravages  the  vagina,  perinaeum,  and  anus,  and  sometimes  even 
the  bladder  and  uterus." 

Dr.  Egan's  essay  is  principally  devoted  to  the  treatment  of  the  dis- 
ease. He  deprecates  strongly  the  employment  of  mercury,  and  in 
the  condemnation  of  this  medicine  he  is  sustained  by  Lawrence, 
Carmichael,  Ricord,  and  other  distinguished  surgeons.  He  admits, 
however,  that  there  are  a  few  cases  in  which  mercury  acts  benefi- 
cially, but  the  indications  for  its  use  do  not  seem  very  plain. 

"According  to  one  author  it  may  be  prescribed  where  there  is 
nothing  but  ulcerative  absorption,  without  any  trace  of  inflammation 
in  ihe  surrounding  parts,  and  where  no  constitutional  disturbance  is 
present ;  according  to  another  it  should  be  used  as  a  last  resource, 
where  every  other  remedy  has  failed  to  arrest  the  destructive  pro- 
cess ;  and  on  the  authority  of  a  third,  its  use  is  only  admissible  when 
the  ulcer  assumes  an  indolent  character.  I  need  scarcely  say,  that 
definite  as  these  directions  may  appear  to  the  theorist,  they  will  prove 
almost  useless  to  the  practical  surgeon,  in  the  treatment  of  the  dis- 
ease.    Experience  alone  will  solve  the  difficulty.     As  far  as  my  ob- 


  The  pain  and  constitutional  disturbance,  however,  often  keep  pace  with  the 


1845.]  Dublin  Journal.  201 


servation  extends,  I  may  remark,  that  the  cases  benefitted  by  mercury 
are  "  few  and  far  between,"  and  it  is  with  fear  and  trembling  I  resort 
to  it,  even  where  other  remedial  agents  have  proved  ineffectual." 


The  principal  indications  of  cure  are  to  subdue  the  accompanying 
fever  to  allay  irritation,  and  to  check  the  sloughing  process.  To 
effect  the  first,  Dr.  Egan  advises  the  use  of  the  lancet,  or  of  local 
abstractions  of  blood,  and  the  employment  of  tartar  emetic,  when  the 
condition  of  the  patient  will  permit ;  but  in  broken  down  constitu- 
tions such  active  treatment  cannot  be  borne.  In  such  cases  it  is 
advised  to  give  small  and  repeated  doses  of  the  antimonial  in  combi- 
nation with  opium.  To  allay  the  irritation  the  muriate  of  morphia 
is  advised,  to  be  given  in  pills  at  bed  time. 

"The  grand  object  to  be  attained,  to  which  the  foregoing  treat- 
ment is  merely  preliminary,  and  in  comparison  of  which  every  other 
indication  must  be  looked  upon  as  subservient,  is  the  arresting  of  the 
ulcerative  or  sloughing  process.  I  will  not  stop  here  to  recount  the 
various  remedies  that  have  been  had  recourse  to  at  different  times, 
and  by  different  practitioners,  for  this  purpose,  the  task  would  prove 
as  useless  as  it  would  be  uninstructive,  as  many  of  them  have  long 
since  sunk  into  deserved  oblivion,  but  at  once  proceed  to  a  plan  ot 
treatment,  which  is  attended,  for  the  most  part,  with  beneficial  re- 
sults, and  which  I  have  now  employed  extensively  in  the  wards  of 
this  hospital,  with  the  most  complete  success.  I  allude  to  the  appli- 
cation of  the  strong  nitric  acid,  which  is  to  be  used  freely  to  the  sore, 
and  repeated  until  a  clean  vascular  surface  comes  into  view.  The 
first  or  second  application  is  not  attended  with  any  considerable  de- 
gree of  pain,  as  the  disorganized  material  tends  to  protect  the  more 
sentient  parts,  but  in  proportion  as  the  more  sloughy  matter  becomes 
detached,  the  pain  is  increased  on  each  successive  application.  I 
am  in  the  habit  of  enveloping  the  parts  in  a  warm  poultice,  immedi- 
ately  after  the  employment  of  the  escharotic,  which  is  most  grateful 
to  the  patient,  and  assists  the  separation  of  the  disorganized  mass. 
If  the  slough,  as  occasionally  happens,  should  be  reproduced,  it  will 
generally  he  to  a  partial  extent,  and  at  this  period  equal  portions  of 
balsam  of  Peru  and  castor  oil  will  hasten  its  detachment ;  |)oultice8 
subsequently  encourage  granulation,  and  promote  cicatrization. 

"At  the  same  time  that  active  to|)ical  measures  are  resorted  to, 
constitutional  remedies  must  not  be  neglected.  The  administration 
of  dilute  nitric  acid,  in  combination  with  the  compound  decoction  of 
sarsaparilla,  acts  favourably  in  the  early  stages  of  the  disease,  but  at 
a  more  advanced  period  the  preparations  of  iodine  appenr  to  exert  a 
considerable  control  ovrr  this  sj)ecies  of  ulceration.  With  this  in- 
tention I  prescribe  the  hydriodate  of  potnsh,  commencing  wiih  five- 
grain  doses,  three   times  a  day,  and  gradually  increasing  it   to  ten, 


20J  French  Journals.  [April, 


which  I  seldom  am  obliged  to  exceed  ;  if  pushed  farther,  the  super- 
vention of  colicky  pains  renders  its  discontinuance  imperative." 

For  the  eruption  which  sometimes  follows  such  ulcers,  and  which 
is  generally  of  the  runial  form,  Dr.  Egan  recommends,  after  the  in- 
llammatory  symptoms  are  subdued,  the  use  of  the  Ilydriodate  of 
Potash  in  doses  of  five  grains,  three  times  a  day. 

"  When  I  was  first  appointed  to  this  hospital,  I  was  in  the  habit  of 
treating  tiiesc  cases  with  alterative  doses  of  mercury  in  the  form  of 
Plummer's  pill;  but  although  the  apparent  cure  wis  in  many  instan- 
ces expedited  by  tliat  remedy,  yet  the  relapses  were  so  numerous, 
that  I  determined  to  abandon  it  to  a  great  extent,  and  seek  some  other 
rv'^modial  agent  ;  and  none  appeared  to  answer  the  desired  object  so 
well  as  the  hydriodate  of  potash.  TTy  reasons  for  giving  it  the  pre- 
fM-ence  are  First.  It  cures  the  eruptive  and  ulcerative  disease.  Se- 
condly. It  is  useful  in  these  articular  pains,  so  often  accompanying 
ir.  Tliirdly.  It  acts  beneficially  in  the  form  of  sore  throat,  which  at 
a  more  remote  period  attends  upon  the  disease:  and  lastly,  it  is  par- 
tir-ularly  applicable  in  the  treatment  of  nodes,  wdiich  not  unfrequently 
present  themselves,  especially  after  mercurial  courses.  As  a  local 
upp'icj'.tion,  1  have  found  the  Unguent.  Hydrarg.  Nit.  Oxyd.,  diluted 
with  an  equal  proportion  of  lard,  particularly  usefid,  first,  in  tending 
to  soften  the  crusts,  and  subsequently  as  a  stimulant  in  assisting  to 
heal  the  ulcers." 

There  are  several  other  articles,  of  lesser  interest,  which  our  limits 
will  not  permit  us  to  notice. 


ARTICLE  IV. 


Gazette  Medical e  de  Paris,  No.  1  to  5  1845. 

Journal  des   Connaissances   MeUco-CliirurgicaJes. 

Bulletin  General  de  Therapeuiique  Medicale  ct  Chiritrgicale, 

We  have  received  several  of  the  latest  numbers  of  the  Journals 
above  named,  and  propose  to  notice  briefly  some  of  the  articles  which 
they  contain. 

1.  Tiie  Medical  Gazette  of  Paris  is  one  of  the  most  popular  journals 
of  the  French  capital.  It  has  now  reached  its  13th  vol.  ;  it  is  pub- 
lished every  Saturday,  in  newspaper  form,  in  numbers  containing  IG 
pages  of  double  columns,  and  its  chief  editor  is  M.  Jules  Guerin,  of 
orthopedic  notor!e'y.     The  price  per  annum  is  about  60. 


1845.]  French  Joiirnah.  203 


The  loading  Article  in  the  first  and  tiic  three  following  Nos.,  is 
entitled  the  "Disease  of  the  sternal  and  vertehral  articulations  of  the 
Ribs,  with  or  w^ithout  tubercular  softening  and  necrosis  of  the  Bones 
of  the  spinal  column."  By  A.  Toulmoucho,  M.  D.  &c.,  of  Rennes, 
France.  Althoiigii  this  is  an  excellent  production,  from  the  paucity 
of  affections  of  bones,  even  of  the  vertebrcs,  in  this  section  of  coun- 
try, we  shall  pas?  over  it  with  on!y  a  few  extracts.  Dr.  T.  commen- 
ces by  acknowlcdiiing  the  difficullies  in  relation  to  the  diagnosis  in 
the  affection.  "  Nevertheless,"  snys  he,  'Mho  works  of  ?!.  M.  Nichet, 
Nelaton,  Parise,  occ,  have  greatly  advanced  science,  and  dissipated 
in  pnrt  the  indcfinitencss  which  obtains  in  the  writing.-?  left  by  Pott, 
Pouteau,  Bra.sdor,  and  many  other  paliiclogists  of  the  last  centurj-. 
But  they  have  not  removed  the  uncertainty  and  obscurity  which 
still  reigns  in  the  syirptcmalclcgy.  Did  the  disease  under  consid- 
eration, begin  by  attacking  tlie  parts  situated  superficially,  it  would 
not  be  so  diflicidt  to  recognize  it ;  but  unfortunately,  {\\c  first  lesion 
is  in  the  bodies  of  the  vertebra)  deeplv  lodged  in  the  thoracic  or  ab- 
dominal cavity,  and  gives  rise  to  collection  of  pus  or  soAcned  tuber- 
culous matter,  inacce.>si!)le  to  all  means  hitiierto  employed  for  its 
early  recognition.  It  is  only  when  progress  has  been  made  by  this 
affection  in  the  advanced  stages,  and  when  paraphlegia  or  paralysis 
of  the  bladder,  succeed  to  the  pre-existcnce  of  pain  in  the  spinal  re- 
gion, or  the  detection  of  d"forinity  in  one  or  many  spinal  processes 
of  the  vertebra?,  that  we  arc  certain  in  our  diagnosis."  This  memoir 
of  M.  T.  comprehends  three  orders  of  facts  viz  :  1st.  those  in  which 
there  is  necrobis  of  the  head  of  a  rib  in  its  articulation  with  the  ver- 
tebral column,  destruction  of  this  part  and  symptomatic  abscess; 
2nd.  those  where  the  same  lesion  has  taken  place,  but  with  tubercu- 
lar  softning,  and  necrosis  of  the  neighboring  vertebra);  and  3rd. 
those  comprehending  the  same  morbid  affections  limited  to  the  spinal 
column.  Wc  object  to  the  word  necrosis  employed  in  this  article, 
it  should  have  been  caries. 

There  is  an  Article  in  Ophtalmology,  and  particularly  directed  to 
the  three  images  reflected  in  the  eye  ;  by  Dr.  Mngne,  of  Paris.  This 
writer  stales  that  since  he  addressed  a  memoir  to  the  Academy  of 
Sciences,  relative  to  a  black  cataract  upon  which  he  had  operated 
by  couching,  several  of  his  professional  brethren  had  called  upon 
him  fur  explanations  in  reference  to  the  imnges  refierted  in  tho 
eye,  and  which  induced  liim  to  believe  that  the  discovory  of  his  pre- 
ceptor, the  late  Prof.  Sanson,  was  neither  acknowledged   nor  appro- 


204  French  Journals.  [April, 


ciated  as  it  should  be.  He  then  states  that,  in  1835,  Dr.  S.  com- 
menced to  observe,  and  in  1837,  demonstrated  in  his  clinic,  that 
when  a  candle  was  placed  before  an  eye  whose  pupil  was  dilated, 
three  images  were  seen,  and  succeeding  each  other  from  before  back- 
wards. The  first  and  anterior  one,  is  the  most  evident,  and  is  up- 
right or  straight  the  second  or  middle  one  is  less  distinct  than  the 
anterior,  and  the  reflected  image  is  reversed,  or  upside  down  and 
the  posterior  is  (he  faintest  of  all,  and  is  upright  like  the  first.  Sanson 
and  his  pupils  arrived  at  the  same  results  in  their  investigations  on 
this  subject;  and  the  explanation  of  these  phenomena  is,  that  the 
first  or  anterior  image  is  produced  by  the  cornea ;  the  middle  or 
reversed  image  is  the  reflection  from  the  posterior  segment  of  the 
crystalline  capsule ;  and  the  third  or  posterior  straight,  is  due  to  the 
reflection  of  the  light  from  the  anterior  segment  of  the  capsule.  An 
opacity  of  the  cornea  destroys  all  the  images;  opacity  in  the  ante- 
rior capsule  prevents  the  two  posterior ;  and  that  of  the  posterior 
capsule,  the  reversed  image.  In  other  words,  in  cataract  of  the 
posterior  capsule,  the  middle  or  reversed  reflection  of  the  candle  is 
not  seen  ;  in  that  of  the  anterior  capsule  or  capsulo-lenticular  cata- 
ract, the  anterior  or  first  upright  image  is  alone  visible.  In  this 
catoptric  examination  of  the  eye,  the  two  following  circumstances 
must  be  remembered,  viz ;  to  have  the  pupil  well  dilated  and  the 
room  darkened. 

The  Review  of  Journals  contains  a  notice  of  the  Surgical  clinic 
of  Fribourg,  service  of  Prof.  Stromeyer,  from  1st  November,  1842,  to 
end  of  October,  1843,  414  patients  were  admitted,  and  245  consulta- 
tions were  held.  There  were  8  amputations,  6  of  the  leg  and  2  of 
the  thigh,  2  of  this  number  died,  3  excisions  of  cancerous  inferior 
lips,  all  cured,  4  cases  of  Lithotomy,  all  successful.  We  notice  in 
one  Journal,  the  case  of  a  girl,  aged  14,  who  in  17  days  past  898 
lumbricoides.  Except  being  pale-faced,  she  had  enjoyed  good  health. 
Means  employed  to  expel  the  worms,  not  indicated. 

At  the  session  of  the  Academy  of  Sciences,  M.  Baldacconi  pre- 
sented a  specimen  of  petrified  animal  substance,  produced  by  long 
immersion  in  a  saturated  solution  of  12  parts  of  bi-chloride  of  mercu- 
ry and  1  or  2  parts  of  hydrochlorate  of  ammonia. 

M.  Maisonneuve  proposed  a  new  mode  of  Cathetcrism  viz:  first 
to  introduce  a  very  small  bougie  of  gum-elastic  into  the  bladder,  and 
then  slide  upon  it  a  catheter  open  at  both  ends.  This  latter  instru- 
ment is  rendered  easv  of  introduction  bv  n  thread  of  silk  or  metal, 


1845.]  French  Journals,  S05 


tied  to  the  external  extremity  of  the  bougie,  after  passing  it  previously 
through  the  catheter.  This  is  now  to  be  pushed  gently  upon  the 
conducting  gum-elaslic  into  the  bladder. 

Dr.  Roesch,  who  writes  upon  the  subject,  says,  Goitre  is  the  com- 
panion and  precursor  ofcretenism,  wherever  this  disease  is  endemic  ; 
at  least  there  is  always  aujrmentation  or  deiicnorafion  of  the  thvroid 
gland  and  of  the  surrounding  cellular  tissue,  with  a  lymphatic  tem- 
perament and  a  physical  and  moral  apathy. 

M.  Lereboullet,  prot'essor  at  Strasbourg,  communicated  to  the 
Academy  a  case  of  distinct  inflammation,  and  of  its  usual  efTocts, 
intense  redness,  exudation  of  plastic  lymph,  formation  of  false  mem- 
branes, agglutination  and  purulent  secretion  in  a  coldblooded  animal, 
(a  species  shark.) 

2.  The  Journal  of  Medico-Chirurgical  Knowledge,  is  issued  every 
month  in  loose  sheets,  containing  46  pages,  and  is  accompanied  each 
year  with  two  Atlases  containing  six  Plates  of  Anatomy  of  the  natu- 
ral size,  engraved  upon  steel.     Price  82  50. 

The  leading  Article  in  the  January  No.  is  by  M.  Piorry,  one  of 
the  Professors  to  the  Faculty  of  ]\Jcdicine  in  Paris,  and  is  on  the 
effects  of  Sulph.  of  Quinine  upon  the  Spleen.  Given  in  20  gr.  dose, 
in  40  seconds  this  organ,  which  was  enlarged,  (hypersplenotrophy,) 
began  to  diminish  ;  and  in  five  minutes  the  diminution  was  very  con- 
siderable. Another  similar  dose  on  the  next  day  reduced  it  to  its 
natural  size,  and  cured  the  patient. 

In  the  sitting  of  the  Academy,  2nd  December,  1844,  M.  Maison- 
ncuve  proposed  in  cases  of  intestinal  obstruction,  to  cut  the  intestine 
above,  and  secure  it  by  sutures  to  another  opening  below. 

M.  Valenciennes  was  elected  on  the  9th  December,  in  the  section 
of  Zoology  of  the  Academy  of  Sciences,  in  the  place  vacated  by  the 
death  of  M.  GeoflVoy-Saint-Hilaire. 

The  Journal  states  that  800  Students  had  entered  the  School  of 
Medicine  in  Paris,  being  51  more  than  the  j)receding  year. 

The  plates  of  the  Atlas  for  January,  1845,  are  2  for  the  external, 
2  for  the  middle  and  2  for  the  internal  Ear.  We  need  scarce  add, 
they  are  most  minute  and  splendidly  executed. 

3.  The  General  Bulletin  of  IModical  and  Surgical  Therapeutics,  is 
edited  by  Dr.  Miquel,  and  is  issued  once  a  month ;  each  number  con- 
tains 80  pages,  and  it  is  exclusively  devoted  to  practice.    Price  4  50. 

Our  limits  will  not,  at  present,  permit  us  to  notice  the  contents  of 
this  work,  but  we  may  have  occasion  to  recur  to  it  hereafter. 


20G  Local  Ilijsieria,  [April, 


I\I.  Dcvcrgie  snys  lie  lias  employed  tho  following  recipe  for  an 
ointnicnt  for  Chilblr.ins  for  scveial  years,  and  almost  always  with 
f  ucccs  :. 

R.  Axiin^ia,  sjss;  Creosote,  10  drops;  Liquor  plumbi  sub-acctali.s, 
10  drops;  Thebaic  Extract  gr.  2.  I\I.  Make  Ointment.  Spread 
morning  and  evening  a  thin  layer  of  this  ointment  upon  the  parts 
affected  with  chilblains,  and  maintain  it  by  means  of  linen. 

We  learn  from  tiie  Bulletin,  that  the  number  of  physicians  in 
Paris  is  1430,  a  pretty  large  regiment.  Total,  in  France,  18,803. 
This,  we  think,  is  about  the  number  in  cur  own  Country. 


Local  Hysteria.     Bv  R.  B.  Todd,  ]\r.  D.,  F.  R.  S.j  Physician  to 
King^s  College  Hospital,  eye. 

It  is  difficult  to  assign  a  cause  for  the  fixation  of  the  hysterical 
phenomena  in  particular  localities.  We  have,  indeed,  very  much 
the  same  difficulty  here,  as  in  explaining  other  examples  of  general 
or  constitutional  disease  exhibiting  local  symptomps.  It  may  be  that, 
in  many  cases  at  least,  the  local  symptoms  should  be  regarded  as 
reflected  nervous  j)henomena,  cither  of  sensation  or  motion  ;  some 
part  of  the  great  gasfro-intestinal  surface,  or  some  internal  viscus, 
being  the  scat  of  a  primary  disturbance,  which  creates  an  irritation 
of  a  portion  of  the  nervous  centre,  and  this  affects  some  sentient  or 
motor  fibres  connected  with  it,  which  propagate  their  irritation  to 
some  peripheral  region.  Or,  again  (and  this  i)erhaps  is  of  rare  occur- 
rence), there  may  be  some  immediate  irritation  of  a  part  of  a  nervous 
centre,  not  propagated  from  any  sentient  surface,  but  caused  by  some 
local  disturbance  of  the  circulation,  and,  consequently  of  nutrition. 
Or,  lastly  (and  this  is  not  unfrequent),  the  patient  may  have  received 
a  strain  or  hurt  at  some  part,  and  her  attention  being  strongly  di- 
rected to  that  part,  and  her  anxieties  aroused  respecting  it,  that  part 
has  become  the  seat  of  a  fixed  pain.  And  even  if  there  has  been 
no  previous  injury,  there  can  be  no  doubt  that  a  part  may  become 
irritable  and  painful,  about  which  the  patient's  thoughts  and  anxieties 
have  been  occupied  for  a  considerable  time.  I  could  quote  to  you 
many  authentic  instances  of  this  power  of  the  mind  to  create  pain,  as 
it  were,  or  to  perpetuate  it,  after  it  had  been  excited  by  some  physical 
cause.  But  it  m.ust  suffice  for  me,  at  present,  to  direct  your  attention 
to  the  fact  as  one  of  which  it  is  most  important  that  the  practitioner 
should  be  cognizant.  I  do  not  profess  to  give  an  account  of//the 
forms  that  local  hysteria  may  assume,  so  many  and  so  various  arc 
they.  I  shall,  however,  briefly  refer  to  the  principal  varieties  that  are 
likely  to  be  met  with  in  practice. 


1845.]  Local  Hysteria,  207 


Pain  in  the  Side.  Amon2  the  most  common  forms  of  local  hys- 
teria are  those  pains  in  the  riuht  or  left  side  ;  of  these  I  believe  the 
most  frequent  is  that  on  the  leftside;  the  pain  is  referred  to  a  spot 
immediately  beneath  the  left  mamma,  corresponding  very  nearly  to 
the  situation  of  the  apex  of  the  heart.  In  m<i.st  cases  the  pnin  is  in- 
creased on  pressure:  sometimes,  however,  firm  and  steady  pressure 
gives  case,  and  I  have  sometimes  ohsorved  patieiits  to  make  pressuro 
themselves,  in  order  to  obtain  some  relief.  It  is  quite  extraordinary 
what  a  common  symptom  this  pnin  is,  or  that  on  the  right  side.  If 
you  watch  the  out-patients  of  this  hospital  for  a  day  or  two,  you  will 
find  a  large  portion  of  the  female  applicants  complainining  of  pain  in 
the  left  or  right  side.  It  is  very  frequently  (that  on  the  left  side 
especially)  accompanied  with  leucorrhoDa  or  some  form  of  uterine 
derangement,  so  much  so,  that  now,  after  I  have  learned  that  a  young 
woman  of  hysterical  appearance  complains  of  this  pain,  my  next 
question  invariably  refers  to  the  existence  of  leucorrhoea.  In  some 
instances  this  pain  is  always  increased  on  inspiration,  and  is  attended 
with  a  short  but  frequent  cough,  without  expectoration.  If  there  be 
any  emaciation,  or  if  there  has  been  phthisis  in  the  family,  the  fears 
of  the  patient's  friends  become  excited,  lest  this  cough  and  pain  should 
be  the  forerunners  of  consumption.  And  it  is  not  always  easy  to 
assure  oneself  that  the  irntaiion  of  nascent  tubercles  may  not  have 
some  share  in  the  production  of  the  phenomena.  Some  time  ago  I 
was  consulted  in  the  case  of  a  young  lady  of  good  family,  who,  from 
a  long-continued  pain  in  the  left  side  and  frequent  cough,  was  con- 
sidered to  be  phthisical,  and,  in  consequence,  was  kept  in  a  regtilafed 
temperature  for  a  considerable  period.  By  several  very  careful  ex- 
aminations of  the  chest,  I  teit  myselfat  liberty  to  pronounce  her  free 
from  tuhercular  disease,  and  prescribed  an  opposite  mode  of  treat- 
mont,  good  air,  carriage  exercise,  and  tonics,  with  great  advantage; 
and  now  I  sometimes  see  this  lady,  who  enjoys  good  health,  but  is 
subject  to  the  occasional  recurrence  of  this  pain  in  the  side  and  cough, 
whenever  any  anxiety  occurs  to  excite  her  hysteria. 

IrrilubJe  Spine.  The  irritable  sjiine  is  another  form  of  local  hys- 
teria,  which,  if  treated  on  erroneous  principles,  or  if  its  real  nature 
be  not  detected,  may  lend  to  very  serious  consequences.  This  aflec- 
tion  has  been  deemed  of  sufficient  importance  by  some  practitioners, 
to  merit  its  being  designated  by  the  special  name  of  spinal  irritation, 
But  this  term  is  highly  ohjectionable  ;  for  it  implies  that  the  essence 
of  the  patient's  mahidy  is  to  be  found  in  the  spinal  aflection,  and  that 
the  treatment  is  chiclly  to  be  directed  to  relieve  the  local  sutferino-. 
And  many  who  have  written  upon  this  suiijoct  have  striven,  on  very 
insufficient  evidence,  to  show  lliat  the  spinal  cord  itself  is  at  fault. 
The  truth,  however,  is  that  the  spinal  irritation  is  hut  a  svmptom  of  a 
general  state,  a  local  malady  depending  on  a  constitutional  cause. 
These  cases  are  often  mistaken  for  actual  disease  of  the  vertebra?, 
and  |)atients  have  been  confined  to  the  recinnbint  posture  for  its  cure,   
a  mode  of  treatment  admirably  calculated  to  perpetuate  the  real  com. 


208  Local  Hysteria,  [April, 


plaint.  It  often  happens  that  the  patient  has  difficulty  in  walkinjr, 
and  this  is  regarded  as  tlie  consequence  of  the  spinal  afiection.  She 
at  first  finds  lierscif  easily  fatin[iied  ;  the  pain  in  her  back  is  increas- 
ed by  walking  or  standinrj;  she  frradually  becomes  disinclined  to 
move,  and  jiets  accustomed  to  the  horizontal  position,  and  therefore 
readily  yields  to  any  sug-geslions  in  favor  of  quiet,  or  reluctantly 
obeys  the  advice  which  recommends  an  opposite  plan.  The  most 
acute  pain  is  felt  over  a  particular  spot  on  the  back.  Slight  pressure 
will  produce  it,  when  the  patient's  attention  is  alive  to  it ;  and  firm 
pressure  will  often  fail  to  create  it  when  her  attention  has  been  di- 
verted from  it.  But  there  is  always  a  good  deal  of  tenderness  in  the 
whole  course  of  the  spine,  and  in  other  parts  also.  You  will  derive 
great  assistance  in  your  attempts  to  distinguish  the  real  nature  of 
thisatfection,  by  attending  to  the  nature  of  the  pain  ;  it  is  always  of 
that  exaggerated  kind  which  I  alluded  to  in  my  last  lecture,  as  being 
characteristic  of  hysterical  pain.  It  is  much  more  acute  than  the 
pain  which  attends  diseased  vertebrae ;  it  is  more  superficial,  so  as 
often  to  appear,  as  I  believe  it  is,  seated  in  the  skin  that  covers  the 
spinous  processes.  We  had  one  of  these  cases  here  not  long  ago, 
which  very  forcibly  illustrated  the  importance  of  a  right  diagnosis. 
A  young  woman,  of  highly  hysterical  constitution,  was  sent  here  for 
pain  in  the  back  and  weakness  of  the  lower  limbs;  she  declared  that 
she  was  quite  unable  to  walk,  although  she  could  move  her  limbs 
very  well  as  she  lay  in  bed.  There  was  great  tenderness  over  two 
vertebrae  in  particular,  but  the  whole  spine  was  tender  also.  She  had 
been  treated  for  some  time  by  rest,  and  her  spine  had  been  cauter- 
ised. Vv'^e  humoured  her  a  little  for  a  day  or  two,  and  then  I  thought 
it  right  to  assure  her  that  she  could  walk,  and  that  she  must  walk  a 
little  every  day.  I  had  her  taken  up  and  supported  between  two 
women,  and  by  making  her  move  about  the  ward  in  this  way  a  little 
every  day,  and  increasing  the  walk  each  succeeding  day,  she  soon 
began  to  find  out  that  she  had  the  use  of  her  limbs,  and  ere  long  was 
enabled  to  walk  to  the  shower-bath. 

I  may  remind  you  of  another  case  still  in  the  hospital,  in  which 
this  plan  of  treatment  was  pursued  with  very  striking  success.  This 
is  the  case  of  the  woman  named  Collier,  in  Augusta  ward,  who  has 
been  so  long  under  treatment.  She  was  sent  here  completely  para- 
plegic, and  stated  that  she  had  been  bed-ridden  for  ten  years.  On 
examining  her  I  found  some  tenderness  of  spine,  but  no  unnatural 
condition  of  it.  The  power  over  the  bladder  and  rectum  was  unim- 
paired. She  is  highly  hysterical  and  rheumatic  also.  The  lower 
extremities,  from  disease,  were  completely  wasted  ;  she  could  not 
stand,  but  as  she  lay  could  move  about  her  limbs  freely.  I  encour- 
aged her  to  expect  a  cure,  and  told  her  that  she  must  exert  herself. 
She  was  supported  by  the  nurses  and  made  to  walk  a  little  every  day, 
and  after  persevering  a  few  weeks  in  this  treatment,  she  was  able  to 
walk  a  little  alone  ;  by-and-by  she  got  on  with  the  help  of  a  stick,  and 
now  she  can  walk  up  and  down  stairs  without  any  assistance.     Had 


1S45.]  Local  Hysteria.  209 


we  treated  this  poor  woman  on  the  supposition  of  her  having  spinal 
disease,  she  would  have  been  bed-ridden  all  her  life.  And,  indeed,  I 
attribute  the  slowness  of  her  recovery  (for  she  has  been  several 
months  under  treatment)  to  the  extreme  atrophy  of  her  muscles,  and, 
as  we  may  fairly  assume,  of  her  nerves  too,  which  was  brought  on  by 
the  disuse  of  them  for  so  long  a  time. 

Pain  in  the  region  of  the  sacrum  and  in  that  of  the  coccyx  are  less 
common  forms  of  local  hysteria.  They  may  probably  be  connected 
more  directly  with  uterine  irritation,  and  in  some  instances,  perhaps, 
with  imperfect  action  of  the  rectum,  and  accumulation  of  flatus  in  it. 

Local  Pulsation.  We  had  lately  a  case  in  which  this  form  of 
local  hysteria  was  very  well  marked  ;  and  it  was  accompanied  with 
another  symptom  not  uncommon  in  hysterical  persons.  This  was  a 
strong  pulsation  of  the  arota  in  the  epigastric  region,  simulating 
aneurism.  For  some  time  the  pulsation  appeared  so  strong,  and 
was  so  circumscribed,  that  had  I  not  known  the  decidedly  hysterical 
character  of  the  patient's  constitution,  I  should  have  felt  considerable 
apprehension  on  her  account.  However,  as  her  strength  improved, 
and  her  catamenia  became  regular,  those  symptoms  disappeared. 

Hyslerical  Affeciions  of  Joints.  The  profession  is  much  indebted 
to  Sir  Benjamin  Brodie  fljr  having  directed  attention  to  the  frequency 
with  which  local  hysteria  manifests  itself,  especially  among  the  higher 
classes,  in  the  form  of  aliections  of  the  large  joints,  simulating  tliose 
diseases  with  so  much  accuracy  that  practitioners  have  frequently 
been  misled  by  it.  Sir  Benjamin  states  the  remarkable  fact,  which 
no  one  is  so  well  able  to  ascertain  as  a  surgeon  of  his  great  experi- 
ence, that  four-fifths  of  the  supposed  cases  of  joint-disease  which 
occur  among  the  higher  classes  are  hysterical.  This  statement  ought 
to  impress  us  strongly  with  the  importance  of  being  well  acquainted 
with  the  peculiar  features  of  these  hysterical  atrcctions  of  the  joints. 

You  will,  of  course,  expect  to  find  in  these  cases  indications  of 
the  hysterical  constitution;  globus;  perhaps  occasional  hysterical 
paroxysms;  genera!  irritability;  enfeebled  nutrition;  pain  easily 
excited  on  pressure  at  various  parts  of  the  body;  irregular  cata- 
menia, or  some  uterine  disturbance.  The  joints  which  are  most 
frequently  afiected  are  the  hip  and  knee.  The  patient  keeps  the 
painful  joint  quite  at  rest,  being  fearful  of  the  least  disturbance. 
When  the  joint  is  moved,  she  will  call  out  with  much  more  expression 
of  pain  than  if  there  were  actual  ulceration  of  the  cartilages. 
*' There  is  always  exceeding  tenderness,"  Sir  Benjamin  Brodie  re- 
marks, "connected  with  which,  however,  we  may  observe  the  re- 
markable circumstance,  that  gently  touching  or  pinching  the  intctuj. 
ments  in  such  a  way  as  tliat  the  pressure  cannot  allect  the  deep-seated 
parts,  will  often  be  productive  of  much  more  pain  than  the  handlin"- 
of  the  limb  in  a  more  rude  and  careless  way."  As,  however,  in  most 
hysterical  atiections,  if  you  can  succeed  in  engaging  your  patient's 
attention  about  some  other  object,  and  lims  directing  her  thou>-|)ts 
from  her  own  sufferings,  you  will  iind  that  the  joint  can  be  moved 

14 


210  Local  Htjslcria.  [April, 


with  comparatively  little  or  with  no  pain.  I  need  not,  however,  dwell 
U|)on  this  suhject,  for  you  will  tind  it  admirably  discussed  in  Sir  Ben- 
jamiu  Brodic's  "Treatise  on  the  Joints,"  and  in  a  very  interesting 
and  practical  little  volume  on  "Local  Nervous  Aflections,"  which  I 
stronrrly  recommend  you  to  study. 

IrrilahJe  Brcasl.  Another  very  serious  form  of  painful  hysterical 
afiection  is  the  irritahle  bueast.  It  is  not  generally  attended  with 
swelling  or  enlargement.  The  irritability  is  excessive,  and  the  pa- 
tient shrinks  quite  as  much  from  superficial  as  from  deep-seated 
pressure,  and  even  before  she  hns  been  actually  touched  at  all.  These 
characters,  along  with  the  evidence  of  hysterical  constitution,  are 
sutiicient  to  enable  the  attentive  practitioner  to  distinguish  the  real 
nature  of  the  afiection. 

Aphonia   I  have  alluded  to  various  forms  of  hysterical  paralysis  ; 
you  may  have  numbness  in  the  course  of  particular  nerves,  or  para- 
lysis of  motion,  in  some  cases  putting  on  the  features  of  hccmiphlegia 
 in  others  of  paraphlcgia.  Hysterical  aphonia  must  be  regarded  as 
the  same  kind,  the  palsy  or  weakness  aflecting  the  muscles  of  the 
larynx.  The  patient  is  unable  to  speak,  except  in  a  whisper,  and 
even  then  not  without  eflbrt.  It  often  begins  and  ends  suddenly. 
Sometimes  it  remains  after  a  severe  hysterical  paroxysm  has  passed 
away.  This  is  a  form  of  local  hysteria  of  very  common  occurrence, 
and  not  likely  to  be  mistaken  lor  any  laryngeal  disease,  for  respira- 
tion remains  quite  unimpaired. 

Paralysis  of  the  Bladder.  Hysterical  paralysis  of  the  bladder  is 
also  common,  and  much  mischief  may  arise  from  neglect  of  constitu- 
tional  treatment,  and  too  close  attention  to  the  local  affection.  Sir 
Benjamin  Brodie  lays  down  the  rule,  that  in  these  cases  the  catheter 
should  not  be  had  recourse  to ;  and  the  only  exceptions  to  it  are  in 
those  extreme  cases  in  which  actual  paralysis  has  taken  place,  and 
the  bladder  is  likely  to  become  diseased,  if  not  artificially  relieved. 
A  similar  want  of  pov/er  over  the  rectum  may  occur  in  hysterical 
women.  I  have  known  women  complain  that  they  were  unable  to 
retain  the  contents  of  the  rectum,  although  they  were  conscious  of 
fajces  having  passed  into  it.  With  respect  to  many  of  these  cases  of 
hysterical  paralysis,  there  is  much  truth  in  Sir  B.  Brodie's  remark, 
*'  that  it  is  not  that  the  muscles  are  incapable  of  obeying  the  act  of 
volition,  but  that  the  function  of  volition  is  suspended." 

Spasmodic  Affections.  Among  the  various  forms  of  local  hysteria 
we  may  class  some  singular  spasmodic  affections  which  often  prove 
exceedingly  trouhlesome  ;  for  example  

Laryngeal  Affections.  In  the  woman  Collier,  whose  case  I  have 
had  occasion  to  refer  to  as  an  instance  of  paraphlegia,  we  had  an  ex- 
ample of  a  spasmodic  affection  of  the  muscles  of  the  larynx,  very 
much  resembling  the  spasmodic  croup,  or  laryngismus  stridulus, 
which  occurs  in  children.  This  attack  was  always  preceded  by 
depression  of  spirits  and  hysterical  crying;  the  breathing  became 
diiiicult,  and  both  inspiration  and  expiration  were  attended  with  a 


1845.]  Local  Hysteria.  211 


stridulous  noise  ;  there  was  also  a  loud  barking  cough,  which  could 
be  heard  at  a  considerable  distance.  The  attack  passed  off  as  the 
temporary  excitement  disappeared. 

Hysterical  Sobbing.  One  of  the  most  singular  cases  I  ever  saw 
was  that  of  a  girl  named  Howe,  a3tat.  19,  wlio  was  admitted  in  conse- 
quence of  a  peculiar  spasmodic  affection  of  the  diaphragm,  of  a  most 
severe  kind,  and  which,  while  it  lasted;  was  most  troublesome  and 
painful.  This  girl  has  been  a  long  time  in  the  hospital.  At  her 
admission,  on  the  28th  of  March,  she  stated  that  for  the  last  three 
months  she  had  been  very  sul)jcct  to  leucorrhcea.  In  other  respects 
she  was  in  good  health.  Her  face  has  the  aspect  of  hysteria;  the 
full  upper  lip  is  very  well  marked.  Four  days  before  her  admission, 
in  taking  down  a  bedstead,  she  fell  and  struck  the  right  side  of  her 
abdomen.  She  suffered  so  much  pain  at  the  moment  that  she  was 
obliged  to  rest  for  ten  minutes;  she  then  resumed  her  work  and 
thought  no  more  of  the  accident.  In  half  an  hour  she  was  seized 
with  a  catching  of  her  breath,  and  with  pain  in  the  right  side  of  the 
abdomen.  This  continued  for  two  or  three  hours,  so  as  to  interrupt 
her  work,  and  then  went  off.  Her  bowels  were  open  at  the  time,  but 
she  is  of  costive  habit.  In  the  evening  the  catching  of  her  breath 
and  the  pain  returned;  it  now  continued  sometime,  so  that  she 
scarcely  lay  down  during  the  night.  Next  morning  there  was  great 
epigastric  tenderness,  and  she  was  unable  to  bear  the  pressure  of  her 
stays.  The  catching  of  the  breath  and  pain  in  the  side  continued  to 
recur  in  fits  till  the  morning  of  the  26th,  when  they  discontinued,  but 
returned  in  the  evening,  and  have  continued  at  intervals  ever  since. 
At  our  first  visit  we  found  her  affected  with  this  catching  of  the 
breath.  It  exactly  resembled  a  violent  fit  of  sobbing,  unattended 
witli  flow  of  tears.  There  is  a  jerking  movement  of  the  neck  from 
side  to  side  with  each  sob,  but  the  limbs  are  motionless.  Any  ex- 
citement increases  the  sobbing.  It  was  much  increased  by  our  visit, 
and  subsided  after  we  left.  On  the  29tli,  whenever  she  was  visited 
by  myself,  or  by  the  pliysician's  assistant,  the  sobbing  was  brought 
on.  'i'he  pressure  of  the  stethoscope  in  exploring  the  chest  was 
sufficient  to  bring  it  on.  The  upper  extremities  are  now  thrown 
into  jerking  movements,  resembling  those  of  chorea,  shortly  after 
the  soljbing  begins.  The  slightest  touch  on  the  epigastrium  or  tick- 
ling the  soles  of  the  feet  brings  on  the  paroxysm,  even  when  her 
attention  has  been  directed  to  some  other  oi)ject. 

Her  treatment  consisted  in  free  purging  for  the  first  few  days,  lest 
there  should  be  any  lodgment  in  the  intestinal  canal,  and  sub^cquently 
tonics.  On  the  31st  her  attacks  ceased,  and  as  she  remained  quite 
free  up  to  the  5th  of  April,  and  her  health  was  inucii  improved,  she 
was  discharged.  She  was,  however,  readmitted  on  the  lOtli,  with  a 
recurrence  of  the  paroxysms,  without  any  a|)parent  cause.  They 
are  accompanied  with  jerking  movements  of  the  upper  limbs,  and 
tremblings  nf  the  lower  ones,  which  give  her  an  unsteady  gait  in 
walking.     Pressure  excites  or   increases    the  sobbing,   particularly 


212  Local  Hysteria,  [April, 


when  applied  on  tlie  right  side  ;  and  if  the  pressure  be  continued, 
the  sobhing  becomes  excessively  violent,  and  the  wl-olo  boily  is 
thrown  into  convulsive  movements.  The  fits  last  lor  three  or  four 
hours,  during  whicli  time  the  nurse  is  obliged  to  wall;  with  her  up 
and  down  the  wards  or  passages ;  for  she  cannot  remain  still,  during 
the  whole  time  she  is  affected  with  jerking,  chorea-like  movements. 
It  is  extraordinary  what  a  slight  pressure  will  excite  the  sobbing. 
If  she  accidentally  press  the  epigastrium  herself,  it  will  come  on  ; 
the  weigiit  of  the  bed-clothes,  the  least  pressure  or  even  touch  with 
the  top  of  the  finger,  or  even  the  near  approach  of  the  finger  to  the 
epigastrium,  will  excite  it.  She  had  followed  a  tonic  treatment  for 
a  considerable  time  without  any  benefit  to  these  paroxysms.  I  de- 
termined now  to  try  a  succession  of  blisters  to  the  epigastrium.  The 
first  excited  a  very  severe  paroxysm ;  however,  by  perseverance  in 
the  use  of  them,  she  has  not  only  become  able  to  bear  them,  but  the 
paroxysms  have  considerably  diminished  in  frequency  and  5everity, 
so  that  now  she  can  bear  a  good  deal  of  pressure  without  inducing 
the  sobbing. 

Sir  B.  Brodie  has  recorded  a  case  very  similar  to  this.  A  young 
married  lady,  who  was  liable  to  ordinary  attacks  of  hysteria,  com- 
plained of  a  tender  spot  on  the  anterior  part  of  the  abdomen,  a  little 
below  the  ensitbrm  cartilage.  The  slightest  pressure  of  the  finger  on 
it  caused  excessive  pain,  and  was  followed  by  violent  agitation  of  the 
whole  person,  bearing  a  nearer  resemblance  to  the  convulsive  motions 
of  chorea  than  to  any  thinfj  else,  and  continuing  for  several  minutes. 

Hysterical  Sneezing .  Women  are  sometimes  attacked  with  violent 
fits  of  sneezing,  coming  on  at  particular  periods  and  lasting  for  a 
considerable  time.  Of  my  own  knowledge  I  am  aware  of  but  one 
instance  of  this,  in  a  newly  married  lady,  in  whom  the  fits  of  sneezing 
used  to  come  on  early  in  the  morning.  There  was,  I  had  reason  to 
believe  in  this  case,  great  disappointment  that  the  signs  of  pregnancy 
did  not  appear  about  the  usual  time;  and  it  was  curious  that  these 
attacks  should  have  come  on  chiefly  when  the  morning  sickness 
would  have  shown  itself  in  the  early  stage  of  pregnancy.  Women 
who  are  expecting  pregnancy  become  very  familiar  with  the  ordinary 
symptoms  of  it.  Sir  B.  Brodie  relates  two  cases  of  this  kind,  in 
which  the  fits  of  sneezing  were  severe,  and  do  not  appear  to  have 
yielded  readily  to  treatment.  In  the  case  to  which  I  allude  no  relief 
had  been  obtained  when  I  last  heard  of  the  patient. 

Lancet,  July  15,  1843. 


1845.]  Hooping  Cough,  213 


PART  III. MONTHLY  PERISCOPE. 

Hooping  Cough.  The  popular  and  professional  catalogue  of  rem- 
edies for  hooping-cough  is  both  lengthened  and  varied,  proving  the 
usually  obstinate  nature  of  the  disease-  It  cannot,  however,  he 
doubted  that  particular  combinations  have  at  times  been  attended 
with  more  than  ordinary  success;  and  it  is  the  part  of  sound  wis- 
dom to  treasure  up  these  evidences  of  remedial  triumphs,  since  cir- 
cumstances may  arise  in  the  practice  of  all,  where  we  are  baffled  in 
the  application  of  our  general  principles,  and  are  glad  to  resort  to 
more  specific  and  empirical  means.  There  is,  no  doubt,  a  tendency 
in  most  minds  to  place  exaggerated  reliance  on  particular  remedies, 
and  to  attach  to  them  results  which  are  attributable  to  the  natural 
progress  of  the  disease;  but,  on  the  other  hand,  it  is  possible  to 
under-estimate  their  value,  and  to  adhere  too  obstinately  to  imagin- 
ary  principles.  Success  is,  after  all,  the  best  test  of  being  right, 
though  it  is  often  very  obscurely  obtained  ;  and  in  the  practice  of 
our  art  we  are  frequently  compelled  to  be  content  with  results  apart 
from  their  explanations,  and  to  submit  to  failure  where  our  theory 
seems  most  complete. 

Dr.  Thompson  considers  prussic  acid  his  sheet  anchor,  gradually 
increasing  the  dose,  and  combining  carefully  regulated  temperature 
with  a  milk  and  vegetable  diet.  He  says  the  disease  seldom  resists 
more  than  four  to  five  weeks. 

When  the  acute  symptoms  have  subsided,  the  following  extensively 
used  formula  of  Dr.  Beatty,  of  Dublin,  recommended  by  Dr.  Graves, 
has  proved  very  useful  : 

R'.  Compound  tincture  of  bark,  five  ounces  ;  tincture  of  lytta,  tinc- 
ture of  camphor,  of  each  half  an  ounce.     Mix.     A  tea  spoon- 
ful three  times  a-day  in  linseed  or  barley  tea. 
Above  five  or  six  years  of  age  the  dose  may  be  increased  one  third 
daily  until  half  an  ounce  is  taken. 

The  liquor  arsenicalis,  in  decoction  of  bark,  is  favorably  mention, 
ed;  and  in  the  second  volume  of  the  "Provincial  Transactions,"  p. 
412,  a  combination  of  the  tincture  of  lytta  with  the  tincture  of  lobelia 
is  stated  to  have  proved  successful. 

Belladonna,  by  liniment,  plasters,  and  intornnrlly,  is  undo'.ibtedly  a 
valuable  agent.  Dr.  VValdeck,  of  Berlin  (Bui.  Cen.  de  Ther.  1838), 
gave  from  one-tenth  to  one-twelfth  of  a  grain  for  a  dose,  and  speak.-? 
very  positively  in  its  favour.  Dr.  Loujbard,  of  Geneva  (French 
"Lancet,"  9th  June,  1839),  mentions  as  a  sure  symptom  of  the  de- 
cline of  the  disease,  the  greater  frequency  of  accesses  during  the  dav 
than  night,  and  vice  versa.  He  speaks  highly  of  the  sesquioxvde  of 
iron  in  diminishing  the  number  and  violence  of  tlie  fits,  giving  twenty- 
four  (o  thirty-six  grains  a-dny  in  divided  doses.  Dr.  Steyrnann  ("Bui. 
O.-^n.  doThi^r."  Plnrch,  1^:$-^).  brings  forward  siiuihir  evidence. 


214  Iloojnng  Cough,  [April, 


Dr.  Crosslcy  Ilnll's  great  remedy  in  all  cases,  was  powdered  alum, 
wliich  he  prescribed  in  a  little  water  eight  times  a  day,  beginning 
with  ten  grains,  to  be  increased  two  grains  each  dose  till  twenty  are 
reached,  which  was  then  continued  till  the  counh  had  coaled,  which 
he  states  was  tiic  case  generally  in  a  week  or  less.  The  above  doses 
arc  for  young  persons,  about  Iburtecn  ;  adults  may  increase  the  dose 
to  twenty. six  grains.  Infants  are  to  begin  with  four  or  live  grains, 
increasing  two  grains  a  dose  to  fifteen.  No  other  medicine  was  giv- 
en ;  milk  to  be  avoided. 

Dr.  Reecc  strongly  advises  a  warm  irritating  plaster  to  the  chest, 
and  the  following  medicine  : 

R.  Tincture  of  assafoetida,  one  drachm  ;  tincture  of  opium,   ten 
minims;  powder  of  ipecacuanha,  ten  grains;  water,  two  oun- 
ces.    Mix.     A  tea  spoonful  every   three  hours  to  a  child  two 
years  old,  increasing  the  dose  ten  minims  for  every  year. 
When  this  fails,  the  two  following  formulae  are  (too)  highly  praised  : 
Ft.  Powdered  leaves  of  conium,  one  scruple  ;  mint  water,  two  oun- 
ces ;  syrup,  two  drachms.     3Iix.     A  tea  spoonful  three  times 
a-day  to  a  child  of  any  age,  adding  ten  minims  to  the  dose,  till 
nausea  and  giddiness  are  felt. 
Br.  Di-acetate  of  lead,  four  grains;  syrup  of  poppies,  two  drachms; 
fennel  water,  two  ounces.     Two  tea  spoonsful  to  a  child  from 
two  to  ten  years  every  five  hours;   half  an  ounce  for  an  adult. 
It  is  said  to  cure  generally  in  three  days  (?).     There  is  other  confirm- 
ative evidence  in  favour  of  lead   in   this  disease,  and   a  formula  in 
combination  v/ith  conium  is  given  in  our  report  of  the  Reading  Pa- 
thological Society  for  1842. 

Mr.  C.  H.  Chavasse("  Lancet,"  May  30,  1840),  speaks  highly  of 
the  following  formula : 

R.  Sulphate  of  coi)per,  half  a  grain;  syrup   of  poppies,  half  an 
ounce  ;  anise  water,  an  ounce  and  a  half.     Mix.     A  tea  spoon- 
ful to  be  taken  every  second  or  fourth  hour,  according  to  age. 
Sir  William  Watson's  celebrated  prescription  was  
R.  Tartar  emetic,  one  grain  ;  tincture  of  opium,  twenty  minims; 
distilled  water,   one  ounce.     Mix.     A   tea  spoonful  every,  or 
every  other  night. 
Mr.  Pearson,  after  premising  an  emelic,  relied  much  on  
R.  Tincture  of  opium,  one  minim  ;   ipecacuanha  wine,  five  drops; 
carbonate  of  soda,  two  grains  ;  water,  halt  an  ounce.     Mako 
a  draught  to  he  taken  every  four  hours. 
Dr.  C.  Wachtl,  of  Vienna  (vide  Provincial  Journal,  Jan  21,  184a), 
has  foimd  Cochineal  very  useful  in  rapidly  checking  the  paroxysms. 
R.  Cochineal,  ten  grains;  hitartrate  of  potash,  one  scruple;  sugar, 
one  ounce;   water,  six  ounces.     A  tea  spoonful  every  four  or 
six  hours. 
It  is  an  old  and  popular  remedy. 

The  following  is  Roche's  far-Himed  enihrncation  : 
R.  Olive  oil,  one  ounce;  oil  of  cloves,  half  an    ounce;  succinum 
oil,  half  0!i  ounce.     iIix. 


1845.  J  Acute  Diseases  in  the  Throat,  215 


We  are  not  the  advocates  of  one  or  all  of  the  above,  but  think 
their  occasional  efficacy  sufficiently  attested  to  justifv  their  use  in 
particular  cases.  Prov.  Med.  Jour,,  May  13, 1843.  {Braithwaite's.) 


Cases  of  Acute  Diseases  in  the  Throat  and  Larynx.  By  Dr.  James 
Arthur  Wilsox,  Physician  to  St.  George'' s  Hospital. 
There  can  be  no  doubt  that  many  lives  are  lost  by  the  above  in- 
flammations for  want  of  tracheotomy.  In  Nov.,  1830,  Dr.  Wilson, 
with  Dr.  Xcvenson  and  Mr.  Keate,  attended  a  gentleman  who  died 
of  cynanche  supervening  on  erysipelas.  On  examination,  the  epiglot- 
tis and  posterior  membrane  of  the  tongue  were  found  to  be  highly 
vascular  and  thickened,  and  pus  was  iniiltrated  in  the  cellular  mem- 
brane of  the  fauces.  The  larynx  below  the  cordas  vocales,  and  the 
trachea,  were  fiee  from  disease  or  obstruction.  Here  was  a  case 
where  tracheotomy  would  have  saved  life,  almost  to  a  certainty. 
The  event  made  a  deep  impression  on  Dr.  W.'s  mind,  and  was  of 
service  thirteen  years  afterwards. 

Case.  Mr.  W.  C,  aged  27,  full  habit,  got  heated  at  a  ball,  and 
caught  cold  going  home.  He  was  unable  to  sleep,  from  general  un- 
easiness and  sense  of  choking  on  attempting  to  swallow.  Leeches, 
calomel,  and  other  measures,  were  em))loycd;  but  the  breathing  was 
not  relieved,  even  by  the  abstraction  of  twenty-four  ounces  of  blood 
from  the  arm.  In  the  evening  of  July  8,  1843,  he  was  inextremis^ 
and  xMr.  Keate  exposed  the  trachea  below  the  thyroid  gland,  and 
made  an  opening  into  it,  inserting  a  canula  in  the  aperture.  Instan- 
taneous relief  was  the  consequence. 

"On  the  first  rush  of  air  into  the  trachea,  the  patient  appeared  to  feel  instant 
relief,  and  his  countenance  be2:an  at  once  to  resume  its  natural  expression;  but 
from  this  time  not  two  minutes  could  have  elapsed,  when  he  was  suddenlv  at- 
tacked by  most  violent  spasms  of  his  whole  frame,  with  a  stru2:2:le  for  breath,  as 
if  threatening  immediate  suffocation.  All  consciousness  directly  ceased,  the 
eyelids  chx<ed,  tlie  face  was  livid,  the  features  were  distorted,  the  blood,  still 
bubbling,'  from  the  wound,  became  suddenly  black  as  ink.  The  breath  was 
drawn  convulsively,  and  at  Ions:  intervals.  All  movement,  excepting  that  of 
the  pulse,  had  ceased,  and  the  patient  appeared,  literally,  at  his  last  gasp.  Du- 
ring this  awful  crisis  of  the  young  man's  fate,  which  lasted  for  perhaps  a  minute, 
(seemingly  tor  a  much  longer  time.)  his  head  washeld  forcibly  bade,  the  cr.nula 
was  withdrawn.  and  the  orifice  in  the  tracliea  cleared  from  blood,  and  kept 
widely  open.  The  breathing  at  length  became  more  natural;  the  face,  no  long- 
er ghastly,  began  to  resume  the  character  and  tint  of  life.  IN'ot  long  after  this 
most  fearful  convulsion,  a  large  quantity  of  mucus,  mixed  in  part  witii  bloo<l, 
v.-as  rejected,  in  long  viscid  rojies,  from  the  mouth;  and  it  v.as  then  found  that 
the  patient  again  breathed  through  the  larynx,  Ujxm  this,  the  canula  was  final- 
ly withdrawn.  A  profuse  perspiration  now  burst  forth  from  the  face,  neck,  and 
chest  of  the  patient,  who  gradually  recovered  his  consciousne.<^<,  and  expressed 
by  writing  tliathis  'brealhin'.:  was  quite  easy.'  He  slept  at  intervals  during  the 
night,  and  was  convalescent  from  this  time." 

Although,  as  Dr.  Wilson  remarks,  the  operation  can  linrdlv  bo  too 
Into,  yet  ihochnnce  of  succor's  is  preatlv  los.^cncd  bv  dolav,  bccniso 
the  patient  is  bt'Iiiir  poisont  d  by  bis  own  b!r,.fl.      '!'!,. .r<^  i^  n  good  deal 


216  Effects  of  Indian  Hemp  Chronic  Diarrhcca.         [April, 


of  nianafTcmcnt  necessary  in  preventing^  the  blood  from  flowing  down 
the  trachea  into  the  I'.'ngs.  The  operation  of  traclieotomy  lias  now 
been  so  often  performed  with  success,  that  no  patient  should  be  al- 
lowed to  be  sutlucated  by  obstruction  about  the  throat,  without  open- 
ing the  vvind-pij)e.  A  gentleman  of  our  acquaintance  breathed  more 
than  twenty  years  through  a  tube.  Medico- Chirurgical  Review, 


The  Physiological  and  Thrrcfpeulical  Effects  of  Indian  Hemp. 
Bv.  Dr.  Lauuie.  The  following  arc  the  principal  conclusions  to 
which  his  experiments  lead:  

1.  It  seems  to  belong  to  that  class  of  narcotics  which  rapidly  in- 
duce excitement  and  intoxication,  followed  by  sleep,  neither  sound 
nor  refreshing. 

2.  In  a  full  dose  it  acts  powerfully  on  the  heart,  causing  palpita- 
tions, and  rapid,  weak,  intermittent  pulse ;  and  on  the  nervous  system, 
producing  delirium,  coma,  convulsions,  and  dilated  pupils. 

3.  Its  eflects  are  generally  transitory.  In  one  case,  however,  the 
intoxication  and  dilatation  of  the  pupils  lasted  nearly  forty-eight  hours. 

4.  It  is  a  very  uncertain  agent,  in  some  cases  producing  the  most 
violent  and  seemingly  dangerous  symptoms,  in  others  being  nearly 
inert. 

5.  It  very  frequently  causes  vomiting,  which,  whether  it  occur 
spontaneously  or  from  emetics,  very  speedily  relieves  its  unpleasant, 
and  perhaps  dangerous  effects. 

6.  Applied  around  the  eye,  it  does  not  dilate  the  pupil. 

7.  It  exerted  little  influence  on  the  few  patients  to  whom  it  was 
given  in  the  form  of  enema. 

8.  He  does  not  think  it  is  a  valuable  addition  to  our  narcotic  medi- 
cines. In  very  few  instances  did  it  act  as  an  agreeable  soporific  and 
anodyne  ;  in  none  did  it  succeed  when  opium  had  failed  ;  and  in  one 
case  only  was  it  preferred  to  opium. 

9.  So  far  from  acting  generally  as  an  anodyne,  its  clTecfs  was  so 
disan-reeable,  that  the  majority  of  those  who  took  it  once,  only  did  so 
a  second  time  on  compulsion;  and  this  is  the  more  remarkable,  as 
the  patients  on  v/liom  he  experimented  belong  to  a  class  to  whom 
stimulants  of  all  kinds  are  familiar,  and  who  would  greedily  swallow 
opium  and  spirits  to  an  unlimited  asnount. 

10.  It  caused  an  immediate  cravinjr  for  food,  and,  in  a  few,  per- 
manently increased  the  appetite.  Edinburgh  Monthly  Journal, 

Nitrate  of  Silver  in  Chronic  Diarrhoea.  Drs.  Bertini  and  Bellin- 
ciere,  in  ol>stinate  diarrhoea  and  dysentery,  have  found  great  advan- 
tao-e  from  the  use  of  enemata  and  of  cry!>talized  nitrate  of  silver. 
These  enemata  are  prepared  by  dissolvini:  half  a  grain  of  nitrate  of 
silver  in  half  a  pint  of  water.  The  patient  sijould  retain  the  enema 
for  some  hours.  If  necessary,  the  dose  of  nitrate  of  silver  may  be 
increased  to  three  grains  for  each  enema.  Terza  Statistica  Nosolo- 
fica,  4'^.,  1843,  p.  37,  quoted  in  Annalcs  de  Thcrapeutiquej  Nov., 
1843.     American  Journal  of  Medical  Sciences. 


1845.]  The  Use  of  Pure  Tannin.  217 


The  Use  of  Pure  Tannin.  By  Robert  Druitt,  Esq.  In  any 
case  in  which  a  vegetable  astringent  is  indicated,  Mr.  Druitt  believes 
that  the  tannin  ought  to  have  the  preference.  A  simple  solution  of 
it,  in  distilled  water,  he  says,  is  much  more  easily  and  quickly  pre- 
pared, as  well  as  much  more  elegant,  than  the  ordinary  decoction?  or 
infusions  of  oak-bark,  catechu,  &c. ;  moreover,  it  may  be  prepared 
of  uniform  strength,  and  free  from  foreign  inert  matter,  and  is  not 
liable  to  decompose  quickly ;  in  fact,  it  has  all  the  advantage  which 
the  other  simple  vegetable  principles  have  over  crude  preparations 
from  the  herbs  or  extracts  in  which  they  are  contained. 

The  cases  in  which  3Ir.  D.  has  employed  it,  are  sore  nipples, 
excoriations  about  the  anus  and  scrotum,  piles,  leucorrhosa,  atonic 
phagedenic  sores,  tooth-ache,  aphthous  sores  in  the  mouth,  severe 
salivation  and  relaxed  sore  throat. 

Vov  sore  nipples  especially,  Mr.  D.  has  found  it  ''invaluable." 
Every  accoucheur  knows  what  a  source  of  wretchedness  and  illness 
these  are  to  the  young  mother,  and  how  diincult  it  often  is  to  find  a 
decisive  remedy  ;  but  Mr.  D.  has  never  been  disappointed  in  the  use 
of  tannin,  except  once  in  a  neglected  case,  with  deep  irritable  cracks, 
for  which  it  was  necessary  to  use  the  lunar  caustic.  The  form  in 
which  he  employed  it,  is  a  solution  of  five  grains  in  an  ounce  of  distil- 
led water  ;  this  is  applied  to  the  nipple  on  lint,  covered  with  oil  silk. 

For  the  itching  excoriations  about  the  anus  and  scrotum,  which  so 
much  infest  old  men,  he  has  used  it  with  benefit,  but  prefers  lemon 
juice  as  a  local  application.  For  piles,  with  mucous  discharge,  he  has 
also  found  it  of  use,  but  he  cannot  say  much  on  this  point  from  his 
own  experience. 

"In  one  or  two  cases  oflin^erins:  atonic  phagedena,"  says  Mr.  D.,  "I  have 
found  it  of  some  service,  sprinkled  thickly  on  the  sore;  but  more  parlieiilarlj'so 
in  those  aphthous  ulcers  which  sometimes  occur  in  the  mouths  of  adults,  from 
acidity  of  the  stomach,  and  congestion  of  the  liver.  I  may  say  that  I  believe  it 
the  be.^t  possible  remedy  for  severe  salivation,  and  for  all  cases  of  relaxed  sore- 
throat  attended  with  superabimdance  of  mucus.  It  coasrulates  the  mucus  and 
enables  the  patient  to  get  rid  of  it  easily.  Of  course  I  do  not  use  it  to  the  exclu- 
sion ofcon.stitutional  remedies;  but  of  all  the  local  means  of  making  the  mouth 
comforUihk,  1  believe  it  to  be  the  l)est. 

"But  of  all  the  cases  for  wliich  it  is  adapted,  that  common  trou])lcsome  com- 
plaint, tooth-aclie,  is  that  in  which  I  believe  it  is  most  to  be  depended  on.  For 
this  piece  of  useful  knowledge  I  am  indebted  to  my  friend  Mr.  Tomes,  and  I  have 
te.sted  it  by  ainj)le  personal  experience.  It  willofien  l)e  found,  as  Mr.  Tomes 
told  me,  that  the  gum  around  a  carious  tootli  is  in  a  spungy,  llabby  condition;  a 
little  piece  of  it,  perhaps,  growing  into  the  cavity.  The  ache,  too,  is  often  quite 
as  much  in  the  gum  as  in  the  tooth  it.sclf.  But,  be  this  as  it  may.  when  the  tooth 
aches,  let  the  patient  wash  out  the  mouth  thoroughly  with  a  .solution  of  carbonate 
of  .soda  in  warm  water;  let  the  giun  around  the  tooth,  or  between  it  and  its  neigh- 
bors, be  scarrilied  witii  di  fine  lancet;  then  let  a  little  bit  of  cotton  wool,  imbued 
"widi  a  solution  of  a  scru]le  of  tannin,  and  five  grainsof  mastich,  in  two  drachms 
of  aether,  be  put  into  the  cavity,  and  if  the  ache  is  to  he  cured  at  all,  this  plan  will 
put  an  end  to  it  in  nine  cases  out  of  ten.  1  think  that  practitioners  are  to  blame 
in  not  paying  more  attention  to  the  cure  of  icoth-ache;  1  am  convinced  that,  in 
most  cases,  it  is  as  curable  as  a  colic  or  a  pleuri.sy ;  the  chief  points  being  loopen 
the  bowels,  and  put  the  .serreiions  of  the  mouth  in  a  healthy  state,  and  to  apply 
some  gentle  astringent  and  dcfcn?ative  to  the  diseased  tooth,  till  it  is  capable  of 


219  A  Test  for  Bile  Medicinal  Substances.  [April, 


bein<3:  stopped  by  some  metallic  substance.  I  say  emphatically  afiie  lancet,  be- 
cause llie  coarse,  round,  blunted  tools  that  are  generally  sold  under  the  name  ot" 
fum-lancets,  only  bruise  the  gum,  and  cause  horrible  pain.  The  lancet  \vhich 
use  is  sickle-shaped,  cutting  on  both  edges  and  finely  ground;  and  it  guarded 
Avith  the  middle  finder  of  the  right  hand,  it  may  be  used  in  the  case  of  the  most 
unruly  children,  without  any  possible  i\\  icsu\C^-I'Vwii  Am.  Jour.  Mtd.  Sciences. 


A  Test  for  Bile.  M.  Pcttinkofttr,  a  German  student,  lias  discov- 
ered a  test  for  the  presence  of  bile.  It  consists  in  addintr  to  the  fluid 
supposed  to  contain  bile,  concentrated  sulpliuric  acid,  until  it  becomes 
hot,  and  then  dropping  into  it  a  solution  of  suj^ar  (syrup.)  the  pre- 
sence of  bile  is  manifested  by  tiie  mixture  becoming  of  a  deep  pink 
or  red  colour,  varying  in  intensity  with  the  amount  present. 

*^*  This  seems  to  be  a  merely  accidental  discovery,  the  reaction 
being  inexplicable  upon  any  known  relation  or  analogy  between  the 
substances.  London  Lancet. 


On  the  passage  of  Medicinal  Substances  through  the  human  econ- 
omy. MM.  Millon  and  Laveran,  after  going  through  a  series  of  re- 
searches, witli  a  view  to  ascertain  in  what  manner  certain  medical 
substances  atiect  the  urinary  secretions,  have  arrived  at  the  following 
interesting  results:  

The  substances  experimented  on  were,  principally,  the  double  tar- 
trate of  soda  and  potash,  which  was  administered  208  times;  the 
Hulphate  of  soda  was  administered  fifteen  times  ;  sulphur,  four  times  ; 
and  salicme,  ten  times.  The  tartrate  of  soda  and  potash  was  chosen 
in  order  to  ascertain  whether  the  opinions  generally  entertained  re- 
specting the  conversion  of  alkaline  tartrates,  citrates,  and  acetates, 
into  carbonates,  into  the  animal  economy,  are  correct.  So  far  from 
this  being  invariably  the  case,  it  was  found  that  the  transformation 
was  very  uncertain.  Tiius,  of  the  two  hundred  and  sixty-eight  cases 
in  which  the  double  tartrate  was  administered,  in  one  hundred  and 
seventy-five  the  urine  was  alkaline;  in  eighty-seven,  acid  ;  and  in 
six  neutral.  The  mode  of  expulsion  of  the  salt  appears  to  depend 
nearly  entirely  on  the  mode  of  administration.  If  taken  in  large 
doses  ten  or  twelve  drachms,  for  instance,  in  a  limited  period  
its  effect  is  generally  concentrated  on  the  intestinal  canal,  and  its 
ingestion  is  Ibllowed  by  several  liquid  stools.  Sometimes,  however, 
no  purgative  effect  is  produced  on  the  digestive  tube,  and  then  the 
urine  is  alkaline,  the  salt  evidently  l)eing  absorbed  and  expelled 
through  the  urinary  organs.  When  the  same  quantity  is  administered 
in  fractional  doses,  duiing  a  period  of  ten  or  twelve  hours,  the  effect 
produced  is  different.  The  salt  docs  not  then  give  rise  to  purging, 
but  is  absorbed  and  eliminated  as  an  alkaline  carbonate  by  the  urin- 
ary organs.  In  the  first  instance,  indigestion  follows  its  administra- 
tion, and  it  may  be  looked  upon  as  an  aliment;  in  the  second,  there 
are  absorption,  assimilation,  and  secretion,  and  it  is  then  a  medi- 
cine. In  order  to  ascertain  whether,  when  the  urine  was  acid  or 
neuter,  alter  the  administration  of  the  salt,  the  soda  and  potash  might 


1845.]  Medical  Memoranda.  219 


not  escape  non-docoraposcd,  combined  with  tartaric  acid,  or  united  to 
some  organic  acid,  several  experiments  wore  instituted,  by  which  it 
was  ascertained  that  the  proportion  of  alkali  contained  in  the  acid 
or  neutral  urine  was  identically  the  same  as  that  contained  in  normal 
urine.  It  thus  became  evident  that  the  double  tartrate  did  not  escape, 
as  such,  along  with  the  urine. 

Ro])ust  men,  slightly  unwell,  shewed  the  greatest  aptitude  to  digest 
the  tartrates.  Tiicy  occasionally  digest  part  of  the  salt,  even  when 
given  at  once  in  large  doses.  Sometimes,  although  administered  in 
fractional  doses,  the  urine  remained  acid.  This  was  the  case  when 
the  patient  was  attacked  with  diarrhcea,  or  was  in  an  acutely  febrile 
state.  But  even  ihen,  by  persisting  in  its  use,  the  urine,  at  first  acid, 
gradually  became  alkaline.  On  the  other  hand,  absorption  was  fa- 
voured by  constipation. 

The  administration  of  the  citrate,  in  absorbing  doses,  was  tried  in 
pneumonia  and  rheumatism.  The  blood  of  the  patients  thus  treated 
was  analyzed  ten  times.  The  fibrin  was  not  found  to  have  dimin- 
ished in  quantity,  and  the  bufi\'  coat  was  as  great  as  before  it  had 
been  given.  Although  the  alkaline  carbonate  was  formed  in  the 
urine,  these  diseases  progressed  as  usual.  The  increase  of  the 
powers  of  oxidation,  rendered  evident  by  the  excess  of  urea,  led  to 
its  trial  in  cases  in  which  the  nutrition  was  languishing ;  and  it  was 
found  useful  in  general  debility,  phthisis,  albuminuria,  6^c. 

The  sulphate  of  soda  gave  the  same  results  as  the  double  tartrate. 
Sulphur  was  never  found  in  the  urine,  under  whatever  shape  it  was 
administered.  Ibid, 


MEDICAL    MEMORANDA. 

Quinine  in  Ague.  Dr.  Stratton  thinks  a  single  large  dose  in  the 
interval,   cures   more  rapidly  than  repeated  small  doses. 

Treatment  of  Neuralgia.  Dr.  Jacques,  of  Antv.erp,  recommends 
inoculation,  by  means  of  a  vaccinating  lancet,  with  a  solution  of 
sulphate  of  morphia. 

M.  LafarfTue  recommends  inoculation  in  the  same  way,  with  a  sat- 
urated solution  of  veratria  ;  and  M.  Roclauts,  a  Dutch  physician, 
gives  nux  vomica,  in  doses  of  from  three  to  ten  grains  in  the  twenty- 
four  hours. 

Succinate  of  Ammonia  in  Delirium  Tremens.  M.  Scharn  has 
Bcen  the  most  lurious  delirium  overcome  as  by  enchantment,  and  the 
disease  removed  in  a  few  hours,  by  the  use  of  this  remedy  alone. 

Arsenic  in  Peritoneal  Dropsy.  Dr.  Dc!)avay  has  treated  a  case 
successfully.  One-twentieth  of  a  grain  was  given  twice  a  dav.  The 
improvement  was  nolable  in  six  weeks,  and  in  six  months  all  symp- 
toms had  ceased,  and  the  catamcnia,  which  had  been  suppressed, 
were  restored. 

Mustard  in  the  Convulsions  of  Children.  Dr.  Tripler  was  led  to 
the  employment  of  this  remedy  as  an  emetic,  and  finding  it  arrest  in 


220  Extensive  Burn  Galvanism.  [April, 


a  few  minutes  an  attack  of  convulsions  that  had  lasted  five  hours,  he 
has  employed  it  in  (liree  other  cases  with  complete  success. 

Prophylactic  Remedy  against  PtyaVism.  Dr.  Schoepf  recom- 
mends llic  following  tooth-powder  during  the  administration  of  mer- 
cury, to  prevent  salivation.  Dried  alum,  powdered,  3ij.;  powder  of 
cinchona,  sj.;  to  be  used  by  means  of  a  soft  brush,  morning  and  even- 
ino-.  Ibid, 


We  take  llie  following  Extracts  from  a  notice  in  the  last  No.  of 
the  Medico-Chirurgical  Review,  of  a  work  entitled  "Facts  and  Ob- 
servations in  Medicine  and  Surgery.     By  John  Grantham.  : 

Extensive  Barn.  A  case  of  a  burn  from  gunpowder  is  related,  in 
which  nearly  the  whole  of  the  trunk  and  a  portion  of  the  extremities 
were  involved,  "  the  whole  measured  above  600  superficial  inches, 
or  four  feet,  24  inches,  and  averaged  a  quarter  of  an  inch  in  depth. 
Also  the  subcutaneous  structure  was  completely  lost,  so  that  the  ar- 
teries and  veins  were  seen,  as  if  neatly  dissected,  lying  on  the  surface 
of  the  muscles  and  fascia."  The  successful  issue  of  the  case  reflects 
great  credit  upon  the  author,  especially  as  more  than  one  untoward 
occurrence  intervened.  Three  principles  especially  guided  him,  the 
due  supply  of  nutritive  food,  the  regulation  of  the  animal  heat,  and 
the  external  and  internal  use  ofantiseptic  agents,  such  as  the  a|)plica- 
tion  of  yeast,  the  evolution  of  oxyminiatic  gas  into  the  apartment, 
the  administration  of  alkalis,  &c.  During  the  extensive  suppuration 
which  occurred,  six  pints  of  milk  in  the  twenty-four  hours  served  to 
support  the  youth's  (oet.  17)  strength.  A  sphacelated  wound  over 
the  sacrum,  an  attack  of  bronchitis,  and  an  extensive  re-opening  of 
the  wound  by  erysipelas,  successively  retarded  the  cure,  and  long 
rendered  recovery  apparently  hopeless.  It  required  several  years  to 
produce  entire  healing,  during  and  subsequently  to  which  th.ere  has 
been  much  tendency  to  congestion  of  the  brain,  requiring  small  de- 
pletions and  aperients,  and  attributable  to  the  imperfect  re-establish- 
ment  of  the  functions  of  the  skin  over  so  large  a  surface. 

Galvanism.  We  quite  agree  with  ^[r.  Grantham,  that  the  appli- 
cation  of  galvanism  in  paralysis,  and  other  chronic  affeclions  of  ihe 
nervous  system,  has  been  too  much  neglected.  Indeed,  its  adminis- 
tration seems  to  be  confined  almost  to  empirics,  who  apply  it  in  all 
cases  indiscriminately,  and  consequently  do  more  harm  than  good. 
Why  a  full  and  fair  trial  of  its  medicinal  powers  should  not  be  made 
in  some  of  the  numerous  chronic  cases  which  encumber  the  hospitals, 
we  cannot  imagine.     Mr.  Grantham  relates  some  cases  in  which  he 

o 

found  this  agent,  carefully  administered  for  a  prolonged  period,  com- 
j)lctely  successful ;  and  states  the  results  of  his  experience  in  its  em- 
ployment in  these  conclusions. 

"  1.  Galvanism  is  identical  with  the  vital  action  of  the  nerves  of  organic  life, 
and  the  nerve?  of  volition.    2.  Its  action  is  determined  bv  the  healthv  condition 


1815,]  Symvaihetic  Nerve  Thymus  Gland,  221 


of  the  brain  and  spinal  marrow.  3.  The  skin  must  possess  a  normal  sensation, 
as  well  as  temperature,  before  the  j^alvanic  action  can  affect  the  muscular  fibre. 
4.  The  positive  plate  or  wire  should  be  applied  over  the  re;^ion  of  the  origin,  and 
the  negative  to  the  region  of  the  termination  of  the  nerve.  5.  The  galvanic 
influence,  when  passed  along  the  spine,  wilfbe  most  active  in  the  paralyzed  limb. 
(>.  Galvanism  is  assisted  by  the  alkalis  and  mercurial  action.  7.  It  restores 
diminished  temperature,  decreased  circulation,  and  lost  muscular  action,  in  the 
following  order:  1st,  temperature,  2d,  circulation,  and  muscular  action  last. 
8.  It  has  no  effect  in  disease  that  alters  the  structure  of  nerves.  9.  It  supersedes 
manual  friction.  10.  It  is  assisted  by  immersion  of  the  affected  limb  in  a  warm 
bath,  into  which,  the  negative  plate  or  wire  is  placed.  In  passing  a  current  from 
the  head  through  one  half  of  the  body,  the  foot  should  be  immersed  in  warm  wa- 
ter. 11.  It  is  injurious  when  much  pain  is  caused  in  the  muscles  by  its  applica- 
tion. 1-2.  It  may  be  carried  to  an  undue  extent,  so  as  to  produce  congestion  of 
the  brain." 


On  Exlirpaiion  of  the  Superior  Cervical  Ganglions  of  the  Sympa- 
thetic Nerve,  M.  Dupiiy  (the  Alfort  veterinary  professor)  stated, 
that  in  1806,  along  with  Diipuytren,  he  had  extirpated  the  superior 
cervical  gan^rlions  of  the  sympathetic  nerve  in  the  horse.  The  result 
of  the  experiment  was  redness,  with  infiltration,  and  swelling  of  the 
ocular  and  palpebral  conjunctiva,  and  diminution  of  the  volume  of 
the  globe  of  the  eye.  The  horse  was  killed  four  months  afterwards, 
and  the  ends  of  the  nerve  were  found  rounded  and  swollen.  Thft 
sympathetic  nerve  is  evidently  insensible.  When  the  branches  of 
the  fifth  pair  are  cut  or  lacerated,  a  horse  shrieks  with  pain,  whereas 
nothing  of  the  kind  occurs  when  the  sympathetic  is  divided.  M.  Du- 
puy  repeated  the  experiment  seven  times,  and  each  time  with  the 
same  results.  London  Lancet. 


On  the  Use  of  the  Thymus  Gland.  Dr.  Picci,  after  glancing  at 
the  theories  of  his  predecessors,  suggests  that  the  use  of  this  Gland  is 
chiefly  of  a  mechanical  nature  ;  viz.  to  occupy  a  certain  space  within 
the  thoracic  cavity,  while  the  lungs  remain  unexpanded  in  the  fcEtus  ; 
and  thus  to  prevent  the  ribs  and  sternum  from  flilling  in  too  much 
upon  these  vital  organs.  The  size  of  the  Thymus  is  inversely  as  the 
volume  of  the  lungs;  and,  when  the  latter  become  dilated  afterbirth 
by  the  admission  of  air  into  their  cells,  the  former  immediately  begins 
to  shrink  and  become  atrophied.  In  truth,  it  is  only  in  the  adult 
that  the  thoracic  parietes  are  moulded  completely  upon  the  lungs; 
for,  in  infancy  and  youth,  it  is  rather  the  Thymus  gland  that  is,  in 
their  place,  moulded  uj)on  the  thorax. 

The  situation  of  this  gland  in  the  anterior  mediastinum  and  alonix 
the  median  line,  the  very  nature  of  its  tissue,  and  the  greater  expan- 
sion and  development  of  its  inferior  half,  are  adduced  as  arguments 
in  favour  of  the  opinion  now  adduced.  Besides  the  well-known 
circumstance  that,  in  those  new-born  children  in  whom  the  thorax  is 
very  largely  developed,  the  Thymus  continues  to  increase  gradually 
even  to  the  end  of  the  second  year,  it  deserves  notice  that  all  those 
animals,  in  which  the  lungs  are  similar  to  those  in  the  human  subject, 
arc  provided  with  this  gland  ;  whereas,  we  find  it  to  be  entirely  want- 


'-^  Crolon  Oil  Plaster Castor  Oil  [April, 


ing  in  those  which  breathe  by  Branchiii?  or  membranous  lungs.  In 
h}bcrnaling  animals,  also,  the  Thymus  exhibits  altcrnations^of  en- 
largcment  and  decrease,  according  to  the  state  of  the  respiratory 
organs.     In  the  Amphibia  it  attains  its  maximum  of  development. 

'J'he  cu-cumstance  too  of  the  gland  being  usually  rather  larger  than 
ordinary  in  phthi.^^ical  patients  maybe  mentioned  as  lending  somo 
prohabdity  to  tiie  view  wo  have  proposed. yl/i/za/i  Unkersali.  Med, 
ChirurfT,  Review. 


Crolon  Oil  Plaster. M.  Bouchardat  recommends  the  following 
method  of  preparing  croton  oil  plaster.  Melt  eighty  parts  of  gum 
diachylon  plaster  at  a  very  gentle  fire,  and,  when  it  is  semi-liquid, 
mix  with  It  twenty  parts  of  croton  oil.  The  plaster  which  results  is 
to  be  spread  thickly  on  muslin.  It  will  produce  considerable  irrita- 
tion  of  the  skin,  and  may  be  employed  in  all  cases  where  revulsives 
are  required.  It  does  not  cause  such  severe  pain  as  many  other 
counter-irritants  ;  and  it  may  be  applied  over  an  extensive  siirface,  so 
that  a  derivative  action  may  bo  established  proportional  to  the  irrita- 
tion which  is  to  be  combated,  an  indispensable  condition  in  the 
employment  of  these  heroic  remedies.  M.  Bouchardat  is  fully  of 
opinion  that  the  croton  oil  plaster  will  be  found  available  in  the  treat- 
ment of  many  chronic  diseases,  both  of  the  respiratory  apparatus,  and 
of  the  abdominal  vkcera.Anjiuairede  Therapeuiiqite.  Ameriean 
Journal  Medical  Sciences. 


MEDICAL  INTELLIGENCE. 

Extract  of  a  heller  from  Professor  Mr.xss,  to  the  Editors: 

Castor  Oil,  maxlfactured  in  Georgia. AVhile  the  great  staple  of  the  South 
has  become  a  drug  upon  the  markets  of  the  world,  and  its  extensive  cultivation 
IS  discouragc<:I  by  the  consequent  reduction  in  price,  the  public  mind  has  been 
fortunately  constrained  to  direct  its  attention  to  other  ample  and,  hitherto,  unap- 
preciated facilities,  completely  within  its  reach furnished  bv  our  bold  and 
effective  water-falls,  diversified  soil,  and  delightful  variety  of  climate,  and  pro- 
mising equal  usefulness,  and  a  better  remuneration  for  an  equivalent  outlay  of 
labor  and  expense. 

Actuated,  as  we  suppose,  with  these  views,  our  worthy  and  enterprising  friend 
Mr.  Joshua  Willis,  of  Troup  county,  Ga.,has  abandoned  the  cultivation  of 
Co/ton,  and  most  successfully  commenced  the  growth  of  the  nicijuts  Communis, 
or  Palma  Cliristi  (the  Castor  Oil  Plant.)  During  the  past  3'ear,  he  manufac- 
tured about  1500  gallons  of  oil,  which  Avere  mostly  (we  believe)  purchased  by 
the  druggists  and  physicians  of  Columbus,  and  the  circumjacent  country.  % 

We  were  favored  with  a  .'specimen  of  the  article  referred  to,  and  cannot  but 
regard  it  as  a  fair  and  beautiful  oil almost  destitute  of  color,  or  smell,  and 
with  as  liule  of  the  unpleasant  flavor,  peculiar  to  the  Castor  Oil  Bean,  as  is 
consistent  with  an  unadulterated  preparation Clear,  bland,  free  from  rancidity, 
and  without  any  foreign  admixture,  it  constitutes  an  admirable  article  for  do- 
mestic use,  and  in  our  hands,  manifested  mildly,  but  efTectivelv,  its  cathartic 
property.  The  East  Indies  have  heretofore  furnished  probably  seven-eighths  of 
all  the  oil  consumed  in  England,  but  for  the  last  several  years,  American  Oil, 
derived  chiefly  from  the  British  Colonies  and  the  Western  States,  has  been  ex- 


1845.J  Medical  College  of  Georgia,  2'2'd 


ported  to  that  country,  to  the  amount  of  perhaps,  from  fifty  to  eighty  thousand 
pounds  annually.  The  latter  article,  though  confessedly  of  fine  quality,  and 
possessing  a  flavor  superior  to  the  East  India  Oil,  has  yet  been  regarded  is  ob- 
jectionable on  account  of  the  deposit  (in  cold  weather)  of  a  white,  flaky  matter, 
which  some  have  supposed  to  be  Margaratine  a  flatty  salt,  consisting  of  the 
two  i^roximate  constituents,  Margaritic  Acid  and  Glycerine.  Others  have 
supposed  it  to  be  the  result  of  adulteration  from  Olive  Oil,  which  is  knov^n,  at 
low  temperatures,  to  deposit  what  Pclouze  and  Soudet  regard  the  Margarate  and 
Oleate  of  Glyceril  ^theHydrated  Oxide  of  Glycerine)  an  unlikely  supposition 
however,  in  our  estimation,  as  most  of  the  latter  oil  isimportcd  into  this  country 
from  the  south  of  Europe,  and  at  too  high  a  price  to  warrant  the  fraud  of  ad- 
mixture with  the  Castor  Oil  designed  for  exportation. 

We  are  rather  inclined  to  the  belief  that  such  deposits,  so  frequently  found  in 
the  American  article,  is  from  the  liberal  admixture  of^nnimaloW  (Adeps  Suillus) 
which  does  not  sustain  its  fluidity  under  from  78"^  5'  to  87'^  5'.  This  ma  v,  perhaps, 
account  for  the  rancid  and  acrid  nature  of  some  of  the  Castor  Oil  of  Commerce, 
as  the  Oleine  of  the  Lard,  readily  becomes  rancid,  i.  e.  acquires  a  disagreeable 
odor,  and  acid  properties,  by  exposure  to  the  Oxygen  of  the  atmosphere.  Indeed 
the  deposite  of  Margaratine,  from  Castor  Oil,  if  any,  should  be  exceedingly 
small,  as  not  more  than  .002  of  the  entire  products  of  saponification,  consist  of 
Margaritic  Acid. 

The  oil  manufactured  by  Mr.  Willis,  we  believe,  fully  sustains  the  truth  of 
this  latter  remark,  and  as  a  specimen  of  Southern  enterprise,  alike  honorable  to 
his  skill  and  industry,  commends  itself  to  public  confidence  and  popular  use. 
Mr.  W.  Avill  be  prepared  to  execute  large  orders  this  fall  and  winter,  and  assures 
us  that  "it  shall  not  cost  more  to  druggists  or  other  purchasers,  whom  he  may 
supply,  than  the  best  article  does  from  any  other  quarter,"  and  all  he  asks  is, 
that,  other  things  being  equal,  home  mamifacture  mav  have  the  preference. 

A.  MEANS. 


Medical  College  of  Gcor^rin.HhQ  Annual  Commencement  of  this  Institution 
wa.s  held  in  the  Masonic  Hall,  on  Tuesday,  the  4th  day  of  March,  when  the 
degree  of  M.  D.  was  conferred  upon  the  following  gentlemen  : 

Milton  Antonv,  of  Georgia  Thesis  ox  Aneurism. 


A.  F.  Anderson, 

S.  C. 

Circulation  of  the  Blood. 

A.  R.  Bexley, 

Gco.- 

Congestive  Fever. 

J.  M.  Bowers, 

Prolapsus  Uteri. 

S.  R.  Caver, 

Ala. 

Gonorrhoea. 

G.  M.  Cade, 

Geo., 

Secale  Cornutum, 

W.  L.  Cochran, 

S.  C. 

The  Liver. 

W.  E.  M.  Cousins, 

Fla. 

Rheumatism. 

W.  H.  Davis, 

S.  C. 

Intermittent  Fever. 

W.  H.  Ellington, 

Ala. 

Cluinine. 

T.  B.  Gordon, 

Geo. ' 

Hs-pochondriasis. 

J.  M.  Galphin, 

s.q. 

Circulation  of  the  Blood. 

Thos.  Graves, 

" 

C}'nanche  Trachcalis. 

J.  S.  Holliday, 

Geo,  ' 

Dysentery. 

J.  A.  Harlov.', 

"     ' 

Intermittent  Fever. 

A.  L.  Hammond, 

i( 

The  Blood. 

James  Hill, 

S.  C. 

Prolapsus  Uteri. 

Taliaferro  Jones, 

Geo.   - 

Pneumonia. 

A.  H.  Jackson, 

1.1- 

Prolapsus  Uteri. 

J.  H.  Jennings, 

S.  c. 

Acute  Rheumatism. 

W.  W.  Leak, 

Geo.   - 

Moiins  Ojx'randi  of  Modi(  iiies 

J.  T.  Lamar, 

1.    - 

RuN'ola. 

224        Medical  College  of  the  State  of  South  Carolina^  ^c. 


Jesse  Lowe, 

(( 

Dysentery. 

I.  M.  Morai^nc, 

S.C. 

Importance  of  Scientific  Accoucheurs. 

R.  M.  Paries, 

Geo. 

Healthy  Menstruation. 

H.  W.  Rutherford 

,S.C. 

Abortion. 

J.  P.  Ralls, 

Geo. 

Scarlatina. 

R.  M.  Stell, 

(( 

Uterine  Hemorrhaj!:e. 

B.  R.  StronjT, 

Tenn. 

Pathology  of  Fever. 

E.  A.  Stribling, 

Geo. 

Phthisis  Pulmonalis. 

J.  W.  Todd, 

(( 

Gastritis. 

T.  A.  Wakefield, 

S.C. 

Signs  of  Pregnancy. 

F.  B.  Wakefield, 

Geo. 

Congestive  Fever. 

Medical  College  of  the  Sintc  of  South  Carolina.  This  Institution  has  conferred 
the  degree  of  M.  D,  on  seventy-four  gentlemen :  of  whom,  six  were  from  Geor- 
gia nine  from  Alabama  two  from  Mississippi  one  from  Florida  five  from 
North  Carolina  and  the  remaining  fifty-one  from  South  Carolina. 


We  are  highly  gratified  to  learn  that  Prof.  Charles  A.  Lek  has  assumed  the 
Editorial  management  of  that  valuable  periodical,  the  New  York  Journal  of 
Medicine.  We  know  no  one  better  calculated  to  occupy  the  post  and  become 
the  successor  of  the  indefatigable  and  lamented  Forry. 


METEOROLOGICAL  OBSERVATIONS,  for  February,  1845,  at  Augusta,  Ga. 
Latitude  33^*  27'  north Longitude  4  32'  west.    W. 


^rj 

TilKKMOMI-T    '. 

Barometer. 

WlKD. 

Remarks. 

cr 

7,  A.  M. 

a,  p.  M. 

7,  A.  M. 

6,  P.  M. 

~I 

-2sr- 

51 

30  inch. 

29  9-10 

N.    E. 

Variable. 

2 

31 

58 

29  9-10 

30 

N.    E. 

Fair. 

3 

31 

45 

30 

29  9-10 

E. 

Cloudy. 

4 

50 

47 

29  4-10 

29  4-10 

N.  W. 

Rain  7-10  inch high 

wind. 

5 

28 

42 

29  5-10 

29  7-10 

N.  W. 

Hisrh  wind  night  and 

day. 

G 

28 

51 

29  8-10 

29  9-10 

N.  W. 

Fair, 

7 

28 

47 

30 

30  1-10 

E. 

Cloudy. 

8 

30 

02 

30  1-10 

29  9-10 

W. 

Fair. 

9 

31 

GO 

30 

30 

w. 

Fair. 

10 

32 

GO 

30 

30 

vv. 

Fair. 

n 

30 

73 

29  8-10 

29  8-10 

.s.  w. 

Fair. 

12 

48 

70 

'29  7-10 

29  7-10 

s.  w. 

Fair. 

13 

40 

80 

29  7-10 

29  7-10 

s.  w. 

Fair. 

14 

49 

52 

29  9-10 

29  9-JO 

E. 

Cloud  V. 

\b 

54 

GO 

29  8-10 

29  8-10 

variable. 

Rain  3-10  inch. 

10 

35 

57 

29  8-10 

29  9-10 

w. 

Fair. 

17 

38 

70 

29  9-10 

29  8-10 

s.  w. 

Fair. 

18 

40 

09 

29  8-10 

29  8-10 

s.  w. 

Fair. 

19 

40 

72 

29  8-10 

29  8-10 

s.  w. 

Fair. 

20 

45 

70 

29  8-10 

29  8-10 

S.  E. 

Fair. 

21 

50 

75 

29  8-10 

29  8-10 

S.  E. 

Fair. 

22 

00 

74 

29  8-10 

29  8-10 

S. 

Cloudy. 

23 

50 

02 

29  7-10 

29  0-10 

P. 

Rain  1  inch  5-10 

24 

44 

08 

29  7-10 

29  7-10 

w. 

Fair. 

2.5 

40 

08 

29  7-10 

29  8-10 

w. 

Fair. 

20 

39 

70 

29  7-10 

29  7-10 

w. 

Fair. 

27 

38 

59 

29  0-10 

29  .5-10 

N.  W. 

Fair  high  wind. 

28 

33 

59 

29  8-10 

29  8-10 

N.  W. 

Fair. 

Glnantitv  of  Rain  2  1-2  inches.     J9  Fair  davs. 


SOUTHERN 

MEDICAL  AND  SURGICAL 

JOURNAL. 

Vol.  I.]  NEW  SERIES. MAY,  IS15.  [No.  5. 

PART  I. ORIGINAL  COMMUNICATIONS. 

ARTICLE    I. 

A  Case  exhibiting  the  good  effects  of  Opiates  in  large  doses  in  fre- 
venting  Abortion.  By  Henry  S.  Levert,  M.  D.,  of  Mobile^ 
Alabama* 

Mrs. ,  aged  24  years,  was  married  early  in  April,  1842 : 

she  was  of  delicate  constitution,  subject  to  frequent  attacks  of  syn- 
cope, and  for  several  years  previously  had  suffered  from  severe 
pulmonary  hemorrhage,  unattended  with  cough  or  other  symptoms 
indicating  disease  of  the  lungs.  Her  habit  was  constipated,  having 
a  discharge  from  the  bowels,  upon  an  average,  once  in  six  days. 

On  the  20lh  May,  next  after  her  marriage,  she  aborted.  This  was 
attributed  to  a  slight  accident,  the  overturning  of  the  chair  upon 
which  she  was  sitting.  Eight  or  ten  weeks  from  this  time  a  similar 
accident  occurred,  and  in  both  instances  the  effect  was  so  prompt  that 
no  treatment  was  or  could  be  resorted  to,  to  prevent  the  miscarriage. 
It  was  now  observed  that  her  general  health  began  to  decline  rapid- 
ly. The  hemorrhages  were  more  frequent  and  alarming  syncopo 
of  almost  daily  occurrence,  and  a  slight  cough  added  to  her  other 
symptoms,  whenever  she  was  exposed  even  in  the  slightest  dcgrco 
to  dampness  or  the  night  air.  About  the  expiration  of  the  second 
month,  after  the  last  abortion,  she  supposed  herself  to  be  again  preg- 
nant,  and  fearing  a  similar  accident,  she  consulted  a  medical  gentle- 
man, who  advised  her  to  watch  her  symptoms  carefully,  and,  if 
pfKSRihle,  prevent  a  recurrence  of  the  abortion.     To  do  this,  she  was 


226  Opiates  in  preventing  Ab,ortion.  [May, 


directed  to  take  opium  in  some  form,  and  in  doses  sufficiently  large 
to  allay  all  pain.  The  opium  was  proscribed  for  each  and  every 
paroxysm  of  pain.  Up  to  this  period  she  had  never  taken  opium  in 
any  form.  As  in  the  former  instances,  a  few  weeks  only  had  elapsed, 
when  she  was  again  threatened,  having  pain  and  hemotrhage  with 
this  difference,  however  in  this  instance  she  had  received  no  injuryor 
shock,  as  in  the  two  former  cases.  The  fourth  of  a  gr.  of  the  sulphate 
morph.  was  promptly  administered,  which  gave  immediate  relief, 
checking  the  pain  and  hemorrhage  at  once.  This  occurred  again  and 
again  at  intervals  of  a  few  days,  and  always  yielded  to  the  same  treat- 
ment; small  doses  of  the  sulph.  morph.  During  one  of  these  attacks, 
which  was  much  more  violent  than  usual,  aggravated  as  it  was  sup- 
posed by  mental  suffering,  she  was  attacked  with  convulsions  for  the 
first  time ;  and  so  severe  were  these  convulsions,  that  upon  three 
different  occasions,  during  one  night,  her  shoulder  was  dislocated. 
This  was  each  time  reduced  as  soon  as  the  paroxysm  passed  off. 
She  took  at  intervals  of  one  hour  GO  drops  of  laudanum  during  the 
night,  making  in  all  480  drops.  Towards  morning  she  grew  better, 
and  the  attack  finally  passed  off  without  abortion.  As  she  advanced 
in  her  pregnancy,  it  was  found  necessary  to  increase  the  quantity 
of  opium  before  the  desired  effect  could  be  produced,  each  trifle 
causing  an  attack  every  two  or  three  days.  "  When  she  was  about 
six  months  gone,"  says  her  husband,  "she  had  a  severe  fall  upon  her 
face  on  the  instant  I  did  not  hesitate  to  give  her  a  much  larger 
quantity  of  opiutn  than  she  had  ever  before  taken,  for  I  knew  that 
her  pains  would  soon  be  very  hard.  I  think  I  gave  her  150  drops 
on  this  occasion,  and  repeated  the  laudanum  in  smaller  quantities, 
say  75  drops,  every  hour  for  five  successive  hours:  in  addition  to 
which  I  bled  her."  After  a  great  deal  of  suffering  the  pains  were 
moderated,  but  she  was  never  entirely  free  frompain  until  after  her 
accouchment ;  nor  was  she  again  able  to  leave  her  bed  until  after 
that  period.  Opium  was  given  daily,  in  doses  gradually  increased 
during  the  whole  period  of  her  gestation.  She  had  frequent  attacks 
of  convulsions,  similar  in  every  respect  to  those  first  mentioned, 
which,  when  violent,  were  always  relieved  by  bleeding  in  conjunc- 
tion with  opiates.  Her  bowels,  as  may  be  supposed,  were  obstinately 
constipated  during  the  whole  of  this  time  never  having  an  evacua- 
tion unless  some  artificial  means  were  resorted  to. 

At  the  expiration  of  nine   months  she  was  delivered  of  a  healthy, 
full  grown  SOD,  af\er  a  protracted  labour  of  14  hours,  during  which 


J845.]  Opiates  in  preventing  Abortion.  227 

time  she  had  several  severe  puerperal  convulsions.  No  opium  w^s 
given  after  it  was  ascertained  that  she  was  in  labour,  nor  was  she 
bled.  Immediately  after  her  delivery,  she  began  to  diminish  the 
doses  of  opium,  and  at  the  end  of  five  weeks  abandoned  its  use  alto- 
gether,  although  she  suffered  much  from  its  discontinuance. 

In  October  following  she  again  aborted,  and  again  in  January, 
and  so  suddenly  on  each  occarfion  that  there  was  no  time  to  put  her 
on  treatment. 

In  the  spring  following,  (1844,)  she  again  became  pregnant.  As 
soon  as  this  was  satisfactorily  ascertained,  every  precaution  was 
adopted  to  prevent  abortion.  But  a  short  time  elapsed  before  she 
complained  of  pain,  d:c.,  and  recourse  was  had  immediately  to 
opium.  The  same  success  attended  its  administration  in  this,  as  in 
the  former  instance.  The  only  difference  observable  in  this  and  the 
former  pregnancy,  was  the  more  frequent  recurrence  of  the  parox- 
ysms of  pain  and  their  greater  severity.  It  was  not  unfrequent  for 
her  pains  to  last  24  hours,  returning  at  intervals  of  five  minutes  ;  and 
so  violent  were  they  as  to  induce  her  attendants  to  believe  that  abor- 
tion would  certainly  be  the  result.  Twelve  or  fil'teen  grains  of  crude 
opium  would  be  given  during  one  of  the  paroxysms  before  relief  could 
be  ohtained. 

xVbout  the  fifth  month  these  attacks  came  on  periodically  each 
morning  at  the  same  hour,  and  again  in  the  evening.  They  were 
always  subdued,  by  giving  grs.  x.  of  opium  at  one  dose  as  soon  as 
they  were  felt,  both  in  the  morning  and  at  night.  The  opium  about 
or  a  little  after  this  time  was  laid  aside,  and  the  sulph.  morph.  u-ed 
in  its  stead.  Of  this  latter  article  she  took  daily  grs.  iii.  at  two 
doses.  It  was  soon  ascertained  that  this  dose  did  not  suffice,  and  it 
was  gradually  increased,  until  she  took  the  enormous  quantity  of 
grs.  ix.  twice  a  day  regularly,  and  frequently  three  times  a  day,  until 
her  confinement. 

At  4  o'clock  on  the  morning  of  the  121h  February,  (1845,)  she  felt 
more  |)ain  than  usual,  or  rather  than  it  was  usual  for  her  to  have  at 
that  period  of  the  24  hours,  and  she  took  her  accustomed  portion 
(grs.  ix.)  of  morphine,  although  it  was  four  hours  in  advance  of  the 
hour  when  she  had  been  accustomed  to  take  it.  This  procured  no 
relief,  but  on  the  contrary  seemed  to  increase  her  suffering.  I  was 
invited  to  visit  her  at  8  o'clock  on  the  same  morning,  and  found  her 
suffering  a  good  deal  from  inefficient  uterine  pains.  An  examina- 
lion  satisfied  me  that  labour  had  commenced.     The  os  uteri   beinn^ 


228  Opiates  in  preventing  Abortion,  [May, 


slightly  dilated  and  yielding,  but  the  pains  were  too  inefficient  to 
effect  the  delivery.  I  came  to  the  conclusion  that,  in  consequence 
ot  the  large  dose  of  morphine  which  she  had  taken  four  hours  pre- 
viously, the  pains  had  been  subdued,  and  that  after  its  impression  had 
passed  off'tlie  uterine  action  would  increase,  the  pains  become  more 
efficient,  and  that  the  labour  would  be  terminated  favorably.  I  left 
her,  therefore,  with  directions  to  take  no  more  morphine,  but  to  wait 
patiently  for  the  eflect  produced  by  that  already  taken  to  wear  off. 
At  4  o'clock  in  the  afternoon  I  called  again:  her  condition  was 
pretty  much  as  it  was  at  my  first  visit  in  the  morning  pains,  perhaps 
not  quite  so  violent,  and  the  pulse  more  feeble.  The  os  uteri 
being  soft  and  yielding,  I  determined  to  give  the  ergot,  and  accord- 
ingly gave  her  grs.  x.,  and  repeated  it  at  intervals  of  15  or  20 
minutes,  until  she  took  5jj.  Not  the  slightest  effi^ct  seemed  to  bo 
produced  by  it.  The  pains  were  not  increased,  the  pulse  became 
more  and  more  feeble,  great  jactitation,  with  sighing,  &c.,  superven- 
ed, and  I  almost  despaired  of  conducting  the  case  to  a  favorable 
issue.  Believing,  however,  that  much  of  the  restlessness,  the  feeble 
pulse,  &c.,  resulted  from  the  want  of  her  accustomed  stimulus,  the 
morphine,  and  seeing  that  no  good  was  to  he  expected  from  a  continu- 
ance ofthe  ergot,  I  determined  to  suspend  the  latter,  and  give  her  a 
decided  dose  of  morphine.  If  it  produced  no  good  effect,  it  could 
only  suspend  the  uterine  pains  for  a  few  hours,  and  1  should  find  her, 
after  the  impression  of  the  anodyne  had  passed  off,  in  the  same  situa- 
tion  that  she  now  was.  I  accordingly  gave  her  grs.  vij.  of  morphine 
at  one  dose.  She  took  the  morph.  at  7-i  o'clock,  P.  M.  In  20 
minutes  her  pulse  became  fuller  and  firmer,  the  restlessnes  materially 
abated,  and  the  pains  much  more  decided  in  their  character.  She 
continued  to  have  pretty  good  pains  until  10^  o'clock,  when  they 
ceased  almost  altogether.  At  this  time  I  gave  her  another,  though 
smaller  dose,  of  morphine  ;  and  in  half  an  hour  she  was  delivered, 
by  a  single  pain,  of  a  healthy,  full-grown  son. 

Nothing  unusual  has  occurred  since.  She  is  now  quite  as  well  as 
other  women  after  parturition  nurses  her  child  and  enjoys  more  than 
her  accustomed  heallh. 

Some  four  or  five  days  after  her  delivery,  I  directed  the  morphine 
to  be  reduced  ^  gr.  at  each  exhibition  making  a  ^  gr.  daily.  It  is 
now  reduced  to  one  grain  daily,  and  in  the  course  of  a  few  days 
more,  she  will  have  abandoned  its  use  altogether. 

This  case  is  iiiteresting  in  more  particulars  than  oDe  Ist,  the  im. 


1S45.]       Cough  and  Pleurodynia  from  Spinal  Irritation.  229 


mense  doses  of  morphine  which  it  became  necessary  to  administer, 
to  prevent  abortion  2nd,  the  entire  success  with  which  it  was  given 
in  tills  and  her  previous  pregnancy  3d,  the  facility  with  which  she 
has  been  enabled  to  abandon  its  use  after  each  delivery  lastly,  the 
non  control  which  the  morphine  exercised  over  natural  labour  pains* 
III  fact,  its  effects  was  indirectly  that  of  the  ergot  of  rye  :  by  stimu- 
lating the  system  to  that  point  which  from  long  habit  had  become 
second  nature,  the  uterus  was  enabled  to  perform  its  functions  pro- 
perly.  My  conviction  is,  that  had  not  this  remedy  been  employed, 
the  labour,  to  say  the  least  of  it,  would  not  have  been  terminated  so 
soon  ;  if  indeed  she  could  have  been  delivered  at  all. 


ARTICLE    II. 

Cough  and  Pleurodynia  from  Spinal  Irritation.     By  J.  J.  Robebt- 
soN,  ?rl.  D.,  of  Washington,  Ga. 

Whether  we  regard  spinal  irritation  as  an  idiopathic  affection,  or 
ns  a  result  from  derangements  in  other  organs  exhibiting  itself  in 
this  disorder,  in  the  great  nervous  centre  of  reflex  action,  we  must 
admit,  that  there  arc  few  diseases  in  which  a  proper  appreciation  of 
cause  and  effect  is  of  more  importance  in  a  practical  point  of  view. 

The  various  and  complicated  symptoms  ofan  irritation  of  the  medulla 
spinalis,  simulate  in  their  character,  so  nearly  inflammations  of  other 
important  organs,  that  were  we  to  omit  a  manual  examination  of  the 
spinal  column,  in  connection  with  the  consideration  of  other  symp- 
toms,  we  would  be  subject  to  frequent  error  in  diagnosis,  and  con- 
sequent injudicious  application  of  our  therapeutic  agents.  There 
are  many  affections,  which  were  formerly  regarded  as  inflammations 
or  derangements  of  organs,  remote  from  the  spinal  marrow,  which, 
by  more  modern  pathology,  are  clearly  rclbrable  to  an  irritation  in 
some  portion  of  this  organ  ;  and  notwithstanding,  there  are  so  many 
recorded  facts,  the  result  of  careful  investigation,  which  should  im- 
press  upon  u-<  the  importance  of  nn  examination  of  the  spinal  column 
in    many   diseases,    yet    there  are   n,  numbor    of  practitioners,  who 


230  Cough  and  Pleurodynia  from  Spinal  Irritation,         [May, 


cither  from  an  ignorance  of  the  important  pathological  relations  of 
the  medulla  spinalis,  or  from  a  tenacious  adherence  to  some  favorite 
doctrine,  altogether  reject  such  an  examination,  and  regard  it  onh', 
as  "an  empirical  demonstration,  or,  at  least,  an  insane  manoeuvre." 
How  they  can  satisfactorily  and  successfully  treat  many  diseases 
which  every  one  meets  with,  in  a  general  practice,  we  are  at  a  loss 
to  divine.  For  ourselves,  we  should  be  subject  to  many  frequent  and 
perplexing  difficulties,  which  otherwise  are  rendered  comparatively 
clear.  We  do  not  contend,  that  a  manual  examination  of  the  spinal 
column  will  in  every  instance  give  evidence  of  an  irritation  of  that 
organ,  when  such  irritation  really  exists,  but  we  maintain,  that  in  a 
large  majority  of  cases,  such  a  result  will  be  found  to  follow.  We 
do  not  wish  to  be  classed  among  those,  who  without  due  considera- 
tion, are  led  off  by  every  "  wind  of  doctrine,"  for  we  deprecate  the 
course  of  those  who  from  an  ardent  zeal,  or  a  morbid  thirst  for  some- 
thing new,  precipitately  adopt  every  new  theory  and  doctrine,  and 
generalize  from  isolated  f\icts ;  yet,  as  is  justly,  and  forcibly  said  by 
an  able  writer,  "a  too  obstinate  and  inflexible  adhcrance  to  doc- 
trines because  they  bear  the  impress  of  age,  would  as  certainly  retard 
the  progress  of  true  philosophy,  as  that  laxness  of  reason  that  would 
allow  every  induction  of  sense,  to  be  counted  of  equal  weight  with 
the  most  obvious  and  practical  truths." 

Our  attention  was  more  particularly  directed  to  the  importance  of 
this  subject  by  the  able  Professor  of  the  Theory  and  Practice  of  IMedi- 
cine,  in  the  Medical  College  of  Georgia,  who  at  that  time  seemed  to 
have  advanced  further  in  his  investigations  of  this  subject,  than  any, 
with  whose  researches  we  were  acquainted.  His  pathology  of  Inter- 
mittent and  Remittent  Fevers,  as  recorded  in  the  Southern  Medical 
and  Surgical  Journal,  for  1836,  as  well  as  his  more  recent  article  on 
the  Pathology  of  Intermittent  Fever,  to  be  found  in  the  first  No.  of 
the  New  Series  of  the  same  Journal,  are  worthy  of  a  careful  perusal,  as 
having  an  application  of  this  important  doctrine,  which  of  late,  has 
become  one  of  increasing  interest  and  investigation.  We  would  also 
refer  the  reader  to  an  interesting  article  contained  in  the  fourteenth 
No.,  seventh  volume,  of  the  American  Journal,  by  Austin  Flint,  M. 
D.,  of  Nev/-York,  in  which  are  collected  a  number  of  cases,  exhibit- 
ing a  diversity  of  distressing  and  alarming  symptoms,  all  of  which 
were  referred  to  this  common  source,  the  treatment  regulated  accord- 
ingly, and  the  diagnosis  fully  and  successfully  sustained  by  theresull. 

Notwithstanding  we  have  used  the  term  "Spinal  Irritation,"  which 


1945.]       Cough  and  Pleurodynia  from  Spinal  Irritation,  231 

in  its  common  acceptation  conveys  the  idea  of  the  derangement  to 
which  we  allude,  yet  it  must  be  obvious  that  it  is  objectionable;  for 
the  true  nature  of  the  derangement,  we  must  admit,  in  the  present 
state  of  our  knowledge,  we  cannot  accurately  determine.  Various 
are  the  opinions  respecting  it ;  and  perhaps  the  appellation  which 
now  distinguishes  it,  is  the  least  objectionable,  until  future  investiga- 
tions shall  have  determined  its  true  character.  We  are  disposed  to 
regard  it,  as  a  local,  venous  congestion.  The  peculiar  anatomical 
arrangement  of  the  vessels  on  the  surface  of  the  cord,  as  well  as  the 
fact  which  appears  to  have  been  demonstrated,  that  the  spinal  vessels 
are  destitute  of  valves,  and  consequently  have  to  perform  their  func- 
tions in  opposition  to  the  force  of  gravity,  without  the  aid  of  these 
valuable  auxiliaries,  thereby  rendering  the  blood  exceedingly  liable 
to  be  obstructed  in  its  ascending  course,  even  bv  slight  and  trivial 
causes:  the  fact  of  the  suddenness  of  its  invasion  in  most  cases,  and 
also  that  the  remedial  agents  that  usually  give  speedy  relief,  are  of  a 
character  calculated  to  relieve  this  state  of  things;  all  combine  to 
favor  this  conclusion.  We  can  readily  conceive,  how  such  a  conges, 
tion  can  produce  neuralgia,  together  witii  all  the  evidences  of  a 
deranged  inervation.  Various  other  reasons  might  be  adduced  in 
support  of  this  opinion  ;  but  as  it  is  not  our  purpose  in  this  place  to 
discuss  the  nature  of  a  disorder  that  is  involved  in  so  much  doubt,  
and  as  we  have  already  extended  this  portion  of  the  article  to  a  great- 
er length  than  originally  designed,  we  proceed  to  transcribe  the 
following  particulars  of  a  case  which  we  find  recorded  in  our  note 
book. 

We  were  summoned  to  see  Mrs.  J.  at  5  o'clock,  A.  M.,  on  29th 
April,  1844.  She  was  aged  23,  and  her  health  generally  good  previ- 
ous to  her  present  indisposition.  We  received  from  her  the  following 
history  of  her  case  :  Her  digestive  organs  had  been  somewhat 
deranged  for  three  weeks  past  ;  two  weeks  previously  she  was  at- 
tacked with  pain  in  left  side,  of  an  intermittent  character;  a  few 
days  subsequent  there  came  on  a  harsh  cougii.  unaccomj)anied  with 
expectoration;  the  cough  recurred  during  tlie  day  in  paroxysms  at 
irregular  intervals,  which  aggravated  the  |)ain  in  the  side  ;  she 
thought  she  had  taken  cold,  and  used  the  ordinary  domestic  remedies 
with  no  permanent  amondment.  Some  days  previous  to  our  visit, 
she  was  advised  to  apply  a  blister  over  the  scat  of  pain,  with  which 
we  furnished  her,  having  made  no  examination  of  her  condition. 
The  blister  gave  but  transient  relief;  the   symptoms   recurred,  and 


233  Cough  and  Pleurodynia  from  Spinal  Irritation.         [May, 


gradually  increased  until  some  time  during  Ihc  night  previous  to  our 
visit  they  became  suddenly  greatly  aggravated.     We  found  her  con- 
dition as  follows  :  Pain  in  the  left  side,  constant  and  intolerable  
cough  recurring  in  paroxysms,  at  intervals  of  about  an  hour,  which 
aggravated  the  pleuralgia  ;  dyspnoea  very  great ;  inability  to  keep 
the  recumbent  posture,  which  seemed  to  increase  the  dyspnoea,  and 
favor  the  return  of  cough  ;  pain  aggravated  by  every  deep  inspira- 
tion; pulse  one  hundred,  small  and  soft;  skin  of  a  natural  tempera- 
ture; tongue,  coated  with  long  white  fur.     We  had  no  stethescopo 
at  hand,  and   consequently  made  no  auscultory   exploration  of  the 
chest,  nor  did  we  deem  such   investigation  necessary  at  the  time  ; 
because,  from  the  history  of  the  case,  as  well  as  from  the  slight  con- 
stitutional   derangement,  we   were   not  disposed  to  regard   it  of  an 
inflammatory  character.     We  proposed  an  examination  of  the  spinal 
column  ;  when  she  informed  us  that  she  had  no  uneasiness  whatever 
in  that  region,  but  she  submitted  to  the  examination.     We  proceeded 
to  examine  each  separate  vertebrae  in  the   usual  manner,  without 
giving  any  uneasiness,  until  we  peached  the  last  cervical,  which  v.as 
found  exquisitely  tender  on  slight  pressure;  and  in  proceeding  down- 
wards, we  found  the  tirst  fiVe   dorsal  equally  so;  but  there  was   no 
indication  of  derangement  iti  any  other  portion.     The  result  of  this 
examination,  together  with   the   history   of  the  case,  afforded  stron 
presumptive  evidence  that  the  present  distressing  symptoms  were 
mainly,  if  not  entirely  referable  to  an  irritation  of  the  medulla  spin- 
alis.    W^e  immediately  ordered  halfgr.  of  acet.  morph.  to  be  given 
immediately,  and  applied  caustic  ammonia  to  the  diseased  portion  of 
the  spine,  which  produced  vesication  in  a  few  minutes.     In  half  an 
hour  she  was  somewhat  easier.     V/e  gave  another   portion  of  mor- 
phine,   placed   her  in  a   recumbent  posture,  and  directed  one-third 
of  a  grain  of  morphine  to  be  given  every  half  hour  until  relief  should 
be  obtained. 

At  1  o'clock,  P.  M.,  she  was  much  easier  than  when  we  left  her  ; 
has  taken  during  our  absence  two  portions  of  morphine  ;  can  keep 
t'.ie  recumbent  posture  without  aggravating  the  symptoms  :  dyspnoea, 
greatly  relieved,  but  still  troublesome ;  intervals  between  the  parox- 
vsms  of  cough  much  longer,  and  the  cough  unaccon)panicd  with  the 
distress  previously  produced.  We  gave  morphine  one-third  ofa  grain, 
and  directed  the  vesicated  portion  of  the  spine  to  be  rubbed  with 
tart.  ant.  et  pot.  ointment,  twice  a  day,  until  pustulation  should 
take  place. 


or 


1945.]       Cough  and  Pleurodynia  from  Spinal  Irritation,  233 

At  7  o'clock,  P.  M.,  the  pleurodynia  was  but  slight,  and  of  an  in- 
termittent character  ;  the  cough  not  very  troublesome  ;  the  dyspnoea 
entirely  relieved;  the  pulse  ninety,  rather  fuller,  but  soft :  she  had  a 
comfortable  sleep  of  half  an  hour,  since  our  last  visit,  and  feels  dis- 
posed  to  sleep.  We  gave  the  following  pills,  and  left  her  for  the 
night: 

R.    Ext.  Colocynth,  comp.     .     .     .     x  ij.  grs. 

Blue  Mass V        " 

Ext.  Hyoscyami, iij.     " 

Mix,  and  divide  into  four  pills. 
On  the  30th,  at  8  o'clock,  A.  M.,  she  was  much  better  than  last 
evening;  had  slept  some  during  the  night;  had  coughed  several 
times  since  our  last  visit,  which  somewhat  increased  the  pain  in  the 
side;  pulse  and  skin  natural;  tongue  cleaning.  The  pills  had  pur- 
ged twice  this  morning.  We  left  one-third  of  a  grain  of  morphine, 
to  be  given  in  two  hours. 

At  5  o'clock,  P.  M.,  we  found  her  entirely  relieved  of  her  primary 
symptoms,  except  an  occasional  cough,  which  was  but  slight ;  she 
complained  of  her  back  from  the  effects  of  the  ointment.  We  left 
one-third  of  a  grain  of  morphine,  to  be  given  should  the  pain  in  the 
side  return,  or  the  cough  become  troublesome. 

May  1st,  8  o'clock,  A.  M.  She  expresses  herself  as  entijrely  reliev- 
ed. She  had  slept  some  during  the  night,  and  thinks  she  would  have 
slept  all  night,  had  not  the  pain  in  her  back  been  troublesome,  though 
the  morphine  left  yesterday  was  not  taken.  We  found  a  fine  crop 
of  pustules  on  the  part  rubbed  with  the  ointment.  It  was  ordered 
to  be  discontinued,  and  an  emolient  poultice  applied  to  the  back,  to 
he  followed  with  dressings  of  olive  oil.  As  there  was  no  operation 
from  the  bowels  since  yesterday,  we  ordered  a  dose  of  the  same  pills 
as  on  29th. 

On  the  2nd  May,  at  10  o'clock,  A.  M.,  we  found  her  sitting  up. 
She  says  she  feels  quite  comfortable ;  had  rested  well  during  the 
night ;  the  pills  given  on  yesterday  produced  three  evacuations  by 
bed-time,  and  one  this  morning  ;  the  pustules  discharging  freely  ;  no 
cough  or  pain,  tongue  cleaning,  pulse  and  skin  natural. 

She  was  now  placed  upon  a  course  of  the  Siisq.  Oxid.  Ferri,  to  bo 
continued  regularly  ;  the  bowels  to  be  kept  soluble  by  mild  laxatives, 
and  her  diet  to  be  unirritating,  but  nutritious.  This  course  she  pur. 
sued  with  progressive  amendment  for  three  weeks:  nt  the  expiration 
of  which  time,  she  discontinued  the  use  of  all  remedial  agents,  her 
health  being  entirely  restorejl. 


234  Cough  and  Pleurodynia  from  Spinal  Irritation,        L^^X' 

We  were  again  called  to  see  her  July  4th,  10  o'clock,  A.  M.,  when 
we  found  iier  suffering  from  pleurodynia  of  an  intermittent  character 
in  the  left  side.  She  staled  tiiat  her  digestive  organs  had  again  be- 
come deranged  t'rom  an  imprudence  in  diet.  Upon  examination,  the 
four  first  dorsal  vertebrae  were  found  to  be  tender  on  pressure,  and 
although  we  regarded  the  pain,  <kc.,  as  purely  neuralgic,  yet,  from 
an  undue  determination  to  the  brain,  a  few  ounces  of  blood  were 
extracted  before  we  ventured  on  the  use  of  anodynes.  The  vene- 
section  gave  little  or  no  relief  to  the  pain  in  the  side.  We  applied 
sinapsisms  to  the  spine  gave  a  dose  of  pills,  the  same  as  in  the  pre- 
vious attack,  only  substituting  ten  grains  of  the  submuriate  of  mercu- 
ry for  the  mass. 

We  saw  her  again  at  8  o'clock,  P.  M.,  when  the  pills  had  operated 
several  times,  entirely  relieving  the  cerebral  symptoms.  The  pain 
in  the  side  still  occurred  at  intervals.  We  gave  a  quarter  of  a  grain 
of  morphine,  to  be  repeated  every  hour  until  relief  was  obtained. 

On  the  next  morning  she  had  taken  two  portions  of  morphine, 
with  entire  relief;  had  rested  well  during  the  night,  and  now  feels 
quite  comfortable.  The  same  general  course  was  directed  as  before, 
and  was  attended  with  the  same  happy  results.  She  has  since 
continued  in  good  health,  with  the  exception  of  a  slight  attack  of 
gastralgia  in  January  last,  which  readily  yielded  to  appropriate 
treatment. 

The  foregoing  case  has  been  selected  from  others  before  us,  as 
possessing  peculiar  interest,  from  the  exhibition  of  symptoms  analo- 
gous to  those  usually  presented  in  phlegmasia  of  the  respiratory 
organs,  but  which  have  their  origin,  for  the  most  part,  if  not  entirely, 
in  a  lesion  of  the  spinal  marrow. 

In  the  treatment  of  this  case,  we  made  liberal  use  of  anodynes, 
although  we  believe  they  can  exert  no  other  than  a  temporary  influ- 
ence, while  the  derangement  of  the  spine  exists;  still  we  always 
administer  them  in  urgent  cases  of  this  character,  when  there  is  no- 
thing to  contra-indicate  the  employment.  Although  we  believe  that 
the  pain,  &;c.,  may  be  relieved  by  applications  to  the  spine  alone,  yet, 
when  this  lesion  in  the  spinal  marrow  has  existed  for  some  time,  the 
applications  which  produce  vesication  immediately,  or  even,  the  local 
abstraction  of  blood,  will  not  always  afford  immediate  and  entire 
relief;  and  it  is  not  until  we  establish  a  more  decided  and  permanent 
revulsion,  that  the  symptoms  altogether  subside  :  hence,  the  necessity 
of  adniiiiistering  opiates  in  such  cases,  to  give    some   relief  to   the 


1S45.J        Cough  and  Pleurodynia  from  Spinal  Irritation*  235 


urgent  symptoms,  and  allow  time  for  the  establishment  of  a  decided 
revulsion.  We  have  seen  cases,  that  had  existed  for  some  time, 
which  resisted  all  topical  applications  until  a  discharge  of  pus  was 
established  by  tartar  emetic  ointment.  It  may  be  objected,  that  this 
is  contrary  to  our  reasoning  in  proof  of  its  being  o.  local  congestion. 
But  not  so;  for  as  in  the  case  just  related,  we  believe  the  derange- 
ment to  have  been  primarili/  a  simple  congestion  ;  but  having  existed 
for  some  time  prior  to  our  examination,  it  had  assumed  a  new  and 
more  permanent  character.  Had  we  seen  our  patient  in  the  onset 
of  the  derangement,  doubtless  the  first  application  made  to  the  spine 
would  have  proved  adequate  to  the  entire  relief  of  the  then  existing 
symptoms.  This  fact  we  have  verified  in  a  number  of  cases;  and 
when  the  neuralgic  symptoms  are  not  urgent,  we  always  procure 
relief  from  topical  applications  to  the  spine. 

It  would  appear  from  the  history  of  this  case,  that  the  spinal  irrita- 
tion  was  symptomatic,  from  the  fact  that  the  pleurodynia,  iScc,  did 
not  occur,  until  after  the  digestive  organs  had  become  deranged. 
We,  however,  had  no  opportunity  of  examining  the  spinal  column, 
prior  to  the  development  of  t'le  urgent  symptoms.  The  derange- 
mem  may  have  existed,  and  produced  the  indigestion,  and  subse- 
quently, the  cough  and  pleuralgia ;  but  we  are  not  disposed  to  think 
so,  from  the  fact  that  the  patient  could  trace  the  disorder  of  the  diges- 
tive  organs  to  improper  ingesta.  Yet  we  do  not  believe,  that  a  cor- 
rection of  this  disorder  would  have  relieved  the  neuralgia,  dsc. ;  for 
there  was  a  lesion  in  the  spinal  marrow,  which  required  a  distinct 
treatment. 

My  friend.  Dr.  E.  L^mar,  of  Lincolnton,  has  kindly  oiTered  to 
furnish  me  with  some  interesting  cases  of  spinal  irritation,  which 
manifested  itself  in  painful  affections  of  remote  organs,  and  was  re- 
licved  by  treatment  directed  particularly  to  the  spine.  These,  toge- 
ther  with  others  that  have  come  under  our  personal  observation,  we 
may  report  in  some  future  number  of  this  Journal. 


236  Remarks  on  a  Lecture  on  Mesmerism.  [May, 


ARTICLE  III. 

Remarls  on  a  Lcchire  on  Mesmerism,  published  in  the  Aih  No.  of 
the  Southern  Medical  and  Surgical  Journal.  By  L.  A.  Dugas, 
M.  D.,  Professor  of  Physiology,  <S^'C.  in  the  Medical  College  of 
Georgia. 

The  Lecture  on  Mesmerism,  by  my  esteemed  friend  and  colleague, 
Prof.  P.  F.  Eve,  inserted  in  the  last  number  of  the  Southern  Medical 
and  SurgicalJournal,  being  evidently  designed  to  lessen  the  value 
that  may  be  attached  to  Mesmerism  as  a  means  of  diminishing  or 
preventing  pain  during  the  performance  of  surgical  operations,  and 
having  a  tendency  to  invalidate  the  testimony  I  have  borne  of  itg 
efficacy  in  the  case  published  by  myself  in  the  3d  number  of  the 
same  journal,  I  trust  it  will  not  be  deemed  inappropriate  that  I  ex- 
amine the  grounds  on  which  rests  the  defence  of  the  positions  assumed 
in  the  lecture.  And,  before  going  any  farther,  I  must  assure  the 
reader,  in  the  language  of  my  colleague,  that  "  in  examining  the 
subject,  I  hope  to  do  so  as  a  medical  philosopher,  to  offend  none  who 
may  not  share  my  own  opinions,  to  violate  in  no  instance  propriety 
or  courtesy,'-  and  to  ask  nothing  moro  than  "a  fair  hearing  and  an 
impartial  judgment."  Differences  of  opinion  in  matters  of  scientific 
enquiry,  wheti  discu><scd  in  this  spirit,  can  certainly  lead  to  no  un- 
pleasantness, and  must  redound  to  the  benefit  of  >all  parties. 

Prof.  Eve  endeavors  to  establish  the  three  following  propositions : 

"  1st,  That  Mesmerism,  or  animal  magnetism,  was  unanimously 
condemned  by  the  commission  appointed  in  1784  by  the  King  of  France 
to  examine  and  report  upon  it;  and  that  it  has  never  received  any 
favor  or  approbation  from  any  scientific  or  learned  society  whatever. 

'2d,  That  Mesmerism  is  not  a  reality;  but  that  the  phenomen.a 
ascribed  to  it,  are  justly  due  to  the  imagination  and  excited  feelings. 

*'  3d,  That  the  non-expression  of  pain,  is  no  proof  of  its  non. 
existence,  and  that  there  are  conditions  of  the  body  and  mind,  in 
which  no  sufForing  is  evinced,  and  moreover,  that  this  stale  of  the 
system  is  independent  of  Mesmerism." 

Now  let  us  see  how  these  propositions  arc  sustained.  It  is  stated 
distinctly  in  the  first  proposition,  that  Mesmerism  was  vnajiimously 
condemned  by  the  French  committee;  yet,  as  soon   as  the   details 


1845.]  Remarks  on  a  Lecture  on  Mesmerism.  237 


of  the  Report  are  given,  we  find  the  statement  that  "  the  report  was 
confirmed  by  every  member  of  the  commission,  except  one,  M.  Jus- 
sieu."  "He  was  however,  but  one,  out  of  fourteen."  Was  the  re- 
port  then  unanimously  confirmed?  The  names  of  Franklin,  Bailly 
and  Lavoisier,  also  are  heralded  as  "inseparable  from  the  annals 
of  science."  Why  omit  that  of  Jussieu,  who  was  confessedly  one 
of  the  most  distinguished  naturalists  of  the  age?  Is  it  because  he 
was  so  indiscreet  as  to  differ  in  opinion  with  them  on  the  subject  of 
Mesmerism  ?  In  the  paragraph,  page  171,  we  find  the  following 
quotation  from  their  Report:  "We  cannot  prevent  ourselves  from 
recognizing  in  these  constant  effects  a  powerful  agent,  which  acts 
upon  patients,  subdues  them,  and  of  which  the  person  who  magnet- 
izes them  seems  to  be  the  depositary."  They  recognize  then  the 
facts,  as  does  Jussieu,  and  only  differ  with  regard  to  their  explanation. 
They  refcr  them  to  an  operation  of  the  mind  whereas  Jussieu  thinks 
they  may  be  attributed  to  some  other  agent.  Admit  the  facts,  and 
I  care  not  a  whit  for  the  explanation. 

But  I  am  really  at  a  loss  to  perceive  what  bearing  the  decision  of 
that  committee  can  have  on  Mesmerism,  as  at  present  understood  and 
practiced.  The  following  extract  from  the  Report  of  the  majority, 
will  show  the  process  and  phenomena  upon  which  they  were  called 
to  decide : 

"  They  saw  in  the  centre  of  a  large  apartment,  a  circular  box,  mado 
of  oak,  and  raised  a  foot  or  a  foot  and  a  half  from  the  floor,  and 
called  the  tub,  {bacquel.)  The  cover  of  this  box  is  pierced  with  a 
number  of  holes,  through  which  pass  bent  and  movable  bars  of  iron. 
The  patients  are  placed  in  several  rows  around  the  tub,  and  to  each  is 
assigned  one  of  the  bars  of  iron,  which  may  be  applied  directly  to 
the  region  affected.  A  cord,  j)assed  around  their  bodies,  connects 
them  with  one  another;  sometimes  a  second  chain  of  communication 
is  established  by  their  hands,  that  is  to  say,  by  applying  the  thumb 
between  the  thumb  and  index  finger  ofthe  next  person,  and  compress- 
ing the  thumb  thus  held.  The  impression  received  from  the  left, 
passes  to  the  right,  and  thus  round  through  the  whole.  In  one  cor- 
ner of  the  chamber  a  piano  is  placed,  upon  which  various  airs  are 
performed,  and  to  which  are  added  singinj^  and  other  vocal  sounds. 
All  those  who  magnetize,  hold  in  their  hand  an  iron  rod  10  or  12 
inches  long.  This  rod,  which  is  the  marriietic  conductor,  concen- 
trates the  fluid  towards  its  point,  by  which  the  emanations  are  ren- 
dered stronger.  The  sound  of  the  piano  is  also  a  conductor  of 
magnetism.  The  patients,  placed  in  very  large  numbers,  and  in 
fleveral  rows  around  the  tub,  therefore  receiv(r  magnetism  atthrsame 
time  from  all  these  Hources  :  by  tin;  iron  branches  issuing   from  thv 


23S  Remarks  on  a  Lecture  on  Mesmerism,  [May, 


tub,  by  the  cord  encircling  the  body,  by  the  union  of  thumbs,  and  by 
the  sound  of  the  pfano.  The  patitMits  arc  moreover  directly  mag- 
netized by  means  of  the  fini^or  and  iron  rod  passed  before  the  face, 
over  or  behind  the  head,  and  ahout  the  affected  region  ;  hut  they  are 
es  Kicially  magnetized  by  the  application  of  hands  and  by  pressure 
of  iho  hy|)nchondriac  and  hypogastric  regions,  frequently  continued 
for  a  longtime,  and  occasionally  for  several  hours." 

The  effects  produced,  are  tiius  related  by  the  Committee  : 

"  In  the  experiments  they  (the  committee)  have  witnessed,  the  pa- 
tients, being  thrown  into  various  states,  present  quite  a  singular  spec- 
tacle :  some  are  calm,  quiet,  and  experience  nothing  ;  others  cough, 
spit,  feel  slight  pains,  a  local  or  general  warmth,  and  perspire  ;  others 
are  annoyed  and  agitated  with  convulsions.  These  convulsions  are 
of  extraordinary  continuance  and  violence  :  as  soon  as  convulsions 
occur  in  one,  they  are  manifested  in  many  others.  The  committee 
have  seen  them  continue  more  than  three  hours  :  they  are  attended 
with  the  expectoration  of  a  turbid  and  viscid  fluid,  forced  up  by  the 
violence  of  contractions,  and  in  which  may  sometimes  be  detected 
streaks  of  hlood.  They  are  characterized  by  rapid,  involuntary 
movements  of  the  linihs  and  whole  body,  by  constriction  of  the  throat, 
by  tremors  of  the  hypochondriac  and  epigastric  regions,  by  confusion 
and  wildness  of  the  eyes,  by  piercing  cries,  weeping,  hicough,  and 
immoderate  laughing;  they  are  preceded  or  followed  by  a  state  of 
languor  or  of  reverie,  a  kind  of  prostration,  and  even  sleep.  The 
slightest  unexpected  noise  occasions  trembling,  and  it  was  observed 
that  any  change  in  the  tone  or  time  of  the  airs  played  on  the  piano, 
affected  the  patients,  so  that  a  brisk  air  was  attended  with  increased 
agitation  and  more  violent  convulsions.  Nothing  is  more  surprising 
than  this  scene  of  convulsions;  one  who  has  not  seen  it  can  form 
no  idea  of  it,  and,  when  witnessing  it,  one  is  equally  astonished  at 
the  perfect  tranquility  of  a  portion  of  the  patients,  and  at  the  agita- 
tion of  the  others,  at  the  variety  and  repetition  of  the  phenomena,  at 
the  sympathies  established.  Some  of  the  patients  seek  each  other, 
rush  together,  smile,  converse  affectionatply,  and  endeavor  to  soothe 
each  other's  feelings  All  are  under  snhjcction  to  the  magnetizer  ; 
however  drowsy,  a  word,  a  look,  or  a  sign  from  him,  arouses  them. 
We  cann<it  but  recognize  in  these  constant  eflects  a  powerful  influ- 
ence which  acts  u|)on  the  patients,  subdues  them,  and  of  which  the 
person  who  magnetizes  them  seems  to  be  the  depositary." 

How  different  are  these  procedures  and  effects  from  those  of  the 
present  day  !  Instead  of  a  charlatanical  and  ostentatious  display  of 
causes  and  effects,  the  philosophic  inquirer  proceeds,  without  extra- 
neous parapharnalia,  to  the  investigation  of  nature's  truths.  With 
perfect  quiet  around  him,  and  nothing  calculated  to  strike  the  ima- 


1845.  J  Remarks  on  a  Lecture  on  Mesmerism.  239 

ginalion,  he  r.ses  but  his  volition  and  a  few  passes  of  his  hands  along 
the  person  of  liis  subject.  Yet  how  much  more  astounding  the  effects 
thus  simply  produced,  than  even  those  related  above !  Even  llie 
production  of  mere  somnambulism,  now  so  common  as  to  have  been 
\vitnessed  by  every  one  who  has  taken  the  least  trouble  to  investigate 
the  matter,  was  entirely  unknown  at  the  date  of  the  celebrated  Re- 
port. With  what  point  then  can  the  authority  of  this  committee  be 
invoked  in  an  argument  to  disprove  that  of  which  they  could  have 
had  no  idea  whatever  ? 

In  the  second  division  of  the  lecturer's  first  proposition  it  is  assert- 
ed that  Mesmerism  "has  never  received  any  favorer  approbation 
from  any  scientific  or  learned  society  whatever."  My  friend  must 
have  forgotten  several  facts  rather  adverse  to  such  a  conclusion.  In 
1815,  the  Emperor  of  Russia  appointed  a  committee  of  able  physi- 
cians to  investigate  the  subject,  who  reported,  that  having  ascertained 
that  animal  magnetism  is  a  very  important  agent,  they  would  recom- 
mervd  that  its  practice  be  restricted  to  enlightened  physicians.  An 
Imperial  edict  was  accordingly  promulgated  to  that  effect.  In  1816, 
a  similar  law  was  passed  in  Denmark,  at  the  instance  of  the  College 
of  Health.  In  1817,  the  King  of  Prussia,  by  Royal  edict,  prohibited 
the  practice  of  animal  magnetism  by  any  other  than  physicians.  And 
in  1818,  the  Academy  of  Sciences  of  Berlin,  which  is  confessedly 
one  of  the  ablest  bodies  in  Europe,  offered  a  prize  of  upwards  of  $600, 
for  the  best  work  on  animal  magnetism,  thus  showing  their  belief  of 
its  importance. 

In  1925,  a  committee  was  appointed  by  the  Royal  Academy  of 
Medicine,  of  Paris,  to  report  on  the  expediency  of  appointing  a  sjland- 
ing  committee  for  the  investigation  of  facts  relating  fo  animal  mag- 
netism. The  committee,  consisting  of  Adelon,  Marc,  Burdin  aine, 
Pariset,  and  Husson,  reported  that  it  ^cas  expedient  to  establish  a 
committee  on  animal  magnetism;  and,  on  the  question  being  taken, 
35  voted  in  favor  of  the  report,  and  25  against  it.  The  President 
then  appointed  the  following  gentlemen  as  that  committee  viz: 
Lcroux,  Bourdois  de  la  Motte,  Double,  Magendie,  Guersent,  Laennec, 
Tnillaye,  Marc,  Itard,  Fouquier,  ami  Gueneau  de  Musi-y.  Lacnuec's 
health  very  soon  became  such  as  to  necessitate  his  resignation,  and 
M  Husson  was  appointed  in  his  place.  During  upwards  of  five  years 
this  able  committee,  with  the  exception  of  Magendie- and  Double, 
who  would  not  serve,  were  engngod  in  the  discharge  of  the  duties 
nsuigned  them,  proceeding  with  the  circumspection  and  impartiality 


240  Remarks  on  a  Lecture  on  Mesmerism,  [May, 


of  true  philosophers,  in  the  observation  anil  interpretation  of  facts. 
In  June,  1831,  their  Report  was  read  to  the  Academy,  and  concludes 
with  the  following  coroihirics  : 

1.  The  moans  employed  to  establish  relation,  or,  in  other  words, 
to  transmit  the  magnetic  influences  of  the  operator  to  the  magnetized, 
are  the  contact  of  thumbs  or  hands,  frictions,  and  certain  gestures 
made  near  the  body,  called  passes. 

2.  The  external  and  visible  means  are  not  always  necessary,  for 
on  several  occasions,  the  will,  or  the  eyes  fixed  on  the  patient,  have 
produced  the  magnetic  effects,  even  without  the  knowledge  of  the 
magnetized. 

3.  Magnetism  has  acted  on  persons  of  different  sexes   and    ages. 

4.  The  time  required  to  produce  the  magnetic  effects  varies  from 
half  an  hour  to  one  minute. 

5.  Magnetism  does  not  usually  affect  persons  in  good  health. 

6.  It  docs  not  affect  all  sick  persons. 

7.  During  the  process  of  magnetizing,  there  are  sometimes  man- 
ifested insignificant  and  transitory  effects,  which  we  do  not  attribute 
to  magnetism  alone,  such  as  slight  oppressiork,  heat  or  cold,  and  other 
nervous  phenomena  which  may  be  accounted  for  without  the  inter- 
vention of  any  special  agent ;  viz.  by  hope  or  apprehension,  by  pre- 
possession or  the  expectation  of  something  unknown  and  novel,  by 
the  ennui  resulting  from  monotonous  gestures,  by  the  silence  and 
quiet  attending  such  experiments,  and  by  imagination  which  exerts 
such  powerful  influence  on  certain  minds  and  constitutions. 

8.  A  number  of  the  phenomena  observed  have  appeared  to  us  to 
depend  on  magnetism  alone,  and  were  not  reproduced  without  it. 
They  are  well  established  physiological  and  therapeutic  phenomena. 

9.  The  true  effects  of  magnetism  are  various:  It  agitates  some, 
and  composes  others;  it  causes  most  commonly  temporary  accelera- 
tion of  respiration  and  circulation,  slight  convulsive  actions  of  the 
muscular  fibres  resembling  electric  shocks,  more  or  less  numbness, 
drowsiness,  sleep,  and  in  a  few  cases  what  magnetizers  term  som- 
uambulism. 

10.  The  existence  of  a  uniform  feature  by  which  the  truth  of  this 
somnambulism  can  be  determined,  has  not  been  established. 

11.  Nevertheless  the  existence  of  this  state  may  be  certainly 
known,  when  it  occasions  the  development  of  the  new  tacullies  de- 
nominated clairvoyance.,  intuition,  internal  prevision,  or  that  it  pro- 
duces striking  physiological  changes,  as  insensibility,  a  sudden  and 
considerable  increase  of  muscular  'power ^  and  when  this  state  cannot 
be  referred  to  any  other  cause. 

12.  Inasmuch  as  ?ome  of  the  effects  attributed  to  somnambulism, 
may  be  simulated,  somnambulism  itself  may  sometimes  be  simulated, 
and  furnish  charlatanism  with  means  of  deception. 

13.  The  sleep  induced  more  or  less  promptly,  and  more  or  less  pro- 
foundly, is  a  true  effect  of  magnetism,  although  not  an  invariable  on. 


1845. J  Remarks  on  a  Lecture  on  Mesmerism,  241 


14.  It  is  demonstrated  to  us  that  it  has  been  induced  under  cir- 
cumstances in  which  the  magnetized  could  not  see  and  were  ignorant 
of  the  moans  employed  to  produce  it. 

15.  When  the  magnetic  sleep  has  been  once  induced,  it  is  not  al- 
ways necessary  to  resort  to  contact  and  to  passes  to  induce  it  again. 
The  look  and  will  alone  of  the  ma^netizer  have  the  same  influence. 
Not  only  an  effect  may  then  be  produced  on  the  magnetized,  but 
complete  somnambulism  may  be  induced,  and  removed  without  his 
knowledge,  beyond  his  sight,  at  a  certain  distance,  and  beyond  closed 
doors. 

16.  There  are  usually  effected  changes  more  or  less  remarkable 
in  the  perceptions  and  faculties  of  individuals  thrown  into  somnambu- 
lism by  magnetism. 

A.  Some  of  them,  in  the  midst  of  noisy  conversation,  bear  only  the 
voice  of  the  Mesmerizer  ;  many  reply  correctly  to  questions  propoun- 
ded by  him  or  by  those  with  whom  they  have  been  put  in  relation  ; 
others  will  converse  with  any  person  present :  yet  it  is  rare  that  they 
hear  what  occurs  about  them.  They  are  generally  unconscious  of 
external  and  unexpected  sounds  produced  about  their  ears,  such  as 
the  sound  of  brass  vessels  stricken  near  them,  the  fall  of  a  piece  of 
furniture,  <S:c. 

B.  Their  eyes  arc  closed,  their  eye-lids  resist  efforts  made  to  sepa- 
rate them  with  the  hands  ;  this  operation,  which  is  not  done  without 
pain,  shows  the  globe  of  the  eye  convulsed,  carried  upwards,  and 
sometimes  downwards. 

c.  The  sense  of  smell  is  sometimes  abolished.  Muriatic  acid,  or 
ammonia,  may  be  inhaled  without  discomfort  and  even  without  their 
knowledge.  The  reverse  sometimes  obtains,  and  they  are  then  sen- 
sible to  odors. 

D.  Most  of  the  somnambulists  we  have  seen,  were  completely  in- 
sensible. We  might  tickle  their  feet,  nostrils,  and  the  corners  of  their 
eyes  with  a  feather,  pinch  their  skin  so  as  to  produce  cchymosis, 
plunge  suddenly  and  unexpectedly  to  a  considerable  depth  a  pin  un- 
der the  finger  nails,  without  any  indication  of  |>ain,  and  without  their 
knowledge.  Indeed  one  has  been  found  insensible  to  one  of  the  most 
painful  surgical  operations,  whose  countenance,  pulse,  and  respira- 
tion, indicated  no  emotion  whatever.* 

17.  Magnetism  is  equally  intense  and  is  as  readily  felt  at  a  distance 
of  six  feet  as  at  six  inches,  and  the  phenomena  are  the  same  in  both 
cases. 

18.  It  appears  that  those  only  who  have  been  previously  magneti- 
zed can  be  acted  on  at  a  distance. 

19.  We  have  seen  no  one  in  whom  somnambulism  was  induced  at 
the  first  sitting.     In  some   cases  eight  or  ten  sittings   were  required. 

20.  We  have  always  observed  that  natural  sleep,  which  is  the  re- 


Cloqilfitt'srasF. 


242  Remarks  on  a  Lecture  on  Mesmerism.  [May, 


pose  of  the  organs  of  the  senses,  of  the  intellectual  faculties,  and  of  vo. 
luntary  motion,  precedes  and  terminates  the  state  of  somnambulism. 

21.  Whilst  in  the  state  of  somnambulism,  the  ma^rjelized  \vhom 
we  have  seen,  retain  the  exercise  of  their  wakinjr  faculties.  Their 
memory  appears  even  more  faitliful  and  more  extended,  since;  they  re- 
inembi'ruhat  occurred  durinj:  every  previous  slate  of  somnambulism. 

22.  Whpn  awake,  they  aver  to  have  forgotten  entirely  all  the  oc- 
currences durinj:  their  somnambulism,  and  never  recollect  them  af- 
teruards.     On  this  subject  our  sole  reliance  must  be  on  their  veracity. 

23.  The  muscular  ))oucr  of  somnambulists  is  sometimes  benutjibed 
and  paralysed.  At  other  times  their  movements  are  merely  impeded, 
and  in  walking  they  stagger  as  if  intoxicated,  avoiding  or  not  obsla- 
cles  in  their  way.  There  are  somnambulists  who  retain  complete, 
their  powers  of  motion,  and  some  of  them  are  even  stronger  and  moro 
active  than  when  awake. 

24.  We  have  seen  two  somnambulists  distinguish,  with  closed  eyes, 
objects  placed  before  them;  they  designated,  without  touching  them, 
Ihe  color  and  suit  of  cards;  they  read  words  in  hand-writing,  or  sev- 
eral lines  in  books  opened  at  random.  These  phenomena  occurred 
even  when  their  eye-lids  were  kept  perfectly  closed  with  our  fingers. 

25.  We  have  met  with  two  somnambulists  who  possessed  the  fac- 
ulty of  foreseeing  (prcioir)  acts  of  the  organism  more  or  less  remote 
and  more  or  less  complex.  One  of  them  announcrd  several  days, 
nay,  several  months  beforehand,  the  day,  hour  and  minute  of  iho 
the  recurrence  of  epileptic  paroxysm  ;  the  other  indicated  the  period 
at  which  he  would  be  cured.  Their  predictions  (previsions)  wcro 
realized  w  ith  remarkable  precision.  'I'his  faculty  seemed  to  us  to  bo 
possessed  only  in  relation  to  acts  or  lesions  of  the  organism. 

20.  We  have  met  wilh  but  one  somnambulist  who  indicated  the 
symptoms  of  the  disease  of  three  persons  wilh  whom  she  had  been 
put  in  relation  [c7i  rapport).  We  had  however  made  experiments  on 
a  pretty  large  number  of  them. 

27.  In  order  to  establish  wilh  accuracy  the  relation  of  mngnelism 
to  therapeutics,  it  would  be  necessary  to  observe  the  effects  on  a 
fjreat  numher  of  individuals,  and  to  make  for  a  long  lime  daily  exper- 
ifnents  on  the  same  patients.  Tiiis  not  having  been  done,  the  com- 
mittee  confines  itself  to  the  statement  of  what  it  has  seen,  although 
in  too  small  a  number  of  cases  to  venture  on  any  positive  conclusion. 

28.  Some  of  the  patients  experienced  no  relief  from  magnetism  ; 
others  have  been  more  or  less  manifestly  benefitted  by  it ;  for  example  : 
one  was  entirely  relieved  of  habitual  pains ;  another  recovered  his 
strength  ;  a  third  had  his  epileptic  attacks  deferred  several  monlhs; 
and  a  fourth  was  completely  cured  of  a  serious  and  long-standing 
paralysis. 

29.  Whether  considered  as  an  agent  of  physiological  phenomena, 
or  as  a  thera[)cutic  means,  Magnetism  ousht  to  be  included  among 
medical  studies,  and  consequently  its  practice  and  supervision  should 
l>p  restricted  to  physicians,  as  is  the  case  in  the  Northern  countries. 


1845.]  Remarks  on  a  Lecture  on  Mesmerism,  243 


39.  The  committee  did  not  verify,  for  want  of  opportunity,  other 
faculties  which  had  been  stated  by  mnjrnetizers  to  exist  in  somnam. 
bwiisls.  But  Ihey  have  collected  and  now  communicate  facts  of 
sufficient  importance  to  authorize  them  to  think  that  the  Academy 
ouglit  to  encourafiG  researches  on  MajL^nctisfn,  as  a  very  curious 
branch  cf  psychology  and  of  natural  iiislory. 

The  Report  was  listened  to  by  the  Academy  with  much  interest^ 
received  and  ordered  to  be  autographed,  {auto graphic).  Consisting  as 
it  did,  of  mere  facts  observed  by  the  committee,  it  could  give  rise  to 
no  discussion  without  impeaching  the  veracity  of  those  respectable 
men.  Hence,  although  there  were  probably  many  members  who 
still  remained  skeptics,  as  the  Report  was  not  objected  to,  it  must  bo 
considered  as  in  accordance  with  the  views  of  the  Academy,  or  at 
least  of  a  majority  of  that  body. 

It  is  truly  a  matter  of  astonishment  that,  notwithstanding  the  gen- 
eral admission  of  the  truths  of  Mesmerism  in  all  the  nations  of  con- 
tinental Europe,  and  tlie  aclion  of  their  respective  governments  and 
scientific  bodies  on  the  s  bject,  it  should  have  attracted  but  little  at- 
tention in  England  until  a  comparatively  recent  date.  One  would 
certainly  suppose  that  a  doctrine  advocated  in  Germany  by  such  men 
as  Klugge,  Sprengel,  Treviranus,  Weinhold,  Hermstaedt,  Meckel, 
Klaproth,  Hufuland,  Shiglitz,  (Sec.  ;  and  in  France,  by  La  Place,  Cu- 
vier,  Virey,  Rostan,  Orfila,  Marc,  Itard,  Gcorget,  Guersent,  Husson, 
Fouquier,  Andral,  6rc.  was  worthy  of  being  at  least  listened  to  by 
the  members  of  the  Royal  Medico-Chirurgical  Society  of  London, 
even  at  as  late  a  day  as  1843  !  It  should  be  remembered,  however, 
that  notwithstanding  the  indignity  with  which  the  great  majority  of 
this  body  treated  the  presentation  of  facts  to  them,  there  arc  yet 
some  in  England,  who,  rising  above  the  influence  of  blind  prejudices 
and  the  fear  of  popular  odium,  have  candidly  investigated  the  sub- 
ject, and  dared  to  proclaim  their  belief  in  Mesmerism.  Among  these, 
we  find,  Arnott,  Oliver,  Symes,  Townshend,  Elliotson,  <Scc.  men 
whose  abilities  and  standing  entitle  them  certainly  to  as  much  consid- 
eration as  the  herd  of  opponents  who  "peremptorily  dismissed  Mes- 
merism from  the  society,"  without  ever  having  taken  any  steps  to 
verify  its  claims.  That  Dr.  Elliotson,  who  had  long  been  regarded 
as  one  of  the  ablest  professors  in  the  London  University,  whose  clin- 
ical Lectures  and  Hospital  success  had  won  him  the  applause  of  the 
Profession  and  patronage  of  the  public,  who  had  been  for  years  the 
respected  President  of  this  very  Medico-Clnrurgical  Society,  that 


244  Remarks  on  a  Lecture  on  Mesmerism.  [May, 


such  a  man  shoukl  be  "ejected  from  his  professorship,"  dismissed 
from  his  Hospital,  and  compelled  to  resign  his  membership  of  tho 
society,  merely  because  of  "his  belief  in  magnetism,"  are  facts  that 
so  closely  resemble  the  inquisitorial  tyranny  of  the  dark  ages,  that 
\\c  can  scarcely  realize  that  they  have  occurred  but  yesterday,  and 
in  the  Emporium  of  the  civilized  worki ! 

It  is  said  that  the  Professor  of  Philosophy  at  Padua  refused  to 
walk  into  Galileo's  house  and  look  through  his  telescope,  to  see  whe- 
ther the  satellites  of  Jupiter  really  existed  ;  and  that  the  Professor  at 
Pisa  delivered  lectures  to  show  that  the  facts  could  not  be  facts. 
Verily  it  would  seem  that  we  are  not  so  fiir  in  advance  of  the  age  of 
Galileo  as  we  had  thought,  and  that  human  nature  is  still  the  same 
now  that  it  was  centuries  ago  I  hope,  however,  that  for  the  honor 
of  the  age  in  which  we  live,  I  have  sufficiently  established  that  it  is 
an  error  to  suppose,  that  Mesmerism  "  has  never  received  any  favor 
or  approbation  from  any  scientific  or  learned  society  whatever,"  and 
that  it  h?.s  on  the  contrary  been  recognized  by  learned  medical  socie- 
ties, legalized  by  governments,  and  advocated  by  a  large  number  of 
the  most  scientific  authorities  of  Europe.  Fortunately  for  our  coun- 
try, we  have  no  society  constituted  for  the  purpose  of  determining 
ex  auclorltale  what  we  may  or  may  not  believe.  Hence  it  is  that 
since  the  subject  of  Mesmerism  has  been  agitated  amongst  us,  it  has 
received  the  attention,  not  only  of  scientific  men,  but  of  observers 
of  all  classes,  who,  unbiassed  by  the  vain  phantom  of  authority  and 
high  sounding  titles,  have  examined  for  themselves  and  become  con- 
vinced that  Mesmerism  is  "a  reality." 

But  my  friend  urges  that  the  "  phenomena  ascribed  to  it  (mesmer- 
ism) are  justly  due  to  the  imagination  and  excited  feelings,"  and  that 
"the  non-expression  of  pain,  is  no  proof  ofits  non-existence."  The 
latter  of  these  propositions  is  so  self-evident  that  I  am  surprised 
that  so  much  labor  should  have  been  spent  in  the  collection  of 
cases  to  substantiate  it.  I  might  have  furnished  a  goodly  number 
of  the  kind  which  have  come  under  my  own  observation;  but  I 
would  add,  that  Mrs.  Clark  is  the  only  person  I  have  ever  seen, 
who  not  only  expressed  no  pain,  but  honestly  averred  having  felt 
no  sensation  whatever  during  the  operation. 

With  regard  to  the  first  of  the  above  propositions,  I  am  happy  to  find 
that  its  phraseology  contains  no  denial  of  the  phenomena  ascribed  to 
Mesmerism,  and  that  at  page  183,  my  friend  admits  "that  sleep,  con- 
vulsive movements,  insensibility.  Ace,  may  be  produced,  and  have  been 


1845.]  Remarks  on  a  Lecture  on  Mesmerism.  245 


produced  by  one  person  operating  on  the  feelings  of  another."  True, 
in  his  opinion,  they  are  the  "legitimate  results  of  the  imagination," 
&;c.  No  one  will  deny  that  the  phenomena  have,  and  will  give  rise 
to  differences  of  opinion  in  relation  to  the  channel  through  which 
they  are  induced,  as  well  as  to  the  agency  by  which  they  are  occa- 
sioned. Whether  it  be  through  the  mind  that  wo  operate  on  the  bo- 
dy, or  through  the  body  that  we  operate  on  the  mind,  in  the  induction 
of  mesmeric  phenomena,  are  questions  of  minor  importance  in  de- 
termining the  great  fact  of  our  ability  to  place  the  body  in  such  a 
state  that  a  surgical  operation  may  be  borne  without  pain.  Of  what 
moment  can  it  be  to  my  patient,  or  even  to  her  surgeon,  that  her  in- 
sensibility be  attributed  to  "  a  trance  or  reverie,"  or  even  to  Mes- 
merism? Is  it  not  to  her  a  source  of  unspeakable  thankfulness  that 
a  method  has  been  discovered  by  which  she  has  been  spared  the 
pangs  of  one  of  the  most  painfnl  operations,  and  relieved  from  the 
presence  of  a  loathsome  disease  without  her  consciousness,  and  as 
if  by  enchantment?  And  yet  is  she,  and  all  who  may  be  so  unfortu- 
nate as  to  require  surgical  operations,  to  be  told  that  this  is  all  a  farce, 
that  it  is  the  mere  workinss  of  imairination,  and  that,  in  thelanfjun^e 
of  Dr.  Copland  of  the  Medico-Chirurgical  Society  of  London,  ^^ihe 
fact  is  unworthy  of  consideration,  because  pain  is  a  wise  provision  of 
nature^  and  patients  ought  to  suffer  pain  while  their  surgeon  is  oper- 
ating V  or  rather  is  it  not  more  philosophic,  whilst  we  may  differ  in 
opinion  on  points  of  theory,  that  we  yield  to  the  strength  of  facts, 
and  endeavor,  by  multiplying  them,  fo  to  perfect  our  means  as  to 
render  them  available  to  ail  sufferers,  instead  of  being  limited  as  at 
present  to  a  favored  few.  That  we  cannot  induce  insensibility  in  all 
cases,  is  but  too  true  ;  may  we  not  indulge  the  hope,  however,  that 
by  becoming  more  familiarized  with  this  mysterious  agency,  and  the 
laws  by  which  it  is  governed,  we  may  ultimately  be  enabled  so  to 
control  it,  as  to  render  it  of  general  applicability  ? 


240  A  Case  of  Lithotomy  in  the  Female.  [May, 


ARTICLE    IV. 

A  Case  of  Lillwiomy  in  the  Female  douhlc  Calculus.     By  B.  W. 
Gkoce,  M.  D.,  of  Talladega  County,  Ala. 

During  the  month  of  April,  1843,  I  was  called  to  visit  Mrs.  N.  S. 
(aged  23  years,  and  of  leuco-phlcgmatic  temperament,)  in  consulla- 
tion  witii  Dr.  Sumners,  for  the  purpose  of  removing  stone  in  tho 
bladder,  by  an  operation.  I  found  Mrs.  S.  in  an  extremely  dcbil- 
itated  condition.  She  informed  me  that  she  had  been  sufiering  from 
the  effects  of  the  stone  for  several  years.  She  iiad  taken  various 
medicines  without  producing  any  more  than  mere  temporary  relief; 
and  was  at  this  time  laboring  under  the  distressing  effects  of  dyspep- 
sia. On  further  enquiry,  she  informed  me,  that  in  childhood  she  had 
been  very  much  trou!)lcd  with  asthma,  but  which  pretty  much  subsi- 
ded  about  the  agc.ot  *puberty.  Siie  did  not,  however,  long  enjoy 
the  consolation  of  having  gotten  rid  of  this  disease,  before  one  of  an 
cqiuilly  distrcssingcharactcrmadc  its  appearance,  to-wit,amenorrlioca; 
under  wliich  she  labored  until  near  the  age  of  nineteen.  Upon  tho 
appearance  of  her  catamenia  she  began  to  experience  symptoms  of 
gravel;  which  continued  to  increase  in  violence,  until  she  was  hap- 
pily relieved  by  an  operation.  On  my  arrival.  Dr.  S.  represented 
the  stone  as  being  about  three-fourths  of  an  inch  from  the  external 
orifice  of  the  urethra.  Upon  making  a  minute  examination,  I  dis- 
covered  this  to  bo  the  case,  and  that  the  stone  was  so  large  as  to 
prevent  the  passing  of  the  finger  up  the  vagina.  Deeming  dilatation 
impracticable,  we  immediately  determined  to  <5perate  ;  which  was 
performed  by  making  an  incision  (with  the  smallest  scalpel  in  tho 
dissecting  case,)  through  (he  vagina  and  urethra,  immediately  upon 
the  stone.  After  completing  the  incision,  the  dressing  forceps  (in 
the  pocket  case)  were  introduced  and  the  stone  grasped;  but  dis- 
covering that  it  could  not  be  extracted  without  considerable  effort, 
the  finger  was  inserted  and  the  calculus  raised  from  its  bed,  near  tho 
internal  orifice  of  the  urethra,  (for  it  had  been  so  long  in  this  situa- 
tion  that  it  had  become  pretty  firmly  attached  to  the  mucous  mem- 
brane,) and  then  easily  removed. 

In  a  few  moments  after  the  operation,  the  patient  was  attacked 
with  rigors,  but  which  subsided  immediately  upon  the  administration 


1845.]  A  Case  of  Lithotomy  in  the  Female.  247 


of  a  little  camphor  water.  She  soon  fell  into  a  quiet  and  pleasant 
sleep,  and  rested  well  during  the  after-part  of  the  day  and  that  night. 
I  visited  her  the  second  day  after  the  operation  and  found  her  doing 
well:  pu!s2  83,  in  no  pain,  the  incision  was  healing  by  the  f^.rst  in- 
tention, and  the  urine  passing  ofT  by  the  natural  channel. 

1  heard  nothing  more  of  our  patient  (as  I  lived  at  some  distance,) 
until  about  eight  diiys  afcer,  when  I  was  unexpectedly  summoned  to 
to  sec  her  again.  When  I  arrived,  I  found  Dr.  Sumncrs  already  in 
attendance,  who  stated  that  another  calculus,  fully  as  large  as  the 
first,  had  come  down  and  occupied  pretty  much  the  same  position 
as  the  one  already  removed.  1  was  indeed  astonished;  but  it  imme. 
diately  occurred  to  me  that,  we  had  neglected  the  imj)ortant  and 
necessary  precaution  of  sounding  the  bladder  afier  the  oj)eration. 

We  determined  to  make  a  second  effort  to  relieve  the  sufferings 
of  our  patient,  whose  pains  had  now  become  almost  intolerable. 
Upon  making  a  vaginal  examination,  we  found  the  previously  made 
incision  partly  re-opened;  this  we  enlarged,  then  introduced  the  for- 
tops,  and  removed  the  stone  without  difficulty.  The  bladder  wag 
now  thoroughly  explored,  and  no  other  stone  being  detected,  she  was 
placed  quietly  in  bed,  and  the  strictest  orders  given  as  to  her  regi- 
men, (Sec. 

She  recovered  from  this  second  operation,  without  a  sirjgle  un. 
favorable  symptom,  excej)t  incontinence  of  urine,  wliich,  for  somo 
time,  threatened  to  be  very  obstinate.  'J'his  however  was  finally 
relieved  by  astringent  injections,  bathing,  <S:c.,  and  I  am  now  happy 
(o  say,  that  she  has  since  been  delivered  of  a  fine,  healthy  boy,  and 
is  at  this  time  enjoying  unusually  good  health. 

The  calculi  are  of  the  mulberry  character  ;  each  half  as  largo  as 
n  pullet's  og^^  and  weighing  something  over  an  ounce.  The  one 
first  removed  is  of  an  oval  shape,  with  the  upper  surface  smooth  and 
polished;  produced  I  suppose  from  the  urine  passing  over  it;*  the 
other  part  of  the  stone  is  exceedingly  rough.  The  second  stono  is 
round,  and  rough  over  its  entire  surface. 


  Most  probably  from  friction  of  the  second  calculus  which  latter  became  rough 
over  its  entire  surface  in  the  eight  days  after  the  removal  of  tlie  first.  Edits. 


249  Case  of  Procidentia  Uteri  during  Labor.  [May, 


ARTICLE    V. 

Case  of  Procidentia  TJieri  during  Labor,  in  which  artificial  means 
were  necessary  to  effect  Delivery,  with  subsequent  replacement  of 
the  Uterus,  and  complete  recovery.  By  John  M.  B.  Harden,  M.  D., 
of  Liberty  County,  Ga. 

The  following  case,  the  narration  of  which  I  have  received  from 
my  friend  Dr.  Raymond  Harris,  of  Bryan  county,  is  so  very  curious 
and  interesting,  that  I  have  considered  it  worthy  of  permanent  record 
and  therefore  send  it,  with  the  request  that  it  be  inserted  in  the  next 
number  of  the  Southern  Medical  and  Surgical  Journal.  Although 
not  occurring  under  my  own  observation,  yet,  from  the  known  char- 
acter of  the  gentleman  who  has  furnished  it  to  me,  I  have  no  hesi- 
tancy  in  vouching  for  the  general  accuracy  of  the  details. 

In  April,  1829,  a  negro  woman  belonging  to  Capt.  George  Rcntz, 
of  Mcintosh  county,  was  taken  in  labor  She  was  about  40  years  of 
age,  of  good  constitution,  mother  of  several  children,  and  so  far  as  is 
known,  not  subject  to  any  previous  prolapsus  or  other  disease  of  the 
womb.  Something  unusual  and  anomalous  having  occurred  during 
the  progress  of  the  labor,  Dr.  Harris  was  sent  for.  He  found  her,  on 
his  arrival,  in  the  following  condition  :  She  was  lying  on  her  back, 
with  the  whole  gravid  uterus  between  her  thighs,  retained  only  by  the 
ligaments,  which  were  much  stretched  but  not  ruptured,  and  dis- 
charging from  its  external  surface  a  serous  or  sanious  fluid.  The 
woman  had  been  in  this  condition  for  about  24  hours.  She  had  had 
no  pain  since  the  descent  of  the  uterus,  and  was  complaining  of 
none  at  this  time.  The  liquor  amnii  had  been  discliarged.  After  a 
careful  examination,  no  motion  or  other  sign  of  life  in  the  foetus  could 
be  perceived.  The  uterus  appeared  to  be  in  a  perfectly  quiescent 
state,  without  any  disposition  to  contract.  The  os  tincoe  was  barely 
dilated  sufficiently  to  allow  the  introduction  o^  two  fingers.  Finding 
it  absolutely  necessary  to  relieve  her  as  soon  as  possible,  the  Doctor 
proceeded  to  deliver  her  by  artificial  means  He  opened  the  head  of 
the  child  with  a  suitable  instrument,  and  then,  having  an  assistant  to 
hold  and  support  the  uterus,  he  introduced  his  hand,  and  by  careful 
traction  succeeded  in  removing  its  contents.  There  was  very  little 
pain  during  his  manipulations.     He  now  returned  the  womb,  which 


1845.  J  Case  of  Procidentia  Uteri  during  Labor,  249 


had  scarcely  contracted  at  all,  and  advising  the  recumbent  position, 
left  her.  She  had  a  very  good  ^^ getting  vp,"  and  two  years  ago  tho 
Doctor  learned,  teas  in  good  health. 

Re3iarks.  Cases  of  the  above  character  must  be  of  very  rare 
occurrence.  I  have  not  been  able  to  lay  my  hands  on  more  than  two 
bearing  any  resemblance  to  it  one  is  noticed  in  West's  Report,  pub- 
lished in  the  British  and  Foreign  Medicat  Review  for  April,  1844,*  and 
occurred  in  the  practice  of  Dr.  Perfetti.  In  this  case,  however,  the 
procidentia  was  not  complete,  the  uterus  only  reaching  "something 
more  than  six  fingers  breadth  beyond  the  external  parts.  The  woman 
had  been  subject  to  prolapsus  "ever  since  she  was  fifteen  years  old." 
The  other  had  been  communicated  to  the  Dublin  Medical  Press,  by 
Dr.  Darbey,  of  Droghedaf  The  woman  was  42  years  of  age,  and 
had  had  prolapsus  uteri  for  some  years.  This  was  her  seventh  preg- 
nancy. "On  examination.  Dr.  D.  found  the  uterus  lying  between 
the  patient's  thighs,  pvcscnUn^  a  livid  appearance,  and  the  os  uteri 
having  a  dry  feel  and  no  symptoms  of  dilatation.  The  labor  pains 
were  strong,  with  violent  cramps  in  the  lower  extremities.'' 

2.  The  treatment  of  these  cases  seems  to  have  been  governed  by 
the  circumstances  attending  them.  In  our  first  case,  the  os  uteri  was 
*'  so  hard  and  undilatable,''  that  Dr.  Perfetti  deemed  it  necessary  to 
malce  incisions  into  it.  He  then  introduced  the  forceps  and  extracted 
the  child.  Tho  mother  recovered.  Dr.  Darbey  "took  thirty  ounces 
of  blood  from  the  arm,  and  administeied  the  following  draught :  
R.  Aq.  Menth.  Pip.  iss;  Tr.  Opii.  Acet.  gtt.  4  ;  Syrup  Cort.  Aur- 
ant.  3ij.  I\I.  which  procured  rest,  and  checked  the  cramps  and  other 
bad  symptoms.  After  a  comfortable  repose  of  two  hours,  labor 
pains  returned,  the  os  uteri  gradually  and  steadily  dilated,  and  a 
healthy,  but  small  sized  child^  was  born.  The  placenta  followed 
after  a  short  time,  and  the  uterus  being  replaced  and  suitably  secured^ 
nothing  untoward  followed.'^  In  our  case,  the  dilatation  was  efTect- 
ed  by  the  hand  after  having  lessened  the  dimensions  of  the  head  ; 
and  certainly  this  method  should  always  be  preferred  to  incisions ^ 
unless  it  be  found  impracticable. 

3.  There  is  an  important  physiological  fact  to  be  gleaned  from  these 
cases:  namely,  the  poorer  o/'///e  abdominal  muscles  in  effecting  de- 
livery ;  and  the  case  which  we  have  now  related  shows  plainly  that 


*  Am,  Jour.  Med.  Scionces,  N.  S.  vol.  8,  p.  257. 
i  Am.  Jour.  Mod.  Sciences,  N.  S.  vol.  9,  p.  232. 


ii^O  A  Case  of  Uterine  Hydatids.  [May 


parturition  may  he  carriel  through  by  the  action  of  these  muscles 
alone,  mithout  the  c^nctrrencc  rf  uterine  contraclicn,  an!  nn!uially 
suggests  the  question,  which  plays  the  most  important  part  in  Labor? 
Anyone  who  has  ever  had  his  liancl  in  the  uterus  during  a  labor  jiain, 
must  know  that  there  is  most  powerful  action  of  muscles  somewhere, 
and  he  would  no  doubt  be  inclined  to  refer  it  to  the  uterus  itself but 
may  not  the  most  of  this  force  arise  from  the  abdominal  muscles  act- 
ing through  the  parietes  of  the  litems?  and  may  not  the  mechanism 
of  labor,  in  this  regard,  bo  similar  to  the  mechanism  of  vomiting? 
For  our  part,  we  arc  very  much  inclined  to  adopt  the  alfirmativc  ; 
while  at  the  same  time  we  admit  that  the  uterus  has  an  independent 
action  and  jioicer  of  its  own,  nnd  that  in  every  healthy  labor,  this 
action  and  contraction  march  pari  passu  with  the  expulsion  of  its 
contents. 


ARTICLE   VI. 

A  Case  of  Uterine  Hydatids.     By  George  G.  Smith,  M.  D.,  of 

Oxford,  Ga. 

At  the  instance  of  some  medical  friends,  who  supposed  that  this 
case,  from  its  novelty,  might  be  deemed  worthy  of  an  insertion  in 
your  Journal,  I  place  it  at  your  disposal  to  publish  or  reject,  as  you 
may  think  proper. 

Cases  like  the  following,  may  have  frequently  fallen  under  the 
notice  of  other  practitioners,  but  as  wilh  me  it  was  a  novel  one,  I 
noted  carefully  its  developments  and  progress,  and  preserved  my 
notes. 

On  the  eleventh  of  November,  1843,  I  was  consulted  by  the  bus. 
band  of  Mrs.  N.,  a  lady  about  thirty  years  of  age,  respecting  certain 
ascitic  and  anasarcous  symptoms,  with  which  she  was  aflected  ;  they 
bad  made  their  appearance  but  a  short  time  previous,  and  were 
increasing  from  day  to  day. 

She  was  represented  to  bo  pregnant  with  her  second  child,  nnd 
about  four  months  advanced,  having  had  the  derangements  of  health 
usually  attendant  on  gestation. 

Knowing  the  frequency  of  a  hydropic  diathesis,  in  females  in  that 


1845.  J  On  the  Action  and  Uses  of  Aloes,  251 


situation,  I  was  indisposed  to  subject  her  to  the  operation  of  active 
remedies,  until  I  saw  her,  when  the  alarming  extent  of  her  dropsical 
symptoms  satisfied  me  that  her  condition  would  brook  no  delay  ;  and 
that  active  measures  must  be  instituted  immediately  for  her  relief. 

The  pulse  being  full  and  bounding,  I  bled  her  copiously,  and  put 
her  on  the  use  of  active  hydragogue  cathartics  continuing  them 
from  day  to  day,  and  occasionally  repealing  the  venesection,  v.ilh 
evident  benefit  to  her  general  healih. 

On  the  evening  of  the  22d,  I  was  summoned  in  great  haste  to  her 
bedside;  profuse  uterine  hemorrhage,  with  occasional  contraction 
of  the  womb,  had  occurred  ;  and  about  an  hour  after  I  arrived,  a 
discharge  of  hydatids  took  place,  consisting  of  innumerahle  liltlo 
encysted  transj)arcnt  globules  of  various  sizes,  the  largest  about  iho 
size  of  a  pea  ;  they  were  floating  in  a  reddish  liquid,  and  intermingled 
with  coagula  the  discharge  continued  during  the  night,  until  a 
q'-iart  or  more  were  expelled,  and  finally  an  organized  mass,  as  largo 
as  the  palm  of  the  hand,  resembling  the  placenta,  came  away  ;  the  los3 
of  blood  was  very  great,  and  she  was  much  exhausted  by  the  cxces- 
siveness  of  the  hemorrhage.  I  entertained  some  fears  for  her  safety, 
but  re-aclion  soon  occurred  in  her  system,  and  on  the  next  day,  slight 
febrile  symptoms  supervened. 

A  course  of  ferruginous  tonics  soon  dissipated  the  remaining  drop, 
sical  symptoms,  and  she  recovered  her  health,  which  has  since  con- 
tinued without  interruption. 


Part  II. REVIEWS  AND  EXTRACTS. 

On  the  Action  and  Uses  of  Aloes.     By  John  C.  Pl:ters,  M.  D.,  of 

New-  York. 

1.  It  is  a  specific  purgative,  for  when  applied  externally  to  a  b!i5 
ter,  it  operates  in  the  same  manner  as  when  administered  internally 
(Gerhard);  tincture  of  aloes  applied  to  a  carious  bone,  has  excited 
purging  (Monro) ;  an  aloetic  pill  applied  to  an  issue  has  had  thesamo 
t-fll'ct  (^Pereira);  also,  an  aloetic  salve,  when  rubbed  upon  the  ubJo- 
mcn  (Dierbach). 


25'2  On  the  Action  and  Uses  of  Aloes.  [May, 


2.  The  part  operated  upon,  however,  is  in  dispute.  Wood  and  Bache 
think  it  has  a  peculiar  affinity  for  the  large  intestine;  and  ratlier  to 
its  muscular  coat,  than  the  exhalent  vessels,  as  the  evacuations  pro- 
duced arc  seldom  very  thin,  or  watery.  Cullcn  agrees  with  this,  and 
asserts  that  it  rarely,  or  ever,  produces  more  than  one  stool,  which 
seems  to  he  merely  an  evacuation  of  what  may  be  supposed  to  have 
been  present  in  the  great  intestine,  while  hardly  any  dose  under  20 
grs.  will  produce  a  liquid  stool,  which  effect  is  always  attended  with 
pain  and  griping.  On  the  other  hand,  the  ordinary  bulUy  and  rather 
liard  evacuation  ^nay  in  innumerable  instances  he  constantly  obtain- 
ed from  1  or  2  grs.  The  slowness  of  its  operation  has  also  been 
advanced  by  Lewis,  as  proof  that  it  acts  on  the  large,  rather  than  on 
the  small  bowels,  for  it  hardly  ever  operates  under  10  or  12  hours, 
often  not  till  16  or  18,  while  even  24  hours  may  elapse  ;  but  this  may 
be  attributed  to  its  insolubility  in  the  stomach.  Finally,  to  be  still 
more  minute,  Newmann  conjectures  that  it  acts  especially  on  the 
circular  muscular  fibres  of  the  colon.  Whether  given  in  large  or 
small  doses,  it  hardly  ever  causes  a  copious  evacuation. 

3.  On  the  other  hand,  aloes  has  been  supposed  to  act  upon  tlio 
liver  from  times  immemorial :  Aloe  blJem  riiheam  exveUit  (Rhazes) ; 
Aloe  ad  inferiiifs  inlestinum  bihm  diicAt  (Aretaeus).  According  to 
Sigmond,  its  influence  upon  the  liver  is  marked  by  the  peculiar  con- 
dition of  the  evacuations,  the  color  and  odor  of  which,  and  their 
peculiar  pungent  effect  on  the  rectum,  prove  that  an  increased  quan- 
tity of  bile  has  been  poured  forth.  Wedekind  assumes  that  the  oper- 
ation of  the  aloes  depends  on  an  increased  secretion  of  bile,  excited 
by  its  specific  action  on  the  liver,  and  asserts  that,  as  long  as  the 
stools  are  white  or  grey,  in  jaundice,  aloes  will  not  purge  even  in 
large  doses,  while  the  purgative  effect  supervenes  as  soon  as  the  faecal 
matter  contains  bile;  he  even  carries  this  opinion  so  far  as  to  de- 
clare that  if  given  when  the  quantity  of  bile  is  normal,  or  increased, 
aloes  may  induce  bilious  dysentery  and  hepatitis.  Vogt,  too,  says  it 
is  not  to  be  doubted  that  it  has  a  special  action  on  the  liver,  and 
tends  more  to  restoration  of  a  checked  secretion  of  bile  than  any 
other  drastic  purgative.  It  never  causes  watery  stools  ;  but  the  de- 
jections are  always  yellowish,  greenish,  or  blackish,  and  slimy,  and 
often  have  a  peculiarly  putrid  smell  (Dierbach).  Antyllus  counts  it 
among  the  remedies  which  evacuate  yellow  bile.  According  to  No- 
ack  and  Trinks,  it  causes  aching  and  tension  in  the  right  hypochon- 
drium,  bilious  papescent  stools,  with  heat  of  the  whole  body,  and 
uneasiness  in  the  region  of  the  liver,  while  the  evacuations  produced 
are  faecal,  bilious,  not  watery  or  copious,  and  emit  a  peculiar  putrid 
smell.  Its  effects  are  so  distinct  and  characteristic,  that,  when  added 
to  other  purgatives,  they  do  not  take  place  until  some  hours  after  the 
evacuations  caused  by  the  other  purgatives,  and  its  stools  differ  both 
in  color  and  smell. 

4.  A  third  set  of  physicians  believe  that  it  acts  primarily  and  spe- 
cifically upon  the  vena  porta  system,   and  assume  that  its  influence 


1845.]  On  the  Action  and  Uses  of  Aloes  253 


upon  the  liver  and  bowels  is  secondary  to  this.  Thus,  Braithwaite 
says  :  "That  it  acts  upon  the  vena  portnrum,  is  fairly  to  be  deduced 
frcMn  the  very  peculiar  state  into  which  the  haemorrhoidal  vessel?  are 
tiirown  by  the  congestions  which  so  rapidly  occur  after  a  dose  of  this 
drug  has  been  taken,  and  also  by  the  condition  of  the  uterine  vessels, 
which  has  led  to  its  employment  as  an  cmmenagoge."  When  fre- 
quently repeated,  it  is  apt  to  irritate  the  rectum,  giving  rise  in  some 
instances  to  hcemorrhoids,  and  aggravating  them  when  already  exist- 
ing; it  also  has  a  decided  tendency  to  the  uterus,  for  its  influence  in 
promoting  menstruation  is  by  no  means  confined  to  cases  in  which 
its  action  on  the  neighboring  rectum  is  most  conspicuous  (Wood  and 
Bache).  CuUen  has  seen  haemorrhoids  pryduced  from  large  and 
frequent  doses ;  it  acts  specifically  upon  the  rectum,  and,  in  a  full 
dose,  is  in  some  persons  apt  to  excite  heat  and  irritation  about  the 
rectum  and  tenesmus,  while,  in  those  troubled  with  piles,  it  is  said 
not  unfrequently  to  increase,  but  even  to  bring  on  the  sanguineous 
discharge  (Percira).  Fallopius  says,  that  of  100  persons  who  had 
used  aloes  freely  as  a  purgative,  90  became  afiected  with  a  liaemorr- 
hoidal  flux  which  ceased  when  its  use  was  omitted;  it  causes  a  de- 
termination of  blood  to  the  uterus,  and  fulness  of  the  bloodvessels, 
especially  its  veins,  and  thus  uterine  irritation  and  menorrhagia  are 
apt  to  be  induced  or  increased  by  it  (Percira).  Wedekind  says  it 
exerts  a  specific  stimulant  action  on  the  venous  system  of  the  abdo- 
men and  pelvis,  and  hence  causes  increased  secretion  of  bile,  irrita- 
tion about  the  rectum,  and  vascular  excitement  of  the  sexual  organs; 
piles,  strangury,  immoderate  flow  of  menses,  and  racking  pains  in  the 
loins,  like  labor  pains,  are  frequently  induced  by  it  (Fothergill).  The 
congestive  power  of  aloes  may  go  so  far  as  to  cause  a  flow  of  blood 
from  the  kidneys,  uterus  and  rectum  (Soternheim).  It  readily  causes 
stagnation  and  accumulation  of  blood  in  the  abdominal  vessels,  and 
various  aflbctions  and  consequences  of  Plethora  Abdominalis  ;  some- 
times, even  when  given  in  small  doses,  it  may  cause  congestions, 
anxiety,  burning  when  urinating,  urging  to  stool,  increased  pain  in 
the  loins  (Vogt).  It  is  a  heating  remedy,  and  in  young  persons  read- 
ily excites  febrile  symptoms,  quick  pulse,  troublesome  sensation  of 
warmth  in  the  abdomen,  &;c.  (Dierbach).  Finally  the  excited  con- 
dition of  the  vena  porta  system  may  extend  to  the  whole  of  the  venous 
side  of  the  circulation,  and  congestion,  to  the  head  and  chest,  but 
especially  to  the  abdomen,  may  arise,  attended  with  an  unpleasant 
heat,  anxious  ieelings  and  throbbing,  with  increased  sensibility  and 
distension  of  the  abdomen,  frequent  watery  stools,  mixed  with  blood, 
or  bloody  stools  with  violent  and  cutting  abdominal  pains,  piles,  vio- 
lent pains  in  the  kidneys,  scanty  hot  urine,  burning  when  urinating, 
discharge  of  blood  from  urethra,  drawing  and  burning  in  the  sacral 
region,  A:c.  (\oack  and  Trinks).  llarnisch  says,  alter  the  use  of 
aloes  ill  very  sensitive  or  plethoric  persons,  we  notice  burning  when 
urinating,  tenesmus,  aching  and  heaviness  in  the  pelvis,  erections  and 
pollutions,  an  excifpment   of  the  hjemorrhoidal  and   uterine  vessels. 


254  On  the  Action  and  Uses  of  Aloes.  [May, 


and  even  a  similnr  action  of  the  whole  vascular  system,  so  that  the 
pulse  becomes  fuller  and  harder,  the  mouth  dry  with  thirst,  scanty 
discharge  of  red  urine,  increased  sensation  of  warmth  in  the  abdomen, 
tiirobbing  and  aching  in  the  right  hypocliondrium  (liver),  cnngeslioa 
of  blood  to  the  head  and  chest,  with  anxiety,  bleeding  from  the  lungs, 
and  even  apop'.cvy. 

To  conclude  the  enumeration  of  the  peculiarities  of  the  action  of 
aloes,  we  would  slate  that,  an  increased  quantity  does  not  produce  a 
corresponding  cathartic  effect;  it  is  alleged  by  Lewis  that  its  effects 
are  more  permanent  than  any  other  purgative,  allhough  Cuilen  con- 
tradicts this,  and  states  that  r)ot\vilhstanding  the  use  of  aloes,  cos- 
tiveness  will  return  at  its  usual  period.  Small  doses  often  cccasion 
erections,  and  increase  of  sexual  appetite  (Wedekind).  Greenhow 
asciibes  a  diuretic  elTect  to  aloes,  and  IMoirond  injected  4  drachms 
into  a  \c'n  of  a  horse,  with  no  other  effect  than  producing  the  cvnc* 
I' '  on  ofa  liirge  quantity  of  urine.  It  may  cause  emaciation,  stric- 
ture of  rectum  and  enteritis;  and  ifgiven  during  pregnancy,  in  largo 
doses,  it  may  produce  abortion  (Vogl).  If  its  use  be  long  continued, 
it  causes  dryness  of  the  intestines,  paralytic-like  rigidity  of  the  mus- 
culnrcoat,  esj)ecially  of  the  colon  and  rectum,  in  consequence  of 
which  o')stinato  constipation  may  result;  in  too  large  doses  it  causes 
violent  cutting  abdominal  pains,  watery  and  long-continued  diarrhccn, 
tenesmus  and  inflammation  of  the  lower  portion  of  alimentary  canal 
(Vogt).  In  Moirond's  experiment  of  injecting  4  drachms  into  a  vein 
ofa  horse,  the  faeces  were  passed  enveloped  in  a  thin  pellicle  of  al- 
tered intestinal  mucus.  It  causes  discharges  of  menjbranous-liko 
pieces  of  mucus  from  the  rectum,  and  very  large  roUed-up  pieces  of 
intestinal  mucus  (Noack  and  Trinks).  It  has  caused  vomiting  of 
blood.  From  very  large  doses,  we  at  limes  get  a  watery  diarrhoea, 
with  violent  cutting  pains,  or  a  long-continued  sanguineous  diarrhoea, 
^vith  tenesmus  and  even  inflammation  of  the  bowels.  Cuilen  says 
it  was  once  a  common  opinion  that  aloes  dissolved  the  blood,  or  in- 
creased  its  fluidity,  and  Lewis  alleges  that  this  is  the  condition  of  tho 
blood  drawn  from  persons  who  are  in  the  habit  of  using  aloetics, 
although,  accordinix  toSchwenke,  it  seems  rather  to  coajiulate  than 
dissolve  the  blood  when  added  to  some  which  has  been  drawn  from  a 
vein.  Itwasan  old  opinion  that  it  proved  emmenagogue  from  its 
power  of  dissolving  the  blood,  and  hence  was  hurtfid  in  scurvy,  and 
all  haemorrhages  proceeding  from  a  lax  state  of  the  blood  and  system. 
It  acts  as  readily  in  substance  as  in  solution  (Cuilen). 

Therapeutical  uses  and  effects.  1.  In  disturbances  of  digestion 
dependent  upon  weakness  of  the  muscular  fibres  of  the  stomach  and 
1)owels  ;  in  abnormal  secretion  of  mucus,  acid,  gas,  &lc.  ;  in  anorexia, 
dyspepsia,  fliitulent  distension,  and  painful  aching  in  the  region  of  tho 
stomach,  with  acid,  rancid  eructations,  sluggish  digestion,  and  consti- 
pation, especially  of  hypochondriacal  persons  (Sobernheim).  It 
generally  sits  well  upon  the  stomach,  for  its  bitterness  renders  it  an 


1815.]  On  the  Action  and  Uses  of  Aloes, 


admirable  stomachic,  wiiich  promotes  both  nppetite  and  dii^estion  ; 
some  think  that  it  regulates  the  due  secreiion  of  the  gastric  juice, 
while  Ihe  ancients  tertrrjd  it  animn  venfricuIL 

2.  But  its  |)rincipnl  use  is  in  habitual  coslivencss  and  obstinato 
constipation  from  a  h^iig  dilatation  of  ttie  muscular  fibres  of  the  in- 
testine, witli  dryness  of  the  mucous  membrane,  diminished  and  ab- 
normal secretion  of  bile  ;  under  such  circumstances  it  is  often  iho 
only  remedy  wiiich  may  be  used  for  years  without  injury.  (Doses, 
1  or  2  grs.) 

3.  In  diseases  of  the  liver,  we  have  already  alluded  to  Wcdckind's 
experience  with  it  in  jaundice;  as  long  as  the  stools  remain  light 
colored,  he  pushed  it  in  large  doses,  viz.  half  a  scruple  twice  a  day  ; 
as  soon  as^bile  began  to  aj>pear  in  the  fseceji,  he  immediately  reduces 
the  quantity  to  one  or  two  grains,  and  even  omits  its  use  for  one  cr 
several  days. 

4.  In  affections  of  the  menstrual  hemorrhoidal  secretions.  The 
experience  here  is  very  curious  ;  in  former  times  it  was  regarded  as  tho 
sacra  anchora  in  the  cure  of  hoDmnrrhoids  of  an  asthentic  character, 
although  aloes  produces  active  congestive  piles.  It  was  also  used  to 
restore  the  ha^morrhoidrJ  flux,  when  troublesome  nervous  affections, 
such  as  hypochondria,  melancholy,  mania,  cramp  of  the  stomach, 
d:c.,  were  induced  bv  their  suppression.  Five  grains,  several  times 
a  day,  was  then  the  usual  dose.  By  restoring  the  lia3morrhoidal  se- 
cretion, it  has  also  relieved  the  sensations  of  aching  and  weight  in  tho 
p(dvis,  the  eruptions,  pollutions,  urging  to  stool,  &;c.,  which  are  often 
felt  as  premonitory  phenomena  of  tho  occurrence  of  piles.  At  times 
these  moliminal  hacmorrhoidaloc  pass  over  into  flowing  piles,  under 
the  use  of  aloes,  while  at  others  they  cease  without  any  discharge  hav. 
iug  been  produced.  Under  the  latter  circumstances,  Ilarnisch  con. 
jectures  that  the  tonic  and  stimulating  efl'ects  of  aloes  removes  tho 
weakness  of  the  vessels  upon  which  tho  preinonition  of  piles  has  de- 
pended, i.  c.,  the  active  congestion  produced  by  the  aloes  overcomes 
the  passvc  one,  which  previously  existed  in  his  o|)inion.  Locseko 
also  asserts,  that  ifaloes  be  given  before  the  accustomed  flow  of  piles 
comes  on,  tho  flux  will  ensue;  but,  on  the  other  hand,  if  given  whilo 
they  are  flowing,  a  stoppage  will  be  eflx^cted.  Irregular  ha;morrhoidal 
congestion  to  the  head,  chest,  stomach,  bowels,  liver,  spleen,  kidneys, 
uterus,  bladder,  &c.,  with  their  attendant  redness  and  heat  ol  the  face, 
illusions  of  vision,  threatened  apoplexy,  a  constriction  and  anxiety 
about  the  chest,  and  even  haimoptysis,  or  throbbing,  aching,  &c., 
about  the  stomach,  with  hematcmesis,  or  aching  in  the  liver  or  spleen, 
with  threatened  dropsy,  or  hajmorrhage  from  the  stomach  or  bowels, 
or  aching  in  the  region  of  the  kidneys  with  scanty  discharge  of  hot 
urine,  or  tenesmus  of  the  bladder  fnmi  venous  congestion  of  it,  and 
luem  ituria,  or  congestion  to  the  uterus  with  menorrhagia,  etc.,  have 
nil  given  way  before  the  use  of  aloes  (Ilarnisch).  Eberle  corrobo- 
rates  the  above  in  one  paiticular  (see  Practice,  vol.  i.,  p.  572).  Ho 
writes  ;   "  Woubl  not  I>r.  Dfnvey  consider  alots  a  vrrv  improper  rem- 


250  On  the  Action  and  Uses  of  Aloes,  [May, 


edy  in  the  menorrhagias  of  young,  sanguineous  and  robust  females? 
lie  no  doubt  would;  and  why?  because  experience  has  shown  that 
this  arlicic  is  amonf;  our  most  efficient  means  for  exeiiinor  the  uterine 
vessels  and  directing  the  afTlux  of  blood  to  ihem.  Yet  ibis  article, 
given  in  small  doses,  but  frequent  ones  deserves  to  be  accounted  the 
best  remedy  wo  possess  for  those  protracted,  exhausting,  and  obstinate 
bremorrhages  from  the  uterus  which  occur  in  those  of  relaxed,  nervous, 
and  phlegmatic  habits,  about  the  critical  period  of  life.  When, 
therefore,  we  see  a  particular  modification  of  this  discharge  arrested 
by  a  remedy  which  we  arc  accustomed  to  regard  as  decidedly  calcu- 
lated to  stimulate  the  vessels  from  whence  the  bleeding  occurs:  .in 
in  other  words,  when  \vc  cure  haemorrhage  by  stimulating  applica- 
tions, the  conclusion  is  irresistible  that  it  depended  upon  debility." 

The  above  is  a  good  example  of  the  very  numerous  instances  in 
which  a  very  close  symptomatic  similarity  masks  a  very  wide  patho- 
logical difierence.  According  to  Andral,  it  is  a  law  in  pathology 
that  very  similar  symptoms  may  arise  from  very  different  aflections. 
It  is  notorious  that  anccmia  is  often  attended  hy  symptoms  which 
render  it  liable  to  be  mistaken  for  hyperaemia  ;  thus  the  pulse  may  be 
frequent,  vibrate  violently,  be  deceptively  hard  and  tense,  while  the 
heart  palpitates  and  beats  forcibly  as  in  active  congestion  or  inflam- 
mation  ;  anjpmia  of  the  brain  and  spine  is  often  attended  with  pain 
and  throbhing  in  the  head,  delirium,  ringing  in  the  ears,  sparks  before 
the  eyes,  and  general  convulsions;  the  npoplexia  ex  inanitione  may 
be  attended  with  the  vertigo,  stupefaction,  entire  loss  of  conscious- 
ness, stertorious  respiration,  &c.,  which  attend  true  apoplexy  with 
effusion  ;  bloodless  lungs  are  dyspnoic  ;  the  bloodless  heart  palpitates 
violently;  the  bloodless  stomach  is  dyspeptic,  tender  to  touch,  nau- 
seated,  (Sec.  Bark  and  iron  cure  the  above  anaemic  affections,  antipa- 
thically,  although  they  produce  very  similar  symptoms,  depending, 
however,  upon  the  very  opposite,  i.  e.,  a  plethoric  stats  of  the  system. 

According  to  Symonds,  the  evacuations  produced  by  the  purgative 
which  cures  a  diarrhcEa,  are  very  different  from  those  that  constitu- 
ted the  latter,  and  argue  a  dissimilarity  in  the  state  of  the  membranes 
that  furnished  them.  The  inflammation  produced  in  the  eye  by  the 
nitrate  of  silver  is  different  in  character  from  the  inflammation 
which  it  is  so  useful  in  removing,  &c.  In  Fletcher's  "Elements  of 
Pathology,"  p.  4S6,  we  learn  that  "  In  the  first  stage  of  inflammation 
there  is  constriction  of  the  capillaries;  in  the  second,  there  are  re- 
laxation and  enlargement  of  these,  allowing  an  increased  quantity  of 
blood  in  them,  causing  redness,  swelling,  beat  and  pain  in  the  part. 
Now,  if  in  the  latter  state  of  the  vessels,  a  stimulus  be  applied,  it 
must  produce  constriction  or  contraction  of  the  enlarged  vessels,  and 
hence  remove  one  cause  of  the  disease,  viz.,  the  enlargement  and 
relaxation  of  the  vessels.  Examples  of  the  utility  of  stimulants  in 
this  second  stage  of  inflammation  are  familiar  in  the  treatment  of 
ophthalmia  and  gonorrhoRa." 

Constipation  may  be  cured   antipathically  by   drugs,  (he  marked 


1845.]  On  the  Action  and  Uses  of  Aloes.  257 


action  of  which  is  to  induce  constipation.  Thus,  one  of  the  most 
common  causes  of  this  state  of  the  bowels,  is  a  torpid,  relaxed,  dilated 
and  enfeebled  condition  of  the  colon  ;  now  iron,  lime,  lead,  alum,  all 
which  cause  a  constipation  depending  on  a  dry  and  contracted  state 
of  the  colon,  may  cure  the  first-described  condition.  Xux  vomica 
causes  constipation,  depending  on  a  spasmodic  state  of  the  bowels, 
and  may  cure  antipathically  a  constipation  arising  from  a  sub-para- 
lytic state.  Opium  induces  constipation  by  benumbing  and  stupify- 
ing  the  muscular  fibres  of  the  colon,  and  will  cure  constipation 
depending  upon  spasm,  &c. 

Again,  admitting  that  Peruvian  bark  causes  chills,  fever,  and  sweat, 
this  by  no  means  proves  that  this  remedy  cures  fever  and  ague  ho- 
mceopathically.  For,  in  the  first  place,  we  have  perused  Hahnemann's 
description  of  the  efTects  of  bark  on  the  healthy,  repeatedly  and  care- 
fully, and  never  have  succeeded  in  finding  any  proof  that  it  induces 
intermittent  affections  of  any  kind  ;  much  less  a  fever  characterized 
by  regularly  periodical  exacerbations  and  intermissions.  In  the  se- 
cond place,  the  bark-fever  is  an  arterial  congestive  fever,  while  the 
intermittent  is  a  venous  congestive  one.  Professor  Mitscherlich,  of 
Berlin  (see  Mat.  Med.,  224),  says,  "From  th^  long  continued  use 
of  bark,  we  notice  an  increase  in  the  quantity  of  the  blood,  which 
also  becomes  more  arterial  in  quality,  hence  the  pulse  becomes  fuller 
and  stronger,  the  skin,  especially  of  the  face,  becomes  redder,  con- 
gestions ensue,  and  a  continued  fever  may  arise."  Dr.  James  John- 
son (see  Med.  Chir.  Rev.,  Jan.,  1837,  p.  193),  says:  "If  we  watch 
the  operation  of  Peruvian  bark,  we  find  that  it  excites  the  action  of 
the  heart  and  capillaries,  increases  the  strength  and  invigorates  the 
system.  If  pushed  beyond  a  certain  point,  the  bad  efiects  that  fol- 
low are  just  what  might  be  supposed  to  result  from  an  excess  of  the 
same  sort  of  action ;  too  much  blood  is  made,  and  it  is  circulated 
with  too  much  force.  Sanguineous  congestions  or  local  infiamma- 
tions  ensue,  and  the  whole  system  becomes  overloaded  and  oppressed 
with  blood."  How  dilTerent,  nay,  how  exactly  opposite,  are  the  ul- 
timate effects  of  fever  and  ague,  viz.,  a  cachectic,  almost  chlorotic, 
or  leucophlcgmntic  state,  marked  by  paleness  and  sallowness  of  the 
surface,  a  deficiency  of  fibrin  in  the  blood,  which  becomes  more 
venous  and  watery,  and  hence  predisposes  to  dropsical  affections, 
starrnations,  and  infarctions  of  the  blood  in  the  liver,  spleen,  &c. 

Mercury  produces  ulcers  and  eruptions,  but  they  ditfer  widely 
from  the  syphilitic.  The  true  Hunterian  chancre,  or  indurated  ulcer, 
against  which  mc^rcury  is  most  serviceable,  is  rather  small,  nearly 
circular,  deep,  a!i(l  excavated,  the  base  and  edges  as  hard  as  car:ila- 
ges,  and  is  attended  with  little  pain  or  inllammation,  d:c. ;  on  the  other 
hand,  the  mercurial  ulcer  is  superficial,  has  a  broad  base,  bleeds  easily, 
is  painful,  and  most  nearly  resembles  a  phagedenic  ulcer,  while,  ac- 
cording to  P(>reira,  it  is  well  known  that  venereal  sores  at  times 
assume  a-  sloiighinrj  (ilr.position  from  the  improper  use  of  mercury. 
Hence  it  ^  evident  that  mercury  is  most  homccopathic  to  the  phaga- 

17 


258  On  the  Action  and  Uses  of  Aloes,  [May, 


denic  variety  of  venereal  ulcer."  But  in  deciding  on  the  use  of 
mercury  in  syphilis,  another  point  deserving  attention  is  the  condition 
of  the  primary  sore  ;  if  it  be  of  ihc  kind  called  phagedenic,  or  at  all  dis- 
posed to  slough,  mercury  must  be  most  carefully  avoided,  as  it  increases 
the  disposition  to  sloughing,"    (Pcrcira,  Mat.  Med.,  vol.  i.  p.  597.) 

Mercurial  eruptions  are  as  rare  as  the  syphilitic  arc  frequent :  of 
these,  a  vesicular  eruption,  the  eczema  mercuriale,  is  the  most  fre- 
qucnt  and  best  known.  On  the  otiicr  hand  it  is  ^vcll  known  that 
*'an  eruption,  having  the  vesicular  form,  and  developed  under  the 
influence  of  a  syphilitic  cause,  is  unquestionably  not  a  common  oc- 
currence." (Willis.)  Rayer,  too,  speaks  of  syphilitic  eczema  .is 
extremely  rare,  for  in  all  his  vast  intercourse  with  skin-diseases,  he 
met  with  two  examples  only.  An  acrous,  or  indurated  tuberculous, 
is  the  most  common  syphilitic  eruption.  We  can  readily  conceive 
how  a  drug  which  tends  to  produce  broad,  superficial,  spongy,  and 
relaxed  ulcers,  may  change  the  action  of  a  narrow,  deep,  firm  and 
hard  ulcer;  a  drug  which  tends  to  cause  vesicular,  i.  c.,  serous  erup- 
tions, may  change  the  action  of  a  tubercular  one,  which  depends  upon 
the  pouring  out  of  plastic  and  firm  lymph  from  the  blood-vessels,  A:c. 

It  is  needless  to  multiply  examples,  for  it  is  evident  from  those  al- 
ready given,  that  renledies  which  act  very  similar  to  the  action  of  a 
given  disease,  in  reality  exert  an  aJleralive  action  upon  that  disease. 
In  the  earlier  stages  of  his  discoveries,  Hahnemann  recognized  the 
truth  of  this  position,  for  he  states  in  the  45th  paragraph  of  his  "  Or- 
ganon,"  that  "two  diseases  which  differ  grealhi  in  their  species,  but 
which  bear  a  strong  resemblance  in  their  symptoms,  always  mutually 
destroy  each  other;"  and  volunteers  the  admission  in  his  "Spirit  of 
the  Homoeopathic  Doctrine,"  that  "without  this  nalural  difference 
between  the  affection  arising  from  the  disease,  and  that  arising  from 
the  drug,  no  cure  could  possibly  take  place,  but  only  an  exasperation 
of  the  evil."  At  a  later  period,  he  became  so  blinded  and  infatuated 
as  to  overlook  the  above  irresistible  conclusion,  and  in  his  precepts 
and  practice  even  virtually  to  deny  it,  and  setup  the  law,  ^^ similia 
similibus  curaiitiir,^'  is  the  only  true  law  in  therapeutics;  but,  strug- 
gle as  he  would,  all  his  attempts  at  explanation  resolved  themselves 
into  old  school  theories,  as  is  again  evident  in  his  assumption,  that 
every  remedy  has  two  sets  of  actions,  viz.,  primary  and  secondary, 
the  latter  of  which  is  exactly  opposite  to  the  former;  whence  he 
again  assumes  that,  although  the  primary  action  of  homoeopathic 
remedies  is  similar  to  that  of  the  disease,  yet  their  secondary  one  is 
exactly  opposite,  and  is  willing  to  admit  that  this  secondary  opposite 
action  eflectsthe  cure. 

"  We  have  names,  diseases,  remedies,  notions,  theories  and  expla- 
nations difTerent  from  those  of  olden  times;  but  the  art  of  healing 
is  still  the  same,  nature  is  the  same,  and  the  same  capacities  are  re- 
quired  for  becoming  an  adept  in  medicine,  as  at  the  time  of  Hippoc- 
rates."-( Hufeland.*) 


  5;e*i  "LLchiridioL  ^leJicim* 


1845.]  Essay  on  Inverted  Toe  Nail,  259 


The  preceding  excellent  article,  we  hfive  taken  entire  from  the 
original  department  of  the  March  No.  of  the  New  York  Journal  of 
Medicine.  The  only  omission  we  notice  by  its  author  of  the  action 
and  uses  of  aloes,  is  that  recommended  a  few  years  ago  by  Professor 
Trousseau,  of  Paris,  viz.,  as  revulsive  to  the  rectum  in  cases  of  apo- 
plexy, &c.  A  suppository  or  injection  of  aloes  bringing  on  in  a  short 
period,  an  attack  of  piles,  or  an  effort  that  way. 


Essay  on  Inverted  Toe  NaiL     By  Dr.  E.  Zeis. 

The  affection  usually  known  as  the  "inverted  Toe  Nail,'' or,  to  trans- 
late the  denomination  employed  by  our  author,  '  the  growing  of  the 
nail  into  the  flesh,"  is  one,  when  we  consider  the  frequency  of  its  oc- 
currence, and  the  severe  suffering  by  winch  it  is  attended,  and  the 
impediment  to  the  use  of  the  foot  in  walking  which  it  presents,  is 
one  of  no  trifling  importance.  Every  thing,  therefore,  that  is  cal- 
culated to  throw  light  upon  its  true  nature  and  causes,  and  the  means 
by  which  it  may  be  most  certainly  and  etfectually  remedied,  becomes 
of  interest. 

By  almost  every  writer  the  entire  afi'cction,  the  inflammation  of  the 
soft  parts,  their  suppuration,  the  intensely  sensible  fungous  granula- 
tions wliich  shoot  up  from  the  lateral  edge  of  the  nail,  and  cover  the 
greater  part  of  the  latter  together  with  all  the  attendant  suffering 
and  lameness  and  which,  in  many  cases,  continue  for  months  and 
years  have  been  ascribed  to  the  cd^o  of  the  nail  pressing  upon  or 
penetrating  abnormally  the  soft  parts  either  in  consequence  of  the 
too  great  breadth  of  the  nail,  its  too  arched  form,  or  the  unnatural 
downward  direction  of  its  edge;  and  hence  the  remedy  that  is  pro- 
posed  by  diirerent  surgeons  is  either  the  destruction  of  more  or  less 
of  the  nail,  the  changing  of  its  form,  or  the  drawing  out  of  its  edge 
from  the  flesh,  and  the  preventing  its  again  embedding  itself  into  it. 
They  all  consider  that  it  is  the  nail  whicii  is  in  fault,  and  the  whole  of 
their  attention  is  directed  to  correct  its  abnormal  action  upon  the  soft 
parts. 

Many  of  the  operations  proposed  even  by  surgeons  of  a  very  late 
date,  are  painful  and  cruel  in  the  extreme,  and  few  of  them  afford 
any  otiier  than  a  temporary  relief,  while  some  are  calculated  ulti- 
mately to  increase  the  very  evil  they  are  intended  to  remove. 

"If,"  remarks  Dr.  Zeis,  "the  cure  of  the  affection,  supposed  to 
result  from  the  growing  of  the  nail  into  the  flesh,  was  formerly  too 
often  attempted  by  the  destruction  of  the  nail,  it  is  only  since  Du. 
piivtror.  has  counselled  its  entire  oiitrooting,  that  the  operation  has 


260  Essay  on  Inverted  Toe  Nail,  [May, 


been  generally  sanctioned  and  adopted.  Me  it  has,  in  every  in- 
stance, filled  with  horror,  and  I  am  happy  to  say  that  I  could  never 
be  induced  to  perform  it.  I  have  had  repeated  opportunities  of  ob- 
serving those  patients  who  had  been  operated  on,  according  to  Du- 
puytren's  method,  by  other  piiysicians  ;  and  found  them  far  being 
relieved  from  their  sufferings.  ?sotwithstanding  the  offending  por- 
tion of  the  nail  had,  in  each  case,  together  with  its  root,  most  cer- 
tainly been  torn  out,  as  was  evident  from  the  separated  portion,  which 
they  showed  me,  yet,  they  had  again  been  supplied  by  the  lateral 
growth  of  the  remaining  part  of  the  nail,  but  without  any  connec- 
tion being  formed  between  the  new  growth  and  the  matrix,  so  that  a 
probe  could  be  passed  freely  from  its  upper  edge  to  its  root.  The 
free  lateral  edge  of  this  new  unattached  portion  kept  up  a  constant 
irritation  in  the  soft  parts,  and  re-excited  an  inflammation  in  them,  un- 
less it  was  kept  constantly  cut  short,  and  in  such  a  manner  as  to  pre- 
vent the  occurrence  of  a  thin  sharp  edge  by  which  the  original  af- 
fection would  be  liable  to  be  reproduced.  Now  this  repeated  trim- 
ming of  the  nail  the  patient  was  unable  properly  to  perform  himself, 
but  it  required  that  he  should  call  in,  from  time  to  time,  the  aid  of 
the  surgeon,  if  he  would  avoid  the  very  suffering,  for  the  removal  of 
which  he  had  already  undergone  a  most  painful  operation." 

In  the  14th  volume  of  Graefe  and  Walther's  Journal,  (page  234,) 
the  render  will  find  an  excellent  essay  on  the  invertion  of  the  nail, 
by  H.  S.  Michaelis,  in  which  is  contained  a  very  complete  notice  of 
the  several  operations  proposed  for  its  cure  and,  in  the  same  jour- 
nal, (vol.  xxii.  p.  108,)  there  is  a  paper,  by  A.  Sachs,  on  the  same 
subject,  in  which  the  different  plans  of  treatment  that  have  been  re- 
commended are  examined  systematically. 

In  the  medical  journals,  particularly  those  of  France  and  Eng- 
land, we  meet  almost  constantly  with  the  recommendation  of  novel 
modes  of  treatment,  which,  however,  are,  in  most  cases,  merely 
modifications  of  those  thad  had  already  been  proposed 

The  most  cruel  of  these  operations  is  that  described  by  Neret, 
{Archives  Generalcs  de  Med.,  June,  1838,)  who  directs  a  spatula  to 
be  forced  down  beneath  the  nail  to  its  root,  and  then  carried  towards 
the  offending  edge,  so  as  to  separate  it  fully  from  all  its  adhesions; 
the  nail  being  now  turned  towards  the  opposite  side  of  the  toe,  is  to 
be  torn  out.  Dr.  Zeis  very  properly  remnrks.  that  the  amputation  of 
the  toe  would  be  a  more  gentle  and  preferrable  operation  to  that  of 
Neret. 

Larrey  (CUnique  Chirurgicale,  1836)  recommends  the  nail  to  be 
divided,  a  short  distance  from  the  diseased  edge,  (one-third  the 
breadth  of  the  nail,)  by  means  of  a  sharp-pointed  scissors  ;  the  divi- 
ded portion  is  then  to  be  separated  at  its  root  from  the  skin  by  which 
it  is  there  covered,  turned  back  nnd  torn  out.  As  soon  as  the  hem- 
orrhage ceases,  the  part  from  which  the  nail  is  removed  is  to  be  cau- 
terized hy  a  hot  iron  ;  the  dressings  are  then  to  be  applied  and  kept 
on  fourteen  days,  when  the  lunar  caustic  is  to  be  freely  applied.  


1845.]  Essay  on  Inverted  Toe  Nail.  261 


This  differs  from  Dupuytren's  operation  only  in  the  smaller  portion 
of  the  nail  that  is  removed. 

Baudens  directs  the  knife,  which  is  to  be  held  in  the  same  manner 
as  in  cutting  a  pen,  to  be  applied  a  few  lines  above  the  root  of  the  nail, 
on  its  diseased  side,  and  then  carried  down  to  the  bone,  when,  with 
one  sweep  forwards,  the  whole  of  the  inverted  edge,  together  with  the 
spongy  flesh  in  which  it  is  imbedded,  is  to  be  removed. 

Others  advise  the  destruction  of  the  whole  nail,  or  a  portion  of  it, 
by  the  application  of  caustics.  Thus  Payan,  (Revue  MtrL,  July, 
1840,)  after  covering  so  much  of  the  nail  as  is  not  to  be  destroyed 
with  adhesive  plaster,  applies  to  the  uncovered  portion  a  caustic 
composed  of  equal  parts  of  caustic  potass  and  lime.  The  same 
procedure  is  recommended  by  Barbette  and  Bordes,  (Journ.  des 
Connaissances  Med.  Chirurg.,  Nov.,  1839  June,  1840,)  by  Al- 
bers,  (Correspondenz  hlatt  Rhein.  u.  Westphdl.  Aerzte,  B.  1.  N.  5,) 
and  by  Moreau,  {Gaz.  Med.  de  Paris,  1836,  No.  52  ;)  the  latter, 
however,  employed  the  caustic  burnt  alum,  which  required  eighteen 
to  twenty  months  to  effect  a  cure.  Labat,  (Broussais^  Annates, 
1834,  No.  9,)  in  order  more  rapidly  to  relieve  the  patient  of  his 
suffering,  destroyed  at  once  the  root  of  the  nail  by  the  actual  cautery, 
which  is  the  treatment  recommended,  also,  by  the  reviewers  of 
Schregor's  "Grundriss  der  Chir.  Operationen,"  in  \\\e  Salzb.  Med 
Cliir.  Zeitung,  1827,  No.  55. 

'Dov\zc\\Essai  sur  VongJe  incarne,  etc.,  Strasbourg,  1836)  directs 
the  skin  to  be  dissected  back  from  the  root  of  the  nail,  and  the  wound 
to  be  filled  with  charpie ;  on  the  following  day  it  is  to  be  filled  with 
pate  causlique  the  joint  of  the  finger  being  first  well  dried  and  cov- 
ered with  adhesive  plaster.  After  the  separation  of  the  slough,  the 
edge  of  the  nail,  which  has  been  laid  bare,  is  to  be  removed  by  the 
scissors. 

Others  object  to  the  destruction  of  any  portion  of  the  nail,  either 
entirely  or  temporarily,  and  propose  various  procedures  by  which  the 
nail  may  be  kept  from  contact  with  the  inflamed  portion  of  the  soft 
parts,  until  these  have  been  completely  healed.  Sachs  {Graefe  and 
Wahher^s  Journ.,  vol.  xxii.  p.  108)  directs  the  general  health  of  the 
patient  to  be  restored  by  appropriate  remedies,  in  conjuction  with  a 
proper  diet  and  regimen ;  the  inflammation  of  the  foot  to  be  reduced 
hy  the  usual  antiphlogistic  means;  and  the  pus  which  is  formed  to  be 
discharged,  and  at  the  same  time  the  loosened  edge  of  the  nail  to  be 
removed  by  means  of  a  forceps  and  scissors,  eitiier  by  a  simple  or  V 
formed  incision.  If  the  swelling  of  the  soft  parts  prevents  this  from 
being  readily  effected,  a  portion  of  compressed  s|)ongc  should  be  in- 
troduced beneath  the  edge  of  the  nail  and  kept  there  until  this  has  been 
sufficiently  freed  from  iho  spongy  granulations  by  which  it  has  be- 
come imbedded,  taking  care,  however,  at  the  same  time,  not  to  employ 
too  great  a  degree  of  pressure,  as  this  may  increase  the  suffering  ot  the 
patient.  The  healing  of  the  ulceration  may  be  promoted,  after  tho 
excision  of  the  nail,  by  the  use  of  tonics. 


262  Essay  on  Inverted  Toe  Nail.  [xMay, 


Martin  {Recueil  de  Memoires  de  Med.  de  Chir.  et  de  Pharm. 
Militaires,  vol.  '.]9,  183G)  recommends  a  triangular  portion  to  be  cut 
out  of  the  middle  of  the  nail,  the  base  being  at  the  free  edge  ;  and 
then  the  cut  edges  of  the  nail  to  be  drawn  together  by  means  of  a 
suture  of  brass  wire,  witli  the  view  of  rcmoviuir  the  lateral  edges  of 
the  nail  from  contact  with  the  inflamed  portion  of  the  toe.  This 
operation,  independently  of  being  very  painful,  can  afford  only  tem- 
porary relief,  inasmuch  as  the  constant  growth  of  the  nail  will  quick- 
ly counteract  whatever  advantage  may  result  from  the  artificial 
reduction  of  its  breadth.  " 

Cooper  and  Buvncit  (Land.  Med.  and  Pliys.  Journ.,  Ap.  1827, 
and  Feb.,  1829)  simply  recommend  the  inverted  edge  of  the  nail  to 
be  removed  from  the  point  to  the  root. 

Other  surgeons  have  proposed  to  give  to  the  nail  a  less  arched  or 
flatter  form,  so  as  to  prevent,  in  this  manner,  its  edges  from  pressing 
inward  upon  the  soft  parts.  Houllon  (Land.  Med.  Kcpos.,  Sept., 
1824)  directs  the  nail  to  be  shaved  as  thin  as  possible  at  its  centre ; 
a  triangular  piece  of  cork  is  then  lo  be  inserted,  on  each  side,  be- 
tween the  nail  and  the  toe  whether  under  or  above  the  nail  is  not 
said  and  a  third  piece,  about  one-third  the  breadth. and  of  the  same 
length  as  the  nail,  upon  the  thinned  portion  of  the  latter,  and  over 
these  a  piece  of  adliesive  plaster  and  a  bandngc,  which  is  to  bo 
changed  every  three  days.  Biessy  (Revue  Mod.,  1830,  t.  ii.  p.  54) 
shaves  the  whole  of  the  nail  as  thin  as  possible,  and  then  touches  it 
six  or  eight  times  with  lunar  caustic,  until  it  shrivels  up, and  its  edges 
are,  in  consequence,  drawn  out  of  the  soft  parts.  This  procedure 
cannot  fail  to  produce  the  entire  destruction  of  the  nail.  Rothamel 
(Zcitschrift  fur  die  Ges.  Heilk,  etc.,  B.  1,  Hft.  1)  directs  the  nail,  for 
the  breadth  of  two  lines,  extending  from  the  point  to  the  root,  to  be 
scraped  as  thin  as  possible,  by  means  of  a  piece  of  glass.  Pressure 
being  now  made  upon  the  central  portion  of  the  nail,  the  edges  are  so 
far  drawn  up  as  no  longer  to  bear  upon  and  irritate  the  inflamed  soft 
parts.     The  scraping  of  the  nail  is  to  be  repeated  every  other  day. 

Petrequin  (Archlv.  de  Med.  Beige.,  March,  1841)  thins  the  nail 
by  means  of  a  file,  and  applies  pressure  upon  it  by  means  of  sponge 
and  adhesive  plaster;  others,  as  Bonnet  {Bulletin  de  Tlierop.,  Aug., 
1834,)  propose  to  flatten  the  nail,  and  thus  relieve  its  edges,  by  ban- 
dages and  graduated  compresses  alone.  Labarraque  [Gazette  des 
Hdp.f  April,  1837)  employs  a  thin  plate  of  lead,  bent  in  a  particular 
manner,  one  edge  of  which  is  inserted  beneath  the  edge  of  the  nail. 
A  somewhat  similar  plan  is  pursued  by  Lechler  (Wartemh.  Med. 
Correspondenz  Matt,  B.  8,  N.  47).  According  to  Vesignie,  {Joxirn. 
Hebd.,  S.  34  3G,  1836.)  the  plan  of  Brachet  consists  in  cutting 
away  the  soft  parts;  and  when  the  nail  requires  to  be  entirely  des- 
troyed,  he  prefers  Dupuytren's  operation,  in  conjunction  with  the 
cautery.  In  the  generality  of  cases,  he  merely  removes  the  superflu- 
ous portions  of  the  nail,  and  then  puts  on  a  clasp  composed  of  a  nnm- 
ber  of  silver  plates,  which  is  elevated  by  means  of  a  screw,  and  raises 
up  with  it  the  edges  of  the  nail,  by  which  means  all  pain  is  removed. 


1845.]  Essay  on  Inverted  Toe  Nail  263 


*  It  is  not,"  remarks  Dr.  Zeis,  "  merely  the  painful  and  cruel  char- 
acter of  the  principal  operations  that  have  been  proposed  for  the  euro 
of  the  inverted  toe  nail,  that  renders  them  so  disgusting  to  me  other 
operations  are  attended  with  much  pain  and  sutiering,  which  excite 
in  me  no  such  feeling.  But  my  opposition  to* them  is  derived  from 
the  circumstance,  of  the  whole  of  them  being  based  upon  erroneous 
principles,  and  their  being  all  unadapted  to  afford  any  radical  and 
permanent  relief." 

In  many,  though  by  no  means  in  the  majority  of  cases,  the  cutting 
the  nail  too  short  is  the  primary  cause  of  the  atTection.  The  soft  parts, 
being  no  longer  kept  down  by  the  projecting  free  edge  of  the  nail, 
are  forced,  by  the  pressure  of  the  shoe  or  boot  in  walking,  against  and 
even  over  the  truncated  end  of  the  nail,  and,  as  this  again  increases  in 
length,  it  may  be  made  to  even  penetrate  into  them  giving  rise  thus 
to  inflammation,  swelling,  ulceration  and  fungous  granulations,  with 
a  decree  of  sufferinir,  which  often  renders  the  slightest  motion  of  the 
foot  unbearable.  The  disease  is  most  liable  to  occur  in  the  great  toe, 
in  consequence  of  the  greater  amount  of  motion  and  pressure  to  which 
it  is  subjected  in  walking.  The  patient  seeks  to  relieve  his  sufferings 
by  constantly  cutting  away  portions  of  the  nail,  but  in  so  irregular 
and  unskilful  a  manner  as  rather  to  increase  than  diminish  the  evil. 

The  disease  most  commonly  occurs  at  one  or  otlier  of  the  lateral 
edges  of  the  nail  of  the  great  toe  and  in  this  case  without  the  nail 
having  been  cut  at  all.  Xo  doubt,  in  numerous  instances,  it  results 
entirely  from  the  soft  parts  being  pressed  by  too  narrow  or  misshapen 
boots  or  shoes  against  and  over  the  sharp  edge  of  the  nail.  But 
cases  frequently  occur  where  it  cannot,  with  propriety,  be  referred  to 
this  cause.  Dr.  Zeis  believes,  that  under  such  circumstances,  its 
production  is  to  be  attributed  to  that  particular  constitution  of  the 
blood,  which,  in  certain  persons,  predisposes  to  furunculi  and  other 
spontaneous  local  inflammations. 

The  inflammation  once  established,  it  is  evident  that  the  hard  and 
sharp  edge  of  the  nail  must  act  as  a  foreign  body,  and,  by  its  constant 
irritation,  keep  up  and  aggravate  the  disease  ijiving  rise  to  suppu- 
ration, ulceration  and  the  production  of  luxuriant  fungous  granula- 
tions, of  an  intensely  painful  character,  which  rise  up  over  the  edge  of 
the  nail,  and  often  cover  it  to  so  great  an  extent,  that  we  are  unable 
to  obtain  a  sight  of  it,  even  by  drawing  them  on  one  side.  It  is  this 
that  has  favored  the  belief,  that  the  whole  of  the  evil  has  resulted 
from  the  too  great  breadth  of  the  nail  causing  its  edges  to  grow  into 
the  flesh;  but  there  occur  a  greater  number  of  broad  nails  uncon- 
nected with  the  aflection  under  consideration,  than  there  do  in  con- 
nection with  it. 

Micliaelis  describes  a  condition  of  the  nail,  which  he  supposes  to 
particularly  favour  its  growth  into  the  flesh.  This  is  a  very  rounded 
form  of  the  nail,  so  much  so,  that  it  resembles  the  half  of  a  pertect 
cylinder.  This  condition  of  the  nail  Dr.  Zeis  has  repeatedly  observ- 
ed, but  not  always  in  cases  of  its  so  called  growth  into  the  flesh  ;  on 


264  Essay  on  Inverted  Toe  Nail.  [May, 


he  contrary,  he  has,  in  numerous  instances,  met  with  it  in  individu- 
als who  had  never  suffered  from  this  affection.  Even  when  the  dis- 
ease has  been  connected  with  an  arched  condition  of  tlie  nail,  it  has 
been  entirely  healed  without  the  destruction  or  flattening  of  the  latter. 
Dr.  Zeis  considers  that  it  is  all-important,  in  every  case,  to  attend 
to  the  condition  of  the  patient's  general  health,  which,  in  a  largo 
number,  will  be  Ibund  to  be  more  or  less  deranged.  As  the  patient's 
health  improves,  tinder  an  appropriate  therapeutic  and  hygienic  treat- 
ment, the  affected  foot  being  kept  at  rest,  and  the  toe  guarded  from 
all  pressure,  either  in  walking  or  from  a  too  narrow  boot  or  shoe,  the 
local  disease  will  be  found,  very  generally,  to  diminish,  and,  in  a  short 
time,  to  disappear  entirely. 

If,  however,  the  disease  has  resulted  from  keeping  the  nail  too 
short,  the  doctor  considers  it  indispensable  that  it  should  be  allowed 
to  attain  its  proper  length,  which,  with  the  simplest  dressings,  and  the 
avoidance  of  motion  and  pressure,  is  sufficient  to  effect  a  perfect 
cure.  So  soon  as  the  nail  acquires  the  slightest  projection,  he  is  in 
the  habit  of  introducing  beneath  it,  by  means  of  a  fine  probe,  a  small 
portion  of  charpie,  and  to  prevent  the  falling  out  of  this,  he  covers  the 
end  of  the  toe  with  adhesive  plaster,  spread  upon  gold-beater's  skin, 
which  adaptsitself  l)etter  to  the  parts,  and  produces  a  less  amount  of 
pressure  than  when  it  is  spread  on  silk  or  linen.  The  toe  is  then  to 
be  bathed  frequently,  during  the  day,  in  warm  water. 

If  the  soft  parts,  at  the  point  of  the  toe,  are  in  so  swollen  a  condi- 
tion as  to  interfere  with  the  dressing  just  directed,  or  completely  to 
cover  and  conceal  the  edge  of  the  nail,  Dr.  Zeis  is  in  the  habit  of  re- 
moving them  by  the  knife. 

"Even  in  those  cases,"  he  remarks,  "in  which  the  nail  has  been 
cut  so  close  as  to  be  reduced  to  one  half  its  length,  under  the  above 
treatment,  it  will  require  but  two,  or,  at  the  furthest,  three  months  to 
effect  a  permanent  cure,  and  to  restore  to  the  nail  its  proper  length 
and  natural  shape. 

"  Much  more  obstinate,  however,  are  those  cases  in  which  the  dis- 
ease affects,  at  the  same  time  or  is  entirely  confined  to,  the  side  of  the 
nail.  These  are,  especially,  the  cases  in  which  the  destruction  of  the 
whole  or  a  part  of  the  nail  has  been  considered  indispensable  to  the 
cure.  I  have,  however,  in  such,  seldom  failed  to  secure  the  entire 
and  permanent  relief  of  the  patient  by  rest,  the  frequent  use  of  the 
foot  bath,  and  the  removal,  by  the  knife,  of  the  fungous  granulations 
or  spongy  and  morbidly  sensible  flesh,  by  which  the  edge  of  the  nail 
becomes  covered.  I  will  not,  however,  pretend  to  deny,"  he  adds, 
"  that  cases  of  a  very  aggravated  character  may  occur,  in  which  the 
unhealthy  condition  of  the  ulceration,  seated  beneath  the  nail,  will 
require  the  loosened  edge  of  the  nail  to  be  cut  away,  that  our  appli- 
cations may  be  applied  directly  to  the  ulcerated  surface,  and  also  to 
prevent  the  constant  irritation  which  is  kept  up  in  it  by  the  detached 
portion  of  the  nail.  It  is  never  necessary  to  destroy  the  whole  or 
any  part  of  the  nail,  even  under  such  circumstances." 


1845.]  Essay  on  Inverted  Toe  Nail.  265 


The  leading  propositions  which  Dr.  Zeis  has  attempted  to  estab- 
lish ill  the  essay  before  us,  are  thus  summed  up  in  the  author's  own 
words. 

"1.  The  so  called  growing  of  the  nail  into  the  flesh,  is  not,  ex- 
cepting, perhaps,  in  a  very  few  cases,  the  result  of  a  too  great  breadth 
of  the  nail ;  but  is  caused  entirely  by  the  inflammation  and  intumes- 
cence of  the  soft  parts. 

"2.  The  arched  condition  of  the  nail,  which  is  of  frequent  occur- 
rence, is  perfectly  natural,  and  neither  can  nor  requires  to  be  changed 
by  shaving  away  the  nail  and  the  application  of  pressure. 

"  3.  It  is  not,  therefore,  to  the  removal  of  any  morbid  condition  of 
the  nail  that  the  attention  of  the  surgeon  must  be  directed,  but  to  the 
removal  of  the  inflammation  of  the  soft  parts,  the  healing  of  an  ulcer- 
ation that  may  exist,  and  the  destruction  of  the  intumescence  caused 
by  the  fungous  flesh  about  the  edge  of  the  nail,  which  latter  is  best 
effected  by  cutting  it  away  with  the  knife. 

'*  4.  In  the  treatment  of  the  local  inflammation,  in  the  affection 
under  consideration,  the  frequent  use  of  warm  pcdiluvia  is  preferable 
to,  and  more  effective  than  most  other  means. 

"  5.  In  a  few  cases,  of  infrequent  occurrence,  the  temporary  remo- 
val of  the  loosened  edge  of  the  nail  will  be  required:  in  the  majority 
of  cases,  however,  even  this  will  not  be  necessary. 

"6.  The  removal  or  destruction  of  the  whole  or  any  part  of  the 
nail,  is  in  no  case  required ;  and  from  its  severity,  and  the  mutilated 
state  in  which  it  ever  after  leaves  the  foot,  should  be  considered  as 
an  unwarrantable  practice,  and  one  to  be  entirely  banished  from 
among  the  operations  of  surgery." 

We  have  given  to  the  essay  before  us  an  extended  notice,  because 
the  frequent  occurrence  of  the  affection  of  which  it  treats,  the  intense 
sufliering  with  which  it  is  invariably  attended,  as  well  as  the  evident 
ignorance  that  exists  in  relation  to  its  true  character,  as  is  evidenced 
by  the  severe  and  uncalled  for  operations  which  have  been  proposed 
for  its  removal,  induce  us  to  believe  that  a  very  full  exposition 
should  be  given  of  the  views  of  an  author  who  has  thrown  much 
light  upon  its  pathology,  and  presented  a  plan  of  cure  as  simple  as  it 
is  effectual. 

The  views  advocated  by  Dr.  Zeis  in  relation  to  the  causes  of  the 
inverted  toe-nail,  we  have  entertained  for  many  years;  and  have 
pursued  a  plan  of  treatment  very  similar  to  that  which  he  recom- 
mends. In  no  instance  have  we  had  occasion  to  remove  any  portion 
of  the  nail,  though  we  can  conceive  of  cases  in  which  the  cutting 
away  of  the  loosened  edge  of  the  nail  may  be  necessary,  as  Astlcy 
Cooper  remarks,  to  allow  of  the  healing  of  the  ulceration  of  the  soft 
parts,  by  removing  the  irritation  which  the  nail  constantly  keeps  up. 
The  success  with  which  this  plan  of  treatment  has  been  attended,  in 
the  cases  that  have  fallen  under  our  care,  emboldens  us  to  recom- 
mend it  strongly  to  the  notice  of  the  profession.  The  American 
Journal  of  the  Medical  Sciences, 


2(56  Mercury  and  Iodine.  [Way, 


Comparative  value  of  the  different  Preparations  of  Mcrcvry  and 
Iodine,  and  the  best  modes  of  administering  them.  Bv  Edward 
OcTAvius  HocKEN,  M.  D.,  &c.,  Pkyslciaji  to  the  Blenheim-street 
Infirmary. 

Mercury  is  employed  locally  and  generally,  eilherto  produce  a  local 
efTect  simply,  or,  by  its  admission  into  the  system,  to  bring  the  whole 
constitution  under  its  influence.  The  mercurial  influence  is  induced 
in  the  system  by  the  introduction  of  mercurial  preparations  into  the 
stomach,  or  by  fumigation,  or  by  inunction.  In  the  first  method  we 
employ  the  chloride,  bichloride,  iodide,  pil.  hydrarg.,  d:c.,  dec. 

Chloride.  Calomel  is  chiefly  useful  when  we  wish  to  produce  a 
speedy  and  powerful  action  on  the  constitution,  as  in  venereal  iritis 
or  orchitis,  but  is  less  adapted  to  the  ordinary  symptoms.  On  the 
Continent  it  is  extensively  employed  in  tubercles  of  the  labia,  with 
or  without  ulceration,  in  various  forms  of  creeping  ulcers,  and  also 
in  ulcerations  of  the  throat  and  nasal  fjsscc.  Desruelles  says,  that 
he  cannot  too  much  recommend  this  preparation,  which,  united  to 
opium,  and  an  anti-j)hlogistic  regimen,  may  produce  the  most  bene- 
ficial results.  Ricord  employs  the  following  pills  in  the  treatment  of 
enlarged  testicle,  which  remains  after  inflammation  of  that  organ  :  

Hyd.  Chlor.  3i.  Pulv.  Conii,  Sapon.     Hisp.  aa  3ij.  M.  ft.  pil.  xxiv. 

Bichloride.  31.  Dupuytren  ordered  this  remedy  in  small  doses, 
one-sixth  of  a  grain  three  times  a  day,  in  constitutional  syphilis,  and 
on  the  Continent  it  still  continues  to  be  extensively  used  for  this  pur- 
pose. In  some  chronic  cases  of  syphilitic  skin  disease,  I  have  seen 
it  used  with  advantage  ;  but  as  a  general  remedy  in  secondary  syphilis 
it  requires  more  care,  is  more  dangerous,  and  altogether  is  a  less  eli- 
gible  medicine  than  blue  pill. 
^  Piliila  Hydrargyri.  This  medicine  is  the  form  most  used  and 
relied  on  in  England,  and  as  it  is  one  of  the  njildest,  safest,  most 
certain,  and  most  manageable  preparations  of  mercury,  it  justly  de- 
serves the  preference  given  to  it.  In  doses  of  five  grains  two  or 
three  times  a  day,  it  is  applicahlc  to  nearly  all  those  conditions  which 
we  have  shown  to  be  benefitted  by  mercury. 

Proto-iodurct.  MM  Cullerier,  Biett,  Ricord  and  others  employ 
this  remedy  in  many  forms  of  constitutional  syphilis,  especially  where 
secondary  and  tertiary  symptoms  are  combined,  and  in  primary  sores 
in  strumous  habits.  Cullerier  says,  that  it  is  chiefly  in  constitutional 
syphilis  that  the  proto-ioduret  of  mercury  is  administered  with  success. 
Its  effects  are  principally  evident  in  secondar}-  ulcerations  of  the  mu- 
cous membrane, cutaneous  tubercles,  exostoses,  and  chronic  affections 
of  the  joints,  where  the  other  preparations  of  mercury  have  had 
little  effect.  It  should  always  be  guarded  by  opium,  and  given  in 
half  ijrain  doses  twice  or  thrice  a  day.     The  deuto-ioduret  is  more 


1S45.]  Mercury  and  Iodine.  287 


stimulating,  and  consequently  its  dose  is  smaller.  Either  of  these 
may  be  employed  in  friction  upon  tumours  and  indolent  buboes,  after 
the  removal  of  all  acute  inflammatory  symptoms. 

Tiic  cyanuret  and  deuto-phosphate  of  mercury  are  occasionally 
employed.  The  former  is  said  to  be  preferable  to  the  bichloride, 
being  less  apt  to  disagree,  and  less  readily  decomposed.  It  is  an 
useful  external  application  in  some  skin  affections,  allaying  the  violent 
itching  and  irritation  of  what  M.  Alibert  terms  herpes  squamosus. 

Inunclion.  Inunction  by  the  mercurial  ointment  was  formerly 
employed  to  mercurialize  the  system  more  frequently  than  at  the 
present  day.  In  this  way  the  mineral  is  less  apt  to  disagree  with  the 
system,  especially  the  alimentary  canal,  although,  when  used  alone, 
it  is  less  speedy  in  its  effects.  In  buboes,  I  imagine  that  Hunter  was 
correct  in  his  opinion  concerning  the  advantajies  of  making  mercury 
]:ass  through  the  affected  absorbents.  The  Ung.  Hydrarg.  is  used 
in  the  quantity  of  half  a  drachm  to  a  drachm  night  and  morning,  to 
be  well  rubbed  in,  before  a  fire,  on  the  more  delicate  portions  of  the 
skin.  Culicrier  prefers  using  mercury  by  friction  in  primary  sores  ; 
he  orders  fiorn  a  quarter  of  a  drachm  to  a  drachm  and  a  halfof  mer- 
curial ointment  ateacli  friction,  leaving  an  interval  between  them  of 
one,  two,  or  three  days,  with  the  view  of  not  irritating  either  the  sore 
or  the  constitution,  by  bringing  the  latter  suddenly  under  the  influ- 
ence of  the  remedy.  Ricord  frequently  orders  the  frictions  to  the 
axilla;,  and  they  are  employed  in  this  manner  by  Cullerier,  in  certain 
forms  of  ulcerations  of  the  mouth  and  fauces.  He  narrates  two 
cases  cured  by  mercurial  frictions  in  this  situation,  which  had  resist- 
cd  its  employment  on  other  parts. 

J'umigation.  Fumigation  of  the  whole  surface  of  the  body  is,  at 
present,  rarely  used  as  a  method  of  affecting  the  system,  but  the  ap- 
paratus formerly  employed  is  still  to  be  found  in  some  of  our  hospitals. 
It  is  very  speedy  in  its  action.  The  remedy  is.  however,  employed 
locally,  and  with  great  advantage,  in  some  affections  of  the  throat 
anl  nasal  fos-ac,  directed  to  the  part  by  a  suitable  apparatus,  and 
more  generally  in  some  obstinate  diseases  of  the  skin.  For  patients 
who  have  not  strength  to  rub  in  mercury,  and  whose  bowels  will  not 
bear  the  use  of  internal  remedies,  it  has  been  esteemed  highly  ad- 
vantageous. 

Topical  Applications.  As  mere  local  applications,  calomel,  black 
wash  (Hydrarg.  Chlorid.  x  vel  xv.  grs.,  Aquae  Calcis  gi.),  yellow  wash 
(Hyd.  Bichlorid.  i.  vel  ij.  grs.,  Aq.  Cal.  ^i.),  solutions  of  the  bichlo- 
ride in  distilled  water,  the  nitric  oxide  ointment,  the  nitrate  ointment, 
the  simple  blue  ointment,  and  the  Ung.  Hyd.  c.  Ammoniaco,  are  all 
of  them  occasionally  applied.  We  select  from  these  in  proportion  to 
their  stimulating  j)roperties,  adapting  to  the  condition  of  the  svmp. 
toms  we  treat.  Whatever  preparation  of  mercury  be  selected  for 
internal  employment,  it  should  always  be  combined  with  opium  or 
conium,  as  a  certain  degree  of  constitutional  irritability  alrndst  al- 
ways  accompanies  syphilis,  which  is  most  favorably    influenced  by 


268  Mercury  and  Iodine.  t^^y 


such  medicines,  and,  in  some  cases  where  there  is  sthenic  inflamma- 
tion or  fever,  antimony.  M.  IJiett's  practice  has  constantly  furnished 
numerous  instances  where  these  affections  have  disappeared  under 
the  influence  of  opium  alone  without  mercury,  and  MM  Ricord  and 
Cullerier  support  similar  views.  Dr.  Wallace  says,  that  it  will  be 
always  most  prudent  to  combine  the  mercury  with  opium  and  anti- 
mony. No  harm  can  result  from  this  practice;  and  by  it  much  in- 
convenience may  perhaps  be  avoided.  The  combination  of  anti- 
mony and  mercury  has  always  appeared  to  him  to  render  the  influ- 
ence of  the  latter  more  nianageable,  as  well  as  more  certain,  while 
the  addition  of  opium  diminishes  the  irritating  influence  of  mercury 
on  the  bowels,  and  subdues  the  disposition  to  an  irritable  state  of  the 
general  system,  or  of  the  local  disease.  During  its  administration 
we  must  also  carefully  watch  the  health  of  the  patient  and  the  con- 
dition of  his  disease,  and  omit  its  further  use  for  the  time,  should  any 
unfavorable  symptoms  arise.  The  diet  should  be  mild,  and  the  state 
of  the  stomach  and  bowels  attended  to.  Dr.  Wallace  recommends 
the  patient  to  eat  a  few  grains  of  allspice  or  pepper  during  the  day, 
and  to  cover  the  abdomen  with  two  or  three  folds  of  flannel.  Mr. 
Parker  says,  that  a  nightly  pill  or  draught  of  some  preparation  of 
opium  with  capsicum  jnay  be  employed  with  advantage  even  during 
the  period  the  patient  is  using  mercurial  frictions ;  the  former  not 
only  prevents  those  attacks  of  pain,  griping,  and  diarrhoea,  which 
sometimes  come  on  during  a  mercurial  course,  and  materially  retard 
the  healing  process,  but  they  contribute  directly  to  the  therapeutic 
effects  of  the  mercury. 

The  aspect  of  the  sore  is  to  be  watched  carefully,  as  it  frequently 
points  out  when  mercury  does  or  does  not  agree  with  the  system. 
Dr.  W^allace  says  that  it  will  be  found  a  most  important  rule  in  prac- 
tice to  omit  all  mercurial  treatment  wheneverthere  appears  an  increase 
of  inflammation  or  sensibility,  to  arise  in  the  local  disease  during  the 
employment  of  mercury  ;  for  a  perseverence  in  its  use,  under  such 
circumstances,  will  almost  invariably  tend  to  some  form  of  destructive 
action,  determined  in  its  character  by  the  constitution  of  the  patient. 
In  such  cases  we  must  have  recourse  to  emollients  and  anodyne  ap- 
plications, purgatives,  rest,  abstinence,  and  diaphoretics,  with  or  with- 
out narcotics,  and,  as  soon  as  the  morbid  actions  which  have  superve- 
ned have  been  removed,  mercury,  if  necessary,  may  be  again  resumed, 
to  be  suspended  afresh  in  case  of  a  return  either  of  inflammation  or 
irritability.  Should  an  indolent  condition  of  the  sore,  and  absorp- 
tion of  the  granulations,  come  on  during  mercurial  influence,  we 
must  determine  the  cause  and  act  accordingly. 

The  quantity  of  mercury  is  always  to  be  regulated  with  the  design 
of  deranging  the  system  as  little  as  possible,  and  patients  should  be 
abstracted  from  all  causes  of  excitement :  ptyalism,  d:c.,  being  con- 
sidered accidental  occurrences.  Dr.  Wallace  supports  the  opinion, 
that  the  greater  the  degree  of  excitement  or  of  derangement  in  the 
functions  which  mercury  produces,  the  greater  is  the  danger  of  its 


1S45.]  Mercury  and  Iodine.  269 


action  being  followed  by  tleletericus  effects,  or  of  its  ceasing  to  influ- 
ence the  sx'inptoms  of  syphilis  in  a  salutar}'  manner.  We  judge  of 
the  requisite  quantity  from  its  effects  on  the  disease,  and,  in  general, 
it  is  necessary  to  affect  the  gums  slightly,  and  to  produce  a  metallic 
taste  in  the  mouth  ;  hut  complete  salivation  is  rarely  if  ever  necessary 
to  obtain  all  the  good  effects  possible  in  curing  chancres,  or  prevent- 
ing secondary  symptoms.  The  cicatrization  of  the  sore,  without 
leaving  a  hardened  cicatrix,  should  be  the  rule  for  discontinuing  the 
remedy.  When  sores  remain  indolent,  under  the  continued  lise  of 
mercury,  it  may  be  intermitted  for  some  time,  and  then  resumed  in 
some  other  form.  It  is  a  mistaken  notion  to  suppose  that  continuing 
the  medicine  after  the  sore  has  healed,  and  all  induration  of  the  cica- 
trix has  disappeared,  will  protect  the  patient  from  secondary  symp- 
toms; these  will  appear  after  the  fullest  course,  and  yet  occasionally 
they  will  not  appear  when  not  a  single  grain  of  mercury  has  been  used. 
Another  point  to  be  borne  in  mind  is,  to  examine  the  condition  of  the 
mouth  previous  to  the  exhibition  of  mercury,  as  a  state  of  inflamma- 
tion or  ulceration,  with  foul  breath,  might  lead  us  to  attribute  to  the 
mercury  what  really  depends  on  other  causes. 

Iodine.  M.  CuUerier  thinks  that  the  effects  of  the  iodide  of  po- 
tassium are  less  prompt  than  those  of  mercury,  and  that,  on  this  ac- 
count, more  should  be  given,  if  the  stomach  will  bear  it.  Reem- 
ploys grain  doses  of  iodine  with  from  two  to  four  of  the  iodide  of 
potassium  in  an  ounce  of  water,  given  at  intervals  during  the  day; 
but  he  does  not  increase  the  iodine  beyond  two  grains  in  the  day,  or 
the  iodide  beyond  ten.  I  fully  believe  that  the  iodide  is  much  more 
beneficial  without  the  pure  iodine,  which  disorders  the  stomach  with- 
out benefitting  the  complaint.  Mr.  Stone,  formerly  apothecary  to 
St.  Thomas's  Hospital,  told  Dr.  Williams  that  he  was  called  to  pre- 
scribe for  ten  patients  taking  the  compound  of  iodine  and  iodide  of 
potassium  for  one  that  was  taking  the  last  medicine  only. 

Dr.  Wallace  found  by  experience  that  the  iodide  of  potassium 
was  the  only  form  of  the  remedy  which  agreed,  that  pure  iodine  was 
a  very  powerful  irritant,  very  frequently  occasioning  severe  symp- 
toms, whilst  the  iodide  of  potassium  was  perfectly  harmless.  Pure 
iodine,  moreover,  is  converted  into  hydriodic  acid  in  the  stomach. 
lie  has  seen  many  cases  in  which  the  tincture  of  iodine,  both  simple 
and  ioduretted,  failed  to  produce  any  favorable  influence,  because 
the  irritation  excited  in  the  stomach  prevented  its  employment  in 
such  doses  as  were  sufficient  to  act  on  the  disease,  and  in  tliese  very 
cases  the  action  of  the  iodide  of  potassium  was  subsequently  most 
beneficial.  In  other  cases,  where  pure  iodine  was  em[)loyed.  alihough 
the  disease  was  cured,  still  it  was  at  the  ex|)ense  of  an  injured  stom- 
ach, and  great  emaciation.  On  the  contrary,  he  asserts  that  he  has 
never  seen  unpleasant  cfljcls  result  iVom  the  iodide  of  potassium, 
except  from  mismanagement. 

Kicord  employs  the  iodide  of  potas'^ium  in  gnuluallv  increasing 
doses,  commencing  with  ten  grains  dissolved  in  three  ounces  of  dis- 


270  Mercury  and  Iodine.  [May, 


tilled  water,  and  given  at  intervals  diirinfj  .the  day,  in  any  suitable 
vehicle.  Accordinfr  to  its  ciTucts  so  must  the  dose  be  cither  increased 
or  diminished;  wiien  the  remedy  n<rrees,  which  it  always  docs,  if 
the  stomach  be  healthy,  the  dose  siiould  be  increased  ten  grains  every 
two  or  three  days,  till  it  is  earned  to  one  or  one  and  a  half  drachms, 
or  even  more,  in  the  course  of  the  day.  The  iodide  of  potassium, 
in  full  doses,  when  it  agrees,  occasions  a  sensation  of  warmth  in  tho 
stomach,  imjuoves  the  api)ctite,  accelerates  digestion,  so  that  many 
grow  quite  fit,  and  quickens  the  pulse.  A  constant  cficct  is  an  in- 
creased diuresis. 

When  pure  iodine  is  used,  or  the  iodide  given  in  excessive  quanti- 
ties, or  from  idiosyncracy  of  constitution,  unpleasant  symptoms  may 
arise.  Sometimes  those  are  slight,  and  resemble  a  common  catarrh  ; 
at  others,  ringing  in  the  ears  and  pain  in  the  head,  or  the  skin  may 
suffer  from  a  slight  pustular  eruption  ;  occasionally  it  disorders  the 
bowels,  or  produces  j)ain  or  uneasiness  in  the  stomach,  having  some 
resemblance  to  pleurodynia,  but  seated  more  deeply,  and  an  acrid 
dryness  of  the  throat.  Mr.  Mayo  says  that  we  may  sometimes  cor- 
rect these  symptoms  by  adding  a  few  drops  of  laudanum  to  each 
dose,  and  by  administering  aperient  medicine.  Authors  assert  that 
some  patients  experience  ioditic  intoxication,  characterized  by  a  slight 
uncertainty  in  the  voluntary  movements,  some  subsuhus  tendbuim^ 
heaviness  in  tho  head,  a  species  of  intellectual  idleness,  and  some- 
times slight  delirium.  Soreness  of  the  gums  and  ptyalism  are  also 
said  to  occur  occasionally.  Mr.  Mayo  has  heard  of  effects  resenibling 
mercurial  erythismus.  Should  any  of  these  symptoms  occur  in  a 
severe  degree,  the  dose  must  be  diminished,  or  even  abandoned  alto- 
gather  for  a  few  days,  and  its  exhibition  re-commenced  in  smaller 
doses. 

Dr.  Wallace  found  the  urine  to  be  the  best  test  of  the  effects  of 
the  iodide  of  potassium  on  the  system,  by  testing  it  with  starch,  &c. 
In  some  of  his  patients  he  remarked  a  great  increase  of  perspiration 
 sometimes  constipation,  salivation,  roughness  of  the  throat  and 
heartburn;  he  found  that  quinine  controlled  thc'^itate  of  the  throat 
and  stomach.  Delicate  females,  he  says,  sometimes  lose  the  power 
of  sleeping  so  much  as  is  natural  a  state  of  wakefulness  often  ac- 
companied by  peculiar  feelings  of  the  head,  which  is  relieved  by  a 
purgative  and  interruption  of  the  medicine.  Emaciation,  great  gas- 
tric irritation,  wasting  of  the  mammae  and  testes,  &;c.,  only  occur 
from  the  use  of  free  iodine.  In  two  patients  who  had  drachm  doses 
of  tho  iodide  of  potassium  administered  by  mistake  for  one  day, 
there  occurred  in  both  sickness,  soreness  of  the  throat,  colicky  pains, 
vomiting  and  purging  to  a  slight  degree,  frequent  pulse,  and  exhaus- 
tion, quickly  disappearing.  Several  patients,  while  under  the  full 
action  of  the  iodide,  were  attacked  with  an  acute  pain  in  the  anterior 
and  lower  part  of  tiie  left  side,  precisely  in  the  centre  of  the  superfi- 
ces  formed  by  the  false  ribs,  accompanied  by  some  cough,  difficulty 
of  breathing  and  fever.     In  all,  the  affection  went  off  without  much 


1845.]  Mercury  and  Iodine.  271 


trouble.  The  medicine  was  omitted  and  subsequently  resumed  with- 
out inconvenience.  In  a  private  patient  it  produced  severe  indiges- 
tion,  a  rapid  and  quivering  pulse,  headache,  and  a  peculiar  condition 
of  the  eyes  the  |)upils  were  dilated,  and  both  eyes  in  a  state  of  in- 
cessant  motion.  He  was  soon  after  seized  with  symptoms  of  paralysis 
on  one  side  of  his  body,  preceded  by  muscular  tremblings,  which 
remained  for  three  weeks,  but  eventually  passed  ofT. 

Ricord  stales  that  the  good  effects  of  the  iodide  of  potassium  have 
been  constant  in  his  practice,  but  not  produced  with  equal  rapidity, 
in  this  respect  differing  from  Mr.  Mayo,  who  says  that  no  medicine, 
where  it  does  good,  produces  amendment  so  ra|)idly  ;  therefore  the 
propriety  of  continuing  it  is  never  doubtful.  As  far  as  I  have  observed 
myself,  iodide  of  potassium  nevergives  rise  to  any  serious  symptom, 
provided  that  it  be  unmixed  with  pure  iodine,  and  be  administered  in 
moderate  doses.  Apoplectic  and  paralytic  symptoms  sometimes  como 
on  during  the  existence  of  tertiary  symptoms,  and  these  are  then  at- 
tributed to  the  mercury  or  the  iodine  which  the  patient  may  be  using 
at  the  time,  but  it  is  hardly  fair  that  the  whole  blame  should  fall  on 
the  remedy.  For  an  adult  it  is  sufficient  to  commence  with  five 
grains  of  the  iodide  of  potassium  three  times  a  day,  and  increase  it 
gradually  to  seven  or  eight.  Dr.  Williams,  while  he  admits  that  somo 
constitutions  are  aiTected  even  by  one  or  two  grains,  thinks  that  the 
average  dose  should  be  eight  grains  three  times  a  day  ;  for,  says  he,  a 
smaller  dose  can  hardly  be  recommended,  for  the  patient's  sufferings 
are  so  intense  as  to  require  immediate  relief,  and  consequently  wo 
ought  to  begin  with  as  large  a  dose  as  his  stomach  will  probably  bear. 
This  reasoning  is  not  altogether  conclusive,  for  if  the  dose  be  sufficient 
to  excite  or  endanger  unpleasant  symptoms,  we  shall  have  to  stop  its 
use  altogether  for  some  time,  and  then  finally  resort  to  smaller  doses, 
which,  if  used  at  first,  would  most  probably  have  removed  the  com- 
plaint without  any  distress  or  delay.  Dr.  Williams  remarks,  that 
when  mercury  has  been  previously  and  unsuccessfully  used,  the  quan- 
tity  of  the  iodide  necessary  for  the  cure  of  the  patient  is  often  much 
greater  than  where  none  has  been  exiiibited. 

lleuiemof  (he  com-parative  value  of  mercury  and  iodine  in  the  IreaU 
ment  of  syphilis.  If  we  take  a  review  of  what  has  now  been  written, 
we  can  readily  determine  the  comparative  value  of  mercury  and 
iodine  in  the  treatment  of  syphilis  that  mercury  and  iodine  form  the 
two  main  remedies  on  which  the  best  and  most  unprejudiced  treat- 
ment of  the  various  symptoms  and  stages  of  syphilis  mainly  hinges, 
although  neither  of  them  should  be  regarded  as  a  specific,  nor  can 
cither  ofthem,  to  be  used  well  and  successfully,  be  exhibited  empirical- 
ly ;  that  mercury  and  iodine,  when  guided  by  observation,  reason, 
and  experience,  and  combined  with  such  treatment  and  medicines  as 
the  profession  would  emf)loy  were  they  to  lay  aside  all  notions  of 
something  specific  requiring  a  blind  and  specific  use  of  some  reme- 
dial  agent,  they  stand  alone,  and  infinitely  superior  to  all  other  medi- 
cines which  the  materia  mcdica  can  furnish;  that  a  modified  use  of 


272  Bibliographical  Notices,  [May, 


mercury  is  adapted  to  nearly  all  the  forms,  but  especially  the  indura- 
ted, of  primary  syphilis;  that  in  constitutional  syphilis  a  modified  use 
of  mercury  is  almost  a  sine  qua  non  m  the  preat  majority  of  seconda- 
ry symptoms, -but  is  either  hurtful  or  useful  in  the  tertiary;  that 
iodine  is  inert  in  almost  all  the  symptoms  of  primary  syphilis,  with 
the  exception  of  some  forms  of  phan;odena.  attended  with  great  debili- 
ty and  deranjrement  of  the  health;  that  in  constitutional  syphilis  it 
is  a  less  valuable  remedy  in  the  majority  of  secondary  symptoms  than 
mercury,  with  the  exception  of  some  severe  cases  of  pustular  erup- 
tion, phagedenic  throat,  rupia,  and  secondary  ulcerations  of  bad 
character,  all  of  them  marked  by  a  cachetic  and  debilitated  constitu- 
tion ;  while  in  tertiary  symptoms  iodine  is  far  more  valuable  than 
mercury,  and  its  efiects  more  certain  and  decided  than  in  any  other 
set  of  symptoms  ;  that  mercury  and  iodine  are  most  advantageously 
combined  in  cases  presenting  both  secondary  and  tertiary  symp- 
toms;  that  many  forms  of  mercury,  having  local  or  constitutional' 
actions,  are  applicable  to  the  various  symptoms  of  syphilis,  but  that 
the  mildest  constitutional  effect,  capable  of  overcoming  the  disease,  is 
always  to  be  preferred  :  that  the  only  form  of  iodine  safely  applica- 
ble to  the  treatment  of  syphilis,  is  the  iodide  of  potassium,  which 
should  never  bo  carried  beyond  moderate  doses ;  hence,  however 
valuable  the  iodide  of  potassium  may  be  in  seme  forms  of  syphilis,  it 
cannot  be  substituted  with  advantage  for  mercury  in  the  great  ma- 
jority. Edinburgh  JSled,  Surg.  Journal. 


BibUographical  Notices. 


The  First  Lines  of  the  Theory  and  Practice  of  Surgery;  in- 
cluding the  principal  Operations.  By  Sami'el  Coopek,  senior, 
Surgeon  to  the  University  College  Hospital,  and  Professor  of  Sur- 
gery in  the  same  Colleoe,  &:c.  With  Notes  and  Additions,  by 
WiLLARD  Parker,  M.  D.,  Professor  of  Surgery  in  the  College  of 
Physicians  and  Surgeons  in  the  University  of  the  State  of  New-. 
York,  dec,  d:c.  In  two  volumes,  pp.  540,  and  531.  Fourth 
American,  from  the  seventh  London  edition.  Published  by  S.  S. 
&  Wm.  Wood,  New  York,  1844. 

Of  the  three  Coopers,  who  have  become  distinguished  during 
the  first  half  of  the  present  century  in  the  city  of  London,  not 
the  least  worthy  is  the  veteran  author  of  the  First  Lines,  and 
Professor  of  Surgery  in  the  London  University.  His  great  work, 
the  Dictionary   of  Practical  Surgery,  containing,  together  with  the 


1845.]  Bibliographical  Nuliccs.  273 

additions  by  Dr.  Reese,  in  the  American  edition,  nearly  2500 
pages  of  ordinary  print,  was  sufficient  to  have  transmitted  his  name 
to  posterity. 

Cooper's  First  Lines  of  the  Theory  and  Practice  of  Surgery,  was 
originally  designed  as  an  elementary  treatise  on  the  subject,  and  as  a 
text  book  for  students  attending  his  lectures.  A^this  is  only  an  im- 
proved edition  of  a  work  long  and  favorably  known  to  the  profession, 
no  review  of  it  is  expected  at  our  hands.  From  an  examination  of 
the  notes  and  additions  by  Dr.  Parker,  \vc  are  disposed  to  think,  they 
have  considerably  enhanced  the  value  of  this  edition.  We  commend 
it  to  all  desirous  of  keeping  pace  with  the  improvements  in  Surgery, 
both  theoretical  and  practical. 

The  Principles  of  Surgery.  By  James  Miller,  F.  R.  S.,  C. 
S.  E.,  Professor  of  Surgery  in  the  Universily  of  Edinburg,  Sur- 
geon  to  the  Royal  Infirmary,  &c.  &c.  Philadelphia:  Lea  & 
I5la?>chard.     1815.     pp.  519. 

This  work  is  very  favorably  noticed  by  our  exchange  Journals.  It 
was  first  issued  last  year  in  the  city,  in  which  the  author  is  a  professor, 
in  12  mo.,  pp.  710.  It  is  gotten  up  in  a  very  creditable  manner  by 
Messrs.  Lea  &;  Blanchard,  to  whom  the  profession  is  so  greatly  in- 
debted for  valuable  publications,  both  original  and  re-prints.  Prof. 
Miller's  work  commences  with  an  historical  notice  of  Surgery,  in  38 
pages.  Chapter  i.,  is  devoted  to  Perverted  Action  of  the  Blood  ves- 
sels. Chapter  ii.,  to  Perverted  Action  of  the  Nerves.  Chapter  in., 
to  Perverted  Actions  of  the  Absorbents.  Chapter  iv.,  to  Suppura- 
tion. Chapter  v.,  to  Ulceration.  Chapter  vi.,  to  Mortification.  Chap' 
tor  VII.,  to  Perverted  Action  in  certain  Tissues.  Chapter  viii.,  to 
Perverted  Action  occurring  in  Bone.  Chapter  ix.,  to  Diseases  of  the 
Joints.  Chapter  x.,  to  Diseases  of  the  Arteries.  Chapter  xj.,  to 
Aflections  of  the  Veins.  Chapter  xii..  to  Hemorrhage.  Chapterxiri., 
to  Afiections  of  the  Lymphatics.  Ciiajitcr  xiv.,  to  Aflections  of 
Nerves.  Chapter  xv.,  to  Tumours.  Chapter  xvi.,  to  Wounds.  Chap- 
ter  xvii.,  to  Burns  and  Scalds.  Chapter  xviii.,  to  the  Efiects  of  Cold.. 
CMiaptcr  XIX.,  to  Fracture.  Chapter  xx.,  to  Dislocation.  Chapter 
xxi.,  to  Sprain  and  Rupture  of  Muscle  and  Tendon.  Chapter  xxii., 
to  Bruise. 

The  reader  can  now  judge  of  the  character  of  the  \v#rk,  and  we 
fully  accord  with  those  who  have  recommendLd  it,  as  the  best  book 
\ot  published  on  Ihe  Priiiripbv5i  of  Surgery. 

1 


74  Blbliogrttphical  Nutices.  [May, 


A  Treatise  on  the  Diseases  and  Special  Hygiene  of  Females. 
By  Colomb.'it  I)c  L'Isero.  Translated  from  the  French,  bv 
Charles  D.  ]Meirs,  M.  D.,  Professor  of  Midwifery  and  Diseases  of 
Women  and  Children,  in  the  Jefferson  Medical  College,  Philadel- 
phia, &:c  ,  d:c.     Lea  &  Blanchard  :   1845.   1  vol.  octavo,  pp.  720. 

The  medical  profession  is  much  indebted  to  Prof.  Meigs,  for  his 
excellent  translation  of  this  valuable  work.  Some  idea  may  be 
formed  of  the  immense  labor  and  research  of  its  author,  when  it  is 
understood  that  he  has  cited  more  than  one  thousand  authorities,  and 
has  given  the  opinions  and  practical  methods  of  the  most  celebrated 
practitioners  of  ancient  and  modern  times.    The  notes  of  Professor 
Meigs,  included  within  brackets  in  the  body  of  the  text,  and  consti- 
tuting nearly  one-seventh  part  of  the  volume,  impart  additional  value 
to  the  work,  which  we  feel  no  hesitation  in  saying,  should  be  in  tho 
hand  of  every  student  and  practitioner. 

A  Practical  Treatise  on  the  Diseases  peculiar  to  Women,  illus- 
trated by  cases,  derived  from  hospital  and  private  practice.  By 
SAaiup:L  AsiiwELL,  M.  D.,  London.  With  Notes  by  Paul  God- 
DARD,  M.  D.  Lea  &  Biianciiaed:  Philadelphia,  1845.  1  vol. 
8vo.  pp.  520. 

We  are  much  gratified  to  see  this  complete  edition,  with  notes,  by 
Dr.  Goddard.  With  no  work  arc  we  acquainted,  in  which  the  pleas- 
ant and  the  useful  are  more  happily  blended  :  It  combines  the  greatest 
elegance  of  style  with  the  most  sound  and  valuable  practical  informa- 
tion. We  feel  justified  in  recommending  it,  in  unqualified  terms,  to 
our  readers,  as  a  book  from  which  they  can  scarcely  fail  to  derive 
both  pleasure  and  improvement.  It  is  truly  a  model  for  medical 
composition.  We  are  pleased  to  see  that  Dr.  Goddard  has  not  placed 
liis  name  on  the  outside  of  this  book.  It  is  humiliating  to  our  na- 
tional pride  to  observe  so  many  able  and  eminent  American  physi- 
cians, whose  ambition  might  well  have  soared  higher,  attempting  to 
ride  to  distinction,  upon  the  backs  of  transatlantic  authors.  They 
should  scorn,  like  satellites,  to  borrow  light  from  distant  luminaries, 
but  in  the  noble  strife  for  ffime,  aspire  to  deck  their  brows  

"  With  honors  all  their  own." 

J.  A.  E. 


Remarks  on  the  Influence  of  Mental  Cultivation  and  Meiital 
Excitenmit  upon  Health.  By  Amariah  Brigham,  M.  D.,  Super- 
intendant  and  Physician  of  the  State  Limatic  Asylum,  Utica,  N.  Y. 
Third  edition.     LeaA:  Blanchard,  1845.     1  vol.  12mo.  pp.  204. 

V/e  are  pleased  to  find  that  this  useful  work  has  passed  to  a  third 


lS4o.]  Malformalion  of  the  Heart. 


edition.  Its  value  is  acknowledged  abroad  as  well  as  at  home,  the 
work  having  been  rc-piiblished  in  London,  Edinburgh  and  GleLSgow. 
The  facts  and  reasonings  of  Dr.  Brighain  shew  conclusively  that 
'early  mental  excitement  will  serve  only  to  bring  forth  beautiful  but 
premature  flowers,  w  hich  are  destined  soon  to  wither  away,  without 
producing  fruit."  Vsc.  commend  the  book  as  well  to  parents  and 
teachers  as  to  physicians. 


PART  III. MONTHLY  PERISCOPE. 

Malformation  of  the  Heart.  The  Gazette  Medicale  of  15th  Feb- 
ruary last,  contains  the  description  of  an  interesting  case  of  malfor- 
mation of  the  heart,  by  M.  Aug.  Valette,  of  Strasburg.  The  subject, 
Julie  Rieder,  died  at  the  age  of  six  years  and  twelve  days,  from  an 
attack  of  acute  Bronchitis.  During  the  first  six  weeks  of  her  exist- 
ence her  health  was  good,  and  notiiing  indicated  any  malformation; 
but  she  was  then  suddenly  seized  with  dyspnoea,  accompanied  by 
marked  cyanosis  of  the  skin.  When  six  months  old  an  attack  of 
convulsions  occurred,  which  left  her  right  side  paralysed.  From  this 
she  gradually  recovered,  and  enjoyed  pretty  good  health  subsequent- 
ly. Tiie  cyanosed  condition  of  the  skin  persisted  till  her  death,  was 
increased  by  active  exercise,  but  was  always  more  decided  on  the 
side  afiected  with  paralysis.  The  dyspnoea  also  continued.  By 
auscultation  of  the  heart,  a  double  bellows  sound  was  heard.  Intel- 
lect normal. 

Post-mortem  inspection  revealed  the  almost  total  absence  of  inter- 
ventricular septum,  the  orifices  of  the  aorta  and  pulmonary  artery 
being  separated  only  by  a  small  spur  of  the  remaining  portion  of  the 
septum.  The  aorta  was  about  double  the  size  of  the  pulmonary 
ar(ery.  Tiie  auricles  communicated  freely  with  each  other  by  means 
of  the  unclosed  foramen  ovale  and  of  another  large  opening  beneath 
this.  There  was  but  one  auriculo-ventricular  orifice,  which  was 
large,  protected  by  a  triangular  valve,  and  which  consequently  com- 
municated   equally    with    both   ventricles.       This    heart,   therefore. 


276  Vaccine.  '  [May, 


although  prcscnliiig  (he  vestiges  of  a  double  organ,  was  in  reality 
reduced  to  the  condition  of  that  of  the  Batracians.  Notwithstanding 
the  intimate  admixture  of  the  venous  and  arterial  blood  which  must 
necessarily  have  taken  place  in  this  case,  the  individual's  life  was 
prolonged  much  beyond  what  is  usually  supposed  possible  under  such 
circumstances.  It  is  suggested  by  the  writer  that  the  increased 
cyanosis,  manifested  in  the  paralysed  side,  may  be  attributed  to  the 
slower  return  of  venous  blood  from  this  side,  and  that  this  fact  should 
probably  lead  us  not  to  attribute  cyanosis  too  exclusively  to  the  mere 
admixture  of  the  two  bloods  in  the  heart.  D. 


Vaccine.  M.  M.  Dumiril,  Magendie,  Breschet,  Roux,  and  Serres, 
having  been  appointed  by  the  Academy  of  Sciences,  of  Paris,  a 
Committee  to  investigate  several  questions  relating  to  Vaccine, 
made  a  partial  Report  on  the  24th  February,  1845,  from  which  we 
glean  the  following  conclusions  : 

1st-  That  rather  more  than  one  third  of  those  attacked  with  small- 
pox in  France  had  been  vaccinated  ;  and  that  the  proportion  of 
deaths  among  these  was  very  small.  That  the  results  are  about  the 
same  in.England,  Sweden,  Denmark,  Italy,  Malta,  Geneva,  &c. 

2nd.  That,  in  general,  vaccination  insures  exemption  from  variola 
in  a  direct  ratio  with  the  recentness  of  its  performance.  The  statis- 
tics derived  from  the  various  parts  of  Europe,  show  conclusively  that 
until  nine  years  after  vaccination,  children  are  rarely  attacked  with 
small-pox,  and  that  this  disease  occurs  most  in  such  as  have  been 
vaccinated  ten,  fifteen,  twenty,  or  even  thirty. five  years  before.  On 
the  other  hand,  those  who  have  been  vaccinated  more  than  thirty-five 
years,  are  rarely  affected  with  variola,  a  fact  that  may  be  attributed 
to  the  diminished  tendency  to  eruptive  diseases  in  general  at  this  age. 

3rd.  That  vaccination  may  be  regarded  as  procuring  complete 
exemption  from  variola  for  five  or  six,  and  even  for  ten  or  eleven 
years.  That  after  this  age,  and  especially  during  the  prevalence  of 
epidemics,  a  portion  of  the  vaccinated,  become  subject  to  the  small- 
pox. And  that  the  majority  of  the  vaccinated  are  permanently  ex- 
empted. 

4th.  That  the  intensity  and  protecting  influence  of  the  vaccine 
virus  are  greatest  when  it  is  most  recently  taken  from  the  cow.  And 
that  exemption  is  not  proportionate  to  the  degree  of  local  disease  in- 
duccd.  Condensed  from  the  Gazelle  Mcdicalc  of  1st  March,  1845. 

D. 


1845.  J  Scarification  of  the  Gums.  277 


Scarification  of  the  Gums  during  Dentition.  By  Marshall  Hall, 
M.  D.,  F.  R.  S.,  &;c.  Tiiere  is  no  practical  fact  of  the  truth  and  value 
of  which  I  am  more  satisfied  than  that  of  the  effect  and  efficacy  of 
scarification  of  the  gums  in  infants,  and  not  in  infants  only,  but  in 
children.  But  the  prevailing,  1  may  say  the  universal  idea  on  the 
subject  is,  that  we  should  lance  the  gums  only  when  the  teeth  are 
ready  to  pierce  through  them,  and  only  at  the  most  prominent  parts 
of  the  gums,  as  the  occasion  to  which  I  have  referred  may  re- 
quire ;  and  no  idea  of  this  important  measure  can  be  more  inadequate 
to  its  real  value.  The  process  of  teething  is  one  of  augmented  arte- 
rial action  and  of  vascular  action  generally ;  but  it  is  also  one  of 
augmented  nervous  action ;  for  formation,  like  nutrition,  secretion, 
&;c.,  generally,  is  always  one  of  nervi-vascular  action,  and  of  this 
the  case  in  question  is,  from  its  peculiar  rapidity,  one  of  the  most 
energetic.  Like  other  physiological  processes,  it  is  apt  to  become, 
from  that  very  character  of  energy,  pathological,  or  of  morbid  activi- 
ty.  It  is  obviously,  then,  attended  with  extreme  suffering  to  the  little 
patient;  the  brain  is  irritable,  and  the  child  is  restless  and  cross;  the 
gums  are  tumid  and  heated  ;  there  is  fever,  an  affection  of  the  gene- 
ral vascular  system,  and  there  are,  too  frequently,  convulsions  of 
various  degrees  and  kinds,  manifested  in  the  muscles  which  move 
the  eye-ball,  the  thumb  and  finger,  the  toes;  the  larynx,  the  parietes 
of  the  res|)iratory  cavities;  and  the  limbs  and  frame  in  general  ; 
affections  of  the  excito-motor  part  of  the  nervous  system,  and  of  the 
secretions  of  the  liver,  kidneys,  and  intestines;  affections  ^f  the  gan- 
glionic division  of  that  system. 

What  is  the  precise  cause  and  source  of  these  formidable  effects? 
Can  the  mere  tension  and  irritation  of  the  gum  situated  over  the  more 
prominent  part  of  the  teeth  be  the  cause  of  such  extensive  morbid 
Jiclions?  I  think  not.  The  real  source  of  these  phenomena  is  in 
the  entire  dental  system,  in  which  actions  of  unusual  energy  and  ex- 
tent are  going  on  sub-inffummatory  they  might  be  called,  were 
they  not  in  reality  of  an  essentially  different  nature  and  origin. 
This  undue  action  takes  place  in  the  fangs  and  sockets  of  the  teeth 
in  their  whole  extent,  with  their  connections,  vascular,  nervous,  and 
membranous.  But  the  focus  from  which  the  nervous  actions  ema- 
nate is,  I  believe,  not  as  is  generally  imagined,  t!ie  nerves  of  the  mere 
gujns  seated  Qver  the  prominent  j)arts  of  the  teeth,  but  the  nerves 
which  may  emphatically  be  termed  the  nerves  of  the  terlhthcmscJrrSy 
the  nerves  which  enter  into  the  very  fangs  and  substance  of  the 
teeth.  It  is  to  the  base  of  the  gums,  not  to  their  aycx  merely^  that  the 
scarification  should  be  applied.  The  most  marked  case  in  which  I 
hav(?  observed  the  instant  good  effect  of  tcarilication  was  one  in 
which  all  the  trrfh  had  pirrrrd  the  gums! 

This  view  of  tlie  sui>je<t  may  assist  in  removing  the  iutile  objection 
of  sonio  who  have,  wifluiuf  dtu'  <'onsid(ialioti  I  am  convinced,  ()j)])os- 
ed  my  \)\nn  of  rrcquiiit,  ol'ien  daily,  scarificalion  of  the  gums,  to 
whi)m  I  would  say,  as  niy  sule  reply  Better  scarify  the  gums  //j/?c- 


27Q  Sulphate  of  Quinine.  [May, 


ccssarihj  one  hundred  times,  than  allow  the  accession  of  one  fit  or 
convulgion  from  the  neglect  ot  this  operation,  which  is  equally  im- 
portant in  its  results,  and  trifling  in  its  character.  And  it  is  not 
merely  the  prominent  and  tense  frum  over  the  edges  of  tlie  tcelh  which 
thould  be  divided;  the  gums,  or  rather  the  blood-vessels,  immediately 
over  the  very  nerves  of  the  teeth,  should  be  scarified  and  divided,  as 
you  would  divide  the  vessels  of  the  conjunctiva  in  inflammation  of 
that  membrane. 

Now,  whilst  there  is  fever  or  restlessness,  or  tendency  to  spasm  or 
convulsion,  this  local  blood-letting  should  be  repeated  daily,  and  ia 
urgent  cases  even  twice  a  day.  I  would  here  repeat  my  maxim  
better  do  this  one  hundred  times  unnecessarily  than  have  one  single 
^t  frpm  the  neglect  of  so  trifling  an  operation.  A  skilful  person  does 
it  in  a  minute,  and  in  a  minute  often  prevents  a  most  serious  attack  
an  attack  which  may  cripple  the  mind  or  limbs,  or  even  take  the  life 
of  our  little  patient,  if  frequently  repeated.  There  is,  in  fact,  no 
comparison  between  the  means  and  the  end,  the  one  ko  trifling,  the 
other  so  momentous. 

I  svould  refer  those  who  wish  to  prosecute  this  subject,  to  my  work 
on  the  '*  Diseases  and  Derangcnients  of  the  Nervous  System,"  but 
especially  to  my  "New  Memoir,"  which  contains  the  most  lucid  and 
recent  view  of  the  whole  subject  of  the  physiology  and  pathology  of 
the  true  spinal  system,  ^d  plates  which,  for  skill  in  the  draughtsman 
(Mr.  Simpson,  of  Stamford)  both  that  of  the  artist  and  that  of  tho 
physician,  and  for  interest  in  a  practical  point  of  view,  have  not  been 
surpassed.  Each  plate  evolves  a  principle  of  physiology  or  pathology 
cf  great  interest  and  value. 

1  have  frequently  thought  the  vascular  condition  of  the  gums  during 
dentition  might  be  ascertained  by  means  of  a  thermometer  properly 
guarded.  The  results  of  a  series  of  observations  on  this  point  could 
not  fail  to  possess  much  value,  whilst  they  would  probably  suggest  a 
means  of  diagnosis  in  some  serious  disease.  I  do  not  pretend,  in  the 
above  proposition,  to  have  advanced  anything  new  ;  but  in  the  locali' 
ty  chosen  for  the  operation,  and  in  the  promptitude,  repetition,  per- 
severencc,  and  in  the  energy  and  steadiness  of  purpose  with  which  I 
recommend  the  measure  to  be  adopted if  these  be  fully  apprehend- 
ed I  believe  I  do  propose  something  new ;  and  when  I  repeat  (hat 
since  I  adopted  the  plan  o{  effectually  removing  all  kritation  of  the 
gums,  stomach,  and  intestines,  in  cases  of  crowing  and  other  convul- 
sions of  the  same  nature,  early  enough,  I  have  not  known  or  seen  a 
fatal  case,  I  am  aware  that  I  propose  a  plan  of  treatment  at  once  new 
and  invaluable.  But  half  measures  are  of  no  efficacy.  These  re- 
marks do  not  apply,  of  course,  to  convulsive  diseases  of  centric  origin. 

      London  Lancet. 


The  effect  of  Sulphate  of  Quinine  in  diminishing  the  size  of 
the  Spleen.  About  two  years  ago,  it  was  announced  by  M.  Piorry 
that  the  administration  of  a  solution  of  50  or  GO  grains  (1  gramme) 


Is45.]  Treatment  of  Diabetes .  '^79 


of  Sulphate  of  Quinine  (in  water  and  a  small  quantity  of  sulphu- 
ric acid)  was  attended  wilh  a  considerable  reduction  of  the 
size  of  the  spleen,  and  tiint  this  effect  could  be  detected  as  soon  as  40 
seconds  after  taking  the  remedy.  M  Piorry  has  since  repeatedly  de- 
monstrated this  singular  phenomenon  in  his  clinics.  M.  Gouraud, 
however,  desiring  to  test  the  matter  more  fully,  measured  carefully 
by  percussion  the  dimensions  of  the  spleen,  and  then  administered 
various  liquids  in  the  same  quantity.  He  gave,  for  example,  a  cer- 
tain quantity  of  distilled  water  with  a  ^ew  drops  of  sulph.  acid,  the  same 
quantity  of  distilled  water  alone,  of  lemonade,  of  wine  and  water,  of 
herb  teas,  <S:c.,  and  in  every  instance  obtained  the  same  results  as  he 
did  when  giving  the  solution  of  quinine.  M.  Gouraud  therefore  con- 
cludes that  M.  Piorry  is  in  error  in  supposing  thnt  the  spleen  is  really 
diminished,  and  that  the  difference  observed  in  percussing  the  spleen 
after  the  ingestion  of  liqiiids  is  to  be  explained  by  reference  to  the 
fact,  that  even  a  sniull  quantit}"  of  tituJ  taken  into  the  stomach  is  at- 
tended with  a  considerable  evolution  of  gas  in  this  viscus,  and  conse. 
quently  with  a  corresponding  extension  of  the  sonorousness  of  the 
splenic  region,  even  amounting  in  some  cases  to  the  tympanitic  sound. 
]M.  Gouraud  insists  that  this  apparent  reduction  of  the  spleen  mav  be 
induced  equally  wliethcr  the  spleen  be  enlarged  or  in  a  healthy  state, 
by  the  same  process,  a  fact  which  had  been  stated  by  M.  Piorry  also. 
IM.  G.  has  observed  that  it  is  only  necessary  that  the  patient  shall 
have  abstained  from  drinks  for  some  hours  previously,  for  if  they  havo 
taken  liquids  a  short  time  before,  the  effect  will  not  be  induced. 

M.  Piorry  replies  that  he  has  repeated  the  experiments  of  M. 
('ouraud  without  by  any  means  ohtaining  similar  results,  and  still 
insists  on  the  correctness  of  his  observations.  The  subject  must 
therefore  be  investigated  by  other  and  impartial  persons,  and  its  im- 
portance is  such  that  it  is  to  be  hoped  that  the  truth  may  be  accurate* 
ly  established.  Condensed  from  the  Gazette  Mcdicale^  for  March^ 
1845.  D. 


Treatment  of  Diabetes  by  Dr.  Keith  I^ikay.  I  have  found 
tartar-ernelic  of  great  value  in  the  treatment  of  diabetes:  it  is  prefer- 
able to  James's  powder,  which,  even  in  the  largest  doses,  is  uncertain 
and  produces  very  liule  eff*ect ;  the  former  remedy  given  so  as  to  ex- 
cite occasional  nausea  diminishes  the  desire  for  food,  and  has  also 
consiflorable  influence  in  moderating!;  the  thirst,  and  thus,  bv  dimin- 
ishing the  iniipsta,  is  if  very  ess'.Mitial  service.  It  also  has  a  greater 
tendency,  than  any  other  remedy  that  1  havo  tried,  to  promote  per- 


'JSO  Creosote  Croton  Oil  Tic  Douloureux.  [May 


Hpiration,  when  its  use  is  steadily  preserved  in  for  some  length  of 
lime.  A  much  greater  quantity  of  ihis  remedy  may  be  taken  with- 
out producing  sickness  at  stomach  when  combined  with  laudanum. 

Success  in  a  few  cases  docs  not  authorihC  me  to  draw  a  strong 
conclusion.  Dut  I  am  nevertheless  much  impressed  with  the  belief 
that  residence  in  a  warm  climate,  when  practicable,  conjoined  with 
l)ropcr  regimen,  will  hereafter  be  found  to  possess  greater  influenco 
over  diabetes  than  any  other  remedial  means  liitherto  proposed. 
The  powerful  and  continued  operation  of  a  warm  climate,  and  its 
simplicity  as  a  remedial  agent,  give  it  a  decided  superiority  when 
contrasted  with  the  many  unscientific  and  uncertain  remedies 
which  have  l)een  hitherto  used  to  overcome  this  obstinate  and  dan- 
gerous malady.  Edln.  Med.  and  Surg.  Journal. 


Creosote  in  a  Case  of  Vomiting  by  Dr.  John  M.  Brewsi  er,  Jr. 
On  Tuesday  morning,  February  25,  1845,  C  o'clock,  I  was  called  to 
visit  a  young  man  (a  student  in  Amherst  College)  who  had  been 
taken  ill  about  five  hours  previous  with  the  most  violent  retchings  and 
vomiting.  I  found  the  patient  vomiting  every  ten  or  fifteen  minutes. 
The  matter  ejected  was  mostly  bilious.  As  to  the  origin  of  all  this 
gastric  irritability,  I  could  not  learn  any  suflicient  cause.  The  young 
man  retired  the  night  before  with  his  usual  good  health.  But  there 
was  no  time  to  be  lost  in  vain  speculations.  The  patient  was  rapid- 
ly becoming  exhausted.  What  was  to  be  done  ?  I  ordered  a  strong 
counter-irritant,  as  hot  as  the  patient  could  bear,  to  be  placed  over 
the  stomach,  and  began  immediately  to  administer  creosote.  A  sin- 
gle drop  of  creosote  to  an  ounce  of  pure  water  was  the  strength  of  my 
medicine.  Of  this  I  gave  a  teaspoonful  every  fifteen  minutes  till  the 
vomiting  was  checked.  After  the  fourth  dose  the  intervals  between 
llie  vomiting  began  to  lengthen,  and  continued  to  do  so  until  the 
stomach  bocame  perfectly  quiet  and  natural.  The  exhaustion  and 
soreness  of  the  parts  consequent  on  such  violent  action  have  now 
nearly  disappeared,  and  the  patient  is  engaged  in  his  usual  college 
duties  and  calls  himself  entirely  well.  Boston  Med.  and  Surg.  Jour. 

Croton  Oil  in  Dropsij.  Dr.  Fife  has  narrated  in  the  Provincial 
Medical  Journal,  several  cases  of  ascites,  originating  frem  or  com- 
plicated with,  organic  lesions,  in  treating  which  he  derived  great 
benefit  from  the  sustained  exhibition  c.f  croton  oil,  which,  he  observes, 
possesses  one  very  decided  advantage  over  elaterium,  that  even  when 
its  extreme  action  is  manifested,  it  is  not  jollowed  by  the  depression 
inseparable  from  the  eiTective  action  of  the  latter;  but  that  wljere  the 
greatest  vis  inertia^,  has  prevailed,  accompanied  by  absolute  incapa- 
city for  exertion,  a  sensible  amelioration  in  these  respects  has  follow- 
ed its  continued  exhihition.  .Y.  Y.  Journal  of  Medicine. 


Tic  Douloureux  treated   hy    Veratria.  Dr.  Le  CaUe    cites  two 
severe  cases  of  this  painful  disorder,  whicli  were  entirely  cured  by 


1345.]  Epidemic  Erysipelas.  281 


frictions  with  veratria  ointment.     The  first  is  that  of  a  person  em- 
ployed as  inspector  of  a  telegraph,  who,  having  exposed  himself  for 
half  an  hour  to  a  very  cold  air,  was  a  few  minutes  after  seized  with 
violent  pains.     They  proceeded  from  the  frontal  branch  of  the  oph- 
thalmic  nerve,  and  radinted  over  the  temple;   the  eye  was  injected, 
and  there  was  considerable  spasm  of  the  eyelid,  and   dread  of  light. 
Dr.  Le  Calve  immediate  prescribed  the  veratria  ointment.     After  the 
first  friction,  at  the  end  of  a  few  seconds,  the  pains  ceased    with  ex- 
ceeding rapidity.     The  patient  thought  himself  cured,  and  was  soon 
asleep.     At  two  in  the   afternoon  a  fresh  attack  came   on,   which 
yielded  to  a  friction  continued  for  fjur   minutes.     In  the  evening  a 
preventive   friction  was  made,  and  the  patient  passed  an   excellent 
night.     The  next  day,  about  six  in  the  morning,  the  pains  re-appear- 
ed  ;  but  this  time  they  proceeded  from  the  superior  maxillary  nerve, 
at  the    point  where  it  issues  from   the  infra-orbital    foramen,  and 
thence  they  spread  rapidly    to   the  posterior   and    superior   dental 
branches.     A  friction  which  lasted  five  minutes  caused  this  attack  to 
disappear.     It  was  fallowed  by  a  few  others  which  always  yielded  to 
the  same  means.     From  this  period,  for  more  than  a  year,  the  neural- 
gia has  not  re-appeared.     The  other  case  was  that  of  a  merchant's 
clerk,  about  fony-one  years  of  age,  of  sanguine  temperament,  who 
was  seized  six  days  after  a  journey,   during  which  he   had   exposed 
himself  all  night  at  the  coach  window,  with  a  violent  pam  proceeding 
from  the  frontal  branch  of  the  ophthalmic,  and  radiating  over  the  tem- 
pie  of  the  right  side  of  the  back  part  of  the  head.     Dr.  Le  Calve 
tbund  his  patient  in  violent  agitation,  and  uttering  piercing  shrieks. 
The  right  conjunctiva  was  much  injected,  the  eye  was  sufi*used  with 
burning  tears,  and  the  dread  of  light  was  extreme.     There  was  also 
a  lancinating  pain  at  the  bottom  of  the  orbit.     The  veratria  ointm.nt 
was  immediately  applied,  and  the  pain   yielded  to  a   friction  which 
lasted  sixty-two  seconds.     At  two  in  the  morning  a  fresh  paroxysm 
occurred,  which  yielded  like  the  former  to  a  friction  of  two  minutes. 
Ffteen  months  have  elapsed  without  any  rettirn  of  the  neuralgia.     In 
the  preparation  of  the  ointment,  Dr.  Le  Calve  gives  the  preference  to 
rancid  lard,    as  it  favors  the  formation  by  its  acidity,  of  acetate  of 
veratria.  Med.  Times. 


Epidemic  Erysipelas.  Dr.  Kognetta  states,  in  the  number  of  his 
Annales  de  Therapeutique  M6 licale  el  Chirur^icalc^  for  June  last, 
that  erysipelas  prevails  in  all  the  hospitals  of  Paris.  At  the  Hotel- 
Dieu,  at  Beaujon,  at  St.  Louis,  and  at  La  Chariie,  erysipelas,  he  says, 
is  general.  The  slightest  contusion,  the  least  irritation,  the  punc- 
turo  of  an  abscess,  promptly  give  rise  to  erysipelas,  which  often  runs 
a  falal  course. 

At  the  liopital  Veneriens,  the  disease,  in  manv  cases,  affects  the 
pcriloneiim,  and  terminates  fatally.  At  La  Chariie,  it  ctmstantly 
assumes  the  phlegmonous  form,  and  is  very  formidable  and  frtqnent- 
ly  falal.     Of  foui  patients  recently  Iri  iitcd  in  ihes^ervice  of  M.  Cirdy, 


282  Treatment  of  Lupus,  tSyc.  [May, 


for  contusion  of  the  elbow,  every  one  was  seized  with  severe  plilcg- 
inonpus  erysipelas,  with  sphacelus  of  the  subcutaneous  cellular  tissue. 
At  St.  Louis  the  epidemic  has  assumed  even  a  still  more  terrible  form, 
that  of  hospila] ga?)grcne.  At  the  Hotel-Dieu  punctures  from  bleed- 
ings,  or  from  leech  bites,  inflame,  suppurate  and  terminate  in  fatal 
plebitis;  or  they  induce  erysipelas,  which  extends  to  other  parls  and 
occasions  very  dangerous  symptoms.  Abscesses  ol'liltle  consequence, 
which  at  other  times  would  heal  in  a  few  days,  become  a  soured  of 
phlegmonous  erysipelas  after  being  opened,  which  requires  a  long 
treatment  and  the  |)rotracted  stay  of  the  patients  in  the  hospital, 
ev(!n,  indeed,  if  they  do  not  fall  vietims  to  it. 

The  treatment  has  been  antiphlogistic  in  all  the  hospitals.  M. 
Gcrdy  has  employed  deep  scarifications;  M.  Blandin  leeches,  in 
great  numbers,  along  the  course  of  the  vessels  and  over  any  engorged 
ghinds  which  may  exist.  M.  Jobert  treats  the  disease  with  frictions, 
with  an  ointment  of  nitrate  of  silver,  which  he  regards  as  a  powerful 
antiphlogistic,  and  M.  Rognetta  says  that  the  disease  is  conslanfiy 
limited  by  it.  M.  Jobert  employs  the  ointment  of  three  degrees  of 
strength,  according  to  the  intensity  of  the  disease;  the  |)ropoilions 
are  four,  eight,  and  twelve  parts  of  the  salt,  to  thirty  parts  of  laid. 
This  ointment  is  copiously  applied  over  the  whole  part  affected  with 
the  disease,  even  the  whole  body  if  necessary,  which  gives  to  the  pa- 
tient the  appearance  of  a  negro,  but  no  injury  has  ever  resulted.  M. 
Rognetta  says  that  he  has  seen,  in  the  service  of  M.  Jobert,  cases  of 
extremely  severe  erysipelas  arrested  and  cured,  as  if  by  enchantment, 
solely  by  the  use  of  this  ointment.  Am.  Jour,  of  the  Med.  Sciences. 


Treatment  of  Lupus,  <^'c.  By  Robert  Liston,  Esq.  We  have 
fo  deal  with  ulcersofthe  face,  and  they  are  of  different  kinds.  We 
do  not  f)ften  meet  with  simple  ulceration  here  except  from  accident. 
Ulcers  in  the  upper  part  of  the  body  heal  very  rapidly  ;  the  blood 
flows  freely  away,  and  this  is  very  essential  to  the  healing  process. 
Wounds  in  the  tipper  part  of  the  body  heal  in  one-fourth  part  of  the 
time  that  they  do  in  the  lower. 

Many  ulcers  here  assume  a  specific  clyii''^ctcr,  and  sometimes  com- 
mence from  very  slight  injury.  A  man  has  cut  himself  in  shaving, 
and  the  wound  has  become  poisoned,  as  the  saying  is,  somehow. 
Some  corrosive  or  irritating  stuffhas  been  applied  to  it  by  accident  or 
design,  the  oxide  of  some  metal,  such  a  panacea  as  brown  soap  and  su- 
gar; or  a  small  softish  wart  appears,  or  a  little  eruption,  and  from  this 
ulceration  takes  place.  These  ulcers  arise  about  the  alaeof  the  nose, 
sometimes  at  the  corner  of  the  eyes,  and  sometimes  on  the  cheek. 
Occasionally  they  begin  as  hard  tubercles,  and  go  on  extending. 
IVrhaps  the  sore  heals  at  one  [dace  and  spreads  at  another.  Although 
these  sores  are  troublesome  to  the  patient  and  intractable,  they  can 
scarcely  he  looked  upon  as  thoroiifihly  malignant.  'I'li^y  may  go  on 
and  destroy  all  the  parts  wilh  which  they  come  in  contnrt  ;  skin, 
muscles,  cartilages,  ;ind  bones  all  p(  rish  before  them.      Cases  which 


1845.]  Treatment  of  Lupus,  i^^-c.  l-'33 


are  neglected  may  proceed  from  bad  to  worse  for  a  number  of  years, 
until  scarcely  any  vestige  of  the  bones  of  the  face  or  their  covermfis 
is  left.  I  have  over  and  over  again  seen  patients  who  had  lost  all 
their  features,  lips,  nose,  and  eves ;  nolhinf;  remained  but  the  bram- 
pan  and  tongue,  and  they  required  to  be  fed  by  a  funnel  introduced 
over  the  base  of  this  organ  and  into  the  pharynx. 

These  ulcers  have  a  sharp  edge;  the  integument  around  them  >s 
sometimes  slightly  tuberculated,  and  the  edges  are  now  and  then,  as  it 
were,  worm-eaten,  but  there  is  noinflammation  around,  they  are  glaz- 
cdon  the  surface,  and  there  is  no  api)earance  of  granulation  in  them; 
they  may  continue  for  a  great  many  years,  causing  t^he  destruction 
I  lu'ive  mentioned  without  the  lymphatics  being  nt  aii  alTectcd,  without 
the  constitution  suffering  much,  and  without  the  disease  appearing 
in  other  tissues  or  organs  of  the  body. 

These  sores,  however,  may  be  made  to  heal  by  proper  treatment, 
however  extensive  they  may  be.  We  had  a  man  in  the  hospital 
lately,  an  honest  dealer  in  horses,  from  Yorkshire,  who  had  lost  a 
great  part  of  the  nose,  the  lips,  the  side  of  th#face,  and  one  eye. 
Trie  disease  had  been  going  on  lor  a  great  many  \cars;  when  ho 
came  in  there  was  a  sore  on  the  cheek  as  large  as  the  palm  of  the 
ban  1.  extending  in  all  directions,  but  he  left  with  this  sore  not  one 
quarter  that  size,  and  the  ulceration  was,  to  a  great  extent,  healed, 
though  not  entirely,  and  it  is  doubtful  whether  it  ever  will  be.  There 
beinz  such  an  excessive  loss  of  substance  the  remaining  soft  parts 
could  not  come  together,  so  as  to  assist  in  covering  the  void. 

Now,  this  affection,  which  has  been  termed  lupus,  or  noli  me  tan- 
gore,  or  herpes  exedens,  &c.,  may  be  at  once  put  a  stop  to  by  appro- 
priate treatment.     It  has  been  supposed  that  internal  medicines  do 
^rood;  arsenic  is  said  to  be  efTicacious,   but   it  is  by   local  treatment 
that  you  principally  succeed.     There  may  be  some  slight  swelling 
in  tlie  part,  and  the  parts  underneath  may  be  healed,   but  whenever 
you  see  the  edges  assume  a  sharp  appearance  they  mtist  be  destroyed 
by  an  active  escharotic.     You  may  employ  arsenical  paste,  but  tho 
consiitiition  is  apt  to  bo  dangerously  affected  by  it.     The  best  appli- 
cation  i.s  the  chloride  of  zinc,  mixed  up  dry,  with  an  equal  quantity 
<f  flour,  and  then  moistened,  by  abiding  a  little  water  to  it.     It  must 
be  ixw^eA  up  to  the  consistence  of  bird    lime,  and  you    may  spread  it 
on  lint;  but  the  better  plan  is  to  put  it  on  a  spatula,  dip  your  finger 
in  water,  and  then  lay  it  on  with  accuracy  round  the  sore,  and  then 
over  the  whole  of  it-     It  subjects  the  patient  to  some  pain,  but  that 
ceases  after  a  time,  and  tiie  paste  becomes  elevated  at    the  edges. 
You  then  find  that  an  extensive  slough  has  formed,  and  immediately 
that  separates,  instead  of  the  old  eating  ulcer  you  have  substituted  a 
healthy  granulating  surface,  the   part  furnishes    good   matter,   and 
there  is  soon  the  commencement  of  cicatrisation  all  around.     This 
may  be  done  in  all  stages  of  the  disease;  even  where  the  greater 
part  of  the    fei^tiires    are   destroyed  you    may    in    this    way    check 
the  dlsi>:is(^  ;  and  wherc*lhc  afleclion   is  not  so    far  advanced    you 


"N 


jy-l  Dangers  of  Surgical  Operations  Lilhotrity.  [May, 


may  destroy  it   altogether,   and   obtain  a  healthy  cicatrix   without 
much  deformity. 

'J'he  chloride  of  zinc  used  thus  is  a  most  active  and  effectual  reme- 
dy, but  it  causes,  as  might  be  expected,  severe  pain  for  some  hours 
after  its  application.  Lancet. 


Dangers  of  Surgical  Operations.  M.  Ballard,  Surgeon  in  Chief 
of  the  Military  Hospital  of  Bosancon,  read  (to  the  Academy  of  Sci- 
ences) a  paper  in  which  he  endeavors  to  show  that  the  dangers  and 
accidents  consequent  on  important  surgical  operations,  depend  much 
less  on  the  7node  of  operating  than  on  the  treatment  before  and  after 
its  performance.  He  has  observed  also  that  although  the  regimen 
maybe  various,  the  proportion  of  deaths  does  not  differ  materially  ; 
but  that  in  tliose  cases  in  which  a  liberal  diet  and  tonics  were  allow- 
ed, the  deaths  usually  occurred  from  the  fifth  to  the  tenth  day,  whereas 
it  took  place  betwe^  the  thirtieth  and  fortieth  day  among  those  sub- 
jected to  low  diet  and  blood-letting. 

The  autlior,  in  endeavoring  to  determine  the  causes  of  death  after 
surgical  operations,  enumerates  as  the  most  common  the  dread  of 
the  operation,  the  pain,  the  traumatic  or  suppurative  fever,  the  des- 
truction  of  tissues  by  suppuration,  and  finally,  the  collection  together 
of  large  numbers  of  sick,  marsh  efHuvia,  defective  ventilation,  d:c. 
M.  Ballard  therefore  looks  to  each  of  these  causes  in  establishing  the 
indications  to  be  attended  to.  In  the  first  place,  the  patient  should 
be  kept  in  ignorance  not  only  of  the  time  of  the  operation,  but  also  of 
its  necessity,  prior  to  its  performance.  Secondly,  the  sensibility 
should  be  destroyed  or  diminished,  so  as  to  render  the  operation  tol- 
erable ;  and  this  is  accomplished  by  the  author  by  compressing  the 
principal  nervous  trunks,  and  the  use  of  narcotics  in  full  doses  for 
several  days  in  succession.  Thirdly,  the  supervention  of  inflamma- 
tion should  be  prevented,  by  obviating  the  increase  of  heat  and  pain, 
which  may  be  done  by  surrounding  the  limb  with  bladders  filled 
with  water  of  such  a  tempei'ature  as  may  be  necessary. 

By  means  of  these  proj)hylactics,  the  author  says  he  lias  diminished 
the  mortality  to  such  a  degree  that  of  28  amputations,  (20  being  of 
thelower  extremity  and  12  of  the  thigh,)  ho  succeeded  in  every  in- 
stance, that  is  to  say,  that  death  did  not  occur  in  any  case  before 
complete  cicatrization,  nor  during  the  year  following.  Translated 
from  the  "  Gazette  MclicaJe,"  of  U^lh  Feb.,  1845.  D. 


Jjitliotrily.  ^I.  Arthauit,of  Paris,  lia<;4Rvonted  a  new  instrument 
by  which  he  can  irducc  large  urinary  calculi  into  cxtrejiuly  minute 


1845.]         "Treatment  of  Syphilis  Immovable  Bandages,  285 


fragments  in  a  single  sitting.  An  exhibition  of  this  method  was 
deemed  highly  satisfiictory  by  the  enhghtencd  persons  present.  The 
peculiarity  of  this  instrument  consists  in  the  sui)stitution  of  files  for 
the  perforating  and  crushing  agents  hitherto  employed.  Condensed 
from  the  Gazette  Medicate,  of22d  Feb.,  1845.  D. 


On  the  Treatment  of  Syphilis  by  Tartar- Emetic.  Dr.  Willebrand 
was  induced  to  make  trial  of  tartar-emetic  in  the  treatment  of  syphili- 
tic complaints,  in  the  military  hospitals,  from  observing  the  rapid 
removal  of  a  blenorrhoea  in  a  patient  who  was  using  that  medicine 
for  an  attack  of  rheumatism.  On  trying  the  efficacy  of  this  medicine 
on  a  large  scale,  he  found  that  urethral  discharges  were,  in  general, 
removed  in  from  six  to  fifteen,  or,  at  the  most,  twenty  days.  It  was, 
however,  in  the  cure  of  true  syphilis  that  this  medicine  was  found  of 
superior  efficacy.  Cases  of  primitive  chancre  were  cured  by  the  in- 
ternal use  of  tartar-emetic  alone,  in  from  ten  to  twenty  days,  no  ap- 
plication having  been  made  to  the  sore  but  simj)ie  water  dressing.  In 
a  few  cases,  in  which  there  was  much  induration  of  the  base  of  the 
sore,  a  cure  was  not  effi^cted.  In  fhirty  cases  of  secondary  affection, 
under  thcform  of  ulcerations  of  the  throat,  &c.,all  symptoms  of  the 
disease  disappeared  in  from  eleven  to  fifteen  days.  The  tartar-emetic 
was,  however,  continued,  as  a  precautionary  measure,  for  five  or  six 
days  longer,  after  which  the  medicine  was  discontinued  ;  and  though 
two,  and  in  some  instances,  three  years  have  since  elapsed,  no  relapse 
has  occurred  among  all  these  cases.  Most  of  the  cutaneous  affec- 
tions rapidly  and  easily  yielded;  but  some  of  the  more  inveterate 
ones,  as  the  pustular  and  squamous  syphilitic  eruptions,  required  from 
twenty  to  twenty-eight  days  for  their  removal.  In  some  of  these, 
from  the  antimony  disagreeing,  it  was  requisite  to  intermit  its  use. 

In  all  the  cases,  the  tartar-emetic  was  administered  internally  in 
the  same  manner,  viz.,  half  a  grain  six  or  eight  times  a-day.  The 
first  doses  generally  produced  vomiting;  but  by  the  second  day  tol- 
erance was  produced.  When  this  large  dose  seemed  to  disagree,  an 
eighth  of  a  grain  was  given  in  the  same  manner,  but  then  it  often 
failed  to  effect  a  permanent  cure.  Cleanliness,  'repose,  an  equable 
temperature,  and  regulated  diet,  were  the  only  adjuvant  means  used  ; 
and  Dr.  Willebrand  thinks  that  these  cases  show,  that,  in  very 
many  cases,  the  tartar-emetic  may  be  substituted  with  advantage  for 
the  more  dangerous  mercurial  treatment.  Edin.  Med.  and  Surg, 
Journ.,  from  Gaz.  Med.  de  Paris. 


Immovable  Bandages  of  Starched  Paper  fur  the  Treatment  of 
Fractures  of  the  Limbs.  By  M.  Laugikr.  Bands  of  starched 
jiaper  are  arranged  as  in  Scultets'  bandage,  and  form  three  super- 
imposed layers.  The  limb  is  placed  upon  these,  and  after  the  frac- 
ture is  reduced,  the  bands  are  applied.  Other  bands  of  paper,  also 
starched,  are  applied  around  the  foot,  and  extending  up  the  K'g  so  as 


:83        Encysted  BronchoceJc  Copuiba  Pills  Ointments.     [May, 


to  form  a  boot,  accurately  moulded  to  the^part.  After  drying,  which 
is  obtained  in  twelve  hours  in  summer,  and  twenty-four  hours  in 
winter,  by  the  aid  of  iicated  balls  or  bricks,  this  apparatus  forms  a 
very  solid  and  lijjlit  mould,  which  allows  the  patient  to  move  in  bed. 
Before  drying,  this  bandage  is  firmer  than  the  ordinary  Scullets' : 
the  patient,  however,  must  be  perfectly  quiet  for  some  hours  after  its 
jipplication.  It  can  never  be  too  tight;  it  is  suited  to  every  stage 
of  fracture,  even  to  fractures  complicated  with  wounds.  But  in  the 
latter  case,  the  limb  must  be  first  enveloped  in  gum-elastic  cloth,  in 
a  single  piece,  to  preserve  the  paper  from  the  pus,  which  softens  it. 
Surgeons  who  have  used  tiiis,  are  pleased  with  it.  It  may  be  errt- 
phiyed  in  all  cases  to  which  the  immovable  apparatus  is  applicable  :  
it  cannot,  however,  be  used  for  e fleeting  compression:  it  is  useful 
principally  to  secure  the  immobility  of  fragments,  and  painful  parts. 
It  commends  itself  by  its  lightness  and  its  cheapness;  the  latter  of 
some  importance  for  poor  patients,  in  the  country,  and  in  charitable 
institutions  poorly  provided  with  bandages.  U Experience  Ameri- 
can Journal  Sciences. 


Encys'ed  Bronchocele.  According  to  Dr.  Bouchacourt,  this  dis- 
case  is  not  seated  in  ttic  thyroid  gland,  but  in  the  lympha.tic  glands 
situated  near  it.  Of  all  the  methods  recommended,  injection  is,  he 
j^ays,  that  w  hich  offers  the  greatest  chance  of  success.  A  mixture 
of  one  part  of  the  tincture  of  iodine  with  two,  three,  four,  or  five 
j)arts  of  water,  is  sufficiently  irritating.  It  is  not  necessary  to  inject 
a  quantity  of  the  iodine  solution  equal  to  that  of  the  liquid  withdrawn  ; 
c)ne-half  or  one-third  is,  in  general,  sufficient,  and  it  may  be  left  in 
the  cyst  without  inconvenience.  The  hypertrophied  thyroid  gener- 
jilly  diminishes  from  the  excitation  produced  by  the  injection;  should 
this,  however,  be  insufficient,  iodine  may  be  given  internally  and 
rubbed  in  at  the  same  time.  An  appropriate  treatment  must  be  ad- 
ministered, according  to  the  constitution  of  the  patient.  Bulletin 
ds  Therapeutique. 


Pills  and  Boluses  of  Copaiba.  To  form  balsam  of  copaiba  into 
pills  and  boluses,  Dr.  J.  F.  R.  Simon  recommends  wax.  He  employs 
the  following  proportions,  which  have  been  very  generally  adopted  : 
For  pills:  liquified  white  wax,  one  drachm  ;  balsam  of  copaiba,  tw^o 
drachms;  powdered  cubebs,  three  drachms.  For  boluses:  liquified 
white  wax,  one  drachm;  balsam  copaiba,  three  drachms;  powdered 
cubebs,  six  drachms.  Med.  Times. 


Preparation  and  Preservation  of  Ointments.  M.  Deschamps,  in 
"  The  Journal  de  Pharmacie,^^  has  thrown  out  a  suggestion  upon 
this  subject  which  deserves  attention.  He  made  many  experiments, 
he  says,  first,  to  ascertain  whether  the  several  varieties  of  fat  may, 
in  all  cases,  be  used  indiscriminately;  and,  second,  whether  any 
means  can  be  devised  to  prevent  fats  from  becoming  rancid,  which 


le  lo.J  To  the  Reader.  297 


must  greatly  impair  their  value.  He  found  that  an  ointment,  prepared 
by  heating  the  buds  of  the  poplar  in  melted  lard,  is  subject  to  very 
little  alteration  by  keeping;  and  it  therefore  occurred  to  him  that, 
as  this  may  depend  vipon  a  portion  of  resin  extracted  from  the  poplar- 
buds,  asuKill  proportion  of  gum  benzoin  might  answer  a  similar  pur- 
pose. On  preparing  these  ointments  and  keeping  them  for  several 
years,  he  found  they  had  undergone  no  change,  no  approach  to  ran- 
cidity. Iodide  of  |)otassium  is  a  very  cxcolicnt  test  of  any  acidity 
in  fat.  And  by  this  test  he  found  that  no  admixture  with  fat  tends  to 
preserve  it  from  change  so  well  as  benzoin  or  poplar-buds  ;  the  latter 
produces  an  orange-yellow  colour,  but  its  colour  is  not  affected  by 
lonix  keeping,  even  mixed  with  acetate  of  lead. 

Fat  or  lard,  thus  prepared  with  poplar-buds,  or  gum  benzoin,  then, 
is  the  best  possible  basis  for  ointments  containing  melallic  substances, 
red  oxide  of  mercury,  acetate  of  lead,  iodide  of  potassium,  &c.;  with 
essential  oils  it  makes  lip-salve,  and  an  application  to  blisters  very 
much  preferable  to  ordinary  ointments.  London  Lancet. 


TO  THE  READER. 

In  the  original  department  of  this  No.  of  the  Journal,  ^'\\\  be  seen  an  Article 
from  my  respected  friend  Prof.  Du?as,  entitled  "Remarks on  a  Lecture  on  Mes- 
merism." I  here  propose  to  close  the  whole  discussion  of  this  subject;  thinking 
that  the  pages  of  the  Journal  may  be  more  profitably  filled  with  the  consideration 
of  matters  coming  more  within  the  scop^  of  scientific  inquiry  as  conducted  on 
acknowledged  and  well  establislicd  principles.  Mesmerism  is,  with  me,  not 
worth  a  controversy,  nor  can  I  persuade  myself  to  quarrel  with  my  friend  about 
the  mere  shadow  of  so  doubtful  a  substance ;  more  especiallv  as  he  would  have 
so  much  the  advantage  over  me;  for  by  "his  volition  and"a  few  passes,"  his 
opponent  might  be  thrown  into  a  mesmeric  state  and  mysterious  condition.  In 
the  way  oi  belief  too,  l,would  stand  no  chance  with  him.  It  is  not  my  desire  to 
enter  into  extended  controversy  in  the  Journal  on  this  or  anv  other  subject. 
Viewing  Mesmerism  in  the  light  I  do,  I  regret  the  space  occupied  by  it  in  the 
Journal;  but  it  was  unavoidable the  Editors  having  been  disappointed 
by  the  Gentleman  who  had  promised  an  Article  for  the  4th  No.  I  feel  my- 
self bound,  however,  to  make  in  passing  a  few  brief  notes  where  I  consider 
the  respected  author  of  the  Article  to  have  incorrectly  stated  my  meaning;  and 
I  do  so  the  more  trecly  inasmuch  as  I  have  received  from  him  a  private  commu- 
nication stating  he  does  not  object  to  my  taking  this  course, 

1st.  Jussieu  did  not,  as  I  have  amply  shown  in  my  Article,  confirm  tJie  report 
of  the  majority  of  the  commission;  biit  though  he  did  not  agree  to  every  thing 
in  that  report,  he  did  condemn  Alrsmer.  I  do  not  repeal  the  proof  of  this  undenia- 
ble fact,  but  refer  to  my  Lecture  inthe  Journal. 

2nd.  This  whole  matter  is  so  shadowy  and  uncertain  to  our  apprehension, 
that  we  arc  never  sure  that  we  have  a  correct  view  of  its  outlines.  It  did  seem 
to  me,  however,  that  the  ghostly  shape  of  modern  Mesmerism,  so  far  as  it  has  a 
.sAr/;;^,  does  .so  resemble  that  of  the  Mesmerism  of  sixty  years  ago,  as  to  force 
iipon  the  mind  of  every  common  observer  the  idea  of  at  least  a  paternal  rela- 
tion, if  not  an  identity.  And,  in  truth.  Dr.  Dugas  seems  to  have  had  some  such 
idea  himself  when  he  wrote,  "admit  the  facts  and  I  care  not  a  whit  for  the  ex- 
planation." If  the  Mesmeri.sm  ot  1784,  istoto  ccclo  different  from  the  Mesmerism 
of  184.5,  how  can  the  admission  of  the  facts  aUcsed  in  relatim.  to  the  foimcr  be  of 
any  avail  tn  him  in  the  endeavoi  to  establish "/A^  laUer?  We  do  sincerelv  ac- 
knowledge that  we  have  had  great  difficulty  in  geuing  any  definite  notion  of 
uluit  Mesmerism  ?.^,  though  we  have  found  no  difficulty  in  determining  to  our 
own  satisfaction  what  it  is.  net. 


2S8 


Meleoroloskal  Table. 


3rd.  The  RovrI  Academy  of  Medicine,  of  Paris,  in  1825,  received  a  report,  and 
ordered  it  to  be  published,  but  without  r/isaissioji  and  idthout  adoption.  Surely 
Dr.  Dugas  is  not  unaware  of  the  distinction  between  receiving  imil  adopting  sl 
rei)ort.  The  Royal  Academy  did  not  snnctimi  tkc  things  contained  in  that  Report. 
But  farther,  this  very  Academy  in  1S37,  by  a  commission  of  MM.  Roux,Bouil- 
laud,  tl.  Cloquct,  Emery,  Pellctier,  Cavcnton,  Cornac,  Oudet,  and  Dubois  con- 
doinied  Mesmerism.  The  same  inconclusiveness  is  observable  in  the  other 
ir.cts  mentioned  by  my  friend.  The  Royal  edictof  the  King  of  Prussia,  in  1817, 
does  not  prove  that  he  believed  Mesmerism  true.  And  so  of  the  Academy  of 
Sciences  of  Berlin  their  offering  a  prize  for  "  the  best  work  on  animal  magnet- 
ism," is  no  proofthat  they  believed  all  its  wonders.  But  even  had  the  Emperor 
of  Russia,  the  Kingof  Denmark  and  the  King  of  Prussia,  put  forth  edicts  assert- 
ing the  truth  of  Mesmerism,  what  must  be  thought  of  the  strength  of  an  alleged 
doctrine  of  medical  philosophy,  that  has  to  lean  for  support  upon  the  authority 
of  the  crowned  heads  of  Europe  as  they  existed  thirty  years  ago  1 

If  this  is  all  the  extent  of  fact  and  all  the  force  of  argument  that  can  be  brought 
forward  to  disprove  my  positions,  I  thank  my  learned  friend  for  the  incidental 
support  which  I  regard  those  propositions  as  receiving  from  his  "  Remarks." 
In  truth,  those  propositions  seem  to  me  stronger  than  before.  Truth  is  always 
advanced  by  fair  and  amicable  discussion. 

P.  S.  Those  who  may  wish  to  pursue  the  .subject  of  Mesmerism,  are  referred 
to  a  full  expose  in  the  last  No.  of  the  London  Lancet.  PAUL  F.  EVE. 


METEOROLOGICAL  OBSERVATIONS,  for  March,  1815,  at  Augusta, 

Ga. 

Latitude  33^'  27 

north  ] 

lEtER. 

3,  p.  M. 

jongitude 

4*^  32'  west  Wash. 

Thermometer. 
Sunrise.  3,  p.m. 

Baroj 
Sun  rise 

Wind. 

Remarks. 

1 

33 

64 

29  8-10 

a)  8-10 

s.  w. 

Fair. 

2 

44 

69 

29  8-10 

29  8-10 

s. 

Variable. 

3 

60 

77 

29  7-10 

29  8-10 

s. 

Variable. 

4 

68 

72 

29  8-10 

29  7-10 

S.  E. 

Rain  2-10  inch. 

5 

56 

68 

29  6-10 

29  7-10 

W. 

Fair. 

6 

46 

73 

30  in. 

30  in. 

E. 

Fair. 

7 

52 

77 

30 

29  9-10 

S.  E. 

Variable. 

8 

60 

80 

29  9-10 

29  8-10 

S. 

Variablv.-*, 

9 

58 

80 

29  8-10 

29  7-10 

S.  W. 

Variable. 

10 

e-2 

v59 

29  6-10 

29  6-10 

N.  W. 

Rain  3-10  inch. 

11 

42 

58 

29  7-10 

29  8-10 

N.W. 

Fair. 

12 

45 

55 

29  9-10 

29  9-10 

N.    E. 

Cloudy. 

13 

47 

57 

29  8-10 

2i)  8-10 

N. 

Rain  1  inch. 

14 

49 

63 

29  7-10 

29  6-10 

W. 

Variable. 

15 

41 

57 

29  7-10 

29  7-10 

w. 

Fair. 

16 

38 

60 

29  7-10 

29  6-10 

w. 

Variable. 

17 

45 

76 

29  5-10 

29  4-10 

w. 

Fair  high  wind. 

18 

47 

61 

29  5-10 

29  5-10 

w. 

Fair  high  vvind. 

10 

37 

53 

29  7-10 

29  7-10 

w. 

Fair high  wind. 

20 

33 

56 

29  9-10 

30  in. 

N.  W. 

Fair. 

21 

3:j 

58 

30  in. 

30 

N.  W. 

Fair. 

22 

31 

60 

30 

30 

E. 

Fair. 

23 

39 

61 

30 

29  9-10 

S. 

Cloudy rain  at  sun-set. 

24 

48 

52 

29  8-10 

29  8-10 

S. 

Rain  to  3,  p.  m.,  5-10  inch. 

25 

38 

60 

30  in. 

30  1-10 

\.    F,. 

Fair. 

2<) 

33 

6f; 

30  1-10 

30  2-10 

f-'.    E. 

Fair. 

27 

36 

72 

30  1-10 

30  1-10 
^0  1-10 

S.  W. 

Fair. 

28 

Ai 

72 

30  1-10 

s. 

Variable. 

29 

51 

76 

30  1-10 

30  1-10 

S.   E. 

Variable. 

30 

55 

74 

30  in. 

29  9-10 

E. 

Variable. 

31 

56 

61 

29  8-10 

29  8-10 

E. 

Cloudy. 

duantit.v  of  Rain  2  inrhes.     14  Fair  d? 


SOUTHERN 

MEDICAL  AND  SURGICAL 

JOURNAL. 


Vol.  I.]  NEW  SERIES. JL\E,  1815.  [No.  6. 


PART  I. ORIGINAL  COMMUNICATIONS. 


ARTICLE    I, 


Remarks  on  SecaJe  Cornutiim  in  Obstetric  Practice.  By  Joseph 
A.  Eve,  M.  D.,  Professor  of  Obstetrics  and  Diseases  of  Women 
and  Infants,  in  the  Medical  College  of  Georgia, 

It  has  been  remarked  of  Digitalis  by  Dr.  Ferriar,  "If  any  person 
were  disposed  to  write  a  satire  on   medical   evidence,   the  different 
testimonies  rcspoctinir  the  properties  of  this  single  plant  would  fur- 
nish abundant  materials;  'It  is  a  diuretic,'   snys  one  physician;   It 
has  no  diuretic  power,' says  another ;   It  is  a  stimulant,' says  a  third  ; 
*  It  is  a  sedative,'  cries  another  ;  '  It  has  no  properties  at  all,'  exclaims 
a  fifth."     The  opinions  entertained  by  the  profession  with  respect 
to  sccale  cornutum  are  equally  various  and  contradictory.     While 
by  some  it  is  extravaoranlly  lauded  as  a  powerful  and  valuable  agent 
in  obstetric  practice,  by  others  it  is  condemned  as  a  destructive  poi- 
son ;  others  again  regard  it  to  be  a  totally  inert  substance,  and  consi- 
der its  chief  merit  to  consist  in  its  incapacity  to  do  harm,  and  ascribe 
any  apparent  good  results  that  may  follow  its  administration,  to  mere 
coincidence,  or  to  the   influence  that  the  mind  exercises  over  the 
uterus,  and  profess  to  believe  that  any  other  substance,  devoid  of  all 
active  properties,  if  given  with  the  same  understanding,  would  an- 
swer altogether  as  well.     Even  among  those  who  admit  that  it  pes. 
scsses  valuable  powers,   there   is  great  contrariety   of  opinion  with 
respect  to  the   particular  cases,   conditions   and   circumstances    of 

10 


290  RemarJiS  on  Sccale  Cornutnm.  [June, 


cases,  to  which  it  is  applicable,  and  also  with  respect  to  the  variety 
and  extent  of  its  application  in  obstetric  practice. 

For  the  natural  and  medical  history  of  this  article  and  its  pharma- 
ceutic preparations,  we  would  refer,  as  to  the  best  sources  forcorrapt 
information,  to  the  last  edition  of  the  United  States  Dispensatory, 
Pereira's  ]\rateri:i  Medica,  Trai;e  Theoriqiie  et  pratique  de  I'Art  des 
Accouchements  par  P.  Cazeaiix,  the  Diclionnaire  des  Sciences 
Medicales  and  the  Dictionnaire  de  Medicine  et  de  Chirurcie. 

Our  design  is  to  treat  of  the  active  properties  of  ergot  and  its 
employment  in  obstetric  practice  and  only  to  mention,  in  passing, 
the  modes  of  administration  we  have  generally  found  most  conven- 
ient and  eflicient.  Before  proceeding  to  treat  the  subject  as  proposed, 
it  may  not  bo  uninteresting  or  inappropriate  to  make  a  hasty  and 
cursory  review  of  the  opinions  and  views  of  the  most  distinguished 
recent  obstetric  writers. 

The  late  Dr.  Gooch  condoinncd  ergot  in  the  most  summary  man- 
ner, without  a  trial.  This  most  reprehensible  inconsistency  does  not 
comport  with  the  superior  judgment  and  discrimination  evinced,  by 
this   highly  talented   author,  on  other  subjects. 

"The  Americans  (says  he)  recomtnend  the  ergot  of  rye,  in  doses 
of  a  drachm  or  two  scruples,  and  affirm  that  the  uterus  is  almost 
immediately  excited  by  it  to  a  vigorous  action.  1  never  used  it, 
neither  do  I  credit  what  has  been  said  respecting  its  efficacy." 

Dr.  Hamilton  of  Edinburgh,  than  whom  there  is  no  higher  author- 
ity in  obstetrics,  objects  most  decidedly  to  the  use  of  ergot,  after 
what  appears  to  be  a  most  fair,  candid  and  thorough  investigation  of 
the  subject,  and  arrives  at  the  conclusion  that  "the  evidence  of  the 
harmlessness  of  this  medicine,  when  given  in  moderate  doses,  is  sat- 
isfactorily established,  that  is,  that  it  has  no  power  either  to  do  good 
or  harm."  Our  limits  will  not  permit  us  to  state  the  facts  he  relates, 
or  the  arguments  he  advances,  to  support  his  position  ;  we  refer  the 
reader  to  his  most  excellent  "Practical  Observations  on  various  sub- 
jects relating  to  Midwifery." 

Madame  La  Chapplle,  after  having  instituted  a  series  of  experi- 
ments  with  the  secale  cornutum  in  the  Hospice  de  la  Maternite,  at 
the  suggestion  of  ?tIons.  Chaussicr,  says,  ''the  medicine  has  by  no 
means  realized  the  high  expectations  held  out  by  its  favorers,  and  its 
chief  virtue  consists  in  its  producing  no  bad  effect." 

Other  respectable  authorities  might  be  cited  who  denounce  it  as 
inert  and  useless.    On  the  other  hand,  in  support  of  the  high  claims  of 


1S45.]  Remarks  on  Secale  CorniUum.       -  291 


this  medicine,  and  in  proof  of  its  valuable  properties,  we  nnight  bring 
forward,  were  it  requisite,  a  preponderating  weight  of  authority  ; 
indeed  nearly  all  of  the  nnost  recent  authors  who  have  written  on  the 
subject  declare  more  or  less  in  favor  of  its  usefulness.  The  late  Pro- 
fessor De  wees  was  one  of  its  most  decided  and  strenuous  advocates, 
although  he  employed  it  with  much  more  caution  and  discrimination 
than  Professor  James  who  was  accustomed  toprej--cril>c  it,  with  a  free- 
dom and  fearlessness  which  few  at  present  would  venture  to  imitate. 
Dr.  Dewees  was  extremely  particular,  in  limiting  the  use  of  ergot  to 
certain  specified  conditions,  and  evinced  great  ar;umen  and  judgment 
in  defining  the  rules  and  explaining  the  principles  by  which  its  ad- 
ministration should  be  governed;  but  notwithstanding  he  restricts 
its  use  so  rigidly,  he  bears  the  following  high  testimony  in  favor  of  its 
valuable  powers  "  I  am  certain  that  I  do  not  use  the  forceps  now, 
where  I  formerly  u-jed  them  ten  times."  "  And  the  reason  of  this 
abatement,  in  the  employment  of  the  forceps,  may  I  think  be  fairly 
attributed  to  the  almost  universal  use  of  ergot,  by  every  kind  of 
practitioner  of  midwifery :  and  hence  I  presume  that  the  secale  cor- 
nutum  now  achieves  deliveries  that  would  have  required  the  forceps 
formerly  ;  for  were  this  not  the  case,  I  think  I  should  be  called  upon, 
as  formerly,  to  aid  labours  with  these  instrun}ents." 

Professor  Meigs  acknowledges  its  great  powers,  but  appears  to 
entertain  such  horror  of  the  disastrous  consequences  to  be  apprehend- 
ed from  its  use,  that  he  seldotn  employs  it  except  for  its  haemostatic 
properties.  "Upon  the  wliole,  (says  Dr.  Meigs.)  I  must  say  that  I 
feel  far  more  comfortable  and  free  from  apprehensions  for  the  child 
and  the  mother,  when  I  deliver  with  the  forceps,  than  in  waiting  the 
result  of  secale  cornutum." 

Professor  Antony  held  secale  cornutum  in  high  estiniation.  both  as 
a  haimostatic  remedy,  and  a  promoter  of  the  parturient  action  of  the 
uterus,  but  he  exercised  his  wonted  good  judgment,  in  defining  well 
the  cases,  to  which  he  considered  it  applicable,  condemning  most 
severely  the  indiscriminate  and  incautious  use  of  so  powerful  an 
agent. 

Although  long  known  upon  the  continent  of  Europe,  and,  especial- 
jy  in  Germany  and  France,  among  the  common  people,  as  an  ao-ent 
by  which  the  action  of  the  uterus  njight  be  increased,  and  althoufrh 
Desgranges  published  researches  on  the  subject  as  early  as  1777,  and 
Camerarius  published  on  the  same  subject  in  1709,  it  owes  its  gen- 
eral  introduction  into  regular  practice  to  American  physicians,  and 


292  Remarks  on  Sccale  Cormitum.  [June, 


principally  to  Dr.  Stearns,  of  New-York,  who  first  published  a  letter 
on  the  subject  in  1808  ;  and  subsequently,  but  in  a  greater  degree, 
to  the  great  influence  of  Dr.  Dewees.  In  our  country  there  are, 
now,  very  few  obstetric  authors  or  practitioners  who  do  not  acknow- 
ledge its  great  power  over  the  uterus,  however  much  ihey  may  difier, 
with  respect  to  its  value  and  safety  in  practice,  and  the  principles 
which  should  direct  and  govern  its  administration. 

Notwithstanding  the  great  opposition  and  prejudice  which  it  had 
to  encounter  in  Great  Britain,  Ireland,  and  the  continent  of  Europe, 
it  has  surmounted  every  impediment  against  its  introduction  into 
practice,  and  commended  itself  to  the  confidence  of  a  large  majority 
of  the  most  distinguished  obstetric  practitioners,  although  there  is 
considerable  diflcrence  of  opinion  among  them  with  respect  to  its 
safety,  utility  and  the  principles  that  should  govern  its  administration. 
Burns  admits  that  ergot  has  occasionally  a  decided  effect  in 
accelerating  delivery,  but  docs  not  appear  to  have  a  proper  apprecia- 
tion of  its  properties. 

Campbell,  in  his  "Introduction  to  the  study  and  practice  of 
Midwifery,"  speaks  of  it  as  one  of  the  acknowledged  resources  of 
the  art. 

Dr.  Collins,  in  his  valuable  "Practical  Treatise  on  Plidwifery,'* 
acknowledges  the  power  of  ergot  in  promoting  the  parturient  action 
ofthe  uterus,  and  remarks  that  he  has  been  particularly  struck  with 
its  sedative  effect  upon  the  circulation,  in  almost  every  instance  in 
which  he  has  exhibited  it. 

The  late  Dr.  David  D.  Davis,  in  his  luminous  and  voluminous 
work  entitled  "Obstetric  Medicine,"  acknowledges  himself  a  tardy 
believer  in  its  properties,  but,  contrary  to  his  usual  custom  with  other 
subjects,  says  very  little  about  it. 

Dr.  Blundell  expresses  himself  decidedly  in  its  favor.  "In  lin- 
gering parturition,  (he  says.)  you  will  frequently  find  the  ergot  of 
invaluable  use,  for  it  has,  in  a  high  degree,  the  power  of  exciting  the 
muscular  efforts  of  the  uterus."  "After  all  that  I  have  seen  and 
heard  respecting  the  action  ofthe  secale  cornutum,  I  think  there  is 
no  doubt  that  it  has  a  specific  power  of  stimulating  the  uterus,  pro-  . 
vided  its  muscular  irritability  be  in  a  state  well  fitted  to  receive  its 
impression."  Dr.  B.  does  not  believe,  though  he  is  by  no  means 
prepared  to  deny,  that  ergot  exerts  any  poisonous  influence  over  the 
child  in  utero. 

Dr.  Rigby  acknowledges  the  great   influence  of  ergot,  and  some 


1845.]  Remarks  on  Secale  Cornutum.  298 


other  substances,  over  uterine  contraction  ;  but  he  is  extremely  re- 
strictive of  its  use  during  labour  and  remarks,  that  "the  chief  value 
of  these  remedies  is  for  the  purpose  of  exciting  uterine  contraction3 
after  labour,  and  thus  to  promote  the  safe  expulsion  of  the  placenta, 
when  there  is  a  disposition  to  inertia  uteri,  and  insure  the  patient 
against  haemorrhage." 

The  testimony  of  Dr.  F.  H.  Ramsbotham  is  decidedly  in  favor  of 
the  utility  and  safety  of  secale  cornutum,  when  employed  with  proper 
caution  and  discrimination.  "I  have  (says  Dr.  R.)  given  the  ergot, 
in  the  doses  recommended,  every  four  or  six  hours,  for  many  succes- 
sive days,  on  several  occasions,  and  never  knew  it  produce  any  bad 
effect  upon  the  mother,  except,  occasionally,  nausea  and  vomiting. 
Usually  there  is  no  more  influence  perceptible  on  the  general  system 
than  would  be  obtained  after  taking  a  cup  of  tea  ;  but  its  effects  upon 
the  uterus  in  labour  are  often  speedy,  powerful  and  astonishing." 

Dr.  Churchill  says  "From  repeated  trials  I  can  bear  testimony  to 
its  efficacy,  though  it  is  somewhat  irregularly  exerted;  but  I  must 
add  that  I  have  seen  it  do  mischief." 

Dr.  Robert  Lee  remarks  of  ergot,  "there  can  be  no  doubt  that  it 
occasionally  does  act  upon  the  uterus,  and  very  violently  ;  but  he  ap- 
pears to  be  more  impressed  with  an  idea  of  the  dangers  to  be  appre- 
hended,  than  of  the  benefits  to  be  derived,  from  its  use:  I  have  never 
ventured,  (says  he,)  in  either  public  or  private  practice,  except  in 
cases  of  accidental  uterine  haemorrhage  and  retained  placenta,  to 
administer  the  ergot  of  rye  to  a  woman  in  labour." 

M.  Velpeau  expresses  the  most  decided  confidence  in  the  power  of 
ergot  to  re-excite  and  increase  the  contraction  of  the  uterus. 

We  have  already  referred  to  M.  Cazeaux  for  the  natural  history  of 
secale  cornutum,  and  with  equal  propriety  we  might  refer  to  his 
theoretic  and  practical  treatise,  for  a  most  excellent  account  of  its 
therapeutic  action.  His  views  are  strongly  in  its  favor,  both  as  a 
mean  to  expedite  labour,  and  restrain  haemorrhage. 

Cazeaux,  Chailly,  Dubois,  F.  H.  Ramsbotham,  and  some  other 
authors,  consider  ergot  not  only  capable  of  re-exciting,  and  augment- 
ing the  contractions  of  the  uterus,  but  of  originating  them  at  any  time 
during  gestation:  hence  they  regard  it  as  a  valuable  agent,  when  it 
becomes  necessary  to  induce  premature  lal)our. 

M.  Moreau,  in  his  "Traile  Pratique  des  accouchements,"  remarks 
of  ergot,  "  we  arc  of  opinion  that  it  is  far  from  being  inactive,  but  that 
its  action  is  neither  so  constant,  nor  so  active  as  many  suppose  :"  he 
iays,  *  he  is  far  from  proscribing  it  but  riirely  uses  it." 


294  Remarks  on  Secale  Cornulum.  [June, 


We  have  now  brought  forward  the  opinions  of  a  number  of  the 
most  (listinguislied  American  and  European  Obstetricians  on  the 
subject  of  ergot;  some  ofwiiom  wo  find  reject  it  as  powerless,  otliers 
condemn  it  as  violent  and  dangerous,  whilst  others  recommend  it  as 
an  efficacious  and  invaluable  agent  in  obstetric  practice. 

In  farther  testimony  of  the  useful  properties  of  ergot  in  the  prac- 
tice of  midwifery  and  the  treatment  of  the  diseases  peculiar  to 
woman,  were  corroboration  necessary,  we  might  adduce  the  names 
of  Baudelocque,  Goupil,  Roche,  Gardien,  Diiparcque,  Ashwell,  Lis- 
franc,  Trousseau,  Waller,  Ingleby,  and  Colombat :  indeed  the 
catalofTue  of  hii^h  authorities  mif^ht  be  extended  to  an  almost  inter- 
minable  extent. 

It  appears  to  me,  if  any  one  were  to  approach  the  investigation  of 
the  properties  of  secale  cornutum,  unprejudiced,  for  or  against  it,  and 
without  any  previous  acquaintance  with  it,  after  carefully  weighing 
and  balancing  all  the  discordant  testimony  and  the  various  opinions 
of  distinguished  authors,  he  would  come  to  the  conclusion,  that  those 
who  found  it  productive  ol'no  decided  eiTect,  were  very  unfortunate  in 
the  choice  of  the  article  they  prescribed,  or  in  the  selection  of  the 
subjects  to  whom  they  administered  it,  and  that  as  it  is  generally 
acknowledged  to  be  a  very  perishable  substance,  it  must  have  lost  its 
properties,  or  the  patients  must  have  resisted  its  influence  from  some 
peculiarity  of  constitution  ;  that  on  the  whole,  it  is  neither  so  gener- 
ally dangerous,  as  some  apprehend,  nor  so  invariably  safe  as  others 
seem  to  believe;  that  it  undoubtedly  exercises  great  power  over  the 
action  of  the  uterus,  and  consequently,  must  be  as  capable  of  doing 
injmy  when  improperly  used,  as  of  accomplishing  good  when  judi- 
ciously prescribed:  and  we  cannot  conceive  how  any  person,  after 
examining  its  properties  experimentally,  and  carefully  and  candidly 
observing  its  eO(;cts,  could  arrive  at  any  other  conclusion. 

That  ergot  does  possess  a  peculiar  and  powerlul  influence  over  the 
uterus,  is  now  too  well  established  to  be  called  in  question  an  influ- 
ence that  may,  with  proper  sliill,  be  wielded  for  the  achievement  of 
the  most  beneficial  effects,  but  which,  by  ignorance  and  temerity,  may 
be  rendered  productive  of  the  most  disastrous  results.  A  powerful 
and  safe  medicine  is  certainly  a  solecism,  most  absurd  and  ridicu- 
lous;  the  ability  to  eflect  good  imj)liosthe  power  to  do  harm. 

We  will  now  proceed  to  give  our  own  viewt  of  i(s  tflJcts,  and 
describe  the  cascis  to  which  we  consider  it  applicable,  with  due  respect 
and  deference  always  to  the  high  auihorities   from  which   we  may 


1845.]  licniarks  on  Secale  CornuLum>  295 


occasionally  differ  a  difference  which  may  however  be  considered 
pardonable  in  the  most  humble,  as  there  is  so  little  unanimity  among 
themselves :  If,  however,  amid  so  much  diversity,  and  contrariety  of 
opinion,  so  calculated  to  confuse  and  mislead  the  young,  and  inexpe- 
rienced, we  may  be  so  happy  as  to  establish  any  principles,  or  lay 
down  any  rules  that  may,  in  any  degree,  assist  our  junior  brethren,  in 
the  employment  of  an  agent  so  energetic,  and  consequently  so  hazard- 
ous, our  object  will  be  fully  attained. 

Whether  ergot  is  capable  of  originating  the  parturient  action  of 
the  uterus,  before  it  has  commenced,  we  cannot  from  our  experience 
determine,  never  having  prescribed  it  for  that  purpose,  nor  known  a 
case  in'Avhich  that  result  followed  its  use  ;  but  we  can  readily  believe 
it  competent  to  that  effect,  from  what  we  have  repeatedly  witnessed 
of  its  influence  over  the  unimpregnated,  as  well  as  the  parturient 
womb,  and  upon  the  respectable  authority,  already  cited  in  support  of 
that  opinion. 

This  medicine  not  only  puts  into  action  the  longitudinal  fibres  of  the 
uterus,  by  the  contractions  of  which,  while  the  circular  are  passive, 
its  mouth  is  dilated  and  its  contents  expelled,  but  it  stimulates  all  the 
fibres  equally  at  the  same  time  to  contract,  and  thus  produce  an 
equable  and  general  condensation  of  the  coats  of  the  uterus,  contrac- 
tion and  diminution  of  its  cavity,  and  compression,  rather  than  extru- 
sion, of  its  contents. 

The  ergotic  contractions  differ  most  decidedly  from  those  of  natu- 
ral labour,  in  havinsf  no  intermission  between  them,  consisting  in  a 
permanent  spasmodic  contraction  which  admits  only  of  slight  remis- 
sions, but  no  distinct  intervals  of  ease.  This  action  is  so  different 
from  the  natural,  liiat  it  is  truly  astonishing  that  any  candid,  intelli- 
gent  observer  could  ever  fail  todistinguish  between  them  and  attribute 
the  revival  of  labour,  after  its  administration,  to  mere  coincidence: 
It  is  true  that  there  are  exacerbations  and  remissions  of  pain,  but  the 
uterine  globe  continues  permanently  hard  and  contracted  upon  its 
contents :  patients  themselves  readily  recognize  the  difference  be- 
tween natural  labour  and  the  action  of  ergot  :  it  is  usual  to  hear 
those  who  have  experienced  its  effects  before,  when  they  take  it 
again,  say,  "now  I  shall  have  no  rest,  nor  peace,  until  the  child  is 
born." 

(Generally  in  ten  or  twenty  niintites  after  it  is  tak<'n,  its  effect  is 
maniCcsted;  but  ue  nre  contiiliMit,  from  repeated  observation,  (hat 
this  is  not  invarial>ly  the  case.    In  some  instances  we  have  known  no 


296  Remarks  on  Secale  Cornutum.  [June, 


effect  evinced  until  an  liour  or  more  had  elapsed.  In  one  instance  of 
abortion  in  which  it  was  administered  very  liberally  to  restrain 
haemorrhage  and  cause  the  expulsion  of  the  placenta,  but  without 
any  apparent  inllucnce,  its  action  was  so  powerfully  developed,  some 
hours  afier  its  discontinuance,  that  the  placenta  was  ejected  with 
force  some  distance  below  the  patient's  knee.  We  could  account 
for  this  unusual  spasmodic  action  of  the  uterus,  in  no  other  mode, 
than  by  attributing  it  to  the  influence  of  the  ergot  previously  ad- 
ministered. 

Cazeaux  says  the  action  of  the  ergot  decreases  in  an  hour  or  an 
hour  and  a  half,  and  soon  ceases,  and  that  it  becomes  necessary  to 
repeat  it,  or  resort  to  other  means,  if  the  object  for  which  it  was  given 
has  not  been  accomplished.  This  may  be  generally  correct,  but  not 
uniformly  ;  it  sometimes  continues  much  longer,  without  any  mate- 
rial diminution  ;  and  when  its  influence  upon  the  parturient  action  of 
the  uterus  has  subsided  entirely,  its  effect  upon  the  tonic  contraction 
continues  with  little  or  no  abatement.  Dr.  Dewees  was  certainly 
right  in  assertino^  that  the  uterus  is  less  liable  to  fall  into  a  state  of 
inertia  after  being  excited  to  action  by  the  ergot  than  by  other 
means;  an  additional  dose  may  indeed  sometimes  be  necessary,  after 
the  delivery  of  the  child,  for  the  expulsion  of  the  placenta  ;  but  this 
will  not  be  found  generally  requisite. 

From  this  view  of  the  mode  of  operation  of  ergot,  after  having 
given  what  may  be  considered  a  full  dose,  (5i.  to  3ij.  of  the  powder, 
or  from  gi.  to  ii.  of  the  vinous  tincture,)  we  deem  it  expedient  to 
wait  some  hours  before  any  farther  administration,  unless  the  indica- 
tion for  its  employment  be  urgent;  but  when  it  is  clearly  indicated, 
and  the  demand  for  it  pressing,  its  administration  may  be  repeated 
or  carried  to  almost  any  extent,  with  as  great  or  greater  impunity 
than  any  other  medicine  of  the  same  power. 

That  it  may  have  produced  devastating  epidemics,  dry  gangrene, 
narcotism,  and  convulsive  diseases,  when  taken  in  enormous  quanti- 
ties,  or  for  a  very  long  time,  it  would  be  presumption  in  us  to  deny 
in  the  face  of  so  much  respectable  authority,  although  equally  good 
might  be  cited  for  a  contrary  opinion  ;  but  we  do  assert,  after  having 
employed  it,  in  cases  adapted  to  its  use,  very  liberally,  and  witnessed 
its  freer  and  more  incautious  employment  by  others,  we  have  never 
known  it  produce  on  the  mother  any  other  bad  effect  than  nausea 
and  vomiting,  and  these  much  less  frequently,  when  the  wine  has 
been  exhibited,  instead  of  the  decoction.  In  this  our  experience  cor- 
responds  precisely  with  that  of  Dr.  Ramsbotham  already  stated. 


1845.]  Remarks  on  Secdle  Cornutum,  29' 


The  injurious  consequences  that  may  result  to  the  parturient  wo- 
man from  the  development  of  its  specific  action  on  the  uterus,  under 
circumstances  unfavorable  to  its  use,  will  be  detailed  hereafter.  That 
it  often  exercises  a  deleterious  influence  upon  the  foetus  in  utero, 
when  improperly  used,  is  we  believe  generally  acknowledged,  but 
variously  accounted  for  by  different  authors  :  some  attribute  it  to  a 
poisouous  property  absorbed,  and  conveyed  by  the  maternal  blood  to 
the  foetus  ;  and  Dr.  Beatty,  in  an  excellent  article  upon  ergot,  pub- 
lished in  a  recent  number  of  the  Dublin  Journal  of  Medical  Sciences, 
goes  so  far  as  to  lay  it  down  as  a  rule  that  it  should  never  be  admin- 
istered, whenever  there  is  a  probability  that  the  delivery  will  not  be 
accomplished,  before  time  may  elapse,  sufilcient  for  its  absorption 
and  transmission  to  the  foetus  through  the  utero-placental  circula- 
tion, which  time  he  defines  to  be  about  tuo  hours.  The  death  of  a 
foetus,  exposed  for  even  less  than  one  hour  to  the  violent  ergotic  ac- 
tion of  the  uterus,  might,  we  think,  be  reasonably  apprehended  and 
accounted  for,  without  the  supposition  of  the  absorption  and  trans- 
mission  of  a  poisonous  property  through  the  maternal  blood. 

We  have  never  seen  any  cause,  nor  heard  any  argument  advanced, 
sufficient  to  induce  a  belief  that  ergot  possesses  any  such  property  ; 
indeed  our  experience  and  observation  have  furnished  us  with  the 
most  satisfactory  proof  to  the  contrary.  Formerly,  when  we  em- 
ployed it  with  less  discrimination  than  at  present,  and  more  recently, 
when  prescribed  by  others,  we  have  frequently  known  ergot  admin- 
istered for  several  hours  before  delivery,  without  the  foetus  having 
sustained  the  slightest  perceptible  injury.  Were  it  necessary  to  for- 
tify our  opinion,  by  the  corroborative  support  of  high  authority, 
many  of  the  most  distinguished  names  might  be  invoked.  That  the 
foetus  often  perishes  in  consequence  of  the  untimely  and  injudicious 
use  of  this  drug,  we  would  be  the  last  to  deny:  but  we  consider  it 
fairly  attributable  to  the  mechanical  effect  of  the  long  continued,  un- 
intermittent,  violent  pressure  upon  t[ie  foetus  and  the  placenta  and 
umbilical  cord,  chiefly  perhaps  by  impeding  or  suspending  the  pla- 
cento-fa3tal  circulation,  upon  the  regular  performance  of  which  life 
depends  as  essentially,  during  the  fcetal  state,  as  upon  respiration 
after  birth.  But  besides  the  suspension  of  aeration,  it  may  be  the 
consequence  of  congestion  of  the  brain  or  lungs,  caused  by  the  pla- 
centa being  so  constantly  and  firmly  compressed  that,  while  it  can 
receive  little  or  no  blood  from  the  umbilical  arteries,  more  than  dou- 
ble the  usual  quantity  is  forced  through  the  umbilical  vein,  thus  pro- 


^''^^  Remarks  on  Secale  Cornulum.  [June, 


ducing  dangerous  if  not  fatal  pletliora  in  the  fcetal  system.  So  much 
injury  indeed  do  we  consider  likely  in  this  way  to  accrue  lo  the  deli- 
cate organization  of  the  fojUis,  that  we  are  accustomed,  as  highly  as 
we  appreciate  the  powers  of  ergot,  to  abstain  from  its  use,  even  after 
the  birth  of  the  child,  until  the  cord  has  been  ligated,  unless  imperi- 
ously indicated  to  prevent,  or  counteract  some  greater  danger.  In 
some  cases,  the  death  of  the  fa3tus  may,  as  some  suppose,  depend 
upon  the  placenta  becoming  detached  from  the  uterus;  but  we  are 
disposed  to  believe,  when  not  dependent  on  an  interruption  of  the 
placento.fa3tal  circulation,  it  results  from  the  long  continued  and 
severe  compression  and  contusion  of  important  organs,  as  the  brain, 
lungs,  ik,c.  Our  views  with  respect  to  the  effects  of  ergot  upon  the 
fcetus,  summed  up,  are,  that  it  possesses  no  poisonous  property,  but 
that,  although  the  child  may  sometimes  escape  unhurt  after  its  long 
continued  and  often  repealed  administration,  it  is  always  obnoxious 
to  injury  from  it,  at  any  time  before  the  establishment  of  pulmonary 
respiration  and  ligation  of  the  umbilical  cord. 

We  will  now  proceed  to  consider  its  practical  employment,  and 
define  the  cases  to  which  it  is  applicable.  The  therapeutic  virtues, 
and  practical  utility  of  this  article  are  becoming  ni(jre  and  more 
developed,  and  commanding  more  attention  and  higher  respect 
from  the  profession,  but  more  enlightened  views  of  its  properties 
have  greatly  restricted  its  employment  during  labour,  while  they 
have  much  extended  its  application  to  the  remedial  management 
of  the  diseases  peculiar  to  females.  In  this  place,  however,  we 
will  only  consider  its  employment,  during  the  different  stages  of 
labour.  Inasmuch  as  it  acts  equally  upon  the  circular  as  well  as  the 
longitudinal  fibres  of  the  uterus,  it  is  never  proper  in  the  first  stage, 
that  is,  until  the  mouth  of  the  uterus  is  fully,  or  nearly  dilated,  and 
very  dilatable,  except  perhaps  in  some  cases  of  excessive  haemorrha- 
ges  of  the  accidental  kind,  and  in  some  cases  of  violent  convulsions 
occurring  early  in,  or  anticipating  the  commencement  of  labour.  It 
is  a  question,  doubtful  with  us,  whether  even  in  these  cases  it  is  an 
a|)propriate  prescription:  at  least  we  have  never  met  with  a  case  of 
haemorrhage,  in  which  it  appeared  expedient  to  employ  ergot,  before 
the  first  stnge  was  completed,  or  considerably  advanced,  and  we- are 
disposed  to  believe  that,  at  most  witii  very  rare  exceptions,  it  would 
be  preferable  to  defer  its  use,  and  endeavor  to  expedite  delivery  by 
rupturing  the  mcndirancs.  and  assisting  mechanically,  the  dilatation 
of  the  OS  lincir,  and  even  if  it  should  be  deemed  nccesciary,  on  account 


1845.]  *        Remarks  on  Secale  Cornufum.  299 


of  the  extreme  urgency  of  the  symptoms  to  resort  to  it  sooner,  these 
methods  should  be  practiced  simultaneously  as  indispensable  adjuv- 
ants. With  respect  to  convulsions  occurring  during  labour,  or  near 
the  termination  of  gestation,  inasmuch  as  delivery  is  always  essential 
to  a  cure,  and  ever  to  be  looked  upon  as  the  principal,  if  not  sole,  reli- 
ance for  safety  to  the  mother,  it  might  be  proper  to  administer  ergot 
by  the  mouth  if  practicable,  or  in  the  form  of  an  enema,  to  originate 
or  promote  labour  anterior  to,  or  at  the  very  commencement  of  the 
process;  but  we  leave  the  solution  of  the  question  to  others.  Our 
own  practice  has  been  to  defer  ils  exhibition  until  labour  was  consid- 
erably advanced,  when  we  have  had  reason  to  be  pleased  with  ils 
effecfs. 

If  the  first  stage  be  properly  conducted,  so  that  while,  on  the  one 
hand  no  injudicious  interference  is  practiced,  on  the  other  no  impro- 
per  expenditure  of  strength  or  waste  of  time  is  allowed,  artificial 
assistance  of  any  kind  will  seldom  be  required  in  tiie  second  :  some 
cases  however  do  occur,  in  which,  notwithstanding  the  most  skilful 
management,  ergot  may  be  most  advantageously  used,  but  many 
more  arc  to  be  found,  wiiich  result  from  the  ofiiciousness  of 
ignorant  midwives. .  Although  there  is  doubtless  too  often  a  resort 
made  to  ergot,  where  time  and  patience  are  the  appropriate 
remedies,  it  is  equally  certain  that  it  has  often  superseded  the 
employment  of  instruments  to  the  advantage  of  mother  and  otT* 
spring. 

It  has  without  doubt  been  prescribed  too  indiscriminately  to  expe- 
dite delivery  in  lingering  labours.  Il  is  certainly  a  difficult  point  to 
determine  when  to  employ  it  for  this  purpose.  We  seldom  find  it 
necessary,  at  any  rate,  never  venture  to  use  it,  while  the  uterus  is 
acting  with  as  much  force  as  it  appears  capable  of  exerting;  for  il  is 
certainly  hazardous  to  excite  it  to  still  greater  exertion,  as  rupture 
of  the  uterus  itsfdf,  convulsions,  exhaustion,  or  some  other  dangerous 
consequence  might  very  reasonably  be  apprehended  :  under  such 
circumstances  it  is  far  more  rational,  if  possible,  to  endeavor  to  over- 
come the  resistance.  If  exhaustion  should  have  already  supervened, 
or  the  patient  be  approaching  that  state,  from  the  long  continued, 
ineffectual  action  of  the  womb,  if  it  were  practicable  to  re-excite  the 
fatigued  organ  to  renewed  activity,  it  would  only  be  to  render  the 
exhaustion  more  complete,  and  the  fatal  result  more  certain.  It 
is  more  than  probable  that,  before  the  supervention  of  exhaustion, 
the  uterus  has  already  exerted  its  utmost  capacity  toward  the  accom. 


300  Remarks  on  Secale  Cornutum.  [June, 


piishmcnt  of  delivery,  and  (hat  instrumental  aid  furnishes  the  only 
hope  of  rescue  ;  but  there  are  cases  in  which  the  womb,  after  acting 
feebly  for  a  considerable  time,  brings  the  presenting  part  to  rest  upon 
the  perinaeum,  and  all  that  seems  required  to  terminate  the  labour,  is  a 
little  increase  in  its  action,  a  little  more  expulsive  power.  At  such  a 
juncture  we  can  see  no  objection  to  the  administration  of  ergot,  and 
we  believe  it  far  preferable  to  tiie  application  of  the  forceps,  safer  for 
both  mother  and  child. 

It  is  not  uncommon  at  any  period  of  the  labour  for  the  pains  to 
subside,  without  any  of  the  symptoms  of  exhaustion,  afibrding  the 
patient  a  temporary  respite  from  suffering.  Unless  there  be  an  ur- 
gent  necessity  for  prompt  delivery,  it  is  generally  better  not  to 
interfere,  during  this  temporary  suspension,  but  to  allow  her  spirits  to 
revive,  and  strength  to  become  recruited.  Should  this  cessation  of 
the  pains  occur  very  near  the  termination  of  labour,  the  patient  not 
exhausted,  especially  if  she  should  have  passed  without  difficulty 
through  previous  deliveries,  we  would  unquestionably  prefer  the  ad- 
ministration of  ergot  to  the  introduction  of  the  forceps,  or  to  permit- 
ting her  to  remain  long  undelivered.  It  must,  however,  be  remem- 
bered that  near  the  close  of  labour,  alarm,  or  apprehension  of  the  last 
throes,  often  frightens  away  the  pains,  when  hope  encouraged  will 
recall  them  again,  which  expedient  should  always  be  fully  employed, 
before  resorting  to  ergot  or  any  artificial  assistance. 

Many  accidents  or  complications  are  liable  to  occur  during  the 
second  stage,  in  which  ergot  becomes  a  most  invaluable  resource.  In 
accidental  ha3morrhage,  when  uncomplicated  with  preternatural  pre- 
sentation of  the  fcetus,  or  mechanical  impediment  to  the  delivery,  it 
is  a  most  precious  agent,  the  efficacy  of  which  very  few  at  the  present 
day  would  venture  to  call  in  question.  It  is  equally  efficacious  in 
haemorrhage  dependent  on  partial  presentation  of  the  placenta.  In 
complete  placenta  previa,  it  is  generally  inapplicable,  as  the  tendency 
would  be  to  increase  the  separation  of  the  placenta,  and  consequently 
aggravate  the  ha3morrhage.  It  is  not  proper  until  after  turning 
(which  is  the  indication  in  such  cases)  has  been  effected,  after  which 
it  may  be  very  advantageously  employed  to  hasten  delivery,  should 
the  uterus  then  not  act  with  energy.  We  know  of  one  case  of  pla- 
centa previa,  in  which,  contrary  to  the  acknowledged  principles  of 
practice,  ergot  was  administered  and  succeeded  most  admirably  by 
causing  the  expulsion  of  the  placenta  foremost,  and  the  foetus  imme- 
diately after  it ;  such  a  favorable  result,  however,  could  not  be  safely 


1945. J  Remarks  on  Secale  Cormilum.  301 


calculated  on.  In  our  own  practice  a  case  anticipated  our  intention 
to  turn,  by  terminating  suddenly  and  spontaneously  in  this  way  :  the 
ovum  was  expelled  entire,  the  placenta  upon  the  fore-end,  the  foBtus 
alive  and  moving  vigorously  in  the  waters.  These  cases  present 
rare  exceptions  to  the  general  rule  :  the  alternatives  are  usually  turn- 
ing or  death. 

The  following  case  will  illustrate  the  indispensable  importance  of 
ergot,  in  the  management  of  uterine  hsemorragc  during  labour.  At 
our  first  visit  to  a  woman  on  a  neighboring  plantation,  July  r2th, 
1842,  we  found  her  in  a  state  of  extreme  prostration  from  flooding, 
almost  pulseless,  with  cold  surface,  nausea  and  vomiting  ;  she  was  in 
the  eighth  month  ;  labour,  the  result  of  violent  exertion,  commenced 
on  the  11th,  with  rupture  of  the  membranes  and  loss  of  the  liquor 
amnii ;  the  os  uteri  was  considerably  dilated,  but  the  pains  had  near- 
ly ceased.  Nothing  except  ergot  afforded  the  slightest  ground  for 
hope  :  an  attempt  to  deliver  by  turning  would  in  all  probability  have 
exhausted  the  little  remnant  of  life:  the  system  had  not  energy 
enough  remaining  to  accomplish  delivery  unaided  ;  the  vital  fluid  was 
still  steadily  oozing  away  ;  the  stomach  could  scarcely  retain  any 
thing ;  and  there  was  reason  to  fear  that  the  loss  of  blood  would  be 
increased  by  arterial  stimulants.  In  this  dilemma  we  prescribed  the 
wine  of  ergot,  of  which  her  stomach  appeared  more  retentive  tiian  of 
any  thing  else  ;  which  form  was  preferred,  because  the  sedative  pro- 
perty of  the  ergot  is  counteracted  by  the  menstruum.  The  ergot 
promoted  the  tonic  contraction  of  the  uterus,  sufllciently  to  arrest  the 
haemorrhage.  By  the  most  extensive  and  persevering  application  of 
sinapisms,  reaction  took  place  on  the  morning  of  the  13lh,  and  her 
strength  being  recruited,  by  some  light  nourishment  which  her  stom- 
ach became  able  to  receive  and  by  sleep,  in  the  afternoon  the  labour 
became  re-established,  and  about  9  o'clock,  a  foetus,  evidently  some 
time  dead,  was  expelled.  This  patient  suffered  severe  head-ache  for 
some  days,  in  consequence  of  the  excessive  loss  of  blood,  but  in  other 
respects  had  a  very  fiivorable  convalescence.  We  verily  believe  with- 
out the  liberal  administration  of  the  wine  of  ergot,  this  patient  would 
have  inevitably  perished  ;  in  such  an  exigency,  all  the  other  resources 
of  the  profession  would  certainly  have  proven  wholly  unavailing. 

When  hfemorrhage  of  the  accidental  kind,  or  from  partial  pre- 
sentation  of  the  placenta  occurs,  after  the  os  tincse  is  even  two. 
thirds  dilated,  ergot  is  always  proper,  unless  the  labour  is  progressing 
as  rapidly  as  could  be  desired,  or  there  should  be  malposition  of  ^he 


.T32  Rcmarhs  on  SccaJe  CurmUum.  [June, 


foBtus,  disproporlion  or  some  other  mnchanical  impediment  to  delive- 
ry.  When  there  is  no  such  counter-indication  to  its  employment,  if 
it  should  do  no  good,  it  can  certainly  be  productive  of  no  injury, 
for  if  the  uterus  be  stimulated  to  vigorous  contraction,  the  delivery 
\\\\\  be  accomplished,  the  haemorrhage  arrested,  and  the  necessity  for 
turning  super:5eded.  Should  it  fail  to  act,  it  will  not  render  turning, 
which  then  becomes  the  alternative,  any  more  difilcult.  The  ex- 
hibition of  ergot  should  be  accompanied  with  the  artificial  rupture  of 
the  membranes,  should  the  liquor  amnii  not  have  been  already  spon- 
taneously discharged. 

In  all  turning  cases,  after  the  feet  have  been  brought  down  and  the 
version  accomplished,  should  the  uterus  not  act  with  energy,  it  would 
be  much  safer,  both  for  mother  and  offspring,  to  stimulate  it  to  re- 
newed action,  than  to  empty  it  by  manual  traction,  while  in  a  state 
of  inertia  or  feeble  action  ;  for  to  the  mother  this  would  bring  the  dan- 
ger of  haemorrhage ;  to  the  fcetus  the  danger  that,  the  uterus  not 
pressing  firmly  on  the  vertex,  the  chin  would  leave  the  breast,  and 
the  arms  remain  above  the  superior  strait  and  obstruct  the  descent 
of  the  head. 

In  breech,  knee,  or  footling  cases,  the  life  of  the  child  may  often 
be  preserved,  by  administering  ergot  near  the  close  of  the  labour, 
thus  hastening  the  delivery,  and  preventing  the  too  long  compression 
of  the  umbilical  cord  by  the  head  in  its  passage  through  the  pelvis. 

In  prolapsus  of  the  cord,  after  re-position  has  been  accomplished, 
or  when  it  is  found  impracticable,  or  after  turning,  should  that  method 
be  adopted,  the  expulsion  of  the  fcetus  should  be  hastened  by  ergot, 
so  that  the  compression  of  the  cord  may  be  of  the  shortest  possible 
duration. 

In  instruniental  cases,  should  the  uterus  not  continue  to  act  with 
vigor,  the  delivery  should  never  be  terminated  without  the  liberal 
administration  of  ergot. 

In  speaking  of  the  employment  of  ergot  in  convulsions  during  the 
first  stage,  we  have  anticipated  what  we  would  have  said  of  its  use 
in  the  second.  As  respects  the  mode  of  administration  in  convul- 
fions,  we  prefer  the  powder  in  syrup  or  the  decoction  as  an  enema, 
l)ut  after  very  copious  depletion  the  vinous  tincture  is  a  very  eligible 
form. 

Dewees,  Antony,  and  some  others,  to  whom  the  highest  respect  is 
due,  speak  of  the  excellent  effect  of  the  ergot  in  irregular  or  mis- 
placed labour,  declaring  that  it  often  determines  the  action   more 


184.J.]    V  Remarhs  on  Secale  Cornu'iun.  303 


decidedly  to  the  uterus,  and  renders  the  labour  more  natural  and 
efficient,  in  the  first,  if  wo  understand  them  correctly,  as  well  as  the 
second  stages.  Though  our  own  experience  does  not  comport  with 
theirs,  we  do  not  entertain  a  doubt  but  that  they  have  met  with  cases, 
in  which  it  had  or  appeared  to  have  that  effect ;  but  we  have  not,  and 
we  believe  it  far  safer  for  the  mother  and  off-spring  to  resort  to  other 
expedients,  for  relieving  irregular  action  and  determination  of  excite- 
ment to  other  orsrans. 

There  may  be  some  other  occnsionsin  which  during  the  second 
stage  ergot  may  be  advantageously  employed,  all  however  are  enu- 
merated that  are  recollected,  but  writing  as  we  do  in  the  midst  of  the 
hurry  of  professional  business,  we  may  have  forgotten  them,  and 
would  be  gladly  reminded  of  them,  for  we  would  not  willingly  make 
any  omission. 

The  third  stage  of  labour  is  that  in  which  ergot  is  most  frequently 
required,  and  upon  its  effects  in  v.-hich  its  value  chiefly  depends. 
However  useful  it  may  sometimes  prove  as  a  parturient  or  promoter 
of  the  expulsive  power  of  the  uterus,  in  the  earlier  stages,  it  is  far 
more  valuable,  not  only  for  its  effect  in  promptly  expelling  the  pla- 
centa, (rendering  the  introduction  of  the  hand  into  the  uterus  seldom 
if  ever  necessary,)  but  also  as  a  hemostatic  remedy,  in  this  stage. 
Were  this  position  not  too  generally  acknowledged  to  need  corrobor- 
ation, there  would  be  no  difficulty  in  calling  to  its  support  any  amount 
of  the  highest  authority  in  medicine. 

Many  authors  speak  of  the  excellent  effects  of  ergot  Tn  prevent- 
ing hajmorrhago  in  patients  predisposed  to  it,  or  who  have  in  pre- 
vious labours  suffered  from  it,  by  administering  it  a  short  time  before 
delivery.  Whilst  we  do  not  doubt  the  success  of  this  mode  of  cm- 
ploying  it,  we  believe  it  would  be  equally  successful  in  preventing 
flooding,  and  safer  as  respects  the  child,  to  give  it  immediately  after 
the  latter  is  expelled,  unless  hccmorrhage  precedes  its  birth.  We 
have  never  had  cause  to  regret  not  having  administered  it  sooner  ; 
indeed  so  much  have  we  been  pleased  with  the  effects  of  ergot,  ad- 
ministered immediately  after  the  birth  of  the  child,  when  hiemorrhagc 
actually  demanded  it,  and  in  cases  in  which  it  was  apprehended,  that 
we  have,  gradually,  fallen  into  the  habit  of  giving  a  few  drachms  of 
the  wine  of  ergot  after  every  birth,  generally  after  the  ligation  of 
the  cord  for  reasons  already  slated.  A  case  which  occurred  to  us, 
a  few  years  since,  had  considerable  influence  in  determining  the  adop- 
tion of  this  practice  more  generally  :     Mrs  ,  healthy  and  robust. 


304  Remarks  on  Sccale  Cornulum,  [June, 


l^ctwecn  20  and  25  years  of  ajre,  was  delivered  of  her  first  child   
after  a  labour  in  ail  respects  favorable  for  a  first  parturition.  After 
the  uterus  had  contracted  down  firmly,  and  the  binder  had  been 
carefully  applied,  we  left  her  with  injunctions  to  keep  perfectly  still, 
and  drink  nothing:  warm.  As  primiparae  are  less  liable  to 'flooding 
than  others,  no  ergot  was  administered,  but  some  of  the  wine  was 
left,  with  the  most  positive  direction  to  give  a  tablespoonful  and 
tighten  the  binder,  should  the  lochial  discharge  become  too  free  : 
Our  orders,  with  respect  to  moving  at  least,  were  disobeyed  immedi- 
ately after  we  left  the  room,  and  flooding  followed.  A  very  intelligent 
and  experienced  relative  who  remained  with  the  patient,  would  not 
believe  that  she  was  flooding,  so  uncommon  is  it  after  first  births, 
until  the  patient  became  faint  from  loss  of  blood  and,  then  in  the 
consternation  that  ensued,  our  directions  were  forgotten,  and  so 
much  time  lost  before  we  were  summoned  to  her  assistance,  that 
her  life  was  brought  into  the  utmost  peril,  and  required  the  employ- 
ment of  the  most  prompt  and  energetic  measures  for  its  preservation. 
Since  the  occurrence  of  that  case,  we  have  never  felt  satisfied  to 
leave  any  case,  until  an  hour  or  more  had  elapsed  after  the  expulsion 
of  the  placenta,  without  having  given  a  portion  of  the  wine  of  ergot, 
and  no  decided  instance  of  secondary  haemorrhage  has  ever  occur- 
red, in  our  practice,  since  the  adoption  of  this  rule.  Besides  the 
prevention  of  flooding,  and  the  expulsion  of  the  placenta,  ergot, 
administered  directly  before  or  after  the  birth  of  the  child,  by  ex- 
citing  permanently  the  tonic  contraction  of  the  uterus,  regulates  the 
lochial  discharge,  and  renders  the  patient  much  less  subject  to  after- 
pains. 

On  the  subject  of  ergot,  Mr.  Grantham  says,  "  the  ctherial  tinc- 
ture I  have  found  very  valuable  in  suppressing  uterine  haemorrhage, 
and  I  am  in  the  habit  of  giving  one  drachm,  in  a  wine-glass  of  warm 
water,  to  mitigate  the  after-pains  It  relieves  the  patient  better  than 
ojiium,  and  without  producing  any  ill  efl^ect  upon  the  sensorium  com- 
mune." 

Our  object  in  prescribing  a  portion  of  wine  of  ergot  after  delivery, 
is  to  prevent  flooding,  or  excessive  lochial  discharge,  but  we  have 
often  observed  the  most  decided  influence  over  the  after  pains,  in 
those  who  had  generally  suiTered  very  much  from  them,  in  some  in- 
stances preventing  them  altogether,  but  more  frequently  mod,erating 
and  rendering  them  more  tolerable:  In  some  few  instances  no  per- 
ceptible effect  has  been  observed,  at  least  some  patients  have  com- 


1845.]  Remarks  on  Secale  Cornulum.  303 


plained  as  much  after  taking  if,  as  before,  or  as  they  could,  if  they 
had  not  taken  it ;  hut  it  might  have  been  that  they  had  not  taken 
enough,  or  because  some  females  express  as  much  suffering  from  a 
slight,  as  they  possibly  could  from  an  intense  degree  of  pain.  This 
effect  upon  the  after-pains  doubtless  results  from  the  firm  and  per- 
manent  contraction  of  the  uterus,  after  the  expulsion  of  its  contents, 
and  the  consequent  prevention  of  the  accumulation  and  retention  of 
coagula  within  its  cavity,  upon  which  after-pains  principally  depend. 
After-pains  may  sometimes  perhaps  be  caused  by  sympathetic  irrita- 
tion or  excessive  irritability  of  the  uterus,  independent  of  any  con- 
tained matter,  when  of  course  ergot  would  be  inappropriate  for  their 
removal. 

In  the  management  of  abortion,  especially  when  attended  with 
Iiaemorrliage,  ergot  is  an  inestimable  resource:  Whenever  it  has 
proceeded  so  far  as  to  have  become  inevitable,  but  is  progressing 
slowly,  it  is  far  better  to  give  ergot  to  hasten  the  expulsion  of  the 
ovum,  than  to  leave  the  patient  in  a  state  of  protracted  pain  and 
suspense,  exposed  to  danger  from  the  continuance  or  supervention 
of  haemorrhage;  but  whenever  the  patient's  life  is  endangered  by 
the  profaseness  of  the  haemoThage,  it  is  indispensably  necessary  in 
any  stage  of  abortion,  although  the  more  advanced  the  pregnancy 
is,  the  more  desirable  it  is  that  there  should  be  considerable  dilatation 
of  the  OS  tmcsc,  previoiisly  to  its  administration.  After  the  expulsion 
of  the  embryon  in  early  abortions,  there  is  frequently  retention  of  the 
placenta  with  haemorrhage  :  whenever  it  can  be  hooked  away  with 
tl)e  finger  or  conveniently  seized  and  brought  away  by  the  placenta 
forceps,  it  should  certainly  be  done  ;  but  this  will  ofien  be  found  im- 
practicable, and  then  ergot  becomes  an  indispensable  resource,  always 
controlling  the  haemorrhage,  and  sooner  or  later  causing  the  expul- 
sion ofthe  placenta. 

In  cases  of  moles,  hydatids,  polypi,  and  all  morbid  growths  and 
depositions  within  the  uterine  cavity,  ergot  should  he  employed  to 
effect  their  expulsion,  whenever  the  diagnosis  is  satisfactory,  or  the 
attendant  haemorrhage  sufficient  to  excite  alarm. 

Had  we  not  already  transcended  our  prescribed  limits,  it  would  be 
an  agreeable  task  to  notice  the  application  of  ergot  to  the  treatment 
of  various  diseases,  especially  those  peculiar  to  females.  This"  would 
itself  constitute  a  theme  for  an  interesting  article,  which  we  trust 
will  be  adopted,  ere  long,  by  some  one  more  able  to  do  it  justice,  in 
a  communication  to  this  Journnl. 

CO 


306  Scraps  from  my  Case  Book,  [June, 


Wc  have  Hdw.  in  ;i  huiriod  iivmnor,  and  uruler  many  disadvanta- 
ges, ('.\|)rosse  I  our  views  of  iho  eiiiployiniMit  of  ergot  in  obstetric 
prattire,  for  the  bciicKt  of  those  whose  opportiuiitifs  Cur  cxperienco 
mav  have  been  ni  )rc  limited  than  our  own.  Should  these  remarks 
conduce  in  the  sii;ih(est  degree  (o  elucidate  any  of  the  diflicultics 
and  doubts  that  may  ernharrass  the  very  youngest  of  our  brethren, 
ojir  object  will  be  fully  attained;  but  should  the  experience  and  oh- 
servation  of  others  lead  them  to  ado])t  different  opinions,  it  would 
afford  us  pleasure  to  see  them  expressed,  and  to  have  our  own  cor. 
rectfcd  if  wrong,  it  being  always  more  gratifj'ing  to  us  to  receive* 
than  to  attempt  to  impart  information. 

Note.  In  proof  that  the  foetus  in  utero  is  not  easily  affected  by 
medicine  civen  to  the  mother,  (specially  narcotics,  we  would  refer 
to  a  most  interesting  article,  by  Dr.  Levert,  of  Mobile,  published  in 
the  I\lny  nunib(>r  of  this  Journal,  page  225;  in  which  Dr.  L.  re- 
lates a  remarkable  case,  wlierein  enormous  <loses  ot  the  sulphate  of 
morphine  were  given  twice,  and  frequently  three  times  daily,  to  pre- 
vent abortion,  for  a  length  of  time  before  confine^^ent,  with  the  hap- 
piest  result  both  to  mother  and  ofl^spring. 


ARTICLE    II. 

Scraps  from  my  Case  Bonk.     By  Andrew  R.  Kilpathick,  M.  D., 

of  Woodville,  3Ilss. 

The  object  in  writing  this  paper  is  not  to  shew  any  new  theory  of 
disease,  or  any  peculiar  mode  of  treating  it;  but  simply  to  record 
facts  in  pathology,  and  elicit  similar  contributions  from  practitioners 
of  more  experience  and  possessed  of  better  opportunities  for  obser- 
vation. 

Ascaris  Lumbricoides.  These  animals  are  so  familiar  to  every 
person,  and  particularly  every  medical  man,  that  the  question  may 
be  asked,  why  say  any  thing  on  so  trite  a  topic?  It  is  true  we  are 
familiar  with  them,  and  this  familiarity  has  lulled  that  watchfulness 
and  hostility  which  should  be  exercised  towards  them.  Some  physi- 
cians look  upon  the  management    of  such   cases   with    contempt : 


1815.]  Scraps frommy  Case  Book,  307 


npjLlK^cf  ihfm  ns  iriwortliy  a  fl;rt  fron  tluMr  quivor ;  leave  lliein  to 
the  care  of  oltl  woriK-n,  <ir  to  riot  on  liie-vHais  of  tetuler  jrnhjeels, 
until  ihevfiestrov  life.  And  there  are  persons  to  he  f<jtind,  c^ven  in 
the  medical  ranks,  who  look  upon  wornis  as  heneficial  to  the  human 
economy  and  "blessings  in  disguise."  I.  for  one,  can  never  view 
thf^m  in  that  li^ilit.  But  it  is  also  true  tliat  there  are  others  who 
ascribe  nearly  every  distemper  to  which  the  juvenile  system  is  liable, 
to  worms,  and  this  hohliv  causes  ihetn  to  employ  i>nlhe!uiiitr-s  in 
excess,  thereby  superinducing  fatal  disease  in  cases  which  were 
at  first  simple  an(i  curable. 

Cask  1st.  IGth  Nov.  1340,  I  was  called  to  see  a  negro  jtjrl  9 
years  of  ajre,  of  small  and  delicate^frame.  She  complained  first  on 
the  lOlh;  on  the  121)  an  emetic  had  been  riven.  which  acted  par- 
tially. On  the  nl^^ht  of  the  14tli  calonjcl  and  rhubarb  each  x.  ^^rs. 
was  given,  producing  four  operations  and  liie  discharge  of  four  large 
lumbrici  at  once. 

When  I  first  sa XV  her  ibe  skin  was  hot  and  dry,  pulse  quick  and 
freqrenf,  though  compressible;  tongue  coated  wilh  a  thick,  yellowish 
brown  fur;  some  apj)etite  ;  eyes  dull  and  heavy.  She  had  complained 
of  \>n)n  in  the  unibilic  il  re;iion,  but  evidenced  no  uneasiness  or  ten- 
derness, either  by  flintthing  or  speaking,  or  changing  of  countenance, 
wh(!n  the  abdomen  was  |)ressed  by  the  band.  Prescribed  s'atim  ol. 
ter^b.  X.  gult,,  ol.  rieini  <s.  and  an  enuHic  of  ipecacuatiha  in  the 
morning.  Nov.  17th:  Ves|Hre ;  the  oil  had  acted  only  once  ;  the 
emetic  thi<  morning  threw  up  two  large  lumbrici;  fever  continues 
without  remis^;ion  ;  pulse  quick,  freqinuit  and  feeble  ;  warm  and  dry 
skin;  tongue  slill  ful  and  ibitkly  coated,  ('ontinue  the  ol.  tereb. 
in  ten  drop  dose  s  four  linns  a  Hay.  and  cal  mel  x.  ;irs.  at  b(d-time. 
Did  not  see  her  on  the  ISih.  and  was  called  in  haste  to  her  early  on 
the  morning  of  the  19ih.  Extremities  cold  ;  in  attempting  toswal- 
low  lea,  she  coJighed,  strangled,  and  threw  it  back.  Sl)e  began  to 
sink  last  night  ;  vomited  frequently  a  dark  brown  fluid,  exact- 
ly like  the  black  vonjil  of  yellow  ^KiXQr.  She  continued  to  call  for 
tea  and  chicken  water  not  half  an  hour  before  she  died.  She  was 
repeatedly  questioned  as  to  the  seat  of  pain  during  the  two  past 
days,  but  persisted  in  saying  there  was  none.  She  died  about  8 
o'clock,  A.  M. 

Post  Mortem.  Cadaver  not  much  emaciated;  abdomen  fidl. 
When  the  cavity  of  the  abdomen  was  first  entered  by  the  scalpel,  a 
large  qtiantity,  fully  three  pints,  of  a  light  straw-colored   serum, 


308  Scraps  from  my  Case  Boole.  [June, 


giishrd  out  ;  on  layini;  aside  the  walls  of  iho  abdomen,  the  entire 
contents  were  (mid  to  he  afiirliilinated  in  one  common  mass  by  coap- 
iilable  lymph,  and  some  porti<  ns  were  quite  firmly  attached  to  each 
other.  Omentum  and  mesentery  inflamed  and  gannrrenous  in  places  ; 
alimentary  canal  in  its  length,  exrcrnally,  highly  inflamed,  and  in 
many  places  gangrenous  and  softened;  internally  it  was  inflamed  in 
patches,  and  the  colon  not  so  much  as  the  small  intestines.  Inspect- 
ing  these  closely,  I  found  in  the  ileum  an  orifice  about  the  fourth  of 
an  inch  in  diameter  through  which  the  faeces  had  escaped  into  the 
peritoneal  sac.  I  suspected  the  worms  had  made  this,  and  on  ex- 
amining further  I  found  two  large  lumhrici,  one  at  the  base  of  the 
spleen  and  the  other  under  the  stomach.  Here  was  the  cause 
of  disease  and  death.  I  discovered  eight  other  worms  in  other  por- 
tions of  the  canal;  three  in  the  stomach  and  two  in  the  oesophagus, 
which  accounts  for  the  choking  and  strangling  in  attempting  to 
swallow.  The  liver  and  spleen  were  sound:  stomach  externally 
white;  filled  with  the  ahove  mentioned  "black  vomit ;"  heartsound; 
pericardium  distended  with  serum ;  lungs  healthy. 

I  was  astonished  at  the  extent  of  disease  here  present,  when  I 
called  to  mind  the  fact,  that  f.ressure  on  the  abdomen  caused  no  pain. 
On  counting  up  all  the  worms,  we  found  she  had  discharged  twenty- 
four,  and  twelve  were  found  in  her,  which  make  thirty-six  in. all. 

This  case  gave  occasion  for  her  master  to  detail  to  me, 

Case  2d.  In  the  summer  of  1837,  a  negro  woman  of  his  fell 
down  in  the  field  "in  a  fit,"  as  it  is  commonly  termed.  She  was 
taken  to  the  house  in  a  state  of  insensibility,  from  which  she  was 
roused  with  difliculty,  by  venesection,  stimulants,  &:c.  For  some 
days  she  continued  in  a  dull,  moping  condition,  quite  feeble,  with  oc- 
casional nausea  and  vomiting.  He  charged  her  with  "dirt-eating;" 
she  denied,  and  one  morning  exhibited  a  lumbricus  which  bad  es- 
caped from  her  mouth  while  vomiting.  This  was  a  new  feature  in 
the  case,  and  he  proceeded  to  treat  it  for  worms,  administering 
ol.  tereb.  5iij.  and  ol.  ricini  ':.,  which  caused  the  expulsion  per  anum 
of  86  lumbrici  in  a  few  hours;  next  day  the  same  dose  was  repeated, 
and  upwards  of 70  were  discharged.  She  was  much  relieved,  and  in 
a  few  days  was  able  to  wo'k  in  the  field.  The  next  summer  she  was 
similarly  attacked  and  similarly  treated  with  the  like  results.  It  is 
often  the  fact,  that  accident,  as  in  this  case,  reveals  the  true  cause 
of  disease. 

Cases  3d  and  4th.     1844,  Aug.    14lh. Called  this  dav   to  sro 


1345. J  Scrays  from  my  Case  Book.  809 


two  cases  of  fever,  in  a  negro  woman  aged  2G,  and  her  son  aged  10. 
Both  had  been  seized  with  fever  on  the  10th  with  the  same  symptoms, 
and  emetics  of  ipecacuanha  were  administered  to  them,  followed  by 
submur.  hydrarg.  and  ol.  ricini.:  and  sniph.  quin.  during  the  remis- 
sions. There  was  no  severity  in  the  symptoms  until  the  13th,  when 
they  both  were  suddenly  taken  worse,  and  at  nigiU  a  passing  physi- 
cian was  called  in,  but  discovered  that  they  were  beyond  the  reach  of 
medicine,  and  told  the  owners  so,  although  at  their  solicitation  he 
prescribed  for  them.  When  I  saw  them  at  10  o'clock,  A.  IVl.,  14th, 
they  were  moribund,  and  died  within  a  few  minutes  of  each  other, 
about  12,  M.  During  the  afternoon  I  opened  both  bodies,  proceeding 
f.rst  with  the  boy's. 

Cadaver  not  much  emaciated.  On  laying  open  the  abdomen 
the  omentum  mnjus  was  found  q-iite  small  and  as  it  were  wadded 
down  in  the  lumbar  region.  Stomach  small,  empty  and  apparently 
crowded  into  the  left  hypochondrum  by  the  liver,  which  was  very 
large,  of  leaden  color,  soft  and  easily  torn  and  broken  up  by  the  finger. 
Spleen  was  double  the  natural  size,  very  deep  blue  color  externally,   
soft,  easily  ruptured  by  the  finger,  and  internally  presented  the  ap- 
pearance of  "  blood-pudding."  Stomach,  kidneys  and  bladder, 
healthy.  The  small  intestines,  jejunum  and  ileum,  were  almost  emp- 
ty, containing  a  little  frothy  mucus,  thin  faeces  and  dead  worms,  either 
extended  at  length  or  rolled  in  knots.  Theprmcii)al  features  in  this 
case  were  the  intussusceplions,  and  to  which  I  wish  to  direct  tho 
thoughtful  attention  of  the  reader.  There  were  ten  places  where  ono 
portion  of  the  small  intestines  and  mesentery  had  slipped  into  another  ; 
some  were  as  much  as  eight  inclics,  and  so  firm  as  to  require  some 
force  to  draw  them  out.  At  every  one  of  these  places  there  were  two 
and  three  worms  rolled  up  in  a  ball  lying  at  the  upper  part  of  the 
orifice.  The  canal  or  passage  through  these  places  was  so  small  as  to 
allow  only  a  probe  to  pass.  Tho  small  intestines  were  inflamed  in 
their  whole  length,  and  gangrenous  in  spots.  Thoracic  viscera  pre- 
sented nothing  remarkable. 

Post  morlem  of  the  woman.  The  small  intestines  were  the  parts 
principally  diseased,  being  highly  inflamed  and  gangrenous  in  places  ; 
they  were  also  thin,  and  worms  were  easily  discovered  in  them  ;  they 
were  also  nearly  empty.  Intussusception  was  also  here  in  five  places, 
where  from  two  to  eight  inches  of  bowel  were  crowded  into  itself, 
and  a  cluster  of  worms  was  found  at  each  obstructed  place.  Nothing 
of  conHt'quiMKO  in  th<*  othtT  abdominal  vif^cora  or  those  of  the  thorax 


810  A  Case  of  Procidentia  Uteri.  [June, 


wri<?  spi^n.  WliPii  the  intus<:n!(.-o|)tocl  j)I;iccs  were  extricated  (hey 
W;  r?  ftiirifl  com;)l  'ti'ly  Hisiru;uii/cil. 

Ni\v  the  qiicsliou  arises  liow  was  lli>  indi^sinception  prouiincd  ? 
Was  it  ONviii;;  to  the  knots  of  uorins  joinin;^  ihemselves  ti;htly  in 
the  howels,  inercasinr  the  vermiciihir  action  of  those  phices  and 
causinjx  the  stiperior  porti4ii  of  the  t)o\vel  to  s\vai!o\v  the  lower?  or 
were  the  parts  placed  in  this  mal-povition  hy  some  other  eatise,  and 
the  w)rrns  in  traversing  the  canal  met  ihetse  barriers  and  had  there 
collected  ?  I  confess  my  inahility  to  decide  in  this  case.  I  .bserved 
in  many  parts  of  the  intestines  inequalities  in  circumference,  there 
being  spaces  of  from  one  to  three  inches  much  smaller  than  tlo 
balance,  and  it  is  j)ro])able  that  >iniilar  contraciions  had  existed  at 
the  intussuseepted  places  of  a  more  marked  character  than  tliose  I 
saw,  an  1  the  superior  portions  could  easily  envelope  them. 

I  purposely  omitted  myilioning  the  condition  of  the  colon  in  these 
four  cases,  because  I  wish  to  mention  a  fact  which  I  observed  in  all 
of  them,  and  also  in  the  cadaver  of  a  case  of  marasmus  in  a  ne;ro 
child  I  optjned  in  18^^9,  and  that  is.  {])>'  coniroctcrl  conilition  of  that 
gut.  In  all  oi*  these  cases,  the  colons  were  snalh-r  than  the  small 
intestines,  lor)kin<r  like  ropes,  all  their  convolutions  and  rujjosifies 
bad  disappean-d.  and  the  canal  was  so  small  as  to  admit  with  diffi- 
cu'tv  the  little  finj:er.  I  have  examined  many  authors,  to  discover 
their  opinions  on  the  matter,  but  Abercrombie  is  (he  only  one  who 
even  mentions  it.  If  any  one  else  can  account  for  it,  and  will  do  so 
throujih  this  Journal,  he  will  confer  a  favor  on  me,  and  peMhaps  others. 

Another  time  I  will  give  cases  of  a  different  character. 


ARTICLE  III. 


A  Case  of  Procidentia  U.'eri  fermanently  cured  by  excision  of  the 
Vaginal  folds  wilh  remarks.  By  H.  V.  Wooten,  M.  D.,  of 
Lownlesboro',  Ala. 

On  the  12!h  of  July.  1?3S,  I  was  called  to  Retty,  a  negro  woman, 
nged  a!ouf  loif y.five.  I  found  her  greatly  emaciated,  and  so  feeble 
a!  (o  be  iinald!'  to  assume  the  silling  posinre  without  as^isfjinre.  Her 
features  were  shrunken,  her  countenance  anxious,  her  pulse  extremely 


164.''xJ  A  Case  of  Procidentia  Uteri,  311 


frequent  and  iVebie,  and  as  hor  romnlaint  was  represented  to  be  diarr- 
hcE.i,  I  viewed  it  as  a  ho|)eloss  case.  Her  owner  had  njisnnderstood  her 
case,  and  on  rurlher  examination  I  ascertained  that  she  was  affliet(d 
with  procidentia  uteri,  wliich  for  six  weeks  past  had  been  ailrndtd 
with  profuse  leucorrhoea.  She  stated  that  for  eleven  years  she  had 
"falling  of  the  womb,''  that  during  all  this  time  she  had  been  subject 
to  recurrences  of  the  leucorrhoea,  and  that  her  general  health  had 
sufK.red  much,  until  she  now  seemed  reduced  to  the  lowest  extremity 
of  existence. 

On  ins])eclion,  I  found  the  uterus  and  everted  vagina  protruded 
entirely  without  the  vulva,  and  forming  a  tumor  of  about  live  or  six 
inches  in  length.  Its  surface  was  generally  of  a  blanched  and  re- 
laxed appearance,  but  there  were  on  each  side,  and  nearly  opposite 
each  otlier,  two  projections  or  tumors,  about  the  size  of  a  man's 
thumb  and  about  as  long,  with  a  slight  swell  in  the  middle,  one  ex- 
tremity of  these  ridges  arose  within  half  an  inch  o^the  os  uteri,  and 
one  of  them  ran  a  ccjurse  slightly  diagonal  to  the  main  tumor.  They 
were  very  hard,  with  a  glossy  surface  and  of  a  livid  hue.  They 
seemed  to  be  composed  of  the  fdds  of  the  vaginal  mucous  mem. 
brjine  and  their  irjter-cellular  tissue  in  an  advanced  stage  of  inflam- 
n-ation.  On  the  posterior  surface,  and  about  an  inch  from  the  09 
uteri,  was  an  ulcer  of  oblong  shape  and  about  the  size  of  a  half 
dollar,  and  of  an  indolent  appearance.  'J'he  patient  stated  that  about 
four  days  previous,  a  "lump"  similar  to  those  described,  had  sloughed 
from  the  seat  of  this  ulcer. 

I  attempted  a  n  placement  of  the  prolapsed  parts,  but  found  it 
impracticable.  I  ordt  red  the  application  of  sol.  lunar  caustic  to  iho 
ulcer,  an  emolient  poultice  to  the  [larts,  th(  free  use  of  nourishing 
liquid  diet,  and  carbonate  of  iron  in  large  doses  three  times  a  day, 
with  a  view  to  promote  general  streisgih. 

I  saw  the  |>alient  agim  on  the  14:h  Condition  about  tho  same  aa 
at  the  first  visit,  except  that  the  ulcer  had  a  more  healthful  appear, 
ance,  and  the  general  strength  of  the  patient  was  slightly  improved. 
Still  the  prolapsed  parts  were  irreducible.  The  propriety  of  excising 
the  folds  ofthe  vagina,  as  reeoumiended  by  Dietfenhach,  was  forcibly 
suiTgr'stcd  by  the  pecliar  state  of  the  case  ;  so  I  proceeded  at  once 
to  the  operation.  After  making  the  necessary  preparations  of  po.si. 
tion,  (kc,  I  excised  the  tumors  above  deseri!)ed  at  tlu  ir  bases,  aiininf^ 
to  remove  the  entire  fold  wuh  the  engorged  ctllular  tissue,  and  at  the 
sanu^  ti(u.'  avoid  wnnnding  the  oiUuard  c^nt  of  the  vH<rinn,  which  I 


312  A  Case  of  Procidentia  Uteri,  [June, 


found  no  difilculfy  in  doin^^     The  operation  gave  scarcely  any  pain, 
and  the  ha?inorrhan[e  was  inconsiderable. 

Afier  removinjj  botli  folds,  or  tumor*,  and  hathint;  the  parts  with  a 
strong  sohition  of  chloride  of  soda,  I  returned  the  uterus  to  its  proper 
place  without  further  difficulty.  I  used  no  sutures,  as  I  could  see  no 
necessity  fur  them.  I  had  the  patient  placed  in  a  recumbent  position 
with  the  hips  elevated,  ordered  a  continuation  of  the  nourishing  diet 
with  carbonate  of  iron,  and  a  solution  of  cidoride  of  soda  to  be 
thrown  into  the  vagina  twice  a  day.  For  this  purpose  I  used  a  large 
gum  elastic  catheter,  attached  to  a  small  enema  syringe,  fearing  that 
the  size  of  the  common  female  syringe  would  interfere  with  the  pro- 
cess  of  cicatrization.  This  course  was  continued  with  regular  im- 
provement  of  the  patient  fur  six  days,  when,  the  leucorrlioeal  dis- 
charge continuing,  an  infusion  of  nut-galls  was  thrown  into  the 
vagina  once  a  day  in  addition  to  tlie  chloride  of  soda.  The  patient 
was  kept  in  the  recumbent  position,  strictly,  for  four  weeks,  when, 
with  a  compress  to  tlie  hypogastrium  and  bandage  around  the  hips, 
she  was  allowed  to  get  up.  By  this  time  she  had  measurably  regained 
her  flesh,  and  was  very  soon  able  to  attend  to  domestic  business,  with- 
out any  symptom  of  her  old  complaint. 

I  saw  her  in  March,  1845,  when  she  stated  that  she  had  not  had 
the  least  trouble  with  the  disease  since  the  operation. 

I  have  had  but  two  opportunities  to  perform  the  operation  sinco 
this  case,  and  they  were  in  women  within  the  child  bearing  period, 
and  I  refrained,  lest  it  might  interfere  with  the  process  of  parturition, 
should  the  patient  become  pregnant.  Ail  authors  who  have  recom. 
mended  this  operation,  have,  so  far  as  I  have  seen,  observed  this  cau- 
tion ;  but  Mr.  Crosse  mentioned  that  Dr.  Fricke  had  reported  a  case 
to  him  in  v/hich  the  patient  had  become  pregnant,  after  the  operation, 
and  "was  delivered  by  the  forceps  without  the  artificial  bridge 
giving  way."  After  the  child-bearing  period,  however,  there  can  be 
no  doubt  that  this  will  be  found  a  safe  and  highly  successful  operation. 

By  reference  to  writers  on  this  operation,  I  notice  that  there  are 
two  plans  proposed  and  practised  for  performing  it  for  in  principle 
they  are  but  the  same  operation  the  one  to  excise  the  folds  of  the 
vagina  high  up,  and  the  other  to  cut  and  produce  adhesion  at  the 
base  of  the  labia.  It  seems  to  me,  that  in  most  cases  the  former 
would  be  preferable,  because  the  "artificial  bridge"  or  cicatrix  is 
higher  up,  and  belter  calctilatcd  to  support  the  uterus  in  its  natural 
position,  and  becau.-se  ibe  part  (^pcialtdun  is  k>s  sensitive,  giving  the 


1315.]  Hogs  Lard  fur  Obstructions  of  the  BoLceh.  313 


patient  less  pain  in  the  operation,  and  subsequent  treatment. 

I  used  no  sutures  in  this  case,  because  I  expected  the  edges  of  the 
denuded  surfaces  to  approximate  spontaneously,  and  moreover,  the 
object  of  the  operation,  as  I  conceive,  is  not  so  much  to  contract  the 
vaginal  canal,  as  to  lessen  its  dilatability.  ^riie  smallness  of  the  va- 
gina would  ofTer  but  little  obstacle  to  the  descent  of  the  uterus,  if  the 
dilatability  remained  excessive.  A  cicatrix  is  the  in)portant  object 
in  this  plan  of  treatment,  on  account  of  the  firmness  it  imparts  t*) 
the  support  of  the  uterus,  and  this  I  expected  to  obtain  as  well  without 
ss  with  the  sutures.  The  first  case  of  permanent  cure  which  sug- 
gested the  operation  to  Dietienbach,  was  by  sloughing  of  the  vaginal 
fold,  where  of  course,  no  sutures  were  used,  and  he  says  that,  in  hia 
operations  he  frequently  used  none  at  all,  as  "  the  edges  of  the  wound 
frequently  came  in  close  contact  with  each  other,  after  the  reposition 
of  the  uterus."  Whilst  the  sutures  can  do  no  harm,  except  a  slight 
increase  of  irritation,  there  can  be  but  liitlo  doubt,  that  operations  uf 
this  sort  will  generally  do  as  well  without  them. 

The  greatest  possible  caution  should  always  be  used  to  prevent  the 
descent  of  the  uterus  while  tiic  heaiiu'Z  l)roccss  is  jjoincj  on. 


A2TICLE  IV. 

Hogs  Lard  a  Remedy  for  Obstruct  ions  of  the  Boicels.     By  J.  A. 
Mayks,  M.  D.,  of  Bradlcyville,  Sumter  District,  S.  C. 

The  aim  and  object  of  the  medical  profession  is  the  relief  of  human 
suffering;  and,  as  this  object  can  be  best  accomplisiied  by  individual 
members  of  the  profession  freely  communicating  to  each  other,  tho 
results  of  their  experiments  with  the  resources  of  our  art,  and  there- 
by placing  the  knowledge  of  one  at  the  disj)osal  of  another,  no  other 
apology,  it  is  hoped,  will  be  required  for  the  obtrusion  of  this  article 
upon  public  notice. 

The  bowels  frequently  become  so  mucb  obstructed  by  indurated 
faeces,  that  the  best  directed  elForts  of  physicians  to  overcome  tho 
obstruction,  often  prove  useless,  and  even  worse  than  useless,  since 
the  means  we  use  for  relief,  if  they  fail,  are  apt  to  aggravate  the  mis- 
chief, by  producing  inn.nnuvjtlon,   and   con<iqiirntly,  the  chance  of 


314  Hogs  Lard  for  Obstructions  of  the  Bowels.  [Ji\nc, 


savirifT  the  life  ofonr  |)aticnt  is  lessoned.  For  such  conditions  ofthe 
bowels  we  h;ivc  mariy  reini^iies  nlieady,  anrl  the  list  is  rrradually 
lentrthenin^;  but,  occasionally,  all  the  iK^ual  resources  of  art  within 
our  reach  have  been  used,  and  yet  our  patient  has  not  oh  aiiied  relief. 
Such  a  case  as  this  occurred  in  my  prsjctice  a  few  days  ago.  Every 
means  in  my  power  had  to  be  called  into  requisition  i"n  this  case; 
and  my  patient  recovered,  at  last,  under  what  I  believe  a  very  unusual 
course  of  treatment ;  at  least,  a  plan  oftreatment  which  must  be  very 
rarely  employed,  as  I  see  no  mention  made  of  the  successful  remedy 
in  medical  works  in  such  cases,  and  have  never  heard  of  a  similar 
practice  being  adopted  by  any  one.  I,  therefore,  make  this  commu. 
iiicalion,  believing  that  a  sli<:ht  addition  will  be  made,  by  it,  to  the 
general  stock  of  mi.>dical  knowledire. 

Casi:.  George,  a  negrri  man,  aged  30,  a  tailor  by  trade,  was,  on 
Thursday  lOlh  A|)ril,  1815,  attacked  wiih  very  violent  pains  in  the 
bowels,  resem!)lin<^  spasmodic  colic.  For  his  relief.  Dr.  Mwldrow, 
his  owner,  prescrihed  purnalives  ccunbined  with  opiates,  blisters, 
enemata,  (Sec,  without  much  benefit.  Very  small  discharges  from 
the  bowels  could  be  (obtained,  and  these,  not  without  repeated 
enemata.  His  symptoms  being  more  severe  on  Saturday  morning, 
the  12th.  I  was  requested  to  visit  him.  I  found  him  suffering  very 
acute  pain  throughout  the  abdomen,  but  especially  severe  on  the  right 
side;  his  abdomen  was  timiid  and  hard;  com|)Iaincd  very  much  of 
the  slightest  pressure;  breathing,  hurried:  pulse,  soft  and  regular ; 
has  had  no  fever  since  his  atlack ;  pain  occasionally  remitting,  but 
soon  returning  wiih  as  much  secerily  as  ever ;  had  vomited  a  great 
deal  :  for  twelve  months  past  has  been  rather  costive,  and  had  had 
two  or  three  attacks  of  colic  lately,  but  none  of  much  severity  ;  being 
soon  relieved  by  purgatives.  The  existence  of  enteric  inflammation 
in  this  case  was  thought  probable;  but  the  symptoms  and  the  history 
of  the  case  were  such  as  to  incline  us  to  the  opinion  that  spasmodic 
colic  was  the  cause  of  his  sufTerings.  In  consultation,  it  was  deter- 
mined  to  administer  calomel  10  grs.,  Dover's  powder  20  grs.,  every 
three  hours  mucilaginous  drinks  to  be  used  freely,  and  purgative 
enemeta  to  aid  the  operation  of  medicines. 

Sjuday  morning,  13:h.  George  does  not  complain  so  much  of 
pain  this  morning;  the  medicines  taken  by  the  mouth  had  caused 
V(.mi  iug  of  fluids  in  very  large  quantities,  mixed  with  some  stercora. 
ceous  matter.  The  enemata  had  the  ctK-ct  of  cleansing  out  tho 
lower  l)owc'3  only  ;   the  two  or  three  last  having  been    discharged  in 


1815  ]  Hogs  Lard  for  Obslrucfious  of  the  Bowels.  315 


the  same  s'nte  as  \vh?ii  injected.  His  p..l.s(}  still  remains  soft  and 
rerM!ar,  with  a  litllc  iidness  no  fever;  constant  iiiccup.  Directed 
{\^\},  calomel  and  Dover's  powder  to  be  continued  ;  eneinata  of  castor 
oil  and  spts.  turpentine  everv  two  hours:  to  be  kept  in  the  warm 
bath  tip  to  his  chest  until  his  pulse  becomes  afijcted. 

Sunday  evening.  Constant  slercoraceous  vomitinf^  through  the  dny 
 no  discharge  at  all  downwards,  the  enemata  coming  away  without 
even  a  faecal  odour;  the  pulse  and  other  symi)toms  the  same  as  in 
the  morning.  As  purgatives  by  mouth  seemed  to  increase  the  ster. 
coraceous  vomiting,  the  Dover's  powder  alone,  in  doses  of  10  grs. 
eve  y  Iwo  or  three  hours  was  directed.  10  or  15  grs.  tartar  emetic, 
(ii.ss(lv(.'d  in  a  pint  of  warm  water,  was  directed  as  encrnata,  to  be 
repeated  -pro  re  nMa. 

Monday  morning,  14th.  The  stercoraceous  vomiting  slill  contin- 
ues, and  is  worse  than  ever,  the  matters  vomited  being  large  in  quan- 
tities and  of  a  pea  green  color ;  no  discharge  downwards  the  tartar 
emetic  enemata  were  several  times  repeated,  hut  had  no  perceptible 
efTcfCt.  Other  symptoms  as  before.  Directed  4  grs.  ext.  hyosciaun 
every  three  hours  infusion  of  tobacco  as  enemata  cataplasm  of 
tobacco  over  the  blistered  surface  on  the  abdomen  the  enemata  to 
be  repeated  fro  rr  nata. 

Monday  evening.  The  vomiting  has  ceased  since  10  o'clock  ;  but 
the  tobacco,  twice  u<ed,  producerl  no  other  (fleet  than  very  great 
prostraliim  ;  not  much  pain  in  the  bowels  and  the  di>tention  of  the 
abdomen  not  so  great.  Directed  inject iorjs  of  C(dd  water,  to  1)0 
frequently  repeated  until  nine  or  ten  pints  should  be  thrown  into  the 
bowels.     Ext.  hyosciami  as  ben)re.    . 

Tuesday  morning,  15lh.  Has  had  no  return  of  the  vomiting  the 
injection  of  cold  water  had  come  away  scarcely  colored:  pulse  arid 
other  symptoms  about  the  same  as  before  a  small  quanlitv  of  sol. 
veratrini  was  injected  into  the  rectum,  to  produce,  if  possible,  a  de- 
termination downward,  but  with  no  perceptible  effect.  As  no  instru- 
ment for  passing  fluids  high  u()the  inlvstines,  could  be  procured,  we 
were  at  some  loss  how  to  proceed.*     In  consultation,  it  was  agreed 

  We  have  been  in  the  habit  for  some  years  of  passinc^a  ^nm  elastic  stomach 
tube  into  the  colon,  in  all  cases  of  colics,  throu'^h  which  a  lar^^e  injection  of  salt 
and  water,  or  other  flui-J,  may  be  easily  thrown  up  into  the  lari^e  intestine, 
with  a  common  syrin2:e.  There  is  neither  ditncidty  nor  d;  nj?er  in  the  introduc- 
tion of  the  lube,  ;.nd  in  no  instance  have  we  ever  known  .':n  enema  administered 
ill  this  male  tj  f..il  in  ;2:ivin  .j  prjfnpt  and  elL'clual  relief.  So  uniformly  suc- 
cesslul  is  this  ino.lc  ol  tie.tmetit,  ili;.t  we  have  pretty  much  ceased  to  give  any 
jiieJicines  by  the  month  in  such  c:.sefi.  Enra. 


1310  Ilogs  Lard  for  Obstructions  of  llie  Boicels.  [June, 


to  fill  his  bowels,  by  mouth  and  hy  rectum,  with  some  bland  oil,  and 
afterwards  administer  some  drastic  purgative.  For  this  purpose, 
none  seemed  to  be  better  adapted  than  melted  hogs  lard.  A  largo 
tea  cupful  of  melted  lard  was  immediately  administered,  and  directed 
to  be  repeated  in  three  hours  with  eneniata  of  one  pint  melted  lard 
every  hour.     The  ext.  hyosciami  to  he  continued  as  before. 

Tuesday  evening.  Has  had  no  return  of  the  vomiting,  but  the 
stomach  seems  oppressed  by  the  lard  swallowed  ;  no  pain,  pulse  very 
good.  The  last  enema  of  lard  had  a  very  strong  faecal  odor  w  hen  dis- 
charged. Directed  the  lard  enemata  to  be  repeated  every  hour  
another  tea  cupful  to  be  taken  at  night  a  pill  of  morphia  at  night. 

Wednesday  morning,  IGlh.  We  were,  this  morning,  agreeably 
surprised  to  find  a  large  discharge  from  the  bowels;  the  stomach  no 
ioDger  opprcssetl  by  the  lard  swallowed;  no  hiccup  ;  our  paticnt'd 
countenance  brightened  very  much  no  longer  the  sunken  eye,  tho 
hagnjard  look,  the  image  of  despair.  We  resolved  to  push  our  remedy 
still  further  another  tea  cupful  was  adnjinistered  and  the  lard  ene- 
mata repeated  every  two  hours  with  morphine  in  small  doses  every 
three  hours. 

Wednesday  evening.  Very  large  quantities  of  fccces  mixed  with 
lard  are  now  discharging  (Vom  the  bowels  ;  no  uncomfortable  symp- 
toms about  tho  bowels  at  all  ;  a  small  dose  of  caster  oil  was  now 
given,  directing  it  to  be  followed  by  a  lard  enema,  if  it  does  not 
operate  in  four  hours.     JMorphine  to  be  continued. 

Thursday  morning,  17th.  The  castor  oil  operated  largely,  in  two 
hours  afcer  beirtg  taken,  biinging  away  much  ra3cal  matter  and  about  a 
quart  of  lard.  Directed  nothing  more  to  day  than  light  nourishment 
with  mucilage  of  slippery  elm  morphine  as  ben)re. 

Friday  morning,  18th.  Faeces  mixed  with  lardare  still  beingdis- 
charged  from  the  bowels,  but  not  in  such  abundance  as  before.  A  pill 
of  morphine  was  directed  night  and  morning  for  a  few  days  light 
nourishment,  aromatic  tonics  and  aperients  when  necessary. 

After  this  my  attendance  upon  George  ceased,  and  he  was  left  un- 
der the  management  of  his  owner.  lie  is  now  rapidly  convalescent, 
and  will  soon  regain  his  former  henllh. 

It  is  the  opinion  of  Dr.  INIuldrow  and  myself,  that  (he  favorable  ter- 
mination of  this  case  was  brought  about  by  the  hogs  lard,  when 
nothing  else  would  have  been  of  service.  The  details  of  treatment 
have  been  given,  to  convey  some  ideaof  the  nature  of  the  case  ;  and 
whoever  sludio?;  tho  case  with    attention,   must  arrive  at  the  same 


1845.]  Tubercular  Development  in  an  Infant.  317 


conclusion.  Other  moans,  it  is  possible,  may  have  been  used  with 
success;  but  none,  \\c  venture  toaOlrm.  could  have  acted  so  ofTectu- 
ally  as  the  hogs  lard,  without  producing  some  inflammation  of  the 
bowels.  Being  a  mild  aperient,  and,  at  the  same  time,  a  suitable 
article  for  lubricating  the  bowels,  nothing  could  have  been  better 
adapted  to  the  case.  Our  patient  took  altogether,  by  mouth  and  by 
cnemata,  a  gallon  and  a  half  or  more  of  melted  lard,  without  any  in- 
convenience at  all  resulting  from  the  use  of  such  a  prodigious  quantity 
of  oil  in  his  bowels  a  circumstance,  which  could  have  resulted  from 
the  use  of  no  other  remedy  in  similar  quantities,  and  which,  the  writer 
believes,  will  cause  hogs  lard  to  be  elevated  to  a  more  honorable 
position  in  the  materia  medica  than  it  has  liitherto  occupied. 

In  conclusion,  I  would  respectfully  invite  the  attention  of  practi- 
tioners generally,  to  this  subject;  and  hope,  should  cases  similar  to 
that  reported  occur  in  their  practice,  the  remedy  here  treated  of  may 
have  a  trial.  One  case  does  not  establish  the  utility  of  anv  article  
several  are  required,  and  I  hope  soon  to  hear  of  hogs  lard  being  used 
successfullv  in  several  cases  of  obstructions  of  the  bowels. 


ARTICLE    V. 

Report  of  a  Case  of  Tubercular  Development,  occurring  in  a  Child 
under  one  year  of  age.  By  H.  F.  Campbell,  M.  D.,  Demonstra- 
tor in  the  Medical  College  of  Georgia. 

Inasmuch  as  there  are  comparatively  but  few  cases  on  record 
wherein  tubercular  disease  occurs  in  subjects  under  a  year  old,  as  is 
shown  by  all  tables  of  mortality  from  phthisis,  (the  majority  of  au- 
ihors  estimating  the  disease  as  occurring  in  subjects  over  fifteen  years 
of  age  and  upwards.)  1  would  subjoin  the  following  one  simpiv 
with  the  view  of  corroborating  the  principle  that  consutnption  can 
occur  at  that  early  age,  by  adding  one  more  to  the  small  number  of 
cases  now  on  record.  Dr.  Cless,  of  Stuttgart,  in  a  recent  publica- 
tion  on  the  presence  of  tubercles  in  the  diflerent  organs,  it)  a  January 
No.  of  the  Gazette  MeJicale  de  Paris,  cites  twenty  children  with 
tubercles  in  the  lungs,  but  one  was  under  three  years  of  ngo.  The 
fables  also  of  Baylc  and  Louis  show  their  estimates  to  have  been  taken 
from  subjects  between  15  and  70  years  of  a;:c. 


318  Tubercular  Development  in  an  Infant.  [June, 


'I'lie  case  now  tiiidor  cnusicIiMalioti  wnstliatofa  mwl.ilto  f*  mrilcj 
child,  the  oir>|)iiii<;  of  parents  very  young,  tlio  mother  being  si  niulal- 
to  pirl  ahont  15  years  of  age,  of  a  strninons  habit.  Ti)C  child  from 
birth  had  been  unhealthy,  evincing  a  remarkable  susceplibility  to  cold, 
manifested  by  rcj)eated  attacks  of  pneumonia  and  plouritis  its  di- 
digestive  organs  were  also  frequently  deranged  Siomc  months  pn  vi- 
ous  to  its  death  it  had  been  alibcled  with  opj)ressed  respiration  which 
together  with  hectic  and  other  marked  symptoms  of  pulmonary  dis- 
ease, led  Dr.  Joseph  A.  Eve,  the  attending  physi<:ian,  lodiognoslicate 
the  existence  of  tubercles.  'J'hroughout  its  whole  existence  the  above 
symptoms  were  accompanied  by  an  irritative,  feeble  cough,  without 
much  expectoration,  and  by  the  manifestations  of  the  child,  he  had 
reason  to  suspect  on  certain  occasions  that  it  suffered  an  acute  pain 
in  the  region  of  the  right  lung.  Pulse  feeble  and  very  rapid  ;  within 
from  25  to  30  days  of  its  demise,  there  could  be  distinctly  felt 
through  the  abdominal  parietes  many  rounded  projections  o(  variable 
dimensions,  apparency  attaehed  to  the  posterior  wall  of  the  abdomen 
 its  bowels  had  been,  and  from  the  present  till  its  death  were,  affect- 
ed by  a  colliquative  diarrhoea.  On  the  of  February,  1845,  it 
died  in  a  typhoid  state,  from  exhaustion  and  suffocation.  Autopsy, 
made  in  presence  of  Drs.  J.  A.  Eve,  Low,  and  others,  about  14  hours 
after  death.      Emaciation  extreme. 

On  opening  the  thorax,  I  find  the  Irft  pleura  very  nearly  sound 
and  of  natural  color,  there  being  no  adhesions  and  but  litile  effused 
fluid  in  its  cavity.  The  lung  though  crepitant,  not  entirely  free  from 
disease,  there  being  at  its  base  innumerable  greyish  points  of  various 
magnitude,  the  radicles  of  crude  tid>ercles,  some  of  which  are  (is- 
distinguishable  through  the  pleura  pulmonalis  opposing  the  supiyior 
surface  of  the  diaphragm. 

The  right  vlrura  pulmonalis  adherent  to  the  pleura  cosfatis  and 
pleura  diaphragmatica  throughout  their  whole  extent  by  half  organ- 
ized lymph,  being  in  some  places  one-fourth  of  nn  inch  in  thickness 
while  in  f)thers  the  adhesions  of  the  pleura  are  immediate. 

The  right  lung,  throughout  its  whole  extent,  is  occupied  by  tuber- 
cles in  every  stage  of  development,  and  in  the  lower  lobe  is  an 
abscess  about  three-fourths  of  an  inch  in  diameter,  filled  with  pus, 
there  being  also  a  smaller  one  in  the  n)iddle  lobe. 

Only  at  the  apex  does  there  exist  the  least  crepitus  whatever,  while 
the  remainder  of  the  lung  is  in  a  state  of  complete  tubercular  hepat- 
ization.    Heart  and  pericardium  natural. 


1845.]  Tubercular  Development  in  aji  Infant.  319 


On  opening  (he  cavity  of  the  abdomen,  the  stomacli  is  found  in  a 
normal  condition. 

Sma'l  in'estines  at  particular  places  somewhat  contracted,  though 
no  intussiiscrption. 

Large  intestine,  sound. 

Mescn'erlc  gland'i,{\\vo\\^\\o\\i  t' e  whole  extent  of  the  mesentery, 
enormously  enlarged,  many  of  them  to  nearly  the  size  of  a  walnut, 
while  in  some  few  I  can  plainly  recognize  matter  hearing  a  close 
analogy  to  tubercular  degeneration.  Liver  sound,  wi.h  gall  cyst 
empty.  Spleen  atrophied.  Kidneys  sound.  Pelvic  viscera  unex- 
plored. 

Remarks.  The  development  of  tubercles  in  the  above  case,  was 
favored  by  two  circumstances  to  the  predisposing  influence  of  which 
is  due  perhaps  more  important  consideration  than  is  in  general  ac- 
corded them  namely  :  the  extreme  youth  of  the  child's  parents,  and 
sfill  more,  the  fact  that  it  did  not  claim  its  being  wholly  from  either 
the  Caucasian  or  African  race;  either  of  which,  daily  observation 
inculcates,  is  by  far  better  calculated  to  resist  pulmonary  and  stru- 
mous disease  than  the  truly  unnatural  being,  the  mutual  offspring  of 
these  two  races  so  eminently  ditfering  from  each  other  in  many  essen- 
tial particulars  of  habit  and  constitution. 


Note.  In  corroboration  of  the  paucity  of  cases  on  record  of 
tubercular  development  in  infants  producing  death,  we  observe  in  the 
9(h  vol.  of  the  Mcdico-Chirurgical  Transactions,  London,  a  tabular 
view  of  the  seat  of  tubercle  in  180  cases  of  children,  of  which  num- 
ber not  one  was  under  19  .nunlhs.  Edts. 


320  '    Treatment  of  Sypluliiic  Discis'is.  [June, 


Part  II. REVIEWS  AND  EXTRACTS. 

Treatment  of  SijphiJitic  Diseases  by  Iodide  of  Potassiu7n.  By 
H.  jGouRAUD.  From  the  Journal  des  Connaissances  Medico- 
Chirurgicales,  March,  1815.     (Translated for  this  Journal.) 

Doctor  Coindct,  of  Geneva,  who  first  introduced  Iodine  into  thcra- 
peiitics,  (after  its  discovery,  in  1811,  by  M.  Courtois,)  published,  in 
1820  and  1821,  three  articles  in  wlijch  the  use  of  this  substance  was 
recommended  in  j^oitre,  scrofula,  and  in  some  other  diseases.  M. 
Coindet  even  foresaw  from  the  beginning  the  probable  utility  of  the 
new  medicine  in  certain  forms  of  syphilis. 

Twenty-five  years  only  have  elapsed  since  the  therapeutic  origin 
of  iodine,  and  at  the  present  day  it  is  extensively  employed  and  forms 
one  of  the  principal  agents  in  the  practice  of  a  great  number  of  phy- 
sicians. All  are  acquainted  with  the  excellent  researches  of  M. 
Lugol  upon  the  powerful  action  of  iodine  in  scrofulous  afTections,  and 
know  the  immense  extent  of  this  class  of  affections  in  all  their 
visible  forms,  and  in  their  more  or  less  appreciable  transforma- 
tions. Ifto  the  great  class  of  scrofulous  diseases  and  of  their  numer- 
ous degenerations,  we  add  that  of  syphilitic  affections  with  their 
different  varieties  in  which  iodine  produces  so  many  marvellous 
effects,  we  embrace  at  once  the  majority  of  cases  in  which  the  use  of 
this  medicine  is  irioicatcd.  Formerly  Bordeu  considered  scrofula,  or 
at  least  certain  forms  of  it,  as  being  primitively  of  a  syphilitic  na- 
ture :  this  opinion  has  been  recently  revived  by  M.  Ricord,  and 
certainly  deserves  consideration  ;  it  does  not  exclude  the  important 
opinion  of  M.  Lugol  respecting  the  very  great  power  of  hereditary 
influence,  nor  that  of  M.  Baudelocque,  who,  without  denying  its 
hereditary  character,  places  first  among  the  causes  of  scrofula  the  res- 
piration of  vitiated  air.  These  opinions  do  not  conflict,  but  all  of 
them  seem  to  be  true  in  practice.  Rordeii,  believing  in  the  syphilitic 
origin  of  scrofula,  sometimes  cured  the  disease  by  a  mercurial  treat- 
ment ;  and  does  not  the  success  which  at  the  present  day  so  frequently 
attends  the  treatment  of  scrofula  and  of  syphilis  by  iodine,  prove  an 
affinity  between  these  two  affections? 

Iodine  is  now  very  frequently  employed  as  an  anti-scrofulant,  an 
anti-syphilitic,  a  tonic,  a  sfimnlanf,  an  alterative,   <^-c.      Docs  it  not 


1845.]  Treatment  of  Syphilitic  Diseases.  321 


occupy  at  the  present  day  the  position  formerly  erijoyed  by  mercury? 
For  some  time  a  great  numher  of  poisonous  effects  were  attributed  to 
its  use,  and  the  Germans  have  even  described  a  particular  disease 
produced  by  the  administration  of  this  substance:  but  at  the  present 
day  it  is  employed  without  fear,  and  in  considerable  doses.  We 
believe  that  the  reputation  of  iodine  is  now  permanently  established. 
We  have  seen  it  act  so  beneficially  under  desperate  circumstances,  and 
derive  so  much  advantage  from  its  use  in  our  daily  practice,  that  we 
regard  it  as  an  heroic  and  special  medicine  :  we  also  think  that  it  is 
generally  well  tolerated  by  patients,  (with  some  rare  exceptions,) 
and  that  it  may  be  given  in  large  doses  provided  the  general  laws  of 
therapeutic  toleration  are  observed.  We^do  not  however  design  to 
write  at  this  time  the  therapeutic  history  of  iodine  we  only  desire  to 
call  the  attention  of  our  readers  to  a  very  interesting  work  of  Doctor 
Gauthier,  of  Lyons,  upon  the  treatment  of  syphilitic  diseases  by  the 
iodide  of  potassium.  In  1823,  M.  Ricord  Des  Brus  employed  the 
tincture  of  iodine  in  blennorrhagia  and  in  buboes:  subsequently  M. 
Eu>eSe  de  Salle  made  similar  trials;  and  also  M.  Lallemand,  of 
Montpelier,  in  18'26.  It  is,  however,  to  Doctor  Wallace,  of  Dublin, 
that  belongs  the  honor  of  having  first  employed  the  most  suitable  pre- 
paration of  iodine  the  iodide  of  potassium:  of  having  administered 
it  in  doses  much  larger  than  those  formerly  given,  and  of  having  dis- 
tinguished those  cases  of  syphilitic  affection  in  which  this  medicine 
is  most  efficacious  and  in  which  it  should  be  preferred  to  mercury. 
lie  made  his  experiments  from  1832  to  1836,  and  disclosed  the  results 
in  his  clinical  lectures  which  were  published  in  183G.  Subsequently 
other  English  physicians,  viz:  Doctors  Robert  Williams,  Judd,  A. 
Saville,  Winslow,  and  Bullock,  have  verified  the  results  announced 
by  Doctor  Wallace.  In  Germany,  Doctor  Elbers,  of  Breslaw,  and 
Doctor  Kluge,  of  Berlin,  have  recommended  the  same  practice. 
Finally,  in  1839,  l\I.  Ricord,  in  France,  published  upon  this  point  a 
very  interesting  article.  The  use  of  this  medicine  is  now  universal ; 
facts  abound  in  its  fiivor,  and  the  iodide  of  potassium  may  be  cited  a 
a  specific  in  the  obstinate  cephalalgia  dependent  upon  syphilitic 
exostoses,  in  the  same  way  that  quinine  is  cited  as  a  specific  in  inter- 
mittent fevers. 

We  believe  that  pure  iodine  miited  with  the  iodide  of  potassium, 
and  administered  according  to  the  method  of  M.  Lugol,  is  more  easily 
tolerated  than  some  physicians  pretend,  and  that  the  toleration  is 
^reafpr  in  thos''  ri^p>  in  which  it  is  properly  pr^escribed.      It  must  be 

CI 


322  TrealmeiU  of  Syphilitic  Diseases.  [June, 


confessed,  however,  that  some  patients  either  will  not  bear  the  article, 
or  will  not  tolerate  a  gradual  increase  in  the  dose.  It  is  also  true 
that  it  exerts  upon  the  testes  and  uj)on  the  mammary  glands  an  atro-^ 
phic  action  which  must  be  regarded  as  an  inconvenience.  But  the 
iodide  of  potassium  administered  alone  docs  not  produce  these  bad 
cfFccts.  Wallace,  in  1836,  ascertained  by  experiment  and  by  clini- 
cal observation  that  the  irritating  quality  of  iodine  does  not  ex  st  in 
the  iodide  of  potassium,  or  at  least  only  in  a  very  feeble  degree.  "If 
we  introduce,"  says  he,  "pure  iodine  into  the  stomoch  of  a  dog,  the 
mucous  membrane  is  soon  found  inflamed,  altered  in  its  color  and 
ulcerated,  but  if  we  introduce  an  equivalent  or  greater  quantity  of 
iodide  of  potassium,  the  stomach  undergoes  no  alteration." 

The  same  thing  is  true  with  respect  to  its  atrophic  action.  Wal- 
lace, M.  Ricord,  and  Doctor  Klugc,  of  Berlin,  have  never  observed 
the  absorption  of  the  mammary  glands;  nor  of  the  testes,  nor  emacia- 
tion, although  they  have  practiced  in  large  hospitals.  The  observa- 
tions of  Doctor  Gauthier  have  for  several  years  confirmed  upon  this 
point  the  experience  of  the  physicians  of  Dublin,  Paris  and  Berlin, 
whom  we  have  just  cited.  We  believe  that  this  fact  is  established 
by  daily  practice,  and  we  hear  fewer  complaints  against  iodine  and 
its  preparations,  since  the  exclusive  administration  of  the  iodide  of 
potassium  has  been  so  generally  adopted. 

The  augmentation  of  the  urinary  secretion  is  one  of  the  most  re- 
markable and  constant  effects  produced  by  the  use  of  the  iodide  of 
potassium.  This  phenomenon  arrested  in  a  particular  manner  the 
attention  of  Doctor  Wallace,  who  derived  practical  inferences  from 
it.  The  iodide  of  potassium  is  found  in  considerable  quantity,  not 
only  in  the  urine,  but  also  in  all  the  excreted  fluids,  and  this  explains 
the  reason  why  it  may  be  administered  in  large  doses  without  pro- 
ducing injurious  consequences. 

M.  Ricord  has  described  in  a  very  complete  manner  the  eirccts  of 
the  iodide  of  potassium  upon  the  economy.  In  a  memoir  published 
by  him  in  1841,  he  says  that  this  remedy  produces  frequently  upon 
the  skin  different  kinds  of  eruption  which  resemble  psydracia,  acne 
or  ecthyma,  and  which  are  sometimes  simple  erythemoids ;  that  it 
frequently  causes  a  species  of  salivation  ;  that  it  increases  the  urinary 
secretion;  that  it  causes  often  a  vascular  injection,  with  tumefaction 
of  the  conjunctiva  ;  that  in  many  cases  also  may  be  observed,  under 
its  influence,  ti  peculiar  kind  of  coryza,  and  a  bronchitis  characterized 
by  a  well  marked   embarrassment  in   rcsj)iralion.     M.   Ricord  ali^o 


1845.  J  Treatment  of  Syphilitic  Diseases.  323 


includes  among  the  phenomena  caused  by  this  substance,  cerebral 
congestion^and  a  species  of  intoxication,  and  also  spasmodic  move- 
ments and  tvvitchings  of  the  tendons. 

Some  of  the  phenomena  mentioned  by  M.  Ricord  have  not  been 
observed  by  M.  Gauthier,  but  he  administered  the  iodide  in  smaller 
doses  than  those  used  by  M.  Ricord.  Almost  the  only  phenomena 
which  he  perceived  to  obtain  with  constancy  were,  increase  of  the 
appetite  and  of  embonpoint,  the  coloration  of  the  tissues,  and  the 
more  abundant  secretion  of  the  urine. 

The  iodide  of  potassium  has  been  employed,  and  with  good  suc- 
cess, in  the  primary  symj)toms  of  syphilis  by  several  physicians,  but 
as  these  primary  symptoms  disappear  sometimes  only  by  the  observ- 
ance of  cleanliness,  and  by  an  antiphlogistic  regimen,  facts  of  this 
kind  arc  rather  deficient  in  value.  But  it  is  especially  in  the  second- 
ary and  tertiary  symptoms  that  the  curative  powder  of  the  iodide  of 
potassium  has  been  recognized.  The  patients  treated  by  Doctor 
Wallace  were  affected  with  iritis,  testicular  engorgements,  nodes  and 
other  affections  of  the  fibrous,  synovial  and  osseous  systems,  with 
cutaneous  eruptions,  and  with  diseases  of  the  mucous  membranes. 
M.  Ricord  insists  much  upon  this  distinction,  that  mercury  is  more 
suitable  in  the  secondary  symptoms,  and  the  iodide  of  potassium  in 
the  tertiary  symptoms  ;  and  that  in  general,  in  proportion  as  syphilis 
comes  to  be  transformed  and  its  symptoms  become  tertiary,  mer- 
cury loses  and  iodine  gains  in  cfiicacy. 

31.  Gauthier  has  found  the  iodide  of  potassium  useful  in  the  tertia- 
ry and  secondary  symptoms  of  syphilis  :  he  has  seen  the  most  intoler- 
able pains  of  the  bones  cease  in  a  few  days;  he  has  seen  caries  very 
promptly  modified  ozena,  with  caries  of  the  bones  of  the  nose  and 
perforation  of  the  palatine  arch,  almost  always  cured;  the  gummy 
tumors,  the  deep  seated  tubercles  of  the  skin  and  mucous  membranes, 
and  periostitis,  also  cured.  The  iodide  of  potassium  has  not  appear- 
ed to  him  to  be  suitable  to  all  cases  of  the  syphilides.  "  In  the  exan* 
thcmatous,  papular  and  squamous  pyphilides,"  says  he,  "its  use  has 
produced,  in  general,  no  effects,  or  those  which  were  only  slightly 
advantageous ;  but  in  the  ulcerated  tubercular  syphilide,  in  that  espe- 
cially which  is  called  by  !\I.  Cazenave  perforating  tubercular  syphil- 
ide, in  the  vast  ulcerations  of  the  skin  which  had  destroyed  the 
  cllular  tissue  and  a  portion  of  thesub-jacent  muscles,  I  have  obtain- 
  d  from  its  employment  the  finest  cures,  and  that  too  in  cases  n 
which  mercurial  preparations- had  lecn  rather  injurious  thaij  useful. 


324  Treatment  of  Syphilitic  Diseases.  [June, 


1  have  also  seen  it  cure  syphilide  accompanied  with  larj^e  pustules 
and  ecthyma.  It  may  be  said,  as  a  jijeneral  rule,  that  in  the  syphilides, 
whatever  maybe  their  primitive  forms,  the  iodide  of  potassium  pro- 
duces advantageous  effects,  whenever  they  become  ulcerous.  Mcr- 
cury  may  doubtless  cure  also  in  such  cases;  but  when  it  has  been 
already  employed  by  ihe  patient,  the  iodide  of  potassium  deserves 
the  preference.  Whatever  may  be  the  secondary  or  tertiary  syphil- 
itic symptoms  in  which  this  remedy  is  employed,  it  may  be  remarked 
that,  in  general,  it  succeeds  with  the  greater  certainty  whenever  the 
constitution  of  the  patient  is  deteriorated  in  contrary  cases  it  is  less 
efficncit)us,  and  even  sometimes  fails." 

The  last  remark  of  M.  Gauthier  has  its  importance;  for  it  was  in- 
tended for  certain  anti-syphililic  modes  of  treatment,  particularly  that 
of  Dzondi.  Beside?  it  corroborates  the  opinion  of  M.  Ricord  upon 
the  kind  of  curative  affinity  which  the  iodide  of  potassium  has  for  the 
tertiary  symptoms,  and  for  scrofula,  which  he  regards  as  a  tertiary 
syphilitic  degeneration.  The  physician  then  knowing  the  admirable 
therapeutic  resources  which  the  healing  art  places  at  his  disposal,  will 
be  no  more  discouraged  by  the  cachectic  state  of  his  patients,  than  the 
surgeon  will  be  deterred  by  the  great  debility  of  his  subjects  from  the 
performance  of  amputations,  when  he  recollects  that  very  frequently 
wounded  persons  exhausted  by  suffering,  by  suppuration  and  by  fever, 
present  the  best  chances  for  successful  operations. 

The  physicians  who  have  employed  the  iodide  of  potassium,  vary 
much  in  the  doses  in  which  they  have  administered  it.  For  several 
ye.ir,  only  4  or  5  grains  were  given  in  a  day.  Wallace  employ, 
ed  a  mixture,  composed  of  2-h  drachms  of  iodide  of  potassium  and 

2  ounces  of  water,  of  which  he  gave  a  tea-spoonful  four  times  a  day, 
which  was  equal  to  near  40  grains  daily,  and  administered  always  the 
same  dose  during  the  entire  treatment.  This  is  a  faulty  method,  for 
experience  has  shewn  that  doses  increased  during  the  course  of  the 
treatment  are  much  preferable. 

M.  Ricord  administersthe  iodide  of  potassium  in  much  larger  doses; 
be  commences  with  20  to  40  grains  a  day,  and  pushes  it  rapidly  to  100 
or  120,  and  has  even  given  160  or  180  grains.  He  administers  the 
medicine  in  a  ptisan  ofsoapwort,  or  of  hops,  or  in  the  syrup  of  sarsa- 
parilla.  In  cases  in  which  there  is  a  combination  of  secondary  and 
tertiary  syphilitic  symptoms,  M.  Ricord  prescribes  the  proto-iodide  of 
mercury  at  the  same  time  that  he  uses  the  iodide  of  potassium. 

M.  Gauthier  commences  the  use  of  the  iodide  of  potassium  in  a 


I.,. 


1845.  J  Treatment  of  Syphilitic  Diseases.  325 


small  dose,  such  as  5  grains,  or  even  less.  Ee  regards  this  prac- 
tice  as  necessary  to  avoid  the  occurrence  of  accidents.  As  far 
as  we  are  concerned,  we  have  seen  in  general  the  medicine  tolerated 
easily,  in  doses  much  larger  than  those  employed  by  M.  Gauthier. 
It  is  true,  however,  that  in  some  patients  more  caution  must  be  ob- 
served. The  physician  of  Lyons  increases  rapidly  the  dose  to  several 
scruples,  and  finds  it  useful  to  give  the  medicine  in  a  mucilaginous 
ptisan.  The  ptisan  which  he  prefers  is  composed  of  2  scruples  of 
salep  and  2  ounces  of  gum  arable  boiled  in  6  tumblers  of  water. 

In  ulcerations  of  the  throat,  M.  Gauthier  touches  the  ulcers  with 
charpie,  saturated  in  the  following  mixture: 

R  Iodide  of  Potassium,  .  .  .  gr.  12. 
Tincture  of  Iodine,  .  ...  32 
Distilled   Water,      ....        g    6. 

When  it  is  necessary  to  administer  mercury  at  the  same  time,  ho 
prefers  M.  Boutigny's  syrup  of  the  d^uto-iodide  of  mercury. 

The  iodide  of  potassium  ought  to  be  continued  for  a  certain  time 
after  the  complete  disappearance  ofevery  symptom.  Besides,  accord- 
ing to  the  remark  of  x\I.  Ricord,  there  is  no  inconvenience  in  continu- 
ing a  remedy  which  increases  in  the  most  energetic  manner  the 
activity  of  the  digestive  functions,  and  the  appetite  and  embonpoint  of 
those  who  make  use  of  it.  The  work  of  M.  Gauthier  concludes  with 
thirty-four  cases  in  which  the  iodide  of  potassium  cured,  more  or  less 
rapidly,  deep  seated  ulcerations,  caries,  syphilides,  ulcerated  tubercles, 
pains  of  the  bones,  &c.  We  think  that  some  of  these  cases  will  be 
interesting. 

Cask  1.  Vast  ulcer  of  the  pharynx  with  destruction  of  the  soft 
palate,  in  a  woman  who  had  never  taken  mercury.  Administration 
of  iodide  of  potassium   Cure. 

The  widow  G ,  aged  60,  came  to  consult  me  in  the  early  part 

of  April,  1844;  she  had  a  very  large  ulcer  which  had  destroyed  en. 
tirely  the  soft  palate  and  the  uvula,  and  which  extended  over  all  the 
posterior  face  of  the  pharynx.  All  these  parts  were  the  seat  of  a 
very  abundant  suppuration.  This  woman  could  utter  a  few  words 
only  with  the  greatest  difficulty.  For  a  long  time  she  had  been  able 
to  swallow  only  milk  and  soup  for  her  nourishment.  I  informed  her 
that  she  had  a  venereal  disorder,  and  that  she  could  be  cured.  She 
made  the  most  positive  denial :  asserted  that  she  had  never  had  such 
an  affection  ;  that  she  had  been  a  widow  for  several  years;  that  she 
could  not  hope  for  a  c\ire,  and  only  desired  some  relief  from  her  suf- 


326  Treatment  of  Syphilitic  Diseases.  [June, 

ferings.  A  physician,  deceived  doubtless  by  her  denial,  had  simply 
cauterised  the  ulcerated  parts  with  nitrate  of  silver,  without  employ- 
ing any  anti-syphilitic  treatment.  Having  interrogated  this  woman, 
she  informed  me,  however,  that  siie  had  been  troubled  about  15  years 
before  with  white  discharges  from  the  genital  apparatus,  and  that  she 
had  also  experienced  deep  seated  pains  during  the  night  in  the  head 
and  limbs.  She  had  been  told  that  it  was  a  rheumatic  aflection.  I 
prescribed  immediately  the  iodide  of  potassium  in  the  dose  of  4 
grains  per  day.  I  exhibited  it  in  the  syrup  of  Cuisinier,  diluted 
with  a  mucilaginous  ptisan.  I  ordered  at  the  same  time  an  iodine 
gargarism,  and  recommended  the  patient  to  touch  several  times  a 
day  the  ulcerated  parts  with  charpie,  saturated  in  the  gargarism. 
The  dose  of  the  iodide  was  gradually  increased  ;  it  sometimes  dis- 
tressed the  stomach;  in  which  case  I  added  a  little  syrup  of  poppies. 
After  the  expiration  of  eight  days  the  change  was  very  appreciable, 
the  suppuration  was  much  diminished,  and  the  deglutition  more  easy. 
In  a  month  the  ulcerated  surface  was  entirely  cicatrised.  The  pa- 
tient took,  however,  only  1  scruple  of  the  iodide  a  day,  and  it  was 
sometimes  necessary  to  suspend  the  use  of  it.  The  treatment  was 
continued  for  two  months.  At  the  present  time  the  patient  enjoys 
very  good  health,  has  a  good  appetite,  but  there  is  much  difficulty 
in  eating,  as  the  food  and  drinks  enter  into  t!ie  nasal  cavities;  her 
voite  also  is  much  affected. 

Case  2.  General  perforating  tubercular  syphilide;  pains  of  the 
bones ;  extreme  emaciation  :  the  iodide  of  potassium  in  very  large 
doses  effects  a  cure.  Relapse  after  some  months  ;  pains  of  the  bones 
and  hydarthrosis:  new  cure  by  the  iodide  in  much  smaller  doses 
than  at  first. 

Claudine  J ,  aged  32  years,  of  a  lymphatic  temperament,  was 

attacked,  in  April,  1842,  with  ulcers  on  the  genital  parts,  which  were 
cured  by  cauterisation  and  mercurial  pills.  Three  months  after  this 
cure,  there  supervened  a  tubercular  syphilide  over  the  whole  body, 
which  was  treated  with  sudorific  ptisans,  the  liquo*  of  Van  Swieten, 
the  syrup  of  Cuisinier,  &;c.  The  alimentary  canal  soon  became  irri- 
table, cough  supervened  with  hectic  fever,  the  menstrual  discharge 
ceased,  and  the  syphilide,  instead  of  improving  became  worse  and 
worse.  She  was  admitted  into  the  hospital  of  Antiquaille,  April 
18th,  1842,  in  the  most  deplorable  state:  large  ulcerated  tubercles 
exist  over  the  entire  surface  of  the  body,  some  of  them  upon  the  fore- 
head, the  cheek,   and    behind    the   enrs.  are   ns   Inrgo  as    a   qtiarter 


1!=?45.]  Trcalment  of  Sypli'dilic  Diseases.  327 


dollar,  some  of  them  are  covered  with  a  thick  scab,  and  from  others 
exudes  an  abundant  serous  pus ;  they  penetrate  very  deeply;  the 
largest  ulcerations  occupy  the  left  leg;  this  affection  presents  the 
aspect  of  the  perforating  tubercular  syphilide  of  M.  Cazenave.  The 
patient  is  in  a  very  cachectic  state,  the  ulcers  are  very  painful,  and 
when  in  a  bath  they  bleed  :  cough,  epigastric  pains,  tongue  red,  ces- 
sation of  the  menstrual  discharge  for  five  months,  hectic  fever,  ex- 
treme emaciation,  complexion  livid,  nocturnal  pains  in  the  extremilie.'^, 
which  cause  an  obstinate  want  of  sleep. 

After  having  subjected  this  patient  for  a  month  to  mucilaginous 
drinks,  to  milk,  and  to  opiate  potions,  I  ordered  the  iodide  of  potas- 
sium in  the  dose  of  2  grains  per  day,  which  I  gradually  increased 
to  the  doso  of  1  scruple.  Some  amelioration  then  ensued.  When 
the  dose  reached  3  scruples  the  condition  of  the  patient  remained 
stationary.  I  thought  then  that  the  proto-iodide  of  iron  would  be 
more  suitable,  because  of  the  amenorrhoEa  and  of  the  cachectic  state 
of  the  subject.  I  was  deceived  in  this  opinion.  During  the  admin- 
istration of  the  iodide  of  iron,  1  scruple  of  which  w^s  given  each 
day,  the  ulcers  became  more  extensive  and  painful.  The  iodide  of 
potassium  was  then  resumed.  As  the  condition  of  the  ulcers  had 
remained  stationary  while  she  was  taking  3  scruples,  the  dose  was 
now  increased.  When  it  reached  4  scruples  per  day,  I  perceived 
that  the  patient  tolerated  it  well,  and  that  her  condition  slightly  im- 
proved. The  dose  was  increased  until  7  scruples  per  day  were 
taken.  I  accomplished  a  cicatrisation  of  all  the  ulcer.?.  The  men- 
strual evacuation  returned,  after  having  been  suspended  for  a  year, 
and  the  patient  left  the  hospital  in  a  tolerably  satisfactory  condition. 

Having  been  exposed  to  cold  and  damjmess  she  was  taken  with 
very  acute  pains  in  the  articulations,  and  was  admitted  into  the  Hotel 
Dieu,  of  Lyons,  where  she  was  treated  with  the  extract  of  aconite. 
She  left  that  Hospital  much  relieved,  and  was  admitted  into  that 
of  Antiquaille  the  22d  of  August,  1844.  She  was  then  troubled 
with  nocturnal  pains  in  the  bones  of  the  head,  there  existed  upon  the 
arm  one  tubercle  covered  witii  a  scab,  and  besides  she  was  affected 
with  hydarthrosis  of  the  wrist  and  of  the  fcxit.  I  doubted  at  first  the 
syphilitic  nature  of  these  symj)tonis  I  emjiloyed  vesicalories,  fumi- 
gations, and  vapour  baths,  but  unsuccessfully.  I  had  recourse  again 
to  the  iodide  of  potassium.  I  commenced  the  22d  of  September 
with  a  dose  of  10  grains  ;  on  the  4th  October  she  took  30  grains. 
Tlif   nocturnal   pains  of    the  brad   had    alitady    disnppenrel.     On 


328  Diseases  of  the  Heart.  [June, 


the  8th  October,  35  grains  of  the  iodide  were  administered ;  the 
hydartlirosis  of  the  wrist  and  that  of  the  foot  have  greatly  dimin- 
ished. On  15th  of  October,  2  scruples  of  the  io(Hde  ofpolnssium 
were  taken;  the  hydarlhroses  have  disappeared,  and  the  patient  has 
a  good  appetite.  The  treatment  was  continued  to  the  1st  of  Decem- 
ber, and  the  patient  left  the  hospital  on  the  lOlh  of  that  montii  The 
menstrual  discharge  at  that  time  had  not  re-appeared.  N. 


S(me  of  the  Diseases  of  the  Heart.  By  C.  J.  B.  Williams,  M. 
D.,  F  R  S.,  Professor  of  Medicine  in  the  University  College,  t^c. 
London. 

Sounds  of  the  Heart.  The  sounds  or  murmurs  accompanying  the 
systolic  action,  as  also  the  impulse,  must  be  modified  greatly  by  the 
force  of  the  current  out  of  the  ventricles.  There  are  several  cir- 
cumstances to  be  taken  into  consideration  in  reference  to  this  subject ; 
for  instance,  the  blood  may  flow  in  the  usual  direction,  into  the  aorta, 
the  murmur  being  caused  by  some  irregularity  in  the  orifice;  or  the 
sound  may  depend  on  regurgitation  thrcjugh  the  aortic,  the  mitral,  or 
the  tricuspid  valves.  It  may  also  be  prodiiced  by  perforations  of  the 
heart,  and  communications  with  the  sac  of  the  j)ericardium,  or  open- 
ings existing  between  the  two  ventricles,  etc.  Again,  the  murn)urs 
which  are  heard  during  the  diastole  of  the  heart,  are  produced  by  a 
flowing  back  of  the  blood  into  the  ventricle;  and  they  are  chiefly 
regurgitant  aortic,  regurgitant  mitral,  or  else  obstructive  sounds. 

Now,  with  regard  to  the  distinction  of  the  situation  of  soimds,  we 
find  them  chiefly  produced  or  propagated  in  those  parts  of  the  chest 
which  form  the  best  conducting  media  ;  as  also  in  those  parts  corres- 
ponding  to  the  direction  in  which  the  current  flows.  The  obstructive 
aortic  sound  is  heard  best  when  the  heart  and  the  aorta  are  brought 
near  to  the  surface  of  the  chest,  as  is  sometimes  the  case  in  conse- 
quence of  enlargement  of  the  heart.  Jt  may  be  heard  most  j)iainly 
about  the  middle  of  the  sternum  or  at  its  lower  part,  though  some- 
times more  on  one  side,  sometimes  more  on  the  other.  There  is  no 
certain  rule  with  regard  to  position.  You  find  obstructive  aortic 
disease  sometimes  occupying  one  position,  and  sometimes  another. 
But  it  is  not  the  mere  position  of  the  sound  that  distinguishes  the 
disease.  It  is  heard  where  it  is  produced;  but  it  is  also  |)ropagated 
in  the  direction  of  the  great  arteries,  and  extends  alon^  tiie  aorta 
behind  the  steiniun,  up  the  course  of  the  innominata,  the  left  sub- 
clavian, and  along  the  carotids.  On  the  other  hand,  it  may  be  heard 
pretty  distinctly  downwards  towards  the  apex,  but  is  by  no  means  so 
loud  nor  so  long  as  over  the  course  of  the  arteries.      Then,  again, 


184.3.]  Diseases  of  tlie  Heart.  329 


the  obstructive  pulmonary  sound  is  heard  much  in  the  same  position  : 
it  is  a  very  small  miirmui,  and  may  be  produced  by  constric'.ion  of 
these  arteries.  The  piibnonary  artery  and  the  aorta  lie  so  close  to 
each  other,  that  there  is  some  danofer  of  confi)undinfr  these  sounds. 
There  is  this  difTiircnce,  however,  between  them.  When  you  find 
the  murmur  very  loud,  and  when  it  extends  along  the  carotids,  you 
may  ireneraily  sJispect  it  to  be  seated  in  the  aorta.  The  obstructive 
aortic,  and  the  regur<i[itant  mitral,  are  the  most  common  murmurs 
accompanyincr  the  sounds  of  the  heart.  The  regurgitant  mitral  is 
produced  in  the  mitral  valve.  It  is  heard,  not  so  much  immediately 
over  the  seat  of  the  valve  (about  half  way  between  the  mammilla 
and  the  margin  of  the  sternum)  as  it  is  at  the  apex  of  the  heart,  or 
a  little  bf'low  the  left  breast. 

Functional  Maladies.  I  now  pass  on  to  the  consideration  of  tho 
diseases  of  the  heart;  first  noticing  the  functional  diseases  which 
imply  disorder  of  the  proper  function  of  the  heart's  action.  Disor- 
dered  action  of  the  heart  may  be  divided  into  increased  action,  de- 
tective action,  and  irregular  action.  Inordinate  action  of  the  heart 
is  engendered  by  various  causes,  and  may  be  j)rodured  by  different 
pathological  states.  For  example  :  undue  irritation  of  the  heart,  by 
an  over  stimulating  property  of  the  blood,  as  when  a  person  has  taken 
stimulating  liquors  inconsiderable  quantity.  It  may  also  arise  from 
other  causes  than  I  he  state  of  the  blood  itself:  from  something  extra- 
neous to  the  heart  some  mechanical  cause  interfering  with  the 
heart's  action,  as  the  stomach  being  overloaded  or  from  reflex  irrita- 
tion through  the  medium  of  the  nerves,  caused  by  various  irritating 
matters  in  the  stomach;  also  it  is  produced  by  increased  irritability 
of  the  muscular  fibres  of  the  heart  itself,  which  may  depend  either 
on  a  greater  flow  of  blood  through  the  structure  of  the  heart,  or  on 
a  determination  or  inflammation  of  the  lining  membrane  of  this 
organ.  Palj-itation  of  the  heart  may  be  defined  to  he  that  amount 
of  inordinate  action  which  is  perceptible  to  the  patient  himself,  and  is 
productive  of  more  or  less  distress.  The  distress  produced  by  the 
violent  action  of  the  heart  is  sometimes  very  great;  the  patient  is 
conciousofthe  beating,  which  is  accomj)anied  by  a  hurried  and  vio- 
lent  motion,  as  well  as  by  a  feeling  of  sutibcation.  There  may.  how- 
ever, be  inordinate  action  to  a  considerable  amount,  without  the  patient 
being  aware  of  the  existence  of ihe  disturbance;  many  such  persons 
being  merely  subject  to  short  breath  and  a  feeling  of  faintness.  It  is 
a  remarkable  fact,  that  with  regard  to  junctional  diseases,  generally 
speaking,  the  patient  is  conscious  of  the  palpitation  ;  but  in  cases  of 
structural  disease,  wliere  there  is  inordinate  action,  the  patient  is  not 
invariably  conscious  of  the  existence  of  palpitation,  'i'he  reason  of 
this  is,  that  in  cases  of  functional  disease,  the  affection  is  intermit- 
tent, varying  in  its  degrtM;  at  different  periods;  and  it  is  durirjg  this 
increase  in  degree  that  the  palpitation  becomes  distressing  aiui  un- 
comfortable.  In  these  cases  there  is  an  exalted  sensibility,  a  nervouR 
excitability,  existing  in  a  high  degree  an  undue  sensibility  of  tho 


.*i30'  Diseases  of  the  Heart.  [June, 


nc-rves  that  renders  the  patient  conscious  of  these  inordinate  motions 
of  the  heart.  On  the  other  hand,  in  structural  disease,  the  inordinate 
action  is  developed  gradually,  until  at  last  the  patient  becomes  ac- 
customed to  it. 

Physical  Signs  Accompanying  Palpitation.  The  physical  signs 
of  mere  palpitation,  without  any  structural  disease,  are  fin  increase 
of  the  impulse,  as  well  as  of  the  natural  sounds  of  the  heart,  exactly 
like  that  produced  after  violent  exertion;  violent  exercise,  in  fact, 
picxluces  palpitation,  hut  it  subsides  with  the  cessation  of  the  cause. 
Wifii  tills  augmented  force  of  pulsation,  the  heart  may  be  felt  vi^jor- 
ously  heatinjx  against  the  chest,  and  there  is  increased  loudness  of  the 
first  sound,  in  consequence  of  the  greater  vigor  and  abruptness  with 
wliich  the  muscular  tension  is  produced  ;  but  there  is  not  augmented 
loudness  in  thesecond  sound  :  there  is  not  enough  biood  forced  into 
the  arteries,  at  each  beat,  to  cause  a  sudden  increased  recoil  upon  the 
valves.  In  addition  to  the  greater  strength  of  impulse  and  abruptness, 
there  is  an  absence  of  the  signs  of  enlargement  of  the  heart,  which, 
although  beating  violently,  is  still  in  its  proper  place.  'Jhe  signs  on 
j>ctcussion  are  not  materially  modified.  If  there  be  any  triflinjj 
amount  of  disease  at  tlie  root  of  the  aorta,  or  in  the  aortic  valves,  so 
that  there  is  a  regurgitation  of  hlood  into  the  ventricle,  these  sounds 
become  exaggerated  during  palpitation.  In  violent  palpitation,  the 
phenomena  are  strongly  marked  at  the  top  of  the  sternum,  in  the 
carotids  and  arteries  whiceare  near,  and  in  some  cases  (^i"  this  kind 
the  jugular  veins  may  be  seen  to  pulsate.  Attacks  of  palpitation 
often  terminate  with  eructation  of  wind,  and  when  the  palpitation 
subsides  there  is  a  free  flow  of  urine.  In  some  cases  palpitation  is 
excited  by  temporary  plethora.  Large  quantities  of  fluid  being 
drank,  become  absorbed  into  the  vascular  system,  and  cause  palpita- 
tion and  a  great  flow  of  urine  which  is  thus  an  index  of  the  system 
having  got  rid  of  this  excess.  Sometimes  perspiration  takes  place, 
and  the  thing  subsides  in  this  way.  I'liere  are  various  causts  for 
congestion  wliich  may  produce  palpitation  ;  the  heart  is  sometimes 
active,  but  does  not  contract  fidly  on  its  contents,  and  then  it  is  exci- 
ted to  violent  palpitation.  This  occurs  not  unfrequently  in  connex- 
ion will  asthenic  plethora  ;  and  in  this  case  there  is  increased  dulncss 
of  sound  at  the  region  of  the  heart,  and  this  organ  is  actually  distend- 
ed by  the  quantity  of  l)lood  which  it  is  unable  to  get  rid  of.  This 
likewise,  often  co-exists  with  defective  action  of  the  excretory  organs, 
a  condition  which  thus  induces  great  plethora  of  the  vascular  system. 
Palpitation  is  sometimes  produced  by  other  causes  which  bring  about 
internal  congestion:  such  as  long  cx|)osure  to  cold;  insufiicient 
clothing;  or  even  the  opposite  extreme,  great  heat.  It  is  very  com- 
monly produced  by  extraneous  causes;  such  as  pressure  over  the 
region  of  the  heart ;  flatulence;  accumulation  of  fu;ces  in  tlic  intes- 
tines; iui})n)pcr  food  ;  the  tJ)rmation  of  tumors  near  the  heart  or 
^Mcat  arteries  ;  and  disordered  uterine  fvinction.  In  all  these  difPe r- 
rnt  cases,  the  'lalpitation  is  only  sympathetic;   it  may  be   only  tein- 


1845.1  Diseases  of  the  Heart.  ''Y^i 

porary  ;  but  if  it  continue,  it  becomes  very  distressing,  and  tends  in 
some  instances  to  produce  further  disease,  by  throwing  the  blood 
irregularly  into  different  parts  of  the  system.  Long  continued  pal- 
})itation,  accompanied  by  plethora,  may  cause  permanent  disease  of 
the  heart  or  of  the  great  arteries  (either  hypertrophy  or  dilatation). 
This  is  owing  to  the  activity  of  the  plastic  process.  In  cases  in 
which  it  is  accompanied  by  congestion  or  inflammation,  it  tends,  by 
its  coulinuance,  to  the  production  of  organic  disease  ;  on  the  other 
hand,  as  I  have  said,  it  is  produced  in  the  opposite  state  from  merely 
nervous  causes;  by  an  anemic  state,  or  a  deficiency  of  blood  in  the 
whole  system  ;  and  this  may  go  on  for  a  long  time  without  producing 
any  structural  disease,  merely  accompanied  by  considerable  func- 
tional disturbance. 

Treatmenl  of  Palpitation  of  the  Heart.  The  treatment  of  inordi- 
nate action  of  the  heart  must  depend  on  the  cjuise.     It  may  some- 
times be  relieved  by  stimuli,  which  seem  to  restore  the  natural  action 
of  the  heart,  and  remove  the  nervous  palpitation.     Etiier,  aromati<! 
waters,  ammonia,  and  spirits,  will  give  great  relief  in  some  cases  of 
palpitation,  restore  the  balance  of  the  heart's  action,  and  check  th(3 
nervous  irritability.     These  are  only  temporary  measures.      Incases 
in  which  it  depends  on  congestion,  the  removal  of  the  cause  of  this 
congestion  must  be  considered  as  of  essential  importance.      In  all 
cases  in  which  plethora  exists,  it  is  useful  to  employ  local  depletion 
to  relieve  the  heart,  and   take  away  the   increased  load.     Bleeding 
from  the  arm  is,  under  some  circumstances,  serviceable;  and  it  is 
desirable  to  produce  increased  action  in  the  excretory   organs,  by 
purgatives,  and  various  diuretics.     It  is,  of  course,  necessary  in  cases 
of  palpitation,  accompanied  by   plethora  or  fulness,  thai  the  patient 
should  be  abstinent ;  and  doses  of  calomel,  for  awhile,  and   Dover's 
powder,  are  of  great  efficacy  ;  but  they  njust  bo  used  in  a   moderate 
degree.     The  best  means  of  acting  on   the  urinary  secretion  is  by 
colchicum,  digitalis,  and  nitre.     If  the  disease  occur  simply  from  ner- 
vous sensibility,  without  the  plethoric  stato  I  have  been  mentioning, 
sedatives  should  be  used  in  combination  with  other  medicines  ;  hydro- 
cyanic acid,    hyoscyamus,   opium,   and  quinine,   are   the  renunlies. 
Sedatives,  however,  are  but  temporary  measures,  and  for  permanent 
good  tonics  are  chiefly  to  be  depended  upon,     'i^hc   most  useful  is 
iron,  where  it  can  be  borne;  bismuth,  nitrate  of  silver,  and  sulphate 
of  copper,  are  also  good  remedies.     In  all  cases,  country  air  is  essen- 
tial, an  abstinence  from  sedentary  habits,  regular  exercise,  and  the, 
use  of  cold  water,  either  by  drinking  it,  or  sponging  the  whole  sur- 
face, which  tends  to  improve  the  capillary  circulation  ;  also  a   cold 
plunge  bath;   these  are  the  means  which  are  mf)st  efficaciouJ. 

Irregular  and  defective  action  maybe  classed  together.  Irregular 
action  is  defective  in  its  actual  r(\sult.  Irregularity  in  the  rhythm 
of  the  heart  is  very  common  in  weak  and  nervous  subjects,  both 
young  and  old.  It  consists  in  an  interruption  of  the  boat,  or  a  r"- 
tardalion,  or  clso  in  too  great  an  accel  ration  ;  so  that  insload  fif  re- 


832  Diseases  of  the  Heart.  [June, 

 

cnrrint;  at  rogular  intervals,  one  sometimes  occurs  sooner  than  the 
other,  then  thore  is  an  intcrruplion,  and  then  it  goes  on  again.  A 
constrain(ui  posliire  will  .sometimes  proHuce  this  condition,  as  a^so  ir- 
regularities of  diet,  and  so  forth  ;  this  state,  moreover,  is  usually 
comhined  with  other  symptoms  of  weak  circulation,  such  as  cold- 
ness of  the  ext rem i lies  ^r  a  conijestive  appearance  of  the  face.  Ir- 
regularity and  inequality  of  the  heart's  pulsation  are  more  commonly 
the  efTect  of  struetiual  disease  ;  but  the  palpitations  I  have  been  men- 
tioning, as  accompanying  asthenic  plethora,  are  often  attended  by 
irregular  action,  altliou^h  there  may  be  no  organic  disease. 

Hypertrophy  and  DUntion.  It  is  desirable,  first  of  all,  to  notice 
hypertrophy,  dilation,  and  disenses  of  the  mulcular  structure,  because 
these  require  to  be  carefully  distinguished  in  the  treatment.  Now, 
the  muscular  structure  of  the  heart  is  scarcely  liable  to  inflamma- 
tion in  itself,  and  carditis  in  the  surrounding  coats  is  extremely  rare. 
The  muscular  structure  of  the  heart  is  nevertheless  liable  to  remark- 
able changes,  and  these  appear  to  have  relation  more  to  the  immedi- 
ate derangement  of  its  functions  than  to  inflammation.  'I'here  are 
many  cases  of  structural  disease  in  organs,  in  which  direct  inflam- 
mation is  produced  ;  but  it  is  not  so  with  regard  to  the  heart.  We 
find  the  origin  of  structural  disease  of  the  heart  to  be  more  particu- 
larly depending  on  disorder  of  its  functions;  audit  may  be  stated, 
as  a  general  fact,  that  circumstances  which  interfere  with  the  func- 
tion of  the  heart,  which  over-excite  it  or  tax  it  in  various  ways,  tend 
to  produce  diseases  in  its  structure.  Now,  inordinate  action  and  de- 
fective action  may  both  lead  to  structural  disease  of  the  heart.  On 
the  other  hand,  we  sometimes  meet  with  eases  in  which  tre  structu- 
ral aff'eclions  will  go  on  for  an  almost  unlin)ited  period,  without  lead- 
ing to  great  functional  derangement.  These  are  principally  cases  of 
angemia.  in  which  the  quantity  of  blood  is  insufHcient.  Again  there 
are  cases  in  which  an  over-quantity  of  blood  may  have  an  influence 
in  producing  disease;  where  there  is  a  })lethora  or  fullness  of  the 
vessels.  In  some,  this  is  accompanied  by  a  peculiar  activity  in  all 
the  functions  connected  with  the  circulation,  secretion,  and  nutrition; 
this  is  comprehended  under  ihe  term  sthenic  plethora.  In  the  other 
kind,  there  is  an  absence  of  power  in  the  blood  to  nourish  and  in- 
crease the  muscular  substance  of  the  heart,  arising  from  some  defi- 
ciency in  the  quality  of  the  blood,  or  from  some  other  cause;  and 
this  comes  under  the  head  of  asthenic  plethora.  Now,  in  relation 
to  these  two  cases,  we  may  observe  the  developement  of  two  oppo- 
site conditions  of  the  muscular  structure  of  the  heart.  Sthenic 
plethora,  inducing  an  excitement  of  the  heart,  will  lead  to  hypertro- 
phy  of  this  organ,  and  an  increase  of  the  muscular  structure.  On 
the  other  hand,  the  increased  or  irregular  action  which  you  wdl  fre- 
quently  find  connected  with  asthenic  plethora  a  state  in  which 
there  is  a  distention  of  the  heart,  without  a  corresponding  increase 
in  its  nutrition,  leads  to  a  lesion  called  dilatation  of  the  heart.  These 
aro  the   two  modes  in  which  these  lesions   are  produced,  and   they 


1845.]  Diseases  of  the  Heart.  333 


comprehend  the  various  exciting  causes.  The  nnatter,  however,  may 
be  stated  in  another  point  of  view;  and  this  leads  us  to  an  explana- 
tion  as  to  the  modes  in  which  various  exciting  causes  act ;  as, 
when  the  heart  is  ex<Mted  by  continued  obstruction  when  there  is 
some  difficulty  to  the  passage  of  the  blood  through  the  heart,  either 
from  weakness  in  the  walls  of  the  heart,  or  from  positive  obstruction 
in  the  vessels  leading  from  it.  Either  of  these  causes  excites  the  ac- 
tion of  the  heart,  and  leads  cither  to  dilatation  or  hypertrophy,  ac- 
cording to  the  preponderance  of  the  elements  hitherto  considered. 

N<jvv  we  come  to  hypertrophy.  This  is  a  somewhat  rare  disease. 
But,  when  the  heart  struggles  long  against  an  obstacle  to  the  circu- 
lation, at  the  same  time  that  the  nutritive  function  is  active,  and  the 
muscular  strength  is  kept  up,  hypertrophy  does  take  place.  The  ex- 
citing  causes  of  hypertrophy  are  several:  excessive  muscular  exer- 
tion,  more  particularly  during  the  continuance  of  growth,  when  the 
nutritive  function  is  active,  and  there  is  sthenic  plethora  in  the  sys- 
tem ;  that  condition  in  which  the  blood  is  rich  in  nutritive  matter, 
and  ready  to  deposit  its  fibrine;  when  the  heart  is  strong,  and  great 
excitement  is  given  to  it,  it  then  grows  in  an  inordinate  degree.  It 
is  not,  however,  enough  thr.t  the  muscular  exertion  is  occasional,  it 
must  be  habitual.  Again,  in  structural  diseases,  which  are  accompa- 
nied by  so  much  obstruction  as  to  impede  the  circulation,  and  excite 
the  action  of  the  heart  in  an  inordinate  degree,  as  the  various  ob- 
structions that  arise  in  the  course  of  the  large  arteries,  such  as  aneu- 
rism.  dsc,  or  any  cause  interfering  with  the  current  of  the  circula- 
tion, as  emphysema  of  the  lungs,  and  all  those  various  circumstances 
which  overtax  the  heart ;  in  all  these  cases  the  muscular  fibres  of  the 
heart  are  enlarged  and  hypertro|)hied.  Obesity,  too,  when  it  is  ac- 
companied by  sanguineous  plethora,  has  a  similar  effect ;  and  you 
find  many  cases  of  obesity  attended  with  hypertrophy.  This  always 
manifests  disorder  of  the  circulation.  Whenever  a  person  is  inclined 
to  be  corpulent,  there  is  naturally  more  work  for  the  heart,  accor- 
ding to  the  necessary  order  of  things;  an  increased  task  for  the 
heart  requires  increased  power  and  exertion.  But  in  a  State  of  ca- 
chexia, this  increase  in  the  substance  of  the  heart  does  not  take 
place;  apd  we  find  symptoms  of  weakness  of  the  heart,  tending  to 
palpitation,  and  other  things  undor  the  head  of  defective  action; 
and  though  the  heart  is  not  diminished  in  size,  yet  it  has  become  too 
weak  for  the  work  it  has  to  perform.  These  are  the  only  two  ele- 
ments  required  for  the  production  of  hypertrophy  which  it  is  neces- 
sary to  bear  in  mind:  namely,  sanguineous  plethora,  and  excessive 
and  continuous  excitement  of  the  heart.  Any  circtimstances  con- 
tributing  to  these  two  things,  usually  lead  lo  a  greater  or  less  amount 
of  hypertrophy. 

The  physical  signs  of  hypertrophy  are  very  distinctive.  There  is 
an  increased  developement  of  the  muscular  fibre,  and  this  renders 
the  contraction  stronger,  and  consequently  the  impulse  is  more  per- 
ceptible ;  but  it  is  slow  and  more  heaving.     The  fibres  do  not  con- 


334  Diseases  of  the  Heart.  [June, 


tract  with  the  same  abruptness  and  suddenness,  as  in  the  normal  state, 
and  the  sound  is  more  or  less  modified.  Where  there  is  simply  hy- 
l)ortrophy,  unaccompanied  hy  dilatation,  the  sound  is  usually  dimin- 
ished;  whereas,  in  cases  of  dilated  iiypertrf^^ihy  where  dilatation 
and  hypertrophy  are  combined  there  will  be  an  increased  loudness 
of  sound,  together  with  an  increased  strength  of  impulse.  But  the 
chief  characteristic,  distinctive  of  hypertrophy  without  dilatation,  is 
an  increase  of  impulse  with  a  diminution  of  sound,  just  as  in  dilata- 
tion there  is  an  increase  of  sound  with  a  diminution  of  impulse.  In 
some  cases,  the  tirst  sound  is  very  indistinct  at  the  region  of  the 
heart,  and  the  inipulse  is  strong  and  heaving  ;  but  near  the  large  ar- 
teries, the  first  sound  is  hoard  more  plainly.  Where  the  increase  of 
the  substance  of  the  heart  is  consideral)le,  and  the  dilatation  great, 
we  then  have  a  remarkable  kind  of  motion  produced  during  the  dia- 
stole. In  the  normal  state  of  the  heart,  the  diastolic  motion  is 
scarcely  perceptible;  all  that  is  felt  is  the  apex  of  the  heart  coming 
in  contact  with  the  ribs,  with  the  motion  of  the  ventricle  to  the  left  of 
the  sternum.  But  in  these  cases,  during  the  diastole,  we  have  a  kind 
of  heaving  up  of  the  walls  of  the  chest,  and  that  to  a  great  degree ; 
but  there  is  a  sudden  collapse  or  pulling  back  of  the  walls  at  the  mo- 
ment of  the  contraction.  This  diastole  Dr.  Stokes  called  the  back 
stroke,  and  it  is  frequently  met  with  in  cases  of  dilated  hypertropliy. 
Now,  besides  this,  the  impulse  is  stronger  and  more  extended  ;  but 
the  degree  of  this  extent  will  vary  according  to  the  form  of  the  hyper- 
trophy. If  it  be  simple  hypertrophy,  without  any  great  enlarge- 
ments of  the  cavities  of  the  heart,  the  beat  will  be  found  but  little 
lower  than  usual,  and  the  impulse  will  seem  to  be  directed  down- 
wards, without  exteding  beyond  its  usual  locality.  But,  in  hypertro- 
phy, with  enlargement  of  the  left  ventricle,  the  impulse  will  vary  ac- 
cording to  the  degree.  The  apex  will  be  felt  beating  to  a  greater  or 
less  extent  below  the  left  breast.  On  the  other  hand,  this  dilated 
hypertropiiy  may  sometimes  assume  the  globular  form,  and  then  the 
impulse  is  felt  mostly  higher  up,  and  has  not  that  striking  or  lifting 
character  usually  accompanying  it.  This  is  a  curious  phenomenon 
of  this  species  of  hypertrophy.  Ordinarily,  the  whole  heart  is  lifted 
up,  as  it  were,  duiing  the  diastolic  action,  and  at  the  time  of  the  con- 
traction,  the  apex  is  forced  towards  the  walls  of  the  chest.  This  is 
the  reason  why  there  is  a  sort  of  heaving  swell  felt  in  the  region  of 
the  heart,  when  it  is  considerably  hypertrophied.  This  is  chiefly 
felt  in  the  neighborhood  of  the  sternum,  and  sometimes  as  low  down 
as  the  epigastrium.  Now,  when  the  heart  is  very  much  enlarged, 
and  the  impulse  is  felt  oi^er  a  very  great  extent  of  surface,  we  shall 
find  the  sound  on  percussion  considerably  modified.  The  stetho- 
scope  is  an  invaluable  instrument  in  these  cases,  and  may  be  appli- 
ed with  great  certainty  to  measure  the  dimensions  of  the  heart  in 
contact  with  the  walls  of  the  chest.  And  in  cases  of  greatly  en- 
larged heart,  where  there  is  not  only  hypertrophy,  but  dilatation  of 
the  walls  of  the  heart,  you  will  find  that  this  vi?cus  occupies  a  great 


Diseases  of  the  Heart.  :^>35 


part  of  the  front  of  the  chest,  from  tlie  upper  margin  of  the  second 
rib,  extending  to  the  epigastrium  ;  also,  around  the  left  side,  and  the 
axilla,  and  passing  two  o^r  three  inches  to  the  right  of  the  sternum.  
This  is  particularly  the  case  in  young  subjects  where  the  chest  is  nar- 
row. 

The  effects  of  hypertrophy  vary  very  much.  You  may  find  the 
enlargement  of  the  heart  accompanied  by  a  more  extended  impulse 
than  usual,  but  with  little  increased  dulness  of  percussion,  in  some 
individuals  scarcely  amounting  to  disease;  while  in  others  it  may 
occur  to  the  extreme  degree  I  have  just  been  describing.  Indeed,  I 
believe  that,  in  some  cases,  hypertrophy  may  be  considered  almost 
as  a  corrective  of  disease,  and  sometimes  little  inconvenience  i*5  felt 
from  an  enlarged  heart.  You  find  enlargement  of  the  heart  accom- 
panying  other  diseases  diseases  of  the  lungs  and  visceral  alfections, 
and  in  the  greater  number  of  instances  of  this  kind,  the  progress  of 
the  disease  is  rather  retarded  than  otherwise.  There  is  a  constitu- 
tional state  in  which  there  is  a  diminution  of  energy  in  some  func- 
tions, at  the  same  time  that  others  are  more  active.  Where  enlarge- 
ment of  the  heart  accompanies  emphysema  of  the  lung,  you  do  not 
have  the  dulness  over  the  region  of  the  heart,  nor  the  impulse  usually 
manifested,  in  consequence  of  the  lung  standing  between  the  walls  of 
the  heart  and  the  chest ;  but  you  have  the  signs  of  enlargement  at  the 
epigastrium,  and  you  have  also  increased  pulsation  in  the  arteries.  I 
have  had  cases  of  emphysema  of  the  limg  under  my  care,  in  which 
nature  has  overcome  the  obstacles  in  which  the  enlargement  of  the 
heart  had  originated. 

Treaimcni  of  hypertrophy  of  the  heart.  You  must  remember  that 
hy|)ertrophy,  although  it  may  exist  to  a  great  extent,  is  not  always  a 
disease  against  which  remedies  can  be  directed.  In  fact  hypertro- 
phy is  to  be  considered  as  a  condition  which  may  terminate  in  dis- 
ease. When,  by  the  application  of  auscultation,  we  find  the  heart 
larger  than  usual,  this  indicates  the  necessity  for  precautionary  treat- 
ment, but  not  for  inferring  the  actual  existence  of  disease.  Accord- 
ingly, the  treatment  will  vary  very  much.  In  extreme  cases,  where 
there  is  increased  strength  in  the  heart,  and  the  circulation  is  very 
strong,  there  will  be  sometimes  determination  of  blood  to  the  head; 
and  arising  out  of  this  there  will  be  disorder  t)f  the  secretory  organs, 
and  of  the  system  generally,  which  may  thus  act  secondarily  on  the 
lieart  itself,  the  violence  of  its  action  producing  pain,  and  other  sen- 
sations of  discomfort.  Now,  we  cannot  expect  to  remove  such  a 
state  as  this  altogether  by  bleeding.  In  severe  cases,  where  there  is 
an  extraordinary  amout  of  congestion  and  pressure  in  the  system, 
there  is  no  doubt  of  the  expediency  of  blood-letting.  In  cases  where? 
there  are  symptoms  of  congestion  of  the  brain  from  iletermination  of 
blood  to  this  organ,  blood-letting  may  be  resorted  to  in  {iroportion  lo 
the  strength  of  the  patient.  You  must  not,  however,  lake  too  much 
blood  at  one  tmie,  but  rather  take  a  small  (juantity,  and  repcait  the 
(tperation  if  necessary.      Use  cvacuants,  and  such  medicines  as  will 


336  Diseases  of  the  Heart,  [June, 


reduce  the  quantity  of  blood,  without  much  impairing  its  quality. 
Also,  sc'dfiiivcs  of  various  kinds  ;  such  as  digitalis,  hydrocyanic  acid, 
&c.,  to  diminish  the  irritability  of  the  heart's  action,  which  is  not  to 
ho  knocked  down  at  once,  hut  to  be  reduced  in  a  gradual  manner. 
Where  there  is  much  pain  and  oppres>ion,  with  a  feeling  of  uneasi- 
ness  at  the  chest,  there  is  reason  to  suspect  something  of  an  irjflam- 
aiatory  character,  either  accom|)anying  the  hypertrophy,  or  produced 
by  the  increased  efforts  of  the  enlarged  heart.  In  this  case,  not  only 
the  depletory  measures  I  have  alluded  to  should  he  employed,  but 
mercury  should  be  administered,  and  cupping,  blisters,  and  setons, 
may  be  used.  The  diet  should  be  sparing,  and  irritating  liquors 
should  be  avoided.  The  object  is  not  to  carry  the  antiphlogistic  mea- 
sures to  the  highest  degree,  but  to  produce  a  more  moderate  and  equal 
action. 

The  physical  signs  of  dilataiion  of  the  heart  require  care  to  be 
distinguished  from  those  of  hypertrophy.  If  the  walls  of  the  ventri- 
cles are  thin,  the  contractions  take  place  very  abruptly  and  quickly. 
The  result  of  this  is,  that  the  contraction  ceases  with  the  first  impulse. 
There  is  a  smart  jerk  with  the  first  impulse,  but  it  is  a  very  short 
one,  having  nothing  of  the  heaving  character  of  hypertrophy.  There 
are  several  points  in  which  the  impulse  and  the  sound  differ  from  the 
natural  ones:  the  impidse  is  short  and  abrupt,  possessing  very  little 
strength  or  duration.  In  the  natural  condition  it  is  chiefly  centered 
nt*theapex,  and  extends  but  a  slight  distance  around;  that  of  the 
right  ventricle  is  inferior  in  strength  to  that  of  the  left;  but  when 
there  is  considerable  dilation  of  the  right  ventricle,  so  as  to  make  it 
extend  to  the  anterior  part  ofthe  chest,  you  then  no  longer  have  the 
beating  effect,  located  between  the  cartilages  ofthe  fifth  and  sixth 
ribs.  Under  these  circumstances,  you  have  somewhat  more  of  the 
impulse  under  the  region  ofthe  sternum.  It  is  very  brief  and  slight 
in  its  force,  and  is  accompanied  by  a  short,  abrupt  sound.  If  the  loft 
ventricle  is  not  dilated,  the  natural  obtuse  sound  may  still"  be  heard 
below  the  left  breast.  But  when  the  heart  is  not  in  direct  contact 
with  the  chest,  you  cease  to  have  the  impulse,  which  is  naturally 
communicated,  because  the  dilated  right  ventricle  pushes  aside  the 
left  ventricle.,  Under  these  circumstances  you  do  not  h'lve  symp- 
toms of  weakness  in  the  circulation.  There  is  considerabh'  strength 
in  the  impulse  ofthe  arteries  in  the  neck,  and  at  the  top  of  the  stern- 
um, though  there  may  not  be  the  natural  amount  of  impulse  at  the 
region  of  the  apex.  When  the  left  ventricle  is  dilated,  there  is  a 
change  in  the  condition  ofthe  heart,  and  its  shape  is  altered.  The 
heart  is  altogether  more  globular,  and  there  is  a  diminution  in  the 
natural  impulse.  It  is  far  less  distinct,  and  is  diffused  over  a  larger 
surface  ;  where  dilatation  is  conjoined  with  hypertrophy,  the  impulse 
often  extends  over  ten  or  twelve  square  inches,  over  the  whole  ofthe 
front  ofthe  chest  and  the  left  side.  The  sound  is  otherwise  different 
in  Its  character.  It  is  a  short  first  sound,  extremely  like  the  character 
ofthe  second  sound  ;  so  that  the  two  sounds  following  each  other  are 


1815.]  Diseases  of  the  Heart,  337 

/ ' 

not  to  be  distinguished  in  character,  but  only  by  their  succession.  On 
placing  the  hand  on  the  region  of  the  heart,  there  is  found  to  be  an 
increase  of  the  impulse  as  far  as  extent  is  concerned  ;  but  it  does  not 
lift  up  the  ribs  at  all.  If  it  does  that,  we  may  be  pretty  sure  that 
there  is  hypertrophy,  combined  most  probably  with  extreme  dilata- 
tion of  the  auricles.  We  have,  however,  no  certain  means  of  deter- 
mining this  at  present,  and  we  are  not  acquainted  with  any  peculiar 
pathological  conditions  which  it  tends  to  produce.  Laennec  thought 
that  dilatation  of  the  auricles  produced  modifications  in  the  second 
sound  ;  but  he  seems  to  have  had  a  mistaken  notion  as  to  the  sound 
produced  by  the  contraction  of  the  auricles.  1  have  very  distinctly 
seen  the  pulsation  ofthe  auricles  alternate  with  that  of  the'  ventricles. 
Sometimes  a  double  pulsation  is  seen  in  the  veins;  this  is  especially 
observable  in  the  jugular  veins,  and  the  superficial  veins  ofthe  thorax. 
The  treatment  of  dilatation  is  very  much  the  same  as  that  under 
the  head  of  defective  action.  It  proceeds  essentially  from  weakness  ; 
a  want  of  (one  and  of  strength,  or,  perhaps,  of  both  ;  and  accordingly 
the  treatment  most  generally  applicable  to  the  dilated  heart  is  strength- 
ening by  means  of  tonics.  But  there  are  different  circumstances  to 
be  taken  into  account  in  the  application  of  this  form  of  treatment. 
Sometimes  the  blood  is  more  than  the  heart  can  propel,  and  we  have 
here  to  enable  the  heart  to  propel  this  load  :  it  is  some  time  before  we 
can  give  sufiicient  strength,  but  we  may  give  temporary  relief. 
When  the  dilated  heart  is  palpitating  much,  and  obviouslv  struggling 
\vith  a  load  of  blood  which  we  cannot  propel,  we  should  apply  blood- 
letting and  cupping,  or  leeches  over  the  region  ofthe  heart.  Some- 
times, in  asthenic  plethora,  where  there  is  much  lividity,  or  a  bloated 
appearance  of  the  countenance,  there  is  more  blood  in  the  system 
than  the  heart  can  propel,  and  it  is  useful  to  withdraw  blood  to  re- 
lievo  the  heart.  This  is  only  a  temporary  expedient.  There  is 
another  circumstance  that  indicates  the  necessity  of  a  modification 
of  a  general  tonic  treatment :  you  must  remember  that  there  is  a 
weak  circulation  throughout  the  whole  system,  and  at  the  same  time 
a  weakened  state  of  the  secretions;  and,  therefore,  it  is  important, 
while  we  are  using  tonics  and  stimulants,  also  to  em|)lov  measures  to 
increase  the  action  ofthe  secretory  organs.  This  is  an  indication  that 
should  always  be  attended  to.  Evacuants,  aperients,  diuretics,  and 
dietetics,  may  be  used  at  the  same  time  that  you  are  giving  tonics 
and  stimulants  freely.  The  treatment  should  be  as  strengthening 
and  as  nourishing  as  the  patient  can  bear.  iMineral  tonics,  especial- 
ly  iron,  are  highly  calculated  to  restore  the  strength  ofthe  heart,  and 
to  diminish  the  irritability  of  thesystem.  It  is  desirable  to  vary  the 
use  of  these  from  time  to  time,  at  the  same  time  giving  mineral  acids. 
It  is  difficult  to  say  how.  these  tonics  act  on  the  animal  frame  and  the 
contractile  powers,  but  it  is  certain  that  some  tonics  have  the  effect  of 
tightening  up  the  muscular  fibres:  alum  also  might  be  useful  in  these 
cases.  I  have  seen  this  remedy  so  far  useful  as  to  diminish  the  con- 
gestion of  the  liver.     'J'onics,  however,  arc   slow  of  action,  and  in 


338  The  Spleen  and  its  Functions,  [June, 


cases  of  weakness  stimulants  may  be  given,  especially  where  any  ex- 
ertion is  required  ammonia  and  so  forth  may  be  used.  It  is  very 
desirable  to  keep  down  the  mass  of  the  blood,  and  to  prevent  it  be- 
coming too  bulky,  at  the  same  time  that  we  improve  its  quality,  and 
make  it  as  rich  as  possible.  In  doing  this,  we  must  attend  to  the 
state  of  the  secretions,  keeping  them  quite  free,  more  particularly 
those  of  tlie  kidneys  and  skin.  Warmth  of  the  extremities,  and  so 
forth,  is  useful  to  relieve  the  accumulation  of  blood  towards  the  heart, 
and  to  promote  circulation  towards  the  surface;  keeping  the  diet  of 
as  nourishing  a  character  as  possible.  See  that  the  digestive  organs 
are  well  managed,  and  avoid  excess  of  liquids,  as  these  arc  often  ex- 
tremely injurious,  and  not  only  by  interfering  with  the  digestion,  but 
likewise  by  encumbering  the  organs  of  secretion.  When  a  great 
quantity  of  water  is  taken  into  the  system,  it  must  be  absorbed  and 
carried  away  into  the  vessels.  If  the  heart  is  weak,  too  great  a  quan- 
tity of  liquid  will  encumber  it  still  more.  There  are  many  reasons 
for  adopting  a  diet  of  a  dry  nature,  though  not  absolutely  so.  The 
diet  should  be  as  nourishing  as  it  can  be  borne,  and  4here  should  be 
abundance  of  animal  food  taken  two  or  three  times  a  day,  if  the  diges- 
tive organs  will  bear  it.  A  little  gentle  exercise  is  highly  desirable, 
as  much  as  can  be  taken  without  fatigue,  varying  the  exercise  with 
rest  in  a  recumbent  position.  Where  the  patient  is  too  weak  to  bear 
exercise,  friction  may  be  substituted,  so  as  to  promote  the  circulation, 
and  thus  aid  the  action  of  the  heart.  Great  advantage  is  derived 
from  cold  bathing,  which  tends  to  improve  the  cutaneous  circulation, 
and  ultimately  increases  the  vigor  of  the  system. 

(To  he  concluded  in  next  numher.) 


PART  III.MONTHLY  PERISCOPE. 

The  Spleen  and  its  Functions.  The  observations  on  the  func- 
tions of  the  spleen  have  elicited  the  following  facts.  1.  The  greater 
part  of  the  water,  received  into  the  body,  is  admixed  with  the  venous 
blood  of  the  spleen  in  a  few  minutes,  by  which  means  a  great  disten- 
sion of  this  organ  is  effected.  2.  The  splenic  veins  leading  to  the 
vena  portEe,  are  filled  during  the  digestive  .process  with  a  darker 
blood  than  the  other  veins  of  the  body.  3.  The  spleen  has  been  ex- 
tirpated in  some  animals  (chiefly  herbivorous),  without  any  peculia- 
injury  to  the  system,  with  the  exception  of  a  slight  derangement  in 
the  process  of  chylification.     4.  The  spleen,  por.sessing  no  edu"tory 


1S43.]  Oljservat ions  on  the  Mysteries  of  Generation.  339 


canal,  can  have  no  influence  on  the  formation  of  chyle.  5.  The 
periodical  accumulation  of  blood  in  the  spleen,  particularly  during 
digestion,  makes  it  appear  to  be  a  mere  reservoir  of  blood  for  the  or- 
ganism, favoring  perhaps  chylification  by  its  pressure  on  the  stomach. 
G.  The  lymph,  passing  from  the  spleen,  is  redder  and  more  coagula- 
bie  than  that  of  other  organs.  After  the  extirpation  of  the  spleen,  the 
lymph,  as  it  passed  into  the  thoracic  duct,  was  white,  thin,  slightly 
coagulable,  and,  only  at^ter  it  had  been  exposed  some  time  to  the  air, 
did  it  assume  those  properties  of  redness  and  greater  coagulability, 
usually  communicated  through  the  influence  of  the  spleen.  7.  After 
the  extirpation  of  the  spleen,  a  more  abundant  urinary  secretion  takes 
place,  the  urine  being  thin  and  watery.  8.  The  bile  has,  in  this 
case,  a  much  darker  color  and  an  altered  taste.  9.  The  volume  of 
the  spleen  is  enlarged,  and  the  texture  relaxed,  by  intermittent  fever, 
as  well  as  by  typhus  abdominalis.  In  explanation  of  the  above  facts, 
it  is  shown  that  the  larger  viscera  of  the  body,  and  particularly  of 
the  abdominal  cavity,  have  a  specific  attraction  or  relation  to  the 
elements  of  which  the  organism  is  chiefly  composed,  and  by  which 
it  is  reproduced  :  i.  e.  oxygen,  hydrogen,  carbon  and  azote  :  the  lungs 
to  oxygen,  the  kidneys  to  azote,  the  liver  to  carbon.  Now,  hydrogen 
alone  remains,  which  is  not  always  found  combined  with  oxygen,  in 
the  form  of  water,  in  the  organism,  but  also  (pathologically)  with 
other  gases  in  the  blood.  The  spleen  seems  to  form  the  point  of  at- 
traction for  this  hydrogen,  a  view  confirmed  by  the  fact,  that  in  all 
countries  in  which  an  excess  of  hydrogen  is  found  in  the  air,  and  thus 
received  in  the  blood,  affections  of  the  spleen  are  chiefly  produced. 
Thus,  we  may  say,  that  the  spleen  has  a  specific  relation  to  hydrogen, 
separating  it  from  its  combinations,  in  order  to  elaborate  it  for  its  pe- 
culiar organic  purposes.  Thus,  water  undergoes  a  decomposition  in 
the  spleen  ;  the  hydrogen  is  carried  with  the  blood  of  the  splenic 
veins  to  the  liver,  and  used  for  the  secretion  of  bile.  This  accounts 
for  the  dark  color  of  the  venous  blood  of  the  spleen,  during  digestion; 
therefore,  the  bile  becomes  changed  in  character,  and  the  urine  wa- 
tery, after  extirpation  of  the  svleen.  The  oxygen  of  the  water  is 
absorbed  by  the  lymph,  and  produces  the  color  and  coagulability 
proper  to  this  fluid.  In  intermittent  fever,  the  spleen  becomes  en- 
larged and  softened,  in  consequence  of  the  hydrogen  collected  in  it. 
In  perverted,  or  obstructed,  function  of  the  spleen,  the  water  is  left 
in  the  blood  circulating  through  the  body,  and  produces  abnormal  and 
morbid  phenomena  in  consequence.  The,  so  called,  splenic  vertigo^ 
appearing  under  the  form  of  a  derangement  of  the  functions  of  the 
brain,  seems  to  be  produced  by  this  abnormal  reception  of  hydrogen 
into  the  blood.  Dr.  Frank  of  Berlin  in  Casper^s    Wochenschrift. 

[N.  Y.  Journal. 


Ohservalions  on  the  Mysteries  of  Generation.  By  M.  Moeeau, 
{Bulletin  Gen.  de  Therupeui.  Med.  Ckirurg.  1644.)  It  is  not  our 
object  to  write  a  dissertation  upon  the  various  systems  by  which  the 


340  Observations  on  the  Mysteries  of  Generation,  [June, 


mysteries  of  generation  have  been  attennpted  to  be  explained;  we 
wish  sinnply  to  state  an  opinion  of  the  pre-eminence  of  one  over 
another,  which  we  have  heard  advanced  by  our  learned  professor  of 
midwifery,  M.  Moreau.  This  view  of  the  act  of  generation  presents 
to  the  physician  an  important  practical  question,  which  should  attract 
his  attention.  It  may  not  be  peculiar  to  Professor  Moreau,  but 
these  observations  assume  much  more  weight  in  our  estimation  as 
emanating  under  the  patronage  of  a  name  so  respectable  as  his,  and 
more  particularly  as  they  are  strengthened  by  a  great  number  of  ob- 
servations taken  from  his  practice. 

Every  one  knows  that  all  the  systems  proposed  and  discussed,  from 
the  earliest  period  to  the  present  day,  may  be  reduced  to  two  the 
ovarists  and  the  epigenesists.  The  former  maintain  that  the  new 
being  exists  e/i  germe  in  the  female  ovary,  and  man  only  contributes 
in  the  act  of  generation  by  vivifying  the  germ.  With  the  latter,  the 
individual  is  formed  entirely  by  the  materials  furnished  by  both  sex- 
es, each  taking  a  more  or  less  active  part  in  the  product  of  conception. 

M.  Moreau  believes  in  the  doctrine  of  epigenesis.  He  thinks  it 
incontestable  that  the  individual  who  is  the  strongest,  who  enjoys  the 
best  health  at  the  moment  of  conception,  will  have  a  pre-eminence 
over  the  other,  and  that  the  sex  of  the  child  will  be  determined  by 
this  pre-eminence.  It  has  been  ascertained  by  M.  Moreau,  a  num- 
ber of  times,  and  every  one  can  appreciate  the  truth  of  the  remark, 
that  in  families  where  the  man  is  vigorous  and  robust,  and  the  woman 
is  feebte  and  delicate,  the  males  predominate  ;  and  where,  on  the 
contrary,  the  woman  is  very  young  and  robust,  and  the  man  is  sickly 
or  old,  the  females  outnumber  the  males.  In  some  families  we  find 
all  boys;  in  others,  all  daughters.  In  such  cases,  the  predominence 
of  one  sex  or  other  is  constant  it  is,  in  some  measure,  constitutional. 
But  the  predominence  of  the  man  over  the  woman,  or  of  the  woman 
over  the  man,  arises  from  the  state  of  the  physiological  foices  
from  the  vital  powers  of  each,  at  the  moment  of  reproduction. 
If,  then,  the  husband,  although  the  most  vigorous,  is  enfeebled, 
is  suflering  from  any  depressing  cause,  the  wife,  although  apparently 
more  feeble  than  he,  will  have  the  pre-eminence,  and  vice  versa. 
In  a  word,  it  is  not  always  from  the  exterior  from  appearances,  that 
we  ought  to  judge  of  the  physiological  state  of  the  reproductive  for- 
ces.  The  state  of  the  organism  at  the  moment  of  copulation,  exer- 
cises an  immense  influence,  and  the  sex  of  the  child  will  be  determined 
by  the  relative  state  of  the  parties  concerned,  at  the  time  of  coition. 

From  these  considerations  it  follows  that  we  may,  at  pleasure,  in 
some  degree  determine  the  production  of  one  or  the  other  sex  This 
fact,  which  sometimes  possesses  a  high  degree  of  social  importance, 
is  indisputable,  according  to  M.  Moreau.  He  is  convinced  that  he 
has,  in  a  number  of  cases,  influenced  by  the  above  considerations, 
determined  the  production  of  a  boy  or  girl.  M.  Moreau  reduces  to 
practice  the  well  established  rules  of  hygiene ;  which  consists  in 
tonifying  the  one  and  reducing  the  other;  this  is  all.     A  captain  of 


1845.  J  Diseases  of  the  Negro  Fopulatioii.  341 


huzzars,  of  some  renown,  about  34  years  old,  having  led  a  dissipated 
lite  lip  to  the  period  of  his  marriage,  espoused  a  young  girl  of  22 
years,  strong  and  in  fine  health.  His  first  and  second  children  were 
daughters.  He  was  anxious  for  a  son.  M.  Moreau,  being  a  witness 
to  his  despair,  promised  him  a  son  if  he  would  consent  to  change  his 
habits.  He  renounced  a  mistress  whom  he  kept;  he  took  tonics  and 
a  substantial  diet,  and  drank  Bordeaux  wine  to  recruit  his  strength, 
enim  in  vino  Venus;  he  observed  the  most  absolute  continence;  and 
during  this  time,  his  young  wife  was  subjected  to  the  use  of  prolonged 
tepid  batl'.s,  and  to  a  light  vegetable  regimen.  He  seized  for  the  conju- 
gal embrace  the  moment  when  his  wife  was  languid,  and  mala  Vaise; 
a  third  pegjnancy  followed,  and  behold  a  son  was  born  unto  him  !  
N.  O.  Med.  Jour. 


Diseases  of  the  Negro  Population.  By  Daniel  Drake,  M.  D., 
in  a  letter  to  Rev.  Mr.  Pinney. 

Medical  Institute  of  Louisville,  Nov.  15,  1844. 

Dear  Sir :  Smce  our  interview  in  Cincinnati,  1  have  been  so  much 
engaged  in  entering  on  my  duties  for  the  winter,  as  to  be  unable  till 
now  to  comply  witli  your  request,  for  some  notice  of  the  diseases  of 
the  colored  population  of  the  South  and  West.  As  I  told  you  then, 
my  inquiries  were  chiefly  made  in  Alabama,  Mississippi  and  Louisi- 
ana, in  the  spring  and  summer  of  1843  and  '44.  Of  the  diseases  of 
which  I  am  about  to  mention,  I  witnessed  most  of  the  varieties,  but 
the  greater  and  better  part  of  my  information  was  derived  from  con- 
versation with  physicians,  planters,  and  overseers,  carefully  noted 
down  at  the  time.  By  referring  to  these,  I  give  you  the  following 
statement : 

1.  Many  infants  die  of  trismus,  or  lock-jaw,  when  they  are  but  a 
few  days  old  ;  after  that  early  age,  convulsions,  and  summer  sick- 
ness, (cholera  infantum.)  and  worms,  carry  off  quite  a  number. 

2.  They  are  liable  to  measles  and  scarlet  fever,  both  of  which 
were  prevailing  (but  especially  the  former)  on  many  plantations 
which  I  visited  ;  which  diseases  seem  to  be  as  fatal  to  them  as  to  the 
whites. 

3.  Scrofula  or  kings-evil  is  of  frequent  occurrence  ;  and  consump- 
tion, or  cachexia  Africana,  as  it  has  been  called,  is  prevalent  and 
always  fatal. 

4.  On  many  plantations  the  strange  habit  prevails  of  eating  dirt 
or  clay,  the  common  soil  of  the  fields,  particularly  that  of  the  Mis- 
sissippi bottoms,  producing  serious  and  fatal  diseases.  I  was  told  of 
one  estate  in  South  Alabama,  on  which  fourteen  slaves  had  died  from 

<his  cause,  and  visited  another  in  Louisiauii,  on  which  I  saw  nearly 
half  that  number  unable  to  work  from  the  same  practice. 

5.  A  disease  of  the  heart,  conjectured  to  arise  from  dirt-eating, 
destroys  quite  a  number.  I  met  with  several  cases,  and  heard  of  a 
plantation  on  Red  River,  where  more  than  thirty  died  from  this 
maladv. 


342  Diseases  of  the  Negro  Populalion.  [June, 


6.  Tetanus  or  lock-jaw  from  wounds,  is  extrennely  common  and 
almost  uniformly  fatal.  Some  cases  occur  without  previous  wound. 
A  physician  in  Alabama  told  me  he  had,  in  fifteen  years,  met  with  at 
least  tifty  cases,  nearly  all  colored  people,  and  all  but  one  mortal.  I 
met  with  several  young  physicians  in  the  smaller  towns,  vv'iio  had, 
respectively,  met  with  more  cases  than  have  occurred  in  Cincinnati 
from  its  first  setliernent. 

7.  Diarrhoea  and  dysentery,  of  frequent  occurrence,  are  often  fital. 

8.  Where  the  cholera  was  epidetnic,  in  1832,  '33  and  '34,  it  swept 
off" great  numbers;  was  more  destructive,  in  fact,  to  the  colored  than 
the  white  people  of  the  Southwest. 

9.  Epidemic  erysipelas,  or  black  tongue,  has  prevailed  on  many 
plantations  within  the  past  year.  I  was  told  of  one,  in  Mississipi>i, 
on  which  seven  had  died  of  it. 

10.  The  colored  people  are  not  proof  against  the  cause  of  yellow 
fever,  but  as  they  are  not  numerous  in  the  cities  and  towns,  where 
only  it  prevails,  the  mortality  from  this  disease  is  not  great. 

11.  Acute  inflammation  of  the  lungs  is  among  the  most  destruc- 
tive diseases  of  the  colored  population.  These  are  catarrh,  croup, 
bronchitis,  pleurisy,  and  pneumonia,  or  inflammation  of  the  substance 
of  the  lungs,  which  is  the'most  frequent  and  fatal  of  the  whole.  These 
maladies  often  destroy  life  in  a  few  days  ;  but  sometimes  the  patient 
recovers  with  his  lup.gs  rendered  permanently  unsound.  I  saw  many 
cases  of  this  kind.  This  group  of  diseases,  produced  by  changes  of 
weather  in  winter  and  spring,  occasions  more  deaths  than  any  other, 
except  the  next. 

12.  Intermittent,  and  remittent  fevers;  simple,  and  malignant  or 
congestive,  are  the  greatest  outlets  of  human  life  among  the  people 
of  whom  I  am  speaking.  They  return  every  year  in  the  latter  part 
of  summer  and  in  autumn,  and  one  attack  is  no  security  against  a  no- 
ther.  When  they  do  not  prove  fatal,  they  leave  behind  them  diseases 
of  the  spleen,  and  dropsy.  In  the  following  winter  those  who  were 
down  in  the  autumn,  are  tender,  and  often  die  of  inflammation  of  the 
lungs. 

In  addition  to  the  diseases  I  have  named,  others  occur  now  and 
then,  with  considerable  frequency,  of  which  I  may  mention  rheu- 
matism, epilepsy,  colic,  hysteria,  and  several  infirmities  peculiar  to 
women. 

From  this  catalogue  you  will  perceive  that  the  colored  population 
of  the  Souttnvest  are  by  no  means  exempt  from  a  variety  of  formida- 
ble diseases.  As  we  come  further  nortli,  tetanus  and  autumnal  fever 
get  less,  but  consumption  and  inflammations  of  the  lungs  increase. 
All  over  the  region  of  which  I  have  spoken,  the  greatest  part  of  tho 
practice  of  every  country  physician  is  among  the  colored  people.  A 
gentleman  in  Louisiana  told  me  that  he  received  a  salary  of  Si, '200 
a  vear  for  attending  on  a  sinfrle  plnntadon.  From  all  I  have  read 
and  heard  of  the  diseases  of  Liberia,  my  impression  is,  that  if  half 
the  colored  population  of  a  S.ailhwestcrn  phinlalion  were  sent  to  the 


lS4o.J         Htmicianiuy  J^'c.  Discharges froiu  the  Ears.  343 


colony,  they  and  tlicir  descendants,  in  ten  years,  would  number  more 
than  those  left  behind.  New  Orleans  MedicalJournah 


Treatment  of  Hcmicrania  and  Tic  Douloureux  hy  Cauterizing  the 
Palate.  Wy  Al.  Duckos,  of  Marseilles.  In  the  most  intense  hemi- 
crania,  and  in  the  most  obstinate /ic  douloureux,  whether  fronto-facial 
or  temporo-facial,  the  pain  disappears  instantaneously  on  the  appli- 
cation ol'ammonia  at  25'^,*  to  the  palatine  arch,  by  means  ofa  [camel's 
hair]  brush;  the  brush  being  allowed  to  remain  on  the  part  till  a  co- 
pious  flow  of  teajs  has  been  excited.  I  have  tried  this  for  the  last 
three  months  in  a  very  great  number  of  cases,  and  the  pain  has 
always  ceased.  If  the  pain  returns,  a  fresh  application  again  pro- 
duces a  cessation  of  the  neuraliiia.  Gazette  Medicale. 


Discharges  from  the  Ears.  Mr.  Wilde,  of  Dublin,  has  written 
\ Dublin  Journal  of  Medical  Science,  January,  lS44,]-a  most  excel- 
lent treatise  on  the  causes  and  treatment  of  otorrhoea,  chiefly 
dwelling  on  the  aflections  of  the  external  tube  and  external  surface 
oftlic  membrana  tympani.  There  are  few  diseases  which  are  more 
frequently  neglected  and  carelessly  treated,  than  those  of  the  external 
car;  and  few  which,  when  allowed  to  proceed,  entail  more  incon- 
venience on  a  patient  during  the  remainder  of  his  life.  In  simple 
otorrhcea,  Mr.  V/ilde  paints  over  the  surface  with  a  solution  ofnilrato 
of  silver,  ten  grains  to  the  ounce,  applied  with  a  fine  camel's  hair 
pencil,  either  to  the  wbole  or  a  portion  of  the  surface,  according  to  the 
extent  of  tho disease.  This  is  repeated  every  third  day,  and  in  tho 
interval  ihe  ear  is  syringed  night  and  morning,  and  oftener  if  the  dis- 
charge is  copious,  with  plain  tepid  water,  by  means  of  a  gum-elastie 
hag,  which,  when  used  by  friends,  is  much  preferable  to  the  usual 
piston  syringe,  and  at  night  a  slightly  astringent  lotion  is  dropped  into 
the  ear  till  Jt  fills  up  the  meatus,  and  allowed  to  remain  there  for  a  few 
njinutes.  For  tills  purpose  we  mayuseliq.  plumbi  diacet.  one  drachm, 
to  an  ounce  of  water  or  rose  water ;  or  weak  solutions  of  alum,  copper, 
or  chloride  of  lime.  But  otorrhcea  is  often  exceedingly  difiicult  to 
cure,  owing  to  its  being  caused  by  morbid  vascular  growths,  such  as 
granulations  on  the  membrana  tympani,  which  are  allowed  to  pro- 
ceed undiscovered.  In  such  a  case  the  part  aj)pears  quite  red  and 
vascular,  and  Mr.  Wilde  recommends  the  application  of  the  solid 
nitrate  of  silver,  rubbed  over  the  part  about  every  second  day,  or  of- 
tener if  necessary;  and  for  this  purpose  he  uses  a  very  neat  little 
instrument  which  is  five  and  a  halt  inches  long,  consisting  ofa  silver 
tube,  cut  spirally  for  three-fifths  of  its  length,  and  having  an  aperture 
on  the  side  near  the  extremity.  In  using  this  port-caustir,  a  little 
nitrate  of  silver  is  melted  over  the  lamp  on  a  small  platina  ladle,  and 


*  A  solution  of  ammonia,  showing  23  on  Baumf's  hydrometer,=  a  specific 
^rravity  of  .900.  The  liquor  ammonice  fort,  of  the  London  CoHege  is  of  the  sp. 
m.  -8^2.   Tran^to/o/^s  nri!(:  in  Md.  Guz. 


344  A  Sharp  'pointed  Body  in  the  Intestines.  [Juno, 


then,  when  about  cooling,  the  end  o^  the  port-caustic,  is  dipped  into  it 
till  the  aperture  and  extremity  are  filled  and  coated  over  with  the 
caustic.  We  often  find,  however,  that  discharges  from  the  ear  are 
kept  up  by  polypi,  which  it  becomes  necessary  to  remove;  and  for 
this  purpose  Mr.  Wiide  recommends  a  little  instrument,  first  recom- 
mended, we  believe,  by  Mr.  W  Robertson,  surgeon  to  the  Kelso 
Dispensary.  It  is  a  small  snare-like  apparatus,  consisting  of  a  fine 
steel  stem,  with  a  movable  bar  sliding  towards  the  handle.  It  is  so 
constructed  that  a  noose  made  of  fine  silver  or  platina  wire  may  be 
pushed  down  to  tlie  polypus,  so  as  to  surround  and  ensnare  it.  The 
morbid  growth  may  thus  be  safely  and  cautiously  taken  away,  either 
in  part  or  wholly,  and  by  the  regular  application  of  the  armed  port- 
caustic  from  day  to  day,  all  trace  of  the  growth  may  ultimately  be 
extiniruished. 


A  Case  in  which  a  sharp  pointed-  body  was  swallowed  by  a  child, 
passing  the  bowels  vithont  injury.  By  Dr.  B.  W.  Avent,  of  Murfrees- 
b  'ro',  Teiin.  On  Thursday  evening,  8th  July,  I  was  requested  to  visit 
a  little  girl,  4  yt^ars  old,  who,  whilst  engaged  at  play,  had  accident- 
alh'  swallowed  a  sharp-pfjinted  instrument,  about  two  and  a  half 
inches  long.  This  instrument  was  originally  the  handle  of  a  long- 
bladed  knite,  the  jaws  of  which  had  Leen  filed  off'  about  its  centre, 
leaving  the  back  spring,  which  had  been  ground  very  sharp  at  its 
point. 

I  saw  the  patient  an  hour  after  the  accident  occurred,  and,  as 
might  have  been  expected  under  such  circumstances,  found  the  fami- 
ly in  great  alarm,  and  in  the  act  of  pre])arintj  an  emetic,  with  a  view 
to  cause  the  stomach  to  eject  this  foreign  body. 

The  little  girl  was  suffering  no  pain  at  all,  and  on  examination  I 
was  satisfied  that  the  instrument  had  passed  the  cardiac  orifice  with- 
out producing  any  injury  in  its  passuge.  Aware  that  the  point  of 
this  instrument  was  sufficiently  sharp  to  pcnetrnle  the  stomach,  should 
it  come  in  contact  with  it  during  any  contractile  action  of  that  organ, 
I  at  once  explained  to  the  parents  the  great  dnnger  of  any  medical 
interference,  and  advised  that  the  unassisted  efforts  of  nature  should 
be  relied  upon  for  relief,  at  least  until  some  unpleasant  symptoms 
sh<  uld  arise.  With  this  advice,  I  left  the  patient  about  as  comforta- 
ble as  f  nothing  unusual  had  happened. 

On  the  following  morning  she  complained  of  some  pain  in  the  epi- 
gastrium, but  it  was  not  of  sufficient  violence  to  excite  much  alarm. 
She  took  her  breakfast  as  usual,  and  was  permitted  to  engage  in  her 
accustomed  amusements.  After  the  morning,  the  pain  in  the  stom- 
ach subsided.  Sometime  during  the  day  her  bowels  were  evacuated, 
without  presenting  any  unusual  appearance  in  the  fteces.  On  the 
next  (Saturday)  morning,  she  was  still  well,  had  no  fever  or  visceral 
excitement  whatever,  and  had  complained  of  no  pain  since  the  morn- 
ing of  the  |)revious  dav.  Through  tins  d;iv  she  continued  to  be 
plavful,  :uul  sufft'red  no  inconvenience,  'i'lie  bo^^els  were  once 
moved  without  medicines. 


1845.]               Treatment  of  Strictures  of  ihe  Vrcthrd.  .'M.') 
-..4..^ 

Sunday  morning.  Patient  still  (red  from  all  excitement.  At  9 
o'clock  this  moininj;,  just  64  hours  after  the  occurrence  of  the  acci- 
dent, the  instrument  was  discharged  from  the  bowels,  enveloped  in 
iaeces,  without  any  pain  or  inconvenience  whatever.  But  little,  if 
any  visible  impression  had  been  produced  upon  it  during  its  passage 
through  the  bowels. 

In  the  management  of  this  case  I  applied  no  medical  treatment, 
though  often  solicited  to  do  so.  I  advised  that  the  little  patient  should 
be  permitted  to  engage  in  her  customary  amusements,  and  to  take 
her  ordinary  diet,  hoping  by  this  course  to  kee|)  her  system,  as  nearly 
as  possible,  in  a  normal  condition,  the  nalural  action  of  the  aliment- 
ary canal  undisturbed,  and  that  thus,  as  happened,  the  "unwelcome 
visiter"  might  be  expelled. 

Medical  interference,  in  this  case,  M'ould  have  consisted  either  in 
vomiting,  with  a  view  to  the  ejection  of  the  contents  of  the  stomach, 
or  in  the  use  of  purgatives,  more  speedily  tp  evacuate  the  contents  of 
the  bowels.  In  either  plan  of  treatment  there  would  have  been  great 
danger  to  the  patient.  The  contraction  of  the  stomach,  necessary  in 
vomiting,  would  undoubtedly  have  endangered  the  wounding  its 
coats,  by  coming  in  contact  with  the  sharp  point  of  the  instrument,  at 
every  effort  of  that  character,  to  say  nothing  of  the  great  improbabili- 
ty of  effecting  the  object  desired  ;  whilst,  on  the  other  hand,  cathariics 
would  not  ordy  have  ()roduced  irritation  of  the  bowels,  but  by  carry- 
ing off  too  hastily  their  liecal  contents,  might  have  left  the  foreign 
body  behind,  in  a  condition  to  wound  them  at  every  peristaltic  motion. 

Two  circumstances  existed  in  this  case  which  favored  the  safety  of 
the  patient.  First,  the  instrument  was  swallowed  with  the  handle  or 
blunt  end  downwards,  which  prevented  its  wounding  the  parts  in  it3 
passage;  and,  secondly,  its  length  prevented  its  taking  a  transverse 
])osition  ;  either  of  which  circumstances  might  have  greatly  endan- 
gered, if  not  destroyed,  the  life  of  the  patient.   V/estern  Med.  Jouriu 


Treatment  of  Strictures  of  the  Urethra.  By  Dr.  J.  Benique.  The 
author  prefers  dilatation  to  every  other  mode,  but  employs  it  in  a 
manner  more  convenient  to  patients.  He  introdnccs  into  the  urethra 
a  bougie  whose  volume  varies  accordinj;  to  circumstances.  As  soon 
as  it  has  penetrated,  it  is  withdrawn  and  a  more  voluminous  one  in- 
troduced. Thus  in  succession  three  or  four  bougies,  each  larger  than 
the  other,  are  employed  in  the  space  of  two  or  three  minutes.  The 
next  day,  he  introduces  the  bougie  which  had  been  last  used  on  the 
preceding  day,  and  several  others,  increasing  in  size  in  the  space  of 
some  minutes  :  thus  he  continues  every  day  until  he  succeeds  in  the 
introduction  of  the  largest  bougies,  which  are  not  permitted  to  remain 
in  the  urethra  for  a  longer  period.  Experience  has  demonstrated  to 
M.  Benique  that  this  mode  of  producing  a  gradu;il  dilatation  succeeds 


IHG  Surgical  Cases.  Cause  of  Error  in  Diagnosis.       [June, 


as  well  as  that  of  leaving  bougies  in  the  urethra  for  several  hours  or 
the  entire  day;  it  has  the  advantage  of  not  disturbing  the  urinary- 
passage,  and  of  not  keeping  the  patient  from  his  ordinary  occupation. 
(Trans,  from  Archives  Centrales  de  Med.,  March,  1845  )         N. 


Surgical  Cases.  Case  I.  Fracture  of  the  Femur,  Fibula  and 
Radius.  A  young  man,  ml.  23  years,  was  thrown  from  the  top  of  an 
omnibus,  which  caused  a  fracture  of  the  femur  and  tibula  of  the  rigi)t 
side,  and  of  the  radius  of  the  left.  He  was  brought  in  the  Hospital 
and  kept  perfectly  quiet  until  the  second  day  after  the  accident,  when 
Dr.  Mcrcier  npplied  the  starch  bandage  to  the  whole  injured  leg.  
Simple  dressing  with  splints  and  ordinary  bandage  were  applied  to  tho 
arm.     The  patient  is  free  from  irritation,  lying  quiet  and  doing  well. 

Case  H.  Simple  Fracture  of  the  Femur ;  of  about  four  weeks 
standing  ;  still  ununited  The  subject  of  this  case  is  a  vigorous  young 
man,  aged  20,  apparently  of  fine  constitution  ;  entered  the  Hospital 
llth  ^Tarch  last.  Dr.  xMemier  found  him  in  the  ward  when  he  took 
charge  of  it.  Heat  once  applied  the  starch  bandage  from  the  toes 
to  the  hip.  Seven  days  afterwards,  the  young  man  left  his  bed  and 
walked  out  into  the  yard  with  the  aid  of  his  crutches.  He  appears  to 
l;e  recovering  rapidly. 

Case  III.  Fracture  of  the  Humerus,  of  six  weehs^  standing; 
ununited.  Dr.  M.  found  this  case  also  in  the  Hospital  when  he 
commenced  duty.  He  applied  the  starch  bandage  immediately.  It 
is  now  nearly  three  weeks  since,  and  the  patient  is  perfectly  com- 
fortable the  cure  nearly  completed. 

Dr.  Mercicr's  Treatment  of  Ulcers.  An  immense  number  of 
chronic  ulcers  are  admitted  into  the  Hospital,  and  quite  a  variety 
may  generally  bo  seen  in  the  surgical  wards.  The  subjects,  for  the 
most  part,  belong  to  the  poor  class  of  Irish  laborers,  whose  habits 
are  bad,  who  are  very  mu(di  exposed  to  the  inclemencies  of  the 
weather,  and  who  are  proverbial  for  their  disregard  of  all  the  dictates 
of  prudence.  Their  constitutions  are  generally  very  much  injiired 
by  intemperance,  and  it  is  almost  impossible  to  establish  the  healing 
process  when  any  injury  is  inflicted  upon  their  shins,  for  this  is  the 
most  comnion  seat  of  ulceration.  Dr.  Mercier  has  found  the  follow- 
ing plan  of  treatment  to  succeed  better  than  any  other :  He  gives 
iodid.  potass.  5ss.,and  iodine  gr.  i,  dissolved  in  decoc.  sars.,  vi  daily. 
When  sujipuration  is  copious,  he  has  the  sore  washed  clean  with 
chloride  of  soda,  and  dresses  it  with  lint  wet  with  vin.  aromat.  
when  the  discharge  is  moderated  and  granulations  spring  up,  hn 
covers  the  sore  with  narrow  strips  of  adhesive  plaster;  with  the  triple 
view  to  counter-irritation,  compression,  and  exclusion  of  the  air.  
N.  O.  Med.  Journal. 


Singular  cause  of  Error  in  Diagnosis  of  Affections  of  the  Knee.  
In  the  last  Concours  for  the  chair  of  Clinical  Surgery  in  the  Facully 


1^'45,J  On  tht  Medicinal  Properties  of  the  Bebccrine.  .'UT 


of  Paris,  a  singular  case  occurred,  the  diagnosis  of  which  gave  rise 
to  a  difference  of  opinion  both  amongst  the  competitors  and  judges, 
and  in  which,  moreover,  had  an  error  been  committed,  the  result 
might  have  been  a  serious  operation.  M.  A.^erard,  the  actual  nomi- 
nee to  the  chair,  thought  that  he  recognized  the  existence  of  a  f()r- 
cign  body  in  the  knee-joint  of  a  patient  aliectcd  with  hydarthrosis, 
and  which  had  fallen  to  his  lot  as  the  subject  of  lecture.  On  exam- 
ination he  found,  besides  an  effusion  of  serum,  a  distinct  circumscribed 
t  jmour,  of  the  size  of  an  apricot  stone;  it  rolled  under  the  r)nger,and 
was  situated  at  t!ie  external  side  of  the  knee,  above  the  i)atelia.  M. 
Mdrio\'ii),jiige  dc  concoitrs,  did  not  coincide  with  this  opinion,  nnd 
jitrirmed  that  what  was  considered  as  a  foreign  body  was  nothing 
niore  than  an  adherent  tumour,  very  often  found  in  those  afft-cted  with 
hyciarthrosis:  he  was  ignorant  of  its  nature,  never  having  hud  an 
opportunity  of  dissecting  one.  M.  Malgaigne,  one  of  the  competitors, 
and  who,  like  M.  Berard,  believed  in  the  existence  of  a  foreign  body 
within  the  joint,  hastened  to  examine  this  tumour  on  two  patients 
afft'Cted  with  hydarthrosis,  then  under  his  care  in  the  Bicetre,  and  ho 
Ibund  it  exactly  the  same  as  in  the  patient  of  M.  Eerard.  One  of 
these  patients  died  shortly  after ;  he  thus  had  an  opportunity  of  de- 
termining  its  nature,  and  found  that  the  apparently  foreign  body  w.is 
nothing  more  than  a  pellet  of  fat,  of  a  perfectly  healthy  appearance. 
M.  M.  next  inquired  whether  this  tumour  was  entirely  the  result  of 
inflammation,  or  whether,  previously  existing  in  the  natural  state,  it 
only  acquired  an  increase  of  development  in  consequence  of  disease? 
To  determine  this  point  he  opened  a  number  of  healthy  knee-joints; 
in  almost  all  of  which  he  found  the  above-mentioned  tumour,  gener- 
ally on  the  external  side  of  the  articulation,  but  sometimes  on  the 
internal.  Its  normal  existence  is  no  way  connected  w  ith  hydarthro- 
sis ;  but  it  appears  to  increase  in  size  under  the  influenqp  of  the  pain 
and  articular  inflammation:  it  is  not  found  in  all  subjects  aff'ecled 
with  hydarthrosis;  but  when  it  does  exist  during  the  course  of  the 
disease,  it  continues  after  the  disappearance  of  the  latter;  pain  or 
pressure  continues  longer  over  the  site  it  occupies  than  anywhere 
else,  as  if  the  irritation  disappeared  more  readily  when  the  synovial 
membrane  alone  is  affected  than  when  it  spreads  to  the  adjoining  adi- 
])ose  tissue.  Lond.  and  Edin.  Month.  Joiirn.  Med.  Sci.,  Oct.,  1841, 
from  Encyclographie  Med. ,  June,  1644.     A7n.  Jour.  Med.  Sciences. 


On  the  Medicinal  properties  of  the  Bebeerine  In  the  April  No. 
of  the  Edinburg  Medical  and  SurgicalJournal,  Dr.  Maclagan  reports 
a  number  of  cases  of  intermittent  and  remittent  fever  treated  with 
the  Sulphate  of  Bebeerine,  the  active  principle  of  the  Nectandra 
Rodiei,  a  tree  found  in  British  Guiana,  and  so  called  in  honor  of  Dr. 
Rodie,  the  original  discoverer  of  its  medicinal  powers.  "The  cases 
of  fever  treated  with  bebeerine, "  snvs  Dr.  ![.,  "with  which  I  am 


348  Anlidote  to  Poisoning.  Placeiiia  Free  via.  [June, 


ncquainted,  amount  to  about  40.  In  all  of  them  it  appears  to  have 
inunifested  more  or  less  of  anti-periodic  action.  In  6  cases,  or  nearly 
one  in  7.  it  does  not  seem  to  have  acted  satisfactorily.  Of  26  cases, 
the  details  of  which  are  given,  5  only,  suffered  from  any  unpleasant 
effect,  and  this  seems  not  to  have  gone  beyond  a  little  ^i/2/ii/i/5  auri- 
t/m."  The  bebeerine  has  also  been  used  with  benefit  in  neuralgias. 
Dr.  M.  states  that  the  bebeerine  d i fie rs  from  the  quinine  in  not  being 
so  liable  to  excite  the  circulation,  or  affect  the  nervous  system.  He 
gives  it  in  the  form  of  pill,  made  with  conserve  of  roses,  in  the  same 
way  and  doses  of  quinine.  It  can  also  be  given  in  the  liquid  form, 
the  addition  of  a  few  drops  of  diluted  sulphuric  acid  sufiicingto  form 
with  it  a  perfect  solution. 


Inhalalion  of  Oxygen  Gas  an  antidote  to  poisoning  with  carbonic 
acid.  An  individual,  in  the  course  of  some  pharmaceutical  experi- 
ments, itiiialed  a  large  quantity  of  carbonic  acid.  Removed  into 
another  chamber,  he  lay  motionless,  the  eyes  closed  and  the  face  a 
pale  vellow,  the  cheeks,  together  with  the  lips,  tongue  and  hands, 
were  livid  ;  the  pupils  were  fixed  and  somewhat  dilated;  all  the  sen- 
ses had  entirely  disappeared  ;  the  carotids  beat  violently  ;  the  action 
of  the  heart  was  frequent  but  weak,  the  pulse  scarcely  perceptible, 
and  the  breathing  weak  and  irregular.  The  cold  douche,  bleeding 
and  other  means  were  unsuccessfully  had  recourse  to.  A  quantity  of 
oxvgen  gas  was  then  prepared,  and  this  he  was  made  to  inhale,  to  the 
extent  of  two  quarts  and  a  half.  In  about  fifteen  minutes  be  rallied, 
as  if  from  a  deep  sleep,  and  recovery  was  progressive.  The  use  of 
the  oxvgen  gas  is  in  this  case  sufficiently  evident.  We  have  seen 
the  chlorate  of  potass,  which  contains  a  lai'ge  amount  of  oxygen,  ad- 
ministered under  similar  circumstances,  with  a  most  beneficial  result. 
This  case  is  recorded  at  length  in  the  Xorthern  Journal  of  Medicine. 


On  Detaching  the  Placenta  in  cases  of  Placenta  Prcevia.     By 

Radford,  M.  D.  Since  my  observation  on  galvanism  in  uterine 
ba?morrhage,  published  in  the  Provincial  Medical  and  Surgical  Journal, 
I  liave  had  letters  from  many  gentlemen,  inquiring  whether  I  confined 
lhe|)ractice  to  detaching  the  placenta  in  cases  of  placenta  praevia  to 
those  of  exhaustion  alone.  In  order,  then,  to  supersede  the  necessity 
of  writing  to  each  correspondent,  I  make  the  reply  through  the  same 
channel.  In  my  paper  I  stated  that  I  had  detached  the  placenta  in  a 
case  which  occurred  in  1819,  but  did  not  then  state  that  it  was  un- 
attended  by  exhaustion.  From  this  and  other  cases  then  alluded  to, 
I  conclude  that  on  a  complete  separation  of  the  placenta,  the  heemorr- 
hagc  is  ini mediately  and  completely  suppressed,  provided  the  uterus 
is  in  a  condition  to  so  far  contract,  as  to  torce  down  the  head  with  the 
placenta  upon  the  uterine  openings.     V>y  this  practice  it  may  be  said 


1845.J  Placenta  Prajcia.  'MO 


thnt  the  life  of  the  child  is  sacrificed  :  but  tliis  will  not  al  \vn  ys  hnppen. 
We  find  from  hospital  and  individual  reports,  that  the  child  is  usually 
dead  when  the  case  has  been  treated  by  the  present  recooriiized  means. 

In  nearly  all  cases  which  I  have  collected  and  referred  to  in  my  pa- 
per, of  expulsion  of  the  placenta  by  the  natural  elForts,  we  find  that 
the  mother  recovered  ;  and  when  this  fortunate  event  did  not  hnppen, 
it  depended  upon  the  serious  impression  made  upon  the  vital  powers 
before  the  placenta  was  completely  detached. 

It  may  also  be  stated  that  uterine  phlebitis  takes  place  more  fre- 
quently in  cases  of  placenta  praevia,  when  the  ordinary  practice  is 
adopted,  than  we  observe  in  the  same  numher  of  cases  of  accidental 
hicmorrhage.  This  result,  in  the  opinion  of  the  writer,  arises  from 
the  contusion  and  slight  lacerations  which  are  consequent  upon  ;i 
forced  delivery. 

From  the  above  statement,  I  consider  lam  justified  in  recommend- 
ing a  modified  practice ;  but  I  shall  not  enter  fully  into  the  details  of 
the  plan,  as  this  brief  communication  will  not  allow  of  it. 

First.  Then,  as  neither  delivery,  nor  detaching  the  placenta,  ought 
ever  to  be  attempted  until  the  cervix  and  os  uteri  will  safely  allow  the 
introduction  of  the  hand,  rest,  the  application  of'  cold,  but,  above  all, 
the  use  of  the  plug,  must  never  be  omitted  in  cases  where  they  are 
respectively  required. 

Secondly.  If  there  are  unequivocal  siorns  of  the  child's  death,  the 
placenta  is  to  be  complete!}'  d('tached,  and  the  membranes  are  to  bo 
ruptured.  The  case  is  then  to  be  left  to  the  natural  efforts,  provided 
there  be  sufficient  uterine  energy  ;  if  otherwise,  the  ordinary  means 
are  to  be  used,  and,  in  addition,  galvanism. 

Thisdly.  When  the  narrow  pelvis  exists  in  connection  with  placen- 
ta praevia,  the  practice  is  to  detach  the  placenta  and  to  remove  it,  then 
to  perforate  the  head  as  soon  as  the  condition  of  the  parts  allows, 
and  to  extract  it  by  means  of  the  crotchet. 

Fourthly.  When  the  os  uteri  is  partially  dilated,  and  dilatable  so 
as  to  allow  the  easy  introduction  of  the  hand,  when  the  membranes 
are  ruptured,  and  strong  uterine  contraction  exists,  the  practice  is  to 
detach  the  placenta  completely. 

Fifthly.  In  all  cases  of  exhaustion,  as  already  referred  to  in  my 
paper,  the  practice  is  to  draw  off  the  liquor  amnii,  by  perforating  the 
placenta,  as  then  recommended,  then  to  detach  completely  this  organ, 
and  apply  galvanism. 

Sixthly.  In  all  cases  of  partial  presentation  of  the  placenta,  the 
artificial  rupture  of  the  membranes  v\ill  crenerally  be  found  sufficient 
to  arrest  the  haemorrhbge,  but  if  that  should  prove  ineffectual,  then 
we  must  apply  galvanism. 

The  practice  of  detaching  and  removing  the  placenta  was  adopted 
by  some  of  the  older  writers ;  and  as  I  have  mentioned  in  my  paper 
*'0n  galvanism  applied  to  the  treatment  of  uterine  haemorrhage, "  I 
detached  this  organ  in  the  year  1S19,  although  it  was  not  my  custom 
to  do  so. 


350  Expulsion  of  Fceius  throvgh  Abdomen.  [June, 


Early  in  October,  I  received  a  letter  from  my  respected  friend,  Pro- 
fessor Simpson,  in  whicii  he  stated  he  removed  the  placenta  in  a  case  of 
nnavoidable  haemorrhage.  Ho  "had  the  placenta  on  a  plate  two  hours 
before  the  baby  was  born."  The  mother  recovered.  Dr.  Simpson 
has  collected  a  great  number  of  cases  of  expulsion  of  the  placenta 
before  the  child,  and  has  come  to  the  conclusion,  that  the  practice  of 
its  removal,  in  some  cases  of  i)lacenta  prsevia,  is  calculated  to  save 
the  parent's  life. 

I  am  glad  to  have  my  views  on  this  most  important  subject  corrobor- 
ated by  an  authority  so  deservedly  esteemed  as  Dr.  Simpson,  to  whom 
I  am  disposed  to  award  every  degree  of  merit  which  really  belongs  to 
him,  as  having  by  observation  and  research  accumulated  materials  to 
bring  him  to  the  same  conclusion  at  which  I  arrived  myself.  Although 
I  feel  thus  gratified  in  having  the  authority  of  Dr.  Simpson  in  support 
of  this  practice,  I  must  confass  that  it  is  to  be  the  late  Mr.  Kinder 
Wood,  who  for  many  years  was  an  active  and  deservedly  respected 
colleague  of  mine  at  (he  Lying  in  Hospital,  that  the  merit  (if  there 
be  any)  is  due  for  the  first,  as  a  modern  obstetrician  adopting  this  prac- 
tice, and  also  recommending  it  in  his  lectures.  'J'he  practice  I  allude 
to,  is  that  of  detaching  and  removing  the  placenta  in  cases  of  una- 
voidable haemorrhage,  attended  with  exhaustion.  In  the  foregoing 
ohservations  I  have  ventured  to  recommend  this  practice  as  applica- 
ble to  cases  in  which  tliere  exist  different  conditions,  convinced  that 
there  are  many  mothers  sacrificed  by  the  rash  manoeuvres  consequent 
on  a  forced  and  indiscriminate  delivery.  Provincial  Medical  and 
Sur(^ical  Journal. 


a' 


Successful  Case  of  Expulsion  of  the  Fcrius  through  a  rupture  of  the 
Uterus  and  Abdominal  Parietes.  By  Dr.  Prael  of  Hildesheim. 
(Allegemei?ies  Repcrtorium,  June,  1844.)  A  woman,  28  years  of 
age,  deformed  by  rickets,  and  the  largest  diameter  of  whose  pelvis 
did  not  exceed  two  and  a  half  inches,  was  delivered  by  the  Caesarean 
section  on  the  11th  of  January,  1842.  The  child  was  a  female,  and 
alive,  but  died  of  trismus  the  ninth  day.  The  mother  made  a  tolera- 
bly good  recovery,  notwithstanding  the  feverish  symptoms  induced  by 
the  suppression  of  the  milk  st^cretion  from  the  death  of  the  iniant. 
It  was  a  couple  of  months,  however,  before  the  cicatrization  of  the 
\vound  was  complete.  She  again  became  pregnant  in  January, 
1843,  and  about  the  fourth  month  a  small  ulcerated  point  made  its 
appearance  on  the  right  side  of  the  abdomen,  about  a  hand's  breadth 
from  the  cicatrix.  It  daily  increased  till  it  attained  the  size  of  the 
palm,  when  the  feverish  symptoms,  &c.,  induced  her  to.  apply  for 
medical  a^stance.  When  raising  herself  on  the  18th  July,  a  slight 
cracking  noise  was  heard,  and  the  abdominal  parietes  gave  way,  as 
well  as  the  uterus  itself,  allowing  the  fcEtus,  still  surrounded  with  its 
envelopes,  to  project  through  the  rupture.  Before  assistance  could 
be  procured  the  infant  was  dead  ;  a  midwife  cut  through  the  chord, 
and  got  the  woman  put  to  bed.     Dr.  Schroeder,  who  arrived  about 


1845. J  Transylvania  University  and  the  Navy  351 


an  hour  after  this,  separated  the  placenta,  and  removed  some  clots 
trom  the  uterus.  He  could  not  ascertain  the  direction  of  the  rupture 
through  the  walls  of  the  uterus,  but  that  through  the  abdominal  parie- 
tes  was  transverse,  and  crossed  the  line  of  the  Caesarean  cicatrix. 
The  edges  of  this  wound  were  sv/ollen,  soft, oedema tous,  and  unequal, 
and  as  they  seemed  as  if  unable  to  bear  stitches,  adhesive  straps  were 
used  to  bring  the  edges  in  contact.  The  fever  of  reaction  which  fol- 
lowed  was  slight ;  a  considerable  quantity,  however,  of  bloody  sanies 
flowed  out  eacli  lime  the  wound  was  dressed.  Acute  pain  was  short- 
ly after  complained  of  at  each  extremity  of  the  wound,  which  assum- 
ed  a  gangrenotis  appearance,  and  discharged  a  very  fetid  sanies. 
Under  quinine  the  state  of  the  wound  gradiially  improved;  but  she 
was  again  thrown  back  by  a  rheumatic  affection,  and  then  by  the 
formation  of  an  abscess  in  the  left  inguinal  region,  accompanied  with 
oedema,  and  partial  paralysis  of  the  corresponding  limb.  Under  ton- 
ics and  generous  diet  the  wound  slowly  healed,  though  the  old  ulcer- 
ation of  the  surface  continued  to  be  the  seat  of  painful  sensations. 
By  the  5th  of  October,  the  cicatrization  of  the  wound  was  complete  ; 
she  suffered  no  pain ;  had  recovered  her  usual  appearance  ;  her 
menses  had  reappeared ;  and  she  was  able  to  resume  her  household 
duties.  The  transverse  cicatrix  was  situated  four  inches  below  the 
umbilicus,  and  measured  four  inches  one  line  in  length.  It  was  very 
uneven  and  presented  many  unequal  dilatations.  The  parietes  over 
it,  and  the  seat  of  the  old  ulcer,  were  very  soft  and  thin.  Edinburgh 
Med,  and  Surtr.  Journal, 


MEDICAL  INTELLIGENCE. 

Transylvania  University  and  Hie  Navy.  The  "Observer  and  Reporter,"  pab- 
bshed  tit  Lexington,  Ky.,  has  been  sent  us,  containing  a  reply  from  the  Dean  of 
the  Medical  Faculty  of  Transylvania  University,  to  an  article  in  the  New- York 
Herald,  of  April  7th.  The  Herald  published  a  letter  in  which  the  writer  assert- 
ed, "that  at  the  last  examination  of  applicants  for  the  appointment  of  Assistant 
Surgeons  for  the  Navy,  out  of  thirty  examined,  only  sixteen  Avere  found  quali- 
fied, and  that  the  fourteen  rejected  as  incompetent,  \\^re  graduates  of  the  Medi- 
cal Colleges  of  Lexington,  and  Cincinnati."  In  answer  to  a  communication 
from  the  Faculty  of  Trans3^1vania  University,  Surgeon  Harrington  of  the  Navy 
Board,  says,  "it  gives  me  pleasure  to  state,  that  of  the  candidates  for  admission 
into  the  Medical  Department  of  the  Navy,  rejected  by  the  last  Board  of  Naval 
Surgeons,  not  one  was  a  graduate  of  either  Lexington  or  Cincinnati.  Nor  has 
any  graduate  of  the  Transylvania  University  yet  presented  himself  before  any 
Board,  of  which  I  have  been  a  member." 


832      UtilccrsUij  of  Pciinsyhania.  Obiluanj.  Meteorology. 


University  of  Pernisylvania.  At  the  Commencement  of  the  University  of 
Pennsylvania,  held  April  4th,  1845,  the  degree  of  Doctor  of  Medicine  was 
conferred  upon  one  hundred  and  sixty-four  persons  two  of  whom  were  from 
Georjria,  and  three  from  South  Carolina. 


Obituary.  We  regret  to  have  to  record  the  death  of  Professor  Thomas  Sewall, 
M.  D.,  of  Washington,  D.  C,  which  occurred  on  Monday,  the  10th  instant,  in 
the  fifty-ninth  year  of  his  age.  Dr.  Sewall  was  a  native  of  Augusta,  in  the 
State  of  Maine.  He  graduated  at  the  Medical  School  of  Boston,  and  about  the 
year  1820  removed  to  the  City  of  Washington,  where  his  talents  and  acquire- 
ments, with  an  upright  deportment  and  great  urbanity  of  manners,  soon  procur- 
ed for  him  the  respect  and  patronage  of  a  large  portion  of  the  inhabitants.  He 
Avas  appointed  Professor  of  Anatomy  in  the  Medical  School  of  that  place  on  its 
first  organization,  and  continued  to  discharge  the  duties  of  the  Chair,  with  dis- 
tinguished ability,  until  the  time  of  his  death.  By  the  public  prints  we  observe, 
that  the  members  of  the  profession  of  the  city  in  which  he  resided,  and  the  stu- 
dents of  the  College  to  which  he  was  attached,  adopted  suitable  measures  to 
express  their  grief  for  his  loss.  Ee.ide  tliese,  his  remains  were  followed  to  the 
grave  by  a  larife  concourse  of  people,  including  a  number  of  eminent  statesmen, 
and  the  distinguished  citizens  of  the  place.  Medical  Examiner. 


METEOROLOGICAL  OBSERVATIONS,  for  April,  1845,  at  Augusta,  Ga. 
Latmide  33'^  27'  north  Longitude  4^^  32'  west  Wash. 


> 

Thkrmomrter. 
Sun  rise.    3,  p.  m. 

B.\ROMETER. 

Sun  rise.    3,  p.  m. 

Wind. 

Remark-s. 

~1 

58 

70 

29  7-10 

29  8-10 

s.  w. 

Cloudy  to  12,  M. 

2 

41 

79 

29  9-10 

29  9-10 

w. 

Fair. 

3 

4-1 

82 

29  9-10 

29  9-10 

.s. 

Fair.                              [thunder. 

4 

50 

85 

29  8-10 

29  8-10 

s.  w. 

Fair  some  drops  of  rain,  and 

5 

50 

81 

29  7-10 

29  6-10 

^\'. 

Fair.            do.              do. 

6 

58 

60 

29  (5-10 

29  7-10 

w. 

C 1  oudy  spr  i  n  kle , 

7 

51 

68 

29  7-10 

29  7-10 

w. 

Fair. 

8 

45 

64 

29  8-10 

29  9-10 

N.  W. 

Fair windy. 

9 

37 

62 

30  1-10 

30 

N.    E, 

Fair. 

10 

39^ 

76 

29  9-10 

29  7-10 

s.  w. 

Fair. 

11 

54 

84 

29  7-10 

29  7-10 

N.  W. 

Fair. 

12 

56 

78 

29  9-10 

29  9-10 

E. 

Fair. 

13 

44 

81 

29  9-10 

29  8-10 

S.  W. 

Fair. 

14 

50 

84 

29  8-10 

29  7-10 

s.  w. 

Fair. 

15 

59 

88 

29  7-10 

29  7-10 

S.  E. 

Cloudvj* 

16 

62 

84 

29  7-10 

29  7-10 

s.  w. 

Cloudy  to  12,  'SI. 

17 

65 

86 

29  7-10 

29  7-10 

s.  w. 

Fair. 

18 

60 

85 

29  7-10 

29  8-10 

s.  w. 

Fair. 

19 

60 

88 

29  7-10 

29  7-10 

w. 

Fair.       ^ 

20 

64 

88 

29  7-10 

29  6-10 

w. 

Fair. 

21 

58 

83 

29  7-10 

29  7-10 

N.  W. 

Fair. 

22 

55 

83 

29  7-10 

29  7-10 

N,  W, 

Fair. 

23 

62 

82 

29  8-10 

29  8-10 

S. 

Cloudy. 

24 

62 

87 

29  8-lQ 

29  8-10 

S.  E. 

Fair. 

25 

64 

84 

39  8-10 

29  7-10 

S,  W. 

Cloudv. 

26 

64 

87 

29  7-10 

29  7-10 

. 

Variable. 

27 

68 

90 

29  8-10 

29  8-10 

S. 

Fair thun.  and  light.  at9,  p.m. 

28 

64 

86 

29  8-10 

29  8-10 

S. 

Fair. 

29 

60 

88 

29  9-10 

29  8-10 

S.    E. 

Fair. 

30 

58 

86 

29  9-10 

29  8-10 

S.  E. 

Fair. 

23  Fair  days,    auantity  of  Rain,  none.    We  had  no  rain  from  the  S^lth  of 
March  to  the  12th  of  May  a  period  of  49  days. 


SOUTHERN 

MEDICAL  AND  SURGICAL 

JOURNAL. 

Vol.  I.]  NEW  SERIES. JULY,  1845.  [No.  7. 

PART  I. ORIGLNAL  COMMUxMCATIONS. 

ARTICLE   I. 

Reworlis  on  the  use  of  the  Sub-Nitrate  of  Bismuth  in  certain  gastric 
derangements.  By  I.  P.  Garvin,  M.  D.,  Professor  of  Materia 
Medica^  (Sfc,  in  the  Medical  College  of  Georgia, 

The  utility  of  the  Sub-nitrate  of  Bismuth  in  certain  painful  affec- 
tions of  the  stomach,  has  been  known  to  the  profession,  ever  since 
the  publication  of  Odier,  of  Geneva,  who  was  the  first  to  employ  it 
internally.  In  presenting  the  remarks  which  follow,  we  are  therefore 
not  to  be  understood  as  claiming  any  originality,  either  as  to  the 
mode  of  its  action  or  application.  Our  sole  object  is  to  invite  atten- 
tion to  a  most  valuable  remedy  which  we  think  is  too  much  neglect- 
ed. Notwithstanding  the  length  of  time  which  has  elapsed  since  the 
remedial  powers  of  the  sub-nitrate  were  made  known,  and  the  numer- 
ous facts  which  prove  its  value,  some  of  the  best  writers  on  the 
materia medica  have  failed  to  notice  it  at  all.  Under  these  circum- 
stances we  have  thought  that  a  few  cases  illustrating  its  beneficial 
effects,  would  not  prove  unacceptable  to  the  readers  of  the  Journal. 

Bismuth  has  been  employed  with  benefif,  in  the  vomitings  of  chil- 
dren  which  are  connected  with  dentition,  in  the  diarrhoeas  which 
attack  feeble  infants  upon  slight  causes,  and  in  those  which  follow 
acute  diseases,  but  are  unattended  by  fever ;  but  these  and  some 
other  applications  of  the  article  we  do  not  intend  now  to  notice,  but 
shall  confine  our  remarks  to  its  effects  in  some  of  thooe  nervous  dc- 

23 


354  RemarJcs  on  the  use  of  Sub-Nitrate  of  Bismuth,         [July, 


rangements  of  the  stomach,  which  prove  so  distressing  to  the  patient 
and  harrassing  to  the  practitioner.  Our  observation  has  satisfied  us 
that  such  nervous  affections  of  the  stomach,  and  indeed  many  other 
nervous  diseases,  are  of  more  frequent  occurrence  in  malarial  regions, 
than  in  such  as  possess  a  salubrious  atmosphere.  Nor  is  this  fact  at 
all  surprising,  when  we  consider  that  it  is  upon  the  nervous  system 
that  malaria  exerts  its  principal  morbific  influence  as  is  proven  by  its 
agency  in  the  production  of  intermittent  fever  a  disease,  confessedly 
of  nervous  origin.  These  diseases  of  the  stomach,  like  most  nervous 
affections,  are  usually  paroxysmal,  and  whilst  relief  is  most  urgently 
demanded  during  the  sufferings  of  the  paroxysm,  the  patient,  and 
sometimes  the  physician,  neglects  the  radical  treatment,  which  can 
only  be  carried  on  during  the  intermissions. 

Case.  The  first  case  in  which  we  obtained  very  marked  benefit 
from  the  employment  of  the  bismuth,  was  in  that  of  a  female,  of  a 
spare  habit,  nervous  temperament,  and  about  forty  years  of  age.  In 
the  early  part  of  the  summer,  she  had  an  attack  of  fever  in  Florida, 
from  which  she  seemed  to  have  entirely  recovered.  In  the  month  of 
September  she  had  a  succession  of  violent  paroxysms  of  gastralgia, 
occurring  at  irregular  intervals,  sometimes  of  one  or  two  weeks. 
During  the  three  or  four  earlier  attacks,  she  was  from  home,  and  the 
care  of  the  case  devolved  upon  another  physician,  but  we  learn- 
ed that  she  had  taken  morphine,  chloric  ether,  and  other  similar 
remedies  for  the  agonizing  pain.  Between  the  paroxysms  she  was 
directed  to  use  the  sulphate  of  quinine,  in  doses  of  several  grains 
each  day.  This  article,  however,  appeared  to  have  exercised  no 
beneficial  influence,  for  though  it  had  been  regularly  taken,  the  dis- 
ease had  renewed  its  assaults.  The  first  attack  in  which  we  saw 
the  patient  lasted  about  three  hours :  her  face  was  pale  the  skin 
bathed  in  a  cold  sweat  the  pulse  soft,  small,  and  but  slightly  accel- 
erated there  was  an  occasional  vomiting  of  a  fluid  resembling  very 
much  the  black  vomit  of  yellow  fever  and  there  was  pain  in  the 
epigastric  region  of  a  most  distressing  character.  A  large  dose  of 
the  acetate  of  morphine  was  administered,  and  as  tjje  last  matters 
ejected  from  the  stomach  were  mixed  with  blood,  to  the  great  alarm 
of  the  patient,  with  the  morphine  was  combined  four  or  five  grains 
of  the  acetate  of  lead.  The  relief  aflx)rded  by  the  combination  was 
almost  instantaneous,  so  much  so  that  the  patient  expressed  some 
curiosity  to  learn  what  she  had  taken.  At  first  we  were  disposed  to 
attribute  the  usual  promptness  with  which  the  anodyne  acted,  to 


1S45.]       Remarks  on  the  use  of  Sub-Nitrate  of  Bismuth.  355 


some  modification  of  the  condition  of  the  stomach  produced  by  the 
hemorrhage,  but  from  subsequent  trials  of  the  combination  of  the 
acetates  of  morphine  and  lead,  in  this,  as  well  as  in  other  cases  of  a 
similar  character,  we  are  satisfied  that  the  acetate  of  lead  was  also 
an  efficient  agent  in  the  production  of  the  beneficial  effects,  probably 
by  virtue  of  its  sedative  action  on  the  irritated  mucous  membrane, 
and  by  restrainining  the  acrid  secretions  from  the  gastric  surfaces, 
thereby  preventing  the  irritation  which  they  must  excite  on  these 
morbidly  sensitive  parts.  After  the  paroxysm  we  have  just  noticed, 
our  patient  continued  the  use  of  the  quinine  for  some  days,  when  she 
was  again  violently  attarked.  We  should  have  mentioned  before, 
that  these  attacks  did  not  seem  to  depend  at  all  upon  the  ingestion  of 
food,  either  in  too  great  quantity,  or  of  an  indigestible  quality.  In 
this  instance,  a  small  quantity  of  rice  was  the  only  article  which  had 
been  taken  into  the  stomach.  On  this  occasion,  as  before,  the  com- 
binations of  the  acetates  of  lead  and  morphine  gave  prompt  relief. 
The  patient  was  then  put  upon  the  use  of  small  doses  of  blue  mass 
in  conjunction  with  quinine,  but  the  paroxysms  continued  to  return. 
Having  employed  the  bismuth  in  some  other  gastric  derangements 
with  benefit,  and  knowing  that  in  the  hands  of  others  it  had  been 
found  useful  in  cases  very  similar  to  the  one  under  treatment,  we 
abandoned  the  further  use  of  the  mercury  and  quinine,  and  put  the 
patient  upon  the  use  of  the  sub-nitrate  in  doses  of  two  grains  three 
times  a-day,  increasing  the  dose  one  grain  every  two  days.  From 
the  day  on  which  she  began  the  \Xse  of  this  remedy  she  had  no  return 
of  the  disease.  Her  general  health  improved,  and  she  remained  free 
from  this  complaint  up  to  the  time  of  her  death,  which  occurred  about 
a  year  subsequent  to  the  cure. 

The  next  case  was  one  very  similar  in  its  general  features  to  the 
foregoing.  The  patient  was  a  female  of  a  corpulent  habit,  and  about 
thirty.five  years  of  age.  Her  health  had  been  good  up  to  the  latter 
part  of  the  summer,  at  which  time  she  had  an  attack  of  intermittent 
fever,  from  which,  however,  she  soon  recovered,  but  was  soon  after 
attacked  with  paroxysms  of  gastralgia,  occurring  at  uncertain  inter- 
vals, and  lasting  from  one  to  eight  or  nine  hours.  The  duration, 
however,  was  generally  two  or  three  hours.  As  the  earlier  par- 
oxysms were  short,  and  as  she  lived  at  a  considerable  distance,  she 
did  not  apply  for  medical  aid  until  the  attacks  had  become  of  very 
frequent  occurrence,  and  more  protracted  in  their  duration.  When 
we  first  saw  her  she  had  been  laboring  under  a  very  violent  paroxysm 


356  Remarks  on  the  use  of  Sub-Nilraic  of  Bismuth.         [July, 


for  some  hours.  Her  skin  was  cold  and  bathed  in  sweat,  the  pulse 
feeble  and  very  slightly  accelerated,  and  she  vomited  frequently  con- 
siderable quantities  of  an  acrid  and  nearly  colorless  fluid.  The  ace- 
tates of  morphine  and  lead  were  administered,  and  relief  of  the  pain 
promptly  followed.  As  there  was  loss  of  appetite,  with  a  sallowness 
of  the  skin,  and  a  deficiency  of  bile  in  the  evacuations,  she  was  put 
upon  the  use  of  small  doses  of  blue  mass.  Her  skin  soon  became 
clearer,  and  her  appetite  and  general  health  improved,  nevertheless 
the  paroxysms  of  gastralgla  continued  to  return,  though  they  were 
neither  so  frequent  nor  so  violent.  She  was  then  put  upon  the  use 
of  the  bismuth,  and  from  that  day  to  the  present  time  she  has  had  no 
retvrn  of  the  comp  la  in  t . 

The  third  was  one  of  a  different  character.     The  subject  was  Miss 

,  of  a  rather  spare  habit,  and  about  thirty  years  of  age.     For 

a  long  period  she  had  been  subject  to  attacks  of  vomiting,  which 
would  continue  from  two  or  three  hours  to  as  many  days.  During 
these  attacks  the  stomach  would  be  thrown  into  the  most  violent 
contraction  by  the  introduction  of  the  smallest  quantity  of  even  the 
blandest  fluid.  Her  skin  was  cool  and  moist,  and  her  pulse  feeble, 
though  not  at  all  increased  in  frequency.  In  her  most  violent  at- 
tacks she  was  affected  with  spasms.  Upon  the  subsidence  of  the 
vomiting,  a  rash,  very  much  resembling  that  of  scarlatina,  generally 
appeared  upon  the  skin.  Slie  had  gone  through  the  whole  catalogue 
of  anodynes  and  antispasmodics.  In  one  paroxysm  an  article  would 
give  relief,  which  would  fail  entirely  in  the  next,  but  it  not  unfre- 
quently  happened  that  all  failed.  The  dread  of  the  return  of  the 
vomitings  embittered  the  life  of  this  lady,  and  led  her  to  practice  an 
almost  entire  abstinence  from  all  the  common  articles  of  food,  except 
those  of  the  most  digestible  kind,  and  in  very  small  quantities.  After 
a  trial  of  various  medicines,  (quinine  among  the  number,)  she  was 
put  upon  the  use  of  the  sub-nitrate  of  bismuth,  which  was  continued, 
with  occasional  intermissions,  for  a  considerable  length  of  time. 
After  discontinuing  the  remedy,  she  had  a  slight  return  of  her  old 
complaint,  but  with  this  exception  she  has  remained  fr^e  from  the 
disease  ro  the  present  time. 

We  are  informed  by  Dr.  Joseph  A.  Eve,  that  he  has  also  employed 
the  bismuth  in  several  cases  of  gastric  disease  of  a  painful  character, 
with  the  most  marked  benefit.  He  generally  combines  with  its  use, 
the  employment  of  small  doses  of  blue  mass.  The  mercury  he  dis- 
continues in  a  short  time,  but  increases  the  doses  of  the  bismuth  regu- 
larlv. 


1 S45.  J        Remarkii  on  the  use  of  Sub-Nitrate  of  Bismuth.  357 


Dr.  Dugas  also  informs  us  that  he  has  used  it  frequently,  and 
with  almost  invariable  success,  in  those  annoying  sensations  of 
oppression  or  pain  in  the  epigastric  region,  so  common  with  ladies  of 
a  delicate  constitution  and  sedentary  habits.  In  such  cases  he  pre- 
scribes tive  or  six  grains  to  be  taken  about  an  hour  before  each  meal, 
until  relief  be  obtained,  and  then  morning  and  night  for  a  few  days 
longer. 

We  have  also  used  the  article  in  several  cases  of  dyspepsia,  but 
have  not  witnessed  any  very  marked  benefit  from  its  employment, 
except  in  those  instances  where  pyrosis  was  present.  In  such  cases 
we  had  mucl\  reason  to  be  pleased  with  its  effects. 

If  the  mode  of  action  of  bismuth  were  well  understood,  it  is  proba- 
ble  that  it  would  be  found  useful  in  other  diseases  than  those  in  which 
it  is  now  employed,  but  its  modus  operandi  is  exceedingly  obscure. 
"If  we  endeavor  to  ascertain,"  says  Trousseau,  "  the  action  of  the 
Eub-nitrate  of  bismuth,  we  will  be  much  embarrassed  ;  no  intermedi- 
ate effect  between  the  employment  of  the  medicine,  and  its  curative- 
results,  can  be  perceived.  Notwithstanding  the  attention  we  have 
given  to  it,  we  have  not  been  able  to  perceive  the  least  influence  on 
the  general  functions.  When  an  individual  in  good  health  takes  the 
sub-nitrate  of  bismuth,  the  only  phenomenon  to  be  noticed  is  consti- 
pation,but  the  nervous  functions,  the  animal  heat,  the  movements  of 
the  heart,  the  urinary  and  cutaneous  secretions,  are  not  influenced  in 
an  appreciable  manner."  We  can  therefore  only  infer  the  nature  of 
its  action,  from  the  character  of  the  derangements  in  which  it  oper- 
ates beneficially.  As  these  are  characterized  by  an  exaltation  of  the 
nervous  sensibility,  the  medicine  is  supposed  by  Trousseau  to  possess 
sedative  properties,  and  to  be  also  somewhat  astringent.  Meratand 
De  Lens  rank  it  as  a  sedative,  acting  directly  on  thesurface  to  which 
it  is  applied,  and  not  as  the  opiates.  Dr.  Wood  considers  it  as  tonic 
and  antispasmodic.  We  think  that  it  is  an  error  to  attribute  to  it 
any  astringent  property.  Its  effect  in  constipating  the  bowels,  and 
in  arresting  certain  diarrhoeas  is  evidently  due  to  its  property  of  re- 
ducing the  nervous  sensibility. 

Considerable  fear  is  entertained  by  some  lest  poisonous  effects 
should  follow  the  use  of  bismuth.  It  is  true,  that  v.hen  imperfectlv^ 
prepared,  it  may  contain  a  small  portion  of  arsenic  in  the  form  of  an 
arseniate  of  bismuth,  and  to  the  presence  of  this  substance  must  any 
ill  consequences  be  attributed  which  may  follow  ordinary  doses,  for 
when  the  sub-nitrate  has  bt.-en  prepared  from  the  pure  metal,  precipi- 


S^  Strangulated  Omental  and  Intestinal  Hernia.  [  J^'y 


tated  and  well  washed,  no  danger  need  be  apprehended  though 
the  dose  should  be  carried  to  half  a  drachm,  or  even  more.  Howe- 
ver, in  over  doses,  even  the  pure  sub-nitrate  may  produce  alarming 
effects,  such  98  great  gastric  distress,  vertigo,  drowsiness,  6z;c, 


ARTICLE    11, 


Strangulated  Omental  and  Intestinal  Hernia  operation  'and  recovery/. 
By  Charles  West,  M.  D.,  of  Wayneshoro\  Ga, 

On  the  17th  September,  1841,  I  was  called  at  midnight  to  see  a 
'^egro,  (John,)  in  consultation  with  Dr.  S.  I  found  the  patient  suffer- 
ing from  a  tumour  in  the  left  scrotum,  very  painful  on  pressure,  red, 
"dhining  and  elastic.  The  attack  came  on  about  twenty  hours  previ- 
ously when  in  the  act  of  throwing  a  heavy  piece  of  wood  from  a 
wagon.  He  has  had  constant  nausea  for  six  or  eight  hours,  with 
frequent  vomiting,  and  one  or  two  scanty  stools  without  relief.  The 
paroxysms  of  pain  were  intense,  extending  over  the  whole  abdomen, 
with  an  increase  of  nausea  at  each  return  of  pain  ;  the  pulse  was 
100,  strong  and  corded.  He  says,  that  about  twelve  years  ago,  he 
had  a  similar  accident,  which  was  relieved  only  after  great  efTorts, 
and  aided  by  the  use  of  the  tobacco  enema.  He  has  always  felt  a 
considerable  thickness  in  the  scrotum  since  that  attack,  and  has  had 
frequent  returns  of  the  enlargement  coming  on  gradually  after  ma- 
king  any  great  effort  but  he  has  always  succeeded  in  relieving 
himself  by  sitting  in  cold  water  this  relief  occurring  gradually 
during  two  or  three  hours,  and  never  suddenly.  At  the  present  time 
the  presence  of  an  ancient  omental,  and  a  recent  intestinal  hernia,  is 
clearly  perceptible. 

Perseverinn-  efforts  at  the  taxis  alone,  and  then  the  tobacco  enema 
producing  great  relaxation,  followed  by  renewed  efforts,  were  used 
for  several  hours  without  success.  Venesection  and  the  warm  bath, 
both  carried  to  fainting  were  then  resorted  to,  with  as  little  success. 

After  exhausting  every  means  which  was  thought  capable  of  avert- 
ing an  operation,  \^e  latter  alternative  was  advised  at  8  A.  M.  
Thiough  the  opposition  of  both  master  and  servant,  the  operation 
was  postponed  till  night,  about  forty  hours  after  the  beginning  of  the 


1845.  J  Strangulated  Omental  and  Intestinal  Hernia.  359 


attack.  At  this  time  the  tumour  was  red,  glossy,  hard,  and  very 
painful,  the  whole  abdomen  very  sensitive  on  pressure,  the  paroxysms 
of  pain  extremely  severe  tiie  pulse  140,  small  and  feeble.  There 
was  nausea,  but  no  vomiting. 

The  cremaster  muscle  was  found  to  have  lost  its  fibrous  appear- 
ance entirely,  and  seemed  confounded  with  the  serous  membrane 
beneath.  The  division  of  the  hernial  sac  permitted  about  an  ounce 
of  serum  to  escape,  and  brought  into  view  a  portion  of  omentum. 
This  was  found  closely  adherent  to  the  tunica  vaginalis,  the  false 
membrane  being  very  strong,  and  requiring  the  use  of  the  point  of 
the  knife  te  detach  it.  When  dissected  from  its  adhesions,  it  mea- 
sured six  inches  in  length,  four  in  breadth,  and  one  in  thickness. 
Beneath  this,  a  fold  of  intestine  was  found  of  a  dark  red  color,  so 
closely  strictured,  that  it  was  impossible  to  draw  out  any  portion,  or 
to  return  it.  At  the  external  ring  there  was  no  stricture,  though  the 
omentum  had  formed  close  attachments  to  the  whole  inguinal  canal, 
and  seemed  sufficient  to  compress  strongly  the  intestine.  At  the  in- 
ternal ring,  a  stricture  was  found  so  rigid  and  clo;se,  that  the  finger 
nail  could  not  enter.  From  the  presence  and  adherences  of  the 
omentum,  the  stricture  was  with  difficulty  divided,  by  using  a  small 
conductor,  and  a  sharp  pointed  bistoury;  the  probe-pointed  bistoury 
and  Sir  Astley  Cooper's  hernia  knife,  being  both  too  thick  to  pass 
between  the  intestine  and  fibrous  cord,  thouf^>  repeated  efforts  were 
made  to  effect  it.  Having  returned  the  intestine,  the  omentum  was 
next  cut  ofTclose  to  the  abdominal  fascia  with  little  or  no  hemorrbao-e. 

o 

The  wound  was  dressed  with  four  sutures,  and  adhesive  strips.  Four 
hours  afterwards,  a  blister  was  applied  over  the  whole  lower  abdo- 
men, though  complete  reaction  did  not  take  place  until  several  hours 
had  elapsed,  and  about  the  time  of  the  drawing  of  the  blister. 

A  saline  cathartic  was  then  given,  which  did  not  operate  till  eight 
hours  after.  The  wound  cicatrized  without  difficulty,  and  on  the 
twenty.first  day  the  patient  was  discharged.  For  three  months  after 
he  suffered  severe  colic  pains  after  eating  indigestible  substances,  but 
these  gradually  disappeared.     There  has  been  no  return  of  hernia. 

This  case  has  been  recorded,  not  for  any  thing  remarkable  in  its 
history,  or  the  operation,  but  as  connected  with  some  reflections 
which  it  suggests. 

1st.  The  necessity  of  carefully  examining  every  case  of  hernia 
after  the  reduction  has  taken  place,  so  as  to  avoid,  if  possible,  leavinij 
any  portion  of  omenluni  in  the  sac  unreduced,  since  it  will  render 


An  Essay  on  the  Abuse  of  Diuretics.  [July, 


an  operation  at  some  future  day  inevitable,  and  by  prolonging  and 
complicating  the  operation,  increase  the  danger  of  the  patient. 

The  presence  of  an  unreduced  omentum,  though  small,  renders 
the  use  of  a  truss  highly  dangerous,  and  if  large,  doubly  so,  from 
concealing  the  presence  of  a  small  nucleus  of  intestine  from  even  a 
careful  observer.  The  irritation  produced  by  that  instrument  always 
causes  a  thickening  of  both  omentum  and  intestine,  and  renders 
reduction  without  an  operation  a  matter  of  impossibility. 

2d.  The  diagnosis  of  this  case  was  materially  aided  by  attention 
to  its  history  since  the  previous  accident.  The  constant  presence  of 
something  not  intestine,  in  the  scrotum  of  that  side,  its  volume  fre- 
quently increased  by  bodily  effort,  and  always  relieved,  not  by  pres- 
sure, or  favorable  position,  but  by  the  use  of  cold  water,  not  suddenly 
with  a  gurgling  noise,  but  gradually,  seemed  to  point  out  the  exist- 
ence of  an  old  omental  hernia,  which  was  confirmed  in  the  sequel. 


ARTICLE  III. 

An  Essay  on  the  Abuse  of  Diuretics  some  of  the  morbid  conditions 
of  the  Urinary  Organs  arising  therefrom,  and  their  Treatment, 
with  Cases  :  Read  before  the  Medical  Society  of  Augusta,  June 
7th,  1845.  By  H.  F.  Campbell,  M.  D.,  Demonstrator  in  the 
Medical  College  of  Georgia. 

In  the  selection  of  a  subject  for  this  essay,  the  above  particularly 
urges  itself  upon  my  attention  first,  from  its  great  importance 
in  a  pathological  and  therapeutical  point  of  view  ;  and  secondly, 
from  the  fact  that,  I  have  recently  had  occasion  to  deplore  the 
pernicious  eflfectsof  the  abuse  of  this  class  of  medicines,  in  several 
interesting  cases. 

In  the  relation  of  the  few  following  cases,  every  practitioner  may 
recognize,  perhaps,  many  similar  coming  under  his  own  observation, 
wherein  the  empirical  efforts  of  the  patient  to  relieve  himself,  have  so 
complicated  his  primary  disease,  as  to  render  the  treatment  very 
unsatisfactory  to  the  physician,  and  ultimate  cure  almost  hopeless. 

Diuretics  are  that  class  of  medicines,  which  increase  the  secretion 
of  the  kidneys,  and  the  term  owes  its  etymology  to  the  two  Greek 


1845.  J  An  Essay  on  the  Abuse  of  Diuretics.  3G1 


words  Sia,  by  or  through,  and  ovpeio,  I  pass  the  urine.  All  agencies 
which,  directly  or  indirectly,  exert  an  influence  on  the  urinary 
organs,  producing  an  increase  in  their  secretion,  may  with  propriety 
be  termed  dmretics  ;  hence  these  agents  have  been  classed  under  two 
heads,  direct  and  indirect  diuretics:  the  direct  are  those  substances 
that  produce  a  specific  action  upon  the  kidney  through  the  circulating 
fluid,  and  which  if  injected  into  the  blood  in  proper  doses,  would  by 
selection,  exercise  their  specific  influence  upon  these  organs  ;  and 
secondly,  the  term  is  applied  to  any  agency  which  under  certain 
peculiar  circumstances  has  in  any  way  become  the  cause  of  diuresis  ; 
among  these  are  diluents  which  by  increasing  the  amount  of  the  cir- 
culating fluid,  will  consequently  produce  an  increase  in  the  urinary 
secretion,  any  diminution  in  the  amount  of  the  cutaneous  or  pulmo- 
nary exhalations  will,  from  the  antagonism  existing  between  these 
great  depurators,  result  in  a  proportionate  increase  in  the  urinary 
secretion  ;  in  exemplification  of  this  we  see  cases  daily,  many  indeed 
have  come  under  my  own  observation,  wherein  the  patients  had 
been  subject  to  irritability  of  the  bladder,  and  invariably  on  the  ad- 
vent of  inclement  wet  weather  the  disease  became  aggravated,  even 
producing  haematuria,  from  the  increase  in  the  urinary  secretion  con- 
sequent upon  the  diminution  of  the  cutaneous  exhalation. 

Depletion  and  other  antiphlogistic  means,  under  certain  circum- 
stances, become  powerful  diuretic  agents ;  when  there  exists  an 
inflammatory  condition  of  the  kidneys,  interfering  with  their  secre- 
tion, blood-letting,  by  removing  this  condition,  re-establishes  the 
normal  functions  of  these  organs ;  nauseants  also  act  in  this  way 
beneficially  by  controlling  the  circulation  in  nephritis  ;  indeed  the 
means  and  circumstances  which,  in  certain  conditions  of  the  system 
may  induce  an  increase  in  the  urinary  secretion,  are  multifarious 
and  innumerable. 

While  I  have  deemed  it  proper,  thus  at  the  beginning  of  this  essay, 
to  glance  briefly  at  the  normal  modus  operandi  (if  I  may  use  the 
term)  of  this  class  of  therapeutic  agents,  it  would  perhaps  be  super- 
fluous to  enter  into  further  detail  of  such  action;  I  will  therefore  now 
consider  their  improper  application,  and  the  morbid  conditions  in  the 
urinary  organs  thus  superinduced. 

On  a  review  of  distinguished  authors  on  urinary  diseases,  the  abuse 
of  diuretics  stands  among  the  first  on  the  list  of  causes  producing 
derangement  in  this  set  of  organs,  of  which  the  proper  exercise  of  the 
functions  is  so  eminently  important,  and  the  morbid  condition  or  im- 


362  An  Essay  on  the  Abuse  of  Diuretics.  [July, 


perfect  action,  so  surely  entail  a  life  of  misery  upon  the  patient. 
M.  Chopart,  in  his  valuable  treatise  on  the  diseases  of  the  urinary 
passages,  has  occasion  more  than  once  to  deplore  the  sad  havoc 
caused  by  the  improper  use  of  diuretics,  and  relates  at  length  cases, 
wherein  some  of  the  most  obstinate  affections  of  the  kidneys  and 
bladder  have  been  the  direful  result  of  the  injudicious  use  of  this  class 
of  remedies.  He  deprecates  their  abuse  by  empirics,  and  by  pa- 
tients themselves ;  indeed  there  is  scarcely  a  disease  of  the  kidneys 
or  bladder  reviewed  by  him,  wherein  he  does  not  cite  this  as  an  occa- 
sional cause  of  that  morbid  condition  of  those  organs  upon  which  it 
depends.  In  his  chapter  upon  the  vices  in  the  secretion  of  the  urine, 
he  mentions  the  abuse  of  diuretics  first,  among  those  causes  which 
superinduce  the  diseased  states  giving  rise  to  such  vices.  In  nephri- 
tis it  is  often  the  cause  of  the  inflammation,  by  too  actively 
promoting  the  flow  of  blood  to  the  kidneys,  impeding  their  functions, 
and  giving  rise  to  ischuria  and  all  its  attendant  evils.  I  have  fre- 
quently found  this  a  cause  of  simple  retention  of  urine  from  the 
violent  irritation  of  the  neck  of  the  bladder,  producing  either  tume- 
faction or  spasm  at  that  portion  of  this  organ  ;  but  what  I  have  found, 
and  this  is  the  case  in  most  of  the  reports  on  this  subject,  the  most 
frequent  r'6sultof  the  abuse  of  diuretics  has  been  an  irritable  state  of 
the  bladder  and  kidneys,  attended  with  incontinence  of  urine  and 
hsematuria;  and  it  is  more  especially  to  this  particular  condition  of 
the  urinary  organs  that  I  wish  at  present,  most  respectfully  to  call 
the  attention  of  the  Society,  adducing  a  few  cases  with  the  treatftient 
found  most  efficient  for  their  relief. 

There  is  perhaps  nothing  more  common,  and  yet  nothing  more 
trying,  to  practitioners  in  their  intercourse  with  patients,  than 
the  empiric  treatment  to  which  they  almost  invariably  subject 
themselves  in  venereal  diseases,  before  submitting  to  the  advice 
of  a  physician.  More  than  two-thirds  of  the  cases  we  are  called 
upon  to  treat,  have  perhaps  run  the  gauntlet  of  all  the  alleged  rem- 
edies the  patient  has  ever  heard  of,  and  when  at  length,  application 
is  made  to  a  physician,  the  'primary  affection  forms  but  a  part  of  the 
difficulty  to  be  surmounted. 

Case  1st.  Not  long  since,  I  was  called  upon  to  treat  what  the 
patient  called  a  very  obstinate  case  of  gonorrhoea.  Mr.  K.  said  that 
notwithstanding  the  most  active  treatment,  his  disease  had  increased  in 
violence,  until  he  became  alarmed  and  bought  four  ounces  of  balsam 
copaiba,  and  took  the  whole  of  it  in  two  days,  and  in  spite  of  all,  the 


1845.]  An  Essay  on  the  Abuse  of  Diuretics.  363 


burning  and  discharge  continued,  and  when  he  urinated,  (which  was 
very  often)  he  passed  apparently  all  blood  and  indeed  he  was  in  a 
deplorable  condition :  the  bladder  was  so  irritable  as  not  to  retain  an 
ounce  of  urine ;  the  haBmorrhage  so  abundant  as  to  be  rapidly  ex- 
hausting his  strength  ;  and  he  at  the  same  time  complained  of  severe 
pain  in  the  lumbar  region  the  discharge,  it  is  true,  still  existed,  but 
it  was  only  of  minor  consideration  in  the  sum  total  of  his  ills.  Ho 
was  treated  with  rest  in  the  horizontal  position,  and  a  styptic  powder 
of  alum,  kino  and  opium,  to  be  repeated  more  or  less  frequently  accor- 
ding^ to  the  amount  of  hoemorrhaire,  with  demulcent  drinks  and  an 
occasional  dose  of  camphor  water,  to  allay  irritation  at  the  neck  of 
bladder.  After  the  haemorrhage  was  somewhat  checked  by  this 
treatment,  the  buchu  and  uva  ursi  were  steadily  applied  in  the  form 
of  the  compound  syrup  repeated  three  times  a  day,  and  the  cure  was 
complete  in  less  than  a  week.  The  gonorrhoea  was  afterwards  re- 
lieved by  a  lunar  caustic  injection  followed  by  mild  diuretics. 

It  is  remarked  by  Dr.  Willis,  in  his  learned  and  concise  Treatise 
on  Urinary  Diseases  and  their  Treatment,  "that,  in  certain  morbid 
conditions  of  the  kidney,  the  increase  in  the  quantity  of  urine  pour- 
ed out  by  that  organ,  is  followed  by  unusually  frequent  calls  to  relieve 
the  bladder,  and  these  calls  have  been  Observed  to  have  this  peculiar- 
ity about  them,  that  they  are  singularly  urgent  when  they  supervene" 
 a  remark  that  the  following  case,  which  is  one  like  the  above,  of 
irritable  bladder  with  hsematuria,  supervening  upon  the  abuse  of  di- 
uretics, will  go  in  some  measure  to  corroborate. 

Case  2d.     Mr.   B A ,   a   young  man,   aged   18  years, 

contracted  gonorrhoea,  and  applied  to  an  apothecary,  who  furnish- 
nished  him  with  a  balsamic  emulsion,  which  he  applied  with  all  dili- 
gence, till  he  had  the  disease  as  he  thought,  pretty  well  subdued  :  as 
he  had  anticipated,  while  taking  the  balsam  and  nitre,  his  urinary 
secretion  was  very  much  augmented,  but  a  short  time  before  apply- 
ing io  me,  these  calls  had  become  so  frequent  and  required  such 
prompt  attention,  that  he  could  not  go  into  company  at  all,  being 
obliged  to  void  his  urine  with  scarcely  a  premonition,  after  which  he 
also  passed  a  few  drops  of  blood. 

When  I  saw  him,  he  was  not  laboring  under  haematuria,  but  com- 
plained of  a  constant  uneasiness  in  the  perineum  and  a  very  frequent 
and  painful  voiding  of  scant,  highly  colored  urine ;  he  also  had  a 
dull  pain  in  the  lumbar  region  and  a  sense  of  fatigue  in  the  thighs 
and  knees.     The  gonorrhoea  had  ceased,  but  in  its  place,  he  had  su- 


364  An  Essay  on  the  Abuse  of  Diuretics.  [July, 


perinduced  a  nephritic  condition  of  the  kidneys  and  an  irritable  blad- 
der. Under  the  antiphlogistic  treatment,  with  rest  in  the  horizontal 
position,  followed  by  the  full  exhibition  of  buchu  and  uva  ursi,.  with 
occasionally  a  little  camphor  and  opium,  he  slowly  recovered  the 
the  tone  of  his  urinary  organs. 

Case  3d.  Simon,  a  boat  hand,  had  had  gonorrhoea  for  some  time, 
and  been  treated  with  balsam  copaiba,  of  which  he  says  he  has  taken 
a  great  deal.  The  Agent  of  the  Company, supposing  that  the  disease 
was  slight,*  as  there  was  no  discharge,  and  as  he  could  not  well  de- 
fine his  feelings,  referred  him  to  me  for  examination,  previous  to 
sending  him  with  the  boat.  When  I  saw  him,  he  had  a  dull,  fatigued 
look,  said  he  felt  tired  and  heavy,  and  when  asked  where  he  had 
pain,  complained  of  a  vague  feeling  of  uneasiness  in  the  region 
of  the  bladder  and  in  the  perineum,  and  said  he  felt  bruised  in  the 
lumbar  region.  The  discharge  had  ceased  :  the  pulse  and  respiration 
were  natural  urine  scanty  and  attended  with  slight  burning. 

Treatment  I  applied  a  tartar  emetic  plaster  to  the  lumbar  region 
and  gave  an  active  cathartic  after  its  operation,  he  took  half  an 
ounce  of  syrup  of  buchu  and  uva  ursi,  three  times  a  day,  under 
which  treatment  he  recovered  in  a  week. 

Case  4th.     Mr.  M.  Z ^  aged  about  35  years,  had  gonorrhoea, 

and  took  an  emulsion  of  balsam  copaiba,  with  oleum  cubebae,  oleum 
pimentaB,  and  several  other  essential  oils,  making  in  all  a  very  stim- 
ulating prescription;  this  he  had  taken  for  a  week,  and  the  disease, 
though  somewhat  checked,  was  still  very  troublesome.  When  he 
applied  to  me,  he  was  in  the  greatest  distress,  from  the  highly  irrita- 
ted condition  of  his  urinary  organs,  in  consequence  of  the  almost 
destructive  diuretic  course,  to  which  he  had  subjected  them;  he  com- 
plained of  severe  pain  in  the  lumbar  region,  which  evinced  much 
tenderness  on  pressure ;  pulse  rapid  and  full,  respiration  somewhat 
hurried ;  his  whole  appearance  indicated  intense  suffering.  He 
voided  his  urine  about  every  ten  minutes,  in  small  quantities,  and 
very  pale  for  an  hour  or  two  belore  I  saw  him,  he  was  unable  to  sit, 
from  the  severe  pricking  sensation  in  the  perinaeum  which  that  po- 
sition produced  his  bowels  were  constipated,  and  had  been  so  for 
several  days.  Treatment.  The  patient  objected  to  being  bled,  and 
to  relieve  his  immediate  distress,  I  administered  ij.  of  camphor  wa- 
ter, with  half  a  grain  of  sulphate  of  morphine  ;  a  short  time  after,  four 
ounces  of  the  compound  decoction  of  buchu  and  uva  ursi ;  to  relax 
the  bowels  I  gave  four  comp.  cath.  pills.    He  afterwards  continued  to 


1845.]  An  Essay  on  the  Abuse  of  Diuretics.  ^Qo 


use  (he  decoction  ofbuchu  and  uva  ursi  every  three  hours,  with  an 
occasional  dose  of  camphor  water.  The  effect  was  immediately  and 
decidedly  beneficial  he  was  well  in  three  days.  The  gonorrhoea 
was  afterwards  successfully  treated  with  the  carbonate  of  potassa, 
dissolved  in  the  syrup  of  buchu  and  uva  ursi,  to  which  was  added  a 
small  portion  of  balsam  copaiba. 

The  above  cases  I  have  adduced  with  the  view  of  showing,  as  I 
have  found  them,  the  particular  train  of  symptoms  attendant  upon 
that  pathological  condition  of  the  urinary  organs,  superinduced  by 
the  improper  use  of  diuretics,  and  also  to  offer  my  own  experience, 
though  limited  indeed,  in  a  remedy  to  which  many  ascribe  but  little 
specific  influence  over  the  urinary  apparatus.  With  regard  to  the 
curative  effect  of  uva  ursi  in  urinary  diseases,  there  exists  among  au- 
thors  even  at  the  present  day,  the  greatest  discrepancy  ;  some  claim- 
ing for  it  all  the  sanative  power  usually  ascribed  to  a  favorite  remedy, 
while  others  contend  that  it  is  wholly  devoid  of  any  action  whatever, 
save  perhaps  a  slight  tonic  effect  upon  the  system.  Alibert,  in  refer- 
ence to  this  article  of  the  Materia  Medica,  says:  "All  that  can  be 
said  of  this  remedy  is  that,  its  action  is,  under  certain  circumstances, 
manifestly  diuretic,"  and  he  denies  it  any  influence  whatever  over 
nephritic  and  other  diseases  of  the  urinary  organs.  Dr.  Farriar 
speaks  favorably  of  it,  in  some  few  instances,  and  reports  twelve  out  of 
sixteen  cases  of  urinary  disease  relieved  by  it,  though  the  value  of  the 
deduction  from  these  cases  is  somewhat  impaired  by  the  fact,  that 
he  combined  its  application  with  other  acknowledged,  and  very  effi- 
cient remedies  for  the  same  affections. 

M.  Biett,  in  his  valuable  contribution  to  the  Dictionnaire  des  Sci- 
ences Medicales,  on  this  subject,  evinces  but  a  feeble  belief  in  the 
specific  virtues  of  this  plant,  in  diseases  of  the  urinary  organs,  and 
advances  in  close  relation  with  his  own  views,  the  experiments  of 
Dr.  Alexander,  which  tend  to  prove  that  it  is  scarcely  endowed  with 
diuretic  properties,  and  coinciding  with  him,  he  further  cites  the  high 
authority  of  Werlhof,  Acrel  and  Dr.  Fothergill,  who,  he  says,  contest 
(he  question  of  its  efficacy  with  some  degree  of  reason  ;  and  later,  we 
have  the  opinion  of  Sir  Benj.  C.  Brodie,  who  in  his  excellent  Prac- 
tical Lectures  on  the  Diseases  of  the  Urinary  Organs,  confesses  with 
his  wonted  candor,  his  comparative  want  of  success,  with  the  remedy 
in  question,  in  the  following  words  :  "The  uva  ursi  has  the  reputation 
of  being  useful  as  a  remedy  for  chronic  inflammation  of  the  bladder. 
I  must  say  however,  that  this  remedy  has  generally  disappointed  me 


303  An  Essay  on  the  Abuse  of  Diuretics.  [July 


in  these,  and  that  I  have  not  seen  those  advantages  produced  by  it, 
which  the  general  reputation  of  the  medicine  had  led  me  to  expect." 
And  in  another  lecture,  whila-  he  extols  the  other  article  in  the 
combination  used  in  the  above  cases  of  urinary  disease,  the  diosma 
crenata  or  buchu,  he  again  expresses  his  unbelief  in  the  virtues  of 
the  uva  ursi. 

Indeed  with  such  decided,  adverse  testimony,  from  the  very  exalt- 
ed  authority  above  quoted,  it  would  appear  even  unscientific  to  hold 
an  opinion  very  favorable  to  the  specific  action  of  uva  ursi,  in  certain 
diseases  of  the  urinary  organs,  could  we  not,  on  the  other  hand,  ad- 
duce a  weight  of  authority  equally  as  respectable,  Galen,  it  is  ra- 
ther suspected  by  Dr.  Murray,  in  his  treatise  on  this  subject,  recom- 
mended the  uva  ursi  under  the  name  o^  apKov  srai-X/j,  as  a  remedy 
against  haemoptisis.  The  physicians  of  Montpelier,  and  more  recently 
De  Haen,  as  M.  Biett  remarks,  have  singularly  contributed  to  spread 
the  use  of  it  in  these  modern  times,  and  since  them  we  have  the  tes- 
timony of  Model,  Gerardi,  Joseph  Quer,  and  Dr.  Murray  all  of 
whom  speak  in  the  highest  terms  of  its  efficacy,  and  Joseph  Quer 
more  especially  in  his  "Dissertation  on  the  Nephritic  Passion,"  pub- 
lished at  Madrid,  1765,  lauds  it  as  "the  veritable  specific. ^^ 

A'though  the  majority  of  the  above  cited  authors  have  valued  the 
uva  ursi,  more  particularly  for  its  supposed  virtues  as  a  lithontriptic, 
a  class  of  medicines  which  were  since  exploded  by  the  chemical  ex- 
periments of  M.  M.  Vauquelin  and  Fourcroy,  on  calculus,  and  which 
now  are  but  little  esteemed  by  the  profession;  still  I  have  deemed  it 
expedient  to  adduce  them,  inasmuch  as,  in  their  hands,  the  remedy 
invariably  exerted  a  decidedly  beneficial  influence  over  the  urinary 
organs  in  certain  states  of  disease.  Later  we  have  the  favorable 
testimony  of  Dr.  Farrair,  Dr.  Eberle,  and  Dr.  Chapman,  and  lastly, 
we  may  quote  Dr.  William  Prout,  perhaps  the  highest  practical  au- 
thority on  diseases  of  the  urinary  organs  now  extant.  This 
author,  in  his  justly  styled  "elaborate  and  profound"  treatise  on 
"the  stomach  and  renal  diseases,"  recommends  it  in  terms  of  the 
highest  praise  for  its  astringent  and  tonic  effect,  in  many  diseases  of 
the  kidney  and  bladder,  among  which  are  the  secretion  of  serous 
urine,  suppuration  and  abscess  of  the  kidney,  chronic  inflammation  of 
the  bladder,  with  cystorrhosa,  &c. 

In  the  cases  given  above,  of  disease  of  the  urinary  organs  from  the 
abuse  of  diuretics,  the  uva  ursi  has  been  administered  in  combination 
with  buchu,  which  latter  is  rendered  a  very  proper  and  efiicient  addi- 


1845.  J  ,       A  Case  of  Hydrocele.  367 


tion  in  such  cases,  from  its  demulcent  and  slightly  balsamic  charac- 
ter, which  last  principle  is  said*  to  act  topically  upon  the  secreting 
organs,  as  it  passes  through  them,  while  it  adds  materially  to  the  tonic 
effect  of  the  bear  berry  upon  these  diseased  surfaces.  The  forms  in 
which  I  have  applied  the  remedy  most  frequently,  have  been  in  that 
of  the  decoction  of  the  uva  ursi  and  infusion  ofbuchu,  given  three 
times  a  day,  in  portions  of  two  ounces  each  ;  but  a  preferable  prepara- 
tion is  the  syrup,  prepared  from  the  leaves  of  these  two  plants,  with  a 
sufficiency  of  sugar  to  prevent  fermentation.  This  mode  of  admin- 
istration, while  it  combines  all  the  virtues  of  the  two  plants,  is  not 
obnoxious  to  the  almost  invariable  objection  made  to  their  employ- 
ment in  substance,  or  even  in  decoction,  their  liability  to  nause- 
ate :  indeed  Dr.  Lewis  complains  that  in  all  the  cases  wherein  he 
has  administered  the  uva  ursi,  it  has  produced  the  most  distressing 
nausea. 

I  have  used  the  buchu  and  uva  ursi  in  one  or  two  instances,  in 
other  affections  of  the  urinary  organs  than  those,  the  result  of  the 
abuse  of  diuretics,  but  with  indifferent  success;  and  its  effect  was 
only  appreciable  after  a  long  continued  administration  ;  but  in  the 
above  named  cases,  where  there  was  but  little  organic  lesion,  and  also 
in  the  dysuria  and  violent  irritation,  attendant  upon  the  absorption 
of  cantharides  from  a  blister,  their  action  has  appeared  to  me,  gener- 
ally prompt  and  effectual  in  removing  the  most  distressing  symptoms. 

*  Pereira's  Materia  Medica  and  Therapeutics,    Vide  Art.  Diosma  Crenata. 


ARTICLE  IV. 


A  Case  of  Hydrocele  iwenly-iTiree  and  a  half  inches  in  circumference 
and  containing  thirty-seven  ounces  of  serum  cured  hy  Iodine 
Injection.  By  Paul  F.  Eve,  ]\I.  D.,  Professor  of  Surgery  in 
the  Medical  College  of  Georgia. 

In  November  last,  as  will  be  perceived  by  the  following  extract  of  a 
letter  from  my  friend  Dr.  Wm.  J.  Johnson,  an  intelligent  practitioner 
of  Fort  Gaines,  I  was  consulted  in  reference  to  a  case  of  hydro-scarco- 
cele.  "I  write  you  this  at  the  request  of  a  friend  of  mine,  Barnett 
Cody,  of  this  (Early)  county.     He  is  a  worthy  citizen  and  most  estima- 


SG3  A  Case  of  Hydrocele,  [July, 


bic  man,  somewhat  past  fifty  years  old,  and  the  father  of  several  chil- 
dren. Some  four  or  five  years  since  a  small  tumour  was  detected  at 
the  bottom  of  the  scrotum,  which  has  continued  gradually  to  enlarge 
to  the  present  time.  The  old  gentleman  being  very  modest  felt  a  great 
disinclination  to  consult  a  physician,  and  would  doubtless  have  con- 
cealed his  condition  until  now,  or  even  longer,  if  he  could,  had  not  the 
tumour  increased  so  much  in  bulk  as  to  have  attracted  the  notice  of 
his  friends  and  annoyed  him  greatly  by  its  w^eight.  Yesterday  he  visited 
this  place  for  the  purpose  of  consulting  me,  and  I  made  a  thorough  and 
critical  examination  of  the  tumour.  It  is  now  quite  large,  and  would 
weigh,  I  have  no  doubt,  could  it  be  extirpated  without  loss  of  blood,  at 
least  five  or  six  pounds.  It  is  attended  as  yet  with  no  pain.  It  feels 
hard  and  unyieldmg.  There  is  no  discoloration  of  the  integuments, 
no  ulceration,  no  abrasion  of  surface.  The  veins  at  the  bottom  of  the 
scrotum  are  quite  enlarged,  and  appear  turgid  and  full.  The  SAvelling 
v  ithin  the  last  year  has  progressed  upwards,  towards  the  abdominal 
ring,  and  the  spermatic  cord  with  its  tegumentary  envelope  are  prodi- 
giously enlarged.  I  should  say  the  track  of  the  cord  w^as  as  large  as 
my  arm.  Mr.  C.  informs  me  that  he  was  many  years  ago  a  hernial 
subject.  The  hernia  occupied  the  right  side,  but  he  has  been  radical- 
ly cured  of  that  affection  for  at  least  twenty  years.  The  tumour  which 
he  now  has,  is  confined  to  the  right  spermatic  cord  and  right  testicle  
the  penis  and  left  testicle  being  perfectly  healthy. 

I  cannot  detect  the  presence  of  the  testicle  as  a  distinct  body  in  the 
tumefaction.  The  tumour  does  not  feel  uneven  or  rough  or  knotty  or 
doughy ;  but  is  quite  even  and  possesses  considerable  elasticity.  May 
it  not  be  an  hydro-scarcocele  ?  I  suppose  it  will  require  a  surgical 
operation,  and  have  advised  my  friend  to  visit  you  as  soon  as  possible." 

In  December  last,  Mr.  Cody  arrived  in  Augusta,  and  on  the  30th  of 
the  same  month,  he  was  prepared  for  the  operation.  I  found  the  case 
so  accurately  described  by  Dr.  Johnson,  that  I  have  not  a  word  to  add 
to  it.  The  tumour  measured  twenty-three  and  a  half  inches  in  its 
longest  circumference,  and  having  punctured  it  with  the  trocar,  I  drew  off 
by  the  canula  thirty-seven  ounces  of  straw  colored  serum.  The  testi- 
cle on  this  (right)  side,  was  now  found  to  be  twice  the  size  of  the 
other.  My  patient  experiencing  some  pain  and  being  threatened  with 
syncope,  was  placed  in  the  recumbent  position,  and  drank  some  water. 
In  from  five  to  ten  minutes  I  injected  tr.  iodine  six  drachms  to  eight 
ounces  of  water.  The  pain  was  felt  to  be  increasing  in  a  minute  or  two, 
and  the  injection  wa?  allowed  to  escape.     IMr.  C.  suficred  considera- 


1845.]  A  Case  of  Hydrocele,  .         369 


bly  for  two  hours,  to  moderate  which,  morphine  was  given  and  a  warm 
poultice  applied  over  the  scrotum. 

Dec.  31st.  Had  not  slept  the  patient  attributes  it  to  the  morphine. 
Very  little  pain  was  experienced.     Diet,  absolute. 

Jan.  1st,  1845.  Patient  is  doing  well.  A  little  more  tumefaction, 
though  no  increase  of  pain  in  scrotum. 

2nd.     Ordered  a  dose  of  oil.     Diet,  gruel,  tea  and  bread. 

3rd.     Patient  doing  well. 

4th.  Tumefaction  of  scrotum  considerable ;  feels  doughy.  Punc- 
tured the  cicatrix  of  the  trocar  with  lancet,  and  it  bled  freely,  nearly  two 
ounces  of  venous  blood.     Swelling  greatly  abated. 

5th.  He  feels  well,  and  now  thinks  the  operation  will  succeed. 
Diet  increased.  The  patient  up,  dressed,  and  moving  about  the  room 
for  the  past  day  or  two. 

6th.  Started  home  (a  distance  of  300  miles,)  by  easy  stages,  in  his 
carriage. 

The  following  letter,  addressed  to  me  by  Dr.  Johnson,  two  months 
and  a  half  after  the  operation,  will  give  the  result : 

"Fort  Gaixes,  14th  March,  1845. 

"Dear  Doctor,  I  have  purposely  postponed  writing  to  you  in  refer- 
ence to  the  case  of  my  friend,  Bamet  Cody,  Esq.,  on  whom  you  oper- 
ated for  Hydrocele,  in  order  to  ascertain  whether  the  operation  has 
been  successful  in  effecting  a  permanent  cure.  I  saw  Mr.  C.  on  last 
Tuesday,  and  made  inquiiies  concerning  the  result  of  the  operation. 
He  informed  me  that  his  affection  first  made  its  appearance  about  five 
years  ago.  The  tumour  for  the  first  two  or  three  years  enlarged 
gradually,  but  for  the  past  two  it  increased  rapidly,  reaching  nearly  to 
the  knees,  and  being  so  bulky  and  unwieldy  as  to  incommode  him  in 
walking  or  sitting;  and  the  deformity  occasioned  by  its  presence 
caused  him  to  shun  society  and  confine  himself  to  his  house.  The 
swelling  upwards  towards  the  abdominal  ring,  along  the  course  of  the 
spermatic  cord,  commenced  only  a  few  months  before  he  consulted  me, 
and  was  very  rapid.  You  know  the  shape,  form,  dimensions,  &c.,  of 
the  tumour,  when  he  presented  himself  to  you  in  December  last,  the 
amount  of  serous  fluid  evacuated,  the  treatment  pursued,  d:c.,  up  to  the 
time  of  his  leading  Augusta.  Upon  his  return  home,  'Mr.  C.  was  under 
the  fearful  apprehension  that  the  operation  had  been  unsuccessful,  but 
he  is  now  thoroughly  convinced  that  it  has  succeeded  in  effecting  a 
radical  cure.  You  wrote  me  that  one  of  the  testicles  was  enlarged  to 
about  t^^icc  the  uHial -izc  .  that  enlargement  ccntinue:,  and  I  -uppc.-e 

24" 


370  Diseases  of  the  Heart.  [July? 


will  be  permanent.  The  cavity  of  the  sac  is  entjjrely  obliterated,  and 
the  scrotum  is  but  little  larger,  if  any,  than  in  its  normal  state. 

"  I  informed  Mr.  Cody  that  yoru  had  written  me  requesting  to  know 
the  result  of  the  operation,  that  you  might  make  a  report  of  the  case  for 
the  Southern  Medical  and  Surgical  Journal.  He  expressed  a  de- 
sire to  have  it  made  out  and  published,  even  giving  hi^  name,  resi- 
dence, &c."     *     *     * 

I  heard  of  Mr.  C.  a  few  days  ago,  and  learned  that  he  was  well  and 
attending  to  his  ordinarj^  business. 


PART  II. REVIEWS  AND  EXTRACTS. 

Some  of  the  Diseases  of  the  Heart.  By  C.  J.  B.  Williams,  M.  D., 
F.  R.  S.,  Professor  of  Medicine  in  the  University  College,  <^c. 
London,     (Concluded.) 

Now,  we  come  to  a  subject  of  much  more  frequent  occurrence,  and 
more  important  in  a  practical  point  of  view :  Disease  of  the  valves 
and  orijices  of  the  heart.  We  have  hitherto  considered  diseases  of 
the  muscular  fibres  and  of  the  membranes  covering  them,  and  we  have 
now  to  attend  to  the  lesions  of  the  mechanism  by  which  the  circulating 
current  is  directed  and  conductedfrom  the  heart.  We  now  come  more 
especially  to  the  diseases  of  what  may  be  termed  the  hydraulic  appara- 
tus of  the  heart,  in  contra-distinction  to  that  of  the  muscular  structure, 
or  the  dynamic  apparatus  of  the  heart. 

Now,  it  is  desirable  to  divide  the  diseases  of  the  orifices  and  valves 
into  two  great  classes.  First,  there  are  the  obstructive  lesions  where 
there  is  more  or  less  obstruction  to  the  current  of  the  blood  in  its  pro- 
per channel ;  and  secondly,  those  that  occasion  the  blood  to  take  a 
reverse  direction,  or  a  backward  course,  and  these  may  be  called  re- 
gurgitant diseases.  Now,  the  lesions  that  produce  these  different 
affections  are  very  numerous,  and  I  will  describe  the  chief  of  them 
under  different  classes. 

First  of  all,  those  which  are  allied  to  the  affections  we  have  already 
considered,  as  connected  with  endo -carditis.  Istly.  Under  this  head 
may  be  mentioned  a  thickening  of  the  endo-cardium,  causing  a  similar 
condition  in  the  valves.  Sometimes  this  resembles  a  deposit  of  l}Tnph, 
as  in  cases  of  recent  endo-carditis  a  sort  of  fibrous  matter  on  the  sur- 
face. This  may  occur  in  various  parts.  *  It  is  found  at  the  semi-lunar 
valve,  giving  rise  to  a  tlilrkciiirig"  of  ihp  niargin  of  the  valve?,  and  often 


1S45.J  Diseases  of  the  Heart.  371 


taking  a  peculiar  shape  from  the  contact  of  one  valve  with  another. 
It  very  commonly  happens  that  there  is  a  thickening  of  the  membrane, 
deposited  in  the  shape  of  a  festoon,  or  what  is  called  a  scutiform  thick- 
ening of  the  valve.  The  pressure  of  the  valves  against  one  another, 
modities  the  appearance  of  the  deposition ;  generally,  the  valves  are 
thickened  to  a  considerable  extent,  there  being  little  vegetations  round 
their  margins :  the  orifice  of  the  valve  is  also  sometimes  a  little  fringed. 
In  one  case  that  I  witnessed,  there  were  as  many  as  eighteen  of  these 
fibrinous  tumours,  connected  with  the  cords  of  the  tricuspid  valve. 
Another  effect  of  this  deposition  is  adhesion  of  one  valve  to  another : 
this  is  a  very  common  lesion.  It  is  very  common  to  find  two  of  the 
aortic  valves  adherent  to  each  other;  so  that  instead  of  having  three 
A'alves,  you  have  but  one  valve  entire,  and  the  other  two  adherent,  the 
intermediate  portion  forming  a  sort  of  projection  between  them.  The 
effect  of  this  is  to  cause  an  obstruction  to  the  passage  of  the  blood. 
The  same  thing  may  occur  in  the  mitral,  and  more  rarely  in  the  tendons 
of  the  tricuspid  valve. 

2dly.  There  is  another  class  of  lesions  included  in  some  of  the  depo- 
sitions I  have  already  mentioned.  Besides  a  deposition  of  fibrine  on 
the  endo-cardium,  there  is  a  thickening  of  the  fibres  and  texture  of  the 
valve  beneath  this  membrane,  and  the  formation  of  a  tense  yellowish- 
white  structure,  so  that  the  muscular  portion  becomes  so  altered  as  to  a 
great  degree  to  present  that  peculiar  appearance  which  constitutes  hy- 
pertrophy of  the  texture.  This  appears  to  be  a  deep-seated  lesion, 
connected  with  a  change  in  the  muscular  structure,  besides  an  affection 


of  the  endo-cardium.  Well,  then,  this  probably  arises  fi'om  the  forma- 
tion of  a  sub-serous  coat  or  texture,  most  commonly  in  the  laminmof 
the  valves,  and  the  tendinous  cords ;  and  in  connection  with  this  hyper- 
trophy, there  is  very  commonly  a  sort  of  elongation  in  the  fibres  ;  and 
I  have  often  found  that  where  these  deposits  have  taken  place,  there  is 
an  imj)aired  elasticity,  and  a  disposition  to  contract  at  one  time,  and  to 
elongate  at  another,  and,  on  that  elongation,  to  break  ;  thus  producing 
great  irregularity  in  the  apparatus  of  the  valves,  and  interfering  with 
their  proper  functions.  Sometimes  this  may  lead  to  rupture  of  the 
heart.  Frequently,  in  addition  to  this,  there  are  small  osseous  deposits 
in  the  thicker  portions  of  this  fibrinous  matter ;  and  sometimes  the 
tendons  arc  quite  thickened  in  this  way.  There  may  be  various  de- 
grees of  this.  There  may  be  a  mere  thickening  not  interfering  with 
the  action  of  the  valves,  which  is  comparatively  rare.  Then  there  is 
a  thickening  with  shortening  of  the  valves,  causing  a  partial  closure  of 
the  orifice  ;  and  thickening  with  elongation,  causing  irregular  enlarge- 
ment of  the  opening.  For  instance,  suppose  thickening  with  elonga- 
tion to  take  place,  it  has  the  effect  of  rendering  the  affected  side  of  the 
valve  quite  loose,  so  that  it  never  becomes  tightened,  and  it  cannot  act 
perfectly  at  each  systole  ;  the  blood  gets  behind  it.  and  is  forced  by  re- 
gurgitation backwards  into  the  different  cavities.  This  will,  ovrntual- 
Iv,  produce  lesions  ofthe  heart  itself 

MHly.    Another  ihinjr  to  be  c(msidpr"d  is  that  aficrtion  of  the  orifice?^. 


372  Diseases  of  the  Heart,  [July, 


in  which  there  is  an  osseous  or  cartilaginous  rigidity,  especially  at  the 
aortic  orifice,  causing  thus  an  obstruction  to  the  circulation.  Deposi- 
tion is  extremely  common  at  the  root  of  the  aortic  valves,  causing  ob-' 
structive  disease,  without  any  actual  projection  of  these  processes. 
The  most  remarkable  form  of  deposition  of  osseous  matter  is  a  cohesion 
of  the  valves,  causing  almost  a  complete  closure  of  the  orifice,  or  so 
reducing  it  as  to  make  it  only  capable  of  admitting  a  tube  of  the  size  of 
a  crow-quill.  The  same  thing  occurs  with  regard  to  the  left  auriculo- 
ventricular  opening.  This  adhesion  of  the  laminae  of  the  valves  redu- 
ces the  orifice  to  one-fourth  or  one-fifth  of  its  natural  size,  causing 
obstructive  disease.  This  state  is  always  combined  with  regurgitant 
disease.  You  seldom  see  this  without  some  regurgitation  into  the 
ventricle,  or  auricle,  through  this  narrow  orifice. 

4thly.  There  is  another  kmd  of  thickening,  attended  with  a  sort  of 
disposition  to  ulceration,  or  at  least,  to  rupture.  This  usually  affects 
the  aortic  valves,  and  is  one  of  the  most  serious  diseases  to  which  the 
heart  is  liable  ;  in  which  the  valve  is  broken  down,  leaving  only  a  rim 
or  a  sort  of  cord  across  the  orifice  of  the  artery ;  the  other  valves  are 
here  very  much  diseased  likewise:  it  is  generally  the  result  of  a  de- 
gree of  acute  inflammation,  involving  not  only  the  membranes,  but  also 
the  deeper-seated  structure.  Persons  addicted  to  habits  of  intoxication 
are  subject  to  this  form  of  disease. 

5thly.  There  is  atrophy  of  the  substance  of  the  valves ;  this  may 
take  place  simultaneously  with  thickening  of  their  lower  portions ;  and 
if  it  is  extensive,  it  must  produce  serious  results,  leading  to  considera- 
ble regurgitation.  Shortening  and  atrophy  of  the  valves  is  not  a  very 
common  disease.  It  may,  however,  vary  very  considerably  in  extent, 
the  laminae,  in  some  cases,  being  much  longer  than  in  others.  With 
vahailar  imperfection,  there  is  generally  hypertrophy,  or  dilatation  of 
the  heart,  or  both.  I  have  already  mentioned  that  this  combination 
has  been  usually  considered  a  great  aggravation  of  the  mischief;  but 
I  am  quite  sure,  in  many  cases,  it  is  so  far  from  being  an  aggravation, 
that  it  is  rather  a  compensation  ;  and  the  effect  of  this,  at  least  of  hy- 
pertrophy, and,  perhaps,  partly  of  dilatation,  is  a  sort  of  counteraction 
to  the  imperfections  of  the  valves.  When  there  is  obstructive  disease, 
the  blood  is  not  forced  with  freedom  through  the  orifice,  and  increased 
force  is  required  to  propel  it  with  sufficient  power.  On  the  other  hand, 
when  regin'gitation  takes  place,  the  same  thing  may  be  said.  When 
there  is  obstruction  to  the  passage  of  the  blood  from  the  auricle  to  the 
ventricle,  dilatation  is  the  morbid  consequence.  If  there  were  no  re- 
ceptacle for  the  blood  to  regurgitate  into,  it  would  press  on  the  affected 
parts,  and  rupture  would  be  the  consequence.  The  same  sort  of  thing 
is  found  to  take  place,  naturally,  in  diving  animals.  There  is  no 
doubt  that  hypertrophy  is  a  great  cause  of  evil  in  many  instances,  and 
it  does  not  compensate  for  the  mischief  occasioned  by  the  increased 
violence  of  the  circulation.  Dilatation,  too,  may  be  said  to  have  a  bad 
result  in  many  instances,  because  it  is  accompanied  by  weakness  of 
action.     All  the  lesions  I  have  been  considering  affect  the  left  side  of 


1845.  J  Diseases  of  the  Mean.  373 


the  heart  infinitely  more  than  the  right  side,  at  least,  generally  speak- 
ing, and  the  reason  for  this  has  been  variously  ascribed.  It  has  been 
attributed  to  the  stimulating  quality  of  the  arterial  blood.  But  there 
are  several  causes ;  first  of  all,  there  is  the  more  active  function  of 
the  left  side  of  the  heart ;  this  increased  activity,  therefore,  predisposes 
to  disease.  2nd]y,  there  is  the  different  stnicture  of  the  left  side  of  the 
heart ;  the  left  side  is  altogether  stronger  and  thicker  than  the  right ; 
but  this  very  strength  and  thickness  oiler  a  greater  facility  to  the  in- 
crease of  disorder,  when  it  is  once  induced  in  the  walls,  ^rdly.  ^  e 
must  consider  the  more  extensive  relations  of  the  left  ventricle,  lou 
cannot  disturb  any  part  of  the  body,  without  the  left  ventricle  bearing  a 
portion  of  the  disorder.  Violent  exertion,  sudden  chill,  or  any  check 
to  the  circulation,  all  bear  more  on  the  left  ventricle  than  on  the  right ; 
and  the  resuk  of  this  frequent  exertion  or  interruption  imposed  on  the 
left  ventricle,  renders  it  more  liable  to  disease  than  the  other. 

The  Physical  Signs  of  Valvular  Diseases.  These  are  highly 
characteristic.  I  have  stated,  that  what  are  called  muiTuurs,  or  abnor- 
mal sounds  produced  in  the  region  of  the  heart,  are  most  generally 
caused  by  some  modification  of  the  current  passing  through  the  orifices 
of  the  heart;  and  it  is  by  these  sounds  mainly  that  we  distinguish  the 
character  of  the  lesion  and  its  seat.  But  we  must  observe  that  it  is  not 
every  modification  of  the  orifices  of  the  heart,  that  will  produce  a 
murmur;  it  is  only  those  that  fulfil  or  complete  the  elements  of  sound, 
and  give  a  vibrating  lesistance  to  the  current  as  it  passes.  Hence  you 
will  understand,  that  where  the  obstacle  in  the  orifice  is  very  small,  it 
does  not  inteifere  materially  with  the  current  of  the  blood,  and  it  may 
give  no  \'ibratory  resistance.  With  some  pulsations,  there  is  no  mur- 
mur, but  during  strong  pulsations  there  will  be  a  munnur  produced. 
Sometmies  the  aortic  valves  may  be  closely  pressed  together,  so  that 
the  blood  is  forced  out  through  a  small  orifice ;  in  this  case,  the  vibra- 
ting resistance  may  not  be  enough  to  produce  a  murmur.  Again,  the 
thin  state  of  the  blood  in  anaemia  may  produce  a  murmur,  though  rich 
blood  may  not.  It  may  happen,  if  the  vahiilar  disease  is  considerable, 
that  the  murmur  is  not  heard  in  the  weak  pulsations,  but  it  will  be 
heard  when  the  heart  beats  more  strongly.  In  the  tricuspid  orifice, 
there  is  frequent  regurgitation,  so  as  to  produce  pulsation,  not  only  in 
the  auricles,  but  in  the  great  veins,  as  the  jugular.  This  is  not  accom- 
panied, in  most  instances,  by  any  murmur ;  and  the  reason  of  this  is, 
because  the  laminae  of  the  tricupsid  valve  are  placed  fiat  against  the 
direction  of  the  current,  and  being  rather  light  and  yielding,  they  do 
not  aftbrd  enough  resistance  for  perfect  vibration. 

The  murmur  is  then,  generally  speaking,  a  certain  rule  and  indica- 
tion of  some  vahiilar  disease.  But  the  amount  and  degree  of  murmur 
is  far  from  being  proportioned  to  the  amount  of  the  lesion.  You  may 
have  a  very  loud  murmur  indeed  produced  by  a  very  slight  lesion  ;  this 
is  more  particularly  the  case  with  those  lesions  that  are  called  regurgi- 
tant. The  loudest  murmurs  are  what  are  called  musical  murmurs, 
where  the  vibrations  produced  by  the  current,  are  not  only  noisy  but  so 


374  Diseases  of  the  Heart.  [July, 


regular  in  utterance  as  to  constitute  a  prolonged  musical  tone,  the 
vibrations  being  equi-distant.  The  quality  of  the  murmur  is  the  best 
guide  to  the  amount  of  the  lesion,  though  even  this  is  not  a  sure  one. 
Those  which  are  uniform,  whether  of  the  blowing  or  the  whistling 
character,  generally  announce  slighter  lesions  than  the  murmurs  that 
are  gratmg,  or  more  deep-toned.  This  is  a  general  iTile.  The  musi- 
cal sounds,  when  of  a  simple  blowing  or  uniform  character,  are  mostly 
caused  by  regurgitation  through  the  smaller  channels ;  on  the  other 
hand,  the  deep-toned  murmurs  mark  the  larger  currents,  and  a  harder 
kind  of  obstruction.  Laennec,  Drs.  Hope,  Wilson,  and  others,  have 
thought  the  rough  murmurs  indicative  of  a  rigid  state  of  the  orifices. 
Now  the  contrary  is  the  case,  for  where  this  state  exists,  there  is  a 
great  amount  of  looseness  in  the  sound ;  and  one  of  the  harshest  mur- 
murs lever  heard,  was  in  a  case  where  there  was  no  ossification  at  all. 
The  breaking  down  of  one  of  the  valves  caused  a  vibrating  obstacle  in 
the  direction  of  the  current.  The  intensity  of  the  sound  is  not  at  ail 
in  proportion  to  the  loudness,  but  it  depends  rather  on  the  capacity  of  the 
obstacle  for  vibrating.  There  are,  as  I  have  mentioned,  some  obsta- 
cles which  do  not  vibrate  at  all. 

Natural  sounds  superseded  by  the  murmur.  There  is  another 
character  about  the  murmur,  and  that  is  the  degree  in  which  it  supplants 
or  supersedes  the  natural  sounds,  whether  the  first  or  the  second. 
Whenever  you  have  a  murmur  so  intense  and  loud  that  you  hear  no- 
thing at  all  of  the  first  sound,  you  may  be  pretty  sure  that  the  lesion 
which  produces  it  is  very  considerable,  not  merely  as  to  the  anatomical 
condition,  but  as  to  its  effect  on  the  constitution.  On  the  other  hand, 
when  you  have  a  murmur  added  to  the  natural  sounds,  there  is  a  certain 
degree  of  proof  that  the  natural  actions  are  going  on  well ;  accordingly, 
when  there  is  extreme  disease  of  the  mitral  orifice,  you  find,  towards 
the  apex,  that  you  can  scarcely  hear  the  first  sound  at  all,  but  merely  a 
prolonged  blowing,  not  only  obscuring  by  its  loudness  the  first  sound, 
but  actually  overpowering  it.  But  if  you  apply  the  stethoscope  over 
the  right  ventricle,  you  hear  the  sound.  It  modifies  the  suddenness 
and  the  character  of  the  tension  on  which  the  first  sound  depends,  and 
converts  it  into  one  which  takes  its  character  from  the  murmur  itself. 
And  it  would  appear  in  these  cases,  as  if  the  vibrations  naturally  pro- 
duced in  the  walls  of  the  heart  were  converted  into  vibrations  of  the 
murmur  a  conversion  of  the  one  into  the  other.  We  find  these 
sounds  arrested  under  various  circumstances.  If  we  throw  a  string 
into  vibration,  and  while  it  is  vibrating  bring  it  near  to  another  string 
also  in  vibration,  and  hitherto  incapable  of  vibrating  an  octave,  the 
octave  sound  will  be  very  loud  indeed ;  and  you  find  that  the  second 
string,  instead  of  responding  a  lower  note,  responds  an  octave  ;  one 
vibration  therefore  supersedes  other  vibrations  previously  existing;  and 
it  appears  that  the  murmur,  to  a  great  extent,  not  only  mufi^es,  but  en- 
tirely destroys  the  natural  sound  of  tlie  heart,  and  converts  the  simple 
obtuse  sound  that  naturally  arises,  into  a  prolonged  blowing.  .Again, 
with  regard  to  the  second  sound,  the  same  thing  is  ))articu!arly  observ- 


1845.]  Diseases  of  the  Heart.  375 


t'd.  There  is  sufficient  reason  for  this,  for  where  the  disease  is  con- 
siderable, you  have  not  only  the  second  sounds  superseded,  but  the 
tension  of  the  valves,  oa  which  the  second  sound  depends,  may  be 
-entii'ely  destroyed.  In  the  musical  murmur  I  mentioned  just  now,  the 
natural  sound  was  not  entirely  superseded,  showing  that  the  amount  of 
disease  was  limited.  The  patient  did  not  die  of  disease  of  the  heart, 
though  there  was  a  certain  amount  of  li)-pertrophy  of  its  walls  ;  but  he 
died  of  a  fever. 

The  two  chief  classes  of  vahoilar  disease  are  the  obstructive  and 
the  regurgitant.  The  signs  of  the  obstructive  aortic  being  connected 
with  the  first  sound,  and  the  regurgitant  aortic  with  the  second  sound  : 
but  regurgitant  mitral  is,  in  some  measure,  connected  with  the  first 
sound.  The  distinction  between  the  obstructive  aortic  and  the  regur- 
gitant aortic  is  obvious.  The  mode  in  which  it  is  distinguished,  is  by 
the  manner  in  which  the  sound  is  propagated  to  the  walls  of  the  chest ; 
the  regurgitant  mitral  being  transmitted  most  distinctly,  and  chiefly  at 
the  part  corresponding  with  the  apex  and  surface  of  the  left  ventricle; 
it  is  not  heard  so  much  in  the  upper  part  of  the  chest;  whereas  the 
sound  of  the  obstmctive  aortic  is  above  that,  and  is  chiefly  heard  from 
the  middle  to  the  top  of  the  sternum.  Speaking  of  the  symptoms 
produced  by  disease  of  the  aortic  valves  connected  with  arterial  excite- 
ment, there  is  almost  always  hypertrophy  of  the  heart,  and  the  arteries 
become  the  seat  of  an  unusual  impulse,  a  jerking  kind  of  motion ;  and 
the  symptoms,  if  the  hypertrophy  is  considerable,  are  rather  those  of  ar- 
terial excitement  than  of  venous  obstruction.  On  the  contrary,  mitral 
regurgitation  and  mitral  obstruction  produce  especially  the  signs  of  ac- 
nous  obstruction  in  various  parts  of  the  system;  in  the  vessels  above 
the  left  auricle,  and  in  the  lungs,  producing  pulmonary  congestion,  pul- 
monary apoplexy,  bronchial  flux,  sometimes  hydrothorax,  and  bronchial 
congestion,  with  a  liability  to  inflammation  and  congestion  of  all  the 
other  viscera,  to  a  great  degree.  Thus  the  whole  venous  system  is 
affected ;  the  right  side  of  the  heart  is  dilated,  and  regurgitation 
takes  place,  and  the  veins  of  the  neck  and  brain  become  congested. 
The  regurgitation  produces,  sometimes,  lethargy  and  stupor;  and  the 
other  organs,  more  particularly  the  liver,  are  affected. 

We  find  that  a  long  continuance  of  this  disease  causes  structural 
changes  to  take  place  in  the  different  viscera ;  the  lungs  are  more  hy- 
pertrophied  than  usual ;  the  liver,  more  especially,  is  enlarged,  net 
merely  under  the  influence  of  congestion,  but  a  species  of  hypertrophy ; 
and  sometimes  there  is  a  transition  to  a  state  of  subsequent  contraction 
and  degeneration.  The  same  thing  takes  place  m  the  kidneys  ;  and 
thus  diseases  of  other  organs  are  superadded  to  the  disease  of  the 
heart,  and  this  superaddition  of  other  diseases  is  really  a  common 
cause  of  the  fatal  termination  of  regurgitant  disease.  The  difierer.t 
valvular  lesions  I  have  mentioned  may  be  combined  together  ;  in  some 
subjects  you  will  have  murmurs  in  both  situations,  referable  to  the  mitral 
valves  and  the  aortic  orilice.  The  mode  of  distinction  here,  is  by  the 
loudness  and  the  distinctness  of  character  of  the  murmur  in  both  situ- 


376  Diseases  of  the  Heart,  [July, 


ations.  Under  these  circumstances,  you  may  have  the  aortic  murmur 
heard  in  the  middle  of  the  sternum,  and  transmitted,  as  usual,  to  the 
arteries  ;  but  yet  you  hear  also  a  loud  distinct  murmur  at  the  apex,  as 
loud  as'at  the  mid-sternum. 

I  have  already  mentioned  that  there  are  some  cases  of  aortic  mur- 
mur transmitted  to  the  apex  of  the  heart ;  but  the  character  is  usually 
different  in  this  and  in  mitral  disease.  The  sound  of  the  latter  is 
shorter  than  in  the  murmur  which  is  produced  at  the  aortic  orifice. 
The  aortic  murmurs  are  never  so  superficial.  The  blowing  or  whistling 
sounds  are  likewise  difierent  in  character  in  these  two  cases ;  there  is 
a  deep,  grating,  hoarse  murmur  in  the  aorta,  whereas  the  murmur  at 
the  apex  is  loud,  whiffing  or  blowing.  This  distinction  is  very  useful 
in  our  prognosis,  more  particularly  if  these  murmurs  supersede  the  nat- 
ural sounds.  Then,  you  know,  in  conjunction  with  these,  the  other 
signs  of  the  disease  may  be  different ;  and  the  great  reason  why  these 
signs  of  heart-affections  are  sometimes  so  complicated,  that  we  cannot 
determine  the  position  of  the  murmur  at  any  one  particular  spot,  is,  as 
I  before  stated,  because  the  enlargement  of  the  difierent  parts  of  the 
heart  causes  great  displacements  and  alterations  of  position  ;  and  the 
only  constant  relation  which  is  preserved,  is  with  regard  to  the  direc- 
tion of  the  current  into  the  arteries,  or  its  direction  backwards  through 
the  auricles. 

The  general  treatment  of  a  diseased  heart,  in  the  first  place,  is  to  be 
directed  according  as  excessive  or  defective  action  predominates.  
There  are  cases  in  which  excessive  action,  connected  with  h}'pertrophy, 
is  predominant,  and  the  action  of  the  heart  and  neighboring  arteries 
very  strong.  Moderate  sedative  and  depletory  measures  should  be 
here  adopted.  The  same  thing  is  to  be  said  in  case  of  inflammation  : 
the  treatment  must  be  more  or  less  antiphlogistic,  although  w^e  have 
not  the  same  means  of  knocking  down  the  inflammation  altogether,  as 
>ve  cannot  w  ith  impunity  reduce  the  system  to  too  great  an  extreme  in 
these  cases.  Another  class  is  that  in  which  the  action  is  altogether 
defective,  as  shown  by  faintness,  weakness  in  the  circulation,  and  irreg- 
ularity of  the  heart's  action.  This  is  generally  benefited  by  stimula- 
ting means ;  but  remember,  there  are  some  instances  of  defective 
action,  where  the  heart  has  already  got  such  a  load  that  it  cannot  propel 
it,  and  we  shall  here  give  more  relief  by  taking  away  some  of  the  blood. 
This  is  the  congestive  form  ot  the  aflection;  and  in  congestive  affec- 
tions, as  well  as  in  increased  excitement,  it  may  be  useful  to  use  deple- 
tion to  a  moderate  extent,  and  as  a  temporary  measure ;  on  the  other 
hand,  where  there  is  a  deficiency  of  blood  in  the  system,  and  a  tendency 
to  ansemia  is  obvious,  from  the  pallidity  of  the  countenance,  and  the 
extreme  tendency  to  dropsical  effusions,  this  generally  speaking,  will 
be  benefited  by  a  treatment  of  a  more  or  less  stimulant  character. 

We  must  consider,  likewise,  the  different  kinds  of  lesions  as  modi- 
fying, in  some  degree  the  treatment.  As  a  general  rule,  it  may  be  sta- 
ted (from  which  however,  there  are  some  exceptions),  that  diseases  of 
the  aortic  orifice,  connected  with  a  considcrabie  amount  of"  hypertrophy, 


1845]  Diseases  of  the  Heart. 


commonly  require  a  great  amount  of  depletion,  and  an  antiphlogistic 
treatment.  I  question  if  the  same  treatment  should  be  observed,  with 
regard  to  medicine  and  regimen,  in  lesions  of  the  mitral  valves  also. 
This  is  the  general  rule  ;  but,  still,  all  is  to  be  done  in  a  gentle  way, 
not  carrying  the  depletory  measures  to  an  extreme.  The  diseases  con- 
nected with  the  mitral  orifice  are  more  commonly  attended  by  weakness 
of  the  system  and  the  circulation,  by  which  the  pulmonary  organs  may 
be  greatly  congested :  and  mild  tonics  should  be  administered  at  the 
same  time,  or  subsequently  to  other  measures.  When  the  structural 
disease  is  considerable,  these  medicines  should  be  reserved  for  the  pe- 
riods of  intermission.  We  may  divide  the  exacerbations  into  t\\o 
classes  :  1*^  They  may  take  place  from  mere  nervous  excitement,  men- 
tal  or  otherwise ;  attacks  of  violent  nervous  palpitation,  referable  to 
mental  anxiety,  or  something  disturbing  the  digestive  organs.  Here, 
palliatives,  such  as  hydrocyanic  acid  and  opium,  with  mild  aperients, 
will  often  prove  means  of  relief.  There  are  effects  produced  by  these 
exacerbations  that  require  attention;  when  the  heart  is  healthy,  the 
effects  will  pass  off  without  any  remedies ;  but  when  the  heart  is  dis- 
eased, we  have  not  only  to  remove  the  immediate  consequences  of  this 
excitement,  but  also  the  previous  morbid  efiects  ;  thus,  if  the  lungs  be 
congested,  means  should  be  adopted  to  act  on  the  circulation,  and  keep 
up  the  action  of  the  blood  ;  if  the  liver  is  affected  measures  should  be 
taken  to  act  on  its  secretion,  as  doses  of  mercurial  medicines.  It  is  a 
very  usefiil  practice  in  all  these  cases,  to  give  diuretics,  combined  with 
mercury,  for  a  short  time,  after  any  attack  of  this  kind.  I  do  not  know 
that  any  thing  better  can  be  suggested.  In  combination  with  blue  pill, 
henbane  and  squill,  with  a  little  digitalis,  if  the  action  of  the  heart  is 
not  very  weak,  may  be  given  ;  two  or  three  grains  of  blue  pill,  the  same 
quantity  of  extract  of  henbane,  one  grain  of  quinine,  one  grain  of  squill, 
and  half  a  grain  of  digitalis,  are  the  best  constituents  for  a  pill,  and 
form  one  of  the  most  useful  combinations  that  I  know  of,  not  only  for  re- 
moving congestion,  but  also  the  low  inflammatory  states  that  are  some- 
times  produced. 

2"^  Besides  these  nervous  cases,  there  are  exacerbations  of  a  sub- 
inflammatory  character,  produced  by  exposure  to  cold,  over-exertion 
and  the  occurrence  of  rheumatic  affections.  Under  these  circumstan- 
ces the  chief  remedies  are :  moderate  antiphlogistic  measures  ;  gener- 
ally local  depletion  at  the  region  of  the  heart,  by  cupping  or  by  leeches, 
followed  by  blisters,  and  mercury  and  opium  are  sometimes  usefiil  in 
these  cases,  but  the  pill  mentioned  before  answers  extremely  well. 
Diuretics  should  be  combined  with  these  until  the  congestive  and  sub- 
inflammatory  s}Tnptoms  are  removed.  When  the  patient  is  extremely 
weak,  so  that  we  are  afraid  of  withdrawing  blood,  dry  cupping  is  often 
usefiil.  This  is  not,  however,  so  saving  a  measure  as  is  generally  sup- 
posed. I  have  found  many  physicians  recommend  dry  cupping,  mider 
the  idea  that  it  saves  the  blood,  but  this  is  a  great  mistake.  It  causes 
extensive  effusion  of  blood  in  the  cellular  texture,  and  the  blood  is  de- 
composed, and  is  no  longer  useful ;  it  is  formed  into  a  clot,  and  must  be 


378  Diseases  of  the  Heart.  [July, 


absorbed  again,  in  an  altered  state.  The  exhaustion  from  dry  cupping 
is  much  greater  than  when  the  scarificator  is  used.  Besides  this  reme- 
dy, plunging  the  hands  in  hot  water  rendered  stimulant  by  mustard,  or 
tiie  application  of  a  poultice  is  useful.  If  there  is  any  thing  like  a 
rheumatic  tendency,  the  best  kind  of  remedies  are  colchicum,  and 
iodide  of  potassium,  as  a  means  of  acting  on  the  secretions.  When 
these  temporary  exacerbations  have  subsided,  and  the  circulation  is 
relieved,  great  benefit  will  be  derived  from  tonics  or  mineral  acids. 
The  most  usefiil  is  nitric  acid.  Gentian,  too,  is  used  with  benefit. 
Mineral  acids  are  serviceable  where  there  is  a  disposition  to  dyspepsia. 
In  cachectic  states,  where  there  is  a  deficiency  in  the  quantity  or  qual- 
ity of  the  blood,  stronger  tonics  are  employed,  particularly  iron  in  its 
various  forms. 

Complications  of  Heart  Disease.  In  cases  of  disease  of  the  heart, 
we  have  likewise  to  consider  the  morbid  conditions  that  arise  from  a 
defective  state  of  the  circulation.  Dropsy  is  the  chief  of  these  con- 
ditions, and  it  has  to  be  treated,  generally  speaking,  with  diuretics 
and  purgatives.  Those  diuretics  I  have  mentioned  under  the  head 
dropsy,  are  useful;  acetate  of  potass  is  serviceable  in  inflammatory 
cases,  combined  with  digitalis  or  squills,  and  also  sweet  spirits  of  nitre, 
and  spirits  of  juniper  ;  tmcture  ot  cantharides  is  also  allowable  ;  but 
no  diuretic  has  so  good  an  effect,  in  such  cases,  as  the  pill  I  mentioned 
bcf  jre.  Measures  should  also  be  adopted  to  relieve  the  congested 
state  of  the  kidneys,  where  their  secretion  does  not  go  on.  Cream 
of  tartar,  &c.,  is  useful.  Elaterium  is  an  admirable  remedy  forget- 
ting  rid  of  the  dropsy,  and  improving  the  action  of  the  liver.  It, 
however,  is  apt  to  cause  great  sickness,  and  a  tendency  to  faintness, 
and,  generally  speaking,  cream  of  tartar,  in  large  doses  of  from  half 
an  ounce,  to  an  ounce,  taken  in  the  morning,  produces  free  watery 
stools,  to  a  great  amount.  It  should  be  continued  at  the  same  time 
that  tonics  are  given.  After  this,  it  may  be  useful  to  give  tincture 
of  digitalis,  with  the  tincture  of  cantharides.  When  this  dropsy 
continues,  it  may  be  necessary  to  combine  these  diuretics  with  tonics. 
Dr.  Abcrcrombie  recommends  a  combination  of  squills  with  sulphate 
of  iron  ;  but  1  am  not  so  strongly  impressed  with  its  utility.-  Tartar 
emetic  is  very  useful  in  cases  where  there  is  not  too  great  weakness. 
Chalybeates  and  tonic  medicines  do  much  towards  promoting  the 
action  of  the  excretory  organs,  as  well  as  increasing  the  general 
strenorth  of  the  system.  The  treatment  of  diseases  of  the  heart  is 
a  very  important  subject.  The  chief  object  is  to  preserve  a  proper 
balance  in  the  system;  to  avoid  extremes;  and  to  try  to  adapt  the 
circulating  powers  to  the  existing  defects,  as  well  as  to  avoid  all  cir- 
cumstances which  overtask  the  organs  of  circulation.  Gentle  exer- 
cise, or  friction,  greatly  promotes  circulation,  and  it  is  also  much 
benefited  by  the  improvement  of  the  excretory  and  digestive  organs. 
As  a  general  rule,  in  organic  diseases  ol  the  heart,  the  diet  should  be 
as  nourishing  as  the  digestive  organs  will  bear,  without  producing 
fulness  or  inflammation.     T!ie  starving  plan,  in  organic  diseases  of 


I;? 45. J  DUcascs  of  the  Heart.  379 


the  heart,  is  most  prejudicial.  I  have  seen  many  cases  where  this 
plan  has  been  adopted,  and  which,  with  scarcely  one  exception,  were 
invariably  benefitted  by  a  return  to  a  moderate  nourishing  diet.  The 
diet  must  be  proportionate  to  the  digestive  powers.  There  are  some 
few  cases,  it  is  true,  in  which  the  regimen  must  he  abstemious. 
These  are  when  inflammation  is  present,  and  exacerljations  arising 
from  inflammatory  action  ;  or  else,  where  there  is  a  great  amount  of 
hypertrophy  of  the  heart,  and  continued  increased  action,  <kc.  Un- 
der these  circumstances,  the  diet  must  be  extremely  sparmg  for  a 
time.  But  by  far  the  greater  number  of  cases  of  heart  disease  pro- 
ceed from  nervous  irritability.  One  great  rule,  in  relation  to  the  diet 
of  a  patient  afiected  with  cardiac  disease,  is  to  take  care  that  the 
quantity  of  food  taken  is  not  too  great  in  bulk,  and,  therefore,  vege- 
table food  should  be  avoided  as  much  as  possible.  This  is  one  rjiason 
why  a  moderate  animal  diet,  in  conjunction  with  farinaceous  food,  is 
better  than  slo})s,  or  things  of  that  kind,  which  distend  the  stomach 
without  giving  it  strength.  It  is  neces^^ary,  therefore,  to  avoid  any 
large  bulk  of  liquid.  Many  patients  find  out  by  experience  the  utility 
of  modifying  their  diet,  so  as  to  make  it  of  as  dry  a  condition  as  is 
consistent,  taking  scarcely  more  than  half  a  tumbler  of  liquid  at  their 
dinner.  If  the  system  becomes  encumbered  with  a  great  quantity 
of  liquid,  mischief  results.  Further,  it  is  important  to  avoid  any- 
thing that  will  tax  the  heart,  and  excite  it  to  excessive  and  undue 
action.  In  severe  cases,  this  should  be  particularly  studied,  and  the 
patient  should  not  even  be  allowed  to  go  up  stairs,  or  ascend  to  any 
apartment  not  on  the  same  floor  ;  he  should  always  walk  on  the  same 
level.  Constantly  lying  down,  or  sitting  in  one  position,  should  bo 
avoided  :  and  walking  about,  now  and  then,  so  as  to  enliven  the  sys- 
tem,  is  desirable.  Friction  of  the  extremities,  if  the  patient  is  too 
weak  to  move  about,  should  be  employed,  two  or  three  times  a  day,  so 
as  to  promote  the  circulation.  In  many  cases,  moderate  exercise  is 
highly  usefu',  not  merely  on  account  of  promoting  the  circulation,  but 
also  the  action  of  the  various  functions  of  secretion  and  digestion. 
Exercise  in  the  open  air,  and  on  horseback,  is  highly  desirable  ;  gentle 
riding  answers  very  well.  In  this  way  I  have  seen  cases,  that  had 
gojie  on  apparently  to  their  last  stage,  completely  recover.  Mental 
tranquillity  is  an  important  element  towards  recovery. 

No  absolute  rule  can  be  laid  down  with  regard  to  stimulants. 
They  should  be  used  in  the  smallest  quantities.  Malt  liquors  increase 
the  action  of  the  heart  to  a  great  degree.  Many  persons  are  in  the 
habit  of  taking  malt  liquors,  and  a  certain  quantity  in  these  cases  is 
essential  to  their  common  mode  of  diet;  so  this  must  depend  very 
much  on  the  habits  of  the  individual.  Generally  speaking,  white 
wine,  with  a  little  water,  or  weak  spirits  and  water,  are  useful  to  act 
on  the  kidneys.  Medical   Times. 


380  Punctured   Wound,  t^-c.  [July, 


Case  of  Punctured  Wound,  followed  hy  a  remarlcahle  train  of 
Symptoms.  By  Luther  Ticknor,  M.  D.,  o/  Salisbury,  Presi- 
dent of  the  Connecticut  State  Medical  Society,  {with  remarks  by 
the  Editor  of  the  New- York  Journal  of  Medicine.) 

Mrs.  A.,  about  the  middle  of  November,  1844,  in  washing  some 
small  articles  of  dress,  pierced  the  end  of  the  middle  finger  with  the 
head  of  a  threaded  needle  which  she  supposed  penetrated  the  ball  of 
the  finger  to  the  depth  of  from  one  third  to  one  half  inch.  The  first 
sensation  was  that  of  numbness,  instantly  following  the  infliction, 
extending  up  the  arm  to  the  axilla  and  front  part  of  the  shoulder. 
This  was  followed  immediately  by  numbness  of  the  fingers  of  the 
other  hand,  and  next  with  faintness  and  vertigo,  which  brought  her 
pretty  soon  to  her  bed.  Some  mitigation  of  these  symptoms  was 
procured  by  laudanum,  so  that  I  did  not  see  her  until  severe  pain  and 
febrile  symptoms,  oppressed  respiration  and  gastric  sinking,  excited 
some  alarm  for  her  safety,  about  forty-eight  hours  after  the  injury. 
I  found  her  with  hurried  anxious  breathing,  very  frequent  obscure 
pulse,  a  moist  surface,  with  temperature  but  little  increased,  almost 
constant  chilliness,  and  what  the  patient  call  faintness.  These 
two  latter  symptoms  continued  with  very  little  variation  five  or  six 
weeks.  A  ditiused  swelling  not  easily  defined  occupied  the  upper 
portion  of  the  "  pectoralis  major  muscle,"  extending  upward  to  the 
articulation  of  the  shoulder ;  certain  points  on  this  tumefaction  were 
excessively  painful  and  tender  to  the  touch.  These  tender  points 
changed  their  location  from  time  to  time,  so  as  to  encourage  the  hope 
that  some  improvement  was  going  forward. 

The  local  treatment  consisted  of  dry  cupping,  epispastics,  fomenta- 
tions, anodyne  poultices,  anodyne  linaments,  &c.,  with  very  little 
apparent  benefit ;  and  yet  anodyne  poultices  did  the  best.  Internal- 
ly, opium,  in  some  form,  and  in  large  quantities,  was  indispensable 
throughout  her  treatment.  Profuse  perspiration,  subsultus  and  inci- 
pient delirium,  pretty  early  suggested  the  use  of  tonics,  of  which 
sulph.  quinine  was  preferred  and  freely  used  with  advantage.  About 
six  weeks  after  the  injury  a  slight  fluctuation  was  felt  under  the  edge 
of  the  tendon  of  the  pectoral  muscle,  within  the  axilla.  Forty-eight 
hours  after  it  was  discovered,  a  spontaneous  discharge  of  at  least 
eight  ounces  of  rather  thin  purulent  matter  took  place,  and  continued 
profuse  from  this  orifice,  and  one  made  subsequently  a  little  lower 
down  upon  the  chest,  for  about  two  weeks,  when  constitutional  and 
local  symptoms  gave  place  to  returning  health.  Immediately  after 
the  fluctuation  was  discovered,  Mrs.  A.  made  free  with  London  por- 
ter, it  being  the  only  stimulus  of  the  diffusible  kind  her  stomach  would 
bear,  and  this  it  bore  to  good  purpose.  Mrs.  A.  is  now  entirely  well, 
I  believe,  though  perhaps  the  shoulder  droops  a  little  from  tl^e  awk- 


1845.]  Punctured  Wound,  i^c,  381 


ward  position  in  which  the  arm  was  kept  for  a  long  time,  rather  than 
from  any  imbecility  of  the  muscles.  A  deep  depression  marks  the 
site  of  the  abscess,  showing  a  pretty  extensive  condensation  or  loss  of 
cellular  tissue. 

Now,  sir,  is  or  is  not  this  rather  an  uncommon  history  of  a  ptinc- 
tured  wound  ?  Nothing  like  it  has  occurred  within  my  field  of  vision, 
but  that  is  no  proof  of  anomaly.  Is  there  not  some  analogy  observa- 
ble in  this  case,  with  poisoned  wounds?  Will  you  be  so  good  as  to 
furnish  some  remarks  on  this  case. 

Remarks.  We  thank  our  old  and  honored  preceptor.  Dr.  Ticknor, 
for  the  above  very  interesting  case,  and  hope  he  will  favor  our  read- 
ers with  still  further  contributions  of  a  similar  kind.  Although  we 
cannot  hope  to  elucidate  the  pathology  of  this  particular  case  by  any 
remarks  of  our  own,  still  we  feel  obliged  to  comply  with  his  request 
by  stating  such  suggestions  as  its  perusal  has  given  rise  to  in  our 
own  mind. 

The  case  is  one  of  uncommon  interest,  both  physiologically  and 
pathologically.  We  shall  first  notice  the  physiological  deductions 
which  seem  to  flow  from  this  accidental  wound,  which,  for  our 
present  purpose,  we  will  view  as  one  instituted  for  experimental  pur- 
poses. 

The  nerve  which  was  punctured,  was  undoubtedly  a  branch  of  the 
median,  which  is  formed  by  the  two  lower  cervical  and  the  first  dor- 
sal nerves ;  and  is  the  largest  of  the  brachial  plexus,  which  latter 
supplies  two  or  three  filaments  to  the  phrenic  or  internal  respiratory 
nerve,  and  sends  numerous  branches  to  the  external  muscles  of  res- 
piration, to  the  pectoral  and  deltoid  muscles,  and  indeed  to  the  whole 
external  part  of  the  chest  and  neck;  and  to  the  serraius  magnus,  a 
large  branch  is  sent,  called  by  C.  BeW,  the  external  respiratory  nerve, 
which  is  also  connected  by  a  filament  with  the  phrenic. 

It  appears  that  when  the  wound  was  first  inflicted,  n.  sensation  of 
numbness  was  felt  running  up  the  arm  to  the  axilla  and  shoulder,  and 
immediately  afterwards  the  same  feeling  was  experienced  in  the  fin- 
gers  of  the  other  hand;  as  no  mention  is  made  of  spasms  or  convul- 
sions, it  is  inferred  that  none  were  manifested,  except  suhsulius, 
which  occurred  at  a  later  period  of  the  disease. 

This,  so  far  as  our  reading  and  observation  extend,  is  a  rare  phe- 
nomenon, and  one  well  worthy  of  consideration.  According  to  Mar- 
shall HalVs  doctrine  of  the  reflex  function  of  nerves,  which  supposes 
that  a  nerve  is  compounded  of  sentient  and  excitor  filaments,  and  has 
probably  two  origins,  one  in  the  cerebrum,  the  other  in  the  medulla 
spinalis,  so  powerful  a  stimulus  applied  to  an  incident  or  sentient 
nerve,  ought  to  have  encited  contraction  instead  o^ pain  in  other  re- 
mote parts  of  the  muscular  system.  How  are  the  phenomena  of  this 
case  to  be  reconciled  with  the  doctrine  of  the  reflex  function,  as  ex- 
plained by  Mr.  Hall  ? 

Again,  Midler  observes,  that  "  the  sensationtproduced  by  irritation 


382  Puncturisd   Wound^  (Sfc.  [July, 


of  a  hrancli  of  a  nerve,  is  confined  to  the  parts  to  which  that  branch  is 
distributed,  and  generally,  at  least,  does  not  affect  the  branches  which 
come  off  from  the  nerve  higher  up,  or  from  the  same  plexus.^^  In  this 
case,  however,  we  find  a  similar  sensation  experienced  by  the  corres- 
ponding nerve  distributed  to  the  opposite  side  of  the  body;  and  not 
only  this,  but  painful  sensations  in  the  region  of  the  axillary  plexus, 
and  the  parts  which  it  supplies  with  nervous  influence  ;  and  also  dis- 
tressing sensations  in  the  epigastric  region,  which  would  seem  to 
indicate  irritation  of  the  coeliac  plexus  and  other  portions  of  the  gan- 
glionic system  of  nerves.  And  yet  MuUer  states  that  irritation  is 
felt  "  only  in  the  spot  ichere  the  irritant  is  applied,  and  that  it  never 
reacts  upon  the  brachial  plexus,  and  on  the  other  nerves  which  arise 
from  it.^'  One  clear  case,  like  the  above,  in  contradiction  of  a  state- 
ment like  this,  is  as  valid  in  physiology  as  a  thousand.  Sensation, 
we  know,  is  generally  transmitted  from  the  periphery  to  the  centre, 
from  the  surface  of  the  body  to  the  source  of  all  sensation,  the  brain. 
In  addition  to  this,  we  here  find  sensation  transmitted  from  the  brain 
to  the  extremities,  as  well  as  to  the  vital  organs  of  the  thoracic  and 
abdominal  cavities.  Examples  of  radiated  sensations,  in  the  same 
limb,  or  region  of  the  body,  are  not  uncommon,  as  the  extension  of 
the  pain  of  tooth-ache  over  the  whole  face,  of  pain  in  one  finger  to 
the  hand,  arm,  and  other  fingers.  In  the  London  Medical  Gazette 
for  1834,  a  case  is  related  where,  after  amputation  of  the  thigh,  a 
swelling  formed  in  the  ischiatic  nerve  at  its  extremity,  where  it  was 
also  firmly  united  to  the  cicatrix  and  bone;  after  a  short  time  the 
skin  of  the  entire  stump,  and  sometimes  even  distant  parts,  as  the 
integuments  of  the  abdomen,  became  aflJected  with  severe  pain,  with- 
out  any  inflammatory  symptoms  ;  but  the  trunk  being  amputated  at  a 
higher  point,  the  pains  did  not  return.  Muller  states  that  these  sym- 
pathetic sensations  do  not  occur  in  health,  because  of  the  isolation 
of  the  nervous  fibres  in  their  course  to  the  brain  ;  but  there  is  no  more 
isolation  in  health  than  there  is  in  disease. 

The  following  case,  which  we  find  in  Mr.  Swanks  "  Treatise  on 
Diseases  and  Injuries  of  the  Nerves,''''  has  many  and  close  points  of 
resemblance  with  the  one  reported  by  Dr.  Ticknor.  Mrs.  E.,  aged 
40,  received  a  cut  on  the  inside  of  the  first  phalanx  of  the  left  thumb. 
Immediately  after  the  accident  she  felt  a  numbness  in  the  arm,  and 
a  sense  of  fulness,  as  if  the  skin  would  burst;  these  sensations  con- 
tinued for  a  fortnight,  and  the  wound  healed  very  well.  At  the  end 
of  this  time,  violent  pain  came  on,  when  a  tremulous  motion  could  be 
seen  in  the  part  which  it  occupied.  The  pain  was  termed  startings 
or  spasms,  by  the  patient,  and  was  felt  in  different  ways,  but  the  mus- 
cles were  not  affected.  T/iCse  spasms  were  felt  all  over  the  body, 
though  they  were  by  far  the  most  frequent  in  the  upper  half  of  it. 
She  frequently  felt  a  great  heat  in  the  che^t  and  abdomen,  but  most 
particularly  in  the  latter,  and  the  same  startings  as  in  other  parts  of 
the  body.  The  sensations  were  sometimes  as  if  the  flesh  was  pinched 
u'ith  hot  i?-ons :  sometimes  a  great  heat,   as  if  hot  watcmvas  poured 


n45.]  Puncture^   Wound,  iSfc.  3^3 


down  her  back  ;  sometimes  she  had  frequent  shakings  of  tlie  whole 
body,  which  were  unattended  with  pain,  and  were  most  relieved  by- 
drinking  hot  water.  The  spasms  were  not  confined  to  the  left  arm, 
but  she  had  them  at  the  same  time  in  the  right,  and /rf(^ue//y  in  the 
right  when  she  had  none  in  the  left.  The  fore-finger  was  as  painful 
as  the  thumb,  and  ifany  thing  touched  either  of  them  the  spasms  were 
produced,  which  continued  many  days.  She  had  a  good  appetite, 
her  bowels  were  confined  and  her  tongue  furred.  But  she  had  no 
thirst. 

Sedatives  and  antispasmodics  seemed  to  do  her  most  good,  though 
nothing  was  productive  of  much  benefit.  At  the  end  of  six  months 
the  spasms  were  less  frequent,  but  were  reproduced  if  the  thumb  or 
fore-finger  was  moved  or  touched.  Succeeding  years  brought  each 
some  mitigation  of  her  sufferings,  but  even  after  seven  had  elapsed, 
extreme  susceptibility  of  any  impression  still  remained  in  the  thumb, 
and  the  fore-finger  had  not  recovered  its  natural  condition.  Liftingj 
a  weight,  or  using  the  right  arm  much,  always  produced  sensations 
as  if  needles  were  running  into  it,  and  attempting  to  use  the  fingers 
of  the  left  hand,  as  in  knitting,  produced  giddiness.  She  continued 
to  be  affected  with  spasms  in  every  part  of  her  body  till  her  death, 
which  happened  nine  years  and  six  months  after  the  occurrence  of  the 
accident,  when  she  seemed  to  die  worn  out. 

The  following  are  examples  of  a  similar  kind.  Dr.  Wollaston 
states  (Sir  B.  Brodie  on  Nervous  Affections)  that  he  ate  some  ice- 
cream after  dinner,  which  his  stomach  seemed  to  be  incapable  of 
digesting.  Sometime  afterwards,  when  he  had  left  the  dinner  table 
to  go  to  the  drawing  room,  he  found  himself  lame  yVom  a  violent  jpain 
in  one  ankle.  Suddenly  he  became  sick;  the  ice-cream  was  rejected 
from  the  stomach,  and  this  was  followed  by  an  instantaneous  relief 
of  the  pain  in  the  foot. 

"  A  gentleman  consulted  me,"  says  Sir  Benjamin  Brodie,  "  con- 
cerning a  pain  in  one  instep.  The  pain  was  severe,  causing  lame- 
ness, so  that  he  walked  with  difficulty  ;  but  there  was  neither  swel- 
ling,  nor,  except  the  pain,  any  mark  of  inflammation.  I  prescribed 
some  remedies,  which,  however,  were  of  no  avail.  One  morning  he 
called  on  mfe,  still  suffering  from  the  pain  in  the  foot,  and  so  lame 
that  he  could  not  get  out  of  his  carriage  and  walk  into  the  house 
without  the  assistance  of  his  servant.  Now,  however,  he  complained 
of  another  symptom,  he  had  a  difficulty  of  making  his  water,  and  a 
purulent  discharge  from  the  urethra.  He  had  labored  under  a  strict- 
ure of  the  urethra  for  many  years,  and  had  occasionally  used  bougies. 
Of  late,  the  stricture  had  caused  more  inconvenience  than  usual ;  but 
he  had  abstained  from  mentioning  it,  thinking  it  would  be  better  that 
he  should  (if  possible)  be  relieved  of  pain  in  the  foot  before  any  treat- 
ment was  adopted  on  account  of  the  stricture.  Under  these  circum- 
stances I  introduced  a  bougie,  which  penetrated  the  stricture,  and 
entered  the  bladder.  Immediately  on  the  bougie  having  been  used, 
the  pain  in  the  foot  abated  :  and  in  less  than  a  quarter  of  an  hour  he 


334  Punctured  Wound,  Sfc,  [July, 


left  the  house  free  from  pain,  and  walking  without  the  slightest  diffi- 
culty !  This  happened  some  years  ago,  but  I  have  seen  the  patient 
at  intervals  ever  since;  and  from  a  most  careful  observation  of  his 
case,  he  and  1  are  both  satisfied  that  the  pain  in  the  foot  is  connected 
with  the  disease  in  the  urethra,  and  we  have  never  found  any  thing 
to  relieve  it  except  the  introduction  of  the  bougie." 

The  following  may  also,  perhaps,  be  regarded  as  cases  illustrating 
the  tortuous  or  anomalous  route  sometimes  pursued  by  sensation:  as 
when  pain  is  felt  in  the  testicle,  from  the  passage  of  a  calculus  along 
the  ureter  from  the  kidney  into  the  bladder,  on  the  same  side ;  or  pain 
on  the  outside  of  the  hip,  from  inflammation  of  the  testicle.  The 
former  may  perhaps  be  explained,  by  the  circumstance  that  many  of 
the  nerves  of  the  testicle  derive  their  origin  from  the  renal  'plexus, 
which  also  supplies  the  kidney,  and  which  is  formed  by  branches  of 
the  great  sympathetic  nerve.  Now  the  calculus  operates,  in  the  first 
instance,  on  the  nerves  of  the  kidney,  by  which  its  influence  is  trans- 
mitted to  the  renal  plexus,  and  thence  reflected  to  the  nerves  of  the 
testicle. 

In  the  latter  case,  the  nerves  which  supply  the  scrotum  and  cord 
have  the  same  origin,  viz.  the  lumbar  plexus,  as  the  cutaneous  nerves 
of  the  outside  of  the  hip.  The  irritation  of  the  former  is  thus  com- 
municated to  the  latter  and  referred  to  the  parts  to  which  they  are 
distributed,  attacks  of  gout  in  the  foot  from  the  presence  of  acid  or 
other  irritating  matters  in  the  stomach,  are  also  examples  to  prove 
that  irritation  in  one  part  of  the  body  may  cause  pain  in  another  and 
remote  part. 

Instances  are  common  enough  where  irritation  at  one  extremity  of 
a  nerve  is  felt  at  the  other,  or  at  its  origin  :  as  when  pain  is  experi- 
enced in  the  back,  from  injecting  port  wine,  &;c.,  into  the  tunica 
vaginalis  testis,  head-ache  from  irritating  matters  in  the  stomach 
(which  is  instantly  relieved  by  an  emetic). 

Now,  how  are  we  to  explain  these  facts  from  recognized  physiolo- 
gical laws  ?  Is  an  impression  conveyed  to  the  sensorium  by  one 
nerve,  and  transmitted  by  it  to  another  nerve?  Is  it  possible  to  de- 
.termine,  in  particular  cases,  why  a.  particular  route  is  taken  by  sen- 
sation ?  Is  it,  in  short,  reflex  action  from  the  brain  or  spinal  cord,  at 
all?  Muller  has  asked,  whether  a  current,  in  such  cases,  passes  from 
the  cerebral  or  spinal  extremity  of  the  nerve  in  a  retrograde  course, 
to  its  peripheral  extremity ;  or,  if  there  is  no  current,  but  merely 
oscillation  of  a  nervous  principle?  whether  the  impression  conveyed 
to  the  brain  by  the  nerve  primarily  excited,  gives  rise  to  a  reflex  oscil- 
lation in  another  nerve,  from  its  cerebral  to  its  peripheral  extremity  ? 
It  seems  altogether  improbable  to  us  that  either  currents  or  oscilla- 
tions are  propagated  in  a  retrograde  direction  from  the  brain  ;  nor  is 
it  necessary,  in  explaining  the  phenomena  in  question,  to  suppose  the 
existence  of  any  such  law,  or  mode  of  action;  it  is  more  rational, 
and  certainly  more  philosophical,  to  suppose  that  the  irritation  is 
transmitted  to  the  origin  of  the  nerve,  in  the  bram  or  spinal  cord. 


1S45.J  Punctured   Wound,  ^-c.  3S5 


which  supplies  the  part  aOected,  and  tJiere  affects  the  origin  of  other 
nerves,  going  to  other  parts,  and  thus  giving  rise  to  sympathetic  sen- 
sations  in  those  parts  to  which  such  nerves  are  distributed.  As  when 
a  limb  has  been  amputated,  sensations  are  ai)parently  felt  in  the 
limb  that  has  been  removed  ;  and,  in  epilepsy,  an  aura  is  experienced 
in  the  lower  extremities,  although  we  know  that  the  cause  and  true 
seat  are  not  in  those  parts,  but  in  the  spinal  marrow  or  brain ;  being, 
in  fact,  nothing  more  than  the  first  symptoms  of  the  affection  of  the- 
spinal  marrow  and  brain,  which  show  themselves  during  the  attack. 

In  alTections  of  the  spinal  cord,  moreover,  the  sensations  are  felt 
in  the  peripheral  ])arts  of  the  body,  as  in  inflammation  of  the  cord, 
we  feel  violent  pains  in  the  limbs.  In  this  manner,  we  apprehend, 
are  sensations  sometimes  radiated  to  different  and  remote  parts  of 
the  body. 

In  the  case  of  Mrs.  A.,  the  function  of^  rcsjnraiion  nnd  circulation 
was  seriously  affected,  and  that  immediately  upon  the  infliction  of  the 
wound.  Our  first  inference  from  this  fact  is,  the  phenomena  were 
manifestly  the  result  oi" irritation,  and  not  inflammation,  as  sufficient 
time  hftid  not  elapsed  for  the  processes  of  the  latter  to  have  been  in- 
stituted. Hence,  the  opinion  of  some,  that  all  phenomena  that  arise 
in  consequence  of  injuries  to  the  nerves  are  owing  to  inflammation,  is 
erroneous,  and  should  be  abandoned. 

The  symptoms  also  indicate,  that  that  portion  of  the  spinal  cord 
and  medulla  oblongata,  that  gives  origin  to,  or  is  connected  with,  the 
par  vagum,  sympathetic,  phrenic,  and  other  nerves  that  minister  to 
the  functions  of  organic  life,  was  profoundly  affected  ;  and  it  is  a  re- 
markable fact,  that  an  impression  of  so  grave  a  character  was  chiefly 
confined  to  that  portion  of  cerebral  or  medullary  matter  that  is  con- 
cerned in  sensation,  and  did  not  involve  the  tract  concerned  in  motion. 
The  cold  and  moist  surface  shows  a  suspension  of  capillary  circula- 
tion a  function  well  known  to  depend  on  the  integrity  of  the  nervous 
power.  The  sensation  of  "faintness"  may  perhaps  be  referred  to 
the  deranged  function  of  the  nerves  which  constitute  the  cardiac  and 
solar  plexus.  The  sensation  of  "  rigor,"  or  constant  chilliness,  is  an 
attendant  upon  local  irritation,  under  a  great  variety  of  forms  ex- 
pressive of  a  sympathy  of  the  circulating  with  the  sensorial  organ  
of  the  heart  with  the  brain.  It  may  arise  from  fear,  from  cqld,  from 
suppurative  action,  from  a  direct  nervous  impression,  as  syncope, 
from  the  prostrative  character  of  severe  irritation,  as  a  severe  shock 
or  blow;  and  in  general,  perhaps,  it  indicates  returning  animation 
and  reaction.  Another  remarkable  feature  in  this  case,  was  the  for- 
mation of  an  extensive  abscess  beneath  the  pectoral  muscle.  When 
we  take  into  consideration  the  state  of  the  system  at  the  time,  the 
low  state  of  the  circulation,  and  the  imperfect  manner  in  which  all 
the  vital  functions  were  performed,  we  arc  certainly  forced  to  the 
conclusion,  that  suppurative  inflammation  does  not,  at  least,  always 
indicate  a  high  grade  of  arterial  action,  and  that  it  may  be  sometimes 
combat  tod   most   successfully  by  anody  nei   and  tonics  remedies  to 

25 


386  Punctured  Wound,  t^c.  [July, 


allay  irritation  and  support  the  integrity  of  the  vital  powers.  The 
effect  of  the  remedies  will,  also,  clearly  lead  to  the  same  conclusion. 
May  we  not  hence  derive  a  useful  lesson?  and,  when  we  meet  with 
local  inflammation,  with  deteriorated  condition  of  the  general  health, 
and  symptoms  of  irritation  present,  in  one  or  more  organs,  whether  it 
be  the  brain,  the  stomach,  or  the  urinary  apparatus,  instead  of  gener- 
al or  local  bleeding,  resort,  with  advantage,  to  a  cordial,  supporting 
plan  of  treatment? 

Mr.  Travers,  in  his  excellent  work  on  "  Constitutional  Irritation," 
has  pointed  out  with  great  clearness,  the  distinguishing  marks  between 
inflammation  and  irritation,  which  the  reader  may  profitably  consult 
in  connection  with  this  subject.  This  case  proves  very  conclusively 
that  if  much  may  be  said  as  to  the  '  constitutional  origin  of  local  dis- 
eases," much  may  also  be  advanced  upon  the  local  origin  of  constitu- 
tional diseases. 

Dr.  T.  has  inquired  whether  there  is  not  some  analogy  in  this  case 
with  poisoned  wounds  ?  So  much  so,  we  would  say,  that  had  the 
same  symptoms  occurred  from  a  dissecting  wound,  few  would  have 
doubted  that  they  were  occasioned  by  the  absorption  of  morbid  mat- 
ter. Mr.  Lawrence  thinks  it  very  doubtful,  whether  "  any  thing  that 
can  be  called  virulent  or  poisonous,  is  introduced  into  the  human 
frame  by  dissecting  wounds,"  but  imputes  the  efl^ects  to  the  mechani- 
cal injury  inflicted.  Such  cases  as  the  above  would  seem  to  lend 
considerable  support  to  such  an  opinion.  Th6  instantaneous  occur- 
rence, however,  of  some  of  the  gravest  symptoms,  may  serve  to  dis- 
tinguish such  a  case  from  one  where  poison  has  been  absorbed,  as, 
in  the  latter  instance,  some  time  would  be  required  for  the  develop- 
ment of  the  disease.  It  depends,  we  believe,  entirely  on  the  state  of 
the  general  health  at  the  time,  whether  such  accidents  ever  lead  to 
any  serious  result ;  certainly  in  a  very  large  majority  of  cases,  no 
unpleasant  symptoms  whatever  follow  such  wounds.  During  our  ap- 
prenticeship in  our  younger  years,  as  demonstrator  of  anatomy,  we 
often  met  with  these  accidents  in  dissecting,  but  never  experienced 
the  slightest  injurious  effects,  although  we  used  little,  if  any  precau- 
lion.  In  some  instances,  we  believe  the  effects  produced  are  such  as 
Would  arise  in  wounds  considered  in  themselves,  without  any  refer- 
ence to  ihe  absorption  of  morbid  matter;  in  other  cases  it  is  more 
probable  that  a  poison  is  introduced  into  the  system,  to  which  the  sub- 
sequent phenomena  are  to  be  attributed.  We  here  close  our  dis- 
course, with  many  thanks  to  our  friend  who  has  furnished  us  with 
our  text. 


1S45.]  T^atment  of  Sciatic  Neuralgia,  '  387 


On  the  employment  of  Vesicatories  in  ilie  treatment  of  Sciatic  Neural' 
gia,  according  to  the  method  of  Cotugno.     By  I.  Gari^^  translated 

from  the  Bulletin  General  dc  Therapeuiique, 

The  facts  which  I  am  about  to  relate  are  not  very  important  either 
for  their  rarity,  or  for  the  obscurity  of  the  diagnosis,  or  for  the  de- 
ductions which  might  be  drawn  from  a  greater  number  of  cases. 

Sciatic  neuralgia  is  an  affection  which  if  not  always  well  determ- 
ined as  to  its  nature  and  the  kind  of  lesion  which  causes  it,  is  at  least 
generally  well  known  by  its  symptoms ;  and  the  rare  cases  in  which  it 
may  be  confounded  with  incipient  coxalgia,  or  with  neuritis,  are  the 
only  ones  in  which  the  diagnosis  presents  some  difficulty. 

It  is  especially  with  regard  to  its  treatment  that  this  affection  has 
arrested  the  attention  of  practitioners,  and  they  have  exhausted  means 
of  every  kind  in  their  attempts  to  remedy  the  cruel  pains,  of  which  it 
is  the  prolific  source.  Thus  the  number  and  the  variety  of  the  means 
employed,  prove  the  great  difficulty  and  uncertainty  of  the  treatment, 
and  are  at  the  same  time  but  little  calculated  to  encourage  new  re- 
searches. In  a  therapeutic  view,  however,  the  following  facts  may 
possess  some  interest.  Without  extending  the  already  long  page  of 
the  treatment  of  sciatica,  they  will  disclose  the  peculiar  employment 
of  a  known  remedy,  and  they  will  shew  that  there  is  a  proper  mode 
of  employing  topical  applications,  as  well  as  of  administering  medi- 
cine internally,  and  that  both  fail,  unless  upon  certain  conditions, 
which  ought  to  be  well  appreciated. 

Case  1.  A  carpenter,  aged  37,  sent  for  me  April  7th,  1844.  He 
was  of  a  strong  constitution,  and  of  a  sanguine  temperament,  had 
lived  at  Lyons  for  ten  years,  and  had  never  been  sick  eight  days 
before,  while  working  in  a  shop  exposed  to  currents  of  air,  he  experi- 
^enced  in  the  left  thigh,  a  sensation  of  pricking,  and  of  numbness, 
which  attracted  but  little  attention.  During  the  night  the  pain  be- 
came more  severe,  and  the  next  day,  and  the  two  following  days,  it 
})egan  to  embarrass  his  movements,  and  although  it  seemed  to  be 
less  acute  during  action,  than  when  in  a  state  of  repose,  the  patient 
discontinued  his  work,  believing  that  tranquility  would  be  sufficient 
to  restore  the  use  of  his  limb.  In  this  he  was  disappointed,  as  the 
pain  hccamo  morn  and  more  developed.     It  occupied  the  posterior 


388  Treatment  of  Sciatic  Neuralgia*  [July, 


part  of  the  thigh,  from  the  gluteal  region,  to  the  popliteal  hollow, 
without  extending  below  the  knee.  For  two  days,  the  patient  em- 
ployed frictions  with  camphorated  oil,  without  any  relief.  On  the 
fourth  day,  he  applied  a  blister  upon  the  thigh.  The  pain,  instead  of 
diminishing,  increased,  and  extended  below  the  knee,  along  the  ex- 
ternal margin  of  the  leg  to  the  external  malleolus  and  the  instep, 
following  the  course  of  the  external  popliteal  nerve.  The  limb  be- 
came very  sensitive  upon  the  slightest  motion,  so  that  the  patient 
was  obliged  to  send  for  a  physician.     T  was  called. 

On  the  8lh  of  April,  the  ninth  day  of  the  disease,  the  pain  was  very 
acute  the  patient  had  not  slept,  the  face  was  red,  the  head  of  a  burn- 
ing heat,  no  appetite,  intense  thirst,  the  tongue  white  and  the  pulse 
hard  and  frequent. 

Prescription.  Bleeding  of  about  sixteen  ounces  ;  barley  ptisan ; 
gum  syrup,  with  one  grain  of  the  watery  extract  of  opium.     Diet. 

On  the  9th,  the  patient  having  slept  a  part  of  the  night,  was  free 
from  cephalalgia,  and  asked  permission  to  eat.  He  continued  to 
complain  however  of  pain,  which  was  fixed  continuous,  sometimes 
of  a  crawling,  sometimes  of  a  lancinating  character,  and  which  was 
occasionally  aggravated  ;  two  cramps  had  occurred  during  the  night 
 the  leg  was  flexed,  and  motion  impressed  upon  it  caused  acute  pain. 
The  latter  extended  from  the  hip  to  the  foot  where  it  was  especially 
acute,  and  also  in  the  gluteal  region,  but  less  severe  at  any  interven- 
ing point.  There  was  no  redness,  heat,  or  swelling,  along  the 
course  of  the  nerve,  but  pressure  at  certain  points  increased  the 
suffering. 

The  signs  of  acute  sciatica  being  indubitable,  I  resolved  to  employ 
immediately  the  method  of  treatment  by  multiple  vcsicatories,  which 
I  had  seen  in  Paris  to  be  successful  in  the  practice  of  M.  Gendrin, 
and  which  had  appeared  to  me  to  be  most  expeditious.  I  applied  im- 
mediately three  blisters,  the  first  opposite  to,  and  a  little  behind  the 
trochanter  major,  the  second  upon  the  external  side  of  the  tibio-femoral 
articulation,  opposite  the  superior  extremity  of  the  fibula,  and  the  last 
upon  the  inferior  extremity  of  that  bone,  so  as  to  cover  the  malleolus 
externus,  and  the  superior  and  external  part  of  the  dorsal  face  of 
the  foot.  These  blisters  were  applied  simultaneously,  and  were  of 
the  following  dimensions  :  the  first,  six  inches  in  diameter,  the  second, 
four  inches,  and  the  third,  five  inches,  as  I  had  seen  practised  by  the 
physician  of  the  Hopital  de  la  Pitie.  In  addition,  the  same  potion 
and  ptisan  were  renewed,  and  soup  allowed. 


1845.]  Treaimcnt  of  Sciatic  Neuralgia.  389 


April  10th.  The  patient  has  had  fever;  ho  has  not  slept;  but  the 
sciatic  pain  is  obscured  by  that  of  the  blisters.     Same  prescription. 

The  11th.  The  sciatic  pain  is  less  violent  in  the  thigh,  but  very 
acute  in  the  foot.  The  blisters  removed  on  the  previous  evening, 
after  an  application  of  24  hours,  had  produced  a  circumjacent  eryth- 
ema, upon  which  were  placed  compresses  smeared  with  an  opiate 
cerate.  Semi-regimen  ;  the  same  ptisan ;  the  opiate  potion  is  sup- 
pressed. 

Three  days  afterwards,  (the  14th,)  the  blisters  have  ceased  to  be 
painful,  the  neuralgia  is  much  less  severe,  and  the  patient  complains 
only  of  a  very  uncomfortable  sensation  of  numbness.  Same  prescrip- 
tion. Tiie  blisters  shewing  a  tendency  to  dry  up,  are  excited  by  an 
epispastic  pomatum  of  cantharides. 

The  17th.  The  patient,  who  had  been  previously  unable  to  place 
his  foot  upon  the  ground,  got  up  without  any  increase  of  pain  ;  but 
the  limb  is  weak,  and  scarcely  able  to  support  the  weight  of  the 
body.  From  this  time,  I  did  not  see  him  until  the  23rd,  when  I 
learned  from  him  that  he  could  walk  without  difficulty,  and  without 
pain.  I  advised  him  to  make  dry  frictions  upon  the  extremity,  every 
morning  and  evening,  and  to  resume  his  ordinary  occupation. 

This  is  a  case  of  acute  sciatica,  which  presents  nothing  peculiar, 
except  its  rapid  termination.  The  duration  was  about  twenty  days, 
and  the  cure  was  accomplished  by  the  employment  of  blisters  in  the 
course  of  twelve  days.  The  following  case  of  chronic  sciatica  pre- 
sents the  same  success. 

Case  2.  A  plasterer,  about  44  years  of  age,  had  been  affected 
with  sciatic  neuralgia  of  the  right  extremity  for  two  years,  for  which 
he  had  been  treated  from  the  beginning,  at  the  Hotel  Dieu  of  Lyons, 
by  oily  and  aromatic  frictions,  by  vapour  baths,  and  sudorific  drinks, 
whose  nature  he  could  not  specify.  This  pain  was  very  acute  for  a 
month,  and  ceased  gradually  during  summer. 

September  18th,  1844,  he  came  to  me  with  a  new  sciatic  pain  of 
the  same  extremity.  The  pain  presented  the  peculiarity  of  having 
commenced  at  the  foot,  thence  extending  progressively  along  the 
fibular  margin  of  the  leg,  without  ascending  above  the  knee.  The 
general  healtii  of  the  patient  is  not  good,  his  constitution  is  feeble, 
he  is  emaciated  and  pale.  The  pain  of  tiie  leg  is  deep-seated,  dull, 
and  seems  according  to  the  expression  of  the  patient,  to  occupy  the 
marrow  of  the  bones.  Pressure  along  the  course  of  the  external 
popliteal  nerve   increases  the  pain,  and  transmits  it  to  the  hip,  the 


390  Treatment  of  Sciatic  Neuralgia.  [July, 


same  result  is  not  obtained  by  compressing  the  sciatic  nerve  near  its 
origin. 

Prescription  Two  blisters,  one  upon  the  malleolus  externus,  the 
other  upon  the  head  of  the  fibula,  with  the  respective  dimensions  in- 
dicated in  the  preceding  case. 

On  the  following  day,  the  pain  which  had  been  fixed  in  the  leg 
was  experienced  in  the  thigh,  and  in  the  gluteal  and  lumbar  regions  ; 
the  patient  has  not  slept,  the  pain  having  kept  him  constantly  awake, 
and  it  was  with  great  difficulty  that  I  could  persuade  him  to  permit 
the  application  of  another  blister  of  six  inches  in  diameter  on  the 
gluteal  region. 

Prescription  Two  pills  with  half  a  grain  of  opium  ;  ptisan  of  the 
flowers  of  the  orange  tree  ;  soup. 

Sept.  20th.  The  patient  suffers  lancinating  and  lacerating  pains  in 
the  thigh,  which  upon  pressure  or  motion,  are  increased  and  propagated 
to  the  gluteal  region  and  to  the  scrotum.  He  has  slept  but  little,  the 
suffering  is  greater  during  the  night  than  in  the  day.  The  prescrip- 
tion is  continued  ;  the  regimen  is  slightly  increased. 

The  22d.  The  pain  has  diminished ;  pressure  not  so  painful,  but 
every  movement  renews  the  suffering. 

The  25th.  The  blistered  surfaces  are  revived  by  a  cantharides  po- 
matum. 

The  27th.  The  neuralgia  has  nearly  disappeared  ;  the  patient  can 
perform  the  movements  of  flexion  and  extension,  without  pain,  but 
is  still  unable  to  walk  or  to  get  from  bed. 

The  30th.  Pain  is  no  longer  experienced  ;  the  patient  can  turn  in 
his  bed,  and  begins  to  walk  about  in  his  room.  Six  days  afterwards, 
he  resumed  his  occupation,  which  has  not  been  interrupted  up  to  the 
present  time.  This  was  a  case  of  sciatica,  in  which  pressure  dis- 
closed with  precision  the  extent  of  the  phlegmasia.  It  extended 
upward  along  the  course  of  the  external  popliteal  nerve,  as  high  as  a 
point  at  which  pressure  ceased  to  be  painful.  We  may  here  also  ob- 
serve the  same  fact  which  may  be  remarked  in  the  preceding  case, 
viz.,  the  exacerbation  of  the  pain,  and  its  extension  to  the  entire 
nerve  immediately  after  the  application  of  the  blisters.  This  is  a 
phenomenon  which  I  have  constantly  observed,  and  which  is  explain- 
ed by  the  vivid  irritation  caused  by  vesicatories  applied  to  a  large 
portion  of  the  cutaneous  surface. 

Case  3.  The  employment  of  multiple  vesicatories  is  not  only  very 
advantageous  in  cases  of  simple  sciatica,  as  in  those  which  I  have 


1345. J  Trealmcnl  of  Scialic  ycuraJgia.  391 


just  reported,  and  which  are  the  most  common,  but  these  powerful 
derivatives  may  also  be  very  successfully  used  in  chronic  lumbago, 
which  is  sometimes  accompanied  by  a  double  sciatica,  as  the  follow- 
ing example  proves: 

One  of  my  friends,  aged  42  years,  of  a  good  constitution,  and  of 
a  nervous  temperament,  has  been  subject  from  his  infancy  to  head- 
ache of  the  most  violent  kind,  and  very  frequently  repeated.  It  is 
the  only  affection  with  which  he  has  been  troubled,  except  the  one 
about  to  be  described. 

For  about  fifteen  years,  he  has  experienced  almost  constant  pains 
in  the  lumbar  region,  which  he  attributed  to  the  accidents  of  the 
chase,  for  which  he  had  a  great  passion  in  his  youth.  He  has  suc- 
cessively employed  every  variety  of  treatment,  shower  baths,  vapor 
baths,  sand  baths,  sea  bathing.  He  has  visited  Aix,  Cette,  Balaruc  ; 
but  nothing  had  been  successful.  The  pain  seemed  on  the  contrary 
to  have  increased,  and  from  the  lumbar  region,  it  had  extended  to  the 
thighs,  to  the  legs,  and  even  to  the  plantar  surface  of  the  feet,  which 
were  particularly  painful,  so  as  sometimes  to  prevent  walking  or  even 
standing. 

I  had  frequently  advised,  but  not  very  urgently,  the  employment 
of  blisters  on  a  large  scale,  being  doubtful  whether  they  would  pre- 
vail against  an  affection  of  so  old  a  date,  and  which  I  regarded  with 
other  physicians  as  an  inflammation  of  the  medulla  spinalis.  Tired 
of  the  means  which  had  been  previously  employed  without  success, 
he  determined  in  the  month  of  September  last,  to  try  this  last  chance. 
I  will  not  enter  into  the  details  of  a  treatment  which  continued  for  a 
month,  and  during  which  the  patient  remained  constantly  in  his  bed, 
or  in  his  room.  I  will  only  state  that  at  three  different  times  blisters 
were  applied  upon  all  the  joints  of  the  inferior  extremities,  and  upon 
both  sides  at  once,  and  also  that  four  different  applications  were 
made  upon  the  lumbar  regions.  All  these  blisters  had  the  dimensions 
which  I  have  already  indicated,  and  those  upon  the  loins  were  even 
seven  inches  in  length  and  eight  in  width  ;  so  that  it  might  be  said 
that  the  body  was  but  one  vast  wound,  judging  at  least  by  the  enor- 
mous quantity  of  linen  which  was  daily  stained  by  the  suppuration, 
by  the  excessive  pains  of  the  patient,  and  by  the  rigorous  immobility 
to  which  he  was  condemned.  From  this  extensive  vesication,  I  had 
no  accidents  to  combat,  either  with  respect  to  the  urinary  bladder,  or 
the  genital  organs,  or  the  head  ;  ptisans  of  barley  and  flaxseed,  emol- 
lient injections,  and  some  opiate  potions,  were  the  only  internal 
remedies  cmploved  duiinji  the  treatment. 


392  Treatment  iyf  ISciafic  Neuralgia.  [-^uly, 


Six  months  have  elapsed  since  this  treatment  was  adopted,  and  ever 
since  tlie  patient  has  remained  in  the  possession  of  good  health  ;  the 
loins  and  the  inferior  cxtr^iities  have  regained  their  strength,  and 
are  competent  for  ordinary  exercise.  Long  continued  walking,  how- 
ever, or  tolerably  great  fatigue,  causes  weakness,  without  re-exciting 
the  pain, 

I  could  take  from  my  old  notes  of  the  clinic  of  M.  Gendrin,  many 
facts  in  support  of  the  treatment  which  I  have  just  detailed,  but  they 
would  add  nothing  to  the  single  inference  which  I  wish  to  draw  from 
the  preceding  cases,  viz.,  that  blisters  in  the  conditions  which  I  have 
indicated,  having  been  successful  in  the  cases  just  reported,  and  in  a  . 
great  number  of  analogous  cases,  we  should  hasten  to  employ  a 
method  which  is  so  easy,  and  is  preferable  to  others  that  have  been 
more  vaunted  ;  such  as  the  employment  of  morphine,  incision  along 
the  course  of  the  sciatic  nerve,  and  the  application  at  the  bottom  of 
the  wound  of  a  belladonna  pill,  a  treatment  which  is  imprudent  and 
which  I  have  seen  to  fail,  and  finally  the  worst  method  of  all,  the 
section  of  the  sciatic  nerve,  advised  in  extreme  cases  by  Galen,  and 
practised  without  success  by  Mareschal,  Louis,  Sabatier,  and  more 
recently  in  1828,  by  M.  Malagodi,  who  is  mentioned  by  Velpeauin 
his  Operative  Surgery. 

If  vesication,  employed  in  the  particular  case  which  now  occupies 
our  attention,  has  been  sometimes  unsuccessful,  these  failures  must  be 
attributed  rather  to  the  mode  of  application  than  to  the  inertness  of 
the  remedy.  Thus  to  speak  only  of  the  ordinary  blisters  of  canthar- 
ides,  they  are  employed  most  frequently  singly,  and  of  the  dimen- 
sions of  two  or  three  inches,  and  applied  only  over  the  great  troch- 
anter. Some  go  so  far  as  to  renew  them  from  time  to  time,  in  order 
to  obtain  a  constant  suppuration,  but  many  abandon  the  essay  after 
the  first  application.  This  mode  of  vesication  has  most  frequently 
failed,  for  two  reasons ;  first,  because  it  is  too  limited  to  act  effica- 
ciously upon  the  affected  nerve  which  is  siluated  deeply  in  a  case  of 
sciatica  ;  and  secondly,  because  neuralgia,  though  sometimes  limited, 
is  most  commonly  extended  along  the  whole  nervous  trunk,  and  it  is 
not  sufficient  to  act  upon  the  nerve  only  at  its  origin,  but  it  is 
necessary  also  to  operate  upon  it  throughout  its  entire  course  to  its 
termination. 

  That  thiscxplanution  of  the  insufficiency  ot'  a  single  small  blister, 
is  true,  rannot  l).;  tlonbted;  observation  and  txperience  testifv  this 
insufficiency,  to  be  almost  constant   when  fhe  neuralgia  is  of  some 


I"?  13. J  Treaimtn!  of  Scialic  yvuralgia.  ;^U3 

extent  and  importance.  This  was  perceived  by  M^.  Velpeau,  ^vhen 
lie  employed  blisters  in  strij)s  along  the  entire  course  of  the  sciatic 
nerve,  and  of  the  external  popliteal  nerve.  I  know  not  if  these 
strips  were  too  narrow,  or  if  the  &ui)puratron  was  not  maintained 
sufTiciently  long,  but  it  seems  that  this  plan  was  unsuccessful,  since 
it  has  been  renounced  by  its  author. 

The  method  of  vesication  which  I  have  employed,  after  the  exam- 
pie  of  r>I.  Gendrin,  is  not  new;  but  the  physician  just  cited  has 
added  some  modifications  to  it.  It  is  the  method  of  Cotugno,  and 
is  also  recommended  by  Hufeland,  in  his  Manual  of  Practical  Medi- 
cine, with  this  single  difference,  that  the  Italian  physician  and  the 
physician  of  the  Prussian  king,  gave  to  their  blisters  equal  dimen- 
sions, and  applied  them  only  at  intervals  of  one  day,  fearing 
doubtless  to  produce  erysipelas,  and  a  too  vivid  irritation  of  the  cuta- 
neous surface.  But  we  know  that  if  blisters  have  been  able  to  fix 
erratic  erysipelas,  they  rarely  determine  its  production.  As  to  my- 
self, I  have  never  seen  the  least  inconvenience  result  from  their 
multiple  application.  I  conclude,  then,  that  monstrous  blisters,  if 
they  may  be  so  called,  though  still  larger  are  employed,  are : 

1st.  The  best  mode  of  treatment  for  sciatica,  whether  dependent 
upon  an  inflammatory  or  upon  a  rheumatismal  cause,  experience 
having  shewn  that  they  succeed  in  both  cases. 

2d.  That  these  blisters  having  the  dimensions  above  stated,  ought 
to  be  applied  upon  the  three  articulations  of  the  inferior  extremity, 
with  this  exception,  that  we  apply  only  two  when  the  sciatica  is  con- 
fined to  the  thigh  or  to  the  leg,  but.  the  third  one  is  to  be  applied,  if, 
as  sometimes  happens,  the  neuralgia  invades  the  entire  limb  after 
the  first  application. 

3d.  That  these  blisters  do  not  have  the  danger  of  the  employment 
of  morphine,  whose  effects  cannot  be  calculated  in  the  endermic 
method,  because  of  the  difference  of  its  action  upon  different 
subjects.  I  heard,  during  my  residence  at  the  Hotel  Dieu,  that  a 
patient  had  died  with  symptoms  of  poisoning,  after  the  application 
of  one  grain  of  acetate  of  morphine,  upon  a  denuded  surface.  While 
in  the  service  of  one  of  the  divisions  of  the  Ward  Quatre  Rangs,  I 
saw  a  patient  experience  poisonous  effects  f.cm  the  employment 
of  half  a  grain  of  the  hydro-chlorate  of  moipliine,  and  neverthe- 
less, authors  council  us  to  trust  to  the  absorption  of  even  two 
grains.  Finally,  as  f;ir  as  inconvonionces  arc  concerned,  these  mon- 
strous bliijters   cannot  bo  compared  with  the  section  of  the  sciatic 


394  Cons  icier  ulions  upon  Ataxic  Pneumonia^  J^'c.  L'^"b' 


nerve,  which  in  the  case  cited  by  M.  Velpeau,  was  followed  by  a 
very  slow  cicatrisation,  after  the  expiration  of  one  year,  and  by  de- 
bihty  of  the  limb  which  remained  in  a  state  of  semi-paralysis. 

4th.  My  fourth  and  last  conclusion  is,  that  blisters  of  large  dimen- 
sions  have  not  produced  erysipelas,  or  other  accidents,  and  that  ves- 
ication, whose  employment  has  been  so  frequently  modified,  and 
which  has  been  regarded  alternately  as  an  inoffensive  remedy,  and 
as  an  heroic  remedy,  ought  to  be  much  used  in  sciaiica,  not  with  the 
view  of  endermic  medication,  but  as  an  evacuant  and  a  derivative. 

N. 


Considerations  upon  Ataxic  Pneumonia  with  Delirium  and  its  treat- 
ment by  Musli  contained  in  a  letter  from  Thibeauu,  Professor 
of  Clinical  Medicine  at  Nantes,  to  the  Editor  of  the  Bulletin  de 
Th  erapeutique.      ( Translated.) 

I  have  just  read  in  the  January  number  of  the  Bulletin  de  Thera- 
peutique,  a  case  of  j)eripneumony,  accompanied  with  delirium  during 
its  course,  and  which  terminated  fatally  on  the  eighth  day.  The 
disease  had  existed  for  five  days  before  the  patient  was  admitted  into 
the  hospital,  when  he  was  affected  with  so  violent  a  delirium  that  he 
was  unable  to  give  any  account  of  his  condition.  Pneumonia  of  the 
light  side  having  been  recognized,  several  venesections  were  pre- 
scribed without  obtaining  any  amendment.  Death  occurred  on  the 
third  day  after  the  admission  of  the  patient  the  delirium  persisted  to 
the  last,  and  so  also  did  the  signs  of  pneumonia  ;  the  pulse  presented 
but  a  moderate  degree  of  development. 

To  this  case  were  appended  the  following  reflections: 

"The  delirium,  rather  than  the  pneumonia,  should  have  been  the 
source  of  indications  after  the  failure  of  the  venesections,  and  we 
believe,  after  an  attentive  examination  of  the  different  elements 
which  this  case  presents,  that  the  use  of  musk  would  most  probably 
have  subverted  the  delirium  which  embarrassed  the  progress  of  the 
disease,"  &c. 

It  is  with  the  view,  I^Ir.  Editor,  of  corroborating  your  opinion,  and 
of  insisting  upon  a  therapeutic  point  of  great  interest,  that  I  take 
the  liberty  of  addressing  you  this  letter. 

Most  certainly  there  are  cases  of  peripneumonia  in  which  the  pul- 


1845.  J  Consider  alio  lis  upon  Ataxic  Pneumonia^  iS^c.  395 


monary  inflammation,  if  we  may  so  speak,  occupies  only  the  second 
rank,  and  is  eclipsed  in  importance  by  a  superior  element  the  ner- 
vous element.     Indeed  the  doctrine  of  elements  developed   by  the 
physicians  of  the  school  of  Montpellier  is  here  eminently  applicable. 
Delirium,  the  form  assumed  in  these  cases  by  the  nervous  phenomena, 
occurs  under  a  peculiar  aspect,  and  has  been  well  appreciated  by  M. 
Recamier,  Trousseau  and  Pidoux.     In   the   majority  of  cases  it  is 
violent,  accompanied  by  incoherent  vociferations,  and  by  unreasona- 
ble acts.     The  features  bear  the  impress  of  afTright,  or  of  intense 
pre-occupation,  the  patient  has  not  an  instant  of  repose  sleep  aban- 
dons  him,  and  the  room  in  which  he  is  placed  is  disturbed  by  his 
threats  and  his  cries  most  commonly  it  is  necessary  to  confine  him 
in  a  straight-jacket.     During  this  time  the  pulse  is  small,  weak,  fre- 
quent, and  sometimes  irregular.     The  general  and  local  signs  of  the 
pulmonary  affection  undergo  but  little  change  ;  auscultation  announ- 
ces generally  a  stationary  condition.     It  is  not  then  in  the  extension 
or  in  the  increased  intensity  of  the  j)ljlegmasia  that  the  danger  re- 
sides.    In  such  cases  you  have  said,  as  has  been  also  established  by 
Sarcone,  Recamier,  and  others,  that  musk  produces  marvellous  ef- 
fects.    This  is  no  exaggeration,  this  medicine  becomes  under  such 
.circumstances  truly  heroic.     If  the  diagnosis  be  exact,  if  we  have  not 
mistaken  for  this  ataxic  delirium^  which  I  have  just  endeavored  to 
describe,  a  sub-delirium  without  any  particular  character  which  oc- 
curs  about  the  termination  of  certain  cases  of  pneumonia,  or  indeed 
the  delirium  which,  combined  with  other  characteristic  symptoms, 
announces  the  existence  of  cerebral  meningitis,  we  are  almost  cer- 
tain to  triumph  over  the  threatening   symptoms  which  make  their 
appearance.     I  am  at  the  present  time  so  well  convinced  of  what  I 
have  just  advanced,  that  in  my  clinic  I  have  frequently  predicted  to 
my  pupils  the  immediate  and  ulterior  effects  which  were  to  follow  the 
administration  of  the  musk.     Indeed  after  a  dose  somewhat  large  of 
this  medicine,  one  scruple  or  more  has  been  administered,  the  agita- 
tion  is  diminished,  the  delirium   is  appeased,  the  superior  eye-lids 
become  heavy,  yawning  and  pandiculation  occur,  the  patient  seems 
under  the  influence  of  an  imperative  desire  to  sleep,  and  which  he 
endeavors  in  vain  to  resist.     This  sleep  soon  supervenes,  and  is  pro- 
tracted for  several  hours,  and  during  this  time  the  pulse  becomes 
slower  and  incieases  in  force,  a  general  perspiration  breaks  out,  and 
when  he  awakes  the  patient  is  restored  to  consciousness.     If  the  de- 
lirium returns  it  is  only  at  intervals,  and  at  length  entirely  disap- 


396  Co!isideralioii8  upon  Ataxic  Pneumonia,  dj^c.  [July 


pears.  But  although  he  has  recovered  his  consciousness,  the  patient 
remains  soqietimes  in  a  state  of  numbness  which  continues  for  seve- 
jal  days.  The  senses  are  obtuse  ;  audition,  vision,  and  touch  give 
but  confused  perceptions,  and  the  answers,  although  correct,  resemble 
those  sometimes  made  b}*^  persons  at  the  moment  of  being  aroused  from 
slumber.  However  the  local  symptoms  of  the  peripneumonia,  which 
until  this  time  had  remained  stationary,  change  immediately.  The 
resolution  of  the  phlegmasia  which  had  been  suspended  by  the  dis- 
turbance of  the  economy  resumes  its  progress,  and  auscultation  proves 
that  the  pulmonary  parenchyma  is  becoming  pervious  to  the  air. 

Ataxic  pneumonia  is  not  very  common,  and  hence  probably  the 
astonishment  which  it  causes  in  some  practitioners,  and  the  errors  of 
diagnosis  committed  by  even  eminent  men.  The  opportunities  of 
giving  musk  as  a  specific  medicine  do  not  occur  as  frequently  as  is 
supposed.  Here  I  speak  only  of  those  cases  in  which  this  substance 
produces  evident  effects,  and  which  the  most  sceptical  cannot  deny. 
At  the  present  moment  I  leave  out  of  the  question  certain  acute,  and 
particularly  numerous  chronic  affections  in  which  musk  has  been 
recommended.  In  such  cases,  new  researches  are  necessary,  and 
it  is  perfectly  legitimate  to  doubt.  Thus,  musk  is  one  of  those  reme- 
dies which  is  employed  by  one  practitioner  or  disdained  by  another, 
according  to  their  different  opinions  or  the  nature  of  their  studies; 
but  this  is  not  the  case  in  the  disease  which  we  we  are  now  consider- 
ing. I  said  that  ataxic  peripneumonia  did  not  appear  to  me  to  bo 
very  common,  thus  in  a  service  of  more  than  forty  beds,  where  the 
admission  of  patients  is  pretty  frequent,  I  have  not  observed  more 
than  one  or  two  cases  of  this  kind  each  year  ;  and  even  sometimes  a 
greater  interval  elapses  before  such  cases  are  received  in  my  service. 
I  orivc  musk  therefore  but  rarely,  and  only  under  the  above-mentioned 
circumstances,  being  doubtful  of  its  good  effects  in  many  other  mor- 
bid affections. 

I  will  also  add  that,  during  the  progress  o^ pneumonia,  with  deliri- 
um^ complications  sometimes  supervene  and  oppose  an  invincible 
obstacle  to  the  good  effects  of  the  musk.  Two  such  cases,  which  I 
cannot  now  report  with  all  their  details,  and  which  were  observed  in 
my  clinic  in  1841  and  1844,  were  especially  very  remarkable.  In- 
dependently of  the  hepatisation  of  the  lung,  as  denionstrated  by 
autopsy,  there  existed  in  both  traces  of  acute  pericarditis,  and  in  one 
of  them  traces  of  cerebral  meningitis.  In  both  these  patients  the 
delirium  v.hicli   occurred  during   the   course  of  the  peripneumonia 


IS  15.]  Considerations  upon  Ataxic  Pneumonia,  c^'C.  397 


presented  the  characters  above  indicated,  and  yielded  completely  to 
musk,  which  was  given  in  a  large  dose.  It  was  only  secondarily 
that  a  new  phase  presented  itself,  and  that  symptoms  of  another  na- 
ture occurred  and  occasioned  the  death  of  the  patients.  In  one  of 
these  cases,  the  pericarditis  was  not  recognised;  in  the  other,  a  re- 
markable agony,  and  a  great  intermittence  of  the  pulse,  were  the 
only  signs  which  induced  us  to  suspect  its  existence. 

These  cases,  however,  are  of  a  particular  kind,  and  cannot  invali- 
date others  now  recorded  in  the  annals  of  our  science.  Cases  of  the 
latter  kind  are  now  well  known,  and  their  number  increases  daily. 
In  1S39,  in  the  7th  volume  of  the  Journal  desConnaissances,  Medico- 
Chirurgicalcs,  we  published  ourselves  such  a  case.  The  peripneu- 
mony  had  occurred  under  the  influence  of  a  cold  temperature  acting 
during  the  night  upon  a  young  soldier  while  on  duty.  It  had  reached 
the  ninth  day  without  any  appreciable  change ;  the  most  energetic 
treatment  had  been  adopted  ;  eight  venesections  had  been  successive- 
ly practised,  thirty  leeches  had  been  applied  upon  the  thorax,  and 
subsequently  two  blisters  ;  kermcs  mineral  also  had  been  administer- 
ed. After  several  apparent  and  temporary  ameliorations,  a  violent 
delirium  suddenly  seized  the  patient,  the  pulse  became  small,  feeble, 
and  frequent,  (115  per  minute,)  respiration  frequent,  (40  per  minute,) 
the  local  signs  of  pneumonia  persisted,  the  countenance  was  greatly 
altered,  the  features  cramped,  and  tlie  delirium  so  great  that  it  was 
necessary  to  tie  the  patient  to  prevent  his  escaping  from  bed.  In 
this  state  of  things,  musk  was  administered  in  pills  in  the  dose  of  one 
grain  per  hour.  Eight  grains  had  been  given,  and  already  the  deliri- 
um was  sensibly  diminished,  and  the  pulse  had  lost  its  frequency. 
The  following  night,  during  which  the  musk  was  continued,  a  calm 
sleep  supervened.  The  second  day,  after  the  administration  of  one 
scruple  of  the  medicine,  convalescence  commenced,  and  during  this 
time  the  signs  furnished  by  auscultation,  announced  a  free  solution  of 
the  pneumonia. 

On  13th  May,  1844,  M.  Botte,  a  pupil  of  the  Hotel  Dieu  of  Nantes, 
selected  ataxic  pneumonia  as  the  subject  of  his  inaugural  thesis.  In 
the  course  of  his  researches,  he  reports  several  cases  collected  in  the 
different  services  of  the  hospital,  and  particularly  in  the  clinical 
wards.  Two  of  these  cases  seem  to  me  well  calculated  to  demon- 
strate the  incontestible  efiicacy  of  musk,  and  were  prepared  under 
my  direction. 

A  patient  was  admitted  into  the  Hotel  Dieu  on  the  fifth  day,  of  a 


398  Considerations  upon  Ataxic  Pneumonia,  <^c.  [July, 


peripneumonia,  for  which  two  venesections  and  an  application  of 
leeches  had  been  rhade.  On  the  third  day  he  was  taken  with  a  vio- 
lent delirium,  which  rendered  it  necessary  to  tie  him,  and  in  that 
condition  he  was  brought  to  the  hospital.  During  the  day,  after  a 
third  bleeding  and  the  administration  of  a  bottle  of  Sedlitz  water,  the 
symptoms  were  aggravated  to  the  highest  point,  the  eyes  became 
brillrant,  the  expression  of  the  countenance  threatening,  and  the 
straight.jacke't  was  used  to  prevent  the  patient  from  escaping  from 
bed.  His  strength  declined,  tongue  and  lips  parched,  pulse  frequent, 
concentrated,  and  depressible,  the  bladder  distended  with  urine,  and 
requiring  the  introduction  of  the  catheter.  During  all  this  time, 
auscultation  discloses  posteriorly,  and  upon  the  left  side  a  crepitant 
rale,  a  broncheal  souffl  j,  and  bronchophony  ;  the  expectoration  of  a 
peripneumonic  character.  In  the  midst  of  this  frightful  array  of 
symptoms,  musk  was  proscribed  in  a  large  dose,  and  in  thirty  hours 
(counting  from  its  administration)  yawning  and  pandiculation  took 
place,  followed  soon  by  a  quiet  sleep,  with  a  gentle  moisture  of  the 
skin,  announcing  the  beginning  of  improvement.  On  the  next  day 
some  vestiges  of  delirium  still  persist,  but  soon  disappear  entirely. 
The  pulse  loses  its  frequency,  the  signs  of  resolution  are  manifested, 
and  five  days  afterwards  the  convalescence  is  confirmed. 

Another  patient  was  admitted  into  the  hospital  on  the  seventh  day, 
of  a  peripneumonia,  after  having  been  bled  three  times,  and  after 
the  application  of  fifteen  leeches  upon  the  affected  side.  The  steth- 
oscopic  signs  of  pneumonia  were  recognised,  and  two  additional 
venesections  were  practised  the  day  after  his  admission.  On  the 
following  day,  delirium  suddenly  supervened,  and  attended  for  some 
moments  by  a  kind  of  cataleptiform  stupor.  Consciousness  is  entire- 
ly lost  the  eyes  immovable,  seemed  fixed  upon  any  object  before 
the  patient.  The  pupils  are  contracted  ;  deglutition  difficult ;  pulse 
very  frequent  (1:24  per  minute)  and  very  depressible.  At  the  mo- 
ment of  the  visit,  this  condition  suddenly  gave  way  to  a  violent  par- 
oxysm of  delirium,  with  a  disposition  to  escape  and  to  seize  upon 
the  persons  who  approached  him.  After  the  administration  of  one 
scruple  of  musk,  the  delirium  is  replaced  by  a  kind  of  profound  tor- 
pidity, the  pulse  is  pliant,  of  moderate  consistence  and  less  frequent 
(92  per  minute.)  A  chill,  without  any  known  cause,  supervenes 
during  the  day,  and  is  followed  by  a  return  of  the  delirium.  One 
scruple  of  musk  is  again  prescribed,  and  "kfter  a  calm  night  and 
refreshing  sleep,  the  intellect  becomes  clear,  signs  of  the  resolution 


1845.]  Venous  Pulse.  399 


of  the  phlegmasia  are  manifested,  the  appetite  returns,  and  the  patient 
is  convalescent. 

Thus  in  certain  cases  of  pneumonia,  there  may  occur  new  morbi  I 
elements  of  such  a  nature  as  to  arrest  the  resolution  of  the  phlegmasia 
and  to  threaten  life.  In  such  circumstances,  appropriate  remedies 
ought  to  be  substituted  for  the  ordinary  treatment.  Ataxic,  or  deliri- 
ous pneumonia,  furnishes  an  instance  of  this  kind,  and  in  the  same 
way,  that  in  pernicious  fevers,  although  attended  with  phlegmasia, 
the  sulphate  of  quinine  constitutes  the  fundamental  plan  of  medica- 
tion ;  because  a  special  element  here  predominates  over  the  entire 
affection  ;  so  in  like  manner,  musk  is  the  heroic  medicine  to  which 
we  should  promptly  have  recourse  in  ataxic  pneumonia  accompanied 
with  delirium.  Physicians  have  been  so  much  fascinated  by  the 
doctrines  of  exclusive  organicism,  that  they  can  hardly  comprehend 
how  very  intense  cerebral  symptoms  (such  as  those  which  we  have 
indicated  in  this  article,)  can  exist  without  meningitis,  and  how  con- 
sequently any  other  than  an  antiphlogistic  treatment  can  succeed 
in  such  cases.  The  same  thing  is  true  in  many  other  diseases.  But 
nevertheless,  the  accomplished  physician,  enriched  by  the  knowledge 
of  modern  discoveries,  tends  each  day  to  resume  the  route  which  has 
been  too  much  abandoned,  and  to  study  morbid  affections  by  means 
of  clinical  observation,  in  preference  to  any  thing  else^  and  not  ex- 
clusively by  the  light  of  Pathological  Anatomy.  N. 


PART  III. MONTHLY  PERISCOPE. 

Venous  Pulse.  M.  Martin  Solon  read  a  paper  on  the  Nature  and 
Causes  of  the  Venous  Pulse,  which  occasioned  several  animated  and 
interesting  discussions.  The  term  venous  pulse  is  generally  applied 
to  the  pulsations  which  are  observed  in  the  jugular  and  subclavian 
veins,  in  cases  of  great  repletion  of  the  cavities  of  the  heart,  or  of 
insufficiency  of  the  tricuspid  valves.  The  latter  not  closing  when 
the  ventricles  contract,  the  blood  is  expelled,  as  it  were,  into  a  third 
artery,  and  venous  pulsations  ensue,  more  or  less  synchronous  with 
the  arterial  pulsations.  M.  Martin  Solon,  having  lately  observefl 
})ulsations  in  the  dorsal  veins  of  the  hands  in  two  instances,  in  which 
it  appeared  to  him  that  the  pulsations  were  evidently  transmitted 
through  the  capillaries,  wished  to  draw  the  attention  of  the  Academy 
to  this  phenomenon.     The  patients  on  whom  he  observed  the  venous 


400    ^  Venous  Pulse.  [July, 


pulsations  were  both  attacked  with  violent  pleuro-pneumonia,  had 
been  bled  several  times,  and  had  taken  tartar  emetic  in  large  doses. 
The  veins  were  prominent,  rounded,  of  a  bluish-rose  colour,  and  pre- 
sented a  diastolic  and  systolic  motion,  easily  appreciable  by  the  eye, 
and  synchronous  with  the  pulse.  On  a  carefid  examination  being 
made,  it  was  evident  that  this  motion  was  not  communicated  by  any 
adjacent  vessels.  When  the  fingers  were  pressed,  the  pulsations 
ceased,  but  when  ^he  wrists  were  pressed,  they  remained  as  before. 
When  the  brachial  artery  was  pressed,  the  pulsations  of  the  radial 
and  cubital  arteries,  and  of  the  dorsal  veins  of  the  hands,  all  disap- 
peared together.  In  both  cases  the  patients  gradually  recovered. 
In  one,  the  venous  pulsation  appeared  on  the  fifteenth  day,  and  re- 
mained seven  days,  the  cardiac  impulsion  being  strong;  in  the  other, 
the  impulsion  of  the  heart  was  weak,  and  the  symptom  was  not  of 
so  long  a  duration.  M.  Martin  Solon  thought  t)iat  the  abnormal 
fluidity  of  the  hlood  in  these  patients  facilitated  the  passage  of  the 
blood  through  the  capillaries,  and  thus  enabled  it  to  retain  the  im- 
pulsion communicated  hy  the  heart.  The  same  phenomenon,  he 
stated,  had  been  observed  by  Dr.  Ward,  on  a  woman  recently  deliv- 
ered, *and  attacked  with  pneumonia,  and  by  Dr.  Graves,  on  a  woman 
labouring  under  peritonitis.  In  both  instances  the  patients  had  been 
bled  largely.  This  symptom  was  of  great  importance  in  a  patholo- 
gical point  of  view,  as  it  indicated  a  state  of  fluidity  of  the  blood 
which  might  render  further  bleeding  unadvisable;  he  consequently 
thought  that  the  attention  of  practitioners  should  be  directed  to  its 
existence.  In  a  physiological  point  of  view,  the  fact  of  the  arterial 
systole  and  diastole  being  thus  communicated  to  the  veins,  was  of 
great  importance,  as  it  proved  that  the  entire  circulation  is  under  the 
influence  of  the  heart. 

M.  Cruveilhier  stated  that  he  had  several  times  observed  venous 
pulsation  in  the  veins  of  the  bend  of  the  arm,  but  never  in  the  dorsal 
veins  of  the  hand.  He  thought  it  most  probable  that  such  pulsations 
were  the  result  of  a  shock  conveyed  to  the  venous  column  by  the 
neighbouring  arteries. 

M.  Velpeau  had  seen  venous  pulsation  in  all  the  superficial  veins 
of  the  thoracic  limbs,  but  attributed  it  to  a  kind  of  reflux,  such  as  is 
frequently  observed  in  the  jugular  veins. 

M.  Blandin  admitted  fully  the  explanation  of  M.  Martin  Solon. 
Harvey  had  stated  that,  in  some  cases,  the  heart  was  able  to  transmit 
pulsations  to  the  veins,  and  the  experiments  of  M.  Magendie,  which 
he  himself  had  successfully  repeated,  showed  that  this  was  really  the 
case.  If,  on  the  dead  subject,  a  part  of  the  circulatory  system  having 
})ecn  previously  cleared  by  an  injection,  fluid  is  injected  into  an  arte- 
rial trunk  by  successive  jerks,  it  passes  out  in  a  jerk  from  an  opening 
made  in  a  corresponding  vein.  If  an  interrupted  flow  of  blood  from 
a  vein  can  be  produced  in  a  dead  subject  through  the  capillaries,  why 
should  not  the  same  phenomenon  be  possible  in  the  living? 

M.  Dubois  d'Amiens  remarked,  that  when  the  circulation  is  exam- 


1845.]  Venous  Pulse.  401 


ined  with  the  microscope,  it  proceeds  byjerks,  until  the  blood  reaches 
the  capillaries,  when  its  flow  becomes  uniform  ;  it  was,  therefore, 
scarcely  possible  to  admit  the  interpretation  which  M.  Martin  Soloa 
had  given. 

?.r.  3Iartin  Solon  replied,  that  he  did  not  reason  from  experiments, 
but  from  pathological  facts.  He  had  been  careful  not  to  be  misled 
by  the  proximity  of  arterial  branches,  and  by  the  communication  of 
their  shocks  to  the  veins.  If  the  pulsation  had  depended  on  reflux 
from  above,  pressure  above  the  veins  ought  to  have  arrested  them, 
which  it  did  not.  The  valves  of  the  veins  would  prevent  the  jugular 
reflux  from  propagating  itself  far. 

M.  Poiseuille  stated,  that  researches  which  he  had  recently  made 
with  reference  to  this  subject,  would  enable  him  to  throw  some  light 
on  the  question.     When   the   capillary  circulation  of  reptiles  and 
mammiferous  animals  is  examined  with  the  microscope,  its  flow  ap- 
pears perfectly  uniform  ;  but  this  is  not  really  the  case  ;  for  although 
continuous,  it  is  insensibly  interrupted,  jerked  (saccade),  a.s  is  proved 
by  the  following  experiment :  If  a  curved  tube,  containing  a  solu- 
tion of  subcarbonate  of  soda,  to  prevent  the  coagulation  of  the  blood, 
is  adapted  to  one  of  the  veins  of  a  thoracic  or  pelvic  limb,  so  as  for 
the  opening  to  be  turned  towards  its  extremity,  the  blood  enters  the 
tube  continuously,  but  not  uniformly.     The  flow  is  interrupted-co7i- 
iinuous,  [continu-saccade.)  which  would  not  be  the  case  if  the  flow  of 
blood  in  the  capillaries  was  uniform.     This  experiment  is  the  same 
on  thelivinor  as  the  one  described  by  M.  Blandin  on  the  dead  subject, 
and   the  result  is  also  the  same.     Careful  examination  of  the  jet  of 
blood  in  ordinary  venesection,  equally  demonstrates  the  truth  of  this 
fact.     The  amplitude  of  the  jet  is  never  identically  the  same,  even 
when  the  openings  of  the  skin  and  of  the  vein  remain  perfectly  paral- 
lel, and  the  arm  and  its  muscles  are  perfectly  inactive.     That  this  is 
the  case  may  be  perceived  by  observing  attentively  the  spot  where 
the  blood  falls  ;  it  will  be  seen  to  recede  or  approximate  alternately. 
It  is  scarcely  necessary  to  add  that  the  greatest  amplitude  of  the  jet 
coincides  with  a  contraction   of  the  heart,  or  with   an  expiration, 
which  increases  the  impulsive  force  of  the  arterial  flow,  and  that  the 
smallest  amplitude  coincides  with  the  diastole  of  the  heart,  or  an  in- 
spiration.    If  this  normal  state  is  exaggerated,  it  may  give  rise  to  the 
venous  pulse,  or  uneven  flow,  which  is  sometimes  observed  in  bleed- 
ing, and  which  is  usually  attributed  to  the  communication  of  arterial 
shocks.     In  the  mesenteric  circulation  of  young  rats  and  mice,  no 
intermittence  is  at  first  visible;  but  if  blood  is  lost  in  any  quantity, 
the  circulation  becomes  jerked  (saccade)  both  in  the  capillaries  and 
in  the  veins.     The   heart  losing  its  energy,  a  smaller  quantity  of 
blood  is  thrown  into  the  arteries,  which  being  less  dilated,  contract 
with  less  force,  and  thus  lose  their  power  of  converting  the  intermit- 
tent flow  into  a  continued  one,  as  is  normally  the  case.     This  ac- 
counted for  the  venous  pulse   having  been  observed  by   M.  Martin 
Soloji,   Dr.  Graves,  and    Dr.  Ward,  on  patients  who  had  lost  much 

2r, 


402  Periodic  Discharge  of  Ova,  4'^  U^^Yt 


blood.  M.  Martin  Solon  attributed  the  phenomenon  to  the  greater 
fluidity  of  the  blood.  But  his  own  experiments,  as  well  as  those  of 
M,  Magendie,  proved  that  the  more  aqueous  the  blood  became,  the 
greater  was  the  difficulty  with  which  it  passed  through  the  capillaries, 
owing  to  imbibition.  He  thought  it,  therefore,  more  correct  to  ex- 
plain the  influence  which  loss  of  blood  evidently  had  in  producing 
venous  pulsation,  as  he  had  done. 

M.  Priorry  had  seen  jerks  occur  in  bleeding  patients  who  presented 
obstructions  in  the  right  heart,  when  a  pound  or  a  pound  and  a  half 
pf  blood  had  been  withdrawn.     At  the  same  time  the  blood  became 
red  instead  of  black,  showing  that  the  action  of  the  heart  had  become, , 
momentarily,  stronger.  Lancet 


On  the  Periodic  Discharge  of  Ova,  and  the  Function  of  Menstrua- 
tion. The  following  propositions  embody  the  most  important  con- 
clusions that  have  been  formed  by  the  best  authorities  on  this  highly 
curious  subject : 

1.  Menstruation  commences  at  the  period  of  the  maturity  of  the 
ovules. 

2.  The  final  cessation  of  the  catamenial  secretion  coincides  with 
the  abolition  of  the  formative  function  of  the  germs.     3.  The  ovaries 
of  women,  who  have  ceased  to  menstruate,  never  contain  the  appear- 
ance of  any  vesicles  that  have  recently  burst,  or  that  are  about  to  do 
so  (Negrier.)     4.  At  each  menstrual  period,  the  highly  excited  state 
of  the  ovaries  induces  in  the  female  a  decided  propension  to  coition. 
5.  The  aptitude  for  fecundation  is  greatest  on  those  days  that  imme- 
diately precede    the    menstrual    discharge.     6.   In    all   the    lower 
animals,  the  ovaria  become  tumid  during  the  season    of  rutting, 
7.  Women,  in  whom   there  is  a  congenital  absence  of  the  ovaria, 
never  truly  menstruate,  however  perfect  may  be  the  structure  of  the 
uterus  and  other  parts  of  the  generative  system.     8.  The  extirpation 
of  these  organs  puts  a  complete  stop  to  menstruation,  in  cases  where 
this  function  had  been  already  established.     9.   Women,  in  whom 
there  is  a  congenital  absence  of  the  uterus,  but  in   whom  the  ovaria 
are  normally  developed,  experience  every  month  all  the  phenomena 
of  menstruation,  the  sanguineous  discharge  alone  excepted.     10. 
The  catamenial  secretion  ceases  completely  in  women,  in  whom  the 
ovaria  have  become  affected  with  organic  degeneration.     11.  It  has 
been  asserted  by  some  writers  that   lascivious  girls  have  in  this  re- 
spect like  the  common  hen  occasionally  discharged  ova  from  the 
vagina,  and  that  a  mere  voluptuous  thought  will  suffice powr  ehranler 
these  minute  vesicles.     12.  In   very  many  women,  the  menstrual 
period  is  preceded  by  severe  colicky  pains,  attributable  most  likely 
to  the  turgid  and  excited  state  of  the  ovaries. 

13.  In  those  who  sufl^er  much  at  these  periods,  the  cavity  of  the 
uterus  sometimes  becomes  lined  with  a  soft  flocky  membrane  a 
genuine  memhrana  caduca  the  formation  of  which  isefttirely  inde- 
pendent of  coition.     14.  Lastly,  in  that  singular  case  of  monstrosi- 


1845.]  Epidemic  of  Erysipelas  Epilepsy.  403 


ty  in  which  the  two  girls,  Helen  and  Judith,  were  united  to  each 
other  hy  the  posterior  and  lower  parts  of  the  back  the  catamenial 
discharge  took  place  in  different  quantities  and  at  different  times 
from  each  subject,  although  there  was  a  complete  anastomosis  between 
the  abdominal  vessels  of  the  two.  Memoire pour  servir  a  V etude  des 
Maladies  des  Ocaires,par  Achille  Chereau.  Paris,  1844.  Medico- 
Chirursical  Review. 


Epidemic  of  Erysipelas,  in  the  Hospitals  of  Paris.  Bulletin  de 
Therapeufique,  April,  1845.  The  surgeonsof  the  Parisian  hospitals 
have  had  frequent  opportunities  of  observing  epidemics  of  erysipelas. 
At  this  moment,  one  of  these  epidemics  prevails  in  several  of  the  hopi- 
tals  of  Paris.  At  the  Hopital  de  la  Pitie,  the  service  of  M.  Lisfranc  is 
crowded  with  erysipelatous  patients;  in  198  patients,  25  are  attacked 
with  erysipelas,  occurring  in  the  hospital  and  following  operations 
which  had  been  performed  upon  them.  M.  Lisfranc  has  never  seen 
an  epidemic  more  general  and  more  intense.  Six  women,  from 
whom  he  had  removed  the  mammae  were  all  of  them  seized  with 
erysipelas,  and  with  the  bad  consequences  which  thence  ensue.  A 
simple  ligation  of  haemorrhoids  produced  in  a  patient  a  very  serious 
erysipelas,  which  extended  gradually  over  the  whole  back,  and  even 
to  the  nape  of  the  neck.  This  patient  is  in  danger.  The  disease 
has  also  been  developed  in  patients  who  entered  the  hospital  in  con- 
sequence of  accidents  from  vehicles,  falls,  6cc.  A  simple  application 
of  leeches,  the  smallest  operation,  the  slightest  incision,  are  sufficient 
to  excite  the  disease.  Some  of  the  cases  are  very  serious,  and  have  a 
tendency  to  terminate  in  a  typhoid  state  ;  no  patient,  however,  thus 
far  has  died.  It  appears  that  the  same  epidemic  influence  is  equally 
felt  at  the  Hopital  Beaujou.  M.  Martin  Solon  has  also  several  ery- 
sipelatous patients  under  treatment.  In  presence  of  such  an  epidemic, 
surgeons  who  see  farther  than  their  bistouries,  and  who  are  governed 
by  general  principles,  will  admit  in  this  fact  the  incontestable  exist- 
ence of  a  particular  medical  constitution  which  should  influence  their 
conduct.  Under  such  circumstances,  the  prudent  surgeon  should 
abstain  from  operating  or  performing  only  those  operations  which 
are  urgent.  N. 


Corrosive  Sublimate  in  Epilepsy.  In  an  elaborate  article  upon 
the  Neuroses  of  the  Ganglionic  Nerves  by  M.  Merat,  Member  of  the 
Royal  Academy  of  Medicine,  we  find  the  following  remarks  :  

''Since  the  year  1810,  I  have  been  in  the  habit  of  administering 
the  Corrosive  Sublimate  in  the  treatment  of  several  nervous  diseases, 


404  Treatment  of  Chlorosis  Cautery  in  Gangrene,        [July, 


and  more  especially  of  Epilepsy.  I  have  witnessed  decidedly  suc- 
cessful results  from  its  use  in  a  good  many  but  certainly  it  roust  be 
confessed,  not  in  the  majority  of  the  cases  of  this  malady.  The 
formula,  which  I  use,  will  be  found  in  the  Dispensatory  of  Bouchar- 
daut  (ed.  1840,  p.  394.)  A  pill,  consisting  of  a  sixteenth  part  of  a 
grain  of  the  Sublimate,  one  grain  of  Camphor,  three  fourths  of  a 
grain  of  Opium,  and  half  a  grain  of  Musk,  is  given  daily ;  thisdose 
is  to  be  increased  every  eight  days  by  an  additional  pill  of  the  same 
ingredients.  Some  patients  have  been  able  to  take  one  or  even  two 
grains  of  the  sublimate  in  the  course  of  the  twenty-four  hours.  As 
a  general  rule,  I  have  never  wished  to  exceed  half  a  grain  at  most  ^ 
unwilling  to  run  the  risk  of  inducing  a  black  colour  of  the  skin,  as 
has  happened  to  some  patients  after  a  protracted   use  of  the  drug. 

Revue  Medicale, 


Professor  Cornealini  on  the  Proximate  Cause  and  Treatment  of 
Chlorosis.  From  an  extensive  experience  in  the  wards  of  thePavia 
Hospital  to  which  he  is  attached  as  the  professor  of  clinical  medi- 
cine the  author  deduces  the  following  conclusions  respecting  this 
not  unfrequent  disease  :  

1.  The  essential  nature  of  chlorosis  consists  of  two  pathological 
conditions,  both  of  them  appertaining  to  the  solids;  the  frst  being 
an  inordinate  excitation  of  the  heart  and  arteries,  and  the  second  a 
chemico-vital  alteration  of  the  assimilative  functions  of  Chylification 
and  Haematosis.  It  is  not  possible  to  determine  which  of  these  two 
conditions  is  the  primary  and  causal  one. 

2.  No  plan  of  treatment  is  so  certain  and  efficacious  as  the  exhi- 
bition of  steel  in  $ome  form  or  another  :  the  preparations  of  this  metal 
acting  curatively  upon  both  of  the  pathological  states  now  mentioned. 

3.  There  is  no  very  marked  difference  in  the  comparative  efficacy 
of  different  chalybeate  preparations,  except  in  so  far  as  relates  to 
their  solubility  in  the  animal  fluids,  and  perhaps  also  to  their  readiness 
to  become  disaggregated  by  the  process  of  digestion. 

4.  The  addition  of  an  acid  decidedly  increases  the  efficacy  of 
steel  remedies. 

5.  Steel-filings  become  converted,  in  the  stomach  of  chlorotic  pa- 
tients, into  the  lactate  of  iron. 

6.  It  is  useless  and  not  unfrequently  it  is  unsafe  to  administer 
very  large  doses  of  ferruginous  preparations. 

Professor  Corneliani  has  examined  with  great  care  the  state  of  the 

blood  in  chlorosis ;  and  most  of  his  observations  go  to  confirm  the 

accuracy  of  MM.  Andral  and  Gavarret's  statements  respecting  the 

diminution  of  the  normal  proportion  of  red  globules  and  hsematosine. 

Annali  Universalis     Med  Chir.  Review, 


The  Actual  Cautery  successfully  employed  in  Gangrene  of  the 
mouth.  The  case  occurred  in  a  female  child,  five  years  of  age,  du- 
ring the  convalescence  from,  an  attack  of  Typhus  fever.     The  pecu- 


1845.]  Digitalis  in  Diseases  of  the  Heart.  405 


liar  (by  some  deemed  pathognomonic)  offensive  odour,  that  accom- 
panies this  species  of  gangrene,  was  remarked  before  any  actual 
appearance  of  the  disease  was  discoverable.  There  were  four 
gangrenous  patches  on  the  upper  and  lower  gums,  besides  one  on 
the  inner  surface  of  the  right  cheek.  Dr.  Weber  determined  to 
apply  the  actual  cautery  to  all  the  diseased  spots,  and  the  immediately 
adjacent  parts-  This  was  done,  not  without  difficulty,  as  may  be 
imagined  ;  and  the  mouth  was  directed  to  be  afterwards  washed  out 
every  two  hours  with  a  decoction  of  Cinchona,  to  which  some  spiritus 
cochlearecB  was  added  The  offensive  smell  ceased  immediately  after 
the  application  of  the  cautery,  and  did  not  again  return. 

On  the  third  day,  the  sloughy  parts  began  to  detach  themselves ; 
at  the  same  time,  a  few  suspicious-looking  spots  were  touched  with 
the  nitrate  of  silver.  Several  teeth  remained  ^^dechaussees,^'  and 
at  three  points  the  maxillary  (upper)  bone  was  exposed.  These  ne- 
crosed portions,  inclosing  a  molar  tooth,  and  two  smaller  bits  of  the 
lower  jaw  were  subsequently  detached.  During  the  progress  of  the 
case,  an  offensive  purulent  discharge  took  place  from  the  ears,  and 
numerous  small  abscesses  formed  on  different  parts  of  the  body. 

Dr.  Weber  does  not  think  that,  in  this  case  (nor  indeed  generally), 
there  was  any  reason  to  suspect  that  the  gangrenous  ulceration  of  the 
mouth  was  in  any  degree  attributable  to  the  action  of  mercury  upon 
the  system.  He  points  out  the  analogy  between  this  disease  which 
he  designates  by  the  name  of  noma  or  corroding  ulcer  and  the 
pustule  ?naUgne,  so  actually  described  by  Boyer  and  other  continental 
writers.  Gazette  Medicale  de  Strasbourg,  from  Ibid. 


On  the  action  of  Digitalis  and  its  rises  in  Diseases  of  the  Heart. 
By  Wm.  Muxk.  M.  D.  {Guy's  Hospital  Reports,  1844.) This 
practical  paper  is  founded  upon  upwards  of  400  observations,  which 
were  made  during  five  years  of  dispensary  practice.  The  tincture 
has  been  found  the  most  successful  form  of  preparation  as  regards 
the  effect  produced  upon  the  action  of  the  heart,  while  the  infusion 
is  incomparably  superior  as  a  diuretic  ;  and,  from  want  of  attention 
to  this  distinction,  discrepant  opinions  as  to  the  utility  of  the  medi- 
cine have  doubtless  arisen.  The  powder,  used  alone.  Dr.  Munk 
considers  as  worthless,  an;!  although  in  combination  (with  mercury 
and  squill)  it  forms  a  valuable  diuretic,  it  cannot  be  so  employed  as  a 
sedative. 

The  action  of  digitalis  upon  the  heart  is  manifested  in  two  ways  : 
by  the  exertion  of  a  depressing  influence,  and  as  an  antispasmodic. 
Hypertrophy  of  the  organ,  whether  simple  or  complicated  with  other 
disease,  causing  increased  impulse,  may  be  benefitted  by  the  depress- 
ing  influence  of  digitalis,  which  is  best  obtained  by  giving  the  un- 
combined  tincture,  in  tolerably  full  doses,  at  intervals  of  eight,  ten, 
or  twelve  hours.  The  antispasmodic'in^uence,  acting  so  beneficially 
in  the  irritable  condition  of  the  heart  manifested  by  palpitations, 
irregularity,  <5wC.,  is  that  which  is  usually  sought  from  digitalis.     Dr. 


406  Digitalis  in  Diseases  of  the  Heart.  [July, 


Munk  does  not  agree  with  those  writers  who  state  the  action  of  the 
digitalis  upon  the  heart  to  be  uncertain.  Its  operation  is  as  certain, 
in  properly-selected  cases,  as  that  of  other  medicines,  and  may  be 
maintained  with  safety. 

There  are,  however,  circumstances  under  which  this  medicine 
cannot  be  exhibited  usefully  or  safely.  Thus,  in  a  plethoric  state  of 
the  system,  its  employment  must  be  deferred  until  bloodletting  or 
other  evacuants,  for  which  it  is  no  substitute,  have  played  their  parts. 
An  inflammatory,  or  sub-inflammatory  condition  of  the  gastric  and 
intestinal  mucous  membrane,  seems  to  prevent  the  action  of  digitalis 
upon  the  heart ;  and  increased  irritation  results  if  it  be  persisted  in. 
Such  complication  of  lesion  of  the  heart  and  gastric  derangement 
is  by  no  means  rare,  and  in  such  cases  prussic  acid  is  the  appro- 
priate medicine.  Quietude  of  mind  and  body  much  favor  the  action 
of  digitalis.  The  recunjbent  posture  is  very  adjuvatory  to  its  de- 
pressed action ;  and  Dr.  Lombard  truly  observes,  that  it  is  rarely 
efficacious  in  those  who  take  much  exercise,  or  whose  attention  is 
much  occupied  during  its  use.  Dr.  Munk  gives  ^x.  ad  xxx. 
every  eight,  ten,  or  twelve  hours,  and  is  rarely  disappointed.  He 
does  not  reduce  the  pulse,  which  is  to  be  carefully  watched,  below 
60  in  the  adult,  and  thus  derives  the  beneficial  without  risking  the 
production  of  the  dangerous  effects. 

Digitalis  rarely  acts  as  a  diuretic  when  its  influence  upon  the  heart 
is  marked,  and  vice  versa.  The  author  quite  concurs  in  the  high 
opinion  Withering  entertained  of  its  power  of  increasing  the  flow 
of  urine,  which  is  seldom  accomplished  by  any  other  drug  after  its 
failure.  It  is  not  to  the  robust,  fiorid,  or  wiry-pulsed,  but  to  the  en- 
feebled, shattered,  condition  of  the  system,  that  digitalis  is  applicable. 
*'If  the  pulse  be  feeble  or  intermitting,  the  countenance  pale,  the 
lips  livid,  the  skin  cold,  the  swollen  belly  soft  and  fluctuating,  or  the 
anasarcous  limbs  readily  pitting  on  pressure,  we  may  expect  the 
diuretic  effects  to  follow  in  a  kindly  manner,"  These  remarks  were 
penned,  it  is  true,  in  reference  to  dropsy,  from  whatever  cause 
arising;  but  mutatis  mutandis,  they  are  equally  applicable  to  all 
cases  in  which  the  diuretic  operation  of  foxglove  is  required.  In 
disease  of  the  heart,  a  diuresis  is  frequently  a  valuable  means  of 
preventing  effusions  by  diminishing  congestion,  or  of  producing 
their  absorption  if  they  have  already  occurred  ;  but  whether  digitalis 
be  the  appropriate  remedy  or  not,  depends  in  chief  upon  whether  a 
sthenic  or  asthenic  condition  of  the  system  prevail.  Thus  in  the 
case  of  hypertrophy,  it  is  seldom  apprfpriate,  while  in  dilatation  it 
is  usually  the  best  of  diuretics.  Valvular  disease  is  that  in  which 
digitalis  proves  most  useful,  except  in  cases  in  which  this  is  compli- 
cated with  hypertrophy.  The  infusion  is  to  be  given  in  doses  of 
ss.  to  j.  every  six  or  eight  hours.  With  a  view  of  preventing 
the  sedative  operation  of  the  drurj,  moderate  exercise,  short  of 
diaphoresis,  should  when  possible  be  taken.  A  moderate  quantity 
of  drink  may  be  given,  and  the  loins  must  be  covered  with  a  double 


KSl.j.J  XcurJiria.    407 


roll  of  flannel,  or,  as  recommended  by  Lombard,  a  stimulating  plaster 
may  be  applied  to  them. 

Dr.  Munk  believes  that  untoward  and  fatal  effects,  resulting  from 
the  continued  employment  of  this  medicine,  are  "  exceedingly  rare," 
and  cites  the  opinions  of  Drs.  Holland  and  Pereira  as  confirmatory 
of  his  own. 

"It  has  only  occurred  to  me  to  see  the  slighter  and  less  porten- 
tous of  these  symptoms  as  a  consequence  of  foxglove ;  such  as 
inequality  or  intermittence  of  the  pulse,  loss  of  appetite,  and  frontal 
headache  :  either  or  all  of  which  have  at  once  subsided  on  discon- 
tinuing the  medicine.  I  believe  that  such  symptoms  will  only  occur 
when  the  drug  fails  to  act  in  a  normal  manner  as  a  sedative  or  a 
diuretic.  If  cither  of  these  effects  are  once  obtained  in  a  kindly 
manner,  I  then  consider  my  patient  safe  from  the  poisonous  opera- 
tion of  the  drug.  If  on  the  contrary,  it  does  not  evidence  its  usual 
effects  within  a  ^e\v  days,  the  medicine,  I  believe,  accumulates  in 
the  system,  and  the  patient  is  in  danger  of  experiencing  its  poison- 
ous influence.  I  am  therefore  in  the  habit  of  prescribing  it  for  a 
week  :  and,  if  within  that  period,  I  perceive  neither  sedative  or  diur- 
etic effects,  I  then  invariably  desist  from  its  administration.  Let 
these  effects,  however,  be  once  kindly  indiced  and  the  medicine  may 
then  be  continued  with  safety  for  a  considerable  period.  In  no  one 
instance  have  I  seen  a  bad  effect  follow'the  use  of  digitalis  where 
the  first  consequences  of  its  exhibition  were  the  removal  or  material 
alleviation  of  prominent  or  distressing  cardiac  symptoms,  whether 
this  has  been  brought  about  by  its  operation  as  a  sedative  or  as  a 
diuretic."  Med.  Chir.  Rev. 


Neuralgia  Introduction  of  Medicated.  Fluid  to  the  Nerve.  By 
Mr.  Ryxd.  (Reported  by  Mr.  Richard  Gregory*)  Margaret  Cox, 
fEtat.  59,  of  spare  habit,  was  admitted  into  the  hospital,  May'lSth, 
1844.  complaining  of  acute  pain  over  the  entire  of  left  side  of  face, 
particularly  in  the  supra-orbital  region,  shooting  into  the  eye,  along 
the  branches  of  the  portio  dura  in  the  cheek,  along  the  gums  of  both 
upper  and  lower  jaw,  much  increased  in  this  situation  by  shiitting 
the  mouth  and  pressing  her  teeth  close  tofiether,  and  occasionally 
darting  to  the  opposite  side  of  the  face  and  to  the  top  and  back  of 
her  head.  She  states  that  about  six  years  ago  she  fell  from  a  wall, 
and,  in  the  act  of  falling,  a  stone  struck  her  in  the  temple;  that 
twelve  months  after  this  she  was  much  exposed  to  cold,  and  one  night 
was  suddenly  seized  with  the  most  agonizing  pain  in  the  si.tuations 
above  dosrrribod.  "She  thought  her  eve  was  being  torn  out  of  her 
head,"  and  her  cheek  fiom  her  face;  it  lasted  about  two  hours,  and 
then  suddenly  disappeaied  on  taking  a  mouthtul  of  ice.  Slie  had 
not  had  any  return  for  three  months,  when  it  came  back  even  worse 


Menth  Flospital  zul  County  of  Dublin  Infirmary. 


408  Neuralgia.    [July, 


than  before,  quite  suddenly,  one  night  on  going  out  of  a  warm  room 
into  the  cold  air.  On  this  attack  she  was  seized  with  chilliness,  shiv- 
ering, and  slight  nausea  ;  the  left  eye  lachrymated  profusely,  and 
became  red  with  pain  ;  it  went  in  darts  through  her  whole  head,  face 
and  mouth,  and  the  parox)'sm  lasted  for  three  weeks,  during  which 
time  she  never  slept.  She  was  bled  and  blistered,  and  took  opium  for 
it,  but  without  relief.  It  continued  coming  at  irregular  intervals,  but 
each  time  generally  more  intense  in  character,  until  at  last,  weary 
of  existence,  she  came  to  Dublin  for  relief. 

She  had  been  salivated  three  times,  and  had  been  so  much  in  the 
habit  of  taking  laudanum  that  latterly  half  a  drachm,  three  times  in 
the  day,  had  no  effect  in  lulling  the  pain,  and  was  the  quantity  she 
commonly  took.  She  was  a  miserable,  sallow-complexioned  looking 
creature,  had  been  sleepless  for  months,  and  her  face  was  furrowed 
with  constant  pain. 

On  the  3d  of  June  a  solution  of  fifteen  grains  of  acetate  of  mor- 
phia, dissolved  in  one  drachm  of  creosote,  was  introduced  to  the 
supra-orbital  nerve,  and  along  the  course  of  the  temporal,  malar,  and 
buccal  nerves,  by  four  punctures  of  an  instrument  made  for  the  pur- 
pose. In  the  space  of  a  minute  all  pain  (except  that  caused  by  the 
operation,  which  was  very  slight)  had  ceased,  and  she  slept  better 
that  night  than  she  had  done  for  months.  After  the  interval  of  a 
week  she  had  slight  return  of  pain  in  the  gums  of  both  upper  and 
under  jaw.  The  fluid  was  again  introduced  by  two  punctures  made 
in  the  gum  of  each  jaw,  and  the  pain  disappeared.  After  this  the 
pain  did  not  recur,  and  she  was  detained  in  the  hospital  for  some 
weeks,  during  which  time  her  health  improved,  her  sleep  was  restored, 
and  she  became  quite  a  happy  looking  person.  She  left  the  hospital 
on  the  1st  of  August  in  high  spirits,  and  promised  to  return  if  she 
ever  felt  the  slightest  pain  again.  We  conclude  she  continues  well, 
for  we  have  not  heard  from  her  since. 

Case  II.  R.  Dolon,  a3tat.  28,  a  thin  spare  man,  of  middle  stature, 
was  admitted  into  the  hospital  9th  September,  1844,  and  came  under 
Mr.  Rynd's  care  on  the  10th  of  November,  complaining  of  acute 
pain  in  the  right  hip,  thigh,  and  leg,  to  the  sole  of  the  foot,  along  the 
entire  course  of  the  sciatic  nerve  and  its  branches,  but  chiefly  in  the 
main  trunk  of  the  nerve.  He  is  unable  to  sleep  from  the  pain,  and 
quite  unable  to  walk.  He  is  much  emaciated,  and  the  muscles  of 
the  limb  are  attenuated  and  wasted.  He  has  been  ill  for  three  years, 
during  which  time  he  has  been  almost  always  confined  to  bed.  He 
has  been  frequently  treated  for  the  disease  with  calomel,  to  produce 
salivation,  cupping,  blistering,  leeching,  &:c.,  all  without  any  salutary 
effect.  Exposure  to  cold  and  wet  is  assigned  as  the  cause  of  the 
disease. 

On  the  13th  of  November,  the  fluid  was  introduced,  ten  grains 
acetatis  morphite  to  the  drachm  of  creosote,  one  puncture  behind  the 
trochanter,  and  one  half-way  down  the  thigh.  He  was  instantly  re- 
lieved from  pain,  and  walked  steadily  through  the  ward  without  any 


1845.]  yeuralgia.  409 


pain  or  difBculty  ;  before,  walking  increased  the  pain.  For  about 
half  an  hour  after  the  operation  he  felt  uneasiness  from  the  puncture. 

16th.  Says  he  is  perfectly  well  in  the  thigh,  and  feels  only  a  slight 
pain  in  the  course  of  the  anterior  tibial  nerve.  The  fluid  was  again 
introdaced"to-day  to  the  seat  of  pain  by  two  punctures  ;  it  disappeared 
as  before. 

29th.  Says  he  is  perfectly  well ;  has  walked  every  day  since  ;  has 
slight  stiffness  in  the  knee  from  previous  want  of  use. 

Ordered,  camphorated  oil  to  rub  the  knee  with. 

December  15th,  Left  the  hospital  to-day,  saying  he  felt  perfectly 
free  from  all  pain  and  uneasiness. 

February  6th.  He  walked  up  to  Dublin  to-day  (twenty  miles),  and 
says  that  since  the  last  operation,  on  the  IGth  of  November,  he  has 
never  felt  his  old  pain,  and  is  perfectly  well. 

ADDITIONAL  TESTIMONY. 

Gentlemen,  I  observed  in  the  Medical  Press,  March  12,  two 
cases  of  neuralgia,  treated  by  Mr.  Rynd  in  the  Meath  Hospital,  by  a 
new  method  of  introducing  morphine  and  creosote  to  the  nerve 
affected;  the  result  proved  most  satisfactory.  It  had  been  my  in- 
tention long  since  to  have  sent  you  an  account  of  some  cases  treated 
by  me  during  the  last  summer  in  a  similar  manner,  and  with  most 
happy  results,  but  much  occupation  this  winter  prevented  my  doing 
so.  I  hope,  also,  on  a  future  occasion,  to  send  you  some  cases  of 
other  diseases,  such  as  dyspepsia,  hooping-cough,  &;c.,  treated  with 
proto-iodide  of  silver  a  remedy  I  believe  hitherto  little  used. 

Case.  Last  summer,  an  elderly  female,  much  emaciated,  and 
with  countenance  indicative  of  much  pain  and  suffering,  was  sent 
up  by  her  medical  attendant  from  the  country  for  the  purpose  of  sea- 
bathing. She  had  had  severe  neuralgia  of  the  nerves  on  outer  side 
of  leg,  shooting  from  her  knee  to  her  ankle  and  foot.  She  had  been 
subjected  to  a  variety  of  treatment,  such  as  leeches,  blisters,  an  in- 
cision down  to  nerve,  and  cutiing  it  across,  &;c.  She  was  quite 
lame  when  I  saw  her,  and  it  hurt  her  much  to  put  her  foot  to  the 
ground  ;  she  suffered  greatly  at  night,  and  could  not  sleep.  She  had 
been  here  some  time,  and  had  bathed  without  any  benefit.  I  made 
several  small  punctures  along  the  course  of  the  nerve  affected.  I 
used  a  common  lancet,  armed  with  morphine,  mixed  in  a  little  water, 
about  the  consistence  of  paste,  and  operated  precisely  as  is  done  in 
vaccinating  an  infant;  1  did  not  use  creosote  with  it.  She  felt  slight 
stinging  and  uneasiness  for  a  short  time  after,  but  that  night  she 
slept  well,  and  next  day  stated  that  the  pain,  with  the  exception  of 
one  or  two  spots,  was  quite  gone.  I  punctured  in  these  places  again. 
She  again  recovered. 

On  inquiring  from  her  friends  a  short  time  since,  I  heard  she  has 
continued  in  good  health  ever  since  a  period  of  nearly  nine  months. 

I  adopted  the  same  mode  of  treatment  in  a  case  of  sciatica  with 
similar  success.  In  another  bad  case  of  neuralgia  in  the  foot  and 
leg  in  a  man  who   had  been  subjected  to  a  variety  of  most  active 


410  Toolh-Ache  Jaundice  Febrile  Periodicity,  (^'C.      [July, 


treatment  in  hospital,  and  with  very  little  benefit,  I  determined  on 
using  creosote  wilhout  morphine.  I  had  not  heard  of  its  being  used 
before  until  1  read  of  it  in  the  Press  as  used  by  Mr.  Rynd,  but  in 
his  case  he  mixed  it  with  morphine.  It  was  of  decided  benefit  in 
my  case,  and  the  man  has  been  able  to  go  to  his  work,  and  has  con- 
tinued well  to  this  time  a  period  of  about  seven  months. 

As  neuralgia  is  a  disease  that  so  frequently  bafiles  the  skill  of  the 
physician,  I  think  it  is  not  unworthy  of  the  profession  to  give  this 
mode  of  treatment  a  trial,  and  I  should  much  like  to  know  whether  it 
has  as  yet  been  much  adopted. 

I  beg  to  remain,  gentlemen, 

Your  obedient  servant, 

ARTHUR  GUINxNESS. 
Dublin  Med.  Press. 


Caouichouc  as  a  Remedy  for  Toofk-acJie.  Caoutchouc  becoming 
very  smooth  and  viscous  by  the  action  of  fire,  has  been  proposed  by 
Dr.  Rolfis  as  an  excellent  remedy  for  filling  hollow  teeth  and  allevia- 
ting the  toothache  proceeding  from  that  defect.  A  piece  of  caoutch- 
ouc is  to  he  put  on  a  wire,  then  melted  at  the  flame  of  a  candle  and 
pressed,  while  warm,  into  the  hollow  tooth,  and  the  pain  will  disap- 
pear instantly.  The  cavity  of  the  tooth  should  first  be  cleaned  out 
with  a  piece  of  cotton.  In  consequence  of  the  viscosity  and  adhe- 
siveness of  the  caoutchouc,  the  air  is  completely  prevented  from 
coming  in  contact  with  the  denuded  nerve,  and  thus  the  cause  of  the 
toothache  is  destroyed.  Brail hwaite's  Retrospect. 

Jaundice.  The  Gazette  Medicale  (April,  1845,)  contains  a  notice 
of  M.  de  Lonjon's  researches  on  the  diagnosis  of  Icterus,  from  which 
it  appears  that  he  has  ascertained  that,  besides  the  usual  yellow  tint 
j)resented  by  the  mucous  lining  of  the  mouth,  this  is  strongly  mani- 
fested, even  in  the  slightest  cases  of  this  disease,  in  the  soft  palate,  or 
velum  pendulum  palati,  from  its  posterior  margin  to  its  juncture  with 
the  bony  roof  of  the  mouth.  D. 


Febrile  Periodicity,  as  influenced  by  the  Sulphate  of  Quinine. 
By  Thos.  D.  Mitchell.  M.I).,  Prof.  Mat.  3Ied.  and  Therap.,  in 
Transylvania  University.  But  a  few  years  ago,  the  therapeutical 
application  of  th.s  invaluable  salt  of  Peruvian  bark,  was  exceedingly 
limited  ;  and  with  some,  even  at  tliis  day,  it  is  held  to  be  competent, 
as  a  remedy,  only  to  true  intermitting  ^ever,  or  ague  and  fever. 

The  doctrine,  that  all  fevers  and  all  diseases,  are  essentially  inter- 
mittent, has  long  been  before  the  public;  and  while  we  are  ignorant 
of  the  nature  and  source  of  periodicity,  theyV/ci  of  intermittence  is 
as  well  established,  as  any  other  in  medicine.  And  although  a  latewri- 
ter  has  asserted   l^oltily,   and   without  exception,    that    Therapeutics 


1645.]       Tracheotomy,  in  a  case  of  (Edema  of  the  Glottis.  Ill 


cannot  be  based  on  Pathology,  we  aver  as  po^itivel3\  that  the  direct 
opposite  is  true.  We  believe,  especially  in  reference  to  fevers,  almost 
without  exception,  that  they  are  curable  by  sulphate  of  quinine, 
simply  and  solely,  because  it  is  a  remedy,  al)ove  all  others,  adapted 
to  diseases  of  an  intermittent  and  remittent  character;  their  terms 
being  substantially,  and  in  fact,  as  to  periodicity,  the  same. 

In  regard  to  the  Pathology  of  Fevers,  we  know  almost  nothing, 
perhaps  nothing  at  all.  that  is  practically  of  the  smallest  value,  save 
the  naked  fact  of  intermittence  or  periodicity.  This  is  cognisable 
when  we  can  scarcely  lix  upon  another  point,  that  is  worthy  of  notice 
or  remark. 

We  cure  an  ague  and  fever,  by  sulphate  of  quinine,  no  matter 
whether  it  be  a  true  and  open  ague,  or  a  masked  intermittent.  And 
we  cure  many  diseases  of  genuine  neuralgia,  unattended  by  chill  or 
fever,  at  all  perceptible,  by  the  same  agent.  These  are  common 
cases,  with  which  all  practitioners  are  familiar,  and  they  clearly  set 
forth  the  adaptation  of  the  remedy,  on  the  ground  of  intermittence. 

But  if  we  look  a  little  further,  wesliall  discover,  that  other  fevers, 
called  by  different  names,  merely  to  subserve  the  interests  of  theory, 
possess  one  common  property,  which,  confessedly  under  the  control 
of  the  sulphate  of  quinine  in  the  case  of  common  ague  and  fever,  is 
no  less  so  in  Typhoid,  Typhus,  Congestive,  Yellow,  and  it  may  be, 
all  the  fevers  named  in  the  books. 

The  position  I  assume  here,  is  plainly  and  boldly  this  :  there  is  hut 
one  feature  or  element  in  either  of  the  fevers  named,  that  is  essential 
ioi's  pathology,  and.  that  feature  or  property  or  element  hows  before 
the  potent  sicay  of  the  sulphate  of  quinine,  and  for  this  reason  only, 
we  cure  the  patient.  Wesiern  Lancet, 


Tracheotomy,  performed  successfully  in  a  case  of  Oedema  of  the 
Glottis  translated  from  the  Bulletin  de  Therapeutique.  On  the  23d 
March,  1845,  Sageot,  while  in  the  Hopital  du  Midi,  into  which  he 
had  been  admitted  on  February  1st,  was  taken  with  a  quinsey,  appa- 
rently slight,  and  which  for  three  days  caused  only  a  slight  difficuky 
of  deglutition.  On  the  mornino:  of  the  27th,  an  inconsiderable 
febrile  movement  occurred,  with  loss  of  appetite;  soon  dyspnoea 
supervened,  and  increased  suddenly  in  the  evening  to  a  frightful  de- 
gree. The  patient,  in  a  sitting  attitude,  makes  unheard  of  efforts  to 
inspire  air  which  penetrates  with  a  whistling  sound  the  voice  is 
nearly  extinct  expiration  is  easy;  on  inspection,  a  slight  tumefac- 
tion of  the  amygdalffi  is  found,  with  redness  of  the  mucous  mem- 
brane. The  finger  carried  deeply  into  the  pharynx,  discovers  in  the 
vicinity  of  the  arytaeno-opiglottic  dnplicatures.  a  soft  tumour,  yielding 
to  pressure.  This  tumour  is  incised  with  the  point  of  a  bistour}'',  and 
from  it  only  a  few  drops  of  blood  escape.      Suffocation  becoming  more 


412  Gazenave  on  Caustics.  [July, 


and  more  imminent,  M.  Ricord  is  sent  for  at  10  o'clock,  P.  M.;  finding 
the  patient  with  his  face  of  a  violet  color,  the  extremities  cold,  the  pulse 
very  frequent  and  very  small,  and  the  pupils  enormously  dilated,  that 
surgeon,  after  having  again  recognised  the  existence  of  the  supra- 
epiglottic  tumour,  determined  to  perform  tracheotomy.  The  incision 
was  made  in  the  crico-thoroid  membrane  and  in  the  cricoid  cartilage, 
the  lips  of  the  wound  were  kept  separate  by  hooks  fixed  by  means  of 
a  riband  behind  the  neck.  Respiration  was  immediately  re-estab- 
lished, and  in  an  hour  the  patient  slept  quietly.  The  pulse  having 
risen  three  hours  afterwards,  M.  Ricord  prescribed  twelve  leeches, 
six  on  each  side  in  the  vicinity  of  the  jugular  veins.  April  4th,  the 
supra-epiglottic  tumour  presents  but  a  very  small  volume,  and  the 
canula,  which  on  the  29th  March  had  been  substituted  for  the  hooks 
was  withdrawn,  and  the  patient  was  much  improved  after  the  extrac- 
tion of  the  canula.  On  the  following  days  the  opening  made  in  the 
trachea  diminished  more  and  more  in  extent,  respiration  and  deglu- 
tition are  performed  without  any  pain  or  embarrassment,  and  on  the 
12th  April  the  patient  was  perfectly  cured.  N. 


31.  Cazenave  on  the  different  sorts  of  Caustics.  The  Poicder  of 
Dupuytren,  is  composed  of  one  part  of  arsenious  acid  and  200  parts  of 
calomel.  It  is  a  mild  and  very  manageable  caustic,  that  is  useful  in 
cases  of  lupus  in  women  and  children,  when  the  ulceration  is  super- 
ficial and  of  limited  extent.  If  the  diseased  part  be  dry,  it  may  be 
necessary  to  denude  it  by  means  of  a  blister,  and  then  to  sprinkle  the 
powder  upon  the  raw  surface.  A  certain  amount  of  heat  and  painful 
swelling  is  usually  caused  by  this  application.  When  it  falls  off,  there 
is  generally  observed  a  decided  modification  of  the  diseased  surface. 
A  few  applications  are  sufficient  to  effect  a  cure  in  a  great  many 
instances. 

The  Vienna  power  and  paste  are  remedies  of  great  power  in  cer- 
tain cases  of  lupous  ulceration.  They  are  composed  of  equal  parts 
of  powdered  quicklime  and  potnssa  cum  calce.  In  using  it,  we  take  a 
portion  of  this  mixture,  and  add  a  small  quantity  of  spirits  of  wine  to 
bring  the  powder  to  the  consistence  of  a  paste.  A  piece  of  adhesive 
plaster,  with  a  hole  in  it  of  the  size  of  the  intended  eschar,  should  he 
laid  over  the  diseased  surface,  and  the  paste  is  then  applied  on  the 
exposed  parts.  It  is  to  be  \ei\  for  ten  or  twenty  minutes,  according 
to  the  depth  of  the  eschar  that  is  wished,  and  the  ability  of  the  pa- 
tient to  endure  the  pain. 

The  chJoruret  of  zinc  paste  is  much  used  in  the  presenr  day.  It  is 
made  by  mixing  one  part  of  this  substance  with  one  or  two  parts  of 
flour,  moistening  the  mixture  with  as  little  water  as  possible.  The 
pain  produced  by  this  application  usually  lasts  for  several  hours.     A 


Id  15. J  Cazenave  on  Caustics.  413 


greyish-coloured  eschar  is  formefl ;  and  this,  in  most  cases,  remains 
attached  for  two  or  three  weeks  hefore  it  is  separated.  The  surface 
underneath  is  generally  not  ulcerated.  M.  Cazenave  very  frequently 
has  recourse  to  this  caustic  in  certain  cases  of  lupus,  to  destroy  the 
non-ulcerated  tubercles. 

For  this  purpose  he  applies  only  a  very  thin  layer  of  the  paste,  so 
as  not  to  destroy  the  entire  tubercle  ;  and  in  this  manner  he  often 
succeeds  in  effecting  a  complete  resolution  of  it,  without  any  scar 
being  left  behind. 

In  very  many  cases  of  long  standing  and  deeply-corroding  lupous 
ulceration,  he  gives  the  preference  to  the  arsenical  paste  over  the 
two  others  which  we  have  mentioned  :  its  action  is  twotold  ;  local  as 
a  caustic;  and  general  by  becoming  absorbed,  and  exercising  a  po- 
tent alterative  or  modifying  influence  upon  the  economy.  The  fol- 
lowing is  the  formula  which  he  invariably  uses  : 

Take  of  White  oxyde  of  arsenic,  2  parts. 
Sulphate  of  mercury,  1  part. 
Animal  charcoal  in  powder,  2  parts. 

When  used,  a  small  quantity  of  this  powder  is  to  be  made  into  a 
thin  paste  by  the  addition  of  a  few  drops  of  water ;  this  is  put  upon 
the  denuded  surface  which  should  seldom  or  never  exceed  in  extent 
that  of  a  franc-piece.  This  application  usually  produces  not  only 
very  sharp  pain,  but  also  a  severe  erysipelatous  swelling,  which  lasts 
for  24  or  36  hours,  and  is  sometimes  accompanied  with  grave  consti- 
tutional symptoms.  GeneraMy  these  siibside  very  quickly  ;  and  then 
there  remains  on  the  cauterized  part  a  hard  brown  crust  which  often 
adheies  for  nearly  a  month,  before  it  is  detached. 

Fluid  Caustics.  M.  Cazenave  frequently  makes  use  of  a  solution 
of  the  sulphate  of  copper  for  the  removal  of  those  small  warts  that 
"Dften  form  upon  the  shoulders  and  back,  also  of  certain  pediculated 
horny  productions,  which  occasionally  appear  upon  these  parts.  A 
stronger  solution  must  be  used  for  the  latter  form  of  cuticular  excre- 
scence. 

In  the  treatment  of  favus  and  tinea,  he  recommends  a  weak  solu- 
tion either  of  this  salt  of  copper,  or  of  the  nitrate  of  silver,  or  of 
acetic  acid. 

Of  fluid  caustics,  one  of  the  most  potent  and  useful  is  the  acid  nitrate 
of  mercury.  When  used  to  the  surface  pure  and  undiluted,  it  acts 
as  a  mere  caustic  ;  but  when  considerably  weakened,  and  especially 
when  applied  to  a  large  surface,  it  is  unquestionably  absorbed,  and 
then  it  acts  on  the  system. 

It  usually  causes  a  good  deal  of  pain  and  inflammatory  swelling. 
The  cases  most  benefitted  by  its  application  are  those  of  lupus,  in 
which  the  ulceration  is  extensive  and  not  deep-seated. 

The  erysipelatous  inflammation,  which  this  as  well  as  other  caus- 
tics more  especially  the  arsenical  paste  are  apt  to  produce,  need 
not  be  much  dreaded  ;  nay,  the  effects  of  the  cutaneous  phlegmasia 
seem  sometimes  to  be  decidedly  salutary  in  the  end.  AnnaJes  ties 
Maladies  de  la  Peau. 


414  Tuhercular  Lip,  ^^c.  Spasmodic  Strictures.  [Jiily 


M.  Gibert  has  recorded  in  a  recent  No.  (Oct.,  1844)  of  the  Revue 
Medicale,  a  case  of  severe  scrofalous  lupus  of  the  face,  in  which  the 
progress  of  the  disease  was  arrested  and  the  extensive  ulcerated  sur- 
face became  cicatrized  under  the  employment,  external  as  well  as 
internal,  of  cod-liver  oil.  The  use  of  this  medicine  was  steadily  per- 
severed in  for  a  full  year  and  a  half.  During  this  time  not  only  did 
the  local  malady  become  healed,  but  the  general  health  which  had 
formerly  been  very  weak  and  ailing  was  very  decidedly  improved. 

The  patient  was  a  young  woman,  and  the  disease  had  existed  for 
nearly  six  years.  On  one  occasion  she  had  derived  very  considera- 
ble benefit  from  the  internal  administration  of  the  deuto-ioduret  of 
mercury,  and  the  external  use  of  the  proto-ioduret  ointment;  but  the 
benefit  was  temporary  only.  She  had  been  subjected  to  a  regular 
and  protracted  course  of  iodine  treatment ;  but  certainly  with  no 
advantajre.  Med.  Chir.  Rev. 


Tuhercular  ihicJcening  of  the  Lip,  successfully  treated  by  Iodide 
of  Potassium.  By  Alexander  Ure.  Mrs.  H.,  aged  28,  admitted 
the  16th  Sept.,  1844.  The  upper  lip  is  greatly  enlarged  and  promi- 
nent;  its  external  surface  is  the  seat  of  superficial  ulcers,  for  the 
most  part  covered  with  crusts.  The  afl^ection  commenced  six  months 
previously,  as  a  hard  round  swelling  in  the  right  side  of  the  lip,  unat- 
tended with  discoloration.  The  swelling  subsequently  extended  over 
the  whole  lip,  and  is  always  most  conspicuous  in  the  morning.  
Several  indurated  tubercles  can  be  felt  imbedded  throughout  its  sub- 
stance. States  that  her  general  health  is  good.  Her  tongue  is  clean, 
but  the  pulse  is  rather  frequent,  and  she  complains  of  thirst. 

Ordered  a  solution  of  Epsom  Salt  and  Tartar  Emetic  twice  a  day; 
and  to  pencil  over  the  excoriated  surface  every  morning  with  a  lotion 
containing  ten  grains  of  Nitrate  of  Silver  dissolved  in  an  ounce  of 
pure  water. 

23d.  Sores  are  all  healed,  but  the  swelling  remains  as  before. 

To  take  five  grains  of  Plummer's  Pill,  night  and  morning. 

27th.  No  change  in  the  condition  of  the  lip. 

Ordered  five  giains  of  the  Iodide  of  Potassium,  dissolved  in  water, 
twice  daily. 

Oct.  4.  The  swelling  is  considerably  diminished ;  the  tubercles 
much  lessened  in  size. 

To  continue  the  Iodide  of  Potassium. 

8th.  Tumefaction  quite  gone;  no  tubercles  to  be  felt. 

The  above  case  exemplifies,  in  a  striking  manner,  the  power  of 
iodide  of  potassium  in  promoting  the  absorption  of  a  variety  of  tu- 
bercular deposition,  which  seemed  to  bear  some  resemblance  to  ele- 
phantiasis in  its  primal  stage.  Med.  Gaz. 


Spasmodic  Strictures  of  the  Urethra.  The  'Archives  Medicales' 
for  February,  1845,  contains  an  able  article  on  the  subject  of  spas- 
modic strictures  of  the  urethra,  by  M.  Gossclin,  one  of  the  'agreges' 


1845.]  Stalistics  Mi  J  wives  in  Paris  Medical  Intelligence.       415 


of  the  Faculty  of  Paris.  M.  G.  arrives  at  the  following  conclusions  : 
1st,  That  anatomy  forl)ids  the  belief  that  spasmodic  strictures  can 
exist  in  any  other  than  the  membranous  portion  of  the  urethra ; 
2d,  That  the  arguments  of  authors  opposed  to  this  view,  are  very 
weak;  3d,  That  facts  authorize  their  admission  only  in  such  cases 
where  already  exists  an  organic  stricture,  or  gonorrhoea.  D, 


Medical  Statistics.  It  appears  from  the  Medical  statistics  of 
France,  published  by  M.  Lucas  Champoniere,  that  there  are  in  that 
kingdom  18,800  Doctors  of  Medicine,  or  one  to  every  1810  inhabit- 
ants ;  besides  8,088  sub-physicians  termed  '  officiers  de  sante."  That 
the  number  of  the  latter  class  of  practitioners  is  diminishing  whilst 
that  of  the  former  is  on  the  increase.  In  the  course  ol  the  last  nine 
years  the  Degree  of  M.  D.  has  been  conferred  on  4,774  persons,  and 
2,616  "officiers  de  sante"  have  been  licensed.  D. 

Gaz.  Med.,  Afril,  1845. 


Instruction  of  Midwives  in  Paris.  According  to  the  new  regula- 
tions regarding  the  instruction  of  Midwives  in  Paris,  it  is  required 
that  they  shall  present  testimonials  of  good  character,  be  at  least 
eighteen  years  of  age,  and  be  able  to  read  and  write  correctly  the 
French  language,  before  they  nan  be  admitted  to  the  clinical  lying- 
in  hospital.  It  is  only  after  having  diligently  attended  this  institution 
for  twelve  months,  and  taken  two  full  courses  of  lectures  on  the 
Theory  and  Practice  of  Mid.vifery,  that  they  can  present  themselves 
as  candidates  for  the  Defjree.  D. 


MEDICAL  INTELLIGENCE. 

Extract  of  a  Utter  from  John  McLester,  M.  D.,  late  Danonstrator  of  Anatomy  in 
the  Medical  College  of  Georgia. 

Paris,  March  30th,  1845. 
Longei's  lectures  on  the  Anatomy  and  Physiology  of  the  Nervous  System, 
with  vivisections,  are  extremely  interesting.  He  has  devoted  himself  to  this 
branch  of  science  for  several  years,  and  at  this  time,  is  unequalled  in  it.  His 
demonstrations  are  admirable,  and  by  varying  his  experiments  in  almost  every 
possible  manner,  he  has  made  sorne  discoveries,  and  exposed  the  errors  of 
Majendie,  Marshall  Hall,  Charles  Bell,  and  others.  I  saw  him  demonstrate 
the  existence  of  an  electrical  current  in  the  muscular  tissues  in  the  following 
manner :  He  stripped  the  skin  off  the  inferior  extremities  of  some  frogs,  decapi- 
tated  at  the  moment,  then  cut  the  thighs  off  close  to  the  body,  separating  them 


416 


Meteorological  Observations. 


from  the  legs,  by  carefully  disarticulating  the  knee  joint.  Five  thighs  thus  pre- 
pared, were  arranged  in  a  semicircular  manner,  with  the  lower  end  of  one, 
stuck  in  among  the  muscles  of  the  upper  extremity  of  another,  and  so  on.  The 
battery  being  thus  completed,  he  used  bits  of  moistened  paper,  or  wire  for  con- 
ductors, and  by  operating  on  the  sciatic  nerve  of  another  frog,  contractions  were 
produced,,  precisely  similar  to  those  caused  by  galvanism.  This  current  runs 
from  the  centre  towards  the  extremities.  These  experiments,  though  cruel,  are 
extremely  interesting.  Most  of  them  are  easy  of  performance,  and  with  proper 
precaufions,  are  highly  satisfactory  and  conclusive.  Longet's  dissections  of  the 
brain,  spinal  marrow,  and  nerves,  are  superior  to  any  I  have  seen.  His  work 
on  this  subject  is  the  best  extant.  *******  Foville  is  publishing 
a  work  on  the  Anatomy,  Physiology,  and  Pathology  of  the  Cerebro-spinal  Sys- 
tem of  Nerves,  in  three  volumes,  with  an  atlas  of  twenty-three  plates.  The 
first  volume  and  the  atlas  are  published.  It  is  said  to  be  an  excellent  work, 
***********  Ricord  is  publishing  his  cliniquc,  accompa- 
nied by  fifty  or  sixty  plates,  in  quarto,  colored.  The  work  is  said  to  be  nearly 
completed,  and  will  cost  ninety  francs.  It  is  said  he  has  changed  his  opinions 
in  some  respects,  since  the  publication  of  his  former  work. 


METEOROLOGICAL  OBSERVATIONS,  for  Mav,  1845,  at  Augusta, 
Latitude  33=*  27'  north Longitude  4*=*  32'  west  Wash. 


Ga. 


Thermomkter. 
Sunrise.    4,  p.  m. 

Barometer. 
Sunrise.    4,  p.m 

Wind. 

Remarks. 

~r 

62 

85 

30  in. 

29  9-10 

S.  E. 

Fair. 

2 

64 

79 

29  8-10 

29  8-10 

N.  W. 

Cloudy thunder. 

3 

65 

86 

29  8-10 

29  8-10 

N.  W. 

Variable.                                  o 

4 

65 

88 

29  8-10 

29  8-10 

s.  w. 

Variable. 

5 

67 

87 

29  8-10 

29  8-10 

s.  w. 

Variable thunder  and  light'g. 

f) 

70 

83 

29  7-10 

29  7-10 

s.  w. 

Cloudy. 

7 

62 

83 

29  7-10 

29  6-10 

w. 

Fair. 

8 

53 

78 

29  8-10 

29  9-10 

N. 

Fair. 

9 

47 

78 

30  in. 

30 

S.    E. 

Fair. 

10 

51 

82 

30 

30 

S.  E. 

Fair. 

11 

60 

79 

30 

29  9-10 

E. 

Cloudy.                [1  5-10  inches. 

12 

62 

74 

29  8-10 

29  8-10 

N.    E. 

Commenced  to  rain  at  4,  p.  m., 

13 

65 

78 

29  8-10 

29  8-10 

N.  W. 

Variable. 

14 

62 

84 

29  8-10 

29  7-10 

s.  w. 

Variable. 

15 

63 

62 

29  5-10 

29  5-10 

N. 

Clear rain  last  night  1 3-10  in. 

16 

53 

66 

29  6-10 

29  6-10 

N.  W. 

Fair. 

17 

47 

72 

29  7-10 

29  7-10 

W. 

Fair. 

18 

49 

80 

29  8-10 

29  8-10 

w. 

Fair. 

19 

52 

83 

29  8-10 

29  8-10 

.^.  w. 

Fair. 

20 

56 

86 

29  8-10 

29  8-10 

s.  w. 

Fair. 

21 

62 

86 

29  8-10 

29  8-10 

K.  E. 

Cloudy,  and  thunder, 

22 

62 

8G 

29  8-10 

29  7-10 

S.  E. 

Misty  in  morning. 

23 

65 

88 

29  6-10 

29  6-10 

W. 

Variable. 

24 

66 

74 

29  .5-10 

29  6-10 

N. 

CJoudy  a  little  rain. 

25 

59 

74 

29  8-10 

29  8-10 

N.   I-. 

Variable. 

26 

50 

78 

29  8-10 

29  8-10 

S. 

Fair. 

27 

53 

80 

29  8-10 

29  8-10 

E. 

Fair. 

28 

60 

82 

29  8-10 

29  7-10 

N. 

Variable. 

29 

63 

89 

29  7-10 

29  6-10 

W. 

Fair  dry  storm  at 7,  p.m. 

30 

6(\ 

80 

29  7-10 

29  8-10 

K.   E. 

Variable. 

31 

55 

74 

30  in. 

30  in. 

N.  E. 

Fair. 

Fair 


1 1.     Qnantitv  of  Rain.  2  8-10  in.^hp' 


SOUTHERN 

MEDICAL  AND  SURGICAL 

JOURNAL. 

Vol.  I.]  NEW  SERIES. AUGUST,  1S45.  [No.  8. 

PART  I. ORIGINAL  COMMUNICATIONS. 

ARTICLE    I. 

Observations   on   Geophagy.      By   Johx   Le  Conte,  M.  D., 
of  Savannahf  Georgia. 

MiRBEL  has  proposed  to  distinguish  vegetables  from  animals  by  the 
different  nature  of  their yborZ. --^the  former  deriving  their  nutriment, 
as  he  affirms,  from  inorganic  matter,  and  the  latter  from  organic  :   
That  plants  transform  dead  matter  into  organized  principles,  and  thus 
prepare  food  suitable  for  animals.  [Traiie  d\4.natomie  et  de  Physi- 
ologic Vegetale,  etc.)  Another  distinguished  physiologist,  M.  Virey, 
in  the  Nouveau  Dictionnaire  d^Histoire  Naiiirelle,  Article  Alimext, 
maintains,  on  the  contrary,  that  plants  as  well  as  animals  are  sup. 
ported  by  oro^a/izc  food ;  since,  as  he  contends,  it  is  the  debris  of 
organized  matter  mixed  with  the  soil,  that  furnishes  vegetables  with 
their  appropriate  pahuhim,  as  likewise  those  animals,  such  as  earth- 
worms, the  larvae  of  ephemerae,  etc.,  which  have  been  supposed  to 
live  upon  earth.  M.  Virey  ingeniously  endeavors  to  support  this 
hypothesis  by  the  fact,  that  the  fertility  of  a  soil  depends  upon  the 
quantity  o^  hmniis  or  vegetable  mould,  which  it  contains,  and  that 
worms,  etc.,  are  not  to  be  found  in  very  barren  soils.  It  appears, 
however,  from  the  masterly  researches  of  Liebig  and  others,  that  the 
so-called  httmus,  in  the  form  in  which  it  exists  in  the  soil,  does  not 
yield  the  smallest  nourishment  to  plants;  that  it  only  tccelerateg 
their  growth,  in  so  far  as  it  serves  as  a  medium  of  fixing  the  inor- 
ganic elements  around  the  spongioles  or  absorbing  extremities  of  the 


418  Observations  on  Geojphagy.  [August, 


roots,  or  of  slowly  extricating  carbonic  acid  in  the  gradual  progress 
of  decomposition.  Moreover,  it  is  universally  admitted  that  humus 
arises  from  the  eremacausis  or  slow  decay  of  plants.  No  primitive 
humuSf  therefore,  can  have  existed  ;  for  plants  must  have  preceded 
the  humus.  The  first  vegetables  must  have,  consequently,  derived 
their  carbon  from,  some  other  source  than  organic  matter:  that 
supply  is  furnished  in  the  form  of  carbonic  acid  by  the  atmosphere. 

There  are  satisfactory  evidences  drawn  from  geological  considera- 
tions, as  well  as  a  priori  reasons  deduced  from  the  physiology  of  the 
function  of  nutrition  in  the  respective  kingdoms  of  organic  nature, 
for  believing  that  vegetable  organization  preceded  the  development 
of  animal  life,  in  the  physical  revolutions  which  the  crust  of  the  globe 
has  undergone.  Vegetables  seem  to  constitute  the  intermediate 
link  in  the  scale  of  creation,  between  the  Inorganic  world  and  the 
Animal  kingdom ;  and  although  in  a  few  instances  they  are  partially 
dependent  upon  the  latter  for  their  existence,  it  cannot  be  doubted 
that  the  general  balance  is  greatly  in  favor  of  the  supplies  they  afford. 
The  distinction  laid  down  by  M.  Mirbel,  based  upon  the  character  of 
food,  has,  therefore,  been  confirmed  as  a  general  law  in  the  two  or- 
ganic kingdoms. 

Plants  constitute  an  immense  apparatus  for  reduction,  in  which  is 
habitually  created  true  organic  matters  fit  for  the  assimilation  of 
animals :  so  that,  in  this  point  of  view,  we  might  justly  and  philo- 
sophically say,  that  "  all  flesh  is  grass,"  without  even  imposing  a 
violently  metaphorical  character  upon  our  language.  On  the  other 
hand,  animals  constitute  an  immense  apparatus  for  combustion,  
reproducing  the  elements,  which  are  returned  into  the  air  and  the 
earth.  Thus  it  is  in  the  vegetable  kingdom  that  the  great  laboratory 
of  organic  life  resides;  there  it  is  that  the  vegetable  and  animal 
matters  are  formed,  and  they  are  produced  at  the  expense  of  the  air 
and  the  inorganic  constituents  of  the  soil.  From  plants,  these  mat- 
ters pass  ready-formed  into  the  herbiverous  animals,  which  destroy  a 
portion  of  them,  and  accumulate  the  remainder  in  their  tissues:  
From  these,  they  pass  unaltered  into  the  carnivorous  animals,  who 
destroy  or  retain  some  of  them  according  to  their  wants:  Lastly, 
during  the  life  of  these  animals,  or  after  their  death,  these  organic 
matters,  as  they  are  destroyed  and  resolved  into  their  ultimate  ele- 
ments, return  to  the  atmosphere  and  to  the  earth,  the  reservoirs 
whence  they  proceeded,  to  be  again  used  in  perpetuating  the  myste- 
rious cycle  of  organic  life  on  the  surface  cf  our  planet.     It  is  thus, 


1845.]  Observations  on  Geophagy.  419 


that  the  grand  "physiological  balance"  in  organized  beings,  so 
eloquently  illustrated  by  M.  Dumas,  is  maintained  :  adaptations, 
adjustments,  reciprocal  dependence  of  parts,  and  conformity  of  ar- 
rangement, appear  everywhere  pervading  both  systems  ;  checks  and 
compensations  are  perpetually  in  operation,  which  must  maintain 
the  equilibrium  between  the  kingdoms  of  organic  nature,  just  as 
the  masses  of  the  planets,  the  eccentricities  of  their  orbits,  the 
direction  of  their  motions,  and  the  inclinations  of  the  planes  in  which 
they  revolve,  are  all  arranged  so  as,  according  to  the  beautiful  theo- 
rems of  Lagrange  and  Laplace,  to  preserve  the  stability  of  the  solar 
system,  by  affixing  limits,  maxima  and  minima,  between- which  the 
irregularities  oscillate. 

As  there  exists  a  close  affinity  between  animals  and  vegetables  in 
the  respective  groups  of  Phy  tozoa  and  Protophyta  ;  so  do  we  observe 
an  analogous  gradation  with  respect  to  the  sources  of  nutriment. 
Some  appear  to  be  exceptions  to  the  general  law  founded  on  the  dif- 
ference of  food.  The  only  class  of  Plants  which  seems  to  be  depen- 
dent for  its  support  upon  matter  already  organized,  is  that  of  Fungi,  
a  group  of  peculiar  interest,  as  presenting  us  with  two  curious  analo- 
gies with  the  Animal  kingdom,  in  the  extrication  of  carbonic  acid, 
and  in  containing /wTio^m,  a  proximate  principle  as  highly  azotized 
as  animal  flesh.  (Carpenter's  Principles  of  General  and  Comp. 
Physiology,  2d  Ed.  London,  1841.  Paragraph  277,  p.  217.)  A  re- 
markable  mode  of  obtaining  nutriment  is  afforded  by  some  species  of 
Parasitic  fungi,  which  are  found  growing  on  the  larvae  of  certain 
coleopterous,  lepidopterous  and  hymenopterous  insects.  One  species, 
which  was  sent  to  France  by  Father  Parenin,  is  in  high  estimation, 
as  an  article  of  the  Materia  Medica,  among  the  celestial  nobles  at  the 
palace  of  Pekin.  Dr.  J.  Pereira  thinks  that  this  fungus  belongs  to 
the  genus  Sphaeria,and  is  closely  allied  to  the  Sphmria  entomarrhiza 
of  Dickson.  An  analogous  species  has  been  found  in  New  Zealand, 
called  the  Spharia  Robertsii,  which  grows  from  the  neck  of  the  cat- 
terpillar,  to  the  length  of  six  or  eight  inches.  (Phar.  Journ.,  as  cited 
in  the  New-York  Journ.  of  Med.,  etc.,  vol.  1,  p.  128-131.  1843.) 
Such  growths  are  also  found  on  coleopterous  insects.  The  larvae  of 
the  meloloniha,  not  unfrequently  exhibit  a  vegetable  sprout  three 
inches  in  length,  proceeding  from  between  the  head  and  the  under 
part  of  the  thorax.  The  larvae  aj-e  not  only  dead^  hut  in  a  state  of 
decay,  and  the  sprout  rising  from  the  ground  indicates  where  they  are 
found.     A  species  o^ciirculio,  in  the  perfect  state,  from  Mexico,  has 


420  Observations  on  Geophagy.  [August, 


also  been  mentioned  as  having  long  slender  filaments  attached  to 
various  parts  of  the  body,  and  in  one  specimen,  it  had  a  sprout  on 
the  rostrum  or  beak,  which  gave  it  the  appearance  of  an  additional 
horn.     A  species  of  hymenopterous  insect,  made  known  under  the 
name  of  "  vegetating  wasp  "  by  a  Spaniard,  named  Father  Torrubia, 
inhabits  the  same  country.     He  says,  that  in  1749,  he  found  some 
dead  wasps  in  a  field  in  New-Spain,  from  the  belly  of  each  of  which 
a  plant  germinated,  growing  about  five  spans  high.     Similar  vegeta- 
ting wasps  are  said  to  have  been  found  in  the  Island  of  Dominica. 
The  parasitic  plant,  considered  to  be  a  species  of  clavaria,  which 
grows  frofn  them,  bears  several  pods,  which  are  supposed  by  the  in- 
habitants to  "drop  off" and  become  worms,  and  from  thence  flies." 
The  common  wasp  of  this  country,  when  dead,  has  been  observed  to 
give  origin  to  analogous  vegetable  growths,  as  likewise  the  pupae  of 
a  species  of  cicada  which  is  common  in  Martinique  and  Dominica, 
Kirby  and  Spence  mention  one  specimen  of  the  last  genus  in  their 
cabinet,  "with  a  kind  of  Sphseria  with  a  twisted  thickish  stripes  and 
oblong  head,  springing  up  in  the  space  between  the  eyes."     Some 
imago  specimens  of  lepidopterous  insects  have  been  brought  from  the 
tropical  regions,  covered   with  long  slender  filaments.     They  are 
always  in  a  very  decayed  state.     (Vide.  Natural  History  of  Insects, 
Harper's  Family  Library ;  Second  Series,  No.   74,  p.  260  to  265 : 
New-York,  1840.     12mo.     Also,  Dr.  Samuel  L.  Mitchell's  letter  to 
A.  P.  De  Candolle,  in  Am.  Journ.  of  Science  and  Arts,  vol.  12, 
p.  21-28, 1827.)     M.  J.  B.  Ricord-Madianna,  however,  states,  that 
he  has  observed  at  Guadaloupe  a  nest  of  wasps,  the  greatest  number 
of  which  were  encumbered  with  these  cryptogamous  excrescences. 
As  they  quitted  the  nest,  they  fell  to  the  ground,  and  could  not  rise 
again  on  account  of  the  weight  of  the  plant,  which  had  taken  root  on 
some  part  or  other  of  their  body,  particularly  on  the  sternum.     Hav- 
ing observed  the  larvse  contained  in  the  cells,  M.  Ricord  remarked, 
that  they  also  had  this  cryptogamous  appendage,  but  then  it  was  very 
small.     Of  course  the  fungus  was  developed  on  the  living  insect, 
although  apparently  in  the  last  stages  of  existence,  and  seeming 
about  to  perish  from  the  influence  of  its  destructive  parasite.     This 
species  appears  to  have  been  the  SphcBria  entomorhiosa  of  the  Eng- 
lish botanists.     {Journal  de  Pharmacie,  as  cited  in  Brando's  Quar- 
terly Journal  of  Science,  etc.,  New  Series,  vol.6,  No.  12,  p.  437-438  : 
London,  Jan.,  1830.) 

The  singular  epidemic   disease  to  which   the  silk-worm  is  liable, 


1845.  J  Observations  on  Geophagy.  421 


called  muscadine,  and  first  described  by  M.  Bassi,  is  occasioned  by 
a  parasitic  fungus,  named  the  Botrytis  Bassiana,  from  the  discoverer. 
The  characteristic  signs  of  the  d^ease  do  not  appear  until  after 
death,  when  the  body  is  bedecked  with  a  white  powdery  efflorescence, 
becomes  dried  up,  and  as  it  were,  mummified.  This  efflorescence  is 
mould,  the  germs  of  which  must  have  been  nourished  at  the  expense 
of  the  silk-worm.  According  to  Dr.  Stilling,  of  Cassel,  an  analo- 
gous disease  is  found  in  frogs,  under  certain  circumstances.  (Vide. 
Fletcher's  Elements  of  Gen.  Pathology,  Edited  by  Drs.  Drysdale 
and  Russel,  pp.  74  et  75.  (note.)  Edinburgh,  1S42.)  In  the  majori- 
ty of  the  above-mentioned  cases,  it  is  reasonable  to  presume,  from 
the  decayed  state  of  the  insects,  that  the  spores  of  the  fungi  found 
a  suitable  nidus  for  germination  in  the  mass  of  decomposing  organ- 
ized matter.  The  two  last  instances  appear  to  be  exceptions  to  this 
general  rule.* 

When  plants  are  made  to  grow  in  infusions  of  madder,  the  radical 
fibres  are  tinged  of  a  red  color.  From  experiments  made  by  Sir  H. 
Davy  on  the  growth  of  plants  in  weak  solutions  of  sugar,  *gum,  gela- 
tine, the  tanning  principle,  etc.,  in  all  of  which  they  grew  luxuriantly; 
and  from  those  of  M.  Biot,  in  which,  a  white  hyacinth  became  red 
after  a  few  hours,  when  the  earth  in  which  it  was  planted  was  sprin- 
kled with  the  juice  of  the  Phytolacca  decandra;  it  has  been  con- 
cluded that  organic  substances,  do,  under  favorable  circumstance?, 
enter  into  the  roots,  and  thence  into  the  circulation,  of  vegetables. 
It  is  to  be  remarked,  however,  that  organic  coloring  matters,  when 

*  A  species  of  parasitic  fungus  discovered  by  Lewis  D.  De  Scliweinitz,  and 
described  under  the  name  of  Isaria  Sphingum  (S^-nop.  Fung,  carol.  Sup.  p.  100,) 
is  remarkable  as  being  found  proceeding  in  ail  directions  from  the  abdomen, 
nerves  of  the  wings,  etc.,  of  a  sphinx  resting  upon  a  branch  with  expanded  wings. 
Although  the  insect  was  dead  when  thus  discovered,  yet  the  position  in  which  it 
is  usually  detected,  and  the  other  attending  circumstances,  afford  a  strong  pre- 
sumption that  the  fungus  was  evolved  while  the  sphinx  was  5-et  in  a  state  of  ex- 
istence. It  may  be  doubted  whether  the  vegetable  ever  predominates  over  the 
animal  life,  while  the  vital  principle  of  the  latter  is  in  full  energ}';  but  that  the 
larvae,  in  a  feeble  state,  may  have  afforded  a  fit  recipient  for  the  seed  of  the  fun- 
gus, while  their  complete  evolution  was  retarded  by  some  cause,  until  the  final 
transformation  of  the  insect,  is  certainly  not  improbable.  In  this  respect  they 
may  offer  some  analogy  with  the  helminthoid  entozoa,  such  as  the  ascaridcs, 
tanice,  hydatids,  etc.,  which  are  most  commonly  observed  to  prey  upon  animals 
of  debilitated  or  languishing  health.  (Vide.  Paper  by  Abraham  Halsey,  in 
Annals  of  the  Lyceum  of  Nat.  IIii<t.  of  New- York,  vol  1,  Part  1st,  p.  1'25-126: 
18-24.) 


422  Ohservations  on  Geophagy.  [August, 


thus  introduced  into  plants,  do  not  generally  extend  upwards  to  the 
leaves  and  flowers.  The  madder  does  not  usuallj'  discolor  the 
leaves.  The  color  imparted  to  tUe  white  hyacinth,  in  the  experiment 
of  M.  Biot,  disappeared  in  the  sunshine  in  the  course  of  a  few  days. 
Organic  matters,  therefore,  undergo  some  chemical  change  either  in 
the  stem,  in  the  leaf,  or  in  the  flower.  (Vide.  Lectures  on  the  Ap- 
plications of  Chemistry  and  Geology  to  Agriculture.  By  James  F. 
W.  Johnson,  M.  A.  F.'  R.  SS.  L.  et  E.  etc. Am.  Ed.  Wiley  and 
Putnam:  New-York,  1844.  Part  1st,  p.  64.)  According  to  Mr. 
G.  T.  Burnett,  the  pitchers  of  the  Sarracenia  and  Nepenthes  are 
true  sarcophagi,  and  constitute  the  nearest  approaches,  the  strong- 
est adumbrations  of  a  stomach  in  vegetables.*  in  them,  a  processs 
very  much  like  animal  digestion  goes  on;  for  it  appears  that  the 
fluid  they  contain  is  very  attractive  to  insects,  which,  having  reached 
its  surface,  are  prevented  from  returning  by  the  direction  of  the  long 
bristles  that  line  the  cavity.  The  bodies  of  those  which  are  drown- 
ed seem,  in  decaying,  to  afford  a  supply  of  invigorating  nutriment 
as  favorable  to  the  growth  of  these  plants,  as  a  similar  process  on  the 
leaves  of  the  well-known  DioncBa  muscipula,  to  the  health  of  which, 
a  supply  of  animal  food  appears  to  be  essential.  (Vide.  Brande's 
Quarterly  Journal  of  Science,  etc. ;  New  Series,  vol.  6,  No.  12, 
p.  279  to  293  :  London,  Jan.,  1830.) 

Although  such  instances  as  these  may  seem  to  contradict  the  gen- 
eral statement,  that  Plants  derive  the  materials  of  their  nutrition 
from  the  inorganic  world,  yet  they  probably  do  so  more  in  appear- 
ance than  in  reality.  In  most  cases  where  previously-organized 
matter  influences  their  growth,  it  is  only  whilst  in  a  decomposing 
state,  during  which  it  is  separated  into  its  ultimate  elements  or  very 
simple  combinations  of  them.  We  find  in  the  Animal  kingdom  also, 
many  apparent  exceptions  to  the  general  statement  which  has  been 
made  respecting  the  source  of  their  nutrition.  Thus  the  spatangus^ 
various  species  of  holothuricB,  the  earth-worm,  some  kinds  of  heetleSf 
many  conchifera,  and  several  cephalopoda,  are  known  to  swallow 

*  Rumphius  has  observed,  that  a  certain  small  squilla  or  shrimp,  is  some- 
times found  living  in  these  pouches;  so  that  even  this  simple  digestive  appara- 
ratus  is  not  free  from  intestinal  worms.  The  discolored  spots  occasionally 
observed  in  the  pouches  of  the  Sarracenia  have  been  supposed  to  indicate 
serious  disorganization,  and  the  powerful  and  rapid  decomposition  of  food, 
when  taken  in  too  great  abundance,  has  been  fancifully  likened  to  indigestion 
from  repletion,  and  then  the  occasional  offensive  odors  may  perhaps  be  symp- 
tomatic of  vegetable  dyspepsia.     (Burnett  op.  cit.  p.  290.) 


1845.]  Observations  on  Gcophagy.  423 


moist  sand  and  comminuted  shells ;  but  it  is,  probably,  only  in  order 
to  derive  nourishment  from  the  innumerable  animalculae  and  remains 
of  organized  matter  so  abundant  in  it.*  The  stomach  of  many  of 
these  invertebrated  animals  is  provided  with  a  thick,  tough,  coriace- 
ous epithelial  lining,  to  protect  it  from  the  dense  inorganic  substances 
taken  along  with  their  food.  (Vide.  Outlines  of  Comparative  Anato- 
my,  by  Robert  E.  Grant,  M.  I).,  F.  R  S.,  etc.,  London,  1841, 
pp.  329,  331,  343,  366,  376.  Also.  Lectures  on  the  Comp.  Anat. 
and  Physiology  of  the  Invertebrate  Animals,  by  Richard  Owen,  F.  R. 
S.,  etc.,  London,  1843.     Passim.) 

Such  being  the  general  and  broad  distinction  between  the  vegeta- 
ble and  animal  kingdoms,  as  indicated  in  the  sources  of  nutriment, 
it  is  certainly  an  extraordinary  physiological  phenomenon  that 
Geophagists  should  be  found  among  men, the  highest  in  the  scale 
of  animal  organization. 

Geophagy,  as  a  habit,  prevails  chiefly  among  savage  tribes  inhabit- 
ing the  intertropical  regions.  Alexander  de  Humboldt  has  recorded 
some  highly  interesting  observations  on  this  singular  physiological 
phenomenon  as  presented  to  him  in  the  tropics  of  South  America. 
The  Otomacs,  a  tribe  of  Indians  inhabiting  the  mission  of  Uruana  on 
the  Orinoco  river,  were  found  to  swallow  every  day,  during  several 
months,  very  considerable  quantities  o^ earth,  without  injuring  their 
health.  They  belong  to  those  most  uncivilized  nations  of  the  savan- 
nas, who  have  a  decided  aversion  to  cultivate  the  soil,  and  live  almost 
exclusively  on  hunting  and  fishing.  They  are  men  of  very  robust 
constitution;  but  ugly,  savage,  vindictive,  and  passionately  fond  of 
fermented  liquors.  They  are  omnivorous  animals  in  the  highest  de- 
gree ;  and,  therefore,  the  other  Indians,  who  consider  them  as  barba- 
rians, have  a  common  saying,  "nothing  is  so  disgusting  that  an 
Otomac  will  not  eat."  While  the  waters  of  the  Orinoco  and  its 
tributary  streams  are  low,  they  subsist  on  fish  and  turtles.  At  the 
time  of  the  periodical  inundations  of  the  Orinoco,  which  last  two  or 
three  months,  it  is  extremely  difficult  to  procure  fish,  and  the  Oto- 
macs are  in  the  habit  of  swallowing  a  prodigious  quantity  of  earth. 
The  clay  ig  kneaded  into  balls,  called  poz/cr,  of  from  five  to  six  inches 
in  diameter.     M.  M.  Hurnboldt  and  Bonpland  found  heaps  of  these 

*  The  stomach  of  the  Siren  lacertina,  a  species  oi  perennih-anchicde  reptile 
having  only  one  pair  of  feet,  which  inhabits  the  Southern  States,  is  usually 
found  to  contain  little  else  than  mud.  (Vide.  Annals  of  the  Lyceum  of  Nat. 
ITist.  of  New- York,  vol.  1,  Part  1st,  p.  53.     1824. 


424  Observations  on  Geophagy.  [August, 

balls  in  their  huts,  piled  up  in  pyramids  three  or  four  feet  high.  The 
Otomacs  do  not  eat  every  kind  of  earth  indifferently;  they  display 
considerable  epicurean  skill  in  selecting  the  alluvial  strata  that  con- 
tain a  very  fine  and  unctuous  clay,  remarkably  smooth  to  the  feel,  
of  a  yellowish  gray  color.  Being  slightly  baked  in  the  fire,  the  hard- 
ened crust  has  a  tint  inclining  to  red,  owing  to  the  oxide  of  iron 
which  is  mingled  with  it.  When  about  to  be  used,  these  clods  aie 
moistened  afresh,  and  each  individual  consumes  dail}',  during  several 
months,  three  quarters  of  a  pound  of  clay  slightly  hardened  by  fire, 
without  any  sensible  effect  on  the  health.  (Vide.  Personal  Narrati\  e 
of  Travels  to  the  Equinoctial  Regions  of  the  New  Continent,  during 
the  years  1799-1804.  By  Alexander  de  Humboldt  and  Aime  Bon- 
pland.  Translated  into  English  by  Helen  Maria  Williams,  vol.  5, 
Part  2,  p.  639  et  seq.  London,  1821.)  No  trace  of  the  mixture  of 
an  organic  substance,  whether  oily  or  farinaceous,  could  be  detected 
in  the  balls  o^  poya,  which  Humboldt  took  to  Paris.  Neither  is  it 
steatitic ;  for,  M.  Vauquelin  did  not  discover  any  traces  of  magnesia 
in  it.  He  found,  that  it  contained  more  silex  than  alumina,  and  three 
or  four  per  cent,  of  lime.  (Humboldt  op.  cit.,  vol.  5,  p.  641-642.) 
When  questioned  concerning  the  nature  of  his  subsistence  during  the 
two  months  when  the  Orinoco  is  the  highest,  the  Otomac  shows  his 
balls  ofclayey  earth.  This  he  calls  his  principal  food;-  for  at  this 
period  he  can  seldom  procure  a  lizard,  a  root  of  fern,  or  a  dead  fish 
swimming  at  the  surface  of  the  water.  But  he  does  not  the  less  re. 
gale  himself  with  this  species  of  aliment  during  the  rest  of  the  year. 
Every  day  in  the  season  of  drought,  when  fishing  is  most  abundant, 
he  scrapes  his  balls  o^ poya,  and  mingles  a  little  clay  with  his  ordina- 
ry food,  (p.  642-^643.)  What  is  most  surprising  is,  that  the  Oto- 
macs do  not  become  lean  by  swallowing  such  quantities  of  earth : 
they  are,  on  the  contrary,  extremely  robust,  and  are  far  from  having 
the  abdomen  tumid  and  puffed  up.  The  missionary  Fray  Ramon 
Bueno,  assured  IM.  Von  Humboldt,  that  he  never  remarked  any  alter- 
ation  in  the  health  of  the  natives  at  the  period  of  the  great  risings  of 
the  Orinoco,  (p.  648.)  It  has  not,  as  yet,  been  possible  to  verify 
with  precision  how  much  nutritious  vegetable  or  animal  matter  the 
Otomacs  take  in  a  week  during  the  same  period  ;  but  it  is  certain, 
that  they  attribute  the  sensation  of  satiety,  which  they  feel,  to  the 
clay,  and  not  to  the  wretched  aliments  which  they  occasionally  take 
with  it.  M.  Von  Humboldt  also  *'  found  some  traces  of  this  vitiated 
appetite  among  the  Guamoes;  and   between  the  confluence  of  the 


lS4o.]  Observaliuns  on  Geophagy.  4*25 

Meta  and  the  Apure,  where  every  body  speaks  of  Geophagy  as  of  a 
thing  anciently  known.     (Op.  cit.,  vol.  5,  Part  2,  pp.  G39  et  640.) 

The  same  distinguished  traveller  observed  every  where  within  the 
torrid  zone,  in  a  great  number  of  individuals,  children,  women,  and 
sometimes  even  full-grown  men,  an  inordinate  and  almost  irresistible 
desire  of  swallowing  earth  ;  not  of  an  alkaline  or  calcareous  charac- 
ter, to  Mutrali/.e  (as  is  commonly  supposed)  acid  juices  in  the  stom- 
ach, hut  a  fat  clay,  unctuous,  and  exhaling  a  strong  smell.  It  is  often 
found  necessary  to  tie  the  hands  of  children,  or  to  confine  them,  to 
prevent  their  eating  earth,  when  the  rain  ceases  to  fall.  At  the  vil- 
lage of  Banco,  on  the  river  Magdalena,  he  saw  the  Indian  women 
who  make  pottery  continually  swallowing  great  pieces  of  clay. 
These  women  were  not  in  a  state  of  pregnancy  ;  and  they  affirmed, 
that  ^'carth  is  an  aliment  which  they  do  not  find  hurtful.'^  (Op.  cit. 
supra.,  p.  643-644.)  In  other  South  American  tribes  people  soon 
become  sick,  and  waste  away  when  they  yield  too  much  to  this  mania 
of  eating  earth.  The  same  excellent  authority  informs  us,  that  he 
found  at  the  mission  of  San  Borja  an  Indian  child  of  the  Guahiba 
nation,  who  was  reduced  to  a  lamentable  state  of  atrophy  in  conse- 
quence of  a  disordered  appetite,  having  refused  during  four  months 
to  take  almost  any  other  food  than  clay.  Yet  San  Borja  is  only 
twenty-five  leagues  distant  from  the  mission  of  Uruana,  inhabited  by 
that  tribe  of  the  Otomacs,  who  swallow  the  poya  without  experiencing 
any  pernicious  effects,  (p.  644.)  Father  Gumilla  asserts,  that  the 
Otomacs  mingle  the  flour  of  maize  and  the  oil  of  turtles'  eggs  with 
the  clay,  and  that  they  purge  themselves  with  the  melted  fat  of  the 
crocodile,  when  the\"  feel  any  gastric  obstructions  :  .but  the  testimony 
of  resident  missionaries,  as  well  as  the  inquiries  of  31.  M.  Humboldt 
and  Bonpland,  have  failed  to  confirm  either  of  the  above  assertions 
of  this  credulous  traveller.  As  already  remarked,  the  balls  of  po^a 
which  were  taken  from  the  winter  stores  of  the  Indians,  contained  no 
trace  of  animal  fat,  or  of  amylaceous  matter.  (Humboldt  op.  cit., 
vol.  5,  Part  2d,  pp.  642,  645,  657,  et  658.) 

In  the  Indian  Archipelago,  at  the  island  of  Java,  between  Soura- 
baya  and  Samarang,  M.  Labillardiere  observed  little  square  reddish 
cakes  exposed  to  sale.  These  masses,  called  tana-ampo,  were  cakes 
of  clay,  slightly  baked,  which  the  natives  eat  with  appetite.  (Voy- 
age in  Search  of  La  Perouse.  English  Ed.  vol.  2,  p.  333.  Lon- 
don. 1800.)  According  to  M.  Leschenault,  (one  of  the  naturalists 
of  the  Expedition  to   the   Southern  Lands,  under  the  command  of 


426  Ohservdlions  on  Geophagy.  [August, 


Captain  Baudin,)  the  cakes  of  earth  which  the  Javanese  are  fond 
of  eating,  and  which  are  sold  in  the  public  markets,  are  composed  of 
a  reddish  and  somewhat  ferruginous  clay,  which  is  spread  on  a  plate 
of  iron,  and  baked.  "  This  clay  has  a  peculiar  taste,  which  is  owing 
to  the  torrefaction ;  it  is  very  absorbent,  and  adheres  to  the  tongue, 
which  it  dries.  In  general,  it  is  only  the  Javanese  women  who  eat 
the  ampo,  either  in  the  time  of  their  pregnancy,  or  in  order  to  grow 
thin  ;  the  want  of  plumpness  being  a  kind  of  beauty  in  this  country. 
The  use  of  this  earth  is  fatal  to  health ;  the  women  lose  their  appe- 
tite imperceptibly,  and  no  longer  take  without  disgust  a  vety  small 
q'lantity  of  food  ;  but  the  desire  of  becoming  lean,  and  of  preserving 
a  slender  shape,  can  brave  these  dangers,  and  maintain  the  credit  of 
the  ampo,"  (Letter  from  M.  Leschenault  to  M.  de  Humboldt  on  the 
kind  of  Earth  which  is  eaten  at  Java,  as  cited  by  Humboldt,  op.  cit. 
vol.  5,  Part  2,  p.  647.)  Even  in  the  most  highly  civilized  countries 
this  habit  is  frequently  voluntarily  induced,  particularly  among 
exquisitely  Hishionable  ladies,  by  a  vain  desire  of  improving  the 
beauty  of  the  person,  of  giving  a  graceful  slenderness  to  the  form,  or 
a  languishing  fairness  to  the  skin,  through  the  medium  of  chalk,  vin- 
egar,  slate  pencils,  and  other  empirical  materials.*  Without  pre- 
tending to  passjudgment  on  a  subject  so  delicate  as  the  complicated 
elements  which  are  brought  into  harmonious  action  by  the  all-subdu- 
ing manifestations  of  feminine  charms;  I  am  rather  inclined  to  think 
that,  the  leanness  and  etiolation,  which  is  thus  induced  by  the  con- 
sequent supervention  of  a  chlorotic  state  of  the  system,  is  any  thing 
but  attractive  to  the  opposite  sex!  Among  the  Greeks, who  seem 
to  have  distancec^  the  most  ambitious  modern  dandies  in  foppery  as 
well  as  in  Epicurism,  this  practice  appears  to  have  been  more 
common  than  even  in  our  own  day,  and  this  too,  among  young  men 
as  well  as  young  women  ;  in  consequence  of  which,  their  physicians 
gave  to  this  variety  of  the  disease  the  name  of  iiaXada,  softness,  or 
effeminacy. 

M.  Labillardiere  informs  us  that  the  savage  inhabitants  of  New- 

*  Dr.  H.  Nims  has  given  an  account  of  the  death  of  a  girl  17  years  of  age, 
from  eating  large  quantities  of  slate-stone,  of  which  she  passed  nearly  a  pound, 
in  a  short  time,  by  enemata.  On  dissection,  the  slate  was  found  lining  the  in- 
testinal canal,  from  the  stomach  to  the  rectum,  and  in  the  stomach  near  the 
pylorus,  was  discovered  a  perforation  about  the  size  of  a  goose  quill,  with  the 
usual  marks  of  inflammation,  evidently  caused  by  a  sharp  portion  of  the  slate. 
(Boston  Med.  ct.  Surg.  Journ.,  vol.  25,  p.  11.) 


1S45.J  Observations  on  Geophagi/.  427 


Caledonia,  eat  great  pieces  of  a  friable  steatite  or  lapis  ollaris,  which 
were  of  a  greenish  color,  very  soft,  and  twice  as  large  as  a  man's 
fist,  to  appease  their  hunger  in  times  of  scarcity.  (Voyage  in  search 
of  La  Perouse,  English  Ed.,  vol.  2,  p.  213-214:  London,  1800.) 
3L  Vauquelin  analized  specimens  of  the  earth  which  were  transmit- 
ted to  him  by  Labillard^ere.  It  was  soft  to  the  touch,  composed  of 
small  fibres,  which  were  easily  separated,  and  when  incinerated  lost 
about  four  per  cent,  of  its  weight.     He  found  it  to  consist  of  

Magnesia, 37 

Silex,         3G 

Oxide, 17 

Water, 04 

Lime  and  Copper,    .     .     *    03 

Loss, 03  ' 

100 
From  which  he  concluded  that  it  does  not  contain  any  alimentary 
quality,  and  can  only  be  considered  a  kind  of  mechanical  expedient 
to  suspend  the  pains  of  hunger.  (Vide.  Notice  of  M.  Vauquelin's 
paper  read  before  the  Philomatic  Society  of  Paris,  in  Tilloch's  Philo- 
sophical Magazine,  1st  Series,  vol.  11,  p.  231  :  London,  1802.) 

Goldberry  had  seen  the  Negroes  in  Africa,  in  the  islands  of  Bunck 
and  Los  Idolos,  eat  an  earth,  of  which  he  had  himself  eaten,  without 
being  incommoded  by  it,  and  which  also  was  a  white  and  friable 
steatite.  (Goldberry's  Voyage  en  Afrique,  vol.  2,  p.  455,  as  cited  by 
Humboldt,  p.  648.)  The  Negroes  on  the  coast  of  Guinea  delight  in 
eating  a  yellowish  earth,  which  they  call  caoiiac.  The  slaves  who 
have  been  taken  to  America  try  to  procure  for  themselves  the  same 
enjoyment ;  but  it  is  constantly  detrimental  to  their  health.  They 
say  "  that  the  earth  of  the  West  Indies  is  not  so  easy  of  digestion  as 
that  of  their  country."  Thibaut  de  Chanvalon,  in  his  voyage  to 
Martinico,  expresses  himself  very  judiciously  on  this  phenomenon. 
"  Another  cause,"  says  he,  "  of  this  pain  in  the  stomach  is,  that  sev- 
eral of  the  Negroes,  who  come  from  the  coast  of  Guinea,  eat  earth; 
not  from  a  depraved  taste,  or  in  consequence  of  a  disease,  but  from  a 
Iiabit  contracted  at  home  in  Africa,  where  they  eat,  they  say,  a  par- 
ticular earth,  the  taste  of  which  they  find  agreeable,  without  suf- 
fering any  inconvenience.  They  seek  in  our  islands  for  the  earth 
most  similar  to  this,  and  prefer  a  yellowish  red  volcanic  tufa.  It  is 
sold  secretly  in  our  public  markets ;  but  this  is  an  abuse  which  the 


428  Observations  on  Geophagy.  [August, 


police  ought  to  correct.  The  Negroes  who  have  this  habit  are  so 
fond  of  caouac,  that  no  chastisement  will  prevent  their  eating  it." 
{Voyage  a  la  Martinique,  1763,  p.  84,  as  cited  by  Humboldt,  loc.  cit. 
p.  646.) 

M.  M.  Humboldt  and  Bonpland  saw  at  Popayan,  and  in  several 
mountainous  parts  of  Peru,  lime  reduced  to  a  very  fine  powder,  sold 
in  the  public  markets.  This  powder,  when  used,  is  mingled  with 
coca,  that  is,  with  the  leaves  of  the  erythroxylum  peruvlanum.  In- 
dian messengers  frequently  take  no  other  aliment  for  whole  days 
than  lime  and  coca.  In  other  parts  of  South  America,  on  the  coast 
of  Rio  de  la  Hacha,  the  Guajiroes  swallow  lime  alone,  without  adding 
any  vegetable  matter  to  it.  They  always  carry  with  them  a  little 
box  filled  with  lime,  as  some  more  civilized  men  do  snuff-boxes,  and 
as  in  Asia  people  carry  a  betel  box.  It  has  been  conjectured  that, 
the  lime  may  he  used  for  the  purpose  of  blackening  the  teeth;  as  in 
the  Indian  Archipelago,  as  among  several  American  hordes,  black 
teelh  are  esteemed  highly  ornamental.  According  to  the  same  ob- 
server, in  the  cold  regions  of  Quito,  the  natives  of  Tigua  eat  habitu- 
ally  from  choice,  and  without  being  incommoded  by  it,  a  very  fine 
clay,  mixed  withquartzose  sand,  suspended  in  water.  Large  vessels 
filled  with  this  milky  water,  which  serves  as  a  beverage,  were  found 
in  their  huts.  (Humboldt  op.  cit.,  vol.  5,  Part  2,  pp.  648,  649.)  It 
is  well  known  that  the  water  of  the  Mississippi  river,  which  is  usual- 
ly surcharged  with  mud  and  dirt  to  the  extent  of  nearly  one  fourth  of 
its  bulk,  forms  a  favorite  and  healthy  drink  with  our  Western 
people. 

The  banks  of  the  McKenzie  river,  a  few  miles  above  the  Bear 
Lake,  contain  layers  of  a  kind  of  unctuous  mud,  which  the  Indians 
in  that  neighborhood  eat  occasionally  during  seasons  of  scarcity,  and 
also  take  it  even  at  other  times  for  an  amusement.  (Vide.  Food  and  its 
Influence  on  Health  and  Disease,  by  Mathew  Freeman,  M.  1).;  Lon- 
don, 1842,  p.  67.)  It  is  known,  that  great  use  is  still  made  in  the 
East  of  the  bolar  and  sigillated  earths  of  Leranos,  which  are  fat, 
unctuous,  aluminous  clay,  mixed  with  oxide  of  iron.  The  German 
workmen  employed  in  the  quarries  of  sandstone  worked  at  the 
mountain  of  *  Kiffhauser,  spread  a  very  fine  clay  upon  their  bread, 
instead  of  butter,  which  they  call  steinbuiter,  stone  butter ;  and  they 
find  it  singularly  filling,  and  easy  of  digestion.  (Freiesleben,  Kupfer- 
schiefer,  vol  4,  p.  118.  Kesler,  in  Gilbert's  Annalen,  B.  28,  p.  492, 
as  cited  by  Humboldt,  op.  cit.  vol.  5,  Part  2,  p.  654.)     According  to 


1845.]  Observations  on  Geophagy.  429 


Pliny,  the  Romans  invented  a  broth  or  porridge  called  Allca,  which 
was  made  oift  of  a  grain  resembling  spelt,  which  was  also  called  Zea. 
In  order  to  make  the  AJica  white  and  tender,  it  was  mixed  with  chalk 
t>om  the  hills  between  Naples  and  Puteoli.  (Nat.  Hist,  xviii.,7,  10, 
11,  29.)  Mr.  Medhurst  informs  us  that,  the  Chinese  use  great 
quantities  of  sulphate  of  lime,  (gypsum,)  which  they  mix  with  pulse, 
in  order  to  form  a  jelly,  of  which  they  are  very  fond.  (China,  its 
State  and  Prospects,  p.  39  :  London,  183-8.)  The  fosil  farina^ 
which,  according  to  Stanislas  Julien,  {Cojnptes  Rendus,  1841,  2  Se- 
mest,  p.  358,)  is  used  in  China,  in  times  of  great  scarcity,  as  a  food, 
contains  13.2  per  cent,  of  organic  matter,  (Payen,  ibid  p.  480.  Vide 
Pereira's  Treatise  on  Food  and  Diet,  Am.  Ed.,  by  C,  A.  Lee,  New 
York,  1843.  p.  4,  note.)  The  earth  called  berg?nehl,  or  flour  of  the 
mountain,  which  has  been  employed  at  Degerfors,  on  the  frontiers  of 
Lapland,  in  times  of  scarcity,  admixed  with  flour  "hnd  the  bark  of 
trees,  has  been  shown  by  the  microscopic  researches  of  Prof.  Retzins 
to  consist  of  the  fossil  remains  of  nineteen  different  forms  of  infu- 
soria with  ^liceous  carapaces,  yielding  twenty  per  cent,  of  animal 
matter  by  incineration.  (Poggendorf's  Ann.,  B.  29,  p.  261,  as  cited 
by  J.  Muller,  in  his  Elementsof  Phys.,  Am.  Ed.  Philadelphia,  1843. 
p.  328.  Also,  Truman,  op.  cit.,  supra.,  p.  &7.)  In  view  of  such 
examples  as  the  above  mentioned,  Dr.  Trueman  has  been  led  to 
affirm  that,  "all  edible  earths  most  likely  contain  portions  of  organic 
matter,  which  is  the  reason  of  their  being  taken  as  food"  (op.  cit.  p. 
67) ;  an  assertion  directly  at  variance  with  the  analyses  of  IVL  Vau- 
quelin,  who  could  detect  no  organic  matter  either  in  the  balls  of  clay- 
eaten  by  the  Otomacs,  or  in  the  steatite  consumed  by  the  New  Cale- 
donians. 

Dr.  James  Copland  once  saw  a  robust  seaman,  who  occasionally 
would  devour  a  whole  wine  or  ale  glass,  having  previously  crushed  it 
in  small  pieces  with  his  teeth,  and  yet  no  bad  effects  resulted,  at  least 
for  many  months  afterwards.  (Lend.  Med.  Repos.,  vol.  1,  7.)  The 
only  other  instance  on  record,  where  this  dangerous  feat  has  been 
performed,  is  given  by  Camerarius.  (Memorab.  cent.  5.)  (Vide. 
Copland's  Die.  of  Practical  Med.,  Am.  Ed.,  Art.  Appetite,  vol.  1, 
p.  123.)  Indeed,  the  Ephemerides  of  Natural  Curiosities  from  Ovid, 
through  Darwin's  Zoonomia,  down  to  the  Dictionnairc  des  Sciences 
Medicates,  abound  in  examples  of  paniophagists  or  polyphagous 
monsters,  who  have  swallowed  clasp-knives,  musket  bullets,  stones, 
billiard  balls,  gold  watches,  and  Louis-d'ors ;  and,  what  is  still  more 


II 


430  Observations  on  Geophagy.  [August, 


singular,  generally  passed  them  through  their  callous  digestive  tubes 
a  few  days  afterwards.  In  the  case  recorded  by  M.  Fournier,  in  his 
Cas  Rares,  the  stomach  of  a  galley-slave  became  gradually  enlarg- 
ed into  a  warehouse  of  all  sorts  of  marine  stores.  But  these  remark- 
able instances  o^paniophagy  do  not  come  within  the  same  category 
M'ith  the  habits  of  Geophagy  which  I  have  noticed;  for  they  are 
comparatively  rare,  are  confined  to  isolated  individuals,  and,  so 
far  from  being  prompted  by  the  cravings  of  a  natural  i    ,  are 

usually  nothing  more  than  exploits  of  reckless  hardihood. 

In  the  Southern  States,  Geophagy  prevails  to  a  considerable  ex- 
tent, particularly  among  the  Negroes,  in  whom  the  habit  is  frequent- 
ly indomitable,  and  almost  invariably  proves  fatal,  unless  broken 
before  the  morbid  symptoms  are  manifested.  I  have  before  me  the 
Notes  of  a  case  of  a  Negro  girl,  aged  seventeen  years,  who  was  pro- 
bably more  or  less  addicted  to  this  pernicious  habit  from  childhood. 
General  swelling  and  emaciation  supervened,  attended  with  loss  of 
appetite,  difficulty  of  breathing  upon  the  slightest  exertion,  drowsiness, 
inactivity,  and  general  debility,  despondency,  with  fondness  for  soli- 
tude, together  with  the  characteristic  white  and  pallid  appearance  of 
the  nails,  palms  of  the  hands,  and  the  soles  of  the  feet,  the  peculiar 
bloodless,  translucent  and  blanched  hue  of  the  inside  of  the  lips,  gums, 
tongue,  and  lining  membrane  of  the  mouth,  and  glossy  state  of  the 
tunica  adnata,  with  other  signs  of  depressed  vital  power  and  deficient 
assimilation.  The  cause  of  her  difficulty  being  suspected,  and  being 
now  confined  to  her  bed,  a  strict  guard  was  kept  to  prevent  the  in- 
dulgence of  the  vitiated  appetite,  while  the  certainty  that  a  continu- 
ance of  the  habit  would  inevitably  result  in  death,  was  strenuously 
urged  upon  her  attention.  But  nothing  could  prevent  the  gratifica- 
tion of  the  invincible  craving  for  earthy  substances  ;  for  the  cunning 
plans  of  the  patient  to  procure  her  desired  repast,  eluded  the  utmost 
vigilance.  She  at  length  sank  under  the  joint  influences  of  extreme 
debility  and  inanition.  After  death,  a  ball  of  clay  as  large  as  a 
man^s  Jist,  and  partly  eaten,  was  found  under  the  bed-clothes!/ 
There  appears  to  have  been  a  complete  arrestation  of  the  reproduc- 
tive functions.  In  her  general  appearance,  she  presented  the  char- 
acters of  a  girl  of  only  twelve  years  of  age ;  there  was  no  augment- 
ation of  the  mammae,  no  manifeslion  of  a  catamenial  discharge,  or 
any  other  indications  of  puberty  ! 

According  to  Dr.  Joseph  Pitt,  Geophagy  prevails  cndemically 
among  the  poor  white  people,  as  well  as  the  negroes,  in  North  Caro- 


1845.]  Observations  on  Geophagij.  431 


lina,  along  the  borders  of  the  Roanoke  river.  (New-York  Med. 
Repos.,  2d  Hexade.,  vol.  5,  p.  340  :  N.  Y.,  1808.)  I  have  frequent- 
ly  observed  the  same  habit  among  the  poorer  classes  of  white  persons, 
inhabiting  the  pine  barrens  and  thinly  settled  portions  of  Georgia. 
The  influence  of  example,  especially  among  children,  doubtless  con- 
tributes materially  to  the  perpetuation  and  extension  of  this  perni- 
clous  habit,  when  once  established  in  a  community.  The  endemic 
affection,  called  Dirt-eating,  Mai  d'Esiomac,  Cachexia  Africana, 
etc.,  so  well  described  by  John  Hunter,  George  Davidson,  James 
Dancer,  John  Ferguson,  and  other  writers  on  the  diseases  of  the  Ne- 
groes of  the  West  Indies,  as  well  as  by  Prof.  W.  M.  Carpenter  of 
Louisiana,   appears  to  be  the  entailment  of  a  habit  contracted  in 
Africa.  Whether  the  conjecture  of  Thibaut  de  Chanvalon,  previous- 
ly alluded  to,  that  the  indulgence  of  the  habit  in  Africa,  is  not  perni- 
cious to  health,  be  tenable  or  not,  we  have  not  the  means  of  deter- 
mining with  certainty  ;  but  there  are  facts  as  well  as  analogies, 
which  throw  considerable  probability  on  the  opinion,  I  have  already 
noticed  the  fact,  that  among  some  savage  tribes,  Geophagy  is  not 
fatal  to  health. 

According  to  M.  Moreau  de  Jonnes,  it  has  been  supposed  to  be 
observed,  that  the  inordinate  taste  for  eating  earth  autrments  amonj^ 

'  o  o  o 

the  African  slaves,  and  becomes  more  pernicious,  when  they  are  re- 
stricted to  a  regimen  purely  vegetable,  and  deprived  of  spirituous 
liquors.  (Obs.  on  the  Dirt-eaters  of  the  West  Indies.  Bullet,  dela 
Soc.  Med.,  Mai,  1816,  as  cited  by  Humboldt  op.  cit.,  vol.  5,  Part  2d, 
p.  645.)  With  regard  to  the  influence  of  spirituous  liquors,  my  ob- 
servation does  not  furnish  me  with  the  data  requisite  for  giving  a 
decided  opinion  ;  but  I  am  quite  sure,  that  a  liberal  supply  o^ animal 
food  has,  in  many  instances,  removed  the  malady,  and  that  a  con- 
tinuance of  its  use  has,  apparently,  contributed  much  towards  the 
eradication  of  the  habit  from  many  plantations,  ^noh  ^  permanent 
effect  could  be  scarcely  ascribed  to  a  mere  change  of  diet. 

No  physiological  phenomenon  being  entirely  insulated,  it  may  bo 
interesting  to  examine  several  analogous  phenomena,  which  present 
themselves  in  other  departments  of  the  animal  kingdom.  Kirby,  the 
distinguished  entomologist,  informs  us  that  he  found  the  larvae  of 
the  Dermestes  vulpinus,  Fabr,  feeding  on  a  specimen  oC  amianthus, 
and  perforating  it  in  various  directions,  and  that  they  underwent 
their  customary  metamorphoses.  As  this  class  of  insects  is  not  par- 
ticular in  selecting  a  place  in  which  to  undergo  their  metamorphoses^ 


432  Observations  on  Geophagy.  [August, 


it  is  not  probable  that  they  would  have  taken  the  trouble  to  perforate 
the  asbestus  for  that  sole  purpose:  but  a  further  proof  that  this  was 
not  their  object,  is  furnished  by  the  varying  size  of  the  holes  perfora- 
ted in  the  specimen.  There  were  three,  one  of  which  was  one  and  a 
half  lines  in  diameter  ;  another,  one  and  three  quarler  lines  ;  and  a 
third,  two  lines:  from  whence  it  seems  to  follow  that  the  insects 
that  perforated  it  were  in  different  stages  of  growth  ;  and  consequent- 
ly derived  nutriment  from  that  substance."  (Vide.  Tilloch's  Phil. 
Mag.,  1st  Series,  vol  61,  pp.  3  et  4  :  1823.)  A  large  Spider  of  the 
species  Aranea  scenica,  Linn.,  has  been  supposed  to  be  capable  of 
obtaining  nutriment  from  devouring  sulphate  of  zinc.  Two  ounces 
of  this  salt  were  closed  up  in  a  box  with  the  spider,  of  which  it  was 
found,  at  the  end  often  weeks,  he  had  eaten  a  considerable  quantity. 
At  the  time  the  paper  was  read,  the  insect  seemed  in  perfect  health, 
having  in  about  six  months  eaten  nearly  four  ounces  of  the  sulphate 
of  zinc.  Other  metallic  salts, sulphates,  muriates,  and  nitrates,  were 
also  offered  to  the  spider,  but  he  would  not  touch  them,  even  when 
denied  his  favorite  salt.  From  some  experiments  made  on  the  yel- 
lowish brown  powder  found  at  the  bottom  of  the  box,  the  author  con- 
cludes that  the  sulphate  of  zinc  had  been  deprived  of  a  part  of  its  acid 
in  passing  through  the  spider.  (Tilloch's  Phil.  Mag.,  1st  Series, 
vol.  53,  p.  61 :   1819.) 

Assuming  that,  in  the  instance  recorded  by  Kirby,  the  Derraestes 
had  the  power  of  resolving  the  amianthus  into  its  ultimate  elements, 
let  us  inquire  what  were  the  sources  of  nutriment  of  this  insect. 
According  to  the  analysis  of  Meitzendorf,  asbestus  consists  of 

Silica 55.8G9 

Magnesia, 20.334 

Lime, 17.764 

Protoxide  of  Iron,      .     .       4.309 

Prot.  Manganese,      .     .       1.115 


99.391 
(Vide.  James  D.  Dana's  System  of  Mineralogy,  2d  Ed.,  New-York, 
1844,  p.  370.)  If  we  grant  these  coleoptera  the  extraordinary  power 
of  appropriating  from  the  atmosphere,  carbon  in  the  form  of  carbonic 
acid,  nitrogen  either  alone  or  in  the  form  of  ammonia,  oxygen,  
and  hydrogen  in  the  form  of  aqueous  vapor,  perhaps,  with  the 
assistance  of  the  elements  of  amianthus,  we  will  be  furnished  with 
materials  sufficient  for  the  nutriment,  growth,  and  metamorphosis  of 


1845. J  Ohservatlona  on  Gfophagy.  433 


(hem.  Ktit  tlie  Aranea  which  luxuriated  on  sulphate  of  zinc,  must 
have  been  provided  with  still  more  extraordinary  powers  of  assimili- 
tion;  for  the  sources  of  his  nutriment  were  attenuated  to  the  ele- 
ments of  that  salt,  viz:  sulphur,  oxygen,  and  zinc,  together  with 
the  materials  furnished  by  the  atmosphere.  Great  caution  should, 
however,  be  observed  in  generalizing  from  instances  drawn  from  the 
lower  orders  of  animals,  and  especially  from  insects,  with  regard  to 
the  sources  of  nutriment.  The  mere  air,  or  that  in  conjunction  with 
the  impurities  usually  suspended  therein,  appears  to  afford  nourish- 
ment enough  for  many  forms  of  animal  life.  Snails  and  chameleons 
have  often  been  known  to  live  upon  nothing  else  for  years.  The 
scorpion  has  been  knowm  to  endure  an  abstinence  of  three  months, 
and  the  Melasoma,  one  of  the  beetle  tribe,  has  lived  seven  months 
pinned  down  to  a  board.  Garman  found  that  this  nutriment  is  suf- 
ficient for  the  support  of  the  voracious  spiders;  and  M.  Latreille 
confirmed  the  experiment  by  fixing  a  spider  to  a  piece  of  cork,  and 
precluding  it  from  any  communication  with  every  kind  of  food  for 
four  months  ;  at  the  end  of  which  period  he  appeared  to  be  as  lively 
as  at  first.  Mr.  Baker  in  like  manner  confined  a  Scaraboeus  beetle 
under  a  glass  for  three  years  ;  allowing  him  nothing  but  air  for  diet : 
at  the  expiration  of  this  period,  he  was  fortunate  enough  to  effect  his 
escape,  and  go  in  pursuit  of  a  more  substantial  repast.  Every  ento- 
mologist repeatedly  sees  insects  living  in  their  cases,  although  pinned 
down  for  an  incredible  length  of  time.  I  have  frequently  observed 
several  of  the  larger  species  o^  EJaier  to  survive  the  transfixing  of  a 
pin  for  many  months.  It  is  a  well-established  fact  in  the  history  of 
fishes,  that  many  species  will  live  and  thrive  upon  water  alone  in  a 
marble  basin;  although,  it  seems  probable,  that  they  may  obtain 
some  nutriment  from  organic  impurities,  and  from  the  numerous 
animalculae  which  the  microscopist  reveals  to  us  in  the  purest  forms 
of  rain-water.  Bruce  kept  two  cerastes  or  horned  snakes,  in  a  glass 
jar  for  two  years,  without  any  apparent  food  ;  and  they  cast  their 
skins  at  the  usual  period.  Lizards,  toads,  frogs,  and  many  other 
reptiles  of  the  batrachian  family,  have  dragged  out  anchoritic  lives 
of  indefinite  duration,  imbedded  in  trunks  of  trees,  and  blocks  of  mar- 
ble ;  cut  off  from  every  kind  of  food  except  the  moisture  by  which 
perhaps  they  are  surrounded,  and  the  indirect  communication  of  air 
through  the  pores  and  crevices,  which  the  experiments  of  W.  F. 
Edwards  have  demonstrated  to  be  essential  to  the  maintenance  of 
life  in  such  ci;  cumatances.     Ht  nee  it  is  very  clear,  thaf,  it  is  possible 


434  Observations  on  Geophagy.  [August, 


that  the  Dermestes  and  the  Spider  above-mentioned,  might  have 
lived  without  any  ostensible  nutriment,  and  might  have  consumed 
the  amianthus  and  the  sulphate  of  zinc  as  a  matter  of  amusement, 
without  abstracting  any  nourishment  therefrom  :  although  it  must 
be  confessed,  that  the  varying  size  of  the  perforations  and  the  regular 
metamorphoses  which  the  insects  underwent  in  the  example  recorded 
by  Kirby,  as  well  as  the  alteration  of  the  physical  characters  of  the 
salt  of  zinc  which  had  passed  through  the  spider,  appear  to  indicate 
that  these  minerals  subserved  some  more  substantial  purpose  in  their 
unique  system  of  dietetics. 

Like  man  in  a  savage  state,  some  animals  also,  when  pressed  by 
hunger  in  winter,  swallow  clay  or  friable  steatites ;  such  are  the 
wolves  in  the  north-east  of  Europe,  the  reindeer,  and,  according  to 
the  testimony  of  Patrin,  the  kids  of  Siberia.  The  Russian  hunters 
on  the  banks  of  the  Jenisey  and  the  Amour  use  a  clayey  matter,  which 
they  call  rock-hutter^  as  a  bait.  The  animals  scent  this  clay  from 
afar,  and  are  fond  of  the  smell ;  as  the  clays  of  bucaros,  known  in 
Portugal  and  Spain  by  the  name  of  odoriferous  earths,  have  an  odor 
agreeable  to  women  ;  especially  to  those  of  the  province  of  Alentejo, 
who  have  acquired  a  habit  of  chewing  it,  and  feel  a  great  privation, 
when  they  cannot  indulge  this  violated  taste.  (Humboldt  op.  cit., 
vol.  5,  Part  2,  pp.  655,  656.)  My  uncle,  Maj.  John  Le  Conte,  F.  L. 
S  ,  of  New-York,  has  kindly  furnished  me  with  the  details  of  an  ex- 
traordinary example  of  canine  Geophagy,  which  fell  under  his  own 
observation.  This  bitch,  when  very  young,  nearly  killed  herself  by 
eating  the  skin  of  boiled  ham,  and  was  ever  after  more  or  less  trou- 
bled with  indigestion.  She  remained  in  New-York  until  she  was  half 
grown,  when  he  brought  her  to  Georgia,  where  she  killed  herself  in 
about  eighteen  months,  by  eating  clay.  Although  she  was  a  remark- 
ably large  dog,  and  lived  three  years,  she  manifested  no  disposition 
to  breed,  and  never  had  any  offspring.  Her  appearance  was  always 
rather  lank,  notwithstanding  she  belonged  to  a  variety  distinguished 
for  stoutness  and  a  tendency  to  be  corpulent.  She  was  very  robust, 
but  seemed  incapable  of  getting  fat.  The  kind  of  clay  which  she 
preferred,  and  which,  it  is  believed,  is  always  selected  by  every  ama- 
teur Geophagist,  was  a  white  clay  which  could  be  obtained  in  the 
sides  of  newly-dug  ditches  and  had  a  slight  aluminous  taste.  Ho 
likewise  informs  me,  that  in  the  mountains  of  North  Carolina  and 
Tennessee,  he  has  seen  horses,  horned-cattle,  and  hogs,  eat  a  kind  of 
red  clay,  strongly  impregnated  with  iron,  which  is  not  unfrcqucnt  in 


1S45.]  Observations  on  Gcophagy.  435 

that  part  of  the  country.  The  natives  ascribed  the  habit  to  an  inade- 
quate supply  of  salt.  Whether  this  practice  was  injurious  to  them, 
or  whether  it  ever  degenerated  into  a  disease,  he  was  not  able  to 
ascertain. 

It  is  an  unquestionable  fact  in  the  history  of  the  crocodilian  rep- 
tiles, ihni  fragments  of  stone  are  frequently  found  in  their  stomachs. 
Humboldt  and  Bonpland  dissected  a  crocodile  eleven  feet  long,  at 
Batalley,  on  the  banks  of  the  Rio  Magdalena,  the  stomach  of  which 
contained  fish  half  disrested,  and  rounded  fra<j^!nents  of  ojranite  threo 
or  four  inches  in  diameter.  (Op.  cit.,  vol.  5,  Part  2,  p.  656.)  M. 
GeofFroy-Saint-Hilaire  met  with  a  quantity  of  small  pebbles  in  the 
stomach  of  the  Egyptian  crocodile,  ^' the  polish  of  which  annaunced 
that  they  had  served  for  the  trituration  of  the  alimentary  inatters.'^ 
(Annales  du  Museum  d^IIisioire  NatureUe,  Xo.  7,  as  cited  in  Til- 
loch's  Phil.  Mag.,  1st  Series,  vol.  16,  p.  440-441 :  1803.)  Mr. 
Richard  Owen  also  found  them  in  a  Crocodilus  acittus,  Cuv.,  which 
died  at  the  Gardens  of  the  Zoological  Society.  (Phil.  Mag.,  New 
Series,  vol.  11,  p.  63 :  1832.)  I  have  repeatedly  taken  stony  masses 
of  various  sizes  from  the  stomachs  of  our  Alligators,  (Crocodilus 
lucius,  Cuv.);  and,  in  one  case,  an  Indian  arrow-head  of  hornstonc 
was  extracted,  which  was  as  beautifully  polished  as  though  it  had 
been  in  the  hands  of  an  accomplished  lapidary.  The  savages  of 
South  America  believe  that  these  indolent  animals  like  to  augment 
their  weight,  that  they  may  have  less  trouble  in  diving;  while  the 
inhabitants  of  Ceylon  and  Luconia,  seem  to  have  a  superstition  that 
the  reptile  swallows  "  a  stone  whenever  he  kills  a  human  being,  as  if 
to  keep  account  of  his  misdoings."  (Siliiman's  Journal,  vol.  38, 
p.  319-320:  1S40.)  The  two  prevailing  opinions  are,  either,  that 
these  sauria  swallow  stones  only  when  they  are  going  into  a  torpid 
state,  for  the  purpose  of  keeping  up  the  action  of  the  stomach  during 
the  period  of  hybernation  ;  or,  that  it  is  to  appease  hunger  in  times 
of  scarcity,  by  exciting  an  abundant  secretion  of  gastric  juice.  But 
I  am  disposed  to  think,  that  the  true  object  in  swallowing  the  inorganic 
masses,  is,  to  provide  these  animals  with  the  means  of  accelerating 
the  trituration  of  the  aliments  in  a  muscular  and  thick  stomach  ;  as 
the  Crustacea,  insects,  and  many  gasteropods,  are  furnished  with 
gastric  teeth;  and  as  the  graniverous  birds  take  small  pebbles,  to 
assist  mechanically  in  the  reduction  of  the  food.  The  teeth  of  these 
reptiles  are  exclusively  prehensile  organs  ;  consequently  their  food 
is  swallowed  without   mastication,   requiring  Fome  other  mechanical 


436  Observations  on  Geophagy.  [August, 


power  to  reduce  it  to  a  mass  fit  for  assimilation.  The  stomach  of 
this  class  of  reptiles,  like  that  of  several  phytophagous  Chelonia,  re- 
sembles that  of  graniverous  birds,  in  the  thickness  of  its  coats,  and 
the  approximation  of  its  two  apertures.  Its  muscular  character  and 
gizzard-like  form,  had  long  drawn  attention  to  the  analogy  which  it 
bears  to  the  true  gizzards  of  birds  ;  but  the  propriety  of  this  denomi- 
nation has  been  questioned  by  M.  Geoffroy-Saint-Hilaire,  on  the 
ground  of  its  wanting  a  cuticular  lining.  In  a  young  Alligator 
(Croc,  lucius,  Cuv.)  which  I  dissected  during  the  past  spring,  I  found 
that  viscus  in  the  form  of  an  ellipsoidal,  strong  muscular  gizzard,  
the  villous  coat  being  remarkably  thick  and  highly  vascular ;  the 
muscles  do  not  form  a  digastric  mass  as  in  gallinaceous  birds,  but 
the  muscular  fasciculi  radiate  from  an  anterior  and  posterior  central, 
shining,  circular,  tendinous  part  to  the  margins,  as  in  many  species 
of  cephalopoda  and  rapacious  birds.  In  short,  the  absence  of  an 
epithelium  appears  to  be  the  only  reason  for  withholding  from  this 
viscus  the  function  of  a  true  triturating  organ  ;  while  the  muscular 
character  of  its  parietes,  and  the  polished  condition  of  the  stony 
masses  found  therein,  would  seem  to  indicate  that  it  does  actually 
perform  that  office  in  the  economy  of  this  class  of  reptiles,  without  the 
protection  of  a  cuticular  membrane.*  According  to  this  view  of  the 
question,  therefore,  these  sauria  cannot,  properly  speaking,  be  regard- 
ed as  Geophagists. 

When  we  reflect  on  the  whole  of  the  facts  connected  with  the 
phenomena  of  Geophagy,  we  perceive,  that  this  disorderly  appetite 
for  clayey,  magnesian,  and  calcareous  earth,  is  most  common  among 
the  inhabitants  of  intertropical  regions;  that  it  is  not  always  a  cause 
of  disease  ;  and  that  some  tribes  eat  earth  from  choice,  while  others 
(the  Otomacs  in  America,  and  the  New-Caledonians  in  the  Pacific 
Ocean,)  devour  it  to  appease  hunger,  and  to  give  bulkiness  to  the 
meagre  supply  of  organic  food  which  they  can  obtain  in  times  of 
scarcity. 

That  the  habitual  indulgence  of  an  appetite,  apparently  so  un- 

*  It  is  somewhat  remarkable  that  Prof.  Rudolph  Wagner  affirms,  contrary  to 
the  observations  of  Geoffroy-Saint-Hilaire  and  Owen,  that,  the  stomach  of  the 
Crocodile  is  ^^  lined  loith  a  hard  epithelium^  (Elements  of  the  Comp.  Anat.  of 
of  the  Vertebrate  Animals.  Edited  from  the  German,  by  Alfred  Tulk :  London, 
1845,  p.  16-2.)  A  re-examination  of  the  specimen  taken  from  an  Alligator, 
w^hich  I  have  preserved  in  spirits,  does  not  show  any  appreciable  development  of 
a  cuticular  membrane  distinct  from  the  villous  tunic. 


^45. J  Observalions  on  Geophagy,  437 


uatural,  should  not  always  result  in  the  induction  of  a  pathological 
state  of  the  system,  is  certainly  an  extraordinary  physiological  phe- 
nomenon. Our  knowledge  of  the  physical  and  chemical  properties 
of  the  different  kinds  of  earth  which  are  eaten  by  various  tribes  of 
savages,  is  not  sufficiently  accurate  to  admit  of  a  definite  conclusion, 
with  regard  to  what  constitutes  the  deleterious  qualities  of  some,  and 
the  innocuous  character  of  others.  I  am  disposed,  however,  to  ascribe 
the  diversity  of  effects,  in  a  great  measure,  to  the  difference  in  the 
mechanical  states  of  the  kinds  of  inorganic  materials  which  are 
swallowed.  A  careful  review  of  the  facts  above  collected,  will  show 
that  those  tribes  which  indulge  their  Geophagous  propensities  tcith 
impunity,  always  select  a  fat,  smooth,  and  unctuous  magnesian  or 
aluminous  earth ;  the  mechanical  condition  of  which,  is  precisely 
such  as  would  be  least  liable  to  produce  gastric  or  intestinal  irritation. 
The  clay  consumed  by  the  Otomacs  without  any  perceptible  injury 
to  health,  which  was  analyzed  by  M.  Vauquelin,  appears  to  have 
been  a  silicate  of  alumina  and  lime,  analogous  to  that  resulting  from 
the  decomposition  of  feldspar,  possessing  all  the  characters  of  a 
fat,  unctuous  variety  of  clay.  The  steatitic  masses  swallowed  by 
the  savage  inhabitants  of  New-Caledonia,  seem  to  be  a  silicate  of 
magnesia  mingled  with  the  oxides  of  calcium  and  copper,  present- 
ing the  same  smooth,  unctuous  character.  The  white  friable  steatite 
which  Goldberry  observed  the  Negroes  on  the  coast  of  Africa  to  eat, 
and  of  which  he  had  himself  eaten,  without  being  incommoded  by  it, 
was  probably  a  serpentine  or  talcose  variety  of  stone.  Substances 
so  smooth  and  unctuous  would  not  probably  cause  any  gastric  or  in- 
testinal irritation,  even  w^re  they  to  pass  unchanged  through  the 
whole  length  of  the  alimentary  canal. 

On  the  contrary,  it  is  not  at  all  astonishing,  that  the  ferruginous 
clay  called  ampo,  which  the  Javanese  women  eat,  should  produce 
emaciation  and  loss  of  appetite  ;  since  it  is  probable,  that  the  angu- 
lar silicious  particles  mixed  with  it,  would  speedily  occasion  some 
visceral  disturbance,  merely  from  the  mechanical  irritation  which 
the  presence  of  such  materials  must  develop.  Still  less  remarkable 
is  it,  that  the  Negroes  of  the  West  Indies,  who  had  been  in  the 
habit  of  eating  an  unctuous  steatite  on  the  coast  of  Africa  without 
experiencing  any  inconvenience  from  the  diet,  should  speedily  become 
sick  when  they  consume  the  rough  volcanic  tufa  of  these  islands. 

A  variety  of  physiological  phenomena  prove,  that  a  temporary 
cessation  of  hunger  may  be  produced,  without  the  substances  that 


438  Observations  on  Geophagy.  [August, 


are  submitted  to  the  organs  of  digestion  being,  properly  speaking, 
nutritive.  This  observation  has  been  confirmed  by  the  direct  ex- 
periments of  two  distinguished  French  physiologists,  M.  M.  Hippo- 
lyte  Cloquet  and  Breschet.  After  long  fasting,  they  ate  as  much  as 
five  ounces  of  a  silvery  green  and  very  flexible  laminar  talc.  Their 
hunger  was  completely  satisfied,  and  they  felt  no  inconvenience  from 
a  kind  of  food,  to  which  their  organs  were  unaccustomed.  (Hum- 
boldt, op.  cit.  vol.  5,  Part  2,  p.  653.)  Indeed,  the  experiments  of 
Dr.  Beaumont  and  others,  have  demonstrated  that  bulkiness  of  ali- 
ment, is  almost  as  necessary  to  healthy  digestion,  as  the  presence  of 
nutrient  matter  itself.  It  is,  probably,  from  this  cause,  that  the 
Kamschatdales  and  the  Veddahs,  or  wild  hunters  of  Ceylon,  mix 
earth  or  saw-dust  with  their  train-oil  and  honey.  Hunger  is  appeased, 
the  painful  feeling  of  inanition  ceases  when  the  stomach  is  filled.  In 
vernacular  phraseology,  this  viscus  is  said  to  stand  in  need  of  ballast ; 
and  every  language  furnishes  figurative  expressions,  which  convey 
the  idea,  that  a  mechanical  distention  of  the  stomach  causes  an 
agreeable  sensation.  We  may  readily  conceive,  that  the  secretion 
of  the  gastric  and  pancreatic  juices  is  augmented  by  the  presence 
of  earths  in  the  stomach  and  intestines  of  the  Otomacs :  but  how 
does  it  happen,  that  such  abundant  secretions,  which,  far  from  fur- 
nishing the  body  with  new  matter,  only  produce  the  elimination  of 
substances  already  acquired  by  other  means,  do  not  at  length  cause 
emaciation  and  exhaustion?  M.Humboldt  thinks  that  "It  can  be 
attributed  only  to  a  habit,  prolonged  from  generation  to  generation." 
(op.  cit.  p.  655.)  The  influence  of  habit  is,  without  doubt,  very 
powerful:  we  are  able  gradually  to  change  the  regimen  of  herbivo- 
rous and  carnivorous  animals,  to  feed  the  former  with  flesh,  and  the 
latter  with  vegetables.  Spallanzani  habituated  an  eagle  to  live  on 
bread,  and  a  pigeon  on  flesh.  {Experience  sur  la  Digestion,  c.  74, 
et.  75.)  Sometimes  a  long  deviation  from  the  natural  food  is  follow- 
ed by  a  change  in  the  structure  of  the  digestive  organs :  thus,  Hunter 
found  that  after  a  sea-gull  has  lived  for  a  year  upon  grain,  the  strength 
of  the  gizzard  is  vastly  increased,  (vide.  Home.  Comp.  Anat.,  vol. 
1,  p.  354.)  It  is  asserted  that,  the  domestic  cat,  which  eats  bread  as 
well  as  flesh,  has  an  alimentary  canal  considerably  longer  than  that 
of  the  wild-cat ;  thereby  presenting  an  approximation  to  the  herbivo- 
rous mammalia  in  the  structure  of  the  digestive  apparatus,  (vide. 
Good's  Study  of  Med.,  Doane's  Ed.,  vol.  1,  p.  24,  New-York,  1836.) 
Like  many  animals,    man  can  accustom    himself  to  extraordinary 


1^43. J     "  Ob:iervaiioii6  on  Geophagy.  439 


abstineDce:  but  we  can  scarcely  ascribe  to  the  effects  of  a  habit 
progressively  acquired,  the  power  which  the  Otomacs  possess,  not 
only  of  living,  but  of  enjoying  vigorous  healthy  with  no  other  appa- 
rent  subsistence,  during  two  months  of  the  year,  than  masses  of 
silicate  of  alumina  and  lime  !  Assuredly  it  is  more  rational  to  sup- 
pose, that  the  life  of  indolence  and  the  almost  complete  cessation  of 
muscular  exercise,  which  these  savages  have  associated  with  the 
periodical  overflowings  of  the  Orinoco,  enables  them  to  be  supported 
on  the  comparatively  insignificant  amount  of  organic  matter  w^hich 
is  occasionally  taken  with  the  clay.  This  view  is  strengthened  by 
the  consideration,  that  in  intertropical  regions,  where  the  tempera- 
ture of  the  surrounding  atmosphere  is  high,  but  a  small  amount  of 
the  elements  of  respiration  is  consumed  in  the  function  of  calorifica- 
tion; and  during  the  period  of  muscular  inactivity,  where  there  is 
very  little  manifestation  of  mechanicaiybrce,  a  comparatively  scanty 
supply  of  materials  is  sufficient  to  maintain  an  equilibrium  between 
the  supply  and  waste  of  matter  in  the  system  ;  especially  when  it  is 
taken  in  conjunction  with  other  matters,  which,  while  they  afford 
little  or  no  nutriment  to  the  body,  yet  serve  to  give  that  hulk  to  the 
aliment,  which  is  one  essential  condition  of  active  and  thorough 
assimilation. 

It  cannot  be  doubted,  that  the  great  mass  of  substances,  inservient 
to  the  nourishment  of  man,  is  obtained  from  the  animal  and  vegeta- 
ble kingdoms  ;  but  there  seems  to  be  no  sufficient  reason  for  excluding 
those  articles  of  the  mineral  world  that  are  necessary  for  the  due 
constitution  of  different  parts  of  the  body.  JMost  of  these  inorganic 
elements  enter  into  the  constitution  of  the  vroteinaceous  compounds 
of  animals  and  vegetables,  as  well  as  into  other  organic  aliments,  in 
sufficient  quantity  to  supply  the  wants  of  the  system.  When  they 
are  not  thus  furnished  in  adequate  quantities,  it  is  by  no  means  un- 
reasonable to  suppose  that  they  will,  when  presented  in  a  form  suit- 
able for  assimilation,  be  appropriated  directly  from  the  mineral 
kingdom.  Such  a  deficiency  of  the  mineral  ingredients  of  the  ali- 
ments, may  be  the  cause  of  the  prevalence  of  Geophagism  among 
certain  tribes  of  savages.  I  do  not  now  speak  of  the  vitiated  appe- 
tite for  inorganic  substances,  manifested  as  a  symptom  of  derange- 
ment of  the  function  of  digestion,  but  of  the  habit  f-s  it  prevails  amonn- 
apparently  healthy  individuals.  All  of  the  edible  earths  contain 
more  or  less  lime,  an  element  essential  to  (he  proper  nourishment 
of  the  osseous  structures. 


440  Observations  on  Geophagy.  '[August, 


The  essential  constituents  of  the  human  body  are  thirteen  viz  : 
carbon,  hydrogen,  oxygen,  nitrogen,  phosphorus,  sulphur,  iron,  chlo- 
rine, sodium,  calcium,  potassium,  magnesium,  and  fluorine;  and  the 
same,  therefore,  must  be  the  elements  of  our  food.  Several  of  them 
are  required  in  such  minute  amounts,  that  considerable  time  must 
elapse  before  their  want  is  manifested  by  derangement  of  the  animal 
economy;  but  it  seems  certain,  that  no  one  of  those  primary  or 
simple  substances  can  be  wanting  in  the  nutriment  without  the  body 
ult  mately  feeling  the  ill  effects  of  its  absence.  From  experiments 
on  the  nutrition  of  a  calf,  and  a  cow  in  calf,  M.  Boussingault  concluded 
that  there  is  a  portion  of  the  mineral  substance  taken  in  with  the 
food,  which  remains  definitively  fixed,  to  concur  in  the  growth  or  in 
the  evolution  of  the  individual.  In  an  adult  animal,  it  is  to  be  pre- 
presumed,  that  no  such  definitive  fixation  of  inorganic  principles  takes 
place,  or  that  it  is  much  less  considerable.  Nevertheless,  it  would 
be  a  grave  mistake  to  suppose,  that  an  adult  animal  could  go  on  for 
even  a  very  short  period  of  time,  upon  food  that  contained  no  miner- 
al matter.  Precisely  as  in  the  case  of  organic  matter,  it  appears 
that  a  portion  of  inorganic  matter  is  also  fixed  in  the  living  frame, 
where,  for  a  time,  it  forms  an  integral  element  in  the  wonderful 
structure ;  and  a  supply  of  the  latter  kind  is  undoubtedly  no  less  ne- 
cessary, than  is  the  supply  of  the  former  description  recognized  by  all 
the  world.  (Vide.  Rural  Economy,  in  its  relations  with  Chemistry, 
Physics,  and  Meteorology  ;  or.  Chemistry  applied  to  Agriculture.  By 
J.  B.  Boussingault,  Member  of  the  Institute  of  France,  etc.  Trans- 
lated by  George  Law,  Agriculturist :  Am.  Ed.,  New-York,  1845, 
p,  410  et  seq.)  Were  there  an  inadequate  quantity  of  phosphoric 
acid,  of  lime,  etc.,  in  the  aliment,  no  question  but  that  the  body  would 
speedily  feel  the  effects  of  the  deficiency,  and  that  disease  and  death 
would  eventually  put  an  end  to  existence.  So  much,  indeed,  seems 
demonstrated  by  the  very  interesting  experiments  of  M.  Chossat,  in 
which  he  kept  graniverous  animals  upon  a  diet  rich  in  azotized  prin- 
ciples and  in  starch,  but  deficient  in  lime.  From  previous  inquiries, 
M.  Chossat  had  observed  that  pigeons  even  require  to  add  a  certain 
proportion  of  lime  to  their  ordinary  food,  the  quantity  naturally  con- 
tained in  which,  does  not  suffice  them.  Wheat,  though  it  contains  a 
large  proportion  of  phosphate  of  magnesia,  yields  very  little  phos- 
phate  of  lime ;  and  pigeons  fed  on  this  grain,  though  they  do  per- 
fectly  well  at  first,  and  even  get  fat,  begin  after  a  while  to  fall  oflT. 
In  from  two  to  three  months,   the  birds  appeared  to  suffer  from  con- 


1845.]  Observatiuns  on  Geoyhagy.  441 


stant  thirst ;  they  drank  frequently ;  the  faeces  became  soft  and 
liquid,  and  the  flesh  wasted,  and  in  from  eight  to  ten  months  the 
creatures  died  under  the  effects  of  a  diarrhoea,  which  M.  Chossat 
attributed  to  deficiency  of  the  calcareous  element  in  the  foo(\.  And 
it  is  neither  uninteresting  nor  unimportant  to  observe,  that  the  same 
thing  occasionally  occurs  in  the  human  subject  during  the  period  when 
the  process  of  ossification  is  usually  most  active.  But  one  of  the 
most  remarkable  features  of  M.  Chossat's  experiments  was  observed 
in  the  state  of  the  bones  of  the  pigeons;  they  became  so  thin  and 
weak  that  they  broke  during  the  life  of  the  birds  with  the  slightest 
force.  (Chossat,  in  Compies  Rendus,  tom.  14,  p.  451,  as  cited  by 
Boussingault,  op.  cit.,  p.  413.)  From  these  instructive  experiments 
M.  Boussingault  very  justly  concludes,  that  "supplies  of  all  the 
elements  of  all  the  parts  of  the  body  are  indispensable  to  the  main- 
tenance  of  health,  to  the  continuance  of  life."  (loc.  cit.)  A  pigeon 
will  eat  about  463.140  grains  of  wheat  per  diem,  containing  9.725 
grains  of  ash,  in  which  analysis  discovers  4.569  grains  of  phosphoric 
acid,  and  0.277  of  a  grain  of  lime.  But  this  small  quantity  of  lime 
is  incompetent  to  maintain  the  bones  in  their  standard  condition. 
(Boussingault,  op.  cit.,  p.  413.) 

The  importance  of  the  inorganic  principles  of  food,  has  not  been 
sufficiently  recognized  :  it  is  not  only  indispensable  that  the  allow- 
ance of  an  animal  in  full  growth  be  adequate  to  support,  and  even  to 
add  to  the  soft  textures  ;  it  must  further  contain  the  elements  re- 
quisite for  the  nutrition  of  the  osseous  system.  While  the  ashes  of 
wheat  contain  about  2.85  per  cent,  of  lime,  that  of  maize  or  Indian 
corn  grown  at  Bechelbronn,  yields,  according  to  the  analysis  of  M. 
Letellier,  but  1.3  per  cent,  o^  lime,  to  50.1  of  phosphoric  acid,  and 
17.0  of  magnesia.  (Vide.  Drs.  Will  and  Fresenius  on  the  Inorganic 
Constituents  of  Plants,  in  Phil.  Mag.,  3d  Series,  vol.  25,  p.  517. 
1844.)  Very  probably  the  amount  of  lime  contained  in  maize,  may 
vary  considerably,  according  to  the  character  of  the  soil  in  which  it 
is  grown ;  but  the  foregoing  analysis  seems  to  indicate,  that  this 
grain  usually  contains  less  of  it  than  wheat.  Hence,  M.  Boussin- 
gault remarks  that,  "  in  South  America,  where  the  animals  have  it 
largely,  I  have  observed  that  they  frequently  eat  earth."  "  The  hab- 
it,"  he  continues,  "  which  certain  tribes  of  the  natives  have  of  eating 
earth,  too,  which  has  been  particularly  remarked  upon  by  travellers 
and  missionaries  as  an  instance  of  depravation  of  taste,  presents  itself 
to  me  in  quite  another  light,  since  I  became   acquainted  with  the 


442  Observations  on  Geophagy.  [August, 


composition  of  the  ashes  of  the  ordinary  article  of  diet  (maize)  in  the 
countries  where  it  occurs."  (Op.  cit.,  p.  414.)  The  calcareous  and 
other  salts  necessary  to  nutrition  are,  however,  not  derived  from  the 
food  exclusively;  the  water  that  is  generally  consumed  contains  a 
quantity  which  is  hy  no  means  to  be  neglected.  Liebig  seems  to 
think,  that  the  habit  of  eating  calcareous  substances  observed  among 
children,  arises  from  an  insufficient  quantity  of  lime  in  their  diet:  
the  validity  of  which  assertion,  is  questioned  by  Pereira,  on  the  ground 
that  there  is  no  evidence  to  prove,  that  in  these  cases  the  food  is  defi- 
cient in  its  ordinary  proportion  of  lime.  (Vide.  Pereira,  op.  cit., 
ante.  p.  37.) 

In  confirmation  of  the  importance  of  inorganic  principles  in  the 
food,  I  will  here  adduce  a  remarkable  fact  which  has  repeatedly  fal- 
len under  my  own  observation.  The  cows  which  live  on  the  exten- 
sive savannas  and  pine  barrens  lying  on  the  North  side  of  the  Alta- 
maha  river  in  Mcintosh  county  in  this  State,  subsist  upon  very  coarse 
species  of  grasses,  which  are  probably  deficient  in  some  of  the  phos- 
phatic  or  calcareous  ingredients  essential  to  healthy  nutrition  ;  for 
these  animals  are  constantly  observed  io  chew  hones:  frequently 
remaining  stationary  for  several  hours,  with  the  head  elevated  at 
an  angle  of  forty.five  degrees  to  prevent  the  saliva  from  escaping 
from  the  mouth,  they  will,  by  constant  trituration,  gradually  reduce 
the  bony  mass  to  a  very  small  size,  when  it  is  rejected  as  an  unman- 
ageable morsel.  The  catile  in  this  section  of  the  State  are  usually 
rather  lean;  and  cows  brought  from  the  fertile  plantations  in  the 
neighborhood,  if  allowed  to  subsist  on  what  they  can  procure  in  the 
savannas  and  pine-barrens,  in  the  course  ofa  year  or  two,  become 
equally  thin,  and  ultimately  fall  into  the  habit  of  eating  hones.  I 
have  not  been  able  to  ascertain  whether  these  animals  indulge  in  this 
habit  to  a  greater  extent  when  they  are  in  a  state  o^ pregnancy  and 
when  they  are  giving  milk;  but  it  appears  reasonable  that  the  in- 
creased demand  for  mineral  matters  under  such  conditions  of  the 
economy,  would  call  for  a  proportionate  supply.  The  intelligent 
instinct  which  prompts  these  animals  to  seek  for  a  diet  so  extraordin- 
ary,  must  originate  in  an  inadequate  supply,  in  their  impoverished 
aliment,  of  some  of  the  inorganic  principles  (probably  the  phospha- 
tic  salts)  essential  to  a  proper  nourishment  of  the  osseous  structures. 
The  above-mentioned  fact  confirms  the  justice  of  the  observation  of 
Prof.  J.  F.  W.  Johnson,  who  recommends  upon  theoretical  grounds, 
that  bone-dust  or  bone  meal  be  introduced  as  an  article  of  general 


1845. J  Observalionson  Geophagij.  4 13 


food,  for  growing  and  pregnant  animals,  with  a  view  of  supplying  the 
large  quantity  of  the  phosphates  required  for  increasing  the  osseous 
system  of  the  one,  and  for  the  healthy  evolution  of  the  foetus  in  the 
other.     (Op.  cit.,  arite.  pp.  G03  et  605,  Part  4.) 

Such  being  the  importance  of  mineral  elements  in  the  animal 
economy,  it  does  not  appear  either  extraordinary  or  very  astonishing, 
that  the  dogs,  geese,  and  other  animals,  which  M.  M.  Magendie, 
Tiedemann  and  Gmelin  fed  exclusively  on  sugar,  or  gum,  or  starch 
and  distilled  water,  should  have  gradually  become  extremely  emacia- 
ted and  eventually  died  of  inanition ;  or  that  the  unfortunate  Dr. 
Stark  should  have  fallen  a  victim  to  a  system  of  exclusiveness  in 
diet.  It  is  scarcely  to  be  expected  that  animals  could  subsist  for  any 
length  of  time,  on  aliment  which  did  not  contain  all  of  the  constitu- 
ents of  their  bodies,  which  could  not  repair  the  waste  of  the  system. 
The  necessity  for  variety  in  diet  so  clearly  illustrated  by  the  experi- 
ments of  M.  M.  Magendie  and  Burdach,  is  very  probably  owing  to  a 
deficiency  of  one  or  more  of  the  inorganic  principles  in  the  alimentary 
substances  which  were  given  to  the  animals.  Some  articles  of  food 
contain  an  inadequate  quantity  of  some  salts,  w^iich  are  supplied  by 
others ;  and  thus  arises  the  necessity  for  variety  in  diet.  In  milk 
nature  has  furnished  a  product  perfectly  adapted  to  sustain  and  de- 
velope  the  young  animal :  it  contains  all  of  the  proximate  principles 
necessary  for  the  increase  of  the  soft  textures,  and,  likewise,  all  of  the 
saline  ingredients  required  for  the  consolidation  of  its  bones. 

Every  fresh  discovery  in  Organic  Chemistry  brings  vital  phenome- 
na  more  within  the  grasp  of  physical  laws,  and,  in  so  far,  more  within 
the  provinces  of  exact  research.  We  have  yet  to  learn  what  chronic 
diseases  are  produced  by  restricting  individuals  to  a  diet  deficient  in 
certain  inorganic  principles  which  are  indispensable  to  healthy  nutri- 
tion. The  importance  of  a  good  allowance  of  chloride  of  sodium  in 
the  food,  is  universally  acknowledged ;  but  the  influence  of  the  phos- 
phates, of  the  salts  of  lime,  magnesia,  potassa,  iron,  etc.,  has  not  been 
sufficiently  investigated.  Certainly  it  is  not  an  irrational  conjecture 
to  suppose,  that  the  Geophagous  propensity  manifested  by  certain 
tribes  of  savages,  not  as  a  vitiated  appetite  resulting  from  a  nervous 
lesion  of  the  function  of  digestion,  but  as  an  uncontrolable  habit,  
maybe  owing  to  a  deficiency  of  some  of  the  saline  ingredients  in  their 
ordinary  food,  which  nature  prompts  them  to  supply  in  this  remarka- 
ble manner.  This  view  derives  confirmation  from  the  fact,  that  an 
indulgence  of  the  appetite,  does  not  always  produce  disease.     Might 


444  Volvulus  and  Strangulation  of  the  Intestines.       [August, 


not  a  due  admixture  of  bone-meal  with  maize  and  other  kinds  of 
aliment,  afford  a  cheap,  efficacious,  and  palatable  mode  of  furnishing 
the  saline  materials  required  in  the  reparation  of  the  osseous  struc- 
tures ?  Might  not  such  a  plan  contribute  greatly  towards  the  eradi- 
cation of  the  Cachexia  Africana  from  the  Southern  and  Western 
States? 

Man  can  never  devise  a  system  of  dietetics  which  will  embrace  but 
one  single  alimentary  principle^  for  the  obvious  reason  that  his  body 
is  composed  of  a  number  of  such  elements.  It  is  highly  amusing  to 
notice  the  great  attention  with  which  some  persons  regard  the  ver- 
riest  trifles  in  diet,  and  the  hopes  which  they  entertain  of  the  advan- 
tages to  be  derived  from  strict  constancy  in  some  particular  style  of 
self-management.  Some,  like  Sanctorious,  measure  with  scrupulous 
accuracy  the  prescribed  quantity  of  their  ingesta,  while  others, 
like  Bouleau,  religiously  abstain  from  sitting  near  the  fire,  lest  per- 
adventure  it  should  dry  up  their  radical  moisture.  Notwithstanding 
all  this,  man  is  not  made  to  last  forever  :  it  is  scarcely  reasonable  to 
imagine  that  he  will  ever,  in  the  language  of  Dr.  Fletcher,  "  instead 
of  sitting  down,  as  at  present,  to  his  pound  and  a  half  of  mutton  chop 
and  pot  of  porter,  will  swallow  for  his  dinner  a  fine  grain  pill  com- 
posed of  equal  parts  of  ovine  and  cerevisine,  or  some  such  matters  of 
which  science  has  yet  to  be  delivered ;"  but  rather,  that  all  attempts 
to  work  miracles  on  himself,  and  render  him  unsusceptible  of  disease, 
must  be  forever  frustrated,  and  that  he  must  always  continue  to  exist, 
the  same  "poor,  bare,  forked  animal"  that  he  was  originally  created. 

Savannah,  June  25th,  1845. 


ARTICLE    II. 

A  RemarJcable  Case  of  Volvulus  and  Strangulation  of  the  Intestines 
within  the  Abdomen,  By  Jasies  M.  Gordon,  M.  D.,  of  Law- 
rencevillej  Ga, 

It  is  to  be  regretted  that  comparatively  so  few  cases  of  mortality 
have  a  place  assigned  them  in  our  medical  journals,  notwithstanding 
many  of  them  might  be  productive  of  unusual  interest.  A  large 
majority  of  physicians  who  write,  very  naturally,  entertain  a  predilec- 
tion to  report  those  cases  only  which  have  terminated  in  remarkable 


l'^45.J  Volvulus  and  Strangulation  of  the  Inlesiines.  445 


cures,  or  at  least  successful  issues  ;  to  the  utter  exclusion  of  those  of 
an  opposite  character,  however  advantageous  to  the  medical  profes- 
sion. The  following  case,  although  it  may  avail  but  little  practically, 
may  not  prove  wholly  unacceptable  to  the  pathologist. 

D.  P.  C,  of  Gwinnett  county,  aet.  35,  a  respectable  planter,  and 
a  man  of  uncommon  strength  and  vigorous  health,  was  attacked  on 
the  18th  of  May  last  with  the  most  excruciating  pains  in  the  abdomen, 
which  were  attended  with  obstinate  constipation  of  the  bowels.  As 
he  was  supposed  to  be  laboring  under  an  attack  of  colic,  various  do- 
mestic remedies  were  administered  without  effecting  the  slightest 
abatement  of  pain,  or  relief  to  the  confined  bowels.  A  Thompsonian 
physician  of  the  neighborhood  was  requested  to  see  him,  and  who 
had  charge  of  the  case  for  the  subsequent  week,  but  without  afford- 
ing any  relief.  My  partner,  Dr.  Russell,  and  myself,  were  then 
requested  to  visit  him,  and  found  him  the  subject  of  most  violent 
paroxysms,  of  pain  in  the  abdomen,  with  partial  remissions  of  com- 
parative ease.  The  skm  w^as  cool,  tongue  coated  with  a  dark  brown 
fur,  pulse  nearly  naturd,  bowels  constipated.  Upon  further  exam- 
ination it  was  discovered  that  considerable  pain  and  tenderness  were 
evinced  from  pressure  upon  the  lower  dorsal  and  lumbar  vertebra?. 
Local  revulsives  were  freely  applied  to  the  spinal  column ;  opiates 
and  antispasmodics  were  then  administered,  which  had  the  effect 
to  allay  all  pain.  An  active  cathartic  was  now  retained  till  tibout 
the  time  catharsis  should  have  been  produced,  when  the  pain  returned 
with  its  full  force  of  intensity.  Laxative  enemata  were  given  in 
such  quantity  as  to  distend  the  whole  colon,  but  all  to  no  purpose,  the 
stricture  not  being  removed.  The  pain  soon  gave  place  to  a  death- 
like sickness  at  the  stomach,  pallid  countenance,  cold  extremities, 
surface  bedewed  with  a  cold  clammy  perspiration,  followed  by  vomit- 
ing of  an  abundance  of  stercoraceous  matter  very  offensive  to  the 
smell.  The  most  energetic  means  were  adopted  for  his  relief  yet 
nevertheless  without  averting  the  fatal  result  of  this  unfortunate  case. 
For  the  few  last  days  such  remedies  were  used  as  were  best  calcula- 
ted to  allay  pain  and  support  the  sinking  powers  of  nature.  He  con- 
tinued to  grow  worse  and  expired  in  the  most  intense  agony  at  8 
o'clock,  P.  M.,  of  June  1st,  thirteen  days  after  the  attack. 

Post  mortem  appearances  twelve  hours  after  death.  On  opening 
the  abdomen  the  ileum  exhibited  a  dark  red  (almost  black)  appear- 
ance, which  extended  through  all  of  its  coats,  and  also  to  the  mesen- 
tery.    Upon  examination  it  was  ascertained  that  an  infrosuscrpfion 


446  Volvulus  and  Strangulation  of  the  Intestines,      [August, 


of  about  an  inch  and  a  half  in  length  existed  about  four  inches  above 
the  termination  of  the  ileum.  So  firmly  had  the  coats  of  the  intestine 
become  agglutinated  that  they  presented  the  appearance  of  a  fleshy 
tumour,  blocking  up  its  entire  caliber.  It  was  also  observed  that  the 
ileum  had  made  a  complete  revolution  upon  itself,  with  the  peritone- 
um as  an  axis,  so  as  to  strangulate  a  knuckle  of  intestine  five  inches 
in  length.  The  first  point  of  strangulation  was  immediately  above 
the  introsusception,  and  the  second  twelve  inches  above  the  last. 
They  were  twisted  around  each  other  so  as  to  form  a  knot  which  was 
with  difficulty  relieved  after  the  morbid  specimen  had  been  removed 
from  the  body.  The  incarcerated  noose  of  intestine  presented  an 
almost  black  color,  and  was  greatly  distended  with  gas.  About 
twenty  inches  of  intestine  were  involved  in  the  congestion.  The 
points  where  the  intestine  passed  around  itself  were  of  a  dull  white 
color,  presenting  a  striking  contrast  with  the  surrounding  parts. 

Remarks.  The  above  case  presents  several  interesting  peculiari- 
ties :  First,  the  complicated  nature  of  the  disease ;  secondly,  its 
length  of  duration  ;  thirdly,  the  attendant  symptoms.  So  far  as  our 
information  at  present  extends  we  believe  there  has  been  no  case  in 
which  introsusception  complicated  with  a  linking  oHhe  intestine  so 
as  to  produce  an  additional  cause  of  strangulation  has  been  recorded, 
although  instances  of  either  of  the  obstructions  separately  are  upon 
record.  The  most  remarkable  circumstance  in  relation  to  the  case  is 
the  great  length  to  which  it  was  protracted,  and  in  our  mind  it  can 
he  accounted  for  in  but  one  way,  and  that  is  by  the  supposition  that 
the  introsusception  was  the  original  obstruction,  and  the  knotting  of 
the  intestine  a  secondary  legion,  and  a  consequence  of  the  great  in- 
crease of  peristaltic  motion  of  the  intestines  produced  by  the  active 
cathartic  medicines  administered  or  otherwise  by  the  violent  com- 
motion of  the  contents  of  the  abdomen  in  the  efforts  at  vomiting.  A 
pretty  conclusive  evidence  of  the  fact,  that  the  introsusception  must 
have  existed  from  the  attack,  is  the  firmness  with  which  adhesions 
existed  between  the  intestinal  folds  so  perfect  that  the  different  lay- 
ers could  be  but  very  indirectly  traced.  It  is  but  reasonable  to  sup- 
pose that  the  introsuscepted  portion  was  not  entirely  deprived  of 
circulation,  or  the  process  of  gangrene  and  sloughing,  which  was 
slowly  progressing,  must  have  advanced  much  more  rapidly.  On  the 
contrary,  the  knot  was  so  firmly  made  as  to  exclude  all  circulation, 
and  the  noose  of  strangulated  intestine  actually  in  a  state  of  incipient 
iianfT^rcnc  which  could  have  only  existed  for  the  space  of  a  few  davs, 


1845.]  Jasminiim  Revolutum  in  Syphilis.  44' 


otherwise  death  must  have  ensued  at  a  much  earlier  period.  A  re- 
markable fact  in  regard  to  the  symptoms  is,  that  there  was  no  vomit- 
ing (except  after  a  cathartic  had  been  administered)  throughout  the 
course  of  the  disease.  Had  not  the  secondary  lesion  supervened,  it 
is  not  impossible  but  that  there  would  have  been  sloughing  and  a  dis- 
charge per  anum  of  the  invagiuated  portion  of  intestine,  and  a  spon- 
taneous yet  complete  cure. 


ARTICLE  III. 

Jasminum  Revolutum  in  Syphilis.     By  J.  M.  Gardner,  M.  D.,  of 
Fort  Gaines^  Ga. 

The  Jasminum  Revolutum,  commonly  known  as  the  Yellow  Jas- 
mine or  Jessamine,  is  found  in  great  abundance  throughout  the 
United  States.  Its  active  principle  resides  in  the  root,  particularly 
the  young  root,  which  should  be  gathered  in  the  spring. 

The  medicinal  properties  of  this  plant  are  very  imperfectly  under- 
stood. When  taken  in  a  large  dose,  it  produces  the  usual  effects  of 
narcotics;  such  as  stupor,  convulsions  and  death. 

In  some  cases  of  scrofula,  I  have  used  the  Jasmine  with  success. 
The  late  Dr.  Garbel,  of  Columbia,  Alabama,  experimented  very 
largely  with  it,  particularly  in  paralysis,  but  with  what  success,  I  am 
unable  to  say.  But  it  is  chiefly  in  diseases  of  a  syphilitic  character 
that  it  has  been  successfully  employed. 

The  treatment  of  syphilis  with  yellow  jasmine,  was  known  anl 
practised  among  the  Indians  living  on  the  Chatahoochie.  An  Indian 
negro,  \^ho  had  become  celebrated  among  them  for  curing  this  disease 
*with  roots,'  is  said  to  have  made  the  profession  acquainted  with  its 
medicinal  virtues.  Dr.  Johnson  and  the  late  Dr.  Brown  used  it  in 
syphilis,  and  have  spoken  favorably  of  its  powers.  In  the  hands  of 
the  latter  it  was  signally  successful.  In  my  own  practice,  the  action 
of  the  jasmine  has  proved  more  effectual,  where  the  system  had  been 
first  prepared  by  the  administration  of  pil.  hydrarg.  until  the  gums 
were  slightly  touched.  But  Dr.  Brown,  I  believe,  used  it  without 
any  previous  preparation  of  the  system  by  mercurials. 

While  under  the  influence  of  the  jasmine,  the  patient  should  re- 
main within  doors,  exposure  to  the  sun  producing  vertigo  and  loss  of 


446  Dickson's  Practice.  [August, 

sight.  He  should  also  abstain  from  greasy  food,  since  it  counteracts 
the  effect  of  the  medicine  upon  the  disease,  without  lessening  the 
danger  to  be  apprehended  from  an  over  dose. 

In  cases  of  poisoning  with  the  jasmine,  we  are  induced  from  its 
narcotic  properties,  to  employ  the  same  antidotes  as  are  directed 
against  an  excessive  dose  of  opium.  I  know  of  only  three  cases  of 
poisoning  with  this  article:  one  terminated  in  convulsions  and  death, 
the  other  two  were  relieved  by  prompt  medical  aid. 

The  form  best  adapted  for  use  is  that  of  tincture,  prepared  by 
taking  of  the  jasmine  root  and  cross  vine,  each  a  pound,  proof  spirits 
half-gallon.  Cut  the  roots  into  small  pieces,  and  macerate  for  twenty 
days  in  a  warm  place. 

The  dose  for  an  adult  is  from  five  drops  gradually  increased  to  a 
teaspoon  ful. 

In  applying  the  yellow  jasmine  to  the  treatment  of  syphilis,  I  have 
been  guided  by  no  other  data,  but  what  were  gleaned  from  the  In- 
dians. I  added  the  pil.  hydrarg.,  which  seemed  to  render  the  system 
more  susceptible  to  its  influence.  I  hope  that  those  who  have  a  wider 
field  of  labor  than  lias  fallen  to  my  lot,  will  test  its  properties,  for  I 
feel  assured  that  when  they  are  better  known,  the  yellow  jasmine 
will  obtain  a  place  among  the  articles  of  our  materia  medica. 


PART  II. REVIEWS  AND  EXTRACTS. 

Essays  on  Pathology  and  Therapeutics,  being  the  substance  of  a 
Course  of  Lectures  delivered  by  Sam'l  Henky  Dickson,  M.  D., 
Professor  of  the  Institutes  and  Practice  of  Medicine,  in  l^e  Med- 
ical College  of  the  State  of  South  Carolina.  Charleston:  1845. 
2  vols.  8  vo. 

The  well  established  reputation  of  Professor  Dickson,  cannot  fail 
to  secure  to  the  work  before  us  an  extensive  circulation  throughout 

D 

our  country,  and  particularly  in  the  Southern  States,  where  the 
author's  abilities  and  professorial  eloquence  have  long  been  familiar 
to  the  profession.  The  first  treatise  on  the  Practice  of  Physic  which 
has  emanated  from  a  Southern  pen,  it  will  necessarily  find  a  place  in 
the  library  of  every  Southern  practitioner,  and  be  regarded  as  the 
exponent  of  Southern  views  in   Medicine.     Wo  will  nafurally  turn 


1S45,]  DicJcson's  Praclice.  449 


to  it  for  light,  especially  on  the  forms  of  disease  most  peculiar  to  our 
latitude,  and  cannot  but  be  disappointed  if  we  find  it  at  all  lacking 
on  these  topics,  however  full  it  may  be  on  others.  We  are  aware  that 
a  preface  is  rarely  read,  yet  it  not  unfrequently,  as  in  the  present  in- 
stance, deserves  attention  as  an  index  of  what  may  or  may  not  be 
expected  in  the  body  of  the  work.  '  The  author,  after  stating  that 
he  has  been  repeatedly  solicited  to  publish  a  "complete  and  system- 
atic Treatise  on  the  Practice  of  Medicine,"  adds :  "  But,  I  have 
now,  neither  (not?)  the  ambition  to  attempt  the  task,  nor  do  I  ima- 
gine, that  the  advantage  to  be  attained  by  its  performance,  would  be, 
in  any  degree,  commensurate  with  the  sacrifice  of  time  and  labor 
which  it  would  demand."  The  confession  is  candid  yet  may  lead 
to  the  regret  that  one  who  has  ambition  enough  to  publish  so  exten- 
sive a  work,  and  professional  lore  in  abundance,  should  not  have  had 
sufficient  ambition  to  make  the  work  "complete." 

The  ten  first  chapters  of  the  work  are  devoted  to  general  consider- 
ations on  the  causes  of  disease,  malaria,  animal  putrefaction,  conta- 
gion, endemics,  epidemics,  seats  of  diseases,  tendency  of  disease, 
symptomatology,  diagnosis  and  prognosis.  These  several  subjects 
are  treated  in  the  usual  felicitous  style  of  the  author,  and  in  an  off- 
handed manner  remarkably  well  adapted  to  their  want  of  minuteness 
and  sometimes  of  accuracy.  The  following  quotation  will  illustrate 
this  observation : 

"  Amidst  the  rank  grass  of  Africa,  the  lion  couches,  and  her  forests 
resound  with  the  roar  of  her  beasts  of  prey.  The  jungles  of  India 
nourish  the  elephant  and  the  tiger,  and  the  thick  foliage  shelters 
innumerable  tribes  of  apes  and  serpents.  In  the  swamps  and  bays 
of  America,  the  panther  and  the  wild  cat  seek  their  food,  and  the 
deer  hides  himself  from  the  red  Indian  and  the  hunter.  Animal  as 
well  as  vegetable  life,  luxuriates  in  heat  and  moii-ture  ;  hosts  of  reptiles 
crawl  abroad  in  the  mud  of  each  slimy  pool,  and  countless  insects 
sport  in  every  sunbeam  that  glances  from  its  surface.  To  man  to 
the  white  man  alone,  is  this  prolific  combination  unfriendly. 

"But  the  structure  and  functions  of  the  lungs  and  stomacn  are 
not  obviously  different  in  the  black,  or  red,  or  tawny  tribes  ;  like  the 
lower  animals,  they  are  chiefly  distinguished  from  us  anatomically 
and  physiologically,  by  the  peculiarities  of  the  cbtaneous  integument. 
We  account  then,  most  readily,  for  their  remarkable  difference  as  to 
susceptibility  of  malaria  impression,  by  reference  to  the  structure  of 
the  skin,  which  would  therefore  seem  to  be  the  surface  primarily 
acted  on. 

"It  is  true  that  negroei?  born  and  constantly  resident  in  healthy 
positions,  who  have  been  housed  and  clothed  delicately,  will  become 

29 


450  Dickson's  Practice,  [August, 


in  a  certain  limited  degree  susceptible  of  miasmatic  influences.  It 
is  possible,  too,  that  animals  long  domesticated  and  carefully  sheltered 
and  tended,  may  take  on  a  like  susceptibility,  though  this  is  not  well 
established.  In  this  part  of  the  world,  where  we  have  but  too  fa- 
miliar an  acquaintance  with  this  subject,  we  are  persuaded  that  our 
negroes  are  comparatively  little  our  flocks  and  herds  not  at  all, 
liable  to  malaria  diseases." 

It  may  be  that  negroes  are,  in  the  neighborhood  of  Charleston, 
"comparatively  little  liable  to  malaria  diseases."  Such  is  however 
far  from  being  the  case  in  Georgia  and  in  the  upper  districts  of  South 
Carolina,  as  will  be  attested  by  every  planter.  It  is  well  known  that 
one  of  the  greatest  objections  to  the  settlement  of  our  most  productive 
lands,  is  the  fact  that  a  large  number  of  the  hands  who  till  them  are 
disabled  by  fever  at  the  very  time  when  they  are  most  needed  in  the 
cotton  fields.  We  are  not  prepared  to  admit  even  that  the  fatality  of 
fevers  is  less  in  the  black  than  in  the  white  race.  We  hesitate  not 
to  express  the  belief  that  by  statistical  researches,  it  will  be  demon- 
strated that  there  is  but  little,  if  any,  difference  either  in  liability  or 
fatality  between  the  two  races  under  similar  circumstances  of  expo- 
sure, regimen,  &c. 

We  fully  concur  with  the  author  in  the  following  views  : 

"Of  these  (intestinal  worms)  there  are  several  varieties,  whose 
generation  within  the  body  is  altogether  unaccountable,  and  forms 
one  of  the  most  plausible  instances,  among  those  alleged  by  philoso- 
phers, of  the  spontaneous  developement  of  life  and  organization.  The 
lumbricuS  or  round  worm,  so  familiarly  known  to  parents  and  nurses, 
is  indeed  very  rarely  wanting  in  the  bowels  of  children,  and  is  fre- 
quently met  with  in  the  alimentary  canal  of  the  most  vigorous  adults. 
Parr,  Rush  and  several  other  physicians,  have  regarded  them,  on  ac- 
count of  their  uniform  presence,  as  intended  for  some  useful  or  salu- 
tary purpose  in  the  animal  economy  ;  perhaps  aiding  in  the  removal 
of  effete  portions  of  the  food  taken.  I  am  by  no  means  disposed  to 
coincide  in  these  views,  although  I  believe  that  they  very  often  bear 
the  blame  of  occasioning  diseases  in  which  they  have  had  no  share. 
I  do  not  believe  them  to  be  capable  of  producing  any  specific  form  of 
disease;  but  they  give  impulse  and  efficiency  to  a  great  number  and 
variety  of  morbid  influences.  By  inordinate  increase  of  number, 
they  impair  the  constitution,  preventing  the  free  and  due  performance 
of  the  functions  of  the  intestines,  whose  surfjice  thus  takes  on  a  diver- 
sity of  modes  of  irritation.  Even  when  present  in  moderate  number, 
they  may  become,  by  a  change  in  the  condition  of  the  mucous  tissue 
of  the  digestive  canal,  sources  of  severe  additional  excitement  and 
disturbance." 


1S45.]  Dickson's  Practice.  451 


It  is  indeed  too  frequently  the  case,  especially  with  the  unprofes- 
sional, that  diseases  of  a  serious  nature  are  overlooked  in  the  anxiety 
to  get  rid  of  worms.  That  their  presence  may  aggravate  certain 
affections  of  the  bowels  and  stomach,  cannot  be  denied  ;  but  that 
they  often  occasion  disease  is  extremely  questionable.  It  is  a  matter 
of  daily  observation  that  children  in  the  enjoyment  of  fine  health 
will  pass  large  numbers  of  worms  on  the  administration  of  anthel- 
mintics. This  especially  obtains  among  the  negro  children  of  our 
plantations,  who  are  unusually  robust.  There  is  a  circumstance  in 
connexion  with  this  subject  that  we  do  not  recollect  to  have  seen 
alluded  to  by  any  writer,  viz.,  that  worms  endeavor  to  escape  from 
the  alimentary  canal  on  the  supervention  of  fever  of  any  kind,  and 
that  they  are  not,  unfrequently,  passed  off  lifeless  if  this  state  of  the 
system  have  existed  for  some  days  previous.  How  common  it  is  to 
see  worms  working  themselves  out  of  the  rectum  and  even  the  stom- 
ach, during  febrile  disorders  of  children,  although  their  total  number 
may  prove  to  be  very  small  by  the  subsequent  administration  of  the 
most  certain  vermifuges.  This  may  serve  to  explain  the  popular 
disposition  to  attribute  almost  every  attack  of  sickness  in  children  to 
the  presence  of  worms.  That  extraordinary  numbers  of  worms  may 
exist  in  the  alimentary  canal  without  producing  any  appreciable  im- 
pairment of  health,  is,  as  already  hinted,  well  established. 

We  need  offer  no  apology  for  introducing  the  following  very  hand- 
some and  appropriate  extract  on  a  subject  worthy  of  attention : 

"  Would  to  Heaven  that  the  good  sense  of  mankind  would  lead  the 
civilized  and  christian  nations  to  resume  the  ancient  classical  practice 
of  burning  the  bodies  of  the  dead.  There  is  surely  something  shock- 
ing in  the  very  idea  of  inhumation.  It  is,  I  confess,  revolting  to  my 
own  mind  in  the  highest  degree,  to  remember  that  custom  dooms  me 

'  To  lie  in  cold  obstruction  and  to  rot! 
Tljis  sensible,  warm  being  to  become 
A  kneaded  clod!" 

"But  there  is  a  much  better  argument  than  that  derived  from  mere 
feeling,  against  the  mode  now  universally  practised  indisposing  of  the 
human  corpse.  Upon  the  funeral  pile  we  reduce  to  a  heap  of  inno- 
cent dust,  that  which  in  a  few  days  will  be  changed  into  a  mass  of 
putrefaction,  tainting  the  air  and  spreading  around  it,  if  not  taken  far 
away,  horror  and  pestilence.  What  matters  it  that  we  are  at  present 
able  to  remove  it  to  such  a  distance,  and  to  hide  it  so  completely  that 
it  affects  our  senses  neither  of  sense  nor  smell ;  although  we  have  not 
succeeded,  if  we  may  believe  the  statements  of  several  respectable 
writers,  Walker  and  Chr.dvvick  among  them,  in  obviating  the  deleteri- 


452  Dichson^s  Practice.  [August, 


ous  influences  of  its  putrefaction  upon  the  living,  who  breathe  the 
neighboring  atmosphere  affected  by  it.  The  mere  concealment  of 
the  decaying  remnants  of  mortality,  will  not  always  be  in  our  power. 
The  'city  of  the  tombs'  is  already  more  crowded  with  inhabitants, 
than  the  busy  streets  of  Constantinople ;  the  catacombs  of  Paris, 
and  the  cemeteries  of  London,  are  filled  to  overflowing.  Nay,  cer- 
tain facts  stated  recently,  with  regard  to  the  burial  grounds  of  two  of 
the  cities  of  this  new  world,  would  lead  us  to  doubt  whether  similar 
evils  were  quite  so  distant  from  our  apprehension,  as  might  have  been 
imagined,  from  the  comparative  sparseness  of  population  in  our  im- 
mense extent  of  territory. 

"  How  much  better,  then,  for  the  cold  and  clammy  clay,  and  the 
noisome  grave-yard,  to  substitute  the  polished  vase,  the  marble  urn  
in  which  we  may  preserve  deposited,  the  relics  of 'all  that  our  souls 
held  dear,'  and  dwell  upon  the  remembrance  of  our  friends  with 
emotions  of  tender  melancholy,  mingled  with  no  gloomy  ideas  of  re- 
coiling disgust.  Their  ashes  may  thus  become  the  inmates  and  the 
ornaments  of  our  habitations;  and  their  constant  presence  may  serve 
to  over-awe  us  from  what,  being  evil,  would  have  been  frowned  upon 
by  them  when  living,  and  to  encourage  us  to  those  good  actions,  which 
we  feel,  would  have  deserved  and  met  with  their  approbation.'* 

Prof.  Dickson's  nosological  arrangement  comprehends  seven  divis- 
ions or  classes  viz:  1st.  Dis.  of  the  Circulatory  System  ;  2d.  Dis. 
of  the  Digestive  System;  3d.  Dis.  of  the  Respiratory  System  ;  4th. 
Dis.  of  the  Sensorial  System  ;  5th.  Dis.  of  the  Motory  System  ;  6th. 
Dis.  of  the  Generative  System;  7th.  Dis.  of  the  Excretory  System. 
Under  the  first  of  these  divisions  we  find  the  various  forms  of  fever  
intermittent,  remittent, yellow,  catarrhal,  typhus,  typhoid,  pneumonia, 
symptomatic.  Without  commenting  upon  the  propriety  of  the  above 
arrangement,  we  hasten  to  more  practical  matters.  On  fever,  in  gen- 
eral, the  author  expresses  himself  thus: 

"  You  will  not  expect  from  me  any  additional  attempt  at  promulga- 
ting a  theory,  or  striking  out  a  definition  of  this  Protean  disease ;  and 
I  cannot  describe  it  to  you  better  than  by  a  familiar  quotation  from 
Fordyce,  which  with  all  its  simplicity  and  quaintness,  is  often  refer- 
red to  as  conveying  more  truth  than  is  to  be  found  elsewhere  in  the 
same  brief  limits. 

'*  'A  fever,'  says  Fordyce,  'is  a  disease  that  affects  the  whole  sys- 
tem ;  it  affects  the  head,  the  trunk  of  the  body,  and  the  extremities  ; 
it  affects  the  circulation,  the  absorption,  and  the  nervous  system  ;  it 
affects  the  skin,  the  muscular  fibres,  and  the  membranes ;  it  affects 
the  body  and  likewise  the  mind.  It  is,  therefore,  a  disease  of  the 
whole  system,  in  every  kind  of  sense.  It  does  not,  however,  affect 
the  various  parts  of  the  system  equally  and  uniformly  ;  but  on  the 


1845.]  Dickson  s  Practice.  453 


contrary,  sometimes  one  part  is  much  affected  in  proportion  to  the 

atlection  of  another  part.' 

******** 

"I  shall  not  hesitate  to  retain  the  long  established  distinction  of 
fevers  into  Symptomatic  and  idiopathic.  My  senses  and  my  reason 
both  recognize  an  obvious  difference  between  the  febrile  disorder  con- 
sequent upon,  and  produced  by,  a  wound  of  soft  parts,  dislocation  of  a 
joint,  or  fracture  of  a  bone,  and  that  which,  however  apparently  analo- 
gous, arises  without  the  occurrence  or  manifestation  of  any  notable 
accident,  or  evident  change  previously  affecting  the  body,  or  any  of 
its  parts  ;  and  there  seems  to  me  little  risk  of  confounding  exanthe- 
matous  fever,  and  that  which  is  connected  with  inflammation  of  the 
pleura,  or  of  the  brain,  with  any  of  the  numerous  types  attributed  to 
malaria,  and  offeringat  their  invasion  no  constant  injury  of  a  special 
organ,  but  rather  dividing  (as  in  the  faithful  sketch  from  Fordyce)  its 
disturbing  influence  over  the  w^hole  constitution.  Notwithstanding 
these  points  of  separation  and  contrast,  however,  which  seem  toaflbrd 
safe  and  broad  ground  for  a  rational  diagnosis,  the  weight  of  modern 
authority  is  decidedly  in  favor  of  considering  all  fevers  as  symptom- 
atic the  extension  of  general  irritation  and  disorder  from  some  local 
aff*ection.  There  is  much  dispute,  however,  as  to  the  point  of  local 
origin.  Clutterbuck  fixes  it  in  the  head,  and  regards  fever  as  nothing 
more  than  the  secondary  or  constitutional  result  of  inflammation  of 
the  brain  and  its  membranes.  Broussais  attributes  it  to  an  inflam- 
matory irritation  of  the  mucous  tissue  of  the  digestive  tube,  and 
especially  the  stomach.  With  vastly  more  plausibility  others  have 
rejected  these  exclusive  theories,  and  considered  all  irritated  and 
inflamed  organs,  as  centres  from  which  may  radiate  the  different 
modifications  of  fever.  Thus  Professor  ^larcus  finds  in  the  brain  the 
original  irritation  upon  which  typhus  is  generated  ;  in  the  lungs  that 
of  hectic;  in  the  trachea,  that  of  catarrhal  fever,  etc. 

"I  am  not  disposed  to  pursue  this  discussion,  and  shall  therefore 
hazard  but  one  remark  farther  on  this  point  so  warmly  disputed.  It 
is  highly  probable  that  no  cause  of  disease  possesses  such  indefinite 
extent  of  impression,  as  to  act  at  once  upon  more  than  a  single  part ; 
and  besides,  it  is  consistent  with  all  analogy  to  suppose  that  every 
cause  of  disease  is  determined  to,  and  fitted  to  act  specifically,  or  at 
any  rate  specially  upon  one  organ  or  tissue.  It  follows,  therefore, 
or  it  is  highly  probable,  that  all  disease  is,  to  speak  with  logical  pre- 
cision, local  in  its  origin. 

******** 

"  We  may  conclude  here  this  brief  discussion  of  the  general  subject 
of  fever,  with  an  enumeration  and  cursory  description  of  its  conse- 
quences, or  th^  effects  of  febrile  disorder  upon  the  several  organs  of 
the  body  assailed  in  its  progress,  as  manifested  in  examinations  post 
mortem. 

"The  brain  rarely  fails  to  present  the  signs  of  vascular  engorge- 
ment, and  very  often  shows  the  results  of  inflammation  in  greater  or 


454  Dickson's  Practice,  [August, 


less  degree  in  either  of  its.substance  or  membranes.  This  occurs  so 
generally  that  inflammation  of  the  brain  and  membranes  is  considered 
by  a  pretty  numerous  class  of  physicians  with  Clutterbuck  at  their 
head,  as  the  true  proximate  cause  of  fever.  Numerous  facts  have 
been  brought  forward  to  establish  this  conclusion,  which  has  been 
very  plausibly  advocated,  and  much  ingenious  reasoning  employed  to 
explain  away  the  difficulties  and  exceptions  adduced  by  its  opponents. 
"Analogous  marks  of  lesion  in  the  mucous  membrancof  the  stom- 
ach and  intestines,  have  occasioned  this  tissue  to  be  in  a  similar 
manner  selected  as  the  seat  of  an  inflammatory  irritation  alleged  to 
be  the  proximate  cause  of  fever,  or  rather  fever  itself,  for  such  is  the 
doctrine  of  Broussais  and  his  followers.  Nor  do  the  other  abdominal 
and  pelvic  viscera  escape  during  the  tumults  of  this  pervasive  malady  ; 
though  as  we  shall  hereafter  inform  you  more  in  detail,  they  exhibit 
these  disturbances  rather  in  derangement  or  suspension  of  their  func- 
tions than  in  anv  material  alterations  of  structure.  Yet  we  can  ob- 
serve occasionally  not  only  engorgement  but  inflammation  with  its 
results  in  the  liver,  spleen,  kidneys  and  bladder. 

"The  respiratory  organs  also  sufler  in  fever,  though  not  so  gener- 
ally or  m  so  striking  a  degree  as  the  viscera  above  spoken  of.  Pul- 
monar}^  conjjestion  is  often  one  of  the  early  symptoms  of  the  attack, 
but  in  a  majority  of  instances  it  undergoes  a  spontaneous  solution 
during  the  successive  changes  of  action  and  determination. 

"It  is  admitted  that  these  local  febrile  affections  are  usually  of  the 
nature  of  iiflammation,  or  display  an  almost  irresistible  tendency  to 
run  promptly  into  that  condition.  The  opinion  certainly  derives 
strong  support  from  the  phenomena  exhibited  in  fatal  cases  of  pro- 
tracted duration.  In  these  we  almost  invariably  meet  with  inflam- 
matory disorganization.  On  the  other  hand,  it  is  contended  that 
these  are  incidental  and  not  essential  results,  as  they  are  not  found  to 
take  place  in  the  most  violent  attacks  if  they  terminate  unfavorably- 
after  a  brief  course.  Here  no  lesions  are  discoverable.  In  still  more 
numerous  instances  we  find  the  determinations  to  and  aftecfions  of 
particular  parts  to  be  clearly  and  simply  congestive,  and  these  are 
among  the  most  mortal  and  malignant  of  febrile  modes  of  derange- 
ment. Still  faither,  it  seems  to  me  reasonable  to  regard  many  if  not 
most  of  the  determinations  that  occur  in  the  course  of  an  ordinary 
attack  of  fever  as  simply  irritafive,  in  contradistinction  to  inflammato- 
ry and  congestive  conditions  of  parts.  The  numerous  head-aches, 
spinal  and  muscular  pains,  and  gastric  oppressions  and  annoyances 
connected  with  fever  at  particular  stages  or  periods,  subsiding  rapidly 
and  often  disappearing  altogether  when  these  stages  are  past,  are,  I 
should  think,  clearly  of  this  character.  In  different  seasons,  climates 
and  localities,  and  in  different  types  of  fever,  we  find  these  several 
local  affections  difl^ering  notably.  Some  of  these  variations  appear 
to  be  incidental,  while  others  are  uniform  and  essential,  occurring  in 
rnasses  and  showing  little  respect  to  individual  peculiarities  of  con 
fttitution. 


1845.]  Dickaons  Practice.  455 


"Here  we  find  a  majority  of  the  lesions  presented,  in  the  viscera 
of  the  abdomen.  The  mucous  membrane  of  the  stomach  and  intes- 
tines very  rarely  escapes  injury  in  cases  protracted  to  any  length. 

"The  next  greatest  number  is  of  the  cerebral  affections,  and  these 
are  met  with  in  attacks  that  prove  rapidly  fatal,  and  such  as  run  into 
a  typhous  state.  Comparatively  few  lesions  of  the  pulmonary  organs 
take  place  in  our  genial  climate,  and  though  not  absolutely  confined 
to  the  winter  season,  usually  occur  during  cold  weather." 

We  have  thus  drawn  largely  on  the  author,  in  order  to  place  be- 
fore the  reader,  in  his  own  language,  Prof.  Dickson's  views.  We 
do  not  object  so  much  to  what  is  expressed,  as  to  what  has  been 
omitted.  Indeed,  unless  we  can  find  enough  of  Pathology  in  these 
quotations,  we  need  look  no  farther,  for,  strange  as  it  may  appear,  we 
have  in  vain  sought  for  it  under  the  heads  of  Intermittent  and  Remit- 
tent fevers.  The  interest  at  present  excited  with  regard  to  the 
pathology  of  these  fevers  is  such,  that  as  soon  as  the  work  was  placed 
in  our  hands,  we  immediately  turned  to  the  chapters  treating  of  them, 
in  order  to  ascertain  the  views  of  so  distinguished  a  Southern  prac- 
titioner. But  to  our  utter  surprise  we  found  not  a  syllable  on  the 
subject  of  Pathology  !  In  the  chapter  on  Intermittents,  the  five  or 
six  first  pages  furnish  us  with  symptomatology,  causation,  and  prog- 
nosis. The  treatment  is  then  taken  up  and  occupies  the  remaining 
fourteen  pages.  The  chapter  on  Bilious  Remittents  comprehends 
about  forty-two  pages,  equally  barren  on  the  important  subject  of 
Pathology.  Why  this  extraordinary  silence?  Can  it  be  possible 
that  the  teacher  thinks  it  of  too  little  consequence  to  occupy  the  at- 
tention of  the  youthful  and  inexperienced  student,  (for  it  must  be 
remembered  that  these  pages  contain  the  substance  of  a  Course  of 
Instruction  to  a  Collegiate  Class,)  or,  what  is  still  more  improbable, 
can  it  be  that  the  learned  author  has  no  fixed  views  on  the  pathology 
of  such  common  aflfections  ?  Foiled  in  our  expectations  on  this  point, 
we  turn  to  the  treatment  of  Intermittents  and  Remittents,  and  find,  in 
relation  to  their  most  potent  antidote,  the  following  language  : 

' Thus  you  will  hardly  venture  upon  the  exhibition  of  cinchona, 
when  the  apyrexia  is  imperfect,  and  where  there  are  present  obvious 
marks  of  local  disorder  of  some  important  organ.  The  continuance 
of  headache,  gastric  oppression,  abdominal  pain  and  tension  these 
symptoms  demand  farther  general  or  preliminary  treatment. 

"Bark,  in  all  its  modes  of  preparation,  even  the  sulphate  of  qui- 
nine,  is  generally  regarded  as  inadmissible  whenever  the  apjTexia  is 


456  DicJison's  Practice,  [August, 


notably  incomplete,  and  when  there  are  any  prominent  affections  of 

important  organs.     To  such  cases,  fortunately,  sulphur  is  perfectly 

well  adapted,  and  in  such  I  have  often  found  it  productive  of  the  most 

obvious  and  lasting  benefit. 

******** 

"The  obvious  analogy  of  the  remittent  with  the  malarious  inter- 
mitlent,  and  of  the  remission  of  the  former  with  the  apyrectic  stage 
of  trie  latter,  long  since  suggested  the  employment  of  cinchona  in 
protracted  instances  of  autumnal  fever  of  the  present  type.  The 
practice  is  becoming  more  and  more  common  to  resort  to  some  one 
of  the  preparations  of  this  powerful  febrifuge  in  the  better  and  moro 
marked  remissions.  Nay,  some  practitioners  regarding  quinine  with 
Bell  as  a  f-cdative,  do  not  wait  long  for  an  opportunity  of  this  sort, 
but  administer  it  generally  after  premising  such  depletory  measures 
'  as  may  be  demanded.  As  yet  I  cannot  but  look  upon  both  the  theory 
and  practice  as  uncertain,  yet  the  experiment  deserves  to  be  cau- 
tiously made.  If  the  sulph.  quinine  in  ordinary  doses  be  cfTensive 
to  the  stomach,  however,  or  determine  to  the  head  as  it  will  some- 
times do,  with  pain,  dizziness,  tinnitus  aurium,  I  would  desist  and  fall 
back  upon  the  less  impressive  but  safer  course  already  pointed  out." 

It  is  truly  to  be  lamented  that  a  work,  destined  to  be  the  guide  of 
many  young  practitioners,  should  inculcate  such  obsolete  principles. 
We  had  thought  it,  long  since,  an  acquired  fact  in  practice,  that 
quinine  could  be  given  with  impunity,  not  only  during  an  intermis- 
sion but  also  during  a  remission  of  our  "  malaria  fevers,"  as  the 
author  terms  them.  We  have  never  known  it  to  act  otherwise  than 
beneficially  under  such  circumstances,  and  this  is  the  experience  of 
all  who  have  used  it  similarly.  Having  been  for  a  number  of  years 
convinced  that  the  sulphate  of  quinine  exerts  rather  a  sedative  than  a 
stimulating  effect  on  the  system,  that  it  blunts  the  nervous  sensibilities, 
and,  regarding  our  Intermittents  as  well  as  Remittents  as  primarily  lo- 
cated in  the  nervous  system,  whose  derangement  may  lead  to  disorder 
in  other  organs,  we  have  always  made  it  a  point  to  restore  the  nervous 
system  to  a  normal  state,  as  early  as  our  services  were  required,  and 
by  so  doing  to  arrest  the  development  of  the  secondary  phenomena. 
This  can  always  be  done  with  entire  safety  by  the  applicction  of 
revulsives  to  the  spine,  and  the  free  use  of  quinine  during  the  periods 
of  intermission  or  remission,  without  regard  to  the  condition  of  the 
system  or  of  any  particular  organ.  We  are  aware  that,  even  now, 
most  practitioners  hesitate  to  administer  quinine  in  cases  presenting 
a  predominence  of  gastric  or  of  rercbral  affliction.  Our  case  book 
bears  unequivocal  testimony  of  the  fallacy  of  such  hesitation. 

Having  neglected  the  study  of  the  Pathology  of"  malaria  fevers," 


1S45.]  DicLsoji's  Practice.  \h' 


and  misapprehended  the  effects  of  quinine,  the  author,  instead  of  ar- 
resting the  disease  at  once,  still  adheres  to  the  routine  treatment, 
such  as  it  was  practised  ten  or  fifteen  years  ago.  Wc  find  no  allu- 
sion made  to  revulsive  applications  to  the  spine  in  Interinittcnts, 
and  a  mere  incidental  reference  to  them  in  Remittents. 

' V/Hile  the  sensorial  energies  are  active,  and  the  vascular  excite- 
ment  high,  tiie  pain  and  inliamination  of  a  blister  will  probably  add 
more  to  the  general  irritation  of  the  disorder  than  will  be  compensa- 
ted for  by  its  revulsive  impression.  But  when  the  case  is  protracted 
beyond  a  certain  point,  the  former  eficcts  do  not  follow,  or  are  of  less 
relative  importance  nay,  the  exciting  as  well  as  the  revulsive  influ- 
ence of  the  epipastic  becomes  desirable.  Ey  the  selection  of  proper 
periods,  we  may  make  this  class  of  remedies,  however,  entirely  safe, 
and  far  more  valuable  than  if  this  be  unattended  to.  If  you  use  them 
chiefly  as  revulsives,  apply  them  in' the  remission  and  in  the  vicinity 
of  the  organs  you  desire  to  relieve;  to  the  epigastrium  or  side  for 
the  benefit  of  the  stomach  or  liver;  to  the  back  of  the  neck  or  be- 
tween the  shoulders  if  the  head  be  threatened  ;  along  the  spine  or  on 
the  sacrum  to  relieve  congestion  or  irritation  of  the  vertebral  cord." 

We  have  deemed  it  a  duty  to  notice  these  omissions,  because  of 
the  great  advance  made  of  late  years  in  the  Pathology  and  treat- 
ment  of  the  class  of  affections  we  are  most  frequently  called  on  to 
combat,  and  because  v.e  think  it  inexcusable  in  an  author  of  such 
repute  as  Prof.  Dickson,  to  have  made  no  allusion  to  them,  when  so 
ably  advocated  by  Maillot  in  his  work  on  fevers,  and  by  others  in  our 
country.  We  would  refer  with  especial  pleasure  to  an  article  on  the 
subject,  published  as  long  ago  as  1838,  by  Prof.  Ford,  in  the  1st  vol. 
of  the  Southern  Medical  and  Surgical  Journal,  and  which  can  scarce- 
ly have  failed  to  meet  the  eye  of  so  near  a  neighbor  as  Prof.  Dickson. 

In  regard  to  the  use  of  the  lancet  in  Remittents,  Prof.  Dickson 
expresses  himself  thus  : 

"  For  myself,  it  is  proper  to  avow,  that  in  the  practice  of  a  quarter 
of  a  century,  I  have  bled  as  {ew  patients  in  bilious  remittent  as  any 
physician  who  uses  the  lancet  at  all.  I  cannot  presume  to  aflirm, 
that  I  have  always  selected  the  cases  proper  for  its  employment,  or 
that  I  have  omitted  none  in  which  it  was  indicated  ;  but  the  instances 
are  very  few  in  which  I  have  been  satisfied  of  my  having  derived  any 
decided  advantage  from  it ;  nor  have  I  been  disposed,  in  reviewing 
my  course,  to  regret  its  omission  in  any.'' 

The  author  advocates  strongly,  and  we  think  very  judiciously, 
cold  affusion. 


458  Dickson's  Practice.  [August, 


"  The  cold  bath,  one  of  the  most  ancient  and  universal  remedies  for 
fever,  demands  our  early  attention  as  specially  indicated  in  the  varie- 
ty of  it  under  discussion.  The  temperature  of  the  season,  the  very 
nature  of  the  attack,  the  symptoms  present,  the  condition  of  the  pa- 
tient, are  all  such  as  to  prepare  us  to  expect  from  its  employment 
tiio  happiest  results.  Accordingly,  I  am  disposed  to  rank  it  among 
the  most  efficient  of  our  febrifuge  measures  here  far  above  the  lancet 
both  in  the  extent  of  its  adaptation  and  in  its  degree  of  specific  utili- 
ty. All  that  we  can  hope  or  anticipate  from  [)loodletting  may  be 
obtained  in  a  majority  of  cases  by  the  use  of  the  bath,  while  the  lat- 
ter possesses  this  striking  and  obvious  advantage,  that  we  can  repeat 
it  as  often  as  the  symptoms  are  renewed  that  require  it.  Nor  can  I 
help  expressing  my  surprise  at  the  very  limited  resort  of  my  profes- 
sional brethren  to  it,  when  I  consider  how  instinctively  we  desire  it 
as  a  relief  from  the  burning  heat  that  oppresses  us,  and  how  certain 
and  immediate  a  means  it  is  of  affording  the  relief. 

"Of  the  three  modes  of  employing  it,  namely,  affusion-,  immersion 
and  ablution,  the  first  is  the  most  impressive  and  efficacious,  the  last 
the  least  liable  to  objection  or  risk  in  doubtful  cases.  The  particular 
indications  which  demand  the  resort  to  it  unhesitatingly,  are  found  in 
the  yeuth  and  general  vigor  of  the  patient  and  the  heat  and  dryness 
of  the  surface.  The  local  determination  which  it  controls  most 
promptly  is  that  to  the  brain,  shown  by  headache,  flushed  face,  red 
eye,  delirium,  etc.,  with  a  full,  hard,  bounding  pulse.  Seat  your  pa- 
tient in  a  convenient  receptacle  and  pour  over  his  head  and  naked 
body  from  some  elevation  a  large  stream  of  cold  water  ;  continue 
this  until  he  is  pale  or  his  pulse  loses  its  fullness,  or  his  skin  becomes 
corrugated  and  he  shivers.  On  bc-ing  dried  and  replaced  in  bed,  a 
genial  sense  of  comfort  and  refreshment  will  attest  the  benefits  de- 
rived from  the  process,  which,  as  I  said  above,  may  be  repeated 
whenever  the  symptoms  are  renewed  which  it  is  so  well  adapted  to 
remove. 

"If  the  shock  of  this  shower  bath  or  cataract  be  too  great,  immer- 
sion, which  fnany  prefer,  may  be  substituted.  Few  shrink  from  this, 
and  almost  every  one  will  evince  the  high  gratification  and  enjoy, 
ment  derived  from  it.  One  of  the  pleasantest  effects  following  the 
bath,  is  the  complete  relaxation  of  the  surface  which  it  so  often  brings 
on,  attended  with  a  copious  and  salutary  sweat.  I  need  not  warn 
you  against  the  nearly  obsolete  practice  of  endeavoring  to  acceler- 
ate or  increase  this  by  wrapping  in  blankets  or  shutting  up  the  apart- 
ment, or  warming  it  artificially.  'J'he  patient  is  to  be  covered  agree- 
ably to  his  sense  of  comfort ;  and  though  I  would  not  place  him  in  a 
current  or  draught  of  air,  I  would  have  his  chamber  fully  and  freely 
ventilated." 

We  find  nothinfj  in  the  volumes  before  us  on  Malignant  Intermit- 
tents.  The  subjoined  extract  will  show  how  summarily  our  author 
disposes  of   congestive    fever,    malignant    remittent,    and    country 


16-15.  J  DicJisun^  Practice.  459 


fo-ver ;  forms  of  disease   so  interesting  to   Southern   and   Western 
practitioners. 

"It  would  evidently  be  futile  to  attempt  to  lay  down  rules  for  the 
adaptation   of  details  of  treatment,   to   the  several  varieties  of  torm, 
wiiich  under   diverse  circumstances  and    in  different  constitutions, 
may  be  assumed  by  our  autumnal  remittent.     IMie  principal  of  llu'se 
is  known,  as  1  before  said,  by  the  title  of  "congestive  fever."     The 
specitic  peculiarity  of  this  dreaded  disease  is  the  centripetal  tendency 
of  the  tluids  of  the  body,  the  consequent  enQ:orgement  of  the  internal 
organs,  and  the  general  oppression  and  obstruction  of  the  vital  func- 
tions which  result  of  necessity  from  this  vicious  condition  of  the  cir- 
culatory mass.     Some  bold  practitioners  employ  the  lancet  here  as  a 
revulsive,  or  for  the  purpose  of  resolving  congestion  ;  and  the  meas- 
ure is  certainly  an  efficient  one,  and  as  well  adapted  as  in  Mcintosh's 
use  of  it  in  the  cold  stage  of  intermittents.     It  is  full  of  serious  risk, 
liowever,  and  I  cannot  venture  to  recommend  it,  though  I  can  readily 
imagine  cases  in  which  it  would  be  very  likely  to  prove  serviceable. 
And  the  same  remark  holds  equally  true  as  to  cold  atfusion.      A  far 
sat'er  course  and  equally  promising,  is  the  early  resort  to  the  warm  or 
even  hot  bath,  which  often  rouses  the  patient  at  once  from  his  sullen 
languor,  or  relieves  his  sufferings  from  visceral  engorgement.     The 
free  exhibition  of  the  stimulant  diaphoretics  should  tbllow,  with  assidu- 
ous application  of  external  irritants,  mustard  and  cantharides.    Cam- 
phor or  ammonia  may  be  combined  with  our  mercurial,  and  free 
doses  of  quinine   administered.     Indeed,  our  brethren  of  the  south 
and  west  have  placed  their   principal   reliance,   within  the  last  {e\v 
years,  upon  the  sulphate  of  quinine,  almost  exclusively  exhibited,  and 
prescribed  in  immense  doses.      Congestive  fever  has  been  reported  to 
have  been  successfully  treated  by  doses  of  twenty  to  thirty,  and  even 
fifty  grains  of  the  remedy.     I  have  heard  authentically  of  an  instance 
in  which  one  hundred  grains  were  given,  in  little  more  than  twelve 
hours,  and  of  another,  in  which  half  the  contents  of  an  ounce  bottle 
were  administered  during  a  similar  period.     I  have  as  yet  met  with 
no  attack  which  required  such  enormous   amounts.     I  will  not  dis- 
pute their  necessity  or  propriety;  of  which  indeed  time  and  enlarged 
experience  must  constitute  the  true  tests.     Unless  the  drug,  as  thus 
employed,  is  strangely  adulterated,  evidence  enough  has  been  offered 
to  prove  that  the  danger  of  these  large  doses  has  been  grievously  ex- 
aggerated.    Turpentine  and  capsicum  are  used  freely  here  by  many, 
and  it  is  said  with  the  best  effect.     The  Dover's  powder  determines 
well  to  the  surface,  and.  unless  where  there  is  coma,  seems  appropri- 
ate to  our  purposes.     Many  of  these  congestive  cases  resemble,  from 
the  first,   or  readily  run  into   a  typhoid   condition,   with  abdominal 
irritation  diarrhoea,   tenesmus,   meteorism.     I  have  found,  in  such 
instances,  denominated  in  some  parts  of  our  State  ilictis,  the  nitrate 
of  silver  productive  of  benefit.     I  prescribe  the  sixth  or  fourth  part  of 
a  grain  every  three  hours,  without  allowing  it  to  interfere  with  such 
other  remedial  measures  as  mav  be  indicated. 


4(iU  Dickson's  Practice.  [August, 


"  In  the  malignant  remittent,  occasionally  met  with  and  formerly 
described  to  you,  the  vital  forces,  rapidly  crushed  by  the  overwhelm- 
ing intensity  of  the  morbid  cause,  fail  apparently  to  exhibit  any 
resistance  or  reaction.  They  must  be  sustained  by  every  means 
within  our  power,  while  we  have  immediate  recourse  to  our  most 
impressive  revulsives.  The  hot  bath,  sinapisms,  vesicatories,  must 
1)0  quickly  and  assiduously  applied,  while  we  stimulate  by  the  freest 
use  of  internal  remedies,  carefully  selecting  such  as  are  best  adapted 
to  the  circumstances  presented.  If,  as  is  often  the  fact,  the  patient 
suffers  severely  from  pain  in  the  abdomen  or  chest,  large  doses  of 
opium  or  morphine  must  be  administered,  while  we  keep  up  his  sink- 
ing strength  by  brandy,  ammonia  or  aether.  In  your  diligent  super- 
intendance  of  such  cases,  make  it  a  rule  rather  to  incur  the  risk  of 
over  stimulating  transiently,  than  fall  below  the  requisite  point  of 
excitement  in  your  use  of  stimulants.  I  am  fully  persuaded  that  I 
have  seen  more  than  one  man  die  from  the  timidity  of  his  physician 
in  this  respect ;  who,  keeping  at  a  cautious  distance  behind  the, dis- 
ease, would  not  venture  on  the  exhibition  of  any  excitant  adapted  to 
the  feeble  excitability,  until  the  vital  energies  upon  which  alone 
stimulants  can  act,  had  become  worn  out  and  exhausted. 

*'  If  the  stomach  will  bear  it,  add  to  your  formula  some  of  the  pre- 
parations of  cinchona.  The  sulph.  quinine  in  full  doses  will  be  often 
retained  and  do  good.  Alternate,  combine,  and  recombine  your 
stimulants,  which  may  perhaps  be  aided  also  by  warm  and  nu- 
tritious fluids,  wine  whey,  arrow  root  with  wine,  wine  alone  or  spiced, 
brandy  with  milk  or  in  mucilage.  These  energetic  agents  will 
usually  be  found  effective  within  a  very  short  period,  improving  the 
pulse  and  arousing  the  general  powers  of  the  system.  Yet  you  must 
not  permit  yourselves  to  be  disheartened  into  inaction  by  their  ap- 
parent inefficacy  or  slowness  of  impression.  Persevere  not  only 
while  there  is  a  reasonable  hope,  but  even  after  all  hope  seems  extin- 
guished ;  and  though  your  hearts  will  now  and  again  be  wrung  with 
painful  disappointment,  by  the  feebleness  and  inutility  of  your  reme- 
dies, yet  you  will  feel  yourselves  ami)ly  repaid  by  the  gratification, 
which  will  not  be  denied  you,  of  saving  more  than  one  fellow  crea- 
ture from  the  destruction  which  seems  inevitably  to  await  him. 
instances  of  such  recovery  do  occur,  though  rarely,  and  bear  honor- 
able testimony  to  the  skill  and  unv/earied  humanity  of  the  physician. 
They  display  too,  the  excellent  pov/ers  of  our  medicaments,  the  capa- 
city for  endurance  inherent  in  the  human  constitution,  and  show 
forth  above  all,  the  unspeakable  benevolence  of  the  former  of  these 
wonderful  though  frail  frames. 

"In  the  bills  ofmoitality  for  the  city  of  Charleston,  you  will  find 
every  year  a  certain  number  of  cases  distinguished  by  the  appellation 
of 'country  fever.'  The  phrase  is  employed  to  denote  the  febrile 
attack  which  follows  within  a  short  time,  and  with  appalling  certainty, 
an  exposure  to  the  concentrated  malaria  of  the  low  country  in  our 
immediate  vicinity.     To  sleep  a   single  night   upon  his  plantation, 


1S45.]  Dickson's  Practice.  461 


involves  the  southern  agriculturalist  in  the  most  serious  danger  ;  nay, 
he  is  not  safe  if  he  indulge  himself  in  frequent  visits,  even  by  day,  to 
his  rice  fields,  or  inhale  too  often  under  any  circumstances,  the  pes- 
tilential air  of  our  swamps  and  marshes. 

"Country  fever,  using  the  term  as  above  defined,  is  a  very  instruc- 
tive and  interesting  variety  of  fever,  exhihiting  in  a  very  striking 
manner  the  tendency  of  the  several  types  which  have  a  miasmatic 
or  paludal  origin  to  mingle  with  or  run  into  each  other.  Through 
the  progress  of  a  given  case  you  may  indeed  have  each  of  them  in 
turn  presenting  itself.  An  attack  commencing  as  intermittent,  or 
single  tertian,  will  thus  become  a  double  tertian,  then  a  triple  tertian, 
then  a  remittent  of  greater  or  less  distinctness  and  regularity ;  if 
successfully  managed  it  may  become  again  intermittent  by  restoration 
of  the  apyrectic  interval ;  if  otherwise  it  prove  violent  and  tenacious, 
it  is  not  rare  to  see  it  degenerate  into  that  low  and  typhoid  condition 
in  which  the  remissions  becoming  irregular  and  uncertain,  and  in- 
distinct, it  approximates  at  least,  if  it  does  not  assume  the  continued 
form. 

"As  early  as  May,  in  ordinary  seasons,  attacks  of  country  fever 
follow  the  exposures  above  pointed  out.  I  have  known  a  few,  even 
in  April,  ascribable  perhaps,  to  some  uncommon  contingencies.  The 
period  of  their  appearance  has,  undoubtedly,  a  reference  both  to  the 
temperature  of  the  past  winter  and  that  of  the  advancing  spring  a 
cold  winter  and  a  late  spring  being  unfavorable  to  the  invasion. 
Much  also,  is  owing  to  the  habits  and  constitutional  predisposition  of 
the  subject  exposed,  who  is  especially  liable  to  be  assailed  ifimprudent 
or  intemperate,  or  a  subject  of  fever  the  year  previous. 

"It  has  been  a  long  received  opinion  that  a  return  to  our  compar- 
atively healthy  city  atmosphere,  the  ordinary  summer  residence  of 
so  many  planters,  during  the  latent  period  which  ensues  after  efficient 
exposure  as  above  described,  endows  the  coming  attack  in  some 
obscure  manner  with  a  peculiar  violence  and  malignity.  The  type 
assumed,  as  I  have  stated,  is  apt  to  be  irregular,  confused  and  com- 
plicated. We  meet  frequently  with  the  herosthesis  of  the  ancients, 
recognized,  as  I  formerly  mentioned,  by  Robert  Jackson  an  accu- 
mulation of  unexpected  paroxysms  or  exacerbations  one  upon  ano- 
ther, or  an  exacerbation  interposed  at  the  most  unlocked  for  period 
of  the  day,  just  when  a  remission  was  anticipated,  and  both  patient 
and  physician  were  congratulating  themselves  upon  the  prospect  of 
a  brief  but  solacing  respite. 

"It  is  a  most  insidious  modification  of  fever,  requiring  to  be 
watched  with  the  greatest  attention  and  assiduity.  The  sick  man 
will  often  make  little  complaint,  his  symptoms  will  appear  mild,  and 
yet  you  will  perceive  that  he  gets  steadily  weaker  and  worse  ;  or  the 
remission  shall  have  become  very  distinct,  nay,  shall  amount  to  com- 
plete intermission,  and  you  flatter  yourself  with  the  hope  that  conva- 
lescence is  become,  when  some  single  paroxysm  shall  intervene  with 
such  overwhelming  violence,  that  prostration  and  fatal  exhaustion 
ensue  in  a  few  hours. 


402  Dickson's  Practice.  [August, 


"  In  the  diffjculty  of  accounting  for  this  strange  assumption  of 
malignity  under  the  circumstances,  it  has  been  argued  that  these 
modifications  were  determined  by  the  peculiar  state  of  the  city  atmos- 
phere  in  relation  to  its  capacity  for  producing  the  more  pestilential 
grades  of  fever,  as  it  is  well  known  that  cities  are  the  exclusive  sources 
ofyellow  fever  and  of  the  plague;  and  it  is  thus  attempted  to  be  explain- 
ed why  we  also  meet  in  the  suburbs  with  similarly  modified  fevers.  As 
regards  Charleston  Neck,  the  remark  holds  good  fevers  originating 
in  this  mixed  atmosphere  very  often  partaking  of  the  dreaded  charac- 
teristics of  countr}^  fever.  But  there  is  an  insuperable  difficulty  in 
the  way  of  (his  suggestion,  in  accordance  with  which  we  should  find 
the  bilious  remittents  of  the  city  itself  severe  and  fatal.  The  fact  is 
notoriously  otherwise.  Here,  they  are  indeed  both  infrequent  and 
comparatively  mild  and  manageable,  as  formerly  stated  to  you. 

'* Besides  this,  a  similar  aggravation  of  violence  and  danger  is 
affirmed  to  occur  every  where,  when  a  subject  efficiently  exposed  to 
the  influence  of  febrific  miasmata,  has  removed  during  the  latent  pe- 
riod to  a  pure  and  salubrious  atmosphere.  This  is  true,  as  Flint  tells 
us,  of  the  upland  prairies  of  the  far  west,  and  as  I  have  more  than 
once  had  unhappy  occasion  to  note,  in  our  own  lofty  motmtain  regions. 

"The  prognosis  in  such  cases  you  will  at  once  infer  to  be  very 
doubtful ;  nay,  it  is  hardly  safe  to  regard  your  patient  as  better  until 
he  is  quite  well. 

"The  treatment  also  requires  to  be  managed  with  great  diligence 
and  nicety.  Frequent  visits  are  absolutely  necessary,  and  with  all 
possible  watchfulness  and  assiduity,  you  will  still  be  liable  to  fall  into 
serious  errors.  It  is  exceedingly  difficult  to  distinguish  in  the  early 
stages  the  most  unimportant  attack  from  the  most  dangerous.  Hence 
it  has  become  my  custom  to  lock  upon  all  such  seizures  with  a  jealous 
eye,  and  to  institute  from  the  commencement  such  a  course  of  treat- 
ment as  shall  otier  the  best  resources  under  any  sudden  development 
of  malignity  or  aggravation  of  violence.  Under  these  circumstances 
too,  I  watch  anxiously  for  the  first  opportunity  of  administering  some 
preparation  of  cinchona  the  infusion  in  some  of  its  combinations, 
or  the  sulph  :  quinine  in  proper  and  efficient  doses.  The  system 
sinks  so  readily  under  such  exacerbations  or  such  accumulation  of 
them  as  I  have  above  alluded  to,  that  I  often  venture  upon  the  exhi- 
bition of  this  class  of  remedies,  even  in  remissions  somewhat 
indistinct  and  obscure,  after  the  first  vehemence  of  febrile  action 
has  passed  by,  and  the  appropriate  measures  of  depletion  have  been 
premised. 

"I  have  very  rarely  observed  any  evil  results  follow  this  practice  ; 
its  worst  consequence,  if  not  most  injudiciously  timed,  nor  pressed 
obstinately  against  contra-indicating  contingencies,  will  be  an  in- 
crease of  violence  in  the  next  exacerbation  ;  but  to  compensate  for 
this,  the  succeeding  remission  will  rarely  fail  to  be  more  distinct  and 
better  adapted  for  the  use  of  our  febrifuge,  and  thus  the  disease  is 
made  to  vield  more  readily  than  under  any  other  course."' 


1845.]  Dickson  s  PracUce.  4G3 


Chapter  VII.  treats  of  Yellow  fever.  The  annexed  corollaries 
contain  the  author's  views  oi' the  generation  of  this  disease. 

"  1st.  This  malady  is  the  effect  of  a  specific  and  peculiar  cause. 

"2d.  In  certain  localities,  this  obscure  cause  is  permanent  and 
always  active;  in  others,  it  exhibits  only  an  occasional  activity,  by 
which  alone  its  presence  can  be  inferred.  In  Vera  Cruz,  Havana, 
Kingston,  it  is  perennially  endemic  ;  it  is  occasionally  so  in  New 
Orleans,  Mobile,  Savannah  and  Charleston;  which  last  city  seems 
to  be  placed  upon  its  extreme  northern  limits  of  spontaneous  pro- 
duction. 

"  3d.  Its  relation  to  season  and  temperature  is  equally  well  made 
out;  being  efficient  only  during  the  hot  months  of  summer  and 
autumn. 

"4th.  Yellow  fever  is  contagious;  in  other  words,  a  case  of  yellow 
fever  having  been  generated  in  favorable  season  and  locality,  by  its 
unknown  and  undetected  cause,  becomes  itself  a  generating  centre 
productive  of  other  cases,  or  of  a  morbid  agent  capable  of  producing 
them. 

"  5th.  It  is  transmissible  from  any  one  centre  to  another,  or  from 
any  one  of  its  generating  centres  to  a  healthy  locality  ;  and  this  com- 
munication or  extension  may  lake  place  in  two  modes,  either  by 
conveyance  of  a  portion  of  atmosphere  in  which  is  diffused  its  unde- 
fined specific  cause,  as  in  the  hold  of  a  foul  vessel,  from  any  placo 
where  it  prevails  epidemically;  or  by  the  introduction  of  a  sick  body 
or  any  fomites  imbued  with  its  contagion. 

"6th.  As  a  general  rule,  we  may  add  that  the  contac^iousness  of 
yellow  fever  is  limited  by  certain  contingencies.  This  is  Hosack's 
doctrine  of  contingent  contagion;  but  the  same  circumstances  limit 
the  efficiency  also  of  the  generating  cause,  as  indeed  of  all  the  al- 
leged causes  of  yellow  fever.  Thus,  high  temperature  is  necessary 
to  its  production,  existence  and  extension.  No  matter  liow  it  is  gen- 
erated, the  fact  is  known  that  it  does  not  exist  any  where  in  winter. 
Hence  it  follows,  that  if  carried  into  a  cold  region  from  a  hot  one,  it 
will  not  diffuse  itselt".  An  exception  to  this  rule  is  said  to  have  oc- 
curred in  Halifax,  N.  S.,  whither  the  disease  was  carried  from  the 
West-Indies,  in  May  ;  but  the  case  is  not  satisfactorily  made  out." 

AVe  add  Prof.  D.'s  opinion  on  the  nature  of  black  vomit. 

"The  majority  at  the  present  day  regard  it  as  a  form  of  gastric 
hemorrhage.  Warren,  of  Barbadoes,  calls  it  "mortified  blood." 
Bancroft  says  it  is  "  merely  effused  blood  altered  in  appearance  and 
darkened  in  color  by  the  gastric  juice,  or  by  some  chemical  decom- 
position. But  this  view  is  not  altogether  free  from  difficulties.  The 
change  of  appearance  is  not  accounted  for,  as  we  know  it  takes  place 
in  the  vessels.  We  never  meet  with  it  in  acknowledged  hemateme- 
sis,  the  blood  being  always  recognizable  in   that  hemorrhage  by  its 


4G4  Dickson's  Practice.  [August, 


proper  qualities.  Dr.  Rhees,  of  Philadelphia,  informs  us  that  on  in- 
stitutincr  a  series  of  observations  with  the  solar  microscope  upon 
black  vomit,  he  found  it  to  contain  innumerable  animalculcer  A 
single  drop  exhibited  many  thousands,  being  indeed  a  mere  congeries 
of  them.  When  recent  fluid  was  examined,  they  were  alive  and  in 
constant  motion  ;  if  suffered  to  stand  awhile,  and  when  taken  from 
the  dead  subject,  they  were  still  and  torpid.  Comparative  examina- 
tions were  made  of  the  discharges  from  the  stomachs  of  patients  ill 
with  bilious  remittent  and  other  autumnal  fevers,  but  no  similar  ap- 
pearances were  detected." 

The  author's  treatment  of  Yellow  fever  consists  principally  of  cold 
affusion,  revulsives,  and  the  free  use  of  calomel  as  a  cathartic,  and 
\Mitha  view  to  the  early  establishment  of  complete  mercurialization. 
His  aversion  to  the  use  of  venesection  is  thus  summed  up  :  "I  re- 
peat then,  that  while  I  propose  to  you  no  speculative  objections 
against  the  lancet,  and  admit  that  circumstances  may  call  for  its  oc- 
casional employment,  the  results  of  experience  and  observation^  are 
unfavorable  to  the  general  or  frequent  resort  to  it."  The  whole 
chapter  is  one  of  deep  interest,  although  lamentably  deficient  in 
autopsic  research  and  pathological  considerations. 

The  limits  assigned  to  this  paper  will  not  permit  us  to  review  the 
other  diseases  comprehended  under  the  author's  first  division,  and 
which  complete  the  first  volume.  We  therefore  proceed  to  notice 
some  of  the  contents  of  the  second  volume.  Under  the  head  of 
"  Diseases  of  the  Digestive  System,"  we  -find  the  chapters  on  Dys- 
pepsia, Gastritis,  Enteritis,  Milk-sickness,  Colic,  Cholera,  Diarrhoea, 
Dysentery,  Cholera  Infantum,  Helminthia,  Hepatitis,  Icterus,  Splen- 
itis, Parotitis,  and  Pharyngitis. 

Affections  of  the  spleen,  although  exceedingly  common  in  our 
latitude,  have'hitherto  received  but  little  attention  from  the  profession. 
Nor  do  we  find  any  new  light  thrown  upon  them,  or  upon  their  treat- 
ment, by  Prof.  D.  He  makes  the  following  concession  in  relation  to 
the  treatment  of  splenitis  : 

"  For  my  own  part,  I  cannot  recommend  any  particular  formula 
with  great  confidence,  in  this  obstinate  malady.  I  think  I  have 
found  most  benefit  from  the  use  of  iodine  combined  with  mercury,  as 
in  the  deutiodide  of  mercury  and  potassium,  while  the  patients 
bowels  were  kept  soluble  by  the  employment  of  the  blue  pill  with 
rhubarb  in  such  doses  as  were  requisite,  never  pressing  this  matter 
very  far.  Cups  or  leeches  over  the  tumor  relieve  pain.  Fomenta- 
tions applied  to  the  side  are  also  useful." 


1845.]  Dickson's  Practice,  465 


It  is  to  be  regretted  that  the  author's  extensive  experience  has  not 
led  him  to  test  the  efficacy  of  the  use  of  quinine  in  large  doses,  as 
recommended  by  the  French,  We  have  used  it  with  manifest  ad- 
vantage in  several  cases  of  chronic  enlargement  of  this  organ. 

Of. the  "  Diseases  of  the  Respiratory  System,"  the  author  notices, 
Croup,  Laryngitis,  Bronchitis,  Pleuritis,  Pneumonia,  Phthisis,  Asth- 
ma, and  Pertussis.  We  are  much  pleased  with  the  stress  with  which 
is  urged  the  exploration  of  the  chest  by  physical  means.  The  histo- 
ry of  auscultation  and  percussion  furnishes  a  strong  illustration  of 
the  reluctance  with  which  improvements  are  adopted,  when  industry 
is  necessary  to  the  appreciation  of  their  merits-  Although  the  great 
advantages  of  these  physical  means  have  been  known  upwards  of  a 
quarter  of  a  century,  and  made  an  essential  part  of  a  physician's 
education  in  France,  we  still  find  that  in  our  country,  they  are 
totally  neglected  by  the  great  mass  of  practitioners.  Indeed  it  is  but 
a  few  years  since  they  have  been  systematically  taught  in  our  medi- 
cal schools.  Justice  requires,  however,  that  we  award  to  the  Jack- 
sons,  to  Morton,  to  Gerhard,  &;c.,  of  our  own  country,  the  merit  of 
having  labored  with  successful  zeal  in  the  advancement  of  our  know- 
ledge  of  these  means,  and  in  the  promulgation  of  their  importance. 
Nor  should  we  omit  the  claims  of  Drs.  Cammann  and  Clark,  of  New 
York,  who  by  the  happy  combination  of  simultaneous  auscultation 
and  percussion,  have  made  the  greatest  improvement  discovered  since 
the  days  of  Laennec.  It  is  to  be  regretted  that  Prof.  D.  has  not 
availed  himself  of  their  valuable  publication  (in  theNew  York  Journal 
of  Medicine  and  Surgery,  for  July,  1840)  in  his  remarks  on  the 
exploration  of  the  heart.  The  author,  however,  is  not  singular  in 
this  neglect  of  improvements  made  at  home.  We  do  not  recollect 
ever  seeing  the  slightest  reference  to  the  paper  alluded  to,  in  any  of 
the  periodicals  or  works  issued  from  the  Philadelphia  press.  How 
different  would  it  have  been,  had  such  an  advance  in  our  means  of 
diagnosis  been  made  in  Europe  !  The  American  Journal  of  the 
Medical  Sciences,  which  claims  to  be  "the  organ  "  of  the  Profession 
in  America,  would  certainly  not  have  passed  it  over  in  silent  con- 
tempt. Can  it  be  that  jealous  rivalry  precludes  the  notice  in  Phila- 
delphia of  anything  done  in  the  neighboring  city  of  New  York? 
We  do  not  for  a  moment  impute  such  unworthy  motives  to  the  au- 
thor before  us,  and  must  attribute  his  neglect  of  our  countrymen  to 
the  fact  that  this  portion,  at  least,  of  his  work  was  probably  written 

30 


466  Dickson's  Practice.  [August, 

before  the  publication  ofDrs.  Cammann  and  Clark,  and  has  not 
since  been  carefally  revised. 

The  division  of  "Diseases  of  the  Sensorial  System"  includes 
Phrenitis,  (acute  and  chronic,)  Mania-a-Potu,  Apoplexy,  Paralysis, 
Chorea,  Epilepsy,  and  Neuralgia.  The  diseases  of  the  "  Motory 
System,"  treated  of  in  this  volume,  are  Gout  and  Rheumatism. 

Of  the  seat  of  Rheumatism  our  author  entertains  the  following 
views : 

"For  my  own  part,  I  am  inclined  to  hold,  with  Craigie,  that  the 
chief,  if  not  the  exclusive,  seat  of  rheumatism,  is  the  tissue  which  is 
termed  'aponeurotic'  'the  aponeurosis,  fascia,  or  tendinous  ex. 
pansion,  which,  invariably  connected  with  the  periosteum  or  capsular 
ligaments  at  the  articular  extremities,  covers  or  supports  each  mus- 
cle to  a  greater  or  less  extent,  penetrates  into  the  substance  of  the 
muscle  and  passes  at  each  joint  from  one  part  of  a  limb  to  the  other, 
and  from  the  limbs  to  the  trunk,  forming  a  covering  of  the  greatest 
extent,  next  to  the  skin,  in  the  human  body.'  " 

Prof.  D.  admits  the  hereditary  prexiisposition  to  Rheumatism,  and 
adds  : 

"Beyond  this,  and  the  fact  that  a  second  attack  supervenes  more 
readily  upon  any  given  individual,  owing  not  only  to  the  building  up 
of  a  constitutional  diathesis,  but  probably  also,  in  some  measure  at 
least,  to  obscure  changes  impressed  upon  the  parts  first  affected  be- 
yond this,  we  know  little  of  the  predisposing  causes  of  rheumatism. 
Muscular  fi\tigue  is,  perhaps,  the  only  one  which  we  can  affirm  to  be 
definitely  pointed  out,  and  the  malady  is  hence  accounted  for  in  its 
aptness  to  attack  the  hard-working  laborers  of  the  lov.er  classes.  It 
is  also  commonly  believed,  that  a  limb  or  joint  which  has  been  previ- 
ously twisted  or  dislocated,  or  weakened  by  a  blow  or  sprain,  is  ever 
after  more  liable  to  be  acted  on  by  the  several  circumstances  that 
tend  to  give  rise  to  rheumatic  inflammation." 

On  the  treatment  of  acute  Rheumatism  wo  find  that  "Prof. 
Mitchell,  of  Philadelphia,  has  discovered  that  counter-irritants  of  this 
sort,  are  frequently  more  serviceable  when  applied  to  the  spine,  than 
directly  over  the  part.  He  selects  the  portion  of  the  column  whence 
issue  the  nerves  that  supply  the  seat  of  the  inflammation.  The  sug- 
gestion is  a  valuable  one,  and  deserves  your  attention."  On  the 
treatment  of  Chronic  Rheumatism  no  allusion  is  made  to  the  spinal 
applications.  Yet,  nothing  is  more  satisfactorily  demonstrated  than 
the  efficacy  of  this  plan  of  treatment  in  both  forms  of  the  disease, 
but  more  especially  in   the  chronic.     The  pathology  of  Rheumatic 


IS  15.]  On  Ascites.  467 


affections,  as  at  present  understood  by  many,  would  lead  irresistibly 
lothis,  as  the  most  efficacious  treatment,  even  were  it  not  substantia, 
ted  by  the  daily  observations  of  those  who  resort  to  it.  We  would 
refer  to  a  paper  on  the  subject  published  as  long  ago  as  1836,  in  the 
Southern  ^Medical  and  Surgical  Journal. 

The  "  Diseases  of  the  Excernent  System  "  comprehend  Variola, 
Varioloid,  Varicella,  V'accinia,  Rubeola,  Erysipelas,  Scarlatina,  and 
Dengue.  The  last  chapter  of  the  work  occupies  about  twenty  pages, 
and  treats  in  general  terms  of  some  of  the  affections  of  the  "urinary 
organs,"  as  Diabetis,  anuria,  morbid  urines,  gravel,  renal  calculi, 
nephritis,  Bright's  disease,  nephralgia,  cystitis,  cytherismus,  vesical 
calculi,  and  lithic  diathesis. 

In  concluding  this  very  imperfect  notice  of  the  work  before  us,  we 
appprehend  that  we  may  incur  the  imputation  of  having  dealt  unfair- 
ly with  the  author  in  presenting  a  picture  rather  of  its  defects  than  of 
its  intrinsic  merits.  We  felt,  however,  in  accomplishing  the  task, 
that  whilst  nothing  we  might  say  could  add  to  the  deservedly  high 
reputation  of  the  distinguished  author,  it  was  due  to  the  Profession, 
and  especially  to  the  Profession  at  the  South,  to  notice  some  of  the 
most  important  omissions  in  a  work  emanating  from  so  imposing  a 
source.  Errors  are  baneful  in  proportion  to  the  authority  by  which 
they  are  sanctioned.  We  trust,  therefore,  that  our  strictures  may  be 
received  in  the  spirit  by  which  they  were  dictated,  and  that  a  new 
edition  of  the  work  will  be  brought  up  "  au  niveau  de  la  science." 

D. 


PART  III MONTHLY  PERISCOPE. 

On  Ascites.     By  Prof.  C.  J.  B.  Williams,  M.  D.,  F.  R.  S.,  &c. 

We  now  go  on,  from  inflammatory  affections,  to  ascites,  which  is  a  spe- 
cies  of  flux,  or  more  properly,  dropsy  of  the  abdomen.  There  is  an 
increased  secretion  of  serum,  frequently  to  a  great  extent,  and  this  we 
have  found  to  be  sometimes  the  result  of  chronic  peritonitis  ;  at  other 
times,  however  it  is  a  consequence  of  disease,  not  of  an  infiammato- 
ry  nature.  It  may  arise  from  the  sudden  suppression  of  another  flux, 
such  as  diarrhcea,  or  the  stoppage  of  the  ca4amenia.  Sometimes, 
ascites  occurs  as  a  part  of  general  dropsy,  from  disease  of  the  heart 
or  imperfect  action  of  the  kidneys,  or  a  general  cachectic  slate.  IMore 
commonly,    ascites  arises  from   an  obstruction  to  the  return  of  the 


468  On  Ascites.        '  [August, 


blood  from  the  abdominal  vessels,  as  in  disease  of  the  liver.  In  such 
case,  it  is  frequently  unaccompanied  by  any  considerable  swelling  of 
the  legs  or  other  parts  of  the  body.  The  usual  symptoms  are  :  swell- 
ing of  the  abdomen,  attended  by  fluctuation,  and  a  dull  sound  in  the 
most  dependent  parts,  but  the  position  of  this  varies;  where  there  is 
a  slight  degree  of  effusion,  the  fluid  in  the  abdomen  may  be  best  felt 
in  the  sitting  or  standing  posture,  in  the  pubic  and  iliac  regions.  It 
may  be  felt  by  the  usual  process  for  ascertaining  the  presence  of 
fluctuation,  by  pressing  the  hand  on  the  abdomen  on  one  side,  and 
gently  tapping  on  the  other ;  each  stroke  from  the  finger  is  followed 
by  a  movement  of  the  fluid,  which  is  impelled  onwards  to  the  opposite 
side.  There  must  be  some  quantity  of  liquid  to  effect  this.  It  very 
frequently  happens  that  the  intestines,  or  some  of  the  solid  contents, 
fall  down  to  the  middle  part  of  the  abdomen,  and  cut  off'the  commu- 
nication between  the  two  sides;  and,  therefore,  though  there  is  a 
considerable  quantity  of  fluid,  you  get  no  fluctuation.  In  that  case, 
you  may  ascertain  it  by  pressing  the  hand  on  the  lower  part  of  the 
abdomen,  and  adopting  the  process  on  a  smaller  scale.  There  may, 
however,  be  a  source  of  error  here;  the  soft  parts  do  not  fluctuate; 
but,  where  there  is  a  solid  tumor,  there  is  a  sort  of  fluctuation  induc- 
ed. I  have  been  deceived  in  this  manner,  repeatedly,  and  no  very 
correct  idea  can  be  obtained  by  percussion.  If  you  strike  the  abdo- 
men high  up,  a  fluctuation  or  tremulous  motion  is  propagated  to  the 
finger;  the  same  thing  is  found  with  a  tumor,  such  as  the  enlarged 
liver  or  spleen,  and,  on  one  occasion,  I  was  thus  led  to  mistake  an 
enlarged  spleen,  of  enormous  size,  for  a  tumor  in  the  ovarium.  The 
same  thing  will  occur  when  you  try  fluctuation  between  bodies  at  a 
short  distance  ;  and  it  isdiflficult  to  say,  where  the  walls  of  the  abdo- 
men are  thick,  or  where  there  is  a  considerable  amount  of  soft  or 
fatty  matter,  whether  such  fluctuation  is  the  result  of  the  liquid  or  of 
the  solid  matter.  The  best  mode  of  distinction,  therefore,  for  small 
quantities  of  liquid,  is,  certainly,  the  sound  on  percussion,  as  I  point- 
ed out  in  speaking  of  chronic  peritonitis.  In  this  manner  you  may 
readily  displace  a  small  quantity  of  liquid  by  pressure.  You  will  find, 
in  these  cases,  the  lower  part  of  the  abdomen  to  sound  dull  on  per- 
cussion ;  but,  if  you  press  inwards,  you  get  rid  of  a  quantity  of  liquid, 
and  come  in  contact  with  the  intestines;  and,  therefore,  the  diflfer- 
ence  of  forcible  percussion,  and  of  gentle  percussion,  will  enable  you 
to  distinguish  the  presence  of  liquid.  Hence,  you  find,  when  pres- 
sure is  not  employed,  that  there  is  a  dull  sound  on  percussion,  but  by 
pressing  on  the  parts,  and  then  percussing,  there  is  a  clearer  sound, 
and  this  is  a  pretty  sure  proof  of  liquid  being  present  in  the  lower 
part  of  the  abdomen  ;  this  may  be  ascertained  by  the  patient  stand- 
ing; and,  in  order  to  get  the  liquid  in  front,  the  patient  should  be 
desired  to  lean  forward.  This  plan  is  also  available  for  making  fluc- 
tuation more  distinct,  or  perceptible  in  other  cases.  The  same  prac- 
tice may  be  applied  to  the  flanks,  and  I  have  been  enabled,  in  many 
instances,  to  announce   this  commencement  of  ascites,  before  many 


i^lo.J  On  Ascites,  4ti9 


others  could  detect  it  by  fluctuation.  Another  mode  of  diagnosis 
between  ascites  and  ovarian  tumor  between  liquid  in  the  peritoneal, 
and  liquid  in  the  ovarian,  sac  is  important  to  be  noticed ;  its  dis- 
tinction is,  however,  very  easy.  Ovarian  tumors  begin  low  down,  on 
one  side,  gradually  rising  up,  and,  when  they  occupy  a  great  extent 
of  the  abdomen,  the  dulness  will  be  found  to  be  more  defined,  and 
will  extend  higher  up ;  below,  there  is  a  sort  of  tympanitic  sound  of 
the  intestines,  which  are  pushed  aside  by  the  tumor.  In  ascites,  it  will 
be  more  in  the  dependent  parts,  that  there  will  be  dulness  towards 
the  pubic  region ;  and,  if  there  is  any  resonance  at  all,  it  will  be  per- 
ceived towards  the  umbilicus,  and  in  the  pit  of  the  stomach.  On  the 
contrary,  in  ovarian  tumor,  the  chief  dulness  will  be  in  the  central 
portion  of  the  abdomen,  whilst  the  intestinal  resonance  will  be  in  the 
flanks.  In  some  instances,  however,  of  very  advanced  ascites,  the 
fluid  may  be  so  extensive  as  to  cover  the  intestines  completely  over, 
so  that  the  abdomen  is  dull  in  every  region,  both  behind  and  before; 
but,  such  cases  are  unusual;  and,  even  then,  by  pressing  inwards,  as 
far  as  the  walls  will  allow,  and  using  strong  percussion,  the  tympan- 
itic sound  may  usually  be  heard  towards  the  umbilicus.  There  are 
cases  of  adhesion  ot  the  intestines  to  the  sides,  so  that  they  cannot  be 
displaced  by  liquids.  Under  such  circumstances,  although  dropsy  be 
present,  there  will  be.a  degree  of  resonance  on  percussion,  along  the 
tract  of  the  intestines.  In  most  cases,  ascites  is  accompanied  by  a 
scanty  and  turbid  condition  of  the  urine,  which  is  also  high  colored, 
or  else,  in  many  instances,  it  is  impregnated  with  albumen.  It  is, 
not  unfrequently,  also  connected  with  disease  of  the  kidney;  and 
you  must  remember  that  ascites,  or  dropsy  of  the  peritoneal  sac,  may 
be  dependent  on  some  other  causes,  of  which  there  will  be  found  signs : 
for  instance,  a  person  will  be  suddenly  attacked  with  swelling  in  the 
abdomen,  on  the  suppression  of  some  discharge.  The  disease  is,  here, 
somewhat  of  an  inflammatory  character,  and,  not  unfrequently,  if  it 
remain  unsubdued,  anasarca  will  take  place.  In  ascites  from  diseas- 
ed  liver,  there  is,  generally,  some  local  sign  of  hepatic  disease.  Some- 
times  attacks  of  jaundice,  or  bilious  affections,  occur,  and  the  intesti- 
nal  and  urinary  evacuations  show,  more  or  less,  symptoms  of  disorder. 
The  ascites  must  be  diminished  or  removed,  before  we  can  determine 
the  exact  position  of  the  liver.  In  many  cases  of  ascites,  the  enlarge- 
ment of  the  liver  may  be  felt  by  pressing  the  hand  on  the  right  side, 
or  using  gentle  percussion  :  this  presses  away  the  fluid,  and  you  then 
find  some  resisting  body  in  that  direction.  Extensive  ascites  will 
impinge  on  the  region  of  the  chest,  and  cause  some  of  the  signs  of 
disease  of  the  thoracic  organs ;  the  tumor,  pressing  up  the  diaphragm, 
will  produce  imperfect  respiration,  or  interfere  with  the  due  perform- 
ance of  this  function.  In  other  cases,  there  will  be  symptoms  of 
something  like  hypertrophy  of  the  heart,  this  organ  beina  thrown 
forwards  against  the  chest.  You  judge  of  this  by  the  amount  of 
swelling.  There  is  yet  another  cause  of  ascites  to  be  noticed,  and 
that  is  a  curious  one :  it  is  obliteration  of  the  ascending  cava  ;  in  a 


470  Treatment  of  Typhus.  [August, 


^Q\v  instances,  in  which  this  has  been  observed,  not  only  ascites  of  the 
belly,  but,  likewise,  dropsy  of  the  lower  extremities,  have  been  re- 
marked as  a  consequence  ;  obstruction  of  the  vena  cava  inferior,  or 
of  a  portion  of  the  venaportas,  generally  leads  to  ascites. 

The  irealment  will  depend  very  much  on  the  cause.  When  it 
arises  from  simply  suppressed  excretion,  it  may  require  general  de- 
pletion, or  cupping  over  the  region  of  the  loins.  The  chief  medicinal 
remedy,  in  these  cases,  is  eiaterium,  in  small  doses;  or  cream  of 
tartar,  in  doses  of  from  half  an  ounce  to  an  ounce;  taken  the  first 
thing  in  the  morning,  and  sometimes  combined  with  jalap;  after 
this,  diuretics  may  be  given  ;  but  the  greater  portion  of  these  are  of 
no  use,  until  the  main  symptoms  are  reduced,  and,  often,  such  medi- 
cines are  found  merely  to  irritate,  instead  of  doing  good.  Sometimes 
a  warm  bath  is  useful,  particularly  where  the  disease  is  connected 
with  suppressed  perspiration,  and  a  dry  state  of  the  skin.  In  cases 
of  diseased  liver,  or  diseased  heart,  or  both,  mercurials,  combined 
with  diuretics,  answer  best :  such  as  squills  and  colchicum,  digitalis, 
tincture  of  cantharides,  cream  of  tartar,  spirits  of  juniper,  tincture  of 
horse-radish,  acetate  of  potash,  iodide  of  potassium,  &c. ;  these  two 
last  may,  sometimes,  bo  combined  together.  Blisters  to  the  abdo- 
men are  also  of  great  efficacy,  in  some  cases  of  low  inflammation  of 
these  parts.  If  the  ascites  be  extensive,  and  the  above  medicines 
produce  but  little  impression,  hydrngogue  purgatives  sometimes 
cause  copious  evacuations,  but  they  exhaust,  rather  than  relieve,  the 
system.  Diuretics  do  no  good  ;  and,  then,  we  must  have  recourse 
to  tapping,  which  gives  present  relief,  and  is  further  useful,  inasmuch 
as  other  remedies  are  then  enabled  to  act  with  more  freedom. 
It  is  on  these  occasions,  that  we  are  often,  for  the  first  time, 
enabled  to  examine  the  abdomen  clearly,  and  to  make  out  the 
diagnosis.  In  the  same  way,  we  may  be  guided  to  the  use  of 
mercury,  if  the  disease  be  in  the  liver;  or  of  iodine,  if  there  is 
any  enlargement  of  the  general  glandular  system.  After  tapping 
has  removed  the  fluid,  a  tumor  may  still  remain  in  the  abdomen,  and 
this  may  then  be  found  to  depend  on  an  enlarged  ovarium.  Some- 
times it  is  the  liver  which  is  enlarged  ;  or,  again,  it  may  be  the 
spleen.  In  all  these  cases,  iodide  of  potassium  has  been  known  to 
exercise  very  good  effects.  London  Medical  Times. 

Treaiment  of  Typhvs.  Dr.  Davidson,  in  the  London  and  Edin- 
hurgh  Medical  Journal,  thus  sums  up  the  treatment  of  typhus  fever. 
He  considers  that,  as  typhus  is  a  disease  which  cannot  be  checked 
in  limine,  and  is  often  tedious  in  its  progress,  causing  great  emacia- 
tion and  exhaustion,  measures  which  may  vitally  lessen  the  powers 
of  life,  such  as  bleeding,  vomiting,  and  excessive  sweating  or  purg- 
ing, ought  not  to  be  used  without  very  strong  and  special  reasons. 
The  ordinary  measures  may  be  the  following  :  Place  the  patient  in 
a  large,  well-ventilated  apartn)ent,  on  a  mattress,  with  few  bed- 
clothes; let  the  head  be  shaved,  and  kept  cool  with  an  evaporating 


1845.]  Nitric  Acid  ill  Purpura  IliBmorrhagica.  471 


lotion,  give  a  gentle  purgative  every  second  or  third  day,  let  the  skin 
be  bathed  once  or  twice  a  day  with  tepid  water,  and  this  may  be  ac- 
companied with  small  doses  of  tartarized  antimony,  antimonial  pow- 
der, or  ipecacuana.  The  drmk  should  be  liglit,  cooling  and  slightly 
diuretic  ;  and  the  diet  nutritive,  but  light,  and  little  liable  to  acescen- 
cy.  When  there  is  a  tendency  to  congestion  in  any  organ,  a  little 
calomel,  or  hydrargyrum  cum  crela,  may  be  combined  with  the  pur- 
gative, or  calomel  with  a  small  quantity  of  opium  may  be  given  every 
six  or  eight  hours.  The  application  of  two  or  three  leeches  to  the 
temple  or  nostrils  is  often  useful  in  congestion  of  the  brain,  and  also 
where  there  is  intense  head-ache,  which  is  often  the  forerunner  of 
delirium.  Blisters  are  also  often  advantageous  in  such  cases.  De- 
rangements of  particular  functions,  or  symptoms  arising  from 
idiosyncracy  of  constitution,  sometimes  occur,  and  must  be  treated 
accordingly.  Mercury  in  small  doses  is  frequently  useful  in  pro- 
moting several  of  the  secretions,  and  in  relieving  the  congestion  of 
internal  organs.  Opium  is  injurious  in  a  large  proportion  of  cases, 
from  its  tendency  to  cause  congestion  in  the  head  ;  but  where  diarr- 
hoea is  a  symptom,  it  ought  to  be  administered  with  a  view  to  check 
the  exhausting  evacuations.  Wines  and  other  alcoholic  liquors,  as 
they  contain  both  stimulant  and  alimentary  elements,  are  the  most 
to  be  relied  on  for  supporting  the  strength,  and  are  the  least  injurious. 
The  pulse,  taken  along  with  the  general  symptoms  of  exhaustion, 
may  be  held  to  be  the  rule  for  its  exhibition,  both  as  to  time  and 
quantity.  Ammonia,  camphor,  quinine,  and  other  similar  tonics,  are 
not  to  be  depended  on  in  bad  cases  ;  and  when  exhibited  along  with 
wine,  frequently  cause  the  patient  to  refuse  both.  When  the  disease  is 
complicated  with  local  alTections  in  the  head,  chest  or  abdomen, 
they  must  be  treated  on  the  same  general  principles  as  the  idiopathic 
disease  which  they  represent,  with  this  important  modification,  that 
evacuations  of  all  kinds  must  be  employed  more  sparingly,  and  with 
much  caution;  and  that  even  in  these  cases,  if  there  be  much  pros- 
tration of  strength,  and  a  very  weak  pulse,  wine  must  be  administer- 
ed, although  more  moderately  than  in  the  simple  disease.  New-  Yoi^k 
Journal  of  Medicine. 


Successful  use  of  Nitric  Acid  in  a  case  of  Purpura  Hoimorrhngi. 
ca.  By  J.  J.  Bradford,  M.  D.,  of  Augusta,  Ky.  On  the  12th  of 
April,  1844,  I  was  consulted  by  Mr.  Cline  in  reference  to  the  case 
of  his  son,  aged  ahout  12  years.  His  health  had  been  generally 
pretty  good,  and  he  was  free  of  scrofulous  disease,  either  hereditary 
or  acquired. 

For  about  two  weeks  prior  to  the  attack,  he  had  complained  of 
lassitude  and  pains  in  the  inferior  extremities.  His  appetite  was 
very  little  affected,  and  the  alvine  discharges  had  a  healthy  appear- 
ance until  a  few  days  before  his  seizure,  when  he  passed  a  good  deal 
of  dark  grumous  blood,  which  greatly  alarmed  his  parents. 


472  Blisters  in  Children.  [August, 


At  the  time  of  attack  his  countenance  was  pale,  the  skin  cool,  the 
muscles  shrunken  and  flaccid,  the  pulse  quick,  feeble,  and  varying 
from  120  to  140,  on  the  slightest  exertion  of  body  ;  fullness  of  the 
abdomen  was  obvious,  with  slight  tenderness  in  the  right  hypochon- 
driacal region  ;  the  urine  was  turbid  and  in  diminished  quantity.  We 
found  the  lower  extremities  completely  covered  with  spots,  varying 
in  bulk  from  mere  scarlet  points  no  larger  than  flea  bites,  to  large 
purple  blotches,  of  the  size  of  a  fifty  cent  piece.  The  front  part  of 
the  abdomen  presented  numerous  purple  spots,  quite  large.  On  the 
chest  there  were  some  also,  of  less  size,  while  those  on  the  neck,  face 
and  upper  extremities,  gave  the  speckled  appearance  of  the  turkey 

error. 

There  was  a  constant  oozing  of  blood  from  the  tunica  conjunctiva, 
from  the  schneiderian  membrane,  the  gums,  the  tongue,  the  soft  pa- 
late, the  fauces,  and  indeed  from  all  the  mucous  membranes,  except- 
ing only  the  bladder  and  urethra. 

The  treatment  of  the  case  was  at  first  by  calomel  and  rheubarb,  as 
follows  :  R.  Cal.  and  Rhei.  aa.  grs.  xv  ;  mix,  and  divide  into  three 
parts  and  give  one  every  night,  with  a  dose  of  castor  oil  on  the  next 
morning  if  the  powders  fail  to  give  one  or  two  good  alvine  discharges. 

April  14.  The  first  two  powders  acted  freely  on  the  bowels,  but 
the  symptoms  were  arrgravated.  The  third  powder  was  not  given, 
but  in  its  place  the  following  prescription  was  administered  :  R.  Ni- 
tric Acid  1  drachm,  pulv.  gum  arable,  white  sugar,  aa.  2  drachms, 
water  5  oz.  mix,  and  give  balf  a  table-spoon  full  every  six  hours, 
followed  every  third  day  by  sulphate  of  magnesia,  if  the  bowels 
should  not  be  opened. 

April  17.  Symptoms  rather  better.  Patient  is  not  so  weak.  Less 
blood  passes  from  the  stomach  and  bowels,  and  he  has  a  motion  with- 
out resorting  to  the  cathartic.  The  petechial  appearance  is  stationary. 
Continue  the  medicine. 

April  19.  Evident  improvement  in  all  the  symptoms.  The  ap- 
petite increased.  Pulse  112,  and  very  little  blood  oozes  from  any  of 
the  mucous  membranes.     Continue  the  medicine. 

jVIay  1.  The  medicine  was  renewed  to-day  for  the  last  time,  and 
by  the  20th  of  the  month  he  was  entirely  restored. 

From  the  success  of  nitric  acid  in  this  alarming  case,  1  feel  justi- 
fied in  recommending  the  remedy  to  the  notice  of  my  professional 
brethren  ;  at  the  same  time  I  resign  to  others  all  speculations  as  to 
the  modus  operandi.  Western  Lancet. 


Blisters  in  Children.  Some  discussion  took  place  repecting  the 
use  of  blisters  in  children.  Generally,  their  employment  was  looked 
upon  as  only  a  choice  of  evils,  and  two  cases  were  related  in  which 
their  application  produced  fatal  results.  The  President  had  found,  in 
cases  where  blistered  surfaces  were  healed  with  difficulty,  that  the 
mixture  of  a  grain  or  two  of  opium  with  an  ounce  of  spermaceti 
ointment  was  of  great  benefit.     In  cases  in  uLich  morphia  was  em- 


1845.]  Valerianate  of  Quinine  473 


ployed  endermically,  the  difficulty  often  was,  to  keep  the   blistered 
surface  open.  London  Lancet. 


Valerianate  of  Quinine  its  Therapeutic  Employment  Mode  of 
Preparation  and  Adviinistration.  (Translated  froin  the  French  
UAheille  Medicate.)  Dr.  Francis  Devay,  Physician  to  the  Ho'el 
Dieii  de  Lyons,  through  an  essay  published  in  the  Gazette  Medicate^ 
directs  the  attention  of  practitioners  to  a  new  comhination  of  valeri- 
anic acid  with  a  vegetable  alkali  quinine.  We  arc  induced  to 
augur  favorably  of  this  union  of  the  active  principle  of  valerian  to 
the  medicinal  agent  of  the  most  powerful  of  our  exotic  products. 
According  to  M.  Devay,  this  provision  is  fully  justified  by  clinical 
verification:  valerianate  of  quinine  in  small  doses  is  anti-periodic, 
very  effectual,  and  superior  to  the  sulphate  by  its  nevro-sthenic  pro- 
perties. 

Doubtless  the  gastro-intestinal  accidents  produced  by  this  latter 
salt  have  been  much  exaggerated;  still,   it  is  no   less  true  that  the 
sulphate  is  much  more  irritating  than  the  bark  in  substance;  first,  by 
reason  of  its  greater  solubility;  and  again,  because  it  has  not  the 
corrective  properties  possessed  by  the  Peruvian  bark,  viz   tannin. 
It  is  not  so  with  the  valerianate.     In  this  last  product  the  quinine 
is  modified  by  its  intimate  association  with  a  vegetable  acid,  which, 
to  a  slightly  perturbating  action    upon  ihe   nervous  system,    joins 
those  eminently  characteristic  of  Peruvian  bark.     There  is,  in  this, 
a  fact  connected  with  therapeutic  dynamics,  concerning  which   we 
cannot  too  much  engage  physicians  to  consider  attentively.     Thus, 
as  we  said  before,  in  our  first  memoir,  valerianate  of  zinc  is  an  anti- 
spasmodic raised  to  its  highest  power ;  so  valerianate  of  quinine  is  a 
medicine  endowed  with  anti-periodic  powers  of  the  greatest  energy. 
This  is  a  fact  we  have  acquired  through  numerous  cases  zealously 
collected  several  months  since.     But  it  is  due  to  us  to  say,  that  the 
administration  of  the  valerianate   will   for  a  long  time  expose  the 
practitioner  to  mistakes,    until  the  apothecaries  generally  become 
experienced  in  its  composition,  and   in  all  the  minute  and   delicate 
preparations  required  by  it.     M.  Devay  remarks,  that  to  judge  of 
the  therapeutic  action  of  valerianate  of  quinine,  it  is  necessary,  first 
of  all,  to  satisfy  ourselves  of  the  excellence  of  its  composition.     His 
experiments  were  made  with  valerianate  of  quinine,  prepared  under 
his  supervision  by  Mr.  Guillermond,  a  skilful  pharmaceutist  of  Lyons. 
Characters.  According  to  the  analysis  of  the  Prince  of  Canino, 
who  was  the  first  to  prepare  and  describe  valerianate  of  quinine,  this 
salt  is  formed  of  one  equivalent  of  valerianic  acid,  one  of  quinine, 
and  two  equivalents  of  water,  of  which  one  constitutes  its  water  of 
crystallization.     The  crystalline  form  of  this  salt  is  very  difl^crent ; 
it  is  octcedrical  or  hexsedral.     We  have  ourselves  obtained   it  in 
hexaedrons,  flattened  on   two  faces,  and  forming  rhomboidal  tables 
perfectly  characterized.     It   is  often   agglomerated   in   light,  silky 
masses.     Independent  of  this  last  fact,  the  crystals  are  hard  and  tol- 
erably heavy. 


474  Valerianate  of  Quinine.  [August, 


Valerianate  of  quinine  has  a  slight  odor  of  valerianic  acid,  and  a 
decided  bitter  taste,  recalling  that  of  cinchona.  It  dissolves  with  fa- 
cility in  water  at  a  common  temperature.  Alcohol  is  a  better  sol- 
vent; and  olive  oil  dissolves  it  equally  well,  assisted  by  a  slight  heat. 
The  mineral  acids,  and  most  of  the  organic  acids,  decompose  it. 
Submitted  to  a  heat  of  about  90,  crystallized  valerianate  of  quinine 
looses  an  equivalent  of  water,  softens,  and  melts  like  a  resinous  sub- 
stance. Depriv'ed  of  water,  it  is  rendered  insoluble  in  this  liquid, 
while,  on  the  contrary,  it  is  very  soluble  in  alcohol.  Exposed  to  a 
bight  r  tempernture,  it  cannot  be  made  to  part  with  its  other  equiva- 
lent of  water,  but  is  decomposed,  and  mono-hydrated  valerianic  acid 
vapors  are  seen  to  escape  from  the  resinous  mass.  The  aqueous 
solutions  of  this  salt,  exposed  to  the  heat  of  boiling  water,  also 
decompose,  and  oily  drops  are  seen  to  float  upon  the  surface  of  the 
liquid,  which  cannot  be  made  to  redissolve  in  the  water,  except  by 
means  of  spirit  of  wine,  and  is  nothing  more  than  mono-hydrated 
valerianate. 

Preparation.  To  a  concentrated  alcoholic  solution  of  quinine  add 
valerianic  acid  in  slight  excess.  Dilute  the  alcoholic  solution  with 
twice  its  volume  of  distilled  water;  mix  intimately,  and  evaporate  in 
a  stove  at  a  heat  not  surpassing  122'^  Fahr.  After  the  evaporation 
of  the  alcohol,  the  valerinnate  is  exhibited  in  the  form  of  handsome 
crystals,  here  and  there  grouped  or  isolated,  which  increase  from  day 
to  day. 

The  valeriannte  of  quinine  may  likewise  be  prepared  by  double 
decomposition,  in  mixing  sulphate  of  quinine  with  valerianate  of 
lime  or  baryta,  both  being  d.ssolved  in  wenk  alcohol.  We  have  our- 
selves obtained  this  salt  in  mixing  an  alcoholic  solution  of  the  neutral 
sulphate  of  quinine  with  an  alcoholic  solution  of  valerianate  of  potash. 

The  process  succeeds,  after  several  successive  tiials,  to  insure  the 
perfect  decomposition  of  the  two  salts.  These  methods  are  only 
good  in  saving  time  ;  it  is  far  better  to  act  in  a  direct  manner,  so  as 
to  have  finer  and  purer  products. 

Whatever  mode  of  preparation  be  adopted,  it  should  always  be 
home  in  mind  that  the  solution  must  be  evaporated  slowly,  with  a 
gentle  heat,  and  the  crystals  not  bo  separated  from  the  mother  waters 
except  to  dry  them  in  the  open  air. 

Valerianate  of  quinine  may  be  distinguished  as  follows  : 

1st.  A  concentrated  alcoholic  solution  of  valerianate  of  quinine 
precipitates  the  concentrated  neutral  aqueous  solution  of  nitrate  of 
silver:  this  ])recipitate  is  redissolved  in  a  large  quantity  of  water. 

2d.  An  aqueous  solution  of  valerianate  of  quinine  does  not  pre- 
cipitate  one  of  chloride  of  barium. 

3d.  This  aqueous  solution,  submitted  to  ebulition,  allows  some 
oleaginous  drops  of  melted  hydrated  valerianate  to  separate. 

4th.  If  this  solution  be  treated  with  acids,  valerianic  acid  is  dis- 
engaged, which  may  easily  be  recognized  by  its  odor  ;  and  if  this 
decomposition  be  effected    with    crystallized   valerianate  of  quinine 


1845.]  Copaiba  with  Purgalives  in  Gonorrhcea.  475 


and  a  concentrated  liquid  acid,  valerianic  acid  will  be  obtained  in  an 
olean;inous  form. 

Mode  of  Adminisfratlon.  Like  the  valerianate  of  zinc,  this  of 
quinine  being  very  delicate,  or  more  correctly  speakinfr,  easily  de- 
composed,  it  is  best  to  administer  it  in  the  most  simple  form  :  in  this 
belongs  a  necessary  condition  to  its  successful  use. 

We  mostly  give  it  in  a  gummous  solution.  Five  decij^rammcs  f 
the  salt,  (8  grs.)  according  to  our  experiments  uith  ^{r.  Guiilermond, 
dissolve  easily  in  100  ;i;rammes  of  gummous  vehicle.  One  of  the 
great  advantages  of  valerianate  of  quinine  is  to  be  able  to  dissolve 
it  easily  in  oil,  and  use  it  in  this  manner  for  frictions  and  embroca- 
tions upon  the  region  of  the  spleen.  With  this  object  we  have  made 
use  of  the  following  liniment: 

R  Olive  Oil 60  grammes. 

Valerianate  of  Quinine,         1  gramme,     (near  20  grs.) 

For  neuralgia  we  use  commonly  pills  containing  6  centigrammes 
each,  prescribed  in  the  simplest  manner. 

To  appreciate  the  therapeutic  value  of  valerianate  of  quinine,  M. 
Devay  reports,  out  of  many  cases  under  his  observation,  14,  for  the 
most  part  severe  and  complicated  intermittent  fevers,  which  were 
cured  by  the  administration  of  valerianate  of  quinine,  when  the 
sulphate  even  proved  abortive.  Each  dose  from  10  to  40  centigram- 
mes (1^- to  6  grs.)  a  day,  according  fo  circumstances.  The  author 
cites  no  instances  offliiluro,  and  mentions  no  inconvenience  resulting 
from  the  employment  of  this  new  therapeutic  agent. 

He  concludes  thus : 

1st.  Valerianate  of  quinine  is  a  superior  antiperiodic  to  the  sulph- 
ate by  its  nevro-sthenic  properties,  and  because  it  acts  in  smaller 
doses. 

2d.  Its  pure  and  simple  administration  is  of  equal  value  with  that 
of  cinchona  and  the  nevriliques  combined. 

3d.  In  fevers  of  the  worst  character  (ataxiquesmalignes)  it  is 
thought  to  render  the  most  eminent  services  by  its  specific  proper- 
ties.  Am.  Jour,  Phar. 


Combination  of  Copaiba  with  Purgatives  in  Gonorrhma.  From 
an  account  given  by  M.  Jacquetant  of  the  Hospital  practice  of  M. 
Diday,  it  would  seem  that  the  balsam  of  copaiba  acts  much  more 
energetically  in  the  removal  of  gonorrhoea  if  combined  with  purga- 
tives. The  formula  which  ^I.  Diday  found  most  successful,  was  three 
drachms  of  the  balsam  of  copaiba,  four  drachms  and  a  half  of  the 
powder  of  cubebs,  and  forty-live  grains  of  the  powder  of  jalap,  made 
into  an  electuary,  of  which  one  half  is  taken  in  the  morning  and  the 
remainder  in  the  evening.  The  treatment  rarely  lasted  more  than 
five  days,  by  which  time  a  permanent  cure  was  in  general  effected.  
Gazette  Medicate  de  Paris  and  Edinburg  Med.  <S^  Surg.  Jour. 


476  Mammary  Abscess.  Nervous  Action,  iS^c.        [August, 


Proposal  to  treat  Protracted  Mammary  Abscess  by  the  Breast-pump 
and  the  Syringe.  By  Alex.  Wood,  M.  D.  This  proposal,  which 
appears  to  be  a  novel  one,  and  to  be  well  worthy  of  trial,  is  as  fol- 
lows: "As  soon  as  the  indistinct  fluctuation  or  rather  the  boggy 
feeling,  by  which  the  formation  of  matter  in  these  abscesses  can  be 
defected,  is  distinctly  ascertained,  let  a  small  bist6ury  or  abscess  lan- 
cet* (the  common  lancet  will  sometimes  not  penetrate  deep  enough) 
be  carried  down  until  the  matter  begins  to  escape.  After  all  that 
can  be  squeezed  out  by  pressure  is  removed,  let  the  breast-pump  be 
applied  over  the  orifice,  and  the  rest  of  the  matter  be  drawn  out.  The 
sinus  is  then  to  be  injected  with  some  astringent  solution,  by  means  of 
a  small  syringe.  The  syringe  employed  is  the  small  glass  one  for 
the  urethra,  sold  by  most  apothecaries.  The  lotion  I  have  hitherto 
used  is  the  one  recommended  by  Mr.  Hey,  though  it  may  be  doubt- 
ful if  it  possesses  any  peculiar  advantages.  R.  aquae  purae  gxv;  spt, 
rosmarin.  i ;  spt.  lavandul.  com.  5i;  zinci  sulphat.  gr.  xxx.  M. 
Iiat  lotio.  The  sulphuric  acid  lotion  of  Sir  A.  Cooper  will  probably 
answer  as  well. 

"  A  pledget  of  lint  dipped  in  the  lolion  is  then  to  be  applied  outside,  and  cover- 
ed with  oiled  silk;  over  this  a  compress  may  be  placed,  and  firm  pressure  main- 
tained on  it  by  means  of  adhesive  plaster.  In  some  cases  the  walls  of  the 
abscess  will  unite  at  once,  and  all  that  remains  to  be  done  is  to  trust  to  time  for 
the  removal  of  the  surroimdiiig  induration,  or  to  attempt  to  discuss  it  by  frictions 
with  camphor  liniment,  mercurial  or  iodine  ointment,  or  the  application  of  the 
emplast.  ammoniaci  cum  hydrargyro.       

"Where  the  surfaces  do  not  thus  unite,  the  falling  in  of  the  breast,  produced 
by  the  exhaustion  of  the  glass,  will  be  found  to  have  disappeared;  the  cavity  in 
such  cases  has  only  to  be  injected  two  or  three  times  a-day,  which  will  serve  at 
once  to  keep  the  opening  free  for  the  discharge  of  matter,  and  will  also  tend  to 
arrest  the  further  extension  of  the  ulcerative  process. 

"  The  treatment  of  acute  and  more  superficial  abscess  may  be  conducted  on 
the  same  general  principles.  The  early  evacuation  of  the  matter  saves  the  pa- 
tient much  suffering,  and  also  enables  the  nursing  on  that  breast  to  be  resumed 
at  a  much  earlier  period.  The  cicatrix  is  also  much  smaller  than  in  cases 
wdiere  the  matter  is  allowed  to  discharge  spontaneously ;  indeed,  if  the  incision 
be  made  in  the  direction  of  the  natural  folds  of  the  breast,  that  is,  radiating  to- 
wards the  nipple,  the  cicatrix  will  in  a  short  time  be  imperceptible. 

"Dr.  Wood  has  tried  this  plan  in  three  cases,  and  with  results  which  war- 
rant him  in  suggesting  it  to  the  consideration  of  theproliession,"  Northern  Jcmr- 
nal  oj Medicine.     From  Am.  Jour.  Med.  Sciences. 


Re-establishment  of  Nervous  Action  after  Autoplastic  Opera- 
tions. M.  Robert  (de  Lamballe)  in  a  memoir  read  before  the 
French  Academy  of  Sciences  in  February  last,  states  the  following 
to  be  the  results  of  his  experiments  on  man  and  animals :  1st.  Im- 
mediately after  autoplastic  operations,  sensibility  diminishes  or  dis- 
appears in  the  flaps,  the  diminution  of  the  sensibility  being  directly 
in  reason  of  the  loss  of  blood.  2d.  The  section  of  the  pedicle  is 
followed  by  complete  loss  of  sensibility,  but  after  a  certain  length  of 
time  it  reappears,  and  increases  in  the  same  proportion  as  the  vascu- 

*  A  subcutaneous  incision-knife  would  answer  well. 


1845-J  Injiammation  of  the  Knee- Joint,  Hernia.  ^11 


larity;  both  sometimes  increase  beyond  the  limits  of  the  normal 
state,  but  always  simultaneously.  The  anatomical  examination  of 
the  pedicle  gives  the  following  results:  1st.  After  its  section,  the 
flaps  are  separated  from  all  parts  of  the  economy  by  cicatricial  tissue. 
2d.  The  only  means  of  communication  that  exist  between  the  flaps 
and  the  rest  of  the  economy,  arc  the  vessels,  more  or  less  developed, 
which  pass  through  the  cicatricial  tissue  ;  no  nervous  filaments  are 
ever  met  with.  3d.  The  nerves  which  existed  primitively  in  the  flap 
become  atrophied,  and  may  end  by  disappearing.  4th.  Those  of  the 
neighboring  parts  stop  at  the  level  of  the  cicatrix.  Sometimes  they 
are  suddenly  interrupted,  presenting  a  kind  of  swelling  of  the  neuri- 
lemma ;  sometimes  they  lose  themselves  in  the  cicatricial  tissue,  but 
it  is  never  possible  to  follow  them  into  the  flap.  Lancet, 


Case  of  Extensive  Inflammation  of  the  synovial  membrane  of  the 
Knee  Joint  terminating  in  suppuration,  without  inducing  ulceration 
of  eithet  the  hard  or  soft  textures  of  the  Joint.  By  Sasiuel  Tyler, 
M.  D.  I  was  called  on  the  29th  of  October,  1844,  to  visit  a  patient 
15  years  of  age,  laboring,  as  it  was  then  supposed,  under  a  scrofulous 
affection  of  the  knee-joint.  Upon  inquiry  into  the  history  of  the 
case,  I  learned  that  some  six  months  previous  the  patient  had  given 
the  limb  a  severe  twist,  whilst  running  over  rutty,  uneven  ground. 

Finding  the  joint  excessively  swollen,  the  leg  so  contracted  as  to 
render  it  almost  impossible  to  place  the  foot  upon  the  ground  by  force, 
I  proceeded  to  treat  the  case  in  the  following  manner: 

Commencing  with  the  ap|)lication  of  a  blister  which  surrounded  the 
joint,  which  was  afterwards  kept  discharging  by  the  use  of  warm 
poultices,  I  gave  on  each  alternate  day  the  favorite  purgative  of  Dr. 
Physick,  jalap  and  cream  of  tartar,  in  doses  sufficient  to  procure  free 
evacuations. 

Under  thiff  treatment  the  general  system  improved  somewhat,  but 
the  joint  continued  to  swell,  when  on  the  IGth  of  November  I  made  a 
free  incision  upon  the  inner  side  of  the  joint,  evacuating  at  least  one 
quart  of  pus.  A  continual  discharge  was  kept  up  from  this  openmg 
until  the  29th  of  December,  when  I  made  use  of  "Chase's  apparatus" 
to  overcome  the  contraction  of  the  limb,  which  was  perfectly  eflfected 
in  less  than  three  weeks'  time,  leaving  the  patient  with  a  limb  perfect- 
ly straight,  and  entire  mobility  of  the  joint. 

I  consider  the  great  peculiarity  of  this  case  to  consist  in  the  fact, 
that  where  there  should  be  so  excessive  and  long  continued  inflamma- 
tion of  the  synovial  membrane,  that  it  should  terminate  without  in- 
ducing ulceration  either  of  the  soft  or  hard  textures  of  the  joint. 

Am.  Med.  Journ.  of  the  Med,  Sciences. 

[Certainly  a  surprising  case.  Edts.] 


Statistics  of  Hernia.  M.  Maisonneuve  has  made  a  statistical  re- 
port of  11,644  cases  of  hernia,  which  were  examined  during  a  period 
of  six  years,  at  the  Central  Bureau,  Paris;  he  thus  distributes  them  : 


478  Case  of  Ticins.  [August, 


Of  11,644  cases  of  abdominal  hernia  of  every  description,  8790 
were  observed  in  males;  2,854  were  observed  in  females. 

Of  8,790  cases  of  hernia  ohserVed  in  males,  8.237  were  inguinal 
hernia;   307  were  crural  hernia;  246  were  umbilical  hernia. 

Of  2,854  cases  observed  in  females,  1,112  were  inguinal  hernia; 
639  were  crural  hernia;  560  were  umbilical  hernia  ;  543  were  vagi- 
nal hernia. 

Of  8,237  cases  of  inguinal  hernia  observed  in  males,  4,483  occur- 
red on  the  right  side  ;  3,733  occurred  on  the  left  side  ;  16  not  deter- 
mined. 

Of  1,112  cases  of  inguinal  hernia  in  females,  542  occurred  on  the 
right  side  ;   564  occurred  on  the  left  side  ;  6  not  determined. 

Of  307  cases  of  crural  hernia  observed  in  males,  171  occurred  on 
the  right  side  ;   125  occurred  on  the  leftside  ;   11  not  determined. 

Of  639  cases  of  crural  hernia  observed  in  females,  344  occurred 
on  the  right  side;  255  occurred  on  the  left  side;  40  not  determined. 

From  these  figures,  Mons.  Maisonneuve  deduces  the  following 
corollaries:  

First.   Hernia  in  males  are  to  hernia  in  females,  as  3  to  1. 

Secondly.  In  100  hcrniae  found  in  males,  93  were  inguinal,  4 
were  crural,  3  were  umbilical;  whilst,  in  100  cases  of  hernia  found 
in  females,  the  proportion  was  40  inguinal,  21  crural,  20  umbilical, 
19  vaginal. 

Thirdly.  In  men,  inguinal  hernia  are  met  with  as  often  on  both 
sides  as  on  one  only,  and  in  the  latter  case,  those  of  the  right  side 
are  to  those  of  the  left,  in  the  proportion  of  5  to  4. 

But  in  women,  inguinal  hernia  are  met  with  on  both  sides,  three 
times  out  of  Hmr,  aiid  those  of  the  right  side  are  to  those  of  the  left, 
in  the  proportion  of  5*42  to  5'64. 

Fourthly.  In  men,  crural  hernia  are  met  with  on  one  side  only, 
three  times  out  of  four,  and  tho?e  of  the  right  side  are  to  those  of 
the  left,  as  7  to  5  ;  whilst  in  women,  crural  hernia  are  met  with  on 
one  side  only,  4  times  out  of  5;  and  those  of  the  right  side  are  to 
tho<?e  of  the  left  as  7  to  5. 

Under  the  head,  vaginal  hernia,  are  included  all  tumours  of  the 
vagina  and  uterus  presenting  externally,  and  requiring  the  use  of  the 
pessary,  as  cystcceles,  rectoceles,  and  prolapsus  of  the  vagina  and 
uterus. 

Under  the  head  umbilical  hernia,  are  included  hernia  of  the  linea 
alba,  and  displacements  referahle  to  the  neighboring  regions.  Med, 
Times,  from  Gazette  des  Hopitaux. 


Case  of  Twins  ;  tJiere  being  an  interval  of  tliirty-iiDO  days  between 
their  Birth.  John  IRVI^'E,  a  surgeon  in  the  British  navy,  records, 
in  the  Medical  Times,  (28lh  Dec,  1844,)  the  following  remarkable 
case.  Mary  F.,  aged  35  years,  was  seized  with  labour  pains,  on  the 
1st  of  October,  at  the  full  period  of  utero-gestation  ;  and  was  deliv- 
ered  by  Dr.  Burleigh,  of  a  healthy,  but  rather  smalbsized  female 


1845.]        Term  of  Pregnancy.  EvoIuUon  and  Delivery.  479 


infant,  Thr^e  hours  afterwards  the  placenta  was  cast  off  by  tho 
natural  contraction  of  the  uterus.  Dr.  Burleigh,  on  examining  the 
patient  at  this  stage,  clearly  ascertained  that  the  uterus  was  still  in  a 
gravid  state.  After  waiting  some  time  for  the  renewal  of  parturient 
efforts,  he  left,  with  instructions  to  be  sent  for  when  labour  commenc- 
ed. On  visiting  his  patient  three  days  afterwards,  he  found  her  out 
of  bed  following  her  usual  domestic  affairs,  and  in  good  health.  On 
the  2d  of  the  following  November  labour  pains  came  on,  and  just  as 
Dr.  Burleigh  arrived,  a  large  healthy  male  infant  was  born,  and  two 
hours  afterwards,  Dr.  B.  extracted  the  placenta.  The  patient's  re- 
covery was  as  rapid  as  previously,  for  on  the  third  day  she  was  at- 
tending to  her  family  concerns.  Am.  Jour,  of  Med.  Sciences. 


Term  of  Pregnancy  exceeded  by  Four  Weeks.  A  pregnant  wo- 
man, who  had  already  borne  three  children,  was  attended  by  Dr. 
Hayn,  of  Konigsberg,  for  "gastro-nervous  fever."  The  affection 
was  so  severe  that  premature  labour  was  threatened.  Dr.  H.  mado 
an  examination  jper  vaginam,  and  felt  satisfied,  as  well  from  this  as 
from  the  woman's  account,  and  her  other  symptoms,  that  the  natural 
term  of  her  utero-gestration  would  expire  about  the  23d  of  May, 
1841.  The  patient  recovered  from  her  fever,  and  at  the^above-men- 
tioned  date  was  seized  with  weak  labour  pains,  copious  mucous  se- 
cretion from  the  vagina,  and  remarkable  sinking  of  the  uterus  into 
the  pelvis.  After  three  days  the  pains  wore  away;  and  four  weeks 
thereafter  the  woman  wns  with  difficulty  delivered  of  an  unusually 
large  child.  IS orlhern  Journal  of  Med. ^  May,  1844, /rom  Caspar's 
IT  oc/iencAri/i!,  No.  47,  1843.    Ibid. 

Evolution  and  Delivery  with  Presentation  of  the  Arm  and  Shouh 
^er.  By  Dr.  Sussewind.  [We  give  the  foilov.'ing  case  as  we  find 
it  quoted  in  the  London  Medical  Gazette,  2()th  December,  1844, 
from  Caspar's  JVochenschrift,  No.  23,  the  dimensions  of  the  foetus 
are  not  given.] 

A  healthy  woman,  who  had  already  had  several  children  without 
difficulty  of  any  kind,  was  taken  in  labour  again,  and  besides  the 
waters,  lost  a  considerable  quantity  of  blood.  When  seen  first,  the 
right  upper  extremity  of  the  fcetus  was  found  projecting  from  the 
external  parts  of  the  mother  :  the  pains  at  this  time  had  almost  ceased, 
but  on  an  attempt  being  made  to  introduce  the  hand,  and  turn,  they 
came  on  again  with  such  violence  that  the  attendant  was  on  the  point 
of  taking  away  some  blood  to  moderate  their  force.  The  mother 
now  said  she  felt  the  child  advancing,  and  in  fact,  the  right  shoulder 
and  collar  bone  were  forced  beyond  the  vulva  :  the  lower  extremities 
and  buttocks  were  at  the  same  time  forced  into  the  hollow  of  the  sa- 
crum, and  by  and  by  the  right  ramus  of  the  lower  jaw  came  into 
sight,  the  shoulders  and  arm  having  receded.  But  little  effort  was 
required  to  disengage  the  breech,  upon  which  the  child  was  quickly 
born  ;  but  it  was  dead.  The  placenta  followed,  and  an  hour  after- 
wards the  woman  felt  herself  very  comfortable.  Amcr,  Jour. 


480 


Medical  Intelligence,  Meteorological  Table. 


MEDICAL  INTELLIGENCE. 


We  learn  from  a  correspondent  that  a  Medical  Society  was  formed  for  East 
Tennessee,  at  Knoxville,  on  the  7th  May  last.  The  name  assumed  is  "  The 
Medical  Society  of  East  Tennessee."  The  object  of  the  association  "will  be  to 
improve  and  elevate  the  standard  of  Medical  Science  within  its  limits  to  elicit 
information  by  reports  of  cases,  epidemics,  &c."  At  the  annual  meeting  in  May 
next  a  prize  will  be  awarded  to  the  best  essay  on  Erysipelas.  S.  B.  Cunning- 
ham, M.  D.,of  Jonesboro',  is  President,  and  F,  Ramsay,  M.  D.,  of  Knoxville? 
Corresponding  Secretary  of  the  Society. 


METEOROLOGICAL  OBSERVATIONS,  for  June,  1845,  at  Augusta,  Ga. 
Latitude  33  27'  north  ^Longitude  4  32'  west  Wash.  Altitude  above  tide 
152  feet. 


Thermometer. 
Sunrise.    4,  p.  m. 

Barometer. 
Sunrise.    4,  p.m. 

Wind. 

ReMj^RKS. 

1 

48 

77 

30  in. 

29  9-10 

E. 

Fair. 

2 

53 

78 

9-10 

7-10 

S.  E. 

Fair. 

3 

59 

82 

9-10 

9-10 

s.  e. 

Fair. 

4 

59 

85 

9-10 

9-10 

s.  e. 

Fair. 

5 

62 

   87 

8-10 

8-10 

s. 

Cloudy. 

6 

66 

88 

9-10 

9-10 

s. 

Flying  Clouds. 

7 

66 

82 

9-10 

9-10 

S.    E. 

bo.        do. 

8 

68 

88 

9-10 

8-10 

S.    E. 

Do.        do. 

9 

70 

85 

9-10 

8-10 

S.    E. 

Fair  blow. 

10 

72 

83 

9-10 

9-10 

S. 

Showry  1^-10  in.  hot  vapour. 

11 

72 

86 

9-10 

8-10 

w. 

Cloudy. 

12 

,    72 

90 

8-10 

7-10 

w. 

Blow variable. 

13 

76 

94 

7-10 

8-10 

w. 

Fair.                           [1-10  inch. 

14 

68 

94 

8-10 

8-10 

w. 

Fair  storm  of  wind  and  rain 

15 

69 

90 

9-10 

8-10 

N.  W. 

Fair  shower  2^-10  inch. 

16 

69 

77 

9-10 

9-10 

Variable. 

Rain  8-10  inch storm. 

17 

69 

88 

8-10 

9-10 

s.  w. 

Cloudy  thunder,  &c. 

18 

69 

88 

8-10 

9-10 

N.  W, 

Rain  at  3,  p.  m.,  1  inch. 

19 

70 

87 

30  in. 

29  9-10 

S.    E. 

Fair. 

20 

71 

86 

9-10 

9-10 

S.    E. 

Cloudy. 

21 

70 

92 

8-10 

7-10 

W. 

Fair. 

22 

72 

94 

7-10 

7-10 

W. 

Fair stiff  breeze. 

23 

72 

98 

7-10 

7-10 

w. 

Fair,            do. 

2^1 

73 

98 

8-10 

8-10 

w. 

Fair,            do. 

25 

76 

96 

8-10 

7-10 

w. 

Fair  thunder  and  lightning. 

26 

72 

96 

7-10 

8-10 

w. 

Fair thund. and  light.  9,  p.m. 

27 

73 

92 

8-10 

8-10 

s. 

Variable  thunder,  showery. 

28 

72 

94 

8-10 

7-10 

N.  VV. 

Variable  storm  of  wind. 

29 

73 

89 

7-10 

5-10 

W. 

Showery  3-10  inch. 

30 

65 

83 

9-10 

8-10 

W. 

Fair. 

16  Fair  days.  Gluantity  of  Rain,  2,  6-10  inches.  (Quantity  of  Rain  for  first 
six  months  of  1845  14,  2-10  inches.  During  the  last  four  months,  less  than  7i 
inches.    Julv  23d,  at  4,  P.  M.,  Therm.  100 in  sun  131. 


SOUTHERN 

MEDICAL  AND  SURGICAL 

JOURNAL. 

Vol.  I.]  NEW  SERIES SEPTE)1BER,  1S45.  [No.  9. 

PART  I. ORIGINAL  COMMUNICATIONS. 

ARTICLE    I. 

Intermittent  Fever  -its  various  forms  their  treatment  with  Cases, 
By  Lewis  D.  Ford,  M.  D.,  Professor  of  the  Institutes  and  Practice 
of  Medicine  in  the  Medical  College  of  Georgia, 

The  writer  of  the  present  article  comes  to  redeem  the  promise 
made  at  the  conclusion  of  a  former  one  on  the  Pathology  of  Inter- 
mittent Fever,  in  the  1st  No.  of  this  Journal,  by  noticing  some  of  the 
varied  forms  of  Intermittent  fever,  with  a  view  more  especially,  to 
their  treatment. 

Under  this  head  he  proposes  to  take  up  Malignant  Intermittent, 
Remittent,  and  some  forms  of  Continued  Fever. 

In  the  "Practice  of  Physic  "  of  almost  every  author  in  our  Ian- 
guage,  these  forms  of  fever  are  considered  as  different  species  of  the 
same  genus  or  as  themselves  distinct  genera;  and  the  doctrine  too 
generally  inculcated  is,  that  they  have  no  common  pathology,  so  that 
it  may  be  taken  as  the  prevalent  opinion,  that  each  requires  a  dis- 
tinct and  peculiar  treatment.  In  this  state  of  things,  the  writer  is 
not  without  his  fears,  that  to  arrange  these  forms  under  one  head  to 
co-ordinate  them  by  one  general  principle  of  pathology  and  of  treat- 
ment, may  be  regarded  a  presumptuous  deviation  from  the  beaten 
track  ;  but  he  hopes  to  show  that  though  different  in  manv  of  their 
external  features,  yet  they  are  fundamentally,  of  the  same  nature 
and  require  the  same  general  mode  of  treatment. 

It  is  propped  to  give  a  brief  description  of  these  three  forms io 

31 


482  Intermittent  Fever.  [September, 


illustrate  them  by  specific  cases,  and  to  deduce  from  these  cases, 
some  general  considerations  as  to  their  pathology  and  treatment. 
We  shall  embrace  in  one  view  almost  all  the  varieties  of  fever  known 
to  this  region  of  country,  by  whatever  names  they  may  generally  be 
called  ;  for  it  is  well  known  to  every  practitioner  of  experience,  that 
idiopathic,  endemic  fevers  of  this  climate  of  miasmatic  origin,  pre- 
vailing in  the  summer  and  autumn,  uniformly  present  at  their  begin- 
ning, at  least,  a  paroxysmal  character  that  cases  of  fever  continued 
from  their  commencement  are  extremely  rare,  this  latter  form  being 
the  endemic  of  the  winter  season  of  cold  climates  and  caused  by 
concentrated  human  effluvia. 

Malignant  Intermittent.  This  form  receives  its  name  from  its 
great  danger.  If  simple  Intermittent  fever  claims  our  attention  by 
the  interest  of  its  pathology,  this  complicated  form  demands  it  on 
higher  grounds;  for,  whereas  the  first  is  a  disease  easily  diagnostica- 
ted, easily  cured  cured,  in  the  great  majority  of  instances,  as  well 
by  the  intelligent  planter  and  by  the  ignorant  doctor  as  by  the  most 
skilful  of  the  profession,  and  never  fatal;  the  latter  is  insidious,  rapid 
in  its  progress,  and  without  appropriate  treatment,  uniformly  fatal  in 
its  termination  ;  and  yet,  with  all  this,  in  competent  hands,  as  man- 
ageable almost  as  the  simpler  form. 

This  disease  is  known  to  the  profession  at  large,  by  the  elegant 
standard  works  of  Torti,  Alibert  and  Bailly,  as  raging  endemically, 
at  Rome  and  other  localities  within  the  influence  of  the  celebrated 
Pontine  Marshes,  s  Subsequent  to  these,  we  have  histories  of  the  dis- 
ease by  some  distinguished  French  army  surgeons,  as  it  occurs  in  the 
north  of  Africa  and  in  other  situations  exposed  to  malarious  exhala- 
tions of  peculiar  virulence.  But  it  is  a  sad  mistake  to  think  that  it  ex- 
ists only  in  such  pestiferous  localities.  \The  young  practitioner  of  this 
climate  should  know,  that  although  his  lot  is  not  cast  within  the  influ- 
ence of  the  pontine  marshes,  he  will  be  called  upon  to  treat  sporadic 
cases  of  this  disease,  occurring  in  situations,  where  simple  intermit- 
tents  and  remittents  are  the  prevalent  forms.  The  lineaments,  there- 
fore, of  this  formidable  disease  should  be  known  to  him,  its  danger 
appreciated,  its  pathology  and  its  proper  treatment  settled,  otherwise 
liis  sporadic  cases  will  too  often  prove  fatal  cases,  in  his  hands. 

The  forms  of  Malignant  Intermittent  are  almost  infinite  ;  but  this 
general  description  will  apply  to  them  all  viz :  intermittents  at- 
tended with  inflammation  or  congestion  of  some  vital  organ,  so 
extreme  as  to  endanger  its  integrity  and  the  life  of  the  patient,  during 


1S45.]  ^  Intermittent  Fever,  483 


the  paroxysm  ;  at  the  conclusion  of  which,  however^  there  comes  on  a 
perfect  intermission  of  all  the  violent  symptoms.  This  latter  trait 
is  apt  to  deceive  the  inexperienced  physician,  leading  him  to  a  false 
prognosis  and  consequently  to  an  inefficient  practice,  when  the  most 
prompt  and  energetic  treatment  is  demanded  ;  for  one  of  these  vio- 
lent paroxysms,  whether  the  first  of  the  attack  or  succeeding  to  milder 
ones,  is  the  sure  harbinger  of  others  still  more  violent  so  that  if 
unchecked,  the  disease  will  prove  flital  at  the  third,  fourth  or  fifth 
paroxysm. 

Torti,  the  distinguished  physician  of  Modena,  in  his  work,  enumer- 
ates seven  varieties  of  this  fever.  Subsequently,  Alibert,  in  his  Inau- 
gural Thesis,  extended  the  number  to  nineteen,  naming  the  varieties, 
according  to  the  prominent  malignant  symptom  ;  such  as,  the  hepatic, 
syncopal,  algid,  soporose,  nephritic,  &;c.  They  may  all,  however, 
be  embraced  under  three  general  divisions:  1st,  those  cases  in 
which  the  cerebro-spinal  organs  are  chiefly  affected  ;  2nd,  those  cases 
in  which  the  thoracic  organs ;  and  3rd,  those  in  which  the  abdominal 
organs  suffer  most. 

The  first  division  embraces  the  comatose,  delirious,  convulsive, 
tetanic,  tScc.  varieties  marked  respectively  by  coma  with  its  accom- 
panying symptoms,  by  delirium,  convulsions,  &c.,  these  symptoms 
becoming  urgent  during  the  paroxysm,  and  disappearing  as  it  abates. 
In  the  comatose  variety,  of  the  tertian  type,  it  is  not  uncommon  for 
the  intermission  to  pass  without  a  trace  of  head-ache  remaining  ;  not- 
withstanding which  a  more  violent  paroxysm  may  confidently  be 
expected. 

The  second  division  embraces  such  as  are  marked,during  the  par- 
oxysm, by  symptoms  of  pleuritis,  pneumonia,  syncope,  &;c. 

The  third  embraces  such  forms  as  the  cardialgic,  peritonitic,  chole- 
ric, dysenteric,  hepatic,  &c. 

The  cardialgic  is  marked  by  excruciating  pain  at  the  epigastrium, 
either  continuous  or  intermittent ;  in  the  latter  case,  grievous  com- 
plaints are  forced  from  the  patient,  accompanied  with  great  anxiety 
of  countenance,  and  vomiting,  and  often  with  general  spasm  of  the 
muscles.  Thus  too,  in  the  choleric  form,  the  paroxysm  is  marked 
by  all  the  symptoms  of  cholera  morbus,  the  intermission  being  free 
from  them. 

But  there  is  a  form  of  malignant  intermittent,  of  more  frequent 
occurrence,  perhnps,  than  any  other,  known  by  the  name  oi  algid 
fever,  and   marked  by  the   following  symptoms :  During  the  cold 


484  '   Intermittent  Fever,  [September, 


stage,  which  is  unusually  protracted,  there  is  a  great  degree  of  op- 
pression at  the  chest  and  abdomen,  prostration  of  strength  and  rest- 
lessness. There  is  an  attempt  at  the  formation  of  the  hot  stage, 
which  proves  abortive ;  for  soon  the  skin  becomes  cold,  pale  and 
shrunken,  on  the  extremities,  but  cool  elsewhere,  and  covered  with 
a  cold,  clammy  perspiration,  while  only  the  central  parts  of  the  body 
are  very  hot.  The  pulse  is  small,  frequent  and  almost  imperceptible 
at  the  wrist,  increased  restlessness,  jactitation,  impatience  of  bed 
covering,  with  complaint  of  oppressive  heat,  not  only  at  the  chest  and 
abdomen,  but  even  on  the  cold  extremities,  so  that  the  patient  refuses 
to  have  them  covered.  The  intellect  is  generally  undisturbed,  and 
the  expression  of  the  countenance  quiet,  even  where  the  disorder  of 
the  temperature  and  circulation  is  so  extreme,  that  the  tongue  even 
becomes  cold  and  the  pulse  ceases.  This  irregularity  continues 
through  the  whole  period  of  the  paroxysm,andit  isonly  at  theend  of  it 
that  the  temperature  and  circulation  are  partially  restored.  When 
we  consider  that  the  functions  most  conspicuously  disordered  in  this 
algid  fever,  are  those  of  circulation  and  of  calorification  functions 
dependent  on  cerebro-spinal  nervous  influence,  we  are  disposed  to 
place  this  form  under  the  first  division,  and  to  regard  these  symptoms 
as  dependent  on  an  aggravation  of  that  peculiar  lesion  of  these  cen- 
tral organs,  which  constitutes  the  fundamental  character  of  intermit- 
tent fever.  At  any  rate,  this  algid  state  is  not  a  prolonged  chill ;  for 
almost  universally,  in  such  cases,  the  chill  is  separated  from  this 
peculiar  cold  state,  by  symptoms  of  imperfect  reaction.  The  two 
states,  moreover,  are  shown  to  be  different  by  this  striking  fact,  that 
in  the  chill,  the  temperature  is  not  absolutely  diminished  at  least, 
not  in  proportion  to  the  patient's  complaints  of  coldness;  whereas  in 
the  algid  state,  the  temperature,  as  measured  by  the  thermometer,  is 
positively  diminished,  while  the  patient  complains  of  burning  heat. 

In  each  of  these  forms,  as  will  be  perceived,  there  is  combined  a 
local  phlegmasia  or  congestion  with  intermittent  fever,  which  latter 
may  be  of  the  quotidian,  tertian  or  any  other  of  its  types.  What  is  the 
relation  of  the  local  affection  to  the  intermittent  fever  ?  a  most  im- 
portant question,  inasmuch  as  the  decision  of  it  must  necessarily 
determine  our  therapeutic  measures ;  for  if  it  bear  the  relation  of 
cause  to  the  intermittent  fever  if  it  be  the  fundamental  lesion,  upon 
which  the  whole  disease  depends,  then  the  rational  treatment  is  to 
subdue  this  local  affection  ;  and  the  antiphlogistic  regimen  becomes 
the  main  part  of  the  practice.     If,  on  the  other  hand,  it  be  regarded 


11^45. J  Intermiltent  Fever.  485 


only  as  an  accident,  complicating  the  intermittent  fever,  which  latter 
disease  might  continue,  even  if  this  were  removed,  then  the  indication 
is  to  treat  both  the  intermittent  and  the  accident,  each  by  its  appro- 
priate remedy.  This  latter  view,  it  is  believed,  is  the  correct  one. 
The  writer  contents  himself  with  merely  stating  this  opinion  here, 
leaving  the  considerations,  by  which  it  is  sustained,  to  be  adduced, 
when  commenting  upon  special  cases,  hereinafter  given.  Let  us 
regard,  then,  this  disease  as  consisting  of  two  distinct  elements  an 
intermittent  fever  and  a  local  phlegmasia  or  congestion,  having  no 
necessary  relation  with  each  other ;  at  least  the  latter  not  the  cause 
of  the  former  let  us  regard  the  recurrence  of  successive  paroxysms 
as  the  true  source  of  danger,  inasmuch  as  they  renew  the  local  affec- 
tion and  push  it  to  the  degree  of  fatal  disorganization.  By  this 
view  the  intermittent  fever  becomes  the  main  affection,  and  our  ruling 
indication  must  be,  to  prevent  the  recurrence  of  its  parozysms;  and 
the  local  affection  will  rank  only  as  ah  accident,  yet  not  an  immaterial 
accident,  but  one,  the  increase  of  which  constitutes  the  final  danger 
of  the  case.  Of  course,  another  prominent  indication,  under  this 
view,  will  be  to  subdue  the  local  phlegmasia,  or  congestion.  Thus, as 
in  simple  intermittent,  the  treatment  will  have  respect  both  to  the 
intermission  and  to  the  paroxysm,  and  so  will  be  both  antiphlogistic 
and  antiperiodic.  But  how  shall  an  expected  paroxysm  be  met?  
May  we  venture,  in  such  cases,  to  use  the  great  antiperiodic  quinine? 
What !  administer  quinine  after  a  paroxysm,  during  which  the 
patient  has  manifested  the  symptoms  of  congestive  apoplexy  or  of 
pleuritis,  or  above  all,  of  gastritis,  and  while  there  yet  remains  the 
symptoms  of  gastritis  or  phrenitis,  only  a  little  moderated  in  vio- 
lence, what!  in  an  hour  or  two  after  having  depleted  the  patient 
to  the  fullest  extent  that  prudence  could  justify,  urged  thereto  by 
extreme  violence  of  the  local  affection,  shall  we  suddenly  turn  round 
and  administer  the  iowjc  quinine?  We  answer,  yes  for  it  is  the 
only  hope  of  the  patient  the  sheet-anchor  of  the  case,  and  if  it  hold 
not,  the  vessel  is  a- wreck. 

It  seems  proper  here  to  specify  two  practical  precepts  of  great 
value  the  one  in  reference  to  the  dose  of  quinine,  the  other  to  the 
time  for  its  administration.  As  to  the  dose,  the  quantity  given  during 
the  intermission,  is  to  be  directly  proportioned  to  the  danger  appre- 
hended from  the  expected  paroxysm,  if  from  the  existing  state  of 
the  patient  and  the  violence  of  the  preceding  paroxysm,  we  apprehend 
that  tiie  coming  one   will  prove   fatal,  the  quantity  given  should  be 


/ 


486  Intermittent  Fever.  [September, 


thirty-five  or  forty  or  fifty  grains.  As  to  the  time  for  commencing  its 
use,  this  is  immediately  on  the  cessation  of  a  paroxysm;  even  if  the 
case  have  the  tertian  type,  this  rule  must  not  be  violated,  for  we  have 
no  security  that  it  may  not  change  into  the  quotidian.  If  of  the 
quotidian  type,  we  should  not  wait  for  the  entire  cessation  of  the 
paroxysm,  but  commence  the  use  of  the  specific,  with  the  sweating 
stage,  lest  the  complete  intermission  should  not  allow  time  enough  to 
bring  the  patient  under  its  peculiar  influence. 

It  need  scarcely  be  added,  that  the  treatment  during  the  paroxysm 
is  that  which  would  be  appropriate  to  an  idiopathic  inflammation  
general  bleeding  and  local  by  leeches,  and  cups  and  revulsives, 
sinapisms  and  blisters. 

This  way  of  treating  both  elements  of  this  compound  disease,  by 
the  alternate  and  sometimes  even  the  conjoined  use  of  active  deple- 
tion and  quinine,  is  directed  by  an  enlightened  pathology,  and  sanc- 
tioned by  the  highest  authority. 

The  following  cases  from  the  writer's  note-book  will  sufficiently 
show  the  sporadic  occurrence  of  this  disease  in  situations  remarkable 
for  the  benign  character  of  their  fevers,  and  at  the  same  time  exhibit 
its  symptoms  more  in  detail.  Other  cases  from  foreign  authors  are 
added  to  illustrate  its  pathology  and  its  appropriate  treatment. 

Case  1.  T.  H.,  aged  about  thirty-five,  was  brought  to  the  City 
Hospital  on  28th  Sept.,  1840,  at  5,  P.  M.,  with  no  account  of  him, 
except  that  he  was  brought  from  Bridge-row,  and  was  taken  with  fever 
in  Hamburg,  two  days  before.  At  6,  P.  JM .,  this  was  his  state  ;  Skin 
uniformly  hot.  perspiring  on  the  head  and  breast;  face  flushed  ;  abdo- 
men moderately  ful!,  fsBces  (yellow)  and  urine  discharged  in  his 
clothes  ;  pulse  105,  full  and  strong  ;  respiration  frequent ;  tongue  and 
lips  moist;  breath  very  offensive  ;  eyes  closed,  the  eye-lids  resisting 
attempts  to  open  them,  eye-balls  turned  upwards ;  slight  spasmodic 
twitching  of  the  muscles  of  the  extremities,  when  the  limbs  are 
moved  ;  no  paralysis  ;  perfectly  stupid,  and  not  aroused  by  the  loud- 
est call ;  shrinks  and  groans  from  pressure  on  the  middle  dorsal  ver- 
tebrae. (A  ligature  to  the  top  of  each  thigh  to  produce  distention 
of  the  veins  of  the  lower  extremities;  V.  S.  20  oz.  produced 
diminution  in  the  strength  of  the  ^^w/^e,  almost  obliterating  it; 
gaping,  diminished  redness  of  the  face  and  a  relenting  of  the 
current  of  blood  from  the  arm.  In  this  state,  thefnger  being  upon 
the  pulse,  the  ligatures  on  the  thighs,  were  simulianeously  and  sud- 


Ib45.]  Intermittent  Ftcer.  4a7 


denly  relaxed;  the  current  of  blood  from  the  open  vein  was  renewed 
and  the  pulse  increased  in  strength.  Scarifications  to  the  dorsal 
spine,  with  cups,  yielded  3  oz.  stupor  unrelieved ;  10  grs.  sulphate 
of  quinine,  in  solution,  every  two  hours,  as  soon  as  the  patient  can 
swallow.) 

29th,  8,  A.  M.  Pulse  90  and  soft ;  skin  cool ;  eyes  still  closed  ; 
resisting  attempts  to  move  him  ;  impossible  to  arouse  him  ;  has  taken 
nothing,  having  remained  stupid  during  the  night.  (10  grs.  sulphate 
of  quinine,  in  solution,  every  two  hours :  one  dose  was  forced  down 
him  ;  saline  injection.)  12,  M.  Has  taken  the  third  dose  of  quinine ; 
injection  has  procured  stools.  {Blister  plaster  7  by  4  inches  to  the 
dorsal  spine.)  8,  P.  M.  Still  stupid;  pulse  90 ;  respiration  not 
hurried;  opens  his  eyes,  when  loudly  called.  (Two  blister  plasters 
to  the  legs ;  water  during  the  night,  if  called  for ;  two  more  doses  of 
quinine.) 

30th,  8,  A.  M.  No  fever  ;  very  deaf;  asks  for  water;  complains 
of  blisters.  (Cold  water  and  thin  gruel.)  3,  P.  M.  Met  the  patient 
stalking  about  the  entry,  begging  for  water;  skin  cold;  pulse  ex- 
tremely feeble  from  this  effort.  (Blisters  to  be  dressed;  water  and 
gruel.) 

Oct.  1st,  9,  A.  M.  Quietly  in  bed;  no  fever;  senses  entirely 
restored ;  hearing  good  ;  asks  for  water.  The  case  was  transferred 
to  the  Physician  for  October. 

Note.  Intermittent  fever  at  this  time  prevalent  in  Augusta  and 
Hamburg. 

P.  S.  The  convalescence  of  T.  H.  was  steady ;  he  was  discharged 
in  a  few  days. 

The  facts  with  regard  to  this  patient  that  he  was  taken  with  fever, 
in  Hamburg,  on  the  26th,  and  that  on  the  28th  he  was  picked  up  in 
Bridge-row,  in  Augusta,  seemed  to  warrant  the  conclusion,  that  sub. 
sequently  to  his  attack  of  fever,  he  was  so  far  recovered  as  to  be  able 
to  walk  over  the  bridge,  and  farther  that  he  was  laboring  under  par- 
oxysmal fever  that  he  was,  on  his  admission  to  the  hospital,  either 
in  the  second  or  third  paroxysm.  Notwithstanding  the  depletion,  gen- 
eral and  local,  the  coma  continues  through  the  whole  period  of  a  parox- 
ysm, no  abatement,  until  the  following  morning,  and  this  improvement 
coinciding  with  the  abatement  of  fever.  In  the  uncertainty  as  to  the 
type,  whether  quotidian  or  tertian,  the  q'jinine  is  ordered  as  soon  as 
the  patjput  can  be  rni'le  to  swallow  it,  lot  by  waiting  for  a  perfect 


/ 


488  IniermiUcnl  Fever.  [September, 


recovery  of  the  senses,  the  remaining  time  of  the  intermission  should 
not  be  sufficient  to  place  the  patient  under  its  influence.  It  is  worthy 
of  remark,  that  here  is  a  case  of  the  most  malignant  character,  brought 
to  a  happy  and  a  speedy  termination,  simply  by  general  and  local 
depletion  and  revulsion  external,  and  one  saline  injection,  without  a 
single  dose  of  cathartic  medicine.  Would  this  antiphlogistic  treat- 
ment alone,  without  the  quinine,  have  arrested  the  paroxysms?  The 
fact  in  this  one  case  will  not  warrant  us  in  answering  No  ;  but  the 
writer  feels  fully  assured  that  the  candid  practitioner,  who  has  had  a 
fair  opportunity  of  contrasting  the  two  modes  of  treatment,  will  an- 
swer  no,  unhesitatingly.  V  But,  who  would  incur  the  hazard  of  another 
paroxysm  in  such  cases,  when  he  holds  in  his  hand  a  remedy  of  un- 
doubted power  to  prevent  it,  and  this  a  safe  remedy  ?  for  surely  we 
are  warranted  by  the  facts  of  this  case,  to  draw  the  conclusion,  that 
quinine  may  be  safely  used  in  large  doses,  even  in  the  comatose  form 
of  Intermittent  fever.  Here,  under  the  action  of  45  grains  of 
quinine,  the  patient  comes  out  from  a  profound  stupor,  and  recovers 
his  senses,  while  under  the  full  influence  of  the  quinine,  as  his  deaf- 
ness proves.  This  case  also,  incidentally  illustrates  the  value  and 
mode  of  operation  of  the  tourniquet  as  a  therapeutic  agent. 

Case  2.  A.  B.,  aged  thirty-five,  residence  middle  of  Broad-street, 
cotton-buyer  habits  intemperate  full  habit,  plethoric.  Oct.  19th, 
1840. On  the  17th,  at  11,  P.  M.,  had  a  chill,  and  on  the  morn- 
ing of  the  18th  represented  himself  to  have  had  fever  and  to  have 
passed  a  restless  night  was  not  confined  to  bed  on  the  18th,  but  at 
11,  P.  M.,  of  the  18th  had  a  chill,  (as  he  subsequently  informed  the 
family,)  and  two  hours  afterwards  was  found  stuj)id  ;  on  the  afternoon 
of  the  18th  was  free  from  fever,  and  sat  up  for  two  or  three  hours. 
Has  taken  no  medicine.  On  the  KJth,  2,  A.  M.,  first  visit,  find  him 
thus:  Head  hot,  face  flushed,  skin  universally  hot  and  dry;  breath 
very  offensive;  respiration  hurried;  breathing  laborious;  pulse  full 
and  strong  and  115;  eyes  closed,  resists  attempts  to  open  the  lids; 
impossible  to  arouse  him  or  to  command  his  attention;  the  arms  are 
folded  on  the  breast,  the  fore-arms  rigidly  flexed  upon  the  arms,  and 
he  resists  attempts  to  extend  them ;  lower  extremities  extended  at  full 
length,  the  legs  crossed  over  each  other;  he  resists  every  attempt  to 
change  his  position.  (F.  *S^.  about  50  02.,  reduced  the  strength 
and  frequency  of  the  pulse ;  30  grains  Calomel,  irhcn  able  to  swaL 
lo  w  ;  s  a  I  i  n  e  i  njectio  n  ;   hot  jfcdiluviu  m . ) 


1845]  Intermittent  Fever.  489 


19th,  8,  A,  M.  Got  neither  the  injection  nor  the  pediluvium  ; 
took  the  calomel,  with  great  difficulty,  at  4,  A.  M.  Muscles  less 
rigid  ;  unable  to  speak  ;  only  opening  his  eyes  slightly,  on  the  great- 
est efforts  ;  pulse  100,  full  and  soft.  {Saline  injection;  Infusion 
of  Senna,  Salts  and  Manna.)  1,P.  M.  Head  more  clear  ;  muscles 
relaxed ;  has  been  up  to  stool ;  three  copious  stools.  (40  grains 
quinine  in  solution  quarter  every  two  hours.)  9,  P.  M.  Has  taken 
40  grains  quinine;  pulse  105,  soft  and  full ;  his  intellect,  under  the 
use  of  quinine,  has  become  entire  ;  three  more  stools  ;  roaring  of  the 
ears.  {Sinapis?ns,  the  whole  length  of  the  spine,  at  10,  P.  M.)  11  ^, 
P.M.  No  chill;  very  deaf ;  no  head-ache;  pulse  as  before.  {Cold 
water  and  gruel. ) 

20th,  8,  A.  M.  No  chill,  last  night ;  has  slept  a  little;  pulse  115 
and  strong;  head-ache;  is  quite  deaf.  {V.  S.  20  or.)  3,  P.  M. 
Still  head-ache  violent;  deafness  somewhat  abated.  {V.  S.,  Com- 
pound Senna  Infusion.)     ' 

During  the  night  of  the  20th,  his  fever  was  light ;  on  the  morning 
of  the  21st,  he  was  without  fever  he  was  salivated.  His  convales- 
cence was  slow,  being  retarded  by  an  attack  of  mild  delirium  tremens; 
which  was  due  possibly  to  too  free  depletion  ;  it  was  relieved  by 
morphine.  On  the  10th  November,  he  suffered  a  paroxysm  of  Inter- 
mittent fever;  which  was  followed  by  two  others,  of  the  tertian 
type.     This  simple  fever  was  arrested  by  moderate  doses  of  quinine. 

This  is  a  case  ofquotidian  Malignant  Intermittent,  and  shows  strik- 
ingly many  of  the  characteristics  of  this  affection  :  that  paroxysms, 
marked  by  the  most  malignant,  dangerous  symptoms,  may  yet  be  fol- 
lowed by  a  perfect  intermission  this  patient  being  comatose  in  the 
second  paroxysm,  is  yet,  before  its  access,  sitting  up  and  conversing 
freely  with  the  family,  giving  an  account  of  his  chill,  &c.  that  it  is  a 
perfect  Intermittent.  It  shows,  too,  a  progressive  increase  in  the  vio- 
lenceof  the  paroxysms;  the  second  so  violent  as  to  warrant  the  opinion, 
that  another  would  prove  fatal.  It  shows  the  safety  of  giving  40  grs.  of 
quinine  a  few  hours  after  a  state  of  cereljral  congestion  so  great  as  to 
require  most  copious  bleeding  to  relieve  it,  and  therefore  commends 
this  medicine  to  our  fullest  confidence,  under  such  circumstances. 
To  any  one,  who  could  possibly  doubt  if  this  were  a  case  of  Intermit- 
tent fever,  we  have  a  corroboration  in  the  fact,  that  at  the  third  heb- 
domadal period,  it  is  renewed,  in  the  simple  form. 

,     Case  3.     Nov.  22d.     A.  R..  aged  fiftv-five ;  residence  on  lower 


^ 


490  Intermittent  Fever.  [September, 


^  Broad-street ;  of  active  habits  :  full  habit,  florid  complexion,  perma- 
nently red  nose  and  cheeks  a  free  liver  and  drinker.  Three  weeks 
since,  he  had  three  paroxysms  of  quotidian  Intermittent  fever;  for 
which  he  took,  by  his  own  prescription,  one  active  cathartic  and  ten 
grains  of  quinine.  Since  then  his  mind  has  been  harrassed  by  em- 
barrassed business. 

On  the  20th,  had  a  slight  chill,  about  the  middle  of  the  day.  On 
the  morning  of  the  21st,  represented  himself  as  having  been  crazy 
during  the  previous  night.  On  the  21st,  a  chill  about  12,  M. ;  was 
in  his  room  alone,  upon  the  sofa,  during  the  afternoon,  and  slept  alone. 
On  the  morning  of  the  22d,  was  at  the  breakfast  table,  but  was  ob- 
served to  look  very  unwell,  and  represented  his  head  as  feeling  very 
bad,  and  that  he  had  slept  soundly,  without  waking,  the  whole  night; 
ate  a  hearty  meal.  At  10|,  was  suddenly  seized  with  a  chill ;  free 
vomiting,  discharged  the  whole  of  his  breakfast ;  went  to  bed,  com- 
plaining  of  a  violent  head-ache.  22d,  1,  P.  M.,  first  visit  this  is 
his  state:  face  flushed  ;  skin  hot,  universally  ;  eyes  staring,  the  eye- 
lids frequently  snapping  violently;  he  answers  to  every  question  in 
a  hurried  manner  Yes  sir  and  attempting  further,  to  speak,  but 
splutters  with  his  tongue  ;  the  muscles  of  the  extremities  as  well  as 
of  the  tongue  are  extremely  agitated  fingers  and  toes  being  perpet- 
ually in  motion,  and  occasionally,  one  or  other  of  the  limbs  convul- 
sively agitated ;  lies  on  his  back,  and  resists  every  attempt  to  move 
him  ;  the  action  of  the  heart  excessive,  and  its  impulsion  against  the 
ribs  fearfully  violent ;  pulse  in  the  left  arm  very  small,  but  tense; 
{Note.  Anomalous  distribution  of  radial  artery  of  the  left  side.) 
in  the  right  arm,  full,  strong  and  utterly  incompressible,  elevating  the 
finger,  when  forcibly  held  upon  it  120.  (F.  S.  50  to  60  oz. ; 
40 grs.  Calomel;  strong  Saline  Injection.)  Bleeding  was  difficult, 
on  account  of  the  restlessness  of  the  patient,  uncontrolable  ;  by  this 
copious  bleeding,  the  pulse  was  not  entirely  subdued,  being  still  full 
and  strong.  The  calomel  was  greedily  swallowed.  The  introduc- 
tion of  the  saline  injection  increased  his  agitation  extremely ;  this 
agitation  seemed  to  depend  on  the  effort  to  resist  its  rejection  from 
the  bowels  and  that  of  attempting  to  get  out  of  bed  ;  during  this  time, 
he  was  pulling  forcibly,  at  the  penis  and  testicles ;  was  lifted  from 
bed  and  placed  upon  the  easy-chair  stool  ;  still  he  had  not  intelli- 
gence  enough  to  perceive  that  he  was  on  the  stool ;  but  forcibly  closed 
the  spincter  of  the  rectum,  and  continued  to  drag  at  the  testicles,  6zc. 
This  resistance  to  discharging  of  the  bowels  wns  finally  overcome 


1845.]  Intermittent  Fever.  491 


only  by  filling  his  bowels  with  repeated  injections.  During  this 
manipulation  with  the  patient,  his  linen  was  observed  to  be  exten- 
sively stained  with  urine,  but  now  dry  ;  during  tiiis  struggle,  the 
orifice  in  the  vein  bled  an  indefinite  amount,  saturating  the  sleeves 
of  two  shirts  and  running  down  to  the  hand,  before  the  accident  was 
discovered  ;  after  discharging  the  bowels,  he  was  removed  to  bed  ; 
the  pulse  now  much  reduced  in  fret[uency  and  strength  ;  muscles 
composed;  skin  perspiring  ;  still  answers  but  yes  sir,  to  every  ques- 
tion ;  same  want'of  control  over  the  muscles  of  the  tongue,  on  any 
attempt  to  speak  ;  at  4,  P.  M.,  a  compound  cathartic  of  salts  and 
senna ;  this  produced  three  or  four  copious  stools,  in  the  beginning 
af  the  night.  22d,  12  at  night  pulse  100,  soft  and  full ;  skin  soft ; 
muscles  not  entirely  quiet,  but  much  less  agitated  ;  still  answers, 
yes  sir,  to  all  questions,  but  with  less  vehemence  and  with  more  de- 
liberation ;  the  attempt  at  further  articulation,  ends  in  a  spluttering  ; 
I  estimate  that  he  does  not  know  me.  (36  grains  quinine,  in 
solution,  one-third  every  two  hours,  commencing  at  2  o'clock.) 
^  23d,  8,  A.  M.  Has  taken  36  grains  quinine,  the  last  dose  at  six 
this  morning;  he  recognizes  me;  indisposed  to  talk  answering  no 
to  some  questions,  but  cannot  command  his  tongue  perfectly  enough 
to  utter  more  than  four  or  five  words ;  slight  head-ache ;  pulse  95, 
soft;  skin  soft ;  tongue  soft  and  moist,  not  furred,  trembles  on  thrust, 
ing  out ;  has  taken  some  gruel.  [Sinapism  to  the  whole  of  the  sjjine^ 
which  is  tender  on  pressure,  at  the  third,  fourth  and  fifth  dorsal  ver- 
tebrae to  be  kept  on  as  long  as  it  can  be  borne.)  12,  M.  No 
chill;  speech  much  improved;  some  remaining  difficulty  of  utter- 
ance;  complains  of  difficulty  in  finding  words  to  express  himself ; 
gives  some  account  of  the  state  of  his  health,  previous  to  yesterday, 
but  remembers  nothing  of  the  transactions  of  yesterday.  10, 
P.  M.  Still  deaf;  no  head-ache  ;  improved  in  every  respect ;  two 
yellow  stools  in  the  afternoon.  (3  grains  quinine  every  two  hours, 
from  12  to-night  to  8  in  the  morning  equal  to  15  grains.) 

24th,  9,  A.  M.  Has  passed  a  comfortable  night ;  asks  for  coffee. 
{No  medicine  gruel  and  water.)  9,  P.  M.  Very  deaf;  no  fever. 
{Pediluvium  hot.) 

25th,  9,  A.  M.  Has  passed  a  good  night ;  is  sitting  up,  taking 
coffee  and  toast ;  hearing  perfect;  some  soreness  of  the  gums,  the 
more  annoying  from  having  a  set  of  artificial  teeth. 

28th.  Discharged,  having  improved  steadily  ;  suffering  only  some 
slight  inconvenience  from  sore  gums. 


492  Intermittent  Fever.  [September, 


Here  is  a  patient,  about  the  tiiird  hebdomadal  period  from  an  at- 
tack of  simple  intermittent,  seized  with  intermittent  malignant  in  its 
very  first  paroxysm  :  yet  that  first  not  so  violent  as  subsequent  ones  ; 
for  he  retained,  during  the  night  of  the  20th  and  the  subsequent 
morning,  some  recollection  of  his  case,  saying  he  had  beei^crazy. 
The  second  paroxysm,  more  violent  than  the  first,  passed  without  his 
consciousness,  as  he  represented  himself  to  have  slept  soundly  ;  and, 
moreover,  the  urine-stain  on  his  shirt,  and  its  dry  state,  warrants 
the  inference,  that  his  coma  was  so  profound  as  that  Re,  unconsciously, 
discharged  the  urine  in  his  bed.  A  quotidian  Intermittent  a  true 
intermittent,  for  he  is  able,  after  such  a  violent  paroxysm,  to  dress 
himself,  appear  at  the  breakfast  table,  and  even  to  eat  a  hearty  meal. 
The  third  paroxysm  still  more  violent,  the  local  symptoms  so  urgent, 
as  well  as  the  general  arterial  action,  as  to  warrant  the  opinion  that 
without  the  freest  depletion,  irrecoverable  injury  would  have  been 
done  to  the  brain  illustrating  the  necessity  of  treating  vigorously, 
the  local  affection,  whether  of  the  nature  of  congestion  or  of  inflam- 
mation. The  question  very  naturally  presents  itself  what  would 
probably  have  been  the  course  of  this  case,  had  it  been  trusted  to  the 
antiphlogistic  and  revulsive  treatment  alone,  without  quinine?  In 
all  probability,  the  paroxysm  would  have  returned  on  the  23d,  and 
considering  the  degree  of  cerebral  disease,  which  existed  at  11,  A.  M. 
of  that  day  the  period  of  the  expected  paroxysm,  is  it  not  reasona- 
ble to  presume,  that  under  the  commotions  ofa  paroxysm,  the  brain 
would  have  been  disorganized  to  a  fatal  degree  ?  When  it  is  remem- 
bered that  the  brain,  at  11,  A.  M.,  of  the  23d,  was  in  a  state  of  far 
greater  disease  than  at  11,  A.  M.,  of  the  22d,  and  the  danger  of  that 
paroxysm  is  remembered,  we  think  another  one  would  have  proved 
fatal,  notwithstanding  the  most  vigorous  antiphlogistic  measures  had 
been  used.  At  any  rate,  where  is  the  wisdom  or  prudence  of  sub- 
jecting a  patient  to  such  imminent  danger,  when  it  can  be  arrested 
by  a  safe  remedy?  for  surely  this  case  confirms  the  opinion  of  the 
safety  of  quinine  in  large  doses,  on  the  decline  ofa  paroxysm  of  cere- 
bral malignant  fever.  This  patient  was  not  exposed  to  any  peculiarly 
virulent  miasma  ;  for  he  was  still  living  under  the  same  circumstan- 
ces as  when  he  suffered  an  attack  of  simple  intermittent,  three  weeks 
before ;  one  of  the  commemorative  circumstances,  however,  sug- 
gests to  us  the  determining  cause  of  the  malignity  of  cases  occurring 
in  ordinarily  healthy  localities.  One  of  his  organs  (the  brain)  was 
found  prcdispoi;cd  to  become  congested  by  the  high  general  arterial 


1845.]  Intermittent  Fever.  403 


action  of  a  paroxysm  predisposed  by  fatigue  and  over-exertion  coin- 
cident  with  an  anxious  state  of  mind.  An  analogous  case  is,  at  thij 
time  passing  under  the  writer's  notice  a  case  of  chronic  diarrhoea 
of  three  months  standing,  from  which  the  patient,  a  young  man  of  20, 
was  gradually  recovering  when  after  a  week's  residence  on  the 
bank  of  a  mill-pond,  an  attack  of  a  quotidian  remittent  fever  renewed 
the  chronic  affection  of  the  bowels  the  choleric  symptoms  increasing 
and  abating  with  the  exacerbations  and  remissions  of  the  fever,  and 
becoming  more  and  more  violent  in  each  succeeding  paroxysm,  until 
on  the  5th,  the  patient  seemed  in  imminent  danger.  The  antiphlogis- 
tic treatment  alone,  founded  upon  the  opinion  that  the  prominent 
local  disease  is  the  essential  cause  of  the  fever,  maybe  demonstrated 
by  the  records  of  practical  medicine,  to  be  not  a  uniformly  unsuccess- 
ful, but  certainly  a  hazardous  one  as  hazardous  as  unphilosophical, 
for  well  authenticated  cases  conclusively  establish  the  principle,  that 
the  Intermittent  fever  is  independent  of  the  local  inflammation  or 
congestion.  Impressed  with  the  importance  of  this  principle,  the 
writer  here  adduces  a  case  from  Bailly,  with  the  remark  that  such 
like  cases  could  be  multiplied  indefinitely.  / 

Case  4.  *"An  Irishman,  living  at  Rome,  was  attacked,  in  the   
month  of  August,  1822,  with  fever,  and  extreme  pain  in  the  belly.  In 
the  morning,  when  I  saw  him,  he  was  in  a  state  of  agitation,  difficult  to 
describe  he  was  tossing  himself  upon  the  bed,  with  his  hands  pressed 
against  the  belly ;  screaming  from  the  violence  of  pain ;  his  tongue  was 
a  little  white,  but  neither  red  nor  dry;  no  thirst ;  the  pulse  strong  and 
very  full.  He  was  bled  16  ounces  from  the  arm,  and  twenty  leeches 
applied  to  the  abdomen.  In  the  evening,  the  paroxysm  had  abated 
and  a  tranquil  night  ensued.  The  next  day  was  passod  without 
fever  or  pain.  The  third  day,^in  the  morning,  a  paroxysm  com- 
menced with  a  chill,  and  was  marked  by  the  same  violent  abdominal 
pains  as  in  the  first  paroxysm.  Bled  again  to  the  same  amount,  and 
twenty  leeches  applied  to  the  abdomen ;  diet  and  mucilaginous 
drinks.  This  paroxysm  is  terminated  as  the  first,  in  the  evening ; 
the  night  tranquil.  The  fourth  day  a  complete  intermission.  On 
the  fifth  day,  the  paroxysm  returns  in  the  morning,  but  with  this 
striking  difference  although  agitated  as  much  as  in  the  preceding 
paroxysms,  his  complaints  as  desperate,  his  restlessness  as  great,  in 
short,  seeming  to  suffer  as  much  pain,  yet  he  could  not  designate  the 

*  BMLLYTraitc  Ficvrcs  Inkrmiitcnfcs.  18C5. 


491  '  Intermiltent  Fever.  [September, 


seat  of  his  suffering.  As  his  intellect  was  perfect,  I  repeated  fre- 
quently the  question  Have  you  pain  in  the  belly?  lie  uniformly 
answered  me  that  he  had  not,  and  continued  to  refer  his  distress  to 
the  general  state  of  his  system.  Judging  him  to  be  free  from  danger, 
without  medication,  he  passes  through  the  paroxysm,  which  termin- 
ates as  before,  in  a  perfect  intermission  ;  the  calmness  of  which 
contrasts  strikingly  with  the  anguish  and  distress  of  the  previous  par- 
oxysm. I  prescribed  15  grains  sulphate  of  quinine,  in  three  powders, 
during  the  morrow.  On  the  seventh  day,  he  experienced  a  general 
uneasiness,  but  not  to  be  compared  to  the  suffering  of  previous  par- 
oxysms. The  sulphate  of  quinine  was  continued,  for  a  few  days,  and 
his  recovery  was  perfect." 

This  case  distinctly  proves  the  independence  of  the  fever  upon  the 
local  affection  ;  for  by  the  judicious  antiphlogistic  treatment  daring 
two  succeeding  paroxysms,  this  abdominal  disease  is  subdued  so  com- 
pletely, that  in  the  third  paroxysm,  no  further  antiphlogistics  are 
used  ;  yet  the  tertian  fever  continues  continues  until  arrested  by  the 
specific.  It  shows  also  the  insufficiency  of  the  antiphlogistic  treat- 
ment, even  when  it  entirely  cures  the  local  phlegmasia,  to  arrest  a 
paroxysmal  fever.  A  case  analogous  to  this  is  recorded  by  Morgag- 
ni :  "A  patient  was  first  attacked  with  dysentery  without  fever  
then  fever  supervened,  of  the  tertian  type,  the  dysentery  still  con- 
tinuing its  course  ;  the  intermittent  ceased,  yet  the  dysentery  still 
continued  ;  finally  a  continued  fever  comes  on,  with  stupor,  deafness 
 death."  We  must  infer  from  such  like  facts  as  these,  that  the 
lesion  upon  which  depends  intermittent  fever  is  a  specific  one  of  the 
cerebro-spinal  system  ;  and  that  whilst  the  local  congestions  of  ma- 
lignant intermittents  are  controlled  by  anti-phlogistic  measures,  this 
is  controllable  with  even  greater  certainty,  by  the  specific  quinine. 

J  Case  5.  Oct.  11th,  1842.  A  mulatto  woman  resides  at  the 
Academy  lot,  aged  42,  having  borne  many  children,  has  now  an  infant 
of  8  months.  Represents  herself  to  have  had  a  chill,  on  the  after- 
noon of  the  9th,  followed  by  fever  was  up  and  about  her  work  on 
the  morning  of  the  10th  ;  but  at  noon  was  taken  with  a  chill,  since 
which  she  has  suffered,  up  to  the  present  moment,  with  head  ache, 
vomiting,  pain,  &c.  This  is  now  (11th  Oct.,  9,  A.  M.)  her  state  :  skin 
covered  universally  with  urticaria^  itching  extremely ;  skin  warm  ; 
intellect  perfect,   hut  her  communications  are  interrupted  by  violent 


1845.]  Intermittent  Fever,  495 


pain  at  the  epigastrium,  increased  at  intervals ;  no  cough  except  after 
vomiting;  respiratory  murmur  perfect,  but  respiration  frequent  and 
irregular,  rendered  irregular  by  the  violence  of  epigastric  pain,  urgent 
thirst,  the  tongue  of  a  natural  color  and  moist,  perfectly  clear  at  the 
anterior  half,  slightly  furred  behind,  where  the  papillae  are  enlarged. 
At  the  bed-side  is  a  tin  basin,  nearly  filled  with  matter  vomited,  con- 
sisting of  watery  fluid  and  mucus  in  large  flakes  floating  upon  it, 
and  of  a  brownish  black  colour  ;  pain  at  the  epigastrium  increased 
by  pressure  ;  exquisite  pain  on  pressing  third,  fourth  and  fifth  dorsal 
vertibrce  ;  one  stool  yesterday  ;  pulse  extremely  small,  barely  per- 
ceptible and  very  frequent.  10  ne  pint  of  Cold  Water  at  a  draught; 
V.  S.  16  oz.)  Faintness,  as  was  anticipated,  followed  the  bleeding 
and  vomiting  of  the  same  dark  colored  mucus  and  some  perspiration 
over  the  upper  part  of  the  body.  At  10,  A.  M.,  she  took  16  grains  qui- 
nine, in  solution,  which  being  vomited,  with  more  of  the  black  mucous, 
another  dose  was  given  and  retained,  and  repeated  at  11  and  at  12 
M.,  and  retained  At  12  M.,  two  scarifications  to  the  spine  with 
cups  drew  4  ounces  blood.  Sinapisms  over  the  whole  abdomen  and 
spine  to  be  renewed,  llth,  9,  P.  M.  Has  retained  all  the  quinine  ; 
has  great  distress  at  the  epigastrium,  with  a  desire  to  vomit,  the  pain 
less  violent  than  formerly;  sense  of  suffbcation  prompts  her  to  find 
relief  by  rising  up  to  the  erect  position  ;  is  deaf,  and  has  roaring  as 
of  waters,  in  the  ears  pulse  more  developed,  120  ;  no  stool.  (Cup- 
ping the  dorsal  spine  to  3  oz.  relieved  her  head-ache  and  epigastric 
distress ;  sinapisins  renewed  to  the  abdomen  and  spine ;  saline  injec- 
tion.     10  grs.  quinine,  in  powder,  at  5  in  the  morning  and  at  7.) 

12th,  8,  A  M.  Has  passed  a  comfortable  night  injection  produ- 
ced two  stools  has  taken  this  morning  the  20  grs.  quinine,  in  two 
doses.  No  vomiting  during  the  night.  Pain  still,  at  the  epigastrium, 
but  less  violent  pulse  110,  and  moderately  full ;  nettle-rash  has  dis- 
appeared thirst  still  urgent.  (10  ^r*.  quinine,  at  9.  Cold  toast- 
water.  Sinapisms  to  be  renewed.)  1,  P.  M.,  no  more  vomiting  no 
stool  less  pain  at  epigastrium  ;  bat  has  a  sense  of  fulness  of  the 
abdomen  ;  pulse  120,  soft  and  full ;  skin  warm  and  moist ;  deafness 
and  sense  of  confusion  in  the  head.  (Saline  enema^  at  2,  P.  M. 
Chicken  water.)  9,  P.  M.  Has  slept ;  still  pain  at  the  epigastrium; 
pulse  110  and  soft ;  skin  warm  ;  has  taken  no  nourishment,  (1  oz, 
castor  oil,  to-morrow  morning.) 

13th,  10,  A.  M.  Has  passed  a  tolerably  comfortable  night ;  has 
taken  and  retained  the  oil ;  heavy  pain  still  at  the  epigastrium  ;  pulse 


490  Infermillent  Fever.  [September, 

100.  4,  P.  M.  Three  stools  extremely  black,  so  reported  by  nurse  ; 
pain  at  epigastrium  unrelieved,  increased  by  pressure,  which  produces 
also,  a  sense  of  suffocation.     {Blister plaster  7  by  9  to  epigastrium,) 

14th,  10,  A.  M.  Drawing  of  blister  has  relieved  pain  at  epigas- 
trium ;  patient  relishes  cold  water  and  has  taken  some  gruel.  Pulse 
80,  and  quick ;  tongue  furred  yellow,  but  moist ;  several  stools,  du- 
ring the  night.     (Gruel  and  cold  water.) 

16th.     Convalescent. 

Here  is  a  case  of  quotidian  Intermittent,  simple  in  its  first  parox- 
ysm ;  but  the  second  continues  nearly  up  to  the  time  of  access  of 
the  third,  with  severe  local  gastric  symptoms.  At  9,  A.  M.,  the 
symptoms  being  very  urgent,  and  another  paroxysm  being  reasona- 
bly expected  to  supervene  about  1,  P.  M.,  and  it  being  apprehended 
that  great  danger  would  arise  if  that  paroxysm  were  not  prevented, 
the  patient,  for  the  relief  of  the  local  epigastric  symptoms,  is  bled  to 
fainting,  and  at  the  moment  of  relaxation,  the  stomach  cleansed  by  an 
emetic  of  cold  water,  and  in  anticipation  of  the  period  of  access,  to 
this  distressed  stomach  is  administered  48  grains  of  quinine  in  two 
hours.  The  effect  of  this  administration  is  to  moderate  the  vio- 
lence to  break  the  force  of  the  succeeding  paroxysm,  and  that  with- 
out materially  aggravating  the  local  gastric  symptoms.  With  con- 
tinued revulsive  applications  to  the  epigastrium  and  spine,  30  grains 
of  quinine  are  administered,  in  anticipation  of  the  paroxysm  of  the 
12th,  with  the  effect  of  preventing  it  and  curing  the  Intermittent  par- 
oxysmal fever.  But  stilly  the  local,  phlegmasial  affection  continues, 
after  the  cure  of  the  fever,  until  it  is  arrested  by  a  blister  drawn  upon 
the  epigastrium. 

The  previous  case  proves  the  independence  of  the  Intermittent  fever 
upon  the  local  affection,  inasmuch  as  the  first  continues  under  the  use 
of  the  antiphlogistic  treatment,  which  cures  the  local  affection.  This 
last  case  shows  the  Intermittent  fever  cured,  by  a  treatment,  which 
did  not  reach  the  local  inflammation,  which  latter  continued  until 
relieved  by  the  blister. 

Case  6.  *  "  Muller,  asoldier,  aged  22,  of  a  good  constitution,  hav- 
ing been  discharged  from  the  Hospital  about  a  month  previous,  was 
brought  back  on  the  15th  January,  1835,  in  the  afternoon.  He  was  in 
the  most  profound  coma  ;  the  pulse  full,  large,  soft ;  the  skin  not  hot ; 

  Mali,ot  Trailc  des  Ficvrcs,  Paris,  1836. 


1^15.]  Intermittent  Fever.  497 


respiration  deep  ;  the  physiognomy  that  ofa  man  asleep  ;  altogether 
insensible  to  pinchingof  the  skin.  No  information  on  the  course  of  his 
disease.  {Diet,  lemonade;  V.S,\boz.  ;  2>0  leeches  to  the  jugulars ;  a 
small  starch,  opiated  hijection,  with  60  grains  sulphate  of  quinine,  40 
grains  quinine  in  potion,  blisters  to  the  thighs,  sinapisms  to  the  legs.) 
At  8,  P.  M.,  the  coma  continues,  but  the  insensibility  less  absolute,  the 
skin  more  warm.  {Bleeding  from  the  temporal  artery  from  8  to  10 
oz. ;  40  grains  sulphate  quinine,  in  two  doses,  at  the  interval  of  two 
hours.     Cold  fomentations  to  the  head.) 

16th.  In  the  morning,  the  tongue  is  slightly  gastritic,  epigastrium 
painful  on  pressure  ;  some  remaining  heaviness  of  expression  of  the 
face,  but  the  intelligence  is  restored ;  during  the  night,  a  copious 
sweat.  The  patient  now  relates  that  he  has  had  five  paroxysms  of  fe- 
ver, each  commencing  about  3,  P.  M.,  daily  during  the  fifth  he  was 
brought  to  the  hospital  that  the  first  paroxysm  was  accompanied 
with  violent  head-ache  and  efforts  to  vomit.  {Diet,  lemonade,  4:0 grs. 
quinine  immediately,  at  one  dose ;  cataplasm  to  the  epigastrium ;  cold 
fomentations  to  head  continued.)  Apyrexia  was  complete  during  the 
day  ;  and  in  the  evening,  the  state  of  the  patient  was  very  desirable. 

17th.  Morning  complete  apyrexia  ;  no  head-ache,  no  lassitude 
of  the  limbs ;  no  stools  for  many  days.  {Diet,  lemonade,  24  grains 
quinine,  enema  emollient.) 

18.     Convalescent,  &;c. 

This  case  is  worthy  of  consideration,  as  shewing  the  safety  of  lafgd 
doses  of  quinine  even  in  the  comatose  form  of  malignant  intermittent. 
Here  the  administration  of  quinine  commenced  at  a  time,  when  the  pa- 
tient was  in  the  deepest  coma,  was  continued  to  the  extent  o^one  hundred 
and  eighty  grains,  in  the  course  of  ZQ  hours.  Such  an  administration  of 
quinine,  the  writer  apprehends,  would  seldom  be  found  necessary  ini 
this  climate;  but  such  cases  are  valuable,  as  fixing  the  general  prin- 
ciple of  practice,  that  quinine  may  be  used  in  such  extravagant  quanti- 
ties, if  necessary,  and  as  dissipating  that  too  common  prejudice  against 
this  heroic  medicine,  that  it  disposes  to  cerebral  congestion  that  it 
produces  head-ache,  and  therefore  that  the  existence  of  heaid-ache 
contra-indicates  its  use.  It  is  curious  to  observe  how  much  more 
correct  were  the  opinions  of  the  master-spirits  of  the  profession,  as 
to  the  effects  and  mode  of  operation  of  quinine,  at  the  time  of  its 
first  introduction,  than  those  of  the  great  mass  of  the  profession  in 
after  times..     The   reason  of  this,   however,  is  sufficiently   obvious, 

32 


498  Intermittent  Fever.  [September, 


The  attention  of  men,  whose  crancl  dependance  in  the  treatment  of 


malignant  fever,  was  Peruvian  Bark,  must  have  been  strongly  arrested 
by  the  high  claims  of  the  sulphate  of  quinine,  and  accordingly  they 
subjected  these  claims  to  the  most  severe  and  candid  examina- 
tion, under  circumstances  favorable  to  the  establishment  of  a  true 
opinion  as  to  its  merits  and  its  mode  of  operation.  Bailly,  e.  g. 
says  of  it  "If  I  do  not  regard  quinine  to  be  an  antiphlogistic,  I  am 
as  ftir  from  regarding  it  a  stimulant.  At  Rome,  1  have  taken  a  hun- 
dred grains  of  sulphate  of  quinine,  in  some  days  ;  on  an  attentive 
examination  I  have  found  no  marks  of  irritation,  which  such  dose 
must  have  produced,  were  it  an  irritant.  It  is  a  specific,  sui  generis  
a  sedative  of  the  nervous  system,  and  only  of  certain  of  its  periodical 
and  intermittent  functions,  for  it  exercises  no  action  either  upon  sen- 
sibility or  locomotion,  it  does  not  relieve  pain  or  convulsions,  except 
these  be  dependent  on  an  intermittent  excitation  of  the  general  mo- 
tions of  the  economy.  It  is  the  specific  sedative  of  the  abdominal 
nervous  system."  Soon  coming  into  universal  use,  the  general  opinion 
of  its  mode  of  operation  was  naturally  determined  by  the  prevailing 
doctrine  as  to  the  j^atliology  of  fever  debility  being  regarded  as  the 
essential  foundation  of  fever,  and  quinine  being  observed  to  cure  it, 
by  inference,  it  was  called  a  tonic  ;  its  location  in  the  class  of  tonics 
seemed  further,  to  be  sanctioned,  by  the  fact  that  cinchona  was  at 
the  head  of  the  list.  Too  often  is  it  thus,  that  the  opinions  of  the  mass, 
founded  in  prejudice  and  ignorance,  overshadow  the  exact  and 
carefully.formed  opinions  of  the  true  philosopher.  And  such  is  the 
influence  of  names  with  mankind,  that  it  is  to  be  apprehended,  so  long 
as  sulphate  of  quinine  continues  to  be  called  a  tonic,  so  long  will 
these  unfounded  prejudices  against  its  use  last.  To  the  existence  of 
such  prejudice  against  this  valuable  article  of  the  materia  medica,  the 
following  sentence  from  Professor  Dickson's  recently  published 
''Practice,"  testifies  "Even  the  sulphate  of  quinine  is  generally 
regarded  as  inadmissible,  whenever  the  apyrexia  is  incomplete,  and 
where  there  are  any  prominent  affections  of  important  organs."  He 
specially  instructs  his  pupils:  "Thus,  you  will  hardly  venture  upon 
the  exhihition  of  cinchona,  when  the  apyrexia  is  imperfect,  and  when 
there  are  present  obvious  marks  of  local  disorder  of  some  important 
organs.  The  continuance  of  head-ache,  gastric  oppression,  abdomi- 
nal  pain  and  tension  these  symptoms  demand  farther  general  or 
preliminary  treatment." 


1:^45. J  Intermittent  Fever.  499 


Case  7.  Oct.  3(1,  1844,  Thursday The  pnlicnt,  a  l)oy  of  nine 
years  of  ago,  rcsiclos  iintiicdiatc  ly  on  (ho  river,  9  miles  ahovc  (own. 
On  Saturday  last,  had  tho  ladiiis  of  the  left  fore-ann  hrokcn  ;  is  rep- 
resented to  have  had  fever  on  Monday  iii<;htlast;  heUer  on 'J'liesday 
morning;  Tuesday  night,  restless  wilh  very  hot  skin;  Wednesday 
night,  high  fever  with  delirium,  copious  sweat  towards  morning.  This 
morning,  Thursday,  was  out  of  bed,  but  complained  of  bead-ache; 
had  no  appetite  ;  at  12,  M.  to-day,  fever  commenced  ;  at  2,  P.  M. 
had  a  strong  convulsion,  followed  by  stupor,  which  lasted  till  moment 
of  first  visit,  about  5,  P.  I\I. ;  after  convulsion,  a  tea-spoon-ful  of 
ipecac  was  forced  upon  him  ;  since  which  time  he  has  had  several 
involuntary  stools.  Now  perfectly  stupid,  not  aroused  by  the  loudest 
calling  ;  occasionally  restless,  mourning  and  screaming  when  moved  ; 
pulse  90,  soft  and  full;  skin  perfectly  natural  in  temperature, 
except  the  extremities,  which  are  cool,  and  the  head,  which  is  very 
hot;  pupils  dilated;  adnata  not  injected;  bowels  soft  and  supple. 
(F.  S.  12  oz. ;  scarification  beticecn  ths  slirnihlcrs,  with  cups,  draW' 
ing  about  4  ounces  ;  hot  mustard  pediluvium,  every  two  hours  ;  cold 
affusion  to  head,  erery  two  hours ;  sinapism  the  whoJe  length  of  the 
spine  ;  two  blister -plasters  to  the  legs ;  to-morrow  morning  at  5,  four 
grains  quinine  in  solution,  to  be  repeated  every  hour,  for  five  doscSf 
unconditionally.) 

Left  him  at  7,  P.  M.,  still  stupid,  with  no  other  marks  of  returning 
sensibility,  than  groaning  under  tho  hard  pressure  of  the  cu|)s,  and 
great  restlessness  under  the  first  application  of  undiluted  mustard  to 
the  spinal  column.  Being  une.'^iectcdly  again  in  his  neigliborhood, 
at  midnight,  found  his  consciousness  so  far  restored,  that  he  asks  for, 
and  drinks  water. 

Friday,  4th,  11,  A.  M.  Perfectly  conscious  ;  skin  cool ;  has  taken 
20  grains  of  quinine,  and  is  deaf  and  complains  of  roaring  in  the  ears; 
fretful  from  pain  of  blisters  ;  no  stool.  (5  grains  blue  mass  every  two 
hours,  for  four  doses,  commeneing  at  2,  P,  M. ;  enema  saline,  if 
fever  returns;  hot  pediluvium  and  cold  affusion  to  the  head;  12 
grains  quinine,  commencing  to-morrow  morning  at  5  o'clock,  in 
three  doses ;  oil  -|  oz.  to-morrrow,  at  4,  P.  M.,  if  bowels  shall  not 
have  been  freely  moved.) 

Was  subsequently  informed  that  be  passed  the  night  of  the  4tb, 
with  but  little  fever ;  since  which  bis  convalescence  has  been  rapid. 

The  accident  of  a  simple  fracture  of  one  of  the  bones  of  the  fore- 


^00  Intermittent  Fever.  [September, 


arm  is  not  sufficient  to  account  for  the  violent  character  of  this  case, 
in  a  healthy  robust  boy.  The  following  facts  warrant  the  belief 
that  this  character  was  determined  by  extreme  virulence  of  the 
exciting  cause,  peculiar  to  this  and  some  other  localities  in  the  neigh- 
borhood: One  month  before  the  occurrence  of  this  case,  there  was  a 
similar  one  in  the  same  family,  treated  successfully  in  the  same 
manner,  by  Dr.  Robert,  of  Columbia  county.  In  July,  1843,  a 
boy  of  twelve  years,  from  the  city,  was  on  a  visit  at  this  house;  at 
the  end  of  two  weeks,  he  was  taken  with  light  fever,  consisting  of 
daily  paroxysms  ;  which  having  returned  for  two  or  three  days,  it  was 
thought  prudent  to  bring  him  home ;  on  the  morning  following  a 
night  of  severe  fever,  with  delirium,  he  was  so  well,  that  he  dressed 
himself,  and  begged  to  remain  on  the  way  down,  in  a  carriage, 
fever  supervened;  he  arrived  at  home  in  a  state  of  profound  stupor, 
in  which  state  he  died,  notwithstanding  the  diligent  use  of  appropriate 
remedies.  Two  days  ago,  whilst  visiting  at  the  same  house,  the 
writer  incidentally  saw  a  negro  child  about  five  years  of  age,  in  a 
paroxysm  of  algid  fever,  which  terminated  fatally  in  two  hours ;  this 
child  had  been  slightly  unwell  for  two  or  three  days,  and  on  this 
morning  had  been  playing  in  the  yard.  A  negro  woman  at  this  time, 
was  convalescent  from  a  similar  attack  of  algid  fever.  There  are 
other  well  known  localities  in  our  climate,  where  the  malignant  form 
of  fever  is  endemic.  The  native  of  the  city  of  Charleston,  e.  g.  sleep- 
ing but  one  night,  in  the  summer  season,  in  the  neighboring  country, 
insures  to  himself  an  attack  of  much-dreaded  "  Country  fever." 
From  descriptions  of  this  fever,  by  friends  professional  and  non- 
professional, and  the  occasional  notice  of  supposed  cases  occurring  on 
steamboats,  formerly  running  between  this  city  and  C-harlcston,  the 
writer  has  long  entertained  and  expressed  the  opinion,  that  this 
"  Country  fever,"  of  Charleston,  was  the  Malignant  Intermittent  or 
Remittent  fever,  of  Torti,  Morton,  Bailly,  d:c.;  and  that  when  the 
profession  of  that  city  shall  have  adopted  the  uncompromising,  uncon- 
ditional use  of  cinchona  and  quinine,  as  recommended  by  such  high 
authority,  this  now  formidable  disease  will  be  stripped  of  its  terrors, 
and  be  found  as  manageable  almost  as  simple  Intermittents.  His 
opinions  are  confirmed  by  Professor  Dickson's  description  of  Country 
fever,  which  though  very  general,  yet  sufficiently  shows  the  true  na- 
ture  of  the  affection.  "An  attack  commencing  as  intermittent  or 
single  tertian  will  thus  become  a  double  tertian,  then  a  triple  tertian, 
then  a  remittent  of  greater  or  less  distinctness  and  regularity." 


1845.]  Intermittent  Fever.  501 

He  says  again,  "  Or  the  remission  shall  have  become  very  distinct, 
nay  shall  amount  to  complete  intermission,  and  you  flatter  yourself 
with  the  hope  that  convalescence  is  begun,  when  some  single  parox- 
ysm shall  intervene  with  such  overwhelming  violence,  that  prostration 
and  fatal  exhaustion  ensue  in  a  few  hours."  The  paroxysmal  char- 
acter is  here  assigned  to  it  -remittent  and  even  intermittent  and 
that  peculiar  insidiousness  which  it  has  been  the  writer's  object  to 
illustrate,  is  fully  set  forth  in  the  last  quotation.  The  treatment 
mentioned  by  Professor  Dickson  is  not  very  exactly  specified  he, 
remarking  that  his  custom  is  "to  institute,  from  the  commencement, 
such  a  course  of  treatment  as  shall  offer  the  best  resources  under 
any  sudden  developement  of  malignity  or  aggravation  of  violence." 
But  upon  the  use  of  the  great  specific,  he  immediately  adds,  "under 
these  circumstances,  too,  I  watch  anxiously  for  the  first  opportunity 
of  administering  some  preparation  of  cinchona  the  infusion  in 
some  of  its  combinations,  or  the  sulphate  of  quinine  in  proper  and 
efficient  doses.  The  system  sinks  so  readily  under  such  exacerba- 
tions, or  such  accumulation  of  them,  as  I  have  above  alluded  to, 
that  I  often  venture  upon  the  exhibition  of  this  class  of  remedies, 
even  in  remissions  somewhat  indistinct  and  obscure,  after  the  first 
vehemence  of  febrile  action  has  passed  by  an^l  the  appropriate  mea- 
sures of  depletion  have  been  premised."  It  is  not  such  a  use  of 
quinine,  to  which  the  writer  alludes,  but  the  early  use  of  it,  in  full 
doses. 

Knowing  sulphate  of  quinine  to  possess  the  power  of  preventing 
the  paroxysms  of  periodic  fever,  he  would  anticipate  X\\e  first  expected 
remission  estimating  the  time  of  its  return,  either  from  the  previous 
history  of  the  individual  case,  or  from  "the  general  history  of  the 
existing  epidemic  by  doses  of  10  or  20  grains,  pressing  it  "  obsti- 
nately against  contra-indicating  contingencies"  that  is,  acknow- 
ledging no  such  contingencies  to  exist  seeing  in  the  circumstances 
generally  considered  such,  only  the  stronger  indications  for  its  use; 
fearing  no  danger  so  much  as  the  danger  of  a  repeated  paroxysm. 
This  is  the  course  of  treatment,  which  the  writer  feels  confident, 
would  offer  the  best  security  against  those  sudden  developments  of 
malignity,  so  characteristic  of  the  country  fever  of  Charleston. 

It  is  with  reluctance  that  the  writer,  finding  this  article  already  so 
extended,  yields  to  the  necessity  of  postponing  his  remarks  upon 
Remittent  Fever,  &c.,  to  some  future  number  of  the  Journal. 


502  Acute  Peritonitis,  [September, 


ARTICLE    II. 

Cases  occurring  in  the  Practice  of  Drs.  Qgilhy  dj-  Robert :     Reported 
by  W.  H.  Robert,  ^I.  D.,  of  Madison,  Ga. 

Case  No.  1.  Acti'e  Peritonitis.  Mr.  J.  L.  Caverly,  a  school 
teacher,  aged  27,  of  tall  stature  and  largo  frame,  gave  the  following 
history  of  his  case  previaiis  to  our  visit : 

For  several  days  he  had  experienced  a  general  uneasiness  of  the 
whole  body,  but  more  particularly  of  his  lowels,  locating  the  pains 
about  the  region  of  the  umbilicus,  although  even  here  they  constituted 
more  an  uneasiness  than  an  actual  pain.  On  Friday,  seven  days 
previous  to  our  being  called  to  him,  he  had  gone  to  the  country,  and 
very  imprudently,  eaten  heartily  of  muscadines,  shortly  after  which 
he  was  taken  with  a  severe  chill.  He  returned  to  town  the  next 
day.  On  Sunday,  being  costive,  he  took  a  dose  of  epsom  salts, 
which  operated  mildly.  The  general  symptoms  not  yielding,  and 
still  complaining  of  the  uneasiness  of  his  bowels,  he  continued  to 
attend  to  the  duties  of  his  school,  abstaining  almost  entirely  from 
food,  until  our  visit,  on  Thursday: 

September  19lh  when  the  following  symptoms  were  present- 
ed:  Skin  warm,  dry,  and  of  a  pale  yellow  colour;  tongue  dry, 
tip  and  edges  very  red,  centre  loaded  with  a  brown  fur;  forcible 
pressure  upon  the  bowels  caused  very  little  pain,  and  that  was  princi- 
pally about  the  region  of  tic  ilio-crecal  valve;  the  rest  of  the 
bowels  had  a  very  knotty  and  doughy  feel;  pulse  hard  and  wiry, 
115  to  the  minute;  stomach  irritable;  bowels  had  not  been  operated 
on  for  the  last  forty-eight  hours.  18  ounces  of  blood  were  taken 
from  the  arm;  li.  Cah  mcl  30  grs.,  opium  8  grs.,  mix,  from  mass  and 
divide  into  eight  pills,  one  to  be  taken  every  three  hours ;  diluent 
drinks,  &c. 

20th.  Symptoms  in  almost  every  respect  the  same  as  yesterday ; 
did  not  sleep  much;  complains  of  very  little  pain  in  the  abdomen. 
Castor  oil  given,  and  the  operation  promoted  by  cnemata.  Had 
several  very  offensive  discharges,  of  rather  a  serous  consistence  and 
cf  an  ashy  colour. 

Evening  visit  Skin  hot  and  dry;  tongue,  pulse,  A:c.,  as  hereto- 
fore ;  stomach  still  irritable.  Calomel  and  opium  pills  resumed,  with 
soda  powders  in  cold  water. 


1845.]  Acute  Peritonitis.  503 


21st.  Rested  better;  skin  cool,  but  dry;  tongue  the  same  tis  yes- 
terday ;  bowels  a  little  tympanitic;  complains  of  no  pain  and  only 
slight  soreness  on  i)ressiiro  of  the  abdomen.  Calomel  and  opium 
continued,  with  20  drops  chloride  soda  every  three  horns  ;  soda 
water,  &;c.,  also  a  large  number  of  leeches  to  the  abdomen. 

22d.  Had  several  small  serous  and  offensive  discharges  from  his 
bowels  during  the  night ;  did  not  sleep  well  ;  wandering  and  deleri- 
ous  ;  tympanitic  state  of  the  bov/els  has  increased  ;  pulse  125  to  the 
minute  ;  treatment  continued,  with  cups  to  the  abdomen. 

23d.  No  material  change  in  the  sym.ptoms  since  yesterday,  except 
an  increase  in  the  frequency  of  the  pulse,  which  is  now  140 ;  tongue 
very  dry.  Ordered  castor  oil,  which  operated  twice:  discharge 
pale,  thin,  and  very  offensive.  Evening  visit,  ordered  following  :  
R.  Blue  Mass,  Dover's  powders  aa.  30grs.,  divide  into  12  pills,  one 
to  be  taken  every  three  hours;  blister  over  the  abdomen,  and  to  be 
dressed  with  mercurial  ointment ;  soda  water  continued. 

24th.  He  is  worse  this  morning  :  pulse  feeble  and  150  per  minute  ; 
skin  cooler ;  hiccough  since  early  last  night,  w-ith  more  constant  de- 
lirium ;  tympanitis  increased;  no  pain  or  uneasiness  produced  by 
pressing  the  abdomen.  Ordered,  oil  turpentine,  to  be  given  every 
two  hours,  and  sinapisms  to  the  extremities.  Continued  to  grow 
worse,  and  died  that  night  at  12  o'clock. 

Autopsy,  sixteen  hours  after  death,  in  the  presence  of  Dr.  E.  E. 
Jones.  Upon  opening  the  abdomen,  a  large  quantity  of  foetid  gas 
escaped,  which  dispersed  some  of  the  bystanders  ;  the  intestines  were 
knotted  together  from  contraction  and  adhesion  of  a  very  highly 
inflamed  peritonium  ;  every  part  of  the  peritcnium  that  covered  the 
intestines  was  in  a  high  state  of  inflammation ;  that  which  formed 
the  omentum  was  in  a  gangrenous  state,  and  the  right  lower  edge  of 
the  omentum  adhered  to  the  peritoneal  covering  of  the  right  iliacus 
muscle:  on  separating  these,  we  discovered  a  large  ulcer  of  the  peri, 
tonium,  to  the  right  of  the  ilio-coecal  valve  it  measured  an  inch 
wide  by  two  and  a  half  long,  extending  towards  the  pelvis,  in  which 
we  collected  about  one  pint  of  pure  pus.  The  mucous  membrane  of 
the  stomach  and  intestine  was  inflamed,  but  not  so  much  as  the  peri- 
tonium.    The  thoracic  organs  were  not  examined. 

Here  we  have  a  case  of  Peritonitis  progressing  on  to  gangrene 
and  suppuration,  and  the  patient  complaining  of  scarcely  any  pain 
indeed  be  attended  to  his  school  until  a  day  or  two  previous  to  our 


504  Paralysis.  [September, 


first  visit.  Could  the  pain  have  been  controlled  by  the  patient's  for- 
titude, or  was  it  really  not  felt  because  of  a  morbid  impairment  of 
sensibility?  From  the  extent  of  the  disease,  I  think  it  impossible 
that  any  man  with  ordinary  sensibility,  could  have  borne  it  without 
complaint.* 

C4.SE  No.  2.  Paralysis,  or  Loss  of  Muscular  Motion  of  the  right 
arm.  On  the  12th  of  March  last,  we  were  called  to  see  a  negro  boy 
about  ten  years  of  age,  the  property  of  Miss  D*****,  and  found  him 
laboring  under  complete  paralysis  of  the  right  arm.  The  boy's  mo- 
ther gave  us  the  following  history  : 

Two  nights  previous  to  our  visit,  something  like  a  noise  caused  her 
to  notice  the  boy  :  she  found  him  somewhat  stupid,  partially  blind, 
and  unable  to  move  the  right  arm.  He  remained  in  this  condition 
until  our  visit,  about  forty  hours  after. 

The  patient  then  presented  the  following  symptoms:  Stupor, 
such  as  to  render  it  difficult  to  arouse  him  ;  pulse  firm  and  slow ; 
bowels  costive;  complains  only  of  pain  in  the  head.  We  bled  him 
generally  and  locally ;  blistered  the  nape  of  the  neck  ;  ordered  mer- 
curial and  aloetic  purges  his  bowels  v/ere  all  the  time  very  difficult 
to  move.  This  treatment  was  pursued  ten  or  twelve  days,  without 
any  improvement.  We  then  put  him  under  the  operation  of  the 
electro-galvanic  battery,  the  operation  of  which  was  confided  to  his 
young  master,  to  be  made  daily. 

April  12.  I  happened  to  be  in  the  neighborhood,  and  called  to  see 
the  boy.  I  found  him  almost  entirely  relieved:  he  could  throw  a 
stone  about  as  far  as  he  ever  could,  and  the  only  difficulty  was  a 
little  weakness  of  the  arm.  The  use  of  the  battery  was  shortly  after 
discontinued. 

June  17.  The  arm  has  been  gradually  improving,  and  there  is 
now  scarcely  any  difference  between  it  and  the  other. 

*  See  Dr.  Carr's  Article  under  head  of  Extracts.  Was  this  not  a  case  of  dis- 
ease originally  located  at  the  CEecum  1  May  there  not  have  been  some  of  the 
muscadine  seeds  lodged  in  the  Appendix  ?  Edts. 


1*^45.  J  A  Case  of  Lumbar  Ahscess.  oOo 


ARTICLE  III. 

A  Case  of  Lumbar  Abscess.     By  E.  M.  Pexdletox,  ^^I.  D., 
of  Sparta,  Ga. 

  Aa extract  in  the  March  No.  of  the  Southern  Medical  and  Surgical 
Journal,  from  Dr.  Oke,  of  Southampton,  defining  tlie  diagnosis  be- 
tween several  disL^ases,  which  produce  pain  in  the  loins,  has  directed 
my  attention  to  a  case,  occurring  in  my  practice  during  the  last 
autumn,  and  which  strikingly  exemplifies  the  difficulty,  as  well  as 
necessity,  of  a  correct  diagnosis  in  all  such  cases. 

I  first  saw  the  patient  on  the  21st  November  last.  He  was  a  far- 
mer, residing  near  this  place,  about  thirty-five  years  of  age,  and  was 
in  the  following  condition  :  Countenance  depressed,  indicatinf^pain 
and  anxiety  of  the  mind  ;  pulse  very  feeble  and  thready ;  voice  weak ; 
great  emaciation,  &c.,  reminding  one  of  the  last  stage  of  phthisis 
])ulmonalis.  He  lay  on  his  back,  could  not  move  himself  except 
when  assisted,  and  then  only  with  great  pain  ;  his  whole  complaint 
was  referred  to  the  lumbar  region  extending  down  the  left  hip  to  a 
little  below  the  joint ;  he  had  severe  diarrhoea,  his  stools  indicating 
considerable  derangement  in  the  bilary  secretions.  The  urine  was 
passed  freely,  and  without  difficulty,  and  the  appetite  but  little  im- 
paired. On  examination,  I  found  two  small  tumours  occupying  each 
side  of  the  lumbar  vertebroe  which  evidently  contained  matter.  There 
was  slight  tenderness  and  fiuctuation  also  extending  down  the  left 
hip  to  the  upper  and  outer  part  of  the  thigh.  I  could  not  hesitate  for 
a  moment  as  to  the  nature  of  the  case,  and  directed  my  treatment 
accordingly. 

The  following  is  a  succinct  history  of  the  case,  as  given  by  the 
patient,  and  his  attendants  previous  to  this  time  :  Sometime  during 
the  month  of  May,  1344,  he  was  attacked  with  pain  and  weakness  in 
the  lumbar  region  after  considerable  exposure  to  cold,  damp  weather; 
he  applied  for  relief  to  an  experienced  and  skilful  physician,  which 
was  but  partially  afforded.  A  fresh  exposure  produced  a  recurrence 
of  the  pain,  and  though  subsequently  treated  for  acute  nephritis  and 
lumbago,  only  a  mitigation  of  the  symptoms  was  obtained  for  a  time. 
He  continued  to  grow  worse  and  waste  away  until  the  latter  part  of 
August,  when  he  became  perfectly  bed-ridden,  suffering  the  most 
intense  pain,  and  giving  up  all  hope  of  recovery. 


506  A  Case  of  Lumbar  Abscess  [September, 


As  a  dernier  resort,  however,  finding  that  science  had  failed,  he 
had  recourse  to  empiricism.  A  notorious  steam  doctor  was  sent  for, 
who  having  exhausted  the  routine  of  lYo.  6,  composition,  lobelia  and 
steam-bath,  gave  up  the  case  as  utterly  hopeless,  declaring  to  the 
alarmed  and  awe-stricken  patient,  that  he  could  have  cured  him,  but 
one  of  his  kidneys  was  entirely  destroyed,  and  he  could  not  make  a 
new  one. 

I  will  merely  give  the  outlines  of  the  treatment  instituted  in  tno 
case.  My  attention  v/as  first  directed  to  the  diarrhoea,  which  was 
very  exhausting.  Tiiis  I  succeeded  in  checking  in  the  first  twenty- 
four  hours  with  powdered  opium.  I  next  corrected  the  bilary  de- 
rangement  by  blue  pills  and  a  large  blister  over  the  right  hypochon- 
driac region,  where  tliere  was  pain  and  tenderness  on  pressure,  and 
then  directed  my  attention  to  strengthening  the  patient.  Fearing 
lest  a  too  speedy  abstraction  of  matter  might  be  too  much  for  his 
extremely  weakened  state,  I  applied  blisters  over  the  tumours,  and 
upon  the  tender  point  dosvn  the  thigh,  that  external  suppuration 
might  go  on  gradually,  while  I  plied  the  exhausted  powers  of  the  con- 
stitution, with  wine  and  a  nourishing  diet,  hoping  to  restore  its  recu- 
perative energies,  in  some  degree  at  least,  before  operating. 

Night  sweats  supervening  in  a  ^g\w  days,  I  added  about  ten  drops  of 
elixir  vitriol  to  the  wine,  to  be  taken  thrice  daily.  The  blue  pill  was 
continued  until  ptialism  was  produced,  and  the  blisters  applied  and 
re-applied  with  but  little  effect,  except  the  one  on  the  hip,  which 
seemed  to  suppurate  considerably.  Early  in  December,  the  tumour 
broke  at  the  upper  and  outer  portion  of  the  left  thigh,  and  ran  an 
immense  quantity  of  pus  during  several  succeeding  weeks.  The  ton- 
ics  were  gradually  increased,  and  my  patient  commenced  to  improve. 
By  the  30th  December,  (ray  last  visit,)  the  tumours  had  entirely  dis- 
appeared, and  firm  and  healthy  granulations  taken  their  places,  and 
the  issue  on  the  thigh  nearly  healed  up.  He  had  also  been  able  to 
sit  up  a  little.  Subsequently  he  continued  to  invigorate  very  fast, 
and  was  soon  able  to  go  about  and  attend  to  his  business.  He  how- 
ever complained  of  considerable  weakness  of  the  left  side,  no  doubt 
occasioned  by  the  shrinking,  from  long  inertia,  if  not  partial  loss,  by 
suppuration,  of  some  of  the  cellular  tissue,  dsc,  about  the  hip. 

The  chief  points  of  interest  in  this  case  are,  first,  its  Etiology.  The 
patient  had  received  an  injury  in  the  loins  a  number  of  years  since, 
from  a  fall,  which  had  produced  weakness  and  occasional  pain  ever 
since.     I  believe  it  is  generally  conceded,  that  exposure  to  alterna- 


1S45.]  A  Case  rf  Lumbar  Abscess.  507 


tions  of  temperature,  or  any  other  cause  which  tends  to  produce 
inlhrnmatory  action  in  the  system,  will  always  attack  the  weak  part 
first.  I  regard,  then,  in  this  case,  the  injury  as  the  remote  cause, 
inducing  a  preternatural  weakness  of  the  parts;  and  the  exposure  to 
cold  as  the  proximate  caus?  superinducing  an  inflammatory  action 
about  the  muscles  and  the  cellular  texture  beneath,  which,  from  the 
fiiilure  of  antiphlogistic  treatment  in  the  outset,  terminated  in  suppu- 
ration and  lumbar  abscess. 

Next,  the  Diagnosis.  No  scientific  physician  had  seen  tiie  patient 
for  near  two  months  prior  to  my  being  called  in.  Hence,  I  apprehend 
the  case  to  have  been  more  difticult  of  diagnosis  in  the  early  stages 
than  when  I  first  saw  him.  As  the  pain  in  each  loin  was  immediately 
over  the  kidneys,  and  psoas  abscess  is  so  unfrequentin  this  country, 
the  attention  of  the  physician  should  have  naturally  been  directed  to 
nephritis  first.  But  v/ hen  he  ascertained  that  the  secretion  of  the 
kidneys  had  not  been  disturbed  in  the  least,  it  would  not  be  strange 
for  him  to  recur  to  lumbago  or  some  spinal  afiection  for  a  solution  of 
the  ditficulty.  Had  I  formed  a  hasty  diagnosis,  founded  upon  pre- 
conceived notions  and  a  casual  examination,  the  true  pathology  of 
the  disease  would  have  remained  undiscovered,  and  by  consequence, 
the  treatment  ofsuch  a  character,  as  to  endanger  the  life  of  the  pa- 


tient. I  first  ascertained  that  the  lungs,  stomach,  liver,  kidneys,  and 
all  the  important  viscera  of  the  system  were  not  materially  diseased  : 
when  by  careful  examination  and  pressure  upon  the  loins,  I  detected 
deep  seated  fluctuation,  the  problem  was  at  once  solved,  and  the 
case  made  out.  I  was  enabled  to  encourage  the  patient  to  hopo 
for  life. 

The  third  point  of  interest,  is  the  treatment.  An  immediate  open- 
ing of  the  abscess,  (as  a  physician  subsequently  told  me  should  have 
been  his  course,)  would,  I  am  sure,  hae  effectualjy  prostrated  the 
patient.  However  difficult  maybe  the  rationale  of  the  thing,  facts 
have  established  the  principle  in  pathology,  that  a  large  quantity  of 
fluid,  v/hether  water  or  pus,  suddenly  abstracted  from  the  system, 
produces  debilitating  effects.  The  draughts  made  upon  the  vital 
powers  (already  so  much  weakened  by  disease)  to  restore  the  lost 
fluid  to  the  system  by  the  secretive  process,  produces  a  prostration 
from  which  none  but  the  strongest  constitutions  may  hope  to  recover. 
Such  was  the  fact  in  a  case  which  I  saw  while  at  Lectures,  operated 

on  by  Professor  F  < .     He  mentioned  his  apprehension  to  the 

class  at  the  time,  although  the  patient  was  able  to  walk  about,  and 


508  Extirpation  of  a  Schirrous  Tumour,       [September, 


seemed  to  have  considerable  strength.  A  large  quantity  of  matter 
was  abstracted,  and  in  two  days  the  patient  was  dead.  This,  and 
another  case  of  a  similar  character  and  history,  decided  me  in  delay- 
ing the  operation,  (until  the  very  last  point  of  time,)  and  instituting 
a  course  of  stimulants  and  tonics,  that  I  might  strengthen,  if  possible, 
the  recuperative  energies  of  the  system,  so  as  to  aid  nature  in  throw- 
ing off  the  extraneous  matter  in  a  more  gradual  manner  than  could 
have  been  effected  by  surgical  interference.  The  blisters  aided  our 
efforts  considerably  by  their  counter-suppurative  effects.  In  review- 
ing the  history,  pathology  and  treatment  of  the  case,  we  are  constrain- 
ed to  believe  that  the  recovery  of  the  patient  turned  mainly  on  the 
constant  administration  of  stimulants  and  tonics,  and  the  refraining 
from  a  sudden  abstraction  of  the  matter,  while  yet  the  system  was 
unable  to  sustain  itself,  under  an  exhausting  issue,  of  a  deep  seated 
and  large  abscess. 


ARTICLE  IV. 


'IC 


Extirpation  of  a  schirrous  tumor,  the  patient  being  in  the  Mesmeri 
state,  arid  evincing  no  sensihiUty  whatever  during  the  operation. 
By  L.  A.  DuGAs,  M.  D.,  Professor  of  Physiology,  <5'c.,  in  the 
Medical  College  of  Georgia. 

Mrs.  Clarke,  the  lady  whose  mamma  I  removed  in  January  last,* 
enjoyed  for  several  months  afterwards  an  unusual  degree  of  health. 
In  the  month  of  May,  however,  she  began  to  suffer  almost  daily  with 
slow  fever,  and  perceived  a  small  induration  in  the  adipose  tissue 
surrounding  the  region  formerly  occupied  by  the  breast.  This  soon 
assumed  the  form  of  a  distinct  tumor,  which  was  increasing  in  size 
with  some  rapidity,  and  was  becoming  painful,  when,  in  the  early 
part  of  June,  I  advised  Mrs.  C.  to  have  it  extirpated.  To  this  pro- 
posal she  readily  consented,  remarking  very  philosophically,  that  she 
would  rather  have  such  a  tumor  removed  every  six  months,  than 
permit  it  to  remain  and  grow  on  her.  There  was  no  evidence  of 
disease  in  the  axilla. 

I  now  requested  Mr.  Kenrick  to  ascertain  whether  he  could  still 

  Ca^e  published  in  the  March  Iso.  of  this  Journa]. 


1845.]  Extirpation  of  a  Shir rous  Tumour.  509 


mesmerise  her,  and,  if  she  were  susceptible,  to  repeat  the  operation 
a  few  days,  so  that  we  might  test  her  sensibility  in  that  state.  Mrs. 
C.  was  readily  put  into  the  mesmeric  state,  and  found  to  be  entirely 
insensible  during  its  continuance.  Deeming  it  unnecessary  to  repeat 
the  tests,  I  determined  to  operate  on  the  13th  June,  several  days 
sooner  than  was  expected  by  either  herself  or  her  friends.  The 
operation  was  performed  in  presence  of  Professors  L.  D.  Ford  and 
Jos.  A.  Eve,  Drs.  L.  Kennon  and  J.  F.  Hammond,  the  Rev.  Mr. 
Alfred  Ford  and  Mr.  F.  J.  xAIartin.  The  patient  was  mesmerized  at 
9  o'clock,  A.  M.,  and  the  extirpation  effected  at  about  10  o'clock,  by 
making  a  semilunar  incision  along  a  portion  of  the  circumference  of 
the  tumor,  turning  over  a  flap,  and  dissecting  away  the  indurated  mass 
and  surrounding  tissues,  making  up  the  volume  of  a  hen's  egg. 

During  the  operation,  Mr.  Kenrick,  being  biind-folded  to  avoid  the 
unpleasant  spectacle,  sat  by  the  patient,  with  her  hands  in  his.  Mr. 
K.  avers  that  Mrs.  C.  evinced  no  uneasiness  by  grasping  his  hands, 
that  her  fingers  did  not  twitch,  and  in  short,  that  her  hands  remained 
perfectly  passive.  Prof.  Ford,  whom  I  had  requested  to  note  the 
pulse  and  respiratory  act  particularly,  informs  me  that  there  was  no 
appreciable  change  in  their  character  and  frequency  before,  during 
and  after  the  operation.  The  countenance  of  the  patient  and  the 
hue  of  her  cheeks  presented  no  change  whatever,  nor  was  there  iho 
least  indication  of  sensibility  detected  during  or  subsequently  to  the 
operation,  by  those  who  were  present  and  anxiously  watching  the 
result.  There  was  neither  twitching  of  the  pectoral  muscle  when 
touched  with  the  sponge,  nor  tremor  of  the  lower  jaw.  Indeed  the 
patient  slept  on  as  quietly  as  an  undisturbed  infant,  through  the  entire 
operation. 

The  wound  v/as  left  open  about  half  an  hour,  a  small  vessel  ligated 
and  the  ordinary  dressing  applied.  The  patient  was  permitted  to 
sleep  on,  and  awoke  spontaneously  at  a  quarter-past  1  o'clock,  P.  M., 
in  the  presence  of  Dr.  Ford,  the  Rev.  Mr.  Ford,  Mr.  Kenrick  and 
myself.  Dr.  Kennon  arrived  a  moment  afterwards.  She  appeared 
entirely  unconscious  of  what  had  been  done,  and  was  much  surprised 
as  well  as  gratified,  on  being  informed  that  the  operation  was  over. 
She  stated  that  she  had  not  suspected  our  design,  and  had  no  recollec- 
tion of  having  experienced  the  least  uneasiness  during  her  nap. 

I  will  add  on  this  occasion,  as  I  did  on  reporting  the  former  case, 
that  the  above  statement  has  been  submitted  to  all  the  professional 
gentlemen  present,  and  that  they  fully  concur  in  its  accuracy.     This 


10  Diseases  of  the  CcBcum.  [September, 


is  perhaps  the  only  instance  on  record  in  which  avserious  and  painful 
operation  has  been  twice  performed  on  the  same  individual  in  the 
mesmeric  state,  a  circumstance  that  may  lend  it  additional  interest 
with  those  who  are  disposed  to  collect  facts  on  an  interesting  subject. 
Augusta,  1st  Julv,  1845. 


PART  IL REVIEWS  AND  EXTRACTS. 

Cases  ilJnslrotive  of  the  Diseases  of  the  Ccccvm  and  its  Appendix^ 
By  EusoN  Caer,  M.  D.^of  Canandaigiia,  N.  Y. 

The  cscum  has  manifestly  an  individuality  both  of  function  and 
disease  having  otTices  to  perform  in  some  respects  quite  pecuh'ar  lo 
itself,  while  it  is  subject  to  frequent  derangements  and  fataldiseases, 
m  which  no  other  portion  of  the  digestive  apparatus  is  implicated. 

While  the  former  have  received  fiir  less  consideration  than  their 
relative  importance  would  seem  to  demand,  the  latter  can  scarcely 
be  said  to.bave  a  place  in  our  systematic  practical  works. 

A  Monograph  by  Dr.  John  Burne,  an  article  in  Copland's  Diction- 
ary of  Practical  Medicine,  and  the  cases  which  are  detailed  in  Du- 
])uytren's  Clinical  Lectures,  embrace  nearly  all  that  has  fallen  under 
Hiy  notice  upon  this  interesting  class  of  affections  ;  with  the  exception 
of  sin"-le  cases  which  occasionally  appear  scattered  through  our  peri- 
odicals. 

If  we  take  but  a  very  superficial  view  of  this  organ,  its  situation 
and  capacity,  its  attachment  to  the  parietes  of  the  abdomen,  so  con- 
fining it  that  its  relative  position  admits  of  no  change,  and  the 
circumstance  that  its  contents  are  moved  forward  in  opposition  to 
the  laws  of  gravitation,  it  must  be  evident  that  the  alimentary  sub- 
stances were  designed  to  remain  here  longer  than  in  any  other 
portion  of  the  alimentary  canal. 

These  considerations  have  very  naturally  suggested  the  idea  that 
the  caecum  constitutes  a  kind  of  second  stomach. 

Aiiain.  if  we  examine  a  little  more  carefully  into  its  organization, 
we  find  the  caecum  liberally  furnished  with  large  follicular  glands, 
evidently  designed  for  the  abundant  secretion  of  important  fluids, 
while  the  entire  organ,  with  its  appendix,  is  more  richly  supplied  with 
arterial  blood  than  any  other  portion  of  the  intestinal  canal.  It 
appears  from  the  experiments  of  Tiedemann  and  Gmelin,  that  these 
follicular  glands  ''secrete  an  acid,  albuminous  and  solvent  fluid, 
which  mixes  with,  and  promotes  the  digestion  of  those  portions  of 
aliments  which  have  withstood  the  action  of  the  stomach  and  small 
intestines,  or  have  been  insufficiently  changed  by  them.*'     We  may 


1S45.]  Diseases  of  the  CcBcum  511 


also  remark  that  the  contents  of  the  alimentary  canal  first  acquire 
their  peculiar  fecal  odor  in  the  caecum.  This,  according  to  tho 
researches  of  the  same  physiologists,  depends  upon  an  oily  volatile 
substance  secreted  by  the  mucous  follicles.  And  we  think  it  highly 
probable  that  the  appendix  performs  an  important  pan  of  this  work, 
since,  when  examined  in  its  natural  condition,  it  is  generally  found 
to  contain  a  portion  of  this  material.  Indeed,  we  think  it  would  be 
difficult  to  assign  a  more  probable  function  to  this  organ;  inasmuch 
as  its  formation  is  such  as  to  preclude  ihe  idea  of  the  alimentary  sub- 
stances  entering  it,  while  the  large  supply  of  blood  sent  to  it  must 
plainly  bespeak  for  it  a  more  important  office  than  merely  affording  a 
convenient  retreat  for  such  unlucky  cherry  stones  and  the  like,  as 
may  chance  to  escape  from  their  destined  course. 

It  farther  appears  probable  from  the  experiments  of  Tiedeman  and 
Gmelin,  that  the  ccecum  performs  the  additional  function  of  secreting 
"chiefly  from  its  numerous  follicles,  an  unctious  fluid  for  the  protection 
of  the  surfaces  of  the  large  bowels  from  the  irritating  eflects  of  the 
fecal  matters  passing  along  them,"  and  that  the  constituents  both  of 
this  and  of  the  other  secretions  poured  out  from  its  surface,  consist  of 
elements  which  require  to  be  eliminated  from  the  blood;  so  that,  in 
addition  to  its  other  functions,  it  is  also  a  depurating  organ. 

We  may  reasonably  infer  from  the  foregoing  considerations  that 
the  caecum  is  an  ipnportant  organ,  whose  functions  can  neither  be 
suspended  nor  suffer  material  derangement,  without  serious  detri- 
ment to  the  animal  economy. 

My  own  observations  lead  me  to  apprehend  that  such  disturbances 
occur  much  more  frequently  than  it  has  generally  been  supposed. 
Such  suspension  or  modified  function  may  result  from  various  causes, 
as  defective  nervous  stimuli,  the  unnatural  stimulus  of  crude  undi- 
gested  food,  unhealthy  secretions  of  theprimas  viae,  or  sympathetic 
relation  Vvilh  some  other  organ,  in  a  pathological  condition.  The 
following  case  will  perhaps  sufTiciently  illustrate  the  most  simple 
form  of  such  derangement: 

Case  I.  Mrs.  B.,  now  thirty-seven  years  of  age,  experienced 
slight  inconvenience  early  in  the  summer  of  1828,  from  dyspeptic 
symptoms,  which  readily  subsided  under  a  regulated  diet.  From 
early  childhood  to  that  period,  she  had  never  suffered  from  any  serious 
indispositi6Vi.  She  scon  lost  her  ruddy  complexion,  her  usual  elasti- 
city and  strength  began  to  decline,  her  lips  and  tongue  became  pale, 
and  a  general  disinclination  to  physical  and  mental  exerti'on  soon 
followed.  But  the  more  remarkable  circumstances  manifested  in 
this  case,are  a  slight  uneasiness  seldom  amounting  to  pain,  frequently 
felt  in  the  region  of  the  caecum,  and  ascending  colon,  attended  with 
an  evolution  of  gas  which  escapes  entirely  without  odor,  while  the 
fecal  matters,  which  are  quite  natural  in  appearance,  with  iheexcep. 
tion  of  perhaps  being  slightly  softer  than  common,  are  generally 
entirely  wanting  in  fecal  odor. 


512  Diseases  of  the  Civcum,  [September, 


This  state  of  things  has  continued  with  but  short  intervals  of  in- 
terruption for  more  than  sixteen  years.  During  this  period  she  has 
had  a  good  appetite,  with  no  unnatural  thirst,  and  daily  motions  of 
the  howels  without  the  use  ofnaedicine.  The  uterine  functions  have 
been  uniformly  healthy.  She  has  borne  four  children  during  the 
time.  Menstruation  has  never  been  interrupted  except  diu'ing  preg- 
nancy and  nursing.  It  has  never  varied  materially  in  time,  quantity 
or  quality,  and  has  never  been  attended  with  pain  or  any  appreciable 
constitutional  disturbance.  She  has  never  suffered  from  leucorrhoea, 
or  indeed  from  any  other  indisposition  than  the  above  described. 

Several  intelligent  members  of  the  profession  have  been  consulted 
in  this  case,  and  the  functions  of  every  organ  in  the  body  have  been 
faithfully  interrogated  and  carefully  watched,  and  yet  no  one  has  been 
able  to  form  a  satisfactory  opinion  as  to  the  cause  of  these  peculiar 
phenomena. 

The  observations  of  Dr.  Copland  upon  the  functional  derange- 
ments of  the  caecum,  seem  to  throw  some  light  upon  this  and  similar 
cases,  and  make  it  appear  at  least  probable  that  these  peculiarities 
depend  on  such  derangement.  If  the  views  which  are  entertained 
in  regard  to  the  functions  of  the  caecum  be  correct,  there  will  be  no 
ditTiculty  in  coming  to  such  conclusion. 

I  might  here  introduce  several  other  cases  which  would  seem  to 
confirm  the  correctness  of  the  views  above  presented,  but  perhaps 
this  may  be  sufficient  to  direct  the  attention  of  other  and  more  com- 
petent inquirers  to  its  investigation. 

I  will  however  remark,  that  I  had  an  opportunity  about  a  year 
since,  of  making  an  examination  of  a  case  ift  which  the  leading 
symptoms  had  for  a  long  time  been  similar  to  the  one  already  descri- 
bed. In  this  instance,  death  was  occasioned  by  the  sudden  super- 
vention of  acute  gastro-enteritis.  The  lower  part  of  the  ilium,  the 
caecum,  and  a  small  part  of  the  ascending  colon  were  found  very 
much  hypertrophied,  the  parietes  of  the  cascum  measuring  over  two 
lines  in  thickness,  while  the  cavity  of  the  appendix  was  so  nearly 
obliterated  as  barely  to  allow  the  introduction  of  a  small  probe. 

Dr.  Copland  remarks,  that  "  when  the  vital  energies  are  weakened 
and  the  alimentary  canal  debilitated,  the  caecum  often  betrays  greater 
disorder  than  any  other  part  of  the  digestive  system.  Its  situation 
and  functions  will  accoimt  .for  the  frequency  and  importance  of  its 
diseases.  In  some  cases,  the  irritation  produced  by  morfld  or  accu- 
mulated matters  in  it  are  slight,  and  readily  productive  of  sufficient 
reaction  of  its  muscular  coats  to  propel  them  along  the  colon.  In 
other  instances,  the  efforts  made  to  accomplish  this  end,  owing  to  the 
obstructions  occasioned  by  the  lodgment  of  flatus  about  the  right 
flexture  of  the  colon,  or  by  irregular  spasmodic  contractions  of  this 
bowel,  are  ineffectual,  and  give  rise  to  colicky  pains.  If  the  inter- 
ruption  is  removed,  disorder  soon  subsides  ;  but  if  it  continues  for  any 
considerable  time,  the  more  violent  forms  of  colic  or  ileus  supervene." 

The  two  following  cases,  while  they  corroborate  the  foregoing  re- 


1845.]  Diseases  of  the  CcBcum.  513 


marks,  have  some  points  of  peculiar  interest  as  illustrating  the 
fact,  that  the  bowels  may  be  freely  evacuated  with  active  cathartic 
medicine,  while  substances  remain  impacted  in  the  caecum  undis- 
turbed. 

Case  II.  On  the  7th  Aug.,  1835, 1  visited  Saugur  Brockelbank, 
a  lad  thirteen  years  old.  who  had  complained  for  two  or  three  days 
with  colicky  pains.  He  had  taken  salts,  castor  oil  and  cathartic 
pills,  which  had  operated  well,  but  without  relieving  the  pain. 

I  learned  that  four  days  previous  to  this  time,  he  had  eaten  freely 
of  choke  cherries  (prunus  virginiana).  On  examining  the  abdomen, 
he  seized  my  hand  as  it  approached  the  right  iliac  region,  exclaiming 
that  it  was  very  sore.  Careful  examination  discovered  a  distinct 
circumscribed  fullness  and  hardness  over  the  cajcum.  He  complain- 
ed of  thirst  and  head-ache  ;  pulse  eighty-four,  and  rather  hard. 

Pres.  V.  s.  gxv.,  calomel  ten  grs.  to  follow  in  three  hours,  with 
castor  oil.     Warm  fomentations  to  the  bowels. 

8th.  His  bowels  have  been  freely  moved  several  times.  Soreness 
over  the  caecum  still  continues;  pulse  ninety-two,  v.  s.  repeated; 
calomel  four  grs.,  with  one-eighth  gr.  morphine  to  be  repeated  every 
six  hours.     Blister  to  the  seat  of  the  soreness. 

9th.  Bowels  have  not  been  moved  since  yesterday  ;  pulse  ninety- 
two  ;  tongue  slightly  coated^vith  a  white  creamy  covering;  pres. 
calomel  five  grs.,  to  be  followed  with  castor  oil  in  four  hours.  Blis- 
ter to  be  dressed  with  warm  poultice  of  slippery  elm. 

10th.  Soreness  rather  increased;  bowels  moved,  but  slightly; 
pulse  ninety. four,  small  and  quick  ;  pres.  calomel  and  Dover's  powder, 
each  three  grs.  every  four  hours,  and  fomentations  to  the  bowels. 

11th.  Has  had  two  slight  motions  of  the  bowels  without  fecal 
odor.  Calomel  and  Dover's  powders  continued  ;  blister  renewed  and 
to  be  dressed  with  slippery  *elm  poultice. 

Evening.  His  bowels  have  been  moved  several  times  during  the 
day;  no  fecal  odor;  complains  of  thirst,  tongue  heavily  coated  but 
not  dark  ;  five  grs.  of  Dover's  powder  every  four  hours. 

12th.  Relieved  from  pain  by  Dover's  powder,  but  not  otherwise 
improved  ;  calomel  and  Dover's  powders  every  four  hours,  blister 
renewed. 

loth.  Tongue  more  thickly  coated;  pulse  ninety-six,  small  and 
quick;  pres.  cal.  five  grs.,  to  be  followed  in  three  hours  with  salts 
and  senna,  and  in  three  hours  the  following  enema  to  be  administered : 

R.  castor  oil  ij.,  spts.  terebinth  si.,  warm  water  one  pint. 

Evening.  The  bowels  have  moved  freely  several  times  during  the 
day.  The  evacuations  contained  what  the  mother  termed  "a  hand- 
ful of  cherry  stones,  which  had  remained  so  long  that  they  smelt 
very  bad." 

From  this  time  the  soreness  began  to  subside,  and  his  recovery 
was  rapid  and  uninterrupted. 

Can  there  be  any  doubt  that  in  this  case,  the  cherry  stones  were 

83 


514  Diseases  of  the  CcBcuTn,  [September, 


lodged  in  the  csecutn  during  the  nine  days  which  intervened  between 
the  time  of  eating  and  discharging  them? 

Case  III.  At  1,  A.  M.,  August  17,  1S40,  I  was  called  to  R.  B., 
aged  20.  He  complained  of  excruciating  pain  in  the  abdomen,  with 
nausea,  retching,  anxious  countenance,  features  much  contracted, 
pulse  110,  quick,  small  and  tense ;  the  whole  abdomen  extremely 
painful  to  the  touch.  He  had  been  troubled-  for  several  days  with 
diarrhoea,  attended  with  occasional  griping  pains.  For  the  last 
twenty-four  hours,  he  had  felt  a  dull  aching  pain  in  the  bowels,  which 
was  increased  while  in  the  erect  posture,  and  greatly  aggravated  by 
any  slight  jar,  as  in  walking.  But  the  severe  pain  came  on  sud- 
denly on  rising  from  his  bed  jus^ before  I  was  called,  at  which  time 
he  experienced  a  smart  chill.  I  took  from  the  arm  thirty-six  ounces 
of  blood,  gave  him  fifteen  grains  of  calomel  combined  with  one-half 
grain  of  morphine,  and  hot  fomentations  were  applied  to  the  bowels. 
6  o'clock  pain  and  nausea  slightly  relieved,  but  the  soreness  of  the 
bowels  continued.  Bleeding  repeated  to  twenty  ounces,  which  oc- 
casioned fainting:  calomel  ten  grs.  and  Morphine  one-half  gr.:  fo- 
mentations continued,  and  a  mixture  of  calc.  magnesia  3ij,  aromat. 
syrup  of  rhubarb,  i  i ;  to  be  given  in  three  hours. 

2  P.  M.,  pulse  127.  Soft  and  compressible,  pain  much  relieved. 
By  means  of  a  flexible  tube  passed  into  the  colon,  the  following 
enema  was  administered:  R.  castor  oil,  ij;  spts.  turpentine,  i; 
warm  water,  three  pints.  This  passed  off  in  the  course  of  three 
hours,  with  some  fecal  matter. 

9  P.  M.,  pain  much  diminished  and  entirely  confined  to  the  right 
iliac  region,  where  a  distinct  circumscribed  fulness  and  hardness  was 
perceptible.  Calomel,  three  grs.;  morphine,  one-fourth  gr.;  to  be 
given  every  four  hours. 

18th.  Morning.  Pain,  soreness  and  -swelling  over  the  caecum, 
considerably  increased  ;  pulse  130,  small  and  quick.  An  injection 
of  warm  water  and  castor  oil  produced  a  small  fecal  evacuation, 
without  odor.  Calomel  and  morphine  continued  ;  about  four  oz.  of 
blood  was  taken  from  the  region  of  the  caecum  by  cupping,  and  fo- 
mentations to  the  seat  of  pain. 

2  P.  M.  Pain  somewhat  relieved ;  blister  applied  to  the  scat  of 
pain. 

9.  Evening,  pain  much  relieved.  Injections  repeated,  but  with 
slight  effect  calomel  3  grs.,  Dov.  powder  4  grs,  to  be  given  every 
four  hours.     Blister  to  be  dressed  with  slippery  elm  poultice. 

19th.  Morning.  Rested  well :  free  from  pain,  pulse  120,  soft  and 
compressible.  Tongue  slightly  covered  with  moist  white  fur.  A 
mixture  of  castor  oil,  g  i.,  and  an  equal  quantity  of  aromatic  syrup  of 
rhubarb,  to  be  given  directly. 

2  P.  M.  Has  had  rather  a  scanty  evacuation,  tinged  with  bile, 
with  slight  ftecal  odor  ;  feels  much  relieved. 

8  o'clock.  Evening.     Pulse  110,  soft  and  compressible;  bowels 


1S45.]  Diseases  of  the  Ccecinn.  515 


have  been  freely  evacuated ;  foecal  odor,  strongly  marked.  5  grs. 
Dov.  powder  to  be  given  for  the  night. 

20th.  Morning.  Has  had  a  tolerable  night's  rest;  pulse  110; 
bowels  acted  freely ;  complains  of  soreness,  and  some  deep  seated 
pains  in  the  region  of  the  caecum.  Blister  dressed  with  mercurial 
ointment. 

Evening.  Pulse  100;  swelling  and  soreness  still  continues;  cam- 
phor and  opium  pill  to  ba  given  at  bed  time.  Mercurial  dressing 
continued. 

21st.  Still  complains  of  dull,  deep  seated  pain  ;  pulse  100;  cam- 
phor and  opium  pill;  mercurial  dressings  continued. 

Evening.  Pain  continues;  pulse  more  full  and  hard;  tongue 
more  coated,  with  edges  very  red  ;  colon  distended  with  iv.  castor 
oil,  in  five  pts.  warm  water.  This  brought  away  an  apple  seed,  with 
some  flakes  of  hardened  faecal  matter  which  appeared  as  if  broken 
from  a  hard  mass.  Pres.  Dov.  powder  and  calomel  aa  5  grs.  to  be  re- 
peated every  four  hours. 

22d.  Morning.  Has  had  a  quiet  night ;  pulse  100  ;  tongue  Iboks 
belter;  swelling  and  soreness  much  relieved  ;  skin  has  been  in  a 
moist  state  during  most  of  the  night.  Has  had  a  large  evacuation 
of  offensive  foecal  matter,  with  several  hardened  lumps  in  which  were 
found  a  number  of  whole,  unripe  blackberries.  On  inquiry,  no  fruit 
of  the  kind  had  been  taken  since  the  Saturday,  a  week  before  his 
illness. 

Evening.  Has  had  several  evacuations  during  the  day,  with  frag- 
ments of  hardened  faecal  matter,  containing  numerous  seeds  of  black- 
berry. 

From  this  time  he  began  gradually  to  recover,  although  it  was 
several  weeks  before  the  soreness  and  swelling  had  so  far  subsided  as 
to  allow  of  his  returning  to  business. 

He  has  since  had  several  slight  attacks  of  pain  and  soreness  in  the 
region  of  the  Ccecum  from  error  in  diet,  which  have  readily  yielded  to 
prompt  treatment. 

We  may  remark  that  in  both  of  these  cases,  during  the  time  in 
which  foreign  substances  remained  impacted  in  the  caecum,  although 
the  bowels  had  been  repeatedly  freely  acted  upon  by  medicine,  there 
was  almost  an  entire  absence  of  foecal  odor  in  the  alvine  discharges. 
I  have  noticed  the  same  circumstance  in  several  other  similar  cases, 
and  recognized  the  reappearance  of  the  odor,  as  one  of  the  earliest 
symptoms  of  anything  like  permanent  relief.  ^ 

Case  IV.  On  the  evening  of  the  29tli  of  August,  1835,  I  visited 
Miss  ,  a  young  lady,  16  years  of  age.     She  had  suffered  from 

slight  headache,  for  two  or  three  days.  Four  days  previous,  while 
walking  in  the  garden,  she  had  taken  several  unripe  plums,  since 
whicli  lime  she  has  had  no  motion  of  the  bowels.  I  attributed  her 
headache  to  this  circumstance,  and  directed  castor  oil  and  aromatic 
syrup  of  rhubarb,  of  each  one  ounce. 


516  Diseases  of  the  C(Bcum.  [September, 


80th.  She  has  had  no  motion  of  the  bowels :  headache  continues ; 
pres.  R.  Calc.  magnesia  3i.;  spts.  ammon.  aromat.,  3i.;  mintwater, 
i.;  to  be  taken  directly,  and  repeated  in  three  hours  if  required. 

Evening.  Medicine  has  had  no  effect,  and  the  following  was  or- 
dered ;  calomel  8  grs.,  com.  ext.  colocynth  12  grs.,  and  should  this 
have  no  effect,  it  may  be  repeated  in  six  hours. 

31st.  Her  medicine  has  had  no  effect ;  complains  of  pain  in  the 
bowels.  On  examination,  I  discovered  tenderness  and  slight  fullness 
in  the  right  iliac  fossa.  V.  S.  sxvi.  fomentations  to  the  abdomen, 
and  an  enema  to  be  administered  directly,  and  should  there  be  no 
motion  of  the  bowels  in  three  hours,  the  following  mixture  to  be  given  : 
castor  oil,  si,  aromatic  syrup  of  rhubarb,  |ss,  with  the  addition  of 
two  drops  of  croton  oil. 

From  this  time  to  the  third  of  September,  being  ten  days  from  the 
time  she  had  taken  the  plums,  although  ordinary  means  have  been 
resorted  to,  such  as  bleeding,  blistering,  warm  baths,  enemas  and 
active  cathartics,  no  passage  of  the  bowels  had  been  effected. 

At  the  request  of  Dr.  Bristol,  who  was  now  called  in  consultation, 
the  croton  oil,  warm  bath  and  enema  were  repeated,  but  all  with  no 
effect. 

Sept  4th.  The  soreness  and  pain  have  increased  during  the  night: 
tongue  loaded  with  a  heavy  white  coat ;  pulse  88,  quick  and  small ; 
calomel  and  Dover's  powder  each  three  grs.  every  three  hours.  About 
noon  she  experienced  a  sYnart  chill,  which  was  followed  by  severe 
pain  and  exquisite  tenderness,  which  spread  rapidly  over  the  whole 
abdomen. 

Drs.  Cheney  and  Bristol  were  now  called  in  consultation.  The 
stomach  had  become  sa  irritable  as  to  reject  every  thing  taken  into  it, 
and  the  rectum  so  sensitive,  that  enemas  by  an  ordinary  syringe 
could  not  be  retained,  and  it  was  proposed  to  distend  the  colon  freely 
by  means  of  a  long  flexible  tube.  In  attempting  to  pass  this  into 
the  colon,  I  met  with  a  difficulty  which  I  had  frequently  encountered 
in  similar  attempts. 

When  the  tube  reaches  the  angle  which  the  intestine  makes,  in 
passing  over  the  psosas  muscle  and  common  iliac  artery,  it  meets  the 
side  of  the  gut,  nearly  at  a  right  angle,  and  after  forcing  the  intestine 
before  it  as  far  as  its  loose  folds  at  this  point  will  allow,  the  tube  is 
doubled  upon  itself,  some  two  or  three  inches  from  its  point,  and 
broken.  That  this  is  the  nature  of  the  difficulty,  which  frequently 
occurs  in  passing  a  flexible  tube  into  the  colon,  I  have  satisfied  my- 
self by  laying  open  the  abdomen  of  the  dead  subject,  and  introducing 
it  with  the  intestine  exposed  to  view.  Indeed,  I  think  it  requires  espe- 
cial good  luck,  as  well  as  dexterous  mancEuvering,  to  be  able  in  all 
cases  to  pass  an  elastic  gum  tube  into  the  colon,  although  from  the 
representations  of  Mr.  O'Beirn  and  some  others,  it  seems  quite  other- 
wise. 

In  order  to  satisfy  myself  whether  there  was  any  unnatural  ob- 
struction in  this  case,  I  took  a  common  rectum  sound,  and  passed  it 


1845.]  Diseases  of  the  Caciim.  517 


into  the  colon  without  difficulty.  It  now  occurred  to  me  that  a  flex- 
ible metallic  tube,  made  in  shape  similar  to  the  sound,  might  be 
introduced  without  trouble.  I  accordingly  prepared  one  the  size  of 
a  large  catheter,  with  an  egg  shaped  bulb  upon  the  end,  pierced  with 
several  holes  like  the  tube  of  the  womb-syringe  passed  it  into  the 
colon,  attached  it  to  the  tube  of  Reed's  double  valve  pump,  and 
gradually  distended  the  colon  with  a  mixture  of  castor  oil  ^iv.,  spts. 
turpfentine  i.  and  five  pts.  warm  water.  This  soon  passed  off,  and 
with  it  a  large  quantity  of  dark  fcEcal  matter,  containing  several  balls 
of  black,  hardened  faecal  matter,  about  the  size  and  in  appearance 
not  unlike  the  black  walnut.  The  evacuations  were  attended  with 
alarming  fainting,  but  were  soon  followed  by  relief  from  all  pain  and 
threatening  symptoms. 

The  three  preceding  cases,  I  apprehend,  furnish  us  with  examples 
of  the  most  common  causes  of  acute  inflammation  of  the  caecum, 
viz.  foreign  indigestible  substances,  or  hardened  faecal  matter,  im- 
pacted in  the  caput  coli. 

Mr.  John  Burne,  Physician  to  the  Westminster  Hospital,  in  an 
article  published  in  the  20th  vol.  of  the  Medico-Chirurgical  Transac- 
tions, has  given  a_  history  ofeight  very  interesting  cases  of  this  disease. 
He  tells  us  he  has  seen  not  less  than  twenty  cases,  in  all  of  which  he 
has  not  seen  a  single  example  of  the  idiopathic  inflammation  of  the 
caecum  from  the  ordinary  general  causes  exposure  to  the  vicissitudes 
of  weather,  &;c.  "But  every  instance  has  been  symptomatic  of 
some  mechanical  exciting  cause,  as  the  lodgment  of  undigested  food, 
of  fruit  stones  or  of  concretions  which  the  structure  of  the  caecum 
and  appendix  favors ;  and  hence  the  peculiar  features  of  the  disease." 
It  not  unfrequently  happens,  that  after  an  attack  of  acute  inflamma- 
tion of  the  caecum,  induced  by  some  foreign  substance  impacted  in 
its  cavity,  the  natural  powers  of  the  organ  are  but  slowly  regained  ; 
hence  it  is  subject  to  renewed  attacks  from  any  trifling  error  in  diet, 
or  slight  exposure  to  cold.  Such  cases  often  become  exceedingly 
troublesome  and  difficult  to  manage.  The  following  is  an  instance 
of  the  liabihty  to  a  recurrence  of  this  kind  : 

Case  V.  On  the  evening  of  June  13,  1843,  Miss  E.  J.  W.,aged 
17,  was  seized  with  pain  in  the  bowels,  which  was  attributed  to  her 
having  eaten  freely  of  unripe  gooseberries  during  the  preceding 
afternoon.  Lsaw  her  early  on  the  morning  of  the  14th.  Her  coun- 
tenance was  indicative  of  severe  suffering.  She  had  taken  a  full 
dose  of  Gregory's  Mixture  (magnesia,  rhubarb  and  ginger),  which 
was  rejected.  The  pain  was  referred  to  the  umbilical  region  ;  pulse 
88,  full  and  sharp  ;  pres.  V.  S.  xx.  calomel  gr.  10.  Morphine  gr.  |. 
Hot  fomentations  to  the  abdomen. 

I  saw  her  again  in  three  hours.  Her  medicine  had  been  retained, 
although  there  had  been  some  retching.  Pulse  84,  pain  somewhat 
abated;  pres.  calomel  5  grs.  Morph.  l-3gr.   F'omcntations  continued. 

3  o'clock,  P.  M.     She  complains  much  less  of  pain.     Skin  moist ; 


51S  ~         Diseases  of  the  CcBcum,  [September, 


tongue  slightly  coated  with  moist  white  fur ;  pulse  84,  soft ;  pres. 
half  a  Seidlitz  powder,  to  be  repeated  ever}'  hour,  in  hot  water.  Fo- 
mentations to  be  continued. 

9  P.  M.  Medicine  has  been  retained,  but  there  has  been  no  motion 
of  the  bowels.  Slight  pain  still  complained  of  in  the  umbilical  region. 
Abdomen  soft;  moderate  pressure  occasions  no  pain  except  over  the 
csBcum,  where  there  is  an  evident  fulness,  quite  tender  to  the  touch. 
Pres.  an  enema  of  castor  oil  and  warm  water,  to  be  administered 
directly.  Cal.  and  Dov.  powd.  each  grs.  iii.,  to  be  given  every  four 
hours.     Fomentations  to  be  continued. 

15ih.  Slie  has  passed  a  comfortable  night;  had  a  slight  motion  of 
the  bowels  soon  after  the  enema,  with  some  dark  Itecal  matter. 
TJhe  pain  has  entirely  receded  to  the  right  iliac  fossa,  where  it  re- 
mains constant  but  not  severe.  Soreness  not  diminished  ;  tongue 
more  thickly  coated,  but  white  and  moist.  Pres,  blister  over  the 
caecum.  Half  a  Seidlitz  powder  every  hour  and  an  enema  to  be 
repeated  every  third  hour,  until  free  evacuations  shall  be  procured, 

Eveninii;.  She  has  had  several  small  evacuations  of  a  greenish 
ftuid  with  no  solid  faecal  matter.  Pres.  5  grs.  Dov.  Powd.,  to  be 
given  every  three  hours.  Simple  dressing  to  the  blister,  over  which 
is  to  be  laid  a  warm  bran  poultice. 

16ih.  She  has  had  a  quiet  night,  free  from  pain.  Skin  moist. 
Pres.  The  follovv'ing  enema  to  be  administered  directly :  Castor 
oil  iij.,  spirits  turpentine  fij.,  warm  water  two  pints. 

2  P.  M.  In  the  course  of  the  forenoon,  she  had  several  evacua- 
tions of  dark  faecal  matter  in  which  there  were  several  hard  masses 
containing  portions  of  several  partially  digested  gooseberries.  Pres. 
Hnlf  a  Seidlitz  powder  every  two  hours. 

Evening.  She  has  had  several  evacuations  of  greenish  faecal 
matter  during  the  afternoon.     Pres.  5  grs.  Dov.  Powder. 

17th.  Convalescent. 

On  the  8th  of  June,  1844,  a  similar  attack  occurred  after  eating 
unripe,  or  but  partially  ripened  cherries.  Under  a  similar  course 
of  treatment  she  got  relief  on  the  4th  day  after  the  attack,  but  the 
soreness  and  tumefaction  subsided  much  more  slowly  than  in  the 
first  instance. 

On  the  14tb  of  Sept.  following  she  was  seized  in  the  same  way  
but  the  case  proved  much  more  obstinate  than  in  either  of  the  former 
attacks,  yielding  to  the  treatment  on  the  15th  day  after  its  com- 
mencement. 

On  the  3d  of  Dec.  of  the  same  year,  she  had  a  recurrence  without 
any  knov.-n  cause,  except  a  bad  cold,  under  which  she  had  been 
suffering  several  days.  This  lasted  until  the  21st,  or  eighteen  days 
from  its  commencement.  From  this  time  until  the  following  spring, 
she  was  constantly  troubled  with  constipation  of  the  bowels,  attended 
with  flatulence,  together  with  more  or  less  tenderness  and  pain  in 
the  caecum  and  ascending  colon.  Her  general  health  suffered  ma- 
terially until  the  28d  of  April,  1845^  when  she  had  another  attack, 


1845]  Diseases  of  the  CcBCum.  519 


attended  with  more  acute  inflammatory  symptoms  than  either  of  the 
former,  involving  the  peritoneum  to  considerable  extent.  This 
occurred  in  three  or  four  hours  after  eating  boiled  cabbage.  By 
the  use  of  an  emetic  most  of  this  was  thrown  off  from  the  stomach, 
in  an  undigested  state,  together  with  a  quantity  of  green  bile.  The 
inflammation  subsided,  under  active  treatment,  in  the  course  of  six 
days,  and  the  bowels  slowly  regained  their  natural  powers  so  far  as 
to  be  comfortable  under  a  carefully  regulated  diet,  with  the  occasional 
use  of  tonic  laxatives. 

We  occasionally  meet  with  instances  in  which  the  vermiform  ap- 
pendix seems  to  be  the  principal  seat  of  the  primary  disease.  This 
is  generally  occasioned  by  the  accidental  intrusion  of  some  small, 
hard  substance  into  its  cavity,  which  its  free  communication  with  the 
caecum  readily  allows;  while  there  is  no  way  of  escape  but  by  a 
retrogade  movement.  Whether  this  oi-gan  has  the  power  of  expelling 
offending  matter  in  this  way  or  not,  it  is  well  known  that  they  some- 
times become  impacted  in  this  narrow  tube,  giving  rise  to  irritation 
and  inflammation,  which  result  in  perforative  ulceration  of  its  coats 
with  most  disastrous  consequences. 

Mr.  Copland  mentions  having  seen  four  cases  of  this  description, 
where  the  appendix  was  primarily  and  chiefly  affected,  owing  to  hard 
substances  having  escaped  into  it.  All  of  these  cases  terminated 
in  general  peritonitis  and  gangrene  of  the  appendix. 

It  appears  from  his  description  of  this  affection,  that  in  the  cases 
which  he  has  seen,  the  symptoms  from  the  beginning  were  more 
acute  than  in  inflammation  of  the  caecum  itself.. 

Two  well  marked  instances  of  this  affection  have  fallen  under 
my  observation,  one  of  which  was  occasioned  by  the  presence  of  two 
l)iliary  concretions  lodged  in  the  appendix.  The  symptoms  in  these 
cases  were  less  urgent  than  in  those  related  by  him ;  although  the 
sequel  was  the  same. 

Case  VI.  This  occurred  in  a  young  man  about  17  years  of  age, 
while  attending  school  at  the  Canandaigua  Academy.  I  first  saw 
him  on  Tuesday,  June  6,  1837.  He  complained  of  sickness  at  the 
stomach,  and  pain  in  the  umbilical  region.  He  attributed  his  illness  , 
to  the  eating  of  oranges  on  the  previous  evening.  I  gave  him  calo- 
mel and  rhubarb,  of  each  10  grains  in  powder,  and  directed  hot 
fomentations  to  the  abdomen. 

I  called  again  in  four  liours.  The  sickness  had  subsided  and  pain 
somewhat  abated ;  gave  him  castor  oil  and  aromatic  syrup  rhubarb 
each  1  oz.;  fomentations  to  be  continued,  and  a  copious  enema  to  be 
administered  in  three  hours. 

7th.  The  bowels  have  been  freely  moved  ;  still  complains  of  pain 
about  the  umbilicus.  On  carefully  examining  the  abdomen,  I  dis- 
covered tenderness  on  pressure  deep  in  the  lower  part  of  the  right 
i'.Iinc  fossa  ;  no  febrile  movement  has  manifested  itself. 

I  applied  a  blister  to  the   right  ilio-inguinal  region,   and  directed 


520  '  Diseases  of 'the  Ccecum,  [September, 


calomel  and  Dover's  powders,  each  3  grains,  to  bo  repeated  every 
four  hours. 

Evening.  Several  times  during  the  day  he  has  rejected  from  the 
stomach  small  quantities  of  greenish  watery  fluid,  which  has  left  a 
slight  stain  upon  the  tongue.  The  blister  has  filled  well ;  Dover's 
powder  and  calomel  to  be  continued  through  the  night. 

8th.  Rested  well  during  the  night ;  pulse  76,  soft.  Skin  moist ; 
thin  white  coat  upon  the  tongue  ;  not  dry  ;  no  pain,  but  little  sore- 
ness ;  blister  looks  well.  I  gave  him  ten  grains  of  calomel  to  be  fol- 
lowed in  three  hours,  with  a  draught  of  infusion  of  senna  and  Ep- 
som salt. 

Evening.  His  medicine  has  operated  several  times  during  the  day. 
The  evacuations  contain  a  large  quantity  of  dark  fcccal  matter  but 
without  faecal  odor.  He  expresses  himself  as  feeling  relieved.  Di- 
rected Dover's  powder  for  the  night. 

9th.  Had  a  quiet  night.  No  pain,  but  some  soreness  in  the  right 
iliac  region.  Heavy  white  coat  upon  the  tongue  ;  pulse  78,  and  soft, 
and  yielding  readily  to  slight  pressure.  Has  had  a  small  evacuation 
from  the  bowels.  No  faecal  odor  ;  blister  reapplied.  A  seidlitz  pow- 
der to  be  given  every  three  hours. 

Evening.  Bowels  have  been  moved  several  times,  evacuations 
not  examined.  Entirely  free  from  pain.  I  spent  more  than  an 
hour  with  him,  in  company  with  some  friends,  who  had  called  on 
him.  He  left  his  bed  and  v/alked  to  his  chair  without  assistance. 
Conversed  freely,  and  desired  permission  to  ride  to  his  friends  the 
next  day  a  distance  of  10  miles  which  I  advised  him  to  defer  for 
a  few  days.  Everything  seemed  quite  favorable,  excepting  a  very 
heavy,  white,  clammy  coat  spread  entirely  over  his  tongue.  A 
Dover's  powder  was  the  only  medicine  prescribed  for  the  night. 

10th.  I  was  called  to  him  very  early  this  morning,  and  found  him 
in  articulo  mortis- 

On  post-mortem  examination,  assisted  by  Dr.  Bristol,  there  was 
found  in  the  pelvis  about  half  a  pint  of  purulent  matter.  The  vermi- 
form appendix  presented  an  opening  about  one  inch  from  its  attach- 
ment to  the  caBCum,  in  which  lay  a  bilary  concretion  about  the  size 
of  a  common  white  bean,  and  nearly  of  the  same  shape.  On  raising 
the  appendix  it  separated  from  the  caecum,  and  was  found  in  a  gan- 
grenous state  through  its  whole  extent.  About  half  an  inch  above  the 
ulcerated  opening  already  mentioned,  there  was  an  enlargement  of 
the  appendix  in  which  was  found  another  concretion  of  about  the 
same  size  and  appearance.  On  carefully  cutting  open  the  concre- 
tions, they  were  found  to  be  composed  of  concentric  layers  of  dense 
bilary  concretion  around  a  common  centre  of  the  same  material. 
Marks  of  recent  inflammation  were  traceable  to  a  great  extent,  over 
the  peritonium  as  well  as  the  small  intestines. 

The  most  remarkable  feature  in  this  case,  is  the  amount  of  organic 
lesion  of  so  destructive  a  character,  with  no  more  urgent  symptoms. 

In  the  other  instance  of  this  description  of  disease  to  which  allu- 


11545.]  Diseases  of  the  C(BCU7n.  521 


sion  has  been  made,  the  s^^mptoms  were  more  nearly  allied  to  those 
of  strangulated  hernia.  The  appendix  was  found  imbedded  in  a  mass 
of  omentum,  greatly  hypertrophied,  and  in  a  state  of  ulceration. 
The  cavity  of  the  appendix  was  nearly  obliterated  by  a  thickened 
condition  of  its  mucous  membrane  which  had  assumed  a  kind  of  firm 
pulpy  consistence.  Portions  of  the  mucous  membrane  of  the  caecum 
also  presented  a  similar  appearance. 

Affections  of  the  appendix  are  not  generally  distinguishable  from 
those  of  the  csecum  itself,  during  the  life-time  of  the  patient.  We 
may  sometimes  suspect  them  when  the  seat  of  the  affection  is  deep 
in  the  pelvis,  as  this  organ  is  frequently  found  depending  in  this  situa- 
tion. This  was  noticed  as  detailed  in  Case  VI.  The  soreness  was 
deep-seated  in  the  pelvis,  which  led  to  the  suspicion  that  the  appendix 
was  the  principal  seat  of  the  affection.  Indeed  the  opinion  was  ex- 
pressed before  the  post-mortem  examination.  But  the  situation  of 
the  appendix  varies  so  much  in  different  individuals,  that  even  this 
sign  can  lead  to  nothing  more  than  a  mere  suspicion ;  nevertheless, 
this  fact  is  often  very  important  in  its  practical  results. 

In  the  dissections  which  I  have  made,  I  have  not  discovered  much 
uniformity  either  in  the  size  or  shape  of  the  appendix,  or  of  its  place 
of  origin,  nor  of  the  direction  which  it  takes  on  leaving  the  csecum. 
Among  my  dried  preparations,  I  have  one  colon  of  common  size,  in 
which  the  appendix  measures  six  and  a  half  inches  in  length,  and 
nearly  half  an  inch  in  diameter;  passing  off  nearly  in  a  straight  line 
from  the  most  depending  point  of  the  caput  coeci,  the  extremity  of  the 
appendix  resting  on  the  floor  of  the  pelvis.  I  have  another  colon  of 
equal  size,  in  which  the  appendix  is  less  than  two  inches  in  length, 
and  no  thicker  than  a  crow's  quill.  This  has  its  origin  just  at  the 
margin  of  the  iiio-caecal  valve,  is  coiled  upon  itself,  and  firmly  bound 
to  the  caecum  by  a  fold  of  peritonium.  In  another  specimen  the  ap- 
pendix measures  four  inches  in  length;  has  its  origin  within  half  an 
inch  of  the  termination  of  the  ileon  and  makes  a  turn  round  this  intes- 
tine, firmly  embracing  it.  I  have  preserved  nine  preparations  of  the 
caecum  and  appendix,  all  of  which  vary  materially  in  their  form  and 
construction,  so  that  no  general  description  will  answer  to  any  two 
of  them. 

Dr.  Burne  observes,  that  "The  confirmation  and  situation  vary 
much  in  different  individuals  a  fact  not  noticed  by  anatomists,  but 
which  I  have  found  to  influence  the  phenomena  and  nature  of  its  dis- 
eases very  considerably.  The  conformation  of  the  appendix  is 
generally  described  as  flcxuous,  and  its  situation  as  depending  into 
the  pelvis;  but  by  some  the  situation  is  not  noticed,  further  than  that 
the  appendix  arises  from  the  caecum,  and  is  bound  down  to  it  on  the 
right  by  a  fold  of  peritoneum,  the  meso-appendix ;  whereas  the  ap- 
pendix is  more  frequently  situated  on  the  outer  edge  of  the  psoas 
magnus,  on  the  fascia  iliaca,  snugly  curled  up  beneath  the  caecum, 
and  concealed  by  it  a  fact  which  I  have  verified  by  many  dissec- 
tions, and  one  of  great  importance  to  the  pathologist,  as  will  be  seen. 


522  Diseases  of  the  Ccscum.  [September, 


In  the  event  of  a  perforative  ulceration  of  the  appendix,  and  a  conse- 
quent peritonitis  or  fcecal  abscess,  the  parts  involved  will  ditler  entirely 
according  to  the  situation  of  the  appendix.  If  it  should  happen  to 
depend  into  the  pelvis,  then  the  pelvic  viscera  will  be  implicated ;  if 
it  should  happen  to  bo  situated  on  the  iliac  fiiscia,  and  underneath 
the  caecum,  then  the  belly  of  the  iliacus  internus.and  the  neighboring 
adipose  cellular  tissue  will  be  involved,  and  the  course  of  the  abscess 
be  determined  accordingly  :  so  important  is  the  relative  anatomy  of 
even  inconsiderable  organs  to  the  physician." 

The  foregoing  cases  nre  selected  from  eighteen  well  marked  in- 
stances of  this  class  of  affections  which  have  occurred  under  my 
own  observation  during  the  last  fourteen  years.  I  met  with  several 
other  examples  of  this  disease  during  the  earlier  years  of  my  prac- 
tice, of  which  no  notes  were  made  at  the  time.  I  have  also  occa- 
sionally seen  cases  in  consultation  with  neighboring  physicians,  so 
that  abundant  evidence  is  afforded  of  their  frequent  occurrence,  at 
least  in  this  section  of  the  country. 

They  are  spoken  of  by  some  medical  writers  as  being  obscure  in 
their  origin,  and  often  difficult  of  detection.  Professor  Albers,  of 
the  University  of  Bonn,  makes  the  following  remark,  ''That  the 
diagnosis  of  the  disease  of  the  caecum  is  attended  with  no  inconsid- 
erable difficulty  appears  from  the  well  known  circumstance,  that  very 
often  they  have  never  been  suspected  to  exist  during  the  life  of  the 
patient,  and  have  been  discovered  only  on  dissection." 

Dr.  Burne  remarks,  that  "A  practitioner  who  witnesses  one  of 
these  cases  for  the  first  time,  is  satisfied  it  is  not  a  common  inflam- 
mation of  the  bowels,  although  he  does  not  know  its  exact  nature  
he  says  the  case  is  a  curious  one  he  cannot  make  it  out." 

Dupu3'tren,  in  speaking  of  the  importance  of  a  correct  diagnosis  in 
these  affections,  says,  "I  have  seen  this  inflammation  give  rise  to 
the  belief  of  the  existence  of  internal  strangulation,  hepatitis,  metri- 
tis, and  even  peritonitis."  That  these  affections  are  sometimes 
mistaken  for  common  inflammation  of  the  bowels,  or  "Bilious  Colic," 
I  am  fully  aware,  having  been  consulted  in  four  well  marked  cases, 
the  true  nature  of  which  had  been  entirely  misapprehended.  One 
of  these  terminated  in  the  usual  way  by  resolution  the  other  three 
were  allowed  to  pass  on  to  suppuration,  one  of  which  terminated 
fatally,  the  abscess  bursting  into  the  peritoneum.  The  other  two 
cases  opened  externally,  a  little  above  the  crural  arch,  one  of  which 
formed  ill-conditioned  sinuses  which  remained  open  more  than  a  year 
 and  finally  recovered. 

The  causes  of  failure  in  diagnosis  are  probably  owing  in  part  to  the 
mildness  of  the  earlier  symptoms,  which  attract  but  little  attention 
from  the  patient  or  physician;  but  principally  to  the  fact,  that  the 
pain  attending  ihem  is  generally  described  by  the  patient  as  a  colic, 
and  is  frequently  referred  to  the  umbilical  region,  or  to  the  abdomen 
generally.  Indeed  it  is  very  rare  that  the  patient  directs  attention 
to  the  seat  of  the  disease. 


1S15.]  Diseases  of  the  CcBCum.  523 


It  is  only  by  a  careful  examination  that  the  nature  and  seat  of  the 
difficulty  are  detected.  By  gentle  pressure  or  percussion  over  the 
surface  of  the  abdomen,  as  you  approach  the  right  iliac  region,  the 
patient  shrinks  from  you,  or  perhaps  instantly  seizes  your  hand,  and 
betrays  surprise  at  the  discovery  of  such  exquisite  tenderness. 

Hence  the  importance  of  carefully  examining  every  part  of  the 
abdomen,  in  these,  as  well  as  in  all  other  affections  of  the  abdominal 
viscera. 

If  we  take  into  consideration  the  situation  of  the  ca)cum,  fixed  as  it 
is  in  the  parietes  of  the  abdomen,  admitting  of  no  considerable  varia- 
tion in  its  relative  position  with  regard  to  the  other  viscera,  it  must  be 
evident,  that  \vith  such  an  examination  the  disease  under  considera- 
tion would  seldom  escape  early  detection. 

The  progress  of  the  phenomena  as  developed  in  these  affections,  is 
thus  descubed  by  M.  Dupuytren  :  "  After  some  error  in  diet,  a  con- 
stipation or  diarrhoea,  of  longer  ^r  shorter  duration,  more  or  less  hab- 
itual colic ;  sometimes  without  any  of  these  causes,  the  patient  suffers 
from  violent  colic  and  pain  in  the  bowels,  with  a  tendency  to  concen- 
tration in  the  right  iliac  fossa;  it  may  also  extend  towards  the  large 
intestine,  or  over  the  whole  abdomen.  This  colic  is  generally  ac- 
companied by  constipation,  and  sometimes  vomiting;  such  are  the 
symptoms  by  which  we  may  predict  the  occurrence  of  the  tumor. 
They  are  of  very  various  duration  ;  sometimes  lasting  for  a  month  or 
more,  sometimes  for  a  few  days  only." 

Dr.  Hays,  Editor  of  the  American  Journal  of  the  ?Iedical  Sciences 
(see  Medical  Essays,  vol.  1,  page  81,  published  by  Lea  and  Blanchard, 
1S41),  says:  "the  disease  usually  announces  itself  by  certain  pre- 
cursory  symptoms,  as  coVic,  with  alternate  constipation  and  diarrhoea, 
occurring  at  longer  or  shorter  intervals,  and  continuing  for  a  greater 
or  less  period.  After  a  while  the  attacks  of  colic  become  more  se- 
vere, and  appear  fo  centre  in  the  right  iliac  fossa ;  they  may  also 
radiate  in  the  direction  of  the  great  intestine,  or  spread  over  the  whole 
cavity  of  the  abdomen.  These  pains  are  usually  attended  with  ob- 
stinate constipation,  and  sometimes  with  such  violent  vomitings  as  to 
simulate  an  internal  strangulation.  In  some  cases  the  disease  has 
its  origin,  is  attended  with  less  violent  symptoms,  and  commences 
with  pain  the  right  iliac  fossa.  If  this  region  be  examined,  it  will  be 
found  more  tender  to  the  touch,  more  resisting,  and  sometimes  to 
project  more  than  in  the  natural  state.  It  is  frequently  possible,  by 
pressing  upon  the  abdominal  parietes,  to  distinguish  a  circumscribed 
tumor  of  variable  size,  of  considerable  firmess,  more  sensible  to  the 
touch  than  any  other  part  of  the  abdomen,  and  appearing  to  rest  upon 
the  cscum  ;  the  remainder  of  the  abdomen  is  soft  and  indolent.  The 
patient  continues  at  the  same  time  t^  complain  of  colic  and  constipa- 
tion." 

Dr.  Burne,  ih  the  papers  to  which  we  have  already  alluded,  gives 
the  follo\^ing  graphic  description  of  these  affections:  '  In  all  the  ex- 
amples of  inliammation  of  the  caecum,  which  I  have  witnessed,  the 


524  Diseases  of  the  Ccecum.  [September, 


development  of  the  symptoms  has  been  in  the  following  order :  The 
first  sign  is  a  sense  of  uneasiness,  which  soon  amounts  to  an  aching 
pain,  deep-seated  in  the  right  ilio-inguinal  region,  arising  unexpect- 
edly while  the  person  was  in  health,  and  not  preceded  by  rigor  or 
exposure.  This  pain  increases  progressively  for  twelve  or  twenty- 
four  hours,  retains  its  character,  is  fixed  and  constant,  never  even 
remitting.  Then  supervene  gradually  tenderness,  fullness,  and  ten- 
sion of  the  whole  ilio-inguinal  region  ;  the  bowels  are  constipated 
and  do  not  reply  to  medicine,  and  the  patient  grows  sick  and  vomits. 
Some  febrile  movement  now  begins  to  manifest  itself;  the  tongue 
becomes  white  and  furred ;  the  urine  scanty;  the  appetite  is  gone; 
the  pulse  is  frequent,  tight,  and  sharp,  with  increased  volume,  but 
the  stroke,  though  sharp,  is  not  strong,  nor  is  its  impression  on  the 
finger  decided  it  is  a  pulse  of  irritation  and  inflammation  combined ; 
the  patient  lies  on  the  back  quite  still,  slightly  inclined  to  the  side 
affected,  and  the  case  presents  a  serfous  aspect." 

The  above  is  certainly  a  faithful  delineation  of  most  of  the  symp- 
toms which  are  usually  manifested  in  these  cases,  but  these  phenom- 
ena are  most  invariably  preceded!  bj'  a  series  of  ^^ precursory  symp- 
ioms,^^  as  noticed  by  Dr.  Hays. 

By  referring  to  the  cases  detailed  by  Dr.  Burne,  it  appears  that  no 
one  of  them  came  under  his  observation  earlier  than  the  fifth  day 
after  the  attack ;  a  circumstance  which  fully  explains  the  cause  of 
his  having  failed  to  notice  the  symptoms,  which  usually  precede  what 
may  be  considered  as  signs,  peculiar  to  these  affections. 

Instead,  therefore,  of  waiting  for  the  development  of  local  signs, 
these  symptoms  should  at  once  awaken  our  suspicions,  and  if  we  are 
led  by  them  to  a  careful  examination  of  the  abdomen,  we  may,  even 
before  the  attention  of  the  patient  has  been  directed  to  the  part,  dis- 
cover a  circumscribed  fullness,  well  defined,  and  quite  tender  to  the 
touch,  situated  over  the  ccecum.  It  is  during  the  prevalence  of  these 
earlier  symptoms,  that  a  well  directed  treatment  will  often  prove 
most  successful. 

The  course  of  practice  which  I  have  found  most  successful  in  these 
cases,  previous  to  the  development  of  inflammatory  action,  is  a  free 
use  of  calomel  and  opium,  together  with  warm  fomentations  to  the 
abdomen.  When  the  system  is  fully  under  the  influence  of  opium 
 pain  and  spasmodic  action  having  subsided  an  enema  of  castor 
oil  and  spirits  of  turpentine,  in  a  sufficient  quantity  of  warm  water 
to  freely  distend  the  colon,  will  generally  succeed  in  removing -the 
offending  matters.  By  thus  removing  the  cause  of  the  difficulty,  we 
may  often  avoid  the  more  serious  character  of  these  complaints.  If, 
however,  this  course  proves  unsuccessful,  and  inflammatory  action 
supervene,  it  m.ust  promptly  but  cautiously  be  met ;  and  here  I  cannot 
do  better  than  to  commend  as  worthy  of  special  attention,  the  follow, 
ing  judicious  observations  of  Dr.  James  Johnson.  ''  As  the  inflam- 
mation is  the  result  of  a  mechanical  source  of  irritation,  or,  perhaps, 
obstruction,  it  is  obvious  that  depletion  must  not  be  carried  to  so  great 


1845.]  Diseases  of  the  CcBcum,  ,        525 


an  extent  as  in  idiopathic  enteritis.  Another  consideration  which 
should  moderate  the  employment  of  depletory  measures,  especially 
of  local  or  general  bloodletting,  is  the  reflection  that  the  patient  may 
have  to  go  through  an  iliac  abscess,  and  that  his  powers  should  be 
husbanded  for  its  support.  The  depletion,  then,  should  be  cautious ; 
enemata,  and  such  purgatives  as  the  stomach  will  bear  well,  should  be 
administered;  light  poultices  and  fomentations  are  to  be  applied  ; 
and  about  the  fifth  or  sixth  day  the  bowels  may  begin  to  act,  and  the 
symptoms  to  subside.  Should  they  not  subside,  the  physician  or 
surgeon  must  anxiously  watch  for  the  first  appearance  of  an  emphy- 
sematous tumour,  and  make  an  early  incision  into  it;  foetid  g^is 
escapes,  and  the  cellular  tissue  is  more  or  less  sloughy,  or  actually 
sloughing.  The  patient  must  now,  of  course,  be  supported,  and  even 
stimulated,  to  the  necessary  pitch." 

There  seems  to  be  some  difference  of  opinion  among  practitioners, 
as  to  the  propriety  of  opening  these  abscesses  after  suppuration  has 
taken  place.  M.  M.  Dupuytren  and  Dance  recommend  leaving  them 
to  the  efforts  of  nature,  allowing  the  matter  either  to  make  its  own  way 
to  the  surface,  or  to  escape  through  some  of  the  natural  passages ; 
while  on  the  other  hand,  Drs.  Hargrave  and  Kennedy,  of  Dublin; 
Drs.  Johnson  and  Copland,  of  London ;  and  Dr.  Hays,  of  Philadelphia, 
advise  a  free  opening  for  the  exit  of  purulent  matter,  as  soon  as  a 
tendency  to  the  surface  is  evident.  There  can  be  no  doubt  that  the 
latter  course  will  be  sustained,  when  experience  shall  have  decided 
their  relative  advantages. 

We  occasionally,  in  these  cases,  meet  with  an  exceedingly  irritable 
condition  of  the  rectum.  Under  these  circumstances,  an  enema,  by 
a  common  syringe,  will  not  be  retained  in  sufficient  quantity  to  be 
of  much  advantage.  We  may  then  resort  to  the  use  of  an  elastic 
tube,  passed  high  up  into  the  colon,  as  recommended  by  Dr.  O'Beirn. 

I  have  during  the  last  two  years  made  use  of  the  tube  described  in 
connection  with  Case  IV.,  which  I  have  found  in  some  respects 
preferable  to  the  common  elastic  tube.  Its  advantages  consist  in  its 
being  of  sufficient  firmness  to  retain  whatever  shape  or  course  we 
may  choose  to  give  it,  previous  to  its  introduction,  while  the  bulb  at 
its  extremity  is  not  liable  to  be  obstructed  in  its  passage  by  the  loose 
folds  of  the  mucous  membrane  ;  we  consequently  avoid  all  danger  of 
breaking  the  tube,  or  of  injuring  the  coats  of  the  intestine. 

In  detailing  the  foregoing  cases,  I  have  appended  occasional  re- 
marks; not,  however,  for  the  purpose  of  offering  to  the  profession 
any  thing  new,  but  rather  with  the  intention  ofdirecting  the  attention 
of  the  readers  of  your  Journal  to  a  class  of  affections  which  are 
scarcely  noticed  in  the  systematic  works  which  constitute  the  libra- 
ries of  most  country  practitioners  ;  and  also  of  inviting  their  attention 
to  the  articles  from  which  I  have  drawn  so  largely  in  preparing  this 
paper.  Neiv-York  Journal  of  Medicine,  July,  1845. 


526  Climate,  Diseases,  <SfC.,  of  Middle  Florida,  [September, 


Remarks  on  the  Climate,  Diseases,  <^c.,  of  Middle  Florida parti, 
cularhj  of  Gadsden  county,  ^y  Robeet  Edmonds  Little,  M.  D., 
of  Quincy,     {From  Am.  Jour.  Med.  Sciences,  July,  1845.) 

Gadsden,  one  of  the  most  northern  counties  of  Middle  Forida,  ex- 
tends from  the  Georgia  line  on  the  north,  to  the  Gulf  of  Mexico  on 
the  south,  a  di.stance  not  far  short  of  one  hundred  miles, while  its 
eastern  and  western  boundaries  are  the  Apalachicola  and  Ockolok- 
nee  rivers. 

The  northern  portion  of  the  country  (the  part  most  densely  popu- 
lated)  is  watered  by  numerous  streams  of  considerable  magnitude, 
the  principal  of  which,  beside  the  above  named,  are  Little   river, 
Witlacoochce,  Tellogee  and  Rook  Comfort  creeks.     Their  banks  are 
low  and  often  so  boggy  as  to  cause  it  to  be  necessary  for  the  road 
over  them  for  the  distance  of  several  hundred  yards  to  be  elevated, 
so  as  to  render  the  stream   approachable.     These  waters  are  clear 
and  usually  not  unpleasant  to  the  taste.     The  face  of  the  country  is 
for  the  most   part  rolling especially  the  rich  portions  of  it  in  the 
neighborhood  of  the  hammocks,*  while  the  pine  lands  are  tolerably 
level;  the  former  fertile,  producing  in  abundance  all  the  great  sta- 
ples of  the  climate,  the  latter  are  poor  and  little  adapted  to  cultiva- 
tion;  unless  manured,  being  principally  used  as  ranges  for  cattle,  of 
which  many  of  the  planters  possess  an  immense  number.     The  ham- 
mocks  are  covered  with  a  growth  of  cane,  oaks,   hickories,  poplars, 
sweet  gums,  red  bays,  magnolias,  g:c..  and  vary  in  width  from  fifty 
yards  to  a  mile  the  soil  of  which  they  are  composed  is  a  ])Iack  loam', 
based  upon  a  bed  of  clay.     In  passing  over  the  country  the  traveller 
frequently  meets  with  barrens,  dotted  here  and  there  with  stunted 
oaks,  pines  and  prickly  pears,  which,  however,  are  soon  forgotten  in 
beholdin^g  beautiful  plains,  shaded  by  stately  pines;  now  and   then 
green  mounds,  the  receptacles  of  the  dead  and   not  unfrcquenlly  a 
glassy  pond,  whose  sparkling  waters  are  so  many  mirrors  reflecting 
the  beautit^ul  verdure  of  the  live  oaks  which  dip  their  wide-spreading 
branches  far  over  its  banks.     In  the  early  settlement  of  the  country 
when  land  v.'as  easily  obtained,  no  care  was  taken  to  prevent  a  dete- 
rioration in  fertility  hence  many  fields  are  now  lying  in  a  waste 
condition,  not  worth  cultivating,  v*^hich  will,  however,  in  the  course 
of  a  few  years  be  entirely  renovated  and  capable  of  producing  as  well 
as  formerly,  no  land  in  the  world  being  more  susceptible  of  im- 
provement by  rest. 


*  The  word  hammock  is  applied  indefinitely  in  many  parts  of  the  territorv 
m  one  quarter  it  is  used  to  signify  '-a  thickly  wooded  place:"  in  another  ''a 
mound  raised  out  of  a  swampy  tract  of  land ;"  and  again  it  is  supposed  to  be  a 
corruption  of  Tomaka,  the  Indian  name  for  a  river  whose  banks  are  covered 
With  hammocks  or  swamps.  Webster  derives  it  from  the  Spanish  word  hamucu 
referj-mg  to  the  beds  used  by  sailors,  and  as  the  soil  of  which  these  hammocks 
are  composed  seems  to  be  raised  above  the  surrounding  water. 


1345.]  Climate,  Diseases,  t^Cf  of  Middle  Florida.  527 


The  frvcai  staple  of  Middle  Florida  is  cotton  but  since  its  depre- 
riation  in  value,  many  of  the  planters  are  uirning  their  attention  to 
the  cultivation  of  tobncco,  a  species  of  which  is  produced  in  many 
portions  of  the  district,  almost  equal  to  that  of  Cuba.  Rice  and  sugar 
cane  grow  well  and  are  cultivated  in  quantities  sufficient  for  domestic 
use;  the  latter  mi;:jht  be  made  an  article  of  considerable  revenue, 
as  the  soil  and  climate  seem  to  be  peculiarly  adapted  to  its  cultivation. 
The  fig  and  orange  arrive  at  perfection,  and  with  care  might  be  ren- 
dered a  source  not  only  of  luxury,  but  profit.  From  the  slips  they 
bear  fruit  in  a  very  few  years,  and  the  only  attention  necessary  to 
bestow  on  them,  is  protection  from  the  frosts  of  winter  until  they  are 
matured.  The  apple,  pear,  cherry,  grape,  gooseberry  and  currant 
are  unsuited  to  the  climate, -seldom  arriving  at  perfection  while  the 
peach  and  melon  flourish,  affording  during  the  summer  an  abundance 
of  agreeable  fruit.  The  long  continuance  of  warm  weatber  prevents 
a  proper  attention  being  paid  to  gardening,  yet  so  mild  are  our  win- 
ter and  spring  months,  that  almost  every  article  usually  found  in 
gardens  in  more  temperate  climes  is  capable  of  being  produced  in 
profusion.  The  Irish  potatoe,  onion,  and  cabbage,  degenerate  after 
the  first  year's  cultivation  their  produce  being  small  and  of  unnatu- 
ral flavour,  while  the  sweet  potatoe  furnishes  a  considerable  portion 
of  the  population  with  an  agreeable  article  of  food,  the  soil  being  very 
favourable  to  its  production. 

The  flora  of  Middle  Florida  is  peculiarly  rich  in  the  variety  and 
and  beauty  of  species,  the  surface  presenting  one  vast  bed  of  flowers. 
And  no  portion  of  the  American  Continent  is  so  plentifully  supplied 
with  insects  and  reptiles  as  in  this  "land  of  flowers."  In  rambling 
through  the  woods  scarcely  a  leaf  can  be  turned,  or  brush  disturbed 
without  breaking  in  upon  the  slumbers  of  some  "creeping  thing," 
whilst  at  night,  during  the  summer  season,  our  ears  are  assailed  by 
the  buzzing  of  myriads  of  mosquitoes  in  their  murderous  attacks 
upon  those  of  us  who  are  so  unfortunate  as  net  to  have  pr<J\ided 
bars  as  a  means  ofdefence.  So  formidable  are  their  stings,  that  cat- 
tle and  deer  are  often  compelled  to  leave  the  swamps,  and  take  up 
their  residence  in  the  pine  woods  to  avoid  them. 

In  all  parts  of  Florida  is  to  be  found  a  species  of  land  tortoise, 
called  the  Gopher  {Goiiff re, French),  (Testudo  Polyphemus).  Alli- 
gators of  large  size  are  numerous,  and  on  the  banks  of  the  Apalachi- 
cola,  on  a  bright  day,  hundreds  of  these  monsters  are  to  be  seen 
basking  in  the  rays  of  the  sun,  ready  to  pounce  on  any  prey  that  may 
be  so  unlucky  as  to  be  accidentally  thrown  in  their  way  or  so  hardy 
as  to  approach  them. 

Of  the  feathered  tribe  we  have  a  great  variety  especially  aquatic 
 the  most  prominent  of  which  is  the  large  wood  pelican;  an  awk- 
ward bird  in  its  movements  on  land,  but  when  placed  upon  its  conge- 
nial element,  graceful.  Large  droves  of  the  paroquet  are  seen,  a 
noisy  but  beautiful  bird,  singularly  graceful  and  rapid  inflight. 

As  objects  of  greater  interest  to  the  sportsman,  various  quadrupeds 


528  Climate^  Diseases^  (Sfc,  of  Middle  Florida.  [September, 


are  found  in  a  wild  state.  Luxuriant  in  vegetation,  the  Territory  af- 
fords ample  opportunity  for  the  hunter  to  indulge  in  the  exciting  chase 
after  deer,  and  for  the  hardy  woodman  to  hunt  bears.  Wolves  and 
panthers  are  numerous,  frequently  proving  troublesome  to  the  settlers. 

Of  the  climate  of  our  American  Italy  much  has  been  said,  and  sit- 
uated as  Florida  is,  in  the  southernmost  part  of  our  great  confederacy, 
for  years  past  it  has  been  looked  to  with  the  hope  of  its  possessing  a 
climate  capable  of  affording  relief  to  those  afflicted  with  diseased 
lungs,  scores  of  whom  annually  leave  their  northern  homes  but  to 
languish  and  die  on  a  foreign  shore.  Whether  this  hope  is  likely  to 
be  realized  or  not,  time  alone  can  certainly  determine. 

Warm  weather  usually  makes  its  appearance  about  the  middle  of 
April,  and  continues  with  but  little  variation  until  the  last  of  Septem- 
ber ;  when  the  mornings  and  evenings  begin  to  grow  pleasantly  cool 
 although  the  weather  remains  at  mid  day  warm  until  November  is 
ushered  in.  During  the  last  two  months  of  the  year,  the  days  are 
pleasant ;  but  few  blasts  of  cold  weather  sweeping  across  the  land  to 
remind  us  of  overcoats  or  cause  us  to  desire  to  exchange  our  pine 
knot  for  the  anthracite  fires  of  our  northern  friends.  Although  hot 
weather  is  of  long  continuance,  the  thermometer  seldom  indicates  a 
temperature  higher  than  95,  the  mean  heat  of  January  being  55, 
of  July  and  August  87^^ ;  and  of  November  and  December  58.  At 
this  point  (Quincy  inlet,  30  40',)  a  breeze  from  the  Gulf  of  Mexico  is 
generally  felt  about  ten  in  the  morning  which  continues  until  late 
in  the  evening,  thus  mitigating  considerably  the  heat  of  summer  and 
rendering  our  almost  tropical  chme  not  only  endurable,  but  pleasant 
at  a  time  when  the  inhabitants  of  a  more  northern  region  are  sighing 
for  the  zephyr's  breath  to  stir  the  dormant,'  sultry  atmosphere  with 
which  they  are  surrounded.  Our  nights  in  summer  are  cool,  especi- 
ally towards  the  latter  part,  so  cool,  indeed,  as  not  unfrequcntly  to 
make  it  necessary  to  add  a  blanket  to  the  usual  articles  of  clothing. 
In  summer,  droughts  of  long  duration  are  not  uncommon  much  to. 
the  injury  of  the  planting  community.  The  spring  months  are  those 
most  usually  productive  of  rain,  which  falls  not  gently  for  a  few 
hours,  but  in  torrents,  and  for  whole  days  with  such  impetuosity  as 
to  have  gained  the  distinctive  name  of  "Florida  rains."  As  the  banks 
of  the  water  courses  are  low  they  are  easily  overflowed ;  the  rush  of 
waters  sweeping  every  thing  before  them,  fences,  bridges,  &;c.  noth- 
ing being  safe  from  their  desolating  influence.  Such  was  the  case  in 
the  spring  of  last  year.  For  three  days  the  rain  fell  in  such  torrents 
as  to  darken  the  atmosphere,  rendering  it  almost  impossible  for  a  man 
to  be  recognized  at  the  distance  of  twenty  steps.  The  streams  were 
carried  far  beyond  their  banks;  lagunes  overflowed;  roads  rendered 
invisible  ;  in  short,  the  appearance  of  the  whole  country  was  chang- 
ed. Traveling  was  suspended  for  weeks;  as  well  as  intercourse 
between  neighbours ;  all  waiting  for  a  subsidence  of  the  waters  and 
rebuildingof  bridges,  many  of  which  were  swept  away  all  injured. 
Rains  are  usually  succeeded  by  pleasant  weather,  the  surface  of  the 


1845.]  Climate,  Diseases,  <^c.,  of  Middle  Florida,  529 


country  drjing  in  the  course  of  a  few  hours,  the  soil  being  very  ab- 
sorbent. 

The  summer  winds  generally  come  from  the  south  and  west,  and 
when  these  are  accompanied  by  clouds,  rain  is  pretty  sure  to  follow  ; 
while  northern  winds  seldom  precede  or  attend  rain.  From  our 
proximity  to  the  Gulf  of  Mexico,  tornadoes  are  not  unusual.  The 
one  which  occurred  in  the  fall  of  eighteen  hundred  and  forty-three 
will  be  long  remembered,  because  of  its  violence  and  the  destruction 
of  property  caused  by  it.  Port  Leon,  St.  Marks,  and  most  of  the 
settlements  on  the  Wakulla  were  destroyed.  The  gale  commenced 
in  a  gentle  breeze,  causing  but  a  slight  agitation  of  the  waters  and 
rustling  the  leaves  ;  gradually  it  increased,  the  waves  began  to  lash 
the  banks,  and  the  trees  to  bend  ;  and  after  a  time  to  be  prostrated, 
unable  to  withstand  the  fury  of  the  enraged  elements.  Time  only 
served  to  add  strength  to  the  winds,  and  they  ceased  only  when  every 
thing  had  fallen  before  them.  Gales  such  as  that  alluded  to  seldom 
occur  in  this  region,  although  almost  every  spring  and  fall  are  at- 
tended by  storms  of  considerable  violence. 

Our  coldest  months  are  December  and  January.  The  past  was 
the  most  severe  winter  experienced  in  Middle  Florida  for  the  last 
twenty  years  ;  in  several  instances  the  small  pools  of  standing  water 
caused  by  the  hoofs  of  horses,  were  frozen  over  and  remained  so 
until  9  o'clock  in  the  morning.  Snow  has  fallen  but  twice  in  the 
last  eighteen  years,  and  then  only  in  quantities  sufficient  to  give  the 
ground  here  and  there  a  white  appearance.  Atmospheric  changes 
are  frequent,  the  mercury  falling  and  rising  again  15^  to  25'^  within 
a  few  hours  ;  but  fortunately  the  cold  spells  last  but  a  few  days  at  a 
time  and  are  succeeded  by  weather  most  delightful  to  the  invalid ; 
although  the  changes  are  sudden,  there  are  but  few  days  in  winter  so 
unpleasant  as  to  prevent  the  valetudinarian  from  taking  necessary 
exercise  in  the  open  air  either  on  foot  or  horseback.  As  before 
remarked,  an  opportunity  is  seldom  wanting  in  winter  to  indulge  in 
the  chase  after  deer,  or  less  fatiguing  sport  of  hunting  wild  turkeys. 

In  the  villages,  the  accommodations  for  the  sick  are  good  the 
hotel  tables  being  bountifully  supplied  with  all  the  delicacies  of  the 
season,  a  circumstance  heretofore  much  complained  of,  to  say  nothing 
of  the  exorbitant  charges  of  the  worthy  Bonifaces  of  our  land. 

Separate  and  apart  from  the  evidence  of  meteorological  registers, 
we  are  strongly  inclined  to  the  opinion  that  the  climate  of  Middle 
Florida  presents  inducements  as  a  winter  residence  to  those  who  are 
predisposed  to,  or  have  already  contracted  tuberculous  affections  in  a 
northern  latitude  (provided  they  are  not  far  advanced),  equal  to  any 
portion  of  the  eastern  division  of  the  territory  ;  taking  into  consid- 
eration the  influence  of  good  society  accommodations,  &;c.  To- 
wards the  permanent  restoration  of  advanced  cases  nothing  can  be 
done;  such  we  would  advise  to  remain  at  home  and  not  to  seek  a 
grave  in  a  strange  land. 

A  common  opinion  prevails  at  the  north,  not  only  among  the  un- 

34 


530  Climate,  Diseases,  <Sfc.,  of  Middle  Florida.  [September, 


informed,  but  even  among  physicians,  that  consumption  is  a  disease 
that  rarely  originates  in  warm  cHmates,  an  opinion  not  more  com- 
mon than  erroneous.  In  the  southern  country  tuberculous  diseases 
are  often  met  with,  not  the  result  of  colds  but  of  the  long  continu- 
ance of  warm  weather  and  the  use  of  food  almost  entirely  vegetable, 
circumstances  tending  to  produce  a  debilitated  state  of  the  system. 
This  cause  is  not  liable  to  operate  with  the  same  force  upon  natives 
of  a  northern  as  upon  those  of  a  southern  region,  the  former,  reared 
in  a  climate  whose  tendency  is  to  invigorate  the  frame  and  render  it 
capable  of  enduring  for  a  number  of  years  the  debilitating  influence 
of  Vvarmth,  resist  phthisis  for  a  great  length  of  time,  while  the  latter, 
subjected  from  infancy  to  a  high  temperature,  early  fall  victims  to 
tuberculous  cachexy  upon  the  occurrence  of  even  the  slightest  agent 
in  its  production. 

The  prevailing  diseases  of  this  portion  of  the  southern  country 
^re  those  which  are  supposed  to  have  a  relationship  or  connection 
with  that  peculiar  agent  termed  malaria,  and  our  territory  is  rich  in 
all  the  elements  favourable  to  the  elimination  of  this  poison,  viz : 
vegetable  matter  in  a  state  of  decomposition ;  high  temperature  and 
moisture  ;  a  union  of  all  these  being  necessary,  or  either  alone  being 
capable  of  generating  it,  while  a  superabundance  of  the  latter,  moist- 
ure, although  the  other  constituents  are  in  exact  proportion,  prevents 
its  formation.  No  fact  is  better  known  in  the  southern  country,  than 
that  for  the  first  few  years  after  the  settlement  of  a  particular  dis- 
trict, its  inhabitants  are  more  exposed  to  disease  than  in  after  years, 
because  of  the  evolution  of  miasm  in  large  quantities,  caused  by  the 
felling  of  the  forest  and  cultivation  of  the  soil ;  a  greater  amount  of 
the  earth's  surface  being  exposed  to  the  action  of  the  sun's  rays,  but 
in  subsequent  years  when  it  has  been  deprived  of  its  superabundant 
vegetable  matter  and  well  drained,  its  inhabitants  are  exempted  in  a 
great  measure  from  malarious  diseases.  The  pine  lands  which  are 
dry  and  removed  from  the  water  courses,  are  always  considered 
healthy ;  one  of  the  malarial  elements,  moisture  being  absent ;  a 
fact  also  strikingly  illustrated  in  the  epidemics  which  annually  devas- 
tate Egypt,  caused  by  the  overflowing  of  the  Nile,  ^the  disease  never 
extending  into  the  arid  plains  of  the  desert.  An  excess  of  moisture 
tends  to  the  destrifction  of  any  poison  which  may  have  been  in  exist- 
ence prior  to  its  creation,  for  instance  flat  places  in  ordinary  seasons 
unhealthy,  become  healthy  if  completely  overflowed,  while,  on  the 
contrary,  high  lands  where  sickness  was  never  known  to  prevail 
before,  emit  a  miasm  which  sweeps  every  thing  before  it.  The  advice 
of  Lancisi  to  those  travelling  near  the  Pontine  marshes,  not  to  do  so 
after  dusk  or  early  in  the  morning,  as  the  dew  in  their  neighbour- 
hood is  largely  adulterated  with  miasm  in  a  concentrated  state,  might 
well  be  given  to  travelers  in  Florida,  where  the  dews  are  remarkably 
heavy,  and,  from  the  great  susceptibility  of  the  system  in  warm 
climates  to  the  impression  of  morbific  agents,  capable  of  doing  much 
injury  at  that  lime. 


1345.]      '      Climate,  Diseases,  i^c,  of  Middle  Florida.  531 


Dirt  Eating.  Apart  from  the  sickening  influence  of  malaria,  we 
cannot  refrain  from  noticing  the  degeneration,  mental  and  physical, 
of  children  reared  in  this  extreme  southern  portion  of  the  Union. 
During  our  first  months'  residence  in  Florida,  in  passing  through  the 
country,  we  often  stopped  boys  on  the  road,  not  over  ten  or  twelve 
years  of  age,  who  presented  the  most  abject  state  of  degeneration 
imaginable;  with  head  and  body  large,  limbs  shrivelled  and  deform- 
ed, eyes  dull  and  of  a  bilious  tinge,  lips  colourless,  and  features  dis- 
torted. This  degeneration,  by  many,  has  been  attributed  to  dirt- 
eating,  a  propensity  very  general  throughout  the  whole  country. 

Having  completed  a  general  and  consequently  incomplete  descrip- 
tion of  the  physical  phenomena  of  a  portion  of  the  Territory,  reference 
will  now  be  made  to  its  diseases.  If  the  remark  made  by  Dr; 
Macculloch  be  true,  that  the  disorders  produced  by  malaria  include 
more  than  half  the  number,  prevailing  at  any  moment  throughout  the 
universe,  it  may  readily  be  inferred  from  what  has  been  said  above, 
that  a  majority  of  our  diseases  arc  malarial. 

Intermittent  Fever.  There  is  no  disease  with  which  physicians  are 
supposed  to  be  better  acquainted  than  intermittent  fever  but  on  the 
other  hand  it  must  at  the  same  time  be  confessed,  there  are  few 
which  occur  under  so  many  different  circumstances modified  by  so 
many  causes,  both  malarial  and  geological,  and  so  difficult  to  be  re- 
cognized in  its  anomalous  forms.  But  few  cases  of  an  inflammatory 
character  are  met  with  they  are  usually  adynamic  and  complicated 
with  visceral  obstructions,  and  if  suffered  to  go  on,  degenerate  into 
remittent  or  congestive  fever,  or  assume  the  appearance  of  slight 
apoplectic  or  epileptic  attacks  ;  palpitation  of  the  heart,  toothache, 
"sun  pain,"  dec.  diseases  Dr.  Macculloch  would  have  us  believe 
identical  with  intermittent  fevers,  because  of  their  liability  to  slight 
remissions  their  alternating  not  unfrequently  with  it,  and  their  be- 
ing cured  by  the  same  remedies.  Enlargement  of  the  spleen  and 
night  sweats  are  the  most  troublesome  sequelae  of  intermittent  fever. 
When  the  disease  becomes  chronic,  the  intellect  is  impaired  which, 
together  with  the  physical  degeneration,  renders  life  a  burden.  Re- 
lapses are  frequent,  and  each  succeeding  attack  increases  the  suscep- 
tibility of  the  patient  to  another. 

Remittent  Fever.  Intimately  related  to  intermittent  fever,  and 
produced  by  the  same  cause  is  bilious  remittent  fever,  the  prevailino- 
febrile  disease  of  our  summer  months.  So  much  do  the  two  diseases 
resemble  each  other,  as  to  be  considered  by  many  as  identical,  or  at 
any  rate  modifications  of  the  same  disease,  an  opinion  not  destitute 
of  foundation,  as  their  symptoms  during  life,  and  morbid  appearance 
after  death,  differ  only  in  degree. 

The  disease  is  usually  ushered  in  by  a  chill,  sometimes  severe,' 
frequently  nothing  more  than  a  cold  sensation,  (which  occurs  as  a 
general  rule  every  twenty-four  or  forty-eight  hours)  followed  by  pain 
in  the  back  and  limbs.  The  tongue  in  the  early  stages  of  remittent 
fever  is  moist,  and  presents  a  white  or  yellow  appearance,  but  as  the 


532  Climate,  DiseaseSfi^c.t  of  Middle  Florida.  [September, 


disease  advances,  it  becomes  dry  and  the  colour  changes  to  a  dark 
brown.  Pain  in  the  head  is  a  common  symptom,  frequently  contin- 
uing through  the  whole  progress  of  the  case.  During  the  stage  of 
excitement,  the  pulse  is  increased  both  in  force  and  frequency,  while, 
during  the  remission,  it  is  scarcely  above  the  natural  standard,  fre- 
quently below  it.  The  bowels  are  commonly  torpid,  requiring  the 
most  active  cathartics  to  excite  them.  After  the  disease  has  con- 
tinued for  four  or  five  days,  epigastric  tenderness  is  not  uncommon, 
attended  by  weight  or  tension,  requiring  for  its  relief  the'  abstrac- 
tion of  blood  locally,  blisters,  <&;c.  , 

The  condition  of  the  skin  varies  during  the  stage  of  excitement ; 
its  temperature  is  much  increased,  while  it  is  not  unfrequently  les- 
sened during  the  remission.  In  grave  cases  its  colour  is  inclined  to 
be  yellow;  in  slight  and  even  in  tolerably  severe  cases,  its  appear- 
ance is  not  materially  changed. 

The  intelligence  of  the  patient  being  influenced  by  the  violence 
of  the  headache,  it  may  be  readily  inferred  that  in  the  beginning  of 
both  recovered  and  fatal  cases  where  there  is  much  pain  in  the  head, 
delirium  is  not  an  uncommon  symptom  during  the  exacerbation.  In 
fatal  cases,  towards  their  termination,  there  is  generally  low  mut- 
tering delirium  or  coma. 

Remittent  fever  in  this  climate,  as  a  general  rule,  terminates  in 
from  three  to  ten  days. 

Congestive  Fever.  Of  all  the  diseases  incident  to  a  southern 
climate,  no  one,  perhaps,  is  so  much  dreaded  by  the  profession,  as  con- 
gestive fever,  a  disease  which,  unless  arrested  in  the  onset,  is  gener- 
ally attended  by  the  worst  consequences.  Its  attack  is  preceded  by 
precursory  symptoms,  sudden  and  violent,  and,  unless  the  most 
prompt  measures  are  early  used,  it  runs  its  course  in  from  twenty-four 
to  seventy-two  hours.  For  several  days  prior  to  an  attack,  the  sub- 
ject of  it  complains  of  general  malaise  with  derangement  of  the 
chylopoietic  viscera  ;  finally  a  chill  supervenes  which  ushers  in  the 
disease  in  all  its  violence.  The  pulse  is  now  exceedingly  feeble; 
breathing  quick  and  laborious;  the  tongue  moist;  bowels  usually 
costive;  they  are,  however,  sometimes  fully  acted  upon,  and  not 
unfrequently  there  is  nausea  and  vomiting.  The  patient  complains 
of  internal  heat  and  of  a  heavy  load  pressing  on  the  epigastric;  his 
calls  for  water  and  efforts  to  throv/  off  the  load  pressing  him  are  fre- 
quent. As  the  disease  progresses  the  extremities  become  very  cold 
and  shrivelled  ;  pulse  almost  imperceptible  ;  intellect  clouded  ;  spit- 
tle spontaneously  flows  from  the  mouth ;  subsultus  supervenes  ;  the 
skin  grows  colder,  is  covered  with  a  cold  clammy  perspiration,  and 
loses  its  natural  colour,  particularly  that  of  the  face,  and  finally  it  is 
not  uncommon  for  the  case  to  terminate  in  convulsions,  especially 
if  there  be  congestion  of  the  spinal  cord.  Such  are  the  symptoms 
most  usually  observed.  We  have  not  attempted  a  full  description  of 
them,  as  they  are  modified  by  a  variety  of  circumstances  such  as 
seat  of  congestion,  &c. 


1  ?45.]  Climate,  Diseases,  iSfC.,  of  Middle  Florida.  533 


During  the  summer  and  fall  seasons,  cholera  infantum,  diarrhoea 
and  dysentery  are  very  prevalent,  as  might  be  inferred  from  the  tem- 
perature of  the  weather  and  locality  of  the  country,  being  produced 
by  nearly  the  same  causes  that  give  rise  to  intermittent  and  bilious 
fevers.  To  a  variety  of  other  causes  have  they  been  attributed,  as, 
for  instance  to  eating  fruit,  to  heat,  &>c.  Facts,  however,  seem  not 
to  favour  the  supposition.  That  fruits  in  moderation  are  prejudicial 
to  health  or  productive  of  disease,  we  cannot  believe,  as,  during  sea- 
sons of  great  scarcity  these  diseases  are  not  uncommon,  while  it  is 
not  ascertained  that  th|^'  occur  more  frequently  during  seasons  of 
plenty  than  at  any  other  time.  A  rigid  proscription  of  them  will  not 
prevent  an  attack  of  cholera  infantum  or  diarrhoea,  nor  will  a  free 
use  of  them  bring  on  disease  without  the  influence  of  other  agents, 
as  is  witnessed  in  families  where  no  restraint  is  imposed  on  the  chil- 
dren in  eating  apples,  melons,  currants,  and  other  fruits,  even  before 
they  are  matured.  That  heat  alone  is  incapable  of  giving  rise  to  the 
above  diseases  we  are  assured  from  the  circumstance  of  this  not  be- 
ing most  prevalent  during  the  warmest  summers.  Hence,  we  must 
conclude  that  other  causes  than  warm  weather  and  the  use  of  fruits 
are  necessary  to  their  production.  From  the  prevalence  of  febrile 
diseases  and  of  bowel  complaints  and  disappearance  at  about  the 
same  lime,  it  is  altogether  probable  that  they  are  engendered  by  one 
common  cause. 

Diarrhoea  and  dysentery  are  not  usually  found  uncomplicated  with 
other  disease.  They  are,  for  the  most  part,  sequels  of  obstinate  or 
badly  treated  cases  of  fever,  and  require  for  their  removal  a  long 
course  of  treatment. 

In  the  tropical  climate  of  the  Southern  States  the  liver  is  most  genr 
erally  the  suffering  organ  in  disease,  as  the  respiratory  apparatus  is  at 
the  north ;  as  a  consequence,  the  afiections  to  which  it  is  prone  are 
numerous often  slow  in  their  attack  and  progress,  and  liable  to  be 
misunderstood  from  their  obscurity.  The  organization  of  the  liver, 
its  immense  size  in  comparison  with  the  other  abdominal  organs,  and 
the  important  office  that  it  is  called  on  to  perform,  force  the  belief 
upon  usthat  any  derangement  either  in  structure  or  function  must  be 
attended  with  consequences  which  will  sooner  or  later,  if  not  relieved 
undermine  the  health,  cause  the  patient  to  drag  out  a  miserable  ex- 
istence,  and  finally  end  his  career,  a  victim  to  delay  and  inefficient 
or  misapplied  medical  treatment. 

As  acute  hepatitis  is  uncommon  in  this  climate,  except  as  a  result 
of  the  chronic  form,  a  consideration  of  it  will  not  be  had,  our  object 
being  to  speak  more  particularly  of  the  latter,  as  it  is  a  disease  daily 
encountered  by  the  southern  practitioner.  In  saying  that  acute 
hepatitis  seldom  occurs  except  as  a  sequel  of  the  chronic  form,,  we 
wish  it  to  be  understood  that  the  disease  is  scarcely  ever  a  primary 
affection  itself,  and  that  it  usually  supervenes  upon  or  is  rather  an  ag- 
gravation of  the  last  named  variety.  For  years  patients  will  labour 
under  a  variety  of  symptoms,  without  being  able  to  determine  or  even 


534  Climate^  Diseases^SfC^i  of  Middle  Florida.  [September, 


suspect  their  cause,  when  suddenly  they  are  aggravated,  or  a  new 
one  in  the  catalogue  appears,  and  its  true  nature  revealed.  Such  is 
its  insidious  Protean  character. 

Middle  Florida  has  been  visited  by  scarlatina  very  rarely.  Spor- 
adic cases  are  occasionally  seen,  mild,  however,  in  character.  About 
the  first  of  January  last,  it  made  its  appearance  in  the  village  of 
Quincy,  extending  its  ravages  to  some  two  or  th>ee  plantations  in  its 
immediate  vicinity.  It  was  confined  to  a  few  families,  several  mem- 
bers in  each  being  attacked,  varying  in  age  from  one  to  ten  years. 
The  two  first  cases  that  happened  were  ma||^ed  by  a  peculiar  malig- 
nancy and  terminated,  we  believe,  within  thirty-six  or  forty-eight 
hours  from  the  commencement  of  the  attack.  They  were  for  a  time 
supposed  not  to  be  cases  of  scarlet  fever,  hut  subsequent  cases,  similar 
in  many  respects,  revealed  to  the  attending  physician  the  true  nature 
of  the  disease,  which,  in  the  course  of  the  epidemic,  assumed  all  ap- 
pearances, from  the  mildest  to  the  most  malignant.  The  patients 
were,  as  a  general  rule  attacked  suddenly,  either  with  pain  in  the 
head  or  vomiting.  No  two  cases  presented  exactly  the  same  ap- 
pearance. In  all  severe  cases  the  heat  of  skin  was  great  from  the 
commencement,  to  the  termination  of  the  disease.  The  pulse  was 
frequent  in  some  cases,  whilst  in  others  it  was  slow,  respiration 
difficult,  and  the  thirst  tormenting.  In  a  majority  of  cases,  there 
was  no  affection  of  the  throat  complained  of,  while  in  others  there 
was  soreness  of  the  fauces  and  neighbouring  parts  for  a  month  after 
the  fever  had  subsided.  In  two  or  three  instances  the  glands  of  the 
throat  swelled  and  suppurated,  giving  rise  to  troublesome  sores.  The 
absence  of,  and  the  singularity  of  the  eruption  when  present,  gave 
rise  to  a  doubt  among  some,  whether  the  disease  was  scarlatina  or 
not.  Its  absence  was  no  just  ground  for  doubt,  as  it  often  appears 
without  the  eruption  being  present,  constituting  the  scarlatina  sine 
erupfione  of  some  writers,  and  the  scarlatina  sine  exanthemata  of 
others.  The  eruption,  when  it  manifested  itself,  appeared  simultane- 
ously with  the  other  symptoms,  and  presented  a  variety  of  appear- 
ances in  some,  it  was  papular,  and  in  others  miliary.  The  eruption 
coalesced  in  a  very  short  time,  became  pretty  uniform  over  the  whole 
body,  and  faded  or  assumed  a  livid  appearance  in  the  fatal  cases  prior 
to  death.  Vomiting  and  purging  in  the  commencement  of  the  dis- 
ease were  always  grave  symptoms,  and,  if  we  remember  correctly, 
both  of  the  fatal  cases  which  we  witnessed  had  liquid  operations  for 
a  few  hours  before  their  termination.  The  determination  to  the  brain 
in  manv  cases  was  excessive  ;  when  this  happened,  unless  a  decisive 
plan  of  treatment  was  resorted  to,  convulsions  would  ensue,  and  the 
patient  die  comatose.  This  was  the  case  with  a  fine  little  boy  of  this 
place,  a  son  of  Judge  Allison.  In  the  morning  he  was  restless,  and 
seemed  to  have  contracted  a  slight  cold  ;  no  attention  was  paid  to 
him,  save  the  administration  of  a  mild  aperient;  towards  eVening, 
while  resting  on  his  nurse's  knee,  convulsions  came  on,  and,  notwith- 
standinf;  an   active   course  of  treatment,  he  died  comatose  on  the 


Isio.J  Bibliographical,  535 


third  day  of  his  illness.  Two  or  three  cases  were  reduced  very  low 
by  the  supervention  of  enteric  symptoms,  which  were  difficult  to 
relieve. 

As  before  remarked,  the  disease  was  confined  to  a  few  families, 
and  these  were  either  in  the  same  quarter  of  the  village  or  related 
to  each  other,  and  in  the  habit  of  constant  association.  Its  increase 
was  gradual.  When  it  commenced  it  usually  attacked  all  the  young- 
er members  of  a  family  in  succession.  Several  had  the  disease  who 
held  no  communication  with  the  sick  or  convalescent,  while  many 
escaped  who  were  often  in  the  sick  room.  As  to  its  contagiousness 
or  non  contagiousness  we  are  not  prepared  to  offer  an  opinion. 

Nearly  all  the  recovered  cases  were  afflicted  with  som.e  one  of  the 
sequela}  of  scarlet  fever.  The  lips,  mouth  and  cheeks  in  several 
were  ulcerated,  whilst  others  had  partial  or  general  dropsy,  which 
was  relieved  by  cathartics  succeeded  by  tonics.  Slight  exposure  to 
cold,  or  irregularity  in  diet,  would  bring  on  a  relapse  with  its  attend- 
ant consequences. 

Belladonna  as  a  prophylactic,  was  extensively  used,  but  so  far  as 
we  know,  without  any  good  results,  as  a  number  to  whom  the  bella- 
donna was  adrainisterecU  had  the  disease  in  all  its  violence.  From 
the  trial  made,  we  are  inclined  to  adopt  the  opinions  of  Pereira,  who 
says  that  whilst  the  facts  brought  forward  in  favour  of  the  existence 
of  this  prophylactic  power  are  only  negative,  those  which  can  be 
adduced  against  it  are  positive,  for  twenty  cases  of  failure  are  more 
conclusive  against  it  than  one  thousand  of  non  occurrence  are  in 
favour  of  it. 


BIBLIOGRAPHICAL. 

The  Principles  and  Practice  of  Denial  Surgery.  By  CHAriN  A. 
Harris,  M.  D.,  D.  D.  S.,  Professor  of  Practical  Dentistry,  in  the 
Baltimore  College  of  Dental  Surgery;  Fellow  of  the  American 
Society  of  Dental  Surgeons;  Member  of  the  Medico-Chirurgical 
Faculty  of  Maryland,  etc.,  etc.  Second  edition  ;  revised,  modified 
and  greatly  enlarged.  Illustrated  by  sixty-nine  wood  engravings. 
Philadelphia :  Lindsay  iSc  Blakiston,  1S45.    1  vol.  8  vo.,  600  pp. 

We  have  been  much  pleased  in  looking  over  (though  cursorily)  the 
above  work.  We  feel  warranted  in  saying  that  it  imbodies  more 
practical  information  and  less  faults  than  any  other  work  in  the  Eng- 
lish language,  consequently  would  recommend  its  perusal  in  the  most 
unqualified  terms  to  the  Medical  profession  generally  and  to  the  sci- 
entific surgeon-dentist  in  particular.     It  is  divided  into  six  parts  viz. 

1st.  Anatomy  and  Pin  siology  of  the  3Iouth. 


536  Properties  of  Bile.  Cyanosis  of  Infants.    [September, 


2nd.  Physical  characteristics  of  the  Teeth,  Gums,  Salivary  Cal. 
cuius,  dec. 

3rd.  Diseases  of  the  Teeth. 

4th.  Salivary  Calculus  Diseases  of  the  Gums,  &c. 

5th.  Diseases  of  the  Maxillary  Sinus. 

6th.  Mechanical  Dentristry.  B.  D. 


PART  III. MONTHLY  PERISCOPE. 

Secretion  and  Properties  of  Bile.  "A  series  of  experiments  by 
Schwann  has  led  to  the  distinct  conclusion  of  the  bile  being  indis- 
pensable to  life.  They  consisted  in  removing  a  portion  of  the  com- 
mon bile-duct,  and  establishing  an  external  fistulous  opening  into  the 
gall-bladder,  so  that  the  bile  might  be  naturally  secreted,  but  be  dis- 
charged externally,  and  not  permitted  to  eter  the  intestine.  Their 
general  result  was,  that  of  eighteen  dogs  thus  operated  on,  ten  died 
of  the  immediate  consequences  of  the  operation,  (by  peritonitis  and 
other  affections,  aggravated,  probably,  by  the  want  of  bile;)  and  of 
the  remaining  eight,  two  recovered,  and  six  died.  In  the  six  which 
died,  death  was  the  result  of  nothing  but  the  removal  of  the  bile ; 
after  the  third  day,  they  daily  lost  weight,  and  had  all  the  signs  of 
inanition  e.  g.,  emaciation,  muscular  debility,  uncertain  gait,  falling 
of  the  hair.  They  lived  from  seven  to  sixty-four  days  after  the 
operation  ;  and  the  inanition  was  the  greater  the  longer  they  survived. 
Young  dogs  appeared  to  die  rather  sooner  than  old  ones.  Licking 
the  bile  as  it  flowed  from  the  fistula,  and  swallowing  it,  had  no  influ- 
ence on  the  consequences  of  the  operation.  In  the  two  dogs  that 
recovered,  the  importance  of  the  bile  was  equally  well  shewn  ;  for 
in  these  it  was  found,  when  they  were  killed,  that  the  passage  for  the 
bile  into  the  intestine  had  been  restored,  and  the  period  of  its  restora- 
tion was  distinctly  marked  by  their  weight  (which  had  previously 
been  regularly  decreasing)  being  augmented,  and  continuing  to  in- 
crease till  it  amounted  to  what  it  was  before  the  operation  ;  and  also 
by  the  fistulous  opening  into  the  gall-bladder  healing,  and  the  dis- 
charge of  bile  ceasing."  British  and  Foreign  Review, 

Cyanosis  of  Infants.  Gazette  Medicale  de  Paris.  Dr.  Meigs, 
Professor  of  Midwifery  in  the  Jefferson  Medical  College,  read  before 
the  Academy  of  Sciences  at  its  session  June  16th,  a  note  upon  this 
subject.  Infants  die  in  this  case,  said  Dr.  Meigs,  from  the  presence 
of  a  black,  veinous,  non-oxygenated  blood  in  the  encephalon  ;  it  is  in 
the  arteries  and  capillaries  of  the  brain  that  this  blood  becomes  des- 


1S45.]  Tartar  Emetic  in  Hydarihrosis,  537 


tructive  to  life,  acting  not  as  a  poison,  but  simply  because  of  its 
incapacity  to  excite  the  innervation  in  this  organ.  The  whole  world 
knows  the  anatomical  cause  of  these  phenomena  it  is  the  persist- 
ance  of  the  foramen  ovale. 

The  occlusion  of  this  foramen  being  prevented  because  the  san- 
guine torrent  coming  from  the  vena  cava  inferior  raises  and  keeps 
raised,  the  inter-auricular  valve  which  is  thin  and  floating  Dr. 
Meigs  conceived  the  idea  of  placing  infants  labouring  under  Cyano- 
sis upon  the  right  side,  with  the  head  and  trunk  slightly  elevated,  in 
order  that  the  inter-auricular  septum  might  become  horizontal,  and 
that  the  blood  contained  in  the  left  auricle  might  press  with  all  its 
weight  upon  the  valve  which  would  thus  be  closed.  Dr.  Meigs  has 
seen  that  at  the  very  instant  when  infants  were  placed  in  this  posi- 
tion the  blue  coloration  would  disappear,  proving  that  there  no  longer 
penetrated  into  the  arteries  any  thing  but  oxygenated  blood.  Dr. 
Meigs  affirmed  that  he  had  rescued  from  death  from  fifty  to  sixty 
infants  in  an  hundred  by  this  method,  while  all  the  other  means  em- 
ployed to  the  present  day,  as  is  well  known,  have  been  unsuccessful. 


On  the  employment  of  Tartar  Emetic  in  large  and  gradually  in- 
creased  doses  in  Hydarihrosis,  By  M.  Gimeiae.  Gazette  Medi- 
cale  de  Paris.  The  author  has  already  published  a  memoir  upon 
the  same  subject,  but  the  present  work  contains  new  facts  entirely 
confirmatory  of  the  preceding  ones.  M.  Gimelle  has  found  the 
medication  which  he  proposes  to  be  efficacious  in  all  cases  of  hydar- 
throsis,  of  however  old  a  date,  provided  that  the  synovial  membrane 
had  experienced  no  organic  alteration,  and  that  the  fluid  secreted  by 
it  retained  its  normal  character.  In  these  twenty  new  cases  the 
absorption  of  the  fluid  was  always  accomplished  in  eight  or  ten  days  ; 
the  dose  of  tartar  emetic  was  never  carried  beyond  SO  centigrammes, 
(16  grains,)  commencing  with  20  and  increasing  10  each  day,  when 
the  toleration  was  established.  The  age  of  the  subjects  varied  from 
27  years  to  63. 

As  a  model  for  the  application  of  the  method  in  all  its  details,  we 
think  it  proper  to  give  one  of  these  cases. 

M.  R.,  a  Belgian  magistrate,  aged  34,  had  been  affected  with 
hydarihrosis  of  the  right  knee  for  three  years.  The  treatment  by 
leeches,  blisters,  caustics,  by  every  kind  of  external  irritation,  by  in- 
ternal remedies,  by  the  use  of  natural  mineral  waters,  by  baths  and 
compression  had  failed,  in   Belgium,   in  Prussia,  and   in  a  private 


538  Acute  Articular  Rheumatism.  [September, 


hospital  in  Paris,  where  the  patient  had  sojourned  for  six  months. 
Such  was  his  condition  when  he  came  to  consult  M.  Gimelle.  The 
volume  of  the  right  knee  was  4  centimetre  (near  2  inches)  greater  than 
that  of  the  opposite  side,  the  patella  was  strongly  pushed  forwards, 
and  on  each  side  of  that  bone  existed  a  protuberance  in  which  fluctu- 
ation was  perceived  the  flexion  of  the  limb  was  much  restricted  
the  whole  extremit)''  was  considerably  emaciated,  and  the  patient 
could  walk  only  with  the  assistance  of  crutches. 

M.  Gimelle  commenced  the  10th  May,  1842,  by  prescribing  tartar 
emetic  in  the  dose  of  20  centigrammes  (4  grains)  in  a  potion  of 
100  grammes,  (45.)  with  the  addition  of  20  grammes  (f  )  of  the 
syrup  of  poppies.  Teb  vomitions  and  six  alvine  evacuations  follow- 
ed. The  same  dose  was  administered  the  next  day  and  produced 
only  two  vomitions. 

On  the  12th,  the  same  dose  produced  only  one  alvine  evacuation, 
but  there  supervened  a  very  abundant  perspiration  which  continued 
during  the  entire  night.  On  the  following  day  the  synovial  mem- 
brane was  less  tense. 

From  the  13lh,  the  dose  of  tartar  emetic  was  increased  each  day 
from  10  centigrammes  (2  grains)  to  20  (4  grains)  until  it  reached 
8  decigrammes,  (16  grains.) 

At  this  date  the  diseased  knee  presented  a  volume  only  2  centimetre 
(1  inch)  greater  than  the  sound  one,  and  the  fluctuation  was  scarcely 
perceptible.  From  this  period  the  emetic  potion  was  continued  in 
the  same  dose  every  other  day,  until  the  31st  May,  when  the  volume 
of  the  right  knee  was  only  one  centimetre  greater  than  that  of  the 
left  one ;  no  fluctuation  could  be  perceived  ;  flexion  could  be  carried 
to  the  extent  of  a  right  angle;  the  patient  made  use  of  only  one 
crutch.  All  treatment  was  arrested,  and  in  the  latter  part  of  June 
the  patient  left  Paris. 

During  the  entire  treatment  M.  R.  ate  and  drank  to  the  satisfac- 
tion of  his  appetite,  and  in  a  letter  written  in  1843,  he  informed  M. 
Gimelle  that  he  had  continued  to  improve  that  the  diseased  limb 
had  regained  its  usual  volume  that  he  still  had  some  lameness,  but 
that  he  could  endure  standing  or  walking  for  several  hours. 


On  the  treatment  of  Acute  Articular  Rheumatism  hy  Sulphate  of 
Quinine  in  moderate  doses.  By  M.  Legeoux.  Gazette  Medicale, 
June  2lst,  1845.  M.  Legroux  having  followed  for  some  time  the 
cliniquc  of  M.  Bouillaud  has  come  to  the  conclusion  that  if  the  me- 


1845.]  Iodide  of  Potassium  in  Syj)hil is.  539 


thod  of  bleeding  at  short  intervals,  as  practised  by  the  latter  physician, 
often  arrests  rheumatism  at  once,  it  nevertheless  has  the  inconven- 
ience of  protracting  convalescence,  of  increasing  and  of  multiplying 
internal  congestions.     Having  tried  the  sulphate  of  quinine  accord- 
ing to  the  formula  of  M.  Briquet,  he  has  Jiiet  with  some  serious  acci- 
dents; but  regarding  the  sulphate  of  quinine  as  a  powerful  sedative, 
he  persisted  in  the  employment  of  it,  greatly  reducing  the  dose, 
however,  according  to  the  following  formula:  Sulphate  of  quinine 
1  gramme,  (20  grains,)  or  150  centigrammes  (30  grains)  for  the  first 
day,  according  to  the  strength  of  the  patient  and  the  intensity  of  the 
rheumatic  diathesis.     This  quantity  is  divided  into  six  or  eight  por- 
tions, one  of  which  is  administered  every  two  hours.     Immediately 
after  each  dose,  half  a  tumbler  of  sulphuric  lemonade  is  given  to  fa- 
cilitate the  solution  of  the  medicine  in  the  stomach.     On  the  next 
day  and  the  following  days,  according  to  the  effects  produced,  the  dose 
is   maintained  or   increased  without   passing,   however,  beyond  2 
grammes  (40  grains)  in  24  hours.     When  the  pain  and  fever  disap- 
pear the  dose  is  gradually  reduced.     This  treatment  has  been  gener- 
ally followed  to  the  exclusion  of  every  other  mode ;  in  some  cases, 
however,  bleeding,  purgatives,  and  blisters  have  been  employed  to 
combat  complications  which  the  sulphate  of  quinine  could  not  reach. 
By  this  treatment,  rheumatism  was  cured  generally  with  as  much 
rapidity  as  by  the  employment  of  sulphate  of  quinine  in  large  doses, 
or  by  the  other  medications  so  much  vaunted  in  modern  times.     In 
the  majority  of  cases  the  duration  of  the  disease  was  from  ten  to 
eleven  days,  when  the  patients  entered  the  hospital  about  the  second 
or  third  day  of  the  affection.     As  to  the  infiuence   of  the  quinine 
medication  upon  the  blood,  it  results  from  the  experiments  of  M. 
Legroux  that  the  fibrine  already  superabundant  in  rheumatic  pa- 
tients is  still  farther  augmented  for  forty-eight  hours  after  the  first 
dose  of  the  quinine,  but  that  in  ninety-six  hours  it  is  diminished  by 
one-third,  and  tends  to  become  normal  in  quantity.     On  the  other 
hand,  if  the  analysis  be  correct,  the  globules  would  follow  an  opposite 
proportion,  that  is  to  say,  that  their  relative  proportion  would  tend  to 
decrease.     These  results  may  explain  why  in  larger  doses  the  sul- 
phate of  quinine  often  induces  a  kind  of  typhoid  state.     This  point 
is  worthy  of  attention. 


Employment  of  the  Iodide  of  Potassium  in  the  treatment  of  the 
'primary  symptoms  of  Syphilis,  Bulletin  General  de  Therapeutique. 
At  the  present  day  no  one  denies  seriously  the  efficacy  of  the  iodide 


540  Iodide  of  Potassium  in  Syphilis  [September, 


of  potassium  in  the  tertiary  symptoms  of  syphilis.  This  is  one  of  the 
few  articles  whose  reputation  has  been  as  rapid  as  it  was  just.  It 
was  but  natural  that  the  brilliant  success  obtained  from  its  use  in 
consecutive  syphilis  should  produce  a  disposition  to  make  trial  of  it  in 
the  primary  symptoms.  Such  trials  have  been  made,  but  with  dif- 
ferent results.  While  some  have  obtained  only  a  very  doubtful  suc- 
cess, others  vaunt  its  efficacy  in  every  period  of  syphilis,  even  in  its 
incipiency.  We  have  before  us  a  treatise  by  Dr.  Mistier,  in  which 
he  adopts  the  latter  opinion,  and  from  considerations  which  seem  to 
us  to  be  new  and  worthy  of  interest. 

According  to  this  author,  every  local  and  primary  chancre,  how- 
ever small  and  mild  it  may  be,  when  once  developed,  manifests  itself 
almost  always  after  the  lapse  of  a  certain  time,  by  the  development  of 
consecutive  symptoms,  such  as  buboes,  ulcerations  of  the  throat,  &c., 
although  you  may  have  employed  all  your  efforts  to  prevent  the  ab- 
sorption of  the  virus.  The  same  thing  does  not  take  place  when  the 
iodide  of  potassium  is  employed  from  the  beginning  of  the  affection 
and  conjointly  with  local  treatment.  In  these  cases,  says  M.  Mist- 
ier, the  consecutive  infection  is  as  rare  as  it  is  common  after  the 
ordinary  mode  of  treatment ;  and  nevertheless,  adds  he,  the  iodine 
treatment  produces  no  very  sensible  effect,  either  for  good  or  for  evil, 
upon  the  local  symptoms,  but  it  opposes  the  development  of  the  con- 
secutive, preserving  the  economy  from  virulent  infection.  The  ra- 
pidity of  its  absorption,  far  from  rendering  its  action  uncertain,  as 
has  been  supposed,  constitutes  on  the  contrary  the  preservative  power, 
which  resides  particularly  in  this  property,  of  stimulating  actively  the 
lymphatic  system,  and  thus  counterbalancing  the  action  of  the 
syphilitic  virus. 

All  this  is  perhaps  rather  theoretical,  but  the  author  affirms  and 
this  is  the  important  thing  for  practitioners; that  when  the  iodide  of 
potassium  is  administered  in  sufficient  quantity  in  primary  syphilis, 
it  prevents  infection  and  opposes  the  development  of  consecutive 
symptoms. 

When  a  patient  with  chancre  applies  to  M.  Mistier,  he  endeavors 
to  destroy  it,  to  dry  up  the  local  affection,  or  treats  it  with  the  means 
generally  used  ;  but  at  the  same  time,  in  order  to  preserve  the  pa- 
tient against  the  consecutive  infection,  he  administers  from  25  centi- 
grammes (5  grains)  to  1  gramme  (20  grains)  of  the  iodide  of  potas- 
sium every  twenty-four  hours.  It  is  but  seldom  necessary  to  go 
beyond  1  gramme  per  day.     This  dose  is  sufficient  in  the  majority 


1945.]  Ant i. Syphilitic  Remedies^  4'C.  541 


of  cases.  He  continues  the  use  of  this  remedy  not  only  until  the 
local  symptoms  have  completely  disappeared,  but  for  some  time  after- 
wards, until  it  appears  to  him  that  the  secondary  affection  is  no 
longer  to  be  apprehended. 

This  treatment,  he  says,  has  over  others  incontestible  advantages. 
It  does  not  weaken  the  constitution  like  antiphlogistics  does  not 
act  upon  the  mouth  and  salivary  glands  like  mercury,  and  finally 
docs  not  require  the  patient  to  protect  himself  particularly  against 
taking  cold,  as  is  necessary  after  the  employment  of  sudorifics.  It 
imposes  no  restraint  upon  the  diet  or  regimen  of  the  patient. 

Thirty-eight  patients  affected  with  chancre  have  been  treated  by 
M.  Mistier  according  to  this  plan  thirty-two  have  been  preserved 
from  the  secondary  affection,  and  in  the  other  six  consecutive  symp- 
toms made  their  appearance,  five  of  these  were  cured  by  mercurials 
combined  with  iodine  preparations,  and  only  one  resisted  every  mode 
of  treatment.     He  died  in  consequence  of  ulcerations  of  the  larynx. 


Anti- Syphilitic  remedies  and  their  therapeutic  appplication.  Prize 
E^ay,  by  M.  Payax.  Gazette  Medicale.  In  this  work,  which  ob- 
tained  the  prize  from  the  Medical  Society  of  Bordeaux,  M.  Payan, 
Chief  Surgeon  of  the  Hospital  of  Aix,  expresses  opinions  nearly  in 
conformity  with  those  of  M.  Ricord.  His  therapeutical  experiments 
have  led  him  to  believe  that  the  old  division  of  syphilitic  spmptoms 
into  primitive  and  consecutive  is  insufficient,  and  to  admit  with  M. 
Ricord  in  the  manifestation  of  these  symptoms  three  successive 
phases  or  periods.  In  the  first,  he  ranges  the  symptoms  called  primi- 
tive, without,  however,  considering  them,  with  the  Parisian  Surgeons, 
as  the  simple  effects  af  a  local  disease :  such  are  blennorrhagia, 
chancre,  bubo,  or  adenites.  The  second  period  comprises  symptoms 
which  denote  evidently  a  general  infection,  and  affect  principally  the 
skin,  the  mucous  membranes,  the  eyes,  the  testicles :  such  are  the 
different  syphilides,  fissures,  alopecia,  chronic  furuncles  which  ter- 
minate in  ulceration,  cutaneous  nodosities  or  tubercles,  consecutive 
ulcers  or  chancres,  and  different  excrescences  in  the  vicinity  of  the 
sexual  parts.  In  the  third  period  he  ranges  the  symptoms  which 
denote  an  infection  of  an  older  date,  and  which  are  more  deeply  situ- 
ated :  such  as  deep  seated  tubercles  of  the  skin  and  mucous  mem- 
branes, tubercles  of  the  cellular  tissue,  commonly  called  gummy 
tumours,  periostitis  or  nodes,  caries,  necrosis,  &;c. 

Each  of  these  periods  gives  rise  to  peculiar  therapeutic  indica- 


542  Diagnosis  of  Hepatitis  and  Hepatalgia,    [September, 


tions,  and  has  a  specific  remedy  which  is  not  equally  applicable  to 
the  other  two  periods.  Thus  he  regards  mercury  as  the  specific  of 
the  first  period,  the  iodide  of  mercury  as  the  specific  of  the  second, 
and  the  iodide  of  potassium  as  the  specific  of  the  third. 

M.  Payan  remarks  that  mercurial  fumigations  and  baths  are  in- 
convenient, inasmuch  as  we  are  unable  to  appreciate  the  quantity  of 
mercury  absorbed ;  he  employs  fumigations  only  in  certain  local 
affections,  as  venereal  testicle  and  certain  excrescences ;  he  reserves 
mercurial  frictions  for  those  cases  in  which  a  phlegmasia  of  the  diges- 
tive tube  opposes  the  internal  use  of  mercury ;  with  M.  Ricord,  he 
esteems  the  proto-iodide  of  Mercury  as  much  less  irritating  than  the 
deuto-iodide,  and  he  recommends  the  cyanidide  of  mercury  as  an  ex- 
cellent preparation  for  delicate  and  susceptible  persons. 

He  regards  the  action  of  the  iodide  of  potassium  as  heroic  in  the 
third  period  of  syphilis,  and  that  its  efBcacy  is  proportionately  great- 
er in  old  cases,  an  opinion  generally  entertained  by  modern  writers 
upon  this  subject. 


The  Diagnosis  of  Hepatitis  and  Hepatalgia.  The  following 
summary,  though  it  has  nothing  novel  to  recommend  it,  may  be  ad- 
vantageously borne  in  mind  :  

"Although  the  pains  accompanying  heptalgia,  may  be  as  intense 
as  those  of  heptatitis,  and  in  many  instances,  perhaps  more  urgent, 
they  are  not  constant,  but  are  at  the  outset,  and  frequently,  also, 
during  the  whole  progress  of  the  disorder,  paroxysmal,  affording  in 
the  interval  a  complete  immunity  from  pain.  The  pathognomonic 
signs  indicative  of  inflammatory  action  of  the  liver,  are  pyrexia,  tu- 
mefaction, great  tenderness  in  the  hypochondrium,  frequent  and 
strong  pulse,  thirst,  furred  tongue,  and  vomiting,  sometimes  of  a 
bilious,  and  at  other  times  of  a  dark-coloured  secretion,  as  the  sub- 
stance of  the  liver  more  or  less  partakes  of  the  invading  disease. 
The  bowels  are  irregular  in  their  action,  the  evacuations  presenting 
a  great  variety  of  appearances,  according  as  the  biliary  secretion  is 
more  or  less  afiected.  and  the  urine  is  scanty  and  high-coloured.  In 
hepatalgia,  on  the  contrary,  these  signs  are  invariably  wanting; 
there  may  exist,  indeed,  constant  pain  and  tenderness  over  the  region 
of  the  liver,  increased  to  a  certain  degree  by  pressure,  but  manifest 
exacerbations,  even  in  the  worst  cases,  occur,  which  are  sufficiently 
indicative  of  its  paroxysmal  character.  The  functions  of  the  organ 
may  proceed  uninterruptedly  as  in  its  healthy  condition.  The  tongue 
may  be  quite  clean,  or  sometimes,  in  the  centre,  there  may  be  a 
gentle  creamy  fur,  and  the  urine  is  generally  increased  in  quantity, 
and  is  of  a  lighter  color  than  ordinary."  Treatment  of  Hepatalgia.  
*' Gentle  purgatives,  combined   with  colcliicum,  ipecacuanha,  and 


IS  15.]  Emetics  in  Bronchitis,  543 


hyosciamiis,  will  seldom  fail  to  work  a  speedy  cure  ;  and  if  the  con- 
stitution have  sufFcred  from  protracted,  unmitigated  pain,  alkaline 
vogetable  tonics  wiilcfloct  that  which  we  might  in  vain  expect  from 
the  rough,  insoluble  mineral  preparation.  Dr.  Allnatt.  Medical  Gaz, 

Emetics  in  Bronchitis,  By  John  Higgixbottom,  F.  R.  C.  S., 
Nottingham.  I  have  found  an  emetic  dose  of  ipecacuanha  a  vry 
valuable  remedy  at  tiiat  stage  of  bronchitis  where  a  sudden,  low,  or 
sinking  state  has  come  on  with  oppression  at  the  chest,  and  the  ex- 
pectoration difficult,  endangering  suffocation.  Vomiting  with  ipe- 
cacuanha has  not  only  soon  relieved  these  symptoms,  but  has  roused 
the  whole  system,  and  has  produced  such  a  decided  change,  as  to 
render  the  patient  convalescent  in  a  few  days.  I  have  never  seen 
the  same  good  effects  in  such  circumstances  produced  by  any  other 
remedy.     The  two  following  cases  are  of  that  description  : 

"  3Ir.  D ,  aged  60,  an  inn-keeper,  of  a  gross  habit,  but  not  con- 
sidered intemperate,  had  been  much  reduced  in  consequence  of  a 
neglected  erysipelatous  inflammation  of  the  leg  and  thigh  ;  this  had 
in  some  measure  subsided,  but  he  had  at  the  same  time  bronchitis, 
attended  with  a  troublesome  cough,  difficult  respiration  and  expector- 
ation. A  sudden  state  of  sinking  came  on,  with  increased  dyspnoea, 
and  a  feeble,  quick  pulse.  I  gave  half  a  drachm  of  ipecacuanha  in 
a  little  water  ;  he  vomited  at  different  times  for  two  hours  ;  the  low- 
ness  and  dangerous  symptoms  were  much  relieved  ;  he  had  no  relapse 
of  the  low  or  sinking  state,  and  he  gradually  recovered  under  a 
common  mild  treatment." 

"  Mrs.  C -,  aged  78,  had  an  attack  of  the  prevailing  influenza ; 

saline  aperients,  with  diaphoretic  and  expectorant  medicines,  had 
been  given  for  about  five  days,  when  a  low,  sinking  state  came  on, 
with  difficulty  of  breathing.  I  was  inclined  to  give  an  emetic  of 
ipecacuanha  as  the  most  probable  remedy  to  afford  relief.  I  named 
it  to  her  daughter,  fearing  the  old  lady  would  object  to  it.  I  was 
glad  to  find  my  patient  would  take  it ;  and  I  may  here  mention  the 
favorable  idea  patients  sometimes  have  of  an  emetic,  imagining  that 
vomiting  enables  them  to  throw  up  the  phlegm.  I  gave  her  half  a 
drachm  dose  of  ipecacuanha,  which  had  the  desired  effect  of  com- 
pletely relieving  her.  I  was  only  required  to  visit  my  patient  for 
five  more  days,  she  being  then  quite  convalescent." 

The  following  observations  in  Dr.  Johnson's  Review,  of  April, 
1844,  are  corroborated  by  the  above  case,  and  I  have  no  doubt,  will 
hold  good  in  a  variety  of  diseases,  both  in  the  commencement  and 
in  the  sinking  stage  of  disease  :  "  The  use  of  emetics  (I  would  say 
ipecacuanha,  from  the  great  safety  of  its  operation)  is  far  too  much 
neglected  in  the  present  day,  and  most  practitioners  are  unnecessarily 
timid  about  using  them  to  old  patients ;  a  single  emetic  will  often 
effect  more  good  in  the  course  of  a  day  or  two,  than  other  remedies 
in  a  v/cck  or  two."  London  Lancet. 


544 


Mesmerism.  Meteorological  Observations, 


True  and  False  Mesmerism.  Dr.  Charles  Radclyffe  Hall,  of  London,  in  a 
series  of  Articles  in  the  Lancet,  on  the  Rise,  Progress  and  Mysteries  of  Mesmer- 
ism, in  all  ages  and  countries, deduces  the  following  conclusions: 

"  Of  the  alleged  results  of  mesmeric  processes,  I  believe  there  are 
Proved  Gluietude;  composure;  sleep. 
Probable,  but  requirins:  confirmation  Traction;  muscular  rigidity ;  convulsions; 

heightened  sensibility ;  diminished  sensibility ;  double  consciousness.^ 
Possible,  but  not  very  probaile  Insensibility  to  severe  pain,  for  a  given  length  of 

time,  at  pleasure. 
Impossible,  as  far  as  amy  thing  can  be  so  Clairvoyance;  intuition;  prevision; 

community  of  thought;  involuntary  and  complete  subjection  of  mind  to  the 

mesmeriser. 
And,  lastly,  I  believe  that  we  have  not  a  shadow  of  evidence  in  support  of  the 

existence  of  any  new  agency,  whether  designated  mesmeric,  magnetic,  occult, 

or  by  any  other  name." 

Up  to  the  present  hour,  we  Imow  of  no  Medical  Journal,  either  in  Europe  or 
in  this  Country,  that  looks  upon  mesmerism  with  the  least  allowance. 


METEOROLOGICAL  OBSERVATIONS,  for  July,  1845,  at  Augusta,  Ga. 
Latitude  33^^  27'  north  Longitude  4  32'  west  Wash.  Altitude  above  tide 
152  feet. 


I 

Thermometer. 
Sunrise.    4,  p.  m. 

Barometer. 
Sun  rise.       4,  p.  m. 

Wind. 

Remarks. 

1 

64 

87 

29  74-100 

29  74-100 

w. 

Fair. 

2 

58 

92 

''  74-100 

"  75-100 

s. 

Fair.                       (8-10  in. 

3 

70 

88 

'  75-100 

"  66-100 

s. 

Cloudy shower  at  5,  p.  m., 

4 

70 

90 

''  66-100 

"  66-100 

N. 

Flying  clouds. 

^ 

73 

86 

"  75-100 

"  80-100 

S.  E. 

Variable. 

6 

70 

90 

"  91-100 

"  86-100 

S.  E. 

Variable. 

7 

72 

93 

"  94-100 

"  86-100 

S. 

Fair. 

8 

76 

97 

"  85-100 

"  80-100 

S. 

Variable thunder. 

9 

76 

94 

"  77-100 

"  74-100 

S.  E. 

Cloudy. 

10 

73 

80 

''  76-100 

''  74-100 

S.    E. 

Rain  8-10  inch. 

11 

73 

84 

"  76-100 

"  73-100 

N.  W. 

Fair. 

12 

72 

88 

"  72-100 

"  65-100 

N.  E. 

Variable showery thun.- 

13 

72 

78 

"  70-100 

'  70-100 

S. 

Cloudy  showery,        do. 

14 

72 

86 

"  70-100 

"  70-100 

S.  W. 

Variable  showery,     do. 

15 

73 

87 

''  70-100 

"  70-100 

S.  W. 

Variable  showery,     do. 

16 

73 

87 

"  72-100 

"  75-100 

s.  w. 

Variable,        do. 

17 

73 

93 

"  76-100 

"  78-100 

s.  w. 

Variable  thunder,  &c. 

18 

75 

96 

"  80-100 

"  82-100 

w. 

Fair. 

19 

74 

96 

"  80-100 

'=  78-100 

w. 

Fair. 

20 

72 

96 

"  80-100 

"  80-100 

N.W, 

Fair flying  clouds. 

21 

76 

98 

'=  80-100 

"  78-100 

W. 

Fair,           do. 

22 

77 

100 

"  69-100 

'=  66-100 

W. 

Fair,           do. 

23 

76 

100 

"  64-100 

'  62-100 

E.  &  W. 

Fair  12  m.  change  of  wind. 

24 

76 

93 

"  67-100 

"  69-100 

N. 

Fair. 

25 

65 

93 

"  70-100 

"  70-100 

S.    E. 

Variable. 

26 

75 

91 

"  65-100 

"  55-100 

s.  w. 

Cloudv blow,     [dv,  blow. 

27 

78 

92 

"  54-100 

"  50-100 

w. 

Th.  &light.  last  night,  clou- 

28 

71 

92 

'  64-100 

'  67-100 

N.  W. 

Fair. 

29 

62 

96 

"  65-100 

"  60-100 

S.  W. 

Flying  clouds. 

30 

75 

92 

'  52-100 

"  45-100 

s.  w. 

Do.    do.    thunder,  &c. 

31 

68 

91 

"  58-100 

"  66-100 

w. 

Fair. 

13  Fair  days.    Gluantity  of  Rain,  1  inch  and  6-10. 


SOUTHERN 

MEDICAL  AND  SURGICAL 

JOURNAL. 

Vol.  I.]  NEAV  SERIES. OCTOBER,  1S43.  [^'o.  10. 


PART  I. ORIGINAL  COMMUNICATIONS. 

ARTICLE    I. 

Observations  on  the  Soil,  Climate  and  Diseases  of  Liberty  County^ 
Georgia.     By  John  M.  B.  Hakdex,  M.  D. 

Liberty  county  in  Georgia  is  situated  between  *31  38'  and  32*^ 
north  latitude  and  the  4th  and  5th  degree  of  longitude  west  of  the 
meridian  of  Washington  in  the  District  of  Columbia.  It  extends 
from  the  Atlantic  ocean  on  the  east,  where  it  takes  in  the  Island  of 
St.  Catharines,  sixty  or  seventy  miles  into  the  interior,  where  it  is 
connected  with  Tattnall  county  on  the  west.  At  this  latter  point  it 
has  a  breadth  of  between  thirty  and  forty  miles,  but  at  its  eastern 
extremity  it  is  narrowed  to  a  distance  of  ten  or  fifteen  miles.  It  is 
bounded  on  the  north  by  the  Midway  river,  and  partly  by  the 
Canouchie,  whjch  touches  it  on  the  northwest,  and  on  the  south  by 
the  south  Newport  river,  and  partly  by  the  Alatamaha,  and  has  a 
superficial  area  of  nearly  1800  square  miles. 

Soil.  In  respect  to  its  soil,  Liberty  county  may  be  divided  into 
two  distinct  portions  by  a  line  parallel  with  the  sea  coast  and  equi- 
distant from  its  eastern  and  western  limits,  extending  along  a  ridge 
of  land  which  is  the  commencement  of  what  is  commonly  known  as 
the '' Sandhills,"  \ 

  From  two  observations  made  in,1842,by  means  of  two  Gnomons  of  my  own 
construction,  I  found  the  latitude  of  Bull  town  swamp,  at  the  southern  terminus 
of  the  county,  to  be  31  38'  after  making  corrections  for  Sun's  semidiameter  and 
horizontal  parallax. 

35 


546  Observations  on  the  Soil,  Climate  and  Diseases     [October, 


The  eastern  portion  is  intersected  in  every  direction  by  many  large 
and  dense  swamps,  which  are  the  tributary  branches  of  the  Midway, 
north  Newport  and  south  Newport  rivers;  taking  their  rise  at  the 
ridge  of  the  Sandhills  in  what  are  called  "  Spring  Branches,^'  and 
continuing  down  to  the  head  of  tide-water  ten  or  twelve  miles  from 
the  ocean.  The  surface  is  very  level,  with  a  gradual  but  impercep- 
tible desf  ent  towards  the  coast.  The  soil  is  for  the  most  part  com- 
posed of  ^and*  and  clay  in  various  states  of  intermixture,  in  some 
places  the  sand,  and  in  others  the  clay  seeming  to  predominate.  In 
the  neighborhood  of  the  swamps  the  clay  is  very  pure  and  tenacious, 
and  when  mixed  with  much  vegetable  matter,  it  assumes  a  very  dark 
color  and  is  known  as  ^^  Blue  Clay.'"  This  blue  cZaz/,  with  a  rich, 
vegetable  mould,  form  our  most  valuable  soils  for  the  culture  of  Cotton 
(Gossipium  Barbadense)  and  Corn  (Zea  maize)  and  when  combi- 
ned with  Marie,  it  seems  to  be  inexhaustible. 

The  western  portion  at  the  ridge  has  a  very  evident,  and  in  some 
places,  a  very  abrupt  rise  of  from  10  to  15  {eet,  and  then  with  a 
gradual  ascent  towards  the  west,  it  assumes  the  same  level  aspect 
with  the  eastern  portion,  until  it  reaches  the  limits  of  the  county. 
The  soil  here  is  mostly  sandy  and  barren,  except  in  the  immediate 
vicinity  of  the  branches  which  are  given  off  by  the  Alatamaha  on 
the  south,  and  the  Canouchie  on  the  north.  The  sand  varies  in 
depth  from  4  to  8  Ceet,  and  probably  even  more  in  some  places ;  and 
in  reflecting  upon  the  appearance  presented,  we  can  hardly  resist  the 
impression  that  this  ridge  was  at  one  time  the  limit  of  this  part  of 
our  continent,  and  that  these  sands  were  the  downs  cast  up  by  the 
waves  of  the  ocean.  In  the  midst  of  this  sandy  waste  are  found 
two  or  three  ponds  or  lakes,  which  are  worthy  of  notice.  They  are 
nearly  circular,  having  a  circumference  of  about  four  miles,  and 
discharge  themselves  by  small  outlets  into  the  Alatamaha  and  Ca- 
nouchie  they  are  surrounded  by  a  thick  growth  of  dwarf-baysf  and 
andromeda.J  In  approaching  them,  you  come,  as  it  were,  to  a 
large  clearing,  and  upon  entering,  you  find  nothing  in  the  form  of 
trees,  except  dwarf  or  stunted  pines.  The  surface  is  covered  over 
with  sphagnum  and  ferns,  and  here  and  there  clumps  of  the  androm- 
eda  and  the  bay,  intertwined  with  the  vines  of  the  smilax.||  The 
soil  on  the  top  is  nothing  but  a  complete  mat  of  fern  roots,  covered 
with  the  sphagnum,  upon  penetrating  which,  you  may  sink  a  rod  to 

*  See  Appendix,  Note  A. 

tLauras  Carolinianus.        i  Andromeda  racemosa,        (I  Smilax  laurifola. 


1845.]  of  Liberty  County,  Ga,  547 

any  depth,  apparently,  without  finding  bottom.  The  subsoil  is  dark, 
but  when  dry  has  the  appearance  ofsnuft',  and  (as  I  am  informed  by 
an  intelligent  gentleman,)  will  burn  readily;  indeed  these  ponds 
have  all  the  features  that  characterize  the  peat-bogs  of  Ireland,  the 
moors  of  Scotland,  and  the  turf-bogs  of  the  north  of  Europe. 

In  both  portions  of  the  county  the  surface  is  covered  over  in  many 
places  with  a  very  coarse  white  sand  and  gravel :  this  is  particularly 
the  case  at  "  Gravel  Hill.'' 

In  several  places  there  are  to  be  found  lower  and  level  tracts,  of 
considerable  extent,  destitute  of  shrubbery  and  covered  over  by 
herbaceous  plants,  interspersed  with  tall  pines.  These  tracts  are 
known  among  us  as  savannas.  In  the  adjoining  county  of  Mcintosh 
they  are  very  conspicuous,  and  running  nearly  east  and  west,  present 
very  much  the  appearance  of  water  courses  that  have  been  gradu. 
ally  filled  up  by  alluvial  deposits  from  the  higher  grounds.  These 
savannas  are  capable,  I  believe,  of  great  improvement  by  culture, 
but  they  are  kept  in  this  waste  and  barren  condition  by  the  custom 
of  allowing  fires  to  sweep  over  them  at  least  once  a  year,  in  order  to 
afford  pasturage  for  cattle.  In  the  summer  and  autumn  they  are  cov- 
ered with  the  most  beautiful  flowers,  &;c.,  and  present  a  fine  field  for 
botanical  researches. 

AUhough  not  immediately  connected  with  our  subject,  I  cannot 
omit  to  mention  the  existence  in  many  places  of  Indian  mounds,  or 
tumuli,  which  were  probably  used  by  the  Aborigines  as  places  of  in- 
terment, and  in  and  around  them  are  found  various  instruments  for 
domestic  or  warlike  purposes  such  as,  arrows  and  spear-heads, 
hatchets,  and  mills  for  pounding  grain,  made  of  hard  stone  or  flint, 
and  pieces  of  pottery,  made  of  clay,  on  which  at  times  various  images 
were  curiously  wrought. 

After  penetrating  the  superficial  soil,  which,  as  we  have  seen, 
varies  greatly  in  depth  at  different  places,  we  come  down  to  a  bed  or 
sub-stratum  of  red  clay,  which  is  generally  from  8  to  10  feet  thick  ; 
after  passing  this,  we  next  come  to  a  bed  of  sand,  usually  white,  and 
containing  gravel  or  pebbles,  either  angular  or  rounded,  by  attrition. 
This  is  the  depth  to  which  we  have  to  penetrate  in  digging  our  wells, 
the  deepest  of  which  are  from  10  to  20  feet.  In  some  places,  we 
come  to  a  kind  of  sand-stone,  of  a  very  dark  color,  and  very  hard, 
when  in  situ,  but  upon  exposure  to  the  air,  it  assumes  a  ferruginous 
tint  and  crumbles  readily  beneath  the  pressure  of  the  fingers.  In 
some  places  an  ore  is  found  which  is  very  rich  in  iron. 


548  Observations  on  the  Soil,  Climate  and  Diseases     [October, 


No  fossil  bones  have,  to. my  knowledge,  been  discovered  within 
the  limits  of  the  county.  I  have,  however,  in  my  possession,  por- 
tions of  a  coprotiie,  that  v/as  found  at  the  bottom  of  a  well  17  or  18 
feet  below  the  surface.  It  is  composed  of  silicious  sand,  loosely 
held  together  by  a  small  portion  of  alumine  and  phos.  lime.  The 
proportion  of  the  latter  ingredient  is  so  small  that  I  am  disposed  to 
regard  it  as  the  coprotite  of  a  gramenivorous  animal. 

A  few  feet  below  the  surface,  oyster  shells  of  the  neighboring 
rivers  may  be  found  in  various  localities,  particularly  in  the  eastern 
part  of  the  county,  from  20  to  40  miles  from  the  ocean.  Marie 
beds  also  occur  in  many  places,  which  I  have  no  doubt  are  the  pro- 
duct of  the  decomposition  of  the  shells  of  the  oyster,  (ostrea  edulis) 
although  I  have  never  been  able  to  identify  the  shell.  The  marie  is 
sometimes  very  rich  in  carb.  of  lime,  and  might  be  made  available  as 
an  excellent  manure  I  have  also  some  beautiful  crystals  of  the 
sulphate  of  lime,  found  in  Bulltown  swamp. 

Petrified  wood  is  dug  up  at  various  depths  below  the  surface  ;  and 
on  the  north  Newport  and  Midway  rivers,  the  stumps  and  trunks  of 
Cypress  trees  and  arrow-heads  are  found  at  the  depth  of  ^  feet  or 
more  a  fact  which  was  noticed  by  Bartram,  in  his  travels  through 
this  State  and  Florida,  nearly  seventy  years  ago  and  in  some  places 
I  am  informed,  a  black,  soft  mud,  has  been  found,  having  all  the  smell 
of  ''Marsh  Mud:' 

These  various  facts  seem  to  me  .o  shew  conclusively  that  the  soil 
of  this  county,  and  more  particularly  the  eastern  portion,  is  entirely 
alluvial,  and,  like  that  between  the  Alatamaha  and  Turtle  rivers, 
described  by  Mr.  J.  H.  Couper  in  a  paper  read  before  the  Geological 
Society  of  England,  belongs  to  the  post-pleeocene  epoch. 

The  Sylva  and  Flora  of  this  county  is  unsurpassed*  by  those  of  any 
other  district  of  equal  extent  in  the  world.  Our  swamps  abound 
with  the  tallest  and  most  magnificent  trees  of  various  Jcinds,  and  the 
open  woodland  is  covered  over  at  certain  seasons  with  the  richest 
and  most  beautiful  plants  and  shrubs  

"  Arboribns  varia  est  natura  creandis 
Namque  alias,  nullis  hominum  cogentibus,  ipsae 
Sponte  sua  veniunt  composque  etflumina  late 
Curva  tenent."  Virgil.  Georgics  lib.  2. 

It  is  true,  that  some  of  our  most  luxuriant  forests  have  fallen  under 
the  ruthless  attacks  of  man  for  agricultural  purposes,  and  from  a  mis- 

*  See  Appendix,  note  B. 


1845.]  of  Liberty  County,  Ga,  549 


taken  system  of  culture,  much  of  our  virgin  soil  has  been  worn  out 
and  left  in  the  garb  of  widowhood  ;  but  it  is  to  be  hoped  that  greater 
iraprovement  in  agricultural  science  will  cause  the  most  of  it  to  be 
reclaimed,  and  although  disrobed  of  its  natural  beauty,  that  it  may 
yet  put  on  the  mantle  of  art  and  civilization. 

Climate.  In  determining  the  temperature  of  our  climate,  five 
observations  of  the  thermometer  have  been  taken  every  day  for  a 
period  of  one  year,  commencing  in  August,  183S,  and  ending  in 
August,  1839.  The  hours  chosen  for  these  observations  were  as 
jllows :  7  o'clock,  A.  M.,  and  1,  3,  7  and  11  o'clock,  P.  M.  From 
ihese  observations,  it  appears  that  the  mean  annual  temperature  is 
66^  41'.  The  year  1839,  a  part  of  which  is  included  in  these  obser- 
vations, was  unusually  hot  and  dry,  the  thermometer  rising  in  the 
month  cf  June  to  upwards  of  100*.  This  may  tend  to  raise  the 
mean  of  this  year,  but  it  is  probable  that  the  above  is  not  far  from 
the  mean  cf  any  given  series  of  year^. 

Although  my  observations  with  the  thermometer  have  not  been 
sufficiently  long  continued  to  warrant  it,  yet  I  have  no  doubt  that 
there  is  a  small  oscillation  in  the  mean  temperature  of  our  climate 
during  a  certain  period  of  time.  This  seems  evident  from  the  effects 
of  the  climate  upon  some  of  our  tropical  and  even  indigenous 
'lants.  Thus  there  are  seasons  with  us  in  which  the  cotton  plant 
j>  scarcely  killed,  and  assumes  nearly  the  character  of  a  peren- 
nial,  and  again  it  is  so  injured  by  ihe  cold  that  hardly  a  single 
root  wiii  sprout  up  in  the  ensuing  spring.    The  orange  tree  (Citrus 
Aurantiura)  will  for  many  years  do  well  amongst  us,  particularly  along 
the  sea-coast,  when  a  winter  or  number  of  winters  will  succeed,  ia 
which  they  are  nearly  destroyed.  In  the  winter  of  lS34-'35,  which 
was  the  coldest  winter  recollected  by  the  " oldest  inJuibitanty'^  they 
were  killed  even  in  Florida,  to  the  great  pecuniary  damage  of  the 
citizens  of  that  State.  Indeed  so  intense  was  the  cold,  that  the 
hedges  made  of  the  Cherokee  rose,  (Rosa  levigata,)  one  of  our  most 
hardy  perennials  were  very  seriously  injured. 

The  annual  range  of  the  thermometer  during  this  year  was  83^*  
the  minimum  on  the  24th  December,  1S38,  being  18  the  maximum 
in  June,  1839,  being  101  I  am  disposed  to  believe  that  this  is  not 
far  from  the  mean  annual  range,  although  we  are  subject  to  the  ex- 
tremes of  Zero  during  the  winter,  as  was  the  case  in  January,  1835, 
and  100  in  the  summer,  as  happened  in  1S39.  The  greatest  range 
olserved  in  any  one  month  took  place  in  March,  18-39,  when  the  ther- 


550  Observations  on  the  Soil,  Climate  and  Diseases    [October, 


mometer  on  the  5th  was  at  22^,  and  rose  on  the  23th  to  82 ;  and 
in  December,  1838,  when  the  minimum  was  IS*^  and  maximum  78. 
The  least  monthly  variation  was  22  in  August,  1838,  and  23  in 
July,  1839. 

The  mean  diurnal  variation  for  the  whole  year  was  17  16'  the 
greatest  variation  taking  place  in  the  winter  and  the  least  in  the 
summer  months  the  greatest  mean  diurnal  variation  took  place  in 
the  month  of  March,  1839,  and  was  22  19' the  least  in  the  month 
of  September,  1838,  and  was  9.  The  greatest  variation  between 
the  maximum  and  minimum  for  any  one  day,  was  43  in  March, 
1839  the  least  in  June  and  July,  when  it  was  only  14.  In  the 
months  of  June,  July,  August  and  September,  the  greatest  diurnal 
range  was  not  more  than  18  proving  conclusively  what  has  been 
stated  above,  that  the  temperature  is  far  more  agreeable  during  the 
summer,  than  at  any  other  season  of  the  year. 

The  months,  whose  mean  temperature  corresponds  most  nearly 
with  the  mean  temperature  of  the  year,  are  April,  the  mean  tempera- 
ture  of  which  is  68  and  October,  whose  mean  temperature  is  65. 
These  are  decidedly  the  most  pleasant  and  agreeable  months  in  the 
year. 

The  coldest  month  observed  was  January,  the  mean  temperature 
of  which  was  51.  There  can  be  no  doubt  that  the  coldest  weather 
we  experience  takes  place  after,  rather  than  before,  the  winter  sol- 
stice, and  I  believe  January  is  usually  our  coldest  month.  So,  too, 
our  warmest  weather  is  for  the  most  part  after  the  summer  solstice. 
In  1839,  the  mean  temperature  of  August  was  63,  which  was  also 
the  mean  for  the  month  of  June.  This  last  month,  however,  was 
unusually  hot.     The  mean  for  July  was  80. 

The  temperature  of  our  wells  I  have  found  to  be  in  the  summer 
74  which  is  8  above  the  annual  mean.  I  have  no  doubt  that 
they  are  measurably  affected  by  the  temperature  of  the  air,  on  ac- 
count of  their  being  at  so  little  depth  below  the  surface. 

The  hottest  part  of  the  day  is  after  the  sun  passes  the  meridian, 
and  generally,  unless  interrupted  by  clouds  or  rain,  there  is  a  gradual 
rise  of  the  thermometer  from  the  rising  of  the  sun  until  3  o'clock, 
P.  M.,  when  it  attains  its  maximum.  After  this,  there  is  a  gradual 
fall,  until  11,  P.  M.,  when  it  is  nearly  as  low  as  at  any  other  part  of 
the  day.  I  find  the  mean  difference  between  the  temperature  at  3 
o'clock,  above  that  at  one  o'clock,  to  be  about  .65  of  a  degree  for 
the  whole  year  so  that  the  hour  of  3,  P.  31.,  may  be  considered  the 
warmest  part  of  the  twenty-four  hours. 


1845-]  of  Liberty  Counfy,  Ga,  551 


I  have  made  no  observations  upon  the  barometric  state  of  the 
air,  nor  have  I  measured  the  annual  amount  of  water  that  falls,  my 
observations  having  been  confined  exclusively  to  the  general  condi- 
tions of  the  weather,  in  respect  to  clouds,  wind  and  rain.  By  con- 
sulting, however,  the  meteorological  tables  kept  in  Savannah  by  Mr. 
Oemler  and  Dr.  Posey,  I  find  that  the  mean  quantity  of  water  that 
fell  at  that  place  during  six  years  ending  in  1842,  was  41.52  inches. 
It  is  probable  that  this  is  not  far  from  the  quantity  that  falls  annually 
in  this  county. 

Many  of  our  heaviest  raijisseem  to  be  irregular,  but  I  am  inclined 
to  believe  that  long  continued  pluviometric  observations  will  serve  to 
show  that  we  are  situated  in  that  zone  which  has  been  happily  termed 
sub-tropical  by  M.  de  Buch  where  the  climate,  in  respect  to  seasons 
of  rain,  partakes  of  the  nature  of  that  w  ithin  the  Tropics  but  the 
semestrial  period  of  rain  within  the  Tropics,  instead  of  passing  into 
one  trimestrial  period,  which  is  estival  in  our  hemisphere,  as  stated 
by  M.  Fournet,*  seems  to  me  to  be  divided  into  ttco  trimestrial  peri- 
ods one  of  which  is  estival  and  the  other  hyemal  the  latter  ta- 
king place  in  the  months  of  January,  February  and  March,  and  the 
former  in  the  months  of  July,  August  and  September,  or  probably 
more  correctly  the  first  from  the  winter  solstice  to  the  vernal  equinox, 
the  latter  from  the  summer  solstice  to  the  autumnal  equinox. 

By  consulting  the  Savannah  tables  above  referred  to,  it  appears 
that  the  mean  quantity  of  rain  in  inches  that  fell  during  the  first 
trimestrial  period  for  six  years,  was  8.04  for  the  second  during  the 
same  time,  17.72  whereas  the  quantity  for  the  intermediate  periods 
from  April  to  July,  and  from  October  to  January,  was  for  the  first 
10.50  inches,  and  for  the  second  5.26  inches.  The  apparent  contra- 
diction to  the  law  assumed  above  in  the  mean  quantity  for  the  period 
between  April  to  July,  is  explained  by  the  fact,  that  an  annual  quan- 
tity of  water  fell  during  the  month  of  June',  1838,  amounting  to 
10.03  inches,  and  again  in  May,  1840,  when  it  amounted  to  10.08. 
Omitting  these,  the  quantity  wopld  be  probably  more  near  to  the 
mean  average  for  that  period. 

There  can  be  no  doubt  that  our  irregular  rains  are  sometimes  our 
heaviest  so  that  if  we  are  guided  alone  by  the  absolute  quantity  of 
water  fallen,  we  might  be  led  to  doubt  the  correctness  of  the  law  ; 
whereas  we  may  have  rainy  seasons  when  very  little  water  actually 


*  Annales  de  Cliiraie  ct  de  Phisique,  N.  S.  Tome  onzierne  p.  116. 


552  Observations  on  the  Soil,  Climate  and  Diseases    [October, 


falls.  By  referring  to  the  same  tables,  I  find  that  taking  the  number 
of  rainy  days  we  have  for  the  first  trimestrial  period,  an  average  of 
19.25  for  the  second  14.25  whereas  for  the  other  periods,  we  have 
for  the  first  11,  and  for  the  second  13.75.  From  our  own  observa- 
tions, I  find  that  of  90  rainy  days,  18  occurred  during  the  first,  and 
43  during  the  second  trimestrial  period,  and  for  the  two  others,' 17  for 
the  first  and  16  for  the  latter.  Of  119  clear  days,  37  occurred  du- 
ring the  period  from  January  to  April,  11  from  July  to  October,  31 
from  April  to  July,  and  40  from  October  to  January.  From  general 
observations  of  the  weather  for  some  years  past,  I  am  decidedly  of 
opinion  that  our  dryest  months  are  April  and  October,  and  our  wet. 
test  the  months  of  February  and  August.  The  dew-point  always 
appears  to  me  to  be  highest  in  the  latter  month.  There  is  then  more 
of  sensible  perspiration  from  the  skin,  and  leather,  wood  and  clothes, 
are  more  liable  to  mildew  and  mould,  and  iron  to  rust. 

As  we  are  subject  to  great  extremes  of  temperature,  so  we  are  also 
liable  to  great  extremes  iii  regard  to  the  quantity  of  water  tliat  falls 
at  different  seasons.  Sometimes  we  have  seasons  of  great  rain,  and 
sometimes  seasons  of  great  drought.  We  are  subject,  at  times  to 
great  inundations  from  excessive  rains: 

Ssepe  etiam  immensum  ccelo  venit  agmen  aquarum, 
Et  todam  gloraerant  tempestatem  imbribus  atris, 
CollectoB  exalto  nubes.  Virgil,  Georgics,  lib.  1  332. 

The  quantity  of  water  that  falls  in  a  short  time  is  almost  incredible. 
These  rains  are  for  the  most  part  irregular,  but  they  more  commonly 
occur  during  one  of  the  above  named  trimestrial  rainy  periods.  The 
greatest  freshets  within  my  recollection  occurred  in  March,  1831,  and 
March  and  September,  1841.  At  these  times,  the  swamps  and  rivers 
overflowed  their  banksand  produced  great  injuryto  flocks  and  growing 
crops,  as  well  as  to  the  roads  and  bridges.  In  1841  we  were  two 
weeks  without  a  mail  from  Savannah,  although  running  previously 
three  times  a  week.  The  rise  of  water  in  our  swamps  is  fully  six  to 
eight  feet.  The  year  1839,  and  the  present  year  up  to  this  time, 
have  been  attended  with  the  greatest  drought  that  I  remember  to 
have  observed. 

Thunder  storms  are  very  common  in  our  climate,  and  are  at  times 
very  disastrous  in  their  effects.  It  is  a  curious  fact  in  regard  to 
them,  that  they  always  have  a  tendency  to  the  sea-coast.  As  soon  as 
they  are  formed  they  move  onwards  in  this  direction,  and,  unless  in- 
terrvpied  by  winds,  I  think  I  have  observed  a  marked  disposition  to 


1845.]  of  Liberty  County y  G a.  553 


follow  wafer  courses.  During  the  falling'of  the  rain  from  a  thunder 
cloud,  I  have  often  noticed  that  there  is  a  strong  current  of  air  setting 
in  every  direction  from  the  cloudy  so  that  a  vane  on  this  account 
always  points  towards  the  cloud  when  near  enough  to  be  influenced 
by  it,  both  when  corning  up  and  after  it  has  passed,  provided  the  rain 
is  still  falling. 

Our  winds  are,  for  the  'most  part,  very  variable  if  we  divide  them 
into  easterly  and  westerly,  by  a  line  passing  from  north  to  south,  I 
find  that  for  the  periodof  my  observations,  the  wind  was  easterly  124 
days,  and  westerly  138  days.  Upon  looking  at  the  prevailing  winds 
for  each  month,  I  find  that  they  are  more  prevalent  from  the  west, 
during  the  winter,  and  more  from  the  east,  during  the  summer  months. 
During  the  warmest  days  of  spring  and  summer,  we  enjoy  the  de- 
lightful sea-breezes  that  comes  up  about  10  or  11  o'clock  in  the 
morning,  and  prevail  until  3  or  4  in  the  afternoon,  when  they  die 
away  and  give  place  to  the  land-breeze,  which  sets  in  an  opposite  di- 
rection during  the  night.  Very  near  the  sea-shore,  these  sea-breezes 
continue  much  longer,  and  may  even  blow  during  the  early  part  of 
the  night.  At  a  distance  of  forty  or  fifty  miles  from  the  coast  I  believe 
they  are  rarely  if  ever  felt. 

During  our  eslival  rainy  season,  we  are  subject  to  what  is  com- 
monly known  among  us  as  ^^  north-east  weather ^''^  when  the  wind 
prevails  from  that  direction,  sometimes  without,  but  most  commonly 
with,  clouds  and  rain.  I  am  inclined  to  believe  that  these  winds  are 
really  the  trade  winds  of  the  tropic,  carried  beyond  their  northern 
limits  probably  by  the  influence  of  the  sun.  However  this  may  be, 
it  is  a  remarkable  fact,  that  these  winds  afi*ect  a  certain  pei'iodicity, 
and  are  apt  to  recur  at  weekly  or  semi-monthly  pe?-iods.  It  is  at  these 
periods  that  we  are  liable  to  have  the  most  dreadful  hurricanes  or 
typhoons.  The  most  memorable  of  these,  of  which  I  have  any  ac- 
count, occurred  on  the  15th  August,  1752,  "  which  vvas  in  Carolina, 
the  most  violent  that  was  ever  known  since  the  settlement  of  the 
English  there,  and  which,  in  many  places,  left  not  one  tree  in  twenty 
standing."  [See  an  account  of  the  Congregational  Church  at  Mid- 
way, by  John  B.  Mallard,  A.  M.]  Another  occurred  on  the  8tb  day 
of  September,  1804,  which,  from  all  that  I  can  learn,  must  have  been 
equally  violent.  I  was  mj'self  a  witness  of  the  last  great  hurricane, 
that  took  place  on  Wednesday  night,  the  14th  September,  1844  It 
commenced  to  blow  from  N.  E.  about  3  o'clock  in  the  afternoon,  and 
gradually  increased  until  probably  1  o'clock  at  night,  when  its  rio- 


554  Observations  on  the  Soilf  Climate  and  Diseases    [October, 


lence  was  greatest  the  wind  then  suddenly  shifted  S.  E.,  and  soon 
began  to  moderate.  The  night  was  very  light,  although  I  do  not  re- 
member the  state  of  the  moon.  The  rain,  or  rather  mist,  that  fell, 
had  a  saltish  taste  for  miles  in  the  interior,  evidently  being  mixed 
with  spray  from  the  sea-water.  The  appearance  of  desolation  that 
was  presented  to  the  eye  on  the  next  morning,  was  awful  in  the 
extreme.  There  is  a  disposition  to  these  storms  to  a  greater  or  less 
extent  every  year,  and  we  frequently  experience  slight  ones  :  indeed 
we  always  have  some  indications  of  all  the  hurricanes  that  take  place 
in  the  West  India  Islands. 

Tornadoes  are  by  no  means  frequent,  but  we  sometimes  have  them. 
Besides  one  or  two  of  which  some  traditionary  account  still  lingers 
with  us,  as  having  passed  through  the  county  many  years  ago  I 
remember  one  that  took  place  in  March,  1836  I  have  myself  observed 
the  track  ;  traces  of  which  are  probably  still  visible  Its  course  was 
from  S.  W.  to  N.  E.;  almost  every  tree  of  any  size  was  prostrated  by  ~ 
it,  in  its  path,  and  the  most  of  them  turned  in  towards  the  axis  of 
the  storm.  Its  track  was  probably  fifty  yards  in  width,  and  passed 
through  the  north-western  part  of  the  county. 

Although  not  confined  to  our  county,  I  desire  to  record  here  the 
following  remarkable  meteorological  phenomena  :*  One  week  after 
the  great  hurricane  of  1804,  on  the  night  of  the  15th  of  September, 
there  was  an  appearance  of  a  very  large  and  splendid  meteor,  which 
caused  great  consternation.  The  moon  was  shining  brightly  at  the 
time,  when  suddenly  there  was  heard  a  rumbling  noise  like  distant 
thunder,  which  gradually  increased  until  it  was  sufficient  to  awake 
the  sleeping,  and  at  the  same  time  a  bright  light  was  seen,  superior 
much  to  the  light  of  the  moon.  This  noise  was  continued  for  a  {ew 
moments,  and  subsided  as  it  had  commenced.  The  direction  is  sup- 
posed to  have  been  from  west  to  east.  There  can  be  no  doubt  that 
this  was  an  aerolite,  but  whether  it  fell  to  the  earth  or  not,  I  am  unable 
to  say.  Another  meteor  of  a  similar  kind,  although  not  as  large, 
passed  over  the  county  on  the  night  of  the  10th  day  of  July,  1826,  at 
about  11  o'clock. 

All  of  us  remember  the  very  remarkable  meteoric  shower  that 
took  place  on  the  night  of  the  12th  November,  in  the  year  1833  I 
was  called  up  about  a  half  hour  before  day-light,  and  watched  them 
until  they  were  very  faintly  visible  The  meteors  fell  in  almost  un- 
interrupted succession,  in  a  direction  apparently  very  little  inclined  to 
our  horizon  Many  of  them  were  larger  and  brighter,  and  left  lumin- 


1845.]  of  Liberty  County,  Ga,  555 


ous  trains  that  were  visible  for  some  seconds.  The  scene  was  far 
more  magnificent  than  any  I  had  ever  witnessed,  and  to  describe  it 
accurately  defies  all  power  of  language  it  was  such  a  scene  -^is 
makes  the  beholder  gaze  in  mute  astonishment,  and  the  moral  im- 
pression of  which  can  only  be  conveyed  to  others  by  expressive 
silence. 

Diseases.  Liberty  County  has  shared  the  fate  of  most  newly 
settled  districts  where  there  are  rich  lands,  and  for  many  years  after 
its  first  settlement  was  very  sickly  ;*  but  for  ten  or  fifteen  years  past, 
according  to  the  testimony  of  all,  it  has  proved  to  be  as  healthy  as 
any  other  county  with  the  same  population  in  our  State.  I  am  sorry 
that  no  public  records  are  now  kept,  by  which  I  might  ascertain  with 
certainty,  the  proportion  of  deaths  to  the  number  of  inhabitants ;  but 
from  my  observations,  I  am  sure  that  for  ten  years  past,  the  proportion 
has  not  exceeded  two  per  cent,  per  annum. 

Many  cases  have  contributed  to  bring  about  this  state  of  things. 
For  many  years  after  its  first  settlement  the  culture  of  rice  was  the 
chief  business  of  the  inhabitants.  At  present  the  dry  culture  system 
is  every  where  adopted,  and  nothing  but  cotton  and  corn  is  raised  as 
articles  of  export.  Some  of  the  people  d!irly  introduced  the  custom 
of  removing  from  their  plantations  during  the  summer  and  fall  sea- 
sons, but  it  was  not  generally  adopted  until  of  late.  It  is  now  very 
rare  for  any  family  to  reside  on  their  plantations  during  the  sickly 
seasons,  and  indeed  many  have  entirely  abandoned  them  for  healthier 
locations  in  the  pine  lands  of  this  or  the  adjoining  county  of  Mcintosh. 
But  probably  a  more  important  cause  may  be  found  in  the  change  of 
habits  of  the  people.  The  black  population  is  better  fed  and  clothed 
now  than  formerly,  and  the  habitations  of  both  white  and  black  are 
greatly  improved.  The  use  of  intoxicating  drinks  has  been  almost 
entirely  given  up  and  I  cannot  but  add,  that  the  system  of  practice, 
both  domestic  and  professional,  has  been  greatly  altered  for  the  bet- 
ter. Less  drastic  and  poisonous  medicines  are  now  employed,  and 
indeed  the  heroic  treatment  of  the  early  schools  of  medicine  once 
followed  in  this  country  has  been  exchanged  for  the  milder  and  more 
rational  method  of  assisting  Nature  and  guarding  against  the  "  nimia 
diligenlia  Medici.^^ 

Epidemics  may  be  said  to  be  entirely  unknown  among  us,  if  we 
except  the  Influenza,  which  in  its  progress  through  other  parts  of  the 

*  See  Appendix,  note  C. 


556  Observations  on  the  Soil,  Climate  and  Diseases    [October, 


country  sometimes  makes  its  appearance  here.  The  Asiatic  Cholera 
in  1832  prevailed  to  some  extent  on  the  Ogechee  river,  in  Bryan 
county,  within  a  few  miles  of  Liberty,  but  not  a  case  occurred  within 
the  limits  of  our  county.  There  are  seasons,  however,  in  which  our 
common  endemic  diseases  are  far  more  prevalent  and  fatal  than  at 
other  times,  although  I  have  not  been  able  satisfactorily  to  refer  this 
partially  epidemic  character  to  any  particular  constitution  or  condi- 
tion of  the  atmosphere.  I  am  disposed,  however,  to  believe  that  dry 
seasons  are  more  healthy  than  those  which  are  attended  with  exces- 
sive rains  or  dampness  of  the  air.* 

Sickly  seasons  have  appeared  to  me  to  observe  a  certain  periodicity, 
or  to  prevail  once  during  a  C3xle  of  years.  This  cycle,  so  far  as  I 
can  determine  from  a  very  general  and  brief  experience,  seems  to  be 
a  period  of  about  ten  years,  and  may  correspond  with  the  cycle 
through  which  passes  the  small  oscillation  in  the  mean  temperature 
of  our  climate.  Thus  lam  informed  that  the  years  1817  and  1820 
were  unusually  sickly  so  also  was  the  year  1830.  The  last  sickly 
year  that  we  have  had  was  1840. 

In  regard  to  the  relative  salubrity  of  the  separate  seasons  of  the 
year,  I  would  give  it  as  my  opinion,  that  there  is  more  sickness  during 
the  autumn  and  winter,  and  less  during  the  spring  and  summer. 
Winter  diseases  are  far  more  fatal  than  summer  diseases.  The 
healthiest  month  in  the  year  is  probably  May. 

The  only  contagious  diseases  to  which  we  are  subject  are,  Pertus- 
sis or  Whooping  cough,  Rubeola  or  Measles  and  Syphilis  Varicella 
or  Chicken  pox  sometimes  prevail,  Variola  never  Scarlatina  has 
sometimes  shewn  itself  in  a  sporadic  form,  but  has  never  extended  far 
within  my  observation  Whooping  cougb  and  Measles  are  common, 
and  1  have  known  them  to  exist  together  on  the  same  place,  and,  if  I 
mistake  not,  in  the  same  person  :  which  has  led  me  to  suspect  that 
the  two  diseases  are  isopathic,  or  in  other  words,  that  whooping  cough 
arises  from  measles  in  the  lining  membrane  of  the  air  passages.  The 
venereal  disease  is  probably  more  common  than  my  observations 
would  lead  me  to  believe  ;  but  being  a  disease  that  seeks  concealment, 
it  is  often  cured  in  its  simpler  forms  by  the  aid  of  empiricism,  with- 
out the  advice  of  the  physician.  It  is  confined  almost  exclusively 
to  the  black  population.  Gonorrhcsa  is  universally  known  among 
them   as  '^running  reins,''   and  is  attributed  in  every  instance   to 

  See  Appendix,  Note  D. 


1845.]  of  Liherty  County,  Oa,  557 


blows  on  the  back  or  perineum,  or  some  violent  strain.  The  history 
of  a  very  curious  case  has  come  to  my  knowledge  in  which  a  man 
with  gonorrhoea  communicated  it  to  his  wife  during  pregnancy. 
The  child,  after  birth,  was  affected  with  a  disease  which  was  suppos- 
ed (by  a  physician,  I  think,)  to  be  syphilitic,  and  died.  I  am  sorry 
that  it  did  not  come  under  my  own  observation  ;  but  still  it  tends  to 
confirm  a  suspicion  long  entertained,  and  upon  which  the  medical 
world  is  yet  divided,  that  gonorrhoea  and  syphilis  are  isopalhic 
affections. 

But  by  far  the  most  common  diseases  of  our  climate  are  the  febrile 
and  infiammatory.  During  the  course  of  my  experience,  I  have  met 
with  only  two  species  of  essential  fever  one,  and  by  far  the  most 
common,  is  our  "Marsh-miasmatic  fever,"  an  account  of  which,  to- 
gether with  its  various  modifications,  I  have  given  in  the  October 
number  of  the  American  Journal  of  the  Medical  Sciences  for  the  year 
1844.  The  other  has  been  described  in  the  August  number  of  the 
same  Journal  for  the  year  1840. 

The  form  in  which  the  ^^  marsh  fever^^  usually  makes  its  appear- 
ance is  the  double  tertian,  with  one  severer  and  one  milder  paroxysm. 
The  first  paroxysm,  or  the  more  severe,  is  marked  by  a  more  decided 
chill  or  cold  fit,  and  by  a  more  complete  apyrexia,  usually  beginning 
in  the  morning  and  leaving  in  the  afternoon,  so  that  the  patient  will 
spend  a  comfortable  night,  and  the  next  morning  feels  better ;  but 
sometime  after  midday  another  paroxysm  comes  on  in  a  more  disguis- 
ed or  insidious  manner,  which  continues  all  night  and  runs  into  the 
paroxysm  of  the  next  morning,  without  any  perceptible  remission, 
except  in  the  heat  of  the  skin.  The  crisis  or  acme  of  the  fever  is 
usually  at  the  third 'or  fifth  tertian  paroxysm,  or  on  the  fifth  or  sev- 
enth day. 

The  other  species  of  fever  I  have  supposed  might  be  the  Dothinen- 
terite  of  the  French.  If  it  is  not,  it  is,  so  far  as  my  reading  has  gone, 
an  undescribed  form.  I  have  called  it  the  Sandhills  fever,  from 
the  fact  that  I  have  met  with  most  cases  of  it  in  that  part  of  the  coun- 
ty. Its  progress  is  slow,  and  its  duration  from  twenty  to  thirty  days. 
It  most  commonly  affects  the  young  all  the  cases  I  have  seen  have 
been  of  persons  under  twenty  years  of  age. 

True  Typhus,  the  typhus  gravior  of  authors,  which  I  take  to  be 
the  same  as  the  so-called  camp,  jail  and  hospital  fever,  I  have  never 
seen,  nor  do  I  know  any  physician  here  who  has  seen  it.  Being  the 
product  of  crowded  and  ill-ventilated  places,  it  is  not  to  be  supposed 


558  Observations  on  the  Soil,  Climate  and  Diseases    [October, 


that  it  would  be  apt  to  appear  in  the  country.  One  case  of  true 
Yellow  fever,  attended  with  " blaek  vomit"  brought  from  Augusta, 
Geo,,  during  the  prevalence  of  the  epidemic  there,  I  attended  in  this 
county,  in  the  fall  of  1839.  This  case,  in  my  opinion,  differed  in  no 
essential  particular,  from  the  case  of  a  foreigner  who  was  attacked 
with  our  common  Remittent,  in  October,  1842,  which  afterwards 
assumed  the  congestive  form  and  terminated  with  black  vomit. 

Puerperal  fever  occasionally  occurs.  This  fever,  I  believe,  is  en- 
tirely isopaihic  with  erysipelas  or  in  other  words,  nothing  more 
than  erysipelas  of  the  womb  and  its  investing  membranes.  This  was 
the  opinior  of  the  Father  of  Medicine,  as  appears  from  the  following 
remark  in  his  aphorisms:  "If  a  pregnant  woman  be  afflicted  with 
Erysipelas  of  the  womb,  it  will  prove  fatal  to  her."  [Hippocrates  : 
Aphorisms,  sectio  5th  43.  My  reasons  for  this  opinion  I  hope  to 
give  at  some  other  time.  Milk  fever  is  common  after  acouchement, 
but  rarely  attended  with  serious  consequences.  It  is  sometimes  fol- 
lowed by  collections  of  matter  of  a  milky  purulent  character  in  the 
mammae,  and  sometimes  by  phlegmasia  dolens.  The  best  prophylac- 
tic against  both  results  is  the  early  application  of  the  child  to  the 
breast. 

*  Inflammatory  affections  prevail  mostly  during  the  winter  months. 
Those  of  the  head  are  extremely  rare.  I  have  only  met  with  one 
case  of  acute  inflammation  of  the  brain  or  its  investing  membranes, 
and  this  occurred  in  a  child  about  three  months  old.  It  terminated 
in  effusion  of  water  within  the  cranium. 

Inflammations  of  the  respiratory  organs  are  most  common.  Croup 
in  its  inflammatory  form  is  rare.  Laryngismus  stridulus  is  the  affec- 
tion mostly  known  among  us  as  croup.  Pneumonia,  bronchitis  and 
pleurisy  are  here,  as  almost  every  where,  of  frequent  occurrence  in 
relation  to  other  diseases.     Gangrene  of  the  lungs  sometimes  occurs. 

Acute  inflammation  of  the  abdominal  organs  is  not  very  common. 
Acute  hepatitis  is,  in  my  opinion,  far  less  common  than  it  is  general- 
ly supposed  to  be.  Functional  disorder  is  frequent,  but  I  have  rarely 
met  with  sfny  violent  acute  form  of  disease  that  could  be  referred 
with  certainty  to  the  liver  as  its  primary  source.  It  seems  to  be  an 
universally  entertained  opinion,  that  in  hot  climates  the  liver  must 
be  often  diseased ;  but  according  to  my  observation,  that  organ  is 

*  I  use  this  term  as  commonly  understood,  without  pretending  to  endorse  the 
correctness  of  its  application  to  the  many  different  diseases  included  under  it. 


1845.]  of  Liberty  County,  Ga.  559 


often  blamed  for  disorders  of  which  it  is  entirely  guiltless.  Dr.  John- 
son's works  on  Tropical  Climates  and  Diseases  of  the  Liver,  are,  I 
fear,  somewhat  of  a  libel  upon  both  topics  of  his  very  fertile  and 
ingenious  pen.  Were  intoxicating  drinks,  the  use  of  opium  and 
tobacco,*  the  immoderate  eating  of  animal  and  vegetable  food,  and 
more  particularly  the  former,  entirely  abandoned,  and  people  to  live 
with  a  strict  regard  to  temperance  in  all  things,  the  liver  would  no 
doubt  perform  its  functions  with  as  much  regularity  and  certainty  as 
any  other  organ  in  the  body  and  the  equable  and  balmy  air  of  the 
tropics  would  be  redolent  of  health.  For  my  own  part,  I  cannot  see 
why  the  liver  has  been  so  much  singled  out  by  authors  as  the  strong 
hold  of  disease,  as  it  were,  and  so  many  articles  of  the  Materia  Medica 
collected  together  undfjr  the  name  of  Cholagogues  for  its  especial 
benefit.  Every  young  practitioner  is  for  the  most  part  directed  to 
look  to  it  in  almost  every  case,  and  he  begins  his  career  with  the 
^^  Sampson^^  of  the  Materia  Medica  as  the  ground  of  all  his  hopes, 
and  whenever  put  to  it  to  tell,  in  obstinate  cases,  what  is  the  matter 
with  his  patient,  clothes  all  his  raisgivipgs  in  the  sapient  reply,  that 
it  is  Chronic  Hepatitis, 

A  paralysmic  state  of  the  liver  and  spleen  very  frequently  arises 
as  sequelae  of  intermittents  when  long  continued,  and  should  no  doubt 
be  treated  in  a  similar  manner.  They  are  of  far  less  common  occur- 
rence now  than  formerly,  which  is  to  be  ascribed,  I  think,  mainly  to 
the  fact  that  blood-letting  is  not  pushed  to  so  great  an  extent,  and 
quinine  earlier  resorted  to,  in  the  treatment  of  this  fever  now,  than 
it  was  even  a  few  years  ago.  It  is  but  just  to  remark  here,  that  the 
"observations"  of  Dr.  Wm.  C.  Daniell  "on  the  Autumnal  Fevers  of 
Savannah,"  published  nearly  twenty  years  ago,  contain  the  first 
efforts  that  have  been  made  to  introduce  a  practice  in  our  autumnal 

*  Excess  in  eating  and  drinking  is  injurious  to  health  in  three  different  ways. 
It  immoderately  strains  and  thereby  weakens  the  digestive  organs ;  it  prevents 
digestion,  since  it  is  impossible  that  in  so  large  a  quantity  every  particle  should 
be  digested  properly,  and  it  produces  crudities  in  the  colon  and  morbid  hu- 
mours  Finally,  spirituous  liquors,  of  whatever  name  they  may 

be,  must,  by  all  means,  be  considered  as  substances  that  shorten  human  life. 
They  are  a  liquid  fire,  accelerate  the  consumption  of  the  powers  of  life  in  a 
fearful  manner,  and  in  fact  transform  life  itself  into  a  process  of  combustion. 
Moreover,  they  create  cutaneous  diseases,  aridity  and  torpor  of  the  fibres,  pre- 
mature old  age,  cough,  asthma,  pulmonary  complaints,  and  what  is  worst  of 
all  an  awful  dullness  and  insensibility,  not  only  with  regard  to  physical,  but 
also  with  regard  to  moral  impressions.  Hvfdand  Makro/)istU\2d-,  39.  44. 


500  Observations  on  the  Soil,  Climate  and  Diseases    [October, 


fevers,  which  in  a  modified  form  is  beginning  to  be  universally 
adopted. 

Bowel  affections  are  among  our  most  ordinary  diseases,  but  in  most 
cases  may  be  traced,  I  think,  to  errors  or  irregularities  in  diet,  indi- 
gestion and  dyspepsia,  and  rarely  call  for  medical  aid  ;  but  I  think  the 
former  is  common,  while  the  latter  is  rare.  Cholera  morbus,  diarrhea 
and  dysentery,  most  commonly  arise  from  acrid  or  unwholesome 
food  or  drink.  The  latter  prevailed  to  some  extent  in  1827,  in  the 
form  of  a  local  epidemic,  and  was  very  fatal.  This  was,  however, 
before  my  admission  to  the  pra'ctice  of  medicine,  and  I  know  very 
little  about  it.  Cholera  Infantum  sometimes,  although  rarely,  occurs 
and  generally  terminates  in  marasmus. 

Inflammatory  rheumatism  is  not  frequent,  but  the  neuralgic  form, 
or  what  is  known  as  chronic  rheumatism,  is  more  common.  Gout  is 
rarely  met  with,  and  probably  will  be  unknown  to  the  coming  gen- 
eration. Calculous  affections  are  extremely  rare  I  have  never  met 
with  a  case  ;  and  I  have  never  heard  of  a  case  of  stone  in  the  bladder 
within  the  limits  of  our  county.  Phthisis  pulmonalis  or  consump- 
tion, is  also  very  uncommon  among  our  native  population  I  have 
only  seen  three  cases  among  the  whites,  and  about  the  same  number 
among  the  blacks,  during  the  course  of  fifteen  years.  Scrofulous 
enlargement  of  the  lymphatic  glands,  however,  is  frequently  seen 
among  the  latter.  This  seems  to  indicate  that  our  climate  is  not 
favorable  to  the  development  of  scrofula  in  the  internal,  but  rather 
in  the  external  organs,  for  I  hold  scrofula  and  tubercular  consump- 
tion to  be  truly  isopaihic  affections. 

Two  or  three  cases  of  Goitre  have  come  to  my  knowledge  ;  but 
surely  the  remark  of  Juvenal,  in  reference  to  the  Alps,  has  no  appli- 
cation here  

"Gluis  guttur  tumidum  miratur  in  Alpibus." 

Of  the  cachexies,  however,  among  the  most  familiar  to  us  may  be 
enumerated  cacuexia  africana  or  dirt-eating,  and  dropsy.  My  read- 
ing and  observations  in  regard  to  the  former  disease  have  led  me  to 
the  following  conclusions  :  The  eating  of  earthy  subslances  has  at 
all  times  prevailed  to  a  greater  or  less  extent  among  certain  classes 
of  men.  Celsus  distinctly  alludes  to  it  as  a  cause  of  disease  in  his 
day  *'  Quum  din  color  sine  morbo  regio  malus  est,  hi  vel  capitis 
doloribus  conflictantur  vel  terram  edunt.^'  [Medicina,  lib.  2.]  and 
Baron  Humboldt  mentions  it  as  being  common  among  certain  tribes 
of  American  Indians,  as  well  as  other  people  la  various  parts  of  the 


1845.]  of  Liberty  County,  Ga.  661 


world.  [Personal  Narrative  passim.]  Among  the  negroes  here,  I 
believe  it  to  be  a  very  common  habit,  and  one  that  is  taught  them 
from  childhood,  I  remember  to  have  eaten  clay  myself  when  a  child 
from  the  example  which  was  set  me  by  negro  children. 

It  does  not  appear  that  the  habit  is  necessarily  productive  of  ill 
consequences.  This  was  the  observation  of  Humboldt  in  regard 
to  the  Otomacs  and  others.  Among  us,  I  know  that  it  does  not 
in  most  cases  bring  on  disease.  It  is,  in  my  opinion,  almost  uni- 
versal among  negro  women  who  are  in  a  state  of  pregnancy.  I 
have  seen  places  in  the  fields  where  the  clay  has  been  recently  dug 
at  by  their  fingers  for  the  purpose  of  being  eaten.  I  have  also  known 
a  pregnant  female  to  eat  chalk  in  large  quantities,  and  declare  it  to 
be  a  most  delicious  morsel.  In  such  cases,  the  desire  no  doubt  arises 
from  demand  on  the  part  of  the  system  for  inorganic  elements,  arid 
more  particularly  lime,  and  should  be  gratified  in  a  proper  way.  If 
birds  are  entirely  deprived  of  all  substances  which  contain  lime,  their 
eggs  will  be  soft,  as  I  have  observed  to  be  the  case  with  fowls  that 
have  been  long  kept  in  a  coop,  and  I  have  seen  them,  under  such 
circumstances,  eat  pieces  of  mortar  thrown  into  them  with  i\iQ great- 
est avidity. 

The  disease  connected  with  dirt-eating  is  evidently  chlorosis.  It 
is  for  the  most  part  confined  to  females,  and  appears  to  arise  from 
mal-assimilation  and  defective  hcematosis,  whereby  the  blood  is  near- 
ly deprived  of  its  coloring  matter,  although  the  relative  proportion  of 
albumen  and  fibrine  is  in  a  great  degree  preserved.  That  this  dis- 
ease may  be  brought  on  by  eating  clay,  when  indulged  in  to  too  great, 
an  extent,  I  will  not  deny  ;  but  it  is  certain  that  I  have  seen  it  when 
the  fact  of  eating  it  could  not  be  proved,  and  indeed  where  the  proba- 
bilities were  strongly  against  the  suspicion.  It  is  certain,  however, 
that  the  disease,  when  it  occurs,  is  always  aggravated  by  it,  and  that 
it  should  be  prevented  if  possible. 

I  believe  the  disease  to  be  curable  and  I  will  here  depart  a  little 
from  my  plan,  and  give  the  treatment,  which  I  believe  to  be  best 
adapted  to  its  cure.  In  all  cases,  if  the  patient  is  young,  and  the 
pulse  and  state  of  the  system  will  allow  it,  I  begin  the  cure  by  blood- 
letting. In  two  cases  I  bled  the  patients  from  six  to  eight  times  in  the 
course  of  two  or  three  months,  taking  away  from  half  to  one  pound 
at  a  time,  and  when  I  commenced,  the  blood  would  hardly  have 
reddened  a  white  handkerchief.  My  object  in  doing  this  is  not  to 
subdue  inflammation,  but  to  remove  from  the  vessels  an  impure  fluid 

36 


562  Observations  on  the  Soil,  Climate  and  Diseases    [October, 


which  is  not  blood,  so  that  the  system  may  have  a  better  opportunity 
of  making  good  blood.  The  blood-letting  is  intended  to  act  the  part 
of^vascula?'  cathartic.  My  next  object  is  to  stimulate  the  digestive 
organs  to  the  proper  performance  of  their  functions,  and  this  I  believe 
to  be  best  accomplished  by  occasional  mercurial  cathartics,  and  the 
continued  use  of  the  sesquichloride  of  iron  a  preparation  which  is 
not  found  in  the  shops,  but  which  can  be  very  easily  made.  The  diet 
should  be  generous,  and  consist  of  such  articles  as  they  fancy  most. 

Dropsy,  as  stated  above,  is  very  common,  and  appears  in  the  forms 
of  hydrothorax,  ascites  and  anasarca.  A  great  proportion  of  the 
older  negroes  die  of  this  disease.  In  the  young  it  sometimes  occurs, 
but  in  them  it  is  almost  always  curable.  From  the  result  of  one  case 
recently  under  my  care,  I  beg  leave  here  to  suggest  an  early  resort  to 
paracentesis  in  cases  of  ascites  in  young  persons. 

Passing  over  some  other  affecfions,  which  are  either  common  every 
where,  or  too  rare  to  be  regarded  as  peculiar  any  where,  I  would  con- 
clude this  brief  sketch  by  a  few  observations  in  regard  to  the  Surgi- 
cal,  and  Obstetrical  practice  o(  the  county. 

Surgical  cases  are  of  extremely  rare  occurrence  I  know  not 
whether  this  is  to  be  attributed  to  the  want  of  subjects,  or  to  the  want 
of  confidence  in  the  art  itself,  arising  from  the  small  number  of  striking 
cures  that  have  been  performed  among  us  by  its  aid.  Some  few 
cases  of  dislocations  or  fractures,  call  for  surgical  interference,  and 
occasionally  a  small  encysted  or  sarcomatous  tumor  has  to  be  remov- 
ed, or  a  limb  to  be  amputated  omitting  these  and  such-like,  I  beg 
leave  to  record  the  following  cases,  which  have  occurred  in  my 
practice  : 

The  first  was  an  operation  on  both  eyes,  for  cataract,  by  depression 
or  couching,  in  the  case  of  a  negro  man  about  80  years  of  age.  The 
instrument  used  was  a  No.  6  or  7  sewing  needle,  which  I  ground  to 
suit  myself,  and  then  fixed  into  a  handle.  The  case  terminated  fa- 
vorably. The  second  was  a  case  in  which  I  extirpated  the  right 
mamma  for  a  carcinomatous  affection.  The  wound  healed  readily, 
and  the  patient  appeared  to  be  well  for  one  year,  when  the  disease 
returned,  and  although  removed  a  second  time,  the  woman  died  in 
six  months  after.  On  the  2nd  March,  1843,  I  divided  the  tendo 
achillis  for  talepis  equinus,  and  applied  an  apparatus  of  my  own  con- 
struction upon  the  principle  of  Stromeyer's.  The  operation  has  been 
as  successful  as  could  have  been  expected.  The  last  two  cases  were 
both  hydarlhrosis  of  the  knee  joint ;  in  the  first  of  which  I  operated 


1845.]  of  Liberty  County,  Ga,  563 


by  the  introductiox  of  a  seton,  a  practice  which  I  had  never  heard 
of  before.  In  this  case  the  fluid  was  so  much  like  blood  that  I 
thought  I  had  punctured  an  aneurismal  tumour.*  In  the  second 
case,  I  simply  opened  the  sac,  and  introduced  tents  and  injections 
of  salt  and  water.     Both  cases  have  terminated  favorably. 

Obstetrical  cases,  requiring  either  instrumental  or  manual  assistance, 
are  equally  rare  of  the  tormer,  I  have  only  met  with  one,  and  that 
was  a  case  of  locked  head,  in  which  the  child  was  dead,  and  the  wo- 
man so  much  exhausted  that  I  thought  it  absolutely  necessary  to 
perform  embryotomy.  The  woman,  however,  was  too  far  gone  to 
recoTer.  Besides  this,  the  only  cases  that  have  come  under  my 
care  requiring  manual  assistance,  are  the  following :  One  case  of 
footling,  in  which  the  long  diameter  of  the  head  was  engaged  in  the 
short  diameter  of  the  superior  strait ;  one  case  of  face  presentation, 
in  which  I  rectified  the  position  of  the  head,  without  turning ;  and 
three  cases  of  shoulder  and  arm  presentations.  The  first  of  these  has 
been  reported  in  the  August  No.  of  the  American  Journal  for  1833. 
In  the  last  two,  the  delivery  was  efl?ected  by  turning  :  one  terminated 
favorably  the  other  died  of  puerperal  fever.  I  have  also  seen  one 
case  of  severe  haemorrhage  during  labor,  in  which  turning  was  ne- 
cessary in  order  to  expedite  delivery.  Cases  of  retention  of  the 
placenta  are  common.  I  have  met  with  one  case  of  miscarriage,  in 
which  it  was  adherent,  attended  with  most  profuse  haemorrhage. 

In  closing  these  observations  on  the  Soil,  Climate  and  Diseases  of 
Liberty  County,  I  am  tempted  to  use  the  language  of  Pliny,  in  praise 
of  his  beloved  Italia  of  the  justness  of  its  application  to  this  county, 
let  others  judge.  *'  Nee  ignoro  ingrati  ac  segnis  animi  exisiimari 
posse  meriio,  si  breviter  atque  in  transcurser  ad  hunc  modum  dicatur 
terra  nomine  Deum  electa  qucB  coslum  ipsum  clarius  faceret  et  collO' 
quia  humanitatemqiie  homini  daret,  Sedquid  agara  ?  tanta  nobilitas 
omnium  locorum,  tant  a  rerum  singularum  populorumque  claritas 
tenet  Jam  verotota  ea'yitcdis  ac  perennis  salubritatis  coeli  temper ies, 
tam  fertiles  campi,  tarn  aprici  colles,  tam  innoxii  saltus,  tam  opaca 
nemora,  tam  munifica  silvarum  genera  tot  amnium  fortiumque  uber- 
tas-'' {Natural  History,  lib  3,  6.) 

*  This  case,  I  believe,  has  been  reported  in  the  rs'ew-York  Journal  of  Medicine, 
but  I  have  not  seen  the  number. 


564 


Observations  on  the  Soil^  Climate  and  Diseases     [October, 


APPENDIX. 
Note  A.    I  have  made  no  anal)'sis  of  the  soil  of  the  county,  but  I  subjoin 
here  analyses  of  two  specimens,  from  different  parts  of  the  county,  by  Mr.  Cot- 
ting,  formerly  State  Geologist,  which  will  give  some  idea  of  its  constituents.  
(Vide  his  Essay  on  the  Soils  of  Georgia,  p.  111.) 


1st  analysis 

Water  of  absorption 10.00 

Organic  matter 8.00 

Sulphur 1.40 

Silica 54.00 

Alumina 18.00 

Humin 2.00 

Apocrenate  of  Iron 1 .00 

Sulphuric  Acid 2.04 

Protoxide  of  Iron 50 

Magnesia 96 

Phosphate  of  Iron 2.10 


100.00 


2nd  analysis. 

Water  of  absorption 1.28 

Coarse  and  fine  sand  and  gravel . ,  78.00 

Organic  matter 3.00 

Humate  of  Lime 2.00 

Phos.  and  Crenate  of  Lime 4.00 

Apocrenate  of  Magnesia 2.00 

Sulphate  of  Iron 4.72 

Alumina  and  Silica 5.00 


100.00 


Note  B.  The  following  catalogue  of  the  phenogamous  plants  found  within 
or  near  the  limits  of  Liberty  County,  will  exhibit  the  natural  growth  of  its  soil. 
Jam  aware  that  it  is  very  incomplete,  and  in  some  cases  even  inaccurate,  but  it 
is  sufficiently  full  and  correct  for  our  present  purpose.  Many  plants  among  us 
have,  no  doubt,  escaped  my  notice,  and  there  are  some  which  have  been  omitted 
merely  because  I  have  not  been  able  satisfactorily  to  distinguish  them.  This  is 
particularly  the  case  with  species  belonging  to  the  natural  order  of  the  Graminos 
and  the  families  of  the  Lcguminosa  and  Composita,  and  it  is  possible,  that  of 
those  enumerated,  there  are  many  to  which  I  have  affixed  a  wrong  specific  name. 
In  all  cases  of  doubt,  however,  I  have  added  a  note  of  interrogation.  The  most 
of  these  plants  have  been  seen  and  determined  by  myself a.  few  have  been  given 
from  the  statements  of  others  upon  which  I  thought  I  might  rely :  these  are  dis- 
tinguished by  an  asterisk.    T^e  list  is  in  alphabetical  order. 


Acalypha  virginica 

Acer  rubrum 

Acerates  longifolia 

Achyranthes  repens 

Acorns  calamus 

jEscuIus  pavia 

Agave  virginica 

Agremonia  eupatoiia 

Agrostis  alba 
"      indica 
"     sericea,  &c. 

Aira  obtusata  l 

Aletrisaurea 
"       farinosa 

Alopecurus  gcniculatus 

Allium  inodorum 

Amaranthus  lividus 
"  spinosus 

Amaryllis  atamasco 

Ambrosia  paniculata 
Ammi  capiUaceum 


Amorpha  fruticosa 
"        pubescers 

Amsonia  latifolia 
"        angustifolia 

Anagallis  arvensis 

Andromeda  ferruginea 
"  mariana 

"  nitida 

"  racemosa 

"  spcciosa,  &c. 

Andropogon  celiatus 

"  dissitiflorus 

'*  macrourus 

"  nutans 

"  scoparius,&c 

Antirrhinum  canadense 

Apios  tubcrosa 

Apocynum   androsasmifo- 
lium 

Aralia  spinosa 

Argemone  Mcxicanum 


Aristida  spiciformis 
"      striata 

Aristolochia  serpentaria 

Aronia  arbutifolia 

Arum  triphyllum 
"      virginicnm 

Arundinaria  macrospcrma 

Asarum  virginicum 

Asclepias  amplexicaulis 
"        cinerea 
"        connivcns 
"        angustifolia 
"         obtusifolia 
"        paupercula 
"         tuberosa 
"         verticillata 

Ascyrum  crux-andraea 
"  hypericoides 
"         pumilum? 

Asimina  pygmoca 

Aster  carolinianus 


1845.] 


of  Liberty  County,  Ga. 


565 


Aster  divergens 

"      diversifolius'? 

*      foliolosus 

"      obovatus] 

"      paludosus 

"      racemosus'? 

"      squarrosus 

"      teniufolius 

"      toitifolius 

"      virgatus]  &c. 
Aulaxanthus  ciliatus 
Azalea  nudiflora 

"       viscosa* 
Baccharis  halimifolia 
"        sessiliflora  1 
Balduina  uniflora 
Baptisia  uniflora 
'      alha 
"      lecontii* 
"      tmctoria 
Batschia  gmelini 
Bidens  bipinnata 

"      chrysanthemum 
Bignonia  capreolata 

'        radicans 
Bletiaaphylla* 
Borkhausia  caroliniana 
Briza  eragrostis 
Buchnera  americana 
Buraelia  tenax 
Bup^thalmum  frutescens 
Cacalia  atriplicifolia  ] 
Cactus  opuntia 

*      pes  corvi 
Callicarpa  americana 
Calopogon  pulchellus 
Campanu'a  amplexicaulis 
Canna  flaccida 
Caprifolium  serapervirens 
Cardamine  pennsylvanica 
Cardiospefmum  halicaca- 

bum 
Carex  glaucescens,  &c. 
Carya  aquatica'? 

"      tomentosa  1 
Cassia  marylandica 

"       chamEBchrysta 

"       nictitans 
Castanea  nana 

"        pumila 
Catalpa  cordifolia 
Ceanothus  amcricanus 

"  microphyllus 

Centaurella  verna 
Cephalanthus  occidentalis 
Cerastiura  hirsertum 
Cercis  canadensis 
CharaEBrops  hystnx 
'  palmetto 

Chaptalia  integrifolia 
Cnenopo<tiu!n  antheimin- 
ticum 


Chenopodium  album  Eleusine  indica 

Chionanthus  virginicus      Elodea  virginica 
Chrysobalanas  oblongifo-  Eiytraria  virgata 


Epidendrum  conopseum 
Erianthus  alopccuroides 

"          brevibarbis 
Erigeron  canadense 
'        nudicauie 
"       philadelphicuml 
"       strigosum,  &c. 
Eriogonum  toraentosum 
Eriocaulon  decangulare 

"        villosum  1 
Eryngium  aquaticum  1 
"         virginianum 
Erythrina  herbacea 
Euchroma  coccinea* 
Euonymus  americaiius 
Eupatorium  ccclestinum 
"        fceniculaceum 
"         hyssopifdlium 
"        linearifolium 
"         perfoliatum 
"         rotundifolium? 
"        scabridum 
"        verbenaefolium 
Euphorbia  corollata 
'*  cyathophora 

'  depressa 

''  hypericoides 

Fagus  sylvaticus 
Fragaria  virginiana 
Fraxinua  acuminatus,  &c. 
Galactia  elliotti 

"      glabella 
Galardia  bicoior 
Galium  hispidulum 
Gaufa  angustifolia 
Gelseminum  serapervirens 
Gentiana  catesboei 

"        ochroleuca 
Gerafiium  carolinianum 
Gerafdia  fasciculata 
"      filifolia 
"      linifolia 
'*      pedicularia 
""      purpurea 
"      quercilblia 
Gleditschia  monosperma 
"  triacanthos 

Glycine  erecta 

"     moliissiraa,  &c. 
Gnaphalium  polycephalum 
'     purpureum.  &c. 
Dracocephalura  obovatum'?  Gonolobus  macrophyllus'? 

"  variegatum  "         prostratus 

Drosera  rotijndifolia  Gordonia  lasianthus 

Eclipta  erecta  "         pubescena 

'      procumbens  Gratiola  pilosa 

Elephantopuscaroliniensis  ''       tetrngona 

"  nudicaulis  "       virginica 

Ekufine  cruciata  Gvmr.ostvlcs  stolonifera 


llUs 

Chrysocoma  nudata 
Chrysopsis  argentea 
'  tricophylia 

"  scabra 
Cicuta  maculata 
Cissus  bipinnata 
"  hederacea 
Clematis  viornal 
Cieome  cuneifolia 
Clethni  alni folia 

"       tomentosal 
Clitoria  mariana 

"       virginiana 
Cnicus  glaber 

'*      repandus 
Comraelina  communis 
Convolvulus  raacrorhyzus 
"  panduratus 

"  speciiisus 

"  tenellus 

Coriopsis  gladiata 

"         nudata,  &c. 
Coronupus  didyma 
Cornus  tlorida 
"       stricta 
CratsBgus  lucida  1 
"        pyrifolia 
"        parvifolia '? 
Crotalaria  ovalis 

"  sagittalis 

Croton  argyranthemum 

"      glandulosum 
Cupressus  disiicha 
Cuscuta  americana 
Cyrilia  racemiflora 
Cyperus  flavescens 
'         hydra 
"         mariscoidesi 
"        tenuiflorus 
"         virens,  &c.  &c. 
Datura  stramonium 
Decodon  verticillatum 
Decumaria  sarmentosa 
Dichromena  leucocephala 
Digitaria  dactylon 

"       sanguinalis 
Diodia  hirsuta 
'      tetragona 
"      virginica 
Diospyros  virginiana 


566 


Observations  on  the  Soil^  Climate  and  Diseases    [October, 


Hamamelis  virginica 
Hedyotis  glomerata 
Hedysarum  canadense 
*'  glabellum'? 

"  nudiflorum 

"  rotundifolium 

"  strictum 

Heleniurn  antumnale 
Helianthemum  carolinian- 

um 
Helianthus  angustifolius 

"        scaberrimus?  &c. 
Helonias  erythrosperma 
Herpestis  acuminata 
"         cuneifolia 
"  rotundifolia 

Hibiscus  moscheutos 
"        scaber 
"        virginicus 
Hieracium  gronovii 
Hopea  tinctoria 
Houstonia  ccerulea 

"  rotundifolia 

Hydroeharis  spongiosa 
Hydroeotyle  umbellata 
"  repanda 

"  vulgaris 

Hydrolea  quadrivalvis 
Hypericum  angulosum 

"         fasciculatum  1 
'  nudiflorum 

"  parviflorum 

"      rosmarinifolium 
"      simplex,  &c. 
Hypoxis  erecta 
Hyptis  capitata 
Ilex  cassena 
"     myrtifolia 
"     opaca 
"    prinoides 
Indigofera  caroliniana 
Ipomoea  nil 

"      trichocarpa 
Iris  hexagona 
"    verna 
"    versicolor 
Itea  virgineca 
Iva  frutescens 
Ja.tropha  stimulosa 
Juglans  nigra 
Juncus  acutus 
       "       acuminatus? 
"       aristatus 


Juncus  effusus^ 

"       cchinatus,  &c, 
Jnniperus  virginiana 
Jussieua  grandiflora 
Justicia  humilis 
Kalmia  hirsuta 
Krigia  caroliniana 
Lachnantbes  tinctoria 
Lactuca  elongata  1  &c, 
Lamium  ampiexicaule 
Laurus  caroliniensis 
"       geniculatus 
"       sassafras 
Lechea  minor 
"        villosa 
Leersia  oryzoides  1 

"       virginica 
Lepedium  virginicum 
Lespedeza  frutescens 
"  stuvei 

"  violacea?  &c. 

Liatris  gracilis 
''       graminifolia 
"      odoratissima 
"      secunda 
"      scariosa 
"      spicata,  &c. 
Lilium  catcsboci 

"       coruscum* 
Lindernia  dilata 
Linum  virginianum 
Liquidambar  styraciflua 
Liriodcndron  tulipifera 
Lobelia  amoena 
"       cardinalis 
"       glandulosa 
"       puberula 
Ludwigia  capitata 
"         cylindrica 
"        dicurrer.s 
"         linearis 
"         mollig 
"         pilosa 
"         virgata 
Lupinus  perennis 

"       villosus 
Lycopus  angustifolius 
Lycopus  virginicus 
Lythrum  lanceolatum 

"         lineare 
Magnolia  glauca 

"        grandiflora 
Malva  caroliniana 


t  Manisuris  granularis^ 
Mariscus  cylendricus 

"        retrofractus 
Marrubium  vulgare 
Marshallia  angustifolia 
Melananthera  hastata 
Micranthemum    orbicula- 

tum 
Mikania  scandens  1 
MitcheJlarepens 
Mollurge  verticillata 
Monaida  punctata 
Minocera  aromatica 
Monotropa  uniflora 
Morus  rubra 
Mylocariam  ligustrinuxD 
Myrica  cerifera 

"     caroliniensis^'J 
Nelumbium  lutiuca 
Neottia  tortilis 
Nuphar  advena 
Nymphea  odorata 
]Nyssa  capitata 
"     multiflora 
"     uniflora 
CEnothera  biennis 

"  hybridal 

''  pumila 

"  sinuata 

Olea  Americana 
Onosmodium  hispid ufh 
Ophiorrhyza  mitreola 

"  lanceolata 

Oplotheca  flloridana 
Orchis  blephariglottis 
"      ciliaris 
"      nivea,  &c. 
Orobanche  virginiana 
Oxalis  stricta 

"      violacea? 
Pancratium  mexicanum 
"  maritimum'? 

Panicum  anceps 

"      crus  galli 

"      gcniculatum 

"       hians? 

"      italicum 

"      lanuginosuml 

"       latifolium 

"      virgatum 

"       viscidum,  &c, 

"     $  species  an  nova? 
Paspalum  dasyphyllum 


j-  I  am  very  doubtful  whether  the  plant  referred  to,  under  this  name  is  the  plant  described 
by  Mr.  Elliott.    If  it  is  not,  however,  I  think  I  can  safely  say,  that  it  has  not  been  described 
by  him  at  all. 
'l  The  following  is  a  description  of  this  rem*rkable  plant  :  

P.  Stem  procumbent  12  feet  long,  glabrous,  geniculate,  pubescent  at  the  joints,  com- 
pressed, striate  leaves  6  to  9  inches  long,  .3  to  4  lines  wide,  slig:htly  pubescent  above,  glab- 
rous  beneath,  a  little  sca])rous  at  the  edges,  expanding  horizontally,  linear  lanceolate, 
tapering  to  a  point,  beautifully  marked  by  purple  bands,  which  fade  by  age  Panicle  com- 
posed of  alternate  spikes,  expanding.    Spikes  compound  with  spikelets,  2  to  3  flowered, 


1845.] 


of  Liberty  County,  Ga. 


567 


Paspaluni  distichum 

"        floridanum 

"        Ictve 

''        purpurascens 
Passiflora  incarnata 

"         lulea 
Pedicularis  canadensis 
Pentstemon  levigatum 
Petalostemuni  corynibosum 
Phlox  Carolina 
"        nitida 
"         pilosa 
Physalis  lanceotata 

"        viscosa  1 
Phytolacca  decandra 
Pinckneya  pubescens 
Pinguicula  elatior 

"  lutea 

"  pumila 

Pinus  palustris 
"       inops] 
"      ta;da 
Planera  aquatica 
Plantago  intcrrupta 

"         Virginia 
Platanus  occidentalis 
Poa  annua 
"  eragrostis 
"  quinquefida 
"  retVacta,  &c. 
Podostigma  pubescens 

virides 
Pogonia  divaricata 
Polysrala  corymbosa 

"        cruciata 

"        lutea 

**         polygama* 

"        pubescens 

"        purpurea 

"        raraosa 

"         setacea 
Polygonum  punctatum? 

"  sagittatuiu 

"  scandens 

Polypremurn  punctatum^ 
Pontedcria  cordata 

"  lancitolia 

Portulacca  oleracea 

"       tspecies  an  nova 
Potamogeton    heterophyl- 

lum 
Prenanthes  virgata 
Prinos  ambiguus 

"       glabra 
Prunella  vulgaris 


Prunus  chicasa 

"        umbellata 

"        virginiana 
Psoralea  canescens 

"         melilotoides 
Ptelea  tritbliata 
Pterncaulon  pycnostachy-  Salix  nigra 

urn  Salvia  azurea 

Pychnanthejnum  incanum       "      lyrata 


Sebbatia  corymbosa 
"         gracilis 
"         paniculata 

Sagittaria  lanciiblia 
"         graminea'? 

Salicornia  herbacea 


Pyrus  angustifolius 
Quercus  aiba 

"        aquatica 

"         catesban 

**         chinquapin 

"        cincrea 

"         falcata 

"        laurifolia 

"        lyrata 

"         nigra 

"        obtusiloba 

"        phellos 

"        })uinila 

"         prinus 

"        rubra 

sempervirens 


Sambucus  canadensis 
Samolus  valerandi 
San^uinaria  canadensis 
Sanicula  marylandica 
Sarracenia  variolaris 
Saururus  ccrnuus 
Schoenus  cffusus 
Schrankia  uncinata 
Schwalbea  americana 
Scirpus  autumnalis 

"         capiilaceus 

"         capitatus,  &c.  &c. 
Scleria  obligantha,  &c. 

"      reticulata 
Scutellaria  integrifolia 
'  ovalilblia 


Ranunculus  oblongifolius?  Senecio  tonientosus 
"       lobatus 
Seymeria  tenuifolia 


pusiiius 
Rhamnus  carolinianus 
Rhexia  ciliosa 
"       glabella 
"       lutea 
"      mariana 
'      virginica 
Rhus  copallinam 
"      radicans 
"      toxicodendron 
"      vernix 
Rhynchospora  cymosa 

''  longirostritj  1 

Rosa  lucida 

'     lev'igata 
Rubus  trivialis 
"        villosus 
Rudbeckia  hirta 
"  leviirata 

"  mollis 

Ruellia  oblongifolia 
"         strepens 
"        tubi  flora 
Rumex  acetosella 

"       crispus,  &c. 
Sabal  pumila 
Sabbatia  angularis 
"         calycosa 
"        chloroides 


Sicyos  angulata 
Sida  gracilis 

"  rhombifolia,  &c. 
Siegesbeckia  lacinieta 
Silphium  compositum 

"        pennatiiidum 
Sisj'rinchium  anceps 
Sium  terelitolium 
Smilax  laurifolia 
"         p&eudo-china 
tamnoides 
Solanuai  carolincnso 

"         nigrum 
Solidago  pyramidata 

"       retrorsa 

"      tortitbha 

''      tenuifolia 

'      villosa 

"       virgata,  &c.  &c. 
Sonchus  carolinianusl 
Sparganium  americanum 
Spanina  glabra 
"        JLincea 
"        ])olystachya 
Spergula  arvensis 
Spormacoce  diodina 
Spigclia  marylandica 


spikelets  on  one  side  of  the  Rachis,  appearing  to  be  in  3  or  4  rows.  Calvx,  2  flowered  her- 
maphrodite and  neuter,  accessary  valve  miu-ronate,  all  3  to  5  nerved  ;  nerves  <;recn,  pubes- 
cent,  the  upper  valves  purple,  stigmas  purple.  Common  in  low  grounds,  flowers  in  July 
and  August.  {Jin  s,ibhum  of  Elliolt.) 

t  This  plant  I  have  now  growing.    Tt  is  very  similar  to  the  pilosa  in  the  stem  and  leaves, 
but  ditFors  entirely  in  its  flowers,  which  are  white  and  very  minute.   


568 


Observations  on  the  Soil,  6fC.  of  Liberty  County.  [October, 


Stachys  aspera 
Steuartia  virginica 
Stiliingia  lesastrina 
"         sebifera 
''        sylvatica 
Slipa  avenacea 
Stylosanthes  elatior 
Styrax  grandiflorum 
"      Iseve 

"      pulverulentutn 
Tephrosia  paucifolia 
"         virginiana 
Tetragonotheca  helianth- 

oides 
Teucrium  canaciense 
"         virginicum 
Thalia  dealbata 
Thyrsanthus  frustescens 
Tillandsia  bartrami 

"  tisiieoides 

Tipularia  discolor 
Toiieldia  pubescens 
Tradescantia  virginica 
"  rosea 


Tragia  urens 

Trichostema  dichotema 

Trichodium  laxiflorum 

Tri folium  repens,  &c. 

Tricophorum  cyperinum 

Tripsacum  monostach3^on 

Typha  latifolia 

Ulmus  alata 

"     americana 

Urtica  capitata 

Utricularia  inflata 
"  purpurea  1 

"  setacea 

Vaccinium  arborcuin 
"  corynibosum 

"  dumosum 

"  frondosum 

"  niyrsinites  *? 

"  stamineum  

Verbaseum  tbapsus 

Verbena  urticitblia 

Verbesina  sinuata 

Vernonia  altissima 

"        noveboraccnsis 


Vernonia  oligophylla 
"        scaberrima 
Veronica  arvensis 

"         peregrina 
Viburnum  nudum 

"         prunifolium  7 
Viola  cucullata 

"      palmata 

"       pedata 

"      primulifolia 
Viscum  verticillatum 
Vitis  rotundilblia 

'     ffistivalis 

"    cordifolial 
Xanthium  strumarium 
Xyris  flexuosa 
\ucca  filamentosa 

"      gloriosa 
Zanthoxylon  tricarpum 
Zapanianodillora 
Zizania  raileseca 
"       palustris 
Zizyphus  volubilis. 


Note  C.  In  order  to  give  some  idea  of  the  health  of  the  county,  soon  after  its 
first  settlement,  I  add  the  following  table,  which  has  been  prepared  by  Mr.  J.  B. 
Mallard,  from  the  records  of  Midway  Church.  (Vide  his  acco^int  already 
cited,  p.  20.) 


Year.  |Births.|Deaths.  | 

Year. 

Births. 

Deaths. 

Year. 

Births. 

Deaths. 

1754 

4 

2 

1771 

15 

8   ' 

1788 

2 

35 

1755 

6 

2 

1772 

21 

14   1 

1789 

11 

17 

175G 

14 

3 

1773 

18 

^ 

1790 

2f 

25 

1757 

14 

2 

1774 

11 

16 

1791 

12 

34 

1758 

n 

6 

1775 

7 

11 

1792 

3 

30 

1759 

20 

5 

1776 

17 

10 

1793 

26 

19 

1760 

16 

1 

1777 

15 

15 

1794 

17 

11 

1761 

13 

6 

1778 

20 

8 

1795 

21 

18 

1762 

13 

4 

1779 

1796 

17 

8 

1763 

14 

4 

1780 

1797 

22 

14 

1764 

15 

5 

1781 

.. 

1798 

26 

22 

1765 

2 

8 

1782 

6 

1799 

16 

17 

1766 

6 

19 

1783 

5 

3 

1800 

20 

20 

1767 

4 

21 

1784 

6 

5 

1801 

18 

37 

1768 

6 

12 

1785 

6 

17 

1802 

11 

20 

1769 

10 

Vo 

1786 

15 

8 

1803 

22 

22 

1770 

1 

10 

1787 

4 

8 

'   47 

600 

621 

I  would  remark  that  this  table  includes  the  deaths,  from  casualties,  as  well  as 
from  disease ;  but  of  course  those  from  the  former,  are  comparatively  few. 


Note  D.    The  following  quotations  from  the  Problevts  of  Aristotle,  will  shew 
that  he  also  regarded  wet  and  rainy  seasons  as  productive  of  diseases : 

"  1.  Whjft  is  the  reason  that,  if  a  rainy  and  moist  spring  follow  upon  a  cold 


1^45-]  Clmicifuga  in  Nervous  Diseases,  569 


winter,  the  succeeding  summer  becomes  sickly,  fevers  and  inflammation  of  the 
eyes  prevailing  1 

^'  2.  What  is  the  reason  that,  if  a  dry  and  cold  Spring  follow  upon  a  moist  and 
rainy  winter,  both  spring  and  summer  become  sickly'? 

"  3.  What  is  the  reason  that,  if  upon  a  dry  and  cold  summer  a  rainy  and  moist 
autumn  follow,  headaches  are  frequent  during  the  succeeding  winter,  and  hoarse- 
ness and  coughs,  terminating  in  consumption  1 

"4.  What  is  the  reason  that,  if,  after  a  cold  winter,  and  a  rainy  and  moist 
spring,  the  summer  be  very  dry,  autumn  becomes  most  especially  fatal  to  little 
children,  whilst  among  the  rest  of  mankind,  dysentery  and  quartan  ague  are  of 
frequent  occurrence  ] 

"5,  What  is  the  reason  that,  after  a  rainy  and  moist  summer  and  autumn,  a 
sickly  winter  fellows'? 

'6.  What  is  the  reason  that,  if,  in  consequence  of  the  heat  of  the  sun,  evapo- 
rations rise  from  the  ground  in  large  quantities,  the  year  becomes  pestilential  1 

"  7.  What  is  the  reason  that  those  years  are  always  sickly,  when  the  small 
frogs  are  very  numerous '?" 

It  were  perhaps  well,  if,  like  Aristotle,  we  paid  more  attention  to  climatic 
influences  in  the  aetiology  of  disease,  and  less  to  the  undefined  and  undefinable 
malaria  or  miasmata  arising  from  the  decompositio?i  of  vegetable  substances!! 

The  following  extracts  will  shew  his  opinion,  also,  in  regard  to  the  relative 
or  comparative  influence  of  seasons : 

"1.  What  is  the  reason  that,  although  men  are  more  afflicted  with  diseases 
during  summer,  the  sick  die  in  larger  numbers  during  winter'? 

"  2.  What  is  the  reason  that  spring  and  autumn  are  sickly  1  Is  it  because 
changes  produce  diseases'?  Autumn  is  more  sickly  than  spring, 

"3.  What  is  the  reason  that,  in  winter  there  are  less  diseases  than  in  sum- 
mer, but  that  they  are  more  fatal  in  the  former  season  1 

"  4.  What  is  the  reason  that  burning  fevers  most  frequently  occur  in  autumn 
and  winter,  i.  e.  during  the  cold  seasons ;  and  chills  in  summer,  when  the  wea- 
ther is  hot  1" 


ARTICLE    II. 

Cimicifuga  in  Nervous  Diseases.     By  H.  V.  Wootex,  M.  D.,  of 
Lowndeshoro\  Ala. 

Of  all  the  diseases  which  the  medical  practitioner  is  called  upon 
to  treat,  none  are  so  puzzling  to  his  skill,  or  exhausting  to  his  pa- 
tience, as  those  usually  denominated  nervous  :  their  pathology  is  less 
understood  their  therapeutics  is  less  reliable,  and  consequently, 
their  treatment  is  more  empirical  and  less  satisfactory,  than  that  of 
any  other  class  of  diseases.  Under  these  circumstances,  it  is  not 
surprising  that  any  new  remedy,  that  is  respectably  recommended, 
or  even  suggested,  for  any  of  these  diseases,  should  be  so  readily 
tested  by  the  physician. 


570  Cimicifuga  in  Nervous  Diseases.  [October, 


In  1839,  Dr.  Young,  of  Pennsylvania,  (Am.  Jour.,  Nov.,)  report- 
ed a  [ew  cases  of  chorea,  which  he  cured  by  the  use  of  the  cimicifuga, 
and  suggested  its  use  in  other  nervous  affections,  as  epilepsy,  &;c. 
Not  long  after  I  read  his  paper,  I  was  called  upon  to  treat  a  case  of 
epilepsy,  and  from  the  embarrassment  and  failure  which  I  had  usual- 
ly met  with,  in  the  use  of  other  remedies,  I  determined  to  give  the 
cimicifuga  a  trial.  My  success  in  the  case  induced  me  to  employ 
the  remedy  in  othes  cases  all  of  which  I  will  give. 

Case  1st.  A  girl,  of  delicate  constitution,  aged  11  years;  had 
been  subject  to  the  "fits"  for  six  months,  at  irregular  intervals,  at 
first  about  once  in  two  weeks,  but  of  late  more  frequently.  The  fits 
were  not  long,  but  violent,  and  usually  left  the  patient  in  a  complete 
stupor  for  a  few  hours.  Her  general  health  was  pretty  good,  but  of  late 
the  intellect  had  been  growing  obtuse  and  irregular.  Purgatives, 
indigo,  blisters,  assafoetida,  and  all  the  usual  routine  of  remedies  had 
been  used  in  the  case,  without  effect.  I  gave  a  purge  of  calomel  and 
aloes,  which  acted  thoroughly.  I  then  prescribed  the  pulverized 
cimicifuga  in  doses  of  5ss.,  to  be  given  morning,  noon  and  night; 
and  the  purgative  of  calomel  and  aloes  to  be  repeated  twice  a 
week.  During  the  first  two  weeks  of  the  treatment,  she  had  two  fits, 
but  stated  that  her  feelings  were  much  better,  and  the  obtuseness  of 
intellect  had  disappeared.  The  treatment  was  continued,  increasing 
the  dose  of  the  powder  to  5ii.,  and  giving  the  purgative  once  a 
week  for  six  weeks  longer,  during  which  time  she  had  no  fit ;  her 
general  health  and  strength  appeared  much  improved.  One  year 
afterwards,  she  had  had  no  return  of  the  disease.  Since  that  time  I 
have  known  nothing  of  the  case. 

Case  2nd.  The  mother  of  the  girl  above  mentioned,  aged  about 
40,  of  slender  frame,  but  good  general  health,  had  been  subject  to 
epileptic  fits  for  about  eight  years  ;  at  first  occurring  about  once  a 
month,  but  for  the  last  three  years  oftener,  if  the  patient  was  fatigued, 
or  in  any  way  excited  unusually.  I  put  her  under  a  similar  course 
of  treatment  to  that  of  case  1st.  For  four  weeks  she  had  but  one  fit, 
and  it  was  a  light  one ;  but  she  continued  the  remedy  until  it  seem- 
ed to  lose  its  power  on  her  system,  and  she  was  not  cured.  She  dis- 
continued the  medicine,  and  I  know  not  what  became  of  the  case. 

Case  3rd.  A  girl,  aged  13,  of  good  health  and  full  habit  of  body, 
was  seen  to  fall  from  a  height  of  a  few  feet,  and  was  picked  up  in  a 
stupor,  with  her  extremities  spasmed.  The  symptoms  were  attrilju- 
ted  to  an  injury  supposed   to   have  been   received  in  the  fall ;    but 


1845.]  Cimicifuga  in  Nervous  Diseases.  571 


none  could  be  discovered,  though  the  head  was  shaved,  and  well 
examined.  She  was  bled  freely;  cold  applied  to  the  head,  and  blis- 
ters along  the  spine.  The  fits  ceased,  but  returned  again  in  about 
a  week,  and  continued  to  recur  about  6nce  a  week  for  three  months  ; 
at  the  end  of  which  time  I  first  saw  her.  Of  late  her  paroxysms  had 
become  more  violent  and  exhausting,  and  were  preceded  by  a  fit  of 
mania,  during  which  she  would  scream  violently,  and  endeavor  to 
destroy  every  thing  in  her  way.  This  would  last  about  fifteen  min- 
utes, and  would  end  in  a  stupor,  which  would  last  about  the  same 
length  of  time,  when  the  epileptic  fit  would  ensue.  During  the 
intervals,  her  intellect  appeared  tolerably  good,  and  I  could  discover 
no  particular  disease  or  organic  disorder  about  her,  except  of  the 
nervous  system.  When  she  would  attempt  to  stand  erect  and  still, 
she  exhibited  a  restless  eye,  and  a  slight  tremor  of  the  extremities. 
I  was  accidentally  present  when  one  of  her  paroxysms  occurred,  on 
which  the  history  of  the  case  was  given  me,  with  a  request  for  a  pre- 
scription. It  occurred  to  me  that  the  fall  was  more  likely  the  effect 
than  the  cause  of  the  fits,  and  as  no  physician  was  in  attendance  on 
the  case,  nor  had  been  for  several  weeks,  I  gave  a  prescription  found- 
ed on  that  view  of  the  case.  Her  general  appearance  was  good; 
muscular  and  vascular  systems  sufficiently  full  and  active  ;  pulse  100. 
I  bled  her  fxii.,  gave  a  purgative  of  calomel  and  aloes,  and  continu- 
ed  the  same  prescription  as  case  1st.  She  had  but  two  paroxysms, 
about  five  days  apart,  after  she  commenced  the  use  of  the  remedies, 
and  they  were  light,  and  without  the  antecedent  mania.  She  had, 
when  I  first  prescribed  for  her,  a  long  blister  on  the  dorsal  spine. 
The  course  was  steadily  pursued  for  six  weeks,  when  the  patient  ap- 
peared well,  and  the  medicine  was  discontinued.  She  remains  well 
to  this  time  three  years.  It  may  be  proper  to  state,  that  neither 
this  patient,  nor  case  1st,  had  menstruated  before  they  came  under 
my  treatment,  nor  had  they  done  so  when  it  ceased. 

Case  4th.  A  child,  aged  4  years,  was  seized  with  "fits,"  which 
occurred  once  every  day,  at  irregular  hours,  for  three  days.  The 
symptoms  were  attributed  to  worms,  and  the  child  was  drenched  with 
the  usual  amount  of  "  worm  physic."  The  fits  ceased,  but  returned 
in  four  days,  and  continued  to  recur  about  twice  a  week,  for  three 
weeks,  when  I  saw  it.  It  was  pale,  somewhat  emaciated  ;  appetite 
good,  but  digestion  much  impaired  ;  abdomen  tumid,  d:c. 

I  gave  X.  grs.  blue  mass,  with  ii.  grs.  Dover  powder,  which  seemed 


572  Cimicifuga  in  Nervous  Diseases.  [October, 

to  act  well  upon  the  intestinal  secretions.     I  then  prescribed  the 
cimicifuga  in  the  following  form  : 

Cimicifuga,  powd.     .     .     .      iss. 

Water, Oiss. 

Boil  to  Oi.  strain,  and  add  loaf  sugar  iss.     Of  this,  give  b\.  three 
times  a  day. 

This  was  continued  three  weeks,  the  child  had  no  more  "fits," 
and  its  general  health  became  very  good. 

Of  the  above  cases,  three  at  least  were  epilepsy  ;  three  of  them  were 
cured,  and  one  scarcely  benefitted.  So  far  as  these  cases  go  to 
establish  the  character  of  the  cimcifuga  as  a  remedy  in  this  disease, 
it  would  appear  that  it  is  not  to  be  relied  on  in  cases  of  several 
years'  standing ;  but  that  in  recent  cases,  it  is  a  valuable  remedy, 
and  worthy  of  diligent  trial. 

I  could  not  say,  positively,  that  the  4lh  case  was  epilepsy,  as  I 
did  not  have  an  opportunity  of  seeing  a  paroxysm ;  but  from  the 
account  given  me  of  it,  I  felt  convinced  that  it  was  truly  epileptic  in 
its  character. 

The  account  which  I  have  given  of  the  above  cases,  is  not  so 
minute  and  full  as  I  would  wish  it  to  be ;  but  every  physician  ac- 
quainted with  practice  in  the  country,  over  a  scope  of  many  miles, 
will  understand  the  reason,  why  it  is  necessarily  as  it  is. 

The  cimicifuga  seems  to  act  as  a  tonic  to  the  general  system  ;  but 
its  peculiar  and  most  valued  effects  are  displayed  particularly  on  the 
nervous  system.  To  this  system  it  imparts  permanency  of  tone,  and 
equanimity  of  action.  I  have  used  it  in  several  cases  of  delicate 
females,  whose  nervous  action  was  much  disordered,  producing  hys- 
teria, and  its  kindred  disorders.  I  have  also  used  it  with  great  bene- 
fit, in  cases  of  dry,  hacking  cough,  occurring  in  persons  of  weak 
habit,  and  disordered  nervous  power,  with  neuralgic  pains  about  the 
chest.  I  have,  myself,  been  astonished  at  its  effects  in  restoring  the 
vigor  and  healthful  action  of  the  system  in  such  cases. 

I  could  detail  such,  but  it  is  perhaps  unnecessary.  I  will  only 
remark,  further,  that  in  using  the  cimicifuga,  it  is  altogether  im- 
portant, though  often  difficult,  to  get  that  which  is  good  and  pure. 


1845.]        A  Case  of  probable  Extra-Uterine  Pregnancy   573 


ARTICLE  III. 

A  Case  of  probable  Extra-Uterine  Pregnancy. 

The  interest  at  present  existing  in  the  profession  on  the  subject  of 
Extra-uterine  Pregnancy,  has  induced  us  to  solicit  and  to  place  on 
record,  the  following  facts.  Edts. 

OXFORD,  Ga.,  March,  1845.    ' 

Dr.  Joseph  A^  Eve,  Prof,  of  Obstetrics^  <^c.  : 

Dear  Sir  Your  views  are  desired  in  relation  to  an  interest- 
ing case  connected  with  the  branch  of  the  profession  to  which  your 
attention  has  been  particularly  directed,  for  some  years.  Early  in 
March  of  last  year,  I  was  called  to  a  negro  woman,  belonging  to 
Mr.  Worrill,  of  this  place,  who  complained  of  pain  and  tenderness  in 
the  hypogastric  and  iliac  regions  of  the  right  side :  upon  examina- 
tion, I  found  the  parietes  of  the  abdomen  for  a  circumscribed  space 
indurated,  as  if  covering  a  schirrous  tumour  as  large  as  an  orange, 
the  hardness,  or  apparent  hardness  of  the  skin  was  peculiar;  and 
the  tumour,  which  appeared  intimately  connected  with  the  skin, 
was  distinctly  perceptible  in  the  iliac  region. 

I  bled,  blistered  and  gave  gentle  purgatives,  for  the  subduction  of 
inflammation,  with  decided  benefit  to  the  patient;  the  pain  and 
febrile  symptoms  subsided,  and  she  was  able  in  a  short  time  to  go 
about ;  the  hardness,  however,  and  likewise  the  tenderness  or  pres- 
sure continued.  The  enlargement  of  the  tumour  progressed  gradu- 
ally, and  the  woman  supposed  herself  pregnant.  She  is  about  forty 
years  of  age,  and  her  youngest  child  about  eighteen  years  old. 

She  remained  in  feeble  health,  often  in  bed,  until  September,  when 
her  strength  gave  way  and  she  was  again  prostrated.  I  found  her 
apparently  in  labour,  her  pains,  however,  short  and  ineffectual ;  upon 
examination  per  vaginam  I  was  satisfied  that  the  uterus  did  not  con- 
tain the  foetus ;  after  some  twenty-four  hours  unavailing  efforts  to 
bring  forth,  her  pains  subsided,  lactation  supervened,  but  the  abdomi- 
nal enlargement  remained  unchanged.  She  was  soon  again  able  to 
attend  to  business,  and  has  continued  about  ever  since,  with  occasional 
short  intervals.  Within  the  last  two  months  the  catamenial  dis- 
charge has  returned  which  was  before  interrupted.     At  my  request, 


574  A  Case  of  ijrohahle  Extra-Uterine  Pregnancy.    [October, 


my  friend,  Dr.  Gaither,  visited  her  with  me  a  few  days  ago.  The 
size  of  the  tumour  is  about  that  of  the  gravid  uterus  at  six  months ; 
it  extends  up  to  the  epigastrium,  and  has  inequalities  to  the  touch  which 
very  closely  resemble  the  prominent  points  of  a  foetus;  it  seems  to 
occupy  the  centre  of  the  abdomen,  not  being  confined  to  either  side, 
and  has  neither  increased  nor  diminished  for  several  months.  The 
woman's  general  health  is  tolerably  good.  She  is  a  valuable  ser- 
vant, and  her  owners  feel  great  solicitude  on  her  account,  not  know- 
ing what  may  be  the  final  result.  I  am  deeply  concerned  as  to  the 
issue,  and  should  be  thankful  for  your  opinion  with  respect  to  its 
nature,  and  the  most  advisable  course  to  be  pursued.  I  am  inclined 
to  view  it  as  a  case  of  extra-uterine  pregnancy,  but  do  not  feel  cer- 
tain whether  it  may  not  be  ovarian  schirrous  or  dropsy,  as  some  of 
the  earlier  symptoms  seemed  to  indicate  :  in  either  case,  would  you 
advise  an  operation  ? 

Your  views  at  length,  as  I  have  said,  will  be  thankfully  received, 
and  highly  appreciated. 

Very  respectfully,  yours, 

George  G.  Smith. 


AUGUSTA,  March  27th,  1845. 

Dear  Sir  Your  very  interesting  letter  df  the  19th  instant,  should 
have  received  an  immediate  reply,  had  not  the  pressure  of  business 
and  previous  engagements,  absolutely  prevented  me. 

After  the  most  attentive  and  careful  perusal,  I  cannot  arrive  at 
any  other  conclusion  than  that  to  which  you  have  come,  that  it  is  a 
case  of  extra-uterine  pregnancy. 

With  respect  to  the  peculiar  hardness  of  the  skin  over  the  tumour, 
I  cannot  account  for  it,  but  do  not  suppose  that  it  is  connected  with 
or  depend  on  the  tumour  within. 

My  opinion  is  most  decidedly  against  undertaking  an  operation 
unless  indicated  by  nature  herself,  or  as  it  were  in  cooperation  with 
nature.  When  she  manifests  an  endeavor  to  make  a  way  for  the 
foetus  to  escape,  by  instituting  the  process  of  ulceration,  the  surgeon 
I  think  may,  with  propriety,  and  often  with  advantage,  anticipate 
the  more  tardy  course  of  spontaneous  ulceration,  by  making  an  open- 
ing in  advance  or  enlarging  that  which  may  have  been  commenced, 
through  which  to  extract  the  foetus  and  secundines. 

But  when  nature  is  quiescent,  I  am  decidedly  of  opinion  that  sur- 
gery should  not  interfere. 


1845.]        A  Case  of  probable  Extra-  Uterine  Pregnancy   575 


Time  has  permitted  me  to  refer  only  to  a  very  few  of  the  most 
recent  authorities. 

M.  Chailly  remarks  "The  danger  of  the  operation  ig  far  greater 
than  in  the  gastrotomy  practiced  in  cases  of  normal  pregnancy. 
The  placenta  does  not  separate  of  itself  from  the  internal  surface  of 
the  cyst ;  it  adheres  so  intimately  to  it  that  it  seems  to  be  an  integral 
part  of  it:  its  extraction  is  therefore  very  difficult  and  dangerous." 

"Again,  how  can  we  decide  to  perform  this  operation  when  we 
know  that  the  unhappy  woman,  if  she  should  not  die  immediately, 
will  undoubtedly  sink  gradually,  and  in  the  midst  too  of  the  most 
excrutiating  sufferings." 

"In  a  word,  it  is  my  opinion,  that  if  the  labour  cannot  be  quieted 
by  opium,  the  cyst  being  intact,  nothing  should  justify  an  operation  ; 
and  the  objection,  if  possible,  is  still  stronger,  should  the  cyst  be 
ruptured." 

"Art  cannot  profitably  interfere  until  the  first  phenomena  have 
passed  by,  whether  there  has  been  rupture  of  the  cyst  or  not,  and 
there  should  be  no  haste ;  the  cyst  should  be  allowed  time  for  a 
new  formation,  and  this  is  a  slow  process,  and  then  the  operation  is 
only  to  be  attempted  in  order  to  prevent  imminent  danger,  or  to  re- 
lieve the  woman  from  habitual  suffering  which  renders  life  a  burden 
to  her." 

M.  Moreau  admits  that  very  little  assistance  can  be  rendered,  and 
that  it  would  be  worse  than  rash  to  attempt  an  operation  before  the 
rupture  of  the  cyst,  but  he  declared  himself  decidedly  of  opinion  that, 
if  called  very  soon  after  its  rupture,  gastrotomy  ought  to  be  perform- 
ed ;  he  thinks  the  danger  of  hsemorrhage  has  been  exaggerated,  and 
that  it  promises  more  for  the  safety  of  the  mother  as  well  as  the  child, 
than  abandoning  the  case  to  the  unaided  resources  of  nature. 

Of  all  the  recent  authors  with  whose  writings  I  am  familiar,  M. 
Colombat  expresses  himself  most  decidedly  in  favor  of  an  operation. 
After  weighing  the  arguments  and  opinions  of  authors  for  and  against 
it,  he  observes  "However  it  may  be  in  regard  to  the  different  opin- 
ions we  have  just  mentioned,  we  believe  that  the  operation  ought  to 
be  performed,  even  after  the  rupture  of  the  cyst,  and  that  in  general 
we  ought  not  to  wait  until  the  symptoms  of  peritonitis  shall  have  de- 
clared  themselves,  because  in  that  case  we  are  almost  sure  to  see  the 
child  and  mother  perish,  when  by  operating  earlier,  we  might  perhaps 
have  saved  both." 

Although  I  deemed  that  candor  required  I  should  give  the  opinions 


576  A  Case  of  probable  Extra-  Uterine  Pregnancy,    [October, 


of  Moreau  and  Colombat,  which  militate  somewhat  against  my  own, 
I  am  decided  in  my  opposition  to  an  operation,  except  under  the  cir- 
cumstances already  stated,  and  feel  myself  satisfactorily  sustained,  not 
only  by  the  authority  of  M.  Chailly,  but  also  by  that  of  Dr.  Churchill 
and  Dr.  Lee,  whose  views  I  will  give  you  in  their  own  words. 

"  If  we  find,  after  a  time,  that  any  effort  is  made  to  remove  the 
foetus,  by  the  formation  of  an  abscess  or  fistulous  communication  and 
discharge  of  fcetal  bones,  it  may  be  advisable  in  some  cases  to  assist 
the  process  by  enlarging  the  opening  in  the  abdominal,  vaginal  or 
rectal  parietes,  but  this  should  be  done  with  great  judgment  and  care, 
as  serious  haemorrhage  may  ensue,  and  we  are  never  to  forget  that 
nature  is  generally  competent  to  complete  the  process  she  commen- 
ces." Churchill. 

*'ln  the  treatment  of  these  cases,  the  best  plan  is  to  subdue  the 
inflammation  by  leeches  and  other  means,  and  when  the  bones  ap- 
proach the  surface,  to  make  an  opening  through  the  abdominal 
parietes,  or  to  enlarge  the  natural  opening  of  these,  and  extract  the 
bones  like  any  other  foreign  bodies  lodged  in  the  abdomen.  Even  if 
the  diagnosis  in  these  cases  of  ventral  gestation  were  more  perfect  than 
it  is,  I  do  not  think  we  would  be  justified  in  performing  the  operation 
ofgastrotomy  with  the  view  of  extracting  the  child  alive."  Lee. 

In  addition  to  the  many  cases  on  record  in  which  women  have 
lived  several  years  some  even  twenty  and  thirty  years  with  an 
extra-uterine  foetus  in  the  abdomen.  Dr.  Bacchetti,  of  Pisa,  has  re- 
cently related  an  extremely  interesting  case  of  a  female  who  in 
1836  manifested  signs  of  pregnancy,  and  in  the  ninth  month  signs 
of  true  labour,  which  after  recurring  fifteen  days  successively,  sub- 
sided entirely,  the  volume  of  the  tumour  continuing  of  the  same  size. 

In  1838,  and  again  in  1841,  she  became  pregnant,  and  was  happily 
delivered  each  time.  Ten  months  after  the  last  birth  the  tumour  in 
the  abdomen  became  painful,  and  she  gradually  sunk  in  1842.  On 
examination,  post-mortem,  a  male  foetus  was  found  entire  with  the 
exception  of  the  bones  of  the  cranium  which  were  separated. 

This  is  a  truly  interesting  subject,  and  although  pressed  for  time, 
I  dislike  to  dismiss  it.  I  would  be  happy  to  hear  from  you  again,  and 
learn  the  progress  and  termination  of  this  case ;  in  the  mean  time 
I  do  not  think  you  can  adopt  any  better  course  than  that  you  have 
pursued  to  combat  symptoms  as  they  arise,  and  endeavor  to  improve 
and  support  her  general  health  and  strength. 

With  highest  respect,  your  obedient  servant, 

Joseph  A,  Eve. 


1845.]         Sulphate  of  Quinine  in  Diseases  of  the  South,  577 


PART  II. REVIEWS  AND  EXTRACTS. 

Extracts  from  on  Official  Report  of  J.  J.  B.  Wright.  M.  D.,  Sur- 
geon U.  S.  Army,  to  the  Surgeon-General  U.  S.  Army,  on  the  use 
of  large  doses  of  SuJphafe  of  Quinine  in  Diseases  of  the  South, 
Communicated  by  W.  H.  Van  Buren,  M.  D.  {Fro7n  New-York 
Journal  of  Medicine.) 

*  *  *  Previous  to  April,  1841,  I  had  never  exhibited  qui- 
nine in  larger  quantity  than  twenty-five  grains,  in  twelve  consecutive 
hours.  I  have  a  distinct  recollection  of  the  circumstances  under 
which,  with  a  trembling  hand,  and  doubting  hope,  I  gave  the  quinine 
for  the  first  time  to  the  extent  specified.  The  patient  was  a  lady  of 
great  worth  to  the  community  and  her  family,  and  the  disease,  which 
made  its  approach  in  the  shape  of  remittent  bilious  fever,  had  lapsed 
into  intermittent,  assuming  a  malignancy  of  aspect  which  awakened 
apprehensions  for  the  issue.  I  did  not  leave  the  bedside  of  my  pa- 
tient during  the  continuance  of  the  last  paroxysm,  for  it  presented 
all  the  symptoms  which  indicate  serious  tendency  to  congestion  ; 
and  I  was  persuaded  that  if  another  could  not  be  prevented,  she 
would  not  survive  its  termination.  Under  this  impression,  and  hav- 
ing confidence  in  the  medicine,  (if  it  could  be  introduced  in  sufficient 
quantity  without  incurring  the  risk  of  injurious  effects,)  1  resolved  to 
disregard  the  rule  under  which  I  had  hitherto  acted,  and  to  exhibit 
the  quinine  to  an  extent  to  be  determined  by  its  effect  upon  the  sys- 
tem, given  in  divided  doses.  Commencing,  therefore,  as  soon  after 
the  subsidence  of  the  paroxysm  as  in  my  judgment  was  safe,  I  gave 
the  lady  four  grains  of  sulphate  of  quinine  every  two  hours,  (increas- 
ing the  last  dose  to  five  grains)  until  twenty  five  grains  had  been 
given  anxiously  watching  the  effect  of  each  dose.  With  a  degree 
of  satisfaction  I  have  seldom  felt  under  like  circumstances,  I  witness- 
ed the  index  of  the  clock  pass  the  mark  which  had  indicated  the 
period  of  approach  of  the  previous  paroxysm  for  I  felt  that  my 
patient  was  safe.      Her  convalescence  dated  from  that  time. 

Subsequently,  whilst  engaged  in  private  practice,  and  for  the  first 
years  of  my  service  in  the  army,  I  acted  under  the  rule  comprised  in 
the  particulars  of  the  case  to  which  I  have  alluded. 

In  1834,  whilst  on  duty  in  Arkansas,  I  witnessed  many  cases  of  the 
malignant  bilious  fever  of  that  country.  The  cases  which  came 
under  my  charge  were  treated  in  the  usual  way.  Quinine  entered 
into  the  list  of  remedies,  but  it  was  only  exhibited  under  the  canon^ 
when  an  approach  to  intermission,  or  a  distinct  remission,  was  ap- 
parent. One  case,  however,  occurs  to  me  as  an  exception  to  what 
I  have  stated,  which  I  will  relate. 

Lieutenant  (now  Captain)  H.  of  the  7th  Regiment  of  Infantry, 

36 


578  Sulphate  of  Quinine  in  Diseases  of  the  South.    [October, 


whilst  on  detached  service  in  August  or  September,  sustained  an  at- 
tack of  remittent  bilious  fever,  and  with  a  large  majority  of  his  com- 
mand in  like  condition,  was  brought  into  Fort  Gibson.  For  several 
days  the  fever  pursued  a  regular  course,  and  a  favorable  crisis  was 
hoped  for.  Suddenly,  however,  a  total  change  succeeded.  The 
paroxysm  anticipated  the  usual  hour  of  incursion,  and  was  charac- 
terized by  all  the  sym.ptoms  of  grave  congestive  fever,  the  brain 
being  the  principal  seat  of  congestion.  In  one  hour  after  the  occur- 
rence of  the  paroxysm,  the  sensorial  functions  were  abolished,  and 
very  soon  profound  coma  supervened  ;  the  extremities  were  cold  as 
marble,  the  pulse  almost  extinct,  the  sphincters  of  the  bladder  and 
rectum  utterly  paralyzed,  the  respiration  labored  and  irregular,   
the  eyes  upturned  and  injected ;  in  fine,  the  patient  seemed  in  the 
agonies  of  death.  All  my  sympathies  being  awakened  for  my  friend, 
and  all  my  anxieties  for  my  patient,  T  hastened  to  the  encounter  ; 
but  I  must  confess  with  painful  misgivings  of  my  ability  to  contend 
successfully  with  the  disease.  Having  at  that  time  no  precedent  or 
authority  for  the  exhibition  of  quinine  in  large  doses  under  such  cir- 
cumstances, I  gave  it  in  divided  quantities,  in  union  with  calomel 
and  camphor,  to  the  extent  in  all  of  twenty-five  grains;  applied 
cold  to  the  shorn  head,  epispastics  to  the  thighs,  sinapisms  to  the 
legs  and  arms,  and,  if  I  mistake  not,  opened  the  temporal  arteries,  and 
applied  cups  to  the  neck.  Under  this  treatment  the  patient  gradu- 
ally recovered,  with  the  loss  of  his  hearing  almost  total  for  some 
time,  and  though  ultimately  greatly  improved,  audition  is  to  this  day 
somewhat  defective. 

In  this  easel  confined  the  use  of  the  quinine  within  the  limit 
which  my  previous  experience  had  taught  me  was  safe,  under  dissim- 
ilar circumstances,  and  I  shall  never  cease  to  award  to  it  the  credit 
of  having  saved  to  his  friends,  and  to  the  service,  a  most  worthy  and 
meritorious  officer. 

If  it  be  said  that  the  favorable  result  in  this  case  was  due  to  the 
other  remedies  employed,  and  that  quinine  was  not  the  efficient  agent 
in  accomplishing  the  cure,  I  can  only  say,  in  support  of  its  claims, 
that  I  had  never,  at  that  time,  witnessed  recovery  in  a  case  apparent- 
ly so  utterly  desperate,  and  that  since  then,  I  have  only  known  a  fatal 
issue  averted  when  the  quinine  has  been  administered  in  large  doses. 

In  1840, 1  was  assigned  to  the  Florida  army,  and  ordered  on  duty 
at  Fort  Heileman,  Garey's  Ferry.  I  arrived  early  in  October,  and 
succeded  to  the  charge  of  a  full  hospital.  A  majority  of  the  cases 
(excluding  those  of  intermittent  fever),  were  bilious  remittent  with 
manifest  tendency  to  irregular  sanguineous  determinations,  and  local 
congestions.  Not  yet  having  met  with  any  notice  of  the  modern 
practice  with  the  quinine,  and  having  as  an  example  of  the  safety 
and  advantage  of  its  exhibition  during  the  paroxysm  of  fever,  only 
the  solitary  case  of  Captain  H.,I  did  not  rely  upon  it  as  a  principal 
agent,  but  confined  its  exhibition  to  the  apyrexial  period  of  conges- 
tive intermittent,  and  the  period  of  remission,  in  the  more  continued 


1845.]         Sulphate  of  Quinine  in  Diseases  of  the  South.  579 


forms  of  fever.  My  late  experience  in  the  use  of  quinine  has  indu- 
ced me  to  marvel  at  the  over-caution  with  which  I  exhibited  it  on  this 
occasion  and  formerly,  and  I  can  hardly  repress  a  smile  when  I  bring 
to  my  mental  vision  the  spectres  which  my  imagination  conjured  up. 

In  November,  1S40,  I  joined  the  1st  Regiment  of  Infantry,  which 
had  recently  taken  post  at  Sara-sota,  on  the  western  coast  of  Florida, 
a  position  which  combined  in  an  eminent  degree  all  the  circum- 
stances calculated  to  affect  unfavorably  the  health  of  troops.  Du- 
ring the  winter,  the  command  sutfered,  only  as  might  have  been  anti- 
cipated, from  its  exposed  situation,  taking  into  consideration  the  fact 
that  the  regiment  had  been  three  years  in  the  field,  and  deprived  for 
the  last  few  months  at  least,  of  a  full  supply  of  vegetable  aliment. 
Intermittent  fever  prevailed  to  a  considerable  extent  among  the  troops, 
and  was  interrupted,  ordinarily,  by  the  use  of  quinine  in  doses  of 
five  grains,  repeated  three  times  during  the  interval. 

My  largest  experience  in  the  use  of  quinine  having  occurred  during 
my  service  with  the  1st  Infantry,  and  in  the  quarter  ending  June 
30th,  1S41,  I  beg  leave  to  quote  from  my  Report  to  the  Surgeon- 
General's  office,  for  that  period.  *  *  *  *  "That 
the  1st  Infantry  has  encountered  disease  since  the  last  Quarterly 
Report,  the  present  will  abundantly  testify.  A  strong  scorbutic 
diathesis  pervaded  the  command  from  the  commencement  of  winter, 
which  imparted  to  most  of  the  forms  of  disease  which  occurred  during 
that  season  some  of  the  features  of  its  own  character.  Dysenter)', 
with  tendency  to  total  cachexia,  and  intermittent  fever,  constituted 
the  bulk  of  the  Sick  Report.  About  the  1st  of  April,  there  occurred 
more  cases  of  remittent  fever  than  we  were  prepared  to  expect  so 
early  in  the  season,  but  surprise  gave  place  almost  to  consternation, 
when,  towards  the  close  of  the  month,  there  were  added  to  the  sick 
list  twenty  cases  per  diem  of  congestive  fever." 

The  post  at  Sara-sota  was  abandoned  on  the  2nd  of  May.  The 
sick,  to  the  number  of  two  hundred,  or  more,  were  taken  to  Cedar 
Keys,  and  ultimately  transferred  to  Cantonment  Morgan,  where,  the 
Report  goes  on  to  state,  "after  considerable  delay,  and  some  hurtful 
exposure,  we  are  very  comfortable  in  hospital."  *  *  *  "The 
seat  of  congestion  in  this  fever  varied  in  different  cases.  In  some 
the  brain,  in  others  the  liver  and  spleen,  and  in  some  others  the  lungs, 
constituted  the  principal  seat  of  engorgement,  as  was  evidenced  by 
the  symptoms,  and  by  autopsic  examination  in  the  fatal  cases. 

"Excessive  prostration  of  physical  power  occurred  simultaneously 
with  the  attack,  and  the  mental  functions  sustained  early  impairment. 
The  whole  surface  of  the  body,  but  particularly  the  extremities,  be- 
came preternaturally  cold  after  the  first  paroxysm,  (in  which,  howe- 
ver, but  a  small  degree  of  increased  heat  was  developed).  A  cold, 
clammy,  or  limpid  perspiration  accompanied  this  condition  of  the 
skin.  The  tongue,  at  first  pale,  and  indented,  sometimes  smooth  and 
shining,  became  dry  and  hard  ;  the  teeth  were  encrusted  with  sordes  ; 
the  pulse  was  tVequent,  irritable,  and  often  intermittent ;  and  the 


580  Sulphate  of  Qtiiiiine  in  Diseases  of  the  South.    [October, 


alvine  discharges  watery,  and  sometimes  bloody,  with  tenesmus. 
The  whole  surface  of  the  body  presen<:ed  a  shrunken  and  contracted 
appearance;  the  respiration  was  hurried  and  irregular;  the  patient, 
in  fine,  presented  that  indescribable  picture  of  wretchedness  peculiar 
to  those  forms  of  disease,  in  which  the  Icedentia  impress  with  such 
intensity  as  to  overwhelm  the  vital  energies,  and  prevent  the  develop- 
ment of /lormaZ  reaction. 

"The  treatment  need  not  be  fully  detailed. 

"  But  though  my  observation  during  the  progress  of  this  fever, 
corresponds  with  all  my  previous  experience  in  regard  to  the  impo- 
tence (to  say  the  least,)  of  the  lancet  as  a  remedy  in  advanced  con- 
gestive fever,  and  will  induce  me  to  banish  it  from  my  list  of  curative 
means  in  such  cases  in  all  future  time,  I  am  happy  in  having  been 
directed  to  a  practice,  of  which,  if  I  obeyed  the  impulse  of  my  feel- 
ings, I  should  express  myself  in  terms  of  extravagant  commendation. 
I  allude  to  the  exhibition  of  sulphate  of  quinine  in  twenty,  thirty, 
and  even  forty  grain  doses,  alone,  or  in  combination  with  calomel. 
I  will  content  myself  for  the  present  with  saying,  that  in  numerous 
instances,  it  has  seemed  to  rescue  the  subjects  of  this  form  of  disease 
from  the  most  impending  danger."  *  *  *  *  "It  is 
due  to  Drs.  Harvey  and  Randall,  of  the  army,  to  admit  that  I  entered 
on  this  practice  at  their  urgent  suggestion,  for  I  will  confess  that  I 
entertained  much  misgiving  of  its  safety.  My  doubts  are  now  utterly 
dissipated,  and  I  would  give  a  half,  or  even  a  whole  drachm  of  qui- 
nine, with  as  little  hesitation  as  the  old-fashioned  'ten  and  ten'  of 
Dr.  Rush." 

Having  no  precise  statistical  record  in  my  possession  of  the  cases- 
of  congestive  fever  above  alluded  to,  I  can  only  state,  in  general 
terms,  that  the  cases  of  disease  to  which  I  refer,  in  the  Report,  as 
exposed  to  the  '  most  imminent  danger,"  and  to  whom  the  quinine 
was  administered  in  large  doses,  with  advantage,  could  not  have  been 
less  than  fifty.  I  will  further  state  that  it  was  the  sulphate  of  quinine 
that  I  prescribed,  that  it  was  obtained  in  every  instance  from  the 
Army  Medical  Purveyor,  and  that  in  my  opinion  it  was  pure. 

My  subsequent  experience  with  the  article  relates  principally  to 
its  use  in  the  remittent  and  intermittent  fevers,  which  came  under 
my  notice  in  the  summer  and  autumn  of  1842,  in  Florida,  a  few  cases 
only  of  congestive  fever  having  presented  themselves  during  this 
year.  As  a  remedy  in  all  these  cases,  the  article  fully  sustained  the 
favorable  character  it  had    previously  established   in   my  estimation. 

I  am  not  aware  that  I  have  discovered  any  disparity  of  effect  in 
the  action  of  the  remedy  determined  by  the  ditlerent  states  of  the 
system,  in  reference  to  its  tonic  or  atonic  condition.  1  have  never 
exhibited  it  when  there  seemed  to  be  present  an  inflammatory  dia- 
thesis,  (contra-distinguished  from  a  febrile  condition,)  nor  would  my 
recent  experience  induce  me  to  rely  with  confidence  on  the  quinine, 
as  a  supporting  agent,  in  a  prostrate  condition  of  the  system,  unless 
the  prostration  could  be  regarded  as  the  effect  of  the  febrific  agency 
(malaria,)  still  in  operation. 


1845.]         Sulphate  of  Quimtie  in  Diseases  of  the  South,  581 


I  have  not  witnessed  injurious  effects  from  the  medicine  in  any 
case  that  I  can  call  to  memory,  and  the  only  unpleasant  symptoms 
that  I  have  observed  to  follow  its  use,  were  more  or  less  buzzing  in 
the  ears,  and,  occasionally,  slight  dizziness.  These  symptoms  have 
uniformly  subsided  with  the  paroxysm. 

Modus  Operandi  of  Quinine.  It  is  said  that  the  cotemporariesof 
the  Countess  of  Cinchon  the  Friars  who  first  published  the  fame, 
and  disseminated  the  use  of  the  Peruvian  Bark  as  a  remedy  for  in- 
termittent fever,  regarded  it  as  a  specific,  perhaps  as  an  antidote  to 
the  poison  of  malaria;  and  modern  observation  seems  to  have  fur- 
nished some  reasons  for  doubting,  if  the  speculations  which  have  been 
indulged  by  their  successors  have  led  to  any  better  conceptions  of  the 
modus  operandi  of  its  efficient  principles.  With  the  profession  it  is 
dangerous  at  the  present  day  to  talk  of  ^'  specijics,^^  or  even  o^  anti- 
dotes, unless  we  are  ready  with  a  philosophical  rationale  o{  every 
step  in  the  process  by  which  tho  end  is  attained  ;  yet,  however  hu- 
miliating to  the  pride  of  science,  we  must  admit  that  there  are  many 
things  connected  with  the  principles  and  practice  of  medicine  that  we 
do  not  comprehend.  Individuals  form  theories,  they  indulge  in 
elaborate  and  ingenious  hypotheses,  and  admire  the  creations  of 
their  fancies  the  fictions  of  their  closet  speculations,  until  they 
actyally  persuade  themselves,  and  others  too,  that  their  conclusions 
are  the  result  of  legitimate  deductions  from  ascertained  facts,  that 
even  the  spirit  of  Lord  Bacon  himself  presides  over  their  delibera- 
tions and  has  affixed  its  seal  to  the  truth  of  their  philosophy.  These 
systems  are  destined  to  last  until  some  successful  revolutionist  in 
medicine  saps  their  foundations,  to  erect  on  their  ruins  a  superstruc- 
ture no  less  comely  to  look  upon,  but  awaiting,  in  after  time;  a  similar 
fate ;  because  speculations,  and  not  facts,  constituted  their  basis. 
Thus  it  has  ever  been  since  the  dawn  of  medicine,  and  we  apprehend 
its  future  historians  will  but  record  a  succession  of  like  events,  until 
it  shall  have  established  for  itself  a  place  among  the  fixed  and  cer- 
tain sciences. 

We  would  not  controvert  the  truth  of  the  position  that  medicine 
has  made  great  strides  in  the  way  of  improvement,  within  the  last 
century.  On  the  contrary,  we  are  proud  to  boast  that  every  year 
has  added  to  the  resources  of  the  art ;  for  genuine  inductive  philoso- 
phy has  infused  its  spirit  into  the  investigations  of  many  of  its  ardent 
cultivators.  But  there  are  many  secrets  yet  undivulged  in  philoso- 
phy and  therapeutics,  and  perhaps  a  precise  and  definite  conception 
of  the  manner  by  which  certain  medicines  effect  a  cure  in  diseased 
conditions  of  the  system,  will  remain  among  the  desiderata  until 
medicine  shall  have  received  the  last  finishing  touch  from  the  hand 
of  science. 

We  mean  these  remarks  as  prefatory  to  the  expression  of  a  doubt 
whether  the  bark  or  its  proximate  principles,  arrest  intermittent  fever, 
and  other  forms  of  febrile  disease  dependent  on  miasmatic  origin,  by- 
virtue  of  the  tonic  property  inherent  in  them.     We  are  not  prepared 


582  Sulphate  of  Quinine  in  Diseases  of  the  South.    [October, 


fully  to  deny  that  the  medicine  possesses  tonic  properties ;  it  is  an 
opinion  sanctioned  by  the  concurrent  belief  of  the  profession  for  more 
than  a  century.  But  my  ]ate  experience  authorizes  and  inclines  me 
to  believe  that  the  remedy  exercises  over  fevers  of  this  genus  a  pecu- 
liar and  specific  control,  independent  of,  and  distinct  from,  any  effect 
which  it  may  be  presumed  to  have  upon  the  tonicity  of  the  muscular 
fibre. 

Some  practitioners,  whose  experience  in  the  use  of  this  medicine 
has  been  by  no  means  inconsiderable,  have  been  led  by  observation 
of  its  eifects,  to  class  it  among  the  Sedantla,  and  several  plausible 
articles  have  been  written  in  support  of  this  view  of  its  properties. 
It  must  be  admitted  tiiat  if  I  were  reduced  to  the  alternative  of 
adopting  one  or  the  other  of  these  opinions  in  regard  to  the  character 
of  the  medicine,  my  late  observations  would  incline  me  to  entertain 
the  latter  although  some  unexplained  facts  would  still  stare  me  in 
the  face,  and  perplex  my  understanding. 

They  who  contend  that  its  curative  agency  is  due  to  a  direct 
effect  on  the  tonicity  of  the  muscular  fibre,  would  proscribe  its  use  in 
all  cases  where  this  vital  property,  or  the  contractibility  of  the  mus. 
cular  system,  might  be  presumed  to  be  in  an  exalted  condition.  But 
the  physician  experienced  in  diseases  of  southern  climates  will  tell 
you  that  he  is  in  the  practice  of  administering  it  when  the  condition 
of  these  vital  properties  is,  seemingly  at  least,  above  par.  For  in- 
stance, he  exhibits  the  article  at  the  very  height  of  the  paroxysm  of 
the  remittent  fever  of  his  climate,  and  finds  as  a  result  of  its  action, 
a  reduction  in  the  force  and  frequency  of  the  pulse, a  diminution  of 
animal  heat,<r a  moist  condition  of  the  skin, a  subsidence  of  pain 
and  restlessness ;  in  fine,  a  sudden  conversion  from  febrile  disturb- 
ance to  fair  convalescence.  Now,  if  the  experience  and  observation 
are  right,  can  the  theory  be  otherwise  than  wrong?  On  the  other 
hand,  those  who  mauitain  that  the  remedy  acts  by  sedation,  do  not 
hesitate  to  exhibit  the  article  when  the  powers  of  life  are  depressed 
to  the  utmost  limit  compatible  with  existence  ;  and  they  aver  that  its 
agency  is  curative  under  these  circumstances.  True  it  is  that  the 
writer  has  himself  frequently  given  the  quinine  in  both  of  the  con- 
ditions  stated,  and  in  both  his  experiejice  teaches  that  advantage 
resulted  from  the  practice.  He  has  witnessed  a  decided  improvement 
to  follow  the  exhibition  of  Sij.  of  quinine,  repeated  in  two  hours,  in 
advanced  congestive  fever,  when  the  condition  of  the  case  was 
characterized  by  a  lethargic  state  of  the  sensorial  functions,  verging 
on  coma,  cold  extremities,  cool  surface,  bathed  in  limpid  per- 
spiration,. dry  and  pallid  tongue,  feeble  and  fluttering  pulse,  &;c. 
And  again,  whilst  on  duty  in  Florida,  in  the  summer  of  1842,  in 
charge  of  the  General  Hospital;  it  was  his  usual  custom,  after  atten- 
tive  observation  of  the  safety  of  the  plan,  to  exhibit  twenty  grains  of 
quinine  at  nnypcriod  of  the  paroxysm  of  the  remittent  fever  of  that 
country,  and  he  i.^  s:iC<  in  (Icclarint;  lh;it  the  practice  was  cMrresslhl 
 as   the  Quarterly   Ut.port  to   the   Surgeon-General's  Office   will 


1 S45. ]         Sulphate  of  Quinin 2  in  Diseases  of  the  South.  583 


testify,  not  a  single  death  from  remittent  fever  having  been  reported 
during  the  season,  nor  from  its  sequelae. 

In  southern  climates,  where  high  atmospheric  temperature  pre. 
vails,  the  system,  it  is  well  known,  becomes  languid  and  relaxed.  This 
condition  is  the  eflect,  no  doubt,  of  the  exhausting  influence  of  the 
prolonged  action  of  caloric.  Indirect  debility  is  induced,  and  with 
this  loss  of  tone  in  the  system,  its  irritability  is  exalted.  Excessive 
mobility  is  impressed  on  the  whole  apparatus  of  life.  The  pulse  is 
quickened,  morbid  sensibilities  and  new  susceptibilities,  mental  and 
physical,  are  awakened,  and  hence  do  the  "children  of  the  sun" 
become  dislinguished  for  all  that  relates  to  temperament  and  disposi- 
tion all  that  constitutes  peculiarity  of  sectional  character,  from 
their  cool,  calculating,  deliberate  brethren  of  the  North. 

But  if  this  is  true  in  regard  to  the  system  in  health,  it  is  no  less  so 
when  it  is  under  the  influence  of  morbific  agents  ;  and  it  might,  with 
some  show  of  plausibility,  be  maintained  that,  in  this  condition,  ^owic^ 
operate  indirectly  by  sedation,  quieting  excitement  by  imparting 
tone.  And  thus,  perhaps,  would  they  who  entertain  this  view  of  the 
medicinal  properties  of  the  quinine  reconcile  their  notions  of  it  with 
its  efl^ects,  as  illustrated  in  the  cases  of  fever  in  which  it  has  been 
given  with  advantage  in  the  ijyrexial  period. 

It  is  said  that  recent  observations  in  other  countries  have  demon- 
strated the  advantage  of  quinine  in  acute  inflammations,  rheumatism, 
and  other  forn)s  of  disease  in  which  stimulant  tonics  are,  confessedly, 
not  only  inappropriate,  but  manifestly  pernicious.  We  have  the 
testimony  of  such  men  as  Morton,  Fothergill  and  Haygarth,  of  the 
last  age,  in  favor  of  Peruvian  bark  in  inflammatory  rheumatism  ; 
and  the  present  professor  of  midwifery  in  the  University  College, 
London  (Dr.  Davis),  furnishes  unequivocal  evidence  of  the  paramount 
advantage  of  the  remedy  in  such  cases.  (London  Lancet,  Febru- 
ary, 1841.)  The  writer  has  no  experience  of  its  effects,  when 
exhibited  in  such  conditions  of  the  system,  but  if  time  should  verity 
its  claim  to  confidence  in  these  diseases,  it  will  but  furnish  another 
argument  in  support  of  the  position  assumed,  that  its  medicinal  pro- 
perties are  not  fully  comprehended  or  established. 

There  are  strong  reasons  for  believing  that  the  antimonial  medi- 
cines possess  direct  febrifuge  virtues,  independent  of  any  influence 
they  exert  over  the  heart  and  arteries  by  their  mere  nauseating  effect 
upon  the  stomach. 

The  action  of  mercury  in  the  cure  of  lues  venerea,  has  never  been 
explained  in  a  way  that  can  seem  satisfactory  to  those  who  profess  to 
exhibit  no  article  of  medicine,  the  precise  physiological  effect  of 
which  they  do  not  understand.  To  designate  a  whole  class  of  rem- 
edies as  "alteratives,''  is  but  to  admit  that  they  produce  their  effects 
in  some  occult  way  which  we  do  not  comprehend, in  ffict,  I  might 
go  on  to  enumerate  almost  one-lialf  of  what  is  contained  in  the 
armenlarimn  of  physic,  and  include  tho  whole  in  this  category,  
but  I  will  conclude  what  1  have  to  say  in  regard  to  the  inoJus  operandi 


584  Sulphate  of  Quinine  in  Diseases  of  the  South.    [October, 


of  quinine  in  the  fevers  of  malarial  regions,  and  write  myself  the 
advocate  of  the  notion  entertained  by  the  Jesuits,  to- wit;  its  agency 
is  specific. 

It  is  thought  that  this  article,  in  combination  with  mercurials  
calomel  particularly  accelerates  the  supervention  of  plyalism.  I 
have  no  doubt  of  the  fact.  I  am  disposed  to  ascribe  it  to  a  presum- 
ed chemical  decomposition  in  part  of  the  combined  articles  in  the 
stomach,  and  a  new  arrangement  by  which  the  activity  of  the  mer- 
curial would  be  increased  ;  or,  if  the  chemists  advise  that  no  incom- 
patibility exists  between  calomel  and  quinine,  and  that  no  such 
presumed  change  can  take  place  in  the  stomach  to  account  for  the 
alleged  fact,  then  I  would  suggest  that  the  latter  article  facilitates 
the  mercurial  action  simply  by  counteracting  the  morbid  impression 
of  the  febrific  agent,  and  the  diseased  condition  hence  resulting,  by 
its  specific  effect,  thus  bringing  the  susceptibilities  of  the  system  to  a 
condition  approximating  the  healthy  standard  ;  for  it  must  be  admit- 
ted that  first,  in  proportion  to  the  intensity  of  morbid  action,  is  the 
difficulty  in  establisliing  the  constitutional  operation  of  the  mineral 
in  any  given  case  of  disease. 

Has  the  free  use  of  quinine  increased  the  disposition  to  diseases 
of  the  boicels  e.  g.,  Diarrhoea  and  Dysentery  ? 

Broussais,  in  his  "  Chronic  Phlegmasia,"  has  shown,  as  we  think, 
very  satisfactorily,  that  long-continued  atmospheric  heat,  combined 
with  moisture,  has  an  invariable  tendency  to  induce  chronic  inflam- 
mation of  the  mucous  coat  of  the  larger  bowels,  thus  giving  origin 
to  diarrhoea  and  dysentery,  with  ultimate  liability  to  ulceration  of 
the  colon  and  rectum.  High  and  long-continued  heat  and  moisture^ 
distinguish  the  climate  of  Florida  ;  and  when  it  is  remembered  that 
the  centripetal  tendency  of  the  fluids,  in  the  cold  stage  of  intermit- 
tents,  (so  frequently  recurring  among  the  troops  serving  in  that  Ter- 
ritory,) determines  congestive  accumulations  and  irritations  in  the 
internal  organs,  we  think  that  the  prevalence  of  diarrhoea  and  dys- 
entery, under  these  ciicum^tances,  is  susceptible  of  explanation  with- 
out ciiarging  anything  to  the  account  of  quinine. 

No  patiiological  view  of  these  diseases  can,  it  is  believed,  be  cor- 
rect which  is  irrespective  of  the  condition  of  the  skin.  It  is  fair  to 
presume  that  this  organ  is  primarily  impressed,  and  that  the  lining 
membrane  of  the  primae  vise  is  implicated  in  virtue  of  the  intimate 
sympathy  which  is  acknowledged  to  exist  between  it  and  the  former. 
The  persistence  of  the  bowel  affection  is  then  probably  due  to  the 
derangement  of  the  dermoid  apparatus,  and,  until  the  latter  is  restored 
to  its  integrity  of  function,  the  morbid  condition  of  the  bowels  can 
hardly  be  expected  to  suhside  under  any  plan  of  treatment. 

Broussais  has  remarked  somewhere  that  when  the  skin  in  these 
forms  of  disease  presents  a  straw-colored  appearance  and  inelastic 
condition,  ulceration  of  the  mucous  coat  of  the  howels  may  l)e  ap- 
prehended ;  and  that,  in  a  large  majority  of  such  cases,  a  fatal  result 
will  ensue. 


1845.]  Tables  nf  Mortality  after  Operations,  585 


A  very  enlarged  experience  with  the  bowel  affections  of  Florida 
has  impressed  strongly  on  my  mind  the  opinion,  that  there  are  few 
forms  of  disease  in  the  catalogue  less  amenable  to  the  resources  of 
the  art. 

Post-mortem  examinations  were  instituted  in  a  large  majority  of 
the  fatal  cases  in  the  General  Hospital  at  Cedar  Keys,  as  well  as  the 
Post  Hospitals  at  different  times  under  my  charge  in  Florida.  My 
observation  teaches  that  the  liver  and  spleen,  less  frequently  presented 
evidence  of  diseased  condition,  than  is  usual  in  section5^-of  the  coun- 
try where  miasmatic  causes  of  disease  prevail.  The  proportion  of 
cases  in  which  these  complications  existed,  was  infinitely  smaller  in 
Florida  than  I  had  previously  observed  in  Ari^ansas.  Even  the  swelled 
spleen,  so  common  in  other  aguish  districts,  was  a  rare  spectacle. 

I  can  readily  conceive,  in  explanation  of  this  apparent  immunity 
from  congestive  enlargements,  and  from  other  obvious  disease  of  the 
liver  and  spleen,  that,  where  ulceration  exists  in  the  larger  bowels, 
in  obedience  to  the  law,  pathological  as  well  as  physiological,  "  ubi 
irritatio,  ibi  affluxus,"  the  fluids  impelled  towards  the  central  organs, 
(under  circumstances  calculated  to  produce  irregular  distributions,) 
are  diverted  to  the  point  where  irritation  exists  in  greatest  intensity. 
In  other  words,  the  irritation  of  the  bowels  serving  as  a  "diverticu- 
lum," secures  the  liver  and  spleen  from  an  influx  of  blood,  sufficient 
to  derange  their  healthy  functions,  much  less  to  leave,  after  death, 
appreciable  traces  of  organic  lesion.  I  have  no  reason,  therefore,  to 
think  that  the  use  of  quinine  had  any  agency  in  inducing  acute  and 
chronic  affections  of  the  liver  and  spleen. 

With  the  exception  of  some  few  cases  of  acute  dysentery,  the 
fevers  above  alluded  to,  and  some  cases  of  inveterate  ophthalmia,  the 
great  majority  of  the  sickness  which  came  under  my  notice  while 
serving  in  the  Territory  of  Florida  was  of  a  chronic  character,  and 
mostly  consisting  of  the  protean  forms  of  malarial  disease. 

Surgeon  GeneraVs  Office,  July,  1845. 


Tables  of  the  Mortality  after  Operations.    By  Thojias  Inmax,  M.  D. 
(From  London  Lancet.) 

The  history  of  the  following  tables  is  this.  A  year  or  two  ago,  I 
was  struck  with  the  number  of  deaths  occurring  after  amputation,  and 
about  the  same  time  met  with  Dr.  Lawrie's  and  Mr.  Phillips'  paper 
on  the  same  sul;(ject ;  from  that  date  I  have  been  occasionally  jotting 
down  the  reports  I  have  met  with  in  the  different  periodicals,  but  did 
not  do  much  till  a  \c\v  months  ago,  when  circumstances  induced  me 
to  extend  my  inquiries,  and  to  comprehend  other  capital  operations 
besides  amputation. 


586 


Tables  of  the  Mortality  after  Operations,       [October, 


As  I  have  been  myself  considerably  surprised  by  the  results,  I 
have  thought  it  worth  while,  for  the  information  of  others,  to  give 
them  a  wider  circulation. 

I  doubt  not  that  many  living  operators,  if  they  ever  happen  to  cast 
their  eyes  over  the  columns,  will  find  I  have  in  some  degree  mis- 
stated the  results  of  their  operations.  This  arises  from  many  of  my 
notes  being  taken  long  ago,  and  consequently  representing  what  was 
correct  only  at  the  time  they  were  written.  The  table  would  have 
been  much  more  perfect  had  I  been  able  to  obtain  an  authentic  ac- 
count of  the  practitfe  and  experience  of  our  most  eminent  living 
surgeons. 

I  cannot  help  thinking  that  it  would  be  exceedingly  beneficial,  if 
all  the  hospitals  in  England,  especially  the  larger  (mes,  would  publish 
an  annual  record  of  their  operative  practice,  such  as  is  given  for 
Scotland  in  the  "Edinburgh  Medical  and  Surgical  Journal,"  for 
January,  1844,  No.  158. 


TaUe  sliewirig  the  Average  Mortality  of  Amputations  generally  ^including  secondary , 
primary /for  accident  or  disease. 


Where  occurring,  or  by  whom  reported. 


Cases  ^^^^^^-  Proportion. 


Cases  collected  and  reported  by  Mr,  Phillips,  occur 

ring  in  France,  Germany,  America  and  England . 
Cases  collected  from  the  various  journals  by  the  same 

author,  all  probably  occurring  in  Britain  . . . 
Private  notes  of  London  hospital  surgeons,  by  the 

same  author 

France,  as  reported  by  Malgaigne:  Parisian  hospit 

als  for  four  5^ears 

Guthrie,  on  the  field  of  battle 

Guthrie,  secondary  in  hospitals 

Glasgow  Infirmary,  Dr.  Lawrie 

Pennsylvania  and  Massachusetts  hospitals 

Northern  hospital,  Liverpool 

Gendron,  Paris 

University  College  Hospital 

Emery,  after  battle  of  Navarino 

Liverpool  Infirmar}'^,  three  and  a  half  3-ears 

Guyon,  African  a/my  of  the  French,  i837-9 

Edinburgh,  last  year  

Larger  extremities,  18  cases,  13  dead 

Lesser  extremities,   20      "        2     " 

Dupuytren 

Scotch  Hospitals,  during  last  year,  exclusive  of  Edin- 
burgh   

Larrey  and  Roux 

Larrey,  primar)'',  on  field  of  battle 

Dubois 

After  revolution  of  30th  July,  at  Paris,  the  proportion 
of  deaths  was  three  in  four 

Bell  states,  that  out  of  operations  performed  on  the 
liela  of  battle,  he  lost  one  in  12 


Total 


G40 
308 
107 

587 

291 
551 
276 
14G 
9G 
79 

G8 
5G 
C3 

38 
59 

GO 
38 
13 
28 

4 

12 


150 


28 

301 

24 

2G5 

101 

37 

18 

33 

10 

14 

4 

17 


1  in  4  1^8 
lin4 

1  in  3  3-4 

Jl  in 
\  nearly  2 
1  in  11  1-2 
1  in  2  1-2 
1  in  2  7-10 
lin4 
iin5 
1  in  2  1-2 
1  in  G  1-G 
1  in  4  4-5 
1  in  14 
1  in  4 


1  in  2  1-2 
1  in  4 

1  in  4  1^3 
1  in  2  1-2 
1  in  G  1-2 
lin9 


358G   IMG  J  in  3  7-10 


1845.]    Tables  of  the  Mortality  after  Operations, 


587 


TaJ)le  sMwing  the  Mortality  attending  the  Operation  of  Amputaiivn. 


Opera,  lull. 

No.  of 
Cases. 

Dead. 

Proportion. 

Remarks. 

Amputation 

of  the  thigh 

of  leg 

201 
192 
38 
13 
91 
'IS 
24 

r2G 

lUG 

9 

10 

41 

8 

1 

1  in  1  3-4 
1  in  1  3-4 

1  in  4  1-4 

2  in  3 

1  in  2  1-4 
1  in  3  3-4 
1  in  25 

Collected  by  Malgaigne  from 
the  records  of  the  Parisian 
liospitals,  from  183G  to  1840, 
in  elusive.  Archives   "enef- 

of  foot 

ales   de  Medicine  d  Pans 

of  siioulder  joint. 

of  upper  arm 

of  fore-arm 

of  wrist  and  hand 

April,  1842. 
These  include  amputations  for 
accident  and  disease ;   the 
average  mortality  of  the  two 
is  nearly  equal. 

Amputation 

of  the  thigh 

of  leg 

128 

G2 

5 

6 

53 

20 

4G 

30 

1 

4 

21 

0 

1  in  2  3-4 
1  in  2 
1  in  2  1-2 
1  in  1  1-2 
1  in  2  1^2 

Glasgow  Infirmary,  from  1795 

of  foot  and  ankle. 
Bt  shoulder-joint, 
of  arm 

to    1840,   reported   by    Dr. 
Lawrie  -^Medical    Gazette, 
1841. 

of  fore-arm 

Amputation  ot  upper 
extremities,  collected 
from  V  arious  sources 
(French  military) . . . 

Amputation  of  lower 
extremities 

123 
107 

G9 

J  1  in 

1  about  2 

2  in  3 

These  are  chiefly  taken  from 
the  reports  of  Malgaigne, 
chiefly  military  surgery. 

Amputation  of  upper 
extremities  (various 
sources) 

144 

296 

18 
75 

1  in  8 
lin4 

These  are    collected    chiefly 
from  American  and  British 
reports,  where  no  distinction 
has  been  made  between  arm 
and  fore-arm,  thigh  and  leg. 

Amputation  of  lower 
extremities 

Table  shewing  the  Mortality  attending  the  Operation  of  tying 

the  Large  Arteries. 

Artery  subjected  to  Ligature,  &c. 

iSo.  of 
Cases. 

Deaths. 

Proportion. 

Ca.ses  collected  by  Phillips  from  the  works  of  BoycC) 
Lancici,  Scarpa,  Pelletan,  &c.,  where  old  opera- 
tion was  performed : 
Femoral  tied 

22 
/ 

6 

40 

40 

3 

8 
4 

27 
42 

G 

1 

G 

18 

11 

3 

3 

2 
9 

7 

1  in  3  3-4 

Humeral  tied                    

1  in  7 

Hunterian  ojjeration  

Ligature  of  arteria  innominata* 

all  die 

Li""ature  of  subclavian 

1  in  2 

1  in  4 

Abdominal  aorta 

all  die 

Common  iliac     

1  in  2  2-3 

Internal  iliac           

1  in  2 

External  iliac 

1  in  3 

Femoral    

1  in  G 

Total 

199 

m 

1  in  3 

*  The  only  successful  case,  if  so  it  may  be  called,  is  related  by  Mr.  Porter,  of 
Dublin,  where  the  artery  was  cut  down  upon  and  found  too  much  di.'^eased  to 
bear  the  ligature ;  the  v^-ound  closed  readily,  and  the  aneurism  wa.s  cured. 


588 


Tables  of  the  Mcrtality  after  Operations.       [October, 


Some  discrepancies  exist  in  the  calculations  of  various  authors  as  regards  the 
mortality  of  this  operation.  Phillips  states  that  out  of  171  cases  he  has  collected, 
57  died.  Lisfranc  states  that  he  has  collected  the  reports  of  180  cases  where  the 
Hunterian  operation  has  been  performed,  and  gives  the  deaths  at  40  only. 

The  above  table  is  drawn  out  after  carefully  examining  all  the  medical' periodi- 
cals for  a  long  series  of  years,  and  the  author  believes  it  may  be  relied  on  as 
being  the  closest  possible  approximation  to  the  actual  truth. 


Table  shelving  the  Mortality  attending  the  Operation  for  Lithotomy. 


iNature  of  operaiion,  wlit-re  recorded,  by  whom  or 
where  performed. 


Frere  Jacques  (recorded  by  various  author?) 

Raw  (the  only  official  register  extant  that  1  can  find 

noticed) 

Cheselden 

Naples :  lateral  operation  cases  operated  on  in  the 

public  hospitals,  from  18-21  to  18'28 

Dupuytren  bilateral  operation 

Dupuytren's  account  of  the  practice  of  the  Parisian 

hospitals  and  private  cases,  1636 

Dudley,  Kentucky 

Chrichton,  of  Dundee 

Norwich  hospital  for  the  last  GO  years 

Leeds  Infirmary,  from  1767  to  1817,  according  to  Dr. 

Piout 

Bristol  Infirmary 

Bransby  Cooper 

Liston 

Hotel  Dieu  and  La  Charite,  Paris 

Luneville 

Frere  Come 

Pajola 

Pauza 

Ourrard 

Joucil 


Total 


-NO.  of 
Cases. 


1-24 

2-2 
213 

643 

99 

356 

153 

71 

704 

197 

104 

22 

1200 

1629 

100 

50 

70 

60 

83 


Dtaths 


4 

20 

100 
19 

61 
4 

8 
93 

28 

10 

2 

225 

147 

19 

5 

5 

5 

3 


5900       765       1  in  7  3  4 


Proportion. 


1  in  17  5-7 

1  in  5  1-2 
1  in  10  1-3 

1  in  6  1-2 
J  in  6 

1  in  6 
1  in  38  1-4 
1  in  9 
1  in  7  3-5 

1  in  7 
1  in  4  1-2 
1  in  10 
1  in  11 
1  in  5  1-2 
1  in  11 
1  in  5 
1  in  10 
lin  14 
1  in  12 
1  in  17 


Table  shewing  the  Mortality  aitending  upon  the  Operaiion  of  Gastrotomy  and  the 
Casariayi  Section. 


Where  or  by  whom  recorded,  nature  of  operation,  &c. 


Csesarian  section.     Dr.  Churchill : 

414  cases,    186  died,  =  1  in  2  1-2 
Cases  collected  bv  Mons.  Figuera:    790  cases,  424 
fatal..  =  1  in  l"3-4 

Cases  well  authenticated,  collected  by  Dr.  Churchill, 
all  occurring  since  A.  D.  1750* 

Pcemoval  of  Dropsical  Ovarium,  where  operation  was 
completed 

Operation  for  extirpation,  where  either  no  tumour  ex- 
isted, or  wherrir^surmountable  obstacles  prevented 
the  removal  of  the  diseased  mass 


Total 363 


No.  of 
Cases. 


321 
33 


Deaths. 


173 
11 


ISu 


Proportion. 


1  in 

nearly  2 

1  in  3 

1  in  3 

1  in 
about  2 


Out 


of  twentj'-eight  persons  who  had  the  operation  performed  on  them  more 


1845.] 


Turning, 


589 


Table  shewing  the  Mortality  attending  the  Operation  for  Hernia. 


Where  or  l)y  whom  recorded,  &c. 


In  Sir  A.  Cooper's  work  on  klernia 

By  Travels 

Dewar,  of  Dunfermline 

Scarpa,  (on  Hernia) , 

Lawrence  (on  Hernia) ^ 

Clement 

Hey  (he  performed  the  operation  forty  times,  but  no 

detailed  account  is  given  of  all  the  cases) 

Wurtzburg,  from  1816  to  184'2 

Recorded  in  diflercnt  periodicals  as  isolated  cases,  &c 
Malgaigne,   Hos^iitaU  of  France  : 

Patients  between  fifty  and  eighty  years  of  age  . . . 

Other  ages 

Guy's  Hospital/from  Sept.  1841,  to  Dec.  1842. 

Scotch  Hospitals  during  1843 

Cases  witnessed  by  the  author 

Liverpool  Infirmary,  for  two  years 

Liverpool  Northern  Hospital  nine  years 


No.  of 
Cases. 

77 
14 
17 
16 
2-2 
8 

12 
56 

88 

97 
86 
19 
11 

6 

4 
12 


Total 


545 


Deaths 


36 
8 
4 


6 
24 

30 

70 
44 
10 
3 
3 
1 
6 


Proportion. 


-2 


in  2 
in  I 
in  4 
in  3 
in  3 
in  2 


in  2 
in  2  1-2 
in  3 

in  1  1-4 
in  2 
in  2 
in  3  2-3 
in  2 
in  4 
in  2 


260       1  in  7  3-4 


Turning. By  J.  Y.  Simpsox,  M.  D.,  F.  R.  S.  E  ,  (kc.      (From 
London  and  Edinburg  Monthly  Journ.  of  Med.  Science.) 

[Many  writers  on  Midwifery  recommend  that  in  the  operation  of 
turning,  both  feet  should,  ifpossibie,  he  grasped  and  pulled  down. 
We  entirely  ngree  with  Professor  Simpson  in  the  following  very 
judicious  remarks.] 

In  most  cases  I  hold  this  method  to  be  improper  and  unjustifiable, 
because  it  is  almost  always  more  difficult  to  seize  both  extremities 
than  to  seize  one  ;  because  one  is  quite  sufficient  for  our  purpose, 
and  more  safe  for  the  life  of  the  mother;  and  because  by  pulling  at 
one  extremity  (when  pulling  does  happen  to  be  required  after  the 
version  is  accomplished)  we  more  perfectly  imitate  the  natural  oblique 
position  and  passage  of  the  breech  of  the  infant,  that  when  we  drag 
it  down  more  directly  and  more  upon  the  same  plane,  by  grasping 
and  dragging  at  both  limbs  equally.  The  infant  also  assuredly  in- 
curs less  risk  of  impaction  of  the  head,  and  above  all,  less  chance  of 
fatal  compression  of  the  umbilical  cord,  when  the  os  uteri  and  ma- 
ternal  canals  have  been  dilated  by  the  previous  passage  of  the  breech, 
increased  in  size  by  one  of  the  lower  extremities  being  doubled  up 
on  the  abdomen,  than  when  both  extremities  being  seized  and  ex- 

thanonce,  only  three  died  i.  e.,  there  were  seventy-three  operations  on  twenty- 
eight  persons,  an&  only  three  deaths.  [From  Dr.  Churchill's  Midwifery,  &c. 


590  Turning,  [October, 


tended,  these  same  passages  are  more  imperfectly  opened  up  by  the 
lesser-sized  wedge  of  the  breech  alone.  Notwithstanding,  however, 
the  great  difficulties  and  consequently  the  greater  dangers  attendant 
on  the  operation,  when  we  search  for,  and  grasp  both  lower  extrem- 
ities, instead  of  one,  it  is  still  so  dogmatically  laid  down  as  a  rule  by 
most  obstetric  authorities,  that  many  practitioners  seem  to  deem  it 
a  duty,  not  to  attempt  to  turn  the  child  without  having  previously 
secured  both  feet. 

In  ^ew  or  no  cases  of  turning  is  it  proper  or  requisite  to  bring 
down  both  extremities,  unless  in  the  complication  of  turning  under 
rupture  of  the  uterus.  In  that  case,  but  in  that  only,  ought  we  to 
follow  at  once  this  procedure  and  here  we  follow  it  because,  if  we 
left  the  other  extremity  loose  in  the  uterus  or  abdomen  it  would  be 
apt  to  increase  the  lesion  in  the  walls  of  the  organ,  if  it  happened  to 
get  involved  in  the  aperture,  or  impacted  against  its  edges.  In  some 
very  rare  instances  in  which,  after  version  by  one  leg  has  been  effected 
and  immediate  delivery  is  necessary,  the  cervix  and  os  internum 
occasionally  contract  so  forcibly  and  strongly  upon  the  protruded 
limb,  whenever  we  drag  upon  it,  as  not  to  allow  a  sufficient  amount 
of  traction  being  applied  to  this  extremity  without  fear  of  lacerating 
its  structures.  In  such  cases  it  may  be  well  to  attempt  to  repass  the 
hand  to  secure  the  other  extremity,  for  then  by  pulling  at  both  extrem- 
ities together,  we  incur  less  chance  of  injuring  them  than  if  we  ap- 
plied the  same  required  amount  offeree  to  either  of  them  singly. 

Should  we  seize  one  extremity  ojiJy  ?  From  what  I  have  already 
stated,  you  know  my  opinion  as  to  this  being  the  proper  method  of 
proceeding  in  almost  all  cases  of  difficult  turning.  The  method  was 
long  ago  spoken  of  by  Portal ;  and  within  the  present  century,  Hoff- 
man and  Jeorg  in  Germany,  and  my  friend,  Dr.  Radford,  in  this 
country,  have  severally  written  on  the  subject,  and  upheld,  that,  in 
no  case  of  turning  ought  we  to  lay  hold  of  more  than  one  extremity, 
for  the  purpose  of  effecting  the  version  of  the  infant.  I  have  just 
pointed  out  what  I  conceive  to  be  two  perhaps  the  only  two  ex- 
ceptional conditions  to  this  general  rule. 

I  believe  the  seizure  of  the  knee  to  be  preferable,  in  most,  if  not 
in  all  cases,  to  the  seizure  of  the  foot,  or,  rather,  as  it  should  be  more 
correctly  stated,  to  the  seizure  of  the  ankle  of  the  child,  I  speak, 
you  will  recollect,  of  turning  in  cases  of  shoulder  or  arm  presenta- 
tion, in  which  the  liquor  ajunii  has  been  for  some  time  evacuated,  as 
in  Anderson's  case,  and  the  uterus  by  its  tonic  contraction  has 
clasped  itself  around  the  body  and  head  of  the  child.  Under  such 
circumstances,  it  is  an  object  of  importance  not  to  be  obliged  to 
introduce  our  hand  farther  than  is  absolutely  necessary,  into  the 
cavity  of  the  uterus,  because  the  contraction  of  the  organ,  in  many 
cases,  opposes  its  introduction,  and  the  forced  introduction  of  it  is 
apt  to  produce  laceration.  It  is  an  object  also  of  equal  moment  to 
attempt  to  turn  by  a  part  which  produces  as  little  change  as  possible 
in  the  figure  and  form  of  the  infant ;  because,  if  wc  thrust  any  of  the 


1845.]  Turning.  591 


angulated  parts  of  the  child  against  the  interior  of  the  contracted 
uterus,  we  should  also  thus  be  still  more  liable  to  produce  rupture  of 
that  organ.  Now,  holding  these  points  in  view,  it  appears  to  me, 
that  the  turning  of  the  child,  by  seizure  of  the  knee,  presents  several 
derided  advantages  over  turning  of  the  child  by  seizure  of  the  foot. 
For,  1st.  The  knee  is  more  easily  reached.  As  we  slip  our  hand 
along  the  anterior  surface  of  the  protruding  arm,  and  along  the 
anterior  surface  of  the  thorax  of  the  child,  we  always,  if  the  at- 
titude of  the  child  has  not  been  altered  by  improper  attempts  at 
version,  or  very  irregular  uterine  action,  find  the  knees  near  the 
region  of  the  umbilicus  of  the  infant  the  lower  extremities,  as  you 
are  aware,  being  folded  up  in  utero  so  that  the  knees  are  brought  up 
to  that  part,  and  the  legs  flexed  upon  the  thighs  in  such  a  manner 
that  the  heels  and  feet  lie  nearly  in  apposition  with  the  breech  of 
the  child.  To  seize  a  foot,  therefore,  we  should  require  to  pass  our 
hand  about  three  inches  (or,  in  fact,  the  whole  length  of  the  leg) 
Jurther  than  we  require  to  do  in  order  to  seize  a  knee.  2nd.  The 
knee  affords  the  hand  of  the  operator  a  much  better  hold  than  the  foot. 
By  inserting  one  or  two  fingers  into  the  ham  or  the  flexure  of  the 
knee,  we  have  a  kind  of  hooked  hold  which  is  not  liable  to  betray  us. 
Every  one,  on  the  other  hand,  who  has  turned  by  the  foot  or  feet, 
knows  how  very  apt  the  fingers  are  to  slip  during  the  required 
traction,  and  how  much  in  this  way  the  difficulties  of  the  operation 
are  sometimes  increased.  3d.  We  produce,  I  believe,  the  necessary 
version  of  the  body  of  the  child  more  easily  by  our  purchase  upon 
the  knee-^because  thus  we  act  more  directly  on  the  pelvic  extremity 
of  the  infant's  spine,  than  when  we  have  hold  of  a  foot.  4th.  Turn- 
ing by  the  foot  appears  to  me  to  endanger  greatly  more  the  laceration 
of  the  uterus  than  turning  by  the  knee.  The  reason  of  this  is  suffi- 
ciently evident.  When  we  turn  by  the  foot,  we  have  to  flex  the  leg 
round  upon  the  thigh,  and  thus,  at  one  stage  of  the  operation,  and 
during  one  part  of  the  flexion  of  the  leg,  we  are  obliged  to  have 
the  leg  bent  to  a  right  angle  with  the  thigh,  and  the  foot  of  the 
infant  thus  projected  and  crushed  against  the  interior  of  the  uterus, 
lou  see  this  when,  on  the  infant  before  me,  I  seize  hold  of  the  foot 
and  turn  it  round  from  its  position  at  the  breech,  till  I  bring  it  up  to 
the  shoulder,  the  part  which  we  are  supposing  to  present  at  the  os 
uteri.  You  can  easily  thus  perceive  that,  when  the  angled  and  long 
leg  of  the  child  is  thus  brought  round,  it  must  rasp  and  scratch  (if  I 
may  so  speak)  along  the  interior  of  the  contracted  uterus,  and  endan- 
ger, to  a  fearful  degree,  the  laceration  of  the  organ.  It  is  needless 
to  say  how  much  all  this  danger  is  increased,  when,  after  having 
brought  down  one  foot,  we  pass  again  our  hand,  and  attempt  to  bring 
down  a  second  foot  (as  is  recommended  by  some  authors),  for  thus  we 
only  double  the  danger  of  the  laceration  of  the  uterus,  from  the  forced 
and  obstructed  passage  along  its  interior,  of  this  other  extremity. 

One  point  remains  for  our  consideration.     Granting  that  it  is  pro- 
per to  seize  a  knee,  I  think  it  matter  of  the  very  first  moment  to  know 


5#i  Turning,  [October, 


which  knee  should  be  seized.  On  this  point  you  will  find  no  direc- 
tions in  any  of  our  modern  obstetric  works,  British  or  foreign,  as  far 
as  I  know  them  ;  and  yet  I  believe  the  secret  of  turning  with  facility 
and  safety  in  such  a  case  as  Anderson's  with  the  waters  evacuated 
and  the  uterus  contracted  depends  upon  the  knowledge  of  which 
of  the  two  lower  extremities  of  the  infant  should  be  seized.  If  we 
turn  with  one  of  the  extremities  and  whether  the  foot  or  the  knee  
it  should  be  the  foot  or  knee  of  the  limb  on  the  opposite  side  of  the 
body  to  that  which  is  presenting,  Thus,  if  the  ri^ht  shoulder  or  arm 
presents,  we  should  take  hold  of  the  left  knee  or  foot :  and  if  the 
left  arm  or  shoulder  presents  we  should  take  hold  of  the  right  knee 
or  foot.  I  repeat,  that  I  believe  this  point  to  be  of  the  most  essential 
importance ;  and  the  reasons  for  the  rule  are  simple.  In  bringing 
down  the  foetus  in  the  operation  of  turning,  we  may,  and  should 
produce  two  kinds  of  alteration  in  its  position  and  figure.  Thus, 
we  may  bend  or  flex  the  body  forward  upon  the  transverse  axis  of 
the  trunk  ;  and  we  may  rotate  or  turn  the  body  round  upon  the  Jon- 
gitudinal  axis  of  the  trunk.  If  we  merely  flex  it,  the  operation  of 
version  will  be  one  of  difficulty ;  if  we  both  flex  and  rotate  the 
trunk  at  the  same  time,  the  operation  will  be  one  of  comparative 
facility.  By  merely  flexing  the  body  upon  its  transverse  axis,  we 
are  liable  to  bring  down  one  of  the  lower  extremities,  while  we  do 
not  displace  the  upper  extremity,  which  is  primarily  presenting  at 
the  OS  uteri.  If  we  both  rotate  and  flex  the  body  that  is,  turn  it 
both  on  its  transverse  and  longitudinal  axis  at  the  same  moment, 
while  we  bring  down  the  pelvic  extremity  of  the  child,  the  turning 
of  the  body  of  the  infant  carries  away  from  the  os  uteri  the  part 
originally  presenting. 

Many  of  you  must  be  acquainted  with  the  fact,  that  obstetric  authors 
have  proposed  various  methods  of  removing  away  from  the  cervix 
uteri  the  presenting  arm  or  shoulder,  in  order  to  allow  of  more  space 
for  the  part  which  is  brought  down,  and  to  produce  the  necessary 
evolution  of  the  child.  Thus  some  recommend  the  presenting  part 
to  be  pushed  up  before  we  seize  the  feet ;  others  advise  the  foot  to  be 
seized  with  the  one  hand,  and  the  presenting  part  to  be  pushed  up 
with  the  other;  and  others  again  counsel  us  to  bring  down  one  or 
both  feet,  secure  them  with  a  tape  (as  you  see  in  the  plate  of  Moreau), 
and,  whilst  pulling  with  this  tape,  to  introduce  the  hand,  after  the 
lower  extremities  are  brought  down,  for  the  purpose  of  pushing  up 
the  presenting  portion  of  the  upper  extremity.  All  these  rules  and 
complications  are  at  once  avoided  by  following  the  principle  that  I 
have  just  stated  to  you,  of  bringing  down,  whenever  it  is  possible, 
the  knee  opposite  that  of  the  presenting  arm  or  shoulder.  When 
we  do  this,  by  carrying  the  knee  diagonally  across,  if  I  may  so  speak, 
the  abdcrmen  of  the  child  to  the  os  uteri,  we  both,  as  I  have  said, 
flex  and  rotate  at  the  same  time  the  trunk  of  the  infant,  and  in  doing 
so,  the  semi-rotation  of  the  trunk  inevitably  carries  up  the  present- 
ing arm,  in  proportion  as  the  knee  which  is  laid  hold  of  is  pulled 


1845.]  Ditisionof  the  Sjpinal  Marrow.  593 


down  by  the  operator.  I  would  add  this,  as  another  of  the  advanta- 
ges of  turning  with  one  extremity,  for  if  we  pulled  down  both  knees 
or  both  feet,  or  the  foot  or  knee  which  was  nearest  to  us,  we  should 
produce  in  many  instances  mere  flexion  of  the  body  wiiJiout  that  ro- 
tation of  it  which  is  necessary  to  carry  up  and  out  of  the  os  uteri, 
the  presenting  part  of  the  infant. 

I  have  insisted  upon  the  advantages  of  taking  hold  of  the  knee  that 
is  highest  and  furthest  from  you,  and  believe  this  is  to  be  a  matter 
of  the  very  first  moment.  Now,  it  may  appear  to  some  of  you  that 
it  would  be  more  difficult  to  seize  this  knee  than  the  knee  of  the  side 
corresponding  to  the  presenting  arm  ;  but  if  you  reflect  for  a  moment 
you  will  see  that  this  difficulty  is  more  imaginary  than  real.  Both 
knees  of  the  child,  as  the  infant  lies  folded  up  in  utero,  are  generally 
in  juxta  position,  and  lying  upon  the  abdomen  of  the  infant,  near 
the  umbilicus.  If,  therefore,  in  passing  your  hand  into  the  uterus, 
you  insinuate  it  as  you  ought  to  do,  along  the  anterior  surface  of  the 
thorax  and  abdomen  of  the  child,  you  come  in  contact  with  both 
knees  at  the  same  time,  And  the  rule  which  I  v.ould  give  you  is 
this,  that  instead  of  hooking  your  finger,  or  fingers  into  the  flexure 
of  the  lower  or  nearer  knee,  you  hook  them  instead  into  the  flexure 
of  the  upper,  more  distant,  or  opposite  one.  Both  are  so  far,  in  gen- 
eral, equally  near,  or  equally  distant,  and  you  seize  the  one  or  the 
other  according  as  you  take  care  to  turn  your  finger  so  as  to  hook  it 
into  the  flexure  of  the  lower  or  the  flexure  of  the  upper. 


PART  III. MONTHLY  PERISCOPE. 

Case  of  Division  of  the  Spiiial  Marrow,  By  Eli  Hurd,  I\r.  D.,  of 
Middleport,  Niagara  County.  New  York.  (Communicated  for  the 
N.  Y.  Journ.  of  Medicine,  by  Jas.  Webster,  M.  D.,  of  Rochester.)  
The  following  remarkable  case  of  injury  of  the  spinal  marrow  is 
believed  to  be  without  precedent,  or  at  least  to  present  sufficient 
points  of  interest  to  warrant  its  publication  : 

On  the  24th  of  April,  1829,  J.  S.  Spalding,  of  Hartland.  N.  Y., 
jumped  from  the  top  of  a  lumber  wagon  box  on  to  a  slick  of  timber 
iving  upon  the  ground  :  and  as  his  t'eet  struck  the  timber,  the  surface 
being  wet,  they  slipped  instantly  from  under  him,  and  he  fell  upon 
his  back  and  left  side.  When  he  came  to  a  rest,  he  found  himself 
partly  under  the  wagon,  and  between  tbe  wheels,  the  wagon  and 
timber  being  parallel  to  each  other.  From  this  position  he  endeavored 
to  extricate  himself,  but  found  his  lower  extremities  benumbed  and 
powerless.  He  then  called  out  for  assistance,  saying  that  he  had 
bnjken  his  back  on  the  edge  of  the  timber  in  his  fall.  He  was  im- 
mediately extricated  from  his  perilous  situation,  and  informed  by  his 


594  Division  of  the  Spinal  Marrow,  [October, 


assistants  that  there  was  a  chisel  sticking  in  his  back.  This  chisel, 
when  he"  jumped  from  the  wagon,  was  in  his  coat-pocket.  An  at- 
tempt was  promptly  made  to  extract  the  instrument,  which  resulted 
in  pulling  off  the  handle  only. 

I  was  then  called,  and  in  a  few  moments  was  on  the  spot,  where  I 
found  my  patient  in  the  arms  of  three  or  four  men,  his  back  exposed, 
and  an  iron  tool,  which  proved  to  be  a  part  of  the  shank  of  a  chisel, 
projecting  from  the  skin.  This  I  seized  with  a  pair  of  blacksmith's 
pincers,  such  as  are  used  for  pulling  off  horse-shoes,  and  bracing 
myself,  endeavored  to  extract  it,  instead  of  which  I  pulled  him  out 
of  the  hands  of  those  who  had  hold  of  him.  We  then  braced  our- 
selves once  more,  and  after  a  prolonged  and  severe  effort,  succeeded 
in  drawing  out  a  chisel,  ^ue  inches  in  length  to  the  shoulder,  seven- 
eighths  of  an  inch  wide,  and  from  a  quarter  of  an  inch  at  the  shoulder 
tapering  to  less  than  one-eighth  of  an  inch  in  thickness  at  the  cutting 
extremity. 

The  wound  was  then  dressed,  and  the  patient  carefully  conveyed 
home.  At  the  time  of  extracting  the  instrument,  he  says  that  he 
saw  "vivid  flashes  of  light,  which  were  apparently  followed  by  total 
darkness."  During  the  operation  he  was  conscious  of  very  little 
pain. 

The  wound  made  by  the  chisel  was  opposite. the  spinous  process 
of  the  lower  dorsal  vertebra,  on  the  left  side.  At  its  superior  ex- 
tremity it  was  half  an  inch  from  the  spinous  process,  and  one  inch 
at  its  inferior  extremity;  so  that  a  line  drawn  parallel  to  the  spinous 
process  of  the  vertebrae,  and  three-fourths  of  an  inch  to  the  left, 
would  have  intersected  it  in  the  middle.  The  direction  of  the  instru- 
ment was  upwards,  at  an  angle  from  the  surface  of  twenty  to  twenty- 
five  degrees,  and  to  the  right  of  about  twelve  degrees,  penetrating  the 
spinal  column,  and  undoubtedly  entirely  dividing  the  cord.  Perfect 
insensibility  of  the  skin  below  the  wound,  with  paralysis  of  the  lower 
extremities,  bladder  and  rectum,  was  the  immediate  consequence. 
The  shock  that  the  system  received  produced  great  prostration  for 
some  forty  hours,  when  reaction  took  place,  and  was  followed  by 
fever  for  ten  or  twelve  days.  The  external  wound  cicatrized  in  a 
few  days,  scarcely  discharging  a  spoonful  of  pus.  The  urine  was 
drawn  off  hy  means  of  the  catheter  for  six  days  after  the  accident, 
when  the  bladder  began  to  resume  its  functions,  and  two  days  after 
the  instrument  was  discontinued.  Cathartics  failing  to  move  the 
bowels  during  the  same  period  of  time,  and  for  two  or  three  days 
longer,  dejections  were  procured  by  stimulating  enemata.  Return- 
ing sensibility  occurred  in  the  skin  the  fifth  day, -and  an  imperfect  use 
of  the  limbs  about  the  fifteenth. 

My  attendance  was  twice  and  thrice  daily  for  the  first  six  days, 
once  daily  for  the  next  eleven,  then  occasionally  until  the  twenty- 
first  after  the  accident  (May  15),  when  the  patient  was  dismissed 
from  my  charge.  He  first  commenced  locomotion  on  his  hands 
and  knees,  then  by  pushing  a  chair  round,  and  afterwards  by  moans 


1845.]  Division  of  the  Spinal  Marrow.  595 


of  crutches,  which  he  has  been  obliged  to  use  ever  since.  Distortion 
of  the  feet  and  ankles  commenced  some  weeks  after  his  efforts  to  get 
about  on  crutches,  and  increased  for  several  years  thereafter  ;  yet  his 
general  health  continued  good. 

The  treatment  during  tlie  state  of  prostration  was  by  diffusible 
stimulants,  through  the  febrile  stage  by  antiphlogistics ;  wliile  fric- 
tion,  with  stimulating  liniments  to  the  paralyzed  parts,  was  used 
throughout  both  stages,  and  for  months  afterwards. 

[The  followinfT  additional  particulars,  written  subsequently  and  re- 
cently communicated,  complete  the  history  of  this  remarkable  case.] 

Sensibility  of  the  skin  and  action  in  the  inferior  extremities  returned 
very  slowly  ;  so  much  so,  that  four  years  and  seven  months  after  the 
accident  above-mentioned,  carelessly  sitting  or  kneeling  with  his  left 
knee  nearer  than  usual  to  the  hot  fire,  without  feeling  any  pain,  or 
being  conscious  of  suffering,  the  skin  and  integuments  over  the 
knee-pan  and  on  either  side  of  it  were  so  badly  burned,  that  mortifi- 
cation  and  sloughing  took  place.  This  was  so  deep,  that  the  cavity 
of  the  joint  was  opened  and  exposed  to  view.  The  patella  was  cov- 
ered only  by  the  periosteum,  and  after  a  few  days,  as  he  was  endeav- 
oring to  draw  his  leg  up  in  bed,  broke  transversely  across.  The 
superior  portion  of  the  patella  protruded  so  much  from  the  wound  in 
consequence  of  the  retraction  of  the  extensor  muscles,  that,  after 
various  unsuccessful  attempts  to  reduce  and  keep  it  in  place,  it  was 
removed  by  amputation.  The  knee  was  now  much  inflamed  and 
swollen.  The  wound  gaped  horribly,  and  every  symptom  gave 
indication  of  a  flital  issue.  A  fungus  vegetation  sprang  up  from  every 
side  of  the  wound,  filled  up  the  cavity,  and  formed  a  spongy  protu- 
berant mass  above  and  around  it.  Hemorrhage  followed  every  appli- 
cation  of  caustic  that  was  made  to  check  its  exuberant  growth,  as 
\vell  as  compression,  even  the  slightest  touch.  The  miserable  patient 
became  extremely  exhausted,  and  amputation  of  the  diseased  and 
crippled  limb  seemed  the  only  alternative,  and  even  that  a  doubtful  one. 

At  this  juncture,  December  23,  1833,  which  was  more  than  three 
weeks  from  the  time  of  the  burn,  and  the  seventh  of  my  attendance, 
I  commenced  dressing  the  wound  with  "  Singleton's  Golden  OinU 
jnent,^^  according  to  tiie  analysis  of  Mr.  Thomas  Clark,  of  Glasgow, 
Scotland.*  This  soon  arrested  the  morbid  action,  reduced  the  size  of 
the  fungoid  mass,  and  gave  it  a  healthy  appearance.  Convalescence 
slowly  followed.  January  22, 1834, 1  introduced  a  seton  in  the  sound 
parts  above  the  wound,  and  on  February  4th  the  patient  was  dismissed 
cured.  He  has  since  remained  well.  No  anchylosis  of  the  joint  at 
the  time  occurred,  nor  has  since  taken  place.  On  the  contrary,  he 
has  complained  of  its  being  rather  too  flexible. 

A  large,  ugly-looking  puckered  cicatrix  remains  over  and  above 

*  See  No.  12  of  theGlas^gow  Journal,  or  Medico-Chirurgical  Review,  new  se- 
ries, vol.  XIV. 


596  Conclusions  regarding  Tubercles.  [October, 


the  left  portion  of  the  joint.  The  inferior  portion  of  the  patella  is 
drawn  round  upon  the  outside  of  the  knee-joint.  The  leg  is  rotated 
outwards,  and  the  heel  thrown  in  so  as  to  point  to  the  hollow  of  the 
right  foot.  The  toes  are  thrown  out  and  drawn  up  towards  the  me- 
tatarsal bones,  and  the  whole  foot  is  drawn  inwards,  and  flexed  upon 
the  tibia  in  such  a  manner  as  to  make  almost  a  right  angle  with  the 
leg.  There  is  also  considerable  deformity  of  the  right  foot  and 
ankle,  though  less  than  of  the  left. 

The  general  treatment  was  by  wine,  tonics  and  opiates.  The 
local  unimportant  otherwise  than  above  mentioned.  He  was  under 
my  care,  in  the  treatment  of  the  limb,  for  thirty-three  days,  and 
slowly  thereafter  recovered  the  use  of  his  limbs,  except  the  previous 
decrepitude,  which  has  considerably  increased  since. 

Such  is  a  brief  account  of  this  extraordinary  case ;  embracing 
and  detailing,  however,  all  the  important  and  material  facts  that 
transpired  both  with  regard  to  disease  and  treatment,  from  the  time 
of  its  first  unfortunate  occurrence  till  its  final  termination  in  health. 

There  is  no  curvature  of  the  spine,  nor  has  there  been  at  any  time. 
Nor  is  there  any  complaint  whatever  of  the  back.  He  can  get  into 
and  out  of  a  carriage,  mount  a  horse  from  the  ground  without  assist- 
ance, and  ride  off  at  any  pace.  He  has  bejen  elected  constable  and 
collector  of  the  town  where  he  resides  for  a  number  of  successive 
years,  discharged  the  duties  of  his  office  acceptably  to  the  public, 
and  attends  to  many  other  kinds  of  business.  He  has  married  within 
two  years,  and  has  one  child.  In  fact,  he  is,  in  every  sense  of  the 
word,  as  well  as  he  ever  was,  except  his  crippled  condition. 

[We  regard  the  above  case  as  unique,  as  far  as  our  knowledge  ex- 
tends, and  the  facts  are  abundantly  corroborated.  That  the  spinal 
marrow  was  completely  divided,  and  afterwards  united,  there  seems 
to  be  no  doubt  whatever.  Perhaps  it  may  be  deemed  not  more  re- 
markable than  the  union  of  nerves  after  division  for  tic  douloureux, 
a  fact  well  authenticated,  as  the  spinal  cord  maybe  considered  no 
more  than  a  bundle  of  nerves  contained  within  a  common  sheath. 
Cases  also  are  recorded  where  incised  wounds  of  the  brain  have 
united,  and  the  patient  recovered  ;  but,  so  far  as  we  arc  informed, 
this  is  the  first  instance  on  record  of  a  total  division  of  the  spinal 
Qoxd.Ed.  N.  Y.  Jour,  Med.] 


Conclusions  regarding  Tubercles.  1.  Tubercle  is  a  secreted  sub- 
stance, deposited  under  the  form  of  yellowish  opaque  grains.  It 
grows  b)'  superposition.  2.  There  are  two  species  of  tubercles,  the 
simple  and  the  multiple;  the  latter  forms  by  the  aggregation  of 
several  simple  tubercles.  It  contains  organized  parts  within.  3. 
Granulations  are  a  form  of  chronic  pneumonia  :  they  do  not  pass 
into  tubercles.  4.  The  softening  of  a  tubercle  depends  on  the  action 
of  the  surrounding  living  parts.  5.  Simple  tubercle  never  softens 
from  the  centre  to  the  circumference.  6.  The  multiple  tubercle 
often  softens  from  the  centre  to  the  circumference.     7.  The   most 


1845.]         Various  opinions  respecting  Hooping  Cough,  597 


frequent  seat  of  tubercle  is  the  cellular  tissue.  Tubercle  is  some- 
times to  be  seen  in  the  lymphatic  vessels.  Tubercle  does  not  occur 
on  the  free  surface  of  mucous  membrane  so  long  as  it  is  entire.  8. 
Tubercles  are  often  hereditary.  9.  The  lymphatic  and  sanguineo- 
nervous  temperaments  are  predisposed  to  tubercles.  10.  Infants 
and  females  are  most  subject  to  tubercular  diseases.  11.  Inflamma- 
tion is  an  exciting  cause  of  tubercles.  12.  The  same  is  to  be  said 
of  passive  congestions,  of  over-activity  or  deficient  activity  of  an  or- 
gan,  and  probably  also  of  the  alterations  of  the  fluids.  13.  No  certain 
sign  of  the  rise  of  tubercles  is  known.  14.  The  hectic  fever  which 
occurs  in  tubercular  diseases  results  from  the  act  of  elimination. 

15.  To  prevent  the  tendency  to  tubercles,  we  must  counteract  the 
influence  of  hereditary  disposition,   of  temperament,  of  age,  of  sex. 

16.  In  persons  with  predisposition  to  tubercles,  inflammations  should 
be  guarded  against  with  the  greatest  care,  or  arrested  as  prompti}-  as 
possible.  17.  The  same  rules  apply  to  passive  congestions.  13. 
The  absorption  of  tubercles  is  very  probable.  19.  To  obtain  the 
cure  of  tuberculous  ulcerations  we  must  prevent  the  formation  of 
new  tubercles,  and  confine  the  work  of  elimination  within  certain 
limits.  20.  Tubercles  may  remain  long  in  the  organs  in  a  latent 
state:  to  obtain  this  result  we  must  seek  to  arrest  the  process  of 
elimination  by  antiphlogistic  means,  and  above  all  by  revulsives.  
From  Jf.  Lombard.  {Xorthern  Jour,  of  Med.)     Braithwaiie. 


VAKIOUS  0PIXI0^-S  EESPECTENG  HO0PI>-G-COrGH. 

Dr.  Waller  has  tried  belladonna  in  two  cases  of  hooping-cou^h, 
with  the  best  results.  He  gave  the  extract  in  a  twelfth  of  a  grain 
dose,  three  times  a-day,  to  a  child  four  years  of  age.  In  his  cases 
there  was  no  indication  of  the  presence  of  inflammation,  but  sim- 
ply the  spasmodic  cough.  Prussia  acid  and  conium  had  tailed  in 
affbrdin^I  any  permanent  or  marked  relief. 

Mr.  Crisp  views  the  disease  generally  as  inflammatory,  or  at  least 
congestive,  and  usually  finds  the  antiphlogistic  plan  the  best  treat- 
ment in  the  early  stages.  He  has  proved  prussic  acid  of  ser- 
vice only  for  a  day  or  two. 

Dr.  Willshire  has  treated  simple  uncomplicated  hooping-cough 
with  two  or  three  ipecacuanha  emetics,  one  every  alternate  mornino^, 
followed  for  two  or  three  days  with  nauseating  doses  of  antimony, 
and  has  found  this  plan  of  great  service  in  the  early  stages.  Co- 
nium and  ipecacuanha  were  afterwards  useful.  He  is  atVaid  to 
employ  belladonna,  as  some  have  found  that  it  has  a  tendency  to 
increase  vascular  action  in  the  brain,  and  to  produce  hydrocephalus. 

Dr.  Chowne  lays  particular  stress  on  the  necessity  of  keepinc^  the 
patient  in  a  warm  temperature,  and  using  every  means  to  prevent 
his  catching  cold.  Nauseating  doses  of  ipecacuanha  were  fre- 
quently of  benefit.  He  does  not  believe  that  emphysema  could  be 
produced  by  hooping-cough. 


5^  Effects  of  Conium  Maculatum  or  Hemlock.      [October, 


Dr.  Clutterbuck  looks  upon  hooping-cough  as  a  specific  disease, 
produced  by  a  specific  cause  an  inflammation  of  the  bronchial  mem- 
Israne  of  a  specific  character,  apt  to  induce  inflammation  of  other 
organs,  as  of  the  lungs  or  head,  and  these  complications  constitute 
the  character  of  hooping  cough.  He  has  little  confidence  in  any 
remedy  for  this  affection.  The  disease  should  be  narrowly  watch- 
ed, with  the  view  of  prevention  rather  than  of  active  treatment  ; 
if  mild,  it  would  terminate  spontaneously ;  if  it  tljreatened  the 
complications  alluded  to,  decided  antiphlogistic  means  were  de- 
manded. 

Dr.  Golding  Bird  regards  hooping-cough  in  the  first  stage,  as  inva- 
riably inflammation  of  the  lining  membrane  of  the  bronchial  tubes, 
larynx  and  trachea,  of  a  specific  character,  and  implicating  in  some 
peculiar  manner,  the  par  vagum.  This  inflammation  lasted  a  definite 
period,  which  was  influenced  by  constitution,  and  other  causes.  In 
the  second  stage  of  the  affection,  the  disease  was  nervous,  the  speci- 
fic irritation  of  the  par  vagum  being  kept  up,  altogether  independent 
of  inflammation;  or  if  this  were  present,  it  was  accidental;  the 
hooping  was  afterwards  protracted,  by  the  influence  of  habit.  In  the 
first  stage,  the  remedies  for  bronchitis  were  advisable  such  as 
emetics,  diaphoretics,  the  warm-bath,  and  a  warm  temperature. 
When  the  inflammatory  stage  was  passed,  the  object  of  the  practi- 
tioner was  to  subdue  irritation  in  the  par  vagum,  and  this  was  efl^ected 
by  the  agency  of  narcotics  such  as  conium,  in  conjunction  with  the 
carbonate  of  potash,  hemlock,  and  hydrocyanic  acid.  Embrocations 
to  the  spine  and  chest  were  also  useful.  When  bronchorrhcea  be- 
came troublesome,  small  doses  of  alum,  with  sedatives,  were  employ- 
ed with  advantage.  When  the  bronchoorhoea  had  ceased,  tonics 
were  indicated  the  kind  of  tonic  to  be  determined  by  the  constitu- 
tion of  the  patient.  Emphysema  does  not,  in  his  opinion,  occur  as 
the  consequence  of  hooping-cough. 

Dr.  T.  Thompson  has  found,  in  some  cases,  where  belladonna  was 
given,  that  the  poisonous,  rather  than  the  curative  effects  of  that 
remedy  developed  themselves,  even  though  the  doses  administered 
were  remarkably  small.  With  reference  to  the  irritation  of  the  par 
vagum  in  hooping-cough,  he  relates  a  case  in  which  this  nerve  had 
become  exposed,  from  the  formation  of  an  abscess,  or  other  cause ; 
and  it  was  remarkable,  that  when  the  nerve  was  in  contact  with  air, 
a  spasmodic  action  resembling  hooping-cough  was  produced  ;  when 
the  nerve  was  covered  over  by  a  cicatrix,  the  hooping-cough  ceased.. 

{Lancet,  and  Braithwaite.) 


Phiisiological  Effects  of  Conium  MacuJatum  or  Hemlock.  In  the 
July  No.  of  the  American  Journal  of  the  Medical  Sciences,  is  an 
Article  entitled  "  Experiments  to  determine  the  Physiological  eflTects 
of  Conium  Maculatum,  by  Pliny  Earle,  M.  D."  Dr.  E.  is  well  and 
favorably  known  to  the  profession  and  community,  as  Physician  to 


1845.]  Effects  of  Coniiun  Maciilaium  or  Hemlock,  599 


the  Bloomingdale  Asylum  for  the  Insane,  located  near  New- York 
city ;  and  he  has  contributed  largely  to  the  pages  of  the  valuable 
quarterly  just  mentioned.     In  the  Article  before  us,  he  says: 

"Theconium  maculatnm,  in  the  form  of  extract  or  inspissated 
juice,  is  somewhat  extensively  used  in  general  practice  ;  and,  being 
considered,  as  it  unquestionably  is,  a  narcotic,  is  not  unfrequently 
prescribed  as  a  soporific.  Having  for  several  years  been  accustom- 
ed  to  the  free  use  of  this  preparation  in  the  treatment  of  insanity, 
without  ever  procuring  sleep  as  its  effect,  even  in  doses  gradually 
raised  to  sixty,  eighty  and  ninety  grains,  three  times  in  the  day,  
and  having  not  long  since  heard  an  eminent  physician,  who  prescribes 
for  his  patients  'nearly  a  hundred  dollars  worth'  annually,  express  a 
doubt  that  this  extract  has  'any  medicinal  virtues  whatever,'  I  deter- 
mined to  asceitain,  by  self  experience,  the  nature  of  its  immediate 
effects  upon  the  human  system." 

Having  obtained  a  good  preparation,  he  commenced  his  experi- 
ments by  taking  on  the  1st  January  last,  1  gr.  coses  three  times  a-day. 
These  were  gradually  increased  every  day,  until  he  took  the  enor- 
mous dose  of  60  gis.  three  times  daily.  Indeed,  of  the  English 
preparation,  he  ventured  to  take  80,  90,  and  even  100  grs.  at  a  dose  
^  i.  e.,  in  the  course  of  some  twelve  or  fifteen  hours,  he  swallowed  270 
grs,  of  Cicuta. 

The  effects  were  negative  until  he  reached  25  grs.  taken  fasting, 
when  he  "  felt  a  disagreeable  sensation,  '  like  the  fulness  of  the  head,' 
occasioned  by  a  ligature  around  the  neck  ;  accompanied  by  a  very 
slight  vertigo."  The  two  subsequent  doses  on  this  day  (the  15th) 
were  unattended  by  these  effects.  30  grs.  the  next  day  produced 
symptoms  similar  to  those  of  yesterday  ;  40,  45,  50  and  60  gr.  doses 
gave  rise  to  sensations  of  fulness  of  the  head,  vertigo,  dimness  of 
sight,  dilated  pupils,  double  vision,  weariness  and  weakness  in  the 
limbs,  particularly  in  the  knees;  heat  in  the  gastric  region,  6cc.  In 
ten  minutes  after  taking  a  dose  of  60  grs.,  warmth  in  the  stomach 
was  perceived ;  in  15  minutes  the  cerebral  symptoms  commenced, 
and  in  about  half  an  hour  the  action  of  the  medicine  had  reached  its 
maximum.  In  less  than  two  hours,  the  apparent  effects  had  entirely 
disappeared.  Throughout  the  experiments,  the  sleep  seems  to  have 
been  natural,  appetite  good,  and  the  pulse  regular,  perhaps  a  littlo 
slower,  but  stronger  and  fuller.  The  effects,  as  might  be  expected> 
were  greater  when  tlie  medicine  was  taken  fasting. 


600       Anti-gastralgic  Pills  Dropsy  Cephalalgia^  ^c.  [October, 


'  Anti-gastralgic  Pills.  {Journal  des  Connaisances.)  M.  De  Larue 
asserts  that,  for  the  last  six  years  persons  laboring  under  truegastral- 
gia,  have  generally  found  prompt  relief  from  the  use  of  pills  made 
according  to  the  following  formula  : 

Extract  of  Opium, 30  cent.  (1^:  gr.) 

Sub-Sesqui-Carbonate  of  Iron,     ...     60    " 
Magnesia,        .........  120    " 

Gum  Syrup,  q.  s. 
Make  24  or  43  pills,  according  to  age,  individual  susceptibility,  &c. 
Give  one  two  hours  before  breakfast,  and  another  three  hours  after 
the  last  repast  in  the  evening.  They  should  be  administered  alone, 
or  associated  with  other  auxiliary  remedies,  and  taken  with  or  with- 
out interruption,  according  to  circumstances. 

They  accomplish  a  cure  most  commonly  in  a  month  or  six  weeks. 


Treatment  of  Chronic  Dropsy.  By  Dr.  Kerxee.  Journal  des 
Connaissances.  The  inhabitants  of  Weinsberg,  no  doubt  in  honor 
to  the  name  of  their  locality,  are  great  drinkers,  and  are  therefore 
very  frequently  hydropic.  When  their  anasarca  does  not  depend 
upon  any  organic  visceral  or  vascular  lesion.  Dr.  Kerner  effects  a 
prompt  cure  by  prescribing  a  decoction  of 

Digitalis  Purpurea, 2  gram.  (40 gr.) 

Root  of  the  Ononisspinosa, 4     " 

Senega  root, 6     " 

The  whole  acidulated  with  the  citrate  of  potassa.  This  diuretic 
formula  causes  a  rapid  disappearance  of  the  serous  swelling  of  the 
abdomen  and  feet. 

Treatment  of  Nervous  Cephalalgia.  ^lany  different  preparations 
have  been  proposed  to  combat  simple  nervous  head-ache ;  and  all 
practitioners  have  had  numerous  occasions  to  regret  the  failure  of 
these  different  means.  M.  Scheneider,  one  of  the  most  distinguished 
physicians  of  Germany,  recommends  the  administration,  either  in  the 
form  of  pill  or  potion,  the  alcoholic  Extract  of  Aconite  (aconitum 
napellus)  in  doses  of  ^  to  1  gr.  {Gaz.  des  Hopitaux,  Bulletin 
Gen.  de  Therapeutique.) 

Employment  of  Cochineal  in  the  treatment  of  Hooping  Cough.  
Durino- an  epidemic  of  hooping  cough  which  prevailed  with  measles 
last  winter  in  Berlin,  Dr.  Beunewitz  says  he  had  frequent  occasions 


1845.]  Cases  of  Burn  Amputation  of  the  Penis.  601 


to  satisfy  himself  of  the  therapeutic  efficacy  of  cochineal  in  the  first 
of  these  diseases.  Not  only  did  the  attack  sensibly  diminish  in 
force  and  frequency,  but  complete  restoration  was  often  effected  in 
at  least  fifteed  days.  After  previously  giving  an  emetic,  Dr.  B. 
prescribes  the  medicine  as  follows  : 

a.  Cochineal,  4  grammes  (about  4  3.) 

Salts  of  Tartar,  8  gram. 

Boiling  water  45  gram. 

Simple  Syrup,  30  gram. 
Mix.     Give  this  in  forty-eight  hours.     The  author  says  he  did  not 
succeed  by  this  preparation  in  the  treatment  of  the  cough  complica- 
ted with  the  measles.  (Casper^s  Hochensclirift^  et  Journal  de  Med,, 
1843.     Bulletin  Gen,  de  Therapeutique.) 


Treatment  in  Cases  of  Burn.  Dr.  Wm.  Jones,  of  Lutterworth, 
has  sent  to  us  for  publication,  the  following  fact :  About  twentyfivo 
years  since  I  was  called  to  a  young  lady  who  was  dreadfully  burnt 
on  the  thighs  and  abdomen.  It  appeared  to  us  a  hopeless  case.  It 
immediately  struck  me  that  the  administration  of  a  very  strong  opiate 
afforded  the  only  shadow  of  a  chance  for  the  patient.  That,  there- 
fore, I  immediately  gave  her.  A  tranquil  sleep  resulted.  When  its 
effects  went  off  I  repeated  it,  and  I  was  quite  surprised  not  only  to 
see  how  little  she  suffered,  but  how  kindly  the  burnt  parts  cicatrized 
and  healed.     I  have  always  used  it  with  great  advantage.  Lancet, 

This  treatment  has  been  successful  in  the  hands  of  others.  Edts. 


On  Amputation  of  the  Penis.  By  Robert  Barxes,  M.  D.  M. 
Ricord's  proceeding  is  this  :  having  performed  the  amputation,  with 
the  precaution  of  preserving  sufficient  skin,  and  no  more,  to  sheathe  the 
corpora  cavernosa,  and  secured  the  vessels,  the  surgeon  seizes  with 
the  forceps  the  mucous  membrane  of  the  urethra,  and  with  a  pair  of 
scissors  makes  four  slight  incisions,  so  as  to  form  four  equal  flaps ; 
then  using  a  fine  needle,  carrying  a  silk  ligature,  he  unites  each  flap 
to  the  skin  by  a  suture.  The  wound  unites  by  the  first  intention  ; 
adhesion  being  formed  between  the  skin  and  mucous  membrane, 
which  become  continuous,  a  condition  analogous  to  what  is  observed 
at  the  other  natural  outlets  of  the  body.  The  cicatrix  then  contrac- 
ting, instead  of  operating  prejudicially,  as  in  the  old  methods,  tends, 
on  the  contrary,  constantly  to  open  the  urethra,  whilst  a  perfect 
coveringis  provided  for  the  ends  of  the  corpora  cavernosa.  In  the 
spring  of  1843,  I  had  the  satisfaction  of  seeing  this  ingenious  opera- 
tion performed  by  M.  Ricord,  at  the  liopital  du  Midi ;  when  I  saw 
the  patient,  eight  days   afterwards,  the  sutures  had  been  removed, 


602  Excision  of  Urethra  Ulcers  on  the  Cornea.     [October, 


union  had  taken  place  between  the  skin  and  mucous  membrane,  and 
the  urine  had  freely  passed  without  the  intervention  of  a  catheter. 
I  saw  this  patient  again  when  he  was  about  to  leave  the  hospital,  at 
which  time  the  cicatrix  was  complete,  the  orifice  of  the  urethra  patent ; 
there  was  an  excellent  stump,  and,  in  short,  the  operation  appeared 
to  be  perfectly  successful.  M.  Ricord  has  performed  the  operation  in 
other  cases,  and,  he  reports,  with  the  same  happy  resultc.  I  have 
performed  the  operation  many  times  on  the  subject,  and  have  found 
no  difficulty  in  the  execution  of  it. 

Another  inconvenience  mentioned  by  Mr.  Hancock,  the  difficulty 
of  directing  the  stream  of  urine,  is  one  which  becomes  troublesome  in 
proportion  to  the  shortness  of  the  stump.  It  may  be  obviated  by  the 
contrivance  recommended  by  Ambrose  Pare.  The  patient  must  pro- 
vide  himself  with  a  funnel-shaped  canula,  made  of  box,  ivory,  or 
metal,  the  base  of  which,  being  applied  over  the  stump,  and  resting 
on  the  pubes,  the  other  end  will  serve  to  carry  the  urine  clear  of  the 
person.  London  Lancet. 


Excision  of  the  Urethra  performed  successfully  in  a  wowan. 
By  Prof.  RiBERi.  Archives  General es. 

In  this  case  there  vyas  a  cancerous  tumour  developed  in  the  walls 
and  existing  in  the  cavity  of  the  urethra  in  a  woman  of  60  years  of 
age  the  tumour  projected  towards  the  vagina,  whose  orifice  it 
diminished;  it  caused  almost  continual  pains  and  great  difficulty  in 
urination. 

M.  Riberi  made  an  antero-posterior  incision  on  each  side  of  the 
urethra,  in  the  vagina ;  then  he  dissected  on  each  side  of  it  so  as  to 
leave  the  tumour  adherent  only  by  the  neck  of  the  bladder.  Having 
reached  this  point  of  the  operation,  he  cut  circularly  in  front  of  the 
neck  of  the  bladder,  and  thus  removed  the  tumour.  Finally,  a  sound 
was  introduced  into  the  bladder,  through  the  very  small  portion  of 
the  urethra  which  remained,  and  the  haemorrhage  was  arrested  by  a 
tampon.  The  patient  was  cured,  and  what  is  important,  without 
incontinence  of  urine. 

The  author  believes  that  this  operation  is  unique  in  the  science, 
and  gives  a  more  advantageous  process  in  case  it  should  again 
become  necessary.  This  process  consists  in  placing  the  sound  in 
the  bladder,  before  the  excision  is  made,  and  in  slitting  the  urethra 
upon  that  instrument,  in  order  to  be  enabled  to  remove  the  tumour 
with  greater  facility. 


Treatment  of  Ulcers  on  the   Cornea  hy  occlusion  of  the  eye.  
M.  H.  Lasrey,  Professor  at  theVal-de-Grace  Hospital,  speaks  high- 


1 845.]       Camphor  to  a  Blister  Bile  Secale  Comutum.  603 


ly  of  a  mode  of  treatment  he  has  adopted  for  ulcers  on  the  cornea. 
He  places  on  the  eye  a  little  wad  of  cotton  maintained  by  adhesive 
strips  and  a  bandage.  At  the  end  of  ten  or  twelve  days,  the  con- 
junctivitis which  accompanied  the  ulcer  is  found  to  have  disappeared, 
and  the  latter  h&s  cicatrized  or  been  very  much  reduced  in  size. 

{Gazette  des  Hopitaux.     Bulletin  Gen.  de  Therapeutique.) 


To  apply  Camphor  to  a  Blister.  This  is  often  recommended  to 
prevent  strangury.  To  obviate  the  difficulty  in  powdering  the  cam- 
phor sufficiently  fine,  we  see  in  the  28th  vol.  of  the  Bulletin  General 
de  Therapeutique,  M.  Vei  proposes  a  saturated  solution  of  this  arti- 
cle in  ether.  Spreading  this  on  an  oily  or  greasy  rag,  the  camphor 
is  deposited  by  evaporation. 


Test  for  Bile^  by  M.  Pattexkoffer  {Lancet,  Oct.,  1844).  Add 
to  the  fluid  supposed  to  contain  bile,  concentrated  sulphuric  acid 
until  it  becomes  hot,  and  then  drop  into  it  a  solution  of  sugar ;  the 
presence  of  the  bile  is  manifested  by  the  mixture  becoming  of  a  deep 
pink,  or  red  color,  varying  in  intensity. 

Secale  Cornutiim,  its  therapeutic  action  by  M.  Payax.  Gazette 
Medicale  de  Paris,  June,  1845.  Since  Dr.  Olivier-Prescot  introdu- 
ced secale  cornutum  into  therapeutics,  numerous  researches  have 
been  made  upon  it.  For  a  long  time  it  was  regarded  only  as  an  ex- 
citant of  uterine  contractility,  and  even  this  specific  property  has 
been  sometimes  denied.  At  the  present  time  it  seems  to  be  admit- 
ted that  the  secale  cornutum  acts  not  only  upon  the  uterus,  but  also 
upon  the  rectum,  the  bladder  and  the  inferior  extremities,  whenever 
these  parts  are  in  an  asthenic  condition.  Its  therapeutic  effect  being 
thus  complex,  we  are  compelled  to  refer  its  action  to  some  organ 
which  has  the  power  of  acting  at  once  upon  all  these  parts.  Accord- 
ing to  M.  Payan,  the  spinal  marrow  is  the  organ  primarily  affected 
by  the  action  of  the  secale  cornutum,  and  this  opinion  of  the  direct 
influence  of  this  article  upon  the  spinal  marrow  is  supported  by  very 
ingenious  reasoning,  and  what  is  better,  by  very  interesting  cases. 
These  cases  place  beyond  doubt  the  efficacy  of  this  medicine  in  in- 
complete paralysis  of  the  bladder,  rectum  and  inferior  extremities  ; 
and  in  all  these  cases,  according  to  the  author,  the  excitation  is 
transmitted  bv  means  of  the  nerves  which  have  their  origin  in  the 
medulla  spinalis  or  of  the  plexuses  which  emanate  from  it. 


604        Amenorrhcea  Suicides  New  Medical  Journals,  [October, 


Treatment  of  Amenorrhcea.  Dr.  Chaumet,  of  Bordeaux,  pre- 
scribes the  following  enmanagogue  pill,  which  many  times  has  pro- 
duced the  happiest  effects : 

R.  Ext  of  Gentian,     ....       gr.  V.  ^ 

Aloes,       }  . .         ,    <      Mix. 

Calomel  J                               gr.  1   ^ 

Take  a  pill  thus  made  morning  and  evening.  To  aid  the  purgative 
effect  of  these  pills,  apply  mustard  and  hot  water  to  the  feet,  and  dry 
cupping  to  the  hypogastrium,  and  internal  parts  of  the  thighs.  {Bul- 
letin de  VAcad.  de  Med.     Bulletin  Gen.  de  Therapeuiique.) 


Return  of  Suicides  in  France,  during  the  year  1843.  According 
to  the  official  returns  made  for  1843,  there  were  3,020  suicides  in 
France  that  year.  The  Department  of  the  Seine,  of  which  Paris  is 
the  capital,  furnished  551,  or  nearly  a  fifth  of  the  whole  number. 
Submersion  or  drowning  was  the  mode  generally  resorted  to  1096 
individuals  had  recourse  to  this  means  954  to  strangulation  or  hang- 
ing 450  to  fire  arms  206  to  asphyxia  by  charcoal.  A  fourth  of 
the  suicides  did  not  possess  the  intellectual  faculties  entire.  Among 
the  number  were  729  females,  nearly  a  fourth  15  were  under  six- 
teen years  old,  20  octogenarians,  170  septuaginarians,  and  384  sexa- 
genarians. {Bulletin  General  de  Therapeuiique.) 


MEDICAL  INTELLIGENCE. 

New  Medical  Journals,  We  have  received  the  first  four  numbers  of  the 
Missouri  Medical  and  Surgical  Jmirnal,  a  new  periodical,  which  is  published  in 
St.  Louis,  under  the  editorial  management  of  R.  T.  Stephens,  M.  D.  These 
numbers  give  evidence  of  a  degree  of  enterprise  and  professional  ability  highly 
creditable  to  our  brethren  in  the  far  We^t.  The  Journal  is  published  in  month- 
ly numbers,  each  containing  24  pages.    Price  two  dollars  per  annum. 

We  have  also  received  the  four  numbers  of  The  Buffalo  Medical  Jmirnal,  a 
monthly  periodical  of  24  pages,  published  in  Buffalo,  N.  Y.,  and  edited  by  Austin 
Flint,  M.  D.  The  original  department  contains  a  number  of  useful  articles, 
and  affords  proof  that  there  is  in  that  section  "sufficient  material  to  commence 
an  enterprise  of  this  kind."  Although,  from  the  location  of  Buffalo,  this  Journal 
will  come  into  close  competition  with  some  of  the  older,  and  established  medical 
periodicals,  the  field  is  large  enough  for  many  laborers,  and  we  doubt  not  the 
ability  of  the  phj'sicians  of  Western  New- York,  to  perform  their  part,  in  the 
cultivation,  of  the  Medical  Sciences  and  establish  a  Journal  of  high  character. 


1845.]         Necrology  FortunCf  ^i-c.  New  Instrument,  605 


Our  valued  cotemporary,  the  Nao  Orleans  Medical  Journal,  comes  to  us  with 
a  new  name  The  Louisiana  Medical  and  Surgical  Journal,  and  with  the  addi- 
tion of  Profs.  Harrison  and  Carpenter  to  the  Editorial  department.  These 
changes  have  resulted  from  a  union  of  the  New  Orleans  Medical  Journal,  with 
a  projected  work,  under  the  direction  of  the  Professors  just  named.  We  doubt 
not  that  this  union  will  prove  highly  advantageous,  as  it  will  enlist  the  whole 
profession  in  that  section  in  its  support.  The  ability  with  which  this  Journal 
has  been  heretofore  conducted,  and  the  valuable  accession  to  its  Editorial  de- 
partment, which  it  has  just  received,  will  most  certainly  secure  for  it  an  exten- 
sive patronage.  We  most  cordially  wish  it  success.  The  work  is  published 
every  other  month,  in  numbers  containing  144  octavo  pages,  at  five  dollars  per 
annum,  payable  in  advance. 


Necrology.  The  death  of  M.  Breschet,  one  of  the  Professors  in  the  Faculty 
of  Medicine  at  Paris,  &c.,  &c.,  is  announced  in  the  French  Journals  as  having 
taken  place  on  the  Uth  of  last  May,  He  was  one  of  the  most  industrious  and 
honorable  of  the  Surgeons  in  the  French  Capital. 


The  fortune  let>  by  the  late  Dr.  Abercrombie  of  Edinburg,  was  SoO,000  to  each 
of  his  seven  daughters,  besides  a  considerable  sum  to  the  free  Church  of  Scotland, 
of  which  he  was  an  Elder.  His  family  presented  his  library,  consisting  of 
10,000  volumes,  to  the  Roval  Collesre  of  Surgreons  of  Edinburg. 


Ax  IXSTRUMEXT  DESIGXED  FOR  THE  PERMANEXT  CURE  OF  HeRXIA,  HyDARTHRO- 
SIS,    H'i'DROCELE,  GoiTRE,  ExCYSTED  TUMORS,  AXD  TO    DEPOSIT  MEDICIXES   IX   THE 

TISSUES  OF  THE  BODY.  From  the  favorable  opinion  expressed  by  a  few  friends 
in  regard  to  the  Instrument,  a  cut  of  which  may  be  seen  on  the  opposite  page,  I 
am  induced  to  offer  it  with  a  few  remarks  to  the  profession. 

It  is  known  that  for  the  past  eight  or  ten  years,  considerable  attention  has  been 
bestowed  on  the  subject  of  hernia.  That  the  interest  is  not  yet  exhausted,  and 
the  matter  still  subjudicc,  may  be  seen  by  the  following  question  proposed  for  the 
Boylston  medical  prize  for  1847  "Is  there  any  safe  and  certain  operation  for 
accomplishing  the  cm^e  of  common  reducible  inguinal  hernia  7" 

The  recent  investigations  upon  this  subject  have  resulted,  I  believe,  in  the 
pretty  general  adoption  of  some  modification  of  the  Truss,  first  proposed  by 
Stagner,  (Chase's  or  Landis's  for  instance,)  and  the  rejection  of  any  operation 
for  the  permanent  cure  of  hernia.  The  dread  of  peritonial  inflammation,  the 
occasional  success  ot  the  Truss,  and  the  affection  being  considered  simply  an 
inconvenience,  have  induced  great  caution  in  the  adoption  of  an  operation  not 
absolutely  required.  While  a  properly  adapted  apparatus  is  the  correct  treat- 
ment for  rupture  in  children,  and  sometimes  relieves  the  adult,  still  we  can  with 
no  certaint)^  promise  a  cure  by  it  in  the  latter.  To  effect  this  we  must  resort  to 
other  means. 

That  even  reducible  hernia  is  something  more  than  an  inconvenience  to  pa- 
tients, and  that  the  Truss  is  but  a  palliative  treatment,  the  many  suggestions 
made,  and  operations  proposed  within  the  few  past  years,  sufficiently  attest. 
Some  of  these  are,  (Belmas.)  by  bladders  of  gold-beater's  skin,  sticks  of  gelatin, 
&c.,  deposited  in  the  sac;  (Gerdy.)  by  invaginating  the  skin  and  stitching  il 


606 


New  InsirumenU 


[October, 


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H 

a 
w 

H 

CO 

W 

o 
o 

I 

p^ 

H 

;z: 


d) 


^     ^ 


a 


^       i5 

       CO  ^ 


^  ^  >      b 

J3      O  ^      ''^ 

S    g  o    '-' 

o  ^  o 

O  H  ^ 


1845.]  New  Instrument.  607 


about  the  neck  of  the  hernial  sac ;  (Guerin  and  Velpeau,)  by  subcutaneous  in- 
cisions and  scarifications  of  the  neck  of  the  sac;  (Bonnet,)  with  pins  and  rolls 
of  linen;  (Jameson,)  by  incision  and  intrusion  of  a  piece  of  integument  into 
the  ring  and  retaining  it  by  sutures;  (Stith,)  incision  and  insertion  into  the  sac 
of  a  piece  of  kid  or  buck  skin  softened  in  mucilage ;  (Pancoast,)  by  trocar  and 
injected  fluid.  Of  these  means,  that  by  injection,  from  the  uniform  success  ex- 
perienced by  it  in  hydrocele,  would  seem  to  merit  most  favor  the  objection  to- 
the  operation  being  the  want  of  a  suitable  instrument,  for  Prof.  Pancoast  used  a; 
trocar,  canula  and  syringe. 

Having  been  recently  consulted  by  a  physician,  who  had  been  under  the  pro- 
fessional care  of  Professors  Dudley  and  Geddings,  and  who  was  read)*,  as  he 
stated,  to  submit  to  any  operation,  I  had  concluded  to  propose  to  him  incision  of 
the  sac.  A  few  days  after  this,  Dr.  Wozencraft,  of  Nashville,  Tenn.,  called, 
and  exhibited  a  small  syringe,  invented  and  patented  for  the  cure  of  hernia,  by 
a  Dr.  Ja)'nes,  formerly  of  Virginia,  but  now  of  Missouri.  This  instrument  is^ 
simply  the  upper  part  of  a  common  silver  pencil  case,  having  a  piston  adapted 
to  one  end,  and  the  other  terminated  in  a  gold  pointed  canula.  An  eye  or 
opening  near  the  point,  allows  the  fluid  to  be  injected  into  the  sac  after  the  her- 
nia is  reduced.  Dr.  W.  prefers  oil  of  cloves,  from  three  to  six  drops  is  the 
quantity  generally  introduced,  and  he  says  that  though  hundreds  of  cases  have 
been  operated  upon  by  the  inventor  and  his  agents,  still  no  unpleasant  conse- 
(juences  have  followed.  The  operation  requires  repetition  in  some  instances, 
and  he  also  acknowledges  that  the  spermatic  cord  has  been  punctured.  His 
case  operated  on  here,  is  doing  well,  and  promises  success ;  and  so  is  the  one 
upon  which  I  have  operated. 

As  a  substitute  for  the  patented  Instrument,  the  one  represented  by  the  cut  is 
suggested,  and  it  may  have  some  advantages  over  it. 

1st.  Not  being  patented,  it  may  be  used  by  every  ph5'sician. 

2d.  The  point  being  moveable,  there  will  be  no  danger  of  wounding  other 
parts,  in  ascertaining  when  the  canula  is  in  the  hernial  sac. 

3d.  The  S}Tinge  being  of  glass,  the  action  of  the  piston  upon  fluids,  either  in 
injecting  or  withdrawing  them,  can  be  seen. 

4th.  It  may  be  employed  as  an  exploring  needle,  to  ascertain  the  contents  of 
tumors,  &c. 

5th.  The  canula  opens  at  the  extremity  and  not  at  the  side  of  the  instrument. 

6th.  In  its  application  to  various  affections.  In  h)-drocele,  for  example,  a 
puncture  having  failed  to  cure  the  patient,  as  soon  as  a  re-accumulation  com- 
mences, half-a-drachm  of  tinct.  iodine  may  be  injected.  I  believe  the  very  last 
suggestion  for  this  affection,  was  to  pencil  the  timica  vaginals  through  the  canula 
of  a  trocar  with  this  article. 

Operation  v:ith  the  Instrument.  Fill  the  s}-ringe  with  the  injecting  fluid,  by 
withdramng  the  piston.  Project  the  point  of  the  steel  stilet  beyond  the  gold 
canula,  and  fix  it  by  the  thumb-screw  in  the  handle,  or  ring  of  the  piston. 
Place  the  patient  in  the  horizontal  position,  reduce  the  hernia  for  instance,  then 
with  the  fore-finger  of  the  left  hand  invaginate  the  skin  of  the  scrotum  and 
spermatic  cord  into  the  abdominal  canal.  The  instrument  held  as  a  writing 
pen,  in  the  right  hand,  is  introduced  from  above  downwards  upon  the  tip  of  the 
left  fore-finger.    The  stilet  is  now  withdrawn,  the  canula  ascertained  to  be  in 


608 


Meteorological  Table*  Errata' 


the  sac,  and  the  pistoi^ushed  home  into  the  syringe.  A  Truss  ought  previously 
to  be  well  fitted  to  the  internal  ring.  The  patient  should  be  confined  for  a  day  or 
two,  and  the  Truss  unremittingly  worn  for  a  month.  The  fluid  I  should  select 
is  diluted  tinct.  iodine,  and  the  quantity,  which  of  course  must  vary,  about  3ss. 

The  new  principle,4jf  indeed  it  be  novel,  is  simply  the  union  of  the  syringe 
and  trocar  in  the  above  described  instrument. 

Since  the  above  was  devised.  Dr.  A.  L.  Hammond  of  this  city,  one  of  our 
recent  graduates,  has' suggested  the  addition  of  a  spiral  spring  to  the  stilet,  by 
which  after  the  introduction  of  the  canula,  it  is  withdrawn,  and  the  piston  at 
once  pushed  down  in  the  syringe.  Paul  F.  Eve. 


METEOROLOGICAL  OBSERVATIONS,  for  August,  1845,  at  Augusta,  Ga. 
Latitude  33  27'  north  Longitude  4  32'  west  Wash.  Altitude  above  tide 
152  feet. 


> 
c 
a 

Thermometer. 
Sunrise.    4,  p.  m. 

Barometer. 
Sun  rise.       4,  p.  m. 

Wind. 

Remarks. 

1 

64 

90 

29  74-100 

29  80-100 

S.    E. 

Variable rain  at  10,  p.  m. 

2 

73 

82 

"  88-100 

"  87-100 

N.  E. 

Cloudy.      [sprinkle  to-day. 

3 

65 

74 

'  85-100 

"  80-100 

E. 

Cloudy-^rain  last  night- 

4 

64 

75 

"  85-100 

"  85-100 

E. 

Cloud)- sprinkle. 

5 

65 

72 

"  79-100 

''  79-100 

N. 

Cloudy sprinkle. 

6 

65 

84 

"  79-100 

"  79-100 

N.  W. 

Fair. 

7 

64 

90 

"  80-100 

"  80-100 

S.  E. 

Fair breeze. 

8 

69 

90 

"  82-100 

"  82-100 

S.  E. 

Fair,      do. 

9 

70 

89 

"  82-100 

"  82-100 

S.    E. 

Variable  a  few  drops  rain. 

10 

73 

92 

"  82-100 

"  75-100 

W. 

Fair Blow  at  night. 

11 

73 

88 

"  70-100 

"  62-100 

w. 

Cloudy blow  at  4,  p.  m. 

12 

70 

93 

"  64-100 

"  68-100 

w. 

Cloudy. 

13 

70 

90 

"  78-100 

"  74-100 

S.  E. 

Showery. 

14 

71 

92 

"  80-100 

"  76-100 

w. 

Fair. 

15 

72 

95 

"  76-100 

"  70-100 

s,  w. 

Fair. 

16 

73 

96 

"  76-100 

"  73-100 

w. 

Fair breeze. 

17 

72 

85 

  76-100 

"  70-100 

w. 

Cloudy thund.  &  light. 

18 

72 

92 

"  74-100 

"  68-100 

w. 

Fair breeze. 

19 

72 

94 

"  77-100 

"  67-100 

N.W. 

Fair  breeze. 

20 

72 

90 

"  68-100 

"  06-100 

N. 

Light  .shower. 

21 

70 

86 

"  66-100 

"  62-100 

S.  W. 

Shower. 

22 

68 

90 

"  68-100 

"  67-100 

N.  E.&S. 

Fair. 

23 

70 

78 

"  78-100 

"      -100 

S.  W. 

Showery thund.  &  light. 

24 

70 

90 

"  81-100 

''  78-100 

W.  &  E. 

Fair thunder  &  lightning. 

25 

72' 

88 

"  81-100 

"  75-100 

S.  E. 

Rain th.  &  light,  at  3,  p.  m. 

26 

70 

83 

"  83-100 

"  75-100 

S. 

Do.            do. 

27 

70 

85 

"  75-100 

"  73-100 

S. 

Cloud}-  light  shower. 

28 

70 

85 

"  79-100 

"  73-100 

S.  W. 

Do.  "      do.    do.  [to-day. 
Cl'v  rain  last  night  sprk. 

29 

70 

76 

"  81-100 

''  80-100 

S,  E. 

30 

70 

80 

"  80-100 

"  74-100 

S.E. 

Cldudy sprinkle. 

31 

70 

88 

"  75-100 

"  75-100 

S. 

Fair. 

12  Fair  days.    Cluantity  of  Rain,  3  inches  and  4^-10 


ERRATA   Notwithstanding  all  our  care,several  errors,  we  regret,  have  been  detected 
in  the  1st  Article  of  this  No. 

On  page  550,  14th  line  from  top,  read  equable  for  acrreeablc 

"      "      551,    9lh     "      "      hottoTT,  read  nmtsiwl  for  annual. 

"      "      553,    ."^rd    "       "      bottom,  i-ead  1S24  for  1844. 

"      "       555,  lOth    "      "      top,  read  casex  for  causes. 

"  "  560,  4th  and  5th  line?,  put  period  after  the  word  diei change  semi-colon  to 
comma,  after  the  word  aid,  and  efface  the  word  and  before  rarely. 

On  page  567,  read  procvmhens  for  punctatum. 

We  are  responsible  for  the  translation  of  the  Greek  and  German  of  this  Article. 


SOUTHERN 

MEDICAL  AND  SURGICAL 

JOURNAL. 

Vol.  L]  NEW  SERIES NOVEMBER,  1815.  [No.  11. 

PART  I. ORIGINAL  COMMUNICATIONS. 

ARTICLE    I. 

Case  of  Tetanus^    continuing  tJiirfy-four  d ay S'^ Recovery.  With 
Remarks,     By  J.  P.  Stevens,  M.  J).,  of  Liberty  County^  Ga, 

On  the  6th  April,  I  was  called  to  see  Fanny,  a  negro  girl,  about 
eight  years  of  age,  who,  for  about  twelve  hours  previous  to  my  visit, 
had  been  suffering  from  slight  paroxysmal  attacks  of  pain,  and  con- 
traction of  the  muscles  of  her  abdomen  and  back.  Her  eyes  were 
natural  and  bright;  respiration  easy ;  no  fever;  tongue  a  little  red 
at  the  edges,  with  a  whitish  fur  in  the  centre ;  slight  pain  in  her 
bowels,  and  a  moderate  contraction  of  the  dorsal  muscles ;  bowels 
torpid. 

Prescription.  Apply  sinapisms  to  her  extremities,  and  to  the 
whole  length  of  her  spine;    ii  castor  oil. 

April  7th.  Fanny's  condition  this  morning  is  evidently  worse  in 
every  respect.  The  muscles  of  her  back  are  rigidly  and  permanent- 
ly  contracted,  causing  her  body  to  assume  a  semilunar  form  ;  deglu- 
tition is  almost  impossible  ;  at  intervals  of  fifteen  minutes  there  is 
forcible  contraction  of  all  the  muscles  of  her  body  ;  the  angles  of 
her  mouth  are  violently  retracted,  causing  that  peculiar  aspect  of 
countenance  indicated  by  the  term  risus  eardonicus ;  her  teeth  are 
firmly  set ;  the  muscles  of  her  abdomen  are  as  hard  and  resisting  as 
a  hoard,  and  her  extremities  are  firmly  flexed.  When  interrogated 
with  regard  to  pffin,  she  refers  us  to  the  umbilical  and  epigastric 
regions.     This  state  of  things  continues  for  about  a  minute  or  two, 

39 


610  Case  of  Tetanus,  [November, 


when  there  is  comimrative  relaxation  of  the  muscles  concerned  in 
deglution,  as  well  as  those  of  the  abdomen  and  extremities.  Daring 
the  paroxysms,  a  profuse  perspiration  bathes  the  cutaneous  surface. 
Oil  operated  twice ;  skin  of  natural  temperature  ;  pulse  90  ;  respi- 
ration 30.  Pres  Tinct.  camphor,  tinct.  opii.,  aa  20  gtt. 

4,  P.  M.     No  change. 

R.   Calomel,  1 

Nitr.  potass,  aa  20  grs.  ^      M. 
Opium,  2    "     ) 

Divide  into  two  parts,  and  give  at  an  interval  of  two  hours.  Epispas- 
tic  three  inches  wide,   to  be  applied  from  the  occiput  to  the  sacrum. 

April  8th.  Powders  operated  copiously,  bringing  away  one  large 
lumbricus;  blister  drew  well.  Pres.  Tinct.  camphor,  5i. ;  tinct, 
opii.  5ss.  In  the  afternoon,  10  grs.  calomel ;  and  25  gtt.  laudanum, 
to  be  taken  at  night. 

April  9th.  No  change  in  symptoms;  bowels  moved  with  assist- 
ance of  an  enema.   Pres.  Turpentine  enemata,  at  intervals  of  two 
hours  ;  sponge  the  body  with  hot  brandy  and  vinegar. 

April  10th.  Bowels  evacuated  of  a  very  black  offensive  matter; 
blister  upon  the  spine  still  continues  sore ;  spasms  recur  much  less 
frequently.  Pres.  r'x.  castor  oil,  sinnpisms  to  extremities  ;  10  grs. 
Dcver's  powder,  morning,  noon,  and  evening. 

April  11.  Slept  well  during  the  whole  night,  spasmodic  pains 
recur  but  seldom  ;  skin  moist ;  pulse  108  ;  thirst  moderate  ;  abdo- 
men soft,  but  bowels  not  moved  by  oil ;  lying  upon  her  hack.  
Pres,  Castor  oil,  i. ;  oilterebin.  5ss.    Mustard  poultice  to  abdomen. 

April  12th.  From  this  time,  her  master.  Dr.  Jos.  Le  Conte, 
visited  her  regularly  with  me.  Since  last  report,  Fanny  has  passed 
three  worms. 

There  is  st'iW  co?isf ant  rigidity  of  tne  dorsafi  muscles,  and  general 
spasms  occur  four  or  five  times  during  the  morning,  which  are  pro- 
voked by  the  slightest  foiicJi  or  menial  emotion.  Pres,  Decoction 
spigalia  ;  blister  to  thighs. 

April  13.  Rigidity  of  muscles  of  lower  jaw  so  great  as  to  preclude 
the  admission  of  any  liquid.  Spasms  more  frequent ;  pulse  108  ; 
skin  natural.  Pres.  Tinct.  opii.  5i. ;  frictions  over  the  spine  with 
turpentine  and  tinct.  cantharides ;  10  grs.  calomel,  to  be  divided 
into  two  parts  take  them  at  an  interval  of  two  hours. 

April  14.  Bowels  moved  three  times  ;  the  first  very  dark  and 
offensive  ;  voided  two  worms.  Spasms  frequent,  but  of  transient 
duration. 


1845.]  Case  of  Tetanus,  611 


April  15th.  Countenance  much  better;  indications  more  favora- 
ble. Pres.   5ss.  turpentine,   ^i  castor  oil ;  re-apply  blister  to  spine. 

As  it  is  unnecessary  for  me  to  continue  a  narration  of  the  symp- 
toms and  treatment  of  this  protracted  case,  I  will  only  remark,  that 
anthelmintics,  derivatives  to  the  spine,  and  opiates,  were  continued 
with  very  decided  advanta^^e.  Five  worms  were  brought  away 
simultaneously,  soon  after  which,  her  countenance  assumed  a  calm 
and  natural  aspect  ;  all  the  secretory  functions  of  the  economy  were 
discharged  normally  ;  the  respiration  and  circulation  perfectly  natu- 
ral, but  spasmodic  movements  of  the  abdominal,  dorsal,  and  the 
muscles  employed  in  dio;lution,  recurred  at  regular  intervals,  the 
attacks  of  each  succeeding  day  diminishing  in  force  and  frequency, 
until  they  finally  ceased  entirely. 

During  the  last  two  or  three  days  of  our  visits,  we  prescribed 
36  grs.  sulp.  quinine,  divided  into  six  parts,  one  of  which  was  ad- 
ministered every  fourth  hour,  but  we  did  not  observe  any  very  marked 
benefit  to  follow  its  employment.  The  warm  bath,  which  is  always 
a  valuable  adjuvant  in  spasmodic  diseases,  could  not  be  employed, 
save  in  the  recumbent  posture  ;  and  as  the  facilities  for  making  use 
of  such  remedies  are  rather  meagre  upon  a  j)JantaHon,  we  were  com- 
pelled to  defer  its  trial  until  the  patient  could  tolerate  the  erect 
posture. 

On  the  10th  May,  I  see  noted,  that  "  Fanny  is  this  morning  sitting 
up  alone ;  muscular  contractions  have  ceased,  with  the  exception  of 
occasional  twitches  during  the  day."  She  is  at  this  date,  Aug  15th, 
perfectly  well. 

Remarks.  There  is  perhaps  no  disease  to  which  the  human 
frame  is  subjected  more  to  be  dreaded,  not  only  from  the  excrutiating 
agony  which  is  endured  by  its  victims,  but  the  almost  certain  fatali- 
ty  which  marks  the  progress  of  tetanus.  It  heeds  not  the  tenderest 
sympathies  of  our  nature,  and  has  persisted  invincible  against  the 
united  power  of  the  most  gigantic  intellects,  from  the  time  of  Hippo- 
crates, down  to  the  present  day.  Another  feature  which  mantles  it 
with  horror,  is  the  extremely  trivial  nature  of  the  cause  which  often 
induces  its  attacks.  Lacerated  and  punctured  wounds,  principally 
of  the  extremities,  of  tendons  and  ligaments,  may  be  classed  amom^ 
the  m(jst  ordinary  causes  of  the  disease.  "  Tetanus  has  been 
occasioned  by  a  bite  on  the  finger  from  a  tame  sparrow,  the 
siroko  of  a   whip-la^h    under   the   eye,   although   the  skin   was  not 


612  Case  cf  Tetanus.  [November, 


broken,  a  fish  bone  sticking  in  the  pharynx,  a  seton  in  the  chest,  the 
stroke  of  a  cane  on  the  neck  and  hand,  flagellation,  extraction  of 
a  tooth,  Clipping  and  venesection,  <k;c.,  &;c.  It  has  also  followed 
severe  fractures,  lacerations,  contusions,  punctures,  amputations, 
excision  of  the  mamma,  tying  arteries,  gunshot  wounds,  castration, 
injection  for  hydrocele,  (fee,  &;c.  (J.  H.  Bennet.  Tweedie's  Li- 
hrary  of  Pract.  Medicine,  p.  71.) 

The  case  which  we  have  just  reported,  was  doubtless  occasioned 
by  the  irritation  of  worms  in  the  alimentary  canal.  Although,  during 
the  whole  course  of  the  disease,  there  were  but  eleven  worms  dis- 
charged, still  at  every  evacuation  of  these  troublesome  parasites,  a 
manifest  improvement  in  the  general  symptoms  supervened.  Many 
writers  regard  worms  as  almost  the  only  cause  of  tetanus.  How 
often  it  is,  that  almost  incredihle  numbers  of  them  have  been  voided 
without  previously  having  excited  little  or  any  constitutional  disturb- 
ance.  I  was  informed,  not  long  since,  of  an  instance  which  occur- 
red in  this  county,  where  a  little  negro  passed,  per  rectum,  upwards 
of  seven  hundred  worms,  in  {\^q  course  of  two  days,  without  having 
suffered  any  inconvenience,  with  the  exception  of  a  moderate  pain  in 
the  bowels  !  Any  irritating  substances  in  the  stomach  and  intestines, 
such  as  indigestible  articles  of  diet,  indurated  fasces,  &;c.,  are  not 
unfrcquently  exciting  causes  of  tetanus.  I  recollect  in  the  practice 
of  Dr.  B.  B.  King,  six  years  since,  of  having  seen  a  case  terminate 
fatally,  from  intussusception.  The  subject  was  a  negro  boy,  about 
9  years  of  age,  who  was  attacked  in  the  morning  while  pursuing  his 
usual  routine  of  labor ;  and  notwithstanding  a  most  energetic  and 
judicious  course  of  treatment  was  vigorously  pursued,  he  died  in  the 
course  of  twenty-four  hours.  Constipation  of  the  bowels  was  an 
insuperable  obstacle  in  the  management  of  his  case,  and  upon  post- 
mortem examination,  the  doctor  discovered  an  intussusception  of 
about  three  inches  of  the  ileum.  There  Mas  no  wound  or  external 
injury  discovered  upon  any  part  of  the  body,  save  a  superficial  abra- 
sion of  the  cuticle,  of  about  three  lines  in  length,  which  did  not,  at 
that  time,  or  previously,  excite  any  attention. 

Vicissitudes  of  temperature  are  among  the  most  common  causes 
of  the  idiopathic  form  of  this  disease.  Sudden  alternations  from  heat 
to  cold,  exposure  to  rapid  currents  of  air,  while  in  a  perspiration, 
have  induced  its  attacks.  A  ^e\Y  weeks  since,  a  gentleman  informed 
m\\  that  his  father  lost  a  negro  woman  who  had  aborted  in  about 
the  sixth  monlh  of  her   pregnancy,  and   was  doing  very  well,  v/hen 


1845.]  Case  of  Tetanus.  613 


"  she  took  cold,"  a  tetanus  supervened.  The  first  case  of  tetanus 
which  Dr.  Dunglison  ever  observed,  was  caused  by  a  suppression  of 
perspiration.  "A  young  man,  when  in  a  profuse  perspiration,  went 
into  a  river  to  bathe.  He  was  immediately  struck  with  tetanus, 
from  which,  however,  he  recovered."  (Dunglison^s  Pract.  Physic^ 
vol.  2,  p.  329.)  Dr.  Chalmers  gives  an  instance,  where  it  was 
brought  on  by  sudden  change  of  weather,  in  a  man  who  slept  without 
his  night-cap. 

A  high  degree  of  temperature  is  said  to  predispose  to  this  disease  ; 
hence  the  extreme  liability  of  the  system  to  its  attacks,  when  a  very 
hot  season  is  followed  by  much  cold  and  wet  weather.  "  Thus  it  is 
stated,  that  after  the  battle  of  Muskow,  in  the  midst  of  great  heats, 
very  few  of  the  French  troops  were  attacked  with  tetanus  :  vvhereas, 
those  who  were  wounded  in  the  battle  of  Dresden,  when  the  weather 
was  cold  and  wet,  just  after  a  very  hot  season,  were  decimated  by 
that  complaint."  (Watson's  Pract.  of  Physic,  p.  311.)  I  think 
we  may  venture  the  opinion,  that  negroes  are  much  more  liable  to 
this  complaint  than  whites.  This  fact  may,  in  a  measure,  be  attribu- 
ted to  the  frequent  exposures  to  which  they  are  subjected,  not  only 
to  changes  in  the  weather,  but  irregularities  in  diet,  and  bodily 
wounds  which  are  accidentally  received. 

The  j^athology  of  tetanus  is  involved  in  some  obscurity,  although, 
from  searching  into  the  results  of  the  post-mortem  observations  of 
others,  I  am  inclined  to  the  belief,  that  the  spinal  marrow  and  its 
afferent  nerves  may  be  regarded  as  the  seat  of  this  disease.  Inflam- 
maiion  of  the  spinal  chord,  and  its  nerves,  is  not  discovered  in  every 
case,  but  the  phenomena  observed  during  life,  refer  to  derangement 
of  the  excito-moiory  division  of  the  nervous  system.  The  intellect 
is  unclouded  during  the  whole  progress  of  this  malady.  Conscious- 
ness of  danger,  and  a  perfect  knowledge  of  surrounding  objects  and 
circumstances,  render  the  condition  of  the  patient  peculiarly  deplora- 
ble. He  feels  the  omnipotent  grasp  of  the  monster,  and  is  fully 
aware  of  his  almost  inevitable  dissolution. 

Dr.  Marshall  Hall,  in  his  work  upon  the  nerves,  p.  57,  declares  his 
belief,  that  the  whole  order  of  spasmodic  and  convulsive  diseases  be- 
longs to  this,  the  true  spinal,  or  excito-motory  division  of  the  nervous 
system,  and  that  they  cannot  be  understood  without  a  previous  accu- 
rate knowledge  of  this  system.  His  experiments,  showing  the  inde- 
pendent action  of  the  spinal  marrow  and  its  nerves,  in  the  production 
of  certain  phenomena,  are  highly  interesting.     After  decapitation, 


614  Case  of  Tetanus,  [November, 


and  otherwise  removing  the  influence  of  the  brain,  certain  muscular 
movements  were  provoked  by  the  application  of  appropriate  irritants, 
which  he  found  impossible  to  accomplish,  when  the  spinal  medulla 
was  destroyed.  Upon  severing  the  head  of  a  turtle,  and  exposing 
the  spina!  nerves,  and  pinching  one  of  them  with  the  forceps,  violent 
contraction  of  the  muscles  ensued,  not  only  of  the  parts  supplied  by 
the  irritated  nerves,  but  of  those  situated  above  and  below  this  point 
of  junction  with  the  chord.  He  proposes  to  divide  tetanus  into  cen- 
tric and  eccentric.  When  the  irritating  cause  affects  the  parts  within 
the  spinal  canal,  he  denominates  it  centric ;  a  punctured  nerve, 
lacerated  wound,  or  other  injury,  produces  eccentric  tetanus.  When 
we  observe  the  spinal  marrow  inflamed,  with  the  co-existence  of 
tetanic  spasms,  we  refer  the  phenomena  to  centric  irritation  ;  when 
intestinal  irritation,  and  injuries  of  any  kind,  are  tbUowed  by  spasmo- 
dic contractions,  even  though  upon  post-mortem  examination  no 
decided  evidence  of  pre'existing  wjlammalion  can  be  discovered,  we 
fairly  ascribe  the  symptoms  to  eccentric  irritation. 

Dr.  Gerhard  declares,  that  he  has  examined  "the  brain  and  spinal 
^narrov/  of  tenor  twelve  subjects  dead  of  tetanus,  and  could  not  dis- 
cover any  traces  of  organic  lesion  ;  no  softening  of  the  spine,  or 
inflammatory  congestion,  beyond  what  is  discovered  in  bodies  where 
no  spinal  symptoms  evinced  themselves  before  death."  But  admit- 
ting^ the  accuracy  of  his  observations  does  not  disprove  the  previous 
existence  of  a  high  grade  of  irritation.  How  often  do  post-mortem 
researches  reveal  the  entire  absence  of  any  morbid  lesion  of  structure, 
where,  during  the  life  of  the  patient,  we  were  certain  of  a  high  de- 
gree of  abnormal  action.  But  let  us  refer  to  the  testimony  of  others. 
"  The  spinal  chord  usually  evinces  manifest  congestion,  both  in  itself 
and  its  membranes  ;  more  especially  at  {\\q  origin  of  the  nerves,  and 
the  amount  of  the  serum  is  preternaturally  and  considerably  increas- 
ed. In  the  traumatic  form,  it  is  in  the  nerves  of  the  part  that  inflam- 
matory change  is  to  be  locjked  for  not  in  the  spinal  chord ;  for 
the  disease  is  to  be  regarded  as  an  extreme  example  of  irritation  in 
the  whole  spinal  system,  induced  by  inflammatory  products  in  some 
portion  of  its  sy^iem. {Miller's  Principles  of  Surgery,  p.  474.) 
Alterations  in  the  spinal  chord  and  its  membranes,  are  by  far  the 
most  common  appearances  found  in  tetanus,  and  in  such  caSes  there 
have  generally  been  traces  of  spinal  meningitis.  These  instances 
are  too  numerous  to  be  spoken  of  individually.  Several  have  been  re- 
corded by  Reid,  Kennedy,  Brayue,  and  others,  in  Britain  ;  Larrey, 


1345.]  Case  of  Tetanus.  615 


Broussais,  Magendie,  Recamier,  Ollivier,  and  others,  in  France; 
Bergamaschi,  Brera,  Bellingeri,  Uralli,  Poggi,  in  Itally ;  and  Frank, 
Funk,  &c.,  in  Germany.  In  some  cases,  the  inflammatory  appear- 
ances were  more  or  less  diffused  over  the  spinal  chord  ;  and  in  others, 
recorded  by  Ollivier,  Pclletier  and  Curling,  they  were  limited  to  par- 
ticular portions  of  it.  (J.  II.  Bennet.)  Tetanus  is  evidently  depen- 
dent  upon  a  state  of  undue  excitability  of  the  whole  spinal  system, 
and  this  may  be  produced  by  different  causes.  That  which  is  terra- 
ed  the  idiopathic  form  of  the  disease,  has  its  origin  in  the  centres ; 
it  may  result  in  man  from  the  operation  of  various  predisposing  and 
exciting  causes,  and  may  be  produced  in  animals  by  the  operation  of 
strychnine.  (Carpenter's  Human  Physiology^  p.  217.)  In  an  in- 
teresting case  of  tetanus,  given  by  Dr.  Reid,  in  the  Transactions  of 
the  Association  of  Physicians  in  Ireland,  vol.  1,  p.  113,  great  vascu- 
larity, and  an  effusion  of  blood,  were  found  around  the  spinal  mar- 
row. In  another  case,  detailed  by  Mr.  Brayne,  of  Banbury,  in  the 
London  Medical  Repository,  vol.  14,  p.  1,  two  or  three  inches  of  the 
inferior  dorsal  portion  of  the  spinal  marrow  were  suffused  by  a  con- 
tinuous blush  of  inflammation,  and  three  small,  white,  hard  laminae 
were  seen  between  the  aracnoid  and  pia  mater.  (Hall,  on  the  Nerves^ 
p.  214.)  *  Here  then  we  have  the  evidence  of  some  of  the  most  dis- 
tinguished pathologists  and  physiologists  ia  confirmation  of  the 
pathological  views  which  we  entertain.  If  they  be  correct,  the 
indications  of  treatment  are  obvious.  It  was  the  opinion  of  Hippo- 
crates, that  tetanus  supervening  upon  a  wound  is  mortal,  and  statis- 
tical records  of  the  present  day  lead  us  to  infer,  that  the  number  of 
those  who  die  from  its  attacks  is  incomparably  greater  than  those 
who  survive.  Of  two  hundred  cases  of  tetanus  which  came  under  the 
observation  of  Dr.  O'Beirne,  not  one  recovered.  Sir  J.  McGregor 
saw  several  hundred  cases,  and  but  very  few  recoveries.  Sir  G. 
Blane  mentions  that  three  out  of  twenty  recovered  that  occurred  in 
the  West  Indies,  after  the  battle  of  April,  1782.  Of  thirteen  cases 
witnessed  by  Mr.  Dickinson,  Surgeon  at  Grenada,  four  were  cured. 
(J.  H.  Bennet.) 

In,  prescribing  the  treatment,  it  is  unnecessary  to  notice  the 
effects  of  every  remedy  which  has  been  employed  by  physicians, 
but  merely  to  refer  to  those  which  seem  to  be  most  imperiously  de- 
manded. In  conformity  with  the  benevolent  principle  inculcated  by- 
Prof.  Ford,  that  the  mitigation  of  pam,  is  the  first  consideration 
which  ought  to  engage  the  attention  of  the  practitioner,  the  differ- 


616  Case  of  Tetanus,  [November, 


ent  preparations  of  opium    may   be   considered    as    indispensable 
adjuvants.     But,  I  apprehend,   that  injury  has  been  incurred  rather 
than  benefit,  from  the  inordinately  large  quantities  of  opium  which 
have  often  been  forced  into  the  stomachs  of  patients.     It  is  affirmed, 
that  Mr.  Abernethy  found  thirty  drachms  of  undissolved  opium  in 
the  stomach  of  a  man  who  died  of  tetanus;  and  that  four  pounds,  * 
seven  ounces,  and  six  drachms  of  laudanum,  and  six  ounces,  four 
drachms  and  forty-five  grains  of  solid  opiurn^  were  administered  to  a 
patient  in  ten  days.     Such  a  course  of  treatment  may  in  a  measure 
account  for  that  degree  of  constipation  of  the  bowels  which  is  so 
often  deplored,     ^yhen  called  to  a  case  of  tetanus,  we  should  exam- 
ine first  into  its  cause.     If  the  symptoms  be  dependent  upon  centric 
irritation,   induced   by  a  sudden    check  of  perspiration,    sudorifics 
should  be  perseveringly  employed.    Much  vascular  excitement  should 
be  met  with  general  and  local  blood-letting,  more  especially,  if  there 
be  evidence  of  spinal  engorgement.     Blood  should  be  ^  abstracted 
from  the  arm   until  an   impression   be   made  upon  the  pulse,  to  be 
succeeded  by  the  abstraction  of  twelve  ounces  from  the  spine,  if 
practicable,  hy  cupping;  if  not,  by  leeches.     We  are  told  that  in  one 
case  which  recovered,  M.  Lisfranc  bled  8  times,  and  applied  792 
leeches  to  the  spine.     Sixty  gtt.  of  laudanum  every  hour,  to  be  gradu- 
ally increased  in  quantity,  until  some  appreciable  influence  is  exerted 
upon  the  system,  will  tend  to  assuage  the  agonizing  pains  of  the  suf- 
ferer.    Calomel,  in  combination  with  opium,  given  in  sufficiently 
large  quantities  to  purge  freely,  may  act  beneficially,   not  only  by- 
dislodging  any  irritating  substances,  in  the  form  of  vitiated  secre- 
tions, or  accumulation  of  worms,  but  by  its  revulsive  influence.     A 
vesicatory  three  inches  wide,   extending  from  the  occiput  to  the 
sacrum,  should  be   applied  immediately  after  the  acute  symptoms 
have  subsided  in  a  measure,  and  repeated  sufficiently  often  to  keep 
up  a  sufficient  irritation.     The  warm  bath  should  not  by  any  means 
be  forgotten,  for  its  effects  are  sometimes  astonishing  in  relaxing  the 
cutaneous  emunctories,  and  overcoming  spasmodic  rigidity.     Should 
eccentric  tetanus  be  caused  by  the  presence  of  worms  in  the  intes- 
tines,  i.  turpentine,  and  the  same  quantity  of  castor  oil,  should  be 
given  at  once,  to  be  repeated  in  two  hours,  if  necessary,  and  assisted 
by  enemata.     In  case  of  the  failure  of  this  prescription,  two  drops  of 
croton  oil,  with  one  drachm  of  turpentine,  will  generally  prove  effect- 
ual.    We  are  amazed  at  the  great  quantities  of  drastric  purgatives 
which  are  sometimes  endured  by  the  constitution.     "Dr.  Briggshas 


1845.]  Case  of  Tetanus.  617 


recorded  an  almost  incredible  case  {Edin.  Med.  and  Surg.  Journ..,  ol. 
5,  p.  141,)  in  which,  in  forty-eight  hours,  the  patient  took  210  grains 
scammony,  89  grains  gamboge,  one  ounce  and  four  scruples  of  jalap, 
two  pounds  and  a  half  of  infusion  of  sena,  and  8  grains  of  calomel, 
with  decided  benefit !"  The  nature  of  the  wound  in  traumatic 
tet;yus,  should  be  carefully  observed.  If  a  foreign  substance  exists, 
it  should  be  immediately  removed.  It  is  frequently  necessary  in 
cases  of  punctured  an<H|acerated  wounds,  to  dilate  the  orifice  by 
deep  crucial  incisions,  for  the  purpose  of  encouraging  haemorrhage 
from  the  part,  and  relieving  the  excessively  pair^ul  distension. 
Complete  section  of  a  partially  divided  nerve  has  been  practiced  by 
some,  but  with  little  success.  With  regard  to  amputation  of  the 
wounded  limb,  I  am  impressed  with  the  conviction,  that  when  teta- 
nic symptoms  have  fairly  supervened,  the  records  of  surgery  will 
scarcely  warrant  such  cruel  interference.  The  disease  having  fairly 
commenced,  is  very  rarely  influenced  by  any  local  treatment  to  the 
otTending  part.  "Tetanus  is  one  of  those  diseases  which  renders 
null  the  axiom"  '  suhJata  causa,  iolliiur  effecius.'  "  It  would  be  as 
vain  to  hope  to  cure  rabies  by  amputating  the  bitten  finger ;  consti- 
tutional cancer,  or  syphilis,  by  removing  the  local  disease,  as  to  ex- 
pect to  cure  tetanus,  after  it  had  set  in,  by  removing  the  limb."  
(Dupuytren's  Surgery,  p.  548.)  It  becomes  a  constitutional  disorder, 
and  our  remedies  must  be  directed  accordingly.  The  use  of  mercury 
carried  to  salivation  has  been  extolled  by  many,  as  possessing  pecu- 
liar charms  in  controlling  this  disease. 

Should  deglutition  be  impossible  ill  the  use  of  medicines,  we  must 
inject  large  quantities  into  the  rectum,  and  employ  inunction  upon  a 
Yesicated  surface. 

It  would  require  a  volume  to  enter  into  a  narrative  of  the  effects 
produced  by  the  different  powders,  pills  and  tinctures,  which  have 
been  employed  by  different  medical  men.  Suffice  it  to  say, 
that  antimony,  prussic  acid,  tobacco,  brandy,  musk,  quinine,  phospho- 
rus, electricity,  strychnine,  ether,  stramonium,  coichicum,  the  prepa- 
rations  of  iron,  digitalis,  &c.,  have  been  employed  to  an  unlimited 
extent,  and  neither  one,  nor  all  combined,  have  exerted  any  very  re- 
markable curative  influence.  The  vapor  bath  and  cold  affusion  have 
borne  no  better  testimony  to  the  curability  of  this  disease.  We  have 
already  remarked,  that  the  Ancients  regarded  an  attack  of  tetanus 
as  necessarily  mortal ;  and  as  at  the  present  day  we  do  hear  of  occa- 
sional recoveries,  we  are  encouraged  with  the  hope,  that  erelong,  the 


618  Thoughts  on  Syphilitic  Ulcers.  [November, 


unprecedented  advances  which  are  now  being  made  in  the  Sciences 
of  pathology,  physiology,  and  chemistry,  in  elucidating  the  hidden 
mysteries  of  organism,  will  place  even  tetanus  in  subjection  to  the 
magic  influence  of  the  "  Divine  Art." 


ARTICLE    II. 

Thoughts  on  Syphilitic  Ulcers  their  treatment,  <^c.     By  Robert 
Edmonds  Little,  M.  D.,  of  Quincy^  Middle  Florida* 

Opinions  in  regard  to  the  origin,  nature,  and  progress  of  diseases 
arising  from  impure  coition,  are  not  more  numerous  and  directly 
opposite  in  character,  than  those  maintained  by  the  profession  in 
relation  to  their  treatment ;  opinions  which  not  unfrequently  yield 
to  the  scrutiny  of  experiment  not,  however,  without  first  entailing 
much  difliculty  on  those  who  have  been  so  unfortunate  as  to 
place  too  great  a  reliance  on  any  specific  mode  of  cure,  modified 
by  peculiarity  of  constitution.  Notwithstanding  the  partiality  of 
many  for  the  antiphlogistic  treatment  of  syphilis,  and  the  gen- 
eral concession  that  mercury  is  a  specific  against  its  ravages,  our 
principles  want  stability,  for  neither  the  non-mercurialists,  nor  their 
opponents,  are  guided  by  any  fixed  or  definite  standard.  As  a 
consequence,  cases  are  daily  met  with  which  being  thought  amena- 
ble to  mercury  alone,-  have  been  rendered  truly  deplorable  by  a  too 
free  use  of  the  article  while  others  are  immolated  at  the  altar  of 
fear,  from  a  supposition  that  the  remedy  inflicts  on  the  system  evils, 
scarcely  less  to  be  dreaded  than  the  disease  for  which  it  was  given. 
We  do  not  propose  at  this  time  to  present  any  thing  like  an  elaborate 
notice  of  syphilitic  ulcers,  or  their  peculiar  treatment;  for  this,  our 
means  of  observation  have  been  too  limited,  removed  as  we  are  frbm 
an  extensive  field  for  a  thorough  investigation  of  the  subject.  We 
design  to  produce  observations  not  presented  in  the  illimitable  field 
of  speculation,  but  the  result  of  cases  seen.  In  our  conclusions,  we 
have  been  uninfluenced  by  preconceived  opinions,  or  ex  cathedra  as- 
sertions, well  knowing  how  little  reliance  there  is  to  be  placed  in 
assertions  and  theories,  when  not  backed  by  facts.  All,  however, 
are  not  destined  to  look  through  the  same  medium  hence,  in  a  great 
measure,  the  conflicting  evidence  of  different  individuals,  not  only  in 


1945.]  Thoughts  on  Syphilitic  Vlcers,  619 


regard  to  medical,  but  all  other  subjects,  plain  and  intelligible  though 
they  be  to  the  unprejudiced. 

In  the  July  number  of  the  Western  Lancet,  Dr.  E.  L.  Dudley  de- 
votes several  pages  to  a  consideration  of  diseases  resembling  syphilis. 
Dr.  D.  seems  to  have  been  a  close  observer  of  the  treatment  pursued 
by  the  Professor  of  Surgery  in  Transylvania  University,  in  the 
numerous  cases  presented  for  cure  ;  and  the  conclusions  to  which 
he  has  come  if  we  doot  misapprehend  bis  meaning  arc,  that  all 
ulcers  on  the  genital  organs,  save  the  true  Hunterian  chancre,  are 
to  be  regarded  as  not  syphilitic,  and  consequently  not  requiring 
mercury  for  their  removal  :  conclusions  which  we  apprehend  will 
not  be  adopted  by  a  very  large  number  of  the  profession.  To  ditfer 
upon  subjects  purely  speculative,  is  allowable  among  men  ;  but  for  a  * 
dilTerence  to  exist  between  those  who  are  capable  of  observing  with 
regard  to  facts,  is  contrary  to  reason,  and  can  be  accounted  for  upon 
no  other  principle,  than  that  of  one  or  both  parties  at  issue,  are  led 
astray  by  a  partiality  for  opinions  adopted  without  a  sufficient  exam- 
ination, and  maintained  on  account  of  the  ancient  relationship  exist- 
ing between  these  opinions  and  their  supporters.  It  has  been,  and 
still  continues  to  be  too  much  the  fault  of  medical  men  to  receive  the 
dogmas  of  those  who  rank  high  in  the  profession,  without  taking  upon 
themselves  the  trouble  of  investigating  them,  and  relieving  them- 
selves from  the  errors  into  which  they  have  been  led  by  their  sacred 
authority.  From  the  time  that  John  Hunter's  work  on  the  Venereal 
Disease  first  appeared,  his  authority  has  generally  been  deemed 
supreme,  and  his  followers  blinded  by  his  errors.  Following  in  his 
footsteps,  they  regard  the  ulcer  so  well  described  by  him,  as  the  only 
one  legitimately  venereal ;  thus  lessening  the  number  of  cases  of  pox 
so  greatly,  as  to  cause  one  to  imagine  that  the  disease  had  almost 
disappeared  from  the  long  list  of  those  to  which  flesh  is  heir,  were  it 
not  for  the  deformed  faces  and  altered  voices  so  often  encountered. 

From  the  opinion  of  Dr.  D.  we  beg  leave  to  dissent.  No  one 
form  of  ulcer  is  exclusively  to  be  taken  as  an  index  of  syphilis  they 
are  as  numerous  almost  as  the  hues  of  the  chameleon,  and  he  who 
undertakes  to  diagnosticate  the  disease,  or  the  reverse,  as  the  ulcer 
may,  or  not,  present  the  characteristics  of  the  Hunterian  chancre, 
will,  in  a  majority  of  cases,  fail,  and  suffer  the  mortification  of  hav- 
ing patients  return  to  him  after  a  few  months  afflicted  with  secondary 
symptoms  in  all  their  virulence.  Syphilitic  ulcers  appear  isolated 
and  in  clusters,  with  and  without  indurated  bases,  and  present  all  the 


620  Thoughts  on  Syphilitic  Ulcers.  [November, 


numerous  varieties  from  a  healthy  to  a  sphacelated  ulcer,  whether 
they  be  seated  on  the  genitals  or  in  the  throat.  Like  Dr.  D.,  we 
were  taught  to  regard  a  majority  of  these  as  the  result  of  irritation, 
requiring  for  their  removal  a  simple  antiphlogistic  treatment.  Fully 
impressed  with  the  truth  of  this  doctrine,  we  acted  upon  it,  and  gave 
it  up  only  when  convinced  of  its  futility,  and  of  the  injurious  conse- 
quences attendant  upon  it.  Ulcers  on  the  glans  penis,  and  other 
parts  of  the  genitals,  were,  in  the  beginning  of  our  practice,  treated 
by  us  as  pseudo  syphilitic,  by  mild  aperients,  and  absence  from  all 
general  and  local  stimuli,  but  without  in  the  least  benefitting  the 
patient.  When  suffered  to  remain  untouched,  for  the  purpose  of 
having  our  "  doubts  enlightened,"  we  were  not  unfrequently  mortifi- 
  ed  by  the  appearance  of  syphilitic  psoriasis  and  lepra,  symptoms 
similar,  we  presume,  to  those  attributed  by  Dr.  D.  to  the  use  of  cor- 
rosive sublimate.  From  his  statement,  it  is  to  be  inferred  that 
secondary  symptoms  never  supervene  upon  any  other,  than  the  true 
Hunterian  chancre.  Here  we  are  at  issue.  We  have  been  more 
unfortunate  than  he  has  our  success  less  signal  than  his.  How  to 
reconcile  these  conflicting  statements  we  know  not,  both  being  made 
in  good  faith. 

Dr.  Dudley  says,  "  the  enquiry  may  be  made,  does  a  syphilitic 
chancre  ever  secrete  pus  and  is  not  the  fact  of  a  chancre  having 
commenced  to  form  purulent  matter  to  be  considered  evidence  that 
the  disease  is  mastered,  and  that  healthy  granulation  is  about  to  take 
place?"  We  unhesitatingly  affirm  that  it  does  not  unfrequently 
secrete  pus.  Several  months  ago,  a  young  man  consulted  us,  in  re- 
lation to  an  ulcer  on  his  glans  penis  with  an  elevated  border,  concave, 
and  discharging  a  considerable  amount  o( uniformly  consistent  cream- 
colored  pus.  Our  advice  was  not  adopted,  as  we  recommended  a 
mercurial  course.  Three  months  afterwards  he  returned,  and  pla- 
ced himself  under  our  care  for  the  removal  of  a  long  train  of  second- 
ary symptoms.  We  have  every  reason  to  believe  that  they  would 
not  have  manifested  themselves  if  our  advice  had  been  adopted. 
Similar  cases  might  be  multiplied  almost  ad  infinitum. 

Dr.  D.  considers  the  Hunterian  sore  the  only  index  of  the  exist- 
ence of  primary  syphilis  hence  the  diagnosis  between  true  and 
bastard  syphilis  is  easy.  Ricord  says,  "  no  affection  is  so  ill  defined, 
and  no  diagnosis  so  uncertain"  as  that  of  syphilis.  But  doctors  as 
well  as  philosophers  will  disagree.  With  a  majority,  the  matter 
remains  in  doubt  and  until  the  diagnosis  is  understood  safety  can 


1815.]  Thoughts  on  Syi)liililic  Ulcers.  621 


only  be  ensured  by  a  judicious  use  of  mercury ;  yet  in  avoiding 
Scilla,  let  us  not  run  on  Charybdis. 

The  case  of  the  medical  student  reported,  is  defective  in  descrip- 
tion the  ulcer  is  described  as  being  "  a  long,  narrow,  superficial 
affair"-^yet  notwithstanding  the  omissions,  it  is  fair  to  presume  that 
the  ulcer  was  legitimately  syphilitic,  and  that  the  dangerous  symp- 
toms were  the  result  of  the  injudicious  treatment  pursued.  In  its 
early  stages,  a  light  regimen,  gentle  purgatives,  and  cleanlmess, 
adopted  for  the  space  of  two  or  three  days,  failed  to  improve  its  ap- 
pearances. Becoming  dissatisfied  at  the  progress  m.ade,  he  consulted 
a  second  physician,  who  advised  a  mercurial  course ;  the  sore  in- 
creasing in  size,  a  third  was  visited,  and  he  in  turn  considered  the 
use  of  mercury  necessary.  Blue  pill  and  opium  caused  "  profuse 
salivation,  and  threw  the  bowels  into  a  state  of  excessive  torpor." 
The  ulcer  spread,  and  an  inguinal  gland  suppurated,  and  exposed  a 
foul  ulcer  as  large  as  the  palm  of  a  man's  hand.  The  glans  penis 
was  destroyed,  and  the  scrotum  covered  with  ulcers.  Professor 
Bush  was  now  consulted  all  medicine  was  suspended  a  mush 
poultice  was  kept  constantly  applied,  and  a  light  nutritious  diet 
adopted.  Under  this  course,  the  pritient  recovered  in  six  weeks, 
with  the  loss  of  the  glans  penis.  He  was  afterwards  operated  on 
for  phymosis  by  Prof.  B.  The  "dangerous  extremity  to  which 
he  was  reduced,*'  is  attributed  by  Dr.  Dudley,  to  the  "improper  em- 
ployment of  mercury."  So  far  we  agree  with  him.  The  sore  is 
recognized,  although  the  description  is  vague.  The  ulcer,  from  its 
situation  we  presume,  commenced  on  the  glans  penis  in  the  form  of 
a  vesicle,  which  finally  assumed  the  characteristics  mentioned.  We 
have  met  with  two  cases  similar  to  the  above  in  almost  ex^ry  respect, 
and  producing  like  it,  phymosis.  The  ulcerations  succeeding  vesi- 
cles discharged  a  large  quantity  of  purulent  matter,  and  inoculated 
the  neighboring  parts,  including  the  scrotum,  which  in  each  case  was 
covered  with  a  crop  of  pustules  scattered  over  its  entire  surface* 
Unlike  Dr.  Dudley's  case,  they  were  treated  without  the  use  of  mer- 
cury secondary  symptoms  in  both  cases  supervened.  In  our  cases, 
"the  dangerous  extremity"  to  which  our  patients  were  reduced  was 
certainly  not  to  be  attributed  to  that  disease  producing  remedy  
mercury. 

We  have  said  that  the  ulcer  on  the  glans  penis  of  the  student  was 
in  all  probability  syphilitic  and  we  now  add  that  the  violent  symp- 
toms produced,  as  well  as  the  cure,  were  the  result  of  the  mercury 


622  Thoughts  on  Syphilitic  Ulcers,  [November, 


administered  injudiciousljas  it  was.  The  propriety  or  the  reverse 
of  the  administration  of  mercury  in  the  treatment  not  only  of  syph- 
ilis, but  all  other  diseases,  should  be  based  on  the  peculiar  state  of  the 
system  of  the  individual  for  whom  it  is  prescribed.  Preparatory 
treatment  should  in  all  cases  be  resorted  to,  and  to  an  observance  of 
this  precaution,  is  in  a  great  measure  to  be  attributed  the  success  of 
our  fathers  in  the  management  of  venereal  diseases,  as  well  as  the 
great  length  of  time  that  elapses  between  the  cessation  of  the  treat- 
ment of  the  non-mercurialists  and  the  appearance  of  secondary 
symptoms.  No  practice  is  more  injurious,  or  likely  to  do  harm, 
than  that  of  giving  mercury  for  the  cure  of  a  venereal  ulcer,  simply 
because  the  former  is  deemed  a  specific  for  the  latter,  without  first 
investigating  the  condition  of  the  general  health  of  the  patient, 
which  should  always  be  prepared  for  the  proper  use  of  that  remedy. 
We  could  adduce  instances  of  young,  robust  men,  having  their  con- 
stitutions impaired  to  a  serious  extent  by  an  injudicious  prescription 
of  mercury  which  acted  on  the  salivary  system  but  instead  of 
healing  the  ulcers,  only  tended  to  enlarge  them  thus  disappointing 
the  hopes  of  the  physician  in  regard  to  a  speedy  cure.  Such  a  case 
no  doubt  was  that  of  the  student  of  medicine.  Had  he  been  bled, 
purged,  and  subjected  to  a  meagre  diet  for  a  week  or  ten  days  prior 
to  the  commencement  of  the  mercurial  course,  by  which  means  the 
inflammatory  condition  of  his  system  would  have  been  reduced,  the 
ulcer  would  in  all  probability  have  disappeared  in  a  short  time  the 
patient  would  not  have  been  reduced  to  a  dangerous  extremity,  and 
Prof.  Bush  not  compelled  to  doubt  the  correctness  of  the  diagnosis 
of  the  physicians  who  deemed  the  ulcer  truly  venereal.  Dr.  Dudley 
properly  observes,  that  the  alterative  doses  of  blue  pill  and  opium, 
induced  mercurial  erethism;  thus  substituting  one  disease  for  ano- 
ther converting  the  venereal,  into  a  mercurial  sore,  after  which  a 
withdrawal  of  the  mercury,  and  the  use  of  a  generous  diet,  were  all 
that  was  necessary  to  relieve  him,  of  a  disease  which  at  first  was  an 
ulcer  "long,  narrow  and  superficial." 

In  urging  the  necessity  of  preparatory  measures,  we  do  not  mean 
that  depletion  is  in  all  cases  to  be  used.  Individuals  vary  as  much  in 
their  habits  and  constitutiouy.  as  do  syphilitic  ulcers.  We  must  be 
guided  by  the  condition  of  the  patient  and  appearance  of  the  ulcer. 
In  America,  where  venereal  patients  are  usually  in  the  l.eginninT 
hardy  and  robust,  drpletion  is  rarely  required  to  prepare  the  system 
for  tije  beneficial  itifiuence  of  mercury.     In  the  hospitals  of  Europe, 


181.J.]  Thoughts  on  Syphililic  Ulcers.      ,  623 


the  reverse  is  trile  ;  hence  the  value  to  surgeons  of  the  advice  of  John 
Hunter,  who  said,  "I  think  no  kind  of  diet  has  any  effect  in  retard- 
ing tlie  cure  of  syphilis,  and  I  think  a  man  would  get  equally  as  well 
if  he  lived  ever  so  luxuriant,  got  drunk  every  day,  and  slept  in  the 
fields."  To  a  certain  extent,  Hunter  was  right  his  advice  should 
be  followed  only  in  cases  of  debility,  either  from  previous  dissipation 
or  the  inordinate  use  of  mercury. 

To  surgeon  Rose,  of  the  Cold-stream  Guards,  is  due  the  credit  of 
having  introduced  to  the  notice  of  the  profession  the  fact  that  syphilis 
in  all  its  stages  could  be  cured  without  mercury  ;  his  announcement 
was  accompanied  by  reports  of  numerous  cases  so  relieved.  The 
pretensions  of  the  anti-mercurialists  we  do  not  intend  examining,  as 
it  is  conceded  that  instead  of  advancing  in  popularity,  they  are  losing 
ground.  A  majority  of  the  cases  reported  by  him  and  his  followers, 
(among  whom  may  be  mentioned  M.  Guthrie,  Dr.  Green,  and  others 
equally  distinguished,)  as  cured  finally,  had  secondary  symptoms  
such  as  had  not,  are  considered  by  Dr.  Dudley  (in  his  attempt  to 
limit  the  number  of  true  syphilitic  ulcers)  as  pseudo-syphilitic  sores. 
They  may  or  may  not  have  been  syphilitic;  and  although  we  are  an 
advocate  for  the  use  of  mercury  in  all  cases  as  a  means  of  safety, 
still  we  are  ready  to  admit  that  a  case  now  and  then  occurs,  in 
which  the  primary  ulcer  is  destroyed  by  means  of  cscharotics,  with- 
out the  supervention  of  secondary  symptoms;  although  mercury 
was  not  used  either  internally  or  externally.  Has  Dr.  Dudley  never 
seen  a  case  parallel  to  the  following,  mentioned  by  Rousseau  :  A 
young  man,  having  forgotten  in  a  spell  of  merry  enjoyment  that  he 
had  left  at  home  his  female  companion,  indulged  himself  in  a  taste  of 
variety:  came  to  himself  again,  and  hardly  recollecting  his  dream, 
he  returned  to  his  wife,  without  any  apprehension  of  being  in  a  situa- 
tion to  infect  her ;  a  day  or  two  after,  beginning  to  feel  an  uneasy 
sensation  upon  glans  penis,  he  found  on  examination  that  he  had 
three  little  sores  as  big  as  the  head  of  a  pin.  He  applied  sulphate  of 
copper,  and  in  the  course  of  three  days  was  as  well  as  ever.  Shortly 
after  he  went  to  sea,  leaving  his  wife  unapprised  of  the  impending 
evil.  A  few  days  after  his  departure,  painful  sensations  in  her  ingui- 
nal regions  were  soon  followed  by  the  appearance  of  swelling  :  sup- 
puration and  ulceration  occurred,  and  she  was  relieved  only  after  the 
use  of  medipne  for  six  months.  The  husband  never  afterwards  had 
any  symptom  of  venerial  affection,  Cases  similar  to  the  foregoing 
are  we  presume  familiar  to  every  physician.     Spoken  of  as  they  are 


624  Thoughts  on  Syphilitic  Ulcers.  [November, 


by  Ricord  and  other  writers  on  venereal,  we  are  inclined  to  believe 
that  the  small  sores  on  the  glans  penis  of  the  husband,  and  the  buboes 
in  the  groin  of  his  wife  were  truly  syphilitic  :  the  disease  in  the  for- 
mer was  destroyed  by  the  use  of  an  escharotic,  without  causing 
secondary  symptoms  while  the  latter,  was  less  fortunate,  being  re- 
duced to  a  "dangerous  extremity,"  whether  by  the  injudicious  use 
of  mercury  or  not,  we  are  not  informed.  In  regard  to  escharotics, 
we  can  truly  say,  that  we  have  always  found  them  useful  oftentimes 
indispensable.  Their  employment  is  never  dangerous,  or  likely  to 
disguiso,  or  lock  up  the  disease ;  they  always  leave  behind  them  a 
certain  index  for  the  employment  or  otherwise  of  mercury.  We  refer 
to  the  button-like  hardness  of  the  cicatrix. 

After  all  that  has  been  said  in  favor  of  the  non-employment  of 
mercury,  its  advocates  are  beginning  to  change  their  opinions,  and 
acknowledge  that  mercury  is  the  antidote  for  syphilis.  From  the 
arm\'  reports,  most  of  the  cases  said  to  be  cured,  were  cases  of  recent 
origin,  no  further  advanced  than  the  simple  venereal  pustule,  or 
original  chancre  'while  the  others  were  almost  universally  attacked 
with  secondary  symptoms.  Although  mercury  is  the  only  acknow- 
ledged specific  against  its  ravages,  it  is  not  unfrequently  advised- 
given,  when  its  use  is  certain  destruction.  Its  d,dministration  is  not 
well  understood,  if  we  may  judge  from  the  conflicting  statements  of 
various  writers,  and  knowledge  in  regard  to  it  can  only  be  gained 
by  experience.  The  use  of  mercury  being  in  itself  an  evil,  and  its 
effects  frequently  so  deplorable,  it  has  become  an  object  M^th  the 
profession  to  know  to  what  extent  it  should  be  carried  to  be  benefi- 
cial^a  problem  which  experience  has  heretofore  found  difficult  to 
Solve  :  a  part  of  the  profession  contending  that  it  should  be  carried 
to  the  extent  of  producing  salivation,  while  others  deny  the  necessity 
of  its  being  carried  so  far.  Our  observation  leads  us  to  believe,  that 
A  tnodorate  soreness  of  the  gums,  continued  for  a  time,  proportioned 
to  the  violence  of  the  symptoms,  and  temperament  of  the  individual, 
is  all  that  is  necessary  (so  far  as  mercury  is  concerned)  to  effect  a 
radical  cure  of  syphilis.  The  remedy  should  be  gradually  introduced 
into  the  system,  taking  due  care  not  to  enfeeble  the  powers  of  life  to 
an  unnecessary  extent.  We  regard  not  so  much  the  amount  of  sore- 
ness of  the  gums,  as  the  amount  of  mercury  taken,  and  the  effects 
produced  viz.  healing  of  the  sore,  or  destruction  of  tlie  indurated 
cicatrix,  if  an  escharotic  has  been  used.  A  speedy  salivation  is  to 
be  deplored  while,  on  the  other  hand,  a  too  great  tardiness  in  the 


1845.]  '      Acute  Traumatic  Tetanus.  G25 


specific  effect  of  the  mercury  is  to  be  guarded  against :  in  the  former 
case,  its  effects  are  to  be  counteracted  by  appropriate  living,  and  the 
use  of  adjuvant  remedies  in  the  latter,  the  dose  is  to  be  increased. 
The  danger  arising  from  profuse  salivation,  we  need  not  mention  ; 
its  effects  have  been  witnessed  by  almost  every  practitioner.  It  be- 
comes the  profession  to  be  cautious  in  its  use.  Its  consequences  are 
so  dreadful  under  certain  circumstances,  that  it  is  better  to  err  on 
the  safe  side,  and  give  too  little  rather  than  too  much.  When  not 
enough  has  been  given  to  effect  our  object,  the  dose  can  be  increased  : 
when  too  much  is  administered,  its  ravages  are  almost  without  limit, 
not  unfrequently  leaving  the  original  disease  uncured,  in  addition  to 
its  own  poisonous  effects. 

In  conclusion:  much  has  been  said  and  written  on  the  subject  of 
syphilis,  and  still  the  disease  is  but  little  understood.  Revolutions 
are  constantly  going  on  in  regard  to  its  treatment,  and  it  is  to  be 
feared  that  we  are  not  more  successful  in  its  management  than  our 
fathers.  In  each  successive  change,  there  has  been  but  a  subslitu- 
tion  of  error  for  error.  To  arrive  at  any  thing  like  perfection,  in  the 
treatment  ofthis  or  any  other  disease,  we  must  rely  upon  ficts  only, 
disregarding  the  cherished  opinions  of  teachers  when  not  in  accord- 
ance with  experience.  By  such  a  course  alone  shall  we  be  enabled 
to  gain  true  knowledge  concerning  the  nature  and  treatment  of 
syphilis,  and  thereby  disarm  the  disease  of  all  its  terrors. 


ARTICLE  III. 

Case  of  Acute  Traumatic  Tetanus,  treated  with  the  Cannabis  Indica 
{Indian  Hemp)  unsuccessfully.     By  Paul  F.  Eve,  M.  D.,  Pro- 

fessor  of  Surgery  in  the  Medical  College  of  Georgia. 

To  Professor  O'Shaughnessy,  of  the  Medical  College  of  Calcutta, 
the  profession  is  indebted  for  the  introduction  of  the  Indian  Hemp 
into  the  materia  medica;  and  in  noother  disease  is  it  more  recom- 
mended than  for  traumatic  tetanus.  Within  the  past  few  months, 
there  have  been  various  and  somewhat  conflicting  reports  respecting 
the  efficacy  ofthis  article  as  a  remedial  agent,  in  the  British  medical 
journals,  and  the  subject  is  beginning  to  attract  attention  in  our  own 
periodicals.     In  the  4th  number  of  this  Journal,  we  published  some 

40 


626  ^        Acule  Traumatic  Tetanus,  [November, 


notice  oi'  the  experience  with  il  by  Mr.  Donovan  of  Dublin,  and  Dr. 
Lavvrie  of  Glasnjow ;  and  under  a  ditJerent  head  of  this  number,  the 
reader  may  find  the  subject  continued. 

The  prognosis  of  acute  traumatic  tetanus  is  so  exceedingly  unfa- 
vorable, that  the  profession  is  prepare!  at  all  times  to  give  a  fair 
trial  to  any  suggestion  or  agent  promising  success  in  its  treatment. 
The  aphorisms  of  Hippocrates,  that  te'anus  swpervening  on  a  wound, 
is  mortal  they  who  are  seized  with  tetanus,  die  within  four  days,  are 
just  as  true  now  as  when  they  were  written.  The  great  military 
surgeon  of  England,  the  late  Dr.  Hennen,  confesses  that  he  never 
saw  a  case  of  acute  symptomatic  tetanus  recover.  In  the  acute 
species,  Dr.  Dickson  of  Europe,  found  all  curative  measures  followed 
by  unqualified  disappointment.  Mr.  Morgan's  testimony  is  still 
stronger;  he  says,  I  have  never  yet  seen  or  heard  of  an  instance  of 
recovery  from  acute  tetanus.*  The  fact  that  Dr.  O'Beirne  witnessed 
two  hundred  cases  in  the  peninsula  of  Spain,  not  one  of  which  re- 
coverec. ;  and  the  experience  of  Sir  James  McGregor,  in  several  hun- 
dred cases  which  occurred  among  the  British  troops  in  that  country 
and  Portugal,  very  ^e\w  of  whom,  he  says,  were  benefited  by  any 
medicine  or  plan  whatever,  is  already  alluded  to  in  this  number 
of  the  Journal,  by  our  valuable  collaborator,  Dr.  Stevens,  of  Liberty 
county.  Mr.  Alcock,  surgeon  to  the  British  Legion  serving  in  Spain 
a  few  years  ago,  noticed  seventeen  cases  of  traumatic  tetanus,  one 
of  which  number  alone  recovered.  And  where,  we  ask,  is  the  prac- 
titioner of  medicine  or  surgery,  who  cures  trismus  nascentium  1  It 
is  true  that  occasionally,  by  almost  any  plan  of  treatment,  and  even 
by  very  opposite  ones,  this  affection,  in  some  of  its  varieties,  is  cured. 
Cases  to  this  effect  may  be  found  detailed  in  every  medical  journal, 
(several  even  in  this  very  number)  still  no  one  will  deny  but  that 
acute  traumatic  tetanus  ought  to  be  considered  an  opprobrium  medi- 
corum. 

We  find  it  stated  in  Druitt's  Surgery,  that  with  the  resin  of  the 
Cannabis  Indica,  or  Indian  Hemp,  Dr  O'Shaughnessy  and  others, 
cured  eight  out  of  twelve  cases  of  tetanus;  and  Mr.  Donovan  says  it 
was  almost  uniformly  successful  in  his  practice.  The  variety  of  the 
disease  is  not  mentioned.  In  a  debate  which  occurred  the  22d  April 
last,  in  the  Royal  Medical  and  Chirurgical  Society,  and  reported  in 
the  London  Lancet,  on  the  reading  of  a  "case  of  traumatic  tetanus 
successfully  treated   by   large  quantities   of  wine  and  brandy,  with 

  Vide  Cyclopaedia  of  Practical  Medicine,  vol.  iv,,  p.  369. 


1815.]  Acute  Traumatic  Tetanus.  627 


other  means,"  and  in  which  Drs.  Watson,  Wilson,  Davis,  King, 
Snow,  Curling,  (author  of  a  work  on  tetanus,)  Solly,  Simon,  CaBsar 
Hawkins,  &;c.,  took  part,  we  are  surprised  to  see  no  allusion  made  to 
the  Indian  Hemp. 

In  the  case  of  Prof.  Miller,  (who  has  recently  published  the  best 
work  on  the  Principles  of  Surgery.)  reported  in  the  London  and 
Edinburgh  Monthly  Journal  of  Medical  Sciences,  for  January,  1845, 
the  success  cannot  be  ascribed  exclusively  to  any  one  agent  employ- 
ed. We  refer  to  another  part  of  this  number  for  the  history  of  this 
case,  where  also  may  be  found  two  or  three  others,  taken  from  the 
last  number  of  Braithwaite's  Retrospect. 

In  the  September  number  of  the  New  Orleans  Medical  and  Surgi- 
cal  Journal,  may  be  found  a  case  detailed  by  Dr.  Willson  of  that 
city,  in  which  the  Indian  Hemp  was  used  with  success,  at  least  for  a 
time.  The  tetanus  occurred  in  a  negro  man,  and  on  the  25th  May, 
1845,  Dr.  W.  was  called  to  it  in  consultation  with  Dr.  Farrell.  Two 
weeks  before,  he  was  attacked  "  with  stiffness  and  uneasiness  in  the 
hack  of  his  neck,  consequent  upon  exposure  to  wet  and  inclement 
weather."  "  We  subsequently  learned  (says  Dr.  Willson)  the  fact  of 
his  having  suffered,  about  two  months  previously,  from  a  punctured 
wound  of  his  foot,  that  suppurated,  but  healed  in  a  short  time  without 
any  untoward  symptom."  This  was  a  chronic  case,  continuing  more 
than  a  month,  but  in  which  the  Cannabis  Indica  was  employed  with 
good  results.  In  a  postscript,  however,  by  Dr.  Farrell,  a  few  weeks 
after  the  patient  was  dismissed,  cured,  he  says  "the  case  has  ter- 
minated fatally."  In  live  days  from  the  time  he  was  considered 
well,  he  was  unfortunately  attacked  with  measles  clonic  spasms 
immediately  supervened,  and  notwithstanding  the  "Indian  hemp  was 
given  in  large  doses  also,  brandy,  morphine  and  quinine  without 
for  a  moment  checking  the  progress  of  the  disease,"  Dr  J.  Farrell 
adds  that,  "  two  years  ago  I  treated  a  case  of  traumatic  tetanus  with 
the  Cannabis  Indica ;  on  the  fourth  day  he  symptoms  were  much 
alleviated,  even  in  a  more  marked  degree  than  in  the  preceding  cure  ; 
unfortunately  the  supply  of  the  medicine  became  exhausted,  and 
Bone  could  be  procured." 

From  the  account  of  all  the  cases  of  tetanus  published,  in  which 
the  Indian  hemp  was  tried,  it  still  remained  an  unsettled  question, 
whether  it  could  be  relied  upon  in  the  acute  traumatic  variety.  So 
far  as  one  instance  can  decide  the  matter,  wherein  Xhe.  remedy  was 
faithfully  employed,  and  it  alone  almost  exclusively,  we  are  inclined 


628  Acute  Traumatic  Tetanus,  [November, 


to  the  opinion  tiiat  it  may  relieve,  but  will  not  cure.  Certainly  if 
ever  there  was  a  case  well  adapted  to  give  the  article  a  fair  trial,  this 
was  one.  An  acute  attack  from  a  nail  in  the  foot,  entirely  neglected 
for  near  thirty  hours  after  the  incursion  of  the  symptoms,  the  failure 
of  the  ordinary  means  to  afford  even  relief,  and  then  the  steady  appli- 
cation of  increased  doses  of  the  hemp  for  twenty-four  successive 
hours,  under  unremitting  personal  attention,  were  well  calculated  to 
exhibit  the  remedial  powers  of  the  medicine. 

The  article  used  had  just  arrived  from  England,  and  was  obtained 
through  one  of  our  apothecaries,  a  graduate  of  the  Philadelphia  Col- 
lege of  Pharmacy.  It  was  insoluble  in  water  was  precipitated  when 
the  tincture  was  much  diluted,  and  adhered  to  the  hands  and  vessel. 
The  tincture  was  made  by  adding  an  ounce  of  the  extract  to  a  pint  of 
undiluted  alcohol. 

Case.  Richard,  a  black  man,  aged  25,  and  a  carpenter  by  trade, 
had  a  nail  run  into  his  foot,  by  treading  upon  it,  on  Friday  the  26th 
of  September.  He  was  of  good  constitution,  well  made,  and  enjoyed 
excellent  health.  He  had  a  small  umbilical  hernia,  supposed  to  be 
congenital,  but  which  gave  him  little  or  no  inconvenience.  It,  how- 
ever, rapidly  increased  in  volume  during  the  attack  of  tetanus,  and 
pressure  was  required  over  it  at  every  paroxysm,  to  restrain  the  pro- 
truding bowels. 

The  wound  made  by  the  nail  was  upon  the  planter  surface  of  the 
left  foot,  opposite  the  metatarso-phalangeal  articulation  of  the 
little  toe,  and  was  thought  to  have  pent  trated  deeply.  A  lye-poultice 
was  immediately  applied,  and  Richard  returned  to  his  work,  using 
frequently  a  ladder.  On  the  evening  of  October  2d,  the  seventli 
da}"  after  the  accident,  he  complained  of  pain  in  his  neck  and  back. 
The  next  day  he  kept  his  bed  and  took  salts  and  senna,  which  freely 
moved  his  bowels.  At  midnight  between  the  3d  and  4th,  he  had 
spasms,  and  Dr.  Joseph  A.  Eve  was  sent  for.  He  enlarged  the 
wound  with  a  lancet,  aiad  some  pus  was  evacuated  a  lye-poultice 
was  then  applied  to  the  foot.  A  blister  was  placed  over  the 
whole  length  of  the  spine  ;  a  gr.  of  morphine  given,  and  half  a  tea 
spoonful  of  laudanum  directed  every  hour  until  relief  and  sleep  were 
obtained. 

Oct.  4th,  7  o'clock,  A.  M.  This  is  the  ninth  day  since  the  acci- 
dent, and  about  thirty-five  hours  from  the  commencement  of  his 
present  symptoms.  Dr.  E.  found  he  had  taken  the  laudanum 
three  or  four   times,  and   in   addition  to  the  narcotic  and  revul- 


1845.]  Acute  Traumatic  Tetanus.  629 


sive  treatment,  gave  20  grs.  calomel.  The  body  was  found  arched 
backward. 

I  was  invited  to  see  the  patient  at  10,  A.  M.  Symptoms  trismus 
and  opisthotinos  ;  great  distress  of  countenance  ;  drops  of  sweat  on 
his  face  and  neck  ;  decubitus  on  the  l)ack  ;  great  ditFicuUy  of  deglu- 
tition ;  pulse  90  to  100,  full  but  not  'strong;  respiration  30  to  40  
variations  dependent  upon  convulsive  spasms  which  occur  every  few 
seconds.  Prescription  2  grs.  of  the  Extr.  of  the  Cannabis  Indica, 
in  tincture,  every  fifteen  minutes.  He  swallowed  two  doses  with 
great  difTiculty,  and  then  vomited.  It  will  be  remarked  here,  that 
the  3rd  was  a  cloudy  day,  with  the  wind  at  N.  E.  Thermometer 
60  to  69  Barometer  falling.  On  the  4th,  it  rained  steadily  all  day, 
resembling  the  3rd  in  other  respects.  As  the  patient's  accommoda- 
tions were  not  good,  he  was  brought  to  my  otFice,  and  I  was  not  ab- 
sent from  him  more  than  three  or  four  hours  altofrether  duri^noj  the 
whole  treatment.  I  administered  every  dose  of  medicine,  and  gave 
him  nearly  all  the  nourishment  he  could  be  induced  to  take. 

At  11  o'clock,  examined  the  wound  ;  it  is  healing  under  the  lye- 
poultice;  and  finding  the  stomach  very  irritable,  I  gave  of  the  tine, 
of  the  Indian  hemp  5  grs.  diluted  in  tepid  water  in  an  enema.  At 
12,  M.,  injected  into  rectum  10  grs.  At  half-past  12,  gnve  5  to  6 
grs.  per  orem,  but  which  were  immediately  rejected.  At  1,  injected 
10  grs.  more.  By  great  persuasion  got  the  patient  to  take  some 
brandy  and  water,  and  a  few  table-spoonfuls  of  Madeira  wine.  To 
this  he  was  violently  opposed,  and  though  he  could  now  swallow 
freely  and  his  stomach  retained  these  stimulants,  he  would  not  be  in. 
dnced  to  drink  them  freely.  At  half-past  1,  the  patient  has  evidently 
improved  the  paroxysms  of  spasms  are  now  less  frequent  and  less 
violent  he  sleeps  quietly,  and  occasionally  snores.  He  lies  on  his 
back,  keeps  his  eyes  closed,  can  open  his  mouth  a  little,  but  has  no 
disposition  to  talk  seems  to  be  in  a  half  narcotised  state.  No  ma- 
terial change  yet  in  the  pulse  or  respiration. 

At  20  minutes  past  2  o'clock,  gave  4  grs.  of  the  hemp  per  orem  in 
brandy  and  water  ;  repeated  the  same  quantity  in  5  minutes;  they 
are  vomited  in  8  minutes.  At  3,  administered  15  grs.  to  rectum. 
Gave  5  grs.  sulph.  quinine  in  brandy  and  water;  vomited  in  three 
minutes.  Drs.  Newton  and  Ford  now  saw  the  patient,  and  were  sat- 
isfied  that  the  rigidity  of  the  muscles  was  not  great,  as  he  could  open 
the  mouth  to  about  half  its  usual  extent,  and  he  laid  nearly  straight 
on  his  back  the  convulsive  paroxysms  recurring  about*  every  two  to 


630  Acute  Traumatic  Tetanus,  [November, 


seven  minutes,     Richard  was  observed  to  scratch  his  face  with  his 
hand,  and  to  draw  up  his  left  thigh  and  leg. 

At  4  o'clock,  with  assistance,  he  turned  on  his  right  side,  and  at  5, 
called  for  a  vessel  and  passed  about  half  a  pint  of  high  colored  urine. 
Half-past  5,  gave  15  grains  of  the  Cannabis  Ind.  At  7,  took  a  little 
arrow  root  and  immediately  vomited.  Past  7,  injected  into  rectum 
24  grs.,  and  at  9  o'clock  gave  48  grs.  of  hemp  in  enema.  Half-past 
11,  seems  to  be  doing  well,  pulse  still  100,  respiration  30,  paroxysms 
some  minutes  apart.  We  recommended  the  brandy  and  arrow  root 
to  be  freely  given. 

Oct.  5th,  3  o'clock,  A.  M.  Called  up  to  patient,  and  find  him 
worse  ;  pulse  130  and  respiration  40.  Complains  of  difficult  breath- 
ing, and  his  convulsive  spasms  come  on  every  minute  or  two,  and 
are  more  severe.  Administered  16  grs.  of  hemp  per  anum  ;  and  the 
patient  was  evidently  improved  by  it.  The  respiration  became  bet- 
ter, the  pulse  fell  to  110,  and  quietude  and  sleep  followed.  6,  A.  M. 
Is  again  worse  ;  swallows  with  dirficulty,  cannot  open  the  mouth, 
and  has  obstinately  refused  to  lake  brandy  or  wine.  Immediately 
injected  48  grs.  of  the  Hemp.  At  half-past  8,  repeated  the  48  grs. 
The  patient  is  impressed  with  the  belief  that  he  will  die.  His  respi- 
ration is  26,  pulse  100  to  110  ;  lies  with  his  eyes  still  closed  and  his 
mouth  half  opened  ;  spasms  about  half  an  hour  apart. 

Half  past  10.  The  wound  has  healed,  and  the  patient  has  not 
complained  of  it  at  all  from  the  time  it  was  lanced.  Gave  |^  5  of 
tocacco  in  decoction  per  anum.  The  patient  cannot  be  roused  either 
by  calling  or  shaking  him.  In  a  few  moments  after  this,  he  vomited 
a  dark  colored  fluid.  Appears  to  be  sinking.  Injected  brandy* 
toddy  into  the  cBsophagus  through  a  catheter  past  into  the  nostril, 
but  it  was  returned  by  the  mouth.  At  half  past  12,  applied  electro- 
galvanism,  with  the  assistance  of  my  friends,  Messrs.  Martin  and 
Milligen,  students  of  medicine.  One  wire  was  placed  near  the 
occipito-spinal  junction,  and  the  other  to  the  sacrum.  It  operated 
for  fifteen  minutes,  and  agitated  convulsively  and  forcibly  all  the 
muscles.  The  effects  were  increased  activity  in  the  circulation, 
(pulse  160,)  relaxation  of  rigidity  in  the  muscles,  and  much  improved 
respiration.  " 

Halfpast3,  P.  M.  The  patient  unexpectedly  asked  for  water  
urged  hot  brandy-toddy  and  wine  upon  him,  hut  he  would  swallow 
only  a  little  water.  Pulse  150  respiration  38.  At  4,  gave  in 
enema  1    ti'nct.  assafcelida  and  1    tinct.  hemp,  in  a  little  water. 


1845.]  Acute  Traumatic  Tetanus,  631 


Tried  electro-galvanism  again,  but  found  the  patient  sinking  he 
died  quietly  at  6,  P.  M.  This  was  within  four  days  from  his  attack 
with  the  tirst  symptoms  of  lock-jaw.  He  retained  all  the  injections; 
and  I  find,  by  examining  the  bottle,  five  ounces  of  the  measured  pint 
of  the  tinct.  of  the  hernp  remaining.  I  estimate  the  quantity  admin- 
istered in  24  hours  to  he  near  6  5.  It  preduced  no  aphrodisiac  symp- 
toms he  once  asked  for  bread  ;  took  a  morsel,  but  did  not  swallow 
it.  At  another  time  he  called  for  chicken-soup.  Only  half  a  bottle 
of  Madeira  wine  and  about  the  same  quantity  of  brandy  were  con- 
sumed. 

With  regard  to  the  fact  that  there  were  complete  relaxations  of  the 
muscles  during  the  treatment  of  this  case,  I  think  I  am  positively 
certain.  That  those  of  the  lower  jaw,  neck  and  abdomen  indeed 
I  may  add  too  of  the  lower  and  upper  extremities  were  rigid  only 
at  certain  periods  during  the  spasmodic  contractions,  all  who  saw  the 
patient  will  admit.  The  pulsations  of  the  abdominal  aorta  were 
easily  counted  through  the  opening  of  the  umbilical  hernia.  The 
spasmodic  convulsions  recurred  at  first  every  ten  or  twenty  seconds, 
and  the  longest  intervals  were  about  half  an  hour.  They  more  fre- 
quently came  on  spontaneously,  or  in  the  natural  course  of  the  afiec- 
tion,  but  were  occasionally  excited  by  efforts  of  deglution,  &c.  the 
exacerbations  never  lasted  more  than  a  few  seconds.  The  tonic 
contractions  or  spasm  seem  to  start  convulsively  from  the  spinal 
column  and  agitate  the  whole  frame.  There  was  no  peculiar  action 
r  movement  in  the  leg  or  thiglj  of  the  wounded  foot.  His  bowels 
were  not  moved  during  the  whole  progress  of  his  attack,  to  the  fatal 
termination.  For  several  hours  he  passed  no  urine,  and  after  the 
first  evacuation,  it  would  be  squirted  forth  with  much  force,  and  be- 
fore the  vessel  could  be  prepared  to  receive  it.  His  face  and  neck 
were  bathed  in  perspiration  at  several  different  times,  but  at  other 
moments  was  of  natural  condition  in  this  respect.  He  sometimes 
asked  to  be  fanned,  but  never  complained  of  pain. 

I  believe  this  is  a  faithful  narration  of  all  the  phenomena  which 
transpired  during  the  progress  of  this  case.  And  though  the  con- 
clusion drawn  from  it  is  rather  ad i^erse  to  the  exalted  opinion  enter- 
tained  by  some  of  the  curative  powers  of  the  Cannabis  Indica  in 
acute  traumatic  tetanus,  still  if  it  can  give  only  relief,  it  is  certainly  a 
valuable  acquisition  in  the  treatment  of  this  almost  constantly  fatal 
disease.  As  the  opportunity  is  now  generously  ofl!ered  by  the  spirited 
editor  of  the  Boston  Medical  and  Surgical  Journal,  of  procuring  the 


632  Amputation  of  the  Limbs.  [November, 

article  from  the  original  source,  Calcutta,  ray  next  supply  will  be 
genuine,  whatever  doubt  may  arise  as  to  the  character  of  that  which 
has  just  been  employed. 

(Through  a  mistake,  I  regret  that  a   post-mortem   examination 
was  not  made.) 


PART  II. REVIEWS  AND  EXTRACTS. 

Amputation  of  the  Li.mhs,  in  consequence  of  gun-shot  wounds.  By 
M.  LisFRAXC  being  a  part  of  the  yet  unpublished  Treatise  of 
Operative  Medicine,  by  that  distinguished  Surgeon.  {Translated 
from  the  Bulletin  de  Thcrapeutique.) 

Gun-shot  wounds  are  among  the  most  frequent  of  the  causes  of 
amputation:  they  produce  very  often  comminuted  fractures;  they 
penetrate  often  into  the  articulations ;  they  cause  cpntusions  and 
lacerations  of  the  soft  parts  ;  the  bodies  put  in  motion  by  gun-powder 
convert  superficially  into  an  eschar  the  flesh  with  which  they  come 
in  contact.  When  a  projectile  has  removed  the  muscles  of  the  pos- 
terior part  of  the  thigh  for  about  two-thirds  of  their  length,  when  a 
wound  of  this  kind  occupies  the  gastrocnemial  muscles,  I  think  that 
it  is  necessary  to  amputate,  although  the  arterial  and  nervous  trunks 
may  not  have  been  sacrificed.  The  extent  of  the  solution  of  con- 
tinuity is  very  considerable ;  the  surface  presents  conditions  less 
advantageous  than  the  wound  resulting  from  an  amputation  :  the  for- 
mer will  cause  more  serious  accidents  than  the  second.  The  cutting 
instrument  will  indeed  produce  much  suffering,  but  if  we  do  not  have 
recourse  to  it,  the  gun-shot  wound  will  cicatrize  with  difficulty,  and 
in  (general  after  a  very  long  time,  the  cicatrix  will  be  profound,  ad- 
herent and  of  large  dimensions;  it  will  be  easily  lacerated;  the  loss 
of  substance  experienced  by  the  muscular  system,  will  embarrass  the 
movements  and  render  many  of  them  impossible.  1  have  seen  some 
subjects,  upon  whom  amputations  were  not  performed  after  wounds 
of  this  character,  and  the  slowness  of  the  cicatrization,  the  accidents 
which  preceded  it,  and  the  bad  result  obtained,  caused  much  regret 
that  the  limb  had  not  been  removed.  J>ut  should  the  wounds  of 
which  we  treat,  occupy  the  arm  or  forearm,  inasmuch  as  their  func- 
tions are  not  the  same,  I  think  that  an  operation  may  be  generally 
avoided. 


1845.]  Am-putation  of  the  Limbs.  033 


When  projectHes  have  reduced \(he  muscular  system  into  a  pulpy 
state  in  a  great  extent,  without  having  lacerated  the  skin,  the  patient 
ought  to  be  subjected  to  the. precepts  which  we  have  established,  and 
which  as  we  have  just  seen,  vary  in  different  localities. 

Amputation  is  especially  required  by  vast  solutions  of  continuity 
complicated  with  opening  of*  voluminous  vessels,  or  laceration  of  the 
nervous  trunks. 

We  should  recollect  that  on  the  field  of  battle,  in  the  camp,  we  are 
obliged  to  perform  amputations  much  more  frequently  :  the  opinions 
which  we  are  about  to  advance,  will  be  based  upon  facts  observed 
when  the  wounded  were  in  circumstances  to  receive  all  necessary 
care ;  these  opinions  would  be  essentially  different  in  the  contrary 
case. 

It  has  been  pretended  in  modern  works,  that  wounds  of  the  ariicu- 
lations  produced  by  a  ball,  were  less  serious  when  the  articulation 
had  not  been  largely  opened.  We  do  not  entertain  this  idea,  because 
the  fluids  furnished  by  the  solution  of  continuity  do  not  then  find  a 
ready  escape,  because  they  remain  between  the  wounded  articular 
surfaces  and  determine  much  irritation,  and  inflammation  almost 
always  fatal. 

Larrey  was  so  well  convinced  of  this  truth,  that  he  has  given  the 
advice  to  make  when  necessary  large  openings  to  prevent  the  de- 
tention of  pus.  Experience  has  sanctioned  this  excellent  practice 
in  the  hands  of  its  author,  and  I  have  adopted  it  often  with  success. 
When  the  projectile  opens  the  joints  largely,  without  occasioning  a 
too  considerable  loss  of  substance,  it  produces  then  a  solution  of  con- 
tinuity less  disadvantageous  than  if  it  were  narrow. 

But  is  it  necessary  to  resort  to  an  amputation,  when  an  articulation 
of  the  first  or  second  importance  has  been  opened?  Labastide  re- 
ports many  cases  which  shew  that  the  articulations  of  the  wrist, 
elbow,  foot  and  knee,  having  experienced  penetrating  wounds,  the 
patients  were  cured  without  the  removal  of  the  limb.  Dupuytren 
obtained  the  same  success  in  those  wounded  during  the  revolution  of 
July ;  Lombard,  Leveille,  Percy,  Faure,  &;c.  cite  facts  of  the  same 
kind.  It  is  said  that  these  cases  of  success  are  but  few  in  number, 
and  that  they  are  opposed  by  a  greater  number  of  cases  of  failure. 
This  assertion  is  not  exact  with  respect  to  the  practice  of  Dupuytren, 

I  always  suppose  the  patients,  I  repeat,  placed  under  favo,rable 
circumstances  as  I  have  above  stated,  and  I  maintain  that  by  employ- 
ing the  method  of  treatment  wluch  I  have  modified,  wounds  of  the 


634  Amputation  of  the  Limhs.  [November, 


articulations  should  very  seldom  require  amputatioBs,  unless  the  soft 
parts  surrounding  the  articulation  have  experienced  too  great  a  loss 
of  substance  :  of  this  I  have  given  the  proof  at  the  Hopital  de  la 
Pitie  and  at  the  hospital  of  Grenier-d'Abondance,  where  I  have  pre- 
served  limbs  for  a  great  number  of  patients  whose  scapulo-humeral, 
humero-cubital,  radio-carpal,  carpo-metacarpal,  tibio-femoral  and 
tarso-metatarsal  articulations,  had  been  profoundly  wounded. 

It  is  generally  believed  that  gun-shot  wounds,  although  produced  by 
a  ball,  almost  always  require  amputation,  if  the  body  of  a  long  bone 
and  more  particularly  of  the  inferior  limb,  has  experienced  a  commi- 
nuted fracture.  I  reject  this  precept;  my  opinion  is  based  upon  a  great 
numher  of  successful  cases  in  which  my  mode  of  treatment  was  employ- 
ed, and  without  which  1  am  certain  I  should  have  been  unsuccessful, 
like  the  practitioners  who  do  not  adopt  it.  Among  a  great  number  of 
facts,  the  following  may  he  cited  ;  but  let  us  premise  that  in  fractures 
with  solution  of  continuity  of  the  soft  parts,  the  detention  of  even  a 
small  quantity  of  pus  may  produce  general  accidents  of  a  very  se- 
rious and  often  fatal  character. 

Lieutenant-Colonel  Grand,  was  grievously  wounded  near  Grenier 
d'Abondance  ;  many  halls  riddled  his  arm,  and  the  humerus  was  frac- 
tured in  two  places.  Amputation  was  proposed  ;  I  did  not  entertain 
that  opinion  ;  I  employed  the  medication  above  indicated,  and  for 
ten  days  every  thing  announced  that  it  was  about  to  be  crowned 
with  complete  success.  Suddenly  a  severe  chill  supervened ;  the 
appetite  was  lost,  and  a  serious  gastro-enteritis  was  developed.  No 
error  of  regimen  had  been  committed  ;  the  tumefaction  had  some- 
what increased  in  the  unsound  limb,  and  also  the  pain.  I  believed 
that  all  these  accidents  depended  upon  the  presence  of  pus,  for 
which  I  sough  with  the  greatest  care.  I  recognized  a  slight  fluctu- 
ation, and  gave  issue  to  scarcely  two  tea-spoonfuls  of  purulent  matter 
 the  next  day  the  chill  did  not  return  ;  the  affection  of  the  intestinal 
canal  had  already  disappeared,  the  appetite  was  restored,  and  the 
arm  had  greatly  diminished  in  volume.  M.  Grand  was  cured,  and 
is  now  colonel  of  a  regiment  of  dragoons.  This  fact  alone  is  suffi- 
cient to  excite  the  attention  of  the  practitioner.  We  have  observed 
a  great  many  others  of  the  same  kind,  which  it  is  unnecessary  to 
cite.  It  is  hardly  necessary  to  say  that  by  an  early  evacuation  of  the 
pus,  the  local  and  general  accidents  which  it  produces,  are  dissipated 
even  with  rapidity,  but  that  if  on  the  contrary,  it  is  suffered  to  re- 
main, these  accidents  may  become  very  serious  and  often  fatal.     I 


1845.]  Amputation  of  the  Limbs.  635 


will  add,  (hat  amputation  then  oAen  becomes  indispensable,  and  that 
frequenlly  also  tlie  accidents  are  so  intense  and  rapid,  that  there  is 
no  opportunity  for  performin":  it. 

The  brave  Colonel  Lebeau  had  a  comminuted  fracture  of  the  arm 
at  its  superior  third,  tVom  a  ball  at  the  battle  of  Waterloo  ;  eighteen 
days  afterwards  he  came  to  Paris,  with  the  commencement  of  a  very 
vicious  callus;  I  broke  it  and  placed  the  fragments  in  very  regular 
contact,  and  the  fracture  was  cured  without  deformity. 

When  I  was  charged  at  the  Hotel  Dieu,  with  a  service  in  which 
were  the  soldiers  who  had  been  wounded  at  the  battle  given  under 
the  walls  of  the  capital,  Dnpuytren  and  myself  saved  from  amputa- 
tion six  patients  whose  arms  had  experienced  comminuted  fractures 
by  balls ;  in  two  of  these  subjects,  the  solution  of  continuity  of  the 
bone  occupied  the  middle  part  of  its  body,  in  three  of  them,  it  was 
observed  upon  the  inferior  third  of  the  humerus,  and  in  one,  a  little 
above  the  insertion  of  the  deltoid  muscle;  in  all  these  subjects  the 
suppuration  was  of  long  duration  ;  no  spicula  of  bone  was  extracted  ; 
four  were  cured  perfectiv,  \\ith  a  more  or  less  pronounced  shorten- 
ing of  the  limb,  two  left  the  hospital  with  fistulas  which  furnished  a 
small  quantity  of  purulent  m:itter  ;  one  of  them  returned  after  several 
years  to  show  me  his  wound,  wiiich  did  not  prevent  him  from  exer- 
cising the  business  of  a  jeweller;  sometimes,  however,  the  arm  was 
slightly  tumefied,  because  the  pus  remained  in  the  fistulous  passages. 
I  enlarged  their  orifices,  and  the  accidents  disappeared. 

But  when  the  thighbone  is  the  seat  of  a  comminuted  fracture,  it  is 
generally  believed  to  be  necessary  to  amputate.  Lombard,  IM.  Gaul- 
tier  de  Claubry,  S.  Cooper,  Percy,  Larrey  and  Guthrie,  say  that  they 
have  only  seen  a  few  patients  saved  ;  most  succumbed  when  the  limb 
was  not  ampiJtated  ;  Ravaton  assures  us  that  the  wound  of  which  we 
speak  is  almost  always  mortal  ;  M.  Ribes  has  not  met  with  a  single 
cure  ;  he  has  observed  ten  soldiers,  upon  whom  the  suitable  care  was 
bestowed,  and  they  all  perished  ;  he  adds,  that  in  four  thousand  sol- 
diers in  the  Hopital  des  Invalides,  he  has  never  seen  one  recover  after 
the  accident  of  which  we  speak.  We  should  remark,  however,  that 
with  the  exception  of  the  ten  soldiers  mentioned  by  M.  Ribes,  the 
others  appear  to  have  been  treated  in  the  army,  where  the  necessary 
means  for  the  care  of  the  wounded  are  almost  always  defective,  and 
where  these  unfortunates  are  ^.^nerally  transported  to  great  dij^tances 
in  unsuitable  veliicles  and  over  bad  roads;  the  reverses  which  were 
experienced  must  (hen  almost   necessarily  have  occurred.     It   has 


636  Amputation  of  the  Limbs.  [November, 

been  said  that  in  Paris  and  Belgium,  patients  do  not  suffer  for  the 
Avant  of  any  of  the  means  necessary  for  their  cure,  and  that  never- 
theless more  success  has  not  been  obtained  ;  but  I  do  not  think  that 
they  have  employed  the  mode  of  treatment  which  I  have  indicated^ 
and  by  whose  aid  we  may  almost  always  avoid  or  victoriously  combat 
inflammation.  I  believe  then,  that  in  the  accident  of  which  I  now 
speak,  amputation  of  the  thigh  ought  not  in  general  to  be  performed 
before  the  inflammation  is  developed,  and  before  we  have  acquired  the 
certainty  that  it  will  resist  a  well-directed  medication  ;  the  formula  of 
M.  Serres  d'Uzes  for  mercurial  ointment  should  not  be  forgotten. 
All  surgeons  know,  that  with  the  exception  of  phlebitis  and  the 
absorption  of  the  pus,  which  may  take  place  in  all  wounds,  inflam,- 
matory  engorgements  and  its  consequences  are  the  only  things  for- 
midable in  the  solutions  of  continuity,  of  which  we  treat.  I  cunfess, 
however,  that  my  opinion  is  not  yet  based  upon  a  sufficiently  great 
number  of  facts  ;  but  it  reposes  upon  analogies  furnished  by  the  thor- 
acic extremities,  whose  comminuted  fractures  caused  by  fire-arms 
and  treated  in  the  manner  which  I  have  stated,  are  almost  always 
unproductive  of  any  grave  accident. 

Dupuytren  has  cured  one  patient.  I  have  saved  several ;  I  have 
not  lost  one.  I  have  preserved  in  my  Surgical  Clinique  the  two  fol- 
lowing facts:  "I  cured  without  amputation,  at  the  Hopital  de  la 
Pilie,  two  patients  wounded  in  July,  1830;  one  had  received  a  ball 
which  caused  a  comminuted  fracture  of  the  femur  ;  the  other  had  a 
fracture  of  the  same  limb,  which  was  caused  by  a  bullet,  that  had 
also  caused  a  very  violent  contusion  for  a  pretty  considerable  extent ; 
no  accident  supervened;  the  constitutions  of  these  two  wounded  persons 
were  very  good  ;  their  internal  organs  were  in  an  excellent  condition, 
a  circumstance  which  ought  to  be  much  considered  in  determining 
the  question  of  an  amputation  or  of  the  preservation  of  the  limbs. 

I  also  shewed  this  morning  at  my  Clinique  at  the  Hopital  de  la 
Pitie,  a  patient  who  was  affected  in  1814  with  a  fracture,  with 
wound  and  spiculas  at  the  junction  of  the  superior,  with  the  middle- 
third  of  the  femur ;  a  complete  cure  was  obtained  in  the  course  of  a 
year,  without  a  fistula,  and  was  maintained  until  1835,  at  which 
period  the  patient  walked  very  well  and  experienced  no  other  incon- 
veniences, except  those  resulting  from  a  shortening  of  the  limb,  he  hit 
it  very  violently  against  one  of  the  corners  of  an  anvil,  and  there  su- 
pervened an  abscess,  of  which  he  was  cured. 

It  has  been  said  that  a  comminuted  fracture  of  the  femur,  produced 


1845.]  Amputation  of  the  Limbs,  637 


by  a  ball,  is  almost  always  followed,  when  it  is  cured,  by  fistulse  and 
engorgement  of  the  limb,  which  not  only  prevent  the  complete  exer- 
cise of  its  functions,  but  which  also  cause  eventually  the  death  ofthe 
subjects,  in  a  very  great  number  of  circumstances.  I  cannot  admit 
these  ideas;  I  have  had  the  honor  of  some  experience  in  military 
surgery ;  I  have  preserved  relations  with  officers  in  whom  the  fistulous 
passages  of  which  we  are  speaking,  persisted  ;  I  have  already  said, 
that  there  is  developed,  it  is  true,  from  time  to  time,  tumefaction, 
which  is  owing  to  the  presence  of  pus  in  the  substance  ofthe  tissues, 
but  which  disappears  when  the  fluid  is  extracted.  These  persons 
walk  very  well ;  the  suppuration  which  persists  in  a  small  quantity, 
incommodes  them  but  very  little ;  they  are  in  a  more  advantageous 
condition  than  if  they  had  been  subjected  to  amputation,  which  it  is 
hardly  necessary  to  say  is  too  often  falal. 

The  fistulas  of  which  we  treat,  may  be  complicated  with  even  a 
considerable  engorgement  of  the  limb  ;  sometimes  it  is  the  result  of 
the  inflammations  which  have  primitively  existed ;  at  other  times  it 
is  owing  to  phlegmasia  neglected  or  badly  treated,  and  occasioned 
by  the  presence  of  pus  retained  in  the  fistulous  passages ;  this  latter 
cause  may  be  prevented  by  maintaining  an  easy  escape  for  the  purulent 
matter.  In  all  cases,  we  have  been  in  the  possession  for  a  great 
many  years  of  powerful  means  to  combat  simple  indurations  ;  whe- 
ther by  the  aid  of  local  sanguine  evaluations  wisely  directed  when 
sub-inflammation  exists,  or  with  discutients  when  phlegmasia  is 
absent.  I  have  succeeded  by  following  this  treatment,  in  dissipating 
considerable  hypertrophies  of  the  thigh,  and  the  patients  afterwards 
walked  with  tolerable  facility. 

If  the  treatment  be  directed  by  surgeons  who  believe  in  the  in- 
contestable advantages  of  the  alliance  of  medicine  with  surgery, 
and  who  are  not  entirely  mechanical  in  the  exercise  of  their  profes- 
sion, it  seems  to  me  impossible  that  patients  should  succumb  in 
consequence  of  their  fistulae,  unless  their  constitutions  present  some 
irremediable  vitiation. 

A  soldier  experienced  a  fracture  of  the  right  thigh,  produced  by  a 
ball ;  the  solution  of  continuity  occupied  the  central  region  of  the 
bone  ;  amputation  was  not  performed  ;  the  bone  had  consolidated, 
but  there  remained  three  fistulas  which  penetrated  to  a  great  depth 
into  the  substance  ofthe  limb  ;  no  spicula  was  detected  by  the  probe, 
which  did  not  reach  to  the  osseous  tissue  ;  the  suppuration  was  abund- 
ant ;  the  induration  of  the  soft  parts  was  very  considerable  throughout 


638  Amputation  of  the  Limhs,  [November, 


almost  the  entire  extent  of  the  thigh  whose  volume  was  augmented 
by  one  third,  and  symptoms  of  sub-inflammation  existed.  I  employ- 
ed emollient  cataplasms  ;  I  applied  twelve  leeches ;  this  evacuation 
was  repeated  every  ten  or  fifteen  days,  according  to  the  strength  of 
the  patient,  and  the  progress  or  suspension  of  the  amendment. 
When  the  phlegmasia  disappeared,  and  the  disease  no  longer  contin. 
ued  to  diminish,  we  suffered  seven  days  to  elapse,  when  we  had 
recourse  to  discutients,  and  suspended  the  employment  ofthem  when 
they  caused  too  much  excitement  or  when  the  inflammation  returned. 
Five  months  were  sufficient  to  restore  the  limb  to  its  normal  volume  ; 
there  remained  no  induration  appreciable  by  the  touch  ;  the  pus  was 
formed  in  small  quantity,  and  the  patient  walked  tolerably  well 
when  he  left  the  hospital.  We  have  seen  this  man  for  several  years^ 
and  the  success  has  continued  about  the  same.  In  cases  of  this  kind, 
the  iodide  of  potassium,  administered  internally,  would  produce  ex- 
cellent effects.   

Captain  V.  received  at  the  battle  of  Waterloo  a  ball,  which  frac- 
tured the  femur  at  the  point  of  junction  of  its  superior  with  its  middle 
third ;  the  fracture  was  consolidated,  but  fistulas  persisted.  The 
patient  walks  sufficiently  well.  From  time  to  time  pus  is  retained, 
when  pain  and  difficulty  in  taking  exercise  ensue  ;  but  when  the  pur- 
ulent matter  is  evacuated,  the  tolerably  good  condition  which  we 
have  indicated  returns.  I  have  been  the  physician  of  Capt.  V.  for 
eight  or  ten  years. 

Two  or  three  times  a  year,  there  comes  to  my  consultation  an  old 
soldier,  whose  femur  has  been  fractured  about  an  inch  above  its  mid- 
die;  he  walks  almost  without  lameness,  and  has  two  fistulae,  one 
upon  the  anterior  and  the  other  upon  the  external  region  of  the  limb, 
which  is  slightly  atrophied,  although  there  exists  a  very  limited  indur- 
ation. He  sometimes  experiences  pain,  and  tumefaction  superverfes  ; 
he  has  learned  to  dilate  the  orifices  of  the  fistulous  passages  by  means 
of  prepared  sponge,  the  pus  escapes  and  the  accidents  disappear; 
incisions  are  very  rarely  employed. 

Let  us  say,  in  concluding,  that  if  fractures  caused  by  gun-shot 
wounds  are  complicated  with  laceration  of  the  principal  blood-vessels 
of  the  extremities,  it  is  advised  to  perform  amputation.  But  in  cases 
in  which  the  soft  parts  have  not  experienced  considerable  laceration 
or  loss  of  substance,  and  more  particularly  in  wounds  of  the  thoracic 
extremities,  may  not  an  opposite  course  be  pursued?  If,  indeed,  by 
the  method  of  tieutment  which  I  have  indicated,  we  succeed  almost 


1845.]  Amputation  of  the  Limbs.  639 


always  in  avoiding  or  in  combattinir  victoi  iouslv  acute  inflammation, 
woiilJ  not  the  ligation  of  the  bpened  artery  succeed,  though  we 
should  make  abstraction  of  the  various  kinds  of  apparatus  intended 
to  maintain  the  fragments?  We  know  that  many  fractures  are 
cured  without  this  apparatus,  and  that  frequently  the  callus  is  not 
too  tiisadvantageous  sometimes  even  it  is  not  too  irregular.  I  leave 
to  practitioners  the  care  of  meditating  upon  these  ideas. 

Guns  bursting  in  the  hand  ordinarily  produce  very  extensive 
wounds,  in  consequence  of  which,  however,  amputations  are  very 
rarely  performed  ;  the  flaps  which  cannot  live  are  removed,  the  sur- 
face  of  the  solution  of  continuity  is  made  as  smooth  as  possible,  and 
a  cure  almost  always  takes  place,  though  the  first  metacarpal  bone 
may  have  been  removed  with  the  thumb  though  the  articulations  of 
the  bones  of  the  carpus  with  each  other,  and  with  those  of  the  meta- 
carpus, may  have  been  more  or  less  opened.  I  have  seen  my  father 
obtain  very  great  success  in  c'rcumstances  of  this  kind.  I  should 
remark,  however,  that  he  practiced  in  a  very  healthy  climate,  where 
men  enjoyed  excellent  constitutions.  Would  it  not  be  possible  in 
cases  of  this  kind  to  avoid  an  amputation  of  the  fore-arm,  when  the 
disorders  in  the  radio-carpal  articulation  were  not  too  extensive? 
We  have  cited  above,  a  case  which  inclines  towards  the  affirmative 
of  this  question. 

Other  things  being  equal,  fractures  complicated  with  a  solution  of 
continuity  of  the  soft  parts,  and  occasioned  by  ordinary  causes,  are 
less  serious  than  those  produced  by  gun-shot  wounds  ;  they  offer  also 
less  danger  in  the  thoracic,  than  in  the  abdominal  extremities.  It  is 
often  very  difficult  to  distinguish  the  circnmstances  in  which  amputa- 
tion should  be  performed,  from  those  in  which  it  should  be  rejected. 
If  several  surgeons  are  assembled  to  decide  this  important  question 
with  respect  to  a  patient  who  is  before  them,  it  is  not  uncommon  to 
hear  them  pronounce  opinions  essentially  different.  Let  us  repeat, 
that  if  the  locality  be  advantageous,  if  tlie  patient  be  well  constitu- 
ted and  the  intestinal  canal  in  an  excellent  state,  if  his  moral  con. 
dilion  be  good,  if  the  animal  economy  be  not  tainted  with  any  virus, 
operations  should  be  more  rarely  performed  ;  for  in  the  favorable 
circumstances  which  we  have  just  indicated,  success  has  exceeded 
frequently  all  hope.  lam  fond  of  repeating,  to  young  surgeons  who 
have  pursued  their  studies  in  the  hospitals  of  large  cities,  that  they 
should  distrust  the  cases  and  observations  which  they  have  there  col- 
lected,  and  that  elsewhere  amputations  should  be  much  more  fre- 
quently rejected. 


640  Amputation  of  the  Limbs,  [November, 


When  the  principal  vessels  of  the  fractured  limb  are  divided  when 
there  exist  considerable  ecchymosis.and  sanguine  efTusion  when  the 
soft  parts  are  pretty  extensively  lacerated  or  contused,  and  the  arti- 
culation, either  of  the  shoulder  or  of  the  elbow,  or  of  the  wrist,  or  of 
the  hip,  or  of  the  knee,  or  of  the  foot,  with  the  leg,  is  opened,  it  is 
necessary  to  amputate.  But  when  the  large  vessels  have  been  spar- 
ed, when  the  large  joints  are  not  in  contact  with  the  air,  we  do  not 
have  recourse  to  the  removal  of  the  limb,  though  the  fracture  be  com- 
minuted, though  the  effusion  of  blood  be  pretty  considerable,  and 
though  the  soft  parts  be  lacerated  and  bruised  to  a  certain  extent. 
We  succeed  better,  I  repeat,  upon  the  arm  or  fore-arm,  than  upon 
the  thigh  or  the  leg.  I  have  frequently  applied  these  principles  at 
the  Hopital  de  la  Pitie,  and  all  know  the  great  success  which  I  have 
obtained.  A  patient  who  occupied  No.  14of  the  ward  Saint-Antoine 
of  our  hospital,  was  cured  of  a  fracture  of  the  inferior  third  of  the 
leg,  which  presented  the  following  circumstances:  obliquity  of  the 
osseous  solution  of  continuity  for  two  inches  upon  the  tibia,  which 
was  denuded  to  the  extent  of  about  two  inches  and  a  third  from  the 
tissues  which  should  have  covered  it;  the  superior  fragment  of  the 
bone  crossed  the  direction  of  the  inferior  one  and  was  lodged  at  the 
external  side  of  the  latter.  In  consequence  of  the  dimensions  of  the 
wound,  I  was  enabled  to  recognize  this  displacement.  I  produced  a 
relaxation  of  the  muscles ;  I  seized  the  former  of  these  fragments 
with  the  thumb,  and  index  and  middle  fingers ;  I  raised  it  at  first, 
and  then  carried  it  easily  inwards  and  a  little  backwards,  where  it 
remained  without  the  assistance  of  any  apparatus ;  the  limb  was 
only  maintained  in  a  semi-flexed  position  by  cloths  folded  like  a  cravat, 
and  disposed  transversely  upon  it.  I  will  remark  that,  before  I  had 
recourse  to  the  manoeuvre  which  succeeded  so  well,  it  had  been  im- 
possible for  me  to  reduce  the  fracture,  although  the  displacement 
longitudinally  was  very  slight,  and  although  I  had  employed  great 
efforts,  extension  and  counter-extension  having  been  established.  It 
would  be  useless  to  say,  that  the  soft  parts  had  been  extensively 
lacerated,  and  that  much  blood  had  been  effused  among  the  tissues. 
The  cure  certainly  did  not  take  place  without  deformity  of  the  limb  ; 
but  it  is  evident  that  the  subject  is  in  an  infinitely  more  advantageous 
condition  than  if  amputation  had  been  performed.  The  inflamma- 
tion and  tumefaction  were  slight,  and  a  counter-opening  was  made 
behind  the  fibula  to  flicilitate  tiie  escape  of  the  pus,  the  quantity  of 
which  was  inconsiderable.    General  bleeding  and  diet  were  employed, 


1645.]  Ampulalion  of  the  Limbs.  G41 


according  to  the  principles  upon  which  we  have  insisted.  I  combatted, 
victorioii!.'!}-,  a  delirium  which  was  very  violent  and  without  fever, 
with  musk  administered  internally  in  large  doses;  the  sulphate  of 
quinine  triumphed  promptly  over  the  extreme  prostration  which  had 
followed  the  exaltation  of  the  nervous  system. 

A  Professor  of  one  of  the  Colleges  of  Paris,  had  an  oblique  frac- 
ture of  the  inferior  third  of  the  leg,  with  laceration  of  the  soft  parts, 
to  a  great  extent ;  the  superior  fragment  projected  through  the  flesh  ; 
an  extensive  ecchymosis  existed.  A  surgeon,  attached  to  one  of  the 
hospitals  of  Paris,  had  already  proposed  the  removal  of  the  limb.  T 
was  called  I  did  not  entertain  that  opinion.  I  employed  my  method 
of  treatment ;  the  apparatus  was  not  applied  even  until  the  sixth  day ; 
no  accident  occurred  ;  the  cure  was  complete,  and  the  patient  does 
not  limp.  If  the  nature  of  this  work  permitted,  I  could  analyse 
here  the  cases  of  patients,  cured  without  amputation  at  the  Hopital 
de  la  Pitie,  though  their  limbs  had  been  crushed  by  the  wheels  of 
vehicles. 

When  the  fragment?  have  traversed  the  skin,  and  cannot  be  re- 
duced, in  consequence  of  the  narrowness  of  the  opening,  we  make  a 
suitable  enlargement  of  the  wound,  and  we  remove  that  part  of  these 
fragments  which  is  denuded  of  its  periosteum.  I  have  never  met 
with  cases  in  which  an  enlargement  of  the  wound  was  not  sufficient 
to  permit  the  reduction  of  the  fracture  with  the  assistance  of  appro- 
priate means. 

When  the  large  vessels  have  not  been  divided,  and  the  soft  parts 
do  not  present  a  too  extensive  laceration  and  attrition,  although  a 
large  articulation  is  opened,  I  think  that  it  is  not  necessary  to  ampu- 
tate. I  have  saved  the  limbs  of  persons  in  whom  the  articular  sur- 
faces of  the  elbow,  wrist,  (fcc,  had  been  exposed.  Would  the  same 
success  be  obtained  with  respect  to  the  knee,  and  tibial  and  tarsal 
articulations? 

Much  controversy  has  existed  respecting  the  questions  which  we 
have  just  discussed.  There  are  indeed  some  surgeons  who  have  col- 
lected numerous  facts  in  favor  of  the  preservation  of  the  limbs  there 
are  others  who  report  a  great  number  of  cases  in  favor  of  amputa- 
tion. I  think  that  opinions  would  be  less  discrepant,  and  that  per- 
haps even  all  dispute  would  be  ended,  if  medical  knowledge  was  more 
generally  diffused,  and  if  pre-conceived  ideas  or  a  spirit  of  exaggera- 
tion or  an  education  in  a  bad  school,  did  not  so  frequently  serve  as  a 
guide  to  the  physician.     Read,  indeed,  the  cases  which  have  been 

41 


642  Pathology,  <S^c.^  of  the  Urinary  Deposits.    [November, 


published,  and  you  will  see  that  in  the  majority  of  them,  truly  medi* 
cai  ideas  have  been  singularly  neglected.  "N. 


On  the  Pathology,  <^c.,  of  the  Urinary  Deposits.     By  Dr.  Golding 
Bird.  {Ranking's  Abstract.) 

Although  the  important  researches  of  Dr.  Golding  Bird  are  now 
somewhat  destitute  of  novelty,  having  been  some  time  since  embo- 
died in  the  pages  of  the  Medical  Gazette,  yet  we  think  that  we 
shall  be  conferring  a  benefit  upon  our  readers  by  reproducing  the 
more  important  portions  of  them  in  a  condensed  form,  especially  as 
the  publication  of  a  separate  and  most  valuable  work  on  "Urinary 
Deposits"  comes  within  the  limits  of  our  retrospective  labors.  We 
feci  convinced  that  the  brief  summary  which  we  shall  give  cannot 
fail  to  produce  the  desire  for  a  perusal  of  the  original  work :  

The  principal  pathological  conditions  of  the  urine  which  are  com- 
monly met  with  are  the  presence  of  uric  acid  and  the  urate  of  am- 
monia, the  oxalate  oflimcjof  the  phosphates,  and  of  certain  elements 
of  the  blood. 

URIC  ACID. 

Diagnosis  of  uric  acid  deposits.  Uric  acid  does  not  dissolve  by 
heat,  but  on  the  contrary  is  rendered  more  distinct  by  the  solution  of 
the  urate  of  ammonia  which  frequently  accompanies  it.  Hence,  in 
examining  for  this  deposit,  heat  the  urine  in  a  watch-glass;  the  uric 
acid  becomes  visible  as  the  urate  of  ammonia  dissolves.  Heated  with 
liquor  potassas,  the  uric  acid  dissolves.  With  nitric  acid  it  is  also 
dissolved  ;  leaving,  on  evaporation,  a  residue  of  a  beautiful  pink, 
which  becomes  purple  when  held  over  the  vapour  of  ammonia. 

Microscopic  characters.  The  original  form  of  the  uric  acid  crys- 
tal is  the  rhombic  prism.  In  order  to  observe  these  crystals,  allow 
the  urine  to  repose  in  a  tall  vessel,  decant  the  greater  portion,  and 
place  some  of  the  turbid  layer  into  a  watch-glass  and  warm  it  gently  ; 
remove  the  supernatant  liquor  by  a  pipette,  and  replace  it  with  dis- 
tilled water ;  the  crystals' then  become  distinct.  "All  that  is  then 
required,  is  to  place  on  the  stage  of  the  microscope  and  under  the 
watch-glass,  a  piece  of  black  velvet ;  by  means  of  a  condensing  lens, 
let  a  strong  light  be  thrown  upon  the  crystals ;  then  bring  the  object 
glass  into  proper  adjustment,  and  the  colour,  as  well  as  figure  of  the 
crystals,  will  become  beautifully  defined  on  the  black  ground." 

The  rhombic  form  is,  however,  frequently  replaced  by  others,  espe- 
cially by  the  square.  Sometimes  the  crystals  approach  the  figure  of 
a  fleur-de-lys,  at  others,  they  appear  as  flat  tables,  curiously  mark- 
ed with  longitudinal  strite,  giving  the  appearance  of  a  fimbriated 


1845.]  PaihoIogy,t^''C.,  of  the  Uriuanj  Deposits,  643 


edge.  The  coarse  sand,  which  is  of  a  red  or  deep  orange  color,  is 
crenerally  composed  of  cohering,  thick,  rhomboiual  prisms,  forming, 
indeed,  minute  calculi. 

Diagnosis  of  urate  of  ammonia.  These  deposits  vary  in  colour 
from  absolute  whiteness  to  a  pale  fawn  colour,  brick  red,  pink,  or 
purple.  The  deposit  does  not  appear  until  the  urine  has  cooled,  and 
disappears  on  the  application  of  heat.  If  urine  containing  this  de- 
posit be  placed  between  two  glasses  and  examined  with  the  micro- 
scope, it  is  found  to  be  cojnposed  of  myriads  of  minute  globules, 
forminfj  linear  masses,  or  delicate  stellate  figures. 

Circumstances  giving  rise  to  the  uric  acid  and  its  compounds, 
"  Excluding  all  abstract  theories,  whenever  an  excess  of  uric  acid,  or 
its  combinations,  occur  in  the  urine,  a  normal  quantity  of  water  being 
present,  it  may  safely  be  inferred  that  one  or  other  of  the  following 
states  exist :  

A.  Waste  of  tissues  more  rapid  than  )  Fever,  inflammation,  rheu- 
the  supply ^       matism,  phthisis. 

B.  Supply  of  nitrogen  in  the  food^  Excessive  indulgence  in  an- 
greater  than  is  required  for  the  repara-  [>  imal  food,  or  too  little  ex- 
tion  of  tissues J       ercise. 

c.  Supply  of  nitrogenized  food  not  in  '^ 
excess,  but  digestive  functions  unable  I  All  grades  of  dyspepsia, 
to  assimilate  it J 

D.  The  cutaneous  outlet  for  nitrogen-  "^ 

ized  excreta  being  obstructed,  the  kid-  !  All   diseases  attended  with 
ney  is  called  upon  to  compensate  for  [      arrest  of  perspiration, 
this  deficient  function J 

^  ^.  r  .1      1    1  'I  Blows,  and  strains  of  the 

E.  Lonxestion   of  the  kidnevs,  pro-         i          j-  r *i 

J        ,   ,    "^i       ,  .   'I         L      loins,  diseases  01  the  cren- 

duced   bv  local  causes I        .  i  . 

J       ital  apparatus. 

The  medical  treatment  of  this  condition  of  the  urine  must  be  based 
upon  the  due  discrimination  of  the  exciting  cause.  If  the  first  con- 
dition be  the  cause,  the  remedy  obviously  consists  in  the  withdrawal 
of  a  portion  of  the  animal  food,  or  aii  increase  in  the  amount  of  ex- 
ercise. Under  the  other  conditions  of  the  system  the  treatment 
resolves  itself  into  the  following  indications  :  

1.  Attention  to  the  functions  of  the  skin.  This  is  an  indication  of 
much  consequence.  Warm  clothing,  with  repeated  friction  by  means 
of  a  hair  glove,  removes  the  deposit  of  uric  acid  gravel.  The  warm 
bath,  and  still  better,  the  vapour  bath,  is  also  a  most  valuable  diapho- 
retic. The  latter,  is  conveniently  applied  in  private  practice  by 
means  of  Duval's  apparatus.  Actual  diaphoresis  is  by  no  means  ab- 
solutely necessary. 

2.  Restoring  the  tone  of  the  organs  of  digestion.  This  part  of  the 
treatment  of  calculous  affections  must  be  modified  by  the  peculiarities 
of  the  case,  and  is  identical  with  that  of  the  different  forms  of  dys- 


644  Pathology,  <^c.i  of  the  Urinary  Deposits.    [November, 


pepsia.  Great  relief  may  be  obtained  by  careful  attention  to  the 
bowels,  and  minute  doses  of  mercury,  as  a  grain  of  hyd.  c.  creta, 
with  three  grains  of  extract  conii,  given  three  times  a  day,  with  mod- 
erate  doses  of  the  carbonate  of  potash  in  infus.  serpentariae.  Gas- 
trodynia  and  pyrosis  may  be  met  with  half  grain  doses  of  argente 
nitras,  given  immediately  before  a  meal. 

3.  Remedies  which  act  as  solvents.  These  chiefly  consist  of  alka- 
lies and  their  carbonates  ;  the  biborate  and  phosphate  of  soda,  and 
benzoic  acid.  The  liquor  potassae  may  be  employed  in  half  drachm 
doses  thrice  a  day.  The  carbonate  of  potass  and  soda  are,  however, 
more  agreeable  forms,  and  of  these  the  bicarbonate  of  potass  is  to  be 
preferred.  The  latter  may  be  usefully  combined  with  citric  acid,  in 
the  proportion  of  grs.  V.  to  3ss.  of  the  bicarbonate,  dissolved  in  a 
tumbler  of  luke-warm  water.  This  mixture  evolves  enough  carbonic 
acid  to  be  "sparkling,"  and  is  taken  M'ith  readiness. 

It  is  to  be  remembered  that  some  persons  cannot  bear  the  free  u^e 
of  alkalies  without  suffering  severely  in  their  general  health.  Dr. 
Front  affirms  that  their  injudicious  use  may  lead  to  the  formation  of 
oxalic  acid. 

Other  solvents  are  the  biborate  and  the  phosphate  of  soda  ;  the 
latter  is  specially  recommended  by  Liebig  ;  the  dose  should  be  3j.  to 
5ss,  largely  diluted.  Dr.  Bird  states  that  he  has  administered  this 
drug  in  two  or  three  chronic  cases  of  uric  acid  gravel  with  great 
effect. 

The  benzoic  acid  has  likewise  been  much  praised  of  late,  having 
been  first  introduced  by  Mr.  Ure.  It  may  be  given  in  ten-grain 
doses,  dissolved  in  a  weakselution  of  phosphate  of  soda,  as  below  :  

R.    Sodsb  carb.  3jss. 
Acid,  benzoic!,  3ij. 
Sodse  phosphatis,  5ii^. 
Aquae  ferventis,  giv. 
AquaD  cinnamoni,  sviiss. 
Tinct.  hyoscyami,  3iv.     M.  ft. 
Sumat.  seger.  coch.  in  magna  ier  in  die. 

It  is  important  to  bear  in  mind,  that,  by  the  employment  of  reme- 
dies capable  of  dissolving  a  deposit  in  the  urine,  we  are  merely  pallia- 
ting, and  not  curing  the  disease.  Its  entire  removal  can  only  be 
accomplished  by  remedying  that  state  of  the  system,  or  of  a  par- 
ticular organ,  which  may  be  the  exciting  cause  of  the  calculous 
formation. 

PTJKPURINE. 

Urine  containing  this  substance  is  of  a  pink  or  purple  colour,  and 
of  variable  specific  gravity.  The  purpurine  is  deposited  in  conjunc- 
tion with  urate  of  ammonia,  where  that  product  is  in  excess,  and 
gives  to  it  a  deep  carmine  colour.     If  the  urine  be  evaporated  to  the 


1845.]  Pathologic  <^c,i  of  the  Urinary  Deposits.  645 


consistence  of  an  extract,  and  treated  with  alcohol,  it  yields  a  fine 
purple  tincture.  This  property  will  at  once  distinguish  the  colouring 
matter  from  that  of  blood,  for  which  it  might  otherwise  be  mistaken. 
Pathological  indications.  The  presence  of  purpurine  in  excess  is 
almost  invariably  connected  with  sotne  functional  or  organic  mischief 
in  the  liver,  spleen,  or  some  other  organ  connected  with  the  portal 
circulation.  It  is,  therefore,  in  its  lighter  shades,  a  common  occur- 
rence in  the  dyspepsia  of  the  intemperate.  Pink  deposits  are  almost 
constantly  present  in  cirrhosed  or  contracted  liver. 

OXALATE  OF  LIME. 

Dr.  Bird  was  the  first  to  point  out  the  frequent  occurrence  of  this 
deposit ;  neither  Prout,  (until  his  last  edition,)  nor  Rayer,  nor  Willis, 
have  given  to  it  the  importance  which  it  is  now  sufficiently  clear  that 
it  demands.  It  is,  according  to  the  observations  of  Dr.  Bird,  of  far 
more  frequent  occurrence  in  the  densely  populated  cities  than  the 
deposits  of  earthy  phosphates. 

Diagnosis  and  microscopic  characters  of  oxalate  of  lime.  To  ex- 
amine for  this  deposit,  allow  a  portion  of  urine,  passed  soon  after 
meal,  to  rest  in  a  glass  vessel  ;  decant  the  upper  fluid  six-sevenths; 
pour  a  portion  of  the  remainder  into  a  watch-glass,  and  warm  it  ' 
gently.  This  proceeding  removes  any  obscurity  arising  from  the 
presence  of  urate  of  ammonia.  Having  then  allowed  the  urine  to 
repose  for  a  few  minutes,  remove  the  greater  portion  of  the  fluid  with 
a  pipette,  and  replace  it  with  distilled  water.  A  while  glistening 
powder  will  now  become  visible,  which,  under  a  low  magnifying 
power,  is  found  to  consist  of  octohcdral  crystals  of  oxalate  of  lime. 
These  crystals,  ignited  on  platinum  foil,  give  a  residue  of  carbonate 
of  lime.  The  octohedral  is  the  ordinar\^  shape  of  the  crystals,  but 
the}'^  sometimes  assume  other  forms,  the  most  usual  of  which  is  that  of 
a  dumb-hell. 

A  very  constant  phenomenon  observed  in  the  microscopic  examin- 
ation of  oxalic  urine,  is  the  presence  of  epithelial  scales.  So  constant, 
indeed,  is  this  occurrence,  that  the  presence  of  the  latter  has  fre- 
quently led  to  the  suspicion  of  the  presence  of  oxalate  of  lime. 

Pathological  origin  of  oxalate  of  lime.  This  is  a  question  of  very 
great  interest.  It  is  scarcely  possible  to  avoid  being  impressed  with 
the  probable  physiological  connection  between  this  matter  and  the 
presence  of  sugar.  It  is  indisputable,  that  saccharine  matter  finds  its 
way  to  the  blood  under  certain  circumstances,  and  is  eliminated  by 
the  kidneys;  and  vve  know  that,  under  certain  morbid  influences, 
the  blood  may,  while  in  the  stomach,  be  rapidly  converted  into  suo^ar, 
and  pass  by  the  kidneys  as  an  effete  matter.  Recollecting,  also,  the 
facility  with  which  sugar  and  its  chemical  allies,  as  gum,  starch,  &;c., 
are,  under  the  influence  of  oxydizinjr  agents,  converted  into  oxalic 
(icid,  we  are  tempted,  with  Dr  Prout,  to  the  conclusion  that  the 
oxalate  of  lime  owes  its  origin  to  sugar. 

i)r.  Bird,   however,  has  observed   in  oj)position  to  this  opinion  :  


646  Pathology,  i^'C,  of  the  Urinary  Deposits.    [November, 


1.  That  in  the  urine  oxalate  of  lime  is  diffased  through  the  fluid,  and 
in  a  crystalline  form.  2.  That  the  urates  are  in  excess  in  the  ma- 
jority of  cases.  3.  That  in  all  there  is  more  urea  than  in  healthy 
urine  of  the  same  density.  4.  That  there  is  frequently  an  excess  of 
the  phosphates  attending  the  oxalate  of  lime.  5.  That  no  evidence 
of  free  sugar  has  occurred  in  the  specimens  submitted  to  examination. 
Now,  in  diabetes  there  is  seldom  an  excess  ot'urea  or  the  urates,  the 
increased  specific  gravity  depending  solely  on  the  presence  of  sugar. 
Thus  so  far  as  the  abstract  examination  of  the  urine  is  concerned,  no 
countenance  is  given  to  the  idea  of  there  being  any  relation  between 
oxalic  p.nd  saccharine  urine.  What  then  is  the  source  of  the  oxalate 
of  lime? from  the  symptoms  alone  which  accompany  the  deposit, 
there  can  be  no  doubt  of  the  existence  of  serious  functional  derange- 
ment of  the  digestive  organs,  especially  of  the  stomach,  duodenum, 
and  liver.  Whatever,  therefore,  be  the  immediate  agent  which  cau- 
ses the  kidneys  to  secrete  oxalic  acid,  the  primary  cause  must,  as 
shown  by  Dr.  Prout,  be  referred  to  the  digestive  apparatus.  It  must 
be  recollected,  also,  that  an  excess  of  urea,  and  often  of  uric  acid,  in 
most  instances  accompanies  oxalic  urine  ;  it  is  probable,  therefore, 
that  both  these  products  are  the  result  of  the  same  morbid  influence  ; 
and  when  the  close  chemical  relation  between  urea,  uric,  and  oxalic 
acid,  is  borne  in  mind,  is  it  not  a  legitimate  conclusion  that  the  dis- 
ease under  consideration  is  a  variety  of  azoturia,  in  which  the  vital 
chemistry  of  the  kidney  converts  part  of  the  urea,  or  the  elements 
%vhich  in  health  would  have  formed  urea,  into  oxalic  acid? 

Symptoms  accomj^anying  the  secretion  of  oxalic  acid.  As  a  gene- 
ral rule,  persons  aflected  with  oxalic  urine  are  remarkably  depressed 
in  spirits,  and  exhibit  a  peculiarly  melancholy  aspect.  Dr.  Prout 
mentions  a  lurid  tinge  on  the  skin.  They  are  generally  emaciated, 
hypochondriacal,  and  irritable  in  temper.  The  sexual  power  in  men 
is  deficient  or  absent.  There  is  usually  a  constant  pain  or  sense  of 
weight  in  the  loins,  with  great  derangement  of  the  assimilative  pow- 
ers. [To  these  may  be  added,  according  to  Dr.  Bence  Jones,  fre- 
quent desires  to  micturate  ;  the  urine  in  some  cases  being  scanty,  at 
others  profuse  in  quantity.] 

The  most  common  exciting  causes  appear  to  be  exposure  of  the 
lower  part  of  the  spine  to  cold,  mechanical  violence  in  the  same  re- 
gion, and  unnatural  excitement  of  the  sexual  organs,  as  is  shown  by 
the  frequent  concomitant  of  involuntary  seminal  emissions.  In  ma- 
ny cases  there  v.-as  no  obvious  cause  beyond  mental  anxiety  and 
attention  to  business. 

Therapeutical  indications.  The  treatment  in  the  majority  of 
cases  is  very  successful.  As  a  general  rule,  all  the  functions  of  the 
body,  when  obviously  imperfect,  should  be  corrected;  the  skin 
should  be  protected  by  flannel  ;  and  the  diet  carefully  regiilated. 
This  should  consist  of  well-cooked  digestible  food,  of  vegetable  and 
animal  subslances  ;  all  things  wliich  tend  to  produce  flatulence  being 
carefully  avoided.     Beer  and  wine  should  not  be  allowed,  especially 


1815.]  Pathology,<^c.,of  the  Urinary  Deposits.  647 


the  former.  If  some  stimulus  be  required,  the  best  is  weak  brandy 
and  water.  The  nitric  acid,  or  the  nitro-muriatic  acid  in  infus. 
gentianae,  if  continued  sufficiently  lonrr,  will  generally  be  found  suc- 
cessful. In  cases  where  these  have  failed,  active  tonics,  especially 
the  sulphate  of  zinc,  or  if  the  patient  be  anemic,  the  salts  of  iron, 
appear  to  be  of  great  use,  as  is  likewise  the  shower-bath.  There  is 
one  remedy  which  appears  to  exercise  a  marked  influence  over  the 
characters  of  the  urine,  and  which  holds  out  great  promise  of  utility 
inoxyluria  this  is  colchicum.  In  two  instances  in  which  oxalate  of 
lime  existed  in  abundance  before  its  employment,  uric  acid  reappear- 
ed and  replaced  the  oxalic  acid  in  a  few  days. 

EARTHY  PHOSPHATES  AXD  CARBONATE  OF  LIME. 

Diagnosis.  The  earthy  salts  are  always  white  unlesss  coloured 
with  blood  ;  they  are  soluble  in  dilute  hydrochloric  acid,  and  insolu- 
ble in  ammonia  or  liquor  potassa?.  Heat  does  not  clarify  the  urine. 
The  chief  errors  in  diagnosis  arise  from  the  presence  of  mucous  and 
pus  in  the  urine,  which  mask  the  chemical  character  of  the  earthy 
deposit. 

The  physical  appearance  of  these  deposits  is  variable;  where  it 
consists  chiefly  of  the  triple  phosphates  it  subsides  as  a  white  crys- 
talline gravel,  or  if  the  quantity  be  small  it  appears  on  the  surface  of 
the  urine  in  the  form  of  an  iridescent  pellicle.  At  other  times  the 
phosphates  will  fall  to  the  bottom  like  a  dense  cloud  of  mucus,  or 
hang  in  ropy  masses  so  similar  to  that  product  as  not  to  be  dis 
tinguished  from  it  by  the  naked  eye. 

The  urine  which  deposits  these  salts  is  not  necessarily  alkaline  ; 
it  is  pale,  secreted  in  large  quantities,  and  of  low  specific  gravity 
(1*005  1'014.)  In  the  ease  in  which  the  iridescent  pellicle  ap- 
pears, there  is  usually  present  a  form  of  irritative  dyspepsia,  but  this 
is  merely  a  functional  and  not  an  organic  derangement,  the  urine 
being  often  of  high  specific  gravity  (1-020  1*030,)  and  containing 
an  excess  of  urea.  At  other  times,  the  urine  is  deep  brown,  fcEtid, 
generally  alkaline,  and  loaded  with  ropy  mucus,  in  which  the  crystals 
of  the  triple  phosphate  will  be  discovered. 

Pathological  indications.  These  deposits  always  denote  a  serious 
state  of  things,  being  generally  indicative  of  severe  functional,  and 
oftentimes  of  organic  mischief.  They  always  co-exist  with  a  de- 
pressed state  of  nervous  energy,  which  is  often  generally  and  more 
rarely  local  in  its  seat.  Of  the  former  we  have  instances  in  the  wear 
and  tear  of  body  and  mind  in  old  people  ;  of  the  latter  in  injury  to  the 
spine.  The  occurrence  of  the  triple  salt,  unconnected  with  deposit 
of  phosphate  of  lime,  exhibits  the  least  alarming  course  of  events.  It 
is  generally  in  these  cases  signalized  by  irritability  of  temper,  rest- 
lessness, uncertain  appetite,  and  fatigue  on  slight  exertion. 

In  the  milder  cases  of  indiij;estion,  especially  in  gouty  habits,  the 
phosphates  appear  in  the  form  of  the  pellicle  before  mentioned. 
This  condition  of  tiie  system  is  disinclined  to  the  formation  of  stone, 


648  Pathology,  <SfC.,nfihe  Urinary  Deposits.     [November, 


but  is  rather  to  be  regarded  as  an  index  of  the  state  of  the  assimilative 
functions.  A  valuable  diagnostic  mark  in  these  cases,  in  contra- 
distinction to  those  where  organic  mischief  is  to  be  apprehended, 
consists  in  the  fact  that  in  the  slighter  cases  the  phosphates  appear 
only  in  the  urine  passed  at  night. 

The  triple  salt  likewise  appears  in  the  urine  of  very  old  people, 
especially  if  they  have  been  deprived  of  the  ordinary  comforts  of  life, 
and  occasionally  also,  as  has  been  noticed  by  Simon,  in  acute  dis- 
eases, as  pneumonia  and  pleurisy,  at  a  time  when  convalescence  has 
barely  commenced. 

In  those  cases  in  which  the  phosphates  appear  in  the  form  of 
strings  resembling  mucus,  the  two  classes  of  salts  are  usually  found 
mixed.  The  urine  is  then  almost  invariably  alkaline,  and  more  or 
less  foetid.  The  prognosis  is  always  unfavorable  in  such  instances, 
as  either  organic  disease  of  the  urinary  apparatus,  or  some  serious 
lesion  of  the  spinal  marrow,  is  almost  invariably  to  be  suspected. 

Therapeutical  indications.  In  considering  the  treatment  of  the 
phosphatic  diathesis,  as  it  is  sometimes  called,  four  different  patho- 
logical conditions  are  to  be  taken  into  account,  each  of  which  is  de- 
monstrated by  a  separate  process  of  symptoms. 

A.  Cases  in  which  dyspepsia,  with  some  febrile  and  nervous  irrita- 
tion, exists  independently  of  any  evidence  of  antecedent  injury  to 
the  spine. 

B.  Cases  characterized  by  high  nervous  irritability,  with  a  varying 
amount  of  marasmus,  following  a  blow,  or  other  violence  inflicted  on 
the  spine,  but  without  paralysis. 

c.  Cases  in  which  the  phosphatic  urine  co-exists  with  f>araphlegia, 
results  of  spinal  lesion. 

D.  Cases  of  diseased  mucous  membrane  of  the  bladder. 

Of  these  it  will  be  only  necessary  to  direct  attention  to  the  first, 
second,  and  fourth  series  of  cases,  as  in  the  third  the  deposition  of 
phosphates  is  a  mere  symptom  of  a  serious  lesion,  which,  whether  the 
result  of  violence,  or  of  insidious  disease,  must  be  treated  according 
to  the  particular  disease  existing. 

The  first  class  of  cases  indicative  of  the  presence  of  irritative 
dyspepsia  is  by  no  means  uncommon.  The  treatment  must  be  di- 
rected rather  by  general  principles  than  limited  to  the  solution  of 
the  phosphates.  The  exliibition  of  acids  is  merely  palliative,  and 
rather  does  harm  in  some  cases,  by  masking  an  important  symptom, 
while  the  'fons  et  origo  mali'  still  continues  in  full  force.  After  a 
certain  attention  to  the  moral  bearings  of  the  case,  our  principal 
attention  should  be  given  to  the  re-esfablishment  of  the  general 
health.  The  bowels  are  to  be  regulated  l>y  mild  mercurial  laxatives, 
active  purging  being  striclly  avoided.  When  this  has  been  accom- 
plished, the  following  combination  will  be  of  use:  Tine  hyoscyami, 
et  Sp.  ammon.  aromat.  aa  T^lXX,  et  Misfur.  gent.  c.    j.  Should 
gastrodynia  exist,  great  relief  will  be  obtained  by  the  administration 
of  the  oxyde  of  silver  in  halfgrain  doses.      As  the  patient  apprcachts 


1945.]  Pathology f  <^^c.f  of  the  Urinary  Deposits,  G49 


convalescence,  considerable  benefit  will  be  derived  from  the  sulpliate 
of  zinc  in  increasing  doses,  till  four  or  five  grains  are  taken  thrice 
in  the  day. 

The  second  form  of  the  disease,  which  is  characterized  by  a  higher 
amount  of  nervous  excitability,  and  by  rapid  emaciation,  is  more 
rare,  but  less  amenable  to  treatment  than  the  preceding.  In  this 
form  the  deposit  is  copious,  and  sometimes  consists  nearly  exclusively 
of  the  phospfiate  of  hme.  The  symptoms  are  lumbar  pain,  dry 
skin,  red  and  varnished  tongue,  great  thirst,  and  other  symptoms 
closely  resembling  diabetes.  The  history  generally  affords  some 
evidence  of  a  strain  or  hurt  of  the  back. 

In  the  treatment  of  these  cases,  our  chief  aim  must  be  to  tranquil- 
lize  the  brain  and  nervous  system  by  narcotics,  as  opium  or  morphia, 
as  was  first  suggested  by  Dr.  Prout,  after  which  a  generous  diet, 
With  the  mineral  tonics,  as  bismuth,  zinc,  or  silver,  are  called  for. 

In  some  cases  the  symptoms  are  of  a  milder  character,  but  there 
is  a  great  tendency  to  the  formation  of  a  calculus :  it  is  in  these 
cases  that  acids  are  called  for,  but  there  is  much  uncertainty  attend- 
ing their  use.  The  nitric  appears  the  most  serviceable;  and  the 
benzoic  as  recommended  by  Mr.  lire  may  be  occasionally  beneficial ; 
but  Dr.  Bird  puts  but  little  faith  in  either,  especially  the  lattef. 

The  third  class  of  cases,  in  which  the  phosphates  are  in  all  pro- 
bability secreted  by  the  unhealthy  mucous  membrane  of  the  bladder 
are  familiar  to  all,  as  frequently  following  chronic  cystitis,  retention 
of  urine,  from  stricture  and  enlarged  prostate.  Here  of  course  the 
primary  disease  must  be  treated,  and  not  the  mere  symptom.  It  is 
in  this  form  in  which  much  good  occasionally  follows  the  injection  of 
dilute  acid  into  the  bladder.  An  interesting  case,  in  which  this  mode 
of  treatment  was  completely  successful  after  every  other  plan  had 
failed,  is  related  by  Dr.  Bird,  to  whose  work  we  refer,  as  our  space 
will  not  allow  of  its  extraction.  Deposits  of  carbonate  of  lime, 
and  silicic  acid  are  occasionally  met  with,  but  not  sufficiently  often 
to  render  their  notice  of  any  great  importance. 

ALBUMINOUS    URINE. 

Detection  of  albumen.  As  a  general  rule,  if  urine  becomes  opaque 
by  heat,  and  on  the  addition  of  nitric  acid,  albumen  is  present;  but 
if  one  of  these  tests  alone  be  employed,  there  is  the  possibility  of 
being  misled  by  the  following  sources  of  fallacy  :  

1.  Heat  will  produce  a  white  precipitate  in  urine,  containing  an 
excess  of  the  earthy  phosphates.  This  is  dislingtiished  from  albu- 
men by  disappearing  on  the  addition  of  a  drop  of  nitric  acid. 

2.  Ileat,  when  applied  to  urine  containing  deposits  of  urate  of 
ammonia,  will  sometimes,  if  actual  ebullition  be  prolonged,  produce 
a  deposit  of  an  animal  malter  insoluble  in  nitric  acid.  But  this  ap- 
pearance is  rare,  and  is  distinguished  from  albumen  by  being  depo- 
sited only  after  protracted  ebullition. 

3.  Nitric  acid  will  produce  deposits  in  the  urine  of  persons  who 


650  Treatment  of  Traumatic  Tetanus.         [November, 


are  taking  cubebs  or  copaiba  ;  this  is  distinguished  by  notbeing pro- 
duced by  heat. 

4.  Albumen  may  be  present,  and  yet  not  be  precipitated  by  heat, 
if  the  urine  be  alkaline  ;  nitric  acid  must  be  used  in  this  case  as  a 
test, since  albumen  combined   with  alkalies  is  not  affected  by   heat. 

Therapeutic  indications.  When  albumen  is  the  only  constituent 
of  the  blood  present  in  the  urine,  the  treatment  will  vary,  accordingly 
as  the  kidney  is  merely  congested  or  is  structurally  affected.  [The 
treatment  of  the  latter  is  not  here  alluded  to,  but  the  reader  is  refer- 
red to  the  works  of  Blight,  Christison,  &;c.  The  management  of 
the  congested  kidney,  as  it  occurs  in  the  dropsy  of  scarlatina,  is  thus 
described  :]  The  warm  bath  is  the  most  valuable  prophylactic  re- 
medy. I  scarcely  recollect,  even  in  a  large  experience,  a  case  of 
dropsy  after  scarlet  fever,  when  the  warm  bath  has  been  daily  used  as 
soon  as  the  skin  has  begun  to  exfoliate,  and  continued  until  a  per- 
spiring healthy  surfc\ce  was  obtained.  When  anasarca  has  occurred, 
strict  confinement  to  bed  must  be  enjoined,  the  warm  bath  used 
twice  a  week,  and  free  action  of  the  skin  encouraged.  This  plan 
must  be  continued  until  all  anasarca  has  vanished,  and  the  urine  is 
free  from  albumen.  When  this  has  taken  place,  the  ammonio-tartrate 
of  iron  and  more  liberal  diet  will  speedily  remove  the  anaemic  condi- 
lion  of  the  patient. 

BLOODY  URINE. 

The  presence  of  the  blood-globules  in  the  urine  may  be  recognised 
by  the  microscope.  The  treatment  will  vary  according  to  the  imme- 
diate cause  of  the  hemorrhage.  Absolute  rest,  cold  to  the  loins,  the 
mineral  acids,  and  acetate  of  lead  administered  boldly,  and  for  a 
short  time,  are  our  principal  remedies.  No  remedy  has,  however, 
appeared  to  Dr.  Bird  so  efficacious  in  the  treatment  of  hsematuria  as 
the  gallic  acid.  It  should  be  given  in  five  grain  doses  with  mucil- 
age  and  tincture  of  hyoscyamus. 


Treatment  of  Traumatic  Tetanus.    By  James  Miller,  Esq.,  Profes- 
sor of  Surgery  in  the  University  of  Edinburgh.  {Braithwaite) 

The  case  which  calls  forth  the  following  comments,  by  Mr.  Mil- 
ler, was  that  of  a  girl  of  seven  years  of  age.  We  refer  to  it  in  this 
place  chiefly  to  show  the  value  of  the  Indian  Hemp  in  its  treatment. 
The  wheel  of  a  cart  had  passed  over  the  middle  finger  of  the  right 
hand,  and  of  course  had  inflicted  a  severe  injury.  Tetanus  gradual- 
ly made  its  appearance. 

The  peculiar  risus  had  begun  ;  the  jaws  were  clenched  ;  the  mas- 
seters  and  temporals  were  tense  and  hard,  and  the  seat  of  much  pain  ; 


1315.]  Treatment  of  Traumatic  Tetanus.  651 


the  limbs,  especially  the  upper,  were  becoming  rigid;  the  abdominal 
parietes  were  hard  ;  the  least  exertion,  such  as  endeavoring  to  open 
the  mouth,  and  show  the  tongue,  induced  ag^jravation,  with  marked 
opisthotonos  ;  and  then,  too,  pain  was  complained  of,  not  only  in  the 
jaws,  but  in  the  back.  The  finger  had  never  promised  well  for  sat- 
isfactory recovery ;  and  I  had  no  doubt  as  to  the  propriety  of  its 
immediate  sacrifice ;  being  well  aware,  that  although  in  it  resided 
the  exciting  cause  of  the  formidable  train  of  symptoms  fast  setting 
in,  yet  that  removal  of  this  could  be  expected  to  prove  beneficial, 
only  at  a  very  early  period  of  the  case,  ere  the  spinal  cord  had  been 
all  but  irretrievably  involved.  Amputation  was  accordingly  per- 
formed, with  as  little  delay  as  possible,  at  the  metatarso-digital  arti- 
culation. Little  pain  was  complained  of;  and  blood  flowed  but  spar- 
ingly. I  abstained  from  deligation  of  any  vessels  ;  partly,  because  a 
moderate  loss  of  blood  might  not  be  without  its  use,  at  this  the  com- 
mencement of  the  treatment ;  but  chiefly,  because  I  was  anxious,  by 
avoidance  of  the  use  of  ligature,  to  leave  the  wound  in  as  favourable 
a  state  as  possible  free  from  al!  source  of  further  irritation.  For  a 
like  reason,  no  stitches  were  employed;  sufficient  approximation  be- 
ing effected  by  tying  the  adjoining  fingers  together  by  a  slip  of 
bandage. 

Water  dressing  was  applied,  and  20  drops  increased  to  30  drops 
of  the  tincture  of  Indian  hemp  every  hour  or  two,  were  administered. 
The  further  account  and  result  of  the  case  will  be  best  seen  in  the 
following  remarks  by  Mr.  Miller. 

Perhaps  the  first  questions  which  present  themselves,  in  regard  to 
the  foregoing  case,  are  was  this  an  example  of  acute  tetanus?  or 
was  it,  from  the  beginning,  of  the  chronic  character  ?  According  to 
my  own  conviction,  I  have  no  hesitation  in  answering  the  former 
question  affirmatively  :  and  the  latter,  by  a  negative.  And  this  I  do 
on  the  following  grounds  :  1st,  The  case  was  traumatic  :  the  affec- 
tion following  a  wound,  is  usually  acute.  And,  in  this  instance,  the 
accession  was  at  the  usual  time,  and  in  the  usual  way.  2nd,  The 
symptoms,  at  first  severe,  gradually,  yet  very  perceptibly,  gave  way 
before  the  treatment  employed.  The  trismus,  opisthotinos,  and 
rigidity  of  the  upper  extremities,  as  well  as  of  the  abdominal  muscles, 
were  at  first  great,  and  underwent  frequent  and  cruel  exacerbation  ; 
and  these  aggravations  were  induced  by  the  slightest  exciting  cause. 
Rigidity  gradually  relaxed  ;  and  the  exacerbations  became  less  pain- 
ful, less  frequent,  and  less  easily  induced.  3rd,  During  a  temporary 
interruption  of  the  treatment,  the  symptoms  threatened  to  return  to 
their  original  severity ;  and  again  yielded  to  the  resumption  of  the 
appropriate  remedial  means. 

Then,  as  to  the  treatment-  For  some  time  I  have  been  satisfied 
that  in  the  treatment  of  traumatic  tetanus,  the  most  likely  means  of 
relief  are  to  be  found  1st,  In  early  amputation  of  the  irijured  part, 


653  Treatment  of  Traumatic  Tetanus.  [November, 


or  isolation  of  it  from  the  general  nervous  system  by  suitable  incision 
on  the  cardiac  aspect ;  2nd,  In  effectual  and  early  evacuation  of  the 
bowels,  and  maintenance  of  free  movement  in  them  ;  3id,  In  main- 
taining a  sedative  effect  on  the  nervous  centre  implicated  in  the  dis- 
ease, by  cold  applied  to  the  spine  ;  4th,  In  the  continued  use  of  some 
one  remedy  calculated  to  allay  muscular  spasm  perhaps,  aconite, 
Indian  hemp,  or  tobacco;  5lh,  In  careful  administration  of  nourish- 
ment, so  as  to  husband  the  strength  as  much  as  possible  ;  6th,  In 
maintaining  quietude,  and  avoiding  all  excitement  likely  to  induce 
aggravation  of  the  spasm. 

1.  As  already  stated,  there  could  be  no  doubt  as  to  the  propriety 
of  amputating  the  offending  part  in  this  case;  and  the  operation  was 
accordingly  performed,  as  soon  as  the  tetanic  symptoms  were  fairly 
declared.  The  comparative  absence  of  pain  and  bleeding,  during 
the  incisions,  was  characteristic  of  the  disease.  The  nerves  of  the 
removed  finger  were  examined  by  Mr.  John  Goodsir,  and  found  im- 
bedded in  dense  inflammatory  exudation  themselves  expanded  in 
bulk,  and  presenting  the  appearance  of  considerably  increased  vascu- 
larity. Were  a  similar  case  of  injury  to  present  itself,  with  like  ten- 
dency to  spasmodic  flexion  of  the  parts  implicated,  I  should  be 
inclined  to  regard  that  symptom  as  ominously  premonitory,  and  should 
feel  called  upon,  by  early  amputation,  to  sacrifice  the  part,  even 
though  it  might  otherwise  afford  good  prospect  of  its  own  recovery. 

2.  The  first  prescription  was  a  full  dose  of  calomel  and  jalap,  while 
the  power  of  swallowing  was  yet  comparatively  free.  It  answered 
well,  bringing  away  much  foetid  and  dark-colored  matter  from  the 
bowels,  as  usually  happens  in  such  cases.  Sufficient  action  was  af- 
terwards maintained  by  enemata,  containing  turpentine  and  tincture 
of  assafoetida.  During  convalescence,  a  marked  perversion  of  the 
intestinal  secretions  persisted,  and  was  got  rid  of  only  by  a  corres- 
ponding continuance  in  the  use  of  alterative  aperients. 

3.  Since  the  perusal  of  a  case  of  hydrophobia,  treated  by  Dr.  Todd, 
of  King's  College,  London,  and  published  in  the  Lancet,  No.  960, 
p.  583,  I  have  felt  very  hopeful  of  ice  applied  to  the  spine,  as  a  reme- 
dial agent,  not  only  in  that  disease,  but  n)ore  especially  in  tetanus. 
And  I  was  determined  to  make  trial  of  it  on  the  first  opportunity. 
Its  action  is  obviously  sedative  on  the  nervous  system  ;  powerlully 
and  directly  so.  So  soon  as  circumstances  permitted,  it  was  had 
recourse  to  in  this  case,  and  was  maintained  in  constant,  or  almost 
constant  operation  for  ten  days  ;  the  bngs  of  ice  being  laid  along  the 
whole  spine,  but  with  the  chief  efiect  directed  on  the  upper  part. 
Forewarned  by  the  circumstances  of  Dr.  Todd's  case,  I  was  prepared 
to  use  this  remedy  with  much  caution,  aware  that  the  sedative  pow- 
er might  prove  excessive,  and  might  demand  not  only  considerable 
intermission  of  the  application,  but  a  cotemporaneous  use  of  general 
support,  and,  perhaps,  of  stimuli.  I  was  surprised  to  find,  however, 
that  no  occasion  for  either  presented  itself.  The  pulse  kept  low, 
cerlainly,  and  of  but  sparing  strength,  but  not  too  much  so.     And  the 


1845.]  Treatment  of  Traumatic  Tetanus*  653 


only  complaint  made  of  the  application,  by  the  patient,  >vas  the  at- 
trihnting  to  it  the  severe  pain  folt  in  the  back,  which  was  caused, 
doubtless,  by  the  opistihotonos.  When  the  sytnptomd  had  plainly 
begun  to  yield,  the  ice  was  discontinued  ;  particularly  as,  about  that 
time,  tendency  to  free  perspiration  began  to  manifest  itself.  Very 
shortly  after  discontinuance  of  the  cold,  two  marked  exacerbations 
occurred  at  a  time  when  these  had  greatly  abated  ;  but  as  there 
was  no  recurrence,  I  did  not  think  it  necessary  to  resume  the  ap- 
plication. 

4.  Of  the  three  anti-spasmodics  formerly  enumerated,  I  was  afraid 
of  the  tobacco,  in  so  young  a  patient,  having  both  seen  and  heard  of 
its  unmanageable  action.  Few  will  deny,  that,  with  every  precau- 
tion in  its  use,  it  has  again  and  again  seemed  not  remotely  connect- 
ed with  the  fatal  issue,  more  especially  in  urgent  cases  of  hernia.  Of 
the  aconite  I  had  no  experience,  as  an  opponent  of  spasm.  Of  the 
cannabis  I  had ;  having  used  it  in  private  practice.  Besides,  the 
report  of  Dr.  O'Shaughnessy's  success  with  this  remedy,  in  at  least 
mitigating  the  sufTerings  in  tetanus,  naturally  leads  to  a  prepossession 
in  its  favor  in  an  unprejudiced  mind.  I  resolved  to  give  it  a  fair 
trial.  It  was  begun  in  a  very  moderate  dose,  which  was  gradually 
increased,  until  about  three  grains  of  the  resinous  extract  were  taken 
every  half  hour  a  full  dose  for  an  adult,  in  ordinary  circumstances, 
without  repetition.  A  few  dosesusually  induced  sleep,  with  marked 
mitigation  of  the  spasm ;  and  on  the  patient's  emerging  from  the 
state  of  narcotism,  the  remedy  was  resumed,  and  steadily  continued 
until  a  siinilar  result  was  obtained.  The  period  of  narcotism,  and 
consequent  intermission  of  the  medicine,  did  not  usually  exceed  two 
or  three  hours.  The  sleep  was  deep  and  unbroken,  and  seemed  to 
be  refreshing.  It  certainly  was  followed  by  no  headache,  or  other 
apparent  inconvenience.  The  eyelids  were  seldom,  if  ever,  shut,  as 
in  ordinary  sleep;  but  remained  half  open,  disclosing  the  eyes,  dull 
and  upturned,  and  giving  to  the  countenance  a  very  peculiar  expres- 
sion. While  the  exhibition  of  the  drug  was  at  its  maximum,  great 
irritability  and  peevishness  of  temper  was  shown  by  the  patient,  dur- 
ing her  waking  moments  ;  but  it  were,  probably,  unfair  to  attribute 
this  to  the  medicine. 

As  the  symptoms  began  to  recede,  the  cannabis  was  proportiona- 
bly  diminished  in  dose.  Ultimately,  it  was  discontinued  altogether, 
while  yet  a  hardness  of  the  abdominal  muscles  remained  ;  it  seeming, 
then  to  meet  with  comparatively  little  tolerance  in  the  system,  and 
to  induce  a  quick  and  irritable  state  of  the  circulation.  Throughout 
the  whole  period  of  its  use,  its  effects  on  the  appetite  was  most  obvi- 
ous; but  greatest,  as  was  to  be  expected,  during  convalescence. 
The  craving  for  food,  of  all  kinds,  was  stated  to  be,  at  times,  abso- 
lutely voracious. 

In  this  case  the  CoIeraTiCe  of  the  cannabis,  engendered  by  the  teta- 
nus, must  be  apparent  to  every  one.  A  slim  girl,  seven  years  of  age, 
took  every  half  hour  and  sometimes  for  many  hours  in  succession  


654  Treatment  of  Traumatic  Tetanus.         [November, 


a  dose  of  hemp  sufficient  to  throw  a  healthy  adult  into  strong  narcot- 
ism. Also,  the  unfavorable  effects  which  commonly  follow  experi- 
ments with  it,  on  ordinary  patients,  whose  ailments  (if  any)  do  not 
require  the  remedy  -as  headache,  delirium,  visions,  vertigo,  vomit- 
ing, palpitations,  general  feeling  of  great  discomfort,  &;c.  seem  to 
have  been  wholly  absent  in  this  case,  where  uature  demanded  the 
use  of  the  medicine. 

The  Indian  hemp  I  believe  to  be  comparatively  valueless,  as  an  ano- 
dyne, as  well  as  a  hypnotic,  in  ordinary  circumstances  ;  and  as  such 
I  would  not  think  of  administering  it.  Its  virtue  seems  to  consist  in 
a  power  of  controlling  inordinate  muscular  spasm  ;  and  the  result 
in  this  case  has  certainly  tended  to  confirm  that  opinion.  I  shall 
not  attempt  to  separate  the  various  remedial  agents  employed;  ap- 
portioning to  each  their  share  in  the  fortunate  issue.  I  consider  that 
the  early  amputation,  and  subsequent  gentle  treatment  of  the  wound, 
may  have  done  some  good.  I  have  no  doubt  that  very  great  benefit 
followed  on  the  due  evacuation  of  the  bowels.  The  cold  to  the  spine 
may  have  been  beneficially  co-operating,  perhaps  in  no  inconsidera- 
ble degree.  Yet,  I  am  inclined  to  ascribe  the  greatest  portion  of  the 
benefit  to  that  remedy  of  which  the  system  proved  so  remarkably 
tolerant  the  cannabis  Indica. 

5.  The  fifth  indication  of  cure  was  never  lost  sight  of.  From  the 
first,  very  strong  beef  tea  was  ordered  to  be  always  in  readiness,  and 
to  be  frequently  administered.  As  the  trismus  yielded,  and  the  power 
of  swallowing  was  regained,  ordinary  food  was  offered  in  addition, 
and  usually  was  taken  with  greediness. 

6.  In  the  open  ward  of  a  public  hospital,  it  is  not  easy  to  obtain 
quietude  for  the  patient,  and  avoidance  of  excitement  to  spasmodic 
aggravation.  I  have  no  doubt  that,  latterly,  many  of  the  aggrava- 
tions were  attributable  to  the  circumstance  of  this  indication  being 
necessarily  so  imperfectly  fulfilled.  In  conclusion,  I  would  beg  to 
state,  that  I  have  no  wish  to  arrogate  for  the  cannabis  more  virtue 
than  what  may  seem  its  just  due.  The  case  may  have  been  of  a 
chronic  character  throughout,  though,  in  my  humble  apprehension, 
it  is  very  far  from  being  apparent  that  such  was  its  nature.  At  all 
events,  by  this  case,  evidence  as  to  the  action  of  the  cannabis  Indica 
seems  to  be  borne  to  the  following  effect :  

1st.  It  has  the  power  probably  not  slight  of  controlling  inordin- 
ate  muscular  spasm.  2d.  In  tetanus  there  is  a  marked  tolerance  of 
the  remedy ;  both  as  regards  the  safe  exhibition  of  large  doses,  in 
frequent  repetition,  and  the  absence  of  such  unpleasant  consequen- 
ces as  the  usual  dose,  in  ordinary  cases,  is  apt  to  induce.  3J.  With 
its  anti-spasmodic  virtue,  in  appropriate  cases,  it  probably  conjoins 
hypnotic  and  anodyne  properties,  though  in  a  minor  degree.  4lh. 
It  has  the  effect  of  remarkably  increasing  the  appetite  ;  and  digestion 
does  not  seem  to  be  impaired.  The  dejections,  though  dark  and 
offensive,  contained  no  unchanged  ingesta.  5th.  It  does  not  induce 
constipation.     6th.  On  recedence  of  the  tetanic  symptoms,  the  dose 

/ 


1S45.]  Treatment  of  Traumatic  Tetanus,  655 


of  the  medicine  should  proportionably  decrease.  The  tolerance  is 
passing  off,  and  if  the  original  dose  be  continued,  some  of  the  unto- 
ward effects  are  not  unlikely  to  occur. 

In  a  case  of  idiopathic  tetanus  which  occurred  in  Guy's  Hospital, 
and  reported  by  Mr.  Arnold,  the  symptoms  were  chiefly  those  which 
characterize  this  disease,  and  Dr.  Babington  prescribed  the  Cannabis 
Indica  as  follows  :  

Extract  of  Indian  hemp,  three  grains ;  rectifie'd  spirit,  half  a  drachm. 
Mix  tor  a  dose,  to  be  taken  every  half  hour  in  a  spoonful  of  barley- 
water.  The  effects  of  each  dose  to  be  carefully  watched.  The  first 
dose  was  taken  at  twelve  o'clock.  At  half  past  twelve  the  pulse  was 
92,  and  intermitting.  In  a  quarter  of  an  hour  after  the  second  dose, 
the  patient  showed  symptoms  of  excitement ;  his  eyes  brightened, 
and  the  masticatory  muscles  seemed  to  him  to  be  less  rigid  ;  no  pri- 
apism, but  some  little  flushing  of  the  face  ;  pulse  102.  A  moisture 
on  the  face  and  hands  now  appeared,  amounting,  on  the  latter,  to 
profuse  perspiration,  accompanied  with  tingling.  Just  before  the 
third  dose  the  pulse  was  107,  and  still  irregular;  the  rigidity,  howe- 
ver, was  decidedly  less.  Third  dose  He  swallowed  better  than  the 
preceding.  Fourth  dose  Respiration  twenty-two  ;  pulse  1'2S  ;  dis- 
posed to  sleep.  Fifth  dose  Respiration  the  same.  He  complains 
of  pain  in  the  back  and  occiput,  and  of  lying,  as  it  were,  on  some- 
thing very  hard  ;  but  he  rests  motionless,  with  composed  features, 
and  is  drowsy.  He  swallowed  this  dose  without  much  difficulty.  At 
a  quarter  past  two  (fifteen  minutes  after  taking  the  dose)  he  fell  into 
a  quiet  sleep.  The  dose  of  Indian  hemp  was  now  augmented  to  five 
jjrains  in  fiity  minims  of  spirits  to  be  taken  in  barley-water  every  two 
hours.  The  sixth  dose  was  taken  at  three  o'clock.  Respiration 
twenty  ;  pulse  110,  full  and  strong.  He  had  a  general  perspiration, 
swallowed  well,  and  said  that  the  pain  in  the  back  and  occiput  was 
relieved  ;  bowels  not  yet  moved. 

Ordered,  at  half-past  four,  a  turpentine  enema,  and  to  continue  the 
extract;  and  at  eleven,  p.  m.,  twelve  grains  of  calomel. 

May  3d.  Ten  o'clock,  a.  m.  No  dose  had  been  administered 
from  eleven  o'clock  on  the  preceding  night,  utill  two;  and  again  at 
four,  one  was  given.  He  has  had  in  all  forty-eight  grains  of  the  ex- 
tract, up  to  the  present  time,  and  has  now  just  taken  another  dose. 
He  dozed  all  night,  but  had  no  sound  sleep.  Bowels  still  constipated. 
Ordored,  in  the  afternoon,  an  enema  of  turpentine,  with  two  ounces 
of  castor  oil.  To  repeat  the  extract  of  Indian  hemp  every  hour,  and 
to  have  one  plaster  of  this  material  placed  on  the  chest,  and  another 
along  the  spine.  The  patient  was  at  this  time  in  nearly  the  same 
state  as  when  admitted,  but  complained  of  greater  pain  in  the  lumbar 
and  dorsal  regions.  No  spasm  in  the  extremities,  but  some  numb- 
ness in  the  fingers.  He  feels  that  he  has  less  power  over  himself 
than  before,  and  cannot  now  turn  in  his  bed.     Perspires  a  great  deal 


656  Treatment  of  Traumatic  Tetanus,  [November, 


on  the  face  and  forehead,  as  well  as  on  other  parts ;  and  the  skin  is 
warm  as  well  as  moist.  Pulse  about  80,  (thoujrh  it  varies  considera- 
bly at  difTerent  times,)  regular  and  strong.  The  patient  does  not 
swallow  better  than  he  did  yesterday;  there  is  a  catching  in  the 
epigastrium  when  he  swallows  or  speaks,  though  the  ordinary  breath- 
ing is  more  free  than  yesjerday, 

4th.  Ten  o'clock,  a.  m.  Buwels  freely  opened  last  night,  and 
again  this  morning  ;  motions  are  solid  and  shapeless,  "just  like  a 
piece  of  liver"  in  appearance,  and  smell  strongly  of  the  remedy.  He 
passed  a  very  restless  night.  Great  pain  is  induced  by  attempting 
to  speak;  the  mouth  is  quite  closed,  and  the  disease  appears  to  be 
slowly  gaining  ground  ;  pulse  100,  with  less  power  than  before.  The 
patient  complains  of  the  medicine  as  burning  his  throat.  Ordered, 
six  ounces  of  wine,  and  to  continue  the  extract.  Two,  p.  m.  
Spasms  in  the  trunk  have  grown  stronger  since  the  morning,  and 
incretij^ed  in  frequency,  occurring  now  about  every  five  minutes,  and 
sometimes  apparently  extending  down  the  left  leg,  causing  violent 
pain  throughout  the  whole  body,  and  occasionally  jerking  the  patient 
off  his  back;  pulse  the  same.  At  four,  p.  m.,  Mr.  Stocker  saw  him, 
.  and  ordered  the  extract  of  Indian  hemp  to  be  administered,  in  an  in- 
jection ofa  pint  of  beef-tea  and  wine.  This  was  done  at  the  hours 
of  tour,  six,  nine,  and  twelve,  the  last  time  with  the  addition  of  an 
egg ;  and  on  the  5th,  at  two,  four,  and  six  o'clock,  a.  m. 

5th.  Eleven,  a.  m.  The  injections  have  all  been  retained.  He 
got  a  little  sleep,  at  intervals,  during  the  last  night,  and  says  that  he 
is  in  less  pain  than  yesterday,  yet  still  complains  of  much  pain  about 
the  mouth.  The  muscles  of  the  face  are  less  contracted,  and  the 
teeth  can  be  separated  to  the  width  of  about  a  quarter  of  an  inch. 
He  has  a  control  over  his  arms  and  legs,  and  can  draw  the  latter 
upwards  ;  spasms  less  violent,  though  more  frequent,  occurring  every 
two  or  three  minutes;  bowels  confined;  pulse  about  100 ;  more 
feeble;  breathing  easy.  Ordered,  four  ounces  of  brandy,  with  two 
eggs,  in  a  pint  of  beef-tea,  and  a  little  decoction  of  starch,  to  be  ad- 
ministered as  an  injection,  every  four  hours.  This  was  done  at 
eleven,  a  m.,  two,  six,  and  eleven,  p.  m.  ;  and  on  the  6th,  at  two, 
half-past  five,  and  ten,  a.  m. 

6th.  Three,  p.  m.  Injections  retained.  Very  restless  all  the 
past  night;  complains  of  feeling  cold  this  morning,  and  drowsy; 
could  not  sleep,  however,  for  the  spasms,  which  have  become  strong- 
er; there  is  more  difficulty  of  breathing  ;  but  he  retains  the  free  use 
of  his  arms  and  legs.  His  mind  has  wandered  at  intervals  during 
the  day,  but  he  now  answers  questions  rationally;  pulse  110,  with 
some  sharpness;  much  less  perspiration  to-day.  He  had,  a  little 
while  since,  requested  to  have  a  little  brandy  in  barley-water,  but  the 
first  gulp  of  it  brought  on  a  violent  spasm,  that  prevented  its  being 
swallowed.     Complains  of  the  light  and  noise  of  the  ward. 

7th.  Half-past  twelve,  p.  m.  The  injections  have  been  continu- 
ed.    He  craves  after  brandy,  and  the  previous  night  some  was  given 


1845.]  Treatment  of  Traumatic  Tetanus,  657 


him  in  water,  which  he  contrived  to  swallow  ;  his  mind  rambled  dur- 
intjthe  night,  as  it  has  durin;^  the  day,  but  he  answers  questions  ra- 
tionally ;  perspiration  returninfr,  and  spasms  diminished;  he  can 
open  his  month  better  ;  pulse  120  ;  bowels  still  constipated.  Ordered 
the  enema  of  turpentine  and  castor  oil,  as  before,  and  to  continue 
the  Indian  hemp.  Two,  p.  m.  one  injection  had  returned  ;  the 
rest  were  retained.  At  6  o'clock  Mr.  Stocker  visited  him  ;  the 
spasms  were  again  more  frequent;  the  thoughts  of  the  patient  still 
wandered,  but  he  protruded  his  tongue  when  told  ;  pulse  160  ;  powers 
rapidly  declining;  and  at  half-past  two  the  next  morning.  May  8th, 
he  died. 

The  exact  quantity  of  the  extract  of  Indian  hemp  administered, 
whether  by  the  mouth  or  per  anum,  is  ascertainable  from  the  dis- 
pensary  book,  which  shows  that  the  following  quaq^ities  were  made 
up  for  this  patient :  

May  2d.  Eleven,  a.  m.,  twenty-four  grains.  Four,  p.  m.,  twenty- 
four  grains. 

3d.  Nine,  a.  m.,  twenty-four  grains.  Four,  p.m.,  forty-eight  grains. 

4th.  Ten,  a.  m.,  forty-eight  grains.  Ten,  p.  m.,  twenty  grains. 

5th.  Seven,  p.  m.,  forty-eight  grains 

6th.  Ten,  p.  m.,  forty-eight  grains.  But,  of  the  last  named  quan- 
tity, thirty. six  grains  remained  after  the  patient's  death.  It  thus 
appears  that  the  total  quantity  taken  amounted  to  two  hundred  and 
forty-eight  grains.  It  was  obtained  from  three  several  sources,  in 
nearly  equal  proportion  viz:  the  first  from  Mr.  Squire,  of  Oxford- 
street  ;  the  second,  through  Mr.  Pearce,  from  a  gentleman  who 
brought  it  from  India  ;  and  the  third  from  Mr.  Rouse,  in  the  Borough. 
The  gentleman  who  supplied  the  second  portion  tested  the  effects  of 
one  grain  on  his  own  person:  it  produced  the  symptoms  of  intoxica- 
tion, with  the  excitement  common  in  that  state,  to  such  a  degree, 
that  it  was  found  necessary  to  call  in  medical  aid  a  sufficient  proof 
of  the  potency  of  his  specimen  of  the  extract. 

Mr.  Potter,  of  Newcastle,  thinks  that  the  power  of  Indian  hemp  in 
spasmodic  affections  is  not  sufficiently  appreciated  ;  and  publishes  a 
case  of  traumatic  tetanus,  in  which  it  was  used,  and  seemed  to  pos- 
sess great  control  over  the  tetanic  spasms.  The  patient  had  received 
a  severe  laceration  on  the  upper  part  of  the  right  thigh,  which  ex- 
posed the  femoral  vessels.  Everything  went  on  well  till  the  twelfth 
day,  when  symptoms  of  tetanus  appeared.  A  large  dose  of  calomel 
and  Dover's  powder  was  then  given,  followed  by  ten  grains  of  extract 
of  Indian  hemp,  repeated  every  two  or  three  hours.  As  his  bowels 
were  confined,  two  drops  ofcroton  oil  were  placed  on  the  tongue,  and 
an  injection  given  made  \\\i\\ 

Tobacco  leaves,  one  scruple  ;  boiling  water,  eight  ounces  ;  macer- 
ate ;    strain    for  an  enema.     These   produced    free   action  of   the 

12 


658  Treatment  of  Traumatic  Tetanus.         [November, 


bowels.  In  consequence  of  the  difficulty  in  swallowing,  I  determin- 
ed to  give  the  extract  in  the  form  of  injection,  and  therefore  ordered 
him  to  have  the  following  enema  every  two  hours:  Extract  of  In- 
dian hemp,  one  scruple ;  strong  beef-tea,  six  ounces  :  mix.  This 
was  done,  and  the  injections  retained.  No  violent  spasmodic  actions 
took  place,  but  the  back  became  gradually  more  and  more  arched, 
so  that  it  was  necessary  to  place  a  pillow  beneath.  The  extract  did 
not  cause  any  marked  symptom  of  intoxication,  though  it  evidently 
produced,  at  intervals,  calm  sleep.  Without  suffering  any  pain,  the 
disease  gradually  progressed,  death  taking  place  on  the  fourth  day 
after  symptoms  appeared.  In  this  case,  four  drachms  and  two  scru- 
ples of  the  extract  were  administered,  and  to  the  action  of  this  medi- 
cine  I  attribute  the  freedom  from  pain  and  clonic  spasm,  which  surely 
is  sufficient  to  induce  any  one  to  give  this  remedy  a  full  trial  in  so 
fearful  a  disease.* 

The  following  case  of  idiopathic  tetanus  is  given  by  Dr.  Newbig- 
ging  :  The  patient  was  a  baker,  who,  while  perspiring  profusely, 
went  out  to  chop  wood,  at  a  time  of  intense  cold.  In  the  evening  of 
the  same  day  he  complained  of  tetanic  symptoms,  which  gradually 
increased.  Dr.  N.  saw  him  first  a  week  after  the  attack.  The 
pulse  was  natural;  bowels  constipated  ;  urine  scanty.  He  was  bled 
to  12  oz. ;  a  drop  of  croton  oil  was  administered,  and  a  large  blister 
was  applied  to  the  upper  part  of  the  spine.  The  bowels  were  opened 
by  the  oil,  and  he  felt  altogether  relieved.  Three  days  after,  he  was 
again  bled  to  14  oz. ;  and  a  strong  dose  of  morphia  with  30  drops  of 
tinct,  cannabis  ind.  were  given  at  bedtime.  Three  days  after  this, 
spasmodic  action  had  commenced  in  the  limbs  ;  the  dose  of  morphia 
was  then  increased,  and  ordered  to  be  given  four  times  a  day,  and 
elaterium  to  be  used  as  purgative.  Next  day,  croton  oil  was  again 
had  recourse  to,  the  elaterium  having  proved  ineffectual.  Dr.  Aber- 
crombie,  at  the  same  time,  recommended  the  use  of  arsenic,  which 
was  given  with  the  morphia.  He  continued  to  improve  for  a  week, 
when  he  was  suddenly  seized  with  great  dysphagia  and  tremors, 
which  were  soon  removed  by  placing  him  in  the  erect  position.  His 
medicines  having  been  discontinued  for  two  or  three  days,  were  re- 
newed. About  five  weeks  after  the  commencement  of  the  attack, 
he  expectorated  a  quantity  of  pus  mixed  with  mucus,  whick  expec- 
toration continued  three  weeks.  He  had  afterwards  thickening  of 
the  spinous  processes  of  the  cervical  vertebrae,  and  was  attacked  with 
anasarca,  which  was  subdued  by  diuretics,  actively  administered,  and 
in  about  three  months  he  was  able  to  return  to  business. 

The  principal  features  of  interest  in  this  case  of  what  is  considered 


1845.]         Opium  in  Fevers  and  Injlammatory  Affections,  659 


a  rare  disease  in  this  country,  are,  the  jrradual  affection  of  the  differ- 
ent muscles  of  the  body,  commencing  with  those  of  the  jaw,  and  the 
successful  issue  of  the  treatment,  which,  however  varied,  may  be 
considered  to  have  resulted  from  the  persevering  employment  ofcro- 
ton  oil  and  opium  ;  for  although  arsenic,  Indian  hemp,  colchicum, 
&;c.,  were  administered  to  him  at  different  periods,  I  believe,  to  none 
of  these  was  so  much  benefit  attributed  by  us  and  he  was  occasion- 
ally visited  by  Dr.  Abercrombie,  Sir  George  Ballingal,  my  father, 
and  Dr.  Duncan  as  from  the  exhibition  of  opium  in  full  doses,  with 
the  occasional  use  of  croton  oil ;  for,  whether  we  consider  this  medi- 
cine to  be  endowed  with  any  specific  effect  or  not,  as  reasoning  from 
somewhat  analogous  cases  of  nerv^ous  atrections  I  feel  disposed  to  do, 
it  certainly  seemed  to  be  followed  !)y  greater  relief  to  the  tetanic 
symptoms  than  when  an  ordinary  purgative,  such  as  scammon3%  gam- 
boge, &;c  ,  was  exhibited.  I  have  occasionally  observed  benefit  from 
the  Indian  hemp  in  allaying  irritation  and  causing  sleep,  particularly 
when  opium  was  contra-indicated  ;  but  I  am  somewhat  doubtful  of 
the  value  of  this  remedy  in  tetanus,  and  am  disposed  to  think,  that 
no  case  where  opium  is  so  decidedly  indicated  can  be  benefited  by 
the  administration  of  hemp,  if  the  former  powerful  remedy  has  failed 
to  be  of  service. 


Large  Doses  of  Opium  in  the  Treatment  of  Fevers  and  Inflamma- 
tory Affections. 

In  the  August  No.  of  the  3Iissouri  Medical  and  Surgical  Journal, 
we  find  an  interesting  article  by  A.  G.  Henry,  M.  D.,  of  Pekin, 
Illinois;  on  the  treatment  of  Fevers  and  Dysentery  with  large  doses 
of  Opium  :  and  in  the  September  No.  of  the  same  Periodical,  Prof. 
Thomas  Barbour,  M.  D.,  of  Kemper  College,  St.  Louis,  continues 
the  subject.  After  congratulating  the  profession  on  the  appearance 
of  Dr.  Henry's  communication,  who  gives  opium  in  four  to  six  grs. 
doses  in  fevers  and  dysentery,  Prof.  B.  says  

There  are  two  propositions  which,  I  suppose,  every  accurate  observer 
will  admit  to  be  true,  and  if  true,  will  afford  a  satisfactory  explana- 
tion of  the  utility  of  full  doses  of  opium  in  febrile  and  inflammatory 
affections  :  1st,  That  all  the  j)henomena  of  the  initial  stage  of  mias- 
matic fevers,  and,  I  may  add,  of  the  acute  phlegmasia?,  clearly  de- 
monstrate that  the  first  link  in  the  chain  of  disordered  actions  which 
constitute  fever  or  inflammation,  is  a  morbid  impression  on  the  ner- 
vous system,  the  immediate  ofiect  of  which  is  exalted  sensibility,  or 
irritability,  of  which  the  successive  events  are  necessary  sequences: 


660  Opium  inFevers  and  InfMmmatory  Affections.  [November, 


2d,  That  it  is  of  paramount  importance  to  control  the  nervous  sys- 
tern  the  "the  primum  mobile"  the  mainspring  which  gives  impulse 
to  all  the  complicated  actions  that  make  up  lever  and  inflammation  ; 
and  that,  in  proportion  as  we  do  so,  shall  we  be  able  to  modify  the 
results  of  its  action  on  the  vascular  and  secretory  systems. 

The  generality  of  practitioners  attempt  the  accomplishment  of  the 
important  ohject  referred  to,  by  the  use  of  agencies  calculated  to 
subdue  the  effects  of  an  unduly  excited  nervous  system,  and  thus  but 
too  often  prostrate  the  powers  of  life  ;  the  object  of  the  opiate  treat- 
ment in  connection  with  such  agencies,  to  a  prudent  extent^  is  to 
directly  modify  and  control  the  fountain  of  vital  action,  in  order  to 
obviate  its  effects  upon  the  animal  economy,  without  the  necessity  of 
so  great  an  expenditure  of  the  resources  of  nature. 

Having  these  principles  in  view,  I  have  been  in  the  habit,  during 
the  last  four  years,  of  using  large  doses  of  opium  say,  3  to  5  grs., 
in  all  the  various  modifications  of  fever,  for  the  purpose  1st,  of 
counteracting  the  febrile  periodicity;  2d,  of  promoting  the  reactive 
powers  of  nature  ;  3d,  of  diminishing  excessive  evacuations  ;  4th,  of 
quieting  nervous  irritability,  and  thus  guarding  against  locaj  conges- 
tions and  inflammations  ;  and,  5th,  of  shortening  the  course  of  fever. 
1  have  not  regarded  this  valuable  agent  as  the  ''febrifugum  mag- 
num,^^  to  the  neglect  of  any  of  the  remedies  of  acknowledged  effica- 
cy ;  but  have  used  it  as  a  powerful  auxiliary  to  those  means,  and  I 
acknowledge  that  the  efl'ects  have  been  most  gratifying.  The  con- 
ditions in  which  I  have  used  full  doses  of  opium,  say  from  3  to  5 
grains,  are  the  following  : 

1st :  Simple  Intermittent.  I  administer  it  say  1  drm.  tinct.  opii, 
or  30  to  40  grs.  of  Dover's  powder,  either  alone,  or  in  connection 
with  calomel  and  quinine,  in  the  latter  part  of  the  apyrexial  period,  to 
prevent  the  recurrence  of  the  paroxysm  ;  and  in  the  cold  stage,  to 
shorten  its  duration,  and  lessen  the  violence  of  the  succeeding  hot 
stage.  So  frequently  havo  I  succeeded  in  warding  off  a  chill  by  the 
use  of  opium,  together  with  warm  stimulating  drinks,  that  if  quinine 
could  not  be  obtained,  I  would  place  more  confidence  in  it  as  a  sub- 
stitute than  any  other  agent  with  which  I  am  acquainted. 

2d:  Remittent  Bilious  Fever.  Having  bled,  if  necessary,  or  ad- 
ministered an  effectual  mercurial  cathartic,  it  has  been  my  practice, 
for  several  years,  to  give  a  full  opiate  say,  3  to  5  grs.  of  opium,  or 
from  30  to  40  grs.  of  Dover's  powder  every  night,  or  every  other 
night,  with  10  to  20  grs  of  calomel.  I  am  not  deterred,  generally^ 
from  its  use,  even  when  those  conditions  exist  which  authorities 
declare  to  be  centra-indications,  namely,  red  and  dry  tongue  ;  dry 
skin,  excited  pulse,  and  moderate  cerebral  disturbance,  provided  the 
liver  is  acting,  and  the  bowels  have  been  freely  opened.  Under  such 
circumstances,  instead  of  an  aggravation,  I  have  generally  witnessed 
a  decided  amendment.  Nor  should  this  excite  astonishment,  when 
it  must  be  conceded  that,  most  generally,  all  of  the  above  phenomena, 
occurring  in  the   early    period    of  fevers,   are  dependent   on    high 


1845.]         Opium  in  Fevers  and  Inflammatory  Affections,  661 


nervous  excitement,  and  not  on  an  inflammatory  condition  of  the 
vessels.  Even  in  the  latter  stage  of  remittent,  and  typhoid  and 
typhus  fevers,  when  there  are  unequivocal  evidences  of  cerebral  in- 
flammation, after  general  and  topical  blood-letting,  cathartics, 
refrigerants  to  the  head,  and  revulsives  to  the  nucha,  we  are  justified 
in  the  use  of  large  doses  of  morphia  or  common  opium,  as  no  other 
remedy  will  so  effectually  relieve  the  restlessness,  jactitation,  subsul- 
tus  tendinum,  and  other  urgent  symptoms,  and  impart  reactive  energy 
to  the  nervous  system.  Indeed,  opium  and  stimulants  constitute  the 
sheet-anchor  of  hope  under  such  circumstances.  For  this  purpose, 
the  following  combination  is  an  exceedingly  valuable  one:  R. : 
Mist,  camphorae,  4  oz.;  moschi,  ^  drm.;  antim.  tart.,  grs  2;  morph. 
acet.,  3  to  4  grs.     Dose,  a  table-spoonful  every  4th  or  6th  hour. 

3d :  The  Congestive  modification  of  Intermittent  or  Remittent 
Fever.  Opium  is  a  most  valuable  adjuvant  in  these  cases,  in  order 
to  the  developement  of  full  reaction.  Its  mode  of  operation  is  diffi- 
cult of  explanation  ;  I  suppose,  however,  that  it  tends  to  equalize  the 
circulation,  by  allaying  the  excessive  nervous  excitability,  which 
rapidly  induces  exhaustion.  For  the  above  object,  I  would  especial- 
ly recommend  the  following  preparation  :  R.  :  Opii,  2  oz.;  camph., 
capsic,  cinnam.,  ol.  caryophy!.,  aa  I  oz.;  Hofiman's  anodyne  liquor, 
1  pint.  Dose,  1  drm.,  equal  to  4  grs.  of  opium,  every  fourth  or 
sixth  hour,  in  connection  with  calomel,  quinine  and  revulsives.  Its 
effects  are  often  wonderful. 

In  the  treatment  of  both  intermittent  and  remittent  fevers,  during 
the  past  sickly  season,  I  have  used  the  two  following  prescriptions 
with  the  very  best  effects  :  1st  R. ;  Hydrarg.  chlor.  mit-,  1  drm.; 
opii,  24  grains,  made  into  24  pills,  of  which  I  have  given  four  every 
night  until  slight  mercurial  action  is  induced  :  two  doses  are  gener- 
ally sufficient.  2d  R.  :  Mass.,  hydrarg.,  sulph.  qnina?,  aa.  ^  drm., 
made  into  fifteen  pills,  of  which  I  have  given  two  every  two  hours 
during  the  intermission  or  remission.  Among  the  many  cases  that 
have  come  under  my  care,  very  few  have  continued  beyond  the  third 
or  fourth  day. 

4th :  Puerperal  Fever.  After  copious  blood-letting,  our  chief 
reliance  should  be  placed  on  opium  in  large  doses,  combined  with 
calomel  say  4  to  5  grs.  of  the  former  with  10  of  the  latter,  to  begin 
with  ;  then  2  grs.,  each  repeated  every  two  or  four  hours,  until  the 
abdominal  pain  is  relieved.  I  believe  that  the  full  developement  of 
this  dreadful  malady  may,  generally,  be  prevented  by  opium  thus  ad- 
ministered, together  with  hot  fomentations. 

5th  :  Acute  Rheumatism.  In  the  treatment  of  this  painful  afTec- 
tion,  I  would  especially  recommend  the  following  combination,  after 
one  full  bleeding :  R.  :  Rad.  colchici  p.,  |  drm.;  antim.  tart.,  grs. 
3  ;  morph.  acet.,  grs.  3,  made  into  twelve  pills,  of  which  two  may  be 
given  every  fourth  hour,  until  relief  is  obtained. 

6th  :  Acute  Pleurisy.  After  one  full  blood-lotting,  the  best  means 
of  relief  in  acute  pleurisy  is  a  full  dose  of  opium,  in  combination  with 


662  Opium  in  Fevers  and  Inflammatory  Affections.  [November, 


calomel  and  tartarized  antimony.  The  following  is  a  convenient 
mode  of  admifiistration  :  B.  :  Opii,  hydrarg.  sub.  miir.,  aa.,  grs. 
12.;  antim.  tart.,  grs.  2,  made  into  6  pills,  of  which  two  may  be  given 
at  first,  and  afterwards,  one  every  two  or  four  hours.  With  this  mode 
of  practice,  it  will  rarely  be  necessary  to  bleed  a  second  time. 

Tth  :  Acute  Pneumonia.  In  pneumonia,  the  fidl  doses  of  opium 
are  of  great  value,  after  full  blood-letting,  but  they  should  be  used 
only  once  in  twenty. four  hours  ;  the  calomel  and  antimony  being 
used,  as  is  customary,  at  short  intervals. 

8th  Gastritis.  After  free,  general  and  topical  blood-letting,  my 
reliance  is  on  opium  and  calomel  ;  4  or  5  grains  of  the  former  with 
2  of  the  latter  at  first,  then  1  to  2  grains  each,  every  two  hours,  with 
cold  drinks,  purgative  enemata,  hot  poultices,  and  a  blister,  in  the 
severest  cases,  over  the  epigastrium. 

9th  :  Enteritis.  in  this  form  of  inflammation,  so  rapidly  fatal  in 
its  tendency,  after  free  general  blood-letting,  I  would  resort,  with 
great  confidence,  to  opium  in  the  fullest  dose,  4  to  6  grains,  combined 
with  1  to  2  grains  of  calomel,  after  which,  1  to  2  grains  of  each  may 
be  safely  given  every  two  hours,  with  oft-repeated  hot  poultices,  an 
occasional  mild  aperient,  as  castor  oil,  and  a  large  vesicatory,  after 
the  more  acute  symptoms  are  relieved. 

10th  :  Acute  Dysentery.  If  there  is  much  fever  present,  with 
great  abdominal  tenderness,  I  think  it  safest  to  commence  the  treat- 
ment with  one  full  blood-letting,  alter  which,  35  or  40  grains  of  Do- 
ver's powder,  or,  if  the  stomach  is  very  irritable,  4  grains  of  pulverized 
opium,  with  5  to  10  of  calomel,  mixed  in  an  ordinary  dose  of  castor 
oil,  is  the  best  remedy  I  ever  used.  If  there  is  no  necessity  for  bleed- 
ing, the  above  portion  may  be  administered  at  once;  and  not  unfre- 
quently,  it  will  relieve  the  disease  without  other  means:  generally, 
however,  it  will  be  necessary  to  continue  the  use  of  2  grains  each  of 
calomel  and  opium  every  four  or  six  hours,  until  the  abdominal  ten- 
derness, tormina  and  tenesmus,  are  removed.  As  auxiliary  to  the 
above,  mucillaginous  drinks  should  be  freely  allowed  ;  occasional 
portions  of  castor  oil,  or  oleaginous  mixture,  should  be  given,  and 
anodyne  injections,  as  tinct.  opii,  1  drm. ;  assafcetid.,  ^  drm.,  in 
aqueous  sohilion,  repeated  twice  or  thrice  daily.  When  the  more 
acute  symptoms  are  relieved,  and  there  exists  chronic  irritation,  with 
copious  mucous  and  bloody  discharges,  I  use,  with  great  efiicacy,  the 
acetate  of  lead,  combined  with  opium,  in  the  proportion  of  5  to  10 
grains  of  the  former  to  2  of  the  latter,  every  six  or  eight  hours  ;  and 
ifthe  disease  persist  under  this  course  and  especially,  should  there 
be  tympanitis.  I  would  recommend  a  large  blister,  and  the  following 
mixture,  which  is  applicable  to  the  chronic  stage  of  mucous  inflam- 
mation of  ihe  whole  alimentary  canal,  whether  it  be  gastritis,  ilietes, 
or  colitis  :  B:.:  Mist,  camph.,  4  oz. ;  tinct.  opii  acet.,  2  drm. ;  acid, 
nitric,  |drm. ;  spirit,  terebinth.,  -i  oz, ;  dose,  a  dessert  or  table- 
spoonful  every  four  or  six  hours. 

In  conclusion,  I  will  express  the  hope,   that  all  medical  men  wjio 


1S45.]  Source  of  Convulsions.  663 


may  read  this,  or  Dr.  Henry's  paper,  may  so  far  confide  in  our  judg- 
ment, and  the  results  of  our  experience,  as  to  wive  nfair  trial  to  the 
use  of  opium,  as  recommended  in  fevers  and  inflammatory  afTections  ; 
if  so,  I  do  not  doubt  but  that  the  testimony  of  all  would  tend  to  estab- 
lish the  safety  and  value  of  the  practice.  It  is  a  subject  of  vital 
interest,  and  is  worthy  of  the  candid  investigation  of  the  whole  pro- 
fession. 


PART  III. MONTHLY  tERISCOPE. 

Source  of  Convulsions.  By  T.  Wilkinson  King,  Esq.  It  is  a 
little  remarkable,  that  hitherto  there  has  been  no  settled  opinion  in 
the  profession,  as  to  the  primary  seat  of  derangement  in  convulsive 
affections.  Dr.  Hall  and  some  others,  seem  to  refer  the  spasms  to 
general  disorder  of  a  specific  nature  in  the  spinal  marrow.  Others 
impute  them  rather  to  meningeal  or  to  superficial  affections  of  the 
cerebrum. 

Convulsions,  which  leave  the  patients  as  well  as  ever,  even  after 
many  attacks,  cannot  be  expected  to  have  any  visible  permanent 
local  alteration  connected  with  them. 

In  the  first  place,  I  shall  proceed  to  show  what  I  have  concluded 
the  pons  varolii  has  to  do  with  convulsions  for,  here,  all  motor  tracts 
converge  and,  here,  one  thrust,  as  it  were,  may  stir  up  every  muscle 
of  the  body.  I  assume  that  no  affection  of  bone,  nor,  indeed,  any 
meningeal  affection,  necessarily  affects  brain  or  nerve,  and  I  could 
almost  add  no  tumour.  I  see  that  all  the  affections  here  named  begin 
and  go  on  to  a  great  extent  without  nervous  symptoms,  and  that  the 
signs  of  nerve-disease,  when  they  do  supervene,  proceed  independ- 
ently, and  without  any  strict  relation  of  duration,  degree,  or  conse- 
quences, to  the  extraneous  disorder.  I  find,  moreover,  two  sets  of 
real  nerve  disorders,  i.  e.,  Istly,  with  a  palpable  cause  and  a  definite 
site  ;  and,  2ndly,  devoid  of  visible  local  change  ;  and  I  cannot  doubt 
but  that  some  of  the  latter  are  fairly  illustrated  by  the  former.  A 
new  and  gradual  growth  deranges  no  new  fibre^  a  strumous  tubercle 
in  the  thalamus  gets  large,  unsuspected ;  and  consequent  affections 
of  the  opposite  arm  come  and  decline  variously,  according  to  the 
varying  incidental  changes  in  the  brain,  around  the  tubercle.  Such 
a  body,  in  a  renovated  constitution,  rather  wastes,  turns  to  cholester- 
ine  and  may  be  unheeded  through  a  long  life.  Strumous,  cancerous, 
inflammatory,  and  apoplectic  diseases  of  the  brain  are  occasionally 
found  to  become  arrested  at  every  stage  of  their  course,  as  when 
wasting  or  other  disorders,  elsewhere,  come  into  greater  activity. 

On  the  other  hand,  I  think  it  is,  in  the  main,  pretty  certain  that 
cysts,  tumours,  inflammations,  softenings,  extravasations,  whose  size 
or  extension  may  gradually  encroach  on  the  pons,  induce  convulsions 


664         Explanation  of  the  sizes  in  the  Urinary  Bladder.  [November, 


before  the  final  coma  a  certain  state  of  injection,  or  nutrition,  or  of 
nerve-irritation,  preceding  total  oppression. 

Every  known  disorder  of  the  spinal  cord  causes  lesions  of  motion 
(rigidity,  spasm,  or  palsy)  and  of  sense  (pain  darting,  or  numbness) 
in  proportion  to  its  severity,  and  only  in  parts  below  the  seat  of  the 
disorder ;  but,  if  these  affections  involved  the  excitor  cords  of  some 
physiologists,  surely  we  should  have  universal  disturbances.  The 
convulsions  of  known  spinal  diseases  are  all  comparatively  limited 
or  insignificant.  To  what  nervous  lesions  do  we  not  look,  for  most 
general  palsy,  or  tremor  ?  As  disease  approaches  the  centre  of  the 
pons,  so  general  convulsion  or  fatal  paralysis  attends.  Slow  tumours 
thus  indicate  the  site  of  th#  transitory  actions  which  cause  convul- 
sions. The  same  diseases  in  the  cerebrum,  cerebellum,  and  spinal 
marrow,  cause  no  general  convulsions.  These  assertions  I  hope  to 
make  good.  If  any  one  should  think  he  can  do  as  much  in  opposi- 
tion, I  can  only  wish  to  see  it. 

1.  There  are  various  diseasesof  the  cerebrum,  which  approaching 
the  pons  varolii,  produce  convulsions,  first  of  the  opposite  side  of  the 
body,  and  then  generally. 

2.  There  are  various  diseases  of  the  cerebellum,  which,  gradually 
advancing  upon  its  cura,  &lc.,  cause  convulsions,  first  of  the  opposite 
side  of  the  body,  and  then  generally. 

3.  There  are  various  diseases  of  the  tuber  annulare  itself,  which, 
in  their  course,  usually  set  up  universal  convulsions. 

4.  There  are  some  exceptions  to  the  above  statements,  but  the 
consideration  of  them  rather  illustrates  than  refutes  the  main  princi- 
ples advanced.  Medical  Times. 


On  the  Explanation  of  the  Difference  in  size  of  the  Male  and  Fe- 
male Urinary  Bladder.  By  John  LeConte,  M.  D.,  of  Savannah. 
The  fact  that  the  urinary  bladders  of  women  are  considerably  more 
capacious  than  those  of  men,  has  been  observed  by  anatomists  from 
the  earliest  ages.  This  was  attempted  to  be  explained  by  supposing 
that  the  conventional  rules  of  society,  together  with  the  sedentary 
habits  of  females,  rendered  extraordinary  distension  of  that  viscus 
from  protracted  retention  of  urine,  more  frequent  and  extensive 
among  them,  and  thus  the  organ  became  enlarged  mechanically. 

This  explanation  appears  to  be  exceedingly  plausible.  Indeed,  it 
has  found  its  way,  as  if  by  general  consent,  into  almost  all  our  stand- 
ard works  on  anatomy  and  physiology. 

It  seems  that  no  one  has  heretofore  noticed  the  unquestionable 
fact,  that  the  same  difference  in  the  size  of  the  bladder,  in  favor  of 
the  female,  obtains  in  many  of  the  inferior  animals ;  where,  of 
course,  this  cause  cannot  be  presumed  to  operate  in  the  slightest  de- 
gree. It  most  assuredly  does  exist  in  the  hog,  the  sheep,  and  the 
cow.  I  have  remarked  it  so  often  among  these  animals,  as  to  be 
able  to  select  out  the  bladders  of  the  females  from  among  a  number 
of  others  of  those  of  both  sexes.     In  view  of  this  established    fact, 


1845.]       Explanation  of  the  sizes  in  the  Urinary  Bladder.  665 


therefore,  the  received  explanation  becomes  at  once  untenable.  We 
must,  therefore,  seek  for  a  more  rational  explanation.  Let  us  appeal 
to  nature  let  us  see  how  she  accommodates  herself  to  circumstances. 
It  is  well  known  to  every  observant  surgeon,  that  when  the  urethral 
passage  is  constricted  from  any  cause,  whether  mechanical  or  the 
result  of  disease,  the  bladder  very  soon  diminishes  in  capacity,  and 
becomes  contracted  and  thickened.  This  occurs  when  there  ia  no 
disease  of  the  bladder  itself,  and  when  that  of  the  urethra  has  com- 
pletely subsided,  leaving  nothing  behind  but  a  mechanical  obstruction 
of  the  passage.  Now,  what  is  the  deduction  to  be  drawn  from  this 
natural  process  ?  The  conclusion  seems  to  be  inevitable,  that  the 
diminution  of  the  capacity  of  the  bladder,  under  such  circumstances, 
is  an  expedient  of  nature  to  meet  the  exigencies  of  a  contracted  out- 
let. Herein,  I  think,  we  are  furnished  with  a  clue  to  the  true  expla- 
nation of  the  difference  of  size  of  the  male  and  female  urinary 
bladder,  when  every  thing  is  in  a  normal  state.  The  female  urethra 
is  not  only  larger  and  more  dilatable  than  that  of  the  male,  but  is 
also  shorter  and  straighter.  It  is  generally  of  uniform  diameter, 
varying  trom  three  to  four  lines,  slightly  curved,  with  the  concavity 
looking  upwards,  and  so  extensible  that  calculi  as  large  as  walnuts 
have  been  known  to  pass.  (Vide  Lond.  Lancet,  1841-2,  vol.  1st, 
p.  583  ;  also  vol.  2d,  p.  41.)  Now,  as  we  have  shown  that  the  size 
of  the  bladder  is  in  proportion  to  that  of  the  urethra,  it  follows,  a  pri- 
or/, that  the  male  must  have  it  smaller  than  the  female  ;  a  process  of 
reasoning  which  has  the  advantage  of  being  equally  applicable  to 
many  of  the  inferior  animals.  In  this,  nature  has  not  departed  from 
her  ordinary  hydrodynamical  laws;  the  size  o^  \.\\e  outlet  is  propor- 
tional to  the  capacity  of  the  reservoir,  and  vice  versa.  Perhaps,  it 
may  not  be  beyond  the  resources  of  the  analytical  mathematician  to 
deduce  the  capacity  of  the  bladder  from  a  single  measurement  of  the 
diameter  of  the  urethra!  At  any  rate,  ^formula  might  be  easily 
obtained  from  hydraulics,  which  would  give  us  approximative  values, 
not  only  of  the  size,  but  also  of  the  contractile  force  of  the  bladder  ! 
It  Will  be  observed,  that  one  of  the  conditions  induced  by  a  con- 
stricted  state  of  the  urethral  passage,  is  a  marked  augmentation  in 
the  thickness  of  the  coats  of  the  bladder.  I  consulted  Dr.  Alban 
Goldsmith,  so  well  known  in  the  treatment  of  diseases  of  the  genito- 
urinary apparatus,  whose  skill  and  long  experience  in  these  affec- 
tions entitles  his  opinion  to  great  consideration.  He  informs  me, 
that  he  has  had  numerous  opportunities  of  observing  the  changes 
which  are  wrought  in  the  bladder  by  obstructions  in  the  urethra.  He 
finds  that  the  organ  diminishes  in  size,  and  that  all  the  coats  are 
affected,  but  particularly  the  muscular ;  the  fibres  growing  fleshy 
and  strong,  are  collected  into  bundles,  giving  the  surface  a  fasiculated 
appearance.  This  strengthening  of  the  coats  of  the  bladder,  seems  to 
be  another  device  of  nature  in  addition  to  the  diminution  of  capa- 
city to  increase  the  propulsive  power,  which  is  required  to  force  the 
urine  through  a  small  outlet.     In   accordance  with  our   preceding 


666  Castration.  [November, 


mode  of  reasoning,  we  should  be  led  to  expect  that  the  urinary  blad- 
ders of  male  animals  should  also  possess  a  greater  degree  of  muscu- 
larity than  those  o^  females.  So  far  as  recollection  serves  us,  we 
think  that  such  is  actually  the  case  in  nature ;  and  we  venture  to  pre- 
dict, that  minute  measurement  and  close  inspection  will  demonstrate 
that  the  urinary  bladders  of  male  animals  are  both  thicker  and  more 
muscular  than  those  of  the  opposite  sex. 

Why  the  urinary  bladders  of  the  females  of  many  animals,  and 
as  a  natural  consequence,  the  urethra,  should  be  larger  than  those 
of  the  males,  is  a  problem  which  admits  of  a  far  less  satisfactory  so- 
lution. The  supposition  most  in  accordance  with  design,  is,  that  a 
greater  quantity  oi  urine  is  secreted  in  the  female.*  This  idea  seems 
to  be  fortified  by  the  anatomical  characters  of  their  system,  in  which 
the  fluids  appear  to  bear  a  greater  proportion,  and  which  predomin- 
ance has  been  supposed  to  have  some  necessary  connection  with  the 
functions  of  reproduction.  But,  of  course,  this  question  can  only 
be  settled  by  an  appeal  to  expertmental  determinations  of  the  rela- 
tive amounts  of  urine  secreted,  under  the  same  circumstances,  by 
either  sex.  At  any  rate,  be  this  last  conjecture  right  or  wrong,  we 
trust  that  we  have  established  beyond  a  reasonable  doubt,  that  the  dis- 
parity in  the  size  of  the  organ  in  the  sexes,  is  a  natural  conformation, 
andwoi  the  result  of  mechanical  distension.  Transaction  of  the  Soci- 
ety of  Alumni  of  the  College  of  Physicians  and  Surgeons  of  N.  Y, 


Castration^  when  two  years  old,  in  a  man  now  quite  aged.  In  the 
Hotel  of  the  Invalides  is  a  man  aged  71  years,  who  was  castrated  at 
Sens  when  two  years  old,  by  a  villanous  quack,  to  cure  him  of  hernia. 
This  mutilated  person  is  of  small  stature,  his  extremities  are  slender, 
his  bones  feeble,  his  voice  sharp,  and  his  chin  without  beard.  He 
does  not  detest  women,  but  when  near  them  has  only  fugitive  desires, 
and  his  enjoyment  in  coition  has  always  been  scarce  appreciable. 
His  penis,  like  all  organs  which  do  not  perform  their  functions,  is 
atrophied,  and  the  prepuce  is  much  longer  than  the  gland.  In  this 
stunted  body,  which  has  evidently  been  arrested  in  its  development, 
there  has  nevertheless  been  energy  and  courage.  This  individual, 
though  exempt  from  military  service,  joined  the  army  he  was  in  the 
wars  of  the  French  Empire,  and  the  scars  which  he  bears  are  authen- 
tic certificates  of  his  ardor  in  battle,  and  of  his  bravery.  At  present, 
one  is  struck  in  passing  his  bed,  with  all  the  traits  of  an  old  woman. 
Notwithstanding  his  advanced  age,  his  memory  is  good  ;  he  relates, 
with  precision,  the  events  in  which  he  assisted,  and  his  language  is 


*  Since  the  above  was  written,  this  point  has  been  clearly  demonstrated  by 
the  experimental  researches  of  Dr.  Wm.  Prout  and  Mr.  Alfred  Becqnerel,  of 
Paris.  J.  LeC. 


1845.]    Reunion  of  Nerves  Reproduction  of  Jaw-hone^  S^c,     '  667 


expressive  of  much  goodness  of  heart.  Every  thing  about  him 
breathes  the  air  of  sadness  and  the  impress  of  a  vague  melancholy; 
a  regret  attaches  to  each  step  of  his  life,  and  which  has  its  origin  in 
the  dreadful  mutilation  to  which  he  was  made  to  submit  in  childhood. 
(Journal  des  Con.  Medico- Chiriirgicales.) 


Re-union  of  divided  Nerves.  M.  Marjolin  takes  great  pleasure  in 
relating  an  operation  which  he  witnessed,  where  the  surgeon,  M. 
Michon,  found  it  necessary  in  extirpating  a  degenerated  mass,  to  in- 
clude more  than  an  inch  of  the  trunk  of  the  sciatic  nerve.  Paralysis 
of  all  the  movements  of  the  limb  ought  to  have  been  the  consequence. 
Nevertheless  this  person,  after  his  cure,  recovered  such  a  degree  of 
muscular  agility,  that  he  could  dance  and  waltz  as  formerly. 

In  the  Provincial  Medical  and  Surgical  Journal,  Dr.  Oke  reports  a 
case,  where  he  had  to  cut  the  musculo-cutaneous  nerve  in  operating 
upon  a  necrosed  humerus.  This  brought  on  paralysis  instantly  of 
the  movements  of  the  right  hand.  This  patient  was  an  excellent 
scribe.  He  took  lessons  for  four  months  to  learn  how  to  write  with 
the  left  hand,  at  which  time  he  began  to  feel  movements  in  the  fingers 
of  the  other,  and  in  a  few  weeks  he  had  so  far  recovered,  that  he 
could  write  well  with  both  hands.  {Jour,  des  Con.  Medico-Chir.) 


Reproduction  of  a  portion  of  the  lower  Jaw-hone  with  Teeth.  
By  E.  S.  Bennett,  M.  D.,  of  Charleston,  S.  C.  Early  in  the 
month  of  i\Iarch,  1845,  I  was  requested  to  visit,  professionally,  a 
negro  child  about  thirty  months  old,  the  property  of  Col.  J.  L.,  of 
our  city,  who  was  reported  to  have  a  singular  appearance  about 
the  mouth,  resembling  a  piece  of  bone  growing  from  and  connected 
with  the  inferior  maxillary,  preventing  the  child  from  mastication, 
and  it  could  only  take  fluids,  and  that  but  sparingly.  I  found  the  child 
in  an  extremely  emaciated  condition  having  been  suffering  for  five 
months;  upon  examining  it  with  some  care,  I  found  the  bone  (infe- 
rior maxilla)  in  a  state  of  necrosis,  extending  from  the  canine  tooth 
on  the  right  side,  along  the  whole  bone  on  its  entire  aspect,  to  the  ar- 
ticulation on  the  left.  The  anterior  portion  of  the  bone  had  been 
raised  from  its  natural  position,  and  becoming  elevated  as  far  back 
as  the  ramus  on  the  left,  and  its  point,  which  was  rough  and  very 
rugged,  iixed  in  the  soft  parts  on  the  right  side  of  the  corner  of  the 
mouth,  and  from  this  state  of  irritation  an  extensive  and  frightful 
nicer  was  developed.  The  only  question  suggesting  itself  was, 
whether  the  child,  in  its  then  emaciated  condition,  could  survive  the 
operation  ;  the  chances  I  considered  as  equal,  and  determined  upon 
dilation  of  the  soft  adhering  part  within  the  mouth,  and  removing  the 


668       New  Hemostatic  Means.  Operation  of  Rectum,  [November, 


whole  mass,  which' was  accordingly  done,  and  with  a  pair  of  strong 
curved  forceps,  the  bone  was  seized  as  far  back  as  the  bend,  and  by 
a  careful  rotary  motion  of  the  hand,  the  disarticulation  was  ac- 
complished, and  the  bone  removed.  Within  a  few  days  a  decided 
pleasing  improvement  was  observed  ;  and  in  four  weeks,  I  was  ena- 
bled to  return  the  little  sufferer  to  the  country. 

It  may  be  asked,  and  with  propriety,  what  was  the  exciting  cause 
of  so  frightful  state  of  things?  had  the  child  taken  mercury  in  any 
of  its  forms?  I  think  I  may  safely  say  no;  having  been  myself  in 
attendance  on  the  plantation  for  ten  years,  and  can  safely  say  none  ; 
but  the  disease  may  be,  and  probably  was,  sui  generis,  or  the  result  of 
some  local  hyperemia  the  result  of  the  process  of  dentition. 

This  case  settles  the  question  definitely  as  to  whether  nature  of 
herself  is  capable  of  reproducing  the  bony  structures  entirely  ;  in  this 
case,  not  only  the  whole  bone  has  been  reproduced,  but  dentition 
also  bemg  now  armed  with  two  formidable  grinders.  American 
Journ.  of  Denial  Science. 


A  new  hcemostaiic  means  sheep  brains.  M.  Dupuy,  at  the  sitting 
of  the  Academy  of  Medicine  in  Paris,  17th  June,  stated,  that  the 
cerebral  matter  of  sheep  possessed  in  a  very  high  degree  the  proper- 
ty of  coagulating  the  blood,  and  of  immediately  arresting  hoemorrha- 
ges.  A  small  portion  of  the  brain  injected  into  the  femoral  vein  of 
an  animal  produced  death  in  a  few  minutes.  The  blood  was  found 
coagulated  in  the  heart,  and  in  the  vessels,  as  M.  D.  had  predicted. 
He  thought  that  surgeons  might  profit  by  this  fact.  {Journ.  des  Con, 
Medico- Chirurg.) 


A  new  operation  for  defect  of  rectum  in  the  infant.  M ,  Baude  - 
locque  proposed  to  the  Academy  of  Sciences  on  the  26th  August,  a 
new  operation,  as  a  substitute  to  opening  the  colon  either  in  the 
lumbar  or  iliac  regions,  when  the  infant  at  birth  is  found  to  be  deprived 
of  a  rectum.  The  absence  of  this  intestine  being  established,  it  is 
necessary  at  first  to  dilate  the  natural  anus  by  prepared  sponge,  then 
to  introduce  a  speculum  two  and  a  half  inches  long;  at  the  sacro- 
vertebral  angle  the  cul-de-sac  of  the  descending  colon  will  be  found, 
and  may  be  seized  with  a  tenaculum.  If  this  cannot  be  done,  then 
an  incision  is  to  be  made  in  the  linea  alba  of  the  abdominal  wall,  and 
the  cul-de-sac  of  the  colon  carried  down  to  the  natural  anus,  to  which 
it  is  to  be  attached  by  sutures. 

We  find  this  proposed  by  M.  B.,  in  one  of  the  last  numbers  of  the 
Journal  des  Connaisances  MeJico-Chirurgicales.  We  are  not  dis- 
posed to  place  a  very  high  estimate  upon  it,  for  the  operation,  as 


1845.]         Employment  of  Blistei's  Ale  aline  Medication,  669 


described,  we  do  not  hesitate  to  say  cannot  well  be  performed  without 
opening  the  abdomen.  In  the  first  place,  infants  having  a  malforma- 
tion or  defect  of  the  rectum,  have  also  generally  an  imperforated  anus. 
Secondly,  there  would  be  considerable  difficulty  to  dilate  a  passage 
from  the  anus  to  the  sacro-vertebral  junction  for  a  speculum.  Third- 
ly, when  arrived  at,  who  could  distinguish,  at  this  depth,  the  descend- 
ing colon  from  the  surrounding  tissues  ?  Still,  however,  we  confess 
we  have  no  objection,  in  defect  of  the  rectum,  to  opening  the  abdo- 
men in  the  linea  alba,  if  by  this  operation,  the  intestine  can  in  any 
way  be  attached  to  the  anus. 


The  employment  of  Blisters  in  acute  diseases  of  the  Brain,  By 
Dr.  Tritschler.  Blisters  are  frequently  used,  and  applied  to  all 
parts  of  the  body,  except  the  frontal  region,  which,  according  to  Dr. 
T.,  is  the  best  place  to  make  them  act  in  acute  affections  of  the  brain. 
He  covers  the  whole  frontal  region,  and  even  the  root  of  the  nose, 
by  a  vesicatory,  and  remarks,  that  besides  a  free  suppuration  produc- 
ed by  it,  there  is  generally  a  copious  flow  of  mucous  from  this  organ. 
We  learn,  too,  from  the  Journal  des  Connaisances  Medico-Chirurgi- 
cales,  that  the  physicians  of  the  Parisian  Hospitals  employ  these 
blisters  with  success  against  cerebral  symptoms  in  severe  fevers. 
The  application  of  a  single  one  is  not  sufficient  to  disfigure  a  patient. 

FormulcB  of  Alcaline  Medication.     By  M.  Devergie,  Physician 
to  St.  Louis  Hospital,  Paris.  At  the  close  of  an  article  by  M.  D.,  in 
the  Bulletin  General  de  Therapeutique,  on  the  Alcaline  Medication 
for  diseases  of  the  Skin,  we  find  the  following  prescriptions : 
Artificial  water  of  Vichy  :     R.  Bicarbonate  of  Soda,  31 

Spring  water,     pint,     1^ 
To  take  in  two  portions  during  the  day.     The  dose  of  the  bicarbon- 
ate may  be  increased  to  2,  3,  or  4  3  each  day ;  it   is  proper  then  to 
augment  the  water  to  3  or  4  tumblers.     Gaseous  or  the  Soda  water 
of  the  shops,  will  make  this  drink  more  agreeable. 

Alcaline  Syrup.     R.  Bicarbonate  of  Soda,     gr.  xv. 
Syrup  of  Sugar,     .     .        x. 
Dose,  a  table-spoonful,  morning  and  night,  in  a  fourth  of  a  tumbler  of 
water.     For  an  infant,  a  tea-spoonful  is  the  dose  in  the  same  quanti- 
ty of  water. 

Alcaline  Potion.     R.  Bicarbonate  of  Potash,     .     3v. 
Infusion  of  Linden,     .      .      iv. 
.    Syrup  of  Mucilage,     .     .      i. 
Distilled  water  of  mint,     gtt.  xxv. 
Dose,  two  or  three  tablo-spoonfuls  each  day  for  an  adult. 


670  Poison  by  Tartaric  Acid.  [November, 


Alcaline  Wash.     R.  Carbonate  of  Soda,     ^ss. 
Water,  O.      1^ 

More  active  Alcaline  Wash.     R.  Carbonate  of  Soda,   3vi. 

Comnion  Salt,      .      f  ii. 
Water,  O.     li 

Alcaline  Liniment.     R.  Carbonate  of  Soda  or  Potash,   gi. 

Olive  01!, f  iv. 

Yellow  of  egg,      ....     one. 
Moisten  the  carbonate  before  adding  the  oil. 

Weak  Alcaline  Ointment.     R.  Carbonate  of  Soda,     gr.  x. 

Lard,      .     .     .     .      i. 
The  carbonate  may  be  increased  to  4  or  6  3,  when  a  more  active 
ointment  is  desired  ;  and  3  4  of  slacked  lime  may  be  added  using 
then  the  carb.  of  potash. 

Alcaline  Bath.  Carbonate  of  Soda  or  Potash,  from  a  half  to  a 
pound. 

Alcaline  and  Tonic  Bath.  R.  Carbonate  of  Soda,  froma  half  tea 
pound  ;  Common  salt,  1  to  2  pounds.  Gelatine  or  soap  may  be  ad- 
ded to  this. 

When  sulphur  is  added  to  the  alcaline  preparations,  the  latter  have 
only  a  secondary  place  in  the  composition. 


Poison  hy  Tartaric  Acid.  It  has  been  questioned  if  this  acid  be 
a  poison.  Pommer  and  M.  Orfila  are  for  the  affirmative;  Coindet 
and  Christison  for  the  negative.  The  followi^ng  fact  strengthens  the 
opinion  of  the  two  first  named  :  Wm.  Wats,  being  affected  with 
rheumatism,  applied  the  7th  Dec,  1844,  to  ChaTles  Watkins,  drug- 
gist, to  purchase  2  5  of  Epsom  salts.  Before  leaving,  the  thought 
suddenly  occurred  td  him  of  changing  it  for  another  salt  less  bitter. 
This  was  granted  to  him,  and  having  returned  home  and  dissolved 
the  new  article  given  him,  he  swallowed  it.  His  face,  some  moments 
after  this,  became  red.  He  cried  out  he  was  poisoned,  and  then 
ceased  to  speak.  Other  symptoms  were  developed,  and  Mr.  Wats 
died  on  the  16th.  Mr.  Brood,  charged  with  the  examination  of  what 
remained  in  the  glass  from  which  he  had  drank,  recognized  Tartaric 
Acid.  The  apothecary,  Mr.  Watkins,  confessed  his  error,  and  attri- 
buted it  to  the  change  which  some  one  had  made  of  the  bottle  of  the 
acid,  for  that  commonly  occupied  by  an  insipid  salt.  [Pharmaceuli- 
calJournal.) 


1845.]  Uva  Ursi  Treatment  of  DysmenorrhcBa,  071 


Lithontriptic  action  of  the  Uva  Ursi.  By  Dr.  Fenolio.  An 
old  calculous  patient  had  fever,  and  experienced  severe  pain  in  the 
bladder.  He  would  not  consent  to  be  sounded.  Dr.  F.  prescribed 
a  decoction  of  the  uva  ursi,  prepared  thus :  IX,  Uva  Ursi,  ss.  ; 
Water  5ix.  Boil  for  fifteen  minutes;  strain,  add  syrup  of  gum,  5  v., 
and  take  the  whole  in  three  doses.  After  using  this  tea  for  three  days, 
the  patient  passed  13  pretty  large  gravels,  and  in  five  days  more,  90 
others.  The  whole  formed  a  considerable  mass.  His  suflfering  and 
fever  disappeared.  {Jour,  des  Con.  Mtdico-Chir.) 


Treatment  of  Dysmenorrhcea.  Dr.  Rigby,  in  his  treatise  on  this 
subject,  considers  that  it  depends,  in  common  with  some  other  uterine 
affections,  on  derangement  of  the  assimilating  processes  which  may 
be  merely  "the  local  phenomena  of  a  general  condition  of  the  sys- 
tem." This  general  condition,  he  thinks,  is  chiefly  dependent  on  a 
gouty  or  rheumatic  diathesis.  He  generally  begins  the  treatment 
with  one  active  dose  of  calomel,  from  five  to  eight  grains,  followed 
by  a  mild  purge  of  rhubarb  or  magnesia  next  morning.  Leeches  to 
the  anus,  either  immediately  before  the  menstrual  period,  or  equi- 
distant between  the  two  periods,  are  very  efficacious;  but  often  re- 
quire repetition  before  their  full  value  is  seen. 

"The  attention  of  the  practitioner  must  now  be  devoted  to  the  more  specific 
treatment  in  the  case.  If  the  circulation  be  plethoric  and  strong,  the  urine 
scanty,  high-colored,  with  considerable  excess  oflithic  acid  and  lithates,  colchi- 
cum,in  the  form  of  the  acetous  extract,  with  extract  of  hop  or  henbane,  may  be 
given  at  night,  or  night  and  morning,  and  some  mild  saline,  with  sp.  aslheris 
nitrici,  occasionally  during  the  day. 

"  The  salines,  as  recommended  by  Dr.  Prout,  are  well  worthy  of  attention  ; 
the}'  not  only  diminish  the  disposition  to  the  formation  oflithic  acid  during  the 
processes  of  primary  assimilation,  but  allay  the  irritable  state  of  the  digestive 
organs,  and  the  urine  becomes  increased  in  quantity  and  more  healthy  in  its 
,  characters. 

"  Where  the  disease  assumes  the  rheumatic  or  rheumatic-gouty  character,  we 
usually  find  it  associated  with  less  power  of  general  circulation,  and  with  local 
symptoms  of  less  active  character.  Guaiacum  and  iodine  are  valuable  reme- 
dies in  these  affections,  either  separately  or  combined.  The  tinctura  guaiaci 
ammoniata  may  be  taken  in  milk  night  and  morning;  or  ten  grains  of  pulv. 
guaiaci  and  of  magnes.  carb.  every  morning,  and  from  two"  to  five  grains  of 
potass,  iod.  with  extract  of  hop  or  henbane  at  night;  or  if  it  be  deemed  unneces- 
sary to  use  the  guaiacum,  the  potassae  iod.  may  be  given  two  or  three  times 
a-day  in  sarsaparilla  with  liq.  potassae,  and  the  bowels  regulated  by  an  altera- 
tive or  laxative  pill  at  night ;  or,  if  it  be  desirable  to  promote  diaphoresis,  by  a 
dose  of  Dover's  powder. 

"There  are  few  remedies  which  keep  up  a  healthy  action  of  the  liver  so  well 
as  the  taraxacum,  especially  when  preceded  by  a  dose  or  two  of  mercurial  med- 
icine. In  most  of  the  afiections  under  consideration,  where  it  is  important  to 
maintain  this  function  indue  activit)^,  and  j'et where  the  constant  use  of  mercu- 
rials is  highly  inexpedient,  taraxacum  becomes  a  valuable  adjunct.  It  is  pre- 
pared under  a  variety  of  forms,  but  I  preler  the  extract  as  being  the  most  certain 
and  convenient;  half  a  tea-spoonful  at  night,  dissolved  in  a  little  warm  milk, 
forms  a,  by  no  means,  disagreeable  cocea-like  drink;  or  it  may  be  taken  with 
milk  and  lime-water  if  necessary.    Besides  its  ordinary  eflect  on  the  liver,  and 


672  Surgical  Anecdote  Meteorological  Observations, 


therefore  indirectly  upon  the  bowels,  by  supplying  them  with  healthy  bile,  I  have 
reason  to  think  that  it  also  acts  upofi  the  skin  like  sarsaparilla,  and  (or  this  pur- 
pose may  sometimes  be  advantageously  combined  with  it." 

Braiihicaite's  Retrospect. 


A  Surgical  Anecdote.  We  find  the  following  in  the  last  No.  of 
the  Journal  des  Connaissances  Medico-Chirurgicales  :  One  of  the 
most  distinguished  surgeons  of  Paris,  being  about  to  operate  upon 
what  he  supposed  a  common  cataract  of  the  eye,  observed  to  the 
students  present,  at  the  close  of  a  brilliant  lecture,  Here  is  a  cata- 
ract easy  to  operate  by  displacement.  The  needle  introduced  into 
the  eye  was  manoeuvred  for  a  long  time  without  causing  the  opacity 
to  disappear.  The  instrument  was  then  w  thdrawn,  and  the  opera- 
tor, without  saying  a  word,  turned  his  back  upon  the  patient.  A 
witty  confrere,  wishing  to  ascertain  the  cause  of  this  bad  humor, 
examined  the  eye,  and  laughingly  said,  "I  see  what  it  is.  It  ap- 
pears that  there  has  only  been  here  a  displacement  of  diagnosis. 


METEOROLOGICAL  OBSERVATIONS,  for  Sept.,  1845,  at  Augusta,  Ga. 
Latitude  33''  27'  north  Longitude  4  32'  west  Wash,  Altitude  above  tide 
152  feet. 


Thermometer. 
Sunrise.    3^  p.  m. 

Barometer. 
Sunrise.       3,  p.m. 

Wind. 

Remarks. 

1 

71             88 

29  74-100    29  63-100 

w. 

Cl'dy,  th.  &  light.  &  sprink. 

2 

71              82 

"  65-100      ' 

'  63-100 

s.  w. 

Clotidy. 

3 

72             86 

'*  62-100      ' 

'  68-100 

s.  w. 

Fair.           [p.  m. sprinkle. 

4 

71              90 

"  73-100      ' 

'  72400 

s.  w. 

Fair  thunder  light,  at  5, 

5 

71             93 

"  73-100      ' 

*  68-100 

s.  w. 

Fair. 

G 

70              88 

"  71-100      ' 

'  78-100 

N.W. 

Fair. 

7 

71              89 

"  80-100      ' 

'  70-100 

s.  w. 

Fair. 

8 

72              92 

"  70-100      ' 

'  73-100 

w. 

Fair.                [rain  2-10  in. 

9 

72             92 

*'  73-100      ' 

'  71-100 

w. 

Fair  storm  at  3,  p.  m.  

10 

70             87 

"  78-100      ' 

'  87-100 

N.  W. 

Fair. 

11 

64             84 

"  80-100      ' 

'  81-100 

N.  E. 

Fair. 

12 

65              86 

"  95-100      ' 

'  92-100 

N.   E. 

Fair. 

13 

67              83 

"  95-100      ' 

'  92-100 

E. 

Fair.           [blow  last  night. 

14 

64             77 

"  81-100      ' 

'  66-100 

W. 

Variable,  cl'dy,  rain  1-10  in. 

15 

64              81 

"  69-100      ' 

'  72-100 

N. 

Fair. 

16 

58              79 

"  78-100      ' 

'  82-100 

E, 

Fair. 

l7 

66             82 

"  85-100      ' 

'  81-100 

N.  E. 

Cloudv. 

18 

62              79 

"  87-100      ' 

'  85-100 

N.  E. 

Variable. 

19 

64             88 

"  82-100      ' 

'  78-100 

W. 

Fair. 

20 

68              84 

"  75-100      ' 

'  58-100 

S. 

Fair.    [a.m.  &  ceased  1,  p.m. 

21 

69        .     68 

"  53-100      ' 

'  47-100 

N. 

Rain  7-10  in. began  at  3, 

22 

60              70 

"  65-100      ' 

'  72-100 

N. 

Fair. 

23 

58              76 

"  80-100       

'  78-100 

Fair. 

24 

52              71 

"  79-100      ' 

'  84-100 

N.  W, 

Fair. 

25 

51              72 

"  87-100      ' 

'  85-100 

N.  E. 

Fair. 

2G 

48              76 

"  82-100      ' 

'  82-100 

N.E.&  S.W. 

Fair. 

27 

49              80 

"  85-100      ' 

'  90-100 

W,  &  E. 

Fair. 

28 

52              80 

"  93-100      * 

'  93-100 

S.  E. 

Fair some  clouds. 

29 

56              82 

"  90-100      ' 

'  85-100 

P.    E. 

Fair     do.        do. 

30 

59             73 

"  76-100      ' 

'  73-100 

vS.  E. 

Cloudy  sprinkle. 

23  Fair  davs.    *iRain,  1  inch. 


SOUTHERN 

MEDICAL  AND  SURGICAL 

JOURNAL. 


Vol.  I.]  NEW  SERIES. DECE)IBER,  1845.  [No.  12. 

PART  I.ORIGIXAL  COMMUNICATIONS. 

ARTICLE    I. 

On  the  Treatment  of  the  Tertiary  Symptoms  of  Syphilis  hy  Hydrio- 
date  of  Potash,  with  Cases.  By  Paul  F.  Eve,  M.  D.,  Professor 
of  Surgery  in  the  Medical  College  of  Georgia, 

It  is  not  my  intention,  in  the  present  article,  to  enter  upon  the 
subject  of  the  venereal  disease  further  than,  to  exhibit  the  speedy  and 
potent  effects  which  the  combination  of  Iodine  and  Potash  has  over 
its  last  or  third  order  of  symptoms. 

It  is  known  to  the  profession,  that  within  a  few  years,  an  effort  has 
been  made,  particularly  by  M.  Ricord  of  the  Venereal  Hospital  of 
Paris,  to  divide  the  constitutional  symptoms  of  Syphilis  into  seconda- 
ry and  tertiary.  The  following  classification  of  the  phenomena  of 
this  disease,  according  to  its  pathology,  appears  now  to  be  gaining 
favor  with  the  best  informed  physicians  : 

The  venereal  disease  employed  as  a  generic  term,  embraces  two 
distinct  species  viz  :  Gonorrhoea  and  Syphilis.  These  do  not  de- 
pend upon  the  same  virus.  Gonorrhoea  has  probably  prevailed  from 
time  immemorial,  and  is  not  accompanied  with  peculiar  constitutional 
symptoms.  Syphilis  was  first  observed  about  the  close  of  the  15th 
century,  and  if  not  aborted  by  treatment,  almost  invariably  infects 
the  system,  and  becomes  a  constitutional  disease.  Both,  however, 
are  contagious,  and  propagated  in  the  same  manner,  (by  the  promis- 
cuous intercourse  of  the  sexes,)  and  both  may  exist  simultaneously 
in  the  same  person.     One  is  generally  confined  to  the  mucous  surfaces 

43 


674  Treatmentof  Tertiary  Symptoms  of  Syphilis.  [December, 

of  the  genital  organs  ;  the  other,  though  local  at  first,  soon  extends 
to  nearly  all  the  tissues  of  the  body. 

The  primary  symptoms  of  syphilis,  are  chancres  and  buboes.  The 
matter  or  pus  produced  in  these  is  contagious,  and  will  transmit  the 
same  disease  by  inoculation.  This  virus  may  be  destroyed,  by 
caustic,  (for  example,)  if  applied  within  five  days  from  the  appearance 
of  a  chancre,  and  then  no  general  or  constitutional  effects  are  likely 
to  occur.* 

When  a  bubo  is  the  first  symptom  discovered,  it  is  supposed  to  be 
dependent  upon  a  previously  existing  but  concealed  chancre ;  and  it 
will  communicate  syphilis,  if  it  be  genuine.  Buboes  may,  and  often 
do  arise  sympathetical  or  symptomatica!  of  other  diseases  ;  but  then 
they  contain  no  virus,  and  attempts  at  inoculation  fail. 

The  secondary  symptoms  of  syphilis  appear  on  the  mucous  mem- 
brane and  skin,  as  the  ulcerated  sore  throat,  and  lenticular  eruption 
upon  the  surface  of  the  body  some  add  alopecia,  or  falling  of  the 
hair,  and  condylomata,  or  tubercles  about  the  anus  and  genital  or- 
gans. These  result  from  the  absorption  of  the  syphilitic  virus,  and 
are  the  first  series  of  constitutional  infection.  They  generally  appear 
about  four  or  six  weeks  after  the  existence  of  the  primary  symptoms. 
The  disease  cannot  be  communicated  by  any  secretion  taken  from 
the  second  class  of  symptoms  ;  but  though  non-contagious,  still  it  is 
hereditary,  descending  through  parents  to  children. 

The  tertiary  phenomena,  or  third  class  of  symptoms  of  syphilis, 
exhibit  themselves  in  the  shape  of  nodes,  deep-seated  tubercles, 
warts  on  the  genitals,  chronic  ulcerations  of  the  throat,  rhagades  or 
eruptions  in  the  hands  and  feet,  ulcerations  of  the  nose  or  about  the 
face,  horny  excrescences,  &;c.  Although  the  system  is  more  pro- 
foundly affected,  yet  the  disease  in  these  forms  is  neither  contagious 
nor  transmissible  by  inheritance.  These  symptoms  never  occur 
without  being  preceded  by  the  primary  and  secondary,  and  seldom 
appear  before  these  have  existed  for  some  six  or  eight  months,  and 
sometimes  not  until  years  afterwards. 

To  recapitulate.  1st,  the  primary  symptoms  of  syphilis,  chancres 
and  buboes  are  contagious  ;  2nd,  the  secondary,  sore  throat,  blotches, 
&c.,  are  hereditary,  but  non-contagious  ;  3rd,  the  tertiary,  nodes, 
chronic  ulcerations,  &.C.,  are  neither  contagious  nor  hereditary. 

*  The  prophylatic  soap  of  Dr.  Pfeffqr  used  with  success  in  St.  Petersburgh, 
contains  in  500  grains  of  the  substance,  6  grs.  of  bichloride  of  mercury,  4  of 
tannin,  and  45  of  chloride  of  lime,  incorporated  into  a  soap  with  soda.  In  its 
application,  some  difficulty,  of  course,  is  experienced  in  the  female. 


1 845.]         Treatment  of  Tertiary  Symptoms  of  Syphilis.  675 


Not  only  in  a  diagnostical  point  of  view,  is  ttiis  classification  of  the 
phenomena  of  syphilis  important,  but  we  shall  find  it  equally  so  in  a 
therapeutical.  If  nature  has  been  followed  in  the  description  of  the 
symptoms,  and  the  changes  from  a  healthy  to  an  abnormal  condition 
defined  in  the  order  of  their  appearance,  we  are  surely  in  the  right 
path  to  correct  this  state.  Phenomena  difliering  so  widely  as  do  the 
primary  and  secondary  symptoms  of  the  disease  under  consideration, 
have  always  been  admitted  to  require  modifications  in  the  modes  of 
treatment,  and  so  indeed  must  it  necessarily  be  with  the  tertiary. 
The  discrepancy  in  reference  to  the  best  plan  of  curing  the  constitu- 
tional symptoms  of  syphilis,  may  be  explained  by  the  want  of  discrimi- 
nation in  the  general  classification  of  all  these  phenomena  under  the 
head  of  secondary.  It  is  only  during  the  past  few  years  that  ano- 
ther division  has  been  insisted  upon,  and  a  third  order  attempted  to 
be  established. 

Nodes,  exostoses,  caries  of  the  bones,  chronic  ulcerations  of  the 
mucous  membrane  and  skin,  tubercles,  &;c.,  have  co-existed  with 
other  symptoms  of  syphilis,  and  have  all,  until  recently,  been  sub- 
jected to  the  same  treatment.  So  indiscriminately  was  mercury 
employed  in  this  disease,  that  the  question  arose,  whether  these  very 
phenomena  were  not  the  sole  effects  of  the  remedy  itself.  In  his 
system  of  clinical  medicine,  published  in  1843,  Dr.  Graves,  of  Dub- 
lin, remarks  on  this  subject,  "  notwithstanding  all  that  has  been  said 
and  done,  a  good  deal  still  remains  to  be  accomplished,  before  the 
treatment  of  syphilis  can  be  said  to  be  placed  on  a  solid  and  rational 
basis.  *  *  *  In  treating  cases  of  primary  or  secondary  symp- 
toms, which  have  existed  for  some  time,  and  where  the  patient  has 
been  taking  mercury,  it  is  hard  to  unravel  the  perplexities  which  sur- 
round the  case,  and  ascertain  whether  the  mercury  has  been  proper- 
ly administered  or  not. 

"  Where  a  patient  laboring  under  syphilis  has  been  salivated  with- 
out being  improved,  one  of  two  things  must  be  inferred  either  that 
the  mineral  has  had  no  effect  on  the  disease,  or  that  it  had  an  injuri- 
ous effect  on  the  constitution.  The  great  point  to  arrive  at  in  the 
treatment  of  syphilis,  is  to  make  the  mercury  act  on  the  disease,  and 
not  on  the  constitution.  This  I  have  often  endeavored  to  impress 
on  my  class.  I  will  venture  to  say,  that  I  would  engage  to  give  a 
patient,  laboring  under  primary  symptoms,  any  quantity  of  mercury, 
without  producing  a  favorable  effect  on  the  disease,  or  doing  him 
any  good.     I  would  engage  to  salivate  a  man  affected  with  sore  throat. 


676  Treatmentof  Tertiary  Symptoms  of  Syphilis,  [December, 


and  yet  leave  him  as  bad,  or  even  worse  than  ever.  1  have  witness- 
ed this  occurrence  over  and  over  again,  and  have  laid  it  down  to 
myself  as  a  proposition  that  the  venereal  may  be  treated  with  mer- 
cury, to  the  fullest  extent,  without  being  cured." 

Of  the  opposite  plan  of  treating  syphilis,  i.  e.,  the  non-mercurial, 
it  is  known  that  a  good  deal  was  said  and  published,  especially  by 
some  of  the  army  surgeons  of  Europe,  fifteen  or  twenty  years  ago. 
But  the  very  favorable  statistical  reports  then  made,  have  not  been 
sustained  by  subsequent  observations  and  experience  ;  it  is  even  said, 
that  Mr.  Rose,  formerly  one  of  the  most  zealous  advocates  of  the  non-' 
mercurial  plan,  has  not  only  abandoned  it,  but  adoped  the  mercurial 
course  of  treatment. 

With  regard  to  the  propriety  of  insisting  upon  the  classification 
of  the  symptoms  of  syphilis,  advocated  by  this  article,  it  may  be  re- 
marked that  John  Hunter  divided  the  parts  afl^ected  by  the  secondary 
symptoms,  into  two  orders,  and  these  included  the  second  and  third 
class  of  M.  Ricord.  In  the  edition  of  his  work  on  the  Venereal, 
edited  by  Babington,  (1839,)  he  says,  the  first  symptoms  of  the  dis- 
ease, after  absorption,  appear  either  on  the  skin,  throat,  or  mouth  ; 
and  again,  in  the  second  stage  of  Lues  Venerea,  in  the  deeper-seated 
parts,  as  the  periosteum,  tendons,  fasciae  and  ligaments.  He  also 
distinctly  states  the  order  in  which  these  parts  are  affected  viz : 
1st,  the  mucous  membrane  and  skin,  and  2nd,  the  internal  or  deep- 
seated  organs.  We  may  also  observe,  that  Samuel  Cooper,  and 
others,  often  allude  to,  and  speak  of  the  secondary  venereal  ulcera- 
tions. Still,  with  scarcely  an  exception,  their  countrymen,  even  to 
the  present  day,  admit  but  the  two  classes,  the  primary  and  second- 
ary ;  we  are  therefore,  compelled  to  request  the  reader  to  make  the 
distinction,  when  we  refer  to  writers  in  Great  Britain  on  this  subject. 
By  the  term  secondary  symptoms,  they  include  all  those  which  occur 
after  chancres  and  buboes,  while  the  French  divide  them  into  se- 
condary and  tertiary. 

Of  the  recent  contributions  of  chemistry,  none  seem  to  promise 
more  in  the  practice  of  medicine  than  the  preparations  of  iodine ; 
and  of  these,  one  of  the  most  valuable  is  certainly  the  hydriodate  of 
potash.  Its  synonyms  are  potassii  iodidum,  potassse  hydriodas, 
iodide  of  potassium,  proto-ioduret  de  potassium,  hydriodate  of  potassa 
or  potash.  Its  medical  properties  and  uses  have  not  yet  been  fully 
ascertained.  Even  its  dose  is  not  satisfactorily  defined  ;  for  while 
some  give  only  a  ^QVf  grains,  others  have  ventured  to  administer  half 


1845.]         Treatment  of  Tertiary  Symptoms  of  Syphilis.  Gil 


an  ounce  of  the  pure  salt.     It  is  generally  considered  to  be  diuretic, 
alterative,  resolvent,  and  deobstruent. 

The  introduction  of  this  article  into  the  treatment  of  syphilis,  may 
be  learnt  from  the  following  extract  of  a  report  on  the  subject,  made 
by  M.  Rattier's  on  M.  Ricord's  practice  :  In  our  researches  on 
the  administration  of  the  ioduret  of  potassium,  we  have  been  able  to 
follow  out  the  treatment  of  all  the  various  forms  of  tertiary  syphilis. 
Often  the  ioduret  alone  has  been  found  sufficient  for  the  cure ;  but 
whenever  any  complication  has  happened  to  be  present,  it  has  re- 
ceived an  appropriate  medication.  By  having  recourse  at  one  time 
to  tonics  and  stimulants,  at  another  time  to  antiphlogistics,  M.  Ricord 
combines  the  various  resources  of  therapeutics,  according  to  the  cir- 
cumstances of  each  case  ;  and  in  some  patients  who,  in  consequence 
of  successive  infections,  have  exhibited  the  disease  in  all  its  stages  
primary,  secondary,  and  tertiary  a  local  treatment  has  been  direct- 
ed to  the  chancres,  the  use  of  mercury  (proto-iodide)  has  caused  the 
secondary  symptoms  to  disappear,  and  the  hydriodate  of  potash  has 
been  equally  successful  against  the  tertiary  symptoms.  Such  is  the 
basis  of  M.  Ricord's  treatment.  If  those  principles,  now  explained, 
be  not  attended  to,  the  physician  will  be  apt  to  commit  many  serious 
errors ;  of  which  we  meet  with  numerous  examples  in  the  assertions 
of  those  writers  who  have  attempted  to  disparage  the  utility  of  the 
ioduret  of  potassium,  on  the  ground  that  they  have  observed  certain 
secondary  symptoms  resist  its  administration.  Had  a  few  mercu- 
rial pills  been  exhibited  at  the  same  time,  these  symptoms  would 
speedily  have  vanished.  In  conclusion,  the  proto-ioduret  of  potas- 
sium amply  deserves,  in  the  treatment  of  tertiary  syphilitic  symp- 
toms, all  the  praise  which  mercury  is  entitled  to  in  the  treatment  of 
the  secondary  symptoms  with  this  difference,  that,  very  seldom,  or 
never,  has  it  given  rise  to  those  numerous  and  distressing  accidents 
which  are  too  well  known  to  have  been  frequently  induced  by  the 
injudicious  administration  of  its  rival.  (La  Lancette  Frangaise  
Medico-Chirurg.  Review.) 

M.  Ricord,  in  his  practice,  commences  with  10  grs.  a-day  of  the 
iodide  of  potash,  in  some  convenient  vehicle,  as  the  decoction  of  hops, 
&;c.,  and  increases  the  dose  every  third  or  fifth  day,  until  it  amounts 
to  36  grs.  during  the  twenty-four  hours.  He  has  administered  as 
much  as  5ii.  a  day;  but  thus  given,  it  is  apt  to  produce  the  iodic 
intoxication,  a  certain  nervous  tremor  of  the  muscles  with  confusion 
of  the  brain. 


678  Treatment  of  Tertiary  Sym'ptoms  of  Syphilis.  [December, 


CuUerier's  prescription  is  R.  Iodine,  gr.  1 ;  Potassae  lodid.,  ii.  ad 
iv. ;  Aquse,  ^i.  M.  This  is  put  into  a  pint  or  quart  of  decoction  of 
sarsaparilla,  and  is  to  be  given  at  intervals  during  the  da3^  The 
dose  of  iodine  may  be  increased  to  2  grs.,  and  that  of  the  iodide  of 
potass  to  6  or  10  in  the  day. 

The  Reviewer,  in  the  Mcdico-Chirurgical  Journal,  1840,  says  that, 
in  the  mixed  symptoms  of  cachexia,  (resulting  from  syphilis,)  the 
preparations  of  iodine  act  almost  marvellously.  In  the  rupial  or 
ecthymatous  ulcerations  of  the  skin,  in  diseases  of  the  bones  that 
sometimes  may  result  from  syphilis,  and  often  do  result  from  mercu- 
ry, the  iodide  of  potassium  is  highly  beneficial ;  yet  he  adds,  it  seems 
inconsistent  and  uncertain  in  its  operations. 

While  we  admit  that  preparations  of  mercury  do  oftener,  more 
speedily,  and  with  more  certainty  and  permanency,  cure  confirmed 
secondary  symptoms  of  syphilis  than  any  other  plan  yet  adopted, 
still,  in  the  ^er^zcrr?/ forms  of  this  disease,  its  rival,  iodide  of  potash, 
has  decided  preference.  The  late  M.  Biet,  whose  extensive  oppor- 
tunities at  the  St.  Louis  Hospital,  in  Paris,  entitle  his  opinion  on  this 
subject  to  some  respect  and  weight,  stated  "that  mercury  did  not 
produce  any  marked  effect  over  the  syphilitic  tubercula."  Samuel 
Cooper,  Prof,  of  Surgery  in  the  London  University  College,  says,  "  I 
doubt  whether  secondary  symptoms  are  more  frequent  after  the 
treatment  of  primary  sores  with  iodide  of  potash  and  sarsaparilla, 
than  after  mercurial  treatment."  James  Miller,  Prof,  of  Surgery  in 
the  University  of  Edinburgh,  in  his  Principles  of  Surgery,  observes 
on  Diseases  of  Bones,  "  but,  as  a  general  rule,  mercury,  in  any  form, 
is  never  to  be  given  in  periostitis,  more  especially  so  as  to  produce  a 
constitutional  effect,  unless  other  and  safer  means  have  proved  una- 
vailing. For  that  mineral  we  well  know  to  be  as  likely  to  cause  as 
to  cure."  He  gives  the  preference  to  the  iodide  of  potassium.  "  Dr. 
Williams,  of  London,  considers  it  (hydriodate  of  potassa)  applicable 
to  the  treatment  of  various  forms  of  secondary  syphilis.  He  used  it 
with  success,  in  a  majority  of  cases,  in  removing  hard  periosteal 
nodes,  and  found  it  beneficial  in  the  treatment  of  tubercular  forms 
of  venereal  eruptions.  It  is  also  considered  as  one  of  the  best  altera- 
tive remedies  in  mercurio-syphilitic  sore  throat."  Mr.  S.  Cooper 
not  only  doubts  which  is  the  best  mode  of  treatment  for  primary 
sores  the  mercurial  or  iodide  of  potass,  with  sarsaparilla but  he  is 
a  strenuous  advocate  for  the  use  of  the  latter  in  the  various  secondary 
and  tertiary  venereal  affections.     He  recommends  its  employment 


1845.]         Treatment  of  Tertiary  Symptoms  of  Syphilis.  679 


in  the  eruptive  form,  in  nodes,  phagedenic  ulcers,  d:;c.,  and  these 
belong  to  the  tertiary  division.  He  generally  gives  from  3  to  5  grs. 
of  iodide  of  potassium  in  decoction  of  sarsaparilla  thrice  a  day.  In 
Listen's  Elements  of  Surgery,  edited  by  Prof.  Gross,  of  Kentucky, 
the  latter  says  in  a  note,  "  it  is  surprising  that  the  author  has  made 
no  mention,  in  connection  with  this  subject,  (constitutional  symp- 
toms of  syphilis,)  of  the  iodide  of  potassium,  so  justly  lauded  by 
Mons.  Ricord  and  some  other  French  surgeons.  For  the  last  two 
years,  or  more,  I  have  been  constantly  in  the  habit  of  employing  this 
article  in  Zerifiary  syphilis,  in  mercurial  diseases  of  the  bones,  and  in 
chronic  rheumatism,  in  which,  I  am  convinced,  it  is  as  much  of  a 
specific  as  quinine  is  in  intermittent  and  miasmatic  neuralgia." 
Dr.  G.  gives  the  article  in  large  doses,  even  half  a  drachm,  after 
having  commenced  with  10  grs.  three  or  four  times  a  day.  He  adds, 
"patients  who  have  labored  under  nodes  and  nocturnal  pains  for 
months,  whose  health  has  become  greatly  impaired,  and  who  have 
not  slept  soundly  perhaps  for  weeks  together,  have  often  perfectly 
recovered  under  this  treatment  in  less  than  a  fortnight."  In  the 
Bulletin  of  General  Therapeutics,  of  last  year,  is  an  article  from  M. 
Ricord,  on  what  he  terms  Syphilitic  Chlorosis.  He  states  that,  in 
his  examinations  of  the  blood  taken  from  patients  laboring  under 
syphilis,  he  has  found  a  diminution  in  its  globules  ;  a  condition  which 
obtains  in  common  chlorosis.  This  particular  state  of  the  blood 
grows  worse  as  the  syphilitic  infection  gives  place  to  secondary  or 
tertiary  symptoms.  It  may  continue  in  different  degrees  after  they 
disappear.  The  first  conclusion  to  be  drawn  from  these  considera- 
tions is,  that  syphilis  being  an  anemic  disease,  or,  at  least,  always 
complicated  with  anemia,  the  antiphlogistic  method  of  treatment  is 
dangerous.  The  second  conclusion  is,  the  necessity  of  a  nutritious 
diet.  "The  treatment  that  I  adopt,"  says  M.  R.,  "consists  in  the 
combination  of  ferruginous  and  mercurial  preparations,  if  there  ex- 
ist no  counter-indications.  When  the  secondary  symptoms  pass  to 
tertiary,  the  mercurials,  combined  with  iodide  of  iron,  or  with  iodide 
of  potassium,  suffice  to  reconstitute  the  blood." 

In  Braithwaite's  Retrospect  for  July  to  January,  1845,  No.  10, 
may  be  found  an  article  by  Dr.  Skae,  taken  from  the  Northern  Jour- 
nal of  Medicine,  on  Condyloma.  This  writer  refers  to  the  Lectures 
of  the  late  Dr.  Wallace,  of  Dublin,  as  published  in  the  London  Lan- 
cet, who  gave  the  name  of  "exanthematic  primary  syphilis,  to  the 
group  of  symptoms  consisting  of  moist  elevated  patches  upon  the 


680  Treatment  of  Tertiary  Symptoms  of  Syphilis.  [December, 


mucous  membrane  of  the  lips,  cheeks,  tonsils,  &;c.,  of  a  whitish  color, 
as  if  touched  with  nitrate  of  silver,  or  coated  with  milk,  mucous  tu- 
bercles about  the  genital  organs  or  anus,  &c. ;  and  which  are  asso- 
ciated with  the  eruption  on  the  skin.     Dr.  Skae  says,  these  are  cura- 
ble without  the  use  of  mercury.     "My  treatment  consisted  chiefly  in 
the  application  of  stimulants  to  the  condylomata;  the  use  of  astrin- 
gent injections  and  cold  washing,  for  the  cure  of  the  vaginal  and 
uterine  discharges  ;  and  incases  of  the  latter  kind,  the  internal  admin- 
istration of  tinct.  of  cantharides.     In  several  cases,  when  there  ex- 
isted cutaneous  eruptions,  the  iodide  of  potassium  was  given.     In  no 
instance   was  any  mercury  administered,  except  in  the  case  of  the 
woman  affected  with  iritis."     For  the  treatment  of  these  symptoms, 
which  are  now  classed  under  the  head  of  tertiary,  in  the  September 
No.  (1844)  of  the  London  and  Edinburgh  Monthly  Journal  of  Medi- 
cal Science,  Dr.  Rose  Cormack  writes,  "  besides  corrosive  sublimate, 
(which  he  recommends  in  repeated  small  doses,  largely  diluted,)  there 
are  several  valuable  therapeutic  agents,  which  may  be  given  inter- 
nally in  the  treatment  of  condyloma.     As  the  chief  of  these,  I  would 
mention  hydriodate  of  potash.     *     *     *     I  generally  prescribe  three 
grains  of  the  hydriodate  of  potash  to  be  taken  in  twenty-four  hours, 
in  four  or  six  doses,  each  being  dissolved  in  several  ounces  of  water, 
with  or  without  infusion   of  gentian."     He    also   recommends  in 
syphilitic  skin  diseases,  after  repeated  small  bleedings,  the  hydriodate 
of  potash.     He  says  it  was  first  employed  in  secondary  and  tertiary 
syphilis,  by  Brera,  in  1821 ;  and  his  example  has  since  been  follow- 
ed by  very  many,  among  whom  deserve  special  notice,  Ricord,  Biett, 
Baumes,  Wallace,  Sperine,  (of  Turin,)   Schultzemberger,  (ofStras- 
burg,)  and  Guetine,  (of  Antwerp).     In  the  hands  of  these  physicians, 
he  adds,  it  seems  to  have  cured  every  form  of  secondary  and  tertia- 
ry venereal  disease. 

We  give  the  following  extract,  as  it  bears  so  forcibly  in  favor  of 
our  position : 

The  report,  which  M.  Gauthierhas  recently  published  respecting 
the  curative  power  of  this  salt  of  Iodine  in  secondary  and  tertiary 
syphilitic  affections,  is  on  the  whole  highly  favourable  to  its  use. 
He  has  administered  it  in  a  vast  number  of  cases,  and  has  rarely 
noticed  any  injurious  or  even  unpleasant  effects  fairly  attributable 
to  its  operation.  On  a  few  occasions  it  appeared  to  cause  a  saliva- 
tion ;  which,  however,  speedily  ceased.  Now  and  then,  an  innocu- 
ous exanthem  made  its  appearance  on  the  surface.  In  some  persons 
it  causes  slight  gastric  irritation;  but  in  most,  the  digestive  functions 


1845.]         Treatment  of  Tertiary  Symptoms  of  Syphilis,  681 


appear  to  be  decidedly  improved  under  its  use.  In  no  instance  has 
any  wasting  of  the  body  seemed  to  be  induced  by  it,  as  has  occa- 
sionally been  observed  with  respect  to  Iodine.  One  of  the  most 
constant  effects  of  the  loduret  is  to  increase  the  flow  of  the  urine. 
It  seems  to  pass  very  rapidly  into  this  and  the  other  secretions;  its 
presence  is  readily  discoverable  by  its  well-known  appropriate  tests. 
M.  Gauthier  has  often  detected  it  in  the  saliva. 

The  following  are  the  forms  of  the  syphilitic  disease  in  which  he 
has  witnessed  the  most  decided  curative  effects.  Pains  of  the  bones, 
even  when  most  severe,  are  often  very  rapidly  and  effifctually  subdu- 
ed ;  nay,  when  caries  exist,  a  salutary  change  is  not  unfrequently 
obtained.  Thus  in  Ozoena,  complicated  with  disease  of  the  palate, 
or  nasal  bones,  we  seldom  fail  in  greatly  benefiting,  if  not  in  curing, 
the  disease.  In  various  tubercular  affections  of  the  ski?i  and  mucous 
membranes,  the  loduret  will  be  found  most  useful.  Deep  ulcerations 
of  the  throat  and  pharynx,  rhagades  or  fissures  about  the  anus  and 
nails,  will  not  unfrequently  heal  up  most  satisfactorily,  even  when 
mercury  has  been  previously  tried  and  tailed.  It  is  sometimes  truly 
marvellous  to  witness  the  decided  improvement  of  the  general  health 
in  the  course  of  a  few  days,  under  the  use  of  the  loduret  when  judi- 
ciously administered.  M.  Gauthier  considers  that  it  is  a  most  valu- 
able remedy  in  many  cases  of  mercurial  cachexy :  an  ioduretted 
gargle  will  often  serve  to  check  salivation  from  this  cause. 

He  invariably  begins  its  administration  in  small  doses  from  two 
to  four  grains,  or  even  less  twice  a  day.  The  quantity  should  be 
doubled  every  third  or  fourth  day,  until  it  reaches  15  or  20  grains. 
This  dose  should  be  continued  for  some  time  ;  but,  if  it  fails  in  pro- 
ducing any  decided  effect  upon  the  disease,  it  may  be  increased  to 
two  scruples  or  even  a  drachm.  In  a  few  cases,  he  has  given  as 
much  as  two  drachms  in  the  course  of  twenty-foui-  hours. 

A  solution  of  the  loduret  in  water,  to  which  some  tincture  of 
Iodine  has  been  added,  may  be  advantageously  used  as  a  gargle  in 
ulcerated  sore-throat,  and  as  a  wash  to  ulcers  on  the  surface,  or  on 
the  Schneiderian  membrane. 

The  average  period,  during  which  the  internal  use  of  the  loduret 
should  be  continued,  may  be  stated  to  be  from  six  to  eight  weeks. 
Much  will  depend  on  the  gradual  increase  of  the  doses  given.  Many 
cases  will  remain  stationary,  if  the  quantity  of  the  salt  administered 
be  not  progressively  and  this,  too,  rapidly  augmented.  Jled. 
Chir.  Rev.,  from  Observations  pratiques  sur  le  Traitement  des  Mal- 
adies Syphilitiques  par  VIodine  de  Potassium,  by  M.  L.  Gauthier. 

In  the  General  Bulletin  of  Therapeutics,  for  January,  1845,  will 
be  found  an  article  on  the  efficacy  of  corrosive  sublimate  in  the  treat- 
ment of  the  secondary  and  tertiary  symptoms  of  syphilis,  by  M.  A. 
Devergie,  Physician  of  St.  Louis  Hospital.  In  this  is  reported  an 
interesting  case  of  an  officer  long  affected  by  the  disease,  and  where- 


682  Treatment  yf  Tertiary  Symptoms  of  Syphilis.  [December, 


in  the  iodide  of  potassium  alone,  failed  to  produce  a  cure.  This  was 
finally  affected  by  the  combination  of  the  mercurial  with  the  iodide 
of  potash  and  iron,  quinine,  &;c.  In  general,  M.  Devergie's  treat- 
ment for  the  secondary  and  tertiary  symptoms  of  syphilis,  is  "a  quart 
of  sudorific  ptisan,  in  which  from  5  to  20  grs.  of  the  ioduret  of  potash 
have  been  dissolved,  and  also  to  take  every  morning,  fasting,  a  pill 
composed  of  guiac,  opium,  and  a  minute  quantity  of  the  corrosive 
sublimate.  In  the  course  of  a  week  or  so,  a  second  pill  is  to  be  taken 
at  night  also.  '  These  medicines  are  to  be  persevered  with  for  two, 
or  even  three  months,  without  intermission.  A  tepid  bath  is  to  be 
taken  once  a  week." 

To  that  variety  of  the  venereal  disease,  known  as  the  most  intract- 
able and  destructive  1  mean  the  constitutional  effects  of  syphilis  in 
a  scrofulous  diathesis  the  iodide  of  potash  seems  peculiarly  appro- 
priate. Indeed,  should  this  fail  to  cure,  mercury  being  out  of  the 
question,  we  may  try  iodide  of  iron  or  preparations  of  arsenic;  but 
fortunately,  the  hydriodate  is  usually  well  adapted  to  the  case. 

In  the  use  of  the  article,  we  remark  a  considerable  difference  in 
the  dose  as  employed  in  England  and  France.  While  the  English 
recommend  it  in  doses  of  3  to  5  grs.,  the  French  give  10  to  20  grs. 
a  day.  The  preparation  which  I  first  used  was  obtained  from  Pelle- 
tier  dc  Berthemot,  of  Paris.  My  mode  of  administration  is  to  put  i. 
of  the  salt  into  8  ounces  of  water,  and  give  a  half  tea-spoonful  three 
times  a-day,  increasing  the  dose  to  a  full  tea-spoon.  This  will  make 
from  10  to  20  grs.  in  twenty-four  hours.  I  have  thus  directed  the 
hydriodate  of  potash,  in  a  goodly  number  of  cases  in  private  practice, 
and  in  the  majority  have  lost  sight  of  their  issue  the  result  not  hav- 
ing been  reported.  It  is  well  known,  that  but  little  that  is  satisfacto- 
tory  can  be  derived  in  the  treatment  of  the  venereal  disease  out  of 
hospitals.  Few  patients,  in  private  practice,  will  submit  to  the  diag- 
nostic test  by  inoculation,  and  fewer  still  will  make  regular  reports 
to  the  physician  or  surgeon  of  their  cases.  Of  those  I  have  treated 
with  the  hydriodate  of  potash,  the  following  three  cases  have  been 
the  most  striking,  and  exemplifies  the  good  effect  of  the  medicine  in 
persons  of  different  age,  sex  and  color  : 

Case  i.  Philip,  a  black  man,  aged  about  50,  has  had  syphilis  for 
many  years.  When  purchased  by  his  present  owner,  I  was  requested 
to  give  an  opinion  as  to  the  state  of  his  health.  He  was  pronounced 
unsound,  and  to  be  then  laboring  under  the   tertiary  effects  of  the 


1845.]         Treatment  of  Tertiary  Symptoms  of  Syphilis.  683 


venereal  disease.  This  was  in  the  sumhier  of  1843.  In  May,  1844, 
he  was  placed  under  my  care.  He  was  then  in  a  very  desperate 
condition.  His  master  tiiought  his  death  inevitable,  and  only  ex- 
pected some  mitigation  of  his  suffering.  He  could  scarce  articulate 
so  as  to  be  understood  ;  and  deglutition  was  affected  with  great  pain. 
Has  had  alopecia  to  some  extent.  Tiie  surface  of  his  body  in  pla- 
ces, particularly  on  the  forehead  and  breast,  was  covered  w  ith  irregu- 
lar tubercles,  varying  in  size  and  shape.  The  frontal  bone  exhibited 
ulcerated  nodosities,  and  the  extremity  of  his  nose  was  greatly  en- 
larged. The  whole  of  the  soft  palate  had  been  removed  by  ulceration, 
and  the  throat  presented  one  large  irregular  and  offensive  ulcer. 
Philip,  it  need  scarce  be  said,  had  been  subjected  to  a  variety  of 
treatment,  for  he  was  a  favorite  and  valuable  servant,  being  an  ex- 
cellent cook. 

I  immediately  put  him  upon  the  hydriodate  of  potash  in  10  grs. 
doses,  in  conjunction  with  sassafras  tea,  the  warm  bath  and  good 
light  nourishing  diet,  such  as  he  could  conveniently  swallow.  The 
iodide  was  ordered  to  be  increased  to  1*2  or  15  grs.  three  times  a-day, 
if  the  previous  doses  were  tolerated.  In  ten  days  the  improvement 
was  most  gratifying.  He  took  about  iii  3  of  this  preparation  during 
the  treatment,  and  by  kind  attention  and  good  nursing,  perfectly  re- 
covered. He  married  the  following  winter,  and  may  be  now  seen 
almost  any  day,  and  in  all  kinds  of  weather,  driving  a  market-wagon  in 
our  streets.     The  defect  of  palate  is  scarcely  detected  by  his  speech. 

Case  ii.  This  is  a  mulatto  man,  aged  40,  and  a  brick  layer  by 
trade.  He  has  had  the  venereal  disease  several  times,  the  first  attack 
near  twenty  years  ago.  He  has  been  for  several  months  under  the 
care  of  another  physician,  and  been  thoroughly  treated  by  the  usual 
method  for  a  chronic  sore  throat.  In  November,  1844, 1  commenced 
to  give  him  the  hydriodate  of  potash.  It  was  with  great  difficulty 
he  could  swallow  the  dose  of  5  grs.  three  times  a  day.  In  a  day  or 
two  the  soft  palate  dropped  off,  the  immense  ulcer  then  began  to 
heal,  and  in  less  than  a  month  he  asked  permission  to  go  to  work. 
The  quantity  of  the  iodide  used  in  this  case  was  greater  than 
in  the  first  reported,  and  it  had  to  be  continued  much  longer.  He 
tookoveriv5  ofthe  hydriodate,  and  was  under  treatment  two  months. 
This  patient  too,  had  had  alopecia  and  chronic  ulcerations  upon  the 
skin.  In  both  these  cases  the  iodic  intoxication  was  slightly  felt, 
although  the  quantity  of  the  preparation  never  reached  50  grs.  in 
twenty. four  hours. 


684  Treatment  of  Tertiary  Symptoms  of  Syphilis.  [December, 


Case  hi.  For  the  notes  of  this  case,  I  am  indebted  to  my  friend, 
Mr.  Jeter  Martin,  who  has  been  acting  as  resident  physician  to  our 
city  hospital  during  the  past  summer.  This  patient,  although  not 
cured  by  the  hydriodate  of  potash,  owing,  as  is  believed,  to  her  ina- 
bility to  retain  it  in  sufficient  quantity,  was  nevertheless  so  strikingly 
improved  by  it,  and  that  too  in  a  very  short  time,  and  witnessed  by  a 
whole  class  of  students  in  attendance,  as  to  be  worthy  of  notice  here. 

S.  C,  aged  17,  of  luco-phlegmatic  temperament,  and  of  small 
statue,  had  the  misfortune  to  be  attacked  in  March,  1844,  with  syph- 
ilis. It  commenced  with  chancres,  and  being  in  the  country,  she 
took  no  medicine  for  the  disease.  In  August  following,  she  says 
she  was  covered  with  small  yellow  blisters,  and  in  six  weeks  there- 
after each  blister  had  become  an  ulcer,  and  these  in  their  turn  as- 
sumed the  appearance  of  small  irregular  horns. 

When  she  arrived  at  the  hospital,  so  entirely  was  she  covered  with 
ulcerations,  that  she  \vould  allow  no  one  to  assist  her  in  moving,  for 
fear  of  increasing  her  pain  and  suffering.  On  the  29th  September 
she  entered  under  the  service  of  Dr.  Garvin.  Her  forehead  present- 
ed some  five  or  six  excrescences,  projecting  from  half  to  three-fourths 
of  an  inch  beyond  the  skin,  but  attached  to  it,  (tubercular  syphilida,) 
her  elbows  and  knees  were  covered  with  large  ulcerations,  she  had 
chronic  sore  throat,  &:c.,  &c. 

Dr.  Garvin  first  put  her  upon  the  blue  mass,  and  directed  chloride 
of  soda  to  the  ulcers.  This  treatment  was  changed  to  corrosive 
sublimate  and  a  wash  of  decoction  of  sage,  tinct.  of  myrrh,  borax 
and  honey.  This  preparation  of  mercury  affected  the  bowels  and 
had  to  be  discontinued,  and  the  iodide  of  mercury  was  substituted  for 
it ;  the  ulcers  were  then  dressed  with  calomel  13  and  simple  cerate 
15.  She  also  took  some  quinine.  This  was  the  treatment  pursued 
up  to  December  1st,  and  under  which  she  had  somewhat  improved. 

So  evident  were  her  chlorotic  symptoms,  that  upon  entering  this 
month  on  duty  at  the  hospital,  I  first  prescribed  the  iodide  of  iron  in 
simple  syrup  three  times  a  day  in  3  grs.  doses.  December  3d,  the 
hydriodate  of  potash  was  given  in  the  same  doses,  as  the  iodide  of 
iron  is  not  retained  upon  the  stomach.  December  8th,  the  hydrio- 
date is  increased  in  quantity;  and  on  the  15th,  she  takes  25  grs.  per 
twenty-four  hours.  Up  to  the  15th  January.  1845,  this  treatment 
was  perseveringly  attempted  to  be  continued,  but  no  effort  could  suc- 
ceed in  getting  a  larger  quantity  of  this  medicine  into  her  system. 
Indeed,  it  had  frequently  to  be  interrupted  on  account  of  the  irrita- 


1845.]  Case  of  Fungus  HcBmatodes.  685 


bility  of  her  stomach.  Still  her  improvement  was  such,  that  her 
ulcers  almost  entirely  healed  up,  her  horny  excrescences  ceased  to 
be  reproduced,  her  throat  appeared  healed,  she  gained  much  flesh, 
and  left  her  bed  to  take  regular  daily  exercise. 


ARTICLE    II. 

Case  of  Fungus  Hcematodes.     By  Gilbert  H.  Wootten,  M.  D., 
of  Florence,  Ga. 

The  extreme  infrequency  ofsuch  cases  in  the  United  States,  induces 
me  to  prepare  this  brief  history  of  one  that  partly  came  under  my 
management.  The  patient,  the  Rev.  David  Cox,  aged  about  40,  of 
leuco-phlegmatic  temperament,  was  attacked  some  time  in  the  year 
1840,  by  the  disease  in  question.  The  tumor  formed  about  midway 
between  the  trochanter  major  and  the  knee,  on  the  external  part  of  the 
thigh.  In  its  formation  it  presented  the  usual  characteristics  of  fun- 
gus haematodes,  and  was  developed  quite  rapidly  to  the  size  of  a 
cocoa  nut.  At  this  juncture  Mr.  Cox,  acting  under  the  advice  of  a 
gentleman  ofthis  county,  (Stewart)  who  practices  medicine,  submitted 
to  an  operation.  The  wound  healed  kindly, but  the  tumor  re-appear- 
ed very  soon,  at  the  place  from  which  it  was  excised,  and  on  the 
1st  of  June,  1844,  about  six  months  subsequent  to  the  operation,  had 
attained  to  about  its  original  size.  Up  to  this  time,  I  am  indebted 
to  the  family  for  the  details  of  the  case.  Dr.  Strawn,  my  co-partner, 
and  myself,  were  now  consulted,  and  requested  to  take  control  of  the 
case.  The  patient  was  importunate  for  a  second  operation,  which 
we  discouraged,  and  declined  performing,  for  the  following  reasons  : 
1st,  we  regarded  the  disease  as  constitutional,  and  not  local;  2nd, 
there  were  few,  if  any  cases  recorded,  of  success  by  an  operation  ; 
3rd,  the  previous  operation  had  not  only  failed,  but  had  evidently 
augmented  the  rapidity  and  violence  of  its  formation  ;  4th,  the  sys- 
tem gave  evidence  o^  jjarticipation,  by  the  intensely  inflamed,  and 
very  much  enlarged  condition  of  the  inguinal  glands.  Had  we  have 
seen  thease  previous  to  the  condition  of  our  "  4th  reason,"  we  might 
have  counselled  as  the  only  prospect  of  success  amputation  of  the 
thigh.     Would  it  have  been  good  practice  ? 

The  tumor  in  the  groin  (I  mean  the  enlarged  gland)  continued  to 


686  Case  of  Fungus  HcBmatodes.  [December, 

develope  very  rapidly  and  fearfully,  and  on  the  1st  of  August,  there- 
after, had  acquired  the  dimensions  of  a  half-bushel  measure  the 
original  one  on  the  thigh  having  ceased  to  grow,  remained  the  size 
previously  indicated.  The  inguinal  tumor  now  shot  out  fungus  ex- 
crescences, (till  its  surface  was  dotted  all  over,)  whose  mouth  resem- 
bled an  inverted  stocking,  and  over  all  its  surface  the  meanderingsof 
large  veins  could  be  distinctly  traced.  It  now  bled  frequently  and 
copiously,  owing,  as  I  presume,  to  the  perforation  of  its  vessels  by 
an  ulcerative  action.  The  bleedings  were  controlled  by  tamponing 
these  orifices,  and  by  compression.  The  odour  it  emitted  was  ex- 
tremely offensive,  rendering  the  sick  chamber  a  place  of  absolute 
suffering  to  the  attendants  and  visitors.  I  should  perhaps  remark, 
that  in  the  progress  of  this  tumor,  and  before  its  character  was  so 
well  defined,  we  were  frequently  importuned  by  the  patient  to  punc- 
ture it,  he  hoping  and  believing  it  to  be  only  an  abscess,  contrary  to 
our  assurances.  We  refused  to  operate,  but  gave  our  consent  to  its 
being  done,  merely  to  gratify  and  convince  him.  We  remarked, 
however,  that  it  yielded  physical  indications  of  distinct  fluctuation. 
He  procured  the  services  of  a  Botanical  physician  to  open  it.  Blood 
in  small  quantity  was  the  only  result  of  the  puncture.  After  attain- 
ing the  dimensions  and  character  before  described,  sphacelation  en- 
sued, and  the  entire  tumor  sloughed  out,  leaving  a  cavity  or  basin 
that  would  have  contained  two  or  more  gallons  of  fluid,  with  a  sub- 
tegumentary  hollow  or  channel,  communicating  with  the  original 
tumor  on  the  thigh.  Knowing  that  Sir  Astley  Cooper  had  reported 
one  case  of  recovery,  by  the  occurrence  of  the  same  process,  we  en- 
tertained some  hopes  that  the  sloughing  would  proceed  and  eradicate 
the  original  tumor,  and  thus  save  our  patient.  But  contrary  to  our 
hopes  it  did  not  do  so.  The  patient  was  now  extremely  emaciated, 
aspect  ccfJareroiw,  breathing  scarcely  perceptible,  voice  entirely  inau- 
dible, with  almost  constant  sleeping.  At  this  stage,  after  putting 
him  under  prescriptions,  the  case,  owing  to  incidental  circumstances, 
passed  to  the  control  of  another  physician,  and  was  not  seen  again 
by  us,  until  about  the  middle  of  November,  a  period  of  two  months. 
When  we  again  visited  the  patient,  he  had  recovered  his  strength, 
the  cavity  left  by  the  sloughing  of  the  tumor  had  filled  up  kindly, 
but  on  the  margin  of  the  cicatrix,  six  or  eight  other  tumors,  about 
the  size  of  lemons,  had  formed.  The  patient  died  about  the  15th  of 
December,  with  rigors.  During  the  progress  of  the  disease,  we 
frequently  interrogated  the  various  organs  of  the  system,  to  discover, 


1845.]  Case  of  Secondary  Syphilis.  G87 


if  possible,  whether  they  had  taken  on  lesions.  The  most  prominent 
evidences  discovered  were  furnished  by  the  lungs,  the  spinal  column 
and  the  rectum.  These  we  briefly  mention.  The  expectoration  was 
profuse,  and  resembled  thick  mucus,  having  a  very  unp  easant  odour. 
No  blood  was  discovered  with  it.  Hemiplegic  paralysis  ensued, 
and  there  was  tenderness  upon  pressing  the  vertehrce.  This  we 
made  no  effort  to  relieve,  as  it  occurred  only  a  few  days  prior  to  his 
demise.  The  rectum  was  the  seat  of  excrutiating  pain,  in  voiding 
i\\Q  fcBces^  or  in  the  escape  o^ flatus.  This  we  supposed  was  owing 
to  an  inflammatory  action,  resulting  from  the  contiguity  of  the  tumor. 
It  would  seem  useless  to  give  in  detail  the  system  of  medication 
adopted  in  the  management  of  this  case.  SuflSce  it  to  say,  that  we 
directed  opiates  in  sufficient  quantities  to  lull  the  sufl^ering  ;  zf-'Z7jeand 
ammonia  to  support  the  patient  under  the  sloughing  process ;  elixir 
vitriol  to  control  the  colliquative  sweats ;  saline  aperients  to  keep 
the  bowels  gently  open  ;  and  the  pyroligneous  acid  locally,  to  correct 
the  fetor  of  the  exhalations.  We  should  perhaps  mention  the  fact, 
that  the  patient  was  also  visited  occasionally  by  Dr.  Hay,  of  this 
county. 


ARTICLE  III. 

Case  of  Secondary  Syphilis.  Read  before  the  Georgia  Medical 
Society,  December  lith,  1843  By  Johnstox  B.  Tufts,  M.  D.,o/ 
Savannah,  Ga. 

The  patient  in  this  instance  was  a  native  of  Ireland,  aged  32  years  ; 
a  man  in  good  circumstances,  but  of  very  intemperate  habits;  gen- 
eral health  not  very  good,  owing,  no  doubt,  to  his  liberal  use  of  ardent 
spirits.  This  individual  had  contracted  a  venereal  affection  some 
months  before  he  applied  to  me  for  advice.  For  this  primary  disease, 
he  had  been  under  the  hands  of  two  medical  gentlemen  of  this  city, 
who,  according  to  his  account,  dismissed  him  as  cured.  The  primary 
affection  seems  to  have  consisted  of  a  large  chancre  on  the  glans 
penis,  and  a  bubo  in  the  right  groin.  These  two,  viz.,  the  chancre 
and  the  bubo,  he  states  were  evidently  cured  ;  but  upon  making  an 
examination  of  the  seat  of  the  former,  I  found  quite  an  induration 
existing  there :  thus  verifying  M.  Ricord's  opinion,  that  induration 


688  Case  of  Secondary  Syphilis.  [December, 


may  remain  after  cicatrization,  and  being  generally  a  sign  of  future 
symptoms,  requires  peculiar  attention.  Not  very  long  after  his  sup- 
posed cure,  he  was  attacked  with  a  sore  throat,  as  he  imagined,  which 
terminated  in  a  large  ulcer  in  the  left  side  of  the  fauces,  and  likewise 
one  on  the  velum  pendulum  palati,  which  were  soon  succeeded  by  the 
following  symptoms,  at  the  time  (the  3d  of  November,  1842,)  the 
case  fell  into  my  hands  :  The  glands  on  the  right  side  of  the  neck, 
to  the  number  of  four  or  five,  were  very  much  enlarged,  painful, 
hard  to  the  touch,  and  slightly  red  externally.  The  iris  of  the  right 
eye  was  intensely  inflamed  ;  in  fact,  a  pure  syphilitic  iritis.  This 
also  was  quite  painful,  particularly  on  the  application  of  a  strong 
light.  Some  contraction  of  the  pupil.  The  ulcer  in  the  fauces  dis- 
charged freely ;  so  also  did  that  of  the  uvula,  three-fourths  of  which 
latter  was  destroyed.  He  also  complained  of  osteo-copic  pains  gen- 
erally, but  more  particularly  in  the  lower  extremities.  These  seemed 
to  annoy  him  more  at  night  than  during  the  day;  although,  even 
then,  at  times.  I  had  good  reason  to  believe  from  his  statements, 
that  he  had  never  sufTered  from  any  thing  like  a  rheumatic  afTection; 
no  fever  or  other  indisposition  than  as  noted  above.  From  the  his- 
tory of  the  case,  as  narrated  by  the  patient,  together  with  the  present 
symptoms,  it  will  be  perceived  that  this  was  a  case  of  secondary 
syphilis,  resulting  from  an  induration,  in  accordance  with  which,  I 
ordered  the  following  treatment :  

R.  Proto  iodide  Merc 3i. 

G.  Opii grs.  v. 

Ext.  Guaiac 3i. 

Ft.  pill  No.  36 

Of  these  pills,  I  directed  one  to  be  taken  every  day,  two  hours  after 
supper.  I  was  thus  guarded  in  using  the  protoiodide  in  so  small  a 
dose,  because  I  had  no  great  experience  in  relation  to  its  activity, 
and  was  desirous  of  becoming  better  acquainted  with  its  strength, 
before  pushing  it  actively.  As  a  gargle  for  the  throat,  I  ordered  the 
following : 

Corrosive  Sublimate,     .     .     .     grs.  xv. 

Water, lb.     1.  (mix.) 

With  this,  the  patient  was  directed  to  gargle  the  throat  three  times  a 
day.  He  was  also  advised  to  bathe  the  eye  in  warm  milk  and  water 
 to  use  the  diet  drink,  in  the  proportion  of  three  tumblers  full  du- 
ring the  day  to  abstain  from  drinking  and  exposure  and  to  live 
upon  a  vegetable  diet ;  in  which  latter  particulars,  he,  like  most  of 


1845.]  Case  of  Secondary  Syphilis,  689 


devotees  of  Ventis  and  B.u-chns,  heeded  me  )ut  little;  inasnuich  as 
he  got  diunk  several  times  during];  his  illness  exposed  himself  to  all 
sorts  of  weather  and  fed  largely  on  bacon. 

Nov.  4.  'I'he  same  treatment  was  continued,  except  that  the 
quantity  of  the  proto-iodide  was  increased.  I  directed  him  to  take 
one  pill  in  the  morning  and  one  in  the  evening,  I  thus  increased 
the  quantity  of  the  proto-iodide  much  sooner  than  I  expected  to  do 
at  first,  on  account  of  an  increased  pain  in  the  eye  and  throat  during 
the  night.  At  this  time,  the  patient  was  in  a  very  desponding  mood 
 thought  that  he  did  not  get  well  fast  enough  (rather  early  I  think 
to  complain  on  this  score)  and  stated  to  me,  after  I  had  ordered  an 
increased  dose  of  the  pills,  that  he  had  taken /owr  already  this  morn- 
ing on  the  principle  that  as  they  had  no  taste,  they  consequently- 
had  no  strength.  I  requested  him  to  sin  no  more  in  this  respect,  but 
to  stick  to  the  two  per  diem  until  further  orders  ;  to  which  plan,  by 
holding  the  fear  of  salivation  before  his  eyes,  he  adhered. 

Nov.  5.  Same  treatment  continued.  I  would  remark  here,  that 
I  have  been  touching  the  ulcers  in  the  throat  every  morning  with 
nitrate  of  silver. 

Nov.  6.     Same  treatment  continued. 

Nov.  7.  Same  treatment  continued,  except  an  alteration  of  the 
gargle.  The  ulcers  in  the  throat  having  assumed  more  of  an  irritable 
appearance,  1  ordered  the  following: 

R.  Corros.  sublim.     .     .     .     grs.  xv. 

G.  Opii 3i. 

Aq.  pur lb.  1.         (mix.) 

The  throat  to  be  gargled  with  this,  as  before. 

Nov.  8.     The  same  treatment  continued. 

Nov.  9.  Same  treatment  continued,  with  this  addition  :  I  order- 
ed him  to  rub  in,  night  and  morning,  upon  the  malar  process  of  the 
right  side,  a  lump  of  ung.  mere,  about  the  size  of  a  nutmeg.  Order- 
ed  likewise  a  blister  upon  the  right  temple.  This  particular  symptom 
(iritis)  would  have  been  treated  actively  before  could  leeches  have 
been  obtained,  or  the  patient  have  been  induced  to  submit  to  cup- 
ping.  But  the  exhibition  of  the  mercurial  internally  alone,  had 
evidently  produced  a  change  for  the  better,  before  recourse  was  had 
to  the  topical  application.  I  was  also  desirous  of  seeing  how  soon 
the  internal  exhibition  of  the  remedy  would  act  independent  of 
assistance  externally. 

Nov.  10.     Same   treatment  continued.     Blister  has  drawn  well. 

44 


690  Case  of  Secondary  Syphilis.  [December, 


A  considerable  improvement  of  the  eye  has  taken  place  in  this  short 
time.  Directed  the  blistered  surface  to  be  dressed  with  mercurial 
ointment.  The  ulcers  in  the  throat  have  improved  rapidly  since 
using  the  gargle  last  ordered.  There  is  not  the  least  evidence  of 
ptyalism. 

Nov.  11.     Same  treatment  continued. 

Nov.  12  and  13.  Did  not  see  the  patient,  as  he  had  felt  so  much 
better,  that  he  took  the  liberty  of  leaving  his  house,  and  strolling 
about  the  streets,  notwithstanding  the  inclemency  of  the  weather. 

Nov.  14.  Patient  has  improved  very  much.  Ulcers  doing  well, 
and  the  eye  nearly  clear.  Says  he  took  the  last  of  his  pills  to-day. 
He  has  therefore  taken  the  36  pills  in  twelve  days.  Continues  the 
use  of  the  ung.  mere,  to  the  molar  process,  and  as  a  dressing  to  the 
blistered  surface.     Directed  the  following  : 

R.  Proto  iodide  Merc.     .     .      3ss. 

G.  Opii grs.  ix. 

Ext.  Guaiac.        .     .     .      3ss. 
Ft.  pill  No.  36. 
One  pill  to  be  taken  every  evening  two  hours  after  supper. 

Nov.  15.  Patient  doing  remarkably  well.  The  eye  is  at  this 
time  perfectly  free  from  inflammation.  Ulcers  in  the  throat  healing 
rapidly.  No  mercurial  effect  upon  the  system  perceptible,  except  the 
check  upon  the  disease.  He  has  discontinued  the  use  of  the  ung. 
mere,  as  a  dressing  to  the  blistered  surface,  substituting  ung. 
simplex,  to  which  I  assented,  considering  the  state  of  the  eye. 
The  other  remedies  continued  as  before. 

Nov.  16.  By  reason  of  other  engagements,  I  did  not  see  the  pa- 
tient to-day.  On  the  17th  and  18th,  he  was  absent  from  his  house, 
and  therefore  I  did  not  see  him. 

Nov.  19.  He  is  now  perfectly  cured.  There  is  no  evidence 
whatever  of  the  affection  remaining.  The  ulcers  in  the  throat  have 
entirely  healed  ;  no  tumefaction  of  the  glands  of  the  neck  whatever ; 
710  induration  of  the  former  seat  of  the  chancre;  and  he  is  entirely 
free  from  pain  in  all  parts  of  his  body.  During  the  whole  treatment 
he  has  not  had  the  least  soreness  of  gums,  or  any  other  symptom  in- 
dicative of  the  specific  action  of  mercury,  other  than  the  cure  of  the 
disease. 

Remarks.  This  cure  presents  at  least  one  singular  feature.  The 
resistance  to  the  specific  action  of  the  proto-iodide,  which  is  gener- 
ally considered  as  very  active  in  producing  ptyalism. 


1 S45.]  Case  of  Dry  Mortification,  691 


Note,  Since  the  above  was  reported,  I  have  had  a  number 
of  similar  cases,  which  have  terminated  in  the  same  happy  man- 
ner, and  in  no  single  instance  have  I  been  under  the  necessity  of 
producing  ptyalism.  Taking  these  cases  into  consideration,  I  am 
somewhat  inclined  to  think  that  the  remedy  acts  more  beneficially 
when  this  latter  is  not  produced. 

Our  experience  corobnratesthat  of  Dr.  T.  We  have  not  remark- 
ed that  the  proto-iodide  of  mercury  is  more  apt  to  salivate  than  the 
other  preparations  of  this  mineral,  but  the  reverse  we  believe  is 
true.  Edts. 


ARTICLE  IV. 

Case  of  Dry  3Toriif  cation,  occuring  immediately  after  Delivery  
amputation  of  the  Leg  recovery.  By  John  G.  Westmore- 
land, 31.  D.,  of  Zebidon,  Ga. 

Mrs. ,  aged  about  thirty,  in  the  eighth  month  of  utero-gesta- 

tion,  suffered  two  or  three  weeks  from  great  irritability  of  stomach, 
and  during  which  time,  very  little  nourishment  was  retained.  Pre- 
mature labor  then  came  on,  and  she  was  delivered.  Soon  after  this, 
she  complained  of  pain  and  uneasiness  in  her  second  toe,  with  cool- 
ness of  the  foot,  which  she  had  felt  several  hours  before  delivery. 

On  examination,  I  found  an  unusual  coolness  of  the  right  foot  and 
leg ;  but  thinking  that  notiiing  serious  was  to  be  apprehended,  pre- 
scribed some  warm  application,  and  left  her.  I  returned  late  the 
next  day,  and  to  my  surprise  found  her  suffering  excruciating  pain 
in  her  toes  and  the  contiguous  part  of  the  foot.  The  toes  were 
shrivelled,  and  the  whole  foot  deathly  cold.  I  immediately  pronoun- 
ced it  a  case  of  dry  mortification,  and  which  it  has,  unquestionably, 
proved  to  be. 

The  acknowledged  proximate  cause  of  this  disease  being  an  oblit- 
eration of  the  calibre  in  the  principal  arteries  of  the  leg;  or  from 
disease,  in  some  other  way  interfering  with  the  circulation  of  blood 
through  them,  I  have  thought  proper  to  mention  the  situation  of  my 
patient  previous  to  the  attack,  that  your  readers  may  have  the  better 
opportunity  of  determining  the  predisposing  cause  in  this  case. 

Immediately  on  discovering  ihe  lady's  true  situation,  I  applied  a 
blister  to  the  foot,  and  wrapped  the  part,  thickly,  with  carded  wool, 


692  Case  of  Dry  Mortification.  [December, 


to  the  extent  of  spveral  inr-hes  above  the  ankle.  In  twenty-four 
hours  aft<T  these  applications,  the  toes  presented  a  more  natural  ap- 
peararu-e,  the  tenjpcra'ure  of  the  font  fjeneraliv.  was  raised,  and  the 
pain  diminished:  in  fact,  every  thing  seemed  to  flatter  us  witli  the 
hope  that  the  part  was  reviving.  In  two  davs  m')re,  however,  nil  the 
symptoms  grew  worse  the  foot  became  swollen,  and  the  arterial 
action,  which  for  the  first  two  or  three  days  was  moderate,  now  as- 
sumed a  decidedly  febrile  character.  The  only  position  which 
afforded  any  relief  for  the  excruciating  pain,  was  with  the  shoulders 
elevated,  and  the  foot  hanging  out  of  the  bed.  Warm  applications 
increa  ed  the  pain,  and  venesection,  to  say  the  best  of  it,  did  no  good. 
In  this  state  of  extreme  suffering.  I  made  an  application  of  cold  wa- 
ter by  afl^usion,  which  in  an  hour  gave  almost  perfect  ease  ;  and  from 
this  time  she  could  rest,  in  the  recumbent  position,  with  her  foot  on 
the  b  'd,  better  than  in  any  other  way. 

This  treatment,  with  nauseating  doses  of  ipecac,  allayed  the  pain 
and  fever,  increased  the  temperature  of  the  foot,  and  restored  a 
cheerful  countenance.  But  this  apparent  amendment  was  of  short 
duration.  In  two  or  three  days  the  pain,  and  other  symptoms,  indi- 
cating rapid  progress  of  the  disease,  returned.  Tho  toes  became  of 
a  dark  color,  the  cuticle  separated,  and  in  a  few  days  more  most  of  the 
foot  was  sphacelated.  Large  and  repeated  doses  of  opium,  with  the 
cold  affusions,  were  now  brought  into  constant  requisition,  to  moder- 
ate the  excessive  pain,  which  threatened  her  dissolution.  About  the 
twentieth  day  the  line  of  demarkation  began  to  form  an  inch  or  two 
above  the  ankle  ;  and  in  five  or  six  days,  was  complete.  I  amputated 
about  the  thirtieth  day.  The  leg  was  taken  ofl^above  the  knee  ;  and 
now  (ten  days  since  the  operation)  the  slump  is  healing  kindly,  with 
every  prospect  of  speedy  recovery. 

[Upon  the  reception  of  the  above  communication,  we  addressed  a 
letter  to  its  author,  requesting  a  few  a(iditional  particulars,  to  make 
the  article  more  complete  and  satisfactory.  We  give  below  the  ad- 
ditional  facts. 

We  recently  noticed  a  very  similar  case  in  a  late  Journal,  with  the 
diff*erence,  however,  that  our  contributor  and  estimable  pupil  saved 
his  patient,  while  the  one  mentioned  in  the  foreign  periodical  died. 
The  mortification  in  these  cases  may  have  originated  either  from 
inanition,  the  result  of  the  irritable  condition  of  the  stomach,  or  more 
probably  to  some  pressure  upon  the  vessels  or  nerves  of  the  pelvic 
region.  Edts.] 


1845.]  On  the  Buffy  Coat  of  the  Blood,  693 


I\Iy  patient  had  i)orn  two  childrpn  she  felt  the  pain  in  her  toe  the 
day  preceding  the  night  she  was  dtlivored,  perhaps  six  or  eijiht  hours 
previous  to  delivery.  I  have  no  idea  thiit  (his  pain  induced  lahor, 
for  it  was  inconsiderahle  at  the  time;  but  1  tijiirK  labor  was  brou^iht 
on  by  exces>ive  vomitinrr.  Her  temperament  is  more  l)iHous  than 
otherwise  there  is  no  hereditary  disposition  to  mortification.  I 
judged  of  the  temperature  by  my  own  feelings  in  touching.  She 
used  no  particular  article  of  diet,  before  nor  after  the  attack.  1  nev- 
er could  feel  the  pulsation  of  any  artery  lower  down  than  the  femoral. 
About  a  week  elapsed  from  the  commencement  of  the  pain,  to  the 
separation  of  the  cuticle.  The  arteries  divided  in  amputating  had 
their  caliber  almost  entirely  destroyed  ;  so  much  so  that  not  a  drop 
of  blood  escaped  from  them,  consequently  no  ligatures  were  requir- 
ed. The  arteries  had  the  appearance  of  white  cords,  with  capillary 
orifices  the  size  of  the  point  of  a  pin. 

There  is  no  disease  in  any  other  artery  of  the  body  that  I  can  de- 
tect. The  sturnp  now  (twenty-seventh  day  since  the  amputation) 
has  nearly  healed,  and  the  patient  is  doing  very  well. 


PART  II. REVIEWS  AND  EXTRACTS. 

On  the  Buffy  Coat  of  the  Blood.  By  George  Gulliver.  F.  R.*S., 
Surgeon  in  the  Royal  Rpgimrnt  of  Horse  Guards.  Read  at  the 
Royal  Medical  and  Chirurgical  Society,  February  11,  1845. 
(From  the  Edinburgh  Med.  and  Surg.  Journal.) 

I.  Historical  notices  of  the  consistency  of  the  Blood,  and  of  the  con- 
dition of  the  red  corpuscles  in  inflammation.  Boerhaave*  and  his 
commentator  Van  Swieten  maintained  that  a  lentor  or  vicidity  of  the 
blood  is  connected  with  inflammatory  disease.  Langrishf  describes 
the  blood  in  acute  fevers  as  being  more  than  usually  viscid  and  tena- 
cious, and  as  containing  an  excess  of  red  corpuscles.  He  held  the 
incorrect  opinion,  common  to  many  eminent  men,  either  his  cotem- 
poraries  or  immediate  predecessors,  as  Boerhaave.lj:   Keill,   Jurin^H 

*  Aphor.  lOD,  119,  117,  375,  6G3. 

t  Pn.ctice  of  Pb\-sic,  pp.  "22  and  74,  8vo.     Lend.  1735. 

t  Praslectiones  AcademicaB,  ed.  Alb.  Haller,    ccxxvii.  t.  ii,  Svo.  Gottingae, 
1743. 

  Essays  on  several  parts  of  the  Animal  Economy,  p.  95,  et  seq.  2d  ed.  Svo. 
Lond.  1717. 

li  Phil.  Trans.  1719,  vol.  30.  p.  1000. 


694  On  the  Buffy  Coat  of  the  Blood.  [December, 


and  Haller,*  that  coagulation  is  caused  merely  by  a  running  together 
of  the  red  corpuscles.  Triiler,"}*  Sch\venke,:j:  Dr.  Francis  Home, 
Huxam,||  and  Marherr,1[  concluded  that  the  viscidity  of  the  blood  is 
increased  during  inflammation  ;  and  this  state  of  the  blood  was  made 
the  subject  of  several  dissertations  about  the  middle  of  the  last  centu- 
ry, as  by  Klein,**  Goeslingjff  PohliuSjJt  and  Nicolai, 

On  the  contrary,  Buechner||||  wrote  a  treatise  on  the  thinned  state 
of  the  blood.  Quesnay^^  believed  that  the  floating  of  the  humour 
which  forms  the  buffy  coat,  and  which  he  states  is  of  the  same  na- 
ture as  the  lymph,  so  far  from  indicating  a  thickening,  really  shows 
that  the  fluidity  of  the  blood  is  increased. 

Quesnay  also  states,  in  anticipation  of  a  very  recent  doctrine,  that 
the  buffy  part  is  formed  from  the  red  corpuscles,  destroyed  and  re- 
duced into  a  glaire  by  the  action  of  the  arteries,  and  that  this  glairo 
abounds  in  acute  diseases  at  the  expense  of  the  corpuscles,  sometimes 
to  such  an  extent  that  the  red  part  is  much  diminished.  Bordenave*** 
held  somewhat  similar  views. 

Dr.  Richard  DavieSjfj'f  observing  the  quickened  sinking  of  the 
red  corpuscles  in  blood  becoming  buffy,  inferred  that  there  was  a 
preternatural  attenuation  of  the  coagulable  lymph.  He  called  this 
spontaneously  coagulable  matter,  after  Borelli^tt  *^^^  gluten.  We 
owe  to  Dr.  Davies  the  earliest  correct  description,  printed  in  our 
language,  of  this  principle  of  the  blood;  which  I  mention  with  the 
hope  of  drawing  him  from  the  oblivion  to  which  he  has  been  so  long 
and  so  unjustly  consigned,  and  to  notice  the  strange  silence  of  the 
Hunters  and  their  encomiasts  about  his  researches. 

It  is  now  well  known  that  the  buffy  coat  is  formed  of  fibrin  left  at 
the  surface  of  the  clot  by  the  sinking  of  the  red  corpuscles.  Like 
Davies,  Mr.  Hewson  and  Dr.  Davy||||||  attributed  this  sinking 
chiefly  to  an  increased  tenuity  of  the  coaguhible  lymph,  an  inference 
which  the  two  last  distinguished  physiologists  drew  from  the  fact 
discovered  by  Hewson,  that  the  corpuscles  fall  more  rapidly  in  the 
entire  mass  of  the  blood,  during  the  formation  of  the  buffy  coat,  than 
they  will   do  in  the  serum  alone.     Similar  views  were  adopted  by 

*  Deux  Memoires  sur  le  Moiivement  du  Sang,  p.  21-22, 8vo.  Lausanne,  1756. 
t  Com.  de  Pleuritide,    xxviii,  and  xlvii.  8ro.    Francof.  et  Moenum,  1740. 

I  HfEmatologia,  p.  154,  et  scq.  8vo.     Hagsee  Com.  1843. 
  Principia  Medicinse,  p.  101.    8vo.    Edin.  1758. 

II  Essay  on  Fevers,  chap.  4,  p.  30.    8yo.     Lond.  1760. 

IT  Prselectiones  in  H.  Boerhaave,  lust.  Med.  t.  2,  p.  254.    Vien  etLips.  1773. 

**  De  Massse  Sang.  Viscedine.    4to.    Argentorati,  1737. 

+t  Diss.  Inaug.  de  Spissitudine  Sanguinis.    4to.     Gottingae,  1747. 

U  De  Spissitudine  Sanguinis  a  neglectomotu.    4to.    Lips.  1749. 

  De  Spissitudine  Sanguinis.   4to.     Halse,  1749, 

III!  De  nimia  Sang.  Flui'dit.   4to.     Haloc,  1749. 

HIT  Traite  de  la  Saignee,  pp.  405,  406,  415, 416.    8vo.    Paris,  1760. 

***  Essai  sur  la  Physiologie,  p.  155-150.    8vo.    4eed.    Paris,  1787. 

ttt  Essays  on  the  Human  Blood,  p.  23.   8vo,    Bath,  1760. 

J+J  De  Motu  Animalinm,  Op.  posth.  pars.  alt.  Prop,  exxxii.  4to.    Roman,  1681. 

  Exp.  Inq.  Part  1,  p.  45,  d  scq.    8vo.    Lond.  3d  ed.  1780. 

mill  Researches,  Phy.  and  Anat.  vol.  ii.  p.  48.   8vo.    Lond.  1839. 


1345.]  On  the  Buffy  Coat  of  the  Blood,  695 


Thomas  Houlston,*  Dr.  George .  Ford\'ce,f  Dr.  William  HLiDter,J 
Dr.  James  Makittrick,  Dr.  George  Levison.||  Dr.  James  Gregory,^ 
Dr.  Cullen,**  Hugh  Moises,tt  James  Wilson.ijit  ^"d  others.  But 
Mr.  Hey'$>  maintained  that  the  blood  is  not  thinned  during  inflano- 
mation :  Air.  Grainger|j||  is  of  the  same  opinion,  and  Professor 
Henle  and  ]\Ir.  Wharton  Jones^?  state  that  the  coagulable  lymph  is 
really  thickened. 

The  last  two  authors  and  Professor  Wagner  ascribe  the  formation 
of  the  bulTy  coat  to  an  increased  disposition  of  the  red  corpuscles 
to  run  together,  as  originally  explained  by  Professor  Hermann 
Nasse***  of  Marbourg.  and  thus  described  by  Mr.  Jones :  "  The 
minute  process  leading  to  the  separation  of  the  liquor  sanguinis  from 
the  red  corpuscles,  the  visible  condition  for  the  formation  of  the  huffy 
coat,  consists  in  an  exaltation  both  of  the  rapidity  and  closeness  with 
which  the  red  corpuscles  aggregate  into  rolls,  and  these  again  into  a 
sponge-work,  thus  squeezing  out  the  liquor  sanguinis  from  among 
the  corpuscles,  and  allowing  the  greater  specific  gravity  of  the  latter 
to  come  more  fully  into  play,  whereby  the  liquor  sanguinis,  which  in 
such  cases  is  in  relatively  greater  quantity,  collects  at  the  top,  and, 
coagulating,  cives  rise  to  the  buffy  coat." 

Dr.  Davyftt  observed,  that,  in  certain  cases  in  which  the  inflam- 
matory state  is  best  marked,  the  separation  of  the  corpuscles  and 
coagulable  lymph  is  most  rapid.  Dr.  Stokeriii  has  also  shown  that 
the  buffy  coat  may  occur  in  blood  which  coagulates  more  quickly 
than  usual.  In  a  thin  film  of  such  blood,  Schroeder  Van  der  Kolk, 
and  Dr.  Alison. $*  observed  that  the  corpuscles  separate  laterally, 
giving  it  a  mottled  appearance,  as  characteristic  of  the  state  of  the 
blood  as  the  butTy  coat  itself:  a  fact  which  seems  to  have  been  des- 
cribed by  ]Nlr.  Hunter,  as  follows,  in  his  Surgical  Lectures,  when 
speaking  of  the  blood  in  inflammation  :  "  The  blood  has  an  increased 
disposition  to  separate  into  its  component  parts,  the  red  globules  be- 
come less   uniformly   diffused,    and   their   attraction  to  one  another 

*  Diss.  Med.  laaiis:.  de  Inflammatione.  p.  14.  4to.    Liisrd.  Bat.  1767. 

t  Elements  of  ihe  Practice  ol  Physic.  Part  2,  p.  '2S-S0.  8vo.    Lend.  1768. 

J  Lectures,  p.  8-9,  4to,  MS.  press  mark  D.  D.  f.  6,  in  Lib.  Roy.  Med.  Ch.  Soc. 
No  date,  but  some  of  Hewson's  experiments  are  noticed. 

  Com.  on  the  Princ.  and  Practice  of  Physic,  p.  154.  8vo,    Lond.  1 1  i2. 

II  An  Essav  on  the  Blood,  p.  86.    8vo.    Lond.  1776, 

^  Conspectus  Med.  Theor.  t,  1,    503  and  504.    8vo.    ed.  alt.    Edin.  1782. 

**  First  Lines  of  the  Practice  of  Physic,  vol.  i.    ccxli.   8ro.     Edin.  1789. 

tt  Treatise  on  the  Blood,  p.  48.    8v6.    Lond.  1794. 

tz  Lectures  on  the  Blood,  p.  53.   8vo.    Load.  1819. 

  Observations  on  the  Blood,  p.  14.    8vo.    Lond.  1779. 

nil  Elements  of  G^en.  An  at.  p.  41.   8vo.    Lond.  1829. 

ir^  Report.    1,  '2.  40. 45, 49,  in  No.  34  of  Brit,  and  For.  IMed.  Rev.,  and    9, 
107  in  Xo.  35  of  same  Review. 

**  Henle,  Anat.  Gener.  tr.  par  Jourdan,  p.  463.  8vo.  Paris,  1843;  and  Mr. 
Jones's  Obs.  on  the  Blood,  pp.  1*2-17,  reprinted  from  No.  28  ot  Brit,  and  For. 
Med.  Rev. 

ttt  Phil.  Trans.  1822,  p.  271. 

i::  Pathological  Observations,  np.  37  and  44.    8vo.    Dublin,  1823. 

  Outlines  of  Phys.  and  Path.  p.  47.    8vo.     Edin.  1833. 


696  On  the  Biiffy  Coal  of  the  Blood.  [December, 


becomes  stronger,  so  that  the  bloo^  when  out  of  the  vessels  soon  be- 
comes cloudy  or  uiiid<ly  and  dusky  in  its  colour,  and,  when  spread 
over  any  surface,  it  appears  mottled,  the  red  blood  attracting  itself 
and  forming  spots  of  red.  This  is  so  evident  in  many  cases  that  it 
is  hardly  neeessary  to  wait  till  the  whole  coaL^ulates  to  form  a  judg- 
ment of  it."*  Dr.  Charles  J.  B.  Williams-]-  thinks  that  the  agiirega- 
tion  of  the  corptiscles  may  be  a  mechanical  one,  induced  bv  a  change 
in  the  relative  dilution  of  the /z'^wor  sanguinis,  or  serum,  within  and 
without  the  blood  corpuscle. 

S  nee  the  publicatiou  of  the  accurate  description  by  Dr.  Hodgkin 
and  iNIr.  Lister. :j:  the  running  together  of  the  red  corpuscles  of  the 
healthy  blood  of  mammalia  into  piles  has  become  well  known   
The  effect  of  mucilage  or  white  of  eug  in  promoting  their  further 
aggregation  was  observed  by  Mr.  Wharton  Jone>||  and  Professor 
Henle;  and  I  have  been  informed  by  Mr.  Jones  that  there  are  some 
observations  on  the  subject  by  Nasse.lT  The  efF^ct  of  neutral  salts 
in  separating  the  corpuscles  from  each  other  was  noticed  by  Eller,** 
and  since  by  Dr.  Dav\-j"|-  and  others. 

II.  Separation  of  the  red  corpuscles  and  liquor  sanguinis  in  the 
blood  of  the  horse.  When  the  venous  blood  of  this  animal  is  re- 
ceived into  a  small  narrow  vase,  an  upper  buffy  part  regularly  forms, 
quite  equal  in  perpendicular  measurement  to  the  lower  red  part  of 
the  riot.  This  s|)ontaneous  separation  was  pr(il);i!)ly  known  to  Har- 
vey:|:  ;  it  is  mpntioued  by  Dr.  Allen  Thomson.   and  more  particu- 
larly bv  Andral  {||{  Gavarret,  and  Delafond.  My  observations,  unless 
otherwise  expressed,  were  made  on  the  blood  of  the  horse. 

III.  Sinking  of  the  corpuscles  in  the  liquor  sanguinis  and  in  the 
serum.  It  is  certain  that  the  corpuscles  siik  at  least  twice  faster  in 
the  entire  mass  of  the  blood,  during  the  formation  of  the  buffy  coat, 
than  they  will  do  in  the  serum  alone,  as  is  shown  in  the  details  of 
experiments  4-10. 

IV.  Spontaneous  acceleration  of  the  rate  of  sinking  of  the  cor- 
puscles in  the  liquor  sanguinis  and  in  the  serum.  During  the  forma- 
tion ofthe  buffy  coat,  it  is  very  remarkable  that  the  corpuscles  fall 
much  faster  after  the  first  two  or  three  minutes  than  before.  In  a 
mixture  of  serum  and  corpuscles,  either  fresh  or  after  it  has  been  kept 
some  hours  and  occasionally  agitated,  there  is  also  an  acceleration, 
though  to  a  less  dejjree,  in  the  rate  with  which  the  corpuscles  subside. 

*  Hunter's  Works  by  Palmer,  vol.  i.  p.  235.   8vo.    Lond.  1835. 
t  Principles  of  Medicine,  p.  89.    8vo.    Lond.  1843. 
:  Philosophical  Magazine,  vol.  ii.  p.  135,  July  December,  1827. 
  Dr.  Daw  has  lately  des^cribed  the  viscid  or  adhesive  quality  ofthe  corpuscles. 
See  Trans.  Rov.Soc.  Edin.  1845,  vol.  xvi.  p.  54-55. 
II  Report,  "2 and  3.  Brit,  snd  For.  Med.  Rev.  No.  34. 
IT  Das  Elm.  pp.  223,  225,  and  231.   Svo.    Bonn,  1836. 
**  Hist.  del'Acad.  des  Sceinces.  annce  1751,  pp.13.  14. 
++ Res.  Phy.  fnd  Anr.t.  vol.  ii.  p.  178.    8vo.    Lond!  1839. 
::  De  Generctione  Animilinm,  p.  1()0.    4to.     Lond.  1G51. 
0  Syllabus  of  Lectures  on  Physiolos^y,  p.  13.   8yo.     Edin.  1835. 
nil  Hematologie  Pathologique,  pp.  28 "and  50.   8vo.    Paris,  1843. 


1845.]  On  the  Buffy  Coat  of  the  Blood,  CQI 


It  is  commonly  greatest  in  the  liquor  sanguinis  he\\veen  the  third  and 
sixth  minutes,  and  s^ofnelimes  hiler  ;  and  latter  siill  in  the  sernm. 

V.  The  fallini:  of  the  corpusclts  rather  retarded  than  hastened 
hy  a  thinning  of  the  liquor  sanguinis   If  the  rnpid  faHino:  of  the  cor- 
puscles, dnrin*!  the  formation  ol  tl:e  biiffv  coat,  be  du*  to  an  aiteniia- 
lion  of  the  liquor  sanguinis,  it  follows,  that,  if  we  increase  thisqiiality 
without  ha!tening  co;j<iula(ion  or  makin:  the  corpuscles  lighter  in 
rei.ilion  to  the  cfinlaining  fluid,  ihey  will  sink  still  more  quickly, 
and  he  suspended  aga.n  wlu^n  the  mixed  fluid  is  made  thicker.  I 
accordiniriy  mixed  dilute  saline  solutions  and  urine  with  the  blood,  by 
all  of  which  its  consisiency  and  specifif  gravity  were  reduced,  and 
its  co;igilation  somewhat  retarded.  Yet  in  none  of  these  mixtures 
was  lliH  falling  of  the  corpuscles  so  rapid,  nor  the  biiiTy  coat  so  thick, 
as  in  some  pure  blood  set  apart  for  com])arison  ;  while  in  one  mix- 
lure  of  urine  and  blood,  which  remained  liquid  for  upwards  of  fifteen 
minutes,  the  corpuscles  never  sank  enough  to  leave  the  slightest 
buffy  surface. 

It  was  remarkai)le,  too,  that  whrn  there  was  a  falling  of  the  cor- 
puscles in  these  mixtures,  the  acceleration  above  noticed  in  the  rate 
of  sinking  after  a  few  minutes  was  prevented. 

When  the  same  quantity  of  salt  was  dissolved  in  mucilage  and 
mixed  with  the  blood,  the  corpuscles,  so  far  from  being  susj)ended, 
always  fell  more  rapidly  than  in  blood  thinned  by  saline  matter  in 
water,  sometimes  as  quickly  as  in  pure  blood,  occasionally  quicker; 
and  now  and  then  with  such  velocity,  that  a  clear  floating  portion  of 
liquor  sanguinis,  two  inches  de  p,  appeared  in  five  minutes. 

In  this  case,  the  acceleration  in  the  rate  with  which  the  corpuscles 
sunk,  after  the  first  two  or  three  minutes,  was  still  greater  than  in 
pure  Idood. 

Some  trials  were  next  made  on  the  falling  of  the  corpuscles  in 
serum  made  thinner  and  lighter  by  the  weak  saline  solutions,  and  in 
serum  made  tliicker  and  heavier  hy  mucilage ;  whence  it  resulted, 
calculating  from  the  time  required  for  the  appearance  of  a  clear 
stratum  of  fluid  at  the  top  of  the  mixtures,  that  the  corpuscles  subsided 
more  rapidly  ^n  the  thicker  than  in  the  thinner  fluid. 

'Vhai  [he  liquor  sanguinis  becomes  viscid  in  chanrring  from  the 
liquid  to  the  solid  stale,  as  originally  described  by  Dr.  Davy,*  is  a  fact 
easily  shown.  But.  on  the  other  hand,  it  has  never  been  supposed 
that  it  becomes  thinner  bef  re  it  coagulates,  after  its  abstraction  from 
the  animal.  Yet  to  this  improbable  conclusion  we  shall  be  led.  if  we 
admit  that  the  sinking  of  ihe  corpuscles  in  the  liquor  sanguinis  is  a 
correct  measure  of  its  consistency  or  tenuity. 

VI  State  of  the  red  eorpuscles  in  huffy  blood.  As  it  is  certain, 
ccEteris  paribus,  that  the  falling  of  particlts  throujih  a  light  and  thin 
fluid  must  be  quicker  than  throu.<rh  a  heavier  and  thicker  one,  the 
state  of  the  corpuscles  in  these  difii;renl  fluids  cannot  be  equal. 

And  that  such  is  really  the  case,  may  easily  be  seen  with  the  naked 

  Phil.  Trans.,  I8i>2,  p.  273.  ~ 


698  On  the  Buffy  Coat  of  the  Blood.  [December, 


eye.  Thus,  in  thin  layers  of  those  viscid  mixtures  in  which  the 
corpuscles  sunk  most  rapid!}',  they  were  so  clustered  as  to  appear 
like  particles  of  coarse  and  dark  red  powder  in  an  excess  of  limpid 
fluid  ;  while  the  thinner  mixtures,  in  which  the  corpuscles  fell  most 
slowly,  were  of  an  uniform  and  lighter  red  colour,  from  the  separa- 
tion and  equable  diffusion  of  the  corpuscles  throughout  the  fluid. 
With  the  aid  of  the  microscope  the  corpuscles  of  human  blood,  which 
had  no  buffy  coat,  were  seen  frequently  in  piles;  but  these  were 
only  occasionally  grouped  into  clusters,  and  by  far  the  greater  num- 
ber of  the  corpuscles  were  either  separate  or  very  loosely  connected 
together.  In  buffy  human  blood  the  corpuscles  are  more  aggregated. 
But  it  is  in  the  naturally  buffy  clot  of  the  horse's  blood  that  the  ag- 
gregation of  the  corpuscles  is  most  remarkable  ;  they  appear  as  if 
melted  together,  and  are  almost  universally  collected  into  clusters, 
the  piles  sticking  to  each  other.  These  observations  were  made  at 
various  times  after  coagulation. 

Yll.  Agents  which  prevent  and  increase  the  aggregation  of  the 
corpuscles.  When  a  saline  solution  was  mixed  with  the  clustered 
corpuscles,  their  connection  was  quickly  dissolved,  so  that  they  were 
all  separated  and  equably  diffused  throughout  the  liquid.  Either 
urine  or  syrup  had  the  same  eflect.  On  adding  mucilage,  the  cor- 
puscles again  became  aggregated,  and  they  were  again  dispersed  by 
another  dose  of  saline  matter.  A  small  proportion  of  salt  mixed 
with  the  mucilage  promotes  the  clustering  of  the  corpuscles  more 
than  the  mucilage  alone,  as  is  shown  in  experiments  22-25.  The 
salt  alone  had  the  effect  of  more  or  less  reducing  the  size  of  the  cor- 
puscles, as  if  it  dissolved  a  part  of  their  surface.  The  serum  of  one 
animal  often  causes  the  corpuscles  of  another  animal  to  become  ag- 
gregated very  quickly. 

VIII.  A  probable  cause  of  the  efUcacy  of  saline  medicines  in  in- 
flammations. As  only  a  very  weak  saline  solution  is  required  to 
prevent  or  destroy  the  aggregation  of  the  corpuscles,  and  to  correct 
the  tendency  in  the  blood  to  the  formation  of  the  buffy  coal,  may 
not  this  action  of  the  salt  be  one  cause  of  the  well-known  utility  of 
saline  medicines  in  inflammatory  diseases  ? 

IX.  Cause  of  the  rapid  sinking  of  the  corpuscles,  and  of  its  ac- 
celerated rate  during  the  formation  of  the  buffy  coat.  The  aggrega- 
tion of  the  corpuscles  was  connected  with  their  most  rapid  sinking, 
and  their  separation  and  diffusion  with  their  most  tardy  sinking; 
while  their  rate  of  falling  was  hastened  by  a  thickening  and  retarded 
by  a  thinning  g^  the  liquor  sanguinis.  The  largest  particles  of  a 
powdered  substance  will  sink  quicker  in  a  fluid  than  the  smallest 
particles.  In  some  experiments  with  magnesia  in  a  solution  of  Ep- 
som salt,  and  with  poppy  seed  in  mucilage,  there  was  no  evident 
acceleration  in  the  rate  of  sinking,  similar  to  that  of  the  red  corpus- 
cles through  the  liquor  sanguinis.  I  know  not  that  this  acceleration 
can  be  explained  otherwise  than  by  the  increasing  aggregation  of 
the  corpuscles  during  their  descent.     Yet  there  was  a  like  accelcra- 


1S45.]  On  the  Buffy  Coat  of  the  Blood.  699 


tion,  though  to  a  less  degree,  in  the  falling  of  the  corpuscles  through 
the  serum,  in  which  they  were  clustered  from  the  beginning  of  the 
experiment,  or  even  many  hours  before.  But  the  masses  may 
coalesce  still  further  during  their  descent ;  and  it  will  be  recollected 
that  the  accelerated  sinking  is  quite  prevented,  or  even  reversed, 
when  the  corpuscles  are  kept  apart  by  weak  saline  solutions. 

X.  Details  of  Erperimcnts.  For  the  sake  of  precision,  which 
appears  the  more  necessary  since  Mr.  Prater*  has  shown  the  opposite 
etlects  on  the  blood  of  ditlerent  quantities  of  the  same  substance,  I 
shall  detail  some  of  the  principal  experiments  made  in  the  course  of 
the  present  inquiry.  They  will  be  found  to  illustrate  many  points 
foreign  to  the  subject  now  considered,  such  as  the  elTects  of  various 
substances  on  coagulation  and  on  the  contraction  of  the  clot.  The 
experiments  were  all  conducted  under  the  following  circumstances, 
unless  otherwise  mentioned ;  and  my  best  thanks  are  due  to  Mr.  Sid- 
dall,  the  able  veterinarian  of  the  Blues,  for  his  kind  assistance.  The 
blood  used  was  drawn  trom  the  jugular  veins  of  troop  horses;  and, 
in  comparative  trials,  in  order  that  every  portion  of  it  should  be  as 
nearly  as  possible  alike,  the  blood  was  received  from  the  animal  into 
a  pitcher,  stirred  for  a  few  seconds  with  a  stick,  and  then  quickly 
poured  into  the  ditlerent  vases  for  observation.  These  were  com- 
mon circular  glass  bottles,  with  the  tops  cut  off,  and  holding  about 
six  ounces  when  filled  within  about  half  an  inch  of  the  rim  ;  thus 
filled,  the  column  of  fluid  measured  about  four  inches  in  length,  and 
one  and  three-fourths  in  diameter.  The  agitation  used  to  mix  the 
ditferent  matters  with  the  blood  was  also  applied  to  the  pure  blood 
set  apart  for  comparison.  As  the  corpuscles  in  pure  blood  are  soaked 
in  the  liquor  sanguinis,  they  were  well  mingled  with  the  artificial 
fluids.  If  dropped  on  or  only  just  dipped  in  a  dense  saline  solution, 
they  may  remain  awhile  at  the  top,  just  as  a  piece  of  fibrin  will  do, 
though  it  sinks  at  last,  in  a  saturated  soluiion  either  of  Glauber  salt, 
of  nitre,  or  of  muriate  of  soda.  This  is  an  important  fact  in  rela- 
tion to  the  use  of  such  solutions  in  estimating  the  specific  gravity  of 
fibrin,  as  was  done  by  that  excellent  observer,  Dr.  Benjamin  Babing- 
ton.*  His  estimate  was  probably  too  high,  as  the  saline  solution 
deprives  the  fibrin  of  some  of  its  natural  moisture.  In  a  weak  saline 
solution,  the  corpuscles  will  fail  rapidly  before  they  become  disjoined 
and  saturated,  though  very  slowly  afterwards.  If  they  become  speci- 
fically heavier  or  lighter  by  endosmosis  or  exosmosis.  it  may  be  sup- 
posed that  their  specific  gravity  would  only  be  approximated,  within 
certain  limits,  to  that  of  the  fluid  in  which  they  are  placed  ;  and  that 
they  would  difler  no  more  from  the  fluid  in  that  respect  than  they  did 
originally  from  iheliquor  sanguinis.  When  the  corpuscles  are  stated 
to  have  sunk  to  any  extent,  it  is  merely  meant  to  express  that  a  clear 


*  Experimental  Inquiries  in  Chemical  Physiolog)'-,  Part  1,  p.  37,  8vo.  Lond., 
1832.  He  observes  that  adding  serum  to  blood  hastens  its  coagulation.  Op. 
cit.  p.  105. 

*  Cyclop,  of  Anatomy,  vol.  1.  p.  418. 


700 


On  the  Buffy  Coat  of  the  Blood, 


[December, 


su[>ernatant  stratum  of  fluid  was  left,  corresponding  to  the  given 
measure;  and  when  it  is  nofed  that  there  was  no  sinking  of  the  cor- 
puscles, it  is  simply  to  affirm  that  enough  of  them  remained  at  the 
top  to  preserve  its  opaque  red  colour. 

XL  Sinking  of  fhe  corpuscles  in  blood  received  from  the  animal^ 
and  not  agitated  aflcrwards, 

I.  In  3|  minutes  the  corpuscles  sunk  |  inch. 
51-  ...  1 

7^  .  .  .  li 

8|  .  .  .2  inches. 

n       '     .  .       .     n- 

Xir.   Sinking  of  the  corpuscles  in  the  same  blood,  broken  up  in  the 
serum  twenti/fonr  hours  afterwards,  and  strained  through  linen, 
II.  In  6  minutes  the  corpuscles  sunk  ^  inch. 
8  .  .  .  i 

11  .  . 

16 
26 
34 

3.  In  some  blood  from  another  horse,  treated  in  the  same  way 
aftr  keeping  seven  hours,  the  corpuscles  fell,  in  eleven  minutes,  one 
inch,  and  in  twenty-three  minutes,  two  inches. 

XIII.  Comparative  sinking  of  the  corpuscles  in  the  liquor  sangui- 
nis and  in  serum. 

4.  Blood  divided  into  three  portions.  In  the  liquor  sanguinis  the 
corpuscles  sunk. 

In  2^  minutes,  .  .  ^  inch. 

34 


2  inches. 


4^ 
5 

6 

7 


5.  In  a  second  portion,  deprived  of  fibrin  by  whipping,  the  corpus- 
cles  sunk, 

In  5  minutes,  .  .         ^  inch. 

7  .  .  .         i 


9 


i 


10  ... 

13  ...         f 

15  .  .  .1. 

6.  In  the  third  portion,  deprived  of  fibrin  by  agitation  with  nails 
in  a  bottle,  excludinir  air  as  murh  as  possihle,  the  corpuscles  fell  at 
the  same  rate.  The  specific  fjravily  of  the  serum  at  G0  was  1029; 
and  it  roajriilated  at  a  heat  of  158*^. 

7.  In  the  liquor  sanguinis  of  another  horse  the  corpuscles  subsided. 

In  2|  minutes,  .  .         i  inch. 

3i  .  .  .         i 

4i  .  .  .  I 


1845.J 


On  the  Buffy  Coat  of  the  Blood, 


701 


In  4^ 
5 
6 

8 
9 

10|- 
At  the  end  of  roiiitoon  minutes 
nealh  quite  liquid;   coafrnlnted  in 


inch. 


.      If 
     u 

2  inches, 
there  was  a   film    on  the  top;  be- 
sixteen    minutes.      Final    perpen- 
dicular (neasuremimt  ot  the  upper  butiy   part  two  and  a-half,  and  of 
the  lower  red  part,  one  and  three-fourth  inches. 

8.  In  a  second  portion,  immediately  after  removing  ihe  fibrin  in  a 
bottle,  excluding  air,  the  corpuscles  subsided, 
In  8  minutes, 
11  .  .  . 

12^...  I 

13  ...  ^ 

14  ...         f 
15^  ...         I 


^  inch. 


17^ 
20 
21 
24 

27 


1 
If 

H 
^\ 

2  inches. 


9.  A  Her  the  lapse  of  twenty-four  hours  the  superstratum  of  serum,  in 
Exp.  8,  measured  two  and  seven-eighth  inches,  and  the  substratum 
of  corpuscles  one  and  three-fourth.  The  mixture  was  then  shaken, 
when  the  corpuscles  sunk  as  follows  : 

In  11  minutes,  .  .         |-  inch. 

14  .  .  .  i 

iH        ...       I 

16i  .  .  .  i 

17f  .              .              .  f 

19  ...  f 

20  ...  i 

21  ...  1 
22^...  IJ 
23|  .  .  .  li 
25  .  .  .  If 
27  .  .  .  l| 
31  .      .      .  1| 

36      .      .      .2  mches. 

10.  In  the  same  mixture,  after  ajritation  the  next  day,  the  corpus- 
cles fell  at  the  same  rate.  They  subsided  most  slowly  in  the  newest 
serum  in  Exp.  35  and  38. 

XIV.  Sinking  of  ike  corpuscles  of  one  animal  in  the  serum  of 
another. 

11.  Corpuscles  of  human  i)lood  which  took  13  minutes  to  sink  ^th 
of  an  inch  in  their  own  serum,  sp.  gr.  1028,  sunk  in  horse's  serum, 


702  On  iJie  Bvffy  Coat  of  the  Blood.  [December, 


of  the  same  sp.  gr.,  above  twice  as  rapidly,  and  with  a  remarkable 
acceleration  after  they  began  to  sink.  The  aggregation  of  the  cor- 
puscles was  very  plain  to  the  naked  eye  quickly  after  they  were  put 
into  the  horse's  serum.     See  Exp.  37  and  41. 

12.  Corpuscles  from  horse's  blood  sunk  quicker  in  human  serum, 
sp.  ^r.  1032,  than  in  their  own  serum,  sp.  gr.  1028. 

XV.  Slow  sinJcing  of  the  corpuscles  in  iceaJc  saline  solutions. 

13.  f  ss.  of  mixed  serum  and  corpuscles  agitated  with  giv.  of  solu- 
tion of  nitre,  10  grains  to  an  ounce  of  water,  sp.  gr.  1020.  The 
corpuscles  to9k  an  hour  to  sink  an  inch. 

14.  A  similar  trial,  substituting  urine,  sp.  gr.  1024,  for  the  solu- 
tion of  nitre.     The  corpuscles  fell  equally  slow. 

15.  In  the  serum,  sp.  gr.  1028,  for  comparison  with  Exp.  13-15, 
the  corpuscles  sank  half  an  inch  in  15  minutes. 

XVI.  Formation  of  the  hxiffy  coat  prevented  or  lessened  hy  making 
the  blood  thinner  and  lighter,  and  its  coagulation  retarded.  Sinking 
of  the  corpuscles  slower  after  a  few  minutes,  contrary  to  their  rate  of 
falling  in  pure  blood.  N.  B.  Sp.  gr.  of  the  weakest  saline  solution 

1011,  five  grains  of  common  salt  to  an  ounce  of  water;  the  weak 
saline  solution,  sp.  gr.  1020,  10  grains  to  the  ounce.  Urine,  sp.  gr. 
1023. 

16.  Equal  parts  of  urine  and  blood.  Liquid  at  the  end  of  fifteen 
minutes;  began  to  coagulate  around  the  margin  in  seventeen  min- 
utes; a  soft  jelly  in  twenty. two  minutes.  There  was  no  buffy  coat. 
See  Exp.  19. 

17.  Pure  blood,  for  comparison  with  Exp.  16.  The  corpuscles 
fell  an  inch  in  seven  min.ites,  and  it  coagulated  in  twelve  minutes. 

18.  Blood  for  this  and  the  next  three  experiments  from  another 
horse.  A  portion  of  the  unmixed  blood  coagulated  in  ten  minutes, 
and  the  corpuscles  sunk  very  nearly  as  noticed  in  Exp.  4. 

19.  Equal  parts  of  urine  and  blood.  In  four  minutes  the  corpus- 
cles sunk  one-fourth  of  an  inch  ;  and  ultimately  no  more  than  three- 
eighths  of  an  inch.  Coagulation  did  not  begin  until  after  sixteen 
minutes.  Differs  from  the  like  Exp.  16,  in  which  there  was  no 
sinking  of  the  corpuscles. 

20.  Equal  parts  of  weakest  saline  solution  and  blood.  In  four 
minutes  the  corpuscles  sunk  one-eighth  of  an  inch  ;  in  eight  and 
a-half  minutes  one-fourth  of  an  inch;  and  never  more  than  three- 
fourths  of  an  inch.  Mixture  liquid  at  the  end  of  twenty-two  min- 
utes; viscid  in  twenty-five  ;  jellied  in  twenty-eight. 

21.  Equal  parts  of  weak  saline  solution  and  blood.  In  four  min- 
utes the  corpuscles  sunk  one-eighth  of  an  inch  ;  and  finally,  no  more 
than  three-eights.  Coagulation  two  minutes  sooner  than  with  the 
weakest  saline  solution,  Exp.  20. 

XVII.  Sinking  of  the  corpuscles  accelerated  by  adding  mucilage 
and  salt  to  the  blood. 

22.  giss.  of  mucilage,  sp.  gr.  1030,  seven  and  a-half  grains  of 
muriate  of  soda,  iii.  of  blood.  Sinking  of  the  corpuscles  very  ra- 
pid, and  the  rate  much  accelerated  after  a  minute  or  two,  viz  : 


1S45.]  On  the  Bitffy  Coat  of  the  Blood.  703 


In  3  minutes, 

J  inch. 

3i 

i 

5 

2  inches. 

7 

2i 

9 

.         2|. 

Coagulated  in  eighteen  minutes;  butTy  part  throughout  firm  and 
contracted  next  day. 

23.  siss.  of  the  same  mucilage,  ten  grains  of  muriate  of  soda,  and 
Siii.  of  blood.     The  corpuscles  sunk. 

In  3  minutes,  .  .  |  inch. 

4  ...  1 

5  .  .  .  H 
9             .             .             .15. 

Coagulated  in  thirteen  and  a-half  minutes.  Bufiy  part  firm  and 
contracted  next  day.  Aggregation  of  the  corpuscles,  as  in  Exp.  22, 
quite  plain  to  the  naked  eye. 

24.  gi.  mucilage,  sp.gr.  10S5,  and  giv.  of  blood.  The  corpus- 
cles sunk. 

In  4  minutes,  .           I  inch. 

7  .  .  .         i 

9  .  .  ,         i        

10  ...         t 

13  .  .  .         1^. 

Not  coagulated  in  less  than  twenty  minutes.  Contraction  of  clot 
very  slight  next  day.  The  corpuscles  sank  rather  slower  than  in 
pure  liquor  singuinis,  but  much  taster  than  in  blood,  mixed  with  dilute 
saline  solution  without  mucilage. 

25.  fi.  of  the  same  mucilage,  ten  grains  of  muriate  of  soda,  and 
iv.  of  blood.     The  corpuscles  sunk. 

In  6  minutes,  .  .         f  inch. 

8  .  .  .         t 

10  ...       H 

13  .  .  .         li. 

Coagulated  two  or  three  minutes  quicker,  and  the  clot  contracted 
rather  more  than  in  Exp.  24. 

26.  giss.  weakest  saline  solution,  and  giii.  of  blood.  In  three 
minutes  the  corpuscles  sunk  one-eighth  of  an  inch:  in  five  minutes 
one.fourth ;  in  ten  minutes  one-half.  A  film  on  the  top  in  twelve 
minutes;  coagulated  in  fourteen. 

27.  giss.  weak  saline  solution,  and  fiii.  of  blood.  In  three  and 
a  half  minutes  the  corpuscles  sunk  one-eighth  of  an  inch ;  in  six 
minutes  one-fourth;  and  finally,  only  three-eighths  of  an  inch. 
Viscid  in  ten  minutes  :  a  trembling  clot  in  twelve. 

28.  A  portion  of  blood  used  in  the  experiments  from  22  inclusive, 
coagulated  in  ten  minutes,  and  had  an  upper  bufiy^  part  equal  in  per- 
pendicular  measurement  to  the  lower  red  part. 

In  all  the  trials  of  urine  and  the  saline  solutions  with  blood,  the 
contraction  of  the  clot  was  either  much  diminished,  or   prevented; 


704 


On  the  Buffy  Coat  of  the  Blood  [December, 


Conoiilation 


tho.mh  not  so  w!,Pn  mncilage  was  arlded  with  the  salt.      v.wu., 
wa^most  retarded  hy  the  weakest  snhno  shition. 

XVI! I.  Sinking  of  the  Corfwsrhs  more  rapid  in  serum  made 
thirn-sr  an  I  h,,LH^r,  th.n  m  serum  made  fhhi.rr  and  li.h'^r.  The 
accehrnted^rale  oj  si^^  ^^^^j   ."rf^trn^ed!  or 

aiminixhorJ  hii  iho  th:y^^  -0..:.!        nt    r     o.    .  .     .       ^ 


1     i-;''a.ns  of  .n-.nate  of  soda  to  an  ounce  of  water.       Urine    sn.   gr. 

10.6       -Mnc.Ia^o   sp.  .r.  1085    ^'v.  of  cru.n  aral.ic  to  a  pint  ofwater. 

hinod  m  Exp.  29-30  drawn  twenty  four  hours;  fihrin  separated 
from  It  m  a  hott!e  excludincr  air;  sp.  gr.  of  serum  1028. 

29.  Kqual  parts  of  saline  soh.tion  and  hhmd  without  fihrin.  In 
forty  minutes  the  corpuscles  fell  one-twelfth  of  an  inch,  in  150  min- 
utes  three-eirrhthsof  an  inch. 

30  The  same,  addina  gj.  of  mucilage.  Sinking  of  the  corpuscles 
rapid  but  the  separation  of  them  from  the  fluid  at  first  imperfect  It 
was  clearer  in  one  minute  half  an  inch  from  the  top.  In  six  minutes 
the  corpuscles  had  fallen  through  the  column  of  the  fluid,  the  line  of 
separation  between  it  and  the  corpuscles  being  distinct  one  inch  from 

he  hottom.  After  shaking  the  mixture  next  dav,  they  subsided  in 
two  mmufes  one-fourth  of  an  inch,  and  then  with  the  same  velocity 
as  the  day  before.  "^ 

31.  Equal  parts  of  urine  and  blood  without  fibrin.  In  forty  min- 
utes  the  corpuscles  fell  one  twelfth  of  an  inch  ;  in  150  one-fourth  of 
an  inch. 

32  The  same,  adding  one  ounce  of  mucilage.  In  fourteen  min- 
utes  the  corpuscles  sunk  one-fourth  of  an  inch;  in  seventeen  minutes 
hnit  an  inch  ;  in  twenty-three  minutes  one  inch ;  in  thirty-one  min- 
utes one  and  a-half  inch  ;  in  forty-eight  minutes  one  and  seven- 
eighths  of  an  inch. 

33.  5i.  of  saline  solution  and  giii.  of  blood  without  fibrin.  In 
eleven  minutes  the  corpuscles  sunk  one-eighth  of  an  inch;  in 
fifteen  minutes  one  fourth  of  an  inch. 

34.  ^i.  of  mucilage  and  fiii.  of  blood  without  fibrin.  Sinking 
of  the  corpuscles  quick,  but  the  line  between  them  and  the  superna- 
tant  fluid  at  first  indistinct.  In  six  minutes  they  suhsided  about 
one  eighth  of  an  inch;  in  eleven  minutes  three-fourths  of  an  inch; 
in  fifteen  minutes  one  and  a  half  inch,  with  a  distinct  line  between 
tfie  corpuscles  and  the  fluid. 

35.  Blood  without  fibrin  f:)r  comparison  with  Exn.  29-35  The 
corpuscles  sunk  in  six   minutes  one  fourth  of  an  inch;   in  elev'en  and 

LV,"';^^'^^  ^^''^  '"  '"^^5   in   fifteen  minutes  one  and  a  half  inch. 

35.  J  he  same,  only  an  hour  after  it  was  drawn.  The  corpuscles 
fell  in  twelve  mmutes  a  quarter  of  an  inch;  in  fifteen  minutes  half 
an  inch  ;   m  thirty  minutes  one  and  a  half  inch.      Thus   the  sinking 

^'''''o^     i'      ''"""^  '"  ^^"^  "'^"'^''^  ^'^'""''  ^^""'T-v  to  Exp.  8.  9.  and  10. 

37     IJlood  without  a   l.ufl'v   coat,   taken  twentv-four   hours  before 

from  the  basdic  vein  of  a  man,  aged  forty,  aff-.  cted  with  pulmonary 

catarrh.     Clot  broken  up  in  the  serum  and  strained    throucrh  tow. 


1 845.]  On  the  Buffy  Coat  of  the  Blood.  705 


The  mixture  thicker  and  darker  than  horse's  blood,  apparently  from 
a  greater  proportion  of  corpuscles.  They  took  sixty  minutes  to  sink 
one-eighth  of  an  inch.  See  Exp.  11  and  41,  The  three  next  ex- 
periments with  parts  of  the  same  hlood. 

38.  gi.  of  mucilage  mixed  with  giii.  of  the  strained  blood.  The 
corpuscles  sank  in  thirty-two  minutes  one-eighth  of  an  inch;  in 
forty  minutes  one-fourth. 

39.  gr.  of  saline  solution  and  giii.  of  the  strained  blood.  In  forty 
minutes  the  corpuscles  subsided  one-tenth  of  an  inch. 

40.  Sp.  gr.  of  the  serum  1027.     It  congulated  at  a  heat  of  159. 

41.  Blood  with  a  thick  bufTv  coat  from  a  young  man  with  pulmon- 
ary catarrh.  Strained  as  in  Exp.  37.  Thicker  and  darker,  appa- 
rently from  a  greater  proportion  of  corpuscles  than  horse's  blood. 
They  sunk  in  thirty  nine  minutes  one-tenth  of  an  nich  ;  in  fifty-six 
minutes  one-eighth  of  an  inch.      See  Exp.  11  and  37. 

XIX.   Effects  of  syrup  made  of  equal  parts  ofivhite  sugar  and  water. 

42.  iss.  svrup  and  iii.  of  blood.  No  sinking  of  the  corpuscles. 
A  weak  jelly  in  twelve  and  a  half  minutes.  No  contraction  of  clot 
or  exudation  of  serum. 

43.  siss.  svrup,  ten  grains  of  muriate  of  soda,  and  giii.  of  blood. 
Same  as  the  foregoing,  except  tha-  coagulation  was  two  minutes  later. 

44.  Blood  for  comparison  with  Exp.  42  and  43.  Coagulated  in 
eleven  minutes,  with  the  usual  deep  buffy  coat. 

XX.  Effects  of  increasing  the  proportion  of  serum  and  of  water 
in  the  blood. 

45.  ss.  serum  added  to  ^iv.  of  blood.  The  corpuscles  sunk  in 
two  and  a  half  minutes  one  eighth  of  an  inch  ;  in  three  minutes  one- 
fourth,  and  never  subsided  further.  Coagulation  took  place  in  eight 
minutes. 

46.  ^iss.  of  serum  to  iv.  of  blood.  The  corpuscles  fell  in  3 
minutes  \  of  an  inch;  in  5  minutes  |  an  inch,  and  sunk  no  further. 
Coagulation  in  7  minutes. 

47.  Some  blood,  for  comparison  with  Experiment  45  and  46, 
coagulated  in  10  minutes,  and  the  corpuscles  sunk  as  deep  as 
usual. 

48.  i.  of  serum  and  ^iv.  of  blood  from  another  horse.  The  cor- 
puscles sunk  only  fths  of  an  inch.  Coagulation  took  place  in  4 
minutes. 

49.  ii.  of  serum  and  ^iv.  of  blood.  Coagulation  and  sinking  of 
the  corpuscles  the  same  as  in  the  foregoing. 

50.  Blood,  for  comparison  with  Experiment  48  and  49,  coagulated 
freely  in  6  minutes,  when  the  corpuscles  had  fallen  one  inch. 

51.  i.  of  serum  and  iii,  of  blood  from  another  horse.  Corpus- 
cles sunk  ^th  of  an  inch.  Coagulated  in  3^  minutes.  Clot  much 
contracted  next  day. 

52.  fi.  distilled  water  and  iii.  biood.  No  sinking  of  the  corpus- 
cles. Coagulated  in  6  minutes.  Clot  contracted  next  day,  but  less 
so  than  the  preceding. 

45 


706  On  the  Buffy  Coat  of  the  Blood.  [December, 


53.  Blood,  for  comparison  with  Exp.  51  and  52.  Coagulated  in 
three  and  a-hah^'niinutes.     No  buffy  coat. 

54.  i.  of  serum  and  iii.  of  blood  from  another  horse.  Corpus- 
cles sunk  in  four  minutes  three-eighths  of  an  inch  ;  in  five  minutes 
two-thirds  of  an  inch  ;  in  six  minutes  one  inch  ;  in  seven  minutes  one 
inch  and  a  quarter,  and  never  further.     Coagulated  in  eight  minutes. 

55.  gii.  distilled  water  and  giii.  blood.  Corpuscles  sunk  in  seven 
minutes  one-eicjhth  of  an  inch,  and  finally  no  more  than  on'e-third  of 
an  inch.  Began  to  coagulate  in  thirteen  minutes,  and  a  feeble  jelly 
in  fifteen. 

56.  Blood,  for  comparison  with  Exp.  54  and  55.  Corpuscles  sunk 
in  four  minutes  one-eighth  of  an  inch  ;  in  five  minutes  one-fourth  of 
an  inch  ;  and  finally  one  inch  and  three-fourths.  Coagulation  the 
same  as  in  Exp.  55, 

XXI.  Ejects  of  increasing  the  proportion  of  the  corpuscles. 

57.  Ij.  of  corpuscles  and  serum,  obtained  b*y  straining  the  broken- 
up  clot  and  serum  through  linen,  mixed  with  iv.  of  blood,  part  of 
that  used  in  Exp.  48.  49  and  50.  No  sinking  of  the  corpuscles. 
Coagulated  rather  firmly  in  three  minutes. 

58.  The  same,  whh  an  additional  ounce  of  strained  cruor,  gave  the 
same  result,  except  that  coagulation  was  half  a  minute  later. 

59.  svj.  of  whipped  blocd  and  giv.  blood  from  another  animal. 
No  sinking  of  the  corpuscles.     Coagulated  firmly  in  seven  minutes. 

60.  The  same  with  double  the  quantity  of  whipped  blood,  gave 
the  same  result. 

61.  j.  of  whipped  blood  and  "^W.  of  blood.  The  corpuscles  sub- 
sided in  three  and  a-half  minutes  one-eighth  of  an  inch  ;  in  four  and 
a-half  minutes  one-fourth  of  an  inch;  in  six  minutes  three-eighths  of 
an  inch ;  and,  finally,  no  forther.  Coagulated  in  less  than  eight 
minutes.  In  this  experiment  the  corpuscles  sank  more  quickly,  when 
added  to  blood  just  drawn,  than  they  would  do  in  the  serum  alone. 

62.  gvi.  of  corpuscles,  from  which  as  much  serum  as  possible  had 
been  decanted,  and  ^iv.  of  blood.  No  sinking  of  the  corpuscles. 
Coagulated  in  six  minutes. 

63.  A  portion  of  the  blood  used  in  Exp.  50  to  63,  set  apart  for 
comparison,  coagulated  in  fourteen  minutes,  with  a  buffy  part  two 
inches  deep. 


Some  of  the  conclusions  from  the  preceding  experiments  may 
here  be  recapitulated. 

1.  There  is  a  remarkable  acceleration,  after  a  few  minutes,  of  the 
rate  with  which  the  red  corpuscles  sink  in  the  liquor  sanguinis ;  and 
in  the  serum  alone,  though  to  a  less  degree. 

2.  This  acceleration  may  be  increased  by  increasing  the  aggrega- 
tion of  the  corpuscles;  and  prevented  or  reversed  by  preventing  or 
destroying  the  aggregation  of  the  corpuscles. 

3.  The  sinking  of  the  corpuscles  may  he  slower  in  blood  thinned 
by  weak  saline  solutions  than  when  mucilage  is  added  with  the  salt. 


1845.]  Galvanism  applied  to  Uterine  Hemorrhage.  707 


4.  The  sinking  of  the  corpuscles  is  slower  in  serum  made  thinner 
and  lighter  by  weak  saline  solutions,  than  in  serum  made  thicker  and 
heavier  by  mucilage. 

5.  In  the  blood  of  the  horse,  the  huffy  coat  forms  regularly ;  and 
the  red  corpuscles  unite,  as  if  partly  fused  into  each  other,  and  collect 
into  masses. 

6.  There  may  be  no  burly  coat,  or  but  a  comparatively  thin  one,  on 
this  blood,  when  it  has  been  made  thinner  and  its  coagulation  retarded. 

7.  The  formation  of  the  biifly  coat  is  neither  due  to  an  attenuation 
of  the  liquor  sanguinis,  nor  to  a  diminution  of  its  specific  weight,  nor 
to  slow  coagulation  ;  but  to  an  increased  aggregation  and  quickened 
sinking  of  the  corpuscles. 

8.  These  facts  are  favourably  to  the  old  doctrine  of  lentor,  or  vis- 
cidity of  the  blood  and  union  of  the  corpuscles  ;  and  against  the  more 
recent  doctrine  of  attenuation  of  the  blood  in  inflammation. 

9.  The  corpuscles  of  the  horse  sink  much  quicker  in  his  serum 
than  the  corpuscles  of  man  do  in  his. 

10  Increasing  the  proportion  of  the  corpuscles  hastens  coagula- 
tion and  diminishes  the  formation  of  the  bufly  coat  more  than  in- 
creasing the  serum  only. 

11.  Increasing  the  proportion  of  water  simply,  does  not  hasten 
the  coagulation  of  the  blood,  as  increasing  the  proportion  of  serum 
does. 


On  Galvanism  applied  to  the  Treatment  of  Uterine  Hemorrhage, 
By  Thomas  Radford,  M.  D.     {From  Prov.  Medical  Journal.) 

Uterine  hemorrhage  is  usually  divided  into  that  which  takes 
place  in  the  early  months,  and  that  which  takes  place  in  the  latter 
months  of  gestation.  The  latter  class  is  again  subdivided  into  what 
are  called  accidental  hemorrhao;es,  unavoidable  hemorrhages,  and 
the  after  hemorrhages.  Accidental  hemorrhages  are  those  which 
arise  from  accidental  causes;  unavoidable  hemorrhages  are  those 
which  arise  from  a  particular  location  of  the  placenta  in  the  imme- 
diate neighborhood  of  the  os  uteri ;  and  the  after  hemorrhages  are 
those  which  take  place  after  the  delivery  of  the  child,  and  they  may 
occur  either  before  or  after  the  expulsion  of  the  placenta.  You  will 
be  also  aware  that  there  are  a  number  of  other  uterine  hemorrhages 
which  are  unconnected  with  gravidity;  but  it  is  my  object  in  this 
lecture  more  particularly  to  dwell  upon  those  discharges  of  blood 
which  are  connected  with  pregnancy  in  the  latter  months  and  with 
labour.  It  is  not  my  intention,  on  the  present  occasion,  to  enter  into 
a  full  consideration  of  the  subject,  but  more  particularly  to  connne 
my  remarks  to  that  condition  which  is  the  result  of  profuse  and  long- 


708  Galvanism  applied  to  Uterine  Hemorrhage.  [December, 


continued  bleeding,  viz-,  exhaustion,  a  state  highly  interesting  to  the 
obstetrician,  and  which  seems  tome  to  require  more  than  the  recog- 
nized means  for  its  management. 

Now,  we  know  that  exhaustion  may  arise  in  all  the  varieties  of 
hemorrhage  ;  but  we  find  that  it  is  more  especially  produced  i  y  those 
impetuous  and  large  discharges  of  blood  which  take  place  before, 
during,  and  after  labour. 

With  regard  to  those  cases  of  flooding,  before  and  during  labour, 
which  have  proceeded  to  a  state  of  exhaustion,  it  has  been  the  custom 
of  many  obstetrical  writers  to  recommend  the  practice  of  delivery. 
Others  have  discountenanced  delivery  in  this  particular  condition  ; 
and  of  course,  where  the  principles  of  practice  are  unsettled  in  a  case 
so  important,  it  is  very  desirable  that  we  should  endeavour  to  dis- 
cover some  new  method  of  treatment  which  shall  place  the  question 
beyond  dispute.  Although  such  high  authorities  as  Burns  and  Ham- 
ilton advocate  delivery  in  these  cases,  it  has  always  been  my  practice 
to  recommend  non-delivery  ;  and  if  we  were  to  analyse  the  cases  that 
have  been  published  in  the  reports  of  hospital  and  private  practice, 
and  those  that  have  accidentally  come  to  our  knowledge,  we  should 
be  startled  at  the  immense  loss  of  life  arising  from  these  extreme  cases 
of  hemorrhage,  where  delivery  has  been  adopted. 

Now,  I  regret  to  say,  I  believe  that  the  g^reat  ruling  influence  upon 
the  mind  of  practitioners,  in  determining  them  to  deliver  at  all  ha- 
zards in  these  cases,  is  the  dread  of  popular  opinion.  It  is  usually 
stated  that  no  woman  ought  to  die  undelivered ;  and  where  a  woman 
does  die  undelivered,  it  produces  a  very  considerable  sensation,  both 
in  the  neighborhood  and  in  the  mind  of  every  party  who  may  come  to 
a  knowledge  of  the  circumstances.  On  this  account  a  practitioner 
dreads  the  procrastination  of  delivery,  lest  death  should  occur  before 
it  can  be  accomplished,  and  his  character  consequently  involved  in 
censure.  Now  it  appears  to  me,  that  when  a  practitioner  is  thus 
placed,  he  ought  to  possess  sufficient  moral  courage  to  resist  the 
pressure  of  popular  opinion,  and  be  guided  by  a  higher  principle  in 
the  discharge  of  his  duty  ;  and  I  am  convinced  that  if  the  matter  is 
fairly  and  dispassionately  considered,  it  will  be  found  that  there  is  a 
great  advantage  in  not  delivering  in  these  cases  of  exhaustion. 

And  first,  with  regard  to  the  child,  it  is  stated  by  the  advocates  for 
delivery,  that  there  is  the  greater  probability  of  its  being  saved  hy  the 
immediate  adoption  of  this  operation,  than  by  its  delay.  But  if  we 
take  the  pains  to  investigate  the  reports  that  have  been  published,  as 
well  as  to  examine  into  the  results  of  the  practice  of  private  individu- 
als, it  will  be  found  that  the  child  is  nearly  always  dead  in  these  ex- 
treme cases.  Therefore  this  consideration  ought  not  to  have  much 
weight  with  us  in  deciding  upon  the  principle  of  practice.  And  if 
we  reflect  upon  the  causes  whirh  give  rise  to  hemorrhage,  more  espe- 
cially in  placenta  praevia,  we  shall  find  sufficient  reason  for  under- 
standing why  the  child  should  be  generally  dead.  Inthe  accidental 
species  of  hemorrhage,  if  the  cause  has  been  such  as  not  only  to  lead 


1845.]  Galvanism  applied  to  Uterine  Hemorrhage.  709 


to  a  separation  of  the  placenta,  but  to  something  like  a  disruption  or 
a  wounded  state  of  that  organ,  the  death  of  the  child  is  nearly  inevita- 
ble ;  and  in  the  unavoidable  species,  from  the  particular  location  of 
the  placenta,  if  we  recollect  what  must  be  the  influence  of  labour 
upon  the  placenta  itself,  not  only  in  producing  detachment  and  a 
separation  of  its  connection  with  the  sides  of  the  os  uteri,  but  also  the 
mechanical  intluence  applied  by  the  child's  head  corning  upon  it,  we 
must  see  that  in  this  case  there  is  generally  more  or  less  of  a  disrup- 
tion and  breaking  up  of  its  structure;  and  consequently  the  child 
dies  from  bleeding  from  its  own  particular  system. 

If  we  go  into  inquiries  as  to  the  intiuence  of  the  death  of  the  child 
upon  the  hemorrhage,  we  must  look  upon  it  as  being  rather  an  ad- 
vantage to  the  mother,  because  it  takes  off  a  certain  demand  upon  the 
blood,  or  lessens  what  Hunter  calls  "the  stimulus  of  necessity,"  and 
therefore  makes  such  a  change  in  the  balance  of  her  circulation,  as 
would  be  a  means  of  checking,  rather  than  increasing,  the  discharge. 

We  will  now  proceed  to  consider  the  question  as  regards  the  life 
of  the  mother;  and  when  we  are  contemplating  a  subject  of  this 
kind,  a  woman  placed  under  extreme  circumstances  of  inanition  or 
exhaustion,  we  ought  not  to  ask,  "Ought  a  woman  to  be  delivered  ?" 
but,  "  Can  a  woman  be  delivered  safely?^'  That  is  the  question  we 
ought  to  endeavour  to  settle  in  our  minds  before  we  proceed  to  the 
operation.  If  we  have  a  woman  already  in  a  state  of  exhaustion 
from  large  evacuations  of  blood,  we  must  be  certain  that  a  plan  of 
treatment  which,  in  any  way,  produces  an  unfavorable  change  upon 
the  nervous  and  circulatory  systems,  must  add  to  the  evils  already 
existing.  We  have  here  sufficient  prostration  ;  and  the  mere  empty- 
ing of  the  uterus  will  most  inevitably  increase  it.  Every  surgeon  is 
aware  of  the  influence  that  is  produced  by  the  operation  of  tapping 
in  cases  of  ascites  in  men  strong  in  comparison  of  some  of  these  poor 
women,  reduced  as  they  are  by  the  loss  of  so  large  a  quantity  of 
blood.  Sync^pe,  nay,  even  death,  is  sometimes  the  result  of  the 
abstraction  of  the  ascitic  fluid.  We  know  also  in  some  cases,  and 
especially  where  there  is  a  particularly  exalted  state  of  the  nervous 
system,  or  some  particular  idiosyncracy,  that  simple  evacuation  of 
the  uterus,  by  the  natural  efforts,  will  produce  death  !  This  very 
change  then  has  in  itself  a  very  unfavorable  influence  upon  a  woman 
thus  prostrated.  But,  besides  this,  we  must  bear  in  mind  that  there 
must  necessarily  be  a  great  dt^mand  upon  their  powers  by  the  stimu- 
lus of  forcible  delivery. 

There  are  a  number  of  other  circumstances  which  ought  to  be 
taken  into  account,  as  regards  delivery.  And  one  of  the  most  im- 
portant of  these  is  the  physical  or  structural  impediment  that  may 
arise  from  a  rigid  os  uteri.  And  when  we  come  to  the  bedside  of  a 
patient,  (I  am  sure  every  gentleman  who  has  had  much  practical  ex- 
perience, will  bear  me  out  in  this  statement,)  we  shall  find  that  some 
of  those  dogmas  which  are  laid  down  in  books  are  wholly  untrue.  I 
now  refer  particularly  to  that  assertion  of  certain  writers,  who  say, 


710  Galvanism  applied  to  Uterine  Hemorrhage.  [December, 


that  by  the  evacuation  of  blood,  the  soft  parts  become  so  weakened 
and  dilatable,  that  delivery  can  always  be  accomplished.  1'his  I 
most  positively  deny.  And  therefore  I  say  that  there  are  conditions 
of  this  kind  which  will  be  an  obstacle  to  delivery. 

The  OS  uteri  will  continue  undilataUe,  although  the  woman  may 
be  in  such  a  state  of  exhaustion  as  to  be  literally  tottering  on  the 
brink  of  the  grave  !  It  is  true  that  this  state  of  matters  does  not 
generally  exist,  but  it  is  too  frequent  to  be  overlooked  in  determin- 
ing our  line  of  practice. 

Again,  v'e  should  be  aware  that  hetnorrhages  take  place,  and  pro- 
duce this  state  of  exhauslion,  before  the  woman  has  progressed  to 
that  period  of  pregnancy  that  would  justify  a  practitioner  in  having 
recourse  to  forcible  delivery;  and  this  is  a  point  not  sufficiently 
dwelt  upon  by  obstetrical  writers.  In  proportion  to  the  early  occur- 
rence of  hemorrhage,  so  will  be  the  obstacles  to  delivery,  as  regards 
the  introduction  of  the  hand  into  the  uterus.  And  when  we  are 
considering  i\\Q  chances  of  delivery,  and  taking  into  account  the 
dilatable  state  of  the  cervix  and  the  os  uteri,  we  should  never  forget 
the  length  of  the  former  as  regards  the  particular  period  of  pregnancy. 
And  not  only  is  this  to  be  taken  into  account,  but  there  is  another 
circumstance  which  must  not  be  overlooked,  viz.,  the  degree  of  sub- 
sidence of  the  uterus  into  the  pelvis  ;  for  according  as  the  uterus 
remains  high  in  the  pelvis,  so  we  may  be  certain  that  the  difficulties 
of  delivery  will  be  proportionate. 

In  all  uterine  hemorrhages  connected  with  pregnancy,  there  are 
certain  attendant  circumstances,  viz.,  separation  of  the  placenta, 
with  or  without  disruption  of  its  structure ;  exposure  of  the  large 
orifices  connecte<l  with  the  uterine  sinuses,  rupture  of  the  decidual 
vessels  and  atony  of  the  uterus,  which  is  either  primary  or  secondary. 
The  natural  means  lor  suppressing  the  discharge  are  the  formation 
of  coagula,  and  the  contraction  of  the  uterus.  As  to  the  adhesion 
of  the  placenta,  when  once  separated,  or  the  cicatrization  of  this 
organ  when  disrupted,  the  practitioner  can  place  no  reliance  on  them 
in  checking  the  flooding. 

With  respect  to  the  coagulation  of  the  blood,  it  may  become  in- 
fluential in  arresting  slight  discharges,  but  never  ought  to  be  depend- 
ed upon  in  those  profuse  hemorrhages  which  we  are  now  more  par- 
ticularly considering.  The  coagula  which  forms  in  the  vagina,  and 
which  are  stated  to  be  so  important  in  the  suppression  of  the  bleed- 
ing, may  become  indirectly  an  evil  instead  of  an  advantage,  by  deter- 
ring the  practitioner  from  making  a  proper  investigation  of  the  case, 
under  the  idea  "that  the  disturbance  of  these,  congula  is  death." 
In  my  opinion,  the  coagula  which  are  more  particularly  to  be  depend- 
ed upon,  are  those  in  the  immediate  neighborhood  of  the  venous 
orifices  that  have  been  exposed,  and  I  repeat  that  these  are  of  no 
avail  in  the  more  serious  cases;  and  therefore  we  mt;st  solely  trust 
for  the  suppression  of  these  large  discharges  of  blood  to  that  most 
important  agent,  contraction  of  the  uterus. 


1 S  45.  J  Galvanism  applied  to  Uterine  Hemorrhage,  711 


The  ordinary  means  ofproducing  uterine  contraction  are  so  well 
known  that  I  need  merely  refer  to  them  before  the  present  audience. 
We  have  the  bandage,  friction  applied  briskly  over  the  uterus,  grasp- 
ing  pressure,  secale  cornutum,  the  application  of  cold,  and,  in  the 
after  hemorrlia<res,  tiie  introduction  of  the  hand  into  the  uterine 
cavity.  But  all  these  means  may  fail  in  producing  this  desirable 
change,  and  will  fail  and  do  fail  in  the  extreme  cases. 

A  fatal  case  having  recently  occurred  in  this  town  [Manchester], 
which  produced  a  considerable  sensation  at  the  time,  where  delivery 
was  adopted,  contrary  to  the  principles  which  I  had  always  publicly 
inculcated  in  my  lectures,  1  was  led  to  investigate  the  arguments  of 
those  who  advocate  that  practice,  more  closely  than  I  had  perhaps 
ever  before  done  ;  and  it  struck  me  that  we  were  deficient  in  a  means 
on  which  we  might  always  depend  for  inducing  uterine  contraciion, 
and  so  placing  the  woman  in  such  a  state  of  safety  that  the  operation 
of  delivery  might  be  deferred.  Whilst  my  mind  was  so  much  occu- 
pied upon  this  subject,  I  was  consulted  by  my  friend  Dr.  Goodwin,  in 
a  case  of  protracted  labour,  where  the  long  forceps  were  required. 
The  lady  recovered  well,  with  the  exception  of  not  being  able  to  pass 
her  urine.  We  administered  all  the  usual  remedies  for  a  fortnight  or 
more,  using  the  catheter  twice,  sometimes  three  times  a  day,  but 
without  the  least  amendment.  Upon  Dr.  Goodwin's  suggestion,  we 
decided  upon  the  application  of  galvanism,  which  was  undertaken 
by  him,  and  the  result  was  most  gratifying,  for  the  first  application 
proved  permanently  successful.  The  decided  efficacy  of  this  plan 
in  restoring  the  energy  of  the  bladder,  immediately  led  me  to  con- 
clude that  it  was  the  very  agent  that  I  have  already  stated  v.as  a 
desideratum  to  ensure  uterine  contraction  incases  of  severe  flooding, 
attended  with  exhaustion.  We  have  here  a  woman  reduced  by  loss 
of  blood,  with  an  atonic  state  of  the  uterus,  either  primary  or  as  the 
result  of  the  discharge.  Now,  as  the  advocates  of  delivery  (vide 
Burns  and  Hamilton)  say  that  this  proceeding  gives  the  woman  the 
only  chance  of  living,  because,  so  long  as  the  uterus  remains  distend- 
ed by  its  contents,  and  its  parietes  atonic,  those  large  venous  orifices 
which  have  been  exposed  by  the  separation  of  the  placenta,  are  so 
situated,  that  the  chances  of  further  effusion  of  blood  exist ;  it  occur- 
red to  me  that  the  application  of  galvanism  would  so  effectually  act 
upon  the  uterine  tissue  as  to  induce  firm  contraction  of  its  fibres,  and 
thereby  at  once  lessen  those  large  openings,  and  bring  the  walls  of 
the  uterus  into  firm  apposition  with  the  body  of  the  child,  so  as  to 
entirely  close  them.  This  great  object  having  been  attained,  we 
might  safely  procrastinate  the  delivery,  and  adopt  such  means  as 
would  tend  to  raise  the  vital  powers  of  our  patient,  such  as  the  ad- 
ministration of  opium,  stimulants,  and  support ;  and  the  performance 
of  the  important  operation  of  transfusion.  With  the  uterus  in  this 
favorable  condition,  our  restorative  means,  and  particularly  transfu- 
sion, would  be  far  more  likely  to  be  attended  with  successful  results 
than  if  the  organ  were  distended  and  atonic ;  for  in  this  case,  the 


712  Galxanism  applied  to  Uterine  Hemorrhage.  [December, 


blood  which  is  introduced  into  the  system,  either  directly  by  transfu- 
sion or  indirectly  by  nourishment,  produces  no  permanent  benefit, 
because  it  is  rapidly  discharged  again.  Analogy  further  led  me  to 
believe  that  my  conjectures  would  not  prove  unfounded,  for  galvan- 
ism  is  particularly  impressive  in  its  influence  upon  the  muscles  of 
recently. killed  animals,  and  we  know  how  strictly  allied  inaction,  if 
not  in  structure,  the  uterus  is  to  muscle. 

1  mentioned  my  views  to  a  number  of  medical  friends,  who  gener- 
ally much  approved  of  them;  and  1  was  soon  enabled  practically  to 
prove  their  correctness,  by  being  called  in  consultation  to  a  case  of 
frightful  hemorrhage  during  labor,  attended  with  extreme  exhaustion, 
and  where  the  os  uteri  was  so  rigid  that  the  advocates  of  delivery 
could  not  possibly  have  carried  their  views  into  practice,  without 
lacerating  the  os  and  cervix  uteri.  By  this  case  I  ascertained  that 
galvanism  produces  an  effective  and  powerful  contraction  of  the 
uterus;  and  not  only  so  as  regards  its  tonic  contraction,  but  it  has 
also  the  power  of  energetically  exciting  alternate  contraction  when 
applied  at  intervals.  I  can  tell  you,  most  seriously  and  most  solemn- 
ly, that  it  produces  these  two  important  changes  upon  the  uterus  in 
such  a  degree  as,  in  my  previous  reflections  on  the  subject,  I  had  no 
conception  of.  The  alternate  contraction  excited  by  this  agent  is 
analagous  to,  and  as  powerful  as,  that  which  is  observed  in  normal 
labour,  and  the  tonic  contraction  is  greater.  I  shall  not  relate  cases 
in  detail,  because  it  would  occupy  too  much  time;  but  I  may  state 
that  I  applied  galvanism  in  a  case  where  the  membranes  were  unrup- 
tured, and  the  uterus  in  a  state  of  great  inertia,  and  alternate  con- 
traction was  immediateh'^  produced.  Before  this  the  membranes 
were  very  flaccid  ;  but  as  soon  as  the  galvanic  circle  was  completed, 
they  became  extremely  tense,  and  protruded  low  down  into  the  vagi- 
na ;  and  this  stare  of  tension  did  not  subside  when  the  alternate  con- 
traction ceased,  as  is  observed  in  some  degree  in  normal  labor;  for 
although  the  galvanic  conductors  were  removed,  so  great  a  degree  of 
tonic  contraction  of  the  uterus  had  been  induced,  that  this  mem- 
branous bng  could  not  collapse. 

I  am  thus  satisfied,  that  by  the  application  of  this  means,  we  can 
induce  such  a  state  of  chronic  contraction  in  the  uterus,  that  in  these 
extreme  cases  of  exhaustion  from  hemorrhage,  the  woman  may  be 
placed  in  such  a  state  of  safety,  that  delivery  may  be  postponed  until 
a  time  arrives  when  it  can  be  safely  accomplished,  and  in  the  mean- 
time we  can  have  recourse  to  those  measures  which  tend  to  raise  the 
vital  powers. 

I  think  it  probable  that  it  may  also  produce  one  of  the  other  natural 
means  of  suppressing  hemorrhage  which  I  have  already  referred  to, 
viz.,  coagulation  of  the  blood  ;  but  this  I  have  not  yet  positively  as- 
certained  by  experiment,  although  I  am  led  to  conclude  that  such  is 
the  fact,  from  some  remarks  miule  by  Dr.  Apjohn,  in  the  article 
Galvanism,  in  the  Cyclopaedia  of  Practical  Medicine. 

In  my  previous  remarks,  gentlemen,  I  must  be  understood  to  refer 


1845.]  Galvanism  applied  to  Uterine  Hemorrhage.  713 


to  those  cases  of  hemorrhajie  where  the  placenta  is  not  placed  over 
or  near  the  os  uteri  ;  but  1  shall  now  proceed  to  speak  of  those  cases 
in  which  uterine  contraction  has  a  tendency  to  increase  the  dis- 
charge, cases  which  are  usu;illy  described  as  belonging  to  the  class, 
unavoidable  hemorrhage.  In  these  cases,  wjiere  the  peculiar  loca- 
tion of  the  placenta  deprives  us  of  the  benefits  that  usually  accrue 
from  uterine  ct>ntraction,  and  as  it  is  the  special  influence  of  galvan- 
ism to  prodtice  this  effect,  it  ought  to  be  the  object  of  the  obstetrician 
so  to  modify  his  practice,  as  to  place  them  within  the  range  of  this 
remedy  Before  entering  upon  a  description  of  the  plan  which  I 
would  recommend  to  be  adopted  in  these  cases.  I  shall  first  direct 
your  attention  to  the  practice  of  the  older  writers;  and  secondly, 
refer  to  the  mode  in  which  nature  sometimes  terminates  them  when 
left  to  herself.  In  looking  over  the  authorities  from  1612  to  1790, 
we  find  that  they  vary  in  their  practice.  Some  recommend  the  re- 
moval of  the  placenta  before  the  child  ;  others  advise  the  same 
course  conditionally,  that  is,  providing  it  is  offering  itself  very  largely 
or  decidedly  to  the  finger  of  the  attendant ;  others  again,  say  that 
where  it  cannot  be  pushed  back,  it  should  be  brought  away  before 
the  child.  It  must  he  understood  that  many  of  these  writers  had 
not  a  correct  knowledge  of  the  true  anatomical  condition  of  parts 
in  cases  of  placenta  pravia,  and  I  do  not  think  it  necessary  to  enu- 
merate their  names,  as  it  would  be  occupying  too  much  of  your 
valuable  time.  You  will  find  that  in  some  of  these  cases,  where  the 
placenta  was  brought  away  before  the  child,  according  to  the  state- 
ment of  these  writers,  the  latter  was  even  born  alive,  and  in  most  of 
them  the  hemorrhage  was  suppressed.  And  whilst  on  this  subject,  I 
may  call  your  attention  to  a  few  cases  of  more  recent  occurrence, 
where  this  practice  has  been  adopted.  It  happened  to  me  in  1819, 
to  have  a  case  of  placental  presentation,  where  I  detached  the  pla- 
centa, because  it  was  hanging  down  so  low  in  the  vagina,  that  there 
was  no  chance  of  doing  any  thing  else;  the  hemorrhage  was  imme- 
diately suppressed,  and  the  child  expelled  by  the  natural  efforts.  I 
am  also  indebted  to  my  friend  Mr.  Jesse,  who  is  present,  for  the  de- 
tails of  a  case  in  which  he  detached  the  placenta,  and  in  which  the 
hemorrhaore  thereupon  subsided.  It  was  the  practice  of  the  late  Mr. 
Kinder  Wood,  of  this  hospital,  in  many  of  these  cases,  to  detach  and 
bring  away  the  placenta,  and  afterwards  to  leave  them  to  the  opera- 
tion of  nature,  or  to  extract  the  child  by  the  feet,  as  the  case  demand- 
ed. A  case  also  occurred  to  Mr.  Wilson,  of  this  town,  who  kindly- 
related  the  circumstances  to  me ;  the  placenta  had  been  rudely 
brought  away  by  the  attendant,  and  Mr.  Wilson  found  the  patient  in 
a  state  of  exhaustion,  with  the  child  still  in  utero.  He  extracted  the 
child  a  considerable  time  after  the  removal  of  the  placenta  It  has 
occurred  to  me,  in  my  hospital  practice,  to  find  that  the  placenta  bad 
been  brought  down  in  mistake  by  the  midlives  in  these  cases,  and 
this  without  causing  an  increase  of  the  flooding. 

Smellie  mentions  cases  in  which  the  placenta  was  brought  away. 


714  Galvanism  applied  to  Uterine  Hemorrhage,  [December, 


and  where  the  hemorrhage  subsided.  In  Dr.  Collins's  Reports  of  the 
Dublin  Lying-in  Hospital,  there  is  a  case  in  which  the  placenta  was 
brought  away  by  the  midwife  the  evening  before  the  admission  of  the 
patient  iuto  the  hospital,  and  the  hemorrhage  was  thereby  suppressed. 
Baudeioque  relates  a  somewhat  similar  case.  And  now  let  us  con- 
sider the  method  in  which  naturesometimes  terminates  labours  where 
there  exists  placenta  prsevia  ;  and  for  this  purpose  I  have,  without 
any  great  pains,  collected  36  cases,  illustrative  of  her  powers  in  sepa- 
rating and  expelling  the  placenta  before  the  chil(i. 

Gitfard  mentions  one  case  ;  Perfect,  one  case  ;  Smellie,  four  cases  ; 
Chaptnan,  one  case  ;  Ramsbotham,  sen.,  six  cases ;  Merriman,  one 
case:  Hamilton,  two  cases ;  Collins,  one  case ;  Barlow,  one  case ; 
Dr.  Robert  Lee,  two  cases;  Gower,  one  case;  Millington,  one  case ; 
Bailey,  one  case  ;  Wood,  three  cases ;  Lowe,  one  case ;  Huut,  one 
case;  Wm.  Lowe,  three  cases;  Dorrington,  two  cases;  and  I  have 
met  with  three  cases  of  the  same  nature  myself.  Besides  these,  Mr. 
Jesse  has  related  to  me  a  case  of  placenta  praevia,  where  the  entire 
ovum  was  expelled  ;  Mr.  James  Kenworthy,  a  similar  case  ;  and  the 
late  Dr.  Rigby  has  published  a  case  also.  Now,  the  bulk  of  these 
casus,  gentlemen,  have  been  detailed  without  any  specific  practical 
object,  and  consequently  are  more  valuable  to  my  present  purpose 
than  if  they  had  occurred  to  myself,  and  had  been  brought  forward 
to  serve  my  own  particular  viev*'s.  You  may  refer  to  many  of  them 
yourselves;  and  you  will  find  in  nearly  all  of  them  that  the  hemorr- 
hage  was  suppressed  immediately  after  the  placenta  was  thrown  off. 

These  cases,  then,  and  the  practice  already  referred  to,  as  adopted 
by  the  older  writers,  and  several  modern  obstetricians,  appear  to  me 
to  furnish  data  of  a  most  important  character,  whereupon  a  practice, 
adapted  to  cases  of  exhaustion  from  unavoidable  hemorrhage,  may 
be  based,  in  order  to  bring  them  within  the  sphere  of  the  application 
of  galvanism.  And  before  entering  upon  a  description  of  my  pro- 
posed plan  of  managing  these  cases,  I  beg  to  remind  you  that  it  is  an 
established  fact,  that  partial  separation  of  the  placenta,  whether  in 
simple  or  in  complicated  retention  of  that  organ  after  labour,  or  in 
placenta  praevia,  is  attended  with  far  more  profuse  bleeding  than  total 
separation. 

In  the  early  part  of  the  lecture,  I  stated  that  one  means  of  adding 
to  the  exhaustion  already  existing,  is  the  evacuation  of  the  uterus, 
Avhether  that  evacuation  be  partial  or  entire  ;  therefore  I  consider 
that  in  these  cases  of  placental  presentation,  it  would  be  a  decidedly 
important  point  of  practice  to  draw  off  the  liquor  amnii  ^racZ?*<7//v,  as 
the  first  step  in  the  management  of  the  case.  For  this  purpose  1  have 
somewhat  modified  Mr.  Holmes's  instrument  for  perforating  the 
membranes,  making  the  canula  much  larger,  and  having  an  oval 
aperture  placed  on  each  side  near  its  open  extremity.  The  entire 
instrument  consists  of  a  canula  and  trocar,  which  latter  always  lies 
concealed  within  the  canula,  by  means  of  a  spiral  spring,  except  when 
pushed  out  by  pressure  on  its  button-like  extremity.     This  trocar  can 


1845.]  Galvanism  applied  to  Uterine  Hemorrhage,  715 


be  entirely  withdrawn  from  the  canula,  so  as  to  leave  the  latter  free 
for  the  passafje  of  fluid.  Now  I  propose  to  pass  this  instrument 
through  the  placenta  into  the  amniotic  bag,  and  then  remove  the 
trocar,  so  that  the  li(}uor  amnii  may  escape,  a  plan  which  I  prefer  to 
rupturing  the  membranes  at  the  side  of  the  placenta,  because  the 
water  in  tiie  latter  case  would  flow  too  rapidly,  on  account  of  the  prac- 
titioner not  being  able  to  limit  The  size  of  the  opening  he  might  make, 
and  al>o  because  by  the  plan  now  recommended,  the  integrity  of  the 
membranes  be  in  2:  preserved,  the  placenta  is  thereby  maisitained  in  a 
belter  position  for  acting  as  a  tampon  against  the  open  venous  aper- 
tures when  the  head  comes  to  press  upon  it. 

In  rupturing  the  membranes  in  the  ordinary  method,  it  is  quite  ob- 
vious that  as  the  connectiop  between  the  membranes  and  placenta  is 
broken,  the  latter  is  liable  to  fliil  down  more  or  less  into  the  vagina. 
Having  thus  drawn  ofFthe  liquor  amnii,  the  next  step  will  be  to  intro- 
duce  the  hand  into  the  vagina,  then  to  pass  the  fingers  to  the  edge  of 
the  placenta,  and  carrying  them  on  between  it  and  the  os  uteri,  to 
sweep  the  hand  round  its  whole  circumference,  so  as  completely  to 
detach  the  placental  mass,  care  being  taken  to  avoid  rupturing  the 
membranes.  We  have  now  brouirht  the  case  into  such  a  stale  as  to 
be  within  the  influence  of  galvanism;  for  although  this  practice  of 
detaching  the  placenta  may  be  a  means  of  suppressing  the  bleeding, 
yet  it  will  not  restore  the  depressed  pov,ers  of  the  woman  ;  and  on  that 
account  we  still  require  an  agent  to  induce  such  a  degree  of  uterine 
contraction  as  will  secure  her  from  all  chances  of  further  hemorrhage, 
while  we  have  recourse  to  such  measures  as  will  tend  to  support  her 
strength. 

In  order,  then,  to  insure  uterine  contraction,  we  must  have  re- 
course to  galvanism,  and  the  subsequent  management  of  the  case 
must  be  conducted  on  ordinary  principles,  such  as  supporting  the 
woman  by  stimulants,  nutritious  articles  of  diet,  and  transfusion. 
The  delivery  should  be  deferred  until  the  powers  of  the  patient  are 
so  far  rallied  as  to  justify  its  being  undertaken,  however  long  the  in- 
terval may  be ;  and  that  mode  adopted  which  makes  the  least  de- 
mand upon  her  constitutional  powers.  It  rnay  happen  that  a  repeti- 
tion of  the  galvanic  shocks  may,  after  a  certain  period,  induce  such 
uterine  action  as  will  expel  the  whole  of  the  contents  of  the  organ  ; 
and  if  this  should  not  happen,  it  appears  to  me  that  it  would  be  the 
best  practice,  to  apply  the  long  forceps,  having  previously  removed 
the  placenta,  that  is  if  the  head  presents.  If  any  other  part  of  the 
child  presents,  the  case  must  be  managed  on  ordinary  principles. 

The  novelty  of  these  views  may  produce  an  impression  unfavora- 
ble to  their  proper  estimation,  but  I  hope,  gentlemen,  you  will  recol- 
lect that  it  has  been  my  object  to  bring  I  hern  before  the  profession 
in  order  that  their  correctness  may  be  tested.  I  wish  to  benefit  poor 
suffering  women  in  their  hour  of  danger,  and  to  be  candid  in  my 
communications  to  my  professional  brethren.  In  my  own  mind  I 
am  satisfied  as  to  the  influence  of  galvanism,  and  its  power  of  pro- 


\ 

"716  Galvanism  applied  to  Uterine  Hemorrhage,  [December, 


ducing  uterine  contraction.  Tarn  also  convinced  that  it  has  no  evil 
influence  on  the  life  of  the  child  in  utero,  and  after  its  birth  that  it 
is  an  important  means  of  resuscitation  in  cases  of  asphyxia.  Ob- 
jections may  be  raised  that  we  have  not  always  the  apparatus  at 
hand.  The  answer  to  (his  objection  is  the  same  as  that  which  refers 
to  the  application  of  all  instrumental  means.  In  my  opinion,  no 
gentleman  who  possesses  the  principles  of  a  correct  obstetrician, 
would  carry  his  forceps,  veclis,  perforator,  crotchet,  or  transfusion 
apparatus  along  with  him.  These  things  are  to  be  sent  for  in  emer- 
genrios  only,  and  the  same  remark  applies  to  the  galvanic  apparatus. 

My  remarks  have  hitherto  been  confined  to  the  treatment  of  those 
cases  of  hemorrhage  that  are  attended  with  exhaustion  before  deliv- 
ery, but  there  are  other  cases  to  which  galvanism  is  equally  applica- 
b'e.  If  we  investigate  tne  cases  given  by  authors,  we  shall  find  that 
there  are  many  cases  of  accidental  hemorrhage  before  delivery,  where 
artificial  rupture  of  the  membranes  has  not  succeeded  in  arresting 
the  discharge,  on  which  account  several  writers,  Burns  and  Hamilton 
amongst  them,  advocate  delivery  in  preference  to  this  operation. 
Now,  the  artificial  rupture  of  the  membranes  is  recommended  for 
adoption  without  reference  to  the  condition  of  the  os  uteri ;  and  it 
must  be  obvious,  if  this  part  is  rigid  and  undilatable,  and  the  flooding 
should  continue  although  the  membranes  have  been  ruptured,  that  it 
would  be  highly  hazardous  to  introduce  the  hand  and  to  deliver  by 
force.  In  such  a  case  galvanism  would  place  the  woman  in  a  state 
ofst^curity,  by  exciting  the  contraction  of  the  uterus.  I  also  consid- 
er  that  this  would  be  useful  in  some  of  the  hemorrhages  of  the  early 
months  of  pregnancy. 

With  regard  to  the  after  hemorrhages,  especially  those  attended 
by  exhaustion,  I  consider  it  particularly  applicable  where  atony  of  the 
uterus  is  the  principal  feature  of  the  accident.  In  those  cases  which 
occur  previous  to  the  expulsion  of  the  placenta,  it  would  be  the  duty 
of  the  practitioner  to  assure  himself  that  this  mass  was  not  morbidly 
adherent  to  the  sides  of  the  uterus. 

In  hour-glass  contraction,  and  other  forms  of  irregular  uterine  ac- 
tion nfier  labour,  I  anticipate  great  benefit  from  its  use.  In  these 
cases  there  is  a  loss  of  balance  between  the  contractile  power  of  dif- 
ferent parts  of  the  uterine  fibre,  one  part  being  in  a  state  of  atony, 
whilst  the  other  is  in  a  state  of  firm  contraction.  Now,  if  the  gal- 
vanic current  be  directed  in  the  longitudinal  axis  of  the  organ,  it 
strikes  me  that  you  might  excite  the  longitudinal  fibres  to  contrac- 
tion, and  thereby  restore  the  balance. 

There  are  several  other  topics  not  directly  connected  with  the 
subject  of  this  evening's  lecture  which  I  shall  slightly  notice,  in  re- 
ference to  galvanism.  lam  satisfied  from  positive  trial  of  the  reme- 
dy, that  it  will  be  foiind  a  most  important  agent  in  tedious  labour, 
depending  upon  want  of  power  in  the  uterus,  and  where  no  mechan- 
ical obstacle  exists.  I  would  also  suggest  the  probability  of  its  prov- 
ing valuable  in  originating  uterine  action  de  novOy  in  cases  where  it 


1845.]  Galvanism  applied  to  Uterine  Hemorrhage.  717 


may  be  consiHered  iipcessary  tn  indiiro  premature  labour.  It  seems 
to  me  aKso  to  be  worthy  of  trial  in  certain  cases  ofmenorrhafiia  in  the 
ungravid  state,  where,  on  vajiinal  examination,  the  uterus  is  found  to 
be'atonic,  as  evidenced  by  its  large  flaccid  condition,  and  the  patu- 
lous state  of  the  os  uteri. 

Having  made  this  dic;ression,  it  is  proper  that  I  should  remark,  m 
reference' to  cases  of  hemorrhaore,  that  I  am  not  urging  this  plan  of 
treatment  upon  the  profession,  with  the  view  of  superseding  the  or- 
dinary means,  but  rather  with  the  view  of  supplying  a  remedy  in  those 
extreme  cases  where  these  have  failed.  I  do  unhesitatingly  say  that 
the  obstetrician  has  the  power  in  most  cases  tocontroul  uterine  hem- 
orrhage, so  as  to  prevent  them  ever  reaching  this  extreme  state  of 
exhaustion.  But,  nevertheless,  we  do  meet  with  this  condition  fre- 
quently in  a  large  hospital  practice,  and  also  in  private  consultation 
practice.  A  number  of  cases  have  come  to  mv  knowledge  within  a 
very  few  months,  where  d^ath  have  resulted  from  this  excessive  ex- 
haustion.  I  there-fore  say  that  we  ouizht  to  have  some  more  certain 
means  than  delivery  to  depend  upon  in  these  cases;  for,  if  this  expe- 
dient be  so  important  a  means  of  saving  life,  how  is  ijt  that  it  so  often 
fails? 

With  regard  to  the  mode  of  applying  galvanism  in  these  cases,  I 
have  used  an  electro-macrnetic  apparatus,  contrived  by  Messrs.  Abra- 
ham and  Dancer,  of  this  town,  for  medical  and  other  purposes.  It 
consists  of  a  battery  in  a  small  jar,  and  a  helix  with  conductors. 
For  the  sake  of  convenience,  the  latter  are  connected  with  the  hebx 
by  means  of  long  v/ires  covered  with  an  isolating  material.  The 
strength  of  theshuDck  is  regulated  by  a  small  contrivance  situated  on 
the  st'and  of  the  helix,  by  means  of  which  it  can  be  either  diminished 
or  increased.  One  of  the  conductors,  which  is  applied  externally, 
has  a  hollow  wooden  handle,  through  which  passes  the  wire  before 
alluded  to,  in  order  to  join  a  brass  stem  terminating  at  its  extremity 
in  a  ball.  The  other  conductor,  which  is  contrived  by  myself,  con- 
sists of  a  strong  brass  stem,  seven  inches  long,  curved  to  suit  the 
vagina,  and  covered  with  a  non-conducting  material,  having  a  small 
screw  at  its  distal  extremity  for  attaching  it  to  a  silver  ball ;  at  its 
other  extremity  it  is  received  within  an  ebony  handle,  which  is  hol- 
low, and  through  which  passes  a  strong:  brass  wire,  looped  at  the  end, 
and  connected  with  the  long  wires  before  alluded  to.  This  wire  is 
kept  disconnected  from  the  brass  stem  by  means  of  a  spiral  spring 
concealed  within  the  ebony  handle.  The  loop  is  covered  with  silk, 
and  is  intended  for  the  thumb  of  the  operator,  when  he  is  bringing 
the  wire  into  connexion  with  the  stem. 

When  the  remedy  is  applied,  the  brass  ball  of  the  vaginal  conduc 
tor  is  to  be  passed  up  to  the  os  uteri,  and  moved  about  at  intervals,  on 
to  various  parts  of  this  organ.  At  the  same  time  the  other  conductor 
must  be  applied  to  the  abdominal  parietes  over  the  fundus  uteri. 
Shocks  may  be  also  passed  transversely  through  the  uterus  by  simul- 
taneously  applying  the  conductor  on  each  side  of  the  belly. 


718  Epidemic  Erysipelas,  with  Cases.         [December, 


The  application  should  be  used  at  intervals,  so  as  to  approximate 
in  its  effects  as  nearly  as  possible  to  the  natural  pains.  It  may  be 
continued  until  it  meets  the  exisencies  of  the  case. 


An  Account  of  the  Epidemic  Erysipelas ;  with  Cases.  By  R.  G. 
Whaetox,  IM.  D.,  of  Grand  Gi/lf,  Mississippi.  [From  the  New 
Orleans  Medical  and  Surgical  Journal.) 

During  the  months  of  April  and  May,  1844,  and  the  first  quarter 
of  the  present  year,  the  town  of  Grand  Gulf  suffered  very  much 
from  an  epidemic,  which  has  been  described  very  properly  by  Drs. 
Hall  and  Dexter  in  the  January  No.  (1844,)  of  the  American  Jour- 
nal of  Medical  Sciences,  as  an  erysipelatous  fever;  the  same  disease 
has,  since  that  time,  prevailed  very  extensively  in  isolated  localities 
throughout  most  parts  of  the  United  States,  and  even  now,  is  sweep- 
ing with  unabated  violence  over  many  parts  of  this  State.  It  has 
assumed  in  no  place  a  more  malignant  form  than  it  did  in  this  town  ; 
and  I  am,  consequently,  enabled  to  give  a  description  from  observa- 
tion of  a  form  of  disease,  which  whether  we  regard  its  frightful 
appearance,  or,  in  many  cases,  its  intractableness  to  all  remedial 
means,  is  unsurpassed  by  cholera.  The  name  of  black  tongue,  ac- 
corded to  it  in  the  newspapers,  was  well  calculated  to  inspire  terror 
at  its  approach,  and  though  unappropriate  and  vague,  that  very 
vagueness  rendered  it  more  fearful. 

It  attacks  in  so  many  different  forms,  and  assumes  such  a  variety 
of  appearances,  that  it  is  impossible  to  give  any  description  which 
will  apply  to  all  cases.  The  first  cases  assumed  the  form  of  acute 
laryngitis  of  the  most  obstinate  kind,  and  several  proved  fatal  in 
spite  of  the  most  active  depletion  by  the  lancet,  frequent  emetics  of 
tartar  emptic,  warm  baths,  and  blisters  to  the  throat.  At  the  time,  I 
did  not  suspect  this  inflammation  to  be  of  the  erysipelatous  kind, 
but  in  a  short  time  I  became  convinced  that  it  was.  These  cases 
occurred  in  March,  1844.  Early  in  April,  several  were  suddenly 
seized  with  violent  fever,  swelling  and  slight  redness  of  the  parotid 
glands,  headache,  drowsiness  almost  approaching  to  stupor,  severe 
pain  in  the  ear  and  pains  in  the  limbs.  In  the  course  of  36  to  48 
hours,  the  swelling  and  inflammation  extended  from  the  parotid  to 
the  larynx,  producing  all  the  symptoms  of  acute  laryngitis,  such  as 
great  difficulty  and  pain  in  deglutition,  which  was  performed  with  a 
convulsive  effort,  and  with  a  gurgling  sound;  small  quick  pulse,  ten- 
derness on  pressure  of  the  larynx,  anxious  countenance,  &;c. 

After  these  sj^mptoms  had  continued  for  two  or  three  days,  or  had 
been  somewhat  relieved,  a  slight  swelling  and  great  tenderness  and 
redness  might  be  seen  in  some  part  of  the  face,  generally  about  the 


1845.]  Epidemic  Erysipelas^  with  Cases.  719 


ear  or  in  the  ear  sometimes  about  the  nose ;  the  throat  symptoms, 
thoufih  much  slighter,  still  harrassed  the  patient :  there  was  a  conslant 
hawking  up  of  a  tough  mucus,  and  a  difficulty  of  deglutition  differ- 
ent from  that  first  experienced,  and  now  depending  apparently  on  a 
paralysis  of  the  muscles  of  the  throat.  The  uvula  and  velum  were 
ot  a  dark  purple,  and  very  much  swollen  ;  also  the  tonsils  in  many 
cases;  the  pulse  rose  very  much  in  frequency  as  the  swelling  of  the 
face  progressed  ;  and  the  drowsmess  or  stupor  also  kept  pace  with  it. 
The  swelling  extended  rapidly,  and  involved,  in  most  cases,  the 
whole  of  the  face,  ears,  forehead,  and,  in  a  few  cases,  the  whole  scalp, 
sometimes  extending  down  the  breast  or  back.  In  these  cases  there 
was  total  blindness  for  five  or  six  days  from  the  swollen  state  of  the 
face  and  eyelids;  and  the  patient  generally  lay  either  drowsy, 
with,  a  muttering  delirium,  or  stupid  ;  feet  and  hands  cool  or  cold  ; 
head  hot ;  with  great  pulsation  of  the  carotids.  The  pulse  is  now 
very  weak  and  rapid,  and  it  is  with  the  Utmost  difficulty,  that  the  pa- 
tient takes  any  medicine  or  water.  In  favorable  cases,  the  swelling 
gradually  subsides,  first  on  that  side  of  the  face  on  which  it  com- 
menced ;  a  copious  secretion  of  purulent  matter  torms  under  the 
cuticle:  the  eyes  open  ;  fever  gradually  abates;  and  in  the  course 
of  eleven  to  fifteen  days  the  patient  is  convalescent.  It  may  prove 
fatal  in  the  early  stage,  (if  not  actively  and  promptly  treated,)  from 
suffocation.  Laryngeal  symptoms  in  the  swelling  even  may  subside, 
and  matter  may  be  freely  secreted,  yet  there  is  an  absolute  impossi- 
bility of  swallowing,  from  the  paralysis  of  the  muscles  of  deglutition  ; 
nervous  symptoms  supervene  tremors;  inability  of  urinating,  and 
the  patient  dies  about  the  tenth  day,  sometimes  as  late  as  the  fifteenth. 

This  was  the  form  the  first  cases  assumed  ;  but  soon  after  others 
occurred,  in  which  the  first  symptoms  were  precisely  similar  to  those 
above  detailed  ;  there  was  violent  fever:  pain  and  swelling  of  the 
parotids.  Sometimes,  however,  these  glands  were  unaffected,  the 
disease  attacking  the  muscles  and  tendons  on  the  side  of  the  neck, 
causing  the  most  excrutiating  pain,  swelling  and  tenderness  on  pres- 
sure; there  was  soreness  of  the  throat,  pain  and  difficulty  of  degluti- 
tion, the  fauces  were  of  a  dark  or  livid  color,  the  tonsils  "were 
enlarged,  and  patches  of  ulceration  might  be  observed,  or  a  tough 
mucus,  which  looked  like  ulcers.  In  these  cases  there  were  severe 
pains  felt  in  different  parts  of  the  body,  generally  on  top  of  one  or 
both  shoulders,  shooting  up  the  sides  of  the  neck;  sometimes  there 
was  violent  pain  in  the  feet  and  legs.  Numbness  of  limbs  was  a 
very  general  symptom.  Though  these  cases  constituted  a  much 
milder  form  of  the  disease  than  the  first,  the  pains  were  often  excru- 
ciating, the  fever  very  high,  with  a  pulse  always  frequent,  sometimes 
strong  and  full. 

Sometimes,  without  any  external  inflammation,  the  disease  attack- 
ed the  lungs,  producing  the  most  malignant  form  of  pneumonia; 
sometimes  the  stomach  and  bowels,  producing  the  most  intractible 
form  of  gastritis  or  enteritis.     We  consider  these  to  be  cases  of  erv- 


720  Epidemic  Erysipelas,  with  Cases,  [December, 


sipelatoLis  inflammation,  because  they  appeared  at  the  same  time,  in 
the  same  families,  some  members  of  which  were  attacked  in  this 
manner,  others  with  the  other  forms  of  the  disease;  and  because 
these  are  symptoms  common  to  nearly  every  form  of  it.  I  had  one 
patient  who  was  attacked  in  the  usual  manner,  with  chill  and  high 
fever,  violent  pain  in  the  side  of  the  neck,  with  soreness,  pain,  and 
difficulty  of  deglutition,  pains  in  the  limbs.  Me  was  relieved  in  the 
course  of  fi)ur  or  five  days;  when,  from  imprudent  exposure  to  the 
sun,  he  relapsed,  and  the  disease  attacked  the  lungs,  stomach  and 
bowels;  producing  pneumonia  with  gastro-enteritis,  which  nothing 
could  relieve.  In  the  relapse  there  was  severe  pain  in  the  neck,  and 
sore  throat.  Again,  in  other  cases,  after  suffering  for  two  or  three 
days  in  a  slight  degree  with  fever,  pain  in  the  neck,  and  sore  throat, 
the  patient  was  attacked  in  the  stomach  with  nausea  and  vomiting, 
and  other  symptoms  of  gastritis  which  was,  as  far  as  I  have  seen 
and  heard,  always  fatal.  When  the  viscera,  lungs,  stomach,  or 
bowels  were  the  seat  of  the  disease,  I  have  never  yet  seen  a  case 
recover.  It  generally  attacked  these  organs  when  the  patient  was 
in  general  bad  health,  was  addicted  to  habits  of  intemperance,  or 
dyspeptic;  always  attacking  the  weakest  organ.  In  these  visceral 
cases  there  was  a  degree  of  malignancy  which  I  have  never  before 
witnessed  in  any  disease.  In  the  course  of  a  very  few  hours  the 
countenance  is  entirely  changed  and  collapsed  ;  the  pulse  not  very 
weak  and  not  very  frequent ;  the  prostration  of  strength  astonishing. 
You  may  })leed  which,  however,  must  be  cautiously  done  ;  cup, 
bathe  and  blister ;  and  though  you  reduce  the  patient  by  these  means 
as  much  as  you  dare,  he  still  complains  that  the  pain  is  only  partially 
relieved,  and  the  disease  proceeds  with  more  or  less  rapidity  to  a 
fatal  termination,  while  the  physician  can  scarcely  even  palliate 
symptoms. 

I  had  a  number  of  slight  cases  characterized  by  chill,  fever,  pains 
and  numbness  in  the  arms  and  legs,  pain  and  soreness  in  the  side  of 
the  neck,  slight  soreness  of  the  throat.  These  were  generally  re- 
lieved in  the  course  of  four  or  five  days  ;  the  patient,  however,  was 
left  in  a  very  weak  and  languid  condition  for  several  weeks. 

The  tongue,  in  most  cases,  where  the  stomach  was  not  particu- 
larly affected,  was  not  much  changed  from  its  natural  state  ;  some- 
times it  was  dry  and  glazed,  and  in  a  few  cases  it  was  covered  from 
the  beginning,  with  a  heavy  coat  of  dark  fur. 

I  saw  several  cases  where  the  violence  of  the  disease  was  concen- 
trated in  the  muscles  of  the  neck,  causing  the  most  exquisite  tender- 
ness and  swelling,  which  often,  in  the  course  of  two  or  three  hours, 
was  as  large  as  a  hen's  eo:cT '  this  swelling  and  tenderness  would 
remain  stationary  for  several  days,  and  then  disappear,  or  disperse, 
by  extending  in  the  form  of  erysipelas  of  the  skin  around  the  neck. 

In  all  forms  of  the  disease  there  was  a  remarkable  tendency  to 
relapse.  Often,  when  the  patient  was  apparently  out  of  danger,  the 
slightest  imprudence  was  sufficient  to  produce  a  relapse  of  the  most 
formidable  kind. 


1845.]  Eindemic  Erysipelas^  with  Cases,  721 


The  question  whether  or  not  it  be  contaj^ions,  was  much  agitated 
on  its  first  appearance  here  ;  sufficient  proof,  however,  has  since  that 
time  accumulated  to  convince  the  most  sceptical  that  under  certain 
circumstances  it  is  contafjious.  It  may  be  taken  by  inoculation  ; 
several  cases  of  this  kind  have  occurred  in  this  county.  One  of 
them  was  that  of  a  physician,  who  lost  his  life  in  consequence. 
When  proper  cleanliness  and  ventilation  are  neglected,  it  is  very 
apt  to  be  communicated  to  the  nurses  and  attendants.  This  is  not 
peculiar,  however,  to  this  disease,  but  is  common  to  it  with  many 
others  not  usually  considered  very  contagious.  By  observing  the 
precautions  of  cleanliness  and  free  ventilation,  every  member  of 
one  family,  the  head  of  which  had  a  most  violent  attack,  escaped 
entirely  ;  whilst  in  another  family,  where  these  wholesome  safe- 
guards were  neglected,  the  disease  attacked  every  member,  several 
of  them  more  than  once.  I  have  thought  that  those  cases  where  the 
throat  was  deeply  affected  were  most  contagious;  probably  from  the 
fact  that  the  breath  of  the  patient  is  then  more  highly  charged  with 
the  morbific  miasm. 

Prognosis.  Those  cases  where  the  viscera  are  attacked,  are,  so  far 
as  I  have  seen  or  heard,  been  always  fatal,  and  especially  if  our  reme- 
dies produce  only  a  partial  relief.  While  the  pulse  is  weak  and  com- 
pressible the  prognosis  is  unfavorable..  Next  in  the  order  of  malig- 
nancy are  those  in  which  there  is  deep  seated  disease,  swelling  and 
ulceration  of  the  throat,  while  the  face  is  swollen  at  the  same  time. 
In  these  cases,  if  the  mind  remains  clear ;  if  our  remedies,  especially 
emetics,  are  borne  well,  and  if  the  pulse,  though  small  and  rapid,  does 
not  give  way ;  and  if  the  nerves  are  not  much  affected  ;  though 
most  dreadful,  we  may  entertain  a  reasonable  hope  of  recovery. 
The  intemperate,  and  those  delicate  constitutions  whose  viscera  are 
unsound,  and  those  of  advanced  age,  are  those  most  likely  to  suc- 
cumb under  an  attack. 

Trealment.  From  the  description  which  has  been  given  of  the 
various  forms  which  this  disease  assumes,  it  will  at  once  be  readily 
understood  that  considerable  modification  is  required  in  the  remedies 
in  consequence  of  this  variety  ;  and  that,  like  all  other  disease,  it 
must  be  treated  according  to  the  indications  in  each  particular  case. 
When  the  erysipelas  attacked  the  face  and  head  ;  and  when  the 
throat  was  at  the  same  time  affected,  as  was  the  case  when  the  dis- 
ease first  appeared  ;  if  the  pulse  was  full  and  strong,  as  it  was  in 
nearly  every  instance,  free  and  early  depletion  with  the  lancet  was 
indispensable.  I  had  to  bleed  most  of  those  who  suffered  under  this 
form  of  the  disease  twice,  with  most  happy  effect.  A  few  cases  oc- 
curred in  this  form  in  old  and  debilitated,  or  intemperate  subjects 
who  could  not  bear  the  lancet.  The  next  remedy,  and  a  most  im- 
portant one  it  is,  is  the  free  exhibition  of  antimonial  emetics;  the 
laryngeal  symptoms  here  were  most  urgent,  and  nothing  has  such  a 
controlling  power  over  them  as  tartar  emetic.  Besides  rdieving^e 
Upatient  of  the  symptoms  of  suffocation,  which  were  most  distres 

4ri 


lothc 


722  Epidemic  Erysipelas,  with  Cases.  [December, 


and  alarming,  the  frequent  exhibition  of  emetics  had  a  most  happy 
effect  in  keeping  down  the  arterial  excitement,  which  ran  high  ;  it 
equalized  the  circulation,  and  removed  the  stupor  caused  by  so  great 
a  determination  of  blood  to  the  head.  This  emetic,  or  nauseating 
course,  I  had  to  pursue  in  some  instances  for  three,  four,  or  even 
five  days. 

The  throat  required  some  especial  remedies  ;  and  when  the  velum 
and  uvula  were  swollen,  as  it  was  in  many  cases  very  much  from  the 
commencement ;  free  and  deep  incisions  were  necessary  to  relieve 
the  patient  of  the  difficulty  of  breathing  and  deglutition  ;  and  after 
this  had  been  done,  or  without  it,  when  the  parts  were  not  much 
swollen,  but  very  sore  and  ulcerated,  a  strong  solution  of  argent, 
nitrat.  (5i.  to  gi.  water.)  as  recommended  by  Tissot  in  chronic 
laryngitis,  was  applied  to  the  throat  by  means  of  a  mop  or  sponge 
fastened  to  the  end  of  a  whalebone,  being  careful  to  make  the  patient, 
take  a  litile  salt  and  water  in  case  any  of  the  solution  might  be  swal- 
lowed. I  saw  several  cases  where  the  uvula  and  velum  were  so 
enormously  swollen  as  almost  to  impede  the  entrance  of  air  into  the 
larynx.  By  free  and  deep  incisions  a  large  quantity  of  purulent 
matter  was  discharged,  to  the  great  relief  of  the  patient. 

Many  of  these  cases  were  most  distressing  to  witness;  the  patient 
lay  drowsy  or  perfectly  stupid,  snoring,  his  face  enormously  swollen, 
and  of  a  dark  purple  color,  almost  black,  so  that  it  would  be  impossi- 
ble for  his  friends  to  recognize  him  ;  eyes  closed,  a  constant  sense 
of  suffocation,  extreme  difficulty  (sometimes,  for  seven  or  eight  hours, 
an  actual  impossibility)  of  swallowing,  and  it  was  necessary  to  raise 
him  to  a  sitting  posture  every  time  he  attempted  to  swallow.  This 
motion  almost  exhausted  him.  The  pulse  is  weak  and  rapid,  and 
altogether  the  case  appears  desperate.  After  remaining  in  this  ap- 
parently hopeless  condition  from  24  to  48  hours,  the  throat  appears  a 
little  better;  the  patient  can,  by  great  exertion,  take  a  little  water  ; 
and  now  a  state  of  collapse  or  great  debility  occurs ;  and  by  the  cau- 
tious exhibition  of  carb.  ammon.  and  quinine,  the  pulse  becomes 
firmer,  more  steady,  the  s\ielling  of  the  face  rapidly  subsides,  and 
with  the  improvement  in  swallowing  there  is  a  return  of  appetite. 

The  convalescence  is  most  tedious ;  desquamation  of  the  cuticle 
takes  place;  large  collections  of  pus  form  under  the  cuticle,  as  well 
as  in  the  deep  seated  cellular  substance,  requiring  deep  incisions  to 
the  bone  to  discharge  it.  For  a  long  time  the  patients  looked  badly  ; 
the  skin  was  red  and  claret  colored,  like  that  of  a  patient  recovering 
from  the  small-pox. 

In  those  forms  of  the  disease  where  the  internal  organs  were  at- 
tacked, though  the  indications  were  plain,  unfortunately  medicine 
afforded  only  a  temporary  relief.  The  pulse  in  these  cases  was  weak 
and  soft ;  and  though  the  severe  pain  seemed  to  require  venesection, 
great  caution  was  necessary  in  its  use,  on  account  of  the  prostration 
of  the  general  system.  I  bled,  however,  a  majority  of  the  patients 
a^||cked  with  this  form  of  the  disease,   and  some   of  them   two   orj 


1815. J  Epidemic  Erysipelas,  with  Cases,  723 


three  times,  and  yet  I  could  attribute  only  a  very  temporary  amelio- 
ration of  symptoms  to  it. 

Cupping  was  resorted  to,  and  carried  as  far  as  could  be  borne  ; 
and  this,  too,  afforded  only  a  partial  relief. 

Hot  mustard  baths  was  the  remedy  on  which  I  placed  the  greatest 
reliance,  both  on  the  general  principle  of  a  strong  revulsion,  and  es- 
pecially because  it  appeared  to  be  the  only  remedy  which  afforded 
more  than  a  very  slight  mitigation  of  the  patients'  sufferings.  I 
usually  ordered  it  I'rom  three  to  six  times  in  the  24  hours,  and  con- 
tinued it  each  time,  as  long  as  the  patient  could  bear  it. 

Large  blisters  were  applied  over  the  seat  of  the  pain,  and  in  most 
cases  it  was  difficult  to  get  them  to  draw  ;  like  all  the  other  remedies, 
however,  they  afforded  little,  or  only  a  very  partial  and  temporary 
relief. 

Calomel  and  opium,  in  large  doses,  were  used  in  addition  to  the 
revulsive  means  ;  and  this,  too,  instead  of  doing  good  in  many  cases, 
evidently  aggravated  the  symptoms,  inducing  irritation  in  the 
bowels,  and  great  distress;  and  thus,  in  spite  of  every  rational  re- 
source, we  were  destined  to  see  our  patients,  in  the  midst  of  tlie  most 
horrid  tortures,  snatched  away  by  the  relentless  hand  of  the  scourger. 

In  some  of  these  cases,  hovvever,  tovvards  the  close  of  the  disease 
the  patients  sunk  into  a  state  of  quiet  delirium,  unconscious  of  every 
thing  ;  and  with  little  suffering,  breathed  their  last;  the  sensibilities 
having  been  previously  exhausted  by  the  violence  of  the  pains,  [n 
one  case  that  I  saw,  the  force  of  the  disease  was  concentrated  on  tiie 
feet  and  legs,  producing  the  most  excrutiating  pains,  as  severe  as  an 
attack  of  the  gout,  extending  up  the  body  ;  with  great  restlessness, 
fever,  full  and  strong  pulse.  In  this  case  I  bled  freely  ;  and  at  the 
suggestion  of  my  friend,  Dr.  Wilson,  of  Port  Gibson,  (who  saw  many 
of  these  cases  with  me,  and  whose  practical  suggestions  in  all  cases 
of  disease  are  characterized  by  a  discriminating  tact  rarely  met  with,) 
had  the  patient's  feet  and  legs  immersed  in  a  hot  lime  bath,  made  by 
dissolving  one  gallon  of  lime  in  four  gallons  of  hot  water.  This  had 
a  most  happy  effect  in  relieving  the  pains,  and,  together  with  other 
means,  which  were  indicated,  soon  restored  the  patient  to  health. 
There  were  a  number  of  cases  comparatively  mild  where  the  vio- 
lence of  the  disease  was  spent  on  the  lace  and  head,  producing  fever 
and  pain  of  the  face,  which  was  so  much  swollen  that  the  person 
could  not  be  recognised,  nor  see  at  all  for  several  days.  The  pa- 
tients were  very  drowsy  constantly  in  a  state  of  muttering  delirium  ; 
the  feet  and  legs  disposed  to  be  very  cold,  with  great  heat  of  head. 
In  these  cases  the  throat  was  unaffected  ;  consequently  there  was  no 
difficulty  of  deglutition  ;  the  pulse,  though  frequent,  being  sufficiently 
firm  ;  therer  was.  besides,  no  malignancy.  A  very  simple  course  of 
treatment  was  sufficient  for  these.  Mild  saline  purgatives,  the  con- 
stant application  of  cold  cloths  to  the  head,  and  hot  mustard  baths 
to  the  feet  and  legs,  wherever  there  was  much  delirium  or   stupor; 


these  were  the  means  which  being  persevered  in  for  six  to  ten  days 


724  Epidemic  Erysipelas^  with  Cases.         [December, 


would  always  bring  the  case  to  a  favorable  issue-  A  mild  anodyne 
at  night  was  sometimes  required  in  the  latter  stages  of  these  cases. 

There  were  a  number  of  other  cases  in  which  the  patients  com- 
plained of  severe  pains  in  the  sides  of  the  neck,  shooting  down  the 
arms;  soreness  of  throat,  with  considerable  difficulty  of  deglutition  ; 
fever,  severe  headache,  numbness  of  the  limbs,  and  a  great  depression 
of  spirits,  attributable  in  part  to  the  alarm  occasioned  by  the  preva- 
lence of  the  epidemic.  The  stomach  was  generally  irritable  ;  the 
tongue  red  ;  pulse  weak,  and  rather  frequent.  All  these  cases  were 
successfully  treated  by  hot  mustard  baths,  and  copious  draughts  of  a 
strong  hot  infusion  of  eupatorium  perfoliatum,  which  produced  a  co- 
pious perspiration,  v.'hich  was  kept  up  for  two  or  three  days,  to  the 
great  relief  of  the  patient. 

I  have  said  nothing  as  yet  about  the  local  treatment  for  the  erysipe- 
las when  it  attacks  the  surface,  being  well  convinced  from  large 
experience  that  no  local  applications  have  any  great  effiict  in  the 
worst  cases,  and  in  the  milder  cases  they  are  not  much  required.  I 
have,  however,  in  nearly  every  case  endeavored  to  arrest  the  progress 
of  inflammation  by  surrounding  it  with  blisters,  or  cauterising  the 
skin  around  with  argent,  nit.  In  many  cases  the  disease  was  arrest- 
ed by  the  lines  drawn  around  it ;  but  in  the  bad  cases  where  such 
effects  were  most  desired,  they  did  no  good  the  inflammation  ex- 
tending as  rapidly  as  if  they  had  not  been  applied.  I  have  covered 
the  face  with  mercurial  ointment,  and  have  applied  nearly  every  kind 
of  lotion,  and  from  the  result  of  this  experience  have  as  much  faith 
in  cold  water  as  in  any  other  one  remedy.  Still  it  is  well  to  try  a 
variety  of  them,  as  there  are  some  patients  who  receive  more  benefit 
from  certain  lotions  than  others.  For  this  purpose  we  may  use  solu- 
tions of  sal.  ammon.,  plumb,  acet.,  a  mixture  of  equal  parts  of  alcohol 
and  ether,  &c. 

Case  1st.  April  6th,  1844,  called  to  see  Mr.  T.  A.  Applegate, 
who  was  the  first  one  attacked  with  the  erysipelas  of  the  surface. 
He  was  taken  down  the  day  previous  with  high  fever,  swelling  of  the 
parotid  glands,  inability  to  protrude  the  tongue.  He  was  very  rest- 
less severe  headache  tender  on  pressure  over  prtecordia  drowsy, 
and  rather  stupid.  Bled  to  ^xvi,  cupped  over  the  stomach,  and  or- 
dered warm  bath.  9.  P.  M.  Bath  produced  perspiration,  but  the 
fever  continued  high.  7th.  Rather  better  this  morning;  still  con- 
siderable fever;  gave  mass.  hyd.  grs.  xii.  At  7  P.  M.  not  much 
better;  complains  of  general  fullness  about  the  head;  ordered  blister 
to  nape  of  neck.  Was  called  up  at  one  o'clock,  A.  M.  found  him 
laboring  under  acute  laryngitis,  the  inflammation  having  extended 
from  the  parotids,  which  were  still  very  much  swollen  and  inflamed. 
There  was  considerable  difficulty  of  deglutition,  which  was  perform- 
ed with  a  convulsive  effort,  and  with  a  gurgling  noise  ;  there  was 
also  tenderness  on  pressure  of  the  top  of  the  hirynx.  Used  frictions 
of  Granville's  liniment  to  the  throat,  without  benefit.  At  4  A.  M. 
he  was  much  worse  ;  gave  emetic  of  tartar  and  ipecac,    which  af- 


1845.]  Eindemic  Erysipelas,  with  Cases.  725 


forded  considerable  though  temporary  relief.  8th,  at  6  A.  M.,  in  a 
very  bad  condition  ;  countenance  frowning  ;  extreme  pain  in  swal- 
lowing ;  pulse  quick  and  tense  ;  frequent  watery  discharges  from  the 
bowels.  Bled  to  fxvi;  ordered  laudanum  enema,  and  applied 
emollient  poultices  of  onions,  tansy  and  rue,  as  hot  as  they  could  be 
borne,  changing  them  every  fifteen  minutes.  The  poultices  had  a 
most  happy  effect  in  relieving  the  urgency  of  the  laryngeal  symp- 
toms ;  much  better  than  blisters  to  the  throat,  which  I  now  never 
use  in  such  cases.  At  12  M.  still  improving,  can  swallow  without 
that  convulsive  effort  so  characteristic  of  laryngitis.  At  3  P.  M. 
pulse  100,  soft;  free  perspiration  gave  10  grains  Dover's  powder 
at  bedtime.  9th.  Slept  well  pulse  90,  soft;  feels  much  better, 
still  there  is  considerable  pain  in  swallowing;  has  much  thirst.  Order- 
ed ^  grain  tartar,  antim.  every  two  hours,  and  the  hot  poultices  to 
be  continued  to  the  throat.  Visit  at  9  P.  M.  He  had  vomited  two 
or  three  times  during  the  day  ;  spits  frequently  a  tough  mucus  which 
is  secreted  in  large  quantities ;  pulse  100,  quiet;  had  two  opera- 
tions ;  ordered  6  grains  Dover's  powder  ;  discontinued  the  poultices. 
lOih.  Passed  a  tolerable  night.  At  3  P.  M.,  he  was  rather  drowsy 
and  stupid  ;  pulse  110.  Ordered  the  solution  of  tartar  every  two 
hours;  this  reduced  the  pulse  to  104  by  9  P.  M.  and  produced  free 
secretion  from  the  throat,  which  appears  to  be  almost  entirely  re- 
lieved. There  is  still,  however,  a  great  determination  to  the  head 
with  considerable  discharge  from  the  nostrils.  He  complains  of 
tenderness  and  swelling  of  the  leftside  of  the  face,  in  front  of  the 
ears.  11th.  Face  still  swelling  on  the  left  side.  Ordered  the  tartar 
water  during  the  day ;  at  night  gave  hyd.  chlorid.  mit.  grs.  vi.  ; 
pulv.  jalap  gr.  iv.  to  relieve  the  bowels.  12th.  The  face  very  much 
swollen  this  morning;  pulse  110;  medicine  acted  well  on  the 
bowels,  with  some  relief;  scarified  the  velum  and  uvula,  which  were 
very  much  swollen,  and  impeded  the  passage  of  air.  I  now  became 
aware  of  the  necessity  of  arresting,  if  possible,  the  extension  of  the 
erysipelas,  and  for  this  purpose  surrounded  the  inflamed  parts  with 
strips  of  emplast.  episp.,  about  1^  inches  broad,  and  covered  the  face 
with  unguent  hydrar.  At  7  o'clock,  A.  M.,  no  better  ;  pulse  116; 
gave  hyd.  chlorid.  mit.  grs.  viij.  13th.  Medicine  taken  last  night 
operated  once ;  pulse  100 ;  blisters  drew  well ;  face  still  more 
swollen  ;  quiet,  disposed  to  sleep.  3  P.  M.,  pulse  120  ;  still  drowsy, 
intelligent  when  aroused;  great  difficulty  of  swallowing  from  appar- 
ent immobility  or  paralysis  of  the  muscles  of  mouth  and  throat. 
Ordered  carb.  amm.  of  which  he  took  two  doses  without  any  good 
effects.  14th.  Passed  a  tolerable  night;  pulse  during  the  last  night 
varied  from  120  to  112,  changing  every  half  hour  ;  it  is  now  112. 
Ordered  2  grains  quinine  every  three  hours;  this  had  a  fine  effect ; 
under  its  use  the  pulse  became  firmer  and  more  steady.  15th. 
Much  better  ;  pulse  108  ;  continued  quinine  ;  the  swelling  is  now 
abating;  swallows  much  better.  Ordered  light  broths,  with  a  little 
wine  whey.     lOth.  Improving  rapidly  ;    pulse   88  ;    continued  qui- 


726  Epidemic  Erysipelas^  with  Cases.  [December. 


nine  every  two  hours.  17th.  Pulse  82;  quinine,  broths,  wine 
whey  ;  at  bedtime  ordered  a  dose  of  laudanum  to  quiet  the  bowels. 
He  was  now  rapidly  recovering,  and  in  the  course  of  four  or  five 
days  was  able  to  sit  up.  Large  quantities  of  purulent  matter  formed 
on  the  cheek  bone  and  between  the  upper  eyelids,  which  had  to  be 
opened  with  a  lancet. 

Case  2d.  Tiie  following  case  has  some  peculiarities,  worthy  of 
notice.  It  is  the  only  one  that  Isaw  where  the  tongue  was  so  much 
affected.  June  5th,  at  eleven,  A.  M.,  called  to  see  W.  Gott,  a  boy 
aged  sixteen,  who  had  returned  from  school  about  two  hours  before, 
complaining  very  much  of  his  tongue,  which  he  said  felt  very  sore, 
and  was  swelling  rapidly.  Found  him  with  a  frequent  pulse,  rather 
hot  skin,  complaining  of  his  tongue  as  well  as  a  pain  on  each  side  of 
neck,  the  surface  of  which  looked  a  little  red,  and  was  painfully  sen- 
sitive to  the  slightest  touch.  The  tip  of  the  tongue  for  an  inch  was 
very  much  swollen,  and  there  were  several  white  specks  on  it.  Or- 
dered warm  mustard  baths,  blisters  to  the  painful  surface  of  the  neck, 
red  pepper  tea  as  a  drink,  and  as  a  gargle  or  mouth  wash.  At  four 
P.  M.  he  was  much  worse,  his  tongue  enormously  swollen,  so  that  his 
jaws  could  not  be  closed,  and  he  could  not  speak;  great  difficulty  of 
swallowing,  mind  stupid,  does  not  complain  of  pain  in  the  tongue. 
Pulse  120,  and  very  small  ;  great  heat  of  skin.  Ordered  mustard 
bath  again  in  two  hours  bled  to  f  xvi,  cupped  on  back  of  neck  and 
behind  the  ears,  to  relieve  the  determination  to  the  head.  I  request- 
ed Dr.  Wilson,  of  Port  Gibson,  to  meet  me;  we  applied  a  strong 
solution  of  argent,  nit.  to  the  fauces,  which  appeared  ulcerated  and 
dark  colored,  and  scarified  deeply  under  the  tongue.  At  midnight 
ordered  another  bath,  and  gave  strong  infusion  of  serpentaria  and 
chamomile  flowers.  6\h.  Somewhat  better  this  morning;  head 
clearer;  pulse  120,  and  rather  small ;  continued  the  infusion.  Swell- 
ing of  the  tongue  subsided,  so  that  he  could  articulate.  Throat 
better ;  repeated  the  caustic,  and  gave  a  cathartic  last  night  of  sulph. 
magnes.  which  operated  well.  There  was  not  much  change  during 
the  day  at  midnight  was  sent  for  in  haste,  and  found  him  suffering 
from  intense  pain  of  the  throat,  so  that  every  breath  caused  him  to 
cry  out ;  pulse  120,  weak  and  quick,  skin  moderately  hot  mind  not 
clear.  Ordered  him  to  be  put  in  a  mustard  bath  for  twenty  or  thirty 
minutes,  and  a  large  blister  to  be  applied  to  the  abdomen.  7th.  
Somewhat  easier,  though  not  relieved  of  the  pain.  Countenance 
bad  sleeps  with  eyes  half  open  rather  delirious  ;  pulse  130,  weak 
and  irritable.  Continue  the  chamomile  and  serpentaria  with  eupa- 
torium.  Towards  evening  became  much  worse;  the  pain  left  the 
stomach  and  bowels,  and  attacked  the  throat,  so  that  every  inspira- 
tion caused  him  to  cry  out  as  if  he  had  been  stabbed.  The  pain  was 
deep  seated,  and  changed  its  seat  constantly  first  on  the  right,  then 
on  the  left  side;  pulse  140,  weak'  and  quick;  countenance  more 
cadaverous.  Again  used  the  hot  bath,  as  it  was  the  only  remedy 
which  seemed  to  afford  even  a  temporary  respite  to  his  ngony.      The 


IS  15. J  Epidemic  Erysipelas,  with  Cases.  727 


skin  having  relaxed,  added  3  grains  quinine  to  the  other  medicines. 
8th.  Pulse  intermitting  ;  delirious  all  night ;  skin  cool  and  relaxed  ; 
talks  coherently  when  roused  ;  pain  still  severe,  though  much  light- 
er ;  pulse  140  to  150 ;  gave  the  quinine  in  large  doses,  but  as  it  did 
no  good,  and  he  was  sinking  fast,  discontinued  every  thing.  '  He 
expired  about  day,  on  the  morning  of  the  9th.  This  boy  was  appa- 
rently of  a  good  constitution.  His  family  had  suffered  very  much 
from  the  erysipelas  for  six  or  seven  weeks,  and  his  was  the  last  case 
that  occurred  during  the  last  year.  The  attack  appears  to  have 
been  brought  on  by  his  bathing  in  a  muddy  pond  of  water  during 
the  heat  of  the  day. 

Case  3d.  April  26th,  1844.  Visited  Mr.  Calahan,  who  was 
suffering  with  acute  pains  in  the  feet  and  legs,  arms,  stomach  and 
bowels.  Pulse  85  ;  stomach  tender  on  pressure  ;  tongue  clear  and 
rather  red  ;  no  headache.  As  he  had  taken  some  cathartic  pills  over 
night  which  operated  harshly,  ordered  nothing  biit  a  hot  bath. 
At  7,  P.  M.,  the  bath  had  not  relieved  the  pains,  which  were  very 
severe  in  the  abdomen.  Cupped  very  extensively.  27th.  Passed 
a  very  restless  night  ;  the  pains  are  very  severe  in  the  hollow  of 
both  feet,  and  in  both  big  toes,  one  spot  being  particularly  painful. 
The  pain  extends  from  this  up  the  legs  and  thighs  ;  pulse  80,  and 
rather  full;  skin  hot ;  very  restless.  Bled  to  ^xxiv  ;  put  him  into  a 
hot  bath.  11,  A.  M.  The  bath  relieved  him  for  one  or  two  hours  ; 
as  the  pain  in  the  abdomen  is  severe,  cupped  again,  and  gave  the 
following :  R.  mass.  hyd.  grs.  vi.,  extract  conii.  grs.  iij.  M. ;  or- 
dered the  bath  again  at  1,  P.  M.  At  2|,  P.  M.,  more  quiet,  and 
easier  than  he  had  been  ;  dozes  occasionally  ;  pulse  80,  and  softer. 
Says  the  pains  are  much  slighter,  though  still  severe.  Ordered  the 
same  dose  at  4,  P.  M.  At  6,  P.  M.,  complains  very  much  of  the 
pain  in  his  feet  and  legs,  which  is  very  excruciating;  has  a  most 
distressinfy  nausea  and  vomiting.  Requested  Dr.  Wilson  to  see  him. 
We  had  his  feet  and  legs  immersed  in  a  hot  lime  bath  several  times 
during  the  night,  and  applied  a  large  blister  to  the  abdomen.  The 
]>ath  relieved  the  pain  very  much;  the  nausea  was  partly  relieved  by 
the  blister.  28th.  Slept  very  little,  skin  hot ;  pulse  85  ;  complains 
still  of  nausea.  Gave  snlph.  morph.  gr.  i,  and  as  soon  as  the  stom- 
ach is  composed,  ordered  hot  infusion  of  eupatorium  perfoliatum  and 
a  general  warm  bath.  These  means  relieved  him  very  much.  At 
8,  P.  M.,  complained  of  inability  of  urinating  relieved  by  sp.  a3th. 
nit.  and  emollient  fomentations  over  the  bladder.  29th.  Slept  rather 
badly,  feverish,  some  pain  in  the  abdomen.  Another  bath,  with  the 
infusion  of  eupatorium.  This  again  relieved  him,  and  in  a  day  or 
two  he  was  convalescent.  This  case  differed  very  much  from  the 
ordinary  forms  of  the  disease  ;  still  I  class  it  with  them  as  it  occurred 
at  the  same  time,  and  in  a  family  where  several  others  were  then  suf- 
fering with  the  more  common  forms  of  the  disease.  I  have  seldom 
seen  a  patient  suffer  more  than  did  this  one  from  the  pain  in  the  feet 
and  legs,  and  I  feel  confident  tiiat  without  prompt  treatment  he 
would  have  .sunk  ujKlcr  it. 


728  Bibliographical  Notices.  Digestion.       [December, 


BIBLIOGRAPHICAL    NOTICES. 

A  neiD  edition  of  '' Ramshotham' s  Process  of  Parturition.^^  
Messrs.  Lea  &  Blanchard  have  recently  re-published  the  last  London 
edition  of  this  invaluable  work,  carefully  revised  and  considerably 
enlarged.  Ramsbotham's  Process  of  Parturition,  has  been  so  long 
and  favorably  known  to  the  profession  in  the  United  States,  that  it 
needs  no  commendation.  It  certainly  stands  at  the  head  of  the  long 
list  of  excellent  obstetric  works  published  within  the  last  few  years 
in  Great  Britain,  Ireland  and  continental  Europe.  So  far  as  respects 
the  science  and  practice  of  midwifery,  both  in  description  and 
demonstration,  it  is  comprehensive  and  complete,  leaving  little  if  any 
farther  to  be  desired  in  this  department.  We  consider  this  book 
indispensable  to  the  library  of  every  physician  engaged  in  the  prac- 
tice of  midwifery. 

The  present  edition  contains  six  additional  figures,  and  fifty-nine 
pages  of  interesting  and  useful  matter,  worth  alone  the  price  of  the 
whole  work.  j.  a.  e. 


A  new  edition  of  Professor  Meigs''  Translation  of  Velpeau's  Mid- 
wifery ;  with  notes  and  additions,  by  William  Harris,  M.  D.  Pub- 
lished by  Messrs.  Lindsay  dc  Blackiston,  Philadelphia.  If  the 
reputation  of  this  work,  were  not  already  sufficiently  established  in 
tho  United  States,  the  names  of  Velpeau  and  Meigs  would  be  ample 
recommendation  ;  but  we  can  with  propriety  and  truth  say,  that  it  is 
rendered  much  more  perfect  and  valuable  by  Dr.  Harris'  interesting 
and  useful  notes  and  additions.  J.  a.  e. 


PART  III. MONTHLY  PERISCOPE. 

The  chemical  'phenomena  of  Digestion.  MM  Bernard  de  Ville- 
franche  and  Barreswill,  whose  researches  on  digestion  we  some  time 
since  published  in  the  Lancet,  have  addressed  another  communica- 
tion to  the  French  Academy,  in  which  they  observe,  "  We  formerly 
stated  that  the  gastric  juice  contains  two  active  principles,  1  free 
lactic  acid,  2  an  organic  matter,  which  is  precipitated  and  destroyed 
by  a  heat  of  85,  or  90^  cent.  It  is  the  presence  of  this  organic 
matter  which  gives  the  gastric  juice  its  digestive  power,  since  it  loses 


1845.]  Antagonism  of  CachexicB,  729 


this  power,  when  the  said  matter  is  destroyed  by  an  elevated  tem- 
perature. 

One  of  the  remarkable  properties  of  this  organic  matter  is,  that 
its  digestive  powers  vary,  according  as  it  is  associated  with  a  fluid 
having  an  acid  or  an  alkaline  reaction.  Thus,  in  the  gastric  juice, 
which  is  acid,  it  readily  dissolves  (as  is  well  known)  azotized  substan- 
ces, fibrin,  gluten,  albumen,  6:c.,  whilst  it  is  altogether  without  action 
on  starch. 

The  object  of  the  present  paper  is  to  show,  that  if  we  destroy  this 
acid  reaction  of  gastric  juice,  and  render  it  alkaline  by  the  addition 
of  carbonate  of  soda,  its  active  organic  matter,  being  now  in  presence 
of  an  alkaline  fluid,  changes  its  physiological  action,  and  becomes 
able  rapidly  to  modify  starch,  whilst  it  loses  its  power  of  digesting 
meat  and  azotized  substances.  As  the  latter  is  exactly  the  charac- 
ter of  saliva  and  the  pancreatic  fluid,  it  was  interesting  to  know 
whether  a  change  in  the  chemical  reaction  of  these  two  fluids  would 
produce  in  them  the  same  change  of  properties  as  in  the  gastric  juice. 
Our  experience  has  demonstrated  that  it  does  so.  If  we  render  the 
pancreatic  fluid,  or  the  saliva,  (which  are  both  naturally  alkaline,) 
acid,  we  invert  their  ordinary  action,  and  give  them  the  power  of  dis- 
solving meat  and  azotized  substances,  whilst  they  lose  their  influence 
upon  starch. 

The  numerous  and  varied  experiments  related  in  this  memoir 
fully  support  these  assestions,  and  prove  that  in  the  gastric  juice,  the 
pancreatic  fluid,  and  the  saliva,  exists  an  organic  principle,  an  active 
agent  of  digestion,  which  is  common  to  all  of  them,  and  that  it  is 
the  nature  of  the  chemical  reaction  associated  with  it,  which  alone 
determines  their  power  of  digesting  the  different  alimentary  prin- 
ciples. 

In  an  alkaline  fluid,  all  three  have  the  power  of  transforming 
starch,  and  do  not  digest  meat,  whilst  in  an  acid  fluid  they  dissolve 
meat,  but  do  not  act  upon  starch.  Thus,  it  appears  easy  to  transform 
these  fluids  into  each  other,  and  to  make  an  artificial  gastric  juice 
from  the  pancreatic  fluid,  and  vice  versa.  The  action  of  saliva, 
however,  is  less  energetic,  whether  on  meat  or  starch,  than  the  pan- 
creatic juice.  Compies  Rendus.     Lancet. 


A.ntagonis7n  of  Cachexur.  In  the  Foreign  Department  will  be 
found  a  brief  analysis  of  an  essay  lately  published  by  M.  Trousseau, 
(the  well  known  pathologist,  and  professor  of  therapeutics  in  the 
Faculty  of  Paris,)  to  which  we  wish  to  draw  attention.  The  views 
contained  in  this  essay  are  ingenious,  and  deserve  to  be  seriously 
considered  ;  although  they  are  much  too  speculative  to  be  adopted  in 
the  present  state  of  medical  knowledge. 

M.  Trousseau  first  points  out,  in  an  extremely  lucid  and  forcible 
manner,  a  fact  in  general  pathology  which  is  generally  admitted, 
although  ot'ten  lost  sight  of,  viz.,  that  anaemia,  as  indicated  by  the 
cha-nges  that  take  place  in  the  composition  of  the  blood,  is  the  pre- 


730  Antagonism  of  CachexicB.  [December, 


dominant  symptom  of  very  varied  morbid  states,  each  of  which 
requires  different  treatment.  So  far  every  one  will  agree  with  the 
Parisian  professor.  This,  however,  cannot  be  the  case  when  he  at- 
tempts taestabhsh  a  kind  of  antagonism  between  these  varied  each- 
ectic  states,  when  he  asserts,  for  instance,  that  the  cachexia  of 
chlorosis  preserves  from  that  of  tubercuhzation,  and  that  by  restor- 
ing, through  the  agency  of  ferruginous  preparations,  to  its  normal 
condition,  the  blood  of  a  weak,  or  chlorotic  person,  in  whom  there  is 
the  slightest  predisposition  to  phthisis,  we  expose  him  to  immediate 
manifestation  of  the  latter  disease.  M.  Trousseau,  it  is  true,  asserts 
that  this  opinion  is  the  result  of  lengthened  experience  ;  but  we  have 
a  right  to  question  his  interpretation  of  the  facts  he  has  seen,  when 
we  find  it  running  counter  to  the  experience  of  the  great  majority  of 
physicians.  That  chlorosis  does  not  so  often  lead  to  phthisis  as 
might  be  expected,  when  we  consider  that  it  is  a  disease  of  debility, 
we  must  admit.  The  chlorotic  cachexia  is  evidently  different  from 
the  tubercular  cachexia,  or  we  should  not  sec  so  many  young  females 
remain  during  several  years  in  an  anaemic  condition,  and  yet  ulti- 
mately rally,  under  proper  treatment,  without  tuberculization  taking 
place.  But  there  is  a  great  difference  between  admitting  that  such 
is  the  case,  and  looking  upon  the  chlorotic  cachexia,  along  with  M. 
Trousseau,  as  absolutely  guaranteeing  persons  against  scrofula  and 
phthisis.  It  is  difficult  to  believe  that  a  disease  which  breaks  up  the 
health,  depraves  the  fluids  and  the  solids  of  the  body,  and  gradually 
depresses  its  vitality,  should  preserve  from  another  disease,  the  man- 
ifestation of  which  is  generally  considered  to  be  induced  precisely 
by  those  causes  that  tend  to  reduce  the  powers  of  life.  It  is  equally 
difficult  to  believe  that  a  therapeutic  agent  which  is  calculated  to  re- 
store the  diseased  blood  of  a  chlorotic  patient  to  its  normal  state, 
should  expose  that  individual,  as  M.  Trousseau  says  it  does,  to  the 
attacks  of  phthisis,  precisely  because  it  vitalizes  and  animalizes  the 
animal  fluids. 

M.  Trousseau  has,  we  believe,  fallen  into  the  very  error  with 
which  he  reproaches  M.  Rayer,  when  the  latter  recommends  iron  in 
albuminuria,  on  account  of  the  anaemic  state  of  the  blood.  He  has 
allowed  himself  to  be  led  away  by  a  theory.  That  theory  is,  the  an- 
tagonism  of  cachexiae,  which  may  exist  even  to  the  extent  supposed 
by  M.  Trousseau,  but  the  existence  of  which  has  certainly  yet  to  be 
proved. 

The  learned  professor  brings  forward,  in  support  of  this  view,  the 
reputed  antagonism  of  intermittent  fever  and  phthisis.  Our  readers 
will  remember  that  we  have,  at  various  periods  within  the  last  few 
years,  laid  before  them  accounts  of  the  labours  of  different  conti- 
nental practitioners  who  assert  that  there  is  an  evident  antagonism 
between  the  cachexia  of  intermittent  (ever  and  that  of  phthisis,  and 
that  in  marshy  districts,  where  all  the  population  is  more  or  less  under 
the  influence  of  the  miasmatic  cachexia,  scrofula  and  phthisis  are 
nearly  unknown. 


1^45.]  EJicient  modes  of  administering  Medicines.  731 


The  recent  researches  of  French  pathologists  have  rendered  it 
very  prohable  that  such  reallv  is  the  case,  but  they  cannot  be  said 
to  liave  proved  it.  M.  Trousseau's  views  respecting  the  antagonism 
of  chlorosis  and  nhthisis  were,  nnost  likely,  suggested  to  him  by  the 
discussions  which  have  taken  place  on  that  subject.  He  has  endeav- 
ored  to  generalize  a  principle  of  pathology,  which  he  has  accepted  as 
proved,  althoui^li,  in  reality,  it  is  yet  sub  lite.  Such  an  attempt  at 
generalization'cannot  but  be  looked  upon  with  interest,  especially 
when  made  by  a  man  of  M.  Trousseau's  scientific  authority,  but  it 
ouTht  not  to  be  adopted  without  due  reflection  and  proof. 

Although  we  are  thus  inclined  to  receive  with  doubt  and  suspicion 
the  theor'v  of  "the  antagonism  of  cachexiae,"  yet  we  must  confess 
that  its  verv  simplicity  renders  it  attractive,  and  that  it    is  one  of 
the  questions  of  general  pathology  which  is  most  deserving  of  eluci- 
dation.     Indeed,  principally  with  the  view  of  drawing  the  attention 
of  British  pathologists  to  the  consideration  of  this  asserted  pathologi- 
cal law,  do  we  now  so  pointedly  allude  to  it,  wishing  to  stimulate  our 
readers  to  inquiry,  and  taking  the  present  opportunity  of  mention- 
incr  that  we  shall  be  happv  to  give  publicity  to  any  researches  which 
may  be  made  in  this  direction.     The  marshy  districts  of  Lincoln- 
shire,  and  of  other  parts  of  England   in  which   intermittent  fever 
reigns  supreme,  must  afford  as   good  opportunities  of  observing  the 
ant'igonism  of  miasmatic  cachexia  and  phthisis,  as  those  of  France. 
On  the  other  hand,  our  large  manufacturing  towns,   in  which  both 
chlorosis  and  phthisis  are  so  extremely  prevalent,  must  present  ex- 
cellent  opportunities  for  observing  their  connexion  one  with  the  other. 
The   influence  of  preparations   of  iron   over  tuberculization  is  a 
question  which  also  deserves  to  be  seriously  investigated.     The  opin- 
ion of  M.  Trousseau  is  certainly  opposed  to  the  opinions  and  experi- 
ence of  many  practitioners,  who  have  been  in  the  habit  ofadininis- 
terintr  iron  in  the  incipient  stages  oftuberculization,  with,  we  think, 
marlfed  benefit.     In  works  on  pathology,  experiments  are  mentioned 
in  which  rabbits  and   other  animals  fed  on  moist  unwholesome  food 
mixed  with  iron,  and  kept  in  damp,  dark  localities,  did  not  beconie 
tuberculous  :  whilst  others,  fed  and  kept  in  the  same  way,  but  with- 
out iron,  rapidly  fell  victims  to  tubercalization.     These  experiments 
might  be   easily  repeated,  especially  by  practitioners  living   m  the 
country.  London  Lancet.   

Some  hints  on  the  most  efficient  modes  of  administering  Medicines. 
By  a  nractitioner  ofhalfa'^century. Many  of  the  most  important 
discoveries  and  improvements  in  medical  science  are  rendered  com- 
paratively useless,  in  consequence  of  being  unskilfully  applied  to 
actual  practice.  In  no  department  of  knowledge  is  this  detect  more 
conspicuous  than  in  therapeutics.  Man  (and  I  believe  the  same  re- 
mark applies  to  all  created  beings)  is  born  with  a  kind  of  instinctive 
antipathy  to  physic,  which  antipathy  he  retains  from  the  cradle  to 
the  Ti-ave.     Look  at  the  ingenious  spoons  that  have  been  invented  to 


733  EJicientmodesof  administering  Medicines.  [December, 


force  physic  down  the  throats  of  infants  !  Observe  the  mantle-pieces 
of  sick  chambers,  and  count  how  many  phials  are  either  uncorked, 
or  only  half  emptied  !  How  great  a  proportion  of  mankind  hate  the 
very  name  of  physic  !  If  the  stomach  is  apt  to  turn  at  the  thought 
of  medicine,  when  we  are  in  health,  how  much  less  capable  is  it  to 
bear  nauseous  drugs  in  the  various  forms  of  disease,  nine-tenths  of 
which  affect  the  stomach  sympathetically  with  squeamishness, 
nausea,  and  aversion  to  food  as  well  as  physic  ?  The  evil  consequen- 
ces of  nauseous  forms  of  medicine  being  used  in  sickness,  are  great 
beyond  all  calculation  or  belief.  One  result  is,  that  medicine  is  not 
taken  in  sufficient  quantity,  sufficiently  often,  or  for  a  proper  length 
of  time. 

What  practitioner  will  fail  to  recognize  the  following  picture  of 
almost  daily  occurrence  ?  A  medical  man  is  in  anxioiis  attendance 
on  a  patient  say  a  lady  after  confinement,  and  threatened  with 
some  grave  malady,  peritonitis,  for  instance  he  prescribes  what  he 
conceives  to  be  active  and  etEcient  remedies  for  the  night,  and  gives 
strict  injunctions  to  the  nurse.  In  the  morning,  when  he  calls,  he 
meets  the  nurse  on  the  stairs.  Have  you  given  your  mistress  the 
medicines  punctually  ?  Most  punctually,  sir.  Well,  what  has  been 
the  effect?  "  Brought  everything  up  again  sir."  What,  all?  "Eve- 
ry drop,  sir  and  I  thought  she  would  have  brought  her  very  heart 
up  with  it."  After  such  intelligence,  the  feelings  of  the  doctor,  on 
entering  the  chamber,  are  not  particularly  enviable.  Now  all  this 
is  more  frequently  owing  to  the  form  than  the  substance  of  the  medi- 
cine exhibited. 

In  chronic  diseases,  where  the  remedial  process  is  necessarily 
chronic  also,  we  are  daily  baffled  by  the  repugnance,  nay,  the  resist- 
ance  of  the  patient  to  a  protracted  course  of  physic.  Yet  it  might 
very  generally  be  so  contrived,  that  the  patient  would  desire  rather 
than  loathe  his  medicines. 

I  am  aware  that  in  some  acute  diseases,  the  state  of  nausea  itself 
is  desirable  and  salutary.  But  it  is  not  the  mere  nausea  or  sickness 
which  lessens  the  velocity  of  the  circulation,  opens  the  secretory  ves- 
sels, and  checks  inflammation.  These  remedial  processes  depend 
much  upon  the  quantify  of  medicine,  say  antimony,  which  the  patient 
can  bear  in  order  to  induce  them.  Thus  double  or  triple  the  quantity 
of  tartrate  of  antimony  will  be  borne,  before  sickness  is  induced,  if 
g*iven  in  an  effervescing  draught,  as  compared  with  the  same  medi- 
cine given  in  plain  water.  And  the  remedial  effects  will  be  in  pro- 
portion. This  is  a  truth  that  should  ever  be  held  in  mind,  and  the 
principle  was  well  understood  by  Rasori,  Thomasini,  and  others. 
The  contra-stimulant  effects  of  antimony  are  trifling  during  the 
nausea  and  sickness  at  the  befjinnino;.  It  is  when  the  tolerance  is 
acquired  that  the  inflammation  or  high  fever  is  controlled. 

But  there  is  a  large  class  of  diseases  in  which  the  stonsach  is  mor- 
bidly irritable,  and  where  nauseating  medicines  are  positively  injuri- 
ous.    Putting  aside  the  multitudinous  forms  of  dyspepsia,  we  have 


1845.]  Constipation. -^hifantile  Gastric  Fever,  733 


affections  of  the  uterus,  the  kiclne5%  the  liver,  the  pancreas,  (Sec,  where 
the  stomach  is  prone  to  disordered  function,  and  where  it  i^  of  the 
greatest  consequence  to  exhibit  medicines  in  forms  that  will  tranquil, 
ize  rather  than  nauseate  the  stomach.  Diseases  and  disorders  of  the 
kidney  are  now  acknowlcdored  to  be  much  more  frequent  than  they 
were  formerly  suspected  to  be  and  these  are  very  generally  attend- 
ed with  gastric  irritability.  In  these  it  is  of  great  importance  not 
to  ruffle  the  stomach  by  medicines.  In  affections  of  the  brain,  now 
so  exceedingly  common  in  consequence  of  the  advanced  stage  of 
civilization,  and  the  operation  of  various  perturbing  moral  causes,  the 
stomach  is  often  the  organ  most  conspicuously  deranged  and  we  are 
not  seldom  foiled  in  the  exhibition  and  perseverance  of  proper  reme- 
dies, from  the  sympathetic  disorder  of  stomach. 

Nine-tenths  of  the  cures  that  are  said  to  be  performed  by  homceo- 
pathy,  result  from  the  spare  diet  and  the  nullity,  as  it  were,  of  the 
medicine  employed.  Of  all  the  medicines  that  are  prescribed  by  the 
physician,  the  class  of  salines  are  the  most  generally  beneficial,  as 
opening  the  secretory  organs,  as  the  skin,  the  liver,  the  kidneys,  &;c., 
besides  improving  the  state  of  the  blood,  and  restraining  febrile  ac- 
tion in  the  constitution.  These,  when  exhibited  in  an  effervescing 
state,  are  far  more  palatable,  as  well  as  more  efficacious,  than  when 
given  in  a  plain  form. 

Tonics,  on  which  the  routine  practitioner  so  much  relies,  and 
which  he  exhibits  with  no  sparing  hand,  are  more  frequently  injuri- 
ous than  beneficial.  They  give  a  feeling  ot  tone  for  a  time  ;  but  they 
lock  up  the  secretions,  increase  too  much  the  appetite,  and  lay  the 
foundation  for  future  states  of  plethora,  congestion,  or  indigestion. 

Now  saline  effervescents  may  be  made  the  vehicle  for  many  of  the 
most  powerful  tonics,  and  indeed  the  most  potent  medicines  which 
we  possess.  The  citrate  of  iron,  colchicum,  antimony,  arsenic,  qui- 
nine, iodine,  &;c.,  &;c.,  may  all  be  exhibited  in  a  form  that  increases 
their  remedial  efficacy,  and  lessens  their  tendency  to  nauseate  the 
stomach.  Bulletin  of  Medical  Science. 


Ox-gall  in  Constipation.  Dr.  R.  H.  Allnat,  in  a  paper  in  the 
Lancet,  (June  7th,  1345.)  relates  several  cases,  illustrative  of  the 
good  effects  of  inspissated  ox-gall  in  the  cure  of  habitual  constipation. 
In  a  subsequent  No.  of  the  same  Journal,  (July  12th,)  he  recom- 
mends that  the  ox-gall  should  be  prepared  in  a  water-bath,  the  gall 
being  frequently  stirred,  to  produce  a  perfectly  homogeneous  extract. 
The  addition  of  a  small  quantity  of  magnesia  will,  he  says,  expedite 
the  process.  He  gives  it  in  doses  of  five  grains  made  into  pills, 
three  times  daily.  He  administers  it  also  in  some  cases,  in  the  form 
of  enema.  American  Journal. 


Treatment  of  Infantile  Gastric  Fever.  By  Goldixg  Bird,  A.  M., 
M.  D.  The  origin  of  gastric  fever  occurring  among  children  is 
usually  to  be  ascribed  cither  to  unhealthy  ingesta  or  depraved  secre- 


'34  Sulphate  of  Quinine.  Vaccination,        [December, 


tions.  The  pulv.  sodae  comp.*  of  Guy's  Parmacopceia,  in  doses  of 
three  to  eight  grains  at  night,  and  a  full  dose  of  the  pulv.  rhoei  salin.f 
every  morning  for  a  week  or  so,  will  in  most  cases  be  found  very 
successful  treatment.  To  the  latter  compound,  so  well  known  to  the 
profession  for  its  almost  specific  power  in  these  affections,  Dr.  For- 
dyce  accorded  this  elaborate  praise  '  Had  I  been  more  ambitious 
of  dying  a  rich  man,  than  of  living  a  useful  member  of  society,  the 
powers  of  our  anti-hectic  powder  in  curing,  as  if  by  miracle,  the 
hectic  fever  and  the  swelled  bellies  of  children  in  this  town  would 
have  remained  a  secret  while  I  lived."  Guy's  Hospital  Reports.  
Braithwaite's  Retrospect. 


Sulphate  of  Quinine  not  absorbed  when  applied  Endermically.  By 
M.  Martix  Solon.  {Bulletin  de  Therapeutique,T>ec.  1844.)  Many 
medicines,  when  applied  to  the  skin  either  whole  or  deprived  of  ils 
cuticle,  act  energetically  on  the  economy,  and  may  be  detected  in 
the  secretions,  thus  showing  they  have  been  absorbed.  Sulphate  of 
quinine,  when  given  internally  in  the  dose  of  one  grain,  may  easily 
be  detected  in  the  urine  by  means  of  the  ordinary  tests,  as  iodide  of 
potassium,  &c.  Martin-Solon,  however,  has  made  many  experiments 
on  twenty  individuals  affected  with  various  maladies,  relative  to  this 
medicine  being  absorbed  when  applied  to  the  skin,  and  in  no  case 
has  he  succeeded  in  detecting  the  slightest  traces  of  the  medicine  in 
tne  urine.  The  sulphate  of  quinine  w^s  applied  by  fliction  to  the 
sound  skin,  and  to  that  denuded  of  cuticle,  in  baths  and  by  means  of 
ointments.     The  effect  was  null  in  all. 


Report  relative  to  Vaccination.  The  French  Academy  of  Medi- 
cine offered  a  prize  of  10,000  francs  for  the  best  report  upon  the 
following  questions,  viz : 

1st.  Is  the  preservative  power  of  the  vaccine  permanent,  or  is  it 
merely  temporary  ?  In  the  latter  case,  the  time  during  which  vacci- 
nation will  protect  from  small-pox,  is  to  be  determined  by  precise 
observation,  and  well  authenticated  facts. 

2d.  Does  the  cow-pox  afford  a  more  certain  or  permanent  preserv- 
ative effect,  than  the  vaccine  which  has  been  employed  in  a  number 
of  successive  vaccinations,  more  or  less  considerable  ?  Does  the 
intensity  of  the  local  phenomena  of  vaccination,  bear  any  relation 
to  its  preservative  effects  ? 

3d.  In  case  the  preservative  property  of  the  vaccine  becomes  en- 
feebled by  time,  must  it  be  renewed,  and  by  what  means  ? 

4th,  Is  it  necessary  to  vaccinate  the  same  person  several  times, 

*  Sodae  Carbonatis  exsiccataB  5v.    Hydrarg}Ti  Chloridi  51.    Pulv.  Cretae 
'  ompositi  5x.  m, 
t  Rhaei  radicis  pulv.  5i.    Potassae  Sulphatis  3ij.  m. 


ISlo.J  Vaccination.  'i''^^ 


and  if  so,  after  the  lapse  of  Iiow  many  years,  should  a  now  vaccin- 
ation be  made  ? 

The  questions  were  proposed  by  the  Academy  for  1842,  but  in 
view  of  the  great  number  (35)  of  works  which  were  sent  to  the 
concours,  a  decision  upon  their  respective  merits  was  postponed  until 
1843  Even  up  to  that  time  the  whole  of  the  articles  had  not  been 
examined,  and  a  further  postponement  of  the  report  of  the  commis- 
sion was  decreed. 

In  April  1845,  this  commission,  consisting  of  M.  M.  Magendic, 
Breschet,  Dumeril,  Roux,  and  Serres,  made  a  report,  which  from  its 
length  we  cannot  give  entire,  we  will  therefore  only  extract  their 
conclusions. 

1st.  The  preservative  power  of  the  vaccine  is  permanent  in  the 
greater  number  of  vaccinated  subjects,  and  temporary  in  a  small 
number.  Even  among  the  latter,  it  affords  an  almost  entire  protec- 
tion up  to  adolescence. 

2d.  Variola  rarely  attacks  vaccinated  persons  before  the  age  of 
ten  or  twelve  years  It  is  from  this  period  up  to  the  thirty-fifth  year 
that  they  are  principally  exposed  to  its  attacks. 

3d.  Besides  its  preservative  property,  the  vaccine  effects  a  modifi- 
cation of  the  organization,  which  renders  variola  more  mild,  and 
abridges  its  duration. 

4th.  The  cow-pox  gives  to  the  local  phenomena  of  vaccination  a 
marked  intensity,  and  its  effects  are  more  certain  than  when  old  vac- 
cine matter  has  been  employed  But  after  some  years  of  transmission 
through  the  human  subject,  this  local  intensity  disappears. 

5th.  The  preservative  property  of  the  vaccine  does  not  appear  to 
be  dependent  upon  the  intensity  of  the  local  symptoms  ;  nevertheless 
to  preserve  its  properties,  it  is  prudent  to  renew  the  vaccine  as  often 
as  practicable. 

6th.  Among  the  means  proposed  for  its  renewal,  the  only  one  in 
which  confidence  can  be  reposed,  consists  in  procuring  the  matter 
from  its  original  source. 

7th.  Re-vaccination  is  the  only  mode  by  which  we  can  distin- 
guish those  vaccinated  subjects  who  are  fully  protected  from  variola, 
from  those  who  are  only  partially  so. 

8th.  The  proof  afforded  by  re-vaccination,  does  not  furnish  certain 
evidence,  that  the  vaccinated  persons  in  whom  it  succeeds,  would 
have  contracted  variola  ;  but  it  merely  offers  a  probability  that  such 
would  be  the  case,  as  it  is  only  among  such  subjects,  that  the  disease 
is  developed. 


736         Meteorological  Observations.  Medical  Intelligence. 


9th.  In  ordinary  times  re-vaccination  should  be  practised  about 
the  fourteenth  year  ;  during  an  epidemic,  it  is  prudent  to  renew  it 
at  an  earlier  age.  Jour,  des  Connaissances  Med.  and  Chir. 


MEDICAL  INTELLIGENCE. 

Medical  College  of  Georgia.  The  annual  course  of  Lectures  in  this  Institu- 
tion, began  on  Monday  the  10th  November.  The  Introductory  Lecture  was 
delivered  by  Prof.  Ford,  to  a  large  audience  of  students  aDd  citizens.  The  claps 
now  in  attendance,  both  in  numbers  and  general  intelligence,  is  not  surpassed 
by  any  which  has  preceded  it. 


METEOROLOGICAL  OBSErxVATlONS,  for  October,  1845,  at  Augtista,  Ga. 
Latitude  33  27'  north  Longitude  4  32'  west  Wash.  Altitude  above  tide 
152  feet. 


o 

Thermometer. 
Sunrise.    3,  p.  m. 

Barometer. 
Sun  rise.       3,  p.  m. 

Wind. 

Remarks. 

1 

60 

78 

29  71-100 

29  74-100 

w. 

Fair. 

2 

48 

73 

"  81-100 

"  87-100 

N.  E. 

Fair. 

3 

60 

69 

'  90-100 

"  87-100 

N.   E. 

Cloudy sprinkle,    [night. 

4 

61 

64 

"  84-100 

"  72-100 

N.  E. 

Rain  from  4,  a.  m.  till  mid- 

5 

64 

70 

"  64-100 

"  70-100 

N.  W. 

Flying  clouds fair. 

6 

49 

71 

"  81-100 

"  83-100 

N.  E. 

Fair.                           [rain. 

7 

58 

72 

"  87-100 

"  86-100 

N.  E. 

Cloudy,  sprinkle  11,  p.  m. 

8 

68 

80 

"  84-100 

"  76-100 

S.  E. 

Cl'dy  spr.  9,  p.m.  r.  blow. 

9 

70 

79 

"  84-100 

"  73-100 

S. 

CI  0  udy  sprin  kle . 

10 

71 

67 

"  68-100 

"  59-100 

N.  E. 

Rain  all  day,  and  at  night. 

11 

64 

65 

"  55-100 

"  37-100 

N.  E. 

Rain  all  day,  and  at  night. 

12 

46 

59 

"  35-100 

"  56-100 

N.  W. 

Fair  breeze. 

13 

41 

64 

"  91-100 

"  98-100 

N. 

Fair. 

14 

43 

68 

30    3-100 

30    3-100 

N.  W. 

Fair. 

15 

45 

68 

29  98-100 

29  98-100 

N. 

Fair  some  clouds. 

16 

46 

61 

30  14-100 

30  10-100 

N. 

Fair. 

17 

40 

m 

30    6-100 

30    6-100 

N.  E. 

Fair. 

18 

.  46 

72 

30    4-100 

30 

E. 

Fair some  clouds. 

19 

56 

71 

30 

29  95-100 

N.  E. 

Cloudy. 

20 

62 

60 

29  85-100 

29  77-100 

N.  E. 

Rain  all  day. 

21 

59 

61 

29  76-100 

29  82-100 

N.  E. 

Cloudy  breeze.        [night. 

22 

40 

55 

30    5-100 

30    3-100 

N.  E. 

Fair  some  cl'ds bio  w  last 

23 

41 

62 

30    6-iOO 

30    4-100 

N.  E. 

Fair. 

24 

42 

65 

30    4-100 

30 

N. 

Fair. 

25 

46 

66 

30 

30 

E. 

Fair. 

26 

42 

70 

30    7-100 

30    7-100 

N. 

Fair. 

27 

42 

69 

30    7-100 

30    7-100 

N. 

Fair. 

28 

42 

64 

30    7-100 

30    3-100 

E. 

Cloudy. 

29 

42 

71 

30 

30 

W. 

Fair. 

30 

46 

72 

29  95-100 

29  90-100 

w. 

Fair. 

31 

48 

74 

29  92-100 

29  90-100 

w. 

Flying  clouds. 

18  Fair  days.    (Quantity  of  Rain,  7  inches. 


tj^iii 


INDEX. 

Age  of  puberty Page  41 

Albumen  as  an  antidote,  caution  in  giving 155 

Aloes,  its  action  and  uses 251 

Araenorrhoea,  treatment  of 604 

American  Journal  of  Medical  Sciences 23 

Amputation  of  limbs 633 

Amputation  of  penis 601 

Anasarca,  causes  of 90 

Antidotes  of  Corrosive  Sublimate,  &c 154 

Antigastralgic  pills 600 

Ascites 467 

Ash  well,  diseases  of  females 274 

Ataxic  Pneumonia  with  delirium 394 

Auscultation,  essay  on 68 

Bebeerine,  medical  properties  of 347 

Biett's  formulary  for  skin  diseases 155 

Bile,  test  for 218-603 

Bile,  secretion  and  properties  of 536 

Bismuth,  subnitrate  in  gastric  affections 353 

Bladder,  difference  of  size  in  male  and  female 664 

Blisters  in  acute  inflammatory  diseases 83 

"       in  children 422 

"       in  acute  diseases  of  the  brain 669 

Brigham  on  mental  cultivation,  &c 274 

Bronchocele  encysted 286 

Buffy  coat  of  the  blood 693 

Bulletin  General  de  Therapeutique , 202 

Burn,  extensive 226 

Burns,  treatment  of 601 

Cachexia  Africana 126 

Cachexias,  antagonism  of  729 

Calomel 79 

Campbell,  Dr.  H.  F.  on  Gonorrhoea 15 

"  "    "    *'  case  of  tubercular  development 317 

''  "    "    "  abuse  of  Diuretics 360 

Camphor,  a  preservative  of  ergot 95 

"         to  blisters 603 

Caoutchouc  in  toothache 410 

Case  of  sharp  pointed  body  in  intestine 344 

Cases  Surgical,  by  Dr.  Mercier 346 


IV  INDEX. 

Case  of  Twins Page  478 

Cases,  by  Dr.  W.  H.  Robert 502 

Castor  Oil 222 

Castration,  case  of 666 

Caustics,  different  sorts 412 

Cauter}^  actual  in  gangrene  of  the  mouth 404 

Chronic  rheumatism  and  neuralgia 151 

Cimicifuga  in  nervous  diseases 569 

Climate,  diseases,  &c.,  of  Middle  Florida 526 

Cochineal  in  hooping  cough 600 

CoBcum,  diseases  of 502 

Conium  Maculatum^  effects  of 598 

Contributions  to  Therapeutics 141 

Convulsions,  pathology  and  treatment  of 49 

Convulsions,  source  of 663 

Copaiba  pills 286 

"        with  purgatives  in  gonorrhcea 475 

Cornea,  ulceration  of 157 

Cornealini,  in  chlorosis 404 

Cooper's  first  lines 272 

Corrosive  sublimate  in  Epilepsy 403 

Cough  and  pleurodynia  from  spinal  irritation 229 

Creosote  in  case  of  vomiting 280 

Croton  oil  in  Dropsy 280 

"       '    for  Neevi 157 

'      "    piaster: ...222 

Gumming,  Dr.  W,  H.  letter  from  China 47 

"  "      "    "    on  Auscultation 68 

Cunningham,  Dr.  S.  B.   Case  of  Monstrosity , 79 

Death  of  Brcschet 605 

Dental  Surgery,  principles  and  practice  of ....  535 

Diabetes,  treatment  of 279 

Diagnosis,  cause  of  error  in 346 

Digestion,  chemical  phenomena  of 728 

Digitalis  in  diseases  of  the  heart 405 

Diuretics,  abuse  of 360 

Dropsy,  chronic 600 

Dublin  Journal 193 

Dugas,  Dr.  L.  A.  on  Convulsions 49 

"        "    "    "    case  of  extirpation  of  Mamma 122 

        "    "    "    remarks  on  lecture  on  Mesmerism 236 

"        "    "    "     case  of  extirpation  of  the  Tumor 508 

Dysmenorrhcea,  treatment  of 671 

Ears,  discharge  from 343 

Emetics  in  Bronchitis 543 

Epidemic  Erysipelas 281-718 

Epilepsy  cured  by  blisters 150 

Epi.sioraphy,  cases  of 112 


INDEX.  V 

Eiysipelas,  epidemic  in  Parisian  hospitals Page  403 

Escape  of  ova,  in  iependent  of  fecundation 38 

Eve,  Dr.  P.  F.  on  bilateral  operation  of  Lithotomy 19 

"       "     "    "  Lecture  on  Mesmerism 167 

"      "     "    "  case  of  Hydrocele, - 367 

"      "     "    "  case  of  Tetanus   625 

"      "    "    '  on  Tertiary  Symptoms  of  Syphilis 673 

Eve,  Dr.  Joseph  A.  on  Secale  Cornutum 289 

"      "        "        "    letter  to  Dr.  Smith 574 

Evolution  and  Delivery,  with  presentation  of  shoulder,  &c 479 

Excision  of  the  urethra  in  a  woman 602 

Extirpation  of  Mamma 122 

"  of  superior  cerv^ical  ganglion,  &:c       221 

'*  of  schirrus  tumor 5^^ 

**  of  lachrymal  gland l^^ 

Extra-uterine  pregnancy ^'^ 

Fisk  fund  prize  questions, 96 

Ford,.  Dr.  L,  D.  on  Intermittent  fever _2as488''~    ^    ._ 

Foreign  bodies,  extraction  of  from  GEsophagus 137 

Formulae  for  alcaline  medication     669 

Forry,  Dr.  death  of 47 

Galvanism 220 

Galvanism  in  uterine  hemorrhage "707 

Gangrene,  dry,  case  of , 691 

Gardner,  Dr.  J.  M.  on  Jasminum  Revolutum 447 

Garvin,  Dr.  L  P.  on  Sub-nitrate  of  Bismuth 353 

Gazette  Medicale  de  Paris 202 

Generation,  mysteries  of 339 

Geophagy 417 

Gonorrhoea,  treatment  of 1^ 

Gordon,  Dr.  J.  M.  case  of  Volvulus 444 

Graduates  of  Yale  College 160 

Groce,  Dr.  B.  W.  case  of  Lithotomy 246 

Gums,  scarification  of,  during  dentition 277 

Harden,  Dr.  J.  M.  B.  notice  of  Holdat's  Memoir 161 

"        "        "         case  of  Procidentia  Uteri 248 

"        "        "         soil,  climate,  &c.  of  Liberty  county 545 

Heart,  diseases  of 328-370 

Hemicrania  and  Tic  Douloureux,  treatment  of 343 

Hepatitis  and  Hepatalgia,  diagnosis  of 542 

Hernia,  strangulated,  operation  for 358 

"        statistics  of 477 

Hogs  lard  in  obstructions  of  the  bowels 313 

HoopingCough 213-597 

Hydatids,  uterine,  case  of 250 

Hydrocele,  treated  with  ioduretted  injections 92 

'*  case  of. 367 

Hysteria,  local 260 


VI 


INDEX. 


Immoveable  bandages  of  starched  paper Page  285 

Indian  Hemp,  effects  of 216 

Infantile  gastric  fever 733 

Inflammation  of  synovial  membrane  of  knee  joint 477 

Inhalation  of  oxygen  gas,  an  antidote  lor  carbonic  acid 348 

Instruction  of  Midwives  in  Paris 415 

Intermittent  fever 3-481 

Intermittence  of  intermittent  fever 43 

Inverted  toe  nail *. 259 

Iodide  of  Potassium  in  Asthma 151 

"     "  "  in  primary  S}Tphilis 539 

Itch,  treatment  of 44 

Jasminum  Revolutum  in  Syphilis 447 

Jaundice 4l0 

Journal  des  Connaissances  Medico-Chirurgicale 202 

Kilpatrick,  Dr.  A.  scraps  from  case  book 306 

Lake,  Dr.  John,  cases  of  Episoriaphy 112 

Le  Conte,  Dr.  John,  on  Geophagy 4l7 

Letter  from  Dr.  John  McLester 414 

Levert,  Dr.  H.  S.  on  Opium  in  Abortion 225 

Liquor  Potassse 159 

Lithontriptic  action  of  Uva  Ursi 671 

Lithotrity  284 

Lithotomy,  bilateral  operation  of 19 

"         cases  of 116 

"         in  the  female,  case  of 246 

Little,  Dr.  R.  E.  on  Syphilitic  ulcers 618 

Lumbar  abscess 505 

Lupus,  treatment  of  282 

Malaria 45 

Malformation  of  the  heart 275 

Malignant  tumor,  case  of 684 

Mammary  abscess  treated  by  the  breast  pump 476 

Mayes,  Dr.  J.  A.  on  Hogs  lard  in  obstructed  bowels 313 

Means,  Dr.  Alex,  on  Calomel 79 

Medical  Memoranda 219 

"       College  of  Georgia,  annual  commencement 223 

"  <      "   State  of  South  Carolina 224 

"       Statistics  of  France 415 

"        Society  for  East  Tennessee 480 

Medicinal  Substances,  passage  through  the  economy- 218 

"  "  efficient  modes  of  preparing 731 

Meigs'  Columbat  De  L'Isere 274 

Mesmerism  1 67 

"  remarks  on  a  Lecture  on 236 

"  true  and  false 544 

Miller's  principles  of  Surgery 373 

Monstrosity,  case  of  120 


,     INDEX.  ^^' 

Negro  population,  diseases  of Page    3^^H| 

Nervous  action  re-established  after  autoplastic  operations ^''^ 

Nervous  Cephalalgia 600 

Neuralgia ' 407 

New  instrument,  by  Dr.  P.  F.  Eve- 605 

New  hasmostatic  means 668 

New  Medical  Journals 604 

New  York  Journal  of  Medicine 25-96 

Nitrate  of  Silver  in  chronic  diarrhoea 216 

Nitric  Acid  in  Purpura  Hemorrhagica 471 

Obituary  of  Prof.  Sewell 352 

Observations  on  soil,  climate,  &c.  of  Liberty  county 545 

Ointments,  preparations  of 286 

Open  foramen  ovale 38 

Operation  for  defect  of  Rectum 668 

Opium  in  large  doses,  in  abortion ^ 225 

"      in  fevers,  inflammatory  diseases,  &c. 659 

Ovariotomy 92 

Ox-gall  in  Constipation 733 

Pains  in  the  loins 152 

Paracentesis  thoracis  in  acute  pleurisy 88 

Patholog}'  and  Therapeutics,  essays  on,  by  Prof.  S.  H.  Dickson 448 

Pendleton,  Dr.  E.  S.  case  of  Lumbar  Abscess 505 

Pennsylvania  University 352 

Period  at  which  the  foramen  ovale  is  obliterated 38 

Periodic  discharge  of  ova 402 

Periodicity,  febrile,  influenced  by  Q.uinine 410 

Pillulas  Ferri  Iodine 96 

Placenta  praevia 348 

Poison  by  Tartaric  Acid 670 

Pregnancy,  term  of  exceeded 479 

Premature  Delivery 160 

Preparations  of  Mercury  and  Iodine 266 

Presentatfon  of  arm  and  shoulder 479 

Process  of  secretion  37 

Procidentia  Uteri  during  labor 248 

'           "       cured  by  excision,  &c. 310 

Punctured  wound,  case  of 380 

Cluinine,  Sulphate,  in  enlarged  spleen -OSS'        5-  /  % 

"  "  in  acute  Rheumatism 538 

"  "  in  diseases  of  the  South -593 iS"  7  7 

"  "  employed  endermically,  not  absorbed 734 

Ramsbotham's  Process  of  Parturition 728 

Reproduction  of  a  portion  of  the  lower  jaw 667 

Reunion  of  divided  nerves 667 

Rhatany  in  chronic  catarrhal  opthalmia 96 

Robertson,  Dr.  J.  J.  on  Cough  and  Pleurodynia 229 

Robert,  Dr.  W.  H.    Cases 502 


VIII  INDEX.   

r^ecale  Cornutum Page  289-603 

Smith,  Dr.  G,  G.    Case  of  uterine  hydatids 150 

Spasmodic  Stricture  of  the  urethra 414 

Spinal  Marrow,  division  of 593 

Spleen  and  its  functions   338 

Stevens,  Dr.  J.  P.    Case  of  Tetanus 609 

Strictures  of  the  urethra 345 

Suicides  in  France 604 

Surgical  operations  in  Cancerous  diseases 91 

"             "          dangers  of 284 

"         anecdote 672 

Syphilis  treated  with  Tartar  Emetic 285 

"        treated  with  Iodide  of  Potassium 320 

Syphilitic  ulcers 618 

S}'philis,  treatment  of  tertiary  symptoms 673 

"        case  of 685 

Tables  of  Mortality 585 

Turpentine,  use  of   217 

Tetanus,  case  of 609 

'        traumatic,  treatment  of  625 

"       treatment  of. 650 

Therapeutics  applied  to  chronic  diseases 30-77 

Throat  and  Larynx,  diseases  of 216 

Thymus  gland,  uses  of- 221 

Tracheotomy  in  (Edema  of  the  throat 411 

Transylvania  University 351 

     Tubercles,  conclusions  concerning 596 

Tubercular  development  in  an  infant 317 

"            thickening  of  the  lip 414 

Tufts,  Dr.  J.  B.    Case  of  secondary  syphilis 686 

Turning  559 

Typhus,  treatment  of 470 

Ulcers  of  the  Cornea,  treatment  of 602 

Urinary  deposits  642 

Vaccination,  Report  on 734 

Vaccine - 276 

Valerianate  of  Gluinine 473 

Velpeau's  Midwifery 728 

Venous  pulse 399 

Vesicatories  in  Sciatic  neuralgia 387 

Volvulus  and  strangulation  of  the  intestines  444 

West,  Dr.  Charles.    Case  of  Hernia 358 

Westmoreland,  Dr.  J.  G.    Case  of  dry  Gangrene 691 

Wildman,  Dr.  P.  H.    Cases  of  Lithotomy 166 

Wooten,  Dr.  H.  V.    Case  of  Procidentia  Uteri 310 

'        "      "    "    onCimicifuga 569 

"        "    G.H.    Case  of  Malignant  tumor - 684